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    The Effect of Oxidative Stress Which Can Be Demonstrated with Thiol/Disulfide Homeostasis in Varicocele Patients on Sperm Parameters
    (CLIN LAB PUBL, 2018) Sonmez, Mehmet G.; Kozanhan, Betul; Deniz, Cigdem D.; Iyisoy, Mehmet S.; Kilinc, Muzaffer T.; Ecer, Gokhan; Sonmez, Leyla Ozturk
    Background: We planned to evaluate the effects of thiol/disulfide homeostasis (TDH) on sperm parameters in varicocele patients in this study. Methods: According to sperm concentration (< 15 x 10(6)/mL) sperm morphology (<4%) and progressive motility values (<32%) in the semen analysis, patients were divided into four groups as oligozoospermia (OS, n = 27), oligoasthenozoospermia (OAS, n = 20), oligoteratozoospermia (OTS, n = 26), and oligoasthenoteratozoospermia (OATS, n = 19). Patients with varicocele diagnosis but no pathology in semen analysis were accepted as the control group (n = 25). Groups with impaired semen analysis results were compared to the control group. Results: No difference was detected between OS, OAS, OTS, and OATS groups and the control group in demographical (age, BMI) and varicocele parameters (vein diameter, grade). A significant difference was observed in disulfide level, disulfide/native thiol, disulfide/total thiol rates among OS, OAS, OTS, OATS groups and the control group in the evaluation of TDH parameters. They were significantly higher in OATS group. In OS, OAS, OTS, and OATS groups, it was found that native thiol and total thiol levels were lower and disulfide level was higher than control group, and thiol/disulfide homeostasis shifted to the disulfide side. It was detected that when disulfide value increases 1 mu mol/L, the morphology deteriorated 0.3% and sperm concentration (10(6)/mL) decreased 0.74 and progressive motility decreased 0.68%. Conclusions: The results of the present study suggest that patients with varicocele who have impaired sperm parameters have oxidative stress characterized by TDH slide towards disulfide side and inadequate antioxidant response identified by a lower level of native thiol compared to controls.
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    The Effects of Positive End-Expiratory Pressure on Cross-Sectional Area of Internal Jugular Vein in Obese Patients
    (MARY ANN LIEBERT, INC, 2016) Kozanhan, Betul; Apiliogullari, Seza; Basaran, Betul; Iyisoy, Mehmet Sinan; Ozmen, Sadik
    Introduction: Obesity is one of the most important risk factors for complications of internal jugular vein (IJV) cannulation. The efficacy and safety of positive end-expiratory pressure (PEEP) are still under debate in obese patients. The aim of this prospective randomized ultrasound study was to investigate effects of different PEEP levels on the cross-sectional area (CSA) of right IJV and overlap with carotid artery (CA) in anesthetized obese patients. Materials and Methods: Seventy-two obese patients undergoing various elective surgeries under general endotracheal anesthesia were enrolled. We measured CSA of right IJV, margin of safety (MOS), and degree of overlap between CA and IJV at PEEP 0 (P0), 5 (P5), and 12 (P12) cm H2O levels. We defined a 20% increase in CSA as clinically relevant. Results: Data were collected for all the 72 patients enrolled in the study. Application of 12, but not 5cm H2O PEEP, resulted in a clinically significant increase in CSA of right IJV. When compared to P0, application of P5 and P12 increased both degree of overlap (p<0.001 each) and MOS (p<0.001 each). None of the patients experienced severe hypotension or bradycardia. Conclusions: Application of 12cm H2O PEEP provides a clinically significant increase in CSA of right IJV without relevant reduction of MOS in anesthetized obese patients.
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    What should be done to minimize pain without any sexual function deterioration in transrectal prostate biopsy?
    (POLISH UROLOGICAL ASSOC, 2017) Sonmez, Mehmet Giray; Kozanhan, Betul; Demirelli, Erhan; Sonmez, Leyla Ozturk; Kara, Cengiz
    Introduction The aim of this study was to find an ideal method for the application of a transrectal ultrasound-guided prostate biopsy (TRUS-Bx) without deteriorating patient comfort. Material and methods TRUS-Bx was applied in a total of 93 patients. Taking the application method into consideration, these patients were divided into three groups, each consisting of 31 patients. Methods applied for pain control in the different groups were compared (groups 1, 2 and 3). Age, prostate specific antigen (PSA), prostate volume, cancer detection rate, re-biopsy consent ratio, complication rates, visual analog scale (VAS), and International Index of Erectile Function (IIEF-5) scores were compared among the groups. Results Age, PSA, prostate volume, cancer detection rate, and fever complication rate were not statistically different between the three groups. However, a statistically significant difference was detected among the groups for the VAS measured during and after TRUS-Bx, re-biopsy consent ratio, and hematuria (p < 0.001, p < 0.001, p < 0.001, and p = 0.027, respectively). There was no detected difference in pre-operation IIEF-5 scores, but the difference in IIEF-5 scores in the first month after the operation was significant (p = 0.116, p = 0.024, respectively). Conclusions Anal dilatation after the application of intrarectal topical anesthetic to provide anesthesia during TRUS-Bx and giving lidocaine hydrochloride with epinephrine for periprostatic nerve blockage (PNB) is a successful and effective method to maintain patient comfort, especially as it relates to pain control and sexual function. Anal dilatation seems to minimize any pain that may occur due to probe transition, and adding epinephrine as a vasopressor to the anesthetic agent chosen during the operation will be rather helpful for hemostasis control and pain that results from the needle.