Mechanical and oral antibiotic bowel preparation versus no bowel preparation in right and left colectomy: subgroup analysis of MOBILE trial.

BACKGROUND: In retrospective series, mechanical and oral antibiotic bowel preparation (MOABP) has been reported to reduce surgical-site infections (SSIs) after colectomy compared with no bowel preparation (NBP). METHOD: This was a subgroup analysis of a multicentre randomized trial that included patients scheduled for elective colectomy. The MOABP group underwent mechanical bowel preparation, and took 2 g neomycin and 2 g metronidazole orally during the day before surgery. The NBP group did not undergo bowel preparation. Patients were categorized according to the side of resection (right versus left colectomy), and these subgroups compared for postoperative outcomes. RESULTS: Among 217 patients undergoing right colectomy (106 in MOABP and 111 in NBP group), SSI was detected in seven (7 per cent) and 10 (9 per cent) patients (odds ratio (OR) 0.71, 95 per cent c.i. 0.26 to 1.95; P = 0.510), anastomotic dehiscence in two (2 per cent) and two (2 per cent) patients (OR 1.05, 0.15 to 7.58; P = 1.000), and the mean(s.d.) Comprehensive Complication Index (CCI) score was 9.4(12.9) and 10.5(18.0) (mean difference -1.09; 95 per cent c.i. -5.29 to 3.11; P = 0.608) in the MOABP and NBP groups respectively. Among 164 patients undergoing left colectomy (84 in MOABP and 80 in NBP group), SSI was detected in five (6 per cent) and eight (10 per cent) patients (OR 0.57, 0.18 to 1.82; P = 0.338), anastomotic dehiscence in four (5 per cent) and five (6 per cent) patients (OR 0.75, 0.19 to 2.90; P = 0.742), and the CCI score was 10.2(13.1) and 6.5(11.0) (mean difference 3.68, -0.06 to 7.42; P = 0.053) in the MOABP and NBP groups respectively. CONCLUSIONS: MOABP did not decrease the rate of SSI or complications in patients undergoing either right or left colectomy compared with NBP.

Oncological outcomes before and after the extralevator abdominoperineal excision era in rectal cancer patients treated with abdominoperineal excision in a single centre, high volume unit.

AIM: The extralevator abdominoperineal excision (ELAPE) has been expected to reduce the risk of positive circumferential resection margins (CRMs) and local recurrence in locally advanced distal rectal cancer. The aim was to determine whether there is any difference in local recurrence rates between patients who were operated on for distal rectal cancer before and after the introduction of ELAPE in our unit. PATIENTS AND METHODS: In all, 206 patients with distal rectal cancer without distant metastases (T1-4N0-2M0) were treated with curative intent. The patients were divided into two cohorts operated in 2000-2007 (A) and 2008-2014 (B). The ELAPE procedure was introduced in 2008. Since then, it has been used in cases of T4 and T3 tumours with threatened margins. In T1-T3 tumours without threatened margins a conventional abdominal perineal excision has been performed. RESULTS: There was no significant difference in overall survival or cancer-specific survival between the two time periods. The local recurrence rate was 15.5% in group A and 6.7% in group B (P = 0.048), although there was no significant difference in the cumulative local recurrence rate. Intra-operative tumour perforation occurred significantly more often during the earlier period when ELAPE was not in use: group A 15/71 (21.1%) vs group B 11/135 (8.1%), P = 0.01. CRM was positive more often in group A (16.4%) vs group B (7.4%), P = 0.054. CONCLUSION: The local recurrence rate, intra-operative tumour perforation and positive CRM rate were significantly lower during the later period when more extensive surgery (ELAPE) was performed for locally advanced T3-T4 rectal cancer with threatened margins.

Genetic evidence for panmixia in a colony-breeding crater lake cichlid fish.

