Warren May

Three-year follow-up of laser prostatectomy versus transurethral resection of the prostate in men with benign prostatic hyperplasia ☆

OBJECTIVES To present our 3-year data comparing laser prostatectomy and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). Laser prostatectomy was one of the first new minimally invasive treatment modalities for BPH, and few reports of the long-term results of this treatment regimen have been published. METHODS One hundred men with BPH in whom medical therapy had failed were randomized to undergo either laser prostatectomy or TURP. Preoperative measurements included American Urologic Association symptom score, prostate-specific antigen, uroflowmetry, and transrectal ultrasonography (TRUS). Laser prostatectomy was performed using the potassium titanyl-phosphate/neodynium:yttrium aluminum-garnet laser. TURP was performed in a standard manner with video monitoring. Patients were seen in follow-up at 1, 3, 6, and 12 months and every 12 months thereafter, with the following data obtained: symptom score, peak urinary flow rate, prostate-specific antigen level, and TRUS volume. RESULTS A total of 100 patients were entered into the study, with 50 patients in each treatment group. The mean age was 68.2 years (range 45 to 90) for the laser patients and 67.4 years (range 54 to 82) for the TURP group. The mean symptom score decreased from 22.0 to 9.9 at 36 months of follow-up for the laser patients compared with 21.2 to 7.7 for the TURP patients. The mean peak flow rate increased from 8.2 to 12.3 mL/s at 36 months for the laser group with a similar increase from 7.3 to 12.8 mL/s for the TURP patients. The mean TRUS volume for the laser patients decreased from 33.9 to 32.9 cm3 at 36 months compared with a mean TRUS volume of 29.6 cm3 preoperatively for the TURP patients that decreased to 26.3 cm3 at 36 months. CONCLUSIONS At 36 to 72 months of follow-up, the durability of results achieved by the patients in the laser cohort was similar to that for patients undergoing TURP.

Isoform-specific effects of apolipoprotein E on secretion of inflammatory mediators in adult rat microglia.

Inflammation mediated by activated microglia cells has been shown to contribute to the pathogenesis of Alzheimer disease (AD) [1]. Microglia are the immune cells in the central nervous system, and when activated they secrete the lipid-derived mediator prostaglandin E2 (PGE2), the cytokine interleukin-1beta (IL-1beta), and other inflammatory mediators. Apolipoprotein E isoform 4 (apoE4), coded for by the gene APOE4 (epsilon4), has been shown to correlate with higher risk of onset of AD, as well as with increased severity of other diseases with a neuroinflammatory component. This study investigated isoform-specific effects of apoE on the regulation of PGE2, COX2, and IL-1beta expression. Two physiologically relevant preparations of apoE displayed an isoform-specific effect on inflammation in primary adult microglia cultured from adult rat brain cortex. Specifically, apoE4 alone, but not the more common isoform apoE3, stimulated secretion of PGE2 and IL-1beta. The increase in PGE2 release stimulated by apoE4 was not accompanied by the upregulation of the COX-2 enzyme in microglia.

In vitro effects of hyperbaric oxygen on sickle cell morphology.

STUDY OBJECTIVE To determine in vitro whether hyperbaric oxygen has any effect on the morphology of sickle cells. DESIGN Prospective, in vitro, study, with each patient sample serving as its own control. SETTING University medical center. PATIENTS 10 children known to be homozygous for hemoglobin S. INTERVENTIONS Blood samples were obtained from 10 children during routine visits to the University sickle cell clinic. Blood samples were exposed to room air to achieve maximal sickling. Each sample was divided into control and study aliquots, and the study portions placed in a research hyperbaric chamber with 100% oxygen at 3 atmospheres absolute pressure for 15 min. Then smears were prepared from all samples at regular intervals and examined by technicians in the sickle cell clinic who were blinded as to the details of this study. MEASUREMENTS Percentages of normal cells, sickle cells and sickle forms were reported. Data were interpreted using t-tests. MAIN RESULTS Hyperbaric oxygen appeared to have no effect on sickle cell morphology. Percentages of each cell type were unaffected by hyperbaric oxygen exposure. CONCLUSIONS Hyperbaric oxygen appears to have no effect on the morphology of sickle cells in vitro. Other mechanisms may account for the beneficial clinical effects of hyperbaric oxygen in sickle cell crisis, although in vivo studies are warranted.