BACKGROUND:

Attention-deficit hyperactivity disorder (ADHD) is a neuropsychiatric disorder that begins in childhood. Atomoxetine is a selective inhibitor of the presynaptic norepinephrine transporter. Several studies have demonstrated the safety and efficacy of atomoxetine in the treatment of ADHD.

OBJECTIVE:

The objective of this analysis was to provide additional information on the frequency, time to onset and time to resolution of sexual and genitourinary (GU) treatment-emergent adverse events (TEAEs) reported during atomoxetine treatment in clinical trials.

METHODS:

Data from all adult atomoxetine placebo-controlled ADHD trials were pooled for this analysis, for a total of 3,314 patients (atomoxetine, n = 1,738; placebo, n = 1,576). Additionally, data from all adolescent patients (baseline age ≥13 to <18 years) within all ADHD placebo-controlled trials were pooled for analysis, for a total of 538 patients (atomoxetine, n = 329; placebo, n = 209). Rates of sexual and GU TEAEs were summarized by sex for each age group. Time to onset and resolution of sexual and GU TEAEs were summarized and compared using Kaplan-Meier methods.

RESULTS:

Overall, the baseline characteristics of randomized patients in the atomoxetine and placebo groups were similar. Profiles of sexual and GU TEAEs for atomoxetine appeared clinically similar to placebo in female patients and in adolescent male patients. Adult male patients reported relatively more sexual and GU TEAEs when taking atomoxetine compared with placebo, with libido decreased (4.6 vs. 3.0 %), dysuria (3.7 vs. 1.5 %), urinary hesitation (6.9 vs. 2.4 %), urine flow decreased (2.5 vs. 0.6 %), ejaculation disorder (2.8 vs. 1.1 %) and erectile dysfunction (8.0 vs. 1.9 %) being the most common. The time to onset of the most common TEAEs in adult male patients tended to occur relatively early in dosing: within the first 2 weeks for GU TEAEs, and during the second and third week of dosing for erectile and ejaculation issues. The median time to resolution for these events ranged from around 3-8 weeks after event onset, depending on the event. While the common sexual and GU TEAEs showed numerically higher percentages of discontinuations in atomoxetine-treated patients compared with placebo, most incidences of the sexual and GU TEAEs were not considered severe.

CONCLUSIONS:

The sexual and GU TEAE profiles of patients taking atomoxetine were generally similar to those of patients taking placebo in the female and adolescent male populations, with greater frequency of TEAEs reported in adult males taking atomoxetine compared with placebo. The time to onset of the TEAEs tended to be shorter, and time to resolution tended to be longer in adult male patients treated with atomoxetine compared with those receiving placebo. The conclusions must be interpreted with caution because the TEAEs were likely underreported.

Extranodal NK/T cell lymphoma(NKTCL), nasal type, occurring primarily in the prostate gland, is extremely rare. We present a case of primarily prostatic NKTCL in a 59-year-old man suffering from dysuria. Histological examinations revealed t hat diffused, large-sized, pleomorphic lymphocytes were arranged in an angiocentric distribution with large areas of geographic necroses. Additionally, the prostatic glands were diffusely infiltrated byheteromorphous lymphocytes forming lymphoepithelial lesions. The tumor cells were strongly expressed CD3epsilon, CD56, TIA-1, granzyme B and EBV-encoded RNAs. And interestingly, the lymphoid cells were also strongly immunoreactive with CD30. A rearrangement study showed T-cell receptorgamma -chain gene rearrangement with monoclonal appearance. Though postoperative combination of chemotherapy was given, the patient died four months later. Our observation and other literatures indicate that extremely rare NKTCLs unusually express CD30. TCR gene arrangement existed in some NKTCL, suggesting that a subset of NKTCL may be a mixed NK/T-cell differentiation. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/9671878568932824.

