THE OFFICIAL PATIENT’S SOURCEBOOK
on
ROSTATITIS
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
ii
ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Prostatitis: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83228-5 1. Prostatitis-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
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Dedication To the healthcare professionals dedicating their time and efforts to the study of prostatitis.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to prostatitis. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to prostatitis, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Childhood Nephrotic Syndrome
·
The Official Patient's Sourcebook on Cystocele
·
The Official Patient's Sourcebook on Glomerular Disease
·
The Official Patient's Sourcebook on Goodpasture Syndrome
·
The Official Patient's Sourcebook on Hematuria
·
The Official Patient's Sourcebook on Hemochromatosis
·
The Official Patient's Sourcebook on Immune Thrombocytopenic Purpura
·
The Official Patient's Sourcebook on Impotence
·
The Official Patient's Sourcebook on Interstitial Cystitis
·
The Official Patient's Sourcebook on Kidney Failure
·
The Official Patient's Sourcebook on Kidney Stones
·
The Official Patient's Sourcebook on Lupus Nephritis
·
The Official Patient's Sourcebook on Nephrotic Syndrome
·
The Official Patient's Sourcebook on Peyronie
·
The Official Patient's Sourcebook on Polycystic Kidney Disease
·
The Official Patient's Sourcebook on Prostate Enlargement
·
The Official Patient's Sourcebook on Proteinuria
·
The Official Patient's Sourcebook on Pyelonephritis
·
The Official Patient's Sourcebook on Renal Osteodystrophy
·
The Official Patient's Sourcebook on Renal Tubular Acidosis
·
The Official Patient's Sourcebook on Simple Kidney Cysts
·
The Official Patient's Sourcebook on Urinary Incontinence
·
The Official Patient's Sourcebook on Urinary Incontinence for Women
·
The Official Patient's Sourcebook on Urinary Tract Infection in Children
·
The Official Patient's Sourcebook on Urinary Tract Infections in Adults
·
The Official Patient's Sourcebook on Vasectomy
·
The Official Patient's Sourcebook on Vesicoureteral Reflux
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION ................................................................................................................................. 1 Overview ....................................................................................................................................... 1 Organization ................................................................................................................................. 3 Scope.............................................................................................................................................. 3 Moving Forward............................................................................................................................ 4 PART I: THE ESSENTIALS ............................................................................................................. 7 CHAPTER 1. THE ESSENTIALS ON PROSTATITIS: GUIDELINES ......................................................... 9 Overview ....................................................................................................................................... 9 What Is Prostatitis?..................................................................................................................... 11 For More Information.................................................................................................................. 12 Additional Information on Prostatitis ......................................................................................... 12 More Guideline Sources .............................................................................................................. 13 Vocabulary Builder...................................................................................................................... 21 CHAPTER 2. SEEKING GUIDANCE ................................................................................................... 25 Overview ..................................................................................................................................... 25 Associations and Prostatitis ........................................................................................................ 25 Finding More Associations ......................................................................................................... 27 Finding Doctors........................................................................................................................... 28 Finding a Urologist ..................................................................................................................... 29 Selecting Your Doctor ................................................................................................................. 30 Working with Your Doctor ......................................................................................................... 31 Broader Health-Related Resources .............................................................................................. 32 PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ........................... 33 CHAPTER 3. STUDIES ON PROSTATITIS ........................................................................................... 35 Overview ..................................................................................................................................... 35 The Combined Health Information Database .............................................................................. 35 Federally-Funded Research on Prostatitis................................................................................... 45 E-Journals: PubMed Central ....................................................................................................... 53 The National Library of Medicine: PubMed................................................................................ 53 Vocabulary Builder...................................................................................................................... 54 CHAPTER 4. PATENTS ON PROSTATITIS .......................................................................................... 63 Overview ..................................................................................................................................... 63 Patents on Prostatitis .................................................................................................................. 64 Patent Applications on Prostatitis .............................................................................................. 72 Keeping Current .......................................................................................................................... 73 Vocabulary Builder...................................................................................................................... 73 CHAPTER 5. BOOKS ON PROSTATITIS.............................................................................................. 75 Overview ..................................................................................................................................... 75 Book Summaries: Federal Agencies ............................................................................................. 75 Book Summaries: Online Booksellers .......................................................................................... 80 The National Library of Medicine Book Index............................................................................. 81 Chapters on Prostatitis ................................................................................................................ 83 Directories ................................................................................................................................... 86 General Home References ............................................................................................................ 88 Vocabulary Builder...................................................................................................................... 88 CHAPTER 6. MULTIMEDIA ON PROSTATITIS ................................................................................... 91 Overview ..................................................................................................................................... 91 Video Recordings......................................................................................................................... 91 Bibliography: Multimedia on Prostatitis..................................................................................... 93
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CHAPTER 7. PERIODICALS AND NEWS ON PROSTATITIS ................................................................ 95 Overview ..................................................................................................................................... 95 News Services & Press Releases .................................................................................................. 95 Newsletters on Prostatitis ......................................................................................................... 101 Newsletter Articles .................................................................................................................... 102 Academic Periodicals covering Prostatitis ................................................................................ 104 Vocabulary Builder.................................................................................................................... 106 CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES .............................................................. 107 Overview ................................................................................................................................... 107 NIH Guidelines ......................................................................................................................... 107 NIH Databases .......................................................................................................................... 108 Other Commercial Databases .................................................................................................... 121 Specialized References ............................................................................................................... 122 Vocabulary Builder.................................................................................................................... 123 CHAPTER 9. DISSERTATIONS ON PROSTATITIS ............................................................................. 125 Overview ................................................................................................................................... 125 Dissertations on Prostatitis ....................................................................................................... 125 Keeping Current ........................................................................................................................ 126 PART III. APPENDICES .............................................................................................................. 127 APPENDIX A. RESEARCHING YOUR MEDICATIONS ..................................................................... 129 Overview ................................................................................................................................... 129 Your Medications: The Basics ................................................................................................... 130 Learning More about Your Medications ................................................................................... 131 Commercial Databases............................................................................................................... 134 Contraindications and Interactions (Hidden Dangers)............................................................. 135 A Final Warning ....................................................................................................................... 136 General References..................................................................................................................... 137 Vocabulary Builder.................................................................................................................... 138 APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ............................................................... 139 Overview ................................................................................................................................... 139 What Is CAM? .......................................................................................................................... 139 What Are the Domains of Alternative Medicine? ..................................................................... 140 Can Alternatives Affect My Treatment?................................................................................... 143 Finding CAM References on Prostatitis ................................................................................... 144 Additional Web Resources......................................................................................................... 153 General References..................................................................................................................... 159 Vocabulary Builder.................................................................................................................... 160 APPENDIX C. RESEARCHING NUTRITION..................................................................................... 161 Overview ................................................................................................................................... 161 Food and Nutrition: General Principles .................................................................................... 162 Finding Studies on Prostatitis................................................................................................... 166 Federal Resources on Nutrition................................................................................................. 169 Additional Web Resources......................................................................................................... 170 Vocabulary Builder.................................................................................................................... 173 APPENDIX D. FINDING MEDICAL LIBRARIES ............................................................................... 175 Overview ................................................................................................................................... 175 Preparation ................................................................................................................................ 175 Finding a Local Medical Library ............................................................................................... 176 Medical Libraries Open to the Public ........................................................................................ 176 APPENDIX E. YOUR RIGHTS AND INSURANCE ............................................................................. 183 Overview ................................................................................................................................... 183 Your Rights as a Patient............................................................................................................ 183 Patient Responsibilities ............................................................................................................. 187
Contents
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Choosing an Insurance Plan...................................................................................................... 188 Medicare and Medicaid ............................................................................................................. 190 NORD’s Medication Assistance Programs............................................................................... 193 Additional Resources................................................................................................................. 194 Vocabulary Builder.................................................................................................................... 195 ONLINE GLOSSARIES ............................................................................................................... 197 Online Dictionary Directories................................................................................................... 202 PROSTATITIS GLOSSARY ........................................................................................................ 203 General Dictionaries and Glossaries ......................................................................................... 217 INDEX.............................................................................................................................................. 220
Introduction
1
INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Prostatitis
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Prostatitis has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to prostatitis, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on prostatitis. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on prostatitis should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching prostatitis (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to prostatitis. It also gives you sources of information that can help you find a doctor in your local area specializing in treating prostatitis. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with prostatitis. Part II moves on to advanced research dedicated to prostatitis. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on prostatitis. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with prostatitis or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with prostatitis. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with prostatitis.
Scope While this sourcebook covers prostatitis, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that prostatitis is often considered a synonym or a condition closely related to the following: ·
Chronic Bacterial Prostatitis
·
Pelvic Pain Syndrome
·
Prostate Infection (inflammatory)
4
Prostatitis
·
Prostatodynia
In addition to synonyms and related conditions, physicians may refer to prostatitis using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for prostatitis:4 ·
601.0 prostatitis, acute
·
601.1 prostatitis, chronic
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to prostatitis. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with prostatitis will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
5
are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with prostatitis is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of prostatitis, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
7
PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on prostatitis. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of prostatitis to you or even given you a pamphlet or brochure describing prostatitis. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
CHAPTER 1. GUIDELINES
THE
ESSENTIALS
ON
9
PROSTATITIS:
Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on prostatitis. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on prostatitis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on prostatitis. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Prostatitis
There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with prostatitis and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·
Division of Diabetes, Endocrinology, and Metabolic Diseases
·
Division of Digestive Diseases and Nutrition
·
Division of Kidney, Urologic, and Hematologic Diseases
The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The Institute supports basic and clinical research through investigator-initiated This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6
Guidelines 11
grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on prostatitis.
What Is Prostatitis?7 Prostatitis may account for up to 25 percent of all office visits by young and middle-age men for complaints involving the genital and urinary systems. The term prostatitis actually encompasses four disorders: ·
Acute bacterial prostatitis is the least common of the four types but also the easiest to diagnose and treat effectively. Men with this disease often have chills, fever, pain in the lower back and genital area, urinary frequency and urgency often at night, burning or painful urination, body aches, and a demonstrable infection of the urinary tract, as evidenced by white blood cells and bacteria in the urine. It is treated with an appropriate antibiotic.
·
Chronic bacterial prostatitis is also relatively uncommon. It is acute prostatitis associated with an underlying defect in the prostate, a focal point for bacterial persistence in the urinary tract. Effective treatment usually requires identifying and removing the defect and then treating the infection with antibiotics. However, antibiotics often do not cure it.
·
Chronic prostatitis/chronic pelvic pain syndrome is the most common but least understood form of the disease. It is found in men of any age; symptoms go away and then return without warning. Chronic prostatitis/chronic pelvic pain syndrome may be inflammatory or noninflammatory. In the inflammatory form, urine, semen, and other fluids from the prostate show no evidence of a known infecting organism but do contain cells the body usually produces to fight infection. In the noninflammatory form, no evidence of inflammation, including infectionfighting cells, is present.
·
Asymptomatic inflammatory prostatitis is the diagnosis when the patient does not complain of pain or discomfort but has infection-fighting cells in his semen. Doctors usually find this form of prostatitis when looking for causes of infertility or testing for prostate cancer.
Adapted from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/urolog/summary/prostat/prostat.htm. 7
12 Prostatitis
For More Information More information is available from: American Foundation for Urologic Disease 1128 North Charles Street Baltimore, MD 21201 Tel: (800) 242-2383, (410) 727-2908 E-mail:
[email protected] Home page: http://www.afud.org Thomas Bruckman, Executive Director and CEO The Prostatitis Foundation 1063 30th Street, Box 8 Smithshire, IL 61478 Tel: (888) 891-4200 Fax: (309) 325-7184 E-mail:
[email protected] Home page: http://www.prostatitis.org Mike Hennenfent, President
Additional Information on Prostatitis The National Kidney and Urologic Diseases Information Clearinghouse collects resource information on kidney and urologic diseases for the Combined Health Information Database (CHID). CHID is a database produced by health-related agencies of the Federal Government. This database provides titles, abstracts, and availability information for health information and health education resources. To provide you with the most up-to-date resources, information specialists at the clearinghouse created an automatic CHID search. To obtain this information, you may view the results of the automatic search on prostatitis. Or if you wish to perform your own search of the database, you may access the CHID Online and search CHID yourself. National Kidney and Urologic Diseases Information Clearinghouse 3 Information Way Bethesda, MD 20892-3580
Guidelines 13
E-mail: National Kidney and Urologic Diseases Information Clearinghouse The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1987, the clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. NKUDIC answers inquiries; develops, reviews, and distributes publications; and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases. Publications produced by the clearinghouse are carefully reviewed for scientific accuracy, content, and readability.
More Guideline Sources The guideline above on prostatitis is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to prostatitis. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with prostatitis. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas.
14 Prostatitis
If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on prostatitis and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Prostatitis: Understanding and Treating Inflammation of the Prostate Source: San Bruno, CA: StayWell Company. 1999. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. E-mail:
[email protected]. Website: www.staywell.com. Price: $20.00 for pack of 50; plus shipping and handling. Summary: This patient education brochure describes prostatitis, an inflammation of the prostate that often causes swelling or pain. This common condition takes three forms: nonbacterial prostatitis, acute bacterial prostatitis, and chronic prostatitis. The prostate is a small reproductive gland in the male, located just below the bladder and in front of the rectum. For a variety of reasons, ranging from stress to bacterial infection, prostatic ducts may become inflamed, irritated, or blocked; then prostatitis may develop. By examining the urine and physically examining the prostate (with a digital rectal exam and prostatic massage, used to collect a sample of prostatic fluid), the physician can identify which type of prostatitis is present and rule out more serious problems such as prostate cancer. Treatment for nonbacterial prostatitis includes antiinflammatory medications or muscle relaxants and lifestyle approaches, including taking hot baths, relaxing
Guidelines 15
when urinating, drinking more fluids, and ejaculating frequently (to help drain the gland and relax the muscles); dietary changes may also be recommended. Acute prostate infections are often treated with antibiotics, bed rest, stool softeners, and increased fluid intake. Chronic prostate infections may be treated with antibiotics or other medications. The brochure concludes by encouraging readers to undergo regular prostate checkups and to share the information in the brochure with their sexual partner. The brochure is illustrated with full color line drawings, including a depiction of the anatomy of the male urogenital tract. 8 figures. ·
Prostatitis: The Basics Source: Marietta, GA: GU Logic. 1994. 2 p. Contact: Available from GU Logic. 2470 Windy Hill Road, Suite 108, Marietta, GA 30067. (800) 451-8107. Price: $35 for 50 copies. Order Number: GU60. Summary: This patient education brochure covers the basics of prostatitis, a term used to describe a variety of inflammatory conditions of the prostate gland. Topics include symptoms of prostatitis, the causes of prostatitis, the physical examination, including the digital rectal exam, treatment for prostatitis, and treatment myths. The brochure cautions that prostatitis can be very frustrating for patients and doctors alike and counsels patience in the search for a satisfactory treatment regimen. One illustration depicts the digital rectal exam and the anatomy involved.
·
Chronic Prostatitis Source: Norwich, NY: Procter and Gamble Pharmaceuticals. 1993. 13 p. Contact: Available from Procter and Gamble Pharmaceuticals. 17 Eaton Avenue, Norwich, NY 13815. (607) 335-2111. Price: Free. Summary: This brochure provides information on the characteristics of chronic prostatitis, a common disorder in younger men between ages 30 and 50, resulting in permanent, slowly progressive benign enlargement of the prostate with age. Information is presented on the cause, symptoms, anatomical characteristics, diagnosis, and treatment of chronic prostatitis. While it is rarely cured it is not life-threatening, and does respond to timely treatment.
·
Prostatitis: Patient Education Source: Tarrytown, NY: Bayer Corporation. 1999. 11 p.
16 Prostatitis
Contact: Available from Bayer Corporation. Diagnostics Division, 511 Benedict Avenue, Tarrytown, NY 10591-5097. (800) 445-5901. Price: Single copy free. Summary: This patient education brochure reviews prostatitis, inflammation or infection of the prostate gland. The brochure defines the condition, describes risk factors and causes, outlines the diagnostic approaches that may be used, reviews treatment options, and offers suggestions for prevention. In most men, the prostate gland begins a gradual process of enlargement at about 40 years of age; benign prostatic hyperplasia (BPH) does not always cause problems, although it can result in problems with urination. Prostatitis is a different condition, usually caused by infections by bacteria or other organisms. Prostatitis can be a secondary problem related to the urinary retention (urine remaining in the bladder or urethra after urination) caused by BPH; a chemical in the urine (urate) can irritate the tissues of the prostate gland and cause inflammation. There are three major types of prostatitis: bacterial, nonbacterial, and prostatodynia (pain in the area of the prostate gland). Symptoms of bacterial prostatitis are often severe and therefore quickly diagnosed; they include fever, chills, pain in the lower back, aching muscles, fatigue, and frequent or painful urination. Nonbacterial prostatitis (occurring in about 10 percent of cases) is harder to diagnose and often presents with occasional vague discomfort in the testicles, urethra, lower abdomen, and back, discharge from the urethra, blood or urine in the ejaculate, low sperm count, sexual difficulties, and frequent urination. Diagnosis includes the digital rectal exam (DRE) to reveal the size, shape, and texture of the prostate; prostate massage; sequential urine test; needle biopsy; prostate specific antigen (PSA) test; and imaging tests, such as ultrasound, x rays, magnetic resonance imaging (MRI), and computed tomography (CT scan). Treatment often includes antibiotics and other drugs to combat urinary problems; thermotherapy (heating the prostate gland) may also be used. Alternative or adjunctive therapies include topical heat and cold therapy, zinc supplemenation, and antianxiety medications. The brochure concludes with a brief glossary of terms and a short list of resources for readers wishing to obtain additional information. A tear-off section lists the topics covered in the booklet; readers are encouraged to check off the items corresponding to issues they would like to discuss with their health care provider, to use the checklist as a reminder tool. ·
Prostatitis: Answers to Your Questions Source: Baltimore, MD: Prostate Health Council, American Foundation for Urologic Disease. 1991. 13 p.
Guidelines 17
Contact: Available from American Foundation for Urologic Disease. 1126 North Charles Street, Baltimore, MD 21201. (800) 242-2383 or (410) 4681800. Fax (410) 468-1808. Website: www.afud.org. Price: Single copy free. Summary: This brochure is designed to answer questions that men with newly diagnosed prostatitis may have. In addition, the brochure describes the location and physiology of the prostate itself. Topics include the three types of prostatitis; how prostatitis develops; the symptoms of prostatitis; key facts about prostatitis and its diagnosis; other prostatic problems including benign prostatic hyperplasia, urethritis and prostatodynia; the diagnosis of prostatitis; the treatment of prostatitis; and how prostatitis can impact upon the patient's lifestyle. A simple quiz is included at the beginning of the brochure to test the reader's knowledge of the prostate. A glossary of terms is appended.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “prostatitis” or synonyms. The following was recently posted: ·
National guideline for the management of prostatitis. Source: Association for Genitourinary Medicine/Medical Society for the Study of Venereal Diseases.; 1999 August; 5 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1441&sSearch_string=prostatitis
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database:
18 Prostatitis
·
Chronic Prostatitis Collaborative Research Network Summary: CPCRN is involved in research study of all aspects of chronic prostatitis with the hope of improving diagnosis and treatment. Source: Prostatitis Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3915
·
Executive Summary: Chronic Prostatitis Workshop Summary: This report summarizes the findings of the chronic prostatitis workshop, the purpose of which was to identify current knowledge and help the NIH research institute, NIDDK, develop a long-range Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3973
·
Prostatitis Alternative Medicine FAQ Summary: Answers to questions about alternative medical treatment options for prostatitis, a disorder of the prostate gland. Source: Prostatitis Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3925
·
Prostatitis Information Summary: This web site contains information that is designed to give consumers a clear definition about prostatitis -- symptoms, diagnostics, treatment and causes are discussed. Source: Prostatitis Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3956
Guidelines 19
·
Prostatitis Page Summary: This prostatitis patient information web site encourages participation by health care professionals involved in treating the disorder. Source: Prostatitis Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3917
·
Prostatitis Symptom Index Summary: This guideline was developed for use by patients and the health care professional that caring for them. It seeks to identify the major symptoms and the impact of the condition. Source: Prostatitis Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6175
·
Prostatitis: Disorders of the Prostate Summary: Prostatitis may account for up to 25 percent of all office visits by young and middle-age men for complaints involving the genital and urinary systems. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6534
·
Special Topics in Treating Prostatitis Summary: This consumer health information document discusses methods and themes -- including herbal remedies and traditional (mostly Asian) medical approaches -- for treating prostatitis. Source: Prostatitis Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3916
20 Prostatitis
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to prostatitis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
NORD (The National Organization of Rare Disorders, Inc.) NORD provides an invaluable service to the public by publishing, for a nominal fee, short yet comprehensive guidelines on over 1,000 diseases. NORD primarily focuses on rare diseases that might not be covered by the previously listed sources. NORD’s Web address is www.rarediseases.org. To see if a recent fact sheet has been published on prostatitis, simply go to the following hyperlink: http://www.rarediseases.org/cgibin/nord/alphalist. A complete guide on prostatitis can be purchased from NORD for a nominal fee. Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
·
drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
·
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
Guidelines 21
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Asymptomatic: Showing or causing no symptoms. [EU] Baths: The immersion or washing of the body or any of its parts in water or other medium for cleansing or medical treatment. It includes bathing for personal hygiene as well as for medical purposes with the addition of therapeutic agents, such as alkalines, antiseptics, oil, etc. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU]
22 Prostatitis
Cystitis: Inflammation of the urinary bladder. [EU] Cystoscopy: Direct visual examination of the urinary tract with a cystoscope. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Flaccid: Weak, lax and soft. [EU] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Penis: The male organ of copulation and of urinary excretion, comprising a root, body, and extremity, or glans penis. The root is attached to the descending portions of the pubic bone by the crura, the latter being the extremities of the corpora cavernosa, and beneath them the corpus spongiosum, through which the urethra passes. The glans is covered with mucous membrane and ensheathed by the prepuce, or foreskin. The penis is
Guidelines 23
homologous with the clitoris in the female. [EU] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatitis: Inflammation of the prostate. [EU] Prosthesis: An artificial substitute for a missing body part, such as an arm or leg, eye or tooth, used for functional or cosmetic reasons, or both. [EU] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Relaxant: 1. lessening or reducing tension. 2. an agent that lessens tension. [EU]
Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Urethritis: Inflammation of the urethra. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH]
Seeking Guidance 25
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with prostatitis. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with prostatitis. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Prostatitis As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
26 Prostatitis
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Foundation for Urologic Disease Address: American Foundation for Urologic Disease 1128 North Charles Street, Baltimore, MD 21201 Telephone: (410) 468-1800 Toll-free: (800) 242-2383 Fax: (410) 468-1808 Email:
[email protected] Web Site: http://www.afud.or Background: The American Foundation for Urologic Disease (AFUD) is a national not-for-profit health organization dedicated to the prevention and cure of urologic diseases through the expansion of medical research and the education of health care professionals and the public. Such urologic diseases include bladder cancer, urinary incontinence, urinary tract disorders, interstitial cystitis, kidney stones, benign prostatic hyperplasia, prostate cancer, prostatitis, and sexual dysfunction. Established in 1987, the Foundation sponsors a Research Scholars Program to encourage physicians to conduct research into urologic diseases, provides appropriate referrals, engages in patient advocacy, and offers networking services. AFUD also offers a variety of educational materials including brochures, pamphlets, and a quarterly magazine entitled 'Family Urology.' In addition, the Foundation has a web site on the Internet at http://www.afud.org. Relevant area(s) of interest: Impotence, Interstitial Cystitis, Kidney Stones, Prostatitis
Seeking Guidance 27
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about prostatitis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “prostatitis” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “prostatitis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “prostatitis” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with prostatitis. You should check back periodically with this database since it is updated every 3 months.
28 Prostatitis
The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “prostatitis” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective. The following Internet links may be of particular interest: ·
Emotional Support on the Internet http://www.faqs.org/faqs/support/emotional/resources-list
·
Med Help http://www.medhelp.org/HealthTopics/Prostatitis.html
·
HealthLink USA http://www.healthlinkusa.com/395ent.htm
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with prostatitis must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
Seeking Guidance 29
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 11 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
Finding a Urologist The American Urological Association (AUA) provides the public with a freeto-use “Find A Urologist” service to help patients find member urologists in their area. The database can be searched by physician name, city, U.S. State, or country and is available via the AUA’s Web site located at http://www.auanet.org/patient_info/find_urologist/index.cfm. According to the AUA: “The American Urological Association is the professional While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 11
30 Prostatitis
association for urologists. As the premier professional association for the advancement of urologic patient care, the AUA is pleased to provide Find A Urologist, an on-line referral service for patients to use when looking for a urologist. All of our active members are certified by the American Board of Urology, which is an important distinction of the urologist’s commitment to continuing education and superior patient care.”12 If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor13 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about prostatitis?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for prostatitis?
