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Biomedical subjects

Erdal Yilmaz

Publications and source records attributed to Erdal Yilmaz.

At least 37 records · Page 2Linked to original sources
PubMed2005

Trigeminal neuralgia in a patient with Dandy-Walker malformation.

BACKGROUND: Trigeminal neuralgia may be idiopathic or secondary to a number of cranial pathologies. We report a novel case of trigeminal neuralgia associated with Dandy-Walker malformation, which may be an etiologic factor. CASE DESCRIPTION: A 32-year-old male presented with shock-like pain in the somatosensory distribution of the right trigeminal nerve, which was refractory to all medication. MRI revealed a cystic lesion in the posterior fossa and a hypoplastic vermis. The pain was diagnosed as trigeminal neuralgia and was thought to be secondary to the Dandy-Walker malformation. The trigeminal neuralgia was treated successfully with radiofrequency thermocoagulation rhizotomy (RF-TR). CONCLUSION: Trigeminal neuralgia may be associated with Dandy-Walker malformation, however an etiological relationship is not proven. We suggest that traction on the trigeminal nerve may be significant. The posterior fossa cyst of Dandy-Walker malformation may be a complicating factor when considering microvascular decompression to treat the trigeminal neuralgia. Collapse of the cyst at surgery may destabilize the posterior fossa and further deform the trigeminal nerve. We suggest that RF-TR, which is minimally invasive and reliable, may be preferable.

Adult↗
PubMed2005

Giant abdominal wall abscess dissecting into thorax as a complication of ESWL.

Abscess as a complication of extracorporeal shock wave lithotripsy is a rare condition. We present the computed tomography findings of an abdominal wall abscess that occurred after extracorporeal shock wave lithotripsy for which prophylactic antibiotics had not been given. The abscess destroyed the posterior abdominal wall muscles and dissected into the thorax. The muscles were thickened and showed enhancement. A parenchymal defect in the right kidney adjacent to a caliceal stone, with strands extending from this defective region to the abscess, was observed, and was thought to be the result of parenchymal destruction caused by the shock waves. Other parts of the kidney and psoas muscle were normal. Microbiologic examination revealed Escherichia coli.

Abdominal Abscess↗
PubMed2005

Optimal frequency in extracorporeal shock wave lithotripsy: prospective randomized study.

OBJECTIVES: To determine the optimal frequency of extracorporeal shock wave lithotripsy of urolithiasis, in terms of efficacy and duration, by comparing three different shock wave frequencies. METHODS: A total of 170 patients between the ages of 18 and 69 years with radiopaque kidney stones were included in the study. The patients were randomly separated into three groups. Group 1 (56 patients) received 120 shock waves per minute, group 2 (57 patients) received 90 shock waves per minute, and group 3 (57 patients) received 60 shock waves per minute. The duration, analgesic or sedative requirement, and complications were recorded for each treatment. All patients were evaluated in terms of successful treatment by radiography of the kidneys, ureters, and bladder and abdominal ultrasonography 10 days after the single-session therapy. RESULTS: No statistically significant difference was observed in patients according to age, sex, stone size, side, composition, location in the kidney, total energy level, or number of shocks. The successful therapy rate in groups 2 and 3 was prominently greater compared with that for group 1, and the difference was statistically significant (P = 0.032 between groups 1 and 2 and P = 0.015 between groups 1 and 3). The analgesic or sedative requirement in groups 2 and 3 was lower than that in group 1, and the difference was statistically significant (P = 0.003 between groups 1 and 2 and P = 0.001 between groups 1 and 3). The duration was longer in group 3 than in groups 1 and 2, and the difference was statistically significant (P = 0.000 between groups 1 and 3 and P = 0.009 between groups 2 and 3). CONCLUSIONS: The results of our study have shown that the optimal frequency during extracorporeal shock wave lithotripsy is 90 shock waves per minute in terms of duration, efficacy, and analgesic and sedative requirement at the same total energy level.

