RESUMEN
Neisseria meningitidis is an obligate human commensal bacterium that frequently colonises the upper respiratory tract. Person-to-person transmission occurs via direct contact or through dispersion of respiratory droplets from a carrier of the bacteria, and can lead to invasive meningococcal disease. Rare sporadic cases of meningococcal urogenital and anorectal infections, including urethritis, proctitis, and cervicitis, have been reported, typically following orogenital contact with an oropharyngeal meningococcal carrier. The resulting infections were clinically indistinguishable from infections caused by Neisseria gonorrhoeae. Over the past two decades, there have also been multiple outbreaks across North America and Europe of invasive meningococcal disease among men who have sex with men (MSM). The responsible meningococci belong to a highly virulent and predominantly serogroup C lineage, including strains that are able to express nitrite reductase and grow in anaerobic environments, such as the urogenital and anorectal tracts. More recently, a distinct clade within this lineage has expanded to cause urethritis predominantly among men who have sex with women. Evolutionary events giving rise to this clade included the loss of the ability to express a capsule, and acquisition of several gonococcal alleles, including one allele encoding a highly efficient gonococcal nitrite reductase. Members of the clade continue to acquire gonococcal alleles, including one allele associated with decreased antibiotic susceptibility. This evolution has implications for the clinical and public health management of those who are infected and their close contacts, in terms of both antibiotic treatment, and prevention through vaccination.
Asunto(s)
Enfermedades Urogenitales Femeninas/epidemiología , Enfermedades Urogenitales Masculinas/epidemiología , Infecciones Meningocócicas/epidemiología , Infecciones Meningocócicas/transmisión , Neisseria meningitidis , Enfermedades del Recto/epidemiología , Enfermedades Bacterianas de Transmisión Sexual/epidemiología , Femenino , Enfermedades Urogenitales Femeninas/microbiología , Enfermedades Urogenitales Femeninas/prevención & control , Heterosexualidad , Homosexualidad Masculina , Humanos , Transmisión Vertical de Enfermedad Infecciosa , Masculino , Enfermedades Urogenitales Masculinas/microbiología , Enfermedades Urogenitales Masculinas/prevención & control , Infecciones Meningocócicas/prevención & control , Enfermedades del Recto/microbiología , Enfermedades del Recto/prevención & control , Enfermedades Bacterianas de Transmisión Sexual/prevención & controlRESUMEN
Dietary methionine restriction (MR) has been found to enhance longevity across many species. We hypothesized that MR might enhance longevity in part by delaying or inhibiting age-related disease processes. To this end, male Fischer 344 rats were fed control (CF, 0.86% methionine) or MR (0.17% methionine) diets throughout their life until sacrifice at approximately 30 months of age, and histopathology was performed to identify the incidence and progression of two important aging-related pathologies, namely, chronic progressive nephropathy (CPN) and testicular tumorigenesis. Although kidney pathology was observed in 87% CF rats and CPN in 62% of CF animals, no evidence of kidney disease was observed in MR rats. Consistent with the absence of renal pathology, urinary albumin levels were lower in the MR group compared to controls throughout the study, with over a six-fold difference between the groups at 30 months of age. Biomarkers associated with renal disease, namely, clusterin, cystatin C, and ß-2 microglobulin, were reduced following 18 months of MR. A reduction in testicular tumor incidence from 88% in CF to 22% in MR rats was also observed. These results suggest that MR may lead to metabolic and cellular changes providing protection against age-related diseases.
Asunto(s)
Envejecimiento , Dieta , Enfermedades Urogenitales Masculinas/prevención & control , Metionina , Animales , Riñón , Masculino , Ratas , Ratas Endogámicas F344RESUMEN
BACKGROUND: The objective of this study was to examine the proportion of missed infections and correlates of pharyngeal gonorrhea among young people attending public sexually transmitted disease (STD) clinics. METHODS: We conducted a case-control study of 245 young men and women between April 2012 and May 2014. Participants were eligible for inclusion if they (1) were 15 to 29 years of age, (2) reported giving oral sex to a partner of the opposite sex in the past 90 days, and (3) attended 1 of 12 public STD clinics in Los Angeles County. Computer-assisted self-interviews were used to collect information on sexual behaviors and tests were conducted for pharyngeal and urogenital gonorrhea. RESULTS: Most participants were younger than 25 years (69%) and more than half were female (56%). We identified a total of 64 cases (27%) of gonorrhea, of which 29 (45%) were a urogenital only infection, 18 (28%) were a pharyngeal only, and 17 (27%) were dually infected at both sites. Pharyngeal testing increased case finding by 39% from 46 to 64 cases. After adjusting for age, sex, and number of sex partners, those who reported consistent pharyngeal exposure to ejaculate/vaginal fluids were 3 times as likely to have pharyngeal gonorrhea as compared with those without this exposure (adjusted odds ratio, 3.1; 95% confidence interval, 1.3-7.5). CONCLUSIONS: A large proportion of gonorrhea cases among young people would be missed in the absence of pharyngeal testing. These results have implications for those who provide medical care to clients at STD clinics and highlight the need for pharyngeal screening recommendations and counseling messages related to strategies to reduce exposure to infected fluids.
