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Objective: In this study, the economic cost, diagnostic and prognostic laboratory markers of lumbar spondylodiscitis, which emerged as a complication after surgical intervention in the lumbar region, were investigated.Material and Methods: Age and gender of the patients were recorded. Furthermore, surgical intervention type (spinal instrumentation, lumbar discectomy), biopsy results of infected tissue, concomitant morbidities, duration of hospital stay and microorganism growth in culture materials were evaluated in patients. In addition, values of serum C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), leukocyte, neutrophil and lymphocyte count which were obtained from these patients at admission to hospital and at discharge from hospital were recorded. Moreover, treatment costs of these patients were examined.Results: Nine patients (women=7, men=2) with a mean age of 58±14.92 years were included in this study. All parameters of patients were not different in terms of surgical intervention type. However, when the patients were discharged from the hospital, their ESR and neutrophil counts decreased and lymphocyte count increased in all of them. Although CRP level values decreased as numerical value at discharge, this decrease was not statistically significant. Correlation analysis showed that length of hospital stay and tissue biopsy performed to the patients increased the economic cost.Conclusion: It was concluded that any routine laboratory parameter investigated in this study could not be a valid biomarker for diagnosis and follow-up of spondylodiscitis that emerged after surgical intervention. On the other hand, it was concluded that diagnosis and treatment of this disease, whose prevalence is increasing, may have a high economic cost for patients and countries., Amaç: Bu çalışmada lomber bölgeye cerrahi müdahale sonrası komplikasyon olarak ortaya çıkan lomber spondilodiskitte ekonomik maliyet ile tanısal ve prognostik laboratuvar belirteçleri araştırıldı.Gereç ve Yöntemler: Hastaların yaşı ve cinsiyeti kaydedildi. Ayrıca, cerrahi girişim tipi (spinal enstrümantasyon, lomber diskektomi), enfekte olmuş dokunun biyopsi sonuçları, eşlik eden morbiditeler, hastanede kalış süresi ve alınan kültür materyallerinde mikroorganizma üremesi değerlendirildi. Ek olarak, hastaneye yatışta ve hastaneden taburcu edildiğinde bu hastalardan elde edilen serum C-reaktif protein (CRP) seviyesi, eritrosit sedimantasyon hızı (ESH), lökosit, nötrofil ve lenfosit sayıları kaydedildi. Ayrıca, bu hastaların tedavi maliyetleri incelenmiştir.Bulgular: Çalışmaya yaş ortalaması 58 ± 14,92 yıl olan dokuz hasta (kadın=7, erkek=2) dahil edildi. Hastaların tüm parametreleri cerrahi girişim tipi açısından farklı değildi. Ancak, tüm hastalar için, hastaneden taburcu olurken ESH ve nötrofil sayıları azalmış ve lenfosit sayıları artmıştır. CRP düzeyleri taburculuk sırasında sayısal değer olarak düşse de bu düşüş istatistiksel olarak anlamlı değildi. Korelasyon analizi, hastanede kalış süresinin ve hastalara biyopsi yapılmasıyla ekonomik maliyeti artırabileceğini göstermiştir.Sonuç: Bu çalışmada, incelenen herhangi bir rutin laboratuvar parametresinin cerrahi girişim sonrası ortaya çıkan spondilodiskit tanısı ve takibinde geçerli bir biyobelirteç olamayacağı sonucuna varıldı. Öte yandan, prevalansı artmakta olan bu hastalığın tanı ve tedavisinin hastalar ve ülkeler için yüksek bir ekonomik maliyete sahip olabileceği sonucuna varılmıştır.

Insecticides are an example of an environmental contaminant that can cause harmful effects on various types of organisms. Implementation of continuous monitoring program is needed to ensure the level of contamination can be controlled. In this present study, acetylcholinesterase (AChE) from the brain of Monopterus albus was elucidated to determine the potential alternative source of biosensor kit, which is sensitive towards various insecticides, especially carbamates. AChE from M. albus brain was extracted and purified through ammonium sulfate precipitation followed by procainamide-based affinity chromatography. Carbamate insecticides were used, such as bendiocarb, carbaryl, carbofuran, methomyl, and propoxur, to test their ability to inhibit AChE activity. Bendiocarb and methomyl show the capability to inhibit almost half of the enzyme activity at 51.05 and 51.20 %, respectively, while carbaryl, propoxur, and carbofuran inhibit 43.03, 42.80, and 15.06 %, respectively. Bendiocarb and methomyl were selected, and M. albus AChE was separately exposed with different concentrations of those carbamates and half maximal inhibitory concentration; IC50 was determined at 0.874 and 1.639 ppm, respectively. A field trial was conducted by testing the enzyme with various vegetable samples. All samples show no significant effect on AChE activity, meaning there was no existence of insecticides in each sample (p > 0.05). This study could be used as an alternative source for developing biosensor kits for the environmental monitoring program.

