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Allele frequencies of 15 STRs included in the PowerPlex 16 System (D3S1358, TH01, D21S11, D18S51, Penta E, D5S818, D13S317, D7S820, D16S539, CSF1PO, Penta D, VWA, D8S1179, TPOX and FGA) were calculated from the referent sample of 100 unrelated individuals of both sexes from Turkish student population living in Sarajevo, Bosnia and Herzegovina. Buccal swab, as a source of DNA, was collected from the volunteers from whom the informed consent form was obtained. DNA extraction was performed using QIAamp DNA Micro kit by Qiagen. DNA template ranging from 0.5 to 2 ng was used to amplify 15 STR loci by PCR multiplex amplification which was performed by using the PowerPlex 16 kit (Promega Corp., Madison, WI, USA) according to the manufacturer’s protocol. The amplifications were carried out in a PE Gene Amp PCR System thermal cycler (Applied Biosystems) and capillary electrophoresis was car- ried out in an ABI PRISM 310 Genetic Analyzer (Applied Biosystems) in accordance with the manufacturer’s recommen- dations. The frequency of each locus was calculated from the numbers of each observed genotype. Deviation from Hardy- -Weinberg equilibrium and observed heterozygosity were calculated. Data were analyzed by using Microsoft Excel work- book template – Powerstats V12 and the power of discrimination (PD), power of exclusion (PE), as well as other popula- tion genetic indices for the 15 STR loci were calculated. Obtained results contribute to existing Turkish DNA database, as well as insight of differences and similarities in comparison to population of Bosnia and Herzegovina. In addition, 13 autosomal STR loci frequencies (D3S1358, TH01, D21S1 1, D18S51, Penta E, D5S818, D13S317, D7S820, D16S539, CSFIPO, Penta D, VWA, D8S1 179, TPOX, and FGA) were studied in 15 different worldwide populations (Turkish, Bosnian, Croatian, Serbian, Montenegrin, Macedonian, Albanian, Kosovan, Greek, Russian, Japanese, Korean, Lithua- nian, Iraqi, Belarusian). For the proof of corresponding data, two different Turkish population STR data obtained from previously published articles were compared with our data and this showed that our data correspond to these 2 previ- ously published data. Further, STR allele frequency data for 13 loci for each population were obtained from previous sci- entific articles and the allele frequencies and genetic diversity among the 15 sample populations were compared. In addi- tion, even though the populations are from different nationalities, the STR data are similar among the geographically close populations. The phylogenetic tree established among worldwide populations and genetic distance values show a great affinity among the 15 populations. Our data is useful for anthropological and further comparative genetic studies of populations.

Computer-aided diagnosis is developed for assessment of allergic rhinitis/rhinoconjunctivitis measuring the relative redness of sclera under application of allergen solution. The patient’s eye images are taken from commercial digital camera. The iris is robustly localized using a gradient-based Hough circle transform. From the center of the pupil, the region of interest within the sclera is extracted using geometric anatomybased a-priori information. The red color pixels are extracted thresholding in the hue, saturation and value color space. Then, redness is measured by taking mean of saturation projected into zero hue. Evaluation is performed with 92 images taken from 13 subjects, 8 responders and 5 non-responders, which were classified according to an experienced otorhinolaryngologist. Provocation is performed with 100, 1,000 and 10,000 AU/ml allergic solution and normalized to control images without provocation. The evaluation yields redness of 1.14, 1.30, 1.60 and 1.04, 1.12, 1.11 for responders and non-responders, respectively. This indicates that our method is suitable as reliable endpoint in controlled clinical trials.

β-Glucosidase was purified from Brassica oleracea by salting out with ammonium sulfate and hydrophobic interaction chromatography. Results demonstrated that the enzyme is a dimer (130 kD) made up of one major (80 kD) and one minor subunit (50 kD). The pH optimum is 6.0, with 50% of the enzyme's original activity remaining between pH 4.0 and pH 7.0. The temperature optimum is 35C, and activity did not decrease after two hours of exposure to this temperature. The activity of the enzyme was investigated on four substrates, 4-Nitrophenyl β-D-glucopyranoside (p-NPG), ortho-Nitrophenyl-β-D-glucopyranoside (o-NPG), para-Nitrophenyl-β-D-galactoside (p-NPGal) and ortho-Nitrophenyl-β-D-galactoside (o-NPGal), and km values were shown to be 0.755 mM, 0.174 mM, 0.988 mM and 0.213 mM, while Vmax values were 604 U/mg, 38 U/mg, 556 U/mg and 308 U/mg, respectively. The enzyme is completely inhibited by gluconolactone and glucose against p-NPG as substrate, with ki values of 0.038 mM and 0.64 mM, respectively. To our knowledge, this is the first study demonstrating purification and characterization of β-glucosidase from broccoli, thus providing a better understanding of its role in the plant, and establishing a basis for further research. Practical Applications To our knowledge, this is the first study demonstrating purification and characterization of β-glucosidase from broccoli, thus providing a better understanding of its role in the plant, and establishing a basis for further research. The results of this research highlight the potential of the enzyme isolated from broccoli for further research. Succeeding efforts would involve optimization of this procedure for increasing the enzyme yield, in order to make it a viable candidate for industrial application.

