Statins benefit in androgen levels and target organ damage in hypertensive males with erectile dysfunction

Background

Statins may benefit cardiovascular physiology by cholesterol independent or pleiotropic actions. Target organ damage (TOD) amplifies cardiovascular risk in essential hypertension and endogenous testosterone (TT) exhibit vasoprotective effects. Erectile dysfunction (ED) is frequent in hypertensive middle aged men when androgen levels typically fall, impairing thus quality of life.

Purpose

To investigate the effect of statins in TT and TOD in hypertensive middle aged men with ED, independently of cholesterol levels.

Methods

248 hypertensive ED males (mean age: 57 yo) with no history of diabetes mellitus or overt cardiovascular disease enrolled the study. Of those 95 (38%) were on statin therapy for treatment of dyslipidemia. There were all screened for the presence of microalbuminuria, defined as urinary albumin loss 30–300 mg in a 24 h urine volume collection. TT, total cholesterol (Tchol) and low density lipoprotein (LDL) levels were measured on blood samples taken before 09:00 am. All individuals underwent a non invasive evaluation of the carotid-femoral pulse wave velocity (PWV), estimation of central pressures and augmentation index (AIx) a parameter of wave reflection amplification (Sphygmocor device). ED severity was assessed by the SHIM-5 score (range: 0–25) and higher values indicate a better erectile ability.

Results

In bivariate analysis statin use was positively related to TT (p<0.05 – Figure 1) and negatively to microalbuminuria, Tchol and LDL (p<0.005). Moreover TT was negatively related to PWV, AIx, microalbuminuria (all p<0.005) and positively to the SHIM-5 score (p: 0.003). By linear regression analysis association of TT to statins remained significant after correction for age, BMI, PWV, AIx, Tchol and LDL levels.

Conclusions

Statin therapy benefits endogenous testosterone in hypertensive middle aged men with ED and so lessens TOD and enhances erectile ability independently of cholesterol levels. In such population group pleiotropic effects of statins may help restoring androgen levels, decrease cardiovascular risk and ameliorate quality of life.

Funding Acknowledgement

Type of funding sources: None.

Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?

Complex posttraumatic stress disorder (Complex PTSD) has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases, 11^th version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder (BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses (PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities’ biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.

Report of two cases of endobronchial metastases secondary to colorectal cancer

Two cases of endoluminar/endobronchial metastases (EEM) from a secondary extrathoracic tumour are reported. The patients, eight years after the curative treatment of colorectal adenocarcinoma, were examined exhibiting pulmonary symptoms with radiological findings in the chest and endobronchial lesions as an initial presentation. The use of fiberoptic bronchoscopy of endoluminar/endobronchial lesions may help in diagnosing the origin of metastatic spread in the presence or absence of a primary tumour.

Comparison of two commercial methods with PCR restriction fragment length polymorphism of the tuf gene in the identification of coagulase-negative staphylococci

AIMS

Two commercial methods for the identification of coagulase-negative staphylococci (CNS) were compared with the restriction fragment length polymorphism (RFLP) of the amplified tuf gene, which served as the reference method.

METHODS AND RESULTS

One hundred and forty-five CNS were evaluated using the API 32 Staph ID and the Crystal GP/ID BBL systems. The PCR-RFLP of the tuf gene served as the reference method. The APIStaph and the GP/ID BBL had an overall rate of agreement with the molecular method of 58.6% and 46.2% respectively, with the inability of the GP/ID BBL to characterize 11.7% of the isolates. The APIStaph showed higher sensitivity and better agreement than the GP/ID BBL with the PCR-RFLP, except for Staphylococcus hominis and Staphylococcus capitis.

CONCLUSIONS

Neither of the commercial systems was as reliable as the PCR-RFLP method for identifying isolates of CNS. Overall the APIStaph had better agreement with the PCR-RFLP than the GP/ID system.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results indicate that the PCR-RFLP method is more reliable than the two commercial systems tested, suggesting that it is more reliable for routinely identifying CNS.

One-session bilateral ureteroscopy: is it safe in selected patients?

The aim of this study was to investigate the possibility to perform bilateral ureteroscopy in one session and to determine the procedure's indications and complication rate. Twenty-two patients underwent bilateral ureteroscopy in one session. Eighteen patients had bilateral lithiasis of the lower ureteral third, three patients had unexplained haematuria and one had unexplained bilateral hydronephrosis. The rigid ureteroscope was used in cases with stones and the flexible one in cases with haematuria and hydronephrosis. Ureteral catheters were placed in all patients. The overall stone-free rate was 83.3%. The procedure failed to confirm a diagnosis in 2 patients with unexplained haematuria. Follow-up included IVU and retrograde cystogram 3 months after the procedure and a renal scan one year later. No major complication was observed. It is concluded that bilateral ureteroscopy in one session can be performed safely in selected patients. The method does not yield major complications and saves patients from a second procedure and a second anaesthesia.

