Ultrafine particles and black carbon personal exposures in asthmatic and non-asthmatic children at school age.

Traffic-related air pollution (TRAP) exposure during childhood is associated with asthma; however, the contribution of the different TRAP pollutants in each microenvironment (home, school, transportation, others) in asthmatic and non-asthmatic children is unknown. Daily (24-h) personal black carbon (BC), ultrafine particle (UFP), and alveolar lung-deposited surface area (LDSA) individual exposure measurements were obtained from 100 children (29 past and 21 current asthmatics, 50 non-asthmatics) aged 9±0.7 years from the INMA-Sabadell cohort (Catalonia, Spain). Time spent in each microenvironment was derived by the geolocation provided by the smartphone and a new spatiotemporal map-matching algorithm. Asthmatics and non-asthmatics spent the same amount of time at home (60% and 61%, respectively), at school (20% and 23%), on transportation (8% and 7%), and in other microenvironments (7% and 5%). The highest concentrations of all TRAPs were attributed to transportation. No differences in TRAP concentrations were found overall or by type of microenvironment between asthmatics and non-asthmatics, nor when considering past and current asthmatics, separately. In conclusion, asthmatic and non-asthmatic children had a similar time-activity pattern and similar average exposures to BC, UFP, and LDSA concentrations. This suggests that interventions should be tailored to general population, rather than to subgroups defined by disease.

Does the adjunct of ecographic contrast medium Levovist improve the detection rate of prostate cancer?

OBJECTIVES: To evaluate whether the adjunct of an ultrasound contrast medium improves the detection rate of prostate cancer. METHOD: In 34 patients, scheduled to undergo a trans-perineal extended prostate biopsy, we carried out a color-Doppler ultrasound (CDU) of the prostate before and after i.v. injection of Levovist, an ultrasound contrast medium. Further bioptic samples were taken in the areas where a marked increase in vascularization was noticed. RESULTS: The overall diagnostic sensitivity, specificity and efficiency were respectively 72.7, 56.2 and 62.9% for transrectal ultrasound (TRUS); 80, 56.2 and 65.3% for CDU and 88.8, 54.5 and 68% for CDU after Levovist injection; 66.5, 72.6 and 65.1% for digito-rectal examination (DRE); 100, 51.4 and 65.4% for total PSA; and 100, 88.8 and 94.3% for PSA free/total. In the 16 patients with prostate carcinoma, the sensitivity of CDU after Levovist was 92.3, 66% for both DRE and TRUS, and 80% for DRE plus TRUS. CONCLUSIONS: Considering the cost and the results obtained (high sensitivity and low specificity), a routine use of Levovist does not seem indicated in patients undergoing prostatic biopsy. An exception may be represented by patients with both negative DRE and TRUS.

[Treatment of urinary tract infections with macro-crystalline nitrofurantoin]. / Terapia delle infezioni del tratto urinario con nitrofurantoina macrocristalli.

Therapy of urinary tract infections with nitrofurantoin macro-crystals. The aim of this study is to evaluate the therapeutic effectiveness of two dosages of nitrofurantoin macro-crystals. Between January 1993 and February 1994, 101 patients (54 male and 47 female), either suffering from urinary tract infections or on whom internal examination had been carried out, were treated with nitrofurantoin macro-crystals. There were divided into two groups: A, a posology of 100 mg 3 times daily for 7 days and B, a posology of 100 mg 4 times daily for 7 days. A urine culture was carried out on all patients before and after treatment. E. Coli was found in 60.5% of cases, Streptococcus Faecalis in 12.7% and Staphylococcus aureus in 5.6%. Infection was eliminated in 85.3% of patients in group A and 93.9% in group B. The dysuric symptomatology was cured in 84.6% of patients in group A, and 89% in group B. The statistic elaboration of the results with X2 and p tests did not reveal any difference between the two groups examined.

[Volocimetric evaluation of spermatic vessels with echo color doppler in patients with idiopathic varicocele]. / Valutazione velocimetrica delle arterie spermatiche mediante eco color-Doppler in pazienti affetti da varicocele idiopatico.

