The treatment of chronic bacterial prostatitis

Chronic bacterial prostatitis, the most common cause of recurrent urinary tract infections in the male patient, is a clinical entity accurately defined by two essential features: (1) recurrent urinary tract infections and (2) persistence of gram-negative bacteria in the prostatic secretion. Chronic bacterial prostatitis is mainly a bacteriologic diagnosis and, therefore, sequential bacteriologic localization cultures are the only way to correct diagnosis. Thirty-five of 39 patients (90%) with chronic bacterial prostatitis were cured of their disease either by a short-term (14- day) intramuscular kanamycin treatment or a long-term (average of five months) oral co-trimoxazole, pure trimethoprim or ciprofloxacin treatment; selected patients suffering from chronic bacterial prostatitis with an associated pathology such as benign enlargement of the prostate, associated occasionally with infected prostatic calculi, who did not respond to medical therapy alone, were cured by a combined adequate antibacterial and surgical (a modified retropubic prostatectomy) treatment. All the patients were followed up for at least one year and most patients several years following treatment.Die chronische bakterielle Prostatitis ist die häufigste Ursache rezidivierender Harnwegsinfektionen bei männlichen Patienten. Das klinische Bild wird im wesentlichen durch zwei Charakteristika geprägt: 1. rezidivierende Harnwegsinfektionen, 2. Persistenz gramnegativer Bakterien im Prostatasekret. Die Diagnose chronische bakterielle Prostatitis beruht im wesentlichen auf bakteriologischen Untersuchungen, und kann folglich nur durch sequentiell entnommene Kulturen, die eine Lokalisation zulassen, gestellt werden. Von 39 Patienten mit chronischer bakterieller Prostatitis wurden 35 (90%) durch antimikrobielle Therapie geheilt. Verabreicht wurde entweder eine Kurzzeit (14-Tage-)Therapie mit Kanamycin i. m. oder eine Langzeit (durchschnittlich 5-Monate-)Therapie mit oralem Cotrimoxazol, Trimethoprim allein oder mit Ciprofloxacin. Einzelne Patienten, die neben der chronischen bakteriellen Prostatitis andere Veränderungen wie eine benigne Prostatahypertrophie aufwiesen und gelegentlich auch infizierte Prostatasteine hatten und auf die medikamentöse Therapie allein nicht ansprachen, wurden durch kombiniertes Vorgehen mit adäquater antibakterieller und chirurgischer Therapie geheilt. Dabei wurde eine modifizierte Methode zur retropubischen Prostatektomie eingesetzt. Alle Patienten wurden mindestens ein Jahr, einige mehrere Jahre lang nachbeobachtet.     

Practice management of chronic bacterial prostatitis with levofloxacin

The aim of this prospective observational study was to present relevant data on the efficacy and safety of levofloxacin in the treatment of chronic bacterial prostatitis (NIH-II) in the daily clinical routine of urologists in their practices. In total, 243 patients were treated, including 62 patients with a microbiologically confirmed diagnosis -based on expressed prostatic secretion (EPS). The current evaluation is based on these patients. Their median age was 53 years. The patients were treated with levofloxacin 500 mg / day for 29 days (median) which is in accordance to the -registered recommendation for this indication. Clinical symptoms were assessed using a standardised questionnaire. The clinical symptoms dysuria, painful ejaculation, perineal pain, urinary obstruction, increased urgency, prostate pain during palpation as well as CRP and number of leukocytes showed statistically significant improvements at the end of therapy with levofloxacin as compared to baseline. At the end of treatment 93.5 % (n = 58 / 62, 95 % confidence interval: 84.5 %-97.8 %) of the patients were cured or improved. The patients were able to resume their regular activities after 10 days (median). 93.5 % (n = 58 / 62) of the patients and 95.2 % (n = 59 / 62) of the doctors were satisfied or very satisfied with this treatment. In all 62 patients the diagnosis was microbiologically confirmed based on EPS. In 39 patients (62.9 %) E. coli was identified. At the end of therapy microbiological testing was performed in 62.9 % (n = 39 / 62) of the patients, in 29 cases including EPS. In 37 of these 39 patients (94.9 %) no pathogen was identified. In 2 cases (5.1 %) a pathogen was identified (Proteus mirabilis and Staphylococcus species). In 181 patients without microbiological confirmation -based on EPS comparable clinical results were found. In the total population of 243 patients 5 adverse drug reactions were reported in 3 patients (incidence 1.2 %, n = 3 / 243), The results of this study confirm the efficacy and safety of levofloxacin in the treatment of chronic bacterial prostatitis in daily clinical practice.     

