Injection Of Verapamil Research Articles

P-glycoprotein-mediated herb-drug interaction evaluation between Tenacissoside G and paclitaxel.

P-glycoprotein (P-gp)-mediated herb-drug interactions (HDIs) may impact drug efficacy and safety. Tenacissoside G (Tsd-G), a major active component of Marsdenia tenacissima, exhibits anticancer activity. To analyze the effect of Tsd-G on the pharmacokinetics of paclitaxel (PTX), researchers selected 30 Sprague-Dawley (SD) rats, randomized into a solvent control group, a verapamil positive control group, and 20, 40, and 60 mg/kg Tsd-G groups. After seven consecutive days of intraperitoneal injection of verapamil or Tsd-G, a single dose of 6 mg/kg PTX was injected intravenously. Plasma samples were collected at different time points, and proteins were precipitated using a methanol-acetonitrile solution. An ultrahigh-performance liquid chromatography-tandem mass spectrometry method was developed, with docetaxel as an internal standard, and quantified using positive ion multiple reaction monitoring (MRM) mode. This analytical method's specificity, accuracy, precision, recovery, matrix effect, and sample stability meet the requirements for biological sample determination. After Tsd-G administration in rats, the mean residence time of PTX was significantly prolonged. And Tsd-G can stably bind to P-gp by forming hydrogen bonds and inhibiting the expression of P-gp in rat liver. Although the metabolites of PTX were not detected in this study, the above results still indicate the existence of HDIs between Tsd-G and PTX, and P-gp may be the main target to mediate HDIs.

Multimodal treatments based on Tadalafil during acute phase of Peyronie's disease: experience at two referral academic centers.

The purpose of this study is to identify the clinical outcomes of patients during acute phase of Peyronie's disease (PD) treated with daily Tadalafil 5mg associated with non-surgical treatments such as intra-plaque verapamil injections (IVI), vacuum erection devices (VED) or extra corporeal shockwave therapy (ESWT). 445 patients with PD in acute stage were treated as it follows: Group 1(G1) 117 men with only Tadalafil 5mg once a day for 3months; Group 2(G2) 106 men with IVI plus Tadalafil 5mg for a period of 12weeks; Group 3(G3) 124 men that received ESWT for 6weeks plus Tadalafil with the same protocol of G1; Group 4(G4) 98 men with VED plus Tadalafil 5mg for 3months. There were assessed at baseline and follow-up: Erectile dysfunction (ED), presence and severity of painful erections, penile plaque size and penile curvature degree. The results were evaluated at baseline and 3,6,12months. Not statistically significant differences emerged between the two groups at baseline, except for higher presence of patients with ED in in G3(7.4%) vs other groups(p < 0.001). Three months after the treatment in G3 men had a significant reduction of penile curvature degrees after 1year by treatments, whereas pain in an erection or during intercourse was resolved completely in 75% of the patients. Our study highlights that multimodal therapy has beneficial long-term effects not only in the decrease of ED symptoms, but also in the relief of the penile curvature and the quality of life.

Verapamil and tangeretin enhances the M1 macrophages to M2 type in lipopolysaccharide-treated mice and inhibits the P-glycoprotein expression by downregulating STAT1/STAT3 and upregulating SOCS3

