Noninvasive ventilation with nursing perspective: Impacts on patient tolerance, short-term adverse effects, and nursing workload

Background

The success of noninvasive ventilation (NIV) treatment is closely related to high levels of clinical support.

Aims

In this study, we sought to analyze patient mask compliance and minor side effects and to evaluate additional nursing workload needed for the NIV care.

Materials and Methods

The study was designed as a prospective and observational. The data were collected from an intensive care unit. Clinical and physiological data, patient tolerance and adverse effects, subjects' complaints about their experience, and additional nursing workload associated with NIV treatment were assessed.

Results

Statistically significant improvements were obtained in arterial blood gas analysis, respiratory rate, and heart rate during treatment. In the first 2 h, 65% of subjects had poor mask compliance, patients' comfort scores were poor, and incompliance was associated with discomfort. The ratio of skin problems was 15% in the first 24 h and reached 60% at 48 h. The pain rate due to mask ties was 80% and then increased to 90% at 48 h. There was a significant relationship between the problems detected by the nurses and problems described by the subjects. Additional nursing workload was found as 110 min for 0-6 h.

Conclusions

We observed that the mask compliance and comfort levels of the subjects were poor. Skin breakdowns increased depending on the duration of treatment. Treatment would require continuous nursing support in seven areas. NIV treatment generated a significant amount of workload for nurses. Additional nursing workforce planning is required for NIV units for successful NIV treatment.

Fabrication and characterization of large numerical aperture, high-resolution optical fiber bundles based on high-contrast pairs of soft glasses for fluorescence imaging

Fabrication and characterization of flexible optical fiber bundles (FBs) with in-house synthesized high-index and low-index thermally matched glasses are presented. The FBs composed of around 15000 single-core fibers with pixel sizes between 1.1 and 10 μm are fabricated using the stack-and-draw technique from sets of thermally matched zirconium-silicate ZR3, borosilicate SK222, sodium-silicate K209, and F2 glasses. With high refractive index contrast pair of glasses ZR3/SK222 and K209/F2, FBs with numerical apertures (NAs) of 0.53 and 0.59 are obtained, respectively. Among the studied glass materials, ZR3, SK222, and K209 are in-house synthesized, while F2 is commercially acquired. Seven different FBs with varying pixel sizes and bundle diameters are characterized. Brightfield imaging of a micro-ruler and a Convallaria majalis sample and fluorescence imaging of a dye-stained paper tissue and a cirrhotic mice liver tissue are demonstrated using these FBs, demonstrating their good potential for microendoscopic imaging. Brightfield and fluorescence imaging performance of the studied FBs are compared. For both sets of glass compositions, good imaging performance is observed for FBs, with core diameter and core-to-core distance values larger than 1.6 μm and 2.3 μm, respectively. FBs fabricated with K209/F2 glass pairs revealed better performance in fluorescence imaging due to their higher NA of 0.59.

Prevalence of male pelvic dysfunction: results from the Turkish society of andrology male sexual health study group

The objective of this study was to determine the prevalence of male pelvic dysfunction (MPD) and its correlation in men ≥40 years of age in a population-based study. This study was designed as a non-interventional, observational, cross-sectional field survey. Participating males of ≥40 years were randomly selected from 19 provinces of Turkey. All participants were asked to complete a survey including data regarding demographics, socio-economic status, socio-cultural factors, medical and sexual history, current medications, comorbidities and three validated questionnaires assessing lower urinary tract symptoms (International Prostate Symptom Score), erectile dysfunction (International Index of Erectile Function) and ejaculatory behaviour (Male Sexual Health Questionnaire-4). MPD was defined by combining abnormal scores calculated from all three questionnaires. All data were analysed statistically and p < 0.05 was accepted as significant. A total of 2730 males of ≥40 years (mean, 54.2 ± 10.6 years) were enrolled in this study. The prevalence of MPD was calculated as 24.4% among all participants. The prevalence of MPD was lowest at age between 40 and 49 years (9.1%) and highest at ≥70 years (76.6%), exhibiting correlation with age. Each decade of increase in age was associated with a 3.4-fold increase in presence of MPD. At logistic regression analyses; age, diabetes, hypertension, dyslipidemia, cardiovascular disease, obesity and lower income were found to be independent predictors for increased prevalence of MPD. This study reports prevalence of MPD as 24.4% in males of ≥40 years. Furthermore, age was found to be the main independent predictor of having MPD.

