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Wir berichten uber einen 56-jahrigen Patienten, der im Jahr 1987 in Russland mit phaken Hinterkammerlinsen versorgt wurde und sich 31 Jahre spater mit einer anterioren kortikalen Katarakt und beginnenden Hornhaut-Endothel-Epithel-Dekompensation (HHEED) beider Augen in unsere Behandlung begab. Geschildert werden die strategische Planung und Durchfuhrung der chirurgischen Versorgung und der klinische Verlauf.

Purpose Chronic graft versus host disease is a major consequence after allogeneic stem cell transplantation (allo-SCT) and has great impact on patients’ morbidity and mortality. Besides the skin, liver, and intestines, the eyes are most commonly affected, manifesting as severe ocular surface disease. Treatment protocols include topical steroids, cyclosporine, tacrolimus, and ASED. Since these patients often receive systemic immunosuppressant therapy from their oncologists, a topical re-administration of these drugs via ASED with potentially beneficial or harmful effects is possible. The purpose of the study was to determine whether and to which extent systemic immunosuppressants are detectable in ASED. Methods A total of 34 samples of ASED from 16 patients with hemato-oncological malignancies after allo-SCT were collected during the manufacturing process and screened for levels of cyclosporine, mycophenolic acid, everolimus, and tacrolimus via liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). The study followed the tenets of the Declaration of Helsinki and informed consent was obtained from the subjects after explanation of the nature and possible consequences of the study. Results Cyclosporine was found in 18 ASED samples in concentrations ranging from 6.5–105.0 ng/ml (32.0 ± 22.8 ng/ml, mean ± SD). The concentration range of mycophenolic acid in 19 samples was 0.04–25.0 mg/l (4.0 ± 5.4 mg/l, mean ± SD). Everolimus and tacrolimus concentrations were well below the respective limits of quantification ( Conclusions Our study suggests that orally administered cyclosporine and mycophenolic acid for the treatment of systemic GvHD, but not everolimus and tacrolimus, are distinctly detectable in ASED in relevant concentrations. It is highly likely that these agents affect topical therapy of ocular GvHD. However, the extent of this effect needs to be evaluated in further studies.

Giriş: Kronik Hepatit C (HCV) enfeksiyonu, siroz ve hepatosellüler karsinom (HCC) etyolojisinde rol ayan etkenlerden olup, son yıllarda tedavide direkt etkili antiviral (DEA) ilaç kombinasyonları sayesinde oldukça iyi tedavi başarıları mevcut olup, son yayınlar kalıcı viral yanıt oranlarının %97-99 seviyelerinde olduğunu bildirmektedir. Kronik HCV enfeksiyonunda tedavinin amacı; HCV eradikasyonu, siroz, HCC ve ekstrahepatik komplikasyon (esansiyel mikskriyoglobulinemi, HCV-immun kompleks ilişkili nefropati, B hücreli Non Hodgkin Lenfoma) gelişimininin engellenmesi, mortalite ve morbiditenin azaltımasıdır. Tedavi öncesi tüm hastaların; Hepatit B virüs (HBV), Hepatit Avirüs (HAV) ve (Human Immmunodeficiency Virus) HIV açısından tetkik edilmesi önerilmektedir. HCV tanısı ile DEA ilaç tedavisi alan ve izole hepatit B kor antikoru (anti-HBc IgG) pozitif olan hastalarda şiddetli hepatit B reaktivasyonu olabileceği unutulmamalıdır.Gereç ve Yöntem: Bu çalışmada; Ocak 2016 ile Aralık 2018 tarihleri arasında polikliniğimize başvuran kronik HCV tanılı hastalardaki, HBV koenfeksiyonu ve izole hepatit B kor antikoru seropozitifliği araştırıldı. Bulgular: Çalışma grubunu oluşturan toplam 313 hastanın, 135’i (% 43.1) kadın, 178’i (%56.9) erkekti, yaş ortalaması 48.2±11.5 idi. 19 (%6) hastada eşlik eden HBsAg pozitifliği, 8 (%2.5) hastada HBV-DNA pozitifliği ve 39 (%12.5) hastada izole Anti-HBc IgG seropozitifliği saptandı. Kronik HCV tanılı hastalarda izole Anti-HBc IgG seropozitifliği; 20-29 yaş aralığında %5.3, 30-39 yaş aralığında %8.7, 40-49 yaş aralığında %9.7, 50-59 yaş aralığında %15.6, >60 yaş %29 ve tüm yaş gruplarında %12.5 olarak tespit edildi. Sonuç: Çalışmamızda saptanan izole Anti-HBc IgG seropozitiflik oranı ülkemizde yapılan çalışmalara benzer bulunmuştur. Kronik HCV tanılı hastaların HBV serolojisi açısından taranması, seronegatif kişilerin HBV koenfeksiyonu gelişmesini engellemek amaçlı aşılanması gerekmektedir.

Bu çalışmada, MATLAB/Simulink ortamında modellenen iki-seviyeli bir evirici ile sabit mıknatıslı senkron motor(SMSM) tahrik edilmiştir. Gerçek test düzeneklerindeki sonuçlara uyumlu sonuçlar verebilecek bir simülasyon modeli oluşturulmuştur. Gerçeğe uygun sonuçlar ve dalga şekilleri elde edebilmek için ideal modeller yerine eşdeğer modeller kullanılmıştır. Örneğin, SMSM elektriksel ve mekanik eşdeğer modellerinin kullanılması, şebeke tarafına direnç ve endüktans katkılanması ve DC bara kapasitörünün eşdeğer direnci(ESR) ile birlikte modellenmesi elde edilen sonuçların gerçek test düzeneklerinden alınan sonuçlara yakınsamasını sağlayacaktır. SMSM, açık-çevrim olarak kontrol edilmiştir. Yarı-iletken anahtarlar için gerekli kapı işaretleri SPWM(Sinüzoidal Darbe Genişlik Modülasyonu) anahtarlama yöntemi ile üretilmiştir. Bu PWM(Darbe Genişlik Modülasyonu) yönteminin çalışma mantığı detaylı olarak incelenmiştir. Evirici üzerindeki yapıların anlaşılması için simülasyon modelleri, önemli parametreler ve matematiksel denklemler ilgili bölümlerde sırasıyla verilmiştir. Verilen simülasyon görüntülerinde evirici ve SMSM üzerindeki birçok önemli noktanın akım-gerilim dalga şekilleri incelenmiştir. Şebekeden çekilen akım, DC bara kapasitörü üzerindeki gerilim dalgalanması, SPWM yöntemiyle üretilen anahtarlama işaretleri, evirici çıkış faz akımları, motor faz-nötr gerilimleri, motor faz-faz gerilimleri önemli görülen ve bu çalışma kapsamında sunulan işaretlerdir. Özellikle, güç hesabının yapılabilmesi için evirici çıkış akım-gerilim işaretleri verilmiştir. Tüm bu temel incelemelerden sonra, evirici çıkış gücü yani motor giriş gücü ölçülmüştür. Motor faz akımı ve faz-nötr gerilimi arasındaki faz açısı bulunmuştur. Son olarak Simulink ortamında yapılan bu ölçümler, teorik hesaplamalarla kıyaslanmış ve modellerin doğruluğu ispatlanmıştır., In this study, a permanent magnet synchronous motor (PMSM) was driven by a two-level inverter modeled in MATLAB / Simulink environment. A simulation model has been created that can give results compatible with the results in real test setups. In order to obtain realistic results and waveforms, equivalent models were used instead of ideal models. For example, the use of PMSM electrical and mechanical equivalent models, adding resistance and inductance to the grid side, and modeling the DC bus capacitor with equivalent series resistance (ESR) will ensure the convergence of the obtained results to the results from real test setups. Open-loop control of PMSM has been provided. Gate signals required for semiconductor switches were produced by SPWM (Sinusoidal Pulse Width Modulation) switching method. The working principle of this PWM (Pulse Width Modulation) method has been studied in detail. In order to understand the structures on the inverter, simulation models, important parameters, and mathematical equations are given in the relevant sections respectively. In the given simulation outputs, the current-voltage waveforms of many important points on the inverter and PMSM were examined. Current drawn from the grid, voltage ripple on the DC bus capacitor, switching patterns produced by the SPWM method, inverter output phase currents, motor phase-to-neutral voltages, motor phase-to-phase voltages are the waveforms that are considered as important and presented within the scope of this study. In particular, the inverter output current-voltage signals are given for power calculation. After all these basic examinations, the inverter output power, as known as the motor input power, was measured. The phase angle between the motor phase current and phase-neutral voltage was found. Finally, these measurements made in the Simulink environment were compared with theoretical calculations and the accuracy of the models was proved.

