Complications In Men Research Articles

Andropausal symptoms in men with Type 2 diabetes

Serum androgen concentration is reported to be low in patients with Type 2 diabetes. There have been no studies comparing andropausal symptoms such as sleep disturbance, depression, erectile dysfunction and lower urinary tract symptoms simultaneously between men with Type 2 diabetes and subjects without diabetes. We compared andropausal symptom scores such as the Pittsburgh Sleep Quality Index, the Self-Rating Depression Scale, the International Index of Erectile Function and the International Prostate Symptom Score in 296 men with Type 2 diabetes and in 267 subjects without diabetes. Furthermore, we evaluated relationships of andropausal symptom scores to various anthropometric factors and compared andropausal symptom scores according to diabetic complications in men with Type 2 diabetes. Andropausal symptom scores such as the Pittsburgh Sleep Quality Index, the Self-Rating Depression Scale, the International Index of Erectile Function and the International Prostate Symptom Score were 4.2 ± 2.6 vs. 5.0 ± 3.3, P<0.01 by unpaired Student's t-test, 34.8 ± 8.2 vs. 38.4 ± 9.3, P<0.0001, 11.5 ± 6.4 vs. 9.9 ± 6.9, P<0.01 and 7.3 ± 6.7 vs. 9.0 ± 7.1, P<0.01 in subjects without diabetes and in patients with diabetes, respectively. The Pittsburgh Sleep Quality Index was higher in patients with neuropathy than without. The Self-Rating Depression Scale was higher in patients with advanced retinopathy. The International Index of Erectile Function was lower in patients with advanced retinopathy and nephropathy. The International Index of Erectile Function was lower and the International Prostate Symptom Score was higher in patients with cardiovascular disease than without. Our data demonstrated that men with Type 2 diabetes have higher prevalence of andropausal symptoms, especially those with diabetic complications.

Targeted Antimicrobial Prophylaxis Using Rectal Swab Cultures in Men Undergoing Transrectal Ultrasound Guided Prostate Biopsy is Associated With Reduced Incidence of Postoperative Infectious Complications and Cost of Care

We evaluated targeted antimicrobial prophylaxis in men undergoing transrectal ultrasound guided prostate biopsy based on rectal swab culture results. From July 2010 to March 2011 we studied differences in infectious complications in men who received targeted vs standard empirical ciprofloxacin prophylaxis before transrectal ultrasound guided prostate biopsy. Targeted prophylaxis used rectal swab cultures plated on selective media containing ciprofloxacin to identify fluoroquinolone resistant bacteria. Patients with fluoroquinolone susceptible organisms received ciprofloxacin while those with fluoroquinolone resistant organisms received directed antimicrobial prophylaxis. We identified men with infectious complications within 30 days after transrectal ultrasound guided prostate biopsy using the electronic medical record. A total of 457 men underwent transrectal ultrasound guided prostate biopsy, and of these men 112 (24.5%) had rectal swab obtained while 345 (75.5%) did not. Among those who received targeted prophylaxis 22 (19.6%) men had fluoroquinolone resistant organisms. There were no infectious complications in the 112 men who received targeted antimicrobial prophylaxis, while there were 9 cases (including 1 of sepsis) among the 345 on empirical therapy (p=0.12). Fluoroquinolone resistant organisms caused 7 of these infections. The total cost of managing infectious complications in patients in the empirical group was $13,219. The calculated cost of targeted vs empirical prophylaxis per 100 men undergoing transrectal ultrasound guided prostate biopsy was $1,346 vs $5,598, respectively. Cost-effectiveness analysis revealed that targeted prophylaxis yielded a cost savings of $4,499 per post-transrectal ultrasound guided prostate biopsy infectious complication averted. Per estimation, 38 men would need to undergo rectal swab before transrectal ultrasound guided prostate biopsy to prevent 1 infectious complication. Targeted antimicrobial prophylaxis was associated with a notable decrease in the incidence of infectious complications after transrectal ultrasound guided prostate biopsy caused by fluoroquinolone resistant organisms as well as a decrease in the overall cost of care.

