[Neurologic emergency in children's hospital. Stroke]

AIM

The results may be related to the relative delay in diagnosis and thus in treatment. The authors hope that their paper will help make physicians who work in emergency rooms more aware of the increase in stroke in children.

METHODS AND RESULTS

The study a departmental study in the Children's Hospital, carried out at the Giannina Gasslini Children's Hospital of Genoa, Italy. The authors report on 23 children with stroke who were admitted at onset to the pediatric emergency department. The incidence of patients with stroke at the Institute between 2001 and 2005, was 0.8% among neurology patients and 0.02% among all pediatric patients. This incidence would appear to be lower than the rates reported in the literature. This is most likely due to the fact that patients who presented at the Emergency Department at onset of the stroke were not taken in consideration. In the last few years, children with stroke have been treated empirically by anticoagulant or antiplatelet therapy. Patients with sickle cell disease, with venous stroke, or with heart disease are all treated in a rather homogeneous manner.

CONCLUSIONS

These cases represent the different types of presentation of stroke in children and also clearly display the different therapeutic strategies that have been applied. In fact, the patients were treated on the basis of an individual protocol which was decided case by case but a critical review of these cases establishes a necessary multidisciplinary protocol.

Epidemiology of ALS in Padova district, Italy, from 1992 to 2005

BACKGROUND AND PURPOSE

Several studies have reported an increase in ALS incidence in recent years but population-based studies in Europe do not confirm this trend. To analyze ALS incidence over time we conducted a retrospective incidence study in the Padova district of Italy (1992 to 2005). We had previously conducted a survey in the same area in the years 1980-1991.

METHODS

We used the archives of all the neurological wards of the Padova district to identify all subjects with a discharge diagnosis of ALS or motor neuron disease and resident in the Padova district.

RESULTS

We ascertained 182 patients (85 males and 97 females; male:female ratio 0.88:1) over the 14-year study period. The annual incidence rates adjusted by sex and age increased from 1.31/100,000/year in the years 1992-1994 to 1.92/100,000/year in the years 2004-2005.

CONCLUSIONS

This study confirmed an ALS incidence increase over the last 25 years in the Padova district. The increase in incidence may be partially explained by the ageing of the general population rather than by an improved diagnostic assessment.

[Diagnostic and surgical problems of ectopic breast cancer]

Cancer of supernumerary breast or ectopic breast tissue has haigher incidence than the cancer on ortotopic breast. This finding puts some problems about the diagnosis and therapy of ectopic breast cancer. The Authors describe their personal experience in three patients surgically treated and discuss about problems and solutions of this pathology.

Extracorporeal Shock Wave Therapy as First Line Treatment in Patients with Peyronie's Disease

Introduction

Extracorporeal Shock Wave Therapy (ESWT) is a minimal invasive treatment for patients with Peyronie's Disease (PD). Currently, however, controversial data exist on the efficacy of ESWT as first-line treatment.

Methods

We performed a prospective, randomized, double blind, placebo-controlled trial to evaluate the efficacy of ESWT in a group of 100 patients with disease duration <12 months, naive to previous treatments, with a single plaque, erectile dysfunction and/or painful erections and/or penile recurvatum. Patients were randomized to undergo ESWT or Placebo. The Storz Duolith device was employed for treatments. A non-functioning probe was employed as placebo. Treatments were administered in four sessions at weekly intervals. The following evaluations were performed at baseline and at 12- and 24-week intervals from treatment: IIEF-5 (International Index of Erectile Function) questionnaire, VAS (Visual Analogue Scale), plaque size measurement, penile curvature measurement.

Results

Only patients treated with ESWT reported a significant improvement of mean VAS score and of mean IIEF-5 score at a 12-week follow-up. Mean plaque size and mean curvature degree did not improved significantly in patients treated with ESWT but showed a significant worsening at the 24-week follow up compared to baseline values in the placebo group.

Conclusions

ESWT can improve significantly painful erections and erectile functions in patients with PD naive to other treatments. Moreover, ESWT can stabilize plaque size and penile curvature thus preventing disease progression.

