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A young man presented with a subfrenular nodule of the penis that proved to be ectasia and chronic inflammation of the periurethral glands of Littre. Pathological processes involving these glands are rare but must be considered in the differential diagnosis of penile or urethral lesions.
OBJECTIVE: To study the effects of ursodeoxycholic acid (UDCA) on lipid levels in patients with primary biliary cirrhosis (PBC). DESIGN: A randomized, placebo-controlled prospective trial of UDCA was conducted in 177 well-characterized patients with PBC. MATERIAL AND METHODS: The two treatment groups (placebo and UDCA) were matched at entry with respect to age, sex, histologic stage of PBC, biochemical values, and serum lipid levels. Serum cholesterol, high-density lipoprotein cholesterol, and triglyceride levels were measured at entry, 1 year, and 2 years. RESULTS: The decrease in total cholesterol level at 1 and 2 years in the UDCA-treated group was significant in comparison with that in the placebo group. Serum high-density lipoprotein cholesterol and triglyceride levels, however, were unchanged. No severe side effects from UDCA were noted. The changes in serum cholesterol levels at 2 years were directly and strongly correlated with changes in serum bilirubin concentrations (r = 0.70; P < 0.001) and inversely correlated with initial serum cholesterol levels (r = -0.86; P < 0.00001). CONCLUSION: The cholesterol-lowering effect of UDCA could be related to amelioration of the underlying liver disease or to a direct effect of the drug on the metabolism of cholesterol in patients with hypercholesterolemia.
Circumcision is a commonly performed procedure, but medical indications remain controversial. Most disorders of the penis in childhood can be diagnosed and managed by the primary care pediatrician. However, some require early recognition and surgical intervention, and prompt referral to a pediatric surgeon or urologist will optimize outcome. This article discusses the recognition and initial management of these problems, particularly those most commonly seen or followed in the outpatient setting. In addition, the authors review the issues of circumcision.
Following exposure of anesthetized and unanesthetized rats to hypercapnic stress, arginine vasopressin (AVP)-containing neurons of the hypothalamic paraventricular (PVN) and supraoptic (SON) nuclei were examined for expression of the c-fos gene encoded protein (c-Fos). In addition, we determined whether AVP-containing PVN neurons activated by hypercapnia project to phrenic nuclei. In adult control rats, only scant c-Fos-like immunoreactive neurons were observed within the hypothalamic nuclei. A marked increase in c-Fos positive cells was induced after 2 h of breathing a gas mixture with elevated CO(2) (5% CO(2), 21% O(2) and 74% N(2), or 1 h following breathing of 12% CO(2,) 21% O(2,) and 67% N(2)). Colocalization studies of AVP and c-Fos protein revealed that in the PVN, 75% of AVP-containing cells expressed c-Fos immunoreactivity. c-Fos and AVP were coexpressed in 60% of SON neurons in anesthetized rats. In addition, retrograde labeling studies with cholera toxin b subunit (CTb) revealed that a subpopulation of PVN cells (15%) that project to phrenic nuclei are activated by hypercapnia, as indicated by c-Fos expression. These results indicate that (i) PVN and SON AVP-containing neurons are part of the neuronal networks that react to hypercapnic exposure; and (ii) a subset of CO(2) reactive PVN cells innervate phrenic nuclei.
PBC and AIH recur after OLTx. The recurrence of PSC is less clear. Recurrence of these diseases seems to be of relatively little importance in the short term; however, longer follow-up is required to address the significance of recurrent disease. Immunosuppression in these patients may alter the natural history of these entities in the post-transplant setting.
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Ulcerative lesions of the penis have many possible etiologies, including infectious, neoplastic, traumatic, drug-induced, and autoimmune. Although the most frequent neoplasm presenting as an ulcerative penile lesion is squamous cell carcinoma, it may rarely be a manifestation of other malignancies, including those of hematolymphoid origin. We report a case of ulcerative balanoposthitis as a manifestation of chronic lymphocytic leukemia. Chronic lymphocytic leukemia and other hematolymphoid malignancies should be considered in the large differential diagnosis of nonhealing penile ulcers.
