Tadalafil versus sildenafil citrate in the treatment of ED: Italian patients’ preferences and explanatory notes

This is an open, multicentre, randomized, crossover study having the aim to evaluate the preference for sildenafil citrate or tadalafil in a population of Italian patients affected by ED, and to compare the efficacy and safety of these two drugs.

Material and Methods.

From October 2003 to November 2004, thirteen Italian centers enrolled ED patients (age >18) being in steady and naïve relation to ED treatment, both through PDE5 inhibitors and any other treatment option. These patients were randomized to sildenafil or tadalafil for 12 weeks, after which they were switched to the alternative treatment for a further 12 weeks. The preference was evaluated through the Treatment Preference Question (TPQ): “During this clinical trial you have taken tadalafil and sildenafil for the treatment of erectile dysfunction. Which medication do you prefer to take for the next 8 weeks of treatment?”. Moreover, patients were asked to express their preference as “strong” or “moderate” and to answer some questions to clarify the reasons behind their preference. SEP and IIEF-EF questionnaires were used for a comparison of efficacy.

Results.

167 patients were enrolled, 144 of whom completed both treatment periods. On being asked the TPQ, 75% of patients (n=108) decided to continue treatment with tadalafil, in particular because it made it possible to have an erection many hours after taking the medication (first or second preference reason for 64.8% of patients), while 25% (n=36) preferred sildenafil (p=0.001). Both drugs improved the IIEF-EF and SEP scores compared to baseline, with a slightly but significantly greater improvement with tadalafil for both parameters.

Conclusions.

Tadalafil and sildenafil are both effective and well tolerated. Most of the patients prefer tadalafil thanks to the possibility of having sexual intercourse many hours after taking the medication.

Echotomography in unilateral renal disease

A review of about 300 patients with unilateral renal disease shows that echography is valuable for a correct diagnosis in numerous cases. The authors emphasize the role of A-B mode ultrasonographic scanning in the exploration of IVP nonvisualized kidneys, renal trauma, and other disorders.

[Tadalafil versus sildenafil citrate in the treatment of ED:Italian patients' preferences and explanatory notes]

This is an open, multicentre, randomized, crossover study having the aim to evaluate the preference for sildenafil citrate or tadalafil in a population of Italian patients affected by ED, and to compare the efficacy and safety of these two drugs. MATERIAL AND METHODS. From October 2003 to November 2004, thirteen Italian centers enrolled ED patients (age >18) being in steady and naïve relation to ED treatment, both through PDE5 inhibitors and any other treatment option. These patients were randomized to sildenafil or tadalafil for 12 weeks, after which they were switched to the alternative treatment for a further 12 weeks. The preference was evaluated through the Treatment Preference Question (TPQ): "During this clinical trial you have taken tadalafil and sildenafil for the treatment of erectile dysfunction. Which medication do you prefer to take for the next 8 weeks of treatment?". Moreover, patients were asked to express their preference as "strong" or "moderate" and to answer some questions to clarify the reasons behind their preference. SEP and IIEF-EF questionnaires were used for a comparison of efficacy. RESULTS. 167 patients were enrolled, 144 of whom completed both treatment periods. On being asked the TPQ, 75% of patients (n=108) decided to continue treatment with tadalafil, in particular because it made it possible to have an erection many hours after taking the medication (first or second preference reason for 64.8% of patients), while 25% (n=36) preferred sildenafil (p=0.001). Both drugs improved the IIEF-EF and SEP scores compared to baseline, with a slightly but significantly greater improvement with tadalafil for both parameters. CONCLUSIONS. Tadalafil and sildenafil are both effective and well tolerated. Most of the patients prefer tadalafil thanks to the possibility of having sexual intercourse many hours after taking the medication.

ABO-incompatible bone marrow transplantation: a GITMO survey of current practice in Italy and comparison with the literature

ABO incompatibility is not considered a contraindication for allogeneic haematopoietic stem cell transplantation (HSCT) despite its association with several immunohaematological complications. At present, there is no general agreement concerning the best methods to reduce these problems. To survey current practice related to ABO-incompatible HSCT in Italy, a questionnaire was sent to all GITMO centres. Specific questions were addressed for management in pretransplant, peritransplant and post transplant phases. A comparison was made with the experience reported in the literature. In all, 74% of GITMO centres answered the questionnaire. A high degree of heterogeneity concerning the pretransplant tests, methods to overcome infusion of ABO-incompatible marrow and post transplant transfusion policy and monitoring was evident. For many of these aspects the literature does not contain unanimous guidelines. The considerable degree of heterogeneity that reflects, at least partially, the lack of consensus in the literature demonstrates that ABO incompatibility is still an open issue in the setting of HSCT and that further studies are needed for a more rationale approach and for the production of evidence-based guidelines.