In the Qur’an, which has a wealth of meaning, the use of a word in different places with different meanings is defined as “vücûh” and the use of several words with the same meaning is defined as “nezâir”. This knowledge is important in determining the meaning indicated before and after verses. Most especially, there are subtle differences in meaning between synonymous words and words with similar meaning related to nezair science. Although sensitivity was displayed in the early periods, these concepts were generally used interchangeably in later times. These uses prevent the true understanding of the verses and making correct judgements, and can lead to twisted mind, false definitions, misjudge and false practises. In this study, that there are differences in meaning between the concepts such as kebîr, ism, zenb, hatîe, vizr, hûb, hins, seyyie and lemem, which are translated into Turkish as “sin/günah” will be evaluated within the scope of “furûku’l-luğa” in the framework of “nezâir”. These concepts, which directly mean “sin” in the Qur’an, will be mentioned with their semantemes, places they are used, the messages given by them and the meanings. By determining the differences in meaning between the concepts, it will be concluded why they should not be used interchangeably as synonyms or words with close meaning. The reason why different concepts are used in the Qur’an will be understood even though they are synonymous or close to each other in meaning. This study on the concept of “sin” is not the first and last in its field but just a drop in the pocess

Objective: In this report, we determined the efficacy and the toxicity of low dose weekly gemcitabine with radiotherapy, in medically unfit or refused surgery muscle-invasive bladder cancer (BC) patients. Materials and Methods: From 2008 to 2012, 15 patients were included into the retrospective analysis. Weekly gemcitabine was administered at a rate of 50 mg/m 2 with a median dose of 63 Gy radiotherapy. Results: The median age was 69 (range, 55-86). Median follow-up was 15 months (range, 5-53 months). A complete response was achieved in 12 patients (80%). Median progression free survival and overall survival were 15 months (range, 7-23 months) and 18 months (range not calculated), respectively. Local recurrence was found in 3 patients (20%) and distant recurrence was found in 5 patients (33.3%) for the entire group. While salvage surgery was performed on 1 patient, salvage chemotherapy was delivered for 4 patients. Treatment was well tolerated, there was no treatment interruption or instances of toxic death. A serious toxicity (grade 3) cystitis was seen in only 1 patient. Conclusions: Multimodality treatment of muscle invasive BC proved a feasible and effective treatment option. Gemcitabine based chemoradiation is an active treatment option with a low toxicity profile for patients with muscle invasive BC, who are not suitable medically or refused to surgery.

The androgen insensitivity syndrome (AIS) formerly known as testicular feminization is transmitted on a recessive X-linked. Its diagnosis is usually made at puberty if primary amenorrhea is present because the external genitalia are female. We report the case of two sisters aged 30 and 18 years, with testicular feminization syndrome discovered during the exploration of primary amenorrhea. Clinical examination found fairly well developed mammary glands, an hypertrophied clitoris, two formations in the labia majora corresponding to the testicles and agenesia of vagina. The uterus has not been seen on pelvic ultrasound and computed tomography scan of the pelvis. Cytogenetic analysis has objectified the chromosomal formula: 46 XY. We performed a vaginoplasty using peritoneum from the pouch of Douglas, a clitoroplasty and bilateral orchiectomy. The result was excellent. A neovagina with a depth of 6 cm was created. After 6 months of follow-up, the two sisters keep beautiful vaginal cavities with regular digital dilation. Peritoneum vaginoplasty is a simple and easy method for creating a neovagina with minimal complications. Its anatomical and functional results are satisfactory.

The antioxidant activities of rosemary and green tea leaves, aqueous and ethanolic extracts, have been studied by using two different methods (reducing power and chelating ability). It was found that the total phenolic compounds in aqueous and ethanolic extracts of rosemary and green tea leaves were 13.44, 18.75, 39.38 and 48.44 mg/ 100 mg dry extract respectively. The flavonoids (which is a part of the phenolic compounds) were found to be 9.54, 12.65, 17.69 and 22.70 mg/ 100 mg dry extract in aqueous and ethanolic extract of rosemary and green tea leaves respectively. The ethanolic extract shows high content of phenolic compounds and in turn highly antioxidative activiy for both rosemary and green tea leaves as compared with aqueous extract.The aqueous and ethanolic extracts of rosemary and green tea leaves show high reducing power ability comparing with their abilities as chelating agents. Although, the phenolic compounds of green tea leave almost about 3-fold as compared with rosemary leave in both aqueous and ethanolic extracts, their extracts show extremely the same mode of action in both methods of determination (the reducing power and chelating ability). Therefore, we are fully recommended the rosemary leave extracts as a potent food preservative.

