Efficacy of combination therapy with biofeedback and dapoxetine in lifelong premature ejaculation treatment: a prospective randomized study.

PURPOSE: Premature ejaculation (PE) is a common sexual dysfunction that significantly affects the quality of life of the patient and their partner. We aimed to compare the efficacy and safety of the combination therapy with biofeedback-guided pelvic floor exercise therapy (BFT) and dapoxetine 30 mg. METHODS: Sixty-five patients diagnosed with lifelong PE were included in the study. Patients were divided into three groups as BFT, dapoxetine 30 mg and a combination of BFT and dapoxetine 30 mg. The patients were compared with the intravaginal ejaculatory latency time (IELT) pre-treatment and post-treatment 1st and 3rd months. RESULTS: The mean IELTs of the patients in Group 1 were 40 s in pre-treatment, 115 s at the end of the 4th week and 140 s at the end of the 12th week. The IELT values of the patients in Group 2 were 40 s in pre-treatment, 145 s in the 4th week and 170 s in the 12th week. The IELT values were calculated in Group 3 as 42.5 s in pre-treatment, 185 s in the 4th week and 205 s in the 12th week When the IELT was statistically compared between the groups at 1st and 3rd months, the duration in the combination group was found to increase significantly (p < 0.001). CONCLUSION: Combination therapy with BFT and dapoxetine 30 mg in lifelong PE treatment is a good alternative with a low side effect profile and acceptable continuous efficiency.

Copeptin is a predictive biomarker of severity in acute pancreatitis.

BACKGROUND: Acute pancreatitis remains a common intraabdominal disease with a complex pathophysiology. The overall outcome has improved, but specific treatment remains elusive. The challenge is the early identification and treatment of patients who will develop severe acute pancreatitis. Therefore, the aim of the present study is to investigate plasma levels of copeptin in the initial phase of predicted severe acute pancreatitis. METHODS: Between August 2008 and December 2011, 57 patients with acute pancreatitis and 30 healthy individuals were included in the study. Four blood samples, for serum copeptin measurement, were taken from each individual in each group. The first measurement was taken from the admission blood sample. The subsequent 3 samples were taken at 12, 24, and 48 hours after the onset of pain. RESULTS: Copeptin plasma concentrations were significantly higher in patients with acute pancreatitis when compared with healthy controls. Copeptin plasma concentrations in severe pancreatitis patients were significantly higher than in mild pancreatitis patients. CONCLUSIONS: Copeptin plasma concentrations were significantly higher in patients with acute pancreatitis when compared with healthy controls. Copeptin plasma concentrations in severe pancreatitis patients were significantly higher than in mild pancreatitis patients.

Torsion of extraperitoneally transplanted kidney: an unusual complication.

Torsion of the extraperitoneally transplanted kidney is rare complication with no clinical data in the literature. The authors present the case of a 44-year-old man with end-stage renal disease who received a kidney transplant from his father. On postoperative day 4, serum urea and creatinine levels increased and urine output decreased. Renal ultrasonography revealed the renal hilum to be rotated to the lateral pelvic border, causing mild pelvocaliectasis, and Doppler ultrasonography, the patients showed a poststenotic flow pattern. After the patient underwent urgent reoperation, all laboratory values and ultrasonography findings returned to normal. To the authors' knowledge, this is the first published case report of torsion of the extraperitoneally transplanted kidney. When posttransplant deterioration in renal function occurs, renal torsion should be considered in the differential diagnosis.

Serum visfatin levels in acute appendicitis.

The clinical importance of the novel adipokine visfatin are still largely unknown. Our aim was to evaluate diagnostic accuracy of visfatin serum concentrations in Acute appendicitis(AA). Total of 34 patients with preoperative AA diagnosis (18 men and 16 women, mean age 28.8 +/- 10.9 years) were enrolled this study. The appendix specimens were classified as normal appendix (10 patients), acute appendicitis (24 patients). The serum levels of visfatin measured Diagnostic value of the preoperative serum visfatin levels as assessed through the corresponding ROC curve was well. (area under the curve [AUC] = 0.926, P < .001). In this small case series, visfatin level was found to be useful marker for diagnosis of AA.

A solid pseudopapillary tumour arising from mesocolon without ectopic pancreas.

A solid pseudopapillary tumour (SPT) is an uncommon pancreatic tumour. Very rarely it has also been described outside the pancreas, usually arising from heterotopic pancreatic tissue. In this paper, we described a case arising from the transverse mesocolon without heterotopic pancreatic tissue in an 18-year-old girl.

Risk factors for surgical site infection after gastrectomy with D2 lymphadenectomy.

