COSMIC RADIATION EXPOSURE CALCULATIONS FOR INTERNATIONAL AND DOMESTIC FLIGHTS DEPARTS FROM ISTANBUL AND ANKARA

In this study, cosmic radiation doses were calculated for domestic and international flights departing from Istanbul and furthermore for domestic flights departing from Ankara using a software program called CARI-7A and also a mathematical method approach. Main parameters for calculating cosmic radiation are vertical cut-off rigidity, flight duration, latitude-longitude and altitude of the flight. Our calculation results agree with the measurements for domestic and international flights departing from Istanbul and Ankara.

Comparison of initial oral microbiomes of young adults with and without cavitated dentin caries lesions using an in situ biofilm model

Dental caries is caused by acids released from bacterial biofilms. However, the in vivo formation of initial biofilms in relation to caries remains largely unexplored. The aim of this study was to compare the oral microbiome during the initial phase of bacterial colonization for individuals with (CC) and without (NC) cavitated dentin caries lesions. Bovine enamel slabs on acrylic splints were worn by the volunteers (CC: 14, NC: 13) for in situ biofilm formation (2 h, 4 h, 8 h, 1 ml saliva as reference). Sequencing of the V1/V2 regions of the 16S rRNA gene was performed (MiSeq). The relative abundances of individual operational taxonomic units (OTUs) were compared between samples from the CC group and the NC group. Random forests models were furthermore trained to separate the groups. While the overall heterogeneity did not differ substantially between CC and NC individuals, several individual OTUs were found to have significantly different relative abundances. For the 8 h samples, most of the significant OTUs showed higher relative abundances in the CC group, while the majority of significant OTUs in the saliva samples were more abundant in the NC group. Furthermore, using OTU signatures enabled a separation between both groups, with area-under-the-curve (AUC) values of ~0.8. In summary, the results suggest that initial oral biofilms provide the potential to differentiate between CC and NC individuals.

Evaluation of TH17 and TH1 Immune Response Profile in Patients After Renal Transplant

BACKGROUND

Renal transplantation (RT) is the best treatment option for patients with end-stage renal disease (ESRD) because it improves both quality of life and survival. However, allograft rejection remains the most important barrier to successful transplantation. Underlying immunologic mechanisms should be understood to develop appropriate treatment strategies.

METHODS

In this prospective study, we followed renal transplant recipients for 6 months. The study population comprised 50 recipients of renal transplants, and these were divided into 2 groups: 44 patients with stable graft function (SGF) and 6 patients with rejection (RX). Peripheral blood samples were drawn from patients on the pre-RT day, at post-RT day 7, month 1, and month 6, and on the day of rejection for analysis of the percentages of cytokines interleukin (IL) 17 and interferon (IFN) γ with the use of flow cytometry and enzyme-linked immunosorbent assay.

RESULTS

The percentages of intracellular IFN-γ were not significant in the group with RX compared with SGF. Levels of intracellular IL-17 obtained at the 6th month after RT were significantly higher in the RX group than in the SGF group. Plasma levels of pre-RT IL-17 were also higher in the RX group; therefore, it may be a predictive biomarker of acute rejection of renal transplants.

CONCLUSIONS

The present study provides information about pre-RT and post-RT cytokine profiles of Turkish patients with ESRD. We consider cytokine analysis to be a valuable biomarker panel in the prevention of rejection and in assisting with new treatment strategies for patients undergoing renal transplant.

Relevance of Flow Cytometric Auto-Crossmatch to the Post-transplant Course of Kidney Transplant Recipients

INTRODUCTION

The crossmatch test is essential prior to kidney transplantation (tx) to confirm compatibility between the donor and the recipient. However, its results can be misleading due to "undetectable antibodies" in the recipient's serum. To establish if undetectable autoantibodies are responsible for a positive result, an auto-crossmatch test can be performed. In this study, we aim to determine the long-term prognostic value of auto-flow cytometric auto-crossmatch (FCXM) test on kidney survival in kidney tx recipients.

MATERIALS AND METHODS

The primary outcome variable was reduced renal function. Secondary endpoints were incidence of biopsy-confirmed chronic antibody-mediated rejection (CAMR) and recurrent glomerulonephritis (GN).

