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Aytaç E, Özer L, Baca B, Balık E, Kapran Y, Cığ Taşkın O, Uluç BO, Ufuk Abacıoğlu M, Gönenç M, Bölükbaşı Y, Çil BE, Baran B, Aygün C, Erdem Yıldız M, Ünal K, Erkol B, Yaltı T, Özbek U, Attila T, Tözün N, Gürses B, Erdamar S, Er Ö, Beşe N, Bilge O, Onur Ceyhan G, Molinas Mandel N, Selek U, Yakıcıer C, Kayserili Karabey H, Saruç M, Özben V, Esen E, Özoran E, Vardareli E, Güner L, Hamzaoğlu İ, Buğra D, Karahasanoğlu T, İstanbul Group T. Optimizing the Personalized Care for the Management of Rectal Cancer: A Consensus Statement. Turk J Gastroenterol 2022; 33:627-663. [PMID: 35993526 PMCID: PMC9524446 DOI: 10.5152/tjg.2022.211103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Colorectal cancer is the third most common cancer in Turkey. The current guidelines do not provide sufficient information to cover all aspects of the management of rectal cancer. Although treatment has been standardized in terms of the basic principles of neoadjuvant, surgical, and adjuvant therapy, uncertainties in the management of rectal cancer may lead to significant differences in clinical practice. In order to clarify these uncertainties, a consensus program was constructed with the participation of the physicians from the Acıbadem Mehmet Ali Aydınlar and Koç Universities. This program included the physicians from the departments of general surgery, gastroenterology, pathology, radiology, nuclear medicine, medical oncology, radiation oncology, and medical genetics. The gray zones in the management of rectal cancer were determined by reviewing the evidence-based data and current guidelines before the meeting. Topics to be discussed consisted of diagnosis, staging, surgical treatment for the primary disease, use of neoadjuvant and adjuvant treatment, management of recurrent disease, screening, follow-up, and genetic counseling. All those topics were discussed under supervision of a presenter and a chair with active participation of related physicians. The consensus text was structured by centralizing the decisions based on the existing data.
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Affiliation(s)
- Erman Aytaç
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Leyla Özer
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Bilgi Baca
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Emre Balık
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Yersu Kapran
- Koç University Faculty of Medicine, İstanbul, Turkey
| | | | - Başak Oyan Uluç
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | | | - Murat Gönenç
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | | | | | - Bülent Baran
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Cem Aygün
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Erdem Yıldız
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Kemal Ünal
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Burçak Erkol
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Tunç Yaltı
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Uğur Özbek
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Tan Attila
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Nurdan Tözün
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Bengi Gürses
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Sibel Erdamar
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Özlem Er
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
- Corresponding author: Erman Aytaç, e-mail:
| | - Nuran Beşe
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Orhan Bilge
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Güralp Onur Ceyhan
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | | | - Uğur Selek
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Cengiz Yakıcıer
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | | | - Murat Saruç
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Volkan Özben
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Eren Esen
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Emre Özoran
- Koç University Faculty of Medicine, İstanbul, Turkey
| | - Erkan Vardareli
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Levent Güner
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - İsmail Hamzaoğlu
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Dursun Buğra
- Koç University Faculty of Medicine, İstanbul, Turkey
| | | | - The İstanbul Group
- Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
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Aygün C. Improving the quality of colonoscopy: Impact of efficient and safer preparation protocols and shorter waiting times. Turk J Gastroenterol 2018; 29:4-6. [PMID: 29391302 DOI: 10.5152/tjg.2018.18003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Cem Aygün
