Relevance of genetic investigation in male infertility.

Genetic causes can be directly responsible for various clinical conditions of male infertility and spermatogenic impairment. With the increased use of assisted reproduction technologies our understanding of genetic basis of male infertility has large implications not only for understanding the causes of infertility but also in determining the prognosis and management of such couples. For these reasons, the genetic investigations represent today an essential and useful tool in the treatment of male infertility. Several evidences are available for the clinical practice regarding the diagnosis; however, there are less information relative to the treatment of the genetic causes of male infertility. Focus of this review is to discuss the main and more common genetic causes of male infertility to better direct the genetics investigation in the treatment of spermatogenic impairment.

Lung nodule management: a new classification proposal.

Management of solitary pulmonary nodule (SPN) and micronodule (SPMN) is still debated. The use of 18F-FDG PET/CT or CT multislice screening for early lung cancer detection, have increased the frequency of displaying indeterminate single lung nodule with diameter between 0.1 cm and 2 cm. The first choice is to wait and do radiological follow-up, since the evaluation of temporal changes in a small mass may contribute to differentiate a malign from benign pathology. In case of unchanged images not capable of orientating the diagnostician or no possible preoperative diagnosis by bronchoscopy and percutaneous needle biopsy, surgical treatment is necessary allowing the histological characterization of lesion and a good prognosis of disease. Video-assisted thoracoscopic surgery and muscle-sparing minithoracotomy have become routine, each of these furnishing precise indications. The purpose of the study was to establish the main investigative method for indeterminate lung nodules, considering the continuous evolution of endoscopic and radiological techniques.

18-fluorine fluorodeoxyglucose positron emission tomography with computerized tomography versus computerized tomography alone for the management of solitary lung nodules with diameters inferior to 1.5 cm.

OBJECTIVE: Aim of the study was to establish a noninvasive method for the preoperative characterisation of a pulmonary nodule when biopsy of the small mass is impossible. METHODS: From 1 January 2006 to 31 December 2008, we observed 124 asymptomatic patients with a noncalcified single lung nodule highlighted by computerised tomography (CT) of the thorax. Patients were divided into 2 groups: Group A consisted of 57 patients with lesion diameters between 0.5 cm and 0.99 cm; Group B consisted of 67 patients with lesion diameters between 1.0 cm and 1.5 cm. Fibreoptic bronchoscopy was negative for endobronchial neoformation in all patients. The topographic distribution of the lesions advised against CT-guided transthoracic needle biopsy or video-assisted thoracoscopy. All patients had preoperative 18-fluorine fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) associated with CT of the thorax, which was compared with CT for evaluation of the mass. RESULTS: Postoperative histological diagnosis revealed 54 primary lung cancers, 47 lung metastases and 23 benign lesions. In Group A the sensitivity of 18F-FDG PET/CT and CT was 95 % and 73 % and the specificity was 72 % and 64 %, respectively ( P = 0.000001 for 18F-FDG PET/CT; P = 0.000177 for CT). In Group B the sensitivity of 18F-FDG PET/CT and CT was 95 % and 97 %, and the specificity was 80 % and 87 %, respectively ( P = 0.000001). CONCLUSIONS: Our study shows that 18F-FDG PET/CT improves the identification and characterisation of potentially malignant pulmonary nodules with a diameter < 1 cm. This technique could be a valid alternative to a surgical approach, currently the main method to investigate indeterminate lung nodules.

Ethmoidal adenocarcinoma with lung metastases: diagnosis and multimodal treatment.

We report a case of 68-year-old patient underwent a magnetic resonance imaging (MRI) of the skull and a computed tomography (CT) of the thorax for rhinorrhea and dyspnea. The MRI showed an irregular ethmoidal lesion and the CT of the thorax underlined a solid nodular neoformation in the upper right pulmonary lobe. The patient underwent rhinoscopy with biopsies that showed an ethmoidal adenocarcinoma; excision of the tumour was carried out via trans-sphenoid. After one month the patient underwent wedge-resections in video-thoracoscopy (VATS). Perioperative histologic examination revealed a lung metastases due to an adenocarcinoma of the ethmoid. The patient was treated with chemotherapy and did not show relapses after 12 months from VATS.

Pulmonary and parotid hydatid cyst: an unusual double localization.

We described a rare case of pulmonary and parotid cyst for echinococcus granulosus in an eighty-one-year-old patient. Lesion was discovered in the lung owing to a clinical presentation. A swelling was the only sign in the parotid gland. Time between lung and parotid excision was 14 days. Time of hospitalizations was 4+/-1 day.

Video-assisted thoracoscopic surgery versus thoracotomy for recurrent spontaneous pneumothorax. A comparison of results and costs.

OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) represents at present the most suitable treatment of recurrent spontaneous pneumothorax. After three years we consider this interesting to draw up a trial balance of our VATS experience in comparison with the cases treated before 1991 with the classic thoracotomic approach. METHODS: We have considered retrospectively the results obtained in a series of 30 consecutive patients with recurrent spontaneous pneumothorax treated with VATS between November 1991 and August 1994 in comparison with those obtained in a group of 30 patients previously treated with a traditional thoracotomy. The groups have been selected in such a way that surgical indications, sex ratio, age and number of episodes were homogeneous. The parameters we have compared were the postoperative complications, the duration of chest drainage and hospitalization, the operating times and the relapses. Besides these technical parameters we considered the economic data too. RESULTS: On average drains removal occurred one day before in VATS-Group: the time spent in the Hospital was significantly shorter in VATS-Group, being on average 1 week. Short term complications may be considered similar in the two Groups. Prolonged air leaks occurred in 13% and 16% respectively. Emothorax requesting reoperation occurred in 1 case for each Group. One death occurred in thoracotomy-Group in an old patient presenting a severe chronic respiratory insufficience with exacerbation in postoperative time. We have registered 2 relapses after VATS and none after thoracotomy. CONCLUSIONS: The study has demonstrated the therapeutic efficacy of VATS and in the same time that in VATS the total economic cost is lower (22.7%) in comparison with traditional thoracotomy.

Is video-assisted thoracic surgery justified at first spontaneous pneumothorax?

OBJECTIVE: The fundamental role of video-assisted thoracic surgery (VATS) in the treatment of spontaneous pneumothorax is generally acknowledged today. This study intends to evaluate whether VATS is justified at the onset of a first spontaneous pneumothorax through analysis of parameters tested on two group of patients treated respectively with pleural drainage and VATS. PATIENTS/METHODS: The study includes 70 patients affected by first spontaneous pneumothorax divided into two groups of 35 patients for the purpose of therapeutic treatment. The first group underwent pleural drainage while the second underwent VATS. Parameters analyzed were as follows: (1) prolonged air leaks (more than 6 days); (2) time required for pleural drainage; (3) time of hospital stay; (4) management costs; (5) recurrences (follow-up at 12 months). RESULTS: Prolonged air leaks occurred in four patients (11.4%) in the first group and two patients (5.7%) in the second; recurrences occurred in eight patients in the first group (22.8%), and only one in the second group (2.8%). Mean time for drainage and hospitalization was, respectively, 9 and 12 days in patients with pleural drainage against 3.9 and 6 days of those using VATS. Average management costs per patients including hospitalization was calculated at $2,750.00 per patient for the first group compared with $1,925.00 for the second group. CONCLUSIONS: The use of VATS at first spontaneous pneumothorax is justified in the interest of both patients and health administrations as demonstrated by the number of recurrences in patients in the first group and economy savings resulting from use of VATS.

MR study of N2 disease in lung cancer: contrast-enhanced method using gadolinium-DTPA.

OBJECTIVE: In several previous studies, including one of our own, CT and MRI provided similar information on N2 detection in the staging of lung cancer. Both imaging techniques can be considered effective in detecting enlarged mediastinal lymph nodes but the results are often inaccurate when confronted with pathological findings. The purpose of this study was to assess the diagnostic accuracy of gadolinium-DTPA enhanced MRI in the detection of mediastinal lymph nodes in lung cancer. METHODS: A prospective study to compare standard unenhanced MRI and Gd-DTPA enhanced MRI was carried out in patients with diagnosed lung cancer. The study focused on the status of mediastinal lymph nodes. Gd-DTPA was administered at a dosage of 0.2 mmol2/KG before T1 weighted sequences. Qualitative visual analyses of both standard and contrast enhanced MRI images were performed on each patient by 2 independent radiologists. The imaging results were then compared to pathological findings obtained after surgical operation. RESULTS: In the identification of mediastinal lymph node metastases standard MRI was 62% sensitive, 100% specific and 74% accurate whereas Gd-DTPA enhanced MRI was 100% sensitive, 91% specific and 97% accurate. CONCLUSIONS: Gd-DPTA enhanced MRI was more accurate than standard MRI in the detection of metastatic lymph nodes in patients with lung cancer. These initial results can be considered encouraging especially with regards to the reduction of false negative findings although further confirmation is, understandably, required.

Cytogenetic findings in primary non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) shows a complex cytogenetic heterogeneity and up to now no particular chromosomal aberration seems to characterize its malignant evolution. We therefore performed cytogenetic analyses of 20 primary NSCLC, 8 adenocarcinomas and 12 squamous cell carcinomas on direct preparations or short-term cultures. Only 1 case was analyzed after long-term culture. Results were obtained from 11 samples and clonal rearrangements were found in 3 cases, a diploid and a near-triploid clone with several aberrations such as i (9q), rob (14; 15) and rob (21; 21) in 1 case, a near-triploid clone in 1 case, and Y chromosome loss in 1 case. Other aberrations found were sporadic, but +7 aneuploidy and translocations involving 1p were detected in 2 and 3 samples respectively. Although to date it has been very difficult to recognize primary changes in NSCLC, nevertheless a literature review and our results indicate that i(9q) and robertsonian translocations are relevant findings.

