Cytomegalovirus and Epstein-Barr virus reactivation in the intensive care unit

AIM

The purpose of this work was to evaluate the reactivation of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in immunocompetent patients in the intensive care unit (ICU) and to identify risk factors associated with reactivation.

MATERIALS AND METHODS

In this observational prospective study, 60 adult immunocompetent patients who stayed at least 7 days in an ICU were evaluated. During hospitalization, the viral load was monitored at admission and on day 7 with polymerase chain reaction to detect viral reactivation and weekly thereafter on days 14, 21, and 28 if hospitalization continued.

RESULTS

The mean age of patients was 63.3 years (±23.4 years) and 34 (56.7 %) of them were male. Mean APACHE II scores for patients was 25 at admission. Of these patients, 28 were hospitalized in the internal ICU and 32 were hospitalized in the anesthesiology ICU. CMV/EBV reactivation was found in 17 individuals (12 for EBV, 3 for CMV, and 2 for both). The median high-sensitive C-reactive protein value in patients with CMV reactivation was significantly higher than in those patients without CMV reactivation (p = 0.037). EBV reactivation was statistically higher in patients with mechanical ventilation compared to patients without mechanical ventilation (p = 0.023). EBV reactivation in patients with fever was found to be statistically higher than in the patients without fever (p = 0.035).

CONCLUSION

There is a need for extended studies with a larger number of patients from specific groups to better understand the reactivation frequency and identify risk factors. EBV and CMV reactivation should be taken into consideration in critically ill patients with fever, without specific symptoms and unresponsive to the treatment.

Gram-Negative Bacterial Resistance to Cephalosporins in Community-Acquired Infections in Turkey

Cephalosporins are widely used and trustworthy antibiotics in daily medical practice. Although antibacterial resistance has been reported in hospital wards, there are less data for community-acquired infections. In this study we investigated the cephalosporin susceptibility profiles of community-acquired Gram-negative bacteria isolates in Sivas Kizilay Medical Center (Turkey) between March 2002 and March 2003. In our study, 949 Escherichia coli, 165 Proteus spp., 97 Enterobacter spp., 24 Klebsiella spp and 84 Pseudomonas aeruginosa strains were evaluated. Cefepime seemed to be the most effective antibiotic against our community-acquired Gram-negative isolates. Resistance to this drug was 19.3% for P. aeruginosa and around 0-10.6% for enteric bacteria. Enteric pathogen resistance ranged between 44.3-100% for cefazolin, 25-51.9% for cefuroxime, 4.8-25.3% for ceftriaxone, 5.4-14.5% for ceftazidime. Resistance in enteric pathogens to gentamicin ranged between 5.8-15.4%, to amikacin between 3.8-6.25%, to ciprofloxacin between 6.7-20%. 8.1% of P. aeruginosa were resistant to ciprofloxacin. With these profiles the aminoglycosides and ciprofloxacin resemble highly effective cephalosporins like cefepime. On the contrary, first- and second-generation cephalosporins, trimethoprim-sulfamethoxazole, ampicillin and ampicillin-sulbactam are no longer used in probable Gram-negative bacterial infections in our region. Since treatment based on cephalosporins was less efficacious than expected in community-acquired infections, urgent measures are needed to limit antibacterial resistance outside of hospitals.

Comparison of rapid rhino and merocel nasal packs in endonasal septal surgery

OBJECTIVE

Our study compared Rapid Rhino (RR; Applied Therapeutic Ltd, Leicestershire, UK) and Merocel (Medtronic Xomed, Jacksonville, FL) nasal packing materials in endonasal septoplasty surgery in terms of postoperative patient comfort and reactionary bleeding.

PATIENTS AND METHODS

Fifty-one patients underwent endonasal septoplasty. One nasal cavity was packed with Merocel packs and the RR pack was used for the other side. The pain and nasal fullness levels on each side were studied at 1 and 6 hours postoperatively. Pain level was also studied during the removal of the nasal packs on the second day. These levels were scored on the basis of a visual analogue scale (VAS) between 0 and 10. Reactionary bleeding after nasal pack removal was also recorded. The Wilcoxon test was used for statistical analysis of the VAS scores, and the McNemar test was used for comparison of bleeding levels after pack removal. A p value<.05 was considered to be statistically significant.

