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Biomedical subjects

L Fiorentini

Publications and source records attributed to L Fiorentini.

At least 19 recordsLinked to original sources

[Adenoid cystic carcinoma of the prostate. Clinical case].

The authors report an extremely rare case of adenoid cystic carcinoma of the prostate. No satisfactory clinical and pathological classification exists for this tumour, creating particular difficulties for therapeutic decisions and prognosis. Descriptions of cases with excellent survival rates are reported in the literature, to the extent that this is sometimes regarded as a low-malignancy tumour, but other reports also exist of massive diffusion of the pathology with fatal consequences. Advances in the knowledge of this tumour have enabled a number of earlier pathogenetic hypotheses to be ruled out, namely its possible derivation from ectopic salivary cells, ectopic periurethral glands or metaplastic urethral mucosa, but the origin of this carcinoma is still not certain. It is also difficult to differentiate this form from the typical adenocarcinoma and to make a prognosis for survival. In the case reported here, the final diagnosis was made on the lymph node biopsy obtained during surgery, given that a preoperative biopsy was not feasible owing to the scarcity of material available. The patient received standard hormonal therapy for prostate carcinoma.

Adenocarcinoma↗

Correlation between Gleason score of needle biopsy and radical prostatectomy tissue.

Gleason score has been identified as an important variable to predict disease extent and biologic behaviour of prostate cancer. However, the correlation between Gleason score of needle biopsy and surgical specimen is often poor. We studied 72 patients who underwent needle biopsy and radical prostatectomy to correlate Gleason score with PSA, clinical and pathological tumour stage. Only 47.2% of Gleason scores were identical in the biopsy and specimens, 37.5% were undergraded and 15.2% were overgraded. Correlations between clinical and pathological stage were identical in 30.5% of patients, 61.1% of patients were understaged and 8.3% overstaged. In conclusion, accuracy of clinical staging and grading of prostate cancer is low. Although the Gleason score on needle biopsy might be useful to predict the final stage and grade, correlation with surgical specimen is poor.

Aged↗

Bladder involvement in systemic sclerosis: urodynamic and histological evaluation in 23 patients.

Lower tract involvement of systemic sclerosis is an uncommon manifestation. In this study we have evaluated the functional and morphologic vesical changes in 23 female patients with systemic sclerosis to investigate if bladder dysfunction was correlated with an extended skin sclerosis and/or a more serious organ involvement. Urodynamic alterations were observed in only 3 cases. Urinary symptoms and urodynamic features were correlated neither with severity of vesical fibrosis nor with visceral involvement. Autonomic dysfunction was detected in 13 patients.

Adult↗

Functional evaluation of different ileal neobladders and ureteral reimplantation techniques.

OBJECTIVES: To compare and assess the function of ileal neobladders with different reconfiguration and with several types of ureteral reimplantation. METHODS: Forty-five male patients underwent radical cystectomy and detubularized ileal neobladder. In 20 patients an ileal neobladder was carried out according to Studer's technique, in 12 a 'W'- and in 13 a 'U'-shaped neobladder. In the Studer's patients 60 cm of ileum was used, in the 'W' 40 and in the 'U' 30 cm. For the uretero-ileal anastomosis Nesbit's technique was utilized in the Studer's, in the 'W' and 'U' neobladders Camey Le Duc's technique was performed instead. Four patients underwent a serous-lined extramural tunnel reimplantation. Follow-up included a functional and morphological study of the urinary system and a urodynamic study. RESULTS: All Nesbit's uretero-ileum anastomoses resulted refluent when the reservoir was filled up, 15 of 50 ureteral reimplantations according to the Camey Le Duc technique showed reflux at full filling. At 3, 6 and 12 months follow-up, the double reconfiguration reservoirs (Studer's and 'W') showed a larger capacity and a lower maximum pressure than neobladders with a single bending. At 12 months, continence and the voiding interval time was significantly higher in the double reconfiguration than in the 'U' neobladders. CONCLUSION: The double reconfiguration of the reservoir ('W') might be preferable to that with a single one. As for the type of ureteral anastomosis to select, the problem is still debatable even if in our case-control study we have had better results in terms of reflux and stenosis with the uretero-enteric anastomosis with Nesbit's and associated afferent long tubular ileal limb than with Studer's technique.

Aged↗

[Prostatic endoprosthesis in the treatment of prostatic obstruction: preliminary experience with the new Trestle model].

The urethral stent is a relatively new treatment modality for benign prostatic hypertrophy ostruction. Although the ultimate prostatic endoprosthesis has yet to be developed, various stents have been produced and investigated with good results. We review the several currently available stents and we report the preliminary clinical experience with a new device (Trestle).

Catheterization↗

Painless treatment of hydrocele: EMLA cream anaesthesia and fibrin adhesive sclerotherapy.

