[Show abstract][Hide abstract] ABSTRACT: Wolfram syndrome, seen in 1/770000 of the population is an autosomal recessive dysmorphogenetical disease with unknown pathogenesis. It is characterized with the association of diabetes insipidus, diabetes mellitus, optic atrophy and deaf-ness, and also known as DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness). Patients demonstrate diabetes mellitus followed by optic atrophy in the first decade, diabetes insipidus and sensorineural deafness in the second decade, dilated renal outflow tracts early in the third decade, and multip-le neurological abnormalities early in the fourth decade. We present a boy 14 ye-ars old who had been followed-up with the diagnosis of Wolfram syndrome in this article. He had been followed-up with juvenile-onset diabetes mellitus for 9 years. Physical and laboratory exam revealed neurogenic bladder, deafness and optic de-fect. We emphasize the importance of family screening regarding the early diag-nosis of Wolfram syndrome in the other individuals of the family since the disea-se shows an autosomal recessive inheritance.
[Show abstract][Hide abstract] ABSTRACT: The severe ischemia or necrosis of the glans penis is a rarely seen complication after circumcision. We report the case of a 7-year-old boy with severe glans penis ischemia occurring 24 hours after circumcision with local anesthesia (0.1% xylocaine containing ephedrine). His hemogram and levels of proteins C and S and fibrinogen were normal, but the D-dimer level was higher than normal (2.57 mg/L; normal level 0-0.5 mg/L). Normal blood flow was indicated on color Doppler ultrasonography. The severe ischemia in the glans penis was successfully treated with subcutaneous injection of enoxaparin (low-molecular-weight heparin) for 5 days, and the appearance of the glans was close to normal on the fifth day. The patient did not require any surgical intervention and was discharged without sequelae. As a result, we consider that ischemia of the glans penis may initially be managed with enoxaparin, especially in cases in which the D-dimer level is higher than normal.
[Show abstract][Hide abstract] ABSTRACT: Some biopsy techniques may cause oxidative stress. Therefore, we aimed to evaluate the possible role of testicular biopsy-induced damage on production of reactive oxygen species using quantitative and biochemical methods. Adult male Wistar albino rats were randomly divided into five groups. Group 1 (sham) (n = 6) was sham operated. Group 2 (n = 7) underwent fine-needle aspiration testicular biopsy. Group 3 (n = 6) underwent microscopic testicular sperm extraction (micro-TESE). Open testicular biopsy was performed to rats in group 4 (macro-TESE) (n = 8). Group 5 (n = 7) underwent Tru-cut biopsy. Six weeks after the initial operations, orchiectomies were performed. Oxidative stress biomarkers such as superoxide dismutase (SOD) and catalase (CAT) activities, and malondialdehyde (MDA) in biopsy samples were measured as spectrophotometric. Compared with group I, SOD and CAT activities, and MDA levels were elevated significantly in the fine-needle aspiration group, in the macro-TESE group and in the Tru-cut biopsy group (groups II, IV, and V), (p < 0.05). However, there were no significant differences between group I and group III (p > 0.05). These data suggest that micro-TESE biopsy is the best technique among all others. All of the biopsy techniques except micro-TESE may cause the overproduction of reactive oxygen species. We consider that the increased antioxidant enzyme activities (CAT, SOD) may reflect the cellular response against oxidative stress in these groups.
No preview · Article · Jan 2013 · Indian Journal of Surgery
[Show abstract][Hide abstract] ABSTRACT: Purpose. Fournier’s gangrene is a fulminant and destructive inflammation of the scrotum, penis, and perineum. The objective of this study was to compare 2 different approaches to wound management after aggressive surgical debridement. Methods. Data from 14 patients with Fournier’s gangrene were retrospectively collected (2005–2011). Once the patients were stabilized following surgery, they were treated with either daily antiseptic (povidone iodine) dressings (group I, 𝑛 = 6 ) or dressings with dakin’s solution (sodium hypochloride) (group II, 𝑛 = 8 ). Results. The mean age of the patients was 68.2 ± 7.8 (55–75) years in group I and 66.9 ± 10.2 (51–79) years in group II. Length of hospital stay was 13 ± 3.5 (7–16) days in group I and 8.9 ± 3.0 (4–12) days in group II ( 𝑃 < 0 . 0 5 ). The number and rate of mortality was 1/6 (16.7%) in group I, and 1/8 (12.5%) in group II. Conclusions. The hospitalization time can be reduced with the use of dakin’s solution for the dressings in the treatment of FG. Also, dressings with dakin’s solution seems to have favorable effects on morbidity and mortality. Consequently dakin’s solution may alter the treatment of this disastrous disease by reducing cost, morbidity and mortality.1. IntroductionFournier’s gangrene (FG) is a fulminant necrotizing fasciitis of the genitalia that progresses from erythema to necrosis . A bacterial infection spreads quickly from the urinary tract and anorectal area and causes gangrene due to thrombosis of small subcutaneous vessels. It can spread from the external genitalia through the inguinal region towards the thighs and finally to the peritoneum along the fascia . Anorectal and urogenital infections and trauma play an important role in the etiology. Diabetes mellitus (DM), steroid use, older age, chronic ethanol abuse, malignancies, liver and kidney diseases, local traumata, and obesity have been found as risk factors for FG [3–5]. Despite the development of knowledge regarding the etiology, diagnosis, treatment, and intensive care techniques, the mortality rate of FG patients is still approximately 15–50% [6, 7].Treatment involves surgical debridement of all infected and necrotic tissues and administration of broad-spectrum antibiotics . Following radical excision, a wide variety of approaches are used to manage the wound until healing is complete . Dakin's solution (sodium hypochlorite) was originally developed to treat battlefield wounds. It was used during the 20th century for cleansing and disinfecting wounds . Dakin's solution is effective against a broad spectrum of aerobic and anaerobic organisms and fungi, including organisms now highly resistant to systemic antibiotics [11, 12].The purpose of our study was to compare the effect of conventional (povidone iodine) dressings and dressings with dakin’s solution on wound healing and patient survival of FG patients.2. Materials and Methods