Comparison of international index of erectile function with nocturnal penile tumescence and rigidity testing in evaluation of erectile dysfunction

We tried to compare the parameters of nocturnal penile tumescence and rigidity (NPTR) testing with erectile function (EF) domain score of International Index of Erectile Function (IIEF), which is used in diagnosis and determining the severity of erectile dysfunction (ED), and to assess the sufficiency of IIEF in the diagnosis of ED. A total of 90 men, mean age 46 years (24-75), presenting with ED to our clinic between January 2001 and March 2003 were included in the trial. All the men answered the standard IIEF (15 questions) forms and was divided into four groups as mild ED, moderate ED, severe ED and no ED according to the EF domain score that is obtained from 1st, 2nd, 3rd, 4th, 5th and 15th questions. Then NPTR testing with the RigiScan Plus monitoring device was performed for two consecutive nights on those men. The distribution of the six parameters of NPTR testing (number of erections, duration of erections, TAU base, RAU base, TAU tip, RAU tip) among the four groups and the correlation with IIEF-EF domain score were evaluated. Additionally, the distribution of the risk factors (diabetes mellitus, hypertension, atherosclerotic heart disease, dyslipidemia and smoking) was analyzed both among the four groups and in each group. According to IIEF-EF domain scores of 90 patients, 16 (18%) had severe ED, 21 (23%) moderate ED, 41 (46%) mild ED and 12 (13%) no ED. There was no statistically significant difference between the risk factors among the men in these groups (P > 0.05). When the IIEF-EF domain scores were compared with parameters of NPTR testing, no statistically significant difference was obtained among ED groups (mild, moderate, severe) (P > 0.05). However, we observed a statistically significant difference between three ED groups and no ED group (P < 0.05). If NPTR testing is considered as a gold standard test, sensitivity, specificity, positive predictive value and negative predictive value of IIEF-EF domain score in ED diagnosis are 100, 17.9, 29.4 and 100% respectively. In conclusion, we did not observe a clinical correlation between IIEF-EF domain scores and NPTR parameters in the whole population; however, we observed that if IIEF-EF domain scores were normal, NPTR parameters were also normal. In other words, we can say that if the initial IIEF-EF domain scores are normal, then we do not have to perform NPTR testing. This could be helpful to make a cost-effective diagnosis.

Effect of penile size on nocturnal erections: evaluation with NPTR testing with men having micropenis

There has been conflicting opinions in the literature regarding sexual function in hypogonadal men with micropenis. In this study we aimed to evaluate erectile function in hypogonadal men with micropenis by nocturnal penile tumescence and rigidity testing (NPTR) and compared the results with young potent normal penile sized men. A total of 15 men (ages 17-30 y) defined having a micropenis with a stretched penile length of less than 9.3 cm were constituted the study group. Mean stretched penile length was 6.8+/-1.6 cm (range 3.6-7.8 cm). Karyotype analysis showed 46XY in all cases. Control group included 22 potent and normal penile sized men (23-29 y). All subjects completed three sessions of consecutive nights using the RigiScan Plus device. Comparison of the results of NPTR of control group with study group revealed that number and duration of erectile episodes (P < 0.001), duration of tip rigidity > 60% (P < 0.01), TAU tip and TAU base (P = 0.001), and RAU base (P = 0.01) were found to be significantly lower in men with micropenis. In conclusion, our study showed that men with micropenis are associated with decreased nocturnal erectile activity.

Effect of aging on quality of nocturnal erections: evaluation with NPTR testing

Nocturnal penile tumescence and rigidity testing (NPTR) has traditionally been performed to distinguish psychogenic from organic impotence. However, considerable lack of uniformly accepted normative data for NPTR readings makes the reproducibility of the method questionable. In this study, we try to evaluate the impact of aging as independent criteria for quality of erectile episodes. A total of 455 patients (ages 20-71 y) whose initial complaints were erectile dysfunction underwent two nights NPTR measurement with Rigiscan device. After analyzing the data, 353 men out of 455 were regarded as having normal NPTR recordings. The number of normal erectile episodes (erectile episode of penile tip rigidity greater than 60% more than 10 min duration), RAU Tip, RAU Base, TAU Tip, TAU Base, Average event rigidity of Tip (%), Average event rigidity of Base (%) and Duration of erectile episodes > or =60% minute were re-evaluated with regard to five age groups (group I: <30 y; group II: 30-39 y; group III: 40-49 y; group IV: 50-59 y; group V: > or =60 y). The mean values of erectile episodes in the age groups were as follows: group I, 2.46; group II, 2.28; group III, 2.40; group IV, 1.58; group V, 1.27. When we analyzed the groups between themselves, we observed statistically significant difference after the age of 50 y. The mean erectile episodes in patients younger than 50 y were 2.37 (s.d.: 1.50), whereas 1.49 (s.d.: 1.15) in patients older than 50 y (P<0.001). We also observed statistically significant difference at all of the above-mentioned NPTR parameters with regard to age. The results of our study showed that aging negatively influence quality of nocturnal erections especially after 50 y and we suggest that age needs to be taken into account in the diagnostic interpretation of NPTR testing.

