Transmesenteric hernia after right nephrectomy: diagnostic and therapeutic management.

Internal abdominal hernias are a rare cause of intestinal obstruction (0.2-0.9%). Transmesenteric hernia is a rare type of internal hernia and usually in adult people is acquired. We report the case of a 44 year-old caucasian female with a small bowel occlusion after right nephrectomy for clear cell renal carcinoma caused by an acquired transmesenteric hernia. We emphasize the role of CT scanning for a prompt diagnosis and a quick surgical treatment in order to avoid intestinal gangrene.

What hides beneath the scar: sexuality and breast cancer what women don't say: A single-center study.

Background: Breast is a symbol of femininity, motherhood and sexuality. Breast cancer (BC) is the leading cause of cancer death in women worldwide and most frequent cancer in Italy: in 2019, 53.500 new cases were diagnosed. BC and its treatment, the disturbances of body image, and mental health problems such as anxiety and depression could influence sexuality. Very often the aspect of sexuality in BC is likely not to be fully investigated: cultural barriers may also contribute to lack of attention to these issues. In Italy, there are very few Breast Units that provide the figure of the sexologist and psycho-oncologist. Methods: We enlisted 141 BC patients (pts), mean age was 54 years afferent to Breast Unit S. Maria Goretti Hospital, Latina, from March 2019 to March 2020. All pts had undergone surgical intervention. Participants were invited to complete a structured questionnaire, which included four close-up questions regarding self-image, sexual activity, sexual satisfaction, analyzing these aspects before and after BC and its treatments. Finally the participants were asked if they needed the sexologist and psycho-oncologist. Results: Only 2/141 pts (1.41%) refused to participate in our study. Of 139 participants, 68 (48.92%) had disturbances of body image, 26 (18.7%) had sexuality greatly negatively affected, and 103 (74.1%) every kind of sexual dissatisfaction after BC. 38 pts (27.3%) would require the help of the sexologist. 135 ( 97%) would require the help of the psycho-oncologist. Despite the negative influence in their body-image and sexuality, few pts require the help of the sexologist, but nearly all pts require the help of the psycho-oncologist. Conclusion: In our study nearly all pts require the help of the psycho-oncologist, but few pts of the sexologist. Further studies will be needed to understand the reasons for this disparity: at the moment we are carrying out another project following this illustration, with the aim of understanding why this disparity.

Molecular and cellular signatures of human vaccine adjuvants.

Oil-in-water emulsions are potent human adjuvants used for effective pandemic influenza vaccines; however, their mechanism of action is still unknown. By combining microarray and immunofluorescence analysis, we monitored the effects of the adjuvants MF59 oil-in-water emulsion, CpG, and alum in the mouse muscle. MF59 induced a time-dependent change in the expression of 891 genes, whereas CpG and alum regulated 387 and 312 genes, respectively. All adjuvants modulated a common set of 168 genes and promoted antigen-presenting cell recruitment. MF59 was the stronger inducer of cytokines, cytokine receptors, adhesion molecules involved in leukocyte migration, and antigen-presentation genes. In addition, MF59 triggered a more rapid influx of CD11b+ blood cells compared with other adjuvants. The early biomarkers selected by microarray, JunB and Ptx3, were used to identify skeletal muscle as a direct target of MF59. We propose that oil-in-water emulsions are the most efficient human vaccine adjuvants, because they induce an early and strong immunocompetent environment at the injection site by targeting muscle cells.

Phosphorylation of human pro-urokinase on Ser138/303 impairs its receptor-dependent ability to promote myelomonocytic adherence and motility.

Serine phosphorylation of human pro-urokinase (pro-uPA) by A431 human carcinoma cells results in a catalytically active molecule with reduced sensitivity to plasminogen activator inhibitor type 1. We mapped the phosphorylated seryl residues by analyzing the in vivo phosphorylation state of engineered pro-uPA variants carrying a COOH-terminal poly-histidine tag. Stably transfected A431 cells do not incorporate radioactive phosphate into tagged pro-uPA in which the serines 138 and 303 have been replaced with glutamic residues, although endogenous nontagged pro-uPA is 32P-labeled on A and B chains. Moreover, the catalytic-independent ability of the mono- and di-substituted "phosphorylation-like" variants to bind to the GPI-anchored urokinase receptor (uPAR) and promote adherence of differentiating U937, HL-60, and THP-1 myelomonocytic cells was examined. We found that glutamic residues as well as the naturally occurring phosphoserines at positions 138 and 303 abolish proadhesive ability, although they do not interfere with receptor binding. In addition, pro-uPA carrying Glu138/303 lacks the capability to induce a chemotactic response of THP-1 cells. The exclusive presence of Glu138 reduces pro-uPA proadhesive and chemotactic ability by 70-80%, indicating that a phosphoserine residue at the same position plays a major inhibitory role of myeloid cell response to pro-urokinase. The di-substitution does not affect pro-uPA ability to interact with vitronectin or to enhance binding of urea-denatured vitronectin to uPAR. However, unlike wild-type tagged pro-uPA, the di-substituted variant does not induce receptor polarization in pre-adherent U937 cells. Taken together, the data support the possibility that pro-uPA phosphorylation on Ser138/303 can modulate uPAR transducing ability.

