The value of penile duplex in the prediction of intracavernous drug-induced priapism

The aim of this work is to assess the value of penile duplex in the prediction of intracavernous drug-induced ischemic priapism. A total of 400 patients with erectile dysfunction were evaluated before and after diagnostic intracavernous injection of a trimix solution (papaverine+phentolamine+PGE1) using color Doppler sonography. In all, 29 patients experienced sustained rigid erections for more than an hour. Patients were further divided into two groups. Group A included patients with spontaneous resolution of their rigid erection within 3 h (10/29) and group B included patients with priapism (19/29) that did not resolve within 3 h. In group A, patients had minimal cavernous artery blood flow within the first hour postinjection, that increased with relief of their erection. Group B patients had no blood flow in their cavernous artery an hour after intracavernous injection and for 6 h later. The disappearance of blood flow in the cavernous artery after an hour of sustained rigid erection predicted priapism with 100% specificity and sensitivity. The persistent absence of cavernous artery blood flow for more than an hour, as detected by color Doppler ultrasound, is an objective predictor of priapism. This may guide early intervention to resolve the prolonged erection.     

Expression of CD44 protein in bilharzial and non-bilharzial bladder cancers

OBJECTIVES: To investigate the expression of CD44 protein in bilharzial and non-bilharzial bladder carcinomas, and to relate the results of immunohistochemistry to the established prognostic factors, as studies clearly show that altered adhesive function of tumour cells is important in the metastatic process and CD44 is assumed to be critical in the malignant progression of many human tumours. PATIENTS AND METHODS: The study included 55 patients with bladder carcinoma confirmed by cystoscopy and biopsy. Of the 33 patients with transitional cell carcinoma (TCC), 19 were bilharzial and 14 non-bilharzial, and of 22 with squamous cell carcinoma (SCC), 12 were bilharzial and 10 non-bilharzial. CD44 expression was measured by immunohistochemical analysis of paraffin-embedded tissue obtained from these patients after appropriate treatment (transurethral resection, partial or radical cystectomy). RESULTS: There was significantly less CD44 expression in invasive TCC than in normal urothelium and pre-invasive TCC (P = 0.05). The expression of CD44 was inversely related to the tumour grade and depth of invasion (P = 0.05). However, there was no such relation for SCC; there was no significant difference between CD44 expression in metaplastic squamous epithelium, pre-invasive and invasive SCC. The presence or absence of bilharzial ova had no apparent effect on the expression of CD44, with no significant difference between CD44 expression in bilharzial and non-bilharzial bladder carcinomas. CONCLUSIONS: These data confirm that there is a reduction in CD44 expression with increasing tumour grade and stage of TCC, and may provide an additional aid in predicting the progression of this tumour. There was no such relationship with SCC, and no difference between CD44 expression in bilharzial and non-bilharzial bladder carcinomas.     

冠状动脉狭窄的16层螺旋CT造影检查

目的以常规X线冠状动脉造影为标准,评价16层螺旋CT（MSCT）无创性检查冠状动脉及诊断冠状动脉狭窄的价值。资料与方法65例临床初诊为冠心病,无冠状动脉成形术和搭桥术史的患者,在冠状动脉16层MSCT造影检查后,回顾性重建心电门控轴位图像,并采用容积成像（VR）、多平面重建（MPR）、曲面MPR、最大密度投影（MIP）等后处理方法,对所有冠状动脉及其分支进行重建,统计可供临床评价的、管径≥1．5mm的冠状动脉段,以选择性冠状动脉造影（SCA）为标准,对比分析MSCT诊断冠状动脉显著性狭窄（管腔平均直径缩小超过50％）的准确性。其中8例在检查前心率超过80次／min的患者使用了B受体阻滞剂。结果93％的冠状动脉节段和94％的冠状动脉主干可供评价,不能评价的主要原因分别为：心脏运动伪影（58％）,致密钙化（28％）和管腔显影不良（14％）。除外不能评价的冠状动脉,按节段和主干分类,MSCT诊断冠状动脉显著性狭窄的敏感性和特异性分别达到92％、98％和95％、97％。结论无需常规使用B受体阻滞剂,16层MSCT冠状动脉造影即可获得较好的图像质量用于诊断冠状动脉狭窄,是一种值得临床医师信赖的检查冠状动脉有无狭窄的非创伤性方法。     

Biology of the estrogen receptor,GPR30, in triple negative breast cancer

Background

Triple-negative (TN) breast cancer lacks a known signaling pathway amenable to targeted therapy. The authors hypothesized that the G protein–coupled receptor GPR30 may be present in TN breast cancer and serve a role for tumor growth.

