Biomedical subjects
Publications and source records attributed to S Ferretti.
Three cases of penile injury secondary to mishap during sexual intercourse are described. The injury involved unilateral corpus cavernosum associated with urethral rupture in one case, penile fracture in the second patient and isolated urethral fracture in the third. Diagnosis and treatment of these uncommon lesions are discussed.
No clear relation between lipoprotein(a) [Lp(a)] and endogenous gonadal hormones has been demonstrated. In this study, we compared the effects on Lp(a) of pharmacological castration in 50 patients with prostate cancer who were undergoing therapy with a gonadotropin-releasing hormone agonist (goserelin), with effects on 58 age-matched controls. We also studied 16 untreated patients under baseline conditions and after 3 months of therapy with goserelin alone or combined with an antiandrogen (flutamide). Neither cross-sectional nor prospective studies showed any significant effects of therapy on Lp(a). However, cluster analysis identified a subgroup of patients showing slight but significant increases in Lp(a) concentrations, as well as greater declines of testosterone and estradiol, suggesting that androgen, like estrogen, can exert some slight, though not easily detectable, influence on Lp(a).
Xantogranulomatous pyelonephritis is a rare disease, occuring most frequently in middle-aged woman. The patients usually present with recurrent fever, dysuria, renal colic or aspecific findings. We report a case of focal PXG (paranephric stage) treated with conservative surgery. Generally, treatment consists of nephrectomy for diffuse or advanced stage diseases, excision of the diseased renal segment for localized and low/high stage.
BACKGROUND: The biologic profile of 907 infiltrating breast carcinomas was determined considering estrogen receptor (ER) and progesterone receptor (PR), proliferation index (PI) and c-erbB-2/Neu expression. The relationship with pathologic parameters (lymph node status, size, histotype) were studied by a multivariate analysis. The clinical prognostic power of biologic profile also was evaluated for 265 patients. METHODS: In 907 infiltrating breast carcinomas, the quantitation of ER, PR, an PI was obtained with an image analysis system (CAS 200, Becton Dickinson Cell Analysis Systems, San Jose, CA); Neu was evaluated semiquantitatively. A clinical study of 265 patients was performed (median follow-up, 42.5 months). RESULTS: Seventy-seven percent of tumors were ER-positive, 70% were PR-positive, 58% had a high PI, and 35% were Neu-positive. The overall analysis indicated a direct correlation between ER and PR (Spearmans' rho [rs] = 0.47, P < 0.001) and an inverse correlation between PI and ER (rs = -0.39, P < 0.001), PI and PR (rs = -0.32, P < 0.001), Neu and ER (rs = -0.20, P < 0.001), and Neu and PR (rs = -0.21, P < 0.001). Cluster analysis, performed based on the biologic profile (ER, PR, PI, c-erbB-2/Neu expression), identified two final groups of tumors with different pathologic features. This study showed a longer relapse free interval for patients with ER- and PR- positive tumors (P = 0.016 and P = 0.007) and low PI and Neu-negative tumors (P < 0.001 and P = 0.047). CONCLUSIONS: These results stress the importance of the biologic profile for defining tumor behavior and patient management, leading to integration of, and eventually the substitution for, the actual staging system.
The effects of increasing concentrations of Cl-, ClO4-, and HCO3- on the redox potential of Rhodopseudomonas palustris cytochrome c2 indicate that the two polyatomic anions bind specifically to the protein at one site, while chloride simply exerts an ionic atmosphere effect. The change in E degree upon specific anion binding allows us to probe for the influence of surface charges on the redox potential of cytochromes c. The decrease in redox potential at null ionic strength (delta E degree I = 0) due to anion neutralization of one positive surface charge was found to be 23 mV with perchlorate and 33 mV with bicarbonate. These values compare reasonably well with previous theoretical predictions and estimates of the effect of charge alteration on the E degree values in cytochromes c chemically modified or mutated at surface lysines. These delta E degree values, determined on the unmodified protein, are unprecedented for c-type cytochromes. The anion-induced chemical shift changes of the hyperfine-shifted heme 1H-NMR resonances of the oxidized protein yield lower limit values of 53 M-1 and 18 M-1 for the affinity constant for specific HCO3- and ClO4- binding, respectively.
