Hyaluronic acid-chondroitin sulfate: a potential factor to select pure stress urinary incontinence in patients with interstitial cystitis/painful bladder syndrome and mixed incontinence symptoms.

AIM: Aim of the study was to validate the Hyaluronic acid-Chondroitin sulfate (HA-CS) as ex adiuvantibus criteria to identified patients with urgency symptoms related to interstitial cystitis/painful bladder syndrome (IC/PBS) and to obtained a population of patients with pure stress urinary incontinence. METHODS: We retrospectively analysed clinical data of 17 patients with clinical suspect of IC/PBS, which received intravescical HA-CS to reduce pelvic pain and urgency symptoms waiting for surgical treatment for stress urinary incontinence. The main outcomes were reduction of urinary frequency, urgency, and bladder pain. RESULTS: Compared to baseline, a significant decrease in pain, urgency and frequency were observed. Of the 17 patients, 82.3% reported resolution of pain and urge symptoms and in patients with persistence of urge symptoms the urodynamic assessment showed an overactive bladder syndrome (OAB). CONCLUSION: HA-CS treatment induces an improvement in pain and urgency symptoms in patients with IC/PBS that referred also stress urinary incontinence. Therefore, HA-CS treatment could be use as clinical adjunctive parameter to select patients with pure stress urinary incontinence.

[Use of progesterone-releasing intra-uterine system in menhorragia relapse prevention after laparoscopic myomectomy]. / Impiedo della spirale medicate al progesterone nella prevenzione delle recidive menorragiche dopo miomectomia laparoscopica.

AIM: Abnormal uterine bleeding (AUB) affects about 30% of women in childbearing age with negative impact on patient's quality of life and uterine myomas represent one of the major cause of AUB. Laparoscopic myomectomy has proven to be efficient to reduce uterine bleeding and pelvic pain, but some patients presents postsurgery menhorragia with anemia. To reduce it, the combined use of levonorgestrel releasing intrauterine system (LNG-IUS) positioned at the end of surgery, seems to produce a clinically relevant decrease in AUB with a symptomatology improvement. The aim of this study was to retrospectively evaluate if postsurgery placement of LNG-IUS improves hematological outcomes (hemoglobin and ferritin level) in woman submitted to laparoscopic myomectomy. METHODS: We retrospectively collected data from 58 women who underwent laparoscopic myomectomy from September 2010 to September 2011. Twenty-six patients were treated by laparoscopic myomectomy followed by LNG-IUS positioning at the end of surgery (Experimental group) and thirty-two patients were treated by surgery alone (Control group). We compared blood hemoglobin and ferritin levels assessed preoperatively, in day one and 6, 12 and 18 months after surgery. RESULTS: There was a statistically significant improvement in terms of post-surgery hemoglobin and ferritin levels at 6 month follow up (P=0.02 and P=0.002 respectively) and 12 month follow-up (P=0.001 and P=0.001, respectively) in experimental group vs. control group and a positive trend, but not statistically significant, in ferritin levels at 18 month-follow-up (P=0.1). CONCLUSION: Our data suggest that combined treatment with laparoscopic myomectomy followed by LNG-IUS produces a clinically relevant improvement in hematological values.

Wild animals as sentinels of Paracoccidioides brasiliensis in the state of Rio Grande do Sul, Brazil.

Paracoccidioides brasiliensis, a dimorphic pathogenic fungus, causes the principal form of systemic mycosis in Brazil. The literature furnishes only limited data on the ecology of this fungus in the state of Rio Grande do Sul, the southernmost state of Brazil. The purpose of this study was to evaluate the prevalence of fungal infection in wild animals, using serological tests and using the animals as sentinels of the presence of P. brasiliensis in three specified mesoregions of Rio Grande do Sul. A total of 128 wild animals from the three mesoregions were included in the study. The serum samples were evaluated by immunodiffusion and the enzyme-linked immunosorbent assay (ELISA) technique to detect anti-gp43 antibodies from P. brasiliensis. Two conjugates were tested and compared with the ELISA technique. Although no positive samples were detected by immunodiffusion, 26 animals (20%), belonging to 13 distinct species, were found to be seropositive by the ELISA technique. The seropositive animals were from two mesoregions of the state. The results were similar according to the gender, age, and family of the animals, but differed significantly according to the conjugate used (p < 0.001), showing more sensitivity to protein A-peroxidase than to protein G-peroxidase. The finding that wild animals from the state of Rio Grande do Sul are exposed to P. brasiliensis suggests that the fungus can be found in this region despite the often-rigorous winters, which frequently include below-freezing temperatures.

