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Öğe Active surveillance of small renal masses: progression patterns of early stage kidney cancer(Galenos Yayincilik, 2011) Atasoy, Nursen; Ayan, SemihBackground: Most early stage kidney cancers are renal cell carcinomas (RCCs), and most are diagnosed incidentally by imaging as small renal masses (SRMs). Indirect evidence suggests that most small RCCs grow slowly and rarely metastasize. Objective: To determine the progression and growth rates for newly diagnosed SRMs stratified by needle core biopsy pathology. Design, Setting, and Participants: A multicenter prospective phase 2 clinical trial of active surveillance of 209 SRMs in 178 elderly and/or infirm patients was conducted from 2004 until 2009 with treatment delayed until progression. Intervention: Patients underwent serial imaging and needle core biopsies. Measurements: We measured rates of change in tumor diameter (growth measured by imaging) and progression to >= 4 cm, doubling of tumor volume, or metastasis with histology on biopsy. Results and limitations: Local progression occurred in 25 patients (12%), plus 2 progressed with metastases (1.1%). Of the 178 subjects with 209 SRMs, 127 with 151 SRMs had>12 mo of follow-up with two or more images, with a mean follow-up of 28 mo. Their tumor diameters increased by an average of 0.13 cm/yr. Needle core biopsy in 101 SRMs demonstrated that the presence of RCC did not significantly change growth rate. Limitations included no central review of imaging and pathology and a short follow-up. Conclusions: This is the first SRM active surveillance study to correlate growth with histology prospectively. In the first 2 yr, the rate of local progression to higher stage is low, and metastases are rare. SRMs appear to grow very slowly, even if biopsy proven to be RCC. Many patients with SRMs can therefore be initially managed conservatively with serial imaging, avoiding the morbidity of surgical or ablative treatment.Öğe Analysis of a 1-year-old cystinuric patient with recurrent renal stones(BLACKWELL PUBLISHING, 2006) Tanzer, Fatos; Ozgur, Arzu; Bardakci, Fevzi; Cankorkmaz, Levent; Ayan, SemihCystinuria is a hereditary disorder of cystine and dibasic amino acids (lysine, arginine, ornithine) transport across the luminal membrane of renal tubules and intestine, resulting in recurrent nephrolithiasis. Cystine stones frequently occur in the second or third decade of life with an occasional occurrence in infancy and in old age. Herein is presented the case of a 1-year-old girl with cystinuria and recurrent urolithiasis; the genetic basis of the disease was investigated by mutational analysis of the SLC3A1 gene. The data show that the present patient has an increased cystine (923.08 mu g/mL) level and was heterozygote for M467T mutation.Öğe Case report: Nonobstructive giant urethral stone with two safety pins(SPRINGER, 2003) Gokce, Gokhan; Topsakal, Kahraman; Ayan, Semih; Kilicarslan, Hakan; Gokce, Seyda Figul; Gultekin, Emin YenerThe urethra can be the site of various types of foreign bodies. A 61-year-old man having a giant urethral stone with two safety pins was evaluated according to the literature. To our knowledge, we report the first case of foreign bodies in urethra in which existing non-obstructive giant urethral stone with two safety pins.Öğe Case report: Nonobstructive giant urethral stone with two safety pins(Springer Netherlands, 2003) Gokce, Gokhan; Topsakal, Kahraman; Ayan, Semih; Kilicarslan, Hakan; Gokce, Seyda Figul; Gultekin, Emin YenerThe urethra can be the site of various types of foreign bodies. A 61-year-old man having a giant urethral stone with two safety pins was evaluated according to the literature. To our knowledge, we report the first case of foreign bodies in urethra in which existing non-obstructive giant urethral stone with two safety pins. © 2004 Kluwer Academic Publishers.