bluuebunny/crossref_metadata_2025 huggingface dataset:
Benefits to be expected from informatics in Radiotherapy
Authors: Balli M. , Ferrari V. D. , Lonardi F. , Pavanato G. , De Lucchi A. , Coeli M.
Published: November 2018

The role of informatics in radiotherapy planning concerns dose calculation, dose distribution and quality assurance. Software research has recently developed to obtain 3-dimensional planning of treated volume and to reach more homogeneous dose distribution within radiation target volume. To increase therapeutic effectiveness, lower local relapses and reduce treatment sequelae, several quality assurance systems are being used, such as portal image analysis which allows an immediate comparison with the simulation film. Such procedures are carried out through informatics and need state-of-the-art computed systems, dedicated radiological devices and highly qualified teams as well.
Urologist: Clinical information system for urology
Authors: Romano C. , Guizzetti C. , Graziotti P. , Ranieri A. , Losa A. , Sacchi C. , Rizzi M. , Lembo A.
Published: November 2018

“Urologist” was developed to run a Department of Urology. A local area network (LAN), one server and five stations, connects the single functional units of the Department (O.R.; I.C.U.; wards; Spinal Unit and Patient services). A Patient Identification Card integrates both clinical and organisational data. A multidisciplinary group, consisting of medical and non-medical specialists, was necessary to develop this system.
Multiple prostheses for complex urethral diseases
Authors: Muto G. , Moroni M. , Comi L , Leggero R. , Bozzo R. , Piras D.
Published: November 2018

Urethral prostheses for strictures or urinary incontinence are becoming more and more diffuse in urological practice for their simple use and low complication rate. Multiple prostheses can be used for complex urethral diseases, in which the contemporary correction of a stricture and urinary incontinence due to a sphincteric disease are needed.
Experience with a new prostatic prosthesis: Ultraflex
Authors: Martorana G. , Oneto F.
Published: November 2018

Ultraflex is a new type of prosthesis not yet on sale. It is made with a biocompatible single filament in nickel/titanium alloy. It has a considerable radiai force while being extremely flexible and adaptable to the morphology of the urethra. Unlike other traditional, more rigid stents, it allows better epithelisation, avoids irritation and should it be incorrectly placed, is easy to remove by means of a distai pulling thread. Our first experience is reported with 5 patients with urinary retention, 4 of whom regained spontaneous micturition immediately after introduction of the prosthesis. The fifth, probably due to detrusorial insufficiency, regained spontaneous micturition after 15 days and an epicystotomy therefore had to be carried out. In the post-operative stage no patient complained of irritative or painful symptoms for more than 3 days.
“Ballistic” endoscopic lithotripsy in the treatment of ureterai stones
Authors: Bonacina R. , Baresi A. , De Cenzo S. , Perego S.
Published: November 2018

Even though extracorporeal shock wave lithotripsy is the mainstay of urolithiasis treatment there is stili a need for endourological treatment of ureteral and renal calculi. Stone fragmentation is usually achieved either with ultrasonic electrohydraulic or laser lithotriptors. A new, inexpensive machine has recently been developed: the EMS Lithoclast, based on pneumatic shock waves, for endoscopic stone disintegration. This device was used to treat 44 patients with ureteral stones with complete disintegration of all stones.
Two cases of retroperitoneal seminoma secondary to “burned out” testicular tumour
Authors: Privitera O. , Catania G. , Benecchi L. , Spinelli R. Bordinazzo M.
Published: November 2018

Testicular tumours with locai regression and progressive retroperitoneal progressive metastases are rarely described in medicai literature with the term of “burned out” tumours. We present two cases of retroperitoneal metastases causing a symptomatology of retroperitoneal compression. Examination of the testis revealed no palpable abnormaiity. In both cases a fine needle biopsy of a retroperitoneal nodal mass was done. Microscopic examination revealed a typical seminoma. Scrotal sónography revealed the presence of a small asymptomatic testicular lesion on the same side as the retroperitoneal mass. In both cases a homolateral orchiectomy was done. At the histological study a fibrous scar was found without malignant neoplastic cells, so it was diagnosed a “burned out’ testicular tumour. The possibility of testicular origin must be considered in the presence of extragonadal germ cell tumours, even if the testes are without palpable abnormaiity.
PSA and clinical problems relating to prostate cancer
Authors: Grosso G. , Pecoraro G. , Parise G. , Vitale S. , Sidoti O.
Published: November 2018

The PSA is the most important tumoral marker for prostate cancer. Not all Authors agree that it plays an important role in screening and diagnosis, classification and prognosis; they agree, instead, about its monitoring the response to therapy. Two personal experiences are presented: in one the PSA values are compared with the prostatic biopsies in 100 patients with suspect rectal exploration; in the other the PSA value, taken at the moment of diagnosis, is compared with the result of the radionuclide bone scan in 43 patients with prostate cancer.
Urothelial neoplasms and tumoral markers
Authors: Pecoraro G. , Grosso G. , Mostacci R. , Vitale S. , Sidoti O.
Published: November 2018

