Evaluation and therapeutic regulation of erectile dysfunction with visual stimulation test. An objective approach by using sildenafil citrate test

AIM: An objective evaluation of the psychogenic cause of erectile dysfunction by performing the visual stimulation tumescence and rigidity (VSTR) test and sildenafil citrate test, together with the effectiveness of sildenafil citrate medication on impotence caused by different etiologies. MATERIAL AND METHODS: Between 1998 and 2000, a total of 36 men (12 patients with diabetic etiology, 5 patients with vasculogenic risk factor) were enrolled in this study. The mean age of patients was 53 (27-67) years. Following standard questionnaires, including a detailed anamnesis from an andrologic viewpoint, VST was performed in an ambulatory setting and beginning with a test dose of 50 mg. At the end of 2 h, the data was evaluated with computer assistance (Rigiscan device) and if a satisfactory erection had not occurred, an additional second dose of sildenafil citrate (50 mg) was given until there was a satisfactory erection. Results obtained from VST: results were classified as group I (fully rigidity, >10 min erection, >70% of rigidity, possible vaginal penetration), group II (unstable erection, 5 min erection, >70% of rigidity, possible vaginal penetration) and group III (tumescence without rigidity, <5 min erection, <70% of rigidity, impossible vaginal penetration). The results obtained during the first 1 h of the VSTR test were regarded as the patient's own erectile condition and later data was accepted as the real effect of sildenafil citrate. The Fisher exact test was used for statistical evaluation including pre- and post-sildenafil effect on erectile rigidity and duration of erection. RESULTS: The erection status of patients was sufficient in 17 (47.2%) in group I, it was insufficient but sufficient enough with an increased dose of sildenafil citrate in 10 (27.7%) in group II, and insufficient without/with full dose of sildenafil citrate in 9 (25%) in group III. Considering rigidity and total erectile period, there was a statistical significant difference between the first two groups with respect to the early and late sildenafil citrate effects on the VSTR test (p < 0.05). Again, 10 patients with known risk factors (diabetes mellitus 5 and vasculogenic 5) in the second group seemed to give a good response to repeated dosage of sildenafil citrate which has been found to be very interesting. However, the rest of the diabetic patients (n = 7) in the third group showed no erection despite the increasing and repeated doses of sildenafil citrate. CONCLUSION: Sildenafil citrate with the VSTR test has effective and reliable results which was regarded as very important to diagnose and determine objectively the amount of therapeutic doses in impotence. In accordance with the literature data, our results also confirm the reliability and the practical nature of the VSTR test, which is less time-consuming and cheaper than the nocturnal penile tumescence and rigidity (NPTR) test. In the VSTR test, necessary doses of medication needed for satisfactory erection were easily regulated in patients with certain kinds of impotence. Additionally, self-criticism advantage of the patients on erection and an unnecessary need for regular sexual partners may make this test preferable in the near future. However, we believe that a large group of patients with other definite parameters are certainly needed in order to obtain more reliable data.     

Inflammatory breast carcinoma: mammographic,ultrasonographic, clinical,and pathologic findings in 142 cases

PURPOSE: To determine and quantitate radiologic characteristics of inflammatory breast carcinoma and to report clinical and pathologic findings. MATERIALS AND METHODS: A retrospective review of records of 2,733 women who received a diagnosis of breast carcinoma between January 1988 and May 2000 revealed 142 histologically proved inflammatory carcinomas. Analysis included history; findings at physical examination, mammography, and ultrasonography (US); and histologic type of inflammatory carcinoma. RESULTS: At physical examination, skin changes (n = 115, 81%) were the most common findings. A palpable mass was noted in 62% (n = 88), with axillary lymph node involvement in 68% (n = 96) of the carcinomas. Mammography revealed findings in carcinomas: skin thickening, 84% (n = 119); diffusely increased density, 37% (n = 53); trabecular thickening, 81% (n = 115); mass, 16% (n = 23); asymmetric focal density, 61% (n = 87); microcalcifications, 56% (n = 80); nipple retraction, 43% (n = 61); and axillary lymphadenopathy, 24% (n = 34). US showed changes in carcinomas: skin thickening, 96% (n = 136); parenchymal echogenicity changes, 73% (n = 104); dilated lymphatic channels, 68% (n = 96); solid mass, 80% (n = 114); pectoral muscle invasion, 10% (n = 14); focal areas of parenchymal acoustic shadowing, 37% (n = 52); and axillary lymphadenopathy, 73% (n = 104). CONCLUSION: Presence of isolated inflammatory signs is sufficient to suggest inflammatory breast carcinoma clinically. Inflammatory breast carcinoma has a mammographic pattern of inflammatory changes, such as skin thickening and stromal coarsening and/or diffusely increased breast density with or without an associated mass and/or malignant-type microcalcifications. US is helpful not only in depiction of masses masked by the edema pattern but also in demonstration of skin and pectoral muscle invasion and axillary involvement.     

