Monitoring of the heavy-ion beam distribution using poly- and monochromatic x-ray fluorescence imaging

In this work, the first proof of the principal of an in situ diagnostics of the heavy-ion beam intensity distribution in irradiation of solid targets is proposed. In this scheme, x-ray fluorescence that occurs in the interaction of heavy-ions with target atoms is used for imaging purposes. The x-ray conversion to optical radiation and a transport-system was developed, and its first test was performed in experiments at the Universal Linear Accelerator in Darmstadt, Germany. The Au-beam intensity distribution on thin foils and Cu-mesh targets was imaged using multiple x-ray pinholes (polychromatic imaging) and 2D monochromatic imaging of Cu K_α radiation by using a toroidally bent silicon crystal. The presented results are of importance for application in experiments on the investigation of the equation of states of high energy density matter using high intensity GeV/u heavy-ion beams of ≥10¹⁰ particles/100 ns.

Postacute Sequelae of COVID-19 Pneumonia: 6-month Chest CT Follow-up

Background

The long-term post acute pulmonary sequelae of COVID-19 remain unknown.

Purpose

To evaluate lung injury in patients affected by COVID-19 pneumonia at six-month follow-up compared to baseline chest CT.

Methods

From March 19th,2020 to May 24th,2020, patients with moderate to severe COVID-19 pneumonia and baseline Chest CT were prospectively enrolled at six-months follow-up. CT qualitative findings, semi-quantitative Lungs Severity Score (LSS) and well-aerated lung quantitative Chest CT (QCCT) were analyzed. Baseline LSS and QCCT performances in predicting fibrotic-like changes (reticular pattern and/or honeycombing) at six-month follow-up Chest CT were tested with receiver operating characteristic curves. Univariable and multivariable logistic regression analysis were used to test clinical and radiological features predictive of fibrotic-like changes. The multivariable analysis was performed with clinical parameters alone (clinical model), radiological parameters alone (radiological model) and the combination of clinical and radiological parameters (combined model).

Results

One-hundred-eighteen patients, with both baseline and six-month follow-up Chest CT, were included in the study (62 female, mean age 65±12 years). At follow-up Chest CT, 85/118 (72%) patients showed fibrotic-like changes and 49/118 (42%) showed GGOs. Baseline LSS (>14), QCCT (≤3.75L and ≤80%) showed an excellent performance in predicting fibrotic-like changes at Chest CT follow-up. In the multivariable analysis, AUC was .89 (95%CI .77-.96) for the clinical model, .81 (95%CI .68-.9) for the radiological model and .92 (95%CI .81-.98)for the combined model.

Conclusion

At six-month follow-up Chest CT, 72% of patients showed late sequelae, in particular fibrotic-like changes. Baseline LSS and QCCT of well-aerated lung showed an excellent performance in predicting fibrotic-like changes at six-month Chest CT (AUC>.88). Male sex, cough, lymphocytosis and QCCT well-aerated lung were significant predictors of fibrotic-like changes at six-month with an inverse correlation (AUC .92).

See also the editorial by Wells and Devaraj.

Radiomics in Oncology, Part 2: Thoracic, Genito-Urinary, Breast, Neurological, Hematologic and Musculoskeletal Applications

Simple Summary

This Part II is an overview of the main applications of Radiomics in oncologic imaging with a focus on diagnosis, prognosis prediction and assessment of response to therapy in thoracic, genito-urinary, breast, neurologic, hematologic and musculoskeletal oncology. In this part II we describe the radiomic applications, limitations and future perspectives for each pre-eminent tumor. In the future, Radiomics could have a pivotal role in management of cancer patients as an imaging tool to support clinicians in decision making process. However, further investigations need to obtain some stable results and to standardize radiomic analysis (i.e., image acquisitions, segmentation and model building) in clinical routine.

Abstract

Radiomics has the potential to play a pivotal role in oncological translational imaging, particularly in cancer detection, prognosis prediction and response to therapy evaluation. To date, several studies established Radiomics as a useful tool in oncologic imaging, able to support clinicians in practicing evidence-based medicine, uniquely tailored to each patient and tumor. Mineable data, extracted from medical images could be combined with clinical and survival parameters to develop models useful for the clinicians in cancer patients’ assessment. As such, adding Radiomics to traditional subjective imaging may provide a quantitative and extensive cancer evaluation reflecting histologic architecture. In this Part II, we present an overview of radiomic applications in thoracic, genito-urinary, breast, neurological, hematologic and musculoskeletal oncologic applications.

