[Our experience in using a synthetic prostacyclin analog in the treatment of critical ischemia of the extremities]. / La nostra esperienza sull'utilizzo dell'analogo sintetico della prostaciclina nel trattamento dell'ischemia critica degli arti.

The authors, after examination of pharmacologic profile of Iloprost, prostacyclin synthetic analogue, report their clinical experience from January 1992 to June 1997 on 105 patients with severe ischaemia of inferior limbs. They utilize two protocols: 0.5-2 ng/kg/min x 6 hs once a day x 28 days and 1-1.5 ng/kg/min x 6 hs twice a day x 12 days. The first protocol were practise along the first 2 years; the second on following period as long as today. The results, evaluated on clinical criteria, are referred entity and time of pain remission and decrease of analgesic use, performance status improvement, increase of gear autonomy and, if present, wound healing. The incidence of amputation was 4.76% (5 pts). The authors issue that Iloprost is a conservative treatment, often alternative with amputation, giving sometimes to patients a longtime functional "restitutio ad integrum".

[Multiple bilateral biopsy of the prostate]. / Biopsia prostatica multipla bilaterale.

INTRODUCTION: Transrectal guided biopsy is the method of choice to detect carcinoma of the prostate. Systematic bilateral biopsies have been recently introduced in clinical practice because they provide valuable information about the local staging of the cancer and better representation of the actual Gleason grade of the whole tumor. The purpose of this study is to assess the frequency of neoplastic lesions in prostatic areas with normal structure at US and rectal examination and to identify, if possible, some criteria to be used in the selection of patients for random biopsies. MATERIAL AND METHOD: Systematic bilateral prostatic biopsies were performed in 155 patients with elevated prostate specific antigen (PSA) values, not exceeding 40 ng/mL and with suspected neoplastic unilateral lesion at rectal examination or US. All patients with bilateral or diffuse nodules were not included in this analysis. Three random biopsies for every side of the gland were performed using a 16-18 gauge tru-cut needle. A direct biopsy of the hypoechoic nodule or area was always performed. All specimens results were correlated with PSA and PSA density values obtained before biopsy. RESULTS: Systematic biopsy identified cancers in 53/155 patients (34.19%). Of 53 cases, 35 (66%) had unilateral prostatic carcinoma and 18 (34%) had bilateral cancer. The final diagnosis was benign prostatic lesion in the remaining 102 patients (benign prostatic hyperplasia, nonspecific granulomatous prostatitis, chronic prostatitis). Dividing all the patients into main groups on the basis of pathologic findings (benign, unilateral and bilateral carcinoma) there was a statistically significant difference of PSA values between the 3 groups. CONCLUSIONS: Our observations confirm the utility of systematic US-guided biopsies in the detection of tumors in normal appearing areas at US and transrectal examination, but the clinical utility of this approach needs further confirmation. Additional data on cancer volume, Gleason grade, capsular infiltration, lymph node metastasis and long term survival must be evaluated with large number of patients. In our experience PSA values can be used as a criterion to select the patients to submit to this technique to provide useful, preoperative information suspected prostatic malignancy.

[Intercostal incisional hernia: case report]. / Il laparocele intercostale: caso clinico.

The authors report a case of intercostal incisional hernia following marsupialization of liver hydatid cyst stressing the considerable rarity of the pathology and describing the restorative procedure by intercostal plastic with polypropilene Mesh and rib's approach with stainless steel wires.

The role of ultrasonographic percutaneous cholecystostomy in treatment of acute cholecystitis.

BACKGROUND/AIMS: The Authors propose ultrasonographic percutaneous cholecystostomy in the treatment of acute cholecystitis. MATERIALS AND METHODS: During the period between July 1991-December 1993, 26 patients with acute cholecystitis (18 calculous and 8 acalculous) were observed. The cholecystostomy was performed in principle on patients aged over 70 years and in those with acalculous acute cholecystitis. To rationalize the indication for cholecystostomy in patients aged under 70 years with calculous acute cholecystitis, the Authors elaborated a Risk Score. RESULTS: The cholecystostomy was performed in 23 patients, 15 with calculous and 8 with acalculous acute cholecystitis, and was successful in 22 patients (95.7%). In the group with acalculous acute cholecystitis, the cholecystostomy was the resolutive treatment, while in that with calculous acute cholecystitis was associated, when indicated, to the surgery. CONCLUSIONS: The cholecystostomy interrupted the natural history of the disease and has a low morbidity and mortality. It is an effective and rationale contribution to the treatment of the acute cholecystitis.

Orally administered HSV-specific transfer factor (TF) prevents genital or labial herpes relapses.

Forty-four patients suffering from genital (22) and labial (22) herpes were orally treated with HSV-1/2-specific transfer factor (TF). TF was obtained by in vitro replication of a HSV-1/2-specific bovine dialysable lymphocyte extract. Treatment was administered bi-weekly the first 2 weeks, and then weekly for 6 months, most patients received 2-3 courses. The total observation period for all patients before treatment was 26,660 days, with 544 relapses, and a relapse index of 61.2, whereas the cumulative observation period during and after treatment was 16,945 days, with a total of 121 relapsing episodes and a cumulative RI of 21.4 (P < 0.0001). Results were equally significant when the 2 groups of patients (labial and genital) were considered separately. These observations confirm previous results obtained with bovine HSV-specific TF, and warrant further studies to establish HSV-specific TF as a choice of treatment for preventing herpes recurrences.

A preliminary report on the use of transfer factor for treating stage D3 hormone-unresponsive metastatic prostate cancer.