The majority of urothelial neoplasms are superficial bladder carcinoma, the prognosis of which cannot be evaluated with current parameters. Several studies have tried to isolate one or more reliable markers. Although some results are satisfactory these markers have not however been used in the clinical practice. The Authors investigate recent reports, quoting those that, in their opinion, are the most interesting.
Orthotopic neo-bladder techniques
Authors: Anselmo G.
Published: November 2018

“Replacement” intestinal neo-bladders have been created or refined in many cases following cystectomy for various pathologies (iatrogenic, phlogistic, neurologic or neoplastic), in order to permit natural micturition and to keep the patient's body image intact. The requisites of the neo-reservoir are: adequate capacity, reduced internal pressure, an anti-reflux ureteral and continent urethral anastomosis. Based on the principles of hydraulic physics, literature considers that the double folding configuration (with front and sagittal folding guaranteeing the desynchronisation of peristalsis, maximum increase in capacity and reduction in reservoir pressure) is a confirmation of the excellency of the “spherical reconfiguration” of the detubularised segment. Thanks to the use of anti-reflux methods, the attention paid to the urethral anastomosis and the possibility in selected cases of nerve sparing surgery, today the orthotopic neo-bladder is the best and least costly diversion operation (no expendable materials used, reduced management time). The orthotopic diversion techniques most widely known and used in Italy are described. These involve the use of ileal, ileo-cecal, ceco-colic or sigmoid segments. Results are analysed from a clinical and urodynamic aspect. Points which are stili not clear concern the behaviour in time of the reservoir capacity, the repercussions on the upper urinary tracts and on the metabolism, as well as the long-term effects on the intestinal mucosa. Long follow-ups and comparative studies on homogeneous and numerically consistent case histories are therefore considered appropriate.
Interleukin-1 excretion in urine specimens of renal transplant recipients with acute rejection using matrix dot-blot assay
Authors: Mukhtar A.
Published: November 2018

Interleukin-1 is a polypeptide mediator involved in the regulation of inflammatory responses. Mesangial cells IL-1 may act as an autocrine growth factor (Lovett et al., 1983). The local release of such growth factors may be important in the development of mesangial proliferative lesions characteristic of many forms of immune-mediated glomerulonephritis (Lovett et al., 1986). Secretion of IL-1 in urine specimens of renal transplant recipients with acute rejection was studied using matrix APAAP dot-blot assay, to determine any alteration of IL-1 changes that could reveal any pathological correlation. Twelve urine specimens from 6 persons with acute rejection revealed IL-1 staining in the dot-blot assay while there was no staining for IL-1 in the urine specimens of healthy persons. The immunological changes correlated with acute renal rejection could lead to autocrine and apocrine secretion of IL-1 its secretion in urine.
Neuromodulation in the treatment of hyperactive bladder: Literature review
Authors: Tuccitto G. , Anselmo G.
Published: November 2018

Neuromodulation through stimulation of the sacral nerves at the vertebral foramina has recently been introduced into clinical practice. Only a few specialised centres at an international level currently use this therapy as second choice treatment of lower urinary tract dysfunction secondary to detrusorial hyper- or hypoactivity and pelvic pain. The authors report the experience of the more well-established centres, emphasising that the temporary percutaneous stimulation techniques are by now widely standardised and accepted. There is, however, still doubt about how to identify with precision the predictive factors for best application of the method. It is to be hoped that useful answers with regard to this will come from multicentre studies and larger numbers of case histories.
Current pharmacological treatment of bladder hyperactivity
Authors: Checchin P. , Anselmo G.
Published: November 2018

Bladder hyperactivity is a serious pathology with a high clinical incidence. Various drugs have been used to try to inhibit involuntary detrusorial contractions and to increase bladder capacity. The authors describe the properties, action mechanism, clinical use and side effects of the main drugs analysed. Most of the data regarding drug influence on the vesico-urethral apparatus are obtained from “in vitro” or “in-vivo” studies on animals and therefore cannot always be related to the clinical effects that would occur in man. It is still difficult to find an “ideal” drug with high detrusor selectivity, due to both the lack of knowledge on neuro-mediators and the difficulty in identifying receptors and “action sites”.
Potassium channel openers for treatment of bladder hyperactivity
Authors: Hedlund H.
Published: November 2018

The potassium (K+) channel openers induce hyperpolarization by ATP-sensitive K+ channels. This group of compounds has been demonstrated to effectively relax the human detrusor and reduce bladder hyperactivity in obstructed rats. In patients with overactive bladders, oral administration and intravenous infusion of different K+ channel openers were without significant effect on urodynamic variables. In conscious dogs, a new K+ channel opener was found to increase bladder compliance with reduced micturition frequency. K+ channel openers have an interesting potential for the treatment of bladder hyperactivity, but development of new selective compounds with further clinical experience are demanded.
Fluoxiuridine (FUDR) chronoinfusion and Interferon for treatment of metastatic renal carcinoma
Authors: Dal Bianco M. , Prayer-Galetti T. , Iafrate M. , D'Urso L. , De Zorzi L.
Published: November 2018

