Penile prosthesis implantation: A single center 25 years of experience.

OBJECTIVES: We analyzed the long-term results of malleable and inflatable penile prosthesis: the rates of complications, revision surgery and patient satisfaction. MATERIALS AND METHODS: Between January 1996 and December 2020, a total of 138 patients underwent implantation of a malleable or inflatable types penile prosthesis. The data of the patients were derived from the patient files and digital recording system. The patients were contacted face-to-face interaction if possible. If it is not possible, phone connection was made. RESULTS: The median age of patients was 56 (21-83) years. Fourteen (10.2%) 1-piece, 46 (33.3%) 2-piece and 78 (56.5%) 3-piece penile prosthesis were implanted. The mostly used perioperative antibiotic was teicoplanin+amikacin in 107 patients. Total complication rate was 30% (n=42). Prosthesis infection constituted 9% (n=13) of these complications. The total satisfaction rate was 89.1%. There was no correlation between the complications and antibiotic regimen or prosthesis type (P=0.488, P=0.454, respectively). The rate of infection showed a slight increase in 3-piece penile prosthesis without any statistically significance (P=0.633). The patients with complications expressed more dissatisfaction compared to those without complications (P=0.001). CONCLUSIONS: In our series, penile prosthesis implantation seems to be a recommended treatment method with high patient satisfaction in the treatment of refractory erectile dysfunction. LEVEL OF EVIDENCE: 4.

HMGCR and ApoE mutations may cause different responses to lipid lowering statin therapy.

Coronary artery disease (CAD) and its complications are the major causes of death in the world. Although statins have been used to lower lipid levels in CAD patients, this goal can not be attained in 1/3 of the patients. The objective of this study was to investigate whether common variations in HMG-CoA Reductase(HMGCR) and Apolipoprotein E (ApoE) genes involved in lipid and statin metabolism modify the effect of statins on serum lipid and lipoprotein concentrations in CAD patients.A hundred  CAD patients were enrolled into the study. At the beginning of the study biochemical measurements were performed to determine the baseline levels performed. Patients were treated with 40 mg atorvastatin for 2 months and biochemical measurements were repeated. According to the post-treatment, LDL-c levels,  patients were divided into 2 groups as non-responders and responders, respectively. The information regarding the risk factors such as smoking, alcohol consumption etc. were also obtained. DNA was isolated from peripheral blood. The presence of rs17244841 ve rs17238540 mutations in HMGCR and ε2, ε3 and ε4 variants of ApoE were determined by using RT-PCR. Results were evaluated statistically. HMGCR mutatations were mostly found in responders and ε4 variant of ApoE was mostly found in non-responders. It was also found that presence of HMGCR mutations causes a significant reduction in total cholesterol and LDL-c levels. Also presence of ε2 variant of ApoE causes a statistically significant increase in trigliseride levels. Our findings should be investigated with other researchers to clarify the mechanism.

Acethylcholinesterase inhibitory potential and antioxidant properties of pyrogallol.

Pyrogallol is found naturally in crops and fruits of many plants. It is also an active ingredient of many pharmaceuticals. For this reason, we employed different in vitro antioxidant assays such as cupric ion Cu(2+) reducing power, Fe(3+) reducing power, total antioxidant activity by ferric thiocyanate method, ABTS radical scavenging, DMPD radical scavenging, DPPH • scavenging, Fe(2+) chelating, [Formula: see text] scavenging and H(2)O(2) scavenging activities of pyrogallol. Pyrogallol inhibited 77.95% lipid peroxidation of linoleic acid emulsion at 30 µg/mL concentration. BHA, BHT, α-tocopherol and trolox exhibited inhibitions of 89.88, 89.97, 83.82 and 91.85% against peroxidation of linoleic acid emulsion at the same concentration, respectively. In addition, pyrogallol was an effective of all the scavenging and reducing power results. In this study, pyrogallol was also evaluated as potential inhibitor for acethycholinesterse enzyme. The results showed that pyrogallol exhibited potent acetylcholinesteras inhibitory activity with IC(50) and K(I) values 10.2 and 8.6 µM, respectively.