In a study of the Bosnian-Herzegovinian (B&H) population, Y-chromosome marker frequencies for 100 individuals, generated using the PowerPlex Y23 kit, were used to perform Y-chromosome haplogroup assignment via Whit Athey's Haplogroup Predictor. This algorithm determines Y-chromosome haplogroups from Y-chromosome short tandem repeat (Y-STR) data using a Bayesian probability-based approach. The most frequent haplogroup appeared to be I2a, with a prevalence of 49%, followed by R1a and E1b1b, each accounting for 17% of all haplogroups within the population. Remaining haplogroups were J2a (5%), I1 (4%), R1b (4%), J2b (2%), G2a (1%), and N (1%). These results confirm previously published preliminary B&H population data published over 10 years ago, especially the prediction about the B&H population being a part of the Western Balkan area, which served as the Last Glacial Maximum refuge for the Paleolithic human European population. Furthermore, the results corroborate the hypothesis that this area was a significant stopping point on the "Middle East-Europe highway" during the Neolithic farmer migrations. Finally, since these results are almost completely in accordance with previously published data on B&H and neighboring populations generated by Y-chromosome single nucleotide polymorphism analysis, it can be concluded that in silico analysis of Y-STRs is a reliable method for approximation of the Y- chromosome haplogroup diversity of an examined population.

BACKGROUND: Blood neutrophil‐to‐lymphocyte (N/L) ratio is an indicator of the overall inflammatory status of the body, and an alteration in N/L ratio may be found in ulcerative colitis (UC) patients. The aims of this study were to investigate the utility of N/L ratio as a simple and readily available predictor for clinical disease activity in UC. J. Clin. Lab. Anal. 27:72–76, 2013. © 2012 Wiley Periodicals, Inc. METHODS: Twenty‐six patients and 28 healthy controls were enrolled in the study. The neutrophil and lymphocyte counts were recorded, and the N/L ratio was calculated from these parameters. The extent of disease classified according to the Montreal classification, clinical disease activity was evaluated using a modified Truelove–Witts severity index, and endoscopic disease activities were classified according to Schroder et al. RESULTS: The serum N/L ratios of active patients were significantly higher than those of inactive UC and controls (P < 0.001). The optimum N/L ratio cut‐off point for active UC was 2.47. There was no significant difference between inflammation parameters, disease extension, and disease activity. CONCLUSION: Our results demonstrate that N/L ratio is higher in patients with active UC compared with controls and UC patients in remission and a cut‐off value of 2.47 can be used to identify patients with active ulcerative colitis.

To investigate the prevalence of high-risk (HR) and low-risk (LR) human papillomavirus (HPV) in prepuces of boys and men without any HPV related lesions. Between 2009 and 2011, a total collective of 250 boys and men were investigated in this prospective study. The samples were subdivided into 3 groups regarding their age, consisting of 125 (50 %) children (0-10 years), 38 (15.2 %) adolescents (11-20 years) and 87 (34.8 %) adults (> 20 years). In situ hybridization (ISH) was performed to detect HR and LR virus types within the epithelium, followed by microscopic interpretation and determination between episomal and integrative signal pattern. Our results revealed high levels of HPV concentration (HR and LR) in all age groups: HR versus LR positivity was seen in 45.5 versus 35 % (children), 60.6 versus 63.6 % (adolescents) and 58.3 versus 48.6 % (adults). The topmost rate of HR (59.8 %)- and LR (50.6 %)-positive probes was found in the group with high estimated sexual activity (> 14 years). Concerning the high prevalence of male HPV infection even in children, indicating non-sexual transmission pathways, inclusion of boys in the vaccination program seems to be required reducing their burden of HPV related disease.

To compare the outcomes of percutaneous nephrolithotomy (PCNL) in 2 age groups. Fifty-one renal units (RU) of 45 patients were operated between January 2006 and December 2010. In all patients, PCNL was performed by pediatric nephroscope of 17F size through a 20F Amplatz sheath. Patients were examined in 2 groups (Group1: a parts per thousand currency sign5 years, Group 2: > 5 years) and outcomes were compared accordingly. The mean age was 5.95 +/- A 3.63 years and male-to-female ratio was 23/22. The mean stone burden, operative time, and postoperative hospital stay were 4.24 +/- A 2.03 cm(2), 94.30 +/- A 37.28 min, and 5.18 +/- A 2.97 days, respectively. In the postoperative period, 44 renal units (86.2%) were stone-free. Two age groups were similar regarding the postoperative hospital stay, gender distribution, stone location, stone composition, and complication rates. However, stone burden and number of access was less and stone-free rate was higher in younger age group. The stone-free rate in preschool children is at least as good as older children without an increase in complication rates. The older children (> 5 years) have a higher stone burden and need multiple accesses more frequently. The complications are mostly low grade and can be managed conservatively. Our results showed that PCNL in younger children as safe and effective as in the older children and age should not be considered as a limiting factor.

Objective. Urotensin II is a potent vasoactive peptide that has been implicated in the pathophysiology of many diseases. There is no study reporting the role and level of this peptide in recipients of kidney transplant. So we aimed to study the plasma levels of urotensin II in this group of patients. Methods. Plasma urotensin II levels were analyzed in 110 subjects, who were divided into three groups: group 1 (35 kidney transplant recipients), group 2 (36 patients with chronic kidney disease), and group 3 (39 healthy controls). Results. Analysis of logarithmic transformation of urotensin II, i.e. log (urotensin II × 1000) levels, with a one-way analysis of variance yielded a P value of 0.001. Post-hoc analysis showed significantly higher log (urotensin II × 1000) levels in group 1 than groups 2 and 3 (P = 0.001 and 0.017, respectively). One of the important features of the subjects of this group was that they were taking immunosuppressive drugs because of renal transplantation. Conclusions. High urotensin II levels in recipients of kidney transplants could be drug-related (immunosuppressive drugs) and may be of practical importance that may be used to improve the long-term outcome of the patients.

