A randomized split-face clinical trial of conventional vs indoor-daylight photodynamic therapy for the treatment of multiple actinic keratosis of the face and scalp and photoaging.

BACKGROUND: Recently, indoor daylight photodynamic therapy (idl-PDT) has been developed; however, its efficacy and tolerability remain to be assessed. OBJECTIVE: This is a not-inferiority study to compare treatment outcomes of cPDT with a red LED lamp and idlPDT with a polychromatic white LED lamp in adult patients affected by symmetrical AKs of face and/or scalp. METHODS: In this comparative, intra-patient, split-face, randomized clinical trial forty-three adult patients were enrolled. Two contralateral and symmetrical target areas of the face and/or scalp harboring at least 5 AKs were selected and randomized 1:1 to treatment with cPDT and idlPDT. The AKs number and cumulative area were assessed at baseline (T0). Efficacy and cosmetic outcome were assessed 3 months after treatment (T1). RESULTS: Total AKs number and area reduced significantly with both idlPDT (p < .0001) and cPDT (p < .0001) in comparison to baseline. cPDT was more painful (p < .0001) and induced a more severe inflammation (p < .0001). Twenty-nine patients (70.7%) gave their overall preference to idlPDT (p < .001). CONCLUSION: idlPDT may represent an alternative treatment protocol to cPDT for in-office treatment of AKs patients with better tolerability and a not inferior efficacy.

Human immunodeficiency virus (HIV) in developing countries.

The human immunodeficiency virus (HIV) is causing the most destructive epidemic of recent times, having been responsible for the deaths of more than 25 million people since it was first recognised in 1981. This global epidemic remains out of control, with reported figures for 2005 of 40 million people infected with HIV. During 2005 there were 4.9 million new infections, showing that transmission is not being prevented, and there were 3.1 million deaths from the acquired immunodeficiency syndrome (AIDS), reflecting the lack of a definitive cure and the limited access to suppressive antiretroviral treatment in the developing countries that are most severely affected. The current state of the epidemic and the response to date are here reviewed. Present and future opportunities for prevention, treatment and surveillance are discussed, with particular reference to progress towards an HIV vaccine, the expansion of the provision of highly active antiretroviral therapy, and the need to focus control programmes on HIV as an infectious disease, rather than as a development issue.

Estimating the number of people at risk for and living with HIV in China in 2005: methods and results.

BACKGROUND: No new estimates of HIV infection have been available for China since 2003. However, since then, data availability has increased dramatically. OBJECTIVES: To use internationally recommended methods to make new estimates of the number of people exposed to HIV in China, the number living with HIV, and the number of new HIV infections and deaths in 2005. METHODS: The UNAIDS Workbook method was adapted to meet the needs of China. Local data were used to estimate the size of each risk population and HIV prevalence by risk group for every prefecture. These estimates were combined into provincial and national estimates. The UNAIDS Estimates and Projections Package and Spectrum were used to derive estimates of incidence and mortality from prevalence data, taking into account treatment. RESULTS: It was estimated that 650,000 people are living with HIV/AIDS in China (range 540,000-760,000), of whom 70,000 were newly infected in 2005 (range 60,000-80,000). Between 20,000 and 30,000 people are estimated to have died of HIV in 2005. The new estimate compares with an estimate of 840,000 people living with HIV/AIDS in 2003 (range 650,000-1,020,000). The estimated number of infected former plasma donors fell from 199,000 to 55,000. Infections remain concentrated among drug injectors, those buying and selling sex, and men who have sex with men. CONCLUSION: The new estimates are based on a much wider range of surveillance data as well as mass screening of former plasma donors, and are made at the prefecture level. More limited data from high prevalence provincial surveillance sites led to past estimates that now seem too high. New infections outpace death, and the HIV epidemic in China is still growing.

Polymeric nano/microcapsules of liquid perfluorocarbons for ultrasonic imaging: physical characterization.

