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The case of a patient with a giant renal calculus weighing 770 g in a solitary functioning kidney is reported. A 57-year-old man presented with right lumbar pain and macroscopic hematuria, and a giant stone was diagnosed in his right kidney. Nine days after a percutaneous nephrostomy placement, the patient underwent selective right renal angiography and transcatheter superselective embolization due to a sudden gross hematuria observed from both the nephrostomy tube and urethra. Embolization was successful. Right anatrophic nephrolithotomy was performed after stabilization of the patient. There were no complications during the recovery period. The case reported here is significant not only because it is the 7th biggest and the heaviest stone in the literature but also because it is the first giant stone reported to be in a solitary functioning kidney and treated without nephrectomy.

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AIM: To evaluate the effects of Teicoplanin and/or Granulocyte-Colony Stimulating Factor (G-CSF) on survival in an experimental model of MRSA pneumonia. MATERIAL AND METHOD: Seventy five Swiss Albino mice weighing 35 gr (32-43) were used. 50 microl of clinical isolate of MRSA (3 x 10(8) CFU/ml in saline solution) was administered by tracheal puncture to neutropenic mice. Neutropenia was achieved by using Cyclophosphamide 200 mg per kg intraperitoneally. The groups were consisted of tracheal puncture control in neutropenic mice (group 1) (n = 15), pneumonia in neutropenic mice (group II) (n = 15), Teicoplanin therapy for pneumonia in neutropenic mice (group III) (n = 15), G-CSF therapy for pneumonia in neutropenic mice (group IV) (n = 15), Teicoplanin and G-CSF combined therapy for pneumonia in neutropenic mice (group V) (n = 15). Differences in the survival rates within 72 hours among the groups, microbiological analysis of various tissue samples were accomplished and white blood cell counts were obtained. Kaplan-Meier statistics was used for survival analysis. Subgroup comparisons were done by using Breslow statistics. RESULTS: Teicoplanin therapy increased the survival rate (p = 0.0001) whereas G-CSF therapy did not in comparison to other groups. Teicoplanin and G-CSF combination therapy improved survival rate when compared with groups II, III, IV (p = 0.0001, p = 0.003, p = 0.0001, respectively). CONCLUSION: Teicoplanin and G-CSF combination therapy seems effective in reducing mortality rates in MRSA pneumonia in an experimental setting. Further animal and clinical studies must be done to achieve success in the treatment of nosocomial MRSA pneumonia.

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BACKGROUND/AIMS: In the current investigation, we evaluated patients with hepatitis B infection to determine whether serum soluble interleukin-2 receptor and interleukin-10 levels were changed and whether the degree of these changes in serum levels correlated with histologic severity of hepatitis related liver injury. METHODOLOGY: 25 patients diagnosed of chronic active B hepatitis, 25 asymptomatic hepatitis B carriers, 25 healthy people with antibody to hepatitis B surface antigen and 20 healthy people without any hepatitis marker positivity were included in the study. Serum interleukin-10 and soluble interleukin-2 receptor levels were measured. The association between liver pathology, HBV DNA, serum transaminase values and these parameters were researched. RESULTS: Serum soluble interleukin-2 receptor and interleukin-10 levels were significantly higher in chronic hepatitis cases and asymptomatic carriers than that of others (P < 0.01). Serum interleukin-10 levels correlated with histological activity index and HBV DNA values (r = 0.7, P < 0.01) but not with soluble interleukin-2 receptor levels and transaminase values. CONCLUSIONS: Our results support the observation that interleukin-10 and soluble interleukin-2 receptor may play an important role in the inappropriate regulation of immune response in patients with chronic hepatitis B virus infection and interleukin-10 may be responsible for chronicity.

