Histological and immunohistochemical characterisation of uterine adenocarcinoma in an Asian elephant (Elephas Maximus).

A 56-year-old nulliparous female Asian elephant (Elephas maximus) living at the zoological garden of Naples (Italy), with a clinical history of recurrent colic, was found in agonal state and humane euthanasia was elected. At necropsy the uterine body was moderately increased in size and the lumen was reduced due to a poorly demarcated and infiltrative neoplasm. Furthermore, multiple, whitish, firm nodules were present in both lungs. Histological examination of the uterine mass revealed epithelial cells arranged in tubular or solid pattern infiltrating the endometrium and the muscular layer. Immunohistochemical examination showed immunoreactivity of neoplastic cells to oestrogen receptors antibody. Pulmonary lesions were histologically and immunohistochemically superimposable to the epithelial uterine neoplasm. A definitive diagnosis of uterine adenocarcinoma with pulmonary metastases was made.

Medición de los resultados estéticos y funcionales desde la perspectiva del paciente en rinoplastía: creación del instrumento nose-qol / Development of a new patient-reported outcome measure for rhinoplasty suergery: the Nose-QoL

Background: Instruments that assess the results of plastic surgery from patient's perspective allow a multidimensional evaluation of surgical results. Aim: To develop a new instrument to assess the functional and esthetic results of rhinoplasty from the point of view of the patient. Material and Methods: A conceptual framework about important results for nasal image was developed using information from in depth interviews to patients, focal groups with experts and interviews to esthetic surgeons and patients subjected to rhinoplasty. Results: Four patients and four plastic surgeons were interviewed. The three sub scales identified for the conceptual framework were quality of life, postoperative disability and pain and surgeon's objective evaluation scale. Five domains for quality of life were identified including nose size and form, self-image and esteem, third party perceptions and social relationships, nasal function and segmental nasal analysis. Conclusions: After completion of the psychometric assessment, the Nose-QoL instrument will become a valuable instrument to measure the impact and effectiveness of rhinoplasty from the patient's perspective.

Objetivo: Desarrollar un nuevo instrumento de resultados estéticos y funcionales desde la perspectiva del paciente, diseñado para medir la satisfacción de éstos en relación a rinoplastía. Métodos: Revisión de la literatura, entrevistas en profundidad a pacientes, grupos focales de discusión de expertos, a cirujanos plásticos y pacientes sometidos a rinoplastías, con lo que se desarrolló un marco conceptual en relación a los resultados considerados importantes para la imagen nasal. Resultados: Se entrevistó a cuatro pacientes y cuatro cirujanos plásticos. Las tres Subescalas identificadas para el marco conceptual incluyen: la Calidad de Vida (CdV), la Escala de Discapacidad y Dolor Post-operatorio (EDDP) y Escala de Evaluación Objetiva del Cirujano (EEOC). Se identificaron 5 dominios para la subescala CdV, que incluyen: tamaño y forma de la nariz, autoimagen y autoestima, percepción de terceros y relaciones sociales, función nasal y análisis nasal segmentario. Conclusiones: Una vez completada la evaluación psicométrica, el instrumento Nose-QoL y subescalas, proporcionará una herramienta confiable para cirujanos plásticos, investigadores y pacientes para medir el impacto y la eficacia de las rinoplastías, desde la perspectiva del paciente. Nivel de Evidencia: 1 -Estudio cualitativo, generación de instrumentos de medición de resultado desde la perspectiva del paciente.

Medición de los resultados desde la perspectiva del paciente en cirugía de contorno corporal: creación del instrumento Body-QoL / Development of an instrument to evaluate the results of plastic surgery from the perspective of the patient

Background: Body remodeling surgical procedures requires an assessment from the client's point of view in terms of esthetic satisfaction. Aim: To develop an instrument of assess body remodeling surgical results from the point of view of the patient. Material and Methods: A literature search for assessment methods was carried out. Posteriorly, in depth interviews and focus groups with plastic surgeons and patients subjected to plastic surgery procedures were performed. With this information, a conceptual framework was established to devise the instrument. Results: Sixteen patients and five plastic surgeons participated in the interviews and focus groups. The domains included in the conceptual framework were outfit and body image, affective and sexual life, self-image and esteem, social relationships and physical symptoms. Conclusions: The conceptual framework for the instrument is ready and the psychometric evaluation is the next step in its development.

