Ultrafine particles and black carbon personal exposures in asthmatic and non-asthmatic children at school age.

Traffic-related air pollution (TRAP) exposure during childhood is associated with asthma; however, the contribution of the different TRAP pollutants in each microenvironment (home, school, transportation, others) in asthmatic and non-asthmatic children is unknown. Daily (24-h) personal black carbon (BC), ultrafine particle (UFP), and alveolar lung-deposited surface area (LDSA) individual exposure measurements were obtained from 100 children (29 past and 21 current asthmatics, 50 non-asthmatics) aged 9±0.7 years from the INMA-Sabadell cohort (Catalonia, Spain). Time spent in each microenvironment was derived by the geolocation provided by the smartphone and a new spatiotemporal map-matching algorithm. Asthmatics and non-asthmatics spent the same amount of time at home (60% and 61%, respectively), at school (20% and 23%), on transportation (8% and 7%), and in other microenvironments (7% and 5%). The highest concentrations of all TRAPs were attributed to transportation. No differences in TRAP concentrations were found overall or by type of microenvironment between asthmatics and non-asthmatics, nor when considering past and current asthmatics, separately. In conclusion, asthmatic and non-asthmatic children had a similar time-activity pattern and similar average exposures to BC, UFP, and LDSA concentrations. This suggests that interventions should be tailored to general population, rather than to subgroups defined by disease.

Does the adjunct of ecographic contrast medium Levovist improve the detection rate of prostate cancer?

OBJECTIVES: To evaluate whether the adjunct of an ultrasound contrast medium improves the detection rate of prostate cancer. METHOD: In 34 patients, scheduled to undergo a trans-perineal extended prostate biopsy, we carried out a color-Doppler ultrasound (CDU) of the prostate before and after i.v. injection of Levovist, an ultrasound contrast medium. Further bioptic samples were taken in the areas where a marked increase in vascularization was noticed. RESULTS: The overall diagnostic sensitivity, specificity and efficiency were respectively 72.7, 56.2 and 62.9% for transrectal ultrasound (TRUS); 80, 56.2 and 65.3% for CDU and 88.8, 54.5 and 68% for CDU after Levovist injection; 66.5, 72.6 and 65.1% for digito-rectal examination (DRE); 100, 51.4 and 65.4% for total PSA; and 100, 88.8 and 94.3% for PSA free/total. In the 16 patients with prostate carcinoma, the sensitivity of CDU after Levovist was 92.3, 66% for both DRE and TRUS, and 80% for DRE plus TRUS. CONCLUSIONS: Considering the cost and the results obtained (high sensitivity and low specificity), a routine use of Levovist does not seem indicated in patients undergoing prostatic biopsy. An exception may be represented by patients with both negative DRE and TRUS.

[Male cervico-urethral obstruction of organic cause: transrectal prostatic ultrasonography versus permicturition and urethral ultrasonography]. / Ostruzione cervico-uretrale maschile da causa organica: ecografia prostatica transrettale versus eco perminzionale ed uretrale.

AIM: This paper reports personal experience relating to the use of "static" and "permicturition" prostatic transrectal ultrasonography and urethral ultrasonography in the imaging diagnosis of obstructed patients. METHODS: Between January 1996 and January 1998 we selected 96 consecutive patients aged between 25 and 73 years old (mean 54 years) with symptoms of obstructive dysuria with pathological uroflowmetry and pressure/flow rates (Qmax ranging between 5-12 ml/sec and URA between 34-81). Eighteen of the patients selected had previously undergone prostate surgery for benign pathologies. All patients underwent a standard and permicturition transrectal ultrasonography and urethral ultrasonography using a retrograde approach. The results were compared with those obtained by retrograde urethrocystography and urethrocystoscopy, regarded as the "gold standard" for the diagnosis of urethral obstruction. RESULTS: Sixty-three (65.5%) patients were able to execute the permicturition phase, but only 54 (56.2%) reported that the test was indicative of "real urination", whereas retrograde urethral ultrasonography was well tolerated in all cases and easy to accomplish. In 19 (20%) patients (6 of whom had undergone prostate surgery and 13 were suffering from urethral stenosis), "major" organic alterations responsible for urethral obstruction were observed with the combined use of these ultrasonographic methods. These were not evident using static transrectal ultrasonography and increased the diagnostic sensitivity from 80 to 98%. CONCLUSIONS: We feel that an increasingly complete ultrasonographic study of the lower urinary tract is necessary, above all in obstructed patients. This can be achieved using permicturition and urethral transrectal ultrasonography, ensuring an accurate diagnosis and optimising health expenditure.