Radiomics in Oncology, Part 1: Technical Principles and Gastrointestinal Application in CT and MRI

Simple Summary

Part I is an overview aimed to investigate some technical principles and the main fields of radiomic application in gastrointestinal oncologic imaging (CT and MRI) with a focus on diagnosis, prediction prognosis, and assessment of response to therapy in gastrointestinal cancers, describing mostly the results for each pre-eminent tumor. In particular, this paper provides a general description of the main radiomic drawbacks and future challenges, which limit radiomic application in clinical setting as routine. Further investigations need to standardize and validate the Radiomics as a helpful tool in management of oncologic patients. In that context, Radiomics has been playing a relevant role and could be considered as a future imaging landscape.

Abstract

Radiomics has been playing a pivotal role in oncological translational imaging, particularly in cancer diagnosis, prediction prognosis, and therapy response assessment. Recently, promising results were achieved in management of cancer patients by extracting mineable high-dimensional data from medical images, supporting clinicians in decision-making process in the new era of target therapy and personalized medicine. Radiomics could provide quantitative data, extracted from medical images, that could reflect microenvironmental tumor heterogeneity, which might be a useful information for treatment tailoring. Thus, it could be helpful to overcome the main limitations of traditional tumor biopsy, often affected by bias in tumor sampling, lack of repeatability and possible procedure complications. This quantitative approach has been widely investigated as a non-invasive and an objective imaging biomarker in cancer patients; however, it is not applied as a clinical routine due to several limitations related to lack of standardization and validation of images acquisition protocols, features segmentation, extraction, processing, and data analysis. This field is in continuous evolution in each type of cancer, and results support the idea that in the future Radiomics might be a reliable application in oncologic imaging. The first part of this review aimed to describe some radiomic technical principles and clinical applications to gastrointestinal oncologic imaging (CT and MRI) with a focus on diagnosis, prediction prognosis, and assessment of response to therapy.

Deep Learning Can Differentiate IDH-Mutant from IDH-Wild GBM

Isocitrate dehydrogenase (IDH) mutant and wildtype glioblastoma multiforme (GBM) often show overlapping features on magnetic resonance imaging (MRI), representing a diagnostic challenge. Deep learning showed promising results for IDH identification in mixed low/high grade glioma populations; however, a GBM-specific model is still lacking in the literature. Our aim was to develop a GBM-tailored deep-learning model for IDH prediction by applying convoluted neural networks (CNN) on multiparametric MRI. We selected 100 adult patients with pathologically demonstrated WHO grade IV gliomas and IDH testing. MRI sequences included: MPRAGE, T1, T2, FLAIR, rCBV and ADC. The model consisted of a 4-block 2D CNN, applied to each MRI sequence. Probability of IDH mutation was obtained from the last dense layer of a softmax activation function. Model performance was evaluated in the test cohort considering categorical cross-entropy loss (CCEL) and accuracy. Calculated performance was: rCBV (accuracy 83%, CCEL 0.64), T1 (accuracy 77%, CCEL 1.4), FLAIR (accuracy 77%, CCEL 1.98), T2 (accuracy 67%, CCEL 2.41), MPRAGE (accuracy 66%, CCEL 2.55). Lower performance was achieved on ADC maps. We present a GBM-specific deep-learning model for IDH mutation prediction, with a maximal accuracy of 83% on rCBV maps. Highest predictivity achieved on perfusion images possibly reflects the known link between IDH and neoangiogenesis through the hypoxia inducible factor.

Typical and atypical COVID-19 computed tomography findings

In December 2019 a novel coronavirus, named severe acute respiratory syndrome coronavirus 2 was identified and the disease associated was named coronavirus disease 2019 (COVID-19). Fever, cough, myalgia, fatigue associated to dyspnea represent most common clinical symptoms of the disease. The reference standard for diagnosis of severe acute respiratory syndrome coronavirus 2 infection is real time reverse-transcription polymerase chain reaction test applied on respiratory tract specimens. Despite of lower specificity, chest computed tomography (CT), as reported in manifold scientific studies, showed high sensitivity, therefore it may help in the early detection, management and follow-up of COVID-19 pneumonia. Patients affected by COVID-19 pneumonia usually showed on chest CT some typical features, such as: Bilateral ground glass opacities characterized by multilobe involvement with posterior and peripheral distribution; parenchymal consolidations with or without air bronchogram; interlobular septal thickening; crazy paving pattern, represented by interlobular and intralobular septal thickening surrounded by ground-glass opacities; subsegmental pulmonary vessels enlargement (> 3 mm). Halo sign, reversed halo sign, cavitation and pleural or pericardial effusion represent some of atypical findings of COVID-19 pneumonia. On the other hand lymphadenopathy's and bronchiectasis' frequency is unclear, indeed conflicting data emerged in literature. Radiologists play a key role in recognition of high suspicious findings of COVID-19 on chest CT, both typical and atypical ones. Thus, the aim of this review is to illustrate typical and atypical CT findings of COVID-19.

