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Om prover, behandling och priser Mikael i Göteborg har under mars 2003 varit i kontakt med Dr. Guercini och har i stora drag fått reda på följande. Prover Att skicka ner proverna med UPS eller DHL kostar i runda tal 1000 kr. Han vill endast få proverna till sitt kontor tisdagar eller onsdagar före kl 11. Han påstår sig behöva 40 dagar för att analysera proverna innan behandlingen kan börja. Han vill ha 3 provrör: Ett med enbart urin (mid-stream), ett spermaprov, och ett urinprov cirka 15 minuter efter utlösning. Provrören ska kylas med kylpåsar (eller kylblock), som man kan köpa på sportaffärer. Provrören ska även vara sterila innan de fylls upp, man kan nog få dessa på vanlig vårdcentral, det fick jag i alla fall enkelt och gratis. Frågan är om Dr. Guercinis test är lika bra som Dr. Dimitrakovs PCR test, som enl. Dimitrakov testar "allt". Guercinis PCR test testar mycoplasma, klamydia, herpes, och nåt annat jag har glömt av (kanske svamp?). Meddela mig (via vårt Diskussionsforum) om du vill ha hans kompletta svar så kollar jag upp. Resterade "vanliga" bakterier typ e-coli testar han med urinodlingar. Behandling Om man inte skickar prover till Dr. Guercini inför sin behandling, så får man Guercinis "standard-cocktail", det är för övrigt samma typ som Dr. Höeg erbjuder i Oslo. Om man nu skickar prover till Guercini, så kan han blanda ihop en "specialare" med bättre möjligheter för just den individen. Han tar 950 Euro för 3 behandlingar (direktinjektioner). Vad som inte framgått tidigare någonstans, är att det lab. han anlitar vill ha ytterligare 520 Euro för deras DNA/PCR test. Guercini låter ALLTID ovanligt positiv och enl. honom finns det inga biverkningar eller problem med hans metod och direktinjektioner, vilket man nog ska ta med en nypa salt. I hans senaste svar har han dock låtit meddela, att han vill inte ha några fler frågor från mig. Han får väl för många frågor från alla andra i våran situation. Dimitrakov påstår att koncentrationen av antibiotika är lika hög i prostatan även om man får det insprutat i blodet. Det behövs dock större doser för att räcka till hela blodomloppet. En fördel med denna metod är om infektionen/inflammationen befinner sig även utanför prostatan, då kan Dimitrakovs metod vara bättre än direktinjektioner och även urinvägsinfektionerna brukar gå över med Dimitrakovs metoder. Det gör det inte automatiskt med Guercinis injektioner, utan han brukar komplettera med antibiotika i tablettform ifall man även har bevisad UVI. Om man reser till Rom, kostar det otroligt mycket mer i boende och levnadskostnader än om man besöker Plovdiv i Bulgarien, där Dimitrakov håller till. Plovdiv är otroligt billigt (men tråkig) stad att besöka jämfört med Rom. Mvh, Mikael
Brevväxling med Dr. Guercini (angående direktinjektion i prostatan) En av nätverkets medlemmar har ställt följande 30 frågor till Dr. Guercini under augusti/september 2001 angående direktinjektion av antibiotika m.m. i prostatan och fått följande mycket intressanta svar: Q1:
What is the cost of your treatment (one initial visit
and then 3 injections)? Q2:
How many percent of the patient are symptomfree after 6
months and 12 months? Q3:
How many percent of the patient
have negative cultures after 6 months and 12 months? Q4:
Have you ever tried to inject
ozone-gas or a solution of betadine in the prostate? Q5:
Is there a risk of overgrowth of
resistant bacteria, virus or fungus in the prostate after you have inject ABX? Q6:
Is there a risk that resistant
bacteria overgrow because of the cortisone you inject? (that happen to me after
orally ABX and cortisone 4 years ago). Q7:
Is the ABX getting spread to all
blood vessels in the prostate? Q8:
Is there a risk that you are
pushing the calcifucation deeper into the prostate? (seminal vesical channel for
exampel). Q9:
How many percent of the patient are
getting rid of the calcification? Q10:
Do you also treat for anaeroba
bacteria? Q11:
Is
there a risk for damage on the pudendal nerve from the needle? Q12:
How many percent of the patient shows sub-dominant bacteria or fungus other
then the initials after the treatment? Q13:
What is the cure rate of symptoms and cultures of them? Q14:
How do you treat infection in the seminal vesicles, epididymis and urine? Q15:
Is the cure rate (symptoms) for Chlamydia the same as other bacteria? Q16:
Do you always use ABX for anaeroba bacteria or only when they have been found? Q17:
Is it possible to find anaeroba bacteria in a mailed sample (2 days) to
Dr. Sandra Mazzoli? Q18:
Why do you think that not all patients are getting cured from symptoms? Q19:
Of the patients that are not getting fully cured, what symptom are most
declined? Q20:
I have sometimes pain on the right side after ejaculation and sometimes TRUS
shows a dilation in the right seminal vesicle channel just above the
calcifications that I have in the area of the veru. Is there a risk that the
injection are pushing the calcification into the channel so I am getting a permanent
right-sided ejaculatory duct obstruction? Q21:
Do you use different ABX for Chlamydia trachomatis and Chlamydia pneumoniae? Q22:
Is it possible to have Chlamydia in the prostate only when it is also found in
the urine in addition to the semen? Q23:
How much of the injected cocktail is coming out in the blood-stream? Q24:
How is the body excrete the cocktail? Q25:
Do you also treat for nanobacteria? See:
http://www.nanobaclabs.com/ Q26: Can
you do the first injection at the first initial visit? Q27:
If no, how close to the initial visit can you do the
first injection? Q28:
How do you diagnose epididymitis and seminal
vesikulitis?
