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    Antifungal Stewardship
    (2019) Kurt-Azap, Ozlem
    Invasive fungal infections are commonly detected because of increasing number of immunocompromised patients. Emerging antifungal resistance in addition to high mortality and costs are the triggers for the implementation of antifungal stewardship (AFS) programmes. The aim of stewardship programmes is the quality improvement in health care and better outcomes for the patients rather than the costs. Optimizing the use of antifungal drugs to achieve the best outcomes while minimizing adverse events and the emergence of resistance are the accompanying goals. AFS is less established than antibacterial stewardship because of a narrower and more complex evidence base along with only a few number of available drugs. Rapid diagnostic tools and therapeutic drug monitoring are the key components of the AFS programmes. Available data show that AFS programmes are feasible, sustainable and well accepted and favor the implementation of AFS programmes in routine care.
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    Experimental Bladder Cancer Models for Animals
    (2015) Kosan, Murat; Mungan, Aydin
    Transitional cell carcinoma (TCC) is the most common malignancy of the genitourinary tract and TCC models are being developed over the past decades. Experimental models are needed so that more effective treatments can be developed in preclinical evaluation. Even if, in vitro models are useful for initial development and evaluation of therapeutic agents and modalities, adequate animal models are still essential in the preclinical development of new effective and safe therapies. A great variety of ex vivo and in vivo models has been described in the literature. Chemical carcinogens are most commonly used to induce bladder cancer. Cell culture techniques are also widely used to study different oncological processes. To test potential new drugs in a preclinical setting, a clinically relevant orthotopic bladder tumor model is highly desirable. The aim of this review article was the assessment of different animal models available for the study of bladder carcinogenesis.
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    The Risk Stratifications in Non-Muscle Invasive Bladder Cancer: How Much Accurate are the Methods That We Use? A Multi-Directional View
    (2015) Kuzgunbay, Baris; Beyazit, Yildirim
    Non-muscle invasive bladder cancer (NMIBC) have heterogeneous pattern inside, rapid recurrence might be seen in some of the patients while earlier progression might be seen in other patients. Recently, European Organization for Research and Treatment of Cancer (EORTC) risk tables are the most commonly used as scoring systems in stratifying the risk group in NMIBC. The scoring system was developed based on tumor number and size, prior recurrence rate, T stage, concurrent CIS and tumor grade, thus the total score should be calculated individually for recurrence and progression. EAU guidelines also advices stratifying the patients into 3 risk groups according to the prognostic factors and data from the EORTC tables. In addition, the maintenance BCG therapy, secondary TUR operation, substaging in T1 tumors, pathological variants of uroepithelial carcinoma, lymphovascular invasion and some molecular markers have been reported to significantly affect the prognosis of NMIBC in consecutive studies. Today, EORTC and other stratification remains valid, however, needs to be improved and validated under the guidance of the previous studies.
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    Abdominal Compartment Syndrome
    (2015) Zeyneloglu, Pinar
    Intraabdominal hypertension and Abdominal compartment syndrome are causes of morbidity and mortality in critical care patients. Timely diagnosis and treatment may improve organ functions. Intra- abdominal pressure monitoring is vital during evaluation of the patients and in the management algorithms. The incidence, definition and risk factors, clinical presentation, diagnosis and management of intraabdominal hypertension and Abdominal compartment syndrome were reviewed here.
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    Evaluation of the Current Situation Tissue and Serum Biomarkers in Prostate Cancer
    (2015) Kervancioglu, Enis; Kosan, Murat
    Prostate cancer, is the most commonly diagnosed cancer in the United States and in many parts of the world and ranks 2nd in death from cancer among men. Lifetime risk of developing prostate cancer is 16%. Currently the only accepted screening tool Prostate Specific Antigen (PSA) and Digital Rectal Examination (DRE). PSA is a specific biomarker but non-specific for prostate cancer. In diseases such as Benign Prostatic Hyperplasia (BPH) and prostatitis high serum PSA levels can be detected. Therefore, identifying prostate cancer only with serum PSA measurement has lower specificity and may lead to false positive results and unnecessary biopsies. Some encountered problems such as unnecessary diagnoses of clinically insignificant cancer and the non-diagnosis of early stage cancers can take. In recent years there are too many studies to investigate new biomarkers for replacing or helping PSA. The aim of this article was the evaluation of the current situation for PSA and non-PSA tissue and serum biomarkers which are published.
