Raymond's syndrome following petrosal sinus sampling

Summary Inferior petrosal sinus sampling (IPSS) is used to evaluate the pituitary-dependency of Cushing's disease, and to predict the laterality of a microadenoma prior to transsphenoidal operation. A serious complication occured in a 14-year-old boy: he suffered brain stem ischaemia with abducens nerve palsy and hemiparesis (Raymond's syndrome). The case prompted us to reconsider the indication for this investigation.     

High flow cytometric scores identify adverse prognostic subgroups within the revised international prognostic scoring system for myelodysplastic syndromes

The estimation of survival of myelodysplastic syndromes (MDS) and risk of progression into acute myeloid leukaemia is challenging due to the heterogeneous clinical course. The most widely used prognostic scoring system (International Prognostic Scoring System [IPSS]) was recently revised (IPSS‐R). The aim of this study was to investigate the prognostic relevance of flow cytometry (FC) in the context of the IPSS‐R. Bone marrow aspirates were analysed by FC in 159 patients with MDS. A flow score was calculated by applying the flow cytometric scoring system (FCSS). Patients were assigned to IPSS and IPSS‐R risk groups. The FCSS correlated with the World Health Organization classification, IPSS and IPSS‐R risk groups. Mild flow cytometric abnormalities were associated with significantly better overall survival (OS) and lower risk of disease evolution. The presence of aberrant myeloid progenitors was associated with transfusion dependency and disease progression. Most importantly, the FCSS identified prognostic subgroups within the IPSS‐R cytogenetic good risk and low risk group. Flow cytometric analysis in patients with MDS provides additional prognostic information and is complementary to the IPSS‐R. The addition of a flow cytometric score next to the clinical parameters within the IPSS‐R is a further refinement of prognostication of patients with MDS.     

Primary myelofibrosis: risk stratification by IPSS identifies patients with poor clinical outcome

OBJECTIVES:

To evaluate whether risk scores used to classify patients with primary myelofibrosis and JAK-2 V617F mutation status can predict clinical outcome.

METHODS:

A review of clinical and laboratory data from 74 patients with primary myelofibrosis diagnosed between 1992 and 2011. The IPSS and Lille scores were calculated for risk stratification and correlated with overall survival.

RESULTS:

A V617F JAK2 mutation was detected in 32 cases (47%), with no significant correlation with overall survival. The patients were classified according to the scores: Lille - low, 53 (73.%); intermediate, 13 (18%); and high, 5 (7%); and IPSS – low, 15 (26%); intermediate-1, 23 (32%); intermediate-2, 19 (26%); and high, 15 (31%). Those patients presenting a higher risk according to the IPSS (high and intermediate-2) had a significantly shorter overall survival relative to the low risk groups (intermediate-1 and low) (p = 0.02).

CONCLUSIONS:

These results emphasize the importance of the IPSS prognostic score for risk assessment in predicting the clinical outcome of primary myelofibrosis patients.     

Prostatic Artery Embolization with 250-μm Spherical Polyzene-Coated Hydrogel Microspheres for Lower Urinary Tract Symptoms with Follow-up MR Imaging

Purpose

To evaluate clinical outcomes and possible MR imaging predictors of clinical success after prostatic artery embolization (PAE) with 250-μm hydrogel particles.

原位肝移植大鼠肝内门-体分流量的变化

目的 测定原位肝移植大鼠移植肝肝内门-体分流量的变化。方法健康清洁级封闭群雄性SD大鼠，分为供体组和受体组，采用简化二袖套法建立大鼠原位肝移植模型（rat orthotopic liver transplantation model。ROLTM）24只，分为移植后2h、4d、7d三组，每组8只。各组于相应时间点进行肝脏活体在体灌注。经小隐静脉插管连续灌注D-山梨醇，同时取门静脉和肝静脉血，用酶分光光度法测定山梨醇浓度，计算肝内门-体分流量。结果2h、4d、7d组肝内门-体分流量分别为39．9％，52．3％，27．6％，组间差异显著，且均比正常大鼠明显增高。结论 ROLTM大鼠移植肝血供恢复后即存在肝内门-体分流，并随时间推移分流量变化呈先增加后减少的过程。     

Terazosin in the Treatment of Premature Ejaculation: A Short-term Follow-up

Aim: The aim of the present study was to evaluate the efficacy of terazosine in patients with premature ejaculation and lower urinary tract symptoms (LUTS), after excluding other sexual disorders and chronic prostatitis. Methods: A total of 90 patients with premature ejaculation and LUTS were enrolled to the study after excluding sexual disorders, prostatitis and benign prostatic hyperplasia. The patients were divided into two groups. Sixty patients in group 1 were treated with terazosine 5 mg daily for a month. Patients were followed monthly and questioned for their ejaculation problem. The results were classified as cure, improvement and ineffective. If patients showed improvement and ineffectiveness, the treatment was continued with 10 mg daily for the following month. Group 2 was included 30 patients, and placebo was applied for a month. At the end of this period, in patients who did not show any improvement, terazosine 10 mg was started. Results: In the treatment group, at the 1st month follow-up, 21 patients (35%) were cured, 20 (33.3%) showed improvement. In 19 (31.7%) patients, the treatment was ineffective. In group 2, 9 (30%) patients showed improvement and the rest had no-changes after one-month follow up. There was statistically significant difference between two groups (Pearson χ² test=0.000). Later, terazosine 10 mg was given to the patients in group 2 and to the patients who showed improvement or unsuccessful result with terazosine 5 mg. With terazosine 10 mg, 10 (14.5%) patients were cured, 29 (42.2%) patients were improved. Finally, terazosine treatment in patients with premature ejaculation was found to be effective in 60 patients (66.7%).Conclusion: Alpha blockers seem to be physiological medical agents in the treatment of premature ejaculation since ejaculation is under sympathetic control. Moreover, these agents are effective in lower urinary tract and they should be used in patients with premature ejaculation and lower urinary tract symptoms.     

