The soluble form of urokinase receptor promotes angiogenesis through its Ser88-Arg-Ser-Arg-Tyr9² chemotactic sequence.

BACKGROUND: The urokinase plasminogen activator receptor (u-PAR) focuses the proteolytic activity of the urokinase plasminogen activator (u-PA) on the endothelial cell surface, thus promoting angiogenesis in a protease-dependent manner. The u-PAR may exist in a glycophosphatidylinositol-anchored and in a soluble form (soluble u-PAR [Su-PAR]), both including the chemotactic Ser88 -Arg-Ser-Arg-Tyr9² internal sequence. OBJECTIVE: To investigate whether Su-PAR may trigger endothelial cell signaling leading to new vessel formation through its chemotactic Ser88 -Arg-Ser-Arg-Tyr9² sequence. METHODS AND RESULTS: In this study, the formation of vascular-like structures by human umbilical vein endothelial cells was assessed by using a matrigel basement membrane preparation. First, we found that Su-PAR protein promotes the formation of cord-like structures, and that this ability is retained by the isolated Ser(88) -Arg-Ser-Arg-Tyr9² chemotactic sequence, the maximal effect being reached at 10 nmol L⁻¹ SRSRY peptide (SRSRY). This effect is mediated by the α(v) ß3 vitronectin receptor, is independent of u-PA proteolytic activity, and involves the internalization of the G-protein-coupled formyl-peptide receptor in endothelial cells. Furthermore, exposure of human saphenous vein rings to Su-PAR or SRSRY leads to a remarkable degree of sprouting. Finally, we show that Su-PAR and SRSRY promote a marked response in angioreactors implanted into the dorsal flank of nude mice, retaining 91% and 66%, respectively, of the angiogenic response generated by a mixture of vascular endothelial growth factor and fibroblast growth factor type 2. CONCLUSIONS: Our results show a new protease-independent activity of Su-PAR that stimulates in vivo angiogenesis through its Ser88 -Arg-Ser-Arg-Tyr9² chemotactic sequence.

[Orthotopic neobladder in women]. / La neovescica ortotopica nella donna.

In women undergoing radical cystectomy for bladder cancer, orthotopic bladder reconstruction is now a viable alternative to urinary diversion: preservation of the external urethral sphincter by sectioning the urethra 0.5-1 cm distally to the bladder neck allows maintenance of urinary continence without compromising cancer control. 12 cases of bladder reconstruction in women operated on from 1986 to 1995 are presented here. A personal technique for the creation of an ileal neobladder is described: the use of staplers for detubularization of the ileum significantly reduces the operating time ("simplified ileal bladder"). Other important points of technique are as follows: 1. Careful preparation of the bladder neck and proximal urethra, staying above the pubo-urethral ligaments that must be preserved as the distal landmark of dissection; 2. "Nerve-sparing" isolation of the posterolateral wall of the bladder from the vagina; 3. Careful positioning of the pouch in the true pelvis, in order to avoid posterior prolapse of the neobladder. So far, results of bladder reconstruction in this series of patients are encouraging, both from a functional and oncological standpoint.

[Pararenal pseudocyst as unusual cause of obstruction in a patient with solitary kidney]. / Seudoquiste pararrenal como rara causa de obstrucción en paciente monorreno.

OBJECTIVE: An uncommon case of left pararenal pseudocyst associated with anuria in a patient with a hypoplastic contralateral kidney is described. METHODS: The etiopathological aspects and the good correlation between the preoperative findings and the information provided by the imaging techniques are analyzed. CONCLUSIONS: Ultrasound is essential in determining the structural characteristics, anatomical relationships and for adequate management of this uncommon condition.

