Biomedical subjects

Massimo D'Armiento

Publications and source records attributed to Massimo D'Armiento.

28 records · Page 2Linked to original sources

PubMed2004

Comparing two different ballistic intracorporeal lithotripters in the management of ureteral stones.

INTRODUCTION: During the 1990s, two different in situ 'ballistic' lithotripters were introduced into clinical practice. The Swiss Lithoclast (SLC) was the first to be clinically tested. After a few years, a very similar device, the electrokinetic lithotripter (EKL), was described and has recently become available to us. In this paper we compare the clinical efficacy and features of these two ballistic lithotripters in the ureteroscopic treatment of ureteral stones. MATERIALS AND METHODS: Thirty-eight patients with ureteral stones were randomized into two equal groups to undergo fragmentation using the SLC or the EKL via semirigid ureteroscope. In both groups the stones were in the mid- or lower ureter. The following parameters were evaluated: total procedure duration, complete fragmentation rate, time to complete fragmentation, proximal migration rate, complications and need for further procedures. RESULTS: Although not statistically significant, a trend towards a higher fragmentation rate, a shorter time to fragmentation and a slightly higher proximal migration rate emerged in the SLC group. No difference was found in the stone-free rate in the two groups (94.7 vs. 89.4%). Only 2 cases of minor ureteric injury were observed in each group. CONCLUSIONS: As previously described by others, the SLC and EKL are both attractive cost-effective options in the treatment of ureteral stones. Ten years after its introduction, the SLC still remains probably the best choice for most urologists.

Adult↗

PubMed2004

Expanding applications of the access sheath to ureterolithotripsy of distal ureteral stones. A frustrating experience.

OBJECTIVE: Distal ureteral stones are routinely managed with semirigid ureteroscopy without the need for ureteral dilatation, but some conditions, e.g. large stone burden or difficult catheterization of the ureteral meatus, are time-consuming and would require a tool to facilitate multiple insertions of the ureteroscope and to avoid ureteral injury. An access sheath is now available and it facilitates ureteroscopy of the upper ureter. To answer the question whether its application could be expanded to the distal ureter is the aim of our paper. PATIENTS AND METHODS: 12 distal ureteral stone patients, 8 with stone size >1 cm and 4 with a large prostate, underwent ballistic ureterolithotripsy with the aid of the Access Sheath. The results of the procedure were compared to a second group of 16 patients from our archives. RESULTS: There was no significant difference in operating time and stone-free rate. Although no complications were related to the ureteroscopy, in 42% (5 patients) of the access group the procedure could be completed only after removing the sheath. CONCLUSION: The Access Sheath does not improve the results of the semirigid ureteroscopy of difficult stones in the distal ureter.

Adult↗

PubMed2003

Adrenalectomy: defining its role in the surgical treatment of renal cell carcinoma.

OBJECTIVES: With the recent widespread use of modern imaging techniques, the frequency of small low-stage renal cell carcinomas (RCC) has grown considerably, giving rise to more conservative surgical approaches. We evaluated the characteristics of adrenal involvement and the accuracy of computerized tomography (CT) in the diagnosis of RCC, defining the real need for adrenalectomy during surgical treatment. METHODS: The medical records of 201 patients undergoing radical nephrectomy and ipsilateral adrenalectomy for localized or advanced RCC, from 1996 to 2002, were analyzed, retrospectively. We considered 76 with stage T1-2 disease and 125 with T3-4N0-1M0-1 disease. In all cases a blinded review of the preoperative abdominal CT was performed. Histopathology records of the surgical specimens were examined to determine the accuracy of the CT in identifying adrenal involvement by RCC. RESULTS: The overall incidence of adrenal metastasis was 4.4%. The mean renal tumor size in patients with adrenal involvement was 7.8 cm. The tumor stage correlated with a probability of adrenal spread (p < 0.05), with T1-2 tumors accounting for 1.3% of cases only. The adrenal gland was diagnosed as abnormal on preoperative CT in 21 patients (10.4%). CT scan demonstrated 88.8% sensitivity, 92.1% specificity, 99.4% negative predictive value and 34.7% positive predictive value for adrenal involvement by RCC. CONCLUSIONS: Adrenal involvement is not likely in patients with localized early stage RCC and adrenalectomy can be omitted in such cases, particularly when CT is negative. However, in selected patients with large high-risk tumors, radical nephrectomy, including removal of the ipsilateral adrenal gland, should be performed.

