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Öğe Effect of sildenafil on platelet function and platelet cGMP of patients with erectile dysfunction(WILEY-BLACKWELL, 2015) Akand, M.; Gencer, E.; Yaman, O.; Erisgen, G.; Tekin, D.; Ozdiler, E.To investigate the effect of sildenafil on platelet function and cyclic guanosine monophosphate (cGMP) levels in patients with erectile dysfunction, we evaluated the association between erectile function and platelet responses after administration of 100mg sildenafil. Erectile responses were monitored after 8 daily doses of the drug. Adenosine diphosphate (ADP) and collagen-induced platelet aggregation and simultaneous adenosine triphosphate (ATP) release and cGMP levels were determined before and after sildenafil therapy. Basal levels for platelet aggregation, ATP release and cGMP were compared with age-matched controls. There was no difference among basal levels of platelet responses between patients and controls, except for ADP-induced platelet aggregation (P=0.04). It was significantly higher in the patient group. Analysis of the responses to sildenafil revealed that for the patients who showed a positive erectile response, there was a significant increase in platelet cGMP (P=0.028) and a decrease in ADP-induced platelet aggregation (P=0.04). However, for those who showed a negative or poor erectile response, there was no change in platelet cGMP levels and platelet functions. Sildenafil did not affect collagen-induced platelet responses although cGMP levels of the responders increased. It is concluded that sildenafil increases platelet cGMP in the patients with positive erectile response. Therefore, it has been speculated that platelet cGMP may be used as an index for erectile response.Öğe The effects of estradiol on cardiac muscle electrophysiology in orchiectomized rat model: a new insight to side effects caused by castration(VERDUCI PUBLISHER, 2015) Ayaz, M.; Akand, M.; Kucukbagriacik, Y.; Dursunoglu, D.OBJCTIVE: Although the testosterone has a protective effect on heart, patients having maximal androgen blockade due to prostate cancer resembles endothelial dysfunction and cardiac problems when compared to normal population. We aimed to test the effect of 17 beta estradiol on the orchiectomized male rat heart electrophysiology and ion channel expression levels. MATERIALS AND METHODS: This study was conducted on 27 male rats with 4 groups (healthy, orchiectomized, orchiectomized+ 17 beta estradiol treated and orchiectomized+ vehicle treated). Action potentials and contractions were recorded simultaneously, while expressions of the calcium and potassium ion channels were measured. RESULTS: Testosterone depletion for 4 weeks has caused a significant prolongation in the action potential durations and decrease in maximal contraction force as well as a deceleration. While this depletion suppressed expression of potassium channels, it increased the expression of calcium ion channels. Application of estradiol on the other hand, except for the calcium ion channel expression, had no positive effect on the tested parameters. CONCLUSIONS: Testosterone has a markedly important and protective effect on male cardiac muscle preparations while estrogen does not have any. It is predicted that testosterone has showed this effect by means of modulation of some key points of excitation-contraction pairing of cardiac muscle.Öğe Evaluation of laparoscopic transperitoneal adrenalectomy: is it feasible for large masses?(EDIZIONI MINERVA MEDICA, 2015) Mesci, A.; Celik, O.; Akand, M.; Aydogdu, O.; Arici, G.; Arici, C.; Erdogru, T.Aim. The aim of this paper was to determine whether laparoscopic adrenalectomy (LA) is a safe and effective treatment for the management of large adrenal tumors. Methods. We retrospectively evaluated the data of patients who underwent LA at our institution between September 2002 and September 2012. Seventy-six transperitoneal LA were performed by the same surgical team. Patients with invasive tumors to adjacent organs or distant metastasis were excluded from the study. All patients were operated using the 450 oblique position as transperitoneal approach. Results. The mean age of the patients was 48.3 years (range 20-68 years). The mean tumor size was 5.37 cm (range 2-15 cm). Sixteen patients had tumor size over 8 