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Kim L. Light, BS, CMD

• Chief Dosimetrist
• Department of Radiation Oncology
• Duke University Medical Center
• Durham, North Carolina

The other major cause is poor technique of pin insertion leading to damage to the bone and surrounding soft tissue bacteria are the simplest single cells that cheap ketoconazole cream 15gm fast delivery. An infected pin site is managed according to whether the pin is frm or loose (see 22 bacteria in water purchase ketoconazole cream discount. Under anaesthesia the track should be curetted and a new pin inserted in a new site antibiotic resistant klebsiella pneumoniae cheap 15gm ketoconazole cream with visa. Whether pin repositioning is possible depends on the fracture site and the design of the construct; the whole fxator may have to be reapplied infection tattoo buy generic ketoconazole cream 15gm. The periosteal reaction around the lowest pin is most probably Delayed union and non-union associated with infection disturbed infection generic ketoconazole cream 15gm on line. The rigidity of bone immobilization with external fxation has a negative infuence on the speed of fracture consolidation antibiotic mouthwash containing chlorhexidine buy ketoconazole cream now. A potent stimulus for periosteal osteoneogenesis is multi-axial micromovement at the fracture site. A special frame to stimulate callus formation must be installed if the fxator is to be left in place for a prolonged period. Dynamization requires much more sophisticated equipment and expertise; again highlighting the importance of early conversion to a weight-bearing plaster cast. External fxation is most useful in those wounds where non-union is likely anyway because of severe comminution associated with a large bone defect and loss of periosteum. Injury to nearby structures Proper placement of the pins involves a good knowledge of the anatomy of the limb. Tethering of tendons and muscles by the pins prevents joint movement, thus defeating one of the main advantages of external fxation. Mechanical problems with the device As with any apparatus consisting of numerous elements, with time and use some components may no longer function properly. This rapid rotation did not allow for a correct follow-up, and most surgeons were unaware of the complications that their successors had to deal with. After a clinical study demonstrated the high rate of complications and failure of treatment, the use of external fxation was radically reduced. The majority had languished for months and years in hospitals or at home, receiving various antibiotic cocktails and dressings; some underwent surgical operations from time to time, whenever they could aford treatment. Conducting clinical studies in the precarious conditions of an active war zone is difcult and, at times, dangerous, both for the patients and hospital staf. Patients 22 requiring an amputation as primary or delayed treatment were excluded. Available healthy muscle tissue was mobilized to cover as much of the exposed bony bed as possible and to fll in any dead space. The wound was dressed using generous amounts of granulated brown sugar and dry compresses. This routine was continued until the wound healed by secondary intention or a split-thickness skin graft was applied. Antibiotic protocol intra-operative cultures of superfcial and deep tissues and also of sequestra if present were routinely obtained. The initial antibiotic protocol consisted of parenteral gentamycin and cloxacillin for 24 hours, followed by 4 weeks of oral cloxacillin. Culture results showed a high level of multiple-resistance, so the protocol was simplifed to a 24-hour course of parenteral benzyl penicillin and metronidazole aimed only at controlling any bacteraemia related to the surgical trauma. Only patients showing poor progress were given additional antibiotics according to laboratory culture and sensitivity. However, in general, it was found that bacteriological studies were seldom of clinical usefulness. The duration of treatment was not systematic but based on the clinical response, as was the choice of second-line antibiotics. Patients were fed a calorie and protein-rich diet, for the frst time in months in many cases. The association between functional outcome and the following variables were found to be statistically signifcant: age (the younger, the better), aetiology (haematogenous better than penetrating injury), and Cierny-mader type (A host better than B host). E bone grafting the iliac crest is used as a donor site because a generous amount of cancellous bone can be harvested and it is easily accessible. For larger grafts, the incision begins at the posterior iliac spine and proceeds forwards along the crest for 8 10 cm. A sharp osteotome is inserted parallel to the crest and the outer cortex cut through along the entire length of the incision. The osteotome is then placed perpendicular to the crest and both outer and inner tables are cut through creating a small fap of cortical bone along the entire length of the exposed crest. Elevating this fap gives access to the cancellous bone and marrow between the two bony tables. Using a narrow bone gouge