Effectiveness of the Epley maneuver versus Cawthorne-Cooksey vestibular exercises in the treatment of posterior semicircular canal benign paroxysmal positional vertigo (BPPV): A randomized controlled trial.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo that mainly affects the posterior semicircular canal. Studies suggest that Epley maneuver could improve balance of patients, but Cawthorne-Cooksey vestibular exercises are still scarce. This study aimed to observe the effects of Cawthorne-Cooksey vestibular exercises applied after the Epley maneuver on balance, vertigo symptoms, and quality of life in posterior semicircular canal BPPV. METHODS: Thirty-six patients with posterior semicircular canal BPPV were randomly assigned into Epley maneuver (EpleyM) and Epley maneuver and exercise (EpleyM&Exe) groups. All patients were treated with the Epley maneuver, while Cawthorne-Cooksey vestibular exercises were given to the EpleyM&Exe group as home exercises for 6 weeks. Their static and dynamic balance, vertigo symptoms, and quality of life were assessed at pre-, post-intervention (1st, 3rd and 6th weeks). RESULTS: Thirty-two patients completed the study (mean age: 46.91 ± 9.78 years). Epley maneuver applied alone and combined with Cawthorne-Cooksey vestibular exercises, was found to be effective in 25 patients (78.1%), 6 patients (18.8%) and 1 patient (3.1%) at the 1st, 3rd and 6th weeks, respectively. After 6 weeks, both groups had gained significant improvements in balance, vertigo symptoms, and quality of life (p < 0.001); however, there were no significant differences between the groups, except for the static dominant leg balance test (p = 0.022). CONCLUSIONS: The Epley maneuver can be considered as the first option compared to Cawthorne-Cooksey vestibular exercises. Exercises do not appear to have any additional effects in improving posterior semicircular canal BPPV symptoms.

The Effects of Dual-Task Training on Patient Outcomes of Institutionalized Elderly Having Chronic Stroke.

BACKGROUND/AIMS: The purpose of our study was to investigate the effects of dual-task training on balance, mobility, functional independence, and fear of falling in geriatrics with chronic stroke. METHODS: Fifty-three geriatrics diagnosed with stroke were included in our study. The elderly were divided into 2 groups, i.e., those walking with (intervention group, n = 25) and those walking without (controls, n = 28) dual-task training. RESULTS: We found statistically significant improvements in all parameters between pre- and posttreatment in both groups (p < 0.05). CONCLUSION: Based on our findings, walking with dual-task training can be used in addition to conventional stroke rehabilitation aiming to improve balance and mobility.

Comparison of abdominal, vaginal, and laparoscopic hysterectomies in a tertiary care hospital in Turkey.

AIM: The aim of this retrospective study was to assess and compare the clinical results of three hysterectomy techniques: abdominal hysterectomy (AH), vaginal hysterectomy (VH), and laparoscopic hysterectomy (LH). METHODS: A total of 2163 patients having undergone AH (n = 1226), VH (n = 426), and LH (n = 511) procedures were analyzed. The mean age, body mass index (BMI), parity, uterus weight, operation time, blood loss, duration of hospitalization, analgesic needs, intra- and postoperative complications, and indications for hysterectomy were analyzed and compared. RESULTS: There were no differences between the groups with respect to the BMI, parity, and intra- or postoperative major and minor complications. The operation time was significantly shorter in the VH group than in the other two groups (p < 0.001), and the blood loss was significantly lower in the LH group than in the others (p < 0.001). The duration of hospitalization and analgesic needs were the shortest in the LH group (p < 0.001), while the uterus weight and previous intra-abdominal surgery rate were the lowest in the VH group (p < 0.001). CONCLUSION(S): Despite the fact that the LH exhibited a longer operation time than the VH, the LH was considered to be a safe and effective surgical procedure due to the lesser blood loss, hospital stay, and analgesic needs.

The effects of formoterol on the serum, peritoneal VEGF, MDA, and VEGF levels in the ovaries and endometrium of rats with OHSS.

