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Nur Aleyna Yetkin,1 Sibel Ak&inodot;n,2 Derya Kocaslan,2 Burcu Baran,1 Bilal Rabahoglu,1 Fatma Sema Oymak,1 Nuri Tutar,1 &Idot;nci Gulmez1 1Pulmonology Department, Erciyes University Faculty of Medicine, Kayseri, Türkiye; 2Geriatrics Division, Internal Medical Sciences Department, Erciyes University Faculty of Medicine, Kayseri, TürkiyeCorrespondence: Nur Aleyna Yetkin, Email alleynakemik@gmail.com, nuryetkin@erciyes.edu.trBackground/Aim: Chronic obstructive pulmonary disease (COPD) is often complicated by sarcopenia, a condition of reduced muscle mass and function that adversely affects quality of life, lung function, and exacerbation rates. Ultrasonography could be an effective tool for detecting sarcopenia, notably by assessing diaphragmatic function, which may indicate muscle health in COPD patients. This study aims to evaluate the effectiveness of diaphragmatic ultrasound in detecting sarcopenia among COPD patients.Materials and Methods: Thirty-five patients with COPD, with a forced expiratory volume in one second (FEV1) between 30% and 80%, were consecutively enrolled in this cross-sectional and double-blind study. Sarcopenia was defined using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle mass was assessed with bioelectrical impedance analysis (BIA), muscle strength was assessed using the handgrip test and physical performance was assessed using a 4-meter gait speed test. Pulmonary function tests (PFT) (including maximum inspiratory pressure-MIP and maximum expiratory pressure-MEP) were performed. Diaphragm excursion and thickness at residual volume, functional residual capacity, and total lung capacity were measured using ultrasound. The diaphragm thickening fraction was calculated during normal (TF) and deep breathing (TLC-TF).Results: Seventeen of 35 patients (48.6%) were found to be sarcopenic. Diaphragm thickness did not show significant variation between the groups. Both TF (27.43%) and TLC-TF (39.7%) were found to be lower in the sarcopenic group (p< 0.05). The diaphragmatic excursion in the sarcopenic group was found to be 1.38 cm (p=0.078). There was no difference in median MIP and MEP values between the groups.Conclusion: Diaphragmatic TF may be a valuable tool for detecting sarcopenia in COPD patients, which may vary independently of PFTs. This study highlights TF as a potential auxiliary measure, but further research with larger sample sizes and additional parameters is needed to confirm its clinical utility.Keywords: excursion, frailty, obesity, respiratory failure, FEV1

- Unknown factors in the seminal plasma of normal semen that affect the motility of spermatozoa have a positive effect on adenosine triphosphatase (ATPase) enzyme activity. In an attempt to produce such an effect, spermine, spermidine and kallikrein were added to the incubation media in which spermatozoal ATPase enzyme activity was determined. These seminal substances increased the triple ATPase enzyme activity of spermatozoa from oligoasthenozoospermic men. We propose that the ATPase enzyme activity of spermatozoa may indicate sperm motility as a biochemical test. [ABSTRACT FROM AUTHOR]

Abstract Backround The emergence of Mycobacterium tuberculosis strains resistant to antituberculosis agents has recently received increased attention owing largely to the dramatic outbreaks of multi drug resistance tuberculosis (MDR-TB). Methods Patients residing in Zonguldak and Kayseri provinces of Turkey with, pulmonary tuberculosis diagnosed between 1972 and 1999 were retrospectively identified. Drug susceptibility tests had been performed for isoniazid (INH), rifampin (RIF), streptomycin (SM), ethambutol (EMB) and thiacetasone (TH) after isolation by using the resistance proportion method. Results Total 3718 patients were retrospectively studied. In 1972–1981, resistance rates for to SM and INH were found to be 14.8% and 9.8% respectively (n: 2172). In 1982–1991 period, resistance rates for INH, SM, RIF, EMB and TH were 14.2%, 14.4%, 10.5%, 2.7% and 2.9% (n: 683), while in 1992–1999 period 14.4%, 21.1%, 10.6%, 2.4% and 3.7% respectively (n: 863). Resistance rates were highest for SM and INH in three periods. MDR-TB patients constituted 7.3% and 6.6% of 1982–1991 and 1992–1999 periods (p > 0.05). Conclusion This study demonstrates the importance of resistance rates for TB. Continued surveillance and immediate therapeutic decisions should be undertaken in order to prevent the dissemination of such resistant strains.

Background/aim: Psoriasis and Hidradenitis Suppurativa (HS) are chronic inflammatory skin conditions that significantly impact quality of life, sleep, and increase morbidity. This study aims to compare sleep quality and the risk of obstructive sleep apnea (OSA) in patients with these conditions. Additionally, it explores the relationships between sleep disorders, demographic factors, disease severity, and inflammatory markers., Materials and Methods: The study included 25 HS and 50 psoriasis patients diagnosed and followed in the Dermatology Department of a tertiary healthcare institution. Disease severity was assessed using the HURLEY score for HS patients and the Psoriasis Area and Severity Index (PASI) for psoriasis patients. Sleep quality and OSA risk were evaluated using the Pittsburgh Sleep Quality Index (PSQI), Berlin, and STOP-Bang questionnaires., Results: A total of 75 patients participated, with 50 in the psoriasis group and 25 in the HS group. Of the participants, %41 were female, with a mean age of 36.4 ± 12.7 years. HS patients had significantly higher PSQI and STOP-Bang scores compared to psoriasis patients (p = 0.001 and p = 0.003, respectively). No significant associations were found between disease severity and questionnaire scores in either condition. However, the rate of high-risk OSA was higher in males (p = 0.004) and more prevalent in HS patients than in psoriasis patients (%64 vs. %26, p = 0.002)., Conclusion: HS patients face a significantly higher risk for OSA due to factors like obesity, smoking, increased neck and waist circumference, and elevated inflammation. Routine assessment of OSA risk using tools like the PSQI, Berlin, and STOP-Bang questionnaires is recommended for these patients., Competing Interests: Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University Erciyes (Date 2023 / No 675). Consent to parcipate: Informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Coronavirus disease 2019 (COVID-19) has affected the whole world and caused the death of more than 6 million people. The disease has been observed to have a more severe course in patients with chronic lung diseases. There are limited data regarding COVID-19 in patients with bronchiectasis. The aim of this article is to investigate the course of COVID-19 and factors affecting the clinical outcome in patients with bronchiectasis., Material and Methods: This study was conducted using the Turkish Adult Bronchiectasis Database (TEBVEB) to which 25 centers in Türkiye contributed between March 2019 and January 2022. The database consisted of 1035 patients, and COVID-19-related data were recorded for 606 patients., Results: One hundred nineteen (19.6%) of the bronchiectasis patients (64 female, mean age 57.3 ± 13.9) had COVID-19. Patients with bronchiectasis who developed COVID-19 more frequently had other comorbidities (P = .034). They also more frequently had cystic bronchiectasis (P = .009) and their Bronchiectasis Severity Index was significantly higher (P = .019). Eighty-two (68.9%) of the patients who had COVID-19 were followed up in the outpatient clinic, 27 (22.7%) in the inpatient ward and 10 (8.4%) patients in the intensive care unit. There tended to be a higher percentage of males among patients admitted to the hospital (P = .073); similarly, the mean age of the patients admitted to the hospital was also higher (60.8 vs 55.8 years for the outpatients), but these differences did not reach statistical significance (P = .071)., Conclusion: In conclusion, this study showed that severe bronchiectasis, presence of cystic bronchiectasis and worse Bronchiectasis Severity Index are associated with the development of COVID-19, but not with the severity of infection.