Purpose: To evaluate the efficacy of intraoperative local anesthetic infiltration in combination with intravenous paracetamol infusion on postoperative pain management in patients who underwent percutaneus nephrolithotomy (PCNL). Patients and Methods: Sixty adult patients were randomized into three groups with 20 cases in each: Group SP, 20mL saline was infiltrated through the whole nephrostomy tract intraoperatively and this was followed by intravenous paracetamol (4 x 1 g) infusion postoperatively; group LP, 20mL of 0.25% levobupivacaine infiltration to the nephrostomy tract followed by intravenous paracetamol infusion; Group LS, 20mL of 0.25% levobupivacaine infiltration to the nephrostomy tract followed by intravenous saline infusion. In the postoperative period, the pain status of patients was evaluated at postoperative 6 and 24 hours by using the visual analogue scale (VAS). In patients who did not completely respond, meperidine (1mg/kg intramuscularly) was administered as an additional "rescue'' analgesic. Patient satisfaction from the postoperative analgesia management was assessed by a 5 point scale. Results: There was no statistically significant difference between the three groups regarding the demographic characteristics, surgical complications, and postoperative hospital stay. Our findings revealed that in group LP, the amount and frequency of opioid used and related side effects was lesser, VAS score was lower, time to full mobilization was shorter, and the patient satisfaction score was higher when compared with the other two groups. Conclusion: Levobupivacaine infiltration through the nephrostomy tract in combination with intravenous paracetamol infusion was shown to be safe and efficacious as an analgesia method after PCNL.

soygur, tarkan/0000-0001-7014-1798; Onal, Bulent/0000-0003-0540-2693; Onal, Bulent/0000-0003-0540-2693; Burgu, Berk/0000-0003-1546-1179; Ozden, Ender/0000-0003-3196-4024 WOS: 000293688300097 PubMed: 21784482 Purpose: We evaluated factors affecting complication rates of ureteroscopy for pediatric ureteral calculi. Materials and Methods: We retrospectively evaluated 642 children who underwent ureteroscopy at 16 Turkish centers between 2000 and 2010. Semirigid ureteroscopy was used with various calibers to treat 670 ureteral units in 660 sessions. Complications were evaluated according to the Satava and Clavien classification systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. Results: A total of 367 females and 265 males were studied. Mean +/- SD patient age was 90.2 +/- 51.4 months (range 4 to 204). Mean +/- SD stone size, operative time and postoperative hospital stay were 8.9 +/- 4.7 mm, 45.8 +/- 23.8 minutes and 1.8 +/- 2.8 days, respectively. At a mean +/- SD followup of 13.3 +/- 17.6 months 92.8% of patients were stone-free and efficacy quotient was 90.3%. Complications, which occurred in 8.4% of patients (54 of 642), were intraoperative in 25 (Satava grade I to II in 22), early postoperative in 25 (Clavien grade I to II in 23) and late postoperative in 4 (all grade III). While operative time, age, institutional experience, orifice dilation, stenting and stone burden were statistically significant on univariate analysis, multivariate analysis revealed that operative time was the only statistically significant parameter affecting the complication rate. Conclusions: Semirigid ureteroscopy is effective, with a 90% stone-free rate and efficacy quotient. Most complications are low grade and self-limiting. Our results confirm that prolonged operative time is an independent predictor of complications, and should be considered when choosing and performing the treatment modality.

Vitamin E is one of the most important lipid-soluble antioxidants, and it prevents lipid peroxidation and scavenges free radicals. As oxidative stress takes a role in the pathogenesis of nonalcoholic steatohepatitis (NASH), vitamin E supplementation acts as a promising therapeutic strategy. In a phase 3, multicenter, randomized, placebo-controlled, double-blind clinical trial (PIVENS) by Sanyal et al., vitamin E therapy (800 IU daily for 96 weeks) was associated with a significantly higher rate of improvement in nonalcoholic steatohepatitis, with reductions in both hepatic steatosis and lobular inflammation (2). They also conclude that serum alanine and aspartate aminotransferase levels were reduced with vitamin E treatment. A recent meta-analysis concluded that vitamin E treatment can optimize ALT and AST levels in patients with NASH (3). Another antioxidant, lycopene, which is responsible for the color of tomatoes and some vegetables, has the capacity to protect against diseases that are associated with oxidative stress and inflammation. Lycopene has a beneficial effect on obesity-related hepatic inflammation and carcinogenesis (4,5). Although lycopene studies come from experimental models, it promises future perspectives for human research.

