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Biomedical subjects

L Miano

Publications and source records attributed to L Miano.

At least 19 recordsLinked to original sources
PubMed1998

[International prostate symptom score: comparison of doctor and patient].

The AUA 7 score was originally designed and validated to be self administrated to patients with LUTS, its subsequent endorsement by the WHO - BPH committee made it the most widely used. Translation into different was provided and sometime validated. Aim of the study was to investigate the possibility to self administer the IPSS questionnaire to patients referred to our Institution for lower urinary tract symptoms. Two hundred and thirty-tree consecutive patients were given the IPSS questionnaire as a part of the routine diagnostic schedule; a senior resident was available to answer any possible question from the patient. After the form was returned, a second IPSS questionnaire was filled in by investigator following patient interview. Data were entered into an Excel database and the following parameters were investigate: number of forms completely filled in by patient, number of question answered in incomplete forms, degree of concordance between patient and investigator. One hundred and fifteen patients were able to fill the AUA 7 form completely; the quality of life question was answered by ninety-six patients only. Comparison of individual scores provided by the patient or assigned by the investigator showed a trend for the physician to underscore the patient problem for question 1-4 and to overestimate it in questions 5 to 7. At the lower range of the IPS score (0-7) no significant different between physician and patient was found. In the intermediate range (8-19) the physician tended to overestimate the patient symptoms. The reverse situations was found in the high score range (20-35). Globally, there was a trend for the patient score to be higher than the one assigned by the investigator, Doctor IPSS and quality of life scores appeared to be significantly related. No relation was found between doctor IPSS and the degree of bladder outlet obstruction as measured by parameter of pressure-flow study and diagnostic nomograms. The IPSS form appeared to be a difficult questionnaire for our patients and less than half of them were able to fill it in properly. Overall, the investigators tended to underestimate the patient voiding disturbances. Careful linguistic review of the Italian version of the IPSS questionnaire is required to make self evaluation of patient symptom possible. Symptom grading by a trained investigator did not seem to introduce any significant bias which might be of importance for the sake of clinical trials.

Adult↗
PubMed1998

[The Studer orthotopic ileal neobladder: patient compliance].

Radical cystectomy represents the gold standard for locally advanced bladder cancer. Orthotopic neobladder is considered the surgical option which may offer the least modification of body image and the best life condition to the unfortunate patient requiring radical cystectomy. Objective of this study was to investigate long term clinical outcome of orthotopic ileal bladder substitute with special reference to late complications and patient compliance. Twenty male patients 48 to 71 years old (mean age 59.8 + 7.4 years) underwent radical cystectomy and Studer orthotopic ileal neobladder for invasive carcinoma of the bladder. Before surgery all patients filled in a phycometric test for evaluating their knowledge capacity; after surgery they underwent a course of biofeedback and instructed to avoid overfilling of the neobladder with timed micturitions and a regular regimen of fluid intake. Pressure flow study was included in the routine follow-up carried out at six months and then yearly. Seventeen patients (85%), with a good knowledge capacity, reported a good compliance to the modified life style imposed by the bladder substitute, they all were dry during the day with 3 to 5.5 hour interval between micturitions; fourteen of these patients were continent at night with timed micturitions every 3-4 hours (mean: 3.2); an average cystometric capacity of 450 ml was found in these patients with no residual urine; three patients (18%) had incontinence episodes once or twice a week during the night; no decompensation of the neobladder, significant ureteral reflux or dilatation were reported; elongation of the afferent loop was found in one patient following small bowel resection for ileal volvulus. Three patients (15%), with a reduced knowledge capacity, who did not follow the suggested life style: fluid intake was irregular, micturitions were not timed during both day and night time, had residual urine larger than 400 ml. and incontinence episodes requiring pads; nevertheless no dilation of the upper urinary tract was found. Our experience suggests that careful compliance of patients to the new life style imposed by the orthotopic neobladder is of importance to avoid its decompensation. The possible causative role of gastrointestinal hormones such as enteroglucagon (EG) and peptide tyrosine-tyrosine (PYY) in the elongation of the afferent limb of the Studer neobladder is proposed. In conclusion, we believe that orthotopic ileal neobladder is an ideal surgical option on in the young, educated and cooperative patients.

