Papillary adenoma of the prostatic urethra is a rare cause of hematuria, hemospermia and lower ur... more Papillary adenoma of the prostatic urethra is a rare cause of hematuria, hemospermia and lower urinary tract obstruction, especially in young adults. We report two cases of papillary adenoma and their endoscopic views. One of the patients had a lesion located on the verumontanum and presented with hematuria, hemospermia and symptoms of lower urinary tract obstruction. The other patient had papillary lesions located in the paramontanal gutter and presented with persistent painless hematuria. The origin of both lesions was proven to be prostatic epithelial differentiation using immunohistochemical identification of prostate-specific antigen. Papillary adenoma is believed to be benign, therefore, both lesions were carefully excised and fulgurated transurethrally.
Objective: To evaluate the correlation between cyclooxygenase-2 (Cox-2) expression and clinicopat... more Objective: To evaluate the correlation between cyclooxygenase-2 (Cox-2) expression and clinicopathologic findings with the effect of these variables on prognosis of bladder cancer. Methods: Cox-2 expression was examined immunohistochemically in paraffin blocks of 99 patients. Correlations between Cox-2 expression and variables like cancer stage and grade, number of mitoses, angiolymphatic invasion, number and size of the lesions were determined. Results: Cox-2 expression was detected in 52 (52.5%) patients. Univariate regression analysis between Cox-2 expression and clinicopathologic findings showed a significant correlation only in the pathologic stage of the patients (p = 0.048) (OR =2.64, CI = 0.97–7.81). Multivariate regression analysis in stage T1 revealed an increasing number of mitoses as an independent prognostic factor for recurrence (p = 0.002) (OR = 1.5, CI = 1.16–1.92) and progression (p = 0.030) (OR = 8.23, CI = 1.22–55.27) although a prognostic factor was not found for progression in stage T2. Conclusion: Univariate analysis showed that only the pathologic stage correlated significantly with Cox-2 expression. Cox-2 expression revealed a significant relation with patient prognosis in stage T2 but not in stage T1. These results support the fact that Cox-2 inhibitors may play a role in progression of invasive bladder tumors.
enal transplantation is the most effective treatment option for end stage renal disease. 1-3 As a... more enal transplantation is the most effective treatment option for end stage renal disease. 1-3 As a consequence of the industrialized world more patients are being diagnosed with end stage renal disease predominantly due to diabetes and hypertension. 4 Although the numbers of the patients in the waiting list for renal transplantation are increasing, kidney donation from deceased patients is not sufficient. 5,6
highly malignant, with 50-70% exhibiting locally advanced lesions at the time of presentation [2]... more highly malignant, with 50-70% exhibiting locally advanced lesions at the time of presentation [2]. Resembling the renal cell adenocarcinoma, ACC also has the ability to develop venous tumor thrombus extension, and one third of primary ACC cases present with tumor thrombus within the inferior vena cava (IVC) [3]. The identification of intracaval thrombus is paramount to the successful treatment of ACC, since complete local excision is the best therapy for advanced local disease [4]. By the evolution of cardiopulmonary bypass (CPB) and circulatory arrest the surgical removal of these thrombi becomes possible and bloodless dissection and inspection of the IVC has helped to reduce the risk of tumor thromboembolus [3]. Case Report A 51-year-old man presented with a 6-month history of leftsided flank pain, weight loss, difficulty in breathing, abdominal discomfort, and swelling and bilateral leg edema. Abdominal computed tomography (CT) confirmed a 12 ! 18 ! 16 cm adrenal mass with obvious involvement of the IVC. Magnetic resonance imaging (MRI) revealed a level III (intraatrial) tumor thrombus extending into the IVC and up into the right atrium (fig. 1). Hormonal evaluation was conducted, and all laboratory values were found within normal limits. The bone scan was normal, but chest radiography and chest CT revealed two pulmonary nodules on the right side. The patient was relatively young and suffering from the obstructive symptoms of vena caval thrombus. The patient under
prospectively. Groups were compared for baseline characteristics, blood loss, change in haematocr... more prospectively. Groups were compared for baseline characteristics, blood loss, change in haematocrit and transfusion using univariate statistics, and an exploratory multivariate model was developed. RESULTS RALP was associated with lower blood loss (median 100 vs 450mL, P < 0.001) and a smaller change in haematocrit (median 7% vs 10%, P < 0.001) than RRP. Although both groups had low transfusion rates, the RALP group required fewer transfusions than the RRP group (0.8% vs 3.4%, P = 0.002). On univariate analysis, surgical approach (RRP vs RALP), estimated blood loss ≥ 500mL and change in haematocrit ≥ 10% were the only the significant predictors of transfusion. In the exploratory multivariate model RALP was the only significant predictor of reduced need for transfusion, with an odds ratio of 0.23 (95% confidence interval 0.09-0.58; P = 0.002). CONCLUSIONS This study shows that RALP is associated not only with less blood loss and a smaller decrease in haematocrit, but also a decreased need for transfusion.
