Evaluation of radon exposure risk and lung cancer incidence/mortality in South-eastern Italy.

INTRODUCTION: Radon and its decay products may cause substantial health damage after long-term exposure. The aim of the study was to perform a spatial analysis of radon concentration in the Salento peninsula, province of Lecce (South-eastern Italy) in order to better characterize possible risk for human health, with specific focus on lung cancer. METHODS: Based on previous radon monitoring campaigns carried out in 2006 on behalf of the Local Health Authority (ASL Lecce) involving 419 schools and through the application of kriging estimation method, a radon risk map was obtained for the province of Lecce, in order to determine if areas with higher radon concentrations were overlapping with those characterized by the highest pulmonary cancer incidence and mortality rates. RESULTS: According to our data, areas at higher radon concentrations seem to overlap with those characterized by the highest pulmonary cancer mortality and incidence rates, thus indicating that human exposure to radon could possibly enhance other individual or environmental pro-carcinogenic risk factors (i.e. cigarette smoking, air pollution and other exposures). CONCLUSIONS: The radon risk should be further assessed in the evaluation of the causes resulting in higher mortality and incidence rates for pulmonary cancer in Salento area vs Italian average national data. For these reasons, ASL Lecce in cooperation with ARPA Puglia and CNR-IFC has included the monitoring of individual indoor radon concentrations in the protocol of PROTOS case-control Study, aimed at investigating the role of different personal and environmental risk factors for lung cancer in Salento.

Effectiveness and safety of multidrug intracavernous therapy for vasculogenic impotence.

A four-drug vasoactive mixture (papaverine hydrochloride, prostaglandin E1, phentolamine mesylate, atropine sulfate) was used for intracavernous injection therapy in 94 patients with vasculogenic impotence as diagnosed by color Doppler sonography and dynamic infusion cavernosometry-cavernosography. At a mean follow-up of twenty months, 66 patients (70%) are using the injections with the initial dose and are satisfied; 14 patients (15%) are using the injections with a smaller dose than initially given; and 14 patients (15%) dropped intracavernous treatment. Only 4 patients (4%) were unable to achieve a sustained rigid erection during the mixture titration phase. Selected cases of vasculogenic impotence can be safely and effectively treated by the association of drugs which rely on different mechanisms of action, producing a pharmacologic synergism which enhances the overall therapeutic effect.

Effect of yohimbine-trazodone on psychogenic impotence: a randomized, double-blind, placebo-controlled study.

OBJECTIVES: The aim of this study was to determine the effectiveness and safety of yohimbine and trazodone used together for the treatment of pure psychogenic impotence. METHODS: Sixty-three patients who had psychogenic impotence diagnosed on the basis of sexual history, results of physical examination, laboratory analysis, polysomnographic recording of nocturnal erections, and dynamic color Doppler sonography of the cavernosal arteries were entered into a randomized, double-blind, placebo-controlled, partial crossover study comparing placebo with yohimbine (15 mg per day orally) and trazodone (50 mg per day orally) used together. Treatment consisted of two 8-week courses. Patients who initially received placebo for 8 weeks were then switched to the 2-drug combination for 8 weeks. Erectile function, ejaculation, interest in sex, and sexual thoughts were investigated at the end of drug treatment and at 3- and 6-month follow-up. For statistical analysis chi-square, McNemar, and Student's t test for unpaired data were used. RESULTS: Fifty-five patients (87%) completed the whole treatment schedule. Positive clinical results (complete and partial responses) were obtained in 39 (71%) patients at the end of the drug treatment phase. These results were significantly better than those obtained with placebo (p < 0.01). Positive results were maintained in 32 (58%) and 31 (56%) patients at 3- and 6-month follow-up, respectively. Minor drug-related adverse effects occurred in 6 (11%) of the patients in the yohimbine-trazodone group and in 2 (4%) in the placebo group. CONCLUSIONS: The combination of yohimbine and trazodone is a safe and effective first-line treatment for psychogenic impotence.

Improved minimally-invasive assessment of penile haemodynamics: the combination of colour Doppler sonography and injection-stimulation test.

The aim of this study was to assess the diagnostic value of erotically enhanced penile colour Doppler sonography as a minimally invasive tool to evaluate penile haemodynamics. Colour Doppler sonography was used to study the cavernosal arteries of 135 consecutive impotent patients after intracavernous injection of a vasoactive mixture (injection phase) and after subsequent genital and audiovisual sexual stimulation (stimulation phase). The erectile response was upgraded after the adjunct of genital and audiovisual stimulation in 36% of patients. Colour Doppler assessment performed after the stimulation phase identified 16% of patients as arteriogenic despite normal erections, and 7% of patients falsely diagnosed as venogenic after the injection phase. When colour Doppler sonography and the injection-stimulation test are performed together as a single diagnostic procedure the overall diagnostic accuracy is significantly enhanced.