A five year retrospective study on Syphilis in the Sexual Transmitted Disease Centre (STDC) of the teaching Hospital Umberto I in Rome

OBJECTIVES

A retrospective study describing syphilis epidemiological and clinical features in patients referring to an infectious diseases centre in Rome, Italy.

METHODS

Between January 2011 and December 2015 demographic, behavioral and clinical data were collected from all adult patients attending the Sexually Transmitted Diseases Centre of the Teaching Hospital Umberto I in Rome.

RESULTS

Overall 723 patients, 495 males and 228 females, with syphilis infection diagnosis were included. Average age 39.6 ± 13.6 years (median 38) was higher in men than women (41.1 ± 13.6 vs. 36.3 ± 13.1; p<0.001). Patients were from Italy (486 or 67.2%), EU (90 or 12.4%), rest of Europe (38 or 5.3 %), Americas (46 or 6.4%), Africa (36 or 5.0%) and Asia (27 or 3.7%). One-hundred-twenty-three (17.0%) presented primary syphilis, 43 (5.9%) secondary syphilis, 8 (1.1%) tertiary syphilis, 246 (34.0%) serological syphilis, 80 (11.1%) preceding syphilis, 56 (7.7%) gravidic syphilis and 167 (23.1%) came to the Sexually Transmitted Diseases Centre to control a preceding syphilis treatment. Fifty-six (24.6%) women were diagnosed with syphilis during their pregnancies. Among Chinese female patients, those pregnant represented 87.5%. There were 100 subjects (13.8%) simultaneously HIV+ and 623 (86.2%) HIV- patients. HIV co-infection affected more frequently men (RR 5.30; CI 2.62 - 10.72; p<0.001). In males HIV co-infection affected more frequently homosexuals (RR 11.72; CI 6.72 - 20.45; p<0.001). Overall HIV co-infection affected more frequently foreign patients, specially from the Americas (26.1%), Africa (25.7%) and Asia (22.2%).

CONCLUSION

A serious problem of "gravidic syphilis" suggests the need for Public Health preventive action. Also an early diagnosis of both syphilis and HIV infection should be reinforced.

Electrochemical behaviour of a cobalt-chromium-molybdenum dental alloy in artificial salivas: Influence of phosphate ions and mucin components

The stability of the Co-Cr-Mo dental alloy immersed in artificial salivas (pH 6.7) was investigated over 24 h. Three artificial salivas have been studied: saline saliva (saliva I); saline saliva buffered with phosphate ions (saliva II) and saliva II plus mucin molecules (saliva III). For all the systems, open circuit potential shift positively over 24 hours of immersion. Data extracted from the steady-state polarization curves demonstrated that the Co-Cr-Mo alloy has higher corrosion potential in saliva III, lower corrosion potential in saliva I and lower initial corrosion resistance in saliva III. After 24 hours of immersion in the artificial salivas, the Co-Cr-Mo alloy presents high corrosion stability, due to the protective action created by the presence of corrosion products. From the analysis of the breakdown potential it was concluded that, the presence of the phosphate ions and mucin promote the oxidation process, inducing the formation of etch pits. Regarding the effect of the mucin concentration in the corrosion behaviour of the Co-Cr-Mo dental alloy, it was observed a negative shift in the corrosion potential, pointing to a cathodic inhibitor role for the mucin molecules. Nevertheless, no correlation between the mucin concentration and corrosion rate was possible to establish.

Long-term outcomes and risk factors for failure with the EX-press glaucoma drainage device

PURPOSE

To report on the long-term outcomes and risk factors for failure with the EX-PRESS shunt implanted under a scleral flap.

SETTINGS

Eye Department, University of Ancona, Ancona, Italy and the Oxford Eye Center, University of Witwatersrand, Johannesburg, South Africa.

