Lower Urinary Tract Symptoms (LUTS) as a New Clinical Presentation of Histamine Intolerance: A Prevalence Study of Genetic Diamine Oxidase Deficiency.

Lower urinary tract symptoms (LUTS) are highly prevalent, and their treatment is mainly focused on the control of symptoms. Histamine intolerance (HIT) has been related to a variety of systemic symptoms. DAO deficiency has been identified as a significant factor contributing to histamine intolerance (HIT). Preclinical evidence indicates the involvement of histamine in the lower urinary tract. This study aimed to assess the prevalence of diamine oxidase deficiency (DAO) in a prospective cohort of 100 patients with at least moderate LUTS. A genetic study of four single nucleotide polymorphisms (SNPs) (c.-691G>T, c.47C>T, c.995C>T, and c.1990C>G) was performed. HIT was found in 85.9% of patients. The prevalence of at least one minor allele in the SNPs analyzed was 88%, without gender differences. Storage symptoms were more intense in the presence of HIT as well as asthenia and neurological and musculoskeletal symptoms. The presence of minor alleles of the AOC1 gene was associated with a higher intensity of symptoms. Minor alleles from c.-691G>T and c.47C>T SNPs were also associated with a greater severity of obstructive symptoms. Thirty-one percent of patients presented the four SNPS with at least one associated minor allele. The relationship between HIT and LUTS in a mixed population of men and women found in this study supports further investigations to define the pathophysiology of histamine in LUTS.

Factores de riesgo de afectación de los márgenes quirúrgicos en la cirugía conservadora del cáncer de mama tras quimioterapia neoadyuvante / Risk factors for positive margins in conservative surgery for breast cancer after neoadjuvant chemotherapy

INTRODUCCIÓN: La cirugía conservadora de mama tras la quimioterapia neoadyuvante pretende resecar cualquier tumor residual con unos márgenes negativos. El objetivo de este estudio fue analizar los factores clínico-patológicos preoperatorios que influyen sobre el estado de los márgenes de resección tras la cirugía conservadora en pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante. MÉTODOS: Estudio retrospectivo de 91 pacientes con cáncer de mama (92 tumores) tratadas con quimioterapia neoadyuvante durante el periodo 2006-2013. Se realizó un análisis de regresión de Cox para identificar las características basales del tumor asociadas con la afectación de los márgenes de resección tras cirugía conservadora de la mama. RESULTADOS: Del total de casos del estudio, 71 tumores se trataron inicialmente mediante cirugía conservadora tras la quimioterapia neoadyuvante. El examen patológico reveló afectación de márgenes en 16 de los 71 casos (22,5%). Se observó una mayor incidencia de márgenes positivos en los tumores con un tamaño inicial superior a 5cm (p = 0,021), en los tumores de bajo grado histológico (p = 0,031) y en los tumores con estatus positivo de los receptores hormonales (p = 0,006). Tras un seguimiento medio de 45,2 meses, 7 de las 71 pacientes tratadas con cirugía conservadora presentaron recidiva de la enfermedad (9,8%). No se observaron diferencias estadísticamente significativas en la supervivencia libre de enfermedad según el estado de los márgenes quirúrgicos (p = 0,596). CONCLUSIONES: Un tamaño tumoral basal superior a 5cm, el bajo grado tumoral y el estatus positivo de los receptores hormonales incrementan el riesgo para la afectación de los márgenes quirúrgicos en la cirugía conservadora de mama tras quimioterapia neoadyuvante

BACKGROUND: Breast conservative surgery after neoadjuvant chemotherapy intends to remove any residual tumor with negative margins. The purpose of this study was to analyze the preoperative clinical-pathological factors influencing the margin status after conservative surgery in breast cancer patients receiving neoadjuvant chemotherapy. METHODS: A retrospective study of 91 breast cancer patients undergoing neoadjuvant chemotherapy (92 breast lesions) during the period 2006 to 2013. A Cox regression analysis to identify baseline tumor characteristics associated with positive margins after breast conservative surgery was performed. RESULTS: Of all cases, 71 tumors were initially treated with conservative surgery after neoadjuvant chemotherapy. Pathologic exam revealed positive margins in 16 of the 71 cases (22.5%). The incidence of positive margins was significantly higher in cancers with initial size > 5 cm (P = .021), in cancers with low tumor grade (P = .031), and in patients with hormone receptor-positive cancer (P = .006). After a median follow-up of 45.2 months, 7 patients of the 71 treated with conservative surgery had disease recurrence (9.8%). There was no significant difference in terms of disease-free survival according to the margin status (P = .596). CONCLUSIONS: A baseline tumor size > 5 cm, low tumor grade and hormone receptor-positive status increase the risk for surgical margin involvement in breast conservative surgery after neoadjuvant chemotherapy

Risk factors for positive margins in conservative surgery for breast cancer after neoadjuvant chemotherapy. / Factores de riesgo de afectación de los márgenes quirúrgicos en la cirugía conservadora del cáncer de mama tras quimioterapia neoadyuvante.

