[Leiomyosarcoma of the vessels of the renal ileus : a case report].
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Aged↗
Biomedical subjects
P Piana
Publications and source records attributed to P Piana.
Bayesian population model of methotrexate to guide dosage adjustments for folate rescue in patients with breast cancer.
BACKGROUND: Methotrexate (MTX) infusions may induce severe side-effects, and alkaline hydration along with folinic acid rescue is a common way to reduce such toxic risks. The purpose of this study was to develop an adaptive rescue strategy based upon the early detection of patients with impaired MTX elimination. METHODS AND RESULTS: In this study, we propose a simple population-based Bayesian approach for predicting MTX plasma concentration from a limited number of samples, so as to adapt both duration and dosage of the rescue agent to be used next. Ten kinetic profiles obtained after 10 courses of MTX (1.5 g/m2) in seven patients with inflammatory breast cancer were used to establish the population pharmacokinetic parameters (Cl, 8.16 L/h; t1/2, 12.7 h). This population was next involved in the Bayesian estimation of MTX individual pharmacokinetic parameters from only two blood samples (T24 and T36 h), thus allowing one to forecast the elimination of this drug by predicting MTX levels at 48 h. According to the MTX concentrations predicted during the elimination phase, folinic acid rescue was then prolonged in patients likely to be overexposed. CONCLUSION: The Bayesian estimation presented in this study was an easy and convenient method to efficiently detect patients with impaired MTX elimination in routine clinical practice. This information enabled the introduction of strategies for minimizing the risk of severe drug toxicity.
Adult↗
Immunohistochemical evaluation of the safety of transurethral electrovaporization of the prostate and its clinical results.
Short term follow up studies on transurethral electrovaporization (TUEVP) have shown a relative low morbidity over TURP. The use of high power current has been claimed as a source of possible damage on the neuronal structures surrounding the prostate. The aims of our study were to assess longer follow up results as well as the safety of this technique. Over an 18 month mean follow up period symptom relief remained relatively stable. Postoperative dysuria was detected in a higher percentage of patients and was seen for a longer period in comparison with previous reports. Immunohistochemical staining performed using S-100 and NF monoclonal antibodies showed anatomical integrity of the prostatic neuronal fibres surrounding the vaporization edge. In conclusion, although the effectiveness and safety of TUEVP are confirmed by the present study, the occurrence of a significant rate of long-lasting postoperative irritative symptoms must be taken into account.
Journal Article↗
[Leiomyoma of the bladder. Report of a case and review of the literature].
Mesoidial tumours are rare benign lesions which may occur wherever mesenchymal tissues are present with an incidence of between 1.5% and 5%. Above all, leiomyomas affect females affect females aged between 30 and 50 years old and show a preference for the uterus (most frequently observed site) and the digestive and urinary tracts, in particular the vescica. Their etiology is still controversial, but the hypothesis of tumoral growth following an altered response to hormone stimulation (spt. Estrogens) appears to be the most credible. Development is mainly endovescical (63%), but extravescical (30%) and intramural cases are not rare; the site and dimensions (mean 6 cm) influence the symptoms, the type of surgery and the prognosis. In intravescical cases the most commonplace symptoms include obstructive urination, including pre-urination delay, a feeling of incomplete emptying, diurnal pollakiuria; these are followed by irritative symptoms (dysuria, burning) and micro-macroscopic hematuria. They are often asymptomatic in other cases. Diagnosis is based on instrumental diagnosis, in particular ultrasonography using a suprapubic and/or transvaginal approach, which gives an hypoechogenic image covered by a thin hyperechogenic line of mucosa. Diagnosis can also be made using CAT and, in some cases, MR for a better definition of the site, dimensions and ratios. Urethrocystoscopy is essential in asymptomatic cases and allows biopsy to be performed in uncertain cases. Treatment is surgical using a transurethral approach in endovescical cases with limited dimensions or open surgery in others. Depending on timely treatment, prognosis is good owing to the low number of recidivations.
Female↗
Recurrent calcium oxalate urolithiasis in a man with familial periodic paralysis and hypokalemia.
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Adult↗
[Biophysical principles of tissue electrovaporization].
The principles of electrosurgery are based upon well defined physical grounds, explaining the type and extent of the lesions induced by the electric current. Technological evolution has led to the creation of dedicated equipment, allowing efficient use of electrosurgical cutting and coagulation of tissues, both in open and endoscopic surgery. Electrovaporization is the thermal effect obtained when an alternating high power-high frequency current (300 W, 400-500 kHz) is applied to the tissue using an electrode with particular geometric aspects. The main feature is the presence of higher and lower current density zones. The first induce electrovaporization, whilst the second produce simultaneous hemostatic coagulation of the rims. New effective vaporizing electrodes have been recently introduced into clinical practice. Their use in the endoscopical treatment of bladder outlet obstructions, a stimulating alternative to standard resection or laser applications, is currently under evaluation.
