Concomitant Systemic Diseases Research Articles

Bullous pemphigoid in Dermatology Departments of Silesia in years 2001-2014

Summary Introduction. Bullous pemphigoid (BP) is the most common disease from a group of bullous dermatoses. It affects mostly elderly people and the relative risk of disease devel- opment in people at the age 90 is 300-fold higher than in individuals who are 60 years old. It is supposed, that 15-20% of patients with BP may have malignant internal tumor and skin lesions can even precede the recognition of malignancy. Aim. The aim of this retrospective study was to assess the occurrence of BP in relation to age of patients and concomitant systemic diseases, including neoplastic disorders. Further analysis gives a review of therapeutic options and the efficacy of these modalities. Material and methods. A study group comprised of 120 patients who were diagnosed with BP: 74 female and 46 male patients. The mean age of patient was 71.13 ± 11.8. Results. Co-existing of other disease was reported in 87.11% of patients and the his- tory towards neoplastic disorder (active or previously treated) was positive in 19.8% of patients. In therapy of the disease, the drug of choice was Methylprednisolone. Other ther- apeutic options were also glucocorticoids (Dexamethasone, Prednisone, Triamcinolone), immunosuppressive agents (Cyclophosphamide, Chlorambucil or Azathioprine), antibiot- ics (Erythromycin, Doxycycline, Ceftriaxone), niacin and Dapsone. Conclusions. Clinical presentation of BP is distinguished and the recognition of the disease should be always supplemented by diverse diagnostic tests towards potent and hidden tumor. Although, glucocorticoids have remained a first choice therapy with good effects, further studies are necessary to establish the efficacy of other therapeutic mo- dalities.

The Relationship of Serum S100B Levels with Infarction Size and Clinical Outcome in Acute Ischemic Stroke Patients.

S100B protein, which helps nerve development and differentiation, is produced by astrocytes and can be detected in peripheral circulation after brain damage. In this study, we aimed to investigate the relationship between the serum S100B protein level and the infarction volume and clinical outcome and also the early prognostic role of serum S100B protein in patients with ischemic stroke. Fifty patients admitted in the first 24-hour period of acute ischemic stroke were evaluated prospectively, and the findings were compared to those of the controls (n=26). S100B levels of the patients and neurological findings on days 1, 3, and 5 and their functional outcomes on the discharge day and at the first month were recorded by the same examiner. S100B levels were not affected by sex, age, or concomitant systemic diseases. The maximum levels of S100B were recorded on the 3rd day, and there was a correlation between infarct size and S100B levels. No correlation between the severity of stroke and S100B level was found. There was a poor correlation between the functional outcomes of the patients at the 1st month and S100B levels and on the 3rd day. The detection of high S100B levels in peripheral circulation after acute ischemic stroke and the correlations of S100B levels with infarct size (good) and disability (poor) imply that S100B protein may be used as a peripheral marker in acute ischemic stroke patients.

Achilles Tendon Infection Risks in Synthetic Augmentations-A Case Report

We report the case of a 53-year old man with a history of achilles tendon suture with the use of Ligastic® synthetic graft in 1991. Twenty years after, the patients, with no history of recent trauma or other concomitant local or systemic diseases, showed up to our Orthopaedic Department because of the onset of high fever, wound dehiscence at the site of the previous surgery along with spontaneous purulent discharge. Results of bacterial cultures showed the presence of Staphylococcus Aureus; after a few days of antibiotic treatment, the patient underwent a new surgical treatment in order to adequately counteract and remove the cause of infection. Surgical treatment showed a massive infection surrounding the reconstructed achilles tendon coming from the synthetic graft positioned inside the tendon itself. Removal of this augmentation led to an immediate improvement of systemic and local conditions with satisfactory recovery of function of the ankle.