To compare histological and urodynamic outcome of the classical detrusorotomy with and without the aid of intravesical balloon distension. We also describe a new technique with multiple detrusor incisions instead of detrusorotomy.A total of 24 animals were included in the study. Three different techniques of autoaugmentation cystoplasty were applied to surgically reduced bladders of 14 sheep. Five sheep underwent surgical reduction of bladder capacity as control group and five sheep underwent sham operation. In Group DIB (detrusor incision with balloon), standard whole thickness incisions on bladder wall were performed and a silicon balloon was inflated intravesically postoperatively. Group DMB (detrusorotomy with balloon) and Group DM (detrusorotomy) underwent standard detrusorotomy. After measuring capacities and compliances, animals were sacrificed on 90th postoperative day. Bladders were histopathologically evaluated. Expression of vascular endothelial growth factor (VEGF), CD31, and microvessel density (MVD) was noted. Quantification of collagen subtypes was also performed.The mean capacity and compliance for Group DM and control were not significantly different and both were lower than other augmentation groups and sham. In Groups DMB and DM fibrosis was significantly increased. The VEGF expression was lower in Group DIB with respect to other augmentation groups whereas MVD was not significantly different. Measurement of total collagen and collagen subtypes revealed an increase in total collagen of groups DMB and DM when compared to other groups. Quantification of collagen subtypes demonstrated that types I and III were significantly increased in aforementioned groups.Autoaugmentation omentocystoplasty in sheep model does not result in a reliable increase in bladder capacity and compliance. Intravesical balloon inflation makes the achievement more pronounced and significantly increases the bladder capacity and compliance.

Objectives This study was carried out to evaluate the impact of the presence of teratomatous component in orchiectomy specimen on complete response rates to primary chemotherapy in a large series of patients with stage II nonseminomatous germ cell tumors (NSGCT). Materials and methods Chemotherapy was administered to 113 patients with stage II testicular NSGCT. Resection of retroperitoneal residual tumor masses was performed in all patients with partial response to chemotherapy. Patients were categorized into 2 groups according to presence or absence of teratomatous component in the primary orchiectomy specimen. Results Of patients with teratomatous component in the orchiectomy specimen, 32.1% (17/53) had complete response to primary chemotherapy and of those without teratomatous component 55% (33/60) had complete response ( P = 0.022). Stage IIC patients had lower response rate 28.8% (23/80) compared with IIA and IIB patients ( P = 0.0001). Teratomatous elements were found in retroperitoneal mass in 70.6% of patients with teratomatous component in orchiectomy specimens compared to 36.8% of patients without teratomatous component ( P = 0.022). After retroperitoneal surgery and additional treatments, complete response rate increased to 92.4% and 89.5% in patients with and without teratomatous component in primary pathology, respectively, ( P > 0.05). Conclusions Since teratomatous component in orchiectomy specimen is a predictor of teratoma in the residual retroperitoneal mass, it decreases the response rate to primary chemotherapy and increases the need for postchemotherapy retroperitoneal lymph node dissection (RPLND) in metastatic NSGCT patients.

Bu çalışma, 14-17 Eylül 2006 tarihleri arasında Antalya[Türkiye]'da dizinlenen 9. Biennial Meeting of the International Childrens Continence Society'da bildiri olarak sunulmuştur. This study aimed to evaluate the voiding characteristics of primary school children by using questionnaires and non-invasive diagnostic tools. The voiding characteristics of 212 healthy children in two primary schools were evaluated with ultrasound for bladder wall thickness (BWT) in association with the Pediatric Lower Urinary Tract Symptom Score (PLUTSS), familial questionnaire, uroflowmetry (UF) and urinalysis. Most of the children (70%) had achieved urinary and fecal continence between the ages of 18 months and 36 months. Twenty-five per cent of heathy children void fewer than four times or more than seven times per day. Ninety percent of children had a PLUTSS within normal ranges (< 9). Fifteen percent of patients had a uroflowmetric pattern other than bell-shaped. The peak and average flow rates were higher in girls. Enuresis nocturna was detected in 10% of children. None of the children had documented urinary tract infection. The average BWT from posterior wall at full bladder in healthy children was 1.1 mm. The anterior and posterior BWT measurements before and after micturition were found to be thicker in boys. Regarding the UF pattern, in post-voiding measurements in children with abnormal UF pattern, the bladder walls were thicker. Non-invasive tests in non-symptomatic children showed a range of variability, and these deviations should be kept in mind during the evaluation of voiding characteristics of a child. The symptom scoring system, with the high sensitivity and specificity rates it possesses, is one of the promising tools for this purpose.

Objective We report our experience with percutaneous nephrolithotomy (PNL) therapy for staghorn or complex pediatric renal calculi. Patients and methods We retrospectively analyzed the case records of 105 patients younger than 17 years who underwent PNL. The cases included 53 complex calculi analyzed in 51 patients. We defined complex calculi as either staghorn or those with a stone bulk larger than 300 mm2, involving more than one calix, the upper ureter or stone in anomalous kidney. Results Mean age of patients with complex calculi was 9.7 ± 0.7 years and stone burden was 654 ± 92.4 mm2. The median duration of PNL was 90 ± 4.7 (30–220) min. Complete clearance was achieved in 39 patients (73.6%). Of these, 32 (60.4%) required a single tract, while 21 (39.6%) required multiple tracts. With subsequent shock wave lithotripsy and PNL, the clearance rate increased to 86.8%. The average hemoglobin drop was 1.6 ± 0.16 g/dL. Assessing the factors affecting the hemoglobin drop, the number of tracts (P = 0.01) and size of tracts (P = 0.002) were found to be significant. The mean change in serum creatinine concentration between preoperative and postoperative measurements was −0.01 ± 0.02 mg/dL, for both patients with a single tract and those with multiple tracts. Conclusions PNL is safe and effective in the management of staghorn and complex renal calculi in children. Tract dilatation and number of tracts are important factors in reducing blood loss.