Background: Bronchiectasis is a chronic lung disease characterized by permanent bronchial wall dilatation. Although it has been known as an orphan disease, it has recently gained attention because of registry-based studies and drug research., Aims: We aimed to use a multicenter database to analyze and compare data regarding the etiology, associated comorbidities, microbiological characteristics, and preventive strategies of bronchiectasis in Türkiye to those of other countries., Study Design: A multicenter prospective cohort study., Methods: The multicenter, prospective cohort study was conducted between March 2019 and January 2022 using the Turkish Adult Bronchiectasis Database, in which 25 centers in Türkiye participated. Patients aged > 18 years who presented with respiratory symptoms such as cough, sputum, and dyspnea and were diagnosed with non-cystic fibrosis bronchiectasis using computed tomography were included in the study. Demographic information, etiologies, comorbidities, pulmonary functions, and microbiological, radiological, and clinical data were collected from the patients., Results: Of the 1,035 study participants, 518 (50%) were females. The mean age of the patients was 56.1 ± 16.1 years. The underlying etiology was detected in 565 (54.6%) patients. While postinfectious origin was the most common cause of bronchiectasis (39.5%), tuberculosis was identified in 11.3% of the patients. An additional comorbidity was detected in 688 (66.5%) patients. The most common comorbidity was cardiovascular disease, and chronic obstructive pulmonary disease (COPD) and bronchiectasis was identified in 19.5% of the patients. The most commonly detected microbiological agent was Pseudomonas aeruginosa (29.4%). Inhaled corticosteroids (ICS) were used in 70.1% of the patients, and the frequency of exacerbations in the last year was significantly higher in patients using ICS than in nonusers (p < 0.0001). Age [odds ratio (OR): 1.028; 95% confidence interval (CI): 1.005-1.051], cachexia (OR: 4.774; 95% CI: 2,054-11,097), high modified medical research council dyspnea scale score (OR: 1,952; 95% CI: 1,459-2,611), presence of chronic renal failure (OR: 4,172; 95% CI: 1,249-13,938) and use of inhaled steroids (OR: 2,587; 95% CI: 1,098-6,098) were significant risk factors for mortality. Mortality rates were higher in patients with COPD than in those with no COPD (21.7-9.1%, p = 0.016). Patients with bronchiectasis and COPD exhibited more frequent exacerbations, exacerbation-related hospitalizations, and hospitalization in the intensive care unit in the previous year than patients without COPD., Conclusion: This is the first multicenter study of bronchiectasis in Türkiye. The study results will provide important data that can guide the development of health policies in Türkiye on issues such as infection control, vaccination, and the unnecessary use of antibiotics and steroids., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

With the onset of the pandemic in 2020, COVID-19 pneumonia has become a common cause for hospitalization and is associated with high mortality rates. Inflammatory biomarkers play a crucial role in understanding and monitoring the progression of various diseases, including COVID-19. The objective of this study was to assess the significance of sequentially monitored standard laboratory tests, including complete blood cell count, D-dimer, fibrinogen, ferritin, albumin, C-reactive protein (CRP), as well as newly calculated inflammatory biomarkers in predicting the severity and prognosis of COVID-19 pneumonia. This single-center retrospective study included 194 patients hospitalized due to COVID-19 pneumonia. Patients were grouped based on the severity of their clinical symptoms, with 134 categorized as severe disease and 60 as mild-moderate disease. The patients' demographic data and laboratory values at hospital admission and on the third day of hospitalization were comparatively evaluated. In the severe illness group, there were more complaints about shortness of breath and a significant drop in the SPO2 value was observed at the time of application (p =0.005 and p<0.001, respectively). The overall mortality rate in all patients was 9% (18/194), and all deaths occurred within the severe disease group. All laboratory parameters, with the exception of platelet count and ferritin levels, were significantly associated and correlated with the severity of the disease during the hospitalization period. Among the biomarkers, there was no significant difference in neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) on the first day, a significant increase was observed on the third day of hospitalization in the severe disease group (p=0.050 vs. 0.003 and p=0.073 vs. 0.020, respectively). No significant difference was observed only in the PNR (platelet/neutrophil ratio) value among the inflammatory biomarkers (p=0.090 vs. p=0.354). In conclusion, the SPO2 level of COVID-19 patients at admission and the subsequent laboratory parameters examined show a significant relationship with the severity of the disease. In addition, simple inflammation biomarkers derived from laboratory values have shown a very significant relationship and correlation in the diagnosis and follow-up of the disease. In both admission and follow-up evaluation, a more significant association was observed with CRP-related biomarkers such as CRP/albumin ratio and CRP/lymphocyte ratio rather than NLR and PLR, which are widely used in the literature, in showing the severity of COVID-19. In patients with pneumonia, the laboratory assessment made on the third day of hospitalization reflects the severity of the disease more clearly than on the first day., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Baran et al.)

