Prevalence and clinical characteristics of pulmonary TB among pregnant and post-partum women.

SETTING: Antenatal care (ANC) and postpartum care (PPC) clinic in Manhiça District, Mozambique.OBJECTIVE: To estimate the prevalence of TB among pregnant and post-partum women and describe the clinical characteristics of the disease in a rural area of Southern Mozambique.METHODS: We conducted a cross-sectional TB prevalence study among pregnant and post-partum women recruited from September 2016 to March 2018 at the Manhiça Health Care Center (MHC). We recruited two independent cohorts of women consecutively presenting for routine pregnancy or post-partum follow-up visits.RESULTS: A total of 1,980 women from the ANC clinic and 1,010 from the PPC clinic were enrolled. We found a TB prevalence of 505/100,000 (95% CI: 242-926) among pregnant women and 297/100,000 (95% CI: 61-865) among post-partum women. Among HIV-positive pregnant women, TB prevalence was 1,626/100,000 (95% CI: 782-2,970) and among postpartum HIV-positive women, TB prevalence was 984/100,000 (95% CI: 203-2,848).CONCLUSIONS: The burden of TB was not higher in postpartum women than in pregnant women. Most TB cases were detected in HIV-positive women. TB screening and diagnostic testing among pregnant and postpartum women attending ANC and PPC clinics in Manhiça District is acceptable and feasible.

A meta-analysis of the vascular-related safety profile and efficacy of alpha-adrenergic blockers for symptoms related to benign prostatic hyperplasia.

OBJECTIVES: To evaluate the safety profile and efficacy of alpha1-adrenergic receptor blockers (A1Bs) currently prescribed for benign prostatic hyperplasia (BPH). DATA SOURCES: A systematic literature search of MEDLINE, the Cochrane Database and the Food and Drug Administration Web site through December 2006 identified double-blinded, prospective, placebo-controlled trials, evaluating agents commercially available by prescription for the symptomatic treatment of BPH. REVIEW METHODS: Data were reviewed by two investigators with the use of a standardised data abstraction form. Studies were evaluated for methodological quality using the Jadad scale. Studies with a score of < 3 were considered of weaker methodology. RESULTS: Of 2389 potential citations, 25 were usable for evaluation of safety data, 26 for efficacy. A1B use was associated with a statistically significant increase in the odds of developing a vascular-related event [odds ratio (OR) 2.54; 95% confidence interval (CI): 2.00-3.24; p < 0.0001]. The odds of developing a vascular-related adverse event were: alfuzosin, OR 1.66, 95% CI: 1.17-2.36; terazosin, OR 3.71, 95% CI: 2.48-5.53; doxazosin, OR 3.32, 95% CI: 2.10-5.23 and tamsulosin, OR 1.42, 95% CI: 0.99-2.05. A1Bs increased Q(max) by 1.32 ml/min (95% CI: 1.07-1.57) compared with placebo. Difference from placebo in American Urological Association symptom index/International Prostate Symptom Score was -1.92 points (95% CI: -2.71 to -1.14). CONCLUSIONS: Alfuzosin, terazosin and doxazosin showed a statistically significant increased risk of developing vascular-related events compared with placebo. Tamsulosin showed a numerical increase that was not statistically significant. All agents significantly improved Q(max) and symptom signs compared with placebo.

Monoclonal antibodies to human renal cell carcinoma: recognition of shared and restricted tissue antigens.

Monoclonal antibodies (MABs) reactive with human renal cell carcinoma (RCC) were generated following immunization of mice with either RCC homogenates, RCC cell lines, or fetal kidney homogenates. The characteristics of four highly reactive immunoglobulin G1 MABs, designated UMVA-RCC-A6H, UMVA-RCC-A36, UMVA-RCC-C5H and UMVA-RCC-D5D are presented. The screening process consisted of a cell binding enzyme-linked immunosorbent assay and immunohistological examination of tumor, normal, and fetal tissue sections. The MABs illustrated various degrees of antigen restriction: A6H identified an antigen common to RCC, some lung and colon carcinomas, the proximal renal tubules but no other normal tissues; A36 reacted with most human tumors, the renal tubules, and many other normal tissues; C5H reacted with nearly every human cancer but of the normal tissues, only the renal glomerulus shared this antigen; D5D was very restrictive, reacting with many although not all RCC and no other cancers or normal tissues with the exception of an occasional reactivity with a Bowman's capsule. Metastatic RCC and RCC xenografts expressed these antigens. None of the MABs participated in complement-mediated cytotoxicity. In immunoprecipitation studies with L-[methyl-3H]methionine and [3H]glucosamine-HCl metabolically labeled RCC cells, C5H was shown to be associated with an antigen of Mr 115,000.

