[Survey of the perceived quality of healthcare in some countries of the former Soviet block]. / Indagine sulla percezione della qualità dei servizi sanitari in alcuni Paesi dell'ex blocco sovietico.

The health systems of countries of the Former Soviet Union are all based on Semashko's system, which is no longer active since 1991 when the fall of communism occurred. Post-soviet states have tried to create new healthcare systems that maintain universal access to care. The goal of this descriptive study, conducted from August 2009 to June 2012, was to investigate the perceived quality of healthcare services in selected post-Soviet states. A questionnaire was administered by trained staff, to samples of adult healthcare service users in five countries (Belarus, Moldova, the Baltic States, Romania, and Ukraine), to investigate different aspects of the health care systems in these countries. Results were analysed by gender, profession, age and country of origin. Overall, 470 subjects participated in the study. Perceived quality of healthcare varied among different countries but an overall negative and pessimistic view of the future was identified. Gender, age group and profession were found to be determinants of perceived quality (p <0.05). The observed variations do not seem to be directly explained by the model of healthcare system adopted, rather by respondents' different socioeconomic and demographical standings.

Adjustable continence therapy for severe intrinsic sphincter deficiency and recurrent female stress urinary incontinence: long-term experience.

PURPOSE: ACT was developed to treat female stress urinary incontinence resulting from intrinsic sphincter deficiency by increasing urethral resistance. We evaluated the implantation procedure and assessed patient outcomes at our center. MATERIALS AND METHODS: The adjustable continence device consists of 2 silicone balloons on either side of the proximal urethra under the bladder neck, each attached to a titanium port buried in the labia to allow postoperative titration. Urodynamic assessment was done in 57 female patients in whom previous pelvic surgery had failed. Pad use and an incontinence quality of life questionnaire were evaluated before ACT implantation, postoperatively at 1, 3, 6 and 12 months, and annually thereafter. Patients recorded the overall impression and percent of improvement postoperatively based on the Patient Global Impression Index and a visual analog scale. RESULTS: Mean followup was 72 months (range 12 to 84). At 6-year followup in 29 patients mean pad use improved from 5.6 daily at baseline to 0.41 and intrinsic sphincter deficiency improved from 27.2 to 78.6 (p <0.001). As measured on the visual analog scale, 68% of patients considered themselves dry. On the Patient Global Impression Index questionnaire 64% were very much improved, 23% were much improved and 13% were only minimally improved or unchanged. No patients considered themselves worse after the procedure. Complications necessitating device removal developed in 21.1% of patients. CONCLUSIONS: Relative ease of insertion and the ability to tailor this therapy to individual needs makes this an attractive option for the challenging treatment for recurrent stress urinary incontinence due to intrinsic sphincter deficiency.

Prognostic factors in a prospective series of papillary renal cell carcinoma.

OBJECTIVE: To prospectively assess the clinical outcome of a series of papillary renal cell carcinomas (PRCCs) to identify possible prognostic clinical variables and tumour markers, as previous retrospective series of PRCC do not provide unanimous results on the prognostic utility of clinicopathological variables. PATIENTS AND METHODS: Forty-six patients with PRCC (median follow-up 40 months) diagnosed in one institution from 1989 to 2002 were prospectively followed until May 2006. The pathology was reviewed, the PRCC subtyped (type 1 and 2) and immunohistochemistry assessed for MIB-1, vascular endothelial growth factor (VEGF), CD31 and c-met oncogenic protein, by a referee pathologist. Prognostic values were estimated by fitting a Cox model. RESULTS: The 5-year survival rate was 49.5%; type 2 histology was predominant and was almost significant in the univariate analysis. Stage and MIB-1 were significant prognostic factors only in the univariate model, while the Cox model identified only the Fuhrman grade as an independent predictor of survival (hazard ratio 3.054; P = 0.007). MET expression, CD31 and VEGF had no prognostic utility. CONCLUSION: These patients with PRCC followed prospectively fared worse than in previously reported series. The Fuhrman grade was the sole independent predictor of survival.