Introduction & Objectives: Obstruction of the ureter leads to hydronephrosis and retrograde mecha... more Introduction & Objectives: Obstruction of the ureter leads to hydronephrosis and retrograde mechanical stretch of the renal parenchyma and can progress to tubulointerstial fibrosis. Previous gene chip analysis of acute unilateral ureteric obstruction (UUO) in rats identified upregulation of Collagen XVIIIalpha1, a basement membrane (BM) protein recently identified as a component of nearly all basement membranes in the body. Expression is increased in pathological situations that involve BM breakdown such as angiogenesis and epithelial to mesenchymal transition. Increased collagen XVIII expression has also been demonstrated in liver fibrosis. The carboxyl terminal of collagen XVIII, the NC1 region, contains a hinge region which is sensitive to protease cleavage and releases 20-34kD fragments eg endostatin (20kD), neostatin (28kD), with potent anti-angiogenic properties. Proteolytic release of these fragments can occur through several pathways which may lead to a switch from a matrix associated to a more soluble endocrine form. Objectives; 1) Validate gene chip analysis that collagen XVIII is upregulated in acute UUO at mRNA and protein level. 2) Demonstrate that when human kidney cells are exposed to the profibrotic cytokine TGFbeta1 there is degration of collagen XVIII and release of endostatin into the supernatant. Material & Methods: In vivo: Left ureters of male rats were obstructed for 3 or 10 days. Obstructive uropathy was confirmed histologically. Expression of full length collagen XVIII, and its proteolytic fragment endostatin was compared in the obstructed (Ob) and non-obstructed (Non-Ob) kidneys by Immunoflourescence, Western Blotting, Real Time-PCR. MMP activity was examined by zymography and Real Time-PCR. In vitro: Human kidney cell (HK2) cells were treated with TGFβ1 for 48 hours and both the monolayer and supernatant were examined for Collagen XVIII and endostatin using Western Blotting and Real Time-PCR. Results: Ob. kidney at day 3 and day 10 showed macroscopic and microscopic evidence of renal fibrosis. Collagen XVIIIa1 mRNA and protein expression was upregulated in Ob. kidney. There was increased generation of the NC1 domain, including the 28kD endostatin spanning fragment called neostatin and the 22kD endostatin. There was increased expression of MMP7, 2 and 9 in obstructed kidney. In vitro experiments demonstrated that TGFβ1 treated HK2 increased expression of endostatin into the supernatant. Currently we are examining whether this is MMP related. Conclusions: We validate prior gene chip analysis showing increased expression of collagen XVIIIa1 in UUO. We further demonstrate a complimentary increase in the protein expression of collagen XVIII, and an increase in the generation of NC1 fragments including neostatin and endostatin. HK2 cells, when treated with TGFβ1, release endostatin into the supernatant.