Behçet's disease presenting as deep venous thrombosis and priapism

Behçet's disease (BD) is a multi-system inflammatory disorder which may involve the vascular system. Currently, it is general practice to use the International Study Group (ISG) criteria for the diagnosis of BD. However, even though vascular involvement may be seen in one-fourth to one-half of BD patients, and occasionally is the presenting and only manifestation of BD, large vessel disease is not included among the ISG criteria. In this report we describe a patient who had deep venous thrombosis and priapism, but who does not fulfill ISG criteria for the diagnosis of BD.

Effect of sildenafil on nocturnal erections of potent men

We try to evaluate the effect of sildenafil on nocturnal penile erections of potent men. We recruited 22 potent men (eight medical students and 14 urology residents) 23-29 years old into the study. A disorder-free medical and sexual history and normal erectile functions were the only inclusion criteria. All subjects completed three sessions of consecutive nights using the RigiScan Plus device. After a first night of adaptation, night 2 recordings were their baseline values whereas they received sildenafil 100 mg on night 3. We observed statistically significant improvement with regard to those NPT parameters at the nights with sildenafil: number of erectile episodes; duration of tip rigidity >60%, RAU tip, RAU base and TAU tip (P<0.005). Although the duration of erectile episodes (min) and TAU base were greater during the sildenafil night, these did not reach statistical significance. In conclusion, our study showed that sildenafil can improve nocturnal erectile quality not only in patients with erectile dysfunction as previously published but also in potent males.

Effect of experimental hypercholesterolemia on cavernosal structures

OBJECTIVES

To determine the effect of experimental hypercholesterolemia on the ultrastructure of cavernosal smooth muscle cells, endothelial cells, elastic fibers, and collagen content, which are the key structures fundamental for erection.

METHODS

Forty-two New Zealand white rabbits were divided into a control group (group 1, n = 7, fed a standard diet), a hypercholesterolemia group (group 2, n = 20, fed a diet containing 1% cholesterol for 8 weeks), and a reversibility group (group 3, n = 15, fed a 1% cholesterol diet for 8 weeks, then switched to a standard diet for 4 weeks). Blood samples were obtained for lipid determination before and after the study. The cavernosal tissues were obtained at the end of 8 weeks for groups 1 and 2 and at the end of 12 weeks for group 3 and immunohistochemical examinations of these cells were performed.

RESULTS

Immunohistochemical analysis revealed that hypercholesterolemia produces marked and reversible decreases in the cavernosal content of smooth muscle cells, endothelial cells, and elastic fibers and increases the content of collagen 3 and 4.

CONCLUSIONS

Our findings suggest that hypercholesterolemia in this animal model affects the percentage of staining for smooth muscle actin, endothelial cells, elastin, and collagen 3 and 4. However, since this effect is temporary depending on the blood cholesterol levels, it might not alter the erectile function.

Effect of glycemia status on endocrinological parameters of impotent and infertile patients

OBJECTIVE

To identify the effects of glycemia status on hormone levels, we evaluated the effects of hypo and hyperglycemia on endocrinological parameters of patients with erectile dysfunction, infertility, varicocele and compared the results with control subjects.

MATERIALS AND METHODS

Twenty patients with erectile dysfunction, 20 infertile patients with oligo-azoospermia, 20 patients with normozoospermic left varicocele and 15 healthy control subjects constitute our study population. Plasma follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T) and prolactin (PRL) levels were measured both in patients in hypoglycemia and hyperglycemia status. Statistical analysis were done by Wilcoxon test.

RESULTS

All endocrinological parameters did not show any statistically significant difference between the hypoglycemia and hyperglycemia status. Also, no abnormalities in the endocrinological parameters were observed.

CONCLUSION

We showed that the glycemia status of the patient (either hypo or hyperglycemia) did not effect the results of endocrine profile. Also, endocrine evaluation is unnecessary in impotence and infertility.

Penile epithelioid sarcoma

Epithelioid sarcoma is a rare mesenchymal neoplasm. We had the opportunity to report a case of epithelioid sarcoma of the penis.

Significance of serum FSH levels and testicular morphology in infertile males

OBJECTIVES

To determine the relationship between plasma levels of FSH and testicular spermatogenic patterns.

METHODS

Testicular biopsies were obtained from 99 infertile men. Biopsies were performed either in order to distinguish the type of azoospermia (obstructive/non-obstructive) or because of severely subnormal semen variables. Serum FSH was measured by immunoassay (normal range is less than 7 mIU/ml).

RESULTS

Statistically significant difference was detected between patients with Sertoli cell only syndrome and normal spermatogenesis, hypospermatogenesis and maturation arrest (p<0.01, p<0.01, p<0.05, respectively). No statistically significant differences were found between normal spermatogenesis, hypospermatogenesis and maturation arrest.

CONCLUSION

Our study revealed that elevation of serum FSH correlates only with the appearance of Sertoli cell only syndrome. We think that azoospermic or severely oligoasthenoteratozoospermic patients with highly elevated plasma FSH levels (three times the normal) could be excluded from separate testicular biopsy, because these patients are not suitable for conventional treatments. If he is willing to undergo an IVF program the sperm will often be present, no matter what the testicular histology is to be used for assisted reproductive techniques, particularly ICSI.

