Assessing the non-motor symptoms of Parkinson's disease: MDS-UPDRS and NMS Scale.

BACKGROUND AND PURPOSE: Although Parkinson's disease (PD) is characterized by typical motor manifestations, non-motor symptoms (NMS) are an outstanding part of the disease. At present, several specific instruments for assessment of NMS are available. The objective of our study was to determine the performance of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS): Part I - Non-Motor Aspects of Experiences of Daily Living (nM-EDL) compared with the Non-Motor Symptoms Scale (NMSS). METHODS: To this purpose, 434 consecutive patients with PD were included in an international, observational, cross-sectional study. The association between scores of both scales was determined by the Spearman rank correlation coefficient. Equations for transformation of total score of a scale to the other were constructed from weighted regression models and both, transformed and observed score, contrasted by means of the Lin's Concordance Correlation Coefficient (LCCC) and Bland-Altman plot. RESULTS: As a whole, the prevalence of the NMS according to each scale was quite similar, and most of the correlations between their corresponding components were high (r(S) > 0.60). The total score correlation of the MDS-UPDRS Part I with the NMSS was high (r(S) = 0.81). Concerning the transformed scores, estimated scores only partially approach the observed ones (sharing about 60-64% of the variance) because residual variance increased with increasing magnitudes of the scores, i.e. the most severe patients (Bland-Altman plot; LCCC < 0.60 for severe patients). CONCLUSIONS: (i) MDS-UPDRS Part I (nM-EDL) and NMSS showed a strong convergent validity; (ii) however, transformed scores using the equations from weighted regression models showed that for patients with the most severe NMS they are not concordant.

Hemorrhagic cytitis after bone marrow transplantation.

OBJECTIVES: Hemorrhagic cystitis (HC) presenting with gross hematuria, bladder pain and urinary frequency develops in 13-38% of patients following bone marrow transplantation (BMT). The objective of the study was to study the characteristics of patients suffering hemorrhagic cystitis after hematopoietic stem cell transplantation in our center. METHODS: We conducted a retrospective chart review of all patients who underwent BMT at our institution between January 1996 and August 2012. We recorded the age, sex, diagnosis, conditioning regimen, interval between BMT and development of symptoms of cystitis and treatment instituted. RESULTS: Five hundred patients underwent BMT in the period of time studied. 52 of them developed hemorrhagic cystitis. The mean age of the affected patients was 39 years; there were 34 males and 18 females. The diagnoses include AML (n=11), ALL (n=8), CML (n=6), MDS (n=11), CLL (n=5), NHL (n=1), HD (n=5), MM (n=2), Medular aplasia((n=3). HC appeared 59.48 days after BMT. There were no differences between sexes. Mortality among the 52 patients was 51.14% but HC was not the cause of death in any patient. Polyomaviruses were detected in the urine of 78.94 % of survivors. CONCLUSIONS: Polyomavirus infection with BK and JC types is usually acquired in infancy and the virus remains latent in renal tissue. Immunosuppression facilitates reactivation of the renal infection and replication of the virus responsible for the clinical manifestations of HC. The differential diagnoses include other urinary infections, lithiasis, thrombocytopenia and adverse effects of pharmacological agents. The urologist plays a limited role in the management of this disease.

Designing a new scale to measure anxiety symptoms in Parkinson's disease: item selection based on canonical correlation analysis.

BACKGROUND AND PURPOSE: The lack of appropriate measures has hindered the research on anxiety syndromes in Parkinson's disease (PD). The objective of the present cross-sectional, international study was to identify shared elements and grouping of components from anxiety scales as a basis for designing a new scale for use in PD. METHODS: For this purpose, 342 consecutive PD patients were assessed by means of the Mini International Neuropsychiatric Inventory (depression and anxiety sections), the Clinical Global Impression of severity of the anxiety symptoms, the Hamilton Anxiety Rating Scale (HARS), the Neuropsychiatric Inventory (section E), the Beck Anxiety Inventory (BAI) and the Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A). RESULTS: As the HADS-A showed a weak correlation with the HARS and BAI, it was not considered for more analyses. HARS and BAI exploratory factor analysis identified nine factors (62% of the variance), with only two of them combining items from both scales. Therefore, a canonical correlation model (a method to identify relations between components of two groups of variables) was built and it showed four factors grouping items from both scales: the first factor corresponded to 'generalized anxiety'; the second factor included muscular, sensory and autonomic 'non-specific somatic symptoms'; the third factor was dominated by 'respiratory symptoms'; and the fourth factor included 'cardiovascular symptoms'. CONCLUSIONS: BAI is heavily focused on panic symptoms, whilst HARS is more focused towards generalized anxiety symptoms. The new scale should include additional components in order to assess both episodic and persistent anxiety as well as items for evaluation of avoidance behaviour.

