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Biomedical subjects

F Zattoni

Publications and source records attributed to F Zattoni.

At least 19 recordsLinked to original sources

Granulomatosis of external genitalia: a new disease or part of a spectrum?

Several efforts have been made to classify the various diseases that can cause ulcerative necrosis of the skin and mucous membranes. All of these lesions have granulomatous inflammation as a common denominator. Wegener's granulomatosis belongs to this area of interest. Most of these diseases affect the head, eyes, nose, respiratory system and kidneys. We present a case of ulcerative necrosis with pathological findings of granulomatous inflammation involving the external genitalia, thighs, perineum and eyes. To our knowledge this is the first reported case of involvement of the external genitalia by such a disease.

Granulomatosis with Polyangiitis

Photosensitization of cystine stones to induce laser lithotripsy.

We report the preliminary results of laser lithotripsy of cystine stones accomplished in 2 patients with the use of a new method of photosensitization. Transurethral rigid ureterorenoscopy was performed with an 8.5F instrument to reach 0.8 and 1.8 cm. stones located in the right and left lumbar ureters, respectively. A 320 mu. fiber was then inserted and pushed into contact with the stone. Then, 400 preliminary impulses were released from a pulsed dye laser (504 nm) with energy output at 140 mJ. and at a rate of 5 Hz. without any visible modification of the stone structure. The saline solution used as irrigation fluid was then substituted with a 2% solution of rifamycin. Totals of 95 and 152 impulses released at the same energy output previously used were then sufficient to produce a satisfactory fragmentation of the stone in both cases. Sonography and excretory urography showed no alterations of the treated urinary tract in either case. The use of rifamycin in the irrigation fluid is suggested for laser treatment of hard or nonabsorbent stones, since this substance favors optical coupling and lowers the threshold of plasma formation on the surface of the stone.

Adolescent

Five years experience in experimental laser lithotripsy.

In the first part of our experience approximately 300 stones of different composition have been treated in vitro with three different laser sources: Nd-YAG laser (1,064 nm), dye laser (504 nm) and alexandrite laser (755 nm). Calcium oxalate monohydrate and brushite stones appeared to be the most resistant to lithotripsy. Highest fragmentation rates were obtained for calcium oxalate dihydrate stones followed by struvite, uric acid and hydroxyapatite stones. The Nd-YAG laser did not appear to be ideal for lithotripsy since early damage to the fiber tip was observed when this source was used. Both the dye and the alexandrite lasers were almost always effective in fragmenting the various types of stones. We subsequently treated some cystine stones while immersed in water or in solutions of carmine indigo (2%), methylene blue (5%), rifamycin (0.6 and 6%) and rifampicin (0.8 and 0.3%) with the dye or the alexandrite laser. The spectra of these solutions, previously analyzed with the spectrophotometer, showed that rifamycin and rifampicin absorbed large amounts of light radiation at the wave length of the dye laser (504 nm). Successful fragmentation occurred only when the dye laser was used to treat stones immersed in the more concentrated solutions of these two substances. The quantity of fragmented material after treating a 10-cm3 cystine stone previously immersed in the more concentrated solutions of rifamycin and rifampicin (30 and 10 mm3, respectively) confirmed previous results.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans

Clinical value of pathologic changes after intravesical BCG therapy of superficial bladder cancer.

Bladder pathologic features related to intravesical bacillus Calmette-Guerin (BCG) therapy in superficial bladder cancer (Ta, T1, Tis) were evaluated and related to clinical outcome. A total of 105 patients were treated with 75 mg Pasteur BCG weekly for six consecutive weeks. When tumor was not demonstrated a maintenance course was given. An additional six-week course was given when tumor recurrence or persistence, without progression, was observed after the induction course. An inflammatory change in the bladder was the most common pathologic finding. Granuloma was the only specific BCG-related feature and did not appear to be a prognostic factor because of low incidence (24%) and lack of correlation with clinical course. Dysplasia occurred more frequently (57%) in nonresponder patients and (26%) in responder patients, often heralding recurrence of tumor. All patients showing concurrent squamous and/or glandular metaplasia were unresponsive to BCG therapy. Histology and cytology did not correlate perfectly: cytology was ineffective in low-grade tumors and improved diagnostic accuracy, particularly when dysplasia was histologically evident.

Administration, Intravesical

Mitomycin C in multiple superficial bladder tumors: short-term therapy, long-term results.

