Search

To determine the risk factors for EDin men treated by prostate brachytherapy (PB) for localized prostate cancer and to propose a model to predict post-implant erectile function. Out of a series of 270 sexually active men treated by PB, 241 (89%) (mean age=66 years (range, 43-80)) accepted to participate in a mail-based study on erectile function. The risk factors for erectile dysfunction were determined by regression analysis and a predictive model was proposed. The performance of the model was determined in this population and subsequently verified in a population of 50 men treated by PB in another treatment center. The risk factors for ED after PB were age, the pre-implant IIEF score and prostate volume. In the studied population, the final model to predict a post-treatment IIEF-5 score, using these factors, had a sensitivity of 69% and a specificity of 68% associated to an area under the ROC curve (AUC) of 0.75. The same performance was obtained in another treatment center. Age, pre-implant IIEF-5 score and prostate volume may be used to predict post-implant erectile function in patients treated by PB. [ABSTRACT FROM AUTHOR]

Background: HMG-CoA reductase inhibitors, more commonly called statins, are widely used in the pharmacological management of hyperlipidaemias. The most common adverse drug reactions (ADRs) of statins are muscular. Other reported ADRs of statins along with other lipid-lowering drugs, namely fibrates, include erectile dysfunction (ED). The relationship between ED and exposure to statins has not clearly been established even though a number of significant case reports have associated ED with exposure to statins.Objective: To investigate the association between exposure to statins and the occurrence of ED on the French Pharmacovigilance System Database.Methods: Within the French Pharmacovigilance System Database, the case/non-case method was used to measure the disproportionality of combination between a statin and ED. Cases are defined as those reports corresponding to the ADR of interest (i.e. ED) and non-cases are all reports of ADRs other than that being studied. The study period was from 1 January 1985 to 31 December 2006, limited to males aged 13-80 years. We estimated the association between ED and statins by calculating a reporting odds ratio (ROR) of exposure to each drug, with its 95% confidence interval (CI).Results: Among the total of spontaneous reports selected (110 685), exposure to statins was identified in 4471 cases (4%), of which 51 reports (1.1%) concerned ED, whereas 431 (0.4%) cases of ED were found in the 106 214 reports without exposure to statins (p < 0.0001). The mean delay of onset of ED after starting statins, known for 19 cases, was 62 days (median 29 days). In 56.9% of cases, recovery occurred after withdrawal of statin, and rechallenge was positive in five cases. The association was statistically significant for all statins (adjusted ROR [aROR] = 2.4; 95% CI 1.8, 3.3), simvastatin (aROR = 2.6; 1.6, 4.1), atorvastatin (aROR = 3.4; 2.1, 5.4) and rosuvastatin (aROR = 7.1; 2.6, 19.4) [p < 0.001 for all] but not for pravastatin and fluvastatin. We did not find any relationship between the occurrence of ED and the daily dose or the duration of exposure to statins (data not shown). Assessment of the association between drugs other than statins known to be at risk of ED confirmed a significant association for finasteride (aROR = 14.5; 95% CI 8.3, 25.4), fibrates (aROR = 3.6; 2.6, 5.1), beta-adrenergic receptor antagonists (aROR = 1.5; 1.01, 2.1) and tricyclic antidepressants (aROR = 2.0; 1.2, 3.4) [all p < 0.05].Conclusion: Despite some methodological limitations, the present study suggests that statins may induce or worsen ED in accordance with other data. Further pharmacoepidemiological studies are necessary to confirm this conclusion and to improve the precision of the prevalence and/or the risk factors of this ADR. [ABSTRACT FROM AUTHOR]