[Headache in a pediatric emergency department]

INTRODUCTION

Headache, a very frequent symptom in pediatrics, can severely affect the child and his family's life quality, representing an important reason of access to a Pediatric Emergency Department. From a clinical point of view, it is useful to subdivide headaches in primary and secondary ones. As far as the primary ones are concerned, the common migraine without aura is recognised as the most frequent in the child, while the most recurrent among the second ones are due to infective processes, and they represent 57% of the patients admitted to ED for headache with acute onset.

MATERIALS AND METHODS

We analyzed data collected from June 2000 to December 2006, at the Pediatric Emergency Department of Institute "G. Gaslini" Genoa, concerning the admissions of patients with headache, with particular attention to the necessity of coming up with a clinical and diagnostical path.

RESULTS

During the study, there have been 228.255 admissions, 2.214 of which with a diagnosis of discharge from ED of headache (55% males, 45% females). After triage, 14,3% has been evaluated as white code, 74,3% as green one, 10,8% as yellow one and 0,6% as red code. Final outcome of these patients has been hospitalization for 38%, OBI for 8%, home or ambulatory control for 54%.

CONCLUSIONS

The accesses to ED for headache are increasing. Better information of the family is needed, with coordination among territorial structures and clinic management in ED.

[Cutaneous B-cell non-Hodgkin lymphoma: clinical aspects, diagnostic and surgical approach]

By clinical observation and surgical treatment of a patient with cutaneous B-cell non-Hodgkin lymphoma, the Authors describe the nosological approach, the correct diagnosis and the surgical treatment in this disease.

[Diagnostic value of out-patient lymph node biopsy]

Authors review their outpatient lymph node biopsies in order to verify safety and diagnostic accuracy. They didn't observe any complication and in every case, the procedure provided the correct diagnosis. Lymph node biopsy is the procedure of choice to study the pharmacologic therapy non responsive lymph node pathology that is not surely defined by fine needle aspiration, as almost always in lymphomas.

[Seroma in residual fibrous capsule after breast implant explantation: a case report]

The Authors present a singular case of seroma which developed in residual fibrous capsule after explantation of breast prostheses without replacement. Mammographic and sonographic findings of the seroma make difficult the diagnosis: mammograms revealed a radiopaque, well-circumscribed mass anterior to the pectoralis major muscle in the region of the prior sub-glandular implant, that was initially misinterpreted as breast implant radiographic feature. It is particularly important review and carefully correlate mammographic and sonographic findings with patient's surgical history for a correct diagnosis.

Enhancement of SPES source performances

Installation of SPES source at LNL was finished in July 2006 and the first beam was extracted in September 2006. Commissioning results confirmed very good performance of the extracted current density. Conversely, source reliability was very poor due to glow-discharge phenomena, which were caused by the ion source axial magnetic field protruding in the high-voltage column. This problem was fixed by changing the stainless steel plasma electrode support with a ferromagnetic one. This new configuration required us to recalculate ion source solenoids positions and fields in order to recover the correct resonance pattern. Details on magnetic simulations and experimental results of high voltage column shielding are presented.

The MTHFD1 gene is not involved in cleft lip with or without palate onset among the Italian population

Nonsyndromic cleft lip with or without cleft palate (CL/P) is the most common orofacial malformation, having a non-Mendelian and multifactorial aetiology. It has been shown that polymorphic variants of genes encoding key proteins of folate and methionine metabolism might be important maternal risk factors for having a child with these craniofacial anomalies. The aim of this study was to evaluate the role of two polymorphisms of the methylenetetrahydrofolate dehydrogenase 1 (MTHFD1) gene, the A1958G and the G401A variants, on the risk of CL/P in the Italian population. A1958G and G401A polymorphism genotyping of MTHFD1 was performed on 216 CL/P triads, (patient and parents), for this study by restriction endonuclease digestion of PCR products. Linkage disequilibrium between markers and disease was tested using both pairwise and haplotype analyses. In our case-parents triad design no significant association between MTHFD1 and the disease is evident. Our data do not support MTHFD1 involvement in CL/P onset among the Italian population.

[Multiple repetitive mammary fibroadenomas. Case report]

Multiple and ripetitive mammary fibroadenomas represent a rare disease. The etiology is uncertain. The diagnostic radiology is able to allow a correct diagnosis. The authors report a case of a woman 22 years old undergone a surgical treatment many times to remove multiple and ripetitive mammary fibroadenomas. The proposed management provides for periodic radiological exams; the surgical treatment is proposed only for the lesions with a rapid growth.

