Urothelial bladder carcinoma and viral infections: different association with human polyomaviruses and papillomaviruses.

Bladder cancer is the second most commonly occurring genitourinary cancer in adults. The interaction of different carcinogenic and cocarcinogenic agents are responsible for bladder urothelial carcinoma: alcohol and smoking habits, Schistosoma haematobium infection, exposition to chemicals, analgesic and antineoplastic drugs prolonged use. Recently also viral infections have been associated to this pathology. In this study the correlation between viral infections and bladder carcinoma has been evaluated. A group of 32 patients affected by primary bladder neoplasia has been analysed. A control group of 20 autoptic samples of healthy bladder was analysed. The DNA of the following viruses has been searched by polymerase chain reaction (PCR): Adenovirus, Herpes simplex virus type 1 (HSV-1), Herpes simplex virus type 2 (HSV-2), Human Papillomaviruses (HPV), Polyomaviruses (BKV and JCV). In the examined population the association bladder carcinoma-HPV, found by others, has not been confirmed. The high percentage of human polyomaviruses present in the samples is a statistically significant data (p=0.0087) and allows to presume that BKV and JCV may play a role in the aetiology of bladder tumor. In particular the polyomavirus BK, which is found in significative percentage both in single infection (p=0.0036) and in co-infections with other viral species (p=0.035), may be an important co-factor in the pathogenesis of bladder carcinoma.

Challenging the role of cremasteric reflux in the pathogenesis of varicocele using a new venographic approach.

PURPOSE: Cremasteric or extrafunicular reflux is considered by many a major cause of primary and recurrent varicocele. Therefore, surgical techniques that allow ligation of the intrafunicular and extrafunicular veins are often performed. We evaluated the incidence of cremasteric reflux in patients with primary or recurrent varicocele with a new and simple venographic technique. MATERIALS AND METHODS: A series of 73 patients with primary (54) or recurrent (19) varicocele underwent venography of the left iliac vein while standing and performing Valsalva's maneuver to reveal the possible presence of reflux in cremasteric or other extrafunicular veins. In patients with recurrent varicocele antegrade transcrotal spermatic venography was also performed immediately before surgery. RESULTS: None of the patients presented with reflux of contrast material from the left iliac vein to the left pampiniform plexus via the extrafunicular veins. Cremasteric veins, in particular, were always continent at the confluence with the epigastric vein even when grossly dilated at spermatic antegrade venography in recurrent cases. CONCLUSIONS: Cremasteric reflux seems to have a limited role if any in the pathogenesis of primary and even recurrent varicocele. Dilatation of the extrafunicular veins is not necessarily a sign of reflux but may represent only a consequence of venous overflow due to insufficiency of the internal spermatic vein and possibly partial obstruction of the left iliac vein. The rationale of surgical treatments aimed at ligation of the extrafunicular veins should be questioned.

Scrotoscopy: a promising future? Our preliminary experience.

Scrotoscopy is a new endourologic technique for the exploration of the scrotum. After distention of the tunica vaginalis space with saline, a standard arthroscope was employed in 20 cadavers and subsequently in 5 patients before full surgical exploration for hydrocele (1 case), testicular biopsy (3 cases), or orchidectomy (1 case). There was a clear view of the testis and epididymis. The procedure was easy, and there were no major complications. Scrotoscopy could potentially be performed on an outpatient basis. Its indications in infertility appear to be particularly promising.

Reproducibility of histological diagnoses and diagnostic accuracy of non palpable breast lesions.

Twelve pathologists independently examined and classified a set of 25 cases of non palpable breast lesions selected from the archival files of the Pathology Department in Florence. A final consensus diagnosis was reached for all cases at a slide seminar. Individual diagnoses were first combined in 3 broad categories (benign lesion, in situ and invasive carcinoma), then compared to each other and then to the "consensus". Results show that among these 12 pathologists there was complete agreement in 14 cases. Discrepancies for the other 11 cases varied in the number of pathologists and diagnostic categories involved. Overall agreement was excellent (median kappa 0.86) but cases of potentially harmful errors were evident. The authors discuss these findings in the frame of a breast cancer screening program planning.

