Synthesis, characterization and electrochemical properties of 5-aza[5]helicene-CH2O-CO-MWCNTs nanocomposite.

In this study, we report the preparation of a novel nanocomposite, 5-aza[5]helicene-CH2O-CO-MWCNTs, obtained by grafting the 5-aza[5]helicene moiety on the surface of multi-walled carbon nanotubes (MWCNTs). Thermogravimetry (TGA), Fourier transform-infrared spectroscopy (FTIR), ultraviolet (UV), and photoluminescence (PL) measurements provided evidence that the organic moiety is covalently grafted to the MWCNTs. The 5-aza[5]helicene-CH2O-CO-MWCNTs nanocomposite was utilized to fabricate modified commercial screen-printed carbon electrodes. Its electrochemical behavior was studied in neutral buffer solution in the presence of ferricyanide and hydroquinone (HQ). Finally, the electrochemical sensing of epinephrine in the presence of ascorbic acid by using the linear sweep voltammetry (LSV) technique was investigated. Results have demonstrated the enhanced electrocatalytic activity and excellent ability of the 5-aza[5]helicene-CH2O-CO-MWCNTs-modified electrode in the separation between the anodic peaks of epinephrine (EP) and ascorbic acid (AA), even in the presence of a high amount of AA, with a detection limit (S/N = 3) of 5 µmol l-1.

Epidemiology and risk factors in urolithiasis.

Stone formation in the urinary tract affects about 5-10% of the population in industrialized countries, although it is very rare in other countries such as Greenland or Japan. The high incidence and recurrence rate contribute to making the urolithiasis a serious social problem. Nowadays, urolithiasis must be considered a 'disease in evolution' for several reasons, such as epidemiological changes, evolution of the methods used for diagnosis, and the treatment and prophylaxis of the population considered 'at risk' of stone disease. Some features of stone disease have changed over the last few years due to many social, economical and cultural factors that are described here. The increased prevalence of small urinary calculi has brought about a change in clinical symptoms, with frequent episodes of renal-ureteral colic, persistent pain and hydronephrosis. Similarly, the presence of residual fragments after extracorporeal shock wave lithotripsy has induced a radical change in the management of small calculi through the use of mini-invasive surgical techniques.

Metastatic tumor of the spermatic cord from a primary silent colorectal adenocarcinoma.

Tumors of the spermatic cord are indeed rare and 91% are of mesenchymal origin. Nearly all epithelial tumors are metastases with the primary tumor located in the gastrointestinal tract, prostate, kidney. In 9.5% of cases, initial symptoms are localized to the metastatic site prior to the discovery of the primary tumor. When a diagnosis of epithelial malignant tumor of the spermatic cord is made an investigation for the primary site must be performed. We report a case of metastatic tumor of the right spermatic cord occurring as first clinical manifestation of a silent adenocarcinoma of the sigmoid colon.

Dumbbell stone of prostatic fossa after prostatectomy. A combined ESWL and suprapubic percutaneous treatment.

We report our experience with a combined treatment of extracorporeal shock wave lithotripsy and percutaneous suprapubic lithotripsy for a dumbbell-shaped stone of prostatic fossa associated with multiple bladder calculi, in the same operative session. Because of the successful result, we believe the association of the two treatments for this complex calculus to be an easy, effective and minimally invasive method. ESWL should be considered for the primary management of these rare calculi, suprapubic percutaneous endoscopy can be helpful in rapid and complete removal of fragments.

Myelolipoma of the adrenal gland presenting with dyspepsia and epigastric pain.

Myelolipomas are rare benign neoplasms of the adrenal glands, characterized by the presence of adipose tissue and elements of bone marrow in various degrees of differentiation. Usually asymptomatic, they are discovered incidentally or at autopsy; sometimes larger masses may cause local symptoms. We report clinical, radiologic and therapeutic aspects of a large myelolipoma of the right adrenal gland, presenting with unusual epigastric symptoms.

[Role of endovesical echography in the assessment of bladder neoplasms]. / Ruolo dell'ecografia endovescicale nell'inquadramento delle neoplasie vescicali.

