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The aim of this study was to investigate whether vitamin B12 levels are associated with premature ejaculation ( PE). A total of 109 subjects (56 PE and 53 controls) were included in this study. PE was defined as self-reported intravaginal ejaculatory latency time ( IELT) based on the Diagnostic and Statistical Manual of Mental Disorders IV criteria and those who had had an IELT of <2 min was considered as PE. All participants were evaluated using premature ejaculation diagnostic tool ( PEDT), International Index of Erectile Function ( IIEF) and Beck Depression Inventory ( BDI). The vitamin 12 levels were measured in all subjects. The mean age between the PE and controls was comparable ( p = .084). Mean IIEF and BDI scores between the two groups did not statistically differ. The mean IELT values in the PE group were significantly lower than in the control group ( p < .0001). PE patients reported significantly lower vitamin B12 levels compared with the controls (213.14 vs. 265.89 ng ml−1; p < .001). The ROC analysis showed a significant correlation between the diagnosis of PE and lower vitamin B12 levels. This study has demonstrated that lower vitamin B12 levels are associated with the presence of PE. This work also shows a strong correlation between vitamin B12 levels and the PEDT scores as well as the IELT values. [ABSTRACT FROM AUTHOR]

Priapism is a rare but severe urological emergency of erection of penis in the absence of physical and psychological sexual stimulation. Priapism is often idiopathic and is commonly associated with medications and underlying medical or traumatic causes. In this report, we present a case of a 70-year-old White Caucasian man who developed priapism after the administration of ondansetron, which is a selective serotonin type-3 (5- HT3) receptor antagonist. This case is unique, because, to date, there are only two presented cases in literature. The objective of this case report is to highlight the importance of recognising the possibility of priapism with ondansetron because this condition is not commonly seen in clinical practice to be associated with ondansetron and may go unrecognised. Also, potential pathophysiological mechanisms involved in the development of ondansetron-induced priapism are presented. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the effects of not measuring gastric residual volume (GRV) in intensive care patients on a mechanical ventilator and receiving enteral feeding on the feeding intolerance, gastroesophageal reflux (GER) risk, and nutritional adequacy., Methods: This randomized clinical study was performed in 2 medical intensive care units of 2 university hospitals in Ankara, Turkey. The patients were randomized into 2 groups. In the group with GRV monitoring, GRV was measured 3 times a day, and the GRV threshold was accepted as 250 mL. In addition, 24-hour pH monitoring was used in this group to assess the risk of GER. In the group without GRV monitoring, GRV was not measured. The patients were followed-up for 5 days., Results: The feeding targets were reached more quickly in the group without GRV monitoring (n = 26) with no increase in the complication rate (P < .05). No significant relationship was found between GRV and GER in the group with GRV monitoring (n = 25) (P > .05)., Conclusion: The discrepancies in GRV measurement make it unreliable for monitoring feeding intolerance and GER. The use of GRV measurements may therefore be discontinued as part of the standard care protocol in medical intensive care units., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Familial Mediterranean fever (FMF) is an auto-inflammatory disorder characterized by febrile attacks. Increased acute-phase reactants are characteristic during febrile attacks. Ghrelin is a natural G-protein that decreases secretion of pro-inflammatory cytokines and acts as anti-inflammatory agent. The aim of this study was to investigate whether there is any change in ghrelin levels and whether increases in ghrelin levels can be used as a marker in these patients., Subjects and Methods: Thirty-seven male patients and 30 healthy men as a control group were included in the study. Blood samples were obtained for ghrelin measurements both before the attacks (pre-attack period; ghrelin 1 group) and during the attacks (ghrelin 2 group). Samples were kept at -80°C until the analysis was conducted and plasma ghrelin levels were measured using an immune-sorbent assay method., Results: Mean ghrelin levels measured during the attacks were significantly higher (11.01 ± 4.78 pg/ml) as compared to pre-attack levels (5.78 ± 2.17 pg/ml; p < 0.001). Similarly, mean ghrelin levels measured in FMF patients during an attack were significantly different from that of the control group (6.57 ± 4.13 pg/ml; p < 0.001)., Conclusions: In this study, high ghrelin levels were measured during attacks in FMF patients. This finding is in line with previous results regarding the fact that inflammatory response arising during an FMF attack is an acute inflammatory event. Our findings suggest that ghrelin levels measured during FMF attacks could be used as a biochemical indicator for the FMF attack in FMF patients and that it could be used for support of the diagnosis of the disease.

