High intensity focused ultrasound for the treatment of benign prostatic hyperplasia: early United States clinical experience.

High intensity focused ultrasound via a transrectal approach was used to treat 15 patients with symptomatic benign prostatic hyperplasia. The first 10 of these 15 patients underwent continuous temperature monitoring of the periprostatic region throughout the treatment. Patients undergoing transperineal thermocouple placement for the purpose of thermometry were treated while under general or spinal anesthesia, whereas 4 of the 5 remaining patients were successfully treated using intravenous sedation alone. Of the 10 patients 9 did not demonstrate a significant temperature elevation. One patient with a small prostatic anteroposterior diameter had a transient elevation of 17C. No patient experienced a complication related to periprostatic heating. Followup was available at 90 days in all patients. At 90 days the symptom scores decreased from a pretreatment value (American Urological Association questions 1 to 7) of 31.2 (range 22 to 38) to 15.8 (range 8 to 31). Peak flow rate increased by a mean of 4.7 ml per second from 9.3 ml per second before treatment to 14.0 ml per second at 90 days. The most frequent complication was that of transient urinary retention in 11 of 15 patients (73.3%) and hematospermia in 7 (46.7%). No adverse reactions persisted at 90 days. This study represents an initial attempt using high intensity focused ultrasound to treat symptomatic benign prostatic hyperplasia. Overall, the safety and effectiveness of high intensity focused ultrasound demonstrated in this pilot study are encouraging.

Changes in plasma bile acids, plasma amino acids, and hepatic enzyme pools as indices of functional impairment in liver-damaged sheep.

Plasma bile acids, plasma amino acids, and the total hepatic pools of aspartate aminotransferase, gamma glutamyltransferase, glutamate dehydrogenase, and sorbitol dehydrogenase were compared in control sheep (Group 1), sheep with subclinical pyrrolizidine alkaloid toxicosis (Group 2), and in sheep with acute hepatocellular necrosis associated with the hemolytic phase of chronic copper poisoning (Group 3). Subclinical pyrrolizidine alkaloid toxicosis was not associated with any changes in bile acid or amino acid status but was associated with a significant decline in the hepatic pools of sorbitol dehydrogenase and aspartate aminotransferase. This observation could not be explained in terms of enzyme leakage from damaged hepatocytes and suggested that pyrrolizidine alkaloids might specifically inhibit hepatocellular enzyme synthesis. Group 3 sheep also had reduced hepatic enzyme pools which were at least partly referable to enzyme leakage from damaged hepatocytes. In these sheep, increases in plasma bile acids were a more sensitive index of hepatic function than were either increased aromatic amino acid concentration or the ratio between branched chain and aromatic amino acids.

Assessment of the potential toxicity of a poison for rabbits, pindone (2-pivalyl 1, 3 indandione), to domestic animals.

The toxicity of pindone, a rabbit poison, to horses, cattle, goats, chickens, dogs and cats was investigated, using extension of prothrombin time (PT) as an index of poisoning. The daily dose of pindone, administered for 5 days, ranged from 0.3 mg/kg for dogs to 2.5 mg/kg for chickens. This range of dose rates was considered to be indicative of the worst possible case that could arise following a campaign of baiting for rabbits. Although significant elevations in PT (more than double baseline values) were noted in all species other than horses, clinical signs of anticoagulant poisoning were not observed in any of the species tested. From the observed PT, cattle and cats appeared to be the most susceptible, and horses the least susceptible, to pindone toxicity. The half-lives of the elevated PT were calculated as 3.1 days for cattle, 2.8 days for goats and chickens, 1.9 days for horses and dogs and less than one day for cats. It is proposed that these half-lives can be used as a guide for determining the duration of treatment of pindone-affected animals.