PCDD/Fs, DL-PCBs and NDL-PCBs in European catfish from a northern Italian lake: the contribution of an alien species to human exposure.

PCDDs/Fs, DL-PCBs and NDL-PCBs are environmentally persistent substances that have been associated with adverse effects on human health. Humans are mainly exposed to these pollutants through ingestion of contaminated fish and fishery products; the consumption of fatty fish such as European catfish can contribute considerably to the intake of dioxins and PCBs. Samples of fish muscle of the top-of-the-food-chain predator Silurus glanis from the northern Italian Lake Varese were analyzed to detect the levels of 17 PCDD/F and 18 PCB congeners. All samples presented detectable levels of PCDD/Fs and PCBs, with concentrations ranging from 0.001 to 1.310pgg(-1) wet weight (w.w.) for Σ PCDD/Fs, 0.031 to 21.000pgg(-1) w. w. for Σ DL-PCBs, and 0.397 to 117.910ngg(-1) w. w. for Σ NDL-PCBs. One sample exceeded the maximum levels of 6.5pgg(-1) w. w. for the sum of PCDD/Fs and DL-PCBs set by European regulations for fish (1259/2011 EU), while other samples exceeded the action levels of 0.75pgg(-1) w. w. for the sum of PCDD/Fs, and 2pgg(-1) w. w. for the sum of DL-PCBs (277/2012 EU). Consuming contaminated catfish may pose a risk for human health, especially for the subpopulation traditionally accustomed to eating this fish, as well as sensitive individuals, such as children and pregnant women.

Human dietary exposure and levels of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), dioxin-like polychlorinated biphenyls (DL-PCBs) and non-dioxin-like polychlorinated biphenyls (NDL-PCBs) in free-range eggs close to a secondary aluminum smelter, Northern Italy.

PCDD/Fs and PCBs are environmentally persistent substances that have been associated with adverse effects on human health. Contamination of soils, animal feed and pastures leads to their bioaccumulation of in food products of animal origin, which are considered the major source of intake of these contaminants in humans. We analyzed eggs from free-range hens, sampled from small farms, located within a distance of 4.5 km from a secondary aluminum smelter in Northern Italy. The concentrations of PCDD/Fs, DL-PCBs and NDL-PCBs were higher in eggs from locations close to the plant, and strongly exceeded the limits set by EU Regulation 1259/2011 (2.5 pg WHO TEQ fat g(-1) for PCDD/Fs, 5.0 pg WHO TEQ g(-1) for PCDD/Fs and DL-PCBs L, 40 ng g(-1) for NDL-PCBs). Without the prompt and immediately applied control strategies, the consumption of contaminated eggs may have posed [corrected] a risk for human health, especially for children (≤9 years) and infants (≤3 years), due to the 2-fold excess of the current exposure limits.

[Transurethral alprostadil (MUSE) in erectile dysfunction]. / Alprostadil transuretrale (MUSE) nella disfunzione erettile peniena.

The ideal therapy for erectile dysfunction should be easy, non invasive, painless, with a high success and a low side effects rate. Alternative methods of delivery drugs to the erectile body, instead of intracavernosal injection of vasoactive drugs such as prostaglandin, have been evaluated. Vasoactive agents can be administered topically into the urethral mucosa for absorption into the corpus spongiosum and transfer into the corpora cavernosa via small communicating veins. We report data from the literature and our experience with MUSE (Medicated Urethral System for Erection) for the treatment of erectile dysfunction. Penile pain or discomfort is the common adverse effect reported, while no priapism of fibrotic complication is reported. But local discomfort, limited efficacy, and cost are to be considered.

A prospective study of recurrence rate and risk factors for recurrence after a first renal stone.

