Biomedical subjects
Publications and source records attributed to Carlo Bettocchi.
We report a fatal case of acute pancreatitis which developed in a 76-year-old male with hormone-refractory prostatic carcinoma who was being treated with lanreotide, a slow-release somatostatin analog.
OBJECTIVE: To describe a novel phalloplasty technique and to study the results and complications in female patients with gender dysphoria. PATIENTS AND METHODS: Between 1989 and 2000, 85 female-to-male transsexual patients had a phalloplasty fashioned from suprapubic abdominal wall flap that was tubed to form the phallus, and which incorporated the neourethra made from a pedicled tube of labial skin. The complete neourethral reconstruction was in one stage in 32 patients and in two in 48; five patients did not wish to have the neourethra fashioned. RESULTS: The cosmetic appearance of the phallus was considered good in 68% of the patients. The major complications (in 60 patients) were related to the neourethra (75%) with stricture formation (64%) and/or fistulae (55%) predominating. This complication rate was significantly less (P < 0.001) when the neourethra was created in two stages. Once the neourethra was completed, patients were then offered both penile and testicular prostheses. Sexual intercourse was possible with no prosthesis in 16 patients. CONCLUSIONS: The pubic phalloplasty offers an acceptable neophallus without disfiguring the donor skin site. The main complications stem from creating the neourethra and these may be reduced by a two-stage procedure.
AIM: To evaluate the efficacy, safety, and tolerability of a flexible-dose regimen of vardenafil in a community-based population of men with erectile dysfunction (ED). METHODS: This was a 12-week, open-label, flexible-dose, multicenter study of unselected men with ED of diverse origins and severity. Unlike previous studies, prostatectomy-induced ED and previous unresponsiveness to sildenafil were not exclusion criteria. After 4 weeks of treatment with 10 mg of vardenafil, the dose could be continued or titrated to 5 mg or 20 mg, depending on efficacy and tolerability. After 8 weeks, another dose change was possible. Efficacy was assessed with International Index of Erectile Function erectile function (IIEF-EF) domain scores, diary questions of the Sexual Encounter Profile (SEP), and a global assessment question (GAQ) about erection improvement during the previous 4 weeks. RESULTS: Safety was evaluated in 497 patients, and 480 were suitable for intention-to-treat analysis. After 12 weeks of treatment, the mean per patient rate of successful intercourse, defined by an affirmative response to SEP questions 1-3, was 72%, and was related to age and ED duration. The overall success rate increased from 66% at week 4 to 77% at week 12. The mean IIEF-EF domain score of the whole population increased from 17.2 (baseline) to 24.4 (endpoint). At week 12, the best scores were obtained by patients taking 5 mg and 10 mg. At week 12, GAQ scores showed improved erection in 97.4%, 94.8%, and 78.8% of patients in the 5 mg, 10 mg, and 20 mg group, respectively. Safety was excellent: no serious drug-related event was reported, and only 2.2% of patients discontinued treatment because of side-effects. CONCLUSIONS: Vardenafil was effective and well tolerated in this community-based ED population that is truly representative of the general ED population. Dose titration meets the patient's needs and optimizes clinical outcome.
Penis and testicle amputation, vaginoplasty, and clitoroplasty are procedures that help male-to-female transsexuals to accept their body and to increase psychosocial well-being. We describe a successful correction of prolapse of the neovagina with abdominovaginal sacropexy in a male-to-female transsexual who had undergone penoscrotal flap vaginoplasty. Although the reasons for a neovaginal prolapse are not completely known, in our case vaginal sacropexy was successful, with good functional and cosmetic results.