Effect of microsurgical subinguinal varicocele ligation to treat pain

OBJECTIVES

The traditional treatment for a painful varicocele consists of conservative measures followed by varicocelectomy. We report our results with microsurgical subinguinal varicocele ligation to treat pain.

METHODS

From 1996 to 1999, a total of 119 men underwent subinguinal microsurgical varicocele ligation for painful varicocele. The diagnosis of varicocele was based on the findings of both physical examination and color Doppler ultrasound. Patients described pain with testicular discomfort as scrotal heaviness or a dull ache. While waiting for the operation (range 3 to 5 weeks), all the patients underwent a preoperative trial of conservative management for pain.

RESULTS

Of 119 men, 82 (69 %) were available for follow-up 3 months postoperatively. Of those 82 patients, 72 (88%) reported complete resolution of pain, 4 patients (5%) partial resolution, 5 patients (6%) no change, and 1 patient (1%) epididymal discomfort that resolved with conservative measures. Of the 9 patients with partial or no change, 2 patients had reflux recurrence as seen on color Doppler ultrasound.

CONCLUSIONS

Subinguinal microsurgical varicocele ligation is an effective treatment for painful varicocele when performed in selected patients.

The prognostic value of peripheral blood lymphocyte subsets in patients with bladder carcinoma treated using neoadjuvant M-VEC chemotherapy

OBJECTIVES

To assess the prognostic value of peripheral blood lymphocyte subsets in patients with bladder cancer who were treated with neoadjuvant chemotherapy.

PATIENTS, SUBJECTS AND METHODS

Thirty patients with a histological diagnosis of invasive bladder transitional cell carcinoma and 30 age-matched controls with no evidence of cancer and immunological disorders were evaluated. Peripheral blood samples were assessed in both groups using monoclonal antibodies. Patients with bladder cancer who achieved complete or partial responses and those who had progression of the disease after systemic chemotherapy with methotrexate, vinblastine, epirubicin and cisplatin were compared according to the pretreatment values of the peripheral blood lymphocyte subsets.

RESULTS

There were no significant differences in B lymphocyte levels between the groups. In patients with bladder cancer, the percentages of T lymphocytes (P<0.01), natural killer (NK) cells (P<0.05) and the CD4+/CD8+ ratio (P<0.05) were significantly lower than in the control group. In patients who responded to the chemotherapy regimen, the pretreatment values of T lymphocytes (P<0.001), the CD4+/CD8+ ratio (P<0.01) and NK cell levels (P<0.01) were significantly higher than in the patients who did not.

CONCLUSION

In patients with invasive bladder carcinoma, cell-mediated immunity may have a role in the resistance to this malignancy and in these patients the pretreatment levels of T lymphocyte subsets may be an indicator of the potential response to chemotherapy.

Spinal subarachnoid hemorrhage attributable to schwannoma of the cauda equina

BACKGROUND

Cauda equina syndrome occurring as a result of spontaneous spinal subarachnoid hemorrhage (SAH) from a spinal tumor is reported to be rare.

CASE DESCRIPTION

A 28-year-old woman presented at our clinic with a history of severe back pain for 10 days, progressive paraparesis, and urinary retention. Her physical examination revealed a mass located intradurally at the level of L1-2 and a massive SAH. An L1-L2, laminectomy and a hemilaminectomy from D9 to D12 were performed and the SAH was evacuated and the cord was decompressed.

CONCLUSION

At the first year follow-up, her restricted dorsal and plantar flexion continued. Post-gadolinium magnetic resonance imaging revealed no mass.

Transmurally absorbed intravesical chemotherapy with dimethylsulfoxide in an animal model

BACKGROUND

The purpose of the present study was to investigate the hypothesis that dimethylsulfoxide (DMSO) enhances the absorbtion of the intravesical chemotherapeutics.

METHODS

Fifty male Wistar rats received 1.5 mg N-methyl-N-nitrosourea (MNU) intravesically every other week (weeks 0, 2, 4, 6 and 8) for a total of five doses. After week 14, rats underwent intravesical installation of either epirubicin (1 mg) or epirubicin + DMSO (50%) every other week (weeks 14, 16, 18, 20 and 22). The absorbtion of epirubicin was estimated histologically by observing its fluorescence in the bladder.

RESULTS

We observed papiller and/or hyperplastic formations in rat bladders (10/50 rats) due to installation of MNU. Epirubicin fluorescence was observed in the entire bladder wall of normal or hyperplastic regions in rats that were given DMSO prior to epirubicin. However, epirubicin was observed only in normal-appearing mucosa or in superficial layers of hyperplastic regions.

