Triamcinolone acetonide injections for the treatment of recalcitrant post-radical prostatectomy vesicourethral anastomotic stenosis: A retrospective look at efficacy and safety

IntroductionWe aimed to evaluate the success of bladder neck injections of triamcinolone at the time of transurethral bladder neck incision (BNI) for prevention of recurrent vesicourethral anastomotic stenosis (VUAS) following prostate cancer treatment.MethodsThis is a retrospective cohort study examining patients with recurrent VUAS post-radical prostatectomy (RP) ± radiation treated with triamcinolone injections at the time of BNI. VUAS was diagnosed by symptoms followed by cystoscopy or urethrography. The outpatient procedures were done under general anesthesia. Cold knife incisions were made at the three, nine, and 12 o’clock BN positions, followed by triamcinolone injections (4 mg/mL) into the three and nine o’clock incision sites. Treatment outcomes were determined with cystoscopy.ResultsEighteen men underwent 25 procedures over a four-year period. Median age at diagnosis of VUAS was 65 (interquartile range [IQR] 61–68); median time to VUAS from RP was eight months (IQR 5–12). Fourteen patients (78%) had radiation treatment. The cohort had 128 unsuccessful VUAS treatments, with a median of five failed treatments per patient (IQR 3–10). Failed treatments included BN dilation, BNI, BN injection of mitomycin C, and urethral stent placement. Success rate after a mean of 16.3 months (standard deviation [SD] 8.1) from the time of triamcinolone injection was 83% (15/18). Six patients went on to have successful incontinence surgery. Five patients (28%) had treatment complications (bleeding, urinary tract infection, pain, and urinary extravasation). The three non-responders are stable and awaiting re-treatment with triamcinolone injection.ConclusionsTriamcinolone bladder neck injections for post-RP VUAS are a useful and safe treatment for recurrent stenosis.     

Should competent patients or their families be notified before HECs review the patients' cases? Yes

In summary, it is, I believe, fairly uncontroversial that a patient always should be notified before a bioethics committee reviews the case. Respect for a patient"s confidentiality and autonomy also require that patients be asked prior to being interviewed or identifying the patient's name in a committee meeting. Permission is not required for an anonymous discussion of the case with a bioethics committee.     

Personality traits and dopamine receptors (D2 and D4): linkage studies in families of alcoholics

Activation of the mesolimbic dopamine pathway appears to promote drug- and alcohol-seeking behavior in laboratory animals. Results for association and linkage analysis between various alcohol dependence phenotypes and the dopamine receptors have been quite mixed. Similarly, both positive and negative results have been presented concerning dopamine receptor genes and temperament. Cloninger has postulated that the novelty seeking factor from the Tridimensional Personality Questionnaire (TPQ) may be related to the dopamine neurotransmitter system. As novelty seeking is a trait of some importance for substance-dependent individuals, our goal was to test this relationship within a sample of families of alcoholics. No evidence favoring linkage between D2, D4, or DAT1 was found for TPQ novelty seeking. However, the harm-avoidance trait from the TPQ showed evidence for linkage to both the D4 and one of the D2 loci (TaqI A). The Multidimensional Personality Questionnaire (MPQ) was used to provide converging evidence for these results. The TPQ harm-avoidance scale loads heavily on introversion (worry, pessimism, shyness), characteristics that may be especially salient in alcoholic families. Thus, planned comparisons were made between selected MPQ traits measuring the affective dimension (negative affectivity, stress reaction, alienation, and well-being). We find evidence favoring linkage between the D2 and D4 receptor loci and these MPQ traits, with stronger evidence being seen for the D2 polymorphisms. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:634-641, 1999.     

A molecular phylogenetic study of the caecal fluke of poultry,Postharmostomum commutatum (= P. gallinum) (Trematoda: Brachylaimidae)

Parasitology Research - Postharmostomum commutatum (Dietz, 1858), a parasite of the caeca of poultry, has been reported from many different parts of the world. Despite its importance,...     

Use and Non-Use of Medication by Sufferers of Selected Symptoms of Depression

Abstract

The overuse of drugs as a means of alleviating stress and anxiety is thought to be characteristic of modern American society. This article addresses the problem by asking the question: given the number of people suffering from certain common symptoms, what percentage will seek relief through the use of medication? Multiple standardization is used to assess the effects of race, sex, age, marital status, and SES on the proportions of people reporting each symptom and the proportions of those who took medications, both before and after standardization for subgroup differences. More than 40 percent of the nearly 4000 adults surveyed reported some problems of sleeplessness and enervation, but when only those who reported persistent problems are examined, very few resorted to medications. The authors conclude that the U.S. is not a “pill-popping” society as depicted by the popular press.