Er:YAG laser in hysterectomized women with stress urinary incontinence: a VELA retrospective cohort, non-inferiority study.

Objective: To test whether the erbium-doped yttrium aluminum garnet (Er:YAG) SMOOTH® laser treatment efficacy on stress urinary incontinence (SUI) in hysterectomized patients is non-inferior to its efficacy in non-hysterectomized patients.Methods: In this real-world, retrospective cohort study performed in Turkey, Croatia and Italy, we enrolled a consecutive sample of 35 hysterectomized and 34 non-hysterectomized patients with SUI. We used the Er:YAG SMOOTH® laser (Fotona, Slovenia) with a wave length of 2940 nm. The primary outcome was median reduction of SUI symptoms measured by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short-Form (ICIQ-SF) with the non-inferiority margin defined as the minimum clinically important difference of ICIQ-SF (δ < 2.52 points).Results: In hysterectomized patients, the ICIQ-SF was reduced by 5 points (95% confidence interval 3-8; p < 0.001), a reduction of 45% (95% confidence interval 36-67%). After adjustment for baseline ICIQ-SF and five covariates, the reduction of symptoms in the hysterectomized group was not inferior to the reduction in the non-hysterectomized group.Conclusion: The Er:YAG SMOOTH® laser treatment seems to improve the symptoms of SUI in hysterectomized women not clinically relevantly less than in non-hysterectomized women. It seems that the beneficial effect of Er:YAG SMOOTH® laser treatment for SUI in hysterectomized women is time-limited.

Critical current density and flux pinning in BaFe1.9Pt0.1As2 and La doped Ba0.95La0.05Fe1.9Pt0.1As2 polycrystals.

We present the field and temperature dependence of the magnetizations of BaFe1.9Pt0.1As2 and Ba0.95La0.05Fe1.9Pt0.1As2 samples synthesized by solid-state reaction method. The samples were formed as a single phase in the ThCr2Si2-type structure. Replacing Ba with the smaller La atom results in a lattice shrinkage. The critical current, J c (H, T) has been determined (using Bean's critical state model) from magnetic hysteresis loops in a temperature range between T = 5 K and the superconducting transition temperatures (20 K), in fields up to H = 9 T. We find a nonmonotonic 'fishtail' shape (exhibiting a second peak) of the magnetization loops as well as a very large irreversibility. We observe a remarkable flux jump at T = 5 K for BaFe1.9Pt0.1As2 due to magneto-thermal instability, but a very sharp magnetization peak for Ba0.95La0.05Fe1.9Pt0.1As2 near H = 0, which corresponds to a much-reduced relaxation rate of vortices. J c decreases exponentially with temperature as well as with field in lower temperatures and fields ranges. La doping causes a considerable increase in the irreversibility, leading to a significant enhancement of J c. The analysis shows that the high J c is mainly due to collective (weak) pinning of vortices by dense microscopic point defects with some contribution from a strong pinning mechanism. The normalized pinning force F p/F p,max as a function of the reduced magnetic field h = H/H irr is also obtained. Using the approaches of Dew-Hughes (1974 Phil. Mag. 30 293) and Kramer (1973 J. Appl. Phys. 44 1360), we determine the nature of the pining sources. It is found that many different pinning mechanisms are active simultaneously. The modified expression of F p/F p,max based on collective pinning theory enables us to determine the field dependence of the relaxation rate S(H, T = 5 K) indirectly instead of using more difficult relaxation measurements. Finally, all drastic changes with La doping are clearly demonstrated and investigated under different models introduced in the literature.

Research on Toxocara canis antibodies obtained from patients with eosinophilia.

