No Correlation between Blood Benzene Levels and Luteinizing Hormone Plasma Values in Outdoor Workers.

OBJECTIVE: The purpose of the study is to evaluate whether low-dose exposure to benzene, an environmental pollutant to which male and female traffic policemen are daily exposed to could cause alterations in plasma luteinizing hormone (LH) levels. METHODS: From an initial sample of 1594 workers, we only selected 95 workers of whom study we knew the values of late-shift benzene and LH hormone. All subjects underwent biological monitoring (final blood benzene evaluation) and luteinizing hormone dosing. Excluding subjects with the main confounding factors, the final sample included 76 workers. The normal distribution of the variables was evaluated using the Kolmogorov - Smirnov test, followed by the logarithmic transformation of the LH and benzene values. The comparison among means was performed by using the t-test for the independent samples. The ANOVA test was performed for variables with more than 2 modes (ages and seniority) and Pearson correlation index between variables in the total sample and after subdivision as to sex, job, sports activity and smoking. The results were considered significant when p values were less than 0.05. RESULTS/CONCLUSION: The study did not show a correlation between benzene levels and LH plasma levels in outdoor workers.

Cardiac Tumors: Echocardiographic Diagnosis and Forensic Correlations.

In the past, cardiac tumors were a just clinical curiosity and the prognosis was poor. Surgical management became possible after the advent of cardiopulmonary bypass, and more recently, preoperative diagnosis was greatly improved by the development of echocardiography, computed tomography, and magnetic resonance imaging. The value of echocardiography for diagnosing cardiac mass lesions has become well established. Numerous advances have occurred in the last 5 decades, and the evolution of echocardiography involves the development of its many modalities. This review is intended to help echocardiologists and forensic pathologists in providing good medical practice when faced with the challenge of investigating unexpected clinical signs, particularly in young people, or unexpected postmortem findings.

[Pseudomonas infection: biological risk by occupational exposure and results of an environmental monitoring]. / Intezione da Pseudomonas: rischio biologico da esposizione professionale e risultati di un monitoraggio ambientale.

The biological risk of Pseudomonas aeruginosa for activities involving exposure to contaminated water, such as, for example, routine maintenance of swimming pools, is related to the availability of effective prophylactic and therapeutic measures. The authors present the data of the microbiological analyzes made on 2349 samples taken from pools in Rome and province. The contamination by Pseudomonas was found in 191 samples with 13 samples that had a level > 100 cfu/100 ml and 5 samples with level > 200 cfu/100 ml. Useful considerations derived from the analysis of the literature about the profile and prophylactic treatment of infection by Pseudomonas, necessarily to be taken into consideration for an adequate risk assessment.

New surgical technique for ventral penile curvature without circumcision.

OBJECTIVES: To describe and report on our variant of penile corporoplasty, the 'double-breasted' corporoplasty, with penoscrotal and infrapubic access not requiring circumcision. The medicolegal aspects of treatment are also discussed. PATIENTS AND METHODS: Between February 1995 and October 2012, double-breasted corporoplasty was performed in 93 patients with congenital ventral penile curvature. Preoperative assessment comprised RigiScan monitoring, prostaglandin E1 injection with photographic documentation and measurement of penile angulation, administration of the International Index of Erectile Function-5 (IIEF-5) questionnaire, and biothesiometry up until 5 years ago when it was substituted with the Genito Sensory Analyser for testing sensitivity. Dorsal infrapubic access was used in the patients with ventral curvature. After preparation and incision of Colles' fascia, the penis is degloved and double-breasted corporoplasty is performed at the site established at preoperative assessment. The tunica albuginea is prepared, an incision is made, and the cavernous tissue is isolated from the albuginea to obtain two flaps that are then overlaid and sutured asymmetrically with interrupted 2-0 polyglactin 910 (Vicryl®) sutures. After the free edge of the albuginea is sutured with a running polyglactin 910 suture, a non-absorbable monofilament and uncoated suture made of polypropylene (Premicron®) suture is placed at the point of maximum traction. RESULTS: Complete correction of penile curvature was achieved in 96% of patients; recurrence occurred in 4%. No major complications were reported, nor were there neurovascular lesions or change in erectile function. Palpable subcutaneous irregularities at the site of the corporoplasty, without functional or aesthetic impairment, were reported by 35% of patients. There was no change in the appearance of the penis as circumcision was not performed and the residual scar was barely noticeable as it was hidden in the infrapubic fold. The corporoplasty technique can adequately restore the patient's psychophysical integrity, making it, from a medicolegal perspective, one of the most reliable procedures in the surgical repair of penile curvature. CONCLUSIONS: This original technique is associated with low morbidity, a low recurrence rate and excellent aesthetic results. The results show that it is safe and effective. When indicated for the surgical treatment of penile curvature, the choice of the technique satisfies the criteria of diligence and prudence for the surgeon's conduct.

Reconstructive surgery of the sulcus of glans penis for balanopreputial adhesion due to lichen sclerosus. Our experience and medicolegal implications.

