Double-blind, placebo-controlled, randomized clinical trial of sublingual or intramuscular piroxicam in the treatment of renal colic. A comparative study.

AIMS: To investigate the therapeutic effect of the fast-dissolving dosage form (FDDF) of sublingual piroxicam on renal colic compared with the intramuscular (IM) injection form of the same agent in a randomized, double-blind, placebo-controlled clinical trial. METHODS: 80 patients were assigned to one of two treatment groups: Group 1 received 40 mg piroxicam FDDF sublingual tablets and IM injection of 2 ml distilled water. Group 2 received an IM injection of 40 mg piroxicam and two sublingual tablets of placebo. At baseline and 30 min after the medication, vital signs were recorded and the pain intensity was evaluated by the patient using a numeric rating scale. RESULTS: The overall efficacy of the treatment was 90%. There was no significant difference with respect to the required rescue treatment (p = 0.328), pain relapse within 24 h (p = 0.434) and the decrease in vital signs and numeric rating scale in both groups (p > 0.05). CONCLUSION: The piroxicam FDDF tablet was found to be as effective as the IM injection form of the same agent in the treatment of renal colic. The FDDF is a good alternative to the parenteral form because of its earlier onset of action and ease of self-administration which increases patient compliance.

[The relationship between uretero-cloacal structure in birds and sigmoidorectal pouch surgery]. / Verwandtschaft zwischen der ureterokloakalen Struktur bei Vögeln und der sigmoidorektalen Pouch-Chirurgie.

PURPOSE: The present study was planned to investigate morphological, functional and histological properties of the natural ureterocloacal for in birds as well as to provide an appropriate information which may contribute to rectosigmoidal pouch surgery and to decrease its complications. MATERIALS AND METHODS: Thirty chickens (Gallus domesticus, 26 broilers, 4 layers) with a mean weight of 1870 +/- 88 g were used for this study. Histological and morphological evaluation of the cloaca was performed. Urethral reflux was estimated using X-rays. RESULTS: We found that the cloaca had three parts from cranial to caudal: coprodeum, urodeum and proctodeum respectively. A coprourodeal fold (CUF) between the coprodeum and urodeum and a uroproctodeal fold between the urodeum and proctodeum were detected. Settling of the muscle clusters both in the ureter and urodeum near the opening area appeared to be a strong sphincter structure and the ureters are opened to a structure covered by a transitional epithelium, which is similar to bladder in humans (connecting two identical epithelia). According to X-rays following the administration of a radio-opaque substance, there was no ureteral reflux in any of them. CONCLUSIONS: The natural urointestinal structure in birds has a spontaneous ureterointestinal anti-reflux opening. The coprourodeal fold that prevents the mixing of faeces and urine, inhibits the effects of increased pressure and prevents the reflux of urine to the upper segments is provided with many of desired hinders properties for urointestinal diversion.

Rectodynamic and radiological assessment in modified mainz pouch II cases.

OBJECTIVE: To evaluate the radiologic findings and to measure the pressure changes in a modified sigmoidorectal pouch (Mainz pouch II procedure). METHODS: A total of 26 patients who had a radical cystectomy because of muscle-invasive bladder tumor underwent a Mainz pouch II procedure between 1993 and 1998. The differences from the original definition was a reverse ureteral anastomosis and a detubularized segment at least 30 cm in length. In all cases, sigmoidoscopy was done and sigmoidal pressure and capacity were measured preoperatively and at the 3rd and 6th months postoperatively besides the colon X-rays. The 24-hour pouch pressure changes called 'natural pouch pressure' was measured using a handmade system with a central venous pressure (CVP) manometer at the 3rd month postoperatively. RESULTS: Preoperative colon X-rays showed a passage of opaque substance through the descending colon at an average volume of 150 ml (average sigma capacity), whereas postoperative anteroposterior and oblique pouch X-rays showed no passage up to an average volume of 520 ml (270-650) though the descending colon. The sigmoidal colon pressure that was on average 20 cm H(2)O at the preoperative evaluation was measured as 6 cm H(2)O at the 3rd month and 6.5 cm H(2)O at the 6th months during the postoperative period. 24 hour natural pouch pressure was found to be 8.7 cm H(2)O on average while the pressure was found to be 13.8 cm H(2)O on average when the patient felt abdominal discomfort, in other words the desire to defecat (miction). CONCLUSIONS: A modified sigmoidorectal pouch procedure not only provides a reservoir with a higher capacity and lower pressure without a reflux to the upper urinary tract and descending colon with lower metabolic acidosis problem, but it is also a good alternative diversion procedure that whould be preferable especially in Muslim countries as it does not cause any difficulties in terms of Islamic worship.

Effect of long-term sitting on serum prostate-specific antigen levels.