Electrocoagulation↗
[Primary signet-ring-cell carcinoma of the bladder. Description of a case and review of the literature].
The authors describe a case of infiltrating signet-ring cell carcinoma of the bladder, a rare and extremely aggressive form of adenocarcinoma. This neoplasia in only rarely found in a histologically pure form. In the majority of cases the atypical elements which characterise it are mixed with the gland-like and papillary structures of the adenocarcinoma and with foci of transitional or pavimentous carcinoma. The origin is probably metaplastic. These carcinoma are generally invasive, scarcely differentiated and often cause linitis plastica of the bladder. The histological picture is characterized by atypical epithelial elements with abundant, vacuolised cytoplasma. The nuclei are hyperchromic and eccentric, thus representing the typical appearance of signet-ring cells. The histological picture cannot be distinguished from that of a secondary gastrointestinal or prostatic form, therefore the primary diagnosis requires a full clinical and pathological examination of the sectors describes. The prognosis is severe. Elective therapy consists in radical cystectomy with pelvic lymphadenectomy.
Carcinoma, Signet Ring Cell↗
[Appearance in 2 brothers of double primary neoplasms: right renal carcinoma and gastric adenocarcinoma].
We report a clinical case of a double primitive tumour (right kidney clear cell carcinoma and gastric carcinoma) in two brothers. There is no history of cancer in the parents. Both patients were previously affected by gastric ulcer. No report of association between the two neoplasms was found in literature. The age of the patients (61 and 70 years) and the singleness of the kidney tumour seem to exclude the case of a familial kidney cancer. The neoplastic transformation of the gastric ulcer is instead a quite frequent report with an incidence of about 1%. Alterations of oncogenes or tumour suppressor genes shared from both neoplasm are at present still unknown. Nevertheless molecular analysis of patients' neoplastic genome could point out typical chromosome translocations/deletions or gene mutations.
Adenocarcinoma↗
[Measurement of skeletal alkaline phosphatase in prostatic carcinoma. Preliminary report].
Bone metastases frequently occur in prostate carcinoma. Total body radionuclide scan with diphosphonate methylene labelled with 99Tc is commonly used to diagnose such metastases. However this technique is aspecific and frequently unreliable. In recent years several biological markers dealing with bone metabolism were studied. Serum determination of skeletal alkaline phosphatase (ALP) and moreover of its bone isoenzyme (BAP) could be considered a reliable index of osteoblastic activity. In this preliminary report we analyzed a group of 43 patients affected by prostate carcinoma with or without bone metastases. The American Urological Association (AUA) staging system was adopted. Sixteen patients were D2, bone metastases had been suspected by means of radionuclide bone scan and confirmed by Computerized Tomography and/or aimed X-rays. Tandem R-Ostase by Hybritech was used to measure BAP, normal value is set to 20 micrograms/L. All D2 tumours had pathological BAP values (mean value 87.50 micrograms/l); 1/3 stage A, 5/13 stage B, 5/9 stage C and 0/2 stage D1 patients had pathological findings. One of this patients, stage C, revealed a bone metastase at a later bone scan.
Acid Phosphatase↗
[Surgical treatment of benign prostatic hypertrophy and Kelami syndrome].
The authors analyze a group of 116 consecutive patients treated with transvesical prostatic adenomectomy or transurethral prostatic resection for benign prostatic hypertrophy (BPH) isolated five of them with a Kelami syndrome. These patients, aged between 53 and 70 years old, had a relevant ventral penile deflection with severe sexual impairment postoperatively. Among them only one asked for a corrective surgical procedure. Aetiology, preventive measures and therapeutic choices are discussed. Authors pointed out that this syndrome is actually underestimated considering the high number of transurethral or open surgery procedures for BPH.
Aged↗
[Suspected spontaneous rupture of the ureter. Report of a clinical case].
A 57 year old man was admitted with left abdominal pain; radiological investigation showed a rupture of the left ureter. The authors discuss the diagnosis and the pathogenesis of ureteral rupture.
Humans↗
Urinary levels of tumour associated antigens (CA 19-9, TPA and CEA) in patients with neoplastic and non-neoplastic urothelial abnormalities.
The urinary excretion of carbohydrate antigen 19-9 (CA 19-9), tissue polypeptide antigen (TPA) and carcinoembryonic antigen (CEA) was evaluated in 264 patients with bladder cancer. Cut-off levels were established using a pool of healthy blood donors. The combined determination of CA 19-9 and TPA had a sensitivity of 74% in pTa and 83% in pT1 tumours, and 62% in grade 1, well differentiated tumours. Absence of disease at follow-up was related to a significant decrease in CA 19-9 and TPA in 129 patients with superficial (pTa or pT1) bladder carcinoma, followed up for at least 3 years. Recurrences, defined as new tumours at the same site or elsewhere in the bladder, were associated with an increase in the mean values but this was not statistically significant. A poor prognosis was indicated in patients with infiltrating tumours and the following pre-operative levels: TPA > 1500 u/l or CA 19-9 > 300 u/ml or CEA > 50 ng/ml.