RESULTS

There were no differences regarding initial serum creatinine levels between the study and control groups (P = .441). Patients who had positive auto-B FCXM had a significantly reduced renal function compared with the control group (P = .016). Four patients developed biopsy-confirmed CAMR in the study group and 1 patient in the control group (P = .047). Five patients had biopsy-confirmed recurrent GN in the GN study group, and only 1 patient had recurrent GN in the GN control group (P = .026).

DISCUSSION

Kidney transplant recipients with positive auto-FCXM test had significantly reduced renal function and a higher incidence of recurrent GN and CAMR compared with the control group. The findings of this study suggest a potential role of auto-antibody causing positive auto-FCXM test result, meanwhile increasing the risk of CAMR, recurrent GN, and new-onset diabetes after tx.

Comparison of Surgical Correction Techniques for Post-Renal Transplantation Vesicoureteral Reflux

BACKGROUND

Symptomatic urinary tract infection (UTI) after renal transplantation (RT) is an important morbidity in transplant recipients and may cause pyelonephritis and sepsis. Surgical correction of high-grade vesicoureteral reflux (VUR) after RT is suggested, performing ureteral reimplantation or pyelo-ureteral/uretero-ureteral anastomosis. Recently, extravesical seromuscular tunnel lengthening techniques have been reported with favorable results and low complication rates.

METHODS

We retrospectively reviewed the charts of 38 patients with post-transplantation VUR who underwent reflux correction surgery. Patient characteristics were analyzed to compare our extravesical seromuscular tunnel lengthening technique with uretero-ureteral and pyelo-ureteral anastomosis techniques.

RESULTS

Twenty patients were treated with the extravesical approach (group I) and 18 patients by pyelo-ureteral or uretero-ureteral anastomosis with the use of native ureter (group II). Mean operative time was significantly shorter in group I than in group II (64.8 vs 110.1 min; P < .05), and mean duration of hospital stay after the operation also was shorter in group I (1.5 vs 5.1 d; P < .05). We determined persistent VUR in postoperative voiding cystouretrography in 2 patients (10%) in group I, but there was regression in VUR grades of all of the patients. There was no significant difference in postoperative number of UTI episodes and serum creatinine levels between the 2 groups.

CONCLUSIONS

Extravesical seromuscular tunnel lengthening is an effective and safe technique for post-transplantation VUR management.

An integrated and disease-oriented growth factor-regulated signal transduction network

The importance of Akt, Erk, and their downstream effectors-mediated signaling is indisputable for the proliferation of cell. Growth factor-induced activation of Akt and Erk pathways interacts with each other to regulate proliferation. However, an instructive model, wiring the crucial signaling nodes working in cellular growth and division, is still absent or controversial. Although growth factor-mediated mTORC1 regulation is defined considerably, debates still exist formTORC2. TSC1-TSC2 complex integrates both nutrient and mitogenic signals coming from growth factor receptors. Growth factor-induced PI3K/Akt- and Ras/Erk-mediated TSC2 inhibition is well defined. However, the interaction between TSC complex and new molecules such as Pin1 and DAPK requires further clarifications. Furthermore, the Wnt-β-catenin signaling pathway also intersects with the growth factor signaling at TSC1/TSC2 junction. Therefore, the aim of this perspective paper is to suggest an integrated model, linking growth factor-activated crucial signaling nodes in order to supply key molecular connections to degenerative diseases.

Systemic DNA damage response and metabolic syndrome as a premalignant state

Damaged DNA can lead to aneuploidy and/or chromosomal instability, which is believed to be major contributor to tumor progression. DNA damage in response to genotoxic and oncogenic stresses activate the tumor suppressor pathways initiating DNA damage response (DDR). One of the cellular fates in response to DDR is permanent growth arrest in mitotically active cells, including stem cells, leading to senescence. On the other hand, DDR reasons in adaptive changes in postmitotic cells. These cellular alterations happen through complex interactions and function to disrupt the existing cellular homeostasis. Significant metabolic changes occurred by the influence of the major tumor suppressor protein p53 and other related factors such as FOXO, AMPK, PARP, NF-kappaB and PGC-1 are discussed in the article. After a strong correlation established between the systemic DNA damage response to inhibit ongoing malignant transformation and metabolic syndrome characteristics, logical extrapolations for type 2 diabetes, cardiovascular disease, and aging are carried out. Finally, therapeutic evaluations are performed in the light of the novel pathophysiological data implying that "metabolic syndrome" is a real disease.