Q29:
How long waiting time is it to come to your clinic for treatment? Q
30: Do you also treat infection in women? If so
how?
AUA 2001 Abstract Submitter 96th Annual Meeting, June 2-7 2001, Anaheim, CA. Current Abstract: 2004196 This abstract has been finalized, and can no longer be edited. Preview Introduction and Objectives: In the National Institute of Health Classification, prostatitis syndrome are categorized in clinical practice on the basis of bacteriuria and the number of inflammatory cells in prostatic secretion. According to these indications many patients are considered carriers of abacterial prostatitis and are treated as such. The presence of an agent inflecting the prostate cannot however be completely excluded. It could nest in acini or in fibrous-calcifications but still be active and capable of rendering the so called abacterial prostatitis chronic. Methods: We recruited 56 of last 350 patients referred to our Centre because of prostatitis. The age-range was 18-46 years(average age 32 years). No patients was affected by bacteriuria. In the prostatic secretion all had at least 10 leucocytes per microscopic field according to Stamey's method (1966). Two-four weeks before prostatic secretion sampling, urethral swabs showed no patient was positive for Trichomonas vaginalis, Chlamydia Tracomatis, Micoplasma Hominis, Ureaplasma Urealyticum, HPV and Herpes Genitalis. Using the transperineal route, ultrasound guided needle aspirates were taken from sonographically dishomogenous areas in the prostate. Samples underwent histological analysis, routine cultures and DNA extraction to detect Chlamydia Tracomatis, Neisseria Gonorrhoeae and HPV using PCR amplification. Results: Histological findings were indicative of inflammation in all 56 patients, with lymphocite aggregates being found rarely within the gland(19%)and mostly in the perigland area(46%)and stroma(35%). Cultures were positive for aerobic(56%) and anaerobic(23%)agents. Twenty-one patients(38%)presented with more than 2 species of microorganisms and 9(15%)with more than 3. DNA infected with Chlamydia Tracomatis was found in 19(34%)patients. The 9 samples(16%)with only anaerobic bacteria were associated with a high number of leucocytes in Stamey's test(>15). Conclusions: The accuracy of needle sampling under ultrasound guidance using the transperineal route, excludes false positive results caused by contamination with pathogens in urethra. The high frequency of positivity for microorganisms detected, using these techniques, indicates studies on more patients should be performed, in order to revise the classification of prostatic syndromes and to define them more accurately.
We will present on the next American Urological Association Annual meeting, following paper: Long Lasting Therapy For Recurrent Urinary Tract Infections In Women. Federico Guercini*, Cinzia Pajoncini, Rome, Italy; Elisabetta Costantini, Massimo Porena, Perugia, Italy. Introduction and Objective: Recurrent urinary tract infections (UTI) in women cost the health services in Europe and the USA billions of dollars annually. E. Coli, which causes 70-89% of these infections, has been observed in vitro and in vivo as capable of developing the so-called bacterial biofilms within the bladder, thus reducing the efficacy of any antibiotic treatment. At present, as only long, repeated cycles of therapy overcome this mucopolysaccaride barrier, we administered antibiotics to maintain the urine germ-free for at least six months.