Inhibition profile of a series of phenolic acids on bovine lactoperoxidase enzyme.

Lactoperoxidase (LPO) catalyzes the oxidation of numerous of organic and inorganic substrates by hydrogen peroxide. It has very vital activity in the innate immune system by decreasing or stopping the activation of the bacteria in milk and mucosal secretions. This study's purpose was to investigate in vitro effect of some phenolic acids (ellagic, gallic, ferulic, caffeic, quercetin, p-coumaric, syringic, catechol and epicatechin) on the purified LPO. This enzyme was purified from milk by using different methods such as Amberlite CG-50 resin, CM-Sephadex C-50 ion-exchange and Sephadex G-100 gel filtration chromatography. LPO was purified 28.7-fold with a yield of 20.03%. We found phenolic acids have inhibition effects on bovine LPO enzyme to different concentrations. Our study showed lower concentrations of caffeic acid, ferulic acid and quercetin exhibited much higher inhibitory effect on enzyme, so these three of them were clearly a more potent inhibitor than the others were. All of compounds were non-competitive inhibitors.

Alternative non-femoral accesses for intra-aortic balloon pumping.

Access from the femoral arteries to the thoracic aorta for intra-aortic balloon pump (IABP) insertion may not be feasible in a substantial number of patients with severe peripheral vascular disease. Since using an alternative access is inevitable in a certain number of patients requiring IABP support, all alternative accesses should be added to the surgical armamentarium. Herein, we present our 27-year experience with different alternative accesses for IABP insertion following failed contraindication to femoral artery cannulation. The alternative techniques described below were: transthoracic insertion with a tube graft, transthoracic insertion - direct, transaxillary/subclavian insertion and transbrachial insertion.

A case of L-2 hydroxyglutaric aciduria presenting as febrile seizure.

L-2 hydroxyglutaric aciduria (L2HGA) is a rare, infantile-onset, autosomal recessive organic aciduria affecting exclusively the central nervous system. A case is reported here of L2HGA presenting with macrocephaly and febrile seizure. Although there have been reports of epilepsy associated with L2HGA, to the best of our knowledge this is the second case in literature of febrile seizure in a patient with L2HGA. This report suggests that detailed neurological evaluation of macrocephalic children with febrile convulsion is important. Moreover, metabolic and genetic investigations may be necessary for these kinds of patients.

The effect of nebivolol on internal mammary artery blood flow during coronary artery bypass graft surgery.

BACKGROUND: During coronary artery bypass grafting (CABG), one of the most important complications related to the internal mammary artery (IMA) is perioperative spasm. Nebivolol causes endothelium-dependent vascular relaxation by increasing nitric oxide (NO) release and prevents endothelial dysfunction in long-term use. In our study, we measured the effect of a third generation beta blocker, nebivolol, on the flow dynamics of IMA grafts. METHODS: We recruited 90 hypertensive patients undergoing isolated CABG operation, who were divided into three groups and each group included 30 patients: Group 1 patients were under antihypertensive treatment other than beta-blockers (angiontensin-converting enzyme [ACE] inhibitors, calcium channel blockers or diuretics; monotherapy or combination therapy), Group 2 received metoprolol (50 mg/day) and Group 3 received nebivolol (5 mg/day). These antihypertensive therapies were given for at least one week before the operation and continued thereafter. IMA blood flow volume was measured for one minute just before cardiopulmonary bypass (measurement A) and before left internal mammary artery (LIMA)-left anterior descending (LAD) artery anastomosis (measurement B) in the three groups. Cardiac output measurements were also achieved simultaneously. RESULTS: The measurement A results were 56.3 ± 36.2, 54.6 ± 28.1 and 66.8 ± 34.2 mL/min in Groups 1, 2 and 3, respectively (p<0.05). The measurement B results were 78.3 ± 29.6, 80 ± 28.8 and 91.1 ± 40.8 mL/min in Groups 1, 2 and 3 (p<0.05), respectively. There were no differences in cardiac outputs among the groups; 5.2 ± 1.4, 5.0 ± 1.6 and 5.3 ± 1.1 L/min (p>0.05). While the cardiac outputs were similar within the three groups, the IMA free flow volume was higher in the nebivolol group after local papaverine use. CONCLUSION: Nebivolol might represent a good choice in hypertensive patients undergoing cardiac surgery by preventing perioperative myocardial hypoperfusion which increases early morbidity and mortality.