Influence of age and sex on endoscopic findings of gastrooesophageal reflux disease

Barrett's oesophagus (BO) and oesophageal adenocarcinoma are more common with increasing age and among men. Symptoms of gastrooesophageal reflux disease are equally common in both sexes and at all ages. We hypothesized that reduced postmenopausal female sex hormone levels may remove protection from acid reflux injury, leading to increased oesophagitis and its complications in older women. To examine the incidence of gastrooesophageal reflux disease and its complications in men and women in a large endoscopy database. Anonymized data were extracted from endoscopy databases covering an 11-year period. Patients with an endoscopic diagnosis of reflux oesophagitis (RO), BO, hiatus hernia and benign oesophageal stricture and total number and indications for endoscopies were identified. Out of 154 406 upper gastrointestinal endoscopies, 24 240 (15.7%) patients had RO {13,148 male, 11,092 female, mean age 59 [standard deviation (SD) 17] years}. The incidence of RO increased with age {odds ratio 1.029 [95% confidence interval (CI) 1.026-1.032], P<0.001} but this increase was more marked in women with increasing age [1.01 (1.01-1.02), P<0.001] compared with men. Increasing age was associated with an increased incidence of benign oesophageal stricture [1.02 (1.017-1.023)] and BO [1.02 (1.019-1.021)]. Although the increase in benign oesophageal stricture was more marked in women [1.024 (1.02-1.028) P<0.001] than in men, this was not the case in BO. RO and its complications, BO and benign oesophageal stricture increase with age. RO, BO and stricture are more common in absolute and relative terms among younger men than younger women. RO and stricture increase more rapidly in women than men so that the prevalence in elderly patients is similar in both sexes.

Encounter of cancer cells with bone. Management of bone metastasis arising from prostate cancer

Bone metastases and skeletal complications are major causes of morbidity in prostate cancer patients. Despite an osteoblastic appearance of bone metastases on imaging studies, patients have high osteoclast activity. Current evidence indicates that newer-generation nitrogen-containing bisphosphonates, particularly zoledronic acid, are potent inhibitors of bone resorption via suppression of osteoclast activity. Indeed, zoledronic acid has been reported to significantly decrease the risk of skeletal complications in men with castration-resistant prostate cancer and bone metastases. Additionally, an increased understanding of the pathogenesis of bone metastasis has resulted in the development of several bone-targeted therapies, including a monoclonal antibody targeting the receptor activator of nuclear factor-κB ligand. In this paper, the current state and the future of bone metastases management from prostate cancer are outlined.

Does a Multidisciplinary Team Decrease Complications in Male Patients With Hip Fractures?

Men with hip fractures are more likely to experience postoperative complications than women. The Medical Orthopaedic Trauma Service program at New York Presbyterian Hospital utilizes a multidisciplinary team approach to care for patients with hip fractures. The service is comanaged by an attending hospitalist and orthopaedic surgeon, with daily walking rounds attended by the hospitalist, orthopaedic resident, physical therapist, social worker, and a dedicated Medical Orthopaedic Trauma Service physician assistant. We asked whether a multidisciplinary service for patients with hip fracture decreases (1) the incidence of inpatient complications in men, (2) the length of hospitalization, and (3) 90-day and 1-year mortality. We retrospectively reviewed the charts of 74 men who had surgery for a nonperiprosthetic femoral neck, intertrochanteric, or subtrochanteric fracture for two 7-month periods before and after implementation of the Medical Orthopaedic Trauma Service. Age, ethnicity, comorbidity status, time to surgery, and postoperative complication data were collected. Regression modeling was used to evaluate the likelihood of postoperative complications, length of hospitalization, and 90-day and 1-year mortality while controlling for age, Charlson Comorbidity Index score, fracture type, and time from admission to surgery. We observed a decrease in the likelihood of experiencing at least one inpatient complication in male patients after implementation of the Medical Orthopaedic Trauma Service (odds ratio = 0.264). There was no difference in length of hospitalization, 90-day mortality, or 1-year mortality. Multidisciplinary collaboration for patients with hip fractures can decrease the likelihood of experiencing inpatient complications in male patients. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Preoperative Alcohol Screening Scores: Association with Complications in Men Undergoing Total Joint Arthroplasty

