Angiosarcoma of the adrenal gland. Case report.

The vascular tumours of the adrenal gland are rare, both the benign and the malignant ones. Twenty two cases from the literature are reviewed in a paper by Kareti et al., 1988, among which only one own case of angiosarcoma the authors deem to be the first to be reported. A second case of angiosarcoma of the left adrenal gland, in a 67 y. old man, is herein reported. Notwithstanding a through surgical removal, a quick fatal progression of the disease ensued. Perhaps, considering the high malignancy of these rare tumours, an adjuvant form of treatment seems to be advisable.

Ureteral involvement in the Churg-Strauss syndrome: a case report.

We report a case of the Churg-Strauss syndrome with bilateral ureteral stenosis, secondary obstructive uropathy and anuria. The literature regarding urological implications of this disease is reviewed, and the surgical and medical management of our case is detailed.

[Transurethral bladder echography in staging neoplasms: histopathological correlation (T/pT). Methodological proposal and preliminary results]. / Ecografia vescicale transuretrale nella stradiazione delle neoplasie: correlazione istopatologica (T/pT). Proposta metodologica e risultati preliminari.

By real-time ultrasounds through an intra-vesical probe, bladder mucosal features, wall thickness and external profile, as well as their pathological changes, are beautifully imaged; therefore, the role of this echographic technique in the clinical pre-treatment assessment of tumor local staging is expected to be accurate and reliable, accordingly to the first results by Holms and co-w. We have intended to verify the value of the method, by comparing the pre-treatment staging by the more traditional non-invasive clinical procedures plus intra-vesical sonography to the pathological staging (pT) from the removed tumor samples. Our preliminary results are herein presented, from which the overall accuracy of this staging approach seems to be confirmed and a wider experimentation to be justified.

[Omentoplasty and a temporary internal stent in the treatment of recurrent peri-pyelo-ureteritis. Surgical technic. Apropos of a case]. / Omentoplastica e tutore interno a dimora temporanea nel trattamento della peripieloureterite recidiva. Nota di tecnica chirurgica. A proposito di un caso.

Repetitive surgery on the upper urinary tract calls for extensive and sometimes difficult dissection, therapy exposes to the risk of vascular and nervous injury, as far as tissue trophism is concerned, moreover to secondary severe perivisceral fibrosis. The ureter is particularly liable to such early or late damages. The use of a self-retaining stent, even for a long period of time, and of a pedicle omental graft wrapping ensures a better recovery and the prevention of fistulae or strictures from secondary retroperitoneal fibrosis.

[Diagnostic problems in non-acute prostatitis: experience in 150 cases]. / Problemi diagnostici nelle prostatiti non acute--una esperienza di 150 casi.

The rules for a diagnostic approach to non-acute prostatitis, as applied during a one-year trial in this Division of Urology, are reviewed and their results on a clinical ground of 150 cases are discussed. In fact, this clinical conditions is apt to present often some problems, as far its cure is concerned, due to its variety of symptoms, and not seldom to un-correct previous therapeutic approach, for defect of a precise diagnostic appraisal.

[Epidermoid cysts of the testis: conservative treatment?]. / La cisti epidermoide del testicolo: trattamento conservativo?

The epidermoid cyst of the testis is a monolayer teratoma with no malignant character, when pure. Therefore, its recognition on the basis of macroscopic and freeze histologic grounds should allow a conservative surgical removal, with saving of the testis. Out of the more or less 150 reported cases, about 85% have been treated by orchiectomy, about 15% by either enucleation or partial orchiectomy. In no case except one, a more thorough histologic examination of the removed cyst, malignant structures have been observed. In no case, with a follow-up from a few months to more than 15 years, a recurrence occurred. Two cases are presented and discussed, in which a conservative choice was made and clinical follow-up carried out.

Effects of rociverine on the human ureter: in vivo and in vitro experimental study.

An in vitro and in vivo study was conducted to verify the effects of rociverine--a new spasmolytic agent--on peristalsis in the human ureter. In vitro (human ureter strips), rociverine exerted a spasmolytic activity both on the baseline motility and on the spasm induced by direct contractants (eledoisin, KCl) or by histamine. It may therefore be concluded that rociverine is a predominantly myotropic spasmolytic. In the in vivo study, conducted in patients with cutaneous ureterostomy, the drug showed a marked inhibitory effect on the amplitude and frequency of the ureteral rhythmic spikes, without affecting the baseline tone.

Histamine receptors in the human ureter.