Öğe A comparison of sedation with dexmedetomidine or propofol during shockwave lithotripsy: A Randomized controlled trial(LIPPINCOTT WILLIAMS & WILKINS, 2008) Kaygusuz, Kenan; Gokce, Gokhan; Gursoy, Sinan; Ayan, Semih; Mimaroglu, Caner; Gultekin, YenerBACKGROUND: Dexmedetomidine, because it has both sedative and analgesic properties, may be suitable for conscious sedation during painful procedures. Extracor-Poreal shockwave lithotripsy (ESWL) is a minimal to mildly painful procedure that requires conscious sedation. We thus evaluated the utility of dexmedetomidine compared with propofol during an ESWL procedure. METHODS: Forty-six patients were randomly allocated into two groups to receive either dexmedetomidine or propofol for elective ESWL. Dexmedetomidine was infused at 6 mu g center dot kg(-1) center dot h(-1) for 10 min followed by an infusion rate of 0.2 mu g center dot kg(-1) center dot h(-1). Propofol was infused at 6 mg center dot kg(-1) center dot h(-1) for 10 min followed by an infusion of 2.4 mg center dot kg(-1) center dot h(-1). Fentanyl 1 mu g/kg IV was given to all patients 10 min before ESWL. Pain intensity was evaluated with a visual analog scale at 5-min intervals during ESWL (10-35 min). Sedation was determined using the Observer's Assessment of Alertness/Sedation. The Observer's Assessment of Alertness/ Sedation scores and hemodynamic and respiratory variables were recorded regularly during ESWL (35 min) and up to 85 min after. RESULTS: Forty patients were evaluated. Visual analog scale values with dexmedetomidine were significantly lower than those with propofol only at the 25-35 min assessments (P < 0.05). During sedation, the respiratory rate with dexmedetomidine was significantly slower but Spo(2) was significantly higher than with propofol (P < 0.05). Other clinical variables were similar (P > 0.05). CONCLUSION: A combination of dexmedetomidine with fentanyl can be used safely and effectively for sedation and analgesia during ESWL.Öğe Contractile responses of urinary bladder in an experimental model of chronic renal failure(ASSOC BASIC MEDICAL SCI FEDERATION BOSNIA & HERZEGOVINA SARAJEVO, 2012) Bicer, Huseyin; Korgali, Esat; Gokce, Gokhan; Ayan, Semih; Yildirim, Sahin; Gultekin, E. YenerChronic kidney disease is a public health problem with increasing prevalence caused by diabetes, hypertension and glomerulonephritis. Number of publications investigate the lower urinary tract dysfunction due to CKD is limited. There is a high incidence of bladder dysfunction of different degrees in patients with renal failure. Mechanism of the lower urinary tract dysfunction in these patients is not well known. In this study, we aimed to investigate the effects of CKD on detrusor function in a rat model of CKD. In our study, 20 Wistar Albino rats have been divided into two groups as CKD and control groups. To the experiment group, left partial nephrectomy and right nephrectomy have been applied. CKD confirmation has done with the BUN and creatinin values from the blood of the rats. The bladder strips were prepared from the CKD and control groups and its contractile responses were evaluated in-vitro. There wasn't a considerable difference with the contractile responses caused by carbachol, KCL. There was a considerable increase in the contractile responses caused by ATP, ADP and electrical field stimulation on the behalf of the CKD group. The present study demonstrated that isolated DSM of CKD group showed significantly increased contraction responses to purinergic agonists ADP, ATP and atropine resistant component in electrical field stimulation-induced contractions as compared to those of the control group. Bladder overactivity and reduced bladder volume in CKD patients might be due to the change in purinergic system. (C) 2012 Association of Basic Medical Sciences of FBH. All rights reservedÖğe Effect of angiotensin-converting enzyme inhibition and angiotensin II type 1 receptor blockade on apoptotic changes in contralateral testis following unilateral testicular torsion(SPRINGER, 2008) Gokce, Gokhan; Karboga, Hasan; Yildiz, Esin; Ayan, Semih; Gultekin, YenerIn this experimental study, our aim was to determine whether angiotensin-converting