bluuebunny/crossref_metadata_2025 huggingface dataset:
White matter hyperintensities associated with small vessel disease impair social cognition beside attention and memory
Authors: Kynast Jana , Lampe Leonie , Luck Tobias , Frisch Stefan , Arelin Katrin , Hoffmann Karl-Titus , Loeffler Markus , Riedel-Heller Steffi G , Villringer Arno , Schroeter Matthias L
Published: June 2018

Age-related white matter hyperintensities (WMH) are a manifestation of white matter damage seen on magnetic resonance imaging (MRI). They are related to vascular risk factors and cognitive impairment. This study investigated the cognitive profile at different stages of WMH in a large community-dwelling sample; 849 subjects aged 21 to 79 years were classified on the 4-stage Fazekas scale according to hyperintense lesions seen on individual T2-weighted fluid-attenuated inversion recovery MRI scans. The evaluation of cognitive functioning included seven domains of cognitive performance and five domains of subjective impairment, as proposed by the DSM-5. For the first time, the impact of age-related WMH on Theory of Mind was investigated. Differences between Fazekas groups were analyzed non-parametrically and effect sizes were computed. Effect sizes revealed a slight overall cognitive decline in Fazekas groups 1 and 2 relative to healthy subjects. Fazekas group 3 presented substantial decline in social cognition, attention and memory, although characterized by a high inter-individual variability. WMH groups reported subjective cognitive decline. We demonstrate that extensive WMH are associated with specific impairment in attention, memory, social cognition, and subjective cognitive performance. The detailed neuropsychological characterization of WMH offers new therapeutic possibilities for those affected by vascular cognitive decline.
Communicating Risk
Authors: Bergersen Stine
Published: June 2018

In a press conference on July 24, 2014, the director of the Norwegian Police Security Service (PST) and the Minister of Justice unexpectedly broke the news that Norway was facing an unspecific, but credible threat that terrorists from an “extreme Islamic group” would shortly attack the country. A national terror alert was issued for the first time, followed immediately by exceptional security measures, such as the arming of the usually unarmed police. In the anticipation of an attack, the public was for the first time involved in the counterterrorism efforts by being asked to be vigilant and to report any suspicious behavior. However, there was no attack on Norway, and the alert was called off a few days later without any explicit explanation. As part of the larger context of how risks and threats have been communicated in the past decades, this article describes the materialization of the event and discusses how the announcement and the content of the communications by the authorities were framed in the media coverage of it. Concretely, based on the concept of framing theory, the media coverage surrounding the announcement is considered, and the announcement is discussed via three identified frames emerging from the empirical data. These are discussed against the backdrop of the recent history of Norwegian counterterrorism practices, focusing on the effects and impacts of making such an announcement.
Rural geography III: Marketing, mobilities, measurement and metanarratives
Authors: Argent Neil
Published: June 2018

This report focuses on the individual and collective capacities of rural people to develop innovative and entrepreneurial approaches to local development (e.g. via place marketing) and to create music, art, prose and other cultural forms in place which in themselves serve to promote rural localities and regions to non-local people. In addition, it considers people’s propensities to move to new places on a permanent or temporary basis, and how this mobility affects individuals and host and sending communities. Rural geographers are also taking advantage of new sophisticated geostatistical databases to produce more precise measurements of mobility and migration relevant to rural population geography research. However, in reviewing these two major research fields I also pay attention to the relative mobility of concepts and metanarratives developed in particular national and cultural contexts and the degree to which they successfully travel and ‘take root’ – in the sense of helpfully explaining empirical circumstances – in other places. Far from being a remote outpost of the broader discipline, rural geography, through its practitioners, continues to pose vital normative questions regarding the current and future directions of rural society, economy, population and environment across the globe, and developing the intellectual and practical tools to address those questions.
Multiple Correspondence Analysis of Pedestrian Crashes in Rural Illinois
Authors: Baireddy Raghunandan , Zhou Huaguo , Jalayer Mohammad
Published: June 2018

During the five-year period between 2010 and 2014, there were 24,178 pedestrian crashes in Illinois. Approximately 4.39% of these pedestrian crashes occurred in rural areas; and approximately 40% of the crashes resulted in a severe injury or a fatality. Thus, pedestrian safety problems exist in rural locales, and the factors contributing to these problems need to be investigated. The goal of this study is to answer the question: “Which variable categories, when acting together, contribute more to the occurrence of pedestrian crashes in rural areas?” Crashes are random events stemming from the convergence of various factors. However, traditional statistical tools can only make pairwise comparisons of dependent and independent variables. Therefore, it is necessary to apply an analytical tool that can identify complex underlying structures in crash data and spot associations among variable categories that contribute to crash occurrence. The multiple correspondence analysis (MCA) method, which is used in this study, can do just that. According to the obtained results, categories of variables such as roadway functional class, the number of lanes, lighting conditions, weather conditions, traffic control devices, driver condition, and pedestrian condition were proved to contribute to pedestrian crashes in rural Illinois.
Kings, Brāhmaṇas and Collective Land Grants in Early Medieval Odisha
Authors: Acharya Subrata Kumar
Published: June 2018