Eosinophilic cystitis associated with urethral stricture disease from pelvic trauma. Case report and literature review.

We report a case of eosinophilic cystitis (EC) in a 65-year-old man with urethral stricture disease from blunt pelvic traumatic event. EC is a rare condition characterized by eosinophilic infiltration of the bladder wall, that usually presents with irritative voiding symptoms, suprapubic pain and hematuria. Etiology is still not clear although a review of the literature suggests that pathogenetic mechanisms probably engage an altered immune response in the bladder, with the inflammatory reaction caused by factors such as exogenous allergens and previous bladder injury or surgery to the bladder or the prostate. The diagnosis of EC has to be confirmed by biopsy, since in some cases it may manifest as other inflammatory and malignant bladder disorders. A conservative medical management is indicated initially, since this disease may be self-limited, with a benign course especially in children and young patients. In adults EC is more often a chronic recurrent condition that requires close follow-up since it may lead to serious progressive bladder and/or upper urinary tract disease. More invasive therapies (including transurethral resection, partial or total cystectomy) may also be required when conservative therapy fails.

Preparation and characterization of four new variously deacetylated lysogangliosides, breakdown products of GM1.

Four new deacylated lysogangliosides were obtained through alkaline hydrolysis of either C18 or C20 sphingosine homologues of GM1. By this procedure, both the fatty acids residue and the N-acetyl group of sialic acid were removed to give mono-N-acetyl-lysoGM1 (C18 and C20); the additional loss of the N-acetyl group of the acetylgalactosamine moiety gave de-N-acetyl-lysoGM1 (C18 and C20) with three free amino groups. The structures of four deacetylated lysogangliosides were unambiguously characterized by chemical analysis and 1H and 13C NMR spectroscopy as well as by negative ion FABMS. The aim of this study was to isolate pure breakdown products of gangliosides, enabling the evaluation of the mechanism of action of glycosphingolipids through their cleavage and identification of structures of potential pharmacological activity. These new substances were prepared as candidates to influence eicosanoid production and the mechanisms dependent on protein kinase C and phospholipase A2.

[Pseudosarcoma of the urinary bladder. Report of a case]. / Pseudosarcoma della vescica urinaria. Studio di un caso.

A case of myofibroblastic pseudosarcomatous tumor of the bladder occurred in a patient previously submitted to TURB is reported. Aim of this investigation is to demonstrate, on the basis of the literature, the importance of histopathology in the diagnosis of bladder pseudosarcoma, since endoscopical and radiological methods can erroneously show a neoplasm. A 65-year-old male patient with hematuria, submitted to ultrasonography and cystoscopy, revealed a bladder superficial papillary formation. A TURB was performed and the histological study showed a superficial bladder cancer (T1-G1-2). After a second hematuria episode with stranguria a new bladder formation was diagnosed and resected; the histological study revealed a bladder pseudosarcoma. The absolute benignity of the lesion and the slight difference in the symptomatology between urothelial carcinoma and pseudosarcoma are underlined. Furthermore, the importance of histopathology to obtain an accurate diagnosis is stressed. The difficulty of a preoperative diagnosis without histopathological examination is pointed out.

[Nephrogenic metaplasia. A particular clinical and anatomopathologic entity]. / La metaplasia nefrogenica. Una particolare entità clinica ed anatomopatologica.

Two cases of nephrogenic adenoma are presented. The authors consider nephrogenic metaplasia as a reaction to inflammatory agents and point out the importance of differential diagnosis with nephrogenic adenocarcinoma, in which a different surgical procedure is requested.

[Combined surgical and medical treatment of pilonidal cysts and fistulae as prevention of recurrence]. / La terapia associata chirurgica e medica delle cisti e fistole pilonidali come prevenzione delle recidive.

The possibility of reducing the incidence of postoperative recurrences of pilonidal fistulas by using preoperative doses of Cephoxitine and primary surgical closure is described.

[Risk factors and multicentricity of vascular atherosclerotic disease. Our experience]. / Fattori di rischio e polidistrettualità nella malattia vascolare aterosclerotica. Nostra esperienza.