or osteotome, cancellous bone chips are removed from above downwards. Excessive force should be avoided to prevent breaching the inner table and sacroiliac joint. The harvested chips are kept in a swab soaked with blood and not immersed in saline, which kills bone cells and may remove humoral stimulating factors. A drain, preferably of the suction type, is placed in the subcutaneous tissues for 24 hours and the skin incision closed. Once the fracture is exposed, the bone ends are freshened by excision of adherent fbrous tissue and nibbling by a rongeur. The bone fragments are aligned and an external fxation device is best placed at this time, if necessary. The graft site may be covered by a muscle or skin-and-fascia fap if available, by far the preferred technique. Otherwise the limb is encased in a complete cylindrical cast, without a window, and kept away from prying fngers and eyes (Orr-Trueta technique, see section 22. An alternative is the Papineau technique: leaving the wound open and the graft exposed. To be accepted, the graft must be kept clean and moist and regularly cleared of encrustation and any rejected chips. As the wound heals, the bone chips are incorporated into the granulation tissue and eventually the surface may close spontaneously by secondary intention or accept a skin graft. Depending on which bone is grafted, the Orr-Trueta method of encasing the limb in a complete cast can also be of beneft. The soft-tissue injury usually determines the level for amputation or disarticulation. Debride all dead and contaminated tissue; salvage as much viable tissue as possible. Physical rehabilitation and socio-economic reintegration are the ultimate aims of patient treatment. Local rehabilitation services may ofer only a small variety of prostheses; limited availability of intensive nursing care may dictate earlier amputation so as to save life; imperfect surgical experience and lack of proper suture material and vascular instruments may make vascular repair ill-advised. On the other hand, an amputee is a patient for life; not only must artifcial limbs be replaced on a regular basis, but a high percentage of patients develop anatomic complications in the stump and psychological problems that must be dealt with. Furthermore, most amputations during armed confict afect young and healthy adults in the prime of their productive life. The resulting impairment, especially in a country without the resources to ofer efcient physical rehabilitation and produce afordable prostheses, is a burden on the patient, the family and society at large. Physical rehabilitation and socio economic integration programmes and vocational training are sorely lacking in many low-income countries. Consultation with a colleague is essential to reach the decision to amputate; a second opinion is invaluable. This team should assist the surgeon, not only in deciding on the optimal hospital amputation policy but also on the optimal type of amputation or disarticulation for each kind of patient. The available technology and skills of the local physical rehabilitation centre are fundamental considerations. Fashioning of a stump appropriate for the ftting and prolonged use of a prosthesis. Until the last century amputation was the most common treatment for open fractures in war wounds. During World War ii, Us, German and soviet troops fought on diferent terrain and under diferent tactical considerations, with varying capacities for the rapid and efcient evacuation of the wounded to proper hospitals. The causes of all major amputations performed highlight the consequences of these diferences. Patients may prefer to keep a useless limb or even to die from their wounds rather than sufer amputation. As mentioned, the extended family or clan must be consulted and the amputation, and even the stump length, discussed with them. These are more frequent during conficts where weapons that combine blast and projectile efects, such as anti-personnel mines and sophisticated improvised explosive devices, are widespread. The great majority of all cases proceeding to amputation concern open fractures of the tibia. Vascular injury: cases with established ischaemic gangrene; unrelieved compartment syndrome with necrosis of the muscles afecting two or more compartments of the limb (see section 24. Amputation or disarticulation can be considered damage control surgery in these patients. However, anaerobic cellulitis or myositis confned to a single muscle group can sometimes be managed by excision and extensive decompression of muscle compartments. Continued chronic infection: a limb that is persistently painful and functionally useless. All war wounds are contaminated and many can be described as mangled, but not all are candidates for amputation in modern surgery. The scheme below provides a guideline to aid decision-making, based on a clinico pathological description of various war wounds using the Red Cross Wound score. Even if the nerves are intact, other life-threatening injuries (V = n, T or A) that rule out proper attention to vascular repair also require amputation. Even if reperfusion can be assured, if soft-tissue loss is so severe that it precludes relatively