Taurine Enhances Stretch Reflex Excitability.

The purpose of this study was to characterize the effects of taurine (supplementation and acute injection) on the stretch reflex in the ankle muscles, and in particular to compare the effects of chronic taurine supplementation versus acute injection on the muscle tension, amplitude of electromyogram and velocity of muscle response. Stretch reflex responses were evoked using a specialized stretching device designed for mice. The triceps surae muscle of an awake mouse was stretched at various speeds ranging from 500 to 500,000° per second. A transducer recorded the muscle resistance at each velocity and the corresponding EMG. We found that at each velocity, the taurine-fed mice generated more tension and exhibited a higher EMG response. Acute taurine injection did not affect the tension but significantly reduced the EMG. To evaluate if the enhances response was due to neuronal excitability of changes in the passive properties of the muscles, we anesthetize the mice to eliminate the central component of the reflex. Under these conditions, taurine-fed mice still exhibited an enhanced stretch reflex response. We have previously shown that taurine-fed mice have reduced expression of GABAA receptors and other biochemical changes in the GABAergic system that are consistent with hyper-excitability. GABAA receptor is a major component of the inhibitory (GABAergic) system and its reduced expression probably contributes to the enhanced stretch reflex in these mice through biochemical mechanisms that involve alterations not only at the spinal level but also at the cortical level.

Effects of Taurine Supplementation on Neuronal Excitability and Glucose Homeostasis.

In this study we examined the role of chronic taurine supplementation on plasma glucose homeostasis and brain excitability through activation of the insulin receptor. FVB/NJ male mice were supplemented with taurine in drinking water (0.05% w/v) for 4 weeks and subjected to a glucose tolerance test (7.5 mg/kg BW) after 12 h fasting. We found that taurine-fed mice were slightly hypoglycemic prior to glucose injection and showed significantly reduced plasma glucose at 30 and 60 min post-glucose injection when compared to control mice. Previously, we reported that taurine supplementation induces biochemical changes that target the GABAergic system. Those studies show that taurine-fed mice are hyperexcitable, have reduced GABAA receptors expression and increased GAD and somatostatin expression in the brain. In this study, we found that taurine-fed mice had a significant increase in insulin receptor (IR) immuno-reactivity in the pancreas and all brain regions examined. At the mRNA level, we found that the IR showed differential regional expression. Surprisingly, we found that neurons express the gene for insulin and that taurine had a significant role in regulating insulin gene expression. We propose that increased insulin production and secretion in taurine-fed mice cause an increase activation of the central IR and may be partially responsible for the increased neuronal excitability observed in taurine supplemented mice. Furthermore, the high levels of neuronal insulin expression and its regulation by taurine implicates taurine in the regulation of metabolic homeostasis.

Prostate cancer detection after one or more negative extended needle biopsy: results of a multicenter case-findings protocol.

OBJECTIVES: To evaluate PCa incidence in patients with one or more negative extended prostate biopsy who underwent repeat biopsy or TURP. MATERIAL AND METHODS: From June 2003 to February 2008, 308 patients were submitted to repeat prostate biopsy (median 20.5 cores) and 120 patients underwent TURP after one or more 12 cores prostate biopsy. Indications for biopsy were: abnormal DRE; PSA > 10 ng/mL; PSA included between 4.1-10 or 2.6-4 ng/mL with free/total PSA < or = 25% and < or = 20%, respectively 262 and 46 underwent a second and a third biopsy: 218 because for high levels of PSA, 40 and 50 patients for a previous diagnosis of HGPIN and ASAP, 28 had an abnormal DRE. PSA in patients who underwent TURP was 11.6 ng/mL (median); in all cases DRE was negative and only 76 patients referred LUTS. RESULTS: PCa incidence at repeat biopsy was 16.9%; 96.2% of cancers were diagnosed at a second biopsy and 3.8% at a third one. PCa incidence was higher in patients with previous ASAP (43.4% and 50%) vs patients with HGPIN (25% and 0%) or benign pathology (11.9% and 0%). PCa was diagnosed in 11.1% and 19% of patients who underwent TURP previously submitted to a first and a second biopsy, respectively. CONCLUSIONS: In case of persistent suspicion of PCa after a repeated negative saturation biopsy, TURP should be proposed as part of the diagnostic procedure aside from LUTS, especially in patients with a life expectancy greater than 10 years.

Effects of a shared protocol between urologists and general practitioners on referral patterns and initial diagnostic management of men with lower urinary tract symptoms in Italy: the Prostate Destination study.

OBJECTIVE: To assess whether adopting a shared protocol between urologists and general practitioners (GPs) might change diagnostic procedures and referral patterns in the management of men with lower urinary tract symptoms (LUTS). SUBJECTS AND METHODS: Forty-five urological centres and 263 GPs in Italy participated in this prospective study. Procedures adopted by GPs for evaluating five consecutive patients (aged > or = 50 years) were compared before (phase 1) and after (phase 2) implementation of the shared protocol. An evidence-based diagnostic algorithm was developed and approved by participating urologists and presented to local GPs at a training session. Protocol modifications were allowed after discussion with GPs. Direct costs of diagnostic procedures carried out before and after implementing the protocol were calculated from the perspective of the national health service. RESULTS: In all, 903 patients were evaluable in phase 1 and 856 in phase 2. Implementation of the protocol did not change referral patterns, with about half the patients being managed entirely by GPs. The use of a digital rectal examination by GPs increased from 32% to 41%, use of transrectal and suprapubic ultrasonography decreased from 33% to 23% and 53% to 44%, respectively, (all P < 0.001) and use of the International Prostate Symptom Score increased from 4.5% to 23.1% (P < 0.001). Overall, protocol-recommended tests were used more frequently, while those not recommended decreased after implementing the protocol. However, overuse of the tests not recommended (i.e. urine culture and free/total prostate specific antigen ratio) remained high. The mean cost per patient of diagnostic procedures ordered by GPs decreased from Euros 71.82 to Euros 61.93, with Euros 9.9 saved for each patient. CONCLUSION: Our intervention failed to decrease the percentage of cases of LUTS being referred to specialists, but was moderately effective in inducing changes in the diagnostic management by GPs that were indicative of increased compliance with best-practice principles, and produced cost savings of 13.8%.