[Recurrent thrombosis of the venous supply of the upper extremity]. / Trombosi ricorrente del distretto venoso dell'arto superiore.

The incidence of DVT in axillo-subclavian district is rather low. Up-to-date reports show however it is progressively increasing, owing to the widespread diffusion of intravenous prosthetic devices. While the opportunities of a correct diagnosis are becoming various, particularly because of the development of echo color-Doppler and imaging techniques, there is indecision for the treatment: the question is about a medical and a surgical therapy. Neither the former nor the latter are well established. This case report is about a 61-year-old woman affected by a recurrent DVT of the subclavian and axillary veins, who never underwent operation and/or handling of the venous district. Clinical tests didn't show any well determinate cause of thrombosis. It was decided not to treat the patient surgically, so a medical therapy was undertaken. Now she is completely recovered.

[Screening for prostatic carcinoma in dysuric patients: diagnostic protocols and cost-benefit analysis]. / Screening del carcinoma prostatico in pazienti disurici: protocolli diagnostici e rapporto costi/benefici.

This work deals with our experience of a programme of early diagnosis of prostate cancer carried out on patients suffering from dysuria through rectal-digital examination (EDR), hematic dosage of PSA (IRMA COAT-A-COUNT DPC) and transrectal echtomography. We have also quantified the costs and verified which methods, either single or combined with other methods, are most advantageous as regards costs/benefits. From Jan 1991 to Jan 1995 306 of 1185 patients (25.8%) underwent prostate biopsy by means of transperineal echograph with gauge 18 needles as in Hodge's technique. Histologic examination revealed prostate adenocarcinoma in 81 (26.5%) cases, benign prostate hypertrophy in 196 (64%), acute and/or chronic phlogosis in 26 (8.5%) and granulomatosic prostatitis in 3 (1%). The diagnostic sensitivity, preciseness and accuracy were, respectively, 92.5%, 78.3%, 79.3% for the EDR, 80.2%, 93.3% and 90% for PSA with cut-off 10 ng/ml, 91% 78.3%, and 90% for the PSA with cut-off 4 ng/ml, 100%, 30.3% and 48.6% for the echograph, 98.8%, 60% and 77% for EDR+PSA (cut-off 4 ng/ml), 98.8%, 65.8 and 79.9% for EDR+PSA (cut-off 10 ng/ml), 100%, 22% and 64.2% for EDR+echograph, 100%, 20% and 62.9% for echograph+PSA (cut-off 4 ng/ml), 100%, 26.6% and 64.9% for echograph+PSA (cut-off 10 ng/ml). We calculated that a programme of early diagnosis using the three methods, if completely at the patient's expense, would cost 207.000-437.000 lire (average 322.000) per patient for a total of 245,295,000-517,845,000 (average 381,570,000). An eco-guided prostate biopsy with a histologic examination would cost 250.000-500.000 lire (average 375.000) per patient with a total cost for 306 patients of 76,500,000-153,000,000 (average 114,750,000). We also quantified, in the light of the results reported here, the number of biopsied which would have been necessary if we had used only two methods in the screening and we also estimated the costs. The results reveal that the echograph is not to be considered as a first approach method as it gives a high number of false positive results; in fact if we had excluded it from the screening we would not have ignored any diagnosis of prostate neoplasia and we would have avoided about 141 (46.2%) biopsied with a reduction in health expenditure of 62.1%. On the contrary the EDR and the PSA have a better cost/benefit result: setting the cut-off of the PSA at 4 ng/ml or at 10 ng/ml without varying the diagnostic accuracy, the sensitivity and/or specificity of the method increase respectively. To conclude, we consider the EDR and the serum dosage of PSA necessary and adequate methods in the programme of early diagnosis and screening of prostate neoplasy. The prostate echography should be reserved for cases of doubt (hematic PSA between 4-10 ng/ml etc.) and for the exclusion of needle biopsy. These measures also result in an optimization of health expenditure.