LPS induced sepsis is a complex process involving various immune cells and signaling molecules. Dysregulation of macrophage polarization and ROS production contributed to the pathogenesis of sepsis. PGP is a transmembrane transporter responsible for the efflux of a number of drugs and also expressed in murine macrophages. Natural products have been shown to decrease inflammation and expression of efflux transporters. However, no treatment is currently available to treat LPS induced sepsis. Verapamil and Tangeretin also reported to attenuate lipopolysaccharide-induced inflammation. However, the effects of verapamil or tangeretin on lipopolysaccharide (LPS)-induced sepsis and its detailed anti-inflammatory mechanism have not been reported. Here, we have determined that verapamil and tangeretin protects against LPS-induced sepsis by suppressing M1 macrophages populations and also through the inhibition of P-glycoprotein expression via downregulating STAT1/STAT3 and upregulating SOCS3 expression in macrophages. An hour before LPS (10 mg/kg) was administered; mice were given intraperitoneal injections of either verapamil (5 mg/kg) or tangeretin (5 mg/kg). The peritoneal macrophages from different experimental groups of mice were isolated. Hepatic, pulmonary and splenic morphometric analyses revealed that verapamil and tangeretin decreased the infiltration of neutrophils into the tissues. Verapamil and tangeritin also enhanced the activity of SOD, CAT, GRX and GSH level in all the tissues tested. verapamil or tangeretin pre-treated mice shifted M1 macrophages to M2 type possibly through the inhibition of P-glycoprotein expression via downregulating STAT1/STAT3 and upregulating SOCS3 expression. Hence, both these drugs have shown protective effects in sepsis via suppressing iNOS, COX-2, oxidative stress and NF-κB signaling in macrophages. Therefore, in our study we can summarize that mice were treated with either Vera or Tan before LPS administration cause an elevated IL-10 by the macrophages which enhances the SOCS3 expression, and thereby able to limits STAT1/STAT3 inter-conversion in the macrophages. As a result, NF-κB activity is also getting down regulated and ultimately mitigating the adverse effect of inflammation caused by LPS in resident macrophages. Whether verapamil or tangeretin offers such protection possibly through the inhibition of P-glycoprotein expression in macrophages needs clarification with the bio availability of these drugs under PGP inhibited conditions is a limitation of this study.

Intralesional injection of hyaluronic acid compared with verapamil in acute phase of Peyronie’s disease: A prospective randomized clinical trial

ABSTRACT Purpose The aim of this work was to analyze and contrast the effectiveness and safety of intralesional HA in the acute stage of PD with that of verapamil injection. Methods In this prospective, randomized clinical trial, 42 PD-affected, sexually active men between the ages of >18 and 70 participated. Two groups of patients were recruited; group A obtained weekly intralesional treatment with HA for 12 weeks, whereas group B obtained weekly intralesional therapy with verapamil for 12 weeks. Physical examinations and Duplex Doppler ultrasound were performed on all patients. Results The penile curvature was significantly decreased at 12 weeks after therapy in contrast to baseline in group A (34.1 ± 6.77° vs. 24.7 ± 9.72°, p = 0.005), and was significantly decreased at 12 weeks after therapy compared to baseline in group B (36.2 ± 7.43° vs. 30.8 ± 8.63 °, p = 0.047). The decrease in penile curvature at 12 weeks after therapy was noticeably better in group A in contrast to group B (24.7 ± 9.72° vs. 30.8 ± 8.63°, p = 0.038). Conclusion HA is emerging as a valid choice for the treatment of PD in terms of resolution of the acute phase of the disease, and it is plausible to posit that the use of HA may contribute to the stabilization of the disease and decrease the need for the subsequent choice of a possible surgical strategy, with the ability to reduce penile pain and have a stronger impact on penile curvature and patient satisfaction.

Abstract 091: Intraventricular milrinone for management of vasospasm following aneurysmal subarachnoid hemorrhage

Introduction Aneurysmal subarachnoid hemorrhage (aSAH) accounts for about 10% of hemorrhagic strokes [1] and holds a high mortality and morbidity rate. [2, 3] Vasospasm is one of the more devastating complications of aSAH. Novel imaging modalities have drastically improved our ability in prompt detection of vasospasm in these patients. However, clinical management of this complication is still debated among experts. [4] Systemic cerebral vasodilators are widely used in aSAH patients, but guidelines for interventional and rescue procedures are not well developed. [5] Methods Here, we report a case of severe vasospasm following aSAH that was successfully treated with intraventricular injection of milrinone through external ventricular drain (EVD) in conjunction to standard therapy. Results A 70‐year‐old man with a history of diabetes, hypertension, and hyperlipidemia was brought to the emergency department after he was found down and unresponsive. He was intubated by EMS on route. Head CT on arrival showed a diffuse subarachnoid hemorrhage, more prominent in the posterior fossa, and grade IV on the modified Fisher scale. An initial DSA showed a ruptured aneurysm in the second segment of the right posterior inferior cerebellar artery, second segment. A right frontal EVD was placed on the second day. Hemodynamic augmentation was achieved with intravenous and intraventricular milrinone. Cerebral arterial patency was evaluated with daily transcranial doppler (TCD). The patient did not show any evidence of vasospasm until day 9 where TCD revealed severe vasospasm in the basilar and bilateral vertebral arteries, as well as mild vasospasm of anterior and middle cerebral arteries. Intraventricular milrinone was injected into the EVD in from day 9 to day 12. Using sterile technique, 4 mL of CSF was removed followed by the injection of 0.87mg (2mL) of milrinone into the EVD via a three way stop cock. EVD was then flushed with 2mL of preservative‐free saline and clamped for 1 hour. This procedure effectively improved vasospasm on serial TCDs and also DSAs (Figure1). The patient underwent several DSA’s on days 10, 14, 19, 20, and 21 with targeted intraarterial milrinone and verapamil injections. His final TCD showed only mild middle cerebral artery and moderate basilar artery vasospasm. At that point, no more intervention was deemed necessary. A ventriculoperitoneal shunt was also placed. CT scan before discharge showed mild improvement in ventricular size and stable SAH blood products. The course of hospitalization was complicated by hyponatremia, atrial fibrillation, and respiratory failure with inability to wean off ventilator, resulting in tracheostomy and gastrostomy tube placement. The patient was discharged in stable condition on day 30 to a rehabilitation center. Conclusion Intraventricular milrinone in addition to standard therapy can be an effective method in treatment of severe vasospasm in aSAH patients.