- Division of Gastroenterology, Department of Internal Medicine, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
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Köklü S, Tuna Y, Gülşen MT, Demir M, Köksal AŞ, Koçkar MC, Aygün C, Coban S, Ozdil K, Ataseven H, Akin E, Pürnak T, Yüksel I, Ataseven H, Ibiş M, Yildirim B, Nadir I, Küçükazman M, Akbal E, Yüksel O, Başar O, Alkan E, Baykal O. Long-term efficacy and safety of lamivudine, entecavir, and tenofovir for treatment of hepatitis B virus-related cirrhosis. Clin Gastroenterol Hepatol 2013; 11:88-94. [PMID: 23063679 DOI: 10.1016/j.cgh.2012.10.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 09/26/2012] [Accepted: 10/02/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Data are limited on the efficacy and safety of tenofovir and entecavir when given for more than 1 year to patients with hepatitis B-related cirrhosis. We investigated the long-term safety and efficacy of these antiviral drugs in patients with chronic hepatitis B virus (HBV) infection, with compensated or decompensated cirrhosis, and compared results with those from lamivudine. METHODS We performed a retrospective analysis of data from 227 adult patients with chronic HBV infection who were diagnosed with cirrhosis, beginning in 2005, at 18 centers throughout Turkey. There were 104 patients who had decompensated cirrhosis, and 197 patients were treatment naive before. Seventy-two patients received tenofovir (followed up for 21.4 ± 9.7 mo), 77 patients received entecavir (followed up for 24.0 ± 13.3 mo), and 74 patients received lamivudine (followed up for 36.5 ± 24.1 mo). We collected data on patient demographics and baseline characteristics. Laboratory test results, clinical outcomes, and drug-related adverse events were compared among groups. RESULTS Levels of HBV DNA less than 400 copies/mL were achieved in 91.5%, 92.5%, and 77% of patients receiving tenofovir, entecavir, or lamivudine, respectively. Levels of alanine aminotransferase normalized in 86.8%, 92.1%, and 71.8% of patients who received tenofovir, entecavir, and lamivudine, respectively. Child-Turcotte-Pugh scores increased among 8.5% of patients who received tenofovir, 15.6% who received entecavir, and 27.4% who received lamivudine. Frequencies of complications from cirrhosis, including hepatic encephalopathy, variceal bleeding, hepatocellular carcinoma, and mortality, were similar among groups. Lamivudine had to be changed to another drug for 32.4% of the patients. CONCLUSIONS Tenofovir and entecavir are effective and safe for long-term use in patients with compensated or decompensated cirrhosis from HBV infection.
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Affiliation(s)
- Seyfettin Köklü
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey.
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Onur MR, Ciçekçi M, Kayali A, Kocakoç E, Aygün C. Role of the apparent diffusion coefficient measurement by diffusion weighted magnetic resonance imaging in the diagnosis of Fasciola hepatica in the liver. Jpn J Radiol 2011; 29:688-94. [PMID: 22009419 DOI: 10.1007/s11604-011-0614-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 05/26/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to investigate the diagnostic role of the apparent diffusion coefficient (ADC) measurement in the diagnosis of focal parenchymal lesions and to understand the discriminating role of the ADC value for differentiating Fasciola lesions from other focal liver lesions. MATERIALS AND METHODS We measured ADC values of parenchymal lesions and liver parenchyma in 18 patients with Fasciola hepatica infestation at b 100, b 600, and b 1000 s/mm(2) gradients. We further measured average ADC values of hepatic metastases (n = 21), hepatocellular carcinomas (n = 21), cholangiocarcinomas (n = 7), hydatid cysts (n = 12), and focal nodular hyperplasia (FNH) (n = 12) and compared them with average ADC values for Fasciola hepatica. RESULTS The differences between average ADC values of lesions (2.16 ± 0.36 × 10(-3) mm(2)/s) and parenchyma (1.64 ± 0.2 × 10(-3) mm(2)/s) at three gradients were statistically significant (P < 0.05). Mean ADC values of Fasciola hepatica lesions were significantly different from most of the other focal hepatic lesions, except FNH at all gradients and hydatid cyst at only the b 100 gradient. CONCLUSION ADC measurement may be a complementary method in the diagnosis of Fasciola hepatica, and it may be used to differentiate these lesions from other focal liver lesions.
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Affiliation(s)
- Mehmet Ruhi Onur
- Department of Radiology, Firat University Faculty of Medicine, Elazig 23100, Turkey.