Purpose: Sexual health (SH) is an emerging concern in the assessment of quality of life in patients surviving head and neck cancer (HNC). Using data from the French National Prospective VICAN Survey, this study aimed to assess SH deterioration five years after HNC diagnosis and related factors. Methods: Using univariate and multivariate analyses were performed in the 241 HNC survivors. We studied the factors associated between the sexuality and intimate life of these patients with demographic and medical data from the national epidemiological survey VICAN 5. Results: Sexuality and body image were altered in 78.8% for men and 79.2% for women. This alteration in sexual quality of life affects both men and women. Dissatisfaction with the frequency of sexual intercourse was associated with being treated with radiotherapy (p=0.024), as well as decrease of sexual desire in patients treated with chemotherapy (p=0.044). Fatigue (p=0.002), impaired physical health (p=0.049), and high disease stage (p=0.001) remained significantly associated, after multivariate analysis, with decreased sexual desire. Among these 3 factors negatively influencing sexual quality of life, two are treatable with appropriate management. Conclusion: Five years after the diagnosis of HNC, a decrease in sexuality and body image are frequent and significantly impact the quality of life of survivors. These observations imply an adaptation of the management of the professionals involved. [ABSTRACT FROM AUTHOR]

Purpose: To compare perioperative and functional outcomes of two different energy sources, holmium laser and bipolar current for endoscopic enucleation of prostate larger than 60 mL. Methods: A prospective, monocentric, comparative, non-randomized study was conducted including all patients treated for prostate larger than 60 mL, measured by transrectal ultrasound. Patients were assigned to each group based on the surgeons' practice. Perioperative data were collected (preoperative characteristics, operating, catheterization and hospitalization times, hemoglobin loss, complications) and functional outcomes (IPSS, IPSS Quality of Life (QoL), PSA) at 3 months and 1 year. Results: 100 patients were included in each group from October 2015 to March 2018. No differences between HoLEP and plasma groups were observed at baseline, except for mean IPSS score, IPSS QoL score and preoperative PVR that were significantly higher in the HoLEP group. Operating time (142.1 vs 122.4 min; p = 0.01), catheterization time (59.6 vs 44.4 h; p = 0.01) and hospitalization time (2.5 vs 1.8 days; p = 0.02) were significantly shorter in the plasma group. Complication and transfusion rate were no significantly different between HoLEP and plasma. No significant differences were observed concerning functional outcomes at 3 months and 1 year. The urinary incontinence rate was higher 21.1% vs 6.4% (p < 0.01) at 3 months in HoLEP group, but no difference was observed at 1 year. Conclusion: Holmium and plasma are both safe and effective for endoscopic treatment for prostate larger than 60 mL. Operating, catheterization and hospitalization times were significantly shorter in the plasma group. The complication rate and functional outcomes were not significantly different. [ABSTRACT FROM AUTHOR]

Background Aldosterone-producing adenoma is classically treated by unilateral adrenalectomy. Severe hyperkalemia, related to adrenal insufficiency, have been already reported after surgery. We describe here 4 male patients who, despite subnormal kalemia, developed a failure of the renin-aldosterone (RA) axis, resulting in a decrease in extracellular fluid volume (ECFV) following surgery Methods PA diagnosis was established according to French recommendations. Unilateral adrenalectomy was performed in all. Postoperative explorations included ECFV measurement using inulin, and RA axis functionally test by orthostatic and ACTH stimulation. Abstract P1-10 – Table Patient 1 2 3 4 ECFV (mL/kg) N:180-210 108 165 166 167 Plasma potassium (mmol/L) 4.9 4.6 4.5 4.2 Plasma renin (mUI/L) N:2.8-39.9 5.5 3.1 19.4 10.5 Plasma aldosterone (ng/L): Supine N:10-105 15 10 21 16 1-hour orthostatism N:34-273 <11 14 31 14 Post ACTH 41 35 48 12 A decrease in ECFV with low renin level, and insufficient orthostatism-induced aldosterone production were depicted. The ACTH test demonstrated no glucocorticoid deficiency, along with responsive aldosterone secretion. The discrepancy in aldosterone response in orthostatic position versus ACTH stimulation test suggested that hypoaldosteronism primarily results from the lack of angiotensin 2 stimulation as a result of hyporeninism. Conclusions Following unilateral adrenalectomy for PA, the occurrence of normal-to-high kalemia prompted an evaluation of the RA system using ortho-static stimulation test rather than simply measuring baseline values and evaluating the glucocorticoid axis. When confirmed, RA axis depression causes latent hypovolemia, meaning that all treatment likely to further decrease plasma volume should be avoided, while this may at times require mineralo-corticoid substitution. [ABSTRACT FROM AUTHOR]

