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Öğe Assessment of the relationship between asymmetric dimethylarginine and severity of erectile dysfunction and coronary artery disease(Springer, 2010) Aktoz, Tevfik; Aktoz, Meryem; Tatli, Ersan; Kaplan, Mustafa; Turan, Fatma N.; Barutcu, Ahmet; Atakan, Irfan H.The plasma concentration of asymmetrical dimethylarginine (ADMA), an inhibitor of nitric oxide synthase, has been linked to endothelial dysfunction. We investigated the relation between plasma ADMA concentration and severity of erectile dysfunction (ED) and coronary artery disease (CAD). We measured plasma levels of ADMA in 92 male patients. Patients were divided into three groups: group 1 (n = 41), patients with ED and without CAD; group 2 (n = 29), patients with stable CAD; group 3 (n = 22), control group (patients without CAD or ED). Erectile function was evaluated by the erectile function domain of the international index of erectile function (IIEF-EFD) a validated 15-item self-administered questionnaire. Erectile function is specifically addressed by six questions that form the so-called erectile function domain of the questionnaire. Each question is scored 0-5. ED is defined as any value < 26. Patients with CAD who have stable angina pectoris were selected after coronary angiography. ADMA was analyzed by ELISA method. Group 1 had significantly higher concentrations of plasma ADMA than groups 2 and 3 (respectively, 0.75 +/- A 0.40 vs. 0.50 +/- A 0.30, P = 0.013; 0.75 +/- A 0.40 vs. 0.50 +/- A 0.25, P = 0.021). There was negative correlation between ADMA and IIEF-EFD score in all groups (n = 92) (r = -0.322, P = 0.002). In a multiple logistic regression analysis adjusting for age, hyperlipidemia, ADMA remained independent predictor for severe ED. Odds ratio for plasma ADMA was 14.151 (1.101-181.940; P = 0.042). First of all, this study provides that ADMA concentrations are significantly higher in patients who have ED when compared to patients with CAD and controls. Second, there was a negative correlation between ADMA and severity of ED. Elevating levels of circulating ADMA is an independent risk factor for severe of ED, and ADMA may be a link between CAD and ED.Öğe Case report: Subcutaneous metastasis from small cell carcinoma of the prostate(Springer, 2007) Kaplan, Mustafa; Atakan, Irfan H.; Bilgi, Selcuk; Inci, OsmanPure primary small cell carcinoma of the prostate (SCCP) is an extremely rare entity. Natural history of this tumor is similar to that of the bronchogenic small cell carcinoma. Several theories of histogenesis have been proposed. Most widely accepted view is that SCCP arises from pluripotent stem cells of the prostate, which have the ability to differentiate into either epithelial or neuroendocrine type carcinomas. SCCP has an aggressive course, and a majority of patients have distant metastasis at presentation. Since it is a rare entity, no standard treatment regimen has been established. A case of primary pure SCCP with multiple subcutaneous metastases is presented.Öğe Giant bladder stone in children: case report(Int Scientific Literature, Inc, 2008) Aktoz, Tevfi K.; Kaplan, Mustafa; Atakan, Irfan H.; Inci, OsmanBackground: Pediatric urolithiasis is an endemic disease in certain parts of the world, namely Turkey and Far East. Metabolic and environmental factors, in addition to urogenital abnormalities, should be evaluated thoroughly each patient. The aims of management should be complete clearance of stones, treatment of urinary tract infections, preservation of renal function and prevention of stone recurrence. The giant bladder stone is not very common and it is usually associated with nutritional factors. Case Report: A 3 year-old boy was admitted to our clinic with a 2-year history of recurrent urinary tract infections and urinary complaints like intermittent and painful voiding with terminal hematuria and sharp lower abdominal pain. On physical examination, the weight and height were 10 kg (below the 3rd percentile), and 85 cm (below the 3rd percentile), respectively. Direct urinary system X-ray study and intravenous urography (IVU) showed a giant bladder stone. In this case, we think that giant bladder stone is associated with nutritional factors and we were unable to find an underlying metabolic abnormality. Open surgery was performed to this patient. The bladder stone was 3.1 x 2.0 x 1.7 cm in diameter. Biochemical analysis showed that it was calcium oxalate stone. Conclusions: Treatment of pediatric urolithiasis requires a metabolic and environmental evaluation of all patients. Obstructive pathologies have to be corrected and metabolic abnormalities should be treated. Also nutritional factors related with bladder stones must be considered. Open surgery remains the main treatment of giant bladder stones in children.