Assessment of cryopreserved donor skin viability: the experience of the regional tissue bank of Siena.

Skin allografts from cadaver donors are an important resource for treating extensive burns, slow-healing wounds and chronic ulcers. A high level of cell viability of cryopreserved allografts is often required, especially in burn surgery, in Italy. Thus, we aimed to determine which conditions enable procurement of highly viable skin in our Regional Skin Bank of Siena. For this purpose, we assessed cell viability of cryopreserved skin allografts procured between 2011 and 2013 from 127 consecutive skin donors, before and after freezing (at day 15, 180, and 365). For each skin donor, we collected data concerning clinical history (age, sex, smoking, phototype, dyslipidemia, diabetes, cause of death), donation process (multi-tissue or multi-organ) and timing of skin procurement (assessment of intervals such as death-harvesting, harvesting-banking, death-banking). All these variables were analysed in the whole case study (127 donors) and in different groups (e.g. multi-organ donors, non refrigerated multi-tissue donors, refrigerated multi-tissue donors) for correlations with cell viability. Our results indicated that cryopreserved skin allografts with higher cell viability were obtained from female, non smoker, heartbeating donors died of cerebral haemorrhage, and were harvested within 2 h of aortic clamping and banked within 12 h of harvesting (13-14 h from clamping). Age, cause of death and dyslipidaemia or diabetes did not appear to influence cell viability. To maintain acceptable cell viability, our skin bank needs to reduce the time interval between harvesting and banking, especially for refrigerated donors.

Is osteopontin involved in cutaneous fibroblast activation? Its hypothetical role in scleroderma pathogenesis.

Osteopontin (OPN) is an extracellular matrix protein implicated in bone remodeling, but it presents also pro-inflammatory and pro-fibrotic properties. OPN expression also occurs upon exposure of cells to classical mediators of acute inflammation such as tumor necrosis growth factor alpha (TNF-alpha) and interleukin-1 beta (IL-1beta), as well as fibrogenic cytokines such as transforming growth factor beta (TGF-beta), although a detailed understanding of these regulatory pathways is still unknown. Plasma OPN levels in both limited and diffuse systemic sclerosis patients (lSSc and dSSc) were statistically higher compared to those of control subjects. Immunohistology demonstrated that high TGF-beta levels, alpha smooth muscle actin (alphaSMA) levels and consequently high OPN levels were found in the affected skin of sclerodermic patients (lSSc and dSSc) compared to levels found in healthy skin. In order to better understand how OPN interferes with the fibrotic process, healthy skin fibroblasts were treated for 24 and 48 hours with bleomycin and with endothelin-1 (ET-1) plus TGF-beta in order to induce the fibrogenesis. After 48 hours of stimulation, healthy treated fibroblasts showed statistically increased alphaSMA levels (index of differentiation into myofibroblasts) and simultaneously statistically increased OPN levels compared to healthy untreated ones. This study demonstrates that OPN levels increase simultaneously with the increasing of alphaSMA levels, therefore it is reasonable to hypothesize that OPN interferes in the pathogenesis of Systemic Sclerosis in the early stage of fibroblast differentiation process.

Mycosis fungoides: disease evolution of the "lion queen" revisited.

Mycosis fungoides (MF), which represents the most common subtype of primary cutaneous T-cell lymphoma (CTCL), is an epidermotropic lymphoma included as an indolent form in the recent WHO/EORTC classification. From a clinical point of view, the classic disease progression usually is slow and takes over years or even decades, and characterized by the evolution from patches to more infiltrated plaques and eventually to tumours or erythroderma. However, the analysis of the MF disease course has been greatly impaired by the rarity of the disease, thus data about the time course of disease progression and pattern of relapse during time are not well known. In this review, a summary of published data on MF large patients cohorts will be presented, together with the results obtained by a retrospective analysis of clinical features and follow-up data of 1,422 MF patients diagnosed and followed-up from 1975 to 2010 in 27 Italian Centres (Italian Study Group for Cutaneous Lymphoma). From a clinical perspective, the amount of data support the relevance of a stage-tailored, differentiated follow-up strategy, in as much as the TNMB staging appears not only to be associated with different progression rates, but also shows as a new finding a relationship with different patterns of disease progression. From a biological point of view, there is the need to understand the molecular basis of the different clinical pathways of disease progression, to be able to potentially identify at an earlier phase of disease evolution, the patients who are more likely to develop erythroderma or tumour-stage progression. In conclusion, if MF is indeed a true "lion queen", as dermatologists we need to be expert and wise tamers to keep it under control.

