Stereotactic body radiotherapy with periprostatic hydrogel spacer for localized prostate cancer: toxicity profile and early oncologic outcomes.

BACKGROUND: Multiple phase I-II clinical trials have reported on the efficacy and safety of prostate stereotactic body radiotherapy (SBRT) for the treatment of prostate cancer. However, few have reported outcomes for prostate SBRT using periprostatic hydrogel spacer (SpaceOAR; Augmenix). Herein, we report safety and efficacy outcomes from our institutional prostate SBRT experience with SpaceOAR placement. METHODS: Fifty men with low- or intermediate-risk prostate cancer treated at a single institution with linear accelerator-based SBRT to 3625 cGy in 5 fractions, with or without androgen deprivation therapy (ADT) were included. All patients underwent SpaceOAR and fiducial marker placement followed by pre-treatment MRI. Toxicity assessments were conducted at least weekly while on treatment, 1 month after treatment, and every follow-up visit thereafter. Post-treatment PSA measurements were obtained 4 months after SBRT, followed by every 3-6 months thereafter. Acute toxicity was documented per RTOG criteria. RESULTS: Median follow up time was 20 (range 4-44) months. Median PSA at time of diagnosis was 7.4 (2.7-19.5) ng/ml. Eighteen men received 6 months of ADT for unfavorable intermediate risk disease. No PSA failures were recorded. Median PSA was 0.9 ng/mL at 20 months; 0.08 and 1.32 ng/mL in men who did and did not receive ADT, respectively. Mean prostate-rectum separation achieved with SpaceOAR was 9.6 ± 4 mm at the prostate midgland. No grade ≥ 3 GU or GI toxicity was recorded. During treatment, 30% of men developed new grade 2 GU toxicity (urgency or dysuria). These symptoms were present in 30% of men at 1 month and in 12% of men at 1 year post-treatment. During treatment, GI toxicity was limited to grade 1 symptoms (16%), although 4% of men developed grade 2 symptoms during the first 4 weeks after SBRT. All GI symptoms were resolving by the 1 month post-treatment assessment and no acute or late rectal toxicity was reported > 1 month after treatment. CONCLUSIONS: Periprostatic hydrogel placement followed by prostate SBRT resulted in minimal GI toxicity, and favorable early oncologic outcomes. These results indicate that SBRT with periprostatic spacer is a well-tolerated, safe, and convenient treatment option for localized prostate cancer.

Low magnesium levels an important new prognostic parameter can be overlooked in patients with Fournier's gangrene: a multicentric study.

INTRODUCTION: We evaluated low magnesium levels and three different scoring systems including the Fournier's Gangrene Severity Index (FGSI), the Uludag Fournier's Gangrene Severity Index (UFGSI), and the Charlson Comorbidity Index (CCI) for predicting mortality in a multicentric, large patient population with FG. METHODS: The medical records of 99 FG patients who were treated and followed up in different clinics were reviewed. The biochemical, hematological, and bacteriological results from the admission evaluation were recorded. The CCI, FGSI, and UFGSI were evaluated and stratified by survival. RESULTS: The results were evaluated for the following patients: the survivors (n = 82) and the nonsurvivors (n = 17). The magnesium level for the survivors and nonsurvivors was 2.09 ± 0.28 and 1.68 ± 0.23, respectively (p 0.004). The admission FGSI, UFGSI, and CCI scores were significantly higher in nonsurvivors (p 0.001, p 0.001, p < 0.001, respectively). The receiver operating characteristics analysis revealed that the UFGSI was more powerful than the FGSI. The hypomagnesemia, low hemoglobin and hematocrit, low albumin and HCO3 levels; high alkaline phosphatase; and the high heart and respiratory rates, an FGSI >9, rectal involvement, and a high CCI were associated with a worse prognosis. CONCLUSION: Low magnesium levels might be an important parameter for a worse FG prognosis. Monitoring the serum magnesium levels might have prognostic and therapeutic implications in patients with FG. High CCI, FGSI, and UFGSI scores might be associated with a worse prognosis in patients with FG. The UFGSI might be more powerful scoring system than the FGSI.

Retroperitoneal disorders associated with IgG4-related autoimmune pancreatitis.

IgG4-related autoimmune pancreatitis is frequently accompanied by relevant lesions in the genitourinary tract and retroperitoneal organs, which cause various clinical problems, ranging from non-specific back pain or bladder outlet obstruction to renal failure. The diagnosis of IgG4-related retroperitoneal fibrosis requires a multidisciplinary approach, including serological tests, histological examination, imaging analysis, and susceptibility to steroid therapy. Radiological examinations are helpful to diagnose this condition, but surgical resection is occasionally unavoidable to exclude malignancy, particularly for patients with isolated retroperitoneal involvement. Steroid therapy is the treatment of choice for this condition, the same as for other manifestations of IgG4-related disease. For patients with severe ureteral obstruction, additional ureteral stenting needs to be considered prior to steroid therapy to preserve the renal function. Some papers have suggested that IgG4-related disease can affect male reproductive organs including the prostate and testis. IgG4-related prostatitis usually causes lower urinary tract symptoms, such as dysuria and pollakisuria. Patients sometimes state that corticosteroids given for IgG4-related disease at other sites relieve their lower urinary tract symptoms, which leads us to suspect prostatic involvement in this condition. Because of the limited number of publications available, further studies are warranted to better characterize IgG4-related disease in male reproductive organs.