Collective land grants to the brāhmaṇas by the ruling authorities were a common feature in early medieval India. It was the usual practice to specify the number of brāhmaṇas receiving land, along with their personal names, gotras, Vedic affiliations and respective shares. But there are examples where these details are not furnished. Besides, there are quite a large number of instances where the brāhmaṇas of a single family received land grants collectively. The number of recipients varied and sometimes several thousands were given land grants in the same locality. There are a number of reasons why the brāhmaṇas were granted land collectively. Scholars like R.S. Sharma and B.P. Mazumdar, who have worked on this aspect and mostly examined the North Indian inscriptions, marshaled their own arguments. While the former situated them in the context of agrarian expansion and tribal acculturation, the latter viewed them largely as strategic moves of the kings for defending the frontiers of their kingdoms. In the present article an attempt has been made to review all the collective land grants of early medieval Odisha and explore the possible reasons for land donations to the brāhmaṇas collectively. The period roughly covers from the fourth to fifth century CE to the twelfth to thirteenth century CE.
Visualising the Rāmayāṇa: Power, Redemption and Emotion in Early Narrative Sculptures (c. Fifth to Sixth Centuries CE)
Authors: Bawa Seema
Published: June 2018

This article seeks to explore the images based on the Rāmayāna tradition within archaeological, cultural and literary contexts in late fifth and early sixth century ce. It uncovers elements of politico-religious agency, art and historical knowledge. Narrative panels, spatially located largely in central and north India, narrativise the episodes set in the forest represented in the Aranya and Kiskindhākānda. Evolution of narrative complexities through placement, composition and representational devices in terracotta and stone relief sculptures at sites such as Nachna Kuthara and Deogarh is traced. Rāma’s idealised character, expressed through renunciation, benevolence, ameliorative power, authority and dharma, emerges within the physical and emotional landscape of Rāmayāna imagery. Ideal and deviant behaviour is represented through narratives based on Ahalya, Anusuyā, Śūrpanakhā, Vālin and such characters. The construction of the ‘other’ in form of monkeys and demons, vānaras and rāksasas, in the visual discourse, and the fascination with devotion, romance and heroism that is projected through these is seen as a thread that runs through the Rāmayāna narratives.
Occidental Encounters and Impressions
Authors: Singh Sohini
Published: June 2018

The visual and literary chronicles of British Residents and Surveyors comprise a reservoir of information on the historical, social and economic milieus of various territorial regions within the Indian subcontinent. Further, they contain copious documentation on the art and architectural heritage of these regions. Straddling the realms of antiquarianism and archaeology, the concomitant processes of survey and documentation evolved during the seventeenth century and acquired a panoptic character by the nineteenth century. They were essentially products of the interface between the diametrically opposed occidental and oriental cultures and were furthered by the expedients of colonialism.

This article is divided into three parts. The first part delves into the relationship between antiquarianism and archaeology. The second part elucidates upon the practices of surveying and documentation in India. The third part elaborates upon the career of Lt. Frederick Charles Maisey and his explorations in central India with special reference to his mid-nineteenth century illustrations of Chanderi’s architectural edifices and structural members. Chanderi, a town of historical importance in Madhya Pradesh, is interspersed with tombs, step-wells, mosques and free-standing gateways of Indo-Islamic affiliation, ascribable largely to the fifteenth century. Some of these edifices are in a bad state of preservation and Maisey’s illustrations have been instrumental in reconstructing their effaced architectonic and decorative details. The illustrations under purview have also contributed towards a holistic understanding of the architectural style at Chanderi, an area which is fairly uncharted.
Ureteropelvic Junction Obstruction: Some new Acquisitions about Etiology, Pathophysiology and Diagnostics
Authors: Alberti C. , Tizzani A.
Published: June 2018

The etiopathogenesis of uretero-pelvic junction obstruction (UPJO) has been the subject of many speculations and it remains, in some ways, a debatable matter. Some recently reported thorough research refer to neuro-mediated pathogenetic mechanisms rather than (or together with) myogenic ones.

Advances in US, radioisotopic functional imaging, CT and RM contribute to differentiate the obstructive conditions from the non-obstructive ones and to afford today a better assessment of renal functional damage. Particularly, diuretic renography is a non-invasive test for characterization of the renal functional abnormalities resulting from UPJO. Helical CT with angiography is a useful technique for identification of crossing vessels (pyelo-vascular tangle) which can be used for the pre-surgical planning of endopyelotomy. Endoluminal ultrasonography can be used to guide the position of the incision for endopyelotomy (US-guided endopyelotomy).

Laboratory examinations are important to determine the overall renal function (serum creatinine, acid-base balance, serum electrolytes, etc.), urinary MCP-1 and NAG (markers of tubular damage), and to rule out urinary tract infections.

The management of UPJO (watchful waiting; either open or laparoscopic dismembered pyeloplasty; endoluminal procedures) is greatly influenced by the diagnostic evaluation.

The paper aims to outline the advances in both physiopathology and diagnostics of UPJO on the basis of a review of the literature.
Perioperative Complications of Laparoscopic Radical Prostatectomy: Initial Experience
Authors: Gregori A. , Simonato A. , Lissiani A. , Bozzola A. , Galli S. , Rossi P. , Gaboardi F.
Published: June 2018

We retrospectively evaluated the intraoperative and early postoperative complications of the initial experience with the first 80 laparoscopic radical prostatectomies performed at our institution. Between January 17, 2001 and July 24, 2002, 80 patients with clinically localized prostate cancer underwent transperitoneal laparoscopic radical prostatectomy. The pathological tumor stage revealed 18 pT2a (22.5%), 29 pT2b (36.25%), 21 pT3a (26.25%), 10 pT3b (12.5%), 1 pT4 (1.25%), 1 pT4 N1 (1.25%). No conversion was necessary in all cases. Injury to the epigastric vessels was detected intraoperatively in 5 cases (6.25%) with immediate hemostatis achieved. There was 1 death (1.25%) 35 days after a cerebrovascular accident occurred on postoperative day 3. We observed 1 (1.25%) postoperative ileus, hemoperitoneum in 5 cases (6.25%), 2 (2.5%) acute urinary retentions, 6 (7.5%) anastomotic leakages, 1 (1.25%) anastomotic stricture, 1 (1.25%) hydrocele and 2 (2.5%) urinary tract infections.