[Stress urinary incontinence in women. Our experience with 218 cases]. / Incontinenza urinaria da sforzo nella donna. Nostra esperienza in 218 casi.

From November 1992 to March 1994, in the Gynaecological ward of the Obstetrical and Gynaecological section of Cannizzaro Hospital, 218 patients suffering from urinary stress incontinence (U.S.I.) were observed. Using computerized clinical cards, U.S.I. was found in the 71.79% cases. From the clinical evaluation 38.39% of patients were found to be suffering from 1st degree bladder prolapse, 34.82% from 2nd degree bladder prolapse and 16.97% from, 3rd degree. 9.82% of the patients did not manifest signs of bladder prolapse. Therapy was mainly surgical. Burch colposuspension was carried out on 65 patients. When necessary a total hysterectomy and perineal plastic surgery was carried out. A Perrin-Leger bladder neck suspension was carried out on 10 patients and a Pereyra-Raz on 5. Given the varied aspects of U.S.I., the Authors would conclude that the best results are obtained by combining medical, surgical and rehabilitative treatment.

[Volocimetric evaluation of spermatic vessels with echo color doppler in patients with idiopathic varicocele]. / Valutazione velocimetrica delle arterie spermatiche mediante eco color-Doppler in pazienti affetti da varicocele idiopatico.

BACKGROUND AND AIMS: There is a high incidence of varicocele or dilatation of the spermatic vessels associated with reflux in the male population varying, according to statistics, from 4.5 to 30.7%. Among the numerous hypotheses put forward to explain infertility in approximately 50% of patients with varicocele, it has recently been shown that there is an increased concentration of noradrenalin in the spermatic vessel which might be responsible for chronic arterial vasoconstriction affecting the gonads, leading to endothelial hyperplasia and consequent infertility. MATERIALS AND METHODS: In this study the authors have evaluated the bilateral flow of spermatic arteries at the level of the scrotum in patients with varicocele and in the healthy (varicocele-free) population with normal and hypospermatogenesis. RESULTS: In all groups and in the absence of other major pathologies (including arterial hypertension), no significant differences were found in systolic peak velocity (SPV) in relation to the presence or otherwise of varicocele and the degree of reflux. Mean SPV ranged between 3.5 and 4 cm/sec in patients with hypo- and/or normal zoospermia both in the varicocele and healthy population. CONCLUSIONS: In line with other authors, we feel that despite the lack of substantial differences in arterial flow in the patients examined, it is not possible at present to explore the testicular microcirculation and possible hypoperfusion using eco color-Doppler, in spite of the fact that the method shows a high level of diagnostic accuracy in the diagnosis of phlogistic pathologies and/or twisting of the spermatic cord. New approaches might be provided through the improved study of the microcirculation using power Doppler which appears to be more sensitive than eco color-Doppler in visualizing small intraparenchymal vessels.

[Ultrasound in the study of gynecologic neoplasms]. / Gli ultrasuoni nello studio delle neoplasie ginecologiche.

The authors discuss the state-of-the-art of ultrasound diagnosis for pelvic swellings, with special reference to uterine and ovarian cancer. They review the applications of Eco colour Doppler in gynecological oncology and discuss the protocols for the prevention and/or early diagnosis of gynecological tumours.

[Esophageal diverticulum. A case report]. / Diverticolo dell'esofago. Descrizione di in caso.

The authors report a case of epibronchial esophageal diverticula. The patient underwent a diverticulectomy and subdiverticular myotomy was associated. No significant complications were observed in the post-operative period. In the light of the literature the paper discusses anatomic-clinical, diagnostic and therapeutic aspects of esophageal diverticula.

[PSA and prostatic adenocarcinoma. Experience with 805 patients]. / PSA ed adenocarcinoma prostatico.