Asunto(s)
Enfermedades Urogenitales Femeninas/diagnóstico , Gonorrea/diagnóstico , Enfermedades Urogenitales Masculinas/diagnóstico , Neisseria gonorrhoeae/aislamiento & purificación , Enfermedades Faríngeas/diagnóstico , Adolescente , Adulto , Instituciones de Atención Ambulatoria , California/epidemiología , Estudios de Casos y Controles , Femenino , Enfermedades Urogenitales Femeninas/epidemiología , Enfermedades Urogenitales Femeninas/microbiología , Enfermedades Urogenitales Femeninas/prevención & control , Gonorrea/epidemiología , Gonorrea/microbiología , Gonorrea/prevención & control , Humanos , Masculino , Enfermedades Urogenitales Masculinas/epidemiología , Enfermedades Urogenitales Masculinas/microbiología , Enfermedades Urogenitales Masculinas/prevención & control , Tamizaje Masivo , Enfermedades Faríngeas/epidemiología , Enfermedades Faríngeas/microbiología , Enfermedades Faríngeas/prevención & control , Faringe/microbiología , Asunción de Riesgos , Conducta Sexual , Parejas Sexuales , Adulto JovenAsunto(s)
Infecciones por VIH/prevención & control , Profilaxis Pre-Exposición/economía , Minorías Sexuales y de Género , Medicina Estatal/economía , Determinación de la Elegibilidad , Infecciones por VIH/transmisión , Infecciones por VIH/virología , Humanos , Masculino , Enfermedades Urogenitales Masculinas/prevención & control , Enfermedades Urogenitales Masculinas/virología , Parejas Sexuales , Medicina Estatal/legislación & jurisprudencia , Reino UnidoRESUMEN
The arterial ligation during elective laparoscopic sigmoidectomy for diverticular disease can affect genito-urinary function injuring the superior hypogastric plexus, and can weaken the distal colonic stump arterial perfusion. Ligation of the inferior mesenteric artery distal to the left colic artery or the complete preservation of the inferior mesenteric artery can therefore be compared in terms of preservation of the descending sympathetic fibres running along the aorta to the rectum resulting in a different post operative genito urinary function. From January 2015 to March 2016, 66 patients underwent elective laparoscopic sigmoidectomy for diverticular disease among two enrolling hospitals. In one centre 35 patients underwent laparoscopic sigmoidectomy with the ligation of the inferior mesenteric artery distal to the left colic artery (low ligation). In the other centre 31 patient were operated on the same procedure with complete inferior mesenteric artery preservation (IMA preservation). There was no difference in terms of major complication occurred, first passage of stool and length of hospital stay between the two groups. Time of surgery was significantly shorter in LL group compared to IMA preserving group and intra operative blood loss was significantly lower in the LL group. There were no differences in the genito urinary function between the two group pre operatively, at 1 and 9 months post operatively. Genito urinary function did not significantly change across surgery in each groups. The low ligation and the IMA preserving vascular approach are safe end feasible techniques in elective laparoscopic sigmoidectomy for diverticular disease. They both prevent from genito-urinary post-operative disfunction and allow good post operative quality of life. The low ligation approach is related to shorter operative time and slower intra operative blood loss.