The pH-induced protein conformational transitions and changes in the ligation state of the heme iron in cytochrome c2 from Rhodopseudomonas palustris were monitored by electrochemical and spectroscopic measurements. In the pH range 1.5-11, the E degree values (and/or the peak potentials) determined by cyclic voltammetry, the electronic spectra and the hyperfine-shifted 1H-NMR resonances of the protein are sensitive to a number of acid/base equilibria. In particular, four equilibria have been determined for the oxidized protein with pKa values of 2.5, 5.5, 6.6 and 9.0. The lowest pKa most probably involves disruption of both axial heme iron bonds and protein unfolding. The subsequent pKa is associated with a low-pH oxidation of the protein by dioxygen, which is accompanied by a conformational change. The equilibrium with an apparent pKa of 6.6 modulates the E degree values without determining any detectable spectral change and most likely involves the acid/base equilibrium of an histidine residue in close vicinity of the heme (possibly His53). Finally, the alkaline ionization is due to the replacement of the methionine axially bound to the heme iron with a stronger (most probably N-donor) ligand. The reduced alkaline form is unstable and spontaneously converts to the neutral reduced form with a kinetic constant of 0.98 s-1 at pH 9.2.
A novel iron-sulfur protein from the photosynthetic purple bacterium Rhodopseudomonas palustris was purified to homogeneity and identified as a ferredoxin on the basis of its physicochemical properties. Based on the uv/vis spectrum, iron quantitation, cyclic voltammetry, EPR, and 1H NMR data, the ferredoxin is found to contain two iron-sulfur clusters, one [3Fe-4S] and one [4Fe-4S], which places this protein in the class of 7Fe ferredoxins. The voltammetric peak potentials of the two clusters are -0.260 and -0.560 V at pH 8.0. The molecular mass around 19 kDa makes this protein the heaviest known in this class. This paper further demonstrates the diagnostic power of magnetic resonance spectroscopies in recognition of the two types of clusters in iron-sulfur proteins.
Twelve patients are submitted to orthotopic ileal neobladder, performed using staplers. The simplicity and speed of automatic stapling devices in the Rouxel-Coadou's surgical technique are reported. All patients underwent clinical and urodynamic evaluation at 3, 6, 12 months, after surgery (mean follow-up 6 months). They preferred complete daytime continence and 2 pts/4 night-time continence too. At one year, postvoid residual volume was absent, mean neobladder capacity was 450 ml and mean pressure at maximum capacity was 30-40 cm H2O. These preliminary results indicate that this technique guarantees a low-pressure reservoir with good capacity and compliance.
We report our experience on 63 patients submitted to kidney stone surgery, between january '88 and june '94, at the Division of Urology, in Parma (Italy). Nowadays percutaneous lithotripsy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) permit the resolution of lithiasic disease in more than 90% of the cases; in fact, the incidence of open surgery in only about 1-12%. At the present, the role of traditional surgery is also directed to resolution of damages of endourological and extracorporeal failures, as post-traumatic events. We want to emphasize, as now, that essential surgical approach to kidney surgery is lacking in the aim of young urologists training.
The authors report 106 consecutive patients who underwent percutaneous removal or debulking of renal stones from March '88 to June '94. Removal was successful in 64 pts (60%), while 6 patients (5.6%) needed a second-look section and in one case (0.9%) a third-look; in 33 cases (31.3%) PCNL was performed as debulking procedure before ESWL. The major complications were: 1 severe haemorrhage with secondary nephrectomy, 2 respiratory complications, 1 intestinal fistula, 2 hyponatremic syndromes, 1 global kidney functional exclusion and 1 sectorial exclusion. PCNL is an effective technique to treat the majority of single big renal stone or debulking procedure in staghorn calculi before ESWL.
