Influence of different toothpaste abrasives on the bristle end-rounding quality of toothbrushes.

OBJECTIVES: To evaluate the influence of different toothpaste abrasives on the bristle wear and bristle tip morphology of toothbrushes with different degrees of hardness. MATERIAL AND METHODS: Ninety samples of bovine incisor teeth were used in this study. The samples were randomly divided into three groups according to the bristle hardness of the toothbrush used: soft bristles (S); extra-soft bristles (ES); hard bristles (H). The toothbrushes of each group were randomly divided into six subgroups with five toothbrushes each, according to the abrasive of the toothpaste used in the simulation: Negative control (distilled water); toothpaste 1 (silica); toothpaste 2 (hydrated silica); toothpaste 3 (calcium carbonate, calcium bicarbonate and silica); toothpaste 4 (tetrapotassium pyrophosphate, silica and titanium dioxide); toothpaste 5 (calcium carbonate). The samples were placed in a toothbrushing simulating machine that simulating three months of brushing. The toothbrush bristles were evaluated by the bristle wear index, and the bristle tips morphology was evaluated by the bristle tip morphology index. RESULTS: The ES brush presented the highest bristle wear among the toothbrushes. Additionally, the S brushes showed better morphology of the bristles followed by ES and H brushes. The type of abrasive only influenced the bristle tip morphology of the ES brushes. The toothpaste 3 induced the worse bristle tip morphology than all the other toothpastes. CONCLUSIONS: Different abrasives have influence only on the bristle tip morphology of the ES brushes.

The potential impact of acute coronary syndromes on automatic sensing system in Subcutaneous-ICDs.

BACKGROUND: The Subcutaneous-ICD (S-ICD) is emerging as a suitable option for most ICD candidates, however some open issues regarding the sensing algorithm still remain. OBJECTIVES: We aimed to examine the performance of the S-ICD sensing algorithm in patients hospitalized for ST elevation myocardial infarction (STEMI), non ST elevation acute coronary syndrome (NSTE-ACS) or chronic coronary syndrome (CCS), before and after revascularization. METHODS: We performed a S-ICD automated screening on 75 patients, 21 hospitalized for STEMI, 23 for NSTE-ACS and 31 for CCS, before and after percutaneous revascularization, regardless their eligibility to ICD implantation. RESULTS: Patients did not differ in clinical, electrocardiographic and echocardiographic parameters. Rates of screening pass were significantly lower in STEMI patients compared to NSTE-ACS and CCS (5% vs 56.7% vs 81% respectively, p < .0001). The viability of the primary vector was lower in STEMI patients compared to NSTE-ACS and CCS (33% vs 56% vs 71%, p .027 respectively). After revascularization, there were no more significant differences between groups. Pairing subjects at baseline and after revascularization, STEMI subjects percentages of screening success were respectively 5% and 81% (p < .001) and the rates of primary vector viability were 33% and 81% (p .002). STEMI was the only independent predictor of screening failure at multivariate logistic regression analysis (odds ratio 10.68 confidence interval 2.77-41.38, p = .001). CONCLUSION: The performance of the S-ICD and possible malfunction detections in the context of an acute ischemic event deserve further evaluation. Adequate patient selection and the development of dynamic device programming are warranted.

Fibro-muscular-periosteal flap and bilobed flap for post-auricular cutaneous mastoid fistula closure.

BACKGROUND: A post-auricular cutaneous mastoid fistula is a rare condition that can occur following radical mastoid surgery, chronic suppurative otitis media or spontaneous exteriorisation of cholesteatoma from the mastoid through the post-auricular skin surface. Management of a post-auricular cutaneous mastoid fistula can be challenging for the surgeon. OBJECTIVE: This paper describes a surgical refinement for post-auricular cutaneous mastoid fistula closure, involving a fibro-muscular-periosteal flap to cover the mastoid cavity, combined with a bilobed flap from the mastoid and lateral neck regions for skin closure. METHOD AND RESULTS: A case of a post-auricular cutaneous mastoid fistula developed after revision tympanoplasty for a cholesteatoma. The condition was successfully treated with the presented technique. Pre- and post-operative photographs are provided for demonstration. CONCLUSION: The fibro-muscular-periosteal flap combined with a bilobed flap from the mastoid and lateral neck regions, in our view, can be considered a valid option for post-auricular cutaneous mastoid fistula closure.

