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Alessandro Bertaccini

Publications and source records attributed to Alessandro Bertaccini.

16 recordsLinked to original sources
PubMed2006

Hematoma into peritoneum following transrectal echo-guide prostate biopsy inducing lower abdominal and urinary tract symptoms.

A 58 years man was submitted to a sextant echo-guided transrectal prostate biopsy. Three weeks later he started complaining of lower abdominal and urinary tract symptoms. Abdominal ultrasound and 3D contrast enhanced CT detected an ovular shaped and capsulated 140 cc volume mass into the peritoneum compressing the bladder. Cytology evaluation showed only haemorrhagic content. After the mass evacuation all the symptoms referred, disappeared. Anyway a hematoma into the peritoneum following a transrectal echo-guided prostate biopsy should represent a unique entity. In fact, this is considered a safe procedure in which generally mild complications occur and they stop spontaneously.

Aged↗
PubMed2006

The effects of renal ischemia on kidney function in renal cancer conservative surgery.

Over the past ten years nephron sparing surgery for renal cancer has been compared to radical nephrectomy for what concern oncological results, even in elective situations but it is necessary to consider functional results (renal function) as well. Clamping renal artery, inducing a temporary renal ischemia that might represent the major known cause of permanent renal damage, is advised for both open and laparoscopic conservative approach. Data from literature show that before the clamping, the patient should be adequately hydrated and receive mannitol. Ischemia should last preferentially less than 30 minutes and kidney cooling should be advised in case of more prolonged ischemia. Artery reclamping should be avoided. Both in warm and cold ischemia, the renal tissue should be perfused by mannitol once the circulation is resumed.

Cold Ischemia↗
PubMed2005

Liposarcoma of the spermatic-cord: description of two clinical cases and review of the literature.

Spermatic cord liposarcoma is a rare tumor; currently only 161 cases are described in literature. Natural history of these tumors is marked by the high local recurrence rate. Radical surgery represents the therapy of choice whilst uncertain is the role of regional and retroperitoneal lymphadenectomy as well as the usefulness of adjuvant radiotherapy or chemotherapy. In this paper we describe our experience of two cases treated at our Department between 1995 and 2002 and discuss about the clinical management of this misleading tumor in the light of the several experiences reported in literature.

Aged↗
PubMed2004

Laparoscopic radical prostatectomy: oncological evaluation in the early phase of the learning curve comparing to retropubic approach.

OBJECTIVES: Radical prostatectomy is actually the gold-standard treatment for organ-confined prostate cancer. Since Schuessler et al. performed the first laparoscopical radical prostatectomy (LRP) in 1992 this surgical approach for prostate cancer treatment has been widely diffused among european urologists. In this study we report our initial experience with laparoscopic surgery focusing on the oncological assessments and comparing these results to those of the retropubic approach. MATERIAL AND METHODS: Between March 2002 and November 2003, 50 laparoscopic radical prostatectomy were performed at our Institute. We reviewed the operative times, intraoperative complications, mean catheterization and postoperative hospital stay of these first 50 cases. Moreover during the same period a group of 50 consecutive patients underwent retropubic radical prostatectomy (RRP) and data were analyzed and compared to laparoscopic issues. The laparoscopic approach was performed according to the Montsouris technique. Patient age, Gleason score at biopsy, PSA and clinical stage of the two groups were compared. Positive margins of the two groups were compared in relation to their location and pathological stage. RESULTS: No significative statistical differences of age, preoperatory PSA, Gleason score at biopsy and clinical stage were observed between the two groups (p > 0.05). Also in post-operative data no significative statistical differences regarding the pathological stage (p = 0.54) and the Gleason score (p = 0.714) were noted between the two groups. In RRP group the pathological stage was pT2 in 28 patients and pT3 in 22 patients; in LRP group was pT2 in 31 patients and pT3 in 19 patients. The mean Gleason score resulted 6.16 in RRP group and 6.10 in LRP group. The number of positive surgical margins was low in both groups and the location was similar in retropubic and laparoscopic specimens. We reported 13 positive surgical margins in RRP group and 12 in LRP (p = 0.8). CONCLUSIONS: Basing on our initial experience with 50 patients we can affirm that laparoscopic radical prostatectomy can be performed with a lower morbidity and oncological results similar to the retropubic approach even in the early phase of the learning curve. Our experience could be useful to encourage all the urologists approaching laparoscopy.