Streptococcus agalactiae, is the species designation for streptococci belonging to Lancefied group B and are facultative, gram-positive diplococci. In the previous years, it was known as urinary tract infection agent in pregnant women, it was rarely detected in other infections in adults. Nowadays, S. agalactiae is increasingly recognized as a cause of invasive infections such as bacteraemia without any focus, skin and soft tissue infections, upper respiratory tract infections, osteoarticular infections, peritonitis, cardiac infections, meningitis and other focal infections among non-pregnant adults, especially in the elderly and immunocompromised patients. Although rare in the literature, osteoarticular infections caused by S. agalactiae have been reported in adults. In this case report, we aimed to present a patient with iatrogenic spondylodiscitis due to S. agalactiae after ultrasound-guided transrectal prostate needle biopsy.

The aim of this study was to search for any relations between the neutrophil-tolymphocyte ratio (NLR) and the development of osteomyelitis and the need for amputation in patients with diabetic foot infection (DFI). All data included DFI patients who were hospitalized in our Infectious Diseases Clinic between 2012 and 2015 and who were classified according to International Classification Disease Code System. 75 patients were analyzed in the study. The DFI patients were stratified into 3 groups of whom had amputation procedure, whom had only debridement/drainage procedure and whom had any surgery procedure. Sidac post hoc analysis was used to perform the effects of NLR, C-reactive protein, erythrocyte sedimentation rate and glycosylated hemoglobin on the surgery procedure status. The DFI patients were also stratified into two another separate group for another analysis to search for the effect of NLR values on the development of osteomyelitis. The mean value of NLR in the amputated patients’ group (15.7 ± 10.3 was significantly higher than those with debridement procedure (9.9 ± 5.6) and those without any surgery (6.0 ± 2.8) (p = 0.001). NLR values were also found significantly higher in patients with osteomyelitis in the second analysis (p = 0.004). In this study, the NLR was found to have a predictive value on the development of osteomyelitis and on the progression to amputation in patients with DFI.

Adrenocortical carcinomas are rare and aggressive tumors. The recently described oncocytic subtype has been reported approximately 40 times in the literature.1 In this video, we describe an unusual case of a large adrenal oncocytic carcinoma, its minimally invasive approach, and its anatomopathological features. A 43-year-old male presented to the emergency room with acute abdominal pain and fever. Blood tests showed 20,000 white blood cells and a reactive C-protein of 25. Tomography showed a large right adrenal tumor with necrosis. Antibiotics were started at the intensive care unit. A complete study showed normal tests, including hormones, cortisol, and metanephrines. At the multidisciplinary team meeting it was decided to perform a right transabdominal laparoscopic adrenalectomy. The tumor was approached from the medial side to the lateral side, always controlling the inferior vena cava. Indocyanine green was used to identify vascular structures. Anatomical pathology revealed a 15 cm lesion corresponding to a malignant adrenal oncocytic carcinoma according to the modified Lin–Weis–Bisceglia criteria.2 The patient was discharged without complications on the fifth day. He is receiving mitotane and is disease-free 5 months after surgery. Oncocytic subtype is a rare entity described only a few times in the literature. Surgical treatment is of choice due to its curative potential, and the open versus laparoscopic approach will be chosen depending on the size of the tumor and the surgeon’s experience. It is believed that this subtype may have a less aggressive behavior than the typical adrenal carcinoma,1 therefore its better understanding may help to define therapeutic decisions and prognosis in the future.

Therapy for ocular graft-vs-host disease (ocular GvHD) is challenging for ophthalmologists as progress of the disease often occurs rapidly and is unforeseeable. Primary goal is the preservation or restoration of visual acuity, however, studies on ocular GvHD that have investigated therapeutic concepts are limited. In contrast, most therapeutic recommendations from consensus conferences derive from studies on dry eye diseases other than ocular GvHD. This review demonstrates the available therapies in the following categories: local, systemic, surgical and prophylactic. Primary targets are anti-inflammation, anti-fibrosis and lubrification of the ocular surface. In conclusion, studies strictly on ocular GvHD are needed to enable better evidence-based therapeutic decision-making in the future.

Objectives We hypothesized that deceleration capacity (DC), a novel marker of cardiac autonomic modulation, is an independent predictor for mortality in patients with non-ischemic dilated cardiomyopathy (NICM). Background NICM is associated with a high risk for sudden cardiac death (SCD). However there are no clinically established parameters available for risk stratification beyond LVEF. DC has been previously shown to be a strong independent predictor for total mortality in patients after myocardial infarction. Methods Holter-ECG recordings of 201 patients NICM (83.1% male, mean age: 61.4years, mean LVEF: 33.3%) were analyzed by the method of phase-rectified-signal-averaging (PRSA) to obtain DC. Results During a minimum follow-up of 40month 59 patients died. Kaplan Meyer Analysis showed a significantly higher mortality in patients with a DC below 4.5ms (log rank p=0.012) irrespective to the presence of atrial fibrillation. Conclusions Impaired DC is a powerful independent predictor for mortality in patients with NICM.