CONCLUSIONS

The concomittant addition of DMSO with intravesical epirubicin enhances the absorbtion of epirubicin to the entire bladder wall. In this way, epirubicin cytotoxicity and antitumor activity can be potentiated. This can be useful for both the treatment of superficial bladder cancer (especially in local recurrence and progression) and invasive bladder cancer (especially in regional chemotherapy).

Analysis of the peripheral blood lymphocyte subsets in patients with bladder carcinoma

OBJECTIVES

To evaluate the immune system of patients with bladder transitional cell carcinoma (TCC) by using peripheral blood lymphocyte subsets and to further compare the relationship between these subsets with respect to tumor stage and grade (superficial versus invasive and low versus high grade).

METHODS

Thirty patients with superficial TCC of the bladder, 30 patients with invasive TCC of the bladder, and 30 age- and sex-matched control subjects without any malignancy or immunologic abnormality were included in this study. The peripheral blood lymphocyte subset analysis was performed in all patients before any treatment was performed.

RESULTS

All lymphocyte subset values of patients with invasive bladder cancer, except B cell value, were significantly lower (P < 0.01) than the values of the control group. There were no significant differences between the lymphocyte subset values of patients with superficial bladder cancer and those of control subjects. The comparison of the lymphocyte subset values of the patients with superficial versus invasive bladder carcinoma revealed that in patients with invasive bladder carcinoma, the numbers of T and natural killer (NK) cells were significantly lower (P < 0.05) than those of patients with superficial bladder carcinoma. Patients with high-grade tumors had significantly fewer (P < 0.05) T and NK cells than patients with low-grade tumors.

CONCLUSIONS

Our results indicate that analysis of mean NK and T cell values and the mean ratio of CD4+/CD8+ cells in peripheral blood might be a useful adjunct for the clinical evaluation of patients with bladder cancer.

Clinical experience with Dynaflex penile prostheses in 120 patients

OBJECTIVES

To present our experience with the Dynaflex (American Medical Systems) self-contained inflatable penile prosthesis and define specific complication and patient dissatisfaction rates.

METHODS

From May 1990 through January 1998, 120 men underwent implantation of a Dynaflex prosthesis. The follow-up period ranged from 2 to 80 months (mean 42).

RESULTS

Specific complication rates observed after penile prosthesis implantation were as follows: prosthetic infection, 4.16%; mechanical device failure, 7.5%; and patient dissatisfaction because of inability to work the pump, 16.66%. After intensive teaching, the patient dissatisfaction rate dropped to 0.83%. The overall complication rate was 14.15%.

CONCLUSIONS

With several types of penile prostheses available, Dynaflex can be regarded as an appropriate alternative with a relatively low mechanical failure rate. However, careful preoperative assessment and patient education in the use of the pump mechanism are essential to obtain a successful result.

Is deep dorsal vein arterialization an alternative surgical approach to treat venogenic impotence?

OBJECTIVE

Several surgical techniques have been applied for the treatment of cavernosal venous leakage, sufficient enough to create erectile dysfunction. In light of the variable success rates, we report our experience with deep dorsal penile vein arterialization for the management of severe cavernosal venous leakage.

PATIENTS AND METHODS

Twenty-four impotent patients with venous leakage were treated by the Virag-II type of end-to-end anastomosis of the inferior epigastric artery to the deep dorsal penile vein and ligation of the vein proximally. Diagnostic evaluation included color flow Doppler sonography before and after intracavernous 60 mg papaverine injection and dynamic cavernosometry/ cavernosography, which indicated veno-occlusive dysfunction in 28 patients. Revascularization was technically possible in 24 of the patients, although in 4 anastomosis could not be achieved due to the poor quality of the inferior epigastric artery.

RESULTS

Five patients had early occlusion in the immediate postoperative period and 4 had late occlusion within 8 months. Potency was improved initially in 9 (38%) of the 24 patients in whom successful anastomosis had been achieved, with longer term improvement in 6 (25%) of 24 who realized restoration of erectile potency as defined by clinical investigations. The mean follow-up was 24 months (range 3-36 months).

CONCLUSION

We believe that anastomosis of the inferior epigastric artery to the deep dorsal penile vein and ligation of the vein proximally in cases of venous leakage results in a low success rate due probably to a pancavernosal alteration in corporal tissue compliance.

Carcinosarcoma of the prostate. A case report and a possible evidence on the role of hormonal therapy

A case of prostatic carcinosarcoma is presented with histopathologic and immunohistochemical characteristics. A 70-year-old man presented with a history of anti-androgen (cyproterone acetate) therapy for prostatic adenocarcinoma. Diffuse and strong staining for progesterone receptor was observed in the carcinosarcoma specimen although it was completely negative in the previous adenocarcinoma specimen. It may be speculated that hormonal therapy might have facilitated the selection of a progesterone-dependent subclone of tumor cells with the ability of mesenchymal differentiation and that genetic instability due to p53 inactivation might have played a role in this process.