Vascular endothelial dysfunction in cyclosporine-treated rat aortas is not associated with serum total homocysteine levels

OBJECTIVES

Elevation of serum total homocysteine (tHcy) is considered to contribute to endothelial cell dysfunction, which is considered to be the initial event in posttransplant vascular disease. We sought to investigate whether an association existed between serum tHcy levels and vascular endothelial function during cyclosporine (CsA) treatment.

MATERIALS AND METHODS

Endothelium-dependent and -independent relaxation responses (to acetylcholine [ACh] and sodium nitroprusside [SNP]) were determined on thoracic aortae from CsA-treated rats (5 mg kg/d, subcutaneously, for 14 days). A correlation analysis was performed between ACh responses and tHcy levels.

RESULTS

CsA decreased the responses to ACh and the pD(2) values of the concentration-response curves compared with controls (P < .05). Responses to SNP and serum tHcy levels were unchanged among the groups. tHcy negatively correlated with the ACh pD(2) values among control (r = -0.69; P < .05) and vehicle (r = -0.73; P < .05) groups, indicating that the increase in tHcy was associated with decreased sensitivity to ACh. In CsA-treated rats, no association was observed between these parameters. Also, no correlation was noted between CsA concentrations and tHcy levels.

CONCLUSION

These data suggested a possible link between serum tHcy and decreased vascular sensitivity to endothelium-dependent vasorelaxation in control aortae, but CsA-induced vascular endothelial dysfunction was not associated with an effect of the drug on homocysteine metabolism.

Mode of administration of international prostate symptom score in patients with lower urinary tract symptoms: physician vs self

International prostate symptom score (IPSS) was claimed to be complicated for patients. The aim of this study was to measure differences in IPSS when introduced by a physician vs self-administration. Patients with lower urinary tract symptoms completed two IPSS questionnaires: one self-administrated and the other by a physician 1 week apart. Results with 75 patients in each group suggested that there was no statistically significant difference between patient and physician administration, although the mean scores of patients' administration were higher in both groups. In conclusion, when assessing IPSS before treatment, we found no difference between patient administration and physician administration.

The reliability and validity of the Turkish version of Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO)

The purpose of this study was to investigate the reliability and validity of the Turkish version of Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). The patient group included 43 females aged between 55 and 78 years with vertebral fractures due to osteoporosis. The control group consisted of 43 healthy female volunteers whose ages matched those of the patients. All of the participants were evaluated using both QUALEFFO and SF-36. In the reliability studies, internal consistency within the domain of QUALEFFO was generally good, with Cronbach's alpha values ranging between 0.70 and 0.96. Convergent and discriminant validity rates of domains were both found to be between 89% and 100%. Significant correlations existed between scores of similar domains of QUALEFFO and the SF-36, especially for pain, physical function, social function and general health perception. The receiver operating characteristic (ROC) curve analysis of QUALEFFO and the SF-36 indicated that all five domains in each questionnaire were significantly predictive of vertebral fractures. However, when comparing similar domains of the two questionnaires, the social function domain of QUALEFFO demonstrated a significantly better performance. In conclusion, the Turkish version of QUALEFFO was found to be reliable and valid in the evaluation of patients with vertebral fractures due to osteoporosis. Our study also suggests that the patients with vertebral fractures due to osteoporosis have impairment in quality of life.

The efficacy of an abbreviated model of the International Prostate Symptom Score in evaluating benign prostatic hyperplasia

OBJECTIVES

To investigate the acceptability to patients in Turkey of the International Prostate Symptom Score (IPSS) for evaluating benign prostatic hyperplasia (BPH), and to devise a possible abbreviated model, saving time when administered by a physician.

PATIENTS AND METHODS

The IPSS questionnaire was initially self-administered in 200 consecutive patients aged> 50 years and with lower urinary tract symptoms. Patients were instructed only to mark questions which they clearly understood. The IPSS was then administered to 500 consecutive patients by the same physician. Subsequently, each of the seven questions was separately correlated with the IPSS and quality-of-life (QoL) score. The first five questions with the highest correlation coefficient for both the total IPSS and QoL score were identified, and every possible combination of these questions produced and correlated.

