QuantiFERON-TB Gold and the TST are both useful for latent tuberculosis infection screening in autoimmune diseases.

Screening for active tuberculosis (TB) and latent TB infection (LTBI) is mandatory prior to the initiation of tumour necrosis factor-alpha inhibitor therapy. However, no agreement exists on the best strategy for detecting LTBI in this population. The aim of the present study was to analyse the performance of the tuberculin skin test (TST) and QuantiFERON-TB Gold in-tube (QFT-GIT) on LTBI detection in subjects with immunomediated inflammatory diseases (IMID). The TST and QFT-GIT were prospectively performed in 398 consecutive IMID subjects, 310 (78%) on immunosuppressive therapy and only 16 (4%) had been bacillus Calmette-Guérin (BCG) vaccinated. Indeterminate results to QFT-GIT were found in five (1.2%) subjects. Overall, 74 (19%) out of 393 subjects were TST-positive and 52 (13%) were QFT-GIT-positive. Concordance between TST and QFT-GIT results was good (87.7%): 13 were QFT-GIT-positive/TST-negative and 35 QFT-GIT-negative/TST-positive. By multivariate analysis both tests were significantly associated with older age. Only the TST was associated with BCG vaccination and radiological lesions of past TB. Use of immunosuppressive drugs differently modulated QFT-GIT or TST scoring. Use of the QuantiFERON-TB Gold in-tube, as a screening tool for latent tuberculosis among immunomediated inflammatory disease subjects, is feasible. Until further data will elucidate discordant tuberculin skin test/QuantiFERON-TB Gold in-tube results, a strategy of simultaneous tuberculin skin and QuantiFERON-TB Gold in-tube testing in a low prevalence bacillus Calmette-Guérin vaccinated population, should maximise potentials of latent tuberculosis diagnosis.

Cyclophosphamide, epidoxorubicin and Carboplatin as treatment for advanced-carcinoma of the bladder - a phase-ii study.

In advanced carcinoma of the bladder, the M-VAC chemotherapy schedule can yield positive results, but at the cost of very high toxicity. Recent studies have shown epidoxorubicin and to a lesser degree, carboplatin to be active against urothelial tumors, with cardiac, haematological and renal toxicity lower than that observed with CISCA or M-VAC chemotherapy regimens. In this study, we determined the toxicity and efficacy of cyclophosphamide 400 mg/m(2), epidoxorubicin 75 mg/m(2) and carboplatin 300 mg/m(2) in a 28-day course. From February 1990 to December 1991, we enrolled 33 advanced bladder cancer patients (25 males, 8 females), mean age 63 years. 31 patients were evaluable for toxicity and response. The major disease localizations were: locoregional 15 (48%), lymph nodes 6 (20%), liver 5 (16%), lung 3 (10%) and bone 2 (6%). A total of 186 cycles of therapy were administered, with a mean of 5.4 per patient. Six patients (19%) had a complete response (CR): 2 locoregional, 3 lymph node and 1 lung. Eleven patients (36%) had a partial response (PR), for an overall response rate of 55%. The median duration of response was 53 weeks and median survival for the entire group of patients was 40 weeks. No delays or interruptions due to sepsis occurred during therapy; haematological, cardiac and renal toxicity were below WHO grade 3. The efficacy of this chemotherapy regimen proved to be comparable to that of more aggressive schedules, while its toxicity was markedly lower.

[Alternative treatment of benign prostatic hypertrophy]. / Il trattamento alternativo della ipertrofia prostatica benigna.

