Metastasic Prostate Cancer: Predictive Factors of Earlier Progression to Castration-Resistance

Introduction: Prostate cancer (PCa) can progress to the lethal phenotype of metastatic castration resistance (mCRPC), either from initially localized disease or de novo metastatic cancer. New drugs improving overall survival are now the cornerstone of treatment. Nevertheless, there are no defined sequences or established timing to initiate or discontinue treatments; besides, not all patients end in CRPC or reach this stage at the same time. Objective: To evaluate characteristics of patients who progress to mCRPC and establish an association with time to mCRPC diagnosis. Material and Methods: Retrospective, descriptive and observational study of 35 mCRPC patients, performed from 2013 to 2017. Variables analyzed were age, Gleason score and prostate-specific antigen (PSA) at diagnosis, initial stage, response time to androgen deprivation therapy (ADT), PSA nadir on ADT and time until mCRPC progression. Statistical analysis comparing variables with time to mCRPC diagnosis was performed. Results: Average age at diagnosis was 68.9 years; PSA values were classified into 3 categories: <20 ng/ml, 20-50 and >50. Gleason score was 7 in 50%, and 8-9 in the rest. Tumor was initially localized in 46% of the patients and metastatic in the rest. PSA nadir on ADT was <1 ng/ml in 67%. Average time to androgen deprivation: 5.5 years, time to mCRPC diagnosis: 6.9 years. Significant associations between time to mCRPC and time of androgen deprivation, PSA nadir during ADT and stage at diagnosis were found. Conclusion: Response time to ADT <1 year, PSA nadir value >5 ng/ml during treatment and metastatic stage at diagnosis were associated with earlier progression to mCRPC (AU)

Introducción: El cáncer de próstata (CaP) puedeprogresar al fenotipo letal de resistencia a la castraciónmetastásica (CPRCm), ya sea por enfermedad inicialmentelocalizada o por cáncer metastásico de novo. Los nuevosmedicamentos que mejoran la supervivencia general sonahora la piedra angular del tratamiento. Sin embargo, nohay secuencias definidas ni tiempos establecidos para iniciar o suspender los tratamientos; además, no todos los pacientes terminan en CPRC o llegan a esta etapa al mismotiempo.Objetivo: Evaluar las características de los pacientesque progresan a CPRCm y establecer una asociación entreéstas y el tiempo hasta el diagnóstico de CPRCm.Material y Métodos: Estudio retrospectivo, descriptivo y observacional de 35 pacientes con CPRCm, realizado entre 2013 y 2017. Las variables analizadas fueronedad, puntaje de Gleason y antígeno prostático específico(PSA, por sus siglas en inglés) al diagnóstico, estadio inicial, tiempo de respuesta a la terapia de deprivación androgénica (TDA), Nadir de PSA en TDA y tiempo hastala progresión a CPRCm. Se realizó un análisis estadísticocomparando las variables con el tiempo hasta el diagnósticode CPRCm.Resultados: La edad promedio al diagnóstico fue de68,9 años; Los valores de PSA<20: 15% de los pacientes,PSA 20-50: 63% de los pacientes, y PSA>50 20%. La puntuación de Gleason fue de 7 en el 50% y de 8-9 en el resto.El tumor fue inicialmente localizado en el 46% de los pacientes y metastásico en el resto. El nadir de PSA en TDAfue <1 ng / ml en 67%. Tiempo medio de respuesta a TDA:5,5 años, tiempo hasta el diagnóstico de CPRCm: 6,9 años.Se encontraron asociaciones significativas entre el tiempohasta CPRCm y el tiempo de deprivación de andrógenos, elnadir de PSA durante el TDA y el estadio al momento deldiagnóstico.Conclusión: el tiempo de respuesta a TDA <1 año... (AU)

[Viagra: oral therapy of male erectile dysfunction I]. / Il Viagra: terapia orale della disfunzione erettile maschile. I.

Sildenafil, the active component of Viagra was synthetized in 1992-3 and registered for sale in US and subsequently in Europe in 1998, on the basis of positive results of numerous preclinical and clinical studies. In the first part of this review, male sexual impotence (recently named erectile disfunction) is defined and its history and epidemiology is reported. The anatomy, physiology and biochemistry of erectile disfunction and the cycle of male sexual response are also discussed.

Cardiotoxicity from orphenadrine intoxication in humans.

Eight cases of Orphenadrine intoxication were treated in the Resuscitation Centre of Rome's University Medical School. All these cases arrived in coma, after taking an overdose of Orphenadrine in an attempt at suicide. The clinical signs and therapy are reported in detail; the cardiovascular side-effects, in particular those involving arrhythmias are dangerous and life threatening. From the clinical data it is believed that these changes in rhythm are mostly due to the autonomic nervous system (A.N.S.). In fact all the 8 patients survived, without treatment never having been treated with cardiokinetic or antiarrhythmic drugs, but a few were given Diazepam as well as respiratory assistance, cardiovascular assistance, and forced diuresis.

Chlorpromazine plus thiorazidine poisoning and treatment with extracorporeal dialysis.

One case of self-poisoning by 3075 mg of Chlorpromazine and 250 mg Thiorazidine is referred. In this case coma and uremia rose 3 days after the intoxication. Treated with extracorporeal circulation through Travenol Coil kidney, this patient recovered from coma and uremia and survived. Chlorpromazine and Thiorazidine intoxications are reviewed with particular attention to the possible kidney damage.