[Segmental testicular infarction. Report of two clinical cases and literature review].

Segmental testicular infarction is rare. To the best of our knowledge forty cases are reported in literature. We present two cases of segmental testicular infarction with different etiology. The first case was observed after herniorrhaphy and varicocelectomy. The second one occurred after acute epididymitis. Both cases have been treated without radical orchiectomy. We have also reviewed the pertinent literature in terms of differential diagnosis, etiology and management, with particular regard to testicular sparing.

[Balanitis xerotica obliterans].

Balanitis xerotica obliterans (BXO), first described by Stuhmer in 1928, is a chronic, progressive, atrophic, sclerosing process involving prepuce, glans and urethra. Its aetiology is unknown. After a short terminological excursus and a review of the aetiological hypothesis, we have focused on BXO in daily urological practice. We are here describing the clinical presentation and its differential diagnosis with premalignant and malignant lesions of the penis. We tried to define the relationship between BXO and squamous cell carcinoma of the penis. Particular attention was then cast on urethral stenosis. Finally, we focused on the treatment of BXO: corticosteroid local therapy as first line treatment or as adjuvant therapy after circumcision, surgical therapy including circumcision, laser therapy of the glans lesions, meatoplasty in the stenosis of the anterior urethra. We also stressed the need for histological examination of the preputial specimen for a correct follow-up and for medicolegal reasons.

[Circumcision: what do we cut when we are cutting?].

The term circumcision refers to partial or complete excision of the foreskin. There are three types of circumcision: ritual circumcision, performed for religious practice, as a rite of passage, usually during neonatal or transpubertal age; prophylactic circumcision, as preventive measure against future potential diseases; therapeutic circumcision, performed because of an evident pathology of the foreskin with clear medical indications. The investigation on the meaning of the ritual circumcision goes beyond the boundaries of the present paper; we are referring to anthropological literature to better understand its origin and reasons. Prophylactic circumcision spread among English-speaking peoples in the nineteenth century as a means against masturbation. In the twentieth century prevention against cancer, urinary infections, sexually transmitted diseases and, eventually, AIDS took over. The controversy about prophylactic circumcision is increasing nowadays in the United States whereas in the other English-speaking countries the procedure has almost disappeared and this represents what Edward Wallerstein calls "the uniquely American medical enigma". There are many interpretations for prophylactic circumcision and its lasting success in the United States. Each explanation probably hits the target only partially because this procedure takes its roots in the cultural history of the above mentioned country and in the relation with its puritan origins. Therapeutic circumcision is performed because of a clear and evident pathology of the prepuce. The embryological development of the prepuce is completed at the sixteenth week of pregnancy. At birth, this tissue covers the glans without an apparent plane of cleavage and should be defined as 'non-retractile prepuce' instead of 'phymosis'. The prepuce in its free development becomes completely retractile at puberty. These evolutionary concepts about prepuce have been described by Douglas Gairdner in 1948 and Jacob Oster in 1968. The prepuce is an integrant part of the male genital system. It has three functions: protective, immunological and sexual. The extremely complex innervation of the prepuce explains its sensibility and makes it an extraordinary erogenous zone. In view of these features, the excision of the prepuce necessarily interferes with the patient's sexual function, and possibly involves serious psychological concerns. Circumcision represents a minor surgical procedure but, like any other surgical techniques, can result in complications: A) operative: hemorrhage, removal of too much skin from the penile shaft infection; B) post-operative: sepsis, urethrocutaneous fistula, gangrene of the penis; C) long-term complications: meatal stenosis, skin bridge between the glans and the penile shaft. Sometimes complications are severe and can cause death of the patient, especially during ritual circumcision. Given these aspects, a well informed consent is mandatory both in terms of potential complications linked to surgical procedures, and in terms of sexual and psychological consequences.

Sclerosing Sertoli cell tumor of the testis.

Sclerosing Sertoli cell tumor of the testis is a very rare neoplasm. To date only 19 cases have been reported in the literature. We present the twentieth case in a 39 yearold man treated with conservative surgery with a review of the pathological and urological literature.

Deterioration of protein fraction by Maillard reaction in dietetic milks.

The development of the Maillard reaction in pasteurized, UHT and in-bottle sterilized dietetic milks was studied. In these products damage caused by heat treatments could increase as a result either of the addition of various ingredients or of manufacturing processes that alter their content of reducing carbohydrates. Protein damage was evaluated by measuring furosine by reversed-phase ion-paired HPLC. The levels of furosine detected made it possible to assess the amounts of biologically unavailable lysine. In all milks analysed blocked lysine values were < 340-350 mg/g total lysine, the level at which lysine becomes the limiting amino acid in milk. Pasteurized dietetic milks had levels of blocked lysine similar to that in ordinary pasteurized cows' milk. In some UHT and in-bottle sterilized dietetic milks their different composition resulted in an increase in the blocked lysine content. In some in-bottle sterilized milks, protein damage greatly reduces the beneficial effects of milk as a dietary supplement. Lactose-free milks, which are more susceptible to protein deterioration because of their higher content of reducing carbohydrates, were also analysed after storage at 20 degrees C and at < or = 4 degrees C. At the end of their recommended storage times, they contained limited amounts of blocked lysine only if they had been stored at < or = 4 degrees C.

Sterol oxidation in infant milk formulas and milk cereals.

7-Ketocholesterol and 7-ketositosterol were chosen as reliable markers of the oxidation of cholesterol and phytosterols in infant milk formulas and infant milk cereals. A reversed-phase HPLC method was developed to measure them simultaneously in infant formulas. This method was then tested on a wide range of infant milk formulas and milk cereals on sale in Italy whose lipid composition is representative of the most common commercial formulas. The analytical results revealed no significant differences in the extent of oxidation of cholesterol and sitosterol. As the level of 7-ketocholesterol often followed the cholesterol level, a cholesterol content similar to that of human milk produced amounts of cholesterol oxides with possible negative effects on infant health. In contrast, the low cholesterol content of milk cereals never produced amounts of cholesterol oxides high enough to cause concern. The contents of phytosterols and hence their oxides were always low.