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Öğe A rare complication of amplatz sheath: Amplatz sheath rupture during percutaneous nephrolithotomy(Mary Ann Liebert Inc., 2020) Kurt, Hasan Anıl; Demirci, EmrahIntroduction: Amplatz sheaths are hollow tubes that serve as the portal for the insertion of the nephroscope during percutaneous nephrolithotomy (PCNL). Breakage of this tube during the procedure is rare, but when it does occur it should be recognized and addressed promptly. Case Presentation: A 46-year-old Caucasian male patient was scheduled for PCNL. The Amplatz sheath was inserted in the usual manner over a balloon dilator and nephroscopy was performed. Profuse bleeding was encountered early. Upon meticulous endoscopic navigation, the broken Amplatz tube was recognized and replaced. This allowed us to identify and remove the fragment of the Amplatz tube, followed by stone fragmentation and removal. Conclusion: Our experience highlights the importance of recognizing this rare complication of a broken Amplatz sheath that should be managed promptly and effectively through endoscopic means without the need to abort the planned PCNL. © Mary Ann Liebert, Inc.Öğe Comparison of Conventional Wet Dressing and Vacuum Assisted Closure with Hypochlorous Acid Application in Fournier Gangrene Treatment(Harran Üniversitesi, 2022) Kurt, Hasan Anıl; Demirci, Emrah; Özkaya, Hüseyin UğurBackground: Bacterial toxins cause local tissue damage and necrosis. This can continue until a significant amount of tissue becomes necrotic. Neutralization of bacterial toxins improves results. Low concentrations of Hypochlorous Acid can be antimicrobial without causing cytotoxicity in normal cells in the wound and surrounding tissues. In this study, we aimed to compare the results of patients treated with hypochlorous acid (0.01% w/v) through Vacuum Assisted Closure and with traditional wet dressing after surgical debridement due to Fournier Gangrene in our clinic. Materials and Methods: 73 patients treated for Fournier Gangrene between 2009-2019 in our clinic were evaluated retrospectively. The patients were divided into two groups: those who received Hypochlorous Acid with Vacuum Assisted Closure (Group A, n = 30) and those who received traditional wet dressing (Group B, n = 42) after the first debridement. Hypochlorous Acid (0.01% w/v), known to destroy bacteria and bacterial toxins, was administered to 30 patients with Fournier Gangrene in saline with a pH of 4-5, 5-6 times a day. Using Vacuum Assisted Closure, 5-10 ml of 0.01% Hypochlorous Acid was applied to the wound and aspirated. For wet dressing application, the wound was closed by applying mupirocin calcium and rifamycin to an appropriate number of wet sponges suitable for the wound surface and depth after cleansing the wound with sponges moistened with isotonic 3 times a day. The collected data were compared. P values smaller than 0.05 were considered significant. Results: The hospitalization time and wound healing time of 30 patients who received Hypochlorous Acid with Vacuum Assisted Closure were shorter (p <0.05), and the number of patients requiring secondary debridement was also lower (p <0.05). Conclusion: Hypochlorous Acid application with Vacuum Assisted Closure is an effective, successful and important postoperative treatment and wound care method that provides shorter hospital stay and faster recovery time. Toxicity and immune dysfunction due to bacterial toxins and toxins released from damaged cells can be alleviated with 0.01 Hypochlorous Acid application via Vacuum Assisted Closure. We recommend this method, which is easy to apply and inexpensive in certain Fournier Gangrene casesÖğe Diagnostic Value of Plasma Pentraxin3- Level For Diagnosis of Erectile Dysfunction(2018) Eren, Ali Erhan; Ersay, Ahmet Reit; Demirci, Emrah; Alan, Cabir; Basturk, GökhanPURPOSE: Erectile dysfunction (ED) is a sexual dysfunction described as the inability to develop or maintain an erection of the penis adequate for sexual intercourse, and its prevalence increases with age. Seen as a common sexual disorder worldwide, organic causes are the underlying reason for 80 percent of ED cases, with the most characteristic pathology responsible for organic ED being atherosclerosis. This study investigates the diagnostic value of plasma PTX-3 levels in arterial ED. MATERIALS AND METHODS: This study included a total of 45 patients who were admitted to the urology and cardiologyoutpatient clinics of the Medical Faculty of Canakkale Onsekiz Mart University (COMU) and consented to participate in this study. Patients were categorized into three equal groups in number: (1) patients with ED diagnosed with coronary artery disease (CAD) (15 patients in total); (2) patients with ED not having coronary artery disease or any other equivalent diseases (diabetes mellitus, hypertension and hyperlipidemia) (15 patients in total);and (3) ordinary patients with no ED (15 patients in total). An interview was