Twenty-five milligrams of clomiphene citrate presents positive effect on treatment of male testosterone deficiency - a prospective study.

INTRODUCTION: Male testosterone deficiency is associated with bad sexual function and quality of life (QoL). The aim of this study was to determine whether a daily dose of 25 mg clomiphene citrate (CC) is effective in stimulating the endogenous testosterone production pathway and to address the applicability of this medication as a therapeutic option for symptomatic hypogonadism. MATERIALS AND METHODS: This was a prospective study. Men with low sexual desire and testosterone levels (T) below 400 ng/dL were selected to receive CC. Blood samples were obtained to determine baseline measurements of serum T, estradiol, LH, lipid profile and fasting plasma glucose. Each patient was treated with a daily dose of 25 mg CC for at least 3 months. Patients were asked if they experienced any side effects related to the use of CC and if they experienced any improvement in their sexual profile. Paired samples T-test was utilized to analyze responses to therapy. RESULTS: Our cohort consisted of 125 men with hypogonadism and low libido. Mean age was 62 years (± 11.1 years). Serum T levels ranged from 309 ng/dL (baseline, mean value) to 642 ng/dL (3 months after CC initiation, mean value) (p < 0.001). Serum cholesterol levels ranged from 197 to 186 mg/dL (p = 0.003). There were no statistically significant differences when comparing pre and post-treatment HDL-Cholesterol, triglycerides, fasting plasma glucose and prolactin. All men reported improvements in the post-treatment QoL scores. No serious adverse events were recorded. CONCLUSIONS: The CC was effective in stimulating the endogenous production of testosterone. A lower level of total cholesterol was verified after three months of treatment. This medication should be considered as a therapeutic option for some patients with symptomatic male testosterone deficiency.

Twenty-five milligrams of clomiphene citrate presents positive effect on treatment of male testosterone deficiency - a prospective study

INTRODUCTION: Male testosterone deficiency is associated with bad sexual function and quality of life (QoL). The aim of this study was to determine whether a daily dose of 25 mg clomiphene citrate (CC) is effective in stimulating the endogenous testosterone production pathway and to address the applicability of this medication as a therapeutic option for symptomatic hypogonadism. MATERIALS AND METHODS: This was a prospective study. Men with low sexual desire and testosterone levels (T) below 400 ng/dL were selected to receive CC. Blood samples were obtained to determine baseline measurements of serum T, estradiol, LH, lipid profile and fasting plasma glucose. Each patient was treated with a daily dose of 25 mg CC for at least 3 months. Patients were asked if they experienced any side effects related to the use of CC and if they experienced any improvement in their sexual profile. Paired samples T-test was utilized to analyze responses to therapy. RESULTS: Our cohort consisted of 125 men with hypogonadism and low libido. Mean age was 62 years (± 11.1 years). Serum T levels ranged from 309 ng/dL (baseline, mean value) to 642 ng/dL (3 months after CC initiation, mean value) (p < 0.001). Serum cholesterol levels ranged from 197 to 186 mg/dL (p = 0.003). There were no statistically significant differences when comparing pre and post-treatment HDL-Cholesterol, triglycerides, fasting plasma glucose and prolactin. All men reported improvements in the post-treatment QoL scores. No serious adverse events were recorded. CONCLUSIONS: The CC was effective in stimulating the endogenous production of testosterone. A lower level of total cholesterol was verified after three months of treatment. This medication should be considered as a therapeutic option for some patients with symptomatic male testosterone deficiency.

Long-term follow-up of penile curvature correction utilizing autologous albugineal crural graft.

PURPOSE: Peyronie 's disease is an acquired connective tissue disorder of the penile tunica albuginea with fibrosis and inflammation. The disease produces palpable plaques, penile curvature and pain during erections. Usually it results in impairment of the quality of life. Our objective is to review the long-term results of the albugineal grafting harvested from the penile crura for the treatment of severe penile curvature. MATERIALS AND METHODS: Thirty-three patients with Peyronie 's disease were submitted to a grafting with tunica albuginea from the penile crura for the correction of penile curvature. The results were evaluated after 6 months of the procedure. Variables studied were overall satisfaction with the procedure, correction of the penile curvature, erectile capacity, penile shortening and the presence of surgical complications. RESULTS: Mean follow-up after surgery was 41 months. Complete correction of the curvature was achieved in 30 patients (90%). The mean preoperative curvature was 91.8 degrees and median plaque length was 2 cm (ranged from 1 to 5 cm). Three patients (9%) experienced recurrence of the penile curvature and required a new procedure. In 30 men (90%) the procedure fulfilled their expectations and in 31 patients (93.9%) their opinions were that sexual partners were satisfied with the penile correction. Penile shortening or augmentation was referred in 6 (18.1%) and 1 (3%) patient, respectively. CONCLUSION: Our series demonstrated that grafting the albugineal defect after incision of the tunica albuginea with tunica from the crus for the correction of penile curvature is safe and results in satisfactory straight erections during along-term follow-up.

