How to manage sepsis associated with ureteral calculi?

[No Abstract Available

Intravesical Migration and Calcification of Intrauterin Device: A Case Report and Review of the Literature

Intrauterine device (IUD) is widely used for the long duration of protection, cost-effectiveness and for being a reversible contraceptive method as well as having low complication rates. Despite low complication rates, various IUD-related complications, such as spontaneous aborts, bleeding, infection, and uterine perforation may occur. Although perforation of the uterus by an IUD is not uncommon, bladder perforation is a rare complication. A regular follow-up of patients with IUDs for the complications and training of clinicians for insertion and removal are mandatory to provide better and safe family planning services. Here, we report a case of a patient with uterine perforation with a calcified IUD migration into the the bladder

The effectiveness of biofeedback therapy in children with monosymptomatic enuresis resistant to desmopressin treatment

Objective: To investigate the effect of biofeedback therapy on children with desmopressin-resistant primary monosymptomatic enuresis (MsE). Material and methods: The study comprised both retrospective and prospective sections. A total of 262 medical files of patients who were diagnosed as enuresis between November 2012 and January 2015 were retrospectively screened. Patients with neuropathic bladder, daytime voiding problems, anatomical pathology and enuresis-related diseases were excluded from the study. The demographic data and family characteristics of 29 children with desmopressin-resistant primary MsE were recorded. After biofeedback treatment patients whose frequency of enuretic episodes decrease by more than 50% were included in the successful biofeedback treatment group (SBTG), while other patients were categorized in the unsuccessful biofeedback treatment group (USGBT). The outcomes of uroflowmetry, voided volume, postvoiding residue (PVR) and total bladder volume/age-adjusted normal bladder capacity (TBV/NBC) were recorded before and at the sixth month of the treatment. Results: The mean age of 29 patients included in the study was 9.14 +/- 3.07 (6-15) years. Of patients, 16 were male (55.2%) and 13 were female (44.8%). Before biofeedback treatment the frequency of enuresis was 25.1 +/- 5.76 days/month, while after treatment this was calculated as 8.52 +/- 10.07 days/month. After treatment 8 patients (28.6%) achieved complete dryness. Twenty patients (69%), benefited from biofeedback (SBTG), while there were 9 patients (31%) in the USBTG group. There was no significant difference between the SBTG and USBTG groups in terms of age, body mass index and sex. The average bladder capacity of the patients increased from 215 mL to 257 mL after biofeedback treatment (p<0.001). The TBV/NBC value before treatment was 0.66, while after treatment it was 0.77 (p<0.001). There was a statistically significant difference between the SBTG and USBTG groups in terms of presence of MsE in mother, and both parents (p=0.001, p=0.016, respectively). Conclusion: Biofeedback therapy is a safe, simple, and minimally invasive treatment modality in children with MsE resistant to desmopressin treatment. This treatment, which was found to increase total bladder capacity, may be recommended for children with MsE when conventional desmopressin treatment fails

The effectiveness of biofeedback therapy in children with monosymptomatic enuresis resistant to desmopressin treatment

OBJECTIVE: To investigate the effect of biofeedback therapy on children with desmopressin- resistant primary monosymptomatic enuresis (MsE). MATERIAL AND METHODS: The study comprised both retrospective and prospective sections. A total of 262 medical files of patients who were diagnosed as enuresis between November 2012 and January 2015 were retrospectively screened. Patients with neuropathic bladder, daytime voiding problems, anatomical pathology and enuresis-related diseases were excluded from the study. The demographic data and family characteristics of 29 children with desmopressin- resistantprimary MsE were recorded. After biofeedback treatment patients whose frequency of enuretic episodes decrease by more than 50% were included in the successful biofeedback treatment group (SBTG), while other patients were categorized in the unsuccessful biofeedback treatment group (USGBT). The outcomes of uroflowmetry, voided volume, postvoiding residue (PVR) and total bladder volume/age-adjusted normal bladder capacity (TBV/NBC) were recorded before and at the sixth month of the treatment. RESULTS: The mean age of 29 patients included in the study was 9.14±3.07 (6–15) years. Of patients, 16 were male (55.2%) and 13 were female (44.8%). Before biofeedback treatment the frequency of enuresis was 25.1±5.76 days/month, while after treatment this was calculated as 8.52±10.07 days/month. After treatment 8 patients (28.6%) achieved complete dryness. Twenty patients (69%), benefited from biofeedback (SBTG), while there were 9 patients (31%) in the USBTG group. There was no significant difference between the SBTG and USBTG groups in terms of age, body mass index and sex. The average bladder capacity of the patients increased from 215 mL to 257 mL after biofeedback treatment (p<0.001). The TBV/NBC value before treatment was 0.66, while after treatment it was 0.77 (p<0.001). There was a statistically significant difference between the SBTG and USBTG groups in terms of presence of MsE in mother, and both parents (p=0.001, p=0.016, respectively). CONCLUSION: Biofeedback therapy is a safe, simple, and minimally invasive treatment modality in children with MsE resistant to desmopressin treatment. This treatment, which was found to increase total bladder capacity, may be recommended for children with MsE when conventional desmopressin treatment fails