Asunto(s)
Colon Sigmoide/cirugía , Divertículo del Colon/cirugía , Procedimientos Quirúrgicos Electivos , Laparoscopía , Arteria Mesentérica Inferior , Calidad de Vida , Sigmoidoscopía , Adulto , Anciano , Pérdida de Sangre Quirúrgica/prevención & control , Procedimientos Quirúrgicos Electivos/métodos , Estudios de Factibilidad , Femenino , Enfermedades Urogenitales Femeninas/prevención & control , Humanos , Italia , Laparoscopía/efectos adversos , Laparoscopía/métodos , Ligadura/métodos , Masculino , Enfermedades Urogenitales Masculinas/prevención & control , Arteria Mesentérica Inferior/cirugía , Persona de Mediana Edad , Tempo Operativo , Tratamientos Conservadores del Órgano , Estudios Prospectivos , Factores de Riesgo , Sigmoidoscopía/efectos adversos , Sigmoidoscopía/métodos , Resultado del TratamientoRESUMEN
Radiation therapy is a treatment modality that is often used in the uro-oncological setting. The common indication for the radiation therapy in the urological sphere is prostate cancer, whether it is used primarily as a radical approach, or postoperatively as adjuvant or salvage therapy. All urological organs are sensitive to radiation injury with the urinary bladder being the most susceptible with a typical cascade including acute and late changes, arising in the dose-dependent manner. The common indication for radiation therapy in urology is prostate cancer, which collaterally affects the urinary bladder and rarely urethra (especially the bulbo-membranous urethra). Ureteral damage and stricture formation is almost always restricted to the cases of intraoperative therapy and external beam radiation therapy for other urological malignancies (gynecological organs, rectum, retroperitoneal soft tissue tumors) and should not be underestimated. Postradiotherapeutic tissue changes, especially of the prostate, can cause difficulties for pathologists and urologists with regard to diagnosis of prostate cancer recurrence and salvage therapy.
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Enfermedades Urogenitales Femeninas/etiología , Enfermedades Urogenitales Femeninas/patología , Enfermedades Urogenitales Masculinas/etiología , Enfermedades Urogenitales Masculinas/patología , Traumatismos por Radiación/etiología , Traumatismos por Radiación/patología , Radioterapia/efectos adversos , Relación Dosis-Respuesta en la Radiación , Medicina Basada en la Evidencia , Femenino , Enfermedades Urogenitales Femeninas/prevención & control , Humanos , Masculino , Enfermedades Urogenitales Masculinas/prevención & control , Traumatismos por Radiación/prevención & control , Dosificación Radioterapéutica , Factores de Riesgo , Resultado del TratamientoRESUMEN
The aim of this study was to assess Chlamydia trachomatis (CT) infection prevalence and serovar distribution in a high-density urban area in the north of Italy, by comparing different groups of subjects divided on the basis of the type of care provider they referred to (STI Clinic, gynaecologists or general practitioners). From January 2011 to May 2014, all the specimens submitted to the Microbiology Laboratory of St Orsola Hospital in Bologna for CT detection were tested by PCR assay. For positive specimens, molecular genotyping based on RFLP analysis was performed. Total prevalence of CT infection was 8.1 %, with significant differences between subgroups (P<0.01) but stable during the study period. The STI Clinic was mainly responsible for CT diagnosis, whereas the lowest infection prevalence was detected in gynaecological clinics, despite the high number of tests performed. Extra-genital samples were almost exclusively collected from males at the STI Clinic. Interestingly, 13.3 % of patients providing extra-genital specimens were positive for CT on rectal and/or pharyngeal swabs, and 4.4 % of cases would have been missed if extra-genital sites had not been tested. The most common serovar was E, and serovar distribution was influenced by gender (P<0.01), age (P<0.01), care provider (P=0.01) and anatomical site (P<0.01). The L2 serovar was detected only in extra-genital samples from males at the STI Clinic. Knowledge about care providers' contributions in CT testing and diagnosis is essential for infection control. CT typing is crucial for appropriate management of specific infections, such as lymphogranuloma venereum in extra-genital samples of high-risk populations.