Sclerotherapy for hydroceles was performed in 18 patients. Cutaneous anaesthesia was induced with an anaesthetic cream (lidocaine and prilocaine, EMLA cream) and a fibrin sealant (Tissucol) was injected into the sac after fluid aspiration. Patients experienced no pain during needle insertion and sclerosant procedure; 2 recurrences were observed during follow-up. EMLA cream anaesthesia and fibrin adhesive sclerotherapy represent a useful alternative to surgical treatment of hydroceles.

Aged↗

Bladder replacement with modified Studer pouch using absorbable staples.

The use of absorbable staples may allow to reduce the operating time of orthotopic bladder replacement. We report our experience in 14 patients with a modification of the Studer technique using absorbable PolyGIA instruments. The technique has been shown to be simple and quick to perform (time for pouch creation 15-40 minutes, mean 16 minutes) with no significant intraoperative difficulties. Urodynamic data and continence are satisfactory and seem comparable to different procedures and not related to staples' use. The main question remains if the reduced operating time equalizes the high cost of staple devices.

Absorption↗

[Fracture of the penis: description of a case].

Fracture of the penis is not a frequent event and it consists of a rupture of the tunica albuginea of the corpora cavernosa and sometimes of the urethra; the lesion occurs when the penis is erect because during erection the tunica albuginea is very thin and not flexible and it can be easily damaged by a trauma; most lesions occur during intercourse for impact of the erect penis against the female perineum or the pubic synphisis, but lesions during masturbation, fightings or falling off the bed are also described [1-2-3]. Clinically there are pain, detumescence, hematoma and recurvatum of the penis toward the opposite side of the lesion and hematuria if also the urethra is damaged. Usually diagnosis is quite easy with a good anamnesis, clinical examination and echotomography which can reveal presence of hematoma and hypoechogenic areas along the tunica albuginea or the urethra that appears irregular. Nowadays, fractures of the penis need a surgical approach to obtain good results avoiding consequences such as recurvatum or fibrotic areas [3-4-7-8]. We describe two cases of fracture of the penis occurred in two young men during masturbation and treated surgically with excellent results: twelve and eighteen months respectively after surgery patients are well and can enjoy a normal sexual activity with no problems at all.

Adult↗

[Liposarcoma of the spermatic cord. Clinical case].

Sarcomas are neoplasms originating from connective tissues of any anatomical region; the sarcoma of spermatic cord is a rare neoplasm with only little more than two hundred cases described in the literature. Rhabdomyosarcomas in childhood and leiomyosarcomas in adults are the most frequent histological types. Liposarcomas, fibrosarcomas and osteosarcomas are less frequent. The spermatic cord liposarcoma originates from the spermatic cord fatty tissue and therefore it consist of adipose cells, fibroblasts and myxomatosus cells; such neoplasms are usually very well differentiated. Diagnosis is suggested by the appearance of a progressively enlarging mass and by echotomography which shows a solid or liquid mass of the spermatic cord. Therapy consists of surgical intervention (orchifunicolectomy) which also allows a correct histological diagnosis. The case of a 56 year-old male who underwent left orchifunicolectomy for a sarcoma of spermatic cord occasionally discovered during surgical repair of a left groin hernia is reported. Six months after the intervention the patient is in good condition and there is no evidence of relapse.

Genital Neoplasms, Male↗

[Unusual development of urothelioma of the upper urinary tract].

A case of extrarenal spreading of transitional cell carcinoma caused by rupture of ureterohydronephrosis by ureteral transitional cell carcinoma is reported. Ultrasonography and CT revealed the presence of a severe right ureterohydronephrosis with large septa and a 2 cm diameter exophytic neoplasia of the middle ureter. Nephroureterectomy was performed with excision of a perirenal mass. Histologic examination revealed the presence of transitional cell carcinoma in the perirenal mass, caused by dissemination after renal rupture. CT and ultrasonography were not able to differentiate hydronephrosis from pericapsular spreading because of the extreme disruption of the renal parenchyma.

Aged↗

Bladder instability and incontinence after radical prostatectomy.

Thirty-nine patients were evaluated after retropubic prostatectomy, by urodynamic studies. They were divided into three groups depending upon the degree of urinary continence. A statistically significant difference was found between different groups in mean functional profile length and maximal urethral closure pressure. Differences in age, previous prostatic surgery, tumour extension, or preservation of the neurobundles did not have any significant influence on recovery of continence.

Aged↗

Recurrences and progression of superficial bladder cancer following long-term intravesical prophylactic therapy with mitomycin C: 48-month follow-up.