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Guven S, Istanbulluoglu O, Gul U, Ozturk A, Celik H, Aygün C, Ozdemir U, Ozturk B, Ozkardes H, Kilinc M. Successful Percutaneous Nephrolithotomy in Children: Multicenter Study on Current Status of its Use, Efficacy and Complications Using Clavien Classification. J Urol 2011; 185:1419-24. [PMID: 21334653 DOI: 10.1016/j.juro.2010.11.055] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Selcuk Guven
- Department of Urology, Selcuk University Meram Medical School, Konya Hospital, Turkey
| | - Okan Istanbulluoglu
- Department of Urology, Baskent University Medical School, Konya Hospital, Turkey
| | - Umit Gul
- Department of Urology, Adana Hospital, Turkey
| | - Ahmet Ozturk
- Department of Urology, Selcuk University Meram Medical School, Konya Hospital, Turkey
| | | | - Cem Aygün
- Department of Urology, Ankara Hospital, Turkey
| | - Umit Ozdemir
- Department of Urology, Selcuk University Meram Medical School, Konya Hospital, Turkey
| | - Bulent Ozturk
- Department of Urology, Baskent University Medical School, Konya Hospital, Turkey
| | | | - Mehmet Kilinc
- Department of Urology, Selcuk University Meram Medical School, Konya Hospital, Turkey
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Yalnız M, Asoğlu M, Demirel U, Aygün C, Bahçecioğlu İH. A case of hyperamylasemia: Macroamylasemia? Review of the literature. J Clin Exp Invest 2011. [DOI: 10.5799/ahinjs.01.2011.01.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Tunç L, Alkibay T, Küpeli B, Tokgöz H, Bozkirli I, Yücel C, Aygün C. POWER DOPPLER ULTRASOUND MAPPING IN NONOBSTRUCTIVE AZOOSPERMIC PATIENTS PRIOR TO TESTICULAR SPERM EXTRACTION. ACTA ACUST UNITED AC 2009; 51:277-83. [PMID: 16036635 DOI: 10.1080/014850190924098] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study was conducted to localize the testicular regions, which have better blood circulation by power Doppler ultrasonography in patients with nonobstructive azoospermia before testicular sperm extraction (TESE), and to investigate whether these vascularized areas have a high sperm retrieval rate or not. We evaluated 110 testes of 55 cases that were diagnosed as nonobstructive azoospermia. The mean age of the study group was 33 years (range 26 to 42). Patients with Y chromosome microdeletions, karyotype and hormonal abnormalities (except elevated FSH levels) were excluded from the study. In all cases, testes were evaluated by power Doppler ultrasonography before testicular sperm extraction. Testis was divided vertically into five equal parts and the area with maximum vascularity was determined subjectively. During testicular sperm extraction, starting from best-perfused areas, biopsies were done. If no motile or sufficient amount of sperm was found, TESE procedure was tried on the contralateral testis. TESE were performed from 82 testes and for the regions that show good and poor vascularity. The sperm finding rate was 38% and 14%, respectively (OR = 3.55)(p = 0.001). Power Doppler ultrasound mapping of the testis in nonobstructive azoospermic cases is a reliable and informative method to assess spermatogenic foci. It is a noninvasive technique that minimizes the unnecessary removal of hormone producing tissue and gives chance to end the TESE earlier than currently practiced procedures.
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Affiliation(s)
- L Tunç
- Gazi University, School of Medicine, Department of Urology, Ankara, Turkey.
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Kocaman O, Alponat A, Aygün C, Gürbüz Y, Sarisoy HT, Celebi A, Sentürk O, Hülagü S. Lower gastrointestinal bleeding, hematuria and splenic hemangiomas in Klippel-Trenaunay syndrome: a case report and literature review. Turk J Gastroenterol 2009; 20:62-6. [PMID: 19330738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Klippel-Trenaunay syndrome is a congenital vascular anomaly characterized by a triad of varicose veins, cutaneous capillary malformation, and hypertrophy of bone and soft tissue. Gastrointestinal and genitourinary vascular malformations in Klippel- Trenaunay syndrome may present with lower gastrointestinal bleeding and hematuria. The majority of patients with splenic hemangiomatosis are asymptomatic. We herein report a case admitted to the Gastroenterology Clinic with life-threatening hematochezia and symptomatic iron deficiency anemia. The patient's history was remarkable for subtotal cystectomy and enterocystoplasty in December 2002 for vascular malformation, located in the bladder, which presented with hematuria. Although the patient was also diagnosed with colonic varices and splenic hemangiomas at that time, due to the asymptomatic mild intermittent hematochezia and splenic hemangiomas, the patient did not seek any help for rectal bleeding until her admittance to our department for evaluation of massive lower gastrointestinal bleeding. Endoscopy revealed vascular malformations starting from the transitional zone in the rectum extending up to the descending colon. Due to this extensive involvement of the rectum and sigmoid colon, no interventional endoscopic procedure was attempted and she was referred to surgery. A very low anterior resection with double stapling technique was done. Postoperative follow-up has been uneventful for six months since the operation. To the best of our knowledge, this is the first Klippel-Trenaunay syndrome case presenting with lower gastrointestinal bleeding, hematuria and splenic hemangiomas. The literature on the evaluation and management of lower gastrointestinal and genitourinary bleeding in Klippel-Trenaunay syndrome is reviewed.
