[A patient suffering from priapism as a side-effect of pipamperone]. / Een patiënt met priapisme als gevolg van pipamperon.

BACKGROUND: Antipsychotic drugs can cause a wide and varied range of side -effects because of their affinity for serotonergic, dopaminergic, adrenergic and histaminergic receptors. Priapism is a rare and serious side-effect of antipsychotic drugs and is probably caused by their alpha 1-adrenergic receptor blocking activity. CASE DESCRIPTION: A 13-year-old boy with a history of Gilles de la Tourette Syndrome was presented to the urologist with a history of a penile erection for more than 24 hours, since waking the previous morning. He had used pipamperone and clonidine for a long period of time and he reported that he regularly had prolonged erections since one year. An ischaemic priapism was diagnosed. Underlying pathology as the cause of the priapism was ruled out and the diagnosis of pipamperone-induced priapism was made per exclusionem. CONCLUSION: The use of antipsychotic drugs should be discontinued in the occurrence of this side-effect. If necessary, an alternative drug with a low alpha 1-adrenergic receptor affinity should be given.

Prognostic value of proliferative activity and nuclear morphometry for progression in TaT1 urothelial cell carcinomas of the urinary bladder.

OBJECTIVES: To analyze the predictive power of Ki67 area% (Ki67), mitotic activity index (MAI), p53 area% (p53), and the mean area of the 10 largest nuclei (MNA10) for progression of stage in 195 primary consecutive TaT1 urothelial cell carcinomas of the urinary bladder. METHODS: Ki67- and p53-positive versus negative nuclei, MAI, and MNA10 using motorized systematic random sampling morphometry were determined. Kaplan-Meier curves and multivariate survival analysis (Cox model) were used to assess the prognostic value of the quantitative and classic clinicopathologic risk factors (age, sex, stage, grade, carcinoma in situ, multicentricity). RESULTS: Thirteen (6.7%) of the 195 patients had progression (0 [0%] of 36 low-risk, 1 [1.1%] of 85 intermediate-risk, and 12 [16.2%] of 74 high-risk patients). In univariate analysis (all variables), the strongest predictors with the highest hazard ratios were Ki67 (threshold 25.0%), MAI (threshold 30), and MNA10 (threshold 170 microm2). In multivariate analysis, the strongest independent combinations for progression--MNA10 (170 microm2) plus MAI (threshold 30) and MNA10 (threshold 170 microm2) plus Ki67 (threshold 25.0%)--overshadowed all other features. p53 was weaker but, combined with Ki67, still predicted progression fairly well. In the total group, the sensitivity, specificity, and positive and negative predictive values of MNA10-MAI and MNA10-Ki67 at the thresholds mentioned were 100%, 89%, 38%, and 100%, respectively. These feature combinations were also strongest prognostically in the high-risk treatment group. CONCLUSIONS: The combined biomarkers MNA10-MAI or MNA10-Ki67 are accurate, well reproducible, and easy to assess progression predictors in all patients with TaT1 urothelial cell carcinomas, as well as in high-risk (bacille Calmette-Guérin-treated) patients.