Methods: 42 female outpatients were recruited to the study. All had
recurrent UTI due exclusively to E.Coli as diagnosed by urine cultures, vaginal
swab, and PCR-DNA amplification of the vaginal swab and cervical smears for
Chlamydia, Ghonococcus, Mycoplasma and Ureaplasma. After giving informed consent
patients were randomly divided into two groups. For the first 10 days both
groups were treated with Ciprofloxacin (500 mg twice daily), vaginal suppository
of doderlain bacteria (one daily), Rifaximin (100 mg twice daily), and oral
lactic zymes. For the following six months the 21 patients in group A were
administered Ciprofloxacin (250 mg daily) on alternative days and instructed to
take a pill containing 250 mg Ciprofloxacin one hour before if any
intercourse. The 21 patients in group B took placebo, Results: Group A(16-51 yrs, mean age 38 yrs): Urine remained germ-free during the six months therapy in all 21 patients and during the 6 months of follow-up in 17 (81%). In this period only one patient presented two symptomatic infectious episodes. Group B(19-48 yrs, mean age 35 yrs): Asymptomatic bacteriuria was already present in 15/21(71%) at 15 days after the first cycle of therapy. 16/21 ( 76%) presented with infectious episodes, sometimes recurrent, in the first 6 months of the study (p<.001) and 19/21 (90%) presented with recurrent UTI throughout the 12 months of the study (p<.001), even though each episode was treated with the initial antibiotic therapy. Conclusions: This treatment schedule is associated with few minor side effects and efficaciously eradicates UTI due to E. Coli.
Federico Guercini*, Rome, Italy, Jaspal Virdi, Horlow, UK, Thomas Kreutzig, T Münch, T Franke, Freiburg, Germany, Cinzia Pajoncini, Rome, Italy, Luigi Mearini, Massimo Porena, Perugia, Italy
Introduction and Objectives: Chronic pelvic pain syndrome (CPPS) in men
is a common condition where Unlike the above mentioned treatment methods, water-induced thermotherapy (WIT™) utilizes conductive heat, maintained at a constant temperature by a computerized console. The heat is transmitted to the prostate via a treatment balloon, and circulated through a proprietary closed-loop catheter system. Methods: Between February and May 2001, 30 patients, (mean age 41 years) with CPPS were treated utilizing water-induced thermotherapy (ArgoMed Inc., Cary NC. USA). Study participants completed their NIH Prostatitis Symptom Score and underwent uroflowmetry at baseline, 1, 6, and 12 months following treatment. Cystoscopic measurement was utilized to determine the prostatic urethral length, measured between the bladder neck and the verumontanum, in order to select the appropriate treatment balloon size. All study participants were treated at 47ºC in a single 45-minute session, utilizing only topical anesthetic gel. Results: NIH-CPSI score improved by 55% at 12 months. Similar responses were noted in pain scores, (57.6%), urinary symptom scores (45.9%) and Quality of life (50%). Peak flow and average flow rates remained constant during the follow-up, indicating the treatment did not negatively affect the patients' urine flow. The most significant predictor of improvement was the change in the degree of symptoms severity (see table). Men with moderate to severe symptoms represented the majority of patients at baseline. In the three scheduled follow-up appointments, the number of patients with severe symptoms constantly decreased, the majority rating their symptoms as mild, with a few reporting moderate symptom scores (see graphs). Conclusions: Preliminary results indicate that WITT, a minimally invasive, well-tolerated procedure, is an efficacious, durable, and viable option for the treatment of CPPS. Conductive heat provides a beneficial homogeneous uniform depth of penetration, and since no necrosis is produced at this lower treatment temperature, there is no need for post-treatment catheterization. CPPS PATIENT OUTCOMES OBTAINED USING WIT Criteria BASELINE (30 patients) 1-MONTH (25 patients) 6-MONTH (17 patients) 12-MONTH (24 patients) Pain (% Change) Score (S): 0-21 11.8 Moderate (7<S?14) 8.9 (-24.6%) Moderate (7<S?14) 6.9 (-41.5%) Mild (0?S?7) 5.0 (-57.6%) Mild (0?S?7) Urinary Symptoms (% Change) Score (S): 0-10 3.7 Moderate (3<S?6) 2.7 (-27.0%) Mild (0?S?3) 2.9 (-21.6%) Mild (0?S?3) 2.0 (-45.9%) Mild (0?S?3) Quality of Life (% Change) Score (S): 0-12 8.6 Severe (8<S?12) 6.8 (-20.9%) Moderate (4<S?8) 5.1 (-40.7%) Moderate (4<S?8) 4.3 (-50.0%) Moderate (4<S?8) Peak Flow (ml/sec) 20.0 20.3 20.2 19.8 Average Flow (ml/sec) 12.3 13.3 11.0 11.1
SYMPTOMS CORRELATED WITH PROSTATITIS F. Guercini, C. Pajoncini, V.Bini, M. Porena INTRODUCTION: A series of factors makes studying and treating chronic prostatitis extremely difficult and even classifying the disease is arduous. One of these factors is a full and clear definition of symptoms, which should include all the symptoms which can be observed in the course of chronic prostatitis but should not be extended to aspecific symptoms. This study, which is the fruit of years of experience in the field of prostatitis, defines as fully and as specifically as possible, the symptoms of prostatitis in an attempt to provide a statistically-based identikit of the patient with prostatitis.