Prostaglandin E(1)-based vasoactive cocktails in erectile dysfunction: how environmental conditions affect PGE(1) efficacy

INTRODUCTION

The chemical stability of prostaglandin E(1) (PGE(1)) in physiological solution has been studied in different environmental conditions. However, very little data exist regarding the PGE(1) stability and the consequent breakdown products in PGE(1)-based vasoactive cocktails under different environmental conditions.

OBJECTIVE

To evaluate the loss of the therapeutic efficacy of PGE(1) either alone or in combination with other vasoactive substances under different storage conditions.

MATERIALS AND METHODS

Utilizing high performance liquid chromatography the PGE(1) content was evaluated alone and in association with papaverine and papaverine plus phentolamine at temperatures of 2-8 and at 20 degrees C, and after 15, 30, 60, 90 and 120 days of storage using multivariate statistical analysis of variance.

RESULTS

We found that the time of storage significantly affects PGE(1) activity. Furthermore, both the storage temperature and cocktail composition had a significant effect on PGE(1) stability. The chromatographic studies did not disclose the presence of the principal degradation products of PGE(1) (PGA(1), PGB(1)). The presence of papaverine and temperature of 20 degrees C have the greatest effect on the degradation of PGE(1 )during the first 30 days of storage.

DISCUSSION

Temperature and time are prevalent factors determining the slow and progressive deterioration curve of PGE(1) after 30 days of storage. None of the environmental conditions evaluated was so drastic to determine the presence of PGA(1) and PGB(1).

CONCLUSION

For clinical use, one should note that PGE(1) maintains 50-80% of its efficacy for about 1 month even if stored at room temperature (20 degrees C) and/or combined with papaverine.

Therapeutic apheresis exchange in two patients with prolidase deficiency

BACKGROUND

Prolidase deficiency is a rare genetic disorder for which a cure has not yet been found.

OBJECTIVES

To assess the effectiveness of apheresis exchange as a new therapeutic approach.

METHODS

Apheresis exchanges were repeated monthly for four consecutive months, in parallel, on two patients, replacing prolidase-deficient red blood cells with normal filtered cells. Prolidase activity and urinary dipeptides were determined at regular intervals.

RESULTS

The constant presence of active prolidase inside cells allowed a continuous, although partial, degradation of imidodipeptides, with a concomitant improvement of skin ulceration.

CONCLUSIONS

Apheresis exchange could be a reasonable way of obtaining a clinical improvement in these patients.

A multicentre evaluation of a new filtration protocol for leucocyte depletion of high-haematocrit red blood cells collected by an automated blood collection system

BACKGROUND AND OBJECTIVES

A multicentre trial was set up to evaluate the performance of a new leucodepletion protocol.

MATERIALS AND METHODS

Filtration at high haematocrit was started during collection of red blood cell (RBC) products by apheresis with Trima. SAG-M was added after filtration through the filter. Haematocrits and haemoglobin of the filtered RBCs were measured. Residual leucocytes were determined by Nageotte counting.

RESULTS

One-hundred and forty seven procedures were carried out. The haematocrit and haemoglobin contents were 57.3 +/- 3.0% and 55.1 +/- 4.3 g/unit, respectively. All products showed low residual leucocyte levels (< or = 0.75 x 106/unit; 99.31% < 1 x 106).

CONCLUSION

Immediate, on-line, high-haematocrit filtration of red cells collected on Trima resulted in leucoreduced RBCs, which met the AABB and Council of Europe criteria.

Evaluation of sexual function in subjects taking finasteride for the treatment of androgenetic alopecia

BACKGROUND

Our practical experience indicates that sexual side-effects in subjects taking finasteride 1 mg (Propecia) for androgenetic alopecia are much less common than reported in the literature.

OBJECTIVE

To evaluate the sexual function in subjects taking finasteride (1 mg) compared with age-matched controls using the International Index of Erectile Function (IIEF).

METHODS

The IIEF, a brief, reliable questionnaire, was self-administered to 236 patients taking Propecia and 236 age-matched males attending the Department of Dermatology of the University of Bologna.

RESULTS

Statistical analysis showed no differences between scores obtained with the IIEF in subjects taking finasteride and controls.

CONCLUSIONS

The sexual and erectile function of subjects taking finasteride does not significantly differ from that of age-matched controls. This is consistent with the experience of many dermatologists who do not see sexual or erectile dysfunction in patients taking Propecia.