Fluoxiuridine (FUDR) chronoinfusion through a subcutaneous pump seems to give a 24% objective response rate with mild side effects. From April 1992 to December 1993 we included 18 patients with metastatic renal cell cancer and good performance status (ECOG 0-2) in a phase II study. In our experience we observed a 16% objective response rate without any major side effect. Based on these results we suggest a phase III prospective randomized study.
Metabolic complications of continent urinary diversions
Authors: Tasca A. , Valotto C. , Pizzol L.
Published: November 2018

The advent of modem reconstructive techniques in urologic surgery has allowed a wide use of intestinal segments in young and older patients. Intestinal conduits and reservoirs can produce a series of complications due to hydroelectrolytic disturbances, alterations of acid-base balance and of bone and hepatic metabolism, intestinal malabsorption. The severity of clinical features depends on the quantity of solute exchanges through the mucosa of the intestinal segment used and on the “age” of the conduit or reservoir.
Role of reflux prevention in urinary diversion
Authors: Tasca A. , Pizzol L. , Valotto C.
Published: November 2018

Considering current pathogenetical knowledge on reflux nephropathy and clinical experience with urinary diversions, it is impossible to arrive at a definitive conclusion on the necessity of reflux preventing techniques in urinary diversion. The decision has to take into account the apparent hazards of reflux in a given diversion and the apparent hazards of preventing reflux with that diversion. Whereas reflux prevention in high-pressure reservoirs and in continent diversion with cutaneous stomy is widely justified, there is no objective evidence to support the need for reflux prevention in urinary diversion with low-pressure bladder substitutes with sterile urine.
Orthotopic ileal bladder substitution in female patients: Our experience
Authors: Cancrini A. , De Carli P. , Fattahi H.
Published: November 2018

Orthotopic bladder reconstruction in women was introduced to guarantee voluntary micturition via the urethra as already obtained in men. A meticulous urethra-sparing surgical procedure and a low-pressure reservoir allow urinary continence to be preserved. Careful selection of patients can reduce the already low risk of urethral relapse. An orthotopic ileal neobladder was performed in 8 women following radical cystectomy for infiltrating bladder carcinoma. Follow-up ranged from 10 to 47 months. There were no serious clinical complications. At 6 months the complete urinary continence rate was 100% during the day and 75% at night with 4-hour interval voiding. At 12 months neobladder capacity varied from 250 to 400 ml and pressure at maximum capacity from 8 to 25 cm water. Urodynamic parameters were stable over a period of time. Four patients died of distant metastasis and 4 are alive and disease-free. In our opinion an orthotopic ileal neobladder in women gives excellent functional results and is a satisfactory option in selected female patients.
Flow-cytometry DNA analysis (FCM) in multiple tissue samples of 69 patients with prostatic cancer treated by radical prostatectomy
Authors: Curti P. , Schiavone D. , Azzolina L.S. , Tontodonati M. , Migliorini F. , Rahmati M. , Comunale L.
Published: November 2018

We subjected 322 tissue samples of 69 patients with prostatic cancer treated by radical prostatectomy to flow-cytometry DNA analysis. From 1 to 8 tissue samples were analysed for all patients: results showed diploidy in 272 cases and aneuploidy in 50 cases. 45 tumours were classified as diploid, and 24 aneuploid. Aneuploid tumours had one or more aneuploid samples, but in no one case were all specimens of the same neoplasm aneuploid. Aneuploidy status could also change in the same tumour. In conclusion, the study shows that prostatic cancer is often heterogeneous with regard to DNA content and that just one specimen cannot be considered representative of the tumour.
Ten years of orthotopic bladder substitution: An analysis of surgical complications
Authors: Allegri C. , Croci A. , Bertolin R. , Pierini P.
Published: November 2018

We analysed the more common surgical complications we have noticed during our ten years experience of orthotopic bladder substitution. The critical review assesses these complications in relation to the different types of bladder substitution we used, beginning from Carney I up to the so-called “J” neobladder, following the natural development of our surgical technique from 1986 to the present (Carney II, ileo-cecal bladder, VIP). We described the early and late complications, carefully pointing out those known to be the most dangerous: enteric fistula, urinary fistula and ureteral reflux. We also reported the corrective treatments adopted and the preventive protocols we could eventually adopt in order to show if there are any technical methods that can significantly reduce the incidence of the above-mentioned complications.
Secondary kidney tumours. Our experience
Authors: Marino G. , Cevoli R. , Pastorini S. , Marten-Perolino R.
Published: November 2018

Secondary tumours of the kidney are becoming an increasingly frequent pathology due to the accurate follow-up and longer survival of cancer patients. The authors report three rare cases of renal metastasis from thyroid, lung and breast carcinoma. At present the definitive diagnosis is histopathologic, the treatment of choice is chemotherapeutic and conservative surgery must be performed in patients with single localisation in relation to neoplastic involvement. Selective embolic treatment may be indicated in patients with macrohematuria and oncological dissemination.
Osteogenic sarcoma of the urinary tract. personal experience
Authors: Morelli B. , Terrone C. , Bianchi M. , Galliano D. , Rossetti S. Rocca
Published: November 2018