Double J (DJ) ureteral stents are frequently used as a natural consequence of common use of endoscopic procedures. Even though use of these stents is practical and safe, undesired problems such as urinary tract infection, kidney dysfunction may develop in case of their long stay in the body. DJ stents staying for a long time in the body due to forgotten by urologist and frequently by the patients or due to carelessness of the patients which may cause serious medical and legal problems. Herein, we reported two cases with DJ stent placed 4 and 2 years ago after open kidney stone operation and encrusted as they were forgotten. These 2 cases were treated by application of ESWL, endoscopic laser cystolithotripsy, suprapubic percutaneous cystolithotripsy, ureteroscopic lithotripsy and percutaneous nephrolithotomy methods consecutively. In conclusion, cases with DJ stents should be informed and warned strictly to avoid rare but serious problems due to delay or forget of these stents. We think that with an algorithm including the consecutive treatment alternatives management of encrusted DJ stents might be more successful. J Clin Exp Invest 2012; 3(2): 263-266, DJ stentler endoskopik uygulamaların yaygınlaşmasıyla beraber sıklıkla kullanılmaktadır. Bu stentler güvenli ve pratik olmalarının yanında vücutta normalden uzun süre kalırlarsa üriner sistem enfeksiyonu, böbrek fonksiyon kaybı gibi yan etkilere sahiptir. Bazen ürologlar çoğu kez de hastalar tarafından unutulan veya hastanın ilgisizliği nedeniyle vücutta uzun süre kalan double J stentler günümüzde halen sorun olmaya devam etmektedir Bu yazıda, biri 4 yıl önce ve diğeri 2 yıl önce açık böbrek taşı ameliyatı sırasında yerleştirilen ve sonrasında unutulup taşlaşan DJ stentli iki hastanın uygulanan ESWL, endoskopi sistolitotripsi, perkütan sistolitotripsi ve perkütan nefrolitotripsinin kombine kullanımıyla taşsız hale getirilmeleri tartışıldı ve ilgili yayınlar gözden geçirildi. Biz DJ stent yerleştirilen hastaların takiplerinde hastaların daha sıkı uyarılmalarının ve daha çok bilgilendirmelerinin gerekli olduğuna inanıyoruz. Bunun için gerekirse iletişim imkanlarından da yararlanılmalıdır. Enkruste veya taşlaşmış DJ stentlerle mücadele etmek için birçok seçeneğin olduğu ve belli bir algoritma ile bu seçeneklerin kullanılarak hastaların taşsız hale getirilebileceği düşüncesindeyiz.

Ovotesticular disorder of sex development (OTDSD) is a rare condition and defined as the presence of ovarian and testicular tissue in the same individual. Most of patients with OTDSD have female internal genital organs. In this report, we present a case in which, we demonstrated prostate tissue using endoscopic and radiologic methods in a 46-XX, sex determining region of the Y chromosome negative male phenotypic patient, with no female internal genitalia. Existence of prostate in an XX male without SRY is rarely seen and reveals a complete male phenotype. This finding is critical to figure out what happens in embryonal period.

Objectives To investigate the effect of testosterone on contractile tone of endothelium-denuded human corpus cavernosum strips. Human studies designed to examine a possible relaxant effect of testosterone on corpus cavernosal circulation are lacking. Methods Testosterone (0.1-300 μM) was added cumulatively to organ baths after precontraction of isolated human corpus cavernosum strips (n = 5) with KCl (45 mM). Testosterone-induced responses were tested in the presence of nonselective, large, conductance Ca 2+ -activated and voltage-sensitive K + channel inhibitor tetraethylammonium (1 mM), adenosine triphosphate-sensitive K + channel inhibitor glibenclamide (10 μM), voltage-dependent inward rectifier K + channel inhibitor barium chloride (30 μM) and voltage-sensitive K + channel inhibitor 4-aminopyridine (1 mM). Results Testosterone (0.1-300 μM) produced relaxation in human corpus cavernosum (maximum relaxation 65.4% ± 3.3% of KCl-induced contraction) that reached a maximum at a concentration of 300 μM. Testosterone-induced relaxation was significantly attenuated by glibenclamide, but it was not affected by the other K + channel inhibitors (tetraethylammonium, barium chloride, or 4-aminopyridine). Conclusions Testosterone might induce relaxation in human isolated corpora cavernosa strips by activation of smooth muscle adenosine triphosphate-sensitive K + channels. This finding suggests that testosterone, in addition to its known endothelial action, might regulate erectile function locally by its action on the smooth muscle of the human corpus cavernosum.

Background: Fournier’s gangrene (FG) is an extensive fulminant infection of the genitals, perineum or the abdominal wall. The aim of this study is to share our experience with the management of this difficult infectious disease. Methods: Thirty-three male patients were admitted to our clinic with the diagnosis of FG between February 1988 and December 2003. The patient’s age, etiology and predisposing factors, microbiological findings, duration of hospital stay, treatment, and outcome were analyzed. The patients were divided into two groups. The first 21 patients (Group I) were treated with broad-spectrum triple antimicrobial therapy, broad debridement, exhaustive cleaning, and then they underwent split-thickness skin grafts or delayed closure as needed. The other 12 patients (Group II) were treated with unprocessed honey (20–50 mL daily) and broad-spectrum triple antimicrobial therapy without debridement. Their wounds were cleaned with saline and then dressed with topical unprocessed honey. The wounds were inspected daily and the honey was reapplied after cleaning with normal saline. Then, the patients’ scrotum and penis were covered with their own new scrotal skin. Results: The mean age of the patients was 53.9 ± 9.56 years (range = 23–71). The source of the gangrene was urinary in 23 patients, cutaneous in seven patients, and perirectal in three patients. The predisposing factors included diabetes mellitus for 11 patients, alcoholism for 10 patients, malnutrition for nine patients, and medical immunosuppression (chemotherapy, steroids, malignancy) for three patients. The mean duration of hospital stay was 41 ± 10.459 (range = 14–54) days. Two patients in Group I died from severe sepsis. The clinical and cosmetic results were better in Group II than Group I. Conclusions: Necrotizing fasciitis of the perineum and genitalia is a severe condition with a high morbidity and mortality. Traditionally, good management is based on aggressive debridement, broad-spectrum antibiotics, and intensive supportive care but unprocessed honey might revolutionize the treatment of this dreadful disease by reducing its cost, morbidity, and mortality.