Aged↗
[A case of priapism of the proximal corpora cavernosa].
A young man presented with a little perineal mass that was found to be secondary to partial priapism of the proximal corpora cavernosa. This is a very rare condition with only 3 previously recorded cases in the urology literature. The patient made a good recovery and was able to resume sexual activity.
Adult↗
Immunohistochemical detection of estrogen and progesterone receptors in the normal urinary bladder and in pseudomembranous trigonitis.
According to recent studies showing the presence of estrogens receptors (ERs) in the human female lower urinary tract, we performed ER and progesterone receptor (PR) assays in fresh frozen and paraffin embedded biopsies taken from the urinary bladder. Fourteen females undergoing endoscopy during staging for gynecological cancer (endometrium, cervix, ovary) and 15 women complaining of recurrent abacterial cystitis (pseudomembranous trigonitis) were enrolled in the study as Group 1 and Group 2, respectively. After informed consent, they were submitted to cystoscopy, during which two biopsies were taken: one on the trigonum and the other on the bladder lateral wall. ERs were identified in both groups only in the trigonum (7/14 patients in Group 1 and 8/15 in Group 2), whereas the bladder lateral wall always stained negative. PRs were found at both sites in both groups (11/14 cases on the trigonum and 7/14 on the bladder lateral wall in Group 1; 11/15 and 2/15 respectively in Group 2). Morphological localization of PRs showed intense omogeneous staining in the nuclei of the stromal fibroblasts too. A clear correspondence between the presence of steroid receptors at the squamous metaplasia of the trigonum was observed. These data are discussed speculating about a possible endocrine pathogenesis of pseudomembranous trigonitis.
Adult↗
Urinary evaluation of tumor-associated antigens in urothelial bladder tumors.
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Aged↗
Detection of estrogen receptors in the trigonum and urinary bladder with an immunohistochemical technique.
In order to detect estrogen receptors (ER) in the female bladder, 5 premenopausal and 10 postmenopausal women affected by gynecological diseases were submitted to cystoscopy, during which both the trigonum and the bladder lateral wall were biopsied. A new, simple, cost-effective immunohistochemical technique was employed to stain the estrogen specific binding sites. ER were found in the trigonum of 3 premenopausal and 4 postmenopausal subjects, while the bladder lateral wall was always ER-negative. A comparison with previously used ER detection methods and a discussion of further hypothetical applications of the immunohistochemical technique in the study of the lower female urogenital tract are reported.
Adult↗
Wheat bran in the selective therapy of absorptive hypercalciuria: a study performed on 18 lithiasic patients.
The binding properties of raw vegetable fiber towards bivalent cations suggested the prescription of brain as a dietary supplement to limit intestinal calcium absorption in hypercalciuric patients. A group of 18 patients with a specific diagnosis of absorptive hypercalciuria received a dietary supplement of 14 gm. wheat bran at the 2 principal meals for 90 days. A complete assessment of mineral metabolism was performed after 45 and 90 days. Mean basal calciuria was 357 mg. per 24 hours and a significant decrease was noted after 45 days (245 mg. per 24 hours) and 90 days (240 mg. per 24 hours), with a p value of less than 0.01. Urinary oxalate did not vary significantly (0.34 to 0.38 to 0.31 mMol. per 24 hours) and neither did phosphate levels (1,020 to 900 to 893 mg. per 24 hours). A slight and pathologically insignificant decrease was noted in serum iron and urinary magnesium; this fact could be considered a side effect owing to the nonselective binding properties of fiber. Therefore, the positive results achieved confirm the effective action of wheat bran in the treatment of correctly diagnosed absorptive hypercalciuria.
Absorption↗
CA-50 as tumour marker in transitional bladder carcinoma.
Monoclonal antibody CA-50 is a useful tumour marker in gastrointestinal carcinoma. We report an assessment of its value in bladder cancer patients. We found raised levels in 2 of 2 patients with infiltrating carcinoma and in 8 of 35 with superficial carcinoma. The recurrence rate was higher in patients with raised levels, since 6 of 8 with elevated levels and 15 of 27 with normal values had a recurrence within 6 months. T1 and T3 carcinoma had a mean CA-50 level higher than normal. G3 tumours had a mean level slightly above normal. A statistically significant difference emerged when comparing Ta with T1 + T3 carcinomas. A longer study, with serial determinations, could assess the role of CA-50 as a prognostic indicator in bladder cancer.
Antigens, Tumor-Associated, Carbohydrate↗