Cost-efficacy comparison of extracorporeal shock wave lithotripsy and endoscopic laser lithotripsy in distal ureteral stones.

Distal ureteral stones are usually treated today by extracorporeal shock wave lithotripsy or extraction by retrograde ureteroscopy with or without previous fragmentation. We performed a cost-efficacy study of three methods to treat them: extracorporeal lithotripsy using either a spark gap lithotripter, the unmodified Dornier HM3 (SWL), or the piezoelectric Wolf Piezolith 2300 (EPL) and endoscopic lasertripsy (LISL) using an alexandrite pulsed laser, the HMT Alexantriptor. The records of 520 patients with distal ureteral stones treated by extracorporeal lithotripsy were reviewed to establish the mean cost of the procedure. Concerning LISL, the first 30 stone patients treated in our institution were evaluated. Four measures were examined: (1) number of sessions; (2) success rate; (3) auxiliary maneuvers; and (4) complications. The economics evaluation considered the direct costs related to personnel, consumables, depreciation, and maintenance. The EPL procedure was the cheapest: $873 US, and SWL the most expensive: $3,572 US. The best cost-efficacy rate was seen with LISL because of its 93% success rate and its cost of $1,390 US.

Inhibition of basal and metoclopramide-induced prolactin release by cabergoline, an extremely long-acting dopaminergic drug.

The aim of this study was to evaluate the effectiveness of the ergoline derivative cabergoline in inhibiting the serum PRL response to metoclopramide (MCP; 5 mg, iv) and the duration of this effect. Seven normal men received cabergoline (600 micrograms, orally) on day 0 and underwent a MCP test on days -1, 1, 4, 8, 15, and 28. Fasting serum PRL levels were significantly depressed from days 1-14; the nadir value occurred on day 4. MCP-induced PRL release was significantly inhibited up to day 28, with a nadir on day 4. Two months later, four of the men received placebo on day 0, and tests with MCP were performed on days -1, 8, and 28; basal serum PRL levels and PRL responses to MCP were superimposable on days -1, 8, and 28. These data indicate that cabergoline is an effective long-acting inhibitor of PRL release in normal men, suitable for use in the management of hyperprolactinemic patients.

Selective and extremely long inhibition of prolactin release in man by 1-ethyl-3-(3'-dimethylaminopropyl)-3-(6'-allylergoline-8'-beta- carbonyl)-urea-diphosphate (FCE 21336).

The effects on anterior pituitary function of FCE 21336 (1-ethyl-3-(3'-dimethylaminopropyl)-3-(6'-allylergoline-8'-beta-ca rbonyl)-urea- diphosphate), a synthetic ergoline derivative with selective dopamine agonistic properties, were studied. Circulating PRL, GH, TSH, cortisol and LH levels were determined up to 96 h after single oral doses of 50, 100, 200 and 300 micrograms of the compound to eight healthy males, and up to 168 h after single oral doses of 400 and 600 micrograms to six healthy males, according to double-blind, within subjects, experimental designs vs placebo. Vital signs, ECG, laboratory tests and the appearance of newly observed signs and symptoms were monitored. A dose-related decrease of serum PRL in comparison with both basal and post-placebo levels was observed after 200 micrograms and greater doses of the compound, with inhibition of spontaneous circadian rhythm. Maximal inhibition (PRL less than 2 ng ml-1) was observed in one out of five subjects after 200, three out of seven subjects after 300, four out of six after 400 and five out of six subjects after 600 micrograms. The effect was of rapid onset and long duration; the maximum or nearly maximum decrease was observed within 3 h after dosing as well as up to 96 h (200 and 300 micrograms) and up to 168 h (400 and 600 micrograms). No modifications of GH, TSH, LH and cortisol as well as of vital signs, ECG and laboratory tests were apparent.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of oral administration of maltitol on plasma glucose, plasma sorbitol, and serum insulin levels in man.

The present study was aimed to investigate the metabolic effects of acute and chronic oral administration of maltitol (4-O-i-D-glucopyranosyl-D-glucitol), a hypocaloric sweetener obtained from maltose by catalytic hydrogenation. Fifty grams of maltitol induced a increase lower glycemic and insulinemic than the same dose of glucose or sucrose. No variations of plasma glucose and serum insulin levels were observed after 180 min. A slight increase of plasma maltitol was observed 45 min after maltitol. The chronic administration of maltitol (10 g 3 X daily for 5 days) induced no variations of glycemia or insulinemia when compared with the same dose of sucrose. Plasma sorbitol levels were slightly higher after maltitol than after sucrose. Low amounts of maltitol were detected in the urine and feces.