At the Institute of Urology, University of Padova, 125 patients with multifocal superficial bladder cancer underwent treatment with intravesical Mitomycin C (MMC; 1 weekly instillation of 40 mg for 8 consecutive weeks) between January 1982 and December 1988. Eighty-four patients had multifocal papillary tumors (stages Ta-T1) and 41 patients had carcinoma in situ of the bladder. At 6 and 36 months the tumor free percentage in the group with papillary tumors was 69 and 36%, respectively; for carcinoma in situ the complete response percentage at the same intervals was 80 and 36%. Thirty-one patients previously unsuccessfully treated with adriamycin did not show any difference compared to untreated ones. The authors emphasize the efficacy and low toxicity of intravesical MMC in multiple superficial bladder cancer. The possibility of long-term relapse suggests maintenance therapy.

Administration, Intravesical

Preoperative and postoperative evaluation of prostate-specific antigen in localized prostatic cancer treated by radical prostatectomy.

Preoperative prostate-specific antigen (PSA) values were determined in 73 patients with clinically localized prostatic cancer and candidates for a radical procedure. Correlation of preoperative PSA with a final pathological stage was attempted. Only in 44.8% of our 22 patients with organ-confined disease was the PSA value within the normal range; in 17.3% of cases PSA values were higher than 20 ng/ml. 18.2% of the patients with locally advanced disease showed normal PSA values, while 45.5% had concentrations above 20 ng/ml. In the case of lymph node involvement, PSA values were normal in 22.7% of the cases. Our data indicate that no strict relationship can be suggested between PSA and the final pathological stage and grading of the tumor in patients who underwent radical prostatectomy.

Biomarkers, Tumor

[Benign prostatic hypertrophy: the therapeutic options].

BPH is a very diffuse condition among males increasing in incidence with the age. This explains the large interest in the evaluation of the different strategies concerning BPH treatment. The gold standard has still to be considered the transurethral resection of the prostate which all the other treatments must be compared to. More recently as alternatives to the invasive therapy, so called minimally invasive treatments have been proposed (thermotherapy, prostate dilatation, intraprostatic stents) whose real significance is not completely evaluable yet. As far as medical treatment is concerned, phyto-therapeutic agents have been partially replaced by different substances (alfa- blockers; 5-alfa reductase blockers) that are expected to have a promising future.

Adult

[Comparison between nuclear DNA and histologic grade of prostatic carcinoma].

DNA nuclear ploidy determined by flow cytometry was evaluated from prostate tissue in 51 patients with prostatic cancer who had undergone radical prostatectomy. DNA ploidy pattern was diploid in 46% and aneuploid in 54% of tumors. DNA ploidy was compared to histological tumor grading. 92 Aneuploidy was found in 0% of the tumors with Gleason score between 2 and 4 in 62% between 5 and 7 and in 50% between 8 and 10. Our results suggest there is no relationship between the two parameters.

Aged

Is there a relationship between benign prostatic hyperplasia and prostatic cancer?

No definite relationship can be demonstrated between benign prostatic hyperplasia (BPH) and prostatic cancer on the basis of various anatomic and morphologic features. However, interesting recent observations suggest a link between BPH and prostate cancer. Clinically, the simultaneous presence of benign and malignant disease is observed quite often, and this coexistence is bound to increase with the age of patients. Possible intermediate forms between BPH and early cancer have been investigated. Two premalignant lesions have been identified: atypical adenomatous hyperplasia and prostatic intraepithelial neoplasia.

Humans

The case for a percutaneous approach to transitional cell carcinoma of the renal pelvis.

Percutaneous treatment of transitional cell carcinoma of the renal pelvis in 4 patients is reported. The presenting symptom was hematuria in 2 patients, while in 2 diagnosis was made by chance at excretory urography. Endoscopic removal of the tumor was not possible in the 2 patients who underwent transurethral ureteroscopy due to the location of the lesion. Percutaneous electroresection of the tumor was performed after puncture of an inferior (3 patients) or middle (1) calix and dilation of the nephrostomy tract up to 30F. Pathological findings revealed a grade 1 papillary carcinoma in 3 patients and a well differentiated inverted papilloma in 1. A single-J ureteral catheter was left in place after the procedure. Cytological, radiographic and endoscopic studies were negative 11, 13, 18 and 24 months after the treatment, respectively. We believe that the percutaneous approach is a feasible option in cases of small, single, low grade lesions not removable via ureteroscopy, particularly in patients at high surgical risk.

Aged

[Endo-urology in diseases of the upper urinary tract other than tumors and calculi].

