Başkent University Alanya Hospital

Cardiac autonomic neuropathy (CAN) is a frequent chronic complication of diabetes mellitus with potentially life-threatening outcomes. CAN is caused by the impairment of the autonomic nerve fibers regulating heart rate, cardiac output, myocardial contractility, cardiac electrophysiology and blood vessel constriction and dilatation. It causes a wide range of cardiac disorders, including resting tachycardia, arrhythmias, intraoperative cardiovascular instability, asymptomatic myocardial ischemia and infarction and increased rate of mortality after myocardial infarction. Etiological factors associated with autonomic neuropathy include insufficient glycemic control, a longer period since the onset of diabetes, increased age, female sex and greater body mass index. The most commonly used methods for the diagnosis of CAN are based upon the assessment of heart rate variability (the physiological variation in the time interval between heartbeats), as it is one of the first findings in both clinically asymptomatic and symptomatic patients. Clinical symptoms associated with CAN generally occur late in the disease process and include early fatigue and exhaustion during exercise, orthostatic hypotension, dizziness, presyncope and syncope. Treatment is based on early diagnosis, life style changes, optimization of glycemic control and management of cardiovascular risk factors. Medical therapies, including aldose reductase inhibitors, angiotensin-converting enzyme inhibitors, prostoglandin analogs and alpha-lipoic acid, have been found to be effective in randomized controlled trials. The following article includes the epidemiology, clinical findings and cardiovascular consequences, diagnosis, and approaches to prevention and treatment of CAN.

BACKGROUND: Appendiceal parasites can cause symptoms of appendiceal pain, independent of microscopic evidence of acute inflammation. The diagnosis of a parasitic infestation is generally achieved only after the pathologic examination of the resected appendices. PATIENTS/METHODS: Pathology department records were reviewed for all patients who required an operation for symptoms of acute appendicitis between 2000 and 2006. The specimens which were pathologically diagnosed to contain parasites were reevaluated for features of acute inflammation, and parasite type. The medical records were reviewed in detail to achieve a diagnostic score(Eskelinen). Radiologic imaging findings were correlated, if present. RESULTS: Of the 190 appendectomies performed, 6 specimens (3,15%) were found to contain parasites(4 Enterobius vermicularis, 2 Taenia subspecies). Appendectomies with Taenia showed acute inflammation, while acute inflammation was absent in the ones with Enterobius vermicularis. The Eskelinen score was higher than the threshold in two cases with an acute inflammation, and in two without. Ultrasound scans, and a computed tomography scan were performed in 5 patients. In 3 of 4 bland appendices, results favored acute appendicitis. CONCLUSION: The diagnosis of gastrointestinal parasites is not only made by examining the stool but the diagnosis can be made by histology from surgical specimens. Timely diagnosis and appropriate therapy might prevent probable future complications that may necessitate surgical procedures, at least in some of the patients. The clinical management of these infections is different from that for classical appendicitis.

Oral isotretinoin is the most effective choice in the treatment of severe acne. Application of isotretionin to acne has been expanded to treat those patients with less severe but scarring acne who are responding unsatisfactorily to conventional therapies. However, its use is associated with many side effects, some of which can result in very disastrous consequences. Data related with intermittent isotretinoin therapy is still limited. Our aim was to asses the efficacy and tolerability of two different intermittent isotretinoin courses and compare them with conventional isotretinoin treatment. In this multicenter and controlled study, 66 patients with moderate to severe cases were randomized to receive either isotretionin for the first 10 days of each month for 6 months (group 1), or each day in the first month, afterwards the first 10 days of each month for 5 months (group 2) or daily for 6 months (group 3). The drug dosage was 0.5 mg/kg/day in all groups. Patients were followed-up for 12 months. Efficacy values were evaluable for 22 patients in group 1, 19 patients in group 2, and 19 patients in group 3. Acne scores in each group were significantly lower at the end of treatment and follow-up periods (P < 0.001). When patients were evaluated separately as moderate (n = 31) and severe (n = 29), no statistically significant differences were obtained among the treatment protocols in patients with moderate acne. However, there was a significant difference between groups 1 and 3 to the response of the treatments in severe acne patients at the end of follow-up period (P = 0.013). The frequency and severity of isotretionin-related side effects were found to be lower in groups 1 and 2 compared with group 3. Intermittent isotretinoin may represent an effective alternative treatment, especially in moderate acne with a low incidence and severity of side effects. The intermittent isotretinoin can be recommended in those patients not tolerating the classical dosage.

