Biomedical subjects

Cengiz Miroglu

Publications and source records attributed to Cengiz Miroglu.

14 recordsLinked to original sources

PubMed2007

The learning curve in the training of percutaneous nephrolithotomy.

OBJECTIVES: To investigate the learning curve in the training of percutaneous nephrolithotomy (PCNL). METHODS: A total of 104 PCNL cases were included in this evaluation to define the learning curve of a surgeon with no previous experience at performing solo PCNL. Two parameters of expertise were reviewed, namely the operation and fluoroscopic screening times. The operation time was calculated as the beginning of access with the needle until the nephrostomy tube was placed and secured. PCNL procedures were analyzed in seven sets of 15 cases regarding the operation and fluoroscopy times, stone size, stone clearance rate, blood transfusion rate, and estimated blood loss. RESULTS: The mean operation time was 2.4 h for the first 15 patients. It decreased to a mean of 1.5 h for cases 46 through 60. No further decrease in the operation time was observed after case 60. The fluoroscopic screening time was a peak of 17.5 min in the first 15 cases, whereas it dropped to a mean of 8.9 min for cases 46 through 60. The decline in the mean fluoroscopy screening time continued in cases 61 to 104, but the decline was not significant. There was no significant difference in stone size, stone clearance rate, blood transfusion rate, and estimated blood loss among each set of cases. CONCLUSIONS: This study suggests that the surgical competence in PCNL can be reached after 60 cases. PCNL and fluoroscopy times drop to a steady-state level after performing 60 procedures.

Clinical Competence↗

PubMed2006

The risk of urolithiasis recurrence may be reduced with anti-nanobacterial therapy.

Urolithiasis is a common disorder responsible for serious human suffering and economic cost to society. Approximately 13% of men and 7% of women in the United States will be diagnosed with urolithiasis at some time in their lives with a recurrence rate of more than 50% in 5 years. Even if some risk factors are defined for stone formation, none of them can fully explain the etiopathogenesis. A controversial pathogen bacteria called 'nanobacteria' (NB) has been associated with several diseases including stone formation in some studies. It is thought to be the nidi for the stone formation after its' isolation from the renal stones and the occurrence of the stone after the percutaneus renal injection of NB. The clinical trials demonstrated that the eradication of NB prevented the calcifications in coronary arteries and prostate with an acceptable level by performing a novel combination therapy called 'ComET' which comprises a tetracycline antibiotic, nutraceutical and EDTA. Based on these findings, we hypothesize that the risk of urolithiasis recurrence may be reduced with combined anti-nanobacterial therapy. Long term prospective studies should be designed for evaluating the patients with positive NB cultures. If our hypotheses can be further supported with clinical trials it may change the approach of the medical management for urolithiasis.

Anti-Bacterial Agents↗

PubMed2006

Single stage Fowler-Stephens orchidopexy: a preferred alternative in the treatment of nonpalpable testes.

In this present study we aimed to discuss the surgical efficacy of single stage Fowler-Stephens orchidopexy (FSO) technique, with an emphasis on its practical and logical application that may be kept in mind during a standard orchidopexy procedure. Twenty-two children have undergone a single stage FSO procedure for nonpalpable testes during the last 9 years in our department. Surgical procedure was initiated with a standard inguinal oblique incision keeping in mind that depending on the position and the anatomic features of the testes a FSO method might be needed. While an excellent result was defined as a testis with good scrotal position, size and adequate blood flow on Doppler sonogram, acceptable result was a palpably normal sized testis in a high scrotal position with adequate blood supply and lastly an unacceptable result was the atrophy of the testis with compromised blood supply. During regular follow-up visits although some cases revealed testicular atrophy; long-term examination (12 months) did show that majority of the testes maintained their normal position and tissue consistency (21/24, 87.5%). Due to the necessity of surgical approach either in the evaluation or the treatment of nonpalpable testes in most cases along with the unsatisfactory data of the time consuming and invasive radiological procedures; we believe that a classical orchidopexy approach together with further single stage FSO will be a rational and satisfactory algorithm in the majority of such cases.

Child, Preschool↗

PubMed2006

Evaluation of bone mineral density after ileocystoplasty in children with and without myelomeningocele.

