Is there a relationship between prostate volume and Gleason score?

OBJECTIVES

To review the relationship between the Gleason grade and prostate volume in biopsy and radical prostatectomy (RP) specimens, and thus assess the hypothesis that smaller prostates have a greater incidence of high‐grade tumours.

PATIENTS AND METHODS

We selected 390 patients who had RP at our institution, with a prostate‐specific antigen (PSA) level of <10 ng/mL and who had not had hormonal therapy. We retrospectively reviewed the data for transrectal ultrasonography (TRUS)‐guided prostate biopsies from these patients and the RP specimens. Indications for biopsy included a PSA level of ≥4 ng/mL or an abnormal digital rectal examination. High‐grade tumours were defined as having a Gleason score of ≥7.

RESULTS

The TRUS volume was statistically related to the rate of high‐grade tumours at biopsy and RP. On multivariate analyses, TRUS volume was a significant predictor of high‐grade tumour for biopsy and RP specimens, with an inverse relationship between high‐grade tumours and prostate volume for biopsy and RP specimens.

CONCLUSIONS

Our data suggest that there is a relationship between the rate of high‐grade tumours and prostate volume even in biopsy and RP specimens and it is not an artefact related to the biopsy.     

Are lower urinary tract symptoms associated with erectile dysfunction in aging males of Taiwan?

INTRODUCTION: This study was conducted to evaluate the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in aging males of Taiwan. PATIENTS AND METHODS: A free health screening for aging males (>or=45 years old) was conducted in Kaohsiung Medical University Chung-Ho Memorial Hospital in August 2004. LUTS and ED were assessed by validated symptom scales: the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function-5 (IIEF-5). The subjects also completed a health and demographics questionnaire and underwent detailed physical examination, serum prostate-specific antigen level determination, and transrectal ultrasonography. RESULTS: The final study population consisted of 141 patients with a mean age of 59.8 years. The severity of LUTS and ED increased with age. After controlling for comorbidities, age (p<0.001) and IPSS score (p<0.001) were significantly associated with the IIEF-5 score. Furthermore, men with moderate to high IPSS scores were more likely to have ED as compared with those with mild symptoms after age adjustment (age-adjusted odds ratio 3.27, p=0.002). CONCLUSIONS: ED and LUTS are highly prevalent in our study population, and this prevalence increases with age. ED is significantly associated with the severity of LUTS after controlling for age and comorbidities. These results highlight the clinical importance of evaluating LUTS in patients with ED and the need to consider sexual issues in the management of patients with benign prostatic hyperplasia.     

Is there a relationship between physical performance and orchiectomy?

Bilateral orchiectomy is indicated for the treatment of patients with testicular cancer or advanced prostate tumours. The influence of hypogonadism on physical performance is still not known. The purpose of this work was to verify the effect of bilateral orchiectomy on physical performance. Sixteen rats were divided into two groups: Group 1 (Control), in which only skin incision and suture were made (n = 5) and Group 2, in which the rats were submitted to bilateral orchiectomy (n = 11). The animals ran on a treadmill at the speed of 20 m min^?1 until they were fatigued and felt once, during 10 s, when the experiment was interrupted. Time to running and weight of animals were verified. The results were compared using the Mann–Whitney test. There was no difference on time to running – minutes – (P = 0.14) and weight – grams – (P = 0.25) between the animals submitted to orchiectomy (100 ± 44 min and 359 ± 38 g) and the control Group (81 ± 40 min to run and 327 ± 25 g). Bilateral orchiectomy does not affect the physical performance of the rat.     

Melorheostosis and FGF-23: Is there a relationship?

Melorheostosis is a rare chronic bone disease of unknown etiology that often affects lower limbs. Onset usually occurs in childhood or early adolescence. The diagnosis relies on the radiographic finding of hyperostosis within or around the cortex responsible for a "flowing wax" appearance. To our knowledge, Fibroblast growth factor-23 (FGF-23) levels have not yet been quantified in melorheostosis. We report an unusual case of this disease for whom the diagnosis of fibrous dysplasia had been wrongly made for a long period of time and the FGF-23 concentration has been found very high without any disturbance of serum phosphate.     

Osteoporosis in males and females: Is there really a difference?

The prevalence of osteoporosis increases with advancing age. Fractures are more common in women than in men and, apart from the menopause, the reasons for this difference remain poorly understood. The growth period is crucial to skeletal development and results in larger bones in males than in females. The sudden drop in estrogen levels that characterizes the menopause contrasts with the gradual decline in sex hormones seen in aging men, and the proportion of individuals with hypogonadism is considerably lower among older men than among older women. Although estrogens play a crucial role in bone homeostasis in both men and women, via direct and indirect mechanisms, differences exist between the sexes in hormonal physiopathology and its consequences on bone tissue. Many genetic and environmental factors influence the fracture risk. Although women are more prone to fractures, the mortality rate associated with fractures is higher in men. Most of the osteoporosis medications were developed for the treatment of postmenopausal osteoporosis and some are licensed for use only in women. Overall, the diagnosis of osteoporosis is somewhat less neglected than previously, but the treatment of high-risk individuals (those with a history of fracture) remains inadequate, most notably among males.     