Le rhabdomyosarcome est une tumeur mesenchymateuse rare. La localisation paratesticulaire est la plus frequente des localisations urogenitales. C’est une tumeur qui interesse surtout l’enfant et reste exceptionnelle chez l’adulte. Le pronostic est mauvais, et le traitement repose sur le trepied chirurgie, chimiotherapie et radiotherapie. A la lumiere d’une revue de la litterature, nous discutons les modalites diagnostiques et therapeutiques de cette tumeur. Une etude retrospective de neuf cas de rhabdomyosarcome (RMS) paratesticulaire chez l’adulte jeune, colliges a l’Institut national d’oncologie de Rabat entre janvier 1995 et decembre 2007. L’âge moyen de nos patients etait de 24 ans (19 et 32). Le tableau clinique etait domine par une grosse bourse indolore chez six malades. Les marqueurs tumoraux βHCG et αFP etaient normaux chez tous les patients. L’echographie etait en faveur d’une masse tissulaire d’echostructure heterogene refoulant le testicule qui apparaissait d’aspect normal. La tomodensitometrie (TDM) thoracoabdominopelvienne realisee chez tous les patients a revele cinq cas de metastases ganglionnaires (55,5 %), trois cas de metastases pulmonaires (33,3 %) et un seul cas de metastase hepatique. Tous les patients ont beneficie d’une orchidectomie par voie inguinale et d’une chimiotherapie a base de vincristine, d’actinomycine D et de cyclophosphamide. Aucun curage ganglionnaire retroperitoneal n’a ete realise. Deux patients ont eu une radiotherapie sur des masses residuelles retroperitoneales. La duree moyenne de suivi etait de 23 mois (12–102), la survie a trois et a cinq ans etait respectivement de 66 et 22 %. Le RMS paratesticulaire est une tumeur agressive et a croissance rapide. Le diagnostic est histologique. Le traitement repose sur la chirurgie et la chimiotherapie. La place de la lymphadenectomie est controversee. La radiotherapie doit etre indiquee en cas de residu tumoral ou d’atteinte ganglionnaire histologique. Une surveillance adequate a long terme doit etre instauree afin de detecter les recidives qui sont generalement fatales.

Le seminome spermatocytaire est une tumeur rare, representant moins de 2% des cancers du testicule, survenant essentiellement chez le sujet âge. Nous rapportons une nouvelle observation d’un patient âge de 48 ans. La tumeur se presentait comme une proliferation de cellules en nappes compactes, avec 3 types cellulaires, des cellules de petite taille, des cellules intermediaires et des grandes cellules. Il n’a ete retrouve ni contingent sarcomateux, ni seminome classique. L’analyse en immun histochimie n’a retrouve aucune expression des cellules tumorales pour les anticorps classiques testes, notamment l’Ac anti PLAP et les marqueurs lymphoides. Le seminome spermatocytaire doit etre reconnu, car son evolution est tres favorable et ne necessite qu’une simple orchidectomie, en l’absence d’un exceptionnel contingent sarcomateux ou de metastase ou une chimiotherapie s’impose.

Introduction A central white scar-like patch and a delicate pigment network at the periphery are the typical signs of dermatofibromas (DFs) on dermoscopy. Aim The aim was to analyze the different dermoscopic appearances of DF. Patients and methods This study was carried out between June 2018 and June 2019 from the Dermatology Outpatient Clinic at Al Zahraa University Hospital, Al Sayed Galal University Hospital, and El-Hood El-Marsood Hospital, and included 50 cases of DF with 63 lesions of DF. Each lesion was examined by dermoscopy and histopathological examination was performed for suspicious lesions. Results A typical pattern (central white scar-like patch and peripheral pigmented network) was observed in 49 of 63 (77.7%) lesions and variants from this typical pattern included peripheral homogeneous pigmentation and central white network in two (3%) lesions, multiple white patches with peripheral pigmented network in two (3%) lesions, central homogenous pigmentation and peripheral pigmented network in one (1%) lesion, and total pigmented network in one (1%) lesion, whereas an atypical pattern, which was named the ‘nonDF-like’ pattern (1%), was seen in 14 of 63 lesions (22.2%). Atypical DFs showed features resembling different conditions such as melanoma in two (3%) lesions, psoriasis-like pattern in one (1%) lesion, basal cell carcinoma in one (1%) lesion, squamous cell carcinoma in one (1%) lesion, and aneurysmal in one (1%) lesion. Vascular patterns in our study were found in three (5%) lesions, which had a linear and dotted pattern. Conclusion DFs may display different morphological faces. The typical dermoscopic patterns allow a confident diagnosis, whereas a full surgical excision is always recommended in all doubtful cases.

