End-to-end urethroplasty: long-term results.

OBJECTIVE: To retrospectively review patients with strictures (<3 cm) of the bulbous urethra who had undergone urethroplasty with excision of the stenotic segment and end-to-end anastomosis. PATIENTS AND METHODS: The review included 74 patients (all men, mean age 39 years, range 18-70) treated between 1989 and 1999 for strictures 5-30 mm long. Forty-one of the patients (55%) had been treated previously, 39 endoscopically (urethrotomy and/or dilatation) and two surgically. Surgical access was perineal, with the patient in an exaggerated lithotomy position; the stenotic segment was excised and the stumps spatulated for end-to-end anastomosis. The mean (range) duration of surgery was 140 (75-280) min. There were no complications during or after surgery, and none related to the duration in the lithotomy position. RESULTS: At a mean follow-up of 60 months, 93% of the patients had no recurrence of the stricture and were therefore considered cured. There were no treatment-related complications. CONCLUSION: End-to-end anastomosis is confirmed as the treatment of choice for short bulbous urethral strictures, giving cure rates close to 100%.

Prostatic malacoplakia associated with prostatic abscess: diagnosis and treatment.

Prostatic malacoplakia associated with prostatic abscess is an extremely rare disease. We present a case of prostatic malacoplakia presenting as a prostatic and seminal vesicle abscess in a patient with diabetes. The diagnosis and management are discussed, and the literature is reviewed.

Maize protein kinase CK2: regulation and functionality of three beta regulatory subunits.

Biochemical and crystallographic data suggest that, in contrast with other organisms, the active maize protein kinase CK2 might be composed simply of a catalytic polypeptide (CK2alpha), thus lacking CK2beta regulatory subunits. To investigate the existence and functionality of CK2beta regulatory subunits in Zea mays, we have screened a maize cDNA library using different approaches and have isolated three full-length cDNAs encoding CK2beta regulatory subunits (CK2beta-1, CK2beta-2 and CK2beta-3) and a cDNA coding for a novel CK2alpha catalytic subunit, CK2alpha-3. The pattern of expression of all these alpha/beta subunits has been studied in different organs and developmental stages using specific probes for each isoform, and indicates that while CK2alpha subunits are constitutive, CK2beta subunits are expressed differentially during embryo development. The yeast two-hybrid system and pull-down assays have been used to study specific interactions between the different subunits. While CK2alpha subunits are unable to self-associate, preferential interactions between alpha/beta isoforms and beta/beta isoforms can be predicted. Furthermore, we show that maize CK2alpha/beta subunits assemble into a structural tetrameric complex which has very similar properties to those described in other organisms, and that expression of maize CK2beta subunits in yeast allows the rescue of the phenotypic defects associated to the lack of CK2 function, thus demonstrating the functionality of maize CK2beta regulatory subunits.

Primary lymphoma of the penis: diagnosis and treatment.

A rare case of primary penile B cell non-Hodgkin's lymphoma is reported. We reported on 75-year-old man with primary penile lymphoma with consideration of the diagnosis and the various therapeutic approaches. We treated this case with local radiotherapy and systemic chemotherapy with good cosmetic and functional results. There was absence of recurrence 42 months after therapy.

Distinctive features of plant protein kinase CK2.

In plants, protein kinase CK2 is involved in different processes that control many aspects of metabolism and development. In mammals and yeast the enzyme is a heterotetramer composed of two types of subunits. During years the subunit composition of the maize protein kinase CK2 enzyme has been a source of controversy. We have recently characterized the maize holoenzyme subunits. Our results show that multiple catalytic and regulatory subunits are expressed in maize and are able to specifically interact with other alpha and beta subunits suggesting a high level of heterogeneity in the typical heterotetrameric structure. Here, we summarize data available on plant CK2 enzymes, in order to clarify the distinctive features and functions of plant protein kinase CK2.

[Retroperitoneal lymphadenectomy and disorders of ejaculation]. / Linfoadenectomia lomboaortica e disturbi dell'eiaculazione.

Retrograde ejaculation is a frequent and permanent complication after bilateral retroperitoneal lymphadenectomy (RPLND). Seminal emission and ejaculation are primarily under sympathetic control. Several studies after RPLND in patients with nonseminomatous testis cancer proved the role of preservation of the efferent fibers originating from the lumbar sympathetic ganglia. Based on the results of anatomical studies, a modified unilateral operative technique and nerve-sparing approach permit to preserve normal anterograde ejaculation without reduction of long-term survival.

Peyronie's disease--incision and dorsal vein grafting combined with contralateral plication in straightening the penis.