simple procedures for closure, then the surgeon is probably best advised to proceed to amputation. The precarious physiological state of the patient may require a damage-control approach. This may involve disarticulation through the knee joint rather than a transfemoral amputation; abbreviated laparotomy and washing and dressing only of a traumatic amputation stump after ligature of the major vessels pending proper debridement after stabilization, etc. Energy expenditure and oxygen consumption increase as the level of amputation rises in the limb. The most severe soft-tissue injury, not the bone injury, usually dictates the level of amputation, which should be at the lowest possible level of viable tissue compatible with good and durable prosthetic ftting. The best length should be decided in consultation with the prosthetist and physiotherapist. In extremis, amputations can be performed under infltration of a local anaesthetic. However, muscle retracts back in relation to the skin and bone after removal of the tourniquet and this should be kept in mind when deciding on the level of bone section. This entails excision of all damaged soft tissues frst and then planning the bone section as distal as feasible. Please note: A muscle that is cut across its fbres swells considerably during the next few days owing to simple infammatory oedema. This swelling the skin fap has been raised and excess does not occur if the muscle is dissected out intact; hence the rationale underlying subcutaneous fat is being trimmed. At the end of the operation, the skin and muscle should approximate easily, without tension, over the bone end. Bone is cleared of muscular and fascial attachments and periosteum up to 1 cm proximal to the level of transection. The bone is sectioned preferably with a Gigli saw and the wire cooled by rinsing with normal saline during the procedure.

Side eects can prove to be benecial for the Antipsychotics are associated with a wide range patient antibiotics for acne redness order on line ketoconazole cream, such as euphoria and an increased appetite in of side eects virus detector discount ketoconazole cream 15gm mastercard. Other toms (rigidity and tremor) due to blockage of dopamine typical side eects such as osteoporosis antibiotics for uti for sale buy ketoconazole cream 15gm mastercard, skin thinning bacteria in urine discount ketoconazole cream 15gm on-line, receptors antibiotics for dogs after giving birth buy generic ketoconazole cream 15 gm line. In this case the temperature regu steroids antimicrobial eye drops generic ketoconazole cream 15gm on-line, and do not use steroids unless critical in the lation centers fail, resulting in a medical emergency, as noncancer patient. Most of the above-mentioned side eects are Neuroleptics fortunately rare and not of relevance in the period of the Neuroleptics are psychoactive drugs that are commonly end of life. Do Benzodiazepines not underestimate the distress for the patient and family Benzodiazepines are a group of drugs with varying in the presence of delirium. Try to identify the reason sedative, anxiolytic, anticonvulsant, and muscle relax for the delirium. The main indication for these drugs in infection, renal failure, dehydration, or electrolyte im pain management and the palliative care management balances. In rare instances, it may also be a side eect of is the treatment of anxiety and intractable dyspnea. For trait anxiety in terminal ill ceptor, the most prevalent inhibitory receptor within ness, unitrazepam subcutaneously once daily is a very the entire brain. The anticonvulsant properties of ben eective choice (normally in a dose range between 0. During the course of therapy with benzodiaze Benzodiazepines are well-tolerated and safe. Diazepam can be administered orally, real contraindication in the palliative setting if used with intravenously, intramuscularly, or as a suppository. Many of the terms were already estab their system for classication, to issue an updated list of lished in the literature. Subsequent revisions are intended to be specic and explanatory and to serve and additions were prepared by a subgroup of the Com as an operational framework, not as a constraint on fu mittee, particularly Drs. In 1984, in particular diverse specialties including anesthesiology, dentistry, response to some observations by Dr. Devor, a fur neurology, neurosurgery, neurophysiology, psychiatry, ther review was undertaken both by correspondence and psychology. Tose The terms and denitions are not meant to pro taking part in that review included Dr. Devor, the other vide a comprehensive glossary, but rather a minimum colleagues just mentioned, and Dr. Mumford, Sir standard vocabulary for members of dierent disci Sydney Sunderland, and Dr. It is important to recognize that al the activation of the endogenous opioid system and the lodynia involves a change in the quality of a sensation, spinal modulation of pain signalling through activation whether tactile, thermal, or of any other sort. Tere are a number of dif nal modality is normally nonpainful, but the response ferent approaches to diagnosis and treatment in modern is painful. Tere is thus a loss of