Long-term treatment outcome of tamsulosin for benign prostatic hyperplasia

BACKGROUND: The present study assessed the long-term efficacy (>12 months) of tamsulosin in 123 patients with lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH). METHODS: The patients received a starting dose of tamsulosin of 0.2 mg/day, with a further titration up to 0.4 mg/day until symptom relief. Subjective and objective clinical variables were assessed using the international prostate symptom score (IPSS), IPSS quality of life (QoL) score, BPH impact index score, peak urinary flow rate (Q(max)) and postvoid residual urine volume. RESULTS: Except for Q(max), all clinical variables showed significant sustained improvements from baseline throughout the study period (median follow up, 43 months). Thirty patients (24.4%) withdrew because of surgical interventions. The Cox proportional hazards model showed that a baseline IPSS total score >or=15 (HR [hazard ratio] 2.13; 95% CI 1.04-4.34) was predictive of failure for tamsulosin therapy. Furthermore, during the first 12 months, a lowest IPSS total score >or=13 (HR 2.34; 95% CI 1.12-4.89), a lowest IPSS QoL score >or=3 (HR 4.16; 95% CI 1.26-13.68), and a lowest BPH impact index score >or=4 (HR 3.54; 95% CI 1.62-7.75) were also predictive of failure for tamsulosin therapy. CONCLUSIONS: Tamsulosin treatment of BPH patients for more than 12 months showed a sustained, stable efficacy. Patients without short-term effects were prone to withdraw from tamsulosin therapy, but so did patients with a high baseline IPSS total score, even if therapy was effective for at least 12 months.     

Inflammatory pseudotumour affecting the lung and orbit

This report describes a rare case of inflammatory pseudotumour arising metachronously from the orbit and lung. A 78-year-old man with a 7-year history of orbital inflammatory pseudotumour developed a solitary mass in the right lung. Serological studies showed elevated levels of IgG and antinuclear antigen. Wedge resection of the lesion was performed under VATS. Histology showed that lymphoplasmacytic infiltration with dense fibrosis and flow cytometry proved these cells to be polyclonal. Immunostaining revealed numerous IgG4-positive plasma cells diffusely infiltrating the lesion.     

Acute Changes in Left Atrial and Left Ventricular Diameters After Physiological Pacing

The present study examined alterations in left atria! diameter (LAD) and diastolic left ventricular diameter (LVDd) in 37 patients (72.2 ± 9.8 years old) who received physiological pacemakers; 22 with atrioventricular (AV) block and 15 with sick sinus syndrome (SSS). After pacemaker implantation, LAD and LVDd were serially measured using echocardiography, and their diameters ware expressed per body surface area (LADI and LVDdl; mm/m). Pulmonary capillary wedge pressure (PCWP) and cardiac output (CO) were measured in ten patients with SSS and ten with AV block during both right ventricular and AV sequential pacing. After AV sequential pacing, CO increased in 19 of 20 patients (3.2 ± 0.9 L/min to 3.9 ± 1.0 L/min: P < 0.001). LADI decreased from 24.9 ± 4.2 mm/m² to 21.8 ± 4.4 mm/m² (P < 0.001) in 22 patients with AV block and from 24.1 ± 3.4 mm/m² to 20.4 ± 3.8 mm/m² (P < 0.001) in 15 SSS patients. However, LVDdl did not change significantly in either group of patients. The changes in LAD after the implantation of a physiological pacemaker occurred rapidly, i.e. LAD began to decrease within 1 minute after the procedure, and then reached a plateau. This plateau phase continued for at least 7 days during physiological pacing. There was a positive correlation between the changes in LADI after pacemaker implantation and those in PCWP observed during the AV sequential pacing performed prim- to the implantation (r = 0.86; P < 0.001). The reduction in LAD following pacemaker implantation was rapid and seemed to be accompanied by improvement of cardiac function. Thus, it is suggested that the serial measurement of LADI is useful to predict the efficacy of physiological pacemaker implantation.     

Prognostic significance of fibroblastic foci in usual interstitial pneumonia and non‐specific interstitial pneumonia

Background and objective: Fibroblastic foci (FF) composed of an accumulation of fibroblasts or myofibroblasts may be related to the progression of pulmonary fibrosis leading to respiratory insufficiency. Several studies have shown that the number of FF is a significant prognostic factor in usual interstitial pneumonia (UIP). The purpose of the present study was to examine whether the extent of FF is related to impairment of respiratory function and prognosis in patients with biopsy‐proven fibrosing interstitial pneumonia, including UIP and fibrotic non‐specific interstitial pneumonia (fNSIP). Methods: Fifty patients with histologically confirmed interstitial pneumonia including UIP or fNSIP were investigated, and correlations between FF and pulmonary function were evaluated. FF area was calculated as the proportion of total area (%FF) and the number of FF (FF/cm²) in the whole histological specimen from each patient. Results: The UIP group showed significantly higher %FF and FF/cm² than the fNSIP group. When UIP and fNSIP patients were analysed together, the group of patients who had died (death group) revealed significantly higher %FF and FF/cm² compared with the group of survivors, and the impairment of vital capacity and diffusing capacity of carbon monoxide was correlated with %FF and FF/cm². Conclusions: FF correlated with impaired pulmonary function and may be a useful parameter to predict prognosis in patients with UIP and fNSIP.     