Our Experience at Tertiary Medical College-Intralesional Injection of Triamcinolone Acetonide Versus Injection Verapamil Following Keloidectomy with Fillet Flap in Auricular Keloids.

Keloid, which forms as an excessive tissue response to trauma to the skin, is a benign, hyperproliferative, recurrent growth of dermal collagen without a quiescent or regressive period throughout the process of wound healing. The aim of this study was to evaluate patient satisfaction with treatment and to compare the efficacy of intralesional injection of triamcinolone acetonide against verapamil after keloidectomy with fillet flap in auricular keloids. Our study was Duration based prospective observational study with a Duration of two years from June 2021 till May 2023 with study population inclusive of 50 patients aged between 20 and 70years having recurrent keloid(s) over the pinna of any size or site. Keloidectomy with fillet flap and intralesional injection of trimcinolone acetonide was performed on 25 patients (30 keloids) in Group A, and keloidectomy with fillet flap and intralesional injection of verapamil was performed on 25 patients (30 keloids) in Group B. With a recurrence rate of 27%, eight keloids in Group A patients had an early recurrence three months following surgery. At nine months, nine more mixed-type cases with a 30% recurrence rate resurfaced. Recurrence seen in eight keloids out of 28 showed a 28.57% recurrence rate 12months following surgery. Three people in Group B with three sessile keloids experienced an early recurrence at three months after surgery, with a recurrence rate of 10%. At nine months, four more cases of mixed kind returned, with a recurrence rate of 13%. A recurrence rate of 14.28% was found in 4 of 28 keloids at 12months postoperatively. The Patient and ObserverScar Assesment Scale scores (POSAS scores) were consistently higher than Beausang scores at 1year, indicating high patient satisfaction compared to physician assessment in both groups A and B. A keloid recurrence-free interval of 11.36months was obtained by the Kaplan-Meier survival test (p < 0.05) in group A. Keloid recurrence-free interval of 10.98months was evaluated by the Kaplan-Meier survival test (p < 0.05) in group B. Among Keloidectomy with fillet flap surgery with intralesional injection of triamcinolone acetonide (group A) and keloidectomy with fillet surgery with intralesional injection of verapamil (group B), at each follow-up the success rate of group B was higher than group A indicating better trend of success in this group in terms of both absence of recurrence and absence of complications without statistically significant difference between them which shown both procedures more or less similar.

Effects of Verapamil on the Reduction of Radial Artery Thrombosis after Coronary Angiography: A Randomized Clinical Trial.

The trans-radial approach significantly reduces access bleeding and underlying vascular complications and is associated with lower health care costs than the transfemoral approach. One of the most common complications, however, is radial artery occlusion (RAO). This study investigates the effects of verapamil on radial artery thrombosis in patients referred to Taleghani Hospital in Tehran between 2020 and 2021. Patients were randomized into 2 groups: the first group received verapamil, nitroglycerin, and heparin and the second group nitroglycerin and heparin. To randomly assign 100 cases to the 2 experimental and control groups, we first formed a framework for sampling 100 people (from 1 to 100); then, based on the table of random numbers, we assigned the first 50 numbers to the experimental group and the remainder to the control group. The 2 groups were compared for radial artery thrombosis. This study evaluated 100 candidates for coronary angiography in 2 groups of 50 with and without verapamil. The mean age was 58.6±11.2 years in the group with verapamil and 58.1±12.7 years in the group without verapamil (P=0.84). The difference between the 2 groups in terms of heart failure was statistically significant (P<0.028). The prevalence of clinical thrombosis was 2.0% in the group with verapamil and 22.0% in the group without verapamil (P<0.004). The prevalence of ultrasound-confirmed thrombosis was 4.0% in the group with verapamil and 36.0% in the group without verapamil (P<0.001). Intra-arterial injection of verapamil added to heparin and nitroglycerine during trans-radial angiography could significantly reduce RAO.