OBJECTIVES: To evaluate the effectiveness of incisions of Peyronie's plaque and vein grafting combined with contralateral plication to straightening the penis. PATIENTS AND METHODS: Twenty-four patients with Peyronie's disease were treated surgically with a vein patch grafting technique to correct penile curvature. Median penile deviation was 70 degrees (range 60-90 degrees ), in 1 patient curvature was 30 degrees and all were unable to have normal sexual intercourse. The deep dorsal vein was excised and opened longitudinally. Transverse relaxing incisions about 1-2 cm long were made on the plaques at the point of maximal curvature, then, two other lateral incisions were made on both ends at 3 and 9 o'clock. The endothelial side of the harvested vein was placed in contact with the cavernous tissue to cover the defect created. Application of the contralateral surface of the tunica albuginea was performed in 21 cases to straighten the penis. RESULTS: After a median follow-up of 24 months, 19 patients were able to perform sexual intercourse, 3 patients who required intracavernous injection to maintain erection presented pre-operative adverse factors affecting erectile function. One patient returned to baseline pre-operative curvature. Twelve patients reported penile shortening, although only 5 patients were concerned about it. None of the patients permanently lost sensation in the glans of the penis. Palpable knots on the site of plication were reported in 5 patients. CONCLUSIONS: Plaque incision and placement of a deep dorsal vein patch graft, combined with contralateral corporeal plication, is a relatively simple, safe and effective alternative to correct angulations greater than 60 degrees.

Characterization, subcellular localization and nuclear targeting of casein kinase 2 from Zea mays.

We have isolated and characterized the genomic clone of maize casein kinase 2 (CK2) alpha subunit using the previously described alphaCK2-1 cDNA clone as a probe. The genomic clone is 7.5 kb long and contains 10 exons, separated by 9 introns of different size, two larger than 1.5 kb and the others around 100-150 bp. The sequence of the exons is 100% homologous to the sequence of the alphaCK2-1 cDNA. Southern hybridization of total genomic DNA from maize embryos with aCK2 cDNA indicated that the alphaCK2-1 gene is part of a multigenic family. We also isolated a new embryo cDNA clone coding for an alphaCK2-2 subunit. We studied the regulation of the enzyme in embryos at the mRNA level, at the protein level and by activity testing. By using immunocytochemistry the CK2 protein was localized in several types of cells of mature embryos. Particularly strong signals were visible in the cytoplasm of epidermis and meristematic cells. Decoration of nuclei of root cortex and scutellum cells was also observed suggesting that CK2 can shift from the cytoplasm into nuclei in specific cell types. We examined whether CK2 contained specific protein domains which actively target the protein to the nucleus by using in-frame fusions of the maize CK2alpha subunit to the reporter gene encoding beta-glucuronidase (GUS) which were assayed in transiently transformed onion epidermal cells. Analysis of chimeric constructs identified one region containing a nuclear localization signal (NLS) that is highly conserved in other alphaCK2 proteins.

[The role of echotomography in minor renal traumatology]. / Ruolo della ecotomografia nella traumatologia renale minore.

We examined retrospectively the records of 108 patients with blunt renal trauma to determine the importance of echography as radiological investigations in minor renal trauma. Of patients 62 (66.6%) had a minor renal injuries, 21 (22.5%) had a moderate injuries and 10 (10.7%) had a major renal renal injuries. All patients who had microscopic hematuria without shock or other associated injuries had minor injuries. Echography and excretory urogram (IVP) confirmed the injuries except in 5 cases who presenting with only gross hematuria and the IVP don't confirmed the presence of a subcapsular hematoma identified by echography. Echography was more sensitive and specific than an IVP in minor renal trauma. Radiological investigations are not needed in those with microscopic hematuria and no shock or associated injuries, however we prefer performing ever an echography for medical and legal risk because a microscopic hematuria may include a neoplasm or other lesions.

Traumatic injury of the penis: surgical management.

Three cases of penile injury secondary to mishap during sexual intercourse are described. The injury involved unilateral corpus cavernosum associated with urethral rupture in one case, penile fracture in the second patient and isolated urethral fracture in the third. Diagnosis and treatment of these uncommon lesions are discussed.

[Xanthogranulomatous pyelonephritis: conservative therapy in the para-nephritic stage. Apropos of a case]. / Pielonefrite xantogranulomatosa (PXG): terapia conservativa nello stadio paranefrico. A proposito di un caso.