OBJECTIVE: The aims of this study were to investigate whether degenerative posterior paraspinal changes are a cause of lower back pain and to determine the age- and sex-related distribution of these changes on MR images acquired with a STIR sequence. SUBJECTS AND METHODS: The lumbar MRI findings of 372 patients (141 men, 231 women; mean age, 51.2 years) with nonradicular lower back pain and of 249 healthy persons acting as controls (126 men, 123 women; mean age, 49.3 years) were analyzed. The sagittal STIR sequence was used for all MRI examinations. Presence of interspinous ligament edema, facet joint effusion, neocysts, paraspinal muscle edema, subcutaneous edema, disk herniation, and disk degeneration was evaluated, and the incidence of each finding was determined. All findings were grouped according to age and sex. Chi-square, Fisher's exact, and independent-samples Student's t tests and Spearman's rank correlation analysis were used for statistical analysis. RESULTS: The incidences of facet joint effusion, interspinous ligament edema, neocyst formation, and paraspinal muscle edema were found to be statistically significantly higher in patients with lower back pain than in controls. The incidences of intervertebral disk degeneration, disk herniation, and subcutaneous edema in persons with and those without lower back pain were similar. Intervertebral disk degeneration, disk herniation, subcutaneous edema, and muscle edema were found to increase with age in both persons with and those without symptoms. CONCLUSION: Degenerative changes in the posterior paraspinal structures were found in a higher percentage of subjects with lower back pain than in controls. Use of a STIR sequence with homogeneous fat suppression facilitates visualization of these changes.

Sciatica is the most frequently encountered symptom in neurosurgical practice and is observed in 40% of adults at some point in their lives. It is described as pain of the hip and the lower extremity secondary to pathologies affecting the sciatic nerve within its intraspinal or extraspinal course. The most frequent cause is a herniating lumbar disc pressing on the neural roots. Extraspinal causes of sciatic pain are usually overlooked because they are extremely rare and due to intraspinal causes (lumbar spinal stenosis, facet joint osteoarthritis, fracture, and tumors of the spinal cord and spinal column) being the main consideration. Early diagnosis of sciatica significantly improves the likelihood of relieving symptoms, as well as avoiding any additional neurologic injury and unnecessary surgery. We evaluate histolopathologically confirmed extraspinal causes of sciatica cases, accompanied by their presented computed tomography and/or magnetic resonance imaging findings.

OBJECTIVE: Recurrent aphthous stomatitis (RAS) is a common oral mucosal disorder characterized by recurrent, painful oral aphthae, and oxidative stress presumably contributes to its pathogenesis. The study was performed to evaluate the involvement of oxidant toxicity in this disorder. METHODS: Patients with RAS (n = 26) and age- and sex-matched healthy control subjects (n = 20) were included in this study. Following an overnight fast, blood specimens were obtained. Plasma malondialdehyde concentrations and erythrocytes glutathione peroxidase activities were determined. Also, plasma vitamin E and selenium levels were detected. Mann-Whitney U-test was performed for statistical evaluation. RESULTS: Oxidative stress was confirmed by the significant elevation in plasma malondialdehyde levels and by the significant decrease in glutathione peroxidase activities, vitamin E and selenium levels (P < 0.001). CONCLUSIONS: Our results indicated that lipid peroxidation and the inadequacy of the defense system seem to play a crucial role in the pathogenesis of recurrent aphthous stomatitis.