Aged↗
PubMed2004

Uro-gramma: the importance of updating the predictive model.

OBJECTIVES: Uro-gramma is a probabilistic predictive model of pathological staging of prostate cancer (Pca) from preoperative parameters (PSA, clinical Gs, clinical stage) published in 2000. Aim of this study is to improve Uro-gramma, updating it, to take into account the continuous evolution of the population. MATERIALS AND METHODS: From 1998 to 2000, 991 Pca patients have undergone radical prostatectomy in several Italian urological centers. Inclusion criteria were: preoperative PSA < 50 ng/ml, clinical stage < or = T3c, availability of a bioptic Gs and pathological staging. A predictive model has been estimated for each year and its behaviour on the following years tested, using Hosmer and Lemeshow tests, which compare the expected rate with the observed one. RESULTS: The mean age was 66.3 years. Pca familiarity was present in 3.2% of the patients in 1998, 2.6% in 1999 and 7.4% in 2000. PSA values < 10 have increased (from 41% to 47%) and those > 10 decreased (from 59% to 53%). The mean number of bioptic samples per patient has increased from 4.9 to 6, while clinical and pathologic Gs have remained stable. An increase in the rate of organ confined Pca has been noticed, either clinically (87.4% in 1998, 92% in 2000) or pathologically (55.2% in '98, 57% in 2000). Staging lymphadenectomy has been performed in 88% of the pts in 1998, 94.2% in 1999 and 94.5% in 2000, whereas the % of N+ patients has moved from 11.3% in 1998 to 9.8% in 2000. CONCLUSIONS: Uro-gramma update results show that the mean estimate error has fallen from 6.4% to 1.2%. The new model strengthens the previous one and confirms its validity, but it also underlines the need of a constant update to take into account the continuous evolution of the population and of the methods of diagnosis and staging.

Aged↗
PubMed2004

Development and validation of the BSP-BPH (Bononian Satisfaction Profile--Benign Prostatic Hyperplasia) a "disease-specific" questionnaire for the evaluation of health related quality of life in patients with benign prostatic hyperplasia.

OBJECTIVES: Lower Urinary Tract Symptoms (LUTS) associated to Benign Prostatic Hyperplasia (BPH) are very common in middle aged and older men. Since BPH, and the related therapies have a significant impact on a patient's Quality of Life (QoL), the health related quality of life (HQoL) evaluation is becoming an important aspect to be considered. The present study deals with the development and validation of a BPH disease specific questionnaire (Bononian Satisfaction Profile - BSP-BPH), considering HQoL in patients seeking medical help for BPH. The innovation of this questionnaire is that the patients' scores achieved are related to their subjective satisfaction. MATERIALS AND METHODS: Questionnaire development: On the base of our previous experience with BSP-PC (a disease specific questionnaire assessing HQoL in prostate Cancer patients), of a careful review of other available instruments (SAT-P, SF-36, ICS-QoL, BPH-HqoL) and of three subsequent meetings with experts (10) and patients (20), we defined the ten life aspects mostly impaired by BPH. We created a first 72-item version of the BSP-BPH. Ten patients cross matched for age end education to our study population were asked to fill in the questionnaire. A 31 item questionnaire version, together with EuroQoL, an already generic validated instrument, was administered to 121 patients as well. Further meetings and statistical analysis defined the 18 items of the BSP- BPH. Questionnaire validation: the BSP-BPH was filled in by 435 patients enrolled in a campaign for detection of prostatic diseases held among the male population of Bologna. RESULTS: Questionnaire development: the participants' mean age was 63 years (N = 121); 47.1% had BPH. The 18 items were selected on the basis of the following criteria: a) r > 0.50, p < 0.05 (correlation test re-test); b) p < 0.05 (ANOVA presence vs absence of BPH); c) r > 0.50, p < 0.05 (correlation with EuroQol). Questionnaire validation: the participants' mean age was 63 years (N = 436). 16 patients with a history of neoplasia were excluded from our study. 21 were missing data. 45% of the sample had BPH. Principal component analysis identified 5 components: 1) satisfaction about sexual functionality (Cronbach alpha = 0.94); 2) satisfaction about social functionality (alpha = 0.80); 3) satisfaction about cognitive/emotional functionality (alpha = 0.82); 4) satisfaction about urinary functionality (alpha = 0.87); 5) satisfaction about physical functionality (alpha = 0.66); total Cronbach alpha was 0.88. CONCLUSIONS: The 18 items version of BSP-BPH questionnaire can be used as an instrument for HQoL evaluation in patients with BPH focusing on patients' subjective satisfaction. At the moment only the Italian version is available.