Fine-scaled genetic structuring, as seen for example in many lacustrine fish, typically relates to the patterns of migration, habitat use, mating system or other ecological factors. Because the same processes can also affect the propensity of population differentiation and divergence, assessments of species from rapidly speciating clades, or with particularly interesting ecological traits, can be especially insightful. For this study, we assessed the spatial genetic relationships, including the genetic evidence for sex-biased dispersal, in a colony-breeding cichlid fish, Amphilophus astorquii, endemic to Crater Lake Apoyo in Nicaragua, using 11 polymorphic microsatellite loci (n = 123 individuals from three colonies). We found no population structure in A. astorquii either within colonies (no spatial genetic autocorrelation, r ~0), or at the lake-wide level (pairwise population differentiation FST = 0-0.013 and no clustering), and there was no sex-bias (male and female AIc values bounded 0) to this lack of genetic structure. These patterns may be driven by the colony-breeding reproductive behaviour of A. astorquii. The results suggest that strong philopatry or spatial assortative mating are unlikely to explain the rapid speciation processes associated with the history of this species in Lake Apoyo.

Background matching ability and the maintenance of a colour polymorphism in the red devil cichlid.

The evolution and maintenance of colour polymorphisms remains a topic of considerable research interest. One key mechanism thought to contribute to the coexistence of different colour morphs is a bias in how conspicuous they are to visual predators. Although individuals of many species camouflage themselves against their background to avoid predation, differently coloured individuals within a species may vary in their capacity to do so. However, to date, very few studies have explicitly investigated the ability of different colour morphs to plastically adjust their colouration to match their background. The red devil (Amphilophus labiatus) is a Neotropical cichlid fish with a stable colour polymorphism, with the gold morph being genetically dominant and having a myriad of documented advantages over the dark morph. However, gold individuals are much rarer, which may be related to their heightened conspicuousness to would-be predators. Here, we tested the ability of differently coloured individuals to phenotypically adjust the shade of their body colour and patterns to match their background. In particular, we filmed dark, gold and mottled (a transitioning phase from dark to gold) individuals under an identical set-up on light vs. dark-coloured substrates. We found that, in contrast to individuals of the dark morph, gold and mottled individuals were less capable of matching their body colouration to their background. As a result, gold individuals appeared to be more conspicuous. These results suggest that a difference in background matching ability could play an important role in the maintenance of colour polymorphisms.

Prospective randomized trial of interferon alfa-2a plus vinblastine versus vinblastine alone in patients with advanced renal cell cancer.

PURPOSE: The combination of interferon alfa-2a (IFNalpha2a) plus vinblastine (VLB) induces objective tumor responses in patients with advanced renal cell cancer. However, no prospective randomized trial has shown that this treatment prolongs overall survival. We compared overall survival after treatment with IFNalpha2a plus VLB versus VLB alone in patients with advanced renal cell cancer. PATIENTS AND METHODS: We prospectively randomized 160 patients with locally advanced or metastatic renal cell cancer to receive either VLB alone or IFNalpha2a plus VLB for 12 months or until progression of disease. In both groups, VLB was administered intravenously at 0.1 mg/kg every 3 weeks, and in the combination group IFNalpha2a was administered subcutaneously at 3 million units three times a week for 1 week, and 18 million units three times a week thereafter for the second and subsequent weeks. For patients unable totolerate IFNalpha2a at 18 million units per injection, the dose was reduced to 9 million units. RESULTS: Median survival was 67.6 weeks for the 79 patients receiving IFNalpha2a plus VLB and 37.8 weeks for the 81 patients treated with VLB (P =.0049). Overall response rates were 16. 5% for patients treated with IFNalpha2a plus VLB and 2.5% for patients treated with VLB alone (P =.0025). Treatment with the combination was associated with constitutional symptoms and abnormalities in laboratory parameters, but no toxic deaths were reported. CONCLUSION: The combination of IFNalpha2a plus VLB is superior to VLB alone in the treatment of patients with locally advanced or metastatic renal cell carcinoma. This is the first study to demonstrate that survival can be prolonged by using IFNalpha2a for these patients.

Finasteride following balloon dilatation of the prostate. A double-blind, placebo-controlled, multicenter study.

