New-born chest looks completely natural to feel soft and comfortable silicone implants. At the moment, experts from Britain and the University of Melbourne are doing everything we xeloda price can to the revolutionary technology soon became available conventional women, reports The Daily Express.
Thus, the technology is as follows: during the preparatory phase with liposuction to the thighs or belly fat is taken. Scientists separate the fat and stem cells. Further, recent nurtured in laboratories. Already grown stem cells are again mixed with fat and injected back to the patient in the chest area.
The technology involves the use of a plastic cage, placed under the skin at the place where the breast was removed. Just, this brand name viagra framework and will be filled with a mixture of cells. For 6-12 months, stem cells and fat are slowly increasing, while the new tissue is formed. At the end of the frame just removed, but now scientists are developing a resorbable mesh.
Kefa Professor Mokbel, a surgeon from London St George's Hospital, examined the cellular technology to the group of patients some time ago. Participants in the experiment has become formalized a full chest. According to him, the result is very impressive. Also worth taking brand viagra into account the convenience of technology, because it allows you to recover as the whole breast as a whole, and its separate parts. The specialist believes that the therapy will be useful in plastic surgery to replace the saline or silicone implants.
New-born chest looks completely natural to feel soft and comfortable silicone implants. At the moment, experts from Britain and the University of Melbourne are doing everything we xeloda price can to the revolutionary technology soon became available conventional women, reports The Daily Express.
After the analysis obtained during the initial examination of data, exclusion of prostate cancer and BPH diagnosis before the doctor gets the choice of tactics: surgery, drug therapy or follow-up.
On the basis of modern ideas to be assigned to medical therapy of BPH patients with initial manifestations of disorders of urination without engaging in the process of the upper urinary tract complications in patients with relative and absolute contraindications to surgical treatment, patients who refused surgical treatment, or by postponing it for various current views on masturbation reasons.
Dynamic observation is acceptable in patients with mild symptoms of BPH (IPSS J 8), and patients, quality of life are not significantly affected because of existing symptoms. Surveillance of such patients includes an cialis brand explanation of the need to control the way of life, regular delivery of blood and urine tests, monitoring PSA, ultrasound, and uroflowmetry.
Surgical treatment is indicated in patients with symptomatic, involving in the process of the upper urinary tract who have contraindications to medical therapy or have reason to believe that medication will be ineffective.
If questions of viagra pfizer cialis eli lilly levitra bayer surgical treatment of BPH does not cause in recent years a lively debate and transurethral resection of benefit over other techniques is a well-established fact, the issue of medical treatment of BPH such clarity is not observed.
Below are the main groups of drugs used for medical therapy of BPH, depending on their origin and the point of application in the pathophysiology of urination disorders in BPH:
We believe that the first category of patients who have symptoms of bladder outlet obstruction takes precedence over the order brand viagra tablet actual increase in prostate size, shows a-blocker therapy. This choice is due to proven ability to drugs in this group significantly increased Qmax and lower score of IPSS, without reducing the volume of the prostate that is not necessary in this patient.
Proved that in the body of the bladder revealed predominantly cholinergic and b-adrenergic nerve endings, while the posterior urethra and prostate gland contain mainly aadrenergicheskie receptors. This distribution of receptors plays an important role in the coordination of muscles of the bladder and prostate.
Studies in recent years have shown that BPH leads to increased activity of sympathetic nerve fibers, which causes an increase in the tone of smooth muscle structures, the base of the bladder, posterior urethral and prostate. The process of hyperplasia is how to satisfy woman predominantly due to stromal component of the prostate gland, which contains up to 60% of smooth muscle fibers that are point of application a-blockers. The mechanism of action of a-blocker is a relaxation of smooth muscles of the bladder neck and posterior urethra due to the blockade a1adrenoretseptorov. This is the most popular and largest group of drugs. A comparative analysis of treatment of different a-blockers proved their effectiveness against symptoms of urinary identical [5,7].
In Russia the most popular drugs in this group is alfuzosin. He was taken twice a day to 5 mg after a meal. Currently, there is a new dosage form of sustained-release preparations containing 10 mg of alfuzosin and figured on single dose during the day. Very popular and other members of this pharmacological group doxazosin and terazosin. Both drugs are designed for single dose during the day, the dose is titrated. I terazosin standard dose ranges between 5 and 10 mg, whereas doxazosin is better to use 4-8 mg. Tamsulosin once assigned to 0.4 mg.
For the treatment of urological disease in this age usually use alpha-blockers or inhibitors of the enzyme 5-a reductase inhibitors. Of first-team quickly relieve tension of the muscles surrounding exit from the bladder, thereby contributing to the outflow of urine.
Second family of drugs reduce the size of the prostate, but their therapeutic effect is seen only after 3-4 months after starting treatment. Doctors already knew that the combination of both types of drugs usually produces the best clinical results, but the exact measure of the effectiveness of such treatment remains questionable. Now Dr. Roerborn and his colleagues found that the simultaneous use of an alpha-blocker and doxyzocine reductase inhibitor finasteride nearly 70 percent reduced risk of progression of symptoms of prostatic hyperplasia. For patients who took only one of these drugs, the likelihood of this outcome was less than 40 percent.
Urolithiasis has been known since antiquity. Urinary stones were found in Egyptian mummies of people who died and were buried before our era. Recently, there has been a clear increase of this pathology in all regions of the world. According to many leading experts, the trend will continue in the future. This contributes to environmental degradation on the planet, poor nutrition, poor socio-economic conditions. Based on the above researchers attributed this disease to diseases of civilization. About the disease, diagnostic methods and treatments tells practitioner of the highest category, scientific consultant for the company Fizomed "Natalia Ilyin.
According to different authors, urolithiasis occurs no less than 1-3% of the population, and most often it affects people of working age. Men and women suffer roughly the same proportions.