Humans↗
PubMed2004

A novel spectral ultrasonic differentiation method for marking regions of interest in biological tissue: in vitro results for prostate.

OBJECTIVE: The aim of the present study was to evaluate the effectiveness of a new method of spectral analysis of the radiofrequency (RF) ultrasonic echo signal in discriminating neoplastic from non-neoplastic tissue of the prostate gland. MATERIAL AND METHODS: The proposed method was previously set up on ten prostatic glands where cancer had been detected by histology in order to correlate the tumour areas with specific spectral parameters. In the present study sixty prostate specimens of patients undergoing radical retropubic prostatectomy for clinically localized prostate cancer were examined. The surgically removed prostate glands were scanned using an echo signal acquisition apparatus and the spectral parameters were obtained by the wavelet transform. The echographic scans of all cases were then compared with the whole-mount histological sections of the prostate in order to evaluate sensitivity and specificity of the proposed method. RESULTS: The sensitivity and specificity for cancer detection were 93% and 91%, respectively. The specificity was invalidated by the fact that in some of the cases studied, the tumour was located in areas of benign prostatic hyperplasia (BPH). As for the sensitivity, of the three false negative cases two were due to the coexistence of cancer foci and BPH. CONCLUSIONS: Our proposed method, named WAMBLE (Wavelet Analysis Multi Band Local Estimator), is accurate in detecting prostate cancer. Further in vivo studies are warranted to confirm the clinical value of this technique.

Diagnosis, Differential↗
PubMed2004

A case of tumor of the penis: interstitial brachitherapy after conservative surgical therapy.

The neoplasms of the penis are extremely rare and have an incidence of 1400 new cases for year in the United States. Higher is the percentage of incidence in Africa and Asia (10-20%) and in some areas of Brasil where the cancer of the penis constitutes 17% of all the male tumors. In Israel this neoplasm is rare, less than 0.1/100000 menfor year, because in Jewish population men are circumcised prematurely. Recently it has been placed attention to the possible aetiologic role of human papillomavirus (HPV-16 and HPV-18) in penis carcinoma. In fact, in the tumoral cells, DNA of this virus has been found with a percentage that varies from the 30 to 82%. Traditional surgical approach is total or partial penis resection basing on the extension of the disease. This procedure is associated to remarkable psycosessuals problems that greatly affect the quality of life. We bring back a case with organ sparing conservative treatment.

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PubMed2003

BSP-PC (Bononian Satisfaction Profile--Prostate Cancer): development and validation of a "disease-specific" questionnaire for the evaluation of health-related quality of life in patients with prostate cancer.

OBJECTIVES: Prostate cancer (PC) is the most common neoplasia in men over 50 years of age in western countries. Nowadays, since there are several alternative medical-surgical treatments for this cancer, health-related quality of life (HQoL) evaluation has become very important. The present study deals with the development and the validation of a questionnaire (BSP-PC), considering the HQoL in prostate cancer patients. The BSP-PC items are mainly related to the subjects' satisfaction. As far as we know, it does not exist any disease specific instrument based on such aspect. MATERIALS AND METHODS: Questionnaire development: During three different meetings, with ten experts and twenty patients, we have defined the life aspects which are the most affected by prostate cancer. Subsequently we have created a first 40-item version of the BSP-PC. Patients were asked to fill in this particular questionnaire in addition to a generic and validated one (the EuroQol). A final 24 item questionnaire version, was finally achieved by other statistical analysis and meetings with experts. Questionnaire validation: the BSP-PC was filled in by 261 patients divided into 3 groups: "healthy" (57), "prostate cancer" (103), "other diseases" (100). RESULTS: Questionnaire development: participants' mean age was 59 years (N=71); 46% had prostate cancer, while 53% of the sample did not report notable diseases. The 24 items were selected on the basis of the following criteria: a) r>0.50, p<0.05 (correlation test re-test), b) p<0.05 (ANOVA presence vs absence of PC), c) r>0.50, p<0.05 (correlation with EuroQol). Questionnaire validation: participants' mean age was 68 years (N=261). Four factors were identified: 1) satisfaction about physical functionality (Crombach alpha=0.95), 2) satisfaction about sexual functionality (alpha=0.94), 3) satisfaction about social functionality (alpha=0.77), 4) satisfaction about urinary functionality (alpha=0.89); total Crombach alpha was 0.94. CONCLUSIONS: The BSP-PC questionnaire can be used as an instrument in the evaluation of HQoL in PC patients by principally considering their subjective satisfaction.