BACKGROUND AND AIMS: To evaluate the efficacy, safety and tolerability of finasteride administered for 24 months following successful balloon dilatation in patients with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: 75 patients with moderate to severe symptoms of benign prostatic hyperplasia were first treated with balloon dilatation. After a 4-week placebo runin period, 64 patients with successful dilatation and over 50 % reduction in symptoms were randomized to receive either finasteride (33 pts.) at 5 mg/day or placebo (31 pts.) for 24 months. Altogether 12 patients dropped out at some stage, and the final analysis hence included 27 patients in the finasteride group and 25 patients in the placebo group. RESULTS: The symptom scores increased by an average of 3.2 points in the finasteride group and 4.4 points in the placebo group during two years. The mean maximum flow in the finasteride group remained constant: 13.7 ml/s at baseline and 13.9 ml/s at 24 months. In the placebo group the mean maximum flow decreased from 13.3 ml/sec to 11.2 ml/s. During the two-year study period, neither of the groups displayed any changes in residual urine. The above mentioned changes were not statistically significant, however. Prostate volume and serum PSA were significantly lower in the finasteride group (p < 0.001). The groups did not differ with regard to side-effects. CONCLUSIONS: On the basis of the findings, BPH patients with moderate to severe symptoms can be treated with balloon dilatation. The effect of balloon dilatation is quick, and it alleviates the patients' symptoms immediately. Finasteride treatment maintains the positive effect of balloon dilatation. This combination of treatment is tolerated well and side-effects are rare. The favourable effect of balloon dilatation was maintained for at least two years. Finasteride treatment diminished significantly both prostate volume and serum prostate-specific antigen after balloon dilatation compared to placebo treatment.

MRI and CT in blunt renal trauma: an update.

In our experience, MRI is as effective as CT in correctly staging renal injury. The coronal and sagittal slice orientations of MRI are particularly helpful in determining the extent of the renal parenchymal damage. Both methods are accurate in finding perirenal hematomas, assessing the viability of renal fragments, and detecting preexisting renal abnormalities but are relatively inaccurate in visualizing urinary extravasation. Although CT remains the method of choice in radiological staging of renal injury, MRI can complement CT in patients with severe renal injury, preexisting renal abnormality, equivocal CT findings, or when repeated radiological follow-up is required. MRI could replace CT in patients with iodine allergy and be used for initial staging if CT is not available.

[Treatment of benign prostatic hyperplasia with Proscar (finasteride). Results of a 10-year Scandinavian study]. / Behandling av benign prostatahyperplasi med Proscar (finasterid). Resultater av en toårig skandinavisk undersøkelse.

707 patients with moderate prostatic hyperplasia were recruited to a two-year Scandinavian multicenter study. The study was randomized, prospective and double-blind. Half of the patients were treated with finasteride (5 mg daily) and the controls were given placebo. The patients were monitored with regard to symptoms, urinary flow rate and prostate volume. In addition, various laboratory examinations were performed. A statistically significant difference was found between the groups with regard to symptom improvement and increase in urinary flow rate in favour of finasteride. Finasteride reduced prostate volume and stopped further growth, leading to a difference of 30% in prostate volume between the two groups after two years of treatment. Thus, finasteride was able to stop the continuous growth of the prostate in the elderly male. The proportion of patients with adverse clinical experiences was similar in both treatment groups. However, the finasteride-treated group contained more patients with sexual dysfunction. We conclude that finasteride is an alternative to vigilant waiting for patients with moderate symptoms of benign prostatic hyperplasia.

[Finanseride in symtomatic benign prostatic hyeprtrophy. A 2-year placebo-controlled study]. / Finasterid ved symptomgivende benign prostatahypertrofi. Et toårs placebokontrolleret studie. Skandinaviske BPH-Studiegruppe.

The efficacy and safety of treatment with finasteride 5 mg daily for 24 months was assessed in this multicentre double blind placebo-controlled study including 707 patients with moderately symptomatic benign prostatic hyperplasia. Efficacy parameters were changes in voiding- and bladder storage symptoms assessed by a validated symptom score, changes in maximum urinary flow rate and changes in the prostate volume. In the finasteride patients, symptom score improved during the whole study with a significant difference between active treatment and placebo after 24 months (p < 0.01). Maximum flow rate increased in finasteride treated patients resulting in a difference between these and the placebo treated patients of 1.8 ml/s after 24 months (p < 0.01). Prostate volume was reduced by 19% in the finasteride treated patients versus an increase of 12% in the placebo treated patient group (p < 0.01). Finasteride was well tolerated. Patients receiving placebo progressed in symptoms after 16 months. Finasteride can halt the natural progression of moderately symptomatic BPH over a 24 month period.

