Review of dutasteride/tamsulosin fixed-dose combination for the treatment of benign prostatic hyperplasia: efficacy, safety, and patient acceptability

Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) will usually affect older men, of whom 50% over the age 60 years and almost 90% in their nineties will be bothered enough by their symptoms that they request some type of treatment. However, symptomatic bother may also affect men in their forties with a prevalence rate of almost 18%. The International Prostate Symptom Score (IPSS) has become the most widely used and best validated questionnaire to allow the patient to quantify the severity of his LUTS/BPH symptoms. This score has become the cornerstone in demonstrating the “rate of symptom response” for the patient who has been exposed to any type BPH management. Question 8 on the IPSS score is what is defined as the “Quality of Life” question or what is also termed the “Bothersome Index.” The score out of 6 as declared by the patient will reflect the degree of concern that the patient is feeling about his symptoms and the reduction of the score after treatment is a statement of their improved quality of life. There are 2 families of accepted medical therapy to treat the symptoms of BPH and potentially prevent the most worrisome long-term sequelae of progression of BPH: urinary retention or the need for surgery. When defining the impact of the main types of medical therapy, the alpha blockers have been termed the “openers” and the 5 alpha-reductase inhibitors are described as the “shrinkers.” Since they each offer a different mechanism of effect, the concept of combination therapy was raised and trialed many times over recent years. The final aspect of any medical therapy is the patient’s satisfaction with the treatment and the side effects. In the CombAT (Combination of Avodart and Tamsulosin) trial a new assessment was developed and tested called the Patient’s Perception of Study Medication (PPSM) which told the investigators if the patients, given free choice, would choose to take that combination of medication to treat their problem and stay on the medication

Corrigendum to "The Effects of Combination Therapy with Dutasteride and Tamsulosin on Clinical Outcomes in Men with Symptomatic Benign Prostatic Hyperplasia: 4-Year Results from the CombAT Study" [Eur Urol 2010;57:123–31]

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A Latin American Perspective to Agricultural Ethics

The mixture of political, social, cultural and economic environments in Latin America, together with the enormous diversity in climates, natural habitats and biological resources the continent offers, make the ethical assessment of agricultural policies extremely difficult. Yet the experience gained while addressing the contemporary challenges the region faces, such as rapid urbanization, loss of culinary and crop diversity, extreme inequality, disappearing farming styles, water and land grabs, malnutrition and the restoration of the rule of law and social peace, can be of great value to other regions in similar latitudes, development processes and social problems. This chapter will provide a brief overview of these challenges from the perspective of a continent that is exposed to the consequences of extreme inequality in multiple dimensions and conclude by arguing for the need to have a continuous South-South dialogue on the challenges of establishing socially and environmentally sustainable food systems

Effectiveness and cost-effectiveness of transmural collaborative care with consultation letter (TCCCL) and duloxetine for major depressive disorder (MDD) and (sub)chronic pain in collaboration with primary care: design of a randomized placebo-controlled multi-Centre trial: TCC:PAINDIP

__Abstract__ Background: The comorbidity of pain and depression is associated with high disease burden for patients in terms of disability, wellbeing, and use of medical care. Patients with major and minor depression often present themselves with pain to a general practitioner and recognition of depression in such cases is low, but evolving. Also, physical symptoms, including pain, in major depressive disorder, predict a poorer response to treatment. A multi-faceted, patient-tailored treatment programme, like collaborative care, is promising. However, treatment of chronic pain conditions in depressive patients has, so far, received limited attention in research. Cost effectiveness of an integrated approach of pain in depressed patients has not been studied. This article describes the aims and design of a study to evaluate effects and costs of collaborative care with the antidepressant duloxetine for patients with pain symptoms and a depressive disorder, compared to collaborative care with placebo and compared to duloxetine alone

4744 Endoscopic small intestine biopsy: comparison of two techniques

Background: The importance of histologic interpretation to establish the diagnosis of diseases affecting the small bowel is well recognized. There is no consensus regarding enteroscopic biopsy technique and the number of biopsies required to enable an adequate histologic diagnosis. Purpose: To assess the utility of endoscopically obtained biopsies in the histologic evaluation of the small bowel and to compare the quality of biopsies obtained taking one piece (“single-bite”) versus two pieces (“double-bite”) with a single passage of the forceps. Methods: Patients undergoing push enteroscopy (Olympus SIF-100) requiring small bowel biopsies were included in the study. A standard biopsy forceps with serrated jaws and central needle (Boston Scientific/Microvasive, Watertown, MA) was utilized. A total of nine specimens were taken from each patient: three “single-bite” and three “double-bite” biopsies in alternative fashion. A specimen was considered adequate for interpretation if contained full thickness mucosa with two or more contiguous, complete, and well oriented villous-crypt gland complexes, and there was no interference due to squashing or fragmentation. Specimens from each patient were evaluated individually for the above criteria and as a group to assess suitability to make a histological diagnosis. Results: Thirty patients were included in the study for an expected total of 270 biopsy specimens. All 90 “single-bite” (100%) but only 153/180 (85%) expected “double-bite” specimens were recovered (p<0.005). 57/90 (63%) “single-bite” and 69/153 (45%) “double-bite” specimens were adequate for histologic interpretation (p<0.05). Biopsies were severely squashed/fragmented in 26/90 (28%) “single-bite” and 64/153 (42%) “double-bite” specimens (NS). Muscularis mucosa was present in 63/90 (70%) “single-bite” and 86/153 (56%) “double-bite” specimens (p<0.05). As a group, “singlebite” and “double-bite” specimens failed to give a diagnosis in 1/30 (3%) and 6/30 (20%) patients respectively (NS). A histologic diagnosis could be made in all patients, using combination of “single” and “double” bite biopsies. Conclusion: Enteroscopically obtained biopsies are adequate for evaluation of small bowel histology. “Single-bite” biopsy technique yields significantly better specimens for histologic interpretation with minimal loss of specimens versus “double-bite” technique. More than three specimens utilizing “single-bite” biopsy technique should be obtained to allow histologic evaluation of the small bowel

Optimizing the management of benign prostatic hyperplasia

One of the challenges facing primary care physicians and specialists as the population ages is the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). While as many as 18% of men in their 40s report bother from an enlarged prostate, that figure rises dramatically, whereby 50% of men in their 50s and 90% of men in their 90s will complain of bothersome symptoms related to an enlarged prostate. Studies have shown that BPH is a progressive disease, which if left untreated can result in worsening of symptoms, acute urinary retention and renal failure. Until about 20 years ago the only management option available to urologists was surgery. In the early 1990s medical therapy emerged as the predominant treatment for BPH. Therapy may be tailored to target symptoms and progression of disease