[Spa and climate therapy in chronic obstructive pulmonary diseases]

The authors remind the main epidemiological and clinical findings of Chronic Obstructive Pulmonary Disease (COPD); the prevalence and incidence of COPD is increasing and COPD is now the IV cause of death in the world. Moreover, it is cause of increasing pharmaceutic and hospital charges. COPD has multifactorial etiology, linked to genetic and exogenous factors, as tobacco smoke, air pollution, microbial infections and cold. The GOLD guide lines of the medical therapy of the COPD are showed. The spa therapy of COPD is based on the inhalation use of mineral water, mainly sulphurous and salsojodic. Sulphurous mineral waters have vasodilating activity on vessels of bronchial mucose, improving its trophic state, and increase the production of secretory IgA and muco-ciliary clearance; they have fluidificant activity on bronchial secretion. Clinical trials showed improvement of cough, sputum and functional indexes as FEV1 and CV. Salsojodic mineral waters increase the fluidity of the bronchial mucus, muco-ciliary clearance and the trophism of the bronchial mucose. The authors remind the properties of sulphate and bicarbonate mineral waters in the spa therapy of COPD. Finally authors refer about some effects of spa therapy and climatic-environmental situations on COPD morbidity.

[Therapeutic effect of the association between pulmonary ventilation and aerosol--inhalation with sulphureous mineral water in the chronic bronchopneumopathies]

AIM

Our research evaluates the efficacy of the inalation therapy by mineral sulphureous water in patients suffering from cronic bronchopneumopathy.

MATERIALS AND METHODS

From August to October 2002, two groups of patients, randomly selected, suffering from cronic bronchopneumonopathy, were studied at spa center "Pompeo" in Ferentino (FR). Every patient was treated daily during a cycle of twelve days. The first group was treated by pneumonic mechanical ventilation associated to sulphureous water aerosolinalation, the second by mechanical pulmonary ventilation associated to sulphureous water aerosol-inalation medicated with flunisolide. Every patient carried out spirometry, before and after treatment, and the measurement of FEV1 was considered a good parameter to evaluate the respiratory function.

RESULTS

All patients reported an improvement in symptoms as dyspnea and cough. Results obtained show a significant functional improvement of respiratory function in both groups, evaluated by FEV1. Equal efficacy treating the patients by medicated and not medicated treatments stress the therapeutic role of mineral sulphureous waters in chronic bronchopneumopathies. Our research points out the usefullness of pneumonic ventilation associated with sulphureous water aerosol-inalation in patients suffering from chronic bronchopneumopathies.

[Immunotherapy in the management of metastatic renal carcinoma]

BACKGROUND

Renal cell carcinoma (RCC) is a relatively rare tumor representing 2-3% of all neoplasias. Approximately 30% of patients diagnosed as having RCC present metastases: mean survival ranges between 6 and 10 months, whilst 10-20% present a 2-year survival rate. Treatment of patients with metastatic RCC is a difficult challenge. Hormones and chemotherapy, either alone or associated with surgical resection of the primary lesion have been used. In our experience, IL-2 + IFN-a has been shown to be an encouraging form of treatment.

METHODS

During the period between October 1997 and December 1999, 5 patients (3 males, 2 females), mean age 52.5 years, with metastatic RCC, came to our attention. TC revealed a circumscribed area the margins of which were not well defined, in a mid-renal localization, positive inter aorta caval and obturator lymph nodes, but no lung, brain or hepatic involvement. Patients were submitted to nephrectomy and lymphadenectomy followed later by immunotherapy with IFN-alpha (3 Mil twice a week) + low dose IL-2 (1 Mil/m2/12 h): treatment was given for 4 consecutive weeks and then repeated every 3 weeks for 1 year.

RESULTS

At 30 months' follow-up all patients showed regression of the disease (100% of cases) and in none of the cases there was evidence of metastases. Only one patient (20%) presented side-effects (nausea, vomiting, slight rise in temperature) all of which disappeared at the end of the first week of treatment.

CONCLUSIONS

These results, even if on a limited number of patients and for a limited follow-up period, show that in some patients with metastatic renal cell carcinoma, treatment with IL-2 and IFN-a following nephrectomy and lymphadenectomy should be considered the therapy of choice.