Asunto(s)
Infecciones por Chlamydia/prevención & control , Chlamydia trachomatis/aislamiento & purificación , Enfermedades Urogenitales Femeninas/microbiología , Enfermedades Urogenitales Masculinas/microbiología , Adolescente , Adulto , Chlamydia trachomatis/genética , Ciudades , Femenino , Enfermedades Urogenitales Femeninas/epidemiología , Enfermedades Urogenitales Femeninas/prevención & control , Humanos , Italia , Masculino , Enfermedades Urogenitales Masculinas/epidemiología , Enfermedades Urogenitales Masculinas/prevención & control , Persona de Mediana Edad , Prevalencia , Adulto JovenRESUMEN
The late-onset hypogonadism is defined as a reduction of blood testosterone values in aging males in combination with sexual symptoms. A hormone substitution is only necessary if desired by the patient. Erectile dysfunction is often caused by vasculopathy. Therefore, vascular risk factors should be evaluated. In case of cardiovascular disease a cardiologist should be addressed before initiating treatment. First line therapy consists of phosphodiesterase inhibitors. In lower urinary tract symptoms prostatic enlargement is the likely cause, but other causes have to be ruled out. Symptomatic therapy can be initiated if the patient is bothered. If voiding symptoms are predominant, alpha blockers or alpha reductase inhibitors are the treatment of choice. In case of storage symptoms, treatment can be started with muscarin receptor antagonists.
Asunto(s)
Enfermedades Urogenitales Masculinas/diagnóstico , Enfermedades Urogenitales Masculinas/prevención & control , Diagnóstico Diferencial , Disfunción Eréctil/diagnóstico , Disfunción Eréctil/etiología , Disfunción Eréctil/prevención & control , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/etiología , Hipogonadismo/prevención & control , Síntomas del Sistema Urinario Inferior/diagnóstico , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/prevención & control , Masculino , Enfermedades Urogenitales Masculinas/etiología , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/etiología , Hiperplasia Prostática/prevención & control , Factores de RiesgoRESUMEN
BACKGROUND: We report the clinical results and prognostic factors of image-guided radiation therapy (RT) with helical tomotherapy (HT) for localized and recurrent prostate cancer (PC). PATIENTS AND METHODS: We evaluated 70 patients with PC (primary diagnosis, n = 48; adjuvant, n = 5; salvage, n = 17) treated with HT from May 2006 through January 2011. The dose prescribed to the prostate/surgical bed ranged between 60 and 78 Gy. Potential risk factors for genitourinary (GU) and gastrointestinal (GI) toxicity were assessed. RESULTS: The median age was 68 years (range 51-87 years). The median follow-up was 37 months (range 3-74 months). The rates of acute grade 2 GI and GU toxicities were 10 and 13%, respectively. Only 1 patient experienced acute grade 3 GU toxicity. The rates of late grade ≥ 2 GI and GU toxicities were 1% each. Multivariate analysis showed an association between rectum mean dose > median (39 Gy) and bladder median dose > median (46 Gy) with a higher grade of acute GI (p = 0.017) and GU (p = 0.019) toxicity, respectively. Additionally, older age was associated with late GU toxicity (p = 0.026). CONCLUSION: Toxicity with HT is low and is associated with higher median/mean doses in organs at risk as well as with older age. A prospective validation would be necessary to confirm these results.
Asunto(s)
Enfermedades Gastrointestinales/etiología , Enfermedades Urogenitales Masculinas/etiología , Neoplasias de la Próstata/radioterapia , Traumatismos por Radiación/etiología , Radioterapia Guiada por Imagen/métodos , Radioterapia de Intensidad Modulada/efectos adversos , Radioterapia de Intensidad Modulada/métodos , Anciano , Anciano de 80 o más Años , Enfermedades Gastrointestinales/prevención & control , Humanos , Masculino , Enfermedades Urogenitales Masculinas/prevención & control , Persona de Mediana Edad , Neoplasias de la Próstata/diagnóstico por imagen , Traumatismos por Radiación/prevención & control , Protección Radiológica/métodos , Dosificación Radioterapéutica , Radioterapia Guiada por Imagen/efectos adversos , Estudios Retrospectivos , Tomografía Computarizada Espiral/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: To assess treatment tolerance by patients treated with a dose-adapted salvage radiotherapy (SRT) protocol based on an multiparametric endorectal magnetic resonance imaging (erMRI) failure definition model after radical prostatectomy (RP). MATERIAL AND METHODS: A total of 171 prostate cancer patients recurring after RP undergoing erMRI before SRT were analyzed. A median dose of 64 Gy was delivered to the prostatic bed (PB) with, in addition, a boost of 10 Gy to the suspected relapse as visualized on erMRI in 131 patients (76.6%). Genitourinary (GU) and gastrointestinal (GI) toxicities were scored using the RTOG scale. RESULTS: Grade ≥ 3 GU and GI acute toxicity were observed in three and zero patients, respectively. The four-year grade ≥ 2 and ≥ 3 late GU and GI toxicity-free survival rates (109 patients with at least two years of follow-up) were 83.9 ± 4.7% and 87.1 ± 4.2%, and 92.1 ± 3.6% and 97.5 ± 1.7%, respectively. Boost (p = 0.048) and grade ≥ 2 acute GU toxicity (p = 0.008) were independently correlated with grade ≥ 2 late GU toxicity on multivariate analysis. CONCLUSIONS: A dose-adapted, erMRI-based SRT approach treating the PB with a boost to the suspected local recurrence may potentially improve the therapeutic ratio by selecting patients that are most likely expected to benefit from SRT doses above 70 Gy as well as by reducing the size of the highest-dose target volume. Further prospective trials are needed to investigate the use of erMRI in SRT as well as the role of dose-adapted protocols and the best fractionation schedule.