Surgical site infection (SSI) is a potentially morbid and costly complication of surgery. We conducted this study to establish the preoperative and operative factors predisposing to SSI after gastric resection and D2 lymphadenectomy. Data on all patients undergoing gastrectomy and D2 lymphadenectomy within a 2-year period, at a tertiary reference hospital in Turkey, were collected retrospectively. The outcome of interest was a diagnosis of incisional SSI as defined by the Centers for Disease Control and Prevention. Multivariate analysis by stepwise logistic regression was then performed on those variables associated with incisional SSI. We identified 72 patients with SSI after gastrectomy and D2 lymphadenectomy. The median age of the patients was 61 years (range 31-81 years) and 43 were men. Incisional SSI was diagnosed in 15 (20.8%) patients. Of all the preoperative and operative variables measured, an increased patient body mass index was an independent predictor of incisional SSI. An increased incidence of SSI was found in overweight patients, but these infections were transient and not life threatening.

Activities of adenosine deaminase and 5'-nucleotidase in cancereous and non-cancereous human gastric tissues.

INTRODUCTION: Gastric cancer is still one of the most common fatal types of cancer in the world. The abnormalities in purine metabolism are a characteristic feature of many human tumors. Little is known about the correlation between the activities of key enzymes of purine nucleotide pathway and some clinical indicators of gastric cancer invasiveness and aggressiveness. METHOD: Seventeen (11 men, 6 women) patients with gastric cancer were admitted to the hospital. The activities of Adenosine deaminase (ADA) and 5'-nucleotidase (5'NT) in their cancerous and non-cancerous tissues were measured. RESULTS: 5'NT activities were significantly higher in cancerous tissues than in non-cancerous tissues. CONCLUSION: 5'NT activities increased in gastric cancer tissues but had no association with clinicopathologic findings (Tab. 2, Ref. 9). Full Text (Free, PDF) www.bmj.sk.

Peritoneal hydatidosis with ileus.

BACKGROUND: The parasitic infection hydatidosis or echinococcosis, is a parasitic infection caused most frequently by flatworm Echinococcus granulosus. Hydatidosis is endemic in Turkey where animal husbandry is common. Eventhough, Hydatid disease can develop anywhere in the human body it is most frequently occurs in the liver and then the lungs. Rupture of hydatid cysts into the peritoneal cavity, although rare, still presents a challenge for the surgeon. CASE: A 20-year-old man presented with ileus after 24 hours of mild abdominal distention, pain and nausea. On examination his abdomen was tender, with guarding and rebound tenderness and had a 3 cm long subcostal incision scar. All laboratory investigations were in the normal range. Exploratory laparotomy revealed multiple peritoneal cyst hydatid lesions with the largest measuring 10 cm in size and one also located in the right lobe of the liver. CONCLUSIONS: Rupture of hydatid cysts into the peritoneal cavity, although rare, still presents a challenge for the surgeon. This pathology should be included in the differential diagnosis of acute abdomen in endemic areas, especially in patients with a history of cyst hydatid (Fig. 1, Ref. 12). Full Text (Free, PDF) www.bmj.sk.

Is incidental Meckel's diverticulum resected safely?

AIM: Meckel's diverticulum (MD) is the most common congenital anomaly of the small intestine. The majority of MD cases are discovered incidentally. On the other hand, there is disagreement about the management of incidentally discovered asymptomatic MD. The aim of the study was to compare the clinicopathologic characteristics of incidentally found and symptomatic cases of MD, and to compare morbidity and mortality in symptomatic and asymptomatic patients. PATIENTS AND METHODS: Records of patients whose MD was resected at our institution between 1989 and 2004 were reviewed and 76 patients were found. The patients were divided into two groups. The incidental group included patients in whom the MDs were found incidentally during the course of laparotomy performed for reasons not related to the diverticular complications. The symptomatic group included patients who presented with complications related to the MDs. We compared the clinicopathologic characteristics of the patients between the two groups RESULTS: The incidental group included 40 patients (34 males) and the symptomatic group included 36 patients (30 males). There was no significant difference between the two groups with respect to age, gender, APACHE scores, postoperative complications, and hospital stay. There were two deaths in the symptomatic group. There was a significant correlation between operative mortality and APACHE II scores. CONCLUSIONS: Resection of incidentally found MD is not associated with increased operative morbidity or mortality.

Receiver operating characteristic analysis of leukocyte counts in operations for suspected appendicitis.

