Postoperative treatment with phytotheraphy Graminex G63 (CERNILEN-Flogo®) after greenlight laser XPS (180W) photovaporization of the prostate (PVP), can affect patient's quality of life?

OBJECTIVE: Phytotherapic treatment as Cernilen-flogo® is commonly used to treat chronic pelvic pain, chronic prostatitis, and BPE (benign prostatic enlargement). In our study, for the first time, we aim to evaluate postoperatively Cernilen-flogo® therapy in patients with BPE/LUTS (lower urinary tract symptoms) previously treated with Greenlight laser XPS (180W) photovaporization of prostate (PVP) to improve surgical outcomes. MATERIALS AND METHODS: We collected data from patients treated with PVP for BPE/LUTS international prostate symptom score (IPSS) >20 unresponding to conventional treatment. Two groups of patients were analyzed: Group A including 15 patients (50%) treated postoperatively with Cernilen-flogo® vs. no treatment Group B. One expert surgeon performed all the procedures. RESULTS: 30 patients included with BPE/LUTs previously treated with PVP. There was no difference between patients' demographic, median age, prostate volume and PSA (prostate specific antigen) level. All patients had a postoperative evaluation after 30-45 days. Patients with postoperative complications (acute urinary retention, postoperative hematuria) were excluded from our study. All patients had a preoperative and postoperative evaluation of IPSS, bother score (BS) and pelvic discomfort (visual analogic scale VAS). Preoperatively there was no significative difference in IPSS, BS and VAS. IPSS Group A was postoperatively 7.13 (SD 1.64) and Group B was 7.33 (SD 1.58) (p=0.67); BS Group A was postoperatively 1.33 (SD 0.81), Group B was 1.73 (SD 1.09) (p=0.30), and VAS Group A was 2.73 (SD 1.9) and Group B was 4.33 (SD 1.58) (p=0.004) showing a statistically significative difference between the two groups in pelvic discomfort with a better outcome in patients treated with Cernilen-flogo®. CONCLUSIONS: Our study showed that Cernilen-flogo® treatment after PVP is effective and minimize patient's pelvic discomfort showed by lower VAS level resulting in better postoperatively patient's quality of life (QOL).

Relationship between body weight, quality of life and cardiovascular risk factors: a general population based Italian experience.

BACKGROUND: Within the framework of the Progetto Faenza, the aim of this study was to evaluate the effect of cardiovascular risk factors (CVRF) on the health-related Quality of Life (H-rQoL) of a cohort of patients in the province of Ravenna, on the basis of body mass index (BMI). METHODS: The following data were collected for each subject: age, sex, weight, height, glycemia, cholesterol (total, HDL and LDL), creatinine, uricemia, systolic arterial pressure (SAP) and diastolic arterial pressure (DAP), presence/absence of previous CV disorders, arterial hypertension, diabetes, antihypertensive therapy, smoking habits and physical exercise. To evaluate the H-rQoL the SF-36 general health survey questionnaire was used, filled in by the patient at the first examination. To test the significance of the differences between the groups (divided by classes of Body Mass Index) as regards the metabolic indicators, a univariate analysis of variance was performed; on the other hand, to assess which factors affect H-rQoL a multivariate analysis was carried out, considering p<0.05 as significant. The results are expressed as +/- 1SD. RESULTS: Of the 1108 subjects enrolled in the study, 343 subjects (31.2%), including 154 males with a mean age of 44.9 +/- 14.9 years, filled in the SF-36 questionnaire. A BMI within the normal range corresponds to a more satisfactory metabolic (p<0.05) and QoL (p=0.001) picture. Age (p<0.001), presence of previous CV disorders (p=0.005), the use of antihypertensive drugs (p=0.041) and physical exercise (p=0.002) correlated significantly with H-rQoL values. CONCLUSIONS: Health condition and perception are significantly affected by a clinical situation characterized by excess weight.

Relationship of systemic hemodynamics, left ventricular structure and function, and plasma natriuretic peptide concentrations during pregnancy complicated by preeclampsia.