Metabolism of 2,4,5,2′,4′,5′-hexachlorobiphenyl (PCB153) in guinea pig

1. The in vitro and in vivo metabolism of 2,4,5,2′,4′,5′-hexachlorobiphenyl (PCB153) in guinea pig has been studied. 2. Seven metabolites were detected in the faeces of PCB153-treated animals and three were identical to those produced by dog liver microsomes. The detection of a metabolite where a chlorine atom was shifted from the 2- to 3-position strongly suggested the involvement of 2,3-arene oxide intermediate, and evidence for the concomitant formation of a 3,4-arene oxide intermediate was provided by identifying other two minor metabolites which were dechlorinated at the 4-position. 3. In vitro studies using liver microsomes from guinea pigs revealed that the 2,3-arene oxide and 3-hydroxylation pathways are the predominant metabolic routes compared with the 3,4-arene oxide pathway. Although the guinea pig is an another species that can metabolize PCB153 mainly to the 2,3-arene oxide intermediate, the rate of formation was only about one-tenth of the dog. 4. These results indicate that the ability to form this unusual 2,3-arene oxide intermediate may not be responsible for high excretion rate of this congener. Our data also suggest that the cytochrome P450-catalysed metabolism of PCB153 in the guinea pig and dog are similar, whereas for post-cytochrome P450 metabolism, the guinea pig resembles the rabbit.     

橄榄叶提取物对实验性兔关节软骨损伤的修复作用

目的探讨橄榄叶提取物(OLE)对实验性兔关节软骨损伤的修复作用。方法 采用手钻在健康新西兰白兔左后膝关节软骨上打3个直径3 mm、深4 mm的洞,制备关节软骨损伤模型。OLE治疗组通过自由饮水每天给予OLE 500 mg.kg-1,连续21 d;模型对照组自由饮用蒸馏水。3周后,处死家兔,用单盲法肉眼观察评分,评价3个损伤部位(洞)软骨的愈合情况;通过石蜡切片和HE染色于光镜下检查损伤部位软骨再生情况;采用番红O和阿尔辛蓝染色分别检测损伤部位蛋白多糖和糖胺聚糖的合成;分别取左右两侧股二头肌和股内侧大收肌称重,计算手术侧和非手术侧肌肉质量的比率。结果 经单盲法肉眼观察评分,OLE治疗组软骨损伤部位3个洞的愈合总评分为(7.2±1.9),明显高于模型对照组(4.6±1.3)(P<0.05)。组织学检查结果表明,OLE治疗组在软骨损伤部位(洞)不仅有大量再生的成熟软骨组织,而且再生的软骨组织周围环绕大量增殖的未分化的软骨胚胎细胞;模型对照组在损伤部位(洞)几乎看不见再生的软骨,仅有大量的再生纤维组织。番红O和阿尔辛蓝染色检查结果表明,OLE治疗组软骨损伤部位软骨基质中蛋白多糖合成明显多于模型对照组(P<0.05),糖胺聚糖含量与模型对照组比较无差异。OLE治疗组股二头肌质量的比率〔(100.1±5.7)%〕明显高于模型对照组〔(89.0±4.9)%〕(P<0.05),OLE治疗组股内侧大收肌质量的比率与模型对照组比较无差异。结论 OLE对关节软骨损伤具有修复作用。     

Intraoperative electrical stimulation of cavernous nerves with monitoring of intracorporeal pressure to confirm nerve sparing during radical prostatectomy: Early clinical results

BACKGROUND: We performed intraoperative cavernous nerve stimulation with an intracavernous pressure (ICP) monitoring system to confirm nerve sparing during radical pelvic surgery and assessed the results. METHODS: Nineteen cases of radical prostatectomy and three of radical cystoprostatectomy were examined. Electrical stimulation of the site where the neurovascular bundle (NVB) was determined to run was performed and changes in ICP were measured before and after prostate removal. RESULTS: Of the 22 patients, bilateral NVBs were preserved in six patients while unilateral NVB was preserved in 16. Before dissection, all NVBs examined exhibited positive responses (ICP changes of>5 mmHg) to nerve stimulation. After removal of the prostate, positive responses were observed in 22 (79%) of 28 macroanatomically preserved NVBs. Of 16 sides on which the NVB was not preserved, there were positive responses in five (31%). In these patients, some nerve fibers were macroscopically observed lateral to the original site of NVB. Finally, bilateral or unilateral nerve sparing was confirmed electrophysiologically in 20 (91%) of the 22 patients. CONCLUSION: Intraoperative stimulation of the NVB while monitoring ICP changes is a simple and reliable method of accurately evaluating the preservation of cavernous nerves. This system may provide further insight into the mechanism of postoperative erectile dysfunction.