The medical records of 14 consecutive patients admitted to the Department of Urology between 2005 and 2011 were retrospectively reviewed. After having acquired ethical approval, data were collected from patients with FG. Patient charts were reviewed, and the parameters such as age, predisposing condition, necessity of diverting colostomy and cystostomy, necessity of orchidectomy, hospitalization time, localization of lesion, number of debridements, and morbidity and mortality rates were recorded.The diagnosis of FG was defined according to the International Classification of Diseases, 10th Revision (ICD-10) and was based on patient history, clinical symptoms, and findings, that is, rash, swelling, and erythema. Immediately after admission, 3rd-generation cephalosporin and metronidazole were used for treatment, and antibiotherapy was adjusted according to culture results. All patients underwent surgical debridement as soon as possible. Following initial removal of necrotic and devitalized tissue, the wounds were postoperatively covered with conventional antiseptic dressings (impregnated with a povidone iodine solution) or with dakin’s solution (0.025% sodium hypochlorite solution). Additional debridements were performed in the case of progressive tissue necrosis. Group I patients continued to be treated with conventional antiseptic dressings until wound beds were clean and healthy and wounds could be closed. Dressings with Dakin’s solution were made in group II patients. Local wound conditions had to meet the same requirements in groups I and II before the wounds were closed.All data were collected and analyzed by using SPSS version 15.0.3. ResultsAll patients in both groups were males. Group 1 was the conventional dressing group. This group were included 6 patients, and the mean age was 68.2 ± 7.8 (range 55–75). Group 2 (dakin’s group) were included 8 patients. Mean age in this group was 66.9 ± 10.2 (range 51–79). There were no significant differences between the 2 groups in the predisposing factors. Overall, predisposing factors were diabetes mellitus in 6 patients (42.9%) and malignancy in 3 patients (21.4%). Only one patient (7.1%) had a history of urethral stricture. Approximately 30% of our patients did not have any predisposing disease. Of the lesions 50.0% ( 𝑛 = 7 ) were located in the scrotum and 28.6% ( 𝑛 = 4 ) in perineal and 21.4% ( 𝑛 = 3 ) in perianal region. The patients’ clinical features are summarized in Table 1.
[Show abstract][Hide abstract] ABSTRACT: To compare reactive oxygen species (ROS) and antioxidants in internal spermatic vein tissue of men with varicocele and a control group with inguinal hernia. Also to compare the levels of oxidants and antioxidants in infertile and fertile men with varicocele.
48 varicocele patients and 12 non-varicocele inguinal hernia patients participated in this study. The varicocele group was again divided into two groups--fertile men with varicocele and infertile men with varicocele. Internal spermatic vein tissue samples were obtained. The level of the malondialdehyde (MDA), an indicator of oxidative stress, and the activities of antioxidant enzymes (defense systems) against oxidative stress such as superoxide dismutase (SOD) and catalase (CAT) were estimated in these tissue samples.
The mean level of MDA in the varicocele group was significantly higher than in the hernia group, whereas the levels of antioxidants (SOD and CAT) were significantly lower in the varicocele group than in the hernia group. When compared with the subgroups of the varicocele group, the MDA levels and SOD and CAT activities were significantly higher in the infertile varicocele group than in the fertile varicocele group.
Antioxidant enzyme levels generally decrease due to a high consumption in varicocele patients. On the contrary, in our study both MDA and antioxidant enzymes increased in the internal spermatic venous wall of infertile varicocele patients. This situation may be explained by an adaptation against oxidative stress in varicocele, which could be defined as a chronic process.
No preview · Article · Nov 2011 · Urologia Internationalis
[Show abstract][Hide abstract] ABSTRACT: Pyonephrosis can be defined as the presence of purulent urine in the
dilated renal collecting system. Previously healthy 20-year-old
male patient was admitted to our clinic witlı left flank pain.
Intravenous pyelography showed no function in the left kidney.
Computed tomography sean revealed significant amount of
echogenic material and multiple calculi in the dilated left
pelvi-calyceal system. Additionally renal parenchymal thickness
was decreased. Pyonephrosis was diagnosed and left nephrectomy
was performed due to non-functioning k:idney. Depending on the
development of imaging techniques pyonephrosis is rare in today's
urology practice. Pyonephrosis should be suspected when elinical
symptoms such as fever and flank pain is together w ith radiological
evidence of obstruction of the collecting system