Levels of the adducts of 4-aminobiphenyl to hemoglobin in control subjects and bladder carcinoma patients.

We determined the hemoglobin adduct levels of one aromatic amine of cigarette smoke, 4-aminobiphenyl (4-ABP), in smoking controls and in patients with transitional cell bladder carcinoma. Covalently bound 4-ABP was measured by capillary gas-chromatography and negative-ion chemical ionization mass-spectrometry, using deuterated 4-ABP as internal standard. Smoking was quantified measuring the urinary excretion of cotinine. Thirteen cases and controls were paired for urinary cotinine levels. Bladder carcinoma patients had slightly higher levels of 4-ABP hemoglobin adducts than controls (means +/- S.D. were 103 +/- 47 and 65 +/- 44, respectively). This difference was significant using a t-test for paired samples (P = 0.04) and non-parametric Kruskal-Wallis rank analysis (P = 0.033).

Simultaneous determination of testosterone, dihydrotestosterone and 5 alpha-androstan-3 alpha,-17 beta-diol by isotopic dilution mass spectrometry in plasma and prostatic tissue of patients affected by benign prostatic hyperplasia. Effects of 3-month treatment with a GnRH analog.

This article reports an isotope dilution mass spectrometric method for the simultaneous measurement of testosterone (T), dihydrotestosterone (DHT), and 5 alpha-androstan-3 alpha, 17 beta-diol (3 alpha-diol) in human plasma and prostatic tissue. After addition of tri-deuterated steroids as internal standards to prostatic tissue homogenates or plasma samples, extraction was performed with diethylether. The extracts were purified by two chromatographic steps (Sep-Pak C 18 cartridge and Sephadex LH-20) and injected into a gas chromatograph coupled with a mass spectrometer after derivatization with heptafluorobutyric acid. This method was highly specific and showed good precision, accuracy, reproducibility and sensitivity. T, DHT, and 3 alpha-diol were measured in human plasma and in prostatic tissue of seven patients with benign prostatic hyperplasia (BPH) treated for 3 months with a long acting GnRH analog before surgery. Plasma levels of T, DHT, and 3 alpha-diol were reduced by GnRH analog treatment to castrate levels. The tissue concentrations of the same steroids, compared with those obtained from 19 untreated patients, showed a mean reduction of about 90% for DHT and 3 alpha-diol, and about 75% for T. These results suggest that about 90% of prostatic DHT and 3 alpha-diol depend on testicular activity because they are dramatically reduced after pharmacologic castration.

[Paraneoplastic syndromes associated with bladder carcinoma. Apropos of 2 cases of hypercalcemia]. / Le sindromi paraneoplastiche associate al carcinoma vescicale. A proposito di 2 casi di ipercalcemia.

Apart from presenting a specific symptomatology, cancer of the bladder in some rare cases may present with a set of symptoms that at first sight seem unrelated to the tumour and that constitute the paraneoplastic syndromes. The importance of these paraneoplastic symptoms is represented by the fact that they may constitute the first sign of malignity, or may be the expression of a recurrence. Two rare cases of paraneoplastic hypercalcemia are reported, the literature is reviewed and the aspects of this rare pathology are analysed.

[Ectopic ureter. Description of a clinical case with appearance of stress urinary incontinence]. / Uretere ectopico. Descrizione di un caso clinico in seguito alla comparsa di incontinenza urinaria da sforzo.

A case of ectopic ureter in a 45 year old woman arising after the onset of stress incontinence is reported. The patient presented complete pyeloureteral duplication with an ectopic ureter whose orifice drained into the proximal urethra. The embryology, diagnostic and therapeutic problems of the case are discussed with emphasis on the tardive appearance of the symptoms.

[Posttraumatic functional exclusion of the kidney of nonvascular origin. Description of a case and review of the literature]. / Esclusione funzionale post-traumatica del rene da causa non vascolare. Descrizione di un caso e revisione della letteratura.

A review of published series about 56 cases with unilateral nonvisualization on excretory urography after external trauma have been described: the renal injury causing the nonvisualization was contusion in 8 patients, laceration in 13, rupture in 12 and renal pedicle in 19. The acquisition of the most important methods has allowed a total view as about minimal lesions (contusion, laceration), as rupture or fragmentation of the kidney and renal pedicle. We have evaluated 32 cases of renal traumatic injuries and we have studied one case with unilateral nonvisualization stressing the diagnostic, etiopathogenetic and therapeutic problems.