specicity of a sensory acupuncture that incorporate medical traditions from modality. By contrast, hyperalgesia represents an aug China, Japan, Korea, and other countries. In allodynia the stimulus mode mostly as a complementary treatment to mainstream and the response mode dier, unlike the situation with medicine. This distinction should not be confused by certain types of joint pain, back pain, and headache syn the fact that allodynia and hyperalgesia can be plotted dromes may benet from acupuncture. Allodynia might be provoked by Addiction is a chronic relapsing condition character the touch of clothes, such as in patients with posther ized by compulsive drug-seeking and drug abuse and by petic neuralgia. Addiction from coanalgesics, local treatment with local anesthetics is the same irrespective of whether the drug is alcohol, and/or capsaicin might be of help. Anesthesia dolorosa Every addictive substance induces pleasant states or re lieves distress. Continued use of the addictive substance Pain in an area or region that is anesthetic. Terefore, induces adaptive changes in the brain that lead to toler neurodestructive techniques in pain management ance, physical dependence, uncontrollable craving, and, should be limited to the few indications where anesthe all too often, relapse. For example, in long Absence of pain in response to stimulation that would term opioid therapy, dependence is a normal result, and normally be painful. As with allodynia, the stimulus is the only clinical implication is that dose reduction has dened by its usual subjective eects. Allodynia is pain due to a stimulus that does not nor Acute and cancer-related pain are commonly treat mally provoke pain. Chronic nonmalignant pain requires a multi and hyperesthesia, the conditions seen in patients with disciplinary approach encompassing various pharma lesions of the nervous system where touch, light pres cological and nonpharmacological. The increase of peripheral ated with surgery, childbirth) and some selected chronic neuronal activity is transmitted centrally and results pain syndromes. In general, the oral route of application in sensitization of second and third-order ascend is preferred, but in emergency situations and periopera ing neurons. The general, high-quality pain management is possible with mechanisms of action of antiepileptics include neuro out them. Tricyclic antidepressants have the highest are currently under intense investigation but are not yet eectivity. Local anesthetics are used for local and of monitoring plasma drug concentrations is not to regional anesthetic techniques. As with all Various antiepileptics (carbamazepine, phenytoin, val coanalgesic treatment options for neuropathic pain, proate, gabapentin, lamotrigine, and pregabalin) have patients should be told before the start of therapy that been used for neuropathic pain and more recently for the treatment goal may only be a 50% pain reduction. Together with antidepres Studies have demonstrated that even with optimized sants, they are the most eective coanalgesics. The most treatment, only half of all patients with neuropathic common adverse eects are impaired mental function pain will achieve this goal. In migraine prophylaxis, the (somnolence, dizziness, cognitive impairment, and fa numbers are higher. Serious side may be increased mortality from sudden arrhythmia, eects have been reported, including hepatotoxicity, and in patients with recent myocardial infarction, ar thrombocytopenia, and life-threatening dermatological rhythmia, or cardiac decompensation, tricyclics should and hematological reactions. Tricyclics also block histamine, cho tions should be monitored to avoid toxic blood levels. In consequence, dis triptyline, imipramine, and clomipramine) and pref orders of anxiety can be the result of chronic pain, but erential norepinephrine reuptake inhibitors. One consequence of chronic pain can be agoraphobia, The reuptake inhibition leads to a stimulation of en for example, if the patient is afraid to leave the house dogenous monoaminergic pain inhibition in the spinal because the pain attack might occur on the street, and cord and brain. In consequence, the pa receptor antagonist, sodium-channel-blocking, and tient tends more and more to avoid leaving the house. The antiepileptic drug pregabalin also has some are serious medical illnesses that aect pain patients anxiolytic eect without the risk of addiction of ben more frequently than the average population. Unlike the brief anxiety caused by a stressful mended in a number of textbooks, there is no indication event such as a business presentation or waiting for for anxiolytics as pain killers. Arthritis is the inammation of a joint, with typical In the case of chronic pain, both in developing symptoms including stiness (especially in the morn and developed countries there is an increased preva ing), warmth, swelling, redness, and pain. The prevalence increases when pain oc tion control comes before pain management to avoid curs at multiple sites. In biopsychosocial models of ex among the drugs of rst choice for severe arthritis. Within the experience of tegrated into palliative care by oering relatives support