Asunto(s)
Fraccionamiento de la Dosis de Radiación , Enfermedades Gastrointestinales/prevención & control , Imagen por Resonancia Magnética/métodos , Enfermedades Urogenitales Masculinas/prevención & control , Recurrencia Local de Neoplasia/prevención & control , Prostatectomía , Neoplasias de la Próstata/radioterapia , Terapia Recuperativa , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Seguimiento , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/patología , Humanos , Masculino , Enfermedades Urogenitales Masculinas/etiología , Enfermedades Urogenitales Masculinas/patología , Persona de Mediana Edad , Recurrencia Local de Neoplasia/etiología , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugíaRESUMEN
BACKGROUND: Treatment-related toxicity and quality of life (QoL) considerations are important when counseling patients with localized prostate cancer (PCa). OBJECTIVE: To determine the incidence and longitudinal pattern of late genitourinary (GU) toxicity and QoL after high-dose, intensity-modulated radiotherapy (IMRT). DESIGN, SETTING, AND PARTICIPANTS: A total of 268 patients with localized PCa were treated between June 2004 and December 2008 at a tertiary referral center. Median follow-up was 5 yr (range: 3-7.7 yr). INTERVENTION: Patients underwent IMRT to a total dose of 86.4Gy; 50% of patients underwent neoadjuvant and concurrent androgen-deprivation therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Patients were evaluated with the prospectively obtained International Prostate Symptom Score (IPSS) questionnaire. GU toxicity was also scored using the Common Terminology Criteria for Adverse Events (CTCAE) v.4.0; toxicity events were defined as increase over baseline. Differences in increases in IPSS sums and QoL index between baseline IPSS sum and QoL index groups were analyzed using the Kruskal-Wallis and Mann-Whitney tests. Univariate and multivariate Cox regression models were applied. RESULTS AND LIMITATIONS: The overall median IPSS sum increase during follow-up was 3 and was less pronounced among patients with severe baseline symptoms compared with those with mild baseline symptoms (median increase: 0 vs 4; p<0.0001). Overall QoL index was unchanged after IMRT but appeared to improve in patients with dissatisfied baseline QoL compared with satisfied baseline QoL (p<0.0001). Fifty-five (20%) and 2 (1%) patients developed grade 2 and 3 late GU toxicities, respectively; however, in 28 of 57 patients (49%), toxicity resolved during follow-up. Even though the IPSS data were prospectively obtained, most patients were not treated within a prospective protocol. CONCLUSIONS: Late GU toxicity after high-dose IMRT was mild; severe, late GU toxicity was rare. Changes in IPSS sum and QoL index were dependent on the baseline GU function, which might be useful for future patient counseling.
Asunto(s)
Enfermedades Urogenitales Masculinas/etiología , Neoplasias de la Próstata/radioterapia , Radioterapia de Intensidad Modulada/efectos adversos , Anciano , Humanos , Incidencia , Masculino , Enfermedades Urogenitales Masculinas/epidemiología , Enfermedades Urogenitales Masculinas/prevención & control , Pronóstico , Estudios Prospectivos , Calidad de Vida , Factores de TiempoRESUMEN
OBJECTIVES: To assess the incidence of genitourinary infections associated with transrectal ultrasound-guided prostate biopsy (TRUS-BX) using endorectal povidone-iodine gel as a bactericidal agent. METHODS: We prospectively studied a total of 530 patients who were given 30g of 10% povidone-iodine intrarectally before TRUS-BX. Each patient received antibiotic prophylaxis with ciprofloxacin, starting the previous day (1g/day x 3 days), as well as cleansing enemas. RESULTS: One patient (0.20%) presented with an E. coli acute bacterial epididymitis after biopsy. CONCLUSIONS: In our study, the intrarectal use of 10% povidone-iodine gel in TRUS-BX is associated with a much lower rate of infectious complications compared to those described in recent literature.
