Corrigendum: Polydeoxyribonucleotide, an adenosine-A2A receptor agonist, preserves blood testis barrier from cadmium-induced injury.

[This corrects the article DOI: 10.3389/fphar.2016.00537.].

Apoptotic Pathways Linked to Endocrine System as Potential Therapeutic Targets for Benign Prostatic Hyperplasia.

Benign prostatic hyperplasia (BPH) is a chronic condition common in older men that can result in bothersome lower urinary tract symptoms. The molecular mechanisms and networks underlying the development and the progression of the disease are still far from being fully understood. BPH results from smooth muscle cell and epithelial cell proliferation, primarily within the transition zone of the prostate. Apoptosis and inflammation play important roles in the control of cell growth and in the maintenance of tissue homeostasis. Disturbances in molecular mechanisms of apoptosis machinery have been linked to BPH. Increased levels of the glycoprotein Dickkopf-related protein 3 in BPH cause an inhibition of the apoptosis machinery through a reduction in B cell lymphoma (Bcl)-2 associated X protein (Bax) expression. Inhibitors of apoptosis proteins influence cell death by direct inhibition of caspases and modulation of the transcription factor nuclear factor-κB. Current pharmacotherapy targets either the static component of BPH, including finasteride and dutasteride, or the dynamic component of BPH, including α-adrenoceptor antagonists such as tamsulosin and alfuzosin. Both these classes of drugs significantly interfere with the apoptosis machinery. Furthermore, phytotherapic supplements and new drugs may also modulate several molecular steps of apoptosis.

Polydeoxyribonucleotide, an Adenosine-A2A Receptor Agonist, Preserves Blood Testis Barrier from Cadmium-Induced Injury.

Cadmium (Cd) impairs blood-testis barrier (BTB). Polydeoxyribonucleotide (PDRN), an adenosine A2A agonist, has positive effects on male reproductive system. We investigated the effects of PDRN on the morphological and functional changes induced by Cd in mice testes. Adult Swiss mice were divided into four groups: controls administered with 0.9% NaCl (1 ml/kg, i.p., daily) or with PDRN (8 mg/kg, i.p. daily), animals challenged with Cd chloride (CdCl2; 2 mg/kg, i.p, daily) and animals challenged with CdCl2 (2 mg/kg, i.p., daily) and treated with PDRN (8 mg/kg, i.p., daily). Experiments lasted 14 days. Testes were processed for biochemical, structural, and ultrastructural evaluation and hormones were assayed in serum. CdCl2 increased pERK 1/2 expression and Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) levels; it decreased testosterone (TE) and inhibin-B levels and induced structural damages in extratubular compartment and in seminiferous epithelium, with ultrastructural features of BTB disruption. Many TUNEL-positive germ cells were present. CdCl2 increased tubular TGF-ß3 immunoreactivity and reduced claudin-11, occludin, and N-cadherin immunoreactivity. PDRN administration reduced pERK 1/2 expression, FSH, and LH levels; it increased TE and inhibin-B levels, ameliorated germinal epithelium changes and protected BTB ultrastructure. Few TUNEL-positive germ cells were present and the extratubular compartment was preserved. Furthermore, PDRN decreased TGF-ß3 immunoreactivity and enhanced claudin-11, occludin, and N-cadherin immunoreactivity. We demonstrate a protective effect of PDRN on Cd-induced damages of BTB and suggest that PDRN may play an important role against Cd, particularly against its harmful effects on gametogenesis.

[Ileal intussusception due to a voluminous inflammatory fibroid polyp. A case report and review of the literature]. / Intussuscezione ileale da voluminoso polipo infiammatorio fibroide. Descrizione di un caso clinico e revisione della letteratura.

An inflammatory fibroid polyp is a rare benign submucosal lesion frequently located in the gastric antrum but it may be found anywhere in the gastrointestinal tract with maximal incidence in the fifth and sixth decades of life. The main histological characteristics are diffuse inflammatory infiltrate with eosinophils, high vascularisation and a myofibroblastic component. Its localisation in the small bowel can cause intestinal invagination in adults, a condition, that occurs most frequently in childhood where, however, it is generally not related to a pathological lesion. The diagnosis may often be delayed because of its non-specific symptoms and most cases are diagnosed at emergency laparotomy, although CT scans can furnish useful preoperative information. In the majority of cases, the treatment of choice is surgical resection. Reduction performed prior to resection proves controversial in patients with colic intussusception because of the high incidence of malignancy. We report a case of a 37-year-old man who had undergone emergency surgery for acute ileum intussusception associated with a voluminous inflammatory fibroid polyp. The case described emphasises that patients with bowel obstruction pose a complex and difficult challenge to surgeons as regards the choice of the correct diagnostic work-up and optimal therapeutic management.

