Psychotherapy and phosphodiesterase-5 inhibitor in early rehabilitation after radical prostatectomy: a prospective randomised controlled trial.

The aim of this study was to evaluate the impact of group psychotherapy and the use of a phosphodiesterase-5 inhibitor (PDE-5i) in the early rehabilitation stage of patients with prostate cancer undergoing radical prostatectomy (RP). Fifty-six patients undergoing RP for prostate cancer were randomised into four groups, and 53 completed the protocol: Group 1 - control (n = 11), Group 2 - group psychotherapy (n = 16), Group 3 - lodenafil 80 mg/one tablet per week (n = 12) and Group 4 - group psychotherapy + lodenafil 80 mg/one tablet per week (n = 14). The groups were individually evaluated for erectile function (IIEF-5) and quality of life - QoL (SF-36) weekly, with two meetings held a week apart before the RP and 12 weekly meetings after surgery. The ages ranged from 39 to 76 years, average 61.84. There were no significant medication side effects. Only Group 4 showed improvement in intimacy with a partner and satisfaction with their sex life (P = 0.045 and P = 0.013 respectively), and with no significant worsening of the IIEF-5 (P = 0.250) reported. All groups showed worsening in the final result of the role limitations caused by physical problems (P = 0.009) and role limitations caused by emotional problems (P = 0.002) of the SF-36, but Group 4 had a significantly higher score for the role limitations caused by physical problems (P = 0.009) than the other groups. In conclusion, precocious integral treatment involving group psychotherapy and PDE-5i before and after RP led to less deterioration of erectile function and other domains related to physical aspects (SF-36), with improvement in intimacy with their partner and satisfaction in their sex life, being superior to single treatments.

Psychotherapy: a missing piece in the puzzle of post radical prostatectomy erectile dysfunction rehabilitation.

OBJECTIVES: To measure the impact of psychotherapy associated to the use of Tadalafil in the improvement of erectile function after radical prostatectomy. METHODS: From 132 patients surgically treated for prostate cancer, thirty sequential patients with bilateral nerve sparing, low risk controlled disease and post-surgery erectile dysfunction (ED) took Tadalafil 20mg and underwent psychotherapy sessions, both weekly for three months. Patients were interviewed to establish the quality of erection using the instrument IIEF-5 and to measure psychological features impacting erectile function, aspects related to function, dysfunction, physical and emotional discomfort were evaluated with the help of an intensity scale. RESULTS: The average age was 62.5 (46 to 77 years), 96.7% had a stable relationship, 56.6% of the patients accepted the diagnosis and 43.2% exhibited defense mechanisms (3.3% negation, 6.6% revulsion, 33.3% concern). A positive correlation was observed between erectile function and time exposed to treatment (IIEF-5 - 9.7 to 13.3, p=0.0006), with increased satisfaction with life in general (2.1 to 2.7, P=.028) and sexual life (3.1 to 3.7, P=.028), added to facilitation of expressing feelings/emotions (1.8 to 3.0, P=.0008). Satisfaction with relationship and intimacy with partner did not present significant improve (P=.12 and P=.61, respectively). CONCLUSIONS: A holistic patient care with more complete ED rehabilitation includes psychotherapy with a positive correlation between erectile function and treatment exposition. Psychotherapy allowed the identification of important spouse related factors in this scenario.

Prostate specific antigen decrease and prostate cancer diagnosis: antibiotic versus placebo prospective randomized clinical trial.