Xantogranulomatous pyelonephritis is a rare disease, occuring most frequently in middle-aged woman. The patients usually present with recurrent fever, dysuria, renal colic or aspecific findings. We report a case of focal PXG (paranephric stage) treated with conservative surgery. Generally, treatment consists of nephrectomy for diffuse or advanced stage diseases, excision of the diseased renal segment for localized and low/high stage.

[The use of PGE1 in the treatment of erectile deficiency]. / Utilizzo della PGE1 nel trattamento del deficit erettile.

A total of 118 patients entered into a pharmacological erection program using prostaglandin E1 (PGE1) from September 1994 to November 1995. Of the men 20 (16.9%) used PGE1 on a regular basis, median duration of drug use was 4 months with a range of 2 to 14 months, while 66 (55.9%) failed to continue in the program after the dose titration period, (median duration of drug use 6 weeks), 32 (27.1%) failed to initiate PGE1 pharmacological erection program. There have been no instances of cavernous fibrosis, systemic reaction, penile pain after injection or priapism (erection present longer than 4 hours) in any patient; 24 (20.3%) men were unable to achieve an adequate erection with PGE1 intracavernous injections. PGE1 appears to have a lower risk of prolonged erections than other intracavernous agents and will continue to increase in popularity. However we report an interesting number of men who fail to continue (55.9%) or fail to initiate (16.9%) PGE1 therapy.

Selective inactivation of two components of the multiprotein transcription factor TFIIIB in cycloheximide growth-arrested yeast cells.

Following protein synthesis inhibition in cycloheximide growth-arrested yeast cells, the rates of tRNA and 5 S RNA synthesis decrease with apparent half-times of about 20 and 10 min, respectively. This effect is mimicked by extracts of treated cells, and the impairment of tRNA gene transcription activity that is observed in vitro parallels the in vivo inactivation of RNA polymerase III transcription. As revealed by experiments in which partially purified class III transcription factors were singly added to extracts of treated cells, only the activity of the multiprotein transcription factor TFIIIB is severely impaired after 3 h of cycloheximide treatment. Similar assays carried out in an in vitro transcription system in which TFIIIB activity was reconstituted by a combination of the TATA box-binding protein (TBP), the 70-kDa component TFIIIB70, plus a partially purified fraction known as B" have shown that the latter two components are both necessary and sufficient to restore control levels of transcription. Their activity, but not TBP activity, is considerably reduced in extracts of treated cells. TFIIIB70 and a component of fraction B" thus appear to be the selective targets of the down-regulation of polymerase III transcription that is brought about by cycloheximide. A substantial depletion of the TFIIIB70 polypeptide was detected by Western immunoblot analysis of extracts derived from cycloheximide growth-arrested cells, indicating that the inactivation of this TFIIIB component results primarily from its enhanced destabilization under conditions of protein synthesis inhibition.

[Venous leakage impotence: anatomical and physiological considerations upon gravity cavernosometry and radio-fluorographic cavernosography]. / Impotenza da fuga venosa: considerazioni anatomo-fisiologiche sulla farmacocavernosometria gravitaria e la farmacocavernosografia radiofluoro-grafica digitale.

We performed gravity cavernosometry and radio-fluoro-graphic cavernosography with pharmacological intracavernous injection in 15 patients with erectile dysfunction. On the basis of cavernosographyc findings, in the 15 patients leak sites visualized included deep dorsal vein in all 15 patients leak sites visualized included deep dorsal vein in all 15 patients (100%), cavernous veins in 7 (46,6%), glans in 4 (26,6%) and corpus spongiosum in 3 (20%). Aberrant veins documented in 4 patients (26,6%): communicating with the saphenous vein in 2 (13,3%), with scrotal veins and femoral vein in 1 (6,6%). Deep dorsal vein leakage as the only venous site was find in 2 patients (13.3%), 9 (60%) had leakage through 2 venous sites, 3 (20%) had leakage through 3 venous sites and 1 (6,6%) had leakage through 4 venous sites. Correlations among hemodynamic and radiographic observations allowed the identification of 2 types of cavernosometric findings. While type I developed an high intracavernous pressure during gravity infusion, an high intracavernous pressure was not observed in type 2. The FCG by the digital radio-fluoro-graphic digital system permit the possibility of sottraction and rielaboration of images and reduces examination and radiation time. The gravity FCM is simple, not expensive and respect the physiological intracavernous pressure.

[Polyp fibroangioma of the ureter. Endoscopic treatment]. / Fibroangioma peduncolato dell'uretere: trattamento endoscopico.

