[The effect of corifollitropin alfa on in vitro fertilization-ICSI patients with previous failure with an FSH/HMG protocol: Preliminary report in Mexico]. / Efecto de la corifolitropina alfa en pacientes de fertilización in vitro-ICSI con falla previa en un protocolo de FSH/HMG: experiencia preliminar en México.

BACKGROUND: The daily application of drugs, often in high doses, is a factor of stress for the infertile couple. During the last decade corifollitropin alpha has allowed a friendlier scheme comparable to traditional protocols (rFSH-HMG) results. OBJECTIVE: To compare the results of corifollitropin alpha in patients with a previous cycle of IVF-ICSI with traditional scheme ovarian stimulation. MATERIALS AND METHODS: Observational, retrospective cohort study type that infertile couples were included. RESULTS: No significant differences in the dose used HFRS (2023U/ total ± 712 vs 636 U/total ± 307) and serum estradiol day shooting HGCr (1972 pg/dL vs 1107 ± 1152 pg/dL ± 775). A higher pregnancy rate was found corifollitropin alpha perhaps because it was a second attempt at in vitro fertilization. CONCLUSIONS: Reproductive outcomes in a cycle of ovarian stimulation with corifollitropin are comparable with the results of a traditional ovarian stimulation cycle. It is important to broaden the experience of the drug indication in Mexican patients.

Treatment outcomes of bladder stones in children with intact bladders in developing countries: A systematic review of >1000 cases on behalf of the European Association of Urology Bladder Stones Guideline panel.

INTRODUCTION: Bladder stones (BS) are still endemic in children in developing nations and account for a high volume of paediatric urology workload in these areas. The aim of this systematic review is to comparatively assess the benefits and risks of minimally invasive and open surgical interventions for the treatment of bladder stones in children. METHODS: This systematic review was conducted in accordance with Cochrane Guidance. Database searches (January 1970- March 2021) were screened, abstracted, and assessed for risk of bias for comparative randomised controlled trials (RCTs) and non-randomised studies (NRSs) with >10 patients per group. Open cystolithotomy (CL), transurethral cystolithotripsy (TUCL), percutaneous cystolithotripsy (PCCL), extracorporeal shock wave lithotripsy (ESWL) and laparoscopic cystolithotomy (LapCL) were evaluated. RESULTS: In total, 3040 abstracts were screened, and 8 studies were included. There were 7 retrospective non-randomised studies (NRS's) and 1 quasi-RCT with 1034 eligible patients (CL: n=637, TUCL: n=196, PCCL: n=138, ESWL: n=63, LapCL n=0). Stone free rate (SFR) was given in 7 studies and measured 100%, 86.6%-100%, and 100% for CL, TUCL and PCCL respectively. CL was associated with a longer duration of inpatient stay than PCCL and TUCL (p<0.05). One NRS showed that SFR was significantly lower after 1 session with outpatient ESWL (47.6%) compared to TUCL (93.5%) and CL (100%) (p<0.01 and p<0.01 respectively). One RCT compared TUCL with laser versus TUCL with pneumatic lithotripsy and found that procedure duration was shorter with laser for stones <1.5cm (n=25, p=0.04). CONCLUSION: In conclusion, CL, TUCL and PCCL have comparable SFRs but ESWL is less effective for treating stones in paediatric patients. CL has the longest duration of inpatient stay. Information gathered from this systematic review will enable paediatric urologists to comparatively assess the risks and benefits of all urological modalities when considering surgical intervention for bladder stones.

Major adverse cardiovascular events associated with VEGF-targeted anticancer tyrosine kinase inhibitors: a real-life study and proposed algorithm for proactive management.