The correct assessment of T (depth of infiltration of bladder wall by cancer) is relevant to plan therapy. In fact, besides staging the local lesion, this can predict pelvic and lumboaortic lymphnode involvement (N parameter) statistically. At the INRCA Hospital in Florence, from January 1987 to December 1989, transurethral US was performed on 66 patients affected with bladder carcinomas, in order to assess the value of this diagnostic method; in all patients pathologic staging on surgical specimens from TUR (63 cases) and cystectomy (3 cases) was performed. Follow-up lasted 24 months at least. When comparing US staging (according to Holm classification) to postoperative histopathologic findings, our results showed that US tends to overstage the lesions, while no understaged tumors were seen in our series. Diagnostic accuracy was 70%. It must be pointed out that TRUS demonstrated hidden submucosal tumors in two patients previously treated with intravesical chemotherapy. Retrospectively, we were able to detect causes of error in cancer staging in some cases--i.e., large carcinomas, calcifications on tumors, radiotherapy scars, bladder wall inflammation due to intravesical BCG therapy. Moreover, some lesions which appeared to have been overstaged with TRUS and which had been treated according to histopathologic findings from TUR exhibited recurrence or disease progression. This was probably due to incomplete TUR and to the presence of residual tumor in the bladder wall.

[The "in situ" treatment of ureteral calculi with extracorporeal lithotripsy]. / Trattamento "in situ" della calcolosi ureterale con litotripsia extracorporea.

The authors report on 80 cases of ureteral calculi treated with in situ extracorporeal shock wave (ESWL), with no retrograde or antegrade maneuvers. Success rate was high (97.5%). Forty-two calculi were located in the proximal ureter above the sacroiliac joint; 10 were in the pre-sacral ureter, and 28 in the pelvic ureter, below the inferior border of the sacroiliac joint. After ESWL, double-J stents were positioned in 5 patients and nephrostomy was performed in 4 cases with positioning of 7-F pig-tail catheters; 8 patients (10%) underwent additional post-lithotripsy urologic and radiologic examinations. Lithotripsy having failed in 2 patients (2.5%), surgery with ureterolithotomy was performed. In situ ESWL of ureteral calculi emerges from this trial as the treatment of choice and not as an alternative to urologic maneuvers or open surgery with ureterolithotomy: the latter methods are necessary only after ESWL failure.

[A new adjuvant therapy modality in the treatment of superficial bladder carcinoma. Study of feasibility of postoperative radiotherapy "flash"]. / Una nuova modalità di terapia adiuvante nel trattamento dei carcinomi vescicali superficiali. Studio di fattibilità del "flash" radioterapico postoperatorio.

The Authors present the preliminary results of a feasibility study on the use of adjuvant radiotherapy (6 Gy single fraction, postoperatively, "flash") as a new treatment modality for superficial bladder cancer (Ta-T1, N0, M0, previously relapsed or not, G I-III). The rationale for this study derives mainly from the favourable results obtained with external beam radiotherapy, when applied before interstitial radiotherapy as a method to avoid scar relapses. Data regarding 55 cases treated with the "flash" are compared retrospectively with those regarding more than 100 cases treated with different types of "conventional" adjuvant therapy at the INRCA Center of Urology, during the last 3-4 years. The Authors stress the need for a prospective, randomized study of selected cases, to clarify if an adjuvant therapeutic modality is superior to the others. The radiotherapeutic option ("flash"), however, clearly produces less iatrogenic damage than the others, and is simpler and cheaper.

[Percutaneous nephrolithotomy of renal staghorn calculi. Experience with monotherapy treatment]. / Nefrolitotomia percutanea della calcolosi a stampo renale. Esperienza di trattamento monoterapia.

Seventy patients with renal staghorn calculi were treated with percutaneous nephrolithotripsy monotherapy. Nine patients (13%) required more than one nephrostomy to remove the stone: an overall success rate was obtained in 67% of the cases, with 27% of residual asymptomatic fragments. Open surgery was necessary in 4 patients for complications. No nephrectomies were carried out. Comparing complete and partial, better results as expected, were obtained in partial staghorn calculi. Evaluating results stratified per number of treatments, we obtained a stone-free rate of 35% with only one treatment, and 61% with two percutaneous sessions, at the discharge from the hospital. To date, initial percutaneous debulking of the stone followed by ESWL treatment on residual stones, seems to be the most suitable approach to branched calculi. However, in selected cases, PCNL treatment alone, can obtain removal of the stone in a significant percentage of cases, with minimal morbility, and, what's more, at the discharge from the hospital, without any ancillary procedure or rehospitalization.