Background: Sequential treatment for Helicobacter pylori (H. pylori) appears to achieve a better eradication rate than triple therapy. However, most of the data have been reported from the Italy, and studies from different population are needed before it is recommended in clinical practice. The present study aimed to assess and compare the efficacy of two separate clarithromycin including sequential regimens in Turkey which is well known with high clarithromycin and metronidazole resistance to H. pylori., Methods: Consecutive H. pylori -positive patients with non-ulcer dyspepsia were randomly allocated to one of the two sequential regimens; the first group was given lansoprazole 30 mg b.i.d. plus amoxicillin 1 g b.i.d. for the first week, followed by lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., and metronidazole 500 mg t.i.d. for the second week (LA-CM). The second arm was given the same regimen but tetracycline500 g q.i.d. instead of metronidazole (LA-CT). H. pylori was detected with urea breath test (UBT) and histology before enrollment. UBT was repeated at 6th weeks after treatment., Results: A total of 200 patients were enrolled in groups and 179 of them completed their protocols. The cumulative per protocol ("PP") and intention-to-treat ("ITT") eradication rates were 74.3% and 66.5% in all patients, respectively. Both "PP" (78.2% vs 70.1%) and "ITT" (72% vs 61%) eradication rates were better in LA-CT group than LA-CM group, but the differences were not statistically significant (p > .05). Both regimens were well tolerated, and the incidence of adverse effects was comparable., Conclusion: Two weeks clarithromycin including sequential regimens with metronidazole or tetracycline were not achieved acceptable eradication rates in Turkey., (© 2012 Blackwell Publishing Ltd.)

Aim: To evaluate the possible relationship between varicocele and chronic constipation., Methods: Between April 2009 and May 2010, a total of 135 patients with varicocele or constipation and 120 healthy controls were evaluated. Patients were divided into two groups. In both groups detailed medical history was taken and all patients were examined physically by the same urologist and gastroenterologist. All of them were evaluated by color Doppler ultrasonography. All patients with constipation, except for the healthy controls of the second group, underwent a colonoscopy to identify the etiology of the constipation. In the first group, we determined the rate of chronic constipation in patients with varicocele and in the second group, the rate of varicocele in patients with chronic constipation. In both groups, the rate of the disease was compared with age-matched healthy controls. In the second group, the results of colonoscopies in the patients with chronic constipations were also evaluated., Results: In the first group, mean age of the study and control groups were 22.9 ± 4.47 and 21.8 ± 7.21 years, respectively (P < 0.05). In the second group, mean age of the study and control groups were 52.8 ± 33.3 and 51.7 ± 54.3 years, respectively (P < 0.05). In the first group, chronic constipation was observed in 8 of the 69 patients with varicocele (11.6%) and 3 out of 60 in healthy controls (5%), respectively. In this regard, there was no statistical significance between varicocele patients and the healthy control (P = 0.37). In the second group, varicocele was observed in 16 of the 66 patients with chronic constipation (24.24%) and 12 out of 60 in healthy controls (20%) respectively. Similarly, there was no statistical significance between chronic constipation and healthy controls (P = 0.72). Internal/external hemorrhoids were detected in 4 of the 16 patients with chronic constipation and varicocele, in the second group. In the remaining 50 patients with chronic constipation 9 had internal/external hemorrhoids. In this regard, there was no statistical significance between chronic constipation and healthy controls (P = 0.80)., Conclusion: Chronic constipation may not be a major predictive factor for the development of varicocele, but it may be a facilitator factor for varicocele.

Objective: The pineal hormone melatonin plays a crucial role in immunomodulation, mainly by effecting T cells. The aims of the present study were to compare the melatonin levels in patients with Familial Mediterranean Fever (FMF) and healthy controls and to find out if it associates with interferon(IFN)γ and interleukin(IL)-10., Materials and Methodology: Twenty five patients with FMF and 16 healthy donors were enrolled into the study. Melatonin, IFN γ and IL-10 measurements were assayed by using enzyme immunoassay (EIA) method., Results: Serum melatonin levels at 03.30 am in both patients during attack-free phase and healthy controls were significantly higher than those levels of corresponding groups measured at 10.00 am. The melatonin levels at 03.30 and 10.00 am in patients during attack-free phase were higher than those levels measured in healthy controls at the same time points. IFNγ and IL-10 did not show any day and night rhythm in both patients and healthy controls. In addition, there was no association among day and night levels of melatonin, IFNγ and IL-10., Conclusions: We conclude that melatonin may play a role in FMF pathogenesis. However, its modulatory effect on immune response most likely does not depend on T cells. Further comprehensive studies should be performed in order to reveal the role of melatonin in the pathogenesis of this disease.

