[Intracavernous infusion of drugs]

In 1982 Virag presented the initial experience of use in diagnosis and treatment of impotence. PGE1 has been showed a safe and effectiveness drug. From september 1989 to october 1991 210 patients with erectile disorders were managed by I.C.I. with PGE1 with minimal side effects.

Chlamydial genital infections and laparoscopic findings in infertile women

Several studies have shown that previous chlamydial genital infection, reflected by serological markers, is strongly associated with tubal damage leading to tubal infertility. In 105 women undergoing laparoscopy, multiple samples were collected from the lower (urethra and cervix) and upper (endometrium, peritoneal fluid, tubal lumen) genital tract, in order to isolate Chlamydia trachomatis in cell culture. Chlamydia trachomatis was isolated from at least one site in 13 (30.9%) of 42 infertile women with tubal infertility, in 5 (12.1%) of 41 women with unexplained infertility, in 1 of 4 women affected by acute salpingitis and in 1 (5.5%) of 18 women with endometriosis or uterine malformations. The latter group was the control group. Thirteen (65%) of the 20 positive women harboured Chlamydia trachomatis in their upper genital tract alone and 16 women were positive in one or both tubes. Only one of the positive women showed laparoscopic signs of acute pelvic infection. Four of the 5 positive women with unexplained infertility harboured Chlamydia trachomatis in the tubal lumen. This study confirms that chlamydial infection is strongly associated with tubal damage. It suggests that cervical cultures are inadequate for excluding a tubal infection and that chlamydial colonization of the tubal mucosa is possible in the absence of symptoms and laparoscopic signs of active infection.

[Salpingoscopy: a new method for the evaluation of the tubal factors in sterility]

Salpingoscopy is a new endoscopic procedure that allows the direct vision of the tubal mucosa. Therefore, it is able to identify and evaluate intraluminal lesions not detected by hysterosalpingography or laparoscopy. The endoscopic evaluation of the tubal mucosa can predict the possibility of an intrauterine pregnancy or laparoscopic tubal surgery, permitting the selection of patients with the most favourable prognosis. This technique may also have a role in identifying patients at risk for a repeat ectopic pregnancy and patients with silent endosalpingitis.

Dehydroepiandrosterone sulphate plasma levels in normal women and patients with benign breast disease

Dehydroepiandrosterone sulphate plasma levels were measured in patients with benign breast disease and in healthy women. In addition the adrenal secretion of dehydroepiandrosterone sulphate was assessed by means of an ACTH stimulation test in some patients and control subjects. The results obtained demonstrate that dehydroepiandrosterone sulphate plasma levels of patients with benign breast disease overlap those found in controls and that the adrenal response to ACTH of patients with breast pathology does not differ from that of healthy women.

PCNL debulking: Our experience

Percutaneous debulking and subsequent ESWL treatment has proved a successful approach to complex stones. Out of 232 patients treated with PCNL from March 1984 to March 1992, 102 (45%) were managed by PCNL debulking and ESWL or EPL (Extracorporeal piezoelectric lithotripsy). Recently (Zingonia period 1988–1992) only 21 patients with bulky or staghorn stones were treated by combination therapy. In our series, there were 1.3 sessions of PCNL and 1.8 sessions of ESWL for each patient. We report a high frequency of retained stone fragments (45% at 3 months follow-up). Out of 21, 3 patients underwent further ESWL procedures because the fragments were conglobed. No complications occurred in present series. In the one case we observed a rise in serum creatinine. In our opinion debulking PCNL and ESWL is the treatment of choice in the following cases: burden pyelitic stones, staghorn stones larger than 3 cm. and smaller than 5 cm., partial staghorn filling renal pelvis and 1 calyx; short length of calyces; pyelitic portion exceeding caliceal mass; infected stones in working kidney, stone in solitary kidney larger than 2 cm and hard; previous surgery.

