[Potential cognitive alterations after treatment of benign prostate syndrome. Investigations on transurethral electroresection and 180 W GreenLight XPS laser therapy]. / Potenzielle kognitive Veränderungen nach Behandlung des benignen Prostatasyndroms. Untersuchungen zu transurethraler Elektroresektion oder 180-Watt-XPS-Greenlight-Laserung.

OBJECTIVE: The study was carried out to detect possible changes in cognition after transurethral resection of the prostate (TURP) and 180 W GreenLight-XPS laser treatment of the prostate. METHODS: Cognitive capacity was assessed by the mini-mental state examination (MMSE) and the clock test preoperatively and on postoperative day 2 in addition to documentation of clinical parameters, such as patient age, prostate size, duration of surgery, comorbidities, co-medications and alterations in hemoglobin (Hb) and sodium concentrations. RESULTS: Patients treated with TURP (n = 88) and 180 W GreenLight-XPS laser treatment of the prostate (n = 114) were comparable regarding age, prostate size and duration of surgery. Baseline characteristics of the patients treated by laser showed an increased potential for postoperative cognitive changes with an average of 3.8 comorbidities (TURP 3.11, p = 0.005) and were using an average of 6.79 multiple medications (TURP 5.24, p < 0.001); however, neither the MMSE nor the clock test demonstrated a decrease in the average postoperative score (difference between postoperative and preoperative MMSE + 0.6 ± 1.6 for 180 W GreenLight-XPS laser treatment and + 0.6 ± 1.6 for TURP, p = 0.944; difference postoperative and preoperative clock test + 0.43 ± 1.44 for 180 W GreenLight-XPS laser treatment and 0.13 ± 1.17 for TURP, p = 0.097). Neither postoperative hemoglobin nor sodium concentrations, as safety relevant parameters, demonstrated clinically relevant changes. The differences between the surgical procedures were not statistically significant. DISCUSSION: Neither 180 W GreenLight-XPS laser treatment of the prostate nor TURP demonstrated changes in cognition by comparing the preoperative MMSE and the clock test scores. In this study, the baseline characteristics of laser-treated patients showed a higher number of comorbidities and a higher use of medications, particular those with anticholinergic potency; therefore, 180 W GreenLight-XPS laser treatment of the prostate appears particularly safe for elderly patients.

[How Useful is a Geriatric Assessment Prior or Urological Surgery with Regard to Cognitive Changes?]. / Wie hilfreich ist ein geriatrisches Assessment vor urologischen Operationen im Hinblick auf kognitive Veränderungen?

OBJECTIVE: Detection of changes in cognition after transurethral resection (TURP) or 180-Watt green-light XPS laser treatment (GLL) of the prostate is required by the German "Krankenhausbedarfsplan" which demands an interdisciplinary dialogue including special aspects of the operating discipline. This has as yet not been investigated in Germany or in Europe. METHODS: Assessments of the cognitive capacity were made by application of the "Mini Mental State Examination" and the "Uhrentest" preoperatively and on postoperative day 2 in addition to documentation of clinical parameters such as patient age, prostate size, duration of surgery, comorbidities, co-medication, changes in haemoglobin and sodium. RESULTS: Patients treated with transurethral resection (n=88) or GLL (n=114) were comparable regarding age, prostate size and operative time. Baseline characteristics of the patients who would be treated with laser showed an increased potential for postoperative cognitive changes: they had an average of 3.8 comorbidities (TURP: 3.11, p=0.005) and were to a greater extent using multiple medications 6.79 (TURP: 5.24, p<0.001). However neither the MMSE nor Uhrentest demonstrated a decrease in the average postoperative score (difference post-preop. MMSE+0.6±1.6 for the GLL and+0.6±1.6 for TURP, p=0.944; difference post- and preoperative Uhrentest+0.43±1.44 for the GLL and 0.13±1.17 for the TURP, p=0.097). Neither the postoperative haemoglobin nor the postoperative sodium, as safety-relevant parameters, demonstrated clinically relevant changes. The differences between the surgical procedures were not statistically significant. 28.6% of the patients with a preoperatively impaired cognition measured by an MMSE-score of≤23.7 incurred a further decline of their cognitive capability in comparison with patients without preoperative cognitive impairment with a further decline in 19.2%. CONCLUSIONS: Neither the GLL nor transurethral prostate resection demonstrated changes in cognition by comparing the preoperative Mini Mental State Examination or the Uhrentest. In this study, the baseline characteristics of lasered patients showed a higher number of comorbidities and a higher use of medication, in particular, with anticholinergic potency. Patients with a preoperatively impaired cognition had an increased risk of further worsening of their cognitive capabilities and should be treated carefully.

Studies of echovirus-12 in volunteers: determination of minimal infectious dose and the effect of previous infection on infectious dose.

A two-part study of echovirus-12 was done in volunteers. In the first part the human infectious dose of the virus was determined in 149 healthy adults with undetectable serum antibody, each of whom drank 0-330,000 plaque-forming units (pfu) of virus in 100 ml of nonchlorinated water. Infection was defined as fecal shedding of virus or significant (fourfold or greater) increases in serum antibody titer. The HID50 (i.e., the dose required for infection of 50% of the volunteers) was 919 pfu. Through statistical analysis of the data by probit transformation, a 1% human-infectious dose of 17 pfu was predicted. These results were used in the second portion of the study to determine the effect of previous infection on the infectious dose. Previously infected volunteers (those with neutralizing serum antibody) were given a dose of echovirus-12 (1,500 pfu) that had been found to infect 60% of persons with undetectable serum antibody. The presence of serum antibody caused no significant change in the percentage of volunteers infected by this dose. Furthermore, the concentration of serum antibody did not affect the rate of infection or the duration of viral shedding. These results indicate that previous infection with echovirus-12 does not provide lasting protection against reinfection.