Background: Non-alcoholic fatty liver disease (NAFLD) is linked to an increased risk of cardiovascular disease. Mean platelet volume (MPV), a determinant of platelet activation, is an emerging risk factor for atherothrombosis., Aims: The aim of this study was to investigate the levels of MPV in subjects with NAFLD having no confounding factors for atherosclerosis such as obesity, diabetes mellitus, and hypertension. In addition, the possible relationship between MPV and carotid artery intima media thickness (CIMT), a well known marker of subclinical atherosclerosis, was also studied., Methods: MPV and CIMT levels were measured in 60 biopsy-proven NAFLD subjects and 54 healthy controls. Age and sex were similar between two groups., Results: Body mass index and waist circumference levels were higher in the NAFLD group when compared to the controls. There were no differences between the two groups regarding LDL cholesterol levels, whereas HDL cholesterol levels were lower in the NAFLD group. MPV and CIMT levels were not different between the two groups. According to the correlation analyses, CIMT levels were positively correlated to age in patients with NAFLD. However, no significant correlation was found between MPV and CIMT levels., Conclusions: The results of this study do not show any difference in MPV levels between subjects with NAFLD and controls. These finding suggests that in the absence of other metabolic risk factors, MPV might not be involved in the mechanism(s) of increased cardiovascular risk in NAFLD.

Background and Aims: Non-alcoholic fatty liver disease (NAFLD) is strongly associated with obesity and diabetes mellitus. IL-18 is associated with obesity and metabolic syndrome. Our aim was to investigate the relationship of IL-18 with adiponectin and liver histology in subjects with NAFLD who had no additional disorder such as morbid obesity, diabetes mellitus and hypertension., Methods: Plasma levels of IL-18 and adiponectin were measured by ELISA in 96 male subjects with NAFLD [n = 65 for non-alcoholic steatohepatitis (NASH) and n = 31 for simple steatosis (SS)]., Results: IL-18 levels were not different between the two groups (p = 0.89). There was no significant association of IL-18 with adiponectin, insulin resistance and histopathological findings. Adiponectin was lower in the NASH group compared to the SS group (p = 0.02) and it was found to be negatively correlated with hepatic steatosis and fibrosis (r = -0.442, p < 0.001 and r = -0.292, p = 0.02, respectively)., Conclusions: This study indicates that circulating IL-18 levels are not altered in male subjects with NAFLD. These results suggest that in the absence of metabolic risk factors, IL-18 per se may not be involved in the pathogenesis of NASH and SS.

Background: Although Helicobacter pylori (H. pylori) has been identified in heterotopic gastric mucosa of Meckel's diverticulum, controversial results are reported in the pertinent literature., Aims: The aim of this study was to evaluate for the presence of H. pylori histologically using hematoxylin-eosin and Toluidine Blue in Meckel's diverticulum and by real-time TaqMan polymerase chain reaction (PCR) in those with heterotopic gastric mucosa., Methods: The study included 21 consecutive patients who had undergone resection of Meckel's diverticulum at our hospital between 1995 and 2007. The paraffin-embedded tissues were retrieved and reviewed for the presence of histological abnormalities and H. pylori-like organisms and for the presence or absence of heterotopic mucosa. H. pylori was sought in those cases that contained heterotopic gastric mucosa using real-time TaqMan PCR to amplify a fragment of the 23S ribosomal RNA (rRNA) gene of H. pylori., Results: Upon histological examination, heterotopic gastric mucosa was found to be present in 12 cases. H. pylori was not identified in any of the sections examined. A genomic PCR product was also not obtained in real-time PCR study., Conclusions: We have confirmed that colonization of H. pylori, if it occurs at all, is exceedingly rare in heterotopic gastric mucosa of Meckel's diverticulum.