PURPOSE: Prostate inflammation can lead to an increase in serum prostate specific antigen concentration and confound the use of prostate specific antigen kinetics. Repeat prostate specific antigen measurements after a period of observation or a course of empirical antibiotics are controversial in terms of the optimal approach to reduce the confounding impact on prostate cancer screening. This issue was analyzed in patients with a diagnosis of type IV or asymptomatic prostatitis (National Institutes of Health classification) and high prostate specific antigen. MATERIALS AND METHODS: We studied 200 men between 50 and 75 years old with a high prostate specific antigen (between 2.5 and 10 ng/dl). Of these patients 98 (49%) had a diagnosis of type IV prostatitis. In a prospective, double-blind trial they were randomized to receive placebo (49 patients, group 1) or 500 mg ciprofloxacin (49 patients, group 2) twice a day for 4 weeks. Prostate specific antigen was determined after treatment and all patients underwent transrectal ultrasound guided biopsy of the prostate. RESULTS: In group 1, 29 (59.18%) patients presented with a decrease in prostate specific antigen and 9 (31%) had cancer on biopsy, while in group 2 there were 26 (53.06%) patients with a decrease in prostate specific antigen and 7 (26.9%) with prostate cancer. There was no statistical difference in either group in relation to prostate specific antigen decrease after treatment or the presence of tumor. CONCLUSIONS: A considerable number of patients (49%) were diagnosed with type IV prostatitis and high prostate specific antigen in agreement with the current literature. Of the patients 26.9% to 31% presented with a decrease in prostate specific antigen after the use of antibiotic or placebo and harbor cancer as demonstrated on prostate biopsy. Prostate specific antigen decreases do not indicate the absence of prostate cancer.

Unusual presentation of a dermoid cyst in the ischiorectal fossa. Magnetic resonance imaging and ultrasound appearances.

The ischiorectal fossa may give rise to a wide variety of pathological entities, although it is composed of relatively few structures. Developmental cysts are included among the list. Large epidermoid cysts in the ischiorectal fossa have been previously described (Fujimoto et al., Clin Imaging 17:146-148, 1993; Ng et al., Can J Surg 49:435-436, 2006). However, to the best of our knowledge, there is no published case in the English literature of a dermoid cyst within the ischiorectal fossa. Using magnetic resonance (MR) imaging and a subsequent ultrasound-guided biopsy, we were able to offer a focused differential that included a dermoid cyst within the ischiorectal fossa in a 55-year-old man presenting with a painful mass on the buttocks. Hair and fatty components were obtained by targeted ultrasound-guided biopsy. On MR imaging, the mass was seen to be well circumscribed and registered a heterogeneous T1-weighted signal that corresponded to layers of fat and debris on short-tau inversion recovery (STIR) imaging. A well-defined ball of fat was noted centrally within the lesion, with a speckled low T1 and low T2 signal within it. Hair admixed with fat was obtained from it by targeted ultrasound-guided biopsy. There was no enhancement of the lesion after administration of gadolinium. On ultrasound, the lesion was well circumscribed and heterogeneous; the echogenic area corresponded to the fat signal seen on magnetic resonance imaging (MRI). The lower level echoes within the lesion corresponded to the debris seen on MRI. The central rounded area of speckling, registering fine posterior shadowing corresponded to the hairy contents obtained by the targeted ultrasound-guided biopsy. A differential diagnosis of all lipomatous lesions was included in the pre-biopsy report: fat necrosis within a lipoma; well-differentiated liposarcoma; myxoid liposarcoma and dermoid cyst. Histopathological diagnosis following complete surgical resection was that of a dermoid cyst.

[Satisfaction analysis in men presenting with localized prostate cancer treated with radical prostatectomy or radiotherapy: psychological and social aspects]. / Análisis de satisfacción en varones que presentaban cáncer de próstata localizado tratados con prostatectomía radical o radioterapia: aspectos psicológicos y Sociales.

OBJECTIVE: Analyze the treatment satisfaction and impact on patients with localized prostate cancer. METHODS: One-hundred and eighty patients, with mean age of 60 years, were divided into three groups: group I--100 patients submitted to radical retropubic prostatectomy (RRP), group II--40 patients who underwent radiotherapy (RT), and group III--40 healthy men. A questionnaire was applied to the groups to assess physical and psychological changes 18 months after treatment. The investigational tool was based on two questionnaires; first: SF-36 (Short Form Health Survey), second: FACT-P (Functional Assessment Cancer Therapy). RESULTS: In group I, 70% never used pads, 5% presented with complete urinary incontinence, and 10% reported occasional stool leakage. In group II, 85% did not use pads and 5% reported two pads a day; 15% reported stool leakage or intestinal cramps. Sexual dysfunction was similar in both groups: 75% of the surgical group and 72.5% of the radiotherapy group reported erectile dysfunction. In the control group, 40% reported erectile dysfunction; 10% reported occasional stool leakage and none had changes regarding the overall treatment-related satisfaction. Seventy-eight percent of the RRP group and 77.5% of the RT group reported being happy respecting satisfaction with the accepted or chosen treatment, and affirmed that would choose it again. CONCLUSIONS: The assessment of treatment-related satisfaction determines the treatment tolerability. This study's results did not show any significant changes in this issue between both treatment modalities (p>0.05).