Adolescent↗
PubMed2005

Effectiveness of eutectic mixture of local anesthetic cream and occlusive dressing with low dosage of fentanyl for pain control during shockwave lithotripsy.

BACKGROUND AND PURPOSE: To investigate the effect and usefulness of Eutectic Mixture of Local Anesthetic (EMLA) applied with an occlusive dressing and used simultaneously with a low dose of fentanyl during shockwave lithotripsy (SWL). PATIENTS AND METHODS: One hundred sixty patients with kidney stones, aged between 19 and 68 years, were randomly divided into seven groups that were treated as follows: group 1: fentanyl 1 microg/kg by intravenous infusion (IV); group 2: IV fentanyl 0.25 microg/kg; group 3: occlusive dressing and IV fentanyl 0.25 microg/kg; group 4: placebo cream and IV fentanyl 0.25 microg/kg; group 5: EMLA cream and IV fentanyl 0.25 microg/kg; group 6: placebo cream and IV fentanyl 0.25 microg/kg with an occlusive dressing; and group 7: EMLA cream and IV fentanyl 0.25 microg/kg with an occlusive dressing. The mean arterial pressure (MAP), heart rate, ventilatory rate, and oxygen saturation (SpO(2)) were recorded on all patients. A visual analog scale 0-100 mm (VAS) was used for the evaluation of pain. The skin integrity was inspected to detect any lesions after SWL. RESULTS: The SpO(2) in group 1 was lower statistically than in the other groups. The VAS score in group 7 was clearly lower than in the others in the first, tenth, and twentieth minutes and at the end of SWL. In groups 6 and 7, additional fentanyl doses were lower than in the other groups, but only in group 7 was the total fentanyl dosage low. Skin lesions were not seen only in groups 3, 6, and 7. CONCLUSION: Use of EMLA and an occlusive dressing with low doses of fentanyl during SWL provides appropriate analgesia with minimal morbidity.

Administration, Topical↗
PubMed2005

The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones.

PURPOSE: alpha1-Adrenergic blockers have recently been shown to increase the rate of spontaneous passage of distal ureteral stones. We compared efficacy of 3 different alpha1-adrenergic blockers for this purpose. MATERIALS AND METHODS: A total of 114 patients between 18 and 65 years old who had lower ureteral stones were included in the study. Patients were randomly divided into 4 groups. Group 1 consisted of 28 patients and acted as the control group. Group 2 comprised 29 patients who received tamsulosin, group 3 was 28 patients receiving terazosin and group 4 was 29 patients receiving doxazosin. These agents were given for up to a month and hydration was also recommended simultaneously. Every week patients were controlled with x-rays of the kidneys, ureters, bladder and urinary ultrasonography. Meanwhile the number of pain episodes, analgesic dosage and the number of days for spontaneous passage of the calculi through the ureter were also recorded. RESULTS: There were no differences between the groups with respect to age, weight, height, sex and stone size. The calculi passed through the ureter spontaneously in 15 patients in group 1 (53.57%), in 23 patients in group 2 (79.31%), in 22 patients in group 3 (78.57%), and in 22 patients in group 4 (75.86%). In groups 2 to 4 the number of pain episodes, expulsion time and analgesic dosage were found to be lower compared with those in group 1. CONCLUSIONS: alpha1-Adrenergic blockers increase the frequency of spontaneous passage of the distal ureteral calculi. All 3 agents tested were equally efficacious.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed2005

Medical haemostasis in acute hepatocyte injury and experimental liver trauma.