Complete blood count and penile colour doppler ultrasonography findings in erectile dysfunction: Is there a relationship?

The aim of this study was to evaluate the relationship between penile colour doppler ultrasonography (PCDUS) and complete blood count parameters in patients with erectile dysfunction (ED). The data of the patients who applied to our outpatient clinic with ED (IIEF‐5 score <22 or IIEF‐EF score <26) between January 2007 and May 2017 were retrospectively analysed. The patients who had available PCDUS results and complete blood count (CBC) values were included in the study. Patients were divided into two groups having normal (n = 530 [68.9%]) or abnormal (n = 240 [31.1%]) PCDUS findings (group 1 versus group 2 respectively). Subsequently, group 2 was divided into three subgroups according to presence of arterial insufficiency (group 2a; n = 85 [11%]), venous insufficiency (group 2b; n = 140 [18.2%]) and both of arterial and venous insufficiency (group 2c; n = 15 [1.9%]), and the four groups were compared in terms of CBC parameters. There was no statistically significant difference between the 4 groups, and between the patients with normal and abnormal PCDUS findings in terms of CBC values. CBC values were not associated with PCDUS findings in patients with ED.     

Is there a role of radial rigidity in the evaluation of erectile dysfunction?

RigiScan has been the most widely utilized device for measuring erectile rigidity. However, the use of the RigiScan in the evaluation of erectile dysfunction has questionable because the RigiScan device does not directly determine axial rigidity. The aim of this study is to clarify that radial rigidity measured by RigiScan reflects the intracorporeal pressure and erectile capability efficiently. From January 1998 to May 1999, a total of 23 patients with erectile dysfunction were involved in the study. They were evaluated by RigiScan and duplex ultrasonography after intracorporeal injection of prostaglandin E1. We investigated the relationship between radial rigidity and the resistance index. The results of radial rigidity were also compared with that of the degree of erection. For the entire group, significant correlations were found between radial rigidity and the resistance index (r=0.680, P<0.001 for tip rigidity; r=0.703, P<0.001 for base rigidity). In addition, for 12 patients whose tip rigidity exceeded 60% and for 10 whose base rigidity exceeded 60%, the correlations between radial rigidity and the resistance index remained (r=0.659, P=0.020 for tip rigidity; r=0.759, P=0.011 for base rigidity). Based on the response determined by patients, radial rigidity represented the degree of erection efficiently.Our findings suggest that RigiScan is a useful diagnostic tool. Radial rigidity represents the intracorporeal pressure efficiently and has an acceptable role in the evaluation of erectile dysfunction.     

Is there a relationship between trauma center volume and mortality?

BACKGROUND: The guidelines for Level I trauma center verification require 1,200 admissions per year. Several studies looking at the relationship between hospital volume and outcomes after injury have reached conflicting conclusions. The goal of our study was to examine the relationship between patient volume and outcomes (mortality and length of hospital stay) in California's trauma centers. METHODS: Data for patients >or= 18 years old admitted after injury (n = 98,245) to a Level I or II trauma center (n = 38) in 1998 and 1999 were obtained from the Patient Discharge Data of the State of California. Hospital volume was derived from the annual number of admissions per center, and covariates including age, sex, mechanism of injury, Injury Severity Score, and trauma center designation were analyzed. RESULTS: Hospital volume was not a significant predictor of death or length of hospital stay. More severely injured patients appeared to have worse outcomes at the highest volume centers. CONCLUSION: In our study, hospital volume was not a good proxy for outcome. Low-volume centers appeared to have outcomes that were comparable to centers with higher volumes. Perhaps institutional outcomes rather than volumes should be used as a criterion for trauma center verification.     

Is there a relationship between weather conditions and aortic dissection?

Background  

Bleeding and rupture of blood vessels has been correlated with weather conditions in the past. This is the first study in the world literature with the aim of investigating the relationship between atmospheric pressure and temperature with the presentation of aortic dissection.     

Associations among disaster exposure,intimate relationship adjustment,and PTSD symptoms: Can disaster exposure enhance a relationship?

This study examined associations among disaster characteristics, relationship adjustment, and posttraumatic stress disorder (PTSD) symptomatology 9 months postdisaster in 205 women exposed to extensive flooding. Bivariately, threat/harm and loss exposure dimensions were related to each other but differentially related to relationship adjustment and PTSD symptoms. Results from structural equation modeling revealed a positive and significant direct association between threat/harm and PTSD symptoms. Conversely, loss was not significantly associated with PTSD symptoms, but was positively and significantly associated with relationship adjustment. Relationship adjustment was negatively and significantly related to PTSD symptoms. These data suggest that some aspects of disaster exposure can have a mobilizing and positive effect on intimate relationships. In turn, positive intimate relationships may buffer individuals against PTSD symptoms.     