BACKGROUND AND AIMS: There is a high incidence of varicocele or dilatation of the spermatic vessels associated with reflux in the male population varying, according to statistics, from 4.5 to 30.7%. Among the numerous hypotheses put forward to explain infertility in approximately 50% of patients with varicocele, it has recently been shown that there is an increased concentration of noradrenalin in the spermatic vessel which might be responsible for chronic arterial vasoconstriction affecting the gonads, leading to endothelial hyperplasia and consequent infertility. MATERIALS AND METHODS: In this study the authors have evaluated the bilateral flow of spermatic arteries at the level of the scrotum in patients with varicocele and in the healthy (varicocele-free) population with normal and hypospermatogenesis. RESULTS: In all groups and in the absence of other major pathologies (including arterial hypertension), no significant differences were found in systolic peak velocity (SPV) in relation to the presence or otherwise of varicocele and the degree of reflux. Mean SPV ranged between 3.5 and 4 cm/sec in patients with hypo- and/or normal zoospermia both in the varicocele and healthy population. CONCLUSIONS: In line with other authors, we feel that despite the lack of substantial differences in arterial flow in the patients examined, it is not possible at present to explore the testicular microcirculation and possible hypoperfusion using eco color-Doppler, in spite of the fact that the method shows a high level of diagnostic accuracy in the diagnosis of phlogistic pathologies and/or twisting of the spermatic cord. New approaches might be provided through the improved study of the microcirculation using power Doppler which appears to be more sensitive than eco color-Doppler in visualizing small intraparenchymal vessels.

[Male cervico-urethral obstruction of organic cause: transrectal prostatic ultrasonography versus permicturition and urethral ultrasonography]. / Ostruzione cervico-uretrale maschile da causa organica: ecografia prostatica transrettale versus eco perminzionale ed uretrale.

AIM: This paper reports personal experience relating to the use of "static" and "permicturition" prostatic transrectal ultrasonography and urethral ultrasonography in the imaging diagnosis of obstructed patients. METHODS: Between January 1996 and January 1998 we selected 96 consecutive patients aged between 25 and 73 years old (mean 54 years) with symptoms of obstructive dysuria with pathological uroflowmetry and pressure/flow rates (Qmax ranging between 5-12 ml/sec and URA between 34-81). Eighteen of the patients selected had previously undergone prostate surgery for benign pathologies. All patients underwent a standard and permicturition transrectal ultrasonography and urethral ultrasonography using a retrograde approach. The results were compared with those obtained by retrograde urethrocystography and urethrocystoscopy, regarded as the "gold standard" for the diagnosis of urethral obstruction. RESULTS: Sixty-three (65.5%) patients were able to execute the permicturition phase, but only 54 (56.2%) reported that the test was indicative of "real urination", whereas retrograde urethral ultrasonography was well tolerated in all cases and easy to accomplish. In 19 (20%) patients (6 of whom had undergone prostate surgery and 13 were suffering from urethral stenosis), "major" organic alterations responsible for urethral obstruction were observed with the combined use of these ultrasonographic methods. These were not evident using static transrectal ultrasonography and increased the diagnostic sensitivity from 80 to 98%. CONCLUSIONS: We feel that an increasingly complete ultrasonographic study of the lower urinary tract is necessary, above all in obstructed patients. This can be achieved using permicturition and urethral transrectal ultrasonography, ensuring an accurate diagnosis and optimising health expenditure.

[Rehabilitation therapy in the treatment of female urinary incontinence. Our experience with 121 patients]. / La terapia riabilitativa nel trattamento dell'incontinenza urinaria femminile. La nostra esperienza su 121 pazienti.

