Calculated free testosterone and radioimmunoassay free testosterone as a predictor of subnormal levels of total testosterone.

PURPOSE: To evaluate the relationship among aFT, cFT, and total testosterone (TT) and the best method in diagnosing subnormal levels of TT. METHODS: A total of 213 men were analyzed. Fasting blood samples were drawn for the determination of the lipid profile as well as of plasmatic glucose and serum levels of albumin, TT, aFT, and sex hormone-binding globulin (SHBG). The values of cFT were determined by Vermeulen's formula. RESULTS: No correlation between aFT and cFT was observed (r = 0.062; P = 0.368), except after controlling for confounders (r = 0.188; P = 0.007). Only 44.8% of hypogonadal men (TT ≤ 300 ng/dL) were classified by aFT, whereas 72.4% of hypogonadal men were classified by both TT and cFT. Sensitivity, specificity, positive and negative predictive values, and positive likelihood ratio were greater in cFT when compared with aFT. CONCLUSIONS: Our results suggest that cFT is more accurate in diagnosing subnormal levels of TT. Furthermore, we do not recommend using aFT due to its lack of accuracy. Further studies should be performed in order to evaluate the correlation between aFT and cFT with clinical signs and symptoms of androgen deficiency.

The influence of age on bioavailable and free testosterone is independent of body mass index and glucose levels.

PURPOSE: To evaluate the influence of age on serum levels of total testosterone (TT), bioavailable testosterone (BT), free testosterone (FT), and sex-hormone binding globulin (SHBG), considering the presence of fasting blood glucose levels and body mass index (BMI) in a selected male population. METHODS: A total of 428 men were analyzed. Anthropometry was taken from all, considering BMI as general obesity indicative variable. Fasting blood samples were drawn for determination of plasma glucose levels and serum levels of albumin, TT, and SHBG. The values of BT and FT were calculated from TT, SHBG, and albumin, by Vermeulen's equation. Statistical significance was set at P ≤ 0.05. RESULTS: Age was negatively correlated to BT (r = -0.301; P < 0.001) and FT (r = -0.273; P < 0.001), but not to TT levels (r = 0.002, P = 0.974). Age was positively correlated to SHBG (r = 0.376; P < 0.001). Age was independently associated with the occurrence of high SHBG levels (OR = 1.07, 95%CI = 1.05-1.10, P < 0.001) and of low BT (OR = 1.04, 95%CI = 1.02-1.07, P < 0.001) and FT levels (OR = 1.05, 95%CI = 1.03-1.08, P < 0.001), but not with low levels of TT (P = 0.08). CONCLUSIONS: Age was significantly associated to high levels of SHBG and to low levels of BT and FT, without significant association to TT. This pattern was independent of BMI and glucose levels.

A cross-sectional study for the analysis of clinical, sexual and laboratory conditions associated to Peyronie's disease.

INTRODUCTION: Although Peyronie's Disease (PD) was first described over 250 years ago, its precise etiology remains obscure. AIM: Analyze a variety of potential associated factors with PD, including erectile dysfunction. MATERIALS AND METHODS: This cross-sectional study included 83 consecutive men with PD and 252 age-matched controls. All men completed the International Index of Erectile Function (IIEF) and were evaluated regarding their clinical and demographic characteristics, comorbidities, and used medications. Anthropometric measures included body mass index and waist circumference (WC). Fasting blood glucose, lipid profile, total testosterone, and dehydroepiandrosterone-sulfate were determined. MAIN OUTCOME MEASURES: Clinical and laboratory characteristics associated to PD. RESULTS: The mean age was 59.2 + or - 10 years in the cases and 59.7 + or - 12 years in the controls. Marital status, current smoking, and excessive consumption of alcoholic beverages were similar between groups (P > 0.05). PD was more common among white skin color males (P = 0.001). The mean score for each IIEF domain and the androgen levels were similar in the two groups. Thiazides were the only medication associated to PD (P = 0.03). Dupuytren's disease was more frequent among individuals with PD (P = 0.001). The distribution of all other comorbidities investigated was similar between groups (P > 0.05). The characteristics WC > 102 cm and levels of low-density lipoprotein (LDL) > 130 mg/dL were more prevalent in the controls (P < 0.05). After multivariate analysis, white skin color (OR: 8.47, 95%CI: 1.98-36.24) and thiazide use (OR: 2.29, 95%CI: 1.07-4.90) were associated to PD, and LDL > 130 mg/dL (OR: 0.55, 95%CI: 0.32-0.92) and WC > 102 cm (OR: 0.53, 95%CI: 0.29-0.96) were inversely associated to PD. CONCLUSIONS: In this study, PD was more common among white skin colored males. An inverse relationship with the presence of elevated serum levels of LDL and WC was observed. We found no association with medications other than thiazides and comorbidities other than Dupuytren's disease. Androgen serum levels and sexual dysfunction had also no association to PD.