The risks associated with preoperative alcohol misuse by patients before undergoing total joint arthroplasty are not well known, yet alcohol misuse by surgical patients is common and has been linked to an increased risk of complications after other procedures. The purpose of this study was to evaluate the association between a patient's preoperative standardized alcohol-misuse screening score and his or her risk of complications after total joint arthroplasty. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is an alcohol-misuse screening instrument administered annually to all patients receiving care through the Veterans Health Administration (VHA). The scores range from 0 to 12, with higher scores signifying greater and more frequent consumption. In a study of 185 male patients who had alcohol screening scores recorded in the year preceding surgery at a Palo Alto VHA facility, and who reported at least some alcohol use, we estimated the association between preoperative screening scores and the number of surgical complications in an age and comorbidity-adjusted regression analyses. Of the 185 patients reporting at least some drinking in the year before their total joint replacement, 17% (thirty-two) had an alcohol screening score suggestive of alcohol misuse; six of those thirty-two patients had one complication, four had two complications, and two had three complications. The screening scores were significantly related to the number of complications in a negative binomial regression analysis (exp[β] = 1.29, p = 0.035), which demonstrated a 29% increase in the expected number of complications with every additional point of the screening score above 1, although with wide confidence intervals for the higher scores. Complications following total joint arthroplasty were significantly related to alcohol misuse in this group of male patients treated at a VHA facility. The AUDIT-C has three simple questions that can be incorporated into a preoperative evaluation and can alert the treatment team to patients with increased postoperative risk. Preoperative screening for alcohol misuse, and perhaps preoperative counseling or referral to treatment for heavy drinkers, may be indicated for patients who are to undergo total joint arthroplasty.

The Preoperative Use of Erythropoietin Stimulating Proteins Prior to Radical Prostatectomy Is Not Associated With Increased Cardiovascular or Thromboembolic Morbidity or Mortality

To critically examine the cardiovascular and thromboembolic risks associated with erythropoietin stimulating proteins (ESPs) in men with normal hemoglobin levels undergoing open radical retropubic prostatectomy. Between October 1, 2000, through December 31, 2006, a total of 1308 men underwent open radial retropubic prostatectomy by a single surgeon. Of these men, 1095 received preoperative ESPs. Hematocrit levels measured at baseline, immediately before anesthesia induction and at hospital discharge, were prospectively entered into a database. Thromboembolic and cardiovascular complications were prospectively captured during the hospitalization and after surgery. The mean Delta preoperative hematocrit level was 5.9 g/dL. The pre-anesthesia induction hematocrit level was 49.2%. Hospital discharge hematocrit level was 33.6 g/dL. The overall risk of cardiovascular and thromboembolic complications in men receiving ESP were 0.55% and 0.45%, respectively. The risk of cardiovascular and thromboembolic complications were independent of the Delta in preoperative hematocrit or the absolute level of the pre-anesthesia induction hematocrit. ESPs represent a safe and effective preoperative blood management strategy for men undergoing open radical retropubic prostatectomy.

Denosumab to Prevent Disease and Treatment-Related Skeletal Complications in Men with Prostate Cancer: Emerging Evidence

Denosumab to Prevent Disease and Treatment-Related Skeletal Complications in Men with Prostate Cancer: Emerging Evidence

Are Fractures Secondary to LHRH Agonist Therapy in Prostate Cancer a Significant Problem?

Are Fractures Secondary to LHRH Agonist Therapy in Prostate Cancer a Significant Problem?