Prospective, randomized, crossover comparison of sublingual apomorphine (3 mg) with oral sildenafil (50 mg) for male erectile dysfunction.

PURPOSE: We established the efficacy and safety of sublingual apomorphine compared with oral sildenafil in comparable groups of patients with erectile dysfunction (ED). MATERIALS AND METHODS: This prospective, randomized, crossover study included 77 heterosexual men with ED of various etiologies and severities. A total of 62 men were randomized but only 34 were evaluable for efficacy and tolerability. The study started with a run-in period of 2 to 4 weeks. The first 4 weeks of treatment were followed by a washout period of 4 weeks, after which patients changed to the alternate treatment for an additional 4-week period. The sequence of the 2 treatments was established by a randomization list in blocks in closed packets. The primary efficacy end point was the percent of attempts resulting in erection firm enough for intercourse. Additional variables were the percent of attempts resulting in intercourse and improvement in ED, as evaluated by the erectile function domain score of the International Index of Erectile Function questionnaire. RESULTS: Sildenafil was significantly more effective than apomorphine in regard to the percent of attempts resulting in erection firm enough for intercourse (85% vs 44%, p <0.0001) and actually resulting in intercourse (81% vs 43%, p <0.0001) as well as erectile function evaluated by the erectile function domain score of the International Index of Erectile Function (p <0.001). The incidence of adverse events was not significantly different for the 2 drugs. Although the number of patients was small, this study had strong statistical power due to the striking difference in results. CONCLUSIONS: Sildenafil was significantly more effective than apomorphine for ED. No statistical difference in adverse events was noted.

Intravesical mitoxantrone in superficial bladder tumours (Ta-T1).

36 patients with histologically proven grade G1-G2, Ta-T1 transitional cell carcinoma of the bladder were introduced, after transurethral resection (TUR), into a study of intravesical chemoprophylaxis with mitoxantrone (20 mg diluted in 50 ml). After a mean follow-up of 23 months, 16 (50%) patients showed a superficial recurrence with a mean recurrence rate of 0.56 per year. In 19 patients with recurring tumours the mean recurrence rate decreased from 1.65 to 0.58 per year. 9 patients (25.7%) suffered from a chemical cystitis that in 2 cases (5.7%) required treatment interruption.

Carcinoma of the prostate. Guidelines for treatment: the role of antiandrogens.

Our preliminary experience shows that flutamide is effective in patients with stage C or D prostate cancer. Local and distant response rates are comparable to those obtained with "classic" hormone therapy. Libido and sexual potency generally are unaffected. Palliation of symptoms, which is frequent, is usually accompanied by improved performance status and quality of life. Side effects are slight or moderate, but elevated transaminase levels in patients with borderline liver insufficiency are possible.

Antiandrogens alone or in combination for treatment of prostate cancer: the European experience.

In Europe, antiandrogens have been used for many years to treat prostate cancer, either as monotherapy or as part of a "combination therapy" with either surgical or chemical castration. However, considerable debate still exists regarding the relative benefits of combination therapy versus antiandrogen monotherapy or castration alone. This article reviews the European experience with antiandrogen therapy, including the personal experiences of the authors.

Results of conservative treatment (transurethral resection plus adjuvant intravesical chemotherapy) in patients with primary T1, G3 transitional cell carcinoma of the bladder.

