Search

Aim: Lower limb ischemia/reperfusion leads to distant organ dysfunction, notably affecting the lungs, resulting in respiratory failure and significant morbidity and mortality. Edaravone is a new free radical scavenger and has attracted the attention of researchers. This study aims to examine edaravone's influence on lung injury arising from lower limb ischemia-reperfusion. Material and Methods: Forty male Wistar rats were categorized into groups: Sham, Ischemia/Reperfusion (IR), Solvent, and Edaravone. The infrarenal abdominal aorta was clamped for 120 minutes and then reperfused for another 120 minutes. Edaravone was administered 30 minutes before the ischemic event. Then we analyzed serum and lung tissue samples for malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), and nitric oxide (NO) levels. Furthermore, a thorough histopathological assessment was conducted. Results: In the IR group, edaravone notably reduced serum and lung MDA levels. While significant differences in serum SOD and NO levels existed between the IR and edaravone groups, similar differences were not found in the lung tissue samples. There appeared to be no significant impact of edaravone on serum and lung GPx levels. The histopathological investigation revealed that the lung injury score was significantly higher in the IR group compared to the control group, a difference mitigated by edaravone treatment. Conclusion: Our findings suggest that edaravone mitigates lower limb ischemia-reperfusion-induced lung injury, both biochemically and histopathologically. Our findings imply the potential utility of this agent in the context of acute ischemia-reperfusion injury following vascular surgery. [Turk J Vasc Surg 2023; 32(3.000): 166-73]

Acute kidney injury (AKI) is defined as a reduction of renal function in hours, including both structural damage and loss of function. There are limited number of biomarkers for early detection and staging of severity. C-type natriuretic peptide (CNP) has been detected in at several tissues. We aimed to evaluate plasma CNP and creatinine levels correlated with duration of ischemia in an experimentally induced AKI rat model. Forty male Sprague-Dawley type rats (aged 8 to 12 weeks, weighing 250-350 g) were used. The animals were randomly seperated into 4 groups: Group 1(n:10): Only laparotomy was performed. The left renal artery was clamped for 3, 6 and 9 hours in groups 2 ( n:10), 3 (n:10) and 4 (n:10) respectively. CNP and creatinine levels were measured in serum samples from rats. A significant increase in creatinine levels was determined in group 2 according to group 1 (p=0.006). The mean plasma creatinine values in group 3 and 4 were decreased compared to group 2 but this difference was not statistically significant (p=0.0862). The mean CNP level in Group 2 (39.5 ± 7.93 mg/dl) was found numerically higher than group 1 (37.90 ± 5.38mg/dl). There was a statistically insignificant decrease in mean CNP levels in group 3 and 4 compared with group 2. Renal ischemia increases the level of CNP. Although the increase in CNP levels is not significant, it can be said that clinical and experimental studies evaluating the timing of ischemia involving different durations should be performed. [Med-Science 2020; 9(1.000): 73-7]

Coronary artery perforation (CAP) is a rare, but potentially mortal possible complication of percutaneous coronary intervention. There are several treatment options for this complication, including prolonged balloon dilatation, use of a coronary stent graft, and bypass surgery. In this case report, a 65-year-old female patient who was admitted to the catheter laboratory with a diagnosis of acute coronary syndrome, was presented. Coronary angiography revealed total occlusion in the mid segment of the right coronary artery and a drug-eluting stent was implanted under 12 atm of pressure following pre-dilatation with a perfusion balloon. In order to perform defragmentation of the thrombus shifted into the proximal stent segment, post-dilatation was performed with a stent balloon (4–6 atm). After post-dilatation, an Ellis Class II perforation developed. In order to control the bleeding, a coronary stent graft was implanted at the perforation area. The rupture was sealed. Control coronary angiography 40 days later indicated that the stent graft was patent, but an arteriovenous fistula (AVF) draining to the right ventricle was detected. To the best of our knowledge, this is the first case of AVF seen as a late complication of CAP treated with a stent graft.

Background: Family history of premature atherosclerosis imposes a high risk to people. The relationship between atherosclerosis and gene polymorphisms of various biomarkers such as Endothelial Nitric Oxide Synthase (eNOS), C-Reactive Protein (CRP), and Interleukin-6 (IL-6) has shown in previous studies. Aims: The major aim of the study was to evaluate the CRP, eNOS, and IL-6 gene polymorphisms in a group of adolescents who have a parental history of early coronary artery disease (CAD). Study Design: Case-control study. Methods: Thirty-six volunteers with a father with obstructive CAD during the first four decades and 46 subjects with a father with normal coronary arteries documented with coronary angiography were included in the study. Polymerase chain reaction-restriction fragment length polymorphism techniques were used to analyze CRP, eNOS, and IL-6 polymorphisms. Results: We did not find any differences between the two groups with regard to age, sex, body mass index, renal functions, systolic and diastolic blood pressures, lipid profile, and fasting glucose, hemoglobin, and high sensitivity CRP. A significant difference was only observed in IL-6-572 G/C genotype distribution and allele frequency between two groups (Pc=0.036 OR=3.48 CI (95%) 1.17-10.32). Conclusion: The present study showed a significant association between the IL-6-572 G/C gene polymorphism (presence of C allele) and adolescents with a parental history of premature CAD.