Sensitivity and specificity evaluation of endorectal magnetic resonance imaging and transrectal sonography in the staging of prostate cancer

Objectives

Nowadays endorectal probes for Magnetic Resonance Imaging (MRI) have better resolutions, which allows to acquire high-level images of prostate and to improve the MRI sensitivity and specificity to determine the cancer volume and the extraprostatic extension. The objective of the present study is to evaluate the sensitivity and diagnostic accuracy of endorectal MRI for identifying the local extension of prostate carcinoma compared to transrectal sonography (TRUS) of prostate.

Materials and Methods

The study included 81 patients with clinical suspect of cancer and/or elevated values of serum prostate specific antigen (PSA), who underwent endorectal MRI with 1.5 T endorectal probe before transrectal biopsy. Patients with localized prostate cancer underwent radical surgery. The results of endorectal MRI were compared to those of TRUS and histopathological examination outcomes.

Results

15 of the 81 enrolled patients had extraprostatic localization of cancer, which was assessed through TRUS in 4 cases only (26%), and through MRI in 7 cases (46%). A seminal vesicle involvement was present in 10 patients, detected by MRI in 5 cases and in no cases by TRUS.

Discussion and Conclusions

Data are similar to the findings collected by several Authors. The endorectal MRI has a better accuracy in staging prostate cancer compared to TRUS. Nevertheless, this procedure has some limits: little availability of equipment in hospitals, physicians’ little experience, and higher costs compared to TRUS.

Effects of Emdogain on osteoblast gene expression

OBJECTIVE

Emdogain (EMD) is a protein extract purified from porcine enamel and has been introduced in clinical practice to obtain periodontal regeneration. EMD is composed mainly of amelogenins (90%), while the remaining 10% is composed of non-amelogenin enamel matrix proteins such as enamelins, tuftelin, amelin and ameloblastin. Enamel matrix proteins seem to be involved in root formation. EMD has been reported to promote proliferation, migration, adhesion and differentiation of cells associated with healing periodontal tissues in vivo.

DESIGN

How this protein acts on osteoblasts is poorly understood. We therefore attempted to address this question by using a microarray technique to identify genes that are differently regulated in osteoblasts exposed to enamel matrix proteins.

RESULTS

By using DNA microarrays containing 20,000 genes, we identified several upregulated and downregulated genes in the osteoblast-like cell line (MG-63) cultured with enamel matrix proteins (Emd). The differentially expressed genes cover a broad range of functional activities: (i) signaling transduction, (ii) transcription, (iii) translation, (iv) cell cycle regulation, proliferation and apoptosis, (v) immune system, (vi) vesicular transport and lysosome activity, and (vii) cytoskeleton, cell adhesion and extracellular matrix production.

CONCLUSIONS

The data reported are the first genome-wide scan of the effect of enamel matrix proteins on osteoblast-like cells. These results can contribute to our understanding of the molecular mechanisms of bone regeneration and as a model for comparing other materials with similar clinical effects.

Study of the PVRL1 gene in Italian nonsyndromic cleft lip patients with or without cleft palate

Nonsyndromic cleft lip with or without cleft palate (CL/P) is a complex genetic trait and little is known about its aetiology. Recent investigations on rare clefting syndromes provided interesting clues about genes involved in face development. The PVRL1 gene encodes nectin1, a cell-to-cell adhesion molecule. Mutations in its sequence have been shown to cause the rare autosomal recessive syndrome CL/P-ectodermal dysplasia syndrome (CLPED1), while heterozygosity for the mutation W185X seemed to increase the risk of non syndromic CL/P in a population from northern Venezuela. In the present study, we screened 143 Italian CL/P patients for mutations in PVRL1. Three rare sequence variants in exon 3 that create amino-acid changes were detected in a total of 7 patients. Two of these mutations were not found in a panel of 292 unaffected controls, while the third was found in two controls. This study describes new mutations that may represent genetic risk factors for CL/P. Even though a study to look at the effects of the mutations on nectin1 function was not feasible, supporting evidence was reported, thus confirming the involvement of PVRL1 in the aetiology of non-syndromic CL/P malformation.