RESULTS

Minimal bleeding was noted in 15 patients following Merocel pack removal; however, no bleeding was seen following RR pack removal. Comparison of the VAS scores of pain and nasal fullness of each nasal pack at 1 and 6 hours postoperatively showed a statistically significant difference (p<.05). Similarly, comparison of the pain level for pack removal and bleeding after removal on the second postoperative day demonstrated a statistically significant difference (p<.05 and p=.001, respectively).

CONCLUSION

RR is more tolerable by patients than Merocel after septoplasty surgery. RR also has some advantages, namely, easy pack removal and less reactionary bleeding.

Pulmonary protective effects of hyberbaric oxygen and N-acetylcysteine treatment in necrotizing pancreatitis

The purpose of this study is to analyze the protective effect of combining N-acetylcysteine (NAC) and hyberbaric oxygen (HBO) treatment in the lung tissue during acute pancreatitis. Sixty Sprague-Dawley male rats were randomly divided into five groups; Group I; Control group (n=12), Group II; pancreatitis group (n=12), Group III; pancreatitis + NAC treatment group (n=12), Group IV; pancreatitis + HBO treatment group (n=12), Group V; pancreatitis + HBO + NAC treatment group (n=12). HBO was applied postoperatively for 5 days, twice a day at 2.5 fold absolute atmospheric pressure for 90 min. Lung tissue was obtained for measuring malondialdehyde (MDA), superoxide dismutase (Cu/Zn-SOD) and glutathione peroxidase (GSH-Px) levels along with histopathological tissue examinations. This study showed that all three treated groups (HBO alone, NAC alone and combined HBO+NAC treatment) had pulmonary protective effects during acute necrotizing pancreatitis.

Venlafaxine extended release for the treatment of patients with premature ejaculation: a pilot, single-blind, placebo-controlled, fixed-dose crossover study on short-term administration of an antidepressant drug

In this study, we aimed at evaluating the efficacy and safety of venlafaxine extended release 75 mg, a serotonin and noradrenaline reuptake inhibitor, in the treatment of patients with premature ejaculation. Thirty-one patients with intravaginal ejaculation latency of less than 2 min received venlafaxine XR (75 mg/day) or placebo during a 2-week period for each agent with a washout period of 1 week between agents. Efficacy was assessed for each agent with changes in ejaculation latency measured with a stopwatch and sexual satisfaction scores of patients and partners. Side-effects, pre- and post-treatment levels of biochemical and spermiogram parameters, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin and total testosterone were recorded for each agent. Statistical analysis was performed on 21 patients. After 2 weeks of treatment with placebo and venlafaxine, ejaculation latency time was significantly increased from 60.1 +/- 39.1 to 126.9 +/- 98.3 sec and to 178.1 +/- 122.8 sec, respectively (p < 0.0001 for each one). However, the difference between the two agents was insignificant (p = 0.144). Venlafaxine and placebo increased sexual satisfaction scores of both patients and partners similarly, no statistically significant difference was found between them in this respect. The incidence of side-effects with venlafaxine was indifferent than that of placebo (p > 0.1) except nausea (p = 0.035). Both agents did not change the blood and spermiogram parameters significantly, except FSH increases. Short-term use of venlafaxine XR 75 mg has only a placebo effect on ejaculation latency and sexual satisfaction scores, therefore, is not appropriate for the patients with premature ejaculation. Further dose-time studies are required to draw final conclusions on the inefficacy of this drug in premature ejaculation.

Evaluation of flow hemodynamics by color-Doppler following two different brachial arterial repair techniques

OBJECTIVES

We compared the clinical and hemodynamic results following surgical repair of traumatic brachial artery injury using two different techniques micro- and macrovascular repair.