Aged↗
PubMed1997

Nocturnal enuresis and daytime wetting: a multicentric trial with oxybutynin and desmopressin.

OBJECTIVE: Different etiopathological mechanisms of enuresis are today under study, and different therapies and drugs have been proposed. The Italian Multicentric Trial was undertaken in twelve pediatric and urological centers in order to assess the efficacy of two of the most popular drugs, desmopressin (DDAVP) and oxybutynin. METHODS: 114 enuretic patients were enrolled in the study. After a 2-week observation period, 66 patients with primary monosymptomatic enuresis were treated with DDAVP, 30 micrograms/day intranasally, for 6 weeks, 48 patients with enuresis and voiding dysfunction were randomly assigned to a protocol with oxybutynin alone or oxybutynin plus DDAVP. The efficacy of the two drugs was measured in terms of reduction of wet nights per week during the 6-week treatment period and a 2-week follow-up period. Children with 0-3 dry nights/week were considered as nonresponders. RESULTS: Patients with monosymptomatic enuresis treated with DDAVP reported a significantly lower number of wet night during treatment than during the baseline period, with 79% showing a 'good' (6-7 dry nights/week) or 'intermediate' response (4-5 dry nights/week). Of the patients with diurnal voiding disturbances and enuresis, those treated with oxybutynin alone had a 54% success rate. The patients treated with both oxybutynin and DDAVP showed a better response, with a 71% rate of success. CONCLUSIONS: The efficacy of the two drugs is confirmed in patients carefully selected on the clinical basis of voiding disturbances. In patients with enuresis and voiding dysfunction, the reduced urinary output and the lower bladder filling rate due to DDAVP can reduce uninhibited bladder contractions, thus enhancing the oxybutynin action.

Administration, Intranasal↗
PubMed1995

The prediction of clinical outcome from transurethral microwave thermotherapy by pressure-flow analysis: a European multicenter study.

A total of 100 patients treated with a single session of microwave thermotherapy at 4 European centers was stratified according to 2 different types of obstruction (constrictive and compressive) and compared to clinical outcome at 6 months. Patients had a Madsen-Iversen score of 8 or more, maximum flow rate of 15 ml. per second or less and residual urine volume of 300 ml. or less at entry. The change in Madsen-Iversen score was the same in the 2 groups. Maximum flow rate increased from 8.71 +/- 2.62 to 14.73 +/- 4.04 ml. per second in the constrictive group, and from 8.54 +/- 2.26 to 10.41 +/- 4.52 in the compressive group (p < or = 0.0001). Residual urine decreased from 96.00 +/- 72.85 to 40.34 +/- 56.33 ml. in the constrictive group and from 109.86 +/- 67.09 to 84.65 +/- 81.45 ml. in the compressive group (p < or = 0.0001). Success, as defined by an increase of 50% or more in maximum flow rate and Madsen-Iversen score, was noted in 68% of the constrictive but only 15% of the compressive groups (p < or = 0.0001 chi-square test for trend). Selection by pressure-flow criteria for patients being considered for thermotherapy should improve the overall clinical results.

Diathermy↗
PubMed1995

Plasminogen activator activities in short-term tissue cultures of benign prostatic hyperplasia and prostatic carcinoma.