OBJECTIVES: To evaluate a selected population of 50 consecutive patients with primary T1, G3 bladder transitional cell carcinoma in the absence of carcinoma in situ (Tis) treated with a bladder-sparing approach. METHODS: Between January 1983 and December 1992, all patients were treated by transurethral resection (TUR) plus adjuvant intravesical chemotherapy over 1 year. In most cases, doxorubicin, epirubicin, and mitomycin were used alone or in combination. RESULTS: At a mean follow-up period of 52 months (range, 18 to 126), 16 of 50 patients (32%) showed a recurrent superficial tumor. The recurrent lesion was of Stage T1 in 11 (22%) cases, but was a T1, G3 tumor only in 5 cases (10%). In 2 additional patients (4%) a Tis developed during the observation period after TUR. The mean interval between TUR and first recurrence was 14.6 months (range, 3 to 38). At a mean time of 17 months after the initial TUR, 3 patients (6%) underwent a radical cystectomy due to a progression in T category and 3 additional patients (6%) developed distant metastases at a mean time of 23 months after TUR. In brief, 84% of the patients are alive and tumor-free. Five patients (10%) died of bladder cancer with a mean follow-up of 52 months. CONCLUSIONS: If no concomitant Tis exist, a conservative approach is a legitimate option as an initial treatment of patients with primary T1, G3 bladder tumors.

Morphometry of in vitro systems. An image analysis of two human prostate cancer cell lines (PC3 and DU-145).

Morphometric analysis on two human prostate cancer cell lines (PC3 and DU-145) was carried out to better characterize these cells and to approach some problems concerning their polymorphism. In our hands, these cells appear to differ either in their ability to oxidize testosterone or in their androgen receptor content. Morphometric evaluation was performed by means of an Interactive Image Analysis System (IBAS 1), which computes several parameters related to the whole cell and to the nucleus. Our results clearly indicate that nuclear parameters alone may discriminate PC3 from DU-145 cells. Particularly, the Nuclear Roundness Factor appeared important, since it quantifies changes in nuclear shape. Nevertheless, the value of this parameter for "in vitro" morphometry may be overshadowed by the polymorphism common to the cultured cells. However, morphometric evaluation of PC3 and DU-145 cells is relevant to a better understanding and definition of the biologic nature of these cells, even if polymorphism, heterogeneity and genetic instability, specially of PC3, require further investigations.

Current views on intravesical treatment and chemoprophylaxis of superficial bladder cancer. The present role of epirubicin and doxorubicin.

Since 1972, a large number of studies have shown that intravesical treatment with doxorubicin (adriamycin) is effective against carcinoma in situ and multiple papillary tumors. Furthermore, it significantly reduces the recurrence rate after transurethral resection. Its efficacy has been compared with that of Bacillus Calmette-Guerin (BCG), which is the only treatment accepted by the US Food and Drug Administration for therapy of carcinoma in situ (Tis). In more recent years, a few studies have been performed using intravesical epirubicin in the hope that different properties of the molecule might enhance the activity of the anthracyclines, but produce fewer and milder side-effects. After weekly instillations of epirubicin (50 mg in 50 ml of sterile water) a complete response is achieved in 47% of patients with a histologically proven papillary marker lesion. The prophylactic efficacy of even a single instillation of epirubicin within 6 hours after transurethral resection (TUR) was proved in a randomized study (30863) of the EORTC (European Organization for Research on Therapy of Cancer) Urological Group. A randomized Italian trial (Blinst 4) of chemoprophylaxis after TUR investigated the efficacy of different intravesical administration schedules of epirubicin (50 mg in 50 ml of sterile water). All treatment regimens were more effective than no treatment. The sequential intravesical combination of epirubicin and interferon-alpha-2b has shown, in our personal experience, encouraging clinical results and our laboratory data suggest the synergic activation of the local immune response.

Intravesical bleomycin in bladder tumour prophylaxis.