BACKGROUND: Vascular endothelial growth factor receptor (VEGFR)-targeted tyrosine kinase inhibitors (TKIs) are widely used in cancer treatment and burdened by cardiovascular toxicity. The majority of data come from clinical trials, thus in selected populations. The aim of our study is to evaluate the cardiotoxicity profile of VEGFR-targeted TKIs and the impact of cardiovascular risk factors in a real-life population. PATIENTS AND METHODS: In this cohort, population-based study, patients treated with VEGFR-targeted TKIs, bevacizumab and trastuzumab between 2009 and 2014 were analyzed. A multi-source strategy for data retrieval through hospital, pharmaceutical and administrative databases of the Lombardy region, Italy, has been adopted. The primary endpoint was to determine the incidence and type of major adverse cardiovascular events (MACEs) along with their temporal trend. The secondary endpoint was to define the impact of cardiovascular risk factors in the occurrence of MACEs. RESULTS: A total of 829 patients were treated with VEGFR-targeted TKIs. Eighty-one MACEs occurred in the first year of follow-up [crude cumulative incidence (CCI): 9.79%] mainly consisting of arterial thrombotic events (ATEs, 31 events, CCI: 3.99%), followed by rhythm disorders (22 events, CCI: 2.66%), pulmonary embolisms and heart failures (13 events each, CCI: 1.57%). While the incidence of most MACEs showed a plateau after 6 months, ATEs kept increasing along the year of follow-up. Hypertension and dyslipidemia were associated with an increase in risk of ATEs [relative risk difference (RRD) +209.8% and +156.2%, respectively], while the presence of previous MACEs correlated with a higher risk of all MACEs in multivariate analysis (RRD 151.1%, 95% confidence interval 53.6% to 310.3%, P < 0.001). CONCLUSIONS: MACEs occur in a clinically significant proportion of patients treated with VEGFR-targeted TKIs, with ATEs being predominant, mainly associated with hypertension and dyslipidemia. A clinical algorithm for effective proactive management of these patients is warranted.

Efficacy and efficiency of Green-Light XPS 180-watt laser system for benign prostatic enlargement in patients treated with 5α-reductase inhibitors.

OBJECTIVE: Aim of the study was to evaluate efficacy and efficiency of 180-watt Green-Light XPS (GL-XPS) laser photoselective vaporization of the prostate (PVP) in patients under 5-Alpha-Reductase Inhibitors (5ARI) treatment. PATIENTS AND METHODS: A consecutive series of patients with lower urinary tract symptoms due to benign prostatic enlargement treated by PVP with the GL-XPS were enrolled. Patients were divided in two groups according to the chronic use (>6 months) of 5ARI. These two groups were compared on lasing density (kilojoules per prostate volume), vaporization efficiency (prostate volume per lasing time), vaporization power (kilojoules per lasing time), Prostate Specific Antigen (PSA) reduction from baseline, symptom score change from baseline and uroflowmetry parameters improvement. Follow-up was performed at 3, 6 and 12 months with International Prostate Symptom Score, Uroflowmetry parameters and PSA. RESULTS: Overall 193 patients were enrolled. Out of them 87/193 (45%) were on 5ARI treatment. No significant differences were recorded between the two groups at baseline. Median age was 68 years old and median prostate volume was 60 ml. In terms of laser efficiency, no statistically significant differences were recorded in terms of lasing time (25 min vs. 24.5 min; p>0.05); energy used (250 kJ vs. 221 kJ; p>0.05), lasing density (6.8 kJ/ml vs. 6.6 kJ/ml, p>0.05), vaporization efficiency (1.4 ml/min vs. 1.3 ml/min, p>0.05) and vaporization power (9.6 kJ/min vs. 9.4 kJ/min; p>0.05). Finally, no significant differences were also recorded postoperatively in the two groups in terms of PSA reduction, improvement in symptom score and uroflowmetry parameters (p>0.05). CONCLUSIONS: Thirty-seven efficacy and efficiency outcomes were not statistically different between the two groups. 5ARI does not reduce the performance and ability of the 180-watt Green-Light XPS laser system.

[Assessment of patient's comfort and functioning of a totally implantable venous system placed in the safenous vein]. / Valutazione del comfort del paziente e della funzionalità di un sistema totalmente impiantabile venoso posizionato in vena safena.

