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    Characteristics of pediatric urolithiasis in south-east Anatolia
    (Blackwell Science Asia, 2000) Ece, A; Özdemir, E; Gürkan, F; Dokucu, AI; Akdeniz, O
    Background: Urolithiasis is endemic in Turkey and characteristics of urolithiasis vary in different regions of the world. The aim of the present study was to evaluate the etiological and clinical characteristics and course of pediatric urolithiasis in south-east Turkey. Methods: The study population consisted of 81 children (52 girls) with urolithiasis at a mean age of 6.2 +/- 4.2 years who were followed up for 1-32 months. Results: Metabolic disorders, anatomical defects and infection stones were found to be the etiological factor in 34.6, 29.6 and 22.2% of patients, respectively, while 13.6% of patients were considered idiopathic. Of all patients, 28.4% were admitted with acute renal failure (ARF) and 72.8% had urinary tract infection. Recurrence was seen in 19.8% of patients at presentation. The localization of the stone was found to be in the upper urinary tract, the lower urinary tract or both in 65.4, 14.8% and 17.3% of patients, respectively. Patients with multiple and bilateral stones had a higher risk for ARF than the others. The risk for chronic renal failure was significantly higher in children with multiple, bilateral or recurrent stones and with ARF at presentation. Conclusions: Early diagnosis and management of renal stones and urinary tract infections is necessary to prevent the development of ARF or chronic renal failure and to improve the quality of a patient's life.
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    p21WAF-1/CIP-1, a downstream regulator of functional p53 loss, in transitional cell carcinoma of urothelium
    (Karger, 2000) Özdemir, E; Kakehi, Y; Yoshida, O
    Objectives: The expression of p21(WAF-1/CIP-1), a downstream regulator of p53, is a universal cycline-dependent kinase inhibitor. The aim of this study is to determine whether p21 expression could be used as a prognostic marker in urothelial carcinomas. Methods: By use of immunohistochemistry, we examined the expression of p21(WAF-1/CIP-1) in 60 patients with urothelial carcinomas and compared the results with the status of nuclear p53 and mdm2 accumulation, expression of type IV collagen in the basement membranes and upregulation of metalloproteinases (MMP-1, MMP-2, MMP-9). Results: p21(WAF-1/CIP-1) immunoreactivity was observed in 51.7% of the tumors, and in only 39% of the tumors with functional p53 loss (nuclear accumulation of p53 and/or mdm2). p21(WAF-1/CIP-1) overexpression was not associated with grade and stage of the tumors and presence or absence of concomitant CIS, Moreover, p21(WAF-1/CIP-1) overexpression was not associated with upregulation of metalloproteinases or destruction of type IV collagen of basement membranes. Conclusions: Our results suggest that p21(WAF-1/CIP-1) expression is regulated by both p53-dependent and independent pathways and is not related to grade, stage or potential markers of invasion in urothelial carcinomas. Copyright (C) 2000 S. Karger AG. Basel.
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    The protective effects of captopril and nitric oxide on solitary kidney after chronic partial ureteric obstruction
    (Blackwell Science Ltd, 2001) Öztürk, H; Dokucu, AI; Otçu, S; Gezici, A; Ketani, A; Yildiz, FR; Özdemir, E
    Objective To determine whether vasodilator agents (captopril and nitric oxide) change the morphological and functional effects of chronic partial ureteric obstruction in solitary kidney tissue in unilaterally nephrectomized rats, Materials and methods Each of 50 prepubertal Wistar albino rats underwent right nephrectomy and were then assigned to one of five groups. Rats in group 1 underwent a sham operation (control) and in the other groups the ureter of the remaining kidney was partially obstructed by surgery. In group 2, no drug treatments were given; in groups 3, 4 and 5 captopril, L-arginine methyl ester (L-Arg) or NG-nitro-L-arginine-methyl ester, respectively, were given for 3 weeks, In all rats, diuretic scintigraphy was used to measure kidney perfusion, glomerular filtration rate (GFR) and concentration. Blood urea nitrogen (BUN), serum creatinine levels, kidney parenchymal weight and pelvic volume were measured and the kidneys evaluated histopathologically. Results Renal perfusion was significantly greater in both group 3 and 4 than in group 2, The GFR was 18% greater in group 3 and 22.3% greater in group 4 than in group 2. The GFR was decreased by 67% in group 5 compared with the control group, The mean parenchymal weight, mean pelvic volume, BUN and serum creatinine in the four groups with a partially obstructed ureter were significantly different from the control group. There also were significant differences between group 2 and groups 3-5, and between group 2 and group 3. Histological damage was severe in all four groups with partial ureteric obstruction, but in the drug-treated groups, medullary fibrosis was less frequent. Conclusion After 3 weeks of treatment, captopril and L-Arg both improved kidney perfusion, GFR, BUN and serum creatinine levels, but were less effective in preventing parenchymal atrophy and changes in pelvic volume.
