Implant surgery in Peyronie's disease

The etiology and evolution of Peyronie's disease are not well known, and this certainly affects patient management. If spontaneous regression or stabilization of the disease is lacking, actually all therapies, except surgery, seem to be only partially successful. We attended 88 patients affected by Peyronie's disease, and 21 patients (23.6%) were referred for surgery and penile implantation; plaque excision was necessary in 8 patients (38.1%). We implanted 10 malleable prostheses and 11 soft prostheses. So far, potency has been the only parameter for evaluating the results of surgery, but in our view both the patient and his partner should be satisfied aesthetically and functionally.

Tilt test results in young and elderly patients with syncope of unknown origin

The effects of aging on the results of prolonged drug-free tilt testing were studied in 175 consecutive patients with unexplained syncope divided into 3 groups: 59 patients < 40 years old; 57 patients between 40 and 60 years; and 59 patients > 60 years old. Tilt-induced vaso-vagal syncope occurred respectively in 17 (29%), 20 (35%), and 18 patients (31%) in the 3 age groups. Vasodepressor, mixed, and cardioinhibitory vaso-vagal syncope occurred similarly in the 3 groups; organic heart disease and systemic hypertension were more frequent in elderly patients without affecting the incidence of tilt-induced syncope. Blood pressure and heart rate variations during syncope were similar in the 3 age groups; in the first 20 minutes of tilt testing, before the appearance of the vaso-vagal reflex, elderly patients showed greater reduction in blood pressure and smaller increase in heart rate than younger patients. Our data indicate that increasing age determines a different blood pressure and heart rate behavior during tilt testing, but apparently does not influence the incidence of vaso-vagal syncope in patients with syncope of undetermined etiology. As the proportion of patients with a positive isoproterenol tilt test was reported to decline with age, our results suggest that the reduced incidence of syncope during isoproterenol tilt testing could be the expression of impaired autonomic response among elderly syncope patients.

Malaric placentas. A quantitative study and clinico-pathological correlations

A histological and morphometric study was conducted on 372 placentae out of a total 440 delivered in Zanzibar. Fibrin (F), intervillous space (IVS) and Villi (V) relative volumes were determined by the point-counting system and the ratio of syncytium to blood capillaries by the linear intercept method. Parasitemia load and inflammatory reaction were graded semiquantitatively by the use of a 1 mm square grid. Parasitised red cells identified active malaria (AM), the presence of malarial pigment only identified past malaria (PM), and the absence of both characterized non-malarial placentae (NM). AM(17.87%), PM(21.61%) and NM(60.52%) placentae did not vary significantly in weight. Newborns from AM had a significantly lower weight than those from PM and NM. Peripheral and placental parasitemia were not coincident. Placental parasitemia load increased parallel with birthweight. The latter decreased with the increasing severity of the inflammation, particularly with the prevalence of lymphocytes in the IVS. Significantly increased volume of F was found in AM and PM placentae, while no significant variation was noticed in IVS and V volumes. The syncytium/capillaries ratio was significantly increased in AM. We conclude that low birthweight in malaria is linked to IVS inflammation but not to F deposits or parasitemia load. Non-leukotactic lymphokines might play some role. Morphologic aspects bespeak for a less mature placenta than expected and this might represent an adaptive change.

Protein nitrogen appearance in CAPD patients: what is the best formula?

BACKGROUND

The protein equivalent of nitrogen appearance is an indirect index commonly used to assess dietary protein intake in patients on CAPD. Moreover it has been suggested that the ratio between nitrogen appearance and dietary nitrogen intake (fractional urea synthesis) can predict nitrogen balance in uraemic patients. Several formulae to directly calculate the protein equivalent of nitrogen appearance have been published. It has not been established, however, what formulae give the most appropriate estimate of protein intake and nitrogen appearance.

STUDY DESIGN

Nitrogen balance studies were carried out in seven stable patients on CAPD. All of the patients were receiving a diet whose protein content (1.2 g/kg/body wt/day) and calorie content (35 kcal/kg/body wt/day) were rigorously controlled. Six formulae for calculating protein equivalent of nitrogen appearance and nitrogen appearance were tested and the agreement of the estimating formulae was evaluated by means of the Bland and Altman method.