OBJECTIVE To determine the structure of the intravesical distal ureteric wall of patients with primary vesico-ureteric reflux (VUR), and to compare the findings with previous reports. MATERIALS AND METHODS Specimens of the distal intravesical ureteric segments were taken surgically from children undergoing ureteric reimplantation surgery for primary VUR. There were 24 distal intravesical ureteric specimens from 15 children (nine female and six male). Ultra-thin sections were cut from the specimens and examined with a transmission electron microscope. RESULTS The appearance of the muscular layers of the specimens of different grades differed markedly. There were intercellular oedematous areas in the muscular layer in specimens from patients with grade 2 and 3 VUR. In specimens from grade 4 VUR there were also intracytoplasmic vacuoles in the smooth muscle cells. The most marked and striking changes were in the specimens from children with grade 5 VUR, in which there were large intercellular oedematous areas and prominent large intracytoplasmic vacuoles. CONCLUSION Refluxing ureters differ from normal ureters in having disorganized smooth muscle fibres and altered smooth muscle cell structure, leading to incompetence of the valve mechanism. Although we cannot confirm that these pathological changes in the smooth muscle layer of the intravesical ureteric wall are caused by VUR we conclude that, with increasing degrees of reflux, the degree of smooth muscle damage increases, and that the rate of spontaneous resolution decreases.

The aim of this study is to compare clinical characteristics, management, complications, in-hospital outcome and mortality of diabetic and nondiabetic patients after the first episode of acute myocardial infarction (MI). This retrospective case-matched study included 60 diabetic and 55 non-diabetic patients. Medical information about patients was retrieved from the hospital recordings. Diabetic patients were older, were more hypertensive and had more coronary artery disease history than nondiabetic patients. The frequency of use of acute reperfusion therapy modalities was not statistically different between the two groups. Diabetes was a significant determinant against the use of beta blockers (OR=0.26; 95% CI 0.06-0.95) but in favor of angiotensin converting enzyme inhibitors (OR=3.3; 95% CI 1.17-9.36), whereas diabetes did not influence the use of other drugs. Diabetic patients had more complications than nondiabetic patients (40.0% and 16.3%, respectively, p=0.005). In-hospital mortality rate for diabetic patients was comparable to nondiabetic patients (16.7% and 10.9%, respectively, p=0.373). Pharmaceutical treatment regimens, particularly beta blockers, are underutilized after acute MI in diabetic patients. More frequent use of these regimens will improve the high complication and mortality rates in diabetic patients as well as in nondiabetic patients.

To evaluate the infectious complications, microorganism distribution and antibacterial treatment in patients who underwent percutaneous nephrolithotomy (PCNL). Three hundred and thirty-eight patients who were 17 years age or older who underwent PCNL between January 2001 and December 2002 have been evaluated retrospectively. Urine cultures obtained before, during and after PCNL and cultures of stone fragments, extracted during PCNL, were analyzed. Eighty-two patients, who have been referred to Section of infectious disease because of postoperative fever (Group 1; 58 males, 24 females, mean age: 45.5 years) and the remainder of patients (Group 2; 169 males, 87 females, mean age: 44.5 years) were compared in regard to infectious complications and microbiological culture results. The evaluation of peroperative urine cultures revealed that patients in Group 1 had more positive urine cultures than the other group. The analysis showed fever developed more frequently in patients with positive stone cultures and also in patients with positive peroperative urine. Overall, during the study period, five of 338 (1.5%) patients developed sepsis and none of them was lost due to sepsis. Comparison of two groups revealed that patients in Group 1 had a larger stone burden, longer operative time and longer postoperative hospital stay than patients in Group 2. Fever and bacteriemia after PCNL are common, through progression to sepsis is rare. Recovery is possible with a high degree of suspicion, early intervention and intensive treatment. The results of cultures taken preoperatively, peroperatively and during the febrile period have great importance for decision of required changes during the treatment.

Celiac disease is a genetic disorder, presenting with malabsorption-related problems because of mucosal damage after ingestion of gluten. The only known effective treatment is a gluten-free diet. Early diagnosis and treatment are essential in preventing complications due to malabsorption. Here we report the case of an elderly patient with a fifteen-year history of diarrhea, diagnosed with celiac disease, who had developed several complications due to malabsorption such as anemia, electrolyte imbalance and osteoporosis. We believe that late diagnosis of celiac disease had played a great role in the development of complications. Moreover, celiac disease poses an increased risk for all types of malignancies. Our patient also had concurrent plasma cell dyscrasia, but did not fulfil the criteria for diagnosis of multiple myeloma.