OBJECTIVE: This study was done to evaluate left ventricular structure and function among pregnant patients with preeclampsia and compare them with those of normotensive pregnant and nonpregnant subjects. It also tested the hypothesis that abnormalities in left ventricular structure and function are associated with elevated plasma levels of natriuretic peptides. STUDY DESIGN: The study compared 75 pregnant women (n = 40 with preeclampsia; n = 35 normotensive pregnant women) and 10 nonpregnant normotensive control subjects undergoing an echocardiographic and biohumoral (renin activity and aldosterone, atrial natriuretic peptide, and brain natriuretic peptide concentrations) evaluation. The statistical analysis was carried out by analysis of variance, and significance was set at P <.05. RESULTS: Comparison of pregnant patients with preeclampsia versus both normotensive pregnant women and nonpregnant women showed significant increases in left ventricular mass and left ventricular endsystolic and end-diastolic volumes and significant reductions in left ventricular ejection fraction and percentage of fractional shortening. These changes coincided with increases in plasma levels of atrial natriuretic peptide and brain natriuretic peptide that were linearly related to the left ventricular structural and functional changes observed in patients with preeclampsia. CONCLUSION: Pregnant patients with preeclampsia showed adaptation to the increase in systemic blood pressure, with significant modification of left ventricular structure and function related to the plasma levels of both atrial natriuretic peptide and brain natriuretic peptide. A simple evaluation of plasma natriuretic peptide concentrations could help to discriminate patients with preeclampsia who have a condition of mild left ventricular overload.

Plasma concentrations of atrial natriuretic factor and hemodynamics in pregnancy-induced hypertension.

Plasma values of atrial natriuretic factor (ANF) were evaluated in 31 women with pregnancy-induced hypertension (PIH) and 31 normal pregnant women at the same age of gestation. In 27 women with PIH and 27 normal pregnant women forearm venous tone (FVT) was evaluated by Strain Gauge Plethysmography. Forearm vascular resistance (FVR) was measured as the ratio of mean blood pressure (MBP) to forearm blood flow. In addition Cardiac Index (CI) by means of transthoracic electrical bioimpedance and total peripheral vascular resistance (TPR) (with the Frank Equation) were also measured. In comparison with the normal pregnant women, the women with PIH had similar values of hematocrit (as an index of plasma volume) and significantly higher levels of FVR and TPR, while ANF plasma values did not differ significantly. Subdividing the women with PIH in relation to the presence of proteinuria (greater than or equal to 0.3 g/l), those with proteinuria, in addition to significantly higher levels of FVR and TPR, had significantly higher levels of FVT than normal pregnant women, while ANF plasma values were higher even though the difference was only near the level of significance. Hypertensive women with proteinuria also had higher values of FVT than hypertensive women without proteinuria. By means of multiple regression ANF did not show any significant correlations with hematocrit or sodium excretion. Hypertension with proteinuria seems to represent a more severe form of the disease in which, in addition to the probable influence of other factors such as the renin-angiotensin and prostaglandin systems, a greater increase in peripheral sympathetic tone than in hypertension alone appears to be present, causing a reduction in venous compliance in addition to the elevation in FVR and TPR, with increase in central blood volume and atrial stretch. This may explain the higher ANF plasma levels in these patients in comparison with normal pregnant women, even though the absence of a significant correlation of ANF with hematocrit and the fact that ANF increase was only near the level of significance may suggest a change in the relation between ANF secretion and atrial volume receptors in pregnancy either normal or complicated by hypertension. ANF does not seem to play an important role in water and sodium excretion in PIH probably because of the presence of very high plasma levels of hormones such as aldosterone, progesterone and oestriol which, together with renal prostaglandins, seem to be involved in diuresis and natriuresis in pregnancy.

Maternal and fetal prolactin in pregnancy-induced hypertension.