Scan of human genome reveals no new Loci under ancient balancing selection

There has been much speculation as to what role balancing selection has played in evolution. In an attempt to identify regions, such as HLA, at which polymorphism has been maintained in the human population for millions of years, we scanned the human genome for regions of high SNP density. We found 16 regions that, outside of HLA and ABO, are the most highly polymorphic regions yet described; however, evidence for balancing selection at these sites is notably lacking--indeed, whole-genome simulations indicate that our findings are expected under neutrality. We propose that (i) because it is rarely stable, long-term balancing selection is an evolutionary oddity, and (ii) when a balanced polymorphism is ancient in origin, the requirements for detection by means of SNP data alone will rarely be met.

[Neurological disorders in a pediatric emergency room: Epidemiology and clinical aspects]

AIM

The aim of this study was to demonstrate how important neurological disorders are in the organization of services and education of staff in a pediatric emergency room. The first objective was to collect and review data in pediatric emergency care; based on an analysis of these data, the second objective was to design an organizational plan for emergency services to be developed in this setting.

METHODS

We used the ICD IX system to search our computerized database created in 2000 and to select diagnoses from the medical records of patients who came to our emergency room with neurological symptoms. Because the system is not yet comprehensive and because this was a retrospective study, we had to select the bulk of the diagnoses following the formulation each of us had given at patient discharge. While this raised the risk of data spread, it still permitted us to identify certain characteristics of the disorders that were particularly useful for classifying their etiopathogenesis.

RESULTS

Selected were 2.630 neurological patients that had been discharged or admitted to our unit (2.7% of all admissions). The patients were stratified by disorder and admission code number. Specific disorders of major impact, the clinical approach to their treatment and etiology were reviewed in detail.

CONCLUSIONS

The results provide evidence that acute neurological disorders command the immediate attention of the emergency room physician and require prompt diagnosis.

[Proposal of health care program for workers of Large Organized Distribution]

The whole of trading enterprises with many average/big saling-centres forms what is today commonly known as Large Organized Distribution (LOD). The main risks regarding the people working in the LOD are: MM, repetitive motion of upper limbs, fixed postures, unfavourable microclimatic conditions and, moreover, the probability of labour accidents. In order to analyse the risks due to MM and false postures, we have used the ergonomic software "Classic Jack" distributed by EAI-UGS, which has been very helpful to find out the most dangerous labour operations (e.g. charging and discharging of goods, fragmentation and reassembling of manufactures, goods-shelving, branding and labelling). We have, then, suggested a programme of health surveillance that includes a medical examination, eventual x-ray exams, specialized examination and a posturologic visit. This posturologic visit has got an olistic diagnostics approach, whose research after the causes that could be responsible for the checked diseases concerns not only the damaged area, but also other parts of the body (ocular system, auditive system, podalic system, masticatory apparatus).

What is the best management for abdominal aortic aneurysm in patients at high surgical risk? A single-center review

AIM

To determine the best treatment for high-risk patients with abdominal aortic aneurysms (AAA).

METHODS

We reviewed a prospective database of all patients who underwent conventional (OPEN) or endovascular aneurysm repair (EVAR) between January 1998 and December 2002. Patients were preoperatively classified according to the American Society of Anesthesiology (ASA). Comorbidities and medical risk factors were categorized according to the Ad Hoc Committee on Reporting Standards. Perioperative mortality and morbidity rates were analyzed according to the type of surgical procedure (OPEN vs EVAR) and ASA class. Patients in ASA classes I and II were excluded. Continuous data were expressed as mean +/- standard deviation. All data were calculated using the cumulated actuarial method of event outcome probability. Kaplan-Meier curves were constructed and the log-rank statistic and chi squared test were used for comparative data. P values less than 0.05 were considered to indicate statistical significance.