Prostate cancer.

Clinically, prostate cancer (prostatic adenocarcinoma) is now the most frequently diagnosed cancer in males and the second leading cause of mortality due to cancer in the United States. However, because 75% of histologic prostate cancers remain functionally benign (will not metastasize and kill the patient), mass screening of the male population for the disease has become a hotly debated issue among urologists. The real challenge in the upcoming decade for geriatricians, though, will be to diagnose earlier in their course the prostate cancers which, if not treated, will metastasize and kill the patient and thus allow this subgroup of patients the opportunity to be treated more effectively. This review briefly discusses the etiology of prostate cancer, ways the disease may present, current treatments, depending on disease stage, screening in the diagnosis of prostate cancer, and quality of life issues important to patients confronted with the disease.

Monoclonal antibodies in human renal cell carcinoma and their use in radioimmune localization and therapy of tumor xenografts.

A series of monoclonal antibodies (Mabs) to human renal cell carcinoma (RCC) material was developed. Two Mabs (D5D and A6H) that showed especially restrictive reactivities were radiolabeled with iodine 131 and tested in nude mice bearing human tumor xenografts for their ability to specifically localize RCC. Extensive studies of tissue radioactive uptake indicated that these Mabs could specifically localize RCC tumors with some mice achieving high tumor:blood ratios ranging from 15 to 60. Scintigraphic scanning revealed specific and consistent detection of RCC xenografts. Finally, preliminary results indicate that larger intravenous doses of radiolabeled RCC Mabs were effective as radioimmune therapy in inhibiting RCC xenograft growth. Mabs can be produced that are highly restrictive to human RCC and may be useful clinically for radioimmunoscintigraphy or therapy.

Questionnaire survey of urologists and primary care physicians' diagnostic and treatment practices for prostatitis.

OBJECTIVES: To establish diagnostic and treatment practices for chronic prostatitis by survey of urologists in Wisconsin and primary care providers in Dane County, Wisconsin. METHODS: All Wisconsin urologists (n = 135) and primary care providers in Dane County, Wisconsin (n = 365) were surveyed by mail with a 10-item questionnaire used to establish diagnostic and treatment practices for prostatitis. RESULTS: Seventy-eight percent of primary caregivers consider prostatitis to be bacterial in nature, whereas 59% of urologists consider it to be noninfectious. Fewer than 50% of primary care providers consider pain to be other than perineal in the diagnosis. Fewer than 50% of urologists or primary caregivers evaluate expressed prostatic secretions and few primary care providers (11%) use nonantibiotic therapy. CONCLUSIONS: The diagnostic and treatment practices for prostatitis do not follow standard textbook algorithms.

Prostate cancer screening in younger men: prostate-specific antigen and public awareness.

The American Cancer Society recommends annual digital rectal examination for men over forty years of age. We evaluated 414 men between forty and fifty-nine years of age with a questionnaire, digital rectal examination (DRE), and prostate-specific antigen (PSA) determination. One hundred ninety were forty to forty-nine years old, and 224 were fifty to fifty-nine years old. Four patients in the forty to forty-nine age group had elevated PSA determinations, and 7 had abnormal findings on DRE. Using prostate ultrasound and biopsy, no cases of prostate cancer were diagnosed. Ten patients in the fifty to fifty-nine age group had elevated PSA determinations, and 5 were diagnosed to have prostate cancer. These data suggest that PSA may have utility in detecting cancer in younger men.

Use of terazosin in prostatodynia and validation of a symptom score questionnaire.

OBJECTIVE: The purpose of this trial was to study the use of terazosin in nonbacterial prostatitis/prostatodynia, and to evaluate a new symptom score sheet for this disease. METHODS: Twenty-five patients who presented with lower urinary tract symptoms suggestive of prostatitis were evaluated for evidence of bacterial infection by Meares-Stamey criteria and found to be negative. They were then treated with the alpha-blocking drug terazosin in doses from 1 to 10 mg. A symptom score index for prostatitis was developed, tested in these patients, and validated against patients with benign prostatic hyperplasia. Normal control patients, who presented for vasectomy, were studied as well. RESULTS: Nineteen patients (76%) responded to one month's therapy, with 11 (58%) remaining asymptomatic three months later. The symptom score index, as measured by Cronbach's alpha measure of index reliability, was excellent at 0.78 and logistic regression analysis demonstrated each prostatitis question to have independent validity (P < 0.001) but not to the extent of the combined score. CONCLUSIONS: Terazosin appears effective in treating patients with nonbacterial prostatitis/prostatodynia. This new symptom score is one way to evaluate and track patients with this disease. A randomized, placebo-controlled clinical trial has been initiated to study this.