We evaluated the bone mineral density (BMD) after ileal augmentation cystoplasty in a group of children with and without myelomeningocele. Between 1996 and 2003, eight patients with neurogenic bladder and seven patients with non-neurogenic bladder underwent augmentation ileocystoplasty. Preoperative and postoperative serum creatinine and electrolytes were measured. All patients underwent clinical evaluation, supine height measurement, blood gas analysis, and BMD measurement using a dual energy X-ray absorptiometry (DEXA) postoperatively. BMD was measured at L1-L4 and femoral neck, and compared to age- and sex-matched population. Follow-up time was calculated from the day of surgery to the day of DEXA performance. A total of eight boys and seven girls with the mean age of 10.2 +/- 4.1 years were evaluated with respect to BMD measurement. Mean age was 9.8 years in neurogenic group and 10.5 in non-neurogenic group. Mean follow-up was 728 and 616 days in neurogenic and non-neurogenic groups, respectively. There were no significant differences between ages, follow-up times, preoperative and postoperative creatinine levels, pH and bicarbonate values, and supine heights. Mean BMD at L1-L4 was 55.7% in neurogenic group and 83.8% in non-neurogenic group. There was a statistically significant difference between the two groups (P = 0.02). Mean BMD at femoral neck was 72% in neurogenic group and 86.2% in non-neurogenic group. The difference was also statistically significant (P = 0.028). After augmentation ileocystoplasty, the BMD in early postoperative period of patients with myelomeningocele is lower than the patients with non-neurogenic neurogenic bladder, which have the same clinical characteristics except the neurologic pathology. In the light of our findings and the reported literature data as well, we may claim that BMD decrease after augmentation ileocystoplasty depends more on the underlying neurologic pathology and its locomotor consequences rather than the enterocystoplasty itself.

Absorptiometry, Photon↗

PubMed2006

Testicular blood flow measurements and mean resistive index values after microsurgical and high ligation varicocelectomy.

OBJECTIVES: To compare the effects of the two most commonly used surgical methods in the management of varicocele disease, namely, microsurgery and high-ligation varicocelectomy, on testicular blood flow changes and mean residual index values in a prospective randomized study. METHODS: A total of 56 patients clinically diagnosed with varicocele were randomized into two groups: 28 were selected for high-ligation surgery and 28 for microsurgery. The testicular blood flow was evaluated in all patients before and 7 days after surgery, and the maximal flow velocity (Vmax), minimal flow velocity, and resistive index were measured. The data assessment was performed using the paired t test, and independent t test was used in comparison of the two groups. RESULTS: No significant difference was detected between the preoperative resistive index, Vmax, and minimal flow velocity of the two groups. The values of the same parameters measured 7 days postoperatively were also not significantly different. The preoperative and postoperative comparison of the three parameters within the microsurgery group revealed no difference, although the postoperative Vmax was significantly lower than the preoperative Vmax in the high-ligation group. CONCLUSIONS: Our data have shown that no significant impairment in testicular circulation results after low microsurgical varicocele repair compared with high ligation.

Adult↗

PubMed2006

Accessory scrotum with multiple skeletal abnormalities.

Accessory scrotum is very uncommon. Here we report a 5-year old Caucasian boy presenting with an accessory scrotum localized to the left side of the pubic area. The penis and the primary scrotum were completely normal, containing two dependent testicles. On the right side of the body there was type B proximal femoral focal deficiency and there was also diastasis of the symphisis pubis. As observed in this case, abnormalities of two different embryological organ systems (accessory labioscrotal fold and proximal femoral focal deficiency) may occur concurrently at the same intrauterine time point as part of an overall embryologic mesenchymal disorder.

Abnormalities, Multiple↗

PubMed2006

Operative failure during ureteroscopic pneumatic lithotripsy: factors affecting successful outcome.

AIM: We aimed to evaluate the predictive factors that would in turn indicate stone migration and the effects of these factors on the ultimate success of the intervention. METHOD: Patients were divided into two groups with respect to the migration of the stone treated. Group I: patients demonstrating stone migration during manipulation; group II: no migration of the stones noted. In the second phase of the study, the results of ureteroscopic management in 433 patients were evaluated with respect to the success rates obtained. Parameters such as stone size, stone burden, experience of the surgeon, length of the ureter proximal to the stone treated, and lastly transverse diameter of the ureter were noted in all patients as possible risk factors for stone migration. RESULTS: Statistical analysis of ureteroscopic success in all patients revealed that there was a meaningful correlation with respect to the length of the proximal ureteral portion (p < 0.0001) and surgeon's experience (p = 0.004). p value for the correlation between stone burden and operative success was 0.056. There was no significant correlation between stone size (p = 0.51), ureter diameter (p = 0.78), and operative success. CONCLUSION: Stones that are close to the renal pelvis and treated by inexperienced physicians are the ones most likely to migrate to the renal pelvis during manipulation with pneumatic lithotripsy.