Surgical treatment of intracranial aneurysms in acute period of hemorrhage in Hunt-Hess grade IV-V patients at Burdenko Neurosurgical Center between 2006 and 2020

Management of patients in acute period of aneurysmal subarachnoid hemorrhage Hunt-Hess grade IV-V is still a complex and unsolved problem, especially regarding surgical treatment and various complications. To analyze postoperative outcomes in patients undergoing surgery in acute period of aneurysmal subarachnoid hemorrhage Hunt-Hess grade IV-V between 2006 and 2020, as well as to assess various factors influencing treatment outcomes. We analyzed 163 patients who underwent surgery within 21 days after aneurysmal subarachnoid hemorrhage Hunt-Hess grade IV-V. All patients were divided into 2 groups depending on the period: 2006-2011 (group 1) and 2012-2020 (group 2). Mortality reduced from 28.6% in group 1 to 8.3% in group 2. At the same time, incidence of vegetative state (GOS grade 2) increased from 4.8% to 17.4%. Incidence of outcomes GOS grade 3 - 5 was similar. Large or giant aneurysm, repeated preoperative subarachnoid hemorrhage, intraoperative aneurysm rupture and prolonged temporary clipping can impair postoperative outcomes in patients with hemorrhage Hunt-Hess grade IV-V. External ventricular drainage, intraarterial injection of verapamil, intracisternal administration of calcium channel blockers and active surgical tactics improve postoperative outcomes and reduce mortality.

Outcomes of Intraplaque Verapamil Injection for Treatment of Peyronie’s Disease

Objective: To determine the outcomes of intraplaque verapamil injection for treatment of Peyronie's disease. Aim:The purpose of this study is to evaluate the outcomes &amp; efficacy of intraplaque verapamil injection in Peyronie’s disease management. Methods: The quasi experimental study was conducted from July 2018 to July 2019 on a group of 26 subjects suffering from Peyronie's disease. After detailed history, complete physical and genital examination, the diagnosis was confirmed. After informed consent, questionnaires regarding pain and sexual satisfaction of patients were filled. All patients received verapamil injections on weekly basis for a period of 10 weeks. After that, all necessary variables were recorded and data analyzed using SPSS version 16. Results: Most of the patients in our study were in the age group of 30-65 years. 26.9 % patients were in the range of 51-55 years old. 53.8% patients got no effect of intralesional injection of verapamil on pain while pain relieved in 38.5% of patients &amp; 7.7% patients experienced an increased in pain intensity after 10 weeks of intralesional injection of verapamil. 61.5%of patients satisfied with their sexual life after 10 week of injections &amp; 30.8% of patients remained unsatisfied with their sexual life while in 7.7%of patients symptoms aggravated. 53.8% of patients experienced no change in size of lesion and curvature of penis, while 30.8% got less than 50% reduction in size of lesion while 15.4% of patients got more than 50% reduction in size after 10 weeks. Practical implication: We can easily find the efficacy of Verapamil injection for management of Peyronie’s disease. Conclusion: This study concluded the efficacy of Verapamil injection for management of Peyronie’s disease disease causes significant decrease in size of lesion and improvement in sexual activity. Keywords: Peyronie’s disease, Improvement, Lesions, Significant