Abstract Background: Ventricular premature contractions (VPCs) may trigger lethal ventricular arrhythmias in patients with structural heart disease. However, this role of VPCs in healthy people remains controversial once that not enough clinical trials are available. Recently, some myocardial repolarization markers, such as Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, have been reported to be useful for predicting lethal ventricular arrhythmias in various clinical disorders without structural heart disease. Objective: In this study, we aimed to investigate the relation between VPC frequent and myocardial repolarization markers in individuals without structural heart disease. Methods: This study included 100 patients who had complaints of dizziness and palpitations. Twelve-lead electrocardiography and 24-hour ambulatory Holter recordings were obtained from all patients. VPC burden was calculated as the total number of VPCs divided by the number of all QRS complexes in the total recording time. P-values < 0.05 were considered significant. Results: Tp-e interval and Tp-e/QTc ratio were significantly higher in patients with higher VPC burden than in patients with lower VPC burden, and a positive correlation was found between these markers and VPC burden. Tp-e (β = 1.318, p = 0.043) and Tp-e/QTc (β = -405.136, p = 0.024) in the lead V5 were identified as independent predictors of increased VPC burden. Conclusions: Tp-e interval and Tp-e/QTc ratio increased in patients with high VPC number. Our study showed that VPCs may have a negative effect on myocardial repolarization. This interaction may lead to an increased risk of malignant arrhythmias.

Purpose Neurogenic detrusor overactivity (NDOA) is characterized by involuntary detrusor muscle contractions during bladder filling in patients with neurological disorders. Anticholinergic therapy is the primary treatment; however, the reasons for treatment resistance in NDOA are not well understood. This study aimed to identify predictors of treatment failure by comparing urodynamic and frequency-volume chart data between patients with NDOA who respond and patients who do not respond to anticholinergic therapy. Methods We reviewed the records of 362 patients presenting with lower urinary tract symptoms and selected 85 who had NDOA and were on anticholinergic therapy. Ultimately, 67 patients were analyzed. We categorized these individuals into responders (group R) and nonresponders (group NR) based on clinical and urodynamic improvements. Three-day frequencyvolume charts and urodynamic study results were retrospectively reviewed. Results Of the 85 initial patients, 12 refused medication, and 6 were lost to follow-up. Pre- to posttreatment changes differed significantly between groups in the number of urgency urinary incontinence (UUI) episodes per 24 hours (P=0.001), maximum cystometric capacity (mL, P=0.003), NDOA frequency (P=0.004), and bladder compliance (mL/cm H2O, P=0.003). Multivariate analysis revealed that NDOA frequency (P=0.014) and UUI episodes per 24 hours (P=0.002) were significant factors associated with treatment failure. Conclusions NDOA varies according to underlying neurological conditions. The frequencies of UUI episodes and NDOA in urodynamic studies can predict resistance to initial anticholinergic treatment.

Entrapment or strangulation of the penis is an uncommon condition that requires prompt medical intervention to avoid mechanical and/or vascular injuries. Severe complications such as edema, necrosis, skin infection, penile amputation, and urethral fistula may occur. There is no universally accepted method for treatment, and medical treatment can be delayed due to feelings of humiliation or self-attempt to release the entrapment. Intracavernosal aspiration is a surgical procedure used to evacuate blood from the obstructed corpus cavernosum. This procedure reduces penile size making it easier to remove the ring. However, it does not alleviate the inflammatory idea in the interstitial spaces and penile skin. This paper describes a case study of a 34-year-old male patient who was evaluated in the department of emergency with penile entrapment in a thick steel ring that was placed for prolonged erection. Removing the ring manually was attempted in the emergency department but failed, causing more engorgement in the distal part of the penis. The following admission, the patient was expeditiously transferred to the operating room where the surgical team interposed a wooden tongue depressor between the penile shaft and the ring. Subsequently, a manual hacksaw was used to excise the constriction device. Nevertheless, owing to the substantial diameter of the ring, the hacksaw became fractured and subsequently, a micromotor was employed for the ring removal procedure. Throughout the cutting process involving the micromotor, the ring was continuously cooled with an iced isotonic solution. Within thirty minutes, the ventral and dorsal sides of the steel ring were cut, and it was removed in two pieces.

