Relationship between urodynamic findings and sexual function in multiple sclerosis patients with lower urinary tract dysfunction.

BACKGROUND AND PURPOSE: Sexual dysfunction (SD) is prevalent in multiple sclerosis (MS) patients and affects quality of life. Furthermore, lower urinary tract dysfunction (LUTD) is common in MS patients. Our aim was to determine the relationship between urodynamic findings and SD in a cohort of MS patients with LUTD. METHODS: From January 2011 to September 2013, 135 consecutive patients with MS in remission phase and LUTD underwent a first urodynamic examination, according to the International Continence Society criteria. Neurological impairment was assessed using the Expanded Disability Status Scale and SD was investigated with the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF-15). Multivariate logistic regression analysis was performed to identify predictors of female SD (FSFI < 26.55) or moderate-severe erectile dysfunction (ED) (IIEF-EF ≤ 16), after adjusting for confounding factors including urodynamic findings. RESULTS: Subjects with maximum detrusor pressure during involuntary detrusor contraction (PdetmaxIDC) ≥20.0 cmH2 O had lower IIEF-EF, IIEF overall satisfaction (IIEF-OS), FSFI-Arousal, FSFI-Lubrication and FSFI-Orgasm. Subjects with maximum cystometric capacity (MCC) ≥135 ml had higher IIEF-EF, intercourse satisfaction (IIEF-IS), orgasmic function (IIEF-OF), sexual desire (IIEF-SD), FSFI-Arousal, FSFI-Lubrication, FSFI-Orgasm, FSFI-Satisfaction and FSFI-Pain. On multivariate logistic regression analysis, PdetmaxIDC ≥20 cmH2 O [odds ratio (OR) 6.7; P < 0.05] and MCC <135 ml (OR 6.80; P < 0.05) were predictors of moderate-severe ED. In a model including all previous variables, compliance ≤3 ml/cmH2 O was an independent predictor of moderate-severe ED (OR 14.49; P < 0.01). No relationship was found between the previous variables and FSFI <26.55. CONCLUSIONS: Neurogenic bladder is associated with SD in MS patients. The presence of PdetmaxIDC ≥20 cmH2 O, MCC <135 ml and compliance ≤3 ml/cmH2 O may significantly predict the presence of moderate-severe ED.

Combination of intralesional verapamil and oral antioxidants for Peyronie's disease: a prospective, randomised controlled study.

The aim of this study was to evaluate the efficacy of the association of intralesional verapamil (ILV) injection with oral antioxidants compared with ILV monotherapy in patients with early onset of Peyronie's disease (PD) at 12-week follow-up. Group A (n = 52) received ILV 10 mg weekly for 12 weeks, while group B (n = 53) received ILV 10 mg weekly for 12 weeks + antioxidants orally one tablet once a day for 3 months. The main efficacy outcomes were the change in plaque size (PS), penile curvature (PC), visual analogue score (VAS), IIEF-15 and IIEF-15 subdomains. Both groups showed significant improvement from baseline to week 12 relative to PS and PC, while group B also in IIEF-15 score (mean difference: 5.51, P < 0.01) and VAS (mean difference: -2.71, P < 0.01). No significant differences were observed between both groups in PS and PC. Finally, both groups showed significant increase in orgasmic function (IIEF-OF) and overall satisfaction (IIEF-OS), while group B showed significant improvement also in intercourse satisfaction (IIEF-IS). Significant differences were found relative to IIEF-OF, IIEF-IS, IIEF-OS and VAS scores in the group B compared with group A. Patients affected by PD may benefit from combination treatment with ILV and oral antioxidants thanks to the improvement in IIEF-OF, IIEF-IS and IIEF-OS at 12 weeks.

Expression of CD7, CD20 and CDX-2 in a secondary signet-ring cell tumor of the prostate: a case report.