RESULT

Net nitrogen balance was 1.68 +/- 0.9 g/N day, protein intake (g/day) 81 +/- 19, protein intake (g/kg) 1.05 +/- 0.17. Differences in protein equivalent of nitrogen appearance of up to about 20% were found. The smallest differences between protein equivalent of nitrogen appearance and protein intake were obtained by the formulae of Bergstrom (1 +/- 7 g, limits of agreement -12 and +15 g) and Blumenkrantz (-2 +/- 5 g, limits of agreement -11 and +7 g). The formula of Bergstrom most closely estimated nitrogen appearance (-0.35 +/- 0.89 g). Using such formula, the fractional urea synthesis was 54 +/- 12%, giving evidence of positive nitrogen balances.

CONCLUSION

For the routine monitoring of protein equivalent of nitrogen appearance in CAPD patients, we recommend Bergstrom's formula with the determination of dialysate protein losses.

Conservative surgery and quality of life in a young patient with synchronous bilateral embryonal carcinoma

Synchronous bilateral testicular germ cell tumours are rare. We report a case with retroperitoneal node involvement (stage IIb). Testis-sparing surgery, followed by systemic PEB chemotherapy, was performed instead of bilateral radical orchiectomy plus retroperitoneal lymphadenectomy. A good quality of life was obtained. Management of the case and review of the literature are presented.

p53 protein expression in fine-needle aspirates of breast cancer: an immunocytochemical assay for identifying high-grade ductal carcinomas

The expression of the p53 gene product was investigated immunocytochemically in a series of 51 fine-needle aspiration (FNA) samples of breast carcinomas. Results were compared with those obtained by immunocytochemically on paraffin embedded tissue sections of the corresponding surgical specimens. Cytological samples showed a variable degree of p53 immunoreactivity in 14 tumors (27.6%), all of ductal type, while p53 immunoreactive tumor cells were present in tissue sections from 15 carcinomas (29.4%). The only discordant case was a signet-ring cell carcinoma. Abnormal p53 expression was significantly associated with high nuclear grade in ductal carcinomas. No association was seen with tumor size, lymph node status, and age of the patient. Detection of p53 altered expression in FNA samples of breast carcinoma may play a role in the assessment of tumoral grading and is predictive of p53 immunoreactivity in histological specimens.

[11 cases of erythema multiforme. The etiological correlations and therapy]

Erythema multiforme (EM) is characterised by a polymorphous eruptive complex which many involve the cutis and oral, genital and conjunctival mucous. Its etiopathogenesis is unclear: it is thought to be associated with various viral or bacterial infective agents (herpes virus, Coxsackie virus, mycoplasmas, etc.), numerous drugs, physical therapy, systemic pathologies of various types. The authors report their experience in relation to 11 patients suffering from EM; the clinical characteristics of each case are reported, together with the course of disease, and the diagnostic and therapeutic protocol adopted. The discussion examines the possible cause of disease: in 5 patients the etiology was traced back to viral infections (4 herpes and 1 coxsackie) and to the administration of drugs in the remaining cases (4 in relation to anti-phlogistic agents and 2 regarding antibiotics).

[Vesico-cutaneous fistula of the thigh as a late manifestation]

Vesico-cutaneous fistulas rarely occur in the urinary tract (1.7% of all urinary fistulas). Trauma, neoplasias, inflammation and iatrogenic pathologies are among the principal causes. The external mouth of the fistula is usually found in the hypogastric area, scrotum, perineum and rarely elsewhere. This report describes the case of a 48 year old woman who, after severe trauma suffered bladder laceration, treated only with cystorraphy. Sepsis and gangrene followed involving the pubic area and the right thigh, associated with acute renal and adrenal gland cortex failure. After emergency treatment, the patient was discharged with an indwelling catheter. Ten months later she was referred to our urology clinic because of a suspected bladder-vaginal fistula. The indwelling catheter was removed and the bladder resumed functioning well. Six months later the external mouth of the fistula appeared on the right inner thigh. NMR confirmed the diagnosis of a vesico-cutaneous fistula. Surgery resolved the abnormality.

[Nucleolar organizer regions of benign pathology of the parathyroids]

Nucleolar organizer regions (NOR) have DNA loops containing genes that encode for ribosomal RNA; some proteins located near the NORs are argyrophilic and by Ploton's one step method we could quantify the NORs in sections of paraffin embedded tissues. We have evaluated the number of intranuclear dots in 46 parathyroid glands from 18 parathyroidectomies. The glands were weighed and the stromal fat was evaluated by a point-counting method. AgNORs were counted in 100 cells from each gland. The mean count was 3.03 in six adenomas (A), 2.39 in six cases of primary hyperparathyroidism (PH) and 2.63 in six cases of secondary hyperparathyroidism (SH). Statistical analysis performed by Mann-Whitney U test showed that differences between A and PH groups were significant. The difference between A and SH was also significant. The residual parathyroid tissue surrounding the adenoma had a significantly lower AgNOR mean count than adenomatous cells. The AgNOR mean number can be useful in assessing normal or suppressed parathyroid tissue.