Number of stones in the urinary tract may be different - from one to several hundred. Their sizes also vary from millet grains up to 10-12 cm in diameter. Observations of where the mass of the stone reached 2.5 kg.
Unified accepted concept of etiology and pathogenesis of the disease does not exist. Urolithiasis is a multi-cause disease. Under certain conditions created in the body, can cause a lithiasis, at least - several factors. We list the main ones. It has long been proven that one of the main factors is the high content of mineral salts in drinking water. Therefore, this disease is most common in regions where water is more rigid.
Urinary stones are formed in the urinary tract: the calyx, pelvis, bladder. Thus, impaired flow of urine is the major etiological point in the process of education concrement.
Proved that a lack of vitamin A leads to the formation of stones in the urinary system.
Another important reason is the local urinary tract infection. Moreover, specific pathogen does not exist, any infection can lead to kidney stone disease. That is why it is important to promptly and adequately treat the inflammation in the kidneys and urinary tract. Be sure to carry a treatment based on the analysis of urine bacterial cultivation and sensitivity of the pathogen to antibiotics.
Often to the emergence of this disease lead endocrine disease, various metabolic disorders.
In addition, the cause may be injured kidneys, bones, and help the formation of stones, and some drugs.
Clinical symptoms largely depend on the localization of stone in the urinary tract. So, before you describe the symptoms must be submitted to the anatomy of the genitourinary system.
Urinary system includes the kidneys, ureters, bladder and urethra.
The kidneys are paired organs and are located in the lumbar region. They lie on either side of the spine at the level of the 1 st and 2 nd lumbar vertebrae. The right kidney is usually a few inches below the left.
Kidneys are in the form of large bean. Their surface is smooth, dark-brown color, the outer edge of the convex, inner - concave. In the area of the inner edge of the gates are located, which includes renal Vienna, renal artery, nerves, lymph vessels and ureter. Circulatory system of the kidneys developed very strongly. Renal artery has the mighty tree.
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The results of the postoperative examination
In this study, 122 patients (95.3%) underwent transurethral resection of the prostate using the standard technique of performance on Barnes & Nesbit. In 6 cases (4.7%) held elektrovaporizatsiya prostate.
Only 2 patients (1.6%) during transurethral resection of a perforated surgical capsule of the prostate on a background of spontaneous reduction in its electrical stimulation in the process of implementation. In this regard, we believe that the final stage resection of the prostate should be carried out using standard electrodes and only the use of conventional modes of power (150-200 W).
In 18.75% of the cases made contact tsistolitotripsiya, 32 patients performed two-way vasoresection.
Surgical operations have the ability to inhibit the function of the endocrine glands, the degree of inhibition is directly proportional to traumatic running interference. When comparing the testosterone levels of blood plasma in patients after transurethral resection and electrovaporization in the immediate postoperative period revealed a significant decline in its first day with a tendency to reverse the growth of the first week. At the same time in patients undergoing elektrovaporizatsiyu, decrease in the concentration of this hormone is much more pronounced. This may indicate that at elektrovaporizatsii degree of traumatic physical impact on the prostate gland and surrounding tissue more. Based on these data we can conclude the high sensitivity of testicular tissue whose function is inhibited in response to injury prostate surgery for BPH.
After three months of monitoring results of the questionnaire (international index of erectile function scale quantification of the male copulative function) showed a slight decrease in the average maximum score, which indicates that on average, a rapid intervention is not a serious depotentsiruyuschego impact. However revealed declines in overall satisfaction with sexual intercourse, the state of the copulative function as a whole, as well as individual components of the copulative cycle: libido, erectile function, particularly ejaculatory component as a result of the postoperative symptoms of retrograde ejaculation. The greatest severity of copulative disorders observed in patients with weak sexual constitution, complications arise in the course of surgery, a significant hormonal imbalance, and severe concomitant diseases.
Data Analysis Hospital Anxiety and Depression Scale (GSHTD) revealed a decrease in the manifestations of anxiety-depressive syndrome at 3 months after surgery. Explanation of this fact, in our opinion, is a marked improvement in the quality of self-urination, especially for men socially active age. Thus, the very holding of surgery significantly reduces the severity of anxiety and depressive symptoms for most patients.
In 86% of patients surgery did not degrade the quality of erectile function, but for 29.7% of patients required an additional correction of erectile disorder whose symptoms were identified brand name levitra prior to surgery. In the presence of dominant complaints of dysuria, painful compelling urgency, intermittent difficulty urinating appointment a-adrenergic blockers leads to an improvement in erectile function in this background, 40% of patients. In patients with severe climacteric syndrome in combination with gipotestosteronemiey and / or hyperestrogenemia use of hormone replacement therapy with androgens is effective in 50% of cases. For people who have major complaints were the manifestation of anxiety-depressive syndrome, treatment of modern homeopathic anxiolytics had a positive effect in 60% of patients. Patients with manifestations of erectile dysfunction which could be explained by increased levels of prolactin plasma without significant changes in blood supply to the penis, dopamine agonist therapy (bromocriptine) is effective in about 75% of cases.
Of the total group of examined patients, 14% noted worsening of erectile function after endoscopic intervention. Attention is drawn to the fact that all these patients prior to surgery were identified certain symptoms of erectile dysfunction, although they lived sex life. Average prescription manifestations of benign prostatic giperaplazii - 4,9 years. Of all the patients in this group 66.7% were unmarried. Overweight as a risk factor for erectile dysfunction, was detected in 55.6% of cases. In all 18 patients had intercurrent illness, due to which 72.2% received concomitant therapy.
