Peyronie’s disease: Contemporary evaluation and management

Peyronie’s disease is a common yet poorly understood condition characterized by penile pain, curvature, sexual dysfunction and psychological bother. Peyronie’s disease represents a penile wound healing disorder, and is thought to arise from exuberant scarring in response to penile trauma in genetically predisposed men. In the absence of active treatment, the majority of men experience stable or worsening symptoms, with few reporting spontaneous resolution in penile curvature or other deformity. In contrast, penile pain improves or resolves in the majority of men. Treatment options vary based on symptom severity and stability. Several oral therapies are commonly prescribed, although to date there are no strong data to support any oral agents as monotherapy for Peyronie’s disease. Other options including penile traction therapy and intralesional injections result in modest improvements for many patients, particularly when used early after symptom onset. Penile straightening through approaches, such as penile plication and plaque incision or partial excision and grafting, represent the most rapid and reliable approach to correct penile curvature once the symptoms have stabilized. Side-effects vary based on the type of surgery carried out, and include penile shortening, sensation changes and erectile dysfunction in the minority of men. In patients with drug refractory erectile dysfunction and Peyronie’s disease, placement of a penile prosthesis will address both issues, and is associated with high levels of patient satisfaction. The current review provides a practical approach to the modern evaluation and management of patients presenting with Peyronie’s disease.     

Effect of collagenase ointment versus moist exposed burn ointment on healing of full‐thickness burns in mice by removing of necrotic tissue

The presence of necrotic tissue is one of the major problems that affect healing of burn wounds. The present study was designed to find the effectiveness of collagenase versus moist exposed burn ointment (MEBO) on removal of necrotic tissue of burns. Twenty mice randomly assigned and divided into four groups. For Group 1, burn wounds were treated with collagenase ointment only, Group 2 burn wounds were treated with MEBO, Group 3 burn wounds were treated with white vaseline alone, and Group 4 burn wounds were considered as control and left without treatment. In each group, the time of treatment was considered. The results indicated that the removal time of necrotic tissue and healing process was better in the case of using collagenase than using MEBO for treatment of burns.     

Treatment of oral submucous fibrosis by collagenase: effects on oral opening and eating function

OBJECTIVE: Patients with oral submucous fibrosis (OSF) suffer from the limitation of the oral opening. The aim of this study was to develop a simple and rapid method to improve the opening of the oral cavity and determine its effect on the incidence of developing oral carcinoma. METHODS: We first induced an OSF-like lesion in rabbits which histopathologically resembles OSF in betel nut chewers and evaluated the effects of exogenous collagenase on these lesions. We then applied the collagenase treatment regimen to patients with OSF. RESULTS: Endogenous collagenase activities in normal oral mucosa of patients exhibited 3- to 5-fold higher levels than that of OSF tissues. The collagenase treatment not only resulted in a significant improvement of oral opening, but patients also experienced a striking reduction in hypersensitivity to spices, sour, cold, and heat which helped restore eating function. Sub-mucosal fibrous proliferation, persistently good vascularization, and a mild increase in thickness of the sub-mucosal fibrous tissues were noticed 10 months after collagenase treatment. Within the 2-year follow-up period none of the treated patients developed an oral squamous cell carcinoma. CONCLUSION: A reduced content of functional collagenase observed in OSF mucosa of patients might be one mechanism responsible for collagen accumulation. Intervention of OSF by collagenase treatment at the early stage may reduce the incidence of developing oral carcinoma.     