Objetivo: Desarrollar un nuevo instrumento de resultados desde la perspectiva del paciente, diseñado para medir la satisfacción de éstos en relación a procedimientos de cirugía de contorno corporal, como li-poescultura, abdominoplastía, lifting corporal, lifting de muslos y brazos. Material y Método: Revisión de la literatura, entrevistas en profundidad a pacientes, grupos focales de discusión de expertos a cirujanos plásticos y pacientes sometidos a cirugías de contorno corporal con lo que se desarrolló un marco conceptual en relación a los resultados considerados importantes para la imagen corporal. Resultados: Dieciséis pacientes y cinco cirujanos plásticos fueron entrevistados. Los dominios identificados para el marco conceptual incluyeron vestimenta e imagen corporal, vida afectiva y sexual, autoimagen y autoestima, relaciones sociales y síntomas físicos. Conclusiones: Una vez completada la evaluación psicométrica, el instrumento Body-QoL y subescalas proporcionará una herramienta confiable para cirujanos plásticos, investigadores y pacientes para medir el impacto y la eficacia de los procedimientos de remodelamiento corporal, desde la perspectiva del paciente. Nivel de Evidencia: 1-Estudio cualitativo, generación de instrumentos de medición de resultado desde la perspectiva del paciente.

AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients.

OBJECTIVES: The aim of this study was to assess the longterm mechanical reliability of AMS (American Medical Systems) three-piece inflatable implants and their impact on patient-partner satisfaction in 200 consecutive patients with erectile dysfunction who underwent surgery in five different institutions. METHODS: Patient charts included in the study were collected and extensively assessed to record pre- and intraoperative data and postoperative complications. All patients and 120 partners were then seen often in the office at a mean follow-up of 59 months (range 6-130) and they were extensively questioned about function of the device and its impact on the couple's sexual life. RESULTS: At the long-term follow-up, 185 patients (92.5%) were still engaging in sexual intercourse with a mean frequency of 1.7/week. Patients and partners reported prosthetic erections as excellent, satisfactory or poor in 96 (48%), 100 (50%) and 4 (2%) cases, and in 20 (17%), 80 (66%) and 20 (17%) cases, respectively. Postoperative sexual activity was considered excellent, satisfactory or poor by 140 (70%), 44 (22%) and 16 (8%) patients and by 34 (28%), 81 (68%) and 5 (4%) partners, respectively. Reasons for patients' complaints included postoperative penile shortening in 60 (30%) cases and poor glandular engorgement in 40 (20%) cases. Partners' main complaint was unnaturalness of the prosthetic erection, a factor reported by 30 (25%) subjects. Complications requiring surgical exploration included infection in 12 patients (6%) and mechanical failure in 8 patients (4%). Kaplan-Meier estimates demonstrated significantly decreased mechanical survival for the Ultrex type of cylinders compared to the CX type of cylinders. CONCLUSIONS: AMS three-piece inflatable implants provide an overall patient and partner satisfaction rate of 92 and 96%, respectively. However, postoperative penile shortening and poor glandular engorgement were the causes of some complaints among the patient population as well as the unnaturalness of prosthetic erection among female partners. In the long-term, mechanically speaking, CX cylinders seem to be more reliable than the Ultrex ones.

Laparoscopic unroofing of adrenal cysts.

OBJECTIVES: This study was aimed to demonstrate the feasibility of laparoscopic conservative surgery of the adrenal gland in the treatment of adrenal cysts. METHODS: Two cases of laparoscopic decortication of symptomatic adrenal cysts with preservation of the adrenal parenchyma are presented. RESULTS: Surgery was uneventful in both cases and patients returned to preoperative activity within 10 days from the operation. At the 3-month follow-up, computerized tomography demonstrated the absence of any cystic recurrence and adrenal endocrine function was normal. These findings were confirmed at the 1-year follow-up by ultrasonography. CONCLUSIONS: Symptomatic adrenal cysts can be effectively and safely treated by laparoscopic unroofing, a minimally invasive procedure which leaves the nondiseased adrenal parenchyma intact.

Correction of stress urinary incontinence: laparoscopy combined with vaginal suturing.

