Accreditation of a screening method for non-dioxin-like polychlorinated biphenyl detection in fishery products according to European legislation

European Commission Regulation 882/2004/EC requires that official control laboratories for foodstuffs in the member states are certified according to UNI EN ISO/IEC 17025:2005 (general requirement for the competence of calibration and testing laboratories). This mandatory requirement has resulted in a continuous adaptation and development of analytical procedures. The aim of this study was to develop a method for semiquantitative screening of polychlorinated biphenyls in fish for human consumption. According to the Commission Decision 657/2002/CE, the detection capability, the precision, the selectivity-specificity, and applicability-ruggedness-stability were determined to validate the method. Moreover, trueness was verified. This procedure resulted in rapid execution, which allowed immediate and effective intervention by the local health authorities to protect the health of consumers. Finally, the procedure has been recognized by the Italian accrediting body, ACCREDIA.

Early inflammatory response in soft tissues induced by thin calcium phosphates

The inflammatory response to titanium and hydroxyapatite (HA)-coated titanium in living tissue is controlled by a number of humoral factors, of which monocyte chemoattractant protein-1 (MCP-1) has been specifically linked to the recruitment of monocytes. These cells subsequently mature into tissue-bound macrophages. Macrophages adhering to the proteins adsorbed at the implant surface play a pivotal role in initiating the rejection or integration of the foreign material. Despite this, little is known about the initial inflammatory events that occur in soft tissues following the implantation of titanium and HA-coated titanium implants. In this study, circular discs of commercially pure titanium (c.p. Ti) with either a thin crystalline HA coating or amorphous HA coating or uncoated were implanted subcutaneously into rats. The implants were retrieved after 24 and 72 h. The lactate dehydrogenase (LD) activity, DNA content, expression of MCP-1, interleukin-10 (IL-10), tumor necrosis factor α (TNF-α), as well as monocyte and polymorphonuclear granulocyte counts in the exudate surrounding the implants were analyzed. There were significantly higher DNA and LD levels around the titanium implants at 24 h compared with HA-coated titanium. A rapid decrease in MCP-1 levels was observed for all the implants over the period of observation. No statistically significant differences were found between the two HA-coated implants. Our results suggest a difference in the early soft-tissue response to HA-coated implants when compared with titanium implants, expressed as a downregulation of inflammatory cell recruitment. This suggests that thin HA coatings are promising surfaces for soft tissue applications.

Impact of a weight loss program on migraine in obese adolescents

BACKGROUND AND PURPOSE

Increased headache frequency and severity have been observed in obese populations, but the real impact of a weight loss treatment on headache has not been studied. We investigated this issue in a sample of obese adolescents.

METHODS

In all, 135 migraineurs, aged 14-18 years, with body mass index (BMI) ≥ 97 th percentile, participating in a 12-month-long program, were studied before and after treatment. The program included dietary education, specific physical training, and behavioral treatment.

RESULTS

Decreases in weight (P < 0.01), BMI (P < 0.01), waist circumference (P < 0.01), headache frequency (P < 0.01) and intensity (P < 0.01), use of acute medications (P < 0.05), and disability (P < 0.05) were observed at the end of the first 6-month period and were maintained through the second 6 months. Both lower baseline BMI and excess change in BMI were significantly associated with better migraine outcomes 12 months after the intervention program.

CONCLUSIONS

Significant improvements in both adiposity and headache data were observed in obese adolescents with migraine who participated in a 12-month-long interdisciplinary intervention program for weight loss. Initial body weight and amount of weight loss may be useful for clinicians to predict migraine outcomes.

Levels of heavy metals in liver and kidney of dogs from urban environment

Lead, cadmium and mercury were detected in liver and kidney tissue of dogs from an urban habitat. Samples were digested in a microwave system and analyzed by atomic absorption spectroscopy. Results of the current study showed that at least one of the three heavy metals was detected in tissues of all examined dogs. These findings make us suppose that humans are exposed to the same heavy metals similar to those of dogs that are exposed since they share the same environment. Mercury concentrations detected in kidney of household dogs were higher than stray dogs, therefore the involvement of pet food in exposure to mercury can be supposed.

Primary nocturnal enuresis and learning disability

AIM

Primary nocturnal enuresis (PNE) is the most common sleep disorder in developmental age, with a prevalence of 6-10% between 5 and 16 years of age, impacting on normal emotional and relational developing. Assessing the prevalence of mild learning disorders in enuretic children and the role of enuresis as risk factor to develop them.

