Nutraceutical treatment and prevention of benign prostatic hyperplasia and prostate cancer.

During the last years, pharmaceutical innovations in primary care are dramatically less frequent and will be even more rare in the next future. In this context, preclinical and clinical research oriented their interest toward natural compounds efficacy and safety, supporting the development of a new "nutraceutical" science. Medicinal plants, in the form of plant parts or extracts of them, are commonly used for the treatment of prostate diseases such as benign hypertrophy, prostatitis and chronic pelvic pain syndrome. The pharmacological properties searched for the treatment of prostatic diseases are anti-androgenic, anti-estrogenic, antiproliferative, antioxidant and anti-inflammatory. The most studied and used medicinal plants are Serenoa repens, Pygeum africanum and Urtica dioica. Other promising plants are Cucurbita pepo, Epilobium spp, Lycopersum esculentum, Secale cereale, Roystonea regia, Vaccinium macrocarpon. In parallel, epidemiological studies demonstrated that diet may play an important role on incidence and development of prostatic diseases. The Mediterranean diet is rich of elements with anti-oxidant properties that act as a protective factor for prostatic cancer. Similarly, low intake of animal protein, high intake of fruits and vegetable, lycopene and zinc are a protective factor for benign prostatic hyperplasia (BPH). Serenoa repens in the treatment of symptoms of BPH has been tested either alone or, more frequently, in combination with other medicinal plants, alpha-blockers and inhibitors of 5- alpha reductase (5-ARI). Recent meta-analyses found the effectiveness of Serenoa repens similar or inferior of that of finasteride and tamsulosin but clearly higher than that of placebo in the treatment of mild and moderate low urinary tract symptoms (LUTS), nocturia and discomfort. Clinical trials showed potential synergistic effect of Serenoa repens with other medicinal plants and drugs. In addition to Serenoa repens, there are many other medicinal plants for which clinical evidence is still controversial. Urtica dioica, Pygeum africanum and Curcubita pepo can be considered as an adjunct to the common therapies and their use is supported by studies showing improvement of symptoms and flowmetric indices. Lycopene and selenium are natural products with antioxidant and anti-inflammatory action. The combination of lycopene and selenium with Serenoa repens was able to reduce inflammation in histological prostate sections and to further improve symptom scores and urinary flow in patients with BPH on tamsulosin treatment. Similar effects could be obtained with the use of other carotenoids, such as astaxanthin, and/or zinc. Efficacy on symptoms of patients with BPH of some polyphenols such as quercitin, equol and curcumin have been demonstrated by clinical studies. Pollen extract is a mixture of natural components able to inhibit several cytokines and prostaglandin and leukotriene synthesis resulting in a potent anti-inflammatory effect. Pollen extracts significantly improve symptoms, pain, and quality of life in patients affected by chronic pelvic pain syndrome and chronic prostatitis. Beta-sitosterol is a sterol able to improve urinary symptoms and flow measures, but not to reduce the size of the prostate gland. Palmitoylethanolamide (PEA) is an endogenous fatty acid amide-signaling molecule with anti-inflammatory and neuroprotective effects that can have an interesting role in the management of chronic pelvic pain syndrome and chronic urological pain. Finally, several plant-based products have been subjected to preclinical, in vitro and in vivo, investigations for their potential pharmacological activity against prostate cancer. Some epidemiological studies or clinical trials evaluated the effects of beverages, extracts or food preparations on the risk of prostate cancer. Some plant species deserved more intense investigation, such as Camelia sinensis (green or black tea), Solanum lycopersicum (common tomato), Punica granatum (pomegranate), Glycine max (common soy) and Linum usitatissimum (linen).

Urinary retention due to benign tumor of the bladder neck in a woman; a rare case of papillary cystitis.

BACKGROUND: Urinary retention (UR) is not common in women. There are numerous causes now recognized in women, broadly categorized as infective, pharmacological, neurological, anatomical, myopathic and functional. As opposed to the male, obstructive UR is unusual in women. METHODS: A 56-year-old woman presented with urinary retention. She reported difficulty in urination for more than 15 days. She had no history of urinary tract infection, bladder surgery and catheterization. Her physical examination revealed a soft tissue mass obstructing the external orifice of the urethra. After its partial removal the patient regained her ability to urinate. RESULTS: The patient underwent urological investigation. Ultrasound examination of the urinary system was normal. Cystoscopic examination revealed a papillary lesion with broad base floating along the bladder neck. The patient underwent transurethral resection of the bladder tumor. DISCUSSION: Pathological examination diagnosed papillary cystitis. She was scheduled for a regular follow-up with urine cytology, ultrasound and cystoscopy. One year after diagnosis the patient remains free of symptoms and no recurrence was observed. CONCLUSIONS: Papillary and polypoid cystitis are benign lesions, however under certain circumstances they should be considered in the differential diagnosis of transitional cell carcinoma of the bladder. Lack of the prominent inflammation and edema that characterizes both papillary and polypoid cystitis, and absence of a history of recent bladder catheterization and presence of vesical fistula may facilitate the decision to biopsy the lesion. To our knowledge, this is the first case of papillary cystitis presenting with urinary retention in a woman to be reported in the literature.

Pancreatic injury revealed in abdominal ultrasound: a case report.

Pancreatic laceration due to blunt trauma is relatively uncommon and it is less likely to accompany injury of a retroperitoneal organ. While renal injuries are easily detectable in both clinical and radiographic imaging examination, pancreatic injuries are difficult to diagnose clinically and in several cases remain occult. Although ultrasonography is not generally recommended for initial assessment of the trauma patient and its role is limited in the follow-up of contained intra- or perihepatic bilomas that are treated conservatively, it was demonstrated to be capable for exploration of pancreatic injuries as well. We present a case of a 23-year-old male with pancreatic injury found in ultrasonography.