Squamous Cell Carcinoma of the Prostate – A Case Report

Squamous cell carcinoma is a rare neoplasm of the prostate gland, forming about 0.5 of all prostatic malignancies. We present a case of squamous cell carcinoma of the prostate. Squamous cell carcinoma is usually indistinguishable from adenocarcinoma of the prostate by clinical features. Diagnosis is by histological examination. There are definite criteria for diagnosis like keratinisation, epithelial pearls and intercellular bridges. The cell of origin is widely accepted as the transitional epithelium of the urethra and periurethral ducts. This tumour is biologically much more aggressive than adenocarcinoma. There is no treatment modality which offers satisfactory results and the survival time is short.     

Resuscitation-induced gut edema and intestinal dysfunction

BACKGROUND: Mesenteric venous hypertension and subsequent gut edema play a pivotal role in the development of intra-abdominal hypertension. Although gut edema is one cause of intra-abdominal hypertension, its impact on gut function is unknown. The purpose of this study was to create a model of acute hydrostatic gut edema and to evaluate its effect on gut motility and barrier function. METHODS: The first study, group A, evaluated the effect of gut edema on transit over time using 20 mL/kg 0.9% saline. The second study, group B, focused on the 12-hour time period using 80 mL/kg 0.9% saline. Rats were randomized to superior mesenteric vein partial occlusion (venous hypertension) or sham surgery. At 6, 12, and 24 hours, group A underwent intestinal transit and tissue water weight measurements. At 12 hours, group B underwent tissue water, transit, ileal permeability and resistance, lactate and myeloperoxidase activity, and mucosal injury measurements. RESULTS: Venous hypertension with fluid resuscitation caused acute hydrostatic gut edema, delayed intestinal transit, increased mucosal permeability to macromolecules, and decreased tissue resistance over time. Mucosal injury was minimal in mesenteric venous hypertension. CONCLUSION: Acute mesenteric venous hypertension and resuscitation-induced gut edema, in the absence of ischemia/reperfusion injury, is associated with delayed intestinal transit and altered gut barrier function.     

Epidemiological aspects of prediabetes--review of the current data

The term 'prediabetes' has been used to describe the condition in which blood glucose levels are higher than normal but not yet diabetic and includes the two abnormalities, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). Subsequent to the American Diabetes Associaton (ADA) recommendation to adjust downward the normal fasting glucose level from 110 to 100 mg/dl, the prevalence of IFG has increased by 2 to 4 fold. The demonstration by recent randomised controlled trials that type 2 diabetes mellitus is preventable has raised hope for the possibility of reducing cardiovascular morbidity and mortality associated with diabetes. Interventions like lifestyle modification and pharmacological therapy are recommended in individuals with prediabetes to achieve the goal of prevention of diabetes in high -risk population.     

Unresolved priapism secondary to tamsulosin

Tamsulosin is the most potent adrenergic alpha-1 antagonist used for the treatment of benign prostatic hyperplasia. Priapism has been reported rarely in patients taking Prazosin, Doxazosin and Terazosin. We describe an otherwise healthy man with recurrent and then persistent unresolved priapism after the use of tamsulosin. Initial treatment consisted of aspiration and intracavernosal irrigation of iced saline and vasoconstrictive agent, but in vain. We then performed Winters procedure but that too failed and the priapism persisted. Health-care professionals should inform all patients taking such medications about rare but possible serious adverse effects.     

Quantitation of seminal factor IX and factor IXa in fertile, nonfertile, and vasectomy subjects: a step closer toward identifying a functional clotting system in human semen

Coagulation factor (F) IX is a zymogen of the plasma serine proteases, one that plays an essential role in the regulation of normal blood coagulation. Congenital defects of FIX synthesis or function cause hemophilia B (originally called hemophilia C). Factor IX is activated by Tissue Factor (TF):FVII/FVIIa complex and FXIa. Subsequent to its activation, FIXa combines with FVIIIa on the platelet surface and activates FX to FXa. Human semen forms a semi-solid gelatinous coagulum, which then liquefies within 5-20 minutes in vitro. In spite of evidence demonstrating the importance of the seminal coagulation and liquefaction process in terms of global fertility and despite the fact that the seminal coagulum is composed of fibrin-like material, it has always been addressed from the perspective of High Molecular Weight Seminal Vesicle (HMW-SV) proteins (Semenogelin I and II) and their cleavage by prostate-specific antigen rather than the conventional hemostatic factors. In this study and as part of our continuing investigation of human seminal clotting factors, we report here on seminal FIX and FIXa in normal, subfertile, and vasectomized subjects. Factors IX and FIXa were studied in a total of 119 semen specimens obtained from subfertile (n=18), normally fertile (n=34), and fertile sperm donors (n=27) and vasectomy subjects (n=40). Seminal FIX and FIXa levels were also measured in a group defined by normality in several parameters derived from the World Health Organization fertility criteria and termed "pooled normal semen parameters." Both FIX and FIXa were quantifiable in human semen. There was a wide individual variation in FIX and FIXa levels within groups. Despite the group size, statistically significant associations with fertility-related parameters were infrequent. There is a positive correlation between FIX and its activation product, FIXa (n=36; r=0.51; P <.05). Factor IXa elevation in the high sperm-clump group was significant (P <.05), and days of abstention correlated with FIXa levels (n=63; r=0.3; P <.05). The key finding of the present study is that both FIX and FIXa are present in concentrations that are not dissimilar to plasma levels and that are apparently functional, as the activated form is also present. This fact, taken with other reports of coagulation factors in semen, raises the likelihood that a functional set of hemostatic coagulation proteins exists in semen, potentially to interact with the HMW-SV proteins and the prostate-specific antigen system.     

