Biomedical subjects

S Cosciani Cunico

Publications and source records attributed to S Cosciani Cunico.

At least 19 recordsLinked to original sources

PubMed2005

[Fluorescence endoscopy in the diagnosis and treatment of superficial bladder neoplasms].

AIM: The results of a clinical investigation on neoplasm and bladder dysplasia detection by 5-aminolaevulinic acid (5-ALA)-induced fluorescence are reported. In this paper the authors report their experience with 5-ALA in the diagnosis, treatment and follow-up of bladder neoplasms after chemotherapy and endocavitary immunotherapy. METHODS: The 5-ALA was instilled in the bladder 2 h before bladder transurethral resection. This method has been used since December 2000 on 163 patients and a total of 266 biopsies were histologically examined. RESULTS: One-hundred and four benign and 92 malignant/dysplastic areas were biopsied; 46 malignant/dysplastic lesions were not detected during routine white-light cystoscopy but were identified with fluorescence cystoscopy. Sensitivity was 99% but specificity was low (20%). CONCLUSIONS: ALA-based fluorescence cystoscopy is a safe and simple technique that enhances the detection of flat and papillary urothelial neoplasms.

Adult↗

PubMed2003

The collecting duct carcinoma of the kidney: a cytogenetical study.

OBJECTIVES: The Heidelberg classification of renal tumours identifies five histotypes of renal cancer, underlining for two of them (conventional and papillary renal cancers) a strict relation between the morphological aspect and the complement of alterations evidenced by the cytogenetic analysis of the neoplastic karyotype. Due to its low incidence, the collecting duct carcinoma (CDC) has not yet been characterized from a cytogenetic point of view. This study analyses the clinical, morphologic and cytogenetic features of the CDC observed and treated in our department. METHODS: From January 1995 to December 2002, among the 591 patients who underwent surgery for renal cancer, we observed 11 cases of CDC (prevalence 1.9%) treated either by radical (9 cases) or partial nephrectomy (2 cases). During radical nephrectomy a loco-regional lymphadenectomy was always performed. In the 9 cases observed after 1997, a complete cytogenetic analysis of the neoplastic karyotype was carried out. RESULTS: At pathological examination the disease was found to be confined to the renal capsule (TNM 1997 stage 1) in only 3 patients; venous neoplastic trombosis and nodal metastasis were present in 3 and 6 cases respectively; 2 patients showed distant metastases (lung, bone). Two of the patients affected with stage 1 tumours are still alive with no evidence of the disease at 48 and 88 months after surgery, while the third died following the systemic progression of a concomitant bladder carcinoma. One patient with stage 4 tumour (no. 11) is alive, but the follow up time is still limited (2 months). All the other 7 patients are dead after a mean survival time of 16.3 months (range 0-45). As for cytogenetic analysis, 2 CDCs didn't grow in culture and in one case no karyotype alterations were reported. In the remaining 6 cases hypodiploid stemlines and a homogeneous chromosome alteration pattern were observed, with multiple numerical and structural aberrations (mean 11.1, range 7-15) and the continuous involvement of chromosomes 1 and X or Y, both as traslocation and deletion/monosomy. Additional abnormalities of chromosomes 22 and 13 were found to be common but less frequent. CONCLUSIONS: The clinical behaviour of the CDC is aggressive and its prognosis is surely poor; surgical treatment seems to be curative only for organ-confined cancer, accounting for the minority of cases. This neoplasm is cytogenetically characterized by hypodiploid stemlines with common involvement of chromosome 1 and the autosomes.

Aged↗

PubMed2003

3-month formulation of goserelin acetate ('Zoladex' 10.8-mg depot) in advanced prostate cancer: results from an Italian, open, multicenter trial.

