Successful use of steroids and ureteric stents in 24 patients with idiopathic retroperitoneal fibrosis : a retrospective study

Original article can be found at : http://content.karger.com/ Copyright Karger [Full text of this article is not available in the UHRA]Background/Aims: Retroperitoneal fibrosis (RPF) is a chronic inflammatory disorder causing obstructive nephropathy and renal failure. We reviewed our management of this condition. Method: All patients with RPF treated at a single center over a 15-year period were identified. A full review of notes and computer records was undertaken. Results: Data was available on 27 patients, 3 of which were excluded from later analysis. Diagnosis was based on clinical history and cross-sectional imaging. Retroperitoneal biopsy was undertaken in 3 patients. 96% had significant renal impairment at presentation with a mean serum creatinine of 688 μmol/l. 46% required emergency hemodialysis. All patients were treated with a combination of ureteric stents and/or steroids with an excellent clinical response. The mean best creatinine reached by the cohort was 136 μmol/l, and renal function remained stable in the long term. No patients required chronic dialysis. Ureteric stents were removed within 12 months and low-dose steroids were continued for a mean of 34 months. Recurrent disease was observed in 25% of patients, who all responded well to further steroid therapy. Mean duration of follow-up was 76 months. Conclusions: RPF is very effectively treated by a combination of ureteric stents and steroids, with excellent long-term results using this approach. Continued follow-up is advised because of the possibility of recurrent disease.Peer reviewe

The use of small angle neutron scattering with contrast matching and variable adsorbate partial pressures in the study of porosity in activated carbons

The porosity of a typical activated carbon is investigated with small angle neutron scattering (SANS), using the contrast matching technique, by changing the hydrogen/deuterium content of the absorbed liquid (toluene) to extract the carbon density at different scattering vector (Q) values and by measuring the p/p0 dependence of the SANS, using fully deuterated toluene. The contrast matching data shows that the apparent density is Q-dependent, either because of pores opening near the carbon surface during the activation processor or changes in D-toluene density in nanoscale pores. For each p/p0 value, evaluation of the Porod Invariant yields the fraction of empty pores. Hence, comparison with the adsorption isotherm shows that the fully dry powder undergoes densification when liquid is added. An algebraic function is developed to fit the SANS signal at each p/p0 value hence yielding the effective Kelvin radii of the liquid surfaces as a function of p/p0. These values, when compared with the Kelvin Equation, show that the resultant surface tension value is accurate for the larger pores but tends to increase for small (nanoscale) pores. The resultant pore size distribution is less model-dependent than for the traditional methods of analyzing the adsorption isotherms

Dutasteride treatment over 2 years delays prostate-specific antigen progression in patients with biochemical failure after radical therapy for prostate cancer: Results from the randomised, placebo-controlled avodart after radical therapy for Prostate Cancer Study (ARTS)

Background: Rising prostate-specific antigen (PSA) levels after radical therapy are indicative of recurrent or residual prostate cancer (PCa). This biochemical recurrence typically predates clinically detectable metastatic disease by several years. Management of patients with biochemical recurrence is controversial. Objective: To assess the effect of dutasteride on progression of PCa in patients with biochemical failure after radical therapy. Design, setting, and participants: Randomised, double-blind, placebo-controlled trial in 294 men from 64 centres across 9 European countries. Intervention: The 5α-reductase inhibitor, dutasteride. Outcome measurements and statistical analysis: The primary end point was time to PSA doubling from start of randomised treatment, analysed by log-rank test stratified by previous therapy and investigative-site cluster. Secondary end points included time to disease progression and the proportion of subjects with disease progression. Results and limitations: Of the 294 subjects randomised (147 in each treatment group), 187 (64%) completed 24 mo of treatment and 107 discontinued treatment prematurely (71 [48%] of the placebo group, 36 [24%] of the dutasteride group). Dutasteride significantly delayed the time to PSA doubling compared with placebo after 24 mo of treatment (p < 0.001); the relative risk (RR) reduction was 66.1% (95% confidence interval [CI], 50.35-76.90) for the overall study period. Dutasteride also significantly delayed disease progression (which included PSA- and non-PSA-related outcomes) compared with placebo (p < 0.001); the overall RR reduction in favour of dutasteride was 59% (95% CI, 32.53-75.09). The incidence of adverse events (AEs), serious AEs, and AEs leading to study withdrawal were similar between the treatment groups. A limitation was that investigators were not blinded to PSA levels during the study. Conclusions: Dutasteride delayed the biochemical progression of PCa in patients with biochemical failure after radical therapy for clinically localised disease. The safety and tolerability of dutasteride were generally consistent with previous experience. Clinical trial registry: ClinicalTrials.gov, NCT00558363

Benign prostatic hyperplasia

Original article can be found at : http://sciencedirect.com/ Copyright Elsevier [Full text of this article is not available in the UHRA]Microscopic benign prostatic hyperplasia (BPH) develops in most Western men, many of whom will develop measurable enlargement of the prostate. Lower urinary tract symptoms (LUTS), in association with prostatic enlargement, are common, especially with increasing age. About 50% of symptomatic men have measurable BPH/enlargement. A focused history and examination (with frequency/volume chart), simple tests (urine dipstick, creatinine) and assessment of voiding function (flow rate, ultrasound) help make the diagnosis, and a prostate-specific antigen (PSA) test should be considered. LUTS can be stratified according to severity by scoring systems (international prostate symptom score). Lifestyle advice can lessen mild symptoms. Medical therapy with α blockers should be offered initially to men with moderate to severe LUTS, and if the PSA is greater than 1.4 ng/ml or the prostate is estimated to be greater than 30 g, a 5-α reductase inhibitor should be offered alone or in combination with α blocker. Anticholinergics should be considered if there are concurrent storage symptoms. Severely symptomatic or obstructed men do best with a surgical technique chosen according to prostate size, that is transurethral incision of the prostate if small, transurethral resection of the prostate (TURP) or holmium laser enucleation (HoLEP) if 30-100 cm3 or open prostatectomy if large (>100 cm3). Pressure-flow studies can improve the accuracy of diagnosis and the selection of candidates for surgery, but most symptomatic men respond well to treatment. Outcomes for obstructed or moderate to severely symptomatic men are good, but the medical alternatives should always be discussed. 5-α reductase inhibitor therapy offers the opportunity to slow the development of further BPH instead of, or after, surgical treatment.Peer reviewe