La migration intravésicale du dispositif intra-utérin (DIU) par perforation utérine est une complication rare. Dans cette étude rétrospective monocentrique, nous présentons notre expérience de 5 cas colligés au sein de notre établissement entre 2004 et 2009. L’âge moyen de nos patientes est de 39 ans (32-48 ans). La symptomatologie clinique révélatrice était dominée par le syndrome irritatif vésical. Le diagnostic a été évoqué sur le couple écho/AUSP, puis confirmé par la cystoscopie. Le traitement a consisté en une lithotritie balistique du calcul avec extraction du stérilet par voie endoscopique chez 4 patientes et extraction chirurgicale chez une seule.Mots clés : Calcul vésical, dispositif intra-utérin, lithotritie balistique, migration

Background The purpose of this study is to assess the clinical outcome of patients with ESFT of the bone treated with the European Intergroup Cooperative Ewings Sarcoma Study (EICESS)-92 treatment protocol at a single center, and to identify prognostic factors. Methods Ninety-eight patients younger than 18 years of age, diagnosed with ESFT of the bone between 1992 and 2005, were analyzed retrospectively. Results Eighty-seven patients were treated with the EICESS-92 protocol. The median follow-up was 105 ± 38 months. The 5-year event-free survival (EFS) survival rate was 40%, the 5-year overall survival (OS) rate was 47%. For non-metastatic disease, the rates of 5-year EFS and OS were 45% and 51%. These rates were 18% and 27%, for metastatic disease. The 5-year EFS and OS rates were 17% and 30%, respectively for females. For males, theses rates were 45% and 48%. Of 87 patients, 52 were admitted with primary extremity lesions. Distant metastasis was detected in 48% of patients with a metaphyseal tumor. In patients with diaphyseal lesions, it was 17%. The 5-year EFS and OS were 35% and 43%, respectively. In non-metastatic disease, these measures were 43% and 50%, whereas in metastatic disease, they were 20% and 27%. In patients with a lesion originating from metaphysis, the 5-year EFS was 17%, and the 5-year OS was 29%, for patients with a diaphyseal lesion, these values were 50% and 54%. Conclusion The presence of metastasis was closely related with metaphyseal tumors. The localization of tumor in the bone (i.e., diaphyseal or metaphyseal) and gender of patients seem to have prognostic importance. Pediatr Blood Cancer 2010; 54:19–24. © 2009 Wiley-Liss, Inc.

In this study we aim to discuss the meaning of the concept of “Jahale” (Ignorance) in Koran. In literary meaning, Ignorance (Jahl) mean is oppsite of Know and theJahl’s mean is doing something without as ignorant. But the mean of this concept in Koran is something more. It is a personal situation no thinking about the universe around him and about himself. We find the “Ignorance" concept in Koran 24 times, in different using. Etimologic and semantic meaning is another target of this study. The “Ignorance”, is a period of Pre Islamic time. Because of polytheistic life Islamic sources call this period “Jahale”. We classificated the Koranic statement of “Ignorance" in four categories

Carelessness, is the subject of this article. we cart see this concept in 35 verses. In 11 verse the statement is ‘Allah is not carelessness about his creatures (Universe and Mankind). The second main subject is the Prophet, He is not also carelessness because heh has a big mission (to transmit the holy message to people). Koran shows the fields that the human is are/essness in four categories: 1- Signs of Allah, 2- Death, 3- The Day of Judgement, 4- The carelessness of idols about themselves. Koran gives us the results of carelessness and warn us about them