The authors report their experience with a third generation lithotripter Storz-Modulith SL 20 with fluoroscopic and echography stone localization. A total of 284 patients, between september '92 and august '94, with 149 renal and 135 ureteral stones, underwent 483 treatments. The mean treatment rate was 1,7 and the over-all stone free rate was 93%. Auxiliary procedures before ESWL were performed in 5.1% of the sessions (stenting, nephrostomy tube) and in 1% post-ESWL manipulations for lithiasic steinstrasse. Complications as: renal damage, steinstrasse etc. occurred in 2.5% of the session; in 20 patients ESWL procedure failed.
We report our experience with orthotopic ileal neobladder, after radical prostatocistectomy for local advanced cancer. We performed 2 reservoirs using Camey's I-II procedure, 4 Studer, 3 Hautmann, 4 VIP and 17 performed using staplers, according to Rouxel-Coadou's technique (we underline the simplicity and speed of automatic stapling devices, very important elements for surgical staff performance in this kind of surgery). Clinical and urodynamic evaluations were performed at 3,6,12,18 months and after every year (mean follow-up 18 months). All patients referred day-time continence already 3 months and 7/10 pts (70%) night-time continence too, after 24 months; the others referred moderate incontinence (1 pad for night). The urethral sphincter was well preserved in all patients (MUCP 72,4 cm H2O). At 18 months, post-void residual volume was absent, basal cystometric pressure was 10-15 cm H2O and mean neobladder capacity was 475 ml. We report 2 cases of reservoir calculosis, 2 stenosis of neobladder-urethral anastomosis and 2 pts with I-II grade hydronephrosis (in first case it's monolateral, the second is a bilateral case) owing to a stenosis of ureteral-ileal anastomosis. In short, the use of debutularizated and bended ileum allows to achieve a low pressure with an adequate capacity and continent orthotopic reservoir.
Fibroangiomatous polyps and its histological variants most often occur in the ureters of young adult. They may be multiple, and rarely occur in the renal pelvis. Microscopically, normal or hyperplastic urothelium cover loose, vascular, edematous, fibrous stroma that may be inflamed. Etiologic factors are unknown. Intermittent flank pain is the most common symptom; dysuria and hematuria occur less frequently. A case of fibroangiomatous polyps of the left ureter, in a 37-years old woman, is presented. We emphasize the endoscopic conservative treatment of this lesion as a valid alternative to the surgical approach; beside, it's important to obtain pre-operative histological finding, confirming the benign lesion.
Dynamic and static factors cause infravesical obstruction in men with BPH. The dynamic component is determined by alpha 1-adrenoceptor-mediated contractions of the prostate smooth muscle and bladder neck. Using alpha-receptor-blockers will relieve bladder outlet obstruction, improving urinary flow rates and obstructive and irritative symptoms as well as the physician's global assessment. This study was performed to evaluate the efficacy and safety of alpha 1 blockers (terazosin and alfuzosin) in ambulatory patients (n = 20) with BPH. After 24 weeks of therapy, the peak flow rate increased 54% from a baseline average of 8.5 ml/s to 13.1 ml/s (p < 0.01). The mean flow rate increased 49%, from a baseline of 4.61 ml/s to 6.9 ml/s (p < 0.01); residual volume decreased 74% from 48.3 ml to 12.5 ml (p < 0.001). Mean systolic blood pressure decreased significantly (p < 0.05) from baseline, but this change wasn't clinically important. The clinical experience with alpha-blockers in BPH indicates that these drugs increase urinary flow rates, decrease obstructive and irritative symptoms, without serious side effects.
Percutaneous approach to complicated small caliceal diverticula is the first choice therapy. Generally, the open surgery is used large diverticula with renal parenchymal damage but, in selected cases, a percutaneous (PCN) treatment may be an effective alternative. The Authors report a case of inferior caliceal diverticulum associated to a parenchymal damage successfully treated using directed PCN management (electrical fulguration) and consequent injection of human fibrin glue.