Evaluation of a therapeutic vaccine for the prevention of recurrent urinary tract infections versus prophylactic treatment with antibiotics.

INTRODUCTION AND HYPOTHESIS: Urinary tract infections (UTIs) are considered the most common bacterial infections, especially in women. The objective of this study was to evaluate the use of the sublingual bacterial vaccine Uromune® in order to prevent recurrent UTIs (RUTIs). METHODS: This study was conceived as a multicenter observational study. The clinical history of 319 women who presented at least 2 episodes of UTI in the last 6 months or 3 in 12 months was reviewed. Data related to treatment and clinical evolution were recorded and analyzed. A total of 159 patients received prophylactic treatment with Uromune® for a period of 3 months (group A) and 160 with sulfamethoxazole/trimethoprim 200/40 mg/day for a period of 6 months (group B). Uromune® contained an inactivated bacterial cell suspension of selected strains of Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, and Enterococcus faecalis. RESULTS: Patients in group A experienced a highly significant reduction in the number of infections compared to patients in group B. In the first 3 months, the mean number of infections was 0.36 versus 1.60 (P < 0.0001), respectively. A significant reduction was also observed after 9 and 15 months (P < 0.0001). The numbers of patients who did not have any UTI at 3, 9, and 15 months were 101, 90, and 55 in group A versus 9, 4, and 0 in group B (P < 0.0001). CONCLUSIONS: The results obtained in this study favor the use of this bacterial-based therapeutic vaccine as an effective strategy to reduce frequency, duration, severity, and costs of RUTIs.

Clinical profile and epidemiological changes of clear cell renal carcinoma during 12 years in our health area.

OBJECTIVES: To investigate changes in the epidemiology and clinical profile of patients diagnosed with renal clear cell carcinoma in a community health area over 12 years. METHODS: Retrospective analysis of epidemiological characteristics and clinical profile of patients diagnosed with renal clear cell carcinoma in a health area composed of a population of 353.619 inhabitants from January 1999 to December 2010. Descriptive statistical and multivariate analysis, Fisher exact test and Chi-Square were utilized. p<0.05 was accepted as significant. RESULTS: 349 diagnoses of renal mass were reported; 165 of them were clear renal cell carcinoma. Median age was 70.41 years, and the Female/Male rate was 28% and 72%, respectively. 4% women and 30% men smoked ≥20 cigarettes/day, more frequently during the period 1999-2001. 52% women and 30% men had hypertension. Hematuria was the most frequent symptom (23%), more frequent in the period 2007-2010, followed by abdominal pain (16%) and renal colic(13%). Weight loss (12%) was more frequent between 1999-2000. Asthenia appeared as the first symptom in 8% of cases. The tumor was incidentally diagnosed in 20% of cases, more frequently in the period between 2007-2010. Diagnosis was established in the Urology Department in 36% of the cases. Stages T1-2 N0 were more frequent between 2007-2010, and M1 between 1999-2000. G3 was more frequent in the entire series. The relative cancer specific mortality of patients who were surgically treated was less in the last 2 years of the period. CONCLUSIONS: Clear renal cell carcinoma is the most frequent renal cancer and its incidence is increasing in our environment. It affects more frequently males than females, and at an earlier age. The last few years are showing a decrease in the habitual smoker males and an increase in HTN in females. A tendency has been detected to the early stage clinical diagnosis but with a higher histopathological grade. It is most frequent diagnosed by a non-Urology speciality.