Assessment of the influence of socio-economic status on aging males’ symptoms in Ijesaland,South-Western Nigeria

BackgroundAging issues are becoming a very serious concern in many developing countries, particularly the health care needs and challenges of the elderly. Crucial among these are the sexual, psychosocial and somatic challenges facing the elderly, and the factors that may influence these. The Aging Males’ Symptoms (AMS) scale was primarily designed for international comparability on measures of quality of life (QoL) among the elderly. The validity and reliability of this instrument have been tested in Nigeria and results confirm its comparability with results from other countries. It is pertinent to examine the influence of some socio-economic factors on the self-reported severity of sexual, psychosocial and somatic measures on the AMS.MethodsThe AMS instrument was administered to 456 males aged 60 years and above in selected communities in Ijesaland, South-West Nigeria. The AMS has 17 items and scoring was done on a scale of 1–5 based on the level of severity. Three outcome variables for psychosocial, somatic and sexual scores were used together with socio-economic variables as co-variates. STATA 11 was used for the analyses, which included frequency distribution, chi-square test and logistic regression model.ResultsIn the bi-variate analysis, wealth index was the only statistically significant variable for predicting the odds of each of the three outcome variables. A logistic regression model showed that higher education and middle income were significant predictors of high severity on the psychosocial score. Oldest age group, polygamous union and a high wealth index were significant predictors of higher somatic scores. None of the co-variates were significantly associated with the sexual score.ConclusionThe study concluded that wealth index and other proxies of empowerment, such as education, to a great extent influence quality of life.     

Foot orthoses and dental appliances—Is there a relationship?

BackgroundThis investigation was aimed at examining whether subjects who wear a combination of functional foot orthoses and dental appliances have less postural sway and furthermore to study if these changes are direction dependent.MethodsCentre of pressure (CoP) displacement in seven subjects, mean age 49 range (39–58) who met the inclusion criteria were evaluated using a pressure platform. Total displacement of the centre of pressure, the reduction in the displacement about the origin, area of the ellipse, total displacement along the x- and y-axes and frequency of sway along the anterior–posterior and mediolateral axes were estimated under four conditions, namely wearing orthoses and appliances, wearing only orthoses, only appliances and finally wearing neither orthoses nor appliances.ResultsIn the six patients who had class II malocclusion there was no significant difference between the displacement (z = 0.314 and p = 0.753) and the frequency (z = 0.680 and p = 0.496) of sway along the medio-lateral or anterior–posterior axes. Under control conditions the mean path length was 780 (SD 415) mm, the mean deviation from origin was 4.76 (SD 5.8) mm and the mean area was 0.83 (SD 1.87) mm²/cm². The mean deviation from origin was seen to reduce under all experimental conditions. Wearing the dental appliance alone was seen to be the most effective although the difference was not statistically significant. The sway area was also seen to reduce under all experimental conditions. The sway was most reduced when participants were wearing orthoses (i.e. conditions 1 and 3) with the reduction being the greatest when the orthoses was worn on its own (i.e. condition 3).ConclusionWhile, foot orthoses have been used for the relief of symptoms either within or extrinsic to the foot, they could have a much wider role in the management of patients with stability problems. Results from this study highlight the need for further research in this exciting and as yet unexplored area.     

Is there an association between a low acromion index and osteoarthritis of the shoulder?

The aim of this study was to evaluate the relationship between a low acromion index and osteoarthritis of the shoulder. Three patient groups were used: (I) instability, n = 53; (II) calcifying tendonitis, n = 109; and (III) osteoarthritis, n = 120. Standardised digital X-rays were evaluated from the true anteroposterior and axillary views. Joint space width at three levels in each plane and the size of humeral osteophytes were measured and osteoarthritis was graded according to Samilson. The acromion index was calculated according to Nyffeler et al. (J Bone Joint Surg Am 88:800–805, 2006) in the true anteroposterior view. There were two independent investigators. Interobserver reliability was excellent for all measurements in the anteroposterior (AP) projection but inferior in the axillary projections, especially in group III. The mean acromion index was 0.64 ± 0.07 in group I, 0.64 ± 0.08 in group II and 0.73 ± 0.12 in group III. The acromion index was not correlated with the joint space width nor with the size of the osteophytes or the Samilson grading in group III. The data of the study did not show a significant association between a low acromion index and typical signs of osteoarthritis at the shoulder. The theoretical concept of a small acromion index associated with the development of osteoarthritis of the shoulder is not supported.     

Testosterone replacement therapy and the risk of prostate cancer. Is there a link?

Substantial evidence supports the value of testosterone replacement therapy (TRT) in improving quality of life in men with proven aging male syndrome (AMS). Benefits of TRT include improved bone mineral density, reduced fracture risk, increased muscle mass, and improved mood, sense of well being, and libido, among others. There is currently a heated debate about the theoretical association between TRT and the initiation, progression, and aggressiveness of prostate cancer; however, this link has not been uniformly studied, and any results have been contradictory and nonconclusive. Although no clear evidence links TRT to prostate cancer, the possibility of increasing the risk of a clinical manifestation of a latent pre-existing malignancy can influence the decision about TRT use. Current recommendations are to exclude prostate cancer before initiating TRT in men over age 40 and to closely monitor men in the first year of testosterone replacement, followed by observation in subsequent years.