RESULTS

In the first group, 29% of the patients did not complete the form and 44% could not mark at least one item; the effect of educational level was significant (P < 0.05). In the second group a combination of the first three items had a Pearson's correlation of 0.90 with the total IPSS; similarly, four questions combined (2, 3, 6 and 7) also correlated well (r = 0.92). Both combinations took significantly less time to administer (P < 0.05).

CONCLUSION

The abbreviated form of the IPSS consisting of three or four items may be used to assess symptoms in patients with BPH, especially in underdeveloped countries.

Malignant mesothelioma of tunica vaginalis testis associated with long-lasting hydrocele: could hydrocele be an etiological factor?

A case of malign mesothelioma of tunica vaginalis testis in a 67 year old man with a 30 year history of hydrocele was reported. The diagnosis was made with an excisional biopsy performed in scrotal exploration and revealed epithelial type mesothelioma. High orchiectomy with hemiscrotectomy was performed. The patient had a local recurrence at the end of two years. As there were no distant metastasis only local excision was performed. In his sixth month after the second surgery he is still tumor free. Related literature reviewed.

Urethral seam formation and hypospadias

Knowledge of the formation of the normal male urethra may elucidate the etiology of hypospadias. We describe urethral formation in the mouse, show the similarities and relevance to human urethral development, and introduce the concept of the epithelial seam formation and remodeling during urethral formation. Three mechanisms may account for epithelial seam formation: (1) epithelial-mesenchymal transformation similar to that described in the fusion of the palatal shelves, (2) apoptosis, and/or (3) tissue remodeling via cellular migration. Urethral development in the embryonic mouse (14-21 days of gestation) was compared with urethral formation in embryonic human specimens (8-16 weeks of gestation) by using histology, immunohistochemistry, and three-dimensional reconstruction. The urethra forms by fusion of the epithelial edges of the urethral folds, giving a midline epithelial seam. The epithelial seam is remodeled via cellular migration into a centrally located urethra and ventrally displaced remnant of epithelial cells. The epithelial seam is remodeled by narrowing approximately at its midpoint, with subsequent epithelial migration into the urethra or penile skin. The epithelial cells are replaced by mesenchymal cells. This remodeling seam displays a narrow band (approximately 30 microns wide) of apoptotic activity corresponding to the mesenchymal cells and not to epithelial cells. No evidence was seen of the co-expression of cytokeratin and mesenchymal markers (actin or vimentin). Urethral seam formation occurs in both the mouse and the human. Our data in the mouse support the hypothesis that seam transformation occurs via cellular migration and not by epithelial mesenchymal transformation or epithelial apoptosis. We postulate that disruption of epithelial fusion remodeling, and cellular migration leads to hypospadias.

Effects of aminoguanidine administration on vascular hyporeactivity in thoracic aorta from endotoxaemic rats

Overproduction of nitric oxide has been implicated in the pathogenesis of the vascular hyporesponsiveness of endotoxic shock. In this study, we investigated the effects of aminoguanidine, an inducible nitric oxide synthase inhibitor, on the decreased vascular responsiveness in endotoxic shock. Male albino rats were administered intraperitoneally aminoguanidine (25, 50 or 75 mg kg(-1)) 1 h after they received saline or lipolysaccharide (Escherichia coli serotype 055:B5). The thoracic aortas were removed 18 h after lipopolysaccharide administration and suspended in organ baths containing Krebs solution, and tested for vascular reactivity. Contractile responses to phenylephrine and potassium chloride, and relaxant responses to acetylcholine were reduced in endotoxaemic animals. Aminoguanidine was ineffective in improving the vascular hypocontractility at 25 and 75 mg kg(-1) doses; but at 50 mg kg(-1) dose, it restored the decreased contractile responses toward normal values. Diminished relaxant responses to acetylcholine were restored by aminoguanidine at all three different doses. There were no significant differences in sodium nitroprusside induced relaxant responses between all groups. Administration of aminoguanidine in control animals did not change vascular responses to any agent. These data suggest that aminoguanidine treatment improves the vascular hyporesponsiveness to contractile- and endothelium-dependent relaxant agents observed in endotoxic shock.

Anatomy of the neurovascular bundle: is safe mobilization possible?