METHODS

Twenty-five patients (14 males) aged 7.59 referred for primary nocturnal enuresis to Sleep Disorder Center for developmental age and Nocturnal Enuresis of Second University of Naples (frequency ≥3/week), were enrolled in study. Reading abilities were evaluated using MT (Memory and Learning Transfer) and cognitive performance was assessed using Wechsler Intelligence Scale for Children-Revised version to excluded the subjects with IQ≤75. The control group consisted in 54 children (23 males) matched for age and sex distribution recruited in Campania region schools. Chi Square test was used to verify the different prevalence of academic problems in group of bedwetters and healthy controls. The P level was set at <0.05 for statistical significance. A logistic regression analysis was performed in order to assess the risk of developing learning disabilities by being enuretic.

RESULTS

Learning difficulties were present in 18 enuretic and in 7 healthy children (χ2 24.873; P<0.001). χ2 test showed a statistic relevant difference in prevalence of "Attention request" (χ2 20.058; P<0.001) and "Border-line level" (χ2 12.979, P<0.001) identified in mild reading learning disorders in bedwetters respect of control group. Logistic regression analysis showed a strong increase to have mild academic impairment due to be a enuretic with an odd ratio (OR) of 17.26 (CI95% 5.30-56.19).

CONCLUSION

Our study shows the higher pre-valence of mild reading difficulties in enuretic children than controls.

Cosleeping in childhood migraine

AIM

Cosleeping is the practice of parents and children sleeping together in body contact for all or part of the night. There is a close relationship between sleep habits and headache disorders. Aim of the study was to identify prevalence of cosleeping in children with migraine disorder.

METHODS

A total of 181 school-aged children referred to Headache Center for Developmental Age for Migraine without aura (MoA). Sex and age matched control group consists of 729 children recruited in schools in Campania.

RESULTS

Cosleeping's prevalence is higher in children with MoA than in the control group (P=0.003) and an OR of 2.32 (95% CI 1.36-3.97).

CONCLUSION

At our knowledge, our study is the first specific on prevalence of cosleeping in MoA school-aged children and show the importance of migraine power to invade all aspect of life of children affecting also their family management.

New trends in bio/nanotechnology: stable proteins as advanced molecular tools for health and environment

In this work the thermophilic trehalose/maltose-binding protein from Thermococcus litoralis is presented as a probe for the design of a high stable fluorescence biosensor for glucose. In particular, we show the possibility of modulating the protein specificity by changing temperature. In addition to glucose sensing, we also report on the possibility of utilizing odorant-binding proteins as a probe for the development of optical sensors for analytes of environmental interests.

[Implementation of methods for detection of perceived quality: the application of the Picker's method in ASL Napoli 1 DS 50]

The evaluation of the patient satisfaction in primary care is quite difficult to evaluate for lack of appropriate indicators. The objectives of this study were the validation of the method, using the Picker Institute's Inpatient Questionnaire, and the assessment of patient judgment about the quality of primary care in the DS 50. The indicators that have been used included 3 areas: communication, organization and patient-staff relationship. The results showed that the patient-staff relationship area was indicated as the most important for the patients and they pointed out several problem either for human (self-reference of the professional, lack of emotional relationship) and or for organizational aspects (waiting time). The study highlight that in order to improve the utility of such method, the health organization must be able to appropriately evaluate the patients' need, setting them in a specific organizational vision.

Test of "crab-waist" collisions at the DAPhiNE Phi factory

The electron-positron collider DAPhiNE, the Italian Phi factory, has been recently upgraded in order to implement an innovative collision scheme based on large crossing angle, small beam sizes at the crossing point, and compensation of beam-beam interaction by means of sextupole pairs creating a "crab-waist" configuration in the interaction region. Experimental tests of the novel scheme exhibited an increase by a factor of 3 in the peak luminosity of the collider with respect to the performances reached before the upgrade. In this Letter we present the new collision scheme, discuss its advantages, describe the hardware modifications realized for the upgrade, and report the results of the experimental tests carried out during commissioning of the machine in the new configuration and standard operation for the users.

Continuous Treatment of Plaque-Type Psoriasis with Etanercept: An Observational Long-Term Experience

To assess the long-term efficacy and safety profile and the patient-reported outcomes (PRO) in patients with moderate-to-severe plaque-type psoriasis receiving continuous etanercept treatment. An open-label study was conducted to evaluate etanercept as long-term treatment for moderate-to-severe plaque psoriasis. Continuous therapy was administered at a dose of 50 mg subcutaneously twice weekly for 12 weeks followed by a continuous treatment with 50 mg subcutaneously once weekly or 25 mg twice weekly throughout a 96-week study. The primary measure of efficacy was the proportion of patients with PASI 75 at week 24, 48 and 96. Patient-reported outcomes (PRO) were also assessed during the study, at week 24, 48 and 96, including the Dermatology Life Quality Index (DLQI) and the Psoriasis Disability Index (PDI). At baseline, mean PASI score, DLQI and PDI for patients eligible to initiate treatment with etanercept showed significant disease severity, quality-of-life impairment and psoriasis-related disability. At week 96, patients showed statistically significant and meaningful improvements. The continuous etanercept regimen provided a consistent improvement in both clinical disease parameters and PRO measures.

