apy) but eventually relapsed with the same pretreatment organism; and the conditions of two patients (15%)
unchanged by therapy (remained symptomatic and had positive prosta¬ tic fluid cultures during therapy). In a more recent research protocol, were
the results of which
published,6
are soon
to be
patients (four patients separate prostatic patho¬ 19
had two gens) received two tablets of tri¬ methoprim-sulfamethoxazole twice daily for 12 consecutive weeks in the treatment of chronic bacterial prosta¬ titis. Six patients (32%) were per¬ manently cured, and 9 of 23 prostatic
organisms (39%)
were
permanently
cleared from the prostate; eight pa¬ tients showed improvement (asymp¬ tomatic and sterile prostatic fluid cul¬ tures during therapy) but eventually relapsed with the same pretreatment prostatic pathogen; and the condi¬ tions of five patients (26%) were un¬
changed by therapy (remained symp¬ tomatic to some degree and had persistently positive prostatic fluid cultures throughout therapy).
Since our cure rate with 12 weeks of continuous therapy was double that of two weeks of therapy, it seems clear that if the physician em¬
ploys trimethoprim-sulfamethoxazole
for the treatment of chronic bacterial prostatitis, a treatment period of at least 12 consecutive weeks is indi¬ cated. Those patients who were not cured have remained essentially asymptomatic with sterile bladder urine cultures during daily therapy with only one tablet of trimethoprimsulfamethoxazole. Edwin M. Meares, Jr, MD
Thomas A. Stamey, MD Stanford University Medical Center
Stanford, Calif 1. Meares EM Jr: Bacterial prostatitis versus "prostatosis": A clinical and bacteriological study. JAMA 224:1372-1375, 1973. 2. Stamey TA, Meares EM Jr, Winningham DG: Chronic bacterial prostatitis and the diffusion of drugs into prostatic fluid. J Urol 103:187-194, 1970. 3. Meares EM Jr, Stamey TA: Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol 5:492-518, 1968. 4. Granato JJ Jr, Gross DM, Stamey TA: Trimethoprim diffusion into prostatic and salivary secretions of the dog. Invest Urol 11:205-210, 1973. 5. Meares EM Jr: Observations on activity of tri-
methoprim-sulfamethoxazole in the prostate. J Infect 128(suppl):679-685, 1973.
Dis
6. Meares EM Jr: Long-term therapy of chronic bacterial prostatitis with trimethoprim-sulfamethoxazole. Can
Med Assoc
J,
to be
Dentin: Not
Tissue
published. a
Pure Extracellular
To the Editor.\p=m-\Inciting the work of Dr Ruben Eisenstein and associates in a MEDICAL NEWS article (232:14, 1975), it was stated that the small
protease inhibitors that decrease the
of immature fibroblasts and endothelial cells "may be extracellular, since they are also present in dentin, which is an acellular tissue." This
growth
statement is
perhaps misleading bedentin, although not containing the bodies of cells, is very rich in
cause
the long cytoplasmic processes of the odontoblasts whose bodies are located in the subjacent pulp of the tooth. Thus, the presence of protease inhibitors in dentin does not necessarily mean that they are located extracellularly. They might have arisen in the odontoblasts and entered the dentin within their processes (Tomes fibers). Even experimental modification of dentin would not necessarily indicate an extracellular location of these protease inhibitors. Finding them in endodontically treated ("root canal") teeth would merely suggest that they
Informed Consent To the Editor.\p=m-\Allof us are distressed by the medicolegal problems facing the practice of medicine today. Even the "Instructions for Authors" illustrate the degree of documentation that has been developed in the proof of informed consent. The medical profession is unique, I think, in its vulnerability to assumed inadequacy
could have left the odontoblastic processes for the surrounding peritubular sheath or dentinal matrix when the processes degenerated fol¬ lowing extirpation of the pulp. Nei¬ ther would finding these inhibitors in intentionally decalcified dentin reveal their precise location, because their presence in association with the re¬
maining organic components might
be either in the extracellular dentinal matrix or intracellularly in the odon¬ toblastic processes. Thus, one cannot infer an extracellular location of a substance merely because it is pres¬ ent in dentin without concomitant lo¬ calizing evidence, such as might be obtained by means of histochemical
fluorescent antibody techniques microautoradiography. or
Mortimer Lorber, DMD, MD
Georgetown University Washington, DC
