Iraklis Mitsogiannis

Sexual dysfunction in newly diagnosed multiple sclerosis women.

Objectives The aim of the study was to evaluate female sexuality in a selective population of newly diagnosed multiple sclerosis (MS) women. Materials and methods In this clinic-based study, 63 newly diagnosed consecutive women affected by definite MS were admitted. Disability and depression were evaluated with the expanded disability status scale (EDSS) and Beck depression inventory, respectively. Sexual function was evaluated with the female sexual function index (FSFI). A group of 61 healthy female volunteers with the same baseline characteristics were used as controls. Postmenopausal women and patients with other major concomitant neurological, endocrinological, vascular, gynecological, psychiatric disorders, use of medicines that can cause female sexual dysfunction (FSD) and disease-modifying drugs were excluded from the study. Results All the evaluated patients were ambulant with no major neurological impairment (mean EDSS score 2.5, range 0—3.5). None of the patients were considered clinically depressed, but some of them were sad or worried. According to the sexual history and FSFI scores, sexual dysfunction was diagnosed in 22 (34.9%) out of the 63 patients and in 13 (21.31%) out of the 61 healthy females (P > 0.05). Conclusions In the newly diagnosed MS patients, FSD represent an important issue even though disability and other concomitant disorders affecting sexual function were excluded. Multiple Sclerosis 2008; 14: 561—563. http://msj.sagepub.com

Current status of ureteroscopic treatment for urolithiasis.

Intracorporeal treatment of urolithiasis is characterized by continuous technological evolution. In this review we present updated data upon the use of ureteroscopy for the management of urolithiasis. Novel digital flexible ureteroscopes are used in clinical practice. Ureteroscopic working tools are revolutionized resulting in safer and more efficient procedures. Special categories of stone patients such as pregnant women, children and patients on anticoagulation medication can now undergo uneventful ureteroscopy. Routine insertion of stents and access sheaths as well as bilateral ureteroscopy is still a controversial issue. Future perspectives include smaller and better instruments to visualize and treat a stone, while robotic ureteroscopy is becoming a fascinating reality.

Clinical efficacy of distigmine bromide in the treatment of patients with underactive detrusor

Purpose: The aim of this study was to assess the clinical efficacy of distigmine bromide, an anti-cholinesterase agent, deemed to improve detrusor function thereby restoring normal voiding patterns in patients suffering from detrusor underactivity. Materials and methods: A total of 27 patients (11 men and 16 women) with poor detrusor function were included in the study. The diagnosis was established using pressure-flow studies. All patients received distigmine bromide at a dose of 5 mg three times daily for 4 weeks and re-attended for a follow-up urodynamic investigation. The results of baseline pressure-flow studies were compared to those after completion of treatment. Results: Treatment with distigmine bromide resulted in a statistically significant reduction of residual volume and percent residual volume, obviating the need for intermittent self-catheterisation in 11 patients. In addition, maximum flow rate and detrusor pressure at maximum flow increased, although not significantly. The drug was generally well tolerated by the majority of patients. Conclusion: Distigmine bromide shows clinical efficacy in patients with poor detrusor function and may therefore be used alternatively in selected cases.

Treatment of relapsed urothelial bladder cancer with vinflunine: real-world evidence by the Hellenic Genitourinary Cancer Group

Relapsed urothelial cancer represents an unmet medical need. Vinflunine is a third-generation antimicrotubuline inhibitor and is currently the only approved drug for second-line treatment across the European Union. We conducted a retrospective analysis assessing the efficacy and safety of vinflunine in 71 Greek patients with relapsed urothelial cancer who were treated between 2005 and 2014. An overall 84% of our patients received vinflunine as second-line treatment, 77% had a performance status of Eastern Cooperative Oncology Group scale 0 or 1, and 30% had liver metastasis at the time of vinflunine administration. A median of four cycles of vinflunine were administered (range 1–16). The most common reported adverse events were constipation, fatigue, and anemia. Median progression-free survival was 6.2 months (95% confidence interval: 4.4–8.8) and overall survival was 11.9 months (95% confidence interval: 7.4–21). Two patients (3%) achieved a complete remission, seven a partial remission (10%), and 22 (31%) had stable disease according to an intention-to-treat analysis. Hemoglobin level less than 10 g/dl and Eastern Cooperative Oncology Group performance status greater than 1 were independent adverse prognostic factors. Stratification according to the Bellmunt risk model was also associated with progression-free survival and overall survival in our population. Vinflunine appears to be a safe and effective treatment modality for relapsed urothelial cancer. More effective therapies and more accurate prognostic algorithms should be sought.