enzyme (ACE) inhibition and angiotensin II type 1 (AT1) receptor blockade affect the apoptotic changes in contralateral testis following unilateral testicular torsion (UTT). Study groups consisted of 30 adult male Wistar rats. The rats were randomly separated into five groups. Group 1 was maintained as control without manipulation. Group 2 underwent the sham operation. Torsion was created by rotating the left testis 720 clockwise for 4 h and maintained by fixing the testis to the scrotum in the other groups. Group 3 underwent torsion and detorsion, with saline administration after detorsion. In group 4, the same surgical procedure was done as in the detorsion group, but AT1 receptor blocker (losartan 30 mg/kg) was injected intraperitoneally for 60 min before detorsion. In group 5, the same surgical procedure was done as in the detorsion group, but ACE inhibitor (lisinopril 50 mg/kg) was injected intraperitoneally for 60 min before detorsion. Bilateral testes were removed from each rat 24 h after surgery. Apoptosis was assessed in paraffin-embedded sections stained for TUNEL method. Reticulum staining was performed to evaluate the extracellular changes semiquantitatively. Testicular biopsy score counts were performed on these sections according to Johnsen. The mean apoptotic scores of group 1, group 2 and group 3 were significantly higher than that of the other groups. There was no difference between the apoptotic scores of groups 1, 2, 4 and 5. Reticulum stain was increased in group 3 as compared to other groups. The mean Johnsen biopsy score of group 3 was significantly lower than that of the other groups. ACE inhibition and AT1 receptor blockade reduced the tubular damage and apoptosis in the contralateral testes after UTT. The beneficial effect of these drugs may arise from inhibition of ischemic process resulting from increased sympathetic activity and elimination of insults subsequent to dysregulation of RAS. These results suggest that ACE inhibitors and AT1 receptor blockers may be of potential value in patients with UTT.Öğe Efficacy of preventive analgesia with tramadol or lornoxicam for percutaneous nephrolithotomy: A prospective, randomized, double-blind, placebo-controlled study(ELSEVIER, 2007) Kaygusuz, Kenan; Gokce, Gokhan; Kol, Iclal Ozdernir; Ayan, Semih; Gursoy, SinanBackground: Prevention of postoperative pain provides better and more rapid convalescence for patients. Objective: The aim of this study was to compare the preventive analgesic effect of tramadol and lornoxicam in the early postoperative period in patients undergoing percutaneous nephrolithotomy (PCNL). Methods: Patients who were scheduled for elective PCNL at the Cumhuriyet University Hospital, Sivas, Turkey, were enrolled in this prospective, double-blind, placebo-controlled study. The patients were randomly assigned to 1 of 3 groups: tramadol, lornoxicam, and normal saline (NS). Ten minutes before induction of anesthesia, the tramadol group received tramadol 100 mg IV, the lornoxicam group received lornoxicam 8 mg IV, and the NS group received NS 2 mL IV. Anesthesia was induced using fentanyl 1 mu g/kg and thiopental sodium 4 to 7 mg/kg. Vecuronium 0.1 mg/kg was used for muscle relaxation. Desflurane 4% to 6% and 50%:50% oxygen/nitrous oxide were used for maintenance. Oxygen saturation, heart rate, and mean blood pressure were recorded before induction and during the postoperative period. During the postoperative period, visual analogue scale (VAS) scores, time to first analgesic (TFA), total analgesic consumption (TAC), and patient satisfaction scores were determined. Data about postoperative nausea and vomiting and other adverse events and complications were also collected. Results: Seventy-three patients were assessed for enrollment and 60 (33 women, 27 men; mean [SD] age, 44.69 [11.27] years; age range, 20-62 years) were included in the study. The baseline demographic characteristics and duration of surgery were similar in all 3 groups. The mean (SD) VAS scores in the tramadol group were significantly lower than