Osteonecrosis of the jaw in a patient taking once-yearly infusion of zoledronic acid for osteopenia

Osteonecrosis of the jaw (ONJ) is an adverse effect of nitrogen-containing bisphosphonates. Advancing age, intravenous administration of zoledronic acid (ZOL), history of dento-alveolar surgery, and concomitant systemic diseases such as diabetes are known as risk factors for developing ONJ. However, despite numerous studies, the exact pathophysiology remains unclear and management strategies are largely anecdotal. Once-yearly intravenously administered 5 mg ZOL was approved by the US Food and Drug Administration in 2007 for the treatment of osteoporosis and its efficacy with 3 year-regimen had been recently proven in preventing new clinical fracture. Although occurrences of ONJ have been reported to be rare with this drug administration, available data is very limited and long-term outcomes are lacking. We present a case of ONJ identified in an osteopenic patient with an intermittent but long standing sore mouth related to exposed mandibular bone. Once-yearly infusion of zoledronic acid used in the treatment of osteopenia may contribute to the spontaneous development of ONJ, especially in those presenting with multiple comorbidity factors. This report suggests the importance of health care professionals keeping abreast of new developments in this area and providing appropriate information to their patients.

Systemic Autoantibodies in Neuromyelitis Optica: Is There Any Impact on Clinical Outcome? (P07.069)

Objective: To characterize the SS/SLE autoantibody profile and its impact on clinical features and disease severity of NMO/NMOSD patients. Background Neuromyelitis optica (NMO) and its spectrum disorders (NMOSD) have been associated with systemic inflammatory disorders, in particular Sjogren9s syndrome (SS) and systemic lupus erythromatosus (SLE). It is presently unknown if concomitant SS/SLE or systemic autoantibody seropositivity confers a worse prognosis in NMO/NMOSD patients. Design/Methods: We retrospectively reviewed patients who fulfilled diagnosis for NMO/NMOSD and underwent SS/SLE autoantibody evaluations, and compared autoantibody seropositivity to clinical characteristics and disease severity. Results: Twenty-nine patients (25 female, 4 male; 18 NMO, 11 NMOSD) were analysed. Mean disease duration was 84 months (range: 9 - 233 months). Overall systemic autoantibody seropositivity was high: anti-nuclear antibodies (48.3% [14/29]), anti-double stranded DNA (anti-dsDNA) (22.2% [6/27]) and anti-Ro and/or anti-La (21.4% [6/28]). Of those who tested for NMO-IgG, 83.3% (20/24) were positive; 55% (11/20) of these patients also had SS and/or SLE autoantibodies. All eleven patients with concomitant NMO-IgG and SS/SLE autoantibody seropositivity were female. Mean annualized relapse rate was not significantly different between systemic autoantibody-positive and autoantibody-negative patients (0.51 vs 0.91 relapse/year, p =0.089). Median Expanded Disability Status Scale (EDSS) score was similar in NMO/NMOSD patients with or without concomitant SS/SLE autoantibody positivity (3.0 vs 3.0, p=0.579). Similarly, there were no differences in ambulation (p=0.238), visual (p=0.702) and bladder/bowel dysfunction (p=0.192) scores in NMO/NMOSD patients with or without concomitant SS/SLE autoantibody positivity. Conclusions: Concomitant systemic inflammatory diseases such as SS and SLE and systemic autoantibody positivity in NMO/NMOSD are common and not mutually exclusive. Concomitant systemic autoantibody seropositivity does not translate to a worse clinical outcome in NMO/NMOSD patients, hence neurological prognosis appears to be exclusively mediated by NMO/NMOSD. Disclosure: Dr. See has nothing to disclose. Dr. Peh has nothing to disclose. Dr. Tan has received personal compensation for activities with Biogen Idec and Merck Serono as a consultant and/or speaker.

Radical cystectomy in patients over 70 years of age: impact of comorbidity on perioperative morbidity and mortality