BACKGROUND: Eosinophils may suggest the presence of a great variety of anomalies whereupon allergies, malignancies, certain tissue disorders, idiopathic hypereosynophilic syndrome and parasitic infections (with the exception of protozoons) can be cited as a few. Although the clinical manifestations may differ, the eosinophils level is quite an important data in cases related to the helminth infections. Similarly, in parasitic infections related to larva migrans (visceral, cutaneous, ocular), the eosinophils level is again a primary indicator and its evident cause is the roundworm Toxocara spp. AIM: The aim of this study was to evaluate the significance characteristics of Toxocara spp. in patients with eosonophilia. MATERIALS AND METHODS: In our study, serums were collected from 93 patients of various age groups with eosonophilia (10% and above) while visiting Istanbul University Medical Faculty due to various complaints. RESULTS: Serum samples were treated with Toxocara IgG ready ELISA kit and Toxocara western blot IgG ready kit. Based on the ELISA method; out of 93 patients, 30 patients (32.3%) were positive. Western blot technique; 45 (48.4%) were positive with anti-toxocara IgG antibodies. CONCLUSION: Results point out to western blot technique being more sensitive and superior on a scale of (P < 0.0001) when compared with the ELISA method.

Recurrent Transient Ischemic Attacks in a Patient with POEMS Syndrome.

A 47-year-old female with a prior history of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome was admitted with transient ischemic attacks complicated by dysarthria and right-sided hemiparesis. A blood survey indicated thrombocytosis and hyperfibrinogenemia while imaging of intracranial vasculature showed occlusion of the bilateral middle cerebral arteries. POEMS syndrome, of which arterial thromboses have been mentioned as a manifestation, is rarely accompanied by transient ischemic attacks. The pathophysiologic mechanism is yet unclear and needs further investigation.

A rare case of urinary schistosomiasis in Turkey.

Schistosomiasis is a chronic, parasitic disease and is endemic in some countries, primarily in Africa, Latin America and Asia. In some regions, Schistosoma haematobium is one of the principal causes of haematuria. In Turkey, due to the increasing amount of travel to and from endemic regions, the number of cases is also rising. We report a case of a 22-year-old Nigerian male who was admitted to our hospital with haematuria. Direct microbiological examination revealed S. haematobium eggs in his urine specimen. Schistosomiasis was diagnosed by pathology testing. Schistosomiasis has not been seen frequently in Turkey, and we therefore discuss the epidemiology, treatment options and clinical importance of S. haematobium.

[Strongyloidosis caused Loeffler's syndrome in an immunosuppressed patient who uses cronic steroid]. / Kronik Steroid Kullanan Immunsuprese Hastada Strongyloidoza Bagli Loeffler Sendromu.

Strongyloides stercoralis is an intestinal nematode of humans that infects tens of millions of people worldwide. It is a rarely reported parasitic infestation in Turkey. Disseminated strongyloidiosis may develop in patients with immunodeficiencies. S. stercoralis hyperinfection is often accompanied by sepsis or meningitis with enteric organisms. Glucocorticoid treatment is one of the conditions most specifically associated with triggering hyperinfection, but cases have been reported in association with hematologic malignancy, malnutrition, and AIDS. Anthelminthic agents such as ivermectin have been used successfully in treating the hyperinfection syndrome. We report a case of Strongiloides stercoralis infection and Loeffler syndrome that developed in a patient who had systemic prednisolone. The patient in the pulmonary disease department clinic was examined because of right lung upper lobe mass image, and referred to us with complaints of abdominal pain, diarrhea and pruritus. Peripheral smear showed 43% eosinophilia. Parasitological examination of faeces showed larvae of Strongyloides stercoralis. Parasitosis and Loeffler's syndrome was considered in the patient. The patient's complaints declined significantly after treatment with albendazole.

The diagnostic value of Western blot method in patients with cystic echinococcosis.