PURPOSE: To investigate the effects of formoterol (a beta2-adrenoreceptor agonist) on serum and peritoneal fluid VEGF, malondialdehyde (MDA) levels, and on VEGF-stained cell counts in the ovaries and endometrium of rats with ovarian hyperstimulation syndrome (OHSS) within the framework of immunohistochemical analysis. MATERIALS AND METHODS: A total of 28 immature female Wistar rats were randomly divided into four groups. Three groups were given ten IU pregnant mare serum gonadotropin/day on days 22-25 of life. They were administered 30 IU hCG on day 26 of life to mimic OHSS. On days 26 and 27 of life, 24 mcg/kg/day formoterol in group 3 and 48 mcg/kg formoterol in group 4 were administered intraperitoneally per animal. RESULTS: Although, there were no statistically significant differences between the groups in terms of serum and peritoneal fluid VEGF or MDA levels (serum VEGF: p = 0.28 1, peritoneal VEGF: p = 0.674, serum MDA: p = 0.543, peritoneal MDA: p = 0.506), there was a significant difference between the control and the OHSS placebo groups (p = 0.013) regarding the VEGF in the ovarian cortex. There was a significant difference between the control and the other groups in terms of ovarian stroma (p = 0.001), and there was also a statistically significant difference between the OHSS placebo and the other groups regarding VEGF in the endometrium (OHSS placebo vs. control group p = 0.002, OHSS placebo vs. the formoterol 24 mcg/kg group, p = 0.008, and OHSS-placebo vs. the formoterol 48 mcg/kg group, p = 0.001). CONCLUSIONS: Formoterol represents a potential novel strategy for the management of OHSS. Further studies, including those examining the dosage of formoterol, are warranted.

A Study of Serum Soluble CD 163 Levels in Women with Polycystic Ovary Syndrome.

The aim of this study was to determine serum soluble CD163 levels in patients with polycystic ovary syndrome and its relation to clinical and metabolic parameters. Eighty-four women aged 18-45 years, 43 with polycystic ovary syndrome and 41 controls were recruited in this case-control study. Serum sCD163 levels of the groups were compared. Other metabolic, hormonal, and clinical parameters including, body mass index, HOMA-IR, highly sensitive C- reactive protein, glucose, glycated hemoglobin, lipids, luteinizing hormone, and total testosterone and waist/hip circumference were also investigated. Patients were further subgrouped according to body mass index and sCD163 levels were investigated in obese and normal weight subjects. We performed a multiple regression analysis to investigate the independent predictors affecting soluble CD163 levels. Significantly higher soluble CD163 levels were found in patients with polycystic ovary syndrome (2.11±0.65 ng/ml vs. 1.69±0.85 ng/ml, p=0.012). We detected positive correlations of sCD163 with total testosterone, total cholesterol, and luteinizing hormone (r=0.330, p=0.002, r=0.356, p<0.001 and r=0.239, p=0.030, respectively). In the multiple linear regression analysis, total testosterone was the variable associated with the elevation of serum soluble CD163 levels. Soluble CD163, which is identified as a marker of inflammation and type II diabetes, is elevated in polycystic ovary syndrome. Elevated sCD163 levels were found to be associated with total testosterone. Further studies to elucidate the exact mechanism underlying the elevation of serum soluble CD163 in polycystic ovary syndrome are needed.

Evaluation of matrix metalloproteinase, myeloperoxidase, and oxidative damage in mesenteric ischemia-reperfusion injury.

