ABSTRACT
The increase of life intensity and its stressful impact, a great number of various risk factors of ED - erectile dysfunction and aging men population lead to a high prevalence and incidence of ED worldwide. It is well known that ED in men is a condition of heterogenous aetiology, which determines ED substantial diagnostic and therapeutic clinical problem. However, in most cases, ED may be managed quite well by the primary care physician who has proper understanding of the pathophysiology of ED. This article is intended especially for primary care physicians. It reviews physiology of erection and then explores pathophysiologic changes that are likely to cause inadequate erection, which enables better understanding of ED and consequently is essential for appropriate management.
Subject(s)
Erectile Dysfunction/diagnosis , Erectile Dysfunction/etiology , Family Practice/organization & administration , Aging , Cardiovascular Diseases/complications , Diabetes Complications/physiopathology , Erectile Dysfunction/physiopathology , Erectile Dysfunction/therapy , Humans , Male , Nervous System Diseases/complications , Penile Erection , Practice Patterns, Physicians'/organization & administration , Urology/organization & administrationABSTRACT
BACKGROUND: Vascular endothelial growth factor (VEGF) inhibition is a valid therapeutic approach in renal cell carcinoma. Therefore, an investigation of the combination treatment of the humanised anti-VEGF monoclonal antibody bevacizumab with interferon alfa was warranted. METHODS: In a multicentre, randomised, double-blind, phase III trial, 649 patients with previously untreated metastatic renal cell carcinoma were randomised to receive interferon alfa-2a (9 MIU subcutaneously three times weekly) and bevacizumab (10 mg/kg every 2 weeks; n=327) or placebo and interferon alfa-2a (n=322). The primary endpoint was overall survival. Secondary endpoints included progression-free survival and safety. An interim analysis of overall survival was prespecified after 250 deaths. On the basis of new second-line therapies that became available while the trial was in progress, which could have confounded analyses of overall survival data, we agreed with regulatory agencies that the pre-planned final analysis of progression-free survival would be acceptable for regulatory submission. The protocol was amended to allow the study to be unblinded at this point. The final analysis of progression-free survival is reported here. Efficacy analyses were done by intention to treat. This trial is registered with centerwatch.com, number BO17705E. FINDINGS: 325 patients in the bevacizumab plus interferon alfa group and 316 in the placebo plus interferon alfa group received at least one dose of study treatment. At the time of unblinding, 230 progression events had occurred in the bevacizumab plus interferon alfa group and 275 in the control group; there were 114 deaths in the bevacizumab plus interferon alfa group and 137 in the control group. Median duration of progression-free survival was significantly longer in the bevacizumab plus interferon alfa group than it was in the control group (10.2 months vs 5.4 months; HR 0.63, 95% CI 0.52-0.75; p=0.0001). Increases in progression-free survival were seen with bevacizumab plus interferon alfa irrespective of risk group or whether reduced-dose interferon alfa was received. Deaths due to adverse events were reported in eight (2%) patients who received one or more doses of bevacizumab and seven (2%) of those who did not receive the drug. Only three deaths in the bevacizumab arm were considered by investigators to be possibly related to bevacizumab. The most commonly reported grade 3 or worse adverse events were fatigue (40 [12%] patients in the bevacizumab group vs 25 [8%] in the control group) and asthenia (34 [10%] vs 20 [7%]). INTERPRETATION: The combination of bevacizumab with interferon alfa as first-line treatment in patients with metastatic renal cell carcinoma results in a significant improvement in progression-free survival, compared with interferon alfa alone.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal/therapeutic use , Carcinoma, Renal Cell/drug therapy , Interferon-alpha/therapeutic use , Kidney Neoplasms/drug therapy , Adult , Aged , Aged, 80 and over , Angiogenesis Inhibitors/adverse effects , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized , Bevacizumab , Carcinoma, Renal Cell/mortality , Carcinoma, Renal Cell/secondary , Disease-Free Survival , Double-Blind Method , Female , Humans , Interferon alpha-2 , Interferon-alpha/adverse effects , Kidney Neoplasms/mortality , Kidney Neoplasms/secondary , Male , Middle Aged , Recombinant Proteins , Vascular Endothelial Growth Factor A/drug effectsABSTRACT
PCNL is an up-to-date endoscopic method of nephrolithiasis treatment, characterized by high efficacy and low invasiveness. In this study we analyze our own experiences in nephrolithiasis treatment. In St. Luke Hospital, Tarnow PCNL has been the leading method of treatment of kidney stones since 1997. Low incidence of complications allows to choose this procedure in more than 90% of nephrolithiasis patients.
Subject(s)
Nephrolithiasis/surgery , Nephrostomy, Percutaneous/statistics & numerical data , Adult , Aged , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Cyclophosphamide (CYP) treatment induces chemical cystitis leading to bladder overactivity (OAB) in animals and humans. There is a great number of OAB models evaluations, which consider the bladder histology, as well as alterations in neurochemical, electrophysiological properties of bladder afferent neurons and reflex arcs activity in the spinal cord. However there are no data differentiating cystometrically acute and chronic models of OAB induced by CYP under urethane anaesthesia. The aim of this study was to investigate the influence of acute and chronic models of CYP-induced cystitis on urinary bladder motor activity in rats.