Intraoperative autotransfusion during radical prostatectomy

Intraoperative autotransfusion is the ideal method for restoring blood loss during surgical procedures. In the last few years the confirmation of damage due to transfusion of stored blood, plus risingcosts, led to a revaluation of this procedure. From March 1990 to December 1991, 18 patients underwent intraoperative autotransfusion during radical prostatectomy for carcinoma stage B, utilizing a Dideco Autotrans BT 795 processor. Recovered blood was washed by physiological solution, centrifuged and filtered for air bubble and aggregate elimination, then reinfused. Average recovered blood rate was 853 ml (640-1087), the retransfused rate was 557 ml (410-727). Preoperative Ht rate was between 38.6% and 42.7% (average 40.8%); in the immediate post operative period (4–6 hours after procedure) Ht rate was between 34.3% and 38.6% (average 36.8%). No stored blood was required. We propose a wider utilization of this procedure for safety and lower cost.

Extracorporeal lithotripsy: Two years experience with the Dornier MPL 9000

In this study we present our experience in extracorporeal lithotripsy using a third generation lithotripter with ultrasound localization system and tubeless shock wave coupling as in the Dornier MPL 9000. The aim was to evaluate the efficacy, range of indications and tolerance in 110 patients treated in 1990–1991. No side effects were observed. Success rate was 76% for renal stones, 70% for ureteral stones. Pain free ESWL was possibile on generator voltage (14–17) which is used in the majority of our cases.

[Endocavernous drug infusions revisited]

From the beginning of the eighties papaverine was well established as the drug of choice for diagnosis and management of vasculogenic impotence. In the second half of the eighties decade many authors referred on experimental use of PGE1 in erection disease. PGE1 has been showed a safe and effectiveness drug. During the period September 1989-October 1990 at our Institution 98 pts. with erectile disorders were managed by I.C.I. with PGE1. Out of 98 cases 88 had success. Prolonged erection occurred in 4 pts. (4.2%). 10 pts. showed only tumescence. So there are been treated by I.C.I. with combined papaverine and PGE1 with better results. No side effects were formed in 10 pts. managed by self-injection of PGE1.

Serum CA-125 levels in the diagnosis and management of endometriosis

The value of CA-125 for the diagnosis and management of endometriosis (EN) was investigated by assaying the marker in the serum and peritoneal fluid (PF) from patients with the disease in comparison with control subjects. Of women who underwent 270 consecutive laparoscopies, 81 with various stages of EN (18 stage I, 13 stage II, 35 stage III and 15 stage IV) and 38 with normal pelvic findings were studied. CA-125 serum values increased progressively in relation to the severity of the disease. The levels in stages III and IV EN were significantly higher (P less than .01) than in stages I and II or control patients. The latter two groups did not differ from each other. High CA-125 PF values were found in all the patients investigated. Twenty-two patients with EN were treated with a gonadotropin releasing hormone agonist for six months before second-look laparoscopy or laparotomy. CA-125 values decreased significantly after one month of medical treatment and remained unchanged during the course of therapy. No significant relationship was found in the outcome after therapy.

Evaluation of the correlation between endometriosis extent, age of the patients and associated symptomatology

Two-hundred-and-six patients newly diagnosed to have endometriosis at laparoscopy were evaluated in order to see if endometriosis-associated symptoms are proportional to the extent of the disease, as assessed using the Revised American Fertility Society Classification, and if the extent worsens with age. At hospital admission 81% of the patients complained of dysmenorrhea, 54% of chronic pelvic pain and 27% of dyspareunia. At laparoscopy, 39% of the patients had stage I endometriosis, 13% stage II, 35% stage III and 13% stage IV. At statistical analysis, no significant differences were found in total endometriosis scores, in active scores or in adhesion scores in different age groups. Although a difference in prevalence rate for dysmenorrhea and dyspareunia stage I versus III was found, a trend of increasing severity of symptoms with more widespread disease was not evident. There was not a significant difference in prevalence rate of symptoms for different aspects of endometriosis (implants, cysts or adhesions). Our data show that the American Fertility Society classification does not reflect the intensity of endometriosis-associated symptoms, probably underestimating the most active forms of this disease, and does not allow to follow a possible natural progression of the disease.