We compared the cost-effectiveness of Laparoscopic Simple Prostatectomy (LSP) versus open prostat... more We compared the cost-effectiveness of Laparoscopic Simple Prostatectomy (LSP) versus open prostatectomy (OP). A total of 73 men treated for BPH were enrolled as OP and LSP in groups 1 and 2, respectively. The findings were recorded perioperative including operation time (OT), blood lost, transfusion rate, conversion to the open surgery, the complications according to the Clavien Classification. The post-operative findings including catheterization and drainage time, the amount of analgesic used, hospitalization time, postoperative complications, IPSS and IIEF scores, the extracted prostate weight, the uroflowmeter, as well as post-voiding residual (PVR) and Quality-of-life (QoL) score at the post-operative 3rd month were analyzed. The cost of the both techniques was also compared statistically. No statistical differences were found in the preoperative parameters including age, IPSS and QoL score, Qmax, PVR, IIEF score, and prostate volumes as measured by transabdominal USG. No statistical differences were established in terms of the operation time and the weight of the extracted prostate. No differences were established with regard to complications according to the Clavien&amp;amp;amp;amp;amp;amp;amp;amp;#39;s Classification in groups. However, the bleeding rate was significantly lower in group 2. The drainage, catheterization and hospitalization time and the amount of analgesics were significantly lower in the second group. The postoperative 3rd month findings were not different statistically. Only the Qmax values were significantly greater in group 2. While there was only a $52 difference between groups with regard to operation cost, this difference was significantly different. The use of LSP for the prostates over 80 g is more effective than the OP in terms of OT, bleeding amount, transfusion rates, catheterization time, drain removal time, hospitalization time, consumed analgesic amount and Qmax values. On the other hand, the mean cost of the LSP is higher than OP. Better effectiveness comes with higher cost.
ABSTRACT We compared biochemical recurrence-free survival of patients who underwent radical retro... more ABSTRACT We compared biochemical recurrence-free survival of patients who underwent radical retropubic prostatectomy vs robot assisted laparoscopic prostatectomy in concurrent series at a single institution. A total of 2,132 patients were treated between June 2003 and January 2008. We excluded from study patients with prior treatment (115), missing data (83) and lymph node involvement (30). The remaining cohort (1,904) was compared based on clinical, surgical and pathological factors. Kaplan-Meier analysis was performed comparing biochemical recurrence after robot assisted laparoscopic prostatectomy and radical retropubic prostatectomy. A Cox proportional hazards model was generated to determine whether surgical approach is an independent predictor of biochemical recurrence. There were 491 radical retropubic prostatectomies (25.9%) and 1,413 robot assisted laparoscopic prostatectomies (74.1%) performed, and median followup was 10 months (IQR 2 to 23). On univariate analysis the robot assisted laparoscopic prostatectomy group was slightly lower risk with lower median prostate specific antigen (5.4 vs 5.8, p &lt;0.01), a lower proportion of pathological grade 7-10 (48.5% vs 54.7%, p &lt;0.01) and lower pathological stage (80.5% pT2 vs 69.6% pT2, p &lt;0.01). The 3-year biochemical recurrence-free survival rate was similar between the robot assisted laparoscopic prostatectomy and radical retropubic prostatectomy groups on the whole as well as when stratified by pathological stage, grade and margin status. On multivariate analysis extracapsular extension (p &lt;0.01), pathological grade 7 or greater (p &lt;0.01) and positive surgical margin (p &lt;0.01) were independent predictors of biochemical recurrence while surgical approach was not. The likelihood of biochemical recurrence was similar between groups when stratified by known risk factors of recurrence. Surgical approach was not a significant predictor of biochemical recurrence in the multivariate model. Our analysis is suggestive of comparable effectiveness for robot assisted laparoscopic prostatectomy, although longer term studies are needed.
Urokinase is synthesized by various cells such as renal, pneumocytes, and phagocytes. It cleaves ... more Urokinase is synthesized by various cells such as renal, pneumocytes, and phagocytes. It cleaves plasminogen to plasmin and hence stimulates fibrinolysis. Urokinase breaks down the matrix protein within the stone thus prevents stone formation and growth. Urokinase ...