[Sex ratio in the offspring of pregnant women with polycystic ovary syndrome: effect of different phenotypes]. / Sex ratio nella prole di donne affette dalla sindrome dell'ovaio policistico: effetti dei differenti fenotipi.

AIM: The aim of this paper was to investigate the sex ratio in the offspring of pregnant patients with polycystic ovary syndrome (PCOS). METHODS: Analysis of 70 pregnant patients with PCOS who achieve a pregnancy without any kind of treatment, and having as controls 63 healthy pregnant women without any feature of PCOS. RESULTS: No significant difference in sex ratio was detected between PCOS and controls, even if it resulted significantly different in the full-blown and non-PCO phenotypes. CONCLUSION: The PCOS phenotypes influenced the sex ratio in the offspring, suggesting that environmental factors could play a role in determination of the offspring gender.

[A retrospective analysis comparing colposuspension and retropubic mid-urethral sling as preventive anti-incontinence measures during laparoscopic sacrocolpopexy]. / Analisi retrospettiva di confronto tra colposospensione e sling retropubica medio-uretrale come misure preventive anti-incontinenza in corso di sacrocolpopessia laparoscopica.

AIM: The aim of this paper was to compare two anti-incontinence procedures during laparoscopic sacrocolpopexy (LSC) to prevent postoperative stress urinary incontinence (SUI). METHODS: Retrospective analysis of 90 continent hysterectomized patients with vaginal vault prolapse treated with LSC plus colposuspension (group A, N.=30), LSC plus retropubic mid-urethral sling (group B, N.=30), or LSC alone (group C, N.=30). RESULTS: De novo SUI rate resulted significantly (P<0.05) lower in group B than C. No difference was detected regarding de novo urge urinary incontinence. Total reoperation rate resulted significantly (P<0.05) higher in group A than B and lower in group B than C. CONCLUSION: When associated to LSC for preventing SUI, colposuspension and retropubic mid-urethral sling are effective and safe, even if mid-urethral sling seems to provide the best risk/benefit profile.

Consideraciones diagnósticas de los trastornos del espectro autista. Experienia de un servicio / Diagnostic Considerations in autism spectrum disorders: experience of a department

El proceso diagnóstico de los Trastornos Generalizados del Desarrollo (TGD) es un camino arduo para la mayoria de las familias. El tiempo hasta el diagnóstico influye en el acceso al tratamiento especifico, en el pronóstico y en el nivel de estrés familiar. Objetivo: describir la población de niños con o sin diagnóstico previo de TGD que consultaron a nuestro servicio, así como también describir el proceso del diagnóstico a través del análisis de algunas variables como: tiempo entre preocupación paterna y diagnóstico, número de profesionales consultados, conducta pediatríca y sintomas más prevalentes como motivo de consulta. Métodos: estudio transversal y retrospectivo. Se incluyeron las historias clínicas de los 76 niños atendidos en el servidio de clínicas Interdisciplinarias del Hospital Garrahan desde enero de 2004 hasta mayo de 2006. Resultados: 76 niños; relación sexo masculino; femenino 3.75:1. Los padres notaron los síntomas a los 25.5 más menos 9,1 meses y se preocuparon a los 28,2 más menos 13,5 meses. La edad de la primera consulta a un profesional fue a los 32 más menos 13.6 meses. El pedíatra fue el primer profesional que consultaron en 67,1 por ciento. La conducta del pediatra, luego de la consulta de los padres fue en el 57,6 por ciento derivar a otros profesionales y 42,4 por ciento adoptaron conducta expectante. Los padres consultaron a 3 más menos 2,3 profesionales hasta el diagnóstico definitivo. Los niños llegaron a nuestro consultorio por primera vez a la edad de 48,8 más menos 15,9 meses, variando de 25 hasta 85 meses. En 73,6 por ciento de los casos consultaron por trastornos en la comunicación, en 50 por ciento por trastornos en la socialización, en 42,1 por ciento por trastornos en la conducta y en el 32,9 por ciento por trastornos asociados. En nuestro análisis encontramos que los padres llevaron un promedio de 20 más menos 14,8 meses hasta el diagnóstico.