Adolescent↗

PubMed2005

Effect of acute alcohol intake on prostate tissue and serum PSA-like protein levels in rats.

OBJECTIVE: To investigate both the possible changes induced by acute alcohol intake on prostate tissue at the ultrastructural level and its effect on serum prostate-specific-antigen (PSA)-like protein levels in rats. MATERIALS AND METHODS: 44 male Wistar rats were included in the study in four separate groups; 7 treatment and 4 control animals were selected for each group. The treatment group received 40% ethanol (6 g/kg) while the control group was injected with the same dose of intraperitoneal isotonic saline. The first group was sacrificed after 3 h, the second group after 24 h, the third group after 72 h and the fourth group on day 7. Samples were examined by light and Jeol-100 electron microscope. Total serum PSA-like protein levels were determined by a Tosoh immunoenzymometric analyzer AIA 600. RESULTS: In groups 1-3, electron microscopy showed dilatations in the endoplasmic reticulum cisternae of prostatic acinar cells, disarrangements in apparent Golgi complex and apertures belonging to the basal labyrinth. It was also observed that there was a mass of debris cells inside the acinar lumen, and the secretory epithelium was detached from the basal membrane in some places. No pathology was found in group 4 by light and electron microscopy. In group 1, significant levels of increased serum total PSA-like protein were found compared to controls and other treatment groups (p = 0.006). CONCLUSIONS: The fundamental effect of acute alcohol intake on prostate tissue was observed in intermediate stages participating in the exocrine secretion process in the cellular organelles. At the same time, this influences the levels of serum PSA-like protein.

Acute Disease↗

PubMed2004

Association of positive serum anti-p53 antibodies with poor prognosis in bladder cancer patients.

AIMS: To assess the association of serum anti-p53 antibodies and overexpression of tumor p53 protein with survival and prognostic factors in patients with urinary bladder tumors. METHODS: Seventy-six patients with transitional cell carcinoma of the urinary bladder were assessed prospectively (Ta, 18; T(1), 30; > or =T(2), 28). Serum anti-p53 antibodies were detected by enzyme-linked immunosorbent assay. Tumor p53 gene overexpression was assessed by immunohistochemical staining. The mean follow-up time was 34 months. RESULTS: Serum anti-p53 antibodies were positive in 25 patients (33%). Overexpression of tumor p53 protein was positive in 41 patients (54%). There was an association between the presence of serum anti-p53 antibodies and tumor p53 gene overexpression (P = 0.001). The total survival of the patients with positive serum anti-p53 antibodies was shorter than the patients with positive tumor p53 gene overexpression (P < 0.001, P = 0.344, respectively). In the multivariate survival analysis, both tumor stage and serum-p53 antibodies were found to be independent survival predictors (P = 0.004, P = 0.006, respectively). CONCLUSION: Serum anti-p53 antibody positive tumors had a worse prognosis than those with negative serum levels, regardless of the p53 status of the tumor.

Adult↗

PubMed2004

Importance of serum p53 antibodies during follow-up after treatment of invasive bladder tumors.

INTRODUCTION: To investigate the prognostic importance of the changes in serum p53 antibody titrations during follow-up of patients who had anti-p53 antibody-positive invasive bladder tumors with transitional epithelial cells. MATERIALS AND METHODS: The study group consisted of 23 clinically T3</=, N0, M0 patients with positive serum anti-p53 antibodies before treatment. 23 cases with negative serum anti-p53 antibodies who were comparable in age, comorbidity and stage with the study group were selected as a control group. The cases whose serum anti-p53 titrations decreased to normal levels after treatment were compared for metastases, death rates and survival with cases who remained serum anti-p53-positive and those who were serum p53 antibody-negative before treatment. Serum anti-p53 antibody titration was determined by ELISA. RESULTS: While serum anti-p53 antibody titrations became negative in 8 (35%) of the 23 seropositive patients, it did not change in 15 patients (65%). There was a correlation between the maintenance of seropositivity, local progression/metastasis and death (p < 0.05). Survival was found to be better in cases who were seronegative after treatment compared with cases who remained positive and also those who were seronegative before treatment (p < 0.05). CONCLUSION: The normalization of serum anti-p53 antibody positivity after treatment of invasive bladder tumors seems to be a good and reliable prognostic indicator.