Rehabilitative therapy of the perineum (FKT, SEF and biofeedback) represents an efficient method in the treatment of urinary stress incontinence without resorting to a complete uro-genital prolapse, as in patients with urethral instability and/or incontinence. One hundred twenty-one women, 55 with urinary stress incontinence (USI), 20 with urge incontinence (UI) and 46 suffering from both types of incontinence, underwent rehabilitative therapy. On each patients the following tests were carried out: an internal test, a urodynamic test (uroflowmeter, PPU, cystomanometry and pessure/flow study), a meter UEC, situated at the bladder neck, anterior and posterior urethra, both clinostatic and orthostatic, urine test with urinoculture and a pap-test. The aim of this study is that of establishing if it is possible a) to simplify the rehabilitative sitting using only FKT with weekly treatment; b) to treat women suffering from urge incontinence or from both types, but with bladder stability (standard cystomanometria) with FKT and Ditropan (1 tablet 3 times daily for weeks therapy). One group of patients underwent rehabilitative therapy while another group underwent traditional therapy, for a minimum of 12 sitting, using also electric functional stimulation (SEF). Of 121 women who underwent rehabilitative therapy, 90 (74.4%) were healed, 30 (24.7%) improved and one (0.9%) showed no signs of improvement. Patients treated with FKT, or FKT and made as good if not better grogress than those who attended more sittings and/or underwent SEF.(ABSTRACT TRUNCATED AT 250 WORDS)

[PSA and prostatic adenocarcinoma. Experience with 805 patients]. / PSA ed adenocarcinoma prostatico.

Over the last decade PSA has been widely acknowledged to be a very sensitive and specific marker of prostatic tumour pathologies. This paper reports the authors' experience relating to the use of PSA in the early diagnosis of prostatic heteroplasia on the basis of results obtained in a study performed in 805 dysuric patients who underwent rectal exploration and CAT. Echo-guided prostate biopsy according to Hodge was performed in 212 (26.4%) out of 805 patients and adenocarcinoma was found in 55 cases (25.9%). PSA ranged between 10-198 ng/ml in 42 out of 212 patients, between 4-10 ng/ml in 60, and was below 4 ng/ml in 110. In addition, PSAd was assayed in all patients with PSA < 10 mg/ml. Having established the cutoff of PSA at 10 ng/ml, it was found that some heteroplasia, above all at the initial sage, presented normal PSA blood values. In fact, in 8 cases, equivalent to 14.5% of the neoplasias diagnosed, values were under 4 ng/ml, and in 5 cases, equivalent to 9%, they ranged between 4-10 ng/ml. This finding showed that the threshold value of 10 ng/ml gives PSA a high specificity, but a lower sensitivity in the early diagnosis of prostatic adenocarcinoma. Moreover, the analysis of PSA-density does not significantly allow the diagnosis of a larger number of heteroplasias: in fact, out of 13 cases of adenocarcinoma with PSA < 10 ng/ml, PSAd was only > 0.15 in 2 patients. Therefore, in line with the data reported in the literature, the authors consider that PSA assay represents a sensitive and specific screening method for prostatic tumour pathologies in symptomatic patients, but in order to obtain an early diagnosis, and especially in cases with serum values between 4-10 ng/ml, it must be combined with both rectal exploration and, above all, transrectal scan.

[The role of TPS in the diagnosis of prostatic carcinoma]. / Ruolo del TPS nella diagnosi del carcinoma prostatico.

From June 1993 to July 1994 we treated 136 male patients affected by dysuria with hematic dosage of TPS and PSA, with DRE, transrectal echography and prostatic biopsy using an echograph. The patients treated were divided into two groups: A and B. Group A (TPS cut-off of 75 U/l) was made up of 91 patients, ages ranging from 41 to 85 years (average 72.5 years). Group B (TPS cut-off > 75 U/l) was made up of 45 patients, ages ranging from 39 to 88 years (average 75.1 years). In group A, 22 patients (24.2%) resulted as suffering from prostatic carcinoma, 4 (4.3%) resulted as suffering from prostatic phlogosis, and 65 (71.4%) resulted as suffering from BPH. In group B, 6 (13.3%) were affected by prostatic heteroplasia, 2 (4.4%) were affected by prostatic phlogosis, and 37 (82.2%) were affected by BPH. The TPS had a sensibility of 21.4% and a specificity of 66.3%. A comparison of the data obtained in the two groups did not reveal any significant differences. In this study the TPS showed a poor diagnostic reliability as a biologic marker of prostatic carcinoma.