Cystic echinococcosis (CE) is the larval cystic stage (called echinococcal cysts) of a small taeniid-type tapeworm (Echinococcus granulosus). Carnivores such as dogs are usually definitive hosts. Intermediate hosts are typically herbivores such as sheep and cattle. CE can be detected using various imaging techniques such as ultrasonography or radiology. Moreover the primary diagnosis has to be confirmed by serological tests since the clinical signs of the disease are non-specific. This study examined the antigenic band patterns useful for serologic diagnosis of hydatidosis. We also report on the post-operative evolution of patients treated for this disease and also determined the diagnostic performance of Western blot IgG kit. Twenty-five (16 females and 9 males) non-operated patients with hydatid cysts (NOP) and 33 (21 females and 12 males) operated patients with hydatid cysts (OP) were included as study group and 22 healthy individuals (14 females and 8 males) with no known chronic diseases were included as a control group. The ages of the patients and control group individuals were between 16-83 years. Patient and control groups were matched for age and sex. Cyst hydatid IgG antibodies were detected in the sera from all patient groups but no antibodies were found in the sera from the control group using ELISA IgG method. Twenty-three (92%) non-operated patients and 18 (54.5%) operated patients exhibited positive results when Western blot IgG kit was used. The P7 band pattern was detected in the sera from all operated and non-operated patients. Twenty-seven of these positive cases had p7 and (p7+p16/18), (p7+p24/26) or (p7+p16/18+p24/26). No antibodies against p7, p16/18 ve p24/26 band patterns were seen in sera from the control group A statistically significant difference was detected between operated and nonoperated patients for Western blot positivity.(p<0.01). p: 0.018- X2=5,604- OR: 0.176- 95% CI: 0.037- 0.841. The sensitivity, specificity, positive prediction and negative prediction values of Echinococcus granulosus Western blot kit for 25 cases with CE and 22 healthy controls were calculated as 92%, 100%, 100% and 91.7%, respectively. In conclusion, we suggest that monitoring p7 in all non-operated patients may be useful to determine the efficiacy of medical treatment and that monitoring p7 antibodies using serological and Western blot methods in operated patients may be useful for the screening of post-operative evolution in patients with hydatid cyst.

Prion protein gene (PrP) polymorphisms in healthy sheep in Turkey.

Scrapie, a transmissible spongiform encephalopathy (TSE) or prion disease, is a fatal, neurodegenerative disease in sheep and goats. This disease has been known in Europe for more than 250 years. Susceptibility to scrapie is associated with polymorphisms in the sheep prion protein gene (PrP) gene. In sheep, polymorphism in the PrP gene has been identified at a number of codons, and polymorphisms at codons 136, 154 and 171 have reported linkage with susceptibility to scrapie. Polymorphisms at the PrP locus were studied in 413 animals representing three native sheep breeds (Imroz, Chios and Kivircik) in Turkey. Genomic DNA was obtained from blood, and genotypes were screened using PCR and direct DNA sequencing. We report 17 genotypes derived from seven different alleles. The most frequent genotype in the Kivircik sheep is ARQ/ARQ, whereas the ARR/ARQ genotype is predominant in the Chios and Imroz breeds. In general, the ARQ haplotype was the predominant haplotype. ARQ haplotype was also predominant in the Kivircik and Chios sheep breeds, whereas the Imroz sheep predominantly had the ARR haplotype. The susceptibility-associated VRQ haplotype was found in 2.38%, 0.35% and 0.81% of the Imroz, Kivircik and Chios sheep, respectively. Moreover, seven additional polymorphisms have been detected at codons G127S, G127V, H143R, G145S, Y172D, N174Y and Q189L. Among these polymorphisms, the N174Y allele is a novel polymorphism, and the G145S allele is a novel allele for a known polymorphic locus.

Vascular loops at the cerebellopontine angle: is there a correlation with tinnitus?