in the NS group at 15 and 30 minutes and 1, 2, 4, and 12 hours after surgery (all, P < 0.05). The VAS scores in the lornoxicam group were significantly lower than in the NS group at 15 and 30 minutes and 1 hour (all, P < 0.05). The VAS score at 1 hour after surgery was significantly lower in the tramadol group than in the lornoxicam group (18 [8] vs 32 [16]; P < 0.05); however, there were no other significant differences in VAS scores between the active groups. A significantly shorter TFA was associated with the NS group when compared with the tramadol and lornoxicarn groups (46 [27] vs 354 [187] and 180 [118], respectively; both, P < 0.05). TFA was significantly shorter in the lornoxicarn group when compared with the tramadol group (180 [118] vs 354 [187]; P < 0.05). TAC was significantly higher in the NS group than in the tramadol and lornoxicarn groups (270 [47] vs 115 [74] and 145 [ 72], respectively; both, P < 0.05). Patient satisfaction score (range) was significantly lower in the NS group when compared with the tramadol and lornoxicarn groups (0 [0-1] vs 3 [0-3] and 2 [0-3], respectively; both, P < 0.05). There were no other significant between-group differences observed. Conclusions: Tramadol and lornoxicam were more effective than NS in preventing early postoperative pain. The preventive analgesic effect of tramadol was comparable with that of lornoxicam, except at I hour when tramadol was more effective among these patients undergoing PCNL. Both drugs were well tolerated.Öğe Epigenetic alterations and oncogenes mutations in urinary bladder carcinomas(SPRINGER, 2009) Ozdemir, Oztuerk; Yildiz, Esin; Ayan, Semih; Gul, Eylem; Gokce, Goekhan; Yildiz, Fazilet; Koksal, Binnur; Goze, Fahrettin; Gultekin, E. Yener…Öğe İzole tavşan korpus kavernozumunda diyabetin adrenerjik ve nonadrenerjik- nonkolinerjik yanıtlar üzerindeki etkileri(Cumhuriyet Üniversitesi, 1997) Ayan, Semih; Gültekin, Yener51 ÖZET Diyabetik erkeklerde, normal popülasyona göre daha yüksek prevalansta görülen erektil impotans bir çok farklı nedene bağlanmaktadır. Son yıllarda yapılan çalışmalarda, diyabetteki erektil disfonksiyonun, penil erektil dokunun nörojenik ve endotele bağımlı gevşeme yanıtlarının bozulması ile ilgili olabileceği düşüncesi yaygınlık kazanmıştır. Tavşanlara intravenöz alloksan verilmesiyle deneysel diyabet oluşturulan çalışmamızda diyabetli tavşanlar üç gruba ayrılarak, gruplardan birine intramüsküler insülin, birine de oral yoldan L-arjinin uygulanmıştır. Deneysel diyabetik tavşanlarda, erektil doku değişikliklerinin gelişmesi için sekiz hafta beklendikten sonra korpus kavemozum dokuları izole edilmiştir. Üç deney grubundaki diyabetli tavşan korpus kavernozumları ile kontrol grubundan elde edilen dokular, organ banyosunda gevşetici ve kasıcı maddeler ile EAU' na maruz bırakılarak alınan yanıtlar karşılaştırılmıştır. Ayrıca insülin ve L-arjinin verilmesinin doku yanıtlarını nasıl etkilediği araştırılmıştır. Endotelden bağımsız etkiye sahip adenozin.papaverin ve sodyum nitroprusiyat ile kontrol grubu ve her üç deney grubundan elde edilen korpus kavernozum şeritlerinin tümünde, aralarında anlamlı fark olmayan52 gevşeme yanıtları alınmıştır. KCI ile de tüm gruplardaki dokularda birbirinden farklı olmayan kasılma yanıtları elde edilmiştir. Fenilefrinle oluşan kasılma yanıtlarında kontrol grubu ile diyabet+insülin grubu arasında anlamlı fark yokken, diyabet ve diyabet+L-arjinin grubunda kasılma yanıtları azalmıştır. Histaminle tüm deney gruplarından ve kontrol grubundan izole edilen dokularda kasılma yanıtı alınırken, bunlardan sadece diyabet grubundakilerin kontrol grubuna göre anlamlı olarak azaldığı izlenmiştir. PGEı ile tüm deney gruplarında kontrol grubuna göre azalmış gevşeme yanıtları alınmış, deney grupları arasında fark olmamıştır. Erektil dokuda NANK nörojenik gevşemeye neden olduğu bilinen EAU ile deney gruplarında kontrol grubuna göre önemli ölçüde azalmış gevşeme yanıtları alınmıştır; deney grupları arasında anlamlı farklılık oluşmamıştır. Gevşeme yanıtını oluşturması için sağlam bir endotele ihtiyacı