Renal cell carcinoma: histological findings in peritumoral tissue after organ-preserving surgery.

OBJECTIVE AND METHOD: This study assessed the involvement of peritumoral renal cell carcinoma tissue and evaluated the efficacy of partial resection versus enucleation by an anatomopathological investigation into the resection margins in 28 cases of partial nephrectomy. RESULTS: Histological findings showed no peritumoral infiltration in 91.6% of elective partial resections (24 patients) and resection margin involvement in 75% of necessary partial resections (4 patients). CONCLUSION: Although the debate between organ-preserving and radical surgery remains open, the conservative approach can undoubtedly be recommended in selected patients.

[Bilateral and subclinical varicocele: clinical experience]. / Varicocele bilaterale e subclinico. Nostra esperienza.

The authors report their experience in clinical and instrumental diagnosis of primary varicocele, with regard to bilateral and subclinical forms. 54 patients affected by varicocele were evaluated comparing the results of clinical examination with those coming from scrotal ultrasonography and Doppler flowmetry of spermatic cords. Bilateral varicocele was found in 26 cases (48.2%); subclinical varicocele, monolateral or bilateral, was evidenced in 25 cases (46.3%). On the basis of this study clinical examination seems not to be ideal for the diagnosis of varicocele, particularly in view of a surgical or percutaneous treatment aimed at complete resolution of venous spermatic reflux.

[Assessment of sapheno-femoral junction continence in 42 patients with primary varicocele]. / Valutazione della continenza ostiale safeno-femorale in 42 pazienti con varicocele primitivo.

Varicose veins present a major health problem, causing chronic leg symptoms and disability to a large segment of population. The prevalence rate in adults shows great geographical variations and increases with age. Several authors reported that most cases of primary varicose veins are due to valvular incompetence of saphenofemoral junctions. On the base of close physiopathologic and hemodynamic relationships between primary varicose veins and primary varicocele we decided to evaluate the continence of saphenofemoral junctions in a selected group of young men affected by primary varicocele. MATERIALS AND METHODS. 42 patients were included in the study. The age ranged from 13 to 55 years; the mean age was 28 years. In all cases a clinical and instrumental (ultranosography. Doppler flowmetry) diagnosis of primary varicocele was performed. Bidirectional Doppler flowmetry was used to evaluate the continence of 84 saphenofemoral junctions. RESULTS. Among the group of studied 36 (85.7%) showed a monolateral or bilateral valvular incompetence of saphenofemoral junctions; in the remaining 6 patients (14.3%) there was no evidence of valvular insufficiency. In 84 saphenofemoral junctions studied 52 (61.9%) were found incompetent, 32 to the left side and 20 to the right side. Moreover 2 patients had clinically detectable varicose veins of the lower limbs and symptoms related to chronic venous insufficiency. DISCUSSION. Varicose veins are one of the most prevalent chronic conditions in industrialized countries and places a considerable demand on the health services. Since this pathology is potentially preventable it seems very important to select within populations asymptomatic groups in which there is an increasing risk of chronic venous insufficiency and to perform a clinical and instrumental assessment, based on non invasive techniques. In the past varicose veins were related to other diseases and among them some authors suggested primary varicocele, that is due to venous spermatic reflux and/or valvular incompetence; furthermore varicocele and varicose veins are often familiar. In our 42 patients affected by varicocele only 6 (14.3%) had no Doppler flowmetry evidence of incompetence of saphenofemoral junctions and more than half (61.9%) of the junctions were found incompetent. CONCLUSIONS. In our experience we found a considerable relationship between primary varicocele and venous incompetence of saphenofemoral junctions. Perhaps these patients must be considered a group with an increasing risk to develop primary varicose veins. So we suggest that clinical examination and instrumental assessment should be performed in young men affected by varicocele, in order to obtain a prevention of chronic venous insufficiency of the lower limbs. Nevertheless this retrospective study has to be further confirmed by longterm prospective studies.

[Leukocytic procoagulant activity and chemotherapeutic drugs: the comparative effects of cisplatin and carboplatin on lympho-/monocytic procoagulant activity in vitro]. / Attività procoagulante leucocitaria e farmaci chemioterapici: effetti comparativi del cisplatino e del carboplatino sull'attività procoagulante linfo/monocitaria in vitro.