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Recent improvements in the biolistic technique and devices have increased its usefulness for transfection of neurons. With these recent advances, both dissociated and slice cultures can be transfected at reasonably high rates. This chapter focuses on the parameters that determine the successful biolistic transfection of neurons in both types of cultures.
Hypospadias is one of the most frequently encountered congenital malformations of the genitourinary system. The incidence in studies of large populations has been reported to be from 1 to 8 per 1000 male births. For centuries the imagination and creativity of surgeons has been challenged to create a phallus that is both functional and cosmetic. Over the last 30 years numerous new operations and techniques have been developed with the objective of achieving improved cosmetic results with minimal complications.
The correction of strictures involving the fossa navicularis poses a distinct reconstructive challenge. Unlike surgical repair of strictures involving other urethral segments where the primary concern is restoration of urethral patency, management of fossa navicularis strictures also requires particular attention to cosmesis. Paramount to the success of any of the described procedures is the careful selection of nondiseased tissue for substitution. If the penile skin is healthy, the preferred urethral substitute is the fasciocutaneous ventral transverse island flap. The inherent characteristics of this versatile flap (i.e., well-vascularized predictable pedicle, nonhair bearing, negligible contraction) provide for an excellent time-tested glandular urethral substitute. In rare cases in which there is a suggestion of penile skin inflammation or scarring, extragenital tissue transfer techniques should be considered. Equally important is the need to substitute the entire length of diseased urethra, preferably as an onlay, preserving the dorsal urethral wall. Persistent proximal urethral disease will eventually result in further stricture formation. Finally, the choice of glanduloplasty is particularly important in achieving a cosmetically appealing outcome. A glans-cap repair is preferred because of the limited dissection required with this relatively simple and bloodless technique. Careful selection of the most appropriate combined urethral substitution and glans reconstruction techniques, as well as meticulous attention to surgical details, are mandatory for achieving a satisfactory functional and cosmetic outcome with fossa navicularis strictures.
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Superficial epidermal surgical removal of a recurrent herpes simplex lesion within 36 hours of onset nearly always prevented recurrence in the site of excision. It is postulated that the surgery results in epidermal denervation, which prevents reinoculation of that epidermal site by the virus-laden sensory neuron. The procedure did not prevent further clinical expression of the disease at other epidermal sites innervated by the same or other infected neurons.
BACKGROUND: Linezolid is a novel oxazolidinone antibiotic that is effective for the treatment of gram-positive bacterial infections. The oral formulation has the potential to reduce length of stay (LOS) when used as a substitute for parenteral glycopeptide antibiotics. In a recent multinational trial comparing linezolid (i.v. followed by oral administration) with teicoplanin (i.v. alone or switched to i.m. administration), linezolid was found to have better efficacy (P = 0.005) and similar safety for treating serious gram-positive infections. OBJECTIVE: The purpose of this study was to compare hospital resource use (primarily LOS) and cost of treatment between linezolid and teicoplanin for hospitalized patients with serious gram-positive infections in South America and Mexico using data from the multinational trial. METHODS: In a multinational, Phase IIIb, open-label, comparator-controlled trial, data were collected from hospitalized patients in centers in 6 South America can countries and Mexico with suspected or confirmed serious gram-positive infections. Patients were randomly assigned to receive i.v. linezolid 600 mg BID (for the entire treatment period [7-28 days] or switched to oral linezolid 600 mg BID) or i.v. teicoplanin (for the entire treatment period or switched to i.m. teicoplanin) dosed per approved prescription information. Data on direct medical resource utilization were collected for each patient, including duration and doses of study medication, location of hospitalization and LOS, comedications, tests and procedures, and outpatient service usage. Unit costs for the medical resources were obtained from secondary sources. RESULTS: A total of 203 patients (97 treated with linezolid and 106 treated with teicoplanin) were enrolled from these 7 countries. The unadjusted results showed that compared with teicoplanin, patients treated with linezolid had a 3.1-day shorter mean i.v. antibiotic treatment duration (P < 0.001), a 2.0- to 2.2-day shorter median and mean LOS (P = 0.03), and a 311 US dollars lower mean total cost of treatment (P = NS). After controlling for age, race, sex, site of infection, inpatient location when the antibiotic treatment started, number of historical and current comorbidities, and whether the patient had a diagnosis of systemic inflammatory response syndrome or sepsis, the multivariate adjusted results were similar to the unadjusted results. The linezolid group had a 1.6-day shorter adjusted LOS or 66% greater odds of early discharge (P = 0.049) and a 335 US dollars lower adjusted mean total cost of treatment (P = NS). CONCLUSION: Linezolid was associated with shorter LOS and duration of IV antibiotic treatment than teicoplanin for serious gram-positive infections in the population studied. Linezolid therapy has the potential to reduce the total cost of treatment.