Aim To evaluate the efficacy of postoperative irradiation in renal cell carcinoma. Patients and methods Forty patients with localized renal cell carcinoma admitted to our hospital between 1986 and 1999 were evaluated. All patients were initially treated with radical nephrectomy. Postoperative radiotherapy was given to 26 of 40 patients (65%). Fourteen patients (35%) received no adjuvant therapy. Median age was 55 years (range, 20–70 years). Twenty-four patients (60%) were men and 16 patients (40%) were women. Histopathological diagnosis was renal cell carcinoma in all of the patients. N+ disease was present in 3 patients (7%). Stage I and II disease was present in 25 patients (63%) and stage III and IV disease in 15 patients (37%). Two patients (5%) had T1a disease, 11 patients (27%) had T1b, 15 patients (38%) had T2, 11 patients (27%) had T3a and 1 (3%) patient had T3b. In the radiotherapy group, renal bed and regional lymphatic fields were irradiated with daily fractions of 180–200 cGy/fraction to a total dose of 46–50 Gy, using parallel opposing fields. Results The 5-year overall survival rates were 70% in the postoperative radiotherapy group and 20% in the no adjuvant treatment group, showing no significant difference (P = 0.1). The 5-year disease-free survival rates were 66% in the radiotherapy group and 16% in the no treatment group, with a significant difference in both univariate and multivariate analyses (P = 0.045 and P = 0.0007, respectively). Stage III and IV disease, tumor size ≥7 cm, presence of distant metastasis and lactate dehydrogenase level >450 U/L were found to be adverse prognostic factors for overall survival in both univariate and multivariate analyses. Analyzing the factors affecting disease-free survival, absence of postoperative radiotherapy and tumor size ≥7 cm were found to be adverse prognostic factors in univariate and multivariate analyses. Conclusion Multi-institutional prospective randomized trials using modern radiotherapy techniques such as conformal radiotherapy and intensity-modulated radiotherapy are necessary to evaluate the real role of radiotherapy and its effect on survival in renal cell carcinoma, especially in selected patients with a high risk of local or regional failure.

Over an 8-year period (January 1996 to December 2003), a total of 171 patients below the age of 15 years were diagnosed with chronic renal failure. The mean incidence rate of CRF in Kuwaiti children was found to be 38.2 per million children per year, with a peak incidence of 55 per million children per year. While the mean age at diagnosis was 33+/-12 months (range: 1 month to 15 years), the male:female ratio was 2.7:1. Etiological factors for chronic renal failure included congenital urological malformation (61.9%), chronic glomerulopathies (5.2%), hereditary nephropathies (21%), multi-system disease (0.5%), chronic pyelonephritis (without VUR) (4.6%), tumors (0.6%), ischemic renal disease (1.1%) and unknown etiology (1.7%). Thirty percent of patients reached end-stage renal disease within a mean of 18 months following diagnosis. The overall mortality before reaching ESRD was reported to be 4%. Kuwait has one of the highest incidence and prevalence rates of CRF in children. It is likely that genetic and hereditary factors are the cause of these high rates.

Strongyloides stercoralis is an intestinal nematode of humans that infects tens of millions of people worldwide. It is a rarely reported parasitic infestation in Turkey. Disseminated strongyloidiosis may develop in patients with immunodeficiencies. S. stercoralis hyperinfection is often accompanied by sepsis or meningitis with enteric organisms. Glucocorticoid treatment is one of the conditions most specifically associated with triggering hyperinfection, but cases have been reported in association with hematologic malignancy, malnutrition, and AIDS. Anthelminthic agents such as ivermectin have been used successfully in treating the hyperinfection syndrome. We report a case of Strongiloides stercoralis infection and Loeffler syndrome that developed in a patient who had systemıc prednisolone. The patient in the pulmonary disease department clinic was examined because of right lung upper lobe mass image, and referred to us with complaints of abdominal pain, diarrhea and pruritus. Peripheral smear showed 43% eosinophilia. Parasitological examination of faeces showed larvae of Strongyloides stercoralis. Parasitosis and Loeffler's syndrome was considered in the patient. The patient's complaints declined significantly after treatment with albendazole.

Prostatic abscess is a rare but nevertheless serious disease. It should be diagnosed at an early stage by the combination of clinical examination and transrectal ultrasound, and drained. We treated a 79-year-old case with multiple prostate abscesses (PAs) by using lavage of the saline and antibiotic (cefoxitin) after transrectal ultrasound-guided transrectal puncture and aspiration. We are presenting the transrectal ultrasound images of pre- and postmedication, where we achieved complete success and no relapse was seen in follow-up of 1 year.

Objective: Microorganisms ping pong effect from hand to cell phone can actualize. The aim of this study was to investigate the bacterial diversity and to compare the similarities of bacteria of the thumb, forefinger cultures and smart phones surface swab cultures taken from the Baskent University Faculty of Medicine students. We also targeted that to compare bacterial disparity of clinical and preclinial students and to see the affect of hand washing, cell phone cleaning practice on bacterial variability. Methods: after voluntary informed consent forms were signed, students from Baskent University Faculty of Medicine were included to the study. Finger cultures were taken from thumb, forefinger of their active hands. Swab cultures collected from surface of the smart phones. Identifications of isolated colonies were performed with conventional methods. Results: Smartphone and finger cultures were collected from total 230 subjects, including 143 women 87 men's. 65% of cultures were taken from preclinical student and the rest from clinical students. Bacterial similarity was recovered from finger cultures and Smartphone cultures in 79% of volunteers (p, Amaç: Cep telefonu kullanan kişinin telefonunun, el florasında bulunan bakterilerle kontamine olabilme olasılığı yüksektir. Başkent Üniversitesi Tıp Fakültesi öğrencilerinin işaret ve baş parmaklarından sürüntü kültürleri ile kullandıkları cep telefonlarından sürüntü kültürleri alınmıştır. Her iki kültürdeki bakteri/lerdeki benzerlikler saptanmıştır. Klinik öncesinde ve klinikte eğitimlerini sürdüren öğrenciler olarak iki farklı gruba bölünerek taşınan bakterilerin benzerlik ve farklılıklarının belirlenmesi; el yıkama alışkanlığının klinikte eğitim gören öğrencilerde, klinik öncesinde eğitim gören öğrencilere kıyasla artıp artmadığının ve bu alışkanlığın kişinin kullandığı cep telefonlarındaki bakteri kolonizasyonlarını değiştirip değiştirmediğinin belirlenmesi amaçlanmıştır. Yöntemler: Başkent Üniversitesi Tıp Fakültesi öğrencilerin gönüllü onam formları alınarak, Kullandıkları telefonlarının yüzeyinden ve bu telefonu kullandıkları ellerinin baş ve işaret parmaklarından sürüntü kültürü yapılmıştır. Bu örnekler alınmadan önce telefon kullanma alışkanlığı ve el yıkama alışkanlığı ile ilgili olarak hazırlanmış anket formu öğrenciler tarafından cevaplandırılmıştır. Üreme olan örneklerde üreyen kolonilerin tiplendirmeleri konvansiyonel yöntemlerle yapılmıştır. Bulgular: Bu çalışmada 87 erkek 143 kadın olmak üzere toplamda 230 kişinin işaret, başparmağı ve telefon ekranından sürüntü kültürleri değerlendirilmiştir. Kültürlerin %65\'i klinik öncesi, geri kalanı ise klinik öğrencilerinden oluşmaktadır. Elden alınan sürüntü kültüründeki bakterilerle telefondan alınan sürüntü kültüründeki bakteriler arasında %79,1\'lik bir benzerlik saptanmıştır (p