Methods

A retrospective pathology study and chart review were conducted. All patients aged ≤49 years from 2000 to 2008 were included (n = 24). Concurrent patients aged ≥50 years were randomly selected. Paraffin sections were stained for GPR30 and reviewed by a pathologist blinded to estrogen receptor and progesterone receptor status. Disease-free survival was analyzed versus age and receptor status. Means were compared using 2-sample t tests and proportions using chi-square analysis.

Results

Twenty-seven patients tested GPR30 positive and 21 GPR30 negative. Seventeen of 18 TN cancers tested positive for GPR30 (P < .0001). Recurrence at a mean follow-up of 36 months was 22.2% in the GPR30-positive group and 9.5% in the GPR30-negative group.

Conclusions

GPR30 is prevalent in TN breast cancer and associated with young age and possibly recurrence.     

Safety of not withholding clopidogrel therapy during the immediate several days pre- and post-trans-urethral resection of prostate (TURP): a retrospective cohort study

Background and aim

Benign prostatic hypertrophy or hyperplasia (BPH) is a frequent urological complain particularly in old-aged individuals. Those patients usually have other risk factors (such as ischemic cardiovascular diseases) for which they might be treated with anti-thrombotic agents chronically. These medicines may induce blood thinning and raise the incidence of hemorrhage. Thus, if those patients needed operative treatment for BPH, they may be at high risk of hemorrhage or its related adverse effects with the usage of anti-thrombotic drugs during the peri-operative time. On the other hand, dis-continuation of these agents can lead to ischemic events in susceptible individuals.

Therefore, this research aims to assess the safety of the continuation of using anti-thrombotic agents throughout the peri-operative duration in patients with prostate surgery in form of Transurethral Resection of Prostate (TURP) only for Benign Prostatic Hypertrophy (BPH).

Methods

Patients’ notes were reviewed retrospectively. The entire participants were categorized into two categories. First category was on clopidogrel therapy (CTC) for prolong time and the usage of these agents was carried on throughout the peri-operative period. The second category was not on clopidogrel therapy at all (NCTC). Both of these categories had Transurethral Resection of Prostate (TURP) for Benign Prostatic Hypertrophy (BPH). A comparison had been conducted between the two categories with regards to: (i) the amount of blood lost intra-operatively (ii) the duration of operation (iii) hematocrit concentration per-operatively (iv) transfused packed red blood cells (PRBC) if needed (v) clearance of hematuria postoperatively (vi) secondary hemorrhage and clot retention after discharge. Pearson Chi-square test, Independent sample t test and test for numeric variables were used as appropriate.

Results

The study identified 329 patients. One hundred and sixty five participants in the CTC (clopidogrel therapy category) and 164 in the NCTC (non-clopidogrel therapy category). It had been revealed that there was no statistically significant difference between the CTC and NCTC regarding: (i) the amount of blood lost intra-operatively (ii) the duration of operation (iii) hematocrit concentration per-operatively (iv) transfused packed red blood cells (packed RBC) if needed (v) clearance of hematuria postoperatively (vi) secondary hemorrhage and clot retention after discharge (P?>?0.65).

Conclusion

The continuation of usage of anti-thrombotic therapy (clopidogrel) during peri-operative period in patients with TURP for BPH is a safe practice. It is not associated with high probability of hemorrhage or PRBC transfusion or other adverse effects.

     

Impact of Sarcopenia on Outcomes Following Intra-arterial Therapy of Hepatic Malignancies

Background

Assessment of patient performance status is often subjective. Sarcopenia—measurement of muscle wasting—may be a more objective means to assess performance status and therefore mortality risk following intra-arterial therapy (IAT).

Methods

Total psoas area (TPA) was measured on cross-sectional imaging in 216 patients undergoing IAT of hepatic malignancies between 2002 and 2012. Sarcopenia was defined as TPA in the lowest sex-specific quartile. Impact of sarcopenia was assessed relative to other clinicopathological factors.