The authors have evaluated the efficacy, tolerability and systemic absorption of bleomycin administered by intravesical route in the prophylaxis of recurrences of superficial vesical tumours after endoscopic resection (TUR). Thirty mg of bleomycin dissolved in 30 ml of saline solution were instilled in the bladder once a week for the first month and then once a month for 12 months. The instilled fluid was held in the bladder for 1 hour. The systemic absorption of the drug was evaluated by a microbiological assay of bleomycin in plasma and in the perfusion liquid recovered from the bladder. Fifteen patients were treated; most had a long history of multiple recurrent tumours despite previous intravesical treatments. Thirteen patients presented tumour recurrences during the treatment; 4 of them were given a second course of instillations following a second TUR and 3 of these presented further recurrences. The authors conclude that the drug, administered intravesically to high-risk patients with the modalities employed in the present study, was not effective in preventing recurrences. It was well tolerated locally and was free from systemic toxicity. The amount of bleomycin that was not recovered from the bladder after a contact time of one hour was relatively high but the drug did not reach measurable levels in the peripheral blood.

The flexible cystoscope.

We have been using the flexible cystoscope since 1987. Detailed information is given concerning the technique of flexible cystoscopy, its indications, advantages and disadvantages. A comparison is made with the results obtained using the rigid cystoscope in an initial series of 100 patients, yielding false negative results in only 8% of cases during the learning period. The flexible scope can be successfully employed for Neodymium YAG laser coagulation of superficial bladder tumours. The conclusion is reached that once the urologist has learned how to use it, he will consider the flexible cystoscope as a fundamental tool in his diagnostic armamentarium and false negative results will decrease almost to zero, especially if additional investigations, namely cytology, are routinely adopted.

[Conservative treatment of locally advanced bladder carcinoma: neoadjuvant chemotherapy, TUR and radiotherapy. Results in 40 patients]. / Trattamento conservativo del carcinoma vescicale localmente avanzato: chemioterapia neoadiuvante, TUR e radioterapia. Risultati su 40 pazienti.

PURPOSE: to assess the results of bladder preservation in infiltrating bladder cancer. The potential for neoadjuvant chemotherapy followed by extensive TUR and radiotherapy was investigated in 40 patients with T2-T4a G2-G3 bladder carcinoma. MATERIALS AND METHODS: from 1983 to 1995, 40 patients were submitted to bladder-sparing treatment consisting of neoadjuvant chemotherapy, extensive, TUR and radiotherapy. Most patients had T3G3 cancer. Cystectomy was not performed due to patient" choice in 29 cases (72.5%), for severe pulmonary or cardiovascular disease in disease in 9 patients (22.5) and age over 80 in 2 (5%) patients. A deep TUR-biopsy was performed before and after chemotherapy and an extensive TUR was repeated at the end of radiotherapy. In the first 30 patients chemotherapy consisted of 2-4 cycles of 70 mg/m2 cisplatin on fay 1, and 40 mg/m2 methotrexate on days 8 and 15. In the last 10 patients chemotherapy consisted of 3 cycles of CMV (100 mg/m2 cisplatin on day 2, 30 mg/m2 of vinblastine on days 1 and 8). Total dose of radiotherapy was 60-65 Gy. Recurrent superficial tumors were treated transurethrally. Radical cystectomy, when feasible, was considered for persistent or recurrent invasive disease. RESULTS: after chemotherapy, a clinical objective response was obtained in 27 patients (67.5%), 19 (47.5%) of whom showed a complete response. Thirteen (32.5%) patients showed no response and 5 (12.5%) progressed during chemotherapy. After extensive TUR of any residual mass and radiotherapy, a complete response was achieved in 6 patients who initially showed a partial response and in other 2 patients and stable disease after chemotherapy. Altogether, 27 patients (67.5%) presented had local recurrences, 3 patients underwent cystectomy. Fourteen patients (35%) are alive and 13 NED (65 months mean survival). Five patients died of unrelated disease. Twenty-one patients (52.5%) died of distant metastases (mean survival 28 months). Four patients presented distant metastases after vesical infiltrating recurrence and 4 patients had distant metastases in the absence of loco-regional recurrence. Twenty-two patients (55%) maintained an intact bladder. Patients with complete response to chemotherapy showed a low risk for developing recurrent infiltrating tumors and metastases. CONCLUSIONS: A complete tumor was maintained at 5 years in over 50% of the patients conservatively treated. Bladder salvage is feasible in selected patients.

