A comparison of the molecular distribution of proangiogenic factors in endometrium of missed abortions and of voluntary first trimester termination cases

OBJECTIVE

The authors aimed to evaluate the angiogenic changes that occur in the cases with missed abortions compared with the voluntary termination of pregnancy as control group, with this controlled clinical study.

MATERIALS AND METHODS

The study included fifteen healthy volunteer women with unwanted pregnancy less than 10th gestational week in an academic research environment. The patients were 19 women between 6th and 11th gestational weeks diagnosed with missed abortion as the patient group. Immunohistochemistry was utilized to examine temporal and spatial expression of vascular endothelial growth factor (VEGF) and their two receptors: VEGF-R1 (Flt-1) and VEGF-R2 (Flk-1/KDR), and Trombospondin-1, eNOS, iNOS, and HIF-1α in the both deciduas and placenta of the both groups.

RESULTS

This study discovered the significant difference (p < 0.005) between the groups of controlled and missed abortion in the decidual and placental cell components, and has put forward that thrombospondin and iNOS have an impact on abortion through antiangiogenic effect in cases of missed abortions.

CONCLUSIONS

The potential role of molecules affecting angiogenesis in the etiology of missed abortion has been evaluated and the authors aimed for this to be a guide for studies on further treatments and on the prevention of the development of missed abortions.

Tuberculous meningitis: a report of 60 adult cases

OBJECTIVE

This was to evaluate the history, clinical and laboratory findings, outcome and prognosis of patients with tuberculous meningitis (TBM).

METHOD

Between 1998 and 2009, 60 patients with TBM were evaluated, retrospectively.

RESULTS

Overall, 60 patients were selected, of which 33 (55%) were male. The patients' ages ranged from 14 to 62 years. In the majority of the patients, disease was in an advanced stage on admission (66% in stage III according to the British Research Council neurological criteria). The rate of complications was highest among patients in stages II and III with an overall mortality rate of 6.6% (n = 2 of stage II patients and n = 2 of stage III patients).

CONCLUSIONS

Earlier admission of the patients with TBM could provide better outcomes with regard to sequelae and mortality. Fatal cases presented with rapid deterioration and were refractory to treatment.

Plasminogen activator inhibitor-1 (PAI-1) gene polymorphism (-675 4G/5G) associated with obesity and vascular risk in children

Atherothrombotic complications in insulin resistance are partly attributed to impaired fibrinolysis caused by increased PAI-1 plasma levels, and 4G/5G promotor polymorphism of the PAI-1 gene may modulate PAI-1 transcription.

OBJECTIVE

To investigate PAI-1-675 4G/5G allele gene polymorphism and its relationship with obesity in children. CHILDREN AND METHOD: The study participants were 133 apparently healthy non-obese children, 24 probable exogenously obese without family history (Group I), 66 probable familial obese (Group II), and 44 obese children who were referred to the pediatric endocrinology department with any complication of obesity (Group III). Group I and Group II obese children were gathered from a school-based epidemiological study.

RESULTS

Incidence of obesity was 19% in a school with high socio-economic status, whereas it was 4% in a school with low socio-economic status. Frequencies of 4G/4G gene polymorphisms were 24.81%, 37.50%, 64.80% and 61.11% in the control group, and groups I, II, and III, respectively. In groups II and III, 4G/4G gene polymorphism, and in non-obese control children 5G/5G gene polymorphism, was common. In obese children in the presence of family history for obesity and metabolic syndrome (odds ratio [OR]: 4.48, 95% confidence interval [CI]: 1.26-15.82), carriage of the 4G allele either in heterozygous or homozygous state increased the risk of vascular disease (OR: 6.10, 95% CI 1.64-22.90). In patients with acanthosis nigricans, high HOMA-IR values, hypertriglyceridemia and elevated atherogenic index, 4G/4G genotype frequency was remarkably higher compared to patients with other features of metabolic syndrome.

