The pathogenesis of hypogonadism in cirrhosis is not completely understood. The levels of insulin-like growth factor-I (IGF-I), an anabolic factor with trophic actions on testes, are reduced in cirrhosis. This study was undertaken to evaluate whether rats with advanced cirrhosis develop hypogonadism and whether the administration of IGF-I exerts beneficial effects on testicular structure and function. Wistar rats with ascitic cirrhosis induced with CCl 4 were allocated into 2 groups (n ؍ 10, each) to receive recombinant IGF-I (20 g · kg ؊1 · d ؊1 , subcutaneously) or vehicle for 3 weeks. Healthy rats receiving vehicle were used as the control group (n ؍ 10). At baseline, both cirrhotic groups showed similar deterioration of liver function tests. Compared with controls, nontreated cirrhotic rats showed decreased serum levels of IGF-I (P F .05), reduced testicular size and weight (P F .001), and intense histopathological testicular abnormalities, including reduced tubular diameters (P F .001), loss of the germinal line (P F .001), and diminutions in cellular proliferation, spermatogenesis (P F .001), and testicular transferrin expression (P F .001). In addition, low serum testosterone (P F .01) and high serum LH (P F .01) were present in untreated cirrhotic animals. Cirrhotic rats that received IGF-I showed full recovery of testicular size and weight and of all histopathological abnormalities (P F .001 to F .01 vs. nontreated cirrhotic rats; P ؍ ns vs. controls). Serum levels of sex hormones tended to normalize. In conclusion, IGF-I deficiency may play a pathogenetic role in hypogonadism of cirrhosis. Low doses of IGF-I for a short period of time revert testicular atrophy and appear to improve hypogonadism in advanced experimental cirrhosis. (HEPATOLOGY 2000;31:592-600.)Hypogonadism is a frequent complication of advanced cirrhosis. This condition is characterized by low testosterone levels and relative hyperestrogenism and is frequently associated with loss of libido, sexual impotence and feminine body habitus in men and amenorrhea in women.
Urinary incontinence after radical prostatectomy has different prevalence depending on the definition. Age, prior transurethral resection of the prostate (TURP), membranous urethral length (MUL) and urethral wall thickness (UWT) were risk factors.
Purpose: Continence assessment is an essential component of follow-up after radical prostatectomy (RP). Several methods exist to assess the severity of urinary incontinence (UI). Our study examined the relationship and degree of agreement between International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) scores and the number of pads used in a 24-hour period in the assessment of UI following RP.Methods: Continence was prospectively assessed in 746 men from a Spanish urology clinic 12 months after RP using the ICIQ-SF and pad usage. The relationship between ICIQ-SF scores and pad usage was assessed using Spearman rank correlation coefficients. The Jonckheere-Terpstra trend test was used to determine whether the ICIQ-SF score and the component question scores increased with increasing pad usage. The Bonferroni-corrected pairwise Wilcoxon rank-sum test was used to determine which pairs of pad usage levels differed. The weighted kappa was used to evaluate the agreement between pad usage levels and ICIQ-SF questions.Results: The continence rate was 82% using the “no pad usage” definition of continence versus 78% using the definition of an ICIQ-SF score of 0 (P<0.001). Strong positive correlations were observed between the number of pads and the ICIQ-SF total and component question scores (r<sub>s</sub>>0.85, P<0.001). The ICIQ-SF total and component question scores increased significantly with increasing pad usage (P<0.001). The ICIQ-SF scores (P<0.018) for all pairs of pad usage levels (0, 1, 2, or 3 or more) differed significantly. The agreement between the ICIQ-SF leakage amount question and pad usage was very good (r<sub>s</sub>=0.861, P<0.001).Conclusions: At 12 months post-RP, 24-hour pad usage was closely correlated with ICIQ-SF, although the continence rate differed depending on the definition used. Higher levels of pad usage were associated with higher questionnaire scores, more leakage, and poor quality of life (interference with everyday life).
Objectives To determine the incidence of renal cell carcinoma (RCC) detected incidentally and to compare the survival of these patients with that of patients presenting with suspected RCC. Patients and methods In a retrospective study, 157 patients surgically treated for RCC from 1979 to 1993 were grouped according to whether the tumour was found incidentally (n=55) or whether the renal tumour was suspected (n=102). The groups were compared for tumour grade, stage and size, patient age, sex and survival using univariate and multivariate analyses. Results There were significant differences between the groups in the number of patients with T2 (P<0.001), T3a (P<0.05), T3b (P<0.01), T4 (P<0.05) and M1 (P<0.05) stages of disease. There was also a significantly greater proportion of patients with grade 1–2 tumours (P<0.05) in those diagnosed incidentally. The accumulated overall survival rate was 64% at 5 years, 50% in the group with suspected RCC and 86% in those with tumours discovered incidentally over the same period. There were significant differences (P<0.001) in the distribution of survival in the two groups. Conclusion The patients with incidentally discovered RCC had a prognostically more favourable tumour stage, grade and size. Pathological stage and lymph node metastases influenced the difference in survival between the groups. As there was no difference in survival with tumour stage (T1–2), we consider that grade, size and particularly pathological stage determine the better prognosis.
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