Immunohistochemical determination of p53 protein in prostatic cancer and prostatic intraepithelial neoplasms

A role of genetic alterations in the p53 tumor suppressor gene has been implicated in many types of human malignancies. In this study, we examined the prevalence of immunohistochemically detectable p53 accumulation in prostatic tissues obtained from patients with prostatic adenocarcinoma, benign prostate hyperplasia and prostatic intraepithelial neoplasms. Six of 36 (16.7%) cancer cases and 2 of 11 (18.2%) cases of high-grade prostatic intraepithelial neoplasms showed p53 expression while no nuclear staining was observed in normal and hyperplastic prostatic tissues. Correlation of p53 expression with cancer stage, Gleason score and serum prostate-specific antigen level demonstrated that there was no statistically significant relationship between p53 expression and these clinicopathological parameters. Also, no significant association between p53 expression and prognosis was observed.

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.

Activity of the enzymes participating in purine metabolism of cancerous and noncancerous human kidney tissues

In this study, activity of some of the key enzymes participating in purine metabolism was measured in cancerous and noncancerous human kidney tissues from 18 patients with renal cell carcinoma. Twelve cancerous tissues were at stage T1-T2 and 6 tissues were at stage T3-T4. Adenosine deaminase (ADA) and guanase (GUA) activity was increased and xanthine oxidase (XO) activity decreased in cancerous tissues compared to noncancerous ones. No difference was, however, found between 5'-Nucleotidase (5'-NT) activity of the tissues. There were also no statistically meaningful differences between the enzyme activities of the cancerous tissues at stage T1-2 and T3-4. Results suggest that the changes observed in the activity of the enzymes participating in purine metabolism result from accelerated DNA turnover in the cancerous tissues and cells, and these changes might provide selective advantage, possibly by causing acceleration of salvage pathway activity, to the cancer cells to grow and develop more rapidly.

Preservation of shock-wave-induced renal histologic changes by dermatan sulfate

OBJECTIVES

To evaluate the protective effects of glycosaminoglycan (GAG) administration on shock-wave-induced renal histologic alterations, an experimental study using dermatan sulfate administration (DS) in rabbits was performed.

METHODS

The study included 45 white New Zealand rabbits; 36 were divided into two groups before shock-wave application. Animals in the first group (n = 18) received no specific medication before or after shock-wave treatment; animals in the second group (n = 18) received subcutaneous DS administration for a period of 2 months, beginning 2 weeks before shock-wave application. Following different numbers of shock-wave application (500, 1000, or 1500 shock waves), histopathologic evaluation of treated kidneys was made under light microscopy after 24 hours and 3 months. Nine animals were used for the control group.

RESULTS

During 24-hour examination, most of the kidneys in both groups demonstrated varying degrees of histopathologic alterations, depending on the number of shock waves applied. Among the most prominent pathologic features were protein deposition with free erythrocytes in the tubular lumen, glomerular hemorrhage, tubular dilation and degeneration, protein in Bowman's capsule, hyperemia, and mononuclear cell infiltration at the interstitial level. As opposed to the 24-hour evaluation findings, long-term (3-month) follow-up examination revealed histopathologic alterations that decreased but did not totally disappear in animals receiving no DS. Glomerular basement membrane thickening, mononuclear cell infiltration and limited protein deposition in some tubules, together with cortical interstitial fibrosis, were observed to some extent in these animals. On the other hand, no severe histopathologic alteration with normal glomerular basement membrane appearance was noted in animals receiving DS medication.

CONCLUSIONS

Our results indicated a long-term favorable protective effect of DS administration on morphologic abnormalities in rabbits undergoing shock-wave treatment. Although tubular alterations persisted to some extent, mononuclear cell infiltration has been limited and the natural appearance of the basement membrane has been well preserved in most of the treated animals.

Stone recurrence after shockwave lithotripsy: possible enhanced crystal deposition in traumatized tissue in rabbit model

To evaluate the possible traumatizing effect of high-energy shockwaves (HESW) on new stone formation as indicated by crystal deposition in the renal parenchyma, we performed an experimental study in 50 rabbits. During severe oxaluria induced by continuous ethylene glycol (0.75%) administration, animals in the first group (N = 15) received 500 to 1500 shockwaves. Animals in the second group (N = 15) underwent no specific therapy apart from ethylene glycol administration. In a third group of animals (N = 15), only shockwave administration was applied. Sham group animals constituted the last group in our study (N = 5). Three months after shockwave application, tissue sections obtained from treated and untreated kidneys were evaluated histopathologically under light and transmission electron microscopy (TEM) for the presence and degree of crystal deposition in the cortical parenchymal region subjected to HESW. Crystal deposition was evident in the intercellular region and intratubular parts of the parenchyma in animals subjected to HESW application, especially in those receiving relatively high (1000 or 1500) numbers of shockwaves. On the other hand, no crystal formation and deposition was detectable in animals undergoing only ethylene glycol therapy or shockwave administration alone. Sham group animals demonstrated no significant renal histopathology. The traumatic effects of HESW should be evaluated as a factor in new stone formation after SWL.