Osteosarcoma is one of the most frequent bone tumours in paediatric age. It has a strong tendency to metastatic spread. Secondary involvement of the kidney with clinical evidence is a rare event (6 cases have been reported in literature). Primary osteogenic sarcoma of the urinary tract is also very unusual (20 cases of primary renal osteosarcoma have been reported until now). To our knowledge primary ureteral osteosarcoma has never been described. We present here one case of symptomatic kidney metastasis of osteosarcoma in a 20-year-old female patient and the first case of primary osteosarcoma of the ureter in an 81-year-old male patient.
Analysis of cell growth with biparametrical flow cytometry in bladder cancer as prognostic evaluation
Authors: Lusuardi L. , Azzolina L.S. , Porcaro A.B. , Caleffi G. , Mastroeni F. , Motta L. , Curti P. , Schiavone D. , Mobilio G.
Published: November 2018

The aim of this work is to compare a biparametrical analysis of DNA using flow cytometry with the monoparametric approach. We analysed 71 samples coming from neoplastic tissue and from non-neoplastic tissue. We compared the average uptake of BrdU (22.37%) with the traditional prognostic parameters. Even if in some cases we found a certain correlation between the traditional prognostic parameters and the average uptake of BrdU, the results are still not encouraging. A final answer can only be supplied after analysing a greater number of cases and after a suitable follow-up period.
A rare case of spontaneous bladder rupture in bladder extrophy
Authors: Marino G. , Cevoli R. , Pugno E. , Cocimano V.
Published: November 2018

The authors report a rare case of spontaneous bladder rupture in a 13-year-old girl who underwent functional closure for bladder extrophy. Although bladder rupture can happen in operations for bladder augmentation, it is very rare in the above cases. The pathogenesis of this complication due to anatomical and functional factors is analysed, emphasising the need for careful long-term urologic follow-up.
Stromal cell and human prostatic epithelial cell in-vitro co-coltures: Growth and morphology
Authors: De Angeli S. , Fandella A. , Gatto C. , Buoro S. , Favretti C. , Ferrante G.L. Drago , Anselmo G.
Published: November 2018

A study was carried out on the effect of stroma-epithelium interaction on cellular growth and morphology in co-coltures of U285 prostatic epithelial cells with human prostatic and esophageal stromal cells and with murine fibroblasts of the 3T3-J2 line. The proliferation rate was determined by growth tests of neutral red and kenacid blue. Morphological observations were made under optical microscope on the same cultures used for the growth tests. Results highlighted a marked reduction in cellular growth in the co-cultures compared to control cultures, as well as the tendency of the stromal and epithelial cells to re-organise themselves in pseudo-acinous structures.
Acute scrotum: Analysis on 333 cases
Authors: Novella G. , Ficarra V. , Motta L. , D'Amico A. , Puce R. , Cicuto S. , Curti P. , Schiavone D. , Malossini G.
Published: November 2018

Treatment of acute scrotum is becoming increasingly more common in urological surgery. The aim of this work was to analyse all the cases of acute scrotum subjected to surgical exploration in the last 20 years. Funicular torsion was found in 51% of patients, appendicular testis torsion in 26%, alterations compatible with previous funicular torsion in 15%, while findings were negative in 7%. Surgery to relieve funicular torsion and eversion of the vaginal was performed in 82% of cases, while the testis was fixed in 12% and in 11 cases orchiectomy was necessary. The contralateral testis was never fixed. No recurrence of funicular torsion has been found during follow-up, but in 9% of patients contralateral funicular torsion occurred at a later date.
Adult spermatic cord sarcomas. Two case reports
Authors: D'INCà G. , Bertoldin R. , Drei G.N. , Meneguolo M. , Camuffo M.C. , Macrì E. , Guazzieri S.
Published: November 2018

Two cases of sarcoma of the spermatic cord in adults are described: a well-differentiated liposarcoma and a high-grade leiomyosarcoma. Elective treatment for both was radical orchiectomy and adjuvant radiation therapy. As already reported in literature, the prognosis for these two patients is not unfavourable.
Müllerian duct cyst: Case report, embryology, pathogenesis and therapeutic options
Authors: Sebastio N. , Poletti F. , Salsi P. , Incarbone P. , Barbieri A. , Cortellini P.
Published: November 2018

We report the case of a 56-year-old male suffering from acute urine retention after a period of increasing dysuria. Physical examination, TRUS and CT showed the presence of a multilocular cystic mass in the space above the prostate and behind the bladder. Pathological findings following surgical exploration indicated a Müllerian duct cyst, few cases of which have been reported in literature. We performed surgery because malignancy was suspected and it was impossible to drain off all the cystic fluid due to the multilocular nature of the cyst. Moreover, cystic adenocarcinomas originating from Müllerian duct remnants have been reported. We agree with other authors that a percutaneous approach should be standard treatment in these cases, leaving open surgery for more complex cases.
Post-comatose cystomanometric peculiarities
Authors: Benecchi L. , Caldera G.L. , Cavestro C. , Bordinazzo R. , Privitera O. , Feller S.
Published: November 2018