METHODS

The medical records of glaucoma patients who underwent consecutive EX-PRESS implantations under a scleral flap between 2000 and 2009 were reviewed. The operations were performed by two experienced surgeons using an identical surgical technique. The potential risk factors for failure that were analysed included age, sex, race, glaucoma type, previous antiglaucoma medications, previous glaucoma surgeries, diabetes, and smoking. Complete success was defined as postoperative intraocular pressure (IOP) 5 mm Hg>IOP<18 mm Hg without antiglaucoma medications. Qualified success was defined as 5 mm Hg>IOP<18 mm Hg with or without antiglaucoma medications.

RESULTS

Two hundred and forty-eight eyes of 211 consecutive patients were included. The mean IOP was reduced from 27.63 ± 8.26 mm Hg preoperatively (n=248) to 13.95 ± 2.70 mm Hg at 5 years (n=95). The mean follow-up was 3.46 ± 1.76 years. Complete and qualified success rates decreased gradually from 83% and 85% at 1 year to 57% and 63% at 5 years follow-up, respectively. The risk factors for failure were diabetes, non-Caucasian race, and previous glaucoma surgery. Complete success rates of diabetic patients and non-Caucasian patients decreased from 63% and 75% at 1 year to 42% and 40% at 5 years follow-up, respectively.

CONCLUSIONS

EX-PRESS success rates decrease over time but compare favourably with trabeculectomy literature data. The main identifiable risk factors for failure are diabetes, non-Caucasian race, and previous glaucoma surgery.

An ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality

OBJECTIVES

In 2006, Médecins sans Frontières (MSF) established an emergency obstetric and neonatal care (EmONC) referral facility linked to an ambulance referral system for the transfer of women with obstetric complications from peripheral maternity units in Kabezi district, rural Burundi. This study aimed to (i) describe the communication and ambulance service together with the cost; (ii) examine the association between referral times and maternal and early neonatal deaths; and (iii) assess the impact of the referral service on coverage of complicated obstetric cases and caesarean sections.

METHODS

Data were collected for the period January to December 2011, using ambulance log books, patient registers and logistics records.

RESULTS

In 2011, there were 1478 ambulance call-outs. The median referral time (time from maternity calling for an ambulance to the time the patient arrived at the MSF referral facility) was 78 min (interquartile range, 52-130 min). The total annual cost of the referral system (comprising 1.6 ambulances linked with nine maternity units) was € 85 586 (€ 61/obstetric case transferred or € 0.43/capita/year). Referral times exceeding 3 h were associated with a significantly higher risk of early neonatal deaths (OR, 1.9; 95% CI, 1.1-3.2). MSF coverage of complicated obstetric cases and caesarean sections was estimated to be 80% and 92%, respectively.

CONCLUSION

This study demonstrates that it is possible to implement an effective communication and transport system to ensure access to EmONC and also highlights some of the important operational factors to consider, particularly in relation to minimising referral delays.

Achieving the millennium development goal of reducing maternal mortality in rural Africa: an experience from Burundi

OBJECTIVES

To estimate the reduction in maternal mortality associated with the emergency obstetric care provided by Médecins Sans Frontières (MSF) and to compare this to the fifth Millennium Development Goal of reducing maternal mortality.

METHODS

The impact of MSF's intervention was approximated by estimating how many deaths were averted among women transferred to and treated at MSF's emergency obstetric care facility in Kabezi, Burundi, with a severe acute maternal morbidity. Using this estimate, the resulting theoretical maternal mortality ratio in Kabezi was calculated and compared to the Millennium Development Goal for Burundi.

RESULTS

In 2011, 1385 women from Kabezi were transferred to the MSF facility, of whom 55% had a severe acute maternal morbidity. We estimated that the MSF intervention averted 74% (range 55-99%) of maternal deaths in Kabezi district, equating to a district maternal mortality rate of 208 (range 8-360) deaths/100,000 live births. This lies very near to the 2015 MDG 5 target for Burundi (285 deaths/100,000 live births).

CONCLUSION

Provision of quality emergency obstetric care combined with a functional patient transfer system can be associated with a rapid and substantial reduction in maternal mortality, and may thus be a possible way to achieve Millennium Development Goal 5 in rural Africa.

Nephron-sparing surgery versus radical nephrectomy in the treatment of renal cell carcinoma up to 7 cm

Purpose

To compare the oncological outcome of nephron-sparing surgery versus radical nephrectomy in renal cell carcinoma up to 7 cm by retrospectively reviewing our surgical experience.

Materials and Methods

Data collected from 1290 consecutive patients, who underwent surgery for renal carcinoma, have been stored since 1983 into a dedicated database. The cases with unilateral carcinoma up to 7 cm, pT1a/pT1b/pT3a N0/Nx M0, followed up for a minimum of 12 months if disease-free were reviewed.

