Deep venous thrombosis in patients undergoing salvage radical cystectomy.

OBJECTIVE: The possible occurrence of venous thrombosis in tumor-bearing patients had already been reported by Trousseau in the past century. The blood clotting alterations in cancer-bearing patients can cause Deep Venous Thrombosis (DVT), especially in those patients with disseminated metastases. Anti-tumor chemotherapy can increase the risk of thrombosis. Herein we report our past experience on a sample of patients who underwent pelvic surgery to treat infiltrating bladder tumors. METHODS: We have retrospectively analyzed the records of patients with infiltrating bladder tumors who underwent salvage radical cystectomy. RESULTS: We observed the highest incidence of DVT (33.3%; 3 out of 9) in those patients with a higher risk due to anesthesia and an absolute need for extensive surgery. One of our patients died of pulmonary embolism. CONCLUSION: The diagnosis of DVT and Pulmonary Embolism is not always easy to achieve and all possible tests must be performed whenever possible (e.g. clinical examination, hematological test, etc.).

Detection of bladder cancer by semi-automated microsatellite analysis of urine sediment.

Patients with transitional-cell carcinoma (TCC) require careful follow-up due to the high risk of recurrence. Cystoscopy and biopsy are reliable but invasive, while urine cytology is plagued by low sensitivity. It has recently been shown that allelic abnormalities detected by microsatellite analysis of DNA extracted from urine can be used to diagnose TCC with high reliability. As this analysis by classic techniques is unfeasible in a clinical setting, we performed a pilot study to determine the possibility of applying quick DNA extraction methods with laser detection and computer-based analysis of 15 fluorescently labeled PCR amplified microsatellites to detect molecular anomalies in urine sediment in 25 TCC follow-up patients. Of the eighteen cases with recurrent TCC, 14 (78%) were positive by the molecular test whereas only eight (44%) were detected by cytology. Of the seven patients with negative cystoscopy, one resulted positive by the molecular test and had recurrent TCC six-months later. Thus, this microsatellite analysis correctly predicted the clinical diagnosis in 84% (21/25) of cases, compared to 60% by cytology. The application of these semi-automated procedures allows the analysis of 18 samples with 15 markers in one day, encouraging a more expedient introduction into routine clinical use.

[Fournier's gangrene: report of 2 cases and review of the literature]. / Gangrena di Fournier: osservazione di due casi e revisione della letteratura.

Fournier's gangrene is an extensive fulminant infection of the genitals, perineum or the abdominal wall. Since the first description by Jean Alfred Fournier in 1883 about 700 cases have been reported in the literature. The main aetiological factors are: perianal, perirectal or periurethral infections, diabetes mellitus and chronic alcoholism. Many aerobic and anaerobic organisms may be involved. Mortality rates range from 30-50%. The dramatic course of Fournier's gangrene requires early recognition, surgical drainage, extensive surgical debridment, antimicrobial therapy, hyperbaric oxygen therapy, as well as intensive care treatment in order to prevent irreversible endotoxic shock. We report two cases of Fournier's gangrene. In both cases symptoms were fever, pain and extensive cutaneous necrosis in the scroto-perineal region.

[Endoscopic treatment of bladder diverticula]. / Il trattamento endoscopico dei diverticoli vescicali.

Since February 1993 six patients with bladder diverticula have undergone resection of the diverticular neck and fulguration of the diverticular mucosa at the time of transurethral resection of the prostate in 5 cases and urethral dilation in one case. The mean dimension of the diverticular was 5.2 cm. After a mean follow-up of 20 months the diverticulum has largely shrunk in one case and has completely disappeared in 5 cases. Our paper demonstrates the effectiveness of this technique in the treatment of bladder diverticular. In our opinion endoscopic fulguration represents a valid alternative to open surgery for the treatment of small bladder diverticular.

[Polyorchidism: 2 case reports]. / Poliorchidismo: descrizione di due casi.

Polyorchidism is a rare anomaly with approximately 70 cases reported in literature. The exact explanation for the production of polyorchidism is not known, although several theories have been proposed, including anomalous appropriation of cells, initial longitudinal duplication of the genital ridge and transverse division of the genital ridge, either through some local accident of development of peritoneal bands. A functional classification based upon the embryogenic development is provided. Type I: the supernumerary testis lacks an epididymis and vas. The split-off part of the primordial gonad does not communicate with the mesonephric tubules from which the epididymis develops. Type II: the supernumerary testis is linked to the regular testis by a common epididymis and shares a common vas with it. The division of the genital ridge occurs in the region where the primordial gonads are attached to the mesonephric ducts, although the latter are not divided (incomplete division). Type III: the supernumerary testis has its own epididymis but shares the vas with the regular testis. This variant results from a complete transverse division of the genital ridge. In the majority of the reported cases, the patients are asymptomatic and have painless groin or testicular masses. Approximately 50% occur as maldescent or cryptorchidism, and about 30% are associated with indirect hernia. The remaining 20% are discovered variously in relation to torsion, or are associated with hydrocele, epididymitis, varicocele or infertility. Moreover, since there is a 20 to 40 fold increase in testicular malignancy in patients with cryptorchidism compared with the normal testis, tumours of the supernumerary testicles are not unusual. We reported two cases of polyorchidism: the first patient is probably a longitudinal division of the genital ridge and the second is a completely duplication of the primordial gonads. The patients described vague, intermittent, testicular pain. Physical examination and the scrotal sonography and magnetic resonance revealed in the first patient a supernumerary testis in the right scrotal space and in the second a bilateral double testis. In conclusion we think that in the absence of any concomitant disorder and if testicular tumor can be ruled out by ultrasonography and magnetic resonance imaging, surgical exploration with biopsy is unnecessary.

Cellular uptake and activity of rufloxacin in different cell types and professional phagocytic cells.

The penetration of the new quinolene rufloxacin into human professional phagocytic cells and different cell types was determined. The intracellular distribution was demonstrated in all cells studied. At 4 degrees C the transport of rufloxacin was reduced. An intracellular dose-dependent activity was demonstrated for rufloxacin in monocytes and granulocytes infected with E. coli and S. aureus. In all the experiments rufloxacin was able to eliminate all intracellular bacteria.