In plasma from 35 women with pregnancy-induced hypertension (PIH) and 35 normal pregnant women both at 39 weeks of gestation, plasma prolactin levels were measured at 8.30 a.m. (PRL1) and 9.30 a.m. (PRL2) under basal conditions. At delivery umbilical cord blood samples were taken for measurement of fetal prolactin (PRLF). PRL1 and PRL2 were higher in women with PIH, but no significant relations were found between PRL1/PRL2 and blood pressure. PRLF did not differ when infants of mothers with PIH and infants of normal pregnant women were compared, but PRLF had a significant direct independent relation with PRL2. The latter relation may be due to the increase in placental oestrogens during pregnancy, which stimulate both the maternal and fetal hypophyses and their prolactin secretion. PRLF did not show any relation with neonatal morbidity, but PRL1 showed a significant direct relation with the Apgar score at 5 min.

Plasma concentrations of atrial natriuretic factor in normal pregnancy and early puerperium.

The atrial natriuretic factor (ANF) and parameters related to renal sodium handling and renal function were evaluated in 92 normotensive pregnant women at different gestational ages (1st group: 7th-13th week, 2nd group: 14th-20th week; 3rd group: 21st-27th week; 4th group: 28th-34th week; 5th group: greater than 34th week), in 15 normotensive non-pregnant women and in 15 normotensive women 6 days after spontaneous delivery at the end of a normal pregnancy. ANF did not differ significantly between the 5 groups of pregnant women while, concurrently with a further increase in plasma volume (as shown by our data) it was significantly higher in late pregnancy (3rd and 5th groups) than in the non-pregnant women. ANF in post-partum women was significantly higher than in non-pregnant and pregnant women. Only in post-partum women was ANF significantly directly related to sodium excretion. Even though ANF does not seem to play an important role in water and sodium excretion in pregnancy in comparison with other hormones such as progesterone, oestriol and aldosterone, the higher levels of ANF in late pregnancy probably represent a compensatory increase when a given threshold of plasma volume (and therefore of atrial stretch) is reached. However ANF does seem to play a more important role in the induction of diuresis and natriuresis in early puerperium.

Clinical and biochemical aspects of pregnancy-induced hypertension.

In order to study what characteristics accompany the development of pregnancy-induced hypertension (PIH) and what parameters, if any, differentiate hypertension alone from hypertension with proteinuria, we evaluated 119 women with PIH who had hypertension alone, 73 women with PIH who had hypertension and proteinuria greater than or equal to 0.3 g/l, 63 women with normal pregnancy, 20 normal non-pregnant women. In comparison with normal pregnant women and normal non-pregnant women, women with PIH showed an increase in heart rate, suggesting an increased peripheral sympathetic tone, and an initial derangement in renal function as shown by the increase in serum uric acid and reduction in sodium excretion and total and fractional calcium excretion at any given level of sodium excretion. These changes were more marked in patients with hypertension and proteinuria. Higher levels of systolic blood pressure (SBP) were present in women with hypertension alone who subsequently developed proteinuria, compared with those who had only hypertension until term. According to our data hypertension alone and hypertension with proteinuria seem to be two aspects of only differing severity of the same disease.

Role of prolactin in pregnancy hypertension.

In 51 patients with pregnancy hypertension (H) and 51 normotensive gravid women (N), matched for age of gestation, plasma prolactin was measured at 8.30 am (PRL1) and 9.30 am (PRL2) in basal conditions and after 10 minutes of upright posture (PRL3). While in N there was a fall from PRL1 to PRL2 which was nonsignificant, in H there was a significant fall from PRL1 to PRL2. With upright posture there was a further decrease in prolactin in N and a significant increase in H. With multiple regression analysis, systolic and diastolic blood pressure did not show any independent relations with PRL1, PRL2 and PRL3, while serum proteins and proteinuria showed a significant relation with PRL1, as did serum proteins, serum potassium and serum urate with PRL2 and serum urate with PRL3. As has been suggested in primary hypertension, a certain increase in peripheral sympathetic tone, dependent on a decreased central dopaminergic activity, may be present in patients who develop pregnancy hypertension compared to normotensive pregnant controls and may be involved in the pathogenesis of pregnancy hypertension.