This study aims at synthesizing evidence from published RCTs about safety and efficacy of Zoledro... more This study aims at synthesizing evidence from published RCTs about safety and efficacy of Zoledronic acid (ZA) on bone mineral density (BMD) for prostate cancer (PCa) patients undergoing androgen deprivation therapy (ADT). Methods: We searched PubMed through September 2014 using relevant key words "zoledronic acid", "prostate cancer", and "bone". Data were extracted from eligible studies, quality was assessed in strict accordance to Cochrane handbook and data were analyzed using RevMan 5.3 for windows. Results: Eight RCTs with a total of 713 patients were eligible for this study. The pooled mean difference of percentage change in BMD between ZA and control group favored the ZA group than the control group in terms of: lumbar spine (MD¼7.80%, 95% CI¼[5.80, 9.80]), total hip (MD¼3.76%, 95% CI¼[3.18:4.35]) and femoral neck (MD¼3.75%, 95% CI¼ [2:84:4.65]). Of the six adverse events we analyzed (arthralgia, constipation, fatigue, fever, respiratory infection and hot flashes), fever and fatigue were more common in Zoledronic acid group than control group (RR¼1.49, 95% CI¼[1.04, 2.12] and RR¼4.27, 95% CI¼[1.59,11.44]) respectively. Conclusion: Intravenous ZA was safe and tolerated in this population. ZA achieved therapeutic success (>3% change in BMD) in patients with PCa undergoing ADT with less adverse events.
Introduction & Objectives: TURP is gold standard treatment in BPH. complications. In spite of tec... more Introduction & Objectives: TURP is gold standard treatment in BPH. complications. In spite of technologic improvements, large adenomas minimally-invasive and radical treatment of the adenoma with the possibility of histologic exam of the enucleated tissue. This video shows a technical Material & Methods: The video shows the main steps of e-TURP adenoma is enucleated in a retrograde approach, starting from the apex. After reaching the surgical capsule, the adenoma is enucleated with a resectoscope with the bipolar energy. In the absence of a morcellator, the bladder. In this case it may be "morcellated in situ" by the resectoscope loop. The same procedure is repeated for the left lobe. The operation is completed by careful hemostasis. Results: Operation lasted 70 minutes. Post operative hospital stay was 1 day. Conclusions: large adenomas. It could be a more precise and cheaper endoscopic V14
A prospective, randomised study comparing outcomes and 2-year follow-up (FU) between holmium lase... more A prospective, randomised study comparing outcomes and 2-year follow-up (FU) between holmium laser enucleation (HoLEP) and standard open prostatectomy (OP) for the treatment of benign prostatic hyperplasia (BPH) of prostates >/= 70 gr. MATERIAL & METHODS: From March 2003 to December 2004, 80 consecutive patients with symptomatic BPH were randomised to be treated surgically either with HoLEP (group 1, n = 41) or standard OP (group 2, n = 39). Patients of both groups were pre-operatively assessed by: scoring of subjective symptoms with International Prostate Symptom Score (I-PSS) and Quality of life (QoL) questionnaires; physical exam, including digital rectal examination, total serum PSA, kidney-bladder and trans-rectal prostatic (TRUS) ultrasonography. Peri-and post-operative parameters were also carefully assessed. Patients were evaluated at 3-, 12and 24-month FU with the same questionnaires, free urofl owmetry and complete urodynamic multichannel evaluation. RESULTS: : Group 1 vs. group 2: mean±SE pre-operative TRUS volume of the prostates: 108.15 +/= 30.5 gr and 116.7 +/= 24.02 gr (p = 0.33); volume of the adenoma: 75.8 +/= 34.5 gr and 82.5 +/= 4.5 gr (p = 0.41), respectively. Pre-operative total PSA values: 5.8 +/= 3.01 ng/dl vs. 6.9 +/= 2.89 ng/dl (p = 0.29); mean weight of the specimens: 28.3 +/= 3.3 gr vs. 32.6 +/= 2.04 gr (p = 0.005). Surgical time was overall longer in the group 1 (62.9 +/= 18.3 vs. 53.5 +/= 11.5 mins; p = 0.06), whilst catheter removal (1.5 +/= 1.07 vs. 4.1 +/= 0.5 days) and hospital stay (2.7 +/= 1.07 vs. 5.4 +/= 1.05 days; p < 0.001) were signifi cantly shorter in groups 1 as compared with