Background/aim: It is known that the correlation of pulmonary function tests (PFT) with muscle dysfunction is insufficient. Here, we aimed to evaluate the diaphragm functions in individuals with Friedreich's ataxia (FRDA) and to examine its relationship with respiratory parameters and disease severity., Materials and Methods: This prospective study, conducted between November and December 2022, at Erciyes University, included 14 individuals with genetically confirmed FRDA and an age- and gender-matched healthy control group of eight individuals. We examined pulmonary functions with spirometric methods and evaluated diaphragm excursion, and diaphragm thickness-expiratory (Tde) and - end of inspiration (Tdi) with ultrasonography during calm breathing. Thickening fraction (TF) calculated. Also, we examined PaCO2 at rest. The neurological status of individuals was assessed using the Scale for the Assessment and Rating of Ataxia (SARA)., Results: The mean values of FEV1(lt), FEV1(%), FVC (lt), and FVC (%) were higher in the control group (p; <0.001, 0.013, <0.001, and 0.009, respectively). Also, mean Tdi, Tde, excursion and TF were lower in the FRDA group compared to the control group (p = 0.005, 0.294,0.005, and 0.019, respectively). The mean excursion value was 1.13 ± 0.54cm in the FRDA group and 1.71 ± 0.49cm in the control group. There is a strong, negative, and statistically significant correlation between SARA total score with excursion and TF (r = -0.7432, p = 0.002; r = -0.697, p = 0.008). There is no statistically significant relationship between excursion and BMI, standing-to-supine decrease in FVC, FEV1, and PaCO2. Also, the relationship between maximal inspiratory pressure (PImax) and excursion was moderate., Conclusion: Diaphragm ultrasound may reveal respiratory dysfunction better than PFT. Diaphragm excursion and TF are associated with disease scores in individuals with FDRA. Further studies are needed regarding the detection of alveolar hypoventilation., (© TÜBİTAK.)

Background: Direct oral anticoagulants (DOACs) have been used in acute pulmonary thromboembolism as an alternative to warfarin due to drug interactions, narrow therapeutic range, and necessary close International Normalized Ratio (INR) monitoring. Phase 3 study results have reported that these drugs are at least as effective as warfarin and beneficial in terms of bleeding; however, studies that present up-to-date life data are necessary., Aims: To evaluate the frequency of using DOACs, which are prescribed with a limited number of indications in our country, and real-life data results., Study Design: Cross-sectional study., Methods: This cross-sectional survey collected the clinical data (history, current treatment, treatment duration, etc.) of patients with pulmonary thromboembolism and who applied to the physician for follow-up between October 15, 2019, and March 15, 2020. The researchers kept the patient records sequentially., Results: Data from 836 patients with acute pulmonary thromboembolism from 25 centers were collected, and DOAC was used in 320 (38.5%) of them. The most preferred DOAC was rivaroxaban (n = 294, 91.9%). DOAC was mostly preferred because it could not provide an effective INR level with warfarin (n=133, 41.6%). Bleeding was observed in 13 (4%) patients., Conclusion: The use of direct oral anticoagulants is becoming almost as widespread as conventional therapy. Real-life data results are important for their contribution to clinical practice.

Background: Although there are many studies presenting the efficacy of omalizumab in severe asthma, the data about the optimal treatment duration are still debated., Objective: In this study, we aimed to investigate the clinical effects of omalizumab discontinuation after 5 years of treatment in patients with omalizumab super-responders, the persistence of response and to compare the features of patients, whose symptoms are still well controlled and those who relapsed and re-treated with omalizumab., Methods: Clinical and laboratory data of 100 adult patients diagnosed with allergic severe asthma and treated with omalizumab between 2008 and 2020 were evaluated retrospectively. Demographic, clinical, functional, and laboratory parameters of the patients who were re-treated with omalizumab and those who did not need to be re-treated were compared., Results: There were 14 super-responder patients, who were treated with omalizumab for 5 years, and the treatment was discontinued then. Omalizumab was not restarted in 9 patients (64%) and was restarted in 5 (36%) patients. No significant difference was presented between these two groups in terms of demographic, clinical, functional, and laboratory parameters. The baseline total IgE levels of patients, who were re-treated with omalizumab, was found to be higher than those who were not, but this difference was not statistically significant (440 [229-864] IU/mL vs. 164 [85-293] IU/mL; p = 0.053, respectively)., Conclusion: One of 3 patients was re-treated with omalizumab due to loss of asthma control after discontinuation of the treatment. Therefore, omalizumab's immunomodulatory effect may seem to persist in a majority of cases after discontinuation. Also, higher baseline total IgE levels might help to predict the cases that need re-treatment after discontinuation., (© 2022 S. Karger AG, Basel.)

Introduction: This study aimed to compare two groups of patients with Chronic Obstructive Lung Disease (COPD) and blood eosinophil values of ≥300 cells/ µL. The patients were followed up for one year in two groups, one receiving inhaled corticosteroids (ICS) and the other not receiving ICS in terms of exacerbation rates, the incidence of pneumonia, mortality rates, FEV1, FVC and FEF25-75 changes, the COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) dyspnea scores., Materials and Methods: Stable patients, who presented to the University Medical Faculty Chest diseases outpatient clinic and diagnosed with COPD according to pulmonary function test results and GOLD stages 2-4 according to the 2017 GOLD criteria and with blood eosinophil counts of ≥ 300 cells/ µL were included in the study., Result: 85 patients were included in the study, of which 76.5% (n= 65) were males. There were no significant differences between the 38 patients receiving ICS and the 47 patients not receiving ICS regarding baseline FEV1, FVC, FEF25- 75 absolute values and percentages, and FEV1, FVC values controlled at month six and month 12, and FEF25-75 absolute values and percentages at month six (p> 0.05). However, the difference between the baseline and month 12 absolute values and percentages of FEF25-75 was statistically significant, and the decrease from baseline was greater in the group receiving ICS (p< 0.05). The difference in CAT and mMRC scores were statistically significant at month six and month nine in favor of the group receiving ICS (p< 0.05). The median number of moderate and severe exacerbations were both one (min: 0, max:3) in the group receiving ICS (n= 38) and in the one not receiving ICS (n= 47). The difference of exacerbation rates in both groups were not statistically significant (p> 0.05)., Conclusions: In this study, it was determined that exacerbation rates of eosinophilic COPD patients did not differ depending on the use of ICS in a one-year period. Nevertheless, the 12-month FEF25-75 values of patients not using ICS were lower to a lesser extent, while the CAT and mMRC scores improved in favor of ICS users at different months in the one-year follow-up.