BACKGROUND: The aim of the present study was to test the effectiveness of aprotinin to reduce bleeding in liver resection of guinea pigs with acutely injured hepatocyte using intraperitoneal d(+)Galactosamine. METHODS: Thirty-two guinea pigs were divided equally into four groups. Group 1 was the control group. Group 2 received intraperitoneal D(+)galactosamine. Group 3 received intraperitoneal d(+)galactosamine prior to a standard liver resection. Group 4 received 10.000 KIU/kg aprotinin infusion via jugular catheter in 10 min prior to standard liver resection in pretreated animals with d(+)galactosamine. All of the measurements and surgical interventions were made 24 h after the administration of d(+)galactosamine. Bleeding amounts were recorded in groups 3 and 4 for 1 h by weighing the sponges placed into the abdomen. Liver function tests, histologic, haematologic and fibrinolytic parameters were measured. RESULTS: Hepatocyte injury and hyperfibrinolysis were seen at the end of 24 h after application of d(+)galactosamine in groups 2, 3, and 4. Statistically significant amounts of bleeding from the resected livers were observed in group 3 and 4. In group 4, the bleeding was reduced (P < 0.05) and fibrinolytic parameters were normalized (P < 0.05) with aprotinin infusion. CONCLUSIONS: Significant bleeding diathesis and hyperfibrinolysis occurred in groups 2, 3, and 4, which had hepatocyte injury proved with histopathologic and haematologic tests. Prothrombin time (PT) and partial thromboplastin time (aPTT) in groups 3 and 4 were fivefold higher than that in the control group (P = 0.0001). The bleeding tendency according to high PT and aPTT levels were continued with application of aprotinin while reduction of bleeding was seen. Parenchymatous organ haemorrhage in acute liver failure or hyperfibrinolytic conditions could be reduced significantly with aprotinin without procoagulant effect.

Animals↗
PubMed2004

Testicular tissue nitric oxide and thiobarbituric acid reactive substance levels: evaluation with respect to the pathogenesis of varicocele.

The aim of the present study is to evaluate tissue nitric oxide (NO) and thiobarbituric acid reactive substance (TBARS) levels in testicular tissue, and to determine their relationship with seminal parameters in order to explain possible effects on varicocele pathophysiology. Ten adult male Wistar rats at 8 weeks old underwent partial left renal vein ligation. A sham operation was performed on control rats in a second group of another ten rats. All animals were killed 4 weeks after surgery. The testes were removed and histological changes were observed by light microscopy with haematoxylin and eosin stain on half of each testis. The rest of testis was used for the evaluation of testicular tissue NO and TBARS levels. Epididymal aspirated seminal plasma was used for semen analysis and morphological analysis was carried out according to Kruger's criteria. Statistical analysis was performed by using Mann-Whitney U-tests and Spearman rank correlations between the two groups for NO and TBARS levels and for seminal parameters. Testicular tissue NO and TBARS levels (mean+/-SEM) were 62.8+/-10.1 micromol/g protein and 4.7+/-0.3 nmol/g protein in group 1. These parameters were 16.9+/-2.2 micromol/g protein and 3.1+/-0.2 nmol/g protein in the group 2 controls. There were significant differences between these parameters ( P(NO)=0.000, P(TBARS)=0.001). Although a positive and significant correlation between testicular tissue NO and TBARS levels was found ( r(s)=0.739, P=0.014), there was only a strong negative correlation between NO levels and sperm motility in group 1 ( r(s)=-0.815, P=0.004). We found that this effect of NO on sperm motility was independent from TBARS levels after regression analysis ( r(2)=-0.687, beta=0.825, P=0.034). Although there were statistically significant differences in seminal parameters between the two groups, there was no difference between them in the histopathological examination. We found that sperm motility was significantly related to testicular tissue NO levels only. Thus, we suggest that NO is an important mediator in the pathogenesis of varicocele. TBARS and other substances have been effective via NO pathways.

Animals↗
PubMed2004

Conservative treatment of postpneumonic thoracic empyema in children.

