Pattern of Recurrence After Stereotactic Radiotherapy in Prostate Cancer Patients With Nodal Pelvic Relapse. A Multi-Institutional Retrospective Analysis.

AIMS: Currently, when nodal pelvic oligorecurrent disease is detected, no standard treatment option is recommended. One possible salvage option is nodal stereotactic body radiotherapy (SBRT). Here we analysed recurrence patterns after nodal SBRT in patients affected by pelvic oligometastatic relapse after radical prostatectomy, and androgen deprivation therapy (ADT)-free survival in this population. MATERIALS AND METHODS: Data on 93 patients consecutively treated in five different institutions for pelvic oligorecurrent disease were reviewed. Inclusion criteria were biochemical recurrence after radical prostatectomy and imaging showing three or fewer metachronous lymphoadenopathies under aortic bifurcation. Patients underwent SBRT on all sites of disease. Concomitant ADT was allowed. RESULTS: After a median follow-up of 20 months (interquartile range 11-41), 57 patients had post-SBRT radiological evidence of relapse, for a median disease-free survival (DFS) of 15 months (95% confidence interval 9-24). Concomitant ADT was administered in 20 patients (21.5%). Overall, eight (8.6%), 21 (22.6%) and 28 (30.1%) patients had prostate bed only, pelvic nodal or distant relapse, respectively. The median ADT-free survival was not reached. Concomitant ADT, International Society for Urologic Pathology pattern at diagnosis < or ≥3, time to relapse ≤ or >12 months, prostate-specific antigen at recurrence < or ≥1.10 ng/ml and prostate-specific membrane antigen staging were not significantly associated with DFS. After relapse, 42 patients (45.2%) received a second SBRT course. CONCLUSION: Nodal SBRT yielded encouraging DFS and ADT-free survival in this population. Only a minority of patients developed prostate bed recurrence, suggesting that local treatment may be safely avoided. A consistent percentage of patients could be managed with a second SBRT course.

Eosinophilic esophagitis: an Italian experience.

BACKGROUND: Eosinophilic esophagitis is an esophageal disorder characterized by esophageal and/or upper gastrointestinal tract symptoms, and by dense esophageal eosinophilia associated with a normal gastric and duodenal mucosa. Prevalently reported in children, eosinophilic esophagitis has recently been reported with increased frequency also in adults. AIMS: The purpose of this study was to report our experience with eosinophilic esophagitis in Italy, since there are only very few series of such patients in our country. PATIENTS AND METHODS: We retrospectively reviewed the histological data of consecutive patients with a diagnosis of esophagitis or reflux disease in the period September 2004-September 2008. Eosinophils were counted where they appeared most numerous in the biopsy, with a cutoff > 15 eosinophils in more than one high-power field as diagnostic of eosinophilic esophagitis. Patients were excluded if gastric or duodenal biopsies showed a prominent eosinophilic infiltrate. RESULTS: Twenty two patients (14 adults, 8 children, age range 2-59 years) were identified according to the above criteria. The average eosinophil count was 86/ high-power field (range 31-150), associated with other pathologic features (eosinophilic microabscesses eosinophil degranulation, basal zone hyperplasia, papillary elongation). The main clinical complaints were dysphagia, food impaction, and heartburn, and endoscopic findings consisted of mucosal thickening and inelasticity, longitudinal shearing, rings, and white specks, without difference between adults and children for both clinical and endoscopic variables. CONCLUSIONS: Eosinophilic esophagitis is not rare in Italy, and displays clinical, endoscopic, and pathologic features similar to those described in other countries.

Eosinophilic esophagitis: an Italian experience

Background: eosinophilic esophagitis is an esophageal disorder characterized by esophageal and/or upper gastrointestinal tract symptoms, and by dense esophageal eosinophilia associated with a normal gastric and duodenal mucosa. Prevalently reported in children, eosinophilic esophagitis has recently been reported with increased frequency also in adults. Aims: the purpose of this study was to report our experience with eosinophilic esophagitis in Italy, since there are only very few series of such patients in our country. Patients and methods: we retrospectively reviewed the histological data of consecutive patients with a diagnosis of esophagitis or reflux disease in the period September 2004-September 2008. Eosinophils were counted where they appeared most numerous in the biopsy, with a cutoff > 15 eosinophils in more than one high-power field as diagnostic of eosinophilic esophagitis. Patients were excluded if gastric or duodenal biopsies showed a prominent eosinophilic infiltrate. Results: twenty two patients (14 adults, 8 children, age range 2-59 years) were identified according to the above criteria. The average eosinophil count was 86/ high-power field (range 31- 150), associated with other pathologic features (eosinophilic microabscesses eosinophil degranulation, basal zone hyperplasia, papillary elongation). The main clinical complaints were dysphagia, food impaction, and heartburn, and endoscopic findings consisted of mucosal thickening and inelasticity, longitudinal shearing, rings, and white specks, without difference between adults and children for both clinical and endoscopic variables. Conclusions: eosinophilic esophagitis is not rare in Italy, and displays clinical, endoscopic, and pathologic features similar to those described in other countries(AU)

N-nitrosoproline excretion in the presence and absence of gastric disease.

