Conformal radiotherapy plus local hyperthermia in patients affected by locally advanced high risk prostate cancer: preliminary results of a prospective phase II study.

PURPOSE: Hyperthermia has been used in several trials to treat pelvic cancers without excessive toxicity and with positive results. The aim of this study was to evaluate feasibility and results in terms of biochemical recurrence-free, disease-free survival, overall survival, and treatment toxicity profile of hyperthermia combined with radiotherapy in locally advanced high risk prostate cancer. PATIENTS AND METHODS: From November 1998 to December 2004, 144 patients with locally advanced prostate cancer (LAPC) were enrolled in a phase II study. They were treated using conformal radiotherapy (CRT) plus local hyperthermia (LHT) and androgen suppression therapy (AST). Treatment modalities consisted of: 1) CRT with a mean dose of 74 Gy (2 Gy/fraction/5 fractions per week); 2) LHT: one session per week during the first, second, third, and fourth week of the radiotherapy course; 3) AST was administered as neo-adjuvant and adjuvant therapy in more than 60% of patients. RESULTS: The median follow-up time was 51.7 months. Four patients were lost at follow-up. Of 140 evaluated patients, four died because of intercurrent diseases and 12 because of progression of disease. Patients were evaluated in terms of five-year overall survival (87%), and five-year biochemical progression-free survival (49%). No significant side effects, except symptoms related to AST have been reported. No late grade 3 toxicity occurred. CONCLUSIONS: In advanced high risk prostatic cancer, hyperthermia is feasible and well tolerated. It may be useful to enhance the radiotherapy efficacy at intermediate dose in order to avoid higher doses of irradiation which increases acute and late sequelae. The advantage of LHT combined with CRT should be confirmed by a randomized phase III trial, comparing irradiation plus AST with or without hyperthermia.

Symptoms, bothersomeness and quality of life in patients with LUTS suggestive of BPH.

The QUIBUS study is the largest investigation ever performed in Italy with an extensive use of the ICS-BPH questionnaire. The internal consistency of each of its three domains was high for ICS-Male (Cronbach's alpha = 0.83 and 0.89 for symptoms and bother, respectively) and lower for ICS-Sex (Cronbach's alpha = 0.63 and 0.75, see a following paper of this issue) and ICS-QoL (Cronbach's alpha = 0.53), as previously reported in the validation study of this tool. Voiding symptoms were more frequently reported, with reduced urinary stream, terminal dribble and incomplete bladder emptying as the most frequently represented. The first storage symptom in the ranking by frequency was 'rush to toilet' (70% of the population), in 7th position; however, the relevant bother was among the highest reported. Items related to urinary incontinence appeared, when present, highly bothersome (87-92% of patients), even though exhibited by a minority of the population (5-34%). The mean (+/-SD) IPSS, calculated on 970 patients, was 15 (+/-7). Two major discrepancies were found in the comparison between IPSS and ICS-Male. First, terminal dribble, which is not considered in the IPSS, is often reported in the ICS-Male. Second, some storage symptoms (nocturia and day-time frequency) are less frequently reported in the ICS-Male than in the IPSS, while being, in general, highly bothersome. As regards QoL, 95% of subjects declared that they would not be completely happy to spend the rest of their life with their actual symptoms (ICS-QoL item 33) and 79% that BPH influences their life from 'a little' to 'a lot' (ICS-QoL item 30). The mean (+/-SD) IPSS-QoL single question score was 3.0 +/- 1.4 (n = 970), and the frequency distribution of scores was equivalent to the one detected by the corresponding question of ICS-QoL (item 33). SF-36, a disease-independent questionnaire about QoL, after a 1-year follow-up is expected to clarify which among the IPSS and ICS-BPH items better describe the impact of BPH on QoL.

Leiomyosarcoma of the bladder fourteen years after cyclophosphamide therapy for retinoblastoma.

We report a case of bladder leiomyosarcoma which occurred in a 22-year-old female who had been treated with cyclophosphamide for a period of 68 months for retinoblastoma diagnosed at 18 months postpartum. Partial cystectomy was performed. Forty-two months after the operation she is tumor-free.

Prostate cancer and coexisting incidental Paget's disease--report on a case.

Prostate cancer coexisting with asymptomatic Paget's disease (osteitis deformans) may be difficult to stage. The skeletal lesions of both prostate cancer and Paget's disease may closely resemble each other, as appearing on imaging. A case of clinically localized prostate cancer coexisting with incidental Paget's disease is herein reported. Prostate cancer and coexisting incidental Paget's disease both need careful evaluation and close follow-up of the skeleton by imaging, because there is a risk of the former involving the skeleton at low clinical stages and low PSA serum levels, as well as the latter developing osteosarcoma.

[Leydig cell tumor of the testis]. / Il tumore del testicolo a cellule di Leydig.

