Identification of favorable subgroups for alternative anti-androgen therapy in castration-resistant prostate cancer.

Although alternative anti-androgen therapy (switching to secondary anti-androgens) is no longer recommended in the clinical guidelines of prostate cancer in light of the new hormonal and cytotoxic agents available, this therapy has proven beneficial for some patients with castration-resistant prostate cancer (CRPC). The objective of this study was to identify favorable subgroups for alternative anti-androgen therapy among CRPC patients. Eighty-eight consecutive CRPC patients treated with alternative anti-androgen therapy were included in this study. All patients were treated with bicalutamide in the initial maximum androgen blockade (MAB) and switched to flutamide in the subsequent alternative anti-androgen therapy, combined with a luteinizing hormone-releasing hormone analogue. Several clinical and pathological factors for predicting the prostate-specific antigen (PSA) decline and PSA progression-free survival (PSA-PFS) of alternative anti-androgen therapy were investigated. Of all patients, 45 (51.1%) patients showed ≥50% PSA decline. The median PSA-PFS was 7.5 months [95% confidence interval (CI), 5.7-10.3]. Notably, 15 (17.0%) patients had a PSA-PFS over 2 years. A multivariate analysis showed that ≥3 bone metastatic lesions and a duration <12 months of initial MAB were significant factors shortening the duration of PSA-PFS, with hazard ratios of 2.11 (95% CI, 1.23-3.62; P=0.007) and 2.08 (95% CI, 1.20-3.57; P=0.008), respectively. Patients without any of these factors had a median PSA-PFS of 22.8 months (95% CI, 6.7-48.8). The overall survival in patients with a ≥7.5-month PSA-PFS receiving alternative anti-androgen therapy was significantly longer than that of patients with a <7.5-month PSA-PFS (109.1 vs. 40.8 months; P<0.001). In conclusion, a longer duration of initial MAB and the absence of severe bone metastasis may predict a favorable response to alternative anti-androgen therapies in CRPC patients. Alternative anti-androgen therapy may still be beneficial for these patients, but this needs to be investigated further.

[Pelvic arteriovenous malformation : a case report].

A 70-year-old male presented with intermittent macroscopic hematuria. There was no history of previous trauma or pelvic operation. At first, we were unable to clarify the origin of the hematuria, but 3D computed tomography revealed an arteriovenous malformation (AVM) consisting of multiple feeding vessels arising from the bilateral, especially right, internal iliac artery. Treatment with transcatheter arterial embolization (TAE) with a combination of lipiodol and N-butyl-2-cyanoacrylate twice was effective. He needs to be followed up carefully for recurrence of AVM.

Mechanism of visual sensations experienced during pars plana vitrectomy under retrobulbar anesthesia.

PURPOSE: To investigate the visual sensations experienced by patients during vitrectomy under retrobulbar anesthesia. METHODS: 30 men and 45 women with a mean age of 65.3 +/- 10.6 years underwent vitrectomy under retrobulbar anesthesia for macular disease. 28 eyes had an idiopathic epiretinal membrane, 13 had an idiopathic macular hole, 32 had macular edema (17 diabetic retinopathy and 15 retinal vein occlusion), and 2 had submacular hemorrhage. 49 patients with nonmacular disease underwent similar vitrectomy procedures and were used for comparison. An interview was conducted with the patient about his/her visual sensations during and within 3 h of the vitrectomy. RESULTS: 70 (93.3%) of the patients reported seeing lights, 53 (70.7%) reported seeing colors, and 48 (64.0%) reported seeing movements or moving objects. Of the patients who reported seeing movements or moving objects, 44 (58.7%) reported seeing surgical instruments, and 5 (6.7%) saw the surgeon's fingers or hands. Patients with macular diseases tended to report more visual sensations than patients with nonmacular diseases. The patients' description and drawings appeared to arise mainly from the shadows cast by the intravitreal objects, and some patients perceived highly accurate details including the movements and color of the objects. CONCLUSIONS: Visual sensations are experienced by approximately 90% of the patients, and there may be a common mechanism by which patients perceive the intravitreal objects that are not focused on by the retina through the eye's optical system.

Patients' descriptions of visual sensations during pars plana vitrectomy under retrobulbar anesthesia.

PURPOSE: To investigate the visual sensations experienced by patients during vitrectomy under retrobulbar anesthesia. DESIGN: Cross-sectional study. METHODS: Fifty-six men and 45 women with a mean age of 62.2 +/- 11.9 years (range, 30 to 89 years) were studied. Twenty-two eyes had an idiopathic epiretinal membrane, 10 had an idiopathic macular hole, 29 had macular edema (16 resulting from diabetic retinopathy and 13 resulting from retinal vein occlusion), 14 had proliferative diabetic retinopathy, 13 had rhegmatogenous retinal detachment, four had proliferative vitreoretinopathy, and nine had other retinal diseases. The patients were questioned about their visual sensations during and within three hours after vitrectomy, which was performed under retrobulbar anesthesia using 2% lidocaine hydrochloride. Visual sensations perceived by the patients during surgery were reviewed. RESULTS: Ninety-one of the 101 patients experienced some type of visual sensation during the vitrectomy. Ninety-one (90.1%) patients reported seeing lights, 73 (72.3%) patients reported seeing one or more colors, and 57 (56.4%) patients reported seeing movements or moving objects. Of these latter 57 patients, 54 saw instruments and nine (8.9%) saw the surgeon's fingers or hands. In the 94 cases that had triamcinolone-assisted vitrectomy, 35 (37.2%) reported seeing many diffuse whirling black spots. Six patients (5.9%) found the visual experiences frightening. CONCLUSIONS: Visual sensations are experienced by approximately 90% of the patients despite full pain control, and surgeons should warn patients of these possibilities because they can be frightening. This should minimize patients' anxiety and stress during the surgery.

Successful pregnancy with intrauterine insemination using vasal sperm retrieved by electric stimulation.

OBJECTIVE: To determine the feasibility of electric stimulation applied to the epididymis or vas deferens to retrieve vasal sperm. DESIGN: Two case reports. SETTING: Assisted reproduction practice in a hospital. PATIENT(S): Two patients with retrograde ejaculation and severe asthenozoospermia. INTERVENTION(S): Pulse electric simulation was applied to the epididymis or vas deferens to retrieve sperm via a tube cannulated into the vas deferens. After diluting with culture medium, retrieved sperm were used for IUI. MAIN OUTCOME MEASURE(S): The volume of retrieved vasal fluid and motility parameters of the sperm, the achievement of pregnancy, and outcome of pregnancy. RESULT(S): In patient 1, the volumes of vasal fluids and numbers of sperm were 10-40 microL and 31.4-75.9 x 10(6), respectively, during two cycles. Sperm motility was 88.4%--93.2%. His wife became pregnant and was delivered of a healthy infant by IUI during the second cycle. In patient 2, 0.6 x 10(6) sperm with a motility of 70% were retrieved and used for IUI. However, his wife did not become pregnant. CONCLUSION(S): Electric vasal sperm retrieval is a feasible method for collecting sperm from the vas deferens in selected patients with male factor infertility.