Papillary adenoma of the prostatic urethra is a rare cause of hematuria, hemospermia and lower ur... more Papillary adenoma of the prostatic urethra is a rare cause of hematuria, hemospermia and lower urinary tract obstruction, especially in young adults. We report two cases of papillary adenoma and their endoscopic views. One of the patients had a lesion located on the verumontanum and presented with hematuria, hemospermia and symptoms of lower urinary tract obstruction. The other patient had papillary lesions located in the paramontanal gutter and presented with persistent painless hematuria. The origin of both lesions was proven to be prostatic epithelial differentiation using immunohistochemical identification of prostate-specific antigen. Papillary adenoma is believed to be benign, therefore, both lesions were carefully excised and fulgurated transurethrally.
Objective: To evaluate the correlation between cyclooxygenase-2 (Cox-2) expression and clinicopat... more Objective: To evaluate the correlation between cyclooxygenase-2 (Cox-2) expression and clinicopathologic findings with the effect of these variables on prognosis of bladder cancer. Methods: Cox-2 expression was examined immunohistochemically in paraffin blocks of 99 patients. Correlations between Cox-2 expression and variables like cancer stage and grade, number of mitoses, angiolymphatic invasion, number and size of the lesions were determined. Results: Cox-2 expression was detected in 52 (52.5%) patients. Univariate regression analysis between Cox-2 expression and clinicopathologic findings showed a significant correlation only in the pathologic stage of the patients (p = 0.048) (OR =2.64, CI = 0.97–7.81). Multivariate regression analysis in stage T1 revealed an increasing number of mitoses as an independent prognostic factor for recurrence (p = 0.002) (OR = 1.5, CI = 1.16–1.92) and progression (p = 0.030) (OR = 8.23, CI = 1.22–55.27) although a prognostic factor was not found for progression in stage T2. Conclusion: Univariate analysis showed that only the pathologic stage correlated significantly with Cox-2 expression. Cox-2 expression revealed a significant relation with patient prognosis in stage T2 but not in stage T1. These results support the fact that Cox-2 inhibitors may play a role in progression of invasive bladder tumors.
enal transplantation is the most effective treatment option for end stage renal disease. 1-3 As a... more enal transplantation is the most effective treatment option for end stage renal disease. 1-3 As a consequence of the industrialized world more patients are being diagnosed with end stage renal disease predominantly due to diabetes and hypertension. 4 Although the numbers of the patients in the waiting list for renal transplantation are increasing, kidney donation from deceased patients is not sufficient. 5,6
highly malignant, with 50-70% exhibiting locally advanced lesions at the time of presentation [2]... more highly malignant, with 50-70% exhibiting locally advanced lesions at the time of presentation [2]. Resembling the renal cell adenocarcinoma, ACC also has the ability to develop venous tumor thrombus extension, and one third of primary ACC cases present with tumor thrombus within the inferior vena cava (IVC) [3]. The identification of intracaval thrombus is paramount to the successful treatment of ACC, since complete local excision is the best therapy for advanced local disease [4]. By the evolution of cardiopulmonary bypass (CPB) and circulatory arrest the surgical removal of these thrombi becomes possible and bloodless dissection and inspection of the IVC has helped to reduce the risk of tumor thromboembolus [3]. Case Report A 51-year-old man presented with a 6-month history of leftsided flank pain, weight loss, difficulty in breathing, abdominal discomfort, and swelling and bilateral leg edema. Abdominal computed tomography (CT) confirmed a 12 ! 18 ! 16 cm adrenal mass with obvious involvement of the IVC. Magnetic resonance imaging (MRI) revealed a level III (intraatrial) tumor thrombus extending into the IVC and up into the right atrium (fig. 1). Hormonal evaluation was conducted, and all laboratory values were found within normal limits. The bone scan was normal, but chest radiography and chest CT revealed two pulmonary nodules on the right side. The patient was relatively young and suffering from the obstructive symptoms of vena caval thrombus. The patient under
prospectively. Groups were compared for baseline characteristics, blood loss, change in haematocr... more prospectively. Groups were compared for baseline characteristics, blood loss, change in haematocrit and transfusion using univariate statistics, and an exploratory multivariate model was developed. RESULTS RALP was associated with lower blood loss (median 100 vs 450mL, P < 0.001) and a smaller change in haematocrit (median 7% vs 10%, P < 0.001) than RRP. Although both groups had low transfusion rates, the RALP group required fewer transfusions than the RRP group (0.8% vs 3.4%, P = 0.002). On univariate analysis, surgical approach (RRP vs RALP), estimated blood loss ≥ 500mL and change in haematocrit ≥ 10% were the only the significant predictors of transfusion. In the exploratory multivariate model RALP was the only significant predictor of reduced need for transfusion, with an odds ratio of 0.23 (95% confidence interval 0.09-0.58; P = 0.002). CONCLUSIONS This study shows that RALP is associated not only with less blood loss and a smaller decrease in haematocrit, but also a decreased need for transfusion.
