Body mass index does not predict prostate-specific antigen or percent free prostate-specific antigen in men undergoing prostate cancer screening

ObjectivesBody mass index (BMI) may alter serum prostate specific antigen (PSA) and percent free PSA (%fPSA) and may mask the risk of prostate cancer. We investigated the relationship between BMI and PSA or %fPSA.Materials and methodsHeight, weight, PSA and %fPSA were assessed in 616 consecutive screened men without prostate cancer. Continuously coded and categorised BMI was studied. Statistical analyses consisted of ANOVA, linear regression, bivariate and partial correlations.ResultsMedian age was 57 years. Median PSA was 1.0 and median %fPSA was 26. Median BMI was 25.8 kg/m². Neither continuously coded nor categorised BMI correlated with either PSA or %fPSA in unadjusted or age-adjusted analyses (all p values ⩾0.3).ConclusionsBody mass index does not affect PSA or %fPSA in men without known prostate cancer, who undergo prostate cancer screening. Therefore, PSA or %fPSA-based screening or early detection efforts do not require an adjustment for BMI.     

Ventricular Septal Crypts: Remnants of Spontaneous Interventricular Defect Closure?

Background: Ventricular crypts are quite a common finding during cardiac imaging, but their etiology is unclear. A possible final result of a spontaneous ventricular septal defect closure has been supposed but never investigated in earlier studies. Method: From January 1997 to December 2020, all newborns diagnosed to have a ventricular septal defect were prospectively entered in our database and those with an isolated defect were included in the study. Ventricular septal defects were classified into four types: perimembranous, trabecular muscular, inlet and outlet. A long-term follow up was performed in order to visualize the possible residual formation of a septal myocardial crypt. Results: A total of 376 isolated ventricular septal defects (314 muscular and 54 perimembranous, 4 inlet, 4 outlet) were detected. Follow up ranged from 1 to 23 years and showed that, among muscular type, a spontaneous closure occurred in 284 (91%), 26 did not close (8,28%), 2 required surgical intervention (0,63%), 3 were lost at follow up (0,95%). During this period, after spontaneous defect closure closure, 20 crypts were found (6,4%). Conclusion: This study shows that a muscular ventricular septal defect may evolve in the 6.4% of cases in a residual septal crypt. Although septal crypts occur more frequently in patients affected by hypertrophic and hypertensive cardiomyopathy, they may also represent the evolution of a spontaneous closure of a muscular interventricular defect.     

Practical insights into chronic management of hepatic Wilson’s disease

Wilson’s disease (WD) is a rare inherited disorder of human copper metabolism, with an estimated prevalence of 1:30000-1:50000 and a broad spectrum of hepatic and neuropsychiatric manifestations. In healthy individuals, the bile is the main route of elimination of copper. In WD patients, copper accumulates in the liver, it is released into the bloodstream, and is excreted in urine. Copper can also be accumulated in the brain, kidneys, heart, and osseous matter and causes damage due to direct toxicity or oxidative stress. Hepatic WD is commonly but not exclusively diagnosed in childhood or young adulthood. Adherent, non-cirrhotic WD patients seem to have a normal life expectancy. Nevertheless, chronic management of patients with Wilson’s disease is challenging, as available biochemical tests have many limitations and do not allow a clear identification of non-compliance, overtreatment, or treatment goals. To provide optimal care, clinicians should have a complete understanding of these limitations and counterbalance them with a thorough clinical assessment. The aim of this review is to provide clinicians with practical tools and suggestions which may answer doubts that can arise during chronic management of patients with hepatic WD. In particular, it summarises current knowledge on Wilson’s disease clinical and biochemical monitoring and treatment. It also analyses available evidence on pregnancy and the role of low-copper diet in WD. Future research should focus on trying to provide new copper metabolism tests which could help to guide treatment adjustments.     

What Is the Definition of a Satisfactory Erectile Function After Bilateral Nerve Sparing Radical Prostatectomy?