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Affiliation(s)
- Orhan Kocaman
- Department of Gastroenterology, Kocaeli University, School of Medicine, Kocaeli, Turkey.
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Kocaman O, Aygün C, Konduk T, Celebi A, Sentürk O, Hülagü S. Infliximab treatment of massive upper gastrointestinal bleeding in gastroduodenal Crohn's disease. Turk J Gastroenterol 2008; 19:197-198. [PMID: 19115158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Kocaman O, Aygün C, Konduk T, Celebi A, Sentürk O, Hülagü S. Pegylated interferon treatment of acute pericarditis associated with acute hepatitis C. Turk J Gastroenterol 2007; 18:268-271. [PMID: 18080927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A 65-year-old female patient was admitted to our hospital with the symptoms of chest pain, dyspnea and fatigue. She had undergone a tooth extraction three months before. She took no medication. Echocardiography revealed pericardial effusion. The serum alanine aminotransferase (ALT) at presentation was 650 IU/L and aspartate aminotransferase (AST) was 600 IU/L. Hepatitis C virus (HCV) RNA level was 150,000 IU/ml. Genotype was 1b. Acute pericarditis was considered to be caused by acute HCV infection. The patient was followed without treatment. One month later, AST and ALT were found as 65 IU/L and 82 IU/L, respectively; there were symptoms of effort dyspnea and fatigue. Echocardiography showed minimal decrease in pericardial effusion compared to one month previously. HCV RNA level was again checked and found as 155,000 IU/ml. The patient was given pegylated interferon. One month later, the pericardial effusion and related symptoms had disappeared. The pegylated interferon treatment was sustained for 24 weeks and HCV-RNA was found negative at the 3rd and 6th months of the treatment and six months after the end of treatment. We conclude that pegylated interferon may be offered to patients with symptomatic acute HCV-related pericarditis.
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Affiliation(s)
- Orhan Kocaman
- Department of Gastroenterology, Kocaeli University, Medical Faculty, Kocaeli, Turkey.
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Kocaman O, Aygün C, Konduk T, Celebi A, Sentürk O, Hülagü S. Pieces of trash bag in the stomach. Turk J Gastroenterol 2007; 18:210-1. [PMID: 17891700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Hülagü S, Sentürk O, Aygün C, Gürbüz Y, Kocaman O, Celebi A, Konduk T. Granular cell tumor of esophagus removed with endoscopic submucosal dissection. Turk J Gastroenterol 2007; 18:188-91. [PMID: 17891693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Granular cell tumors of the esophagus are rare neoplasms and their diagnosis is mainly based on histopathologic examination of endoscopic biopsies. With the development of endoscopy and iodine staining, there has been a marked increase in local treatment alternatives for early esophageal neoplasms. In this case report, we describe a granular cell tumor of the esophagus in an adult patient and briefly discuss the literature concerning clinicopathologic aspects and management of these uncommon tumors. In this patient, we describe the removal of the tumor by endoscopic submucosal dissection technique.
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Affiliation(s)
- Sadettin Hülagü
- Department of Gastroenterology, Kocaeli University, Faculty of Medicine, Kocaeli
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Uraz S, Aygün C, Konduk T, Celebi A, Sentürk O, Hülagü S. A rare gastric outlet anomaly: pyloric ostium on incissura angularis. Dig Dis Sci 2007; 52:1001-3. [PMID: 17342400 DOI: 10.1007/s10620-006-9228-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 12/30/2005] [Indexed: 12/09/2022]
Abstract
Congenital gastric outlet anomalies are rarely seen defects resulting from early embryologic development of foregut. We report a case of congenital pyloric outlet anomaly in a 60-year-old man with mild postprandial epigastric discomfort of approximately 3 months' duration. Endoscopic examination of the stomach showed a pyloric ostium on incissura angularis connecting the stomach to the duodenum. Usual site of pylorus at the end of antrum was closed like a sac. No signs of acute or chronic peptic ulcer were noted. A biopsy was taken from the region showed normal mucosal layers with a mild gastritis. There was no history of surgery, ulcer disease, or use of any medication. The case was considered to be congenital in origin and was successfully treated conservatively with proton-pump inhibitors and gastrokinetics.