·
Spend enough time with me?
Quotation taken from the AACE’s Web site: http://www.aace.com/memsearch.php. section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 12
13 This
Seeking Guidance 31
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor14 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
14
32 Prostatitis
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:15 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
15
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on prostatitis. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on prostatitis. In Part II, as in Part I, our objective is not to interpret the latest advances on prostatitis or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with prostatitis is suggested.
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CHAPTER 3. STUDIES ON PROSTATITIS Overview Every year, academic studies are published on prostatitis or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on prostatitis. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on prostatitis and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and prostatitis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “prostatitis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Prevalence of Prostatitis-Like Symptoms in a Population Based Study Using the National Institutes of Health Chronic Prostatitis Symptom Index Source: Journal of Urology. 165(6): 842-845. March 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: In this community based study, the National Institutes of Health (NIH) chronic prostatitis symptom index was used to determine the prevalence of prostatitis like symptoms among men (age 20 to 74 years) at risk. The questionnaire collected information on two domains of chronic prostatitis identified in the NIH chronic prostatitis symptom index, including pain (location, severity and frequency), voiding function (irritative, obstructive), demographics, quality of life, general health, and health seeking behavior. A total of 2,987 eligible men received the survey, and it was completed by 868 (29 percent). Of these men, 84 (9.7 percent) were identified as having chronic prostatitis like symptoms. The average age of the prostatitis population was 50 years compared with 52 years for men without the prostatitis like symptoms. Prevalence was 11.5 percent in men younger than 50 years and 8.5 percent in men 50 years or older. Of the sample population, 57 (6.6 percent) men had prostatitis like symptoms and an index pain score 8 or greater (moderate to severe). Of the prostatitis group, 60 percent sought medical help for their symptoms. The authors conclude that using this new prostatitis symptom index confirms that chronic prostatitis like symptoms are common. 1 figure. 1 table. 16 references.
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Treatment of Prostatitis Source: American Family Physician. 61(10): 3015-3022. May 15, 2000. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org.
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Summary: The term prostatitis is applied to a series of disorders, ranging from acute bacterial infection of the prostate gland to chronic pain syndromes, in which the prostate gland is inflamed. This article reviews the diagnosis and treatment of prostatitis. Patients present with a variety of symptoms, including urinary obstruction, fever, myalgias (muscle pain), decreased libido or erectile dysfunction, painful ejaculation, and low back or perineal pain. Physical examination often fails to clarify the cause of the pain. Cultures and microscopic examination of urine and prostatic secretions before and after prostatic massage may help differentiate prostatitis caused by infection from prostatitis with other causes. Because the rate of occult (hidden) infection is high, a therapeutic trial of antibiotics is often in order even when patients do not appear to have bacterial prostatitis. If the patient responds to therapy, antibiotics are continued for at least three to four weeks, although some men require treatment for several months. A patient who does not respond might be evaluated for chronic nonbacterial prostatitis, in which nonsteroidal antiinflammatory drugs, alpha blocking agents, anticholinergic agents, or other therapies may provide symptomatic relief. 3 tables. 23 references. ·
Prostatitis: What It Is, How to Cure It Source: American Family Physician. 61(10): 3025-3026. May 15, 2000. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This patient education handout offers information about prostatitis, a term that is applied to a series of disorders, ranging from acute bacterial infection of the prostate gland to chronic pain syndromes, in which the prostate gland is inflamed. The prostate is a gland that lies just below the male urinary bladder. The prostate makes a fluid that provides nutrients for sperm; this fluid makes up most of the ejaculate fluid. Patients with prostatitis present with a variety of symptoms, including urinary obstruction, fever, myalgias (muscle pain), decreased libido or erectile dysfunction, painful ejaculation, and low back or perineal pain. The treatment of prostatitis is based on the type of prostatitis diagnosed. Antibiotics are used to treat infections of the prostate. Because the rate of occult (hidden) infection is high, a therapeutic trial of antibiotics is often in order even when patients do not appear to have bacterial prostatitis. A patient who does not respond to antibiotics might be evaluated for chronic nonbacterial prostatitis, in which nonsteroidal antiinflammatory drugs, alpha blocking agents, anticholinergic agents, or other therapies may provide symptomatic relief. The handout reassures readers that prostatitis does not cause
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prostate cancer, even though sometimes prostatitis can cause a temporary rise in the man's PSA level (a test used to screen for cancer). 1 figure. ·
Diagnosis and Treatment of Chronic Abacterial Prostatitis: A Systemic Review Source: Annals of Internal Medicine. 133(5): 367-381. September 5, 2000. Contact: Available from American College of Physicians. American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Website: www.acponline.org. Summary: The optimal management of chronic abacterial prostatitis (prostate inflammation not due to a bacterium) is not known. This article reports on a literature review undertaken to assess whether there are accurate, reliable tests available to diagnose chronic abacterial prostatitis and whether there are effective therapies available to treat the condition. For each selected article, two investigators independently extracted key data on study design, patient characteristics, diagnostic test or treatment characteristics, and outcomes. The study included 19 diagnostic test articles and 14 treatment trials. The disparity among studies in design, interventions, and other factors precluded quantitative analysis or pooling of the findings. Diagnostic test articles included 1,384 men (mean age, 33 to 67 years) and evaluated infection; inflammation, immunology, and biochemistry; psychological factors; and ultrasonography. Treatment trials included 570 men (mean age, 38 to 45 years) and evaluated medications used to treat benign prostatic hyperplasia (BPH), anti inflammatory drugs, antibiotics, thermotherapy, and miscellaneous medications. The authors conclude that there is no gold standard diagnostic test for chronic abacterial prostatitis, and that the methodologic quality of available studies of diagnostic tests is low. The few treatment trials are methodologically weak and involved small samples. The routine use of antibiotics and alpha blockers to treat chronic abacterial prostatitis is not supported by the existing evidence. 1 figure. 3 tables. 89 references.
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National Institutes of Health Chronic Prostatitis Symptom Index: Development and Validation of a New Outcome Measure Source: Journal of Urology. 162(2): 369-375. August 1999. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: Chronic abacterial prostatitis is a syndrome characterized by pelvic pain and voiding symptoms, which is poorly defined, poorly
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understood, poorly treated, and bothersome. Research and clinical efforts to help men with this syndrome have been hampered by the absence of a widely accepted, reliable, and valid instrument to measure symptoms and quality of life impact. This article reports work on the development and validation of a new outcome measure in which the researchers developed a psychometrically valid index of symptoms and quality of life impact for men with chronic prostatitis. The authors conducted a series of focus groups comprising chronic prostatitis patients at four centers in North America, in which they identified the most important symptoms and effects of the condition. The results were used to create an initial draft of 55 questions that were used for formal cognitive testing on chronic prostatitis patients at the same centers. After expert panel review, formal validation testing of a revised 21 item draft was performed in a diverse group of chronic prostatitis patients and two control groups of benign prostatic hyperplasia (BPH) patients and healthy men. Based on this validation study, the index was finalized. Analysis yielded an index of nine items that address three different aspects of the chronic prostatitis experience. The primary component was pain, which was captured in four items focused on location, severity, and frequency. Urinary function, another important component of symptoms, was captured in two items (one irritative and one obstructive). Quality of life impact was captured with three items about the effect of symptoms on daily activities. The nine items had high test retest reliability and internal consistency. All but the urinary items discriminated well between men with and without chronic prostatitis. The authors conclude that this National Institutes of Health chronic prostatitis symptom index provides a valid outcome measure for men with chronic prostatitis. The index is psychometrically robust, easily self administered, and highly discriminative. It may be useful in clinical practice as well as in research protocols. 2 appendices. 5 tables. 27 references. ·
How Common is Prostatitis? A National Survey of Physician Visits Source: Journal of Urology. 159(4): 1224-1228. April 1998. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a study that used a national database to explore the epidemiology of physician visits for genitourinary symptoms or a diagnosis of prostatitis. The authors analyzed 58,955 visits by men 18 years old or older to office based physicians of all specialties, as included in the National Ambulatory Medical Care Surveys from 1990 to 1994. Physicians selected by random sampling completed visit forms that
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included information on patient reasons for visits and physician diagnoses. From 1990 to 1994, percent of all ambulatory visits by men 18 years old or older included genitourinary symptoms as a reason for the visit. In almost 2 million visits annually, prostatitis was listed as a diagnosis, including 0.7 million by men 18 to 50 years old, and 0.9 million by those older than 50 years. Of the prostatitis visits, 46 percent were to urologists and 47 percent were to primary care physicians. A prostatitis diagnosis was assigned at 8 percent of urologist visits and at 1 percent of primary care physician visits. The odds of a prostatitis diagnosis were 13 fold greater at visits to urologists compared with visits to primary care physicians, and approximately 2 fold greater in the South than in the Northeast. Surprisingly, compared with men 66 years old or older, prostatitis was more commonly diagnosed in men 36 to 65 than in men 18 to 35 years old. This is contrary to previous reports that prostatitis is more commonly a condition of younger men. When a prostatitis diagnosis was given, antimicrobial use was likely to be reported 45 percent of the time for men with, and 27 percent of the time for men without, genitourinary symptoms. Visits to primary care physicians were more often associated with antimicrobial use than visits to urologists. The authors conclude that genitourinary symptoms are a frequent reason for office visits by younger and older men, and prostatitis is a common diagnosis. Despite a report that less than 10 percent of prostatitis cases are bacterial, a much higher proportion of men in whom prostatitis is diagnosed receive antimicrobials. ·
Predictors of Patient Response to Antibiotic Therapy for the Chronic Prostatitis. Chronic Pelvic Pain Syndrome: A Prospective Multicenter Clinical Trial Source: Journal of Urology. 165(5): 1539-1544. May 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: Antibiotics are the most popular choice of therapy for all categories of the chronic prostatitis or chronic pelvic pain syndrome. This article reports on a study undertaken to determine if culture, leukocyte, or antibody status of prostate specific specimens predicts patient response to antibiotic therapy. Patients clinically diagnosed with the chronic prostatitis or chronic pelvic pain syndrome according to the National Institutes of Health (NIH) definition had a lower urinary tract evaluation that included standard microscopy and culture of prostate specific specimens, and determination of the ratios of antibody levels against identified prostate pathogens. Symptom evaluation consisted of
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the NIH chronic prostatitis symptom index pain scale 0 to 21, symptom severity index scale 0 to 100, symptom frequency questionnaire scale 0 to 50, and quality of life scale 0 to 6. Patients were stratified according to microscopy, culture, and immune statu; were treated with 12 weeks of ofloxacin, and were assessed at 4, 12, and 24 weeks with symptom scores as well as global assessments. Based on leukocyte and culture results, 102 evaluable patients were stratified into categories II (14 percent), IIIA (48 percent), and IIIB (38 percent) of the chronic prostatitis or chronic pelvic pain syndrome. Of the cases, 23 percent were categorized as antibody positive and 77 percent as antibody negative. Average age was 42 years (plus or minus 10 years) and 92 percent of patients were white. Of the patients, 57 percent believed that they had moderate to marked improvement. All categories of the chronic prostatitis or chronic pelvic pain syndrome and patients in whom antibody was positive or negative had significant improvement in the NIH chronic prostatitis symptom index, symptom severity index, symptom frequency questionnaire, and quality of life scores compared with baseline. There was no significant difference in patient response to the stratification based on culture, leukocyte, or antibody status. The authors conclude that culture, leukocyte, and antibody status of prostate specific specimens does not predict antibiotic response in patients with the chronic prostatitis or chronic pelvic pain syndrome. The perceived beneficial effect of antibiotics needs to be evaluated in a randomized placebo controlled trial. 3 figures. 3 tables. 34 references. ·
Helping Patients Cope with Chronic Prostatitis Source: Patient Care. 34(8): 22-32. April 30, 2000. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: This article describes a new classification system for prostatitis (prostate infection) that can help focus treatment for patients with chronic symptoms. While many patients respond well to treatment for prostatitis, the overall cure rate is low and relapse and recurrence are common. The new diagnostic system, developed in 1995 and endorsed in 1998, has 4 numbered categories and strives to be more descriptive than its predecessor. Category I, acute bacterial prostatitis, and category II, chronic bacterial prostatitis, are defined as they have always been. An important change is evident in category III, designed as chronic nonbacterial prostatitis or chronic pelvic pain syndrome (CPPS), which encompasses about 90 percent of patients. A new group, category IV, includes patients with asymptomatic prostatitis. Diagnosis begins with a focused history and a physical; the physical assessment should be
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concentrated on the abdomen, external genitalia, perineum, pelvic area, and the prostate gland. Treatment for patients in category I is straightforward, usually beginning with a short hospital stay. The oral fluoroquinolones are excellent choices for patients with category II prostatitis. Trimethoprim or trimethoprim with sulfamethoxazole may be useful. Therapies used in the treatment of patients with inflammatory CPPS include a trial course, of antibiotics, prostatic massage, NSAIDs, alpha 1 adrenergic blockers, and supportive measures. A patient care algorithm (flowchart) is included. 2 figures. 2 tables. 14 references. ·
Autoimmune Prostatitis: Evidence of T Cell Reactivity with Normal Prostatic Proteins Source: Urology. 50(6): 893-899. 1997. Summary: Chronic prostatitis is a common diagnosis, but the disease is poorly understood. Men present with pelvic pain, irritative voiding symptoms, and sexual dysfunction complaints, all of which are nonspecific. This article reports on a study undertaken to determine whether men with chronic prostatitis or chronic pelvic pain syndrome have evidence of an autoimmune response to prostatic proteins. The authors examined men with a history of this problem for evidence of T lymphocyte reactivity to seminal plasma. Patients underwent automated leukopheresis to obtain peripheral blood mononuclear cells. The authors performed a recall antigen proliferation assay to detect specific proliferation of peripheral helper T lymphocytes in men with chronic prostatitis or chronic pelvic pain syndrome and compared the results with those of normal men. The antigen for these studies consisted of seminal plasma from normal donors and men with seminal vesicle atresia. A specific recall proliferative response to seminal plasma was observed in 3 of 10 men with a history of chronic prostatitis or chronic pelvic pain syndrome compared with none of 15 normal men. The recall responses of both the syndrome group and the normal subjects to the recall antigens tetanus toxoid and Candida extract were equivalent. The authors conclude that the data represent the first direct evidence that some men with chronic prostatitis or chronic pelvic pain syndrome have an autoimmune component to their disease. Autoimmunity is a potential etiology for chronic nonbacterial prostatitis. 2 figures. 3 tables. 24 references.
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Quercetin in Men with Category III Chronic Prostatitis: A Preliminary Prospective, Double-Blind, Placebo-Controlled Trial Source: Urology. 54(6): 960-963. December 1999.
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Contact: Available from Urology. P.O. Box 2126, Marion, OH 43306-8226. (800) 215-4692. Fax (740) 382-5866. Summary: The National Institutes of Health (NIH) category III chronic prostatitis syndromes (nonbacterial chronic prostatitis and prostatodynia or prostate pain) are common disorders with few effective therapies. Bioflavonoids have recently been shown in an open-label study to improve the symptoms of these disorders in a significant proportion of men. This article reports on a study undertaken to confirm these findings in a prospective randomized, double-blind, placebo controlled trial. The study included 30 men with category IIIa and IIIb chronic pelvic pain syndrome who were randomized in a double blind fashion to receive either placebo or the bioflavonoid quercetin 500 milligrams twice daily for 1 month. The NIH chronic prostatitis symptom score was used to grade symptoms and the quality of life impact at the start and conclusion of the study. In a followup, unblind, open label study, 17 additional men received 1 month of a supplement containing quercetin, as well as bromelain and papain (Prosta-Q), which enhance bioflavonoid absorption. Two patients in the placebo group refused to complete the study because of worsening symptoms, leaving 13 placebo and 15 bioflavonoid patients for evaluation in the blind study. Both the quercetin and placebo groups were similar in age, symptom duration, and initial symptom score. Patients taking placebo had a mean improvement in NIH symptom score from 20.2 to 18.8 (not significant), while those taking the bioflavonoid had a mean improvement from 21.0 to 13.1. Twenty percent of patients taking placebo and 67 percent of patients taking the bioflavonoid had an improvement of symptoms of at least 25 percent. In the 17 patients who received Prosta-Q in the open label study, 82 percent had at least a 25 percent improvement in symptom score. The authors conclude that therapy with the bioflavonoid quercetin is well tolerated and provides significant symptomatic improvement in most men with chronic pelvic pain syndrome. 1 figure. 1 table. 26 references. ·
Prostatitis Source: Clinical Microbiology Reviews. 11(4): 604-613. October 1998. Contact: Available from American Society for Microbiology. Institutional or Nonmember Subscription Office, P.O. Box 11127, Birmingham, AL 35201-1127. (800) 633-4931 or (205) 995-1567. Fax (205) 995-1588. E-mail:
[email protected]. Summary: Prostatitis (infection of the prostate) is a common urologic condition that many clinicians find difficult to treat effectively. Culture diagnosis of acute bacterial prostatitis is straightforward and easily accomplished in the laboratory. On the other hand, the microbiologic
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diagnosis of chronic prostatitis and chronic idiopathic (nonbacterial) prostatitis (more commonly referred to as prostatodynia) is more of a challenge. This article reviews prostatitis, focusing on its etiology and diagnosis. Topics include acute versus chronic bacterial prostatitis, specimen collection and bacteriologic culture, common bacterial etiologic agents, chronic idiopathic prostatitis (including prokaryotic DNA sequences in patients, bacterial cultures for commensal and fastidious bacteria, difficult to culture Coryneforms in expressed prostatic secretions, Chlamydia trachomatis, and Ureaplasma urealyticum), mycobacterial infection, gonococcal prostatitis, parasitic prostatitis, fungal prostatitis, abscesses of the prostate gland, viral prostatitis, prostatitis in benign prostatic hyperplasia (BPH), urovirulence determinants of bacteria causing prostatitis, antibiotic pharmacokinetics in prostatitis, chemical inflammatory reactions as the cause of nonbacterial prostatitis, and the autoimmune disease hypothesis. The author concludes that reports published within the past 2 years strongly suggest an association between bacteria and chronic idiopathic prostatitis. It is important to undertake research to determine whether there is persistence of bacterial antigens in prostatic tissue and fluids, since these antigens could trigger immunologic and biochemical events that may result in initiation and maintenance of chronic inflammation in this troublesome condition. 1 figure. 73 references. ·
Perplexing Nature of Prostatitis Source: Contemporary Urology. 9(5): 73-74, 77-78, 80. May 1997. Summary: Prostatitis, an infection of the prostate, remains a common and often perplexing problem for the practicing urologist. In this article, the authors present recommendations for differentiating the different types of prostatitis and for the use of new antimicrobials. The authors stress that effective therapy for prostatitis depends upon correct diagnosis and classification of patients into clinically distinct syndromes, which allow the physician a better understanding of the disease process. Prostatitis is classified as bacterial prostatitis (acute and chronic), nonbacterial prostatitis (NBP), or prostatodynia. ABP and CBP are caused more commonly by gram-negative enteric organisms that are usually isolated in urinary tract infections (UTIs). NBP presents similarly to bacterial prostatitis, but as its name implies, bacterial cultures obtained from the urethra, bladder, and prostate are repeatedly negative. In prostatodynia, antimicrobial therapy is not indicated. Antimicrobials discussed include levlofloxacin, ciprofloxacin, ofloxacin, doxycycline, and trimethoprimsulfamethoxazole. 4 tables. 13 references. (AA-M).