Over the last decade PSA has been widely acknowledged to be a very sensitive and specific marker of prostatic tumour pathologies. This paper reports the authors' experience relating to the use of PSA in the early diagnosis of prostatic heteroplasia on the basis of results obtained in a study performed in 805 dysuric patients who underwent rectal exploration and CAT. Echo-guided prostate biopsy according to Hodge was performed in 212 (26.4%) out of 805 patients and adenocarcinoma was found in 55 cases (25.9%). PSA ranged between 10-198 ng/ml in 42 out of 212 patients, between 4-10 ng/ml in 60, and was below 4 ng/ml in 110. In addition, PSAd was assayed in all patients with PSA < 10 mg/ml. Having established the cutoff of PSA at 10 ng/ml, it was found that some heteroplasia, above all at the initial sage, presented normal PSA blood values. In fact, in 8 cases, equivalent to 14.5% of the neoplasias diagnosed, values were under 4 ng/ml, and in 5 cases, equivalent to 9%, they ranged between 4-10 ng/ml. This finding showed that the threshold value of 10 ng/ml gives PSA a high specificity, but a lower sensitivity in the early diagnosis of prostatic adenocarcinoma. Moreover, the analysis of PSA-density does not significantly allow the diagnosis of a larger number of heteroplasias: in fact, out of 13 cases of adenocarcinoma with PSA < 10 ng/ml, PSAd was only > 0.15 in 2 patients. Therefore, in line with the data reported in the literature, the authors consider that PSA assay represents a sensitive and specific screening method for prostatic tumour pathologies in symptomatic patients, but in order to obtain an early diagnosis, and especially in cases with serum values between 4-10 ng/ml, it must be combined with both rectal exploration and, above all, transrectal scan.

[The role of TPS in the diagnosis of prostatic carcinoma]. / Ruolo del TPS nella diagnosi del carcinoma prostatico.

From June 1993 to July 1994 we treated 136 male patients affected by dysuria with hematic dosage of TPS and PSA, with DRE, transrectal echography and prostatic biopsy using an echograph. The patients treated were divided into two groups: A and B. Group A (TPS cut-off of 75 U/l) was made up of 91 patients, ages ranging from 41 to 85 years (average 72.5 years). Group B (TPS cut-off > 75 U/l) was made up of 45 patients, ages ranging from 39 to 88 years (average 75.1 years). In group A, 22 patients (24.2%) resulted as suffering from prostatic carcinoma, 4 (4.3%) resulted as suffering from prostatic phlogosis, and 65 (71.4%) resulted as suffering from BPH. In group B, 6 (13.3%) were affected by prostatic heteroplasia, 2 (4.4%) were affected by prostatic phlogosis, and 37 (82.2%) were affected by BPH. The TPS had a sensibility of 21.4% and a specificity of 66.3%. A comparison of the data obtained in the two groups did not reveal any significant differences. In this study the TPS showed a poor diagnostic reliability as a biologic marker of prostatic carcinoma.

[Ultrasonography and prostatic adenocarcinoma]. / Ecotomografia ed adenocarcinoma prostatico.

In the report we refer to our experience as regards the role of transrectal ultrasonography in the early diagnosis of prostatic heteroplasia based on the results obtained by a research led from January 1991 to January 1995 on 1185 dysuria patients who have been subjected also to a rectal exploration and a serous dosage of PSA. Among the 306/1185 (25.8%) of the patients subjected to prostatic echoguided biopsy sec. Hodge in 238 (77.7%) a hypoechogenic zone on behalf of the periphery of the prostatic parenchyma has been reported. The histological result has pointed out the presence of adenocarcinoma in 81 (26.4%) patients; of benign prostatic hypertrophy in 196 (64%); of acute and/or chronic non specific phlogosis in 26 patients (8.4%) and granulomatosis prostatitis in 3 (1%). The sensibility, the specificity and the diagnostic efficiency of the transrectal ultrasonography in the diagnosis of prostatic heteroplasia have resulted equal, respectively to 100%, to 30.2% and to 48.6%. In 122 patients (66%) the hypoechogenic zone was not pathognomonic of prostatic heteroplasia. Definitely, considering the high sensibility in opposition to the insufficient specificity of the echography, it is our future intention not submit to prostatic biopsy those patients who show only a hypoechogenic zone in absence of pathology EDR and PSA but to monitor them through quarterly clinic checks.

