The effect of finasteride on the prostate gland in men with elevated serum prostate-specific antigen levels.

Prostate cancer is a disease associated with androgens. It has been hypothesized that reducing the conversion of testosterone (T) to dihydrotestosterone (DHT) in the prostate by the use of the drug finasteride, a 5alpha-reductase inhibitor, will reduce the incidence of prostate cancer. We investigated the chemopreventive potential of finasteride by evaluating its effect on the prostate gland of men with elevated serum prostate-specific antigen (PSA). Fifty-two men with elevated PSA and prostate sextant biopsies negative for cancer were randomized to receive finasteride 5 mg day(-1) (27 patients) or no medication (25 patients) for 12 months and were rebiopsied at 12 months. The biopsies were evaluated for the presence of cancer, the proportion of glandular and hyperplastic tissue, and the presence of high-grade prostatic intraepithelial neoplasia (PIN). Epithelial proliferation was assessed in the prestudy and 12-month biopsies by immunohistochemistry using antibody to proliferating cell nuclear antigen (PCNA). Serum blood samples were drawn at baseline and after 1, 3, 6 and 12 months of study. In the control group, serum levels of PSA and T were unchanged throughout the 12 months. In the finasteride group, PSA decreased 48% (P < 0.001), DHT decreased 67% (P < 0.001) and T increased 21% (P < 0.001). Histological evaluation of prestudy and 12-month biopsy specimens revealed that the finasteride group had a 30% reduction in the percentage of hyperplastic epithelial tissue (P = 0.002), although this decrease was not statistically significantly different between the finasteride and control groups (P = 0.11). In patients with PIN on prestudy biopsy, no change occurred in the PIN lesions with finasteride treatment. Finasteride also had no effect on the proliferation index of prostatic epithelial cells. Of the 27 patients treated with finasteride, eight (30%) had adenocarcinoma of the prostate detected on the 12-month biopsy, compared with one (4%) of the control patients (P = 0.025). In the treatment group, six cancers occurred in the eight patients with PIN on the prestudy biopsy; in the observation group no cancers were detected in the five patients with PIN on the prestudy biopsy (P = 0.021). Two cancers occurred in the 19 men in the treatment group with no evidence of PIN on the prestudy biopsy, compared with one cancer in the 20 men in the observation group with no evidence of PIN on the prestudy biopsy (P = 0.60). This study, using a novel model for evaluating short-term efficacy of chemopreventive or therapeutic agents in men at high risk of prostate cancer, provides little evidence that finasteride is an effective chemopreventive agent for prostate cancer in men with elevated PSA.     

Mortality stastistics as indicators of quality of hospital care

Death rates have always been important information for hospitals to provide a solid base for the evaluation of the quality of their medical care. This study was carried out to find out the gross death rate (GDR) as well as net death rate (NDR) in King Fahad hospital, Jeddah, Kingdom of Saudi Arabia (KSA) in the period from 1994-2000 and also to find out demographic characteristics of deaths in the year 2000 according to ICD-10 as indicators of quality of hospital care. Medical records of discharged patients including deaths during the year 2000 were reviewed (13386). Complete data about deaths were obtained. Results of the studied hospital showed gradual decrease in GDR from 5.8% to 4.5% (1994-1998) then slight increase from 4.9% to 5.0% (1999-2000) but still below the year 1994 (5.8%) and also there is gradual decrease in NDR from 4.6% to 3.6% in the studied period. GDR in different departments of the hospital during the year 2000 showed that Medical ICU was the highest (24.5%) followed by Surgical ICU (17.9%) followed by Cardiac ICU (14.3%) while GDR in the Medical department was found to be (12.9 %) of the discharged subjects. According to nationality; proportional mortality rate (PMR) of Saudis represented 62% of total deaths followed by Yemenis (8.2%) meanwhile Egyptians represented 3.7% of total deaths in the studied year. As concerned to age groups; the highest PMR was found among those aged 65-74 years (21.9%) while the lowest PMR was found among those aged 13-24 years (4.2%). The highest PMR of deaths during the studied year was reported in March (10.4%) followed by April (9.7%) then February (9.4%) which are the months of pilgrimage season while the lowest frequency was found in December (6.9%). Also PMR was found to be higher among females (57%) compared to males (43%). According to International Classification of Diseases (ICD-10); diseases of the circulatory system were found to be the commonest underlying cause of death in the studied year. It represented 35.5% of all deaths followed by neoplasms (11.2%) while the lowest cause reported was mental and behavioral disorders (0.1%). In conclusion, combination of the previous indicators and comparing the results with other hospitals in different countries indicates good quality of medical care in the studied hospital.     