Adrenalectomy↗

PubMed2003

[Questionnaire based evaluation of prostate biopsy complication comparing different bioptic schemes].

OBJECTIVES: The systematic parasagittal sextant biopsy technique under transrectal ultrasound guidance, routinely performed to diagnose and stage prostate cancer, has been shown to outperform directed or random biopsies, revolutioning our ability to detect carcinoma of the prostate. Different biopsy schemes have been proposed with similar positive percentage of cancer detection. The present study evaluate from the patient's perspective the complications with the use of two different systematic biopsy protocols with 14 and 8 cores. MATERIAL AND METHODS: Between January 1999 and February 2000, 177 consecutive patients, mean age 64.1 +/- 7.7 years, referred for normal screening digital rectal examination (DRE) and prostate specific antigen (PSA) level 4-10 ng/ml, were submitted to a transrectal US examination followed by lesion directed and 14 scheme systematic biopsies to detect prostate cancer. Biopsies were obtained from conventional sextant biopsies (6 core) and 3 alternate sites which included: the right and left extreme lateral peripheral zone between anterior tissue and posterior gland base (2 core); the right and left transition zone, immediately adjacent to the urethra anterior and posterior (4 core) and the right and left central gland in the mid zone typical of benign prostatic hyperplasia (BPH) (2 core). All specimens were separated for specific location identification. Cancer was identified in 61 patients (34.46%). Traditional sextant biopsies showed 23 patients (37.7%) with positive core to detect cancer, while a sextant regimen incorporating lateral peripheral zone biopsies and transitional zone detected 19 cancer (31.1%). The combination of lateral peripheral and transitional zone alone detected cancer in 59 patients. No cancer was detected in central gland. The lateral peripheral zone was the most frequently positive site biopsy followed by the transitional zone. According the results of our study from April 2000 we started to consider a novel scheme to reduce number of biopsies maintaining the same sensitivity. A subsequent group of 121 patients, mean age 61 +/- 4.6 years, enrolled from April 2000 to May 2001, underwent a transrectal US examination followed by lesion directed and 8 scheme systematic biopsies. None of the patients had previously undergone prostate biopsy. In all patients a visual analog score (VAS) questionnaire about pain and complications was obtained 7 days after the procedure. RESULTS: Of the 149 patients who completed the questionnaire 9.9% found the procedure moderately to extremely painful afterwards, with a VAS > 5, the commonest of these complications being pain and voiding difficulties with a mean value of 15.8%, systemic symptoms as fever or sweats with a mean value of 7.65% of cases. Between the two groups submitted to 14 or 8 scheme biopsies, we detect a statistically significant difference for urethral bleeding (7.3% vs 4.9% p value 0.05) and rectal bleeding (10.3% vs 3.7% p value 0.04), systemic symptoms 10.3% vs 5.0% p value 0.05) and painful voiding afterwards (5.8% vs 2.4% p value 0.02). CONCLUSIONS: Ultrasound guided transrectal biopsy of the prostate is a well tolerated and effective method for obtaining multiple biopsy specimens from the prostate with low incidence of serious complications. The absolute value of referred complications with VAS < 5 results high, but the rate of major complications results low. The 8 biopsy scheme, including sampling in peripherial zone at midgland and transition zone periuretrally toward the base, should be considered in a initial biopsy scheme to reduce number of biopsy and enhancing sensitivity, with a significant less degree of complication rate compared to a extensive 14 biopsy scheme.

Aged↗

PubMed2003

Role of cytokeratins, nuclear matrix proteins, Lewis antigen and epidermal growth factor receptor in human bladder tumors.