Results

Indications for IAT included hepatocellular carcinoma (51 %), intrahepatic cholangiocarcinoma (13 %), colorectal liver metastasis (7 %), or other metastatic disease (30 %). Median TPA among men (568 mm²/m²) was greater than women (413 mm²/m²). IAT involved conventional chemoembolization (54 %), drug-eluting beads (40 %), or yttrium-90 (6 %). Median tumor size was 5.8 cm; most patients had multiple lesions (74 %). Ninety-day mortality was 9.3 %; 3-year survival was 39 %. Factors associated with risk of death were tumor size (HR?=?1.84) and Child's score (HR?=?2.15) (all P?<?0.05). On multivariate analysis, sarcopenia remained independently associated with increased risk of death (lowest vs. highest TPA quartile, HR?=?1.84; P?=?0.04). Sarcopenic patients had a 3-year survival of 28 vs. 44 % for non-sarcopenic patients.

Conclusions

Sarcopenia was an independent predictor of mortality following IAT with sarcopenic patients having a twofold increased risk of death. Sarcopenia is an objective measure of frailty that can help clinical decision-making regarding IAT for hepatic malignancies.     

A quantitative analysis of the effects of different harvesting,preparation, and injection methods on the integrity of fat cells

Background

The percentage of intact fat cells membrane obtained by even a well-known technique remains poorly studied. The purposes of this study were to evaluate and compare the structural effects of various harvesting, preparation, and injection methods on human fat cell integrity.

Methods

We enrolled 20 healthy females in this study, ages ranged from 20 to 41 years with an average age of 31?±?0.5 years. We harvested fat tissues from the abdomen and thigh of donors using two different methods: conventional and syringe liposuction; we treated the aspirated fat specimens within 30 min of harvesting by fine-mesh gauze or using centrifugation. We injected the prepared fat through small or large needle, and then obtained a specimen from each different method. We analyzed all fat graft samples by routine histological examination.

Results

There was a significant difference in the percentage of intact fat cells wall was observed in syringe aspiration (75.95?±?0.31 %) versus vacuum liposuction (56.43 %?±?0.67). There was a significant difference in the percentage of intact fat cells when using centrifugation versus fine-mesh gauze preparation. Also there was a significant difference in the percentage of intact fat cells observed when using large versus small needle for injection.

Conclusions

The highest intact adipocyte counts were in syringe suction, no centrifuge, and using large cannula, while the fewest intact adipocyte counts were in conventional liposuction, using centrifuge, and using small cannula. Level of Evidence: Level IV, prognostic study     

Management of penile fracture: Can it wait?

Objectives

To assess the effect of timing of presentation of cases with penile fracture on the long-term outcome of surgical intervention.

Depression and the subsequent risk of Parkinson's disease in the NIH‐AARP Diet and Health Study

We conducted a case‐control study to examine the association between depression and Parkinson's disease (PD). Participants included 992 PD cases diagnosed after 2,000 and 279,958 individuals without PD from the NIH‐AARP Diet and Health Study follow‐up survey. Physician‐diagnosed depression and PD were self‐reported with information on the year of diagnosis in the following categories: before 1985, 1985–1994, 1995–1999, and 2000–present. Only PD cases diagnosed after 2000 were included in the analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were derived from logistic regression models, adjusted for age, gender, educational level, marital status, smoking, and coffee drinking. Individuals with depression diagnosed after 2000 were more likely to report a concurrent diagnosis of PD than those without depression (OR = 4.7, 95% CI = 3.9, 5.7). Depression diagnosed before 2000 was also associated with higher odds of PD diagnosed after 2000 (OR = 2.0, 95% CI = 1.6, 2.4). This association was stronger for depression diagnosed in 1995–1999 (OR = 2.7, 95% CI = 2.0, 3.6), but was also noted for depression diagnosed in 1985–1994 (OR = 1.6, 95% CI = 1.1, 2.3) or even before 1985 (OR = 1.7, 95% CI = 1.3, 2.3). This association was not modified by other factors and persisted in an analysis excluding participants who reported poor health status. The results suggest that depression may either be a very early symptom of PD or share common etiological factors with PD. © 2010 Movement Disorder Society