Effect of cisapride on gastroesophageal reflux disease of children.
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Adolescent↗
Biomedical subjects
H Ozen
Publications and source records attributed to H Ozen.
Proposal for changes in cystoscopic follow-up of patients with low-grade pTa bladder tumor.
OBJECTIVES: The cystoscopic follow-up of superficial bladder cancer accounts for a considerable workload for urologists and is also an invasive procedure with high costs. There is a potential benefit both to the urologist and the patient if unnecessary cystoscopies can be avoided. METHODS: The recurrence and progression rates of 120 patients with pTa G1 or G2 and small (<4 cm) transitional cell carcinoma were evaluated retrospectively. RESULTS: The recurrence rate was 6.5% (8/120) at 3 months. The recurrence rates at 6 and 9 months were 6.7 (8/119) and 3.6% (4/112), respectively. However, when the third month (first check) was clear, the recurrence rates at 6- and 9-month cystoscopy were 4.3 (5/116) and 2.7% (3/111), respectively. The recurrence rate at 12 months was 8% (8/99). For G1 tumors, the recurrence rates at 3, 6, 9 and 12 months were 6 (5/84), 5 (5/83), 2.5 (2/80) and 7% (5/71), respectively. The same results for G2 tumors were 8 (3/36), 8 (3/36), 6 (2/32) and 10.5% (3/28), respectively. The progression rate for the first year was lower than 1%. The difference between G1 and G2 tumors according to recurrence rate within the first year was not statistically significant (p>0. 05). CONCLUSIONS: This study supports the proposal that for patients with small and welldifferentiated pTa tumors at diagnosis, if the first control cystoscopy is clear, it is appropriate to perform the second check cystoscopy 1 year from initial resection and subsequent controls yearly. One should note that the study group included the most suitable patients for cystoscopic follow-up according to size and multiplicity of the tumor. This change in policy is further supported by the fact that progression occured in less than 1% in this group of patients.
Carcinoma, Transitional Cell↗
Wilson's disease with hepatic presentation in childhood.
OBJECTIVE: To evaluate clinical, laboratory findings, treatment and long-term follow-up of children with Wilson's disease with hepatic presentation. DESIGN: Retrospective study with a median follow-up period of 9 years. SETTING: University medical center. SUBJECTS: Thirty-four children with hepatic involvement, ranging in age from three to fifteen years, were diagnosed as Wilson's disease over an eighteen year period. METHODS: The diagnosis was based on the presence of family history and Kayser-Fleischer rings, low serum ceruloplasmin levels and increased urinary and hepatic copper concentrations. RESULTS: Four patients had also neurological manifestations. Eight patients were diagnosed as fulminating hepatic failure resulting in death in a few days. The most common symptoms were abdominal distension and abdominal pain. Hepatomegaly was the predominant physical finding and serum transaminases were elevated in most of the patients. Twenty patients had cirrhosis and six had chronic hepatitis histopathologically. All patients with fulminating hepatic failure had hyperbilirubinemia with normal alkaline phosphatase and higher aspartate aminotransferase than alanine aminotransferase. Patients were treated with D-penicillamine and zinc sulphate. Three patients underwent liver transplantation. Four more patients besides patients with fulminating hepatic failure died due to end stage liver disease. Twenty-two patients were followed for median 9 years. Four patients with poor compliance progressed to decompensated cirrhosis and the others were stable. CONCLUSIONS: Liver disease with unknown origin with positive family history and parental consanguinity should imply Wilson's disease strongly.
Adolescent↗
Induction of mycobacteremia by intravesical bacillus Calmette-Guerin instillation in an experimental animal model and detection with polymerase chain reaction.
PURPOSE: The aim of this study was to detect mycobacteremia by polymerase chain reaction (PCR), induced by the instillation of bacillus Calmette-Guerin (BCG) to guinea pig bladder. We also investigated the peak time and the effect of the dose of BCG in injured and non-injured bladder. The sensitivities of routine culture and PCR were also compared. MATERIALS AND METHODS: Five different doses (0, 0.069, 0.69, 6.9 and 69 mg.) of BCG were instilled into 5 injured and 5 non-injured bladders. Blood samples were collected at 0, 5, 15, 30 and 60 minutes following instillation for routine culture and PCR for each dose. A total of 50 female guinea pigs were used. RESULTS: Three of 5 samples (60%) obtained 30 minutes after the instillation of 69 mg. BCG into injured bladders were PCR positive. Furthermore, 4 of 5 samples (80%) were PCR positive when samples were obtained at the 60th minute following instillation. All the other samples were negative for PCR and routine culture. All the routine tuberculosis culture results were negative, including those which were PCR positive. CONCLUSIONS: Mycobacteremia was detected only in injured bladders and with high doses of BCG. PCR is a highly sensitive and rapid diagnostic method for detection of mycobacteremia.
