Moderate temperature reduction is sufficient for prevention of 5-fluorouracil-induced oral mucositis: an experimental in vivo study in rats.

PURPOSE: The current idea of how oral mucositis (OM) develops is primarily based on hypotheses and the early events which precede clinically established OM remain to be demonstrated. Cryotherapy (CT) continues to have considerable promise in clinical settings to reduce chemotherapy-induced OM. Although being effective, the knowledge is scarce regarding the ideal temperature for prevention of OM. Thus, the present study had two main objectives: (i) to develop an animal model to investigate the early events of OM; (ii) to study at what cooling temperature these early events could be abolished. METHODS: Male Sprague-Dawley rats were anaesthetized and given an intravenous bolus dose with the cytostatic drug fluorouracil (5-FU). During the first hour following injection with 5-FU, the oral cavity of the rats was cooled to a mucosal temperature at the range of 15-30 â—‹C, or left uncooled (35 â—‹C), serving as control. After 3-5 days, the rats were euthanized, and the buccal mucosa was excised. Subsequently, mucosal thickness and expression of IL-6 and TNF-α were analyzed with immunohistochemistry and enzyme-linked immunosorbent assay (ELISA). RESULTS: Five days following treatment with 5-FU, a statistically significant thickening of the oral mucosa occurred, and a distinct expression of both IL-6 and TNF-α were observed. The cryo-treated groups (15-30 °C) displayed statistically significantly thinner mucosa as compared to the control group (35 °C). The ELISA showed an increase in expression of the proinflammatory cytokines IL-6 and TNF-α in tissues exposed to 5-FU that were treated with increasing temperatures (15-30 °C). CONCLUSION: Bolus i.v. injection with 5-FU in rats can be used to create a functional animal model for chemotherapy-induced OM. Further, moderate temperature reduction is sufficient to reduce the early events which may precede clinically established OM.

Preliminary results with non-centrifuged autologous fat graft and percutaneous aponeurotomy for treating Dupuytren's disease.

The aim of this study was to describe our experience with treating Dupuytren's disease using needle aponeurotomy and non-centrifuged autologous fat grafting. The study included 17 patients (18 hands). Patients were treated with needle aponeurotomy and non-centrifuged autologous fat graft under general anesthesia. The fat grafts were injected into the surgical area so as to stay in contact with the operated site. An extension splint was used for 1 week postoperatively and the patients received hand therapy for 3 weeks. Before the treatment, the contracture in the proximal interphalangeal and metacarpophalangeal joints was a mean of 45.06 ± 13.44 degrees and 36.56 ± 13.09 degrees, respectively. It was 1.61 ± 1.65 and -0.56 ± 3.78 degrees at 3 months, respectively. The difference between these measurements was statistically significant. The mean follow-up period was 12 months. The results were satisfactory and no complications were observed during the follow-up period. Based on the results of the study, percutaneous aponeurotomy with non-centrifuged autologous fat grafting was found to have significantly beneficial effects in the treatment of Dupuytren's disease.

The relationship between acquired premature ejaculation and metabolic syndrome: a prospective, comparative study.

The aim of this study was to investigate the relationship between metabolic syndrome (MetS) and acquired premature ejaculation (PE). A total of 100 patients with acquired PE and 100 control cases were enrolled in the study. After obtaining a detailed medical history, anthropometric (weight, height and waist circumference) and blood pressure measurements were performed. Ejaculation and erection functions were evaluated by Premature Ejaculation Diagnostic Tool (PEDT) and International Index of Erectile Function-5 (IIEF-5), respectively. Self-estimated intravaginal ejaculatory latency time (IELT) of the participants was recorded. Fasting blood samples were taken for biochemical and hormonal work-up. The median PEDT scores were 16 (9-22) and 4.5 (2-8) in acquired PE and control groups, respectively (P<0.001). The mean estimated IELT values in PE patients and controls were 36.1±46.5 versus 488.2±313.8 s (P<0.001). MetS was diagnosed in 51 patients (51%) in the PE group and 24 (24%) participants in the control group (P<0.001). A significant negative correlation was observed between the components of MetS and estimated IELT, except for diastolic blood pressure. Moreover, there was a significant positive correlation between the all components of MetS and total PEDT score, except for fasting blood glucose and high-density lipoprotein cholesterol (HDL) levels. Logistic regression analysis revealed that, except blood pressure and HDL levels, MetS components were significant risk factors for PE after adjusting for age and total testosterone. In conclusion, MetS is associated with acquired PE.