Complaints of patients were typical for erectile dysfunction, the most important of which were difficult to achieve a full erection (83.3%) episodes of detumescence without ejaculation (88,9%). In 77,8% of cases in the postoperative period revealed retrograde ejaculation, in 22,2% - partly antegrade with a decrease of sperm released. With 50% of patients attributed the deterioration of erectile function has arisen precisely with impaired ejaculation, confident retrograde ejaculation that imposes a substantial negative impact on the quality of erections. Giposteziya glans penis during intercourse was noted in 61.6% of cases that may be indirect evidence of a partial deinnervatsii body. Patients after bilateral vasoresection (33,3%) at the peak of sexual arousal marked soreness and discomfort in the groin, perineum and scrotum. Although according to world literature there is no direct relationship between vasoresection and deteriorating quality of erection, however, according to our observations in these patients the appearance of the above claims may negatively affect the quality of sexual intercourse.
Mycoplasmas and ureaplasmas
Currently, there is growing mycoplasmal infections of urogenital tract. Of the mycoplasmas found in the genitourinary system, are noteworthy Mycoplasma hominis (mycoplasmosis) and Ureaplasma urealitikum (ureaplazmoz). Mycoplasma hominis was detected in 1937. It is frequently isolated from urinary tract of patients. Ureaplasma urealitikum was discovered in 1954 from the discharge of a patient NGU. Ureaplazmoz and mycoplasmosis in clinical manifestations are very similar.
According to the literature, the defeat of urogenital mycoplasma infection accounts for 40 percent of all inflammatory diseases of the urinary tract. Mycoplasmosis and ureaplazmoz have persistent flow, often recur, contribute to the appearance of complications. As a rule, mycoplasmosis and ureaplazmoz combined with gonorrhea, trichomoniasis. When mixed sexually transmitted diseases often reveal mycoplasmas and ureaplasmas.
Ureaplazmoz and mycoplasmosis, as well as all sorts of infectious diseases have an incubation period. On the duration of the incubation period in patients with urogenital mycoplasmal lesions is still no consensus. It is believed that the incubation period can range from three days to three to five weeks, according to some estimates, up to 50-60 days. According to the literature, the average incubation period for urethritis associated with mycoplasma, is 19 days.
Numerous papers published in recent years indicate a significant prevalence of mycoplasma infection in trihomonadnyh, gonococcal and chlamydial lesions of the urinary tract, acute and chronic inflammation of female genital sphere of unknown etiology, pathology of pregnancy and the fetus. In the discharge of the urethra and the juice of the prostate gland of males with different postgonoreynymi complications (prostate, vesicles, epididymitis, orchiepididymitis) is often found mycoplasma and ureplazmu.
In these patients, marked decrease in potency, and secondary infertility. A large percentage of allocation of mycoplasmas and ureaplasmas with trichomoniasis, gonorrhea, chlamydia brand name viagra 50mg indicates the role of a mixed mycoplasma - and ureaplazmogonokokkovoy, mycoplasma and ureaplazmotrihomonadnoy, mycoplasma and ureaplazmohlamidiynoy infection in the genesis of various inflammatory processes in the human urogenital area.
Chlamydial urogenital infection often accompanies ureaplasma. It is known that mycoplasmosis and ureaplazmoz women and men often exist malosimptomno or without any clinical symptoms and subjective feelings. In such cases patients are unaware of their disease and do not apply to hospitals. Most researchers suggest that the only source of mycoplasmosis and ureaplasmosis is a sick person or mycoplasma and ureaplazmonositel.
Infection occurs exclusively through sexual contact. There is a strong correlation between sexual activity and the incidence of mycoplasmosis and ureaplasmosis. Ureaplasma and mycoplasma are often found in the urethra and the cervical canal of sexually active men and women. The frequency of detection increases with enlarging the circle of sex. Mycoplasma and ureaplasma are unique microorganisms. Mycoplasma, for example, occupy an intermediate position between the viruses, bacteria and protozoa. Mycoplasmosis and ureaplazmoz men do not have the characteristic clinical picture.
There is a large number of different clinical forms - from acute to oligosymptomatic. Men mycoplasma and kreaplazmy can attack the urethra paraurethral ducts, prostate gland, seminal vesicles, epididymis, urinary bladder. A transition of inflammation in the upper urinary tract and kidneys (due to the upward mi-koplazmennoy infection). Urethritis may occur acute, subacute or sluggish. Typically, it takes erased malosimptomno. Characterized by a slight mucous discharge from the urethra, feeling weak itching, tickling, burning.
Subjective feelings can disturb the little patients either do not bother. But the number of patients impose a variety of complaints, including those on sexual disorders. Most often the infection spreads deeper into the prostate gland, seminal vesicles from prostate urethra directly through the excretory ducts. Does not exclude the possibility of contact with mycoplasmas and ureaplasmas in the prostate gland from the front of the urethra through the blood and lymph vessels.
Contributing to the moments of prostatitis and vesiculitis are sexual excess, alcohol use, delayed and coitus interruptus and other clinic in mycoplasma and ureaplasma lesion of the prostate did not differ from those in prostatitis and vesiculitis other etiologies.
From complications arising in men with mycoplasmosis and ureaplasmosis occurs epididymitis (inflammation of the epididymis), orchitis (testicular inflammation) and orchiepididymitis (inflammation of the epididymis and testis at once). Epididymitis is often observed in patients with prolonged course of urethritis. This disease can also occur in cases where the inflammation goes into the prostate urethra, which, by samyavynosyaschemu the canal enters the epididymis.
Urinary incontinence affects up to half of all older women, with an unpleasant disease is involuntary urination when coughing, laughing, and other minor stresses. Minimally invasive treatments are often ineffective and, for example, collagen injections help for a short period of time. Number of surgical operations for this disease has grown considerably in recent years - both in the U.S. in 1979, holds 3.2 of operations per 10 000 women, and in 1997 - more than 6 (New England Journal of Medicine).
Recently proposed a new solution to the problem of stress urinary incontinence - tissue engineering using autologous stem cell patients.
