Treatment Outcome of Overactive Bladder Patients Receiving Antimuscarinic Therapy for More than One Year

Objectives

Details on the therapeutic effects of long‐term antimuscarinic therapy have not been reported. Thus, the aim of this study is to evaluate the detailed long‐term therapeutic effect of antimuscarinic therapy.

Methods

All consecutive patients who visited the urologic outpatient clinics of a medical center for treatment of overactive bladder syndrome and received antimuscarinic therapy of 12 months or more were retrospectively reviewed. All medical records, including the Overactive Bladder Symptom score (OABSS), the modified Indevus Urgency Severity Scale and the International Prostate Symptoms score (IPSS) questionnaires, and uroflowmetry parameters were reviewed at each visit.

Results

A total of 140 patients had received 12 months or more of antimuscarinic therapy. Sustained therapeutic effects were observed by persistent decreases of IPSS‐storage score, IPSS‐total score and OABSS score. Moreover, the maximum flow rate did not change over time. A temporary increase in postvoid residual volume and decrease in voiding efficiency were found, but these parameters improved over long‐term visits. Side‐effects were observed in 81 patients (57.9%) and included dry mouth (n = 58, 41.4%), constipation (n = 48, 34.3%) and blurred vision (n = 4, 2.9%); all side‐effects were tolerable. Patients aged 75 years or more (n = 94) had a higher comorbidity rate (n = 46, 48.9%) before treatment but generally exhibited similar therapeutic effects as overall patients; elderly patients could also tolerate side‐effects.

Conclusion

Sustained therapeutic effects were observed in patients who received 12 months or more of antimuscarinic therapy, even in elderly patients. In addition, side‐effects in patients receiving long‐term therapy were also common but tolerable.     

经皮肝穿刺胆道引流口发生渗漏患者使用美皮康吸收性敷料的效果观察

目的 探讨美皮康吸收性敷料在经皮肝穿刺胆道引流口发生渗漏患者中的应用效果.方法 经皮肝穿刺胆道引流术后患者留置引流管期间发生渗漏患者98例,采用随机数字表法分成对照组和观察组各49例.对照组采用无菌纱布联合防漏膏换药,观察组使用美皮康吸收性敷料联合防漏膏换药.观察比较2组患者置管期间舒适度、周围刺激性皮炎及意外脱管发生情况.结果 观察组患者置管期间舒适度高于对照组(P<0.05),观察组患者刺激性皮炎发生率低于对照组(P<0.05),2组患者意外脱管发生率的比较差异无统计学意义(P>0.05).结论 使用美皮康吸收性敷料处理经皮肝穿刺胆道引流口发生渗漏患者,可提高患者舒适度,减少刺激性皮炎的发生,值得临床借鉴使用.     

Anticentromere antibodies (ACA): clinical distribution and disease specificity

Sera from 3528 patients with autoimmune disease, and non-autoimmune disease, and 500 normal individuals were studied For the presence of anticentromere antibodies (ACA) by indirect immunofluorescence on HEP-2 cells. Sixty-seven specimens were identified showing discrete speckled staining: 55 (82.1%), 11 (16.4%), and one (1.5%), were from patients with autoimmune disease, non-autoimmune disease and normal control subjects, respectively. These ACA were present frequently in CREST syndrome (55%), Raynaud's disease (29.6%) and primary biliary cirrhosis (30%). Only 16.4% of the antibody positive patients carried a clinical diagnosis of CREST, which means that ACA are not specific for CREST syndrome. High antibody titre persisted irrespective of whether or not the patients had active disease. The ACA were present infrequently in Sjögren's syndrome, systemic lupus erythematosus, rheumatoid arthritis, immune thrombocytopenic purpura, Graves' disease, immune haemolytic anaemia, and vitiligo. Sera from 107 patients with various other autoimmune diseases were negative for ACA.     

IN VITRO STUDY OF ULTRASOUND BASED REAL-TIME TRACKING OF RENAL STONES FOR SHOCK WAVE LITHOTRIPSY: PART 1

PURPOSE: We developed a real-time tracking system for renal stones that decreases the number of shock waves and treatment time of shock wave lithotripsy. MATERIALS AND METHODS: Ultrasound images were analyzed to identify the renal stones. A computer software module for ultrasound image processing was developed to monitor stone location instantaneously. Another computer software module controlled generator movement in real time for tracking the stone. We used 13 ultrasound stone trajectories recorded from patients to test the system in vitro. Two tests were established to verify tracking system reliability. One test focused on improvement in the coincidence ratio, which denotes the matching extent of the stone within the effective focal area. The other test focused on improvement in the efficiency ratio, that is a decrease in the number of shocks for stone fragmentation. For each recorded stone trajectory 2 experiments were done under tracking and nontracking conditions. RESULTS: The average coincidence and efficiency ratios plus or minus standard deviation were 79.6% +/- 9.8% and 45.0% +/- 12.7% without tracking, and 97.0% +/- 3.0% and 85.5 +/- 6.8% with tracking, respectively. All tests were statistically significant (paired t test p <0.01). CONCLUSIONS: An ultrasound based real-time tracking system proved to be significantly helpful for in vitro lithotripsy. It appears that the tracking system may greatly decrease the number of shocks and treatment time for renal stones.     

