CHRONIC TREATMENT WITH FINASTERIDE DAILY DOES NOT AFFECT SPERMATOGENESIS OR SEMEN PRODUCTION IN YOUNG MEN

PURPOSE: Finasteride, an oral type 2, 5alpha-reductase inhibitor, is used in 1 mg. daily doses for the treatment of male pattern hair loss. A dose of 5 mg. finasteride daily reduces ejaculate volume by approximately 25%, and reduces prostate volume by approximately 20% and serum prostate specific antigen (PSA) by approximately 50% in men with benign prostatic hyperplasia. To our knowledge no data exist on the effect of 1 mg. finasteride daily on ejaculate volume or other semen parameters, or on the prostate in young men. Therefore, we studied the potential effect and reversibility of effect of 1 mg. finasteride daily on spermatogenesis, semen production, the prostate and serum PSA in young men. MATERIALS AND METHODS: In this double-blind, placebo controlled multicenter study 181 men 19 to 41 years old were randomized to receive 1 mg. finasteride or placebo for 48 weeks followed by a 60-week off-drug period. Of the 181 men 79 were included in a subset for the collection and analysis of sequential semen samples. RESULTS: There were no significant effects of 1 mg. finasteride on sperm concentration, total sperm per ejaculate, sperm motility or morphology. Ejaculate volume in subjects on finasteride decreased 0.3 ml. (-11%) compared to a decrease of 0.2 ml. (-8%) for placebo, with a median between treatment group difference of -0.03 ml. (1%, 90% confidence interval -10.4 to 13.1, p = 0.915). There were significant but small decreases in prostate volume (-2.6%) and serum PSA (-0.2 ng./ml.) in the finasteride group, which reversed on discontinuation of the drug. CONCLUSIONS: Treatment with 1 mg. finasteride daily for 48 weeks did not affect spermatogenesis or semen production in young men. The effects of 1 mg. finasteride daily on prostate volume and serum PSA in young men without benign prostatic hyperplasia were small and reversible on discontinuation of the drug.     

Temporary Atrial Pacing in the Prevention of Postoperative Atrial Fibrillation

Background: Atrial fibrillation (AF) is a common complication after coronary artery bypass grafting (CABG). Since its prevention with prophylactic drug therapy has limited success, alternative approaches are desirable. This study examined the efficacy of atrial or biatrial pacing, compared with no pacing, on the incidence of AF after isolated CABG.
Methods: From August 2002 to September 2004, 240 patients underwent CABG. After surgery, right and left atrial epicardial pacing wires were implanted for 72 hours of temporary pacing. Patients were randomly assigned to one of three groups: no pacing (control group), right atrial (RA), and biatrial (BiA) pacing. Cardiac rhythm was monitored continuously during intensive care, or daily on the ward. The primary endpoints of this study were an episode of AF occurring up to 72 hours after CABG and the risk factors correlated with this event.
Results: Atrial and BiA pacing significantly lowered the incidence (1.25% vs 25%, P = 0.001) of AF episodes, and were both correlated (odd ratio 0.038; 95% confidence interval 0.005–0.29) with a decrease in rates of postoperative AF. Multivariable analysis identified older age (odd ratio 1.074; 95% confidence interval 1.024–1.12) and no pacing as independent risk factors of postoperative AF.
Conclusions: Temporary right atrial or biatrial pacing after CABG significantly decreased the postoperative incidence of AF. Multivariable analysis identified older age and no pacing as predictors of AF occurrence .     

Octapolar Electrocatheter for His Bundle Recording and Sequential Bedside Electrophysiologic Testing

To reduce the number of electrocatheters required for an electrophysiologic study and to facilitate prolonged monitoring of the electrical properties of the heart, an octapolar electrocatheter was designed and tested in 45 consecutive patients undergoing routine electrophysiologic studies. The electrocatheter introduced into the right ventricle served for: (a) right ventricular pacing; (b) recording of low lateral and low septal right atrial electrograms; (c) recording of the His bundle potential in 39 out of the 45 patients (86%); (d) 24-hour monitoring of the AV conduction intervals and refractory periods at the patients' bedsides. The octapolar electrocatheter reduced the number of probes required for studying the mechanisms of reciprocating tachycardia and allowed 24-hour bedside electrophysiologic monitoring.     