anxiety there is an unspecic feeling of excitement and after the death of the patient. Terefore, palliative care tension as well as unpleasantness and the experience does not stop with the death of the patient. It works as a stimulatory (pronociceptive) neurotransmitter when A disturbance of the brain function that causes confu it is released centrally, and as a proinammatory me sion and changes in alertness, attention, thinking and diator when it is released peripherally. If opioids are nomic changes (changes in the color of the skin, chang suspected to be the cause of delirium, a switch (rota es in temperature, changes in sweating, and swelling). The pathophysiology of causalgia includes local inammation and reorganization processes in the Dependence central nervous system. If causalgia is suspected, diag Physical dependence is a state in which the continuous nosis and treatment should be left to a pain specialist. As a consequence, when opioids have been ad some patients after stroke and may limit the quality of ministered for a prolonged period of time (> 3 weeks) life considerably. All other treatment options are supported only but tapered with a daily dose reduction. Chronic pain Depression Chronic pain is diagnosed if pain persists longer than 6 Depression is a risk factor for pain chronication. For clinical practice it is probably more help tain screening questions aid in diagnosis. Common ful to dene chronic pain as pain that is complicated ndings are sleeping problems, unrest, a lack of ener by certain risk factors according to the biopsychosocial gy that is pronounced in the rst half of the day, and concept of pain chronication: central sensitization to loss of interest. A psychopathological result should howev Approaches to medical treatment that are outside er always form the basis and include an evaluation of of mainstream medical training received in medical suicidal tendency. In accordance with the ndings of 364 Andreas Kopf an investigation by Tang et al. It should always be specied is usually the strongest predictor of desire for death. Since breathing depression ing the point in time are important; the patient may does not cause the patient to suer (and therefore the agree to a postponement. Furthermore, previous suicide patient will not complain), personal or electronic moni attempts should be noted because they are an increased toring, especially in the immediate postoperative period risk factor for a renewed suicidal tendency. Epidural analgesia is specially popular in the limitations in therapy are precisely documented after obstetrics department. Besides helping in dicult medi duced in the last years to allow communication be cal situations, ethics conferences may also help bringing tween the patient and a caregiver in case the patient is together the dierent disciplines of health care, allowing unresponsive due to his health situation. Special cases of dysesthesia include hyperalgesia and A feeling of becoming tired easily, being unable to com allodynia. Fatigue should not be confused Appendix: Glossary 365 with sedation, which usually is a side eect of certain the stimulus and the response are in dierent modes, medical interventions and therefore maybe inuenced whereas with hyperalgesia they are in the same mode. Fatigue is the Current evidence suggests that hyperalgesia is a conse symptom palliative patients complain about most, and quence of perturbation of the nociceptive system with unfortunately it is dicult to inuence. Terefore, current treat Increased sensitivity to stimulation, excluding the spe ment concepts aim at the descending inhibitory system cial senses. Hyperesthesia may refer to various modes of cuta be seen in the same context as other hypersensitiv neous sensibility, including touch and thermal sensation ity syndromes, such as chronic back pain, seronegative without pain, as well as to pain. Allodynia is suggested for pain after stimula A special way of caring for people with terminal ill tion that is not normally painful. The goals of hospice are to keep the patient as comfortable as possible by relieving pain and Hyperpathia other symptoms; to prepare for a death that follows the A painful syndrome characterized by an abnormally wishes and needs of the patient; and to reassure both painful reaction to a stimulus, especially a repetitive the patient and family members by helping them to un stimulus, as well as an increased threshold. Hospice care with allodynia, hyperesthesia, hyperalgesia, or dysesthe especially aims to help patients who are unwilling or un sia. Faulty identication and localization of the stimulus, able to be taken care of in their homes and have stable delay, radiating sensation, and aftersensation may be or manageable symptoms. The with the death of the recipient, while palliative ward changes in this note are the specication of allodynia care allows reambulation of the patient in many patients and the inclusion of hyperalgesia explicitly. Pallium India and Hospice Africa hyperalgesia was implied, since hyperesthesia was men Uganda are remarkable examples of hospice care in low tioned in the previous note and hyperalgesia is a special resource settings.