Background: There is limited information about peripheral blood eosinophilia (PBE) and airway obstruction in sarcoidosis. Since pulmonary sarcoidosis affects the airways, it is often confused with asthma. The aims of the study are to investigate airway obstruction and PBE in sarcoidosis patients and to examine the similarity of clinical presentation with asthma., Methods: The patients matching the ATS/ERS/WASOG diagnosis criteria and were between 18 and 80 years of age were included consecutively between 2018 and 2020. Other diseases causing granulomas were excluded., Results: A total of 84 patients were included of which 26 (31%) had a PBE level of ≥300 µL with no significant difference seen between sarcoidosis stage and PBE (p > 0.05). A significant (p < 0.05) decrease was only seen in FEV1 as the stage of sarcoidosis progressed. Respectively 31 (36.9%), 12 (14.3%) and 4 (4.8%) patients had an obstructive, restrictive and mixed respiratory function disorder. Twenty-four (28.6%) subjects with sarcoidosis had history of asthma. Spring fever, eczema, and skin/nose allergy were noticed in 17 (20.2%) of the patients., Discussion: Mild PBE may be seen in sarcoidosis. Patients applying with PBE, airway obstruction, bronchial hyperreactivity along with spring fever, eczema, skin/nose allergy, wheezing, chest tightness, shortness of breath and cough may be also evaluated in terms of sarcoidosis.

Background/aim: Sensitivity and symptoms related to animal proteins have been investigated in various occupational groups. However, data from horse farm workers are limited. We aimed to determine horse allergen sensitivity in the horse farm workers, and to evaluate its relationship with respiratory symptoms and functional parameters., Materials and Methods: A total of 110 subjects were enrolled in the study. The study group consisted of 80 horse farm workers. Face-to-face surveys, skin prick tests (SPT), and pulmonary function tests (PFT) were performed in the study group. Control group consisted of 30 healthy subjects. SPT and PFTs were also performed for control group. The SPT test results of the horse farm workers were compared with the SPT results provided from the medical records of 1376 subjects who admitted to the outpatient clinic with respiratory symptoms., Results: Atopy rate was significantly higher in horse farm workers than in healthy subjects (41% and 13%, respectively; P = 0.008). Horse allergen sensitivity was positive 8/80 (10%) in horse farm workers, 0/30 in healthy subjects, and 32/1376 (2%) in medical records of subjects who were admitted to the outpatient clinic with respiratory symptoms. (P = 0.07, P = 0.001, respectively). There was no statistically significant relationship between respiratory symptoms and horse allergen sensitivity in horse farm workers (P = 0.67). However, mean FEV1 ratios were lower in horse farm workers with horse allergen sensitivity than healthy subjects (88.6% ± 17.9, 103.7 ± 10, P = 0.031, respectively)., Conclusion: Atopy and animal allergen sensitization were significantly higher in horse farm workers, suggesting the relationship between the intensity of specific allergen exposure and the sensitization to this specific allergen., Competing Interests: The authors declare they have no conflict of interest., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Chronic obstructive pulmonary disease (COPD) is characterized by systemic inflammation that usually is caused by exposure to noxious particles or gases. Thymoquinone (TQ) prevents the production of inflammatory mediators, such as thromboxane B2 and leukotriene, by altering arachidonic acid metabolism. We investigated the preventive and curative effects of TQ on lung damage in rats caused by cigarette smoke (CS). We used 50 adult male rats, 30 of which were exposed to CS every day for 3 months. TQ in dimethylsulfoxide (DMSO) was administered intraperitoneally (i.p.) every day to ten animals to investigate the protective effects of TQ, and to ten other animals during the last 21 days to investigate the curative effect. Ten rats received saline for the last 21 days. Ten subjects were untreated controls. Ten controls that were not exposed to CS received TQ for the last ten days. Serum IL-8, IL-6, IL-1β and MMP-9 levels were measured using ELISA. IL-1β and IL-8 levels were elevated in the group exposed to CS compared to controls. IL-8 levels were decreased in the group that received only TQ compared to controls, which indicated the anti-inflammatory effect of TQ. The apoptotic index (AI) was increased in all groups that were exposed to CS compared to controls. The AI index was decreased in the group that received TQ for the last 21 days compared to the other CS groups. AI was increased in the group that received TQ daily compared to the other CS groups. Our findings indicate that TQ exerts curative effects for the inflammation caused by CS and may prevent apoptosis if administered in appropriate doses; however, long term TQ or DMSO exposure may produce cumulative toxic effects.

Background/aim: Oral corticosteroid (OCS)-dependent severe eosinophilic asthma with chronic rhinosinusitis with nasal polyps (SEA-CRSwNP) would be a suitable phenotype for mepolizumab treatment. This study evaluated the short-term efficacy of mepolizumab treatment in OCS-dependent SEA-CRSwNP., Materials and Methods: Baseline and 24th week results [daily OCS doses, asthma exacerbation frequency, asthma control test (ACT) scores, blood eosinophil levels, FEV1 values, and numerical analog scale (NAS) of CRSwNP symptoms] of patients who were treated for at least 24 weeks with mepolizumab were retrospectively evaluated and compared., Results: A total of 16 patients were enrolled in the study. Mepolizumab was discontinued in one patient due to side effects. The daily OCS dosage was reduced from baseline in all patients, and at week 24 OCS was discontinued in 40% of the patients (baseline mean steroid dose: 9.2 ± 5.2 mg, 24th week: 1.3 ± 1.4 mg; P < 0.001). The number of asthma exacerbations within 24 weeks significantly decreased after beginning mepolizumab treatment (2.1 ± 2.7 vs. 0.07 ± 0.26; P = 0.012), and a significant increase in ACT scores (baseline mean ACT: 18 ± 5.7; 24th week mean ACT: 23.3 ± 3; P = 0.006) was observed despite the decrease in daily OCS dosages. There was no significant difference in FEV1 values between baseline and week 24. Evaluation of the general symptoms of CRSwNP, as per NAS, revealed that the baseline mean NAS was 5.6 ± 4.4, and the 24th week mean NAS was 3.2 ± 3.2 (P = 0.021)., Conclusion: This is the first real-life study evaluating the short-term efficacy of mepolizumab treatment on OCS-dependent SEA-CRSwNP. This study demonstrates that mepolizumab is an effective and safe biologic for the treatment of this severe asthma subphenotype., Competing Interests: The authors declare that they have no personal or professional conflicts of interest regarding any aspect of this manuscript., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Introduction: Why do only some of patients who are prescribed angiotensin converting enzyme inhibitors (ACE-I) develop cough? The pathogenesis of ACE-I-induced cough remains controversial and requires further studies., Objective: We aim to investigate whether asthma is a contributing cause of ACE-I-induced cough., Methods: Patients attending a cardiology clinic between March 2016 and March 2017 who were diagnosed with ACE-I induced cough were included in this study. ACE-I-induced cough was defined as cough which developed within 4 weeks after initiation of ACE-I therapy and which improved within 4 weeks after discontinuation of the ACE-I. Patients who had received ACE-I treatment for at least 6 months without side effects were included in the study as a control group. Face-to-face questionnaires, pulmonary function tests (PFT) and skin prick tests were applied to all the patients. If there was discordance between asthma history and PFT results, a methacholine bronchial provocation test (BPT) was performed., Results: A total of 43 patients with ACE-I induce cough were compared with 50 controls. Bronchial hyperreactivity (BHR), rhinitis, atopy and family history of asthma were more frequent in patients with ACE-I induced cough (P < .001). Patients with ACE-I-induced cough had significantly higher incidence of diagnosed asthma [OR = 8.28 (95%CI: 3.26-21.03) P < .001]., Conclusions: Asthma and an atopic background constitute a substantial risk factor for ACE-I induced cough. The presence of underlying asthma should be investigated in patients diagnosed with ACE inhibitor induced cough. However, the fact that most asthma patients tolerate ACE-I therapy, indicates that other cofactors are likely involved., (© 2020 John Wiley & Sons Ltd.)