Introduction et but de l’étude Les cystites postradiques hémorragiques sont une complication tardive des radiothérapies pelviennes. Le traitement par oxygénothérapie hyperbare est recommandé pour améliorer le pronostic fonctionnel et vital car il favorise la cicatrisation de la muqueuse vésicale. Un statut nutritionnel altéré peut contribuer à un retard de cicatrisation. Le statut nutritionnel avant oxygénothérapie hyperbare est décrit en fonction de la gravité initiale de l’hémorragie. Un lien entre les anomalies nutritionnelles et la réponse clinique à l’oxygénothérapie hyperbare est recherché. Matériel et méthodes L’étude observationnelle et rétrospective a inclus 179 patients atteints de cystite radique isolée, lors de la consultation d’indication d’oxygénothérapie hyperbare dans le centre universitaire de médecine hyperbare de Toulouse de 2011 à 2015. Leur cystite a été classée selon le score SOMA (Subjective Objective Management Analytical), 77 patients avaient un grade 1 ou 2 (hématurie sans anémie), 56 un grade 3 (hématurie entraînant une anémie modérée) et 46 un grade 4 (anémie nécessitant une transfusion). Les patients n’avaient pas de pathologie susceptible d’entraîner une malabsorption intestinale. À l’inclusion, l’albumine, la vitamine C, la 25OH-vitamine D, le pyridoxal phosphate (vitamine B6), le zinc, le sélénium, et les acides gras essentiels des phospholipides plasmatiques ont été dosés. Le devenir des patients a été évalué cliniquement à 3 mois, après la fin du traitement par oxygénothérapie hyperbare (40 à 60 séances). Les comparaisons intergroupes ont utilisé un test Mann-Whitney. L’ACP et le test du X 2 ont permis d’argumenter les niveaux des seuils pronostics des paramètres biologiques étudiés. Résultats Les patients (92 % d’hommes) avaient en moyenne 74 ans. Les cystites de grades 3 et surtout 4 étaient associés à des carences nutritionnelles en albumine, vitamines C, D et B6, zinc, sélénium, et acides gras essentiels. Vingt-quatre pour cent des patients avec cystites de grade 4 avaient une dénutrition protéoénergétique sévère. Quatre-vingt-sept pour cent des patients atteints de cystites de grades 4 avaient des valeurs de vitamine C inférieures au seuil optimal de 10 mg/L et 20 % étaient en dessous du seuil scorbutique (2,5 mg/L). Par ailleurs, les patients atteints de cystite de grade 4 les plus réfractaires à l’efficacité du traitement par oxygénothérapie hyperbare avaient des concentrations initiales significativement plus basses en albumine, vitamine C, et sélénium par rapport à ceux dont l’évolution était favorable : les valeurs prédictives positives (VPP) et négatives (VPN) étaient respectivement de 60 et 77 % pour une concentration d’albumine inférieure à 30 g/L, 86 et 79 % pour une concentration en vitamine C inférieure à 2,5 mg/L et 83 et 79 % pour une concentration de sélénium inférieure à 0,65 μmol/L. Conclusion Cette étude montre l’existence de carences nutritionnelles importantes chez les patients atteints de cystite radique, en particulier de grade sévère. En outre, certaines carences sont associées à un pronostic défavorable de la maladie et ce, même après oxygénothérapie hyperbare. L’évaluation du statut nutritionnel et son optimisation chez ces patients est cruciale pour favoriser la cicatrisation du tissu vésical ; d’après les observations recueillies grâce à ce travail, elle pourrait s’avérer indispensable dans la prise en charge précoce de ces patients. [ABSTRACT FROM AUTHOR]