Endopyelotomy is, in our opinion, the most proper therapeutic strategy for the treatment of UPF post-surgery stenosis, as a traditional re-operation is often difficult to be carried out and not exempt from possible stenotic relapse. We report 2 cases of secondary stenosis and inferior caliceal stones associated. As a first step we subjected the patients to a percutaneous lithotomy of the calculi and we kept a trans-calyceal nephrostomy in situ for about 5 days. Among the different EPT techniques, we chose the "transurethral traction" Rippa-Franch set, as the dynamic combined transurethral traction of the cold-knife allows a smooth dissection of the strongest cicatrix pad, too. The stenting of the dissected UPF has been carried out for few days by means of a Korth's temporaneous nephrostomy and subsequently, at light-coloured urine, by using the definitive Korth endostent by subcutaneous anchorage. This internal stenting system seems to be the most suitable one, as the patient can stand it quite well for long periods of time (3-6 months) too and it is not burden with V-U refluxes that could jeopardize the good result of the operation. The easy performance and good results achieved by this way, persuade us to suggest this two combined techniques as an effective endourological solution for UPF post-surgery stenosis.
Within the framework of an investigation of the electronic structure of oxidized high-potential iron-sulfur proteins (HiPIP), we have studied the HiPIP II from Ectothiorhodospira vacuolata, which was known to have a peculiar temperature dependence of the 1H NMR isotropic hyperfine shifts. The signals of the cysteine ligand protons have been sequence specifically assigned through NOE, NOESY, and TOCSY experiments. Nine hyperfine-shifted signals are observed: seven in the downfield and two in the upfield region. They have been assigned to the eight beta-CH2 protons of the four coordinated cysteines and to one alpha-CH cysteine proton. The two most downfield-shifted signals belong to the beta-CH2 protons of Cys 63 (Chromatium vinosum numbering) and the two upfield protons to those of Cys 43. These two pairs of protons show a Curie-type temperature dependence of the hyperfine shifts. Among the remaining five downfield-shifted signals, three show a Curie-type temperature dependence and two have an anti-Curie temperature dependence. The former are assigned to the beta-CH2 and alpha-CH protons of Cys 77 and the latter to the beta-CH2 protons of Cys 46. The shift patterns are thus similar, in a sequence-specific sense, to those of the analogous proteins from C. vinosum and Rhodocyclus gelatinosus, whereas they differ from those of Rhodocyclus globiformis HiPIP and even more from those of Ectothiorhodospira halophila HiPIP II. Oxidized HiPIPs can be formally viewed as containing a cluster of four ferric ions plus one extra electron. We present here a model based on a chemical equilibrium, fast on the NMR time scale, between two species, both of which contain a pair of iron(III) ions and a mixed-valence pair but are differently oriented within the protein frame. The EPR data are also discussed in the light of the debate on the nature of the different species detected at low temperature. The interpretation of the whole set of data on HiPIPs in the light of the present model is compared with that based on previous models.
Uroflowmetry is the most physiologic and non invasive assessing method of lower urinary tract obstruction: it proves to bring objective evidence of the prostatic blockage degree. We performed 1094 urinary flow tests in 264 patients with BPH, suffering from voiding problems; 188 males had undergone surgical treatment and 86 medical therapy. These patients were examined again about 3 months after prostatectomy and about 3, 6, 9 months during pharmacologic treatment. Symptoms were valued according to international prostatic symptomatologic score (I-PSS). The assessment of residual urine was performed by bladder ultrasound. Among the 264 patients, nocturia was present in 81.8%, weakness of stream in 75% and urgency in 47.7%. The average I-PSS for obstructed patients and postoperative were respectively 26 (21-32) and 5 (0-7). Frequency and weakness of stream were commonly (80% of cases) associated with a reduction in the maximum flow rate (Qmax). Qmax and average flow (Qave) improved after prostatectomy respectively from 7.1 ml/s to 18.9 ml/s and 4.1 ml/s to 8.3 ml/s. 6/264 males with normal Qmax and 132/264 with Qmax < 10 ml/s were shown to have residual urine > 80 ml. Among the uroflowmetry parameters analysed, the best correlation with the degree of prostatic obstruction degree is Qmax. Residual urine is a sign of an abnormality of bladder function rather than the direct result of urethral blockage. Uroflowmetry is a useful clinical tool in the diagnosis and follow-up of males with BPH.