N-nitrosoproline (NPRO) excretion, an indicator of endogenous nitrosation, was measured in a group of hospital inpatients who were identified by endoscopy and gastric biopsy as either having gastric lesions or having healthy stomachs. NPRO was assayed in background 24-hour urine samples and samples collected after loading doses of nitrate and L-proline. The presence of gastric lesions was associated with altered gastric pH and concomitant changes in gastric juice nitrate and nitrite concentration. Gastric juice pH increased with increasing severity of gastric disease (P = 0.031) and patients with normal stomachs had a lower gastric pH than those with chronic atrophic gastritis (CAG) (3.0 vs. 6.5, P = 0.017). The changes in gastric juice nitrate concentration were in the reverse direction (P = 0.002 for trend) with normal patients having higher mean levels than CAG patients (12.7 vs. 5.5 micrograms/ml, P less than 0.0001). Nitrite concentration increased with severity of gastric disease but the results were not significant (normal, 82.9 vs. CAG, 223.4 ng/ml, P = 0.069). No association was found between the presence of gastric lesions and increased urinary NPRO excretion. Mutagenic activity was not detected in any of the gastric juice samples.

N-nitrosoproline excretion in patients with gastric lesions and in a control population.

N-Nitrosoproline (NPRO) excretion was measured in a group of hospital in-patients who were identified as either bearing gastric lesions or having apparently healthy stomachs. NPRO was assayed in background 24-h urine samples and then in urines collected after loading doses of nitrate and proline. The presence of gastric lesions was associated with altered gastric juice pH and nitrite concentration, but not with NPRO excretion. The significance of NPRO excretion as a marker of endogenous nitrosation is dependent on the interpretation of this result.

[Correlation between HBeAg in the blood and HBcAg in hepatocyte nuclei in hepatitis B]. / Correlazione tra HBeAg nel siero e HBcAg nei nuclei epatocitari nell'infezione da HBV.

The Authors have studied the correlation between serum HBeAg and the presence of hepatitis B "core" and "surface" antigens in liver tissue. The histological pictures of the bioptic specimens of patients affected by HBV were classified as: chronic persisting hepatitis, chronic active hepatitis, cirrhosis and minimal aspecific changes. HBcAg was detected in liver cells nuclei in all the patients resulted positive for serum HBeAg. In some of these subjects HBsAg was found to be localized on the hepatocyte membranes, and this seems to be related in some way to the presence of HBcAg in liver nuclei. No presence of hepatitis B associated antigens was observed in biopsies from subjects who were negative for serum HbsAg.

[Australia antigen and liver diseases. Report on personal cases and review of the literature].

The AA. relate the results of HBsAg and homologous antibody research by count-electrophoresis obtained in 274 patients with several chronic and acute liver-diseases. Moreover, the most important data of literature are discussed trying to relate the different results of the various AA. to the different sensitivity of the detection techniques and to the difficulties of classifying some disease (chronic hepatitis) and also to the factors related to the geographic distribution of Australia antigen. On the basis of this discussion the AA. make some general consideration on the meaning of HBsAg in the liver disease especially in the chronic diseases and in the primary liver cell carcinoma.

[Urinary infections due to Serratia marcescens: clinico-statistical pictures of patients hospitalized in the S. Maria della Scala Hospital in Siena during 1971, 1972, and 1973]. / Infezioni urinarie da "Serratia marcescens": indagine clinico-statistica su soggetti ricoverati nell'ospedale "S. Maria della Scala" di Siena negli anni 1971, 1972 e 1973

The Authors have carried out a clinical-statistical research into cases of urinary tract infection by Serratia marcescens isolated in 42 of 2500 urine-cultures effected during the period 1971-1973 by patients hospitalized in "S. Maria della Scala" Hospital of Siena. The Authors point out the high incidence of isolation of Serratia marcescens in urological patients and show some control measures to prevent the diffusion of such infections in hospital.

[Epidemiological study on the incidence of viral hepatitis in the Province of Siena]. / Indagini epidemiologiche sulla incidenza della virus-epatite in provincia di Siena

The AA. carried out an epidemiological survey on 1,420 cases with viral hepatitis ascertained in the Province of Siena during the period January 1, 1962-December 31,1972. Age, sex, profession, place of origin, annual and seasonal prevalence, therapeutic measures, geographic and social-economic features of several districts, and other characteristics of the affected people were examined. The results obtained were discussed keeping in mind the various parameters examined.