BACKGROUND: When venous system of superior vena cava is not useful or when chest wall is not utilizable to place a reservoir, saphenous vein can be utilized for totally implantable venous access device (TIVAD) placement. Aim of this work is to establish the best location of the reservoir for the function and the comfort of the patient. PATIENTS AND METHODS: All the patients submitted to TIVAD placement from January 1995 to October 2004 at the Department of Surgical Science, Organs Transplantations and Advanced Technologies of University of Catania have been considered to the present study. Age, sex, kind of disease, surgical procedure, early and late complications, function of the system and comfort to the patients in relation to the different site of reservoir placement have been studied. RESULTS: 447 TIVAD have been implanted in 258 males and 189 females aged from 31 to 79 years in the period considered for the study. Solid tumors represent the majority of the indications and all the TIVAD have been implanted by surgical cutdown to avoid all the early complications related to the percutaneous approach. Two patients received their TIVAD using saphenous vein by surgical cut-down, and no early complications have been recorded. The reservoirs have been placed respectively: in the chest wall in the first patient; and in the anterior wall of the abdomen, close to the anterosuperior iliac crest, firstly and later in the anterolateral face of the thigh in the second one. The first patient had non complications instead the second one referred discomfort with both reservoir locations. CONCLUSIONS: For the comfort of the patient related to the reservoir position in case of saphenous vein utilization chest wall should represent the best studies are required to validate the appropriate reservoir location.

Endogenous ethanol production and hepatic disease following jejunoileal bypass for morbid obesity.

In this study, we sought to determine whether or not elevated levels of ethanol were present in the systemic circulation, resulting from endogenous ethanol production, which might contribute to the hepatic damage following jejunoileal bypass for morbid obesity. Venous serum samples for assay of ethanol by gas-liquid chromatography were obtained in 8 normal subjects, 9 obese patients prior to surgery, 20 obese patients 2 weeks to 40 months after jejunoileal bypass, and in 2 dogs before and after jejunoileal bypass. Ethanol was detected after jejunoileal bypass in only 7 of the 20 patients and in the 2 dogs. Serum ethanol concentrations ranged from 0.15 to 4.12 mg/100 ml with a mean of 1.18 +/- 1.59 (SD)( mg/100 ml in the 7 patients and ranged from 0.20 to 2.23 mg/100 ml in the dogs. Incubation of the contents of the bypassed intestine of a dog with dextrose resulted in the production of significant amounts of ethanol. However, there was no correlation between the presence of ethanol in the serum and liver histology, when liver biopsy was obtained, postoperatively. Since ethanol was detected in the serum in only small concentrations and in only one-third of the patients, it is unlikely that ethanol production by bacteria in the intestine is of significance in the pathogenesis of liver disease following jejunoileal bypass.

Quantitative analysis of ventricular late potentials in healthy subjects.

Signal averaging is a technique that improves the signal-to-noise ratio. Obscuring random noise, it allows the detection of low-amplitude wave forms in the terminal portion of the QRS complex, also known as ventricular late potentials. A higher incidence of arrhythmic events has been found in patients with abnormal ventricular late potentials after an acute myocardial infarction. Few studies have been conducted in healthy subjects to assess normal values. Sixty-one healthy subjects were enrolled in our study (33 men and 28 women). The results (mean +/- standard deviation) are as follows: duration of the filtered QRS (QRS duration) was 95 +/- 10 ms; duration of the low-amplitude signals in the terminal portion of QRS less than 40 microV (LAS less than 40) was 32 +/- 8 ms; and root-mean-square voltage in the last 40 ms (RMS - 40) was 33 +/- 16 microV. A significant difference was noted in QRS duration between men and women (98 +/- 11 vs 92 +/- 6 ms, p = 0.006); no difference was found in LAS less than 40 (31 +/- 8 vs 34 +/- 8 ms) and in RMS-40 (36 +/- 17 vs 30 +/- 13 microV). QRS duration confidence limits of 95% were less than or equal to 114 ms for the total group, less than or equal to 120 ms for men and less than or equal to 104 ms for women. Normalization of QRS duration for height (normal value less than 66 ms/m) eliminated any difference between men and women.(ABSTRACT TRUNCATED AT 250 WORDS)

CD 34 expression in chronic and neoplastic liver diseases.