Malignant Lymphoma in Manila --A Clinicopathologic Study at the University of the Philippines Philippine General Hospital Medical Center--

An analysis is presented of the histopathologic, clinical andprognostic features of malignant lymphomas (MLs) treated atthe University of the Philippines-Philippine General HospitalMedical Center, Manila, between 1975 and 1981. There were 434malignant lymphomas, constituting 3.86% of all cancers studiedat this institute during this period. Non-Hodgkin's lymphomasaccounted for 82%. Among these, nodular lymphomas constituted8% of the group and diffuse lymphomas 92%. In diffuse lymphomas,poorly differentiated lymphocytic lymphomas (31%) and histiocyticlymphomas (30%) were predominant. Pleomorphic lymphomas, whichare frequently observed in south western Japan and are now knownto be a peculiar type of adult T-cell lymphoma/leukemia, werenot found in this group. Hodgkin's disease constituted 18% ofall the malignant lymphomas, among which there were 52% mixedcellular type and 21% lymphocytic depletion type. These datawere correlated with those of other countries.     

Pulmonary granulomatoses due to inhaled particles: personal experience and some immunological considerations

Clinical, radiological, functional, laboratory and pathologic studies on 114 patients with bronchopulmonary granulomatoses due to inhaled particles are presented, together with measurements of the levels of IgA, IgG and IgM found in the sera of seventy-three of the patients compared with those of forty blood donors used as normal controls. No differences were found between organic or inorganic dusts as causes in any of these parameters. There was, however, a significant increase in IgA and IgG compared with the controls. The possibility of a common pathogenic factor for this disease, independent of the nature of the causal agent is discussed.     

RELATIONSHIP BETWEEN THE PASSAGE OF LOCAL ANAESTHETICS ACROSS THE BLOOD-BRAIN BARRIER AND THEIR EFFECTS ON THE CENTRAL NERVOUS SYSTEM

The transfer of procaine and lignocaine from blood to cerebrospinalfluid (c.s.f.) was studied in six patients and in twelve dogs.Local anaesthetics appeared very rapidly in the c.s.f. afterintravenous administration. Within 20 minutes, a c.s.f./plasmaultrafiltrate ratio around 0.9 was reached. Para-aminobenzoicacid, a procaine metabolite, appeared in c.s.f. later than procaine.This is explained by a different rate of drug entry into thec.s.f. and by the need for previous procaine splitting by plasmacholinesterase. The rapid transfer of local anaesthetics correspondswith their high lipid-solubility and low degree of ionic dissociationat the pH of the body. The free movement of drugs to and fromthe brain accounts for the controllability of general anaesthesiainduced by the intravenous administration of local anaesthetics. ^* Present address: Department of Pharmacology, Cornell UniversityMedical College, 1300 York avenue, New York, N.Y. 10021.     

TREATMENT OF ACTINIC PRURIGO IN CHIMILA INDIANS

Background. Actinic prurigo has a high prevalence in women of child-bearing age. Its treatment has been, among others, with thalidomide. To avoid the deleterious effects of this drug on the embryo, therapeutic alternatives have been sought. Among these, tetracycline and vitamin E have been investigated as to their influence on the symptoms of actinic prurigo. Both these drugs affect superoxide radicals that are thought to be involved in the pathogenesis of actinic prurigo. Materials and Methods. Patients (Chimila Indians with a high prevalence of actinic prurigo) received either (a) tetracycline, 500 mg three times daily, for 6 months, or (b) vitamin E, 100 IU daily, for 6 months. The patients were seen once monthly. There were eight patients in each group. Results. Both drugs used were effective. Pruritus was remarkably improved by either treatment. None of the side effects were severe enough to lead to interruption of treatment, but the observation period posttreatment was relatively short, 4 months for tetracycline and 2 months for vitamin E. The improvement occurred in spite of the continuation of extensive exposure to the sun. Conclusions. Tetracycline and vitamin E are efficacious in relieving the pruritus of actinic prurigo. Preliminary trials of a combination treatment with these two drugs is a new avenue which has shown in preliminary trials to yield synergistic effects which might allow the dosage of tetracycline to be reduced.