Matrix metalloproteinases (MMPs) are involved in the regulation of the extracellular matrix (ECM) of the myocardium and thus the pathogenesis of vascular and cardiac hypertrophy. In this study, we investigated contribution of plasma matrix metalloproteinases to development of left ventricular hypertrophy (LVH) and diastolic dysfunction in hypertensive subjects. Hypertensive patients with (n = 27) and without LVH (n = 23) were included. All participants underwent a complete transthoracic echocardiographic examination, including recordings of the mitral annular early, late, systolic and diastolic velocities by Doppler imaging. Plasma concentrations of MMP-3 and MMP-9 were determined by the one-step sandwich enzyme immunoassay method. Plasma MMP-3 and MMP-9 concentrations were significantly higher in patients with LVH than those without LVH (2.4 +/- 1.2 vs 1.5 +/- 0.7 ng/ml, p = 0.006 and 5.2 +/- 2.8 vs 3.3 +/- 1.7 ng/ml, p = 0.003, respectively). MMP-3 and MMP-9 levels were also correlated with left ventricular posterior wall thickness and Doppler indices of diastolic dysfunction. Our findings have suggested that increased MMP levels may contribute to LVH and left ventricular diastolic dysfunction. Therefore, treatment of hypertension with MMP lowering drugs, such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers, may have favorable effects on LVH and left ventricular diastolic dysfunction.

Vasoactive intestinal polypeptide (VIP) contributes to the regulation of coronary vasomotor tone and circulating levels of VIP have been reported to increase during acute myocardial infarction. However, the changes in VIP concentration during exercise-induced ischemia have not been studied yet. Therefore, we sought to determine whether circulating levels of VIP change during treadmill exercise testing and whether they could be used as a marker of exercise-induced myocardial ischemia. Twenty-nine subjects with definitive positive (group-I) and 20 subjects (group-II) with negative results on treadmill exercise testing were included in this study. In order to assess circulating levels of VIP, blood samples were collected in both groups before exercise, at 5 minutes of exercise, at peak exercise, and at 10 minutes in the recovery period. There were no differences between the two groups with respect to the baseline demographics of age, sex, heart rate, or blood pressure. The metabolic equivalents (METs) values, peak heart rate achieved, peak systolic-diastolic blood pressure, and exercise duration did not differ between the two groups. No significant differences were found in the circulating levels of VIP at any stage of the exercise between the two groups (10.5 +/- 2.5 versus 11.0 +/- 3.5 pmol/L, P = 0.5, 10.6 +/- 2.3 versus 10.6 +/- 3.3 pmol/L, P = 0.9, 10.9 +/- 3.1 versus 11.5 +/- 3.4 pmol/L, P = 0.5, and 10.7 +/- 1.8 versus 11.7 +/- 4.1 pmol/L, P = 0.3, respectively). There was no relationship between the circulating level of VIP and exercise-induced myocardial ischemia, and therefore it could not be used as a marker of exercise-induced myocardial ischemia.

Background Expression of matrix metalloproteinase (MMP) has been shown in aortic dissection and aneurysms indicating increased proteolysis compared with the normal aorta. However, its role in the development of aortic root dilatation has not been studied. We therefore attempted to determine the relationship between aortic root diameter and MMP-9 concentration in a hypertensive population. Methods The 53 hypertensive patients with (n = 27) and without aortic dilatation (n = 26) were included in the study. All participants underwent a complete transthoracic echocardiographic examination including aortic root measurement. Plasma concentration of MMP-9 were determined by the one-step sandwich enzyme immunoassay method and compared in both groups. Results Baseline demographic properties were similar in both groups. No subject had significant valvular disorder and wall motion abnormality on echocardiographic evaluation. On echocardiographic examination only five patients had bicuspid aortic valve. In patients with aortic root dilatation, 21 patients were using an antihypertensive agent, whereas in patients without aortic root dilatation, 19 patients were using an antihypertensive agent. Plasma MMP-9 level was significantly higher in patients with aortic root dilatation than in those without dilatation (2.5 ± 1.0 v 1.6 ± 0.9 ng/mL; P = .003). On correlation analysis, we found a positive correlation between aortic diameter and plasma MMM-9 levels (r = 0.43, P = .001). Conclusions Aortic root dilatation is associated with higher MMP release, which may indicate the role of increased collagenolytic and elastolytic activities in hypertension-induced aortic root dilatation.

In this study we assessed the relative yield of 10 core biopsy, and the whole range of alternative 8 and 6 core biopsy protocols over that of the classic sextant biopsy protocol. We determined the optimum number of cores per biopsy according to prostate volume in patients who experienced prostate biopsy for the first time.A total of 503 men with the indications of abnormal digital rectal examination and/or serum prostate specific antigen greater than 2.5 ng/ml were included in the study. All patients underwent a 10 core biopsy protocol with an additional 1 core from each suspicious area detected by transrectal ultrasound. Prostate volume was divided into quartiles, namely 14.9 to 35, 35.1 to 50, 50.1 to 65 and 65.1 to 150 cc. The optimum number of biopsy cores was determined in patients with different prostate volumes.Median age was 63 years and prostate specific antigen was 7.4 ng/ml in the whole group. Of 503 patients 159 (31.6%) were positive for prostate cancer. Cancer detection rates decreased significantly from 49.6% to 20.8% as prostate volume increased in preset quartiles. Lesion biopsies revealed the lowest unique cancer detection rates for all prostate volume quartiles (0% to 3%). There was an obvious positive trend in cancer detection rates in favor of the 10 core biopsy protocol over sextant biopsies in all patient groups. Classic sextant biopsy protocol proved to be inadequate for all prostate volumes. Among sextant biopsy protocols laterally placed cores including the apex, lateral mid gland and lateral base had the best cancer detection rates (81% to 95%). The 8 core biopsy scheme consisting of the apex, mid gland, lateral mid gland and lateral base resulted in an only 1% lower detection rate (97%) than the 10 core biopsy protocol in the lowest quartile. The yield of the 10 core biopsy protocol in patients with a prostate volume of between 35.1 and 150 cc outscored that of the optimal 8 core biopsy scheme including the apex, base, lateral mid gland and lateral base with 3% to 8% differences in the cancer detection rate.The 10 core biopsy protocol must be used in all group of patients except patients with a prostate volume of 14.9 to 35 cc. In patients with a prostate volume of 14.9 to 35 cc the 8 core biopsy protocol consisting of the apex, mid gland, lateral mid gland and lateral base can be used since it revealed results similar to those of the 10 core biopsy protocol. The classic sextant biopsy protocol seemed inadequate for all prostate volumes. Patients with a larger prostate had lower cancer detection rates. Transrectal ultrasound directed lesion biopsies may be omitted when using 10 core biopsy protocols since the yield of these biopsies was less than 2%.