Öğe Giant unilateral abdominoscrotal hydrocele in an adult: Case report(Springer, 2006) Kaplan, Mustafa; Atakan, Irfan H.; Aktoz, Tevfik; Inci, OsmanAbdominoscrotal hydrocele (ASH) is an apparently highly uncommon clinical entity especially in childhood. While hydrocele is among the commonest inguinal anomaly in adult, its extreme form ASH is infrequently reported form. ASH consists of two large sacs, both abdominal and scrotal, connecting with the inguinal canal. Surgical correction is mandatory. We present a 34-year-old man with giant ASH. He was treated with excision of hydrocele sac through an inguinal approach.Öğe Influence of N-acetylcysteine on renal toxicity of cadmium in rats(Springer, 2008) Kaplan, Mustafa; Atakan, Irfan H.; Aydogdu, Nurettin; Aktoz, Tevfik; Ozpuyan, Fulya; Seren, Guelay; Tokuc, BurcuThe aim of this study was to investigate the ability of N-acetylcysteine (NAC) to prevent cadmium (Cd)-induced renal damage and whether NAC would reverse cadmium damage to the kidney. Fifty adult male rats were divided into five experimental groups: group 1 received tap water for 3 months and 7 days, group 2 received cadmium chloride (CdCl2) for 3 months, group 3 (NAC cotreatment group) received CdCl2 and 0.5% NAC in tap water for 3 months, group 4 received CdCl2 in tap water for 3 months and 3 months later received only tap water for 7 days, and group 5 (NAC posttreatment group) received CdCl2 in tap water for 3 months and 3 months later received 2% NAC in tap water for 7 days. NAC significantly decreased the elevated kidney malondialdehyde levels, as a marker of lipid peroxidation, in both cotreatment and posttreatment modalities. Cotreatment and posttreatment with NAC significantly increased kidney superoxide dismutase enzyme activity and glutathione level but did not change kidney catalase enzyme activity. NAC decreased fractional excretion of sodium in posttreatment group. Neither Cd nor NAC affected the glomerular filtration rate (GFR). Cotreatment and posttreatment with NAC reduced the effects of Cd on proximal tubules. It was found that NAC showed these effects without changing kidney accumulation of cadmium. Exogenously administrated NAC might reduce toxic effects of Cd on the kidney without any reduction in tissue Cd level.Öğe Penile metastasis from small cell carcinoma of the urinary bladder(Int Scientific Literature, Inc, 2008) Kaplan, Mustafa; Aktoz, Tevfik; Puyan, Fulya O.; Alicioglu, Banu; Atakan, Irfan H.; Inci, OsmanBackground: Small cell carcinoma of the urinary bladder is a rare and highly aggressive tumor that has been described in case reports or small series. It accounts for < 1% of all urinary bladder carcinomas. The prognosis of patients with small cell carcinoma of the urinary bladder is poor and depends on the extend of the disease. Case Report: Herein we report a case of a penile metastasis from small cell carcinoma of the urinary bladder. A 70-year-old man was treated for small cell carcinoma of the bladder with radical cystectomy and ileal conduit in 2007. Pathological examination of the radical sistoprostatectomy material revealed an ulcerated, necrotic invasive undifferentiated tumor with bladder wall invasion. Left vesicula seminalis and prostatic tissue was also infi ltrated by the tumor cells. Small cell cancer of the urinary bladder was diagnosed. Adjuvant chemotherapy was planned but the patient did not accept it. Two months after the operation he has noticed a painful swelling on the right side of the penis. But he ignored it. Four months later he admitted to our clinic with a swollen, painful