Vasoactive cocktails for erectile dysfunction: chemical stability of PGE1, papaverine and phentolamine

PURPOSE

Vasoactive cocktails are widely used in diagnosing and treating erectile dysfunction, especially in poor responders to prostaglandin E1 (PGE1). However, very little information as to their chemical interactions and stability is available, despite the huge amount of published work regarding their clinical efficacy. Obviously, medical and legal problems are involved.

MATERIALS AND METHODS

We analyzed four kinds of vasoactive cocktails, composed of papaverine, phentolamine and PGE1 in different combinations, using High Performance Liquid Chromatography analysis after 5 to 60 days of storage at temperatures between 2 and 8C. SPSS MANOVA analysis and a t-test for paired samples were used for statistical purposes.

RESULTS

Papaverine and phentolamine concentrations showed no significant variations during the 2 month study, ranging from a minimum of 96.75+/-1.20 to a maximum of 103.00+/-0.20% of the starting values. In the same period, PGE1 showed an accelerated degradation profile, reaching concentration values, after 60 days, of 76.00+/-2.28% and 70.20+/-2.02% when added to phentolamine or papaverine respectively and 70.00+/-2.40% with both.

CONCLUSIONS

Papaverine and phentolamine are characterized by chemical stability when blended together or with PGE1. Papaverine and/or phentolamine increase the naturally occurring degradation of PGE1 in physiological solution. This effect is most evident in the first 10 days. Papaverine has the greatest deteriorating effect on PGE1. A safe and proper use of these cocktails should take into account the variations of PGE1 concentration.

Mobilization and collection of PBSC in healthy donors: a retrospective analysis of the Italian Bone Marrow Transplantation Group (GITMO)

BACKGROUND AND OBJECTIVE

The number of allogeneic transplants of peripheral blood stem cells (PBSC) is rapidly increasing. Collection of PBSC in healthy subjects currently implies the administration of G-CSF or GM-CSF and, of course, the use of apheretic devices. These procedures involve potential risks, in particular the risk of leukemia secondary to growth-factor treatment. To evaluate the current practice of PBSC mobilization and collection, and initially assess the short-term side effects and efficiency of procedures, the GITMO (Gruppo Italiano Trapianti di Midollo Osseo) promoted a retrospective cooperative study among the Italian centers.

METHODS

Seventy-six healthy individuals donating to their HLA-identical or partially matched sibling recipients in seven Italian centers form the basis of the present analysis. The data were retrospectively collected by proper forms, pooled and analyzed by means of a commercially available statistical soft package.

RESULTS

All donors received G-CSF as mobilizing agent with different schedules according to each single center policy. A median of 2.5 (range 1-4) aphereses per donor were run. The most frequent side effect was bone pain. In no case did the medium term follow-up reveal subjective complaints or laboratory modifications. After G-CSF mobilization, WBC and lymphocytes counts increased to a maximum of (mean +/- SD) 48.1 +/- 15.6 x 10(9)/L and 4.2 +/- 1.5 x 10(9)/L, respectively. The peak was reached on day 5 in both cases. Platelets decreased after the apheretic procedures, reaching a minimum of (mean +/- SD) 77 +/- 26 x 10(9)/L on day 8 and returning to normal values on day 11. Overall, the apheretic collection yielded (mean +/- SD) 18.6 +/- 19.2 x 10(8)/kg donor body weight MNC; 10.4 +/- 5.7 x 10(6)/kg CD34+ cells; 90.6 +/- 75.9 x 10(4)/kg CFU-GM and 4.3 +/- 1.8 x 10(8)/kg CD3+ cells. The target dose of 4 x 10(6)/kg CD34+ cells was harvested in 51.3% donors after a single apheresis, in 85.5% after the second, and in nearly 100% after a maximum of 3 aphereses.

INTERPRETATION AND CONCLUSIONS

These data demonstrate that collection of adequate numbers of circulating progenitors is feasible and well tolerated in healthy donors. However, only careful monitoring of donors and international cooperation will help to definitively assess the long-term safety of G-CSF for mobilization of PBSC.

Alprostadil sterile powder formulation for intracavernous treatment of erectile dysfunction

The main aim of this double-blind randomized crossover study was to compare the efficacy and safety of alprostadil sterile powder (Caverject) (PGE1) in a new sterile powder formulation versus placebo in producing erection in patients with erectile dysfunction. Each patient was treated with 5 or 10 micrograms PGE1 and placebo in random order. If the results of the three injections were unsatisfactory, 20 micrograms PGE1 was administered in an open fashion. A total of 45 patients were recruited and evaluated; 31/45 patients (68.8%) responded to at least one injection of alprostadil. A dose-response relation was observed during the double-blind phase; the 10-micrograms dose was effective in 55.5% of patients. The acceptability and tolerability of the preparation, evaluated both clinically and by laboratory tests, was very good. In particular, only four drug-related side effects were observed, three (penile burning, penile pain and pain after injection) after 10 micrograms and one (hematoma) after 5 micrograms PGE.