MATERIALS AND METHODS

This was a retrospective study of 27 patients who had sustained penetrating, clean cut injuries of the brachial artery. Macrovascular techniques and a saphenous vein graft was used in 13 patients, while 14 patients were treated by primary microsurgical technique. Postoperatively, patients were followed for a mean of 26 months. All patients had color Doppler examination of the brachial artery, digital artery pressures and transcutaneous oxygen saturation determined.

RESULTS

Clinical results based on distal pulses, Allens test and digital pressures were similar in the two groups. Color Doppler showed 8/13 anastomotic stenoses in macrovascular vein grafted repairs and 2/14 in microvascular repairs (p<0.05). The ratio of flow velocity proximal compared distal to the injury was significantly decreased in patients who had macrovascular repairs.

CONCLUSION

Using ratio between proximal and distal site of anastomosis maximal peak systolic velocity as a objective color Doppler parameter, we were able to demonstrate differences in the hemodynamic status following macrovascular repair with vein grafts and microvascular primary repair. The results emphasize the importance of using a standard repair technique for similar injuries rather than the preference of the surgeon.

[A seroprevalence study of Coxiella burnetii in Antalya, Diyarbakir and Samsun provinces]

The aim of this study was to demonstrate the presence of Q fever infection in three selected provinces, located in South Anatolia, Southeast Anatolia and Black Sea regions of Turkey. Specimens of 339 healthy subjects (114 from Antalya, 116 from Diyarbakir, and 109 from Samsun) were randomly selected from serum samples that are stored in National Serum Bank, Refik Saydam National Hygiene Center, and tested for the presence of IgG antibodies against Coxiella burnetii phase II antigen by using indirect immunofluorescent antibody (IFA) test with a commercial kit (Vircell, SL Granada, Spain). IgG antibodies were accepted positive in case of > or = 1:64 titers, and negative in case of < 1:64 titer, according to the test guidelines. IgG seropositivity rates were found 13.2% (n: 15), 6% (n: 7) and 1.8% (n: 2), in Antalya, Diyarbakir and Samsun provinces, respectively, with an overall rate of 7.1% (n: 24). By logistic regression analysis on the positive IgG antibodies, no significant differences were shown in terms of age, gender and residence in all the three selected provinces, but seropositivity rate was significantly higher in Antalya (OR=8.21, %95 GA=1.82-36.96). The study results showed that Q fever exists in Turkey, and it is necessary to take control measures against this disease.

Large cavernous hemangioma of the kidney presenting as a solid renal mass

We report a case of large renal hemangioma that completely filled the collecting system in a 43-year-old man. Most of the renal hemangiomas are small in size and this situation is extremely rare. The diagnosis and treatment of the case is discussed.

Hepatitis agents with enteric transmission--an epidemiological analysis

BACKGROUND

Viral hepatitis is characterized by special clinical, biochemical and serological findings. This study was planned to determine the seroprevalence, epidemiological characteristics and clinical and biochemical findings of hepatitis A virus (HAV) and hepatitis E virus (HEV) infections during an outbreak of jaundice.

MATERIALS AND METHODS

340 children aged 5-16 years were included. Clinical findings and alanine aminotransferase (ALT) levels were documented. Anti-HAV IgG and IgM in addition to anti-HEV IgG and IgM were determined by microELISA.

RESULTS

Clinical findings, high levels of ALT, anti-HAV IgM and IgG, anti-HEV IgM and IgG were present in 6%, 23%, 17%, 100%, 7% and 9% of cases, respectively. The relationship between ALT levels and anti-HAV or anti-HEV IgM seropositivity was significant (p </= 0.0001).

CONCLUSION

HAV and HEV infection were both caused by a contaminated water supply.

Detection of LOH of the RB1 gene in bladder cancers by PCR-RFLP

OBJECTIVES

Retinoblastoma (RB1) gene involves in retinoblastoma, osteosarcoma, bladder, prostate, lung, breast carcinomas, and soft tissue sarcomas. Loss of heterozygosity (LOH) is the most common mutation of the gene.