The high prevalence of prostatic carcinoma (PRCA) and the limited therapeutic possibilities provide a strong stimulus for exploring new approaches in experimental research that ultimately may lead to improved therapy. Indeed, methods for assessing carcinoma prognosis, such as clinical staging (clinical examination, ultrasound, and plasmatic levels of prostatic acid phosphatase and prostate specific antigen) and histopathological grading according to the Gleason score, usually fail to provide consistent predictive information regarding the clinical outcome of single tumors. Increased plasminogen activator (PA) activities have been associated with high-grade malignancies and with the potential for invasion/metastasis in many tumors. Urokinase-type plasminogen activator (uPA) is present in prostatic secretion, and an increased uPA activity has been noted in human prostatic cell lines with metastatic behavior. Unfortunately, any study of uPA production or gene regulation in primary tumors is complicated by the inherent mixture of host stromal cells, infiltrating macrophages, and subpopulations of tumor cells that may have variable metastatic capacity and ability to synthesize uPA. In short-term tissue culture of prostatic samples, it is possible to grow in vitro cancer prostatic epithelial cells and thus exclude the presence of contaminant cells. We have shown elsewhere that the levels of a type IV collagenase, 92-kDa matrix metalloproteinase, a protease involved in tumor progression and invasion, are increased in PRCA primary cell cultures if compared with benign prostatic hyperplasia (BPH) cell cultures (C. Festuccia et al., manuscript in preparation). Activation of matrix metalloproteinases also can be correlated with uPA expression; therefore we studied the expression of uPA in serum-free culture media of primary cultures of PRCA or BPH tissue samples.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMed1993

Early diagnosis of prostatic carcinoma may be achieved through in vitro culture of tumor cells harvested by prostatic massage.

As a new method for early diagnosis of prostatic carcinoma we succeeded in growing in vitro the epithelial cells which can be collected from prostatic fluid after rectal prostatic massage. We report here the updated and statistically analyzed series of data (174 patients) on this new approach, which allows all the harvested cells to express their biological features. The method reaches a sensitivity of 72-86% and a specificity of 88-100%. This noninvasive test, which is also suitable for mass screening, may be very useful for an early diagnosis of the neoplasm.

Adult↗
PubMed1993

[Transurethral thermotherapy by microwaves in patients with benign obstructive prostatic hypertrophy].

The effect of transurethral microwave thermotherapy (TUMT) with Prostatron in patients with benign prostatic hypertrophy was investigated. Two hundred and one patients were treated between January 1991 and June 1992 after informed consent was signed. The following examinations were carried out at screening: interview (including symptoms score evaluation), physical examination (including digital rectal examination), haematology and blood chemistry (including prostate specific antigen), ECG, chest Xray, kidney, bladder and prostate (transrectal) ultrasound sonography (USS) and uroflowmetry; pressure-flow study was performed in a selected group of patients. All enrolled patients had Madsen symptom score > or = 8; peak flow rate < or = 15 ml/s and post void residual urine < or = 200 ml. Patients with obstructive middle lobe of the prostate, any BPH complication or any suspicion of prostatic carcinoma were excluded from the study. Microwave thermotherapy with Prostatron was carried out according to software generation 2.0 (Prostasoft 2.0), the c10 (black) catheter was used in all patients. Follow-up visits were scheduled at 1 week, 1, 3, 6, 12, 18 months after microwave thermotherapy. Overall short- and long-term morbidity rates were 6.09 and 2.73 per cent, respectively. At 12 months, Madsen score was found to be reduced from 11.7 +/- 4.78 to 4.43 +/- 3.30; maximum flow rate (Qmax) was increased from 8.91 +/- 4.20 to 13.20 +/- 4.86; post void residual urine (PVRU) was reduced from 131 +/- 17.6 to 67.40 +/- 34.50.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-Up Studies↗
PubMed1992

[The alpha blockers].

Because the bladder neck contains a large number of alpha-adrenergic receptors, use of alpha-blockers to facilitate micturition in early benign prostatic hypertrophy has been advocated. Effects on micturition and urinary flow were fairly favorable. No adverse effects were recorded. The effect of therapy was transient and slightly greater than the effect of the placebo.

Adrenergic alpha-Antagonists↗
PubMed1991

Coffee and cholesterol, an Italian study.

