Maternal-fetal transfer of saquinavir studied in the ex vivo placental perfusion model.

OBJECTIVE: This study was undertaken to determine the placental transfer of the human immunodeficiency virus protease inhibitor saquinavir. STUDY DESIGN: An ex vivo perfused human placental cotyledon model was used. Ten placental perfusion studies were performed, with concentrations of saquinavir in the maternal compartment ranging from 322 to 2197 ng/mL (within reference therapeutic ranges). Drug concentrations were determined by high-performance liquid chromatography. RESULTS: The mean (+/- SD) fetal transfer rate of saquinavir was 1.8% +/- 1.6%, and the mean (+/- SD) clearance index was 0.05 +/- 0.05. A mean (+/- SD) of 1.6% +/- 3.1% of the perfused saquinavir was retained by the cotyledon. The small amount of saquinavir that crossed the placenta corresponded to the fraction not bound to human serum albumin. CONCLUSION: The low rate of placental transfer of saquinavir suggests that use of this antiretroviral drug by pregnant women may not lead to significant exposure of the fetus.

Influence of surgical bladder reduction on urodynamic parameters: three techniques investigated in a rat model.

PURPOSE: Bladder wall wrapping and invagination have been used for the surgical treatment of the underactive detrusor and improvement of bladder emptying has been described. In a rat model we investigated the evolution in time of urodynamic parameters after 3 techniques of surgical bladder reduction. MATERIAL AND METHODS: Female Wistar rats underwent at random, a bladder reduction with vertical wrapping, the horizontal variant or invagination of the wall. Cystometry was performed before and 30 minutes after surgery, and after 1, 5 and 10 weeks. Sham operated animals had cystometries performed at day 1 and after 1, 5 and 10 weeks. At week 10 contraction of four differently orientated detrusor strips was examined in vitro. A histological study was done. RESULTS: Contraction pressure was not improved in vivo after 10 weeks follow-up. Capacity, despite an early significant reduction, became slightly higher than presurgery in both wrapping groups and even significantly higher in the invagination group. In each group residual volume almost doubled. In vitro some strips containing operated parts did contract more strongly than controls but not significantly. Strips which contain operated parts showed slightly increased fibrosis in the invagination and the vertical wrapping group and a huge amount of fibrosis in the horizontal wrapping group. CONCLUSIONS: This experiment indicated that the rationales behind the techniques of surgical bladder reduction are not correct. The partial successes in men may be explained by the original intrinsic deficiencies of the detrusor which prevent a secondary bladder enlargement as reaction to the volume reduction.

Value of transrectal prostatic echography, prostate-specific antigen and rectal examination in the diagnosis of prostate cancer. Relationship with the result of prostatic biopsies.

UNLABELLED: We retrospectively reviewed the files of patients who had undergone a prostatic biopsy between July 1992 and December 1994. A total of 368 biopsies of 340 patients between 36 and 89 years old, could be used. The pathological examination was used to make the diagnosis of prostate cancer. The specificity and sensitivity values of the diagnostic examinations (TRUS, DRE, PSA and PSAD) were calculated. An abnormal TRUS image (hypodens or hyperdens area or irregular prostate) has the best sensitivity: 91.3%. PSA has the best specificity: 57.2%. The specificity and sensitivity of PSA can be improved by using the PSAD: a PSAD limit of 0.15 has a specificity of 66.4% and a sensitivity of 88.9%. The specificity and sensitivity values are also calculated for several combinations of tests. The combination of abnormal DRE or PSAD higher than 0.15 has a sensitivity of 96.2% and a specificity of 35.0%. CONCLUSION: the combination of abnormal DRE or high PSAD has a high sensitivity with a relatively good specificity. We advise to take biopsy if two or more of the examinations are suspect or if one of them is clearly abnormal.