[Vesico-intestinal fistula in Crohn disease: the role of echography in its diagnosis]

Ultrasound is in widespread use in the study of gastrointestinal pathologies. In Crohn disease it is helpful in diagnosing complications such as thickening of the bowel loop walls, abscesses, lymph node enlargement and vesical-enteric fistulas. This report presents two cases in which vesical-enteric fistulas were visualized by US; confirming a diagnosis of Crohn's disease in one case, and diagnosing the fistula during the follow-up in the second patient in whom Crohn's disease had previously been diagnosed.

Multiple minute digitate hyperkeratoses

A case of non-familial multiple digitate hyperkeratosis is reported. Digitate hyperkeratosis is a new, non-follicular disorder of keratinization and three different types have been distinguished in the literature: the familial type, with an autosomal dominant trait; the sporadic type; and the post-inflammatory type.

[Morphometric evaluation and AgNOR number in c-erbB-2 positive and negative breast carcinoma: absence of correlation]

A total of 722 nuclei from 22 fine needle aspirates (FNA) of breast carcinomas have been subjected to quantitative nuclear analysis. Form Factor, Nuclear Area and Nuclear Major Diameter were determined for each case. An equal number of nuclei from as many aspirates from benign breast nodules was used as control. The aim of the study was to evaluate the predictive value of these parameters on the result of the immunohistochemical determination of the c-erb B-2 antigen in the tumour mass, since 6 of the 22 carcinomas were positive to this antigen. None of these parameters singly or in combination proved of any value in predicting the positive or negative result of the c-erb B-2 antigen determination. Nuclei both positive and negative for the antigen were located within the large cell carcinomas. Nucleolar Organizer Regions were also determined on the histologic sections of both groups to assess any statistically significant difference not only between controls and carcinomas, but also between c-erb B-2 positive and negative cases. Both NOR mean numbers and NOR cytograms were of no use, since no difference was found between c-erb B-2 positive and negative cases.

Prevention of post-herpetic neuralgia. Evaluation of treatment with oral prednisone, oral acyclovir, and radiotherapy

The effects of prednisone, oral acyclovir, and radiotherapy were compared with placebo in the prevention of post-herpetic neuralgia. No treatment used was able to prevent, with statistical significance, post-herpetic neuralgia, although prednisone and acyclovir showed some pain reduction in the acute phase. Radiotherapy was of no value in either the acute or post-herpetic phase.

Human normal-resting epidermal Langerhans cells do express the type 3 complement receptor

The expression of CR3 by murine-resting epidermal Langerhans cells (LC) is well established, but CR3 expression by human normal-resting epidermal LC has not yet been demonstrated. In this study, highly sensitive immunostaining techniques, such as immunogold labelling in transmission- and scanning-electron microscopy, were used on freshly isolated, LC-enriched, normal human epidermal cells. Human normal resting epidermal LC were found to be CR3+, since a low but significant number of gold granules labelled the plasma membrane of all the LC observed under transmission-electron microscopy, and all the epidermal cells showing LC morphology as observed by scanning-electron microscopy.

[Fluconazole in the treatment of dermatomycoses. Clinical experience]

Twenty patients suffering from dermatomycosis have been treated with fluconazole at the dose of 50 mg/daily for 20 days. These patients (10 M + 10 F) were aged 36 years on average (range 17-65 years). And were suffering from the following: Tinea pedis (3 cases), Tinea cruris (1 case), Tinea corporis (9 cases), Tinea versicolor (3 cases), Candidiasis (5 cases). One patient was suffering from Tinea on two different body sites. 19 patients finished the treatment and reported a complete clinical and mycological healing either at the end of the therapy on at follow-up visits. One patient, who was already suffering from gastritis, had to interrupt the therapy early due to abdominal pain. General safety was excellent.

Function of the anal sphincters following anterior resections of rectum

The purpose of the present work is to evaluate the function of the anal sphincter following anterior resections of the rectum. Our data have shown that the anorectal reflex did not depend on the presence of the rectal mucosa. The external anal sphincter contraction involves a reflex which is initiated by stretch receptors in the levator ani muscle. The internal anal sphincter relaxation is likely a local reflex involving nerve pathways not yet completely defined.