Time to onset of bisphosphonate-related osteonecrosis of the jaws: a multicentre retrospective cohort study.

OBJECTIVES: Osteonecrosis of the jaw (ONJ) is a potentially severe adverse effect of bisphosphonates (BP). Although the risk of ONJ increases with increasing duration of BP treatment, there are currently no reliable estimates of the ONJ time to onset (TTO). The objective of this study was to estimate the TTO and associated risk factors in BP-treated patients. SUBJECTS AND METHODS: Retrospective analysis of data from 22 secondary care centres in seven countries relevant to 349 patients who developed BP-related ONJ between 2004 and 2012. RESULTS: The median (95%CI) TTO was 6.0 years in patients treated with alendronate (n = 88) and 2.2 years in those treated with zoledronate (n = 218). Multivariable Cox regression showed that dentoalveolar surgery was inversely associated, and the use of antiangiogenics directly associated, with the TTO in patients with cancer treated with zoledronate. CONCLUSIONS: The incidence of ONJ increases with the duration of BP therapy, with notable differences observed with respect to BP type and potency, route of administration and underlying disease. When data are stratified by BP type, a time of 6.0 and 2.2 years of oral alendronate and intravenous zoledronate therapy, respectively, is required for 50% of patients to develop ONJ. After stratification by disease, a time of 5.3 and 2.2 years of BP therapy is required for 50% of patients with osteoporosis and cancer, respectively, to develop ONJ. These findings have significant implications for the design of future clinical studies and the development of risk-reduction strategies aimed at either assessing or modulating the risk of ONJ associated with BP.

[Nephrogenic adenoma of the bladder. Morphological and immunophenotypic study with particular attention to differential diagnosis]. / Adenoma nefrogenico della vescica. Studio morfologico ed immunofenotipico con particolare attenzione alla diagnostica differenziale.

BACKGROUND: Nephrogenic Adenoma (NA) is a rare lesion of the urinary tract, considered a metaplastic response to chronic inflammation, trauma or immunosuppression. METHODS AND RESULTS: We report two cases of NA arising in the urinary bladder of patients with previous history of recurrent urinary tract infections due to neuropsychiatric disease. Pathological examination of the lesions, resected by transurethral (TUR) management, revealed a papillary proliferation of tubules and cysts lined by cuboidal to low-columnar cells without atypia. Immunohistochemistry showed positivity for Cam 5.2, CK7 and EMA. MIB 1 count demonstrated a positivity in 12/200 cells in case 1 and < 2/200 in case 2. No expression of nuclear p53 was evident. CONCLUSION: NA is a benign unusual neoplasm which might be misdiagnosed as clear cell adenocarcinoma of the bladder or prostatic adenocarcinoma. Its recognition is important because it is a benign lesion cured by a conservative resection and no additional therapy is generally required.

[Extrinsic ureteral endometriosis: diagnostic laparoscopic contribution]. / Endometriosi ureterale estrinseca: contributo diagnostico laparoscopico.

A case of extrinsic ureteral endometriosis diagnosed with laparoscopy is described. Endometriosis, a common disease in premenopausal women, should be considered in differential diagnosis in patients with ureteral obstruction. Usually, the diagnosis of ureteral involvement is made at surgery. Laparoscopy is, therefore, an important diagnostic aid in women with distal ureteral obstruction not attributable to calculous.

[Echography in andrological emergencies]. / L'ecografia nelle urgenze andrologiche.

Ultrasonography is the first imaging method to undertake in all acute andrological disorders. It gives an accurate diagnostic picture in a high percentage of cases and is extremely useful for following patients during therapy and after surgery. The forms of acute andrological disorders, of both medical and surgical pertinence, that can be evaluated ultrasonographically include many prostate, seminal vesicle and external genital afflictions. Among the prostate and seminal vesicle disorders, of particular importance are acute prostate vesiculitis and prostatic abscess. Ultrasonography can be used to advantage in the latter as a guide to percutaneous transperineal drainage. The acute penis disorders that can be assessed by are essentially vascular affections (priapism and thrombosis of the corpus cavernosum). Ultrasonography, however, find its widest field of application in acute scrotum disorders. Ultrasonography is the most valid diagnostic aid for confirming clinical data in all forms of these disorders. It allow these that need medical treatment to be differentiated from those requiring surgery. Ultrasonography has good specificity in the differential diagnosis of spermatic cord and Morgagni's hydatid torsion, an acute scrotal affliction not uncommon in childhood, which is often self-limiting and, therefore, does not necessitate emergency surgery. Finally, ultrasonography is useful for distinguishing minor scrotal trauma which can be treated medically from major scrotal trauma which requires surgical intervention.

[Experimental study of colonic anastomoses. Comparison of different suture methods in the rat]. / Studio sperimentale delle anastomosi coliche. Confronto tra differenti metodi di sutura (nel ratto).

A comparative experimental study was conducted on three different suture techniques for end-to-end colonic anastomoses. The development of stenosis, perivisceral adhesions and resistance to endoluminal pressure were assessed. The results show that the one layer all-coat interrupted stitch anastomosis displays less resistance to endoluminal pressure during the first seven days but is followed by fewer complications.

[Renal adenocarcinoma associated with a polycystic kidney (presentation of a case and review of the literature)]. / Adenocarcinoma renale associato a rene policistico (presentazione di un caso e revisione della letteratura).

The Authors report a case of renal neoplasm association to polycystic kidney. The report was quite occasional, as the patient was not aware to be bearer of a renal dysembryopathy, although such a familiarity was existing formerly. The diagnosis was placed subsequently to ascertainments aiming at establishing the origin of a transient arterial hypertension, occurring recently, in absence of any other symptomatology.

[Neoplasms of the male urethra: diagnosis and therapy]. / Le neoplasie dell'uretra maschile: diagnosi e terapia.

Neoplasms of male urethra are particularly interesting for the diagnostic and therapeutical problems involved, urologist surgeons may be charged to resolve. The authors effected an anatomo-pathologic, diagnostical and especially therapeutical framing, by reviewing the data reported by the literature. The indications the Authors may draw therefrom are favourable to a radical surgery, even in consideration of the extensive nature of such tumours and the poor successes, in terms of survival, got by the conservative therapy.

Radical cystectomy in the treatment of advanced bladder cancer.

Thirty-two cases of advanced bladder cancer (pT3b-pT4) undergoing radical cystectomy are compared with other similar series of patients of the same stages submitted to different treatments (radiotherapy, chemotherapy and combined treatments) reported in the literature. Survival rates at 3 and 5 years are analyzed in relation to the anatomopathological stage, cellular grading, lymph node infiltration, surgical risk and relative mortality. The results confirm that radical cystectomy is presently the most effective treatment.

[Hemitrigonectomy: a personal technic]. / L'emitrigonectomia: tecnica personale.

The Authors show an operation of urological surgery, unusual in relation to the rather limited indications. The operation of hemitrigonectomy, although it is framed in the chapter of the partial resections of bladder, does not get an exact identity in literature; yet, it is peculiar for both technical problems and some basic expedients sheltering surgeons from various complications. Hemitrigonectomy, performed by the Authors in six cases in the last 3 years, supplied excellent anatomic and functional results, and was burdened by no relevant complications.