PURPOSE: We investigate further the recurrence rate and risk factors for recurrence in 300 consecutive patients who presented to our stone clinic after a first stone episode 7 to 17 years ago. MATERIALS AND METHODS: The medical records of the patients who presented consecutively with a first stone episode from 1980 to 1990 were studied and supplemented by a followup mail questionnaire and telephone interviews. At first visit serum samples were taken from all patients and 24-hour urine samples were collected for metabolic testing. RESULTS: A total of 195 patients were followed successfully, of whom 52 (27%) experienced symptomatic stone recurrence after a mean plus or minus standard deviation of 7.5+/-5.9 years. However, ultrasound examination of 36 symptom-free patients showed recurrent stones in 28%. Comparison of patients with or without recurrence confirmed that recurrence was not influenced by sex, family history of stones and urinary risk factors. However, age at onset of the disease was lower for patients who had 2 or more stones during followup than those who had only 1 stone or no recurrence. CONCLUSIONS: Stones can recur as long as 10 years after the first episode, although the rate is lower than previously reported. The metabolic evaluation after a first stone episode needs to be reappraised in terms of its cost-effectiveness, since recurrences do not seem to be predictable from standard laboratory tests.

Hyperoxaluria in patients with idiopathic calcium nephrolithiasis.

We studied 476 patients with idiopathic renal calcium stone disease (286 M, 190 F) while they ate their customary diets. Each subject collected a 24-hour urine sample and completed a dietary diary for a 3-day period. Daily urinary oxalate excretion (M 0.24 +/- 0.15 mg/dl, F 0.23 +/- 0.15 mg/dl) and nutrient intake values were calculated and multiple regression analyses were performed. Daily urinary oxalate excretion was significantly (p < 0.001) related to urinary volume (R = 0.24), vitamin C intake (R = 0.33) and body mass index (R = 0.37) and inversely related to calcium intake (R = -0.35). We conclude that urinary oxalate reflects endogenous oxalate production, presumably related to body size, but also intestinal absorption of oxalate, related to dietary intake and to the effect of dietary calcium intake which reduces intestinal oxalate absorption.

A study of dietary calcium and other nutrients in idiopathic renal calcium stone formers with low bone mineral content.

PURPOSE: Patients with calcium renal stone are reported to have lower bone mineral density. The state of bone density in patients with renal stones have different explanations but the role of nutritional factors seems to be crucial. A group of 48 consecutive male calcium renal stone formers was studied to investigate the relationship between bone density and dietary intake. MATERIALS AND METHODS: Patients completed a dietary diary for a 3-day period during normal diet. Nutrients and calories were calculated by food composition tables using a computerized procedure. Bone densitometry was assessed at the lumbar spine and femoral neck, and expressed as Z score. A blood sample was collected and was analyzed for serum biochemistry including alkaline phosphatase, parathyroid hormone and 1,25 vitamin D. A 24-hour urine sample was analyzed for calcium, phosphate, oxalate, citrate and other electrolytes. RESULTS: Dietary calcium intake was significantly lower (p < 0.01) in patients with low than in those with normal bone mineral density. There was no difference in serum parathyroid hormone levels, phosphate and alkaline phosphatase between the 2 groups. The results suggest that some renal stone formers seem to be unable to decrease renal excretion of calcium on a low calcium diet leading to a negative calcium balance. CONCLUSIONS: A primary abnormality of bone metabolism could be a reasonable explanation of reduced bone density observed in renal stone formers on a low calcium diet since serum parathyroid hormone levels are in the normal range. From a therapeutic point of view these data confirm that restriction of dairy products in renal stone formers should be avoided.

Renal stone fragments following shock wave lithotripsy.

PURPOSE: We describe a select group of asymptomatic patients with fragments and dust 3 months after extracorporeal treatment, who were followed to evaluate the long-term outcome and therapeutic implications. MATERIALS AND METHODS: A total of 129 patients with dust and residual fragments (less than 4 mm.) at 3 months was re-examined at 12 months, and 95 were also evaluated at 24 months. Followup examinations consisted of radiographic studies, renal ultrasonography and urine culture. Dust and residual fragments were sought, and patients were defined as free or as having persistent lithiasis or stone regrowth. At 24 months recurrences in the patients stone-free at 12 months also were considered. RESULTS: At the 12-month followup 60 patients (46.5%) were stone-free and 56 (43.5%) still had dust or residual fragments. The localization of the stones or fragments at 3 months and their sizes did not have a significant influence on the stone-free rate but regrowth was greater in patients with stones larger than 10 mm. (11 of 40 patients, 27.5% versus 2 of 89, 2.2%, p = 0.001). The probability of eliminating residual lithiasis at 12 months was significantly greater in patients with dust than in those with residual fragments (42 of 79 patients, 58% versus 18 of 50, 36%, p = 0.026). Regrowth of residual lithiasis was observed in 13 patients (10%). CONCLUSIONS: Based on our results, we do not believe that patients with fragments require systematic re-treatment in the short term but they may be followed long term and re-treated if symptoms persist or stones recur.

