Jehovah's witnesses, blood transfusions and transplantations.

The firm refusal of blood transfusion treatment by Jehovah's Witnesses has always caused some discomfort to physicians. Two fundamental principles contained in the constitution of our own and other democratic countries specifically dictate that human rights are to be respected. No one may be forced to undergo any particular health treatment, save under the provisions of the law. These principles have led doctors and lawyers to address this difficult patient-doctor issue decisively. On the one hand, a vast jurisprudence has been accumulated, which, although not resolving all the questions regarding the issue, has provided valuable guidelines, elaborated to support physicians in their treatment of patients who refuse homologous blood. On the other hand, wide-ranging research has been undertaken to find therapeutic and surgical methods that make it possible to treat patients without recourse to blood transfusions. Paradoxically, the dilemma presented to doctors by Jehovah's Witnesses has led to new knowledge regarding "the good use of blood," the advantages of which have been experienced also by non-Witnesses. In this article, we briefly consider the roots of Jehovah's Witness beliefs and the principles that lie behind their refusal of blood. Furthermore, we consider which treatments may be accepted, and which are invariably refused. Last, we examine the progress of current scientific research into alternative methodologies and the position of Jehovah's Witnesses when a transfusion is not an option, but a necessity.

The management of idiopathic thrombotic microangiopathy. Changing trends.

Thrombotic microangiopathy, including the two related syndromes thrombotic thrombocytopenic purpura and hemolytic-uremic syndrome, is a rare and severe multisystem disorder, due to widespread deposition of intravascular microthrombi consisting mainly of platelets, with subsequent consumption thrombocytopenia, microangiopathic hemolytic anemia, renal abnormalities, and neurologic disturbances. The epidemic, verotoxin-induced hemolytic-uremic syndrome, typically associated with prodromal diarrhea, mainly affects young children in small outbreaks. By contrast, idiopathic thrombotic microangiopathy generally affects adults in a sporadic form; it has a more devastating course and a less favourable outcome. Over 90% of the reported cases in the adult, when untreated, have progressed to death within three months of diagnosis. Since the introduction of plasma exchange, a dramatic change in the prognosis of the disease has taken place, although the mortality rate still remains considerable. Indeed, improved survival is the most striking feature of adult thrombotic microangiopathy compared to some decades ago. In the present article we will focus on the evolving concepts able to exert a considerable impact in the management of the adult idiopathic form of thrombotic microangiopathy.

[Tridimensional ultrasonography in andrology]. / L'ecografia tridimensionale in andrologia.

Three-dimensional ultrasound has already been employed to improve detection and characterization of the masses in various organs. The system can also be expected to improve qualitative evaluation of vessel pathology. Three-dimensional ultrasound could offer an additional contribution even in Andrology, in at least three fields: in the best evaluation of the anatomical structures; in most accurate measurement of the volumes of the organs; in the study of the Peyronie's disease, for the availability of the coronal plain.

External jugular vein hemangioma occurring as a lateral neck mass.

Hemangioma is an extremely frequent tumor, accounting for 7% of all benign neoplasms. In contrast, hemangioma arising in blood vessels is rare and should be differentiated from other neoplasms of vascular origin, such as hemangioendothelioma, hemangiopericytoma, hemangiosarcoma, and leiomyosarcoma. The case we report has the peculiarity of occurring as a lateral neck mass in which color-coded duplex sonography contributed significantly to diagnosis.

Comparison between plasma concentrations of testosterone, nitric oxide and endothelin 1-2 in penile and brachial venous blood: preliminary results in men with psychogenic impotence.

In the present study venous plasma concentrations of testosterone (T), nitric oxide (NO) and endothelin 1-2 (ET1-2) in the flaccid penis and brachial blood were measured in men with psychogenic impotence. T and NO were significantly lower in the penile venous blood, while ET1-2 showed no statistical difference. These data support the hypothesis of testosterone dependence of penile nitric oxide synthesis (NOS).

Cavernous arterial and arteriolar circulation in patients with erectile dysfunction: a power Doppler study.

PURPOSE: We assessed the morphodynamic features of cavernous arteries and helicine arterioles by power Doppler sonography in vasculogenic and nonvasculogenic impotent men. MATERIALS AND METHODS: A total of 40 impotent patients with and without definite vascular risk factors were studied by penile power Doppler sonography. The test was performed during penile flaccidity, after intracavernous injection of 20 mcg. alprostadil and after subsequent genital and audiovisual sexual stimulation. A second injection and stimulation were given if the erectile response observed after the initial injection was less than the maximum erection seen during sexual activity. Morphodynamic parameters evaluated by power Doppler imaging included vessel course, shape, wall thickness and pulsatility, peak systolic velocity, end diastolic velocity, acceleration time and resistance index. RESULTS: In the nonvasculogenic group all patients who achieved rigid erection showed normal cavernosal artery and helicine arteriole inflow. In these cases the arteriolar picture was characterized by the presence of 3 orders of distal ramifications originating from the cavernous arteries with an acute angle, systolic diastolic flow during penile tumescence and systolic flow alone at full rigidity. In the vasculogenic group patients with normal cavernous artery inflow showed an arteriolar tree that was pathological in 50% and was characterized by a reduced number of ramifications originating perpendicularly from the cavernous arteries and irregular caliber (arteriolar impotence). In the same group patients with reduced cavernous artery inflow also showed normal or pathological arteriolar components (pre-penile arterial impotence and diffused penile arterial impotence). CONCLUSIONS: Power Doppler sonography allows a precise study of the morphodynamics of the cavernous arteries and helicine arterioles. Our preliminary data suggest that the intracavernous arteriolar component may have a significant role in the genesis of some forms of vasculogenic impotence.