Comparison of pneumococcal conjugate polysaccharide and free polysaccharide vaccines in elderly adults: conjugate vaccine elicits improved antibacterial immune responses and immunological memory.

BACKGROUND: High functional antibody responses, establishment of immunologic memory, and unambiguous efficacy in infants suggest that an initial dose of conjugated pneumococcal polysaccharide (PnC) vaccine may be of value in a comprehensive adult immunization strategy. METHODS: We compared the immunogenicity and safety of 7-valent PnC vaccine (7vPnC) with that of 23-valent pneumococcal polysaccharide vaccine (PPV) in adults >/=70 years of age who had not been previously vaccinated with a pneumococcal vaccine. One year later, 7vPnC recipients received a booster dose of either 7vPnC (the 7vPnC/7vPnC group) or PPV (the 7vPnC/PPV group), and PPV recipients received a booster dose of 7vPnC (the PPV/7vPnC group). Immune responses were compared for each of the 7 serotypes common to both vaccines. RESULTS: Antipolysaccharide enzyme-linked immunosorbent assay antibody concentrations and opsonophagocytic assay titers to the initial dose of 7vPnC were significantly greater than those to the initial dose of PPV for 6 and 5 of 7 serotypes, respectively (P < .01 and P < .05, respectively). 7vPnC/7vPnC induced antibody responses that were similar to those after the first 7vPnC inoculation, and 7vPnC/PPV induced antibody responses that were similar to or greater than antibody responses after administration of PPV alone; PPV/7vPnC induced significantly lower antibacterial responses, compared with those induced by 7vPnC alone, for all serotypes (P < .05). CONCLUSION: In adults, an initial dose of 7vPnC is likely to elicit higher and potentially more effective levels of antipneumococcal antibodies than is PPV. In contrast with PPV, for which the induction of hyporesponsiveness was observed when used as a priming dose, 7vPnC elicits an immunological state that permits subsequent administration of 7vPnC or PPV to maintain functional antipolysaccharide antibody levels.

[The biography of Maximilian Nitze (1848-1906) and his contribution to the urology]. / La biografía de Maximilian Nitze (1848-1906) y su contribución a la Urología.

Maximilian Carl Friedrich Nitze was born on the 18 of September of 1848 in Berlin the capital of Prussia. 1869 while still being a Student of the Heidelberg University the first nephrectomy of the world performed by Gustav Simon (1824-1876) woke his interest in urology. 1874 by the age of 26 he passed his state examination and obtained a doctor degree in medicine. On the 2 October of 1877 he presented the first cystoscope to the members of the Real Medical School in Dresden. Nitzes doubtless valuable contribution to urology was making real the endoscopical exploration of the genitourinary system and initializing the era of surgical treatments under direct vision. By the beginning of the XX century urology reached the status of an independent specialty by separating from surgery, dermatology/venerology, internal medicine and pathology.

[Biography of Phillip Bozzini (1773-1809) an idealist of the endoscopy]. / La biografía de philipp Bozzini (1773-1809) un idealista de la endoscopia.

Philipp Bozzini was born the 25 of May of 1773 in Mainz, Germany. The 12 of June of 1797 obtain the title of medicine doctor. From 1804 it is practically dedicated of complete to the development of its instrument, this have the approximated form of one metallic vase of 35 cm height, had in leather. In its previous face it has a circular opening that is divided vertically by a partition. In left half is the luminance source (a wax candle) and behind is a mirror, that it projects the light produced towards the interior of the corporal cavity to explore. By other half, the observer receives the reflected light and the image of the explored organ. In the later face they adapt according to the cavity diverse specula's, this allow to inspect ear, urethra, feminine bladder, rectum, uterine neck, nasal or wounds. Philipp Bozzini, profit with modest means available at the beginning of XIX century, to demonstrate to the medical world the way of endoscopes. It was with its instrument and ideas, 3/4 of century advanced to the technical and scientific possibilities of the moment. The historians are in agreement, in which this instrument, with artificial light, diverse mirrors and specula's war the beginning of a numerous family of endoscopies.