Results

732 patients were selected (mean follow-up: 72 months); 329 had a tumor less than 4 cm in diameter (182 cases of nephron-sparing surgery, 147 cases of nephrectomy), while for 403 of them the tumor was 4 cm or more (57 cases of nephron-sparing surgery, 346 cases of nephrectomy). The comparison between tumors less and equal to/more than 4 cm showed worse progression and disease-free survival rates for the latter, even though the type of surgery (nephron-sparing or radical) had no significant impact. Patients with extracapsular carcinoma >4 cm, treated with nephron-sparing surgery, had a particularly poor prognosis.

Conclusions

The conservative management can be cautiously suggested for renal cancers up to 7cm, since the prognosis worsens proportionally with the diameter increase, with no statistical difference for both nephron-sparing and radical surgery. Nephron-sparing surgery proved to be the suitable treatment modality also for pT3a tumors measuring <4 cm, whereas when the tumor size increases, an adequate intraoperative evaluation of peritumoral tissues is essential to rule out fat infiltration. These results comply with the few similar studies available in literature, and suggest the possibility of designing a prospective study aiming at comparing conservative and radical surgery in the management of renal carcinoma up to 7 cm.

The role of hypoxia in erectile dysfunction mechanisms

Chronic hypoxia is related to many pathological conditions: aging, heart and respiratory failure, sleep apneas, smoke, chronic obstructive pulmonary disease (COPD), diabetes, hypertension and arteriosclerosis, all characterized by reductions of sleep-related erections (SREs) and by erectile dysfunction (ED). Sleep-related erections occur naturally during rapid eye movement (REM) sleep in sexually potent men. Hypoxia is also a physiological condition at altitude. The level of inspired oxygen decreases progressively with the increase of altitude; for this reason, this study was performed to evaluate the relationship of SREs with hypoxic environment. SREs have been recorded by an erectometer (RigiScan) on three mountain climbers (mean age: 32.5) during a 26-day stay at an altitude ranging from 2000 to 5600 m above sea level. Twenty-four records have been made at progressively increasing altitudes. A data analysis was carried out on a statistical mean of the three values of each variable and an analysis of variance (ANOVA) and Newman-Keuls test were carried out for multiple comparison among groups. At altitudes over 4450 m, we found lack of rigidity at 80-100% and 60-79%. Mean % of rigidity and rigidity time of 80-100% (tip and base) decreased progressively with altitude. No significant reductions were shown in rigidity time at 0-19% and at 20-39% (tip and base), of total number, of total and mean duration of SREs. Pathological rigidometric records at high altitude in sexually potent men at sea level clarify the primary role of hypoxia in physiopathological ED pathway.

Bisphosphonates Treatment in Metastatic Prostate Cancer

The skeleton is the third most common site for cancer to spread after the liver and lungs. Malignancies that can cause destruction of skeletal bones include multiple myeloma and metastatic diseases of the lung, prostate and other solid cancers. The clinical complications include pain, fractures, compression of the spinal cord and hypercalcemia of malignancy. Bisphosphonates are bone-seeking agents originally designed to treat loss of bone density. Accumulating data show that they are effective in diseases in which there is upregulation of osteoclastic or osteolytic activity. Bisphosphonates can reduce skeletal-related events and bone pain, as well as reduce the adverse effects of androgen deprivation therapy on skeletal integrity. However, it is clear that bisphosphonates do not represent a decisive treatment in the care of metastases but a therapeutic choice in synergy with regular anti-tumor drugs. The preclinical and clinical data to support this are reviewed here.

Transurethral Resection of Bladder Tumor and Benign Prostatic Hyperplasia: Simultaneous Approach

Approximately 70% of the bladder tumors are superficial, and 10%-20% of these progresses as muscle-invasive. For implant problems is common the practice to immediately instill chemotherapeutic agents after TURBT that a decrease of the recurrence has provoked. Many urologists didn't observe any deleterious effect of simultaneous TURBT-TURP. But really the simultaneous approach provokes an increase of the recurrence of the tumor to the bladder neck or prostatic urethra? We have performed a perspective study after simultaneous approach. In our Clinic any case of solitary recidivist is not occurred in the prostatic site, but in all the patients concomitant multiple locations are been observed.