CONCLUSION

The increasing prevalence of childhood obesity in high socio-economic status is associated with health risks. In obese children with family history of obesity and cardiovascular disease or type 2 diabetes mellitus and in obese children who had any feature of metabolic syndrome, frequency of 4G/4G genotype was more than the 4G/5G and 5G/5G genotypes in the PAI-1 gene. These patients can be at increased risk for developing vascular disease. Acanthosis nigricans, high HOMA-IR value, hypertriglyceridemia and high atherogenic index can also reflect the high risk of vascular disease in metabolic syndrome.

The Efficacy of Tc99m Dimercaptosuccinic Acid (Tc-DMSA) Scintigraphy and Ultrasonography in Detecting Renal Scars in Children with Primary Vesicoureteral Reflux (VUR)

INTRODUCTION

Pyelonephritis-induced renal scarring in children is a major predisposing factor for proteinuria, hypertension, and ultimate renal failure. The aim of this study was to investigate and compare the efficacy of Tc99m dimercaptosuccinic acid (Tc-DMSA) renal scintigraphy and renal ultrasonography (USG) in detecting renal scars in children with primary vesicoureteral reflux (VUR).

MATERIALS AND METHODS

Tc-DMSA scan and USG studies were done in 62 children who were admitted to our clinic between 1997 and 2003 because of documented urinary tract infection (UTI) and diagnosed with primary VUR. Renal scarring detection rates of Tc-DMSA scan and USG were compared according to reflux grades.

RESULTS

In the whole group, renal scars were detected by Tc-DMSA scan and USG in 55% and 38% of refluxing units, respectively. Detection rates of Tc-DMSA and USG according to reflux grades were as follows: 47% and 29 % in low-grade VUR (grades 1 and 2), 46 % and 25% in mid-grade VUR (grade 3), 76% and 65% in high-grade VUR (grades 4 and 5), respectively.

CONCLUSION

USG was found to be an inappropriate study in the detection of renal parenchymal scars, irrespective of the reflux grade. In this study, Tc-DMSA scan detected scars in 35% of kidneys reported to be normal on USG.

Moyamoya syndrome after radiation therapy for optic pathway glioma: case report

We present a 4-year-old girl with neurofibromatosis-1 who developed moyamoya syndrome characterized by bilateral stenosis or occlusion of the distal internal carotid arteries and their branches, leading to the development of an abnormal vascular network. In light of a literature review, the postradiation vasculopathy of the moyamoya type and its relationship with neurofibromatosis-1 are discussed.

Methyl-prednisolone in neurologic complications of Mycoplasma pneumonia

In patients with Mycoplasma pneumonia extrapulmonary manifestations such as encephalitis, meningitis, cerebellar and brain stem involvement, cranial nerve lesions, peripheral neuropathy, polymyositis have been observed. We report a 16-year-old girl with M. pneumonia infection, acute behavioral changes and coma. Treatment with high dose methyl-prednisolone and clarithromycin led to rapid clinical improvement.

Role of apoptosis in testicular tissue damage caused by varicocele

OBJECTIVE

Histomorphological changes reported in patients with varicocele (so-called stress pattern) have some degree of resemblance to the ones observed during apoptosis of various cell types due to a variety of reasons. In order to further clarify a possible role of apoptosis in impaired spermatogenetic activity associated with varicocele, we have investigated the presence of this specific type of cell death in testicular tissue.

MATERIAL AND METHODS

Surgical specimens were obtained after the completion of ligation and division of the spermatic vein(s) in patients with varicocele associated with infertility and testicular tissue obtained by scrotal orchiectomy for hormonal ablation treatment in prostate cancer patients served as the control group. Terminal deoxynucleotidyl transferase end labeling (TUNEL) technique was utilized in paraffin-embedded tissue specimens to demonstrate the presence of apoptosis.

RESULTS

Data obtained from 29 samples (varicocele, 24 patients; control, 5 patients) revealed that apoptosis was quite rare in testicular tissue of control group. Mean percentage of apoptotic cells per high power field (x400 magnification) was 2% for the control group and 14.7% for varicocele patients.

CONCLUSION

In light of our data, it appears that apoptosis may have a significant role in spermatogenetic dysfunction associated with varicocele.

