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Biomedical subjects

R N Thin

Publications and source records attributed to R N Thin.

At least 19 recordsLinked to original sources
PubMed1999

Prostatitis.

Prostatitis, especially chronic prostatitis, is sometimes regarded as an obscure, ill-defined condition, perhaps because the anatomical location of the gland and ill-defined symptoms make diagnosis difficult. Treatment may appear time consuming and tiresome for doctor and patient, but by following established principles, diagnosis is often simple and management straightforward.

Anti-Bacterial Agents↗
PubMed1997

The chronic prostatitis syndromes.

Three chronic prostatitis syndromes are recognised, chronic bacterial prostatitis (CBP), chronic nonbacterial prostatitis (CNBP), and prostatodynia. All may occur in men of military age, and may tax the patience of medical officers and patients whose capacity for full duty will be impaired. Diagnosis depends on identifying micro-organisms in CBP and white cells in CNBP in prostatic secretion (EPS) expressed by prostatic massage. In prostatodynia there are clinical features of prostatitis but no evidence of inflammation. Prostatic massage should be preceded by trans-rectal ultrasound which may show prostatitis and other pathology, and has simplified the investigation of these syndromes. Management includes a high fluid intake, regular bowels with a soft stool, regular prostatic drainage by ejaculation and limited alcohol intake. Antimicrobials are indicated for CBP and probably for CNBP, and need to be continued for at least three months in many cases. Other measures for treating CNBP are less well established. Prostatodynia is an ill defined syndrome which requires careful evaluation and patients may need psychiatric therapy.

Bacterial Infections↗
PubMed1997

Diagnosis of chronic prostatitis: overview and update.

Symptoms and signs are unhelpful in the diagnosis of chronic prostatitis which in many cases continues to rest on comparison of white cells and organisms in urine samples collected before (VB2) and after (VB3) prostatic massage to express prostatic secretion (EPS), and particularly in the EPS itself, if this is obtained. A series of 195 patients is reviewed, 38 with chronic bacterial prostatitis (CBP), 66 with chronic non-bacterial prostatitis (CNBP), 55 with prostatodynia, and 31 with a history of recurrent urethritis without prostatitis. Demographic characteristics and history of recurrent urethritis were similar in all groups indicating that recurrent urethritis alone does not predispose to prostatitis. The upper limit of normal for the EPS while cell count was taken as 1000/mm3 in line with other reports. With this, the upper limit of normal for the estimate of white cells by simple microscopy appeared to be about 5/high power field (hpf) rather than the figure of 10 often quoted; with the latter figure, a number of cases of CNBP would have been missed. All microscopy was undertaken with the same microscope using a x 40 objective. Culture results showed a predominance of enterococci, and cultural and cytological findings in EPS and VB3 were comparable. On microscopy, clumping of white cells was associated with increased numbers-mentioned previously in the literature but not supported by data. Ejaculation just before examination was associated with reduced rather than the increased numbers of cells previously reported. Individual investigators should assess their own methods in determining upper limits of normal for cells. In a separate series of 8 patients with symptoms compatible with prostatitis, transrectal ultrasound scanning showed a prostatic cyst; aspiration was associated with relief of symptoms. It is concluded that transrectal ultrasound scanning (TRUS) should precede prostatic investigation by prostatic massage as this may save the prolonged treatment often necessary for prostatitis.

Chronic Disease↗
PubMed1994

Genital herpes. A guide to pharmacological therapy.

The pharmacological therapy for genital herpes simplex virus (HSV) infection remains dominated by aciclovir, although a number of related compounds are currently under investigation. Recommended treatment for initial genital HSV infection is oral aciclovir 200mg 5 times daily for 5 days, with intravenous therapy reserved for complicated episodes. Although topical aciclovir may be of benefit, no improvement in the systemic symptoms is provided by this formulation. No preparation prevents the onset of recurrent episodes. The management of recurrent episodes is more controversial, with studies of episodic treatment with both topical and oral aciclovir yielding mixed and at times conflicting results. Episodic treatment with oral aciclovir initiated early by the patient appears to have the most favourable results, and if initiated at the onset of prodromal symptoms may abort the episode in some patients. In patients with frequent recurrences, suppressive therapy with oral aciclovir should be considered. A starting dose of 200mg 4 times daily appears to be the most effective, although 400mg twice daily may suffice. The total daily dose should be reduced as far as possible, and treatment should be interrupted on a yearly basis to determine the need for continuing suppression. The management and pharmacological therapy of genital HSV in pregnancy remains controversial and studies of oral aciclovir in late pregnancy are currently under way. Genital HSV infection may be particularly severe in the immunocompromised host and suppressive oral aciclovir should be initiated promptly. HSV resistance to aciclovir is an increasing problem in such patients, in particular those infected with HIV, and may necessitate treatment with intravenous foscarnet.