A 57-year-old male patient presented with an immobile ellipsoid mass of 6-cm diameter in the right occipitoparietal region. Cranial computed tomography showed the mass with dense contrast enhancement causing bone destruction. After embolization of the mass, total resection was performed. Histological examination showed the mass had a capsule, with no invasion of the dura mater or dermis, and the follicles of various sizes covered with mono-lined thyrocytes were full of colloid. Immunohistochemical examination showed positive staining for thyroglobulin. Postoperatively, levels of thyroid hormones were normal, and thyroid ultrasonography and technetium-99m scintigraphy showed no abnormalities. Fine needle aspiration biopsy performed at various locations of the thyroid gland revealed no atypical thyroid cells. Whole body technetium-99m scintigraphy found no abnormal bone involvement. The histological evidence was suggestive of follicular carcinoma metastasis. Surgical treatment was planned for the thyroid gland, but the patient did not consent. Two years later, the patient presented with the pain and sensitivity in the sacrum, the right iliac wing, and the right caput femoris. Computed tomography revealed lytic lesions in these areas. Bone metastases were identified. Whole body scintigraphy showed increased activity in these regions, but the cranium and all other tissues were normal. The patient underwent total thyroidectomy under a diagnosis of follicular carcinoma. The present case of a lytic skull lesion associated with normal thyroid tissue on admission but finally treated as follicular thyroid cancer emphasizes the difficulty in histological discrimination of follicular carcinoma from normal thyroid tissue.

A rare cause of shoulder pain: Ganglion cycts in the spinoglenoid notch Although ganglion cysts are most common soft tissue tumors of foot, hand and wrist, they are rarely seen in shoulder girdle. In this manuscript it is aimed to present a patient who was admitted with shoulder pain due to atypically located ganglion cyct. The symptoms were relieved after excision of lesion.

The goal of this study was to determine the membranous protection of the abducens nerve in the petroclival region. The petroclival portion of the abducens nerve was studied in ten dissections from five cadaveric head specimens. One of the heads was used for histological sections. Four heads were injected with colored latex for microsurgical dissections. The histological sections were prepared from petroclival dura mater, embedded in paraffin blocks, stained, sectioned in the axial, coronal, and sagittal planes, and evaluated by light microscopy. The abducens nerve was covered by a dural sleeve and arachnoidal membrane during its course within the petroclival area. Following the petrous apex, the abducens nerve was fixed by a sympathetic plexus and connective tissue extensions to the lateral wall of the cavernous segment of the internal carotid artery and to the medial wall of Meckel's cave. Fibrous trabeculations inside the venous space were attached to the dural sleeve. The lateral clival artery accompanied the dural sleeve of the abducens nerve and supplied the petroclival dura mater. The arterioles accompanying the abducens nerve through the subarachnoid space supplied the nerve within the dural sleeve. The arachnoid membrane covered the abducens nerve within the dural sleeve to the petrous apex, and arachnoid granulations found on the dural sleeve protruded into the venous space. The extension of the arachnoid membrane to the petrous apex and the presence of arachnoid granulations on the dural sleeve suggest that the subarachnoid space continues in the dural sleeve.

Orbitocranial injuries caused by a wooden foreign body are rarely encountered.We present a 17-year-old boy who sustained an intracerebral injury from a wooden foreign body via the transorbital route. Almost all neuro-ophthalmological signs were present due to penetration of the material into the optic canal and superior orbital fissure.There was a minute laceration on the upper eyelid, whereas the eye bulb was macroscopically intact.The wooden foreign body (6.5cm in length) was removed via the upper eyelid. The diagnostic and therapeutic modalities of intracranial injuries caused by a wooden foreign body through the transorbital route are discussed in this paper.

Background Pericallosal aneurysms are encountered less than 6.7%, and giant aneurysms among them even less. Giant azygos pericallosal artery aneurysm at the callosomarginal bifurcation is extremely rare, and our case presented herein is the second one. The case is discussed with thorough review of the literature. Methods A 65-year-old woman presented with an extremely rare giant aneurysm on the azygos pericallosal artery manifesting as subarachnoid hemorrhage in World Federation of Neurosurgical Societies Grade 3. Computed tomography (CT), magnetic resonance angiography (MRA), and four vessel angiography revealed a giant azygos pericallosal artery aneurysm associated with a second aneurysm at the left M1. Results After recovery to Grade 2, she underwent surgery via the right frontal interhemispheric approach for the azygos artery aneurysm on the 17th day after bleeding. The true dimensions of the aneurysm were greater than indicated by angiography because of partial thrombosis. Trilobulate aneurysm was carefully dissected from the surrounding structures. Postoperative cerebral angiography showed no filling of the clipped aneurysm and preservation of circulation. Conclusion The treatment of distal anterior cerebral artery aneurysms is often difficult, because of their broad-based irregular configurations and adherence to surrounding tissue, tendency to bleed irrespective of size and the coexistence of other cerebral aneurysms. However, excellent outcomes can be obtained based on thorough preoperative radiologic evaluation, including magnetic resonance imaging (MRI), and correct selection of surgical approach.