[Treatment of stress urinary incontinence with perineal biofeedback by using superficial electrodes]. / Tratamiento de la incontinencia urinaria de esfuerzo con biofeedback perineal con electrodos de superficie.

PURPOSE: We analyze the pelvic floor muscles treatment outcomes by using biofeedback (BFB) with electromyography with superficial electrodes in women diagnosed as having stress urinary incontinence (SUI). Besides, we compare this treatment with pelvic floor muscle exercises (PFME) plus vaginal electrostimulation. METHODS: 85 women with stress urinary incontinence, aged 42 - 74 years. We divided the patients in two groups: Group 1 (N = 50): This patients carry out a perineal biofeedback with superficial electrodes without electrostimulation, and Group 2 (N = 35): This patients were treated with pelvis floor muscle exercices and vaginal electrostimulation. All patients carry out two session per week (of 30 minutes each one) during ten weeks. We assess the outcomes through international urinary incontinence questionnaires (IU-5 and ICIQ-SF) and urinary incontinence related quality of life test (King's questionnaire). Student t-test and Fisher Exact test were used, p < 0.05 was considered statistically significant. RESULTS: No difference was found in the age average of both groups. 84% of patients of group 1 and 80% of patients of group 2 were cured with the treatment. We assumed they were cured when incontinence episodes not happened or they do not need to use absorbent materials. In the Group 1, 50% of patients in the fourth week and 84% in the tenth week were cured. In the Group 2, 71.42% of patients in the fourth week and 80% in the tenth week were cured. In the Group 2, eight patients (22.85%) complained side effects. Both groups improved the quality of life similarly. CONCLUSION: Grade 1 and grade 2 stress urinary incontinence treatment by using perineal biofeedback with superficial electrodes electromyography is better or similar to more invasive treatments. Also pelvic floor muscle exercices plus vaginal electrostimulation have good outcomes although some patients complain side effects. Both conservative treatments are effective and feasible.

[Pulmonary cryptosporidiosis in AIDS patients]. / Criptosporidiosis broncopulmonar en pacientes infectados por el virus de la inmunodeficiencia humana.

Pulmonary cryptosporidiosis is a rare complication of intestinal cryptosporidiosis in AIDS patients. We report the epidemiological, clinical, radiological, microbiological and immunological findings in 5 AIDS patients with pulmonary cryptosporidiosis. Diagnosis was based on the detection of acid-fast oocysts in sputum or aspirated bronchial material using the Kinyoun technique. Microbiology laboratories should be alert to the possibility of Cryptosporidium spp oocysts presence in respiratory specimens from patients with advanced HIV/AIDS disease and pulmonary involvement.

Experimental murine model of renal cancer. / Modelo murino experimental de cáncer renal.

INTRODUCTION: The objective of this study was to determine the reproducibility in a murine model of renal tumours of various histological strains that could be useful for investigating the response to target drugs. MATERIAL AND METHODS: Development and analysis of the "in vivo" model: tumour xenograft of renal cell carcinomas with Balb/c nude athymic mice. Nontumourous human renal tissue was implanted in the interscapular region of 5 mice, chromophobe renal cell carcinoma was implanted in 5 mice (which, after checking its growth, was prepared for implantation in another 10 mice) and Fuhrman grade 2 clear cell renal cell carcinoma (CCRCC) was implanted in 5 mice (which was also subsequently implanted in 10 mice). We monitored the tumour size, onset of metastases and increase in size and number of tumours. When the size had reached a point greater than or equal to locally advanced or metastatic carcinoma, the animals were euthanised for a pathological and immunohistochemical study and a second phase of implantation. RESULTS: The subcutaneous xenograft of the healthy tissue did not grow. The animals were euthanised at 6 months and no renal tissue was found. The chromophobe renal cell carcinoma cells grew in the initial phase (100%); however, in the second phase, we observed a chronic lymphomonocyte inflammatory reaction and a foreign body reaction. The CCRCC grew at 5-8 months both in the first and second phase (100%), maintaining the tumour type and grade. CONCLUSIONS: The model with athymic Balb/c nude mice is useful for reproducing CCRCC, with the same histological characteristics and aggressiveness as native human tumours, promoting the development of the second experimental phase.