Extracorporeal shock wave lithotripsy for renal stones in children

The aim of our study is to determine the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) as a method of treatment of nephrolithiasis in childhood. Between 1986 and 1994, 50 children with renal calculi were treated by ESWL in our department. The age of the children ranged from 8 months to 14 years. Thirty-three of them were boys and 17 girls. The stone location was in the renal pelvis in 38 cases, in the upper renal calyx in 4 cases, in the lower calyx in 2, while 6 children had staghorn calculi. The stone size ranged between 3 and 39 mm. All treatments were performed with Dornier HM4 except 12 children, all older than 10 years, who underwent ESWL with Dornier HM3. All ESWL procedures took place under general anesthesia or sedation with ketamine. The number of shock waves varied between 400 and 2,000 per treatment and the standard maximum generator voltage was 18 kV. The overall stone clearance rate at 1 month was 66%. Fourteen children with large residual fragments underwent a second ESWL procedure 3 months later. With a mean follow-up of 33 months, 41 children (82%) are stone-free. Ten children developed urinary tract infection and 5 Steinstrasse. Twelve children had a pre- and post-ESWL DMSA scan and no permanent impairment of renal function was observed. We conclude that ESWL is the treatment of choice for urinary tract lithiasis in childhood. It is a low-risk method, without serious complications, which yields as high a success rate in children as in adults. We believe that as the stone fragmentation and clearance is much higher in children that in adults, the method must be the initial approach and may be the monotherapy even in staghorn or complex stones.

[Fournier's gangrene: etiology, treatment, and complications]

We report our experience in the treatment of Fournier's gangrene. Ten male patients suffering from necrotising fasciitis of the genitalia were treated by extensive surgical debridement and broad spectrum antibiotic administration. Four were alcoholic and six diabetic. The possible cause was perirectal abscess in 3 cases, urethral stricture in two, traumatic urethral catheter insertion in two, epidydimo-orchitis in one and finally herniorraphy in another case. An average of 2.3 operations was required per patient and the average hospital stay was 38.1 days. Three of them underwent bilateral orchidectomy, two colostomy and a suprapubic catheter was inserted in four cases. Four patients developed acute renal failure and three adult respiratory distress syndrome. Three patients died. Reconstruction using skin flaps was necessary in 4 patients. We conclude that Fournier's gangrene is a true urologic emergency, potential lethal, which requires aggressive antibiotic and surgical treatment.

Stimulation of the obturator nerve during extracorporeal shock wave lithotripsy

This paper presents eigth patients with lithiasis of the lower third of the ureter that were treated by extracorporeal shock wave lithotripsy (ESWL). All the procedures were performed with a Dornier HM4 lithotriptor in the sitting position. In all cases clinical signs of stimulation of the obturator nerve were presented. Because of the continuing movement of the patient and the possibility of damage to the obturator nerve, the lithotripsy was interrupted in the sitting position and was performed successfully with patients in the prone position. One possible explanation for the above phenomenon is that the increased abdominal pressure in the sitting position pushes the ureter with the stone towards the side walls of the pelvis and the obturator nerve. In this way, both obturator nerve and stone were included either in the zone of the high concentration of the shock waves, or in the secondary focal point, with the final result of stimulation of the nerve. By placing the patient into the prone position, the abdominal pressure is reduced, the ureter moves towards the center line, the obturator nerve gets away from the shock waves and the ESWL is completed freely without stimulation of the nerve.

The contribution of the obturator nerve block in the transurethral resection of bladder tumors

This study was designed to evaluate the efficacy of local block of the obturator nerve to avoid it's stimulation during transurethral resection (TUR) or tumors localised on the lateral bladder wall. Forty-five patients were studied, in whom the TUR operations were performed under spinal anaesthesia. The patients were divided into two groups: in the first group a local block of the obturator nerve was done, while the second group served as controls, and the stimulation of the nerve was avoided by reduction of the electrocoagulation voltage, incomplete bladder filling and resections of smaller ships. In the first group no stimulation was observed while in 5 patients of the second group was not possible to totally resect the tumor due to the persistent stimulation of the obturator nerve. In conclusion the local block of the obturator nerve is an effective method to avoid it's stimulation, easily performed and without complications.

[Treatment of stress urinary incontinence by the Raz vaginal colpopexy]

In this study we present our experience from the application of the bladder neck suspension as modified by Raz on 37 patients. All patients had severe genuine stress incontinence. Twenty of them had undergone previous surgery for the same problem, and 16 patients had had a previous hysterectomy. In addition 15 patients had a small cystocele. In all cases, the Raz procedure was performed by the same surgical team. The follow-up ranged from 8-32 months (mean follow-up 15.4). The overall success rate was 86.5%. Patients with no history of previous surgery and all patients with cystocele were cured. The 5 failures occurred in patients with previous surgery and hysterectomy. The complications were few. It is concluded that the Raz bladder neck suspension is a safe and effective method for the treatment of stress incontinence, especially in cases with cystocele or failure after primary treatment.

Extracorporeal shock wave lithotripsy in paraplegic and quadriplegic patients

As it is known, paraplegic and quadriplegic patients are at an increased risk for urolithiasis. We have studied the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in 15 patients with spinal cord dysfunction who were treated in our ESWL unit. A total of 23 treatments were performed. The number of shock waves ranged between 1500 and 3000 per treatment. Only 1 and 3 patients were stone-free at one-month and 3-month follow-up, respectively. Ten of 15 patients with long-term follow-up of 6 to 20 months were stone-free. The remaining 5 patients with residual fragments had staghorn calculi or stones larger than 2.5 cm. We conclude that ESWL is an effective and well tolerated method for this population but the fragment clearance is delayed and below that for unselected patients.