Intermittent androgen replacement for intense hypogonadism symptoms in castrated patients.

OBJECTIVES: For locally advanced prostate cancer management, medical androgen deprivation and surgical castration are alternatives. These hormonal treatments may cause a myriad of side effects, such as osteoporosis with increased risk of fractures, anemia, behavioral changes and lack of sexual interest. We evaluated the feasibility of intermittent androgen replacement in surgically castrated patients with significant side effects. METHODS: Five patients with advanced prostate cancer, ranging from 71 to 77 years of age (mean age = 74 years), surgically castrated for at least 3 years, with important symptoms of hypoandrogenism received testosterone replacement. They were followed with PSA and testosterone measurement every other month and bone scans every 6 months. RESULTS: For the first year all patients improved significantly, none of them showed PSA increase over 10 ng/ml. There was no evidence of local recurrence or distant disease. After 18 months, only one patient (20%) had a significant PSA increase, controlled by androgen withdrawal. No side effects or metastasis were observed. CONCLUSIONS: Hormonal replacement in patients that underwent castration seems to be feasible in improving intense symptoms associated to androgen deprivation. After 18 months, no evidence of recurrence was noted. It is an experimental alternative for highly symptomatic patients, but the short follow-up and the small number of patients cannot allow for definitive conclusions and should be studied further.

Tratamento da pielonefrite aguda com a pefloxacina / treatment of the acute pyelonephritis with pefloxacin

De 35 pacientes com pielonefrite aguda, inicialmente triados para participarem do estudo, 28 receberam tratamento com 400 mg de pefloxacina, uma quinolona fluorada, duas vezes ao dia, por um período de 10 dias. Todos os pacientes foram acompanhados, clínica e laboratorialmente, por cerca de 40 dias. O índice de sucesso, ou seja, cura clínica e laboratorial, foi de 96,3 por cento. Três pacientes (10,7 por cento) apresentaram reaçao adversa, caracterizada por intolerância gástrica. Em apenas um paciente foi necessária a suspensao da antibioticoterapia

Rectal endometriosis mimicking solitary rectal ulcer syndrome.

We report a unique case of rectal endometriosis mimicking solitary rectal ulcer syndrome. Several rectal biopsies were performed before the correct diagnosis of rectal endometriosis was made. The lesion had striking histologic features resembling colitis cystica profunda. The presence of two types of glands, i.e., colonic glands with marked depletion of mucin and endometrial glands, were readily apparent on immunohistochemical stain using anticarcinoembryonic antigen showing positive cytoplasmic stain for colonic glands but negative for endometrial glands. However, the distinction between colonic and endometrial glands was very difficult on hematoxylin-and-eosin-stained slides. Endometrial stroma was identified only in the sixth biopsy specimen. Although rare, rectal endometriosis should be considered in the differential diagnosis of solitary rectal ulcer syndrome.

Functional and histologic alterations in growing solitary rat kidney as result of extracorporeal shockwaves.