METHODS

Xba I polymorphism in intron 17 of the gene was used to detect LOH in 20 bladder cancer patients. A cystitis and an osteosarcoma were used as control. LOH was investigated in three different kinds of samples (blood, paraffin-embedded tissue and fresh tissue) belonging to the same patients, and 20 blood samples, 20 paraffin-embedded tissue samples and 16 fresh tissue samples were obtained from 20 cancer patients.

RESULTS

None of the 20 blood samples showed LOH. Eleven out of 20 paraffin-embedded bladder tissues were amplified, 3 of them homozygous and all 8 informative paraffin-embedded tissues showed LOH. Five out of 16 fresh tumor tissues obtained were amplified, in 1 the fresh tissue was normal, 1 fresh tissue showed LOH and 3 were not digested by Xba I.

CONCLUSION

The results of the study have suggested that detection of LOH of the RB1 gene by PCR-RFLP can be a good adjunctive test for evaluation of the bladder cancer.

Influence of antioxidants on the blood-brain barrier permeability during epileptic seizures

Pentylenetetrazol-induced seizures in rats lead to the breakdown of the blood-brain barrier. We compared the disruption of the blood-brain barrier during epileptic seizure in untreated rats and in rats treated with vitamin E or selenium. The rats were supplemented with nontoxic doses of sodium selenite (4 pp) in drinking water for 3 months, or vitamin E (70 mg/kg) was given intraperitoneally for 30 min before the pentylenetetrazole injection. Evans-blue was used as a blood-brain barrier tracer and was given intravenously at a dose of 4 ml/kg of a 2% solution. The rats were divided into four experimental groups. Group I: control (n = 24); Group II: pentylenetetrazole-induced seizure (n = 12); Group III: vitamin E injected + seizure (n = 12); Group IV: Selenium supplemented + seizure (n = 12). The rats subjected to epileptic seizures showed Evans-blue albumin extravasations especially in the thalamic nuclei, brainstem, occipital, and frontal cortex. Mean values for Evans-blue dye were found to be 0.28 +/- 0.04 mg % brain tissue in control rats and 1.6 +/- 0.2 mg % brain tissue after epileptic seizures (P < 0.01). The magnitude of distribution of the blood-brain barrier during epileptic seizures was significantly less in rats treated with vitamin E or selenium. The mean value for Evans-blue dye was found to be 1.2 +/- 0.1 mg % brain tissue in selenium supplemented rats and 1.2 +/- 0.1 mg % brain tissue in vitamin E injected rats after epileptic seizures. This difference between treated and untreated animals was found to be significant (P < 0.05). The findings of the present study suggest that free radicals contribute to disruption of the blood-brain barrier during pentylenetetrazol-induced seizures.

Pigmented villonodular synovitis of the knee presenting as a popliteal cyst

Pigmented villonodular synovitis is a locally aggressive tumor of the synovium of joints and tendon sheaths. It is commonly seen in the synovial lining of the flexor tendons of the hand and in the synovium of the knee and less commonly in other joints. A case of pigmented villonodular synovitis of the knee in a 60-year-old man, with an intra-articular origin extending extra-articularly, is presented. The interesting point is that the initial diagnosis was a Baker cyst.

Do renal failure and hemodialysis have any effect on the elimination of free and total prostate-specific antigen?

OBJECTIVES

The aim of this study was first to determine the serum levels of free prostate-specific antigen (f-PSA), total prostate-specific antigen (t-PSA) and f-PSA/t-PSA ratios in patients with renal failure, and secondary, to investigate whether a significant difference between serum f-PSA and t-PSA levels consists in patients with end-stage renal disease before and after hemodialysis.

METHODS

Serum concentrations of f-PSA and t-PSA were measured in 36 men with end-stage renal disease before and after hemodialysis and in 95 healthy controls. A chemiluminescent enzyme assay was used to determine the levels of f-PSA and t-PSA.