Evaluation of the association between lower urinary tract symptoms and erectile dysfunction, considering its multiple risk factors.

AIM: To investigate the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), while considering multiple risk factors for ED, including an anthropometric evaluation of central obesity. METHODS: A cross-sectional study was carried out with 192 consecutive male subjects (>or=40 years old). Conditions clearly associated with ED, other than obesity and age, were considered exclusion criteria. Men were evaluated routinely for clinical history, received a physical examination, and were subjected to blood analysis for fasting serum glucose, lipid profile, and serum testosterone. Patients with previous known history of diabetes mellitus or hypertension were excluded. Anthropometric measures taken included body mass index (general obesity) and waist circumference, waist-hip index, and sagittal abdominal diameter (visceral obesity). Analyses were performed using bivariate and multivariate models (multiple logistic regression). Age, education, alcohol consumption, smoking, sedentary lifestyle, fasting blood glucose level, dyslipidemia, hypogonadism, general obesity, and visceral obesity were taken into account as potential confounding factors. MAIN OUTCOME MEASURES: All men completed the International Index of Erectile Function and International Prostate Symptom Score (IPSS). RESULTS: IPSS scores were low, intermediate, and high in 89 (46.4%), 76 (39.6%), and 27 (14.1%) men, respectively. Overall IPSS scores were significantly associated with ED (P = 0.002). In addition, an association between the severity of ED and LUTS was observed (P = 0.008). The mean quality of life assessment in the IPSS revealed a statistically significant difference between individuals with varying degrees of ED (P = 0.008). The logistic regression analyses showed that IPSS scores and ED remained independently associated even after the control for confounding factors (odds ratio = 1.07, 95% CI = 1.02-1.13, P = 0.01). CONCLUSION: This study suggests that LUTS are independently associated with ED, taking into account various risk factors for ED, including visceral obesity.

The ratio of serum testosterone-to-prostate specific antigen predicts prostate cancer in hypogonadal men.

PURPOSE: We determined whether the ratio of serum testosterone to prostate specific antigen might provide diagnostic value regarding the risk of prostate cancer in a population of hypogonadal men undergoing prostate biopsy. MATERIALS AND METHODS: The study population consisted of 184 consecutive men with symptomatic hypogonadism and prostate specific antigen 4.0 ng/ml or less who underwent prostate biopsy before the anticipated initiation of testosterone therapy. All men had testosterone 300 ng/dl or less. Testosterone concentrations were converted to ng/ml, eg 270 ng/dl equals 2.7 ng/ml, to calculate the testosterone-to-prostate specific antigen ratio. RESULTS: Mean patient age was 58.5 years. There were 154 men with benign biopsies and 30 with cancer. Testosterone concentrations were similar in the prostate cancer and noncancer groups, although mean prostate specific antigen was higher in the prostate cancer group. The testosterone-to-prostate specific antigen ratio was inversely related to prostate cancer risk (OR 0.49, 95% CI 0.33-0.74). On multivariate analysis performed by logistic regression neither age nor prostate specific antigen was be predictive of prostate cancer. However, the testosterone-to-prostate specific antigen ratio remained strongly associated with prostate cancer risk. An ROC for the testosterone-to-prostate specific antigen ratio suggested that a ratio of below 1.8 was diagnostic for prostate cancer, while values below this threshold were associated with an OR of 3.17 (95% CI 1.17-8.59) for prostate cancer. CONCLUSIONS: A low ratio of testosterone to prostate specific antigen is an independent predictor of prostate cancer in hypogonadal men with prostate specific antigen 4.0 ng/ml or less. Ratios less than 1.8 were associated with a greater than 3-fold increase in prostate cancer risk.