In our initial experience laparoscopic radical prostatectomy was performed with no complications in 77.5% of patients. We observed major and minor complications respectively in 16.25% and 6.25% of the patients. Our series provides evidence that the laparoscopic approach during a learning curve is feasible and associated with acceptable morbidity.
Extensive Neurophisyological Evaluation in Primary Premature Ejaculation Patients
Authors: Imbimbo C. , Granata A.M. , Buonopane R. , Barba C. , Ranavolo R. , Cicalese A.R. , Mirone V.
Published: June 2018

Pudendal nerve somatosensory evoked potentials (PN-SEPs), bulbo-cavernosus reflex (BC reflex) and perineal motor evoked potentials (BC MEPs) following transcranial magnetic cortical stimulation (TMS) were performed in patients with primary premature ejaculation (PPE), to investigate the somatic sensory and motor function of the genital area.

Methods

Fourteen patients with PPE underwent psychological counseling, urologic physical and trasnrectal ultrasound examination, laboratory data and Stamey test. Spinal and cortical PN-SEPs were recorded by dorsal nerve stimulaiton at penile shaft (DN-SEPs) in all patients, and at glans penis (GP-SEPs) in 3 of them. BC reflex was obtained by stimulating the basis of penis.

Results

Mean sensory thresold did not significantly differ between patients and normal subjects. Cortical DN-SEPs were normal in alla patients. Sensory central conduction was significantly smaller in patients than controls. In 3 patients and in 3 controls undergone both DN-SEPs and GP-SEPs, glans penis sensory threshold was lower than dorsal nerve one, and cortical GP-SEP latency longer than cortical DN-SEP latency. BC reflex was normal in most patients. BC MEPs were normal in all patients, but one.

Conclusions

We did not confirm either a faster conduction along the pudendal sensory pathway, or a greater cortical representation of the sensory stimuli from the genital area in oue patients. Moreover, we did not confirm an hyperexcitability of BC reflex in them. Our results suggest that the electrophysiological approach is probably not sufficient to clariphy the causes of PPE and more integrated investigation are requested.
A Case of Renal Pseudoaneurysm Incidentally Discovered
Authors: Mazzariol C. , Ca'Bianca E. , DI Tonno F. , Risica G. , Malossini G.
Published: June 2018

Intrarenal pseudoaneurysms generally derive by renal trauma. They usually present with hematuria after a few time. Angiography combined with embolization represent the best diagnostic and therapeuthic procedure, with a success rate of about 100%.

We report a case of voluminous renal pseudoaneurysm, incidentally discovered and treated with angio-embolization.
Renal Tumours, Epidemiology and Diagnostic Profile
Authors: Ricciotti G. , Bozzo W.
Published: June 2018

Our understanding of the natural history of renal cell carcinoma and the possibilities of new technologies are evolving and being integrated with advances in classification and staging. In this article we reviewed the literature in order to provide an analysis of the changing epidemiology of renal cell carcinoma.

Radiological evaluation of renal masses has rapidly progressed from conventional angiography and intravenous urography to ultrasounds, CT and MRI. As more patients are imaged for many opportunities, the incidental detection has increased. This article reviews the imaging and not techniques in order to characterize these lesions accurately.
Laparoscopic Lymphadnectomy in the Prostate Cancer
Authors: Fasolis G. , Fasolo P. P. , Conti E. , Sebastiani G. , Mandras R. , Puccetti L. , Lacquaniti S.
Published: June 2018

Treating prostate cancer, pelvic lymphadenectomy is still a debating topic in current international licterature. Surgical removal of both internal iliac vessels and obturatory fossa lymphonodes is usefull in order to stage lymphatic spreading of prostate cancer. We evaluated possible indications to laparoscopic limphadenectomy according to present know-ledges.

Methods

From october 2001 to june 2003, at our instituction 18 consecutive patients with clinically advanced prostate carcinoma diagnosed at transrectal ultrasonography guided needle biopsy and >20% preoperative risk of lymphonode metatstasis, underwent laparoscopic pelvic lymphadenectomy. Patients’ surgical postion in the theatre room was according to classic reported transperitoneal approach. Five disposable trocars were used for optical and instruments access.

Results

Mean surgical intervention time, blood loss and number of removed lymphonodes was 163 ± 32.8 minutes, 180 mL ± 25 and 28.7 ± 8.6 respectively. Ten patients (55%) were diagnosed to have lymphonode metastasis. Mean number of metastatic lymphonodes was 3. Conversion to open surgical procedure was not recorded. In 17 out of 18 cases, analgesic therapy was not necessary during hospital stay; in those patients intestinal canalisation, mobilisation and oral food intake restarted in first postoperative day. We had only one major complication. Laparoscopic pelvic lymphadenectomy costs were € 4.244. Regional diagnosis relata groups fee was € 4.463.