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Antiinfecciosos Locales/administración & dosificación , Infecciones Bacterianas/prevención & control , Biopsia con Aguja/efectos adversos , Enfermedades Urogenitales Masculinas/prevención & control , Povidona Yodada/administración & dosificación , Administración Rectal , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/epidemiología , Ciprofloxacina/uso terapéutico , Humanos , Incidencia , Masculino , Enfermedades Urogenitales Masculinas/epidemiología , Persona de Mediana Edad , Estudios Prospectivos , Próstata/patología , Neoplasias de la Próstata/patología , Ultrasonografía IntervencionalRESUMEN
The present study is trying to produce a transdermal microemulsion drug delivery system (TMDDS) for Tripterygium Wilfordii Hook f. (TWHF) and attempting to solve male reproductive toxicity problem of TWHF. The formulation was optimized by the central composite design with response surface methodology and was decided as 12% oleic acid, 19.7% Labrasol S, 19.7% ethanol and 19.7% Pharmasolve, and 29% water. TMDDS for TWHF had stronger transdermal ability than free TWHF, and TWHF microemulsion significantly inhibited the adjuvant-induced arthritis and at the same time, had preferable anti-inflammatory effect with the long-time administration. Various pharmacodynamics parameters proved that TWHF microemulsion can reduce the male reproductive toxicity and hepatotoxicity of rats. All these suggested that TMDDS could be a suitable delivery system for TWHF.
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Antiinflamatorios/administración & dosificación , Artritis/prevención & control , Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Sistemas de Liberación de Medicamentos , Enfermedades Urogenitales Masculinas/prevención & control , Extractos Vegetales/administración & dosificación , Tripterygium/toxicidad , Administración Cutánea , Animales , Antiinflamatorios/uso terapéutico , Antiinflamatorios/toxicidad , Artritis/inducido químicamente , Emulsiones , Masculino , Enfermedades Urogenitales Masculinas/inducido químicamente , Extractos Vegetales/uso terapéutico , Extractos Vegetales/toxicidad , Ratas , Agua/químicaAsunto(s)
Enfermedades Urogenitales Femeninas/prevención & control , Promoción de la Salud , Enfermedades Urogenitales Masculinas/prevención & control , Rol del Médico , Fumar/efectos adversos , Urología , Femenino , Enfermedades Urogenitales Femeninas/etiología , Humanos , Masculino , Enfermedades Urogenitales Masculinas/etiología , Cese del Hábito de FumarRESUMEN
BACKGROUND: With salvage radiation therapy (SRT) in the postprostatectomy setting, the need to deliver sufficient radiation doses to achieve a high probability of tumor control is balanced with the risk of increased toxicity. Intensity-modulated radiation therapy (IMRT) in the postprostatectomy salvage setting is gaining interest as a treatment strategy. OBJECTIVE: Compare acute and late toxicities in patients treated with IMRT and three-dimensional conformal radiation therapy (3D-CRT) in the postprostatectomy salvage setting. DESIGN, SETTING, AND PARTICIPANTS: A total of 285 patients who were treated at our institution between 1988 and 2007 with SRT after radical prostatectomy for biochemical recurrence were identified. All medical records were reviewed and toxicity recorded. Median follow-up was 60 mo. INTERVENTION: All patients were treated with SRT with either 3D-CRT (n=109) or IMRT (n=176). A total of 205 patients (72%) were treated with doses ≥70Gy. MEASUREMENTS: Late gastrointestinal (GI) and genitourinary (GU) toxicities were recorded using the Common Terminology Criteria for Adverse Events v. 3.0 definition. RESULTS AND LIMITATIONS: The 5-yr actuarial rates of late grade ≥2 GI and GU toxicity were 5.2% and 17.0%, respectively. IMRT was independently associated with a reduction in grade ≥2 GI toxicity compared with 3D-CRT (5-yr IMRT, 1.9%; 5-yr 3D-CRT, 10.2%; p=0.02). IMRT was not associated with a reduction in risk of grade ≥2 GU toxicity (5-yr IMRT, 16.8%; 5-yr 3D-CRT, 15.8%; p=0.86), urinary incontinence (5-yr IMRT, 13.6%; 5-yr 3D-CRT, 7.9%; p=0.25), or grade 3 erectile dysfunction (5-yr IMRT, 26%; 5-yr 3D-CRT, 30%; p=0.82). Of patients who developed late grade ≥2 GI or GU toxicity, 38% and 44%, respectively, experienced resolution of their symptoms prior to the last follow-up. CONCLUSIONS: Our experience with high-dose IMRT in the postprostatectomy salvage setting demonstrates that the treatment can be delivered safely with an associated reduction in late GI toxicity.