Preservation of potency after treatment for priapism.

Impotence is the most serious complication of priapism. In order to study its incidence and risk factors, the final outcomes of 124 cases of priapism in previously potent patients were analyzed and correlated with the duration of symptoms, age of the patients, aetiology and modality of treatment. Thirty-nine per cent of the patients became impotent. The duration of symptoms before treatment correlated markedly with the risk of impotence, in that 92% of those whose priapism had lasted less than 24 h remained potent but only 22% of those for whom it had lasted longer than 7 days. The younger the patients the better the prognosis, so that 88% of those younger than 30 years preserved their potency but only 40% of those older than 50 years. The prognosis was poorest when heparin therapy or a combination of alcohol drinking and psychopharmaceuticals was the aetiological factor behind priapism. Only 31% of patients preserved their potency after conservative treatment for priapism, whereas 69% of those treated with small glandocorporeal shunts did so. Priapism is an emergency state, in which immediate procedures are necessary to ensure detumescence as soon as possible. If puncture with lavation and intracorporeal injection of alpha-sympathomimetics does not restore detumescence, small glandocorporeal shunts should be performed.

Results of treatment in testicular nonseminoma.

Seventy-one testicular nonseminomatous germ cell tumours were treated in the Helsinki University Central Hospital between 1980 and 1990. Thirty-five (49%) were stage I, 16 (23%) stage II and 20 (28%) stage III tumours. The 5-year survival rates were 91%, 94% and 70%, respectively. Five of the eight patients relapsing in stage I had adverse histopathological risk factors in their tumours. In the retrospective evaluation two stage I patients had actually a higher stage. The good results in stage II were achieved with a routine combination of chemotherapy and retroperitoneal lymph node dissection. All five patients lost for stage III nonseminoma had risk factors for unfavourable prognosis: liver metastases or very high serum markers at diagnosis. The results presented here are considerably better than in the 1970s in this country and well comparable to results from countries where this malignancy is more common. Still some patients were lost. Co-operation in different fields of medicine is essential to find and treat optimally those with more aggressive disease and those who are cured with less strenuous treatment modalities.

[Can finasteride reverse the progress of benign prostatic hyperplasia? A two-year placebo-controlled study.].

OBJECTIVE: To study if placebo-induced improvement in men with symptomatic benign prostatic hyperplasia (BPH) is maintained over two years, and to study the efficacy and safety from intervention with finasteride 5 mg for 24 months. METHODS: This was a multicenter, double-blind, placeba-controlled study involving 707 patients with moderate symptoms of BPH enrolled at 59 centers in five Scandinavian countries. Following enrollment and a four-week single-blind placebo run-in period, patients were randomized to receive finasteride 5 mg once daily or placebo for 24 months. Urinary symptoms, urinary flow rate, prostate volume, postvoiding residual urinary volume, and serum concentrations of prostate-specific antigen together with laboratory safety parameters were measured at entry and at months 12 and 24. Interim physical and laboratory examinations were performed when indicated clinically. RESULTS: In finasteride-treated patients the total symptom score improved throughout the study, with a significant difference between the two groups at 24 months (p<0.01) whereas in placebo-treated patients, there was an initial improvement in the symptom score but no change from baseline at 24 months. The maximum urinary flow rate decreased in the placebo group, but improved in the finasteride group, resulting in a between-group difference of 1.8 mL/s at 24 months (p<0.01). The mean change in prostate volume was +12% in the placebo group versus -19% in the finasteride-treated group (p%lt;0.01). Finasteride was generally well tolerated throughout the two-year study period. CONCLUSIONS: The efficacy of therapy with finasteride 5 mg in improving both symptoms and maximum urinary flow rate and reducing prostate volume has been shown to be maintained during 24 months while patients receiving placebo experienced a return to baseline or deterioration of these parameters during the study. These results demonstrate that finasteride can reverse the natural progression of BPH.