olduğu bilinen karbakol ile de sadece diyabet grubundaki gevşeme yanıtlarının azalmasının istatistiksel anlam taşıdığı gözlenmiş; insülin ve L-arjinin verilen diyabetik tavşan kavernöz dokularının karbakole verdikleri gevşeme yanıtlarının kontrol grubundan farklı olmadığı görülmüştür. Bu sonuçlara göre, diyabette oluşan erektil impotansta endotelden bağımsız gevşeme fonksiyonu rol oynamamaktadır. Gevşetici faktör NO aracılığıyla endotel üzerinden etkisini gösteren parasempatik uyarıya ve53 yine NO aracılığıyla etki yapan NANK nörojenik uyarıya karşı oluşan gevşeme yanıtları ise olumsuz yönde etkilenmektedir. Deneysel diyabetli tavşanlarda insülin ve L-arjinin verilmesi parasempatik uyarıyla oluşan endotele bağımlı gevşeme yanıtlarını olumlu yönde etkilemektedir.Öğe Prognostic impact of tumor size on pT2 renal cell carcinoma: An international multicenter experience(Galenos Yayincilik, 2007) Ayan, SemihPurpose: The current tumor classification for renal cell carcinoma classifies pT2 tumors as larger than 7 cm in greatest dimension and limited to the kidney. We examined the current pT2 tumor classification of renal cell carcinoma and determined whether a tumor size cutoff exists that would improve prognostic accuracy. Materials and Methods: We studied 706 patients with pT2 renal cell carcinoma treated with surgical extirpation at 9 international academic centers. Data collected from each patient included age at diagnosis, gender, 2002 TNM (tumor, node, metastasis) stage, tumor size, nuclear grade, performance status, histological subtype and disease specific survival. Disease specific survival was evaluated with univariate and multivariate analysis. Results: Median followup was 52 months. Univariate Cox regression analysis showed a significant association of tumor size with disease specific survival (HR 1.11, p <0.001). An ideal tumor size cutoff of 11 cm was identified, which led to the stratification of 2 groups with respect to disease specific survival (p <0.0001) with 5 and 10-year survival rates of 73% and 65% for pT2 11 cm or less, and 57% and 49% for pT2 larger than 11 cm, respectively. The incidence of metastases was significantly greater in the larger than 11 cm group, while Eastern Cooperative Oncology Group performance status, Fuhrman grade and histological subtype were similar. Multivariate Cox regression analysis retained tumor size as an independent prognostic factor and as the strongest prognostic factor for patients with pT2N0M0 disease. Conclusions: Our data suggest that the current pT2 classification can be improved by subclassification into pT2a and pT2b based on a tumor size cutoff of 11 cm. Patients in the proposed pT2bN0M0 group are at higher risk for death from renal cell carcinoma and should be considered for adjuvant therapies. External validation is warranted before suggesting change to the TNM classification.Öğe Public awareness of testicular cancer and self-examination in Turkey: A multicenter study of Turkish Urooncology Society(ELSEVIER SCIENCE INC, 2013) Kuzgunbay, Baris; Yaycioglu, Ozgur; Soyupak, Bulent; Kayis, Aliye Atay; Ayan, Semih; Yavascaoglu, Ismet; Cal, Cag; Beduk, YasarBackground: Testicular self-examination is the easiest and cheapest way to scan testicular cancer. However, the public awareness about testicular self-examination is very low. We aimed to investigate the public awareness of Turkish people about testicular cancer and testicular self-examination. Methods: We performed a survey consisting of 10 questions concerning testicular cancer and testicular self-examination in 799 students in the first year of 12 different medical schools. Aiming for a common method of data collection, the questionnaires were administered to the students during a class just before the lesson started. The whole data from all of the centers were pooled in a common data-base file. Results: Eighty-nine (11.1%) of the participants reported that they had knowledge about testicular cancer, but only 11(1.4%) of them answered all the questions about testicular cancer correctly. Eight (1%) of the participants reported that they had been performing testicular self-examination routinely once a month. Four (0.5%) of them were both well informed about testicular cancer and had been performing testicular self-examination once a month as suggested. Conclusion: The present study showed that awareness on testicular cancer and testicular self-examination is very low and suggests a need for efforts in Turkey to increase public awareness and education. (C) 2013 Elsevier Inc. All rights reserved.