Ultrasonic imaging is a widely available, noninvasive, and cost-effective diagnostic modality, but vessels smaller than 200 mum in diameter are impossible to visualize. Commercial ultrasound contrast agents (UCAs), consisting of encapsulated gas microbubbles injected intravenously, enable only a qualitative visualization of the microvascularization for a short period of time since they are rather unstable. In a strategy to develop more stable UCAs, we designed a process to obtain nano/microcapsules with a single core of liquid perfluorocarbons within a biodegradable polymeric shell of homogeneous thickness. The polymer shell should improve the stability of the capsules as compared to UCAs stabilized by a monomolecular layer, while the acoustic impedance of the perfluorocarbons should ensure their echogenicity. These capsules have been optimized to encapsulate several liquid perfluorocarbons: perfluorohexane, perfluorodecalin, and perfluorooctyl bromide. The system is rather versatile: the mean size of the capsules can be adjusted between 70 nm and 25 microm and the thickness-to-radius ratio (T/R) can be easily modulated by simply modifying the polymer-to-perfluorocarbon ratio. T/R does not depend on the size of the capsules and is between 0.2 and 0.6. The dependence of the echogenic properties of the capsules with their size and their T/R has yet to be studied experimentally before this system can be evaluated in vivo.

Basing policy on evidence: low HIV, STIs, and risk behaviour in Dili, East Timor argue for more focused interventions.

BACKGROUND: East Timor is a newly independent, poor nation with many internally displaced people and foreign peace keeping forces. Similarities with Cambodia, which now has Asia's worst HIV epidemic, caused donors to earmark money for HIV prevention in East Timor, but no data were available to plan appropriate programmes. OBJECTIVES: To determine levels of infection with HIV and other sexually transmitted infections (STIs) and associated risk behaviours in Dili, East Timor, in order to guide resource allocation and appropriate prevention and care strategies. METHODS: In mid-2003, a cross sectional survey of female sex workers, men who have sex with men (MSM), taxi drivers, and soldiers was conducted. Participants provided biological specimens and all answered structured questionnaires. RESULTS: HIV prevalence was 3% among female sex workers (3/100), 0.9% among MSM (1/110), and zero in the other groups. All the HIV infected sex workers reported sex with foreign clients. Partner turnover reported by all groups was among the lowest in Asia, so was condom use. Access to basic HIV prevention services, including condoms and STI services, was extremely low in all groups. CONCLUSIONS: A few sex workers are infected with HIV in East Timor, but the virus is not circulating widely among their clients, and sexual networking is limited. The risk of a generalised HIV epidemic in East Timor is minimal. HIV can be contained by the provision of basic services to the small minority of the population at highest risk, preserving resources for other health and development needs.

HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia.

OBJECTIVES: To establish the prevalence of HIV, syphilis, and sexual risk behaviour among three groups of men who have sex with men in Jakarta, Indonesia, and to investigate sexual links between these men and broader heterosexual populations. METHODS: Anonymous, cross sectional surveys among community recruited transgender and male sex workers and self recognised men who have sex with men (MSM) were undertaken in mid-2002 in Jakarta, Indonesia. Places where transgender and male sex workers sell sex and where men go to meet non-commercial male sex partners were mapped. Probability samples were selected for the sex worker populations, while a mixed probability and convenience sample was drawn for self recognised MSM. Blood was drawn for HIV and syphilis serology and community interviewers administered a standardised questionnaire. RESULTS: HIV prevalence was 22% among transgender sex workers, 3.6% among male sex workers, and 2.5% among self recognised MSM, and syphilis prevalence was 19.3%, 2.0% and 1.1% respectively. 59.3% of transgender sex workers and 64.8% of male sex workers reported recent unprotected anal intercourse with clients, and 53.1% of other MSM reported unprotected anal sex with male partners. Some 54.4% of male sex workers and 18.3% of other MSM reported female partners in the preceding year. CONCLUSION: HIV has reached substantial levels among transgender sex workers, and is not negligible in other MSM groups. Risk behaviour is high in all subpopulations, and bisexual behaviour is common, meaning the threat of a wider epidemic is substantial. Prevention programmes targeting male-male sex are needed to reduce this threat.