Intravitreal bevacizumab for treatment of myopic choroidal neovascularization: the second year of a prospective study

PURPOSE

To evaluate the efficacy and safety of intravitreal bevacizumab for the treatment of myopic choroidal neovascularization (CNV).

DESIGN

Prospective, non-randomized, interventional clinical study.

METHODS

Twenty eyes from 20 patients with CNV secondary to pathologic myopia participated in this study. These patients had already completed 12 months of follow-up. All patients were scheduled for 3 monthly intravitreal bevacizumab 1.25 mg injections. ETDRS best-corrected visual acuity (BCVA), foveal center thickness (FCT) on OCT and CNV size as assessed by fluorescein angiography were examined before and after treatment. Patients were followed up for 24 months.

RESULTS

Mean BCVA (+/- SD) at baseline was 24.8 (+/- 11.86) letters (Snellen equivalent: 20/80). At 24 months after treatment the mean BCVA (+/- SD) improved significantly (p less than 0.05) to 44 (+/- 13.99) letters (Snellen equivalent: 20/33). At 24 month follow-up, BCVA improved of 10 letters or more in 17 (85%) out of 20 treated eyes and improved of 15 letters or more in 15 (75%) eyes. No treated eyes experienced a worsening of BCVA from baseline. Mean foveal center thickness (FCT) (+/- SD) at baseline was 223 (+/- 47,43) microns. By month 24, mean FCT (+/-SD) reduced to 190 (+/- 29.01) microns (p less than 0.05). Mean area of the CNVs at baseline was 0.77 (+/- 0.78) mm2, which decreased to 0.31 +/- (0.51) mm2 and 0.30 (+/- 0.50) mm2 at 12 (p less than 0.05) and 24 months (p less than 0.05), respectively. At 24 months follow-up absence of fluoresce in leakage from the CNV was demonstrated in 18 (90%) out of 20 treated eyes. No ocular or systemic adverse effects from treatment were encountered.

CONCLUSION

Eyes with myopic CNV treated with intravitreal bevacizumab over 2 years had significant anatomic and functional improvement. Further studies will be needed to confirm the long-term efficacy and safety of this treatment.

Levels and congener profiles of polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans and dioxin-like polychlorinated biphenyls in cow's milk collected in Campania, Italy

Polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and certain dioxin-like polychlorinated biphenyls (dl-PCBs) are a family of chemically-related lipophilic compounds characterized by similar toxicity. Due to their properties they are universally distributed in the environment and classified as persistent organic pollutants (POPs). From most of studies carried out to evaluate human dietary intake, milk and dairy products result as a major contributors of PCDD/Fs uptake. Of course the main source of milk contamination is animal feeds. Lactating ruminants, cows included, transfer these compounds to the food chain by ingestion of contaminated vegetables or soil. Their resistance to degradation and a high lipophilicity means that PCDD/Fs and dl-PCBs may be accumulated into fat tissues from which they are transferred to milk during lactation period. Seventy-nine cows milk samples, collected in the monitoring plan 2008, were analyzed for PCDD/Fs and dl-PCBs. Eleven milk samples were non-compliant corresponding to five breeding livestock located in Caserta province. The distribution of PCDD/Fs and dl-PCBs congeners in these samples was examined in order to determine the likely sources of dioxins. The results show that the congener profile is characterized by a prevalence of PCDFs in respect of PCDDs, that represents the typical pattern of thermal origin contamination.

Lower limb involvement in adult-onset primary dystonia: frequency and clinical features

BACKGROUND AND PURPOSE

Despite the growing number of reports describing adult-onset primary lower limb dystonia (LLD) this entity has never been systematically evaluated in the general population of patients with primary adult-onset dystonia.

METHODS

From outpatients with adult-onset primary dystonia attending nine Italian University centres for movement disorders we consecutively recruited 579 patients to undergo a standardized clinical evaluation.