Mannitol has a protective effect on testicular torsion: An experimental rat model

Objective Testicular torsion is an emergency condition that causes testicular injury. Any treatment opportunity reducing the destructive effect of testicular torsion is important for the future life of patients. In this experimental study we investigated the protective effect of mannitol on ischemia-reperfusion (I/R) injury in a rat testes torsion model. Method In total, 32 male Sprague Dawley rats were included. Four experimental groups included eight rats each. Group A was a sham group in which the right testis was brought out through a scrotal incision and then replaced in the scrotum without torsion. In Group B, the right testis was torsioned, by rotating 720 degrees clockwise and fixed to the scrotum with no treatment. In Group C, the same testicular torsion process was performed with saline infusion just after testicular torsion. In group D, mannitol infusion was used just after testicular torsion. Testicles were detorsioned after 3 h and left inside for more than 2 h before orchiectomy. Histopathological, immunohistochemical, and biochemical analyses were performed. Results Testicular architecture was disturbed significantly in the torsion groups without mannitol infusion. However, testicular tissue structure was significantly better in the mannitol-treated group, demonstrating a protective effect. Similar findings were also shown for the proliferating cell nuclear antigen (PCNA) index and antioxidant activity; both were higher in the mannitol group than in the no-treatment and saline groups (p < 0.01). The apoptotic index was also significantly lower in the mannitol-treated group compared with the no treatment and saline groups (p < 0.01). Conclusions The seminiferous tubule structure in testicular torsion without mannitol treatment was significantly disturbed, whereas the structural disruption was considerably less in the mannitol group. Mannitol treatment also decreased reactive oxygen radical levels significantly and was able to decrease apoptosis. These results were consistent with other organ model studies that evaluated the protective effects of mannitol treatment in I/R injury. Mannitol infusion had a protective effect against I/R injury in testicular torsion in rats. This experimental study may guide clinicians to evaluate the effectiveness of mannitol in human testicular torsion.Namik Kemal University, Tekirdag, TurkeyNamik Kemal UniversityThis study was financed by a scientific research project of Namik Kemal University, Tekirdag, Turkey

Female sexual dysfunction in androgenetic alopecia: Case-control study

Introduction: We sought to evaluate the association of female sexual dysfunction (FSD) with androgenetic alopecia (AGA) and metabolic syndrome (MetS) in premenopausal women. Methods: From December 2013 to June 2015, we performed a case-control, prospective study of 115 patients with AGA and 97 age-matched control patients without AGA from among premenopausal women who visited dermatology clinics of the two reference hospitals. Comprehensive history, anthropometric measurements, and questionnaire administration were performed for each of the total of 212 women. The Female Sexual Function Index (FSFI) was used to assess the key dimensions of female sexual function. AGA was assessed and graded by an experienced dermatologist according to Ludwig's classification. The MetS assessment was made according to the NCEP-ATP III criteria. Results: In univariate analysis, age, weight, waist circumference, hip circumference, waist-to-hip ratio, body mass index (BMI), AGA, MetS, cardiovascular event, marital status, hypertension, high fasting plasma glucose, high triglyceride, large waist, total testosterone, and free testosterone were associated with presence of FSD. In logistic regression analysis, age (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.13. 1.30; p<0.001), AGA (OR 3.42, 95% CI 1.31. 8.94; p= 0.017), MetS (OR 5.39, 95% CI 1.34. 21.62; p= 0.012), and free testosterone (OR 0.18, 95% CI 0.09. 0.37; p< 0.001) were independently associated with FSD. Conclusions: Our study suggests that age, AGA, MetS, and free testosterone may have strong impact on sexual function in premenopausal women. Further studies with population-based and longitudinal design should be conducted to confirm this finding