To analyze the impact of comorbidity on the perioperative complication rate after radical cystectomy in patients over 70 year of age. Between April 1993 and August 2010, 830 radical cystectomies were performed at our institution. Of the 830 patients, 365 patients (44.0%) were ≥70-year-old (median age 74 year). This group of elderly patients was compared with a younger group of 465 patients (56.0% of the whole cohort) aged under 70 year (median 63 year). The group of elderly patients had a significantly higher prevalence of concomitant diseases e.g., hypertension (57.3% vs. 38.5%), coronary heart disease (27.1% vs. 14.8%) and diabetes (25.5% vs. 14.6%). Perioperative complications were significantly more frequent in the elderly group: 31.0% versus 21.5% overall complication rate, P = 0.002. Mortality rate was almost similar in both groups: 0.6% (elderly) versus 0.5% (younger). Within the elderly group, the overall complication rate was significantly higher in patients with an ASA score ≥3 (37.0%) than in patients with an ASA score ≤2 (25.0%) (P < 0.02). Multivariate logistic regression analysis was used to identify that chronic obstructive lung disease, ASA score and age were independent predictive factors for perioperative complications. Elderly patients have a higher prevalence of concomitant systemic diseases. Some concomitant diseases can affect surgical outcome after radical cystectomy, particularly the frequency and character of perioperative complications. It is therefore of paramount importance to conduct a comorbidity assessment and preoperative conditioning of each patient, with a special focus on the patient's individual risk factors and age.

Prognostic prediction in patients with hip fracture: risk factors predicting difficulties with discharge to own home

BackgroundLittle is known about risk factors that may prevent hip fracture patients from being discharged to home. The present study was developed to investigate possible prognostic factors.Materials and methodsWe studied 345 patients with hip fracture treated at our hospital since 1997, who were living at home before the injury. There were 84 males and 261 females. Mean age at injury was 81.6 years. Fracture type was femoral neck fracture in 152 patients and trochanteric fracture in 193. Patients were divided into those who were discharged to home (home discharge group) and those who were discharged to rehabilitation facilities or died in hospital (non-home discharge group). Gender, age at admission, fracture type, and other factors were investigated. Multivariate analysis was conducted on these variables for the home discharge and non-home discharge groups.ResultsThere were 202 patients (58.6%) in the home discharge group and 143 patients (41.4%) in the non-home discharge group. The factors significantly associated with not achieving the goal of discharge to home were age 85 years or above [odds ratio (OR) = 1.79, P = 0.0204], chronic systemic diseases (OR = 1.77, p = 0.0225), dementia (OR = 3.17, P < 0.0001), and walking disability before injury (OR = 5.70, P = 0.0328).ConclusionsIn elderly patients with hip fracture, the risk factors that predict difficulties with discharge to home include age at admission, concomitant chronic systemic diseases and dementia, and walking disability before injury.

Hypertrophic cardiomyopathy patients have a steep left ventricle to aortic root angle compared to normal as demonstrated on 3-D Tomographic Imaging: a case-control study

Hypertrophic cardiomyopathy (HCM) is characterized by disproportionate left ventricular (LV) hypertrophy, which cannot be attributed to other concomitant cardiac or systemic diseases. HCM can result in accelerated cardiac remodelling; thus affecting the pathophysiology of the disease. Because of an increased utilization of cardiac magnetic resonance (CMR) in the diagnosis and management of HCM, we have observed that a subgroup of HCM patients had a steep LV to aortic root angle (LVARA, Figure ​Figure11). Open in a separate window Figure 1 Quantification of LVARA using the 5 chamber view.

German register for glaucoma patients with dry eye. I. Basic outcome with respect to dry eye

The purpose of this register was to determine the links between glaucoma, age, concomitant disease, medication, and dry eye in a large group of glaucoma patients. A total of 20,506 patients from 900 centers across Germany were included. The first 30 consecutive glaucoma patients at each center were recruited. Epidemiological data as well as information on glaucoma, medication, concomitant diseases, dry eye, and local symptoms were elicited by means of a questionnaire. We analyzed primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and pigmentary glaucoma (PDG). According to the register data, more women develop dry eye and glaucoma than men (56.9 vs. 45.7%). The most frequent concomitant systemic diseases were hypertension (48.1%), diabetes mellitus (22.5%), and dry mouth, nose, and skin (11.3%). As expected, the highest incidence of dry eye was found in those patients with dry mouth, nose, and skin. Dry eye occurred with dissimilar frequencies in association with the various glaucoma types: PEX>POAG>PDG. The incidence of dry eye increases with age. The gender difference in the occurrence of dry eye becomes apparent from the age of 50. Dry eye occurred more frequently when three or more antiglaucoma drugs were used and increased with the duration of glaucoma disease. We publish the first results from the German Glaucoma and Dry Eye Register. We found that the occurrence of dry eye is linked to several factors. Thus, the type of glaucoma has an impact on the risk of dry eye. The quantity of eye drops applied also plays a role in the development of the dry eye syndrome if more than three medications are used. While POAG is usually treated with one drug, PEX and PDG tend to be treated with multiple drugs. The gender difference in the occurrence of dry eye becomes apparent from the age 50 years. Because of the vicious circle of dry eye, antiglaucoma eye drops containing benzalkonium chloride compromises patient compliance. The results of the register are therefore of key relevance for the care of glaucoma patients.