Eradication of basal cell carcinoma of the head and neck using the surgical excision with a new stained margin technique: a preliminary study.

BACKGROUND: Basal cell carcinomas (BCCs) are common cutaneous neoplasms that mainly affect fair-skinned subjects, in sun-exposed areas of the body. The treatment of choice of BCCs is represented by surgical excision and different techniques are available, in order to allow the complete eradication of the tumor with the best cosmetic results. In this paper, we describe the surgical excision with stained margin technique (SMET) and we report its efficacy for the treatment of BCCs of the head and neck region. METHODS: We retrospectively studied 177 BCCs of the head and neck region treated by SMET: a surgical technique in which each specimen is cut vertically like a bread-loaf in multiple sections of 1 mm of thickness, after marking peripheral margins. RESULTS: We observed an overall recurrence rate of 4.5% after SMET (mean follow-up: 26 months), with higher rate in aggressive subtypes (P=0.04). BCCs located in high-risk sites and those previously undergone to other non-radical therapies required two or more procedures (P=0.008 and P=0.002, respectively), while no correlation was observed between the number of SMET procedures and recurrence rate. CONCLUSIONS: In our experience, since low recurrence rate was obtained by SMET, we suggest that it may be taken into consideration as surgical option for BCCs of the head and neck region.

Narrow-band imaging in diagnosis of endometrial cancer and hyperplasia: a new option?

STUDY OBJECTIVE: To estimate whether the use of narrow-band imaging (NBI) hysteroscopy increases concordance between visual identification and a histologic diagnosis of endometrial cancer and hyperplasia. DESIGN: Prospective study (Canadian Task Force classification: II-2). SETTING: Department of obstetrics and gynecology, University of Eastern Piedmont, Novara, Italy. PATIENTS: 209 consecutive patients with abnormal uterine bleeding. INTERVENTIONS: White-light hysteroscopy and NBI hysteroscopy followed by direct biopsy. MEASUREMENTS AND MAIN RESULTS: The sensitivity and specificity of conventional hysteroscopy in predicting a diagnosis of cancer and hyperplasia were, respectively, 84.21% (95% confidence interval [CI], 79.27-89.15) and 99.47% (95% CI, 98.49-100.0), and 64.86% (95% CI, 58.39-71.34) and 98.77% (95% CI, 97.27-100.0), and of NBI hysteroscopy were 94.74% (95% CI, 91.71-97.76) and 97.89% (95% CI, 95.95-99.84), and 78.38% (95% CI, 72.8-83.96) and 97.67% (95% CI, 96.63-99.72). The concordance of conventional and NBI hysteroscopy with the histopathologic findings (measured using the Cohen kappa) was, respectively, 88.80% (95% CI, 86.2%-96.3%) and 91.78% (95% CI, 89.6%-98.2%), a difference of 2.98% (95% CI, 0-9) in favor of NBI. CONCLUSION: Narrow-band imaging hysteroscopy can accurately predict a histologic diagnosis of endometrial cancer or hyperplasia.

Adjustable continence therapy for treatment of recurrent female urinary incontinence.

PURPOSE: The Adjustable Continence Therapy (ACT) device has been developed for the treatment of recurrent stress urinary incontinence resulting from intrinsic sphincter deficiency (ISD) by increasing urethral coaptation. We critically evaluated the technique and its results. METHODS: The ACT device consists of two balloons each attached to an injectable port placed in the labia majora. The port enables postoperative adjustment in balloon coaptation pressure. All 49 patients had previously failed anti-incontinence surgery. Each patient was implanted with the ACT device and assessed by preoperative and postoperative overall impression, incontinence quality of life questionnaire, and visual analog scale; 38 of the 49 subjects had a minimum of 1 year of data collected, including pad use, number of adjustments needed, and complications. RESULTS: Mean operative time was 20.3 minutes (range 10-30 minutes), with 88% of implantations performed using local or regional anesthesia. Balloon adjustments were needed in 62%; 68% of patients reported being dry and 16% improved. Complications included migration (12%), balloon failure (3.6%), and erosion (4%). CONCLUSION: The ACT device provided significant improvement in at last 70% of patients with recurrent stress urinary incontinence.