In the present study, conducted in northern Italy between 1986 and 1989, the authors investigated the possible association between coffee consumption and serum cholesterol levels in 8,983 subjects, 7,432 men and 1,551 women, managers and employees aged 18-65 years, who were examined during a program of preventive medicine upon an agreement between various companies and the Centro Diagnostico Italiano. Analysis of covariance was used to compare the serum cholesterol levels of the subjects subdivided according to coffee consumption, along with age, body mass index, alcohol consumption, cigarette smoking, and physical activity. An important relation was demonstrated between coffee intake and cholesterol, particularly in the men, the differences in serum cholesterol in the coffee users compared with the nonusers being 6.1 +/- 1.4 (standard error) mg/dl for consumers of 1-3 cups/day (3.4 +/- 1.4 mg/dl after adjustment for age, body mass index, alcohol and cigarette consumption, and physical activity), 9.9 +/- 1.6 mg/dl for those drinking 4-5 cups/day (5.8 +/- 1.6 mg/dl after adjustment), and 14.8 +/- 2.0 mg/dl for those drinking over 5 cups/day (9.6 +/- 2.0 mg/dl after adjustment). This relation remained substantially unvaried when nonsmokers and smokers were analyzed separately. It has been suggested that it is coffee prepared by boiling rather than other methods that has a hypercholesterolemic effect. Our observations demonstrate an interesting relation between coffee and cholesterol, even though the coffee drunk in Italy is mainly filtered and nonboiled. However, our finding is not necessarily in disagreement with the above hypothesis since, when coffee is prepared in the Italian way (with the mocha method), ground coffee is preheated by steam and more importantly, the water passes through the ground coffee at a higher temperature than with the other brewing methods.

Adolescent↗
PubMed1991

Body mass index and liver enzyme activity in serum.

The association between body mass index (BMI) and serum liver enzyme activity [gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST)] was studied in 3167 subjects, 2373 men and 794 women. The subjects were managers and employees, ages 18-64 years, who were examined during a program of preventive medicine. Analysis of covariance was used to compare the serum liver enzyme activities (expressed as natural logarithms) of the subjects, who were subdivided according to BMI, while also considering age, alcohol and cigarette consumption, and physical activity. In men, the percentage increase in the geometric mean of liver enzyme activity of the obese subjects (BMI greater than 30 kg/m2) compared with that of the normal subjects (BMI less than or equal to 25 kg/m2) was 47.7% (P less than 0.001) for GGT, 55.3% (P less than 0.001) for ALT, and 19.7% (P less than 0.001) for AST; in women, the increase was 63.2% (P less than 0.01) for GGT, 58.4% (P less than 0.001) for ALT, and 7.3% (P greater than 0.05) for AST. Thus, our observations demonstrate a relation between BMI and serum liver enzyme activity.

Adolescent↗
PubMed1991

Defects in diagnostic kits for determination of urate in serum.

Certain diagnostic kits that measure serum urate by the Barham and Trinder principle of enzymic liberation of oxygen and its combination with chromogens can give results for urate in fresh serum that are approximately 20% lower than results from serum stored at ambient temperature for 72 h. In fresh serum, antioxidants compete with chromogen for liberated peroxyl-oxygen. We postulate that during storage the interfering antioxidant substances are destroyed. In some diagnostic kits, L-ascorbate oxidase is added to the reaction, eliminating some but not all of this effect. We discuss defects of several commercially available kits for determination of serum urate and recommend comparing results of these kits with results from the phosphotungstic acid method as a precaution against falsely low results.

Blood Preservation↗
PubMed1990

Effect of cigarette smoking and coffee consumption on apolipoprotein B levels.

Apolipoprotein B levels were studied in relation to cigarette smoking, coffee and alcohol consumption, physical activity, age and body mass index in 253 men aged 21-61 years. The mean apolipoprotein B level was 7.3 +/- 3.2 mg/dl and was higher for smokers compared with non-smokers. Considering the smokers of over 20 cigarettes/day and the non-smokers, this difference reached 12.6 +/- 4.3 mg/dl. A significant increase of 7.2 +/- 3.5 mg/dl in apolipoprotein B levels was observed in the subjects who drank over 3 cups of coffee/day compared with the remaining subjects, but the increase was only 4.3 +/- 3.7 mg/dl when we made a correction for cigarette consumption. Furthermore, for cigarette smoking and coffee consumption, there is apparently an interactive effect with BMI and/or age (vs apolipoprotein B levels). However, with a stepwise selection among explicative variables [age, BMI, smoking (yes/no) and coffee consumption (less than or equal to 3, greater than 3 cups/day)] and all their interactions of first order, only the interaction between BMI and smoking (BMI*smoking: b +/- ES (b) = 0.3029 +/- 0.0303), and age and BMI (age*BMI), are significantly and positively related to serum levels of apolipoprotein B. Thus cigarette smoking, interacting with high BMI, appear related to higher apolipoprotein B levels.