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Affiliation(s)
- Süleyman Uraz
- Department of Gastroenterology, Kocaeli University Medical Faculty, Kocaeli, Turkey
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Deveci S, Peşkircioğlu L, Aygün C, Tekin MI, Dirim A, Ozkardeş H. Sublingual sildenafil in the treatment of erectile dysfunction: Faster onset of action with less dose. Int J Urol 2004; 11:989-92. [PMID: 15509203 DOI: 10.1111/j.1442-2042.2004.00933.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the present study was to show the efficacy and safety of sublingual sildenafil and to determine whether lower doses cause the same effect with a faster onset of action in this mode of application. METHODS Forty consecutive patients with erectile dysfunction for more than three months were included in the study. The mean age was 55 years (range, 25-65). Serum glucose and testosterone levels, lipid profile and erectile function scores were obtained in all patients. Twenty patients received placebos and the other 20 patients received 20 mg sublingual sildenafil in a double blind randomized design. RESULTS The effect of sildenafil on erection was significantly higher than that of placebo. Sixty-five percent of patients (13/20) who received sublingual sildenafil achieved satisfying erections and coitus, whereas the rate was 15% in the placebo group (3/20). The mean onset of action with sublingual sildenafil was 15.5 min and lasted for an average of 40 min. Minimal headaches, sweating and flushing were noted as the side-effects. CONCLUSIONS 20 mg sublingual sildenafil is safe and effective in the treatment of erectile dysfunction. Sublingual administration has some advantages as it is not effected by food ingestion and quickly appears in the circulation. These advantages provide a faster onset of action with a lower dose when compared to oral sildenafil. Sublingual use of sildenafil may be more cost-effective and possibly provides a more predictable onset of action.
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Affiliation(s)
- Serkan Deveci
- Department of Urology, Başkent University School of Medicine, Ankara, Turkey
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Aygün C, Ozer C, Dirim A, Tekin MI, Gören MR, Peşkircioğlu CL, Ozkardes H, Haberal M. Renal transplantation experience following endoscopic treatment of vesicoureteral reflux. Transplant Proc 2004; 36:68-70. [PMID: 15013303 DOI: 10.1016/j.transproceed.2003.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The most efficacious treatment for end-stage renal disease is renal transplantation. Because high-grade vesicoureteral reflux forecasts potential future complications, the patients studied were subjected to bilateral nephroureterectomy before transplantation. The aim of this study was to investigate the posttransplantation results of a subureteral injection performed before transplantation to treat high-grade vesicoureteral reflux in end-stage renal disease patients. Renal transplantation was performed on 14 of 52 end-stage renal disease patients that had undergone prior subureteral injection. Subureteral injection had been performed in 24 refluxing renal units of these 14 patients. Ten patients had bilateral and 4 patients unilateral reflux. The treatment criterion was reflux of at least grade III; however, when low-grade reflux was present in the contralateral renal unit, it was also treated during the same session. Success was determined as no (complete) or decrease to grade I (partial) reflux. The patient ages ranged between 13 and 46 years (mean 29.3 years). The reflux resolved in 20 of 24 renal units (83%) and was reduced to grade I in 3 of the others (12%), namely resulting in a total response rate of 95%. Except for 1 patient who was lost to follow-up, the other recipients were observed for 6 to 47 months (mean 23 months). Only 1 patient experienced symptomatic urinary tract infection or asymptomatic bacteriuria after renal transplantation. Acute rejection occurred in 5 and chronic rejection in 3 patients. In conclusion, subureteral injection instead of nephroureterectomy seems to be an efficient and minimally invasive alternative for renal transplant recipients with high-grade vesicoureteral reflux.
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Affiliation(s)
- C Aygün
- Department of Urology, Başkent University, Faculty of Medicine, Ankara, Turkey.
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Abstract
Erectile dysfunction (ED) is more frequent among end-stage renal failure patients than the normal population. Sildenafil citrate has been successfully used for the symptomatic treatment of erectile dysfunction. The aim of this study was to determine the efficacy and safety of sildenafil citrate in the treatment of ED in patients on hemodialysis. Fifty-five hemodialysis patients above 18 years suffering from ED with steady sexual partners were included in the study. The first five and fifteenth questions of the International Index of Erectile Function were employed to evaluate ED in the patient group. A Single 50-mg sildenafil citrate tablet was prescribed for each patient. The patients were encouraged to take it on the day after hemodialysis and 1 hour before sexual intercourse. The erectile function of the patients after the treatment was re-evaluated in the same manner by International Index of Erectile Function. The ages of the patients ranged between 30 and 73 years (mean 50.6 +/- 10.9). The overall response rate was 74.5% (38/51). Side effects were nausea (n = 2), palpitation (n = 2), flushing (n = 1), and angina (n = 1). Sildenafil citrate (50 mg) was observed to be safe and effective for treatment of hemodialysis patients with careful evaluation and proper patient selection.