Objective:Voiding dysfunction is a commonly encountered problem in children. If a patient has a history of urinary tract infection (UTI) and presents with fever, voiding cystourethrography (VCUG) is frequently used. Proximal urethra dilatation in VCUG was determined to be an indication of voiding dysfunction. Studies in literature have been the ones assessing the correlation between the presence of proximal urethra dilatation and voiding dysfunction. In our study, however, we analyzed the relationship between the proximal urethra diameter determined in VCUG of children with voiding dysfunction, the severity of the disease, the presence of reflux, and uroflowmetry parameters.Materials and Methods:Of the 522 VCUG-received patients 96 between the ages of 6-8 with voiding dysfunction concomitant with febrile UTI were evaluated. Dysfunctional voiding incontinence scoring (DVIS), uroflowmetry parameters, post-void residual measurements (PVR), proximal urethra diameter noted in VCUG, and presence of reflux in the patients were analysed.Results:The mean age was 7.2±0.66. The average proximal urethra diameter was 7.6±1.8 mm. Regarding the diameter, the patients were divided into two groups: Group 1 (7.6 mm and below) and group 2 (above 7.6 mm). DVIS was higher but vesicoureteral reflux (VUR) was lower in group 2 (p=0.017, p=0.008; respectively). For uroflowmetry parameters and PVR, no significant differences were noted.Conclusion:In the group with the high-proximal urethra diameter, DVIS was observed to be high. However, a negative correlation was determined between high-proximal urethra diameter and VUR.

Objective: Voiding dysfunction (VD), which encompasses many urinary symptoms that are not caused by neurological or anatomical anomalies, is a frequently encountered functional urinary bladder disorder in children. It was reported that there was an association between lower urinary tract symptoms and fecal microbiota in adult patients. Therefore, we aimed to investigate the differences in fecal microbiota between children with or without VD. Methods: Two patient groups, including 30 patients, were compared. Group 1 included patients with VD, while Group 2 consisted of healthy children. All study participants were asked to fill lower urinary tract and voiding dysfunction symptom score forms with the assistance of their parents. Subsequently, uroflowmetry tests and postvoiding residual urine measurements were performed. Fresh stool samples were collected from all children and analyzed by polymerase chain reaction. General bacterial load and presence of Roseburia intestinalis, Clostridium difficile, Fusobacterium nucleatum, and Bacteroides clarus were tested. Results: The two groups were significantly different regarding general bacterial load; the presence of Fusobacterium nucleatum. Clostridium difficile and Bacteroides clarus was not detected in the fresh stool samples of the patients in Group 2; the counts of Roseburia intestinalis were less in Group 1 than in Group 2, although there was no statistically significant difference. There was a negative correlation between symptom scores, general bacterial load, and the presence of Fusobacterium nucleatum. However, there was no correlation between the presence of Roseburia intestinalis and symptom scores. Conclusions: There is a potential relationship between VD and a deviation in the fecal microbiota in the pediatric population.

Objective:Urinary retention is a common postoperative problem. We aimed to investigate the incidence of postoperative urinary retention (POUR) in surgical population and identify the perioperative risk factors for POUR.Materials and Methods:A total of 332 patients, who underwent elective surgery between May 2012 and July 2012, were included in this prospective observational study. Patients under 18 years of age and those with a history of renal failure or benign prostate obstruction were excluded from the study. Group 1 was consisted of patients who had not developed POUR, whereas patients who experienced POUR were included in group 2. Demographic variables and risk factors related with POUR were compared between the two groups.Results:Of the 332 patients enrolled in the study, 179 (53.9%) were men and 153 (46.1%) were women. Thirty-three (9.9%) patients developed urinary retention. Comparison of demographic and perioperative variables between the two groups revealed that Diabetes Mellitus (DM) and spinal anesthesia were significantly associated with POUR (p=0.039 and p=0.043, respectively). Multivariate logistic regression analysis found that DM [p=0.017, odds ratio (OR): 3.009; 95% confidence interval (CI), 1.221– 7.414] and spinal anesthesia (p=0.031, OR: 2.266; 95% CI, 1.079-4.760) were significant independent risk factors for developing POUR.Conclusion:DM and spinal anesthesia were found to be risk factors for POUR. Awareness of risk factor for POUR during preoperative anesthesiology evaluation may help identify patients at risk for POUR, who could benefit from interventions, and prevent POUR and its potential complications.