The relationship between neutrophil/lymphocyte ratio and the TIMI flow grade in patients with STEMI undergoing primary PCI.

OBJECTIVES: ST segment elevation myocardial infarction (STEMI) is an important cause of the morbidity and mortality in coronary artery disease. The aim of this study is to investigate the relationship between hematologic parameters and post primary PCI coronary no-reflow. PATIENTS AND METHODS: A total of 145 consecutive STEMI patients (mean age=58.2±12.3 years) and healthy volunteer admitted within 6 hours from symptom onset were enrolled to the study in the cardiology clinics. The STEMI patients were divided into 2 groups based on the Thrombolysis In Myocardial Infarction (TIMI) flow grade. No-reflow was defined as post-PCI TIMI Flow Grade 0, 1 or 2 and angiographic success was defined as TIMI Grade 3 Flow. RESULTS: Diabetes mellitus hypertension and smoking status were similar between groups. With respect to baseline laboratory status, fasting glucose, blood urea nitrogen, creatinine levels were not significantly different between groups. The neutrophil/lymphocyte (N/L) ratio was also significantly higher in STEMI group (7.1±4.6 vs. 2.3±1.7, p < 0.001). Additionally, N/L ratio was also significantly higher in No-reflow group (TIMI Flow Grade 0, 1 or 2) group (13.1±4.5 vs. 5.3±2.7, p < 0.001). CONCLUSIONS: The N/L ratio, which is cheaply and easily measurable laboratory data is independently associated with post primary PCI coronary no-reflow.

Shedding light on the next pandemic path, from outpatient to ICU, the effect of vitamin D deficiency in the SARS-CoV-2 pandemic.

Background: Vitamin D insufficiency is named "the pandemic of our era" by some experts. World Health Organization warns against a "deadlier outbreak" than the COVID-19 pandemic. Critical evidence is hereby for future pandemic prevention, with special emphasis on Vitamin D. Methods: A cross-sectional study was conducted with 172 unvaccinated adult participants, who presented to the emergency department. Blood measurements, radiological findings, and demographic features were evaluated in the four categories of "healthy adults, COVID-19 outpatients, hospitalized inpatients on the wards, and in the ICU." Results: Results were statistically significant in association with age, gender, weight, Vitamin D, glucose, urea, creatinine, leucocyte, aspartate transaminase, hemoglobin, C-reactive protein, troponin, platelet/thrombocyte, ferritin, D-dimer, triglycerate, glycated haemoglobin, lactate dehydrogenase measurements, and chest computed tomography features (each p < 0.050). Conclusion: This article presents evidence to support the importance of Vitamin D for global public health. Patients with adequate levels of Vitamin D, glucose, urea, creatinine, leucocyte, aspartate transaminase, hemoglobin, C-reactive protein, troponin, platelet/thrombocyte, ferritin, D-dimer, triglycerate, glycated haemoglobin, lactate dehydrogenase are less likely to be admitted to ICU versus being outpatients. Factors include gender, age, weight, comorbidities, and computed tomography findings. The ultimate goal is to globally minimize preventable burdens of disease and death.

Lymph node density in retroperitoneal lymph node dissection as a novel marker for predicting recurrence in patients with germ cell testicular cancer: A case-control study and long-term clinical experience of a tertiary referral hospital. / La densidad de los ganglios linfáticos en la linfadenectomía retroperitoneal como marcador novel para predecir la recurrencia en pacientes con cáncer testicular de células germinales: estudio de casos y controles y experiencia clínica a largo plazo de un hospital de referencia terciario.