[Lesions of the ureter in obstetric-gynecologic surgery]. / Lesiones del uréter en cirugía obstetro-ginecológica.

The chapter of injuries to the ureter during obstetric-gynaecological surgery continues to be ignored in the literature published over the last decades, in spite of its prevalence in the practice. This has motivated our review and update of this issue. The interest of urological diagnostic procedures prior to surgery and conduit examination at any time during the operation exert some influence on the prevention of this pathology. Preoperative finding and reconstruction lead to better results, which benefit from the use of the urinary route, thus leaving the gut route and self-transplantation for exceptional situations. A new iatrogenic pathology has emerged from the most frequent use of gynaecological endoscopic surgery.

[Post-traumatic arterial priapism resolved using supraselective embolization]. / Priapismo arterial postraumático resuelto por embolización supraselectiva.

Presentation of a new case of high flow priapism in a patient with recent background of perineal traumatism. Diagnosis, already inferred through anamnesis, was later suspected from the results of blood gasometry in cavernous bodies, and eventually confirmed by Eco-Doppler. A revision of the related literature revealed a total of 20 patients in whom supraselective embolization has been used as the therapeutical approach, Bucrylate being used in only two of them. Finally, a few considerations are contributed on the therapeutical management of these patients and the relevance of a correct diagnosis of the two distinct groups of priapism, since they differ considerably in terms of treatment.

[Atypical scrotal leiomyoma. A case report]. / Leiomioma atípico de escroto. A propósito de un caso.

A case of intrascrotal atypical leiomyoma is reported. This lesion is extremely rare and usually misdiagnosed. Microscopically, contain bizarre and pleomorphic tumor cells, as well as showed immunohistochemical evidence of smooth muscle differentiation. An important microscopic criterion in the distinction with other entity, as the leiomyosarcoma, is the number of mitotic figures, scarce in the atypical leiomyoma and high in the smooth muscle tumours malignant.

[Disseminated infection due to strongyloides stercoralis in AIDS patients. A report of 2 cases]. / Infección diseminada por strongyloides stercoralis en pacientes con SIDA. A propósito de 2 observaciones.

Strongyloides stercoralis is an intestinal nematode that infects humans worldwide. Infected patients with severe involvement of cellular immunity may develop a syndrome characterized by the dissemination of larvae throughout the body. Extraintestinal strongyloidiasis has been infrequently reported and despite the prevalence of the helminth in tropical and developing countries there are few cases reported in AIDS patients. Most patients with disseminated strongyloidiasis present with fever, cough, diarrhea and shortness of breath. Chest radiographs usually show diffuse infiltrates. The diagnosis has been made by finding the helminth in respiratory secretions or stool. Enteric organisms like Escherichia coli can often be isolated in the blood or cerebrospinal fluid. We report two cases of disseminated strongyloidiasis in AIDS patients, in which stercoralis larvae were detected in sputum and stool samples.

Paraganglioma of prostatic origin.

INTRODUCTION: Paragangliomas are usually benign tumors arising from chromaffin cells located outside the adrenal gland. Prostatic paraganglioma is an unusual entity in adult patients, with only 10 cases reported in the medical literature. CASE REPORT: A 34-year-old male with a history of chronic prostatitis consulted for perineal pain. On digital rectal examination the prostate was enlarged and firm, without nodules. The PSA level was 0.8 ng/mL and the catecholamines in the urine were elevated. On ultrasound a retrovesical 9 cm mass of undetermined origin measuring was present. A PET-CT scan showed a pelvic lesion measuring 9 cm with moderate increase in glucidic metabolism localized in the area of the prostate. A biopsy of the prostate revealed a neuroendocrine tumor, possibly a prostatic paraganglioma. A body scintigraphy with MIBG I-123 ruled out the presence of metastases or multifocal tumor. A radical prostatectomy with excision of the pelvic mass was performed under adrenergic blockade. One year after surgery the patient is asymptomatic and disease free. DISCUSSION/CONCLUSIONS: Prostatic paraganglioma is a rare, usually benign tumor, which should be considered in the differential diagnosis of prostate tumors in young males. Its diagnosis is based on the determination of catecholamine in blood and 24-hour urine and in imaging studies principally scintigraphy with MIBG I-123. Diagnostic confirmation is by histopathological study. The treatment consists of radical resection under adrenergic blockade and volume expansion. Given the limited number of cases reported, it is difficult to establish prognostic factors. Malignancy is defined by clinical criteria, and requires life long follow-up.