[Treatment of urinary tract infections with macro-crystalline nitrofurantoin]. / Terapia delle infezioni del tratto urinario con nitrofurantoina macrocristalli.

Therapy of urinary tract infections with nitrofurantoin macro-crystals. The aim of this study is to evaluate the therapeutic effectiveness of two dosages of nitrofurantoin macro-crystals. Between January 1993 and February 1994, 101 patients (54 male and 47 female), either suffering from urinary tract infections or on whom internal examination had been carried out, were treated with nitrofurantoin macro-crystals. There were divided into two groups: A, a posology of 100 mg 3 times daily for 7 days and B, a posology of 100 mg 4 times daily for 7 days. A urine culture was carried out on all patients before and after treatment. E. Coli was found in 60.5% of cases, Streptococcus Faecalis in 12.7% and Staphylococcus aureus in 5.6%. Infection was eliminated in 85.3% of patients in group A and 93.9% in group B. The dysuric symptomatology was cured in 84.6% of patients in group A, and 89% in group B. The statistic elaboration of the results with X2 and p tests did not reveal any difference between the two groups examined.

[Rehabilitation therapy in the treatment of female urinary incontinence. Our experience with 121 patients]. / La terapia riabilitativa nel trattamento dell'incontinenza urinaria femminile. La nostra esperienza su 121 pazienti.

Rehabilitative therapy of the perineum (FKT, SEF and biofeedback) represents an efficient method in the treatment of urinary stress incontinence without resorting to a complete uro-genital prolapse, as in patients with urethral instability and/or incontinence. One hundred twenty-one women, 55 with urinary stress incontinence (USI), 20 with urge incontinence (UI) and 46 suffering from both types of incontinence, underwent rehabilitative therapy. On each patients the following tests were carried out: an internal test, a urodynamic test (uroflowmeter, PPU, cystomanometry and pessure/flow study), a meter UEC, situated at the bladder neck, anterior and posterior urethra, both clinostatic and orthostatic, urine test with urinoculture and a pap-test. The aim of this study is that of establishing if it is possible a) to simplify the rehabilitative sitting using only FKT with weekly treatment; b) to treat women suffering from urge incontinence or from both types, but with bladder stability (standard cystomanometria) with FKT and Ditropan (1 tablet 3 times daily for weeks therapy). One group of patients underwent rehabilitative therapy while another group underwent traditional therapy, for a minimum of 12 sitting, using also electric functional stimulation (SEF). Of 121 women who underwent rehabilitative therapy, 90 (74.4%) were healed, 30 (24.7%) improved and one (0.9%) showed no signs of improvement. Patients treated with FKT, or FKT and made as good if not better grogress than those who attended more sittings and/or underwent SEF.(ABSTRACT TRUNCATED AT 250 WORDS)

[Monitoring of low urinary tract infections in patients hospitalized with neurological diseases]. / Monitoraggio delle infezioni delle basse vie urinarie in pazienti ricoverati con patologia neurologica.

Bacteriological and systematic investigation has been carried on 135 confined to bed patients at the Neurological Department of the Policlinico of the University of Catania from January 1993 to June 1993, in order to estimate the frequency of the I.V.U. and the probable correlations with the basic nerve disease. Infections have been found with greater frequency between women and patients with catheter. The microorganisms most frequently isolated were: E. coli (36%) and Streptococcus faecalis (36%). Patients with positive urine culture have been treated in accordance with the indications of the bacterial identification. Particularly, surveys carried out in a group of patients suffering from cerebral stroke (81 cases), showed a frequent association between the I.V.U. and the beforesaid pathology. Similar results have been obtained in the two groups of patients submitted to 2 and to 3 drawings of urine respectively, practised at a distance of 5 of 5 days the one form the other.

[Current advances in the diagnosis of parotid masses]. / Moderne acquisizioni diagnostiche nella patologia espansiva della parotide.