[Diagnostic, clinical and therapeutic aspects of primary transitional cell carcinoma of the prostate]. / Aspetti diagnostici, clinici e terapeutici del carcinoma primitivo a cellule di transizione della prostata.

Transitional cell carcinoma is a rare neoplasm with an reported incidence of 2%. It is biologically different from adenocarcinoma in that it is not hormonally responsive and it is not associated with an elevated serum acid phosphatase. It is marked by local invasiveness and distant metastases. Transitional cell carcinoma has its origin at the level of the periurethral ducts in the area of the junction of the cylindrical and transitional epithelium. Transitional cell carcinoma can be distinguished from adenocarcinoma and carcinoma endometriode exclusively for its histological aspect. Various therapies have been used to treat transitional cell carcinoma but with poor results. Surgical treatment is still today the most efficient with a surviving average of 2 years. The Authors report 3 new cases, discussing diagnostic, clinical and therapeutical aspects of this rare neoplasm.

[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.

[Urethral parameatal cysts. Report of two cases and review of the literature]. / Cisti uretrali parameatali. Descrizione di due casi e revisione della letteratura.

Two cases of parameatal urethral cysts in the male are reported. These round cysts don't interfere with sexual function but can determinate an alteration of the urinary flow (biforcation of the flow). The aetiology of these cysts is not completely understood, while the treatment is univoque and simple: complete excision but no aspiration or marsupialization.

[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.

[Radical prostatectomy: which quality of life?]. / Prostatectomia radicale retropubica: quale qualità di vita?

The aim of the present study was to evaluate quality of life in patients submitted to radical prostatectomy, by correlating the results of the postoperative condition with follow- up data at 6 and 12 months. MATERIALS AND METHODS. Between october 2004 and december 2005, 68 patients - mean age 68 (range 49-76) - treated with radical retro-pubic prostatectomy for localized prostate cancer (T2a, T2b, No, Mo) were consecutively enrolled onto the study. All patients underwent sexual as well as urinary incontinence rehabilitation, showing good compliance. We evaluated quality of life before prostatectomy (T0), 6 (T1) and 12 (T2) months after surgery through the Short Form 36 questionnaire, for which an analysis of variance for repeated measures was carried out. Patients were interviewed by our department psychologist regarding urinary incontinence and erectile dysfunction. All patients were disease-free at the time of evaluation. RESULTS. No significant differences were observed between physical and mental health indices. Conversely, a significant improvement (p<0.001) was seen in all SF-36-questionnaire 8 scales, comparing preoperative T0 values with T1 and T2 values. Of the 68 patients, 53 (78%) no longer needed pads at the T2 follow-up, while 15 (22%) reported using 3-4 pads/day. A significant worsening of the sexual function (maintenance of erection) was observed in 51 (75%) patients, who had reported having normal sexual activity preoperatively (T0). On the other hand, 17 (25%) patients reported having an adequate erection to engage in sexual intercourse. CONCLUSIONS. Despite the differences observed in physical and mental health scores during the three periods evaluated (T0, T1 and T2), overall quality of life does not appear to have been greatly compromised by surgery. At T2 follow-up, in fact, all 68 patients reported to be satisfied with having undergone radical prostatectomy because of its benefits in terms of survival and its limited effects on their quality of life.

[Leydig cell tumor of the testis. Therapeutic and anatomopathologic clinical study of 2 new cases]. / Tumor de células de Leydig del testículo. Estudio clínico anatomopatológico y terapéutico de dos nuevos casos.

Tumors of the testis comprise 1% of male neoplasms. Interstitial cell tumors that originate in Leydig's cells account for 1 to 3% of these testicular tumors. A prognosis is difficult to make since these rare neoplasms manifest clinically in variable forms and it is extremely difficult to distinguish the benign from the malignant. Two new cases of this rare tumor type seen at the Department of Urology of the University Hospital of Florence are reported. The literature is reviewed, highlighting the clinical aspects, particularly the symptomatic, histopathologic, and the differential diagnostic features of the less and highly malignant forms. Furthermore, a protocol for selecting the therapeutic modality for this rare neoplasm is described.

Ureterouterine fistula as a complication of cesarean section.