OBJECTIVES: To determine the endocrine effects, efficacy and tolerability of the 3-month formulation of goserelin acetate ('Zoladex' 10.8-mg depot; 'Zoladex' is a trade mark of the AstraZeneca group of companies) in the treatment of patients with advanced prostate cancer. METHODS: Between February 1996 and October 1997, this open, multicentre study enrolled 120 patients with locally advanced (T3/4) or metastatic (N+ or M1) disease, or an increase in prostate-specific antigen (PSA) level after radical prostatectomy. Patients received goserelin acetate 10.8-mg depot every 12 weeks until clinical progression or interruption for adverse events or other reasons. RESULTS: The mean testosterone concentrations were suppressed to the castration range (< or =2 nmol/l) after 4 weeks of treatment and remained suppressed throughout the study. In total, 99/115 (86%) patients had a serum PSA response, and the mean PSA value decreased significantly during treatment (p = 0.006). The mean PSA level at baseline was significantly lower in patients without disease progression compared to those who experienced disease progression (p = 0.0002). Goserelin acetate 10.8-mg depot was well tolerated and there were no injection site reactions. CONCLUSIONS: The goserelin acetate 10.8-mg depot is well tolerated with no injection site reactions. It produces PSA responses and provides reliable suppression of serum testosterone.

Aged↗

PubMed2002

Use of pedicle flap from the labia minora for the repair of female urethral strictures.

INTRODUCTION: We present the method of pedicle labial urethroplasty for urethral reconstruction in female patients treated for urethral strictures. PATIENTS AND METHODS: We performed urethral reconstruction using a pedicle labial flap in 2 female patients (23 and 70 years old) for urethral stricture (posttraumatic and postinflammatory origin). We used as a patch a pedicle skin flap obtained from the labia minora. The pedicle flap is slid beneath the vulvovaginal wall, until the urethra is reached. RESULTS: In both cases a normal micturition was obtained, and cystourethrography after 24 months showed a good urethral silhouette, without residual urine. CONCLUSION: The pedicle labial urethroplasty seems to be a reliable technique for the repair of urethral strictures.

Adult↗

PubMed1997

[Conservative therapy of renal parenchymal neoplasia].

We review our overall experience in 1375 patients, who underwent surgery for renal cell carcinoma in the Departments of Urology of Brescia and Bergamo from 1983 to 1996. 185 (13.4%) patients had nephron-sparing surgery: imperative procedure was performed in 74 cases, while an elective surgery was done in 111 patients. Three years minimal follow up was considered in order to evaluate the outcome of surgical treatment in 48 patients who underwent imperative nephron-sparing surgery and in 73 with an elective procedure. Disease specific survival was 80.8% in the first group and it was 97% in the latter.

Adult↗

PubMed1996

Bladder cancer and occupation: a case-control study in northern Italy.

OBJECTIVES: A hospital based case-control study was conducted between 1992 and 1993 in the province of Brescia, a highly industrialised area in northern Italy, to evaluate occupational risk factors of bladder cancer. METHODS: The study evaluated 355 histologically confirmed cases of bladder cancer (275 men, 80 women) and 579 controls affected by urological non-neoplastic diseases (397 men, 182 women). Lifetime occupational history, smoking and drinking habits, and sociodemographic characteristics were recorded by means of a structured questionnaire. Odds ratios (ORs) were computed with adjustment for age, smoking, alcohol and coffee consumption, education, and place of residence. RESULTS: A significant (P < 0.05) increase of risk of bladder cancer were found in men for labourers in the construction industry (OR 2.1, 95% confidence interval (95% CI) 1.1-3.9) and for recreational and cultural services (OR 5.0, 95% CI 1.3-18.9). Increased risks, although not significant, were found for various other occupations and industries such as machinery mechanics, metal processers and polishers, blacksmiths, gunsmiths, painters; for transport workers, an increased risk with increasing duration of employment was found. CONCLUSIONS: Occupational exposures seem to contribute to bladder cancer risk in the area under study.

Adult↗

PubMed1996

Damage to the erectile function following radical pelvic surgery: prevalence of veno-occlusive dysfunction.