PURPOSE

We have previously defined the anatomy of the neurovascular bundle in the normal and hypospadiac penis. Historical experience suggests that mobilization of the neurovascular bundle is anatomically possible. We attempt to prove whether mobilization of the neurovascular bundle is safe and theoretically sound. Specific questions that will be addressed are does the neurovascular bundle send perforating branches into the corporal bodies; how far lateral does the dissection need to be before nerves are injured and exactly how deep into Buck's fascia must one go.

MATERIALS AND METHODS

A total of 35 normal human fetal penile specimens, gestational age 8 to 35 weeks, and 3 hypospadiac specimens, 33 to 41 weeks of gestation, were serially sectioned and stained with Mason's trichrome and the neuronal markers PGP 9.5 or S100. Computer reconstruction using commercial software and National Institutes of Health imaging allowed 3-dimensional analysis of the nerves, corporal bodies and glans.

RESULTS

Perforating nerves into the erectile bodies were not documented along the dorsal or lateral aspect of the tunica in any of the specimens studied. Only in the area of the crural bodies on the ventral lateral surface were nerves noted to pierce into erectile tissue. The neural network was extensive from the 11 and 1 to the 5 and 7 o'clock positions corresponding to the erectile tissue and urethral spongiosum junction. At this junction minor nerve branches were noted to perforate into the urethral spongiosum. A microscopic plane exists between the neurovascular bundle and tunica of the corporal bodies measuring 20 to 30 micro. in specimens greater than 30 weeks in gestation.

CONCLUSIONS

Perforating branches from the dorsal lateral neurovascular bundle do not exist based on serial step sectioning and microscopic examination of male genital specimens. Surgically it is possible to elevate the neurovascular bundle but the dissection needs to remain directly on top of the tunica albuginea to prevent neuronal injury. Small perforating branches into the urethral spongiosum may be injured with unknown significance. We continue to advocate plication in the nerve-free zone at the 12 o'clock position for correction of penile curvature.

The prolactin response to buspirone in poststroke depression: a preliminary report

BACKGROUND

The issue of whether a serotonergic abnormality is involved in poststroke depression (PSD) was investigated in a sample of poststroke patients.

METHODS

The severity of depression was assessed by Hamilton Rating Scale for Depression (HDRS). Buspirone was administered to 16 depressed poststroke (DPS), 10 non-depressed post-stroke (NDPS) patients, and 10 male healthy controls (HCs), to evaluate serotonin (5-HT) function.

RESULTS

The prolactin (PRL) response was significantly blunted in DPS patients compared to HCs. There was no significant relationship between the severity of depression and lesion lateralization. Also, no significant differences in buspirone-induced PRL responses were found between DPS patients with right- and left-sided lesions. The severity of depression in DPS patients was not correlated with the time since stroke.

CONCLUSIONS

Our results suggest that serotonergic dysfunction may involve in development of poststroke depression.

LIMITATIONS

The relatively small sample size and the failure to adequately control for age are major limitations of this study.

Anatomical studies of the urethral plate: why preservation of the urethral plate is important in hypospadias repair

OBJECTIVE

To describe the detailed anatomy of the urethral plate in relation to its controversial role in hypospadias surgery.

MATERIALS AND METHODS

A newborn penis with proximal penile hypospadias and two fetal penises with distal shaft hypospadias were included in the study; 30 normal fetal penises served as the control. Specimens were embedded in paraffin and serially sectioned (6 microm) after formalin fixation. Every 10th section was stained with haematoxylin and eosin. Immunohistochemical staining for nerves (S100), smooth muscles (alpha-actin), blood vessels (factor VIII) and epithelium (cytokeratins 7, 14 and 18) were used on selected sections, with particular attention to the urethral plate. Masson's trichrome and Sirius Red stains were used to localize collagen.

RESULTS

There were extensive blood vessels, glands and smooth muscle under the urethral plate in the hypospadias specimens. These relatively well organized tissues corresponded to an abnormally formed corpus spongiosum. The glands underneath the urethral plate and adjacent to the normal urethra showed positive staining for cytokeratins 7 and 18, respectively (markers of endodermal origin) but were negative for cytokeratin 14 (a marker of ectodermal origin). Penile skin and urethral plate epithelium stained positively for cytokeratin 14 but not for cytokeratin 7 and 18. The urethral plate has a rich nerve supply, as determined by S100 staining. Collagen intensity under the urethral plate was no different from that in normal areas. Tunica albuginea stained intensely for type I and III collagen.