Effects of extracorporeal shockwave lithotripsy on urinary concentration of epidermal growth factor

In a prospective study, we tried to determine whether extracorporeal shockwave lithotripsy (SWL) has any effect on urinary epidermal growth factor (EGF) concentrations and to investigate whether EGF can be used as a marker for detecting shockwave-induced impairment of distal tubular cells. A total of 12 patients with renal pelvic or caliceal stones < or = 2 cm undergoing anesthesia-free SWL without ancillary measures and a control group of 10 patients without any urologic symptoms were included in this study. The urinary concentrations of EGF were measured by radioimmunoassay before and 4 hours, 24 hours, and 7 days after SWL. Relative urinary EGF concentrations were expressed as the ratio of EGF to creatinine (ng/mL creatinine). The mean urinary EGF concentration (mean +/- standard error) in control subjects and patients with renal pelvic or caliceal stones before SWL was 23.90 +/- 3.15 ng/mL creatinine and 22.18 +/- 6.85 ng/mL creatinine, respectively (p > 0.05). In patients with stones, we found a decrease in urinary EGF concentration 4 hours, 24 hours, and 7 days after SWL. Indeed, 7 days after SWL, the EGF concentration was on average half of the original value, a biologically significant, although not statistically significant, decrease.

Protective effect of verapamil on renal tissue during shockwave application in rabbit model

Although extracorporeal shockwave lithotripsy (SWL) is the treatment of choice for symptomatic urinary calculi, it has been shown in number of studies that adverse effects of high-energy shockwaves may be encountered in short- and long-term follow-up. To evaluate the possible protective effect of verapamil administration on renal tissue, both magnetic resonance imaging (MRI) and histopathologic examination were performed after SWL in rabbits. Thirty-five animals were divided into three groups. The 15 animals in the first group were fed verapamil (0.1 mg/kg) for 3 days. Another 15 animals received no medication but underwent SWL, and the remaining 5 animals received anesthesia alone (sham group). The animals were then subdivided into three groups according to the shockwave number applied (1000, 15,000, or 2000) and the aforementioned evaluations were performed 24 hours and 3 months after the procedure. We found prominent histopathologic alterations in animals not receiving any medication before SWL. Persistence of these pathologic alterations during 3 months of follow-up indicated the importance of preservation of renal architecture during high-energy shockwave application. On the other hand, animals under verapamil medication prior to SWL demonstrated only a limited degree of histopathologic alteration. Demonstration of a normal histologic pattern after 3 months supported the preservation of tissue structure by such medication. No significant histopathologic alteration could be observed in the sham-group animals, as expected. Our study demonstrates that verapamil is protective against shockwave-induced renal tubular damage. Such medications may be useful to avoid the proven histopathologic and functional side effects of high-energy shockwaves.

Staging with computed tomography, transrectal ultrasonography and transurethral resection of bladder tumour: comparison with final pathological stage in invasive bladder carcinoma

OBJECTIVE

To assess the accuracy of clinical staging methods in patients with locally advanced bladder cancer.

PATIENTS AND METHODS

Sixty-five patients with invasive bladder cancer primarily staged using transrectal ultrasonography (TRUS), computed tomography (CT) and transurethral resection of the bladder tumour (TURBT) were compared with the final pathological stage determined after radical cystectomy.

RESULTS

Accurate staging was obtained by TRUS, CT and TURBT in 40, 35 and 46% of the patients, respectively. The rank correlation between primary clinical stage and final pathological stages was significant by all three methods, but not close.

CONCLUSIONS

The results of this study raise doubts about the assumed benefit of TRUS and CT in the clinical staging of invasive bladder tumours. These methods did not improve the findings obtained by TURBT alone.

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.

Serum neuron specific enolase: can it be a tumour marker for renal cell carcinoma?

Neuron specific enolase (NSE) is an isoenzyme of the glycolytic enzyme enolase. It is not only a marker for all types of neurons but also for all neuroendocrine or paraneuronal cells and various malignant tumours, even of non-neuroendocrine types. We had studied serum NSE in 25 consecutive patients with renal cell carcinoma (RCC). The study included 10 stage I, 3 stage II, 3 stage III-B and 9 stage IV-B patients. Both pretreatment and posttreatment levels were evaluated. Regardless of stage, overall we observed elevated levels of NSE in 80% (20/25) at diagnosis. After the appropriate treatment, according to the stage, there had been a statistically significant (p < 0.05) decrease in the serum levels in all stage I, II and III-B patients. The posttreatment values were not available for stage IV-B patients because they did not come for follow-up. The preliminary results of our study revealed that serum NSE may be considered as a useful marker in the evaluation and surveillance of RCC.