A retrospective study was carried out to investigate the prevalence of venoocclusive dysfunction (VOD) in 44 patients who developed impotence following radical cystectomy (24 patients, 55%) and radical prostatectomy (20 patients, 45%) for invasive cancer, performed using a non nerve-sparing technique. Patient evaluation included sexual history, hormone profile, intracavernosal injection test and, in the nonresponders to the test, dynamic infusion cavernosometry and cavernosography (DICC). The follow-up period investigated ranged from 6 months to 9 years and 5 months (average 2.5 years). Our data indicate a 11% prevalence (5 patients) of postsurgical VOD with impotence following radical cystectomy and a 5% prevalence (2 patients) of impotence following radical prostatectomy. In the 7 patients (5 after cystectomy and 2 after prostatectomy) who underwent DICC, cavernosal artery insufficiency was detected. No correlation was found between VOD and the time from surgery (from 6 months to 9 years, average 4.4 years), in both the post-cystectomy and post-prostatectomy groups. Our data indicate that there are not only neurogenic causes of impotence following radical pelvic surgery, VOD and cavernosal artery insufficiency can also be partly responsible. Furthermore, it was shown that erectile inactivity, even in the long-term, does not affect the possible return of drug-induced sexual potency.

Adult↗

PubMed1996

[T1G3 bladder neoplasms: treatment and results].

The high risk of progression found in T1G3 bladder cancer influence the treatment and follow-up of this kind of patients. From January 1983 to December 1992, 803 patients with superficial bladder cancer (first presentation) had observed in the Urology Department at the Spedali Civili in Brescia. In this group, 96 patients were classified as T1G3 and our retrospective study is a critical analysis about their treatment: 13 patients underwent cystectomy as primary treatment and 83 had been cured with a transurethral resection. Of this last group, 26 patients are still without of disease (mean follow-up: 4.2 years), 30 had a recurrence which, in stage and grade, was identical or lower to the initial disease and 27 patients had a progression. Alltogether 36 patients underwent cystectomy: 15 are tumor-free and 21 died. The results of this retrospective study, led us to believe that T1G3 bladder cancer therapy is endoscopic at the beginning. Adjuvant topic chemotherapy treatments improve the recurrence rate tangibily; an early-operated cystectomy permits a good rate of recovery.

Carcinoma, Transitional Cell↗

PubMed1996

[Vascular and lymphatic anatomy of the penis].

Anatomic considerations of the penis and its lymphatic drainage are analyzed in this issue. The precise anatomic location of the inguinal and iliac lymph nodes and the fascial planes of the femoral canal is very important to the surgeon to reduce the high morbility of lymphadenectomy.

Humans↗

PubMed1996

[Carcinoma of the penis. Staging].

The two main classifications for staging carcinoma of the penis are the Jackson, which is probably the most commonly employed, and the UICC, TNM. A consistent method of staging penile cancer as been difficult, as there is no standard use of classifications. The ideal system would directly or indirectly predict the natural life expectancy of the host, the malignant potential of the tumor, the extent of the tumor and dictate the response of the tumor to treatment. Currently, using a grading system in addiction to the staging system has not improved correlation with prognosis. Prognosis appears to correlate only with stage at presentation, and the most reliable prognostic indicator of survival is the presence or absence of lymph nodes involvement at presentation.

Humans↗

PubMed1996

[Multicenter study of penile cancer].

The authors report the experience about diagnosis, treatment, results and follow-up on penile cancer of 15 department of urology of Lombardia region. The aim of the study is to find, through the historical experience, the better way to menage this rare cancer.

Adult↗

PubMed1996

[Urodynamic evaluation of replacement bladders (Mainz)].

42 ileo-colonic orthotopic reservoirs (M.A.I.N.Z.) following radical cystectomy were evaluated with urodynamic studies. Long term results in 19 patients with a follow up longer than 36 months were compared to the findings of 23 patients with a shorter follow-up. Urodynamic evaluation showed a reservoir with large capacity and low pressure in both groups. Nocturnal incontinence occasionally occurred. Many factors may account for this problem. Instillation of hyperosmotic solution during cystometry resulted in increased amplitudes and frequency of intracavitary pressure waves: the nocturnal increase in urine osmolality could be in correlation with nocturnal incontinence.

Adult↗

PubMed1996

[Morbidity of transperineal echo-guided prostatic biopsy, our experience].