[Retroperitoneal giant schwannoma: a case report and review of the literature]. / Schwannoma gigante retroperitoneale: presentazione di un caso clinico e revisione della letteratura.

Schwannomas are rare tumours that originate in the neural sheath and account for only a small percentage of all retroperitoneal tumours. They are usually solitary, circumscribed and encapsulated lesions eccentrically located on proximal nerves or spinal nerve roots. Presentation is typically varied and non-specific, ranging from abdominal pain, an abdominal mass or an incidental finding. The preoperative diagnosis is difficult and laboratory tests are usually unremarkable. We report the case of a 66-year-old female presenting with abdominal pain in her left flank and with an ultrasonographic diagnosis of a left kidney mass. She was diagnosed as suffering from a giant retroperitoneal schwannoma after surgical exploration and complete excision. The role of CT scan and CT-guided needle biopsy is emphasised, in that ultrasonography and fine needle aspiration alone do not provide sufficient information regarding aetiology and malignancy. Radical surgical excision is curative but recurrences may occur. Careful follow-up is needed.

[The value of diagnostic ultrasound for detecting occult inguinal hernia in patients with groin pain]. / Il valore dell'ecotomografia nell'identificazione dell'ernia inguinale occulta in pazienti con inguinodinia.

The value of diagnostic ultrasound for detecting occult inguinal hernia in The aim of this study was to demonstrate the accuracy of ultrasound in diagnosing occult hernia in patients with recurrent inguinal pain and a negative clinical examination. Over a period of three years, a total of 51 patients were referred for ultrasound examination with clinically suspected occult inguinal hernia. Patients with positive US scans were offered surgery, while those with negative US findings were offered further imaging or other diagnostic tests. The ultrasound examination of the inguinal region was conducted using a 5-10 MHz linear probe. The scan was performed with the patient in the supine and erect positions, in a relaxed state, as well as during coughing and during a Valsalva manoeuvre. Overall, ultrasound diagnosed 20 inguinal hernias and all 20 patients with positive scans underwent surgery. Surgery confirmed the ultrasound diagnosis in 19 patients, only 1/20 having no hernia at operation (100% ultrasound sensitivity and 96.9% specificity). Patients undergoing surgery showed complete symptom resolution at a three-month follow-up. This study confirms that ultrasound is capable of accurately diagnosing groin hernia and this may justify its use in patients with chronic groin pain due to a suspected occult hernia.

Gallstone ileus: report of a case successfully treated by a laparoscopically-assisted enterolithotomy.

Gallstone ileus is an unusual cause of small bowel obstruction that occurs more frequently in elderly patients. The diagnosis is always very challenging and in most of cases this rare complication is misdiagnosed before surgery. The Authors report on a 81-year-old woman with small bowel obstruction who was laparoscopically diagnosed with gallstone ileus and successfully treated by a laparoscopically-assisted enterolithotomy.

Incidental gall bladder carcinoma: does the surgical approach influence the outcome?

BACKGROUND: The aim of the study was to evaluate the outcome in patients with unsuspected gall bladder carcinoma diagnosed after cholecystectomy, comparing the laparoscopic approach with open surgery. METHODS: A retrospective study was done of 16 patients who were diagnosed with unsuspected gall bladder carcinoma out of the 2850 who had undergone cholecystectomy for symptomatic cholelithiasis at our institution between 1990 and 2004. Eight cases (seven women and one man, mean age 63 (range 49-75 years) ) were diagnosed after laparoscopic cholecystectomy (group A) and eight cases (six women and two men, mean age 63 (range 50-79 years) ) after open cholecystectomy (group B). We evaluated the outcome in the two groups correlating the cumulative survival rates with tumour stage and surgical technique. RESULTS: In group A, three patients had port-site recurrence (1 pT1a and 2 pT1b tumours) after 6, 7 and 9 months, one had intraperitoneal dissemination (pT2) after 3 months, and four had no recurrence (1 pTis, 2 pT1a and 1 pT1b). In group B, five patients had recurrences (4 pT1b and 1 pT2) after an average of 8 months (range 5-11) and three had no recurrence (1 pTis and 2 pT1a). Survival rate was statistically correlated with tumour stage but not with the surgical approach used to perform cholecystectomy. CONCLUSIONS: The surgical approach used for cholecystectomy would seem not to influence the outcome in patients with unsuspected gall bladder carcinoma. The tumour stage is the most important prognostic factor.