OBJECTIVE: The aim of this study was to evaluate the effect of long-term sitting on serum prostate-specific antigen (PSA) levels. METHOD: The serum PSA levels of 50 bus drivers under the age of 45 (mean 37.7) years who worked at least 8 h a day for more than 3 weeks were compared with those of 50 healthy surgeons in similar age groups (mean 37.7 years) who spent most of their working time standing. RESULTS: There was no statistically significant difference between the mean PSA level of the study group (1.211 +/- 0.96 ng/ml) and that of the control group (1.214 +/- 0.74 ng/ml; p > 0.05). The PSA levels returned to normal after a 5-day resting period in cases who had higher values than the anticipated 2.5 ng/ml for this age group at the initial determination. CONCLUSIONS: These results suggest that there is no relationship between long-term sitting and serum PSA levels. A second PSA determination after a 5-day resting period may be helpful in cases with higher than normal initial values.

Reiter syndrome following intracavitary BCG administration.

BCG vaccine was given intravesically to a patient with bladder tumour. After the fifth dose she developed bilateral conjunctivitis, painful swelling in her wrist, dysuria and arthritis in her left knee and right metacarpophalangial joints. The diagnosis was Reiter syndrome and is the second case in the literature.

Penile fractures and our treatment policy.

To evaluate our diagnosis and treatment policy of penile fractures, we reviewed 13 cases treated between August 1992 and August 1995. In ten patients early surgical correction, in one patient an elective surgical intervention was carried out. Two patients with minimal haematoma were suggested to undergo conservative treatment, but only one of them came to the control examination and he complained of fixed induration, pain and mild deviation in erection. In the group of early surgical repair there was no complication. In a patient who had had a delayed procedure small induration and minimal deviation were found. In the light of these findings we think that in penile fractures early surgical repair produces the best results.

Transurethral ureteroscopy: is local anesthesia with intravenous sedation sufficiently effective and safe?

OBJECTIVE: To evaluate the effectiveness and safety of local anesthesia and sedation in ureteroscopic interventions and to compare the results with other kinds of anesthesia. METHODS: 107 ureteroscopic interventions have been done to 99 renoureteral units involving 77 patients under different kinds of anesthesia. RESULTS: 45 of 107 procedures were performed under general anesthesia, 11 under spinal/epidural anesthesia, and 51 using local anesthesia and intravenous sedation. The overall success rate was 90%. The failure rate was 18% for the procedures undertaken using local anesthesia. CONCLUSION: Local anesthesia in ureteroscopic interventions may be considered as a first choice because of almost similar success rates to other kinds of anesthesia: is has a low morbidity and low cost.

Comparison of an extrusion procedure and eversion procedures in the treatment of hydrocele.

In a prospective randomized study, the "extrusion" operation modified by McGowan Jr. and Howley and the conventional "eversion" operations were compared with each other in terms of early and late postoperative complications in the treatment of idiopathic scrotal hydrocele. As early complications with the "extrusion" procedure a total of 4 (11.4%) cases were seen: 3 oedemas and 1 epididymitis; and with the "eversion" procedures there were 18 (51.4%) early complications: 3 haematomas, 12 oedemas and 3 wound infections (11.4 vs. 51.4%, p < 0.05). In the late ones 1 recurrence and permanent testicular pain were seen with the "extrusion" procedure.

Definition and treatment of chordee without hypospadias: a report of 5 cases.

The controversies in chordee without hypospadias are mostly focussed on the definition and treatment of type I and type IV chordee. In this respect we believe that surgical exploration is necessary to make a precise classification leading to the most appropriate therapy. We present 5 cases, 3 of which had type I chordee, 1 had type II and 1 had type III. In the 2 cases with type I chordee, type IV chordee coexisted. Although all the patients have had satisfactory cosmetic results, 3 of them should be reevaluated after puberty since they are prepubertal yet.

A report on extracorporeal shock wave lithotripsy results on 1,569 renal units in an outpatient clinic.

We report our experience with extracorporeal shock wave lithotripsy (ESWL*) treatment of 1,569 renal units in an outpatient clinic with a small focused piezoelectric lithotriptor. A stone-free rate of 93% was achieved. In 3.6% of the patients, mainly those with a history of surgery and/or anatomical caliceal deformations, fragments smaller than 3 mm. in diameter remained despite multiple ESWL sessions and intensive upside down physiotherapy. Of the cases 3.4%, including those without sufficient data, were considered unsuccessful. We treated 58 renal units in children 14 years old and younger, 55 patients had a single kidney and 7 had a horseshoe kidney.

Long-term follow-up results of the MAGPI (meatal advancement and glanuloplasty) operations in distal hypospadias.

Between 1985 and 1989, 54 boys underwent a MAGPI procedure. Excellent cosmetic and functional results were achieved in 94% of our cases in the early period. In order to assess the long-term results of this procedure, 41 boys attended long-term re-evaluation between 6 and 40 (mean 29) months postoperatively. MAGPI was a very satisfactory procedure for micturition function. We observed in 22% of cases partial and in 15% complete regression. On the long term, excellent cosmetic results were achieved in all glanular cases but in only 65% of coronal and 15% of subcoronal cases. We believe that the MAGPI procedure is not a suitable operation for subcoronal hypospadias.