conducted at the andrology polyclinic with each patient in order to ascertain detailed information on their medical and sexual history and on demographic characteristics. All patients were also administered the International Index of Erectile Function (IIEF) questionnaire. RESULT: The findings from this study investigating the diagnostic value of plasma PTX-3 levels in ED were statistically significant for two comparisons: the differences between the peripheral blood and cavernous blood values of the patient groups (group 1 and 2) and the control group (group 3), and the differences between the peripheral blood and cavernous blood values of group 2 (patients with ED who do not have CAD) and the control group (group 3). CONCLUSION: As PTX-3 is more specific than the formerly recognized biochemical markers in endothelial dysfunction, it can be used in the diagnosis of vascular originated ED.Öğe Diagnostic Value of Plasma Pentraxin3-Level For Diagnosis of Erectile Dysfunction(Urol & Nephrol Res Ctr-Unrc, 2018) Eren, Ali Erhan; Ersay, Ahmet Resit; Demirci, Emrah; Alan, Cabir; Basturk, GokhanPurpose: Erectile dysfunction (ED) is a sexual dysfunction described as the inability to develop or maintain an erection of the penis adequate for sexual intercourse, and its prevalence increases with age. Seen as a common sexual disorder worldwide, organic causes are the underlying reason for 80 percent of ED cases, with the most characteristic pathology responsible for organic ED being atherosclerosis. This study investigates the diagnostic value of plasma PTX-3 levels in arterial ED. Materials and Methods: This study included a total of 45 patients who were admitted to the urology and cardiology outpatient clinics of the Medical Faculty of Canakkale Onsekiz Mart University (COMU) and consented to participate in this study. Patients were categorized into three equal groups in number: (1) patients with ED diagnosed with coronary artery disease (CAD) (15 patients in total); (2) patients with ED not having coronary artery disease or any other equivalent diseases (diabetes mellitus, hypertension and hyperlipidemia) (15 patients in total); and (3) ordinary patients with no ED (15 patients in total). An interview was conducted at the andrology polyclinic with each patient in order to ascertain detailed information on their medical and sexual history and on demographic characteristics. All patients were also administered the International Index of Erectile Function (IIEF) questionnaire. Result: The findings from this study investigating the diagnostic value of plasma PTX-3 levels in ED were statistically significant for two comparisons: the differences between the peripheral blood and cavernous blood values of the patient groups (group 1 and 2) and the control group (group 3), and the differences between the peripheral blood and cavernous blood values of group 2 (patients with ED who do not have CAD) and the control group (group 3). Conclusion: As PTX-3 is more specific than the formerly recognized biochemical markers in endothelial dysfunction, it can be used in the diagnosis of vascular originated ED.Öğe Efficacy of duloxetine in the early management of urinary continence after radical prostatectomy(S. Karger AG, 2014) Alan, Cabir; Eren, Ali E.; Ersay, Ahmet R.; Kocoglu, Hasan; Basturk, Gokhan; Demirci, EmrahAim: To evaluate the efficacy of early duloxetine therapy in stress urinary incontinence occurring after radical prostatectomy (RP). Material and Method: Patients that had RP were randomly divided into 2 groups following the removal of the urinary catheter. Group A patients (n = 28) had pelvic floor exercise and duloxetine therapy. Group B patients (n = 30) had only pelvic floor exercise. The incontinence status of the patients and number of pads were recorded and 1-hour pad test and Turkish validation of International Consultation on Incontinence Questionnaire-Short Form test were applied to the patients at the follow-up. Results: When the dry state of the patients was evaluated, 5, 17, 3, and 2 of 28 Group A patients stated that they were completely dry in the 3rd, 6th, 9th and 12th month respectively and pad use was stopped. There was no continence in 30 Group B in the first 3 months. Twelve, 6, and 8 patients stated that they were completely dry in the 6th, 9th and 12th month, respectively. But 3 of 4 patients in whom dryness could not be provided were using a mean of 7.6 pads in the first day and a mean of 1.3 pads after 1 year. When pad use of the patients was evaluated, the mean monthly number of pad use was determined to be 6.2 (4-8) in the initial evaluation, 2.7 (0-5) in the in 3rd month, 2 (0-3) in the 6th month and 1.6 (0-2) pad/d in the 9th month in the group taking medicine. The mean monthly number of pads used was determined to be 5.8 (4-8) in the initial evaluation, 4.3 (3-8) in the 3rd month, 3 (0-6) in the 6th month and 1.6 (0-6) pad/d in the 9th month in the group not taking medicine. Conclusion: According to the results, early duloxetine therapy in stress urinary incontinence that occurred after RP provided early continence. © 2014 S. Karger AG, Basel.