group 2. Day-1 post-operative hemoglobin levels: 12.3 +/= 1.8 vs. 11.1 +/= 1.64 g/dl (p = 0.04). Twelve patients from group 2 required blood transfusion compared to 4 from group 1 (p < 0.07). Seventy-eight and 40 patients were available at the 12-and 24-month FU, respectively. No statistical difference was seen between the two groups at urofl owmetry, IPSS and QoL at the 12-and 24-month FU, respectively. Furthermore, in both groups urodynamic fi ndings showed an improvement and durability in terms of relief of obstruction at the 24-month FU. All cases of mild stress incontinence in both groups were resolved at the 12-month FU. One patient in both groups required endoscopic reintervention for urethral stricture/bladder neck sclerosis, at the 24-month FU. Five patients (2 from group 1 and 3 from group 2) were lost to 24-month FU. CONCLUSIONS: HoLEP for treatment of BPH with prostates >70 gr is a feasible technique guaranteeing similar results to OP after 24-month FU. Furthermore, the reduction in catheterization, hospital stay and blood loss make HoLEP an attractive endourologic option for the treatment of large prostates.
two was experts. The mean weight of the resected tissue was 46.5g (8-175). The total operation ti... more two was experts. The mean weight of the resected tissue was 46.5g (8-175). The total operation time was 105 min (54-354) min, and the efficiency of enucleation was 0.71 g/min (range 0.14-1.20). Preoperative mean IPSS, QOL and Q(max) were 19.1 (range 6 to 34), 4.9 and 6.0 ml/sec (range 1.1 to 17.5), respectively. At 3 months after surgery, mean IPSS, QOL and Qmax were improved to 7.1 (range 1-15), 2.0 and 16.2 ml/sec (range 3.4-34.2), respectively. Urethral stricture was noted in 2 patients (2.8%). Postoperative mean hemoglobin decrease was 0.6 g/dl, and there were no cases of transfusion. Clinical SUI at 3 months after surgery was noted in 3 patients (4.7%). Conclusions: These results indicate that our anteroposterior dissection HoLEP is safe and has a low complications rate because of the clear procedure; thus, we can expect a certain quality of several surgeons.
A patient presented to us with a symptomatic, polycystic, nonfunctioning, pelvic kidney, which wa... more A patient presented to us with a symptomatic, polycystic, nonfunctioning, pelvic kidney, which was removed laparoscopically. Laparoscopic removal of multicystic pelvic kidney has not been reported in an adult. The technique we adopted is described, and the relevant literature is reviewed.
The objective of the study was to apply an illness representations framework to examine patients'... more The objective of the study was to apply an illness representations framework to examine patients' beliefs about erectile dysfunction (ED) and the association between those beliefs and reported quality of life. A total of 41 patients attending two secondary care clinics at a teaching hospital completed questionnaires examining quality of life, sexual functioning, illness representations (cause, time-line, coherence, consequences, cure, control and emotion) and perceptions of masculinity. Masculinity, sexual function, emotions and beliefs about consequences were found to be significantly correlated with quality of life. Multiple regression analysis revealed a model that accounted for almost 35% of the variance in quality of life of ED patients. The strongest predictor of higher quality of life was better sexual functioning (b ¼ À0.342, Po0.05) followed by more positive beliefs about the effects of ED on masculinity (b ¼ 0.323, Po0.05). The results suggest that when assessing the quality of life of men with ED, patients' illness representations should be considered along with their level of sexual functioning and the effects of ED on masculinity. Patients may benefit from an intervention programme that includes an educational component, thereby providing patients with more information about treatment options and available support.
This paper has been peer-reviewed but does not contain final published proof-corrections or journ... more This paper has been peer-reviewed but does not contain final published proof-corrections or journal pagination.