Administration, Intravesical↗
A study of the etiology of idiopathic calcium urolithiasis in children: hypocitruria is the most important risk factor.
PURPOSE: To determine the association of metabolic risk factors with pediatric calcium urolithiasis we compared metabolic evaluation data on children with idiopathic calcium stones and those on healthy children. MATERIALS AND METHODS: Metabolic evaluation was done in 78 calcium stone formers 1 to 15 years old (mean age 7.2) who were free of urinary tract infection, anatomical abnormalities, and metabolic, endocrinological and intestinal disorders, and in 24 healthy children. Evaluation included serum biochemistry, and measurement of daily excretion of urinary calcium, oxalate, urate, phosphorus, citrate and magnesium. RESULTS: Demographic characteristics, serum parameters, and daily excretion of calcium, urate, phosphorus and magnesium did not differ statistically in the 2 groups. However, urinary oxalate was significantly higher and urinary citrate was significantly lower in stone formers than in controls (p = 0.002 and 0.028, respectively). Hypocitruria and hyperoxaluria were 4.3 and 3-fold more common in stone formers than in controls, respectively. Multivariate analysis using logistic regression showed that hypocitruria was the only significant risk factor for idiopathic calcium stones (p = 0.008). CONCLUSIONS: Hypocitruria was the most important risk factor in our patients. Hyperoxaluria was also common and accompanied hypocitruria in many stone formers. In contrast to many previous reports, we failed to show that hypercalciuria is an important metabolic defect for idiopathic calcium stones, possibly because our study evaluated a different population.
Adolescent↗
Acromesomelic dysplasia associated with mild lumbar spine stenosis.
A rare case of acromesomelic dysplasia is reported. The radiological findings were consistent with shortness of all tubular bones, especially those of the forearms. There was also evidence of mild lumbar spine stenosis.
Child↗
Prevalence of hepatitis A antibodies in children with chronic liver disease and other gastrointestinal diseases.
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Child↗
Outcome of chronic hepatitis B in children with normal transaminase levels.
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Alanine Transaminase↗
Analysis of three mutations in Turkish children with Gaucher disease.
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Gaucher Disease↗
Multicentricity in renal cell carcinoma.
OBJECTIVE: To find the incidence of multicentric renal cell carcinoma and its possible relationship to the other clinical and pathologic findings. METHODS: A total of 40 patients with renal cell carcinoma underwent radical nephrectomy between March 1994 and January 1996 at Hacettepe University, School of Medicine, Department of Urology. All of the materials were examined grossly and histologically by the same pathologist. RESULTS: Among 40 kidneys 4 had satellite carcinoma (10%), 3 of them had been shown by preoperative imaging techniques, 1 was found histopathologically. CONCLUSION: If preoperative imaging techniques do not show additional lesion in the kidney besides the small early stage primary in incidentally discovered patients, the incidence of satellite renal cell carcinoma is low enough to justify nephron sparing surgery.
Adult↗
Factors involved in diagnostic delay of testicular cancer.
In testicular cancer, which is one of the highly curable cancers, the beneficial effect of early diagnosis on survival has been well accepted for years. This study was planned to determine the probable factors involved in diagnostic delay of testicular cancer. A total of 140 patients with testicular cancer were included in this study. We attempted to find a relationship between the mode of presentation, stage of the tumour, patients' socioeconomic status and the delay in diagnosis. Majority of patients presented with scrotal pain (49.3%). No significant correlation was found between the mode of presentation and stage of the disease (p>0.05). The median time of delay in diagnosis was 5.4 months. The stage at presentation was not influenced by the delay in diagnosis. Similarly the annual income and the educational level of the patients had no significant impact on the delay in diagnosis. No effect of delay in diagnosis on the stage at presentation could be demonstrated in our study. Our results indicate that in this country people are not thoroughly educated about the importance of routine self-examination of the testes. It must also be emphasized that painful testicular masses need to be evaluated carefully to rule out malignancy.
