Diagnosis and treatment of urethritis in men.

Gonococcal and nongonococcal urethritis are the most common sexually transmitted diseases in men. Failure to control these infections is a result of improper treatment of index cases and their sexual contacts. The proper management of urethritis in men is reviewed.     

Myocyte polyploidy in human cardiac pathology]

With general atherosclerosis, the ploidy of left ventricle myocytes in the hearts of patients that underwent infarction corresponds to the norm variation irrespective of the ventricle and heart weights. At heart diseases the myocyte nucleus ploidy is often much higher than the norm variability both in hypertrophied ventricles and in those with normal weight. An additional polyploidization is suggested that may occur at some natural ontogenetic periods of human development (in the childhood) during heart diseases both innate or spontaneously appearing at the particular time. Unlike, the myocardial hypertrophy in adults does not stimulate myocyte polyploidy.     

Perspectives and hopes in infectious pathology]

Over the last few decades, changes in socio-economic conditions and social practices as well as aggressive therapy of many diseases have led to the emergence of new infectious pathologies. These new pathologies are either associated with newly identified microbial species or the emergence of known microbes which have encountered new environments in which they are able to cause disease. Recent progress has allowed us to understand the mechanisms by which these pathogens express their virulence and will certainly allow us to diagnose and treat these infections more efficiently in the future.     

Detection of Trichomonas vaginalis in men]

An infection with T. vaginalis in male patients is difficult to diagnose in case of latent or asymptomatic trichomoniasis. This infection is caused by the round forms of T. vaginalis, which are significantly more frequent in male patients, than trophozoites. Trichomonas vaginalis round forms called pseudocyst due to their specific biological properties are difficult to observe with actually used techniques. It was shown, that round forms of T. vaginalis may be detected by Giemsa modified technique and modified survival technique employing acridine orange. Therefore routine diagnosis of trichomoniasis included direct examination of the discharge from urethra, cultures and survival technique employing acridine orange. In the problematic cases, especially in male patients with the latent or asymptomatic trichomoniasis, full range of methods should be used to examine specimen collected from the each part of the urinary tract.     

Diagnosis delay in Libyan female breast cancer

ABSTRACT: BACKGROUND: To study the diagnosis delay and its impact on stage of disease among women with breast cancer on Libya METHODS: 200 women, aged 22 to 75 years with breast cancer diagnosed during 2008--2009 were interviewed about the period from the first symptoms to the final histological diagnosis of breast cancer. This period (diagnosis time) was categorized into 3 periods: <3 months, 3--6 months, and >6 months. If diagnosis time was longer than 3 months, the diagnosis was considered delayed (diagnosis delay). Consultation time was the time taken to visit the general practitioner after the first symptoms. Retrospective preclinical and clinical data were collected on a form (questionnaire) during an interview with each patient and from medical records. RESULTS: The median of diagnosis time was 7.5 months. Only 30.0% of patients were diagnosed within 3 months after symptoms. 14% of patients were diagnosed within 3--6 months and 56% within a period longer than 6 months. A number of factors predicted diagnosis delay: Symptoms were not considered serious in 27% of patients. Alternative therapy (therapy not associated with cancer) was applied in 13.0% of the patients. Fear and shame prevented the visit to the doctor in 10% and 4.5% of patients, respectively. Inappropriate reassurance that the lump was benign was an important reason for prolongation of the diagnosis time. Diagnosis delay was associated with initial breast symptom(s) that did not include a lump (p < 0.0001), with women who did not report monthly self examination (p < 0.0001), with old age (p = 0.004), with illiteracy (p = 0.009), with history of benign fibrocystic disease (p = 0.029) and with women who had used oral contraceptive pills longer than 5 years (p = 0.043). At the time of diagnosis, the clinical stage distribution was as follows: 9.0% stage I, 25.5% stage II, 54.0% stage III and 11.5% stage IV.Diagnosis delay was associated with bigger tumour size (p <0.0001), with positive lymph nodes (N2, N3; p < 0.0001), with high incidence of late clinical stages (p < 0.0001), and with metastatic disease (p < 0.0001). CONCLUSIONS: Diagnosis delay is very serious problem in Libya. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer awareness and training of general practitioners to reduce breast cancer mortality by promoting early detection. The treatment guidelines should pay more attention to the early phases of breast cancer. Especially, guidelines for good practices in managing detectable of tumors are necessary.     