Uropharmacology: current and future strategies in the treatment of erectile dysfunction and benign prostate hyperplasia antibiotics like amoxicillin ketoconazole cream 15gm line. Self-assessed health bacteria morphology buy generic ketoconazole cream online, sadness and happiness in relation to the total burden of symptoms from the lower urinary tract antibiotics for uti baby purchase ketoconazole cream in india. Smoking influences aberrant CpG hypermethylation of multiple genes in human prostate carcinoma antimicrobial body soap purchase discount ketoconazole cream on-line. Minimally invasive therapy for benign prostatic hyperplasia: practice patterns in Minnesota infection xp king purchase ketoconazole cream with paypal. Transurethral electrovaporization of the prostate versus transurethral resection of the prostate: a prospective randomized study negative effects of antibiotics for acne generic ketoconazole cream 15gm online. Is catheter cause of subjectivity in sensations perceived during filling cystometry. Apoptotic and proliferative index after Alpha-1-adrenoceptor antagonist and/or finasteride treatment in benign prostatic hyperplasia. Increased bladder apoptosis with alpha-1 adrenoceptor antagonists in benign prostatic hyperplasia. The impact of participation in a study of medical treatment of lower urinary tract symptoms on the incidence of prostate surgery. Can prostate epithelial content predict response to hormonal treatment of patients with benign prostatic hyperplasia. Accuracy and repeatability of prostate volume measurements by transrectal ultrasound. Test-retest variation of pressure flow parameters in men with bladder outlet obstruction. Anatomical studies of the urethral plate: why preservation of the urethral plate is important in hypospadias repair. Is bladder cycling useful in the urodynamic evaluation previous to renal transplantation. Plasmakinetic resection of the prostate versus standard transurethral resection of the prostate: a prospective randomized trial with 1-year follow up. Characteristics of drug interactions with recombinant biogenic amine transporters expressed in the same cell type. Changes in molecular forms of prostate-specific antigen during treatment with finasteride. Renal intratubular crystals and hyaluronan staining occur in stone formers with bypass surgery but not with idiopathic calcium oxalate stones. Superior dialytic clearance of beta(2) microglobulin and p-cresol by high-flux hemodialysis as compared to peritoneal dialysis. Patient satisfaction and complications following sacral nerve stimulation for urinary retention, urge incontinence and perineal pain: a multicenter evaluation. Lower urinary tract symptoms, pain and quality of life assessment in chronic non bacterial prostatitis patients treated with alpha-blocking agent doxazosin; versus placebo. Increased prostatic lysophosphatidylcholine acyltransferase activity in human prostate cancer: a marker for malignancy. Transurethral resection of prostate: technical progress by bipolar Gyrus plasma-kinetic tissue management system. Role of Ca 15-3 in patients with biochemically suspected prostate cancer and multiple negative ultrasound-guided prostate biopsies. Transforming growth factor-beta 1 gene polymorphisms and expression in the blood of prostate cancer patients. Current issues and reported findings from the National Survey on Benign Prostatic Hyperplasia. Long-term (4 year) efficacy and tolerability of doxazosin for the treatment of concurrent benign prostatic hyperplasia and hypertension. Hyperphosphatemia is prevalent among children with nephrotic syndrome and normal renal function. Development of a dosage strategy in patients receiving enoxaparin by continuous intravenous infusion using modelling and simulation. Mechanisms and current treatments of urogenital dysfunction in multiple sclerosis. Importance of red patches diagnosed in cystoscopy for haematuria and lower urinary tract symptoms. Expression of vascular endothelial growth factor receptors in human prostate cancer. Randomized comparison of loops for transurethral resection of the prostate: preliminary results. Sleep-disordered breathing occurs frequently in stable outpatients with congestive heart failure. Characterization of prostate-specific antigen binding peptides selected by phage display technology. Effects