BACKGROUND: Capillarisation of hepatic sinusoids is a well recognized phenomen occurring in long standing liver disease, in hepatic cirrhosis as well as in hepatocellular carcinoma. To study immunohistochemically the expression and distribution of CD34 in chronic liver disease and hepatocellular carcinoma in order to evaluate the possible diagnostic implication of this marker. METHODS: Sixty-five samples of liver tissue showing normal liver, different degrees of chronic inflammation, cirrhosis and histological features of hepatocellular adenoma and carcinoma (HCC) were included in the study. The specimens were fixed in formalin and embedded in paraffin and an immunohistochemical investigation was performed by the standard avidin-biotin-peroxidase complex method with CD34. RESULTS: The sinusoids of normal liver showed no immunoreactivity. The sinusoids of liver affected by different degrees of chronic active hepatitis showed no or focal immunostaining for CD34; an increased immunoreactivity was observed in the periportal sinusoids of the cirrhotic nodules whereas diffuse and strong staining was observed in the overall HCC as well as in the hepatocellular adenoma tested. CONCLUSIONS: In HCC, immunoreactivity for CD34 represents an effective method to evaluate angiogenesis and to distinguish well-differentiated HCC from non-neoplastic liver. Its role in clinical stage and prognostic evaluation needs further investigation.

Atherosclerotic aneurysm of the subclavian artery.

Aneurysm of the subclavian artery is unusual and may have several causes. Cases of atherosclerotic origin have been very uncommon, specially if the aneurysm involves normal subclavian arteries. The authors report a case with these characteristics: a 62-year-old female had noted a tumor in the right supraclavicular fossa for thirty years. Angiographically, it proved to be an aneurysm. She was operated on, and a Dacron tubular prosthesis of 6 mm was implanted. The anatomo-pathologic study of the aneurysm showed typical atherosclerotic changes.

A new alternative technique to preserve native flow, for continuous hepatic artery chemotherapy, in presence of a right hepatic artery arising from superior mesenteric artery.

A new alternative technique for regional perfusion chemotherapy in the presence of a right hepatic artery arising from the superior mesenteric artery is described. The cystic artery branch of the right hepatic artery and the gastroduodenal artery can be used to place two catheters and thus apply two implantable systems. This risk-free, straightforward technique preserves native flow and achieves homogeneous distribution of the chemotherapeutic agent.

Totally implantable venous access device inserted during major abdominal operations for cancer. A new technique.

Totally implantable venous access devices are usually implanted by surgical cut-down technique or by percutaneous approach, after a first surgical procedure. The authors describe a new surgical approach utilizing the right gonadal vein or the vena cava for totally implantable venous access device placement in patients submitted to major digestive surgical procedures for tumors. This new surgical approach allows one to avoid a second operative procedure.

Effects of plasma exchange (PE) in primary biliary cirrhosis (PBC). A pilot study.

Six patients were studied to evaluate the efficacy and safety of plasma exchange (PE) in the treatment of primary biliary cirrhosis (PBC). All patients were affected by PBC at stage III-IV and presented symptoms refractory to pharmacologic therapy. Patients underwent PE for a mean period of 40 weeks (range 10-88). A mean of 33 liters (range 17-64) of plasma per patients was removed. Patients reported less fatigue (4/6), pruritus (5/5), nausea (3/3), Sjogren's syndrome (2/6), and painful neuropathy (2/3). A reduction of xanthomata was noted in one of the three affected patients. Definitive improvement was seen in the patient with Raynaud's phenomenon. A significant reduction was noted for serum cholesterol and gammaglobulins. ALT, AST, gamma-GT, alkaline phosphatase, bilirubin, prothrombin activity, AMA titers were not affected by PE. All patients suffered some mild adverse effects during PE. Two patients (IV stage) developed late edema and ascites after 34 and 44 weeks of treatment. We conclude that PE can be considered effective chronic treatment for advanced symptomatic PBC refractory to pharmacological therapy.

Multimodal therapy of hepatocarcinoma: personal experience on 90 cases.