As is well-known, signet ring cell carcinoma (SRCC) rarely appears as a histological finding in the prostatic tissue. Nevertheless, a differentiation should be made between a primary tumor and a metastatic disease. We describe the case of a 52-year-old man with lower urinary tract symptoms, serum total PSA of 0.2 ng/ml, elevated serum CEA and CA19-9 levels. Two years prior to presentation, he underwent total gastrectomy with histological findings indicating poor differentiated adenocarcinoma with signet-ring cell. A palpable nodule was found on digital rectal examination and for this reason he underwent 12-core transperineal prostate biopsy with a diagnosis of poor differentiated adenocarcinoma with signet-ring cell and adipose tissue infiltration. Immunohistochemical examinations revealed positivity for PAS, CK7 and CDX-2, focal positivity for CK20 and negativity for PSA and PSAP. The diagnosis of a prostatic secondary SRCC was possible given the positivity to CK7, CDX-2, focal positivity to CK20 and negativity to PSA.

[The Resident Assessment Instrument Home care: what primary care physician needs to know]. / Le Resident Assessment Instrument-Home-Care (RAI-Domicile): ce que le médecin de premier recours doit savoir.

Following the decision of the Swiss Association for Home Care Services to adopt the Resident Assessment Instrument (RAI), the RAI-Home Care is gradually implemented in all home care services in Switzerland. Based on a comprehensive geriatric assessment, the RAI not only allows to establish an individualized plan of care, but also generates quality indicators and a case-mix classification system that helps financing and planning resources. This article describes the five steps of the RAI-Home Care process and discusses the strengths, future and limitations of the RAI.

Treatment of chronic prostatitis/chronic pelvic pain syndrome category IIIA with Serenoa repens plus selenium and lycopene (Profluss) versus S. repens alone: an Italian randomized multicenter-controlled study.

OBJECTIVES: To evaluate the efficacy and safety of Serenoa repens + selenium and lycopene (Profluss) versus S. repens alone for the treatment of category IIIa chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). PATIENTS AND METHODS: 102 patients with IIIa CP/CPPS were enrolled and randomized into two groups each to receive Profluss or S. repens alone for 8 weeks. Evaluation was based on results of the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), IPSS, maximum peak flow rate (MPFR), and PSA measurements at baseline and at weeks 4, 8 and 8 after the end of treatment. The primary endpoint was a >50% reduction in NIH-CPSI score. Secondary endpoints evaluated were MPFR, IPSS, PSA and white blood cell count. RESULTS: No patients withdrew from the study. The mean NIH-CPSI score decreased significantly (p < 0.001) in both groups; we observed a decrease in the total score from 27.45 to 13.27 in group 1 (-51.64%) and from 27.76 to 20.62 in group 2 (-26.06%). IPSS improved significantly (p < 0.001) in both arms, but more in group 1. PSA and white blood cell count decreased significantly (p < 0.007) only in group 1. The MPFR improved more in group 1 (p < 0.005). CONCLUSION: Profluss is a triple therapy that is safe and well tolerated. It ameliorates symptoms associated with IIIa CP/CPPS.

[Infective endocarditis in patients with chronic hepatic failure: a four cases series]. / Endocarditis infecciosa en pacientes con daño hepático crónico: Serie de 4 casos clínicos.

Infective endocarditis and liver cirrhosis is an infrequent association. A retrospective study was performed in order to characterize predisposing factors, microbial causes and evolution. Medical records between 1995 and 2008 (June) were searched. Four cases were identified. In three cases liver cirrhosis was in stage Child A, and in all 4 there was a predisposing cardiac disease. Clinical manifestations were classical in 3 cases and in one presented as hepatic failure. Only in one case a typical agent was recovered. Other cases were associated to a nosocomial agent or Corynebacterium sp. [corrected] and in one no agent was identified. One patient required valve replacement. Three patients recovered satisfactorily, all of them in Child A stage. One died of non-infectious causes (Child C). Infective endocarditis and liver cirrhosis is an infrequent association in clinical practice, it can be associated to unusual agents or clinical manifestations.

Transurethral resection of the prostate (TURP) vs GreenLight photoselective vaporization of benign prostatic hyperplasia: analysis of BPH6 outcomes after 1 year of follow-up.