[Transitional cell neoplasm of the bladder in childhood: presentation of a clinical case]. / Neoplasia vesical de células de transición en edad pediátrica: presentación de un caso clínico.

A case of urothelial carcinoma of the bladder in a 13-year-old boy is reported. As observed in the literature, it is an extremely rare condition in children. The importance of gross or microscopic hematuria, which is often the only sign of this condition, is underscored. The authors comment on the possible follow-up modalities in relation with the characteristics of this tumor type in young patients. Although it is more invasive (anesthesia, trauma) than US or urinary cytology, cystoscopy is more precise. Because recurrence is extremely rare, it can be performed once a year.

Discontinuing medication in epileptic children: a study of risk factors related to recurrence.

We studied 70 children who had experienced at least two seizures before age 12 years, excluding febrile seizures, neonatal seizures, or seizures occurring during a metabolic, or infectious insult to the central nervous system (CNS) and who had been seizure free for at least 2 years. Twenty children (28.5%) experienced a recurrence, 75% during antiepileptic (AED) drug discontinuation or less than 6 months after discontinuation. Risk factors statistically related to seizure recurrence were greater than 10 seizures before seizure control, an abnormal EEG in the year before AED discontinuation, presence of focal neurologic signs and/or mental retardation, and presence of a mixed seizure pattern. Fourteen children (70%) with recurrence had two or more risk factors, whereas 36 (72%) without recurrence had no risk factor or only one. We conclude that a selected group of epileptic children who remain seizure-free for a period of at least 2 years can have AEDs discontinued based on presence or absence of risk factors.

The incidence of post-operative urinary tract infection in patients with ureteric stents.

Despite the many advantages provided by the ureteric stent, it produces a foreign body reaction and increases the risk of infection. We undertook a study on the rate of infection in a group of paediatric patients with ureteric stents; 40 ureteric stents, 6 to 9 F, were used in 36 children undergoing the following procedures: 18 pyeloplasties, 20 antireflux ureteric reimplantation and 2 uretero-rectal anastomoses. Only patients with sterile urine pre-operatively were included in the study. All received antibiotic cover in the post-operative period. Positive urine cultures were found in only 3 patients (7.5%). In spite of this low incidence, the urine specimens collected from all children 1 month after removal of the stent showed a much higher incidence of infection. It was concluded that ureteric stenting is a safe procedure with a low rate of infection provided that antibiotic cover is given.

[Specular crossed renal ectopia and balanic hypospadias in monozygotic twins]. / Ectopia renale crociata speculare ed ipospadia balanica in gemelli monoovulari.

The observation of a balanic hypospadia with chordee associated with a renal malformation in both of identical twins is reported. Monozygosity of twins was demonstrated with the study of ABO, MNS, HLA and RH factor systems. Urography, performed in both twins, showed a specular crossed renal ectopia with fusion. Abdominal ultrasounds, Chest-X-ray and barium meal showed no other abnormalities. After an analysis of the embryogenetic mechanisms of twinning, the Authors elaborate a hypothesis to explain the development of this specular renal malformation, never reported up to date in identical twins.

[Unilateral primary vesico-ureteral reflux: uni- or bilateral reimplantation?]. / Reflux vésico-urétéral primitif monolatéral: réimplantation mono ou bilatérale?