[Postprostatectomy erectile dysfunction]

BACKGROUND

To evaluate the frequency of erectile dysfunction in patients submitted to radical prostatectomy due to prostate carcinoma and to the possibility, with appropriate treatment, of restoring adequate erections for a satisfactory sexual activity.

METHODS

Between 1996 and 2000, thirty-eight patients with prostate carcinoma have been submitted to radical prostatectomy. According to TNM classification upon diagnosis, thirty-three patients (87%) were stage pT2N0M0 and five patients (13%) stage pT3N0M0. Mean age of patients was 62.4 years (range 55-76). Mean follow-up was two years and seven months. Diagnosis of erectile dysfunction was made from personal history as well as that of the patient plus partner, and from nocturnal penile tumescence evaluation with Rigiscan.

RESULTS

Eighteen patients (47%) presented erectile dysfunction as a complication 16 (89%) of whom showed no nocturnal reaction at the Rigiscan test, while in the remaining two (1%), one-two nocturnal erections of less than five minutes were obtained. Of the eighteen patients, 14 (78%) showed a positive response to treatment with intracavernous drug infusion (papaverine+Phentolamine+Alprostadil), whilst only one patient benefited from treatment with oral Sildenafil.

CONCLUSIONS

This study showed the high frequency (47%) of erectile dysfunction in patients submitted to radical prostatectomy as well as the need to perform radical nerve-sparing surgery (particularly in the neoplastic forms not involving the prostate capsule) which is useful not only for preserving erectile function but also on account of better response to oral Sildenafil treatment following the use of this technique.

[Incidence and treatment of postprostatectomy urinary incontinence. Personal experience]

BACKGROUND

To evaluate frequency of postprostatectomy urinary incontinence in order to establish the last invasive and most efficacious treatment to completely restore urinary incontinence.

METHODS

Between 1992 and 2000, twenty-four patients with retropubic postprostatectomy urinary incontinence were studied. The symptoms reported by all patients referred to lack of control of urine with consequent leakage upon activities exerting increased abdominal pressure (sneezing, lifting of heavy weights). These patients were submitted to urodynamic examinations and the degree of incontinence was further evaluated from the number of pads used daily (slight, 0-1; medium 2-3; severe, >3). Mean follow-up was three years, eight months.

RESULTS

Of the twenty-four patients, twenty (83%) presented stress incontinence, two (8.5%) urge incontinence, and two (8.5%) a mixed type incontinence. Eighteen patients (36%) reported slight precocious incontinence which disappeared spontaneously within three-six months. Six patients (12%) reported total incontinence which had not improved within twelve months, in four of these patients, continence was achieved by means of perineal rehabilitation whilst in the remaining patients, use of pads (up to three pads/day) was necessary, due to failure of rehabilitation.

CONCLUSIONS

Once the need has been established for radical anatomic prostatectomy which offers the possibility of postoperative continence, perineal rehabilitation represents the first choice treatment on account not only of the high percentage of successful results but also due to low invasiveness, whilst the use of the AMS 800 sphincter offers the only solution in those forms of severe incontinence refractory to less invasive forms of treatment.

Effect of water of Anticolana Valley on urinary sediment of renal stone formers

An investigation was carried out to ascertain the effect of drinking Fiuggi water on the microcrystalline structure of the calcium oxalate monohydrate present in urinary sediments provided from patients suffering from recurrent idiopathic oxalic calculosis. The experimental group was administered tap and Fiuggi water for ten days. The control group was administered tap and Fiuggi water according to the same procedure as for the experimental group. The comparative data show that drinking Fiuggi water leads to a strong reduction, and sometimes even to the elimination, of the calcium oxalate monohydrate present in the urinary sediment reducing the risk of oxalic calculosis. Fiuggi water contains organic molecules belonging to the fulvic acid family. These acids are capable of complexing the calcium ions and interact preferentially with the crystal lattice of the calcium oxalate monohydrate via the formation of a film and behave as pumping systems by linking the calcium ion, demolishing the crystal lattice and dissolving calcium and oxalate ions. Mineral water treatments must therefore be viewed as a function of the specific composition of the water administered. The ecosystem influences the composition of water, as a complex matrix containing a number of organic molecules which are potentially biologically active.

