The effects of dexmedetomidine on biomarkers of oxidative stress and antioxidants in kidney.

BACKGROUND AND AIM: Cerebral ischemia not only disrupts brain functions, but also damages other organs. We aimed to determine whether two different doses of dexmedetomidine (DEX) had protective effects against the oxidative damage to kidneys. MATERIALS AND METHODS: Forty-two rats were equally divided into 7 groups. The first group was the control group. Second group members were operated to expose the cerebral artery without inducing cerebral ischemia. The third and fourth groups were DEX treatments groups. The fifth, sixth and seventh group were operated to induce cerebral ischemia. DEX was given to the groups at the 3rd, 24th and 48th hour. RESULTS: MDA levels in the kidneys were higher in the group with cerebral ischemia. Significant reductions in MDA levels were observed after treatment with DEX in the ISCH group (p < 0.05). Decreased GSH-Px activity and reduced glutathione GSH levels in the kidneys were observed with DEX treatments. After treatment, there was a significant increase in α-tocopherol and ß-carotene levels (p < 0.01). CONCLUSION: DEX administration during cerebral ischemia had a positive effect on oxidative stress and antioxidants in rat kidney (Tab. 1, Fig. 5, Ref. 31).

Implantation of fiducial markers for image guidance in prostate radiotherapy: patient-reported toxicity.

The purpose of this study was to evaluate patient-reported morbidity of implanted fiducial markers used for image guidance in prostate radiotherapy. Three fiducial markers were implanted under transrectal ultrasound guidance to 177 patients who were referred to our department for definitive radiotherapy between June 2005 and January 2008. No local anaesthesia was administered. Patients were asked to complete a questionnaire about the possible side effects of this invasive procedure. 135 patients completed the questionnaire at a median of 57 weeks after the procedure. Pain during the procedure was assessed with the Wong-Baker Faces Pain Rating Scale. Patients were also asked to compare the pain with the diagnostic biopsy. Although haematuria, rectal bleeding and fever were reported by 15%, 4% and 2% of the 135 patients, respectively, no major toxicity necessitating any intervention was observed. The mean pain score reported by the patients was 1.7 (range, 0-5). 87% of patients reported less (or comparable) pain than the diagnostic biopsy. In conclusion, implantation of fiducial markers for image guidance in prostate radiotherapy is a safe and well-tolerated procedure.

Serum leptin levels in patients with liver cirrhosis and chronic viral hepatitis.

BACKGROUND: The aim of the present study was to investigate serum leptin levels in relation to anthropometric features in patients with liver cirrhosis (LC) and chronic viral hepatitis (CVH), and to determine the effect of the severity and aetiology of the LC on serum leptin levels. METHODS: Forty-nine patients with LC, 32 patients with CVH and 69 control subjects were age, body mass index (BMI) and sex-matched and included in the study. Plasma glucose, serum leptin and insulin levels were determined. Insulin resistance was assessed using homoeostasis model assessment (HOMA). Body composition was estimated by skinfold thickness. RESULTS: Female patients with Child-A LC had higher levels of leptin, and female and male patients with Child-A LC had higher absolute leptin (leptin/BFM) levels compared to patients with Child-C LC and control subjects. Serum leptin levels of the patients with alcohol LC were higher than the control subjects, but the absolute leptin levels were comparable. When alcoholic and post-viral hepatitis cirrhotic patients were compared with each other on an aetiologic basis, there was no significant difference between them in leptin and absolute leptin levels. There were significant correlations between leptin and BMI, body fat percentage (BFP), BFM (body fat mass) in all three groups in both sexes. CONCLUSIONS: These data suggest that the physiologic correlations among serum leptin level, sex, BMI and BFM were well preserved in patients with chronic liver disease. Patients with alcohol LC had higher leptin levels. In early stages of liver disease, leptin levels and absolute leptin levels are higher than in normal subjects. However, in advanced stages of the disease the significant decline in leptin levels and similar levels of leptin expressed in relation to BFM compared to control subjects predominantly represent the expression of fat mass.

Removal of urolume endoprosthesis using holmium:YAG laser.

A potential complication of UroLume endoprosthesis is migration, which may necessitate removal of the stent. Stent removal may be associated with complications such as urethral injury, bleeding, and external sphincter trauma. We report a patient in whom a holmium:yttrium-aluminium-garnet (Ho:YAG) laser was used to cut the UroLume endoprosthesis into fragments, which led to easy and uneventful stent removal.

Somatostatin and ranitidine in the treatment of non-variceal upper gastrointestinal bleeding: a prospective, randomized, double-blind, controlled study.

