Trends in the use of partial nephrectomy for cT1 renal tumors: Analysis of a 10-yr European multicenter dataset.

AIM: Although extensively addressed in US registries, the utilization rate of Partial Nephrectomy has been poorly addressed in European settings. Our aim is to evaluate the impact of hospital volume on the use of PN for cT1 renal tumors. METHODS: 2526 patients with cT1N0M0 renal tumors treated with either PN or radical nephrectomy at 10 European centres in the last decade were included in the analysis. Joinpoint regression analysis was used to identify significant changes over time in linear slope of the trend for each center. The correlation between yearly caseload and the slopes was assessed with the non-parametric Spearman test. Coincident pairwise tests and regression analyses were used to generate and compare the trends of high-volume (HV), mid-volume (MV) and low-volume (LV) groups. RESULTS: Yearly caseload was significantly associated with increased use of PN (R = 0.69, p = 0.028). The utilization rate of PN was stable at LV centres (p = 0.67, p = 0.7, p = 0.76, for cT1, cT1a, and cT1b tumors, respectively), while increased significantly at MV (p = 0.002, 0.0005 and 0.007, respectively) and HV centers (all p < 0.0001). Regression analysis confirmed the trends for HV and MV as significantly different from those observed in LV centres (all p ≤ 0.002) and highlighted significant differences also between MV and HV centres (all p ≤ 0.03). CONCLUSIONS: We confirmed the association between caseload and the use of PN for cT1 tumors. Our findings suggest that a minimum caseload might turn the tide also in LV centres while a selective referral to HV centers for cT1b tumors should be considered.

Serum and urine biomarkers for human renal cell carcinoma.

Renal cell carcinoma (RCC) diagnosis is mostly achieved incidentally by imaging provided for unrelated clinical reasons. The surgical management of localized tumors has reported excellent results. The therapy of advanced RCC has evolved considerably over recent years with the widespread use of the so-called "targeted therapies." The identification of molecular markers in body fluids (e.g., sera and urine), which can be used for screening, diagnosis, follow-up, and monitoring of drug-based therapy in RCC patients, is one of the most ambitious challenges in oncologic research. Although there are some promising reports about potential biomarkers in sera, there is limited available data regarding urine markers for RCC. The following review reports some of the most promising biomarkers identified in the biological fluids of RCC patients.

Superficial radiotherapy for multiple keratoacanthomas.

We report the case of a 76-year-old Caucasian woman who attended our clinic with multiple keratoacanthomas. Radiotherapy was considered a viable and effective option in such an old patient, who could not be a good surgical candidate for number and distribution of the lesions, and for the age. After a 12-month follow-up, we observed the complete and global disappearance of the lesions; the patient was therefore very satisfied especially in view of the clinical outcome. According to our point of view, radiotherapy allows the physician to obtain a good oncological radicality and excellent cosmetic results too.

Single Walled Carbon Nanotubes/polypyrrole-GOx composite films to modify gold microelectrodes for glucose biosensors: Study of the extended linearity.

A glucose biosensor was assembled using gold microelectrodes (diameter of 250 µm) coated by Single-Walled Carbon Nanotubes (SWCNTs), via the Electrophoresis Deposition Process (EPD). This nanostructured platform was successfully used to deposit the poly(pyrrole)/glucose oxidase film (PPy/GOx). The most important result of this biosensors was the wide linear range of concentration, ranging from 4 to100 mM (covering the hypo- and hyper-glycemia range, useful in diabetes). This extended linearity offered the possibility to measure glucose from 0.560 to 12.0 mM, with a detection limit of 50 µM (useful for hypo-glycemia disease).

Acetylcholinesterase biosensor based on single-walled carbon nanotubes--Co phtalocyanine for organophosphorus pesticides detection.

A simple and reliable technique has been developed for the construction of an amperometric acetylcholinesterase biosensor based on screen-printed carbon electrodes. For the first time, one-step modification using single-walled carbon nanotubes and Co phtalocyanine has been proposed to decrease the working potential and to increase the signal of thiocholine oxidation. The biosensor developed made it possible to detect 5-50 ppb of paraoxon and 2-50 ppb of malaoxon with detection limits of 3 and 2 ppb, respectively (incubation 15 min). The biosensor showed high reproducibility when measurements of the substrate and inhibitor were performed (R.S.D. about 1% and 2.5%, respectively). The reliability of the inhibition measurements was confirmed by testing spiked samples of sparkling and tape waters.

Electrochemical oxidation of ochratoxin A at a glassy carbon electrode and in situ evaluation of the interaction with deoxyribonucleic acid using an electrochemical deoxyribonucleic acid-biosensor.