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Federally-Funded Research on Prostatitis The U.S. Government supports a variety of research studies relating to prostatitis and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.16 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to prostatitis and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore prostatitis and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for prostatitis: ·
Project Title: Biostatistics Support Center for Chronic Prostatitis Principal Investigator & Institution: Landis, J. R.; Professor; Medicine; University of Pennsylvania 1 College Hall Philadelphia, Pa 19104 Timing: Fiscal Year 2000; Project Start 0-SEP-1997; Project End 1-AUG2002 Summary: (Taken from the applicant's Abstract) This is an application for the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania Medical Center to serve as the Biostatistics Support Center (BSC) for the Chronic Prostatitis Clinical Research Group (CPCRG). In order to investigate etiologic, diagnostic, prognostic and therapeutic hypotheses for Chronic Abacterial Prostatitis-Chronic Pelvic Pain Syndrome (CPPS), the BSC will provide administrative, biostatistical, epidemiological and data management leadership for the CPCRG in the design/conduct of collaborative research programs. During Phase I, the BSC will guide (i) the design of an observational, longitudinal Chronic Prostatitis Data Base (CPDB) Study, recruitment of eligible patients into the CPDB Study, and collection of extensive data on symptoms,
16 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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functional status, quality of life, and laboratory specimens. The BSC will provide epidemiological and biostatistical expertise in study design, pain measurement, and methods (ii) to study patient self-reported symptoms, develop and validate survey instruments, produce a symptom severity index of CPPS, and validate the diagnostic criteria established by the NIDDK workshop panel on CPPS. The BSC will also guide (iii) the development of validation protocols to study objective diagnostic findings in men with CPPS, investigate the validity of state-of-the-art laboratory techniques, and develop and conduct standardized protocols for studies of the biological characteristics of semen and expressed prostatic secretions (EPS). The BSC will assist the CPCRG (iv) to develop and validate outcomes measures for CPPS, including indices of pain and quality of life that are responsive to longitudinal change. During Phase II, the BSC will collaborate with the CPCRG to develop protocols and conduct clinical trials and other epidemiological studies of CPPS. The BSC will provide an efficient data management system, accessible through the popular World Wide Web (WWW) technology deployed on existing hardware at the Clinical Research Centers (CRCs), to facilitate data entry, verification and validation at the CRCs, and secure data transmission over the internet to the CPDB server at the BSC. This system will support subject enrollment, randomization and data collection at the CRCs, and tracking of subjects, data, and specimens at the BSC. The BSC will execute procedures for data security and access, data quality control, storage and back-up, and will provide periodic reports of accrual, followup, and data quality. The BSC will organize meetings of the Steering Committee, coordinate the development and distribution of the Protocol and Manual of Operations for the longitudinal CPDB, for each of the validation protocols and for each of the clinical trials/studies. The BSC also will conduct training sessions for the research coordinators, conduct data quality site visits to the CRCs, and provide the Steering Committee with interim data summaries, final statistical analyses and collaboration on all scientific publications. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Chronic Prostatitis Collaborative Clinical Studies Principal Investigator & Institution: Alexander, Richard B.; Professor; Surgery; University of Maryland Balt Prof School Professional Schools Baltimore, Md 21201 Timing: Fiscal Year 2000; Project Start 0-SEP-1997; Project End 1-AUG2002 Summary: This abstract is not available. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Mechanisms of Chronic Prostatitis Principal Investigator & Institution: Kreutzer, Donald L.; Associate Professor; Pathology; University of Connecticut Sch of Med/Dnt of Medicine and Dentistry Farmington, Ct 06032 Timing: Fiscal Year 2000; Project Start 7-JUL-1997; Project End 1-MAY2002 Summary: Currently, virtually nothing is known about the existence and role of T lymphocytes, mast cells and their products in non bacterial chronic prostatitis (NBCP). Thus, it is essential that a systematic characterization of these cells and their products in NBCP be undertaken to fill this major gap in our knowledge of this inflammatory disease. Thus, we propose to: 1) systematically characterize T lymphocyte subpopulations in NBCP and non NBCP patients (for clinical criteria, see Patient Population below); 2) determine the role of CD4 Th2-related cytokines, particularly IL3 in promoting mast cell growth and differentiation in NBCP, and 3) to determine the role of mast cells and their products in NBCP and non NBCP. We hypothesize that NBCP is an inflammatory disease of the prostate that results from an imbalance of specific T-lymphocyte subpopulations. To test this hypothesis, we have developed the following specific aims: (1) to isolate, characterize and correlate T cells and T cell clones from fluids (blood, urine, prostate fluids) and tissue from NBCP, non NBCP and normal patient; (2) to characterize and correlate the distribution of CD4 Th1 and CD4 Th2 lymphocytes and associated cytokines in fluids (blood, urine, prostate fluids) and tissue from NBCP, non NBCP and normal patients; and (3) to characterize and correlate the distribution of mast cells and mast cellrelated factors in NBCP, non NBCP and normal patients. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Pathogenesis of Non Bacterial Chronic Prostatitis Principal Investigator & Institution: Albertsen, Peter C.; University of Connecticut Sch of Med/Dnt of Medicine and Dentistry Farmington, Ct 06032 Timing: Fiscal Year 2000 Summary: Lymphocytes and lymphocyte-derived cytokines are thought to be critical in controlling chronic inflammatory processes by regulating the function of a wide variety of cells including inflammatory, immunologic and tissue cells (e.g. mast cells). Currently, little is known about the existence and role of T lymphocytes, mast cells, nerves and their products in non-bacterial chronic prostatitis (NBCP) and its associated chronic pain. Based on the growing body of literature on the
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role of lymphocyte-mast cell-nerve interactions in pain we have developed the following hypothesis: Hypothesis: Non-bacterial chronic prostatitis (NBCP), prostatodynia and chronic nonbacterial inflammation (CNBI) are inflammatory diseases of the prostate that result from an imbalance of specific T lymphocyte subpopulations (T1 vs. T2), which via their cytokine expression, regulate directly and indirectly the function of inflammatory, immunology and tissue cells (mast cells and nerves) within the prostate microenvironment, and thereby control both inflammation and pain within chronically inflamed prostate tissue. To test this hypothesis we propose the following goals: 1) to isolate, characterize and correlate T cells in fluids (blood, urine, prostate fluids) and tissue from NBCP, prostatodynia, CNBI and control patient populations. 2) to characterize and correlate the distribution of T1 and T2 cytokines in fluids and tissue from NBCP, prostatodynia, CNBI and control patients. 3) to characterize and correlate the distribution of mast cells and mast cell-related factors in NBCP, prostatodynia, CNBI and control patients. 4) to define the relationships between lymphocytes, mast cells and nerves in NBCP, prostatodynia, CNBI and control patients. 5) to quantify pain in patients with chronic prostatitis (NBCP, prostatodynia, and CNBI) using established validated instruments to correlate their clinical course with cell and cytokine results. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Activation of Prostate Specific Antigen Precursor Principal Investigator & Institution: Takayama, Thomas K.; Biochemistry; University of Washington 3935 University Way Ne Seattle, Wa 98195 Timing: Fiscal Year 2000; Project Start 1-AUG-2000; Project End 0-JUN2002 Summary: Serine proteases of the prostate have potentially important roles in the biology of prostatic diseases. Prostate specific antigen (PSA), a member of the tissue kallikrein family of serine proteases, may regulate cellular growth by cleaving insulin growth factor-binding proteins (IGFBP's). This is significant especially since men with elevated IGF levels have recently been shown to have a 4-fold increase risk in the development of prostate cancer. Men with benign prostatic hyperplasia (BPH) also have abnormal progressive growth of the prostate gland. Whether IGF or other growth factors are involved in these processes is an intriguing question worth investigation. PSA has also been shown to elicit a bradykinin response by smooth muscle Cells when pre-incubated with seminal plasma. Because bradykinin stimulates inflammatory response, there may be a potential role of PSA in the pathogenesis of prostatitis. Our hypothesis therefore, is that PSA, and other serine
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proteases of the prostate, may be involved in the development of prostatic diseases such as BPH, prostatitis, and prostate cancer. We therefore, propose to study the potential pathogenic mechanisms of PSA, hK2 (another prostate specific serine protease) and other serine proteases recently isolated from the prostate. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Progression of BPH on Medical Therapy Principal Investigator & Institution: Kaplan, Steven A.; Urology; Columbia University Health Sciences Ogc New York, Ny 10032 Timing: Fiscal Year 2000; Project Start 7-APR-1995; Project End 1-MAR2002 Summary: Benign prostatic hyperplasia (BPH) is the most common affliction of men over the age of 50. Traditionally associated symptoms are felt to be secondary to bladder outlet obstruction, dynamic tone of the smooth muscle of the prostate or inherent bladder dysfunction. A host of alternative therapeutic options have been described in the literature over the past 5 years. However, these studies have focused on the relative efficacy and side effect profile of these therapies. There have been few long term studies of the natural history of BPH progression in those who are either treated or in those who are followed by watchful waiting. Moreover, the natural history of BPH in various age and ethnic groups have been poorly characterized. Finally, to date, there have been no long term studies of the association between bladder function, prostatic obstruction, prostate size, symptoms and therapy employed. This full scale, 7 year trial, will provide enormous insight into the progression of prostate enlargement and symptoms in both an untreated population and one treated with medication. This is of particular importance because efficacy of medical therapy can be truly determined only with an understanding of the untreated natural history of BPH. The effects of pharmacologic reduction in the size of the prostate utilizing the 5alpha reductase inhibitor, finasteride, and/or physiologic reduction of urethral outlet resistance using the alpha1 receptor antagonist, doxazosin, on symptoms, voiding parameters and reversibility of bladder dysfunction will be assessed. Four treatment groups will be studied, l) placebo, 2) 5 mg of finasteride (PROSCAR), 3) 8 mg of doxazosin (CARDURA) and, 4) 5 mg finasteride and 8 mg of doxazosin. Progression of disease will be measured by either a rise in baseline AUA Symptom Score of 4 points, development of urinary retention, incontinence or recurrent urinary tract infections or a rise in baseline serum creatinine of 50%. Through this full scale BPH trial, we hope to ascertain: A) the optimal temporal intervention in the treatment of BPH, B) whether reduction in the size of
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the prostate result in true regression of the disease process? C) a priori prostate tissue characteristics which predict severity of disease or preferential response to medical therapy, D) whether specific ethnic groups manifest various forms of BPH resulting in different rates of progression and differential response to therapy? and, E) whether concomitant prostate conditions such as cancer or prostatitis are effected by pharmacologic intervention for BPH? Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Regulatory Mechanisms of Prostate Tumor Progression Principal Investigator & Institution: Heston, Warren Dw.; Director and Staff; Cleveland Clinic Foundation 9500 Euclid Ave Cleveland, Oh 44195 Timing: Fiscal Year 2000; Project Start 0-SEP-1993; Project End 1-AUG2003 Summary: Abnormal conditions or the prostate constitute a major medical problem in the United States. Prostatitis, benign enlargement (BPH), and malignant growth of the prostate (CaP), will effect the lives of most men over the age of 50. BPH is a bothersome abnormal growth that fortunately is readily treated by a variety of options. Prostate cancer, if detected early is curable. However, metastatic disease can be fatal, as there is currently no available curative therapy for metastatic prostate cancer. In addition, because of the extreme heterogeneity with regard to the biologic potential of prostatic cancer, there is debate on the approach to therapy, even with localized disease. There is a lack of consensus and viable approaches to management and therapy for CaP. This reflects our lack of knowledge regarding the biologic determinants responsible for this spectrum of behavior at a level that would provide appropriate therapeutic intervention. This O'Brien Urology Center project will focus its attention on determining changes in the cellular phenotype that is associated with disease progression from normal to premalignant lesions, to localized cancer, and to distant disseminated disease. In this project we will center on three areas related to cellular signaling and cell cycle programming as it related to benign and malignant prostate growth. The first project will focus its research efforts on cell cycle regulation in prostate cancer progression. The second project will examine alterations in PKC isozyme signaling in metastatic progression and in apoptotic cell death. The third project will examine the role of PSM antigen as a folate hydrolase in the biology of the prostate and its evolution to cancer. These projects and the recruitment of developmental programs to the Center are designed to provide an understanding of the biology of progression of CaP and developing strong rational for innovative interventional strategies.
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Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Targeted CTL Mediated Immunity for Prostate Cancer Principal Investigator & Institution: Frelinger, John G.; Professor; Microbiology and Immunology; University of Rochester River Campus Sta Rochester, Ny 14627 Timing: Fiscal Year 2000; Project Start 1-SEP-1996; Project End 1-AUG2002 Summary: (Adapted from investigator's abstract): A loner term goal of this work is to test the hypothesis that a tissue-specific and developmentally regulated antigen may be used for the effective immuno-therapy of prostate cancer. Prostate cancer is the second leading cause of cancer deaths in men and an important disease of the aged. A serious limitation in the past has been the lack of defined and authentic tumor antigens, which would be applicable to humans, yet have the experimental advantages of an animal model. To address these issues the investigators have developed transgenic mice that express human prostate specific antigen (hPSA) in a pattern remarkably similar to humans. In this project they will examine how the specific expression of hPSA in the prostate affects the cell-mediated immune, response to PSA. Using a novel molecular approach, they will determine which PSA epitopes are recognized in the PSA-expressing mice compared to nontransgenic mice. These studies will test the hypothesis that the PSA-CD transgenic mice, in which PSA is a self-antigen, are tolerant to one or more immuno-dominant epitopes, but are capable of responding to this antigen via recognition of a different subset of PSA epitopes that are normally subdominant or cryptic. The PSA epitopes for both CD4 and CD8 cells restricted to mouse class I molecules, as well as those presented by the human HLA-A2 class I molecule, will be determined. They believe they have incorporated a method for not only identifying, but also improving upon tumor-antigen epitopes. Altered peptide ligands with improved MHC binding or improved recognition by the T cell receptor will be created and tested for their ability to stimulate protective responses against tumors expressing native hPSA. Further, using this model they will explore if a vigorous response to PSA results in autoimmune prostatitis. Finally, these results will be incorporated into immunotherapy strategies using mice that develop prostate cancer spontaneously. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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·
Project Title: Urological Studies of Ideopathic Lower Tract Syndromes Principal Investigator & Institution: Krieger, John N.; Professor of Urology; Urology; University of Washington 3935 University Way Ne Seattle, Wa 98195 Timing: Fiscal Year 2000; Project Start 1-AUG-1991; Project End 1-JUL2001 Summary: (Adapted from the Applicant's Abstract): The etiology of the so-called chronic prostatitis is uncertain in over 90% of men diagnosed, and therapy is largely empirical and ineffective. The long-term objectives of this proposal are to determine the causes, consequences, and optimal therapy for chronic prostatitis syndromes (CPS). The specific aims are: (1) Test the hypothesis that genitourinary tract infection is important using clinical, microbiological, and molecular approaches. Preliminary studies used polymerase chain reaction (PCR) methods to identify microbial DNAs in patients with CPS (25% by one and 77% by another assay) and found that such patients were more likely to have inflammation in their expressed prostatic secretions (EPS). These observations will be extended and it will be determined if the spectrum of organisms associated with chronic inflammatory prostatitis differs from the spectrum of organisms associated with non-inflammatory prostatitis. (2) Test the hypothesis that multiple EPS evaluations are needed for accurate patient classification. The new NIH classification distinguishes patients with EPS inflammation from those without inflammation. Preliminary data suggest that some patients have intermittent EPS inflammation. This study will establish if patients need multiple evaluations of their EPS and provide insight into the sources and characteristics of leukocytes in the prostatic secretions. (3) Test the hypothesis that men with CPS and EPS or seminal inflammation are more likely to have abnormal prostatic blood flow than patients without inflammation. Preliminary studies established methods to evaluate leukocytes in EPS, seminal fluid and prostatic parenchyma, and to measure the amount and distribution of blood flow within the prostate. This study will provide insight into the pathophysiology of chronic prostatitis and establish the clinical utility of these evaluations. (4) Test the hypothesis that patients with EPS inflammation are more likely to exhibit bladder stigmata associated with interstitial cystitis than patients with EPS inflammation. Preliminary data suggest that some patients exhibit petechial bladder hemorrhages and glomerulations after hydrodistension. This study will provide insight into the pathophysiology of chronic prostatitis and the clinical utility of cystoscopy under anaesthesia for evaluating patients. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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E-Journals: PubMed Central17 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).18 Access to this growing archive of e-journals is free and unrestricted.19 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “prostatitis” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for prostatitis in the PubMed Central database: ·
Prevalence of Corynebacterial 16S rRNA Sequences in Patients with Bacterial and "Nonbacterial" Prostatitis by Michael A. Tanner, Daniel Shoskes, Asha Shahed, and Norman R. Pace; 1999 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84971&ren dertype=external
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.20 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals.
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 18 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 19 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 20 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication. 17
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To generate your own bibliography of studies dealing with prostatitis, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “prostatitis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “prostatitis” (hyperlinks lead to article summaries): ·
Acute and chronic bacterial prostatitis: a review of treatment approaches. Author(s): Kot T, Pettit-Young N. Source: Compr Ther. 1990 August; 16(8): 54-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2173653&dopt=Abstract
·
Prostatitis: Man's hidden infection. Author(s): Drach GW. Source: The Urologic Clinics of North America. 1975 October; 2(3): 499520. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=52931&dopt=Abstract
·
The chronic prostatitis syndromes. Author(s): Thin RN. Source: J R Army Med Corps. 1997 October; 143(3): 155-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9403823&dopt=Abstract
Vocabulary Builder Adenoma: A benign epithelial tumour in which the cells form recognizable glandular structures or in which the cells are clearly derived from glandular epithelium. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Anaerobic: 1. lacking molecular oxygen. 2. growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU]
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Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Antigens: Substances that are recognized by the immune system and induce an immune reaction. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antiproliferative: Counteracting a process of proliferation. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Bordetella: A genus of gram-negative, aerobic bacteria whose cells are minute coccobacilli. It consists of both parasitic and pathogenic species. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Chlamydia: A genus of the family chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine.
56 Prostatitis
Chlamydia species are gram-negative and produce glycogen. The type species is chlamydia trachomatis. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Commensal: 1. living on or within another organism, and deriving benefit without injuring or benefiting the other individual. 2. an organism living on or within another, but not causing injury to the host. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Doxazosin: A selective alpha-1-adrenergic blocker that lowers serum cholesterol. It is also effective in the treatment of hypertension. [NIH] Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Finasteride: An orally active testosterone 5-alpha-reductase inhibitor. It is used as a surgical alternative for treatment of benign prostatic hyperplasia.
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[NIH]
Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microscopy: The application of microscope magnification to the study of
58 Prostatitis
materials that cannot be properly seen by the unaided eye. [NIH] Myalgia: Pain in a muscle or muscles. [EU] Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH]
Neonatal: Pertaining to the first four weeks after birth. [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Ofloxacin: An orally administered broad-spectrum quinolone antibacterial drug active against most gram-negative and gram-positive bacteria. [NIH] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Papain: A proteolytic enzyme obtained from Carica papaya. It is also the name used for a purified mixture of papain and chymopapain that is used as a topical enzymatic debriding agent. EC 3.4.22.2. [NIH] Parenchyma: The essential elements of an organ; used in anatomical nomenclature as a general term to designate the functional elements of an organ, as distinguished from its framework, or stroma. [EU] Pathogen: Any disease-producing microorganism. [EU] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume
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and maintenance of the water-electrolyte balance. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the interstitium and rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU] Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Schizophrenia: A severe emotional disorder of psychotic depth characteristically marked by a retreat from reality with delusion formation, hallucinations, emotional disharmony, and regressive behavior. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Serine: A non-essential amino acid occurring in natural form as the Lisomer. It is synthesized from glycine or threonine. It is involved in the
60 Prostatitis
biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Suppository: A medicated mass adapted for introduction into the rectal, vaginal, or urethral orifice of the body, suppository bases are solid at room temperature but melt or dissolve at body temperature. Commonly used bases are cocoa butter, glycerinated gelatin, hydrogenated vegetable oils, polyethylene glycols of various molecular weights, and fatty acid esters of polyethylene glycol. [EU] Surgical: Of, pertaining to, or correctable by surgery. [EU] Symptomatology: 1. that branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. the combined symptoms of a disease. [EU]
Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]
Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into
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the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Ureaplasma: A genus of gram-negative, nonmotile bacteria which are common parasitic inhabitants of the urogenital tracts of man, cattle, dogs, and monkeys. [NIH] Urothelium: The epithelial lining of the urinary tract. [NIH] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU]
Patents 63
CHAPTER 4. PATENTS ON PROSTATITIS Overview You can learn about innovations relating to prostatitis by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.21 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with prostatitis within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with prostatitis. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
21Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Prostatitis By performing a patent search focusing on prostatitis, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on prostatitis: ·
Method for treating chronic prostatitis or chronic pelvic pain syndrome Inventor(s): Stoner; Elizabeth (Westfield, NJ), Waldstreicher; Joanne (Scotch Plains, NJ), Nickel; Curtis J. (Elginburg, CA), Pontari; Michel A. (Lafayette Hill, PA) Assignee(s): Merck & Co., Inc. (Rahway, NJ), Temple University of the Commonwealth of Higher Ed. (Philadelphia, PA) Patent Number: 6,403,640 Date filed: August 24, 2000 Abstract: The use of a COX-2 selective inhibitor for the treatment of chronic prostatitis or chronic pelvic pain syndrome is disclosed. Excerpt(s): Chronic prostatitis or chronic pelvic pain syndrome is an extremely prevalent disease in men (Collins M M, et al., "How common is prostatitis? A national survey of physician visits," Journal of Urology, 159:1224-1228 (1998)). Although the epidemiologic evidence is limited, it appears that the prevalence of prostatitis is approximately 2-9% in adult men. It has been suggested that 35-50% of men are affected by prostatitis at some time in life. Approximately 2 million ambulatory patient visits are made annually for prostatitis, accounting for 8% of all visits to urologists and 1% of all visits to primary care physicians. Many men remain symptomatic for much of their lives. ... Chronic prostatitis is characterized by evidence of prostatic inflammation and by the presence or absence of white blood cells in prostatic fluid and/or pain associated with the prostate. This syndrome does not exist prior to puberty but has a peak incidence between the ages of 18 and 50. Suggestions as to the origins of these conditions have included a chemical imbalance in the prostate, infection undetected by current microbiological methods and autoimmunity to the prostate gland itself. ... Chronic non-bacterial prostatitis and prostatodynia (Chronic Pelvic Pain Syndrome) is
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characterized by pain and/or discomfort in the genitourinary, pelvic or perineal area and is associated with variable voiding and sexual dysfunction. Chronic nonbacterial prostatitis [Chronic Pelvic Pain Syndrome NIH Category IIIA] is an inflammatory and painful condition of unknown etiology characterized by excessive inflammatory cells in prostatic secretions despite a lack of documented urinary tract infections, and negative bacterial cultures of urine and prostatic secretions. Prostatodynia [Chronic Pelvic Pain Syndrome NIH Category IIIB] is a painful condition of unknown etiology characterized by a decided lack of inflammatory cells in prostatic secretions, no documented urinary tract infections and negative bacterial cultures in urine and prostatic secretions. Chronic nonbacterial prostatitis is more common than bacterial prostatitis. Symptoms mimic those of chronic bacterial prostatitis. Patients usually show an increase in the number of white blood cells and oval fat bodies in their expressed prostatic secretions. However, they rarely have a history of urinary tract infection, and lowertract localization cultures fail to reveal a pathogenic organism. Web site: http://www.delphion.com/details?pn=US06403640__ ·
Detection of prostatitis Inventor(s): Wheeler; Ronald E. (412 C.R. 243, P.O. Box 217, Durango, CO 81302) Assignee(s): none reported Patent Number: 6,365,340 Date filed: November 11, 1999 Abstract: The present invention is directed to a method of detecting prostatitis comprising obtaining an expressed prostatic secretion from a patient; contacting a device having diagnostic test reagents to the expressed prostatic secretion, the diagnostic test reagents reacting with the expressed prostatic secretion to produce a change in the device; reading the change in the device to produce a positive or negative experimental test result, wherein the experimental test result is positive when the experimental test result is pre-determined to correspond with a number above 10 for the number of white blood cell per high powered field and the experimental test result is negative when the experimental test result corresponds with a number of 10 or less for the number of white blood cell per high powered field; and determining presence of prostatitis with the positive experimental test result and the absence of prostatitis with the negative experimental test result. The present invention is also directed to a device for use in the inventive method. The
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device has two indicators, one for the presence of prostatitis and one for the absence of prostatitis. Excerpt(s): The present invention relates to a device and process for detecting prostatitis. ... A national survey of U.S. physician visits estimated that the diagnosis of prostatitis results in 2 million office visits per year in the United States and is the most frequent diagnosis resulting in an office visit to urologists in men less than 50-years-old. Collins, M. M., et al. (1998) J. Urol. 159:1224-1228. Prostatitis is defined as an inflammation or infection of the prostate gland. While prostatitis may be acute, associated with systemic findings of fever, chills and rigors, most cases of prostatitis are chronic and tend to be incurable with relatively frequent recurrences despite optimal standard therapy. Chronic prostatitis (inflammation or infection of the prostate) is common to all adult men. It is associated with virtually all cases of prostate cancer and is present in every prostate biopsy regardless of other findings. Chronic prostatitis may not cause significant symptoms in many men, but in others it can be a devastating disease that severely affects the quality of life of those afflicted. It is difficult to diagnose and even more difficult to treat. ... The most common symptom of chronic prostatitis is pelvic pain, followed by various voiding symptoms, impotence, and infertility. Pain from prostatitis is usually located in the groin, testicles, and penis, just above the rectum or in the suprapubic area over the bladder. Pain is frequently associated with ejaculation. Typical voiding symptoms produced by prostatitis include getting up at night to void (nocturia), frequency and urgency of urination, incomplete voiding, decreased force of the urinary stream, intermittency of the stream, and a need to push or strain to void. Impotence or erection difficulties and male infertility are also associated with prostatitis. Web site: http://www.delphion.com/details?pn=US06365340__ ·