Outcomes of Intraplaque Verapamil Injection for Treatment of Peyronie’s Disease

Objective: To determine the outcomes of intraplaque verapamil injection for treatment of Peyronie's disease.&#x0D; Aim: The purpose of this study is to evaluate the outcomes &amp; efficacy of intraplaque verapamil injection in Peyronie’s disease management.&#x0D; Methods: The quasi experimental study was conducted from July 2018 to July 2019 on a group of 26 subjects suffering from Peyronie's disease. After detailed history, complete physical and genital examination, the diagnosis was confirmed. After informed consent, questionnaires regarding pain and sexual satisfaction of patients were filled. All patients received verapamil injections on weekly basis for a period of 10 weeks. After that, all necessary variables were recorded and data analyzed using SPSS version 16.&#x0D; Results: Most of the patients in our study were in the age group of 30-65 years. 26.9 % patients were in the range of 51-55 years old. 53.8% patients got no effect of intralesional injection of verapamil on pain while pain relieved in 38.5% of patients &amp; 7.7% patients experienced an increased in pain intensity after 10 weeks of intralesional injection of verapamil. 61.5%of patients satisfied with their sexual life after 10 week of injections &amp; 30.8% of patients remained unsatisfied with their sexual life while in 7.7%of patients symptoms aggravated. 53.8% of patients experienced no change in size of lesion and curvature of penis, while 30.8% got less than 50% reduction in size of lesion while 15.4% of patients got more than 50% reduction in size after 10 weeks.&#x0D; Conclusion: This study concluded the efficacy of Verapamil injection for management of Peyronie’s disease.

فعالية وأمان علاج الجدرات بالفيراباميل حقناً ضمن الآفة

Objective: The aim of this study is to evaluate the efficacy of intralesional verapamil injection in treating keloids. In addition to, assessment of side effects of the therapy. Patients and Methods: A Prospective study (Before&amp; After) conducted for the period one year (April 2020- April 2021) at Tishreen University Hospital in Lattakia- Syria. 30 patients with keloids who received treatment with verapamil were included in the study. Results: The mean age was 22±6.3 years, 66.7% of patients were females. Most common sites of keloids involvement were shoulders (46.7%), and acne vulgaris was the most frequently etiology (40%). A statistically significantly reduction in the means of: Vancouver Scar Scale VSS 4.66±1.9 (day 21 of last treatment) vs. 7.06±1.8 (Day 0), p: 0.0001), height (1.16±0.6 vs. 2.23±0.6, p: 0.001), and pliability (1.33±0.9 vs. 2.60±0.6, p: 0.003), without recurrence of keloids at the day 90 of the last treatments. Burning pain was the most side effect frequently seen (98%).There was no significant relationship between clinical improvement and each of the following: duration of disease and age of the patient (p&gt;0.05). Conclusion: Verapamil has significant therapeutic effects in decreasing the height of the lesion, improving pliability without recurrence of lesions or serious adverse effects, thus, it could be a safe choice in treatment of keloids.

Outcomes of Intraplaque Verapamil Injection for Treatment of Peyronie's Disease

Outcomes of Intraplaque Verapamil Injection for Treatment of Peyronie's Disease

To study the effectiveness of intralesional verapamil in resolution of plaque of peyronie’s disease

The prospective study was conducted to study the role of intralesional verapamil in resolution of plaque of peyronies disease. Verapamil's effectiveness is predicated on its ability to affect fibroblast function on multiple levels, including cell proliferation, extracellular matrix protein synthesis and secretion, and collagen breakdown. Calcium antagonists may thus have the potential to reduce, halt, or even reverse plaque formation and Peyronie's disease progression. According to the intralesional verapamil injection therapy, the majority of men with Peyronie's disease who receive treatment experience long-term pain relief, curvature reduction, and enhanced sexual performance. Intralesional verapamil injection therapy resulted in reduction of pain in 92% cases, reduction of plaque size in 80% cases, reduction of penile curvature in 75% cases and improvement in erectile dysfunction in 60% cases.