Effects of Denosumab on Bone Mineral Density in Men Receiving Androgen Deprivation Therapy for Prostate Cancer

In a recently completed 3-year, randomized, double-blind study, denosumab, a fully human monoclonal antibody against receptor activator of nuclear factor kappaB ligand, significantly increased bone mineral density and decreased new vertebral fractures in men receiving androgen deprivation therapy for prostate cancer. We conducted subgroup analyses to evaluate the relationships between subject characteristics and the effects of denosumab on bone mineral density at multiple skeletal sites. A total of 1,468 subjects were randomized 1:1 to receive 60 mg subcutaneous denosumab every 6 months or placebo for 36 months. In these analyses we evaluated the effects of denosumab on bone mineral density at the lumbar spine, total hip and distal 1/3 radius (substudy of 309 subjects) during 36 months in specific subgroups according to age, duration and type of prior androgen deprivation therapy, bone mineral density T score, weight, body mass index, bone turnover marker levels and prevalent vertebral fractures. After 36 months denosumab significantly increased bone mineral density of the lumbar spine, total hip and distal 1/3 radius by 7.9%, 5.7% and 6.9%, respectively, compared with placebo (p <0.0001 for each comparison). Denosumab significantly increased bone mineral density to a degree similar to that observed in the overall analysis for every subgroup including older men as well as those with prevalent fractures, lower baseline bone mineral density, and higher serum C-telopeptide and tartrate-resistant alkaline phosphatase 5b. Mean increases in bone mineral density at each skeletal site were greatest for men with the highest levels of serum C-telopeptide and tartrate-resistant alkaline phosphatase 5b. Denosumab significantly and consistently increased bone mineral density at all skeletal sites and in every subgroup, including men at greatest risk for bone loss and fractures.

Bone turnover markers as predictive tools for skeletal complications in men with metastatic prostate cancer treated with zoledronic acid

Bone turnover markers are helpful to diagnose bone metastases. The aim of this study was to evaluate the usefulness of these markers in prostate cancer patients with bone metastases before and during the treatment with zoledronic acid as predictive and monitoring tools of skeletal-related events (SRE). One hundred seventeen prostate cancer patients with bone metastases and treated with zoledronic acid (4 mg every 4 weeks) were examined. Fifty-six patients were with and 61 patients without SRE during a 60-week study. Total and bone-specific alkaline phosphatase, and amino-terminal procollagen propeptides of type-I-collagen (PINP), cross-linked N-terminal (NTx), cross-linked C-terminal telopeptides of type-I-collagen (ICTP), and C-terminal telopeptides of type-I-collagen as well as prostate-specific antigen (PSA) were measured before and 12, 24, 36, 48, and 60 weeks after starting treatment. Higher baseline concentrations were observed in the SRE group. The bone markers except for ICTP and tALP decreased to 20-80% of the baseline values at week 12 after the drug administration showing a generally higher decline in the non-SRE group except for NTx. At all time points during treatment higher and increasing concentrations of bone markers were observed in the SRE group compared with non-SRE group. Cox regression models with clinical data and bone markers showed the baseline NTx concentration as predictor of SREs. During the study, percentage changes of PINP and ICTP were most indicative for SREs. Bone markers are useful tools to predict and diagnose SRE in prostate cancer patients with bone metastases under receiving zoledronic acid therapy.