of 5 alpha reductase inhibitors on androgen-dependent human prostatic carcinoma cells. General state of health and psychological well-being in patients after surgery for urological malignant neoplasms. Antiproliferative B cell translocation gene 2 protein is down-regulated post-transcriptionally as an early event in prostate carcinogenesis. Plasma concentrations of tumor necrosis factor alpha may predict the outcome of patients with acute renal failure. Clinical results of the transurethreal resection and evaluation of superficial bladder carcinomas by means of fluorescence diagnosis after intravesical instillation of 5-aminolevulinic acid. Evaluation of a multivariate prostate-specific antigen and percentage of free prostate-specific antigen logistic regression model in the diagnosis of prostate cancer. Benign prostatic hyperplasia: medical management considering sexual function and prostate cancer. Insulin-like growth factor I is not a useful marker of prostate cancer in men with elevated levels of prostate-specific antigen. Improved diagnosis of early kidney allograft dysfunction by ultrasound with echo enhancer-a new method for the diagnosis of renal perfusion. Facts and future lines of research in lower urinary tract symptoms in men and women: an overview of the role of alpha1-adrenoreceptor antagonists. The clinical efficacy and tolerability of doxazosin standard and gastrointestinal therapeutic system for benign prostatic hyperplasia. The effect of doxazosin on sexual function in patients with benign prostatic hyperplasia, hypertension, or both. An improved approach to followup care for the urological patient: drop-in group medical appointments. Creatinine clearance underestimates renal function and pharmacokinetics remain virtually unchanged. Transurethral microwave thermotherapy in the armamentarium of therapeutic modalities for benign prostatic hyperplasia. Long term followup of randomized transurethral microwave thermotherapy versus transurethral prostatic resection study. Intra-prostatic vasculature studies: can they predict the outcome of transurethral microwave thermotherapy for the management of bladder outflow obstruction. Long term follow-up of laser treatment for lower urinary tract symptoms suggestive of bladder outlet obstruction. High energy transurethral microwave thermotherapy for the treatment of patients in urinary retention. Validation of a computer version of the patient administered Danish prostatic symptom score questionnaire. A prospective study of the natural history of hematuria associated with benign prostatic hyperplasia and the effect of finasteride. Natural history and clinical predictors of clinical progression in benign prostatic hyperplasia. The effect of intestinal urinary reservoirs on renal function: a 10 year follow-up. Quality of life of patients with newly diagnosed poor prognosis M1 prostate cancer undergoing orchiectomy without or with mitomycin C. Randomised evaluation of alternative electrosurgical modalities to treat bladder outflow obstruction in men with benign prostatic hyperplasia. Plasma chromogranin A in patients with prostate cancer improves the diagnostic efficacy of free/total prostate-specific antigen determination. Lower-energy thermotherapy in the treatment of benign prostatic hyperplasia: long-term follow-up results of a multicenter international study. Patients with bladder outlet obstruction who refuse treatment show no clinical and urodynamic change after long-term follow-up. The usefulness of power Doppler ultrasonography for diagnosing prostate cancer: histological correlation of each biopsy site. Holmium laser resection of the prostate is more cost effective than transurethral resection of the prostate: results of a randomized prospective study. Incidence of anemia in sirolimus-treated renal transplant recipients: the importance of preserving renal function. Occupational risk factors for prostate cancer and benign prostatic hyperplasia: a case-control study in Western Australia. Risk factors for surgically treated benign prostatic hyperplasia in Western Australia. Molecular profiling of benign prostatic hyperplasia using a large scale real-time reverse transcriptase-polymerase chain reaction approach. Dexmedetomidine infusion is associated with enhanced renal function after thoracic surgery. Comparison