Erectile dysfunction and Peyronie’s disease in patient with retroperitoenal fibrosis

The aim of this study is to determine the sexual dysfunction in patient with retroperitoneal fibrosis (RPF) and also we explored probability of Peyronie's disease (PD) in this patient group and to compare this with the controls. Ten of 17 male RPF patients formed the basis of this study. Patient's age, concomitant diseases were recorded. The diagnosis of PD was based on a palpable penile plaque or acquired penile curvature. Age-matched 88 patients who were admitted to our outpatient clinic with elevated PSA level served as the control group. All patients were asked to complete the IIEF-5 questionnaire. The severity of the erectile dysfunction (ED) was classified into four categories: severe (5-7), moderate (8-16), mild (17-21), and no ED (22-25). Concomitant systemic diseases were recorded. Statistical analyses were done by the Fisher's exact test and an unpaired-sample t-test. Patients with severe ED or no sexual intercourse in the study group and the control group during the study period were found to be 7 and 14, respectively. The median IIEF-5 score in RPF patients and the control group was 9.8 (min: 5 to max: 23) and 19 (min: 5 to max: 25), respectively. The differences between groups were statistically significant (P = 0.002). In particular, ED was reported in eight RPF patients (80%) which was severe in six (60%) and moderate in two (20%). ED was reported in 45 patients in the control group (51%) which was severe in 14 (15.9%), mild in 25 (28.4%), and moderate in six (6.8%). Patients with RPF had a significant tendency for severe ED compared with the control group (P = 0.0042). Two patients in the RPF group (20%) and one patient in the control group (1.1%) were found to have a penile plaque (P = 0.0279). Relative risk for developing a penile plague was found to be 0.8 in RPF. RPF patients are found to be more prone to developing ED. Penile plaque formation was identified in RPF patients, which may be presumed to relate to the pathological changes of the RPF process, but it remains unclear that these patients demonstrate a higher incidence of plaque formation than the normal population.

Structure–function relationship in ocular hypertension and glaucoma: interindividual and interocular analysis by OCT and pattern ERG

Pattern electroretinogram (PERG) and optical coherence tomography (OCT) represent objective probes to investigate respectively the function of retinal ganglion cells and their structure as retinal nerve fiber layer (RNFL) thickness. We examined interindividual (II) correlations of PERG amplitude and RNFL thickness, as well as correlations between interocular (IO) differences in both measures, in ocular hypertension (OHT) and early glaucoma (EG) patients. Thirty-one OHT, 34 EG (mean deviation: -1 to -6 dB) and 16 age-matched controls were examined in both eyes. Participants had clear optical media, no or moderate refractive errors and no concomitant ocular or systemic diseases. PERGs were elicited by counterphased (16.28 reversals/second) gratings (1.6 cycles/degree spatial frequency). The Fourier isolated 2nd harmonic PERG amplitude and phase were measured. RNFL thickness was quantified by means of OCT Stratus according to a standard protocol. Average, superior and inferior RNFL thicknesses were considered. Mean PERG amplitude was decreased (p < 0.01) in both OHT and EG patients compared to controls. Mean RNFL thicknesses were reduced (p < 0.01) in EG patients compared to both OHT and controls. In OHT patients, PERG amplitude did not correlate significantly with RNFL thickness in both II and IO analysis. In EG patients, PERG amplitude was positively correlated with RNFL thickness in both II (p < 0.005) and IO (p < 0.001) analysis. The slope of the correlation predicted that PERG losses exceeded systematically RNFL losses when the latter were between 0 and -0.25 log units. Both II and IO analyses revealed a lack of structure-function relationship in OHT, suggesting that, at this disease stage, PERG losses appear to affect primarily retinal/optic nerve head function. In EG they reflect both dysfunction and RNFL loss.