Resume Les auteurs rapportent une etude retrospective d’une serie de 225 patients presentant une tumeur de vessie infiltrante. Les tumeurs infiltrantes representent 29,2 % des tumeurs de vessie. L’âge moyen de nos patients est de 59 ans avec un sex-ratio de 7,3 pour l’homme. Le bilan radiologique a permis de trouver un retentissement sur le haut appareil dans 60 % des cas. Sur le plan histologique, 80 % des tumeurs sont un carcinome urothelial et 65 % des patients sont classes stade T3 T4. Le traitement chirurgical a pu etre realise chez 73,3 % des cas et 66,7 % des patients ont eu une cystectomie radicale. La derivation urinaire a ete essentiellement une urostomie cutanee continente utilisant l’intestin avec une valve hydraulique. Avec un recul moyen de 28 mois, une recidive locoregionale a ete notee chez 28 % des resections transurethrales realisees seules et 4 % des cystectomies radicales. Une metastase a distance a ete notee chez 18 % des patients et ceci dans un delai moyen de 12 mois.

Primary non-Hodgkin's lymphoma of the adrenal gland is rare. We report the case of a 31-years-old patient hospitalized with asthenia and adrenal insufficiency. The CT scan showed a bilateral adrenal mass. A scano-guided biopsy suspected an endocrinoid tumor. The surgical exploration demonstrated a huge mass invading the retroperitoneal space, and the biopsy concluded to a central follicular phenotype B rmalignant lymphoma with a high rank of malignity. The thoracic CT scan did not show any lymph node. The medullar biopsy eliminated a secondary lymphoma. The patient was treated by chemotherapy and radiotherapy with a good result during 16 months.

The authors report their experience of neurogenic bladder about 73 cases during 16 years. The analysis of the data permits to affirm that the neurogenic bladder remained a rare pathology, that their aetiologies is acquired in 87.6% of the cases with a predominance of spinal cord traumatisms, which explains the predominance of the pathology among the young subject of masculine sex (middle age of 32 years, sex-ratio is 2.5). The clinical signs are represented by urinary incontinence that constitutes the main motive of consultation, followed by obstructive signs and frequent miction associated to urge miction. The explorations put in evidence an important rate of complications because of the diagnostic delay. The therapeutic management aims to assure a most complete draining of the bladder to low pressure, to assure the continence or at least to manage the incontinence while assuring the comfort and the patient's autonomy.

Resume Les auteurs rapportent une serie de 36 cas de phlegmon perinephretique (PPN) colliges sur une periode de 15 ans. Les patients se repartissent en 27 hommes et 9 femmes. L’âge moyen des malades est de 37 ans (25–70 ans). Le diabete (27,8 %), la lithiase urinaire (22,3 %) sont les facteurs favorisant sa survenue. Quatre-vingt pour cent des patients sont vus avec un retard diagnostique de plus de 3 semaines. Les lombalgies, la fievre et la masse du flanc resument la symptomatologie clinique. L’echographie montre des images evocatrices de PPN dans 84 % des cas. La tomodensitometrie a confirme le diagnostic chaque fois qu’on a eu recours a cet examen. Les bacilles Gram negatif et le staphylocoque sont les germes les plus frequemment isoles. Le traitement comporte une antibiotherapie associee a un drainage percutane de la collection chez 6 patients (16,7 %) et un drainage chirurgical chez 30 patients (83,3 %). L’evolution a ete favorable chez tous nos patients.

Resume Les auteurs rapportent leur experience a propos d’une serie de 1050 fistules vesico-vaginales colligees sur une periode de 30 ans. Ils analysent les aspects epidemiologiques, anatomocliniques et therapeutiques. Les patientes ont pu etre classees en fonction du site de la fistule selon la classification de Benchekroun : type I fistule uretro-vaginale (30 %) ; type II fistule cervico-vaginale (22 %) ; type III fistule vesico-vaginale (48 %). L’etiologie est essentiellement obstetricale (93 %). Des lesions associees ont ete notees dans 10,4 % des cas (fistule vesico-uterine, recto-vaginale, uretero-vaginale). Le traitement de la fistule n’a ete entrepris qu’apres un delai de trois mois apres sa survenue. Les fistules type I ont ete traitees par voie basse exclusivement et ont necessite dans 100 cas, une reconstruction uretrale avec 60 % de bons resultats. Quatre-vingt pour cent des fistules type II ont ete traites par voie basse avec 80 % de bons resultats. Les fistules type III ont eu 98 % de bons resultats a la deuxieme cure. Les resultats globaux ont ete bons dans 80 % des cas. Les echecs ont ete essentiellement des fistules complexes uretro-cervico-trigono-vaginales. Ils ont ete traites par une derivation urinaire incontinente (51 Coffey, 5 Bricker) et depuis 1975, 73 reservoirs ileocoecaux ou ileaux continents utilisant la technique de Benchekroun.