To find answers about preventing the colonic mucosal regrowth after seromuscular enterocystoplasty and the dissection pane, we performed an experimental study in dogs. We also report our experience with mucosal regrowth and bladder function after augmentation colocystoplasty.This study comprised 10 adult healthy female mongrel dogs. We performed this animal experiment in 2 stages. At stage 1 we constructed a low capacity bladder. Stage 2 was performed 6 months after stage 1. At the end of detrusorectomy a 15 cm. segment of sigmoid colon was detubularized. The animals were randomly divided into 2 groups. In the 5 group 1 dogs de-epithelialization was performed with needle point cautery at a low cut setting, and the mucosa, muscularis mucosa and submucosa were resected, leaving the fibers of the muscularis externa exposed. In the 5 group 2 dogs de-epithelialization was performed by the peeling technique, in which the dissection plane was developed between the mucosa and muscularis mucosa, and the muscularis mucosa and submucosa remained on the colonic muscle. The de-epithelialized patch of bowel was shaped as a cup patch and anastomosed to the edges of the detrusor muscle over the bulging urothelium. The animals were sacrificed at 12 months of followup. All bladders were inspected macroscopically for regrowth of the colonic mucosa. Multiple sections of the augmentation patches were obtained and processed routinely for histological evaluation to determine what happened to the urothelium.We noted good urodynamic results in all dogs and there was no statistical difference in the groups in regard to bladder capacity. Mucosal regrowth did not develop in either group.When dissection is performed successfully whether or not the submucosa is removed, there is no observed regrowth or loss of bladder capacity in either technique.

To discuss the diagnosis and treatment of ejaculatory duct obstruction in male infertility.Twenty-four males were treated for ejaculatory duct obstruction between 1994 and 1998 in our clinic. Patients' age varied between 20 and 40 (mean=29). Ejaculatory duct obstruction was considered in patients with low to normal ejaculate volume, azoospermia or oligospermia, decreased motility, normal serum gonadotropin and testosterone levels, absent or low fructose in the ejaculate and evidence of obstruction on transrectal ultrasonography. The definitive diagnosis was made by the absence of efflux of methylene blue injected through the vas during cytoscopy. All the patients were subjected to transurethral resection of ejaculatory ducts and spermograms before and 3 months after resection were compared.Before transurethral resection mean sperm count was 1.66x10(6)/ml compared to 25.4x10(6)/ml postoperatively. The difference was statistically significant (p=0.001). After the operation, 58.3% of the cases had improvement in sperm motility, and 62.5% had increased ejaculate volume. No significant complications occurred, and in only 1 (4.17%) patient, there was persistent hematuria. After a mean follow-up period of 9 (6-18) months, 6 (25%) pregnancies were noted.Although transurethral resection is an effective method for the treatment of ejaculatory duct obstruction, the pregnancy rate is low, which could be related to the hazardous effects of urinary reflux into ejaculatory ducts or functional abnormalities of seminal vesicles.

A 21-year-old man presented with an enlarged giant hemangioma on glans penis which also causes an erectile dysfunction (ED) that partially responded to the intracavernous injection stimulation test. Although the findings in magnetic resonance imaging (MRI) indicated a glandular hemangioma, penile colored Doppler ultrasound revealed an invaded cavernausal hemangioma to the glans. Surgical excision was avoided according to the broad extension of the gland lesion. Holmium laser coagulation was applied to the lesion due to the cosmetically concerns. However, the cosmetic results after holmium laser application was not impressive as expected without an improvement in intracavernous injection stimulation test. In conclusion, holmium laser application should not be used to the hemangiomas of glans penis related to the corpus cavernosum, but further studies are needed to reveal the effects of holmium laser application in small hemangiomas restricted to the glans penis.

Background: Recent studies showed a high frequency of low bone mineral density (BMD) in HIV-infected patients and no reports have been issued in Turkey. Our aim was to evaluate BMD and risk factors for osteopenia/osteoporosis in HIV-infected patients that attended an outpatient clinic in Istanbul, Turkey. Method: In order to determine the prevalence of BMD, 126 HIV-infected patients had been studied with dual energy X-ray absorptiometry (DEXA). The association between BMD and age, gender, body mass index (BMI), habits, 25(OH)vitamin D, HIV RNA, CD4 lymphocyte nadir, using and duration of highly active antiretroviral treatment (HAART) were investigated by using multivariate analysis. Results: Median age was 40.1 years (range, 20–70); 84% were male; 35.7% patients had AIDS, 63.5% were treated with HAART. Osteopenia and osteoporosis were diagnosed in 53.9% and 23.8%, respectively. Mean plasma HIV RNA was 5.2 (SD 1.0) log10 copies/mL and CD4 lymphocyte nadir was 313.8 (SD 226.2)/mm3. Factors associated with bone loss were high viral load (p = 0.034), using (p = 0.033) and duration of HAART (p = 0.008). No correlation had been seen between sex and osteopenia/osteoporosis (p = 0.794). However, males showed higher rates of osteoporosis than females (p = 0.042). Conclusions: Our results show a very high prevalence of bone mass reduction in Turkish HIV-infected patients. This study supports the importance of both HIV and antiretroviral therapy in low BMD. Keywords: Osteopenia/osteoporosis, HIV/AIDS, Prevalence, Risk factors

Objectives To evaluate prospectively the success of scrotal incision orchiopexy (Bianchi technique) with or without inguinal hernia in patients with an undescended testis within the inguinal canal or beyond the external inguinal ring. Methods A total of 72 orchiopexies were performed in 56 patients with a primary undescended testis. The testicular position and size were assessed again at 1 year of follow-up. Results A total of 56 patients had bilateral (n = 14), right (n = 26), and left (n = 18) primary undescended testes. Scrotal orchiopexy was attempted in 72 testes and was successful in 68; the remaining 4 patients required conversion to traditional inguinal orchiopexy because of inadequate mobilization. In 34 children (43 testes), the testis was distal to the external inguinal ring (group 1). Scrotal orchiopexy was performed successfully in 42 testes in this group, and only 1 patient required conversion to a traditional inguinal incision. The average operating time was 18 minutes. In 22 children (29 testes), the testis was located within the inguinal canal (group 2); 3 cases required conversion to traditional inguinal orchiopexy. The average operative time was 25 minutes in group 2. All patients had satisfactory scrotal placement with at least one follow-up examination. Conclusions A scrotal incision for a palpable primary testis is well tolerated, cosmetically pleasing, and associated with a short operative time.

Background/Aims To analyse patients with chronic ocular graft-versus-host disease (GvHD) under treatment with 100% autologous serum eye drops from a sealed manufacturing system. Methods 17 patients with chronic ocular GvHD received 100% autologous serum eye drops from single use vials manufactured in a sealed system. Retrospective analysis included visual acuity, corneal staining, frequency of artificial tears, ocular symptoms by means of a questionnaire and information on subjective side effects and cost compensation. Results Data of prior to autologous serum eye drops therapy and at a 6-month follow-up were obtained. They demonstrated a significant increase in visual acuity (logMAR oculus dexter/right eye (OD) 0.5±0.32 to 0.4±0.3; oculus sinister/left eye (OS) 0.6±0.35 to 0.3±0.35; p=0.177/0.003) and significant improvement in corneal staining (Oxford grading scheme: OD from 3±1.03 to 2±1.43, OS from 4±1.0 to 2±1.09, p=0.004/0.001) and ocular symptoms (ocular surface disease index: 88±20.59 to 63±22.77; p=0.02). Frequency of artificial tears was reduced and no side effects were reported. Patient satisfaction was 100%, and cost compensation by health insurance reached 80%. Conclusions 100% autologous serum eye drops using a sealed manufacturing system were efficient in improving the ocular surface, patient symptoms and visual acuity without side effects. It seems to be safe to use 100% autologous serum despite earlier suspicions regarding immune complex accumulations and exacerbation of ocular surface inflammation. The potential effects of serum levels of systemic immunosuppressives through readministration onto the ocular surface need to be elucidated.