AMS 700 CX inflatable penile implants for Peyronie's disease: functional results, morbidity and patient-partner satisfaction.

This study was designed to clarify the functional results, morbidity and the patient-partner satisfaction observed with, the American Medical System 700 CX three-piece inflatable prosthesis in the treatment of impotence associated with Peyronie's disease. Thirty-three patients were treated and additional plaque surgery was performed in 13 cases (40%). Within 10 days of surgery, four patients (12%) developed a wound infection which was treated conservatively and one patient (3%) experienced glandular ischemia. At the 6-week follow-up, complete penile straightening was achieved in 23 patients (70%), while penile rigidity was considered optimal by all patients. On the contrary, the penis was considered short by 10 patients (30%). Five diabetic patients (15%) complained of severe scrotal and penile pain during full activation of the implant and in one of these patients (3%) the implant had to be removed. Due to spontaneous erections occurring after implant activation one patient (3%) required replacement of the reservoir from the Retzius space into the peritoneum. At the long-term follow-up (mean +/- SE: 17 +/- 2.2 months), 23 patients were evaluated and all found to be engaging in intercourse with the prosthesis. However, five patients (21%) and three of the 13 partners (25%) assessed were not yet completely satisfied. The American Medical System CX700 inflatable penile prosthesis obtains complete penile straightening in 70% and rigidity in 100% of impotent patients with Peyronie's disease. Patients should be fully informed about possible surgical morbidity and actual post-operative penile length.

Electron microscopic demonstration of cerebello-oculomotor fibres in cat.

Few synaptic buttons with the typical changes of "electron-dense degeneration" were found in the nucleus of the oculomotor nerve of cats, which underwent complete bilateral ablation of the cerebellum. The degenerating buttons were mainly found in the neuropil, contacting small dendritic profiles. For the scanty number of degenerating buttons observed and for the particular location of its terminal buttons, the direct cerebello-oculomotor connection appears to be an ancillary route in the cerebello-oculomotor linkage, which involves mainly polysynaptic routes.

Clinical reliability of multi-drug intracavernous vasoactive pharmacotherapy for diabetic impotence.

The aim of this study was to assess the effectiveness and safety of intracavernous injections of a four-drug vasoactive mixture in diabetic patients with organic impotence. A group of 60 diabetic patients with either pure neurogenic, pure vasculogenic or mixed neurovasculogenic impotence were treated with intracavernous injections of a combination of 12.1 mg/ml papaverine hydrochloride, 1.01 mg/ml phentolamine mesylate, 10.1 micrograms/ml prostaglandin E1 and 0.15 mg/ml atropine sulphate ('full-dose' mixture). A mixture of the same drugs but at one-third concentrations ('reduced-dose' mixture) was also used. The mean (+/- SEM) volumes of the full-dose and reduced-dose mixtures used were 0.21 +/- 0.03 ml and 0.31 +/- 0.02 ml, respectively. All the patients were able to sustain a rigid erection at the end of the titration phase of the study. At a mean follow-up of 18 months, 48 patients (80%) were successfully using the mixture, 6 patients (10%) were using the mixture at a dose lower than the initial dose and 6 patients (10%) had dropped out from the injection therapy. No major complications were seen. The association of multiple vasoactive drugs which use different mechanisms of action, thus exerting a pharmacological synergism, is an effective and safe procedure in intracavernous pharmacotherapy for diabetic patients with organic impotence.

Is there a role for transrectal microwave hyperthermia in the treatment of benign prostatic hyperplasia? A critical review of a six-year experience.

We critically reviewed our 6-year experience with transrectal microwave hyperthermia of the prostate for benign prostatic hyperplasia (BPH) in 320 patients either at high surgical risk or refusing surgery. Transrectal prostatic hyperthermia was given in five to ten 60-minute sessions with an intraprostatic temperature ranging from 42 degrees to 43.5 degrees C. Although an amelioration of symptoms and urodynamic measures was seen initially in most patients, only residual urine volume showed a statistically and clinically significant improvement at the long-term follow-up. According to maximum flow nomograms, bladder outlet obstruction was not resolved by the treatment. We conclude that although the transrectal hyperthermia proved to be a safe procedure, it did not cure BPH in the long term. Considering the results seen with newer nonsurgical procedures such as prostatic stents and prostatic lasers, we believe that transrectal hyperthermia should not be recommended to symptomatic BPH patients.

Statistical evaluation of Monson's sphere in healthy permanent dentitions in man.