Salpingoscopy in patients with contralateral ectopic pregnancy

Patients who experience a tubal pregnancy have a poor prognosis in terms of reproductive potential and are at increased risk of a repeat EP. Salpingoscopy is a new endoscopic technique that allows the detection of abnormalities of the tubal mucosa. In seven patients with a follow-up longer than 6 months, an IUP occurred only in patients with a normal ampullary mucosa, whereas a recurrent tubal pregnancy occurred in the patient that conceived with an abnormal tubal mucosa. These preliminary results suggest that salpingoscopy may constitute an important prognostic factor in these patients.

Incidence of genital tuberculosis in infertile patients submitted to diagnostic laparoscopy: recent experience in an Italian university hospital

The incidence of genital tuberculosis is decreasing in industrialized countries. The authors report their experience in 254 patients with primary or secondary infertility. Out of 101 patients with a tubal factor of infertility, two patients were diagnosed as having tuberculosis by both endometrial biopsy and endometrial culture. In a third patient, even in the presence of laparoscopic findings suggesting genital tuberculosis Mycobacterium tuberculosis was isolated only from the urine.

[Complications of percutaneous litholapaxy]

Percutaneous nephrolithotomy has been proved an efficient management of renal calculi. We report, in present review, the complications of PCNL procedure referred by several authors and our casistic since 1985. Major complications occurred in 3-6% of treated patients: severe bleeding, arteriovenosal fistulas, haematoma perirenal, water syndrome, sepsis, DIC, etc.). Nephrectomy was necessary in less than 1% of reported cases. 5 patients died for complications related to PCNL. Early complications occurred during the percutaneous puncture, tract dilation and lithotripsy. Postoperatively bleeding at the time of nephrostomic tube removal was reported in 0.5-1% of cases. Late sequelae of PCNL: stricture, fistulas, renal damage, renal function loss, high lithiasis recurrence rate were reported rarely. We, herein, believe PCNL is a safe and effective procedure with minimal rate of complications and late effects, according to other important authors.

[Complications and limitations of transurethral prostatic resection: retrospective study of 366 patients]

In present paper we report our experience on 366 patients underwent to transurethral resection of prostate from January 1988 to January 1990. All patients were controlled by uroflowmetry and retrograde plus minctional urethrography, with evaluation of the possible immediate and latest complications. Among the latest complications, the most representative had been urethral stricture, occurred in 24 patients (6.5%) according with international literature. We considered also various iatrogenics factors (operator experience, endoscopic time, catheter section, catheter permanence time, use of lubricator, presence of catheter before TURp, preventive Otis urethrotomy). From our study rises out that the most important risk factors are: a) catheter permanence time; b) TURp without preventive Otis urethrotomy.

Gonadotrophin releasing hormone agonist (buserelin) in the treatment of endometriosis: changes in the extent of the disease and in CA 125 serum levels after 6-month therapy

Twenty-two women with endometriosis were treated with the luteinizing hormone-releasing hormone (LHRH) agonist buserelin for 6 months. At second-look laparoscopy the mean score of endometriosis had decreased from 23.1 (SD 17.0) to 17.2 (SD 20.2) (P less than 0.05). CA 125 serum levels decreased from 38.4 (SD 32.2) U/ml at diagnosis to 15.5 (SD 7.0) at second look (P less than 0.005). CA 125 levels correlated at diagnosis with total score of endometriosis (P less than 0.05) and with active score of endometriosis (P less than 0.05), but not with the adhesion score. CA 125 levels were not correlated with endometriosis scores at second look laparoscopy, thus suggesting that mechanisms other than the change in the extent of the disease may be involved in the CA 125 decrease during therapy. CA 125 levels may therefore not be a reliable indicator for monitoring the efficacy of LHRH agonist treatment of endometriosis.