The objective of this study is the identification of the most important risk factors of atherosclerosis and the determination of its multicentricity, the goal being an efficient primary and secondary prevention of this disease. Over the course of eight years, at the Department of Diagnosis and Surgical Physiopathology of Peripheral Vascular Diseases, 829 subjects with atherosclerosis were examined, of whom 513 males and 316 females between 18 and 85 years old, as well as to 200 healthy control subjects. The risk factors in consideration were: age, sex, hypertension, diabetes, lipoidoproteinosis, smoking, alcohol and coffee intake. From the data obtained it was revealed that smoking represents the most important risk factor for atherosclerosis (65% of the cases, 40% of the controls), followed in decreasing order by hypertension (31% of the cases, 6% of the controls), diabetes (26% of the cases, 2% of the controls), lipoidoproteinosis (15% of the cases, 6% of the controls). Furthermore 21% of the subjects drank coffee and 28% ingested alcoholic beverages, compared with, respectively 19% and 24% of the controls. In 70% of the cases the presence of atherosclerotic lesions were found in more than one vascular region. Atherosclerosis has a multifactorial etiology as there exists a correlation between the predisposition of the patient to acquire the disease and environmental factors. It is difficult to distinguish the determining effects of a single risk factor, because often many risk factors are tightly interrelated in the same individual; a nearly direct relationship clearly exists between the number and entity of the risk factors and the clinical picture of the patient examined.(ABSTRACT TRUNCATED AT 250 WORDS)

[Inverted papilloma of the bladder: observation of 3 clinical cases and discussion on their clinico-pathologic characteristics]. / Papilloma invertito della vescica: osservazione di tre casi clinici e discussione sui caratteri clinico-patologici.

Three cases of urothelial inverted papilloma, detected in two female patients aged 32 and 31 years, respectively and in one 67-year-old male patient, are described. Inverted papilloma is a benign lesion which occurs in the urinary epithelium with a 20% incidence in comparison with other urothelial tumours. The male:female ratio is 3:1. The histological structure of urothelial inverted papilloma is similar to that of inverted papilloma of the nasal and paranasal sinuses. It presents interanastomosed epithelial cords, with transitional cells, which develop in the tunica propria connective tissue. Some cells are distributed in such a way as to constitute vacuolated glandular-like structures. The histogenetic origin of the lesion from Home subtrigonal or Albarran subcervical glands is debatable. Recent aetiological hypotheses have claimed that the origin of the lesion may be related to Brunn's nest hyperplasia and/or to chronic urothelial inflammation. The latter hypothesis would currently appear to be the most accredited: immunostaining for cytokeratins would tend to support a urothelial inflammatory aetiology. In our cases, we achieved a definitive diagnosis of inverted papilloma only at histology, because of the specificity of the echotomography and cystoscopy findings. Urinary cytology revealed only a large number of inflammatory cells with anaplastic elements, but without any more detailed morphological description. We performed a transurethral resection of the bladder (TURB) in all three patients: routine follow-up showed the absence of inverted papilloma relapses. On the basis of the above-mentioned data and a thorough review of the literature, we attempt to assess and classify the clinico-pathological findings and the aetiological hypotheses of urothelial inverted papilloma. In addition, the benign nature of the lesion and any malignant transformation factors are discussed.

Prostatic small cell carcinoma diagnosed by tru-cut needle biopsy: discussion of clinico-pathological findings.

The small cell carcinoma is a neuroendocrine tumour characterised by an aggressive clinical course and a high mortality rate. It occurs most commonly in the lung. Small cell carcinomas originating in the genitourinary system have been diagnosed with increasing frequency in recent years, because of the use of immunohistochemistry. Prostatic small cell carcinomas present the same biological behavior and similar histological, immunohistochemical and ultrastructural features to small cell carcinomas of the lungs. We describe the clinico-pathological findings in a 65-year-old male patient with a diagnosis of prostatic small cell carcinoma, obtained by means of a tru-cut needle biopsy. We performed the immunohistochemical tests using neuron-specific enolase and chromogranin A antibodies, according to the literature. On the basis of our experience we stress the malignant features of small cell carcinoma and the difficulty in obtaining an early diagnosis and treatment because of the aggressive course of the lesion and the late symptomatology.

[Spinal cord ischemia following subrenal aortic clamping]. / La ischemia midollare conseguente a clampaggio aortico sottorenale.