CONCLUSION

These results show that the urethral plate is well vascularized, has a rich nerve supply and an extensive muscular and connective tissue backing. These features may explain the lower complication rate with onlay flaps than with tube flaps. Therefore, from these anatomical findings, we continue to advocate preservation of the urethral plate and the onlay island flap for hypospadias reconstruction.

Anatomical studies of the human clitoris

PURPOSE

Endogenous or exogenous testosterone exposure to the fetus during gestation may result in masculinization of the external genitalia. Surgical correction requires a clear understanding of normal female anatomy. We report observations from our anatomical dissections on which we base our approach to reduction clitoroplasty.

MATERIALS AND METHODS

A total of 14 normal human fetal clitoral specimens at 8 to 24 weeks of gestation were serially sectioned after formalin fixation. Every tenth section was stained with Masson's trichrome, smooth muscle alpha-actin and the neuronal markers PGP 9.5 or S-100. Computer reconstruction using imaging software permitted 3-dimensional analysis of the nerves, corporeal bodies and glans clitoris. These specimens were compared with 2 obtained postnatally at feminizing genitoplasty.

RESULTS

The normal fetal clitoris consists of 2 corporeal bodies with a midline septum. The ultrastructure of the female corporeal bodies is similar to that of the male counterpart. The glans clitoris forms a cap on top of the distal end of the narrowed corporeal bodies. There is a midline septum starting on the ventral aspect and extending approximately halfway into the glans. Large bundles of nerves course along the corporeal bodies with the highest density on the dorsal aspect or top. No nerves were noted at the 12 o'clock position, although nerves extend completely around the tunica in a fashion similar to that of the fetal penis. Glans innervation is provided by multiple perforating branches entering at the dorsal junction of the corporeal body and glans. The lowest density of nerves in the glans is on the ventral aspect in juxtaposition to the glans septum. In surgical specimens obtained from patients with congenital adrenal hyperplasia nerves were adjacent to the excised tunica of the corporeal bodies, especially on the lateral aspect.

CONCLUSIONS

A clear understanding of the anatomy of the human clitoris is important for surgical reconstruction. As in the human penis, nerves in the clitoris form an extensive network around the tunica of the corporeal body with a nerve-free zone at the midline 12 o'clock position. Care should be taken to preserve all nerves. Reduction of the glans clitoris should not violate the extensive innervation that predominates on the dorsal aspect of the glans. The normal clitoris has corporeal bodies that are smaller but analogous to those of the penis. One may consider their function when extensive resection is considered.

Anatomical studies of the human clitoris

PURPOSE

Endogenous or exogenous testosterone exposure to the fetus during gestation may result in masculinization of the external genitalia. Surgical correction requires a clear understanding of normal female anatomy. We report observations from our anatomical dissections on which we base our approach to reduction clitoroplasty.

MATERIALS AND METHODS

A total of 14 normal human fetal clitoral specimens at 8 to 24 weeks of gestation were serially sectioned after formalin fixation. Every tenth section was stained with Masson's trichrome, smooth muscle alpha-actin and the neuronal markers PGP 9.5 or S-100. Computer reconstruction using imaging software permitted 3-dimensional analysis of the nerves, corporeal bodies and glans clitoris. These specimens were compared with 2 obtained postnatally at feminizing genitoplasty.

RESULTS

The normal fetal clitoris consists of 2 corporeal bodies with a midline septum. The ultrastructure of the female corporeal bodies is similar to that of the male counterpart. The glans clitoris forms a cap on top of the distal end of the narrowed corporeal bodies. There is a midline septum starting on the ventral aspect and extending approximately halfway into the glans. Large bundles of nerves course along the corporeal bodies with the highest density on the dorsal aspect or top. No nerves were noted at the 12 o'clock position, although nerves extend completely around the tunica in a fashion similar to that of the fetal penis. Glans innervation is provided by multiple perforating branches entering at the dorsal junction of the corporeal body and glans. The lowest density of nerves in the glans is on the ventral aspect in juxtaposition to the glans septum. In surgical specimens obtained from patients with congenital adrenal hyperplasia nerves were adjacent to the excised tunica of the corporeal bodies, especially on the lateral aspect.