Treatment for prostatitis and apparatus therefor Inventor(s): Faour; Ali M. (23412 Al Wahda Street Dafco Build., Sharjah, AE) Assignee(s): none reported Patent Number: 6,136,020 Date filed: June 26, 1998 Abstract: A method and apparatus for treating prostatitis is provided. The apparatus includes two probes, a control unit, and a monitor. A urethral probe selectively applies low frequency pulses to the prostate region as well as infrared heating. A rectal probe applies microwave
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heating to the prostate region and also includes an ultrasound element for generating an image of the prostate to facilitate diagnosis and treatment of the patient. Excerpt(s): The present invention relates to methods for treating prostatitis. More specifically, it relates to an improved method and apparatus for applying thermal and microwave energy, as well as electrostimulation to the prostate region to effect treatment of prostatitis. Ultrasound is used for diagnostic purposes. ... Various treatments for prostatitis and other prostate problems have been developed over the years, and have ranged from various surgical procedures to medication. One of the newest procedures involves the use of heat or thermal therapy, and several devices for applying heat to the prostate tissues have been developed, with varying levels of success. ... Briefly, the invention contemplates a method and apparatus for treating prostatitis. The apparatus comprises two probes, a control unit, and a monitor. A urethral probe has electrodes which selectively apply low frequency pulses to the prostate region as well as resistive heating. A rectal probe applies microwave heating to the prostate region and also includes an ultrasound element for generating an image of the prostate to facilitate diagnosis and treatment of the patient. Web site: http://www.delphion.com/details?pn=US06136020__ ·
Seat for treating prostatitis Inventor(s): Rabon; Larry D (Timmonsville, SC) Assignee(s): Rabon; Larry D. (Florence, SC) Patent Number: 6,125,486 Date filed: July 7, 1999 Abstract: A seat for treating and reducing the occurrence of prostatitis. The seat may be adapted to or formed into any chair, vehicle seat, or any other like device. In particular, the adaptation of the seat in a roughriding vehicle would reduce perineal trauma. The seat comprises an inflatable tube having a hole therethrough that is surrounded by a shoulder and with a cushion in the hole. Although the shoulder is very firm, the cushion is soft and provides relatively no resistance. The user sits in the tube and as a result pressure to the perineum is avoided and pressure is supported by the legs, hip or rear area. Excerpt(s): The present invention relates to a device for treating prostatitis. In particular, the present invention relates to a seat for reducing the occurrence of and providing relief from prostatitis. ... The
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current definition of prostatitis has been put forward by Dr. John Krieger as Chairman of Research and Clinical Definitions Group at the National Institute of Diabetes and Digestive and Kidney Diseases, (NIDDK). Under the NIH/NIDDK system, the nomenclature consists of four main categories: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome (CPPS), asymptomatic inflammatory prostatitis, chronic prostatitis/chronic pelvic pain syndrome. ... According to the June 1996 issue of Urology Times, various theories have been developed to resolve the cause of chronic prostatitis, especially if no infection can be detected. One theory speculates that the cause is urodynamic dysfunction. Others believe that the disease may be caused by psychological factors. While others theorize that the infection is just not detected using traditional techniques. Web site: http://www.delphion.com/details?pn=US06125486__ ·
Method for treating or preventing chronic nonbacterial prostatitis and prostatodynia Inventor(s): Guess; Harry A. (Chapel Hill, NC), Waldstreicher; Joanne (Scotch Plains, NJ), Pearson; Jay Dee (Hatfield, PA) Assignee(s): Merck & Co., Inc. (Rahway, NJ) Patent Number: 6,054,455 Date filed: May 17, 1999 Abstract: A tachykinin receptor antagonist, in particular a neurokinin-1 receptor antagonist, is useful for the treatment or prevention of chronic nonbacterial prostatitis and/or prostatodynia. Excerpt(s): Prostatitis and prostatodynia are extremely prevalent diseases in men (Collins M M, et al., "How common is prostatitis? A national survey of physician visits," Journal of Urology, 159:1224-1228 (1998)). There are more outpatient visits for prostatitis than for benign prostatic hypertrophy (BPH) or prostate cancer. Although the epidemiologic evidence is limited, it appears that the prevalence of prostatitis is approximately 2-9% in adult men. It has been suggested that 35-50% of men are affected by prostatitis at some time in life. Based on the National Ambulatory Medical Care Surveys from 1990-1994, approximately 2 million ambulatory visits are made annually for prostatitis. This accounts for 8% of all visits to urologists and 1% of all visits to primary care physicians. Many men remain symptomatic for much of their lives. ... This category of poorly understood syndromes is characterized by evidence of prostatic inflammation and by the presence or absence of white blood cells in prostatic fluid and/or pain associated with the
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prostate. Within this group of syndromes, the origins of chronic idiopathic prostatitis, asymptomatic prostatitis, and prostatodynia are problematic and are probably the least understood. The origin of these diseases have been attributed to some undefinable bacterial or viral infection, but this has never been proven. These syndromes do not exist prior to puberty but have a peak incidence between the ages of 18 and 50. It is possible that these three specific entities actually represent the same disease process in different phases or forms. Suggestions as to the origins of these conditions have included a chemical imbalance in the prostate, infection undetected by current microbiological methods, and autoimmunity to the prostate gland itself. ... Chronic nonbacterial prostatitis is an inflammatory and pain condition of unknown etiology characterized by excessive inflammatory cells in prostatic secretions despite no history of documented urinary tract infection and negative bacterial cultures of urine and prostatic secretions. Chronic nonbacterial prostatitis is even more common than bacterial prostatitis. Symptoms simulate those of chronic bacterial prostatitis and these patients usually show an increase in the number of white blood cellss and oval fat bodies in their expressed prostatic secretions. However, they rarely have a history of urinary tract infection, and lower-tract localization cultures fail to reveal a pathogenic organism. Patients with prostatodynia have negative bacterial cultures, normal prostatic secretions, and no history of urinary tract infection. Symptoms of chronic nonbacterial prostatitis and prostatodynia vary but include urinary urgency and frequency, nocturia, dysuria, and pain and discomfort perceived in the pelvic, suprapubic, or genital area. Sometimes postejaculatory pain and discomfort are prominent features. Physical findings for both conditions are nonspecific. Web site: http://www.delphion.com/details?pn=US06054455__ ·
Method of producing a medicinal tea for treating infertility in males and for treating prostatitis Inventor(s): Gideon; Salva (201 Lloyd Manor Road, Suite 200, Etobicoke, Ontario, CA) Assignee(s): none reported Patent Number: 5,736,144 Date filed: December 4, 1995 Abstract: A medicinal substance for increasing fertility in mammalian males and for use as an anti-microbial or anti-inflammatory agent by mammals produced by boiling radish leaves, radish stems or portions thereof in water for a period of time sufficient to produce a tea containing
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an extract from the radish leaves and stems or portions thereof. Alternatively, the radish leaves and stems may be placed in hot water for a period of time sufficient to produce a tea containing the extract. The resulting tea can be drunk hot or cold and may be stored in a refrigerator for extended periods of time for later use. Patients taking a daily dosage of this tea have shown greatly improved sperm density and improved motility and morphology after use for several weeks. Dosages of this tea are also effective in treating prostatitis. The preferred radish plant is the spring radish of the species Raphanus sativus. The leaves of other radish plants including wild and winter or oriental radishes may also be used. Excerpt(s): The present invention relates to treatments for treating infertility in males and for treating prostatitis. More particularly, the invention relates to a natural medicine treatment for treating infertility in males who suffer from germinal epithelium failure and for treating prostatitis in males. ... Due to the very nature of idiopathic oligospermia, an etiology is not diagnosed. Nevertheless, it is often suspected that microbes or other infectious agents may be present within the testes which may act as gonadotoxins. Microbes may also affect other areas of the sexual system such as the prostate. One very common ailment amongst men includes prostatitis, i.e. inflammation/infection of the prostate gland. Antibiotics are usually prescribed for males exhibiting this disorder. ... It is an object of the invention to provide a method of producing a medicinal substance for increasing fertility in males or for treating prostatitis. Web site: http://www.delphion.com/details?pn=US05736144__ ·
Method of treatment of chronic prostatitis with 17.beta.-Nmonosubstituted-carbamoyl-4-aza-5.alpha.-androst-1-en-3-ones Inventor(s): Gormley; Glenn J. (Westfield, NJ), Stoner; Elizabeth (Westfield, NJ) Assignee(s): Merck & Co., Inc. (Rahway, NJ) Patent Number: 5,629,318 Date filed: June 2, 1995 Abstract: The present invention is concerned with the use of 17.beta.-Nmonosubstituted-carbamaoyl-4-aza-5.alpha.-androst-1-en-3-one compounds as testosterone-5.alpha.-reductase inhibitors for the treatment of chronic prostatitis. Excerpt(s): The present invention is concerned with the use of 17.beta.-Nmonosubstituted-carbamoyl-4-aza-5.alpha.-androst-1-en-3-one
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compounds as testosterone-5.alpha.-reductase inhibitors for the treatment of chronic prostatitis. ... Prostatitis in general constitutes about 10 to 15% of all urological practice. This category of poorly understood syndromes can be characterized by evidence of prostatic inflammation and by the presence or absence of white blood cells in prostatic fluid and/or pain associated with the prostate. Within this group of syndromes, the origins of chronic idiopathic prostatitis, asymptomatic prostatitis, and prostatodynia are problematic and are probably the least understood. The origin of these diseases have been attributed to some undefinable bacterial or viral infection, but this has never been proven. These syndromes do not exist prior to puberty but have a peak incidence between the ages of 18 and 50. It is possible that these three specific entities actually represent the same disease process in different phases or forms. Suggestions as to the origins of these conditions have included a chemical imbalance in the prostate, infection undetected by current microbiological methods, and autoimmunity to the prostate gland itself. ... What is desired from a therapeutic standpoint is a drug that effectively shuts down the prostate metabolically to inhibit growth and lessen the activity of the prostatitis condition. Particularly what is desired is a drug that blocks the action of the prostatic enzyme that utilizes blood testosterone. Web site: http://www.delphion.com/details?pn=US05629318__ ·
Use of gibberellins for the treatment of prostatitis Inventor(s): Oden; Per (Motorb.ang.tsv agen 38, S-902 91 T afte.ang., SE) Assignee(s): none reported Patent Number: 5,580,857 Date filed: January 24, 1994 Abstract: The use of active gibberellins for the preparation of a pharmaceutical composition for the treatment of prostatitis. The method results in a decrease in prostate mass. Excerpt(s): The present invention relates to the use of the group of compounds known as gibberellins for the preparation of a pharmaceutical composition for the treatment of prostatitis, including hypertrophy and hyperplastic adenoma of the prostate, and psoriasis, as well as a method for treating these and other conditions by administering a gibberellin or a pharmaceutically acceptable salt or lactones thereof. ... It is generally accepted that pollen has a general strengthening effect upon human beings as well as a specific effect against chronic inflammation of the prostate (Br. J. Urol. 64 (1989) pp. 496-499); 66 (1990) pp 393-97; 66
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(1990) pp 398-404. The positive effect of pollen preparations (such as the Swedish preparations Cernilton and Cernitol) on chronic prostatitis has been scientifically proven, and such preparations are registered as medicaments in certain countries. Pollen is naturally rich in gibberellins, but it has not previously been investigated whether the presence of such gibberellins is involved with pollen's beneficial effects. These pollen preparations are dried water-extracts and their content of gibberellins is 0-1 .mu.g per gram dry material from the extract. ... It has now been found that gibberellins possess certain important therapeutic properties that previously have been unknown. According to the inventive concept gibberellins will be available for the treatment of prostatitis as given above and/or psoriasis. Web site: http://www.delphion.com/details?pn=US05580857__
Patent Applications on Prostatitis As of December 2000, U.S. patent applications are open to public viewing.22 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to prostatitis: ·
Composition and method for treating non-bacterial prostatitis Inventor(s): Kastke, Floyd A. ; (Los Angeles, CA) Correspondence: Robert J. Schaap; Suite 188; 21241 Ventura Boulevard; Woodland Hills; CA; 91364; US Patent Application Number: 20010025059 Date filed: January 9, 2001 Abstract: A composition and a method for treatment of prostate related dysfunction and, particularly, non-bacterial prostatitis and, even more particularly, non-bacterial chronic prostatitis. The composition primarily relies upon the use of a bioflavonoid and, particularly, that bioflavonoid known as quercetin. The quercetin is mixed with a proteolytic digestive enzyme protease, such as bromelin and papain, as the primary active ingredients. However, the composition may optionally and beneficially include other prostatitis affecting agents, such as zinc derived from zinc gluconate, cranberry, saw palmetto, as well as some other active and nonactive ingredients.
22
This has been a common practice outside the United States prior to December 2000.
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Excerpt(s): This application is a continuation-in-part of my co-pending U.S. provisional patent application Ser. No. 60,175,286, filed Jan. 10, 2000, for "Composition for Treating Non-Bacterial Prostatitis". ... The invention primarily relates to a composition and method for the treatment of nonbacterial prostatitis and, more particularly, to a composition and method for treating non-bacterial chronic prostatitis syndromes using bioflavonoids in a treatment composition and in a treatment method. ... Prostatitis is a name commonly used for a non-specific group of prostate related problems and is often characterized by prostatic pain, which may actually adopt the form of phantom symptomatic pain. At present, the cause for many of the forms of prostatitis is not fully known. As a result, there is frequently no known cure for non-bacterial chronic prostatitis, although there are several therapies of varying effectiveness, and usually limited effectiveness. These therapies are generally designed to address the issues of pain and discomfort as well as the other symptoms arising from this condition of prostatitis, but are not specific to any effective cure or permanent treatment therefor. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with prostatitis, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “prostatitis” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on prostatitis. You can also use this procedure to view pending patent applications concerning prostatitis. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the
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reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Gibberellins: A class of plant growth hormone isolated from cultures of Gibberella fujikuroi, a fungus causing Bakanae disease in rice. There are many different members of the family as well as mixtures of multiple members; all are diterpenoid acids based on the gibberellane skeleton. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH] Hypertrophy: Nutrition) the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells. [EU] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Proteolytic: 1. pertaining to, characterized by, or promoting proteolysis. 2. an enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU]
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CHAPTER 5. BOOKS ON PROSTATITIS Overview This chapter provides bibliographic book references relating to prostatitis. You have many options to locate books on prostatitis. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on prostatitis include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “prostatitis” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on prostatitis: ·
Clinical Manual of Urology Source: New York, NY: McGraw-Hill, Inc. 2001. 924 p.
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Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $54.95;plus shipping and handling. ISBN: 0071362010. Summary: This handbook serves as a basic, portable reference tool for the busy medical student and house officer rotating on the urology service and enables program directors to use the information presented as a framework on which to present their particular management styles and strategies. In addition, the handbook can serve as a ready reference for the primary care physician, who is often the first person to see the patient with what ultimately proves to be a urologic problem. The handbook offers 31 chapters: anatomy of the urogenital tract; signs and symptoms (the initial examination); diagnostic uroradiology; interventional uroradiology; lower urinary tract infections (UTI) in women; prostatitis (inflamed prostate gland) and lower UTI in men; painful bladder syndromes; pyelonephritis (kidney infections); nephrolithiasis (kidney stones); emergency room urology; urologic trauma; urethral stricture disease; urinary fistulae; voiding function and dysfunction; benign prostatic hyperplasia (BPH, noncancerous overgrowth of the prostate); the physiology of acute and chronic renal (kidney) failure; adult genitourinary cancer; urinary diversion; radiation therapy; male sexual dysfunction; male fertility and infertility; sexually transmitted diseases (STDs); nonmalignant diseases of the retroperitoneum; disorders of the adrenal gland; renal transplantation; renovascular disease; disorders of sexual differentiation (ambiguous genitalia); pediatric oncology (cancer in children); enuresis (bedwetting) and voiding dysfunction in children; congenital anomalies (problems present at birth); and specific infections of the genitourinary tract. The information in each chapter is presented in outline format, for ease of reference. Line drawings and radiographs illustrate the chapters. A detailed subject index concludes the handbook. ·
Atlas of Prostatic Diseases Source: New York, NY: Parthenon Publishing Group. 1997. 96 p. Contact: Available from Parthenon Publishing. One Blue Hill Plaza, P.O. Box 1564, Pearl River, NY 10963. (800) 735-4744 or (914) 735-9363. Fax (914) 725-1385. Price: $85.00. ISBN: 1850705852. Summary: This atlas brings together text and illustrations to tell the story of the prostate gland and the diseases to which it is prone. The author notes that treatment options at present are ever-changing and often ephemeral. As a consequence, this volume concentrates on the causes and pathology of prostatic disorders, together with the methods available for their diagnosis, rather than on their management and treatment. The first section of the book presents a literary review of the major diseases of the
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prostate, beginning with the anatomy and embryology of the prostate, and concluding with the diagnostic tests currently available for assessment of the prostate gland. The second section of the atlas contains 109 photomicrographs and diagrammatic illustrations that convey the important concepts related to prostatic diseases. The author reminds readers that two common disorders, benign prostatic hyperplasia (BPH) and prostatitis, frequently result in considerable impairment of the quality of life; a third, prostate cancer, is now second only to lung cancer as a cause of cancer death in men. The author hopes that this atlas will provide an accessible format to make more health care providers knowledgeable about the various prostatic diseases. A subject index concludes the volume. 48 references. (AA-M). ·
Prostate: Questions You Have, Answers You Need. Revised ed Source: Allentown, PA: People's Medical Society. 1996. 192 p. Contact: Available from Independent Publishers Group. Order Department, 814 N. Franklin Street, Chicago, IL 60610. (800) 888-4741 or (312) 337-0747. Fax (312) 337-5985. E-mail:
[email protected]. Price: $12.95. ISBN: 1882606639. Summary: This book provides readers with a consumer's guide to the prostate and to prostatic diseases. After an introductory chapter on the anatomy and physiology of the prostate, the author describes three types of prostatic disease: prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer. The latter section covers stages of prostate cancer, diagnostic tests including rectal exams, the prostate-specific antigen (PSA) test, transrectal ultrasound, and biopsy and other staging tests, and prevention issues. The next chapter reviews the treatment options for BPH, including surgery, its mortality and complications, alternative procedures, medication, and self help. A final chapter describes treatment options for prostate cancer, including surgery, radiation therapy, hormonal therapy, drug therapy, other therapies, nontreatment, treatment according to stage, and followup and recurrence. The book concludes with a section on informational and mutual-aid groups, a glossary of related terms, a list of suggested readings, and a subject index. The book is written in a question and answer format, with nontechnical language used throughout. 7 references.
·
Patient's Guide to Urology: Plumbing Problems in Layman's Terms Source: Toledo, OH: High Oaks Publishing Company. 1995. 258 p. Contact: Available from bookstores and libraries and, at the wholesale level, from Baker and Taylor, (908) 722-8000. Also available in orders of
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10 or more copies from High Oaks Publishing Company, Center Urology of Toledo, Inc. 3425 Executive Parkway, Suite 214, Toledo, OH 43606. (419) 531-1700. Price: $21.95 (cloth); $12.95 (paperback). ISBN: 0964577305 (cloth); 0964577313 (paper). Summary: In this book, the author presents a clear and concise discussion of the functioning of the normal genital and urinary tracts, the common malfunctions resulting from disease, and the principles of treatment. Twenty-eight chapters cover topics including impotence; circumcision; hypospadias; Peyronie's disease; benign prostatic hyperplasia; prostatic cancer; the bladder and urinary incontinence; stress incontinence; urethral stenosis; interstitial cystitis; bedwetting; blood in the urine and bladder cancer; toilet training; kidney cysts and cancer; kidney stones; dialysis and kidney transplantation; scrotal problems; testicular cancer and the role of male self-examination; vasectomy; male fertility problems; infections of the urinary tract; prostatitis; sexually transmitted diseases; and AIDS. A detailed glossary and brief subject index conclude the book. ·
Prostate Sourcebook Source: Los Angeles, CA: Lowell House. 1994. 242 p. Contact: Available from Contemporary Books. 180 North Michigan Avenue, Chicago, IL 60601. (312) 540-4500. Price: $12.95. ISBN: 1565651170. Summary: This book is a primer on prostate care. Using lay terms and case studies, the authors describe how the prostate works, what problems can arise, and how to solve them. Eleven chapters cover the physiology of the prostate; prostate examination and diagnostic tests; infectious and noninfectious prostatitis; benign prostatic enlargement (hyperplasia); prostate cancer; prostate treatment and sex; coping with incontinence and infertility; exercise and the prostate; how to promote prostate health; the psychological trauma that accompanies prostate problems; and prescription medications and their side effects. Four appendices cover a healthy prostate diet, a basic prostate glossary, prostate medications, and where to get prostate information and support. A subject index concludes the book.
·
Instructions for Patients. 5th ed Source: Philadelphia, PA: W.B. Saunders Company. 1994. 598 p. Contact: Available from W.B. Saunders Company. Book Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 5452522. Fax (800) 874-6418. Price: $49.95. ISBN: 0721649300 (English); 0721669972 (Spanish).
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Summary: This book is a compilation of instructions for patients, published in paperback format. Each fact sheet provides information in three sections: basic information, including a description of the condition, frequent signs and symptoms, causes, risk factors, preventive measures, expected outcome, and possible complications; treatment, including general measures, medication, activity guidelines, and diet; and when to contact one's health care provider. Fact sheets are available on kidney and urologic topics including: enuresis; cystitis in women; cystitis in men; bladder or urethra injury; bladder tumor; glomerulonephritis; male impotence; urinary incontinence; stress incontinence; urge incontinence; acute pyelonephritis; chronic kidney infection; polycystic kidney; kidney stones; the nephrotic syndrome; priapism; benign prostatic hyperplasia; prostatitis; acute renal failure; chronic kidney failure; testicular torsion; urethritis; and Kegel exercises. The fact sheets can be photocopied and distributed to patients as a reinforcement of oral instructions and as a teaching tool. The book is available in English or Spanish. ·
Understanding Your Prostate Problems Source: Woollahra, New South Wales, Australia: Health Books, Gore and Osment Publications. 1993. 64 p. Contact: Available from Health Books, Gore and Osment Publications, Private Box 427, 150 Queen Street, Woollahra, NSW 2025, Australia. (02) 361-5244. Fax (02) 360-7558. Price: $9.95 (as of 1995). ISBN: 1875531459. Summary: This health education book is designed to help readers understand the function of the prostate, prostatic diseases, and treatment options for prostate problems. Eleven chapters cover topics including the anatomy and physiology of the prostate; prostatic enlargement; prostate cancer; other prostate problems, including prostatitis, urethral stricture, and urinary stones; diagnostic tests used to confirm or screen for prostate problems; prostate surgery; other types of treatment, include drug therapy, laser treatments, transurethral resection, stents, catheters, hyperthermia, and balloon dilatation; radiotherapy for prostate cancer; hormone therapy for prostate cancer; chemotherapy for prostate cancer; and suggestions for patient self-care. The book is written in easy-to-read language, with simple illustrations; a brief glossary concludes the volume.
·
General Practitioner's Guide to Genitourinary Medicine and Sexual Health Source: Cambridge, England: Cambridge University Press. 1996. 107 p.
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Contact: Available from Cambridge University Press. 40 West 20th Street, New York, NY 10011-4211. (800) 872-7423. Fax (212) 691-3239. Price: $29.95. ISBN: 0521556562. Summary: This illustrated text provides general practitioners with guidelines for diagnosing and managing the many common genitourinary and sexual health problems seen in general practice. The author provides a symptom-oriented approach. Early chapters provide advice on how to take a patient's sexual history and on indications for referral. Seventeen topical chapters cover bacterial vaginosis; candidiasis; other causes of vaginal discharge; a general approach to the management of vaginal discharge; vulval problems; frequency dysuria syndrome; pelvic pain; cytology and colposcopy; contraception and genital tract infection; dysuria in young men; prostatitis, prostatodynia, and hematospermia; scrotal pain; penile rashes; genital ulceration; genital 'lumps'; genital irritation; human immunodeficiency virus (HIV) infection; and genital problems in children. The text is illustrated throughout with black and white photographs; in addition, a section of full-color plates is included. A subject index concludes the volume. 9 references. (AA-M).
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to prostatitis (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Chronic Prostatitis: Clinical Microbiological, Cytological, and Immunological Aspects of Inflammation by H. Brunner, et al (1986); ISBN: 3794509781; http://www.amazon.com/exec/obidos/ASIN/3794509781/icongroupin terna
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Migraines and More -Conquered-: Including Pms, Prostatitis, Ulcers, Insomnia, Depression, and 22 Other So-Called Diseases by Louis M. Hale (1987); ISBN: 0941219755; http://www.amazon.com/exec/obidos/ASIN/0941219755/icongroupin terna
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Prostatic Diseases by Herbert, MD Lepor; ISBN: 072167416X; http://www.amazon.com/exec/obidos/ASIN/072167416X/icongroupi nterna
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Prostatitis : etiopathology, diagnosis and therapy ; ISBN: 3540566244; http://www.amazon.com/exec/obidos/ASIN/3540566244/icongroupin terna
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Prostatitis : Etiopathology, Diagnosis and Therapy by W. Weidner, et al; ISBN: 0387566244; http://www.amazon.com/exec/obidos/ASIN/0387566244/icongroupin terna
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Textbook of Prostatitis by J C Nickel (Editor); ISBN: 1901865045; http://www.amazon.com/exec/obidos/ASIN/1901865045/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “prostatitis” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:23 ·
Advanced therapy of prostate disease. Author: [edited by] Martin I. Resnick, Ian M. Thompson; Year: 2000; Hamilton [Ont.]: B.C. Decker; Lewiston, NY: Sales and distribution United States, B.C. Decker, 2000; ISBN: 1550091026 http://www.amazon.com/exec/obidos/ASIN/1550091026/icongroupin terna
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
23
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·
Analysis of the use of fluoroquinolones for uncomplicated urinary tract infections, prostatitis, and community-acquired pneumonia: clinical and economic considerations. Author: Brendan Barrett ... [et al.]; Year: 1997; Ottawa, Ont.: CCOHTA Publications, [1997]; ISBN: 1895561531
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Atlas of prostatic cytology: techniques and diagnosis. Author: W. Leistenschneider, R. Nagel; foreword by G. Dhom; [translated by Rick Mills and Deirdre Winter]; Year: 1985; Berlin; New York: Springer-Verlag, c1985; ISBN: 0387139540 (U.S.) http://www.amazon.com/exec/obidos/ASIN/0387139540/icongroupin terna
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Challenge of chronicity in the treatment of urinary tract infections. Author: Nepera Chemical Co; Year: 9999; [Yonkers, 1956?]-
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Chronic prostatitis: clinical, microbiological, cytological, and immunological aspects of inflammation. Author: edited by H. Brunner ... [et al.]; Year: 1985; Stuttgart; New York: Schattauer, 1985; ISBN: 3794509781 (pbk.) http://www.amazon.com/exec/obidos/ASIN/3794509781/icongroupin terna
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Chronic prostatitis and relapsing urinary infections. Author: Edwin M. Meares, Jr; Year: 1975; [New York]: National Kidney Foundation, 1975
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Clinical and economic considerations in the use of fluroquinolones. Author: overview prepared by Judith L. Glennie; Year: 1997; Ottawa, Ont.: Canadian Coordinating Office for Health Technology Assessment, [1997]
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Electro-therapeutist. The modern treatment of stricture, prostatitis, urethritis, cystitis, fistula and ulceration of the rectum by electrolysis and cataphoresis. Author: Smith, Elijah W; Year: 1902; Terre Haute [1902, c1901]
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Etiologic factors in chronic prostatitis. Author: Ghormley, Kenneth Owen, 1921-; Year: 1952; [Minneapolis] 1952
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Granulomatous prostatitis, a histopathologic study of a group of granulomatous lesions in the prostate gland. Author: Tanner, Frank Harold, 1913-; Year: 1942; [Minneapolis] 1942
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Nonspecific granulomatous prostatitis; a clinical and pathological study. Author: Kelalis, Panayotis P. (Panayotis Petrou), 1932-; Year: 1963; [Minneapolis] 1963
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Non-specific urethritis and chronic prostatitis. Author: Cook, Ferris E; [n.p., 194-?]