Conclusion

Laparoscopic lymphadenectomy, when indicated, was in our experience safe and effective but still expensive procedure with high patient’ satisfaction.
Trattamento di Lesioni Traumatiche Renali Mediante Embolizzazione Selettiva Transcatetere
Authors: Menichelli E. , Scardigli A. , Failoni G.L. , Fuochi C. , Moser E. , Luciani L.
Published: June 2018

Nelle lesioni traumatiche renali, la metodica angiografica, oltre ad essere di valido ausilio nella diagnosi di sede dell'eventuale emorragia associata, permette una terapia immediata di queste lesioni, evitando così manovre chirurgiche ben più invasive e rischiose.
Nodal Involvement in Bladder Cancer
Authors: Bassi PF. , DE Marco V. , Tavolini IM. , Dal Moro F. , Battaglia D. , Aragona M. , Longo F.
Published: June 2018

There are many controversies about the actual meaning of nodal involvement in bladder cancer and, subsequently, about the real benefit of pelvic lymph node dissection (PLND) in patients with positive nodes at the time of cystectomy.

In this article we reviewed the literature about the role of nodal involvement and the impact of positive nodes on the prognosis.

The finding of positive nodes after radical cystectomy and PLND makes generally consider bladder cancer as a systemic disease and it is associated with poor prognosis. Therefore many urologists don't perform radical surgery in patients with positive nodes at time of cystectomy.

P category, N category, and distant metastases are the most important factors in determining the outcome of patients with bladder cancer with nodal involvment. PLND is necessary for accurate staging in bladder cancer and appears to benefit patients with limited nodal involvement.

PLND should be considered as a standard procedure that should be performed in every patient with indication of surgical treatment for TCC of the bladder.
Insuline-Like Growth-Factors (IGFs) as Marker of Risk and Progression of Prostate Cancer
Authors: Graziano M.E. , Casetta G. , Tasso M. , Volpe A. , Ferrando U. , Tizzani A.
Published: June 2018

The growing incidence of prostate cancer is stimulating investigations on cancer differentiation and proliferation. Studies on guinea-pigs showed IGF can cause and stimulate cancer as hepatocarcinoma, breast cancer, pancreas cancer and prostate cancer. Between April 2001 and February 2002 we investigated 17 patients (50–75 years old) with prostate cancer. IGF1 serum concentration before surgery was higher than physiological level, at 2 months and, above all, at 6 months after radical prostatectomy this level decreased significantly. Furthermore IGF growing was related with protein and hormone variations (protein and hormone levels were measured before surgery, at 2 and 6 months after surgery; BMI was measured in the same periods). IGF1R concentration on the prostate glande was low expressed as we showed with immunohistochemistry: this could mean a low sensibility to apoptosis. IGF1/PSA was significantly low in patients with prostate cancer. These results suggest the possible role of IGF1 in differentiation-progression of prostate cancer and in metabolic alterations. Other studies about IGF might investigate its diagnostic and therapeutic role.
Quality of Life after Cistectomy
Authors: Azzolini N. , Ferretti S. , Barbieri A. , Maestroni U. , Giollo A. , Ferraro O. , Panteri M. , Cortellini P.
Published: June 2018

We have considered the aspects and the differences of quality of life and erectile function of 32 consecutive patients underwent to surgical operation of radical cistectomy and urinary diversion (11 patients with ileoureteralcutanous sec. Bricker and 21 patients with orthotopic neobladder). Medical Outcomes Study - Short Form - SF36 TEST and International Index of Erectile Function - IIEF-5, TEST have been administered to the patients, to know the Quality of Life assessment and the erectile dysfunction. The evaluation and analysis of the answers show no statistical significant differences between the two groups of patients about quality of life and sexual aspects.
Sparc Sling System for the Treatment of Female Stress Urinary Incontinence (SUI) Due to Uretral Hypermobility: Our Experience
Authors: Facchini F. , Simonazzi M. , Meli S. , Giollo A. , Ferretti S. , Cortellini P.
Published: June 2018

We present a new device, SPARC Sling System, designed for the placement of a pubo-urethral sling for the correction of female stress urinary incontinence due to urethral hypermobility. Twenty patients (medium age 53.4), affected by SUI resulting from urethral hypermobility (range of Q-tip test 30°-70°, VLPP > of 70 cmH2O and POP grade < II according to Baden and Walker classification) are underwent to this surgical procedure. 85% of them, after a medium follow-up of 10.5 months (range 3–21) show a complete correction of SUI. Three patients, in which SUI persists, refer a significant improvement of the incontinence. We think that the high rate of success (85%), the swiftness of the execution and the versatility of the SPARC Sling System put this surgical procedure between the mini-invasive selected methods to correct female stress urinary incontinence due to urethral hypermobility.
Flow Cytometric Assessment of Spermatogenesis in Testicular Biopsies in Infertile Men. Study of 23 Cases
Authors: Leonardi E. , Reich A. , Scardigli A. , Luciani L.G. , Palma P. Dalla
Published: June 2018

Quantitative analysis of biopsy specimens of the testis represents the most direct indicator of spermatogenic function, whereas conventional microscopical procedures are open to subjective interpretation. In this study, the quantification of germ cell lines by means of flow cytometry was investigated and the results compared to histological findings. We studied 23 infertile men with azoospermia or oligospermia. The percentage of haploid-A, diploid –-D, tetraploid-T compartments was determined for each patient. Spermatogenesis was considered normal, decreased or in complete maturation arrest when histograms showed A>D>T, D>A>T or D>T>A patterns respectively. Comparing histograms and histological findings, excellent correlation was found in cases displaying absence of aploid cells, while 3 out 7 histograms showing hypospermatogenesis corresponded to normal spermatogenesis on biopsy specimens. Additionally, one case with complete maturation arrest histogram showed hypospermatogenesis on histologic sample. DNA flow cytometry provides a rapid and objective assessment of spermatogenesis in the investigation of male infertility. Importantly, this procedure might also be performed on aspiration biopsy, avoiding the costs and complications of surgery.
Endoscopy Treatment with Coaptite® in Symptomatic Vesico-Ureteral Reflux after Kidney Transplant: Initial Experience in Four Cases
Authors: Lasaponara F. , Graziano M.E. , Morabito F. , Rossi R. , Squintone L. , Cucchiarale G. , Ferrando U.
Published: June 2018