BACKGROUND: Epicardial adipose tissue (EAT) is a local source of various hormones, cytokines, and vasoactive substances affecting the myocardium. EAT contains abundant ganglionic plexi that interact with the autonomic nervous system. Evidence of the association between EAT and arrhythmia is limited, with the exception of atrial fibrillation. This study aimed to investigate the relation between EAT and cardiac autonomic function using heart rate variability (HRV) and heart rate turbulence (HRT) parameters. METHODS: All subjects underwent a 24-hour Holter recording to assess HRV and HRT parameters and a transthoracic echocardiography to measure EAT thickness. Patients were divided into two groups according to the median EAT thickness (3.9 mm). The higher EAT group consisted of 111 patients with a >3.9-mm thickness and the lower EAT group 113 patients with a ≤ 3.9-mm EAT thickness. RESULTS: HRV and HRT parameters were significantly influenced in the higher EAT group. Moreover, we observed significant correlations between EAT thickness and Holter findings (standard deviation of all NN intervals [SDNN]: r = -0.462, P < 0.001; SDNN index: r = -0.349, P < 0.001; standard deviation of the average NN intervals: r = -0.465, P < 0.001; root mean square of successive differences: r = -0.251, P < 0.001; pNN50: r = -0.354, P < 0.001; turbulence onset: r = 0.172, P = 0.010; turbulence slope: r = -0.279, P < 0.001, HRT category: r = 0.169, P = 0.011). In multivariate regression analysis, EAT thickness was independently associated with all measures of HRV and HRT, with the exception of turbulence onset. CONCLUSIONS: Sympathovagal imbalance, detected by HRV and HRT parameters, is related to EAT thickness. As sympathovagal imbalance is a predictor of arrhythmic events, EAT may play an important arrhythmogenic role not limited to atrial fibrillation.

OBJECTIVES: We investigated the relationship between the lumbosacral morphology and degree of intervertebral disc degeneration in a large sample of young patients. In addition, the relation between various morphological parameters (sacral table angle and sacral kyphosis) and lumbar disc herniation or degeneration was also evaluated. METHODS: The magnetic resonance imaging (MRI) of low back pain patients referred to our department in 2008-2009 were retrospectively evaluated. Patients with prior lumbar spinal surgery, serious congenital anomalies on MRI, incomplete or complete lumbosacral trancision, severe scoliosis, spondylolysis, or spondylolisthesis were excluded from the study. A sample of 131 females between 20-30 years of age was studied. Patients were evaluated for the presence of intervertebral disc herniation or degeneration, and the degree of degeneration was assessed. Angles of lumbar lordosis, sacral table, and sacral kyphosis were also measured for each patient. RESULTS: The degree of intervertebral disc degeneration increased in parallel to the decrease in the sacral kyphosis and lumbar lordosis angles, and to the increase in sacral table angle. A statistically significant difference with regard to the angles of lumbar lordosis, sacral kyphosis, and sacral table was determined between individuals with (23.37±7.09°, 163.09±9.48°, 104.34±5.47°, respectively) and without intervertebral disc degeneration (26.94±7.39°, 168.94±10.52°, 100.83±4.32°; p=0.006, p=0.001, p=0.0001, respectively). In addition, a statistically significant difference with regard to the angles of lumbar lordosis, sacral kyphosis, and sacral table was determined between individuals with (22.82±6.94°, 162.23±9.53°, 104.94±5.19°, respectively) and without intervertebral disc herniation (27.25±7.26°, 169.39±9.96°, 100.48±4.33°; p=0.001, p=0.0001, p=0.0001, respectively). CONCLUSION: The degree and risk of intervertebral disc degeneration and herniation increases in parallel to the decrease in sacral kyphosis and lumbar lordosis, and to the increase in sacral surface angle.