Diffused Pelvic Endometriosis to the Ureter and Rectal: Multidisciplinary Approach

Endometriosis functionally causes lesions, nodules or active bulges to numerous organs. Is the second most common pelvic pathology in woman and strikes the 10–20% of the women in the pre-menopausal epoch (40–45 years) and the interest of the urinary apparatus is 1–11%. Rare to renal level, it mostly strikes the bladder and in smaller measure the ureters and the uretera with a relationship 40/5/1. Ureteral location is common extrinsic, deriving for contiguity of the ovarian endometriosis adherent or of the peritoneum or of the uterus-sacred ligament; rare the ureteral intrinsic endometriosis, primitively located in the organ wall. Our therapeutic orientation is surgical, especially in the cases of wide endometriosis or when the tissue has had a cicatrizial involution with absence of answer to the hormonal therapy.

Chemoprevention in Chronic Prostatitis in BPH and in Low Grade Carcinoma

Prostate cancer is the most common solid malignancy in men in the United States. As a disease predominantly affecting the elderly and with the continuing aging of the population, the importance of studying and treating prostate cancer will continue to increase. Many factors have been implicated in the development of prostate cancer. It presents a variability of incidences influenced by dietary factors. The administration of substances, such as Lycopene, Polyphenols, Iso-flavonoids, Vitamin D, Vitamin E, Selenium and Zinc have a decisive role in the prevention of anti-apoptotic and pro-angiogenesis processes which are long-term developing properties of cancer cells. In this study, we will provide an overview of the current state of art between dietary habits and risk of prostate cancer.

A novel chitin-binding protein from the vestimentiferan Riftia pachyptila interacts specifically with beta-chitin. Cloning, expression, and characterization

A cDNA from Riftia pachyptila was cloned. It encodes a novel 21.3-kDa protein from the worm protective tube, named RCBP (for Riftia chitin-binding protein). On the basis of partial tube-peptide sequences previously obtained, experiments using reverse transcriptase-mediated polymerase chain reaction and rapid amplification of cDNA ends led to the complete cDNA sequence. Analysis of its deduced amino acid sequence shows the presence of two chitin-binding domains. These domains are closely related to type 2 chitin-binding domains that are restricted to the animal kingdom. We showed by affinity assay and immunogold labeling that RCBP is the first protein so far known that binds specifically beta-chitin and that is unable to bind the most common alpha-form found in chitin secreting animals. The RCBP mRNA was found to be present in specific epidermal cells from the worm body wall, but never in the chitin-secreting gland cells. This unexpected result clearly indicates that this tube protein is synthesized in specialized areas of the outer epithelium and that at least two different tissues are involved in this exoskeleton synthesis.

[Betamethasone versus placebo in Peyronie's disease]

The Peyronie's disease or Induratio Penis Plastica, represents one of the most controversial and uncertain points of the modern andrology, since its real etiology is still disputable. Consequently also the non-surgical therapy results as still confused and variable as shown in the considerable number of drugs utilized till now. Our study takes into consideration the injection therapy, by the use of the Betamethasone (corticosteroid), and it tries to explain, how it is possible, the real efficacy of drug versus placebo. The randomized study includes 30 patients. The valuation of the results has been effected in reference to three parameters: disappearance of pain, decrease of plaque volume and consistency of 50%, decrease subjective penile curvature. The data obtained show no significant differences between group A (treated with Betamethasone) and group B (treated with placebo). At twelve months of mean follow-up the pain at erection disappeared in 66.6% of the patients of group A, in 53.3% of the patients of group B. The curvature diminished in 20% of the patients of group A and in 26.6% of the patients of group B. A decrease in plaque volume and consistency was noted in 40% of the patients of group A and in 40% of the patients of group B. The data show that probably the clinical results of the therapy is to refer to a mechanical effect of injected volume and not to the drug action itself.

[Clinical efficacy of intravesical BCG treatment for superficial bladder neoplasms with respect to the iduced immune response]

We evaluated the immune response after BCG treatment in superficial bladder cancer analyzing the modifications induced on lymphocytic sub-populations. In 21 patients with superficial bladder cancer we performed TURB and after 12 days began the induction cycle of 6 weeks with Pasteur BCG (75 mg/50 micromilligrams), followed by one instillation monthly for one year. Before treatment every patients underwent Mantoux intradermoreaction, blood-count and determination of peripheral blood lymphocytic subpopulations. Blood-count and lymphocytic subpopulations were repeated after 1 week, after 6 weeks, after 3 months and after 1 year. During cystoscopy after 3 months every patients underwent vesical biopsy. CD4+ and CD8+ are mainly interested among lymphocytic subpopulations at the beginning: BCG decreased CD4+ value in the patients with complete response and then it increased CD4+ and reversed the ratio between CD4+ and CD8+ on vesical mucosa.

