Biomedical subjects
Publications and source records attributed to F Montorsi.
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From May, 1985 to August, 1987, a total of 2,955 patients with renoureteral stone disease presented at our institution and were treated either by extracorporeal lithotripsy alone or combined with percutaneous nephrolithotomy, ureteroscopy, or open surgery. Seventy-three percent of patients were stone-free at the 3 month follow-up date while 22% presented with negative urine culture and small (less than 5 mm) asymptomatic fragments deemed susceptible to spontaneous discharge. The rate of major complications was extremely low (sepsis, 0.03% and major renal bleeding, 1.55%). The application of this multimodal therapeutic strategy allowed successful treatment in almost every case of renoureteral lithiasis with minor iatrogenic damage to the renal parenchyma.
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.
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Vulvodynia is a clinical syndrome that may include unexplained vulvar pain, sexual dysfunction, and psychological disability. It is a multifactorial syndrome that should be diagnosed, if possible, with an intradisciplinary approach. This article discusses the diagnosis and treatment of vulvodynia, starting with a summary of the complex nervous system within the pelvis. Different clinical pictures and different subtypes of the syndrome have been described in order to identify the etiologic aspects that are essential for diagnosis and subsequent treatment. Clinical evaluation should stress attention to detailed "pain-mapping" and evaluation of past and present history. The gynecological examination should be an overall patient evaluation, incorporating global physical impression, change in posture due to pain and careful examination of the pelvic floor. Examination of the pelvic floor is frequently omitted. Leading to an incorrect diagnosis of psychogenic pain. Such a misdiagnosis can result in the dismissal of appropriate treatment. Proper evaluation requires a comprehensive, multidisciplinary approach that includes medical, rehabilitative, and psychological issues.
The purpose of this study was to clarify the actual therapeutic potential of a new transdermal drug delivery system (electromotive drug administration; EMDA) for selected patients with Peyronie's disease. Forty patients with Peyronie's disease were treated by electromotive administration of the 3-drug association orgotein-dexamethasone-lidocaine in a double-blind, placebo-controlled, partial crossover study (study 1). Another 25 patients were treated by EMDA with a combination of verapamil-dexamethasone in an uncontrolled study (study 2). Treatment sessions lasted 20 minutes each and took place 3 times a week for 3 weeks with a current of 3 mA. Patients were assessed before treatment and at 1- and 3-month follow-up examinations. Assessments were based on sexual history, physical examination, and dynamic color Doppler ultrasonographic results. Adverse effects of EMDA were not reported. In study 1, the clinical results observed after treatment proved to be significantly better than those of the placebo. Penile pain disappeared in all patients in both studies. Penile lesion (nodule or plaque) either disappeared or significantly improved in 79% and 90% of patients treated by the 3- and 2-drug association, respectively. The improvement of penile deformity also was notable although it did not match the effect observed on penile nodules or plaque (62% and 88%, in studies 1 and 2, respectively). In both studies, more than 80% of patients reported a definite amelioration of penile rigidity, which paralleled the improvement of penile dynamic color Doppler ultrasonographic parameters. Overall, the combination of verapamil-dexamethasone achieved better clinical results than the 3-drug combination. Electromotive drug administration is a novel technique capable of safely achieving satisfactory results in selected patients with Peyronie's disease not only in terms of improvement of patient's symptoms but also due to the reduced need for penile surgery.
In the last few years, several drugs have been proposed for the healing of peptic ulcers H2 receptor antagonists are probably the reference-drugs for their efficacy and safety. Acute treatment of peptic ulcer with cimetidine, ranitidine or famotidine gives a high healing rate: from 60% to 90%, depending on the location of the ulcer and the drug used. However, relapse after short-term treatment still remains frequent, and prophylaxis of recurrence must be decided. Long-term treatment with antisecretory drugs could be dangerous for changes of the gastric system, with nitrites and nitro-compounds occurrence, and for the risk of frequent relapses. Therefore, the role of mucus-barrier drugs and surgery must be reconsidered.
The results of jejunoileal bypass for morbid obesity were studied in 192 operated patients. Mean weight loss was 39.3% of initial weight and 80.5% of overweight. Medical benefits (such as improved glucose tolerance, lowered blood pressure, healed Pickwick syndrome, etc.) were maintained during the follow-up (average five years). The most feared complication of the jejunoileal bypass is severe hepatic failure, which appeared in 2.3% of the cases, only after the end-to-end jejunoileal bypass, and never more than 12 months after surgery. Most patients had satisfactory and lasting results due to a careful and assiduous postoperative follow-up, and to the strict co-operation between the medical staff and the patient. Medical therapy in the preoperative period was useful to control the weight gain by administration of a hypocaloric definite diet. In the postoperative period, we usually got benefits for the bypass induced intestinal malabsorption by administration of supportive vitamins and electrolytes. To prevent liver diseases we often found intestinal-specific antibiotics, aminoacidic solutions, hyperproteical diet and anti-steatosis agents helpful.