One step endourologic management of severely encrusted stent in solitary kidney with renal impairment. A case report.

Removing a severely encrusted stent, without an initial preventive descaling of the calcification that envelopes it, can lead to serious complications such as the breaking up of the stent, lesions and ureteral avulsion. We report a case regarding an entirely endourological treatment of an encrusted stent in a single kidney patient with renal insufficiency. The time the stent had been in place was 6 months. The patient underwent bladder lithotripsy of the distal tip of the encrusted stent, ureterolithotripsy to free the intraureteral tract of any incrustation and percutaneous nephrolithotomy to deal with the stone burden around the proximal tip. The stent, once free from fragments, was removed, via anterograde, without causing any friction in the excretory tract. The anesthesia time was 3.5 h. The postoperative period was normal without any septic complications or bleeding. We observed a slight worsening of the creatininemia which, after 3 days, could be compared with the preoperative blood levels. Ten days after the operation, renal function returned to normal. Even for patients with just one kidney and renal insufficiency the endourological management of encrusted stents does not lead to a high morbidity and is quite feasible as a one step operation.

[Clinical characteristics of HCV infection in pregnancy: the role of sexual transmission]. / Caratteristiche cliniche dell'infezione da HCV in gravidanza: il ruolo della trasmissione sessuale. Analisi di 178 casi.

BACKGROUND: There is no uniformity of opinions about the possibility of sexual transmission of hepatitis-C-virus infection. Moreover the infection during pregnancy is often underestimated. METHODS: One hundred and seventy-eight anti-HCV-positive pregnant women were investigated to evaluate the incidence of HCV infection and the possibility of sexual transmission of the disease to the partners. RESULTS: 126 patients out of 178 (70.8%) were positive for viral infection at PCR. In 96 patients (53.9%) HCV-positivity was detected for the first time in the actual pregnancy. 147 male partners out of 178 were checked for HCV-positivity and in 31 of them (21.1%) HCV antibodies were found. CONCLUSIONS: The results underline the importance of a screening for HCV-positivity in every pregnant, searching for anti-HCV antibodies also in patients not reporting risk factors. ALT values seem to be of little importance in the monitoring of the pathology. Sexual transmission of HCV virus from woman to man seems to occur rarely.

[Transcervical electric resection in submucous myomas]. / Elettroresezione transcervicale dei miomi sottomucosi.

Twenty-five patients underwent hysteroscopic resection of large symptomatic intrauterine fibroids. Patients were divided into one of three groups: those with pedunculated myomas (G0), those with intramural extension less than 50% (G1), and those with fibroids with intramural extension more than 50% (G2). In the first group (7 patients) the age ranged from 42-52 years (mean age 48 years), the operating time ranged from 15-60 min. (mean time 27 minutes), and the amount of fluid used for irrigation ranged from 1000-10000 ml (mean fluid 4400 ml). Four of the seven patients had concomitant endometrial polyps. Follow-up ranged from 3-32 months (mean 21 months), one patient was lost, and the success rate in 6 was 100%. In the second group (9 patients) the age ranged from 30-54 years (mean age 43.5 years), the operating time ranged from 35-90 minutes (mean time 62 minutes), and the amount of fluid used ranged from 2800-12500 ml (mean fluid 7150 ml). In one case endometrial ablation was associated. Two patients (45 and 54 years) had histopathological diagnosis of malignancy (endometrial stromal nodule and stromal myoma) and required hysterectomy. No residual stromal nodule was found in the uterus following hysteroscopy resection in one case. Follow-up ranged from 6-38 months (mean 20 months), two patients was lost and one had repeat hysteroscopic procedure. Four of the nine patients had a successful outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence against a pathogenetic role for endothelin in pre-eclampsia.

OBJECTIVE: To assess whether increased placental or systemic endothelin synthesis has a pathogenic role in pre-eclampsia (gestational proteinuric hypertension). DESIGN: Prospective observations study. SUBJECTS: 19 women with pre-eclampsia and 10 healthy pregnant women were studies. All were in the last trimester. MAIN OUTCOME MEASURES: Preproendothelin-1 gene expression by Northern blot analysis and generation of endothelin-1 precursor, big-endothelin-1, and endothelin isoforms, namely endothelin-1, 2 and 3, were assessed by specific radio-immunoassays, in placental tissue. Plasma endothelin-1 levels and urinary excretion of big-endothelin-1 and endothelin-1 were measured. RESULTS: Placental preproendothelin-1 gene expression and immunoreactive big-endothelin-1 and endothelin-1, 2 and 3, were comparable in placental tissue from pre-eclamptic and normal pregnant women. Plasma levels of endothelin-1 did not differ between pre-eclamptic and normal pregnancies. In contrast, urinary excretion of endothelin-1, which is likely to reflect the renal synthesis of the peptide, was significantly decreased in pre-eclamptic, as compared with normal pregnant women. This was not due to a decreased renal generation of endothelin-1 precursor, since urinary excretion of big-endothelin-1 did not differ between pre-eclamptic and normal pregnancies. These data suggest an increased renal endothelin-1 breakdown in pre-eclampsia. CONCLUSIONS: Endothelin is unlikely to play a role in the pathogenesis of pre-eclampsia. Instead, an increased renal breakdown may have a role in limiting the negative effects of other vasoactive factors on the renal circulation.