Orientaçäo atual em abscessos subfrênicos: contribuiçäo clínica / Up-to-date orientation in subphrenic abscesses: clinical contribution

Os traumatismos e as agressöes cirúrgicas abdominais representam, pelo menos na experiência dos autores, as causas que levam mais freqüentemente à formaçäo de abscessos na cavidade peritoneal. Näo obstante os progressos da antibioticoterapia e das técnicas de assepsia, a sua freqüência torna-se alvo de interesse. A presença de febre e leucocitose no pós-operatório ou em paciente politraumatizado devem sempre fazer suspeitar do aparecimento de tal complicaçäo. Um tratamento precose e adequado torna-se fundamental para eliminar o estado tóxico que a coleçäo purulenta produz e permitir a sobrevida do paciente

[Preliminary experience with the Storz Modulith SL 20 lithotriptor in reno-ureteral lithiasis]. / Esperienza preliminare con litotritore Storz Modulith SL 20 nella litiasi reno-ureterale.

The authors report their initial results in ESWL of urinary calculi with the Storz Modulith SL 20 lithotriptor, a multipurpose device for both urinary and biliary stone treatment. During 176 sessions, a total of 144 cases (81 renal and 63 ureteral) were treated and then, followed up. The over-all rate free of stones was 86.8% (90.1% for kidney and for ureteral stones). The treatment rate was 1.23 per patient. Auxiliary procedures before ESWL were performed in 7.9% of the sessions: insertion of "double-J" stent or nephrostomy tube; all ureteral stones received "in situ" treatment. Mean number of shock waves per session was 1836.1 (range 300-3020). The maximum voltage on the average reached was 17.1 kv. Sedo-analgesia by Diazepam and Ketoprofen was given in 75% of the cases. No serious complications were observed. The experience with this machine is discussed in regard to performance; the advantages of its fluoroscopy and ultrasound guided system of focusing are stressed.

[Spermatic cord torsion]. / Torsión del cordón espermático.

Torsion of the spermatic cord constitutes a surgical emergency. Morphologically and functionally, the fate of the compromised testis largely depends on the time elapsed between the acute episode and surgical intervention. Patients who had been treated for testicular torsion by our group from 1976 to 1989 were requested to return for outpatient evaluation. These patient were divided into two groups according to the time elapsed between the diagnosis and surgical intervention. We observed that surgical correction within 12 hours following presentation permitted testicular salvage. Testicular volume was generally preserved and remained normal or slightly diminished. However, when the time elapsed was over 12 hours, testicular atrophy was observed in 46% of the patients. We can conclude, therefore, that detorsion must be performed as soon as possible. Vaginalis testis eversion will generally achieve stable and lasting fixation.

[Staplers in bladder sutures]. / Gli staplers nelle suture vescicali.

Staplers are still little used for suturing a cystotomy. The basic reason for this reluctance is the inadvisability of using non-absorbable material in the lumen of the urinary tract, as this may be the nucleus for the formation of stones. It must be remembered, however, that a correct suture of a cystotomy should be carried out in two layers: one internal mucous layer, consisting of a continuous suture of absorbable material, and a more superficial suture of the margins of the vesical detrusor. The latter can be performed with a linear stapler, as it is completely outside the mucous layer. More recently, linear staplers with absorbable staples have appeared on the market, by which cystotomy sutures can be performed in a single layer.

[Diagnostic screening of varicocele: role of echography and Doppler examination in our experience with 216 cases of primary varicocele]. / Screening diagnostico del varicocele: ruolo dell'ecografia e dell'esame Doppler nella nostra esperienza di 216 casi di varicocele primitivo.

We compared two non-invasive methods to evaluate primary varicoceles: ultrasonography and Doppler examination. We submitted to ultrasonography and Doppler 216 patients, 147 of them were treated by sclerotherapy and 69 by surgery. All ultrasonographic studies were performed by means of a real-time equipment (7.5 Mhz transducer), while Doppler examination was performed with continuous wave equipment. Ultrasonographic findings are reliable for testicular morphology. Doppler examination is useful to evaluate reversed flow. In 4.1% of cases ultrasonography did not agree with the Doppler examination.