The evidence of symptomatic vesico-ureteral reflux after kidney transplant impose its correction. In our experience the incidence of this correction is 1%. The first choice is endoscopes treatment with periorifitial injections (75% good results) with Teflon or Macroplastique. In the latest four patients with symptomatic vesico-ureteral reflux III degree (recurrent urinary infections, serum creatinina >20–40%) we applied Coaptite®, with three periorifitial injections. Coaptite® is a biocompatible material, natural and inert, made of calcium idrossiapatite spheres of 100 micron suspended in a water and glycerine gel. These characteristics made Coaptite® much more suitable in transplanted patients with immunosuppressive therapy. Coaptite® is X-ray opaque: treatments and results are more easily measurable. The results with Coaptite® are superimposable to Teflon or Macroplastique. We observed any complications.
Salvage Radical Prostatectomy
Authors: Acanfora F. , Baima C. , Genesi D. , Ruggiero L.
Published: June 2018

The aim of this film is to demonstrate that salvage radical prostatectomy can be performed preserving urinary continence and with a morbility rate comparable to that of radical prostatectomy performed de novo in patients with a previously untreated tumor. Three consecutive rises in PSA level, above the nadir PSA, and the presence of biopsy-proven prostate cancer, show a recurrent or persistent disease in a patient with prostate cancer, treated with full-dose radiation therapy. Thus, when patients present a life expectancy of at least 10 years and organ-confined disease, salvage radical prostatectomy is the only option of therapy most likely to achieve lasting local control.
An Evaluation of Quality of Life in Patients who Underwent Urinary Diversion after Radical Cistectomy: Comparison of Different Urinary Diversions, our Experience
Authors: Mariani L. , Milanese G. , Piergallina M. , Minardi D. , Polito M. , Muzzonigro G.
Published: June 2018

The aim of the study was to compare health-related quality of life (HRQOL) in 3 groups of patients with different urinary diversions using the “36 Item Short-Form Healt Survey” questionnaire; metabolic changes related to urinary diversion were also evaluated. The study included 22 patients who underwent radical cystectomy for bladder cancer: 10 pts had an an ileal-conduit (Group I), 9 had a retto-sigmoid pouch sec. Mainz II (Group II), and 3 had an ileal orthotopic neobladder (Group III).

There were no significant differences among the 3 groups regarding the metabolic status. The SF -36 survey showed that patients with ileal-conduit (Group I) had a significant decrease of general health (GH) and of physical functioning (AF) scores compared to patients with continent urinary diversion (Groups II and III). This appeared to be related to a decreased emotional drive (RE) rather than to a loss of vitality (VT).

There were no significant differences in any scale score between Group II and III.
Cavai Relapse with Budd-Chiari Syndrome after Radical Nephrectomy for Renal Cancer
Authors: Fulcoli V. , Lavelli D. , Dal Bianco M. , Milani C.
Published: June 2018

A 60-year-old man, who had undergone a right radical nephrectomy and cavaatrial thrombectomy for renal cell carcinoma (RCC), presented a recurrent neoplastic cavai thrombus six months later, associated with Budd-Chiari syndrome. A re-thrombectomy was attempted with technical success, but patient didn't survive the operation.
Endocavitary Therapy of Superficial Cancer Bladder: Evaluation of Photobiological Activity of Psoralen Derivatives on in Vitro Reconstituted Bladder Mucosa
Authors: De Angeli S. , Del Pup L. , Gia O. , Via L. Dalla , Magno S. Marciani , Fandella A , Maccatrozzo L. , Merlo F. , Anselmo G.
Published: June 2018

The development of high selectivity drugs for urothelial neoplasia is one of the goals in endocavitary therapy of superficial cancer bladder improvement. Photochemotherapy could cover an important role, because it enables to selectively treat the neoplastic lesions thanks to compounds sensitised by light sources specifically addressed. Aims of this study was to evaluate the in vitro biological activity on normal and neoplastic urothelium of a psoralen derivative, 4-Methyl-11-dimethilaminopropoxy-benzopsoralen (G50-E), against 8-methoxypsoralen (8-MOP) reference drug. Both of them are photosensitied by UVA radiations (photochemotherapy PUVA). An experimental model, which reproduces, even if in a simplified manner, the human bladder mucosa and submucosa organization, was in this study adopted. Firstly, we evaluated the antiproliferative activity of these psoralen derivatives on neoplastic and normal origin human urothelial cell lines. For this we determined the relative IC50 by means of cytotoxic test on cellular monolayer with Trypan Blue. In a second phase of this study, we took advantage from reconstitution technique of bladder mucosa proposed by Fujiyama and previously optimized by our group to evaluate on a three-dimensional model the IC50 effects due to both considered compound. Pharmacologically treated neo-bladder and the control ones were evaluated by means of scanning electron microscopy (SEM) observations. The meaningful result appeared in cellular monolayer experimentation was the selectivity exhibited by both tested compounds (particularly G50-E) against the neoplastic origin urothelial cells. Moreover, scanning electron microscopy investigation, carried on neo-bladder, confirmed the G50-E cytotoxic effect. Therefore, these results suggested the benefit of PUVA therapy for superficial bladder cancer. But, we have to remind that the microscopic observations are just a initial approach and further researches are necessary to quantify the functional and sub-microscopic damage on three-dimensional models.
Long-Term Results of Nephron Sparing Surgery for Localized Renal Cell Carcinoma
Authors: Autorino R. , De Sio M. , Damiano R. , Schiavo M. , Cosentino L. , Pane U. , Di Giacomo F. , Giordano D.R. , Quarto G. , Mordente S. , Domenico R. , D'Armiento M.
Published: June 2018

Several unrandomized studies from the current literature confirm that in selected patients with localized renal cell carcinoma (RCC), nephron sparing surgery (NSS) shows to be as effective as radical surgery. In this regard, we evaluated the data from patients treated by using such a conservative approach with a long-term follow-up.