[Evaluation of carcinoembryonic antigen (CEA) in the follow-up of patients with inoperable lung cancer undergoing polychemotherapy]. / Valutazione dell'antigene carcino-embrionario (CEA) nel follow-up di pazienti con carcinoma polmonare inoperabile in corso di polichemioterapia.

Twenty-two patients with surgically incurable lung cancer undergoing systemic chemotherapy have been studied with serial determinations of CEA levels during their therapy. The changes of CEA levels in each patients showed that the assay may be useful to evaluate the effects of therapy. The purpose of this preliminary study is to explore the possibility that CEA assay may be a useful guide to the subsequent clinical response of the patient to the drug.

[Functional changes in the esophagus and action of pentagastrin on the competence of the lower esophageal sphincter (LES) after esophageal vagotomy]. / Modificazioni funzionali dell'esofago ed azione della pentagastrina sulla competenza del LES dopo vagotomia esofagea

In pursuance of an investigation of oesophageal physiopathology, a study has been made of the problem of the functional regulation of the inferior oesophageal sphincter in the light of new findings. Experiments carried out on six dogs made it possible to study functional modifications of the oesophagus after vagotomy, completing the technique by administering pentagastrin for the first time in vivo. Radiological and mano metric controls showed in the post-operative period a dilated oesophagus with a fall, in the lower third, of normal pressure values that did not undergo change, unlike what happened in the non-denervated oesophagus after administration of pentagastrin. The results obtained show that the integrity of the nervous structures is not only necessary for the perfect coordination of oesophageal peristalsis, but vital for normal functional response of the inferior oesophageal sphincter, since gastrin action is always mediated by release of acetylcholine by the post-gangliar vagal nerve endings.

[The role of fiberoptic bronchoscopy in the diagnosis of pulmonary cancer]. / Ruolo della fibrobroncoscopia nella diagnosi del cancro del polmone.

Cancer of the lung is becoming increasingly common. In the U.S., it has the highest mortality of the neoplastic diseases, well ahead of cancer of the colon and rectum. Surgical and/or complementary management is poorly effective because it comes too late. Early diagnosis and treatment are essential, therefore. Preclinical diagnosis may be possible radiographically in certain fortunate cases, but this is never an early diagnosis. The latter is only possible through active bronchial cytology (bronchial brushing, selective washing, PBS) during and after flexible fibrobronchoscopy, which can be carried out under local anaesthesia at the outpatient level and causes very little distress to the patient. Data from a personal series are cited in support of the view that cytodiagnosis should be routinely employed in subjects at high risk (heavy smokers, persons with chronic bronchitis, emphysema, etc.).

[Staging of bronchogenic cancer. Determination of mediastinal lymphatic involvement using magnetic resonance]. / Staging del cancro broncogeno. Identificazione dell'interessamento linfonodale mediastinico mediante risonanza magnetica.

Twenty-five patients with bronchogenic carcinoma were prospectively studied by both CT and MR during 10 days preceding thoracotomy. MR scans included contiguous axial and coronal slices. Results of CT and MR studies were compared with the surgical and pathological findings. Although no significant difference was found between the two imaging methods for the evaluation of mediastinal nodes. MR appear to be superior to CT in the aortopulmonary and subcarinal node areas.

[Importance of bronchial biopsy in the histologic typing of cancer of the lung. Case study contribution (1980-1987)]. / Il significato della biopsia bronchiale nella tipizzazione istologica del cancro polmonare. Contributo casistico (1980-1987).

The diagnostic significance of the histological typing of lung cancer carried out on preoperative bronchoscopic biopsy samples is assessed in relation to final morphological diagnosis on operating material. In this connection 176 of 624 cases of lung cancer documented histologically from January 1980 to December 1987 in which preoperative biopsy sample was followed by removal of the lung are analysed. The 4 basic histotypes of lung cancer according to the WHO (1981) classification are considered. A positive diagnosis for cancer was encountered in 138 cases (78.4%) with histotype confirmed in 122, whereas a negative diagnosis was encountered in 38 cases (21.6%). These findings also permitted further considerations, including the possible limitations of the technique.

[Use of magnetic resonance in the study of mediastinal diseases]. / Impiego della RM nello studio della patologia mediastinica.

Clinical research on 75 cases of mediastinal masses has been carried out with the aim of evaluating the diagnostic value of Magnetic Resonance (MR). Results which have been achieved point to a remarkable potentiality of MR especially in the characterization and spatial definition of the masses and in the study of the spinal canal. These results, as well as the non-invasivity of the procedure, lead us to consider MR as an investigation of primary importance in the diagnostic assessment of mediastinal pathology.