RESULTS

The mean concentrations of serum t-PSA were 1.36+/-0.43 ng/ml in patients on hemodialysis and 1.08+/-0.60 ng/ml in controls. There was no significant difference in f-PSA and t-PSA levels between patients with renal failure and controls. F-PSA and t-PSA levels in patients with renal failure also showed no statistical differences before and after hemodialysis.

CONCLUSIONS

The limited kidney reserve in patients with end-stage renal disease is sufficient to maintain the levels of t-PSA and f-PSA within normal ranges and hemodialysis does not alter the serum levels of different PSA forms.

Successful bone marrow transplantation in a case of Griscelli disease which presented in accelerated phase with neurological involvement

Griscelli disease (GD) is a rare disorder characterized by pigment dilution, immunodeficiency and occurrence of accelerated phase consisting of hemophagocytosis, pancytopenia and neurological manifestations. Allogeneic BMT in the early period is an important modality of treatment for GD. We carried out an alloBMT from an HLA-identical sibling donor on a 4-year-old girl who presented in accelerated phase with neurological manifestations including convulsions, strabismus, severe dysarthria, ataxia and clonus. She was treated with etoposide, methylprednisolone and intrathecal methotrexate for 8 weeks and underwent alloBMT after receiving a conditioning regimen including ATG (rabbit, 10 mg/kg x 5 days), Bu/Cy. 8 x 108/kg nucleated bone marrow cells were given. Engraftment occurred early and the post-BMT period was uneventful. Currently, she is at 18 months post BMT with sustained engraftment and with a normal neurological examination except for minimal clonus. Long-term follow-up will determine the prognosis regarding the neurological findings.

Alopecia universalis in a patient with common variable immunodeficiency

A 12-year-old boy with common variable immunodeficiency (CVI) who developed severe alopecia is presented. His sister also had alopecia and recurrent infections and died of lung infection at the age of 7 years. The loss of hair in both children was total; the pathology of a scalp skin biopsy specimen was typical for alopecia areata. The boy was subjected to clinical and immunologic evaluation and the results were compatible with common variable immunodeficiency.

Serum prolactin in neonatal seizures

BACKGROUND

Prolactin is the most specific neurohormone that is elevated after seizures. This study was undertaken to determine the clinical usefulness of plasma prolactin as a diagnostic aid in differential diagnosis of neonatal convulsions.

METHODS

Forty-five patients followed for seizures were included in the study. Postictal serum prolactin levels were obtained 30 min after the onset of the seizures. A second sample obtained 24 h later was used to measure an unstimulated serum prolactin level.

RESULTS

The most common cause of seizure was hypoxic ischemic encephalopathy (HIE) followed by sepsis. In patients with HIE, postictal serum prolactin levels were significantly higher than the unstimulated levels (P < 0.0002). Additionally, postictal prolactin levels were significantly higher than the unstimulated levels in clonic (P < 0.02) and tonic convulsions (P < 0.001).

CONCLUSIONS

We conclude that the postictal serum prolactin level may be a marker in the differentiation of seizures as well as providing important information about their etiology. Further studies are needed to assess the normal range of serum prolactin levels in unstressed newborns.

Serum free and total prostate-specific antigen levels in patients with liver disease

OBJECTIVES

To determine the effect of liver diseases on serum free prostate-specific antigen (fPSA) levels, total prostate-specific antigen (tPSA) levels, and fPSA/tPSA ratios.

METHODS

Serum concentrations of tPSA and fPSA were measured in 18 men with histologically confirmed liver cirrhosis, 20 men with histologically proved chronic hepatitis, and 20 healthy men. All patients underwent a standard urologic evaluation, including history, physical examination, urine analysis, serum fPSA and tPSA determinations, and liver function tests (serum bilirubin, serum glutamic oxaloacetic transaminase, and serum glutamic pyruvic transaminase).

RESULTS

Patients with liver cirrhosis had slightly lower fPSA levels than did control subjects or patients with chronic hepatitis, but these differences did not reach statistical significance. tPSA levels also were not significantly different among the three groups.