Introduction: The results of standard chemotherapy in lung cancer are not very satisfactory, so it is important to identify genetic mutations that provide targeted therapies. Recent reports have suggested influences of racial difference on the frequency of mutation in lung cancer. We aimed to determine the frequency and regional distribution of genetic mutations of non-small cell lung cancer (NSCLC) in Turkey., Materials and Methods: Regional distribution of genetic mutations in lung cancer in Turkey (REDIGMA) study was carried out as a prospective, cross-sectional, observational study in a large number of centers in which lung cancer patients were followed and could perform genetic mutation analysis on patients' biopsy materials., Result: The 703 patients (77.7% male, mean age 63.3 ± 12.5 years) who were diagnosed as NSCLC from 25 different centers were included in the study. Tumor samples from patients were reported as 87.1% adenocarcinoma, 6.4% squamous cell carcinoma and 6.5% other. Mutation tests were found to be positive in 18.9% of these patients. The mutations were 69.9% EGFR, 26.3% ALK, 1.6% ROS and 2.2% PDL. Mutations were higher in women and non-smokers (p<0.000, p<0.001). Again, the frequency of mutations in adenocarcinoma was higher in metastatic disease. There was no difference between the patient's age, area of residence, comorbidity and clinical stage and mutation frequency., Conclusions: Our study revealed that the EGFR mutation rate in Turkey with NSCLC was similar to East European, African-American and Caucasian patients, and was lower than in East Asia.

Objective: Eosinophilic asthma with chronic rhinosinusitis and/or nasal polyposis (EA-CRS/NP) is a subphenotype of adult-onset eosinophilic asthma. Blood eosinophil levels are shown to be highly elevated in patients with EA-CRS/NP and have potential for tissue infiltration. We aimed to demonstrate the clinical features of the patients who have a blood eosinophil level above 10% and have thorax computed tomography findings due to blood eosinophilia., Methods: Patients who were followed up in our clinic between 2012 and 2017 were retrospectively evaluated. Inclusion criteria were as follows: 1) Eosinophilic severe asthma, 2) eosinophilia >10%, 3) chronic sinusitis and/or nasal polyps, 4) patients with pathologic findings on thorax computed tomography, 5) regular follow-up for at least 1 year., Results: We identified 36 patients who met the above criteria. We defined this group as "Eosinophilic Asthma with chronic Rhinosinusitis and/or nasal polyposis with Radiological findings related to blood eosinophilia" (EARR). The mean age was 44.9 ± 11 years and 64% were females. Nasal polyps, aspirin exacerbated respiratory disease, and atopy, were present in 81%, 47%, and 25% of the patients, respectively. The mean blood eosinophil count was 1828.6 cells/mm 3 (19%). The majority of EARR patients had upper lobe dominant ground-glass opacities. The mean follow-up period was 3.2 ± 2.5 years. EARR patients did not evolve into eosinophilic granulomatous polyangiitis in the follow-up., Conclusions: This phenotype is the first eosinophilic asthma sub-phenotype reported in the literature. EARR is the final stage of the allergic march of EA-CRS/NP.

Objectives: Omalizumab is a monoclonal antibody that is used as add-on therapy for treating moderate-to-severe persistant atopic asthma in patients with persistant symptoms and frequent exacerbations, despite step 4 treatment according to GINA guidelines. Real-life studies on omalizumab treatment are limited in Turkey. Thus, the present study aims to assess the clinical efficacy and treatment outcomes of omalizumab in patients with atopic severe persistant asthma., Materials and Methods: Patients with atopic severe persistant asthma who were treated with omalizumab between 2009 and 2017 were retrospectively evaluated. Baseline and last results of the following variables were compared: symptom scores (GINA categorical), controller medications, blood eosinophil counts, forced expiratory volume in 1 second (FEV 1 ) values, and the number of exacerbations that were treated with systemic corticosteroids for at least 3 days within the last 1 year. The effect of coexisting aspirin-exacerbated respiratory disease (AERD) on these parameters was also analyzed. Step-down of other asthma medications was attempted in patients with symptom control and in those without an exacerbation history within the last 6 months., Results: Thirty-eight patients (mean age, 50 years; females, 30) were included in this study, of whom four showed AERD. After treating with a mean time of 30±22.1 (min: 6, max: 92) months, 26 (68%) patients showed complete controlled disease and 12 (32%) showed partly controlled disease, of whom all had uncontrolled disease before. Mean exacerbation rates within the last 1 year decreased by approximately 76% (9.4±8.4 vs. 1.8±1.5; p<0.001) and FEV 1 values increased by approximately 14% (2075±729 vs. 2321±800 cc; p=0.001) compared with baseline levels. Although the reduction in eosinophil count was not significant in all patients (503.8±524.8 vs. 370.8±314.5; p=0.134), repeated measures analysis of variance revealed a more prominent reduction in eosinophil count in the AERD group than in the non-AERD group, independent from the treatment period (F: 4.23, p=0.049). The mean inhaled corticosteroid dose (budesonide eq., 1063±397 vs. 958±439 mcg; p=0.084), the number of other controller medications, and the number of patients with long-term systemic steroid use decreased after omalizumab treatment. No serious adverse events were recorded during the follow-up period., Conclusion: Our results confirm that omalizumab significantly improves disease control and is a safe add-on therapy. In addition, in suitable patients with controlled disease over time, the step-down of other asthma medications will be appropriate.