BACKGROUND/AIMS: The aim of this study was to compare the efficacy of somatostatin vs. ranitidine in controlling acute non-variceal gastrointestinal bleeding. METHODOLOGY: A total of 48 patients with acute upper gastrointestinal bleeding due to duodenal or gastric ulcer were divided into 2 groups. Group I consisted of 15 patients with Forrest IB and Group II consisted of 30 patients with Forrest II. Two regimens were randomly allocated to all patients within half an hour after the endoscopic procedure: 1) somatostatin-UCB 250 mcg i.v. bolus followed by continuous i.v. infusion at a rate of 6 mg/d for 72 h, or 2) ranitidine 300 mg/d by continuous i.v. infusion for 72 h. RESULTS: In Group I, although mean blood transfusion requirements (no. of units) were lower in patients treated with somatostatin than in those treated with ranitidine, this was not statistically significant (mean +/- SD: 2.56 +/- 3.05 vs. 5.17 +/- 4.96, respectively; P > 0.05); the time of bleeding stop was shorter in the somatostatin group than in the ranitidine group (mean +/- SD: 3.24 +/- 2.45 vs. 11.25 +/- 11.63, respectively; P = 0.0383). The rebleeding and the mortality rates did not differ between the treatment groups in both Group I and Group II. CONCLUSIONS: Somatostatin is more effective than ranitidine in controlling acute non-variceal gastrointestinal bleeding in patients with Forrest IB bleeding activity. Somatostatin has no additional benefit in those with Forrest II bleeding activity.

Mirizzi's syndrome: diagnostic and surgical considerations in 25 patients.

Mirizzi's syndrome is a rare complication of long-standing cholelithiasis. Many surgical approaches of varying complexity have been advocated for treatment. However, the distorted extrahepatic biliary anatomy continues to be threatening, with a high risk of biliary complications. Presented here is a series of 25 patients with Mirizzi's syndrome who were treated at the Dokuz Eylul University Hospital since 1985. Type I lesion (without cholecystocholedochal fistula) was encountered in 11 patients, while the remaining 14 had type II lesions (with cholecystocholedochal fistula). Preoperative diagnoses were made in 14 of the 25 patients (56%). Follow-up in 17 patients ranged from 1 to 96 months (mean, 40 months). Unfortunately, the remaining 8 patients were lost to follow-up after discharge. The morbidity rate in our series was 32%, while no mortality was encountered. During long-term follow-up, no biliary stricture was diagnosed. Following an uneventful postoperative course, all of our patients are symptom-free and doing well, with normal liver function. We conclude that partial cholecystectomy alone is a safe and sound surgical approach for the treatment of type I lesions. For type II lesions, depending on the size of the fistula, either primary closure over a T-tube, or bilio-digestive anastomosis, preferably Roux-en-Y, can be an appropriate treatment modality, with a low morbidity rate.

Long-term results of Burch colposuspension.

BACKGROUND: We aimed to determine the long-term results of Burch colposuspension. METHODS: Patients who had undergone Burch colposuspension due to stress urinary incontinence (SUI) in our department between 1991 and 1995 were asked to participate in the study by telephone or mail. Fifty of 78 patients (64%) responded and these formed the study group. Patients were evaluated by a detailed questionnaire, pelvic examination, uroflowmetry and postvoid residual urine determination. Provocative stress test and urodynamic evaluations were performed in those who claimed leakage. Additionally, follow-up charts were retrospectively reviewed from the patients' files. RESULTS: Mean follow-up time was 50.6 months. The subjective cure rate was 52% and the surgical success rate was 84%. The patient satisfaction rate in terms of incontinence was 86%. No correlation was found between pre-operative patient characteristics (i.e. age, number of vaginal deliveries and pregnancies, menopause, previous anti-incontinence surgery and presence of detrusor instability) and outcome of surgery. Although no patient was performing clean intermittent catheterization in the long term, two patients had significant residual urine and obstructive flows. Three patients had severe pelvic prolapse that required surgical correction. CONCLUSIONS: Our results indicate that Burch colposuspension operation is an effective and durable choice of treatment with low complication rates for the treatment of SUI.

Serum concentrations of insulin-like growth factor-I and insulin-like growth factor binding protein-3 in patients with chronic hepatitis.