Reactive oxygen species production by the spermatozoa of patients with idiopathic infertility: relationship to seminal plasma antioxidants

PURPOSE

We attempted to determine reactive oxygen species production by the spermatozoa of patients with idiopathic infertility and healthy donors, and observe whether increased production was due to decreased seminal plasma reactive oxygen species scavengers.

MATERIALS AND METHODS

Reactive oxygen species production by spermatozoa and seminal plasma antioxidants was assayed in 18 patients with idiopathic infertility and 10 controls. Reactive oxygen species formation and seminal plasma antioxidants were measured by luminol and lucigenin dependent chemoluminescence, and enzymatic methods, respectively.

RESULTS

Higher reactive oxygen species production was observed in 16 of the 18 patients (88.8%, p < 0.0001 versus controls). Seminal plasma superoxide dismutase, catalase, glutathione peroxidase and total sulfhydryl group levels in infertile patients were significantly lower than in controls.

CONCLUSIONS

Decreased seminal plasma antioxidant activity and increased reactive oxygen species production can be responsible for idiopathic male infertility.

Enzymatic treatment of ileal segments used for urinary tract reconstruction

Urinary tract reconstruction by using various gastrointestinal segments is not devoid of complications which may hamper to a great extent the beneficial effects of the procedure. Intestinal mucosa is the primary site responsible for these complications and any procedure aiming at the prevention of untoward effects of intestinal interposition should abolish the absorptive and secretory functions of the mucosa. Augmentation cystoplasties by ileal segments were performed on 24 male albino Wistar rats. In 12 animals de-epithelialization of the mucosa with an enzymatic cock-tail, consisting of type I and type V collagenases and trypsin, preceded the cystoplasty. The functional capacity of the epithelium was determined by a simplified glucose absorption test in the third postoperative week. Morphological examination before the absorption test did not reveal any fibrosis or shrinkage of the ileal segments. Complete elimination of the absorptive capability in enzyme treated mucosa was found during the glucose absorption test, while a rapid and highly effective absorption was observed in the control group (p < 0.05). As a result, it seems possible to obtain intestinal segments covered with a mucosa which acquired similar characteristics to uro-epithelium, therefore closely resembling the original urinary tissues.

Changing patient and stone features for shock wave lithotripsy (SWL) in Turkey

Shock wave lithotripsy (SWL) has made a revolution in the treatment of urolithiasis. Recent reports suggesting that stone features for SWL have changed during the last years have forced us to compare our initial and last 250 patients treated at our ESWL unit in terms of stone and patient characteristics. We found that the number of ureteric stones and small calyceal stones have increased significantly with time whereas the number of larger stones undergoing SWL has decreased significantly. We believe that this change in stone features is caused by the changing trends in the treatment of stone disease by incorporating other therapeutic options and modifying the SWL indications according to patient characteristics We also believe that prophylactic lithotripsy for asymptomatic calyceal stones still remains to be a debatable issue.

Extracorporeal shock wave lithotripsy (ESWL) for urinary tract stones using Dornier MFL 5000, performed by the technician

As the only lithotripsy centre at a University Hospital in the most crowded city of Turkey, we have a big number of patients with urinary stones. Between April 1990 and August 1993, 2680 sessions of treatment were done to 1257 renal units. Our study reveals that the results obtained by the performance of an experienced technician are just as reliable as those obtained by an experienced urologist.

Social and medical aspects of undescended testes in Turkey

In this study, 6,381 primary school boys were examined in Turkey in the years 1990 and 1991 and families and medical personnel were questioned about the information they had on undescended testes and their behavior regarding this matter was noted. Undescended testes were found in 91/6,381 pupils (1.43%) Forty-six families (58.7%) were aware of the abnormality. In 36 of these 46 cases (78%), the mother was the first who noticed the problem. Only 3 cases were first diagnosed by medical staff (nurses or doctors). Eighteen cases were diagnosed under 2 years of age, but apparently they had not been managed correctly because of ignorance regarding possible complications. Of the 46 families, who were aware of the problem, only 29 (63%) had seen a physician. In other words, only 31% (29/91) of the boys with undescended testes received medical help. This study has shown that no genital organ examination of the newborn is performed after most deliveries and there is a considerable unawareness of undescended testes both by the families and by medical personnel.