Materials and Methods.

We considered 28 patients (19 M, 9 F; median age 54 years) with unilateral, localized, small (< 4 cm) RCC, submitted to NSS from 1988 to 1994. Only 3 of them (10%) were symptomatic at presentation. Oncological follow-up had been conducted with visits every 4 months for the first two years, every six for another three years and then annually.

Results.

All the patients were clinical stage T1aN0M0 (UICC TNM 2002). Grading was: 10 G1, 10 G2, 8 G3. Mean tumor diameter was 3.2 cm. After a long-term follow-up (mean 10 years, range 8–14), none present local relapse, disease specific survival is 93% and overall survival is 86%. Based on biochemistry, 82% of the remaining patients still have a normal renal function.

Conclusions.

Given the excellent long-term results and the recognized benefits of elective NSS, this approach should be preferentially adopted in a selected population of patients with small (<4 cm), unilateral, RCC.
Transitional Cell Carcinoma of the Posterior Urethra in Men: Our Experience
Authors: Parma P. , Dall'Oglio B. , Schiavon L. , Luciano M. , Guatelli S. , Galletta V. , Bondavalli C.
Published: June 2018

We present the experience of the Division of Urology of Mantova Hospital about the primitive carcinoma of the posterior male urethra. This kind of tumor is very rare and there are't great experiences that permit to define a standardize therapy.

Material and Methods.

Three cases of primary posterior urethral carcinoma who had been treated at our institution between 1999 and 2001 were retrospectively analyzed. The location of the tumor was in 2 cases in the prostatic urethra and in 1 case in the membranosus urethra. The treatment was cistoprostatectomy in 1 case, cistoprostcatectomy associated with penectomy in the case of carcinoma of the membranosus urethra and a prostatectomy in one case of the carcinoma of the prostatic urethra. In 2 cases an adiuvant chemotherapy with cispaltinum was performed while in the third patient a chemiotherapy with gemcitabina was performed at the presentation of a local relapse of tumor.

Results.

In the case of carcinoma of the prostatic urethra treated with cistoprostatectomy and uretrhectomy and adiuvant chemotherapy there was a good local and distand controll of the cancer with a follow up of 24 months. The patients with carcinoma of the membranosus urethra treated with cistoprostcatectomy associated with penectomy and adiuvant chemiotherapy had a local relapse at 24 months and was treated with radiotherapy. The patient treated with only prostatectomy presented a local relapse at 2 months and distant metastasis at 15 months. After 2 years this patient is still alive but in clinical progression.

Conclusions.

The most adequate treatment in the cases of posterior urethral cancer seems the major surgical treatment with urethrectomy associated with radical cistectomy. In advanced stages chemotherapy which by necessity must follow the guidelines established for the treatment of other urothelial cell malignancies seems to give good results. The follow-up of these patients has to be very close.
Osservational Study on Early Diagnosis of Prostate Carcinoma in Sicily and Calabria
Authors: Allegro R. , Serretta V. , Aragona F. , Motta M. , Orestano L. , Cammarata C. , Melloni D. , Magno C. , Aragona C. , Pirritano D. , Paola Q. , Cosentino V. , Capizzi G. , Saita A. , Spampinato A. , Nicolosi D. , Raciti G. , Salvia G. , Rinella M. , Macaluso M. Pavone ,   E MEMBRI DELLA SOCIETÀ SICULO-CALABRA DI UROLOGIA (SSCU) E DEL GRUPPO STUDIO TUMORI UROLOGICI (GSTU), Orestano F. , Vacirca F. , Caramia M. , Cozzupoli P. , De Grande G. , Lapira G. , Ventrici F. , Falvo F. , Galfano G. , Armenio A , Gange E. , Rizzo I. , Massarelli M , Saita A. , Bartolotta S. , Pepe P. , Pavone C. , Ingargiola G.B. , Taschetti S. , Vaccarella G. , Contino G. , De Leo F.
Published: June 2018

The diagnosis of prostate carcinoma has been monitored in Sicily and Calabria for one year.

Material e Methods

Twenty-seven urological centres of Sicily and Calabria joined the study. Detailed informations about age, familiarity, PSA, Gleason score and TNM stage at diagnosis were centralized between november 2001 and november 2002.