Screening for anxiety and depression in early adolescence.

OBJECTIVE: To examine the level of diagnostic and discriminative accuracy of three dimensional rating scales for detecting anxiety and depressive disorders in a school-based survey of 9th grade youths. METHOD: Classroom screening instruments, the Center for Epidemiologic Studies-Depression Scale (CES-D), the Revised Children's Manifest Anxiety Scale (RCMAS), and the Multidimensional Anxiety Scale for Children (MASC) were administered to 632 youths from three sites in 1998. On the basis of rating scale results, samples of high-scoring and non-high-scoring youths were invited to participate in a diagnostic interview conducted within 2 months of the screening sessions. RESULTS: MASC scores were most strongly associated with individual anxiety disorders, particularly among females, whereas the CES-D composite score was associated with a diagnosis of major depression, after controlling for comorbid disorders. The RCMAS was least successful in discriminating anxiety and depression. When receiver operator characteristic curves were examined, diagnostic accuracy was moderate. CONCLUSIONS: The ability of the MASC and CES-D to discriminate within and between categorically defined diagnostic groups has important implications for the accurate identification of youths in need of services.

Long-term follow up of a randomized, controlled trial on prophylactic sclerotherapy of small oesophageal varices in liver cirrhosis.

BACKGROUND: In order to evaluate the prophylactic impact of sclerotherapy of small varices in patients with cirrhosis and no endoscopic signs suggesting risk of haemorrhage, a randomized clinical trial was performed. METHODS: Seventy-one hospitalized patients met the inclusion criteria of diagnosis of cirrhosis with no previous bleeding and small varices. Due to exclusion criteria of: gastroduodenal ulcers (n = 5), diverticulosis (n = 1), hepatic insufficiency (n = 10), hepatocellular carcinoma (n = 4), death before randomization (n = 6), age over 70 (n = 1) and denial of consent to participate in the study (n = 1), 43 patients could be randomized, 21 for sclerotherapy and 22 for the control group. Two patients (one in each group) were lost to follow up, and another patient, although not lost, refused sclerotherapy after randomization. Ethanolamine oleate was used as the sclerosing agent. All patients were followed up for a mean time of 60 months, initially every 2 months for the first 2 years and clinical and endoscopic controls were performed each 6-12 months thereafter. RESULTS AND CONCLUSIONS: During the first 2 years clinical assessment showed that there were five bleedings in the sclerotherapy group and none in the control group, but mortality was similar in both groups. Long-term follow up continued to show a higher prevalence of bleeding in the sclerotherapy group but that mortality was not different from the control group.

[High-dose brachytherapy in endobronchial neoplastic stenoses]. / La brachiterapia con alto rateo di dose nelle stenosi neoplastiche endobronchiali.

Form March, 1991, to September, 1995, twenty-nine patients with endobronchial neoplastic stenosis were treated with high dose rate (HDR) brachytherapy at the Casa Sollievo della Sofferenza Hospital in San Giovanni Rotondo (Foggia, Italy). Fifteen patients had hemoptysis, 10 dyspnea, 6 constant cough and 6 lung atelectasis. The total dose, specified at 1 cm from the source, ranged 5 to 21 Gy and the fraction doses 5 to 15 Gy. Fourteen of 29 patients (48%) died. The mean survival is 7 months, with the follow-up ranging 1 to 22 months. Subjective responses were achieved in 78.4% of cases, with 67.6% complete and 10.8% partial remission rates. Complete remission of hemoptysis was observed in 100% of patients. Dyspnea improved in 70%, cough in 46.4% and atelectasis in 83.2%. Endoscopic findings, 1 month after the end of brachytherapy, showed a response in 79.4% of patients. The complication rate was 13.8% (1 tracheoesophageal fistula, 2 pulmonary hemorrhages and 1 cavitary necrosis). Even though the number of treated patients is small, our experience confirms the efficacy of HDR endobronchial brachytherapy in the palliation of lung cancer-related symptoms. Literature data show that brachytherapy improves the quality of life in the patients with poor prognosis who are otherwise untreatable. The HDR technique is more accurate than the LDR technique and therapy is better tolerated also because execution time is shorter. Prospective clinical trials are needed to investigate the most effective total doses and fractionations and to better define the role of brachytherapy in the curative treatment of lung cancer.