Chemical analysis of water of the Anticolana Valley: isolation of humic compounds

The purpose of this study was to identify and characterize humic compounds in Anticolana Valley (Fiuggi) water. The capacity of this class of compounds to mobilize metals from solid phases could have an important role in calculi solubilization. Humic compounds were isolated, purified and characterised by FTIR, 1H-NMR and 13C-NMR spectroscopy, thermogravimetry and elemental analysis. Only fulvic acids were found. They are mainly composed of aliphatic chains, made of six -CH2O- groups and contain a number of carboxylic groups, responsible for their metal complexing capacity.

Solvent effect in vitro of Anticolana Valley water on renal stones: analytical-instrumental study

The presence of humic and fulvic acids in the Anticolana Valley (Fiuggi) water has been established. On the basis of this evidence we investigated the capacity of Anticolana Valley (Fiuggi) water to dissolve renal calculi in vitro. Crystals of calcium oxalate monohydrate to simulate a kidney stone were prepared. Human renal stones of calcium oxalate monohydrate were obtained by courtesy of the Division of Urology of 'La Sapienza' University (Rome), the Division of Urology of the University of Havana (Cuba) and the ASTIF of Fiuggi. The study was performed using the Anticolana Valley (Fiuggi) water, distilled water and tap water (ACEA, Rome), in a specially designed Perspex apparatus. Each calculus was subjected to a water flow of 2 liters/24 h. The capacity of the Anticolana Valley (Fiuggi) water to dissolve human and synthetic calculi was found to be much higher than that of distilled water which in turn was significantly more effective than tap (ACEA) water.

Epidemiology of nephrolithiasis

The main purpose of the study is to acquire useful information on nephrolithiasis in Italy, given the recent increase in its prevalence. The analysis was based on data from sample surveys of the Italian population carried out in 1983 and 1993-1994 as well as on data obtained from medical records of patients treated at the ASTIF in Fiuggi. An increase in the prevalence of the disease from 11.7 to 17.2 out of 1,000 inhabitants has been observed over the last 10 years; most patients are men and elderly, and the highest frequency is in southern and the lowest in northern Italy. The results of the study confirm the hereditary predisposition, since nephrolithiasis is very common among patients' parents (22.5%) and siblings (14.1%). The patients eat more meat than others and are often overweight or obese; the latter represent 18% of these patients and 11% of the general population.

Stone recurrence after lithotripsy in patients with recurrent idiopathic calcium urolithiasis: efficacy of treatment with fiuggi water

A multicentric study was carried out on 384 patients (231 males, mean age 28.3 years; 153 females, mean age 40.8 years) previously treated with extracorporeal shock wave lithotripsy for recurrent idiopathic calcium urolithiasis. Patients were selected and submitted to different types of high fluid intake treatment (oligomineral water with a calcium content of 15 mg/l vs. tap water with a calcium content ranging between 55 and 130 mg/l) to evaluate stone recurrence and to identify any potential risk factors. During follow-up (range 14-34 months, mean 19 months) 44 (23%) of the 192 patients treated with tap water presented recurrence versus 32 (17%) of the 192 patients treated with Fiuggi mineral water, the difference in incidence between the two groups being 6%. Of the possible predictors of recurrence, evaluated at the beginning of follow-up and analyzed in a multivariate statistical study, the 24-hour diuresis and calciuria were seen to be directly related to the recurrence.

[An observational and longitudinal study on patients with kidney stones treated with Fiuggi mineral water]

PURPOSE

To evaluate the development of clinical conditions particularly the possible expulsion of renal stones, in patients with nephrolithiasis this treated with Fiuggi Mineral Water.

PATIENTS AND METHODS

This study was carried out in 614 patients, by administering them an appropriate questionnaire 6 month after drinking Fiuggi Mineral Water.

RESULTS

The percentage of patients eliminating one or more renal stones was higher in those who drank mineral water at home (55.9%) compared to those who just drank water in Fiuggi (38.5%). Renal stones were eliminated more frequently in case of consecutive treatments than in case of cyclic treatments (54.3% vs 44.4%). Stone elimination was also related to quantity of the water which was daily drunk (up to 1 L/day, 52%; > 2 L/day, 72%). In 29% of the patient a stone relapse after operation or lithotripsy or both was observed.