Activities of Daily Living↗
PubMed2002

Twenty-one day administration of dienogest reversibly suppresses gonadotropins and testosterone in normal men.

Androgen-progestin combinations are promising male contraceptive regimens. Optimization of these regimens includes the development of new progestins with more favorable biological properties. In this context we tested the effects of the progestin dienogest (DNG) on reproductive hormones and metabolic parameters in men. After a 3-wk control period, 25 men were randomly assigned to receive daily doses of 2, 5, or 10 mg DNG or placebo and 10 mg cyproterone acetate for 21 d (n = 5 subjects/group). Subjects were followed for 2 wk after cessation of hormone administration. Weekly blood samples, physical examinations, hormone and chemistry measurements, semen analysis, and sexual/behavioral assessments were performed. These parameters were compared among study groups and within each group at different time points throughout the study periods. DNG and cyproterone acetate administration resulted in profound suppression of gonadotropins and T with no change in SHBG levels. No adverse effects were detected in any subject. Hormone levels returned to baseline after stopping hormone intake. DNG is a potent suppressor of gonadotropins and T in men and does not induce adverse effects over a 21-d administration. DNG is a promising progestin to be used in clinical trials for male contraception.

Adult↗
PubMed2002

[Response to a cognitive questionnaire on the guideline project of prostatic biopsy of the SIEUN--GUONE--SIUrO--SIBioC].

Ultrasound guided systemic sextant needle biopsy of the prostate is the procedure of choice for the diagnosis of prostate cancer. During the past 50 years, the techniques, indications, and pathologic interpretation of prostate biopsies have evolved. Moreover, the indications for prostate biopsy have become more refined. This paper provides the results of an interactive questionnaire on ultrasound guided biopsy of the prostate. 14 questions have been selected. A range of 102-109 answers have been collected for every questions at Castrocaro (Fo) during the 14th National Congress of the Italian Society of Urological, Andrological and Nephrological Ultrasound on May 3rd 2002.

Biopsy↗
PubMedDate not supplied

Checkpoint effectors CDKN1A and Gadd45 correlate with oxidative DNA damage in human prostate carcinoma.

BACKGROUND: Although cellular oxidative stress is a major cause of DNA damage, it is still not clear to what degree it affects genetic instability and malignant progression in established prostate carcinoma (PCa). MATERIALS AND METHODS: We examined the expression of CDKN1A and Gadd45 proteins acting on cell cycle checkpoints and DNA repair in PCa relative to the presence of oxidative DNA damage, as measured by the detection of the DNA adduct 8-hydroxy-2-deoxyguanosine (8-OHdG.). Sixteen PCa and 28 benign prostate hyperplasias (BPH) were analyzed. RT-PCR was used to evaluate WAF1 and Gadd45 transcripts. Western blot and ELISA were used to analyze proteins and 8-OHdG adducts. Proliferation was studied by Ki67 image cytometry; telomerase activity was detected by TRAP- ELISA. RESULTS: Multivariate factor analysis provided evidence that, in PCa, DNA checkpoint proteins were associated with 8-OHdG and did not prevent neoplastic cells proliferation. Conversely, in BPH, oxidative DNA damage was inversely correlated with DNA checkpoint proteins and proliferation, suggesting the presence of energy-depleted senescent cells. CONCLUSION: Although in non-malignant tissue extensive oxidative DNA damage drives cells to a metabolic blockage, in PCa neoplastic cells it activates repair mechanisms favoring the escape from senescence and the expansion of DNA-damaged clones.

Aged↗