As conventional treatments are unsuccessful, the survival rate of stage D3 prostate cancer patients is poor. Reports have suggested the existence of humoral and cell-mediated immunity (CMI) against prostate cancer tumour-associated antigens (TAA). These observations prompted us to treat stage D3 prostate cancer patients with an in vitro produced transfer factor (TF) able to transfer, in vitro and in vivo, CMI against bladder and prostate TAA. Fifty patients entered this study and received one intramuscular injection of 2-5 units of specific TF monthly. Follow-up, ranging from 1 to 9 years, showed that complete remission was achieved in 2 patients, partial remission in 6, and no progression of metastatic disease in 14. The median survival was 126 weeks, higher than the survival rates reported in the literature for patients of the same stage.

Use of transfer factor for the treatment of recurrent non-bacterial female cystitis (NBRC): a preliminary report.

Results of conventional treatment of female non-bacterial recurrent cystitis (NBRC) are discouraging. Most patients show an unexpected high incidence of vaginal candidiasis, while their cell mediated immunity to Herpes simplex viruses (HSV) and Candida antigens seems impaired, and it is known that the persistence of mucocutaneous chronic candidiasis is mainly due to a selective defect of CMI to Candida antigens. Twenty nine women suffering of NBRC, and in whom previous treatment with antibiotics and non-steroid anti-inflammatory drugs was unsuccessful, underwent oral transfer factor (TF) therapy. TF specific to Candida and/or to HSV was administered bi-weekly for the first 2 weeks, and then once a week for the following 6 months. No side effects were observed during treatment. The total observation period of our cohort was 24379 days with 353 episodes of cystitis recorded and a cumulative relapse index (RI) of 43. The observation period during and after treatment was 13920 days with 108 relapses and a cumulative RI of 23 (P < 0.0001). It, thus, seems that specific TF may be capable of controlling NBRC and alleviate the symptoms.

[Inguinal hernia repair in the elderly: modified Shouldice procedure, 10 years of experience]. / L'ernioplastica inguinale sec. shouldice modificata nel paziente anziano. 10 anni di esperienza.

Authors relate their experience of 10 years period (1984-1994) with Shouldice technique for inguinal hernia repair in the elderly. This technique, in the Author's clinical practice, replaced the Bassini operation. The personal series is costituted of 190 patients underwent to inguinal repair during a 10 years period from 1984 to 1994 with recurrence rate of 1.1% (2 pt.). Authors consider Shouldice operation to be most valid from the methods of direct suture, with lower recurrence range.

Palliative endoscopic treatment of malignant esophagorespiratory fistula: case report.

The authors report on a case of esophagorespiratory fistula due to squamous carcinoma of the esophagus treated on an emergency basis by endoscopic insertion of an Atkinson prosthesis following dilation of the malignant stenosis with Savary dilators. The authors suggest the endoscopic insertion of a prosthesis as the first approach in the emergency treatment of a malignant esophagorespiratory fistula because of the easiness of the technique, and its low morbidity and mortality rates; furthermore, this procedure relieves digestive and respiratory symptoms rapidly and reduces hospital stay while providing the patient with a better quality of remaining life.

[Obstructive bladder neck syndrome in women]. / Sindrome ostruttiva del collo vescicale nella donna.

Primary bladder neck obstruction in women is quite rare and its symptoms--dysuria, frequency, and urgency--are equivocal. Routine radiological investigations alone do not allow a diagnosis to be made, due to the lack of simultaneous measurements of detrusor pressure and urine flow. A precise diagnosis is thus to be obtained by synchronous video urodynamic studies which allow the depiction of nonfunneling or tight bladder neck during the entire phase of detrusor contraction, of bladder trabeculae and diverticula, vesico-ureteral reflux, long micturition time and incomplete voiding. When these radiological signs are associated with a rise in detrusor voiding pressure over 60 cm of water and with peak urine flow lower than 15 ml/s, the diagnosis of bladder neck obstruction is unquestionable, and the appropriate pharmacologic/endoscopic treatment can be administered.

[Functional stenosis of the urethra in girls]. / Le stenosi funzionali dell'uretra nella bambina.

The authors studied 24 girls with distal urethral narrowing at voiding cystourethrography. Their observation seem to confirm that the distal urethral stenosis is generally functional, because often an anatomical obstruction can not be detected with the bougie a boule calibration. The urodynamic and urovideocystographic methods of study allow to differentiate three types of functional urethral stenosis that are not detectable with the radiologic examination alone. The physiopathologic mechanism of the obstruction is the condition for a successful pharmacologic treatment of these small girls.

Transitional cell carcinoma of the bladder. Differences between primary tumour and following relapses.

The presence of tumour-associated antigens in bladder carcinomas has been shown in leucocyte migration inhibition and lymphocyte stimulation using formalin-treated autologous tumour cells as antigen. The treatment of patients with an in vitro produced specific transfer factor enhances their reactivity in these tests. However, when tumour cells from relapses were substituted for those of the primary tumour, the reactivity previously observed was abolished. An antigenic modulation and/or a polymorphic expression of bladder tumour-associated antigens in secondary tumours is suggested and might be responsible for some immunological escapes.

[Acute sepsis caused by "Gaffkya tetragena" in adult with hypogammaglobulinemia (author's transl)]. / Sepsi acuta da "Gaffkya tetragena" in adulto con ipogammaglobulinemia

A case of acute sepsis caused by Gaffkya tetragena in an adult with acquired hypogammaglobulinemia has been described. The Authors pointout the importance that particular conditions of disreactivity and/or of immunodeficiency can play in the acquistion of pathogenicity by Gaffkya tetragena. In the case under discussion a high deficit of IgG and IgA was demonstrable, which had previously caused a long series of infective bacterial diseases.