No Relationship Between the International Prostate Symptom Score and Post-Void Residual Volume in Primary Care.

BACKGROUND: Lower urinary tract symptom (LUTS) is a common condition in older men. In accordance with the Dutch College of General Practitioners Guideline "Micturition symptoms in men", the diagnosis can be made based on a patient's medical history and a physical examination. GPs lack additional tools in primary care to assess the residual urine volume. A residual volume usually requires a referral to a urologist. We hypothesized that the IPSS screening questionnaire score (measuring the severity of symptoms) might be related to patients' residual urine volume. The research objective was to examine the relation between the IPSS score and the residual urine volume. METHODS: In a cross-sectional study, we analysed patients' IPSS and residual urine volume. Men aged over 50 with LUTS who consulted Dutch primary-care physicians were included. The interventions comprised an IPSS screening and a bladder scan. Data regarding the patients' residual volume, total IPSS score, single IPSS score, IPSS storage score, and IPSS voiding score were recorded and analysed. We used odds ratios to describe the relation between the IPSS categories associated with the presence of a normal or abnormal (above 100 cc and above 200 cc) residual urine volume. RESULTS: A total of 126 patients were included in this study. Patients with higher scores on the overall IPSS, separate IPSS, IPSS storage and IPSS voiding showed no higher odds ratios of having an abnormal residual volume, neither above 100 mL or 200 mL. CONCLUSION: We did not find a relation between the IPSS core to an abnormal residual urine volume in men aged over 50 with LUTS consulting primary-care physicians. TRIAL REGISTRATION: This study has been approved by the Central Committee on Research Involving Human Subjects for the Arnhem-Nijmegen Region and is registered with ToetsingOnline under ID number 29822.091.10.

[Switching to a generic drugA blessing or a curse?]. / Overstappen op een generiek geneesmiddel.

A patient suffering from Zollinger-Ellison was treated with Nexium, but after patent expiry only the costs of generic omeprazol were reimbursed. Generic tablets and capsules, pantoprazol and rabeprazol, were tried without success and finally the pharmacist dispensed Nexium at his own expense. Registered generic drugs have been shown to be bioequivalent with the originator drug within narrow margins. When two batches of the originator are compared, the same requirements are valid. Although the subject has received a lot of negative publicity, meta-analyses on outcome comparison support generic substitution; problems associated with switching can be partially explained by the loss of trust in the treatment, and differences in appearance also cause confusion. Generic prescribing should be encouraged to keep medical treatment affordable; however, in order to prevent the problems described it is desirable to keep to the same product as far as possible. Effective education and patient information are essential if switching is to be successful.

[2 patients with diarrhea caused by Cyclospora cayetanensis following a trip to the tropics]. / Twee patiënten met diarree door Cyclospora cayetanensis na een bezoek aan de tropen.

A 58-year-old man and his 60-year-old wife returned from a journey through Indonesia with complaints of persisting diarrhoea. In the stools of both patients we found oocysts of the parasite Cyclospora cayetanensis. We treated them with co-trimoxazole which resulted in fast clinical improvement. An infection with the parasite C. cayetanensis should be considered in travellers returning from tropical countries with persisting diarrhoea. Despite the self-limiting nature of the infection treatment with co-trimoxazole 960 mg 2 dd for 7 days may be considered in cases with a protracted course.

HLA-B27 associated reactive spondyloarthropathies in a Dutch military hospital.

Forty-two male patients with reactive spondyloarthropathies in a Dutch military hospital are described with mean age of onset 21.9 years. Peripheral arthritis or sacroiliitis was present in all, eye symptoms in 21 (50%), and genitourinary disease in 15 (35.7%). Evidence of antecedent sexually acquired or enterocolitic infection was found only in three (7.2%). HLA-B27 antigen was detected in 34 (81%) of 42 patients. Additional data suggest that reactive spondyloarthropathies are the most common form of inflammatory arthritis in young men.