In our study we propose to find an alternative to surgery management of IPB usable in DH regime with current instrumentation or with new technology from physics. We retrospectively reviewed techniques commonly mentioned in the literature to value benefits about cost, comfort, outcomes, and, at the same time, we stress disadvantages regarding each of these. TUI is economical, can be done in a few minutes, involves minimum bleeding, but can't be utilized in III lobe prostate and it doesn't provide material for histological tests. TUBT, feasible with light patient sedation, provides not satisfying results. Hyperthermia is necessary in selected cases. TULIP must be effected in anesthesia, needs complicated and expensive instrumentation, and it isn't practicable in III lobe prostate. Urethral stent application is expensive and not satisfactory in large size and III lobe prostate. The outcomes we obtained with TUI are similar to TUR; TUBT obtains good symptomatological results only in 20% of cases at 12 months. Hyperthermia and TULIP obtain an improvement in urinary flow rate from 20 to 60% and 50% respectively. Stent application provides good results. We think that the most modern, effective and economical alternative to the surgery of prostate adenoma is endoscopic surgery in TUI model.

[Oncocytoma in a horseshoe kidney]. / L'oncocitoma in rene a ferro di cavallo.

Oncocytoma is a neoplasm that constitutes 4-5% of tumors located in the renal parenchyma. It was studied for the first time by Zippel in 1942 and since than nearly 150 cases have been described. The association between neoplasm and horseshoe kidney is extremely rare. The horseshoe kidney is a malformation which often becomes complicated by infection, hydronephrosis and calculosis, but very rarely by a neoplasm (only 113 cases). The Authors report a case of oncocytoma in the horseshoe kidney and discuss the diagnostic, clinical and therapeutical aspects.

[The post-adenomectomy dysuria-hematuria syndrome]. / La sindrome disurico-ematurica post-adenomectomia.

The dysuria syndrome consists of the persistence or accentuation following adenomectomy of the symptoms which caused the patient to seek the urologist's advice. It is frequent event whose causes are largely connected to physiopathological events which are also influenced by the developing role between the urologist and patients in view of prostate disease. The authors analyse the various causes of post-adenomectomy dysuria and emphasise the importance of a precise diagnosis and the correct indications for surgery for the prevention of this disease.

Ondansetron-induced headache. Our experience in gynecological cancer.

Chemotherapy-induced emesis is one of the major problems in the treatment of oncologic patients. Recently, a novel class of compounds, the selective 5HT3 receptor antagonists, has been introduced, achieving a dramatic improvement in the control of emesis. The absence of extrapyramidal side effects adds to their safety and good tolerability. The Authors herein analyse their experience on 269 cycles of chemotherapy in 47 patients treated for gynaecological and breast malignancies, with particular regard to adverse events such as headache. Their most frequent side-effects are headache and constipation, that are usually mild and self-limiting. Nevertheless, in some cases, severe, rebel headache has been reported, leading in our experience in 6.4% of cases to discontinuation of the antiemetic regimen. A previous history of recurrent or severe headache or migraine is not correlated with the occurrence of ondansetron-induced headache, as severe headache occurred after ondansetron only in 28.4% of the patients with positive anamnesis, and 70% of the patients that experienced had never suffered from severe headache before. In those patients complaining of severe headache, the Authors suggest an antiemetic association, with a loading dose of ondansetron i.v., followed by metoclopramide i.m. orally for the following days.

Infiltrating lobular carcinoma of the breast (ILC). Diagnostic and therapeutic aspects.

Invasive lobular carcinoma of the breast (ILC) is the second most common form of mammary neoplasm after ductal carcinoma. Due to its histological features, characterised by a diffuse infiltration of the tissue by malignant cells with scarce fibrotic reaction, lobular carcinoma often presents clinical and instrumental diagnostic difficulties. The Authors present a retrospective series of 28 patients with lobular carcinoma, with special regard to the diagnostic work-up. Clinical examination misdiagnosed 10 cases, in which only a mild thickening of the breast parenchyma was present. Mammographic false negatives were 21.4% (6 cases). Ultrasonography allowed correct diagnosis in 5 out of these 6 cases. Fine needle aspiration (FNA) had low sensitivity (33% false negatives). ILC constitutes a diagnostic challenge, often requiring the combination of multiple diagnostic tools.