Synchronous independent primary osteosarcoma and adenocarcinoma of kidney.

Primary osteogenic sarcomas are extremely rare tumors of the kidney. The association with a juxtaposed renal "clear" cell carcinoma would appear to be unique, although several cases of osteogenic sarcomatous differentiation have been described within so-called sarcomatoid renal cell carcinoma variants. We report a case of synchronous independent development of both renal cell carcinoma and osteogenic sarcoma within the same kidney.

Urinary symptomatology in younger men.

OBJECTIVES: We surveyed a "population" of younger men (20 to 49 years old) for lower urinary tract symptomatology and for symptomatology associated with prostatitis. METHODS: A National Guard unit was surveyed by mail with a 58-question urinary symptom questionnaire. Surveys were returned anonymously by mail. RESULTS: International Prostate Symptom Score (IPSS) of 8 or greater was seen in 5% of men in their 20s and rose to 15% of those in their 40s. Approximately 5% (0% to 7%) reported a history of prostatitis. Caffeine caused symptoms in 2% to 13%, while exercise and smoking were not associated with symptoms. Individual prostatitis symptoms were only seen occasionally across this age group. CONCLUSIONS: As measured by the IPSS, urinary symptoms increased during the 20 to 49-year age period. A history of prostatitis in much less common than most nonpopulation studies suggest.

Squamous cell carcinoma of prostate.

A primary squamous cell carcinoma occurring in the prostate of a sixty-nine-year-old man is described. A radical excision that included cystoprostatectomy, total penectomy, scrotectomy, pubic symphysiectomy, and abdominoperineal resection of rectum was done. The patient died of systemic metastases six months after diagnosis. Review of the literature suggests that such a cancer of the prostate is rare, highly aggressive, and responds poorly to any mode of therapy. Histogenesis of this tumor remains controversial; however, it probably does not originate from the prostatic acinar cells.

Testicular teratocarcinoma with intracaval metastases to the heart.

We report a case of testicular teratocarcinoma involving the inferior vena cava with extension to the right atrium and metastases to the tricuspid valve. We believe this to be the first such reported case.

Use of the pneumo sleeve as an adjunct in laparoscopic nephrectomy.

Having "a hand" in the abdomen when performing laparoscopic surgery offers tactile feedback, rapid finger dissection, enhanced retraction capabilities, and simplified hemostasis for the operating surgeon. We utilized the Pneumo Sleeve for technically challenging laparoscopic nephrectomies. This device may have applicability in select urologic laparoscopic operations.

Acid phosphatase for monitoring prostatic carcinoma. Comparison of radioimmunoassay and enzymatic techniques.

We compared a commercial radioimmunoassay kit with an enzymatic assay for prostatic acid phosphatase in monitoring the progression or remission of disease in 27 patients with prostatic cancer. In 5 of the 18 patients whose disease progressed, and in 4 of the 9 whose disease responded to treatment, the change was reflected better by the radioimmunoassay. In no case was the enzymatic assay better. Radioimmunoassay for prostatic acid phosphatase may be an effective and sensitive way to monitor the course of carcinoma of the prostate.

Laparoscopic cryosurgery of the kidney in the porcine model: an acute histological study.

OBJECTIVES: To verify histologically whether cryosurgery of the kidney can be accomplished reproducibly without injuring adjacent structures, using a combination of ultrasound and laparoscopic guidance. MATERIALS AND METHODS: Six kidneys from three domestic female farm pigs were utilized in the study. Under general anesthesia and after obtaining pneumoperitoneum, the lower pole of the kidney was mobilized laparoscopically and the ureter and adjacent bowel were protected with saline-soaked gauze. Two 3.8 mm-cryoprobes were placed percutaneously into the lower pole and cryoablation was carried out under laparoscopic and ultrasound guidance using a double-freeze technique (10-minute freeze and 5-minute thaw cycles to a probe temperature of -185 degrees C to -196 degrees C) in five kidneys (one control). The kidneys, adjacent ureter and bowel were harvested acutely, and macroscopic, histologic, and electron microscopic evaluation of all specimens was performed. RESULTS: Macroscopically, clear margins of cryodestruction corresponded with the ultrasound images of the iceball. In all five treated kidneys, reproducible cell death corresponding to visible margins of cryodestruction were verified histologically. Cell death was further corroborated by electron microscopy. Adjacent structures (ureter and bowel) were sectioned and no significant damage was noted. Blood pressure remained constant throughout the procedure. A crack in the renal parenchyma of one kidney was noted during the thaw phase; at harvest that animal was found to have an intraperitoneal hemorrhage. CONCLUSION: Combined laparoscopic and ultrasound-guided cryoablation of the lower pole of the kidney can be accomplished reproducibly in the porcine model without injury to adjacent structures.