RESULTS

Of the 579 patients assessed, 11 (1.9%) (8 women, 3 men) had LLD, either alone (n = 4, 0.7%) or as part of a segmental/multifocal dystonia (n = 7, 1.2%). The age at onset of LLD (47.9 +/- 17 years) was significantly lower than the age at onset of cranial dystonias (57.9 +/- 10.7 years for blepharospasm, and 58.9 +/- 11.8 years for oromandibular dystonia) but similar to that of all the other adult-onset primary dystonias. The lower limb was either the site of dystonia onset (36.4%) or the site of dystonia spread (63.6%). In patients in whom LLD was a site of spread, dystonia seemed to spread following a somatotopic distribution. Only one patient reported a recent trauma involving the lower limb whereas 36.4% of the patients reported pain at the site of LLD. Only 64% of our patients needed treatment for LLD, and similarly to previously reported cases, the most frequently tried treatments was botulinum toxin and trihexyphenidyl.

CONCLUSION

The lower limb is an uncommon but possible topographical site of dystonia in adulthood that should be kept in consideration during clinical evaluation.

Influence and variation of the body mass index in patients treated with etanercept for plaque-type psoriasis

A relationship between psoriasis, pro-inflammatory cytokines and obesity has been demonstrated. Tumour necrosis factor-alpha (TNF-alpha), that is involved in the pathogenesis of psoriasis, is commonly over-expressed in obese subjects, and seems to be derived from inflammatory cells and adipocytes. The primary aim of this study is to investigate whether the Body Mass Index (BMI) of patients influences the clinical response to etanercept, a competitive inhibitor of TNF-alpha approved for the treatment of moderate-to-severe plaque-type psoriasis. The secondary aim is to evaluate whether the TNF-alpha inhibition influences the weight and BMI profile of patients. One hundred patients received 50 mg etanercept twice weekly for 12 weeks, followed by 25 mg. At weeks-12 and 24, treatment efficacy and tolerability were evaluated, as well as body weight and BMI. BMI values did not correlate with etanercept efficacy. Mean PASI score variation did not show significant differences among the BMI groups. A statistically significant weight gain and BMI variation were observed in a consistent rate of patients. Patient BMI does not influence psoriasis efficacy parameters. Although the role of anti TNF-alpha molecules on weight regulation need to be confirmed, our study shows that etanercept treatment may induce weight gain and a BMI increase.

Coexistence of Different Histotypes of Renal Carcinoma: Our Experience and Literature Review

The coexistence of multiple, synchronous primary tumors of different histology within the same kidney is a rare condition. We report herein a series of five patients with two tumors of different histology involving synchronously the same kidney.

Materials and Methods

We reviewed the pathology reports of a series of 381 patients who underwent surgery for primary renal tumors at our institution from 2000 to 2007. In the files of all patients with synchronous tumors of different histology, special attention was given to the results of imaging studies.

Results

Five out of 381 patients (1.37%) had coexistence of two primary tumors of different histology within the same kidney. Four patients had ultrasonography as the first imaging procedure, one patient had ultrasonography as the second imaging procedure; all had preoperative CT of the abdomen. Both lesions were detected by preoperative CT in 4/5 of the cases; in the remaining one, the smaller lesion was not visible, even in retrospect.

Conclusions

The coexistence of multiple and synchronous primary tumors of different histology within the same kidney has been only rarely described. To the best of our knowledge, in literature there are only case reports with the exception of a case of renal oncocytoma with evolving papillary RCC. We believe that this condition could be more frequent if the radiologist and the anatomopathologist try to find it.

[Is prophyilaxis necessary after urodynamic tests? Our experience]

Urodynamic studies should be performed only on patients with sterile urine. The use of prophylaxis after urodynamic investigation is debated (positive urinoculture in 9 to 15% of cases). The Units of Urodynamics at the Urological Clinic of the University of Genoa and of the Galliera Hospital of Genoa assessed the prevalence of bacteriuria on a sample of 336 patients (314 females and 22 males), average age 62.3, between January and December 2006. All patients with sterile urine before examination underwent a complete urodynamic test. Concomitant diseases were: diabetes (7.7%), multiple sclerosis (3.5%), Parkinson's disease (1.2%), urinary retention treated by autocatheterism (1.2 %). Urinoculture was performed seven days after the urodynamic study. All patients were asymptomatic; 40/336 urinocultures were positive (E. coli 80%, Proteus M. 10%, other 10%). The prophylaxis does not eliminate but only reduces post-urodynamic infections; we believe that the cost-benefit ratio is unfavorable.

Early vs Delayed Radical Cystectomy Compared in Highgrade Superficial Bladder Tumors

Objectives

The treatment of aggressive superficial TCC of the bladder remains controversial. In fact, although still classified as ‘superficial’, it has been shown that the biological characteristics of T1G3 bladder tumors are the same as those of the muscle-invasive group (T2 and above). Even with close monitoring and intensive intravesical therapy, the reported risk of muscle invasion in these patients is 53% and 1/3 die from this disease in the long-term. The aim of this study is to determine whether the timing of radical cystectomy affects the survival of patients with aggressive superficial bladder tumor.