Ondansetron in chemotherapy-induced emesis. Our experience.

UNLABELLED: Chemotherapy-induced nausea and vomiting is one of the major side effects of antiblastic treatment in cancer patients, seriously affecting both the compliance of the patient to therapy and his or her quality of life. OBJECTIVE: The Authors present their experience in the use of ondansetron in 47 patients receiving 186 cycles of chemotherapy for breast or genital neoplasms. RESULTS: Successful control of vomiting was achieved in the first 24 hours, in 74% of the cycles containing cisplatin and 82% of the cycles without cisplatin, if ondansetron was used. On delayed vomiting the difference in results was not as striking as on acute emesis. CONCLUSIONS: The major side effects with ondansetron were headaches (42.4%) and constipation (48.9%). As expected, no extra-pyramidal symptoms were observed in this group, versus 13.3% of the patients treated with metoclopramide.

[Gn-RH analogs in the treatment of benign gynecologic diseases: current trends]. / Gli analoghi del Gn-RH nel trattamento della patologia ginecologica benigna: orientamenti attuali.

Gn-RH analogues have been recently employed for the treatment of oestrogen-dependent benign gynaecological disorders, such as uterine myomata, endometriosis or metrorrhagia. They induce a "pharmacological castration", inducing a marked reduction of serum oestrogen levels. They proved more effective than other drugs used up to now in the medical treatment of these benign gynaecological diseases. Thus they were initially employed in every case. Later it became clear that Gn-RH analogues need a selective indication. The authors herein report their series of 70 patients with benign gynaecological disorders (45 uterine fibroids, 10 endometriosis, 15 metrorrhagia), treated with a Gn-RH analogue depot for 2-3 months preoperatively. They evaluated the efficacy of the treatment in the group with uterine fibroids in terms of disappearance of metrorrhagia, better haemoglobin level in anaemic patients, reduction of fibroids size allowing for a simpler and less extensive surgery (vaginal surgery, myomectomy, hysteroscopic resection). The authors discuss those cases when preoperative treatment with Gn-RH analogues is not indicated, or should be employed only under careful surveillance (in the preparation of multiple myomectomies, big submucosal myomas). In the group of 10 patients with endometriosis we observed the disappearance of pelvic pain and dyspareunia, whereas the size of endometriomas was only minimally reduced. The authors discuss the usefulness of this treatment in case of patients with endometriosis grade I or II (minimal or mild), with desire of children. In the group of 15 perimenopausal patients with metrorrhagia, 10 became amenorrhoic after termination of treatment, thus avoiding surgery. The major benefit for the other 5 patients was a better haemoglobin level at the time of surgery.

[Neoadjuvant chemotherapy in the treatment of breast cancer. Results and prospectives]. / La chemioterapia neoadiuvante nel trattamento del carcinoma della mammella. Risultati e prospettive.

Preoperative chemotherapy for breast cancer has been originally proposed in the treatment of locally advanced tumors (T3b-T4) in order to allow radiotherapy or radical mastectomy. Later, it has been employed also for less advanced stages of the disease (T2-T3), to allow conservative surgery. Personal series of 45 patients that underwent preoperative chemotherapy (FAC) for breast cancer stages T2-T3 is reported. A partial response in terms of reduction of tumor volume was obtained in 80% of these patients, a complete response in 6.6% of the cases. In 48.8% a quadrantectomy has been performed, as the lesion diameter was < 2.5 cm after chemotherapy. The survival rate was 70% at 10 years, and 80% for initially T2 tumors, compared with 50% 10 year survival rate in a group of patients with T2 tumors treated before the introduction of neoadjuvant chemotherapy at our Department. Neoadjuvant chemotherapy allows reduction of the initial volume of breast cancer and performance of conservative instead or radical surgery, with better cosmetic results. Moreover these data suggest that they may improve the plateau of the survival curve of patients with locally advanced breast cancer.