Prostatitis, prostatosis and prostalgia. Psychogenic or organic disease?

The term 'chronic prostatitis syndrome' (C.P.S) encompasses chronic bacterial prostatitis, chlamydia or ureaplasma-associated disease, chronic 'abacterial' prostatitis, and patients with prostatosis or prostatosis or prostalgia. Interesting observations emerged from the evaluation of the clinical material indicating that the patients with abacterial prostatitis and those with prostatosis or prostaglia group have frequent sperm abnormalities and ultrasonographic changes suggesting a more complex pathogenesis than mere congestion and neurosis. Treatment in 144 evaluable patients treated with a long-acting sulphur-trimethoprim combination was almost uniformly well tolerated; Chlamydia was eradicated in all 10 treated patients and 77.4% of patients with bacterial C.P.S. were rendered free of bacteria. Sperm abnormalities were almost invariably resistant to the treatment. Only 44.4% of patients showed a partial improvement, limited to one or more parameters. Results did not differ significantly in the various subgroup. An overall evaluation of results showed that disappearance of every presenting symptom and sign was obtained in 24.3% and a significant improvement in another 25% of patients, including those in the prostatosis-prostalgia group. These results suggest that antibacterial treatment may be followed by favourable clinical results even in patients in whom no bacteria or other aetiological agents could be isolated.

[Associating Serenoa repens, Urtica dioica and Pinus pinaster. Safety and efficacy in the treatment of lower urinary tract symptoms. Prospective study on 320 patients]. / Associazione di Serenoa repens, Urtica dioica e Pinus pinaster. Sicurezza ed efficacia nel trattamento dei sintomi del basso tratto urinario. Studio prospettico su 320 pazienti.

INTRODUCTION: Serenoa repens (saw palmetto) has been employed for the treatment of lower urinary tract symptoms (LUTS) for several years. Its mechanism of action is believed to be due to antiandrogenic, antiproliferative and antinflammatory properties. An association of Serenoa with the nettle "Urtica dioica" showing antiproliferative activity and the pine "Pinus pinaster" derivative, showing antinflammatory action, has been proposed in recent years. Such an action is hoped to act not only by reducing LUTS but also by preventing the development of prostate cancer. MATERIAL AND METHODS: During the years 2007 and 2008, 320 patients suffering from LUTS were treated with an association of Serenoa repens 320 mg, Urtica dioica 120 mg and Pinus pinaster 5 mg, named IPBTRE. This treatment was administered to all patients for a minimal duration of 30 days to a maximum of a year, either alone or in association with antibiotics or alpha-blockers, if needed. Outcome analysis was based on evaluation of symptoms, prostate volume and maximum flow rate (Qmax). RESULTS: From a careful analysis of the data collected in our database, the following observations can be made: ages varied between 19 and 78 years. The patients were affected by BPH in 46% of cases, chronic prostatitis syndrome in 43%, chronic genital-pelvic pain in 7% and other conditions in 4%, the absolute numbers being 147, 138, 22 and 7 patients, respectively. No untoward side effect was reported in any case. Variations in symptom score could be fully evaluated only in 80 of 320 patients (25%), of whom 68 (85%) reported a significant benefit, with special reference to an improvement of pain, urgency, strangury and nocturia. Data on variations in prostate volume, as measured by digital rectal examination, were available in 84 (26.5%) patients. No significant change was observed. Qmax after treatment was measured in 83 (26%) patients. It did not show significant changes from the initial values. DISCUSSION: The association tested in our study appeared to be safe and well tolerated. No changes in flow rate and prostate volume were observed, but a marked reduction of LUTS was observed in 85% of evaluable cases, especially with regard to pain and irritative symptoms. Whether or not such an association may display a prevention of prostate cancer, may be investigated in additional studies.