Comparing the short-term outcomes and complications of monopolar and bipolar transurethral resection of non-muscle invasive bladder cancers: a prospective, randomized, controlled study / Comparación de los resultados a corto plazo y complicaciones de la resección transuretral monopolar y bipolar de tumores vesicales no músculo-infiltrantes: estudio prospectivo, randomizado, controlado

OBJECTIVES: To compare perioperative outcomes and complications of plasmakinetic bipolar and monopolar transurethral resection of bladder tumors (TURBT) in patients with non-muscle invasive bladder cancer (NMIBC). METHODS: Between March and December 2015, a total of 130 consecutive patients underwent TURBT for NMIBC. Patients were equally randomized into monopolar TURBT (M-TURBT) and bipolar TURBT (B-TURBT) groups. Primary outcome of this study was safety of the procedures including obturator jerk, bladder perforation, clot retention, febrile urinary tract infection and TUR syndrome. The secondary outcome was efficacy of both TURBT procedures, including complete tumor resection, sampling of the deep muscle tissue and sampling of the qualified tissues that without any thermal damage. RESULTS: Complete tumor resection rate was higher in B-TURBT than M-TURBT (89.2% vs 78.5%, respectively), but the difference was not significant (p = 0.152). No significant differences were found between the muscle tissue sampling rates (64.6% vs 72.3%, p = 0.345) and the numbers of patients with thermal tissue damage (7 patients vs 3 patients, p = 0.194). Obturator jerk was detected in 21.5% of the patients in M-TURBT group and 4.6% of the patients in B-TURBT group, and this difference was statistically significant (p = 0.013). Bladder perforation was significantly higher in M-TURBT group than B-TURBT (21.5 % vs 6.1%, p = 0.039). CONCLUSIONS: Bipolar TURBT had significantly lower obturator jerk and bladder perforation than monopolar. B- TURBT is a reasonable treatment modality in patients with NMIBC

OBJETIVO: Comparar los resultados perioperatorios y las complicaciones de la resección transuretral bipolar plasmaquinética y monopolar de tumores vesicales en pacientes con carcinoma vesical no musculo-infiltrante (CVNMI). MÉTODOS: Entre marzo y diciembre del 2015, un total de 130 pacientes consecutivos fueron sometidos a RTU de tumor vesical por CVNMI. Los pacientes fueron randomizados por igual en los grupos de RTU monopolar (RTU-M) y RTU bipolar (RTU-B). El objetivo primario del estudio era evaluar la seguridad de la operación incluyendo la contractura del obturador, perforación vesical, retención por coágulos, infección urinaria febril y síndrome post RTU. El objetivo secundario era evaluar la eficacia de ambos procedimientos de RTU, incluyendo la resección completa del tumor, obtención de tejido muscular profundo y de los tejidos cualificados sin lesión térmica. RESULTADOS: La tasa de resección completa del tumor fue superior en el grupo de RTU-B frente al de RTU-M (89,2% vs 78,5%, respectivamente), pero la diferencia no fue significativa (p = 0,152). No se encontraron diferencias significativas entre las tasas de obtención de la capa muscular en las muestras (64,6% vs 72,3%, p = 0,345) ni en el número de pacientes con lesión térmica tisular (7 pacientes frente a 3 pacientes, p = 0,194). Se detectó contractura del obturador en el 21,5% de los pacientes en el grupo de RTU-M y 4,6% de los pacientes del grupo de RTU-B, y esta diferencia era estadísticamente significativa (p = 0,013). La perforación vesical fue significativamente mayor en el grupo de RTU-M frente al de RTU-B (21,5% vs 6,1%, p = 0,039). CONCLUSIONES: La RTU bipolar de tumor vesical tiene una incidencia de contractura del obturador y perforación significativamente menores que la de la monopolar. La RTU-B del tumor vesical es una modalidad de tratamiento razonable en pacientes con CVNMI

Evaluation of laparoscopic transperitoneal adrenalectomy: is it feasible for large masses?

AIM: The aim of this paper was to determine whether laparoscopic adrenalectomy (LA) is a safe and effective treatment for the management of large adrenal tumors. METHODS: We retrospectively evaluated the data of patients who underwent LA at our institution between September 2002 and September 2012. Seventy-six transperitoneal LA were performed by the same surgical team. Patients with invasive tumors to adjacent organs or distant metastasis were excluded from the study. All patients were operated using the 450 oblique position as transperitoneal approach. RESULTS: The mean age of the patients was 48.3 years (range 20-68 years). The mean tumor size was 5.37 cm (range 2-15 cm). Sixteen patients had tumor size over 8 cm. The mean tumor weight was 31.2 gr (range 2-156 g). The lesions were localized on the right side in 42 (55%) patients and on the left side in 34 (45%) patients. The mean intraoperative blood loss was 114 mL (range 20-400 mL) and the mean operative time was 112 min (range 55-300 min). Six patients (7%) required conversion to open procedure. The mean hospitalization time was 2.5 days (range 1-4 days). Five patients (6%) had post-operative minor complications. There were no incidents of capsular invasion or adverse cardiovascular events. CONCLUSION: LA is safe and feasible for both malign and benign adrenal lesions. Good preoperative assessment, surgical skills, team work and adherence to anatomical and surgical principles are the key to success for large adrenal masses.