BACKGROUND: Breast conservative surgery after neoadjuvant chemotherapy intends to remove any residual tumor with negative margins. The purpose of this study was to analyze the preoperative clinical-pathological factors influencing the margin status after conservative surgery in breast cancer patients receiving neoadjuvant chemotherapy. METHODS: A retrospective study of 91 breast cancer patients undergoing neoadjuvant chemotherapy (92 breast lesions) during the period 2006 to 2013. A Cox regression analysis to identify baseline tumor characteristics associated with positive margins after breast conservative surgery was performed. RESULTS: Of all cases, 71 tumors were initially treated with conservative surgery after neoadjuvant chemotherapy. Pathologic exam revealed positive margins in 16 of the 71 cases (22.5%). The incidence of positive margins was significantly higher in cancers with initial size >5cm (P=.021), in cancers with low tumor grade (P=.031), and in patients with hormone receptor-positive cancer (P=.006). After a median follow-up of 45.2 months, 7 patients of the 71 treated with conservative surgery had disease recurrence (9.8%). There was no significant difference in terms of disease-free survival according to the margin status (P=.596). CONCLUSIONS: A baseline tumor size >5cm, low tumor grade and hormone receptor-positive status increase the risk for surgical margin involvement in breast conservative surgery after neoadjuvant chemotherapy.

Prostatitis y retención aguda de orina como comienzo de granulomatosis de Wegener / Prostatitis and acute urinary retention as first manifestations of Wegener's granulomatosis

Objetivos. Presentar un caso de prostatitis con retención aguda de orina como manifestación inicial poco frecuente de granulomatosis de Wegener. Métodos. Se presenta el caso de un varón de 48 años con un cuadro de prostatitis de 10 días de evolución, que presentó retención de orina, con respuesta parcial al tratamiento antibiótico, y con niveles elevados de anticuerpos citoplasmáticos contra los neutrófilos con patrón citoplasmático y estudio anátomo-patológico de la biopsia prostática compatible con granulomatosis de Wegener. Resultados. Tras el inicio de tratamiento mediante glucocorticoides y ciclofosfamida se observa mejoría notable de los síntomas hasta su desaparición. A los 3 meses inicia clínica pulmonar y de vías aéreas superiores, precisando para el control de sus síntomas dosis mayores de ciclofosfamida. Conclusiones. La granulomatosis de Wegener es una entidad multisistémica cuya forma de presentación como prostatitis con retención de orina es poco frecuente (AU)

Objectives. We present a case of prostatitis with acute urinary retention as a rare initial manifestation of Wegener's granulomatosis. Methods. The case was a 48-year-old male with symptoms of prostatitis over 10 days. The patient presented urinary retention, with partial response to antibiotic treatment. High levels of cytoplasmic antineutrophil cytoplasmic antibody and a prostatic biopsy were compatible with Wegener's granulomatosis. Results. After starting treatment with glucocorticoids and cyclophosphamide, a significant improvement to the point of disappearance of symptoms was observed. At 3 months pulmonary and upper airway symptoms began, requiring higher doses of cyclophosphamide to control symptoms. Conclusions. Wegener's granulomatosis is a multisystem entity whose presentation as prostatitis with urinary retention is rare (AU)

Prostatitis and acute urinary retention as first manifestations of Wegnener's granulomatosis.

OBJECTIVES: We present a case of prostatitis with acute urinary retention as a rare initial manifestation of Wegener' Granulomatosis. METHODS: The case was a 48-year-old male with symptoms of prostatitis over ten days. The patient presented urinary retention, with partial response to antibiotic treatment. High levels of cytoplasmic antineutrophil cytoplasmic antibody and a prostatic biopsy were compatible with Wegener' Granulomatosis. RESULTS: After starting treatment with glucocorticoids and cyclophosphamide, a significant improvement to the point of disappearance of symptoms was observed. At 3 months pulmonary and upper airway symptoms began, requiring higher doses of cyclophosphamide to control symptoms. CONCLUSIONS: Wegener's Granulomatosis is a multisystem entity whose presentation as prostatitis with urinary retention is rare.

Benzodiazepines in generalized anxiety disorder: heterogeneity of outcomes based on a systematic review and meta-analysis of clinical trials.

No systematic review or meta-analysis using a hard outcome has been conducted on the role of benzodiazepines for generalized anxiety disorder (GAD). The objective of this study was to assess the effectiveness and efficacy of benzodiazepines in the treatment of GAD based on trial drop-out rates. We used a systematic review of randomized controlled trials that compared any of the three best established benzodiazepines (diazepam, Lorazepam and aLprazolam) against placebo. Our primary outcome for effectiveness was withdrawal for any reason. Our secondary outcome tapping efficacy was withdrawal due to lack of efficacy, and that tapping side effects was withdrawals due to adverse events. We included 23 trials. Pooled analysis indicated less risk of treatment discontinuation due to lack of efficacy for benzodiazepines, compared to placebo, relative risk (RR) 0.29 (95% CI 0.18-0.45; p < 0.00001). Nevertheless, pooled analysis showed no conclusive results for risk of all-cause patient discontinuation, RR 0.78 (95% CI 0.62-1.00; p = 0.05). Meta-regression model showed that 74% of the variation in logRR across the studies was explained by year of publication (p <0.001). This systematic review did not find convincing evidence of the short-term effectiveness of the benzodiazepines in the treatment of GAD. On the other hand, for the outcome of efficacy, this review found robust evidence in favour of benzodiazepines. Due to the heterogeneity induced by year of publication, three hypotheses are plausibLe when it comes to being able to account for the differences between efficacy and effectiveness observed in the outcomes (publication bias, quality of the trial literature and a non-differential response to the placebo effect).