A total of 208 patients with superficial transitional-cell carcinoma of the bladder (STCC) after transurethral resection were treated with 30 mg intravesical instillations of mitomycin C (MMC) weekly for 8 weeks, followed by monthly maintenance doses for 12 months. All patients were controlled with a urinary cytological examination every 2 months and with cystoscopy every 3 months. Mean follow-up was 47.8 and 49.3 months in the prophylaxis and control groups, respectively. The incidence of tumor recurrences at the 12th and 48th months was 29 and 44%, respectively, in the MMC group and 45 and 58%, respectively, in the control group. Progression evaluated by grade and stage was significantly higher in the control group. These data indicate that MMC appears to be effective in the prophylaxis of STCC, but the possibility of long-term relapse suggests maintenance of a longer therapy.

Administration, Intravesical↗

Urodynamic evaluation of urinary incontinence following radical prostatectomy: our experience.

Thirty-four patients after retropubic radical prostatectomy, were evaluated with urodynamic studies. Patients were divided in three groups depending on the degree of urinary continence. A statistically significant difference was found between different groups for the mean functional profile length and maximal urethral closure pressure. Detrusor instability was detected in 11 patients with moderate incontinence and in 1 patient with severe incontinence. Neither differences of age, previous prostatic surgery, tumour extension, nor preservation of the neurovascular bundles had any significant influence on recovery of continence.

Aged↗

[Electrovaporization of the prostate].

Electrovaporization is a new and potentially useful modification of transurethral resection of the prostate which is rapidly becoming a treatment of choice for symptomatic benign prostatic hyperplasia. We report our experience with 22 patients treated using the Circon Acmi Grooved Vaportrode vaporization electrode. Procedures were carried out using the standard technique of electrovaporization with general or regional anaesthesia. Mean operative time was 40 minutes (range 25-65 minutes) and all patients were discharged without catheter after 1 or 2 days. Symptom score, peak uroflow and postvoid residual urine showed statistically significant improvement at 3 months (p < 0.01). There were no significant complications. Transurethral electrovaporization of the prostate seems to be a easy and safe procedure with significantly lower costs and excellent results. However, long-term efficacy and complications need to be evaluated in multicentre clinical trials.

Aged↗

Densitometric and biochemical alterations in bony tissue induced by ureterosigmoidostomy.

The mineral content of bone was measured in 134 male patients who underwent ureterosigmoidostomy within the past 18 years. Moreover, the principal humoral indices of bone metabolism, together with hematic pH and alkaline reserve (BE) values were evaluated. This study showed that after approximately 6 years from a ureterosigmoidostomy there was significant bone demineralization. These data, supported by a parallel increase of serum osteocalcin, show that ureterosigmoidostomy represents a risk factor for osteoporosis especially in those patients who already have below normal values of bone mineral density prior to surgery.

Alkaline Phosphatase↗

Vacuum constriction device and topical minoxidil for management of impotence.

OBJECTIVE: We report our preliminary experience with a vacuum constriction device and topical minoxidil for the management of impotence. METHODS: We evaluated 18 patients, 8 with neurogenic and 10 with psychogenic impotence with a vacuum constriction device and topical minoxidil (1 ml 2% solution). RESULTS AND CONCLUSIONS: All patients responded to treatment but 100 cases refused home use because of psychological impact. Twelve patients did not need the application of the constrictive ring because of the erection facilitation effect of minoxidil. No side effects were observed. In our opinion the association of the vacuum constriction device with topical minoxidil might be useful in the treatment of impotence; however, several factors must be evaluated in selecting patients. Application of minoxidil before vacuum constriction device might be useful to reduce the time of device application, to increase the efficacy of the device and in some cases to avoid the use of the constrictive ring.

Administration, Topical↗

Cellular expression of lymphocyte function-associated antigen-1 and intercellular adhesion molecule-1 in normal kidney structures and in renal cancer. Possible significance in immune response and in the clinicopathological correlation.

In this study we investigated the presence of lymphocyte function-associated antigen-1 (LFA-1) and intercellular adhesion molecule-1 (ICAM-1) on renal cell cancer in 16 patients who underwent nephrectomy. In all cases, normal renal tissues presented ICAM-1 on the parietal epithelial cells lining Bowman's capsule while neither the visceral epithelium nor the glomerular endothelium were stained. The epithelial proximal and distal tubular cells were stained poorly (5 +/- 3 positive tubular cross sections/mm2). No renal cells were stained by the monoclonal antibody for LFA-1. In contrast, in renal cancer tissue we found 6 cases, negative for ICAM-1 and the others positive with a mean number of positive tubular cross sections of 52 +/- 37/mm2. In 10 cases staining with LFA-1 antibody was negative, while for the other cases the mean number of positive tubular cross sections was 11 +/- 8/mm2. Our results suggest that the expression of ICAM-1 and LFA-1 on the surface of malignant cells may explain the unusual clinical aspects of renal cell carcinoma, its association with the immune system, and clarify certain aspects of immunotherapy.

Carcinoma, Renal Cell↗