A 50-year-old female who had undergone laparoscopic total hysterectomy at a local clinic owing to leiomyoma of the uterus was referred to our hospital after having dysuria, urgency, frequency, lower abdominal pain and right flank pain over several months. After routine examinations, cystoscopy, computed tomography and magnetic resonance imaging were performed, and non-ulcerative interstitial cystitis accompanied by postoperative fibrosis secondary to a previous surgery was suggested. Pentosan sulfuric polyester (Elmiron, Alza Pharmaceuticals, Mountain View, CA) reduced her severely debilitating symptoms and improved her quality of life. Both the hydronephrosis and the symptoms were relieved by ureteral stent insertion and percutaneous nephrostomy. However, a few days later, she presented with vaginal bleeding along with her previous symptoms, and punch biopsy of the vaginal stump resulted in a diagnosis of adenocarcinoma. Both ureterocutaneostomy with radical cystectomy and lower anterior resection for rectum invasion were conducted. After the slide review of the original specimen from the local clinic, she was diagnosed with recurrent cervical cancer of the vaginal stump.

A 5-year-old, female neutered Persian cat was admitted to the Small Animal Hospital (Chulalongkorn University, Bangkok, Thailand) with clinical signs of dysuria, haematuria and partial urethral obstruction that had manifested over several months. The animal also had hyperkalaemia and severe azotaemia at the time of presentation. Urinalysis showed haematuria, pyuria and the presence of several transitional cells. In addition, ultrasonography demonstrated an extraluminal mass between the neck of urinary bladder and the colon. Fine-needle aspiration of the mass revealed a fungal form with branching and septate hyphae. Consequently, itraconazole treatment was prescribed and clinical signs of improvement were seen after 7 days. However, 1 month later, the cat died of acute anaemia. Necropsy revealed the presence of extraluminal multifocal fungal granuloma at the neck of the urinary bladder, and contracted kidneys. Histopathological analysis of the fungal granuloma was found to be composed of branching, septate hyphal fungi together with inflammatory cells. Subsequent fungal culture and identification revealed this to be a species of Penicillium.

OBJECTIVE:

To identify the signs that can help to differentiate torsion of the appendix testis (AT) and epididymitis and to establish the incidence of the various pathologic entities in boys with an acute scrotum.

MATERIALS AND METHODS:

A retrospective study was performed of the data from all boys treated at our institute from January 2008 to January 2012 for the diagnosis of an "acute scrotum." The clinical and, if available, ultrasound findings were documented. Differences between groups were calculated using a chi-square test or analysis of variance and classification and regression tree analysis.

RESULTS:

A total of 241 boys with acute scrotal pain were included and underwent surgical exploration. Of the 241 boys, 163 (70%) had AT, 44 (18.5%) had epididymitis, 31 (13.3%) had testicular torsion, and 3 (1.3%) had idiopathic scrotal edema. The incidence of AT was significantly increased in the colder months (P = .01). We found that AT and epididymitis shared several aspects but differed regarding dysuria (epididymitis, P ≤.001), a painful epididymis on palpation (epididymitis, P = .028), increased epididymal echogenicity (epididymitis, P = .043), augmented peritesticular perfusion (epididymitis, P = .05), and a positive blue dot sign (AT, P <.001). The classification and regression tree analysis showed that the presence of dysuria, a positive blue dot sign, and a painful epididymis are the best factors for distinguishing AT and epididymitis.

CONCLUSION:

Most children with an acute scrotum will have AT or epididymitis. It will be possible to differentiate most cases using the clinical and ultrasound findings. In our study, the best predictors were dysuria, a painful epididymis on palpation, and altered epididymal echogenicity and increased peritesticular perfusion found on ultrasound studies for epididymitis and a positive blue dot sign for AT.