The long-term effects of extracorporeal shockwave lithotripsy (SWL) on children treated for renal calculi are unclear. To study the effects on the immature animal, we evaluated 31 Wistar white rats that underwent right nephrectomy at 30 days of age. At 40 days of age they were divided into three groups: a control group of 10 rats that received no shockwaves; Group I (9 rats) that received 1000 shockwaves at 16.0 kV, and Group II (12 animals) that received 1000 shock waves at 17.2 kV. Six months later at maturity (7 months and 10 days of age), the following parameters were measured: (1) body and renal weight; (2) blood lithium, sodium, potassium, and creatinine; (3) fractional lithium, sodium, and potassium excretion; and (4) clearances of lithium and creatinine. The kidneys were studied grossly and histologically. We found no significant changes in overall animal and renal growth between the post-SWL and control groups. However, there were significant changes in renal function. The animals in Groups I and II presented significant increases in blood potassium compared with the control group. Furthermore, the 1000 x 17.2 kV group showed permanent histologic renal changes, including red cells in Bowman's capsule and glomerular congestion. The disorders caused by SWL are compatible with hyporeninemic hypoaldosteronism, inappropriately low plasma renin activity, and aldosterone deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatic interstitial laser photocoagulation. An investigation of the relationship between acute thermal lesions and their sonographic images.

OBJECTIVES: The relationship between hepatic interstitial laser photocoagulation (ILP) lesions and their acute ultrasound images was evaluated. In addition, the natural history of ILP lesions in normal pig liver was documented. METHODS: Eighteen pigs underwent laparotomy and ultrasound-monitored ILP. In part 1 of the study, 12 pigs each had four separate exposures (1.50 W for 60, 100, 300, and 500 seconds) and were divided into four groups according to when they were killed (0, 3, 7, and 21 days). In part 2 of the study, six pigs each had two sequential exposures (1.60 W for 1,000 and then 500 seconds) at separate hepatic sites. Survival time was 3 days. Necropsy and histologic examination were performed in all animals. In 0- and 3-day survivors, actual thermal lesions were compared with "early" (immediately after ILP) and "late" (1 hour after ILP) ultrasound images. RESULTS: In the 300-, 500-, and 1,000-second exposures of parts 1 and 2, thermal lesions were overestimated or approximated by early ultrasound and were underestimated or approximated by late ultrasound. Analysis of variance showed statistically significant differences between thermal lesions and their early and late ultrasound images (F = 18.6, P < .001, no interactions). Time-growth characteristics of ILP lesions were reasonably consistent on ultrasound; exceptions were identifiable 200 seconds into the exposure. In part 2, ultrasound changes were minimal in five of six 500-second (second sequential) technically satisfactory exposures. Thermal lesions were seen at necropsy. All lesions healed by formation of granulation tissue and collagen. CONCLUSIONS: During ILP, early ultrasound images frequently overestimate actual thermal lesions. Ultrasound-monitored ILP of tumors may be most effective if, on early ultrasound, echogenic changes extend beyond the tumor margins. Late ultrasound images underestimate or approximate thermal lesions. Their value in clinical ILP should be investigated. It is unclear why ultrasound images of proven thermal lesions were not seen during 5 of 6 otherwise satisfactory 500-second ILP exposures performed immediately after 1,000-second exposures.

Effects of extracorporeal shockwave lithotripsy on renal growth and function: an animal model.

The long-term effects of extracorporeal shockwave lithotripsy (SWL) on children are unclear. At 40 days of age, with an average weight of 166 g, 34 Wistar white rats were divided into three groups: 9 rats (control group) received no shockwaves, 10 rats (Group 1) received 1000 shockwaves at 16.0 kV, and 15 animals (Group 2) received 1000 shockwaves at 17.2 kV. Six months later, at maturity, body weight; lithium and creatinine; fractional sodium, potassium, and lithium excretion; and the clearances of lithium and creatinine were measured, and the kidneys were studied grossly and histologically. We found no significant changes in overall animal or renal growth between the post-SWL groups and the control group. However, there were significant changes in renal function, mainly in Group 2; the animals of this group presented a significant increase in blood lithium and potassium, besides a significant decrease in the fractional potassium excretion compared with the control group. Furthermore, the animals in Group 2 showed permanent histologic renal changes, including red cells in Bowman's capsule and glomerular congestion. The disorders caused by SWL are compatible with hyporeninemic hypoaldosteronism, an inappropriate low plasma renin activity and aldosterone deficiency. We conclude that SWL does not affect either overall animal or renal growth but may cause permanent histologic damage and significant changes in renal function.

Sonographic changes during hepatic interstitial laser photocoagulation. An investigation of three optical fiber tips.