The main objectives of this retrospective cohort study were to evaluate reproductive endocrine and semen profiles before and after simple orchiectomy in patients with unilateral postpubertal cryptorchidism and to investigate the relationship between hormone levels and histopathology of the removed testis. We evaluated 40 adult males who were admitted to our clinic, between 2001 and 2007, with unilateral undescended testis. Right orchiectomy was performed in 27 patients and left orchiectomy in 13. Semen analysis, serum inhibin B, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were examined in before and 3 months after orchiectomy. Orchiectomy materials were evaluated histopathologically. Semen parameters, as well as testosterone and LH levels, did not change in any histopathological subgroups in the postoperative follow-up. In patients with maturation arrest, mean serum inhibin B level statistically significantly decreased from 160.9 to 83.5 pg/ml, and mean FSH level significantly increased from 4.8 to 7.6 mIU/ml after orchiectomy (p value, 0.008 and 0.008, respectively). Though, the levels were still within the normal range of the two hormones. Simple orchiectomy does not have any effect on semen parameters and testosterone level in patients with postpubertal cryptorchidism. The change in inhibin B and FSH levels after orchiectomy in patients with maturation arrest is not clinically significant.

In two double-blind controlled trials the anti-inflammatory effects of dexamethasone were examined in post-cataract extraction eyes after lens implantation in 321 patients. In the first trial, 103 patients were included. 49 eyes received eye-drops with 0.1% dexamethasone and antibiotics, the control-group of 54 eyes received the same antibiotics without any steroids. The follow-up was 2 months. In the case of unexpected complications, the patients dropped out. This was the case in 48% of the steroid-group and in 79% of the control-group. The main reason for this statistically significant difference were inflammatory complications in the control-group, which are difficult to quantify. The incidence of fibrinous reactions was not significantly different in the two groups, probably because of small numbers. In the second trial, we looked for fibrinous reactions. The follow-up was 3 weeks, 218 patients participated. They were divided into three groups: 71 patients received eyedrops with 0.1% dexamethasone 4x daily, 77 patients received the same drops 4x daily up to the fifth postoperative day, from then on 1x daily. 70 patients received the same drops 1x daily. A mild fibrinous reaction was seen in 10% of the high-dose-group, in 6% of the medium-dose-group and in 21% of the low-dose-group. Only the difference between the last two groups is statistically significant. We conclude that the therapy with corticosteroids after cataract extraction and lens implantation may be reduced early in the postoperative course.

Aims: We retrospectively review patients who underwent ureteral implantation with a psoas hitch during obstetric or gynecologic operations and describe a new modification. Methods: Between December 1997 and May 2005, 20 patients between 26 and 56 years underwent ureteral reimplantation by using the nonrefluxing, extravesical Lich-Gregoir onlay technique with psoas hitch at our institution by the same reconstructive surgery team. Additionally, we used a urethral catheter balloon as a landmark for the bladder mucosa and fixed the bladder to the psoas tendon by using the balloon. We performed 14 ureteral reimplantations during the surgery as intraoperative reconstruction. In 6 patients, delayed reconstruction of the ureter was performed a few days following the previous operation. Results: For intraoperative and delayed reconstructions, the mean operation time for ureteral reimplantation was 24 and 75 min. We took out the urethral catheter on the second operative day and the anastomotic drain on the third. The average hospital stay was 5.7 days. No cases of chronic flank pain, recurrent pyelonephritis, persistent severe hydronephrosis or compromised renal function occurred. No patient required reoperation. Conclusions: Modified psoas hitch ureteral reimplantation is an effective and safe way of reconstruction for treating defects in ureteral length.

Osteogenesis imperfecta (OI) patients represent a challenge to all physicians, as they do for anesthetists and urologists, when they develop symptomatic stones in the urinary tract. We recently treated an OI patient with renal pelvic stone by extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy (PCNL). To our knowledge, this combined treatment modality has not been reported previously in OI. An 18-year-old paraplegic girl with OI presented to our urology department because of right-sided flank pain. She pointed out that she had right kidney stone for the previous 2 years, and because of risks of general anesthesia and surgical procedures, surveillance was recommended. Intravenous pyelography was performed and an 11.9-mm stone at the pelvis of the right kidney and grade 1-2 hydronephrosis at the same side with normal kidney functions and severe left-sided scoliosis were detected. After explanation of risks of the treatment modality and general anesthesia to the patient, extraperitoneal laparoscopy-assisted PCNL was performed. No complications occurred due to general anesthesia or surgical procedure. The operation time was 95 min and no blood transfusion was required. The nephrostomy tube and retroperitoneal drain were removed 2 and 3 days after the procedure, respectively. The patient was doing well at a follow-up of 6 months. Extraperitoneal laparoscopy-assisted PCNL approach may decrease the risk of surgery as an alternative treatment modality for OI patients. Such cases should be operated on at centers with significant experience in the field of endourology, where all the equipment and specialized personnel are readily available.

Premature ejaculation (PE) is the most common sexual problem experienced by men, and it affects 20%-30% of them. Pulsed radiofrequency (PRF) neuromodulation has been shown to be an effective treatment for a wide range of pain conditions. We used PRF to treat PE by desensitizing dorsal penile nerves in patients resistant to conventional treatments. Fifteen patients with a lifelong history of PE, defined as an intravaginal ejaculatory latency time (IELT) of

Aim: To present the results of a new modification of dismembered pyeloplasty performed to prevent the occurrence of secondary obstruction. Methods: Modified dismembered pyeloplasty was performed in 35 children (age range 3 months to 16 years) who had unilateral ureteropelvic junction obstruction. In postoperative follow-up, presence of hydronephrosis on ultrasonography, differential renal function (DRF) and renal drainage half-time on technetium-99m diethylenetriaminepentaacetic acid (DTPA) renography were recorded and compared with preoperative data. Results: Mean anteroposterior renal pelvic diameter, mean preoperative DRF and radioisotope clearance half-time on DTPA renography of the affected kidneys were 61.4 mm, 38.6% and 34.3 min in children with prenatal hydronephrosis, and 67.5 mm, 37.6% and 39.4 min in children that presented with symptoms, respectively. After surgery, mean anteroposterior renal pelvic diameter, mean DRF and radioisotope clearance half-time on DTPA renography of the affected kidneys were 10.9 mm, 45.9% and 11.9 min in children with prenatal hydronephrosis, and 20 mm, 41.9% and 15.2 min in children that presented with symptoms, respectively. No failure was observed in any patient at an average follow-up of 26 months (range 1–5 years). Conclusions: Open dismembered pyeloplasty is the treatment of choice for intrinsic ureteropelvic junction obstruction. The modification of dismembered pyeloplasty that we performed is an alternative for the prevention of secondary obstruction.