Dermatofibrosarcoma protuberans in childhood: two case reports and review of the literature.

Dermatofibrosarcoma protuberans (DFSP) is a rare skin cancer with intermediate malignancy, characterized by a progressive local growth and a propensity for local recurrence. DFSP is most frequent in adults; however, in recent years, DFSP in childhood emerged to be more common than previously believed. Unfortunately DFSP in children may be misdiagnosed, leading to a delay in the treatment. The authors report two cases of childhood DFSP with unusual clinical presentation: a congenital nodular variant and an atrophic variant developed at 2 years of age, both with acral localization. They highlight the importance of an early diagnosis by pediatricians and dermatologists to ensure an appropriate complete excision and reduce the risks of recurrences.

New perspective in the management of neuroendocrine differentiation in prostate adenocarcinoma.

In this review, we will present some of the information that is known about neuroendocrine (NE) cells and differentiation in the prostate. We will then speculate on the potential role that NE differentiation in prostate carcinoma may play and how this differentiation may be clinically analysed and treated. The androgen-independent growth of prostate cancer can be caused by different mechanisms; one of these is receptor-specific paracrine or autocrine growth modulation of human prostatic cancer cells by neuropeptides secreted by NE cells. Our results affirm that different methods of androgen deprivation can influence the serum chromogranin A (CgA) levels to different extents in prostate cancer. In particular, bicalutamide produces a significantly lower increase in serum CgA compared with castration therapy. In the light of other evidence that supports a significant relationship between serum CgA levels, tissue CgA expression and NE activity, we hypothesise that bicalutamide may reduce the risk of NE cell hyperactivation in prostate cancer. It is important to determine whether increases in CgA levels and NE cell activation are associated with progression towards hormone-independent prostate cancer. We recently proposed as therapy of NE activation in hormone-independent prostate cancer, a combination of oestrogens and somatostatin analogues. The combination of ethinyl estradiol and lanreotide had a favourable toxicity profile, offered objective and symptomatic responses in patients with limited treatment options and refractoriness to conventional hormonal therapy strategies and, in particular, offered a median overall survival that was superior to the 10-month median survival in patients with hormone refractory disease. This combination therapy also sustains the novel concept in cancer treatment in which therapies may target not only cancer cells but also its microenvironment in combination, which can confer protection from apoptosis.

Benign prostatic hyperplasia: what about a campaign for prevention?

OBJECTIVES: In an era when prevention is considered better than cure, is there a rationale for benign prostatic hyperplasia (BPH) prevention? MATERIALS AND METHODS: Medline and Current Content databases were searched for studies conduced in the last 10 years on BPH and the feasibility of prevention program. RESULTS: Some important criteria for promoting prevention can be found in BPH disease. The significant impact of BPH on the male population and on its quality of life is well established. Knowledge of the etiopathogenesis of this disease is rapidly improving. However, the use of PSA or other markers to select a population at higher risk for developing BPH and its clinical manifestations needs to be better established. More data are available for secondary prevention against BPH progression. Although the action of some natural and nutritional agents on BPH tissue has been demonstrated experimentally, data from prospective clinical trials are not available. Synthetic agents such as 5alpha-reductase inhibitors or COX-2 inhibitors may be effective, but clinical results for primary prevention of BPH have not been reported. CONCLUSION: At present, we propose a BPH prevention program as a basis for discussion and future work.

Variation of chromogranin A serum levels after radical retropubic prostatectomy for prostate adenocarcinoma.