La vaporización fotoselectiva del adenoma prostático con el ktp-láser (kalium-titanyl-phosphat) de 80 watt y la RTU-P de baja presión hidráulica / The photoselective vaporization of prostate adenoma with the 80 watt ktp-laser (kalium-titanyl-phosphat) and the low hydraulic pressure tur-p

El objetivo de este trabajo prospectivo es determinar la eficacia del método KTP-láser de 80 watt para la vaporización y ablación de la HPB sintomática. También se analizan los resultados al combinar el KTP-láser con la RTU-P y su repercusión sobre la hemoglobina. Material y Método: 300 pacientes con HPB sintomática fueron tratados entre agosto del 2004 y noviembre del 2006 con el KTPláser o combinado con RTU-P. La resección adicional fue efectuada en pacientes con adenomas grandes o por lóbulo medio acentuado. El efecto ablativo fue controlado al final de la operación por medio de TRUS. Resultados: 300 pacientes fueron tratados en 2 grupos. El grupo 1 (n: 50) con sólo tratamiento láser y pequeños adenomas, la hemoglobina se redujo un 3,2 por ciento y nadie requirió una transfusión. El grupo 2 (n: 250) con tratamiento combinado de KTP-láser y RTU-P en adenomas grandes, la hemoglobina se redujo en promedio 15,2 por ciento después de la intervención; 2 pacientes (0,8 por ciento) necesitaron una transfusión. Conclusión: El estudio pone de manifiesto, las ventajas de combinar ambos procedimientos quirúrgicos para obtener un mejor resultado en la ablación del adenoma sobre todo en próstatas de gran tamaño.

The objective of this prospective study is to determine the effectiveness of the 80 watt KTP laser method for the vaporization and ablation of the symptomatic BPH. Also the results when combining the KTP-laser with the TUR-P and their repercussion on the haemoglobin are analysed. Material and Method: 300 patients with symptomatic BPH were treated between august 2004and november 2006 with the KTP-Laser or combined with TUR-P. The additional Resection was carried out in those patients with great adenomas or to have accentuated middle lobule. The ablative effect was controlledat the end of the operation with TRUS (transrectal ultrasound). Results: 300 patients were treated in 2 groups. The group 1 (n: 50) just by laser treatment and small adenomas, the haemoglobin was reduced a 3.2 percent and nobody required a transfusion. Group 2 (n: 250) with combined treatment of KTP-laser and TURP in great adenomas, the haemoglobin was reduced in average 15,2 percent after the intervention; 2 patients (0,8 percent) needed a transfusion. Conclusion: Our study puts of open, the advantages to combine both surgical procedures to mainly obtain a better result in the ablation of the prostate adenoma in prostates of great size.

[The low hydraulic pressure transurethral resection of the prostate results in 340 patients with great adenomas]. / La resección transuretral de la próstata de baja presión hidráulica, resultados en 340 pacientes con adenomas grandes.

INTRODUCTION: the transurethral resection of prostate TURP is the elective treatment for the small and medium adenomas. In this study they analyse the effectiveness, the results and the postoperative morbidity in the resection of the great adenomas. PATIENTS AND METHOD: We study 340 patients with great adenomas and symptomatic infravesical obstruction that were operated with the low hydraulic pressure RTUP between August of 1999 and June of 2006. RESULTS: Average Age of the patients 69 years (range 51-89). Prostate volume by TRUS, 107 ml (70-204). PSA 7,94 ng/ml (0,71-26,4). Weight of the resected fragments: 74,5gr. (50-160), time of the intervention 65 min. (35-155), postoperative urethral catheterisation 1.7 days (1-8), suprapubic derivation 6.5 days (5-15), the duration of hospital stay after surgery were 8 days (7-16), peak flow pre-op. 11.2 ml/sec. (5-15,7), post-operative 19.7 ml/sec. (7-41,3). There were no cases of TURP syndrome in this group. Operative complications: Urinary infection without fever (bacteria >100.000) 95 patients (27.9%), bladder derivation by preoperative urinary retention 53 patients (15,6%). 18 patients (5,3%) with postoperative urinary retention. 11 patients (3,2%), with infection and fever >38 degrees C. 7 patients (2%) with postoperative bladder bleeding, 2 patients (0,6%) with urethral lesion. 1 patient (0.3%), with massive scrotal hematoma (after vasectomy). Control of the pre and post operative hemoglobin: Hemoglobin pre-op 15 g/dl (12-19,3), hemoglobin post-op 11,5 g/dl (7,6-16,4), difference of (- 3,5g/dl) 23,3%. In only 29 patients (8.5%) it was necessary to carry out a sanguineous transfusions (heterolog) of 2 to 4 EC (500 ml), the TRUS was 125 ml, weight of the fragments 90 gr. (52-140), the hemoglobin pre-op was 14,72g/dl and post-op of 8,8g/dl with a difference of (- 5,92g/dl) 40.2%. CONCLUSIONS: The video assisted low hydraulic pressure TURP, is an effective method in the surgical treatment of great prostate adenomas. The severe postoperative complications are little, and in 311 patients (91.5%) it was not necessary sanguineous transfusion. The stationary treatment and the urethral catheterisation is smaller in comparison with the open adenomectomy.