Correction of primary and secondary vesicoureteral reflux by subureteric Teflon injection

Polytetrafluoroethylene (Teflon) has been used for various purposes since 1963 and in urologic practice for the treatment of vesicoureteral reflux (VUR) since the 1980s. In this study we report on our experience with Teflon injection for the treatment of 28 children with primary or secondary reflux. An overall success rate of 91.3% was achieved in the treatment of primary and 66.6% in secondary reflux. With these results we conclude that Teflon injection is a good alternative in the treatment of VUR.

Short-term bioeffects of extracorporeal shockwave lithotripsy

Safety guidelines for shockwave delivery during extracorporeal shockwave lithotripsy (SWL) are not yet clear. Renal functions were assessed by using urinary N-acetyl-beta-D-glucosaminidase (NAG), lactate dehydrogenase (LDH), alanine aminotransferase (ALT; EC.2.6.1.2), aspartate aminotransferase (AST; EC. 2.6.1.1), and gamma-glutamyltransferase (GGT) as well as sodium, potassium, and calcium concentrations in respect to tubular functions after SWL with the Dornier MFL 5000 unit in 32 patients. In order to monitor glomerular function, we determined microalbuminuria. Transient glomerular and tubular damage occurs in SWL-treated kidneys. The minimum interval between two shockwave treatments should be at least 7 days.

Ureteral extracorporeal shock wave lithotripsy utilizing Dornier MFL 5000

Early reports indicated that stones in the upper ureter that have been manipulated back into the kidney have a higher success rate with SWL than those treated in situ. Difficulties in detecting stones in the mid and lower ureter with lithotripters using ultrasonographic localization also limit in situ SWL of ureteral calculi. We treated 254 patients with ureteral calculi (85 upper, 72 mid, and 97 lower) using in situ SWL on the Dornier MFL 5000. The mean stone volume was 1.4 cm2. Approximately one third of the patients required more than one session. The mean number of shock waves was 2010 (range 1400-3000) with a mean voltage of 20 kV (range 14-30 kV). Fragmentation was achieved in 92.6% of the patients. Only 0.4% of the sessions involved general anesthesia. At 3-month follow-up, available in 75% of the patients, the stone-free rate was 82.6%. Ureteral calculi can be treated effectively in situ by means of SWL.

Human leukocyte antigen subtype analysis in patients with advanced adenocarcinoma of the prostate

Human leukocyte antigens (HLA) are cell surface glycoproteins that have a significant role in the immune system. In some cancers, changes in major histocompatibility complex (MHC) class I and II expression, usually a reduction or loss of these molecules, appear to provide a mechanism whereby tumor cells may escape host immunity. HLA analysis in patients with advanced adenocarcinoma of the prostate revealed the antigens with the highest relative risk factors as DRw52, DRw53, Bw73, DR2, and B5(51). As a result, determination of HLA haplotypes may prove to be useful in determining the men with a higher risk of developing prostate cancer.

Transurethral grooving of the prostate in the treatment of patients with benign prostatic hyperplasia. An alternative to transurethral incision

Various alternatives exist for the treatment of bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Incision of the bladder neck and prostate has proved its efficacy in many studies, especially in small prostates. The major drawback of the procedure is inability to obtain tissue specimens to exclude malignancy. We introduced a method to overcome this drawback by incising grooves at 5 and 7 o'clock with standard resection loops which created not only the incisions but also provided enough tissue for pathological examination. Twenty-five patients with BPH underwent transurethral grooving. Pre- and post-operative urodynamic studies revealed significant improvement in both maximum and average flow rates. The re-operation rate in the entire group was 12%. Transitional cell carcinoma of the prostatic urethra was detected in 1 patient, which proved its superiority to standard incision procedures.

