The postfinasteride syndrome; an overview

As a 5-α reductase inhibitor, Finasteride has proven effective in ameliorating two conditions documented to be androgen dependent, namely male androgenic alopecia and benign prostatic hyperplasia. Therapeutic results are maintained as long as the drug is administered, with treatment cessation generally leading to the return of symptomatology for each condition. In addition, during the therapeutic phase, several adverse effects have been reported, some of which persist long or indefinitely after treatment cessation, known as “post-finasteride syndrome.” Herein we present and discuss the most common finasteride side effects, along with a psycho-neuroendocrine rationale that could explain the persistence of many adverse effects after treatment cessation. Moreover, we argue that finasteride adverse effects occurring during finasteride administration should be delineated from postfinasteride side effects (encountered after treatment cessation), suggesting the need to be addressed separately within a therapeutic perspective. Until a tailored therapeutic approach of postfinasteride syndrome becomes available, we have noted that hand preference and sexual orientation seem to be useful as possible predicting factors for finasteride side effects and postfinasteride syndrome. Finally, even though finasteride administration is considered relatively safe, literature data urges prudence. Specifically, recent studies report that some subjects receiving finasteride develop severe depressive episodes including suicidal thoughts, in part due to persistent sexual side effects

CLINICAL EFFECTS OF GESTONORONE CAPROATE ON BENIGN PROSTATIC HYPERTROPHY

Gestonorone caproate was used in 24 cases of benign prostatic hypertrophy, and clinical symptoms were improved in 62.5 % of these cases. There were no severe side-effects following administration of gestonorone caproate

Radiotherapy in langerhans cell histiocytosis : a rare indication in a rare disease

Introduction: Langerhans Cell Histiocytosis (LCH) represents a rare benign disorder, previously designated as "Histiocytosis X", "Type II Histiocytosis" or "Langerhans Cell Granulomatosis". Clinical presentation includes osteolysis, ulcerations of skin and soft tissues but also involvement of the CNS is described.Because treatment concepts are not well defined the German Cooperative Group on Radiotherapy for Benign Diseases performed a retrospective analysis. Methods and material: Eight closely cooperating centres collected patients' data of the past 45 years. As study endpoints disease free survival, recurrent disease, death and therapy related side effects were defined. Results: A total of 80 patients with histologically proven LCH were irradiated within the past 45 years. According to the LCH classification of Greenberger et al. 37 patients had stage Ia, 21 patients stage Ib, 13 patients stage II and 9 patients stage IIIb and the median age was 29 years. The median Follow up was 54 months (range 9-134 months). A total of 39 patients had a surgical intervention and 23 patients a chemotherapy regimen.Radiation treatment was carried out with a median total dose of 15 Gy (range 3-50.4 Gy). The median single fraction was 2 Gy (range 1.8-3 Gy).Overall, 77% patients achieved a complete remission and 12.5% achieved a partial remission. The long-term control rate reached 80%. Within an actuarial overall 5-year survival of 90% no radiogenic side and late effects ≥EORTC/RTOG II° were observed. Conclusion: In the present study a large collective of irradiated patients was analysed. Radiotherapy (RT) is a very effective and safe treatment option and even low RT doses show sufficient local control

CLINICAL EXPERIENCE WITH TSAA-291 FOR BENIGN PROSTATIC HYPERTROPHY

Nineteen patients of benign prostatic hypertrophy in our clinic (Stage I 13, Stage II 6) were treated with 16β-ethyl-17 β-hydroxy-4-estren-3-one(TSAA-291 ), a new strong anti-androgenic agent developed by Takeda Chemical Industries, Ltd. 200 mg/week of TSAA-291 were injected for 11 -12 weeks. Residual urine, dysuria, urinary stream, straining and nycturia were examined as to clinical effect. Clinical findings improved in 14 of 19 cases. Side effects were found in two patients, one was malaise, another one was headache and palpitation. Abnormal change in hemogram, liver function, renal function and serum acid-phosphatase after injection of TSAA-291 were not observed. In conclusion, TSAA-291 can be used without detectable side effects for conservative treatment of some selected cases of benign prostatic hypertrophy

Therapeutic Considerations Related to Finasteride Administration in Male Androgenic Alopecia and Benign Prostatic Hyperplasia

Finasteride has been used extensively until now as a relative efficient therapeutic option for male androgenic alopecia and benign prostatic hyperplasia. Unfortunately, over time several concerns appeared regarding the frequency and magnitude of adverse effects, which in some cases have been even irreversible. Herein we review the recent literature on this topic, trying to clarify the current safety profile of Finasteride for these two therapeutic indications. We concluded that Finasteride could be retained as a therapeutic approach for male androgenic alopecia, based on two important reasons. First, a synergistic action between a partial inhibitor of 5α-reductase (Finasteride) and another compound (like Minoxidil) are preferable to a complete suppression of 5α-reductase (see Dutasteride), in order to preserve the important physiological roles of dihydrotestosterone. Second, Finasteride side effects can currently be addressed in part prior to the onset of the therapy, by using information about the patient such as hand preference and sexual orientation to predict the risk of adverse effects

Willingness to Pay for Agricultural Environmental Safety: Evidence from a Survey of Milan, Italy, Residents