Body fat in men with prolactinoma

(a) To evaluate body fat in men with prolactinoma and healthy controls, using whole body dual energy x-ray absorptiometry (DXA), and (b) to correlate DXA results with anthropometry and clinical aspects of male prolactinomas. A cross-sectional study was performed in two University referral centers. Eleven newly-diagnosed men with prolactinoma and 9 with normal PRL levels due to dopamine agonist treatment were submitted to DXA and blood analysis (PRL, testosterone, dihydrotestosterone, estradiol, and SHBG) by the time of their clinical evaluation. They were compared with 14 control men of similar age and body mass index distribution. Newly-diagnosed men with prolactinoma had higher fat percentage in the arms and the total body, when compared with patients treated with dopamine agonists and controls. The former group also presented higher fat percentage in the legs than the controls. Truncal fat percentage of the newly-diagnosed patients was lower than the dopamine agonist treated group. The 3 groups had similar android and gynoid fat contents. Fat percentage of the 6 sites correlated with PRL, testosterone, and dihydrotestosterone levels. Newly-diagnosed men with prolactinomas had higher body fat content. Body fat was linked to disease control, especially to the PRL and androgen levels. Consequently, adequate control of hyperprolactinemia should be pursued in order to reduce the risk of obesity and its metabolic complications in men with prolactinoma.

Overexpression of Il6 leads to hyperinsulinaemia, liver inflammation and reduced body weight in mice

IL-6 is released by the adipose tissue and increased circulating levels in obesity are associated with hyperinsulinaemia and insulin resistance. Short-term experiments suggest that increased IL-6 release by the skeletal muscle following exercise may improve insulin sensitivity. In order to examine the effect of chronically elevated IL-6 levels, we overexpressed Il6 in skeletal muscle in mice using an electro-transfer procedure. Circulating IL-6 levels were increased and the animals rapidly lost both weight and body fat, but food intake was unchanged, which is consistent with the finding that IL-6 increased energy expenditure. Insulin levels were inappropriately elevated and combined with hypoglycaemia in spite of reduced 2-deoxy-D: -glucose uptake by skeletal muscle. Insulin-stimulated glucose uptake by skeletal muscles ex vivo was reduced, probably due to the decreased amounts of glucose transporter (GLUT)-4. Beta cell insulin content was increased, while apparent beta cell mass was unchanged. Circulating serum amyloid A cluster levels were increased tenfold due to a pronounced proinflammatory state in the liver with infiltration of inflammatory cells. However, no liver steatosis was found, which may be accounted for by concomitant AMP kinase activation. Chronically elevated IL-6 levels lead to inappropriate hyperinsulinaemia, reduced body weight, impaired insulin-stimulated glucose uptake by the skeletal muscles and marked inflammation in the liver. Thus, the pleiotrophic effects of chronically elevated IL-6 levels preclude any obvious usefulness in treating obesity or its associated metabolic complications in man, despite the fact that weight reduction may be expected.

Osteoclast-targeted therapy for metastatic prostate cancer

Bone metastases and skeletal complications are major causes of morbidity in men with prostate cancer. Despite the osteoblastic appearance of bone metastases on imaging studies, patients with bone metastases have elevated markers of bone resorption, indicative of high osteoclast activity. Indeed, increased osteoclast activity is independently associated with higher risk of subsequent skeletal complications. Therapies aimed at reducing osteoclast activity would theoretically diminish disease-related skeletal complications, bone metastases and treatment-related fractures. Phase III clinical trials to address the role of osteoclast-targeted therapy in metastatic prostate cancer are reviewed here. Zoledronic acid, a potent bisphosphonate, significantly decreased the risk of skeletal complications in men with androgen-independent prostate cancer and bone metastases. Ongoing studies will evaluate the use of bisphosphonates or denosumab, a monoclonal antibody that inhibits the receptor activator of nuclear factor-κB ligand signaling in the prevention of bone metastases or skeletal complications. Additional studies are needed to determine the optimal timing, schedule and duration of bisphosphonate treatment in men with bone metastases. The results of these trials in the near future may herald further evolution in the targeting of osteoclasts and optimal supportive care in men with prostate cancer.