Retrograde ejaculation (RE) has been reported in humans and animals but RE with subsequent sperm calculi has rarely been reported. This report documents clinical and pathological findings of spontaneous sperm cystolithiasis in four rhesus macaques. While this condition has been associated with repeated electroejaculation, spontaneous sperm cystolithiasis is highly unusual. The animals presented with either stranguria, dysuria, hematuria, distended abdomen or lethargy. Ultrasound examination revealed several hyperechoic masses within the lumen of the urinary bladder. The animals were euthanized due to poor prognosis or study end points. Postmortem examination revealed multiple angular, amorphous, soft to firm, pale yellow to greenish-brown and variably sized calculi in the lumen of the urinary bladder or prostatic/penile urethra. Histologically, the calculi were composed of numerous sperm embedded in abundant brightly eosinophilic matrix. Based on gross and histologic findings, RE associated sperm cystolithiasis was diagnosed, with ulcerative urethritis as the major primary apparent etiology. To the authors' knowledge, this is the first report of four spontaneous cases of sperm cystolithiasis in rhesus macaques.

This report describes a case of urinary tract infection (UTI) due to Shigella sonnei during pregnancy.A 31-year-old pregnant woman was admitted complaining of left-flank tenderness, dysuria, and fever.Following examination, significant laboratory data were collected including increased leukocyte count (10,800/ul with 86% neutrophils) and C-reactive protein (9.6 mg/dl). Urinalysis revealed 30 to 50 leukocytes per high power field while from the quantitative urine culture Shigella sonnei was recovered after 24 h incubation at 37 degrees C. After a two-week course with 750 mg cefuroxime every 8 h, the patient experienced gradual resolution of all symptoms and urinary cultures were negative two weeks and one month, respectively, after completing the therapy. The gestational course was uneventful and the patient delivered a healthy baby girl at term.Shigella sonnei can be responsible for UTI during pregnancy even when no predisposing factors or an apparent source of infection can be identified.

We report a case of deep vein thrombosis and acute pulmonary thromboembolism that occurred during chemotherapy for urethral carcinoma. A 68-year-old woman suffered from dysuria for a period of 2 years. When the symptoms worsened, a urethral catheter was placed and she was referred to our hospital for further examinations. Imaging analysis revealed a urethral tumor with multiple metastases. Pathological diagnosis on a specimen obtained from transurethral resection of the urethral mucosa was urothelial carcinoma and combined chemotherapy with gemcitabine and cisplatin was administered. On day 6 of the second course, the patient collapsed and was found to be in cardiorespiratory arrest. Cardiopulmonary resuscitation was successful and she received percutaneous cardiopulmonary support. Computed tomography at that time revealed a pulmonary embolism and deep vein thrombosis in the right popliteal vein. After her condition improved, an inferior vena cava filter was inserted to avoid further thromboembolism. The patient decided to continue the chemotherapy despite this episode. After the fourth course of combined chemotherapy, the urethral tumor and metastatic tumors were downsized, and she could urinate as she did before.

To explore operative complications of photoselective vaporization of prostate (120 W) for treatment of benign prostatic hyperplasia (BPH).The clinical data of 186 cases who underwent photoselective vaporization of prostate (120 W) for the treatment of BPH from May 2010 to April 2012, was statistically analyzed.The operative time ranged from 7 to 147 minutes, and the average time was (37.7 ± 21.5) minutes. No patient accepted intraoperative blood transfusion, and occurred transurethral resection syndrome or capsular perforation. The time of postoperative indwelling catheter ranged from 1 to 11 days, and average time was (4.3 ± 2.2) days. Surgical outcome was satisfactory. Early postoperative complications included bladder spasm (3 cases), transient dysuria (19 cases), urinary tractirritation (94 cases), secondary hemorrhage (26 cases), transient urge incontinence (19 cases), all cases were relieved after treatment. Long-term complications, including recurrence (1 case), bladder neck stenosis (2 cases) and urethral stricture (2 cases), who had required reoperation. Postoperative patients with international prostate symptom score (29.4 ± 3.4), maximum urinary flow rate ((6.0 ± 1.6) ml/s) and residual urine ((167 ± 150) ml) had improved (t = -76.0 - 61.4, P < 0.01).With less invasive, less bleeding and rapid postoperative recovery, photoselective vaporization of prostate (120 W) is a safe and effective minimally invasive treatment techniques for BPH. But there is still some complications after surgery and proper handling is required.