Thambi Dorai, C. R. Kandasami, Palayan
The Australian and New Zealand Journal of Surgery. 1991; 61(5): 370-372
The clinical features and management of 12 patients with Fournier's gangrene are described. The patients differed from the usual description of Fournier's gangrene in that they were older, the disease had a less abrupt onset and a definite predisposing factor was identified in 10 of the 12 patients. The importance of early diagnosis and excision of necrotic tissue is emphasized.
Chronic prostatitis/ chronic pelvic pain syndrome is a frustrating, confusing and prevalent syndrome. It accounts for nearly 2 million visits to the physicians annually in US, and in Malaysia, is known to affect the lives of approximately 8.7% of the male population. As recent as 1995, only did this syndrome gain the attention of healthcare providers worldwide. While the causes of chronic prostatitis/ chronic pelvic pain syndrome remain unknown, many therapies have been used with limited success, the most common being antibiotics, alpha-blockers and anti-inflammatories. This prompted many to search for more effective therapies and recent studies suggest that acupuncture may be helpful especially in chronic cases. Prior to conducting the study, the validity of 2 questionnaires used to evaluate the efficacy of treatment outcomes were examined in the local population. The Brief Pain Inventory and Hospital Anxiety Depression Scale were demonstrated to have good reliability and validity as an outcome measure. In the next part, the diagnosis and treatment of prostatitis-like symptoms by primary care physicians were examined. It was found that many patients with prostatitis like symptoms were receiving less than optimal treatment for their condition, further strengthening the need for this study. To achieve a better understanding of this condition and the health status impact on men, the baseline demographics and clinical characteristics of men with chronic prostatitis were evaluated. It was concluded that men experienced disability in the various domains of pain, urinary, sexual function and mental health. The demographics of these participants were similar to those in the United States. Finally, a subset of participants were invited to participate into a randomised, double-blind, sham controlled study involving acupuncture or its corresponding placebo for the treatment of chronic prostatitis. These participants were treated twice weekly for a total of 10 weeks with acupuncture or sham. Thirty-two (73%) of 44 participants responded in the acupuncture group compared to 21 (47%) of 45 participants who responded in the sham group (p=0¬∑01). To determine the applicability of these results in the general population, participants also rated the tolerability and acceptability of acupuncture treatment. Acupuncture was found to be tolerable by majority of participants. Blood samples were also taken to elucidate a scientific explanation for the response of participants. The levels of neurotransmitter Œ≤-endorphin, leucineenkephalin and cortisol were mostly similar between groups but changes in the white cell levels were observed suggesting the role of immune function in the pathogenesis of this disease.