BACKGROUND: In this study, we investigated the alterations of matrix metalloproteinase (MMP) and tissue inhibitors of metalloproteinases (TIMPs), acute inflammation, and oxidative damage in the circulatory system and the intestine in response to mesenteric ischemia/reperfusion (I/R). METHODS: Twenty-one rats were divided randomly into the following three groups (n = 7 in each group): a sham group (CG), an ischemic group (IG), and an I/R group (I/RG). MMP-9, TIMP-1, and myeloperoxidase (MPO) were measured using the enzyme-linked immunosorbent assay method, and lipid peroxidation (quantified as thiobarbituric acid reactive substances (TBARS) content), ischemia-modified albumin, the prooxidant-antioxidant balance (PAB), and ferric-reducing antioxidant power (FRAP) were measured spectrophotometrically. The degree of intestinal injury was evaluated according to the Chiu scoring system. RESULTS: A significant difference between the mean serum TIMP-1 and MMP-9 levels and the alanine transaminase activity was found among the groups. Compared with the I/RG group a significant difference in the mean tissue MMP-9, MPO, and TBARS levels in addition to the PAB and FRAP was found between the CG and IG groups. The level of MMP-9 also demonstrated a strong, positive, and valid correlation with the TBA-RS levels. A significant morphological change was observed in both the IG and the I/RG groups. The degree of intestinal injury was more severe in the I/R group and was characterized by either villous denudation or villous loss. CONCLUSIONS: These results suggest that MMP-9, TIMP-1, MPO, and oxidative stress may be important in the intestinal injury development that is induced by acute mesenteric I/R in a rat model. MMP-9 overexpression may increase the extent of intestinal villous loss, particularly when MMP-9 is upregulated by the TBARS present in the intestinal injury.

A study on the association between serum amyloid A and sperm concentration.

Our aim was to compare peripheral blood and seminal fluid serum amyloid A (SAA) protein levels in men classified on the basis of sperm concentration and investigate whether SAA protein is an important marker of male infertility. A total of 74 first-attempt IVF male partners of infertile couples classified as azoospermic (n = 25), oligozoospermic (n = 25) and normozoospermic group (n = 24) were recruited for this cross-sectional study. There was no difference with respect to age, BMI, infertility period and smoking ratio. No difference in haematologic parameters including white blood cell count, neutrophil ratio, lymphocyte ratio, neutrophil-to-lymphocyte ratio and blood SAA level was found between the groups. Seminal fluid SAA level was 17.85 ± 2.21 ng ml(-1) in azoospermics, 16.13 ± 3.58 ng ml(-1) in oligozoospermics and 15.67 ± 4.77 ng ml(-1) in normozoospermics, showing no significant difference. Seminal SAA level was found to be not correlated with blood SAA levels. Therefore, we could not find any associations between these parameters at all. However, further studies with more participants are needed to address the exact action of SAA on spermatogenesis.

The impact of follicular fluid adiponectin and ghrelin levels based on BMI on IVF outcomes in PCOS.

PURPOSE: This study aimed at evaluating the effects of polycystic ovary syndrome (PCOS) and body mass index (BMI) on follicular fluid (FF) adiponectin and ghrelin levels, and on in vitro fertilization outcomes in patients who underwent controlled ovarian hyperstimulation. METHODS: This prospective cross-sectional study was performed with a total of 120 primary infertile women [group 1; non-PCOS = 60 (BMI <25 = 30, BMI ≥25 = 30) and group 2; PCOS = 60 (BMI <25 = 30, BMI ≥25 = 30)]. On the day of oocyte pickup, FF samples were collected. RESULTS: The FF adiponectin levels were lower in the lean PCOS group than the lean non-PCOS group (p = 0.001), and these levels were lower in the overweight non-PCOS group compared to lean non-PCOS group (0.001). However, there was no difference in the FF ghrelin levels between the groups. Additionally, we could not find a relationship between clinical pregnancy and adiponectin and ghrelin levels. CONCLUSION: The FF adiponectin and ghrelin levels have no effects on clinical pregnancy in PCOS. Therefore, further studies are needed to elucidate this issue.

Dehydroepiandrosterone supplementation improves predictive markers for diminished ovarian reserve: serum AMH, inhibin B and antral follicle count.

