Treatment of hypertensive urgencies with oral nifedipine, nicardipine, and captopril

Sixty-five patients with uncomplicated hypertensive urgencies were treated in the emergency and cardiology departments with 20 mg nifedipine, 20 mg nicardipine, or 25 mg captopril in a randomized study. The study population consisted of 65 patients ranging in age from forty-one to seventy-one. Blood pressure and heart rate were assessed for six hours after intake of the antihypertensive agents. Within sixty minutes nifedipine reduced blood pressure by an average of 74.7 mmHg for the systolic and 35.4 mmHg for the diastolic. Average heart rate increased significantly by 11.6 beats/min at within thirty minutes. Nicardipine and captopril produced equivalent falls in systolic (-81.6 and -79.4 mmHg) and diastolic (-37.3 and -33 mmHg) blood pressure respectively, but did not increase heart rate significantly. The antihypertensive effect of each drug was maintained until six hours after medication. In conclusion, nifedipine, nicardipine, and captopril show similar efficacy in the treatment of hypertensive urgencies. The authors believe that these drugs can be used as first-line therapy in the treatment of hypertensive urgencies safely and effectively.     

Chemokine receptor CXCR4 expression in breast cancer as a potential predictive marker of isolated tumor cells in bone marrow

Interactions between the CXCR4 chemokine receptor in breast cancer cells and the ligand CXCL12/SDF-1α are thought to play an important role in breast cancer metastases. In this pilot study, CXCR4 expression along with other biomarkers including HER2-neu and EGFR, were measured in primary tumor samples of patients with operable breast cancer to test whether any of these biomarkers alone and in combination could indicate breast cancer with high likelihood of metastasizing to bone marrow. Cytokeratin (CK) positive cells in bone marrow were identified by flow-cytometry following enrichment with CK 7/8 antibody-coupled magnetic beads. Primary tumors (n = 18) were stained with specific antibodies for CXCR4, HER2-neu, EGFR, and PCNA using an indirect avidin–biotin horseradish peroxidase method. The majority of the patients had T2/T3 tumors (72%), or lymph node involvement (67%) as pathologic characteristics that were more indicative of high-risk breast cancer. High CXCR4 cytoplasmic expression was found in 7 of 18 patients (39%), whereas 6 of 18 patients (33%) were found to have CK positivity in bone marrow. The median number of CK⁺ cells was 236 (range, 20–847) per 5 × 10⁴ enriched BM cells. The presence of CK⁺ cells in bone marrow was found to be associated with increased expression of CXCR4 alone or in addition to EGFR and/or HER2-neu expression (P = 0.013, P = 0.005, and P = 0.025, respectively) in primary tumors. Furthermore, three patients with high CK positivity (>236 CK⁺ per 5 × 10⁴ enriched bone marrow cells) in bone marrow exclusively expressed high levels of CXCR4 with EGFR/HER2-neu (P = 0.001). Our data suggest that high CXCR4 expression in breast cancer may be a potential marker in predicting isolated tumor cells in bone marrow. CXCR4 coexpression with EGFR/HER2-neu might further predict a particular subset of patients with high CK positivity in bone marrow.     

A novel NPHS1 mutation associated with temporary elevation of maternal serum alfa-fetoprotein and late onset of proteinuria

International Urology and Nephrology -     

Pain during sexual activity and ejaculation following hernia repair: A retrospective comparison of transabdominal preperitoneal versus Lichtenstein repair

Pain during sexual activity and ejaculation are the unspoken long-term complications of groin hernia repair. Laparoscopic surgical techniques are associated with decreased post-operative pain and earlier return to daily activities, but its effect on these complications is unclear. This study aims to investigate the effect of transabdominal preperitoneal repair (TAPP) on de-novo pain during sexual intercourse and ejaculation and to compare with open repair. For this reason, two groups were determined according to the surgical technique: the Lichtenstein repair and the TAPP groups and a questionnaire was sent to the patients a minimum of 6 months following the surgery. A total of 317 patients included, as 115 in TAPP and 202 in Lichtenstein repair group. No significant difference was observed concerning pre-operative pain during sexual activity and ejaculation in both groups (p = .75, p = .56). Following the surgery, the number of patients experiencing painful sexual activity was significantly higher in the Lichtenstein repair group compared to the TAPP group (19.3% vs. 11.3%, respectively, p = .03). The post-operative painful ejaculation rate was also significantly lower for the TAPP group (p = .04). The lower rates of post-operative dysejaculation and pain during sexual activity can be achieved with the advantage of laparoscopic surgery.     