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BACKGROUND/AIMS: Preferential production of immunoregulatory cytokines may play an important role in the pathogenesis of chronic hepatitis B. We aimed to determine the serum levels of IL-2, IL-10 and TNF-alpha in patients with chronic hepatitis B and to correlate these findings with the activity of liver disease, HBeAg/anti-HBe status and replication level of the virus. METHODOLOGY: Seventy-two chronic hepatitis B patients were categorized into 4 groups according to activity of liver disease and HBeAg status. Group 1 (n = 13): HBeAg and HBV DNA-positive with persistently normal ALT. Group 2 (n = 20): HBeAg and HBV DNA-positive patients with persistently elevated ALT. Group 3 (n = 19): HBeAg and HBV DNA-negative patients with persistently normal ALT. Group 4 (n = 20): HBeAg-negative patients with persistently elevated ALT and variable serum HBV DNA. IL-2, IL-10 and TNFa levels were determined in stored patient sera. RESULTS: Apart from group 1 patients, all patients groups had higher IL-2 levels compared to controls suggesting that IL-2 production is increased when liver disease becomes active in HBeAg-positive phase of HBV infection. Only group 2 patients had elevated IL-10 levels compared to controls. None of the HBeAg-negative patients had detectable TNF-alpha levels while 64% HBeAg-positive patients had elevated levels of TNF-alpha irrespective of the activity of liver disease. Except TNF-alpha, no association was found between HBV DNA status and the presence or absence of detectable cytokines in circulation. CONCLUSIONS: Our results suggest that circulating cytokine profile in chronic hepatitis B is related with the HBeAg status, replication level of the virus and the activity of liver disease.

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The present study was undertaken to evaluate the efficacy, safety, and patient tolerability of two antibiotic regimens for the treatment of brucellosis: rifampicin 600 mg/day and doxycycline 200 mg/day for 45 days (group 1), versus rifampicin 600 mg/day and ciprofloxacin 1 g/day for 30 days (group 2). Forty patients were diagnosed with brucellosis based on clinical and microbiological findings. The two groups were comparable regarding age and sex distribution. The average number of days without fever and symptoms was lower in group 2 patients than in group 1 patients (mean+/-SD: 3.85+/-1.98 for group 1 vs. 2.78+/-1.03 for group 2, P=0.044). During the 1-year follow-up period, three (15%) patients in group 2 and two (10%) patients in group 1 had clinical relapses; these rates were not significantly different. Ciprofloxacin and rifampicin treatment for brucellosis is as effective as the standard regimen of doxycycline and rifampicin and offers the advantage of a shorter duration of treatment.

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BACKGROUND/AIMS: In this study, we evaluated the association among serum transaminase values, seropositivity of HBV DNA and liver histopathology of patients with positive HBsAg and HBe antibodies. METHODOLOGY: Thirty-five patients were placed in two groups according to their serum transaminase values. Patients with normal transaminase values were evaluated in the first group. The patients with above normal transaminase values were subjected in the second group. RESULTS: In the first group of patients with normal transaminase values, biopsy-proven moderate or severe chronic hepatitis was not observed. HBV DNA seropositivity was 53.3% in this group. Forty-five percent of the patients with above normal transaminase values had moderate chronic hepatitis and seropositivity for HBV DNA in this group was 55%. Our results supported the association between transaminase values and liver pathology, but no statistically significant association was shown between seropositivity of HBV DNA and liver pathology. CONCLUSION: There is much to be studied to understand the function of HBV DNA in the follow up of HBsAg carriers, and liver biopsy has to be used routinely in the follow up of asymptomatic carriers when they happen to have high transaminase values.

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To explore the efficacy of single dose ciprofloxacin therapy in cholera, a randomized, open, controlled clinical trial was carried out. Seventy-four adult patient with positive Vibrio cholerae 01 isolates were assigned to receive either ciprofloxacin in a single dose of 1 g (CIP1), or ciprofloxacin 500 mg b.i.d., for 1 day (CIP2), or doxycycline 100 mg b.i.d., for 3 days (D), or, for control, no antibiotics. Mean liquid stool output volume did not show any statistically significant difference among CIP1, CIP2 and doxycycline groups The mean duration of diarrhoea in CIP1 group, on the other hand, was significantly lower than that from the D group (p = 0.004), and the control group (p < 0.001). Bacteriologic clearance at the fourth day of treatment were 95.2% for CIP1, 89.5% for CIP2, 90.5% for D group and 15.4% for the control group. We conclude that a single 1 g ciprofloxacin dose is equivalent to doxycycline in its bacteriologic success but has advantages in shortening the duration of diarrhoea and simplicity of use as a single dose.