Correlation of non-invasive urodynamics with International Prostate Symptom Score (IPSS) and prostate volume

AIM: To study the correlation between non-invasive urodynamic data, the International Prostate Symptom Score (IPSS) and the prostate volume. MATERIALS AND METHODS: Data of 667 healthy volunteers participating in a longitudinal study of changes in urinary bladder contractility secondary to BPE were analyzed. The prostate volume was assessed by transabdominal ultrasonography. Uroflowmetry followed to verify if a minimum free flow rate of 4.5 ml/sec could be achieved. While (re)filling the bladder by drinking, the subjects completed the Dutch version of the IPSS. Next, the bladder pressure was non-invasively measured using the condom catheter method. The urethral resistance (URR) was calculated from the maximum condom pressure and the maximum free flow rate. RESULTS: The IPSS ranged from 0 to 29, (6.1 +/- 4.8) (mean +/- SD), whereas the prostate volumes ranged from 8 to 140 cm3, (34 +/- 18). Twenty eight percent (185/667) of the subjects had a non-invasively quantified high URR and a significantly higher IPSS (7.3 +/- 5.2) than those with a low URR (IPSS (5.7 +/- 4.6)), Mann-Whitney U-test: P < 0.001. The IPSS and the URR were significantly correlated, Spearman's rho (rho) = 0.20, P < 0.001. A significant difference between the prostate volumes, 36 +/- 21 cm3 in the high URR versus 33 +/- 17 cm3 in the low URR group, was not found, P = 0.18. CONCLUSIONS: A weak though statistically significant correlation was found between the non-invasively quantified URR and the IPSS. This suggests that an elevated resistance is a necessary, but not a sufficient condition for lower urinary tract symptoms (LUTS). No correlation was found between the URR and the prostate volume.     

Fluorescence in Situ Hybridization (FISH) Utility for Risk Score Assessment in Patients With MDS With Normal Metaphase Karyotype

BackgroundCytogenetic profile is an essential parameter in myelodysplastic syndromes (MDS) risk stratification by both International Prognostic Symptom Score (IPSS) and Revised (R)-IPSS. Almost one-half of patients with MDS have normal cytogenetics by metaphase karyotype. Here we report the yield of MDS fluorescence in situ hybridization (FISH) panel detecting cytogenetic abnormalities in these patients and its impact on risk stratification.Patients and MethodsAmong patients with normal metaphase karyotype, we assessed those patients who had cytogenetic abnormalities detected by an MDS FISH panel, which included probes for del (5), del (7), del (20), trisomy 8, and del (17p). Risk stratification was calculated by both IPSS and R-IPSS.ResultsOf 1600 patients with MDS with normal metaphase karyotype, 53 (3%) patients had cytogenetic abnormality detected by MDS FISH panel. Integrating the MDS FISH panel cytogenetics (IPSS + FISH restaging) resulted in upstaging the score, where 53% of low-risk IPSS were upstaged to intermediate (int)-1, 56% of int-1 were upstaged to int-2, and 78% of int-2 were upstaged to high risk. Based on the R-IPSS, 61% of very low-risk patients, all low-risk patients, 92% of intermediate-risk patients, and 50% of high-risk patients with FISH abnormalities were upstaged, respectively.ConclusionThe yield of MDS FISH panel detecting cytogenetic abnormalities in patients with normal karyotype by G-banding is low and may not warrant ordering the panel in all patients. Among the 3% of patients with normal karyotype who had cytogenetic abnormality detected by FISH, the risk score assignment by IPSS and R-IPSS was upstaged.     

经尿道前列腺电切术在前列腺增生症治疗中的运用

目的 观察经尿道前列腺电切术治疗前列腺增生的临床效果.方法 选择我院收治的78例前列腺增生患者为研究对象,采用随机数字表法随机分为对照组和观察组,对照组采用传统开放性手术治疗.观察组采用经尿道前列腺电切术治疗,比较两组治疗前后前列腺增生临床症状改善情况及日常生活质量改善情况.结果 观察组、对照组患者治疗后IPSS评分（7.3±0.7）、（10.2±1.2）显著优于治疗前（15.4±2.1）、（15.3±2.1）,差异有统计学意义（P＜0.05）.观察组患者治疗后IPSS评分改善情况更佳.观察组、对照组患者治疗后生活质量指数（0.5±0.2）、（2.1±0.6）显著优于治疗前（5.2±0.6）、（5.3±0.7）,差异有统计学意义（P＜0.05）.观察组患者治疗后生活质量改善情况更佳.观察组患者治疗后残余尿量（19.3±4.3）mL及最大尿流率（12.9±2.5）mL/s改善显著优于对照组（50.1±4.5）mL、（10.9±2.3）mL/s,差异有统计学意义（P＜0.05）.结论 采用经尿道前列腺电切术治疗前列腺增生疗效显著,安全性好,可显著提高患者生活质量,值得临床推广应用.