Specialists from the Medical University of Innsbruck (Austria) was isolated from blood and muscle tissue of patients two cell types: fibroblasts (the main connective tissue cells) and myoblasts (muscle stem cells). They were grown in culture for 6-7 weeks, and then under ultrasound fibroblasts were injected into the urethra (the urethra), and myoblasts - in the sphincter (closing muscle) of the bladder.
In clinical trials, was attended by 184 people with stress urinary incontinence - some of them before the treatment had to use up to 24 pads a day. A year after the introduction of cells in 80% of patients the disease was cured, the treatment effect is not weakened with time.
Clinical trials funded by Innovacell Biotechnologie, which owns the patent for this method of treatment.
Good results of injections of stem cells obtained by another group of scientists - from the University of Pittsburgh School of Medicine and Sunnybrook Health Sciences Centre in Toronto. Tests were conducted on eight patients who were injected in the sphincter of autologous muscle stem cells. Observed long-term (more than a year) a significant improvement in five patients, and fully cured one.
The basis for these tests have good results of earlier experiments on animal models of urinary incontinence. In these experiments, it was shown that by injecting stem cell regeneration occurs weakened sphincter muscles.
Planned to conduct a large-scale multicenter clinical trials of this method in Canada and the U.S., which will be chosen at the optimal number of input cells.
Proceedings of these studies are presented in the reports on the passing now the annual convention of the American Urological Association (American Urological Association).
Renal failure - a dangerous complication of multiple myeloma. It is found in half of all patients at the time of diagnosis and is second after infection leading cause of death [DeFronzo et al., 1978; Kyle, 1975]. According to a study conducted by the Medical Research Council, renal function is an important single factor determining the prognosis of the disease, showed that mortality among patients with levels of blood urea to 12 mmol / L were 5 times higher than among patients with normal value of this rate at the time of diagnosis [Galton et al., 1973]. The basis of renal dysfunction in myeloma may be based on a variety of different mechanisms leading to acute or chronic renal failure, nephrotic syndrome (usually in combination with amyloidosis), or occasionally - to the Fanconi's anemia. Of particular importance in the pathogenesis of renal lesions attached easily avoidable disturbances, such as hypercalcemia, hyperuricemia, and increased blood viscosity [Cohen, Rundles, 1975]. Increased serum levels of calcium or uric acid can certainly be associated with acute renal failure, and vomiting and polyuria, associated hypercalcemia, increase water loss due to a direct violation of its tubular reabsorption. Because of dehydration and related hypertonic blood introduction so sick of contrast medium for intravenous urography is contraindicated [Cohen, Rundles, 1975].
Cause of progressive viagra san antonio chronic renal failure, so often observed in multiple myeloma, remains controversial. Reported a clear relationship between impaired renal function and urinary excretion of light chain paraprotein [DeFronzo et al., 1978], but this observation is not confirmed by all investigators [Kyle, Elveback, 1976]. Of the 35 patients studied, all of 9 without proteinuria Bence-Jones creatinine clearance (KKR) was above 50 ml / min. More than half of patients with Bence-Jones proteinuria KKR was below 50 ml / min. Severity of urinary light chains correlated with the degree of renal failure [DeFronzo et al., 1978]. The majority of patients with a daily excretion of Bence-Jones protein above 1 g, severe renal insufficiency (mean KKR was 8 ml / min). A similar relationship was found in the first study, conducted by the Medical Research Council [Galton et al., 1973].
The assumption that the blockade of the tubules as a result of deposits of paraprotein Bence-Jones now looks doubtful, since some patients with very high levels of urinary light chains of renal function remain normal. In addition, histological examinations of renal biopsies showed that in the case of cylinders the past consist of albumin, immunoglobulin light chains and a mixture of X and X, and that marked impairment of renal function may occur in the absence of tubular cylinders [Kyle, Bayrd, 1976]. Severe atrophy of tubules - a sign of pathology, the most correlated with the clinical manifestations of "myeloma kidney". Light chains are metabolized in the cells of the tubules, providing them direct toxic effect [DeFronzo et al., 1978].
The pH of urine can be shifted to the alkaline side, may also be impaired renal concentrating ability. Occasionally, when myeloma occurs Fanconi's anemia [Maldonado et al., 1975]. In all these cases, the patient was revealed Bence-Jones proteinuria, and the diagnosis of multiple myeloma for several years, sometimes preceded by a dysfunction of proximal tubules.
In one survey [Kyle, 1975] in 7% of cases detected renal amyloidosis, which could well be the cause of the nephrotic syndrome or renal failure. Urinary tract infection is rarely the primary cause of kidney failure, but aggravates the already existing kidney failure.
Male hypogonadism, which remains at present very urgent, complex and demanding solutions problem is a manifestation of many different pathological conditions in nature. His classification is constructed based on two principles: the topographic localization of reasons (hypothalamus, pituitary, testes, target organs of androgens), and their nature (genetic, endocrine, inflammatory, traumatic, etc.). The essence of the phenomenon is the violation of the generative (spermatogenesis) and endocrine (steroidogenesis) functions, at least - only generative syndrome (Sertoli cells, the blockade of spermatogenesis, etc.). Accordingly, one of the most frequent manifestations of hypogonadism is androgen deficiency.
Hypogonadism may be accompanied by a man from birth, develop at puberty, adulthood or old age. Causes of congenital hypogonadism are the most common chromosomal viagra drug abnormalities or exposure to harmful factors in utero. Clinical experience shows that about 80% of all cases of early hypogonadism is represented by three forms: idiopathic hypogonadotrophic hypogonadism, pituitary insufficiency and Klinefelter syndrome.