Introduction & Objectives: Obstruction of the ureter leads to hydronephrosis and retrograde mecha... more Introduction & Objectives: Obstruction of the ureter leads to hydronephrosis and retrograde mechanical stretch of the renal parenchyma and can progress to tubulointerstial fibrosis. Previous gene chip analysis of acute unilateral ureteric obstruction (UUO) in rats identified upregulation of Collagen XVIIIalpha1, a basement membrane (BM) protein recently identified as a component of nearly all basement membranes in the body. Expression is increased in pathological situations that involve BM breakdown such as angiogenesis and epithelial to mesenchymal transition. Increased collagen XVIII expression has also been demonstrated in liver fibrosis. The carboxyl terminal of collagen XVIII, the NC1 region, contains a hinge region which is sensitive to protease cleavage and releases 20-34kD fragments eg endostatin (20kD), neostatin (28kD), with potent anti-angiogenic properties. Proteolytic release of these fragments can occur through several pathways which may lead to a switch from a matrix associated to a more soluble endocrine form. Objectives; 1) Validate gene chip analysis that collagen XVIII is upregulated in acute UUO at mRNA and protein level. 2) Demonstrate that when human kidney cells are exposed to the profibrotic cytokine TGFbeta1 there is degration of collagen XVIII and release of endostatin into the supernatant. Material & Methods: In vivo: Left ureters of male rats were obstructed for 3 or 10 days. Obstructive uropathy was confirmed histologically. Expression of full length collagen XVIII, and its proteolytic fragment endostatin was compared in the obstructed (Ob) and non-obstructed (Non-Ob) kidneys by Immunoflourescence, Western Blotting, Real Time-PCR. MMP activity was examined by zymography and Real Time-PCR. In vitro: Human kidney cell (HK2) cells were treated with TGFβ1 for 48 hours and both the monolayer and supernatant were examined for Collagen XVIII and endostatin using Western Blotting and Real Time-PCR. Results: Ob. kidney at day 3 and day 10 showed macroscopic and microscopic evidence of renal fibrosis. Collagen XVIIIa1 mRNA and protein expression was upregulated in Ob. kidney. There was increased generation of the NC1 domain, including the 28kD endostatin spanning fragment called neostatin and the 22kD endostatin. There was increased expression of MMP7, 2 and 9 in obstructed kidney. In vitro experiments demonstrated that TGFβ1 treated HK2 increased expression of endostatin into the supernatant. Currently we are examining whether this is MMP related. Conclusions: We validate prior gene chip analysis showing increased expression of collagen XVIIIa1 in UUO. We further demonstrate a complimentary increase in the protein expression of collagen XVIII, and an increase in the generation of NC1 fragments including neostatin and endostatin. HK2 cells, when treated with TGFβ1, release endostatin into the supernatant.