The anti-oxidant effects of ginger and cinnamon on spermatogenesis dys-function of diabetes rats.

BACKGROUND: Diabetes rats have been linked to reproductive dysfunction and plant medicine has been shown to be effective in its treatment. Antioxidants have distinctive effects on spermatogenesis, sperm biology and oxidative stress, and changes in anti-oxidant capacity are considered to be involved in the pathogenesis of chronic diabetes mellitus. Ginger and cinnamon are strong anti-oxidants and have been shown to reduce oxidative stress in the long-term treatment of streptozotocin (STZ)-induced diabetes in animal models. The present study examined the influence of combined ginger and cinnamon on spermatogenesis in STZ-induced diabetes in male Wistar rats. MATERIALS AND METHODS: Animals (n = 80) were allocated randomly into eight groups, 10 each: Group 1: Control rats given only 5cc Normal saline (0.9% NaCl) daily;Group2: rats received ginger (100mg/kg/rat) daily; Group 3: rats received cinnamon (75mg/kg) daily; Group 4: rats received ginger and cinnamon, (100mg/kg/rat ginger and 75mg/kg cinnamon) daily; Group 5: Diabetic control rats received only normal saline. Group 6: Diabetic rats received 100mg/kg/day ginger; Group 7: Diabetic rats received 75mg /kg/ day cinnamon; Group 8: Diabetic rats received ginger and cinnamon (100mg/kg/day and 75mg/kg /day). Diabetes was induced with 55 mg/kg, single intra-peritoneal injection of STZ in all groups. At the end of the experiment (56th day), blood samples were taken for determination of testosterone, LH,FSH, total anti-oxidant capacity, and levels of malondialdehyde, SOD, Catalase and GPX. All rats were euthanized, testes were dissected out and spermatozoa were collected from the epididymis for analysis. RESULTS: Sperm numbers, percentages of sperm viability and motility, and total serum testosterone increased in ginger and cinnamon and combined ginger and cinnamon treated diabetic rats compared with control groups. Serum testosterone, LH and FSH were higher compared to control group and also serum anti-oxidants (TAC, SOD, GPX and catalase) all were increased at the end of treatment. Combined ginger and cinnamon showed more intense increase in all parameters compare to ginger and cinnamon alone. Most of the results were significant (P<0.05). CONCLUSION: We concluded that combined ginger and cinnamon have significant beneficial effects on the sperm viability, motility, and serum total testosterone, LH,FSH and serum anti-oxidants' level and could be effective for maintaining healthy sperm parameters and male reproductive function in diabetics.

[The comparative characteristic of immune status of males with bacterial inflammatory urogenital pathology of different etiology in the city of Orenburg].

The article discusses presence of typical characteristics of parameters of system immunity under gonococcal and nonspecific uretroprostatitis and diagnostic value of these indicators. The reliable differences of immunologic indicators in patients with gonorrhea are established as compared to patients with nonspecific bacterial uretroprostatitis. The study established in peripheral blood the reliable decrease of level of leukocytes, relative amount of monocytes, phagocyte index, functional reserve of leukocytes at the expense of spontaneous and stimulated NBT test, IgA, sIgA. On the contrary, the study detected increasing of level of IgM and lactoferrin in patients with gonorrhea as compared to corresponding indicators in patients nonspecific infections. Under gonorrhea, the largest deviation of indicators from standard values was established for lactoferrin. The detected differences of immunologic parameters can be used as differentiating markers of nonspecific and gonococcal uretroprostatitis and criteria of effectiveness of immune correction.

The spectrum of IgG4-related disease in the abdomen and pelvis.

OBJECTIVE: IgG4-related disease was not recognized as a specific clinical entity until 2003 when extrapancreatic lesions were reported in patients with autoimmune pancreatitis. IgG4-related disease is characterized by elevated serum IgG4 levels and infiltration of the target organ by IgG4-positive plasma cells. The complete gamut of visceral involvement is still being outlined. The purpose of this article is to highlight the plethora of lesions under the spectrum of IgG4-related disease of the abdomen and pelvis, describe their imaging appearances on multimodality cross-sectional imaging, and discuss the differential diagnoses. CONCLUSION: It is important for radiologists to recognize the multiorgan involvement and few classic features of IgG4-related disease that often tend to simulate malignancy.

[Specific features of a change in some blood biochemical indicators in virus urogenital infections].

Analysis of blood biochemistry in cytomegalovirus, papillomavirus infections and herpes simplex virus showed a significant decrease in blood albumins, a significant rise in total protein, the percentage of alpha2-globulins, and an increase in the activity of ALAT, aldolase 1.6. This reflects the activity of inflammation, reveals hepatic toxic activity, and indicates renal dysfunction and externally asymptomatic active processes in the liver.