Effects of therapy with recombinant human growth hormone on insulin-like growth factor system components and serum levels of biochemical markers of bone formation in children after severe burn injury

Burn injury in children is associated with low bone formation and long-term bone loss. Because recombinant human GH (rHGH) may accelerate burn wound healing, and because rHGH increases bone formation and density in GH-deficient patients, we studied the short-term effects of rHGH on bone fomation, reflected by osteocalcin and type I procollagen propeptide levels in a randomized, double-blind, placebo-controlled study. Nineteen patients were enrolled and received either rHGH (0.2 mg/kg.day) or an equal volume of saline. Mean burn size and age were not different between the groups, and test substances were given from admission to time of wound healing (mean: 43 +/- 22 days). At wound healing, serum levels of insulin-like growth factor (IGF)-1 and IGF binding protein (IGFBP)-3 in the rHGH group rose to mean values of 229% and 187% of the respective means of the placebo group (P < 0.025). Serum osteocalcin concentrations remained below normal in both groups, and type I procollagen propeptide levels achieved a low normal level IGFBR-4 levels were twice that of normal on admission and doubled further at wound healing; IGFBP-5 levels were low on admission but rose to normal at wound healing. We conclude that large doses of rHGH were ineffective in improving disordered bone formation despite increasing serum IGF-1 and IGFBP-3. The rHGH-independent rise in serum levels of the inhibitory binding protein IGFBP-4 suggests a mechanism by which improved bone formation is prevented despite successful elevation of IGF-1 and IGFBP-3 in the burned child.

Clustering of Y chromosome deletions in subinterval E of interval 6 supports the existence of an oligozoospermia critical region outside the DAZ gene

Y chromosome molecular analysis was performed using the STS-PCR technique in 50 patients with oligozoospermia. Microdeletions of interval 6 of the Y chromosome were detected in seven patients, in six of whom subinterval E was affected. All patients retained the RBM1 and DAZ genes, while in one deletion involved the SPGY gene. The size of the deletion was not apparently related to the severity of the disease. These results suggest the presence of an oligozoospermia critical region on the Y chromosome within subinterval E of interval 6.

[Orthotopic continent urinary diversion according to Hautmann: 1989-1995. Physiopathologic, morphologic and urodynamic, metabolic considerations and follow-up]

The orthotopic ileal neobladder is a completely detubularized, low pressure, high capacity reservoir created from the ileum without any valve. After cystoprostatectomy, a bowel segment of 40-60 cms is dissected free at a distance of 15 cms from the ileo-cecal valve. The bowel is detubularized and configurated in a cylinder. Then the neobladder is anatomized to the urethra and ureters. From 1989 to 1995 20 patients underwent ileal orthotopic urinary diversion according to Hautmann. Two patients died, the others are still disease free (mean follow up 36 months). The high capacity and low pressure allow a good continence control, while among metabolic alterations the most frequent is metabolic acidosis. The ileal neobladder represents a valid alternative to any form of cutaneous urinary diversion and is associated to a low incidence of complications.

Dysregulation of calcium homeostasis after severe burn injury in children: possible role of magnesium depletion

OBJECTIVE

To determine the cause and extent of hypocalcemia observed in children after severe burns.

DESIGN

We studied 10 children with burns covering 57% +/- 17% (SD) body surface area, ages 9.6 +/- 4.7 years, who were admitted consecutively during a 6-month period. Diet supplied a minimum of 2.7 gm/m2 of calcium, 0.3 gm/m2 of magnesium, and 2.2 gm/m2 phosphate. Blood specimens were obtained daily for 10 +/- 5 days for the following tests: (1) simultaneous analysis for ionized calcium, magnesium, and intact parathyroid hormone (group A); (2) two of these children, randomly selected, had serial 2-hour determinations on a single day (group B); (3) a modified Ellsworth-Howard test, consisting of a 10-minute infusion of synthetic parathyroid hormone 18 +/- 10 days post-burn and associated changes in urinary cyclic adenosine monophosphate excretion and renal threshold phosphate concentration (group C). Three of these children, when normomagnesemic, also received a standard magnesium infusion to determine magnesium retention (group D). Data were analyzed with chi-square, regression analysis, and non-parametric testing as appropriate.

RESULTS

All patients showed sustained hypocalcemia and hypomagnesemia; intact parathyroid hormone response was inappropriately low and response to synthetic parathyroid hormone infusion was blunted. Lowest ionized calcium levels were associated with hypomagnesemia.