Introduction: Mediastinal and hilar nodal staging is one of the key points for differentiating treatment modalities in patients with non-small-cell lung cancer (NSCLC). The aim of the present study was to determinate the diagnostic yields of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and combined EBUS-TBNA and EUS-FNA modalities for nodal staging in potentially operable NSCLC patients., Materials and Methods: Twenty consecutive patients were prospectively enrolled in the study between March 2014 and November 2015. All patients had a potentially operable NSCLC diagnosis before endosonographic procedures., Result: Thirty lymph nodes were sampled by EBUS-TBNA and 17 lymph nodes were sampled by EUS-FNA in all 20 patients. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of F-18 fluorodeoxyglucose positron emission tomography with computed tomography (PET-CT), EBUS-TBNA, EUS-FNA and combined EBUS-TBNA and EUS-FNA were 100%, 33.3%, 64.7%, 100% and 70.0%; 81.8%, 100%, 100%, 81.8% and 90%; 81.8%, 100%, 100%, 75% and 88.2%; 90.9%, 100%, 100%, 90.0% and 95.0%, respectively., Conclusions: The combined EBUS-TBNA and EUS-FNA technique is a successful procedure for nodal staging in potentially operable NSCLC patients.

Objectives: Eosinophilic granulomatosis with poliangiitis (EGPA) which was previously called Churg-Strauss Syndrome, is classified into eosinophilic and vasculitic phases. To characterize the eosinophilic and vasculitic phases of the disease in terms of clinical findings, serology, and treatment., Materials and Methods: We included 15 EGPA patients in the study. The clinical, serological, and therapeutic characteristics and the treatment responses of the patients were recorded., Results: Thirteen patients were classified as being in the eosinophilic phase and two were classified as being in the vasculitic phase of EGPA. Initial symptoms were worsening asthma in all patients (n=15; 100%). All patients had rhinosinusitis, and 66.6% had hypersensitivity to nonsteroidal anti-inflammatory drugs. The two patients in the vasculitic phase did not have nasal polyposis. Pulmonary and nervous system involvement were the most common symptoms. The erythrocyte sedimentation rates (ESRs) of the two patients in the vasculitic phase were 65 mm/h and 55 mm/h, while ESR was normal in eosinophilic-phase patients. Antineutrophil cytoplasmic antibodies (ANCA) was detected in one patient (6.6%) who was in the vasculitic phase (Case 15). The disease was under control with higher doses of methylprednisolone in the vasculitic phase (Case 14: 12 mg/day, Case 15: 10 mg/day) than in the eosinophilic phase. Relapse was detected in the two patients in the vasculitic phase. Oral corticosteroid was not discontinued in any case, and no mortality was reported., Conclusion: Patients with eosinophilic phase or vasculitic phase EGPA had similar clinical onset. However, higher ESR, ANCA positivity, and extrapulmonary organ involvement were only found in patients in the vasculitic phase. Corticosteroid responsiveness was very good in all patients in the eosinophilic phase, and the disease could be controlled with a very low maintenance dose of a corticosteroid., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Background: Obesity represents a major risk factor for Obstructive Sleep Apnea Syndrome (OSAS). Brain-derived neurotrophic factor (BDNF) affects the mechanisms that regulate weight, eating behavior, and metabolism. This project aims to investigate the possible association of BDNF gene polymorphism with obesity and OSAS, and to contribute knowledge to the understanding of the pathophysiology of OSAS., Methods: The subjects included in this study were selected among the individuals who were hospitalized in the Erciyes University Medical School Chest Diseases Sleep Medicine Laboratory. Subjects were divided into four groups based on the presence of OSAS and/or obesity. Group 1 included OSAS+ obesity+ patients, Group 2 included OSAS+ obesity- patients, Group 3 included OSAS- obesity+ patients, and Group 4 included OSAS- obesity- patients. The targeted patient number per each study group was 45, but only 32 patients could be enrolled into Group 3., Results: Out of a total number of 167 subjects, 117 (70.1 %) had BDNF 196G/G, 48 (28.7 %) had BDNF 196G/A, and 2 (1.2 %) had BDNF 196A/A genotype. Of 48 subjects having BDNF 196G/A genotype, 32 (66.6 %) were obese, and 16 (33.3 %) were non-obese. Out of 90 subjects with OSAS, 64 (71.1 %) had BDNF 196G/G, and 25 (27.8 %) had BDNF 196G/A genotype. Out of 77 subjects without OSAS, BDNF 196G/G, and BDNF 196G/A genotypes were detected in 53 (68.8 %) and 23 (29.9 %) subjects, respectively. A statistically significant difference was demonstrated between the four study groups in terms of BDNF rs6265 polymorphism (p = 0.013). This difference was attributed to OSAS+ obesity- Group, in which BDNF 196G/G genotype was more common and BDNF 196G/A polymorphism was less common than the patients in other groups., Conclusion: In conclusion, BDNF 196G/A genotype was found to be more frequent among obese patients compared to the non-obese individuals, but it was not significantly related to OSAS in the present study. BDNF196G/G genotype was more common and BDNF 196G/A polymorphism was less common among OSAS+ obesity- subjects compared to the other study groups.