CONCLUSIONS

In the presence of liver disease, despite the limited liver reserve, tPSA and fPSA are specific and reliable markers in the clinical management of prostatic diseases in this population. This result should be taken into account when serum concentrations of fPSA, tPSA, and the fPSA/tPSA ratio are evaluated in patients with liver disease.

Ratio of free to total prostate-specific antigen in patients with prostatic intraepithelial neoplasia

OBJECTIVE

There are many reports about the effects of prostatic intraepithelial neoplasia (PIN) on serum prostate-specific antigen (PSA) level. The aim of this study was to determine the relationship between PIN and serum free PSA/total PSA (fPSA/tPSA) ratios.

METHODS

We evaluated 46 patients with PIN, 15 patients with benign prostatic hyperplasia (BPH), and 16 patients with localized prostatic carcinoma (CaP) for the amount of fPSA and tPSA with the chemiluminescent enzyme assay.

RESULTS

fPSA values from BPH to high-grade PIN (PIN2 and PIN3) was increased, and then a decrease was observed from high-grade PIN to CaP. fPSA was significantly different between BPH and low-grade PIN and high-grade PIN. There was no significant difference observed between BPH and CaP. tPSA values increased from BPH to CaP. tPSA was significantly different between BPH and high-grade PIN and CaP. fPSA/tPSA ratios decreased from BPH to CaP. This ratio was significantly different between CaP and BPH and low-grade PIN. There was no significant difference between CaP and high-grade PIN.

CONCLUSIONS

Our results confirm that fPSA/tPSA ratio is better at discriminating between patients with CaP and those with BPH, but not between patients with CaP and those with high-grade PIN. Due to similarities between CaP and high-grade PIN, we think that decreased fPSA/tPSA ratio obtained at the time of intial diagnosis of PIN without concurrent carcinoma could be used as predictive factors to distinguish patients in whom carcinoma will be found on subsequent biopsies from those with PIN not associated with cancer on repeat biopsy.

Systemic candidiasis with acute Epstein-Barr virus infection

Systemic Candida infections are usually encountered as opportunistic infections in a setting of immunologic depression. Sepsis or arthritis due to Candida is not expected in healthy people. Epstein-Barr virus may infect B cells, but does not cause immunosuppression of any clinical significance. As far as we know, invasive non-albicans Candida infection complicating Epstein-Barr virus infection has not been reported in previously healthy children. In this report, two previously healthy children, one with sepsis due to Candida species and the other sepsis and arthritis due to Candida parapsilosis are described. Both patients were male and were aged 2 and 9 y. The diagnosis was confirmed by culture. Both children also had coincidental acute Epstein-Barr virus infection, confirmed by Epstein-Barr virus viral capside antigen-IgM. They were both cured with fluconazole given for 21 days and 48 days, respectively.

Stone disintegration: effect of shock wave projection and electrode age on this parameter in a standard stone model

Despite the real effectiveness and successful results of shock wave application, the effect of some varying parameters, namely number of shock wave (SW) electrical discharge value (kV), projection of the shock waves and electrode age are still to be evaluated. By using a standard stone model, we evaluated the real effect of the projection of shock waves and electrode age on the degree of stone disintegration. Our results indicated no significant relationship between the kV value and the degree of stone disintegration. However, as the number of SW increased, the rate of disintegration became evident. On the other hand, application of the same number of SW from two different angles revealed more effective disintegration rate on standard stone model. Thus SW number, age of the electrode and the projection of shock waves seemed to be important in the disintegration of the stones.

Effects of extracorporeal shock wave lithotripsy on stone forming risk factors

It has been reported in some definite studies that ESWL causes transient deterioration in renal haemodynamics and function. Again certain parameters in blood and urine have been used in order to assess this functional deterioration and different results are reported. In our present study we aimed to describe the adverse effects of shock waves on the excretion of urinary metabolites such as electrolytes, oxalate and citrate. Evaluation of our results in 30 patients revealed that although exposure to shock waves during ESWL for symptomatic renal calculi causes a slight increase in the urinary level of metabolites, all of these changes remained in normal range and no statistically significant changes in the urinary level of the aforementioned parameters could be demonstrated.