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Affiliation(s)
- Y Sahin
- Başkent University, Faculty of Medicine, Department of Urology, Ankara, Turkey
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18
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Abstract
Bilateral double testis, a varient of polyorchidism, is a rare malformation of which six cases have been reported in the published literature. Magnetic resonance imaging was used in the presented case to confirm the diagnosis without surgical exploration.
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Affiliation(s)
- Serkan Deveci
- Department of Urology, Baskent University School of Medicine, Bahçelievler 06490, Ankara, Turkey
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19
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Ozen H, Aygün C, Ergen A, Sözen S, Aki FT, Uygur MC. Combined Use of Prostate-Specific Antigen Derivatives Decreases the Number of Unnecessary Biopsies to Detect Prostate Cancer. Am J Clin Oncol 2001; 24:610-3. [PMID: 11801765 DOI: 10.1097/00000421-200112000-00017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors evaluated the prostate cancer detection rate in Turkish patients with prostate-specific antigen (PSA) levels of 4 ng/ml to 10 ng/ml and who had normal digital rectal examination (DRE) findings. They also aimed to evaluate the value of PSA density and percent free PSA in minimizing unnecessary prostate biopsies for these PSA ranges. This prospective study included 134 consecutive men referred for early prostate cancer detection or lower urinary tract symptoms. All men underwent transrectal ultrasound with systematic sextant needle biopsies. The ability of PSA density and percent free PSA to improve the power of PSA in the detection of prostate cancer was evaluated with statistical analyses as well as receiver operating characteristics curves. Among the 134 men, 124 (92.5%) had a benign histology and 10 (7.5%) had cancer diagnosed on the initial biopsies. Despite the disappointing results in regard to the sensitivity and specificity of PSA derivatives alone, the combination of PSA density and percent free PSA significantly increased the area under the curve compared with the use of each test alone. To increase the specificity of PSA in this patient population, the authors recommend combining two PSA derivatives in deciding whether to perform a biopsy. In a PSA range of 4 ng/ml to 10 ng/ml and with normal DRE, a percent free PSA < 21% and a PSA density > 0.18 yields highest specificity with 90% sensitivity.
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Affiliation(s)
- H Ozen
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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20
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Tekin MI, Aytekin C, Aygün C, PeSkircioğlu L, Boyvat F, Ozkardeş H. Covered metallic ureteral stent in the management of malignant ureteral obstruction: preliminary results. Urology 2001; 58:919-23. [PMID: 11744459 DOI: 10.1016/s0090-4295(01)01414-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of ureteral Dacron-covered metallic stents in the management of malignant ureteral obstruction. METHODS Covered metallic stents were placed unilaterally using a percutaneous approach in an antegrade fashion into nine ureters of 8 patients with bilateral malignant ureteral obstruction. The contralateral kidneys were drained by percutaneous nephrostomy in 7 patients. The primary diagnoses were rectal cancer in 5 patients and cervical, bladder, and prostate cancers in the remaining cases. RESULTS Covered metallic stents could be successfully placed in all patients. Only one of nine ureters was stented with a double J-stent. In a mean follow-up of 9 months (range 1 to 14), 7 of 8 patients died because of their primary disease. During the follow-up period, none of the stents were obstructed, displaced, or infected. CONCLUSIONS Dacron-covered metallic stents appear to be successful in the treatment of patients with malignant ureteral obstruction. The preliminary outcome encourages and justifies the application of this drainage method.
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Affiliation(s)
- M I Tekin
- Department of Urology, Başkent University School of Medicine, Ankara, Turkey
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21
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Aksoy PK, Ozdemir BH, Aygün C, Agildere M. Plasma cell granuloma of the testis: unusual localization. J Urol 2001; 166:1000. [PMID: 11490275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- P K Aksoy
- Department of Pathology, School of Medicine, Baskent University, Ankara, Turkey
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22
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Abstract
Bladder neck contracture is usually a complication of prostatectomy and the treatment of choice in such a condition should be endoscopic surgery. However, in a few patients the bladder neck may be completely obstructed preventing retrograde access into the bladder. A case is presented of complete bladder neck obstruction occurring after transurethral resection of prostate, which was treated after an access was provided by using transurethral Seldinger technique.