Objective To assess the mean time to cancer-speci®c death in patients with prostate cancer, using... more Objective To assess the mean time to cancer-speci®c death in patients with prostate cancer, using a minimum follow-up of 14 years at one institution, and thus evaluate the minimum life-expectancy for eligibility for radical surgery, radiotherapy and, implicitly, prostate speci®c antigen (PSA) screening. Patients and methods The tumour registry of the authors' institution was searched for the records of patients with prostate cancer (stages T1 and nonmetastatic T2±3) over the period 1976±1983, chosen to give a maximum follow-up with suf®cient numbers of patients. Kaplan±Meier curves and the mean time to death to 1995 for palpable and impalpable cancers were calculated. Deaths not from cancer and from unknown causes were censored. Patients still alive were also censored, except for in the calculation of mean time to death. Results Patients with both stages of disease had a steep increase in mortality at 16 years. The mean (SEM) time to prostate cancer-speci®c death for T1 disease was 17 (1.8) years and for T2-T3 (palpable) was 11.7 (1.2 years). Conclusion These results suggest that, if there is to be one at all, the upper age limit for prostate cancer screening should be 62 years.
American Journal of Physiology-Gastrointestinal and Liver Physiology, 2009
Endothelial activation and surface expression of cell adhesion molecules (CAMs) is critical for b... more Endothelial activation and surface expression of cell adhesion molecules (CAMs) is critical for binding and recruitment of circulating leukocytes in tissues during the inflammatory response. Endothelial CAM expression plays a critical role in the intestinal microvasculature in inflammatory bowel disease (IBD), as blockade of leukocyte α4-integrin binding by gut endothelial CAM ligands has therapeutic benefit in IBD. Mechanisms underlying expression of vascular cell adhesion molecule (VCAM)-1, a ligand for α4-integrin in primary cultures of human intestinal microvascular endothelial cells (HIMEC) has not been defined. We investigated the effect of curcumin, phosphatidylinositol 3-kinase (PI 3-kinase)/protein kinase B (Akt), and mitogen-activated protein kinase (MAPK) inhibitors on VCAM-1 expression and function in HIMEC. CAM expression was assessed and HIMEC-leukocyte adhesion was visualized under static and flow conditions. Western blotting and in vitro kinase assays were used to as...
Introduction & Objectives: CAIX expression and the presence of VHL mutation represent promising p... more Introduction & Objectives: CAIX expression and the presence of VHL mutation represent promising predictors of renal cell carcinoma-specific mortality (RCC-SM) in patients with sporadic renal cell carcinoma (RCC). We tested the ability of these two variables to predict RCC-SM in a prospectively recorded cohort of patients treated with nephrectomy. Material & Methods: Radical nephrectomy was performed in 100 patients at two centers. Genomic DNA was extracted using the QIAmp® DNA mini kit (Qiagen) from frozen tumor samples. Four amplimers covering the whole coding sequence and exon/intron junctions of the VHL gene were synthesized by PCR followed by Big Dye sequencing (Applied Biosystems). Mutation-bearing sequences were confirmed in a second round of PCR and sequencing reactions. Tumor CAIX expression was determined by immunohistochemistry. Life table, Kaplan-Meier and Cox regression analyses addressed RCC-SM. Covariates included age, gender, TNM stage, tumor size, Fuhrman grade and ECOG performance status. Results: The median survival of the cohort was 5.5 years. Genomic VHL mutations were identified in 58 patients (58%) and CAIX level ranged from 0 to 100. The most informative CAIX cutoff corresponded to a breakpoint situated at 0.85, similar to what has been previously described. Categorically-coded CAIX represented a statistically significant predictor of RCC-SM (p=0.002). Conversely, VHL mutation failed to show statistical significance, although a trend was observed for a poorer outcome when VHL was not mutated (p=0.08). In multivariable Cox regression analyses, neither CAIX (p=0.06) nor VHL (p=0.4) achieved independent predictor status, when adjustment was made for age, gender, TNM stage, tumor size, Fuhrman grade and ECOG performance status. Conclusions: Neither CAIX nor VHL mutation improve the ability to predict RCC-SM in patients treated with nephrectomy.