Bropirimine immunotherapy of upper urinary tract carcinoma in situ.

OBJECTIVES: Bropirimine has been shown to be effective in treating approximately 50% of patients with carcinoma in situ (CIS) of the bladder in recent clinical trials. Patients with upper tract CIS were treated with bropirimine to determine whether this oral drug might be effective in that setting. METHODS: Twenty-four patients with negative radiographic findings and positive cytologic evidence for upper tract CIS in one or both ureters received bropirimine (3.0 g/day orally) for 3 consecutive days each week for up to 1 year. Ureteral collection of urine or barbotage for cytologic analysis was performed quarterly thereafter. RESULTS: Ten (48%) of 21 evaluable patients had a negative ureteral cytologic analysis after 12 weeks (5 patients) or 24 weeks (5 patients). Of these 10 patients, 8 continue to have negative cytology for a period of 3 to 30 months (median, more than 9 months). In 2 patients, negative cytology reverted to positive at 6 and 9 months, respectively, during therapy. Twelve (50%) of the 24 patients reported no toxicity. Three patients stopped treatment at 2, 3, and 3 weeks due to pruritic rash, nausea and vomiting, and severe bone pain, respectively. Therapy was stopped in 1 additional patient between 4 and 5 months because of transient liver enzyme elevations, yet this patient has had a continuous negative cytologic analysis for more than 9 months. CONCLUSIONS: Orally administered bropirimine may be effective therapy for CIS of the ureter or renal pelvis, with acceptable toxicity in most patients. Further efforts to better define this activity as well as the possible need for maintenance or intermittent long-term therapy are warranted.

Oral bropirimine immunotherapy of carcinoma in situ of the bladder: results of a phase II trial.

OBJECTIVES: Bropirimine is an orally administered immunostimulant that has been shown to have activity against carcinoma in situ (CIS) of the bladder. To further assess this potential activity, bropirimine was administered to 42 patients for bladder CIS in a Phase II trial. METHODS: Patients were treated with bropirimine 3.0 g/day by mouth for 3 consecutive days each week up to 1 year. Cystoscopy with biopsies and bladder wash cytology were performed quarterly. RESULTS: Twenty (61%) of 33 evaluable patients converted malignant biopsies and bladder wash cytology to negative, including 6 (50%) of 12 who failed prior bacillus Calmette-Guérin (BCG) immunotherapy, 14 (67%) of 21 who had not received prior BCG therapy, and 12 (80%) of 15 with primary CIS. Median response duration exceeds 21 months. Four of the 20 responders did have a papillary tumor recurrence at 3 to 15 months, all Stage Ta or T1. Mild toxicity (grade I or II) suggestive to interferon induction or administration occurred in one third of patients. Headache, transient hepatic enzyme elevations, skin rash, and arthralgias each occurred in 5% to 14% of the patients, with nausea or emesis in 21%. Grade 1 tachycardia/palpitations or chest pain each were noted in 5%. CONCLUSIONS: Oral bropirimine can induce remission of bladder CIS with acceptable toxicity at 3.0 g/day. Bropirimine may be a valuable alternative to cystectomy for some failures of BCG therapy and may have the potential to replace BCG as front-line therapy because of its ease of administration.

Prostate cancer.

Prostate cancer is the second leading cause of cancer death in men. Recommendations for screening and treatment are usually made, especially in the popular press, without regard to patient age or medical health. This article focuses on the trade-off between the benefits and side effects of screening and treatment.

Laparoscopic renal cryotherapy in swine: comparison of puncture cryotherapy preceded by arterial embolization and contact cryotherapy.