Effects of salmon calcitonin on the bone loss induced by ovariectomy

We present the results of a 12-month clinical study assessing the effects of synthetic salmon calcitonin (sCT) on a group of fertile white women who had undergone ovariectomy for uterine fibromatosis. The study was performed to verify whether CT can prevent the loss of bone mass and the changes in calcium-phosphorus metabolism associated with acute estrogen deficiency. The study consisted of an initial double-blind phase of 6 months, followed by a 6-month open period. Treated patients were given 100 MRC U of synthetic salmon CT injected i.m. in the morning, every other day, starting on the 7th day after the operation and continued for 12 months. Control patients received a placebo injection for the first 6 months; subsequently, they too were treated with sCT i.m. every other day for 6 months at the same dose as the 12 month-treated group. All patients received 500 mg of elementary calcium p.o., b.i.d. Bone mineral content (BMC) was measured at the extreme distal radius of the nondominant arm by a dual photon bone densitometer which utilizes two radio nuclides, 241 Am and 125 I, with energies of about 60 and 30 KeV. Biochemical parameters of the calcium-phosphorus metabolism were also measured. After 12 months of study, no significant changes of BMC were observed in the 12 months sCT treated group, while control patients, treated 6 months after the ovariectomy, showed a significant decrease in BMC values.(ABSTRACT TRUNCATED AT 250 WORDS)

Secretory immunoglobulin A and inhibitory activity of bacterial adherence to epithelial cells in urine from patients with urinary tract infections

To assess the role of local immune response against bacterial invasion of the urinary tract we studied 168 patients with bacteriuria. Urinary secretory immunoglobulins A (sIgA) were measured using radial immunodiffusion or enzyme-linked immunosorbent assay (ELISA). In particular, ELISA is a very suitable assay for measuring the low levels of sIgA in urine. Furthermore, we used a quantitative in vitro adherence assay to investigate the attachment of Escherichia coli to human uroepithelial cells after incubation in urine from patients with urinary tract infection. Urine from patients with ileocystoplasty was significantly more potent in inhibiting bacterial adherence than was urine from other groups of patients with urinary tract infection. The presence of high urinary sIgA may help explain the increased antiadherence activity of urine in patients with ileocystoplasty. Mean urinary sIgA in patients with upper urinary tract infection was higher than in patients with uncomplicated infection in the lower urinary tract. Alterations in mucosal immune functions may account for the propensity toward bacterial colonization in women prone to uncomplicated urinary tract infection.

Salpingoscopy in patients with endometriosis-associated infertility

Endoscopic evaluation of the tubal mucosa has been shown to be an important prognostic factor in predicting the probability of a subsequent intrauterine pregnancy. A recent classification of the tubal mucosa lesions allows uniformity of evaluation, permitting comparison of results in prospective studies. It has been suggested that endometriosis may be associated with intratubal abnormalities. In this prospective study we evaluated 35 patients with endometriosis-associated infertility. No intraluminal abnormalities were found, and all the patients that subsequently conceived had an intrauterine pregnancy.

Perlaparoscopic salpingoscopy in the evaluation of the tubal factor in infertile women

Endoscopic evaluation of tubal mucosa during tubal reconstructive microsurgery has been shown to be an important prognostic factor in predicting the probability of a subsequent intrauterine pregnancy. Recent reports have described the use of this technique during laparoscopy in order to evaluate the tubal factor in infertility. We report our experience with this new diagnostic procedure. We utilized a flexible fiberscope with an outer diameter of 3.8 mm for endotracheal intubation. The fiberscope was passed through the operating channel of the laparoscope in order to evaluate the tubal mucosa in patients with primary and secondary infertility associated with tubes patent at the distal end. We encountered abnormalities of the infundibulum or of the ampullary mucosa in 24% of the tubes considered normal at HSG and in 27% of the tubes judged normal at laparoscopy. On the contrary, 44% of the tubes with abnormalities at HSG and 58% of the tubes with abnormalities at laparoscopy presented normal mucosa at salpingoscopy. Our results, in addition to those published in the literature, demonstrate that salpingoscopy is an important and valuable diagnostic procedure for an accurate evaluation of infertile patients. With this technique it is also possible to select patients with a favorable prognosis for tubal microsurgery.