Myocardial infarction by complete thrombosis of the common coronary trunk. Two case reports

Complete thrombosis of the left main coronary artery is a rare angiographic finding. It carries a very high mortality rate related to cardiogenic shock; malignant arrhythmia or sudden death. We report two case of a 37 and 65 years old women, admitted to our hospital with complete occlusion of the left main coronary responsible of anteroseptal myocardial infarct. The revascularisation consisted in surgical treatment in one case and percutaneous angioplasty in the second patient. The aim of our study is to discuss the different therapeutic approaches and the prognosis of this affection.     

Tamoxifen and endometrial pathologies: a prospective study.

OBJECTIVE:The purpose of this study was to prospectively follow a group of women with breast cancer, on tamoxifen, for the development of endometrial pathologies. MATERIALS AND METHODS: Eighty women with breast cancer, on tamoxifen, were prospectively followed every 6 months with pelvic examination, Pap smear, vaginal ultrasound, and endometrial biopsy. RESULTS: Nine women were lost to follow-up prior to initiation of treatment and 4 refused biopsies, leaving 67 patients for evaluation. Fifty (74.6%) of the 67 patients were already on tamoxifen for a mean duration of 15.8 +/- 16.6 months and had a baseline benign, unremarkable endometrium at the time of entry into the study. The total duration of treatment was 32.5 +/- 19.6 months (median 30 months). The mean age of the patients was 51.7 +/- 9.9 years (median 52 years). Of the patients, 56.7% were postmenopausal. Sixty-three patients had a benign endometrium (mean age 51.8 +/- 10.1 years, mean duration 33.1 +/- 19.6 months). Two patients had simple hyperplasia (mean age 43.5 years, duration 28.5 +/- 33.2 months), 1 patient had complex hyperplasia with atypia (age 57 years, duration 13 months), and another patient developed adenocarcinoma (grade 3) after 22 months. These 4 patients had abnormal vaginal bleeding. Seven patients developed endometrial polyps (mean age 54.0 +/- 8.5 years, duration 36 +/- 24.2 months). The mean endometrial thickness for patients with histologically unremarkable and abnormal endometrium was not significantly different (7.6 +/- 3.9 vs 8.8 +/- 5.0 mm, respectively) (median 7.0 mm for both groups). No endometrial thickness cutoff point reached statistical significance. The patient who developed endometrial cancer had a thickness of only 3 mm. CONCLUSION: All patients who developed an abnormal endometrium had abnormal vaginal bleeding. There was no correlation between endometrial thickness and endometrial pathology; thus the value of routine screening remains controversial.     

A randomized trial of weighted vest use in ambulatory older adults: strength, performance, and quality of life outcomes

BACKGROUND: Lower extremity weakness is a major risk factor for falls and hip fractures. Aging muscle is capable of responding to strengthening techniques. Strategies for providing accessible, inexpensive, safe, and effective strengthening programs for older adults are needed. OBJECTIVE: To evaluate whether use of a weighted vest improved strength, physical performance, markers of bone turnover, or health-related quality of life. DESIGN: A 27-week randomized, controlled, unmasked clinical trial. The primary outcome was peak isokinetic knee extensor strength at follow-up, adjusted for baseline strength. SETTING: Home-based program. PARTICIPANTS: A total of 62 women and men, mean age 74 years. INTERVENTIONS: Subjects were randomized to: no vest (n = 21), 3% body weight (BW) vest (n = 19), or 5% BW vest (n = 22). The vest is a nylon garment with pockets that are loaded with adjustable weights. The vest was prescribed for 2 hours daily, 4 days per week. No specific physical activities were mandated. MEASUREMENTS: All measures were made at baseline and 27 weeks. These included: knee strength and endurance by isokinetic dynamometer; timed physical performance tests; serum osteocalcin and urinary N-telopeptides; and health-related quality of life scales. RESULTS: Follow-up values of muscular strength and endurance, physical performance, bone turnover markers, and health-related quality of life did not differ by treatment assignment. The final study visit was attended by 19 (90%), 15 (80%), and 20 (91%) of the control, 3%, and 5% groups, respectively. Three permanent discontinuations of vest use occurred. CONCLUSIONS: Weighted vest use did not result in improvement in multiple domains of strength and function and did not affect bone turnover markers. We conclude that the training stimulus afforded by the vest (at the dosage tested) was below the required amount to produce strength gains or bone stimulation.     

New Guaianolides and Farnesol Derivatives from Arctotis arctotoides1

The aerial parts of ARCTOTIS ARCTOTOIDES afforded eight known sesquiterpene lactones and three new ones, the 11beta,13-dihydroguaianolides 9 and 10 as well as the chlorohydrine 8. Furthermore two 2Z-farnesol derivatives 12 and 13 were isolated. The structures were elucidated by highfield (1)H-NMR. The stereochemistry of several compounds has been revised.