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Biomedical subjects

Giorgio Pomara

Publications and source records attributed to Giorgio Pomara.

14 recordsLinked to original sources
PubMed2006

Major invasive surgery for urologic cancer in octogenarians with comorbid medical conditions.

OBJECTIVES: We retrospectively reviewed the records of the octogenarian patients who underwent major surgery for urologic cancer at two institutions. The aims of our study were to assess intra- and postoperative morbidity and mortality rates, and to identify potential risk factors that can predict postoperative complications and, as a consequence, surgical outcome. METHODS: Fifty-five patients (median age: 83 yr) underwent major surgery for urologic cancer. Radical nephrectomy was performed in 27 patients, radical cystectomy with urinary diversion was done in 20 patients, and nephroureterectomy was performed in the remainder. Significant comorbidity was present in 51 patients. RESULTS: The perioperative mortality rate was 9%. The overall mortality rate was 69%; cancer-specific mortality was 28%. Intraoperative complications occurred in 11% of patients. Postoperative intensive care monitoring was required in 29% of patients. The early postoperative complication rate was 33%. Only the presence of more than two comorbidities (p<0.05) and chronic obstructive lung disease (COLD) (p=0.017) resulted in independent prognostic factors for morbidity. Sixteen percent of patients developed a late postoperative complication within the first 6 mo. Median hospital stay was 14 d (range: 6-55), and hospital stays were significantly longer among patients with complications (p<0.05). The 3-yr and 5-yr overall survival rates were 36% and 26%, respectively; these rates were significantly lower in patients with COLD (p<0.01). There was no significant difference between cancer-specific and non-cancer-specific survival rates. CONCLUSIONS: Major surgery for urologic malignancies can be safely performed in selected octogenarian patients.

Aged, 80 and over↗
PubMed2006

Cystic endometriosis of the epididymis.

Endometriosis of the male genitourinary tract is an exceedingly rare entity, with only 6 cases reported to date involving the bladder, prostate, lower abdominal wall, and paratesticular region. We present what we believe to be the first case of cystic endometriosis of the epididymis in a 27-year-old man with scrotal pain, describe its pathologic and immunohistochemical features, and discuss its pathogenesis.

Adult↗
PubMed2005

The use of prostatic intravesical protrusion correlated with uroflowmetry: a new method to measure obstruction in patients with LUTS due to BOO without using P/F studies.

OBJECTIVES: To detect obstruction in patients with LUTS suggestive of BPH comparing the prostatic intravesical protrusion detected by abdominal ultrasounds with uroflowmetry testing results with urodynamic study to make evidence of obstruction. MATERIAL AND METHODS: A series of 25 patients (mean age 67.9 years) at the first visit for BPH problems, underwent to routine examination including: abdominal ultrasound examination, TRUS, uroflowmetry IPSS and QoL questionnaires and urodynamic evaluation. We evaluated the degree in mm of prostatic intravesical protrusion by ultrasounds with a bladder volume between 150-220 cc. The degree of protrusion was classified as mild (<5 mm), moderate (5-10 mm) and severe (>10 mm), Qmax was divided in obstructed (<10 ml/s), equivocal (10-15 ml/s) and unobstructed (>15 ml/s). Confirmation or not of obstruction was validated by urodynamic study. RESULTS: mean prostate volume was 41.4cc; IPSS 22.4; Quality of Life 4.0; post voided residual urine 97.8 cc; DAMPF 62.6; Schäfer 3.4; Qmax 9.9 ml/s. Almost all the patients with severe protrusion had obstructed flow confirmed by P/F study. Patients with severe protrusion and unobstructedflow have obstruction compensated by high pressure voiding. CONCLUSIONS: These results, despite of the numbers of patients, suggest that the degree of prostatic protrusion measured by abdominal ultrasounds is a data that, if correlated to obstructed Qmax, can be used in the evaluation of BPH patients and their grade of obstruction.

Aged↗
PubMed2005

Doppler ultrasonography in a young patient with penile Mondor's disease.