We compared the cost-effectiveness of Laparoscopic Simple Prostatectomy (LSP) versus open prostat... more We compared the cost-effectiveness of Laparoscopic Simple Prostatectomy (LSP) versus open prostatectomy (OP). A total of 73 men treated for BPH were enrolled as OP and LSP in groups 1 and 2, respectively. The findings were recorded perioperative including operation time (OT), blood lost, transfusion rate, conversion to the open surgery, the complications according to the Clavien Classification. The post-operative findings including catheterization and drainage time, the amount of analgesic used, hospitalization time, postoperative complications, IPSS and IIEF scores, the extracted prostate weight, the uroflowmeter, as well as post-voiding residual (PVR) and Quality-of-life (QoL) score at the post-operative 3rd month were analyzed. The cost of the both techniques was also compared statistically. No statistical differences were found in the preoperative parameters including age, IPSS and QoL score, Qmax, PVR, IIEF score, and prostate volumes as measured by transabdominal USG. No statistical differences were established in terms of the operation time and the weight of the extracted prostate. No differences were established with regard to complications according to the Clavien&amp;amp;amp;amp;amp;amp;amp;amp;#39;s Classification in groups. However, the bleeding rate was significantly lower in group 2. The drainage, catheterization and hospitalization time and the amount of analgesics were significantly lower in the second group. The postoperative 3rd month findings were not different statistically. Only the Qmax values were significantly greater in group 2. While there was only a $52 difference between groups with regard to operation cost, this difference was significantly different. The use of LSP for the prostates over 80 g is more effective than the OP in terms of OT, bleeding amount, transfusion rates, catheterization time, drain removal time, hospitalization time, consumed analgesic amount and Qmax values. On the other hand, the mean cost of the LSP is higher than OP. Better effectiveness comes with higher cost.
ABSTRACT We compared biochemical recurrence-free survival of patients who underwent radical retro... more ABSTRACT We compared biochemical recurrence-free survival of patients who underwent radical retropubic prostatectomy vs robot assisted laparoscopic prostatectomy in concurrent series at a single institution. A total of 2,132 patients were treated between June 2003 and January 2008. We excluded from study patients with prior treatment (115), missing data (83) and lymph node involvement (30). The remaining cohort (1,904) was compared based on clinical, surgical and pathological factors. Kaplan-Meier analysis was performed comparing biochemical recurrence after robot assisted laparoscopic prostatectomy and radical retropubic prostatectomy. A Cox proportional hazards model was generated to determine whether surgical approach is an independent predictor of biochemical recurrence. There were 491 radical retropubic prostatectomies (25.9%) and 1,413 robot assisted laparoscopic prostatectomies (74.1%) performed, and median followup was 10 months (IQR 2 to 23). On univariate analysis the robot assisted laparoscopic prostatectomy group was slightly lower risk with lower median prostate specific antigen (5.4 vs 5.8, p &lt;0.01), a lower proportion of pathological grade 7-10 (48.5% vs 54.7%, p &lt;0.01) and lower pathological stage (80.5% pT2 vs 69.6% pT2, p &lt;0.01). The 3-year biochemical recurrence-free survival rate was similar between the robot assisted laparoscopic prostatectomy and radical retropubic prostatectomy groups on the whole as well as when stratified by pathological stage, grade and margin status. On multivariate analysis extracapsular extension (p &lt;0.01), pathological grade 7 or greater (p &lt;0.01) and positive surgical margin (p &lt;0.01) were independent predictors of biochemical recurrence while surgical approach was not. The likelihood of biochemical recurrence was similar between groups when stratified by known risk factors of recurrence. Surgical approach was not a significant predictor of biochemical recurrence in the multivariate model. Our analysis is suggestive of comparable effectiveness for robot assisted laparoscopic prostatectomy, although longer term studies are needed.
Urokinase is synthesized by various cells such as renal, pneumocytes, and phagocytes. It cleaves ... more Urokinase is synthesized by various cells such as renal, pneumocytes, and phagocytes. It cleaves plasminogen to plasmin and hence stimulates fibrinolysis. Urokinase breaks down the matrix protein within the stone thus prevents stone formation and growth. Urokinase ...
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Papers by Yakup Kordan