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Papers dedicated to Paul O. Madsen on the occasion of his sixtieth birthday, July 26th, 1987. Author: editor for this supplementum, Hans
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Wolf; Year: 1987; Stockholm, Sweden: Distributed by Almqvist & Wiksell Periodical Co., [1987] ·
Prostate diseases. Author: [edited by] Herbert Lepor, Russell K. Lawson; Year: 1993; Philadelphia: W.B. Saunders, c1993; ISBN: 0721645453 http://www.amazon.com/exec/obidos/ASIN/0721645453/icongroupin terna
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Prostate gland, morphology and pathobiology. Author: by McNeal; Year: 1983; Princeton, NJ: Published for Burroughs Wellcome Co. by Custom Pub. Services, c1983
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Prostatis chronica. Author: Jaromír Kohlícek; Year: 1970; Praha: Balnea, 1970
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Prostatitis: etiopathology, diagnosis, and therapy. Author: W. Weidner, P.O. Madsen, H.G. Schiefer (eds.); Year: 1994; Berlin; New York: SpringerVerlag, c1994; ISBN: 3540566244 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3540566244/icongroupin terna
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Prostatitis accompanying adenomatous hyperplasis of the prostate: its relationship to complications following transurethral resection. Author: Biorn, Carl Ludvig, 1914-; Year: 1948; [Minneapolis] 1948
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Textbook of prostatitis. Author: edited by J. Curtis Nickel; Year: 1999; Oxford: Isis Medical Media; Herndon, VA, USA: Distributed in the USA by Books International, 1999; ISBN: 1901865045 http://www.amazon.com/exec/obidos/ASIN/1901865045/icongroupin terna
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Therapy of prostatitis. Author: herausgegeben von W. Weidner ... [et al.]; Year: 1986; München; San Francisco: W. Zuckschwerdt, c1986; ISBN: 3886031713
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Vasectomy and prostate cancer [microform]: a case-control study in a health maintenance organization. Author: K. Zhu; Year: 1994; Ann Arbor, Michigan, University Microfilms International, 1994
Chapters on Prostatitis Frequently, prostatitis will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with prostatitis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and prostatitis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You
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may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “prostatitis” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on prostatitis: ·
Prostatitis and Lower Urinary Tract Infections in Men Source: in Hanno, P.M.; Malkowicz, S.B.; Wein, A.J. Clinical Manual of Urology. New York, NY: McGraw-Hill, Inc. 2001. p.185-198. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $54.95;plus shipping and handling. ISBN: 0071362010. Summary: This chapter is from a handbook that serves as a basic, portable reference tool for the busy medical student and house officer rotating on the urology service and that enables program directors to use the information presented as a framework on which to present their particular management styles and strategies. In addition, the handbook can serve as a ready reference for the primary care physician, who is often the first person to see the patient with what ultimately proves to be a urologic problem. This chapter considers prostatitis and lower urinary tract infections (UTIs) in men. Topics include the incidence of and risk factors for UTIs in men; pathogenesis; localization of lower UTI (through the use of segmented bacteriologic localization cultures); the signs and symptoms, diagnosis, and treatment of bacterial cystitis; the epidemiology, classification, and treatment of acute and chronic bacterial prostatitis or chronic pelvic pain syndrome; infection of the seminal vesicles; the etiology, signs and symptoms, laboratory evaluation, differential diagnosis, and treatment of epididymitis; and the diagnosis and care of gonococcal and nongonococcal urethritis. The information in the chapter is presented in outline format, for ease of reference, and line drawings illustrate the chapter. The chapter concludes with a list of ten self-assessment questions. 2 figures. 3 tables. 9 references.
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Urinary Tract Infections in Adults Source: in Landau, L.; Kogan, B.A. 20 Common Problems in Urology. New York, NY: McGraw-Hill, Inc. 2001. p. 63-76. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $45.00;plus shipping and handling. ISBN: 0070634130. Summary: Urinary tract infections (UTIs) continue to occupy a large proportion of the primary care clinician's practice. Primary care clinicians
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must maintain an interest in UTI, must understand the mechanisms that result in such infection, and need to develop a rational, therapeutic strategy that incorporates the most up to date evidence-based information available to them. This chapter on UTIs in adults is from a text on common problems in urology (written for the primary care provider). The author first offers a practical classification system for UTIs to use in general practice; this system simply divides UTIs into two categories: simple and complicated. This categorization of UTIs into uncomplicated and complicated allows the physician to develop a rational diagnostic treatment algorithm that is useful in clinical practice. The author then discusses uncomplicated UTI (simple cystitis or bladder infection, recurrent simple cystitis, and acute nonobstructive pyelonephritis, kidney infection), and complicated UTI, including acute infections, catheter-associated UTI, urinary stones (urolithiasis), pregnancy, UTI in the elderly, and prostatitis. The author covers three types of prostatitis: acute bacterial prostatitis, chronic prostatitis, and prostatodynia. A patient evaluation algorithm is also provided. The presentation, diagnosis, and treatment of simple cystitis are relatively simple and consistent. The patient is started on a short course of a first line antibiotic. It appears from the literature that 3 days of treatment is superior to single dose therapy, and in the particular case of simple cystitis, longer therapy may offer no further advantages. The antibiotics of choice for simple cystitis include the fluoroquinolones, trimethroprimsulfmathoxazole (or trimethroprim alone), or nitrofurantoin. The dose, adverse effects, and potential drug interactions should be familiar to all clinicians; regimes for uncomplicated UTIs are summarized in a table. 3 figures. 6 tables. 15 references. ·
Prostatitis Source: in Rous, S.E., ed. 1997 Urology Annual: Volume 11. Oxford, England: Blackwell Science Ltd. 1997. 321 p. Contact: Available from Blackwell Science, Inc. 238 Main Street, Cambridge, MA 02142. (800) 215-1000 or (617) 876-7000. Fax (617) 4925263. Price: $125.00. ISBN: 0865425671. Summary: This entry from the Urology Annual reviews prostatitis, focusing on etiology and pathophysiology. The author notes that common, poorly understood prostatitis syndromes cause considerable morbidity in men. Specific therapy leads to cure or improvement for men with infectious causes of prostatitis. However, treatment is frequently empirical and unsatisfactory due to limited understanding of the causes and pathophysiology of prostatitis. The author discusses historical background, definitions, epidemiology, host defenses and pathogenesis,
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cellular immunity, lower urinary tract localization studies, differential diagnosis of prostatitis syndromes, acute bacterial prostatitis, chronic bacterial prostatitis, antimicrobial therapy, nonbacterial prostatitis, prostatodynia, and granulomatous prostatitis. Diagnosis may also indicate the need to avoid inappropriate therapy for men without evidence of infection or anatomic or structural problems. The author concludes that chronic prostatitis syndromes may represent the most common indication for antimicrobial therapy in urology. The author briefly discusses the depression, infection, and structural abnormalities that may coexist in men with chronic prostatitis. 2 tables. 216 references. ·
Prostatitis: Inflammation of the Prostate Source: in Walsh, P.C. and Worthington, J.F. Prostate: A Guide for Men and the Women Who Love Them. Baltimore, MD: Johns Hopkins University Press. 1995. p. 276-290. Contact: Available from Johns Hopkins University Press. 2715 North Charles Street, Baltimore, MD 21218-4319. (800) 537-5487 or (410) 5166900. Fax (410) 516-6998. Price: $15.95 paperback; $39.95 hardback (as of 1995). ISBN: 0801849896 (paperback); 0801849888 (hardback). Summary: This chapter is from a book designed to provide patients and their families with extensive information about the prostate gland and its diseases. In this chapter, the authors describe prostatitis, or inflammation of the prostate. Written in a question-and-answer format, the chapter covers a definition of prostatitis and its incidence; acute and chronic bacterial prostatitis; nonbacterial prostatitis; prostatodynia; diagnosis of prostatitis; treatment options, including antibiotics; and risk factors and etiological considerations. One man's experience with chronic prostatitis is outlined.
Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to prostatitis have been published that consolidate information across various sources. These too might be useful in gaining access to additional guidance on prostatitis. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:24 You will need to limit your search to “Directories” and prostatitis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom
24
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1998-1999 Complete Directory for People with Rare Disorders Source: Lakeville, CT: Grey House Publishing, Inc. 1998. 726 p. Contact: Available from Grey House Publishing, Inc. Pocket Knife Square, Lakeville, CT 06039. (860) 435-0868. Fax (860) 435-0867. Price: $190.00. ISBN: 0939300982. Summary: This directory from the National Organization for Rare Disorders (NORD) provides a wealth of information on diseases and organizations. The directory offers four sections: disease descriptions, disease specific organizations, umbrella organizations, and Government agencies. In the first section, the directory includes descriptions of 1,102 rare diseases in alphabetical order. Each entry defines the disorder, then refers readers to organizations that might be of interest. Diseases related to kidney and urologic diseases are Alport syndrome, Bartter's syndrome, blue diaper syndrome, branchiotorenal syndrome, renal cell carcinoma, citrullinemia, cystinuria, Drash syndrome, Fraser syndrome, Galloway Mowat syndrome, Golderhar syndrome, Goodpasture syndrome, benign familial hematuria, hemolytic uremic syndrome, hepatic fibrosis, IgA nephropathy, interstitial cystitis, Loken senior syndrome, medullary cystic disease, medullary sponge kidney, Mullerian aplasia, multiple myeloma, nail patella syndrome, Ochoa syndrome, Peyronie disease, polycystic kidney diseases, prostatitis, purpura, renal agenesis, renal glycosuria, WAGR syndrome, Wegener's granulomatosis, and Wilms tumor. Each of the 445 organizations listed in the second section is associated with a specific disease or group of diseases. In addition to contact information, there is a descriptive paragraph about the organization and its primary goals and program activities. Entries include materials published by the organization as well as the diseases the organization covers. The third section lists 444 organizations that are more general in nature, serving a wide range of diseases (for example, the American Liver Foundation). The final section describes 74 agencies that are important Federal Government contacts that serve the diverse needs of individuals with rare disorders. A name and keyword index concludes the volume.
of the search page where “You may refine your search by”. For publication date, select “All Years”, select language and the format option “Directory”. By making these selections and typing in “prostatitis” (or synonyms) into the “For these words:” box, you will only receive results on directories dealing with prostatitis. You should check back periodically with this database as it is updated every three months.
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General Home References In addition to references for prostatitis, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Urodynamics Made Easy by Christopher R. Chapple, Scott A. MacDiarmid; Paperback -- 2nd edition (April 15, 2000), Churchill Livingstone; ISBN: 0443054630; http://www.amazon.com/exec/obidos/ASIN/0443054630/icongroupinterna
Vocabulary Builder Aplasia: Lack of development of an organ or tissue, or of the cellular products from an organ or tissue. [EU] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Colposcopy: The examination, therapy or surgery of the cervix and vagina by means of a specially designed endoscope introduced vaginally. [NIH] Contraception: The prevention of conception or impregnation. [EU] Cystinuria: An inherited abnormality of renal tubular transport of dibasic amino acids leading to massive urinary excretion of cystine, lysine, arginine, and ornithine. [NIH] Dilatation: The condition, as of an orifice or tubular structure, of being dilated or stretched beyond the normal dimensions. [EU] Electrolysis: Destruction by passage of a galvanic electric current, as in disintegration of a chemical compound in solution. [NIH]
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Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Enuresis: Involuntary discharge of urine after the age at which urinary control should have been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bedwetting, nocturnal enuresis). [EU] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Glomerulonephritis: A variety of nephritis characterized by inflammation of the capillary loops in the glomeruli of the kidney. It occurs in acute, subacute, and chronic forms and may be secondary to haemolytic streptococcal infection. Evidence also supports possible immune or autoimmune mechanisms. [EU] Glycosuria: The presence of glucose in the urine; especially the excretion of an abnormally large amount of sugar (glucose) in the urine, i.e., more than 1 gm. in 24 hours. [EU] Hyperthermia: Abnormally high body temperature, especially that induced for therapeutic purposes. [EU] Hypospadias: A developmental anomaly in the male in which the urethra opens on the underside of the penis or on the perineum. [NIH] Insomnia: Inability to sleep; abnormal wakefulness. [EU] Myeloma: A tumour composed of cells of the type normally found in the bone marrow. [EU] Nephropathy: Disease of the kidneys. [EU] Nitrofurantoin: A urinary anti-infective agent effective against most grampositive and gram-negative organisms. Although sulfonamides and antibiotics are usually the agents of choice for urinary tract infections, nitrofurantoin is widely used for prophylaxis and long-term suppression. [NIH]
Orgasm: The apex and culmination of sexual excitement. [EU] Patella: The flat, triangular bone situated at the anterior part of the knee. [NIH]
Priapism: Persistent abnormal erection of the penis, usually without sexual desire, and accompanied by pain and tenderness. It is seen in diseases and injuries of the spinal cord, and may be caused by vesical calculus and certain injuries to the penis. [EU] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Radiotherapy: The treatment of disease by ionizing radiation. [EU] Resection: Excision of a portion or all of an organ or other structure. [EU]
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Stenosis: Narrowing or stricture of a duct or canal. [EU] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [NIH] Torsion: 1. a type of mechanical stress, whereby the external forces (load) twist an object about its axis. 2. in ophthalmology any rotation of the vertical corneal meridians. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Urodynamics: The mechanical laws of fluid dynamics as they apply to urine transport. [NIH] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU]
Multimedia 91
CHAPTER 6. MULTIMEDIA ON PROSTATITIS Overview Information on prostatitis can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on prostatitis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on prostatitis is the Combined Health Information Database. You will need to limit your search to “video recording” and “prostatitis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “prostatitis” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on prostatitis: ·
When Someone You Love Is at Risk for Prostate Disease Source: Cypress, CA: Medcom/Trainex. 1995.
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Contact: Available from Medcom/Trainex. P.O. Box 6003, Cypress, CA 90630. (800) 877-1443. Fax (714) 891-3140. PRICE: $39.95 plus $1.95 shipping (as of 1995). Also available from Channing L. Bete Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 499-6464. Fax (800) 628-7733. Price: $24.95 plus shipping (as of 1995). Summary: This videotape program, created for wives and partners of men at risk for prostate disease, is designed to promote their role in disease recognition, support, and recovery. Topics include a definition of the prostate and how it functions; diseases of the prostate (including prostatitis, BPH, and cancer); the symptoms of these diseases; diagnostic tests used to confirm prostatic diseases; treatment options; the side effects of common treatments; the emotional and psychological impact of prostate disease; and how to provide support to a man dealing with prostate disease. (AA-M). ·
Straight Talk on Prostate Health Source: [Toronto, Ontario, Canada]: HB Pictures. 1994. (videocassette). Contact: Available from Medical Audio Visual Communications, Inc. Suite 240, 2315 Whirlpool Street, Niagara Falls, NY 14305. Or P.O. Box 84548, 2336 Bloor Street West, Toronto, ON M6S 1TO, Canada. (800) 7574868 or (905) 602-1160. Fax (905) 602-8720. Price: $99.00 (Canadian); contact producer for current price in American dollars. Order Number COR008. Summary: This videotape provides viewers with comprehensive information about prostate health. Topics include the prostate gland, its function, and prostatic problems; effective treatments for impotence and sexual dysfunction; treatment for benign prostatic enlargements (BPH) and prostatitis; prostate cancer and how it differs from other cancers; the pros and cons of the prostate specific antigen (PSA) blood test in detecting prostate cancer; the importance of the early detection of prostate cancer; and treatment options for localized and advanced prostate cancer. The program presents a Decision Analysis Model to help patients weigh benefits versus risks of treatment options. The program concludes with a question and answer session with Dr. Peter Scardino, a practicing urologist specializing in prostate cancer. (AA-M).
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Bibliography: Multimedia on Prostatitis The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in prostatitis (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on prostatitis. For more information, follow the hyperlink indicated: ·
Advanced therapy of prostate disease. Source: Martin I. Resnick, Ian M. Thompson; Year: 2000; Format: Edited by; Hamilton [Ont.]: B.C. Decker; Lewiston, NY: Sales and distribution United States, B.C. Decker, 2000
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Cancer of the urinary system. Source: American Cancer Society; [made by] Sturgis-Grant Productions, inc; Year: 1970; Format: Motion picture; [New York]: The Society, 1970
Periodicals and News 95
CHAPTER 7. PERIODICALS AND NEWS ON PROSTATITIS Overview Keeping up on the news relating to prostatitis can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on prostatitis. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover prostatitis beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on prostatitis is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “prostatitis” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·
New Data Show Flomax(R) (Tamsulosin HCL), Leading Alpha Blocker, May Provide Benefit in Non-Bacterial Prostatitis Summary: ORLANDO, Fla., May 24 /PRNewswire/ -- The first clinical trial results evaluating an alpha-blocker for the treatment of non-bacterial prostatitis were presented Saturday at the annual meeting of the American Urological Association. The study shows that FLOMAX(R) (tamsulosin HCL) -- the first selective alpha(1A) blocker proven effective in treating the signs and symptoms of benign prostatic hyperplasia (BPH) -- may provide clinical benefit in some of the millions of men with nonbacterial prostatitis, which accounts for as many as 95 percent of all prostatitis cases.(1) The study results suggest FLOMAX may be especially effective for patients with severe non- bacterial prostatitis. "The symptoms associated with prostatitis are generally similar to those for BPH," said Perinchery Narayan, MD, study lead investigator and Director of the North Florida Research Institute, North Florida Urology Associates P.A., Worldwide Medicine Group LLC. "As a result, treatment with alpha-blockers makes empirical sense, but until now, we haven't had the benefit of randomized controlled data to validate this strategy." Prostatitis, the inflammation of the prostate, though an extremely pervasive condition that will affect an estimated 50 percent of men in their lifetime(1), is yet to be well understood or studied, leading to difficulty diagnosing and treating the condition. Alpha-blockers, such as FLOMAX, work by relaxing prostate muscles thereby improving the ability to urinate. Difficulty urinating is a commonly occurring symptom in prostatitis patients.(2) Its rapid onset of action, safety, convenient once-daily dosing and lack of titration have made FLOMAX a preferred choice for BPH, and therefore a good alphablocker to study in patients with prostatitis.
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"Prostatitis leads to an estimated 2 million year, making it a serious public health "Urologists, primary care physicians and condition will be reassured there are new FLOMAX may help alleviate the painful, condition."
physician office visits each need," said Dr. Narayan, millions of men with the research findings showing chronic symptoms of this
A Six-Week Double-Blind Study of Tamsulosin versus Placeboin Patients with Chronic Non-bacterial Prostatits/Chronic Pain. The randomized six-week trial studied 58 patients on FLOMAX (0.4 mg) or placebo. The study was designed to provide objective scientific evidence on the modulation of the symptoms in patients with either inflammatory or noninflammatory chronic non-bacterial prostatitis/chronic pelvic pain syndrome (CPPS) following alpha-blocker or placebo therapy. Patients completed the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) at each visit within the two-week washout phase as well as the six-week active treatment phase. The validated index measured three domains (pain, urinary symptoms, and quality of life and impact). Patients in the single-blind screening phase had to have a moderate overall score of greater than or equal to 15 (out of 43 points) and a moderate pain domain score of greater than or equal to 8 (out of 21) at each pre-treatment assessment (Visits: 1 & 2). Randomized patients had their prostatitis symptoms assessed at Visit 3 (Day 15) and at Visit 4 (Day 45). At Visit 4, FLOMAX was statistically better than placebo in men with a baseline greater than or equal to 26.3 (-3.6 difference (p=0.0404)) and for those with severe prostatitis, i.e., baseline greater than or equal to 30 (-7.3 difference (p=0.0014)). Men with the highest baseline scores within each domain showed the greatest response, suggesting the potential of FLOMAX in patients with severe prostatitis.
More about Prostatitis Prostatitis is a chronic and extremely painful condition that appears to primarily affect men between the ages of 35 and 50. In addition to being painful, prostatitis negatively affects men's quality of life. Men suffering from prostatitis often experience significant pelvic pain, difficulty urinating and sexual dysfunction often manifested as pain after ejaculation.
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Until now, primary treatment of prostatitis has been antibiotic therapy to treat bacterial infection. The nearly 95% of these patients who fail antibiotic therapy, however, are thought to have nonbacterial prostatitis, which is commonly viewed as more difficult to diagnose and treat. Currently, non-bacterial prostatitis is typically treated by using nonsteroidal anti- inflammatory drugs (NSAIDs), which reduce inflammation and can help alleviate pain, or alpha-blockers, which relax smooth muscle in the prostate and help relieve urinary symptoms.
Co-promoted by Boehringer Ingelheim Pharmaceuticals, Inc. and Abbott Laboratories, FLOMAX is the most widely prescribed alpha-blocker in the United States, indicated for the treatment of the signs and symptoms of BPH. FLOMAX is generally well tolerated, has minimal effect on blood pressure and can be started at a therapeutically effective dose, which does not require titration. The most common side effects in men with BPH, taking Flomax, were stuffy nose, a decrease in semen and dizziness. As with other drugs of this type, there is a risk of fainting. Therefore, men beginning FLOMAX treatment should avoid situations where injury could result should this occur. About Boehringer Ingelheim Pharmaceuticals, Inc. Boehringer Ingelheim Pharmaceuticals, Inc., based in Ridgefield, CT, is the largest U.S. subsidiary of Boehringer Ingelheim Corporation (Ridgefield, CT) and a member of the Boehringer Ingelheim group of companies.
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Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to prostatitis. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “prostatitis” (or synonyms). The following was recently listed in this archive for prostatitis: ·
Prostatitis and benign prostate hyperplasia often overlap in healthy men Source: Reuters Medical News Date: March 11, 2002 http://www.reuters.gov/archive/2002/03/11/professional/links/20020 311epid002.html
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Environmental factors influence development of chronic prostatitis symptoms Source: Reuters Medical News Date: January 16, 2002 http://www.reuters.gov/archive/2002/01/16/professional/links/20020 116epid005.html
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Prostatitis screening reduces unnecessary biopsies in men with elevated PSA Source: Reuters Medical News Date: October 30, 2000 http://www.reuters.gov/archive/2000/10/30/professional/links/20001 030clin006.html
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Pentosan polysulfate sodium effective for chronic pelvic pain syndrome Source: Reuters Industry Breifing Date: September 21, 2000 http://www.reuters.gov/archive/2000/09/21/business/links/20000921 clin005.html
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More research needed to solve prostatitis puzzle Source: Reuters Health eLine Date: May 01, 2000 http://www.reuters.gov/archive/2000/05/01/eline/links/20000501elin 031.html
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Quercetin alleviates symptoms of nonbacterial chronic prostatitis Source: Reuters Medical News Date: January 17, 2000 http://www.reuters.gov/archive/2000/01/17/professional/links/20000 117clin004.html
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Amikacin, minocycline useful alternatives to fluoroquinolones for bacterial prostatitis Source: Reuters Medical News Date: June 16, 1998 http://www.reuters.gov/archive/1998/06/16/professional/links/19980 616clin011.html
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Chronic Pelvic Pains: "The Most Prominent" Symptom Of Chronic Prostatitis Source: Reuters Medical News Date: November 19, 1996 http://www.reuters.gov/archive/1996/11/19/professional/links/19961 119clin007.html
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Transurethral Microwave Thermotherapy Effective Against Nonbacterial Prostatitis Source: Reuters Medical News Date: May 30, 1996 http://www.reuters.gov/archive/1996/05/30/professional/links/19960 530clin003.html
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
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Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “prostatitis” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “prostatitis” (or synonyms). If you know the name of a company that is relevant to prostatitis, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “prostatitis” (or synonyms).
Newsletters on Prostatitis Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “prostatitis.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “prostatitis” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above:
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Higher PSA May Mean Infection, Not Cancer Source: Urology Times. 22(3): 2. March 1994. Contact: Available from Advanstar Communications, Inc. Corporate and Editorial Offices, 7500 Old Oak Boulevard, Cleveland, OH 44130. (216) 243-8100. Summary: This brief news article from a professional newsletter reminds readers that infection, and not necessarily prostate cancer, can elevate prostate-specific antigen (PSA) levels. The article summarizes a report presented by Dr. Vito Pansadoro at a recent international symposium. Dr. Pansadoro based his warning on the results of a study showing that elevated PSA levels may be particularly common in younger men with acute bacterial prostatitis and to a lesser extent in those with chronic bacterial or nonbacterial prostatitis. Topics discussed include the patients included in the research study, PSA levels in those patients, posttreatment PSA levels, and other research results investigating this same hypothesis.
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “prostatitis” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on prostatitis: ·
Prostatitis: A Common, Often Vexing Problem Source: Mayo Clinic Health Letter. 17(11): 6. November 1999. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465.