It is well known that a number of chemotherapeutic agents are able to induce procoagulating activity not only in neoplastic cells but also in normal, monocyte/macrophage cells, and some of them, including cisplatin, even increase procoagulating activity of the factor already expressed, providing a further example of the possible co-participation of chemotherapy in the onset of thrombotic complications in cancer patients. Carboplatin is an analogue of cisplatin but differs strikingly in terms of its collateral effects, in particular being less oto- and nephrotoxic. To the authors' knowledge there are no data regarding the possible effect of carboplatin on lympho/monocyte procoagulating activity. This study shows that not only platin but also carboplatin is able to increment the levels of lympho/monocyte procoagulating activity in vitro, with a dose-dependent effect, and to synergize with bacterial endotoxin in increasing this leukocyte activity, although the synergic effect is significantly greater in the case of carboplatin. The importance of these findings at a practical and clinical and clinical level still remains to be defined, in particular in the light of the different pharmacokinetic behaviour of these two chemotherapeutic agents and in the context of those neoplastic diseases for which cisplatin and carboplatin treatment is most frequently used.

[Leukocyte procoagulant activity and chemotherapeutic agents: comparison between the effects of adriamycin and epiadriamycin on the procoagulant lympho/monocytic activity in vitro]. / Attività procoagulante leucocitaria e farmaci chemioterapici: comparazione tra gli effetti dell'adriamicina e dell'epiadriamicina sull'attività procoagulante linfo/monocitaria "in vitro".

It is well known that a number of antineoplastic agents are able to induce procoagulant cellular activity and tissue factor not only in neoplastic cells but also in normal, monocyte/macrophage cells, and some of them, including adriamycin, even increase procoagulating activity of the factor already expressed, providing a further example of the possible co-participation of chemotherapy in the onset of thrombotic complication in cancer patient. Epirubicin is an analogue of adriamycin but differs strikingly in terms of its collateral effect, in particular being less cardiotoxic. To the authors' knowledge there are no data regarding the possible effect of epirubicin on lympho/monocyte procoagulant activity. This study shows that not only adriamycin but also epirubicin is able to increment the level of lympho/monocyte procoagulant activity "in vitro", with a dose-dependent effect, and to synergize with bacterial endotoxin in increasing this leukocyte activity, although the effect is significantly greater in the case of adriamycin. The importance of these findings at practical and clinical level remains to be defined, in particular in the length of the different pharmacokinetic behavior of these two chemotherapeutic agents and in the context of those neoplastic diseases for which adriamycin and Epirubicin treatment is most frequently used.

[Reduced ex vivo production of superoxide anion by polymorphonuclear leukocytes during therapy with omeprazole. A pharmacological effect?]. / Ridotta produzione "ex vivo" di anione superossido da parte dei leucociti polimorfonucleati durante terapia con omeprazolo. Un effetto farmacologico?

Among available drugs, omeprazole is the one that cures gastric acid secretion-related pathologies, including reflux oesophagitis which responds poorly to H2-receptor antagonists, most rapidly and efficaciously. This marked therapeutic action is thought to reflect the drug's capacity to adequately control parietal hydrochloric acid secretion. Our data suggest an omeprazole effect on human neutrophil function too. Neutrophils are more or less a constant, and often conspicuous anatomo-pathological component of the phlogistic processes associated with gastric acid secretion. A direct or indirect effect exerted by omeprazole on leukocyte function would be of great scientific-biological and therapeutic interest. Furthermore, it would contribute to marking the drug superior in terms of more rapid relief of the symptoms and range of therapeutic action.

[Echo-guided percutaneous drainage of renal cysts]. / Il drenaggio percutaneo ecoguidato delle cisti renali.

Treatment of renal cysts in the ultrasound guided percutaneous drainage, associated with intra-cavital sclerosis-inducing agents to avoid recurrence, is often proposed. This report describes the technique and the most suitable sclerosis inducing agents. The best results are obtained with alcohol. No increase in complications or discomfort was observed.