Does mean platelet volume (MPV) have a role in evaluation of erectile dysfunction and its severity?

Purpose: The mean platelet volume (MPV) has important role in the pathophysiology of vascular diseases as a marker of the platelet activity. To investigate the association between mean platelet volume and erectile dysfunction (ED) and to search whether this marker can be used for diagnosis of ED. Materials and methods: Of the 312 patients with ED of various degrees, 122 patients without ED (IIEF-5>21) were included in this prospective study. Severity of ED was determined according to IIEF-5 questionnaire. MPV, fasting serum glucose, cholesterol, low density lipoprotein (LDL) and serum testosterone levels are also recorded. The mean platelet volume was calculated by the Coulter counter technique and sexual function was determined by International Index of Erectile Function erectile function domain (IIEF-5). Results: The mean age of patients was 58.4 years. The mean MPV value of patients with ED was significantly higher compared to the non-ED patients (8.91 vs. 8.22, p=0.0001). The severity of ED was shown to have a positive strong correlation with MPV values (r=0.719, p=0.001). Mean serum triglyceride, glucose, total cholesterol and LDL cholesterol levels were noted higher in patients with ED. MPV values were found to be significantly higher in patients with ED. Conclusion: MPV level shows significant correlation with severity of ED. This cheap laboratory test can have potential to be a marker of ED. Further prospective larger studies with vascular wall thickness measurements should be conducted

The impact of vitamin E supplementation on semen parameters and pregnancy rates after varicocelectomy: a randomised controlled study

In this study, we aimed to investigate the impact of vitamin E supplementation on semen parameters and pregnancy after varicocelectomy. Forty-five infertile male patients who were diagnosed with varicocele and underwent subinguinal varicocelectomy were included in the study. After performing subinguinal varicocelectomy, the patients were randomised into two groups: 22 receiving vitamin E for 12 months, and 23 as the control group without receiving any supplementation. The pre-operative parameters of semen analyses and pregnancy rates of both groups were compared with those of post-operative parameters. There were no statistically significant differences between the groups in terms of sperm count and motile sperm percentage, in pre-operative, post-operative 3rd month, post-operative 6th month and post-operative 12th month periods. Repeated-measures anova was performed, and sperm count, percentage of change in sperm count, motile sperm count and percentage of change in motile sperm count of the groups were compared. The administration of vitamin E increased all of these parameters; however, they were not found to be statistically significant. In conclusion, vitamin E supplementation might improve the sperm parameters after varicocelectomy; however, further studies including larger number of samples are needed to make a proper decision on vitamin E supplementation after varicocelectomy

Comparison of the oncological outcomes of patients who underwent radical and partial nephrectomy due to renal cell cancer

Amaç Bu çalışmada renal hücreli karsinom (RHK) nedeniyle radikal ve parsiyel nefrektomi yapılan hastaların evrelere göre onkolojik sonuçlarının karşılaştırılması amaçlanmıştır. Bu amaçla klinikopatolojik özelliklerin rekürrenssiz sağkalım ve kansere özgü sağkalım üzerine etkileri incelendi. ( Sakarya Tıp Dergisi 2019, 9(2):326-336 ) Gereç ve Yöntem 2004-2012 tarihleri arasında renal kitle nedeniyle kliniğimizde parsiyel/radikal nefrektomi uygulanan T3a ve altındaki 200 hastanın verilerini retrospektif olarak inceledik. Klinikopatolojik özelliklerin sağkalımlar üzerine istatistiksel etkileri olup olmadığı Log-Rank testi kullanılarak Kaplan Meier sağkalım analizi ile değerlendirildi. Her bir değişkene ilişkin 1- 3 ve 5 yıllık sağkalım hızları, ortalama yaşam süresi ve bu süreyle ilişkili %95 güven aralıkları hesaplandı. Bulgular Tüm olgular içerisinde 1- 3 ve 5 yıllık rekürrenssiz sağkalım % 95.5, 90.5 ve 85.5, kansere özgü sağkalım % 98.8, 96.4 ve 92.3 olarak tespit edildi. PN grubunda RN grubuna göre rekürrenssiz sağkalım istatistiksel olarak daha yüksekti (p=0,014) ama kansere özgü sağkalımda fark gözlenmedi. Evrelere göre T1a, T1b ve T3a’ da rekürrrenssiz sağkalım ve kansere özgü sağkalım T2a ve T2b’ den daha yüksekti (p=0,023 ve p<0,001). T1a ve T1b evrelerinde 1- 3 ve 5 yıllık rekürrenssiz sağkalım ve kansere özgü sağkalım benzer olarak bulundu ve klinikopatolojik özelliklerle istatistiksel olarak ilişki tespit edilmedi. Tüm olgular içerisinde patolojik tümör boyutu (p=0,026)’ nun rekürrenssiz sağkalımı etkilediği görüldü. Tüm olgular içerisinde multivariate analizlerde yaş (p=0,010) ve patolojik tümör boyutunun (p=0,018) kansere özgü sağkalımı etkilediği görüldü. Sonuç T1a ve T1b böbrek tümörlerinde parsiyel nefrektomi ve radikal nefrektomi yapılan hastalar arasında rekürrenssiz ve kansere özgü sağkalımların benzer olduğu gözlendi ve prognozunun herhangi bir klinikopatolojik özellikten etkilenmediği gözlendi. Klinikopatolojik ve demografik özelliklerin ileri evrelerde sağkalımla ilişkili olabileceği düşünüldü.Objective In this study, we aimed to compare the oncologic results of patients who underwent radical and partial nephrectomy due to renal cell carcinoma (RCC). The effects of clinicopathological features on recurrence-free survival and cancer-specific survival were investigated. ( Sakarya Med J 2019, 9(2):326-336 ). Materialsand Method We retrospectively analyzed the data of 200 patients who underwent partial / radical nephrectomy T3a and under between 2004-2012. Kaplan Meier survival analysis was used to evaluate the clinical effects of the clinicopathological features on survival by Log-Rank test. 1 - 3 and 5 - year survival rates, mean survival time and 95% confidence intervals for this time were calculated. Results When all the cases were evaluated, 1 - 3 and 5 - year recurrence - free survival was 95.5%, 90.5 and 85.5, cancer - specific survival was 98.8%, 96.4 and 92.3%. Recurrence-free survival between groups was statistically higher at PN (p = 0.014), but not differences were in cancer-specific survival. Recurrence-free and cancer-specific survival according to the stages was higher in T1a, T1b and T3a than T2a and T2b (p=0,023 ve p<0,001). 1- 3 and 5-year recurrence-free survival and cancer-specific survival were similar in T1a and T1b stages and this stages are not associated with clinicopathological features. In all cases of pathologic tumor size (p = 0.026) was observed to affect recurrence-free survival. In all cases multivariate analysis, of the age (p = 0.010) and pathological tumor size (p = 0.018) was observed to affect cancer-specific survival. Conclusion Recurrence-Free and Cancer-Specific Survival rates were similar between patients who underwent radical nephrectomy and partial nephrectomy for T1a and T1b renal cell carcinoma and was not affected by any of the clinicopathological prognostic feature. Clinicopathological and demographic characteristics may be associated with survival in advanced stages