This study aims at synthesizing evidence from published RCTs about safety and efficacy of Zoledro... more This study aims at synthesizing evidence from published RCTs about safety and efficacy of Zoledronic acid (ZA) on bone mineral density (BMD) for prostate cancer (PCa) patients undergoing androgen deprivation therapy (ADT). Methods: We searched PubMed through September 2014 using relevant key words "zoledronic acid", "prostate cancer", and "bone". Data were extracted from eligible studies, quality was assessed in strict accordance to Cochrane handbook and data were analyzed using RevMan 5.3 for windows. Results: Eight RCTs with a total of 713 patients were eligible for this study. The pooled mean difference of percentage change in BMD between ZA and control group favored the ZA group than the control group in terms of: lumbar spine (MD¼7.80%, 95% CI¼[5.80, 9.80]), total hip (MD¼3.76%, 95% CI¼[3.18:4.35]) and femoral neck (MD¼3.75%, 95% CI¼ [2:84:4.65]). Of the six adverse events we analyzed (arthralgia, constipation, fatigue, fever, respiratory infection and hot flashes), fever and fatigue were more common in Zoledronic acid group than control group (RR¼1.49, 95% CI¼[1.04, 2.12] and RR¼4.27, 95% CI¼[1.59,11.44]) respectively. Conclusion: Intravenous ZA was safe and tolerated in this population. ZA achieved therapeutic success (>3% change in BMD) in patients with PCa undergoing ADT with less adverse events.
Introduction & Objectives: TURP is gold standard treatment in BPH. complications. In spite of tec... more Introduction & Objectives: TURP is gold standard treatment in BPH. complications. In spite of technologic improvements, large adenomas minimally-invasive and radical treatment of the adenoma with the possibility of histologic exam of the enucleated tissue. This video shows a technical Material & Methods: The video shows the main steps of e-TURP adenoma is enucleated in a retrograde approach, starting from the apex. After reaching the surgical capsule, the adenoma is enucleated with a resectoscope with the bipolar energy. In the absence of a morcellator, the bladder. In this case it may be "morcellated in situ" by the resectoscope loop. The same procedure is repeated for the left lobe. The operation is completed by careful hemostasis. Results: Operation lasted 70 minutes. Post operative hospital stay was 1 day. Conclusions: large adenomas. It could be a more precise and cheaper endoscopic V14
A prospective, randomised study comparing outcomes and 2-year follow-up (FU) between holmium lase... more A prospective, randomised study comparing outcomes and 2-year follow-up (FU) between holmium laser enucleation (HoLEP) and standard open prostatectomy (OP) for the treatment of benign prostatic hyperplasia (BPH) of prostates >/= 70 gr. MATERIAL & METHODS: From March 2003 to December 2004, 80 consecutive patients with symptomatic BPH were randomised to be treated surgically either with HoLEP (group 1, n = 41) or standard OP (group 2, n = 39). Patients of both groups were pre-operatively assessed by: scoring of subjective symptoms with International Prostate Symptom Score (I-PSS) and Quality of life (QoL) questionnaires; physical exam, including digital rectal examination, total serum PSA, kidney-bladder and trans-rectal prostatic (TRUS) ultrasonography. Peri-and post-operative parameters were also carefully assessed. Patients were evaluated at 3-, 12and 24-month FU with the same questionnaires, free urofl owmetry and complete urodynamic multichannel evaluation. RESULTS: : Group 1 vs. group 2: mean±SE pre-operative TRUS volume of the prostates: 108.15 +/= 30.5 gr and 116.7 +/= 24.02 gr (p = 0.33); volume of the adenoma: 75.8 +/= 34.5 gr and 82.5 +/= 4.5 gr (p = 0.41), respectively. Pre-operative total PSA values: 5.8 +/= 3.01 ng/dl vs. 6.9 +/= 2.89 ng/dl (p = 0.29); mean weight of the specimens: 28.3 +/= 3.3 gr vs. 32.6 +/= 2.04 gr (p = 0.005). Surgical time was overall longer in the group 1 (62.9 +/= 18.3 vs. 53.5 +/= 11.5 mins; p = 0.06), whilst catheter removal (1.5 +/= 1.07 vs. 4.1 +/= 0.5 days) and hospital stay (2.7 +/= 1.07 vs. 5.4 +/= 1.05 days; p < 0.001) were signifi cantly shorter in groups 1 as compared with