PHARMACOLOGICAL TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

SUMMARY Although surgery remains the standard treatment for benign prostatic hyperplasia there has been a rise in the number of available drugs for this condition. The current drug therapies appear to be useful for symptomatic short-term treatment, particularly for those patients unfit or unwilling to undergo surgical intervention. Further evaluation of the long-term effects of these treatments and their role in early disease is required, but drug therapy is likely to play a more important part in the management of this condition in the future.     

THE CURRENT MANAGEMENT OF PARACETAMOL OVERDOSAGE

SUMMARY Paracetamol overdosage is a common problem, but severe poisoning occurs in only a small percentage of cases. A patient who has suffered paracetamol overdosage should be monitored carefully to ensure that a specialist liver unit can be contacted at the earliest signs of severe poisoning for optimal management and transfer. Paracetamol overdosage remains the most common cause of fulminant hepatic failure in the UK, with a mortality rate of 90%, but survival rates can be improved dramatically by specialist intensive care management, and with the advent of transplantation a previously untreatable group of patients can be treated successfully. However, a patient who is inadequately monitored and treated in the early stages after an overdose may deteriorate to an extent that renders them unsalvable by the time they arrive at the specialist centre.     

PROBLEMS SOLVED AND LIVES SAVED? CHRONIC HEART FAILURE

SUMMARY Chronic heart failure (CHF) is common, disabling and deadly. Recent studies show that ACE inhibitors reduce morbidity and mortality in all grades of CHF and may even delay or prevent the onset of overt CHF in patients with asymptomatic left ventricular dysfunction. In this review, guidelines are given for how to use these drugs both in hospital and in general practice. New evidence on the benefits of digoxin is also considered, and the management of concomitant problems such as angina and arrhythmias in patients with CHF is discussed.     

Increase of large granular lymphocytes in human ejaculate containing antisperm antibodies

Using flow cytometry, we studied the expression of the CD16 antigen by lymphocytes present in human semen samples from three groups of patients: 60 fertile men attending for vasectomy, 60 sterile patients without antisperm antibodies (ASA) and 18 immunological sterile patients with ASA in their ejaculate. No significant difference was found in the concentration of leukocytes or subpopulations of these cells (monocytes, lymphocytes and granulocytes) between fertile, sterile without ASA and immunological sterile groups. However, we detected a predominance of macrophages/monocytes within the population of seminal leukocytes. No statistically significant difference was found in the absolute number of T and B lymphocytes between the three groups studied. However, a significant increase in the number of CD16+ lymphocytes was observed in the ejaculate of sterile patients with ASA as compared to the other groups. This finding might establish an important parameter in the follow-up and prognosis of patients with immunological sterility.      

Creating a uniform donor medical history questionnaire

Blood Centers of California, Inc. (BCC) is a consortium of 19 independent blood centers that collectively draw approximately 800,000 units of whole blood each year. Over the past several years, a committee of BCC, composed primarily of medical and nursing directors at member institutions, developed a Uniform Donor Medical History Questionnaire (UDMHQ). The UDMHQ, consisting of 42 questions, satisfies the requirements of the United States Food and Drug Administration, the State of California, the American Association of Blood Banks, and the special concerns of the members of BCC. The primary benefit of standardizing the donor medical history was an improvement in its content. Other, unproved benefits include delivering a consistent message to donors and potentially providing some legal protection to participating blood centers.     

Lineage promiscuity in hemopoietic differentiation and leukemia

An increasing number of reports document instances in which individual leukemic cells coexpress markers normally believed to be restricted to a single lineage. This has been interpreted by McCulloch and colleagues as aberrant programming or lineage infidelity and contrasts with earlier suggestions that lineage fidelity of gene expression was usually maintained in leukemia. We argue that several examples of infidelity are suspect on technical grounds, whereas others are bona fide and require explanation, eg, partial rearrangements and expression of Ig heavy-chain and/or T cell receptor genes in inappropriate cells and terminal deoxynucleotidyl transferase in leukemic myeloblasts. Individual examples of truly aberrant gene expression may well occur in leukemia but with insufficient regularity to be of general significance. We suggest that verifiable and consistent examples of apparent lineage infidelity do not reflect genetic misprogramming but rather the existence of a transient phase of limited promiscuity of gene expression occurring in normal biopotential or multipotential progenitors and able to be preserved as a relic in leukemic blast cell populations that are in maturation arrest. This alternative explanation has interesting implications for mechanisms of hematopoietic differentiation and leads to some testable predictions.     

Total Parathyroidectomy Alone or with Autograft for Renal Hyperparathyroidism?

Seventy-six patients underwent parathyroidectomy for renal hyperparathyroidism.There were 10 subtotal parathyroidectomies, 49 total parathyroidectomieswith implantation of part of one gland as an autograft, ninetotal parathyroidectomies with no autograft, and eight patientsin whom only three parathyroid glands were found. In 34 dialysis patients who underwent total parathyroidectomywith an autograft there was a high rate of recurrent hyperparathyroidismafter 6 years in those remaining on dialysis. Fifty per centhad asymptomatic recurrent hyperparathyodism and 30 per centrequired partial autograft excision for symptomatic hyperparathyroidism.In contrast, recurrent hyperparathyroidism was rare in renaltransplant recipients with good renal function. This favourableoutcome did not depend upon whether parathyroid surgery wasperformed before or after transplantation, or on the type ofparathyroidectomy. Total parathyroidectomy without an autograftwas performed in nine dialysis patients without any short-termadverse effects, and with clinical and pathological improvementin bone disease. In summary, the results of surgery for renal hyperparathyroidismwere excellent in patients who received a successful renal transplant.However, there was a high incidence of recurrent hyperparathyroidismin patients who remained on long-term dialysis. Total parathyroidectomywithout an autograft may be the treatment of choice in patientsunlikely to receive a renal transplant.