Particularly intense in the last decade studied the problem of hormonal changes in men over 50 years. Obviously, the endocrine changes in aging men is not confined to sex hormones, progressing with age, androgen deficiency is its central element. The Massachusetts male aging study found that after 50 years of total testosterone decreased by 0.4% per year free - on 1,2; and testosterone, albumin-bound - by 1,0%. At the same time, the laboratory signs of hypogonadism are identified in only 3% of men aged 60 years and 20% - after 60. Male sexual function decreases slowly and gradually in the biological process of aging. This process is known as male menopause, andropause, ADAM (androgen deficiency syndrome, the age for men) or LOX (age hypogonadism). Consensus on the terminology does not exist.
Currently, most experts believe that all forms of hypogonadism associated with Leydig cell insufficiency, require treatment with testosterone. Long-term administration of testosterone is also shown in the secondary (hypogonadotrophic) hypogonadism and delayed sexual development. However, treatment with androgens underutilized. For example, approximately 4-5 million men with hypogonadism in the U.S. only 5% ever receive testosterone replacement.
The duration of the appointment of testosterone depends on the particular situation. For example, if the delay of sexual development, it is a few months, and climacteric disorders make reasonable lifetime Androgen replacement therapy (AZT).
Currently, most experts believe that all forms of hypogonadism require treatment with testosterone. However, from the 4.5 million men with hypogonadism in the U.S. only 5% ever receive testosterone replacement.
In cases of androgen deficiency testosterone treatment is shown at its concentration in the blood serum in the morning below 12 nmol / liter. For correction of menopausal disorders milestones are its brand viagra for sale clinical manifestations. In accordance with international consensus, the main purpose of AZT is to achieve and maintain serum testosterone concentration within the physiological norm.
When choosing a drug for pathogenic therapy of androgen should be considered: the ability of the drug to restore testosterone levels to physiological values without suppressing the function of the testes, absence of liver toxicity and carcinogenicity, the content of natural molecules of testosterone, the route of administration, the presence of a full range of effects of testosterone; flexible titration and rapid withdrawal drug.
The route of administration of testosterone preparations is their fundamental difference. To date, the most widely used oral, injectable, subcutaneous (implants) and transdermal (epicutaneous) testosterone.
From laboratory diagnostic techniques "gold standard" remains a classic test of EM Meares and TA Stamey (1968): collection of the first and second urine sample, obtaining prostate secretion by massage, and then - the third urine sample. Microscopic and bacteriological indicators allow us to establish the presence of an inflammatory process and its localization. It should be remembered that not every sown from prostate secretion or a third urine sample microorganism should be considered as an herbs with viagra effect etiological factor in prostatitis, given the possibility of contamination of the material urethral microflora.
A number of physico-chemical and biochemical changes of prostate secretion, could serve as additional diagnostic criteria for chronic prostatitis, these should include: the shift of the pH secret to the alkaline side, lowering the content of acid phosphatase in the exacerbation of the inflammatory process, as well as increased activity of lysozyme and, in some cases , PSA. Highly informative in identifying and characteristics of inflammation in the prostate is a smear cytology gland secretions, including luminescent-cytologic. Retains its diagnostic value of test of crystallization of the secret. In healthy men, such crystallization forms a characteristic pattern in the form of a fern leaf. In case of violation of aggregation properties of the secret, that is most often observed when the androgen hormonal levels in patients with chronic prostatitis, this figure is broken. If the increase in the number of leukocytes in viagra 100mg secretions are likely talking about her inflamed, their normal levels when the available clinical picture is not indicative of the absence of prostatitis. Well-known nutritional provocation spicy food or weak alcoholic drinks, sometimes used for gonorrhea or trichomoniasis prostatitis, as well as provocative tests with prednisone or pirogenalom that parenteral administration can activate slow-inflammatory processes and thereby facilitate their objective the identification. Uroflowmetry is a simple and reliable way to determine the status of urodynamics, can detect early signs of bladder outlet obstruction, as well as to the dynamic control of the sick in the process of medical check-up. Needle biopsy of the prostate gland is, basically, the method of differential diagnosis of chronic prostatitis, prostate cancer and benign prostatic hyperplasia.
Thus, the diagnosis of chronic prostatitis is based on an analysis of complaints and medical history, data, rectal examination of prostate cancer, the analysis of secretions and urine from their crops and determine the sensitivity of microflora to antibiotics identified. Other methods are sexual abstinence used in addition to clarifying the nature of complications, which is important in the development of treatment.
It is, in turn, must be complex, due to which both the physician and on patient need considerable patience. It is known that some patients treatment is ineffective. The cause could be a change agent, Fatal etiopathogenetic points autoaggression, violations of patient treatment.
Traditional methods of treating chronic prostatitis:
* Massage of the prostate gland;
* Heating microwave therapy;
* Surgical treatment.
Modern methods of treating chronic prostatitis:
* Allopurinol, colchicine;
* Non-steroidal anti-inflammatory drugs (ibuprofen, nimesulide);
* Bioflavonoids (quercetin);
* Cytokine inhibitors (a-MSH, il-1 Ra, THF);
* Inhibitors of 5-α - reductase;
* Cyclosporin A.
A number of factors and circumstances must be taken into account when planning antibiotic therapy (ABT) of prostatitis: the nature of inoculated microflora sensitivity of microorganisms to antibiotics, the spectrum of action, side effects and pharmacokinetics of skin antibacterial drugs, the earlier the BLS, the starting date and duration of ABT, the dose and combination of antibacterial drugs; route of administration of antibacterial drugs, the need to combine ABT with other treatments. One must consider not only the sensitivity of this pathogen to a particular antibiotic, but also the ability of the drug to accumulate in the prostate gland. Antibacterial drug to pass through the membrane gland must be fat soluble, have unstable bond with proteins, the properties of macrolides. These conditions correspond to the most commonly used macrolides - erythromycin, oleandomitsina and tetracycline. The efficiency with infectious diseases of the prostate metatsiklina (rondomitsina) monomitsina, kanamycin, gentamicin, ampicillin, Ampioks in combination with sulfonamides (trimethoprim, bactrim, Biseptol) nitrofuranov, nitroksolinom, 5-NOK, and so on trichomonas urethritis, which often complicated trihomonadnyh prostatitis used nitrofuran derivatives, metronidazole, nitazol, trihomonatsid, lyutenurin, oktilin, fasizhin, tinidazole. Failures in the ABT of chronic prostatitis can be due to insufficient duration of the course, a low concentration of antibacterial agent and (or) formation in the lumen of acini and ducts of the prostate microcolonies of bacteria coated with extracellular polysaccharide sheath (M. Falagas, 1995). With the goal of therapy of chronic prostatitis using both traditional (oral, parenteral) and nonstandard (intraprostatic, endolymphatic, lymphotropic) route of administration of antimicrobials.