cm. The mean tumor weight was 31.2 gr (range 2-156 g). The lesions were localized on the tight side in 42 (55%) patients and on the left side in 34 (45%) patients. The mean intraoperative blood loss was 114 mL (range 20-400 mL) and the mean operative time was 112 min (range 55-300 min). Six patients (7%) required conversion to open procedure. The mean hospitalization time was 2.5 days (range 1-4 days). Five patients (6%) had postoperative minor complications. There were no incidents of capsular invasion or adverse cardiovascular events. Conclusion. LA is safe and feasible for both malign and benign adrenal lesions. Good preoperative assessment, surgical skills, team work and adherence to anatomical and surgical principles are the key to success for large adrenal masses.Öğe Open, laparoscopic and robot-assisted laparoscopic radical prostatectomy: comparative analysis of operative and pathologic outcomes for three techniques with a single surgeon's experience(VERDUCI PUBLISHER, 2015) Akand, M.; Celik, O.; Avci, E.; Duman, I.; Erdogru, T.OBJECTIVE: To compare outcomes of open (O-), laparoscopic (L-) and robotassisted laparoscopic (RAL-) radical prostatectomy (RP) performed by the same surgeon. PATIENTS AND METHODS: From May 1999 to April 2012, 484 RPs were performed by a single surgeon. Patients' data including age, bodymass index, serum prostate specific antigen (PSA) level, Gleason score of prostate biopsy and prostatectomy specimen, preoperative prostate and specimen volumes, clinical and pathologic stages, operation time, estimated blood loss (EBL), catheterization time, blood transfusion rate were recorded. Prospectively collected data was evaluated retrospectively by statistical analyses. RESULTS: Of 484 radical prostatectomies, ORP (50), LRP (308) and RALRP (79) done by the same surgeon were included into study. Mean ages were 63.8, 62.7 and 60.3 years for ORP, LRP and RALRP respectively. Operation times for ORP, LRP and RALRP were 255, 208 and 242 minutes. EBL and hospitalization time were 602, 526, 234 mL, and 9.1, 3.2, 3.2 days for ORP, LRP and RALRP, respectively. While a significant advantage was found for EBL and complication rates in RALRP and for operation time in LRP, significant disadvantages were found in terms of catheterization time, hospitalization time, decrease in hemoglobin and blood transfusion in ORP. However, preoperative prostate volume and serum PSA level, oncologic outcomes and positive surgical margins were nearly similar in all operative techniques. CONCLUSIONS: Minimally invasive techniques such as LRP and RALRP are promising techniques with comparable outcomes with ORP. Shorter catheterization time, less blood loss and fewer complication rates can be provided by RALRP.Öğe Preoperative neutrophil-to-lymphocyte ratio (NLR) may be predictive of pathologic stage in patients with bladder cancer larger than 3 cm(VERDUCI PUBLISHER, 2016) Celik, O.; Akand, M.; Keskin, M. Z.; Yoldas, M.; Ilbey, Y. O.OBJECTIVE: Bladder cancer (BCa) is the most common malignancy of the urinary tract. In this study, we aimed to evaluate the ability of preoperative neutrophil-to-lymphocyte ratio (NLR) to predict pathologic stage of at the time of first transurethral resection of bladder tumor (TUR-BT) in patients with BCa larger than 3 cm. PATIENTS AND METHODS: Records of consecutive patients undergoing TUR-BT for BCa with a diameter >3 cm were reviewed. A total of 222 patients were eligible for analysis, and were divided into two groups: 162 patients in non-muscle-invasive BCa (NMIBC) group and 60 patients in muscle-invasive BCa (MIBC) group. Differences in preoperative blood parameters and NLR were evaluated between groups with an unequal variance t-test. RESULTS: In the NMIBC group, 59 patients had low-grade and 103 high-grade papillary urothelial carcinomas. 60 patients had T2 stage carcinoma. The mean age of the patients was 71.8 and 75.7 years, and mean NLR was 3.44 +/- 2.03 and 4.6 +/- 2.8 in NMIBC and MIBC groups, respectively. In terms of NLR, there was a statistically significant difference between the NMIBC and MIBC groups (p = 0.005). CONCLUSIONS: Our results showed that NLR might act as a significant predictive biomarker on the staging of BCa. Also, NLR could be used as a cost-effective, simple, common usable biomarker in urology clinic practice.