Background/aims: Because of the increasing resistance to clarithromycin and metronidazole, the most frequently used antibiotics in the first-line therapy of Helicobacter pylori eradication, new therapeutic alternatives are needed. The aim of this study was to compare the efficacy of 7- and 14-day triple therapy including lansoprazole, levofloxacin and amoxicillin for Helicobacter pylori eradication as a first-line therapy., Methods: Ninety-one non-ulcer dyspeptic patients infected with Helicobacter pylori as diagnosed by both histology and a rapid urease test were included in this study. Patients were randomized to receive either 7- (Group 1; 51 patients) or 14-day (Group 2; 40 patients) therapy with lansoprazole (30 mg b.i.d.), plus levofloxacin (500 mg o.i.d.) and amoxicillin (1000 mg b.i.d.) and they were followed for six weeks. Eradication was assessed by 14C-urea breath test four weeks after completing the treatment protocols., Results: In Group 1, 41 patients completed the treatment and the eradication rate was 34.15%. In group 2, 36 patients completed the treatment and the eradication rate was 72.2% (p= 0.001 vs group 1)., Conclusions: Triple therapy with lansoprazole, levofloxacin and amoxicillin for 14 days was effective for Helicobacter pylori eradication, but 7-day therapy with the same protocol had a lower and unacceptable cure rate and should not be used.

The patient had a two month history of gastrointestinal symptoms. Upper gastrointestinal endoscopy disclosed 5 mm nodular lesions were seen in the prepyloric area. On pathological examination, two granulomatous lesions were detected in biopsy specimen. Ehrlich Ziehl-Neelsen staining and cultures of the biopsy material were negative, but polymerase chain reaction (PCR) for Mycobacterium tuberculosis complex DNA was positive. Clinical diagnosis of primary gastric tuberculosis (PGTb) was supported by positive PCR assay and histopathological findings. After antituberculosis treatment, nodular lesions were not detected. The diagnosis of PGTb was confirmed definitively by the success of treatment and repeated endoscopic examination.

Background and Aim: The association of hyperbilirubinemia in Gilbert's syndrome (GS) with a decrease in prevalence of coronary artery disease is a well-known phenomenon. In this study, the state of low-density lipoprotein (LDL) oxidation which has been postulated to be a significant determinant at the etiopathogenesis of atherosclerotic disorders was investigated among individuals with GS., Methods: For this purpose, serum cholesterol, LDL cholesterol, high-density lipoprotein cholesterol, triglycerides, uric acid, apolipoprotein A and B, bilirubins, thiobarbituric acid-reactive substances, and the sensitivity of LDL oxidation levels, as well as serum alanine aminotransferase, aspartate aminotranserfase, gamma glutamyl transferase, and alkaline phosphatase activities, were determined in 17 patients with Gilbert's syndrome and 15 healthy adults., Results: There was no significant difference between the groups except the indirect bilirubin parameter (P < 0.001). In comparison with the healthy individuals, LDL oxidation levels between 75 and 120 min were significantly lower (P < 0.005) along with prolonged lag-phase in GS patients, indicating a delay in oxidation susceptibility., Conclusion: It is suggested that the chronic hyperbilirubinemia leading to a lag-phase prolongation in LDL oxidation and a decrease in LDL oxidation may be reason for the low percentage of coronary artery disease.

Background: Acute pancreatitis is the major complication of endoscopic retrograde cholangiopancreatography (ERCP) procedure and there are some reports showing cytokine changes in ERCP-induced pancreatits., Goals: To investigate the association between early changes (within 24 hours) in the serum interleukin (IL)-2, IL-4, tumor necrosis factor (TNF)alpha, and IL-6 levels and the development of post-ERCP pancreatitis., Study: Forty five consecutive patients who underwent therapeutic ERCP and 10 patients with acute pancreatitis without ERCP were enrolled to the study. Serum concentrations of IL-2, IL-4, TNFalpha, and IL-6 were determined immediately before, 12 hours and 24 hours after ERCP., Results: Seven of the 45 patients (15.5%) developed post-ERCP pancreatitis. The levels of IL-4 at 24 hours after ERCP were significantly lower in the patients with post-ERCP pancreatitis than in those without pancreatitis, while TNFalpha levels at 12 hours after ERCP were higher in the complicated group than those of the uncomplicated group. The ratios of TNFalpha/IL-4 at 12 and 24 hours after ERCP were found significantly higher in the patients with post-ERCP pancreatitis than in those without pancreatitis. IL-6 in the complicated patients was found significantly increased at 24 hours after ERCP., Conclusions: The enhancement of serum TNFalpha and IL-6 levels in the patients with ERCP-induced pancreatitis reflects the inflammatory activity. Additionally, these cytokines together with IL-4 can be used in clinical laboratory monitoring of ERCP.