Acyclovir↗
PubMed1993

Health of the nation: way forward in sexual health.

Sexual health is a wide concept encompassing education, health promotion and disease prevention, diagnosis and management of sexually transmitted diseases, screening and counselling for HIV antibodies, management of HIV infected patients, family planning, termination of pregnancy, psychosexual counselling, prevention of cervical and lower genital tract cancers, and sexual abuse. Implementation of The Health of the Nation (1992) will include assessing the current situation, views, alliances and interventions, need for research and development and within alliances setting challenging but achievable targets. The Health of the Nation includes a target for gonorrhoea which is a surrogate for partner change, sexually transmitted diseases in general and HIV infection, and a target for conceptions among those under 16 years of age. These targets need to be adjusted locally and may be staged. All interventions to achieve these targets must be available. Implementation of The Health of the Nation to achieve the main objectives which are to reduce the incidence of HIV infection and other sexually transmitted diseases as well as reducing the number of unwanted pregnancies and provision of effective family planning services will be challenging but sexual health gain will be well worthwhile.

Family Planning Services↗
PubMed1992

Acyclovir vs isoprinosine (immunovir) for suppression of recurrent genital herpes simplex infection.

OBJECTIVE: To compare the efficacy and safety of oral acyclovir (400 mg twice daily) with oral isoprinosine (500 mg twice daily) in the suppression of recurrent genital herpes. DESIGN: Double-blind, double-dummy, randomised, controlled, parallel group trial. SETTING: 13 centres in UK, Belgium and Germany. SUBJECTS: 127 immunocompetent patients with frequently recurring genital herpes. MAIN OUTCOME MEASURES: Proportions of patients reporting recurrences, recurrence frequency, and mean duration of lesions during breakthrough recurrences in each treatment group during a 6 month treatment period; time to first recurrence during treatment and follow-up after treatment cessation. RESULTS: During treatment, acyclovir recipients showed significant differences (p < 0.05) when compared with isoprinosine recipients in terms of a lower proportion reporting recurrences (31% vs 96%), a reduced mean number of reported recurrences per patient (0.6 vs 3.6), a shorter mean duration of breakthrough lesions (6.4 days vs 8.2 days), and a longer mean time (standard error) to first recurrence (143.7 (9.1) days vs 40.5 (5.4) days. The mean time to first recurrence after treatment cessation did not differ between the two groups. As compared with placebo recipients, isoprinosine treated patients had an increased recurrence frequency (3.6 vs 2.5) during treatment, and a shorter time to first recurrence after treatment cessation. All treatments were well tolerated without serious adverse events or toxicity. CONCLUSIONS: Acyclovir is very effective in suppressing recurrent genital herpes and is clearly superior to isoprinosine which is not clinically useful in the dosage studied.

Acyclovir↗
PubMed1991

Episodic acyclovir therapy to abort recurrent attacks of genital herpes simplex infection.

Frequent recurrence of genital herpes simplex infection can be a distressing condition. Continuous suppressive oral acyclovir is effective but expensive. Hitherto episodic therapy has given disappointing results. An open comparative study of patient initiated therapy is reported here. Acyclovir 200 mg five times daily for five days aborted 44% of recurrences and shortened 38% by greater than or equal to 50%, giving useful response in 82% of 34 recurrences. Acyclovir 400 mg twice daily for five days aborted 60% and shortened 17% giving useful benefit in 77% of 20 recurrences. Acyclovir 200 mg twice a day for five days gave unsatisfactory results. Patients were selected for frequent recurrences and a recognized prodrome, and care was taken to help to identify early prodromal symptoms. In these patients acyclovir in dosages of 200 mg five times daily for five days and 400 mg bd for five days proved convenient and cost effective.

Acyclovir↗