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Recurrencia Local de Neoplasia , Prostatectomía , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Traumatismos por Radiación/prevención & control , Radioterapia Conformacional/efectos adversos , Radioterapia de Intensidad Modulada/efectos adversos , Terapia Recuperativa/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/prevención & control , Humanos , Estimación de Kaplan-Meier , Masculino , Enfermedades Urogenitales Masculinas/etiología , Enfermedades Urogenitales Masculinas/prevención & control , Persona de Mediana Edad , Ciudad de Nueva York , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/inmunología , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/secundario , Dosis de Radiación , Traumatismos por Radiación/etiología , Traumatismos por Radiación/mortalidad , Radioterapia Adyuvante , Radioterapia Conformacional/mortalidad , Radioterapia de Intensidad Modulada/mortalidad , Análisis de Regresión , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Terapia Recuperativa/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
Lower urinary tract symptoms (LUTS) in men may be related to micronutrients involved in prevention of oxidative damage or cell growth and differentiation. We tested the hypothesis that carotenoid, vitamin A, and vitamin C intake were inversely associated with total LUTS, voiding, and storage symptoms. We conducted a cross-sectional multivariate analysis of 1466 men aged 30-79 y in the Boston Area Community Health survey (2002-2005), a population-based random sample survey. Data were collected by in-person interview and validated FFQ. Moderate-to-severe LUTS were defined using the American Urological Symptom Index and analyzed using multivariate logistic regression. Overall, men consuming greater dietary lycopene, ß-carotene, total carotenoid, or vitamin A had ~40-50% decreased odds of LUTS compared with the lowest intake quartiles (e.g. ß-carotene and storage symptoms, OR = 0.56, 95% CI = 0.39, 0.82; P-trend = 0.02). Interactions were observed between dietary iron and vitamin C or ß-cryptoxanthin, whereby inverse associations with LUTS, particularly voiding symptoms, occurred only among men with moderate-to-high iron intake (P-interaction = 0.001). High-dose supplemental and total vitamin C were positively associated with LUTS (e.g. supplemental vitamin C ≥ 250 mg/d, OR = 1.83, 95% CI = 1.21, 2.77; P-trend = 0.02). An interaction between ß-carotene and smoking status (P-interaction = 0.004) indicated greater odds of LUTS with higher ß-carotene intake among current smokers. Results suggest that modifying consumption of carotenoids and vitamin C may influence LUTS in men.