Alopecia areata and autoimmunity: a clinical study.

Alopecia areata (AA) frequently occur in association with other autoimmune diseases such as thyroid disorders, anemias and other skin disorders with autoimmune etiology. Despite numerous studies related to individual disease associations in alopecia areata, there is paucity of literature regarding comprehensive studies on concomitant cutaneous and systemic diseases. The present study has been designed to determine if there is a significant association between alopecia areata and other autoimmune diseases. This study covers 71 patients with the diagnosis of alopecia areata as the case group and 71 patients with no evidence of alopecia areata as the control group. Among the cutaneous diseases associated with AA, atopic dermatitis (AD) showed maximum frequency with an O/E ratio of 2.5, which indicates that it is two to three times more common in patients with alopecia areata. In our study, thyroid disorders showed the highest frequency with on O/E ratio of 3.2 and a P value of 0.01, which is statistically highly significant. Among the thyroid disorders, hypothyroidism was the most frequent association (14.1%) in our study. Since systemic involvement is not infrequent in patients with alopecia areata, it is imperative to screen these patients for associated disorders, particularly atopy, thyroid diseases, anemias and other autoimmune disorders, especially if alopecia areata is chronic, recurrent and extensive.

Abstracts

Abstract B. Aktekin , A. Unal , B. Ekmekci Usta , and A. Aralasmak Department of Neurology, Akdeniz University Medical Faculty, Antalya, TurkeyE-mail berrina@akdeniz.edu.tr Background: In recent years, many authors have preferred a revision of the strict definition of status epilepticus (SE) and proposed that any seizure exceeding 5–10 min should be considered as SE. SE is typically classified convulsive and nonconvulsive, based on if rhythmic jerking of the extremities is observed or not. However, further classification of nonconvulsive status epilepticus (NCSE) is still a matter of discussion. NCSE consists of very different syndromes, the diagnosis is difficult and requires electroencephalographic (EEG) confirmation, there is no widely accepted classification and epidemiologic, therapeutic and prognostic studies are lacking. Purpose: To describe electroclinical spectrum of elderly patients with NCSE who underwent video-EEG monitoring for diagnostic purposes. Method: Prospective case series studies of eight representative elderly NCSE patients (aged 69–77 year). Results: All patients had shown electroclinical SE pattern on video-EEG recordings. None of them had been given i.v. benzodiazepines because of concomitant systemic diseases. In the follow-up period, two out of eight patients developed mesial temporal sclerosis, one patient passed away, three patients had shown complete recovery with total seizure freedom with proper antiepileptic medication, and two of them needed additional antiepileptic drugs for complete seizure control. Conclusion: NCSE can occur at any age and the clinical features may vary widely. In our group, almost all of them had different underlying etiologies and needed different treatment regimens and different prognosis. The EEG is very useful tool for diagnosis and helps to evaluate brain dysfunction in acute waxing and waning confusional states associated with agitation, bizarre behavior, staring, mutism, or subtle myoclonus. The prognosis of NCSE is usually depends on the underlying etiology rather than the type of EEG discharges or seizure types. NCSE is an underdiagnosed medical emergency. In order to make correct diagnosis and treatment, high level of suspicion is necessary.