Objective:The aim of the study was to investigate gender-specific differences in the Turkish patients with renal cell carcinoma (RCC) undergoing radical or nephron-sparing nephrectomy and compare the results with those in other regions.Materials and Methods:Data of 76 patients, who were clinically diagnosed with RCC and underwent radical or nephron-sparing nephrectomy from January 2011 to August 2017, were retrospectively evaluated. Age and gender of the patients and the size, histological type, grade and pathological stage of the tumors were recorded. A chi-square test was used for comparing categorical variables, whereas the Student’s t-test was used for the same purpose in the continuous variables.Results:Of the 67 patients, 39 (58.2%) were male and 28 (41.8%) were female; male-to-female ratio was 3:2. The mean age of the male and female patients was 63.4±11.7 years and 59.3±14.3 years, respectively and the mean tumor size was 5.7 and 5.3 cm, respectively. There were differences in mean age, tumor size and Fuhrman grade, however, none of them reached the level of statistical significance. Twenty four of the male and 25 of the female patients had low-stage, 15 of the male and 3 of the female patients had high-stage disease. Thus, the male patients had higher stage disease than the female patients and the difference was statistically significant (p=0.011).Conclusion:Turkish women with RCC had significantly lower stage disease than Turkish men, although grade and size of the tumor did not present a statistically significant difference. The results were similar with other European studies.

Splenogonadal fusion, which can be clinically confused with testicular neoplasms as they present with testicular swelling, is a rare abnormality in young adults. Intraoperative frozen section analysis can be helpful in diagnosing such cases and preventing unnecessary orchiectomies. We report a case in which frozen section analysis was done and testis-sparing surgery could be performed.

Urothelial bladder carcinoma is a rare condition in young patients. Clinicians have less inclination to perform cystoscopy in this age group because benign causes of hematuria are more common. Thus, diagnostic delays of up to one year may occur. We report a 24-year-old male patient with urothelial bladder cancer. Clinical behavior and prognosis in young individuals are controversial. The definitions of “young patient” are highly variable and different World Health Organization pathological classification systems are used for reporting. Generally, it presents as a low-stage and low-grade disease, nevertheless, it may present with high-grade tumors, even with muscle-invasive cancer.

We compare the efficacy of intratesticular ozone therapy with intraperitoneal ozone therapy in an experimental rat model. For this purpose, 24 rats were divided into four groups including sham-operated, torsion/detorsion, torsion/detorsion plus intraperitoneal ozone (O-IP), and torsion/detorsion plus intratesticular ozone (O-IT). The O-IP ozone group received a 4 mg kg−1 intraperitoneal injection of ozone, and the O-IT group received the same injection epididymally. At 4 h after detorsion, the rats were sacrificed and orchiectomy materials were assessed histopathologically. Spermatogenesis in the seminiferous tubules and damage to the Sertoli cells were histopathologically evaluated in the testes using the Johnsen scoring system. i-NOS and e-NOS activities in the testis tissue were also evaluated. Torsion-detorsion caused a decreased Johnsen score and increased apoptosis of spermatogonial and Sertoli cells. Ozone injection prevented increases in Johnsen score and i-NOS level. e-NOS level of the O-IP group was significantly lower than that of the O-IP group, and i-NOS level of the O-IT group was significantly lower than that of the O-IP group. Local ozone therapy is more effective than systemic ozone therapy at improving IRI-related testicular torsion. Our study is the first to show that the efficacy of intratesticular implementation of ozone therapy is higher than that of intraperitoneal ozone therapy.

Erectile dysfunction (ED) is the inability to develop normal erection or an hardening problem at various extent that causes inability to maintain the erection for the sufficient time required for a complete sexual activity. It can be the result of neurologic, psychogenic, vascular, urogenital and hormonal abnormalities. It is reported that it affects 52-67% of men between 40 and 70 years old. Numerous theories and opinions are issued in the literature in order to explain the hemodynamic changea that occur during erection and detumescence. Especially the effects of chronic diseases and psychogenic factors on the pathophysiology of erectile dysfunction are common matters of discussion in recent years. In this review, we will evaluate the current developments in the literature about the etiology of erectile dysfunction.

Primary signet cell carcinoma of the prostate is a rare histological variant of prostate malignancies. It is commonly originated from the stomach, colon, pancreas, and less commonly in the bladder. Prognosis of the classical type is worse than the adenocarcinoma of the prostate. Primary signet cell adenocarcinoma is diagnosed by eliminating the adenocarcinomas of other organs such as gastrointestinal tract organs. In this case report, we present a case with primary signet cell adenocarcinoma of the prostate who received docetaxel chemotherapy because of short prostate specific antigen doubling time.