This study was the result of team work by urologists and neurologists in managing patients who have been in coma. The aim of this study is to evaluate the urodynamic differences between the various clinical conditions which characterise the coming out from a coma state. The second aim is to assess any correlation between clinical parameters (age, noxa of coma, Glasgow Coma Scale (GCS), days since brain lesion, days of catheterisation) and urodynamic findings. A urodynamic study was carried out on 24 patients (20 males and 4 females) who had come out of a coma state and were in the Subintesive Care Unit for coma in the Neurological Rehabilitation Department of our hospital. The patients were divided according to neurological criteria into 3 groups: persistent vegetative state (PVS), evoluted vegetative state (EVS) and minimally responsive state (MRS). No correlation was found between clinical parameters and urodynamic findings except between age and voiding percentage volume (%VV). Patients in PVS show detrusorial hyperreflexia with substantial contractions, while bladder residual volume (RV) is lower and voiding percentage volume (% VV) is higher than in the other two groups (P<0.05). EVS patients show detrusorial hyperreflexia (less than in PVS patients, but the difference is not statistically significant). MRS patients have higher bladder capacity than PVS and EVS patients, but again the difference is not statistically significant. Patients in PVS and EVS have a better micturition reflex (with regard to RV and %VV) than the MRS patients.
Hidden penis: Nosographic assessment and surgical treatment of perigenital lipo-distrophy
Authors: Fontana D. , Rolle L. , Ceruti C. , Verna G. , Del Noce G. , Raso M. , Datta G.
Published: November 2018

Interest in “genital aesthetics” has risen in the last few years and has considerably increased the request for surgical procedures for penile lengthening and girth enhancement. In this field, the urologist first has to detect the patients who can benefit from surgery, then he has to choose, case by case, the most reliable surgical strategy. The authors introduce the problem of correct management of the short penis-complaining patient, with particular regard for the condition known as “hidden penis”. In the second part of the paper, they describe a suitable surgical procedure of penile lengthening in cases of hidden penis; the procedure combines the incomplete section of the suspensory ligament of penis with other manoeuvres (such as perigenital lipo-suction, abdominoplasty etc.) in order to obtain the best aesthetic and functional result.
Urological laparoscopy: Some unusual applications
Authors: Trombetta C. , Liguori G. , Savoca G. , Siracusano S. , Belgrano E.
Published: November 2018

Since its introduction in 1991 laparoscopy has gained a strong foothold in Urology and during the last 5 years laparoscopic technology has been applied to many urological procedures. Today, better skills in laparoscopic techniques and availability of laparoscopic instruments in urological operating theatres, make these procedures suitable for a large number of surgical purposes, some even unusual. Laparoscopy appears to be an increasingly valid alternative to traditional surgery, being minimally invasive, safe and effective. Availability of proper technological devices and experience in laparoscopic techniques allow a considerable reduction in post-operative pain, hospitalization and recovery times.
Percutaneous treatment of renal staghorn calculosis: 8 years experience
Authors: Zucconelli R. , Belmonte P. , Caruso N. , Fiaccavento G.
Published: November 2018

This study reports 8 years of personal experience in percutaneous nephrolithotripsy (PCNL) of complex renal calculosis. It is emphasised that even in this era of widespread use of extracorporeal lithotripsy (ESWL), PCNL is regaining importance in the more complex cases of renal calculosis, to try to reduce times for adequate stone clearance and to reach a better benefit/cost ratio. A success rate of 87.3% with monotherapy PCNL, 78.6% with debulking PCNL and 91.3% with associated PCNL-ESWL (programmed from the beginning or attempted out of necessity), has convinced us of the correct application we have given the method for treating complex renal calculosis.
Mini-invasive surgery of renal cysts: Economic evaluation
Authors: Ficarra V. , D'Amico A. , Motta L. , Tontodonati M. , Comunale L. , Malossini G.
Published: November 2018

The aim of this work is to compare the cost and the financing connected with percutaneous alcoholisation and aspiration, percutaneous resection and laparoscopic treatment of renal cysts. All the techniques in question present an advantageous cost-financing ratio and are typical procedures which can be employed in “one-day surgery”.
Voluntary vasectomy: Medico-legal aspects
Authors: Invernizzi S. , Locatelli G. , Cappoli S. , Butti A. , Librizzi A. , Pozza D.
Published: November 2018

In Italy, although voluntary sterilisation was decriminalised with act No. 194/78, which abrogated section 552 of the criminal code, there is no regulation as yet ratified by law. The authors refer to the trend shown by some sentences, the most important of which is No. 438 of 18.03.1987 (Court of Cassation), highlighting some aspects of physical and psychic health and “informed” consent. The surgical technique of male sterilisation and possible complications are dealt with, as well as the unresolved medico-legal aspects concerning the irreversibility of the operation or vice versa, failure of reversal. The possible judicial implications of claims for compensation for damages caused by malpractice, negligence or imprudence are also discussed. In conclusion, it is hoped that a law regulating this matter will soon be passed, while in the meantime a protocol to avoid legal liability is suggested.
Different therapeutic options for treating ureteral stones. Introduction
Authors: Pisani E.
Published: November 2018