Adjustable Continence Therapy for the treatment of male stress urinary incontinence: a single-centre study.

OBJECTIVE: To evaluate the Adjustable Continence Therapy (ProACT) device, a new device for the treatment of male stress urinary incontinence resulting from compromised sphincteric function. MATERIAL AND METHODS: A total of 64 males with post-prostatectomy incontinence underwent ProACT implantation. Efficacy was assessed by means of a daily pad count, a direct visual stress test, administration of the Incontinence Quality of Life (IQOL) and patient global impression (PGI) questionnaires and use of a visual analogue scale (VAS) to assess improvement in incontinence. These assessments were performed at baseline, 1, 3, 6 and 12 months after the procedure and annually thereafter. RESULTS: The pad count declined from a median of 5.2 at baseline to 2 at 6 months and to 1.54 at 12 months. The median baseline IQOL score was 31.7, and this improved to 62.5 at 6 months and to 71.1 at 12 months. In terms of postoperative daily pad usage, 43 patients (67%) were considered to be dry, 10 (15%) improved and 11 (17%) unchanged. In terms of the post operative PGI score, 42 patients (66%) considered themselves to have improved greatly, 10 (16%) to have improved quite a lot, 6 (9%) to have improved slightly and 6 (9%) to be unchanged. The average improvement based on the VAS was 80%. The average number of postoperative adjustments was three (range zero to nine). Complications included infection (2/64; 3%), erosion of balloons (5/64; 7.6%), migration (2/64; 3%) and balloon deflation (2/64; 3%). Device removal was required in 9/64 patients (14%) but was easily achieved using local anaesthesia, and this thus permitted further therapeutic intervention. New balloons were implanted following endoscopic confirmation of urethral healing. CONCLUSION: The ProACT device represents an efficacious treatment modality, which has an acceptable complication rate for a difficult group of patients.

Is radical prostatectomy feasible in all cases of locally advanced non-bone metastatic prostate cancer? Results of a single-institution study.

OBJECTIVES: Previous prospective studies of the surgical treatment of locally advanced prostate cancer have enrolled patients selected on the basis of a limited T3 disease extension. The aim of the present study was to assess the feasibility and the oncologic outcome of radical prostatectomy administered to a consecutive unselected series of advanced, non-bone metastatic prostate cancers. METHODS: Between March 1998 and February 2003 radical prostatectomy was offered at our institution to any patient diagnosed with prostate cancer with no sign of extranodal metastatic disease. Data on morbidity and survival for 51 clinically advanced cases (any T>/=3, N0-N1, or any N1 or M1a disease according to the TNM 2002 classification system) operated on by a single expert surgeon were compared with a series of 152 radical prostatectomies performed during the same period by the same operator for clinically organ-confined disease. Adjuvant treatment was administered according to current guidelines. RESULTS: The two groups did not differ significantly in surgical morbidity except for blood transfusion, operative time, and lymphoceles, which showed a higher rate in patients with advanced disease. The Kaplan-Meier estimate of overall survival and prostate cancer-specific survival at 7 yr were 76.69% and 90.2% in the advanced disease group and 88.4% and 99.3% in the organ-confined disease group, respectively. CONCLUSIONS: Even in the scenario of extensive surgical indications up to M1a disease, radical prostatectomy proved to be technically feasible and to have an acceptable morbidity rate compared with organ-confined disease. Our initial survival data strengthen the role for surgery as an essential part in the multimodal approach to treating advanced prostate cancer.