Clinical comparison of two new minimally invasive techniques in the treatment of benign prostatic hyperplasia: Twister™ Diode Laser System vs. BiVap (Richard Wolf®) saline vaporization of the prostate.

AIM: The aim of this study was to evaluate complications and postoperative follow-up outcomes of the recently developing endoscopic techniques of BiVap (Richard Wolf®) and Twister™ system in patients with benign prostatic obstruction (BPO). METHODS: Eighty patients treated with BiVap (Richard Wolf®) (N.=46) and Twister™ system (N.=34) were included in the study. Operation, hospitalization and catheter removal time were noted. Postoperative complications including urinary tract infection, transient hematuria, severe dysuria, and fever >38° C, urinary incontinence and urethral stricture were also noted. All patients were evaluated at the postoperative 1st, 3rd, 6th and 12th month and preoperative and postoperative values of IPSS score, QoL score, total PSA, IIEF 15, PVR, Qmax and Qave were compared. Statistical analyses were performed with SPSS version 18. A P-value<0.05 was considered significant. RESULTS: Mean age of the patients was 64.1 ± 7.1 years. Significant improvement was observed for IPSS, Qmax, Qave, PVR, and QoL score by the postoperative first month compared to the preoperative values in both groups. In group 1 maximum improvement in the IPSS, Qmax, Qave, QoL score and PVR were achieved at postoperative 3, 3, 12, 3 and 12th months, respectively. In group 2 maximum improvement in the IPSS, Qmax, Qave, QoL score and PVR were achieved at postoperative 6, 3, 6, 6 and 3rd months, respectively. There was no significant difference between the two groups in terms of IPSS, Qmax, Qave, QoL, PSA, PVR, IIEF (Total), IIEF-EF, IIEF-IS, IIEF-OF, IIEF-SD and IIEF-OS during the 1 year follow-up period. Total IIEF and subgroup scores improved to their preoperative levels by the postoperative 3rd month in both groups. CONCLUSION: Both BiVap (Richard Wolf®) and Twister™ systems are safe and highly effective minimal invasive techniques, which can be used in the surgical treatment of BPO.

The role of stem/progenitor cells and Wnt/ß-catenin signaling pathway in the patients with prostate cancer.

AIM: The aim of this paper was to investigate the possible effect of cancer stem cells (CSCs) and relationship with Wnt/ß-catenin signaling pathway progressing of prostate cancer. METHODS: Thirty men with a pathological diagnosis of benign prostate hyperplasia (BPH) (group 1, N.=10), prostate cancer with a gleason score of ≤6 (group 2, N.=10), and prostate cancer with a gleason score of >6 (group 3, N.=10) were included in the study. The patients' groups were compared in terms of immunoreactivity strength of prostatic stem/progenitor cell surface markers including CD133 and CD117. We also compared the immunoreactivity of Wnt7a, a part of Wnt signaling pathway which has a potential role in the progression of several cancers including prostate cancer. The immunoreactivity of Frizzled 6 (Fzd 6) which is the receptor of Wnt family was also evaluated in all groups. RESULTS: Immunohistochemical analyses demonstrated that although CD133 immunoreactivity was positive in all groups, immunoreactivity was significantly stronger in group 3 when compared to other groups. While CD117 immunoreactivity was negative in group 1 and 2, it was positive in group 3. Wnt7a immunoreactivity was weak in all groups and Fzd 6 immunoreactivity was stronger in group 1 and 3 when compared to group 2. CONCLUSION: Our findings demonstrated that CSCs and Wnt signaling pathway have a potential role in the development and progression of prostate cancer.

Comparison of non-invasive fibrosis markers and classical liver biopsy in chronic hepatitis C.

The aim of this study was to compare the results of nine non-invasive serum biomarkers with liver biopsies to predict liver fibrosis stage. HCV-RNA-positive, HCV genotype 1, treatment-naive patients with chronic HCV infections were included from 14 centers (n=77). The platelet count, AST/ALT ratio (AAR), cirrhosis discriminate score (CDS), FIB4, AST/platelet ratio index (APRI), age-platelet (AP) index, Göteborg University cirrhosis index (GUCI), FibroTest, and ActiTest were calculated and compared to histologic findings. All serum biomarkers, except AAR, were weakly or moderately correlated with liver biopsy results (ISHAK fibrosis score). The mean scores of FibroTest, FIB4, APRI, and AP index were significantly different between F0-F2 and F3-F4 groups and the negative predictive values (NPVs) of the F3-F4 group were 95%, 85%, 85%, and 83%, respectively, for these serum biomarkers. Our study suggests that serum biomarkers may help to diagnose significant fibrosis but inadequate to detect fibrosis in early stages. Although liver biopsy is still the gold standard to diagnose liver fibrosis, FibroTest, FIB4, APRI, or AP index may be used to exclude significant fibrosis with >80% NPV.