BACKGROUND AND OBJECTIVE: Sildenafil citrate enhances the action of nitric oxide by preventing the hydrolysis of cGMP, and is widely used to treat erectile dysfunction. We investigated the effects of sildenafil citrate administration on lipid peroxidation and antioxidant redox enzymes in blood of healthy men. METHOD: Thirty healthy male subjects were divided equally into two groups. The first group was used as the control. A single dose of sildenafil citrate was administrated orally to subjects constituting the second group. Blood samples were obtained at 0, 2, 6 and 24 h after intake of the single dose of 100 mg sildenafil citrate or placebo. RESULTS AND DISCUSSION: The dose of sildenafil citrate resulted in significant increase in the erythrocyte superoxide dismutase and catalase activities at 6 and 24 h. Plasma lipid peroxidation levels decreased slightly. There was no statistical difference in erythrocyte glutathione peroxidase activity between the placebo and sildenafil citrate groups. CONCLUSION: Treatment of blood with 100 mg sildenafil citrate has protective effects on oxidative stress by inhibiting free radical formation and by supporting antioxidant redox systems.

BACKGROUND: Ostructive sleep apnea (OSA) is an independent risk factor for the development of cardiovascular events. Platelet activation and inflammation are the mechanisms involved in the association between OSA and cardiovascular disease (CVD). The markers of platelet activation and inflammation are the mean platelet volume (MPV), platelet-lymphocyte ratio (PLR), red cell distribution width (RDW), neutrophil- lymphocyte ratio (NLR). We aimed to define the association of NLR, PLR, RDW, and MPV with the severity of disease and the presence of CVD. METHODS: This study consisted of 300 patients who were admitted to the sleep laboratory. The patients were classified according to their apnea- hypopnea index (AHI) scores as OSA negative (Group A: AHI<5), mild (Group B: AHI: 5-15), moderate (Group C: AHI=15-30), and severe OSA (Group D: AHI >30). RESULTS: There were no significant differences in the NLR, PLR, and MPV among the groups (P>.05); only RDW differed significantly (P=.04). RDW was significantly higher in patients with than without risk factors for CVD [15.6% (15.4-15.7) vs 15.3% (15.1-15.3), respectively; P=.02]. CONCLUSIONS: NLR, PLR, MPV, and RDW are widely available and easily obtained from a routinely performed hemogram. Among these laboratory parameters, only RDW can demonstrate the reverse consequences of OSA-associated comorbidities, because vascular damage due to systemic inflammation is an important underlying mechanism in these diseases. RDW might be used as a marker of the response and patient compliance with continuous positive airway pressure treatment.

BACKGROUND: The goal of this study was to evaluate the prevalence of Legionella species in hotel water distribution systems in Alanya, Turkey, which is an important tourism center. METHODS: Water and swab samples were obtained from 52 Turkish hotels from August 2003 to September 2005. Water samples were collected in 100 mL sterile containers and were concentrated by membrane filters with a pore size of 0.45 microm. Heat treatment was used to eliminate other microorganisms from the samples, which were then spread on buffered charcoal yeast extract alpha agar plates and glycine, vancomycin, polymyxin, cycloheximide agar plates. Cysteine-dependent colonies were identified by latex agglutination. RESULTS: In all, 491 water and swab samples were analyzed. The results of all samples were negative for Legionella in 16 (30.8%) hotels. Legionella species (92.5% of which were Legionella pneumophila) were detected in 93 (18.9%) of the samples. The most frequently isolated species were L pneumophila serogroups 6 (63.5%) and 1 (21.5%). CONCLUSIONS: Legionella pneumophila serogroup 6 was the most common isolate detected in Turkish hotel water systems in our study. The result of Legionella urinary antigen tests, which are the diagnostic tests most often used to identify legionnaires' disease, may be negative in people infected with L pneumophila serogroup 6. We suggest that clinicians should apply the whole spectrum of laboratory methods for the detection of legionnaires' disease in patients with pneumonia of unknown origin and history of travel to Alanya, Turkey.