Abstract 3628: Differences in Implantation-Related Complications between Men and Women Receiving ICD Therapy for Primary Prevention

Background: Studies suggest that women are at higher risk for complications with some invasive cardiac procedures. Little is known about ICD implantation-related complications in community practice. We compared rates of in-hospital complications in men and women receiving an ICD for primary prevention. Methods: Using the NCDR ICD registry, we identified a cohort of patients receiving an ICD for primary prevention of sudden cardiac death between January 2005 and April 2007. Outcomes included all complications and major complications (cardiac arrest, perforation, valve injury, coronary venous dissection, hemothorax, pneumothorax, deep phlebitis, TIA/stroke, tamponade, MI, and AV fistula). Multivariable analysis assessed the association between gender and complications, adjusting for demographic, clinical, procedural, physician, and hospital characteristics. Secondary analyses stratified by device type (ICD vs. biventricular (BiV) ICD). Results: Of the 59,833 patients, 73% were male and 27% were female. Women were more likely to have a history of heart failure (88% vs. 83%; p&lt;0.01), worse NYHA functional status (57% vs. 50% NYHA Class III; p&lt;0.01), and non-ischemic cardiomyopathy (47% vs. 28%; p&lt;0.01). Women were also more likely to receive BiV ICDs (46% vs. 39%; p&lt;0.01). In unadjusted analyses, women were more likely to experience any complication and major complications (Table ). In multivariable models, women had a significantly higher risk of any complications and major complications. Results were similar when stratified by device type. Conclusions: Women are more likely than men to have in-hospital complications related to ICD implantation. As complications attenuate the benefits that might accrue from ICD therapy, the higher risk of complications may influence the decision to implant a device in women. Additionally, strategies specifically directed at preventing complications will be important to improving outcomes after ICD implantation.

Predictors of Skeletal Complications in Men with Hormone-Refractory Metastatic Prostate Cancer

Skeletal complications are a major cause of morbidity in men with hormone-refractory metastatic prostate cancer. These analyses were designed to identify the variables associated with a greater risk of skeletal complications. The 643 subjects in this report were participants in a randomized placebo-controlled trial to evaluate the effects of zoledronic acid on the incidence of skeletal-related events. All subjects had bone metastases and disease progression despite medical or surgical castration. The relationships between the baseline covariates and the time to the first skeletal-related event were assessed by Cox proportional hazard analyses. The serum bone-specific alkaline phosphatase (BAP) and urinary N-telopeptide level was assessed as a representative specific marker of osteoblastic and osteoclastic activity, respectively. The other covariates included in the model were age, cancer duration, Eastern Cooperative Oncology Group performance status, analgesic use, and prostate-specific antigen, hemoglobin, and lactate dehydrogenase levels. Elevated BAP levels were consistently associated with a greater risk of adverse skeletal outcomes. Elevated BAP was significantly associated with a shorter time to the first skeletal-related event on multivariate analyses of the entire study population (relative risk 1.84, 95% confidence interval 1.40 to 2.43; P <0.001) and in subset analyses of the placebo and zoledronic acid groups. Elevated BAP levels were also consistently associated with adverse skeletal outcomes on multivariate analyses of the time to radiotherapy and pathologic fracture, the most common types of skeletal-related events in the study population. No other baseline variable was consistently associated with the risk of adverse skeletal outcomes. The results of our study have shown that elevated serum BAP levels are associated with a greater risk of adverse skeletal outcomes in men with hormone-refractory prostate cancer and bone metastases.

Using structural equation model to illustrate the relationship between metabolic risk factors and cardiovascular complications in Taiwan