Action of cystine in the cytotoxic response of Escherichia coli cells exposed to hydrogen peroxide.

Cystine markedly enhanced the cytotoxic response of Escherichia coli cells to concentrations of hydrogen peroxide resulting in mode one killing, but displayed little effect in mode two killed cells. The effect of cystine was concentration-dependent over a range of 5-50 microM and did not further increase at higher levels. Cystine had similar effects in other bacterial systems. In order to sensitize the cells to the oxidative injury, the amino acid must be present during exposure to the oxidant since no enhancement of the cytotoxic response can be observed in cystine pre-loaded cells. In addition, no further enhancement of cytotoxicity could be detected when cystine was added before and left during challenge with the oxidant. The enhancing effect of cystine on oxidative injury of E. coli cells appears to be directly mediated by the amino acid and in fact cysteic acid, the most likely oxidation product, had no effect on the killing of bacterial cells elicited by hydrogen peroxide. Other disulfide compounds such as oxidized glutathione, cystamine and dithionitrobenzoic acid only slightly increased the susceptibility of bacteria to the oxidant. The effect of the disulfides was not concentration-dependent over a range of 200-800 microM and was statistically significant only for cystamine. Taken together, these results indicate that cystine markedly increases the cytotoxic response of bacteria to hydrogen peroxide and suggest that the amino acid might impair the cellular defence machinery against hydrogen peroxide. This effect may involve a thiol-disulfide exchange reaction at the cell membrane level.

Ceratopatia em faixa bilateral associada com iridoclite crônica no lupus eritematoso sitêmico / Bilateral band-shaped keratopathy associated with iridocyclitis in systemic lupus erythematosus

Lupus eritemaso sistêmico (LES) é uma doença mediada por imunocomplexos e pela produçäo anormal de anticorpos. Atinge principalmente mulheres jovens. Os sinais oculares mais frequentes säo: hemorragia superficial e manchas algodonosas na retina e edema de papila. No segmento anterior podem aparecer episclerite, conjuntivite, iridociclite, ceratite seca e ceratite epitelial punctata. Temos conhecimento de 2 casos de ceratopatia em faixa bilateral associado com LES na literatura, ambos em pacientes do sexo feminino e na terceira década de vida. No presente trabalho relatamos um caso singular de ceratopatia em faixa bilateral e iridociclite crônica em paciente feminina de 14 anos cujos sinais e sintomas sugeriram artrite reumatoide juvenil (ARJ) e que exames clínicos e laboratoriais realizados demonstraram ser LES

The bone marrow in murine AIDS.

In order to increase the understanding of blood cytopenias in HIV infection we have investigated the bone marrow in murine AIDS. C57BL/6 mice infected with the LP-BM5 retrovirus show a decrease in cellularity, numerous haemophagocytic histiocytes, a reduction of all erythroid precursor cells, an increase in eosinophil number and an increase in lymphocytes. Immunostaining with an anti-Pr60gag antibody shows that the majority of bone marrow cells express the viral protein. Thus, the bone marrow in MAIDS has many similarities with the bone marrow from patients with advanced AIDS and may prove useful as a model for therapy aimed at treating blood cytopenias.

In vitro and in vivo toxicity of 2',3'-dideoxycytidine in mice.