Retinopathy in patients with sickle cell trait

Background Sickle hemoglobinopathies are among the most prevalent genetic disorders in the United States. Sickle cell trait (hemoglobin AS) is the most common genotype and has traditionally been considered a benign condition. Systemic and ocular complications are seen infrequently in patients with sickle cell trait. In the presence of concomitant systemic diseases or trauma, however, marked retinopathy can occur. The presence of retinopathy in patients with sickle cell trait necessitates a comprehensive medical workup, including serologic testing to rule out systemic conditions. Case reports Two cases are presented. The patient in case 1 is a 44-year-old black man with a positive history of sickle cell trait and uncontrolled hypertension. Best-corrected visual acuities (BCVAs) were 20/20 in the right eye (O.D.) and the left eye (O.S.). Retinal evaluation found vitreo-retinal fibrotic scaffolding and “sea-fan” neovascularization. The patient in case 2 is a 45-year-old black woman who presented after a stroke 1-month prior. Her medical history was positive for hypertension, hypercholesterolemia, a recently diagnosed aneurismal dilation of the ascending thoracic aorta, and sickle cell trait. BCVAs were 20/20 O.D., and 20/20 O.S. A single dot hemorrhage was evident O.D., and an inferior-temporal branch retinal artery occlusion with an adjacent area of sea-fan neovascularization was observed O.S. Conclusion Sickle cell disease remains a major public health concern because of its associated significant morbidity and mortality. Sickle cell trait is considered benign in a healthy patient. However, under conditions of stress, concomitant systemic diseases, or trauma leading to hypoxia, sickle cell trait can become a pathologic risk factor.

Long-Term Outcome in Children with Chronic Hepatitis B: A 24-Year Observation Period

Chronic hepatitis B seems to manifest as mild disease in children and young adults. However, data regarding the long-term course of hepatitis B in untreated and interferon-treated children are still scarce. This study investigates the long-term outcome of disease in a large series of untreated and treated children with hepatitis B virus (HBV) infection. Clinical, biochemical, virological, and histological features were evaluated in children (age range, 2-18 years) with chronic HBV infection who did not have concomitant chronic systemic diseases other than HBV infection and who were admitted to the liver unit in the Department of Pediatrics at University "Frederico II" (Naples, Italy) during the period 1981-2005. One hundred eight consecutive patients observed for up to 24 years were studied. During the observation period, 67 children remained untreated, and 41 were treated with interferon-alpha. After a median period of observation of 12.1 years (range, 5-23 years), hepatitis B early antigen loss and serum HBV DNA clearance occurred in 43 untreated patients (69.3%) who were hepatitis B early antigen positive at study entry and in 33 treated children (80%; the P value is not statistically significant). In addition, 6 untreated patients (9.7%) and 4 treated patients (9.7%) became anti-HBs [corrected] positive at the end of the follow-up period. Histological assessment, evaluated for 57 children, showed mild-to-moderate disease in 91.2% of cases of HBV infection. No patient developed end-stage liver disease or hepatocellular carcinoma. Children with chronic HBV infection are symptom free, with morphologically mild liver disease. Considering that the overall long-term outcomes did not differ between treated and untreated patients, the real impact of therapy on the long-term course of HBV infection remains to be established. Additional studies are needed to confirm our conclusions.

Erectile Function in Prostate Cancer–Free Patients Who Underwent Prostate Saturation Biopsy

ObjectiveTo evaluate the erectile function following transrectal ultrasound–guided saturation biopsies of the prostate. Materials and methodsOf the 150 patients included in the study, those with persistently elevated prostate-specific antigen (PSA) level underwent saturation biopsy. A median of 22-core (minimum: 20; maximum: 30) prostate saturation biopsies was taken. Patients were evaluated for erectile function prebiopsy with the 5-item version of the International Index of Erectile Function (IIEF-5) and the IIEF-Erectile Function (IIEF-EF) domain scoring. Concomitant systemic diseases and medications that would interfere with erectile function were recorded. Eighty-eight patients reported to be prostate cancer–free underwent further evaluation with the IIEF-5 questionnaire at 1 and 6 mo postbiopsy. Severity of erectile dysfunction (ED) was classified into four categories. ResultsThe patients’ ages, serum PSA levels, prostate volumes, and number of cores showed no significant correlation with changes in ED scores after the prostate saturation biopsies. According to the IIEF-5, for patients who were previously potent and found to be free of prostate cancer, the ED rates were 11.6% at the first month, and no ED was reported at the sixth month of evaluation. IIEF-5 and IIEF-EF domain scores displayed a statistically significant difference between baseline and first-month scores, but not between baseline and sixth-month scores, which returned to baseline values. ConclusionsAlthough saturation biopsy of the prostate is a safe procedure on the basis of erectile function, the minimal risk of temporary postbiopsy ED should be discussed with previously potent patients.

Can prostate biopsies affect erectile function?