PURPOSE: Many treatment modalities have been described for thoracic empyema in children but the optimal timing of appropriate treatment remains controversial. The aim of this study is to find out the outcome of postpneumonic empyema in children after a conservative approach. METHODS: The reports of patients who were admitted to our hospital from January 1990 to October 2002 with a diagnosis of postpneumonic thoracic empyema were reviewed retrospectively. The comparative data were age, duration of prehospital illness, complaints, blood and pleural fluid analyses, radiological evaluations, microbiological studies, modes of treatment, duration of chest tube drainage, and length of hospital stay. RESULTS: A total of 115 patients (65 males and 50 females), aged from 3 months to 13 years, were evaluated. The most common symptoms were fever (96.5%), cough (85.2%), and dyspnea (50.4%). Chest X-rays revealed a minimal collection in 22 (19.2%), a moderate collection in 40 (34.8%), and a massive collection in 53 patients (46%). Staphylococcus aureus was the most common microorganism isolated from the bacterial cultures and Mycobacterium tuberculosis was the next most common. Twelve patients (10.4%) underwent surgical decortication. The mean duration of chest drainage was 10.1 +/- 1.39 days. The mean hospitalization period was 24.2 +/- 6.15 days and it was significantly shorter in patients with a minimal collection than in those with a massive collection (13.9 +/- 2.21 vs 28.47 +/- 6.38 days, P < 0.01). CONCLUSIONS: The majority of postpneumonic thoracic empyema cases in children can be successfully treated with a conservative approach. Detailed investigations should also be done to rule out tuberculosis in these patients.

Adolescent↗
PubMed2004

Plasma selenium status in children with iron deficiency anemia.

Iron and selenium are trace elements necessary for the maintenance of life and health. Iron deficiency is the most common nutritional deficiency among children in the world. The purpose of this study was to evaluate plasma selenium concentrations in children with iron deficiency anemia (IDA). Plasma selenium levels were investigated in 56 children with IDA and in 48 control subjects aged 1-8 years. A spectrofluorometric method was used for the determination. Plasma selenium concentrations in children with IDA (33.6+/-8.2 microg/l) were significantly lower than in the control group (56.0+/-17.0 microg/l) (p<0.001). However, there was no relation between plasma selenium, iron and hemoglobin concentrations.

Anemia, Iron-Deficiency↗
PubMed2004

Torsion of an epididymal cyst.

Torsion of an epididymal cyst is a very rare condition. We present a case of torsion of an epididymal cyst in a 13-year-old boy. The patient presented with acute scrotal pain. Scrotal ultrasonography showed a 38 x 35 x 30 mm fluid-filled mass within the caput of the left epididymis. Histologically, the cells of the epididymal duct were necrotic. To our knowledge, this is the second case report in the literature.

Adolescent↗
PubMed2004

Prevalence and treatment of Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis in patients with non-gonococcal urethritis.

The aim of present study was to evaluate the occurrence of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum in non-gonococcal urethritis (NGU) and to determine the bacterial resistance to six antibiotics in order to determine the most suitable treatment strategy. A total of 50 patients were enrolled into the study. Urethral samples were taken with a dacron swab placed into urethra 2 - 3 cm in males, and vaginal samples were taken from the endocervical region in women. The patient samples that did not grow Neisseria gonorrhoeae were accepted as NGU. Direct immunofluorescence technique was used for the investigation of C. trachomatis. Mycoplasma IST was used for the isolation of M. hominis and U. urealyticum. U. urealyticum was isolated from 24 patients. Thirteen of them had only U. urealyticum, and the rest had mixed pathogen organisms (7 U. urealyticum + M. hominis; 3 U. urealyticum + C. trachomatis, and 1 U. urealyticum + M. hominis + C. trachomatis). C. trachomatis was detected in 12 patients. While 8 patients had C. trachomatis only, the rest had a mixture of the pathogen organisms listed above. Partner examinations could be performed for only 22 patients' partners. In the evaluation of antibiotic susceptibility, higher resistance was obtained against ofloxacin in U. urealyticum, and against erythromycin with M. hominis. Our results indicated that doxycycline or ofloxacin should be the first choice when empirical treatment is necessary.

Adult↗
PubMed2003

Music decreases anxiety and provides sedation in extracorporeal shock wave lithotripsy.