[Lung cancer with mediastinal lymph node involvement. Results of the combination of surgery and radiotherapy]. / Cancer bronchique avec envahissement ganglionnaire médiastinal: résultats de l'association chirurgie-radiothérapie.

From July 1979 to July 1986, 215 patients with non-oat cell carcinoma of the lung were treated by surgery at our institution. Of these, 169 had complete, potentially curative resection of their primary tumor and all accessible mediastinal lymph nodes. The extent of pulmonary resection consisted of pneumonectomy in 70 patients, lobectomy in 78 patients, bilobectomy in 18 patients and wedge resection in 3 patients. All were staged according to the AJG staging system. There were 88 patients without lymph node metastases (N0), 10 patients with peribronchial lymph node metastases (N1) and 60 patients with regional lymph node metastases (N2). All patients with N2 disease received radiation therapy to the mediastinum after surgery. The overall survival rate was 62% at 1 year, 36% at 3 years and 27% at 5 years. Survival in patients with N2 disease was 56% at 1 year, 23% at 3 years and 12.4% at 5 years. We conclude that patients with mediastinal lymph node metastases can be effectively treated by combined resection and radiation therapy, with prolonged survival.

[Translaryngeal tracheostomy using the Fantoni technique: report of 104 cases]. / La trachéotomie translaryngée selon la technique de Fantoni: à propos de 104 observations.

OBJECTIVE: Surgical tracheostomy morbidity led the authors to investigate new election techniques. The aim of this retrospective study was to assess the translaryngeal tracheostomy (TLT), complications and cost. METHODS: From January 1998 to January 2001, 104 patients were treated with TLT modified: 69 males (66.3%) and 35 females (33.7%), average age 52.6 +/- 9.5 years. The original pathologies were: traumatical (36), neurological (37), surgical (9), heart (4), respiratory (18). The average time between intubation and execution of TLT was 4.2 +/- 1.3 days. RESULTS: Fifty four patients died (52%) and 50 patients lived (48%). Two complications (1.9%) occurred in those who survived: a breaking of the guidewire in traction. Extraction of the tracheostomy tube by clamp, a haemorrhage in 2nd post-operative day due to a thyroid vessel lesion. The haemostasis was performed by classical tracheostomy. The average number of days to decannulation was 25 +/- 1 days. CONCLUSIONS: TLT reduces trauma or trachea and neighbouring structures. This technique is safe and easy. TLT is an effective method, in non-urgent situations, in children and adults, as well as in brachytypes and the obese.

[Small cell cancer of the bronchi: what is the role of surgery?]. / Cancer bronchique à petites cellules: quelle place pour la chirurgie?

A series of 39 operated cases of small cell cancer were analysed. In 15 cases (38.4%) an exploratory thoracotomy only was carried out. 24 patients (61%) had a pulmonary excision: 12 pneumonectomies, 3 bilobectomies and 9 lobectomies were carried out. The hospital mortality was 7.7%. After a study of the surgical specimens these 21 cases were grouped as follows: 5 stage I, 1 stage II and 15 stage III. After surgery 4 patients were treated with radiotherapy alone, 3 chemotherapy alone and 10 by a combination of radiotherapy followed by chemotherapy, finally 4 patients had no post operative treatment. For the 21 patients who had resections the actuarial survival was 12.8% at 5 years and the mean survival 24 +/- 17.2 months. These results were judged as satisfactory and lead one to consider the current place of surgery in the treatment of small cell bronchial cancer.

[Mediastinal lymphatic staging of bronchial cancer. Respective value of x-ray computed tomography and magnetic resonance imaging. Radio-surgical comparison]. / Bilan d'extension ganglionnaire médiastinale du cancer bronchique. Valeurs respectives de la tomodensitométrie et de l'imagerie par résonance magnétique. Confrontation radio-chirurgicale.

Fifty patients with bronchogenic carcinoma were prospectively studied by both CT and MR during 10 days preceding thoracotomy. Results of CT and MR were compared with the surgical and pathology findings. No statistically significant difference was found between the two imaging methods for the evaluation of node involvement (N2). MR appear to be superior to CT in the aortopulmonary and subcarinal areas.

[Video-thoracoscopic surgery: current indications and future perspectives]. / Video-toracoscopia operativa: indicazioni attuali e prospettive future.

The great interest in VATS over the last few years has extended the indications for this technique in order to avoid risks. There are additional indications (e.g. spontaneous pneumothorax), including several benign diseases of the lung, pleura, mediastinum and oesophagus. But other indications for the procedure are still controversial, for example lung resection for primary bronchial cancer. In this report the Authors, on the basis of their own experience, try to define the present and approaching perspectives for VATS.