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A clinical trial was conducted in 50 patients with blood cultures positive for Salmonella typhi or Salmonella paratyphi to compare treatment with ciprofloxacin for seven days, 500 mg b.i.d. (Group 1, 25 patients), with treatment for ten days, 750 mg b.i.d. (Group 2, 25 patients). Clinical cure was defined as defervescence of fever by day 5 of treatment, with an absence of complications and no clinical relapse. The clinical cure rate was 84% for group 1 and 96% for group 2; the difference in these rates was not statistically significant. The blood cultures of all patients were sterile by day 2 of treatment and remained so until the sixth month of follow-up. It was concluded that ciprofloxacin treatment for ten days in enteric fever is not necessary. Further studies are needed to evaluate the efficacy of shortening the duration of antibiotic therapy.

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When the spermatozoa of oligoasthenozoospermic patients were suspended with the supernatant of normal semen, an increase in triple ATPase enzyme activities besides enhancement of spermatozoa motilities were observed. This suggests that factor or factors present in the supernatant of normal semen that effects spermatozoa motility also have a positive effect on triple ATPase enzyme activities. In an attempt to produce such an effect, zinc, arginine and fructose were added to the incubation media where the spermatozoal ATPase enzyme activities were determined. Zinc increased Ca2+-Mg2+ ATPase enzyme activity without affecting Na+/K+-Mg2+ and Mg2+ ATPase activities. Triple ATPase enzyme activities remained unchanged after arginine and fructose additions. As a result zinc is thought to be one of the factors that affect spermatozoa motility in seminal plasma.

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Testicular biopsies obtained from 23 infertile outpatients, found to be normal except for oligospermia, were investigated using a Zeiss electron microscope. Ultrastructural changes in the Sertoli cells were encountered frequently, whilst most of the spermatogenic cells were degenerative. Sertoli cells exhibited abundant microfilaments which were seen to form small clusters leading to the formation of Charcot-Böttcher crystals, whilst the Leydig cells of the same specimens revealed the presence of small microtubular arrays and numerous small sized crystals. Fusion of small sized crystals resulted in the formation of typical Reinke crystals in the Leydig cells. Crystalloid structures similar to those seen in the Sertoli cells were also observed in the cytoplasm of type-A-spermatogonia and in a number of multinucleated cells with cytoplasmic characteristics of spermatogonia and Sertoli cells. Similar crystallization processes in both Sertoli and Leydig cells imply a close relationship between crystallization processes and impairment of spermatogenesis.

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Na+- and K+-activated and Mg2+-dependent adenosine triphosphatase, Mg2+-activated adenosine triphosphatase and Ca2+- and Mg2+-activated adenosine triphosphatase activities were determined in washed spermatozoa and in two fractions (pellet and supernatant) of seminal plasma of oligoasthenospermic patients and men with normal spermiograms. The activities of triple adenosine triphosphatase oligoasthenospermics were significantly lower than those of normals. The morphologic features of spermatozoa of oligoasthenospermics were of normal standards. Possible explanations for the significantly lowered triple adenosine triphosphatase activities from patients with oligoasthenospermia are given with special reference to the ion transport functions of the triple adenosine triphosphatase enzyme system.

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Atopic eczema cases due to S. aureus, the results of immunodiffision analyses of serum samples from the patients, the staphylococcal antibodies before and after the immunisation with different staphylococcal vaccines are discussed.

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The microorganisms which arrive in various ways to dental pulp causes the infections of pulp. The pulp is necrotised in cases it is not possible to keep it alive. In this study arsenic which is known an available material for devitalisation of pulp and its antibacterial effects on microorganisms which are the causes of the infections of pulp have been investigated.

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