Somatostatin analog lanreotide in the treatment of castration-resistant prostate cancer (CRPC).

Prostate cancer is a common disease affecting males. Despite initial sensitivity to hormone treatment, prostate cancer eventually progresses to a castration-resistant stage (CRPC), which carries an ominous prognosis. Lanreotide is a long-acting somatostatin analog with the same properties with the native peptide. It has been shown to be highly efficacious in treating various hypersecretoty disorders and tumors. Lanreotide has been administered to patients with CRPC within a novel treatment concept, with the aim of targeting not only cancer cells but also various factors secreted in the tumor cell milieu that confer protection from apoptosis. Within this concept, lanreotide has been administered as part of the “antisurvival factor therapy” in combination with dexamethasone and a gonadotropin releasing hormone (GnRH) analog. It has also been given combined with oestrogens in patients with CRPC. The so far published series have documented a clinical response in many patients treated along with significant improvement in parameters related to quality of life. In view of these promising results, large-scale, randomized, controlled trials are warranted to clearly define the exact role of lanreotide and other somatostatin analogs in the treatment of patients with CRPC.

Obstruction-induced alterations within the urinary bladder and their role in the pathophysiology of lower urinary tract symptomatology.

Benign prostatic hyperplasia (BPH) is considered a frequent cause of bladder outlet obstruction (BOO) and lower urinary tract symptoms. This review addresses the bladder response to BOO and focuses on the alterations and biochemical adaptability of the bladder wall in the presence of hypoxia. A literature review of published articles has been performed, including both in vivo and in vitro studies on human and animal tissue.

Analgesia during Extracorporeal Shockwave Lithotripsy: Fentanyl Citrate versus Parecoxib Sodium

BACKGROUND AND PURPOSE Shockwave-induced pain may become an important issue during extracorporeal shockwave lithotripsy (SWL), although the new generation of lithotriptors generally produces less pain than previous models. The aim of the study was to compare the analgesic effect of a cyclooxygenase-2-specific inhibitor (parecoxib sodium) with that of our standard method of analgesia (fentanyl citrate) in patients who needed pain relief when undergoing SWL. PATIENTS AND METHODS Fifty-eight patients who were undergoing SWL for renal calculi were randomized to receive intravenously either fentanyl citrate (group A, n = 30) or parecoxib sodium (group B, n = 28) when they felt that their pain during the session became intolerable. Lithotripsy was recommenced 10 minutes after administration of analgesia. The severity of pain before and after administration of the analgesic regimens was evaluated using a five-level verbal scale. The effectiveness of each drug was evaluated with respect to degree of pain relief and ensuing tolerance of the procedure to completion, as well as the need for supplementary analgesia (half the standard dose of fentanyl citrate). RESULTS The patients in the two groups were comparable with regard to age, sex, body mass index, and stone size. There was no statistically significant difference in the maximum energy level achieved as well as in the total number of shock waves given in the two groups. Administration of fentanyl citrate resulted in alleviation of pain and completion of SWL in 27 patients (90%), whereas parecoxib sodium was effective in five patients (17.8%) (P < 0.01). The remaining 23 patients in group B received supplementary analgesia, and 22 completed the lithotripsy session. CONCLUSIONS Parecoxib sodium was not as effective as fentanyl citrate in alleviating pain during SWL. Its use, however, may lower the dose of opioid-based analgesia in this group of patients.

Inflammatory Myofibroblastic Bladder Tumor in a Patient with Von Recklinghausen's Syndrome

Myofibroblastic tumor, also known as inflammatory pseudotumor or pseudosarcoma, is a benign tumor with mesenchymal origin. Bladder location is very uncommon. We report the case of a 58-year-old man with a history of von Recklinghausens disease who complained for painless macroscopic hematuria 5 months after suprapubic prostatectomy. The radiograph evaluation revealed a bladder tumor, and the pathologic examination following a transurethral resection showed inflammatory myofibroblastic tumor of the bladder. The patient finally underwent a radical cystectomy due to the uncertain pathogenesis of inflammatory myofibroblastic tumor as well as the rarity of cases published on bladder tumors in Von Recklinghausens patients.