RESULTS

Of the total 375 patients who underwent AAA repair, 168 (45%) belonged in ASA classes III and IV (85 submitted OPEN and 83 EVAR to repair). Among general risk factors only coronary artery disease differed significantly between the 4 groups (P = 0.04). The Bonferroni correction identified a statistically significant difference between ASA classes III and IV for the OPEN technique and for EVAR (P = 0.007 and P = 0.012). Neither 30-day morbidity or mortality differed significantly according to ASA class and surgical technique. The median follow-up was 19 months (range 5-60 months). The overall survival was 78% at 60 months. Survival rates during follow-up differed significantly in the 2 risk classes (ASA III 5/123, 4% vs ASA IV 9/38, 24%), (P = 0.0001). The deaths in the ASA class 4 patients (12/14; 86%) were caused by preexisting medical comorbidities (in 9 patients cardiovascular, in 1 cancer and in 2 cirrhosis).

CONCLUSIONS

Except patients with small aneurysms (< 6 cm), in whom the risk of death at 1-year due to comorbidities exceeds the risk of a ruptured aneurysm, all patients at high surgical risk (ASA class IV) benefit from AAA repair. Patients with small aneurysms must undergo strict surveillance to assess growth and aneurysmal wall changes to prevent unexpected rupture.

Epidemiology of hydatidosis in the province of Sassari, Italy

Cystic echinococcosis is endemic in certain parts of the world, including Sardinia, Italy. It was performed a study in the province of Sassari in order to evaluate the incidence of the infection in man and the effects of control programs since 1964 to 2002. Data obtained by surgical records, hospital discharge forms, radiological and pathological files were collected using a case report form. During the years 1964-2002, 2702 new cases were identified (average annual incidence: 17 per 100,000) and 1981 (73.3%) were submitted to surgical treatment. In 57.3% municipalities no cases were observed during the years 1998-2002. Males are more affected (56.2%), mostly farmers-shepherdess (68.6 per 100,000) and pensioners (59.6 per 100,000). Control measures led to a significant decline in the incidence rate of hydatidosis during the period 1964-2002, dropping by 27.6 per 100,000. The mean age of surgical patients increased during the years of surveillance, such as the surgical liver/lung ratio as a consequence of a cohort effect. The durability of control programs is the corner stone for obtaining a significant decrease of this infection.

Peripheral relaxant activity of apomorphine and of a D1 selective receptor agonist on human corpus cavernosum strips

Apomorphine is used in the erectile dysfunction therapy and its action has been ascribed to the stimulation of central dopamine receptor. At the present stage, very little is known about the peripheral action of apomorphine on human corpus cavernosum (HCC). We have investigated the peripheral action of apomorphine and the role of dopamine receptors in HCC. We here demonstrate that both D1 and D2 receptors were expressed in the HCC, D1 receptors were two-fold more abundant than D2 and that both receptors were mainly localized on the smooth muscle cell component. Apomorphine in vitro exerted an anti-alpha1 adrenergic activity in human cavernosal strips since it prevented contraction induced by phenylephrine (PE), but not by U46619 or endothelin. Apomorphine elicited endothelium-independent and concentration-dependent relaxation of the strips contracted by PE, U46619 or endothelin. The EC50 values (microM) for apomorphine, in the presence and absence of endothelium, were 51.0+/-16 and 16.0+/-14, 120+/-19 and 150+/-18, 59.0+/-15 and 140+/-50 on PE-, U46619- or endothelin-induced contraction, respectively. Selective dopamine receptor agonist A-68930 (D1-like), but not quinpirole (D2-like), caused concentration-dependent relaxation of the cavernosal strips, which was partially prevented by endothelium removal or by treatment with an inhibitor of nitric oxide (NO) synthase. In conclusion, we show that (1) apomorphine has a peripheral relaxant direct effect as well as an antiadrenergic activity, (2) HCC possesses more D1-like (D1 and D5) than D2-like (D2, D3 and D4) receptors, (3) both D1- and D2-like receptors are mainly localized on smooth muscle cells and (4) the relaxant activity is most probably mediated by D1-like receptor partially through NO release from endothelium.

[Triage and white codes]

AIM

In this paper, the authors analyse the type of accesses to the Emergency Department of the DEA of the G. Gaslini Institute defined by the triage as White Code, monitoring the outcome of said access.

METHODS

This investigation was of retrospective type and lasted 6 months. It employed the fast track triage nursing system for the selection of patients. Independently of their age and sex and presenting pathology, the selected patients, at the moment of nursing triage, received the white code on the basis of EPM (emergency paediatric medicine) paediatric triage guidelines. A specially designed grid containing motivations was applied to those admitted to hospital on the basis of the Emergency Department judgement. The prospective investigation was facilitated by the computerised emergency department patient management system that has been operative in our department since June 2000.