Results

721 patients have been recruited. The median age was 73 years. More than 80% of the patients were older than 65 years. Median PSA was 14 ng/ml. The clinical stage at diagnosis was T1c in 33% of patients and 67% had an organ confined prostate cancer (T1-T2). Familiarity was detected in 8% of cases. Age and PSA at diagnosis in these patients were similar to those of the remaining population. However, only 18% of them had a T1 tumor, emphasizing the delay in diagnosis in these patients. Although only 10% of the patients shows at diagnosis a metastatic tumor, 29% only are fit for radical prostatectomy in according to age, PSA and stage.
Predictive Factors of Prostate Cancer in Patients Subjected a Prostatic Re-Biopsy, with Psa in the Grey Zone
Authors: Zaramella S. , Monesi G. , Sala M. , Favro M. , Marchioro G. , Gontero P. , Kocjancic E. , Ceratti G. , Maso G. , Frea B.
Published: June 2018

In this study we have tried to define which are the most useful predictive factors in the diagnosis of the prostate cancer in patients with first negative biopsy and with PSA in the grey zone. We have therefore analysed 123 patients subjected at re-biopsy: in 25 patients (20%) it is been diagnosed a prostate cancer at the second biopsy, while in 98% (80%) also the second biopsy was negative.

The PSA ratio and the PSA density of the transitional zone have demonstrated having the highest sensitiveness in finding patients with cancer at the re-biopsy (92% and 88%) in comparison with the ER and the TRUS (20% and 32%). Moreover the PSA DTZ let spare the 41% of the re-biopsy that will result negatives.
Hidden Penis in the Great Obese: A Case Report
Authors: Rolle L. , Datta G. , Ceruti C. , Tamagnone A. , Bosio A. , Timpano M. , Bocchiotti G. , Fontana D.
Published: June 2018

The obesity represents an increasing social problem in the Western countries. In Italy, it interests approximately 8% of the population, while 1 Italian on 100 belongs to the category of great obese (BMI 40 kg/m2). In the Western Countries, its prevalence is doubled in the last 10 years and this trend will last for next 50 years. The overfat in pre-pubic region determines several aesthetic and functional alterations that have as common element a false brevity of the penis, defined as “hidden penis”. A standard treatment for hidden penis does not exist; several techniques rather exist, that can be arranged in variable way from case to case in order to let the penis free from the surrounding fat. The case that we describe reports a great obese patient (BMI 42 kg/m2), diabetic, with the penis hidden by the pre-pubic fatty tissue. The severe aesthetic and functional problems have been treated in collaboration with the plastic surgeon.
Bone Involvement in Patients with Idiopathic Calcium Nephrolithiasis
Authors: Cicerello E. , Merlo F. , Maccatrozzo L. , Zanardo A. , Anselmo G.
Published: June 2018

While bone involvement is more evident in case of secondary calcium calculosis, such as hyperparathyroidism, medullary sponge disease, hypercalcemic systemic illness and chronic diarrhea syndrome, less known and more controversial is still the link between bone loss and idiopathic calcium nephrolithiasis. In this study 46 patients with idiopathic calcium nephrolithiasis were consecutively enrolled at their customer diet. Our data show that dietary habits, especially an high sodium and animal protein intake, could seem to influence bone loss of the lumbar spine and of the neck. Furthemore a negative correlation has been found between citrate urinary excretion and bone loss, that suggests a protective role of potassium citrate not only on prevention of recurrent calcium nephrolithiasis, but also on bone loss.
Cystic Tumors of the Kidney. Revision of the Literature and Authors'Cases
Authors: Magro G , Lopes M.
Published: June 2018

The authors report the clinico-pathological features of the so-called “cystic tumors of the kidney”, discussing data of the English literature and providing grossly and histologically illustrations. The following tumor entities will be discussed in detail: “cystic multilocular renal cell carcinoma”, “cystic nephroma”, “cystic partially differentiated nephroblastoma” and mixed (benign or malignant) epithelial/stromal tumor. The awareness of these clinico-pathologic entities by Urologist is important to assure patient a correct treatment and prognostic informations.
Nephrogenic Bladder Adenoma: A Case Report
Authors: Carrieri G. , Corvasce T. , Tolve I. , Annese P. , Caniglia A. , Disabato G.
Published: June 2018

Nephrogenic adenoma is a rare epithelial urothelial metaplasia, occurring frequently in males in the 4th decade of life. We report a case of nephrogenic bladder adenoma occurring in a pre-puberal patient; to date only 19 other cases of nephrogenic adenoma occurring at pre-puberal age have been described. After endoscopic resection, the patient received an early single endoluminal dose of epirubicin, suspecting a urothelial carcinoma; after 7 years no relapses have occurred.
Access to the Ureter with the Semirigid Scope: An Easy and Safe Technique
Authors: Defidio L. , Piccolotti D. , De Dominicis M. , Santini V. , Nesci L.
Published: June 2018

The access to the ureter is the first and most important phase of all the entire procedure of semirigid ureteroscopy, because you can make such kind of complications to do the procedure impossible. In this article we report our experience about the access technique to the ureter we routinally use. The technique consists in introducing a semirigid ureteroscopy over a wire in the space created by a safety guide-wire pre-passed into the kidney, as over a railroad. The safety guide-wire helps in the access and in the progression because lifts the superior lip of the orifice and straightens the ureter. In this experience we got the access to almost all the cases with no complications. We suggest this technique for all the urologists with any kind of experience.
Alpha1 Adrenoceptor Subtypes in Human Urinary Bladder: Sex and Regional Comparison
Authors: Peroni A. , Mirabella G. , Sigala S. , Fornari S. , Palazzolo F. , Faccoli S. , Simeone C. , Pezzotti G. , Spano P.F. , Cunico S. Cosciani
Published: June 2018

The aim of this work is to report a detailed study of the presence of α1 AR subtypes in human urinary bladder areas involved in the micturition (i.e. detrusor, trigone and neck), investigating whether or not there are differences between sexes.