PURPOSE: Reflex seizures are known as the epileptic seizures triggered by some specific stimuli in sensitive patients. They are often classified according to the stimuli that trigger them rather than by the type of the seizure. Epileptic seizures induced by sexual orgasm are very rare in the literature. METHODS: We report six patients with different epileptic syndromes who experienced seizures after sexual intercourse and orgasm. RESULTS: All patients are women whose epileptogenic focus was in the right temporal in four and left frontal in one patient. One patient had pure generalized reflex epilepsy. CONCLUSIONS: Seizures induced by orgasm are very rare, with female and right hemisphere dominance requiring complex mechanisms to occur.

AIMS: To determine whether there is a relationship between Helicobacter pylori (H. pylori) infection, iron deficiency anemia and thrombocytopenia in pregnant women. METHODS: Hemoglobin and ferritin levels and platelet counts of pregnant women were measured during the third trimester. H. pylori infection was determined using a 14C-urea breath test (14C-UBT) after delivery. Statistical analyses were determined with a Mann-Whitney U-test and the chi(2) test. Statistical significance was determined with a P-value less than .05. RESULTS: Seventy-two of 117 women had positive results on the 14C-UBT. Overall, 27 of 117 pregnant women had anemia (23.1%), and all them were in the H. pylori-positive group; 18 of 27 (66.7%) had iron deficiency anemia. Median hemoglobin levels and neonatal body weights were 12.0 g/dL vs 12.0 g/dL and 3320.0 grams vs 3520.0 grams in the H. pylori-positive and negative groups, respectively. Serum hemoglobin and ferritin levels and neonatal body weight were found to be lower in the anemic group compared with the non-anemic group among H. pylori-infected women (P = 0.0001, P = 0.02, P = 0.008, respectively). There were no statistically significant differences with regard to gestational thrombocytopenia between the H. pylori-positive and H. pylori-negative groups (P = 0.532). CONCLUSIONS: Our study indicates that there is a strong relationship between H. pylori infection and iron deficiency anemia in women with uncomplicated pregnancy. However, an association between H. pylori infection and thrombocytopenia was not found.

Perforation of the uterus by an intrauterine device (IUD) is a serious complication occurring at or following 1/350 to 1/2500 insertions. It is more common among women with ‘lost’ IUDs. If a woman presents with pelvic pain and a history of a ‘lost’ IUD, X-rays of the abdomen and of the pelvis should be ordered. We report on a ‘lost’ IUD that had been inserted 12 years previously. It was found in the lower anterior abdominal wall. Most probably uterine perforation had happened during a dilatation and curettage (D & C) attempted for removal of the device. Thereafter the IUD must have migrated to the abdominal wall. This case illustrates that unless it can be recovered by simple traction on the threads, a trained medical professional should be called upon for removal of the IUD.

Crossed fused renal ectopia is a rare congenital anomaly of the urinary system where one kidney crosses over to opposite side and the parenchyma of the two kidneys fuse. Herein, we present an atypical CFRE case whose renal anatomy does not exactly match any of the already defined CFRE types. Both of the kidneys are ectopic with the crossed ectopic right kidney lying superiorly and fused to the upper pole of the left kidney. Renal arteries were originating from the common iliac arteries. A focal 90% stenosis was observed on the right main renal artery. The patient is borderline hypertensive.