Diagnostic procedures by Italian general practitioners in response to lower urinary tract symptoms in male patients: a prospective study.

BACKGROUND: The aim of this prospective, multicentre, observational study was to evaluate the initial diagnostic procedures for lower urinary tract symptoms (LUTS) carried out by Italian general practitioners (GPs). METHODS: Data were collected from 445 GPs in Italy regarding the initial clinical decisions and diagnostic procedures adopted for the management of 1399 male patients with LUTS aged >or= 50 years. RESULTS: 50.3% of patients were managed by the GP,4.9% were referred to the urologist immediately and 44.8% after carrying out some diagnostic procedures. A digital rectal examination was performed in only one-third of the patients, many of whom were not subsequently referred to the urologist (26.4%). Laboratory tests that are usually recommended (i.e. PSA, urinalysis and serum creatinine) were undertaken in 98.3% of patients, while tests that are generally considered optional (such as flowmetry) were undertaken in up to 64%. Other generally not recommended investigations, such as ultrasonography, were carried out in 77.2%. The mean time to diagnosis was significantly shorter when the urologist was not involved (36.0 days for GP only management vs 51.4 days for immediate referral and vs 43.4 days for delayed referral (p = 0.0003). CONCLUSIONS: Our findings show a propensity for the majority of Italian GPs to deal with LUTS patients in a primary setting without immediate referral to the urologist. In principle, this trend could be beneficial for the patient (i.e. by reducing time to diagnosis) and cost saving for the national health system. However, the diagnostic procedures selected by the GPs were not in line with best evidence practice recommendations. Shared-care protocols involving both GPs and urologists may contribute to better implementation of the guidelines on the management of LUTS and benign prostatic hyperplasia in Italy.

[Prevention of venous thromboembolism in urologic neoplasms]. / Profilassi del tromboembolismo venoso in urologia oncologica.

PURPOSE: We report our past experience on a sample of patients who underwent pelvic surgery to treat infiltrating bladder tumours. RESULTS: We observed the highest incidence of TVP (33.3%, 3 out of 9) in those patients with higher risk due to anaesthesia and type of surgery. One of our patients died of pulmonary embolism. DISCUSSION: Abdominal pelvic surgery in tumour-bearing patients can be risky due to high incidence of distal and proximal venous thrombosis often resulting in fatal pulmonary embolism (EP). The general risk factors should be evaluated. The diagnosis of venous thrombosis can be difficult to achieve only by clinical examination. Heparin administration as well as surgical techniques and physiotherapy are used as prophylactic measures to reduce the risk of venous thrombosis and to speed up recovery. Nowadays, there is an increasing risk of running into legal problems if appropriate measures to minimise the thromboembolism are not taken.

[Obstructive uropathy secondary to recurrent pelvic endometriosis: description of a clinical case]. / Uropatia ostruttiva secondaria ad endometriosi pelvica recidivante: descrizione di un caso clinico.

The typical presentation of endometriosis is pelvic pain. Patients with with endometriosis often have associated fertility disorders even if their relationship with the symptoms and signs of endometriosis is not evident. The first line of treatment for endometriosis must be surgery. In case of infertility the preferred approach is laparoscopic, maybe in association with medical treatment and possibly followed up by a second-look. In cases with relevant pelvic pain and involvement of other organs, laparotomy is necessary, particularly when a deep endometriosis is infiltrating the uterosacral ligaments, the rectovaginal septum and the bladder. Medical treatment of endometriosis is based upon the hormone-dependency of the endometriotic lesions inducing a resting status. Adhesions, endometriomas or fibrous sequelae do not respond to medical treatment. We describe a case of recurrent endometriosis treated with radical surgery for relevant lesions and fibrous adhesions of ureters with consequent bilateral hydronephrosis.

Trombosis venosa profunda en pacientes con cistectomía radical de salvación / Deep venous thrombosis in patients undergoing salvage radical cystectomy

OBJETIVOS: La presentación de trombosis venosa profunda en pacientes tumorales, ya fue observada por Trousseau, el siglo pasado. Las alteraciones de la coagulación que ocurren en pacientes tumorales pueden causar trombosis venosa profunda (TVP), especialmente en pacientes con metástasis. La quimioterapia antitumoral, puede incluso incrementar el riesgo de trombosis. En este trabajo presentamos nuestra experiencia. MÉTODO: Hemos analizado las historias clínicas de pacientes sometidos a cistectomía radical de salvación. RESULTADOS: Hemos encontrado la incidencia muy alta de TVP (33,3 por ciento; 3 de 9), en pacientes con riesgo anestésico alto y necesidad de cirugía urgente. Uno de nuestros pacientes falleció de trombosis pulmonar. CONCLUSIONES: El diagnóstico de TVP y trombosis pulmonar, no siempre es fácil y es necesario hacer todas las pruebas para llegar al diagnóstico (examen clínico, test analíticos, etc...) (AU)