Methods

We consider 74 patients who underwent radical cystectomy between November 1994 and October 2006 before a diagnosis of T1G3 bladder tumor. These patients were divided in 2 subgroups: group A (n=27, 25 M and 2 F) who underwent immediate radical cystectomy, and group B (n=47, 40 M and 7 F) who underwent other conservative treatments before radical cystectomy.

Results

The two subgroups were similar concerning age (66.29±8.37 yrs vs 66.87±8.6 yrs, respectively, p NS) and the timing of follow-up (respectively 77±45 vs 60±35 mths, p NS). Moreover, the progression-free survival was significantly higher in subgroup A (53.73±48.54 vs 31.94±35.19 mths, log-rank p<0.05) as well as the overall survival (59.73±45.37 vs 36.45±33.96 mths respectively, log-rank p<0.05). Comparing the histological examinations, the two subgroups were significantly different concerning the T stage (superficial tumors 14/27 vs 16/47, respectively, p<0.05; invasive tumors 13/27 vs 31/47, respectively, p<0.00005) and the lymphonodal dissemination (2N+/27 vs 11N+/47, respectively, p<<0.0005).

Conclusions

Delaying radical cystectomy for aggressive superficial bladder tumors leads to a worse progression-free survival; the overall survival is likely to be due also to an early lymphonodal dissemination, which occurs extending the timing between diagnosis and radical treatment.

Vesical Sequelae of Transverse Myelitis. Long-Term Urodynamics Observations in Adult Patients

Transverse myelitis is a rare autoimmune inflammatory disease often secondary to viral infection of the spinal cord; it frequently has vesico-sphynteric complications. Between January 2000 and December 2005 we performed urodynamic examination on 13 consecutive patients (7 females and 6 males) with previous diagnosis of transverse myelitis. Mean age was 54.5 years; transverse myelitis had been diagnosed a mean of 6.3 years earlier; etiology of myelitis was viral infection in 5 cases, autoimmune in 3 cases, insect bite in 1 case, unknown in 4 cases. The neurological sequelae included paraparesis in 3 cases and tetraparesis in 2 cases. Symptoms: dysuria 46%, slow stream 15%, pollakiuria 23%, urgency 30%; urge incontinence 38%, stress incontinence 15%. 3 patients performed 4 clean intermittent catheterisms (CIC), 2 patients 2 CICs. Eight patients had maximum cystometric capacity above 350 mL, the others had a mean capacity of 223 mL. Four patients showed no bladder sensitivity. Voluntary micturitional reflex was observed in 4 patients. Detrusor overactivity was diagnosed in 9 patients, 10 patients had mean residual post-micturition (RPM) of 218 mL, 2 patients showed detrusor-sphincter dyssynergia, 2 patients were found to be obstructed at pressure-flow study. Urodynamic follow-up is indicated in these patients with or without neurological complications (possibility of detrusor overactivity, urinary retention, detrusor-sphincter dyssynergia); the follow-up personalizes the diagnosis and therapy, and prevents complications.

Disease Progression in Bladder Cancer: Which Developments since 1994

Objectives

The introduction of PSA in clinical practice has resulted in decreasing the death rate form prostate cancer and in a downward shift of the pathological stage in radical prostatectomy specimens. This seems not to be the case for bladder cancer. In order to verify this assumption, we have reviewed the charts of the patients operated on of radical prostatectomy and radical cystectomy between 1994 and 2006.

Methods

456 and 491 consecutive patients, respectively, underwent radical cystectomy and radical prostatectomy with bilateral lymph nodes dissection. We excluded all the patients who had received neoadjuvant treatment or did not undergo node dissection. The patients were divided into two consecutive groups according to the year of treatment: group 1 included pts treated from 1994 to 2000, and group 2 pts from 2001 to 2006. The histopathological findings of the two groups of pts were compared. The difference among TNM systems has been balanced evaluating histopathological reports critically and converting them to the 2002 edition.

Results

For patients with prostate cancer, those in group 2 had a decrease in the incidence of extracapsular extension and lymph nodes invasion. The bladder cancer patients belonging to group 2 had a greater number of T2, but there was an increased number of pN+ in this group.