RATIONALE AND OBJECTIVES: Interstitial laser photocoagulation (ILP) destroys tumors thermally, using laser energy delivered from implanted optical fibers. The objectives of the study are to identify a fiber tip/delivered energy combination which produces lesions of useful size, visible on ultrasound (US) during ILP, and to compare ILP lesions and their US images. METHODS: Hepatic ILP was performed at laparotomy in six pigs, using three different fiber tips (cylindrical diffusing, spherical diffusing, plane-cut). US images were obtained during ILP, immediately after ("early" images), and before the animals were killed (2-2.5 hours, "late" images). Actual lesions were assessed histopathologically. RESULTS: Few US changes were seen around cylindrical diffusing and spherical diffusing tips until tip destruction. Plane-cut tips, at 1.5 to 2.0 W, produced prominent US images of the 1- to 2-cm thermal lesions. Early images tended to overestimate necrosis. Late images approximated necrosis. CONCLUSION: For US-controlled ILP, plane-cut tips are better than currently available cylindrical diffusing or spherical diffusing tips. Lesion image growth periods might enable control of lesion size. Further studies are needed to determine the consistency of the described relationship between lesion images and actual lesions.

Benign biliary cystadenoma.

Biliary cystadenomas and cystadenocarcinomas are rare. They arise in the liver or, less frequently, from the bile ducts. The characteristic appearance of these lesions in computed tomography and ultrasonography scans, as observed in a 26-year-old woman, is described. The features are similar to those of hydatid disease, and without travel history and the results of stool cultures and serologic tests differentiation may be impossible. Other considerations in the differential diagnosis are also discussed. Surgery is always indicated, because benign and malignant tumours in this area cannot be differentiated radiologically.

The normal esophagus.

The diagnosis of diseases affecting the esophagus frequently depends on a knowledge of the normal anatomy and histology of the esophagus. This paper describes and relates normal esophageal gross and histological features to pathological conditions affecting the esophagus. Special attention is given to the problems of diagnosis encountered when confronted with mucosal biopsy specimens from the gastroesophageal junction.

S-100 protein antibodies do not label normal salivary gland myoepithelium. Histogenetic implications for salivary gland tumors.

Neoplastically modified myoepithelial cells have a key role in developing the histologic characteristics of some salivary gland tumors. S-100 protein expressed in certain of these tumors is suggested to support this role, as the principal component in the human salivary gland reported to be S-100 protein-positive is myoepithelium. Confirmation of such an important aspect is required. Immunoperoxidase staining of parotid salivary gland shows considerably different patterns obtained with antibodies to S-100 protein, neuron-specific enolase, and neurofilaments compared with those for muscle-specific actin and cytokeratin 14; many more cells and their processes associated with acini and ducts are evident with the latter two antibodies. Double immunofluorescent staining with antibodies to either S-100 protein or neuron-specific enolase combined with muscle-specific actin does not reveal colocalization of these antigens in myoepithelial cells. The former localize only to nerve fibers adjacent to, but separate from, acini, and the latter only to myoepithelial cells. It is apparent that S-100 protein staining of the rich network of unmyelinated nerves in the interstitial tissues, evident ultrastructurally, has been misinterpreted as myoepithelium. This result has important implications for histogenetic classifications of salivary gland tumors.

Crohn's disease angiographically mimicking vascular malformation or neoplasm.

We report a young woman with lower gastrointestinal bleeding in whom, angiographically and surgically, the offending cecal lesion appeared to be a vascular malformation or neoplasm. Pathologically, Crohn's disease associated with extremely prominent vascularity was discovered to be responsible for this unusual appearance and the bleeding.

Primary adult lactose intolerance protects against development of inflammatory bowel disease.

We have compared the incidence of inflammatory bowel disease (IBD) to the prevalence of lactose malabsorption (LM) in several countries. Our observations indicate that IBD is rare where LM is highly prevalent. The correlation between incidence of Crohn's disease and LM is -0.93, p less than 0.01, the correlation between incidence of ulcerative colitis and LM is -0.89, p less than 0.01. We, therefore, propose that LM results in the formation of volatile fatty acids which may inhibit multiplication of potentially pathogenic organisms.