AIM: Our exeperience with the reconstructive surgery of the adhesion of the glans with the preputial skin due to lichen sclerosus. MATERIAL OF STUDY: Twentyeight patients (mean age, 44 years; range, 28-69) underwent reshaping of the balanopreputial sulcus at our institution. All patients presented with trapped penis resulting from adhesion at the sulcus of glans due to Lichen Sclerosus. The procedure entailed separating the coronal adhesion along its entire length with the use of a blunttipped forceps, then reshaping the balanopreputial sulcus. Though simple, the maneuver is delicate and requires scrupulous attention to the ventral aspect to avoid damaging the urethra. The adhesion is removed circumferentially around the glans by means of electrobistoury. RESULTS: The duration of the follow-up period was 24 months. All patients stated they were satisfied with the cosmetic results and functional outcome. Recurrence of the condition occurred in 7% of the patients and was treated medically; recurrence of adhesion occurred in 2% of the patients and was treated with repeat surgery. DISCUSSION: The indication for medical therapy in early LS is a selective criterion restricted to less severe cases; otherwise, the physician may be held responsible for treatment failure, justified claims for reimbursement, disease progression and the decidedly greater damage that may ensue. Such consequences can be averted when assessment is based on recent scientific evidence and the approach to treatment is appropriate in terms of efficacy and effectiveness. Surgical management is definitive and restores normal penile anatomy and function, including sexual and urinary function, thus enabling the patient to regain sexual confidence CONCLUSIONS: Lichen sclerosus et atrophicus is a rare disease, however, its management is not devoid of medicolegal considerations. The etiopathogenesis of the disease is unknown but progression to carcinoma of the penis has been reported in untreated cases. Consequently, timely diagnosis holds medicolegal relevance for averting delayed initiation of treatment. In cases of balanopreputial adhesion with disappearance of the sulcus of glans, we proceed with lysis and reshaping of the sulcus by means of a simple technique we have developed. The technique involves separating the coronal adhesion circumferentially around the glans using a blunt-tipped forceps, then reshaping the balanopreputial sulcus. Though very simple, the procedure is also delicate as the surgeon must be careful not to damage the urethra beneath the ventral surface.

[Correlation among measures of stress, indicators of biohumoral nature and medico-legal considerations]. / Correlazione fra misure di stress, indicatori di natura bioumorale e considerazioni medico-legali.

INTRODUCTION: Man devotes most of the daily time to work, and also a large part of physical and mental resources. Depression and many other morbid conditions can be related etiopathologically to the performance of a dangerous occupation in terms of quality (hazardous work activities, lack of motivation for deficient career opportunities) or merely quantitative (duration of work shifts, frequency shifts work). The medical legal ascertainment is limited because stress cannot be valued by objective nature, but only through precious elements collected directly by workers by questionnaires. This is in response to legal requirements in terms of civil liability, occupational disease and disability. AIM AND METHODS: The objective of this study is to analyze the change of cytokines (IL-6, IL-12, TNF-α) and stress-related hormones (prolactin and cortisol) in a sample of 314 individuals working at the University Hospital Umberto I in Rome without acute diseases but only with the "feeling stressed" for at least a month and to analyze if there is a correlation between some of these biochemical variables and stress values measured by questionnaire. RESULTS: The results of this study confirm the usefulness to associate laboratory analysis, such as the study of inflammatory cytokines and the hormonal profile, to psychometric tests, precious for the lower cost and in some cases also for the high diagnostic sensitivity, to reach a probative value which satisfies even the most demanding application of accuracy.

Original technique for penile girth augmentation through porcine dermal acellular grafts: results in a 69-patient series.

INTRODUCTION: Although different techniques for augmentation phalloplasty have been reported in the medical literature, this issue is still highly controversial, and none of the proposed procedures has been unanimously approved. AIMS: The aim of this study is to describe an innovative surgical technique for penile girth augmentation with porcine dermal acellular grafts, through a small transverse incision at the penile base, along the penopubic junction. METHODS: Between 2000 and 2009, 104 patients were referred to our institution for penile enhancement. After a preoperative psychosexual consultation and a general medical assessment, 69 patients were deemed suitable good candidates for surgery. The average penis circumference was measured at the mid-length of the penis and was 8.1 cm (5.4-10.7 cm) and 10.8 cm (6.5-15.8 cm) during flaccidity and erection, respectively. All patients received penile augmentation with porcine dermal acellular grafts. MAIN OUTCOME MEASURES: Results evaluation of an innovative technique for penile girth augmentation through exogenous porcine grafts and small penobubic incision. RESULTS: Postoperative measurements were performed at 6 and 12 months. At the 1-year follow-up, the average penis circumference was 11.3 cm (8.2-13.2 cm, 3.1 cm mean increase) during flaccidity and 13.2 cm (8.8-14.5 cm, 2.4 cm mean increase) during erection. No major complications occurred in the series. Minor complications were resolved with conservative treatment within 3 weeks. Sexual activity was resumed from 1 to 2 months after surgery. The psychosexual impact of the operation was beneficial in the majority of cases. CONCLUSION: Penile girth enlargement with acellular dermal matrix grafts has several advantages over augmentation with autogenous dermis-fat grafts: the elimination of donor site morbidity and a significantly shorter operation time. With this approach, through a short dorsal incision at the base of the penis, the scar is concealed in a crease covered by pubic hair and thus hardly visible.