OBJECTIVE: Mondor reported the first superficial venous thrombosis on the chest wall in 1939. This condition is usually a benign and self-limited process, requiring only symptomatic treatment. Mondor's disease of the penis is an uncommon condition, which usually involves the superficial dorsal veins, it was first described by Braun-Falco in 1955. Isolated superficial dorsal vein-thrombosis was reported in 1958 by Helm et al. Since then around fifty cases have been reported. Patients experience a cord or string-like induration along the penile superficial dorsal vein, which is often painful and accompanied by localized inflammatory changes. This condition is benign and self-limited in most patients with complete resolution after 6 to 8 weeks of conservative management although sometimes surgery is indicated when it is associated with chronic or severe local pain. MATERIAL AND METHODS: We report on a 23-year sold man with Mondor's disease of the penis following a normal sexual intercourse, who recently underwent microsurgical left varicocelectomy. RESULTS: Treatment consisted in NSAID Aulin (100 mg orally twice a day for 3 weeks) Ciproxin (500 mg orally twice a day for 10 days), Reparil 1 x 3 orally for 25 days and Lansox 30 mg orally 1 per day for 21 days. The patient was advised to abstain from sexual intercourse or masturbation until the thrombosis had completely resolved. In the follow-up visit there was the complete resolution of the disease with no evidence of superficial dorsal vein thrombosis or palpable penile plaque 30 days later. The patient was also able to have sexual intercourse without problems. CONCLUSION: Although penile Mondors' disease is rare, proper clinical diagnosis and consequent reassurance can help the patient to dissipate the anxiety and the following erectile dysfunction. Ultrasound and Doppler Ultrasonography examination was not useful for diagnosis but helped the clinician to show the patient that the disease is a benign condition.

Adult↗
PubMed2005

Measurements of urinary bladder volume: comparison of five ultrasound calculation methods in volunteers.

OBJECTIVES: To assess the precision of five different calculation methods in real-time bladder volume measurement. MATERIAL AND METHODS: Bladders from 10 medical staff volunteers were examined. Two examinations of each subject were performed by one examiner using the same ultrasound scannet Five different calculation algorithms were used on the frozen ultrasound pictures: the prolate ellipsoid method based on the formula: volume = length x width x heigth x 0.52 on two dimensions; the double area method based on the formula: volume = ex [C1 + C2 x ln(A1) + C3 x ln(A2)] on two dimensions; The double ellipsoid method on two dimensions; the method of one dimension of the shape of the bladder outlined manually with the maximal longitudinal diameter; the method of one dimension of the shape of the bladder outlined by smooth ellipsoid with the maximal longitudinal diameter After registration of the voided volume the subjects were scanned again in order to assure complete emptying. RESULTS: Voided volumes ranged from 120 ml to 465 ml. The precision of each method was equal. Errors were not more than 25% of the voided volume. No significant improvement in accuracy for any of the methods was found. CONCLUSIONS: Ultrasound bladder volume calculation is an easy method for estimation of bladder volume. Errors can be reasonably accepted. Large variation, irrespective of methods, from the true bladder volume, indicates that the clinical evaluation of ultrasound bladder measurement must be interpreted with great care in some patients.

Female↗
PubMed2004

Penile metastasis from primary transitional cell carcinoma of the renal pelvis: first manifestation of systemic spread.

BACKGROUND: Almost one-third of all penile metastases are detected at the same time as a primary tumor, whereas the remaining two-thirds are detected a mean of 18 months after the discovery of the primary tumor. Cutaneous metastasis of transitional cell carcinoma (TCC) is extremely rare and generally accepted as the late manifestation of a systemic spread. CASE PRESENTATION: We report the first case of simultaneous penile and lung metastases from a primary TCC of the renal pelvis in a 76-year-old man, that occurred 8 years after a left nephroureterectomy. CONCLUSIONS: This case report underscores the importance of physical examinations of the skin of patients who undergo surgical procedures for TCC from bladder as well as from the upper urinary tract, including those seemingly without metastatic disease, because of the possibility of skin and penile metastatic spread.

Aged↗
PubMed2004

Primitive Neuroectodermal Tumor (PNET) of the kidney: a case report.

BACKGROUND: A case of Primitive Neuroectodermal Tumor (PNET) of the kidney in a 27-year-old woman is presented. Few cases are reported in the literature with a variable, nonspecific presentation and an aggressive behaviour. In our case, a radical nephrectomy with lymphadenectomy was performed and there was no residual or recurrent tumour at 24-month follow-up. METHODS: The surgical specimens were formalin-fixed and paraffin embedded. The sections were stained with routinary H&E. Immunohistochemistry was performed. RESULTS: The immunohistochemical evaluation revealed a diffuse CD99 positivity in the cytoplasm of the neoplastic cells. Pankeratin, cytokeratin AE1/AE3, vimentin, desmin, S100, cromogranin were negative. The clinical presentation and the macroscopic aspect, together with the histological pattern, the cytological characteristic and the cellular immunophenotype addressed the diagnosis towards primary PNET of kidney. CONCLUSIONS: Since sometimes it is difficult to discriminate between PNET and Ewing's tumour, we reviewed the difficulties in differential diagnosis. These tumors have a common precursor but the stage of differentiation in which it is blocked is probably different. This could also explain their different biological behaviour and prognosis.