[Combined treatment of prostatic adenoma with the 80 Watt KTP-laser and low-pressure transurethral resection]. / Tratamiento combinado del adenoma prostático con el KPT-láser de 80 Watt y la resección transuretral de baja presión.

INTRODUCTION: The purpose of this prospective study is to determine the effectiveness of method for vaporisation and elimination of the prostate adenoma. The results are analysed that obtain when combining this Laser-method with the resection at low pressure. MATERIAL AND METHOD: 151 patients with BPH symptomatic were treated between August 2004 and january 2006 with the KTP-Laser or combined with low pressure TURP. The additional Resection was carried out in those patients with large adenomas or to have accentuated middle lobule. The ablative effect was controlled at the end of the operation with TRUS (transrectal ultrasound). RESULTS: 151 patients were divided in 2 groups, group 1 (n:43) those with single laser treatment and group 2 (n: 108) with combined treatment. The control of the post-miccional peak-flow demonstrates an increase of 65,6% in group 1, and of 122,4 % in group 2. CONCLUSION: Our study reveals the advantages of combining both operative procedures to mainly obtain a better result in the ablation of the prostate adenoma in prostates of great size.

[Pneumonia - pathogen-based or constellation-based therapy?]. / Pneumonie - erregerbasierte oder konstellationsbasierte Therapie?

Community-acquired pneumonia is one of the most frequent infectious diseases with high morbidity and mortality. Early and sufficient antibiotic treatment is crucial for the prognosis of the patient. The underlying pathogens are mostly unknown at the onset of symptoms. The choice of antibiotic treatment depends on the suspected pathogens, derived from the typical germs and the typical resistances in a certain area. In addition, individual risk factors, such as age, severity of the diseases, comorbidities, and previous antibiotic treatment have a major impact on the probability of dying for an individual patient. These factors must be considered at the beginning of any treatment. Pathogen-based treatment has to be switched to constellation-based treatment.

El tratamiento del adenoma protático sintomático con el KPT-Láser de 80 watt y la resección transuretral de baja presión / Treatment of symptomatic prostatic adenoma with the laser-KTP of 80 watt and transurethral resection of low presure

Introducción: La finalidad de este trabajo prospectivo es determinar la eficacia del método KTP-láser para la vaporización y eliminación del adenoma prostático. Se analizan también los resultados que se obtienen al combinar el método KTP-láser de 80 watt con la RTUP de baja presión. Material y métodos: 225 pacientes con HBP sintomática fueron tratados entre agosto del 2004 y mayo del 2006 con el KTP-láser o combinado con RUTP a baja presión. La resección adicional fue efectuada en aquellos pacientes con adenomas grandes o por tener el lóbulo medio acentuado. El efecto ablativo fue controlado al final de la operación por medio de TRUS (sonografía prostática transrectal). Resultados: 225 pacientes tratados en 2 grupos, el grupo 1 (n:50) aquellos con solo tratamiento láser, sobre todo pequeños adenomas y el grupo 2 (n:175) con tratamiento combinado de KTP-láser y RTUP a baja presión en adenomas grandes. La flujometría máxima demuestra una mejoría del 44, 5 porciento en el grupo 1 entre antes y después del tratamiento, en el grupo 2 la diferencia es de 122, 4 porciento. Conclusión: Nuestro estudio pone de manifiesto las ventajas de combinar ambos procedimientos quirúrgicos para obtener un mejor resultado en la ablación del adenoma prostático, sobre todo en próstatas de gran tamaño

El tratamiento del adenoma protático sintomático con el KPT-Láser de 80 watt y la resección transuretral de baja presión / Treatment of symptomatic prostatic adenoma with the laser-KTP of 80 watt and transurethral resection of low presure