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Summary: This brief article from a health newsletter reminds readers of the symptoms of prostatitis, a general term used for inflammation of the prostate. The prostate gland is part of the male reproductive system; it secretes fluids that help transport sperm. The gland is located just below the bladder and surrounds the urethra (the tube that drains the bladder). While usually not life threatening, prostatitis can be challenging to diagnose and treat. Infection that irritates the prostate can inflame the gland, causing swelling. Prostatitis most often occurs in men ages 30 to 50, but it can affect older men too. There are three forms of prostatitis: acute bacterial, chronic bacterial, and chronic nonbacterial. The author describes the symptoms of each type. Typically, the first line of treatment for prostatitis of all types is antibiotics. The acute bacterial form usually clears up with antibiotics; the chronic bacterial form is more resistant so the treatment may take longer and may not be effective. However, symptoms may be controlled with long term, low dose antibiotic therapy. There is not consensus on whether increasing or decreasing sexual activity has any effect on prevention or relief of prostatitis. One sidebar summarizes the diagnostic tests used to confirm prostatitis, including the digital rectal exam and urine testing. ·
Voiding Symptoms: Why do Men Under the Age of 50 Have Them? Source: Issues in Incontinence. 4(1): 1, 5-6. Spring 1997. Contact: Available from Saxe Healthcare Communications. P.O. Box 1282, Burlington, VT 05402. Fax (802) 655-3127. E-mail:
[email protected]. Summary: Many young men (under age 50) with longstanding irritative or obstructive voiding symptoms are commonly and empirically diagnosed as having chronic prostatitis or prostatodynia. This article reports on a video urodynamics study of 137 men under the age of 50 years. This was a select group of men with chronic voiding dysfunction who were found to have abnormalities on urodynamic evaluation. All 137 had been misdiagnosed previously with chronic prostatitis and had been treated unsuccessfully with either antibiotics or alpha blockers. Patients with culture-proven bacterial prostatitis, symptoms for less than 6 months, or previously diagnosed neurologic disease were excluded. A diagnosis of pseudodyssynergia (voluntary closure of the membranous urethra during voiding) was made based on a number of criteria. This diagnosis was made in 24 percent of the patients. Treatment options for this condition include hypnosis and biofeedback, employed to allow patients to understand and correct their dysfunctional voiding patterns. Other urodynamic abnormalities found include vesical neck obstruction in 74 patients (54 percent), impaired bladder contractility in 23 patients (17 percent), and acontractile bladder in 7 patients (5 percent). In the
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same period, 16 men who underwent urodynamic evaluation were found to have no evidence of abnormalities. The authors conclude that these data provide compelling evidence that urodynamic evaluation should be an integral part of the workup for young men without neurologic disease or evidence of active bacterial infection whose urinary symptoms fail to improve after a due course of therapy with currently accepted treatment modalities for prostatitis. 1 table. 9 references. (AA-M).
Academic Periodicals covering Prostatitis Academic periodicals can be a highly technical yet valuable source of information on prostatitis. We have compiled the following list of periodicals known to publish articles relating to prostatitis and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on prostatitis published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on prostatitis: ·
American Family Physician. (Am Fam Physician) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=A merican+Family+Physician&dispmax=20&dispstart=0
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Archives of Andrology. (Arch Androl) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ar chives+of+Andrology&dispmax=20&dispstart=0
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Bju International. (BJU Int) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bj u+International&dispmax=20&dispstart=0
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European Urology. (Eur Urol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Eu ropean+Urology&dispmax=20&dispstart=0
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International Journal of Andrology. (Int J Androl) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Int ernational+Journal+of+Andrology&dispmax=20&dispstart=0
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International Journal of Std & Aids. (Int J STD AIDS) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Int ernational+Journal+of+Std+&+Aids&dispmax=20&dispstart=0
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International Urology and Nephrology. (Int Urol Nephrol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Int ernational+Urology+and+Nephrology&dispmax=20&dispstart=0
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Medicine; Analytical Reviews of General Medicine, Neurology, Psychiatry, Dermatology, and Pediatries. (Medicine (Baltimore)) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=M edicine;+Analytical+Reviews+of+General+Medicine,+Neurology,+Psych iatry,+Dermatology,+and+Pediatries&dispmax=20&dispstart=0
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Psychotherapy and Psychosomatics. (Psychother Psychosom) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ps ychotherapy+and+Psychosomatics&dispmax=20&dispstart=0
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Southern Medical Journal. (South Med J) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=So uthern+Medical+Journal&dispmax=20&dispstart=0
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The Journal of Antimicrobial Chemotherapy. (J Antimicrob Chemother) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Antimicrobial+Chemotherapy&dispmax=20&dispstart=0
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The Journal of Infectious Diseases. (J Infect Dis) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Infectious+Diseases&dispmax=20&dispstart=0
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The Journal of Steroid Biochemistry and Molecular Biology. (J Steroid Biochem Mol Biol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Steroid+Biochemistry+and+Molecular+Biology&dispmax =20&dispstart=0
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The Journal of Urology. (J Urol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Urology&dispmax=20&dispstart=0
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The Prostate. (Prostate) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Prostate&dispmax=20&dispstart=0
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The Urologic Clinics of North America. (Urol Clin North Am) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Urologic+Clinics+of+North+America&dispmax=20&dispstart=0
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Urologia Internationalis. (Urol Int) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ur ologia+Internationalis&dispmax=20&dispstart=0
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World Journal of Urology. (World J Urol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=W orld+Journal+of+Urology&dispmax=20&dispstart=0
Vocabulary Builder Contractility: stimulus. [EU]
Capacity for becoming short in response to a suitable
Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH]
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CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.25 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:26 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 26 See http://www.nlm.nih.gov/databases/databases.html. 25
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·
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat prostatitis, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and prostatitis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “prostatitis” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with prostatitis. The following is a sample result:
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·
Information About Prostate Pain Relief Source: Encino, CA: Institute for Male Urology. 2001. 2 p. Contact: Available from Institute for Male Urology. 16500 Ventura Boulevard, Suite 409, Encino, CA 91436. (888) 724-1113. Website: www.urol.com. Price: Single copy free. Summary: This brochure offers information on prostate pain relief for men who have one or more of the symptoms of chronic, nonbacterial prostatitis, a painful and frustrating inflammation of the prostate gland that can affect men of all ages. The brochure describes the use of ProstaQ, a proprietary, patent-pending formulation of the bioflavonoid quercetin, found in red wine, onions, green tea, and other natural substances. Prosta-Q is available in drug stores without a prescription. The brochure also discusses other treatments for chronic prostatitis, including antibiotics, alpha blockers, nonsteroidal antiinflammatory drugs (NSAIDs), and dietary changes. One chart summarizes the symptoms of the three types of prostatitis: acute bacterial, chronic bacterial, and chronic nonbacterial prostatitis. Another chart summarizes prostate health facts. The brochure briefly describes the work of the Institute for Male Urology (IMU, www.urol.com). 1 figure. 1 table.
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Important Things to Know About Prostate Health Source: Kalamazoo, MI: Hope Publications. 200x. 4 p. Contact: Available from Hope Publications. 350 East Michigan Avenue, Suite 301, Kalamazoo, MI 49007-3851. (616) 343-0770. Website: hithope.com. Price: $1.45 for single copy; bulk copies available. Summary: This brochure familiarizes men with their prostate, prostate problems, and how to incorporate strategies into their health care that identify and manage prostate problems. The brochure emphasizes that increasing age is the major risk factor for both prostate enlargement and prostate cancer. However, prostate symptoms are not a necessary part of getting older; when the symptoms are properly diagnosed and treated, most can be relieved. The brochure begins with an overview of the anatomy of the prostate and its role in producing the fluid that transports sperm. The brochure then describes three prostate problems: prostatitis (inflammation of the prostate), benign prostatic hyperplasia (enlarged prostate), and prostate cancer. The brochure also outlines the common diagnostic tests for prostate problems, including the digital rectal exam (DRE), the PSA blood test, and biopsy. There are four options for men who are found to have prostate cancer: watchful waiting, surgery, radiation therapy, and hormone therapy and chemotherapy. One sidebar lists prostate symptoms to watch for, including weak or interrupted urine
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stream; inability to urinate; difficulty in starting or stopping urination; urgency (difficulty postponing urination); need to urinate frequently (especially at night); blood in the urine; painful or burning urination; continuing pain in the lower back; pelvis, or upper thighs; and a feeling that one still needs to urinate after just finishing. The brochure stresses that these symptoms are most likely due to prostate infection or enlargement, but they should be checked out by a health care provider. The brochure includes the toll free telephone lines of the American Cancer Society (800-ACS-2345) and the National Cancer Institute (8004CANCER). 1 figure. 1 table. ·
Prostate Health: Basic Facts for Better Health. What Every Man Should Know Source: Baltimore, MD: American Foundation for Urologic Disease. 200x. 32 p. Contact: Available from American Foundation for Urologic Disease (AFUD). 1128 North Charles Street, Baltimore, MD 21201. (800) 242-2383. Website: www.afud.org. Price: $13.00 for pack of 50; plus shipping and handling. Summary: Designed for men over the age of 40, this health education brochure explains how the prostate works, the problems that can happen with the prostate, the tests that are used to diagnose prostate diseases, and treatment options. Some of the prostate problems discussed are enlarged prostate (benign prostatic hyperplasia, BPH), prostatitis (inflammation of the prostate), and prostate cancer. The brochure focuses on the importance of the digital rectal examination (DRE) to identify prostate problems of all sorts and to identify them early enough for successful treatment options to be initiated. Some symptoms that may indicate a prostate problem include a weak urinary stream, difficulty starting urination, interruption of the stream (stopping and starting), pain or burning on urination, urgency (difficulty postponing urination), frequent urination, awakening often at night to urinate, and blood in the urine. Diagnostic methods include a thorough medical history, the physical examination (including the DRE), and the prostate specific antigen (PSA) test. For BPH, if men are not bothered by their symptoms, they may just be put on a program of watchful waiting, which entails regular followup but no actual treatment. Other treatments are drug therapy, thermal (heat based) therapy, surgery, and alternative treatments (such as herbal remedies). The brochure describes the four types of surgery that may be used for BPH: transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), open prostatectomy (removal of the prostate), and laser surgery. Prostatitis
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(acute, chronic, or noninfectious) is treated based on type; treatment can include antimicrobials, muscle relaxants, and lifestyle changes. When prostate cancer is diagnosed early, the chances for curative treatment are greatly increased. After classification, the cancer is treated by surgery, radiation therapy, hormonal therapy, or a combination. The brochure concludes with a glossary of terms used in the text. 3 figures. 1 table. ·
Making a Difference: Eliminating Urologic Disease Through Research, Education and Advocacy Source: Baltimore, MD: American Foundation for Urologic Disease. 200x. [6 p.]. Contact: Available from American Foundation for Urologic Disease (AFUD). 1128 North Charles Street, Baltimore, MD 21201. (800) 242-2383. Website: www.afud.org. Price: Single copy free. Summary: The American Foundation for Urologic Disease (AFUD) is an international nonprofit patient based organization founded in 1987 to prevent and cure urologic diseases through the expansion of research, education, public awareness, and advocacy. This brochure describes the activities of the AFUD, including the five health councils within the AFUD that provide educational materials and awareness programs. Prostate Health Month was instituted to give men encouragement to overcome the fear or embarrassment of discussing these problems with their urologist. Prostate Health Month brings together the educational efforts on prostate cancer, benign prostatic hyperplasia (BPH, enlarged prostate), and prostatitis. Prostate Cancer Awareness Week is held each September in an effort to encourage men to be tested for prostate cancer. International Impotence Education Month was designed to educate the media and general public about erectile dysfunction (ED, formerly called impotence). Bladder Health Week, created as an education and awareness effort for bladder health, addresses a different bladder condition each year (e.g., overactive bladder, bladder cancer, interstitial cystitis, and urinary tract infections). AFUD also produces a patient focused educational magazine called Family Urology. The brochure briefly discusses the general advocacy activities of AFUD and the research scholar program, which awards grant money primarily for investigators exploring fundamental biomedical research problems as they relate to urology. The brochure includes a tear off mailing card with which readers can make a contribution to AFUD. The brochure is illustrated with black and white photographs of the celebrities who support the work of AFUD. 8 figures.
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·
PSA Test: Screening for Prostate Cancer. [PSA Prueba del Antigeno Prostatico Especifico: Examen para el Cancer de la Prostata] Source: San Bruno, CA: StayWell Company. 1999. [2 p.]. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $0.40 each; $20.00 per pack of 50; plus shipping and handling. Order number 91728 for English version; 91927 for Spanish version. Summary: This brochure describes the prostate specific antigen (PSA) test, a blood test used to help in the early detection of prostate cancer. PSA, an ingredient of semen, is made by the prostate gland. Some PSA naturally leaks from the prostate into the bloodstream. Problems with the prostate, such as prostatitis (prostate infection), BPH (benign prostatic enlargement), or cancer, may cause extra PSA to enter the blood. The brochure outlines the indications for a PSA test, how the test is done, the results of the test and what they mean, followup care (including the indications for additional testing), and treatment options for the conditions diagnosed with the PSA test. One section reminds readers of the anatomy and physiology of the prostate. The brochure concludes with the recommendations of the American Cancer Society and the American Urological Association which call for yearly PSA tests for all men over the age of 50 and yearly PSA tests for men over age 40 who are African American or who have a family history of prostate cancer. The brochure is illustrated with full color line drawings and is available in either English or Spanish. 7 figures.
·
Prostate Health: Screening for Prostate Cancer Source: San Bruno, CA: StayWell Company. 1999. 7 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. Price: $1.10 per copy; plus shipping and handling. Order number 1335. Summary: This booklet describes the prostate and tests used to screen for prostate cancer and other prostate problems. The booklet stresses that with early detection, the chances for recovery from prostate cancer are high. The booklet begins with an overview of prostate anatomy and the types of health problems that may be encountered, including benign prostatic hyperplasia (BPH), prostatitis (inflammation or infection of the prostate), and prostate cancer. The booklet then describes the tests that may be used to evaluate prostate health, including the patient's medical history, the digital rectal exam, and laboratory tests, including the PSA (prostate specific antigen) and urinalysis. PSA, an ingredient of semen, is
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made by the prostate gland. Some PSA naturally leaks from the prostate into the bloodstream. Problems with the prostate, such as prostatitis (prostate infection), BPH (benign prostatic enlargement), or cancer, may cause extra PSA to enter the blood. Based on the results of this evaluation, the doctor may recommend additional diagnostic tests, including needle biopsy, ultrasound, and imaging tests such as MRI or CT. The brochure concludes by debunking some of the myths about prostate cancer. The brochure is illustrated with full color line drawings. 20 figures. ·
Understanding Urinary Tract Infections: Treatment and Prevention for Women and Men Source: San Bruno, CA: StayWell Company. 1999. 7 p. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. E-mail:
[email protected]. Website: www.staywell.com. Price: $1.10 per copy; plus shipping and handling. Summary: Urinary tract infections (UTIs) are common in both women and men. This brochure helps patients diagnosed with UTIs to understand their infection and how to treat it. The booklet stresses that an early diagnosis offers the best chance for successful treatment and helps prevent the infection from turning into a more serious problem (such as kidney infection). Diagnosis can include medical history, physical exam, and laboratory tests, including urinalysis, urine culture, blood tests, kidney ultrasound, intravenous pyelogram (IVP, an x ray of the kidney), cystoscopy, and cystogram (a x ray of the bladder, ureter, or urethra). The brochure briefly reviews the anatomy of the urinary tract and how UTIs occur, including sexual behavior, poor hygiene, urine that remains in the bladder after urination, a blockage in the kidneys, and a blockage caused by an enlarged prostate (in men). There are different kinds of UTIs, including cystitis (bladder infection) in women, urethral syndrome in women, pyelonephritis in men and women, prostatitis in men, urethritis in men, and cystitis in men. Treatment and prevention strategies include taking medications as directed, drinking enough fluids, practicing good personal hygiene, emptying bladder whenever the urge to urinate is present, avoiding foods that may irritate the urinary tract, and keeping followup medical appointments. Occasionally, surgery may be necessary to relieve blockages, such as an enlarged prostate or kidney stone. The brochure is illustrated with full color line drawings. 25 figures.
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·
Understanding Prostate Changes: A Health Guide for All Men Source: Bethesda, MD: National Cancer Institute (NCI), National Institutes of Health. 1999. 38 p. Contact: Available from National Cancer Institute Public Inquiries Office. Building 31, Room 10A03, 31 Center Drive, MSC 2580, Bethesda MD 20892-2580. (301) 435-3848. Website: www.nci.nih.gov. Price: Single copy free. Summary: Issues surrounding the prostate, and prostate cancer in particular, are immersed in uncertainty. For example, it is not known if the potential benefits of prostate cancer screening outweigh the risks, if surgery is better than radiation, or if treatment is better than no treatment in some cases. By providing some insight into the prostate and prostate disorders, this booklet aims to help readers consult knowledgeably with their doctors when faced with diagnosis and treatment decisions. After an introduction that reviews the anatomy and physiology of the prostate, the booklet reviews prostatitis, benign prostatic hyperplasia (BPH), evaluating prostate health, and prostate cancer. Prostatitis (inflammation of the prostate) can cause difficult or painful urination that is often accompanied by a burning sensation, by a strong and frequent urge to urinate that often results in only small amounts of urine, and by pain in the lower back or abdomen. When prostatitis is the result of a bacterial infection, it usually can be cleared up with antibiotics. BPH is a noncancerous overgrowth of tissue of the prostate which can block the flow of urine. About half of men with BPH develop symptoms that warrant treatment; the remainder opt for watchful waiting (regular monitoring checkups but no intervention). Treatment includes drug therapy, with alpha adrenergic blockers or finasteride; and surgical options, including transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), transurethral needle ablation (TUNA), and open prostatectomy. Tests used for evaluating prostate health include the digital rectal examination (DRE), the prostate specific antigen (PSA) test, and transrectal ultrasound (TRUS). Risk factors for prostate cancer are outlined; they include advancing age, family history, race (African American men have a higher risk than white Americans; Asian immigrants to the United States have much lower rates), hormonal factors, diet, vasectomy, and environmental exposures. Prostate cancer is identified and diagnosed by screening tests, PSA tests, and biopsy; diagnosis includes staging, which helps determine the level of cancer and thus the appropriate treatment approach. The booklet includes numerous sidebars with quotes from men who have survived prostate cancer, lists of questions to consider and to ask one's health care provider, a self test for BPH symptoms, and related research studies. The
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booklet concludes with a glossary of terms and a brief list of sources for additional information. 2 figures. 23 references. ·
Wellness Way: Your Prostate Health Source: San Bruno, CA: StayWell Company. 1998. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. E-mail:
[email protected]. Website: www.staywell.com. Price: $20.00 for pack of 50; plus shipping and handling. Summary: This health promotion brochure offers a guide to prostate health and prostate problems. The brochure emphasizes that as men age, it is especially important for them to pay attention to their prostate health. The key is to have a routine, annual examination after age 40, and an annual PSA (prostate specific antigen) blood test after age 50. The brochure begins with a description of prostate anatomy, including normal prostatic enlargement that occurs with advancing age. The brochure defines benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer. Symptoms that may indicate prostate problems including difficulty in urinating, urinating frequently (especially at night), painful or burning sensation on urination, urine flow not easily stopped, blood in the urine, or pain in the lower back, pelvis, or upper thighs. Risk factors include increasing age, African American ethnicity, and family history. The brochure explains what patients will experience during a digital rectal exam. A checklist for prostate health is also included. The brochure encourages readers to educate themselves about their prostate and symptoms of prostatic problems, and to be vigilant about getting regular exams to help maintain the best health possible. The brochure is illustrated with full color line drawings. 11 figures.
·
Taking Care of Your Prostate Source: Santa Cruz, CA: ETR Associates. 1997. 4 p. Contact: Available from ETR Associates. P.O. Box 1830, Santa Cruz, CA 95061-1830. (800) 321-4407. Price: $16.00 for 50 copies. Summary: This brochure outlines the signs and symptoms of three common prostate problems: benign prostatic hyperplasia (BPH), prostate cancer, and prostatitis. Around age 40, the prostate gradually enlarges; this is normal in all men. But sometimes the prostate may become large enough to squeeze the urethra and interfere with the flow of urine, resulting in BPH. Symptoms include trouble starting to urinate, a slow or trickling urine stream, inability to empty the bladder completely, dribbling after urinating, or urinary frequency at night. Treatment
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options include watchful waiting, medication, and surgery; each is briefly described. Prostate cancer can be totally painless in its early stages, but can be detected by a health care provider before symptoms appear. Early diagnosis and treatment (surgery or radiation) provide the best chance for complete cure of prostate cancer. Prostatitis is an infection or inflammation of the prostate. Symptoms include pain or burning when urinating, difficulty urinating, painful ejaculation, blood in the urine, or aching pain behind the testicles or in the lower back. Bacterial prostatitis is treated with antibiotics; anti-inflammatory medications are helpful to treat nonbacterial prostatitis. One section of the brochure outlines diagnostic tests utilized to confirm prostate problems, including the digital rectal exam, PSA levels, specialized images (ultrasound, X-ray, or magnetic resonance imaging, MRI), and biopsy. Two sidebars review the physiology of the prostate and address issues of impotence. 1 figure. (AA-M). ·
Prostate Health: What Every Man Needs to Know Source: Zetland, New South Wales, Australia: Multicultural Health Communication Service. 1997. (web brochure). Contact: Available from Multicultural Health Communication Service. Royal South Sydney Community Health Complex, Joynton Avenue, Zetland, New South Wales, Australia 2107. (02) 9382 8111. E-mail:
[email protected]. Website: mhcs.health.nsw.gov.au/. Item is available only through the website and can be found under Men's Health. Summary: This brochure, available online through the Multicultural Health Communication Service, is one in a series of health information publications available in languages other than English. The Service facilitates the communication of quality information about health issues and health services to people of non-English speaking backgrounds. This brochure describes the prostate gland, its function, and problems that can be encountered with prostatic enlargement. For some men, prostate enlargement, while normal and not an indication of cancer, can interfere with urination (because the enlarged prostate is pressing on the urethra). The brochure cautions that sometimes similar symptoms can be a sign of prostate cancer, so men should be encouraged to consult their health care providers. A final section briefly defines prostatitis. The brochure is not illustrated and written in straightforward, nontechnical language.
·
Prostate Disorders and Incontinence Source: Olivette, MO: Home Delivery Incontinent Supplies, Inc. 1995. 2 p.
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Contact: Available from Home Delivery Incontinent Supplies, Inc. 1215 Dielman Industrial Court, Olivette, MO 63132. (800) 269-4663. Price: Single copy free. Summary: This patient education brochure provides information on prostate disorders and urinary incontinence. Written in a question and answer format, the brochure covers the role of the prostate gland in the urinary process, the types of prostate disorders that can occur (prostatitis, benign prostate enlargement, and prostate cancer), the types of surgical procedures used in the treatment of prostate disorders, incontinence as a complication of prostate surgery, steps to improve bladder control following prostate surgery, and products available for managing incontinence. ·
Prostate Problems Source: Bethesda, MD: National Institute on Aging, National Institutes of Health. 1994. 4 p. Contact: Available from National Institute on Aging (NIA) Information Center. P.O. Box 8057, Gaithersburg, MD 20898-8057. (800) 222-2225 or (301) 495-3450. Fax (301) 589-3014. TTY (800) 222-4225. E-mail:
[email protected]. Price: Single copy free. Also available from National Kidney and Urologic Diseases Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 6544415. E-mail:
[email protected]. Price: Single copy free; bulk copies available. Summary: This brochure delineates prostate problems common in men over age fifty. The symptoms of and treatments for three non-cancerous prostate problems (acute prostatitis, chronic prostatitis, and benign prostate hypertrophy) are identified. Treatment choices for benign prostate hypertrophy (BPH) are discussed in some detail. The brochure also describes prostate cancer, one of the most common forms of cancer among men in the United States. Diagnosis and treatment options are discussed. The brochure lists 6 organizations to contact for further information, and describes several other brochures and booklets which may be helpful.
·
About Urinary Tract Disorders Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1993. 7 p. Contact: Available from Channing L. Bete Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. Price: $1 each (up to 24 copies) plus shipping and handling (as of 1995); bulk prices available. Order number 12880.
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Summary: This brochure presents basic information about urinary tract problems, including infections, diseases, obstructions, and other disorders that can affect the body's fluid waste disposal system. Topics include the physiology of the urinary tract; the importance of early treatment for urinary tract problems; the structure and function of the urinary tract; three major types of urinary tract problems, including stones, infections, and cancers; diagnostic tests used to confirm urinary tract problems; and common questions and answers. Infections discussed include cystitis, prostatitis, and kidney infections. Types of cancers discussed include bladder, kidney, and prostate cancer. The brochure is illustrated with simple, line drawings of cartoon figures and includes definitions of many medical terms used. ·
Maryland's New Answer to Prostate Disease Source: Baltimore, MD: Maryland Prostate Center. 1993. 4 p. Contact: Available from Maryland Prostate Center. University of Maryland Professional Building, Paca and Redwood Streets, Suite 320, Baltimore, MD 21201. (410) 328-0800. Price: Single copy free. Summary: This brochure describes the Maryland Prostate Center, located at the University of Maryland Medical Center. The Center offers patients the convenience of a doctor's office visit along with access to the resources of a major medical center. The brochure also provides some basic information about prostate disease, covering benign prostatic hyperplasia (BPH), prostatitis, prostate cancer, prostate disease warning signs, and the incidence and prevalence of prostate disease.