Dementia associated with Parkinson's disease: applying the Movement Disorder Society Task Force criteria.

BACKGROUND: Diagnostic criteria and procedures for dementia in Parkinson's disease (PDD) have been proposed by a Movement Disorders Society Task Force (MDS-TF). The objective of this study was to explore the utility of the new MDS-TF criteria and procedures in clinical practice. METHODS: Two hundred ninety nine PD patients (36.5% with PDD as per MDFS-TF criteria; 33.1% according the DSM-IV) were included in the study. A variety of standardized motor, cognitive, psychiatric, and global severity measures were administered. A multivariate logistic regression model was built to determine the variables producing discrepancy between the MDS-TF and DSM-IV criteria for PDD and the clinical features that distinguished false negative cases. RESULTS: Agreement between MDS-TF and DSM-IV criteria was substantial (87.3%; kappa = 0.72), but the DSM-IV criteria failed to identify 22% of patients fulfilling MDS-TF criteria. False negative cases were older and had more severe motor symptoms but less psychosis than those true non-demented PD. False positives had less severe motor symptoms than true PDD, although the difference did not reach statistical significance. CONCLUSIONS: Our findings suggest that the MDS-TF criteria are more sensitive than the DSM-IV for a diagnosis of PDD. Old age, absence of psychiatric symptoms, and severe motor impairment can hinder the diagnosis of PDD.

[Risk factors for failure after transobturator vaginal tape for urinary incontinence]. / Factores de riesgo de fracaso de la corrección quirúrgica de la incontinencia urinaria de esfuerzo mediante cinta suburetral transobturatriz.

OBJECTIVE: To identify risk factors leading to treatment failure in a sample of 302 women with stress urinary incontinence (SUI) treated by transobturator vaginal tape (TOT) with a medium follow-up of 4 years (range 1-6). MATERIAL AND METHODS: A population based cohort study with prospectively data from 302 women, aged 41-81 years underwent TOT between April 2003-November 2010. Data were collected by validated questionnaire on urinary incontinence, the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), and clinical data-records. Continence was achieved in 262 (Group A) and 40 continued with incontinence (Group B). We investigated the relationship between age, SUI evolution time, type and number of childbirths (eutocic, dystocic, nulliparous, multiparous status) and medical and/or surgical backgrounds. The ICIQ-SF questionnaire was used to describe whether the surgery outcomes were successful or not. RESULTS: Group A were younger (p=0.0001), had less SUI evolution time (p=0.017); more eutocic childbirths (p=0.000018). Group B had more dystocic childbirth (p=0.022), previous tension free vaginal tape (TVT) or TOT (p=0.03.), antidepressant-anxiolytic drugs (p=0.003), antihypertensive drugs (p=0.0005), type 1 diabetes (p=0.02), arterial hypertension (p=0.0007), respiratory diseases (p=0.025). Differences were not found with regard to nulliparous (p=0.701), multiparous status (p=0.42), obesity (p=0.18), intestinal disorders (p=0.59), oophorectomy (p=0.19), caesarean (p=0.17), prolapse surgery (p=0.29), hysterectomy (p=0.57), allergies (p=0.48), arthritis (p=0.22), arthrosis (p=0.44), depression (p=0.74), type 2 diabetes (p=0.44), smoking patterns (p=0.28), fibromyalgia (p=0.47). CONCLUSIONS: Elderly women, with long evolution SUI, dystocic delivery, previous TVT or TOT appear as independent risk factors associated to TOT failure. These factors may make the indication of another surgical approach recommendable.