Introducción: La finalidad de este trabajo prospectivo es determinar la eficacia del método KTP-láser para la vaporización y eliminación del adenoma prostático. Se analizan también los resultados que se obtienen al combinar el método KTP-láser de 80 watt con la RTUP de baja presión. Material y métodos: 225 pacientes con HBP sintomática fueron tratados entre agosto del 2004 y mayo del 2006 con el KTP-láser o combinado con RUTP a baja presión. La resección adicional fue efectuada en aquellos pacientes con adenomas grandes o por tener el lóbulo medio acentuado. El efecto ablativo fue controlado al final de la operación por medio de TRUS (sonografía prostática transrectal). Resultados: 225 pacientes tratados en 2 grupos, el grupo 1 (n:50) aquellos con solo tratamiento láser, sobre todo pequeños adenomas y el grupo 2 (n:175) con tratamiento combinado de KTP-láser y RTUP a baja presión en adenomas grandes. La flujometría máxima demuestra una mejoría del 44, 5 porciento en el grupo 1 entre antes y después del tratamiento, en el grupo 2 la diferencia es de 122, 4 porciento. Conclusión: Nuestro estudio pone de manifiesto las ventajas de combinar ambos procedimientos quirúrgicos para obtener un mejor resultado en la ablación del adenoma prostático, sobre todo en próstatas de gran tamaño(AU)

[Problems of pharmacotherapy of infections in the aged]. / Probleme der Pharmakotherapie bei Infektionen im Alter.

Infectious diseases play an important role in the elderly. Disease progression is often more severe, displaying a higher complication rate and causing increased mortality. Elderly patients suffer more frequently than younger under pneumonia, exacerbations of chronic bronchitis, urinary tract infections as well as skin and soft tissue infections. When starting empiric antibiotic therapy one should consider that the bacterial spectrum afflicting elderly patients may differ from that afflicting younger patients. In addition an increasing number of nosocomial and multiresistant pathogens is seen in elderly patients due to more frequent hospitalisation and living in nursing homes. Patient multimorbidity and multiple co-medications make awareness of important drug-interactions essential. The purpose of this article is to review the indications and side-effects of well-tried and newer antibiotics with respect to patients age. Especially the newer antibiotics Ertapenem, Linezolid, Quinupristin/Dalfopristin and Telithromycin are discussed in detail.

[Potency-sparing radical perineal prostatectomy]. / Potenzerhaltende radikale perineale Prostatektomie.

We evaluated the results of a unilateral nerve-sparing radical perineal prostatectomy in a prospective study. Thirty patients with histologically confirmed unilateral prostate cancer and adequate erectile function preoperatively underwent a nerve-sparing procedure. The criteria were a PSA of <10 ng/ml, prostate volume of <60 ml, and a Gleason score <7. In 29 patients the procedure was technically feasible. In one patient significant damage to the neurovascular bundle was seen at the end of the procedure. Bilateral tumors were present in 18 patients on final pathology. Positive surgical margins were observed in five patients (pT2: 2/20; pT3: 3/10). After a follow-up of 3-12 months, 15 of 29 patients (51%) reported some erectile function without additional medication. Of 14 patients, 2 had enough rigidity for penetration within 3 months.The short-term results after unilateral nerve-sparing perineal prostatectomy are encouraging. Since the neurovascular bundle can be exposed very well, interposition of sural nerve should be considered.

Bioenergetics of immune cells to assess rheumatic disease activity and efficacy of glucocorticoid treatment.

OBJECTIVE: To investigate whether activity and glucocorticoid treatment of rheumatic diseases are reflected by selected parameters of cellular energy metabolism of peripheral blood mononuclear cells (PBMC). METHODS: PBMC were obtained from 30 healthy volunteers, 28 patients (16 inactive; 12 active) with rheumatoid arthritis, systemic lupus erythematosus, vasculitis, or other autoimmune diseases, and five patients with infectious diseases. Patients with active rheumatic diseases were examined before and 4-5 days after starting, restarting, or increasing the dose of glucocorticoids. Cellular oxygen consumption (as a measure of ATP production), bioenergetic ability to be stimulated, and major ATP consuming processes were measured amperometrically with a Clark electrode. RESULTS: A normal value for oxygen consumption of 3.84 (SEM 0.1) (all data in nmol O(2)/min/10(7) cells) independent of sex was found. In patients with inactive disease the respiration rate was slightly higher, but was significantly increased in active patients to 4.82 (SEM 0.33) (p<0.001). PBMC from active patients showed a significantly lower bioenergetic response to a mitogenic stimulus than controls (p<0.05). In stimulated cells from active patients there was a significant reduction in cation transport and protein synthesis. All parameters above were almost normalised within 4-5 days upon optimised treatment with glucocorticoids. For comparison, PBMC from patients with active infectious diseases also showed an increased respiration rate; their response to mitogenic stimulation was even higher. CONCLUSIONS: This study shows for the first time that parameters describing the cellular function of PBMC in bioenergetic terms are suitable for (a) describing semiquantitatively the activity of a rheumatic disease and (b) assessing the therapeutic effect on the disease.

