Taurine supplementation protects lens against glutathione depletion.

OBJECTIVE: Cataract which is defined as opacification of eye lens forms approximately 40% of total blindness causes all through the world. Age is the biggest risk factor for cataracts and oxidative stress is known to be one of the most important factors causing cataract formation. Age-related nuclear cataract (ARN) is associated with a loss of glutathione in the center of the lens. Taurine is an important antioxidant in lens tissue. Although, there is a high amount of taurine in lenses in early life, its concentration declines with age. In this study, we aimed to investigate the effects of supplemental taurine in lens tissues in an in vivo oxidative stress model which is induced by glutathione depletion to mimic ARN. MATERIALS AND METHODS: Glutathione depletion was induced in rabbits subcutaneously with l-Buthionine -(S,R)-sulfoximine (BSO)- a glutathione inhibitor and the rabbits were treated with taurine. Total GSH, reduced GSH, GSH/GSSG ratio and MDA levels were measured. RESULTS: BSO lowered the reduced GSH and total GSH levels and GSH/GSSG ratio. Taurine reversed these effects. On the other hand, BSO enhanced MDA level which is normalized by taurine. CONCLUSIONS: These findings suggest that glutathione depletion with BSO may be a useful model to mimic ARN and dietary intake of taurine, may have an important role in decelerating the process of cataract formation.

Diverse effects of taurine on vascular response and inflammation in GSH depletion model in rabbits.

OBJECTIVE: A reduction in GSH and an increase in free radicals are observed in inflammatory diseases, indicating oxidative stress. Taurine protects cells from the cytotoxic effects of inflammation. There have been limited studies to date evaluating the effect of taurine in oxidative stress-induced vascular dysfunction and its role in vascular inflammatory diseases. Therefore, we aimed to investigate the effect of taurine on the regulation of vascular tonus and vascular inflammatory markers in rabbit aortae and carotid arteries in oxidative stress-induced by GSH depletion. MATERIALS AND METHODS: Rabbits were treated subcutaneously with buthionine sulfoximine (BSO), GSH-depleting compound and/or taurine. Cumulative concentration-response curves for acetylcholine (ACh), phenylephrine and 5-hydroxytriptamine (5-HT) were constructed with or without Nω-nitro-L-arginine (LNA) in the carotid artery and aorta rings. Immunohistochemical staining was performed for TNF-α and IL-1ß. RESULTS: BSO increased ACh-induced NO-dependent relaxations, phenylephrine-induced contractions in the carotid artery and 5-HT induced-contractions in both the carotid artery and the aorta. BSO decreased EDHF dependent relaxations only in the aorta. ACh-induced NO-dependent relaxations and augmented contractions were normalized by taurine. BSO increased TNF-α expressions in both carotid arteries and aortas, which were reversed by taurine. The BSO-induced increase in IL-1ß was reversed by taurine only in aortae. CONCLUSIONS: Treatment with BSO resulted in vascular reactivity changes and increased immunostaining of TNF-α in mainly carotid arteries in this model of oxidative stress. The effect of taurine on BSO-induced vascular reactivity changes varied depending on the vessel. The inhibition of the increase in TNF-α expression by taurine in both carotid arteries and aortae supports the proposal that taurine has a beneficial effect in the treatment of inflammatory diseases such as atherosclerosis.

Ileal orthotopic neobladder in women: the first experiences from Turkey and our modifications.

UNLABELLED: The lower urinary tract reconstruction with an ileal neobladder in woman is not very often but has been recently introduced centers. We report 8 female patients with ileal orthotopic neobladders after cystectomy. PATIENTS AND METHODS: Between 1995 to 1999, 7 female patients with organ confined invasive bladder cancer and 1 female patient with severely contracted bladder secondary to tuberculosis were operated. While standard radical cystectomy was done in 7 patients with bladder cancer, only simple cystectomy was performed in patient with contracted bladder. Detubularized ileal W-neobladder with antirefluxive ureteroileal reimplantation were used as a procedure and reservoirs are connected to the proximal urethra in all patients. Cystoscopy and biopsy was done routinely in the bladder neck and there were no tumour and CIS in any patient. RESULTS: The mean age was 65.4 years (53-70) and the mean postoperative follow-up time was 31.8 months (6-48). There was no perioperative or early postoperative (first one month) mortality. Early postoperative complications included acute renal failure in I patient (12.5%), deep vein thrombosis in 1 patient (12.5%) and leakage from the pouch in 2 patients (25%). In one patient (12.5%), ileo-pouchal fistula was seen in sixth month and reoperated. Although there was not hypercontinence. one patient (12.5%) had totally incontinence. All other patients had normal micturition and no residual urine. Urethral recurrence was not seen in this postoperative follow-up period but pelvic recurrence and then distant metastases were found in one case (12.5%). CONCLUSIONS: The results of ileal orthotopic neobladder after radical or simple cystectomy in appropriate female patients are satisfactory. But certainly, we need the more experiences and studies about this subject.