Clinical utility of EDACS-ADP in patients admitted with chest pain to an emergency department

Introduction: Acute coronary syndrome (ACS) is a common cause of mortality and morbidity. An ACS diagnosis can be made with electrocardiogram (ECG) and cardiac markers. However, despite medical advances, 2-5% of ACS patients are undiagnosed and discharged from emergency departments (EDs) because clinicians often find it difficult not only to diagnose and treat high-risk patients but also to define nonemergency diseases or safely discharge healthy patients. Risk stratification can be prevented, and inappropriate diagnosis and treatment protocols can be identified. The ED Assessment of Chest Pain Score-Accelerated Diagnostic Protocol (EDACS-ADP) scoring system, developed to identify patients with chest pain but at low risk for a major adverse cardiac event (MACE), is the first score based on clinical data from emergency medicine. Aim: This study investigates the usability of EDACS-ADP in Turkey. Material and Methods: This is a prospective observational study of 392 patients. The primary outcome was a major adverse cardiovascular event (MACE) within thirty days. Results: A total of 116 MACEs occurred in 65 (16,6%) patients during a one-month follow-up. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+ LR), and negative likelihood ratio (-LR) values of the EDACS-ADP score for the evaluation of 30-day MACE rate in patients who admitted with chest pain for two months were as follows: 96.9%, 64.5%, 35.2%, 99.1%, + LR: 2.73, and -LR: 0.05. Conclusions: Most of these patients were classified by the EDACS-ADP as low risk and suitable for discharge. The 30-day MACE rate of development was significantly low (0.9%) and acceptable in patients grouped as low risk

Predictive role of hematologic parameters in testicular torsion

Purpose: To evaluate the predictive role of the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet count (PLT) in the diagnosis of testicular torsion (TT) and testicular viability following TT

