Updated European Consensus Statement on diagnosis and treatment of adult ADHD.

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.

Women with low libido: correlation of decreased androgen levels with female sexual function index.

The aim of the present study was to investigate a possible correlation between decreased androgen levels and female sexual function index (FSFI) in women with low libido and compare these findings with normal age-matched subjects. In total, 20 premenopausal women with low libido (mean age 36.7; range 24-51 y) and 20 postmenopausal women with low libido (mean age 54; 45-70 y), and 20 premenopausal healthy women (mean age 32.2; range 21-51 y) and 20 postmenopausal healthy women (mean age 53.5; range 48-60 y) as controls were enrolled in the current study. Women with low libido had symptoms for at least 6 months and were in stable relationships. All premenopausal patients had regular menstrual cycles and all postmenopausal patients and controls were on estrogen replacement therapy. None of the patients were taking birth control pills, corticosteroids or had a history of chronic medical illnesses. All completed the FSFI and Beck's Depression Inventory (BDI) questionnaires. Hormones measured included: cortisol; T3, T4 and TSH; estradiol; total and free testosterone; dehydroepiandrosterone sulfate (DHEA-S); sex hormone binding globulin (SHBG). We performed statistical analysis by parametric and nonparametric comparisons and correlations, as appropriate. We found significant differences between the women with low libido and the controls in total testosterone, free testosterone and DHEA-S levels and full-scale FSFI score for both pre- and postmenopausal women (P<0.05). In addition, decreased total testosterone, free testosterone and DHEA-S levels positively correlated with full-scale FSFI score and FSFI-desire, FSFI-arousal, FSFI-lubrication and FSFI-orgasm scores (P<0.05). Our data suggest that women with low libido have lower androgen levels compared to age-matched normal control groups and their decreased androgen levels correlate positively with female sexual function index domains.

Ophthalmic manifestations of Gilles de la Tourette syndrome.

PURPOSE: To present the ophthalmic manifestations of patients with Gilles de la Tourette syndrome (GTS). METHODS: Sixteen children (average age 11.5 years), with multiple motor and vocal tics, with a diagnosis of GTS, were included in this study. All underwent a full ophthalmological examination. RESULTS: All patients except one amblyopic case had best corrected visual acuity of 20/20 in both eyes. Eleven patients (68%) had eye tics; nine had clonic blepharospasm and two had involuntary gaze deviations. Four cooperative children underwent visual field examination with Goldmann perimeter, no visual field defect was detected. Three patients had strabismus (one alternating exotropia and two partially accommodative esotropia). Anterior and posterior segment examinations were within normal limits. The symptoms improved considerably in 82% of the patients with eye tics on treatment with a neuroleptic (pimozide). CONCLUSIONS: Blepharospasm was the most common ophthalmic manifestation of GTS. Ophthalmologists should consider a diagnosis of GTS in the absence of any organic eye pathology that may cause blepharospasm and refer these cases to a child psychiatrist. These children benefit from a treatment with neuroleptics under the supervision of a psychiatrist.

Comparison of Gleason scores from sextant prostate biopsies and radical prostatectomy specimens.

OBJECTIVES: We compared the Gleason scores obtained from sextant prostate biopsy and radical prostatectomy (RP) specimens in patients with localized prostate cancer. PATIENTS AND METHODS: Sixty-one patients having a clinical diagnosis of localized prostate cancer underwent needle biopsy under transrectal ultrasonography (TRUS) and RP. Grading and staging were assigned based on Gleason scores and the TNM system, respectively. RESULTS: Mean patient age was 65.5 +/- 13.43 years and mean PSA level was 14.69 +/- 3.95. Mean Gleason score for prostate biopsy and RP specimen were 5.85 +/- 0.7 and 6.34 +/- 1.44, respectively. With respect to clinical stage, there were 20 patients in stage 1 and 41 patients in stage 2 prostate cancer. Comparing the Gleason scores, the biopsy score was lower in 26 (42.26%) and higher than RP specimens in 7 (11.84%) cases, and there was agreement between the biopsy and RP specimens in 28 (45.9%) patients. The difference between the two Gleason scores was +/- 1 for 18 patients (29.5%) and +/- 2 or more for 17 patients (27.86%). CONCLUSION: In our study, high Gleason score biopsies with elevated PSA level (>10 ng/ml) were risk factors for extraprostatic extension, and we demonstrated that Gleason scores were significantly correlated with seminal vesicle and lymph node invasion (p < 0.05). The Gleason scores of biopsy and RP specimens agreed with 45.9% of TRUS-guided sextant prostate biopsies, and this ratio was 91.1% in moderately differentiated tumors

Use of new automated biopsy device for percutaneous testicular biopsy. A preliminary clinical experience.

Testicular biopsy is indicated in the azoospermic patients to determine if the cause of azoospermia is ductal obstruction or testicular pathology and in certain patients who have severe oligozoospermia. The technique traditionally used is an open testicular biopsy. New Automated Biopsy Device has been used successfully for renal diseases. This instrument is now used by the urologist for transrectal prostate biopsy. The aim of this study was to evaluate whether percutaneous testicular needle biopsy with new automated device can replace open testis biopsy or not. 90 testes of 48 patients between 22 and 43 years olf underwent percutaneous testicular biopsy with a new 18-gauge automated biopsy device. Adequate samples were recovered from 90% cases (average 24.77 tubule sections per testis). When needle biopsy and open biopsy samples were compared in 30 testes of 15 patients, complete agreement was obtained in 93%, whereas slight differences in 7%. These results show that percutaneous needle biopsy with new automated systems is cost-effective, quick, safe, repeatable, relatively painless and effective way to obtain largest possible cores through full cut technique. No serious complications were encountered during or after the procedure. The diagnosis were found to be comparable to those obtained by open biopsy. For these reasons, it is concluded that this new technique can replace the open biopsy.

The role of ESWL in the treatment of calculi with anomalous kidneys.

OBJECTIVE: To evaluate the efficacy of Extracorporeal shock wave lithotripsy (ESWL) in renal anomalies. MATERIAL AND METHODS: From 1991 to May 1995. 53 patients with calculi in anomalous kidneys presented to our clinic for treatment with ESWL. Average patient age was 39 years, a range of 6-66 years. These patients (32 male and 21 female) underwent ESWL treatments. ESWL was performed in 27 patients with urolithiasis in duplex system, 18 with horse-shoe kidneys, 4 with unilateral renal agenesis, 2 with pelvic ectopic kidneys, 1 with sigmoid kidney and 1 with L-shaped kidney. RESULTS: Among patients who completed ESWL the rate free of stones was 60.4% and the rate of clinically insignificant residual fragments was 30.2%. No sign of stone disintegration was observed in 2 patients. They underwent open surgery. The shock waves per therapy varied between 811 and 18,101. Double-J stents were placed in 13 patients. CONCLUSION: Most patients with calculi in anomalous kidneys can be managed primarily with ESWL.

Systemic absorption of gentamicin in penile prosthesis operations.

Irrigation with antibiotic solutions is frequently used in penile prosthesis surgery to avoid infection. We carried out a prospective study to determine the degree of absorption of gentamicin after intracavernous irrigation in 10 patients who underwent penile implantation surgery. All obtained values were below the toxic level of 10 micrograms/ml and decreased gradually within a few hours. We concluded that highly concentrated gentamicin solutions could be used with safety for intracavernous irrigation.