BACKGROUND: Insulin-like growth factor-I is a liver-derived humoral factor, which has important anabolic and metabolic actions and is predominantly bound by insulin-like growth factor binding protein-3. Low serum concentrations of both insulin-like growth factor-I and insulin-like growth factor binding protein-3 have been reported in patients with chronic liver disease, especially cirrhosis, but their conditions in chronic hepatitis are uncertain. The aim of this study was to evaluate the effect of chronic hepatitis on serum concentrations of insulin-like growth factor-I and insulin-like growth factor binding protein-3 and their association with hepatic inflammation activity and fibrosis. METHODS: Serum insulin-like growth factor-I and insulin-like growth factor binding protein-3 were measured by RIA (ng/ml) in 17 patients with mild to severe chronic viral hepatitis (12 chronic hepatitis C, 5 chronic hepatitis B) and 16 healthy subjects. The hepatic inflammation activity and the severity of fibrosis were evaluated using Desmet classification. RESULTS: Both insulin-like growth factor-I and insulin-like growth factor binding protein-3 levels did not correlate with inflammation activity, fibrosis or transaminase levels. In the chronic hepatitis group, insulin-like growth factor-I levels were significantly higher than the control group (mean, 263.8 +/- 27.33 versus 127.14 +/- 10.83 ng/ml, P < 0.001, respectively), whereas insulin-like growth factor binding protein-3 levels were significantly lower when compared with the controls (1643.47 +/- 60.68 versus 2728.87 +/- 284.61 ng/ml, P < 0.05, respectively). CONCLUSIONS: These results suggest that the concomitant states of serum insulin-like growth factor-I and insulin-like growth factor binding protein-3 levels in patients with chronic hepatitis may be different from cirrhotic patients and high serum IGF-I levels may be a specific finding of the stage of chronic hepatitis before developing cirrhosis.

Endoscopic sphincterotomy in the management of biliary leakage after partial hepatectomy.

We present the case of a 22 year-old man with biliary leakage caused by partial hepatectomy. He was successfully treated with endoscopic sphincterotomy alone.

Bladder involvement in Behçet's syndrome.

PURPOSE: We report our clinical experience with Behçet's syndrome and bladder involvement. MATERIALS AND METHODS: From April 1991 through July 1996, 7 men and 1 woman 25 to 53 years old with Behçet's syndrome were evaluated for lower urinary tract symptoms (7) or hematuria (1). Of 8 patients 5 had neurological involvement. Evaluation consisted of history, physical examination, urinalysis and urine culture, excretory urography, urodynamic studies, urethrocystoscopy, bladder biopsies and histopathological examination. RESULTS: Cystoscopy revealed bladder ulcer in 1 patient and an indurated, hypervascular lesion in another with bilateral hydronephrosis. The most common urodynamic finding was detrusor overactivity. Of 4 patients with poor compliance 1 had additional sphincteric deficiency. Common histopathological features were moderate and marked thickening of bladder vessel walls. Lymphocytic vascular reaction was present in 2 patients and lymphocytic vasculitis in 1. Clamshell augmentation ileocystoplasty was performed in 3 patients, including 1 who also underwent a sphincter enhancement procedure. The remaining 5 patients received various nonsurgical treatment. CONCLUSIONS: Various types of voiding dysfunction relating to bladder and sphincteric components in both phases of micturition can be seen in Behçet's syndrome. Voiding dysfunction can be due to either neurological or direct bladder involvement. Augmentation ileocystoplasty is a good treatment option for Behçet's syndrome with severe bladder involvement.

The efficacy of interferon alpha on colchicine-resistant familial Mediterranean fever attacks: a pilot study.

About a quarter of familial Mediterranean fever (FMF) patients have recurrent painful attacks of polyserositis despite regular colchicine treatment. There is no known alternative drug for colchicine-resistant cases. We had previously observed a patient with FMF whose painful attacks disappeared during the 6 month period of interferon alpha (IFN) treatment for his chronic hepatitis B. The objective of the present study was to investigate the possible beneficial effect of IFN on these episodes. Twenty-one consecutive attacks in seven adult patients with FMF were treated at early onset with IFN, the dosage being 3-10 million I U s.c. Eighteen of the 21 attacks could be halted in a mean time of 3.05 h, while the intensity of abdominal pain remained very low. Observed side-effects were generally mild and acceptable. IFN may be a useful adjunct for the treatment of colchicine-resistant attacks in FMF patients.

Superficial dorsal penile vein thrombosis (penile Mondor's disease).

In our center between 1992 and 1994 penile Mondor's disease (superficial dorsal penile vein thrombosis) was diagnosed in 5 patients aged 20-39 years. In all patients the thromboses were noted 24-48 hours after a prolonged sexual act with or without an intercourse. the main symptom was a cord-like thickening of the superficial veins, which were painless or slightly painful. Doppler examination of the superficial dorsal vein revealed obstruction of the vessels. In 2 patients the retroglandular plexus was also involved. Patients were treated with anti-inflammatory medications (Tenoxicam or Ibuprofen). The resolution of the thrombosis occurred uneventfully within 4-6 weeks. No recurrence or erectile dysfunction was noted in any of the patients. Penile Mondor's disease is a benign pathology of the superficial dorsal penile vein and should be taken into account in the differential diagnosis of penile pathologies.