Clinical observations on 2086 patients with upper urinary tract stone.

The present series comprises 2086 consecutive patients who were studied in a stone clinic during a period of 15 years. Each patient was subjected to a comprehensive protocol including a fully biochemical investigation. Calcium stones were by far the commonest accounting for 61% of cases; infection, uric acid/calcium oxalate and cystine stones accounted respectively for 24%, 8%, 5% and 2%. Nephrolithiasis was more prevalent in males with the male to female ratio 1:0.76, on the other hand infection stones were more frequent in females with the male to female ratio 1:1.6. The peak age incidence of renal calcium stones occurred in the third to fifth decades, although about 3.4% reported onset of disease in the first and second decades of life. The onset of cystine stones was always in the first and second decades, while uric acid stones affected older patients. Renal stones were recurrent in about 50% of cases. In a retrospective analysis it was found the interval to first recurrence to be less than 5 years in about half patients. The cystine and uric acid groups had the highest rate of recurrence. In patients with calcium stones a definite metabolic or mechanical cause for their stones was found respectively in 8.2% and 10.1%. Particularly primary hyperparathyroidism was revealed in 2.8%. A metabolic defect could be found in 54% of the patients with idiopathic calcium stones. In these patients with idiopathic calcium stones the prevalence rate of hypercalciuria was 33%. In patients with uric acid stones and with mixed uric acid/calcium oxalate stones a definite metabolic cause for their stones was found respectively in 9.5% and 4.1% whereas an underlying disease of the urinary tract was diagnosed respectively in 8.5% and 6.2%. In patients with struvite stones the incidence of persistent infection was 46% (Proteus 18%). In this group the presence of an underlying disease of the urinary tract was diagnosed in 18.8% whereas a definite metabolic disease was demonstrated in 8.5%, a urinary risk factor for metabolic stone disease in 42% and a previous episode of metabolic stone disease in 33%.

[Preoperative prediction of the presence of lymph node metastasis of prostatic carcinoma: reliability and clinical significance]. / Predizione pre-operatoria della presenza di metastasi linfonodali di carcinoma prostatico: attendibilità e significato clinico.

A total of 28 patients with clinically localized prostate cancer have undergone laparoscopic pelvic staging lymphadenectomy. In 21% of the patients pelvic lymph node metastases were diagnosed. If the Gleason score on needle biopsy was less than 6, the likelihood of lymph node metastases was 15%, whereas 50% of patients with a Gleason score of 6 or more had lymph node spreading; Whatever cutoff was used, the preoperative PSA value unreliable to predict the regional nodal status.

Andrological laparoscopy.

The laparoscopic technique has well defined indications for some andrological procedures such as the diagnosis and the treatment of cryptorchidism, but its role remains controversial in varix ligation for which laparoscopy is however the newest development. At the Institute of Urology of the University of Milan from January 1992 to June 1994 five adults patients with undescended and unpalpable testis underwent laparoscopy. In 4 cases laparoscopic orchiopexy (2 direct and 2 staged procedures) and in one case laparoscopic orchiectomy have been performed. In the same period 20 cases of varicocele (6 bilateral) have been observed and treated by laparoscopic varix ligation. For cryptorchidism after the identification of the testis we decide on the basis of parenchimal trophism wheter to perform orchidopexy or orchiectomy. A single step laparoscopic orchiopexy can be performed if the undescended testis is located proximal to the internal inguinal ring and if the mobilization of the spermatic vessels allows it. A Fowler-Stephens staged orchiopexy is indicated for intra abdominal testicle with short spermatic vessels. In the first stage the spermatic vessels are isolated and divided relying on the compensation offered by the deferential and extrafunicular vessels. After six months, once the testis trophism has been ascertained, the testis can be placed in the scrotum. For varicocelectomy the peritoneum is incised at the projection of the spermatic cord from the internal inguinal ring. A blunt and gentle dissection prepares the spermatic vascular bundle, the spermatic artery is identified and isolated and the vein are clipped and divided.(ABSTRACT TRUNCATED AT 250 WORDS)

Experimental and clinical urinary diversion.