Adolescent↗
Ursodeoxycholic acid treatment in children with Byler disease.
BACKGROUND: There have been a few reports of patients with Byler disease and the best medical treatment is not known. The aim of the present study is to show the effect of ursodeoxycholic acid (UDCA) on clinical, laboratory and histologic findings in children with Byler disease. METHODS: Nine children aged between 1.5 and 9 years with Byler disease were administered UDCA orally at doses of 15-20 mg/kg per day. They were followed for at least 12 months. Clinical, laboratory and histologic outcomes were evaluated after 12 months of treatment. RESULTS: Seven children presented in the first 6 months of life with itching and/or jaundice. Gamma-glutamyl transpeptidase and cholesterol levels were normal in all patients, despite severe cholestasis. With UDCA therapy, pruritus disappeared/diminished in four (44.4%) patients. The mean serum concentrations of alanine aminotransferase, aspartate aminotransferase (AST), total and conjugated bilirubin decreased, although it was significant only for AST (P = 0.01). Before treatment, all biopsy materials showed cellular/canalicular cholestasis and fibrosis. After UDCA therapy cholestasis was ameliorated. Two patients died during follow up. CONCLUSIONS: The results suggest that administration of UDCA leads to clinical and biochemical improvement in children with Byler disease. The UDCA ameliorates symptoms partially, improves the life quality of patients and may be given for as long as the disease continues.
Child↗
Human papillomavirus associated with bladder carcinoma? Analysis by polymerase chain reaction.
BACKGROUND: The aim of the present study was to assess the possible etiologic role of human papillomaviruses (HPV) in bladder tumors. METHODS: Forty-two fresh biopsy specimens from different grades and stages of bladder tumor cases and 10 normal bladder mucosa biopsies were studied. Specimens were analyzed by polymerase chain reaction (PCR) with HPV-specific general primer set for the detection of viral DNA. Polymerase chain reaction-positive samples were also tested with HPV 16- and 18-specific primers by the same method. RESULTS: We found two samples (4.8%) containing HPV DNA among the TaG1 bladder tumors. All other specimens, including the control group, were found to be negative by PCR. Neither of the two HPV-positive patients had immune deficiency and/or genital wars. Human papillomavirus 16 was detected by type-specific primers in one sample, but the other HPV-positive sample could not be typed. CONCLUSIONS: The low prevalence of HPV in this and many previous studies does not support an etiologic role of HPV in bladder carcinogenesis. We detected the virus in two early stage tumors, but none was detected in the high-grade samples. However, to clarify the positivity of HPV in these occasional cases, future studies must be designed by using in situ PCR techniques, including samples from tumors and normal bladder mucosa from the same patient.
Biopsy↗
A comparison of transrectal ultrasonography and endorectal magnetic resonance imaging in the local staging of prostatic carcinoma.
OBJECTIVE: To compare the staging accuracy of transrectal ultrasonography (TRUS) and endorectal magnetic resonance imaging (eMRI) for organ-confined prostatic carcinoma. PATIENTS AND METHODS: Twenty-five patients with clinically confined prostatic adenocarcinoma were evaluated to be candidates for radical prostatectomy. All underwent TRUS and eMRI before surgery. Imaging findings evaluated prospectively in each patient were extracapsular extension (ECE), seminal vesicle invasion (SVI) and the site of involvement. The results of the imaging techniques were compared with the histopathological findings. As two patients with metastatic lymph nodes (detected on frozen-section examination during surgery) were spared radical prostatectomy, the final evaluation included 23 patients. RESULTS: Endorectal coil MRI was more sensitive than TRUS for detecting both ECE, SVI and the site of ECE involvement in organ-confined prostatic carcinoma. TRUS was more accurate than eMRI for detecting the site of SVI involvement. However, the overall staging accuracy rates for both imaging modalities were equal. CONCLUSIONS: Neither TRUS nor eMRI was significantly better than the other for determining the local extent of prostatic carcinoma. Therefore, TRUS should be the study of choice until MRI technology improves sufficiently in the preoperative staging of localized prostate cancer.
Aged↗
The management of brain metastasis in nonseminomatous germ cell tumours.