OBJECTIVE: To evaluate the effect of dehydroepiandrosterone (DHEA) supplementation on ovarian reserve by measuring markers such as antral follicle count, serum anti-Müllerian hormone (AMH) and inhibin B in patients with diminished ovarian reserve. STUDY DESIGN: This prospective study was undertaken at Dr. Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey. Forty-one patients with diminished ovarian reserve were included in the study and received supplementation with DHEA 25mg, t.i.d., for at least 6 weeks. Serum AMH, inhibin B, follicle-stimulating hormone (FSH) and oestradiol, and antral follicle count were determined before and after DHEA supplementation. Baseline ovarian reserve parameters such as antral follicle count, FSH, oestradiol, AMH, inhibin B, clinical and laboratory IVF outcomes, and pregnancy rates were studied. RESULTS: There were significant differences in day 3 FSH, oestradiol, antral follicle count, AMH and inhibin B levels before and after DHEA supplementation in all patients (p=0.001, 0.001, 0.002, 0.001 and 0.001, respectively). The study population was divided into two age groups (<35 and ≥35 years) to determine whether there was a difference in the effect of DHEA supplementation between younger and older patients with diminished ovarian reserve. Significant differences were found in all of the parameters in both study groups (p<0.05). CONCLUSIONS: DHEA supplementation is an effective option for patients with diminished ovarian reserve. Prior to assisted reproductive technology, patients with diminished ovarian reserve should be offered DHEA supplementation as an alternative to oocyte donation.

Evaluation of measurement uncertainty of glucose in clinical chemistry.

The definition of the uncertainty of measurement used in the International Vocabulary of Basic and General Terms in Metrology (VIM) is a parameter associated with the result of a measurement, which characterizes the dispersion of the values that could reasonably be attributed to the measurand. Uncertainty of measurement comprises many components. In addition to every parameter, the measurement uncertainty is that a value should be given by all institutions that have been accredited. This value shows reliability of the measurement. GUM, published by NIST, contains uncertainty directions. Eurachem/CITAC Guide CG4 was also published by Eurachem/CITAC Working Group in the year 2000. Both of them offer a mathematical model, for uncertainty can be calculated. There are two types of uncertainty in measurement. Type A is the evaluation of uncertainty through the statistical analysis and type B is the evaluation of uncertainty through other means, for example, certificate reference material. Eurachem Guide uses four types of distribution functions: (1) rectangular distribution that gives limits without specifying a level of confidence (u(x)=a/ radical3) to a certificate; (2) triangular distribution that values near to the same point (u(x)=a/ radical6); (3) normal distribution in which an uncertainty is given in the form of a standard deviation s, a relative standard deviation s/ radicaln, or a coefficient of variance CV% without specifying the distribution (a = certificate value, u = standard uncertainty); and (4) confidence interval.

Metastasis of prostate adenocarcinoma to testis.

Metastatic carcinoma to the testis is very rare. Metastasis of prostate adenocarcinoma to testis was detected incidentally after bilateral orchiectomy for hormonal management of metastatic prostate carcinoma. The metastatic lesion was not identified in physical examination or in macroscopic dissection of the testis after surgery. Microscopy revealed an adenocarcinoma which, given the history of the patient and a positive immunohistochemical stain for PSA, was identified as metastatic prostatic adenocarcinoma.

Diagnosis and treatment of renal hydatid disease: presentation of four cases.

Hydatid disease of the urinary tract is uncommon, accounting for only 2% to 1% of all hydatid diseases. We report 4 patients with hydatid cystic disease of the kidney. Nephrectomy was performed on 1 patient because of the destruction of renal parenchyma by the hydatid cyst. The other 3 patients were treated by cystectomy to preserve the normal renal parenchyma. In these cases, Casoni's intradermal test and indirect hemagglutination (IHA) test were not found to be helpful in the diagnosis, and eosinophilia was not significant. Diagnostic features of hydatid cysts were mixed echogenicity on ultrasonography, and multivesicular cyst with mixed density on computerized tomography (CT). CT was the most useful and specific investigation. No complications were noted during the first 3 months of the follow-up. Despite its rarity, hydatid disease should be considered in the differential diagnosis of space-occupying lesions of the urinary tract. Parenchyma-sparing surgery (cystectomy, partial nephrectomy) or nephrectomy are the main treatment modalities.

Fournier's disease: adjunctive hyperbaric oxygen therapy to classic therapy.

Fournier's disease is a very rare and highly fatal necrotizing fasciitis of genital and perineal tissues. Conventional treatment of Fournier's disease includes surgical debridement and antibiotic therapy. We describe a case of Fournier's disease where we added hyperbaric oxygen therapy to the conventional treatment regimen.

Ureteral injury during appendectomy.

A case is described of a patient whose right upper ureter had been injured during appendectomy. The defect was too long so we performed ileal substitution for ureter.