细菌基因检测在慢性前列腺炎诊断中的应用研究

目的建立基于16SrRNA基因的PCR细菌学检测方法，用于慢性前列腺炎患者EPS的细菌学检查，以指导临床诊断和治疗。方法建立细菌PCR检测方法，对58例慢性前列腺炎患者的EPS或VB3标本和30例健康对照标本进行检测，并作细菌培养检查。结果PCR扩增产物经1%琼脂糖凝胶电泳，在1 500 bp处有一明显条带，经过优化的PCR方法检测细菌的敏感性为103/ml（每毫升中细菌的个数，下同）。慢性前列腺炎患者的EPS标本PCR检测阳性率46.6%（27/58），培养法阳性率为6.9%（4/58），以PCR法的阳性率较高（χ^2=9.772，P〈0.05）。对照组标本PCR检测阳性率为10.0%（3/30）。结论基于16SrRNA基因的PCR方法具有快速、简便、稳定、不受干扰等优点，可用于慢性前列腺炎患者EPS的细菌检测。     

Endoscopic pilonidal sinus treatment (E.P.Si.T.)

We present a new video-assisted minimally invasive technique for the treatment of pilonidal disease (E.P.Si.T: endoscopic pilonidal sinus treatment). Between March and November 2012, we operated on 11 patients suffering from pilonidal disease. Surgery is performed under local or spinal anesthesia using the Meinero fistuloscope. The external opening is excised and the fistuloscope is introduced through the small hole. Anatomy is identified, hair and debris are removed and the entire area is ablated under direct vision. There were no significant complications recorded in the patient cohort. The pain experienced during the postoperative period was minimal. At 1 month postoperatively, the external opening(s) were closed in all patients and there were no cases of recurrence at a median follow-up of 6 months. All patients were admitted and discharged on the same day as surgery and commenced work again after a mean time period of 4 days. Aesthetic results were excellent. The key feature of the E.P.Si.T. technique is direct vision, allowing a good definition of the involved area, removal of debris and cauterization of the inflamed tissue.     

Review of boceprevir and telaprevir for the treatment of chronic hepatitis C

OBJECTIVE:

To summarize and evaluate the published literature pertaining to boceprevir and telaprevir, and to provide clinicians with suggestions for use in patients with chronic hepatitis C infection.

METHODS:

A standardized search strategy was performed using the MEDLINE, EMBASE, Google Scholar and International Pharmaceuticals Abstracts databases using the search terms “boceprevir”, “telaprevir”, “boceprevir and hepatitis C” and “telaprevir and hepatitis C”. A manual search of references was performed to identify articles missed by the electronic search. Studies were included in the review if they assessed either boceprevir or telaprevir in comparison with standard of care in chronic hepatitis C patients.

RESULTS:

The studies identified assessed boceprevir and telaprevir in genotype-1 hepatitis C patients. In both treatment-naive and treatment-experienced patients, sustained virological response rates were achieved more often with boceprevir or telaprevir in combination with pegylated interferon and ribavirin compared with pegylated interferon and ribavirin alone. Both medications were well tolerated, with anemia presenting as the most treatment-limiting adverse effect.

CONCLUSIONS:

Boceprevir and telaprevir will revolutionize the management of hepatitis C genotype 1 patients and will most likely decrease the burden of end-stage disease worldwide. However, current clinical limitations include establishing appropriate and cost-effective treatment durations, and use in special populations such as transplant patients and patients coinfected with HIV. Future research will need to clarify these clinical obstacles to clearly define the role of these agents in hepatitis C management.     