BACKGROUND AND PURPOSE: Tinnitus is a common disorder, and the etiology remains mostly unclear. The purpose of this study was to investigate the causative effect of the vascular loop and compression of the vestibulocochlear nerve at the cerebellopontine angle in patients with unexplained tinnitus. MATERIALS AND METHODS: This study was approved by our institutional review board. Written informed consent was obtained from all participants. Fifty-eight patients with unexplained tinnitus and 44 age- and sex-matched asymptomatic controls were examined with temporal MR imaging. Besides the tinnitus and control groups, a third group was formed by asymptomatic sides of patients with unilateral tinnitus. A 3D fast imaging employing steady-state acquisition (3D-FIESTA) sequence was performed in addition to the regular pre- and postcontrast axial and coronal sequences. The anatomic type of vascular loop, the vascular contact, and the angulation of the vestibulocochlear nerve at the cerebellopontine angle (CPA) were evaluated by 2 experienced neuroradiologists. The chi(2) test was used for statistical analysis. RESULTS: No statistically significant differences were found between the patient and control groups for the anatomic type of vascular loop, the vascular contact, and the angulation of the vestibulocochlear nerve at the CPA (P > .05). CONCLUSION: Although 3D-FIESTA MR imaging correctly shows the anatomic relationships of the vestibulocochlear nerve, its vascular compression cannot be attributed as an etiological factor for tinnitus.

An unusual case of biliary obstruction caused by Dicrocoelium dentriticum.

Dicrocoelium dentriticum (D. dentriticum) is a liver fluke induced biliary obstruction. Infection usually occurs in herbivores such as sheep, goats and deer; human infection is very rarely encountered in clinical practice. We report on a 65-y-old female presenting with biliary obstruction caused by D. dentriticum. Following treatment with triclobendazole, her symptoms disappeared, and laboratory values returned to normal range within 6 months. Parasitosis is an important cause of biliary obstruction. We suggest that for patients presenting with biliary obstruction, D. dentriticum should be included in the differential diagnosis.

Do procalcitonin and C-reactive protein levels have a place in the diagnosis and follow-up of Helicobacter pylori infections?

The aims of this study were to determine the levels of procalcitonin (PCT) and C-reactive protein (CRP) in Helicobacter pylori-positive (HP+) patients diagnosed with duodenal and gastric ulcer and to evaluate the correlation of PCT and CRP levels with other invasive and non-invasive diagnostic methods for determination of H. pylori eradication in post-treatment follow-up. Thirty-five HP+ patients with dyspepsia were included in this study. Serum samples (5 ml) were collected at admission and after 24 h. Antimicrobial therapy (omeprazole, amoxycillin and clarithromycin) was given for 1 week to HP+ patients who were positive only by culture or by urease test plus pathology. After 1 month, serum samples (5 ml) were collected again and culture, urease and pathology investigations were performed on endoscopic samples. PCT and CRP levels were measured in the collected blood samples. Thirty-five H. pylori-negative (HP-) cases with dyspepsia, 38 cases with bacteraemia and 35 healthy blood donors were included in this study as control groups. The mean and minimum-maximum levels of PCT were 1.39 (0.25-6.75), 0.35 (0.12-0.71), 7.45 (0.68-51.5) and 0.40 (0.12-0.71) ng ml(-1) for the groups of HP+, HP- and bacteraemia patients and healthy donors, respectively. Mean CRP levels were 1.00 (<0.5-8.11), 0.62 (<0.5-3.2), 11.5 (3.2-43.5) and 0.63 (<0.5-5.46) mg dl(-1) for the same groups. A statistically significant difference was found between HP+ patients and both HP- cases and healthy blood donors for PCT levels, and higher PCT levels were found on admission in cases of bacteraemia than in the other groups (P < 0.05). PCT levels of HP+ cases decreased significantly (from 1.39 to 0.86) between admission and the post-treatment period (30 days); however, PCT levels remained higher than the cut-off value (0.5 ng ml(-1)). Similar ranges of CRP levels were found over the same time-period. The sensitivity of PCT was found to be higher than that of CRP on admission, but the specificity of PCT was found to be lower than that of CRP on the day of admission (65 and 74%, respectively). The sensitivity of PCT was the same as that of CRP for the post-treatment period, but specificity of PCT was higher than that of CRP for the post-treatment period (83 and 76%, respectively). It was concluded that PCT and CRP are not very effective markers for H. pylori infection in primary diagnosis or in eradication follow-up after therapy when used in parallel with conventional diagnostic methods, even if there is a difference in PCT and CRP levels between HP+ and HP- cases on admission.