Human placenta expresses endothelin gene and corresponding protein is excreted in urine in increasing amounts during normal pregnancy.

Systemic and renal hemodyanmic changes in normal pregnancy have been attributed in part to altered vascular synthesis of vasodilatory prostaglandins. Besides vasodilatory substances, endothelium also generates vasoconstrictors, including endothelin. We evaluated the capacity of placental tissue from normal pregnant women to express endothelin gene and to generate endothelin. Placental tissue expressed a single 2.3 kb preproendothelin messenger ribonucleic acid and produced comparable amounts of endothelin 3, Big endothelin 1, and endothelin 1 and a minor quantity of endothelin 2. To investigate the possible influence of placental endothelin production on plasma levels of the peptide, plasma endothelin concentrations were measured in normal pregnant women at delivery and were found to be numerically higher than those measured in nonpregnant subjects. Urinary excretion of endothelin, taken as a marker of the renal synthesis of the peptide, tended to increase, although not significantly, in the first 14 weeks of pregnancy. This trend continued throughout pregnancy, resulting in a significant increase from the second trimester to delivery.

Urinary albumin excretion in normal pregnancy and pregnancy-induced hypertension.

We measured the urinary excretion of albumin in 67 healthy primigravidae, at monthly intervals, from 16 to 36 weeks of gestation and 12 weeks postpartum. Of the 67 primigravidae, 55 completed a normal pregnancy and 12 developed pregnancy-induced hypertension. In the latter group, an additional measurement of urinary albumin excretion was performed at 24 weeks postpartum. The aims of the study were: to look for changes of urinary albumin excretion during the progression of normal pregnancy; to assess if microalbuminuria could be an early feature of pregnancy-induced hypertension; to evaluate the effects of physical activity on the excretion of albumin in normal pregnancy and pregnancy-induced hypertension. In contrast with glomerular hyperfiltration and increased urinary total protein, two recognized characteristics of the pregnant state, we found that normal primigravidae, during the day, excrete significantly less albumin (p between less than 0.01 and less than 0.001) in comparison with the postpartum period and nonpregnant women. Normal primigravidae, as a group, showed parallel changes of urinary albumin excretion and diastolic blood pressure throughout pregnancy and postpartum, suggesting an important physiologic role of hemodynamic factors in regulating glomerular permeability to albumin. The daytime urinary albumin excretion in patients developing pregnancy-induced hypertension was significantly higher (p between less than 0.005 and less than 0.001) than in normal pregnancy from the 28th gestational week onwards. The increased urinary albumin excretion preceded the onset of hypertension and tended to persist long after blood pressure had returned to normal levels.(ABSTRACT TRUNCATED AT 250 WORDS)

[The complex relation of pregnancy and diabetes mellitus]. / I complessi rapporti tra gravidanza e diabete.

A glucose metabolism impairment occurs in about 2-3% of all pregnancies. Two different groups of women are involved: diabetic women who become pregnant and healthy women developing gestational diabetes or glucose intolerance during pregnancy. Due to therapeutic improvements and new techniques of fetal monitoring, maternal and perinatal mortality now approaches that of normal pregnancies. On the contrary, congenital anomalies are still four times more frequent. A good control of the mother metabolism is necessary to reduce complications in fetal development, especially during the first six weeks, a crucial period for the early cell division. Fetal monitoring is very important not only to control the normality of the growth and the well-being of the fetus, but also for early identification of possible anomalies.

Tratamento sistemico da moniliase vaginal pelo lauril sulfato sodico de metil partricina. / Systemic treatment of vaginal moniliasis by methyl partricin sodium lauryl sulphate

As tendencias modernas para o tratamento da moniliase cervico-vaginal sao dirigidas para o uso de substancias seletivas e ciclos terapeuticos curtos. Por um estudo randomizado, a eficacia terapeutica e a tolerancia do econazol (ovulos vaginais com 150 mg) e do SPA-S-222 (drageas com 50.000 U de lauril sulfato sodico de metil partricina) - um polienico hidrossoluvel ativo por via sistemica, apos administracao oral - foram avaliadas comparativamente. Os dois medicamentos foram administrados durante um ciclo terapeutico de tres dias consecutivos: um ovulo vaginal a noite para o econazol e quatro drageas orais/ /dia (2 + 2) para o SPA-S-222. Os resultados obtidos colocam em evidencia a superioridade terapeutica do SPA-S-222 sobretudo no que concerne a estabiblidade, a longo prazo, da negativacao microbiologica. O SPA-S-222 se mostrou dotado de uma boa tolerancia e aceitacao por parte das pacientes