It represents a rare and mostly unilateral pathology with benign istological patterns. However, since the biological behaviour of the tumor is not foreseable from the istological characteristics, the follow-up must be prolonged. The treatment of this cancer is orchidofuniculectomy, sometimes associated, in selected cases, with retroperitoneal lymphadenectomy. In presence of tumor of small dimensions, above all if bilateral ones, it may be indicated a conservative treatment. Authors report six cases of Leydig cell tumors of the testis observed in sixteen years. All patients had orchidofuniculectomy by inguinal approach. In only one case has been associated retroperitoneal lymphadenectomy for the suspect of lymphatic metastasis. Follow-up of 3 months to 15 years is available for all patients: no one has died for the tumor and all are without signs of disease.

[Multicenter comparative study of meropenem vs. imipenem in the intramuscular treatment of hospital infections of the urinary tract]. / Studio multicentrico comparativo su meropenem vs imipenem nel trattamento intramuscolare delle infezioni urinarie ospedaliere.

A clinical, multicentre, randomised, comparative study in 283 adult hospitalized patients was carried out to assess efficacy of meropenem in the treatment of complicated and non-complicated urinary tract infections, in comparison to imipenem/cilastatin. Both antibiotics were administered intramuscularly, at a dose of 500 mg bid. The two groups were homogeneous, as regards the distribution between male and female, the mean age of the patients, the severity of infections and the mean duration of treatment. Clinical results were assessed at the end of therapy and follow-up (4-6 weeks). Bacteriological results were assessed at 5-9 days post-treatment and at follow-up. As regards clinical and bacteriological results patients showing a satisfactory response rate were compared, at the end of the treatments using a Chi square test. With both treatments high satisfactory clinical and bacteriological response rates were seen. As regards clinical satisfactory responses (97% of meropenem assessable patients versus 90% of imipenem/cilastatin assessable patients), there was a statistically significant difference in favor of meropenem. The bacteriological outcome was successful (eradication) for 75% of assessable patients in each group. Most failures were seen in the complicated infections, even when pathogens usually sensitives to carbapenemics were initially isolated. Safety was good with both drugs; no withdrawals in any group of treatment was seen because of side effects. The local tolerance of meropenem was globally rated as good.

Vesicovaginal fistulas: our experience and review of literature.

Vesicovaginal fistulas (VVF) still represent a sad complication of surgery of the female genital system. In this article an extensive review of the literature was conducted, analyzing the etiological, pathological and clinical aspects, as well as the therapeutical problems. For this purpose, we have compared the many surgical techniques proposed for treatment of VVF and have also evaluated their results. Furthermore, we report on our series of 35 patients who had undergone treatment for VVF.

[Surgical repair of congenital penile curvature]. / La correzione chirugica degli incurvamenti congeniti del pene.

Congenital penile curvature is not such a rare pathology and it is responsible for important aesthetic and functional problems. This malformation, can render intercourse difficult and painful, but it can be cured with a simple surgical procedure that almost always guarantees excellent results. In this work we report on the treatment of 48 patients (aged 16-34) with congenital penile curvature with a follow-up of 6 months to 10 years. The aetiology is also briefly analysed. A discussion follows on the diagnostic criteria for better interpretation of the main characteristics of this problem in relation to its functional appearance. A comparison of different surgical techniques is also shown, focusing over the procedure we perform: plissettage of the tunica albuginea. This technique is performed through a penile skin incision opposite to the maximal curvature of the organ, exposure of the tunica albuginea and the positioning of one or more series of stitches. The overall results show that 44 out of 48 patients were fully satisfied both from the aesthetic and functional points of view, while 4 were partly satisfied from the aesthetic point of view alone.

Diagnostic and therapeutic problems in multicentric renal angiomyolipoma.

Multicentric renal angiomyolipoma is a rare form of benign tumor. However, its effective incidence as evaluated in autopsy studies may be as high as 8%. There are 2 main types of renal angiomyolipoma, that is isolated forms and those associated with other diseases, such as phakomatosis, polycystic kidneys and fibromuscular dysplasia. The tumor may also display malignant behavior with local invasiveness and regional lymph node involvement. However, the clinical course is benign and multicentricity is important for prognosis. Histopathological diagnosis often is difficult. Immunohistochemical analysis of surgical specimens using a panel of monoclonal antibodies, including HMB-45 and actin, enabled us to make a definitive diagnosis in 3 cases of multicentric renal angiomyolipoma.

[The complications of lumbotomies]. / Le complicazioni delle lombotomie.

After having described the surgical anatomy of the lumbar region, with particular regard to the relationships with pleura and peritoneum, as well as to the course of the nervous structures of the region (12th intercostal, ileohypogastric and ileoinguinal), the authors describe the possible complications related with the surgical approaches to the lumbar region. Pathogenesis of post-operatory pains and parietal hypotonies is especially evaluated; these complications may be caused by section, ligature or compression of one or more nervous trunks. The authors conclude that the respect of the anatomic structures located in the lumbar region represents the best way in order to prevent most complications related to lumbotomies.