Objective: Our aim was to compare the tissue yield of two different prostate biopsy instruments: the newer end-cut versus standard side-notch technique. Methods: A total of 87 patients, who underwent transrectal ultrasound guided prostate biopsy were included in the study between February 2003 and July 2003. Twenty-five patients underwent prostate biopsy with the end-cut technique with a stroke length of 33mm (EC-33), 25 patients were biopsied with a stroke length of 23mm of the same instrument (EC-23) whereas the remaining 37 patients underwent biopsy with an instrument working with side-notch technique with a 22mm stroke length (SN). The length, weight and weight/length ratio (WLR) were measured for each biopsy core. The pathologic specimens were evaluated qualitatively. The length, weight and WLR as well as the complication rates, pain, zero biopsy rates, pathologic quality and cancer detection rates were compared between the groups. Results: Three groups were similar according to age, PSA values (free, total, free/total), prostate volumes (TZ, total) and PSA densities. The cancer detection rate was not statistically different between groups and was overall 20,9%. As the groups were compared according to mean core lengths, weights and densities the sequence was found to be EC-33>EC-23>SN. The EC group had higher prostatic glandular capture rates and better pathological quality. However, the zero biopsy rates were 12%, 7% and 1% for EC-33, EC-23 and SN groups, respectively and the difference was statistically significant. The complication rates after biopsy were similar for each group. The mean visual analogous scale scores were not significantly different between the groups. Another interesting finding was that cores containing cancer were heavier and denser than the others regardless of the instrument type. Conclusion: The use of the presented new instrument, enables to obtain longer, heavier and denser cores with a higher pathologic quality and glandular coverage without increasing the number of biopsies and morbidity. However, the relatively high zero biopsy rate is a handicap that needs to be improved.

OBJECTIVE To review our experience with rigid ureteroscopy and holmium:YAG laser for treating ureteric calculi in children. PATIENTS AND METHODS The study included 35 children who were treated with rigid ureteroscopy for ureteric calculi between November 1997 and June 2003 (15 boys and 20 girls; mean age 6.2 years, range 1–14). The mean (range) stone size was 8 (4–15) mm and the duration of anaesthesia 46.6 (15–90) min. The stone was in the distal third of the ureter in 33 children and in the proximal third in two. We used a 7.5/8/10 F rigid ureteroscopes with routine dilatation of the ureteric orifice. For lower ureteric stones, lithotripsy was carried out with holmium:YAG laser in 29 cases, a pneumatic impactor in two and forceps extraction in two. Both stones in the proximal ureter were pushed back into the collecting system. All the ureters were stented using JJ stents in 31 and ureteric catheters in four cases. The mean postoperative follow-up was 12 (2–30) months. RESULTS Excluding the two stones pushed back, the stone-free rate after a one-stage procedure was 82% (27/33). With repeated procedures in the six (ESWL in two) remaining cases the success rate was 97% (32/33). The ureter was perforated in two patients within the first five in the series. There was no pyelonephritis or gross haematuria after surgery. CONCLUSION Ureteroscopy and lithotripsy using the holmium:YAG laser is effective and safe for treating ureteric stones in children, in experienced hands. The results would be even better using smaller and flexible ureteroscopes.

Ureteritis cystica (UC) is a benign condition. Although it can often be diagnosed with imaging techniques, we report a case of a child for whom we planned nephrectomy and ureteral augmentation cystoplasty, but abandoned the cystoplasty due to extensive UC in the ureter.

Signet ring cell carcinoma is a subtype of adenocarcinoma and mainly originated from stomach. Terminal ileum involvement is uncommon and only 2 cases have been reported in the literature. We represent a case of signet ring cell carcinoma of the terminal ileum showing gross features mimicking Crohn’s disease in a patient with ankylosing spondylitis.

Echinococcosis is the most widespread, serious human cestode infection in the world. Isolated retrovesical cyst hydatid is extremely rare in children and mostly causes symptoms because of its pressure on adjacent organs. We report on the case of an 8-year-old girl with an isolated retrovesical cyst hydatid. Final diagnosis was established after histological examination, whereas imaging techniques failed to establish the diagnosis.