Paraovarian tumors.

Between 1965 and 1985 59 paraovarian cystic tumors, were treated at the First Clinic of Obstetrics and Gynecology, Catania University, Catania (Italy). In 45.76% of cases (27 cases) the cyst was localized on the right and in 40.67% (24 cases) on the left parametrium, bilaterally in 6.77% (4 cases) and multiple on the same side in 6.77% (4 cases). In 91.52% (54 cases) the patients were in fertile age and 8.48% (5 cases) were in menopause. The dimensions of the cysts varied between 2 and 20 cms, with higher incidence between 6 and 10 cms (49.16%). In 1.69% there was benign neoplastic degeneration (1 case of cystadenoma). In 6.77% (4 cases) there were no symptoms, while pelvic pain and menstrual disorders occurred in 57.62% (34 cases) and 35.59% (21 cases) of cases respectively. In 5.08% (3 cases) there was torsion of the cyst. Enucleation of the cyst was performed in 44.06% (26 cases), and in the other cases therapy was adopted according to the patient's age, parity, associated gynecological pathology and neoplastic degeneration.

The detection of internal mammary lymph nodal chain metastases in breast cancer using radiolabelled colloids.

The authors report their studies of 39 lymphoscintigraphies performed on patients with breast cancer. They point out that interpretation of scintigraphic imaging must take into account the morphologic variations of the lymph nodes of the internal mammary chains (i.e. single central chain, single central lymph node) and the morphological difference in the symmetry of lymph nodes considered non-pathologic to avoid false positives. The authors retain that lack of visualization of a chain, conspicuous increase in size of a lymph node, asymmetry of pathologic development, or reduced uptake by one or more lymph nodes of the internal mammary chains must be interpreted as a sign of metastatic spread. The authors recommend lymphoscintigraphy as an effective technique in the screening of breast cancer patients for staging, follow-up, restaging, and planning of radiotherapy.

Dermoid cysts of the ovary.

From 1965 to 1984, 105 cases of ovarian dermoid cysts have been diagnosed and treated at the First Clinic of Obstetrics and Gynecology, Catania University, Catania, Italy. The patients were aged between 9 and 70 years, with a higher frequency of dermoid cysts between 26 and 30 years (21.91%, 23 cases). In 0.95% (1 case) the patient was premenarchal, 84.76% (89 cases) in fertile age, and in 14.29 (15 cases) in menopause. 35.22% (37 cases) were nulliparous with an average of 31 years, and 64.76% (68 cases) pluriparous with an average age of 38.9 years. In 4.76% (5 cases) the patients had already been treated for dermoid cysts. The asymptomatic form occurred in 13.33% (14 cases), while in 9.52% (10 cases) of cases there was torsion of the cyst. In 89.53% (95 cases) the cyst was monolateral, double in the same ovary in 0.95% (1 cases), and bilateral in 9.52% (10 cases). Epithelial cancerous degeneration occurred in 1.95% of cases (2 cases). In 11.43% (12 cases) enucleation of the cyst was performed while in the other cases therapy was chosen in relation to age, parity, and associated gynecological pathology of the patients. The Authors compare their data with that in literature.

[Ultrasound in the study of gynecologic neoplasms]. / Gli ultrasuoni nello studio delle neoplasie ginecologiche.

The authors discuss the state-of-the-art of ultrasound diagnosis for pelvic swellings, with special reference to uterine and ovarian cancer. They review the applications of Eco colour Doppler in gynecological oncology and discuss the protocols for the prevention and/or early diagnosis of gynecological tumours.

Conservative surgery of the ovary.