Adult↗

PubMed2004

Relation between serum anti-p53 antibodies and microvessel density in bladder cancer patients.

INTRODUCTION: Etiology of serum anti-p53 antibodies in bladder cancer patients is still unknown. In this study we evaluated the relationship between serum anti-p53 antibodies and microvessel density in bladder cancer patients. MATERIALS AND METHODS: Seventy-six patients with transitional cell carcinoma of the urinary bladder were assessed prospectively (18 Ta, 30 T1, 28 T2>or =). Serum anti-p53 antibodies were detected by enzyme-linked immunosorbent assay. Tumor p53 overexpression was assessed by immunohistochemical staining. Vessels were stained immunohistochemically using an antibody against platelet endothelial cell-adhesion molecule CD31. Spearman correlation test and t test were used for statistical analysis. RESULTS: Serum anti-p53 antibodies were positive in 25 (60%) of 41 tumor p53-positive patients. While the mean (SD, range) microvessel density was found to be 43 (7.59, 8-99) in patients who had positive serum anti-p53 antibodies, it was found to be 23 (4.53, 6-98) in patients who had negative serum anti-p53 antibodies. There was a good correlation between serum anti-p53 antibodies and microvessel density (p<0.05). No correlation was found between tumor p53 expression and microvessel density (p>0.05). CONCLUSIONS: We found that there is a significant correlation between the microvessel density and serum anti-p53 antibodies. This result may show the role of angiogenesis in the etiology of serum anti-p53 antibodies in bladder cancer patients.

Adult↗

PubMed2003

Prostate mucinous adenocarcinoma with signet ring cell.

Prostate mucinous adenocarcinoma with signet ring cell is a rare neoplasm with only 11 cases reported to date. We present the 12th case of prostate mucinous adenocarcinoma with signet ring cell. The case was detected incidentally as a result of a biopsy taken from a lesion in the prostatic urethra during a urethrocystoscopy of a 47-year-old male patient who underwent an internal urethrotomy operation due to urethrostenosis. Endoscopic examination showed a loose, spongy, gray-white structure covering the prostatic urethra, especially the right lobe of the prostate. The diagnosis resulting from the pathological examination of the biopsy was prostate mucinous adenocarcinoma with signet ring cell. A total of 50 Gy radiotherapy was applied to the patient. In the 27th month of follow-up after treatment, thoracoabdominal computed tomography, bone scintigraphy, and tumor markers (PSA, CEA and CA19-9) were found to be normal.

Adenocarcinoma, Mucinous↗

PubMed2002

Neurapraxic complications in operations performed in the lithotomy position.

In this study, we assessed the incidence and risk factors associated with lower extremity neurapraxia in operations performed in the lithotomy position. A total of 1170 patients, who were operated on in the lithotomy position, were evaluated retrospectively. During the post-operative neurological evaluation, those patients who developed neuropraxic complications were reviewed in detail to identify those with lower extremity sensory and motor deficiencies. The electromyographic (EMG) results of the patients with neurological deficiencies were evaluated. The patients were studied with respect to age, length of operation, type of operation and mode of anaesthesia. Fischer's Exact Probability Test was used for the statistical analyses. Post-operative neurapraxia complications developed in 12 of the patients (1.02%). Of these cases, two had irreversible neurological deficiencies. All other patients recovered without any treatment during the first post-operative month. No correlation was discovered between the type of anaesthesia used and neurapraxia (P> 0.05). However, it was found that age, type of operation and operation time contributed to neurapraxia developing (P < 0.05). Old age (older than 70), prolonged operation time (more than 180 min) and an inappropriate lithotomy position were seen as the main risk factors in developing post-operative neurapraxia. Mistakes in the positioning of the operating staff might be an additional contributing factor.

Aging↗

PubMed2002

Extensive bilateral renal pelvis, ureter and bladder leukoplakia.

We are presenting a case of leukoplakia spread to the bilateral renal pelvis, ureter and bladder in a 52-year-old woman. We believe this case is important because it involves leukoplakia that is more extensive than in any cases previously cited in the literature. No other possible etiologic cause except a heavy smoking habit was defined. Conservative follow-up was preferred to aggressive surgery.

Female↗