Adult↗
PubMed2004

Adrenal myelolipoma associated with adenoma.

The association of an adrenal myelolipoma with a non-functioning adenoma is very rare. Herein, we report on such a case in an asymptomatic 64-year-old woman. To the best of our knowledge, there is only one other case of non-functioning adrenocortical adenoma associated with myelolipoma in the same gland. Furthermore, only two other adenomas (mineral corticoids and corticosteroid producing tumors) associated with myelolipomas have been reported, and both myelolipomas were less than 1 cm in size. In conclusion, the 8.5 cm myelolipoma in our case is the largest compared with the three previously reported ones.

Adenoma↗
PubMedDate not supplied

Cardiovascular parameter changes in patients with erectile dysfunction using pde-5 inhibitors: a study with sildenafil and vardenafil.

Sildenafil is the most prescribed oral agent for patients with erectile dysfunction (ED). Vardenafil is a new phosphodiesterase type 5 (Pde-5) inhibitor that was approved by the US Food and Drug Administration last year to treat patients with ED of various causes. Both of these Pde-5 inhibitors have vasodilating properties and effects on blood pressure (BP), and like nitrates, they work through the nitric oxide cyclic guanosine monophosphate pathway. The aim of this study was to investigate the influence of these Pde-5 inhibitors on BP and heart rate (HR) in normotensive men with ED by a crossover comparison. Thirty-five patients with ED were enrolled to evaluate and compare the effect of sildenafil (50 mg) and vardenafil (10 mg) on BP and HR. At the screening (baseline [B]) visit, sitting systolic blood pressure (B-SBP), diastolic blood pressure (B-DBP), and HR were measured. We performed a multiple administration for both drugs and, therefore, multiple measurements of BP and HR changes, 3 doses a week, on alternate days, late in the afternoon, and on an empty stomach. B-SBP, B-DBP, and HR were recorded before each 50-mg sildenafil dosing and after 30, 60, 120, and 240 minutes. Data were averaged over the 4 time points and compared with the baseline values obtained before each dosing. After a 3-week wash-out period, patients were crossed over to vardenafil (10 mg) with the same study design. After administration of both drugs, we observed a statistically significant decrease of BP and an increase of HR. On average, sildenafil caused a decrease of SBP ranging from 5.1 +/- 3.9 mm Hg during the first dosing to 4.7 +/- 4.2 mm Hg during the third dosing, DBP ranged from 4.4 +/- 4.9 to 4 +/- 4.1 mm Hg, and HR increased 1.8 +/- 2.0 bpm (first dose) and 1.2 +/- 0.9 bpm (third dose). With vardenafil, we recorded a greater variation for SBP and DBP. SBP decreased from 8.02 +/- 8.0 mm Hg during the first dosing to 5.4 +/- 5.5 mm Hg during the third dosing, whereas DBP decreased from 6.6 +/- 7.2 to 5.0 +/- 5.3 mm Hg, respectively. Recorded HR showed an increase of 3.1 +/- 3.2 bpm (first dose) and 2.4 +/- 2.3 bpm (third dose). After the first vardenafil administration, we recorded fainting episodes in 3 patients because of a decrease in BP greater than 20 mm Hg. Two of the patients were in therapy with doxazosin for benign prostatic hyperplasia (BPH). Cardiovascular response was not significantly different after the first dose between the 2 treatments. Vardenafil demonstrated clinically significant differences (fainting) with respect to sildenafil only during the first doses. We suggest that before starting therapies with Pde-5 inhibitors, particularly with the newer ones, that baseline cardiovascular parameters are measured and monitored, especially during the first dose, because of the presence of a "first dose effect." Moreover, it is necessary to pay particular attention to those patients in treatment with other drugs that could have a synergistic hypotensive effect as a result of vasodilation potentiation.

3',5'-Cyclic-GMP Phosphodiesterases↗