penis. Physical examination revealed a hard, ovoid nodule (3x3 cm in diameter) along the shaft of the penis near its base on the right side. Ultrasound revealed a 3x3 cm mass on the right side of the penis that not involved the corpus cavernosum. Pathology of the penile lesion revealed metastatic tumor. Morphological and immonohistochemical fi ndings of the tumor cells were identical to the primary tumor cells. Conclusions: Metastases to the penis are uncommon. Most penile metastases present with swollen and frequently tender penis, pain and/ or priapism. In cases with bladder carcinoma which had metastasized to penis, the histopathologic type is mostly urothelial carcinoma. Small cell carcinoma of the bladder is uncommon and unlike urothelial carcinoma it behaves aggressively. And this is the fi rst case of small cell carcinoma of the bladder which has metastasized to the penis.Öğe Serum, urinary and stone zinc, iron, magnesium and copper levels in idiopathic calcium oxalate stone patients(Springer, 2007) Atakan, Irfan H.; Kaplan, Mustafa; Seren, Gulay; Aktoz, Tevfik; Gul, Hatice; Inci, OsmanMany theories have been put forward to explain the mechanism of stone formation and growth. The aim of this study was to investigate the urinary, serum and stone levels of zinc, iron, magnesium, and copper in patients with calcium oxalate stones and to investigate urinary and serum element levels in healthy controls and to find a possible connection between the elements and calcium oxalate stone formation. A total of 104 patients with calcium oxalate stones ranging in age from 3 to 79 years (mean 44.0 +/- 18.1) and 77 healthy controls ranging in age from 18 to 77 (mean 44.2 +/- 17.9) were included in this study. The mean urinary iron and copper levels in stone patients were significantly higher than healthy controls (P = 0.000). The mean urinary zinc and magnesium levels in healthy controls were significantly higher than stone patients (P = 0.000). There was no significant difference in the serum levels of magnesium and copper in stone patients and healthy controls. Serum zinc and iron level were significantly high in healthy controls as compared to stone patients. Each stone had all 4 elements. Zn and Mg have inhibitory effect on calcium oxalate stone formation. Fe and Cu could be promotor of the calcium oxalate stone formation.Öğe Value of Dynamic Contrast-Enhanced MRI and Correlation with Tumor Angiogenesis in Bladder Cancer(Amer Roentgen Ray Soc, 2009) Tuncbilek, Nermin; Kaplan, Mustafa; Altaner, Semsi; Atakan, Irfan H.; Sut, Necdet; Inci, Osman; Demir, Mustafa KemalOBJECTIVE. The aim of this study was to investigate dynamic contrast-enhanced MRI (DCE-MRI) for the noninvasive measurement of bladder cancer angiogenesis by correlation with microvessel density, histologic grade, and tumor staging, and to predict the outcome of local recurrence. MATERIALS AND METHODS. Twenty-four patients with bladder cancer were examined using DCE-MRI. Hemodynamic parameters obtained by DCE-MRI included peak time enhancement in the first minute (E-max/1) after contrast administration, second minute (E-max/2), third minute (E-max/3), fourth minute (E (max/4)), and fifth minute (E-max/5), and the steepest slope. Microvessel density was identified by immunostaining of endothelial cells using FVIII-related antigen. The Mann-Whitney U test, multivariate discriminant analysis, Spearman's correlation coefficient, and analysis of variance were used for statistical analysis. RESULTS. Correlation was seen between DCE-MRI parameters (E-max/1 and steepest slope) and microvessel density (p<0.05). E-max/1 and steepest slope were found to have a statistically significant correlation with histologic grade (p<0.05 and p<0.01, respectively). A significant difference was seen between groups of patients with and without local recurrence with regard to two of the DCE-MRI parameters (p<0.05 for E-max/1 and E-max/2). CONCLUSION. The contrast enhancement patterns on DCE-MRI are influenced by tumor angiogenesis, as reflected by elevated microvessel density expression. Therefore, they are valuable indicators for assessing tumor angiogenic activity and tumor neovascularization in bladder cancers.