INTRODUCTION AND OBJECTIVES: In this retrospective study, we aimed to evaluate lymph node (LN) density in retroperitoneal lymph node dissection (RPLND) to analyze whether residual mass after chemotherapy might behave as predicting factor for recurrence in patients with germ cell testicular cancer (GCTC). MATERIALS AND METHODS: The data of 185 patients that were operated between 12/2004 and 02/2017 because of GCTC were reviewed retrospectively. LN density was calculated. The patients were compared statistically in terms of demographic features, tumor characteristics, serum tumor marker levels, treatment strategies, and pathological results according to GCTC subtypes. Correlation analysis was performed to determine the parameters related to recurrent disease. RESULTS: The median follow-up was 79 (31-179) months and the median age of the patients was 23 (16-71). The median tumor size was 4 (1-18) cm. Five (2.7%) patients had metastatic disease at initial diagnosis. Seminoma, non-seminomatous-GCT and mix type-GCTC was detected in 62 (33.5%), 60 (32.4%) and 63 (34.1%) patients, respectively. Following inguinal orchiectomy, 48 (25.9%) patients underwent follow-up, 126 (68.1%) patients underwent chemotherapy and 11 (5.9%) patients underwent radiotherapy. A total of 21 (11.4%) patients underwent post-chemotherapy RPLND. Early and late recurrence was seen in 3 (1.6%) and 2 (1.1%) of the patients, respectively. A mild to moderate, negative, but significant correlation was found between the recurrence and the number of LNs containing metastatic deposits and LN density (r= -0.490, P=.024 and r= -0.450, P=.041, respectively). CONCLUSIONS: There was a negative correlation between the number of LNs containing metastatic deposits and LN density and recurrent disease.

Carbonic anhydrase inhibitors. Inhibition of mammalian isoforms I-XIV with a series of natural product polyphenols and phenolic acids.

A series of phenolic acids and phenol natural products, such as p-hydroxybenzoic acid, p-coumaric acid, caffeic acid, ferulic acid, gallic acid, syringic acid, quercetin, and ellagic acid, were investigated for their inhibitory effects against the metalloenzyme carbonic anhydrase (CA, EC 4.2.1.1). All mammalian isozymes of human (h) or murine (m) origin hCA I-hCA XII, mCA XIII and hCA XIV were inhibited in the low micromolar or submicromolar range by these (poly)phenols (K(I)s in the range of 0.87-7.79 microM). p-Hydroxybenzoic acid was the best inhibitor of all isozymes (K(I)s of 0.87-35.4 microM) and the different isozymes showed very variable inhibition profiles with these derivatives. Phenols like the ones investigated here possess a CA inhibition mechanism distinct of that of the sulfonamides/sulfamates used clinically or the coumarins. Unlike the sulfonamides, which bind to the catalytic zinc ion, phenols are anchored at the Zn(II)-coordinated water molecule and bind more externally within the active site cavity, making contacts with various amino acid residues. As this is the region with the highest variability between the many CA isozymes found in mammals, this class of compounds may lead to isoform-selective inhibitors targeting just one or few of the medicinally relevant CAs.

First A2-to-O renal transplantation in the 21st Century: a step in the transplantation history of Turkey.

Renal transplantation is the best treatment modality for patients with end-stage renal disease. Turkey is a country with limited cadaveric donor organ programs. Herein we have reported the first A2-to-O living donor kidney transplantation in Turkey. A 20-year-old female patient was admitted for a living related renal transplantation from her only potential donor her mother. She was blood group O and her mother was blood group A2. Three plasmapheresis sessions followed by intravenous immunoglobulin (IVIG) were performed every other day in the week prior to transplantation. Daclizumab was administered at the time of transplantation with an additional four doses every 2 weeks after the procedure. The immunsuppressive regimen included tacrolimus, mycophenolate mofetil, and prednisolone. Eight plasmapheresis sessions followed by IVIG were performed in the first 2 weeks posttransplant. Six months after transplantation, the serum creatinine was 1 mg/dL. Our experience showed that A2-to-O renal transplantation can be safely performed and may expand the pool of living kidney donors in Turkey.

Retroperitoneal cystic lymphangioma.