Procalcitonin and C-reactive protein in infective endocarditis: correlation with etiology and prognosis.

BACKGROUND: The aim of this study was to investigate the diagnostic values of serum procalcitonin (PCT) and C-reactive protein (CRP) levels in infective endocarditis (IE) and to correlate them with the etiology of the disease and the prognosis of the patients. METHODS: Fifty patients who were diagnosed as having IE based on Duke criteria (major and/or minor) were included in the study at the Istanbul University Cardiology Institute and Florence Nightingale Hospital. Forty patients with bacteremia (non-IE) and 50 healthy blood donors were also included in the study as the control group. During the 45 days of medical follow-up, in those patients who had a response to medical therapy based on the results of left ventricular function tests, transesophageal echocardiography (TEE) and culture, among other factors, PCT and CRP levels were measured in 5-cm(3) blood samples obtained without anticoagulant when they were first admitted (day 0), as well as 24 h and 15, 30 and 45 days after admission. In the patients who had valve replacement, 5-cm(3) blood samples without anticoagulant were similarly obtained on the day of admission, after 24 h and/or on the 15th day, and 1 day before and on the 2nd and 5th days after the operation. RESULTS: In this study, a significant difference (p < 0.001) was found between the IE group and the healthy control group with respect to their serum PCT and CRP levels at the time of admission. No significant difference was found between IE and non-IE groups (p > 0.05). The sensitivity of PCT in comparison to CRP was found to be lower (84 vs. 100%); however, its specificity was determined to be higher (88 vs. 72%). The median values of serum PCT in the nonoperated and operated cases at the time of admission, after 24 h and on the 15th day were 3.71, 5.35 and 0.44, and 2.45, 4.28 and 4.22 ng/ml, respectively, and those of CRP were 9.30, 10.95 and 10.65, and 9.5, 10.9 and 10.2 mg/dl, respectively. The median values of serum PCT were found to be higher in cases with IE and non-IE related to gram-negative bacteria than those related to gram-positive bacteria (p < 0.02). This was found to be insignificant for CRP (p > 0.05). CONCLUSIONS: As a result, this study suggests that in the diagnosis of IE, it would be beneficial to use PCT, besides TEE, culture and other clinical criteria, for its high specificity and positive predictive value in comparison to CRP. This study also suggests that in determining the response to medical treatment in the follow-up period, PCT could be a more valuable parameter than CRP, as PCT has a high prognostic value and is a good indicator for valve replacement in addition to the major criteria. Furthermore, serum PCT levels may help the physician to decide on the antimicrobial therapy combination before obtaining the culture results, or in situations in which the agent could not be isolated yet.

Benefits of tissue harmonic imaging in the evaluation of abdominal and pelvic lesions.

BACKGROUND: We compared tissue harmonic imaging (THI) and conventional ultrasonography to determine whether THI improves image quality and facilitates lesion characterization. METHODS: Eighty-nine various abdominal or pelvic lesions in 71 patients(34 men and 37 women; age range = 3-90 years, median age = 52 years) were evaluated with conventional ultrasonography and THI. Examinations were performed with frequencies of 2-5 MHz. All the images were stored on a hard disk and evaluated separately by three radiologists. RESULTS: According to the interpreters, THI improved overall image quality in 67 (74%) to 76 (84%) and lesion characterization in 28 (31%) to 36 (40%) of 89 lesions when compared with conventional ultrasonography. All three observers agreed that image quality and lesion characterization were improved in 62% and 17% of the lesions, respectively. Lesion groups containing five or more lesions were compared for any difference of improvement in overall image quality and lesion characterization. For overall image quality, a significant difference was found ( p < 0.05). For lesion characterization, there was no significant difference between groups ( p > 0.05). CONCLUSION: THI improved overall image quality and lesion characterization.