The authors review the published techniques of laparoscopic colposuspension combined with vaginal suturing. Particular emphasis is given to their own technique, first published in 1992, and to that of Harewood (1993), which is similar. Both involve a Burch-like colposuspension using a technique similar to that of Gittes and Loughlin. This is possible looking inside the pelvis through a laparoscope and using a handle-needle. Published results are similar (about 70% success rate), but the authors point out that the Breda technique is simpler, cheaper, and less time consuming (only one trocar instead of three) and has had a longer follow-up (up to 3 years instead of 19 months). The authors review many other similar techniques reported between 1993 and 1995 with good results but based on rather limited experience. The conclusion is that the laparoscopic technique with vaginal suturing seems a promising way to approach stress urinary incontinence in the female patient.

[Laparoscopic surgery of stress urinary incontinence in women]. / Chirurgia laparoscopica dell'incontinenza urinaria da stress femminile.

The Authors carried out a literature review on stress urinary incontinence (SUI) treatment using laparoscopy or pelvioscopy. They report their experiences in using a pubo-vaginal percutaneous colposuspension assisted by pelvioscopy. Of 22 treated patients, there was a total correction of the incontinence in 15 patients. (68.12%) with a median follow-up of 18.6 months. They report also their first experience with the Retzius plasty of Manhes by laparoscopy (3/4 patients treated are continent, 1/4 has recurrent SUI during times of stress). They conclude that laparoscopy and pelvioscopy treatment can be valid alternatives to traditional surgery if made on selected patients.

Stage A1 prostate cancer: follow-up with digital rectal exploration, prostate markers, fine-needle aspiration, ultrasonographically guided needle biopsy and biopsies of the residual prostate with resectoscope.

From January 1985 to December 1990, we performed 921 TURP and 23 retropubic adenomectomies. In 70 patients (7.4%) histological examination revealed an incidental carcinoma of the prostate (stage A), 51 of which (72.8%) were A1 and 19 (27.2%) stage A2. In our classification A1 covers cases with < 3 G1 focal lesions [Boxer, 1977]. Thirteen of the A2 cases underwent radical prostatectomy: 1 pT1G1-2, 9 pT2G1-2, 3 pT3G2 (TNM 1978); the remaining 6 were given palliative treatment. The 51 stage A1 patients were recalled for follow-up evaluation, only 20 came for checking. They were reassessed by means of DRE, markers, prostate cytologic aspiration, echo-guided transperineal needle biopsy and resection of the prostatic cavity. Our experience seems to suggest that, if we define A1 as < 3 G1 chips or less, this stage is to be considered an incidental illness that seems not to require further treatment, but only a policy of surveillance with yearly markers, DRE and echo-guided needle biopsy.

Laparoscopic nephrectomy with vaginal delivery of the intact kidney.

The first case of laparoscopic nephrectomy in Italy is described. The patient was a 51-year-old woman with a small, nonfunctional, tuberculous left kidney. The organ, once detached from its lumbar site, was brought in to the pelvic cavity and extracted from the body via a posterior colpotomy. In this way, the integrity of the organ is preserved, hence, this could be the preferable route when dealing with a little kidney tumor in a woman.

[Cost-benefit relationship between endoscopic resection (TURP) and open surgery (Millen) in prostatic hypertrophy ]. / Rapporto costi-benefici tra resezione endoscopica (TURP) e chirurgia a cielo aperto (Millin) nell'ipertrofia della prostata.

Evaluation of the cost/benefit relationship between TURP (50 cases) and Millin (30 cases). The factors considered are as follows: average post-operative hospitalization, average catheterisation time, average operation time, cost of materials, number of operators employed, number of transfused blood units. The post-operative hospitalization relating to the two kinds of operation varies considerably with a difference of 5.15 days less for the TURP, while the average catheterisation time doesn't seem to be affected. Blood transfusion was necessary in the 43.3% (0.75 unit/patient) of cases for the Millin compared to the 14% (0.26 unit/patient) for the TURP. Evaluation of economical advantages between TURP and Millin shows a relationship of 1:2.3 in favour for of TURP.

[Pathology of the residual urachus: a congenital anomality of possibly late clinical onset]. / Patologia dei residui uracali: anomalia congenita a possible espressione clinica tardiva.

The authors report on two rare case urachal residue disease of late onset. They define the pathogenic factors contributing to the disease and describe the semeiological and radiological methods used in diagnosing the condition.

Relationship between increased aerobic glycolysis and DNA synthesis initiation studied using glycolytic mutant fibroblasts.