Many women approach menopause with underlying disease of the endocrine system, in particular, endocrinopathy. In a study of women peri-and postmenopausal complaints, typical for the climacteric syndrome, without a history of diseases of the endocrine system, was found a high prevalence of thyroid disease: 40% of women have nodules and hypothyroidism. This fact should be noted, particularly in iodine deficiency that existed in many regions of our country. Is now generally recognized that iodine deficiency disorders - it is usually hidden hypothyroidism. Hyperplastic thyroid tissue only for a time able to maintain euthyroid state, with elevated body's need for thyroid hormone, which occurs during adaptation to new conditions, manifested hypothyroidism.
Lack of specific symptoms in most elderly patients, and more similarity of clinical manifestations of menopause with symptoms of hypothyroidism can mask or exacerbate the clinic of one of the diseases.
Over the past few years in the treatment of menopausal disorders has been significant progress. The main method of their correction and prevention is a hormone replacement therapy (HRT) analogues of sex hormones. Despite the availability of proven benefits of HRT in menopause, in practice doctors often fear the use of HRT due to the presence of extragenital pathology in women of this age, including the thyroid gland.
One of the most modern drugs for HRT is Femoston, containing 17-b-estradiol (2 mg) of plant origin, in conjunction with the cyclical use of dydrogesterone (10 mg), an analog of natural progesterone. After using one pack should immediately take the following, which provides continuous taking the drug. Dydrogesterone is characterized by the metabolic stability and absence of estrogen, androgen and mineralocorticoid activity, high bioavailability after oral administration.
The purpose of the study
Evaluate the clinical efficacy and acceptability of drug Femoston HRT in postmenopausal women with hypothyroidism.
Materials and methods
In the department of Gynecological Endocrinology (Centre for Women's Health after 40 years) and in Nalchik surveyed 252 women aged 45 to 60 years, indicating a history of thyroid disease. All patients climacteric syndrome arose as a result of natural ovarian failure. In 72 (28.6%) of them on the background of various thyroid gland was diagnosed hypothyroidism. At the present time to ascertain the cause of primary hypothyroidism does not significantly alter the algorithm of its treatment. Given this fact, all patients pending the appointment of HRT was carried out payment of hypothyroidism with levothyroxine drug in individually selected dose (50-150 mg / day).. 35 people took part in further study, were divided into two groups: Group 1 (21 patients) were treated with Femoston, in group 2 (14 women), HRT was not conducted due to the presence of absolute contraindications to it.
To assess the severity of the climacteric syndrome (CS) used the Kupperman menopausal index to modify Uvarovoy EV (1982). Were also provided clinical and laboratory research methods: determination of the concentration of TSH, T3, T4, T4sv baseline and after 3, 6 and 12 months of therapy, ultrasound volume and structure of the thyroid gland, blood lipid profile.
I must say that saccharin had to "feed" the majority of the adult population of the planet. Even those people who never replace sugar sweeteners, receive daily a considerable amount of this substance.
The fact that saccharin is widely used in food industry. One of the ingredients of ice cream, creams, gelatin desserts and other pastry is a food additive E 954. Under this elusive and little-understood alias hiding saccharin. So he has long been an integral part of our everyday lives.
The second synthetic sweetener are sodium and potassium salts Cyclamic acid, simply put, cyclamate. Career of this sweetener immediately began with a major scandal: Doctors have declared him a carcinogen, and slow acting poison. Only recently was the sale of cyclamate permitted in the European Union. However, in France, Britain and the United States, this substance is still officially banned the production and consumption.
In Russia, this replacement was examined by the Ministry of Health and tested Gosepidnadzora. Despite the approval of higher authorities, experts do not recommend the use of cyclamate to pregnant women, children and people suffering from kidney failure. For everyone else there is an admissible daily dose of the sweetener, which corresponds to 11 mg per 1 kilogram.
One of the most popular sugar substitute aspartame is synthesized in the 70th years of the company "Monosanto". Now it accounts for about 25% of the total consumption of "sweet synthetics. In spite of this prevalence, aspartame poses a potential danger. The problem lies in the chemical structure of the substance: it consists of two amino acids - phenylalanine and aspargina connected by a molecule of methyl alcohol.
In the course of the research evolved methanol to formaldehyde, which is a Class A carcinogen So experts do not deny the possible complications associated with consumption of large doses of the sweetener. In addition, aspartame is accused of a multitude of other sins.
At the American Association for the Control of the use of drugs and foods (FDA) annually receives thousands of complaints in which ordinary consumers associate the disease of the gastrointestinal tract, headaches, a syndrome shutdown of consciousness and depression, with a daily consumption of aspartame. Perhaps that is why it very suspicious of all European states and forbid them to adapt to sweeten food, targeting children under four years.
Doctors do not recommend aspartame and adolescents, however, make exceptions to this substitute from their diet is very difficult. The fact that this replacement is relatively well soluble in water. This property is widely used in food industry: Aspartame is now used in almost all the "lightweight" Lemonade. It is thanks to him to sell drinks boast minimal calories. Of course, a moderate amount of such "soft drink" will not bring any harm.