Age at first sex: understanding recent trends in African demographic surveys.

OBJECTIVES: To describe recent trends in age at first sex in African countries, identifying and making due allowances for a variety of common reporting errors. METHODS: Demographic and Health Surveys (DHS) data from six African countries conducting three or more surveys since 1985 were analysed using survival analysis techniques, combining information on virginity status and retrospective reporting of age at first sex. Hazard analysis was used to separate the effects of reporting error and compositional change and to estimate true changes in sexual debut over time. A multistate life table analysis incorporating transition to first marriage allowed cohorts to be classified according to person years spent as virgins, as sexually active unmarried, and married. RESULTS: Intersurvey comparisons generally suggested a slow secular rise in age at first sex. However, tracing birth cohorts between surveys revealed inconsistencies--median ages reported by female members of a birth cohort in their teens were generally higher than those reported when they reached their twenties, even when allowing for residence and education changes--probably a result of young, sexually active women denying they had ever had sex. Male birth cohorts tend to display the opposite kind of bias. CONCLUSIONS: Uganda, Kenya, and Ghana have experienced a more pronounced and unambiguous decline in premarital sexual activity than Tanzania, Zambia, and Zimbabwe, with statistically significant increases in age at first sex. In addition, Uganda has maintained a very short interval between onset of sexual activity and marriage for both sexes.

[Prostate diseases of occupational origin]. / Patologia della prostata ad eziologia professionale.

BACKGROUND: Prostatitis is a poorly defined group of syndromes with multiple causes. Chronic prostatitis may be non-bacterial and due to intrapelvic venous congestion. If the causes persist and adequate treatment is not given, the congestive syndrome may become chronic and interfere with fertility with severe biological damage. OBJECTIVES: Little is known in the field of occupational medicine (as regards clinical and pathogenic aspects) and, on the other hand, little is known by urologists (as far as the aetiological aspects are concerned), the prostatitis-like syndrome due to intrapelvic congestion has been defined in recent studies as non-bacterial prostatitis or prostatodynia, but we prefer to call it "prostatosis". The results of a close cooperation between urologists and occupational physicians are reported. METHODS: Patients with non-bacterial chronic prostatosis were evaluated from the urological and occupational point of view and all the etiological factors of both occupational and non occupational origin were considered. When occupational factors are a conditio sine qua non prostatosis is considered an occupational disease. RESULTS: Two cases of "occupational prostatosis" are described where driving vehicles and a sedentary employment played the most important etiological part. Many other similar cases were observed. CONCLUSIONS: Close cooperation between urologists and occupational physicians makes it possible to complete clinical diagnosis with a careful evaluation of all the factors of both occupational and non-occupational origin and allows the identification of those cases that must be defined as occupational diseases. Prostatosis due to venous congestion deserves the attention of occupational physicians since the distinction between occupational and non-occupational origin must be found both in individual cases and in groups of workers subject to the same factors. Moreover, the present state of knowledge is enough to take preventive measures aimed at reducing the frequency of new cases and avoiding the deterioration of existing cases. It is also possible that some cases of pseudo-cystitis in women might be the result of intrapelvic venous congestion of occupational origin. Anatomical and physiological non-occupational factors as well as certain habits of life style can favor intrapelvic venous congestion, producing conditions of hypersusceptibility to occupational factors and could sometimes cause the disease even in the absence of causes connected to work.

[Erectile disfunction after non nerve-sparing radical pelvic surgery]. / Disfunzione erettiva da chirurgia pelvica demolitiva non nerve-sparing.