An interesting and rare differential diagnosis for a retroperitoneal cystic mass is cystic lymphangioma. A case of a patient presenting with a multicystic mass in the retroperitoneum that was identified as a cystic lymphangioma is reported. These tumours are commonly confused with other cystic masses in the retroperitoneum.

Effect of underground working on vitamin D levels and bone mineral densities in coal miners: a controlled study.

The aim of this study was to determine the effect of underground working on 25-hydroxyvitamin D (25-OHD) levels and bone mineral density (BMD) values in coal miners. Fifty coal miners working underground and 50 surface workers as controls, matched for age and body mass index, from Zonguldak, Turkey, were recruited to the study. Levels of 25-OHD, biochemical bone markers, and lumbar spine and femur BMD values were measured in all study participants. Lumbar spine and femur BMD values were significantly higher in underground workers compared with surface workers, but there was no significant difference in 25-OHD levels between the two groups. Duration of underground working, age, 25-OHD levels, cigarette consumption and dietary calcium intake were not correlated with BMD values. Underground physical working does not seem to be a significant risk factor for low 25-OHD levels or low BMD values.

Response to growth hormone with respect to pubertal status on increased dose in idiopathic growth hormone deficiency: an analysis of Turkish children in the KIGS database (Pfizer International Growth Study).

AIM: To compare the growth response to growth hormone (GH) treatment in patients with idiopathic GH deficiency (IGHD) who were prepubertal with the response of those who were pubertal at the onset of GH therapy on an increased GH dose. PATIENTS AND METHODS: Among the Turkish patients enrolled in the Pfizer International Growth Study (KIGS) database with the diagnosis of IGHD, the growth data over 2 years of GH therapy were analyzed longitudinally of 113 (79 M) prepubertal (Group 1) and 44 (33 M) pubertal (Group 2) patients. Pubertal signs were reported to be present initially or to have appeared within 6 months of GH therapy in Group 2. Mean +/- SD age at onset of therapy was 8.7 +/- 3.5 and 13.5 +/- 1.8 years; height SDS -4.2 +/- 1.4 and -3.2 +/- 1.1 (p < 0.05) in Groups 1 and 2, respectively. Mid-parental height (MPH) SDS did not show a significant difference between the two groups (-1.5 +/- 1.1 vs -1.7 +/- 1.1). RESULTS: Delta height SDS over 2 years of therapy was significantly higher in Group 1 (1.1 +/- 1.0) than in Group 2 (0.7 +/- 0.6) (p <0.05) in spite of a significantly lower dose of GH (14.6 +/- 3.3 in Group 1 vs 17.0 +/- 3.1 IU/m2/week in Group 2, p < 0.05). Ht--MPH SDS showed an increase from -2.4 +/- 1.7 to -1.4 +/- 1.5 in Group 1 and from -1.5 +/- 1.5 to -0.8 +/- 1.3 in Group 2. Overall delta height SDS showed negative correlations with age (r = -0.32), height SDS (r = -0.41) and height--MPH SDS (r = -0.40) at onset of therapy (p < 0.001). CONCLUSIONS: These data show that in IGHD the slight increase (15-20%) in the dose of GH during puberty was not adequate to maintain height velocity at the same magnitude as in prepuberty, and thus was not cost effective.

The importance of the incidental thyroid gland uptake during Tc-99m MIBI myocardial perfusion scintigraphy.

OBJECTIVE: The purpose of study was to investigate whether incidental thyroid gland uptake had an important during Tc-99m sestamibi (MIBI) myocardial perfusion scintigraphy (SPECT). PATIENTS AND METHODS: In the presented study, 968 consecutive patients were evaluated for the presence or absence of thyroid gland uptake in the raw data of the Tc-99m MIBI SPECT. All of the patients had thyroid gland uptake of the Tc-99m MIBI underwent laboratory evaluation of thyroid function, ultrasonographic imaging, and hystopathological examination. RESULTS: The thyroid gland uptake was detected in 14 of 968 (1.4%) consecutive patients during the evaluation of raw images of Tc-99m MIBI SPECT studies. Among these 14 patients, 4 had subacute thyroiditis, 7 multinodular goiter, 3 Graves disease by ultrasonographic imaging and hystopathological examination. TSH levels of all of these patients were < 0.01 U/ml. CONCLUSIONS: Tc-99m MIBI uptake by thyroid gland has been explained with associated clinical thyrotoxicosis. Although the primary goal of myocardial perfusion imaging is the evaluation of myocardial perfusion, the interpretation of myocardial perfusion imaging should not be limited to the heart. Because, it is possible to observe extracardiac radioactivity accumulation, which may then lead to the diagnosis of a noncardiac disease during this detailed examination.