Robotic-assisted Laparoscopic Transperitoneal Adrenalectomy: Outcomes of Initial Five Patients

Objective: To report the outcomes of transperitoneal robotic adrenalectomy (RA) procedures in five initial cases performed at two institutions. Methods: Between March 2012 and November 2014, five patients underwent RA. A transperitoneal approach was taken by using the da Vinci-S four-arm surgical robot. Outcomes were assessed retrospectively. Results: Mean patient age was 42.6±5.1 (range: 34-47) years. Mean body mass index was 30.5±4.5 (range: 23.2-35.2) kg/m². Median tumour size detected on radiological imaging was 3.1±1.7 (range: 1.2-6.0) cm. Mean operation time was 129.0±12.4 (range: 120-150) minutes and median estimated blood loss was 100.0±119.3 (range: 50-350) ml. No intraoperative or perioperative complications occurred according to the modified Clavien complication scale. Median duration of hospital stay was 2.0±1.7 (range: 2-6) days. The fourth robotic arm was used in two patients. Histopathology results demonstrated: metastasis of renal cell carcinoma occurred in 1 case, adrenal cortical adenoma in 2 cases, pheochromocytoma in 1 case, and hyperplasia in 1 case. After a median follow-up of 17.0±15.0 (range: 3-40) months, no local recurrence was detected. Conclusion: RA is a safe minimally invasive surgical approach that has excellent surgical and oncological outcomes in the treatment of adrenal masses <7 cm in size

Invasive Fungal Infections in Children with Leukemia: Clinical Features and Prognosis

Objective: The incidence of invasive fungal infections (IFIs) has increased due to intensive chemotherapy in childhood leukemia. The aim of this study was to evaluate the incidence, risk factors, causative pathogens, and impact on survival of IFIs among pediatric leukemia patients. Materials and Methods: The hospital records of 307 children with acute lymphoblastic leukemia (ALL, n=238), acute myeloid leukemia (AML, n=51), and relapsed leukemia (n=18) between January 2010 and December 2015 were retrospectively evaluated. Results: A total of 1213 febrile neutropenia episodes were recorded and 127 (10.4%) of them were related to an IFI. Of 307 children, 121 (39.4%) developed IFIs. The mean age was significantly older in the IFI group compared to children without IFIs (p<0.001). IFIs were defined as possible, probable, and proven in 73.2%, 11.9%, and 14.9% of the attacks, respectively. Invasive aspergillosis (81.9%) was the most frequent infection, followed by invasive candidiasis (13.4%) and rare fungal diseases (4.8%). The majority of IFI attacks in both ALL and AML occurred during the induction phase. In total, the death rate was 24% and the IFI-related mortality rate was 18%. The mortality rate among children with IFIs was found to be significantly higher than that of children without IFIs (p<0.001). Overall and event-free survival rates at 5 years were also found to be significantly lower in the IFI group (p<0.001). Relapse (odds ratio: 8.49) was the most effective risk factor for mortality, followed by developing an IFI episode (odds ratio: 3.2) and AML (odds ratio: 2.33) according to multivariate regression analysis. Conclusion: Our data showed that IFIs were more common in older children. Although proven and probable IFI episodes were more frequently diagnosed in cases of relapse and AML, children with ALL and AML had similar frequencies of experiencing at least one episode of IFI. Rare fungal diseases were also identified as a major problem. Despite success in treatment, IFIs increased the rate of mortality in children with acute leukemia