Colonization by a linezolid-resistant Enterococcus faecalis caused a urinary tract infection

Sir, Linezolid has played an important role in the management of infections by increasingly resistant Gram-positive organisms [1,2]. Although infections caused by linezolid-resistant E. faecalis were previously described, this is the first report of a urinary tract infection caused by a linezolid-resistant E. faecalis, which colonized the stool of the patient 1 y ago [3]. A 52-y-old male was presented at the emergency department of the University Hospital of Larissa, with suspicion of lower urinary tract symptoms (urgency, dysuria) and mild fever for 3 d. To predict bacteriuria, a dipstick test was performed on a urine sample showing the presence of nitrite and leucocyte-esterase (LE). Laboratory data showed haemoglobin levels at 13 g/dl, a white blood cell count of 11,600 cells/mm (80% neutrophils, 11% lymphocytes, 8% monocytes, 1% eosinophils) and a platelet count of 242,000 cells/mm. Erythrocyte sedimentation rate was 32 mm/h and the C-reactive protein concentration was 5 mg/dl (normal range B/0.6 mg/ dl). In addition, an ultrasound scan of the kidneys and bladder was performed revealing a relatively small prostate (V /38 cm) and a post-void residual urine of 100 ml. The patient gave an obstructed free flow rate (Qmax /9 ml/s), which was probably due to a small anterior urethral stricture, as was shown by a retrograde urethrogram. Urine tract infection was suspected and urine collected in sterile containers and processed immediately upon receipt in the laboratory. Urine culture revealed the presence of Gram-positive cocci at a concentration of /10 cfu/ml. Species identification and susceptibility test were performed using Vitek Automated System (BioMerieux, La Balme les Grottes, France). The microorganism was identified as Enterococcus faecalis; the isolate was susceptible to amoxicillin, vancomycin, teicoplanin and rifampin, while it was resistant to quinolones, tetracycline, erythromycin, gentamicin (high concentration) and linezolid [4]. Determination of MIC to linezolid was performed by agar dilution, according to CLSI guidelines [5]; the strain had a MIC to linezolid of 256 mg/l. The G2576T mutation, which is correlated with the expression of linezolid resistance in clinical strains, was detected by amplification of V domain of 23S rRNA followed by NheI restriction, as described previously; the strain carried 3 to 4 mutated alleles of 23S rRNA [6]. Stool culture obtained from the patient revealed the presence of a linezolid-resistant E. faecalis, with the same resistance pattern. 12 months earlier, the patient had suffered a work accident and undergone an urgent laparotomy for massive intra-abdominal bleeding, during which several hepatic lacerations were recognized and repaired. At the same time, he had also undergone an urgent thoracotomy for haemopneumothorax evacuation. The patient was subsequently transferred to the intensive care unit (ICU), where he received empirically imipenem for 20 d and linezolid for 26 d. According to the protocol applied in our clinical setting, prior to and after treatment with linezolid, stool cultures of the patients are taken for the detection of enterococci; if enterococci are isolated, the isolates are stored at 808C for further

Bilateral spontaneous retroperitoneal bleeding in a patient on nimesulide: a case report

IntroductionSpontaneous retroperitoneal bleeding is a rare but potentially life-threatening event of varied etiology. Herein we report a case of bilateral non-traumatic retroperitoneal hemorrhage.Case presentationA 50-year-old Greek man, who was on a non-steroidal anti-inflammatory agent (nimesulide) for ankylosing spondylitis, presented with a right retroperitoneal hematoma combined with contralateral subcapsular renal hematoma. Bleeding on his right side was successfully controlled by arterial embolization with coils, whereas the left renal hematoma was treated conservatively. His recovery period was uneventful.ConclusionThis is the first reported case of bilateral retroperitoneal bleeding in a patient receiving nimesulide for ankylosing spondylitis. The application of minimally invasive techniques resulted in the desired positive outcome with preservation of both renal units.