Evaluation and surgical treatment of patients with penile curvature

In patients with adult penile curvatures the aim of treatment is to have a penis straight enough and firm enough to allow satisfactory sexual function. Several operative approaches have been used to correct this condition. Herein, we describe our experience with the evaluation and surgical treatment of 37 patients with penile curvature. When we have decided on surgery, we either preferred to elongate the ventral corpora cavernosa by interposition of a piece of dura mater (2 patients) or in most cases (the remaining 35 patients) only excised wedges of tunica albuginea at the arcs of the maximum curvature located with artificial erection (Nesbit's operation). In conclusion, our results showed that Nesbit's operation is a versatile procedure that proved to be useful for correction of penile curvatures in patients with Peyronie's disease. However, further studies and clinical trials are needed to determine if the dura mater is an alternative in the treatment of penile curvatures due to congenital aetiology.

Evaluation of ischemia after ESWL: detection of free oxygen radical scavenger enzymes in renal parenchyma subjected to high-energy shock waves

To evaluate the degree of ischemic formation at the tissue level after high-energy shock wave (HESW) application in a time- and dose-dependent manner, an experimental study in rabbits was performed. Following varying numbers of HESWs (1,000-2,000-3,000 shock waves) under fluoroscopic localization, treated kidneys were removed, by assessing tissue concentrations of two different free-radical scavenger enzymes (superoxide dismutase and catalase) the degree of formation of free oxygen radicals (i.e. ischemia) was evaluated. Evaluation of our results showed a statistically significant (p < 0.05) decrease in tissue scavenger enzyme levels (i.e. formation of free oxygen radicals) after 24 h following HESW application. However, results obtained 7 days after ESWL demonstrated disappearance of ischemia with normalization of tissue enzyme levels (p > 0.05).

A 49-year-old woman with non-complicated exstrophy of the bladder

We report a 49-year-old woman with exstrophy of the bladder. Our living case constitutes a rare example of bladder exstrophy cases, who lived about 50 years without any severe complication or intervention.

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.

Renal liposarcoma of the sinus renalis

We report on 42-month follow-up of a case of renal liposarcoma of the sinus renalis with tumour-free survival. It is a rare condition and occurs generally in the 4th and 6th decades of life. Renal liposarcomas are clinically asymptomatic for a long period of time. Symptoms develop only when the tumours become large enough, as in our case. For the differential diagnosis of renal liposarcoma we performed intravenous urography, computerized tomography and colour flow Doppler ultrasonography. After these diagnostic evaluations the patient underwent right radical nephrectomy. Complete surgical resection was performed. Final diagnosis was made by pathological examination. Because of the poor results of either chemotherapy or radiotherapy, we conclude that 42 months of tumour-free survival is related to complete surgical resection with negative surgical margins.

Leucine aminopeptidase enzymuria: quantification of renal tubular damage following extracorporeal shock wave lithotripsy

To evaluate the extent of renal parenchymal injury following high energy shock wave (HESW) application we measured the urine levels of two renal tubular brush border enzymes: leucine aminopeptidase (LAP) and gamma-glutamyltranspeptidase (GGT) the day before, 24 hours and 7 days after extracorporeal shock wave lithotripsy (ESWL) in 23 patients. All patients had caliceal stones and were treated with a Dornier MPL 9000 lithotriptor under sedoanalgesia. Creatinine concentration of each sample together with total shock wave effect (TSWE) values were also assessed and comparatively evaluated with enzymuria levels. Our results indicated a statistically significant rise in urinary excretion of both enzymes after 24 hours following lithotripsy (p < 0.05). All these values returned to normal limits within 7 days after ESWL (p > 0.05). Transient tubular damage due to HESW was found to be related to TSWE values assessed in our group.

Augmentation duracystoplasty in neurogenic bladder dysfunction

BACKGROUND

Augmentation cystoplasty is the treatment of choice for patients with neurogenic bladder dysfunction in cases that are unresponsive to other medical treatment. Although intestinal segments as bladder substitutes are preferred over the other alternatives at present, they are not ideal bladder replacements due to several potential hazards. The purpose of this study was to determine whether or not augmentation duracystoplasty can be an alternative to augmentation enterocystoplasties.

METHODS

Ten patients with neurogenic bladder dysfunction unresponsive to conservative measures, underwent augmentation duracystoplasty by using the modified Bramble-Clam technique. The follow-up period was T-28 months.

RESULTS

At present, seven of 10 patients are completely continent for with clean intermittent catheterization. The remaining three patients required oral oxybutinin therapy, postoperatively, to achieve continence although lower dosages than those required in the preoperative period. We did not observe any serious pre- or postoperative complications.

CONCLUSIONS

Based on these preliminary findings we think that duracystoplasty can be considered as a treatment alternative for hyperreflexic and/or low compliant neurogenic bladders.