Long-term follow-up of penile curvature correction utilizing autologous albugineal crural graft

PURPOSE: Peyronie's disease is an acquired connective tissue disorder of the penile tunica albuginea with fibrosis and inflammation. The disease produces palpable plaques, penile curvature and pain during erections. Usually it results in impairment of the quality of life. Our objective is to review the long-term results of the albugineal grafting harvested from the penile crura for the treatment of severe penile curvature. MATERIALS AND METHODS: Thirty-three patients with Peyronie's disease were submitted to a grafting with tunica albuginea from the penile crura for the correction of penile curvature. The results were evaluated after 6 months of the procedure. Variables studied were overall satisfaction with the procedure, correction of the penile curvature, erectile capacity, penile shortening and the presence of surgical complications. RESULTS: Mean follow-up after surgery was 41 months. Complete correction of the curvature was achieved in 30 patients (90%). The mean preoperative curvature was 91.8 degrees and median plaque length was 2 cm (ranged from 1 to 5 cm). Three patients (9%) experienced recurrence of the penile curvature and required a new procedure. In 30 men (90%) the procedure fulfilled their expectations and in 31 patients (93.9%) their opinions were that sexual partners were satisfied with the penile correction. Penile shortening or augmentation was referred in 6 (18.1%) and 1 (3%) patient, respectively. CONCLUSION: Our series demonstrated that grafting the albugineal defect after incision of the tunica albuginea with tunica from the crus for the correction of penile curvature is safe and results in satisfactory straight erections duringa long-term follow-up.

Low serum testosterone levels are associated with positive surgical margins in radical retropubic prostatectomy: hypogonadism represents bad prognosis in prostate cancer.

PURPOSE: It has been reported that more aggressive prostate cancer (PC) can be associated with low serum testosterone levels. The relationship between serum androgens and PC is still not completely understood. In this study we examined the association of prognostic factors in men who underwent radical retropubic (RRP) prostatectomy with low or normal total testosterone. MATERIALS AND METHODS: We retrospectively evaluated 64 consecutive patients with localized PC treated with RRP between July 2002 and November 2003. PC was diagnosed by transrectal ultrasonography guided biopsy performed for either a suspicious digital rectal examination or serum prostate specific antigen greater than 4.0 ng/ml. Gleason score was determined in prostatic biopsies. Pathological TNM staging (1997), capsular perforation, seminal vesicle involvement and surgical margin status were determined in all surgical specimens. The threshold for serum total testosterone was 270 ng/dl. In all analyses p <0.05 was considered statistically significant. RESULTS: There were no statistically significant differences among prostate specific antigen, Gleason score (biopsy or specimen), pathological stage, capsular perforation and seminal vesicle involvement. However, patients with low total testosterone had increased positive surgical margins (p = 0.026). CONCLUSIONS: Patients with low total testosterone more frequently present with positive surgical margins in RRP specimens. The true association between low testosterone and poor clinical outcome in the long term needs validation in large prospective studies.

A evolução dos testículos de ratos pré-puberes submetidos a isquemia transitória pode sofrer modificação com a administração intratesticular de testosterona? / Can testicular evolution of pre-puberal rats submitted to transitory ischemia show any change after intratesticular testosterone injection?

A torção testicular, seguida de isquemia, acompanha-se de graus variáveis de infertilidade. Separamos 40 ratos Wistar em 4 grupos de 10, sendo dois grupos controle e os outros dois, submetidos a uma isquemia unilateral de 120 minutos, através da colocação de clampers no funículo espermático esquerdo. Cada grupo foi subdividido em 2 grupos, um para observação e outro recebendo injeção intratesticular de 25 mg de testosterona a partir do terceiro dia...

Histiocitoma fibroso maligno renal: relato de caso / Renal malignant fibous histiocytoma: case report

Os autores relatam um caso de histiocitoma fibroso maligno encontrado no rim direito de paciente masculino, branco, 60 anos. O tratamento consistiu na completa ressecção da lesão através de uma abordagem anterior. O paciente evoluiu bem, porém o período de seguimento ainda é curto. Esta é uma afecção extremamente rara e, segundo revisão na literatura, é o décimo quarto caso relatado

Antígeno prostático específico (PSA) na prática médica / Prostatic Specific Antigen (PSA) i nmedical practice

Antígeno proastático específico (PSA) é uma enzima produzida pelo epitélio prostático e a sua quantificaçäo sérica representa um avanço importante no diagnóstico precoce e no acompanhamento da neoplasia prostática. O objetivo desta revisäo é orientar o médico generalista sobre o valor do PSA na prática médica...