Deneysel Inmemiş Testiste Testosteronun Koruyucu Etkisi

Amaç: İnmemiş testis, yenidoğan erkeklerde en sık görülen konjenital genital anomalidir. Etiyolojisinin multifaktoriyel olduğu düşünülmektedir. Artmış infertilite ve testis kanseri riski, inmemiş testisin önemli komplikasyonlarıdır. İnmemiş testiste, testiküler hasara neden olan iki ana faktör; hormonal yetersizlik ve oksidatif strestir. Bu nedenle, testiküler disfonksiyon riskini azaltmak için hormon replasman tedavisi ve antioksidan tedavi mantıklı görülmektedir. Bu çalışmada, inmemiş testis rat modelinde testestoron ve N-asetilsistin tedavisinin testiküler hasar üzerindeki koruyucu etkisini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Lokal hayvan etik kurulunun onayıyla, toplam 11 adet 10 haftalık hamile Spraguee Dawley ratları çalışılmaya dahil edildi. Çalışmaya dahil edilen 11 gebe rattan 9’una, gebeliğin 14 ile 20. günleri arasında 7 gün süreyle günde 7.5mg flutamid verilerek yenidoğan ratlarda inmemiş testis oluşturuldu. Yenidoğan ratlar 4 çalışma grubuna ayrıldı. Grup 1 kontrol grubu olup, toplamda 8 normal testisi olan rattan oluşmaktaydı. Grup 2, tedavi uygulanmayan inmemiş testisi olan toplam 9 rattan oluşmaktaydı. Grup 3, inmemiş testisi olup NAC tedavisi uygulanan toplam 11 rattan oluşmaktaydı. Bu gruptaki ratlara doğumdan itibaren günlük 100mg/kg intraperitonel NAC tedavisi uygulandı. Grup 4, inmemiş testisi olup testosteron tedavisi uygulanan toplam 9 rattan oluşmaktaydı. Bu gruptaki ratlara doğumdan itibaren haftalık 100mg/kg intramüsküler testosteron undekonat uygulandı. Doğumlarından 70 gün sonra tüm ratlar dekapite edilerek sağ orşiektomi uygulandı. Çıkarılan testis dokuları biyokimyasal ve histopatolojik inceleme için değerlendirildi. Doku Süperoksit dismutaz (SOD), glutatyon peroksidaz (GSH-Px) ve katalaz (CAT) gibi doku antioksidant enzim aktivitesi değerlendirildi. Ortalama seminifer tübül çapları (OSTÇ) ve ortalama testiküler biyopsi skoru (OTBS) histolojik olarak değerlendirildi. Bulgular: N-asetilsistin tedavisi uygulanan ratların doku antioksidan düzeylerinin, tedavisiz gruba göre önemli derecede arttığı gözlendi. (p<0.001). İnmemiş testisi olup, testosteron tedavisi uygulanan ratlarda, SOD, GPx ve KAT seviyelerinde minimal artış tespit edilmesine rağmen, bu yükselme istatistiksel anlam kazanmadı. (p=0.372, p=0.407 ve p=0.392). Lipid peroxidasyon ürünlerinden biri olan malondialdehit (MDA) düzeyi, inmemiş testisi olan ratlarda kontrol grubuna göre belirgin derecede yüksek tespit edildi. N-asetilsistin tedavisi, MDA düzeyini tedavi almayan inmemiş testis grubuna göre anlamlı derecede baskıladı. Testosteron tedavisinde ise, MDA düzeyinde minimal azalma gözlenmiş olsa da, bu azalma istatistiksel olarak anlamlı değildi. (p=0.224) Tedavi uygulanmayan inmemiş testis dokularındaki OSTÇ ve OTBS değerleri, normal testis dokusuna göre belirgin olarak azaldı.(p<0.001) Hem NAC hem de testosteron tedavisinin OSTÇ ve OTBS değerlerini anlamlı oranda artırdığı ve bu artışın NAC tedavisi ile daha belirgin olduğu tespit edildi. (p<0.001) Sonuç: N-asetilsistin ile uygulanan antioksidan tedavinin ve testosterone ile uygulanan hormone raplasman tedavisinin, inmemiş testis rat modelinde koruyucu etkiye sahip olduğu gösterilmiştir. Etkinlik değerlendirmesinde N-asetilsistin tedavisinin, testosterone tedavisine göre daha etkili olduğu gözlenmiştir.Introduction: Undescended testis is the most common congenital genital anomaly in newborn males. Etiology of undescended testis appears to be multifactorial. Increase risk of sterility and testicular cancer are the two main consequences of undescended testis. Hormonal insufficiency and oxidative stress are supposed to be the main factors for testicular damage. In order to decrease the risk of testicular dysfunction, hormonal replacement and antioxidant treatment may be logical. In this study, we aimed to evaluate the protective effect of testosterone and Nacetylcysteine treatment on testicular damage at undescended testis rat model. Material and Methods: With the approval of local animal care and use committee, a total of 11, 10-week-old pregnant Spraguee Dawley rats, were included to the study. In order to form undescended testis, 9 pregnant rats were given 7.5 mg flutamide for 7 days between days 14 and 20 of gestation. New-born rats were divided into 4 groups. Group 1 (control) included a total of 8 rats with normal testes. Group 2 (undescended testis without treatment) included a total of 9 rats with undescended testis that did not receive any treatment. Group 3 (undescended testis plus NAC) included a total of 11 rats with undescended testis that received 100 mg/kg NAC intraperitoneally daily from birth. Group 4 (undescended testis plus testosterone) included a total of 9 rats with undescended testis that received 100mg/kg testosterone undekonat intramuscularly weekly from birth. At the 70th day of birth, all rats were decapitated and right orchiectomy was performed. Tissue antioxidant enzyme activities, including superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and Catalase (CAT) were analysed. Mean seminiferous tubule diameter (MSTD), mean testicular biopsy score (MTBS) and apoptosis index was also evaluated under light microscopy. Results: N-acetlycysteine treatment significantly increased antioxidant levels compared to non-treatment group (p<0.001), but they were still significantly lower than control group (p<0.001). Testosterone treatment showed a slight increase in SOD, GPx and CAT levels but the difference was not significant (p=0.372 and p=0.407, p=0.392 respectively). N-acetlycysteine treatment significantly decreased MDA levels compared to non-treatment group (p<0.001). Testosterone treatment also showed an increase at MDA levels but the difference was not significant (p=0.224). Compared to normal testicular tissue, untreated undescended testicular tissue showed significant decrease in MSTD and MTBS.(p<0.001) Both NAC and testosterone treatment increased MSTD and MTBS and the increase of these parameters was more significant in NAC treatment group.(p<0.001) Conclusions: Antioxidant treatment with N-acetylcysteine and hormonal replacement with testosterone had protective effect on undescended testis at rat model. N-acetylcysteine treatment had more protective effect than testosterone treatment