Hallervorden-Spatz Syndrome.

BACKGROUND: A 28-year-old man was referred to the neurology department of our hospital with difficulty of social interaction, impairment in carrying out daily life activities and muscle rigidity. He had a history of head trauma 3 years ago. Neurological examination revealed bradykinesia, hypophonic speech, resting and postural tremor, rigidity, spasticity, hyperreflexia and psychosis.

Effect of hypothermia in patients undergoing simultaneous carotid endarterectomy and coronary artery bypass graft surgery.

PURPOSE: We sought to determine whether hypothermia provided any benefit in patients undergoing simultaneous coronary artery bypass graft surgery (CABG) and carotid endarterectomy (CEA) using one of two different surgical strategies. METHODS: Group 1 patients (n = 34, 88.2% male, mean age 65.94 ± 6.67 years) underwent CEA under moderate hypothermia before cross clamping the aorta, whereas group 2 patients (n = 23, 69.6% male, mean age 65.78 ± 9.29 years) underwent CEA under normothermic conditions before initiating cardiopulmonary bypass (CPB). Primary outcome of interest was the occurrence of any new neurological event. RESULTS: The two groups were similar in terms of baseline characteristics. Permanent impairment occurred in one patient (2.9%) in group 1. One patient from each group (2.9 and 4.37%) had transient neurological events and they recovered completely on the sixth and 11th postoperative days, respectively. Overall, there was no statistically significant difference between the two groups with regard to occurrence of early neurological outcomes (n = 2, 5.8 % vs n = 1, 4.3 %, p = 0.12). CONCLUSIONS: This study could not provide evidence regarding benefit of hypothermia in simultaneous operations for carotid and coronary artery disease because of the low occurrence rate of adverse outcomes. The single-stage operation is safe and completion of the CEA before CPB may be considered when short duration of CPB is required.

Late coronary stent dislodgement following coronary artery stenting.

Recently, coronary artery stenting has been successful when used as an intervention for percutaneous coronary artery disease. However, the procedure may frequently produce complications. Although rare, stent dislodgement is one such complication, which may result in serious problems including coronary artery dissection, myocardial infarction, peripheral embolisation and death. Stent dislodgement is known to be an early complication of the coronary artery stenting procedure. In this case report, we present a 53-year-old male with late coronary stent dislodgement. To the best of our knowledge, no such case has been addressed in the literature to date.

Laser-assisted fluoroscopic puncture: a new technique for accessing the kidney.

PURPOSE: We developed a laser pointer device that is mounted on the image intensifier of a C-arm fluoroscope. The laser-assisted fluoroscopic puncture technique (LAFPT) is an alternative method of accessing the kidney. MATERIALS AND METHODS: The LAFPT was assessed both in an in vitro model and in a series of cases. The in vitro model was composed of Foley balloons filled with contrast medium of different volumes (2-6 mL) embedded in silicone pads. The total fluoroscopy times and attempts required for a successful puncture with LAFPT were compared with those of conventional fluoroscopic access. RESULTS: The number of attempts required to puncture the 2-mL balloons was significantly greater with the conventional fluoroscopic technique than with LAFPT. The fluoroscopy time in vitro was reduced 50% with LAFPT. However, there was no statistically significant difference in the time required for the two techniques in the clinical series. CONCLUSION: The laser-assisted fluoroscopic puncture technique allows accurate positioning of a needle with reduced radiation exposure.