Achievement of spontaneous tumescence after penile implant surgery has already been reported. However, regular spontaneous full, rigid erection upon sexual arousal that is adequate for vaginal penetration and tumescence for satisfactory sexual performance is an extremely rare condition in men with three-piece hydraulic implants. Similarly, prolonged erection is not expected in such implant cases even with the use of erectogenic agents. We report this interesting phenomenon confirmed by magnetic resonance imaging technique in a patient with inflatable device.

Study Objective We evaluated effectiveness of tension-free vaginal tape application for surgical relief of intrinsic sphincter deficiency. Design A prospective study (Canadian Task Force classification II-3). Setting Tertiary center of medical faculty. Patients We studied 47 patients. Interventions Tension-free vaginal tape procedure, questionnaire form, stress test, cotton swab test, and functional bladder volume measurements. Measurements and Main Results Patients were grouped as intrinsic sphincter deficiency according to American College of Obstetricians and Gynecologists criteria. Operative results were documented at 6, 12, 36, and 60 months after the procedure by using a questionnaire form and objective tests of stress test, cotton swab test, and mean bladder functional volume measurement. At first visit 6 months after procedure, 70% (n = 35) of patients were completely satisfied, 9 (18%) had improved urine control, and 5 (10%) had no change in urine control. Results were: 72% (n = 36), 12% (n = 6), and 14 (n = 7%) at the end of the first year, and 66% (n = 33), 20% (n = 10), and 14% (n = 7) at the end of the third year, respectively. The fifth year’s follow-up visit revealed 57.4% (n = 27 of 47) satisfaction, 17.02% (8 of 47) improved urine control, and 25.5% (12 of 47) no change in urine control. Conclusion Tension-free vaginal tape procedure is a safe and effective technique for patients who have exclusively intrinsic sphincter deficiency. Long-term results will clarify the value of this procedure in comparison with classic antistress surgical techniques.

OBJECTIVES To perform a prospective study to evaluate the success of scrotal incision orchiopexy in children with a palpable undescended testis within the inguinal canal or beyond the external inguinal ring with or without inguinal hernia. METHODS A total 204 scrotal orchiopexies were performed in 166 patients with a primary undescended testis. These children were followed up for an average of 29.4 months to document the testicular position and size. RESULTS The scrotal orchiopexy technique was successful in 192 testes; the remaining 12 testes required conversion to traditional inguinal orchiopexy because of inadequate mobilization. Of 108 children (128 testes) in whom the testis was distal to the external inguinal ring, this technique was successful in 104 (124 testes). The success rate was 96.9% (124 testes of 128), and only 4 patients (four testes) required conversion to a traditional inguinal incision. The average operative time was 15 minutes in this group. In the other group with 58 children (76 testes) with a testicular location within the inguinal canal, conversion to the traditional inguinal orchiopexy was performed in 8 patients (eight testes). The success rate in this group was 89.5% (68 of 76 testes). The average operative time was 21 minutes in these patients, and follow-up ranged from 16 to 68 months (average 29.4). All testes were satisfactorily positioned in the scrotum, and no testicular atrophy developed. CONCLUSIONS The results of our study have shown that scrotal orchiopexy is simple, safe, and effective in selected cases compared with the standard two-incision approach in the treatment of the palpable undescended testis.

Objective To use a new vasovasostomy technique for reversal of vasectomy. Design Case report. Setting Clinical and academic research environment. Patient A patient who had undergone vasectomy. Intervention We used 4/0 prolene as a guide during anastomosis for reversal of vasectomy. Main Outcome Measure Semen analysis. Result(s) Three months after the operation, the spermiogram showed the sperm count, the percentage of normal morphologic sperm, progressive motility, and vitality as 9 million/L, 70%, 33%, and 60%, respectively. Six months later, the spermiogram was repeated and the following results were obtained: the sperm count, the percentage of normal morphologic sperm, progressive motility, and vitality as 14 million/L, 65%, 40%, and 65%, respectively. Conclusion(s) This new technique is cost-effective, easy, cheap, and less time-consuming, and has a high success rate.

Introduction: In this study, our aim was to evaluate the effectiveness of the mucosal flap barrier (MFB) upon the incompetent ureteral orifice of an experimentally produced rabbit reflux model. The rabbit reflux model was done in the first stage of the study. This method is a new and original procedure which is different from Bischoff’s and Witherington’s osteoplasty techniques. Materials and Methods: We performed the mucosal flap procedure in eight 2–2.5 kg male New Zealand rabbits with experimentally produced refluxing ureters. The first stage of our study was to create refluxing ureters. Due to the upward and inward ‘J’ fishhook course of the intravesical ureter of rabbits, we performed two deep 12- and 4-o’clock incisions by suturing the edges of the intravesical ureter apart with catgut sutures. Additionally, to stop the tilting action of the trigonum during micturition, we performed two parallel incisions between the ureteral meatus. These parallel incisions were the authors’ modifications for the rabbit reflux model and which gives long-lasting reflux for the rabbit. We checked the reflux at the end of the 3rd month and performed our new MFB antireflux procedure. This mucosal flap made a cover on the incompetent ureteral orifice. This technique is completely different from the osteoplasty techniques described by Bischoff and Witherington. Results: Four months after the MFB application, we performed intravenous urography, cystometry and cinefluorography. There was no obstruction or reflux. Two rabbits were sacrificed at the 4th month. Both flaps were fully intact without any fixation at the medial side causing obstruction. At present, 3 rabbits are still alive. We did cinefluorography and cystometry at the 15th month and there was no obstruction or reflux. We are trying to keep them alive till the end of their natural lifespan. Conclusions: During the formation of the rabbit reflux model, we observed that spontaneous reflux even at high intravesical pressures did not have high percentages as previously mentioned in the literature. But it is possible and enough to produce an experimental reflux model by using meatotomy and interureteric incisions. Moreover, in rabbits with vesicoureteral regurgitation produced by ureteral meatotomy and interureteral incisions, reflux can be eliminated the MFB procedure. This method is an easy procedure for small bladders or dilated ureters after any kind of open reimplantation applications and it could be used by pneumovesical applications in the future.

Abdominoscrotal hydrocele and transverse testis ectopia are rare clinical conditions. This case report describes the combination of these two rare entities. An azoospermic and infertile adult man presented with left abdominoscrotal hydrocele and a right impalpable testis. He was treated with left orchiopexy, right orchiectomy, and excision of the abdominoscrotal hydrocele. We discuss the diagnosis and treatment of this combination, which has not been previously reported.

Gonococcal infection of a penile prosthesis is a rare presentation of a common disease. Here we report two cases of penile prosthesis extrusion due to gonococcal infection.