[State of antioxidant defense and L-arginin-nitrogen oxide system in blood of patients with urogenital chlamydiosis].

The system L-arginine-nitrogen oxide plays a significant role in maintenance of the anti-infectious protection of an organism. A condition of the given system and activity of a enzymatic part of antiradical protection in the blood of patients with chlamydiosis has been studied. Obtained data specify an intensification of processes of an oxidizing way of recycling of arginine in an organism of patients. Substantial increase of NO-synthase activity and insignificant activity of arginase in the blood is revealed. The level of nitrite-anion in blood cells of patients authentically increases: 1.7 times in erythrocytes, and 1.4 times in lymphocytes. It is shown, that in patients with chlamydiosis glutathione system is intensified, that is evidenced by an increase glutathione-peroxidase activity and authentic increase of glutathione level. It is assummed that the established features of nitrogen oxide exchange play a significant role in formation of a pathological condition at urogenital chlamydia infections.

[Serum detection of human urogenital mycoplasma].

The authors compared the detection rate of DNA of urogenital Mycoplasmas (Ureaplasma spp. and M. hominis) in the urogenital tract (UGT) and serum samples by polymerase chain reaction. Testing the smears and serum samples from the same patients (n = 112) showed that Ureaplasma was more frequently detected in the UGT smears than in the serum samples. There was the same trend towards M. hominis although the difference was not so significant. Therefore, the detection of these microorganisms in UGT is of more informative value for diagnostic purposes. Examination of the serum samples for these purposes provides useful information in understanding the mechanisms of generalization of Mycoplasma infections and studying the routes and modes of spreading these bacteria in the organism.

[Measurement of the reactive oxygen species and cytokines in the seminal plasma of leukocytospermic patients].

OBJECTIVES: To detect the levels of reactive oxygen species (ROS), superoxide dismutase(SOD) and interleukin 8(IL-8) in seminal plasma of infertile patients, and evaluate the possible relationship between those levels. METHODS: Semen was collected from normal donors (15 cases), infertile men without infection (16 cases), and infertile men with infection (leukocytospermia, 11 cases). The routine analysis of semen was accomplished, and then the levels of IL-8, malondialdehyde (MDA), SOD, and white blood cell (WBC) were examined. The correlative analysis between the level of ROS and other parameters in these populations was made. RESULTS: In leukocytospermic group, the levels of MDA, WBC, and IL-8 were higher than those in the other two groups (P < 0.001). Significantly positive correlation was observed between IL-8 and MDA (r = 0.852, P < 0.001) and between the levels of IL-8 and WBC. CONCLUSIONS: These findings suggest that increased oxidative stress in patients with leukocytospermia may cause the increase of IL-8(r = 0.818, P < 0.01). The increased oxidative stress may be due to defect in ROS scavenging system.

Chlamydial antibodies in semen: search for "silent" chlamydial infections in asymptomatic andrological patients.

The importance of a serological diagnostic workup in male genitourinary infections with Chlamydia trachomatis and its relevance for male infertility is still under debate. In a prospective study, antichlamydial serum and seminal plasma antibodies of 131 consecutive patients (mean age 31: 20-57) without evidence of acute urethritis and with negative urethral chlamydial culture were investigated. The antibody determination was carried out with a genus specific rELISA. In patients with positive seminal plasma IgA, chlamydial genome was evaluated by polymerase chain reaction (PCR). The results were associated with standard semen parameters according to evaluated WHO guidelines. Specific serum IgG antibodies were found in 51 patients (38.9%), IgA in 39 (29.7%); both antibodies were present in 25 patients (19%). Seminal plasma IgG was demonstrable in seven patients (5.3%), IgA in 26 (19.9%), and five patients were positive for both antibody classes (3.8%). Of the 26 men positive for specific seminal plasma IgA antibodies 12 did not demonstrate a serum antibody reaction. Only two patients with positive IgA titers in their seminal plasma showed a positive chlamydial genome reaction in PCR (8%). Men with antichlamydial seminal plasma IgA and/or IgG did not differ significantly in any of the standard semen sperm parameters from men testing negative for antibodies, with the exception of peroxidase positive leukocytes (p < 0.01), nor was there an association between any of the ejaculate parameters and any of the antibody titers. The data of about 40% antichlamydial serum antibody findings without a significant association with seminal plasma antibodies and no clinical signs of infection seem to reflect a history of urogenital infection. The unique presence of seminal plasma IgA in 12 of 26 cases may be caused by a local antibody response due to a "silent" infection. Thus, seminal plasma IgA was associated with signs of inflammation, whereas, there was no association with genome or pathogen demonstration. Therefore, it appears to be necessary to reevaluate genus-specific seminal plasma IgA antibodies with a species-specific microimmunofluorescence test and to compare these results with a genome screening using PCR or in situ hybridization.