Conclusions

Even if there is a decline in locally advanced disease in patients with bladder cancer, our retrospective analysis did not show a comparable success in early diagnosis as it did for prostate cancer. There is undoubtedly an increase in the lymph node dissemination, whether this is due to a more extended lymph node dissection or to a premature dissemination remains questionable. Public awareness regarding bladder cancer and its risk factors is limited, but several studies have reported that a delay in diagnosis of invasive bladder cancer is an adverse prognostic factor. A higher care in the development of new diagnostic markers for bladder tumors and especially in the screening protocols together with an earlier radical therapy could hopefully improve the management of such a pathology, as it happened for prostate cancer.

Evolution of Our Experience in Diagnosis and Therapy for Urinary Infections

The therapy for urinary infections is advised according to the antibiogram; the symptoms request an empirical therapy based on urinary infections knowledge and drugs spectrum activity. We considered the urinoculture performed on 3834 patients, 3012 male and 822 female, hospitalized in our Institute in the period between 01/01/2005 and 31/10/2006; 444 of these were positive (12.7 % - 451 bacterial strains). Table 1: bacterial strains isolaed. We reported some evaluations obtained by antibiogram. E. coli strains Ciprofloxacin sensitive resulted in 60% of cases. Enterococcus species and Enterococcus faecalis strains Ampicillin sensitive resulted in 96.4% and 100% of cases, respectively.

In this study there is a Gram negative prevalence, whereas we had previously observed an equivalence between Gram negative and Gram positive (p 0.001). These data are useful for empirical therapy.

[Disease progression in bladder cancer: which developments since 1994]

Objectives The introduction of PSA in clinical practice has resulted in decreasing the death rate form prostate cancer and in a downward shift of the pathological stage in radical prostatectomy specimens. This seems not to be the case for bladder cancer. In order to verify this assumption, we have reviewed the charts of the patients operated on of radical prostatectomy and radical cystectomy between 1994 and 2006. METHODS 456 and 491 consecutive patients, respectively, underwent radical cystectomy and radical prostatectomy with bilateral lymph nodes dissection. We excluded all the patients who had received neoadjuvant treatment or did not undergo node dissection. The patients were divided into two consecutive groups according to the year of treatment: group 1 included pts treated from 1994 to 2000, and group 2 pts from 2001 to 2006. The histopathological findings of the two groups of pts were compared. The difference among TNM systems has been balanced evaluating histopathological reports critically and converting them to the 2002 edition. RESULTS. For patients with prostate cancer, those in group 2 had a decrease in the incidence of extracapsular extension and lymph nodes invasion. The bladder cancer patients belonging to group 2 had a greater number of T2, but there was an increased number of pN+ in this group. CONCLUSIONS Even if there is a decline in locally advanced disease in patients with bladder cancer, our retrospective analysis did not show a comparable success in early diagnosis as it did for prostate cancer. There is undoubtedly an increase in the lymph node dissemination, whether this is due to a more extended lymph node dissection or to a premature dissemination remains questionable. Public awareness regarding bladder cancer and its risk factors is limited, but several studies have reported that a delay in diagnosis of invasive bladder cancer is an adverse prognostic factor. A higher care in the development of new diagnostic markers for bladder tumors and especially in the screening protocols together with an earlier radical therapy could hopefully improve the management of such a pathology, as it happened for prostate cancer.

[Coexistence of different histotypes of renal carcinoma:our experience and literature review]

The coexistence of multiple, synchronous primary tumors of different histology within the same kidney is a rare condition. We report herein a series of five patients with two tumors of different histology involving synchronously the same kidney. MATERIALS AND METHODS. We reviewed the pathology reports of a series of 381 patients who underwent surgery for primary renal tumors at our institution from 2000 to 2007. In the files of all patients with synchronous tumors of different histology, special attention was given to the results of imaging studies. RESULTS. Five out of 381 patients (1.37%) had coexistence of two primary tumors of different histology within the same kidney. Four patients had ultrasonography as the first imaging procedure, one patient had ultrasonography as the second imaging procedure; all had preoperative CT of the abdomen. Both lesions were detected by preoperative CT in 4/5 of the cases; in the remaining one, the smaller lesion was not visible, even in retrospect. CONCLUSIONS. The coexistence of multiple and synchronous primary tumors of different histology within the same kidney has been only rarely described. To the best of our knowledge, in literature there are only case reports with the exception of a case of renal oncocytoma with evolving papillary RCC. We believe that this condition could be more frequent if the radiologist and the anatomopathologist try to find it.

Is Prophyilaxis Necessary after Urodynamic Tests? Our Experience

Urodynamic studies should be performed only on patients with sterile urine. The use of prophylaxis after urodynamic investigation is debated (positive urinoculture in 9 to 15% of cases). The Units of Urodynamics at the Urological Clinic of the University of Genoa and of the Galliera Hospital of Genoa assessed the prevalence of bacteriuria on a sample of 336 patients (314 females and 22 males), average age 62.3, between January and December 2006.