BACKGROUND: The patients who undergo radical pelvic surgery often found that sexual function is impaired. In this research hypothesis, we evaluated the efficacy of alternative therapy to conventional PGE 1 injections, such as the association of Sildenafil and L-Arginine. This association in based on the principle that L-Arginine, the precursor of nitric oxide, improves the effect of Sildenafil, which is effective in the presence of nitric oxide. METHODS: The experimental plan was to make a comparative study of 2 random groups of patients selected from those undergoing radical cystectomies and prostatectomies over the past three years. 116 patients were illegible (64 prostatectomies and 52 cystectomies). The fìrst random group was treated with Sildenafil alone and the second with Sildenafil and L-Arginine. The efficacy of treatment was evaluated by the Buckling test (pressure threshold of cavernous flexation at penile axial rigidity) once-after ambulatorial administration and then by telephonic interview (subjective evaluation) after home administration. RESULTS: The starter dose was 50 mg and was inefficient in both groups (Buckling test between 0 and 250). 100-mg doses gave significant results (Buckling test > 500) in both groups, especially the second. Cardiopathic patients, diabetics and patients with retinal disorders were excluded from the study. The mean age of patients was 65 years. CONCLUSIONS: The resumption of relatively satisfactory sexual activity was demonstrated using non-invasive pharmacological treatment.

[Erectile dysfunction after non-nerve sparing radical pelvic surgery. Therapeutical experience with sildenafil and L-arginine evaluated by Buckling test]. / Disfunzione erettiva da chirurgia pelvica demolitiva non nerve-sparing. Esperienza terapeutica con sildenafil e L-Aginina valutata con Buckling test.

BACKGROUND: Patients undergoing radical pelvic floor surgery are often find that sexual function is impaired. In this research hypothesis, we evaluated the efficacy of alternative therapy to conventional PGE 1 injections, such as the association of Sildenafil and L-Arginine. This association is based on the principle that L-Arginine, the precursor of nitric oxide, improves the effect of Sildenafil, which is effective in the presence of nitric oxide. METHODS: The experimental plan was to make a comparative study between 2 random groups of patients selected from those undergoing radical cystectomies and prostatectomies over the past three years. 116 patients were eligible (64 prostatectomies and 52 cystectomies). The first random group was treated with Sildenafil alone and the second with Sildenafil and L-Arginine. The efficacy of treatment was evaluated using the Buckling test (pressure threshold of cavernous flexation at penile axial rigidity) once after ambulatorial administration and then by telephone interview (subjective evaluation) after administration at domicile. RESULTS: The starter dose was 50 mg and was inefficient in both groups (Buckling test between 0 and 250). 100-mg doses gave significant results (Buckling test >500) in both groups, especially the second. Cardiopathic patients, diabetics and patients with retinal disorders or who were unmotivated were excluded from the study. The mean age of patients was 65. CONCLUSIONS: The resumption of relatively satisfactory sexual activity was demonstrated using non-invasive pharmacological treatment.

HIV surveillance among female sex workers.

Female sex workers are at high risk for infection with HIV, and their clients may act as a bridging population by spreading HIV to the general population. Comprehensive HIV surveillance among sex workers includes surveillance of HIV infection, of sexually transmitted infections and of risk behavior. Surveillance of HIV infection among sex workers is critical for countries with low-level or concentrated HIV epidemics, and can help in monitoring the response to the HIV epidemic in countries with a generalized epidemic. Sex workers are a vulnerable population, and particular attention needs to be paid to human rights issues including consent, confidentiality and stigma. Collaborations with key players in the local sex work scene--sex workers themselves in the first place--and alliances with salient institutions and groups are key to the success of surveillance among sex workers. Surveillance activities should have a strong link to interventions targeted at sex workers. Surveillance for HIV infection among sex workers can be institution- or community-based. Institutional settings include screening programs for registered sex workers, of sexually transmitted diseases clinics, and re-education camps. Specific sources of bias need to be considered in different settings, and must be measured--through the collection of socio-demographic and behavioral data--to allow a correct interpretation of prevalence data and time trends. Community-based HIV infection surveillance can be conducted in a probability sample of the sex worker population, thereby reducing selection bias. This requires the mapping of sex workers' contact venues, and drawing a random sample from the resulting sampling frame.

Extracorporeal shockwave lithotripsy in patients treated with antithrombotic agents.

