The first comparative double-blind trial on efficacy and safety of ergotamine based five-component combination and sumatriptan in migraine without aura.

BACKGROUND: Dihydroergotamine or ergotamine are the most effective preparations for aborting acute attacks of migraine without aura. OBJECTIVE: The aim of our study was to compare the efficacy and safety of ergotamine based five-component drug combination and sumatriptan in the treatment of moderate to severe acute attacks of migraine without aura. METHODS: The study was designed as a randomized, double-blind, double-dummy, placebo-controlled, parallel arm, multi-center clinical trial. The enrolled patients having migraine without aura were randomized to one of the study arms, ergotamine based five-component drug combination or sumatriptan. RESULTS: In total, 201 patients were randomized to one of the treatment arms. Higher percentage of patients was completely free of the headache two hours after dose administration in the ergotamine-based medication group compared to the sumatriptan group, regardless whether all (51.12 % vs 33.70 %) or only repeated attacks were taken into account (50.91 % vs 23.73 %); the salvage therapy (diclofenac) utilization rate was also lower in the ergotamine-based medication group (relative risk 0.61). Photophobia, phonophobia, and osmophobia were reversed more frequently in the ergotamine-based medication group (51.12 % vs 33.70 %), and failure to abort an attack of the migraine without aura occurred more frequently in the group treated with sumatriptan (1.1 % vs 4.9 %). The headache intensity two hours after ingestion of the study medication increased more frequently with sumatriptan, while other adverse events were rare in both groups. CONCLUSIONS: This study demonstrated higher efficacy and similar safety of ergotamine based fixed drug combination in comparison to sumatriptan, when used in the treatment of an acute attack of the migraine. HIPPOKRATIA 2018, 22(1): 17-22.

[Recanalization of urethral strictures using a temporary curved biocompatible new generation metal endoprosthesis]].

The male urethral stricture treatment is actual clinical issue with its resolution being increasingly frequently based on application of minimum invasive therapeutic interventional uroradiology methods. Since the methodology is applied over the last two decades, the most reasonable therapeutic algorithm has not been defined yet with respect to the correlation with the contemporary surgical treatment. The results of application of the temporary covered self-expandable nitinol Allium stents, which have been applied for the first time ever at our Institution in October 2003. Over the last 3 years, the method was applied in 40 males, averagely aged 54 years with urethral strictures previously treated by urological methods. In four cases, stent placement was performed after endourethral incision. The most common etiology of the stricture was the posttraumatic (55%), post-inflammatory (32%) and iatrogenic (10%). In all the cases, stents were removed 12-14 months after their insertions. The results are evaluated using uroflowmetry and urethrocystography, revealing in 85% of the cases permanent recanalization free of dysuric complaints. Development of a stricture on the anterior stent end was evidenced in 15% of the cases.

Stage T2 prostate cancer presented with high serum prostate specific antigen and nonspecific bone lesions.

OBJECTIVE: To present the case of T2 prostate cancer (PCa) mimicking disseminated PCa that was successfully treated with radical retropubic prostatectomy (RRP). PATIENT AND THE METHOD: The patient had prostate specific antigen (PSA) level higher than 30 ng/ml and multiple atypical lesions on bone scan. TRUS-guided biopsy proved small PCa, only in 1/18 biopsy cores, with Gleason grade 6 (3+3). Bone lesions appeared to be posttraumatic. RESULT: The patient underwent RRP; six months after surgery there is no evidence of the disease. CONCLUSION: Serum PSA level is the sum of cancer activity, normal and BHP tissue production, as well as the result of other pathological conditions, like prostatitis. In some cases, inflammation can be responsible for high PSA level and over-staging.

The vascular impact of uterine artery embolization: prospective sonographic assessment of ovarian arterial circulation.

PURPOSE: The etiology of premature ovarian failure after uterine artery embolization (UAE) is unknown. The authors prospectively assessed ovarian arterial circulation before and after UAE with use of ultrasonography (US). The authors hypothesize that nontarget embolization of the ovary occurs during routine UAE. MATERIALS AND METHODS: Twenty-three women (mean age of 42.6 years; range, 35-51 y) participated in the study. Grayscale, color, and pulsed-wave Doppler US studies were performed immediately before and after UAE. Resistive index (RI) and pulsatility index (PI) were calculated. The proportion of women who developed increased vascular impedance after UAE was statistically assessed with use of the Yates-corrected chi(2) test. RESULTS: Seventeen of 23 patients (74%) completed the study. Nine of 17 (54%) showed complete loss of ovarian arterial perfusion after UAE. Six of 17 (35%) had increases in RI and PI, whereas two of 17 (11%) had decreases in RI and PI. The increase in vascular impedance after UAE in 15 of 17 patients was significant (P <.0001). CONCLUSION: Loss of detectable ovarian arterial perfusion occurs in the majority of patients undergoing UAE. Ovarian vascular impedance increases in nearly all patients as a result of UAE. The authors conclude that inadvertent nontarget embolization of the ovarian arterial bed occurs during routine UAE.

[Modern diagnosis of genito-pelvic echinococcosis in women]. / Savremena dijagnostika genito-pelvicne ehinokokoze zene.

From 1927 to 1983, out of 25,388 laparotomies, 10 cases (0.038%), and out of 1,463 vaginal hysterectomies, only one case (0.068%) of genito-pelvic echinococcosis were recorded. Ultrasound (exemplified by a case), and computerized tomography have recently been used for establishing preoperative diagnosis.

[Morcellement in vaginal hysterectomy]. / Morcellement kod vaginalne histerektomije

From 1968 to 1975 the authors performed 632 vaginal histerectomies; morcellement was applied in 81 patients (12.81%). The largest uterus subjected to morcellement weighed 700 g; most of them weighed about 250 g. In all cases morcellement was applied due to the enlarged uterus. In the authors opinion, the uterus can be extirpated vaginally until it reaches the size corresponding to pregnancy up to 12 weeks. The postoperative morbidity rate in patients with vaginal histerectomy and morcellement proved to be 30.56%. Morcellement doest not increase the occurrence of intraoperative injuries of the neighbouring organs or early postoperative morbidity.

[Vaginal hysterectomy following previous abdominal and gynecologic surgery]. / Vaginalna histerektomija posle prethodnih hirurskih abdominalnih i ginekoloskih operacija

The authors analyse 125 cases of vaginal histerectomy (V.H.) preceded by vaginal and abdominal operations (15.3% of a total of 817 V.H.) There were 95 cases of previous abdominal operations and 30 cases of previous gynecological operations (19 vaginal and 11 abdominal). The most frequent previously performed vaginal operation was anterior and posterior colporrhaphy. The authors have come to the conclusion that neither previous abdominal nor previous gynecological surgical interventions make the carrying out of vaginal histerectomy more difficult. Only Doleris's operation, among abdominal ones, may represent a relative contraindication for V.H. In one case the authors had to complete the already started histerectomy abdominally owing to some technical difficulties. The authors maintain that it would be good to use vaginal histerectomy more frequently after previously applied gynecological, vaginal, and abdominal operations.