The surgical treatment of benign prostatic obstruction is changing over the time, thanks the increase evidence about the successful role of laser techniques in this surgery. We aimed to compare prostatic GreenLight photovaporization (PVP) to bipolar transurethral resection of the prostate (TURP) with regard to lower urinary tract symptoms (LUTS) improvement through the evaluation of BPH6. We enrolled 220 consecutive subjects affected by LUTS. We performed a propensity score matching using prostate volume, peak flow and International Prostate Symptoms Score (IPSS). A total of 110 (55 TURP and 55 PVP) were analyzed. We found after 1 year of follow-up that the rate of subjects resulting in greater BPH6 recovery in the PVP group vs TURP (45.6% vs 18.2%; P=0.001). The TURP treatment showed greater catheterization time (4.67 vs 1.25; P<0.01) while PVP showed greater recovery experience (82.4 vs 58.2; <0.01). Postoperative ejaculatory dysfunctions were observed in both groups, 58.8% in TURP and 34.5% in PVP group. The multivariate logistic regression analysis, adjusted for preoperative variables, showed that PVP was independently associated with BPH6 recovery end point (odds ratio=3.77; P<0.01). This study showed data in favor of PVP. Although IPSS and peak flow improvements were similar, PVP showed better clinical outcomes.

Predicting erectile dysfunction in sexually active patients seeking prostate health screening: proposal for a multivariable risk stratification.

To address the severity of erectile dysfunction (ED) in consecutive sexually active men seeking a prostate health screening through a multivariable risk stratification including comorbidities and lower urinary tract symptoms (LUTS). Four hundred and twenty five consecutive subjects with stable sexual relationship with normal testosterone levels were enrolled. The International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS) questionnaires were collected and health-significant comorbidities were scored with the Charlson comorbidity index (CCI). All the independent predictors of ED were combined to form four different risk categories of ED: low (age⩽65 years and IPSS<8 and CCI=0), intermediate (one of the following: age>65 years, IPSS⩾8 or CCI⩾1), high (two of the following: age>65 years, IPSS⩾8 or CCI⩾1) and very high (age >65 years, IPSS⩾8 and CCI⩾1). The prevalence of ED increased with increase of CCI (χ(2) likelihood ratio: 40.85, P=0.001). The median of the IIEF-5 significantly reduced with the increase of the CCI (P<0.001) and with the worsening of our risk group stratification (P<0.001). At univariate logistic regression analysis very high risk was significantly associated with of ED (odds ratio: 26.85, P<0.001). Very high-risk group predicted ED with 88% and 56% of specificity and sensitivity, respectively. Combining these risk factors through our risk stratification may be usefulness in revealing an underling ED.

Performance of biopsy factors in predicting unfavorable disease in patients eligible for active surveillance according to the PRIAS criteria.

BACKGROUND: To assess the added value of biopsy factors, like maximum cancer length in a core (MCL), cumulative cancer length (CCL), cumulative length of positive cores (CLPC), percentage of cancer involvement in positive cores (CIPC) and the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria in patients who underwent radical prostatectomy (RP) but eligible for active surveillance (AS). METHODS: From January 2002 to December 2007, 750 consecutive subjects underwent RP. We identified 147 (19.07%) patients who were eligible for AS based on PRIAS criteria: clinical stage T1c or T2, PSA level of ⩽ 10 ng ml(-1), Gleason score ⩽ 6, PSA-D of <0.2 ng ml(-2) and one or two positive biopsy cores. We calculated the diagnostic accuracy of biopsy factors in determining pathological confirmed unfavorable disease. Decision curve analysis (DCA) were performed. RESULTS: Of all subjects, 95 patients (66.43%) had favorable whereas 48 had (33.57%) unfavorable disease. On multivariate analyses, the inclusion of MCL, CCL, CLPC and CIPC significantly increased the accuracy of the base multivariate model in predicting unfavorable disease. The gain in predictive accuracy for MCL in a core, CCL, CLPC and CIPC ranged from 13 to 27%. The DCA shows that adding MCL, CCL, CLPC and CIPC resulted in a greater net benefit when the probability of ranges between 15 and 50%. The models can be applied at the cost of missing not more than 16.83% of unfavorable disease. CONCLUSIONS: Our findings suggested that the addition of these biopsy factors to PRIAS criteria has the potential to significantly increase the ability to detect unfavorable disease.