The NLM Gateway27 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.28 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).
27 28
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and the public.29 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “prostatitis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 3268 Books / Periodicals / Audio Visual 70 Consumer Health 27 Meeting Abstracts 9 Other Collections 0 Total 3374
HSTAT30 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.31 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.32 Simply search by “prostatitis” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 30 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 31 The HSTAT URL is http://hstat.nlm.nih.gov/. 32 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention 29
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Coffee Break: Tutorials for Biologists33 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.34 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.35 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
(SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 33 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 34 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 35 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
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·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see http://www.lexical.com/Metaphrase.html.
Specialized References The following books are specialized references written for professionals interested in prostatitis (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Adult and Pediatric Urology (3-Volume Set) (Includes a Card to Return to Receive the Free CD-ROM) by Jay Y. Gillenwater, M.D. (Editor), et al; Hardcover - 2828 pages, 4th edition (January 15, 2002), Lippincott, Williams & Wilkins Publishers; ISBN: 0781732204; http://www.amazon.com/exec/obidos/ASIN/0781732204/icongroupinterna · Campbell’s Urology (4-Volume Set) by Meredith F. Campbell (Editor), et al; Hardcover, 8th edition (May 15, 2002), W B Saunders Co; ISBN: 0721690580; http://www.amazon.com/exec/obidos/ASIN/0721690580/icongroupinterna · Clinical Manual of Urology by Philip M. Hanno, M.D. (Editor), et al; Paperback - 924 pages, 3rd edition (May 2, 2001), McGraw-Hill Professional Publishing; ISBN: 0071362010; http://www.amazon.com/exec/obidos/ASIN/0071362010/icongroupinterna · Comprehensive Urology by George Weiss O’Reilly; Hardcover - 724 pages, 1st edition (January 15, 2001), Elsevier Science, Health Science Division; ISBN: 0723429499; http://www.amazon.com/exec/obidos/ASIN/0723429499/icongroupinterna · Manual of Urology: Diagnosis & Therapy by Mike B. Siroky (Editor), et al; Spiral-bound - 362 pages, 2nd spiral edition (October 15, 1999), Lippincott, Williams & Wilkins Publishers; ISBN: 078171785X; http://www.amazon.com/exec/obidos/ASIN/078171785X/icongroupinterna
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· The Scientific Basis of Urology by A.R. Mundy (Editor), et al; 531 pages 1st edition (March 15, 1999), Isis Medical Media; ISBN: 1899066217; http://www.amazon.com/exec/obidos/ASIN/1899066217/icongroupinterna · Smith’s General Urology by Emil A. Tanagho (Editor), et al; Paperback 888 pages, 15th edition (January 21, 2000), McGraw-Hill Professional Publishing; ISBN: 0838586074; http://www.amazon.com/exec/obidos/ASIN/0838586074/icongroupinterna · Urology (House Officer Series) by Michael T. MacFarlane, M.D.; Paperback - 3rd edition (January 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0781731461; http://www.amazon.com/exec/obidos/ASIN/0781731461/icongroupinterna · Urology for Primary Care Physicians by Unyime O. Nseyo (Editor), et al; Hardcover - 399 pages, 1st edition (July 15, 1999), W B Saunders Co; ISBN: 0721671489; http://www.amazon.com/exec/obidos/ASIN/0721671489/icongroupinterna
Vocabulary Builder Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH]
Dissertations 125
CHAPTER 9. DISSERTATIONS ON PROSTATITIS Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to prostatitis. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Prostatitis ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to prostatitis. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with prostatitis: ·
Epidemiological and Diagnostical Aspects of Prostatitis by Mehik, Aare; Phd from Oulun Yliopisto (finland), 2001, 121 pages http://wwwlib.umi.com/dissertations/fullcit/f444321
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Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to prostatitis is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
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PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with prostatitis and related conditions.
Researching Your Medications 129
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with prostatitis. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for prostatitis. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of prostatitis. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
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Your Medications: The Basics36 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of prostatitis. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with prostatitis take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for prostatitis. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
36
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 131
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for prostatitis). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for prostatitis. One such source
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is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.37 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia. It is important to read the disclaimer by the United States Pharmacopoeia (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of prostatitis. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to prostatitis: Caffeine ·
Systemic - U.S. Brands: Cafcit; Caffedrine Caplets; Dexitac Stay Alert Stimulant; Enerjets; Keep Alert; Maximum Strength SnapBack Stimulant Powders; NoDoz Maximum Strength Caplets; Pep-Back; Quick Pep; Ultra Pep-Back; Vivarin http://www.nlm.nih.gov/medlineplus/druginfo/caffeinesystemic 202105.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
37
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Ciprofloxacin ·
Ophthalmic - U.S. Brands: Ciloxan http://www.nlm.nih.gov/medlineplus/druginfo/ciprofloxacinop hthalmic202655.html
Doxycycline ·
Dental - U.S. Brands: Atridox http://www.nlm.nih.gov/medlineplus/druginfo/doxycyclineden tal203716.html
Erythromycin ·
Ophthalmic - U.S. Brands: Ilotycin http://www.nlm.nih.gov/medlineplus/druginfo/erythromycinop hthalmic202220.html
Fluoroquinolones ·
Systemic - U.S. Brands: Avelox; Cipro; Cipro I.V.; Floxin; Floxin I.V.; Levaquin; Maxaquin; Noroxin; Penetrex; Tequin; Zagam http://www.nlm.nih.gov/medlineplus/druginfo/fluoroquinolone ssystemic202656.html
Gentamicin ·
Ophthalmic - U.S. Brands: http://www.nlm.nih.gov/medlineplus/druginfo/gentamicinopht halmic202604.html
·
Ophthalmic - U.S. Brands: Garamycin; Gentacidin; Gentafair; Gentak; Ocu-Mycin; Spectro-Genta http://www.nlm.nih.gov/medlineplus/druginfo/gentamicinopht halmic202604.html
·
Topical - U.S. Brands: Garamycin; Gentamar; G-Myticin http://www.nlm.nih.gov/medlineplus/druginfo/gentamicintopic al202258.html
Trimethoprim ·
Systemic - U.S. Brands: Proloprim; Trimpex http://www.nlm.nih.gov/medlineplus/druginfo/trimethoprimsy stemic202579.html
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Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with prostatitis (including those with contraindications):38 ·
Carbenicillin Indanyl Sodium http://www.reutershealth.com/atoz/html/Carbenicillin_Indanyl_Sodiu m.htm
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Ciprofloxacin http://www.reutershealth.com/atoz/html/Ciprofloxacin.htm
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Flavoxate http://www.reutershealth.com/atoz/html/Flavoxate.htm
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Gatifloxacin http://www.reutershealth.com/atoz/html/Gatifloxacin.htm
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Norfloxacin http://www.reutershealth.com/atoz/html/Norfloxacin.htm
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Ofloxacin http://www.reutershealth.com/atoz/html/Ofloxacin.htm
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Trimethoprim Sulfamethoxazole http://www.reutershealth.com/atoz/html/Trimethoprim_Sulfamethox azole.htm
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information.
38
Adapted from A to Z Drug Facts by Facts and Comparisons.
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Information in Mosby’s GenRx database can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with prostatitis--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat prostatitis or potentially create deleterious side effects in patients with prostatitis. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These
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precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with prostatitis. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with prostatitis. The FDA warns patients to watch out for39: ·
Secret formulas (real scientists share what they know)
·
Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
·
Quick, painless, or guaranteed cures
·
If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov. 39
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Complete Guide to Prescription and Nonprescription Drugs 2001 (Complete Guide to Prescription and Nonprescription Drugs, 2001) by H. Winter Griffith, Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/039952634X/icongroupinterna
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The Essential Guide to Prescription Drugs, 2001 by James J. Rybacki, James W. Long; Paperback - 1274 pages (2001), Harper Resource; ISBN: 0060958162; http://www.amazon.com/exec/obidos/ASIN/0060958162/icongroupinterna
·
Handbook of Commonly Prescribed Drugs by G. John Digregorio, Edward J. Barbieri; Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/0942447417/icongroupinterna
·
Johns Hopkins Complete Home Encyclopedia of Drugs 2nd ed. by Simeon Margolis (Ed.), Johns Hopkins; Hardcover - 835 pages (2000), Rebus; ISBN: 0929661583; http://www.amazon.com/exec/obidos/ASIN/0929661583/icongroupinterna
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Medical Pocket Reference: Drugs 2002 by Springhouse Paperback 1st edition (2001), Lippincott Williams & Wilkins Publishers; ISBN: 1582550964; http://www.amazon.com/exec/obidos/ASIN/1582550964/icongroupinterna
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PDR by Medical Economics Staff, Medical Economics Staff Hardcover 3506 pages 55th edition (2000), Medical Economics Company; ISBN: 1563633752; http://www.amazon.com/exec/obidos/ASIN/1563633752/icongroupinterna
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Pharmacy Simplified: A Glossary of Terms by James Grogan; Paperback 432 pages, 1st edition (2001), Delmar Publishers; ISBN: 0766828581; http://www.amazon.com/exec/obidos/ASIN/0766828581/icongroupinterna
·
Physician Federal Desk Reference by Christine B. Fraizer; Paperback 2nd edition (2001), Medicode Inc; ISBN: 1563373971; http://www.amazon.com/exec/obidos/ASIN/1563373971/icongroupinterna
· Physician’s Desk Reference Supplements Paperback - 300 pages, 53 edition (1999), ISBN: 1563632950; http://www.amazon.com/exec/obidos/ASIN/1563632950/icongroupinterna
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Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Flavoxate: A drug that has been used in various urinary syndromes and as an antispasmodic. Its therapeutic usefulness and its mechanism of action are not clear. It may have local anesthetic activity and direct relaxing effects on smooth muscle as well as some activity as a muscarinic antagonist. [NIH] Norfloxacin: Quinoline-derived synthetic antibacterial agent with a very broad spectrum of action. Oral administration yields highly bactericidal plasma, tissue, and urine levels. Norfloxacin inhibits bacterial DNA-gyrase and is used in gastrointestinal, eye, and urinary infections. [NIH] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU]
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to prostatitis. Finally, at the conclusion of this chapter, we will provide a list of readings on prostatitis from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?40 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 40
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?41 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
41
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.42
42
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Prostatitis Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for prostatitis. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required. The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “prostatitis” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
Integrative Urology: A Spectrum of Complementary and Alternative Therapy Source: Urology. 56(2): 185-189. August 1, 2000.
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Summary: This journal article reviews complementary and alternative medicine (CAM) therapies for urologic disorders and suggests guidelines for integrating CAM into conventional urologic practice. The first part outlines the principles of integrative urology set out in the 1995 Consensus Statement of the Office of Alternative Medicine, National Institutes of Health. The second part reviews research on CAM therapies for benign prostatic hyperplasia, prostatitis, cystitis, and prostate cancer. The author concludes that urologists must familiarize themselves with CAM, which is often self-administered and patient driven, and prepare themselves to counsel patients on the realistic expectations and potential adverse effects of CAM therapies. Clinicians should recognize the potential of CAM therapies to confound the prostate specific antigen and hormonal parameters of standard urologic therapy. Finally, the clinical application of CAM by urologists should use methods that are subjected to evidence-based trials, epidemiologic observations, and standard data analysis techniques. The article has 1 table and 33 references. ·
Male Sexual Vitality: How You Can Benefit from Diet, Vitamins, Minerals, Herbs, Exercise, and Other Natural Methods Source: Rocklin, CA: Prima Publishing. 1994. 150 p. Contact: Available from Prima Publishing. PO Box 1260BK, Rocklin, CA 95677. 916-786-0426. Price: $10.95. ISBN: 1559584289. Summary: This book presents a natural approach to the prevention and treatment of male sexual dysfunctions. Chapter 1 provides an overview of the anatomy and physiology of the male sexual system. Chapter 2 describes the causes of erectile dysfunction, medical treatments for this problem, and a natural approach using exercise and plant-based medicines. Chapter 3 examines male infertility, including its causes, diagnosis, medical treatment, the role of scrotal temperature, and natural treatment with plant-based medicines, glandular therapy, antioxidants, and nutrients. Chapter 4, on prostate health, discusses the diagnosis of prostate disorders, reduction of prostate cancer risk, medical treatment of benign prostatic hyperplasia and prostatitis, and the natural approach to prostate health. Chapter 5 discusses chlamydia infection, and presents a natural approach to treating male genitourinary tract infections. Chapter 6 explains how to eat to maintain or improve virility. It includes recipes and guidelines for menu planning. Chapter 7 discusses the use of nutritional supplements. Chapter 8 discusses the use of ginseng for conditions involving the male reproductive system. The book includes a resource list, references, and an index.
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National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to prostatitis and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “prostatitis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to prostatitis: ·
62 cases of chronic prostatitis treated by rectal ionintroduction of TCM suppository. Author(s): Chen Z. Source: J Tradit Chin Med. 1996 March; 16(1): 15-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8758702&dopt=Abstract
·
Acupuncture treatment in 102 cases of chronic prostatitis. Author(s): Ge SH, Meng FY, Xu BR. Source: J Tradit Chin Med. 1988 June; 8(2): 99-100. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3412022&dopt=Abstract
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Acute and chronic bacterial prostatitis: a review of treatment approaches. Author(s): Kot T, Pettit-Young N. Source: Compr Ther. 1990 August; 16(8): 54-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2173653&dopt=Abstract
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Amebic prostatitis. Author(s): Goff DA, Davidson RA. Source: Southern Medical Journal. 1984 August; 77(8): 1053-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6087468&dopt=Abstract
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Application of millimeter waves in treating chronic prostatitis patients. Author(s): Matveev AG.
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Source: Crit Rev Biomed Eng. 2001; 29(3): 482-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11730107&dopt=Abstract ·
Chlamydia trachomatis in 'abacterial' prostatitis: microbiological, cytological and serological studies. Author(s): Weidner W, Arens M, Krauss H, Schiefer HG, Ebner H. Source: Urologia Internationalis. 1983; 38(3): 146-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6346628&dopt=Abstract
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Chronic prostatitis. Author(s): Mobley DF. Source: Southern Medical Journal. 1974 February; 67(2): 219-24. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4590619&dopt=Abstract
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Chronic prostatitis: psychosomatic incidence. Author(s): Mendlewicz J, Schulman CC, De Schutter B, Wilmotte J. Source: Psychotherapy and Psychosomatics. 1971; 19(1): 118-25. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5146341&dopt=Abstract
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Comparison of expressed prostatic secretions with urine after prostatic massage--a means to diagnose chronic prostatitis/inflammatory chronic pelvic pain syndrome. Author(s): Ludwig M, Schroeder-Printzen I, Ludecke G, Weidner W. Source: Urology. 2000 February; 55(2): 175-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10688073&dopt=Abstract
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Cytokine polymorphisms in men with chronic prostatitis/chronic pelvic pain syndrome: association with diagnosis and treatment response. Author(s): Shoskes DA, Albakri Q, Thomas K, Cook D. Source: The Journal of Urology. 2002 July; 168(1): 331-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12050565&dopt=Abstract
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Diagnosis of chronic prostatitis: overview and update. Author(s): Thin RN. Source: International Journal of Std & Aids. 1997 August; 8(8): 475-81. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9259494&dopt=Abstract
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Does the chronic prostatitis/pelvic pain syndrome differ from nonbacterial prostatitis and prostatodynia? Author(s): Krieger JN, Jacobs RR, Ross SO. Source: The Journal of Urology. 2000 November; 164(5): 1554-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11025703&dopt=Abstract
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Identification of rat prostatic steroid-binding protein as a target antigen of experimental autoimmune prostatitis: implications for prostate cancer therapy. Author(s): Liu KJ, Chatta GS, Twardzik DR, Vedvick TS, True LD, Spies AG, Cheever MA. Source: Journal of Immunology (Baltimore, Md. : 1950). 1997 July 1; 159(1): 472-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9200488&dopt=Abstract
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Measurement of urinary antibodies to crude bacterial antigen in patients with chronic bacterial prostatitis. Author(s): Shortliffe LM, Elliott K, Sellers RG. Source: The Journal of Urology. 1989 March; 141(3): 632-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2918607&dopt=Abstract
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Neuromuscular dysfunction in nonbacterial prostatitis. Author(s): Hellstrom WJ, Schmidt RA, Lue TF, Tanagho EA. Source: Urology. 1987 August; 30(2): 183-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3497475&dopt=Abstract
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Practical approach to the management of prostatitis. Author(s): Nickel JC.
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Source: Tech Urol. 1995 Fall; 1(3): 162-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9118386&dopt=Abstract ·
Prevalence of chronic prostatitis in men with premature ejaculation. Author(s): Screponi E, Carosa E, Di Stasi SM, Pepe M, Carruba G, Jannini EA. Source: Urology. 2001 August; 58(2): 198-202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11489699&dopt=Abstract
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Prospective identification of National Institutes of Health category IV prostatitis in men with elevated prostate specific antigen. Author(s): Potts JM. Source: The Journal of Urology. 2000 November; 164(5): 1550-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11025702&dopt=Abstract
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Prostatitis unplugged? Prostatic massage revisited. Author(s): Nickel JC, Alexander R, Anderson R, Krieger J, Moon T, Neal D, Schaeffer A, Shoskes D. Source: Tech Urol. 1999 March; 5(1): 1-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10374787&dopt=Abstract
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Prostatitis: are the gram-positive organisms pathogenic? Author(s): Jimenez-Cruz JF, Martinez Ferrer M, Allona Almagro A, De Rafael L, Navio-Nino S, Baquero Mochales M. Source: European Urology. 1984; 10(5): 311-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6519134&dopt=Abstract
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Prostatitis: Man's hidden infection. Author(s): Drach GW. Source: The Urologic Clinics of North America. 1975 October; 2(3): 499520. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=52931&dopt=Abstract
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Prostatitis--an increasing management. Author(s): Leigh DA.
clinical
problem
for
diagnosis
and
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Source: The Journal of Antimicrobial Chemotherapy. 1993 July; 32 Suppl A: 1-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8407691&dopt=Abstract ·
Pseudodyssynergia (contraction of the external sphincter during voiding) misdiagnosed as chronic nonbacterial prostatitis and the role of biofeedback as a therapeutic option. Author(s): Kaplan SA, Santarosa RP, D'Alisera PM, Fay BJ, Ikeguchi EF, Hendricks J, Klein L, Te AE. Source: The Journal of Urology. 1997 June; 157(6): 2234-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9146624&dopt=Abstract
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Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience. Author(s): Nickel JC, Downey J, Feliciano AE Jr, Hennenfent B. Source: Tech Urol. 1999 September; 5(3): 146-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10527258&dopt=Abstract
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Significance of Chlamydia trachomatis in "abacterial" prostatitis. Author(s): Krauss H, Schiefer HG, Weidner W, Arens M, Ebner H. Source: Zentralbl Bakteriol Mikrobiol Hyg [a]. 1983 July; 254(4): 545-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6372332&dopt=Abstract
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Studies on the role of Ureaplasma urealyticum and Mycoplasma hominis in prostatitis. Author(s): Brunner H, Weidner W, Schiefer HG. Source: The Journal of Infectious Diseases. 1983 May; 147(5): 807-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6842018&dopt=Abstract
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The characterization of bacterial and nonbacterial prostatitis by prostatic immunoglobulins. Author(s): Shortliffe LM, Wehner N. Source: Medicine; Analytical Reviews of General Medicine, Neurology, Psychiatry, Dermatology, and Pediatries. 1986 November; 65(6): 399-414. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3537628&dopt=Abstract
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·
The chronic prostatitis syndromes. Author(s): Thin RN. Source: J R Army Med Corps. 1997 October; 143(3): 155-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9403823&dopt=Abstract
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The male chronic pelvic pain syndrome. Author(s): Zermann DH, Ishigooka M, Doggweiler-Wiygul R, Schubert J, Schmidt RA. Source: World Journal of Urology. 2001 June; 19(3): 173-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11469604&dopt=Abstract
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The possible role of anaerobic bacteria in chronic prostatitis. Author(s): Szoke I, Torok L, Dosa E, Nagy E, Scultety S. Source: International Journal of Andrology. 1998 June; 21(3): 163-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9669200&dopt=Abstract
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The Pre and Post Massage Test (PPMT): a simple screen for prostatitis. Author(s): Nickel JC. Source: Tech Urol. 1997 Spring; 3(1): 38-43. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9170224&dopt=Abstract
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The role of Chlamydia trachomatis in patients with non-bacterial prostatitis. Author(s): Mutlu N, Mutlu B, Culha M, Hamsioglu Z, Demirtas M, Gokalp A. Source: Int J Clin Pract. 1998 November-December; 52(8): 540-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10622051&dopt=Abstract
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The value of endotoxin concentrations in expressed prostatic secretions for the diagnosis and classification of chronic prostatitis. Author(s): Li LJ, Shen ZJ, Lu YL, Fu SZ. Source: Bju International. 2001 October; 88(6): 536-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11678746&dopt=Abstract
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Transurethral radiofrequency hot balloon thermal therapy in chronic nonbacterial prostatitis. Author(s): Nickel JC, Siemens DR, Johnston B. Source: Tech Urol. 1998 September; 4(3): 128-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9800889&dopt=Abstract
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Treatment of nonspecific chronic prostatitis with Qian Lie Xian Yan Suppository suppository in 104 cases. Author(s): Jia Y, Li Y, Li J, Sun M. Source: J Tradit Chin Med. 2001 June; 21(2): 90-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11498910&dopt=Abstract
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Treatment of prostatitis. Author(s): Stevermer JJ, Easley SK. Source: American Family Physician. 2000 May 15; 61(10): 3015-22, 3025-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10839552&dopt=Abstract
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Ureaplasma urealyticum in the urogenital tract of patients with chronic prostatitis or related symptomatology. Author(s): Ohkawa M, Yamaguchi K, Tokunaga S, Nakashima T, Fujita S. Source: Br J Urol. 1993 December; 72(6): 918-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8306156&dopt=Abstract
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Value of intraprostatic injection of zinc and vitamin C and of ultrasound application in infertile men with chronic prostatitis. Author(s): Fahim MS, Ibrahim HH, Girgis SM, Essa HA, Hanafi S. Source: Archives of Andrology. 1985; 14(1): 81-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3901948&dopt=Abstract
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Zinc concentration in human prostatic fluid: normal, chronic prostatitis, adenoma and cancer. Author(s): Zaichick VY, Sviridova TV, Zaichick SV. Source: International Urology and Nephrology. 1996; 28(5): 687-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9061429&dopt=Abstract
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to prostatitis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Prostatitis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm Prostatitis Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html ·
Alternative Therapy Hydrotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,705, 00.html
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Chinese Medicine Qianlieshu Wan Alternative names: Qianlieshu Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Qianlieshu%20Wan &mh=10&sb=---&view_records=View+Records
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Herbs and Supplements Antibiotics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm Antibiotics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Beta-Sitosterol Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Bromelain Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm Bromelain Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Bromelain.htm Corn Silk Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsa-c.htm Finasteride Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Flaxseed Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Herbal Medicine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Horsetail Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsg-i.htm Nettle Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Papain Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm Pau D’arco Alternative names: Tabebuia avellanedae, Tabebuia impestiginosa
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Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Pau_Darco.htm Pau d'Arco Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm Pollen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm Pollen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Pollen.htm Pollen Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Pollen Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Pumpkin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Pygeum Alternative names: African Prune; Pygeum africanum Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Pygeum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm
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Pygeum Alternative names: Prunus africanum, Pygeum africanum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Pygeum.htm Pygeum Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Pygeum Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000224.html Pygeum africanum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm Pygeum africanum Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Saw Palmetto Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm Saw Palmetto Alternative names: Serenoa serrulata, Serenoa repens, Sabal serrulata Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Saw_Palmetto.htm Saw Palmetto Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Saw Palmetto Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000232.html
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Saw Palmetto Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Serenoa Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Serenoa repens Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Sitosterol Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Urtica Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Urtica dioica Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html ·
Related Conditions Benign Prostatic Hyperplasia Alternative names: Prostate Enlargement Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Male Infertility Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Infertility_Male.htm Prostate Infection Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html
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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna ·
Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna
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Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna
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Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna
· Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna ·
Herbs for the Urinary Tract: Herbal Relief for Kidney Stones, Bladder Infections and Other Problems of the Urinary Tract by Michael Moore; Paperback - 96 pages (June 1998), McGraw Hill - NTC; ISBN: 0879838159; http://www.amazon.com/exec/obidos/ASIN/0879838159/icongroupinterna
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Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001), Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna
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New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna
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· Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH]
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with prostatitis. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with prostatitis may be given different recommendations. Some recommendations may be directly related to prostatitis, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of prostatitis. We will then show you how to find studies dedicated specifically to nutrition and prostatitis.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:43 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
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DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
43
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?44
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”45 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.46 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 45 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 46 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 44
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overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected] Finding Studies on Prostatitis The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.47 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
47
Researching Nutrition 167
found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “prostatitis” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following information is typical of that found when using the “Full IBIDS Database” when searching using “prostatitis” (or a synonym): ·
62 cases of chronic prostatitis treated by rectal ionintroduction of TCM suppository. Author(s): Shijiazhuang Railway Central Hospital, Hebei Province. Source: Chen, Z J-Tradit-Chin-Med. 1996 March; 16(1): 15-7 0254-6272
·
Acupuncture treatment in 102 cases of chronic prostatitis. Source: Ge, S H Meng, F Y Xu, B R J-Tradit-Chin-Med. 1988 June; 8(2): 99100 0254-6272
·
Correlation of beta-endorphin and prostaglandin E2 levels in prostatic fluid of patients with chronic prostatitis with diagnosis and treatment response. Author(s): Harbor-University of California-Los Angeles Medical Center, Torrance, California, USA. Source: Shahed, A R Shoskes, D A J-Urol. 2001 November; 166(5): 1738-41 0022-5347
·
Development of rat prostatitis model by oral administration of isoflavone and its characteristics. Author(s): Department of Urology, Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, C.P.O. Box 8044, Seoul 120-752, Korea. Source: Kwon, S M Kim, S I Chun, D C Cho, N H Chung, B C Park, B W Hong, S J Yonsei-Med-J. 2001 August; 42(4): 395-404 0513-5796
·
Effect of cernitin pollen-extract on experimental nonbacterial prostatitis in rats. Author(s): Department of Urology, Faculty of Medicine, University of Tokyo, Japan.