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    The Treatment Modalities in Stage 1 Seminoma; Alterations in Last Five Years
    (2015) Kuzgunbay, Baris
    Seminomas are diagnosed generally in early period. Eighty-five percent of the patients were in clinical stage (CS) 1 at the time of diagnosis and occult metastasis rate was 10-15% and systemic relapse rate after retroperitoneal treatment was 1-4%. However, there have been significant alterations in treatment of stage 1 seminomas for 20 years; thus, dog-leg radiotherapy had been recommended as the only choice of adjuvant therapy in 1990s, totally 20 Gy adjuvant radiotherapy to para-aortic (PA) field or hockey stick field and single dose carboplatinium based chemotherapy have been recommended since 2010. Active surveillance has become popular after the relation between radiotherapy and platinum based chemotherapy with cardiovascular toxicity and seconder malignancy was proven and long term results of surveillance were reported. Achieving the cure rates of % 100 in CS 1 seminoma patients with all kind of therapy modalities, adjuvant radiotherapy, chemotherapy or active surveillance, indicate that all kinds of therapies are appropriate. However, the relapse rate of 15-20% of the disease in the patients under surveillance without any treatment indicates the over-treatment risk of 80-85%. In conclusion, the identified side effects of the radiotherapy and chemotherapy, the report of successfully treatment of the disease even in the relapse under active surveillance caries the surveillance as the first choice in guidelines however it is seem that the best approach is to give the decision with the patient after detailed information by taking into consideration of the patients expectations.
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    Cytoreductive Nephrectomy in the Targeted Treatment Era
    (2015) Yaycioglu, Ozgur
    To evaluate the role of cytoreductive nephrectomy (CRN) in the treatment of metastatic renal cell carcinoma in targeted therapy era in the light of contemporary data reported in the literature. Recent findings reported in retrospective studies indicate that although the CRN rates are lower than before, the procedure is related with improved survival. Several objective criteria have been proposed for proper patient selection. Results of ongoing prospective studies will help to clarify the role of CRN in the targeted therapy era. Level one evidence is lacking for the role of CRN in the targeted treatment era. However, current data show that the procedure has an essential part in the multidisciplinary treatment of metastatic renal cell carcinoma. Individualization of the treatment decisions is important since not all patients benefit from the operation.
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    The Diagnosis and Treatment of Retroperitoneal Mass
    (2015) Gul, Umit
    Retroperitoneal masses are extremely rare. They may be primary malignant, benign or metastatic. The majority of them are malignant. Possible causes that may reveal the etiology of these masses have not been clarified yet. However some predisposing factors have been identified. These masses are classified according to their histological types. Clinical signs are presence of abdominal mass and abdominal pain. A multidisciplinary approach for diagnosis and treatment in high-volume referral centers is ideal. Retroperitoneal masses are treated surgically as much as possible. It is important to achieve negative surgical margins. Optimal treatment approaches have not been standardized as of today. Anthracycline chemotherapy which may be combined with radiotherapy forms the basis of therapy. Developments related to targeted therapies are particularly promising.
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    Monopolar and Bipolar Modalities of Transurethral Prostate Resection
    (2015) Koseoglu, Hikmet; Akman, Ramazan Yavuz
    Benign prostate hyperplasia (BPH) related lower urinary tract symptoms (LUTS) is among the most common diseases in the aging male. Both medical and surgical treatment modalities have been improved strikingly in the last 20 years. Transurethral resection of the prostate (TUR-P) is still the gold standard for the surgical treatment for the prostates with the volume of 30-80 ml. Today, besides monopolar classical TUR-P systems which are still widely used, bipolar TUR-P systems are also being used in the increasing numbers. Results of recent meta-analyses did not determine difference between monopolar and bipolar systems in terms of clinical efficacy, in addition, showed bipolar advantages in terms of bleeding and clot retention. Both monopolar and bipolar systems shall better be used until the results of multi-centered prospective studies which compare both modalities with high number of patients together with controlling surgeon factors.
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    Surgical Treatment Options for High Risk Patients with Benign Prostatic Hyperplasia
    (2015) Hasirci, Eray; Dirim, Ayhan; Ozkardes, Hakan
    Lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) are a complex symptoms that almost every man will somehow experience in some part of his life. Today, treatment of BPH can be successfully achieved in most of the cases. However, surgical therapies may become inevitable in a group of non-complient patients or in those who have failed medical therapy. The increasing incidence of systemic diseases with age may cause difficulty in decision making for surgey in high-risk patients. In this review, different treatment options such as bipolar resection, laser prostatectomy, microwave thermotherapy, ethanol ablation and radiofrequency ablation in addition to conventional transurethral resection of prostate are compared in high risk patients with BPH. Although treatment options appear to achieve comparable outcome, differences between methods are hidden in side the effects. Choosing the most appropriate method for a particular high-risk case should be based on surgeon's experience, possible side effects of the procedure and severity of comorbidities.