Öğe Endothelial Dysfunction and Ischemia-Modified Albumin Levels in Males with Diabetic and Nondiabetic Erectile Dysfunction(Hindawi Ltd, 2022) Kurt, Hasan Anil; Demirci, Emrah; Alan, CabirIn this study, we aimed to determine endothelial dysfunction and ischemia-modified albumin (IMA) levels in patients diagnosed with erectile dysfunction (ED) and to examine the relationship between these and diabetes disease. 86 male patients (46 patients with diabetes, age: 51.5 +/- 9.2 and 40 patients with nondiabetes (control group), age: 54.78 +/- 12.2) were included in the study. IMA, a new indicator of tissue ischemia and oxidative stress, was checked. Superoxide dismutase (SOD) activity, another oxidative stress indicator, was examined. Endothelin-1 (ET-1), one of the parameters of endothelial dysfunction, was measured. Additionally, endothelial function was evaluated with flow-mediated vasodilatation (FMD). Student's t-test was used for statistical evaluation. p values less than 0.05 were considered statistically significant. SOD activity was significantly lower in the diabetic group than in the control group, and ET-1 was significantly higher (p < 0.001). IMA was found to be significantly higher in the diabetic group than the control group (p < 0.001). FMD was significantly lower in diabetic group compared to the control group (p < 0.002). According to our findings, the co-occurrence of erectile dysfunction and diabetes demonstrates a complex condition that includes endothelial dysfunction, oxidative stress, and tissue ischemia. When the correlation of indicators, which are markers, was examined, the severity of the co-occurrence of diabetes and erectile dysfunction was again demonstrated.Öğe Ratlarda unilateral testis torsiyonu modelinde iskemi reperfüzyon hasarının önlenmesinde ozonun etkinliğinin değerlendirilmesi(Çanakkale Onsekiz Mart Üniversitesi, 2017) Demirci, Emrah; Sancak, Eyüp BurakAmaç: Testis torsiyonu testiste ileri düzeyde iskemiye sebep olan akut seyirli, her yaşta görülebilen ve teşhis sonrasında hızlı şekilde tedavi gerektiren acil ürolojik bir durumdur. Spermatik kord torsiyonu olduğunda, damar obstrüksiyonuna ve uzayan iskemi ile birlikte testiküler hasara yol açar. Torsiyon-detorsiyon sonrasında meydana gelen iskemi ve reperfüzyon süreçleri testiküler hasara neden olur. Bu çalışmanın amacı torsiyon sonrası oluşan testiküler hasarı biyokimyasal, immünohistokimyasal, histopatolojik olarak belirlemek ve ratlarda testis torsiyonuna bağlı gelişen iskemi reperfüzyon hasarında ozonun koruyucu etkisinin araştırılmasıdır. Materyal ve Metod: Deney için Çanakkale Onsekiz Mart Üniversitesi Deney Hayvanları Etik Kurulundan gerekli onay alındı. 40 adet Wistar albino cinsi erkek rat (ağırlık: 250-300 gr) randomize şekilde 5 gruba ayrıldı. 1.Grup sham grubu olarak belirlendi. 2.Grupta sol testis torsiyonu ve detorsiyon oluşturuldu. 3.Grupta 2.Gruba uygulanan prosedüre ek olarak torsiyonun 30. dakikasında intraperitoneal olarak 4 mg/kg ozon uygulandı. 4.Grupta 2.Gruba uygulanan prosedüre ek olarak torsiyonun 30. dakikasında intratestiküler olarak 4 mg/kg ozon uygulandı. 5. grupta 2. gruba uygulanan prosedüre ek olarak torsiyonun 30. dakikasında intratestiküler ve intraperitoneal olarak 4 mg/kg ozon uygulandı. Sham grubu hariç diğer gruplara 60 dakika süren torsiyon sonrasında detorsiyon (reperfüzyon) uygulandı ve 240 dakika reperfüzyon için beklendi. Daha sonra sol orşiektomi yapılıp ratlardan biyokimyasal değerlendirme için kan ve doku, histopatolojik ve immünohistokimyasal değerlendirme için ise doku örnekleri alındı. Ratlar servikal dislokasyon uygulanarak sakrifiye edildi. İşlem sonlandırıldı. Bulgular: Serum ve dokuda elde edilen MDA, TOS ve OSİ değerleri tedavi gruplarında iskemi/reperfüzyon (İ/R) grubuna göre düşük bulundu(p<0,001). TAS ve SOD değerleri incelendiğinde tedavi ve İ/R grupları arasında anlamlı farklılık saptanamadı (p>0,05). İMA ve İMAR değerlerinin İ/R grubunda tedavi gruplarına göre yüksek olduğu tespit edildi (p<0,001). Histopatolojik değerlendirmede tedavi gruplarında İ/R grubuna göre daha düşük skorlar elde edildi (p<0,001). Histopatolojik olarak tedavi grupları arasında etkinlik açısından anlamlı fark saptanmadı (p>0,05). İmmünohistokimyasal değerlendirmede iNOS ve eNOS tutulumunun tedavi gruplarında İ/R grubuna göre anlamlı şekilde düşük olduğu tespit edildi (p<0,001). İmmünohistokimyasal olarak tedavi grupları arasında anlamlı fark saptanmadı (p>0,05). Sonuç: Testis torsiyonu sonrasında oluşan iskemi reperfüzyon sürecinde farklı veriliş yöntemleri ile uyguladığımız ozon tedavisinin oluşan hasarı önlemede etkili olduğunu gördük. Ancak bu bulguların klinik uygulamalara geçiş öncesinde yapılacak daha geniş kapsamlı deneysel çalışmalarla desteklenmesi gerekmektedir. Anahtar Kelimeler: Ozon, iskemi reperfüzyon hasarı, immünohistokimya, iNOS, eNOS