Uterine changes during tamoxifen therapy.

Tamoxifen used for adjuvant therapy in breast cancer, has a complex and unclear action on endometrium and myometrium. Many authors demonstrated endometrial proliferous changes in peri and post menopausal women. Our study shows the development of myomas in three patients without uterine pathology before tamoxifen therapy, and the increase of a polip and a myoma after tamoxifen therapy. Moreover, we observed the development of a myoma in a patient after one year tamoxifen in association with LH-RH analogue therapy. It is necessary to continue our study with a larger number of patients to assess the hyperplasic effect of tamoxifen.

Explaining diversity of livestock-farming management strategies of multiple-job holders: importance of level of production objectives and role of farming in the household.

We characterised the livestock-farming management strategies of multiple-job holders and identified which variables contributed most to the differentiation of these strategies. We hypothesised that they would mainly be differentiated by the contribution of the farming income to the total household income and the availability of the household members for farming. The multiple-job holding livestock-farmer's motivations, decisions and actions about both multiple-job holding and livestock farming were obtained in semi-directed interviews of 35 sheep farmers who held multiple jobs, on farm and off farm. They were synthesised into six variables characterising the diversity of the livestock-farming objectives and management guidelines. Thanks to a multiple factorial analysis, we showed that the diversity of the sheep-farming management strategies of multiple-job holders was better explained by two factors 'level of motivation of the farmer to get high technical results' and 'more personal fulfilling v. the family business conception of farming', than the factors we hypothesised. Within our sample, the performances ranged from 0.7 to 1.4 weaned lambs per ewe per year. Six sheep-farming management strategies were identified. They illustrated the importance of the level of production objectives and of farming income expectation, which were found to be independent, in explaining diversity. No direct relationship between farm work organisation and sheep-farming management strategy was identified. Explaining the diversity of the livestock-farming management strategies of multiple-job holders appears to require that all the benefits expected from farming and their hierarchy be identified before analysing how they are translated into production objectives and management guidelines.

Elective treatment of ureteral stones with extracorporeal shock wave lithotripsy.

Extracorporeal shock wave lithotripsy was used as an elective treatment in 128 ureteral stones. Of the 108 with adequate follow-up, 88% were successfully disintegrated. Ureteral catheters proved to be particularly useful for more precise stone localization and as a mechanical means to push the calculi inside the renal cavities or to create a fluid interface around them, in order to increase the efficiency of the shock waves. When ureteral catheters were used a success rate of 95.5% was observed, as opposed to 82.8% when stents were not used (p less than 0.05).

Coexistence of renal artery stenosis and uretheropelvic junction obstruction in hypertensive patients with elevated renin.

Two hypertensive patients with elevated renin presenting with renal artery stenosis and ureteropelvic junction obstruction are reported. Nephrectomy was successful in 1 patient and the other patient was treated wiht renal autotransplantation and dismembered pyeloplasty. The diagnostic and therapeutic problems of coexistent renal lesions are discussed.

Experimental ureteral replacement with a vascularized gastric tubule.

Total ureteral substitution had been performed with a pedicled gastric flap shaped as a tubule in 6 dogs. No dilatation was found at X-ray controls. No metabolic changes were recorded. The HCl secretion diminished the possibility of an infecting reflux.

Simplified endoscopic suspension for stress incontinence through pervaginal route.

We present an original technique of bladder neck suspension through percutaneous vaginal suspension for stress urinary incontinence. We emphasize the advantages of this technique which permits a close control of the cervico-urethral angle and a symmetrical lifting of the bladder neck.

Tele-thermography and Eco-Doppler evaluation of subclinical varicocele in infertile men.

The diagnosis of subclinical varicoceles in infertile men is available with thermographic and Eco-Doppler evaluation. In our experience the patients with both positive findings showed a more significant improvement of semen analysis after surgery of the varicocele.