Technological development of lithotriptors has made extracorporeal treatment of stones possible in all parts of the ureter. Therapeutic indication, however, should be based on factors such as dimension, seat, nature and permanence of the stone, technological equipment and specific competence of the operators. Basically there is general agreement over extracorporeal treatment as first choice for ureteral lumbar stones. It is stili controversial, however, for other compartments, in particular the distai one, especially given the undoubted success of ureteroscopy. To free patients of stones, the best treatment would be without anesthesia, with low morbidity and low cost – a method that is not yet available despite significant progress having been made over the last few years.
ESWL Monotherapy
Authors: Franch L. , Rippa A. , Arena D. , Franch P. , Sangalli C. , Nicolai N.
Published: November 2018

Between February 1988 and December 1995, 1563 consecutive patients who had never previously been treated for ureteral stones were admitted to our hospital: 1535 (98%) underwent primary ESWL (with Lithostar plus) with fractioned doses and 28 (2%) needed primary endosurgery. At present 1327 (87%) patients can be evaluated. Up to 6,000 SW were given to 733 (55%) patients: 93% achieved complete clearance. Of the 594 (45%) patients who completed treatment, 195 (33%) achieved complete clearance with first treatment, 27 (5%) required endosurgery and 372 (62%) were treated again, of whom 279 (75%) were made stone-free. Overall 877 (66%) were stone-free following first treatment; 1156 (87%) following second treatment and 171 (13%) were failures. Lumbar (9% failure) and ≤0.6 cm (6% failure) stones gave higher success rates. Auxiliary pre-ESWL manoeuvres were reduced from 112/352 (32%) prior to 1990 to 75/975 (8%) after 1990, without affecting outcome (failures were 11 and 13.6% respectively). In-situ ESWL is a safe therapy for ureteral stones and in our experience capable of rendering 87% of patients stone-free.
Ureterolitholapaxy: Our experience
Authors: Cauda F. , De Natale A. , Alladio F. , Ferraris C. , Ferrando U.
Published: November 2018

The authors report on their experience of treating ureteral stones in 1183 patients with ballistic and electrohydraulic endoscopic lithotripsy. Since the outcome was successful in 95% of cases with few complications (2%), this method is considered highly effective for treating stones in any part of the ureter, with the possibility of resolving renal colic in real-time. In the push-up cases (25% for sub-junctional ureteral lithiasis, 10% other sites) a second treatment was performed with ESWL after positioning a double J catheter.
The value of andrology in managing oncological patients
Authors: Piediferro G. , Russo A. , Luciano G. , Crimi A. , Orazzo C. , Palma A. Dl
Published: November 2018

The authors discuss the psychological reactions to surgical procedures that mutilate sexuality. They show the importance of andrology in oncological patients to improve their life quality and the andrological procedures in surgery for prostate and testis cancer. An Andrological Center is useful and profitable because, strictly under sanitary management, it fulfills the aim of improving the QALYs.
Painful bladder syndromes in the female: Anatomopathological aspects
Authors: Giordano R. , Pellizzari L
Published: November 2018

The most common and least understood disease that falls under the painful bladder definition is interstitial cystitis. The term interstitial cystitis can be misleading, since in many cases it refers to a process that pathologically is neither interstitial nor inflammatory. Interstitial cystitis remains essentially a diagnosis of exclusion. Biopsy and cytology are essential to rule out carcinoma in situ and other pathological conditions.
Neuromodulation: Surgical aspects
Authors: Simeone C.
Published: November 2018

Lower urinary tract dysfunction, such as urge incontinence, the urgency- frequency syndrome and pelvic pain, is a challenging therapeutic problem. It can be treated by sacral neuromodulation. To select patients for permanent implantation they are first tested by a very short trial stimulation. During this period a wire electrode connected to an external stimulator is positioned percutaneously in the third sacral foramina. Patients with a good clinical response are candidates for permanent treatment by a surgically implanted device.
Unusual case of metastasis of the scrotal wall secondary to pulmonary adenocarcinoma
Authors: Marzoli E. , Alfano V. , Marini F. , Vancini G.P.
Published: November 2018

The Authors report an unusual case of metastasis of the scrotal wall secondary to pulmonary adenocarcinoma subjected to palliative surgical treatment with good subjective results.
Contrasting Visions for Macroeconomic Theory: DSGE and OEE
Authors: Devereaux Abigail N. , Wagner Richard E.
Published: November 2018

Dynamic stochastic general equilibrium (DSGE) modeling remains the workhorse of contemporary macroeconomics despite a growing number of critiques of its ability to explain the aggregate properties of an economic system. For the most part, those critiques accept the DSGE presumption that traditional macro data are primitive, causal data. This leads to a stipulative style of analysis where macro variables are explained in terms of one another. In contrast, we set forth an open-ended evolutionary (OEE) framework for an OEE macroeconomics. Within this framework, systems data are not primitive, but are derived from prior microlevel interactions without any presumption that those macrolevel derivations reflect systemic equilibrium among the microlevel primitive sources of action. We explore some contours of an OEE framework by placing coordination games within an ecological setting where there is no agent who has universal knowledge relevant to that ecology of games.