Variable results of open, percutaneous, and laparoscopic cryosurgery of the kidney have been reported. Minimally invasive approaches to lower-pole renal ablation were prospectively compared in swine: laparoscopic puncture cryoablation preceded by arterial embolization, laparoscopic contact cryosurgery, and arterial embolization alone. Eighteen kidneys in nine domestic pigs were randomized to one of three treatment groups of six organs each: (1) puncture cryotherapy preceded by selective lower-pole arterial embolization; (2) contact cryotherapy alone; and (3) arterial embolization alone. Under general anesthesia, appropriate animals underwent selective arterial embolization of the lower pole via femoral cutdown using Gelfoam pledgets. Animals randomized to cryotherapy underwent dissection of the lower pole of the kidney using a single 12-mm umbilical and two midclavicular-line ports in the lateral position. Under external ultrasound guidance, two 3-mm cryoprobes (Cryomedical Sciences, Rockville, MD) were positioned in the lower pole of the kidney, and double-freeze technique to -190 degrees C was performed using puncture or contact application. Ultrasonography was used to guide probe insertion during puncture cryotherapy only. Kidneys were harvested 11 to 14 days after the procedure. Both puncture and contact kidneys demonstrated cell death and subsequent necrosis by light microscopy and electron micrography. On average, puncture lesions were heavier than contact lesions, 19.3 g v 10.1 g (P = 0.02; unpaired t-test), whereas the kidneys were equivalent in weight: 74.1 g v 74.1 g. Puncture lesions represented 26.4% of total kidney weight v 13.5% in the contact group (P = 0.002; unpaired t-test). Only focal infarcts were identified in the embolization group. No evidence of adjacent visceral injury was identified in any of the groups, and no animal required conversion to open laparotomy. One kidney bled after contact cryotherapy, and hemostasis was achieved laparoscopically. Laparoscopic cryotherapy is reproducible and effective using either the puncture technique preceded by arterial embolization or the contact technique, without evidence of damage to adjacent structures. Contact lesions were less voluminous and more peripheral than puncture lesions. Embolization alone produces focal infarcts and focal zones of cell death.

Rise in sexually transmitted diseases during democratization and economic crisis in Mongolia.

In 1990, democratic changes and loss of Soviet economic subsidies led to enormous social upheaval in Mongolia. The objective of this study is to map sexually transmitted disease (STD) trends in Mongolia from 1983-1995 and review human immunodeficiency virus (HIV) surveillance data since 1987. Data for syphilis show a decreasing trend from 1983-1993 with a decline in cases from 70 to 18/100,000 population, followed by a rise in cases to 32/100,000 population in 1995. Data suggest a 1.5-3.0 fold higher rate of syphilis for ages 15-24 than for any other group. Data for gonorrhoea show an upward trend in the rate of cases, from 51/100,000 population in 1983 to 142/100,000 in 1995. The majority of cases are aged 15-44. Trichomonas rates also show an upward trend in the number of cases, from 47/100,000 population in 1983 to 155/100,000 cases in 1995. Like gonorrhoea the majority of cases are in the 15-44 year age range. For children aged 0-14, the 1983-1993 rate remained below 4.5/100,000; however, in 1994 and 1995 the rate increased reaching 53 and 48/100,000 respectively. Since 1987, more than 176,000 HIV tests have been done with only one confirmed positive result. Rises in STD rates coincide with deterioration in STD services and reduced active surveillance, suggesting that these data reflect a minimum estimation of the problem. Changes in business and social circumstances may have resulted in increasing HIV and STD risk behaviour.

PIP: Democratic change and the loss of Soviet economic subsidies in 1990 led to major social upheaval in Mongolia. Changes in business and social circumstances appear to have resulted in a higher level of HIV and sexually transmitted disease (STD) risk behavior. The prevalence of syphilis cases declined over the period 1983-93 from 70/100,000 population to 18/100,000, then increased to 32/100,000 in 1995. The data indicate a 1.5-3.0-fold higher rate of syphilis for ages 15-24 years than for any other group. The prevalence of infection with gonorrhea increased from 51/100,000 population in 1983 to 142/100,000 in 1995, with the majority of cases aged 15-44 years, while the level of trichomonas infection also increased, from 47/100,000 population in 1983 to 155/100,000 in 1995. The majority of trichomonas cases were also among people aged 15-44 years. For children aged 0-14 years, the level of trichomonas infection remained below 4.5/100,000 during 1983-93, but increased in 1994 and 1995 to 53/100,000 and 48/100,000, respectively. The more than 176,000 HIV tests conducted since 1987 have identified only one confirmed positive case of infection.