Bioenergetics of human peripheral blood mononuclear cell metabolism in quiescent, activated, and glucocorticoid-treated states.

The first quantitative findings on the energy metabolism of human immune cells are presented. In quiescent peripheral blood mononuclear cells (PBMC) protein biosynthesis and Na+,K+-ATPase activity each accounted for 8% of cellular oxygen consumption. Stimulation with 25, 50, and 75 microg Con A/ml (1.25, 2.5 or 3.75 microg/10(6) cells) increased total oxygen consumption within seconds by 8, 36, and 53%, respectively. After addition of 75 microg Con A/ml, the proportion of cellular oxygen consumption due to protein biosynthesis, Na+,K+-ATPase activity, and Ca2+-ATPase activity was 15% each and that due to DNA/RNA synthesis was 8%. On the basis of these findings the immediate effects of five different glucocorticoids on cellular energy metabolism were investigated. The various glucocorticoids exerted basically the same inhibitory effects on Con A-stimulated cellular respiration and individual ATP-consuming processes, but differed significantly in potency. Similar to previous studies on rat thymocytes, the relative potencies of the glucocorticoids were found to be: prednylidene (1.7) > dexamethasone (1.5) > methylprednisolone (1.0) > prednisolone (0.3) > betamethasone (< 0.2). Given their rapidity of onset, these effects must be nongenomically mediated. The differences between the relative potencies of the various glucocorticoids for these effects and those for the classical genomic effects have important clinical implications, in particular for high-dose systemic and local glucocorticoid therapy.

Tratamiento de HPB sintomática con finasteride: seguimiento a 30 meses / Treatment of symptomatic BPH with finasteride: follow up during 30 months

Entre agosto 1993 y abril 1996 fueron evaluados 92 pacientes con HPB sintomático, tratados con Finasteride 5 mg/día. El objetivo de este trabajo es evaluar la eficacia de este fármaco en el control de la HPB sintomático. Los pacientes fueron evaluados mediante Score Sintomático AUA, APE, flujometría y ecografía prostática transrectal, en 3, 6, 9, 12, 18, 24 y 30 meses. Edad promedio 63 años (45-79). Seguimiento promedio 19 meses. El Finasteride para el tratamiento de HPB sintomático produce una mejoría sintomatológica y en menor medida de flujo urinario, evidenciable a partir de los 3 meses de tratamiento, lo cual se mantiene y aún mejora con el tiempo. Los valores de APE se reducen aproximadamente 50 por ciento a partir de 1 año de tratamiento y luego se mantienen en dichos niveles hasta los 30 meses del seguimiento

Experiencia en 1.000 biopsias prostáticas transrectales ecodirigidas / Experience in 1.000 prostatic transrectal echo-directed biopsies

Entre octubre 1991 y abril 1996, se realizaron 1.000 biopsias prostáticas transrectales guiadas ecográficamente. Este procedimiento fue indicado al hallar tacto rectal sospechoso y/o APE >4 ng/ml y/o ante hallazgo de lesiones dudosas en ecografía transrectal. El procedimiento fue bien tolerado por la mayoría de los pacientes, siendo suspendido en 3 casos (0,03 por ciento). Se diagnosticaron 651 adenomas, 6 prostatitis granulomatosas, 10 adenosis, 39 PIN de alto grado y 244 cáncer de próstata (índice de detección de cáncer 25,65 por ciento), 49 diagnósticos no fueron recogidos. En 562 casos con tacto rectal sospechoso, se hallaron 201 cáncer (VPP 35,76 por ciento). En 700 casos con APE >4 se hallaron 199 cáncer (VPP 28,42 por ciento). La ecografía fue sospechosa en 753 casos, obteniéndose 226 cáncer (VPP 30,01 por ciento). El tacto rectal y APE se encontraban alterados en 375 casos, detectándose 170 cáncer (VPP 45,3 por ciento). Los tres parámetros estaban alterados en 299 casos, hallándose 141 cáncer (VPP 47,15 por ciento). Complicaciones: hemorragia rectal moderada 18, hematuria importante con bloqueo 2, hematuria moderada 18, hemospermia 234, fiebre <38'C 18, fiebre >38' C 1 1, shock séptico 1 caso. Concluimos que este método es muy eficaz en el diagnóstico del cáncer de próstata especialmente en casos en que el hallazgo surgió de la combinación de los tres parámetros alterados