JEL Classifications: B40, C73, D51, D85, E02
Serum Interleukin-6 Level in Children With Attention-Deficit Hyperactivity Disorder (ADHD)
Authors: Darwish Amira Hamed , Elgohary Tarek Mohamed , Nosair Nahla A.
Published: November 2018

Introduction:

Attention-deficit hyperactivity disorder (ADHD) is a common neurobehavioral disorder in children, but its specific etiology and pathophysiology are still incompletely understood.

Objectives:

This case-control study aimed to measure the level of serum interleukin-6 (IL-6) as a predictor of the immunologic status in children with ADHD, and to study its correlation with severity of symptoms.

Subjects and Methods:

60 ADHD children who met the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, criteria for ADHD and 60 control children were subjected to complete history taking, clinical examination, and psychometric tests. Serum interleukin-6 of ADHD patients and control children was measured by enzyme-linked immunosorbent assay.

Results:

The mean serum level of IL-6 was 22.35 (95% confidence interval [CI], 17.68-26.99) in ADHD patients, and it was 5.44 (95% CI, 4.81-6.06) in controls. A significantly higher level of IL-6 was reported in ADHD patients compared with controls ( P = .001). No significant correlation was found between serum IL-6 level and either the Intelligence Quotient (IQ) or the Conners’ Parent Rating Scale score.

Conclusion:

Serum IL-6 values were significantly higher in ADHD patients compared to healthy control children. Increased production of IL-6 may play a role in the pathogenesis of ADHD.
Pharmacist-Initiated Management of a Suspected Case of Risperidone-Induced Neuroleptic Malignant Syndrome in an Aged-Care Resident. The Role of Residential Medication Management Reviews in Medication Safety
Authors: Morcos Michael , Corns Jonathan , Hillen Jodie Belinda
Published: November 2018

A 70-year-old female aged-care resident was referred by her general practitioner for a residential medication management review after nurses reported difficulties with swallowing, episodes of hyperthermia, elevated blood pressure, and tachycardia. These symptoms were accompanied by increasing confusion and drowsiness. Risperidone had recently been prescribed to treat behavioral and psychological symptoms of dementia. This case study describes the pharmacist-initiated management of the symptoms through a national medication review program. It demonstrates the valuable role collaborative medication reviews play in managing adverse drug reactions in aged-care.
Longitudinal melanonychia and subungual hemorrhage in a patient with systemic lupus erythematosus treated with hydroxychloroquine
Authors: Zhang S , Liu X , Cai L , Zhang J , Zhou C
Published: November 2018

Hydroxychloroquine is an antimalarial agent, most commonly prescribed in the treatment of several rheumatic diseases. Although generally well tolerated, a variety of mucocutaneous adverse effects have been reported. Besides the familiar adverse effects, longitudinal melanonychia is rarely seen. Although the incidence is extremely low, systemic lupus erythematosus may also cause nail pigmentation in its own right. We report the case of a 55-year-old woman who was diagnosed with systemic lupus erythematosus and presented with longitudinal melanonychia of all 10 fingernails after 3 years of treatment with hydroxychloroquine, without mucocutaneous hyperpigmentation. The pigment of the nail lasted for more than 15 years. To the best of our knowledge, this is first published report of hydroxychloroquine-induced melanonychia without mucocutaneous hyperpigmentation. This case demonstrates that hydroxychloroquine treatment and the primary disease should be considered in the case of multiple nail changes in patients with systemic lupus erythematosus.
Accurate quantification of uncertainty in epidemic parameter estimates and predictions using stochastic compartmental models
Authors: Zimmer Christoph , Leuba Sequoia I , Cohen Ted , Yaesoubi Reza
Published: November 2018

Stochastic transmission dynamic models are needed to quantify the uncertainty in estimates and predictions during outbreaks of infectious diseases. We previously developed a calibration method for stochastic epidemic compartmental models, called Multiple Shooting for Stochastic Systems (MSS), and demonstrated its competitive performance against a number of existing state-of-the-art calibration methods. The existing MSS method, however, lacks a mechanism against filter degeneracy, a phenomenon that results in parameter posterior distributions that are weighted heavily around a single value. As such, when filter degeneracy occurs, the posterior distributions of parameter estimates will not yield reliable credible or prediction intervals for parameter estimates and predictions. In this work, we extend the MSS method by evaluating and incorporating two resampling techniques to detect and resolve filter degeneracy. Using simulation experiments, we demonstrate that an extended MSS method produces credible and prediction intervals with desired coverage in estimating key epidemic parameters (e.g. mean duration of infectiousness and R0) and short- and long-term predictions (e.g. one and three-week forecasts, timing and number of cases at the epidemic peak, and final epidemic size). Applying the extended MSS approach to a humidity-based stochastic compartmental influenza model, we were able to accurately predict influenza-like illness activity reported by U.S. Centers for Disease Control and Prevention from 10 regions as well as city-level influenza activity using real-time, city-specific Google search query data from 119 U.S. cities between 2003 and 2014.
Application of visible-near infrared spectroscopy to evaluate the quality of button mushrooms
Authors: Giovenzana Valentina , Tugnolo Alessio , Casson Andrea , Guidetti Riccardo , Beghi Roberto
Published: November 2018

