ABSTRACT
In recent years, the advanced knowledge of clinical, biological and molecular features of prostate cancer have led to the introduction of new drugs and have allowed the relocation of old drugs in different settings. In this way, the new concepts of systemic disease arise: high risk or high volume vs. low risk and low volume disease castration sensitive prostate cancer (CSPC), diversifying the use of previously approved drugs (CRPC) and opening new scenarios for sequence therapy. The aim of this review is to integrate new developments into the medical management of systemic prostate cancer.
Subject(s)
Prostatic Neoplasms , Male , Humans , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/surgery , Immunotherapy , Algorithms , Knowledge , CastrationABSTRACT
Melanosis of the bladder represents a rare condition characterized by anomalous deposits of melanin-containing pigment. To our knowledge, so far, just 5 cases have been reported in the literature. We describe a case of a simply melanosis of the bladder confirmed by histochemical stains and immunohistochemistry analysis.
Subject(s)
Cystoscopy , Melanosis/pathology , Urinary Bladder Diseases/pathology , Aged , Humans , MaleABSTRACT
Arterial embolization from thrombolytic therapy for acute myocardial infarction is rare. We report two cases of spontaneous arterial embolization following the use of tissue plasminogen activator for acute myocardial infarction. Transesophageal echocardiography was able to identify the source of embolism as mobile atherosclerotic debris within the thoracic aorta. This information was of value in the management of these patients, in that femoral catheterization which could have precipitated further embolization was avoided.
Subject(s)
Aorta, Thoracic/diagnostic imaging , Arteriosclerosis/diagnostic imaging , Echocardiography, Transesophageal , Embolism/etiology , Myocardial Infarction/drug therapy , Thrombolytic Therapy/adverse effects , Tissue Plasminogen Activator/therapeutic use , Aged , Catheterization, Peripheral , Contraindications , Femoral Artery , Humans , Male , Middle AgedABSTRACT
Amiodarone was used in 86 patients with ventricular tachycardia (VT) (67 patients) or ventricular fibrillation (19 patients) secondary to coronary artery disease. The mean +/- standard deviation left ventricular ejection fraction was 30 +/- 12% (range 8 to 65%). Prior trials with 4 +/- 1.2 alternate antiarrhythmic agents had been unsuccessful. Amiodarone was loaded at dosages of 1,200 to 1,800 mg/day, with maintenance dosages of 400 to 600 mg/day. Drug efficacy was evaluated by programmed stimulation at 10 to 14 days in 68 patients. In 38 patients sustained VT or ventricular fibrillation was inducible (group I), whereas 30 patients (group II) had either no inducible VT (8) or had nonsustained VT induced (22). Holter monitoring was used to assess drug efficacy in 18 patients (group III). All patients were evaluated at 3- to 6-month intervals with Holter monitors for efficacy and a standard protocol for toxicity. During a long-term follow-up of 18 +/- 16 months, sudden death occurred in 5 patients and nonfatal arrhythmia recurrences were detected in 16. The actuarial probability of freedom from fatal and nonfatal arrhythmia recurrences at 24 months was 0.52 for group I, 0.97 for group II and 0.68 for group III. The mode of induction, rate change or hemodynamic tolerance of the induced ventricular tachycardia did not predict arrhythmia recurrence. Among the clinical variables analyzed, only an ejection fraction of less than or equal to 30% was identified as a significant predictor of arrhythmia recurrence. Nonsudden cardiac death occurred in 21 patients, including 19 from heart failure and 2 from myocardial infarction. Noncardiac death occurred in 7 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Amiodarone/therapeutic use , Coronary Disease/complications , Tachycardia/physiopathology , Adult , Aged , Aged, 80 and over , Coronary Disease/physiopathology , Electric Stimulation , Electrocardiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Monitoring, Physiologic , Predictive Value of Tests , Prognosis , Recurrence , Stroke Volume , Tachycardia/drug therapy , Tachycardia/etiologyABSTRACT
It was proposed that the diminished renal function observed with advancing age could be due to a lower concentration of essential ions within the organ or an accumulation of ions which could produce cellular toxicity. This investigation reports the effect of age (3, 6, 12, 24 and 28 months) on the concentrations of magnesium, calcium, zinc, copper and iron in renal homogenates of Fischer 344 strain rats. Samples of renal tissues were homogenized in a solution containing 5 p. 100 La + 25 p. 100 HNO3. The samples were digested, centrifuged and assayed by atomic absorption spectrophotometry. With age, the magnesium concentration decreased (P less than 0.05) while the calcium and copper concentrations remained unchanged, and the zinc concentration decreased slightly while the iron concentration markedly increased (P less than 0.05). In summary, these data and other data obtained from similar studies of the brain and heart, suggest that the changes observed with age are unique to the kidney. Our results suggest that changes in ionic concentration in the kidney with respect to age could contribute to the diminished function observed in that organ with senescence.