Renal peripelvic multicystic lymphangiectasia is a benign disease characterized by multiple cysts arising from the lymphatic vessels of the renal sinus. Cysts, almost always bilateral, surround the profiles of the calices; the biggest cysts can compress pelvis or iuxtapielic ureter and it is difficult to differentiate RPML from hydronephrosis at the Ultrasound. Cysts are asymptomatic, the profiles of calices appear irregular with thin membrane separating each other, the cortical of the kidney is preserved: these are principle elements to distinguish RPML to hydronephrosis at the Ultrasound. Usually it is necessary to confirm the diagnosis at IVP and CT scan evaluation. From 1995 to March 2002, 10 cases of RPML with a long-term follow-up have been studied. IVP in 8 patients and CT scan in 2 have shown compression of the collecting system by multiple cysts. We followed the cases with periodic lab tests of kidney function, ultrasound, IVP, CT scan. In order to valuate the presence of "true obstruction", we tested in over-night urine EGF and MCP-1 as markers of urinary tract obstruction and subsequent renal damage. A valuable data regarding how to differentiate RPML from hydronephrosis at Ultrasound show that RPML does not modify renal function and cyst volume has not changed in the time. In long-term follow-up the prognosis of the RPML is not clear. Particolarly this renal sinus disease has not neoplastic degeneration and the effect of cysts on kidney function is unknown. RPML is an uncommon disease and it can be enclosed in the group of renal sinus pathologies. The absence of symptoms, the hystologic diagnosis, the unchanged dimensions of the cysts confirm the benign prognosis of RPML which does not need a close functional and morphologic monitoring in the long-term follow-up.
Eco colorDoppler flowmetry greatly increased the knowledge about penile erection. This diagnostic tool enables the study of arteriogenic erectile failure. We report on our six-year experience with this procedure on 900 men with erectile dysfunction. This experience lead us to standardise the method utilising high doses (20-40 micrograms) that minimise false negatives.
Congenital 21-alpha hydroxylase deficiency is a syndrome characterized by a cortisol synthesis deficiency and, rarely, by testicular masses. We present a case of bilateral nodular hyperplasia of the testis without adrenal hyperplasia in a patient affected by 21-alpha hydroxylase deficiency. This mass mimicked a testicular tumor and made differential diagnosis with a Leydig cell tumor extremely difficult. Multiple hard nodules (1 cm in diameter) could be palpated in both testes but were more prominent on the right. After an unsuccessful 30-day trial of an adrenocorticotropic hormone suppression regimen with dexamethasone (0.5 mg/qid), a right total orchifunicolectomy was performed. The final histological diagnosis was that of multiple, well-circumscribed nodules consisting of cord-like and microalveolar-like gonadal stroma, typical of an adrenogenital syndrome, and fibrosis. Differential diagnosis between testicular nodules in patients with congenital adrenal hyperplasia and Leydig cell tumors is a major clinical challenge. In cases of cortisol suppression resistant testicular masses, a serum adrenal hormone profile obtained from the gonadal vein and histology of the testicular nodule (with parenchyma sparing surgery) are recommended to obtain a correct diagnosis.
Erectile dysfunction (ED), defined as the inability to achieve and/or maintain an erection sufficiently long for a satisfactory sexual performance or intercourse, is an important and common medical problem. ED is not a life-threatening disorder, but it influences the daily routine, social interactions, well-being and quality of life of the patient. Recent epidemiological data have shown a high prevalence and incidence of ED. The Massachusetts Male Aging Study found that 52% of men between the ages of 40 and 70 years reported ED with 9.6% having mild, 22.2% moderate and 17.2% complete or severe ED. In a large Italian cross-sectional study the overall prevalence of self-reported ED was 12.8% and the frequency of ED increases with age. ED may signal serious underlying and potentially life-threatening diseases, such as diabetes, hypertension, cardiovascular disease, peripheral vascular disease and other neurological and endocrine disorders. Also well documented is the role of some drug groups, certain types of surgery, injuries and the role of risk factors related to lifestyle such as smoking, alcohol consumption and inappropriate dietary habits accompanied by an abnormal serum level of cholesterol. The current availability of effective and safe oral drugs for ED in conjunction with the tremendous media interest in the condition, have resulted in an increasing number of men seeking help for ED. As a consequence, many physicians without background knowledge and clinical experience in the diagnosis of ED are involved in making decisions concerning the evaluation of such patients. The result of this is that some males with ED may undergo little or no evaluation before treatment is initiated and, in such circumstances, the disease causing the symptom (ED) may remain untreated. Baseline diagnostic evaluation for ED can identify the underlying pathological condition or the risk factors associated with ED in 80% of patients. This article reports a sequential approach for the diagnosis of ED that may diagnose reversible causes of ED and also unmask medical conditions that manifest with ED as the first symptom.