CONCLUSIONS

These data in agreement with those of other investigations show that surgical treatment or lithotripsy are not able to avoid stone relapse. Other treatments, such as mineral water drinking, may be useful in this situation.

[Alkalizing activity of a calcium-bicarbonate-containing water, evaluated for pH, in patients with gastroesophageal reflux]

Bicarbonate-calcic water Ferrarelle has been administered both in the fasting state and during meals to patients suffering from gastro-esophageal reflux disease submitted to computerized pHmetry. Marked and lasting increase of esophageal and gastric pH was observed with significant differences from the effect of tap water. In addition, patients reported improvement of heart burn and acidity after the administration of the bicarbonate-calcic water. The alkalizing effect of the mineral water employed is therefore fully confirmed.

[Dyspeptic syndrome. Aspects of physiopathology, clinical features and pharmacological and hydrologic therapy]

The authors summarize findings up to date on dyspeptic syndrome, with special attention to functional dyspepsia. They recall the main aspects of etiopathogenesis, pathophysiology and clinics of functional dyspepsia and its classification. Finally, therapeutic trends, with specific reference to prokinetic drugs and crenotherapy by mineral waters, are outlined.

Mineral waters in treatment of metabolic changes from fatigue in sportsmen

The authors list the principal metabolic consequences of fatigue in athletes with special reference to alterations of fluid-electrolyte balance, acid-base balance, macroelements and trace elements. They then go on to stress the role which mineral waters, especially the bicarbonate ones, can play in the compensation of these disorders thus preventing or curing the fatigue syndrome in athletes.

[Hydrological therapy of renal lithiasis]

The spa treatment most widely used in the management of renal calculosis is the drinking of a certain amount of mineral water under certain predetermined conditions of temperature, time and rhythm. These treatments are always indicated unless there are obstacles to the passage of urine or general contraindications. Chances for success are increased if the diagnosis is exact and the stone has been located. The results obtained by various authors are reported and their statistical validity is discussed. Favorable effects consist in: increased diuresis with urine dilution and correspondingly reduced concentration of lithogenic salts and hence supersaturation of urine; reduced concentration of microorganisms; changes in the physiological condition of the renal medulla; changes in inhibitors of crystallization, in urinary pH; mechanical effect on the urinary passages; increased ureter motility; expulsion of small stones and sand; preventive action on recurrences after surgery and after extra-corporeal shock-wave treatment, percutaneous therapy and uretero-nephroscopy.

[Opioid peptides and digestive activity. Recent directions of physiopathology]

The authors, after having set out the classification and general significance of endogenous opioids (e.o.) on the basis of the most recent researches, have focused attention on the activity of the opioid peptides in gastroenterology. They summarize the main effects of the opioids on the basic digestive functions: secretion, endoluminal digestion, motility, absorption. Particular importance is attributed to the activity of the e.o. on gastric and duodenal secretion. Finally, the possible therapeutic implications of e.o. in the management of digestive disorders are examined.

Polymyalgia rheumatica and systemic giant cell arteritis. Bioptic findings of the subclavian arteries in a case of aortic arch syndrome

A 64 year old woman complained of aches and stiffness of the neck and the shoulders with fever and E.S.R. increase. A nonsteroid anti-inflammatory treatment was unsuccessful. A clinical examination revealed absence of both radial pulses and presence of murmurs at level of the carotids. The angiographic findings confirmed an aortic arch syndrome with severe stenosis of the subclavian and axillary arteries. The diagnostic approach, in spite of a negativity of the temporal artery biopsy, was for systemic giant cell arteries with general manifestations of polymyalgia rheumatica. The biopsies of both subclavian arteries, performed during a surgery revascularization, showed a typical giant cell arteries in acute stage. The histopathological pattern of extratemporal giant cell arteries obtained by means of a surgical biopsy is really uncommon, being the previous reports performed on necroscopic findings only. In addition this case confirms that polymyalgia rheumatica implies a systemic arteries even if the clinical and histopathological signs of temporal arteritis are lacking. Therefore the temporal artery should be only considered as a particular and inconstant localization of this vasculitis.