Öğe Radiological findings in massive inguinoscrotal bladder herniation: Scientific letter(Turkiye Klinikleri, 2008) Atalar, Mehmet H.; E?ilmez, Hulusi; Ayan, SemihInguinoscrotal bladder hernia is a rare entity. The bladder may be a component of inguinal hernias in man over the age of 50 years and only a small portion of the bladder is usually involved. Preoperative diagnosis of such hernias is important to avoid injury to the bladder and ureter. Intra-venous pyelography (IVP), retrograde cystography, pelvic ultrasonography (USG) and computed tomography (CT) have been useful in preoperative diagnosis of inguinoscrotal hernia. In this study, radiological findings of two cases with massive inguinoscrotal bladder hernia are presented and the importance of the imaging modalities in preoperative diagnosis is emphasized. Copyright © 2008 by Türkiye Klinikleri.Öğe Radiological findings in massive inguinoscrotal bladder herniation: Scientific letter(ORTADOGU AD PRES & PUBL CO, 2008) Atalar, Mehmet H.; Egilmez, Hulusi; Ayan, SemihInguinoscrotal bladder hernia is a rare entity. The bladder may be a component of inguinal hernias in man over the age of 50 years and only a small portion of the bladder is usually involved. Preoperative diagnosis of such hernias is important to avoid injury to the bladder and ureter. Intra-venous pyelography (IVP), retrograde cystography, pelvic ultrasonography (USG) and computed tomography (CT) have been useful in preoperative diagnosis of inguinoscrotal hernia. In this study, radiological findings of two cases with massive inguinoscrotal bladder hernia are presented and the importance of the imaging modalities in preoperative diagnosis is emphasized.Öğe Relation of microvessel density with microvascular invasion, metastasis and prognosis in renal cell carcinoma(BLACKWELL PUBLISHING, 2008) Yildiz, Esin; Ayan, Semih; Goze, Fahrettin; Gokce, Gokhan; Gultekin, Emin Y.To clarify the significance of microvessel density (MVD) in a retrospective investigation the relationship between the pattern of MVD (reflecting angiogenesis), and tumour stage, grade, size, and occurrence of microvessel invasion (MVI), metastasis, and cancer-specific survival (CSS) in patients who had surgery for renal cell carcinoma (RCC). Vessels were labelled in sections of formalin-fixed, paraffin-embedded tissues from 54 RCCs by CD34 immunohistochemistry. The mean MVD, expressed as the number of vessels per 10 high-power fields (HPF, x400) were measured for each case. In addition, all pathological slides were reviewed for the presence and absence of MVI. The prognostic value of MVD and MVI was then evaluated, and correlated with the usual prognostic variables, tumour metastasis and CSS. In a univariate analysis of CSS, the MDV tended to be lower as stage increased from pT1 to pT3, and as grade increased from G1 to G4, although it was statistically significant only for stage (P < 0.001 and 0.050, respectively). The mean MVD was higher in 42 nonmetastatic than in 12 metastatic tumours, and in 33 tumours associated with MVI than in 21 with no MVI (P < 0.001). The mean MVD was also lower and significantly different for 28 large than 26 small tumours (P = 0.005). The survival rate of patients with tumours that were small, low-stage, of higher MVD, with no MVI and metastasis was significantly higher than that of patients with large, high-stage, low MVD, with MVI and metastatic tumours (all P < 0.001). MVI was significantly more common with a decreasing trend in MVD and the presence of metastasis (Spearman rank correlation