Thirty-three patients underwent percutaneous treatment for upper urinary obstructive disease in our Institute. Cold-knife incision of 16 cases of uretero-pelvic junction obstruction and 4 cases of infundibular stenosis was performed. Balloon dilatation of the caliceal neck was performed in 1 patient with caliceal diverticulum. In 4 of the patients treatment failed requiring open surgical correction. Thirteen patients presented iatrogenic ureteral obstruction: balloon dilatations or cold-knife incisions were performed. Four of the 9 patients evaluable obtained significant benefit from the endourological treatment. Endopyelotomies for UPJ obstruction seem effective and reduce morbidity and operating times. Ureteral obstructions appear less responsive to the endo-urological approach. Definitive conclusions concerning the effectiveness of these procedures requires larger series of patients and longer follow-up.

Adolescent

Pediatric nephroscope for percutaneous renal stone removal.

A new 17-F nephroscope was used for percutaneous renal stone management. It appeared useful in reducing the possible main vascular injuries after percutaneous nephrolithotomy. Personal experience with pediatric as well as selected adult cases is presented.

Adolescent

[Mitomycin C in the topical treatment of superficial neoplasms of the bladder].

From January 1982 to October 1987, 100 patients with multifocal superficial bladder cancer received intravesical MMC at the Institute of Urology, University of Padova. Seventy-three patients had papillary multifocal superficial bladder carcinoma (stages Ta-T1): treatment was divided into therapeutic (18 cases), and prophylactic (55 cases). 27 patients had carcinoma in situ. 39 patients affected by neoplasia relapsed to previous intravesical ADM treatment. All patients received 40 mg. intravesical MMC weekly for 8 consecutive weeks, repeating the cycle in cases of relapse. Complete response rates at 12 months was 53%, 50 to 67% for each group, respectively. Recurrence rate was lower compared to that before treatment; progression rate was also lower compared to a group who received only endoscopic treatment. In patients who relapsed with ADM treatment, the percentage of complete response was 69%. We underscore the efficacy of MMC in lowering relapse and progression in multifocal superficial bladder cancer, which represents the best indication for this kind of treatment.

Administration, Intravesical

Obstruction or no obstruction.

The authors review critically such parameters as symptomatology, post-micturition residual urine, bladder trabeculation and uroflowmetry that in the actual state of the art appear more accredited in the evaluation of lower urinary tract obstruction. All have some interpretative limits. However, uroflowmetry appears to be the most reliable and for this reason it is the first step in the study of suspected infravesical obstruction. It can discover equivocal situations in which pressure-flow studies only supply diagnostic help in order to avoid false diagnosis of infravesical obstruction and useless therapeutic approaches.

Diagnosis, Differential

Congenital polyp of the prostatic urethra: report on 2 cases.

Congenital polyps of the prostatic urethra are an uncommon cause of obstructive uropathy, infection and/or hematuria in male children. A filling defect localized in the posterior urethra on the voiding cystourethrogram represents the peculiar diagnostic finding. Transurethral resection is the treatment of choice, according to the size of the polyp. Two cases of congenital posterior urethral polyps are reported and the main clinical and radiological features are discussed. This lesion has to be considered in the differential diagnosis of the voiding dysfunction in young boys.

Adolescent

Short-term and stabilized effects of percutaneous nephrolithotomy on the kidney.

A homogeneous group of 15 patients was investigated before and after percutaneous nephrolithotomy (PCN). Creatinine and electrolyte clearances evaluated both before and during saline (NaCl 0.9%) infusion, 4-7 days after PCN remained unchanged with respect to the preoperative values. A significant decrease of urinary PGE2 was observed postoperatively both before and after extracellular volume expansion. 99mTc-DTPA renography performed 26-40 days after surgery showed a scar on the convex margin of one kidney in the area of the nephrostomy and an improved renographic curve in 5 renal units. No difference between pre- and post-PCN isotopic clearances was evident. On the basis of our results we can affirm that PCN is an efficient and safe method for the treatment of nephrolithiasis.

Adult

[Psychogenic retention of urine in women: diagnostic and therapeutic problems].

Psychogenic urinary retention is rare event. 6 cases are reported: diagnostic urologic and neurologic work-up is outlined. The final statement is the exclusion of rare or minimal neurogenic causes (silent disk prolapse, early multiple sclerosis and so on) and the evidence of cause-effect relationship between psychic trauma and starting of urinary symptoms are compulsory to join the diagnosis of psychogenic urinary retention.

Adolescent