An evaluation of fecal incontinence in women with urinary incontinence.

OBJECTIVE: To investigate the occurrence of and risk factors for fecal and/or gas incontinence in female patients having urinary incontinence. PATIENTS AND METHODS: 741 consecutive adult female patients presenting with urinary incontinence alone (group 1, n = 700) or urinary incontinence with fecal and/or gas incontinence (group 2, n = 41) were enrolled into the study. As potential risk factors for fecal and/or gas incontinence in this population, the following variables were investigated: age, body mass index, type of urinary incontinence, childbirth history, menopausal symptoms, history of pelvic surgery, neurological disease, diabetes mellitus, tobacco use, constipation, cystocele, rectocele. Quality of life was assessed with the Urogenital Distress Inventory-Short Form (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). RESULTS: Of the women having urinary incontinence, 5.5% also had fecal and/or gas incontinence. Associated risk factors were history of difficult delivery, postmenopausal symptoms, history of pelvic surgery and constipation. Fecal and/or gas incontinence was also associated with a lower quality of life in terms of both questionnaires. CONCLUSIONS: Women have urinary incontinence may have also fecal and/ or gas incontinence. Particularly if they have chronic constipation, postmenopausal symptoms or history of difficult delivery or pelvic surgery they must be evaluated for this additional symptom. So we can treat these patients appropriately and increase their quality of life.

Temporary vascular access via the external iliac vein as a salvage procedure: a report of two cases.

Central venous catheters (CVCs) provide easy, immediate and rapid vascular access (VA) for hemodialysis (HD) in patients with acute renal failure (ARF), and in an increasing number of patients with end-stage renal disease (ESRD) as well. For this purpose, the vessels mainly used are the cephalic, jugular, subclavian and femoral veins. In some patients, vascular catheter insertion via these routes can become impossible. We report two hopeless cases, in which the external iliac veins (EIVs) were used as a temporary VA insertion site as a last resort.

Sertraline in the treatment of premature ejaculation: a double-blind placebo controlled study.

This study investigated the efficacy and the adverse effects of sertraline in the treatment of premature ejaculation (PE). Thirty-seven patients with PE were randomly assigned to receive either sertraline or a placebo. Of them 22 were given 50 mg of sertraline per day and the other 15 patients were given an identical placebo one per day. After 4 weeks, the latency to ejaculation in the sertraline group was found to be significantly longer than that of the placebo group (p<0.01). None of the patients discontinued therapy due to adverse effects. These results indicate that sertraline is an effective therapy for PE.

Superficialization of basilic vein: last chance for a native arteriovenous fistula in hemodialysis patients.

BACKGROUND: Although the best type of vascular access for chronic hemodialysis patients is a native arteriovenous fistula, in an increasing number of patients all the superficial veins have been used and only the placement of vascular grafts or permanent catheters is left. Superficialization of the basilic vein is a possible alternative.
MATERIALS AND METHODS: In 49 chronic hemodialysis patients who had no possibilities to have a native arteriovenous fistula created, we performed a basilic vein- brachial artery fistula in the arm. During the same operation the basilic vein was then superficialized for easier access for hemodialysis. RESULTS: Mean follow-up was 22.3615.56 months. Forty-eight patients are still undergoing hemodialysis with their superficialized basilic vein native A-V fistula without any complications. Only one fistula was thrombosed just after the procedure because of poor vessel quality. CONCLUSIONS: For hemodialysis patients who have no suitable superficial veins at the wrist or elbow, performing a basilic vein - brachial artery fistula and superficializing the vein to the subcutaneous tissue is an acceptable choice before deciding to use more complicated procedures like vascular grafts.

Enantioselective synthesis of 1-aryltetrahydroisoquinolines.

1-Aryltetrahydroisoquinolines (1-arylTHIQs) are important structural motifs in many alkaloids and biologically active compounds. Ligand 2a promotes the enantioselective addition of arylzinc reagents to 3,4-dihydroisoquinoline N-oxide to yield (S)-1-arylTHIQs in 97-99% ee. Pinacol arylboronic esters are the optimal precursors for the arylzinc reagents. This method is applied to the enantioselective synthesis of Solifenacin.

Outcome of the using older donors for kidney transplantation;Gazi University, Ankara experience.