The three-dimensional curvature of the mandibular dental arch was studied in 20 men and 20 women with sound dentitions and free from temporomandibular joint problems. The x, y, z coordinates of cusp tips of all but the third molars were obtained with a three-dimensional digitizer, and used to derive a spherical model of the curvature of the occlusal surfaces. From the best interpolating sphere the radii of the left and right curves of Spee (quasi-sagittal plane) and of the canine and molar curves of Wilson (frontal plane) were computed. The occlusal curvature of the mandibular arch was not significantly influenced by gender, even if, on average, all the computed variables were larger in men than women. The radii of the overall sphere, right and left curves of Spee, and curve of Wilson in the molar area were about 105 mm in men, and about 100 mm in women. A relatively large intrasample variability in arch curvature was found. The mean sphere radius in men was very close to the classical value of 4 in, confirming Monson's observations, but the relatively large intrasample variability prevented any definitive determination of a sexual dimorphism in the three- dimensional characteristics of occlusal curvature.

Dental arch asymmetry in young healthy human subjects evaluated by Euclidean distance matrix analysis.

Form differences between biological structures can be evaluated using several approaches. A recently proposed method (Euclidean distance matrix analysis; EDMA) seems to be able to differentiate between size and shape differences. Here it has been applied to study the asymmetry of mandibular and maxillary arches in 50 men and 45 women with sound dentitions. The centres of gravity (centroids) of the occlusal surfaces of all permanent teeth (right second molar to left second molar) were individualized on the dental casts of subjects. The form of the right and left maxillary and mandibular hemi-arches was separately assessed by calculating all the possible linear distances between pairs of teeth within arch and side. Side differences were tested by EDMA. In men, the maxillary and the mandibular arches were both symmetrical (i.e. there were no significant differences in size or shape between the left and right hemi-arches). In women, the mandibular arch was symmetrical, but in the maxillary arch the two antimeres had a significantly different shape. No size differences were found between the left and right female hemi-arches.

Maxillary versus mandibular arch form differences in human permanent dentition assessed by Euclidean-distance matrix analysis.

Euclidean-distance matrix analysis (EDMA) was used to analyse the dental arch form in 50 men and 45 women aged 20-27 yr with sound dentitions. Fourteen landmarks, corresponding to the centres of gravity (centroids) of the occlusal surfaces of all permanent teeth (right second molar to left second molar), were identified on the dental casts of subjects. All the possible linear distances between pairs of teeth were computed and maxillary/mandibular arch differences within sex were tested by EDMA. In both sexes, the maxillary arch was larger than the mandibular arch; arch shape was also significantly different. All teeth contributed to the shape difference between arches regardless of gender. EDMA also separated the influence of anterior and posterior teeth in the determination of upper/lower arch characteristics.

Mathematical definition of the curve of Spee in permanent healthy dentitions in man.

The intrinsic morphology of the mandibular curve of Spee (i.e. independent from reference planes) was studied in 50 men and 45 women with sound dentitions. Left and right curves were reconstructed by a second-order quadratic interpolation of buccal cusp tips. Gender differences were found in both sides, while side differences were found only in the male sample. Male and female curves had similar concavities, but the position of the interpolating second-order quadratic curve relative to the dental arch was significantly different. The right and left male sides showed different concavities, the right-hand side being flatter than the left. Male curves appeared larger than female ones, and the left-hand side was significantly larger than the right regardless of gender. The reported second-order quadratic curves could be used as reference for prosthetic and orthodontic reconstructions.

A computerized non-invasive method for the assessment of human facial volume.

The three-dimensional coordinates of 22 standardized soft-tissue facial landmarks were used in the definition of a three-dimensional model of the adult human face. The model allows the estimation of the volume of the face in toto and of its parts (upper, middle and lower thirds, nose). Landmark coordinates were collected in 80 healthy young adults (40 men and 40 women selected according to criteria of dentofacial normality) by infrared photogrammetry by an automated instrument, and facial volumes calculated. Sample variability was larger in women than in men; the nose and the upper third of face had the largest variability regardless of gender. On average, all volumes computed in men were significantly larger than the corresponding values computed in women. Also the lower-to-middle third face ratio was significantly higher in men than in women. The sexual dimorphism in human facial volume did not involve the different parts of the face to the same extent: a large part of male facial volume preponderance was explained by the lower third of face. The proposed facial model could adequately represent the human face in all those research and clinical fields where noninvasive surface measurements could be employed alone or in support of conventional radiographic data.

Considerations on the dynamics of adipose cells in relation to ponderal variations: morphoquantitative aspects.