CONCLUSIONS

A clear understanding of the anatomy of the human clitoris is important for surgical reconstruction. As in the human penis, nerves in the clitoris form an extensive network around the tunica of the corporeal body with a nerve-free zone at the midline 12 o'clock position. Care should be taken to preserve all nerves. Reduction of the glans clitoris should not violate the extensive innervation that predominates on the dorsal aspect of the glans. The normal clitoris has corporeal bodies that are smaller but analogous to those of the penis. One may consider their function when extensive resection is considered.

Anatomical studies of hypospadias

PURPOSE

Hypospadias is the most common congenital anomaly affecting the penis. Successful repair depends on an accurate understanding of anatomy. We compared the anatomy of hypospadiac and normal fetal penises.

MATERIALS AND METHODS

A fetal penis at 33 weeks of gestation with distal shaft hypospadias was serially sectioned and compared to 10 normal human fetal specimens at 8 to 32 weeks of gestation. Immunohistochemical localization was performed with S-100 protein and protein gene product 9.5 to localize neurons. Blood vessels were localized by the presence of red corpuscles, and immunohistochemical staining with von Willebrand's factor and factor VIII. Three-dimensional computer reconstructions of the nerves, corporeal bodies, tunica and urethra of the hypospadiac and normal fetal penises were compared.

RESULTS

Except at the region of the abnormal urethral spongiosum and glans, the hypospadiac and normal penises showed no difference in neuronal innervation, corpora cavernosa and tunica albuginea architecture and blood supply. The nerves started proximally as 2 well defined bundles under the pubic rami superior and slightly lateral to the urethra. As the 2 crural bodies converged into the corpora cavernosa, the nerves diverged, spreading around the cavernous bodies up to the junction with the urethral spongiosum without remaining at the 11 and 1 o'clock positions. Along the entire shaft of the penis there were no neuronal structures at the 12 o'clock position. The most striking difference was in vascularity. In the hypospadiac penis factor VIII immunostaining revealed huge endothelial lined vascular channels filled with red blood cells. In contrast, the normal penis had well defined small capillaries around the urethra that fanned out into the glans. Vascularity was also extensive under the urethral plate. Nerve distribution in the abnormal glans was also less extensive than in the normal penis.

CONCLUSIONS

Increased knowledge of normal and hypospadiac penile anatomy with respect to the nerves, corporeal bodies, glans and vascularity is useful for the strategic design of penile reconstructive procedures.

Intravesical epirubicin in the prophylaxis of superficial bladder cancer

Forty-five patients who underwent transurethral resection (TUR) for Ta-T1 superficial bladder cancer were included in the study. Fourteen patients who had TUR alone were assigned to the control group. Epirubicin therapy was started two weeks after complete TUR of the tumour. Epirubicin in a dose of 50 mg diluted in 50 ml saline was installed weekly for 8 weeks in the epirubicin group. The mean follow-up was 24 months. Although recurrence rate was higher in the control group (64.2% versus 32.2%), it was not found to be statistically significant (p = 0.0914, chi-square test). Tumour-free intervals in patients with recurrent disease were significantly longer in the epirubicin group (p < 0.05, Mann-Whitney U-test).

IN CONCLUSION

intravesical epirubicin therapy, which both reduces recurrence rate and prolongs time to recurrence, was found to be effective in the prophylaxis of superficial bladder cancer.

Neodymium:YAG visual laser ablation of the prostate

OBJECTIVE

This study was performed to evaluate safety and efficacy of laser prostatectomy in the treatment of symptomatic benign prostatic hyperplasia (BPH).

METHODS

Neodymium:yttrium-aluminum-garnet (YAG) visual laser ablation of the prostate was performed in 43 patients (mean age 66 +/- 11.5 years) with BPH. The mean prostatic volume was 44.7 +/- 19.7 ml. A right-angle, side-firing laser fiber (Lasersonics Ultraline) and a neodymium:YAG laser generator (Hercules 5060) were used.