Efficacy of prophylactic gentamicin use in postoperative urinary tract infections after endoscopic procedures of the urinary tract

In this study, the efficacy of prophylactic antibiotic use was investigated. A total of 110 patients undergoing endoscopic procedures of the urinary tract were enrolled in the study. Fifty-five of the patients were treated with 8-hourly, 80 mg gentamicin sulfate of total three doses. The drug administration began just prior to the operation. Seven postoperative infections (12.7%) were detected, the same number as in the control group of 55 patients. The results confirm that there is no place for gentamicin prophylaxis in endoscopic procedures of the urinary tract.

Severe obstruction of the urinary tract due to talcum powder granuloma after surgery. A case report

Talcum powder which is generally used for lubrication of surgical gloves can be responsible for granuloma formation with subsequent complications. This is the report of a case with progressive urinary tract obstruction.

Adenocarcinoma of the prostate with endometrioid features

Two cases of prostatic carcinoma with papillary features resembling the so-called "endometrioid carcinoma" are presented. Immunohistochemical studies, response to therapy and review of the literature support the ductal origin of the tumour, probably multifocal, as it is commonly seen in conjunction with acinotubular carcinoma.

Teflon injection in the treatment of vesicoureteral reflux: a promising alternative for surgery

Vesicoureteral reflux is a common disorder of the urinary tract in children. The incidence is especially high in patients suffering from urinary tract infection. There is controversy in the management of the disorder and a recently introduced method, Teflon injection, seems to offer a promising alternative as a non-invasive technique.

Current approaches in the treatment of bladder cancer and policy in Marmara University Hospital

Bladder cancer is one of the malignancies encountered frequently in urologica practice. Since the three main treatment modalities (surgery, chemotherapy and radiotherapy) may be used alone or together, there are many treatment options. In this paper the current approaches in the treatment of bladder tumours are reviewed and the policy in Marmara University Hospital is described.

Present status of undergraduate urological education in Turkey: is standardization necessary?

23 medical faculties exist in Turkey at the moment and 2 others are being established. Considering that all these faculties run their own programs independently, different education systems might effect the standard of doctors and health care. All of the new graduates in this country face a centralized examination for postgraduate posts in teaching hospitals or start an obligatory service under the authority of the Ministry of Health and Social Welfare. This necessitates standardization in medical education to provide equal facilities and opportunities to all young doctors. Questionnaires, replied to by the urology departments of medical faculties, reflect a wide range of teaching periods in urology with a broad spectrum of topics. Under these circumstances it is advisory to agree on both the time period and content of a standard urology program, as well as other subjects, for better health care and equal chances in centralized examinations.

Ectopic production of human chorionic gonadotropin in transitional cell carcinoma of the bladder. An immunohistochemical study

A retrospective histopathological and clinical analysis of 43 patients with transitional cell carcinoma of the bladder, attending our institution between March 1986 and April 1989, was performed. The indirect immunoperoxidase method was used for the demonstration of human chorionic gonadotropin production in transitional cell carcinoma cells. Nine of the 16 grade III tumors stained positive for human chorionic gonadotropin, while grade I and grade II tumors remained unstained. Our results suggest that the presence of human chorionic gonadotropin in tumor cells is a strong evidence of dedifferentiation, and its association with patient prognosis needs further investigation, especially in high-grade, low-stage tumors.

Urethral caruncle in an unusual location occurring in prepubertal girl

Urethral caruncles are the most frequent benign tumors of the female urethra; the great majority occur after the menopause. Caruncles in prepubertal girls are quite rare and location other than the posterior lip of the urethra is quite rare too. In this paper we report a case with these rare properties.

Urinary hydroxyproline levels in patients with prostatic carcinoma

In this study daily urinary hydroxyproline (HOP) levels were evaluated in 26 patients with advanced prostatic cancer and 15 patients with BPH. In patients with prostatic cancer--the ones with bone metastases proved by bone scanning--urinary HOP levels were found to be 69.58 mg/l/day and in those without metastases the levels amounted to 22.55 mg/l/day. In patients with BPH, serving as controls, urinary HOP was 12.80 mg/l/day. Urinary HOP Levels in cancer patients were statistically higher than in the control group. This difference was even more significant in patients with bone metastases. The method detects small metastatic foci of low activity, therefore it may be used also in smaller centres and for effective monitoring of therapy.