Physiokinesitherapy in the treatment of female stress incontinence

The authors report the results of treatment with physiokinesitherapy (PKT) in 36 women with stress incontinence (29 with genuine-stress incontinence and 7 with urge-stress incontinence). The therapeutic programme consisted of twelve 30-minute sessions, in which biofeedback was alternated with functional electric stimulation. Clinical evaluation included a self-assessment questionnaire, a physiatric visit and a urodynamic examination at 6 and 12 months after treatment. At the end of the PKT cycle, approx. 92% of patients had improved or recovered. After 6 months, however, 53% of patients had recovered, 33% had improved and 14% were stationary. After 12 months, in the 29 patients with genuine-stress incontinence, 66% had recovered, 24% had improved and 3% were stationary, while none of the patients with urge-stress incontinence had recovered (72% improved, 28% stationary). Our study confirms that PKT is helpful in treating urinary stress incontinence in women.

Immunotherapeutic treatment of superficial bladder tumours using BCG. Preliminary results

Chemotherapy using drugs such as mitomycin C or epirubicin is well known in the treatment of superficial bladder tumours, while use of BCG (Bacillus Calmette-Guérin) in the same pathology is more recent. The first authors to test the BCG were Co? and Feldman, then Zbar fixed the criteria for correct use in the treatment of superficial bladder tumours. First results encouraged the preparation of a drug that could reduce the toxic effects without reducing demonstrated efficacy. Our experience started recently with the introduction onto the market of the Connaught strain, which we prefer to use due to its low toxic effects. We wish to evaluate the tolerability of BCG in a short follow-up period (six months) with cystoscopic controls.

A phase I trial of 5-day chronomodulated infusion of 5-fluorouracil and 1-folinic acid in patients with metastatic colorectal cancer

The aim of this phase I study was to establish the maximum tolerated dose (MTD) of 5-fluorouracil (5-FU), administered as a 5-day chronomodulated infusion in combination with 1-folinic acid (FA) to ambulatory metastatic colorectal cancer patients. Consecutive cohorts of 6 patients were given 5-FU and FA infusions from 10.00 p.m. to 10.00 a.m. with peak delivery at 4.00 a.m. by means of a multichannel programmable pump. The FA dose was always the same (150 mg/m2/d). For the first cohort, the 5-FU dose level was 600 mg/m2/d at the first course, escalated by 100 mg/m2 for each subsequent cohort. Intrapatient dose was also escalated by 100 mg/m2 if toxicity was less than grade 2. The courses were repeated every 3 weeks. Thirty-four patients (17 previously treated) received a total of 154 courses. Dose-limiting toxicity consisted of stomatitis and diarrhoea. No significant haematological, cutaneous or cardiac toxicity was encountered. The MTD of 5-FU was reached at the fourth level (first course at 900 mg/m2/d equal to 4500 mg/m2/course) with 5-FU increased to 1100 mg/m2/d (5500 mg/m2/course) in 4 patients. The received 5-FU dose intensity (DI) over the first 3 courses at this level was 1318 mg/m2/week. Thirty-three patients were assessed for response. An objective response was achieved in 1 out of the 13 previously-treated and in 8 out of the 20 previously-untreated patients. The chronomodulated infusion of 5-FU at a dose of 900 mg/m2/d, together with FA at 150 mg/m2/d for 5 days, was safely delivered to out-patients with metastatic colorectal cancer. The low toxic profile and activity of this regimen in previously untreated patients deserves further exploration for the treatment of 5-FU-sensitive tumours.

Enterovesical fistula: Case report

– Since last century cases of abnormal communication between bowel and bladder have been reported. The authors describe a case of enterovesical fistula with unclear symptoms secondary to adenocarcinoma of the colon, which had fully infiltrated the bladder wall and a segment of ileal loop. Surgical management consisted of removing the sigma, bladder and ileal segment.

Detrusorial areflexia secondary to nodous periarteritis. Case report

– A boy with periarteritis nodosa (PAN) came to our department for urodynamic evaluation. The various cystomanometric tests gave alternating areflexic and hyperreflexic pictures. It is advisable in such cases for the neurourologist to follow a clinical screening protocol combined with a “self-oversee” supervision by members of the patient's family.

Vinorelbine neurotoxicity: clinical and neurophysiological findings in 23 patients

Vinorelbine (5'-noranhydrovinblastine) is a new semisynthetic antineoplastic vinca alkaloid which interfers with axonal transport, inducing spiralisation of axonal microtubules and resulting in peripheral neurotoxicity. A prospective detailed neurological and electrophysiological evaluation was performed in 23 patients treated with 25 mg vinorelbine a week. All patients developed a sensory-motor distal symmetric axonal neuropathy. The neurotoxicity increased with cumulative vinorelbine doses and peripheral neuropathy was mild or moderate in most patients. After discontinuation of vinorelbine treatment, neuropathic signs and symptoms were partially reversible.

Therapeutic effect of TRH. T on 26 patients with myelopathy. Neurophysiatric and urological results

TRH.T is a tripeptide functioning as neurotransmitter which aids catecholamine, and especially norepinephrine, release. The neuromodulator action of TRH.T suggests that it could be helpful in the therapy of vesico-sphincteric dysfunctions. 26 patients with myelopathy were treated with TRH.T. The results show an improvement in both the neurological and urological picture. It would also seem possible that TRH.T could play an important role as a neurotransmitter and neuromodulator rather than a receptor-effector, especially in the lower urinary tract.