in this respect. I have submitted as humor (Box) an example of how a consent form would appear if another highly professional and responsible activity that is hazardous to the public were impelled to develop a document similar to that used by most hospitals for all admissions. Edmund B. Middleton, MD University of Maryland School of Medicine Baltimore
Transported by Airline-Operated Carrier
Consent to be
Date_ Time_
transportation by commercial aircraft operated by Skyways Airlines to from [name of passenger] [starting location] I understand that although the purpose of the flight is [destination] to arrive at the destination, the possibility of going elsewhere exists. 2. Alternative methods of transportation, specifically including bus, train, automobile, ship, bicycle, and ambulation have been explained to me, and I have been per¬ mitted to weigh the hazards of air travel against the expected benefits. 3. Specific risks have been described to me by [name of flight crew member] a rated air crew member. I have been informed that collision with one large bird or several small birds can result in loss of power and/or control, with destruction of the aircraft and probable loss of life. Weather analysis is excellent, but I appreciate that possible unpredicted factors may produce severe turbulence or wind shear that may separate the wings from the aircraft in flight. I know that the safety of the flight depends on the integrity of com¬ plicated devices that include approximately 2,800,000 minute electrical connections. 1. I authorize the
of
.
A failure in these systems could result in an uncontrolled termination of the flight. I am aware of the high combustible nature of aviation fuel and that the risk of fire or explosion exists. I understand that my safety depends not only on the skill and performance of the flight crew, but also on various enroute controllers and airport control tower personnel as well as their equipment. Equipment failure or error on the ground could result in the aircraft flying into the ground or into another aircraft. I also know that many other hazards not specifically described exist. At no time did any employee of Skyways Airlines attempt to influence my decision to participate in this flight as a passenger. No warranty or guarantee has been made to me by anyone as to the result of the
planned flight.
Witness_ Signed_
(If passenger
is
a
minor, parent or guardian
or
must
sign.)
Downloaded From: http://jama.jamanetwork.com/ by a Florida International University Medical Library User on 06/05/2015
unchanged by therapy (remained symptomatic and had positive prosta¬ tic fluid cultures during therapy). In a more recent research protocol, were
the results of which
published,6
are soon
to be
patients (four patients separate prostatic patho¬ 19
had two gens) received two tablets of tri¬ methoprim-sulfamethoxazole twice daily for 12 consecutive weeks in the treatment of chronic bacterial prosta¬ titis. Six patients (32%) were per¬ manently cured, and 9 of 23 prostatic
organisms (39%)
were
permanently
cleared from the prostate; eight pa¬ tients showed improvement (asymp¬ tomatic and sterile prostatic fluid cul¬ tures during therapy) but eventually relapsed with the same pretreatment prostatic pathogen; and the condi¬ tions of five patients (26%) were un¬
changed by therapy (remained symp¬ tomatic to some degree and had persistently positive prostatic fluid cultures throughout therapy).
Since our cure rate with 12 weeks of continuous therapy was double that of two weeks of therapy, it seems clear that if the physician em¬
ploys trimethoprim-sulfamethoxazole
for the treatment of chronic bacterial prostatitis, a treatment period of at least 12 consecutive weeks is indi¬ cated. Those patients who were not cured have remained essentially asymptomatic with sterile bladder urine cultures during daily therapy with only one tablet of trimethoprimsulfamethoxazole. Edwin M. Meares, Jr, MD
Thomas A. Stamey, MD Stanford University Medical Center
Stanford, Calif 1. Meares EM Jr: Bacterial prostatitis versus "prostatosis": A clinical and bacteriological study. JAMA 224:1372-1375, 1973. 2. Stamey TA, Meares EM Jr, Winningham DG: Chronic bacterial prostatitis and the diffusion of drugs into prostatic fluid. J Urol 103:187-194, 1970. 3. Meares EM Jr, Stamey TA: Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol 5:492-518, 1968. 4. Granato JJ Jr, Gross DM, Stamey TA: Trimethoprim diffusion into prostatic and salivary secretions of the dog. Invest Urol 11:205-210, 1973. 5. Meares EM Jr: Observations on activity of tri-
methoprim-sulfamethoxazole in the prostate. J Infect 128(suppl):679-685, 1973.