Can finasteride reverse the progress of benign prostatic hyperplasia? A two-year placebo-controlled study. The Scandinavian BPH Study Group.

OBJECTIVES: To study if placebo-induced improvement in men with symptomatic benign prostatic hyperplasia (BPH) is maintained over 2 years, and to study the efficacy and safety from intervention with finasteride 5 mg for 24 months. METHODS: This was a multicenter, double-blind, placebo-controlled study involving 707 patients with moderate symptoms of BPH enrolled at 59 centers in five Scandinavian countries. Following enrollment and a 4-week single-blind placebo run-in period, patients were randomized to receive finasteride 5 mg once daily or placebo for 24 months. Urinary symptoms, urinary flow rate, prostate volume, postvoiding residual urinary volume, and serum concentrations of prostate-specific antigen together with laboratory safety parameters were measured at entry and at months 12 and 24. Interim physical and laboratory examinations were performed when indicated clinically. RESULTS: In finasteride-treated patients the total symptom score improved throughout the study, with a significant difference between the two groups at 24 months (P < or = 0.01), whereas in placebo-treated patients, there was an initial improvement in the symptom score but no change from baseline at 24 months. The maximum urinary flow rate decreased in the placebo group, but improved in the finasteride group, resulting in a between-group difference of 1.8 mL/s at 24 months (P < or = 0.01). The mean change in prostate volume was +12% in the placebo group versus -19% in the finasteride-treated group (P < 0.01). Finasteride was generally well tolerated throughout the 2-year study period. CONCLUSIONS: The efficacy of therapy with finasteride 5 mg in improving both symptoms and maximum urinary flow rate and reducing prostate volume has been shown to be maintained during 24 months while patients receiving placebo experienced a return to baseline or deterioration of these parameters during the study. These results demonstrate that finasteride can reverse the natural progression of BPH.

Permanent open shunt as a reason for impotence or reduced potency after surgical treatment of priapism in 26 patients.

A permanent open shunt as a cause of impotence or impaired potency after a shunt operation for priapism is an unusual situation. In this series we studied the persistence of an open shunt in 26 patients who had developed impotence or impaired potency after operative treatment for priapism. All patients had been examined by cavernosography on the suspicion of an open shunt, giving a positive finding in five of 26 cases, in all of which impotence was cured by closure of the shunt. In five patients without a permanent open shunt potency returned to normal only after 6-12 months.

Comparison of high-field magnetic resonance imaging with computed tomography in the evaluation of blunt renal trauma.

OBJECTIVE: To compare magnetic resonance (MR) imaging and computed tomography (CT) in radiographic staging of blunt renal trauma. DESIGN: A prospective study. MATERIALS AND METHODS: Fourteen patients with blunt renal trauma not requiring early surgical treatment underwent CT, and high-field (1.0 T) MR imaging. MEASUREMENTS AND MAIN RESULTS: MR imaging equaled CT in correctly grading the renal injury. The coronal and sagittal projections of MR imaging were helpful in determining the extent of the renal parenchymal lesion. Both methods were accurate in finding perirenal hematomas, assessing the viability of renal fragments, and detecting pre-existing renal abnormalities, but failed to visualize urinary extravasation on initial examination. CONCLUSIONS: Although CT remains the method of choice in radiographic staging of renal injury, MR imaging can complement CT in patients with severe renal injury, pre-existing renal abnormality, equivocal CT findings, or when repeated radiographic follow-up is required. MR imaging could replace CT in patients with iodine allergy and be used for initial staging if CT is not available.

Priapism, its incidence and seasonal distribution in Finland.

Priapism is regarded as an uncommon disease in white populations, although no previous research has been done into its incidence in a certain geographical area. All cases of priapism in Finland during the years 1975-90 are reviewed here. Its incidence varied from 0.34 to 0.52/100,000 males per year, being very stable during the whole period of 16 years, when cases due to intracorporeal injections for treatment of impotence are excluded. Typical patients were 40-50 years old, and the incidence was higher in the eastern part of the country. Most cases of priapism were seen during the lighter half of the year, between March and August (65%). The use of intracorporeally injected vasoactive drugs for impotence increased the incidence more than two-fold.