RESULTS

A total of 22400 white code accesses were recruited into the study; the admission percentage was 3.7% (89 patients). The most frequent reason for hospitalisation was the need to clinically classify a pathology that persisted without a complete response.

CONCLUSION

This preliminary investigation will be pursued in the future with a collection of data for organisation type purposes and in order to contribute to greater hospital-local district integration.

Maternal MTHFR variant forms increase the risk in offspring of isolated nonsyndromic cleft lip with or without cleft palate

The pathogenesis of cleft lip with or without cleft palate (CL/P) is complex; its onset could be due to the interaction of various genetic and environmental factors. Recently MTHFR functional polymorphisms were found to increase the risk of this common malformation; however, this finding is still debated. We investigated 110 sporadic CL/P patients, their parents and 289 unrelated controls for c.665C>T (commonly known as 677C>T; p.Ala222Val) and c.1286A>C (known as 1298A>C; p.Glu429Ala) polymorphism in the MTHFR gene. Transmission disequilibrium test (TDT) showed no distortion in allele transmission. Nevertheless, association studies revealed significant differences in allele frequencies between mothers of CL/P patients and controls. This work supports the hypothesis that a lower MTHFR enzyme activity in pregnant women, mostly related to the c.665C>T variant form, is responsible for a higher risk of having CL/P affected offspring.

Current drug use as risk factor for erectile dysfunction: results from an Italian epidemiological study

Several drugs have been associated with an increased risk of erectile dysfunction (ED). We analysed the role of pharmacological treatments on the risk of ED using data from a cross-sectional study on prevalence and risk factors for ED in the general population in Italy. A total of 2450 men aged more than 18 years were randomly identified by 143 general practioners (GP) among their registered patients and invited to a confidential interview by their GP. Patients were asked 'about their ability to achieve and maintain an erection sufficient for satisfactory sexual performance'. If they were dissatisfied, they were defined as having ED. Out of the 2450 men identified, 440 (18%) refused to participate. The present analysis therefore includes information on 2010 men. After adjustment for related pathologies, anxiolytics and antidepressants showed insignificantly higher odds ratio (ORs, respectively, 1.7 and 2.1); antipsychotic drug use significantly increased the risk of ED (OR 9.0, 95% confidence interval, CI 1.8-44.4). Diuretics (OR 3.1, 95% CI 1.4-6.9) and anticholinergic drugs (OR 12.8, 95% CI 2.7-60.1) were associated with ED risk. No association emerged between ED and H2 antagonists, anticholesterolemic or hypoglycemic drugs. In conclusion, after taking account of related pathologies, our results suggest that men treated with antipsychotic, diuretic and anticholinergic drugs are at greater risk of ED.

One-trocar laparoscopy: a valid procedure to treat abdominal complications in children with peritoneal shunt for hydrocephalus

BACKGROUND

The aim of this paper is to show the efficacy of laparoscopy using only one umbilical trocar to treat abdominal complications of hydrocephalic children with ventriculoperitoneal shunts (VPS).

MATERIALS AND METHODS

In a 15-year period, 14 laparoscopies were performed on as many children with VPS complications: in the last 4 patients only one trocar was used to solve the complications, and this subgroup will be the object of the present study. Concerning the indication for surgery, the patients presented one catheter lost in the abdominal cavity; one cerebrospinal fluid pseudocysts; one bowel obstruction; and one malfunctioning peritoneal limbs of the catheter. We used the one-trocar laparoscopic approach in all the 4 patients, and the 10-mm trocar was always introduced through the umbilical orifice in open laparoscopy.

RESULTS

The laparoscopic technique was curative in all four cases and permitted the solution of the complication.

CONCLUSIONS

One-trocar laparoscopic surgery can be considered as the ideal procedure in case of abdominal complications of VPS in children with hydrocephalus.