113 patients aged between 16 and 41 underwent conservative surgery of the ovary between 1965 and 1984 in the First Clinic of Obstetrics and Gynecology, Catania University Medical School, Catania, Italy. The frequency of conservative surgery of the ovary was 0.55% of total gynecological admissions. Indications for surgery were sterility due to postinflammatory adherence in 14.15% (16 cases), in 34.51% (39 cases) ovarian polycystosis after failure of medical therapy with ovulation inducers, in 46.92% (53 cases) pelvic tumor, and in 4.42% (5 cases) hemorrhage of the corpus luteum (4 cases) or ovarian pregnancy (1 case). In 53 cases of enucleation of ovarian tumor the most frequent pathology was serous cyst (41.50%; 22 cases), followed by dermoid cysts (33.96%; 18 cases), cyst caused by endometriosis (18.86%; 10 cases). Luteinic cysts were more rare (3.77%; 2 cases), and in only 1 case was there ovarian cystadenoma (1.88%). Postoperative course was febrile in 7.96% (9 cases) of patients. There were no cases of mortality.

A clinical and epidemiological study on eclampsia in the obstetrics and gynecology department of Catania in the years 1978-1983.

From January 1978 to July 1983 22 patients have recovered from eclampsia in the Obstetrics and Gynecology Department - Vitt. Emanuele II Hospital - Catania University. 64% of the patients had hypertension in pregnancy combined with edema in 92.85% of the cases (13 cases) and with proteinuria in 18% of the cases (4 cases). Eclampsia manifested itself before labour in 28.57% (6 cases), during labour in 19.05% (4 cases), in postpartum in 19.05% (4 cases) and in the successive three days after delivery in 33.33% (7 cases). Perinatal death rate was 11.28% and in all the cases it was due to intrauterine fetal death. In 22 patients treated there was a case of acute pulmonary edema and a case of maternal death.

Fecal peritonitis in pregnancy.

The Authors report a case of fecal peritonitis caused by perforating appendicitis in a patient in the 16th week of pregnancy. Appendectomy was performed and the patient successfully delivered a normal sibling weighing 2850 grams in the 37th week.

Induction of abortion by PGF2 alpha in the second trimester of pregnancy.

The Authors evaluate the efficacy of the intravenous infusion of PGF2 alpha in the induction of abortion in the second trimester of pregnancy with live fetus (Italian Law no. 194/1978). Abortion occurred in 3 out of 11 (27.27%) nulliparous patients, and uterine curettage was necessary in 2 cases. The interval between administration of the drug and the beginning of uterine contractions was 31.42 +/- 14.15 minutes (range 10 to 35 minutes), the duration of infusion was 7.55 +/- 3.64 hours (range 7 to 9.15 hours), the interval between initiation of infusion and delivery was 8.10 +/- 2.60 hours (range 7 to 9.45 hours), and the dose administered was 20.23 +/- 3.75 mg (range 15 to 25 mg). Side effects were reported in 10 cases (90.90%), and in 5 cases these effects were caused by interruption of infusion. Abortion occurred in 7 out of 13 pluriparous patients (53.84%), and uterine curettage was necessary in 4 cases. The interval between administration of the drug and the beginning of uterine contractions was 20 +/- 12.24 minutes (range 20 to 45 minutes), the duration of infusion was 8.26 +/- 0.9 hours (range 3.10 to 16 hours), the interval between initiation of infusion and delivery was 8.40 +/- 0.8 hours (range 3.0 to 9.6 hours), and the dose administered was 19.28 +/- 5.34 mg (range 5 to 25 mg). Side effects were reported in 11 cases (84.61%), and in 6 cases these effects were caused by interruption of infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Pelvic tumors in patients under 18 years.

Between 1965 and 1985 28 patients aged between 10 and 18 years (average age 16.3 years) were treated for pelvic tumor, with a frequency of 0.13% of gynecological admissions. Ovarian tumor was the most frequent type (21 cases), followed by paraovarian tumor (5 cases), and uterine tumor (2 cases), 21 of pelvic tumor were neoplastic of which 18 benign. Among the ovarian neoplasias the most prevalent was cystadenoma (9 cases), followed by dermoid tumors (7 cases).

New trends in cesarean section.