A 55-year-old hemiplegic woman with percutaneous endoscopic gastrostomy (PEG) was referred to our clinic for upper gastrointestinal system bleeding and for a high level of cholestatic enzymes. She had a medical history of cerebra vascular accident three years previously and cholecystectomy one year previously. We performed gastroscopy and saw a retained surgical sponge in the bulbus. After removal of the gossypiboma, endoscopic sclerotherapy was performed for the bleeding area at the bulbus. After the procedure, the upper gastrointestinal bleeding stopped and the high level of cholestatic enzymes returned to normal.

Purpose: The aim of the present randomized study was to evaluate the efficacy of lidocaine gel compared with dimethylsulfoxide (DMSO) with lidocaine for transrectal ultrasonography (TRUS)-guided prostate biopsy in patients with anorectal pathologies., Patients and Methods: Sixty-two patients were randomly divided into two equal groups. Group 1 was given 10 mL of 2% lidocaine gel intrarectally 10 minutes before the biopsy. Group 2 was given 10 mL of intrarectal 40% DMSO with an amount of lidocaine equal to that in the lidocaine gel 10 minutes before the procedure. The degree of pain was rated by patients using a 10-point visual analog scale., Results: The pain scores for probe insertion were significantly lower for group 2 (3.15 +/- 1.41) than for group 1 (4.58 +/- 160) (P = 0.01). No significant differences were found between the pain scores of the two groups for biopsy-needle insertion (P = 0.62)., Conclusions: Dimethylsulfoxide with lidocaine instilled into the rectum is a simple, safe, rapid-acting, and effective method of anesthesia delivery before TRUS-guided prostate biopsy in patients with anorectal pathologies.

We report a 35-year-old male patient with chronic constipation and infertility for 4 years. Spermiogram revealed severe oligospermia. An external mass compressing the rectum was found during rectal examination and flexible rectosigmoidoscopy. Abdominal computed tomography showed a presacral cystic mass which displaced the bladder anteriorly. The cyst was completely removed with open surgery. Histopathologic analysis revealed a cystic lesion covered with squamous epithelium including polymorphonuclear leukocytes, macrophages and sperm cells. After the operation, the patient's symptoms were relieved. We considered that the constipation was caused by external compression by the vesicula seminalis cyst. In cases of constipation with infertility, vesicula seminalis cyst should be kept in mind.

Circulating leptin shows a pulsatile secretory pattern along with a nocturnal rise. We have previously shown that circulating leptin concentrations are high in males with untreated idiopathic hypogonadotropic hypogonadism (IHH). However, circadian leptin secretion in IHH before and after gonadotropin treatment is not known. Thus, we studied 14 adult males with IHH who had no history of previous hormonal therapy, and 12 age- and body mass index-matched healthy men. Plasma leptin concentrations were measured with 1-h intervals for 24 h before and 6 months after gonadotropin treatment. The 24-h mean leptin concentration showed a significant decrease, from 11.78 +/- 1.908 microg/liter at baseline to 10.85 +/- 1.939 microg/liter after 6 months of therapy (z = 3.107; P = 0.002). Before and after treatment, 24-h mean leptin concentrations were also significantly higher in the patient group when compared with controls (4.275 +/- 0.711 microg/liter) (z = 5.938; P = 0.0001). Hourly leptin levels demonstrated a diurnal pattern in hypogonadal patients, a surge in the midday, and a peak just after midnight, and this pattern did not differ before and after treatment. We observed a similar diurnal pattern in the control subjects too. Leptin levels were negatively and significantly correlated with free testosterone and total testosterone levels both before (r = -0.656, P = 0.011; and r = -0.639, P = 0.014, respectively) and after (r = -0.537, P = 0.048; and r = -0.563, P = 0.036, respectively) gonadotropin administration. Our observations suggest that the diurnal rhythm of leptin is intact in males with IHH, and short-term gonadotropin treatment does not effect its diurnal rhythm. Moreover, testosterone produced under the influence of the gonadotropin treatment led to decreases in the leptin levels.