INTRODUCTION: Extracorporeal magnetic innervation (ExMI) is a relatively new technology used for pelvic muscle strengthening for the treatment of stress urinary incontinence. We aimed to evaluate the clinical efficacy of extracorporeal magnetic stimulation for the treatment of stress urinary incontinence. MATERIALS AND METHODS: A total of 30 patients with demonstrable stress urinary incontinence were enrolled in this study. All were neurologically normal with normal urinalysis and none was pregnant. Evaluation before treatment included 3-day bladder diaries, a dynamic pad weight test, urodynamics, and a validated quality of life survey. Treatment sessions lasted 20 min, twice a week, for 6 weeks. After ExMI, all measures were repeated at follow-up including 3-day bladder diary, dynamic pad weight test, urodynamics and quality of life survey. The follow-up was done at 3, 12 and 24 months after ExMI therapy but urodynamics were performed only at first follow-up. RESULTS: After ExMI therapy, 8 out of the 27 patients were cured (29.7%) and 13 patients were improved (48.1%) at 3 months. The cumulative success rate was 77.8%. Six patients did not show any improvement after treatment. Pad weight was reduced from 14.4 +/- 10.7 to 6.5 +/- 5.1 g. The mean score of quality of life survey at baseline was 61.6 and this increased to 75.4 at 12 weeks. The effect of ExMI approximately continued until the 1st year after therapy but gradually decreased and came close to baseline at the 2nd year after therapy. CONCLUSION: As a result, ExMI therapy offers a new effective modality for pelvic floor muscle stimulation. ExMI also offers a noninvasive, effective and painless treatment for women with stress urinary incontinence. Further studies are needed to address how long the therapy will continue and benefits will last and whether retreatment or continuation therapy sessions will be necessary.

The exact reason for the development of inguinal hernia has not been completely determined. However, it is known that the fascia transversalis (FT) is one of the structures preventing development of hernias. In the etiology of the inguinal hernia, disorders in collagen metabolism have been proposed, and the role of metalloproteinases in remodeling the collagen has recently been of great importance. We could not encounter any study where the role of metalloproteinase inhibitors was evaluated in inguinal hernia. We obtained samples of FT from patients with direct and indirect hernia and used an immunohistochemical method to determine tissue inhibitor of metalloproteinase-2 (TIMP-2) expression. In the study group, samples of FT were taken during the operation from 45 patients, of which 35 were indirect and 10 were direct inguinal hernias. In the control group, samples of FT from various abdominal incisions were also taken from 45 patients with no hernia and operated upon for another pathology. TIMP-2 scores of a direct inguinal hernia were significantly less than those of the control group. However, no difference has been found between the TIMP-2 scores of an indirect inguinal hernia and those of the control group. Decreased TIMP-2 scores in patients with a direct inguinal hernia, compared with both the indirect inguinal hernia group and the control group, explain the reason for the increase in matrix metalloproteinase-2 (MMP-2) that has been proposed in some studies. Therefore, it can be expressed that a decreased activity of TIMP-2 plays a role in inguinal hernia development.

