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Turk C.,Rudolfstiftung Hospital | Petrik A.,Region Hospital | Petrik A.,Charles University | Sarica K.,Dr Lutfi Kirdar Kartal Research And Training Hospital | And 4 more authors.
European Urology | Year: 2016

Context Management of urinary stones is a major issue for most urologists. Treatment modalities are minimally invasive and include extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL). Technological advances and changing treatment patterns have had an impact on current treatment recommendations, which have clearly shifted towards endourologic procedures. These guidelines describe recent recommendations on treatment indications and the choice of modality for ureteral and renal calculi. Objective To evaluate the optimal measures for treatment of urinary stone disease. Evidence acquisition Several databases were searched to identify studies on interventional treatment of urolithiasis, with special attention to the level of evidence. Evidence synthesis Treatment decisions are made individually according to stone size, location, and (if known) composition, as well as patient preference and local expertise. Treatment recommendations have shifted to endourologic procedures such as URS and PNL, and SWL has lost its place as the first-line modality for many indications despite its proven efficacy. Open and laparoscopic techniques are restricted to limited indications. Best clinical practice standards have been established for all treatments, making all options minimally invasive with low complication rates. Conclusion Active treatment of urolithiasis is currently a minimally invasive intervention, with preference for endourologic techniques. Patient summary For active removal of stones from the kidney or ureter, technological advances have made it possible to use less invasive surgical techniques. These interventions are safe and are generally associated with shorter recovery times and less discomfort for the patient. © 2015 European Association of Urology.

Turk C.,Rudolfstiftung Hospital | Petrik A.,Region Hospital | Petrik A.,Charles University | Sarica K.,Dr Lutfi Kirdar Kartal Research And Training Hospital | And 4 more authors.
European Urology | Year: 2016

Context Low-dose computed tomography (CT) has become the first choice for detection of ureteral calculi. Conservative observational management of renal stones is possible, although the availability of minimally invasive treatment often leads to active treatment. Acute renal colic due to ureteral stone obstruction is an emergency that requires immediate pain management. Medical expulsive therapy (MET) for ureteral stones can support spontaneous passage in the absence of complicating factors. These guidelines summarise current recommendations for imaging, pain management, conservative treatment, and MET for renal and ureteral stones. Oral chemolysis is an option for uric acid stones. Objective To evaluate the optimal measures for diagnosis and conservative and medical treatment of urolithiasis. Evidence acquisition Several databases were searched for studies on imaging, pain management, observation, and MET for urolithiasis, with particular attention to the level of evidence. Evidence synthesis Most patients with urolithiasis present with typical colic symptoms, but stones in the renal calices remain asymptomatic. Routine evaluation includes ultrasound imaging as the first-line modality. In acute disease, low-dose CT is the method of choice. Ureteral stones <6 mm can pass spontaneously in well-controlled patients. Sufficient pain management is mandatory in acute renal colic. MET, usually with α-receptor antagonists, facilitates stone passage and reduces the need for analgesia. Contrast imaging is advised for accurate determination of the renal anatomy. Asymptomatic calyceal stones may be observed via active surveillance. Conclusions Diagnosis, observational management, and medical treatment of urinary calculi are routine measures. Diagnosis is rapid using low-dose CT. However, radiation exposure is a limitation. Active treatment might not be necessary, especially for stones in the lower pole. MET is recommended to support spontaneous stone expulsion. Patient summary For stones in the lower pole of the kidney, treatment may be postponed if there are no complaints. Pharmacological treatment may promote spontaneous stone passage. © 2015 European Association of Urology.

Onur E.,Fatih Sultan Mehmet Research and Training Hospital | Paksoy M.,Istanbul University | Baca B.,Istanbul University | Akoglu H.,Dr Lutfi Kirdar Kartal Research And Training Hospital
Journal of Investigative Surgery | Year: 2012

Background: This study was designed to evaluate the combined effects of hyperbaric oxygen (HBO) and N-acetylcysteine (NAC) on acute necrotizing pancreatitis in rats. Methods: Experiments were performed in 50 male Wistar rats, which were divided into five groups (N = 10 for each group). The first group received normal saline (0.9% NaCl) intraperitoneal and served as the control group. In the second group, acute pancreatitis was induced by 3.2-g/kg body weight L-arginine intraperitoneal twice at an interval of 1 hr, which has been shown previously to produce severe necrotizing acute pancreatitis. In the third group, NAC treatment (1000 mg/kg) was given after 1 hr of the induction of acute pancreatitis twice 24 hr apart. In the fourth group, animals received HBO, 6 hr after the induction of pancreatitis twice 12 hr apart. In the fifth group, animals received together NAC as in Group 3 and HBO treatment as in Group 4. Groups 1, 2, and 3 were left under normal atmospheric pressures. Twelve hours after last treatment, the animals were killed by exsanguinations. Blood samples were studied for amylase, calcium, and lactate dehydrogenase (LDH), pancreatic histology, pancreatic tissue malondialdehyde, superoxide dismutase, and glutathione levels. Results: Acute pancreatitis is reduced by the treatment of NAC, HBO, NAC + HBO. HBO + NAC groups performed statistically the best in preventing L-arginine-induced acute necrotising pancreatitis. Conclusions: NAC especially combined with HBO, decreases oxidative stress parameters, serum amylase, calcium, and LDH levels, as well as histopathologic score. © 2012 Informa Healthcare USA, Inc.

Murat Naki M.,Dr Lutfi Kirdar Kartal Research And Training Hospital | Tekcan C.,Medipol Hospital | Ozcan N.,Sonomed Imaging Center | Cebi M.,Sonomed Imaging Center
Fertility and Sterility | Year: 2010

Levonorgestrel- (LNG) releasing intrauterine device (IUD) insertion revealed significant reduction in visual bleeding scores and spotting with an increase in amenorrhea and uterine pulsatility index scores. LNG-IUD can be considered as a simple and effective alternative to surgical treatment in the management of leiomyoma-dependent menorrhagia of reproductive-age women. © 2010 American Society for Reproductive Medicine.

Karadayi N.,Dr Lutfi Kirdar Kartal Research And Training Hospital | Gecer M.,Dr Lutfi Kirdar Kartal Research And Training Hospital | Kayahan S.,Dr Lutfi Kirdar Kartal Research And Training Hospital | Yamuc E.,Dr Lutfi Kirdar Kartal Research And Training Hospital | And 3 more authors.
Medical Oncology | Year: 2013

Several studies have suggested a possible role of human papillomavirus (HPV) in the pathogenesis of endometrial carcinoma. The aim of the study was to investigate the presence of HPV DNA in endometrium cancers and nonneoplastic endometrium. Sixty endometrial adenocarcinomas with and without squamous differentiation and the nonneoplastic endometrium tissue of fifty-six of the same patients were analyzed for the presence of family 16 and family 6 HPV DNA by using chromogenic in situ hybridization technique on formalin-fixed and paraffin-embedded archival samples, and the results were confirmed by polymerase chain reaction method. HPV DNA was not detected either in the endometrial adenocarcinoma with or without squamous differentiation, or in the nonneoplastic endometrium tissue. It appears that HPV does not play any role in the pathogenesis of endometrial carcinoma, since endometrium may not to be a suitable host for HPV replication. © Springer Science+Business Media New York 2013.

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