[email protected] Source: Kamijo, T Sato, S Kitamura, T Prostate. 2001 October 1; 49(2): 12231 0270-4137
·
Eosinophilic prostatitis simulating invasive prostatic carcinoma: CT appearance. Author(s): Department of Radiology, University of British Columbia, North Vancouver.
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Source: Gibney, R G Hicken, P Nichols, D M Can-Assoc-Radiol-J. 1988 March; 39(1): 48-50 0846-5371 ·
Failure of prostatitis treatment secondary to probable ciprofloxacinsucralfate drug interaction. Author(s): Department of Family Medicine, East Carolina University School of Medicine, Greenville, North Carolina 27858-4354, USA. Source: Spivey, J M Cummings, D M Pierson, N R Pharmacotherapy. 1996 Mar-April; 16(2): 314-6 0277-0008
·
Local transrectal enzymatic treatment for chronic nonbacterial prostatitis and prostatodynia: initial clinical experience. Author(s): Department of Urology, University of Vienna, Austria. Source: Kerbl, K Zisch, R Tech-Urol. 2000 March; 6(1): 22-5 1079-3259
·
Results of treatment with pollen extract (Cernilton N) in chronic prostatitis and prostatodynia. Author(s): Department of Urology, Georg-August-University, Gottingen, Germany. Source: Rugendorff, E W Weidner, W Ebeling, L Buck, A C Br-J-Urol. 1993 April; 71(4): 433-8 0007-1331
·
Soy of dietary source plays a preventive role against the pathogenesis of prostatitis in rats. Author(s): Department of Population Dynamics, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205. Source: Sharma, O P Adlercreutz, H Strandberg, J D Zirkin, B R Coffey, D S Ewing, L L J-Steroid-Biochem-Mol-Biol. 1992 November; 43(6): 557-64 0960-0760
·
The effect of prostaglandin E1 on in vitro transcription of sperm chromatin, isolated from patients with azoospermia, teratospermia and chronic prostatitis. Author(s): Institute of Molecular Biology, Bulg. Acad. Sci., Sofia, Bulgaria. Source: Pironcheva, G Miteva, K Russev, G C Vaisberg, C Zlatarev, S ZNaturforsch-[C]. 1998 May-June; 53(5-6): 421-4 0341-0382
·
Treatment of 133 cases of chronic prostatitis by seminal consolidation and turbidity excretion. Source: Zhu, Y K J-Tradit-Chin-Med. 1989 December; 9(4): 272-4 02546272
·
Treatment of chronic abacterial prostatitis: a review. Source: Evans, D T Int-J-STD-AIDS. 1994 May-June; 5(3): 157-64 0956-4624
·
Treatment of chronic prostatitis and prostatodynia with pollen extract. Author(s): Department of Urology, Leighton Hospital, Crewe.
Researching Nutrition 169
Source: Buck, A C Rees, R W Ebeling, L Br-J-Urol. 1989 November; 64(5): 496-9 0007-1331 ·
Treatment of chronic prostatitis with laser acupuncture. Author(s): Department of Acupuncture & Massage, Zhejiang College of Traditional Chinese Medicine, Hangzhou. Source: Chen, C Gao, Z Liu, Y Shen, L J-Tradit-Chin-Med. 1995 March; 15(1): 38-41 0254-6272
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
·
The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
·
Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
170 Prostatitis
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to prostatitis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Ascorbic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_C.htm
·
Minerals Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm
Researching Nutrition 171
Quercetin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm Quercetin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Quercetin.htm Zinc Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Zinc.htm Zinc Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Zincc s.html Zinc Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000128.html ·
Food and Diet Berries Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Berries.htm Berries Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Coffee Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html
172 Prostatitis
Diabetes Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Fruit Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm Pumpkin seeds Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Pumpkin seeds Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,176,00.ht ml Rye Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm Rye Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Seeds Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Seeds Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html
Researching Nutrition 173
Water Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Prostatitis.htm Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Azoospermia: Absence of spermatozoa in the semen, or failure of formation of spermatozoa. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of
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the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acidbinding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 175
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.48
48
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):49 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
49
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 177
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
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·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
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Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 179
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 181
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
·
South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
·
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
·
Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
·
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
·
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Your Rights and Insurance 183
APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with prostatitis faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.50 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
50Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
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·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
Your Rights and Insurance 185
plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks, nontreatment.
·
Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
186 Prostatitis
·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
Your Rights and Insurance 187
healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.51
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”52 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 52 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 51
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·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
·
Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.53 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.54 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 54 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 53
Your Rights and Insurance 189
3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.
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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
Your Rights and Insurance 191
contact information on how to find more in-depth information about Medicaid.55
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.
55
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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
Your Rights and Insurance 193
phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.56 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
56
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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:57 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
·
Veteran’s Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
57
Your Rights and Insurance 195
Vocabulary Builder Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH]
Online Glossaries 197
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to prostatitis and keep them on file. The NIH, in particular, suggests that patients with prostatitis visit the following Web sites in the ADAM Medical Encyclopedia:
198 Prostatitis
·
Basic Guidelines for Prostatitis BPH Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000381.htm Chlamydia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001345.htm Prostatitis - acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000519.htm Prostatitis - chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000523.htm Prostatitis - non-bacterial Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000524.htm
·
Signs & Symptoms for Prostatitis Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Back pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm Blood in the semen Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003163.htm Blood in the urine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003138.htm
Online Glossaries 199
Chills Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003091.htm Dysuria Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003145.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Frequent urination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm Impotence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003164.htm Incontinence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003142.htm Low back pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm Nocturia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003141.htm Pain with ejaculation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm Pain/burning with urination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003145.htm
200 Prostatitis
Scrotal swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003161.htm Testicle pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003160.htm Testicular pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003160.htm Urinary frequency Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm Urinary frequency/urgency, increased Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm ·
Diagnostics and Tests for Prostatitis Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm Cystoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003903.htm PSA Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003346.htm RBC; urine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003582.htm Ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003336.htm
Online Glossaries 201
Urinalysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003579.htm Urine culture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003751.htm ·
Nutrition for Prostatitis Caffeine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002445.htm
·
Surgery and Procedures for Prostatitis Transurethral resection of the prostate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002996.htm
·
Background Topics for Prostatitis Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Intravenous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002383.htm Penis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002279.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Safer sex behaviors Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001949.htm
202 Prostatitis
Suprapubic catheter Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003981.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 203
PROSTATITIS GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Adenoma: A benign epithelial tumour in which the cells form recognizable glandular structures or in which the cells are clearly derived from glandular epithelium. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Anaerobic: 1. lacking molecular oxygen. 2. growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid
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sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Aplasia: Lack of development of an organ or tissue, or of the cellular products from an organ or tissue. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Azoospermia: Absence of spermatozoa in the semen, or failure of formation of spermatozoa. [EU] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Baths: The immersion or washing of the body or any of its parts in water or other medium for cleansing or medical treatment. It includes bathing for personal hygiene as well as for medical purposes with the addition of therapeutic agents, such as alkalines, antiseptics, oil, etc. [NIH]
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Benign: Not malignant; not recurrent; favourable for recovery. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Bordetella: A genus of gram-negative, aerobic bacteria whose cells are minute coccobacilli. It consists of both parasitic and pathogenic species. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Catheterization: The employment or passage of a catheter. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Chlamydia: A genus of the family chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine.
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Chlamydia species are gram-negative and produce glycogen. The type species is chlamydia trachomatis. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Colposcopy: The examination, therapy or surgery of the cervix and vagina by means of a specially designed endoscope introduced vaginally. [NIH] Commensal: 1. living on or within another organism, and deriving benefit without injuring or benefiting the other individual. 2. an organism living on or within another, but not causing injury to the host. [EU] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contractility: stimulus. [EU]
Capacity for becoming short in response to a suitable
Criterion: A standard by which something may be judged. [EU] Cystinuria: An inherited abnormality of renal tubular transport of dibasic amino acids leading to massive urinary excretion of cystine, lysine, arginine, and ornithine. [NIH] Cystoscopy: Direct visual examination of the urinary tract with a cystoscope. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Dilatation: The condition, as of an orifice or tubular structure, of being dilated or stretched beyond the normal dimensions. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Doxazosin: A selective alpha-1-adrenergic blocker that lowers serum cholesterol. It is also effective in the treatment of hypertension. [NIH]
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Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Dyspareunia: Difficult or painful coitus. [EU] Dysuria: Painful or difficult urination. [EU] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Ejaculation: A sudden act of expulsion, as of the semen. [EU] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU]
Electrolysis: Destruction by passage of a galvanic electric current, as in disintegration of a chemical compound in solution. [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Enuresis: Involuntary discharge of urine after the age at which urinary control should have been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bedwetting, nocturnal enuresis). [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to
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50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Fatal: Causing death, deadly; mortal; lethal. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Finasteride: An orally active testosterone 5-alpha-reductase inhibitor. It is used as a surgical alternative for treatment of benign prostatic hyperplasia. [NIH]
Flaccid: Weak, lax and soft. [EU] Flavoxate: A drug that has been used in various urinary syndromes and as an antispasmodic. Its therapeutic usefulness and its mechanism of action are not clear. It may have local anesthetic activity and direct relaxing effects on smooth muscle as well as some activity as a muscarinic antagonist. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Gibberellins: A class of plant growth hormone isolated from cultures of Gibberella fujikuroi, a fungus causing Bakanae disease in rice. There are many different members of the family as well as mixtures of multiple members; all are diterpenoid acids based on the gibberellane skeleton. [NIH] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Glomerulonephritis: A variety of nephritis characterized by inflammation of the capillary loops in the glomeruli of the kidney. It occurs in acute, subacute, and chronic forms and may be secondary to haemolytic streptococcal infection. Evidence also supports possible immune or autoimmune mechanisms. [EU] Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [NIH]
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Glycosuria: The presence of glucose in the urine; especially the excretion of an abnormally large amount of sugar (glucose) in the urine, i.e., more than 1 gm. in 24 hours. [EU] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Pertaining to the liver. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hyperthermia: Abnormally high body temperature, especially that induced for therapeutic purposes. [EU] Hypertrophy: Nutrition) the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells. [EU] Hypospadias: A developmental anomaly in the male in which the urethra opens on the underside of the penis or on the perineum. [NIH] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU]
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Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Insomnia: Inability to sleep; abnormal wakefulness. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Libido: Sexual desire. [EU] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a
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specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medicament: A medicinal substance or agent. [EU] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Myalgia: Pain in a muscle or muscles. [EU] Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH]
Myeloma: A tumour composed of cells of the type normally found in the bone marrow. [EU] Neonatal: Pertaining to the first four weeks after birth. [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nephropathy: Disease of the kidneys. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nickel: Nickel. A trace element with the atomic symbol Ni, atomic number 28, and atomic weight 58.69. It is a cofactor of the enzyme urease. [NIH]
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Nitrofurantoin: A urinary anti-infective agent effective against most grampositive and gram-negative organisms. Although sulfonamides and antibiotics are usually the agents of choice for urinary tract infections, nitrofurantoin is widely used for prophylaxis and long-term suppression. [NIH]
Norfloxacin: Quinoline-derived synthetic antibacterial agent with a very broad spectrum of action. Oral administration yields highly bactericidal plasma, tissue, and urine levels. Norfloxacin inhibits bacterial DNA-gyrase and is used in gastrointestinal, eye, and urinary infections. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Ofloxacin: An orally administered broad-spectrum quinolone antibacterial drug active against most gram-negative and gram-positive bacteria. [NIH] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Papain: A proteolytic enzyme obtained from Carica papaya. It is also the name used for a purified mixture of papain and chymopapain that is used as a topical enzymatic debriding agent. EC 3.4.22.2. [NIH] Parenchyma: The essential elements of an organ; used in anatomical nomenclature as a general term to designate the functional elements of an organ, as distinguished from its framework, or stroma. [EU] Patella: The flat, triangular bone situated at the anterior part of the knee. [NIH]
Penis: The male organ of copulation and of urinary excretion, comprising a root, body, and extremity, or glans penis. The root is attached to the descending portions of the pubic bone by the crura, the latter being the extremities of the corpora cavernosa, and beneath them the corpus spongiosum, through which the urethra passes. The glans is covered with mucous membrane and ensheathed by the prepuce, or foreskin. The penis is homologous with the clitoris in the female. [EU] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment.
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This includes the killer phenotype, characteristic of yeasts. [NIH] Postmenopausal: Occurring after the menopause. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Priapism: Persistent abnormal erection of the penis, usually without sexual desire, and accompanied by pain and tenderness. It is seen in diseases and injuries of the spinal cord, and may be caused by vesical calculus and certain injuries to the penis. [EU] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatitis: Inflammation of the prostate. [EU] Prosthesis: An artificial substitute for a missing body part, such as an arm or leg, eye or tooth, used for functional or cosmetic reasons, or both. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Proteolytic: 1. pertaining to, characterized by, or promoting proteolysis. 2. an enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychiatry:
The medical science that deals with the origin, diagnosis,
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prevention, and treatment of mental disorders. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the interstitium and rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU] Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] Radiotherapy: The treatment of disease by ionizing radiation. [EU] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refractory: Not readily yielding to treatment. [EU] Relaxant: 1. lessening or reducing tension. 2. an agent that lessens tension. [EU]
Renovascular: Of or pertaining to the blood vessels of the kidneys. [EU] Resection: Excision of a portion or all of an organ or other structure. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It
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occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Schizophrenia: A severe emotional disorder of psychotic depth characteristically marked by a retreat from reality with delusion formation, hallucinations, emotional disharmony, and regressive behavior. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Serine: A non-essential amino acid occurring in natural form as the Lisomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [NIH] Stimulant: 1. producing stimulation; especially producing stimulation by
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causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acidbinding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Suicide: The act of killing oneself. [NIH] Suppository: A medicated mass adapted for introduction into the rectal, vaginal, or urethral orifice of the body, suppository bases are solid at room temperature but melt or dissolve at body temperature. Commonly used bases are cocoa butter, glycerinated gelatin, hydrogenated vegetable oils, polyethylene glycols of various molecular weights, and fatty acid esters of polyethylene glycol. [EU] Surgical: Of, pertaining to, or correctable by surgery. [EU] Symptomatology: 1. that branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. the combined symptoms of a disease. [EU]
Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Torsion: 1. a type of mechanical stress, whereby the external forces (load) twist an object about its axis. 2. in ophthalmology any rotation of the vertical corneal meridians. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH]
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Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Ureaplasma: A genus of gram-negative, nonmotile bacteria which are common parasitic inhabitants of the urogenital tracts of man, cattle, dogs, and monkeys. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Urodynamics: The mechanical laws of fluid dynamics as they apply to urine transport. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU]
Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Urothelium: The epithelial lining of the urinary tract. [NIH] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to
218 Prostatitis
more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
220 Prostatitis
INDEX A Abdomen ...................16, 42, 74, 115, 209 Adenoma .......................................71, 152 Adenosine......................................54, 203 Adrenergic .......................42, 56, 115, 206 Anaerobic ................56, 58, 151, 208, 211 Anaesthesia.............................52, 57, 210 Anatomical...............................15, 58, 212 Antibiotic .......11, 23, 40, 44, 85, 98, 103, 106, 138, 207, 211, 215 Antibody......21, 40, 56, 57, 204, 206, 209, 211 Anticholinergic .......................................37 Antigen .16, 42, 48, 50, 51, 55, 56, 57, 77, 92, 102, 111, 113, 115, 116, 145, 148, 149, 204, 207, 209, 211 Antimicrobial ........40, 44, 56, 86, 206, 207 Aplasia ...................................................87 Assay...............................................42, 52 Asymptomatic ......................41, 68, 69, 71 Autoimmunity.............................64, 69, 71 Azoospermia........................................168 B Back Pain ............................................199 Baths .....................................................14 Biochemical ...........................................44 Biopsy........16, 66, 77, 110, 114, 115, 117 Bradykinin..............................................48 C Candidiasis ............................................80 Capsules..............................................165 Carbohydrate.......................................164 Carcinoma .....................................87, 167 Chemotherapy ...............................79, 110 Chlamydia............................................145 Cholesterol ....................56, 162, 164, 206 Ciprofloxacin..................................44, 168 Circumcision ..........................................78 Colposcopy............................................80 Commensal ...........................................44 Concomitant ..........................................50 Contraception ........................................80 Contractility..........................................103 Curative .........................50, 112, 174, 211 Cystinuria...............................................87 Cystitis .......26, 52, 78, 79, 82, 84, 85, 87, 112, 114, 119, 145 Cystoscopy ....................................52, 114 Cytokines ...............................................47 D Degenerative .......................................163
Diarrhea .............................................. 162 Dilatation ............................................... 79 Dizziness............................................... 98 Doxazosin ............................................. 49 Doxycycline........................................... 44 Dysuria............................................ 69, 80 E Ejaculation . 23, 37, 66, 97, 117, 149, 199, 215 Electrolysis............................................ 82 Embryology ........................................... 77 Enzyme ...... 58, 59, 71, 72, 74, 207, 211, 212, 213 Epidemiological..................................... 45 Epithelium ............................... 54, 70, 203 Epitopes ................................................ 51 Erection................................... 66, 89, 213 F Fatal ...................................................... 50 Fatigue .................................................. 16 Fibrosis ................................................. 87 Finasteride .................................... 49, 115 G Genital ....... 11, 19, 22, 23, 56, 69, 78, 80, 206, 208, 217 Genitourinary ..... 39, 52, 65, 76, 80, 145, 217 Gibberellins ........................................... 71 Ginseng............................................... 145 Glomerulonephritis................................ 79 Glycosuria ............................................. 87 Groin ..................................................... 66 H Hematology........................................... 10 Hematuria ............................................. 87 Hemorrhage .................................. 89, 214 Hepatic.................................................. 87 Homologous.................................. 23, 212 Hormonal ...................... 77, 112, 115, 145 Hyperplasia .... 16, 17, 26, 38, 39, 44, 48, 49, 56, 76, 77, 78, 79, 96, 99, 110, 111, 112, 113, 115, 116, 119, 145, 208 Hyperthermia ........................................ 79 Hypertrophy ............................ 68, 71, 118 Hypospadias ......................................... 78 I Idiopathic............................. 44, 69, 70, 71 Impotence ........... 66, 78, 79, 92, 112, 117 Incision........................ 111, 115, 173, 210 Incontinence ............... 26, 49, 78, 79, 118
Index 221
Infertility ....11, 23, 66, 69, 70, 76, 78, 145, 217 Inflammation .....11, 14, 16, 38, 44, 48, 52, 64, 66, 68, 70, 71, 82, 86, 89, 96, 98, 103, 110, 111, 113, 115, 117, 208 Insulin ......................................48, 57, 210 Intermittent.............................................52 Interstitial .....................26, 52, 78, 87, 112 Intestinal ..............................................162 Intravenous..........................................114 Invasive ...............................................167 L Lesion ............................................74, 210 Libido .....................................................37 Localization............58, 65, 69, 84, 86, 212 M Manifest .................................................50 Medullary ...............................................87 Microbiological.......52, 64, 69, 71, 82, 147 Microbiology ..................................57, 211 Microscopy ............................................40 Minocycline..........................................100 Molecular ..10, 22, 51, 52, 54, 59, 60, 108, 121, 203, 209, 214, 216, 217 Motility ...................................................70 Myeloma ................................................87 N Nephrotic ...............................................79 Neural ..................................................163 Niacin...................................................163 Nitrofurantoin ...........................85, 89, 212 Nocturia ...........................................66, 69 O Occult ....................................................37 Ofloxacin..........................................41, 44 Oral ............42, 79, 88, 167, 173, 205, 212 Overdose .............................................163 P Papain ...............................43, 58, 72, 212 Parasitic .....................44, 55, 61, 205, 217 Parenchyma ..........................................52 Patella....................................................87 Pelvic ....11, 23, 38, 40, 41, 42, 43, 64, 66, 68, 69, 80, 84, 97, 99, 147, 148, 151, 213 Penis..................22, 66, 89, 209, 212, 213 Perineal .....................................37, 65, 67 Pharmacokinetics ..................................44 Pharmacologic...........21, 23, 49, 203, 216 Phenotype ...............................50, 58, 213 Potassium............................................164 Prevalence.........................36, 64, 68, 119 Priapism.................................................79 Protease ..........................................49, 72 Proteins ....... 21, 42, 48, 56, 74, 138, 162, 164, 204, 206, 208, 213
Proteolytic ............................... 58, 72, 212 Psoriasis ................................. 71, 74, 213 Psychosomatic.................................... 147 Puberty...................................... 64, 69, 71 Purpura ................................................. 87 Pyelonephritis ................... 76, 79, 85, 114 Q Quercetin ................................ 43, 72, 110 R Radiotherapy ........................................ 79 Receptor ..................... 21, 49, 51, 68, 204 Rectal....... 14, 15, 16, 60, 66, 67, 77, 103, 110, 111, 113, 115, 116, 117, 146, 167, 216 Recurrence ..................................... 41, 77 Refractory ........................................... 150 Renovascular ........................................ 76 Resection ................ 79, 83, 111, 115, 201 Riboflavin ............................................ 162 S Secretion........................... 23, 59, 65, 215 Selenium ............................................. 164 Semen....... 11, 23, 46, 98, 113, 173, 198, 204, 207, 213 Serine.................................................... 48 Serum ....................... 49, 56, 60, 206, 215 Species ..... 55, 56, 60, 70, 205, 207, 208, 215 Spectrum............. 10, 50, 52, 58, 138, 212 Sphincter............................... 60, 150, 215 Stenosis ................................................ 78 Stents.................................................... 79 Suppository ........... 60, 146, 152, 167, 216 Surgical ...... 23, 56, 67, 88, 115, 118, 205, 208, 217 Symptomatology ................................. 152 Systemic ................. 66, 88, 174, 205, 216 T Testicular ........................................ 78, 79 Tetanus ................................... 42, 60, 216 Thermal................................. 67, 111, 152 Thermoregulation................................ 162 Thyroxine ............................................ 164 Tolerance .............................................. 60 Tomography.......................................... 16 Topical ................ 16, 23, 58, 80, 212, 216 Torsion .................................................. 79 Toxicology..................................... 10, 109 Toxin ............................................. 60, 216 Transplantation ............................... 76, 78 U Ulceration........................................ 80, 82 Ultrasonography ................................... 38 Ureter .................................................. 114 Urethritis...................... 17, 79, 82, 84, 114 Urinalysis .................... 113, 114, 123, 217
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Urodynamics........................................103 Urogenital ....15, 22, 61, 76, 152, 208, 217 Urology ..........10, 76, 84, 85, 86, 112, 145
V Vaginal .................................... 60, 80, 216 Viral........................................... 44, 69, 71
Index 223
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Index 225
226 Prostatitis