Multiplex polymerase chain reaction for the evaluation of cytomegalovirus DNA load in organ transplant recipients.

Because of the considerable impact of human cytomegalovirus (HCMV) infection, sensitive, specific, and standardized methods are required for rapid and accurate evaluation of viral load in monitoring transplant recipients. The aim of the present study was to evaluate the usefulness of a multiplex polymerase chain reaction (PCR) for the coamplification of HCMV-DNA and beta-globin genomic sequence in polymorphonuclear leukocytes (PMNL). Analysis and quantification of PCR products were carried out by a DNA enzyme immunoassay (DEIA), which is based on the hybridization of amplified DNA with a single-stranded DNA probe, which coats microtitre wells. Colorimetric detection of the DNA-antibody complex was carried out and optical density (O.D.) was recorded at 450/630 nm. To quantify HCMV/DNA load, a standard curve to which samples O.D. refer was obtained by amplifying serial dilutions of recombinant PGEM-3Z plasmid DNA containing a genomic fragment of glycoprotein B. 340 PMNL specimens from 102 solid organ recipients were tested for the detection of pp65 antigen and HCMV-DNA. The results showed a good correlation between viral load and clinical symptoms of HCMV infection; high specificity and predictive values for HCMV disease were found by PCR, using a cut-off limit of 10(3) genomic copies per 2 x 10(5) PMNL. These findings indicate that the system described is an efficient and reproducible diagnostic method easy to apply for routine diagnosis and therapeutic monitoring of transplanted patients.

Breathing pattern--gas exchange relation and acute effect of almitrine in severe chronic airflow obstruction.

Using a double-blind cross-over design, a single oral dose of 100 mg almitrine bismethylate and placebo were administered to 7 patients with chronic airflow limitation. In all patients, arterial blood gases at rest, ventilation and breathing pattern at rest and on exercise were measured before and 3 h after administration. Ventilation increased and PaCO2 decreased after almitrine; the mean PaO2 increase was statistically significant after active drug but the value increased more when tidal volume increased. It is concluded that in man the well-documented improvement in the V/Q relationship after almitrine is in part related to a pure ventilatory effect though the possibility of increasing ventilation by mainly increasing tidal volume.

Endocarditis infecciosa en pacientes con daño hepático crónico: Serie de 4 casos clínicos / Infective endocarditis in patients with chronic hepatic failure: A four cases series

Infective endocarditis and liver cirrhosis is an infrequent association. A retrospective study was performed in order to characterize predisposing factors, microbial causes and evolution. Medical records between 1995 and 2008 (June) were searched. Four cases were identified. In three cases liver cirrhosis was in stage Child A, and in all 4 there was a predisposing cardiac disease. Clinical manifestations were classical in 3 cases and in one presented as hepatic failure. Only in one case a typical agent was recovered. Other cases were associated to a nosocomial agent or Corynebacterium diphtheriae, and in one no agent was identified. One patient required valve replacement. Three patients recovered satisfactorily, all of them in Child A stage. One died of non-infectious causes (Child C). Infective endocarditis and liver cirrhosis is an infrequent association in clinical practice, it can be associated to unusual agents or clinical manifestations.

La asociación entre daño hepático y endocarditis infecciosa es infrecuente. Para analizar los factores predisponentes de esta asociación, la etiología microbiana y evolución clínica, se efectuó un análisis retrospectivo de los egresos por endocarditis infecciosa en pacientes con cirrosis hepática desde 1995 a junio de 2008. Se identificaron cuatro casos, asociados a categoría Child A en tres y en todos había una cardiopatía predisponente. Las manifestaciones clínicas fueron clásicas excepto en un caso que se presentó como descompensación hepática. Sólo un caso se asoció a un agente típico, otros a un agente nosocomial y Corynebacterium diphtheriae. En un caso no se identificó la etiología. Uno de los pacientes requirió cirugía de reemplazo valvular. Tres pacientes se recuperaron (Child A) y el paciente en categoría Child C falleció. Aunque infrecuente, la asociación cirrosis y endocarditis ocurre en la práctica clínica, se puede asociar a agentes inhabituales y tener manifestaciones encubiertas.