of marker protein expression in benign prostatic hyperplasia in vivo and in vitro. A review of studies published during 1998 examining the treatment and management of benign prostatic obstruction. Evaluation of greenlight photoselective vaporization of the prostate for the treatment of high-risk patients with benign prostatic hyperplasia. Photoselective vaporization of the prostate in the treatment of benign prostatic hyperplasia. Milestones in endoscope design for minimally invasive urologic surgery: the sentinel role of a pioneer. Prostate-specific antigen changes as a result of chlormadinone acetate administration to patients with benign prostatic hyperplasia: a retrospective multi-institutional study. Variations of transition zone volume and transition zone index after transurethral needle ablation for symptomatic benign prostatic hyperplasia. Magnetic stimulation of the sacral roots for the treatment of stress incontinence: an investigational study and placebo controlled trial. Practice patterns regarding prostate cancer and benign prostatic hyperplasia in Japanese primary care practitioners. Relationship between serum prostate-specific antigen and calculated epithelial volume. Anisotropic diffusion in kidney: apparent diffusion coefficient measurements for clinical use. A prospective randomized trial of nebulized morphine compared with patient-controlled analgesia morphine in the management of acute thoracic pain. Prospective randomized controlled trial comparing plasmakinetic vaporesection and conventional transurethral resection of the prostate. A comprehensive characterization of the peptide and protein constituents of human seminal fluid. The effect of medical therapy and islet cell transplantation on diabetic nephropathy: an interim report. Glomerulation observed during transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia is a common finding but no predictor of clinical outcome. Changes in serum prostate-specific antigen following prostatectomy in patients with benign prostate hyperplasia. Decreased expression of G protein-coupled receptor kinases in the detrusor smooth muscle of human urinary bladder with outlet obstruction. Prognostic significance of serum soluble Fas level and its change during regression and progression of advanced prostate cancer. Prostate-specific antigen, prostate volume and transition zone volume in Japanese patients with histologically proven benign prostatic hyperplasia. Videourodynamic studies in men with lower urinary tract symptoms: a comparison of community based versus referral urological practices. Indium-111 labelled platelet scintigraphy can predict the immunological origin of fever in patients on dialysis carrying a non-functioning renal allograft. Urinary symptoms, quality of life and sexual function in patients with benign prostatic hypertrophy before and after prostatectomy: a prospective study. Prevalence of conditions potentially associated with lower urinary tract symptoms in men. Nephropathic cystinosis in adults: natural history and effects of oral cysteamine therapy. Analysis of renal function in the immediate postoperative period after partial liver transplantation. Vesicourethral anastomosis during radical retropubic prostatectomy: does the number of sutures matter. Abnormalities of apoptotic and cell cycle regulatory proteins in distinct histopathologic components of benign prostatic hyperplasia. Natural history of lower urinary tract symptoms: preliminary report from a community-based Indian study. Histomorphology of the sphincteric musculature of the lower urinary tract including 3D-reconstruction. Muscle systems of the lower urinary tract of the male rhesus monkey (Macaca mulatta): histomorphology and 3-dimensional reconstruction. Urtica dioica agglutinin: separation, identification, and quantitation of individual isolectins by capillary electrophoresis and capillary electrophoresis-mass spectrometry.

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Diseases

• Dibasic aminoaciduria 2
• Osteogenesis imperfecta congenital joint contractures
• Multiple carboxylase deficiency, late onset
• Ciliary discoordination, due to random ciliary orientation
• Wellesley Carmen French syndrome
• Intestinal lipodystrophy
• Familial m Familial w

References

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