BACKGROUND/AIMS: In recent years, surgical and non-surgical options have been developed in the treatment of hepatocellular carcinoma in cirrhotic patients. We review our personal series from 1995-1999, in order to assess the choice of treatment. METHODOLOGY: Of 90 cases of hepatocellular carcinoma observed in the years 1995-1999, 15 underwent curative resective surgery; in 42 cases TAE, PEI or RITA were utilized (9 of them as multimodal therapy). In the remaining 33 patients any kind of therapy was scheduled. RESULTS: The mean survival of the 15 resected patients was 18 months, non-statistically better than RITA survival, compared by Log-Rank test. Perioperative mortality calculated in all procedures was 5.2% (2 pts surgery, 1 pt TAE). CONCLUSIONS: The high percentage of not treated hepatocellular carcinomas in our series is generally due to large tumor size diagnosed in advanced Child's stage. PEI, TAE and RITA have to be considered effective and safe for palliation for HCCs. However, surgical resection represents the curative therapy in selected cirrhotic patients affected by HCC.

Therapeutic plasma adsorption. A review.

Alternative techniques to the traditional plasma exchange are emerging in clinical practice for the treatment of different pathological conditions, particularly autoimmune diseases. Filtration is a technique used to separate blood cells from plasma, which may be further "treated" with other filters or columns. The case for cascade filtration and absorption onto a column is becoming stronger and stronger and the patient population is increasing. Alongside the "historical" techniques of adsorption onto a column, new systems (pairs of self-regenerating columns) and new products (columns with dextran sulphate, tryptophane, anti-human lipoprotein antibodies) are now available. Protein A in particular seems to open up new horizons; in therapeutic plasmapheresis, there are two versions, one Swedish and the other American, based on different theoretical premises and obtaining different results, with different biocompatibilities but good clinical results.

Plasma exchange in systemic lupus erythematosus. Experience in thirty-seven patients.

Thirty-seven (37) SLE patients submitted to therapeutic plasmapheresis were examined. The results were good in the active stage of the disease. Various types of antibody, anti-DNA, anti nucleus, anti-cardiolipine, I.C. (Clq and C3d) were removed. The values of IgG, coagulation factors, creatinine and proteinuria were assessed. Close collaboration with the clinicians is urged, with the aim of applying immunosuppressive therapy immediately after P.E. to consolidate the results obtained.

Plasma exchange in myasthenia gravis.

Results obtained with P.E. therapy on 19 myasthenic patients are reported. 15 of them improved during treatment and 4 remained unchanged. We believe P.E. is an useful therapy in M.G. because it produces a rapid improvement in most patients.

Plasma exchange in radiculopolyneuropathies.

The AA. report the results obtained with Plasma Exchange (P.E.) therapy on 24 cases of polyradiculoneuritis; eleven patients had typical Guillain-Barré Syndrome (G.B.S.) ten suffered from a chronic progressive form and three were affected by a relapsing form. The acute patients were selected according to criteria established by the NNCDS Committee (1978) while guidelines laid down by Pineas & Load (1978) were followed in choosing chronic cases. Patients with G.B.S. had four sessions of P.E. at intervals of one or two days while those with chronic forms of polyradiculoneuritis had a total of 6 sessions spaced one to three days apart. P.E. produced no apparent change in chronic progressive patients but two out of three cases with the chronic relapsing form showed rapid and steady improvement resulting in complete cure within a few months. Nine of the eleven G.B.S. patients showed after only one or two sessions a clear and rapid improvement which led to a complete cure within a matter of weeks. The remaining 2 cases showed only partial improvement at first and remained stationary thereafter. The findings confirm the usefulness of P.E. in acute and chronic relapsing radiculopolyneuritis. However, potential side effects and the procedure's high cost suggest that its use should be limited to carefully selected cases, and in particular to those involving respiratory disorders.

[Ultrasonographic evaluation of timing in emergency cervical cerclage]. / Valutazione ecografica del timing nel cerchiaggio cervicale d'emergenza.

The aim of the present paper is to utilise endovaginal ultrasonography as an instrument for establishing the most appropriate moment for carrying out cervical cerclage after interrupting uterine contractions in a situation of near miscarriage. A patient at 20 weeks and 4 days of gestation, with contractions, integral membranes and complete dilatation, was laid in the Trendelemburg position, keeping the bladder moderately full, and given tocolytic therapy. After 14 days cerclage was carried out on a reconstituted neck. At 37 weeks and 1 day, the patient delivered a female newborn weighing 3.100 g. The Trendelemburg position, the moderately full bladder and tocolytic therapy with endovaginal ultrasonographic monitoring can move the timing of surgery forward so as to render it safer and more useful for prognostic purposes.