Resume Les auteurs rapportent l’observation de fistules enterovesicales secondaires a la maladie de Crohn. La clinique etait representee seulement par des symptomes urinaires evoquant une tumeur vesicale maligne. L’echographie montrait une tumeur vesicale sans retentissement sur le haut appareil urinaire. La cystoscopie montrait une tumeur vesicale retrotrigonale sans individualisation d’orifices fistuleux. L’examen histologique des copeaux de la resection transurethrale de la tumeur vesicale concluait a une pseudotumeur inflammatoire de vessie. L’imagerie par resonance magnetique montrait une fistule sigmoidovesicale avec une tumeur vesicale sans retentissement sur le haut appareil urinaire. Le lavement baryte et le transit de grele ont mis en evidence de multiples fistules enterovesicales en faveur d’une maladie de Crohn. Une resection segmentaire de l’ileon avec ileostomie, colostomie et suture des fistules vesicales etait realisee. L’examen histologique de l’anse ileale resequee a confirme le diagnostic de maladie de Crohn. L’expression clinique, l’etiopathogenie, et le traitement des fistules enterovesicales secondaires a la maladie de Crohn sont discutes.

The authors report 24 patients presenting a transitional tumor of bladder pT1G3 collected between January 1996 and December 2000. They represent 19% of the superficial tumors of bladder. Two patients had of straightaway a cystectomy after resection for an unverifiable tumor by endoscopy and another after a second resection discovering a real pT2. Only 5 patients received a BCG therapy is 24% of the cases. A recurrence without progression has been noted in 38% of the cases and a progression in 19% of the patients. These last patients had a cystectomy and with a follow-up to 28 months, no recurrence has been noted.

The author reports a serie of 4 cases of male urethral diverticulum. All cases were acquired origin. They are complication of urethroplasty. Diagnosis is clinical, based on the development of a perineal mass or phlegmon. This diagnosis is confirmed by cystourethrography. Treatment is by open surgery and consists on diverticulectomy and repair urethra in one stage. Two steps are necessary as the reported cases, where they are urethral stenosis or a inflammatory involvement of the peridiverticulum tissues. This treatment achieves good results.

Although sildenafil citrate (Viagra®) has demonstrated effectiveness in the treatment of erectile dysfunction (ED), the dosing regimens often used in clinical trials may not always match those employed in clinical practice. This study was undertaken to further assess the efficacy and safety of sildenafil taken as required in male outpatients 18 years of age and older with ED (n=71). It was conducted as a placebo-baseline–controlled, open-label, flexible dose-escalation study, with sildenafil (25,50, or 100 mg) administered for 8 weeks following a 4-week placebo run-in. Efficacy variables included questions 3 and 4 of the International Index of Erectile Function (IIEF), other IIEF domains, patient event logs, and quality-of-life (QOL) assessments. Treatment with sildenafil resulted in improvements from baseline in all IIEF domains analyzed (all P

Giant hydronephrosis is uncommon. Ureteropelvic obstruction represent the more frequent cause. In 1939, Stirling defined it as the presence of more than 1000 ml of fluid in the collecting system. The Authors report two cases with ureteropelvic obstruction causing giant hydronephrosis. The treatment includes pyeloplasty in the first case and nephrectomy in the second case.

Isolated tuberculous epididymitis is a rare entity. Because of the increase of this pathology, tuberculosis should be considered in the differential diagnosis of a scrotal swelling even in the absence of a history of previous tuberculosis. We report a case of isolated tuberculous epididymitis, diagnosed in an early stage, with color Doppler ultrasound findings.

Resume Les abces du psoas sont rares. Primitifs ou secondaires leur diagnostic clinique peut s’averer delicat. En ce sens l’apport de l’imagerie et en particulier de la tomodensitometrie est fondamental. Le traitement repose sur le drainage associe a une antibiotherapie. Ce drainage peut etre realise par voie percutanee ou par chirurgie a ciel ouvert. Les auteurs analysent de facon retrospective 12 cas d’abces du psoas.