Central obesity is an independent predictor of erectile dysfunction in older men.

PURPOSE: There is a growing body of evidence in the literature correlating erectile dysfunction to obesity. We investigated the correlation of different anthropometric indexes of central obesity to erectile dysfunction. MATERIALS AND METHODS: A cross-sectional study was performed including 256 consecutive men 40 years old or older. All men completed the International Index of Erectile Function, and were evaluated routinely with a clinical history, physical examination and blood analysis for fasting serum glucose, lipid profile and serum testosterone. Anthropometric measures included body mass index, waist circumference, sagittal abdominal diameter, maximal abdominal circumference, and waist-hip, waist-thigh, waist-height, sagittal abdominal diameter-thigh and sagittal abdominal diameter-height indexes. RESULTS: In men 40 to 60 years old the different anthropometric indexes of central obesity were not correlated with the presence of erectile dysfunction (p > 0.05). Men older than 60 years (41%, range 61 to 81) demonstrated an association among erectile dysfunction and waist-hip index (p = 0.04), waist-thigh index (p = 0.02), sagittal abdominal diameter (p = 0.03), sagittal abdominal diameter-height index (p = 0.02) and maximal abdominal circumference (p = 0.04). After logistic regression analysis an independent effect on the presence of erectile dysfunction was observed for waist-hip index (OR 8.56, 95% CI 1.44-50.73), sagittal abdominal diameter (OR 7.87, 95% CI 1.24-49.75), sagittal abdominal diameter-height index (OR 14.21, 95% CI 1.11-182.32), maximum abdominal circumference (OR 11.72, 95% CI 1.73-79.18) and waist circumference (OR 19.37, 95% CI 1.15-326.55). CONCLUSIONS: This study suggests that central obesity, assessed by several anthropometric indicators, is associated to the presence of erectile dysfunction in men older than 60 years. Sagittal abdominal diameter, sagittal abdominal diameter-height index, maximum abdominal circumference, waist circumference and waist-hip index were useful indicators to predict the presence of erectile dysfunction.

Carcinoma da ampola de Vater e ampulectomia / Vater's Ampulla carcinoma and ampullectomy

O carcinoma da ampola de Vater, juntamente com as demais neoplasias periampulares, tem na duodenopancreatectomia cefálica sua pricipal modalidade terapêutica. Entretanto, obedecendo-se ao preceito de margens cirúrgicas livres de neoplasia, verificamos a possibilidade da realizaçäo de ressecçäo local desta afecçäo, através da ampulectomia, a ser cotejada como tratamento de eleiçäo em determinados pacientes. Os autores fazem um revisäo da literatura, enfocando aspectos clínicos e radiológicos da neoplasia de ampola de Vater...

Colecistite aguda acalculosa / Acalculous acute cholecystitis

Os autores fazem uma revisäo dos aspectos clínicos, diagnósticos e terapêuticos da colecistite aguda acalculosa, entidade de alta morbimortalidade e baixo índice de suspeiçäo clínica. Mesmo sendo de origem incerta e pouco frequente, a colecistite aguda acalculosa pode se apresentar de forma letal, o que torna premente um diagnóstico precoce. Várias säo as modalidades diagnósticas capazes de evidenciá-la, a despeito de um quadro clínico pouco sugestivo. A intervençäo cirúrgica é a terapêutica de escolha, interrompendo a história natural dessa afecçäo e melhorando sensivelmente o seu prognóstico