group 2. Day-1 post-operative hemoglobin levels: 12.3 +/= 1.8 vs. 11.1 +/= 1.64 g/dl (p = 0.04). Twelve patients from group 2 required blood transfusion compared to 4 from group 1 (p < 0.07). Seventy-eight and 40 patients were available at the 12-and 24-month FU, respectively. No statistical difference was seen between the two groups at urofl owmetry, IPSS and QoL at the 12-and 24-month FU, respectively. Furthermore, in both groups urodynamic fi ndings showed an improvement and durability in terms of relief of obstruction at the 24-month FU. All cases of mild stress incontinence in both groups were resolved at the 12-month FU. One patient in both groups required endoscopic reintervention for urethral stricture/bladder neck sclerosis, at the 24-month FU. Five patients (2 from group 1 and 3 from group 2) were lost to 24-month FU. CONCLUSIONS: HoLEP for treatment of BPH with prostates >70 gr is a feasible technique guaranteeing similar results to OP after 24-month FU. Furthermore, the reduction in catheterization, hospital stay and blood loss make HoLEP an attractive endourologic option for the treatment of large prostates.
two was experts. The mean weight of the resected tissue was 46.5g (8-175). The total operation ti... more two was experts. The mean weight of the resected tissue was 46.5g (8-175). The total operation time was 105 min (54-354) min, and the efficiency of enucleation was 0.71 g/min (range 0.14-1.20). Preoperative mean IPSS, QOL and Q(max) were 19.1 (range 6 to 34), 4.9 and 6.0 ml/sec (range 1.1 to 17.5), respectively. At 3 months after surgery, mean IPSS, QOL and Qmax were improved to 7.1 (range 1-15), 2.0 and 16.2 ml/sec (range 3.4-34.2), respectively. Urethral stricture was noted in 2 patients (2.8%). Postoperative mean hemoglobin decrease was 0.6 g/dl, and there were no cases of transfusion. Clinical SUI at 3 months after surgery was noted in 3 patients (4.7%). Conclusions: These results indicate that our anteroposterior dissection HoLEP is safe and has a low complications rate because of the clear procedure; thus, we can expect a certain quality of several surgeons.
A patient presented to us with a symptomatic, polycystic, nonfunctioning, pelvic kidney, which wa... more A patient presented to us with a symptomatic, polycystic, nonfunctioning, pelvic kidney, which was removed laparoscopically. Laparoscopic removal of multicystic pelvic kidney has not been reported in an adult. The technique we adopted is described, and the relevant literature is reviewed.
The objective of the study was to apply an illness representations framework to examine patients'... more The objective of the study was to apply an illness representations framework to examine patients' beliefs about erectile dysfunction (ED) and the association between those beliefs and reported quality of life. A total of 41 patients attending two secondary care clinics at a teaching hospital completed questionnaires examining quality of life, sexual functioning, illness representations (cause, time-line, coherence, consequences, cure, control and emotion) and perceptions of masculinity. Masculinity, sexual function, emotions and beliefs about consequences were found to be significantly correlated with quality of life. Multiple regression analysis revealed a model that accounted for almost 35% of the variance in quality of life of ED patients. The strongest predictor of higher quality of life was better sexual functioning (b ¼ À0.342, Po0.05) followed by more positive beliefs about the effects of ED on masculinity (b ¼ 0.323, Po0.05). The results suggest that when assessing the quality of life of men with ED, patients' illness representations should be considered along with their level of sexual functioning and the effects of ED on masculinity. Patients may benefit from an intervention programme that includes an educational component, thereby providing patients with more information about treatment options and available support.
This paper has been peer-reviewed but does not contain final published proof-corrections or journ... more This paper has been peer-reviewed but does not contain final published proof-corrections or journal pagination.