Interleukin-1α produced in human gingival fibroblasts induces several activities related to the progression of periodontitis by direct contact

Previous observations suggest that interleukin-1 (IL-1) may play an important role in the progression of periodontitis. In the present study, we investigated whether a cell-associated IL-1α (CAIL-lα) produced in human gingival fibroblasts (HGF) induces biological activities related to the progression of periodontitis. HGF were treated with recombinant human IL-1β (rhIL-1β) for 12 h. After that, the cell layers of HGF were washed 3 times with fresh medium and were then fixed with 1% paraformaldehyde. The fixed cell layers of HGF were used for assays for bone resorbing activity, prostaglandin E₂ (PGE₂) production and collagenase activity. Fixed cell layers of HGF treated with rhIL-1β enhanced not only calcium release from BALB/c mouse calvaria but also PGE₂ production and collagenase activity in HGF and human periodontal ligament fibroblasts (HPLF) cultured on the fixed cell layers. These activities were neutralized by treatment with monoclonal mouse anti-human IL-1α antibody, but monoclonal mouse antihuman IL-1β antibody showed no effects on these activities. The induction of these activities by fixed cell layers of HGF required direct contact between the fixed cell layers and the calvaria, HGF, or HPLF. These results suggest that CAIL-1α produced in HGF treated with rhIL-1β induces bone resorbing activity, PGE₂ production and collagenase activity in the target cells by direct contact; CAIL-lα may play an important role in the progression of periodontitis.     

Polymerase chain reaction for the identification of Porphyromonas gingivalis collagenase genes

Porphyromonas gingivalis has been shown to exhibit genetic diversity possibly resulting in variation of virulence. In the present study a potential virulence factor was targeted for the detection of P. gingivalis. A 548 bp fragment of the collagenase gene ( prtC ) from Porphyromonas gingivalis ATCC 33277 was amplified by polymerase chain reaction (PCR) using oligonucleotides derived from the middle portion of prtC. From 16 of 21 clinical P. gingivalis strains, a PCR product of similar size to the prtC could be obtained. These 16 P. gingivalis strains were confirmed as positive for prtC using DNA hybridization with a digoxigenin-labeled prtC PCR product as a probe. In 12 of the 16 prtC positive strains, the restriction analysis of the PCR products revealed fragment patterns identical to the known sequence. In the other 4 prtC positive strains, 4 distinct patterns were found. Of these strains, nucleotide sequence analysis of a 400 bp PCR product stretch revealed 79.1%, 83.0%, 84.8 and 89.5% homology with the known nucleotide sequence for this specific region. Sequence analysis of the PCR products from the ATCC 33277 strain demonstrated 93.7% homology. The limit of detection for the PCR was about 100 organisms. None of the other 48 tested strains of 16 bacterial species derived from oral and extraoral infections yielded a PCR product. The PCR was also used for the detection of prtC sequences in dental plaque. Our data indicate that not all P. gingivalis strains have prtC. Nucleotide heterogeneity exists among P. gingivalis with prtC. Using a potential virulence factor for the detection of putative periodontal pathogens such as P. gingivalis may be valuable for the epidemiology of infection and clinical diagnosis of periodontal diseases.     

Second cycle of intralesional Collagenase Clostridium histolyticum for Peyronie's disease using the modified shortened protocol: Results from a retrospective analysis

The purpose of this study was to evaluate the effectiveness and safety of the second cycle of Collagenase Clostridium histolyticum injections using the modified shortened protocol. We performed a retrospective analysis on patients who had already undergone the first cycle of injections using the modified shortened protocol and requested more injections to improve the remaining curvature. The International Index of Erectile Function, the Peyronie's Disease Questionnaire and the Global Assessment of Peyronie's Disease questionnaire were self-administered to all patients. All the parameters were recorded at baseline, after the first cycle and after the second cycle of injections. All adverse events were recorded. Seventeen patients completed two cycles of injections. All patients had a reduction of the initial curvature after the first cycle, with a mean improvement of 17.4° (27.4%). After the second cycle, the reduction of the curvature was 7.9° (17.1%), and 29.4% of patients had no further improvement. No severe side effect was recorded. The results of the present study confirm the effectiveness and safety of the modified shortened protocol of Collagenase C. histolyticum injections for Peyronie's disease. However, the second cycle of three injections may be less effective, and patients may not be completely satisfied.     