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    The protective effects of nitric oxide on the contralateral testis in prepubertal rats with unilateral testicular torsion
    (Blackwell Science Ltd, 2000) Dokucu, AI; Öztürk, H; Özdemir, E; Ketani, A; Büyükbayram, H; Yücesan, S
    Objective To investigate histological changes in the contralateral testis of rats with unilateral testicular torsion and the protective effects of nitric oxide (NO) on possible damage. Material and methods Twenty-eight prepubertal male Sprague-Dawley rats were divided into four equal groups. Group 1 underwent a sham operation of the right testis under general anaesthesia. Group 2 underwent a similar operation but the right testis was rotated 720 degrees clockwise for 6 h, maintained by fixing the testis to the scrotum, and saline infused during the procedure. Group 3 underwent similar torsion but L-arginine methyl ester (a precursor of NO) was infused during the procedure. In Group 4, N-G-nitro-L-arginine-methyl ester, a NO synthase inhibitor, was infused separately during the administration of L-arginine methylester and torsion. All the left (untwisted) testes were removed from rats 21 days after surgery and evaluated histologically, assessing seminiferous tubule diameter, loss of sperm and spermatids, loss of germ cell layers, disarray of germ cell layers, rupture of tubules, Leydig cell proliferation and reaction in the ruptured tubules, and oedema. Results There was a significant difference in the indicators of histological damage between groups 2 and 4 and groups 1 and 3, except for the Leydig cell reaction in the ruptured tubules and oedema. The damage was significantly less in group 3 than in groups 2 and 4. Conclusion These results suggest that long-term histopathological changes in the contralateral testes are important after unilateral testicular torsion and that NO has a protective effect on the contralateral testis.
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    Protruding urethral leiomyoma obscuring vaginal introitus
    (East African Medical Journal, 1999) Uzunlar, AK; Özdemir, E; Yilmaz, F; Yaldiz, M; Özaydin, M; Arslan, A
    Leiomyoma is quite rare in the female urethra. We report an additional case to 29 reported in the literature. A multiparous woman presented with a complaint of a gradually enlarging mass causing dyspareunia for the last seven months. The mass was originating from the upper part of the distal urethra with a relatively thin stalk covered by squamous epithelia, and immunohistopathological examination confirmed it as leiomyoma.
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    Role of matrix metalloproteinase-9 in the basement membrane destruction of superficial urothelial carcinomas
    (Lippincott Williams & Wilkins, 1999) Özdemir, E; Kakehi, Y; Okuno, H; Yoshida, O
    Purpose: This study was conducted to clarify which matrix metalloproteinases (MMPs) play a key role in destruction of the underlying basement membrane (BM) of superficial urothelial carcinomas. Urine concentrations of MMP-9 and tissue inhibitors of matrix metalloproteinase-l (TIMP-1) were also measured. Materials and Methods: Overexpression of MMP-1, MMP-2 and MMP-9 was analyzed immunohistochemically in 60 patients with transitional cell carcinomas of the urothelium (41 were pTa or pis, 19 were pT(1-4)), and compared them with type IV collagen expression in tumor BM. In 33 of them, urine concentrations of MMP-9 and TIMP-1 were measured by one-step sandwich enzyme immunoassay. Results: Positive expression of MMP-1, MMP-2 and MMP-9 was found in 53%, 17%, and 65% of tumors, respectively. Only MMP-9 expression rates were increased with grades and stages (p = 0.03). In pTa and pis tumors, type IV collagen expression was reduced in 17 of 26 (65.4%), and it was associated with positive MMP-9 expression (p = 0.0283). MMP-9 was detected in all urine samples of urothelial cancer patients, while urine TIMP-1 was detectable in 18 of 33 patients. In 16 healthy volunteers, both of them were below detectable levels, Balance between urinary MMP-9 and TIMP-1 were particularly kept in superficial urothelial carcinomas with intact tumor BM. Tumor BM: status, however, was not associated with urinary MMP-9 or TIMP-1 levels. Conclusions: These results suggest that MMP-9 plays a key role in the invasion step of superficial urothelial carcinomas. Detection of urinary MMP-9 may become a new, non-invasive mean for the diagnosis of urothelial carcinomas.