[Neoadjuvant chemotherapy of locally advanced tumors of the bladder: preliminary experience]

From february 1988 to march 1989, 6 patients with locally advanced bladder cancer (T3b-T4, N0-N1, M0) were treated with 4 courses of neoadjuvant MP chemotherapy (methotrexate 300 mg/mq. + cisplatinum 100 mg/mq). In two patients chemotherapy was stopped because minimal or no response after two courses. Partial response (RP) was achieved in three patients (50%). Two patients died 2 and 5 month later. One patients developed metastases at 11 month. The remaining three cases showed NED at 3, 4 and 15 months of follow-up. In the same period 4 patients with metastatic bladder tumor were treated with M-VAC chemotherapy according to Yagoda before the cystectomy. M-VAC obtained a complete response in one case, and PR in 3 cases. All the metastases showed evidence of objective tumor regression. Reduction of bone pain was observed in one case. One patient died 15 months later with bone massive involvement. Another patient developed invasive tumor at 13 months. Two patients were disease-free at 3 and 5 months, respectively. Toxicity was more frequent in patient treated with M-VAC than with MP chemotherapy. M-VAC, we believe, represents a reliable neoadjuvant treatment of advanced metastatic bladder cancer.

Hormone receptors and enzymatic activities in human endometrial adenocarcinoma

The hormone sensitivity of endometrial carcinoma is related to the presence of steroid hormone receptors. The determination of progesterone receptors has been proposed in order to predict clinical prognosis and to aid treatment selection. The integrity of the hormone receptor system and postreceptoral events in tumors is essential to endocrine therapy response. Nevertheless, although hormone receptors are present in a large number of endometrial carcinomas, only 30% of cases respond to hormone therapy. In some neoplasms the receptors can be present, but not functioning, or else neoplastic transformation could have induced alterations in processes after hormone-receptor interaction.

Oxytocin receptor in human fetal membranes at term and during labor

Human fetal membranes, taken from 30 patients submitted to caesarean section during the final stages of gestation and labor, were examined in order to evaluate the presence and characteristics of the oxytocin receptor. The presence of oxytocin receptors in human fetal membranes, both in the amnion and in the chorion-decidua, was demonstrated in this study. The receptor binding to oxytocin showed a significant increase during early and advanced labor compared with before the onset of labor. When the pre-labor level was taken as the normalized form (control = 100) the increase with respect to the control (10 cases) for the amnion in early labor (2.27 times +/- 0.11, mean +/- SEM, P less than 0.001, 10 cases) and in advanced labor (2.53 times +/- 0.15, 10 cases, P less than 0.001) was highly significant. In the chorion-decidua the increase was 1.61 times +/- 0.09, P less than 0.001 in early labor and 1.66 times +/- 0.19, P less than 0.001 in advanced labor. Scatchard analysis showed a single receptor site for oxytocin in amnion and chorion decidua. The dissociation constant (Kd) did not change during the various stages of labor; the mean values found were 0.228 +/- 0.02 (mean +/- SEM) nM in the amnion and 0.193 +/- 0.03 nM in the chorion-decidua respectively. These findings suggest that human fetal membranes are target organs for oxytocin and that they might play a role in the onset of labor through an increase of receptor binding.