Fibroangiomatous polyps and its histological variants most often occur in the ureters of young adult. They may be multiple, and rarely occur in the renal pelvis. Microscopically, normal or hyperplastic urothelium cover loose, vascular, edematous, fibrous stroma that may be inflamed. Etiologic factors are unknown. Intermittent flank pain is the most common symptom; dysuria and hematuria occur less frequently. A case of fibroangiomatous polyps of the left ureter, in a 37-years old woman, is presented. We emphasize the endoscopic conservative treatment of this lesion as a valid alternative to the surgical approach; beside, it's important to obtain pre-operative histological finding, confirming the benign lesion.

[Clinical effects of verapamil in the treatment of Peyronie's disease]. / Efficacia clinica del Verapamil nella induratio penis plastica.

Calcium antagonist increase extracellular matrix collagenase activity as well as decrease collagen, fibronectin synthesis and secretion, altering fibroblastic metabolism. Preliminary findings reports that Verapamil improves would healing; Levine (1994) suggest that intralesional calcium antagonist (Verapamil) therapy offers an economical and sensible non operative approach for the treatment of Peyronie's disease. We studied and verified the effect of Verapamil in Peyronie's plaque on 39 men. They received injections of Verapamil bi-weekly in to the plaques for 6 months. Subjectively, improvement in rigidity was observed in 23,1% and a plaque softening observed in 48,7%. Rapid resolution of pain was verified in 90,9%. Objectively, curvature improved in 50% of those in which the diagnosis of Peyronie's disease was less than one year old, but in only 10.2% when disease lasted more than one year. A decreased plaque volume was not observed. There was no toxicity related to Verapamil effect. In this nonrandomized study we retained that Verapamil appears to result in an improvement in patients with symptoms lasting less than one year. For patients without pain with symptoms related to more than one year, Verapamil had no important effect.

[Percutaneous nephrolithotripsy (PCNL). The authors' own experience with 106 patients]. / La nefrolitotrissia percutanea (PCNL). Esperienza personale su 106 pazienti.

The authors report 106 consecutive patients who underwent percutaneous removal or debulking of renal stones from March '88 to June '94. Removal was successful in 64 pts (60%), while 6 patients (5.6%) needed a second-look section and in one case (0.9%) a third-look; in 33 cases (31.3%) PCNL was performed as debulking procedure before ESWL. The major complications were: 1 severe haemorrhage with secondary nephrectomy, 2 respiratory complications, 1 intestinal fistula, 2 hyponatremic syndromes, 1 global kidney functional exclusion and 1 sectorial exclusion. PCNL is an effective technique to treat the majority of single big renal stone or debulking procedure in staghorn calculi before ESWL.

[The role of LH-RH analogue in benign prostatic hyperplasia]. / Uso degli analoghi LH-RH nell'ipertrofia prostatica benigna.

In our study 7 patients considered high risk for any surgical and anesthetic intervention, with benign prostatic hyperplasia, whose 2 with permanent catheter, were treated for 6 months with luteinizing hormone-releasing hormone analogue. The treatment resulted in an average decrease in prostatic volume of 21.7%; reduced the serum PSA/PAP values of 52% and 43%, respectively; 4 pz improved their symptom score (1 pz removed the permanent catheter), 2pz kept stationary and 1 pz made worse. No particular side effects were presented and all patients finished the therapy. We conclude that LH-RH analogue therapy should be restricted to selected patients and then it will have to be continued for a long period of time.

Cisplatin and etoposide (VP-16) as a single regimen for small cell lung cancer. A phase II trial.

Forty-seven consecutive patients with small cell lung cancer (SCLC) were treated with a combination chemotherapy program including 60 mg/m2 of cisplatin (P) on day 1 and 120 mg/m2 of etoposide (E) on day 4, 6, 8, every 21 days. Limited disease (LD) patients, achieving complete response (CR) or partial response (PR) after the three initial courses, received radiotherapy (RT) to the pretreatment primary tumor volume and, those achieving CR, additional RT to the brain. During RT, chemotherapy was administered with 50% dose reduction. Forty-three patients were evaluable for therapeutic response. In the 19 patients with LD, CR was achieved in 63% of patients and the PR rate was 32%. In 24 patients with extensive disease (ED), CR was 34% and PR rate was 54%. Median duration of survival was 66 weeks for LD and 48 weeks for ED. Six patients were disease-free after 2 years. Leucocyte count less than 2000/mm3 was seen in 26% of patients; platelet count less than 50000/mm3 was observed in 9%. Nonhematologic toxicity included universal nausea or vomiting and severe neurotoxicity in 7%. These data indicate that PE combination is a very active front-line regimen in SCLC and could be suggested as one of the reference treatments.