PATIENTS AND METHODS: Between January 1996 and December 1999, 749 patients underwent electromagnetic SWL. Among them, 23 patients, 19 with renal and 4 with ureteral stones, were receiving antithrombotic drugs (aspirin, ticlopidine, dipyridamole). According to the cardiologist and hematologist, we divided these patients into two groups: Group 1 had a low thromboembolic risk (previous myocardial infarction), and Group 2 had a high thromboembolic risk (aortocoronary bypass, atrial fibrillation, cerebrovascular disease, peripheral occlusive arterial disease). Group 1 patients discontinued their antiplatelet therapy 8 days prior to SWL to permit a sufficient number of functioning platelets to remain. Group 2 patients suspended antiplatelet therapy, and unfractioned heparin 5000 IU tid (8 a.m., 4 p.m., and 12 p.m.) was administered for the 8 days prior to SWL. On the ninth day of withdrawal, SWL was performed in all patients. Close follow-up was performed during the postoperative period (hemoglobin, hematocrit, kidney ultrasonography, plain abdominal film). The antithrombotic therapy was restored in all patients within 10 to 14 days of withdrawal. RESULTS: Hematomas and thromboembolic events were not observed. At 3 months' follow-up, 14 patients (61%) were stone free, 3 (13%) had <4-mm fragments, and 6 (26%) had >4-mm residual fragments. CONCLUSION: Our schedules for the suspension or substitution of antithrombotic therapy, although tested in a small number of patients, allowed us to perform SWL without hemorrhagic or thromboembolic complications.

Immunohistochemical and quantitative study of mast cells in La Peyronie's disease.

OBJECTIVE: In order to investigate the possible association between mast cells (MCs) and the fibrous plaque of La Peyronie's disease, the number of MCs in normal penile tissue and in the fibrous plaque was determined. METHODS: The control group consisted of 5 total and 3 partial penectomies with no fibrotic lesions, while the study group consisted of 23 excisional biopsies from cases of La Peyronie's disease dating back to at least 2 years earlier and with no signs of activity. The biopsies included tissues from the tunica albuginea (TA), the areolar tissue (Br) between the tunica and the erectile tissue (CC) and from the latter. The number of MCs was counted with the aid of an image analysis program following staining the antibody antitryptase. RESULTS: In the cases of La Peyronie's disease the number of MCs/mm(2) was significantly higher in the TA and Br but lower in the CC. The MCs were related to fibroblasts and vasculonervous channels in the TA, and were concentrated around the fibrous plaques and granulation tissue between the TA and BR and between the latter and the CC. CONCLUSION: Our data indicate that MCs have a role in the genesis of the fibrous plaque in the TA and in the persistent inflammation in the Br. Medical treatment aimed at repressing MC activation and proliferation locally might be useful in La Peyronie's disease.

Increase in the prevalence of symptomatic upper urinary tract stones during the last ten years.

PURPOSE: In industrialized countries the prevalence of upper urinary tract stones has continually increased during the 20th century, but there are considerable differences between countries and also within the same country. To study whether there is still an increase in the frequency of renal stones, an investigation was undertaken to determine the prevalence of stone formers in a village near Milan, Italy, during two time periods, with an interval of 12 years. MATERIALS AND METHODS: Questionnaires were administered in 1986 and 1998 to all adult (age >25 years) occupants of two random samples of households in the village. Participants were asked whether they had experienced a kidney stone during their lifetime. RESULTS: The overall prevalence of stone formers among males was 6.8% in 1986 and 10.1% in 1998; that among females was 4.9% in 1986 and 5.8% in 1998. In all age classes, the respondents in the 1998 survey more frequently reported a history of stones than in 1986, but the prevalence of renal stones was significantly higher in 1998 than in 1986 only among males aged 31-40 and 51-60 years. The yearly incidence was estimated at 0.4%, with 0.6 and 0.18% in men and women, respectively. CONCLUSIONS: This marked increase in renal stones could be the result of environmental factors such as dietary habits and lifestyle, in particular the influence of an increased consumption of animal protein should be considered.