[Clinical and instrumental evaluation of erectile impotence: a proposal of a diagnostic protocol]. / Valutazione clinico-strumentale dell'impotenza erettile: proposta di protocollo diagnostico.

There has been increasing interest in recent years in patients complaining of erectile dysfunction. This has prompted research and the development of diagnostic procedures aimed at allowing increasingly rapid characterization of the type of impotence involved (psychogenic or organic) and thus the most effective treatment. In this preliminary study, we present our study methodology in patients with erectile dysfunction, emphasising in particular the diagnostic procedures best suited to revealing the presence of an organic cause in the pathogenesis of impotence.

[Transitory postoperative anuria after transvesical prostatic adenomectomy: review of the literature, description of new clinical cases and physiopathological considerations]. / Anuria post-operatoria transitoria dopo adenomectomia prostatica transvescicale: revisione della letteratura, descrizione di nuovi casi clinici e considerazioni fisiopatologiche.

Anuria is a rare complication after prostate adenomectomy. Three cases of complete bilateral anuria and one case of monolateral anuria are reported following transvesical prostate adenomectomy, characterized by immediate onset without any apparent cause and by spontaneous resolution within 48 hours. After a thorough review of the literature, the authors analyze the pathophysiological and clinical aspects of post-prostate-adenomectomy anuria and postulate an "obstructive" aetiology for the anuria cases observed in their series.

[Spermatic cord torsion]. / Torsión del cordón espermático.

Torsion of the spermatic cord constitutes a surgical emergency. Morphologically and functionally, the fate of the compromised testis largely depends on the time elapsed between the acute episode and surgical intervention. Patients who had been treated for testicular torsion by our group from 1976 to 1989 were requested to return for outpatient evaluation. These patient were divided into two groups according to the time elapsed between the diagnosis and surgical intervention. We observed that surgical correction within 12 hours following presentation permitted testicular salvage. Testicular volume was generally preserved and remained normal or slightly diminished. However, when the time elapsed was over 12 hours, testicular atrophy was observed in 46% of the patients. We can conclude, therefore, that detorsion must be performed as soon as possible. Vaginalis testis eversion will generally achieve stable and lasting fixation.

[Continuous monitoring of nocturnal penile tumescence and rigidity in the evaluation of erection disorders. Preliminary data]. / Monitorización continua de la tumescencia y de la rigidez peneana nocturna en la valoración de los trastornos de la erección. Datos preliminares.

Nocturnal penile tumescence measurements continues to be an important step in the diagnosis of impaired erectile function. We present our experience with this technique employed on 65 patients who consulted at our andrologic center. Our results corroborate the importance of the NPR-R test with the Rigi-Scan in the evaluation of this pathology to ensure these patients receive the most appropriate treatment.

[Conservative surgical treatment of bilateral renal neoplasms]. / Il trattamento chirurgico conservativo delle neoplasie renali bilaterali.

Surgery seems to be the only effective treatment for bilateral kidney neoplasms as shown by the better survival rate of operated patients compared with those otherwise treated or untreated at all. The best conservative treatments, regarding radicality and security required by these neoplasms, are the enucleation and the partial in situ nephrectomy. Our study is based on 11 patients affected by bilateral kidney neoplasms; 8 of them, in which there were no signs of metastatization, have undergone surgical treatment. In 2 patients (18%) a bilateral enucleation was performed and in 6 (55%) monolateral enucleation together with a controlateral radical nephrectomy. All tumors developed simultaneously have been operated in the same session. No postoperative complications were observed except in 2 patients which developed a transient renal insufficiency. The follow up was from 2 to 66 months. All patients were examined with echotomography or CT scan at least once a year and are, up today, in good health condition and tumor free.

The vesicosigmoidal fistula: diagnosis and surgical treatment.

The authors report their experience in the diagnosis and treatment of 10 cases of vesicosigmoidal fistula. In accordance with the literature the most frequent presenting symptoms were of urinary origin. For the diagnosis urography was helpful, cystography and cystoscopy allowed the observation of a fistulous orifice, while barium enema confirmed, or removed probable doubts about the nature of the intestinal pathology. Surgical treatment varied from one-stage to multi-stage procedures.

Renal lesions after unilateral ureterosigmoidostomy in the rabbit: preliminary results.

Unilateral ureterosigmoidostomy (U.S.S.) was performed on 15 rabbits and then the animals were sacrificed after 3, 8 and 15 months. The gross appearance of the kidney and radiological investigations revealed enlargement of the pelvis and of the ureter on the operated side although the anastomosis was patent in all cases. In rabbits sacrificed 8 months after U.S.S. an adenomatous polyp was present at the site of anastomosis. Histological examination of the affected kidney showed pyelonephritis secondary to obstruction and immunopathological studies revealed in some rabbits glomerular and tubular deposition of immunoglobulins and complement. The contralateral kidney was always normal. Biochemical investigations showed only a moderate increase in blood urea nitrogen and plasma creatinine values.