Effect of total and ionized calcium levels of seminal fluid on sperm motility

Total and ionized calcium (Ca2+) levels of seminal fluid were assessed in 75 semen samples obtained from infertile patients and fertile patients referred to our clinic with different complaints. Patients who showed only motility disorders on sperm analysis were include into the study program. Forty-five patients showing hypomotility (motility < 60%) and 30 patients with normal motility (motility > or = 60%) on sperm analysis were evaluated comparatively. No significant difference was observed in the seminal fluid concentration of total calcium, regardless of spermatozoa motility immediately after ejaculation. However, the seminal fluid of men with hypomotility exhibited a significantly lower Ca2+ concentration (p < 0.05) when compared with that of men with normal motility. A significant difference was observed in the seminal fluid Ca2+/total calcium rate (p < 0.05) when compared with that of men with normal motility. Further, spermatozoa from men with hypomotility exhibited both a significantly lower progression rate and sperm count. Our study suggests a direct relationship between Ca2+ and sperm motility.

Long-term follow-up of renal morphology and function in children after lithotripsy

Between October 1990 and May 1991, extracorporeal shock wave lithotripsy (ESWL) was performed on 35 children. All the treatments were done with the Dornier MPL 9000 Lithotriptor under sedation. Following treatment all the children were controlled regularly every 6 months, and the long-term follow-up results concerning the renal functional and morphological alterations together with changes in blood pressure values and the rate of stone recurrence were analyzed. Renal functional evaluations using a radiosiotope renogram revealed a transient decrease in renal function in the early follow-up period (0-3 months), which returned to normal limits after this period. Sonographic evaluation of the renal dimensions and morphology did not show any gross pathology in the early and long-term evaluation. Again determination of renal parenchymal thickness together with renal growth showed no statistically significant alteration in the late control of the children. Finally, careful monitoring of blood pressure and the recurrence rate of stone disease revealed no statistically significant changes in these aspects. ESWL seems to be the preferred treatment modality in children due to its safe and effective therapy results. Especially the long-term evaluation of our children proved the safety of this procedure.

Evaluation of cellular immunity following bacillus Calmette-Guérin therapy in patients with superficial bladder cancer

Despite its marked effectiveness in the prevention of tumor recurrences, a great deal of information on the mode of action of Bacillus Calmette-Guérin (BCG) as an antitumor therapy modality is still lacking. In this prospective study, by performing lymphocyte subset analysis and quantitative assessment of delayed hypersensitivity skin reactions before transurethral resection of the detected tumor and 3-6 months after intravesical BCG administration in 23 patients with superficial bladder carcinoma, we tried to demonstrate the immunostimulatory effect of BCG therapy. We had 4 recurrences at 6 months' follow-up. Evaluation of lymphocyte subset analysis readings in our group revealed a statistically significant difference (p < 0.05) in CD4+/CD8+ ratio between baseline values and that obtained following BCG administration at 3 and 6 months. However, there was no statistically significant increase of this value in 4 patients who had tumor recurrences. Evaluation of delayed hypersensitivity skin test score results revealed a statistically significant increase in the whole group at 3 months of follow-up (p < 0.05) but the same evaluation at 6 months of follow-up showed no statistically significant difference with respect to this evaluation. Again, no statistically significant difference was found in 4 patients who had tumor recurrences. These results support the idea that BCG-associated antitumor activity is an immune-mediated reaction and the assessment of T-lymphocyte subsets together with quantitative evaluation of delayed hypersensitivity skin reactions would give us a definite idea about the immunotherapeutic effects of BCG in such patients.