Reports from several laboratories have suggested increased rates of glycolysis play an essential part in the initiation of DNA synthesis. This is based on observations that aerobic glycolysis: (1) occurs at low rate in resting mammalian cells and at very high rate in tumour cells; (2) increases rapidly after DNA synthesis is initiated by addition of serum or purified growth factors, and (3) correlates with the expression of the transformed phenotype. Also, specific inhibitors of aerobic glycolysis prevent the initiation of DNA synthesis. To determine whether the rapid activation of phosphofructokinase--and therefore glycolysis--by purified growth factors is necessary for the initiation of cell proliferation, we have isolated and studied two classes of glycolytic mutants. The first, isolated from Chinese hamster fibroblasts, has a total block in the glycolytic pathway. The second, from hamster and Fisher rat fibroblasts maintains a permanent high rate of glycolysis. We have found that both classes of mutants retain normal control of DNA synthesis in response to serum. This dissociation indicates that growth-factor-stimulated glycolysis is not involved in the control of initiation of DNA synthesis and cell proliferation.

Isolation of a Chinese hamster fibroblast mutant defective in hexose transport and aerobic glycolysis: its use to dissect the malignant phenotype.

A procedure is described for the selection of glucose uptake mutants based upon radiation suicide of Chinese hamster fibroblasts by 2-deoxy[3H]glucose. In one of these mutants, DS 7, the ability to transport either 2-deoxyglucose or 3-O-methylglucose was decreased to one-fifth to one-fourth. Besides this defect, DS7 produces 1/14th the lactic acid produced by the parent when grown on 5 mM glucose. This block in aerobic glycolysis is due to a mutation that affects the expression of the phosphoglucose isomerase gene because no isomerase activity is detected in cell extracts of DS7. This glycolytic block makes that cell line dependent exclusively on respiration for its energy requirement. Consequently, DS7 survives well after removal of glucose but dies quickly in the presence of oligomycin. The parental line O23 (subclone of CCl39) grows at low serum concentration, is anchorage-independent, and is tumorigenic in nude mice. The derived glycolytic mutant DS7 has retained both the in vitro transformed phenotype (low serum dependence and loss of anchorage dependence) and the tumor-forming capability. The tumor cells derived from the injection of DS7 cells have kept the original glycolytic defect. This finding suggests that the transformed properties (high hexose transport and aerobic glycolysis) that can be uncoupled from abnormal growth control are not necessary for the expression of the malignant phenotype in fibroblasts.

Cell mutants as a tool to study malignant transformation of fibroblasts.

From 3T3 Balb/c cells, mutants with low adhesiveness to plastic substratum were selected. One of these clones, AD6, was found to be deficient in glucosamine-6-phosphate N-acetylase. A result of this block is a decrease by 60-70% of cell surface carbohydrates, and as a consequence there is a general reduction in the exposure of glycoproteins at the cell surface. This biochemical defect is fully reverted to normal, simply by growing the mutant cells in presence of 10 mM N-acetylglucosamine. This specific and reversible enzymatic block allows us to conclude that the abnormal properties of AD6 cells--low adhesion, round shape, increased agglutinability by lectins, loss of directional locomotion, and absence of microfilament bundles--are the result of the surface carbohydrate defect, since reversion of glycoprotein synthesis to normal results in the general reversion of the altered phenotype. However, in spite of this apparent transformed phenotype, AD6 cells have normal growth control and are not tumorigenic. Using [3H]-2-deoxyglucose suicide, we selected from a spontaneously transformed clone of Chinese hamster lung fibroblasts a mutant (DS7) impaired in glucose metabolism, DS7 has a fourfold to fivefold decreased ability to transport either 2-deoxyglucose or 3-O-methylglucose and produces 14 times less lactic acid than the wild-type when grown on 5 mM glucose. This block in aerobic glycolysis, which is located at the level of phosphoglucose isomerase, makes that cell line dependent exclusively on respiration for its energy requirement. The parenteral line grows at low serum concentration, is anchorage-independent, and is tumorigenic in nude mice. The derived DS7 cells have retained both the in vitro transformed phenotype and the tumor-forming capability. A general conclusion of these studies is that the altered properties and cell behavior of transformed fibroblasts, such as low adhesiveness, round morphology, increased agglutinability by lectins, altered motility, absence of microfilament bundles, and increase in hexose transport and in aerobic glycolysis, are dissociable from malignant transformation. These phenotypic alterations should therefore be considered as events secondary to the mechanism that leads to the loss of growth control.