In order to achieve an appropriate technical experience and explore clinical feasibility of laparoscopic urinary diversion, the authors planned a laboratory experiment. In ten male pigs weighing about 25 kilograms cystoprostatectomy was performed. Ureterocutaneostomy or ureterosigmoidostomy were carried out next. For ureterocutaneostomy a channel was bluntly dissected through the abdominal wall. The ureter was grasped by a clamp passed through the stroma, drawn outside and anstomosed to the skin. Operative time was about 30 minutes. For ureterosigmoidostomy a longitudinal incision of approximately 1 cm was made through the wall of the sigmoid colon in order to reach the mucosa. A very small opening in the angle of the incision was made. A suture was placed in the ureteral tip and secured to the colon wall. Finally, the ureter was covered in its bed with antireflux technique. Operative time was about 180 minutes. Laparoscopic ureterocutaneostomy was also successfully applied in a compromised patient to resolve a particular clinical situation.

Bladder laparoscopic surgery.

The advances made in laparoscopic surgery during the last five years have made possible the performance of a variety of bladder level procedures as suspension of the bladder neck, removal of bladder diverticulum and cystectomy. Laparoscopic bladder-neck suspension is purposed by different Authors as a minimally invasive procedure that can be provide efficacious results as like as open surgery, reducing post-operative disconfort. All different laparoscopic technique provide good results at short-term follow-up. A longer follow-up period is required for the evaluation of the effective efficacy of this treatment. In according with other authors, our experience with laparoscopic bladder diverticulectomy demonstrates the feasibility and the potentiality of this technique. Up to now this procedure has been employed in the treatment of diverticula involved in urinary infection or residual urine. At the beginning, laparoscopic cystectomy has been purposed in patients with begin disease; more recently, laparoscopy has been disease; more recently, laparoscopy has been employed for cystectomy in case of bladder cancer. The few cases described demonstrate that the technique is feasible but, until now, laparoscopic cystectomy has been reported just in female patients.

Urological laparoscopy: our preliminary results.

From the beginning of urological applications of laparoscopy, this technique has found many clinical indications. In our center, after an experimental training in animals, we performed 48 operations using laparoscopy: 18 pelvic lymphadenectomies (15 for prostate cancer, 2 for bladder tumor and 1 for penis carcinoma), 11 ligatures of the spermatic vein (3 bilateral), 4 orchidopexies, 10 excisions of renal cysts, 4 nephrectomies and 1 adrenalectomy. For cryptorchidism, laparoscopy is a less invasive alternative to surgical exploration; in case of prostate cancer, laparoscopic pelvic node dissection has a lower incidence of complications and requires few days of hospitalisation. The excision of renal cysts by laparoscopy, in case of large symptomatic pathology, is an efficacious operation with low morbidity. In case of nephrectomy for small wrinkled kidneys or severe hydronephrosis, long execution time makes cost/benefit ratio somewhat debatable; adrenalectomy, instead, is easier than nephrectomy and offers many advantages in comparison with traditional surgical approach. All indications will be better evaluated at a later date, with the indispensable learning period and the continuous progress of technical equipment.

[Orchiopexy]. / Orchidopessi.

The Authors illustrate their experience in the treatment of a case of left criptorchidism using laparoscopic technique associated with traditional surgery (Fowler-Stephens technique) without important complications during and after the procedure. The non palpable testis was located in the peritoneal cavity. The first step consists in a laparoscopic clip ligation of the spermatic vessels with the intent of improve the vasal collateral blood flow. After a 6 months interval, the patient underwent laparoscopic orchidopexy.

[Laparoscopic nephrectomy]. / Nefrectomia laparoscopica.

Laparoscopic nephrectomy is a new procedure in which the entire kidney is removed introducing it in an Endopouch and, after morcellation pulled out through a 12 mm port. After an initial experimental experience, in our Institute we have performed one laparoscopic nephrectomy for left pyelonephritic kidney and ureteral reflux. The operation required the positioning of 5 trocars and 4 hours for its execution. The discharge of the patient was possible four days after.