[Percutaneous treatment of calculi in the horseshoe kidney]. / Trattamento percutaneo della calcolosi nel rene a ferro di cavallo.

Horseshoe kidney and renal anomalies are not a contraindication for endourological procedures. In horseshoe kidney, anatomical features and impaired drainage of urine, make stone treatment by ESWL technically difficult and fragments output unsuccessfully. By PNL, via a middle or upper calix posterior approach, is possible to remove the stone without serious complications. Technical modifications of traditional percutaneous approach are required to deal with these cases. A careful preoperative study of caliceal and pelvic anatomy by retrograde pyelography with films taken in lateral and oblique position is needed to plan the correct approach to the stone. However, a skilled use of endourological procedures and techniques are required. Authors present our experience on two cases successfully treated.

Immunotherapy of bladder cancer with intralesional injection with BCG.

Immunotherapy of bladder cancer with non specific immunostimulants, such as bacillus Calmette Guerin (BCG), has been shown to significantly reduce tumor recurrences, and, when applied through intravesical BCG instillation to induce the regression of some established tumors, including carcinomas "in situ" and even some invasive tumors. Since in other tumors, namely melanomas, BCG has been proved to be most successful when infected directly into the tumor, intralesional therapy with BCG (1.5 x 10 BCG weekly for four weeks) has been applied in 20 patients affected by bladder cancer (T1 - T2). The local reaction has induced substantial reduction of the tumor mass and, in some cases, (four) total disappearance of the tumor. On the sixteen patients without total disappearance of the tumor, TUR was applied. The successive follow-up of these patients offer at present the following figures: 3 out of the four patients with remission after BCG alone are disease-free after 26-30 months, whereas one has developed after 18 months a papilloma surgically removed; 15 out of the sixteen patients treated with BCG followed by TUR are disease-free after 26-30 months. These data, compared with literature findings, support the idea that intratumoral BCG instillation of bladder cancer permits a longer disease-free period than other therapeutical approaches.

Circadian rhythm in prostatic acid phosphatase (PAP): a potential tumor marker rhythm in prostatic cancer (PCa).

In order to define circadian states for an earlier diagnosis and for optimal response to treatment, the possibility of a circadian rhythm in serum PAP was investigated in subjects with and without prostatic cancer. Two groups of subjects were investigated: a. 12 patients affected by PCa, further subdivided in two subgroups: 1. without metastasis (6 patients) and 2. with metastatic disease (6 patients); b. 9 age-matched healthy control subjects. Controls and PCa patients were synchronized before starting the study with standardized meal times and nocturnal rest (22(00) to 06(00) ). Venous blood samples were drawn at prearranged hours (00(00), 04(00), 08(00), 12(00), 16(00), 20(00) ) for 24 consecutive hours. Each serum sample was assayed for PAP. Data on each group and subgroup were evaluated by conventional statistical analysis and by 'single' and 'population mean cosinor' to define rhythm parameters. PCa patients, as a single group, did not show a significant circadian PAP rhythm. A statistically significant circadian PAP rhythm was however detected in the subgroup without metastasis, on the contrary no rhythm was detected in the subgroup with metastatic disease. The potential of these rhythms as marker of cancer is noted.

Prolactin and prostate: a chronobiologic study.

A possible role of prolactin in prostatic disease has been claimed, but the results are so far misleading. Among the several factors that influence serum prolactin levels, temporal variations, notably circadian, are prominent. This paper shows an impairment in serum prolactin, chronobiologically investigated, in 12 patients with benign prostatic hypertrophy and in 7 patients with prostatic carcinoma. However, a single serum sample cannot be sufficient and may sometimes be misleading if not plotted with an adequate temporal reference standard (chronodesm).