Staging error in the bladder tumor: the correlation between stage of TUR and cystectomy.

OBJECTIVES: Because tumor stage is very important in determining therapy, accurate staging of bladder cancer must be estimated. For this aim, we examined the stage of TUR and compared it with the stage of cystectomy. MATERIALS AND METHODS: From 1992 to 1999, operations were performed on 127 patients with local invasive bladder cancer. Eight cases (74 male, 6 female) underwent complete TUR of the tumor and then radical cystectomy. There was no residual macroscopic tumor after TUR in the bladder. The pathological staging of TUR and cystectomy were estimated and compared in these 80 cases. All pathologies were evaluated by the same pathology center. RESULTS: There was correlation in only 20 patients (25%; 15 were T1, 5 were T2) while there was global error and discordance in 60 patients (75%). All of these 60 cases were overstaging in cystectomy specimens and downstaging was not found in any case. Fifty per cent of 10 T1 tumors were T1, while 50% were T3a; 21.4% of T2 tumors were T2, 35.7% were T3a and 42.8% were T3b. CONCLUSIONS: The staging error of TUR in the bladder tumor may cause severe mistakes on deciding about radical surgery. However, although there was no understaging, which is more risky for false cystectomy indication, urologists must be careful about overstage/understage in the staging of TUR.

Serum PSA and age-specific reference ranges in patients with prostatism symptoms.

Prostatic specific antigen (PSA), a tumour marker helpful in the diagnosis and follow-up of prostate cancer, may rise due to causes other than prostate cancer (i.e. BPH, acute prostatitis, etc.). Investigations in order to increase the sensitivity and specificity of PSA in prostate carcinoma are being carried out. Serum PSA levels of patients with prostatism with regard to age as well as these levels in the male population at risk but without clinical prostatic disease (those above the age of 40) should be well documented. The aim of this study is to find age-specific values and ranges of PSA in patients with prostatism symptoms.

Effects of treatment with FK409, a nitric oxide donor, on collar-induced intimal thickening and vascular reactivity.

Intimal thickening in arteries is considered a site of predilection for atherosclerosis. In a rabbit model of early atherosclerosis, a silastic collar was placed around the carotid artery, which resulted in the formation of intimal thickening. We investigated whether the oral application of FK409 ((+/-)-(E)-4-ethyl-2-[(E)-hydroxyimino]-5-nitro-3-hexenamide , 10 mg kg(-1) day(-1), p.o.), a nitric oxide donor, inhibited the collar-induced intimal thickening as well as accompanying reactivity changes in rabbit carotid artery. The intimal thickening was significantly inhibited by FK409. The collar treatment increased the pD2 value of 5-hydroxytryptamine (5-HT) whereas it decreased those of phenylephrine and acetylcholine and did not significantly alter that of nitroglycerine. Maximal contractile force development in response to potassium chloride (KCl), 5-HT and phenylephrine was decreased in collared arteries. The collar did not alter the maximal relaxant effects of acetylcholine and nitroglycerine. Despite the significant reduction of intimal thickening, FK409 treatment did not affect these collar-induced modifications in vascular reactivity.

Effects of nicardipine on collar-induced intimal thickening and vascular reactivity in the rabbit.

The effects of nicardipine treatment on collar-induced intimal thickening and on accompanying reactivity changes in rabbit carotid artery have been investigated. Treatment for three weeks with subcutaneous nicardipine (20 mgkg(-1) per day) significantly inhibited the intimal thickening caused by perivascular application of a silicone rubber collar. Potassium chloride (KCl), phenylephrine and 5-hydroxytryptamine (5-HT) induced concentration-dependent contractions in both sham-operated and collared arteries. Collar-induced attenuation of maximum KCl-, phenylephrine- and 5-HT-induced contraction was not affected by nicardipine. Collaring caused the means of pD2 values (the negative logarithm of EC50 values, 50% effective concentration) of 5-HT and phenylephrine to increase and decrease, respectively. Nicardipine did not affect the altered sensitivity to these agonists. Neither collar implantation nor nicardipine treatment altered the pD2 values for acetylcholine- and nitroglycerine-induced relaxations. These results demonstrate that nicardipine inhibits collar-induced intimal thickening in rabbit carotid artery without affecting the accompanying changes in vascular reactivity, indicating a possible lack of association between the development of intimal thickening and altered reactivity.

Echo-colour doppler ultrasonography in the diagnosis of varicocele.

