Ultrasonography is not inferior to fluoroscopy to guide extracorporeal shock waves during treatment of renal and upper ureteric calculi : a randomized prospective study

Objective: To investigate whether the visualization modality (ultrasound or fluoroscopy) used during shockwave lithotripsy (SWL) affects the clinical outcome in those instances where both imaging modalities are optional. Methods: Between November 2014 and July 2016, 114 patients with radiopaque upper urinary tract calculi were randomly assigned to an ultrasound-or fluoroscopy-guided SWL group in a prospective, open-label, single-center study. A standardized SWL protocol was used. The stone-free rate and the positive outcome rate (stone-free or asymptomatic residual fragments <= 4 mm) were compared. Results: The stone-free rate was 52% in the ultrasound-guided group compared to 42% in the fluoroscopy-guided group (p = 0.06) and the positive outcome rate was 79% in the ultrasound-guided group compared to 70% in the fluoroscopy-guided group (p = 0.28). These results were not significantly different but proved to be noninferior based on a Wilson confidence interval of independent proportions (noninferiority limit 10%). The mean number of SWL sessions was not significantly different (p = 0.4). Conclusion: Our study demonstrated that the clinical results of ultrasound-guided SWL were not inferior to the results of fluoroscopy-guided SWL, while no ionizing radiation is needed

Successful Perioperative and Surgical Treatment of a Rare Case of Extra-Gastrointestinal Stromal Tumor Arising in the Prostate Gland

We report a very uncommon case of a primary, non-metastatic gastrointestinal stromal tumor (GIST) arising in the prostate gland in a 60-year-old patient. The morphology and immunohistochemical profile of the disease resembled GIST of gastrointestinal origin, and the molecular driver of this malignancy was a double mutation in exons 11 and 13 of the KIT gene. The tumor was proliferating slowly, did respond to neoadjuvant therapy with the KIT-inhibiting agent imatinib and was cured by radical, retro-pubic prostatectomy followed by adjuvant imatinib treatment. We postulate that primary GIST tumors of the prostate can arise from prostatic interstitial cells, which are the pacemakers of smooth muscle contractility in the gland, and possibly share a common precursor with typical GIST and the interstitial cells of Cajal in the gastrointestinal tract

Fluoxetine in Progressive Multiple Sclerosis (FLUOX-PMS) : study protocol for a randomized controlled trial

Background: Currently available disease-modifying treatments acting by modifying the immune response are ineffective in progressive multiple sclerosis (MS), which is caused by a widespread axonal degeneration. Mechanisms suspected to be involved in this widespread axonal degeneration are reduced axonal energy metabolism, axonal glutamate toxicity, and reduced cerebral blood flow. Fluoxetine might theoretically reduce axonal degeneration in MS because it stimulates energy metabolism through enhancing glycogenolysis, stimulates the production of brain-derived neurotrophic factor, and dilates cerebral arterioles. The current document presents the protocol of a clinical trial to test the hypothesis that fluoxetine slows down the progressive phase of MS. Methods/Design: The FLUOX-PMS trial is a multi-center, randomized, controlled and double-blind clinical study. A total of 120 patients with the diagnosis of either secondary or primary progressive MS will be treated either by fluoxetine (40 mg daily) or placebo for a total period of 108 weeks. The primary endpoint is the time to confirmed disease progression defined as either at least a 20% increase in the timed 25-Foot Walk or at least a 20% increase in the 9-Hole Peg Test. Secondary endpoints include the Hauser ambulation index, cognitive changes, fatigue, magnetic resonance imaging of the brain, and in a small subgroup optical coherence tomography. Discussion: The FLUOX-PMS trial will gives us information as to whether fluoxetine has neuroprotective effects in patients with progressive MS

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Penile electromyography and its smooth muscle content: Interpretation of 25 impotent patients

Purpose: We studied the correlation of penile electromyography and the cavernous smooth muscle content in 25 impotent patients. Materials and Methods: After a complete hormonal and diagnostic evaluation, all patients underwent corpus cavernosum penile electromyography and a penile biopsy of the corpus cavernosum with the biopsy gun device. Cavernous tissue was analyzed using immunohistochemical stain actin anti-actin and computerized image analysis. Results: Of the patients 20 had normal and 5 had abnormal corpus cavernosum penile electromyography. Of the 20 patients with normal corpus cavernosum penile electromyography 12 (60%) showed a normal percentage of cavernous smooth muscle and 8 (40%) had abnormal muscle content. All patients with abnormal corpus cavernosum penile electromyography showed abnormally low cavernous smooth muscle fibers. Conclusions: Our study showed an overall low sensitivity between corpus cavernosum penile electromyography potential amplitude and cavernous smooth muscle content. However, a high specificity (100%) of corpus cavernosum penile electromyography in the diagnosis of abnormal low cavernous muscle content was observed. Further studies with a larger number of patients are needed to evaluate corpus cavernosum penile electromyography as a predictor of cavernous smooth muscle function.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Renal Metastasis of a Malignant Myopericytoma: A Case Report and Review of Literature

Myopericytoma is a rare tumour arising from myopericytes. Myopericytes are transitional cells between pericytes, which are perivascular cells adjacent to capillaries, and vascular smooth muscle cells. We report a case of cutaneous myopericytoma metastasising to the right kidney. It represents one of the few cases of malignant behaviour in myopericytoma, and is the first report of a myopericytoma metastasising to the urinary tract. This case suggests that the traditional view that urinary myopericytoma are benign lesions needs to be updated