r(s) = -0.68, P = 0.01, and r(s) = 0.39, P = 0.01, respectively). Independent prognostic factors in a multivariate analysis were: in all patients with RCC, tumour stage (P = 0.013) and metastasis (P = 0.028); in those with low MVD, MVI (P = 0.004) and metastases (P = 0.016); in those with no MVI, stage (P = 0.020); in those with MVI, MVD (P = 0.001); in those with no metastases, stage (P = 0.045); and in those with metastases, MVD (P < 0.001). No independent predictor was identified in patients with high MVD. In patients with no metastases there was a significantly shorter median CSS time in RCCs with low MVD and with MVI (P = 0.004 for both). Similarly, patients who had grade 3-4 tumours, vs those with lower MVD and with MVI, had a significantly shorter median CSS (P = 0.020 for MVD, and 0.01 for MVI). This study suggested that MVD in RCC was inversely associated with MVI, tumour metastasis, patient survival and tumour diameter and stage, from the usual prognostic variables, but MVD was not an independent prognostic factor in multivariate analysis for all patients with RCC. Low MVD and the presence of MVI appears to be a marker for identifying patients with an adverse prognosis.Öğe Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease (Clinical Stage TxN1-2M0): the impact of aggressive surgical resection on patient outcome(Galenos Yayincilik, 2006) Canfield, Steven E.; Kamat, Ashish M.; Sanchez-Ortiz, Ricardo F.; Detry, Michelle; Swanson, David A.; Wood, Christopher G.; Ayan, SemihNodal disease in the setting of metastatic renal cell carcinoma is associated with poor prognosis. However, to our knowledge the biology of nodal metastases in the absence of metastatic disease is unknown. We reviewed our experience with treating this subset of patients with aggressive surgical resection. A total of 2,643 patients underwent nephrectomy at our institution between 1993 and 2003, including 40 with positive lymph nodes but no systemic metastases. All 40 patients underwent nephrectomy with extended retroperitoneal lymphadenectomy and they are the subjects of this study. Pathological characteristics and clinical outcomes were assessed. Median patient age was 58 years and 62% of the patients were male. Median tumor size was 11 cm. Local stage was T1 in 3% of cases, T2 in 17%, T3a in 30%, T3b in 47% and T4 in 3%. Perinephric fat invasion was present in 77% of patients and positive margins were identified in 17%. Nodal status was N1 in 30% of patients and N2 in 70%, including 10 with masses of matted nodes. Histology was conventional in 63% of cases and papillary in 17%. The remaining 20% of patients had sarco-matoid dedifferentiation. Excluding the 10 patients with matted nodes the median number of nodes harvested per patient was 7 with a median of 2 that were positive. Extranodal extension was present in 70% of cases, while in 70% disease recurred at a median of 4.9 months. Median actuarial disease specific survival was 20.3 months. At a median followup of 17.7 months 30% of patients had no evidence of disease, 8% had disease and 62% had died. On multivariate analysis more than 1 positive node was predictive of decreased recurrence-free survival (HR 2.83, 95% CI 1.06 to 7.61, p = 0.039) and overall survival (HR 9.33, 95% CI 1.85 to 47.09, p = 0.007). Nodal metastasis with renal cell carcinoma is an independent predictor of prognosis in patients with M0 disease. Even in the absence of distant metastatic disease patients with positive nodes should be targeted for aggressive surgical resection, followed by clinical trials of adjuvant therapy to improve the outcome.