RESULTS

There were no perioperative complications including hemorrhage and transurethral reflux syndrome. The average postoperative hospital stay was 1.3 days, and the average urethral catheterization time was 3.8 days. Thirty-two patients were evaluated 6 months after the operation. A significant improvement was found in the mean symptom score from 21.8 +/- 7.6 to 8.3 +/- 6.9 (p < 0.001). A significant decrease from 104.3 +/- 78 to 55.7 +/- 30 ml was found between the preoperative and the postoperative mean residual urine volumes (p < 0.001). The mean peak flow rate increased from 8.7 +/- 3.9 to 16.1 +/- 2.4 ml/s (p < 0.001), and the mean average flow rate increased from 4.9 +/- 2 to 10.2 +/- 2.9 ml/s (p < 0.001).

CONCLUSION

Our results indicate that laser prostatectomy is a promising alternative in the treatment of BPH.

Predictive value of a new scoring system for the outcome of primary in situ experimental extracorporeal shock wave lithotripsy of upper ureteral calculi

The results of primary in situ extracorporeal shock wave lithotripsy of upper ureteral calculi were analyzed retrospectively in 491 eligible patients. The treatment was successful in 371 patients (76%). Degree of obstruction, stone size, localization of stone, history of previous ipsilateral surgery, and body mass index were found to be factors that can influence the outcome of treatment. A scoring system based on these factors has been developed to select the appropriate group of patients for primary in situ extracorporeal shock wave lithotripsy of upper ureteral calculi.

Partial bladder reconstruction with pedicled rectus and gracilis muscle flaps: an experimental study in dogs

OBJECTIVE

To investigate the functional, anatomical and histopathological results of partial bladder reconstruction with skeletal muscle flaps.

MATERIALS AND METHODS

Partial bladder reconstruction with gracilis or rectus muscle flaps was performed in 10 mongrel dogs. Bladder compliance and uninhibited contractions were investigated in five female dogs. Pre-operative and post-operative cystograms were performed in four female dogs. The dogs were killed 8-12 weeks after the operation. Bladders and muscle flaps were grossly examined and removed for histopathological examination.

RESULTS

There was no extravasation on post-operative cystography. Bladder compliance was normal and uninhibited contractions were not present. Severe contracture and atrophy of the muscle flaps were observed in all dogs at necropsy. Bladder volumes were not changed significantly (P > 0.05). Histopathological examination revealed severe mesenchymal metaplasia in all of the flaps.

CONCLUSION

Partial reconstruction of the bladder with skeletal muscle flaps did not result in extravasation and bladder function was not altered. However, bladder volume could not be increased because of contracture and atrophy of the flaps.

Endoscopic transvaginal bladder neck suspension for stress urinary incontinence

We report the short-term results in 23 women who underwent endoscopic transvaginal bladder neck suspension for stress urinary incontinence. During follow-up for 3-14 months (mean 6 months) complete dryness was achieved in 15 (79%) of the 19 patients. Significant improvement with only minor occasional leaks after surgery was observed in 2 patients (10.5%) and the remaining 2 cases (10.5%) were failures. Four patients were lost to follow-up. No serious complication was noted. This relatively easy operation with acceptable success and morbidity rates has been found to be comparable with the other surgical techniques being used.

Trial with bacillus Calmette-Guérin and epirubicin combination in the prophylaxis of superficial bladder cancer

The efficacy and side effects of the prophylactic intravesical bacillus Calmette-Guérin and epirubicin combination therapy were evaluated in 14 patients who underwent transurethral resection for Ta-T1 superficial bladder cancer. Therapy was started 7-10 days after the operation and maintained weekly for 6 weeks and then monthly for 6 months unless withdrawal due to side effects. Instillation of 50 mg epirubicin (Farmorubicin, Farmitalia Carlo Erba) diluted in 50 ml saline was followed by 80 mg of the Connaught strain bacillus Calmette-Guérin (ImmuCyst, Pasteur Mérieux) in 50 ml saline and the duration of instillation was 2 h for each drug. All the patients experienced moderate to severe cystitis and fever. Side effects necessitated discontinuation of the therapy in 5 patients (35.7%). Therapy was delayed in 7 patients (50%) for reasons related or unrelated to the side effects. Of the 9 patients who completed the course, 8 (89%) had no tumor recurrence 10-16 months (mean 14 months) after therapy. Results obtained revealed that this treatment schedule cannot be tolerated by a considerable number of the patients. Mainly the side effects of the combination are emphasized in this report. The therapeutic efficacy of such a combination has yet to be determined and further clinical studies are warranted.