We present a review of 1245 patients undergone to ultrasound guided transperineal prostatic biopsy. We examined the complications' incidence of this technique to confirm or exclude presence of prostate cancer. Indications to a prostatic biopsy include an abnormal digital rectal examination, TRUS or PSA values increased. Single biopsy or systematic mapping of prostate were performed. For prostate biopsy a "Biopsy Gun" with 18 G. needle was used. Of 1245 patients, only 31 (2.48%) showed complications. Our experience demonstrates that ultrasound guided transperineal prostatic biopsy is a safe and easy technique and it is well accepted by the patient.

Aged↗

PubMed1995

Surgery of lung metastases in renal cell carcinoma.

OBJECTIVE: To examine the impact on survival of pulmonary resection in the treatment of renal cell carcinoma that has metastasized to the lung. PATIENTS AND METHODS: From June 1986 to July 1991, 19 patients were submitted to synchronous or asynchronous lung metastasectomy. Histological examination confirmed the presence of lung metastases from renal cell carcinoma in 16 cases (six synchronous and 10 asynchronous with a mean disease-free interval of 23 months). In the other three cases, histological examination revealed tuberculomas, chondroid hamartoma and foci of anthracosis. RESULTS: To date, among the six patients with synchronous lung metastases, three have died, two are progressing and one has no evident disease after a mean survival of 24 months. Among the 10 patients who underwent surgical resection of metachronous lung metastases, one has died, three are progressing and six have no evident disease (mean survival time, 43 months). CONCLUSION: While the presence of synchronous lung metastases is an unfavourable prognostic factor even after surgical removal (five out of six patients died or are in progression shortly after metastasectomy), the results after surgery of asynchronous lung metastases are encouraging, although the real efficacy of this treatment is still to be confirmed.

Carcinoma, Renal Cell↗

PubMed1995

[Retropubic adenectomy (Millin's technique). Our experience].

From January 1983 to December 1993, on 1917 ptz who underwent to operations for BPH, 1532 pts (80%) had transurethral adenomectomy, and 385 pts (20%) had retropubic adenomectomy. The prostatic weight, obtained by ultrasound, is the factor which determines the kind of operations: transurethral adenomectomy if the prostate weight is lower than 50 gr, open surgery if it is more than 50 gr. In our experience about retropubic adenomectomy (Millin) we never had patient's death during operation or in the immediate post-operatively period. The early complications were 13.7%, and the late complications were 3.8%. The retropubic adenomectomy, when performed with right indications, is still valid.

Aged↗

PubMed1995

[Role of intraprostatic stents in benign prostatic hypertrophy].

We report our indications and experience in the use of intraprostatic endoprosthesis. We report also our preliminary experience in the use of a new intraprostatic endoprosthesis which has been developed at our institute. This prosthesis can be easily positioned, shows little invasiveness and does not require ultrasonic, radiological or endoscopical guidance.

Adult↗

PubMed1995

[Extra-aponeurotic traditional radical prostatectomy].

Radical extra-aponeurotic prostatectomy is the surgical procedure which guarantees the best chances of total cancer ablation when the lesion is localized. Our incidence of positive specimen margins is low (4.6%). In our experience total incontinence occurs in 3 patients (3.5%). A low rate of post-operative complications makes this operation relatively safe and well accepted by patients. From our data "Nerve Sparing" prostatectomy must be reserved to selected cases in well motivated patients, because with this procedure the risk of oncological failure remains high.

Follow-Up Studies↗

PubMed1994

[Sex-dynamic characterization of patients subjected to radical pelvic cavity surgery].

A retrospective study was carried out using sexual case histories, hormonal profiles, vasoactive drugs test, dynamic cavernosometry and cavernosography on 46 patients who underwent radical cystectomy (26 patients: 57%) and radical prostatectomy (20 patients: 43%) for neoplasia, conducted by means of traditional surgical non-nerve sparing methods, in order to characterize the type of damage affecting the erectile function as a result of surgery. The study was carried out at a minimum of 2 months, a maximum of 9 years and 5 months, an average of 2 years and 6 months, after surgery. One patient (2%) reported intact erectile function and withdrew from the study. 37 patients (80%) showed neurological damage, while the remaining 8 (18%) had prevalently vascular damage.

Adult↗