Hormone receptor status in human endometrial adenocarcinoma

Steroid receptor levels were determined in 196 samples of endometrial adenocarcinoma: cytosol estradiol receptors (ERc) were measured in 171 samples, cytosol progesterone receptors (PRc) in all samples; nuclear estradiol receptors (ERn) and nuclear progesterone receptors (PRn) in 68 samples; total estradiol receptors (ERt = ERc plus ERn) and total progesterone receptors (PRt = PRc plus PRn) were measured in 68 samples. The ERc levels were 88.2 +/- 8.9 (mean +/- SEM) and ERn were 94.4 +/- 15.6 fmol/mg protein; PRc levels were 197.9 +/- 25.9 and PRn 178.3 +/- 55.9 fmol/mg protein. The ERt levels were 162.6 +/- 23.2 and PRt 249.8 +/- 75.7 fmol/mg protein. The presence of PRc was related to the ERc levels according to the cut-off used. Estradiol receptors (ER) and progesterone receptors (PR) were present in the cytoplasmic and nuclear fractions in 60.2% and 36.8% of cases, respectively. The simultaneous presence of both ERt and PRt was observed only in 27.9% of cases. In the normal endometrium ERc and PRc were negatively correlated (r = -0.525, P less than 0.005), whereas in endometrial adenocarcinoma the correlation was positive (r = 0.491, P less than 0.001). In contrast with the normal endometrium the correlation between ERc and ERn was positive (r = 0.582, P less than 0.001) in tumor tissue. In neoplastic tissue Scatchard analysis showed a single class of specific ERc sites with a dissociation constant (Kd) of 1.39 +/- 0.8 X 10(-9) mol/l, one tenth of that found in the normal premenopausal endometrium. Qualitative and quantitative analysis of the receptor status showed that in 30% to 40% of cases studied the behavior of the neoplastic cell was similar to that found in the normal endometrial cell. In a 4-year follow-up of patients affected by endometrial adenocarcinoma there is better survival in the groups of patients with a simultaneous presence of ERt and PRt than in the group with their absence.

[The Wolf piezolith 2300: lights and shadows]

Extracorporeal piezoceramic Wolf lithotripter was developed in West Germany by Ziegler and Associates in collaboration with Wolf GmbH. Piezolith 2300 has no cumbersome water tube and it was constructed as a mobile unit. It requires no patient irradiation, a special room adaptation, a electrodes replacement or any auxiliary staff. From February 1988 up to May 1989 a total of 230 stones in 218 patients, 18 to 79 years old, was treated with Piezolith 2300, in our Center. Ultrasound localization failed in 7 more cases of ureteral stones. Treatment resulted quite painless. Auxiliary measures before EPL, were performed in 12 cases, only (5%). 15 pts were managed with combined procedures: ESWL + EPL, PCNL + EPL, surgery + EPL. The mean of SW was 3000 (800-6500) for each piezoelectric session. In 27 pts (12%), 4 or more EPL sessions were performed. A successful disintegration was achieved in 210 cases (90.2%). Out of 20 unsuccessful cases, 15 were managed by Dornier HM3 mod lithotripter and 4 by ULL. Post EPL ancillary procedures were required in 4 pts (1.8%). No major complications were observed in our series. At the 30-days follow-up, 57.3% of the patients were stone free. At preliminary 3-month follow-up in 120 pts the rate of the entire success raised to 75%. We think, according to others authors, that EPL is the treatment of first choice in 70% of reno-ureteral stones.

Prolactin secretion and dehydroepiandrosterone sulphate plasma levels in women with benign breast disease

The purpose of the present investigation was to verify possible positive correlations between prolactin secretion and dehydroepiandrosterone sulphate levels in plasma of women with benign breast disease. Prolactin secretion was evaluated in terms of basal levels, maximum peak, percent increase above baseline levels, total integrated area, response area after TRH stimulation. No correlation was found between the parameters of prolactin secretion and dehydroepiandrosterone sulphate levels.