Dear Sir: We read the article speculating that a high-fat diet is associated with endotoxemia originating from the gut which is recently published in GASTROENTEROLOGY by Pendyala et al.1 They also proposed that the Western-style diet could contribute to endotoxemia by causing changes in gastrointestinal barrier function or the composition of enteric flora. We offer the following comments. The Western-style diet is characterized by consumption of high amounts of saturated fatty acids and simple sugars, especially fructose. Consumption of fructosesweetened products has grown 5-fold in the last century and doubled in the last 3 decades.2 Fructose ingestion is ssociated with intestinal bacterial dysbiosis and inreased gut permeability.3 Endotoxins, which are found in he outer cell membrane of gram-negative bacteria, can be bsorbed from gastrointestinal tract into the blood circuation via translocation.4 The proinflammatory action of igh fructose consumption owing to increased intestinal ranslocation of endotoxins was shown in an experimenal study.5 Dysbiosis of the intestinal flora may lead to gastrointestinal barrier impairment. Thus, the high fructose content of the Western-style diet may also be responsible for endotoxemia originating from the gut, along with its high fat content.

Purpose We have made a comparative evaluation of PLUTSS, voiding diary and information received from other tools used in the diagnosis and follow-up of LUTS in children. Our main objective was to evaluate the correlation between PLUTS and other tools; and to see if PLUTSS could substitute voiding diary. Material and Methods A total of 40 patients (M:9,F:31) with a mean age of 6.9 years were evaluated for LUTS between December 2005 and September 2006. We performed; a detailed questionnaire for the socio-demographic features, urinalysis and culture, uroflowmetry, post-void residual urine (PVR), PLUTSS and 2 days voding diary in all. The patients with febrile infection have undergone further investigation for reflux. After a standard treatment including urotherapy and anticholinergics the evaluation above was repeated. Results Parameters on family structure, number of siblings, toilet education, pregnancy and infancy period, school success and personality had no relation with diagnosis and prognosis of LUTS. Voiding dysfunction was with UTI in 45%, VUR in 17.5%, incontinence in % 85 and constipation in 30% at presentation. Despite poor compatibility of PLUTS and voiding diary in general, there was a good correlation between them in defining the frequency of daytime incontinence, and moderate correlation for incontinence severity and number of daily voiding. Conclusions PLUTS and voiding diary are incompatible and can not substitute each other as anticipated. PLUTSS was the only tool which could predict the therapy responses. Due to the poor consistency of PLUTSS and voiding diary and their particular distinct advantages, both should be used in the diagnosis and follow-up of voiding dysfunction.

Purpose Urokinase is synthesized by various cells such as renal, pneumocytes, and phagocytes. It cleaves plasminogen to plasmin and hence stimulates fibrinolysis. Urokinase breaks down the matrix protein within the stone thus prevents stone formation and growth. Urokinase concentrations were found lower and urokinase gene 3’-UTR T/C polymorphism was higher in recurrent stone patients. Our aim was to investigate the role of urokinase gene 3’-UTR T/C polymorphism in childhood recurrent stone disease. Material and methods A control group of 40 healthy children having no history of stone formation (group 1) (mean age 10,5 ± 4,2), 40 children (mean age 10,5 ± 4,33) who were first time stone formers (group 2) and 40 patients (mean age 11,2 ± 3,8) with recurrent stone disease (group3) were included into the study. Groups were compared in respect to age, sex and urokinase gene 3’-UTR T/C polymorphism. Polimerase chain reaction based restriction analysis was used to identify C/T polymorphism of the urokinase gene. Results No significant difference was observed between the 3 groups in respect to age and sex. While urokinase gene 3’-UTR T/C gene polymorphism was observed in 4 patients (10%) from group 3. In group 1 and 2 there was no patient with T/C polymorphism. Conclusions Urokinase 3’-UTR T/C gene polymorphism seems to appear more commonly in children with recurrent stone disease than healthy and first time stone formers. These results suggests that the urokinase gene might play a role in childhood recurrent stone disease.

Purpose To report our evolving experience with ureterorenoscopy in the treatment of pediatric ureteric stones. Material and methods Between 1997-2006, 60 ureteroscopic interventions were performed in 54 children (28 male, 26 female) aged 12 months to 14 years (mean 5.3 years). We used rigid ureterorenoscopes (7.5/8/10 F) for all and Ho:YAG laser in 51, pneumatic lithotripsy in 3 and forceps extractor in 4 procedures. Two of 4 proximal ureteric stones were pushed back and treated with ESWL, and 2 were grasped with Nitinol basket at renal pelvis and fragmented using Ho:YAG energy. The mean stone size was 7.8 mm (4-20 mm) and follow up was between 1 to 38 months (mean 14 months). Results The overall stone free rate after a single session of ureterorenoscopy was 88%. All but one patient were stone free following an auxiliary procedure with a final success rate of 98%. Ureteric perforation was noted in 4 patients and 2 were treated conservatively while two had undergone an open surgery. A JJ stent or ureteric catheter was left in place routinely; we still like to use stenting even in uncomplicated procedures. Routine dilatation using balloon or dilators for the distal 4 cm up to 10 F has evolved to water dilatation using Perez-Castro irrigation pump in last 2 years.Use of Nitinol baskets replaced the grasping forceps. The average operative time is markedly shortened. Conclusions Ureteroscopy and lithotripsy using Ho:YAG laser is an effective and safe method for the treatment of ureteric stones seen in children. With increasing experience more proximal and bigger size stones can easily be treated with less complications. In our practice URS is the first line treatment for almost all ureteric stones.