The paraplegia caused by an aortic clamping just below the Renal artery is a rare but very complication in aortic surgery. Such a complication is even rarer if we consider the few cases reported in literature following a reconstructive surgery for occlusive chronic diseases of aortiliac axes. The authors have studied the case of a patient bearing the syndrome of Leriche; this one had an aortic clamping below the kidney and soon after developed an acute ischaemic syndrome below the spinal medulla with flaccid paraparesis, anal and vesical sphincteric diseases and persistence of deep tactile sensibility. After a reconstruction of vascular anatomy of the medulla they emphasize the importance, in such a disease, of the "arteria radicularis magna" of Adamkievicz and its place of origin. After they discuss the severe physioopathologic moments that are connected: with the direct ischaemia following aortic clamping in the cases where the arteria radicularis magna rises at a level lower than the clamping itself; with the embolism or thrombosis caused by surgical manipulation peroperatively (it might be the cause of paraplegia more frequent in aneurysmectomia surgery); with the severe hypotension per- and post operatively for the existence of arteriosclerotic disease of the lumbar arteries. Finally they analyses preoperatively diagnostic possibilities and per operatively methods used in preventing this sort of complication.

[A case of renal infarction: clinical and anatomic contribution]. / Un caso di infarto renale: contributo clinico ed anatomico.

A case of renal infarction presenting with acute abdomen is reported. Due to the extended renal damage nephrectomy was performed. Macroscopic appearance of the kidney (prevalent cortical vascular infarction) and of the surrounding tissues (retroperitoneal edema and abdominal ascites) suggested a comparison with epidemic haemorrhagic fever. Vascular supply to the kidney, in such cases, depends on the perforating arteries which may increase in number and size.

[A case of so-called prostatic hypertrophy with endovesical projection of the lateral lobes]. / Un caso di c.d. ipertrofia prostatica con aggetto endovescicale dei lobi laterali.

A case of benign prostatic hyperplasia with lateral lobes large involvement is reported. On the basis of their own experience and a review of the literature the role of hormonal synergism in the development of the condition is outlined.

[Renal microcarcinomas: a particular clinical entity]. / I microcarcinomi renali. Una particolare entità clinica.

According to the possibility of an early diagnosis, related to diagnostic imaging and predictive indexes such as DNA and vascular permeability, in the presence of a low grade-low stage tumor, and with the support of the Literature, the Authors hypothesize an increasing applicability of conservative surgery in the management of small renal carcinomas.

[Male infertility due to varicocele: their diagnosis and treatment. Our experience]. / L'infertilità maschile da varicocele: diagnostica e terapia. Nostra esperienza.

The Authors have examined, over a period of two years, 110 patients presenting with varicocele and infertility. Varicocele has an incidence of 40% in male sterility, causing oligozoospermia and asthenospermia. Patients first underwent non-invasive tests such as Doppler and echo-Doppler tests. According to the Authors experience, Doppler speedometry is decisive for the diagnosis of both idiopathic and subclinical varicocele, for the post-operative control of microsurgical anastomosis, and for the intra-operative detection of accessory spermatic veins. The surgical technique used by the Authors is the modified Palomo technique, but other techniques are investigated as well. Post-operative results, concerning both spermiogram and relapses are also evaluated.

[Ambulatory phlebectomy: our experience]. / La flebectomia ambulatoriale: nostra esperienza.

The Authors report their experience of out-patient phlebectomy. Over a period of 5 years they have examined 186 patients (156 females, 30 males): 166 had micro- and extra-saphenic varicosities, while 20 had recurrent varices. Patients with ostium failure were excluded. Muller's out-patient phlebectomy implies an accurate mapping of varicosities, local anaesthesia, microincisions which are only exceptionally sutured. The Authors consider that an accurate elastic pressure bandage is indispensable and useful in order to improve the dynamics of the PVC and to avoid haemorrhages. Such a surgical technique bears aesthetic, economic and haemodynamic advantages.

[Thyroid cancer and its incidence in nodular thyroid diseases: our experience]. / Il cancro della tiroide e la sua incidenza nelle tireopatie nodulari: nostra esperienza.

The authors report their experience with 453 cases of thyroid nodules observed over a period of 5 years. The intention was to determine the incidence of malignant lesions. A female prevalence of the nodular pathology was clearly evident (7.2%), with a maximum incidence between the 3rd and 6th decade. Among malignant tumors (14.2%) the following histologic types were most frequently found: papillary adenocarcinoma (5.7%), follicular adenocarcinoma (2.7%), occult cancer (2.7%), anaplastic cancer (2.3%). Up to the 4th decade female prevalence was clearly evident (Max in the 3rd decade; F/M ratio = 6.5); then an increased male incidence was registered bringing to a reduction of the F/M ratio (1.5 in the 5th and 6th decade) and to its inversion in the 7th decade (M/F = 1.25).

[Treatment of stenosis of the posterior urethra using Sachse's urethrotome]. / Trattamento delle stenosi dell'uretra posteriore con l'uretrotomo di Sachse.

The authors suggest to treat the stenosis of the posterior urethra with a technique able to prevent relapses as much as possible. For this reason they recommend the improved technique of Sachse as the more suitable, avoiding, though, irritative stimuli (resections and indwelling catheters).