Objective: to demonstrate the possible effectiveness of a long-term multimodal medical therapy in patients with Peyronie's disease (PD) we carried out a controlled study on 82 patients diagnosed with PD, whereas in the scientific literature the conservative treatment of this disease is much discussed.Methods: 82 patients (mean age=53.6±10.1 years-range 23-68) diagnosed with PD were selected for this study. Of these 41 patients (group A) were treated for 18 months as follows: Verapamil penile injections (12 total injections for six months and subsequently every month for twelve months: total 24 injections) + Iontophoresis with Verapamil/daily + blueberries 160mg/daily + propolis 600mg/daily + Vitamin E 600mg/daily + topical Diclofenac/daily. The other 41 patients spontaneously decided not to receive treatment for several motives and then were introduced as a control group B. All patients were controlled at 6-and 18-month follow up with the same diagnostic tests completed before the therapy (penile ultrasound, photograph documentation, pain scale etc.).
Results:In group A, after treatment of 6 and 18 months, the change in plaque volume consisted in volume reduction= -47.6% and -73.6% respectively, while in group B, the change consisted of an increase in plaque volume= +55.7% and +118.7% respectively (p=0.000). In group A, after treatment of 6 and 18 months, improvement of curvature occurred in 76.3% and 81.5% of the cases respectively, while in group B it occurred in 2.7% and 8.1%, respectively (p<0.0001).
Conclusion:Our results showed that a long-term multimodal medical therapy (Verapamil associated with Antioxidants and local Diclofenac) is statistically effective to treat PD patients, if we consider that lower therapeutic outcomes were achieved after 6 months treatment (medium-term treatment). Furthermore, this study confirms that the best treatment modality for PD is a combination therapy.
Tako-tsubo kardiomyopatie (rovněž stresem navozená kardiomyopatie) je syndrom připomínající akutní infarkt myokardu (AIM); k rozvoji tohoto syndromu často dochází po emoční nebo fyzické zátěži. Popisujeme případ pacientky, u níž došlo k rozvoji tako-tsubo kardiomyopatie, kdy se po implantaci kardiostimulátoru vytvořila koronární píštěl. Tuto možnost musí mít implantující chirurg vždy na mysli; lze jí zabránit vhodným psychologickým screeningem a použitím sedace při vědomí.
A customized conventional mitral reoperation still represents a satisfactory and effective treatment option for PPL and should be considered even in patients with very complex issues.
Rational:
Infective endocarditis (IE) is defined as an infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium.
Patient concerns:
A 53-years-old man with a history of alcohol abuse was admitted in hospital for fever, paroxysmal atrial fibrillation cardioverted by Amiodarone and pulmonary infection.
Diagnosis:
A case of recurrent severe endocarditis, with neurological complications both ischemic and hemorrhagic and heart failure caused by Streptococcus agalactiae in healthy man we reported.
Interventions:
Surgery was performed 2 weeks after admission.
Outcomes:
The onset of intracranial hemorrhage delayed second cardiac surgery and the patient died because of end-stage heart failure.
Conclusions:
Infective endocarditis caused by S. agalactiae is very rare, particularly in patients without underlying structural heart disease. This study showed that IE due to S. Agalactiae is a disease with high mortality when associated with neurological complication, heart failure but especially when it is recurrent and hits valve prosthesis.
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