3T3 mouse embryo fibroblast cell growth was inhibited in a concentration dependent manner by 2',3'-dideoxycytidine (ddCyd), a strong inhibitor of human immunodeficiency virus. Cell growth inhibition was associated with an increased incorporation of ddCyd into cell DNA. In contrast SP2/0-Ag14 (a mouse myeloma) cell growth is not inhibited by 100 microM ddCyd both in the presence or absence of hypoxanthine and thymidine. Furthermore, in vitro spleen cell proliferation, upon phytohemagglutinin (PHA) addition, was much more affected by ddCyd in C57BL/6 mice than in Swiss albino mice. That indeed ddCyd affects spleen cell proliferation was confirmed by studies on splenocytes obtained from C57BL/6 mice that received ddCyd for 2 weeks in drinking water. These results suggest that ddCyd toxicity in mice is cell and strain dependent and that the toxicity mechanism is related to the incorporation of the drug in cell DNA.

Differential effect of the amino acid cystine in cultured mammalian and bacterial cells exposed to oxidative stress.

The effect of cystine in the cytotoxic response of cultured Chinese hamster ovary and Escherichia coli cells to challenge with hydrogen peroxide has been investigated. It was found that this amino acid could either protect or sensitize cells, depending on the cellular system. In fact, although a reduction in the growth-inhibitory effect of hydrogen peroxide was observed in mammalian cells, a marked increase in the susceptibility to oxidative stress was induced by cystine in bacteria. None of the amino acid precursors of glutathione, e.g., glutamate, glycine or cysteine, afforded protection in the mammalian cell system, whereas cysteine, but not glycine or glutamate, markedly sensitized bacteria to hydrogen peroxide-induced cell killing. In mammalian cells, methionine, an amino acid which is converted to cysteine, was also unable to modify the oxidative response. The results presented indicate that cystine displays differential effects in oxidatively injured mammalian or bacterial cells and suggest that the mechanism whereby the amino acid modulates the lethal action of hydrogen peroxide differs in the two cellular systems.

[Cutaneous tumor metastasis. A possible first clinical event of visceral neoplasms]. / Le metastasi tumorali della cute. Un possibile primo evento clinico di neoplasie viscerali.

Two cases of visceral malignant tumours due to cutaneous metastases (stomach adenocarcinoma and left pulmonary adenocarcinoma). Are reported in both cases the cutaneous lesions represent the first clinical phenomenon of the disease.

In vitro toxicity and metabolism of 2',3'-dideoxycytidine, an inhibitor of human immunodeficiency virus infectivity.

U937 human monoblastoid cell growth was inhibited in a concentration-dependent manner by 2',3'-dideoxycytidine (ddCyd) (an antiretroviral drug) up to 500 microM. Cell growth inhibition was associated with a pronounced increase in cell volume, however this was not due to cell ATP or NAD+ depletion that could effect osmotic balance or DNA repair. This ddCyd toxicity paralleled the accumulation of ddCyd into acid soluble material where 2',3'-dideoxycytidine-5'-triphosphate (ddCTP) was the predominant labelled nucleotide up to an extracellular ddCyd concentration of 150 microM. At higher ddCyd concentrations, the amount of 2',3'-dideoxycytidine-5'-diphosphate (ddCDP) became predominant over ddCTP. This increase of phosphorylated dideoxycytidine in U937 cells was also associated with an increased incorporation of the drug into cell DNA suggesting a possible toxicity mechanism. That ddCyd does indeed become cytotoxic to human cell by incorporation into DNA was shown by incubating human resting and stimulated lymphocytes with ddCyd. While the drug does not affect cell viability in resting cells it strongly affects cell proliferation upon phytohemagglutinin (PHA) addition.

[Prevention and control fo side effects in the chemotherapy of advanced lung cancer]. / Metologia di prevenzione e controllo degli effetti collaterali della chemio-terapia del cancro del polmone in fase avanzata.

The side effects of chemotherapy in lung cancer are reviewed and a methodological scheme proposed to prevent and monitor them by means of scrupulous preliminary selection. This is done by studying heart, liver and renal function, as well as by screening the patient's immunity condition. The side-effects of chemotherapy are monitored by monthly repetition of the above tests. Personal cases showing the good results obtained are reported.