Dis
6. Meares EM Jr: Long-term therapy of chronic bacterial prostatitis with trimethoprim-sulfamethoxazole. Can
Med Assoc
J,
to be
Dentin: Not
Tissue
published. a
Pure Extracellular
To the Editor.\p=m-\Inciting the work of Dr Ruben Eisenstein and associates in a MEDICAL NEWS article (232:14, 1975), it was stated that the small
protease inhibitors that decrease the
of immature fibroblasts and endothelial cells "may be extracellular, since they are also present in dentin, which is an acellular tissue." This
growth
statement is
perhaps misleading bedentin, although not containing the bodies of cells, is very rich in
cause
the long cytoplasmic processes of the odontoblasts whose bodies are located in the subjacent pulp of the tooth. Thus, the presence of protease inhibitors in dentin does not necessarily mean that they are located extracellularly. They might have arisen in the odontoblasts and entered the dentin within their processes (Tomes fibers). Even experimental modification of dentin would not necessarily indicate an extracellular location of these protease inhibitors. Finding them in endodontically treated ("root canal") teeth would merely suggest that they
Informed Consent To the Editor.\p=m-\Allof us are distressed by the medicolegal problems facing the practice of medicine today. Even the "Instructions for Authors" illustrate the degree of documentation that has been developed in the proof of informed consent. The medical profession is unique, I think, in its vulnerability to assumed inadequacy
could have left the odontoblastic processes for the surrounding peritubular sheath or dentinal matrix when the processes degenerated fol¬ lowing extirpation of the pulp. Nei¬ ther would finding these inhibitors in intentionally decalcified dentin reveal their precise location, because their presence in association with the re¬
maining organic components might
be either in the extracellular dentinal matrix or intracellularly in the odon¬ toblastic processes. Thus, one cannot infer an extracellular location of a substance merely because it is pres¬ ent in dentin without concomitant lo¬ calizing evidence, such as might be obtained by means of histochemical
fluorescent antibody techniques microautoradiography. or
Mortimer Lorber, DMD, MD
Georgetown University Washington, DC
in this respect. I have submitted as humor (Box) an example of how a consent form would appear if another highly professional and responsible activity that is hazardous to the public were impelled to develop a document similar to that used by most hospitals for all admissions. Edmund B. Middleton, MD University of Maryland School of Medicine Baltimore
Transported by Airline-Operated Carrier
Consent to be
Date_ Time_
transportation by commercial aircraft operated by Skyways Airlines to from [name of passenger] [starting location] I understand that although the purpose of the flight is [destination] to arrive at the destination, the possibility of going elsewhere exists. 2. Alternative methods of transportation, specifically including bus, train, automobile, ship, bicycle, and ambulation have been explained to me, and I have been per¬ mitted to weigh the hazards of air travel against the expected benefits. 3. Specific risks have been described to me by [name of flight crew member] a rated air crew member. I have been informed that collision with one large bird or several small birds can result in loss of power and/or control, with destruction of the aircraft and probable loss of life. Weather analysis is excellent, but I appreciate that possible unpredicted factors may produce severe turbulence or wind shear that may separate the wings from the aircraft in flight. I know that the safety of the flight depends on the integrity of com¬ plicated devices that include approximately 2,800,000 minute electrical connections. 1. I authorize the
of
.
A failure in these systems could result in an uncontrolled termination of the flight. I am aware of the high combustible nature of aviation fuel and that the risk of fire or explosion exists. I understand that my safety depends not only on the skill and performance of the flight crew, but also on various enroute controllers and airport control tower personnel as well as their equipment. Equipment failure or error on the ground could result in the aircraft flying into the ground or into another aircraft. I also know that many other hazards not specifically described exist. At no time did any employee of Skyways Airlines attempt to influence my decision to participate in this flight as a passenger. No warranty or guarantee has been made to me by anyone as to the result of the
planned flight.
Witness_ Signed_
(If passenger
is
a
minor, parent or guardian
or
must
sign.)
Downloaded From: http://jama.jamanetwork.com/ by a Florida International University Medical Library User on 06/05/2015