Surgical treatment of ureterocele in the adult

A ureterocele is a congenital cystic ballooning of the terminal submucosal ureter. Simple orthotopic ureterocele represents about 30% of all ureteroceles and occurs primarily in adult males. Ectopic ureterocele represents about 70% of all ureteroceles, occuring mainly in female children with a left predominance. Ten per cent are bilateral. From 1970 to 1991 we observed 15 patients (11 females, 4 males) with ureteroceles. We preferred the surgical approach for treating ureteroceles in all patients. Only 1 patient treated in this manner had a subsequent reflux.

[Enoxacin in the treatment of asymptomatic bacteriuria in patients with prostatic adenoma]

Fifty patients suffering from prostatic adenoma with asymptomatic bacteriuria, were admitted to an open non comparative trial. Enoxacin was administered at the daily dosage of 300 mg every 12 hours for 10 days. Three cycles of treatment were performed during three consecutive months. Treatment efficacy was established by assessing patient symptoms related to the infection such as pollakiuria , nocturia, decreased flow rate, stranguria, daily temperature. Cultural tests were also performed. All observations were collected at baseline and at the end of each cycle of therapy. Cure was obtained in 43 patients (87, 75%), 1 patient (2,04%) relapsed, 5 patients (10.2%) withdrew because of inefficacy of treatment and 1 patient died of heart failure. No side effects were observed. These results suggest that enoxacin may be successfully used in the treatment of asymptomatic bacteriuria.

[Prostate-specific antigen (PSA): diagnostic and prognostic implications in the evaluation of carcinoma of the prostate]

Prostatic specific antigen (PSA), glycoprotein with molecular weight of 34000, was first identified by Wang and Coll. in prostatic tissue initially; then Papsidero and Wang purified PSA in the sera of patients with prostatic cancer. We determined PSA concentration in 132 serum samples obtained from 111 patients affected by prostatic carcinoma: of these 61 had untreated prostatic cancer (6 had a stage A disease, 10 stage B, 19 stage C and 26 stage D) and 50 were variously treated (17 with cyproterone acetate, 11 with estramustine phosphate, 10 with LH-RH analogues, 9 underwent radical prostatectomy and 3 radiation therapy alone). Each patients was assigned a histological grade according to Gaeta, by means of a perineal transrectally guided prostatic biopsy. At periodical follow-ups of treated subjects, patients' state and neoplastic evolution were considered. Serum PSA has been measured by a competitive radioimmunoassay (PSA-Double antibody, Diagnostic Product Corporation) in which 125-I-labeled PSA competes with PSA in the samples for antibody sites. The antibody-bound fraction is then precipitated and counted. Since manipulation of the prostate gland may lead to elevated PSA levels, patients' samples were obtained prior to rectal examination, biopsy or surgical procedures. On the basis of a preliminary study of samples from healthy blood donors, we fixed the cut-off value at 2.9 ng/ml. In patients with untreated prostatic carcinoma PSA serum mean value was 26.33 ng/ml (range 0.5-100), resulting elevated in 56/61 (90,16%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Radiological aspects and results of percutaneous ultrasonic nephrolithotripsy]

Percutaneous removal of renal stones is becoming an established procedure, especially for stones lying free in the renal pelvis. These techniques, which include: retrograde pyelography to facilitate a thorough understanding of caliceal anatomy and stone position in 3 dimensions; approaches for accurate placement of a nephrostomy tract for straightline access to the stone and stone removal are discussed.

Ultrastructural aspects of human prostate in benign prostatic hyperplasia

The ultrastructural morphology of the prostate in benign prostatic hypertrophy has been studied with particular attention focused on features of prostatic secretory processes and the formation of "corpora amylacea." Morphological and cytochemical comparisons of prostatic secretory vacuoles and multivesicular bodies have been carried out, and the secretory mechanisms of the prostate have been further defined by scanning electron microscopy.

Correlation between clinical response to antiandrogenic therapy and occurrence of receptors in human prostatic cancer

Occurrence of steroid hormone receptor has been evaluated in 30 prostatic cancer-bearing patients: 5 alpha-dihydrotestosterone receptor (DHTR) occurrence was correlated with both tumor grade of differentiation and clinical response to hormone therapy.

Pelvic lipomatosis: a nonsurgical diagnosis

Pelvic lipomatosis is rare in Europe. Preoperative diagnosis is seldom reached and subsequent explorative procedures are necessary. Typical roentgenographic findings are presented. The possibility of an early presurgical diagnosis is emphasized.