Cytopathologic findings in breast masses in men with HIV infection

OBJECTIVE: To report the cytologic findings on 15 men with HIV infection who presented with breast masses and underwent fine needle aspiration (FNA). STUDY DESIGN: The cytopathology files of The Johns Hopkins Hospital (JHH) and the University of Texas Southwestern Medical Center (UTSW) were searched for cases of men with breast masses evaluated by FNA. The HIV status of these men was then ascertained. A total of 15 cases (9 at JHH, 6 at UTSW) of 259 (5.79%) were identified in which the patient was HIV seropositive. The pathologic diagnoses were reviewed, and the clinical history, along with the medication list at the time of FNA, was determined. RESULTS: The men ranged in age from 12 to 51 years (mean, 38). Breast masses were present on either the right (n = 6) or left (n = 7) side or were bilateral (n = 2). In all 15 cases, the masses were retroareolar, firm and tender. FNA showed a ductal and stromal proliferative process, often with focal cytologic atypia and numerous background naked myoepithelial nuclei, features consistent with a diagnosis of gynecomastia. Thirteen of these men were on drug regimens, which included indinivir, stavudine and saquinivir. Two of the men were on azidothymidine only. CONCLUSION: Gynecomastia, although rare in young men, was the sole cause of breast masses in HIV-seropositive men in this study. It has been described as an extremely rare side effect of certain antiretroviral medications, including indinivir, stavudine and saquinivir. FNA is an important tool in determining the benign nature of these lesions and excluding other causes of breast masses in this patient population, such as infections, malignant lymphoma and breast carcinoma.     

Fetomaternal hemorrhages and their importance in perinatal pathology]

Transplacental haemorrhage is usually studied as an aspect of Rh immunisation prevention. In this paper the authors emphasize importance of this syndrome in noe-natology, as massive transplacental blood loss may result in severe foetal and neo-natal anemia or even lead to intra uterine death. Different technics for evidencing the presence of fetal cells in the mother's circulation are first discussed, the acid elution method appearing to be the easiest and fastest one. Results of nearly 40.000 Kleihauer's tests screening routinely performed in Paris at the time of delivery, are reported. The much higher frequency of very large transplacental haemorrhage is pointed out in cases of stillbirth. On a practical point of view, routine testing for transplacental haemorrhage finds its major interest in Rh prevention. A formula is proposed by one of the authors to calculate the most accurate dose of passive anti-D antibody in relation with quantitation of fetal haemorrhage. At last the autors attempt a new approach to the problem of neonatal unexplained anemias. Two different types of fetal bleeding are postulated, either chronic associated with haematologic signs of regeneration, or massive at the time of delivery without haematologic symptomatology. These condtions could lead to two different clinical pictures, either hydropsfetalis when chronic, or hypovolemic schock when massive and immediate.     

Rifampicin in the therapy of gonorrheal urethritis in men]

The therapeutic efficiency of benemycin (rifampicin of Polish production), a semisynthetic antibiotic was studied in 96 male cases with gonorrhea urethritis. The antibiotic was used in a dose of 300 mg every 6 hours (2.1--3gm for the treatment course depending on the desease severity). Observation of the patients for 1--2 months showed etiological recovery in 91 (94.8 per cent) out of 96 patients. Postgonorrhea inflammatory processes were observed in 8.7 per cent of the cases. For studying late results of the treatmant 62 patients were observed for 3 to 12 months. Gonococci were isolated from none of the patients. No side reactions were found in the patients treated with rifampicin.     

Carminomycin study in breast cancer]

Karminomycin was used for the treatment of cases with disseminated cancer of the mammary gland in doses of 5 mg/m2 of the body surface intravenously every day for 5 days (15 patients) or 6 mg/m2 twice a week for 2-3 weeks (30 patients). Partial remission or diminution of the tumor size at least by 50 per cent was observed in 26 and 17 per cent of the patients respectively. The remission duration was from 2 to 6 months. With the use of the shortperiod scheme the frequency of the direct side reactions increased. Leucopenia as a side effect was registered in 100 and 40 per cent of the patients and thrombocytopenia was registered in 18 and 3 per cent of the cases respectively.