The content of urinary bladder cancer antigen (UBC), tissue polypeptide specific antigen (TPS), nuclear matrix protein 22 (NMP22), and the expression of LewisY carbohydrate antigens and of epidermal growth factor receptor (EGF-R) in bladder tumor tissues were determined. These included 14 well, 6 moderately and 11 poorly differentiated bladder cancers. Cytosol UBC and TPS were higher in the well and in the moderately differentiated bladder tumors than in the poorly differentiated bladder cancers; whereas cytosol NMP22 was higher in the poorly differentiated bladder cancers than in the well and in the moderately differentiated bladder tumors. The Lewis related carbohydrate antigens, evaluated by the reactivity of the tissues to monoclonal antibody B3, were highly expressed in poorly differentiated tumors. The EGF-R was strongly expressed in a large number of poorly differentiated bladder tumors. These data suggest that the determination of cytosol NMP22 and the immunoblotting with B3 and EGF-R antibodies might be useful to obtain more information on the differentiation of bladder tumors.

Aged↗

PubMed2002

Early and late complications of double pigtail ureteral stent.

OBJECTIVES: To analyze the early and late complications of indwelling ureteral stents in a series of 146 patients with nephroureteral lithiasis. MATERIALS AND METHODS: 146 patients with obstructing nephrolitiasis were treated for urinary diversion with double pigtail ureteral stent before extracorporeal shock-wave lithotripsy (ESWL) and following ureterorenoscopic treatment of lithiasis. All patients were scheduled for stent removal or replacement at specific 3-month intervals until stone-free status was achieved. RESULTS: Early complications during the first 4 weeks after stent insertion were stent discomfort (37.6%), irritative bladder symptoms (18.8%), hematuria (18.1%), bacteriuria (15.2%), fever >104 degrees F (12.3%) and flank pain (25.3%); late complications included hydronephrosis (5.7%), and stent migration (9.5%), encrustation (21.6%), fragmentation (1.9%) and breakage (1.3%). CONCLUSIONS: Ureteral stents have proven to be an invaluable tool for endourologists. Morbidity is minimal for up to three months but longer indwelling times are associated with an increasing frequency of incrustation, infections, secondary stone formation and obstruction of the stented tract.

Adult↗

PubMed2002

Expression of epidermal growth factor receptor correlates with disease relapse and progression to androgen-independence in human prostate cancer.

PURPOSE: The transforming growth factor alpha-epidermal growth factor receptor (EGFR) autocrine pathway has been implicated in prostate cancer cell growth. Amplification and/or overexpression of c-erbB-2, a receptor closely related to the EGFR, has been recently involved in prostate cancer progression. We investigated EGFR and c-erbB-2 expression in primary androgen-dependent and in advanced androgen-independent prostate cancer and their potential role as markers of disease progression. EXPERIMENTAL DESIGN: EGFR and c-erbB-2 expression were evaluated by immunohistochemistry in a consecutive series of 74 prostate cancer patients with the following characteristics: 29 patients (group 1) treated with radical prostatectomy; 29 patients (group 2) treated with luteinizing hormone-releasing hormone analogues and antiandrogen therapy followed by radical prostatectomy; and 16 patients with hormone-refractory metastatic disease. In all patients we evaluated: association between EGFR and/or c-erbB-2 expression and clinicopathological parameters; and disease-free survival according to EGFR and c-erbB-2 expression in univariate analysis (Kaplan-Meier product-limit method) and in multivariate analysis (Cox proportional hazards regression model). RESULTS: EGFR expression was found in 12 of 29 (41.4%) group 1 patients, in 22 of 29 (75.9%) group 2 patients (P < 0.0005), and in 16 of 16 (100%) metastatic patients (P < 0.005), whereas c-erbB-2 expression was found in 11 of 29 (37.9%) group 1, in 10 of 29 (34.5%) group 2 patients, and in 9 of 16 (56.3%) metastatic patients. A significant association was found between EGFR expression and a high Gleason score (P < 0.01) and between EGFR expression and higher serum prostate-specific antigen values (P < 0.02) in all groups of patients. Among the 58 patients treated with radical prostatectomy, 23 of 34 EGFR-positive patients (67.6%) relapsed, whereas only 2 of 24 EGFR-negative patients (8.3%) relapsed (P < 0.00004). c-erbB-2 expression did not significantly correlate with disease relapse (P = 0.07). In a Cox multivariate analysis, the only parameter with an independent prognostic effect on disease-free survival was EGFR expression (relative hazard, 11.23; P = 0.0014). CONCLUSIONS: EGFR expression increases during the natural history of prostate cancer. Correlation with disease progression and hormone-refractory disease suggests that EGFR-targeted drugs could be of therapeutic relevance in prostate cancer.