Adult↗
PubMed1990

Association between habitual coffee consumption and blood pressure levels.

The relationship between habitual coffee consumption and blood pressure was investigated in 9601 subjects (7506 men and 2095 women) who were office managers and employees, aged 18-65 years. Those who drank coffee had lower blood pressure levels than those who did not and the mean blood pressure levels decreased with increasing coffee consumption. In the men, blood pressure (systolic/diastolic) was highest in the non-coffee drinkers (130.0/83.0 mmHg) and lowest in those drinking greater than 5 cups/day (126.0/81.3 mmHg). Mean differences (+/- s.e.m.) corrected by analysis of covariance for age and body mass index (kg/m2) were: systolic -4.0 +/- 0.7 mmHg, P less than 0.0001; diastolic -1.7 +/- 0.5 mmHg, P less than 0.001. In the women, blood pressure ranged from 121.1/77.4 mmHg in the non-coffee drinkers to 117.7/76.2 mmHg in those drinking greater than 5 cups/day (mean +/- s.e.m. systolic difference -3.4 +/- 1.4 mmHg, P less than 0.05; diastolic -1.2 +/- 0.9 mmHg, P greater than 0.05). These observations were confirmed after correction for physical activity, and cigarette and alcohol consumption (for age and body mass index). In the men, blood pressure ranged from 130.8/83.1 mmHg in non-coffee drinkers to 127.5/81.9 mmHg in those drinking greater than 5 cups/day, with the effect of classification by coffee consumption being very important (analysis of covariance: systolic F = 12.17, 3 degrees of freedom at numerator, P less than 0.0001; diastolic F = 3.56, 3 degrees of freedom at numerator, P = 0.0135).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Magnetic resonance imaging in the localization of undescended abdominal testes.

In children with nonpalpable undescended testes, preoperative localization is very helpful prior to surgical investigation both to reduce the time required for complete exploration and to plan the correct surgical procedure. Magnetic resonance imaging (MRI) was accomplished in 23 patients with a clinical diagnosis of cryptorchidism after ultrasonographic studies were inconclusive in identifying the undescended testis. An abdominal testis was correctly located in 16 cases. No structures resembling testicular parenchyma were detected in 4 instances. The surgical findings confirmed the absence of testes in 2 patients but showed 2 abdominal testes not seen by MRI. The movements of 5 patients caused inadequate MRI examinations, so these patients were not considered in the results. In our experience MRI proved to be effective in locating undescended abdominal testes with a diagnostic accuracy of 90%. Therefore MRI should be performed before any invasive diagnostic procedure. Lack of cooperation in young patients could reduce the accuracy of the procedure, so we think that sedation should be performed in children under 6 years of age.

Abdomen↗
PubMed1990

Review of norfloxacin in lower urinary tract infections.

A review of worldwide clinical trials with norfloxacin in the treatment of uncomplicated urinary tract infections (UTIs), as well as our personal experience with 215 assessable patients, is presented. Almost all patients received 400 mg b.i.d. for 3-15 days. Bacteriological eradication (10(4) CFU/ml of urine or less) was achieved in more than 90% of patients. Short-term therapy (3 days) with norfloxacin proved to be as effective and tolerable as a 10- to 14-day conventional therapeutic schedule in the treatment of lower uncomplicated UTIs. Overall incidence of drug-related adverse experiences was 2.3%.

Clinical Trials as Topic↗