OBJECTIVES: To evaluate the efficacy of music on sedation in extracorporeal shock wave lithotripsy (ESWL) treatment to compare its anxiolytic effects with those of midazolam. METHODS: Ninety-eight urolithiasis patients were randomly divided into two groups. Hemodynamic parameters, including mean arterial pressure, heart rate, respiration rate, and oxygen saturation, were recorded in all patients. In 50 patients (group 1), 2 mg of midazolam was administered intravenously 5 minutes before ESWL. In group 2 (n = 48), music chosen by the patients was listened to with a headset and continued during the treatment. The visual analog scale (0 to 100 mm), Observer's Assessment of Alertness/Sedation Scale, State and Trait Anxiety Inventory-Trait Anxiety test, and State and Trait Anxiety Inventory-State Anxiety test were administered for the evaluation of pain, sedation level, and patient anxiety. RESULTS: For the hemodynamic parameters, a statistically significant decrease in mean arterial pressure was noted at the end of the ESWL procedure in group 2 and in oxygen saturation from the 10th minute to the end of the treatment in group 1. Although the visual analog scale, Observer's Assessment of Alertness/Sedation Scale, and State and Trait Anxiety Inventory-State Anxiety test did not show statistically significant differences, the State and Trait Anxiety Inventory-Trait Anxiety score was found to be lower in the music group (group 2) than in the midazolam group (group 1). CONCLUSIONS: With the anxiolytic effects of music, ESWL can be performed more effectively with the patient in a comfortable state. Listening to music by patients during the ESWL session is a feasible and convenient alternative to sedatives and anxiolytics.

Adult↗
PubMed2003

C-reactive protein in early detection of bacteriemia and bacteriuria after extracorporeal shock wave lithotripsy.

OBJECTIVES: To evaluate the value of plasma C-reactive protein (CRP) levels in early detection of bacteriuria and bacteriemia after extracorporeal shock wave lithotripsy (ESWL) of calcium and infection stones. METHODS: A total of 75 patients who had infection stones (n = 27) and calcium stones (n = 48) were included in the study. All patients had sterile urine before ESWL. The mean age was 41.6 +/- 4.85 and male/female ratio was 2.12. Blood cultures were obtained within 1 hour post-ESWL period. Urine cultures were obtained 3 times just after and on the first and seventh day of ESWL. RESULTS: Post-ESWL evaluations showed 3 positive blood cultures with 2 (2.66%) patients in infection stone and 1 (1.33%) patient in calcium stone groups, whereas urine cultures revealed 6 (8%) positive results in infection stones and 4 (5.33%) in calcium stones. The patients who had positive cultures also had elevated plasma CRP levels when compared to the levels in patients with negative cultures (p = 0.000). CONCLUSIONS: Bacteriuria and bacteriemia after ESWL have been well-identified entities and may be responsible from some of the post-ESWL complications. CRP can be useful for early detection of such complications.

Adult↗
PubMed2003

Primary bilateral spermatocele.

We report the case of a bilateral, relatively huge, multilocular spermatocele diagnosed at sonography with surgical and pathological correlation. A 45-year-old man presented with bilateral, large inguinoscrotal masses. He had had the masses since his adolescence and their size gradually increased in the past 5 years. Scrotal ultrasonographic examination showed cystic fluid masses that were 65 x 45 x 50 mm in size on the right and 55 x 45 x 40 mm in size on the left side in multilocular spaces. The cystic masses were excised via bilateral inguinoscrotal incision staying near the body of the epididymis. The patient had fathered three children with no fertility problem.

Fertility↗
PubMed2003

Psychological trauma of circumcision in the phallic period could be avoided by using topical steroids.