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Affiliation(s)
- C Aygün
- Department of Urology, School of Medicine, Baskent University, Ankara, Turkey.
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23
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Yiğit S, Ciliv G, Aygün C, Erdem G. Breast milk beta-glucuronidase levels in hyperbilirubinemia. Turk J Pediatr 2001; 43:118-20. [PMID: 11432488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Breast milk beta-glucuronidase was thought to be one of the etiological factors in the pathogenesis of late-onset breast-milk jaundice, but results of these studies are conflicting. In this study breast milk beta-glucuronidase levels were determined in groups with physiologic jaundice, early breast-feeding jaundice and late breast-milk jaundice. No difference in beta-glucuronidase levels of these three groups was found in samples taken on the 4th and 15th days of life. beta-glucuronidase activity in breast milk declined from the 4th to 15th day in all groups. These results imply that factors other than breast milk beta-glucuronidase activity should be investigated to reveal the pathogenesis of late-onset breast-milk jaundice.
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Affiliation(s)
- S Yiğit
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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24
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Yurdakök M, Yiğit S, Korkmaz A, Kirazli S, Aygün C. Global fibrinolytic capacity in healthy newborn infants. Turk J Pediatr 2001; 43:177-9. [PMID: 11432503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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25
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Abstract
Although posterior urethral valves are predominant as a cause of obstructive uropathy in children, anterior urethral valves may also appear as the underlying etiologic factor in end-stage renal disease that results from obstruction. Two cases are presented of anterior urethral valve patients that were admitted with end-stage renal disease. The first case was successfully treated with diverticulectomy and urethral reconstruction in preparation for renal transplantation. The second case, however, had been on cystostomy drainage for 6 years and also had a contracted bladder. A more extensive lower urinary tract reconstruction was delayed. Children with poor stream and recurrent infections should be evaluated carefully and anterior urethral valve or diverticula should be considered in differential diagnosis of obstructive lesions.
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Affiliation(s)
- C Aygün
- Department of Urology, School of Medicine, Baskent University, Ankara, Turkey.
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26
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Aygün C, Yiğit S, Gür D, Erdem G, Oran O, Tekinalp G, Yurdakök M. Serratia marcescens: an emerging microorganism in the neonatal intensive care unit. Turk J Pediatr 2000; 42:219-22. [PMID: 11105621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
As smaller babies survive in neonatal intensive care units, late-onset septicemia with unusual pathogens appears. Between 1 January and 31 December 1998, in Hacettepe University Ihsan Dogramaci Children's Hospital Neonatal Intensive Care Unit, seven infants had S. marcescens isolates. Four babies had septicemia with the microorganism. The case fatality rate was 50 percent in infants with S. marcescens septicemia. The combination of ceftazidime or imipenem with amikacin appears appropriate for the treatment of newborns with Serratia infection.
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Affiliation(s)
- C Aygün
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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27
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Abstract
BACKGROUND Bacillus Calmette-Guérin (BCG) and epirubicin have both been shown to be effective in the treatment of superficial bladder cancer. We studied whether the alternating combination of these agents could improve the efficacy with tolerable side-effects in the treatment of high-risk superficial bladder tumors. METHODS Forty-one patients with high-risk superficial bladder transitional carcinoma were included in this study. Twenty-one patients were randomized into the BCG group and 20 patients were treated with sequential BCG and epirubicin. The patients were followed for 9-24 months (mean 18 months). Recurrence rates, median time to the first recurrence, progression rate and complications were compared. RESULTS Fifteen percent of the patients in the BCG and epirubicin group and 19% of the patients in the BCG alone group developed tumor recurrence. Tumor progression was observed in 4.7% and 10% in the BCG/epirubicin group and the BCG alone group, respectively. Median time to first recurrence was 11 months for the BCG/epirubicin group and 16 months for the BCG group (P > 0.05). Three patients in the BCG/epirubicin treatment group developed serious side-effects, which necessitated antituberculosis treatment. CONCLUSION Because the efficacy of combination was no better than the standard treatment and the alternating combination seemed to be related to a higher incidence of side-effects, this study albeit small, does not recommend combination therapy of BCG and epirubicin in high risk patients with superficial bladder cancer.
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Affiliation(s)
- C Y Bilen
- Department of Urology, Sihhiye, Ankara, Turkey
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28
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Affiliation(s)
- C Aygün
- Faculty of Medicine, Department of Urology, Başkent University, Ankara, Turkey.
