Identification of the patient with enlarged prostate: diagnosis and guidelines for management

Benign enlargement of the prostate, also referred to as benign prostatic hyperplasia, is a common condition in men. Because enlarged prostate (EP) was viewed historically as a symptomatic condition, management of voiding symptoms with α-blockers was often the goal of therapy. However, it is now recognized that EP is a progressive disorder, which may be complicated by acute urinary retention and which may eventually require EP-related surgery. The 5α-reductase inhibitors decrease dihydrotestosterone levels, which slow disease progression by causing regression of the prostate epithelial cells. These agents are considered disease modifying, and they may reduce the progression of prostate enlargement. This article reviews evaluation, diagnosis, and treatment strategies for EP, and it provides a practical algorithm for management of patients with EP.     

Phytostabilization of gold mine tailings from New Zealand. Part 2: Experimental evaluation of arsenic mobilization during revegetation

Revegetation of mine tailings usually requires amendments of phosphorus. However, phosphate addition can mobilize arsenic (As) from the tailings. A 5-mo lysimeter field trial was conducted to quantify As mobilization in gold mine tailings, in association with different P amendment products and different plant species (barley Hordeum vulgare, blue lupin Lupinus angustifolius, rye corn Secale cereale) necessary for short-term revegetation of mine tailings. A simultaneous laboratory experiment was run to examine As mobilization in 1-cm-deep tailings in relation to different P amendment rates. The experimental results showed that the amount of As leached was proportional to the amount of P added. In the larger scale lysimeters, P amendment of < 3 g m(-2) caused As leaching of 0.5 mg L(-1) from unplanted lysimeters and up to 0.9 mg L(-1) on average in planted lysimeters. Variable species-amendment combinations produced differences in the amount of As leached and uptaken. Leachates and uptakes were higher with an organic fertilizer amendment than Superphosphate, particularly in combination with barley. Arsenic accumulated in plant biomass to 126 mg kg(-1) in shoots and 469 mg kg(-1) in roots.     

Molecular and morphometric analysis of the rat ventral prostate injected with leptin

The aim of this study was to evaluate the effect of leptin administration on the ventral prostate lobe of adult rat. Twenty adult male rats were divided into 2 groups: L-animals were daily injected with 50 μL of leptin (8 μg/100 g BW, subcutaneous) for four days and C-animals received the same volume of saline solution. Lipid profile and testosterone serum levels were evaluated. The prostate ventral lobe was processed for histomorphometric analysis. Gene expression of aromatase, androgen, leptin and estrogen receptors isoforms was evaluated by real-time PCR. Cell proliferation was evaluated by PCNA immunohistochemistry. Data were expressed as mean±standard error and analyzed by student's t-test. Serum levels of cholesterol (C=39.7±4.2;L=55.2±4.2, mg/dL; P<0.02) increased and testosterone (C=1.6±0.43;L=0.6±0.15, ng/dL; P<0.03) decreased in L group. The histomorphometric analysis showed a reduction in cell density (C=8868±242; L=8211±210, mm(2); P<0.04), in total (C=0.24±0.026; L=0.10±0.009, mm(2); P<0.001) and in the internal acini areas (C=0.16±0.009; L=0.08±0.006, mm(2); P<0.0002). On the other hand, there was an increase in the epithelial height (C=17.3±0.3; L=22.8±0.2, μm; P<0.0001) and in the number of acini (C=7.0±0.2; L=8.7±0.1, mm(2); P<0.0002). The histomorphometric analyses together with PCNA immunohistochemistry results suggest that leptin increases cell proliferation. In relation to the gene expression, leptin treatment increased the expression of all genes, but ER-α, in more than 200 times compared to the expression in C group. In conclusion, in this paper we showed that leptin has a direct effect on the prostate gland of adult rats leading to an increase in proliferation and in the gene expression of aromatase, androgen, leptin and estrogen receptors isoforms that are important for the physiology of the prostate gland.     

Pathophysiology and therapy for haemoglobinopathies. Part II: thalassaemias

Thalassaemias result from mutations of the globin genes that cause reduced or absent haemoglobin production and thus interfere with the critical function of oxygen delivery. They represent the most common single-gene disorders, with 4.83% of the world population carrying globin gene variants. Reduced or absent alpha-globin (alpha-thalassaemia) or beta-globin (beta-thalassaemia) leads to anaemia and multifaceted clinical syndromes. In this second of two reviews on the pathophysiology of haemoglobinopathies, we describe the clinical features, pathophysiology and molecular basis of alpha- and beta-thalassaemias. We then discuss current targeted therapies, including the new oral iron chelators, which, along with chronic transfusions, constitute the mainstay of symptomatic therapy for the majority of patients. Finally, we describe potentially curative therapies, such as bone marrow transplant, and discuss some of the outstanding research studies and questions, including the upcoming field of gene therapy for beta-thalassaemia. An accompanying article on haemoglobinopathies (Part I) focuses on sickle cell disease.     

Experimental pneumococcal meningitis: III. Chemotactic activity in cerebrospinal fluid.

Chemotactic activity was assayed in CSF of rabbits with pneumococcal meningitis to further characterize the inflammatory response in this infection. CSF chemotactic activity was detected in increasing levels for 72 hr after infection. Activity was stable at 56 degrees and was inactivated by agents which denature proteins. Gel filtration demonstrated two chemotactically active fractions in infected CSF with mol wts of approximately 3000 and 11,000. Bacterial products appear to account for a portion of the observed CSF chemotactic activity, but the role of host factors remains to be clarified.     

Hormonal therapy for stage D cancer of the prostate.

Adenocarcinoma of the prostate is the most common malignant neoplasm occurring in men. About half of patients present with metastatic disease. The mainstay of the treatment of stage D cancer of the prostate is hormonal therapy. Bilateral simple orchiectomy remains the gold standard with which other therapies must be compared. Luteinizing hormone-releasing hormone analogues and antiandrogens are now most commonly used but are costly. Initiating hormonal therapy immediately on diagnosing metastatic disease appears to have some advantage over delaying therapy until a patient is symptomatic. Total androgen blockade also appears to be beneficial in terms of survival but at high cost.