IntroductionDifferent cut‐offs of the erectile function (EF) domain of the International Index of Erectile Function (IIEF) have been used as definition of postoperative EF recovery.AimTo test the correlation between patient satisfaction and IIEF‐EF domain score cut‐offs.Main Outcome MeasureThe IIEF was used to evaluate EF and satisfaction before and after bilateral nerve sparing radical prostatectomy (BNSRP).MethodsThe study included 165 consecutive patients treated with retropubic BNSRP at a single institution. All patients had normal preoperative EF (IIEF‐EF ≥ 26) and reached an IIEF‐EF ≥ 17 following surgery. Complete data included EF, intercourse (IS), and overall satisfaction (OS) assessed by the corresponding domains of the IIEF administered prior and after surgery. Patients were divided into three groups according to the highest IIEF‐EF score reached postoperatively, namely 17–21 (group 1), 22–25 (group 2), and ≥26 (group 3). One‐way analysis of variance was used to compare IIEF‐OS and IIEF‐IS domain scores at the time the EF end point was reached. The same analyses were repeated separately in those patients with a complete EF recovery after surgery (group 3).ResultsMean preoperative IIEF‐OS and IIEF‐IS domain score was 8.4, 8.8, 8.7 and 11.6, 11.8, 11.9 in group 1, 2, 3, respectively (all P ≥ 0.3). After a mean follow‐up of 26.7 months, mean postoperative IIEF‐OS and IIEF‐IS domain scores assessed at the time of EF recovery were comparable for patients reaching an IIEF‐EF of 22–25 and for patients scoring postoperatively ≥26 (8.1, 8.1, and 10.6, 11.4; all P ≥ 0.3). However, mean IIEF‐OS and IIEF‐IS domain scores of these patients were significantly higher as compared to patients reaching an IIEF‐EF domain score < 22 (6.3 and 8.4, respectively; all P ≤ 0.006). Similar results were achieved considering only those patients (group 3) who had complete EF recovery after surgery.ConclusionsWe demonstrated that in preoperatively fully potent patients treated with BNSRP a lower satisfaction is expected when an IIEF‐EF cut‐off of 17 is used. Conversely, no difference was found using a cut‐off of 22 or 26. Therefore, our results support that a cut‐off of IIEF‐EF ≥ 22 might represent a reliable score for defining EF recovery after BNSRP. Briganti A, Gallina A, Suardi N, Capitanio U, Tutolo M, Bianchi M, Salonia A, Colombo R, Di Girolamo V, Martinez‐Salamanca JI, Guazzoni G, Rigatti P, and Montorsi F. What is the definition of a satisfactory erectile function after bilateral nerve sparing radical prostatectomy?.     

Recurrence of functional mitral regurgitation in patients with dilated cardiomyopathy undergoing mitral valve repair: how to predict it

This study was aimed at identifying predictive variables for recurrence of mitral regurgitation (MR) in patients with dilated cardiomyopathy (DCM) undergoing mitral valve (MV) repair. From January 1997 to December 2005, 142 patients with DCM, 105 (73.9%) ischemic and 37 (26.1%) non-ischemic, underwent MV repair. Mean age was 66+/-10 years and mean MR grade was 3.2+/-0.7 (scale 1+ to 4+). Ninety-seven (71% ischemic, 29% non-ischemic), out of 98 still alive at follow-up, were included in this retrospective analysis. In all cases MV posterior annuloplasty was performed; all patients were followed-up by echocardiography (mean time interval of 44+/-28 months) to evaluate MR recurrence (>or=2+/4+). Thirty-day mortality was 9.2% (13 patients). Mean MR grade at follow-up was 0.9+/-0.9. Four-year freedom from MR recurrence was 65.5%+/-8.3. Cox analysis showed left ventricular end-diastolic volume index (LVEDVi, OR=1.03, P=0.016, AUC=0.72), left ventricular end-systolic volume index (LVESVi, OR=1.03, P=0.033, AUC=0.71), left ventricular ejection fraction (LVEF, OR=0.82, P=0.001, AUC=0.72), mitral valve coaptation depth (MVCD, OR=1.6, P=0.017, AUC=0.72) to be predictive variables for MR recurrence. Preoperative left ventricular dilatation and function along with degree of papillary muscle displacement can be helpful in identifying patients with higher probability to undergo a durable MV repair.     

Rothmund-Thomson Syndrome (Thomson-Type) and Myelodysplasia

Rothmund-Thomson syndrome (RTS) is a genetic disease characterized by developmental abnormalities and poikilodermatous skin changes that appear in infancy. An association with myelodysplastic syndromes is rarely reported in RTS, even though impairment of immune function and recurrent infections are described in the literature. A case of Thomson-type RTS in a 14-year-old girl with trilinear myelodysplasia is presented. The patient was kept under hematologic surveillance for myelodysplastic syndrome. Bone marrow transplantation was considered unnecessary at present.     

Making sense of epidemiological studies of young children exposed to thimerosal in vaccines

ObjectiveTo compare epidemiological studies dealing with neurological issues (compatible with Hg toxicity) linked to exposing newborns and infants to intramuscular doses of preservative-Hg resulting from vaccination with thimerosal-containing vaccines (TCV).MethodsMajor databases were searched for studies that addressed neurodevelopment outcomes other than autism. Eight studies were identified and compared.ResultsInformation extracted from the studies done in the USA, the UK, and Italy is important in understanding the complex interplay of variables but insufficient to establish non-toxicity for infants and young children still receiving TCV: a) there is ambiguity in some studies reporting neurodevelopment outcomes that seem to depend on confounding variables; b) the risk of neurotoxicity due to low doses of thimerosal is plausible at least for susceptible infants; c) there is a need to address these issues in less developed countries still using TCV in pregnant mothers, newborns, and young children.ConclusionsSince the use of TCV is still inevitable in many countries, this increases the need to protect vulnerable infants and promote actions that strengthen neurodevelopment. Developing countries should intensify campaigns that include breastfeeding among efforts to help prime the central nervous system to tolerate exposure to neurotoxic substances, especially thimerosal-Hg.