OBJECTIVE: The objective of our study was to assess the efficacy of topical steroids in the treatment of phimosis and evaluate patients using the Diagnostic and Statistical Manual-III-Revised (DSM-III-R) test with the aim of eliminating castration anxiety of circumcision in the phallic period. METHODS: One hundred and forty-nine children with phimosis who required circumcision were included the study. The average age of the children was 4.47 years. All children underwent the DSM-III-R test and their parents were questioned. Patients were separated randomly into three groups. Group I comprised 51 children who would undergo circumcision; group II comprised 50 children who would be treated with a topical corticosteroid (0.05% bethamethasone cream) twice daily for 1 month; and group III comprised 48 children who would be treated with a topical placebo cream. On the 5th day of treatment, parents were told to retract the prepuce and were given hygiene routine instructions. Patients were seen immediately after treatment and again 2 months later. RESULTS: In group II, 16 of the 50 children had non-retractable prepuce. Forty-two cases of phimosis were corrected after treatment. Eight patients received further monthly treatment and five benefited from the second course of treatment. In group III, 17 of the 48 patients had non-retractable prepuce and four had satisfactory results. Forty-four patients received placebo treatment for another month and eventually, 40 children underwent circumcision in this group. DSM-III-R test results showed a significant shift to anxiety in the circumcision group. The were no significant differences in the other groups. CONCLUSION: Topical steroids for the treatment of phimosis is a highly effective treatment alternative to surgery. It avoids or delays circumcision and can be practised during the phallic period to decrease castration anxiety. The treatment is suitable for patients from any religious or cultural background.

Administration, Topical↗
PubMed2003

Four analgesic techniques for shockwave lithotripsy: eutectic mixture local anesthetic is a good alternative.

BACKGROUND AND PURPOSE: Various sedative and analgesic medication has been used for shockwave lithotripsy (SWL). The aim of this study was to evaluate the efficacy of different anesthesia modalities in these patients. PATIENTS AND METHODS: One hundred patients were randomly divided into four groups. The first (Group F) received fentanyl 1 microg/kg intravenously (IV), the second (Group D) received diclofenac sodium 1 mg/kg intramuscularly (IM), the third (Group T) received tramadol 1.5 mg/kg IM, and the fourth (Group E) was given 15 g of eutectic mixture local anesthetic (EMLA) cream containing lidocaine and prilocaine. After routine preoperative evaluation, all patients received midazolam 2 mg IV 5 minutes before lithotripsy for sedative premedication. In all groups, a supplemental 25-microg bolus of fentanyl was administered IV when patients complained of pain, moved, or grimaced in response to the shockwaves. Pain intensity was evaluated on a 0- to 100-mm visual analog scale (VAS). The level of sedation was determined using the Observer's Assessment of Alertness/Sedation (OAS/S). Side effects such as bradypnea, oxygen desaturation, bradycardia, pruritus, and nausea and vomiting were recorded. RESULTS: There were no statistically significant differences among the four groups with regard to VAS, OAS/S scores, or side effects. In Group F, the mean arterial pressure was decreased significantly at 10 and 20 minutes. The patients in this group also manifested a decrease of oxygen saturation at the first, tenth, and twentieth minutes and the end of SWL. CONCLUSION: Application of EMLA cream was as safe and effective as fentanyl, diclofenac, and tramadol, and reduction of the fentanyl dose during SWL was possible.

Adult↗
PubMed2003

Alterations of intracorporeal structures in patients with erectile dysfunction.

OBJECTIVE: We sought to quantify intracavernosal smooth muscle content (SMC), endothelial cells (EC) and elastic fibres (EF) in both potent and impotent men. We compare the results in impotent men with regard to patient age, aetiology of impotence, presence or absence of diabetes mellitus and smoking. PATIENTS AND METHODS: Seventy penile biopsies were taken from 10 potent patients with congenital penile curvature (age 17-24 years, mean: 21 +/- 1.16) and from 60 impotent patients (age 28-64 years, mean: 46 +/- 7.64). Biopsies were stained immunohistochemically to quantify the percentage of SMC by anti-desmin and anti-SMA, anti-CD-34 for EC and Verhoeff's histochemical staining for EF. Statistical analyses were performed by using one-way Anova after square root transformation. RESULTS: We observed a statistically significant difference in the amounts of corporeal SMC, EC and EF with regard to the following subgroups: potent versus impotent men; men with arterial aetiology versus veno-occlusive aetiology; men under the age of 45 versus men over the age of 45; patients with diabetes mellitus versus non-diabetes mellitus, and smokers versus non-smokers. CONCLUSION: Quantification of intracavernosal structures appears to be important for either understanding the mechanism of impotence or deciding the appropriate treatment.

Adult↗