CONCLUSION

Hypoparathyroidism and blunted renal response to parathyroid hormone suggest that magnesium depletion may contribute to their pathogenesis. Magnesium repletion and monitoring are recommended.

[Role of MCP-1 chemokine in the response of monocytes of patients with superficial tumors of the bladder treated with BCG immunotherapy]

Mechanism by which intravesical BCG treatment mediates antitumor activity are currently poorly understood. We initiated studies to determine the sequence and the factors that produce the immunological events. During the inflammatory answer a lot of molecules are produced. Chemokines MCP-1 and RANTES induces the mast-cell recruitment, that begins the "immunological fall". In our study 5 patients with superficial bladder cancer treated with BCG present an improvement of this cytokines correlated with a tumor-free status.

[Levels of monokines in peripheral monocytes in patients with superficial tumors of the bladder treated with BCG. Results after 1- and 3-year follow-up]

BCG has been shown in prospective randomized clinical trials to provide superior therapeutic results when composed to transurethral resection alone, or to adjuvant therapy with Thiotepa or Adriamicin. Even if the mechanism by which BCG mediate antitumor activity are not clearly established, an association between the immunological response and antitumoral activity is known IL-1 and TNF alfa are the monokines that have multiple biological effects, including linfocyte proliferation, production of fever, augmentation of cytotoxicity and production of cytokines. The goal of this study is show the response from LPS induced and not peripheral monocytes of superficial bladder cancer patients BCG treated and not, i.e. the levels of TNF alfa, IL-1 and not IL-6.

[Clinico-experimental study of low-mineral "Monteferrante" water: monitoring the recurrences in patients with calculi]

This study presents the use and effects of a low mineral content water called "Monteferrante" on patients with urinary stone disease. We evaluated the blood and urine sample of twenty stone formers and ten healthy volunteers at three and six months after "Monferrante" water intake. Besides a benefic increasing of diuresis, the results show: an increase of: urinary magnesium (p < 0.001), urinary calcium (p < 0.01), uricosuria (p < 0.01), and reduction of: blood uric acid (p < 0.01), blood sodium (p < 0.05), azotemia (p < 0.05) and cholesteremia (p < 0.01). The "Monferrante" oligomineral water can be considered as an efficacy presidium in the prevention of stone disease.

[Half-life of blood PSA after radical prostatectomy. Correlations with pathological stage and clinical course of the disease]

PSA half-life was calculated in 37 patients after radical prostatectomy to identify earlier patients with residual disease. The half-life calculated in patients potentially "cured" with absolute PSA values inferior to 0.5 ng/ml after 28 days, was significantly different (P = 0.0008) from the group of patients "uncured" (PSA > 1.0 ng/ml) and from those ones that, despite of detectable PSA level, had evidence of recurrence in the following follow-up. In comparison with the absolute value, the PSA half-life is able to define in the group of patients potentially "cured" those who could have a recurrence in the future.

Tumori superficiali della vescica: Presentazione di uno studio comparativo tra la sola resezione endoscopica e I'uso di BCG, epirubicina o mitomicina C adiuvanti

A retrospective clinical study was carried out to compare results obtained with just endoscopic resection and with adjuvant use of the Bacillus Calmette-Guérin (BCG), epirubicin and mitomycin C after TURB in patients with superficial bladder tumour (stage pTa/1 grade 1-3). At an average follow-up of 44 months, a decrease in the percentage of recurrences was noted in all the adjuvant therapy groups compared to that in the group subjected to TURB only. The risk of recurrence for the BCG group was 0.427, for the epirubicin group 0.609 and for the mitomycin C group 0.668. There was progression of the disease in: 5.6% of the TURB, 9.1% of the BCG, 5% epirubicin and 3.6% mitomycin C, for a total of 26 patients (7.3%). Twenty-four cystectomies were performed and 2 patients died due to progression of the disease. At 44 months average follow-up, 353 (98.6%) patients are alive and 329 (93.2%) still have their own bladder.

Carcinoma del pene: Chirurgia e chemioterapia

Spinocellular carcinoma of the penis is rare and potentially fatal, especially when there are lymph node metastases. From January 1992 to December 1995 we treated 6 stage T3 N1 M0 tumours of the penis. Six to eight weeks after total penectomy, bilateral inguinal lymphadenectomy and pelvic lymphadenectomy were carried out. These patients also underwent 8 cycles of chemotherapy with vincristine, bleomycin and methotrexate. At an average follow-up of 36 months, all the patients are disease-free with no signs of recurrence either in the lymph nodes or in any organ.