The impact of transrectal ultrasound (TRUS)-guided prostate biopsies on erectile function was prospectively studied. Forty-six men (median age: 67.51 years) who underwent TRUS-guided prostate biopsies completed the International Index of Erectile Function (IIEF)-5 questionnaire at the day of the biopsy, 1 and 3 months later. Erectile dysfunction (ED) severity was classified into five categories. Concomitant ED-related systemic diseases and/or medications that could affect erectile function were also recorded. The paired t-test was used for statistical analysis. The median IIEF-5 score was 15.91 prior to biopsies, while 1 and 3 months after, the median IIEF-5 score was 14.33 and 14.81 respectively (P > 0.05). Prior to prostate biopsies, ED was reported by 38 patients (82.60%): mild ED in 39.13%, mild to moderate in 19.56%, moderate in 15.21% and severe ED in 8.69%. Concomitant ED-related systemic diseases and/or medications were recorded in 28 patients (60.86%). One month after, ED was revealed in 42 patients (91.30%): mild ED in 26.08%, mild to moderate in 30.43%, moderate in 19.56%, and severe ED in 15.21%. Three months post-biopsy, ED was reported by 41 patients (89.13): mild ED in 21.73%, mild to moderate in 28.26%, moderate in 21.73%, and severe ED in 17.39%. Overall, three and two patients (6.52% and 4.34%) had prostate biopsy attributed ED (i.e. without concomitant ED-related disease or medication) 1 and 3 months after prostate biopsies. TRUS-guided prostate biopsies did not induce ED in a statistically significant manner. Evaluating potency at referral for TRUS-guided prostate biopsies is advisable.

Bilateral Lens Subluxation Associated with Atopic Eczema

Ectopia lentis remains a therapeutic challenge for ophthalmologists. It classically presents with a preceding history of blunt or penetrating ocular trauma, or it may be associated with other ocular disorders such as congenital glaucoma and aniridia, or concomitant hereditary systemic diseases such as Marfan syndrome and homocystinuria. Case report. The authors describe a previously unreported mechanism of ocular trauma associated with continuous eye rubbing, resulting in bilateral recurrent subluxation of both intraocular lens and crystalline lens. It is useful for the ophthalmologist to be aware of this uncommon cause of ectopia lentis, since early advice and appropriate medical or surgical intervention may prevent more severe, sight-threatening complications.

Anesthetic Management of Endovascular Stent Graft Placement for Thoracic Aortic Diseases: A case report

Endovascular aortic repair is a new alternative to conventional surgical repair of aortic pathology. It is a less invasive technique and gives less hemodynamic stress to the patients who may have concomitant systemic diseases, compared with open aortic reconstruction. We report 2 cases of patients with thoracic aortic diseases, who underwent endovascular stent graft placement under general anesthesia. We also include a review of the literature about anesthetic management of endovascular aortic repair and present our opinions about the need to choose a suitable anesthetic technique for each patient, the method to recognize and handle the possible complications and hemodynamic changes to which we have to pay attention during procedures.

Gabapentina en el tratamiento de las epilepsias del anciano

Epilepsy is the third most common neurological disease in the elderly. Diagnosis of epilepsy in this age is increasing because more people are reaching older age and physician awareness about this disorder is higher than in the past. Seizures are suspected in patients with episodic impairment of consciousness and neurological function, but in addition, seizures can be the cause of fluctuating cognitive derangement and nocturnal episodes of neurological dysfunction.The etiological spectrum of epilepsy in the elderly is different than in younger adults because of a higher prevalence of cerebrovascular disease and degenerative disorders of the central nervous system. The selection and dosage of antiepileptic drugs requires proper attention to special pharmacokinetic and pharmacodynamic situations that are common in older individuals. Changes that occur with advanced age are responsible of distinct pharmacokinetics, decreased tolerability to antiepileptic drugs, concomitant systemic diseases. In addition poor compliance and polypharmacy can complicate therapy.Gabapentin has favourable pharmacokinetic properties: lack of hepatic metabolism, no protein binding, and easy to calculate regimen for patients with renal failure. For these reasons is a good candidate drug for treatment of seizures in the elderly.