Neurophysiologic evaluation of central-peripheral sensory and motor pudendal pathways in primary premature ejaculation

OBJECTIVES

Pudendal nerve somatosensory evoked potentials (SEPs), the bulbocavernosus (BC) reflex, and BC perineal motor evoked potentials after transcranial magnetic cortical stimulation were performed in patients with primary premature ejaculation to investigate the somatic sensory and motor function of the genital area.

METHODS

Fourteen patients with primary premature ejaculation underwent psychological counseling, urologic physical examination, transrectal ultrasound examination, laboratory testing, and the Stamey test. The spinal and cortical pudendal nerve SEPs were performed by dorsal nerve stimulation at the penile shaft (DN-SEPs) in all patients and at the glans penis (GP-SEPs) in 3 of them. The BC reflex was obtained by stimulating the base of the penis.

RESULTS

The mean sensory threshold did not significantly differ between the patients and normal subjects. Cortical DN-SEPs were normal in all patients. The sensory central conduction time, calculated in 6 patients, was normal. The mean cortical DN-SEP amplitude was significantly smaller in patients than in controls. In 3 patients and in 3 controls who underwent both DN-SEP and GP-SEP testing, the glans penis sensory threshold was lower than the dorsal nerve threshold and the cortical GP-SEP latency was longer than the cortical DN-SEP latency. The BC reflex was normal in most patients. The BC motor evoked potentials were normal in all patients, but one.

CONCLUSIONS

We did not confirm either a faster conduction along the pudendal sensory pathway or a greater cortical representation of the sensory stimuli from the genital area in our patients. Moreover, we did not confirm hyperexcitability of the BC reflex in them. Our results suggest that the electrophysiologic approach is probably not sufficient to clarify the causes of primary premature ejaculation. A more integrated investigation could allow better results in this field.

Female sexual dysfunction: an update on physiopathology

Despite the importance of sexuality for both men and women of all ages, only in the last few years extensive research has been carried out into female sexual problems. It has been discovered that sexual problems affect a considerable number of women each year, and this indicates the validity and necessity of further medical studies. We know that female genital sexual response is a combination of vasocongestive and neuromuscular events in the genital tract and pelvic floor which are controlled in part by specific neurotransmitters. Other pelvi-perineal genital structures undergo vasculogenic changes, namely the labia, periurethral glands, urethra and the Halban's fascia but much less attention has been paid to the role of these tissues in sexual response compared to the clitoris and the vagina. The most common etiologies of female sexual dysfunction are vasculogenic, neurogenic, hormonal/endocrine, muscologenic. The increasing various problems of female sexual dysfunction and the interest in the matter and the subsequent research are factors which keep the scientific community involved constantly active.

The genome of the natural genetic engineer Agrobacterium tumefaciens C58

The 5.67-megabase genome of the plant pathogen Agrobacterium tumefaciens C58 consists of a circular chromosome, a linear chromosome, and two plasmids. Extensive orthology and nucleotide colinearity between the genomes of A. tumefaciens and the plant symbiont Sinorhizobium meliloti suggest a recent evolutionary divergence. Their similarities include metabolic, transport, and regulatory systems that promote survival in the highly competitive rhizosphere; differences are apparent in their genome structure and virulence gene complement. Availability of the A. tumefaciens sequence will facilitate investigations into the molecular basis of pathogenesis and the evolutionary divergence of pathogenic and symbiotic lifestyles.

Central precocious puberty in a girl with triple X syndrome and neonatal diabetes mellitus associated with paternal isodisomy of chromosome 6

We describe a girl with triple X syndrome and paternal isodisomy of chromosome 6 (UPD6), who developed neonatal diabetes mellitus (NDM) and precocious puberty. At birth she presented growth retardation and congenital anomalies (ventricular septal defect, macroglossia, umbilical hernia). Diabetes mellitus (DM) was diagnosed at 31 days of life and treated with insulin for 13 months. DM recurred at 4 years of age and since that time it required insulin, in spite of preserved beta-cell function. Tall stature was present from early childhood. At 7 years of age the girl presented central precocious puberty, height velocity further increased, but her near-final height was normal. This patient is unique in that precocious puberty has never been described in triple X females. Moreover it is a further example of paternal UPD6 causing NDM with a predisposition to type 2 DM in later life.