Objective To assess the mean time to cancer-speci®c death in patients with prostate cancer, using... more Objective To assess the mean time to cancer-speci®c death in patients with prostate cancer, using a minimum follow-up of 14 years at one institution, and thus evaluate the minimum life-expectancy for eligibility for radical surgery, radiotherapy and, implicitly, prostate speci®c antigen (PSA) screening. Patients and methods The tumour registry of the authors' institution was searched for the records of patients with prostate cancer (stages T1 and nonmetastatic T2±3) over the period 1976±1983, chosen to give a maximum follow-up with suf®cient numbers of patients. Kaplan±Meier curves and the mean time to death to 1995 for palpable and impalpable cancers were calculated. Deaths not from cancer and from unknown causes were censored. Patients still alive were also censored, except for in the calculation of mean time to death. Results Patients with both stages of disease had a steep increase in mortality at 16 years. The mean (SEM) time to prostate cancer-speci®c death for T1 disease was 17 (1.8) years and for T2-T3 (palpable) was 11.7 (1.2 years). Conclusion These results suggest that, if there is to be one at all, the upper age limit for prostate cancer screening should be 62 years.
American Journal of Physiology-Gastrointestinal and Liver Physiology, 2009
Endothelial activation and surface expression of cell adhesion molecules (CAMs) is critical for b... more Endothelial activation and surface expression of cell adhesion molecules (CAMs) is critical for binding and recruitment of circulating leukocytes in tissues during the inflammatory response. Endothelial CAM expression plays a critical role in the intestinal microvasculature in inflammatory bowel disease (IBD), as blockade of leukocyte α4-integrin binding by gut endothelial CAM ligands has therapeutic benefit in IBD. Mechanisms underlying expression of vascular cell adhesion molecule (VCAM)-1, a ligand for α4-integrin in primary cultures of human intestinal microvascular endothelial cells (HIMEC) has not been defined. We investigated the effect of curcumin, phosphatidylinositol 3-kinase (PI 3-kinase)/protein kinase B (Akt), and mitogen-activated protein kinase (MAPK) inhibitors on VCAM-1 expression and function in HIMEC. CAM expression was assessed and HIMEC-leukocyte adhesion was visualized under static and flow conditions. Western blotting and in vitro kinase assays were used to as...
Introduction & Objectives: CAIX expression and the presence of VHL mutation represent promising p... more Introduction & Objectives: CAIX expression and the presence of VHL mutation represent promising predictors of renal cell carcinoma-specific mortality (RCC-SM) in patients with sporadic renal cell carcinoma (RCC). We tested the ability of these two variables to predict RCC-SM in a prospectively recorded cohort of patients treated with nephrectomy. Material & Methods: Radical nephrectomy was performed in 100 patients at two centers. Genomic DNA was extracted using the QIAmp® DNA mini kit (Qiagen) from frozen tumor samples. Four amplimers covering the whole coding sequence and exon/intron junctions of the VHL gene were synthesized by PCR followed by Big Dye sequencing (Applied Biosystems). Mutation-bearing sequences were confirmed in a second round of PCR and sequencing reactions. Tumor CAIX expression was determined by immunohistochemistry. Life table, Kaplan-Meier and Cox regression analyses addressed RCC-SM. Covariates included age, gender, TNM stage, tumor size, Fuhrman grade and ECOG performance status. Results: The median survival of the cohort was 5.5 years. Genomic VHL mutations were identified in 58 patients (58%) and CAIX level ranged from 0 to 100. The most informative CAIX cutoff corresponded to a breakpoint situated at 0.85, similar to what has been previously described. Categorically-coded CAIX represented a statistically significant predictor of RCC-SM (p=0.002). Conversely, VHL mutation failed to show statistical significance, although a trend was observed for a poorer outcome when VHL was not mutated (p=0.08). In multivariable Cox regression analyses, neither CAIX (p=0.06) nor VHL (p=0.4) achieved independent predictor status, when adjustment was made for age, gender, TNM stage, tumor size, Fuhrman grade and ECOG performance status. Conclusions: Neither CAIX nor VHL mutation improve the ability to predict RCC-SM in patients treated with nephrectomy.
Uploads
Papers by G. Muir