Evaluation of Sexual Dysfunction in Patients Undergoing Hemodialysis Treatment

Aim

In this study. it was aimed to determine the prevalence of sexual dysfunction (SD) and the factors that may affect the occurrence of SD in patients receiving hemodialysis treatment.

Methods

The sample of the study consists of 49 patients (20 females. 29 males) receiving treatment in the hemodialysis unit of a university hospital. The data of the study were collected through a general information form including socio-demographic characteristics and risk factors. Female Sexual Function Index (FSFI). International Assessment Form for Erectile Function (IIEF) and Quality of Life Scale (SF-36).

Results

In our study. SD was detected in all patient groups. While the most affected area was seen to be orgasmic function and the least affected area was sexual desire in famales. the most affected area was found to be orgasmic function and the least affected area was erectile dysfunction in males. Such factors as age. profession. having a child. working status and duration of hemodialysis were found to affect occurrence of SD. There was a relationship between all sub-dimensions of sexual function and quality of life in male and female subjects.

Conclusion

In conclusion. sexual dysfunction is commonly encountered in patients undergoing hemodialysis treatment. In these patients. psychosocial factors as well as disease-related factors have an effect on SD. Therefore. SD should be evaluated together with disease-related factors as well as psychosocial factors in patients undergoing hemodialysis treatment.

     

Differences between cytokine release from bronchial epithelial cells of asthmatic patients and non-asthmatic subjects: effect of exposure to diesel exhaust particles

BACKGROUND: Recent evidence suggests that the airways of asthmatics are more susceptible to adverse effects of air pollutants than the airways of non-asthmatics, but the underlying mechanisms are not clear. METHODS: We have cultured bronchial epithelial cells (HBEC) from biopsies of atopic mild asthmatic patients and non-atopic non-asthmatic subjects, and investigated constitutive and diesel exhaust particles (DEP)-induced release of several pro-inflammatory mediators. RESULTS: HBEC of asthmatic patients constitutively released significantly greater amounts of IL-8, GM-CSF and sICAM-1 than HBEC of non-asthmatic subjects. RANTES was only released by HBEC of asthmatic patients. Incubation of the asthmatic cultures with 10 micrograms/ml DEP significantly increased the release of IL-8, GM-CSF and sICAM-1 after 24 h. In contrast, only the higher concentrations of 50-100 micrograms/ml DEP significantly increased the release of IL-8 and GM-CSF from HBEC of non-asthmatics. CONCLUSIONS: These results suggest that the increased sensitivity of the airways of asthmatics to air pollutants such as DEP may, at least in part, be a consequence of greater constitutive and pollutant-induced release of specific pro-inflammatory mediators from their bronchial epithelial cells.     

Ureteral displacement due to a migrated intrauterine contraceptive device

Perforation of the uterus is rare but potentially fatal. During puerperium when the uterus is small and its wall is thin, the risk of perforation increases. We report a rare complication from an intrauterine contraceptive device (IUD) which caused deviation of the right ureter in a 31-year-old woman who presented with complaints of insomnia and abdominal pain. Our case shows that perforation of the uterus by an IUD can cause a silent urological complication. The possibility of ureteral involvement and displacement should be kept in mind in a woman in whom a missing IUD is encountered.     

Establishment of a formal program for retinoblastoma: Feasibility of clinical coordination across borders and impact on outcome

Retinoblastoma is an ocular tumor that occurs in young children, in either heritable or sporadic manner. The relative rarity of retinoblastoma, and the need for expensive equipment, anesthesia, and pediatric ophthalmologic expertise, are barriers for effective treatment in developing countries. Also, with an average age‐adjusted incidence of two to five cases per million children, patient number limits development of local expertise in countries with small populations. Lebanon is a small country with a population of approximately 4.5 million. In 2012, a comprehensive retinoblastoma program was formalized at the Children's Cancer Institute (CCI) at the American University of Beirut Medical Center, and resources were allocated for efficient interdisciplinary coordination to attract patients from neighboring countries such as Syria and Iraq, where such specialized therapy is also lacking. Through this program, care was coordinated across hospitals and borders such that patients would receive scheduled chemotherapy at their institution, and monthly retinal examinations and focal laser therapy at the CCI in Lebanon. Our results show the feasibility of successful collaboration across borders, with excellent patient and physician adherence to treatment plans. This was accompanied by an increase in patient referrals, which enables continued expertise development. However, the majority of patients presented with advanced intraocular disease, necessitating enucleation in 90% of eyes in unilateral cases, and more than 50% of eyes in bilateral cases. Future efforts need to focus on expanding the program that reaches to additional hospitals in both countries, and promoting early diagnosis, for further improvement of globe salvage rates.