[a-blockers in benign prostatic hyperplasia: the problem of "floppy iris syndrome". Results of a case-control study to evaluate the surgical risk through the meausurement of pupil diameter].

OBJECTIVES. α-blockers are a group of α-adrenoceptor antagonists used by urologists to treat lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Recent studies have suggested that these drugs - tamsulosin in particular - are involved in the development of iris complications during phacoemulsification. The objective of this study is to investigate the effects of α-blockers - especially tamsulosin - on pupil diameter. MATERIALS AND METHODS. We measured the photopic, mesopic and post-dilatation pupil diameters in both eyes of 24 patients (46 eyes in total), 16 of them treated with α-blockers and 8 of them (16 eyes in total) not treated with any drugs (controls). RESULTS. All patients treated with tamsulosin showed minor photopic, mesopic and post-dilatation diameters compared to controls. Patients treated with other α-blockers did not show any difference compared to controls. CONCLUSIONS. Even if a small number of eyes was evaluated, our study shows that tamsulosin - through its selective effect on α1A receptors - is the most involved drug in the Intraoperative Floppy Iris Syndrome.

[Clinical evaluation of nuclear matrix protein 22 as urinary marker of transitional cell carcinoma of bladder].

OBJECTIVES. Biomarkers (BTA, NMP22, FDP etc.) have been and continue to be evaluated as adjuncts or substitutes for cystoscopy, which is invasive and uncomfortable for some patients. Nuclear matrix protein-22 (NMP22) is involved in the regulation of nuclear processes. The main objective of the present study is to evaluate the clinical utility of urinary NMP22 as a tumor marker in the follow-up of transitional cell carcinoma (TCC) of the bladder. MATERIALS AND METHODS. The study included 62 patients undergoing follow-up, who had had TCC of bladder but who were disease-free at the beginning of the study, as confirmed by cystoscopy. Urine samples were collected for urinary cytology and NMP22 test before the cystoscopy. All samples were processed according to the instructions provided with the manufacturer's kit instructions. Results. 12 cases of TCC recurrences were detected with biopsy. Cystoscopy was positive in 8 cases, NMP22 test was positive in 11 cases, and in only one case the cytopathology yielded positive results. In 14 cases NMP22 resulted as false positive. CONCLUSIONS. Urinary NMP22 appeared to be a potential tumor marker for detecting TCC of the bladder, which might rise the sensitivity of cystoscopy especially in high-grade cancer surveillance more than cytology might do.

[Sensitivity and specificity evaluation of endorectal magnetic resonance imaging and transrectal sonography in the staging of prostate cancer].

OBJECTIVES. Nowadays endorectal probes for Magnetic Resonance Imaging (MRI) have better resolutions, which allows to acquire high-level images of prostate and to improve the MRI sensitivity and specificity to determine the cancer volume and the extraprostatic extension. The objective of the present study is to evaluate the sensitivity and diagnostic accuracy of endorectal MRI for identifying the local extension of prostate carcinoma compared to transrectal sonography (TRUS) of prostate. MATERIALS AND METHODS. The study included 81 patients with clinical suspect of cancer and/or elevated values of serum prostate specific antigen (PSA), who underwent endorectal MRI with 1.5 T endorectal probe before transrectal biopsy. Patients with localized prostate cancer underwent radical surgery. The results of endorectal MRI were compared to those of TRUS and histopathological examination outcomes. RESULTS. 15 of the 81 enrolled patients had extraprostatic localization of cancer, which was assessed through TRUS in 4 cases only (26%), and through MRI in 7 cases (46%). A seminal vesicle involvement was present in 10 patients, detected by MRI in 5 cases and in no cases by TRUS. DISCUSSION AND CONCLUSIONS. Data are similar to the findings collected by several Authors. The endorectal MRI has a better accuracy in staging prostate cancer compared to TRUS. Nevertheless, this procedure has some limits: little availability of equipment in hospitals, physicians' little experience, and higher costs compared to TRUS.