The sizes and numbers of subcutaneous adipose-tissue fat cells were determined in obese patients, some of whom had undergone severe weight reduction induced by a jejuno-ileal bypass operation, and others a moderate thinning by a reducing diet, for comparison with those in normals. The size-class distribution of the fat cells suggests a morphoquantitative, dynamic interpretation of the two known forms of obesity, one being of moderate degree and called hypertrophic, the other more severe and called hyperplastic. The hypertrophic obese condition is characterized by a bimodal size-distribution curve of the adipocytes, similar to the curve in normal individuals. In both the normal and the hypertrophic obese, ponderal variations displace this curve forwards or backwards without altering its shape. By contrast, the hyperplastic obese shows a flat size-distribution curve without discernible modes. The smallest size-class of fat cells are the most sensitive to weight-reduction process and hypotrophize so much that they can no longer be recognized as adipocytes in histological sections; thus the size-distribution curve for hyperplastic obese individuals losing weight changes in shape from uniform to bimodal. The relationship which expresses the mean fat cell diameter as a function simultaneously of the initial weight and of ponderal variation was also studied, and tested by multiple regression analysis.

Human neonatal ovary: proposal of a three-dimensional model.

A model of human neonatal ovary is presented, derived from morphometric, evaluations carried out on left ovaries removed from five full-term neonates with a 46, XX karyotype, free from malformations of the genital apparatus. According to this model, the gonad can be represented by a triaxial ellipsoid with a central medullary core surrounded by a cortical stratum of constant thickness. The germinal population, consisting of follicles and primitive cortical tissue, occupies the cortex, intermingled with the interstitium or stroma. In the cortex it is then possible to describe an outer layer formed by primitive cortical tissue, and an inner portion occupied by follicles. The primary and secondary follicles fill the portion near the medulla and the primordial ones are contained in the middle and outer zones. Since the variability observed among ovaries is slight, we can propose a mean model of neonatal ovary in which the spatial relationships among the different components, the total number of follicles and their position in the cortex can be calculated.

[Rehabilitative physiotherapy in Soviet medicine]. / La fisioterapia riabilitativa nella medicina sovietica.

There are three different levels of rehabilitational physical therapy in heart diseases in the Soviet Union. Natural methods are used such as climate therapy, baths, sunshine and physiotherapy as well as artificial methods including laser, electric and mechanical energy, etc. Artificially produced mineral waters which are identical to natural ones are also applied. All these methods yield good results in myocardial infarction, cerebral ictus, coronary diseases, cerebral ischemia, hypothyroidism, etc.

[Climate and psychosomatic medicine]. / Clima e medicina psicosomatica.

In the last few years, psychosomatic medicine has accomplished very important and interesting analyses of several medical syndromes. On the contrary, medical climatology, even with the development of new tools for climate research, has remained linked to old ideas which need to be revised in order to keep pace with the latest discoveries in this field. It is therefore desirable to undertake research on the action of different climates and microclimates on the human organism, and also to take into account the patients, tendencies and aspirations, because "the climate that will yield the best results is the climate the patient likes best". In conclusion, taking into account a patient's personality and aspirations, thermal therapies and climate treatments may be coupled. As a matter of fact, in our country it is possible to find spas with the same kind of waters but with completely different climates.

[Effects of beta blocking agent iontophoresis by modulated sinusoidal current]. / Effetti della ionoforesi con beta-bloccanti con corrente sinusoidale modulata.

The action of the transcutaneous application of propranolol using modulated sinusoidal current iontophoresis was studied. When this way of administration is used, the drug, while maintaining its negative chronotropic effect, loses the negative inotropic one. Investigations were performed on 58 men aged 32 to 62 who underwent an aortocoronary bypass for myocardial ischemia. Thirty-four patients had already had myocardial infarction. The drug reduced the heart rate and increased cardiac contractility. Moreover, the study showed that only the levogyral isomer of propranolol (the only active one) passes through the skin.

[Effects of short-wave therapy in patients with chronic pyelonephritis]. / Effetto della marconiterapia in pazienti con pielonefrite cronica.

One hundred and twenty patients (64 men and 56 women, aged 19 to 63) with chronic pyelonephritis were subdivided into two groups: a control group of 30 subjects and an experimental one of 90 subjects. Experimental subjects underwent short wave therapy (460 MHz, 50-60 W, for 8-20 minutes) in the lumbar area. Lumbosacral pain disappeared in 87 out of 90, subjects, intercostal pain in 20 out of 28, headache mitigated in 40 out of 53, asthenia was markedly reduced in 49 out of 50. Systolic and diastolic hypertension was reduced, as well as the Kakorski-Addis count in urine. Diurnal diuresis and lysozyme increased, while IgG, IgA and IgM were reduced.