This study evaluated perioperative and postoperative variations in serum CgA levels induced by radical retropubic prostatectomy (RRP) and their relationship with serum PSA levels in prostate cancer patients. Thirty consecutive patients with clinically localized adenocarcinoma of the prostate undergoing RRP were prospectively analyzed. Serum levels of CgA and total PSA were analyzed in each case preoperatively (time 0), at removal of the prostate (time 1), 1 h after the end of RRP (time 2) and then at regular postoperative intervals till 12 weeks (time 14). During the postoperative period no adjuvant therapies were performed and none of the 30 cases showed biochemical (PSA > 0.2 ng/mL) and/or clinical progression. Mean preoperative serum levels of CgA were 57 +/- 14 ng/mL. Immediately after the surgical removal of the prostate gland (time 1), in all 30 cases there was a significant (time 0-time 1: p = .001) increase in serum PSA, but a nonsignificant modification in serum CgA levels (60 +/- 15 ng/mL). After time 1, serum PSA levels progressively decreased to below the detection limit of 0.2 ng/mL. On the contrary, at time 2, serum CgA levels were postoperatively increased (time 2 = 145 +/- 47) and they remained significantly higher than preoperative values (time 0) till the 21-day postoperative interval (time 11). Moreover, at the last control (time 14) mean and median CgA levels were very similar to those shown preoperatively (time 14: 58 +/- 18 ng/mL). In patients with untreated clinically localized adenocarcinoma of the prostate submitted to RRP, surgical and postoperative stress, more than surgical manipulation of the prostate gland, could produce a significant increase in serum CgA levels maintained for a longer period when compared to the increase in serum PSA levels.

[Penile metastasis from bladder cancer. A case report]. / Metastasi peniene da tumore vescicale. Un caso clinico.

Penile metastases from bladder cancer are unusual. A case of a man, 50 years old, with undifferentiated bladder carcinoma submitted to radical cystoprostatectomy and ileal conduit is presented. Twelve months after the primary diagnosis the patient presented metastases of the penis.

[Diverticula of the female urethra. Comparison of imaging techniques]. / Diverticoli dell'uretra femminile. Tecniche di imaging a confronto.

BACKGROUND AND AIMS: Urethral diverticula is a rare pathology with an incidence varying between 0.3 and 6%. It is difficult to diagnose owing to the aspecificity of its clinical symptoms. The aim of this study was to evaluate the imaging techniques now available for its diagnosis. METHODS: The sample consisted of 19 female patients aged between 20 and 53 years old undergoing diverticolectomy owing to urethral diverticula between 1980 and 1996 at the 4th Division of the Department of Urology at "La Sapienza" University of Rome. All patients underwent preoperative X-ray examinations (micturitional cystourethrography and P positive urethrography). A retrospective study was performed in order to evaluate the accuracy of the individual methods. RESULTS: Micturitional urethrocystography showed a sensitivity equivalent to 77% of cases. P positive urethrography showed a 85.7% accuracy rate. Lastly, transvaginal ultrasonography, which always showed the diverticular sac in all patients in which it was used, also highlighting multiple and divided diverticuli which were not visible using traditional radiology. The latter method is easy to use and well tolerated by patients; moreover, it shows the spatial relations of the diverticulum and allows the characteristics of periurethral tissues to be evaluated. CONCLUSIONS: The authors affirm that transvaginal ultrasonography is the first method of choice for the diagnosis of urethral diverticula.

Ureteral injuries during gynecologic procedures.

The reported incidence of iatrogenic ureteral injuries ranges from 0.05 to 30%. These injuries are particularly secondary to gynecologic surgical procedures. Simple abdominal hysterectomy has proved to be the most common procedure leading to such injures. Because some ureteral injuries may be symptomless, leading to silent kidney loss, the incidence may be too low, and a figure of up to 2.5% after gynecologic operations has been suggested. The incidence continues to be about ten cases during abdominal surgery for one case during vaginal surgery. Different risk factors may influence the ureteral injuries rate. An operation at the pelvic brim, distorted anatomy, removal of the adnexa or of ovarian neoplasm, may facilitate the occurrence of an ureteral trauma. The management of ureteral trauma is positively influenced by an early recognition of the trauma. Conventional technique or ureteroneocystostomy or end to end anastomosis with ureteral stent to treat the injury proved successful. Extensive reconstruction draws upon the entire therapeutic armamentarium of the urologist. Surgical options mainly include creation of bladder tubes and autotransplantation. The most important factor influencing the management of ureteral injury is the presence of associated complications. Blandy et al. sustained to attempt repair of these complicated iatrogenic injuries as soon the diagnosis has been made.

[Prognosis of shoulder calcifications after irrigation treatment and roentgen findings. A prospective study and literature review]. / Prognose von Schulterverkalkungen nach Spülbehandlung und Röntgenbefund. Eine prospektive Untersuchung und Literaturübersicht.