The occurrence of histamine H1- and H2-receptors in the human ureter was studied by means of relatively selective agonists and antagonists of both kinds of receptors. Isolated preparations of small strips of human ureters removed during surgery were used. Histamine and the H1-agonist 2-aminoethylthiazole contracted the ureter in a dose-dependent fashion whereas the H2-agonists dimaprit and impromidine were ineffective. The H1-antagonist chlorpheniramine shifted to the right the dose-response curves to histamine and to 2-aminoethylthiazole with the kinetics of the competitive antagonism. Conversely the H2-antagonists cimetidine, metiamide and tiotidine potentiated the effect of histamine by a factor of 3 though high concentrations had to be used (25 - 30 micrograms/ml). Both H1 and H2-antagonists were not able to modify the basal tone and/or motility showed by ureteral strips. All the above data suggested that H1-receptors are predominant in the human ureteral muscle and the contraction induced by their stimulation completely mask the effect of the H2-receptors stimulation. Since H2-agonists were ineffective in basal conditions and H2-antagonists potentiated the effect of histamine which is spasmogenic, we may suggest that H2-receptors are less numerous than H1-receptors and their stimulation cause a slight relaxation of the ureteral muscle. This situation is not uncommon in other smooth muscle system (e.g. respiratory system and gastrointestinal tract).

[Multicystic dysplasia of the kidney in the adult]. / Diplasia multicistica del rene nell'adulto.

Two cases of multicystic renal dysplasia in the adult are presented and the pathogenic theories of the condition are reviewed. The more severe defects of development are those which more often remain clinically silent, until are detected, usually in a casual manner, in the adult age. Palpable mass or, more often, traditional radiology, densito-tomography and echography allow differentiation from other conditions such as polycystic kidney, tumors, tuberculosis, hydronephrosis. Anyhow, in the Author's opinion, surgical exploration is mandatory for definite diagnosis as well as for exeresis of the dysplastic mass.

[Urodynamic assessment in multiple sclerosis and Parkinson's disease]. / La valutazione urodinamica strumentale nella sclerosi multipla e nel morbo di Parkinson.

Twenty five patients with C.N.S. diseases (parkinsonism and multiple sclerosis) have been studied by means of electrocystouretromanometry and electromyography. Cases with patent urological causes of vesico-sphincteric functional impairment have not been included. In multiple sclerosis urodynamic changes, chiefly detrusor hyper-reflexia, have been registered in 75% of cases, EMG sphincter activity disturbances in 85%. Respectively, 90% of cystomanometries and 54% of EMG sphincter activities showed changes in Parkinsonism. The precise assessment of the individual specific urodynamic change seems to allow a rationally better therapeutic perspective.

[To-day clinical features of kidney tumours: a review of 160 cases (author's transl)]. / Aspetti clinici attuali dei tumori del parenchima renale. Analisi di 160 casi.

160 cases of neoplasm of the kidney in the adult are reviewed, with regard to to-day knowledge of problems not yet resolved in the field both of diagnosis and treatment. As diagnosis is concerned, the primary role of angiography is confirmed, though the alternative and/or complementary role of ultrasounds and densitometry cannot be overlooked. As for treatment, the primary choice seems to remain surgery, in which regard a new meaning of radicality and operability is on way to develop, due to improvement of diagnostic means and, in lesser grade, of complementary treatments.

[Uro-enteric prostheses: voiding activity and morphological changes of epithelium (author's transl)]. / Protesi uroenteriche: modalità di svuotamento e modificazioni morfologiche epiteliali. (Rilievi ultrastrutturali).

Ultrastructural findings in epithelium of human entero-urinary grafts are presented, five and ten years after intervention. Severity of changes seems to be in relationship with functional defects of grafts, chiefly as voiding is concerned, more than with the duration of implantation and the presence of a sphincteric control. As a matter of fact, as far as an active, regular, complete voiding is obtained, only slight late changes occur in ultrastructure, while flattening of macrovilli and cohalescence of cryptae are early findings. Anyhow, no favorable effect is to be expected from these epithelial changes in order to prevent absorption and/or secretion.

[Current trend in the medical treatment of oxalic calculosis]. / Indirizzo odierno nella terapia medica della calcolosi ossalica.

On the basis of to-day knowledge about metabolism and excretion of oxalic acid, the rationale of therapy of stone pathology is revieved. The problems of both primary and secondary oxaluria and of inhibiting factors of cristalisation are particolarly discussed.