The need of bilateral reimplantation in unilateral reflux is still stressed by some authors. The following represents the rationale for this surgical management. 1. correction of unilateral reflux may increase bladder pressure and in this way induce a contralateral reflux; 2. the operation on one side may lead to changes in the muscles and cause reflux on the opposite one; 3. reflux, though unilateral, is the result of a malformation involving the whole trigone. Nevertheless, the authors regard as unjustified the reimplantation of a normal ureterovesical junction being in-acceptable the risk, even if low, of operative failure on a ureter without reflux. Literature data show an incidence of contralateral reflux after unilateral reimplantation of 11-32%. Such incidence, however, tends to decrease (1.9-20%) one year after the operation due to the spontaneous resolution of reflux in most of the cases. The grade of reflux was low (I-II grade) in the majority of cases. The authors report on 38 cases of unilateral primitive vesico-ureteral reflux who underwent unilateral ureteral reimplantation between 1981 and 1982. Minimum follow-up was 2 years. After surgery, contralateral reflux occurred in 4 cases (10.5%) but it spontaneously subsided within 3 years in all of them. Contralateral reflux was asymptomatic in 3 cases and in no cases caused renal scars. The authors conclude that unilateral ureteral reimplantation is the procedure of choice in children with unilateral reflux. Bilateral reimplantation, however, will be performed in patients with bilateral reflux who showed disappearance of reflux on one side before the operation.

Clinical-experimental research on aztreonam ampullar and ureteral concentrations.

After pointing out that, during urinary tract infections, bacteria can affect the peristalsis of the renal ampulla and of the ureter, the authors report the results of a trial on aztreonam concentrations in the upper urinary tract, performed in order to evaluate the concentrations of the drug in the ampullar and ureteral tissues. This study was carried out on bioptical specimens collected from 18 subjects (12 children and 6 adults), who underwent surgery for malformations of the urinary system. The authors report and discuss the results of the determinations performed on the samples of urinary tract tissue, serum and urine, 60 to 90 minutes after the i.m. administration of aztreonam.

[Significance and prognosis of idiopathic macrohematuria in childhood. Long-term surveillance of 45 patients]. / Signification et pronostic de la macrohématurie idiopathique en âge pédiatrique. Surveillance à long terme de 45 patients.

Idiopathic macrohematuria represents 14 to 15% of all macroscopic hematurias in children, being more frequent than in adults (5 to 8%). Of 45 children admitted with this affection between 1968 and 1982, 45 were followed up regularly over 2 to 16 years (mean 9 years). Initial investigations included urine cytobacteriology, blood tests, urography and mictional cysto-urethrography, cystoscopy, immunology and renal ultrasound imaging (since 1978). Review examinations were comprised of blood and urine biologic tests, a standard abdominal radiograph, renal and bladder ultrasound imaging and urography (in 19 cases with persistent macro- or micro-hematuria). Of these 45 cases, macrohematuria was no longer present after 1 year in 31 cases (69%), and persisted for a maximum of 8 years until finally disappearing in 10 cases (22%): it persisted without change in 4 cases (8.8%). During follow up surveillance, 37 children (82.2%) failed to present any urinary affection, but 8 children (17.8%) were found to have urologic or nephrologic disease possibly responsible for the hematurial (including 5 cases of lithiasis). Analysis of findings showed associated urinary affections in 6% of cases when hematuria ceased before the 1st year and in 36% when it persisted. At the present time all 45 children have normal renal function, and idiopathic macrohematuria in children can be considered to be a benign lesion when the diagnosis is confirmed by very complete investigations.

[Medical treatment of cystine lithiasis in children]. / Le traitement médical de la lithiase cystinique en âge pédiatrique.

Prophylactic measures or dissolution by medical therapy was used to treat bladder cystine stones in 14 children over about a 10-year period. All patients received alpha-MPG (alpha-mercaptopropionylglycine) except one child allergic to alpha-MPG who was treated with DNP (D-penicillamine). In 10 patients the treatment was administered 11 times to dissolve the stones, with resulting total dissolution in 6 cases, partial removal in one case. Two patients are still under treatment and 2 cases failed to respond. Among the 12 patients receiving preventive therapy, only 2 cases were reported as developing recurrences, due in fact to irregular taking of medication. Lytic treatment proceeded without any particular problems, and results were more than satisfactory, but for preventive therapy the difficulty resides in its application and duration when confronted with the serious and frequent danger of a relapse.