The effectiveness of tamsulosin in Benign Prostate Hyperplasia (BPH) patients with Lower Urinary Tract Symptoms (LUTS): a multi-centre cohort retrospective study

Introduction: Lower urinary tract symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) is a common condition in the ageing male. The first-line treatment of LUTS due to BPH is medical management with α-blockers or 5α-reductase inhibitors (5-ARIs). This study aims to analyze the effectiveness of tamsulosin to improve patients symptoms with LUTS due to BPH

Methods: A cohort retrospective study was conducted among 62 respondents with BPH at dr. Soetomo Hospital and Airlangga University Hospital from 2014-2016. The data collected related to characteristics of patients were age, prostate volume, Prostate-Specific Antigen (PSA), IPSS score, IPSS voiding score, IPSS storage score, IPSS quality of life, Qmax, voided volume and post voiding residual urine (PVR). All of the data were analyzed using SPSS version 17.0 for Windows.

Results: There were 62 samples with a mean age of 62.28 ± 7.3 years old. The average prostate volume was 36.09 ± 8.3 cc, and the PSA level was 2.8 ± 1.45 ng/dl. Most of the respondents were in moderate LUTS criteria (54.8%). IPSS and Qmax score significantly improved in a comparison between pre-treatment, 1 month and 3 months after treatment (p<0.01). There was no adverse event or severe side effect reported.

Conclusion: Tamsulosin 0.4 mg daily resulted in statistically significant improvements of IPSS score, IPSS storage score, IPSS voiding score, IPSS Quality-of-life score, Qmax, Voided Volume and PVR through 1 month, but it also significantly improved IPSS score and uroflowmetry results in 3 months after treatment.

Late stabilization surgery in flail chest and pulmonary contusion

Background: Traumatic thoracic injury is currently the second leading cause trauma-related death after head injury, and rib fracture are the most common of thoracic injury. Flail chest, as defined by the presence of three or more consecutive rib fractures in 2 or more places characterized by paradoxical motion of flailing chest wall. An associated injury directly related to flail chest is pulmonary contusion. Pulmonary contusion in turn is the most common injury in blunt thoracic trauma, occurring in 30% to 75% of all cases.

Case Description: a 69-year-old woman was referred from the rural hospital to the Dr. Zainoel Abidin General Hospital emergency room with chief complains of unconsciousness since 3 days ago after collision. Patients had a motorcycle crush accident and loss of consciousness after the event. Clear airway, but there is a paradoxical motion at left chest wall. Crepitation found from palpation at left hemithorax. From the chest X-ray shown haemothorax, pulmonary contusion, multiple ribs fracture at 3,4,5,6,7,8 at the left hemithorax. From head CT Scan found cerebral oedema. Also closed fracture at left 1/3 medial radius ulna and tibia fibula medial. The patients were performed surgery for open reduction and internal fixation of the flail chest. Hospitalized in ICU afterwards, Unfortunately, the patients were died few days later due to intracerebral worsening.

Conclusion: Flail chest which related with pulmonary contusion must be treated immediately. If it is accompanied by severe head injury, it will make the patient's prognosis worse, if we delay the diagnosis and treatment.

Recurrent acute rheumatic fever: a case report

Introduction. It is estimated that about 3% of people untreated for group A streptococcal infection will develop rheumatic fever. In most case, an appropriate treatment with antibiotics will prevent acute rheumatic fever. However, not all case of acute rheumatic fever showed an apparent clinical presentation. Furthermore, some symptomatic patients did not seek medical treatment. These caused rheumatic fever and rheumatic heart disease still prevalent, especially in the developing country. Proper management, according to the latest guideline should be prompted in those individuals to halt the progression of cardiac damage. This article describes one such case.

Case Description. A 15-year-old boy with a chief complaint of breathlessness during activity and improved with rest and multiple joint pain. He had a history of recurrent upper respiratory infection, which was not treated with antibiotics. On physical examination, the blood pressure was 110/70 mmHg and heart rate 110 bpm. On cardiac examination, he had holosystolic, and mid-diastolic murmur heard best at the apex. Laboratories test found WBC 15.420/μL, ASTO 400 IU/ml and CRP 48 mg/dL. Chest x-ray showed cardiothoracic ratio of 59% and echocardiography showed left atrial enlargement and left ventricular hypertrophy (ejection fraction 66%), mild mitral stenosis (MVA 1,6 cm², mean MVG 13 mmHg), and severe mitral regurgitation. The patient was then diagnosed with recurrent acute rheumatic fever and treated with erythromycin 500 mg q.i.d and aspirin 500 mg q.i.d.

Conclusion. Adequate management of acute rheumatic fever during and after the acute episode aimed to reduce the recurrence, prevent cardiac deterioration and expected to improve quality of life.