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.

Objective and subjective comparison of transurethral resection, transurethral incision and balloon dilatation of the prostate. A prospective study.

Each of the treatment alternatives of benign prostatic hyperplasia (BPH) has its own advantages and disadvantages. The needs and the condition of the patient should be considered in choosing the proper treatment. After the treatment, patient satisfaction should also be considered because objective criteria do not always reflect the efficacy of the treatment. The long-term efficacy of the three alternative treatments of BPH (TURP, TUIP, TUBDP) were compared in a total of 60 men with obstructive symptoms. TUIP was found to be the method of treatment we recommended in young patients with a small and symptomatic adenoma, whereas TURP is still the 'gold standard'.

Androgenic status in patients with lepromatous leprosy.

OBJECTIVE: To assess the incidence of testicular atrophy by evaluation of hormonal status, testicular histology and sperm production in chronic lepromatous patients. PATIENTS AND METHODS: Forty-one male patients with a mean age of 39.5 years (range 16-57) were studied at the Leprosy Hospital, Istanbul, Turkey, and were compared with 15 age-matched controls with proven fertility. RESULTS: Reduced testicular size was observed in 51% and gynaecomastia in 27%. Of the 31 patients who were married, 15 were primarily or secondarily infertile. Twelve of 16 patients had oligospermia or azoospermia. The mean basal luteinizing hormone (LH), follicle stimulating hormone (FSH) and oestradiol levels were significantly elevated and the level of testosterone significantly reduced when compared with the control group. CONCLUSION: Whenever leprosy is diagnosed patients should be informed of the need for treatment of an acute attack and the need for routine assessment of FSH, LH, testosterone and oestradiol levels to detect hypogonadism and potential infertility.

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.

New temporary coil stent (Urocoil) for treatment of recurrent urethral strictures.

The Urocoil is a temporarily inserted self-expanding and self-retaining coil stent made of medical-grade stainless steel that is inserted under fluoroscopy after topical anesthesia of the urethra. This stent was used for 16 patients with a variety of recurring urethral strictures who had been managed in the past by repeated dilatations and urethrotomies. The stent was left in place for 6 months. Unlike permanently implanted mesh stents, no tissue growth into the lumen occurred with this stent, making its removal a simple procedure. With a follow-up of 3 to 9 months after removal, no recurrence of the strictures was observed. This temporary stent seems to be effective in the treatment of recurring urethral strictures. Satisfactory and promising results were obtained without leaving a foreign body permanently in the urethra.

Lupus anticoagulant and leg ulcers associated with ankylosing spondylitis.

We describe a 60-year-old man with ankylosing spondylitis (AS), hospitalized for leg ulcers. Laboratory investigations revealed the presence of the lupus anticoagulant. We found no such an association by a computer assisted search of the literature published from 1975 to 1989. The relationship between the AS, the lupus anticoagulant and leg ulcers is discussed.

Libman-Sacks endocarditis: the diagnostic importance of two-dimensional echocardiography.

In 1980, a 44-year-old woman with the diagnosis of systemic lupus erythematosus presented with fever and mitral and aortic valvular insufficiency. Blood cultures were sterile. M-mode echocardiograms of the mitral valve revealed an image resembling vegetations of infective endocarditis. The diagnosis was rejected after two-dimensional echocardiography which failed to demonstrate vegetation. Two-dimensional echocardiography should therefore be systematically utilized in the diagnosis of valvular lesions in patients with systemic lupus erythematosus.

Calcium entry blocking agents in digital vasospasm (Raynaud's phenomenon).

We have evaluated the therapeutic effect of the calcium entry blocking agent nifedipine in Raynaud's phenomenon associated with connective tissue diseases and in idiopathic digital vasospasm. In a preliminary study 16 patients with a digital vasospasm that could be induced by hand-immersion in cold water (4 degrees C) were challenged a second time with cold water 1 and 6h after 20 mg oral nifedipine. Nifedipine provided an effective protection against this cold-induced vasospasm in 14 of the 16 patients. Thirty patients were included in a short-term ambulatory study: Raynaud's phenomenon was associated with progressive systemic sclerosis (PSS) in 10 patients, systemic lupus erythematosus (SLE) in five and rheumatoid arthritis (RA) in three; it was idiopathic (I) in 12 patients. Each patient received, in a double-blind manner and random order, on two consecutive weeks, nifedipine (20 mg three times daily) and placebo. Nifedipine proved to be effective: the mean number of digital vasospastic attacks per week decreased from 27.3 to 5.8 (P less than 0.01). The results in the SLE and RA groups were similar and were pooled. The improvement (in % decrease) was better in the idiopathic group (90.9) than in the SLE and RA group (78.6, P less than 0.02) and the PSS group (64.0, P less than 0.01).

[Aortic rheumatoid insufficiency. 3 cases and review of the literature]. / Insuffisance aortique rhumatoïde. Trois obsergations et revue de la littérature.

The authors report on three cases of rheumatoid aortic valve insufficiency. The three patients had classic sero-positive rheumatoid arthritis. In one patient aortic valve insufficiency and pericarditis occurred simultaneously; aortic valve insufficiency appeared in two patients less than two years and in the third patient 17 years after the beginning of arthritis. In the first two cases, the aortic regurgitation evaluated by echocardiography and angiography was not severe enough to require valvular replacement. In the third patient, rheumatoid granuloma of the aortic valve caused fatal aortic insufficiency.

[Controlled study of nifedipine in the treatment of Raynaud's phenomenon]. / Etude controlée de la nifédipine dans le traitement du phénomène de Raynaud.

In each of the 16 patients included in our first study [6 idiopathic Raynaud's phenomenon (I), 4 associated with systemic lupus erythematosus (SLE) and 6 with progressive systemic sclerosis (PSS)] digital vasospasm could be reproduced by immersion of both hands in cold water (4 degree C). Each patient received in a double-blind manner and random order on two consecutive days, the calcium-channel blocking agent nifedipine (20 mg) and placebo. Nifedipine protection against vasospasm provoked by cold water (4 degrees C) was considered good or excellent in 14 of the 16 patients (p less than 0.001 versus placebo). In the second study, 30 patients [12 I, 10 PSS, 5 SLE and 3 rheumatoid arthritis (RA)] received in a double blind manner and random order, on two consecutive weeks, nifedipine (20 mg 3 time daily) and placebo. The improvement with nifedipine (in percentage of the decrease of the number of vasospastic attacks) was 90.95 in the 1 group, 78.63 SLE and RA and 64.02 in PSS (p less than 0.01). An open study during 3 months has confirmed the effectiveness of nifedipine (10 mg 3 times daily). The improvement was 88.92 in the 1 group, 76.33 in SLE and RA and 59.16 in PSS, 7 out of 30 patients stopped the treatment because of side effects (headache, flush, nausea, oedema of the ankles). Thus nifedipine appears to be extremely useful in the treatment of Raynaud's phenomenon.