Treating benign prostatic hyperplasia with botulinum neurotoxin.

Botulinum toxin (BoNT) has been increasingly used in the interventional treatment of several disorders; the use of this agent has extended to a plethora of conditions including focal dystonia, spasticity, inappropriate contraction in most gastrointestinal sphincters, eye movement disorders, hyperhidrosis, genitourinary disorders and aesthetically undesirable hyperfunctional facial lines. In addition, BoNT is being investigated for the control of pain, and for the management of tension or migraine headaches and myofascial pain syndrome. Benign prostatic hyperplasia (BPH) is a common condition in ageing men; the goal of therapy is to reduce the lower urinary tract symptoms (LUTS) associated with BPH and to improve the quality of life. However, medical treatment, including drugs that relax smooth muscle within the prostate and drugs that shrink the gland are not totally effective or without complications. The standard surgical treatment for BPH is progressively changing to minimally invasive therapies, but none of them has provided clear results. The use of BoNT-A to inhibit the autonomic efferent effects on prostate growth and contraction, and inhibit the abnormal afferent effects on prostate sensation, might be an alternative treatment for BPH. BoNT injections have several advantages over drugs and surgical therapies in the management of intractable or chronic disease; systemic pharmacologic effects are rare, permanent destruction of tissue does not occur, and graded degrees of relaxation may be achieved by varying the dose injected. In this paper, clinical experience over the last years with BoNT in BPH impaired patients will be illustrated.

[Definition of priorities in health research for the Ministry of Health]. / Proceso para priorizar las líneas de investigación esencial de interés para el Ministerio de Salud de Chile.

Health research oriented to solve the most relevant sanitary problems in Chile must be encouraged. In 2001, the National Health Research Fund (FONIS) was created by the National Research Council of the Ministry of Health and the National Scientific Research Commission, to stimulate relevant health research that contributes to develop health care policies. In 2008 an experts meeting proposed eighty research areas. These areas were grouped in twelve thematic containers. Each of these containers were classified as having maximal, intermediate or minimal priority. The seven most important containers were grouped in three areas. Among the latter, two were selected. One is evaluation of the Ministry programs and, within this area, with the following priorities in decreasing importance: primary prevention, health care priorities, and diseases included in the Explicit Guarantees plan. The second area corresponds to diseases with high prevalence, incidence, costs or impact, including the following priorities in diminishing importance: mental health, diseases of high prevalence and problems with social impact.

Proceso para priorizar las líneas de investigación esencial de interés para el Ministerio de Salud de Chile / Definition of priorities in health research for the Ministry of Health

Health research oriented to solve the most relevant sanitary problems in Chile must be encouraged. In 2001, the National Health Research Fund (FONIS) was created by the National Research Council of the Ministry of Health and the National Scientifc Research Commission, to stimulate relevant health research that contributes to develop health care policies. In 2008 an experts meeting proposed eighty research areas. These areas were grouped in twelve thematic containers. Each of these containers were classifed as having maximal, intermediate or minimal priority. The seven most important containers were grouped in three areas. Among the latter, two were selected. One is evaluation of the Ministry programs and, within this area, with the following priorities in decreasing importance: primary prevention, health care priorities, and diseases included in the Explicit Guarantees plan. The second area corresponds to diseases with high prevalence, incidence, costs or impact, including the following priorities in diminishing importance: mental health, diseases of high prevalence and problems with social impact.

Gamma knife radiosurgery in the management of arteriovenous malformations of the Basal Ganglia region of the brain.

OBJECTIVES: The authors report the results of gamma knife (GK) radiosurgery on a clinical series of selected patients with basal ganglia arteriovenous malformations (BGAVMs) in the brain. Clinical, epidemiological, anatomical and functional characteristics of BGAVMs and of supratentorial cortical AVMs are comparatively analyzed, and their influence on radiosurgical outcome is discussed. METHODS: At our Department, 33 BGAVMs (21 with FU > 2 years) and 209 cortical AVMs (110 with FU > 2 years) with a radiosurgical volume

Arteriovenous malformations in the basal ganglia region: Gamma Knife radiosurgery as first choice treatment in selected cases.

BACKGROUND: The authors report the results of Gamma Knife (GK) radiosurgery on a clinical series of selected patients with brain basal ganglia arteriovenous malformations (BG AVMs). Furthermore, clinico-epidemiological and anatomo-functional pictures of BG AVMs and supratentorial cortical AVMs are comparatively analyzed, and their influence on the radiosurgical outcome is discussed. METHODS: At our Department, 33 BG AVMs (21 with FU >2 years) and 209 cortical AVMs (110 with FU >2 years) with a radiosurgical volume 10 cc underwent GK from February 1993 to July 2001. Mean age, male/female ratio (M/F), and bleeding rate at clinical onset in the 2 subgroups of patients were as follows: 25.5 years (5-62 years), 16 M/17 F, and 30/33 (91%) in BG AVMs, respectively; 34.4 years (8-74 years), 124 M/85 F, and 107/209 (51%) in cortical AVMs, respectively. Statistical analysis performed with contingency table method and deviance analysis according to generalized linear models showed that the differences concerning age at onset and bleeding rate were highly significant. RESULTS: The rates of complete obliteration, permanent morbidity, bleeding/rebleeding during latency period, and unsuccessful embolization attempt in the 2 subgroups of patients were as follows: 81%, 4%, 8%, and 41.7% in BG AVMs, respectively; 85.5%, 2%, 2%, and 2% in cortical AVMs, respectively. CONCLUSIONS: In our experience, the different clinico-epidemiological and anatomo-functional characteristics between BG AVMs and cortical AVMs do not seem to influence the radiosurgical outcome as complete obliteration and permanent neurological sequelae rates are very similar in these 2 subgroups of patients. GK radiosurgery may be considered the first choice treatment modality in BG AVMs with <10 cc volume (very high cure rate, very low permanent morbidity, and zero mortality). Although the haemorrhagic onset in BG AVMs is much more frequent than in cortical AVMs, the difference in the bleeding/rebleeding rate between the 2 subgroups of patients during the latency period is not statistically significant and this occurrence seems to be limited within the first year after GK.