Laparoscopic cholecystectomy in Child-Pugh class C cirrhotic patients.

OBJECTIVES: This study aimed to determine whether laparoscopic cholecystectomy is a safe and advisable procedure in Child-Pugh C cirrhotic patients with symptomatic cholelithiasis. METHODS: The records of 42 laparoscopic cholecystectomies performed between January 1995 and February 2004 in patients with Child-Pugh A, B, and C cirrhosis were retrospectively reviewed, focusing on the 4 patients with Child-Pugh C cirrhosis. RESULTS: Among the 38 Child-Pugh A and B patients, no deaths occurred. In this group, only 1 Child-Pugh B cirrhotic patient required blood transfusion, and postoperative morbidity occurred in 10 patients including hemorrhage, wound infection, intraabdominal collection, and cardiopulmonary complications (morbidity rate 26%). The mean postoperative stay was 5 days (range, 3 to 13). The indication for surgery in the 4 Child-Pugh C patients was acute cholecystitis. In this group, 2 deaths occurred for severe liver failure in 1 case and for sepsis in the other. One patient developed heavy gallbladder bed bleeding, and a second operation was necessary to control the hemorrhage. The morbidity rate was 75%. Only 1 patient had no complications. The mean postoperative stay was 10 days (range, 4 to 17). CONCLUSIONS: Laparoscopic cholecystectomy is a safe procedure in well-selected Child-Pugh A and B cirrhotic patients indicated for surgery, but it is a very high-risk procedure in Child-Pugh C patients. Indications for surgery in Child-Pugh C patients should be evaluated very carefully and surgery should be avoided unless the patient needs an emergency cholecystectomy for acute cholecystitis. Child-Pugh C cirrhotic patients might better benefit from percutaneous drainage of the gallbladder.

Early results after radiofrequency-assisted liver resection.

AIMS AND BACKGROUND: Intraoperative blood loss during liver resection remains a major concern due to its association with higher postoperative complications and shorter long-term survival. The aim of this study was to assess the feasibility and safety of a novel concept for liver resection using a radiofrequency energy-assisted technique. METHODS: From January 2001 to July 2002, 42 patients were operated on using radiofrequency energy-assisted liver resection. Radiofrequency energy was applied along the resection edge to create a 'zone of desiccation' prior to resection with a scalpel. RESULTS: Median resection time was 50 mins (range, 30-110). The median blood loss during resection was 30 mL (range, 15-992). Mean preoperative and postoperative hemoglobin values were 13.7 g/dL (SD +/- 1.6) and 11.8 g/dL (SD +/- 1.4), respectively. No blood transfusion was registered, nor was any mortality observed. There were 3 postoperative complications, one subphrenic abscess, one chest infection and one biliary leak from a hepatico-jejunostomy. Median postoperative stay was 8 days (range, 5-86). CONCLUSIONS: Liver resection assisted by radiofrequency energy is feasible, easy and safe. This novel technique offers a new method for 'transfusion-free' resection without the need for sutures, ties, staples, tissue glue or admission to an intensive care unit.

[Appendiceal mucocele]. / Il mucocele appendicolare.

Mucocele of the appendix is a rare lesion, characterised by distension of the lumen due to accumulation of mucoid substance. Mucocele is often asymptomatic and is found incidentally during surgical explorations or ultrasonography studies. This report illustrates the clinicopathologic features of a case of appendiceal mucocele observed during an emergency laparotomy. The surgical treatment consisted in appendicectomy. Colonscopic examination subsequently revealed a left colonic precancerous lesion that was treated with endoscopic polypectomy. The case described underlines the importance of colonic surveillance in patients with mucocele.