The objective of this study was to perform a population-based screening programme to determine the prevalence of the metabolic syndrome (MetS) and the relationship between metabolic risk factors and prevalent cardiovascular complications in Taiwan. A screening programme recruited residents aged 40 years and older in Sanchih, Taipei County, Taiwan, and collected demographic data, blood and urine samples. Fasting plasma glucose level, serum total cholesterol, high-density lipoprotein cholesterol, and triglyceride were measured. Atherosclerotic complications, including myocardial infarction, stress-positive angina, ischaemic stroke, and proteinuria were confirmed. A structural equation model (SEM) was constructed to identify the association between metabolic abnormality and atherosclerosis. A total of 1494 subjects, 776 male and 718 female, were recruited in this study. The crude prevalence of the MetS was 19.3% for men [95% confidence interval (CI) 16.3-22.2%] and 18.7% for women (95% CI 15.6-22.0%). The presence of the MetS posed a substantial risk to microvascular complications in both sexes [odds ratio (OR) 3.29, P<0.001] and to macrovascular complications in men (OR 1.95, P=0.04) and also a trend in women (OR 2.24, P=0.089). There was a positive association between metabolic abnormality and atherosclerosis (B=0.55, P<0.001). This study has found the prevalence of the MetS and the association with atherosclerotic complications in Taiwan. The SEM approach has demonstrated a positive correlation between metabolic abnormality and atherosclerosis and can be used to explore new risk factors for cardiovascular diseases.

The link between cardiac autonomic activity and sleep delta power is altered in men with sleep apnea-hypopnea syndrome

We hypothesize that sleep apnea-hypopnea alters interaction between cardiac vagal modulation and sleep delta EEG. Sleep apnea-hypopnea syndrome (SAHS) is related to cardiovascular complications in men. SAHS patients show higher sympathetic activity than normal subjects. In healthy men, non-rapid eye movement (NREM) sleep is associated with cardiac vagal influence, whereas rapid eye movement (REM) sleep is linked to cardiac sympathetic activity. Interaction between cardiac autonomic modulation and delta sleep EEG is not altered across a life span nor is the delay between appearances of modifications in both signals. Healthy controls, moderate SAHS, and severe SAHS patients were compared across the first three NREM-REM cycles. Spectral analysis was applied to ECG and EEG signals. High frequency (HF) and low frequency (LF) of heart rate variability (HRV), ratio of LF/HF, and normalized (nu) delta power were obtained. A coherency analysis between HF(nu) and delta was performed, as well as a correlation analysis between obstructive apnea index (AI) or hypopnea index (HI) and gain, coherence, or phase shift. HRV components were similar between groups. In each group, HF(nu) was larger during NREM, while LF(nu) predominated across REM and wake stages. Coherence and gain between HF(nu) and delta decreased from controls to severe SAHS patients. In SAHS patients, the delay between modifications in HF(nu) and delta did not differ from zero. AI and HI correlated negatively with coherence, while HI correlated negatively with gain only. Apneas-hypopneas affect the link between cardiac sympathetic and vagal modulation and delta EEG demonstrated by the loss of cardiac autonomic activity fluctuations across shifts in sleep stages. Obstructive apneas and hypopneas alter the interaction between both signals differently.

Imaging Features of Fabry Disease

Our objective was to describe the various imaging patterns of Fabry disease, including cerebrovascular, renal, cardiac, and other organ involvement. Fabry disease, an X-linked inborn error of glycosphingolipid catabolism resulting from a deficient activity of the hydrolase alpha-galactosidase A, displays more complications in men than in heterozygous women. It is up to radiologists to evoke the diagnosis, help practitioners in treating patients early with enzyme replacement therapy, and monitor its efficacy.

Bisphosphonates for Treatment and Prevention of Bone Metastases

Bone metastases are a major cause of morbidity for men with prostate cancer. Complications of bone metastases include pain, fractures, and spinal cord compression. Although they appear osteoblastic by radiographic imaging, most bone metastases are characterized by excess osteoclast number and activity. In addition, pathologic osteoclast activation is associated with increased risk of skeletal complications. Zoledronic acid, a potent inhibitor of osteoclast activity, differentiation, and survival, decreases the risk of skeletal complications in men with androgen-independent prostate cancer and bone metastases. Other bisphosphonates, including pamidronate and clodronate, seem to be ineffective in this setting. The reduction in risk of skeletal complications with zoledronic acid must be weighed against potential adverse effects. Additional studies are needed to determine the optimal timing, schedule, and duration of treatment in men with bone metastases as well as the potential role of bisphosphonates in other settings including the prevention of bone metastases.