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Ácido Ascórbico/uso terapéutico , Carotenoides/uso terapéutico , Dieta , Suplementos Dietéticos/efectos adversos , Enfermedades Urogenitales Masculinas/prevención & control , Sistema Urinario/efectos de los fármacos , Vitamina A/uso terapéutico , Adulto , Anciano , Ácido Ascórbico/efectos adversos , Ácido Ascórbico/farmacología , Carotenoides/farmacología , Estudios Transversales , Humanos , Entrevistas como Asunto , Hierro de la Dieta/farmacología , Modelos Logísticos , Masculino , Enfermedades Urogenitales Masculinas/etiología , Massachusetts , Persona de Mediana Edad , Análisis Multivariante , Factores de Riesgo , Fumar/efectos adversos , Encuestas y Cuestionarios , Micción/efectos de los fármacos , Vitamina A/farmacologíaRESUMEN
PURPOSE: To assess toxicity outcomes of image-guided intensity-modulated radiation therapy (IG-IMRT) combined with permanent prostate seed implant in a cohort of patients with localized prostate cancer. METHODS AND MATERIALS: A retrospective analysis was performed on 67 patients with the median pretreatment prostate-specific antigen level of 5.4. The Gleason score was less than 7 in 7 patients, 7 in 52 patients, and greater than 7 in 8 patients. The median followup was 28.2 months (range, 12-89.5 months). Treatment consisted of 45 (n=65) or 50.4 Gy (n=2) at 1.8 Gy/fraction of IG-IMRT to the prostate and seminal vesicles. Eight patients had simultaneous irradiation of pelvic lymph nodes to 45 (n=65) or 50.4 Gy (n=2). After IG-IMRT, patients received transperineal prostate implant boost with either (103)Pd (n=65, the prescribed D(90) of 100 Gy) or (125)I (n=2, D(90) of 110 Gy). Eleven patients received androgen deprivation therapy with radiotherapy. RESULTS: Toxicity higher than Grade 3 was not observed. The combined incidence of acute and late Grade 3 genitourinary toxicity was 6%. The combined incidence of acute and late Grade 3 gastrointestinal toxicity was 3%. At least one episode of gastrointestinal bleeding on followup, which could be attributed to radiation, was recorded in 14.9% of patients. For patients achieving erections before radiation, the 3-year Kaplan-Meier potency preservation rate was 66.5%. CONCLUSIONS: The early toxicity of the combination of IG-IMRT and low-dose rate brachytherapy boost in this study was favorable.
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Braquiterapia/efectos adversos , Enfermedades Gastrointestinales/etiología , Enfermedades Urogenitales Masculinas/etiología , Neoplasias de la Próstata/radioterapia , Traumatismos por Radiación/etiología , Radioterapia Conformacional/efectos adversos , Anciano , Terapia Combinada/efectos adversos , Enfermedades Gastrointestinales/prevención & control , Humanos , Masculino , Enfermedades Urogenitales Masculinas/prevención & control , Traumatismos por Radiación/prevención & control , Resultado del TratamientoRESUMEN
Verbal information-giving is good, but only half of cases were reportedly given written information on chlamydia. Follow-up by 'phoning or texting (43%) was as common as follow-up in clinics (39%). About one-fourth of cases did not have follow up, with no recall for around 60% of these cases. Advice about partner notification (PN) was provided by a health adviser or other suitably trained health professional to 91% of cases, and the method of PN was documented for 92% of these cases. PN outcome was not documented for about 25% of these cases. There was no information on the chlamydial status of sexual contacts of about half of cases, and no information about the treatment status of sexual contacts of about 40% of cases. The average number of contacts screened per index was 0.52 outside London and 0.29 for the London Regions, levels below those suggested in the National Guideline.
Asunto(s)
Instituciones de Atención Ambulatoria , Infecciones por Chlamydia/prevención & control , Trazado de Contacto , Auditoría Médica , Educación del Paciente como Asunto/métodos , Enfermedades de Transmisión Sexual/prevención & control , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Infecciones por Chlamydia/tratamiento farmacológico , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/microbiología , Chlamydia trachomatis/efectos de los fármacos , Femenino , Enfermedades Urogenitales Femeninas/tratamiento farmacológico , Enfermedades Urogenitales Femeninas/epidemiología , Enfermedades Urogenitales Femeninas/prevención & control , Estudios de Seguimiento , Humanos , Masculino , Enfermedades Urogenitales Masculinas/tratamiento farmacológico , Enfermedades Urogenitales Masculinas/epidemiología , Enfermedades Urogenitales Masculinas/prevención & control , Parejas Sexuales , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/epidemiología , Teléfono , Resultado del Tratamiento , Reino UnidoRESUMEN
There was a wide range of activity and chlamydial diagnoses between the 177 clinics that responded. Most (92%) clinics have nucleic acid tests for chlamydial diagnosis. Different practitioners largely share roles in providing advice to patients about partner notification, treatment adherence, safer sex advice and abstinence. Most (97%) clinics have information leaflets about chlamydia, although about 30% of clinics lack leaflets containing information about antibiotics and hormonal contraception. About two-third clinics follow the National Guideline recommended interval for providing a test of cure where this is indicated. Only 18% of clinics routinely ask patients to reattend, with 40% having a policy of no routine follow-up and 62% using telephone or text follow-up. These categories were not mutually exclusive. Most (86%) of the 146 English clinics had a local Chlamydia Screening Programme coordinator for their Primary Care Trust area, although cooperation varies, with cooperation over treatment of 70% and Programme policy of 62%.