Economics of reservoir sedimentation and sustainable management of dams

Accepted practice has been to design and operate reservoirs to fill with sediment, generating benefits from remaining storage over a finite period of time. The consequences of sedimentation and project abandonment are left to the future. This 'future' has already arrived for many existing reservoirs and most others will eventually experience a similar fate, thereby imposing substantial costs on society. Such costs could be avoided if sedimentation was minimized and dams were allowed to live forever. The fact that the world's inventory of suitable reservoir sites is limited provides an additional reason for encouraging the sustainable management of dams. This paper provides a framework for assessing the economic feasibility of sediment management strategies that would allow the life of dams to be prolonged indefinitely. Even if reduced accumulation or removal of sediment is technically possible, its economic viability is likely to depend on physical, hydrological and financial parameters. The model presented incorporates such factors and allows a characterization of conditions under which sustainable management would be desirable. The empirical implementation of the model draws upon the substantial amount of technical information available. We analyze the sustainability of reservoirs, with a focus on the trade-off between such sustainability and the short to medium term benefits which a reservoir is expected to produce. The results show that, for a very wide range of realistic parameter values, sustainable management of reservoirs is economically more desirable than the prevailing practice of forcing a finite reservoir life through excessive sediment accumulation.

Variations of proline-rich kinase Pyk2 expression correlate with prostate cancer progression

Proline-rich kinase 2 (Pyk2), also known as CAKbeta (cell adhesion kinase beta), is a cytoplasmic tyrosine kinase that is structurally related to focal adhesion kinase. Pyk2 is expressed in different cell types including brain cells, fibroblasts, platelets, and other hemopoietic cells. Pyk2 is rapidly tyrosine phosphorylated in response to diverse extracellular signals acting via different post receptor pathways. We have investigated whether this protein kinase is functionally expressed in normal and neoplastic prostate tissues. In this study, we demonstrate that Pyk2 is expressed only in normal epithelial prostate tissue and in benign prostatic hyperplasia, whereas its expression progressively declines with an increasing grade of malignancy of prostate cancer.

[Ultrasound-guided ESWT in Peyronie's disease plaques]

The aim of the study was to check the efficiency of shock waves in the treatment of Peyronie's disease. The instrument, because of its lithotriptic power, already used in the treatment of orthopedic disease and salivary stones, can be used to break plaques in induratio penis plastica. A total of 481 patients affected with Peyronie's disease were entered into a prospective trial. Patients with big plaques or with an initial stage of degeneration were excluded. We divided the patients into three treatment groups: a) shock waves alone in 56 patients; b) a combination of shock waves and calcioantagonist (perilesional injection) in 324 patients; c) calcioantagonist alone in 101 patients. The group of 101 patients (group C) treated during the previous 2 years with a medical therapy based only on the injection of calcioantagonist, was used as a control group. Ultrasound evaluation of the treated plaques showed a reduction of size in 27/56 patients of the group A, in 159/324 patients of the group B and in 39/101 patients of group C. Painful erection improved in the 91.5% of group B, against the 45.7% of group C. Furthermore, we pointed out, with interviews to the patients, a considerable improvement of the pain and of the sexual performances. The therapeutic association of shock waves with calcioantagonist injections is an effective non-operative treatment for the stabilization of Peyronie's disease.

A standardized procedure for using human corpus cavernosum strips to evaluate drug activity

The main problem of using human corpus cavernosum (HCC) tissue to perform bioassay is linked to its limited availability further complicated by the heterogeneous source of the tissues used. Here, we show that gender reassignment is a reliable source of human tissue without major ethical problems. Indeed, the entire corpus cavernosum is obtained from the surgery procedure, which allows creating a standardized procedure to prepare HCC strip. In addition, human tissue, if kept in the fridge in the condition described, does not loose its ability to contract to phenylephrine (PE; alpha agonist), angiotensin II (AG II) and KCl up to 4 days. Furthermore, once contracted with PE, HCC relaxes to acetylcholine (endothelium-dependent mechanism); sodium nitroprusside (endothelium-independent mechanism); cromakalim (CRK), a K(ATP) channel opener; or alprostadil, a synthetic PGE2 (ALPR). In conclusion, we have standardized a procedure that allows the use of HCC strips to evaluate drug activity and/or to study pathophysiological mechanisms with an intact functional human tissue up to 4 days from the surgery procedure.