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29
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Aygün C, Ozen H, Kocagöz T, Saribaş Z, Aki T, Tekin I. Induction of mycobacteremia by intravesical bacillus Calmette-Guerin instillation in an experimental animal model and detection with polymerase chain reaction. J Urol 2000; 163:1588-90. [PMID: 10751893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE The aim of this study was to detect mycobacteremia by polymerase chain reaction (PCR), induced by the instillation of bacillus Calmette-Guerin (BCG) to guinea pig bladder. We also investigated the peak time and the effect of the dose of BCG in injured and non-injured bladder. The sensitivities of routine culture and PCR were also compared. MATERIALS AND METHODS Five different doses (0, 0.069, 0.69, 6.9 and 69 mg.) of BCG were instilled into 5 injured and 5 non-injured bladders. Blood samples were collected at 0, 5, 15, 30 and 60 minutes following instillation for routine culture and PCR for each dose. A total of 50 female guinea pigs were used. RESULTS Three of 5 samples (60%) obtained 30 minutes after the instillation of 69 mg. BCG into injured bladders were PCR positive. Furthermore, 4 of 5 samples (80%) were PCR positive when samples were obtained at the 60th minute following instillation. All the other samples were negative for PCR and routine culture. All the routine tuberculosis culture results were negative, including those which were PCR positive. CONCLUSIONS Mycobacteremia was detected only in injured bladders and with high doses of BCG. PCR is a highly sensitive and rapid diagnostic method for detection of mycobacteremia.
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Affiliation(s)
- C Aygün
- Department of Urology, Hacettepe University Medical School, Ankara, Turkey
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30
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Abstract
Metastasis to skeletal muscle from carcinoma of the bladder is extremely rare. To the best of our knowledge, there is no reported case in the English literature. In this report, we describe a 41-year-old man with bladder carcinoma with metastasis to the right deltoid muscle.
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Affiliation(s)
- S Ekici
- Department of Urology, Hacattepe University, School of Medicine, Ankara, Turkey
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31
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Abstract
BACKGROUND The aim of the present study was to assess the possible etiologic role of human papillomaviruses (HPV) in bladder tumors. METHODS Forty-two fresh biopsy specimens from different grades and stages of bladder tumor cases and 10 normal bladder mucosa biopsies were studied. Specimens were analyzed by polymerase chain reaction (PCR) with HPV-specific general primer set for the detection of viral DNA. Polymerase chain reaction-positive samples were also tested with HPV 16- and 18-specific primers by the same method. RESULTS We found two samples (4.8%) containing HPV DNA among the TaG1 bladder tumors. All other specimens, including the control group, were found to be negative by PCR. Neither of the two HPV-positive patients had immune deficiency and/or genital wars. Human papillomavirus 16 was detected by type-specific primers in one sample, but the other HPV-positive sample could not be typed. CONCLUSIONS The low prevalence of HPV in this and many previous studies does not support an etiologic role of HPV in bladder carcinogenesis. We detected the virus in two early stage tumors, but none was detected in the high-grade samples. However, to clarify the positivity of HPV in these occasional cases, future studies must be designed by using in situ PCR techniques, including samples from tumors and normal bladder mucosa from the same patient.
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Affiliation(s)
- M I Tekin
- Department of Urology, Başkent University, School of Medicine, Ankara, Turkey.
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32
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Abstract
Accessory scrotum is an extremely rare congenital scrotal anomaly defined as the occurrence of scrotal skin outside of its proper location with no testicular tissue. We report a preterm twin male infant who had an accessory scrotum located on the right inguinal and proximal femoral region.
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Affiliation(s)
- A Korkmaz
- University of Hacettepe, Ihsan Doğramaci Children's Hospital, Neonatology Unit, Ankara, Turkey
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33
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Kara A, Yiğit S, Aygün C, Oran O. Toxic methemoglobinemia after injection of prilocaine in a newborn. A case report. Turk J Pediatr 1998; 40:589-92. [PMID: 10028870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The acute onset of cyanosis in an infant is an alarming development. We report an infant who became cyanotic after injection of prilocaine. Prilocaine is a local anesthetic that is widely used in clinical practice, but usage in infancy easily causes methemoglobinemia. Acquired methemoglobinemia occurs in individuals exposed to an increased amount of agents that oxidize hemoglobin iron.
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Affiliation(s)
- A Kara
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara
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