Outcomes of Intraplaque Verapamil Injection for Treatment of Peyronie’s Disease

Objective: To determine the outcomes of intraplaque verapamil injection for treatment of Peyronie’s disease. Aim: The purpose of this study is to evaluate the outcomes &amp; efficacy of intraplaque verapamil injection in Peyronie’s disease management. Methods: The quasi experimental study was conducted from July 2018 to July 2019 on a group of 26 subjects suffering from Peyronie’s disease. After detailed history, complete physical and genital examination, the diagnosis was confirmed. After informed consent, questionnaires regarding pain and sexual satisfaction of patients were filled. All patients received verapamil injections on weekly basis for a period of 10 weeks. After that, all necessary variables were recorded and data analyzed using SPSS version 16. Results: Most of the patients in our study were in the age group of 30-65 years. 26.9 % patients were in the range of 51-55 years old. 53.8% patients got no effect of intralesional injection of verapamil on pain while pain relieved in 38.5% of patients &amp; 7.7% patients experienced an increased in pain intensity after 10 weeks of intralesional injection of verapamil. 61.5%of patients satisfied with their sexual life after 10 week of injections &amp; 30.8% of patients remained unsatisfied with their sexual life while in 7.7%of patients symptoms aggravated. 53.8% of patients experienced no change in size of lesion and curvature of penis, while 30.8% got less than 50% reduction in size of lesion while 15.4% of patients got more than 50% reduction in size after 10 weeks. Conclusion: This study concluded the efficacy of Verapamil injection for management of Peyronie’s disease.

PD23-07 PATIENTS' COMPLIANCE WITH SURGERY FOR PEYRONIE DISEASE: A MULTICENTRE EUROPEAN STUDY

You have accessJournal of UrologyCME1 May 2022PD23-07 PATIENTS' COMPLIANCE WITH SURGERY FOR PEYRONIE DISEASE: A MULTICENTRE EUROPEAN STUDY Paolo Capogrosso, Luigi Candela, Georgios Hatzichristodoulou, Juan I. Martinez Salamanca, Andrea Cocci, Marco Falcone, Edoardo Pozzi, Nicolò Schifano, Giorgio Ivan Russo, and Andrea Salonia Paolo CapogrossoPaolo Capogrosso More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Georgios HatzichristodoulouGeorgios Hatzichristodoulou More articles by this author , Juan I. Martinez SalamancaJuan I. Martinez Salamanca More articles by this author , Andrea CocciAndrea Cocci More articles by this author , Marco FalconeMarco Falcone More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Nicolò SchifanoNicolò Schifano More articles by this author , Giorgio Ivan RussoGiorgio Ivan Russo More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002565.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgery still remains the most effective treatment for Peyronie Disease (PD), despite different conservative therapies have been suggested over time. However, surgical procedures are associated with a non-negligible risk of complications and failures. We investigated patients’ willingness of being operated for PD. METHODS: Data of PD patients were prospectively collected in 5 different European academic centers between 2016 and 2020. Baseline data included age, time from PD onset, penile pain, curvature degree, difficulty at penetration, hour-glass deformity, erectile dysfunction (ED) and previous treatments. All patients were offered conservative treatments, including either oral therapy or topical injections. Tunical shortening or lengthening procedures were offered as an alternative to conservative treatments, when indicated. Penile prosthesis implantation was offered to those with concomitant ED. Patients compliance with surgery was recorded. Logistic regression analyses tested the profile of patients who were more likely to comply with surgery. RESULTS: Data were available for 343 patients. Median (IQR) age was 57.3 (49.8, 63.6) years. Median curvature was 40.0° (30.0, 65.0); of all, 48 (14%) patients had concomitant hour-glass deformity and 157 (46%) reported penile shortening. Difficulty at penetration and ED were reported by 161 (47%) and 134(39%) patients, respectively. Overall, 128 (37%) patients had been treated with tadalafil once daily for no less than 12 months; 54 (16%) received verapamil injections; 30 (9%) ESWT; and, 44 (13%) CCH injections. A significant improvement (defined as a curvature reduction≥20°) was reported in 69 (20%) cases. Overall, only 37% (126) patients were willing to undergo surgery for PD. Younger patients (OR:0.97, 95%CI: 0.95, 1.00; p=0.02), patients with more severe curvatures (OR:1.04; 95%CI: 1.03, 1.06 ; p=<0.0001) and patients reporting difficulties at penetration (OR: 1.88; 95%CI 1.04-3.41; p=0.03) were more likely to comply with surgery, after accounting for other clinical variables. CONCLUSIONS: Compliance to surgery is low among patients with PD, thus further stressing the urgent need for effective conservative treatments. Surgery should be comprehensively discussed with younger patients with a severe curvature. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e411 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paolo Capogrosso More articles by this author Luigi Candela More articles by this author Georgios Hatzichristodoulou More articles by this author Juan I. Martinez Salamanca More articles by this author Andrea Cocci More articles by this author Marco Falcone More articles by this author Edoardo Pozzi More articles by this author Nicolò Schifano More articles by this author Giorgio Ivan Russo More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF DownloadLoading ...