All patients with sterile urine before examination underwent a complete urodynamic test. Concomitant diseases were: diabetes (7.7%), multiple sclerosis (3.5%), Parkinson's disease (1.2%), urinary retention treated by autocatheterism (1.2 %). Urinoculture was performed seven days after the urodynamic study. All patients were asymptomatic; 40/336 urinocultures were positive (E. coli 80%, Proteus M. 10%, other 10%). The prophylaxis does not eliminate but only reduces post-urodynamic infections; we believe that the cost-benefit ratio is unfavorable.

[Early vs delayed radical cystectomy compared in highgrade superficial bladder tumors]

Objectives. The treatment of aggressive superficial TCC of the bladder remains controversial. In fact, although still classified as 'superficial', it has been shown that the biological characteristics of T1G3 bladder tumors are the same as those of the muscle-invasive group (T2 and above). Even with close monitoring and intensive intravesical therapy, the reported risk of muscle invasion in these patients is 53% and 1/3 die from this disease in the long-term. The aim of this study is to determine whether the timing of radical cystectomy affects the survival of patients with aggressive superficial bladder tumor. Methods. We consider 74 patients who underwent radical cystectomy between November 1994 and October 2006 before a diagnosis of T1G3 bladder tumor. These patients were divided in 2 subgroups: group A (n=27, 25 M and 2 F) who underwent immediate radical cystectomy, and group B (n=47, 40 M and 7 F) who underwent other conservative treatments before radical cystectomy. Results. The two subgroups were similar concerning age (66.29±8.37 yrs vs 66.87±8.6 yrs, respectively, p NS) and the timing of follow-up (respectively 77±45 vs 60±35 mths, p NS). Moreover, the progression-free survival was significantly higher in subgroup A (53.73±48.54 vs 31.94±35.19 mths, log-rank p<0.05) as well as the overall survival (59.73±45.37 vs 36.45±33.96 mths respectively, log-rank p<0.05). Comparing the histological examinations, the two subgroups were significantly different concerning the T stage (superficial tumors 14/27 vs 16/47, respectively, p<0.05; invasive tumors 13/27 vs 31/47, respectively, p<0.00005) and the lymphonodal dissemination (2N+/27 vs 11N+/47, respectively, p<0.0005). . Delaying radical cystectomy for aggressive superficial bladder tumors leads to a worse progression-free survival; the overall survival is likely to be due also to an early lymphonodal dissemination, which occurs extending the timing between diagnosis and radical treatment.

[Vesical sequelae of transverse myelitis. Long-term urodynamics observations in adult patients]

Transverse myelitis is a rare autoimmune inflammatory disease often secondary to viral infection of the spinal cord; it frequently has vesico-sphynteric complications. Between January 2000 and December 2005 we performed urodynamic examination on 13 consecutive patients (7 females and 6 males) with previous diagnosis of transverse myelitis. Mean age was 54.5 years; transverse myelitis had been diagnosed a mean of 6.3 years earlier; etiology of myelitis was viral infection in 5 cases, autoimmune in 3 cases, insect bite in 1 case, unknown in 4 cases. The neurological sequelae included paraparesis in 3 cases and tetraparesis in 2 cases.

SYMPTOMS

dysuria 46%, slow stream 15%, pollakiuria 23%, urgency 30%; urge incontinence 38%, stress incontinence 15%. 3 patients performed 4 clean intermittent catheterisms (CIC), 2 patients 2 CICs. Eight patients had maximum cystometric capacity above 350 mL, the others had a mean capacity of 223 mL. Four patients showed no bladder sensitivity. Voluntary micturitional reflex was observed in 4 patients. Detrusor overactivity was diagnosed in 9 patients, 10 patients had mean residual post-micturition (RPM) of 218 mL, 2 patients showed detrusor-sphincter dyssynergia, 2 patients were found to be obstructed at pressure-flow study. Urodynamic follow-up is indicated in these patients with or without neurological complications (possibility of detrusor overactivity, urinary retention, detrusor-sphincter dyssynergia); the follow-up personalizes the diagnosis and therapy, and prevents complications.