Overt hypothyroidism with rhabdomyolysis and myopathy: a case report

Muscle involvement in adults with hypothyroidism is common. At least 79% of patients with hypothyroidism have muscle weakness, cramps, and myalgia complaints.1 The patients with hypothyroidism do have myopathy rather than functional muscle diseases.2 Nonspecific muscle stiffness related to myalgia may be associated with serum muscle enzyme elevations. Serum creatine kinase （CK） elevation can be observed in 57%-90% of patients with hypothyroidism. Skeletal muscle is affected more profoundly in cases of overt hypothyroidism,     

Lymphoepithelioma-like salivary gland carcinoma in Taiwan: a clinicopathological study of nine cases demonstrating a strong association with Epstein–Barr virus

Aims : Lymphoepithelioma-like carcinoma (LELC) of the salivary glands is a rather rare tumour. Previous studies have shown its strong association with Epstein–Barr virus (EBV) among Chinese and Eskimos. We tested this observation with nine Chinese patients with salivary gland LELC in Taiwan including one with coexisting nasopharyngeal carcinoma (NPC) and studied the prognostic significance of their histopathological features. Methods and results : This series showed a predilection for female patients and parotid glands with a median age of 50 years. Three patients died 18.5–26 months after the diagnosis including the case with NPC. Six patients were alive without recurrence for 14–45 months with a median follow-up of 34.5 months. Histopathologically, the tumours showed either lobular or diffuse growth pattern. Granulomas and/or germinal centres were observed in most cases and both B- and T-cells were found in the lymphoid infiltrates, indicating that the salivary gland LELC was capable of inducing a strong host immune reaction. Microscopic growth pattern, lymph node metastasis, and presence or absence of granulomas and/or germinal centres seemed to be important prognostic factors. Both salivary gland LELC and NPC shared similar histopathological appearance and positive immunostaining for epithelial membrane antigen and cytokeratin AE1 but not AE3. Granulomas and amyloid might occur in both tumours. A nasopharyngeal examination is indicated in patients with salivary gland LELC to exclude the possibility of coexisting or metastatic NPC. All nine cases showed positive nuclear signals for EBV-encoded RNA by in situ hybridization including the case with NPC. Conclusions : Our study and the previously published studies show that the association of salivary gland LELC and EBV is strongly related to racial and geographical factors.     

CELL KINETICS, DNA CONTENT AND TSH RECEPTOR-ADENYLATE CYCLASE SYSTEM IN DIFFERENTIATED THYROID CANCER

The purpose of this study was to elucidate the changes of the TSH receptor-adenylate cyclase system in differentiated thyroid carcinomas, and their relationships with nuclear DNA content, cell kinetics and clinical stage. The results showed that the papillary carcinomas had an impaired TSH receptor-adenylate cyclase system. The production of cAMP stimulated by TSH was decreased when compared with non-cancerous tissue and high-affinity TSH receptors were reduced in number or even completely lost (nine in 24 cases). Follicular carcinomas also showed a reduction in, or even complete loss, of high-affinity TSH receptor (one in five cases). However, the responses to the stimulation of TSH, Gpp (NH)p and forskolin were not different from those in non-cancerous tissue. Papillary and follicular cancer cells showed more proliferative activity than those in non-cancerous tissue. Follicular carcinomas contained more hyperploid cells (DNA content greater than 2.5 C) than papillary carcinomas. There were no differences in cell kinetics, DNA content or the effects of Gpp (NH)p or forskolin on adenylate cyclase activity between those papillary carcinomas with high-affinity TSH receptor and those without. However, the presence of high-affinity TSH receptors had higher cAMP generation stimulated by TSH. The patients having papillary carcinomas in the absence of high-affinity TSH receptors were all in clinical stage III. These studies suggest that TSH receptors are the major sites influenced in the TSH receptor-adenylate cyclase system in papillary carcinomas. The TSH receptor-adenylate cyclase system of papillary carcinomas differs more from normal than does that of follicular carcinomas.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparing Mini‐Mental State Examination and Attention and Digit Span in elderly exposed to polychlorinated biphenyls and polychlorinated dibenzofurans

Background: Polychlorinated biphenyls (PCB)/polychlorinated dibenzofurans (PCDF) are known to affect central nervous functioning. In recent studies, elderly patients who have been exposed to these have been noted to have psychological deficits. There is little known about which test is sensitive to neurotoxins in cognitive evaluation. The objective of the present study was to compare the significance between selective psychological tests in cognitive assessment in PCB‐laden elderly. Methods: A retrospective PCB/PCDF exposed cohort was observed. Exposed elderly aged ≥60 years and registered in Central Health Administration were enrolled, and similar age‐ and sex‐matched subjects served as non‐exposed controls. The Mini‐Mental State Examination (MMSE) and Attention and Digit Span (ADS) were tested in both groups. Student's t‐test, χ²‐test and linear regression models were used for statistical analysis. Results: A total of 165 exposed patients and 151 controls were analyzed. The exposed group included 49% men, a mean age of 69.3 ± 6.4 years and an education level of 4.0 ± 3.9 years. The controls included 52% men, a mean age of 69.9 ± 5.5 years and an education level of 4.5 ± 3.2 years. There was no statistical difference in MMSE before and after adjusting for the confounding variables of age, sex and education (P= 0.16 vs P= 0.12). However, ADS‐forward and ADS‐total scores showed a significant decline in the exposed subjects (P= 0.0001 vs P= 0.001). Using a linear regression among stratified PCB and cognitive functioning (≤30 ppb; 31–89; ≥90), a dose effect was found at the medium (31–89 ppb) and high exposure (≧90 ppb) levels. Conclusion: Our observations showed attention and short‐term memory were impaired in PCB‐laden elderly patients. Higher exposure level showed lower cognitive functioning in ADS. The MMSE was insensitive to neurotoxins. The present study shows that the selective test has a decisive role in toxic‐related cognitive assessments.