Virulence characteristics of Escherichia coli in acute bacterial prostatitis.

To assess the urovirulence characteristics of Escherichia coli strains causing acute prostatitis, urinary isolates from men with acute prostatitis (n=107) and from women with acute uncomplicated pyelonephritis (n=76) were examined for the prevalence of sfa, foc, and 3 papG allele genotypes and phenotypes and for the production of alpha-hemolysin and cytotoxic necrotizing factor 1. The papG allele III and foc gene were found more frequently and the papG allele II less frequently among prostatitis than from pyelonephritis isolates. A higher proportion of hly+ cnf1+ genotype in prostatitis strains (64% vs. 36%) was particularly striking. Both prostatitis and pyelonephritis strains expressed virulence factors similarly except for a higher proportion of nonhemolytic prostatitis isolates. Although the pathogenetic mechanisms of urinary tract infections in men and women may differ, virulence factors such as adhesins and cytotoxins may have important roles in the pathogenesis of acute prostatitis.     

Insulin resistance in chronic hepatitis B and C.

AIM: To determine whether insulin resistance occurs in patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC) and its relationship with the presence of liver fibrosis and steatosis. METHODS: Untreated patients with CHC (n=60) or CHB (n=40), similar in age, gender, body mass index and waist-hip ratio, were studied. Relationship between anthropometric, biochemical (fasting serum insulin, C-peptide, ferritin, iron, TNF-alpha, cholesterol, triglyceride, bilirubin, hemoglobin and platelet concentrations) and liver biopsy (43 CHC and 20 CHB patients) findings was investigated by insulin resistance determined via the homeostasis model assessment (HOMA-IR). RESULTS: The mean fasting serum insulin was 14.9 (11.9) mU/mL in CHC and 21.4 (17.4) in the CHB group (normal range 0.7-9; p=0.049) and mean HOMA-IR was 3.1 (2.6) in CHC versus 4.7 (4.1) in the CHB group (normal range 0.12-4.61; p=0.036). HOMA-IR was significantly associated with fibrosis stage in the CHC group (p=0.015), but not in the CHB group. CONCLUSION: Hyperinsulinemia occurs in chronic viral hepatitis B and hepatitis C; insulin resistance is associated with stage of fibrosis in hepatitis C.     

A study of IgA.IgG titers for C. trachomatis in serum and prostatic secretion of chronic prostatitis

In order to study the correlation between chronic prostatitis and C. trachomatis, IgA and IgG titers for C. trachomatis in serum and prostatic secretion were measured using the indirect immunoperoxidase assay (Ipazyme Chlamydia). 1) Positive rate of IgA and IgG titers in serum and prostatic secretion was higher in cases of chronic prostatitis than that in cases of suspected chronic prostatitis or the normal male group. 2) In cases of chronic prostatitis, IgA titers showed a tendency to be high in prostatic secretion, and IgG titers showed the same tendency in serum. This result was considered C. trachomatis infection was appeared local immunization in prostate. 3) After treatments with DOXY for cases of positive IgA titers in prostatic secretion, IgA titers of those cases were decreased and inflammations of prostate were cured. 4) The positive rate of IgA and IgG titers in serum was higher in wives with IgA positive cases than in those with the IgA negative. Those results suggested that chronic prostatitis was correlated by C. trachomatis.     

Isoprinosine in the treatment of chronic active hepatitis type B.

21 patients with chronic active hepatitis B (CAH-B) were treated for 1-2 years with isoprinosine, while another 18 patients served as control group. All patients were initially DNA polymerase (DNAp) and HBeAg positive. Nine (43%) treated patients became persistently negative for DNAp, seroconverted to anti-HBe and showed histological remission on follow-up biopsy. Among simultaneously followed controls 5 (28%) lost DNAp and 4 (22%) also lost their HBeAg. However, only 2 (11%) seroconverted to anti-HBe. Histological improvement was seen in 5 (28%) controls. Thus, it seems that isoprinosine may exert a beneficial effect on the course and outcome of CAH-B.