The Agaricus bisporus mushroom is one of the most cultivated and consumed mushrooms in the world, thanks to its delicacy, nutritional value and flavour. The quality evaluation of the A. bisporus during the harvest is generally established by a visual check by trained operators. This method complies with the request of the Distribution Channel (DC) to retailers and guarantees very low physical damage to the mushrooms; nevertheless, it is subjective and it does not guarantee the highest quality standard for the consumer. The aim of this study was to test the use of visible/near infrared (vis/NIR) reflectance spectroscopy (400–1000 nm) to objectively evaluate the quality parameters of A. bisporus mushrooms. A total of 167 samples of A. bisporus mushrooms were harvested according to the main DC purchasing standards. The vis/NIR analyses were performed the day of sampling just before the physico-chemical analyses (sizes, firmness, soluble solids content and moisture content) used as reference quality parameters. The vis/NIR spectra were correlated to reference measures in order to build predictive models using the partial least squares regression method. Calculated models gave positive results regarding the prediction of the moisture content (r2(pred) = 0.78) and firmness (r2(pred) = 0.78). Results of this explorative study could be considered encouraging and demonstrate the applicability of vis/NIR spectroscopy on A. bisporus as a rapid technique (i) to monitor the productive process directly at the company, (ii) to standardize the harvest moment, and (iii) to support DC’s buyers’ choices, nowadays exclusively based on product external characteristics.
Health law, Brexit and medical devices: A question of legal regulation and patient safety
Authors: McHale Jean V.
Published: November 2018

Brexit is already posing many major challenges for those concerned with health and social care. This article explores one area, that of the regulation of medical devices which has been fundamentally underpinned by EU law and asks what Brexit means for future regulation in the United Kingdom. This article begins by outlining the importance of ensuring standards of quality and safety for medical devices and the consequences if things go wrong. The second section of the article outlines the current EU regulation of medical devices. It explores questions such as the role of the notified bodies, the problems of lack of central regulation and the role of vigilance processes. The third section explores the options for medical device regulation post Brexit in the light of the ongoing reform of the law in this area and the implementation of new EU Regulations. It considers the prospects for reciprocity and for alignment in the future. The article concludes by arguing that, while the new system for regulation of medical devices in the EU is not perfect, it nonetheless provides an important opportunity for restructuring device regulation and providing greater opportunities for facilitating safety. It is important to ensure that, as far as possible, we do not lose such an opportunity at domestic level post Brexit.
Nursing students’ ethical challenges in the clinical settings: A mixed-methods study
Authors: Mehdipour Rabori Roghayeh , Dehghan Mahlagha , Nematollahi Monirosadat
Published: November 2018

Background:

Nursing students experience ethical conflicts and challenges during their clinical education. These may lead to moral distress and disturb the learning process.

Objectives:

This study aimed to explore and to evaluate the nursing students’ ethical challenges in the clinical settings in Iran.

Research design:

This was a mixed-methods study with an exploratory sequential design.

Participants and research context:

A total of 37 and 120 Iranian nursing students participated in the qualitative and quantitative phases, respectively.

Ethical considerations:

The ethical committee of Kerman University of Medical Sciences, Iran, approved the protocol of the study.

Findings:

Three main categories were extracted from qualitative data including Low attention of nurses to the patients’ preferences; Lack of authority; and Inadequate support. A total of 97% of the students had more than one ethical challenge in clinical settings and 48% of them stated that their challenges did not resolve. The total score of perceived ethical challenges was 62.03 ± 9.17, which was moderate. The highest mean score related to the “Low attention of nurses to the patients’ preferences” subscale.

Discussion:

The finding confirmed most of the existing results of other international researches about the frequency and kinds of baccalaureate nursing students’ ethical challenges.

Conclusion:

Identifying student ethical challenges helps teachers to manage their clinical learning process better. This study may provide a view for the nurses, clinical educators, and managers toward nursing students’ ethical challenges and their impact on nursing students’ clinical experiences.
Understanding India’s International Space Cooperation Endeavour: Evolution, Challenges and Accomplishments
Authors: Guruprasad B. R.
Published: November 2018

India has now emerged as a major space-faring nation with notable accomplishments in the launch vehicle, satellite, space application and space exploration domains in spite of beginning its space programme from a disadvantageous position vis-à-vis other space-faring nations of the day, besides endeavouring entirely in the civilian domain. International cooperation played an important role during the genesis and the early evolution of the Indian space programme and has played a complimentary role during the progressive accumulation of India’s current space capabilities. Once a recipient of assistance in the domain of space, in the new millennium, India has achieved the status of an equal and even a major partner in some of the joint space endeavours with its erstwhile benefactors and has established facilities for training space personnel from developing countries of the Asia-Pacific region. This article critically reviews India’s international space cooperation endeavour in the past five decades and its influence on the country’s current space capabilities.
Book Review: Rajendra M. Abhyankar, Indian Diplomacy: Beyond Strategic Autonomy
Authors: Harshé Rajen
Published: November 2018

Rajendra M. Abhyankar, Indian Diplomacy: Beyond Strategic Autonomy. New Delhi: Oxford University Press, 2018, 456 pp., ₹795. ISBN: 9780199482184.