Ochratoxin A (OTA) is a fungal metabolite that occurs in foods, beverages, animal tissues, human blood and presents carcinogenic, teratogenic and nephrotoxic properties. This study concerns the redox properties of OTA using electrochemical techniques which have the potential for providing insights into the biological redox reactions of this molecule. The in situ evaluation of the OTA interaction with DNA using a DNA-electrochemical biosensor is also reported. The oxidation of OTA is an irreversible process proceeds with the transfer of one electron and one proton in a diffusion-controlled mechanism. The diffusion coefficient of OTA was calculated in pH 7 phosphate buffer to be D(O) = 3.65x10(-6) cm2 s(-1). The oxidation of OTA is also pH dependent for electrolytes with pH<7 and involves the formation of a main oxidation product which adsorbs strongly at the GCE surface undergoing reversible oxidation. In alkaline electrolytes OTA undergoes chemical deprotonation, the oxidation involving only the transfer of one electron. The electrochemical dsDNA-biosensor was also used to evaluate the possible interaction between OTA and DNA. The experiments have clearly proven that OTA interacts and binds to dsDNA strands immobilized onto a GCE surface, but no evidence of DNA-damage caused by OTA was obtained.

Fibrillar pattern of a plantar acquired melanocytic naevus: correspondence between epiluminescence microscopy and transverse section histology.

The main epiluminescence microscopy (ELM) patterns observed on volar acquired melanocytic naevi are the parallel-furrow, the lattice-like and the fibrillar patterns. Because of the peculiar arrangement and configuration of epidermal rete ridges in the glabrous skin, the traditional histological picture does not provide an exact correlation with ELM features. In particular, the fibrillar pattern lacks a histopathological correlate. To clarify the microscopic features of the fibrillar pattern, we used transverse histological sectioning to study an acquired compound melanocytic naevus of the sole, characterized by a mixed parallel-furrow/fibrillar pattern on ELM. Low-magnification images of transverse sections allowed us to highlight the typical anatomical arrangement of the volar skin clearly, while high-magnification images demonstrated that the fibrillar pattern corresponded to parallel striae of intensely pigmented corneocytes arranged obliquely to the cutaneous surface.

Early echographical assessment of minimal lesions of cavernosum corpora and tunica albuginea in subjects with erectile dysfunction, suggestive of La Peyronie's disease.

The aim of the study is to evaluate the incidence and the echographic characteristics of minimal lesions of cavernosum corpora and tunica albuginea (TA) in subjects reporting erectile dysfunction (ED), which could suggest the suspicious of La Peyronie's disease (LPD). In total, 185 patients (pts) underwent dynamic penile Ultrasound Color Doppler (USCD) for ED. None of the pts presented any clinical symptoms or any clinical findings for LPD. In this study we evaluated, using USCD, thickness, echogenicity, regularity of the surface profile of the dorsal TA, the intercavernous and the intercaverno-spongeous septa, and the extension of the eventual pathologic lesions. In all, 16 pts (8.7%) presented minimal lesions at the ultrasound examinations. In nine of these pts (56%) the lesion was localized at the dorsal position, in six (38%) on the intercavernous septum and in one patient (6%) in both positions. The dorsal lesions were represented in nodular form in four pts (4%), and in diffuse form in five pts (55%). The nodular form was present in all the intercavernous septal lesions observed. As reported in the literature, USCD represents the investigative technique of choice in the study of LPD and in ED. Furthermore, the results of this study suggest that this technique could allow the localization of minimal lesions attributable to LPD during a preclinical phase of this disease. The localization of these lesions could permit to start a therapeutic approach during an early phase of the disease.

Experience with a bone anchor sling for treating female stress urinary incontinence: outcome at 30 months.

OBJECTIVES: To evaluate the clinical and video-urodynamic outcome in women with by stress urinary incontinence (SUI) treated with a bone-anchored pubovaginal sling. PATIENTS AND METHODS: The study included 70 women with SUI (as evaluated by a clinical examination, a voiding questionnaire, a short pad-test and video-urodynamics) who had a bone-anchor sling procedure, with or without cystocele repair, from January 1999 to December 2001; they were re-evaluated after a long-term follow-up (mean 30 months). RESULTS: The long-term outcome showed a success rate of > 95%; the clinical and video-urodynamic findings showed good functional and anatomical results, and an improvement in voiding performance in most patients. There was a low incidence of complications during and after surgery (2.8%). CONCLUSIONS: This approach gives, in highly selected patients, a high success rate and low incidence of complications. The technique is easy to learn and the costs to the financing bodies and public healthcare are low, making it a candidate for an alternative procedure to the standard techniques for SUI.