Colangite obstrutiva supurativa aguda (COSA) / Acute obstructive suppurative cholangite

Os autores apresentam uma série de 12 casos, consecutivos, de colangite obstrutiva supurativa aguda (COSA), tratados cirurgicamente. A etiologia mais frequënte foi a coledocolitíase observada em 75 por cento dos casos. Fatores de risco como idade avançada, icterícia e comprometimento da função renal foram os principais indicadores prognósticos. Cinco (41,67 por cento) pacientes evoluíram ao óbito. O diagnóstico precoce com descompressão imediata da via biliar associado a medidas de suporte e antibioticoterapia são as únicas alternativas de sucesso no tratamento de tal afecção.

Abdome agudo obstrutivo por metástase de melanoma maligno: relato de caso / Obstructive acute abdomen by metastatic malignant melanoma: case report

Apresentamos o caso de um paciente com obstruçäo intestinal aguda causada por metástase de melanoma maligno intestinal, o qual tinha sido submetido, dois anos antes, à ressecçäo de um melanoma maligno na regiäo dorsal. Trata-se de uma neoplasia infreqüente cujo sítio metastático, do caso em questÝo, é ainda mais raro.

Procedimento de resgate na infeccao da protese peniana / Rescue procedure in penile prosthesis infection

Das possiveis complicacoes associadas ao implante de proteses penianas, a infeccao e a mais desastrosa. O tratamento usual e a remocao cirurgica deixando a corporite cicatrizar, para entao reimplantar a nova protese. Apresentamos tres pacientes com infeccao de protese peniana, tratados pela retirada da protese, irrigacao copiosa dos corpos cavernosos com solucao antibiotica e recolocacao de nova protese em curto espaco de tempo. Este procedimento tem sido denominado de "Resgate da Protese Peniana" e parece representar uma alternativa as dificuldades de reimplante pela conduta tradicional...

Teste de erecao farmaco-induzida: normas gerais / Drug-induced erection test: general rules

Nos ultimos 8 anos, o diagnostico e tratamento da impotencia sexual masculina sofreram uma mudanca substancial pela introducao da injecao intracavernosa. O teste de erecao farmaco-induzida (TEFI) tem se mostrado util na avaliacao de pacientes com impotencia neurogenica, associada ou nao a vasculopatia arterial e/ou doenca veno-oclusiva. Os autores apresentam as drogas usadas atualmente, as diretrizes gerais para a realizacao de TEFI e o protocolo vigente no departamento de urologia da FFFCMPA.

Tumor de testiculo e SIDA: apresentacao de caso / Testicular tumor and AIDS: case report

Relatamos o caso de um paciente homossexual portador do virus da Sindrome da Imunodeficiencia Adquirida e Teratocarcinoma de testiculo, com rapida e fatal evolucao. Este caso de tumor testicular serve para aumentar o quadro de neoplasias infrequentes que ocorrem em pacientes jovens e homossexuais que apresentam anormalidades imunocelulares adquiridas.

Tumor de seio endodérmico de ovário: relato de caso / Endodermal sinus tumor of the ovary: case report

Os tumores de seio endodérmico de ovário säo neoplasias raras e extremamente malignas. Geralmente ocorrem em adolescentes e mulheres jovens. Níveis séricos de alfafetoproteína têm sido demonstrados em pacientes portadoras desta neoplasia e servem como marcador tumoral e também como monitor do progresso terapêutico e recorrência tumoral. O prognóstico é péssimo, como demonstrado em nosso caso. Relatamos aqui um caso de tumor de seio endodérmico.

Histerectomia vaginal: análise de 73 casos / Vaginal histerectomy: analysis of 73 cases

Foram analisadas 73 histerectomias vaginais realizadas no Serviço de Ginecologia do Hospital Universitário de Santa Maria, no período de junho de 1975 a fevereiro de 1988, onde o prolapso uterino, nos seus mais variados graus, foi a principal indicaçäo cirúgica (98,6 por cento dos casos). A idade média das pacientes foi de 62,7 anos e a maior causa de prolapso foi a paridade múltipla, estando relacionado somente um caso em nulíparas. Ocorreram 58,9 por cento de complicaçöes no pós-operatório, sendo que dentre as imediatas destacou-se a retençao urinária. O granuloma de cúpula e o fluxo persistente foram as complicaçoes tardias mais encontradas. Houve um caso de óbito, ocorrido no transoperatório.

Colecistite enfisemtosa: uma entidade clínica bem definida? / Emphysematous cholecystitis: a distinct clinical entity

Colecistite enfisematosa é uma afecçäo pouco freqüente, com uma alta taxa de mortalidade e que freqüentemente é confundida com colecistite aguda. Através do relato de um caso e uma breve revisäo da literatura, mostramos alguns aspectos particulares desta doença. Além disso, comparamos ambas patologías indicando as principais diferenças entre elas