The Authors studied the frequency of Cesarean section in relation to deliveries in the last trimester of pregnancy, the frequency of repetitive Cesarean section, age and parity of the patients, indication for cesarean section, week of delivery, and perinatal and maternal morbidity and mortality at the First Clinic of Obstetrics and Gynecology, University of Catania, Catania, Italy, from 1972 to 1974 and from 1983 to 1985. The frequency of Cesarean section has increased from 12.07% (735 cases out 6,086 deliveries) to 16.89% (837 cases out of 4,955 deliveries). There was a decrease in frequency of repetitive Cesarean section from 30.47% (224 cases) to 27.95% (234 cases) and in perinatal mortality rate from 4.35% (32 cases out of 735) to 3.19% (27 cases out of 845 newborn). There were no cases of maternal death, while the most common cause of maternal morbidity was uterine atonia. From 1972 to 1974 mechanical causes were the most frequent indication for Cesarean section (28.16% -207 cases), while from 1983 to 1985 previous hysterotomy (32.73% -274 cases) was the main indications for Cesarean section.

Current aspects of gynecological pathology in postmenopause.

Between 1982 and 1984 330 women in postmenopause for at least one year were admitted to the First Clinic of Obstetrics and Gynecology, Catania University Medical School, Catania, Italy, with a frequency of 10.04% of gynecological admissions. The most frequent pathologies were metrorrhagia (32.72%; 108 cases) from an atrophic endometrium or glandular hyperplasia of the endometrium, vaginoperineal lacerations with cystorectocoele with or without urinary incontinence (10.90%; 36 cases), cancer (11.21%; 37 cases) and ovarian cystoma (11.21%; 37 cases), uterine prolapse (9.30%; 31 cases), and endometrial polyps (9.09%; 30 cases). Uterine fibromyoma (3.93%; 13 cases) and carcinoma of the portio (3.93%; 13 cases) were among the rare pathologies. Uterine pathologies were the most prevalent (68.78%; 227 cases), followed by ovarian (15.15%; 50 cases), pathology of involving the pelvic and perineal containment (10.90%; 36 cases), vulvar pathology (2.72%; 6 cases), and vaginal pathology (1.51%; 5 cases). Malignant neoplastic pathology was reported in 25.45% of cases (84 cases) consisting only of uterine cancer (47.61%; 40 cases) and ovarian cancer (45.23%; 38 cases). In comparison with the study performed by Cetroni in 1952 one notes a net reduction in the frequency of uterine prolapse (by about three times), and a smaller reduction in cancer of the uterine cervix with a slight increase in cervical polyps, endometrial cancer, and above all in metrorrhagia from atrophic endometrium or glandular hyperplasia of the endometrium.

Coxsackie virus and urogenital pathology.

In 43 women (average age 49.6 years), and 70 men (average age 55.2 years) with pathology of the genito-urinary apparatus, seroantibodies to Coxsachie virus B were measured using the passive hemoagglutination method and the virus was isolated in the uterine. Viral isolation test was negative in all urine samples tested. Seropositivity for Coxsackie virus was reported in 26 women (60.46%) and in 51 men (72.85%). Positivity to B1 was 37.16% (42 cases), B2 in 38.05% (43 cases), and to B4 in 35.39% (40 cases). 17.69% (20 cases) of patients were seropositive to only one serotype, 17.69% (20 cases) to 5 serotypes, 14.15% (16 cases) to 3 serotypes, 9.73% (11 cases) to 2 serotypes, and 8.84% (10 cases) to 4 serotypes. B1, 2, 3, 4, 5 (25.97%; 20 cases) and B2, 3, 4, 5 (7.79%; 6 cases) were the most frequent associations. Seropositivity to Coxsackie virus was reported in 100% of patients (4 cases) with urethral caruncola, in 84.21% (16 cases out of 19) with cancer of the bladder, in 81.81% with cystitis (9 cases out of 11) and in 80% with prostatitis (8 out of 10 cases). In relation to sex, seropositivity was higher in males in cases of calculosis (75%; 9 cases out of 12 against 28.57%; 2 cases out of 7) and in cystitis (100%; 6 cases against 60%; 3 cases out of 5). Further studies are necessary to determine the clinical significance of serum Coxsackie virus antibodies in patients with urological pathology in the absence of urinary elimination of Coxsackie virus.