Eptifibatida y vasodilatadores intracoronarios para prevenir la ausencia de reperfusión en el IAMCEST con diabetes y alta carga de trombos. Un ensayo aleatorizado

Introduction and objectivesTo study the impact of injecting intracoronary eptifibatide plus vasodilators via thrombus aspiration catheter vs thrombus aspiration alone in reducing the risk of no-reflow in acute ST-elevation myocardial infarction (STEMI) with diabetes and high thrombus burden. MethodsThe study involved 413 diabetic STEMI patients with high thrombus burden, randomized to intracoronary injection (distal to the occlusion) of eptifibatide, nitroglycerin and verapamil after thrombus aspiration and prior to balloon inflation (n=206) vs thrombus aspiration alone (n=207). The primary endpoint was post procedural myocardial blush grade and corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC). Major adverse cardiovascular events were reported at 6 months. ResultsThe intracoronary eptifibatide and vasodilators arm was superior to thrombus aspiration alone regarding myocardial blush grade-3 (82.1% vs 31.4%; P=.001). The local intracoronary eptifibatide and vasodilators arm had shorter cTFC (18.16±6.54 vs 29.64±5.53, P=.001), and better TIMI 3 flow (91.3% vs 61.65%; P=.001). Intracoronary eptifibatide and vasodilators improved ejection fraction at 6 months (55.2±8.13 vs 43±6.67; P=.005). There was no difference in the rates of major adverse cardiovascular events at 6 months. ConclusionsAmong diabetic patients with STEMI and high thrombus burden, intracoronary eptifibatide plus vasodilators injection was beneficial in preventing no-reflow compared with thrombus aspiration alone. Larger studies are encouraged to investigate the benefit of this strategy in reducing the risk of adverse clinical events.

Intracoronary eptifibatide with vasodilators to prevent no-reflow in diabetic STEMI with high thrombus burden. A randomized trial

Introduction and objectivesTo study the impact of injecting intracoronary eptifibatide plus vasodilators via thrombus aspiration catheter vs thrombus aspiration alone in reducing the risk of no-reflow in acute ST-elevation myocardial infarction (STEMI) with diabetes and high thrombus burden. MethodsThe study involved 413 diabetic STEMI patients with high thrombus burden, randomized to intracoronary injection (distal to the occlusion) of eptifibatide, nitroglycerin and verapamil after thrombus aspiration and prior to balloon inflation (n=206) vs thrombus aspiration alone (n=207). The primary endpoint was post procedural myocardial blush grade and corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC). Major adverse cardiovascular events were reported at 6 months. ResultsThe intracoronary eptifibatide and vasodilators arm was superior to thrombus aspiration alone regarding myocardial blush grade-3 (82.1% vs 31.4%; P=.001). The local intracoronary eptifibatide and vasodilators arm had shorter cTFC (18.16±6.54 vs 29.64±5.53, P=.001), and better TIMI 3 flow (91.3% vs 61.65%; P=.001). Intracoronary eptifibatide and vasodilators improved ejection fraction at 6 months (55.2±8.13 vs 43±6.67; P=.005). There was no difference in the rates of major adverse cardiovascular events at 6 months. ConclusionsAmong diabetic patients with STEMI and high thrombus burden, intracoronary eptifibatide plus vasodilators injection was beneficial in preventing no-reflow compared with thrombus aspiration alone. Larger studies are encouraged to investigate the benefit of this strategy in reducing the risk of adverse clinical events.

Intralesional collagenase Clostridium histolyticum vs. verapamil injections in males with Peyronie's Disease: A prospective, matched-pair, non-blinded, randomised clinical study comparing clinical outcomes and patient satisfaction rates.