A rare case of ureterouterine fistula caused by a complication of cesarean section after a normal pregnancy is reported. The patient presented with a urinous seeping into the vagina, and the fistula was diagnosed preoperatively on urography and computerized tomography. Treatment consisted of a 2-stage surgical approach, including percutaneous nephrostomy and subsequent ureteral reimplantation.

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.

Paraurethral leiomyoma in women.

Two rare cases of paraurethral leiomyoma in women are presented. Physical examination and cystourethrography with previous cytourethroscopy revealed the seat of the masses. Surgical approach by means of incision of the anterior vaginal wall allowed for the complete enucleation of the tumors.

Sacrococcygeal chordoma: clinicoradiological study.

A case of sacrococcygeal chordoma is presented. We review the literature and we discuss the problems related to the etiology, the symptoms, the diagnosis and the treatment of this rare neoplasm. We present and discuss here the importance and the different possibilities of new diagnostic techniques, such as the CT and the MRI in the diagnosis and management of sacrococcygeal chordoma.

[Fibroepithelial polyps of the ureter]. / Le polype fibroépithélial de l'uretère.

The fibroepithelial polyps is a rare benign tumor, that can rise at any level of the upper urinary tracts with a major predisposition at the pyeloureteral junction. The exact etiology is not known, even if we remember that chronic irritation, stasis and infection sometimes caused by an associated calculus are important factors in the genesis of the tumor. The authors report 3 new cases with ureteral seat, of which one is associated with a calculus. This fact underlines the importance of an exact differential diagnostic with the carcinoma as well for the conservative treatment as for the prognosis which is favourable.

Grade 2 urethroprostatic papillary urothelial carcinoma with positive urinary cytology.

A rare case of papillary urothelial grade 2 carcinoma of the prostate and urethra in a patient with a previous papillary neoplasm of the bladder is reported. The tumor caused hematuria and prostatic enlargement suspicious for cancer. Urinary cytology was diagnostic.

HPV and p53 in urinary bladder carcinoma.

We report a study on human papilloma virus (HPV) and p53 protein in 18 cases of urothelial carcinoma grade 1, 2 and 3. The presence of HPV has been correlated to the p53 protein expression, as this virus, once integrated in the cell nuclei, seems to cause the alteration of some genes expression, involved in the cell-cycle regulation, like p53. One case of urothelial papillary carcinoma grade 2, infiltrating the lamina propria, resulted to be positive for HPV type 31/33/51 and for p53 protein. Our data suggest that HPV type 31/33/51 may have played a role in the pathogenesis of this neoplasia causing an alteration of p53 gene.

Variations of cortisol hydroxylation and paracetamol metabolism in patients with bladder carcinoma.

We investigated the possibility that variations of the metabolism of xenobiotic compounds might be involved in the process of bladder carcinogenesis, by studying activation reactions (phase I) and detoxification reactions (phase II) of xenobiotic compounds in a group of patients with transitional cell carcinoma of the bladder and in a group of controls hospitalised with other diseases. As an indirect estimate of activating reactions (phase I) we measured cortisol hydroxylation, expressed as the ratio between urinary 6-beta-OH-cortisol and 17-OH-corticosteroids. Cortisol hydroxylation was not increased in the group of patients when compared with controls. The variations of phase II conjugating enzymes were followed indirectly by administering paracetamol and measuring the urinary excretion of its main metabolites over a period of 12 h. The variations in the metabolic conjugation of paracetamol were expressed as a percentage of each metabolite, or of unmodified paracetamol excreted in the urine, or as the ratio between a given metabolite and unmodified paracetamol. The data were analyzed with a logistic regression model, analysing the effects of possible confounding variables such as age, smoking, alcohol, blood nitrogen, blood creatinine, glutamic-pyruvic (SGPT), glutamic-oxalacetic transaminases (SGOT) and percent recovery of paracetamol in the urine. Statistical analysis showed that the excretion of mercapturate derivatives of paracetamol was significantly increased in the group of patients. The levels of glucuronic, sulphate and cysteine metabolites were not varied significantly. Since mercapturate derivatives are formed as a consequence of the formation of short-lived metabolites of paracetamol which react with protein, nucleic acids or glutathione, the increased excretion of mercapturic acid derivatives in cancer patients might be an indication of a higher capability of forming reactive molecular species from xenobiotic compounds. We suggest that this factor might play a role in the induction of bladder cancer.