METHODS: Two years were spent researching
symptoms and adjusting definitions of terms with the aim of drawing up an easily
understood questionnaire which left patients with no room for doubts or
perplexities. Between February 2000 RESULTS: The Mann-Whitney and Wilconxon tests demonstrate the symptoms statistically significant in prostatitis patients group were: C-urine stream force(p=.0477), D-urine stream type(p=.0081), F-burning during micturition(p=.0000), G-perineal pain(p=.0002), H-inguinal pain(p=.0019), I-scrotal pain(p=.0079), K-suprapubic pain(p=.0003), L-anorectal pain(p=.0144), O-ejaculation precocity(p=.0004), P-type of ejaculation(p=.0001), R-force of ejaculation jet(p=.0008). The logistic regression analysis shows a significant correlation between the chronic prostatitis disease and the following symptoms: F-burning during micturition(p=.0028 R=.2024), H-inguinal pain(p=.0118 R=.1599), K-suprapubic pain(p=.0197 R=.1423), O-ejaculation precocity(p=.0201 R=.1416), R-force of ejaculation jet(p=.0203 R=.1404). CONCLUSIONS: Although many other symptoms scores have been proposed for prostatitis and the NIH scoring is certainly extremely valid, we think this study provides a systematic approach and a better understanding of these patients.
Prostatitis and Crohn's Disease Sun, 14 Sep 2003 Probably you are right. In some chronic prostatitis and on the Crohn disease it's possible to find high levels of Cytokines, markers of autoimmunity. Following this criterion, we have began two months ago a trial in Urologic Department of University of Perugia, after a year of preparation using Thalidomide in chronic prostatitis. This drug seems to be interesting both in Crohn and prostatitis because the relationship with autoimmunity.
In our trial on 350 prostatitis patients: Lower back pain was absent in 64%, sometimes present in 28% and always present in 8%. Dripping 85% Perineal soreness 71% Decrease of ejaculation jet energy 65% Irregular micturition 61% Irregular flow 61% Speedy ejaculation 54%
ULTRASOUND GUIDED INTRAPROSTATE INFILTRATION FOR CHRONIC PROSTATITIS, A MULTI-CENTRE STUDY. Here our accepted abstract for podium session for next AUA 2002 Meeting. Abstract ID:500418 Federico Guercini*, Rome, Italy, Duke Bahn, Ventura,, CA, Cinzia Pajoncini, Rome, Italy, Luigi Mearini, Massimo Porena, Perugia, Italy Introduction and Objectives: Many therapeutic options are available for chronic prostatitis, none is completely efficacious. Systemic antibiotic therapy is useful, however the failure rate is high probably because of an associated local autoimmune disease process (with release of large quantities of TNF alfa), and the possible presence of so-called intraprostatic bacterial biofilms which the drugs cannot penetrate. Given this background we tested ultrasound guided intra-prostate infiltration of a cocktail of antibiotics and betamethazone, for a therapeutical option.
Methods: 150 patients, referred to us between 1999 and 2001 because of
symptoms indicative of chronic prostatitis, were enrolled in this study. Before
treatment, all patients was submitted to: 1) a clinical urological examination
2) TRUS with micturitional dynamics and uroflowmetry 3) routine cultures tests
and DNA amplification with PCR of Chlamidia, Mycoplasmata, Gonorrhea and HPV.
All tests were done on sperm and urine samples. During first consultation
patients completed the NIH Prostatitis Symptoms Score (NIHPSS) and Prostatitis
Symptoms Index (PSI) questionnaires. Patients were divided into three groups on
the basis of laboratory results and each group received an antibiotic cocktail
specifically designed against the infectious agents that had been detected,
associated with betamethazone. Antibiotics Results: Data were analysed using the Wilcoxon test for paired data as follows: baseline vs 6 and 12 months. Statistical analysis of the results showed 65% of patients were included in the fourth group and 17% had obtained no improvement. Conclusions: We are of the opinion this is one of the more valid therapeutical approaches to chronic prostatitis. Results will undoubtedly improve once drugs such as anti-TNF alpha antibiodies are available to be injected into the prostate to inhibit the autoimmune disease process, which in this study was controlled with betametazone.
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