Aetiology of priapism in 207 patients.

Two hundred and seven patients were treated for priapism in Finnish hospitals in 1973-1990. In order to analyse the aetiology of priapism, the original data on these and on 163 age- and time-matched controls, who underwent appendicectomy, were collected from the hospitals. The information was completed by collecting extra data from other hospitals and health centres or by personal contacts. In 43 of the 207 cases (21%), the cause of priapism was an intracavernous injection of a vaso-active drug. These patients were excluded from the logistic regression analysis used to evaluate the most essential factors associated with priapism. They were found to abuse alcohol (p < 0.001), use psychopharmaceuticals (p < 0.001), antihypertensive drugs (p = 0.003), anticoagulants (p = 0.005), as well as to have lumbar disc pain (p = 0.002) and chronic prostatitis (p = 0.01). Smoking was also significantly more common in the patients affected by priapism (56%) than in the controls (33%), being significantly associated with heavy alcohol drinking and use of psychopharmaceuticals. A disease or trauma was a possible causative factor in one third of the patients. The present study confirms the suggestion of a multifactorial aetiology for the initiation of priapism.

Residual stones after percutaneous nephrolithotomy; sensitivities of different imaging methods in renal stone detection.

Kidneys of 35 renal stone patients treated with percutaneous nephrolithotomy (PNL) were examined at 12-36 months (mean 23 months) after the procedure by plain radiography (PR), conventional linear tomography (LT), computed tomography (CT), and ultrasonography (US) to find out the long-term stone-free rate as well as the accuracy of these imaging methods to detect residual or recurrent renal stones. The present series included 36 kidneys with a 56% postoperative stone-free status examined by plain radiography and a 58% one examined by linear tomography at 12-36 months. CT showed 47% and US 72% of the kidneys to be stone-free, respectively. The sensitivity of CT was superior to plain radiography (P < 0.05), linear tomography (P < 0.05) or US (P < 0.001) in the detection of residual or recurrent stones after percutaneous nephrolithotomy analyzed statistically by McNemar's test. In the same group of 35 patients, which consisted of the above 36 postoperative kidneys together with 19 contralateral kidneys, a total of 55 kidneys were evaluated by the above methods, revealing 56 stones in 31 kidneys. Of these stones 95% were detected by CT, 70% by plain radiography, 68% by linear tomography, and 32% by renal US. Of the 55 kidneys, 14 contained 20 stone fragments smaller than 3 mm, and 26 kidneys carried 43 concrements smaller than 6 mm. The sensitivities of the four imaging methods in the detection of these small fragments were as follows: plain radiography 60% and 60%, linear tomography 55% and 58%, CT 95% and 93%, and US 15% and 26%.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of prostatic capsule perforation on the absorption of irrigating fluid during transurethral resection.

Thirty patients undergoing transurethral resection of the prostate using ethanol-tagged irrigating fluid were investigated in order to study the effects of a breach in the prostatic capsule. Measurements were made of end-tidal ethanol (ET-ethanol) in the expired air, serum glycine and sodium, haemoglobin, blood loss and volumetric determination of irrigating fluid absorption. Perforation of the prostatic capsule occurred in 13 patients (Group P), with 17 judged to have no perforation (Group NP). In all Group NP patients the ET-ethanol remained below 0.05/1000, serum sodium decreased by < or = 3 mmol/l and serum glycine remained < 1.5 mmol/l. ET-ethanol was significantly increased in Group P, rising to between 0.1 and 0.45/1000 in 5 patients, 3 of whom showed a reduction in serum sodium > 5 mmol/l. Five patients in Group P demonstrated significantly raised serum glycine concentrations up to 15 mmol/l. These findings suggest that perforation of the prostatic capsule may lead to rapid absorption of irrigating fluid, and that ET-ethanol monitoring is a useful method of detecting this quickly.