The relationship between varicocele and infertility has long been defined. About a third of the male patients undergoing evaluation for infertility present with a varicocele. Sixty male patients between 17 and 35 years of age (mean 25.6) were examined with a colour-doppler flow imaging system. The diameters of the veins in the pampiniform plexus were measured by gray-scale sonography. Our findings were classified with regard to venous diameter, the existence or non-existence of reflux, the circumstances under which these findings were recorded (e.g. during normal respiration and standing position or during Valsalva manoeuvre and supine position). Finally our results suggest that: (a) the clinical significance of the presence of dilated veins or reflux during increased intraabdominal pressure and under similar circumstances should be regarded with caution; (b) positive findings during normal inspirium are highly significant (grades III and IV).

Immature germ cells in semen and their correlations with other semen parameters.

PURPOSE: The significance of the presence of leukocytes and immature germ cells in semen and other parameters of semen is currently a subject of controversy. MATERIALS AND METHODS: Semen from 572 subfertile patients was analyzed according to WHO criteria and leukocytes as well as immature germ cells were assessed by identifying the round cells in semen by peroxidase staining. Microbiological investigation was carried out in cases with leukocyte counts of >1,000,000/ml. RESULTS: It was found that as the concentration of spermatozoa decreased the rate of immature germ cells increased and this increase was accompanied by a decrease in motility and in the number of spermatozoa with normal morphology. As the sperm count increased, motility, number of spermatozoa with normal morphology and of immature germ cells also increased whereas an increase in sperm motility was accompanied by an increase in the percentage of spermatozoa with normal morphology. Microbiological investigations were negative in patients with semen leukocyte counts of >l,000,000/ml. CONCLUSIONS: Although it is possible to establish that the leukocyte and immature germ cell counts correlate with other parameters of semen, these correlations are not statistically significant. The most significant finding is that as the number of sperms decreases, the ratio of immature germ cells to total germ cells increases. While assessing immature germ cells instead of giving special attention to the number of immature germ cells in semen, the ratio of immature germ cells to total germ cells should be considered. The increase of leukocyte count in the semen of oligospermic patients may not always mean leukospermia.

Prospective evaluation of prostate specific antigen (PSA), PSA density, free-to-total PSA ratio and a new formula (prostate malignancy index) for detecting prostate cancer and preventing negative biopsies in patients with normal rectal examinations and intermediate PSA levels.

OBJECTIVE: To improve the specificity and sensitivity of prostatic cancer detection, we prospectively evaluated total prostate specific antigen (PSA) level, PSA density, free-to-total PSA ratio and a new formula called prostate malignancy index (PMI) as a discriminator of prostate cancer in patients with intermediate PSA levels and normal digital rectal examinations. MATERIALS AND METHODS: Between November 1995 and October 1997, 95 patients who had serum PSA levels of 4.0 to 10.0 ng/ml with normal digital rectal examinations were prospectively evaluated. All patients underwent one or two times transrectal ultrasound guided prostate biopsies. Based on age specific reference range of PSA, PSA density and % free PSA ratio, PMI was calculated for each patient. The free and total serum PSA concentrations were determined by an Immulite assay system. (Diagnostic Product Corp., Los Angeles, California). RESULTS: Overall 20 of 95 (21%) patients had prostate cancer. There were no significant differences in patient mean age and mean total PSA between those with benign and those with malignant biopsies (p>0.05). However, there were significant differences in mean PSAD, mean free-to-total PSA ratio and mean PMI (p<0.01, p<0.05, p<0.01, respectively). Benign condition specificities for PM index, percent free PSA, PSA density and total PSA at a 90% sensitivity for prostate cancer were 48%, 10.6%, 8% and 4%, respectively. Of 95 patients, 27 (28.4%) had a PMI of equal or more than 3.1, including 12 of 75 (16%) with negative biopsy and 15 of 20 (75%) with positive biopsy. Furthermore a cutoff MI 0.86 P correctly identified 24% of benign cases without missing any prostate cancer cases. The comparison of receiver operating characteristic (ROC) curve areas showed that PMI was better than total PSA (p<0.01). Although, the area under the ROC curve of % free PSA and PSAD were higher than the area of total PSA, these differences were not statistically significant (p>0.05). CONCLUSIONS: We concluded that the prostate malignancy index could be utilized to differentiate benign conditions from prostate cancer in patients with intermediate PSA levels and normal digital rectal examination. Also significant numbers of negative biopsies can be prevented in these patients.

[The role of trans-rectal echography (TRE) in the evaluation and staging of bladder tumors: comparison with suprapubic echography and computerized axial tomography (CAT)]. / Il ruolo dell'ecografia trans-rettale (ETR) nella valutazione e stadiazione dei tumori vescicali: confronto con ecografia sovrapubica e tomografia assiale computerizzata (TAC).