The Department of Health has recently published a report from the CFS/ME Working Group which concluded that chronic fatigue syndrome (CFS) should be recognized as a chronic illness. Symptoms consistent with CFS are often reported by people who consider their health has been affected by exposure to pesticides, but the Working Group concluded that this type of exposure is not a common trigger for the syndrome. The Veterinary Medicines Directorate (VMD) collects self-assessed reports of ill health in humans associated with veterinary medicines under their Suspected Adverse Reaction Surveillance Scheme. The reporters have mainly been sheep farmers. These reports were used to investigate the possible relationship between chronic fatigue (CF) and exposure to organophosphate pesticides in sheep farming. The overall aim of the study was to investigate a possible association between exposure to organophosphates and the development of CF amongst people who consider their health has been affected by pesticides in sheep farming. The hypothesis investigated was that repeated exposure to organophosphate pesticides in sheep dip may increase the probability of developing CF. A group of mostly sheep farmers who had reported to the VMD surveillance scheme were identified. We planned to use a retrospective case-control study design but the initial symptoms reports were not sufficiently reliable to enable this. The study population was asked to complete two questionnaires. The first questionnaire was designed to identify the history of exposure of subjects to organophosphate pesticides, and their exposure was then reconstructed using a metric specifically developed for this purpose. The second questionnaire collected detailed information to identify whether the subjects had CF when they originally reported to the VMD and at the time of the survey. The questionnaire was sent to a total of 206 subjects, of whom 28 had moved home. A total of 37% of the remaining 178 subjects participated. There was a high prevalence of CF amongst those who completed the questionnaire and this has generally persisted since the subjects reported to the VMD. Higher CF scores were associated with higher exposure to organophosphate pesticides. CF is very common amongst those who consider their health was affected by pesticides and we have shown there is limited evidence of an association between exposure to organophosphates and CF. Further research is needed to investigate the cause of this syndrome amongst farmers exposed to pesticides.

This study was performed to investigate the effect of propylthiouracil (PTU) on rat testis, and to compare the results of the different treatment regimens of levothyroxine and zinc. Twenty sexually mature Wistar albino rats were subjected to PTU for 14 days intraperitoneally to make them hypothyroidic. The effect of PTU on testicular function was assessed histopathologically after unilateral orchiectomy on day 15, and treatment was evaluated by measuring serum thyroid-stimulating hormone (TSH), T3, T4, and zinc levels on days 0, 7, and 15. The rats were then divided into five groups which were given levothyroxine and/or zinc treatment for 15 days. Orchiectomies were repeated on day 30, and specimens were evaluated histopathologically. Although serum T3, T4 and zinc levels decreased, serum TSH levels increased in PTU-treated rats, and the difference to the control group was statistically significant (P < 0.001). Maturation arrest of spermatogenesis, a reduced number of Sertoli and Leydig cells, a decreased tubular diameter, interstitial oedema, and thickening of basal membrane were observed in hypothyroidic testicles. After treatment, testicular histology and spermatogenesis gradually recovered in all groups with hypothyroidism, but maximum improvement was achieved in the levothyroxine + zinc sulphate replacement group, indicating a possible role of zinc in testicular function.

Background: The ideal tissue for complex urethral reconstruction has yet to be determined, especially in patients with deficient preputium. The use of bladder mucosa as a free graft could be an alternative in these problem cases. Methods: Bladder mucosa graft urethroplasty was performed on 14 patients with penoscrotal or scrotal hypospadias. The mean age of the patients was 18.7 (range 14–23) years. Ten cases were subjected to primary urethral reconstruction while four cases had previous hypospadias repair. Results: Complete urethral replacement by the bladder mucosa tube was performed in six patients. Meatal problems occurred in two (33.33%) patients and proximal fistula formed in one (16.67%) patient. A bladder mucosa graft was combined with preputial or tunica vaginalis grafts distally in eight cases, and one patient in the tunica vaginalis group developed fistula at the anastomosis of the bladder mucosa and tunica vaginalis grafts. The overall complication rate was 28.6%. Conclusions: Our initial results showed that bladder mucosa grafts can be used successfully for urethral reconstruction especially when combined with preputial or tunica vaginalis grafts distally.

Traditional augmentation cystoplasty using gastrointestinal segments is known to be associated with metabolic abnormalities and alterations in the bladder causing potential carcinogenesis. In this respect alternative techniques have been searched preferably lined by urothelium. We performed ureterocystoplasty in 7 patients with a diagnosis of neurogenic bladder and investigated the clinical and functional aspects.Between 1995 and 1999, ureterocystoplasty was performed using both ureters in 4 male and 3 female children with bilaterally functional kidneys. Patients' ages varied between 1 and 7 (mean 4.7) years. Before the operation all the children were incontinent, had a small-capacity noncompliant bladder, and high-grade (IV-V, International Classification System) reflux on voiding cystouretrography (VCU). Technetium-99m DTPA renal scintigraphy was also performed in all children to evaluate renal function before and after the operation.Before the operation the mean end-filling intravesical pressure was 45.6 (35-60) cm H(2)O which decreased to 18.9 cm H(2)O 3 months postoperatively. The mean bladder capacity 3 months after ureterocystoplasty was found to be 279.3 (250-330) ml. All the children were continent and VCU showed the absence of reflux. There was mild to moderate improvement in renal function after surgery in both kidneys on technetium-99m DTPA renal scintigraphy. Three (43%) patients could void spontaneously with abdominal straining, whereas 4 (57%) children could empty their bladders by clean intermittent catheterization. A double-J stent was inserted in 1 (14%) patient because of a rise in serum creatinine after the removal of the ureteral catheter. Patients were followed for a mean period of 30 (8-50) months and all the children remained continent. The bladder capacity and end-filling pressure measurements were also stable.Ureterocystoplasty was found to be an effective method for bladder augmentation in bilaterally functional kidneys with an acceptable complication rate

To determine whether there is a significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithothripsy (ESWL).Ninety-six patients with proximal ureter stones underwent ESWL. The procedure was performed in the supine position in 48 of them (group 1) and in the prone position in the other 48 patients (group 2). Stone-free rates, repeat ESWL rates, shocks per patient and shocks per session were compared in both groups.The mean session number per patients was 1.64+/-0.75 in group 1 and 1. 33+/-0.59 in group 2 (p = 0.224). The stone-free rates 3 months after ESWL were 88.3% in group 1 and 90.6% in group 2. The difference between the results was statistically insignificant (p0.05). Therefore, these two parameters were similar in both groups. On the other hand, the number of shocks per session was 4,863.54+/-2, 114.85 in group 1 and 3,704.16+/-1,726.75 in group 2. This difference was statistically significant (p = 0.011). The patients tolerated the supine position better in general. Patients in the prone position experienced discomfort on inspiration and expiration and pain localized to the lumbar vertebrae.These results suggest that the supine position decreases the number of shocks per session in the treatment of proximal ureter stones with ESWL and this will be cost-effective.