Transcranial doppler sonography is useful for the decision-making at the point of care in patients with acute hepatic failure: a single centre's experience

Acute hepatic failure (ALF) is an uncommon disease characterized by a rapid deterioration of the hepatic function with severe derangements of the mental status in previously healthy subjects due to massive hepatocytes necrosis. Neurological impairment, due to intracranial hypertension and cerebral ischemia, is a key factor because it is a main criterion to decide when to proceed to liver transplantation, which is only treatment for these patients. Therefore, neurological monitoring holds an essential role in the clinical management of ALF patients but it needs to be performed at the point-of-care in the majority of the cases as such critically ill patients cannot be moved away from the ICU because they frequently need continuous hemodynamic, ventilatory and renal support. We herein report and discuss our experience relating to the use of transcranial sonography as a neuro-monitoring tool in ALF patients. In our series this technique allowed a repeatable and reliable non-invasive assessment of cerebral blood flow changes at the bedside thus avoiding the complications associated with the use of an intracranial probe to measure intra-cranial pressure and making it possible to correctly evaluate the timing and feasibility of liver transplantation.

Interventions for replacing missing teeth: treatment of perimplantitis

BACKGROUND

One of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (perimplantitis) and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective.

OBJECTIVES

To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 dental implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 9 January 2008.

SELECTION CRITERIA

All RCTs comparing agents or interventions for treating perimplantitis around dental implants.

DATA COLLECTION AND ANALYSIS

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. We contacted the authors for missing information. Results were expressed as random-effects models using weighted mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors.

MAIN RESULTS

Ten eligible trials were identified, but three were excluded. The following procedures were tested: (1) use of local antibiotics versus ultrasonic debridement; (2) benefits of adjunctive local antibiotics to debridement; (3) different techniques of subgingival debridement; (4) laser versus manual debridement and chlorhexidine irrigation/gel; (5) systemic antibiotics plus resective surgery plus two different local antibiotics with and without implant surface smoothening; and (6) nanocrystalline hydroxyapatite versus Bio-Oss and resorbable barriers. Follow up ranged from 3 months to 2 years. The only statistically significant differences were observed in two trials judged to be at high risk of bias. After 4 months, adjunctive local antibiotics to manual debridement in patients who lost at least 50% of the bone around implants showed improved mean probing attachment levels (PAL) of 0.61 mm and reduced probing pockets depths (PPD) of 0.59 mm. After 6 months, patients with perimplant infrabony defects > 3 mm treated with Bio-Oss and resorbable barriers gained 0.5 mm more PAL (borderline difference) and PPD than patients treated with a nanocrystalline hydroxyapatite.

AUTHORS' CONCLUSIONS

There is very little reliable evidence suggesting which could be the most effective interventions for treating perimplantitis. This is not to say that currently used interventions are not effective. The use of local antibiotics in addition to manual subgingival debridement was associated with a 0.6 mm additional improvement for PAL and PPD over a 4-month period in patients affected by severe forms of perimplantitis. After 6 months both augmentation therapies appeared to be successful but improved PAL and PPD (0.5 mm) were obtained when using Bio-Oss with resorbable barriers. In four trials, the control therapy which basically consisted of a simple subgingival mechanical debridement seemed to be sufficient to achieve results similar to the more complex and expensive therapies. Sample sizes were very small and follow up too short, therefore these conclusions have to be considered with great caution. Larger well-designed RCTs are needed.

Elastofibroma dorsi: 8 case reports and a literature review

A series of 8 cases of elastofibroma is reported, and the clinical, pathological and imaging features and different therapeutic modalities are reviewed. On this basis, we suggest an algorithm for the diagnosis and treatment of elastofibroma. Briefly, marginal excision is the treatment of choice in symptomatic patients, while followup appears to be a good solution in asymptomatic ones.

IL4 gene delivery to the CNS recruits regulatory T cells and induces clinical recovery in mouse models of multiple sclerosis

Central nervous system (CNS) delivery of anti-inflammatory cytokines, such as interleukin 4 (IL4), holds promise as treatment for multiple sclerosis (MS). We have previously shown that short-term herpes simplex virus type 1-mediated IL4 gene therapy is able to inhibit experimental autoimmune encephalomyelitis (EAE), an animal model of MS, in mice and non-human primates. Here, we show that a single administration of an IL4-expressing helper-dependent adenoviral vector (HD-Ad) into the cerebrospinal fluid (CSF) circulation of immunocompetent mice allows persistent transduction of neuroepithelial cells and long-term (up to 5 months) CNS transgene expression without toxicity. Mice affected by chronic and relapsing EAE display clinical and neurophysiological recovery from the disease once injected with the IL4-expressing HD-Ad vector. The therapeutic effect is due to the ability of IL4 to increase, in inflamed CNS areas, chemokines (CCL1, CCL17 and CCL22) capable of recruiting regulatory T cells (CD4+CD69-CD25+Foxp3+) with suppressant functions. CSF delivery of HD-Ad vectors expressing anti-inflammatory molecules might represent a valuable therapeutic option for CNS inflammatory disorders.