PurposeTo compare clinical outcomes and patient satisfaction rates between intralesional verapamil (ILV) and collagenase Clostridium histolyticum (CCH) injections in males with Peyronie’s disease (PD).Materials and MethodsFollowing ethics approval, PD patients were prospectively enrolled in this open-label non-blinded study. Patients were randomised to receive ILV or CCH injections with penile remodelling every fortnightly for 6 courses. Patient demographics, change in penile curvature, International Index of Erectile Function-15 and Peyronie’s Disease Questionnaire (PDQ) scores as well as overall patient satisfaction and Patient Global Impression of Improvement (PGI-I) scores were recorded at pre-treatment and 6-, 12- and 24-month post-treatment.ResultsA total of 50 males were recruited and divided into ILV (n=25) and CCH (n=25) groups. The mean changes in penile curvature were -16.8 (standard deviation [SD] 7.65) degrees in ILV and -28.2 (SD 11.5) degrees in CCH groups (p<0.01). Patients in the CCH group scored better than the ILV group on the PDQ psychosexual symptoms (-2.14 vs. -2.9; p<0.01) and symptom bother score (-3.88 vs. -4.16; p=0.08). Minor treatment-related adverse events were more common in the CCH group. The overall satisfaction rate on a 5-point scale was 4.1 in ILV and 4.5 in CCH groups, and there was no statistically significant difference in the PGI-I scores between the 2 groups (p=0.14).ConclusionsCCH therapy is more effective than ILV to treat a carefully selected group of males with PD, with a reasonable safety profile and a higher high level of patient satisfaction rate in the short term.

Efficacité et tolérance des traitements locaux en injections pour le traitement de la maladie de La Peyronie : revue de la littérature

To assess the efficacy and safety of local injection used to reduce penile curvature in Peyronie's disease.A review of the literature was carried out according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) on the Medline database in April 2020, with the research: "collagenase"[All Fields] OR "Interferon"[All Fields] OR "verapamil"[All Fields] OR "betamethasone"[All Fields] OR "hyaluronic acid"[All Fields] OR "Platelet-Rich Plasma"[All Fields] OR "Stem Cells"[All Fields] AND "peyronie's"[All Fields] AND Controlled Clinical Trial[ptyp]. Only controlled studies with placebo group were included in this review.Of the 35 articles identified, 6 placebo-controlled studies were finally included. Intra-plaque injections of verapamil did not show improvement in penile curvature. Injections of interferon α 2b and clostridium histolyticum collagenase allowed a statistically significant improvement in terms of curvature reduction: 13.5 versus 4.5 degrees P<0.01) and 17 versus 9.3 degrees P<0.0001 respectively. However, interferon α 2b is not available in France for Peyronie's disease and clostridium histolyticum collagenase is no longer authorized since March 1, 2020. No controlled studies are available on corticosteroids, hyaluronic acid, platelet-rich plasma or stem cells injections.To correct the deformity in Peyronie's disease in the chronic phase, there is no effective solution currently available in France based on controlled studies. Surgery retains its place for the correction of a curvature of at least 30° associated with a sexual handicap in the stable phase, however at the cost of potential adverse effects. Stem cell or Platelet-Rich Plasma injection might be an injectable therapeutic alternative but need controlled studies.

Electrophysiological study of the interactive role of the cannabinoid breakdown inhibitors and L-type calcium channels on granular neurons in the hippocampal dentate gyrus in rats

ABSTRACT The interaction between L-type voltage-dependent Ca2+ channels and the endocannabinoid system (eCs) in synaptic plasticity is controversial. In the present research, the impact of acute administration of URB597, as an endocannabinoid breakdown inhibitor, was evaluated after chronic injection of verapamil, as a Ca2+ channels blocker, on inducing long-term potentiation (LTP) in the rat’s hippocampal dentate gyrus (DG). Treatment of male Wistar rats was done using intraperitoneal(i.p) injection of verapamil hydrochloride (n = 8) and saline (n = 10), as the solvent of verapamil once a day within 13 days. Anesthetization was done by i.p injection of urethane and the rats were located in the stereotaxic apparatus for surgery, electrode implantation, and field potential recording. After observing a steady-state baseline response, saline or URB597 were injected (n = 9). Measurement of the population spike (PS) amplitude and slope of field excitatory postsynaptic potentials (fEPSPs) in the DG region was performed as a result of perforant pathway (PP) stimulation. Our treatments could inhibit LTP. Our results indicated that the chronic administration of verapamil produced a significant decrease in the slope of fEPSP and PS amplitude. Also, acute URB597 administration decreased the slope of fEPSP and PS amplitude compared to the saline group. Moreover, URB597 administration in combination with chronic administration of verapamil produced a greater decrease in fEPSP slope and PS amplitude than the saline group. These findings indicated that verapamil and URB597 disrupted LTP induction in the DG. Moreover, an interaction was observed between Ca2+ channels and eCs. Therefore, the eCs possibly play a selective role in synaptic plasticity.