Androgens↗

PubMedDate not supplied

HER-2/neu receptor in prostate cancer development and progression to androgen independence.

Development of prostate cancer and progression to androgen-independent disease is correlated with increased expression of growth factors and receptors capable of establishing autocrine and/or paracrine growth-stimulatory loops. A thorough review was made of the current literature and recent abstract presentations at scientific meetings focusing on the role of the HER-2/neu (c-erbB2) receptor in prostate cancer and the potential clinical usefulness of its specific inhibitors. In the past 10 years, conflicting results on HER-2/neu expression in prostate cancer have been reported. More recently, four studies have shown experimental evidence of HER-2/neu in the development of prostate cancer and, more specifically, in the progression to a hormone-refractory clinical behavior. Furthermore, it has been proposed that HER-2 family and androgen receptors function synergistically in the absence of androgen, which suggests a cross-talk between the HER-2/neu and androgen receptor pathways. Finally, clinical trials are in progress in prostate cancer patients to test novel agents that selectively interfere with HER-2/neu activity.

Androgens↗

PubMedDate not supplied

Gemcitabine and cisplatin following surgical treatment of urinary bladder carcinosarcoma.

The clinical case of a 73-year-old man with a history of transitional cell carcinoma of the bladder, an ulcerated mass on the left hemitrigone and left hydronephrosis who underwent radical cystoprostatectomy and urinary diversion followed by cisplatin-gemcitabine chemotherapy is presented. Pathological examination revealed a biphasic mixed tumor characterized by an epithelial and a mesenchymal component. At 24 months of follow-up the patient is alive and free from recurrent disease, with good quality of life and preserved renal function. Carcinosarcoma is highly aggressive and often has a dismal outcome regardless of treatment. Among all the studied prognostic factors, pathological stage is the main predictor of survival. The outcome of our patient suggests that the relatively well tolerated gemcitabine-cisplatin regimen after surgical treatment of invasive carcinosarcoma of the bladder might improve the currently dismal prognosis of selected elderly patients.

Aged↗

PubMedDate not supplied

External beam radiotherapy in bone metastatic prostate cancer: impact on patients' pain relief and quality of life.

Bone metastases are a severe problem in oncology, since they usually are associated with pain. External beam radiation therapy (EBRT) has been, for many years, an important component of the treatment regimen to relieve pain. We have performed a clinical study to evaluate the relationship of response to EBRT in terms of pain relief and improvement in quality of life (QoL). We were also interested in the incidence of acute toxicity with EBRT. We have prospectively evaluated 75 patients (median age 68 years, range 64-79 years) with bone metastases from prostate cancer treated with EBRT, radiographically documented from June 1999 to September 2000. Additional therapies in these patients included: second-line hormonal therapy (HT) in 20 patients, chemotherapy (CT) in 25 patients, biphosphonates in 45 patients. For all patients a pain and narcotic evaluation was done before entering the study. Assessment of response was carried out by evaluating pain relief. QoL was measured by using the EORTC QLQ-C30 questionnaire. Toxicity analysis was based on the ROTG grading system. Survival was calculated by Kaplan-Meier estimate from the start of EBRT treatment until the last follow-up or death. A total of 61 out of 75 patients (81%) experienced some type of pain relief after treatment. The complete response rate was 23%. No significant difference in the response rates was found between the group treated with EBRT alone versus the groups treated with EBRT + CT or EBRT + HT. We noted a significant improvement in some of the scales of the considered EORTC-QLQC30 questionnaire. As expected all treatment-related complications were either grade 1-2 acute or subacute and transitory in nature. The group treated with EBRT + CT experienced slightly higher toxicity rates. There were no treatment-related fatalities. Forteen patients of 61 (23%) responders was alive at 12 months. Our results confirm the ability of EBRT to relieve bony pain in the majority of the cancer patients treated as measured by prospective analysis of pain scales prior to and after EBRT. Minimal side effects were experienced and QoL improved as shown by the results of the specific questionnaire.

Aged↗