TAU and CT are, after cystoscopy, the two most largely used methods in the diagnosis and the staging of the bladder tumors. TRUS is mostly used in the pathologies of the prostate and the seminal vesicles. 38 patients (34 M and 4 F) suffering from bladder cancer are included in this study in the period from July 1995 to January 1997. They are evaluated with TAU, TRUS and CT in order to evaluate the sensitivity and the specificity of TRUS in the diagnosis and the stadiation of bladder tumors. The patients included in this study are divided in two subgroups as patients having superficial and infiltrating tumors according to pathologic stage after TURB or radical cystoprostatectomy. Specificity and sensitivity values, overstaging and undestaging rates are calculated for each group. In the superficial tumors, TAU had a sensitivity and specificity of 72.2%, while with CT these values were respectively 70% and 75%; in the infiltrating tumors, TAU presented sensitivity of 65% and specificity of 70% while CT presented respectively 72.2% and 77.5%. With TRUS these values were 88.8% and 94.4% in the superficial tumors and 90% and 95% in the infiltrating tumors. The method with the highest overstaging rate was CT with 33.3% while the ones with the highest understaging rates were TAU and CT with 22.2%. The sensitivity with TRUS was 100% in a total of 29 infiltrating and superficial tumors of the trigone while it was only 55.5% in the tumors of the lateral walls and the dome. With TAU these values were respectively 82.7% and 22.2%, with CT respectively 79.3% and 44.4%. The specificity with TRUS was 100% for the tumors of the lateral walls and 77.7% of the dome; with TAU these values were respectively 75.8% and 55.5% with CT 75.8% and 77.7%. In conclusion, TRUS may be used with a high sensitivity and specificity in the diagnosis and the stadiation of infiltrating and superficial bladder tumors situated at the peritrigonal zone and in the diagnosis of tumors situated in other regions of the bladder.

Urinary tuberculosis in a two-year-old boy.

The authors describe a case of genitourinary tuberculosis hitherto unobserved in early childhood.

Fracture of the penis.

Fracture of the penis is a rare condition. The fracture is easy to recognize but treatment remains controversial. Between December 1991 and January 1997, eleven patients underwent emergency operation on the first day after penile fracture. Our operative plan consisted of immediate exploration, identification, debridement and primary repair of the tear in the tunica albuginea. The patients' mean age was 27 years (range 21-38 yrs.). Penile fracture was due to sexual manoeuvres in 8, manipulation in 2 and fall onto erect penis in one of 11 patients. The mean hospitalization time was 2.2 days (range 1 to 3 days). There was no significant early postoperative complication except wound infection in one patient. In the first postoperative month, there was a residual fibrosis due to nonabsorbable sutures in one patient and mild pain during coitus in the other one. All patients had full erection and no patient needed additional treatment. To avoid serious complications and preserve penile functions immediate surgical intervention is recommended.

Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction.

We have examined the effects of acupuncture and hypnotic suggestions, and compared them with placebo in the treatment of male sexual dysfunction with no detectable organic cause. The study comprised 15 men (mean age 36.7 +/- 10.43 years) who received acupuncture treatment, 16 men (mean age 38.4 +/- 10.75 years) who underwent hypnosis (mean age 35.3 +/- 11.52 years) and 29 men (mean age 36.2 +/- 11.38 years) who served as controls. They were interviewed periodically; the patients' reports were verified by interviewing their partners. Men who received placebo had a 43-47% improvement in sexual function, while the rates of improvement in the treated groups were higher, but not significantly so. The success rates of acupuncture and hypnotic suggestions were 60% and 75% respectively. Although the improvement was not statistically significant, treatment with acupuncture could be used as an adjuvant therapy in non-organic male sexual dysfunction. The only treatment superior to placebo seemed to be hypnosis. A more effective treatment may be obtained by combining these therapeutic modalities, but this needs further study.

[Rehabilitation of patients after cystectomy and construction of a continent intestinal reservoir]. / Réinsertion des patients après cystectomie et confection d'un réservoir intestinal continent.

Close follow-up and rehabilitation are necessary in order to ensure a good life quality for patients who have undergone cystectomy operations combined with continent reservoir operations. A questionnaire survey was carried out on 19 of our patients with continent reservoirs of different types. Furthermore a number of the leading clinics and urologists were consulted in an effort to find out a common and reliable method for rehabilitation. The most frequently encountered problems were the sexual (13 cases: 72.2%) and psychosocial adaptation (11 cases: 61.1%) among our patients. These figures were lowered to 50% (9 cases) and 33.3% (6 cases) respectively after organizing a special club for these patients in our hospital.