胶原酶盘外持续给药治疗腰椎间盘突出症184例随访观察

目的:对胶原酶盘外持续给药治疗腰椎间盘突出症病人进行近期随访,以观察该治疗的临床效果、技术特点及注意事项.方法: 随访2002年1月至2004年3月采用胶原酶盘外持续给药治疗腰椎间盘突出症184例,记录治疗前后患者视觉模拟评分(VAS)、直抬腿高度、腰椎活动度、感觉和肌力等,进行分析总结.结果:治疗之后7天和90天患者疼痛症状明显好转,VAS治疗后7天、90天分别为3.5±0.25和2.7±0.21,与治疗前7.6±0.45比较P<0.05.治疗后7天、90天临床疗效总有效率分别为81.52 %和83.70 %.结论:采用胶原酶盘外持续给药治疗腰椎间盘突出症能够减轻患者疼痛,具有良好疗效.     

射频联合胶原酶盘内治疗腰椎间盘突出症的对照研究

目的探讨射频联合50单位胶原酶盘内治疗腰椎间盘突出症的临床效果。方法将600例腰椎间盘突出症患者随机分为A、B两组,两组穿刺均在C型臂引导下经安全三角区,进入责任间盘中后113处,B组进行射频热凝治疗,A组在完成B组治疗后,留置射频穿刺针8～10rain后,旋转射频穿刺针斜口对准突出物方向,并退针少许,注造影剂0．5ml,C臂观察造影剂流向突出的椎间盘,5rain后注射50单位胶原酶溶液0．5ml。治疗结果以视觉模拟评分法（VAS）评定。结果治疗后1、6、12个月VAS评分,均明显低于治疗前（P〈0．05）,A组较B组VAS评分明显降低,差异有明显的统计学意义（P〈0．05）。结论射频联合极小量胶原酶盘内应用,是一种较为理想治疗腰椎间盘突出症的好方法,效果明显优于单纯射频治疗。     

Ⅳ型胶原酶在胃癌浸润转移中的作用

应用免疫组化技术研究４６例胃癌手术切除新鲜标本及其引流区域淋巴结中Ⅳ型胶原酶的表达，以探索其在胃癌浸润转移中的作用。结果发现：Ⅳ型胶原酶存在于正常胃小凹上皮和胃癌中，但在５７％（２６／４６）胃癌中的表达增强（Ｐ＜０．０１），而且在有些胃癌组织浸润前缘其表达增强，在胃癌原发灶中Ⅳ型胶原酶的表达和淋巴结转移灶中的表达一致。另外，在有淋巴结转移的胃癌原发灶中，Ⅳ型胶原酶的表达较无淋巴结转移的胃癌原发灶中的表达明显增强（Ｐ＜０．０１）．实验表明，Ⅳ型胶原酶可能与胃癌浸润转移密切相关，它可以作为判断胃癌浸润转移恶性表型的有用生物学标志。     

经皮椎间孔镜联合胶原酶治疗脱出型腰椎间盘突出症的疗效

目的评价经皮椎间孔镜联合胶原酶治疗脱出型腰椎间盘突出症临床疗效。方法选择单间隙脱出型腰椎间盘突出症患者51例,随机分为单纯椎间孔镜组和联合胶原酶组。用视觉模拟评分法(VAS)及Mac Nab标准评价比较两组治疗效果。结果两组患者手术后的VAS评分与术前比较差异有显著性(P0.05),两组术后3 d的VAS评分比较差异有显著性(P0.05),两组术后6和12个月的VAS评分差异有显著性(P0.05)。按照改良Mac Nab疗效评定标准,联合胶原酶组治疗后12个月的优秀率为75%,与椎间孔镜组比较差异有显著性(P0.05)。结论经皮椎间孔镜联合胶原酶和单纯经皮椎间孔镜治疗脱出型腰椎间盘突出症均有效果,但前者的远期疗效更可靠。