The Authors first briefly describe the possible histological features of parotid masses, difficult to differentiate only on the basis of clinical signs. They report on imaging techniques for detecting this kind of pathology and suggest the best diagnostic protocol for correct evaluation of parotid masses, because of its great importance in planning optimal surgical management.

Coxsackie virus and urogenital pathology.

In 43 women (average age 49.6 years), and 70 men (average age 55.2 years) with pathology of the genito-urinary apparatus, seroantibodies to Coxsachie virus B were measured using the passive hemoagglutination method and the virus was isolated in the uterine. Viral isolation test was negative in all urine samples tested. Seropositivity for Coxsackie virus was reported in 26 women (60.46%) and in 51 men (72.85%). Positivity to B1 was 37.16% (42 cases), B2 in 38.05% (43 cases), and to B4 in 35.39% (40 cases). 17.69% (20 cases) of patients were seropositive to only one serotype, 17.69% (20 cases) to 5 serotypes, 14.15% (16 cases) to 3 serotypes, 9.73% (11 cases) to 2 serotypes, and 8.84% (10 cases) to 4 serotypes. B1, 2, 3, 4, 5 (25.97%; 20 cases) and B2, 3, 4, 5 (7.79%; 6 cases) were the most frequent associations. Seropositivity to Coxsackie virus was reported in 100% of patients (4 cases) with urethral caruncola, in 84.21% (16 cases out of 19) with cancer of the bladder, in 81.81% with cystitis (9 cases out of 11) and in 80% with prostatitis (8 out of 10 cases). In relation to sex, seropositivity was higher in males in cases of calculosis (75%; 9 cases out of 12 against 28.57%; 2 cases out of 7) and in cystitis (100%; 6 cases against 60%; 3 cases out of 5). Further studies are necessary to determine the clinical significance of serum Coxsackie virus antibodies in patients with urological pathology in the absence of urinary elimination of Coxsackie virus.

Current aspects of gynecological pathology in postmenopause.

Between 1982 and 1984 330 women in postmenopause for at least one year were admitted to the First Clinic of Obstetrics and Gynecology, Catania University Medical School, Catania, Italy, with a frequency of 10.04% of gynecological admissions. The most frequent pathologies were metrorrhagia (32.72%; 108 cases) from an atrophic endometrium or glandular hyperplasia of the endometrium, vaginoperineal lacerations with cystorectocoele with or without urinary incontinence (10.90%; 36 cases), cancer (11.21%; 37 cases) and ovarian cystoma (11.21%; 37 cases), uterine prolapse (9.30%; 31 cases), and endometrial polyps (9.09%; 30 cases). Uterine fibromyoma (3.93%; 13 cases) and carcinoma of the portio (3.93%; 13 cases) were among the rare pathologies. Uterine pathologies were the most prevalent (68.78%; 227 cases), followed by ovarian (15.15%; 50 cases), pathology of involving the pelvic and perineal containment (10.90%; 36 cases), vulvar pathology (2.72%; 6 cases), and vaginal pathology (1.51%; 5 cases). Malignant neoplastic pathology was reported in 25.45% of cases (84 cases) consisting only of uterine cancer (47.61%; 40 cases) and ovarian cancer (45.23%; 38 cases). In comparison with the study performed by Cetroni in 1952 one notes a net reduction in the frequency of uterine prolapse (by about three times), and a smaller reduction in cancer of the uterine cervix with a slight increase in cervical polyps, endometrial cancer, and above all in metrorrhagia from atrophic endometrium or glandular hyperplasia of the endometrium.

Sexual behaviour in relation to age: a study of 205 puerperal women.

Sexual desire, frequency of coitus, frequency of orgasm, which partner took the first sexual initiative, and the level of sexual satisfaction were studied in 205 women in puerperium in relation to age in the year preceding pregnancy and during pregnancy. It seems evident that sexual desire and the frequency of coitus and orgasm diminish during pregnancy independently of age. The group of younger women (16 to 20 years old) in our study maintained a relatively higher level of sexual activity especially in comparison to older women (36 to 40 years old). The number of women who took the first sexual initiative increased considerably in pregnancy.