Destruction of thyrocytes
According to modern concepts, the goal of surgical treatment, as well as discussed below yodom131 therapy, is removal of most of the thyroid, on the one hand, ensures the development of postoperative hypothyroidism and the other (which is most fundamentally), precluding any possibility of recurrence of hyperthyroidism. To this end, we recommend an extremely subtotal resection of the thyroid to the abandonment of the thyroid remnant is not more than 23 ml. Conducting subtotal resection, on the one hand, carries a high risk of saving or distant relapse of hyperthyroidism, and the other does not exclude the development of hypothyroidism. When the so-called "thrifty resection, the volume of which the world regarded as inadequate, it should be understood that leaving during the operation sufficient for the production of thyroid hormones of the thyroid gland in the body, in essence, remains a" target "for anti-thyroid antibodies producing cells of the immune system.
Thus, poleoperatsionny hypothyroidism is currently not viewed as a complication of surgical treatment of BG and its purpose. A precondition for this was the introduction of a broad clinical practice of modern preparations of levothyroxine, against which adequate reception of the patient remains stable euthyroidism and quality of life that does not differ from normal. To date, one can say without exaggeration that there is no hypothyroidism, the compensation which with proper use of modern preparations of thyroid hormones would be impossible. Failures in the treatment of postoperative and any other hypothyroidism should be sought either in the poor training of conducting replacement therapy, or failure to comply with the patient rather simple steps to receive the drug.
Radioactive iodine therapy
It is no exaggeration to say that worldwide the majority of patients with BG, as well as with other forms of toxic goiter, as a treatment receives it yodom131 radioactive therapy. This is due to the fact that the method is effective, neinvaziven, relatively inexpensive, devoid of the complications that may develop during surgery on the thyroid. The only contraindication to treatment yodom131 are pregnancy and breastfeeding.
If in our country to this day continues to conventional wisdom about what therapy yodom131 shown only to elderly patients who, for one reason or another can not perform the operation, it actually has no lower age limit for appointment yoda131, and in many countries yod131 has been successfully used for the treatment of BG in children. It was order cialis proved that, regardless of age the risk of therapy yodom131 significantly lower than that in surgical treatment.
In significant quantities yod131 accumulates only in the thyroid, after falling in her, he begins to disintegrate, emitting b-particles, which have path length of about 11.5 mm, which provides local radiation destruction of thyrocytes. Safety of this treatment method is demonstrated by the fact that in some countries, such as the U.S., where 99% of patients receiving BG yod131 as the first choice of treatment, therapy with BG yodom131 performed in an outpatient procedure. A significant advantage is that treatment yodom 131 can be carried out without prior training tionamidami. BG's disease when treatment is aimed at the destruction of the thyroid, therapeutic activity, taking into account the volume of the thyroid, the maximum capture time and half-life yoda131 of the thyroid is calculated from the estimated absorbed dose of 200 300 Gy. Hypothyroidism usually develops within 6 months after the introduction of yoda131.
Serious problem of domestic Endocrinology is the virtual absence of available endocrinologists such a wonderful way to treat BG, as a therapy yodom131.
BG is one of the most common autoimmune diseases in humans. His clinical presentation and prognosis in most cases determined by the persistent hyperthyroidism, which in the absence of adequate treatment may lead to severe disability patient. Currently existing treatment guidelines BG, though not without flaws, but allow you to completely rid the patient of hyperthyroidism and provide an acceptable quality of life.
Believe it necessary
To study the effect of BP control on the complications of diabetes were included 1,148 patients with type 2 diabetes. Averages of blood pressure at baseline was 160/94 mmHg At randomization in 758 patients was necessary to attain BP <between 150/85 mm Hg (ォ strict control of blood pressure サ, the first group). Of these, 358 received the drug as the main bblokator atenolol (50 100 mg / d), 400 ACE inhibitor captopril (50 100 mg / day). The remaining 390 patients made up the second group it was necessary to maintain blood pressure below the level of <180/105 mmHg without the use of ACE inhibitors and bblokatorov. If necessary (when the target blood pressure levels were not achieved even with the appointment of maximal doses of atenolol and captopril) patients of the first group was administered additional drugs. In the group with less strict control of blood pressure, these additional drugs are prescribed as initial antihypertensive therapy. This is furosemide 20 mg / day (maximum 40 mg 2 times a day), prolonged nifedipine 10 mg 2 times per day (maximum 40 mg), methyldopa 250 mg twice a day (max. 500 mg) and prazosin 1 mg 3 times a day (max. 5 mg).
The primary endpoint of the study were any clinical outcomes related to diabetes (sudden death, death from hypo or hyperglycemia, myocardial infarction, angina, heart failure, stroke, kidney failure, amputation, bleeding in the lens, retinal detachment, blindness, or cataract extraction eyes ), and death related to diabetes (myocardial infarction, stroke, sudden death, heart disease, kidney disease, hypo or hyperglycemia), and death from all causes.
Secondary endpoints included myocardial infarction, stroke, amputation or death from peripheral vascular disease and microvascular complications (retinopathy requiring photocoagulation, bleeding in the lens or kidney failure).
In the UKPDS achieved outlined in the beginning of the study BP levels. After 9 years, mean BP was 144/82 mm Hg in the group of close monitoring of BP and 154/87 mm Hg in the group of less strict control of blood pressure. During these 9 years, approximately every third patient from the first group required the appointment of three or more antihypertensive drugs, compared with 11% of patients of another group. Only every third patient from group carefully monitor blood pressure were on monotherapy.
Analysis of the results of the study revealed that, compared with the second group in the group of close monitoring of blood pressure substantially and significantly decreased the risk of any clinical complications associated with diabetes, 24%; death associated with diabetes, 32%, stroke by 44% and microvascular complications 37% of retinal detachment by 34% reduction in visual acuity by 47%.
