Single versus double lung transplantation in pulmonary fibrosis: a debated topic.

Idiopathic pulmonary fibrosis (IPF) represents the second most frequent indication for lung transplantation after chronic obstructive pulmonary disease. Survival rate after transplantation is poorer compared with other lung diseases for reasons that are not completely clear. Medical therapy with anti-inflammatory drugs may improve symptoms and quality of life, but it does not influence the survival rate. Lung transplantation is the best therapy for end-stage IPF. The debate regarding the superiority of double lung transplantation (DLT) compared with single lung transplantation (SLT) is still ongoing. Until some years ago, SLT was almost uniformly utilized for this indication. In the most recent years, a larger application of DLT has been observed worldwide, probably related to higher 1-year and 5-year survivals. The unanswered question is whether it is ethical to use two lungs for the same patient, considering the donor shortage, when a single lung would suffice. Many reports have demonstrated that SLT offers acceptable pulmonary function and satisfactory early and intermediate survival. Probably DLT should be reserved for younger recipients, for those with concomitant or possible chronic infection of the contralateral lung, or cases of marginal donors. Further studies will be needed to formulate recommendations regarding the preferred surgical approach in IPF.

Is there a role for pure antiandrogens in the treatment of advanced prostatic cancer?

Our preliminary experience shows that flutamide is an effective treatment in patients with stage C and D prostate cancer. Local and distant response rates appear to be comparable with those obtained by "classic" hormone therapy. Libido and sexual potency are generally not affected. Palliation of symptoms is frequent and is usually accompanied by improvement of performance status and quality of life. The side effects are slight or moderate, but an elevation of transaminases in patients with borderline liver insufficiency is possible.

Hilar fusion: a rare renal malformation. Description of a case in association with lithiasis and tubular precalyceal ectasia in an adult patient.

An uncommon case of a 42-year-old man with hilar renal symphysis in association with lithiasis and 'tubular precalyceal ectasia' is described.

Chronic prostatitis and prostatodynia: ultrasonographic alterations of the prostate, bladder neck, seminal vesicles and periprostatic venous plexus.

Transrectal ultrasonography was performed in 121 patients with the chronic prostatitis syndrome (CPS), and in 20 patients with urological pathology not involving the prostate gland. The ultrasonographic aspects of the seminal vesicles (SV) in normal subjects and in patients with the CPS are described. In the latter group, characteristic ultrasonographic patterns can often be obtained, even in patients affected by prostatodynia, in whom all the other clinical and laboratory findings were absent. They consisted of: (a) dyshomogeneous echo-structure of the prostate; (b) constant dilatation of the periprostatic venous plexus, greater than 150 mm2; (c) dilated, elongated SV, with thickening of their inner septa (they are sometimes asymmetrical), and (d) bladder neck hypertrophy.