Öğe SRY and AZF gene variation in male infertility: a cytogenetic and molecular approach(SPRINGER, 2007) Ozdemir, Ozturk; Gul, Eylem; Kilicarslan, Hakan; Gokce, Goekhan; Beyaztas, Fatma Y.; Ayan, Semih; Sezgi, IhanAim The aim of this study was to identify the genetic effects of Y chromosome and azoospermia factor (AZF) gene variation in men with infertility and to elucidate the molecular mechanism responsible for the identified point mutation. Methods Chromosome analysis was performed according to standard methods on lymphocyte cultured cells and genomic DNA was extracted from the peripheral blood. Three sets of primers were used encompassing the AZFb, AZFc and SRY14 gene regions. Products were genotyped with single-strand comformational polymorphisim (SSCP) analysis. Results The profiles of the mutated genes were detected in five of three azoospermic and two oligoasthenozoospermic infertile males. The SSCP variability of the AZFc gene was detected in all of the cases, while sex-determining region Y (SRY) gene variation was detected in two of the current cases. Three cases with oligoasthenozoospermia showed mutated SSCP profiles in both their SRY and AZFc gene regions. No AZFb variation was detected in the presented cases. Conclusions The AZF locus is assumed to contain the genes responsible for spermatogenesis in human. Deletions in these genes are thought to be involved in male infertility associated with azoospermia, oligozoospermia and/or both. AZF microdeletions and variations that are seen in infertile males suggest the need for molecular screening of such cases. Advance studies are also needed to detect of these variations and their relevance to male infertility before using assisted reproduction techniques in such cases.Öğe Surgical treatment of penil fractures(2003) Kiliçarslan, Hakan; Gökçe, Gökhan; Kaya, Kemal; Ayan, Semih; Gültekin, Yener EBACKGROUND: Patients diagnosis as penil fracture and treated with surgical methods were evaluated retrospectively between January 1990-February 2002. METHODS: Patients were evaluated by age, trauma type, time passed after the trauma, physical examination and radiologic data. RESULTS: The cause of trauma was blunt trauma in all patients. 14 trauma (60.8%) were during sexual activity, 6 trauma (26%) were during handling the erective penis in morning erection, 3 of trauma (13%) were due to the rolling on to the penis. Urethral bleeding was seen in 1 patient and microscopic hematuria was detected in 5 patients. Subcoronal circular incision was carried out in 16 patients (69.5%), semicircular incision was done directly on the injury in 6 patients (26%) and from penis radix to scrotum was done in 1 patient (4.3%). There was unilateral corpus cavernosum injury in 21 patients. Bilateral corpus cavernosum injury in 1 patient, corpuscavernosum, corpus spongiosum and incomplent urethral injury in 1 patient. Wound infection was detected only in 2 patients at postoperatively early period. After evaluating 20 patients with medical history and physical examination in postoperative control penil curvature permitting sexual activity was detected in 3 patients. CONCLUSION: We concluded that patients with penil fracture may be treated with low complication rate by early surgical procedure.Öğe The relationship between symptoms and urodynamic evaluation in women with urinary incontinence(2003) Kiliçarslan, Hakan; Kaya, Kemal; Güvenal, Tevfik; Gökçe, Gökhan; Ayan, Semih; Gültekin, E. YenerOBJECTIVE: In this study we investigated the relationship between urodynamic findings and medical history, the type of urinary incontinence in women with urinary incontinence. STUDY DESIGN: The retrospective analysis which includes 161 incontinent women wham evaluated with urodynamic investigation between 1990-2001 in Urology department of Cumhuriyet University, Faculty of Medicine was performed. RESULTS: A total of 161 incontinent women were investigated and 67 of 90 women with complaints of pure stress incontinence (74.5%) had genuine stress incontinence, 23 of 40 women with complaints of pure urge incontinence (57.5%) had detrusor instability, 13 of 31 women with complaints of mixed incontinence (41.9%) had mixed incontinence in urodynamic evaluation. CONCLUSION: Pure stress incontinence and pure urge incontinence complaints in medical history had high sensitivity and specifity for diagnosis as well as as uradynamic investigations. But without urodynamic evaluation, medical history is not sufficient alone in objective diagnosis.