Hypereosinophilic syndomes (HESs) include potentially lethal multisystem disorders characterized by eosinophilic infiltration of a variable spectrum of target organs, predominantly the skin, heart, lungs, gastrointestinal tract, and nervous system. Based on recent advances in molecular and genetic diagnostic techniques and increasing experience with differences in clinical features and prognosis, subtypes have been defined, including "myeloproliferative-HES ", "lymphocytic-HES", "familial eosinophilia", "overlap HES", "undefined HES" ("complex undefined HES", "simple undefined HES", "episodic undefined HES") and "eosinophil associated diseases" (such as Churg-Strauss syndrome). HES should be kept in mind in the differential diagnosis of eosinophilic lung diseases especially in patients with peripheral eosinophilia and pulmonary infiltrates. Corticosteroids represent an effective firstline approach to decreasing eosinophil counts in the majority of cases. Imatinib might be used for corticosteroid nonresponders. We herein report a patient with "complex undefined HES" who had disease resistant to corticosteroids, but who had a significant response after treatment with imatinib., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Early diagnosis is the key point in the management of acute pulmonary thromboembolism (PTE). There are no reports in the literature comparing the serum cystatin C levels in patients with acute PTE and normal volunteers. Therefore, in this study, we analyzed 50 patients with acute PTE and 45 healthy volunteers with normal renal function. The serum cystatin C level was significantly higher in the PTE group than in the non-PTE group (1.08 mg/dL [interquantile range (IQR) 0.79-1.56] and 0.85 mg/dL [IQR 0.77-1.03], respectively, P = .017). When determining the presence of PTE, the highest value of sensitivity and specificity was set at a cutoff value of 1.15 mg/dL with 93.3% specificity, 46.0% sensitivity, 88.5% positive predictive value, and 60.9% negative predictive value. In the multivariate model, cystatin C was significantly associated with the presence of PTE (odds ratio: 12.34, 95% CI 2.64-57.75). In conclusion, cystatin C may be an indicator of acute PTE in patients with normal renal function., (© The Author(s) 2013.)

Background and Aims: Intrathoracic lymphadenopathy usually occurs as a result of neoplasm, granulomatous diseases, infections or reactive hyperplasia. Conventional transbronchial needle aspiration (C-TBNA) is a cheap and safe procedure for diagnosing intrathoracic lymphadenopathy. The aim of this study was to assess the learning curve and diagnostic accuracy of C-TBNA after an observational education programme., Methods: In the present study, we retrospectively evaluated our first 62 C-TBNA procedures at Erciyes University between May 2012 and December 2012 after an observational education programme. The first 31 patients were defined as group A, and the second 31 patients as group B., Results: One hundred and seven lymph nodes were sampled in 62 patients by C-TBNA. Adequate lymph node samples were obtained in 52 of the 62 patients (83.8%). In these 52 patients, two patients had a diagnosis of 'suspicious of malignancy' by C-TBNA, and these patients were excluded from the analysis. In the remaining 50 cases who had adequate results, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy per patient were 80.6%, 92.9%, 96.7%, 65.0% and 84.0%, respectively. The diagnostic accuracy rates of C-TBNA for Group A and B were 72.0% (18/25) and 96.0% (24/25), and the difference was statistically significant (P < 0.05)., Conclusion: C-TBNA is a useful diagnostic procedure for sampling intrathoracic lymphadenopathies and masses that are adjacent to the bronchial system. An observational education programme is helpful for learning C-TBNA. The diagnostic yield improves in time, and approximately 30 procedures may be sufficient to achieve successful results., (© 2013 John Wiley & Sons Ltd.)

The bleachery procedure is the most frequent method used to decolorize denims since sandblasting has been shown to cause silicosis. The aim of this study was to determined the prevalence of occupational asthma among denim bleachery workers in Kayseri. The study was conducted in 4 factories, in which jean bleachery was performed, in Kayseri between December 2008 and February 2009. Overall, forty-four subjects, 22 from the bleachery section and 22 from the other sections, were included. A questionnaire about respiratory symptoms was administered. Pulmonary function tests (PFTs) and serial peak expiratory flow (PEF) measurements were performed. All subjects were evaluated by posteroanterior chest x-rays. The prevalence of occupational asthma (OA) in the bleachery and other section workers was 23.8% and 9.1%, respectively (p> 0.05). Within workers, exercise dyspnea (23.3%) and wheezing (20.9%) were the most frequent symptoms. The relationship between the duration of employment and PFTs in bleachery workers (n= 21) was negatively correlated and statistically significant with FEV₁, FEF₂₅-₇₅ (moderate; r= -0.477, -0.449, respectively; p< 0.05) and FEV₁/FVC, FEV₁% (well; r= -0.588, -0.509, respectively; p< 0.05). The results of the present study suggest that exposure to denim-bleaching agents plays an important role in the occurrence of respiratory symptoms, reduction in pulmonary functions, and induction of occupational asthma.

Bronchopulmonary sequestration is an unusual congenital malformation consisting of abnormal lung tissue that lacks normal communication with the tracheobronchial tree. The diagnosis of pulmonary sequestration is based on identifying this systemic arterial supply. We aimed to evaluate the sensitivity of multidetector computed tomography in demonstrating the feeding artery and draining veins. Between 2003 and 2008, 8 patients (6 males, 2 females) ranging in age from 5 to 49 years with a diagnosis of pulmonary sequestration were identified. All patients underwent evaluation with chest tomography (spiral or multi detector tomography) and digital subtraction angiography. Aberrant systemic arterial supply was demonstrated in all cases: from the descending thoracic aorta (n= 6); arcus aorta (n= 1), internal mammarial artery (n= 1), intercostal arteries (n= 2) and celiac axis (n= 1). Four patients underwent surgery which confirmed the angioarchitecture depicted on angiography. One patient underwent angiography with embolization using. Computed tomography especially multidetector computed tomography is a powerful noninvasive technique for the detection of pulmonary sequestration.

Purpose: In this clinical study, our aim was to evaluate the results of conventional and step-wise shockwave lithotripsy (SWL) in the management of urinary calculi., Patients and Methods: Fifty consecutive patients seen in our outpatient urology clinic were included and randomized in the clinical study. SWL was performed using a Dornier Compact Delta instrument. Treatment energy was set on 13 kV in the conventional group. In the step-wise SWL group, the patients were subjected to gradually increased (with every 500 shocks) output voltage as 11, 12, and 13 kV, respectively. The SWL session was completed with 13 kV thereafter. The maximum number of shocks in both groups was limited to 3,000., Results: Twenty-five patients in the conventional group and 25 patients in the step-wise SWL were included. The mean ages in the step-wise SWL group and the conventional group were 39.9 and 41.4 years (P > 0.05), respectively. The mean stone size was 0.83 +/- 0.51 cm in the step-wise SWL group and 0.70 +/- 0.41 cm in the conventional group (P > 0.05). There was no difference between the two groups as to the localization of stones in the ureter or kidney. Also, no statistical difference was observed in the number of lithotripsy treatments between the two groups. When we compared the results of two treatment procedures 8 weeks after the initial treatment, the success rate was significantly higher in the step-wise SWL group than in the conventional group (stone-free rate 96% (24/25) v 72% (18/25), P < 0.05))., Conclusions: Step-wise SWL yielded better outcomes than conventional SWL without increased morbidity. Stepwise SWL can be considered as a management option for urinary calculi.