STUDY OBJECTIVE: There has been no clear-cut value of the white blood cell (WBC) count in differential diagnosis of acute appendicitis in emergency medicine. Therefore, the aim of this study was to assess the preoperative WBC counts in 3 groups of patients operated on for a clinical suspicion of acute appendicitis with different findings at appendectomy: uninflamed appendix, uncomplicated acute appendicitis, or complicated acute appendicitis. METHODS: The medical records of 540 patients who underwent appendectomy for suspected acute appendicitis during a 17-month period were retrospectively reviewed. Data for 3 groups of patients were analyzed to calculate the sensitivity and specificity of the WBC count in the diagnosis of acute appendicitis, and we calculated likelihood ratios for 2 cut-points with either high sensitivity or high specificity. Receiver operating characteristic curves were used to evaluate the WBC count in relation to the true diagnosis and severity of acute appendicitis. RESULTS: We were able to identify patients with appendicitis on a statistically significant level using receiver operating characteristic curves of WBC counts (area under the curve = 0.756, P < .001), but the WBC count had no diagnostic value in differentiating between uncomplicated and complicated groups (area under the curve = 0.55, P = .086). Likelihood ratio ranged from 1.79 (95% confidence interval, 1.17-2.3) for WBC count of more than 10,500 cells/mm(3) to 3.20 (95% confidence interval, 2.72-3.24) for WBC count of more than 14,300 cells/mm(3). CONCLUSION: White blood cell count is helpful in the diagnosis and exclusion of appendicitis. However, there is no value to differentiate advanced appendicitis.

Primary echinococcal cyst of the thyroid: report of a case.

A case of primary hydatid disease of the thyroid, a rare location, is presented. The patient was a 50-year-old woman who presented with a neck mass at the thyroid region, which was noticed 2 months before her presentation. Although the clinical impression was of a neoplastic lesion (adenoma or carcinoma), a hydatid cyst was considered intraoperatively and confirmed by a frozen section histology. It was completely removed. No other sites of hydatid disease were found and the patient remained well postoperatively. In patients with a solitary cyst in the thyroid, the possibility of hydatid disease, though rare, should be always kept in mind, because a needle aspiration biopsy is a potentially harmful procedure.

Can biliary-cyst communication be predicted before surgery for hepatic hydatid disease: does size matter?

BACKGROUND: The aim of this study was to determine if there is any predictive factor indicating the risk of bile leakage before surgery for hepatic hydatid disease in clinically asymptomatic patients. METHODS: The data of 116 patients who underwent surgery for hepatic hydatid disease were reviewed retrospectively. There were 43 men (37%) and 73 women (63%) with a mean age of 45 +/- 15 years. Because of high preoperative serum bilirubin and liver function test levels, 12 patients were excluded from the study. These patients underwent preoperative endoscopic retrograde cholangiopancreatography. In addition, 2 medically treated patients were excluded from the study. The following variables were analyzed as potential predictors of biliary-cyst communication: age, sex, physical examination findings, leukocyte count, liver function test results, and ultrasonographic cyst features (type, diameter, number, and localization). RESULTS: Bile leakage was detected in 24 out of 102 patients. There were no differences in age, sex, cyst type, alkaline phosphatase level, gamma-glutamyl transpeptidase level, alanine aminotransferase level, aspartate aminotransferase level, bilirubin level, and number of cysts and cyst locations between the patients with and without bile leakage. The mean cyst size in patients with biliary leakage was 10.2 cm as compared with 6.1 cm in patients with no biliary leakage (P < .05). When the cut-off value of cyst diameter was accepted as 7.5 cm, the specificity and sensitivity for biliary-cyst communication were 73% and 79%, respectively. CONCLUSIONS: These data suggest that cyst diameter is an independent factor that is associated with a high risk of biliary-cyst communication in clinically asymptomatic patients. Preoperative endoscopic retrograde cholangiopancreatography should be performed in these asymptomatic patients to reduce the incidence of postoperative complications.

External validation of prognostic models among cancer patients undergoing emergency colorectal surgery.

BACKGROUND: The aim of this study was to evaluate the predictive accuracy of different scoring systems on patients undergoing emergency colorectal surgery. METHODS: The Acute Physiology and Chronic Health Evaluation II or III, the Simplified Acute Physiology Score II, the Mortality Probability Model II, and the Colo-rectal POSSUM scoring systems were applied to 102 patients who underwent colorectal resection for cancer. Validation of scoring systems was tested by assessing calibration and discrimination. Calibration was assessed using Hosmer-Lemeshow goodness-of-fit test and the corresponding calibration curves. Evaluation of the discriminative capability of both models was performed using receiver-operating characteristic curve analysis. RESULTS: Overall, 17 deaths occurred. The Simplified Acute Physiology Score II showed good calibration (x(2) = 1.079, P = .982) and discrimination (areas under the receiver-operating characteristic curve .83). CONCLUSIONS: These data suggest that the SAPS II scoring system was accurate in predicting outcome for patients undergoing emergency colorectal surgery.