Resume Les auteurs rapportent leur experience dans le traitement des ruptures traumatiques de l'uretre anterieur. Patients et methodes : Vingt trois malades traites entre janvier 1986 et decembre 1998. L'âge moyen des patients est de 29 ans (extremes 19 et 65 ans). Le mecanisme lesionnel est represente par le choc perineal direct dans 17 cas et la rupture des corps caverneux dans six cas. Les manifestations cliniques sont dominees par l'uretrorragie (19 cas), la retention aigue d'urine (16 cas), l'hematome perineal (14 cas). Les explorations radiologiques (uretrocystographie retrograde, urographie intraveineuse) ont montre une fracture du bassin (six cas), une rupture de l'uretre (17 cas) et l'association a une rupture sous-peritoneale de la vessie (trois cas). Le traitement est realise en urgence chez les six patients ayant une lesion des corps caverneux et secondairement chez les 17 autres patients. Resultats : l'evolution etait favorable chez 12 patients. Une stenose s'est manifestee chez les 11 autres patients. Les traitements de ces stenoses ont ete : uretrotomie endoscopique (quatre cas), anastomose termino-terminale (deux cas) plastie B. Johannson (trois cas), uretroplastie par lambeau pedicule (un cas), dilatations iteratives (un cas). Conclusion : la cystostomie a minima avec controle de la cicatrisation pour les ruptures partielles, l'uretrorraphie termino-terminale faite tardivement pour les ruptures totales et l'intervention chirurgicale en urgence, lorsque la rupture de l'uretre est associee a une lesion des corps caverneux, constituent la conduite therapeutique qui parait donner les meilleurs resultats.

We report a new case in a 56 years old patient who manifested right side's pains. The abdominal CT scan showed a tumor of the right adrenal gland with fat density (size: 8 x 6 x 6 cm). This tumor was removed surgically (weight: 300 g). The histological finding revealed a proliferation of adipocyts and myeloid tissue which contains megakaryocytes, erythroid cells and lymphocyts. The outcome is good after three years of surgery. The surgical treatment becomes necessary when the tumor's size increases or it becomes symptomatic.

The diseases ectopic kidney is a rare malformation. It can be associated with other urological or nonurological malformation. We report 11 cases observed between 1980 and 1998. They were five females and six males with a mean age of 28 years. The clinical symptomatology was dominated by pain and urinary symptoms. Diagnosis was based on the IVP data and ultrasonography. Renal stone and hynronephrosis were each associated in five cases and one patient had renal stone associated with hydronephrosis. The treatment consisted on a iliopelvic approach and extraction of the stone and or pyeloplasty. In three cases a nephrectomy was realised for muet kidney or pyonephrosis. The outcome was good in ten cases and one patient had a pyelo-ureteral secondary stenosis managed by endoscopy.

Non Hodgkin's lymphoma (NHL) of the testis in young patient are rare. Bilateral involvement varies from 5 to 20% of cases and has a negative prognosis. The authors report a case of bilateral non Hodgkin's lymphoma of the testis in a 35 year old man. The patient died six months after the diagnosis.

Prevalence of Brucellosis in patients with low back pain and radicular symptoms in regard with unpasteurized use of milk and its products in this region was investigated. In 18 patients out of 1726 (1.04%) applied to Neurosurgery Clinic, Medical School, Firat University, with low back and/or leg pain for 18 months, brucellosis were diagnosed using brucella aglutination test. In this study, it was found that brucellosis did not showed typical clinical symptoms as usual and that six patients had no complaints apart from low back or leg pain. In conclusion, we suggest that brucellosis should not be ignored, even though there is no apparent clinical symptoms, in the etiology of radicular symptoms encountered in the region., Yöremizde pastorize edilmeden hazırlanan süt ve süt ürünlerinin tüketimi dikkate alınarak bel ağrısı veya radiküler semptomları olan hastalarda bruselloz sıklığı araştırıldı. Fırat Üniversitesi Tıp Fakültesi Nöroşirürji Anabilim Dalı' na 18 aylık süre içinde bel ve/veya bacak ağrısı yakınması ile başvuran 1726 hastanın 18' inde (%1.04) brusella tüp aglutinasyon testi ile bruselloz saptandı. Bu çalışmada, brusellozun tipik klinik semptomlarını her zaman göstermediği, altı hastanın bel veya bacak ağrısı dışında hiçbir yakınmasının olmaması dikkat çekti. Yöremizde rastlanan radiküler semptomların etyolojisinde belirgin klinik semptomları olmasa dahi brusellozun gözardı edilmemesi gerektiği kanısına varıldı.