A Novel Navel Presenting as an Umbilical Polyp and Urachal Sinus Associated with an Epigastric Cleft: A Clue to Anterior Midline Fusion Defects

Umbilical and periumbilical disorders may present with a diverse group of anomalies and reflect the developmental embryological events they result from. A rare occurrence in a newborn of an umbilicus with an umbilical polyp together with an urachal sinus associated with a supraumbilical abnormal skin area known as epigastric cleft is reported herein, to help to elucidate embryological steps of anterior midline fusion defects and urachal remnants. Received: November 1, 1999 / Accepted: May 30, 2000     

Fuzzy organ allocation system for cadaveric kidney transplantation

BACKGROUND: The recipient selection decision for a cadaveric donor kidney is complex and based on multiple criteria, not only medical but also ethical and political criteria. METHODS: In this study, we develop the Fuzzy Organ Allocation System (FORAS) to determine who among potential recipients receives a cadaveric kidney when it becomes available. FORAS balances various kidney allocation objectives and deals with the ambiguity and fuzziness in the allocation process. RESULTS: We used simulation to investigate how well FORAS represents the thinking of a transplant physician with regard to kidney allocation. We also compared FORAS with the United Network for Organ Sharing (UNOS) scoring system and the Turkish National Coordination for Organ Transplant (TONKS) algorithm used in Turkey. We found that FORAS well represents expert thinking in kidney allocation. CONCLUSIONS: A simulated kidney allocation experiment based on real patient and donor data showed that FORAS is more useful than other kidney allocation systems because its results more closely reflect the thinking of experienced transplant physicians.     

Repair of multiple muscular ventricular septal defects: septal obliteration technique

BACKGROUND: The management of the apical multiple muscular ventricular septal defects (VSDs) remains still controversial. There are various surgical techniques and approaches for closure of "Swiss-cheese" VSDs. In this study, we report the outcome of multiple muscular VSDs repair, using the septal obliteration technique. METHODS: We used the septal obliteration technique in five "Swiss-cheese" ventricular septal defects cases through right atriotomy. Four of the cases had isolated multiple VSDs. One case also had an aortic arch interruption type A, which was repaired prior to cardiopulmonary bypass. Their ages varied between 43 days and 6 years. RESULTS: We did not experience any mortality or serious morbidity. Tracheostomy was required in one patient. There was no important residual shunt in postoperative period, except a minimal shunt in one case. CONCLUSION: The closure technique of "Swiss-cheese" trabecular multiple VSDs using a large single patch was not troubling. Transatrial approach prevented postoperative problems of ventricular incision. Using a large needle with a large pledgett is the key, which provides deep tissue penetration to avoid residual shunt.     

Endoscopic seminal vesicle stone removal

Seminal vesicle stones are extremely rare, and few cases have been reported. Treatment requires removal of the stone, generally through an open vesiculectomy. A 31-year-old man presented with perineal pain, painful ejaculation, and infertility of several years' duration. Multiple stones in the seminal vesicle duct system were diagnosed by radiologic examination. We treated the patient by seminal vesicle endoscopic stone removal, thereby obviating organ loss. The composition of the stones was whewellite. To our knowledge, this approach has not been previously reported, and our result may be encouraging for treatment of such pathologic conditions of the seminal vesicles.