Cu(II)-Fe(II) hybrid hemoglobins were investigated by UV-vis, Q-band (35 GHz) EPR and resonance Raman spectroscopies. EPR results indicated that Cu-porphyrin in alpha-subunit within hybrid hemoglobin had either 5- or 4-coordination geometry depending on the pH conditions, while Cu-porphyrin in beta-subunit had only 5-coordination geometry at high and low pH values. These results were consistent with UV-vis absorption results. A new resonance Raman band appeared around 190 cm(-1), which was present whenever 5-coordinated Cu-porphyrin existed in Cu(II)-Fe(II) hybrid hemoglobins irrespective of the coordination number in Fe(II) subunit. This Raman band might be assigned to Cu-N(epsilon) (His) stretching mode. These results are direct demonstration of the existence of coordination changes of Cu-porphyrin in alpha-subunit within hybrid hemoglobin by shifting the molecular conformation from fully unliganded state to intermediately liganded state.
BACKGROUND: We evaluated psychiatrically 100 subjects, who were referred to a sleep laboratory in a general hospital because of sleep complaints. METHODS: All subjects were interviewed using a Structured Clinical Interview for DSM-III-R and underwent one night of standard polysomnography (PSG) examination. RESULTS: Forty three percent of the population had at least one Axis I DSM-III-R disorder. High rate of depressive mood disorder (24%) was observed in our sample, in contrast to low prevalence of alcohol and drug abuse (4%). Our results of a Israeli population are different from the United States studies in respect to alcohol and drug abuse. Furthermore, 11% of patients with PSG diagnosis exhibited comorbid psychiatric disorder. CONCLUSION: it appears that individuals with sleep complaints have high rate of psychiatric morbidity, especially mood disorders. LIMITATION: The rapid eye movement (REM) latency, a biological marker for depression, was not investigated. CLINICAL RELEVANCE: it seems that both PSG and psychiatric evaluation of sleep disturbance are of importance for appropriate therapeutic strategy for individuals with sleep complaints, especially in those with features of suspected depressive mood disorders.
Esophageal cancer ranks among the 10 most common cancers in the world, and is almost uniformly fatal. The genetic events leading to the development of esophageal carcinoma are not well established. To identify genomic regions involved in esophageal carcinogenesis, we performed a systematic screening for loss of heterozygosity (LOH) in 24 samples of squamous cell carcinomas, initially focusing the analysis on chromosome 18. Thirteen short tandem repeat markers spanning 18p and 18q were used. We found a broad peak of LOH spanning 18p11.2 and 18q21.1 with the most frequent LOH (72%) at D18S978 on 18q12.2, which coincides with a known fragile site FRA18A. This region is 4 cM proximal to known tumor suppressor genes and therefore suggests the possible existence of a yet undiscovered tumor suppressor gene.