Adenosine: a new agent in the diagnosis of impotence

The haemodynamic effects of different dosages of adenosine were studied using colour flow Doppler sonography (CFDS) in 33 men, whose penile vascular bed responded well to papaverine. In six cases, we injected 25, 50, 100, 250 micrograms dosages of adenosine intracavernously at 15 min intervals and no erection occurred. However, 500 and 1000 micrograms doses of adenosine increased the arterial blood velocities for a few seconds in five cases. Later on, in eight cases, we infused 80 and 120 micrograms/kg/min adenosine for 3 min and only with 120 micrograms/kg/min dosage, did we observe clinical response and significant changes in CFDS parameters. Finally, 120 micrograms/kg/min adenosine dosage was infused for 10 min in 14 men and eight showed full erection while six had only tumescence. As adenosine was rapidly metabolized by adenosine deaminase, the erection lasted for only 5 to 13 min. No prolonged erection and no other side-effect was observed. In addition no fibrosis and curvature was detected 6 months after the injections. We found that, in men, 10 min infusion of 120 micrograms/kg/min adenosine increased the arterial flow and to some extent venous resistance, resulting in full erection or tumescence. Therefore, adenosine may be used as an agent for the diagnosis of vasculogenic impotence, but further studies for determining the standard dosage of adenosine are needed.

Color flow Doppler sonography in the diagnosis of vesicoureteric reflux

We describe an alternative technique using color flow Doppler sonography (CFDS) for detection of vesicoureteric reflux (VUR). Twenty-one children, ages 2-16 years, were investigated for VUR using voiding cystourethrography (VCU) and CFDS. Forty-two ureterovesical junctions were studied and a total of 27 were found to be refluxing at VCU. Five of these 21 patients were operated for VUR and they were also reevaluated 3 and 6 months after the operation. With good diuresis ureteric jets could easily be detected with CFDS and if there was a reflux of urine into the ureter this could also be displayed. Afterwards, the patient was asked to urinate and if reflux into the ureter was detected, particular attention was paid to the detection of ureteral and pelvicalyceal dilatation by conventional gray-scale sonography. Taking VCU as the gold standard, CFDS revealed reflux in all cases except 1. There were 3 patients who had only one-sided reflux at VCU and bilateral reflux at CFDS examination (false-positive: 20%). Correlation of CFDS and VCU was 90, 100 and 75% in low grade, grade III and grade IV reflux, respectively. The results of CFDS correlated well with the results of VCU during the follow-up of 5 patients who had antireflux operations. As a conclusion, CFDS could be used as an adjunct to standard ultrasonography for detection of VUR.

371 bladder calculi in a benign prostatic hyperplasia patient

We describe a patient with 371 bladder calculi secondary to benign prostatic hyperplasia. To our knowledge this patient had one of the highest numbers of the bladder calculi reported.

The place of acupuncture in the management of psychogenic impotence

Successful sexual functioning is a complex process involving psychological and social responses as well as neurological, biochemical and vascular processes. Today it is believed that more than 50% of the sexual dysfunction cases have an organic etiology. Reflecting the controversy over the management of psychogenic impotence, there are several different methods which are currently in clinical use. In this prospective study we aimed to evaluate the curative effects of acupuncture therapy in men with purely psychogenic impotence. Of the 29 patients treated with this procedure 20 patients demonstrated successful erections following a varying number of acupuncture sessions. In the light of our findings we may conclude that acupuncture may be an effective alternative in the management of purely psychogenic impotence.

Aqueous humour and serum zinc and copper concentrations of patients with glaucoma and cataract

Serum and aqueous humour zinc and copper concentrations of 44 patients with glaucoma and cataract were determined. Serum values were found within normal ranges. The highest mean copper concentration was seen in the glaucoma group. In addition there was a significant negative correlation between the aqueous humour levels of zinc and copper in patients with glaucoma. It was concluded that an increased copper value together with a low zinc value might be of importance in patients with glaucoma.

A simple methods for labeling BSP with 131I

BSP was labeled with 131I using the Greenwood and Hunter method, which was rapid and simple. The chromatoelectrophoresis of the labeled compound showed that the labeling efficiency was 100%. Scintigraphic studies gave good results in accordance with radioactive BSP distribution reported in the literature.