OBJECTIVE: To establish an early, safe, and well-tolerated time to start oral hydration after cesarean delivery. METHODS: A prospective randomized trial of women delivered by cesarean under regional anesthesia at Alanya Research and Medical Center, Turkey, between 2005 and 2006. A clear liquid drink was given to 100 women in the early oral intake (EOI) group 2 hours after surgery, and to 100 women in the delayed oral intake (DOI) group 8 hours after surgery. If the drink was tolerated, solid foods were then given gradually. RESULT: In the EOI and DOI groups, respectively, the mean time for the return of bowel movements was 4.4+/-1.9 h vs 6.3+/-2.4 h; mean time elapsed until initial passage of flatus was 12.1+/-5.5 h vs 24.1+/-6.0 h; and mean duration of hospitalization was 29.6+/-5.5 h vs 44.6+/-6.8 h (P<0.05). CONCLUSION: Following cesarean delivery under regional anesthesia, oral hydration given as early as 2 hours after the operation is safe and well tolerated.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To investigate the relation between lumbosacropelvic morphology and the presence and degree of facet joint degeneration. SUMMARY OF BACKGROUND DATA: Osteoarthritis of the facet joints is one of the most common degenerative changes in the spine. It is considered to be formed secondary to repetitive stress or trauma and spinal deformity with secondary overload. The cause(s) of facet joints osteoarthritis, however, have not been clearly identified. METHODS: Abdominal computed tomography (CT) images of 723 patients which were taken between the years 2010 and 2014 were evaluated retrospectively. Patients with prior lumbar spinal surgery, serious congenital anomalies on CT, incomplete or complete lumbosacral transition, severe scoliosis, were excluded from the study. To eliminate the age- and sex-related differences in spinopelvic morphology, a study group was formed of the remaining subjects by including patients from a specific age group (30-35 yr) and same sex (females). For each patient the presence and grade of facet joint degeneration was investigated. In addition, pelvic incidence (PI), sacral slope and the angles of L1-L5 lumbar lordosis, sacral table, L5 vertebra posterior, and sacral kyphosis were measured for each patient. RESULTS: Sacral slope, sacral kyphosis, and L1-L5 lumbar lordosis angle were significantly higher in patients with osteoarthritic compared with normal subjects (P = 0.015, P = 0.018, P = 0.016). L5 vertebra posterior and sacral table angle were found to be significantly lower in patients with osteoarthritic than in normal subjects (P = 0.019, P = 0.007). The degree of facet joint degeneration was noticed to increase parallel to the decrease in the sacral table angle and L5 vertebra posterior angle, and to the increase in the L1-L5 lumbar lordosis, PI, and sacral slope. CONCLUSION: A close relation exists between the presence and degree of degeneration in the facet joint and lumbosacral pelvic morphology. Prevalence and degree of the degeneration in facet joint increases as the angle of sacral slope, L1-L5 lumbar lordosis, and PI increases or the angle of sacral table and L5 vertebra posterior decreases. LEVEL OF EVIDENCE: 4.

We read the article by Storr-Paulsen et al. (2014) with great interests. They contributed literature with a large numbers of patients. It is well known that tamsulosin is associated with intraoperative floppy iris syndrome (IFIS), which includes a triad of a flaccid iris, propensity for the iris and progressive pupil construction, during cataract surgery (Chang & Campbell 2005). Thus, surgical adjustment is needed by ophthalmologists. They also described IFIS with another alpha blocker drug as doxazosin. Additionally, Settas and Fitt described IFIS with alfuzosin (Settas & Fitt 2006). To overcome these issues, we would like to affix a case of IFIS with silodosin. To our best knowledge, this is the first IFIS by silodosin, in the literature. A 60-year-old man, with lower urinary tract symptoms (LUTS) admitted urology outpatient clinic. Detailed clinical and laboratory examinations including uroflowmetry which an obstructive pattern was presented in terms of maximum urinary flow (Qmax) rate was 14 ml/second were performed. Therefore, he was diagnosed as benign prostate hyperplasia, and silodosin 8 mg was prescribed. In the 1st month of drug, he was benefitted from silodosin as Qmax was 19 ml/second and he had few LUTS. After 2 months from start to use silodosin, he went to ophthalmology outpatient clinic and he was diagnosed as cataract in his left eye. The ophthalmology clinic made plan for cataract surgery, and they consulted him with us for possible IFIS. However, there has not been any IFIS by silodosin in the literature; we preferred to stop silodosin. After 45 days, he stopped silodosin; he underwent cataract surgery. During the surgery, ophthalmologist reported the triad of IFIS and the patient needed surgical interventions, during cataract surgery in which surgeons also were allowed to use intraoperative prophylactic measures (Klysik & Korzycka 2014). To our best knowledge, this was the first case of IFIS by silodosin. The rate of IFIS with tamsulosin was 60% in literature (Michel et al. 2006; Settas & Fitt 2006). Michel et al. (2006) reported IFIS with other alpha blockers in rabbits. The main cause seems like it is associated with selective alpha-1 blockage; thereby, silodosin has a selective and strong capacity in alpha-1 blockage (Akin et al. 2013). The ophthalmologist should be aware of IFIS before cataract surgery in men who use alpha blocker drugs specifically selective ones such as tamsulosin and silodosin. Nevertheless, each patients who use alpha blocker would not experience IFIS.