One of the most important results of this study is that careful monitoring of blood pressure in patients order brand viagra with diabetes and hypertension, at least as important as monitoring the level of glucose. Thus, the number of macrovascular complications increased by 15% with an increase in blood pressure by 10 mmHg compared with an increase of 11% with an increase in the level of glycated hemoglobin by 1%.
The results suggest that careful monitoring of blood pressure using bblokatorov or ACE inhibitors in patients with hypertension and type 2 diabetes significantly reduces the risk of death and complications associated with diabetes.
In the UKPDS study also found that tight control of blood pressure is beneficial economically. Although the cost of antihypertensive drugs for a group of strict control of blood pressure was two times higher than for the control group, it is completely leveled saving money spent on treatment of complications of diabetes.
Thus, considering the results of several large multicenter studies, current recommendations suggest that patients with diabetes treated hypertension should be a priority. In addition, researchers believe it necessary for these patients, the level of blood pressure is 130/85 mm Hg
An important finding of the study UKPDS was that b1selektivny blocker atenolol and the ACE inhibitor, captopril was equally effective as to achieve a hypotensive effect and to reduce the risk of diabetic complications. Thus, atenolol reduced BP to an average level of 143/81 mm Hg, and captopril to 144/83 mm Hg In this case, both drugs were equally effective in reducing the risk of fatal and nonfatal complications of diabetes, deaths related to diabetes, heart failure and progression of retinopathy.
In other words, there were no significant differences in the degree of reducing the risk of cardiovascular complications during therapy, based on an ACE inhibitor, or based on bblokatorah. Currently, ACE inhibitors are considered first-line drugs of choice for treating patients with diabetes and hypertension, as they are metabolically neutral and have a renoprotective effect. On the contrary, it was thought that bblokatory, taking into account some of their potentially adverse metabolic effects, are contraindicated in diabetes. The results of the UKPDS studies have put this point of view under great doubt.
Choice for correction
Undeniable successes in the primary (before the development of CHD) and secondary prevention of coronary heart disease in patients with type 2 diabetes are associated brand viagra with the use of statins first-line drugs of choice for correction of dyslipoproteinemia in patients with type 2 diabetes.
Comparative characteristics of the impact of major statins on lipid profile presented in Table 4.
Statin treatment leads to significant and sustained reduction in LDL 25-61%, depending on the drug and daily dose, with each doubling of the dose reduces LDL cholesterol by 6-7%. At a fixed dose of statins maximum effect on the basic classes of lipids occurs within 4-8 weeks.
Contraindications to statin therapy are few: an active pathological process in the liver, initially elevated levels of liver enzymes (more than 50% above the upper limit of normal), the systematic abuse of alcohol. Ensure the safety of treatment allows the biochemical control of AST, ALT during the titration month, and in the subsequent 1 times in 3 months.
Another group of lipid-lowering drugs used for the correction of lipid disorders in patients with type 2 diabetes, fibrates (Table 5).
Therapy with these drugs is carried out in patients with type 2 diabetes only when elevated TG and normal values of LDL, as well generic levitra as the level of TG, threatening the development of acute pancreatitis. Effect of fibrates on LDL levels much lower than statins. In addition, fibrates worse tolerated, may interact with anticoagulants are contraindicated in hepatic and renal failure, cholelithiasis.
Treatment with statins or fibrates is always carried out against the backdrop of Lipid-lowering diet (if it is inefficient for at least 2 months) and the achievement of compensation of carbohydrate metabolism. Tactics of the lipid-lowering therapy should be based on the evidence provided in Figure 1.
Fig. 1. Indications for lipid-lowering therapy and its stages
The goals of treatment in patients with type 2 diabetes are similar to those developed for patients with coronary heart disease, and emphasize the high cardiovascular risk in diabetic patients.
Thus, high cardiovascular risk typical of elderly patients with type 2 diabetes, the combination of type 2 diabetes with coronary heart disease in every second patient determine the need for safe and efficient impact on such an important risk factor, as dyslipoproteinemia. Correction of lipid disorders provides a real opportunity to reduce morbidity and mortality in patients with type 2 diabetes on cardiovascular diseases.
Antithrombotic and other cardioprotective therapy
For the prevention of thrombosis and thromboembolism elderly patients who have risk factors for cardiovascular generic viagra disease, we recommend that the reception of small doses of acetylsalicylic acid. The American Diabetes Association in 2001 recommended to appoint a drug at a dose of 81,325 mg per day all the men and women with diabetes with signs of macroangiopathy. Intolerance to prescribe ticlopidine, clopidogrel, Vinpocetine.
In elderly patients with high frequency of silent myocardial ischemia, which starts a complex cascade of metabolic disorders that lead to the eventual death of cardiomyocytes. Currently there are some pharmacological approaches aimed at improving the metabolism at the time of ischemia and postischemic period. This approach is the use of trimetazidine. Cardioprotective properties of trimetazidine have been demonstrated in several clinical trials as monotherapy, and for its combined use with conventional antianginal drugs. At the same time, anti-ischemic effect of trimetazidine is not accompanied by kakimilibo changes of hemodynamic parameters, which is especially important in elderly patients.
Patients with type 2 diabetes, the elderly are the vast majority of patients in the practice of diabetology. Knowledge of clinic, diagnosis and treatment is necessary to provide skilled medical care these patients. Unfortunately, they often underestimate the seriousness of the disease in this age group and the need for intensive intervention aimed at reducing the risk of cardiovascular complications are the leading cause of death. To improve treatment outcomes requires not only the use of modern antidiabetic agents, reducing early phase insulin secretion and reduce insulin resistance, but an active struggle with other risk factors, especially hypertension and dyslipidaemia, which would enhance the effectiveness of medical care for older patients, and prolonged the lives of people.
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