HLA-DW2, viral immunity and family studies in multiple sclerosis

Fifty patients with definite multiple sclerosis (MS) (as defined by McAlpine's criteria on clinical examination including visual evoked responses) were typed for 13 HLA-A locus and 19 HLA-B locus antigens. The frequency of HLA-A3 was 46% (Sydney normal 28%) and that of HLA-B7 was also 46% (normal 27%). The frequency of HLA-BW17 was reduced at 2% (normal 10%).Forty patients were studied in mixed lymphocyte culture with homozygous HLA-DW2 (LD 7a) typing cells. Twenty of these patients were HLA-B7 positive and 20 HLA-B7 negative. Twenty-five of the 40 (62.5%) were positive for HLA-DW2 (relative response range 1–15%). By contrast only 6 of 34 normals (18%) were positive for HLA-DW2. Of the 20 HLA-B7 positive patients 17 were also HLA-DW2 positive (85%), while 8 of the 20 HLA-B7 negative patients were HLA-DW2 positive (40%).Nine of the patients had suffered from optic neuritis as the sole presenting manifestation of disease. Four of these were HLA-B7 positive and only 5 were HLA-DW2 positive, i.e. the absence of HLA-DW2 in a patient with idiopathic optic neuritis does not exclude MS.Both humoral (antibody titre) and cell-mediated (lymphocyte transformation) immunity to 5 viruses (measles, rubella, parainfluenza 3, mumps and herpes simplex) were studied in 40 MS patients using their normal spouses as controls. No significant difference in viral responses was found and no correlation between HLA typing (A, B locus or HLA-DW2) and viral immunity was detected.A linkage study on all available Australian families with more than 1 member suffering from MS is in progress. To date, the affected members of 4 families have failed to share an HLA haplotype.     

FIGO Save the Mothers Initiative: the Pakistan-UK collaboration.

The pilot study in Punjab, Pakistan was one of the five paired demonstration projects sponsored by FIGO in the "Save the Mothers" maternal mortality project. The goal of the project was to bring basic and comprehensive emergency obstetric care (EmOC) to a semiurban and rural area some 30 km from Lahore, where effectively there was none. The aim was to achieve this by using the existing facilities within the rural health system without the deployment of extra specialist staff other than as initial facilitators. This report shows trebling of some performance indicators and an improvement in met need. There is coincidentally a similar increase in the uptake of general medical services. Reducing maternal mortality requires building local capacity for EmOC; the essential components being the premises, trained personnel, equipment, and availability of drugs and blood. Availability and provision of EmOC coupled with changes in the attitude of the population resulted in marked improvement of process indicators.     

Peer review audit of trauma deaths in a developing country

OBJECTIVES: Peer review of trauma deaths can be used to evaluate the efficacy of trauma systems. The objective of this study was to estimate teh proportion of preventable trauma deaths and the factors contributing to poor outcome using peer review in a tertiary care hospital in a developing country. METHODS: All trauma deaths during a 2-year period (1 January 1998 to 30 December 1998) were identified and registered in a computerized trauma registry, and the probability of survival was calculated for all patients. Summary data, including registry information and details of prehospital, emergency room, and definitive care, were provided to all members of the peer review committee 1 week before the committee meeting. The committee then reviewed all cases and classified each death as preventable, potentially preventable, or non-preventable. RESULTS AND CONCLUSION: A total fo 279 patients were registered in the trauma registry during the study period, including 18 trauma deaths. Peer review judged that six were preventable, seven were potentially preventable, and four were non-preventable. One patient was excluded because the record was not available for review. The proportion of preventable and potentially preventable deaths was significantly higher in our study than from developed countries. Of the multiple contributing factors identified, the most important were inadequate prehospital transfer, limited hospital resources, and an absence of integrated and organized trauma care. This study summarizes the challenges faced in trauma care in a developing country.