Combination treatment in Alzheimer's disease: results of a randomized, controlled trial with cerebrolysin and donepezil.

Treatment with neurotrophic agents might enhance and/or prolong the effects of cholinesterase inhibitors (ChEIs) in Alzheimer's disease (AD). We compared the safety and efficacy of the neurotrophic compound Cerebrolysin (10 ml; n=64), donepezil (10 mg; n=66) and a combination of both treatments (n=67) in mild-to-moderate (mini-mental state examination-MMSE score 12-25) probable AD patients enrolled in a randomized, double-blind trial. Primary endpoints were global outcome (Clinician's Interview-Based Impression of Change plus caregiver input; CIBIC+) and cognition (change from baseline in AD Assessment Scale-cognitive subscale+; ADAS-cog+) at week 28. Changes in functioning (AD Cooperative Study-Activities of Daily Living scale, ADCS-ADL) and behaviour (Neuropsychiatric Inventory, NPI) were secondary endpoints. Treatment effects in cognitive, functional and behavioral domains showed no significant group differences; whereas improvements in global outcome favored Cerebrolysin and the combination therapy. Cognitive performance improved in all treatment groups (mean±SD for Cerebrolysin: -1.7±7.5; donepezil: -1.2±6.1; combination: -2.3±6.0) with best scores in the combined therapy group at all study visits. Cerebrolysin was as effective as donepezil, and the combination of neurotrophic (Cerebrolysin) and cholinergic (donepezil) treatment was safe in mild-to-moderate AD. The convenience of exploring long-term synergistic effects of this combined therapy is suggested.

[Female urinary stress incontinence: transobsturator technique]. / Cabestrillo suburetral transobturatriz en el tratamiento de la incontinencia urinaria de esfuerzo femenina.

The wide use of retropubic TVT has been associated with various complications. To avoid these, alternative procedures have been developed and continence rates obtained with these new routes have been quite similar to those after classic TVT. In the transobsturator technique (TOT) described by Delorme and colleagues in 2001, the tape is inserted through the obturator foramens from outside to inside and is positioned without tension under the urethra. Another surgical technique allows the passage of a tape from inside to outside. The aim of this paper is to describe a new, simple surgical technique for the treatment of female urinary stress incontinence and to evaluate its feasibility.

[Inflammatory pseudomotor of the bladder. A diagnostic and therapeutic dilemma]. / Pseudotumore infiammatorio vescicale. Un dilemma diagnostico e terapeutico.

Inflammatory pseudotumor is a reactive benign lesion which can be very difficult to distinguish from some malignant bladder tumors like sarcomas or sarcomatoid carcinoma. The aim of this study was to present a new case of inflammatory pseudotumor and to review the present diagnostic and therapeutic criteria for this lesion. A 72-year-old female was admitted to the emergency room due to important hematuria. Transurethral resection of a bladder tumor located in the left lateral wall was performed. Pathologic studies were suggestive of inflammatory pseudotumor, but a mixoid leiomyosarcoma couldn t be completely discarded and a partial cystectomy with ipsilateral lymphadenectomy were carried out. Immunohistochemical studies were positive for vimentin, desmin, smooth muscle actin and cytoqueratins while epithelial membrane antigen and S-100 protein were negative. The patient is disease free after a year follow-up. When diagnosis is certain, complete transurethral resection is the treatment of choice. However, if there is no total pathologic confirmation, if it is a very wide lesion or if it is recurring after endoscopic resection, a partial cystectomy is suggested.