We report a case of epidermoid-cell carcinoma of the lung that developed a metastatic lesion in the penis. A 50-year-old male patient was admitted to our hospital with bloody sputum and cough. He had a left pneumectomy and was diagnosed with epidermoid carcinoma of the lung at stage IIB (T2N1M0). He was started on an adjuvant chemotherapy protocol consisting of cisplatin and paclitaxel. He was admitted to our urology clinic with obstructive symptoms during urination and pain during penile erection. Physical examination revealed a firm, 3 cm x 2 cm palpable mass on the radix of his penis. A fine-needle aspiration biopsy of the penile mass revealed epidermoid carcinoma that was consistent with lung cancer. The patient was considered to have penile metastasis from epidermoid carcinoma of the lung.

Purpose: To determine the effects of previous open nephrolithotomy on the results and morbidity of subsequent percutaneous nephrolithotomy (PCNL)., Patients and Methods: Between March 2005 and January 2006, 89 patients underwent PCNL at our institution. We compared the patients who had had previous open surgery on the same kidney (group 1; n = 27) with those who had had no previous surgery (group 2; n = 62). The two groups did not differ significantly in age (45.4 v 44 years), stone burden (361.3 mm(2) v 482.4 mm(2) ), stone number, or laterality. Operative time, hospital stay, success rate, visual analog pain scores 8 hours after surgery, analgesic doses (diclofenac sodium), and intraoperative and postoperative complications were compared., Results: There were no differences in operating time, postoperative analgesic doses, pain scores, intraoperative and postoperative complications, the number of accesses, or the stone-free rate., Conclusions: The morbidity and efficacy of PCNL are similar in patients who have had previous open nephrolithotomy and those having no previous surgery. Previous open surgery does not affect the success of PCNL.

Objective: To assess the effectiveness of stepwise extracorporeal shock wave lithotripsy in the treatment of upper urinary stones in childhood., Patients and Methods: Between August 1998 and August 2003, 31 patients were treated for renal or ureteric stones. All treatments were performed with Dornier Compact Delta lithotripter. The number of shock wave was limited to maximum 3000 shock waves/session. The voltage was started at 10 kV and increased stepwise to 12.75 kV. Stone clearance was assessed at 3 months. The stone free state was defined as the absence of stone fragments., Results: Total 31 stones (24 renal and 7 ureteral stones) were treated. The age of the patients was median 8 (min-max: 0.8-12) years. The length of the stones was median 1 (min-max: 0.5-1.5) cm for renal stones and median 0.5 (min-max: 0.5-1) cm for ureteral stones. As an auxiliary procedure, open pyelolithotomy was required for 1 patient. The overall stone free rates for renal and ureter stones were 79% and 100%, respectively. Post-treatment insignificant hematuria was observed in all cases., Conclusion: Stepwise shock wave lithotripsy was an effective procedure for the treatment of urinary calculi in childhood.

Introduction: Most upper or middle ureteral stones are treated with shock wave lithotripsy or endoscopic techniques. In rare cases the ureteral stones are treated with open surgery after failure of first-line treatments. Retroperitoneoscopy is a minimally invasive alternative to open surgery., Patients and Methods: Between May 1995 and January 2001, twenty-one patients underwent retroperitoneoscopic ureterolithotomy. The stones in upper and middle ureter were large and impacted (5 patients) or not fragmented after shock wave lithotripsy (16 patients). A balloon dissector was placed and infiltrated with 800 ml air in the retroperitoneal space. Three 10-mm trocars were used. The pressure was kept at 15 mm Hg by carbon dioxide insufflation. The stones were extracted from the ureter using a laparoscopic stylet., Results: The stones in 17 patients were successfully removed in a median operating time of 105 (min-max 45-190) min. Urine extravasation in all cases and pnomoscrotum in 2 cases were observed as postoperative complications. The median hospital stay was 6 (min-max 3-22) days with minimal analgesic requirement., Conclusion: Retroperitoneoscopic ureterolithotomy is a useful and effective alternative treatment technique to open surgery when first-line treatments have failed or are unlikely to be effective., (copyright 2004 S. Karger AG, Basel)

Tracheobronchopathia osteochondroplastica (TO) is an unusual disorder. It mainly affects men over 50 years old and clinical manifestations are observed when obstructive or infectious complications occur. A 50-year old woman was investigated because of productive cough and 42 years old man was investigated because of haemoptysis. In two cases, at bronchoscopy, the typical picture of TO was observed. Microscopic examination of the biopsy material revealed bone formation. TO should be considered in the differential diagnosis as an unusual cause of chronic persistent cough, haemoptysis, persistent atelectasis, and recurrent segmental or lobar infection.

Background and Purpose: Laparoscopic varicocelectomy has been performed in patients with bilateral varicocele. This procedure could be performed either transperitoneally or extraperitoneally. The purpose of this study was to compare the effectiveness and morbidity of the two approaches., Patients and Methods: Twenty-one patients underwent transperitoneal repair. Twelve of them had complaints of infertility, and nine of them had pain. Eighteen patient underwent extraperitoneal repair. Twelve of them had complaints of infertility, and six of them had pain. All the patients with pain had clinical varicoceles. In each group, three patients with infertility had unilateral subclinical varicoceles., Results: No significant difference was found in the duration of surgery, artery-vein discrimination, or morbidity between the extraperitoneal and transperitoneal techniques. In both approaches, the previously infertile patients who have been followed more than 6 months had significant improvement in sperm counts and motilities (P < 0.05). There were no significant differences in the improvement in the extraperitoneal and transperitoneal groups., Conclusion: There was no significant difference between the transperitoneal and extraperitoneal techniques in terms of effectiveness and morbidity. The difficulty in identifying the internal spermatic vein and the additional cost of the balloon dissector for the extraperitoneal technique makes us prefer transperitoneal repair.

Spontaneous migration of the intrauterine devices into the bladder and secondary stone formation are rare complications. A 33-year-old women in whom a copper T intrauterine device had been placed two years previously, presented complaining of irritative lower urinary tract symptoms. Intravesical migration of intrauterine device and big stones around it were confirmed by radiography and cystoscopy. The stones were fragmented by using electrohydraulic lithotriptor. And then all fragments of the stones and IUD were cystoscopically removed by a grasping forceps without any complication.