The extreme organ shortage in Turkey has led to expansion of living and diseased donors. We retrospectively analyzed patient data to determine the outcomes of elderly donors. Among 210 donors, 28 (13.3%) were atleast ≥55 years old. In this group, 17 were from living and 11 from diseased donors. Mean cold ischemia time was 68 ± 21 minutes. The immunosuppressive protocol consisted of induction therapy (simulect 20 mg on days 0 and 4) and immunosuppression with calcineurin inhibitors, mycophenolic acid, and steroids. Nine patients (32.6%) with delayed graft function (DGF) required transient hemodialysis. None of the recipients or their grafts were lost due to surgical complications. We noted 5 acute rejection episodes which were all reversed by pulse steroids. Mean creatinine levels at 1, 3, and 5 years were 1.7, 2.1 and 2.3 mg/dL respectively. Patient and graft survivals at 1, 3, and 5 years were 100%, 96%, and 92% and 100%, 92%, and 92%, respectively. Although 3.6% of recipients displayed DGF, it did not affect graft outcomes. In conclusion, kidney transplantation from older donors should be considered to be an option for kidney transplantation.

Squaric acid-based peptidic inhibitors of matrix metalloprotease-1.

[structure: see text] A series of squaric acid-peptide conjugates were synthesized and evaluated as inhibitors of MMP-1. The cyclobut-3-enedione core was substituted at the 3-position with several functional groups, such as -N(alkyl)OH, -NHOH, and -OH, that are designed to bind to the zinc atom in the active site of the metalloprotease. The 4-position of the cyclobut-3-enedione was derivatized with mono- or dipeptides that are designed to bind in the S1' and S2' subsites of the enzyme, and position the metal chelating group appropriately in the active site for binding to zinc. Positional scanning revealed that -N(Me)OH provided the highest level of inhibition among the chelating groups that were tested, and Leu-Tle-NHMe was the preferred amino acid sequence. A combination of these groups yielded an inhibitor with an IC50 value of 95 microM. For one inhibitor, conversion of one of the carbonyl groups on the cyclobut-3-enedione core to a thiocarbonyl group resulted in a 18-fold increase in potency, and yielded a compound with an IC50 value of 15 microM.

Using a lipase as a high-throughput screening method for measuring the enantiomeric excess of allylic acetates.

This report describes a high-throughput method for measuring the enantiomeric excess of allylic acetates. Such methods are useful tools for screening libraries of potential catalysts for enantioselective reactions. This technique, which is called EMDee for an enzymatic method for determining enantiomeric excess, uses the lipase from Pseudomonas cepacia to hydrolyze the (R) enantiomer of an allylic acetate, while the (S) enantiomer does not react. The rate of the reaction is monitored by measuring the acetic acid that is produced during the hydrolysis reaction with a pH indicator. Using the Michaelis-Menten equation, the rate of the reaction can be correlated with the concentration of the (R) enantiomer. This method can process 88 samples in less that 30 min.

Treatment of ureteral stones: comparison of extracorporeal shock wave lithotripsy and endourologic alternatives.

AIM OF THE STUDY: The aim of the study is to compare the effectiveness of ESWL and ureteroscopic lithotripsy with pneumatic, ultrasonic and electrohydraulic modalities in patients with ureteral stones. PATIENTS AND METHOD: In this study, 1,970 patients with ureteral stones were evaluated. ESWL and ureteroscopic lithotripsies were performed in 1,580 and 484 patients, respectively. The ESWL group was treated with a Siemens Lithostar plus. Ureteroscopic lithotripsy was performed with pneumatic lithotripsy (PL), ultrasonic lithotripsy (USL) and electrohydraulic lithotripsy (EHL) in 140 (28.9%), 311 (64.3%) and 33 (6.8%) patients, respectively. 94 patients underwent both because of unsuccessful ESWL therapy. RESULTS: In the ESWL group, the stone-free rate was 49.9% and the fragmentation rate 71.0%. These values were: 95.0 and 97.1% for PL; 88.1 and 89.4% for USL; 90.9 and 93.9% for EHL, respectively. Ureteroscopic lithotripsy has been found more effective than ESWL in the treatment of middle and lower ureteral calculi (p < 0.001) and PL has the greatest success rate within these endoscopic groups. CONCLUSION: ESWL therapy can be the first-line therapy in upper ureteral stones keeping the other modalities for unfragmented stones. However, ureteroscopic lithotripsy is the most effective treatment choice in lower ureteral stones no matter which kind of energy used and PL is the most effective and less complicated among the other types.

alpha-Ketocarboxylic acid-based inhibitors of protein tyrosine phosphatases.

A series of aryl alpha-ketocarboxylic acids was synthesized and investigated as inhibitors for the protein tyrosine phosphatase from Yersinia enterocolitica. IC(50) values for these compounds range from 79 to 2700 microM. Larger aromatic groups, and aromatic groups with high electron density, lead to more potent inhibitors. In general, the related aryl alpha-hydroxycarboxylic acids show lower activity.