OBJECTIVE: To review our experience of patients with brain metastases from nonseminomatous germ cell tumours (NSGCTs) and to indicate important clinical observations. PATIENTS AND METHODS: Between 1990 and 1996, 167 patients with metastatic NSGCT were treated in our department; 11 had brain metastases (eight with solitary metastases and three with multiple lesions, mean age 27 years, range 18-41). These patients were treated initially with either; cisplatin, bleomycin, etoposide and/or cisplatin, vincristin, methotrexate, bleomycin, actinomycin-D, cyclophosphamide, etoposide and intrathecal methotrexate chemotherapy protocols. Six patients received chemotherapy alone, one had chemotherapy plus radiotherapy and four had all three treatments. Patients with brain metastases were classified according to mode of presentation, and their treatments and outcomes analysed. RESULTS: Ten patients presented with symptoms related to intracranial lesions, e.g. intractable headache, seizures, severe vomiting, hallucinations and hemiparesis. All patients with brain metastasis had bulky thoracic disease. The incidence of clinical brain metastases in patients with advanced thoracic disease was 32% (11/34). Four patients with brain metastases at presentation were alive after 3, 12, 34 and 47 months. The only patient with isolated brain relapse died within 7 months, despite combined treatment. Two of the five patients who developed brain metastases during the course of the disease are alive with no evidence of disease at 3 and 6 months after salvage chemotherapy. CONCLUSION: Patients with single brain metastasis seem to have a better prognosis in the present than in other reported series. Chemotherapy was used initially, followed by surgery and radiotherapy in those who did not achieve complete remission with chemotherapy. Patients with progressive disease and multiple brain metastasis do not seem to benefit from initial surgical resection. Importantly, a significant proportion (32%) of patients with bulky lung metastases had or subsequently developed brain metastases. Thus it is suggested that routine cranial imaging should be performed in patients with bulky thoracic disease.
Adolescent↗
Skeletal muscle metastasis from carcinoma of the bladder.
Metastasis to skeletal muscle from carcinoma of the bladder is extremely rare. To the best of our knowledge, there is no reported case in the English literature. In this report, we describe a 41-year-old man with bladder carcinoma with metastasis to the right deltoid muscle.
Adult↗
Nonoliguric renal failure after transurethral resection of prostate.
PURPOSE: To define the relation of nonoliguric renal failure to transurethral resection of the prostate (TURP), its clinical importance, and predictive factors. PATIENTS AND METHODS: The files of 439 patients who had undergone TURP at Hacettepe University School of Medicine, Department of Urology, between January 1991 and 1994 were analyzed. The patients were divided into three groups according to postoperative serum creatinine concentration and the presence of clinical signs and symptoms of TUR syndrome (Group I: patients with preoperative and postoperative creatinine in the normal range; Group II: patients suffering nonoliguric renal failure; and Group III: patients with TUR syndrome). The data of the groups were compared in terms of factors influencing nonoliguric renal failure. RESULTS: The mean postoperative concentrations of sodium, blood urea nitrogen, creatinine, and albumin in Groups II and III were statistically different from those in Group I (P < 0.001). There was a moderate relation between hyponatremia and the occurrence of nonoliguric renal failure (r(s) = -0.56). Capsule perforation increased the risk of nonoliguric renal failure 10.6 fold. All of the patients were managed by a conservative approach, and none of the patients died or progressed to end-stage renal disease. They were all discharged with a mean hospitalization period of 7 days and normal renal function tests. CONCLUSION: Nonoliguric renal failure was thought to be an early step in the pathophysiology of TUR syndrome with acute renal failure. It is an asymptomatic clinical picture that is undiagnosed unless laboratory examinations are performed. A conservative therapeutic approach is enough.
Acute Kidney Injury↗
Bladder cancer.
Bladder tumor antigen, nuclear matrix protein 22, telomerase activity, fibrin degradation products assay, and a number of diagnostic tests on exfoliated urethelial cells are being tried to replace or decrease the frequency of cystoscopies. The results of these studies have shown that although some of these tests are promising, the standard of care for patients with hematuria or previously treated bladder carcinoma is still cystoscopy. New and non-invasive tests are on the horizon, however. It is essential to find accurate prognostic factors in patients with T1 disease which will predict the cases which will progress to muscle invasive disease. It has been clearly shown that the depth of invasion within the submucosa is closely related with survival. It has been established that continent diversions improve the quality of life in patients who have undergone cystectomy. Furthermore, this type of diversion was shown to improve survival. This fact can be attributed to early cystectomy which was prompted by the increased patient acceptance.
Antineoplastic Combined Chemotherapy Protocols↗