Methods

Urinary bladder specimens were obtained as discarded tissue after cystectomy for vesical carcinoma (17 men and 14 women). Molecular characterization of α1 AR subtypes was done by semi-quantitative RT-PCR. The α1 AR protein expression was studied by saturation binding curves using the α1 AR antagonist 125I-HEAT and by western blot. Analysis of data was performed using the GraphPad PRISM 4 software.

Results

Results obtained indicated that α1 AR proteins were detectable in each bladder area. In both sexes, the detrusor and the neck expressed similar levels of α1 ARs: respectively, detrusor: 14.6 ± 1.2 in men and 13.1 ± 1.1 fmol/mg prot in women; neck: 16.9±3.2 in men and 17.5 ± 4.1 fmol/mg prot in women. In the trigone, significantly higher α1 ARs were found in women compared to men (20.6 ± 1.1 vs 11.7 ± 0.7 fmol/mg prot). Subtype analysis indicated that in women, each area was endowed with mRNA and protein encoding for each α1 AR subtype. The men detrusor expressed α1A and α1D ARs, while in the trigone and the neck, each subtype was present.

Conclusions

A selective distribution of α1 ARs did exist between sexes and between the different areas involved in micturition, supporting evidence which indicates a role of different α1 AR subtypes in the pathophysiology of the lower urinary tract symptoms.
Eswl for Ureteral Calculi
Authors: Ayyoub M. , Usai M. , Malloci S. , Solinas A. , Atzori G. , Frongia M.
Published: June 2018

The role of extracorporeal shockwave lithotripsy (ESWL) for ureteral calculi is still being debated. We evaluated our results in a large series to clarify the role of this modality.

Patients and methods

Between September 1997 and December 2004, 657 patients (414 males, 243 females) with ureteral calculi were treated with extracorporeal shock-wave lithotripsy (ESWL) in situ with 2 types of lithotripters (Wolf Piezolith-3000 e Storz Modulith SLX) that offers simultaneously X-ray and ultrasound for stone localization. 971 interventions were performed, with an average of 1.47 sessions/patients. Stone size ranged from a minimum of 5 to 20 mm. Only in one case neuroleptoanalgesia was performed. Targeting was done both by ultrasound and radioscopically.

Results

449 (68.3%) patients were stone-free after a single ESWL session, whereas, for the rest, more than one session was required. Auxiliary measures (double J ureteral stent, nephrostomy) were necessary for 32 (4.8%) patients. In 3 cases, infectious complicantions occurred in patients who had not received any antibiotics prophylaxis. Ureterolithotripsy was performed to resolve the case in 9 patients and in 2 was needed to do ureterolithotomy. A 68.3% success rate was achieved with a single ESWL session, it rose to 94% if we considered patients who required max. 3 treatments.

Conclusions

The results prove that the success rate in ureteral calculi is very high if the indications for ESWL are correctly made. Considering that ESWL is performed under no anaesthesia, with short hospitalization (ambulatory care), and with no endoscopic manouvres, it is concluded that extracorporeal lithotripsy is a cost-effective and efficient method to treat and resolve ureteral calculi.
Diagnostic and Prognostic Value of Testicular Fine Needle Aspiration in Non-Obstructive Azoospermia
Authors: Bettella A. , Tavolini I. M. , Boscolo B.R. , Menegazzo M. , Rossato M. , Bassl P.F. , Foresta C.
Published: June 2018

Modern techniques of assisted reproduction may be useful also in non obstructive azoospermic men using sperm extracted from the testis (TESE). However, no clinical or hormonal parameter has reliable prognostic value in predicting the presence of testicular sperm. We report here our experience with fine needle aspiration cytology (FNAC) of the testes used as a diagnostic tool in non obstructive azoospermic patients looking at its possible role as prognostic parameter for the presence of testicular sperm at TESE.

Methods

One hundred and twenty-five non obstructive azoospermic men candidates to ICSI were analysed for FSH, LH, testosterone, and inhibin B plasma levels, and classified in three groups on the basis of FNAC: Sertoli cell-only syndrome (70), severe hypospermatogenesis (42), and maturation arrest (13). After that, all men underwent TESE for sperm recovery for ICSI.

Results

FNAC detected sperm in 24 of 42 men with severe hypospermatogenesis and 9 of 13 men with maturation arrest. TESE retrieved sperm in all such patients, as well as in additional 29 of 70 men with Sertoli cell-only syndrome, additional 11 cases of severe hypospermatogenesis (35 of 42 in total) and 1 additional case of maturation arrest (10 of 13 in total). Testicular volume and hormonal parameters were not different in men with and without sperm retrieved.

Conclusion

These findings suggest that FNAC may be a simple and valid diagnostic parameter in non obstructive azoospermic men, and it may represent a valid positive prognostic parameter for sperm recovery at TESE.
Microfocal Prostate Cancer
Authors: Montanari E. , Del Nero A. , Mangiarotti B. , Bernardini P. , Confalonieri S. , Grisotto M. , Marchesotti F.
Published: June 2018

To determine whether microfocal prostate cancer on needle biopsy predicts clinically insignificant prostate cancer.

Patients and Methods

We reviewed the records of 257 patients who underwent radical retropubic prostatectomy between January 1999 to September 2003. 18 patients had preoperative diagnosis of microfocal prostate cancer defined as 1 positive core/8 cores, cancer length < 3 mm and Gleason score less than/equal to 6.

Results

Of the 18 patients with preoperative microfocal cancer, only 1 case had clinically insignificant disease. 15 pts had organ confined disease (pT2) and 3 pts had capsular penetration (pT3). The lesion was bioptic undergraded in 33% of cases.

Conclusions

Microfocal prostate cancer as determined by needle biopsy does not predict clinically insignificant disease.