The widespread use of pesticides in agriculture provides a particularly complex pattern of multidimensional negative side-effects, ranging from food safety related effects to the deterioration of farmland ecosystems. The assessment of the economic implications of such negative processes is fraught with many uncertainties. This paper presents results of an empirical study recently conducted in the North of Italy aimed at estimating the value of reducing the multiple impacts of pesticide use. A statistical technique known as conjoint choice experiment is used here in combination with contingent valuation techniques. The experimental design of choice modelling provides a natural tool to attach a monetary value to negative environmental effects associated with agrochemicals use. In particular, the paper addresses the reduction of farmland biodiversity, groundwater contamination and human intoxication. The resulting estimates show that, on average, respondents are prone to accept substantial willingness to pay premia for agricultural goods (in particular, foodstuff) produced in environmentally benign ways.Pesticide risks, Food safety, Willingness-to-pay, Choice modeling, Contingent valuation

Endobronchial Electrocautery Using Snare

Between May 1987 and March 1994, upper airway and tracheobronchial electrosurgery with snare was performed in 13 patients (10 men and 3 women), ranging in age from 18 to 87 years. Four patients had benign lesions, and nine had malignant tumors. Total eradication has been achieved in the two patients with benign lesions. Electroexcision of the endobronchial portion of the tumor helped to clear the respiratory airways in all cases with malignant tumors. There has been no major side effects such as bleeding due to this method. Electrocautery is an available economical tool, which helps to diagnose and treat obstructing airway mass lesions

Adverse Events of Extracorporeal Ultrasound-Guided High Intensity Focused Ultrasound Therapy

High-intensity focused ultrasound (HIFU) is considered to be an alternative to surgery. Extracorporeal ultrasound-guided HIFU (USgFU) has been clinically used to treat solid tumors. Preliminary trials in a small sample of a Western population suggested that this modality was safe. Most trials are performed in China thereby providing comprehensive data for understanding the safety profile. The aim of this study was to evaluate adverse events of USgFU therapy.Clinical data were searched in 2 Chinese databases. Adverse events of USgFU were summarized and compared with those of magnetic resonance-guided HIFU (MRgFU; for uterine, bone or breast tumor) and transrectal ultrasound-guided HIFU (for prostate cancer or benign prostate hyperplasia). USgFU treatment was performed using 7 types of device. Side effects were evaluated in 13262 cases. There were fewer adverse events in benign lesions than in malignant lesions (11.81% vs. 21.65%, p<0.0001). Rates of adverse events greatly varied between the disease types (0-280%, p<0.0001) and between the applied HIFU devices in both malignant (10.58-44.38%, p<0.0001) and benign lesions (1.67-17.57%, p<0.0001). Chronological analysis did not demonstrate a decrease in the rate of adverse events. Based upon evaluable adverse events, incidences in USgFU were consistent with those in MRgFU or transrectal HIFU. Some side effects frequently occurred following transrectal HIFU were not reported in USgFU. Several events including intrahepatic metastasis, intraoperative high fever, and occlusions of the superior mesenteric artery should be of particular concern because they have not been previously noted. The types of adverse events suggested that they were ultrasonic lesions.The frequency of adverse events depended on the location of the lesion and the type of HIFU device; however, side effects of USgFU were not yet understood. USgFU did not decrease the incidence of adverse events compared with MRgFU

Bruising following natalizumab infusion for relapsing-remitting multiple sclerosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Natalizumab is a new treatment for relapsing-remitting multiple sclerosis. Because of limited experience of this treatment, medical professionals must be alert to possible side effects.</p> <p>Case presentation</p> <p>We present a 34-year-old Caucasian woman with relapsing-remitting multiple sclerosis. She developed bruises on her legs after the first and second administrations of the new monoclonal antibody, natalizumab. Clinical and laboratory investigations revealed no hematological abnormalities. At the time of writing, she has remained on natalizumab treatment without any further side effects.</p> <p>Conclusion</p> <p>In our patient, bruises on the lower extremities may be a benign side effect of natalizumab. This is the first documented incidence of this side effect, and the patient did not require discontinuation of natalizumab treatment.</p

Are Italians Willing to Pay for Agricultural Environmental Safety? A Stated Choice Approach

The widespread use of pesticides in agriculture provides a particularly complex pattern of multidimensional negative side-effects, ranging from food safety related effects to the deterioration of farmland ecosystems. The assessment of the economic implications of such negative processes is fraught with many uncertainties. This paper presents results of an empirical study recently conducted in the North of Italy aimed at estimating the value of reducing the multiple impacts of pesticide use. This type of analysis is rather novel in Italy. A statistical technique known as choice modelling is used here in combination with contingent valuation techniques. The experimental design of choice modelling provides a natural tool for tackling simultaneously the economic dimensions of several negative environmental effects associated with agrochemicals use. In particular, the paper addresses the reduction of farmland biodiversity, groundwater contamination and human intoxication. The resulting estimates show that, on average, Italians consumers are prone to accept substantial price mark-ups for agricultural goods (in particular, foodstuff) produced in environmentally benign ways.pesticide risks, food safety, willingness-to-pay, choice modeling, contingent valuation, Environmental Economics and Policy,