In 106 shoulder joints of 94 patients suffering from calcifying shoulder (calcifying tendinitis), needling and lavage were performed. Patients were prospectively investigated before and after treatment to examine if location, size, number and density of calcium deposits would predict outcome after the above-mentioned lavage. Excellent and good results were seen for subacromial calcifications and those situated near the tuberculum majus. Density and number of calcifications were without discriminating value, whereas large calcium deposits (> 1,5 cm) and fairly small calcifications (< 1,0 cm) responded very well to conservative treatment as described above.

Effects of a screening program for hypertension in a community.

The effect of a population screening for hypertension was assessed through a subsequent survey performed 1 year later. All the hypertensives identified at the first visit (239 subjects, 15.6% of the whole screened population) were invited for a re-examination: the adhesion rate was 84.5%. After the screening, a high proportion of subjects (74.7%) had contacted their physicians because of their blood pressure. The most common advice physicians gave was to have further measurements of blood pressure (72.8%). Laboratory tests were prescribed in 62 patients (41.1%), but a complete assessment of a target organ damage was carried out in few cases (1.9%). Only 19.5% of patients started a course of treatment during the year following the screening and no more than one-third of those with moderate to severe hypertension. Out of the 176 subjects showing other cardiovascular risk factors at the screening, only 12 reported they had modified their habits 1 year later. Our results suggest that a screening for hypertension, when performed without any liaison with other medical facilities, seems to have a poor impact on physicians' and patients' attitudes towards hypertension.

Long-term efficacy of screening for hypertension in a community.

Screening for hypertension in the community leads to the identification of hypertensive people not previously detected, and those detected but inadequately treated or not treated at all. The aim of the present study was to assess the long-term efficacy of screening for blood pressure control in a general population. During 1981, 2139 parents of high school students were invited to our institute for a blood pressure measurement; 1533 persons (71.7%) attended the screening; 239 of them (15.6%) were found to be hypertensive (diastolic blood pressure greater than or equal to 95 mmHg or already receiving antihypertensive treatment). Among the hypertensives, 42.3% did not know that they had high blood pressure, and only 7.5% had their blood pressure controlled by treatment. After being informed about the importance of lowering their blood pressure levels, all hypertensives were invited again to the institute for a further evaluation. Two hundred and two persons (84.5%) attended the re-examination. Of these, 154 (76.2%) were still hypertensive. Of the 202, 151 (74.7%) had contacted their physicians. The most common advice was to make further measurements of blood pressure over a period of time, followed by laboratory tests. The proportion of treated hypertensives rose from the initial 33.1% to 53.9%, but in about half the patients normalization of blood pressure was not achieved. Physicians tended to treat only people with moderate to severe hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

[Association between arterial pressure and other cardiovascular risk factors in adolescence]. / Associazione tra pressione arteriosa ed altri fattori di rischio cardiovascolare nell'adolescenza.

A screening for hypertension and other cardiovascular risk factors was carried out during 1981 in a population of 1142 subjects (675 males and 467 females) aged 14-18 years. Aim of the study was to analyze the distribution of blood pressure values and of variables possibly associated with hypertension in a population of adolescents. The mean value of systolic blood pressure was higher in males than in females, slightly increasing with age in males and decreasing in females. The diastolic blood pressure was similar, and increased with age in both sexes. The prevalence of individuals with systolic blood pressure greater than or equal to 140 mmHg resulted of 16.1% in males and of 5.6% in females; the prevalence of adolescents with diastolic blood pressure greater than or equal to 90 mmHg was much lower, being of 2.5% and 1.5% respectively. The average value of heart rate was higher in females and decreased with age in both sexes. Males showed significantly greater height and weight, but the body mass index was nearly equal in the two sexes; females had thicker skinfolds. All these variables only in males were clearly associated with age. Among anamnestic variables, only smoking habits, alcohol consumption and physical activity were significantly different in the two sexes. A positive family history for hypertension was present in 31.4% of the adolescents in whom an objective assessment was possible. In both sexes the systolic blood pressure appeared significantly related to heart rate, body weight, body mass index and skinfold thickness.(ABSTRACT TRUNCATED AT 250 WORDS)