What hides beneath the scar: sexuality and breast cancer what women don't say: A single-center study

BACKGROUND

Breast is a symbol of femininity, motherhood and sexuality. Breast cancer (BC) is the leading cause of cancer death in women worldwide and most frequent cancer in Italy: in 2019, 53.500 new cases were diagnosed. BC and its treatment, the disturbances of body image, and mental health problems such as anxiety and depression could influence sexuality. Very often the aspect of sexuality in BC is likely not to be fully investigated: cultural barriers may also contribute to lack of attention to these issues. In Italy, there are very few Breast Units that provide the figure of the sexologist and psycho-oncologist.

METHODS

We enlisted 141 BC patients (pts), mean age was 54 years afferent to Breast Unit S. Maria Goretti Hospital, Latina, from March 2019 to March 2020. All pts had undergone surgical intervention. Participants were invited to complete a structured questionnaire, which included four close-up questions regarding self-image, sexual activity, sexual satisfaction, analyzing these aspects before and after BC and its treatments. Finally the participants were asked if they needed the sexologist and psycho-oncologist.

RESULTS

Only 2/141 pts (1.41%) refused to participate in our study. Of 139 participants, 68 (48.92%) had disturbances of body image, 26 (18.7%) had sexuality greatly negatively affected, and 103 (74.1%) every kind of sexual dissatisfaction after BC. 38 pts (27.3%) would require the help of the sexologist. 135 ( 97%) would require the help of the psycho-oncologist. Despite the negative influence in their body-image and sexuality, few pts require the help of the sexologist, but nearly all pts require the help of the psycho-oncologist.

CONCLUSION

In our study nearly all pts require the help of the psycho-oncologist, but few pts of the sexologist. Further studies will be needed to understand the reasons for this disparity: at the moment we are carrying out another project following this illustration, with the aim of understanding why this disparity.

Inhibition of Leukocyte Migration by a Human Colon Cancer Extract

The direct leucocyte migration inhibition test in capillary tubes was used to test 10 patients with colonic adenocarcinoma against KCl soluble extracts of an allogenic colon cancer and an allogenic normal colon fragment. Inhibition was consistently found with the cancer extract but not with the normal tissue extract. None of the control group of patients affected by other tumors, intestinal and liver disorders showed a migration inhibition in response to the colonic tumor extract. Our findings strongly suggest the presence of a tumor-associated antigen in the cancer extract.

Transmesenteric hernia after right nephrectomy: diagnostic and therapeutic management

Internal abdominal hernias are a rare cause of intestinal obstruction (0.2-0.9%). Transmesenteric hernia is a rare type of internal hernia and usually in adult people is acquired. We report the case of a 44 year-old caucasian female with a small bowel occlusion after right nephrectomy for clear cell renal carcinoma caused by an acquired transmesenteric hernia. We emphasize the role of CT scanning for a prompt diagnosis and a quick surgical treatment in order to avoid intestinal gangrene.

Eosinophilic cystitis associated with urethral stricture disease from pelvic trauma. Case report and literature review

We report a case of eosinophilic cystitis (EC) in a 65-year-old man with urethral stricture disease from blunt pelvic traumatic event. EC is a rare condition characterized by eosinophilic infiltration of the bladder wall, that usually presents with irritative voiding symptoms, suprapubic pain and hematuria. Etiology is still not clear although a review of the literature suggests that pathogenetic mechanisms probably engage an altered immune response in the bladder, with the inflammatory reaction caused by factors such as exogenous allergens and previous bladder injury or surgery to the bladder or the prostate. The diagnosis of EC has to be confirmed by biopsy, since in some cases it may manifest as other inflammatory and malignant bladder disorders. A conservative medical management is indicated initially, since this disease may be self-limited, with a benign course especially in children and young patients. In adults EC is more often a chronic recurrent condition that requires close follow-up since it may lead to serious progressive bladder and/or upper urinary tract disease. More invasive therapies (including transurethral resection, partial or total cystectomy) may also be required when conservative therapy fails.

Prostatic small cell carcinoma diagnosed by tru-cut needle biopsy: discussion of clinico-pathological findings

The small cell carcinoma is a neuroendocrine tumour characterised by an aggressive clinical course and a high mortality rate. It occurs most commonly in the lung. Small cell carcinomas originating in the genitourinary system have been diagnosed with increasing frequency in recent years, because of the use of immunohistochemistry. Prostatic small cell carcinomas present the same biological behavior and similar histological, immunohistochemical and ultrastructural features to small cell carcinomas of the lungs. We describe the clinico-pathological findings in a 65-year-old male patient with a diagnosis of prostatic small cell carcinoma, obtained by means of a tru-cut needle biopsy. We performed the immunohistochemical tests using neuron-specific enolase and chromogranin A antibodies, according to the literature. On the basis of our experience we stress the malignant features of small cell carcinoma and the difficulty in obtaining an early diagnosis and treatment because of the aggressive course of the lesion and the late symptomatology.

[Inverted papilloma of the bladder: observation of 3 clinical cases and discussion on their clinico-pathologic characteristics]

Three cases of urothelial inverted papilloma, detected in two female patients aged 32 and 31 years, respectively and in one 67-year-old male patient, are described. Inverted papilloma is a benign lesion which occurs in the urinary epithelium with a 20% incidence in comparison with other urothelial tumours. The male:female ratio is 3:1. The histological structure of urothelial inverted papilloma is similar to that of inverted papilloma of the nasal and paranasal sinuses. It presents interanastomosed epithelial cords, with transitional cells, which develop in the tunica propria connective tissue. Some cells are distributed in such a way as to constitute vacuolated glandular-like structures. The histogenetic origin of the lesion from Home subtrigonal or Albarran subcervical glands is debatable. Recent aetiological hypotheses have claimed that the origin of the lesion may be related to Brunn's nest hyperplasia and/or to chronic urothelial inflammation. The latter hypothesis would currently appear to be the most accredited: immunostaining for cytokeratins would tend to support a urothelial inflammatory aetiology. In our cases, we achieved a definitive diagnosis of inverted papilloma only at histology, because of the specificity of the echotomography and cystoscopy findings. Urinary cytology revealed only a large number of inflammatory cells with anaplastic elements, but without any more detailed morphological description. We performed a transurethral resection of the bladder (TURB) in all three patients: routine follow-up showed the absence of inverted papilloma relapses. On the basis of the above-mentioned data and a thorough review of the literature, we attempt to assess and classify the clinico-pathological findings and the aetiological hypotheses of urothelial inverted papilloma. In addition, the benign nature of the lesion and any malignant transformation factors are discussed.

[Pseudosarcoma of the urinary bladder. Report of a case]

A case of myofibroblastic pseudosarcomatous tumor of the bladder occurred in a patient previously submitted to TURB is reported. Aim of this investigation is to demonstrate, on the basis of the literature, the importance of histopathology in the diagnosis of bladder pseudosarcoma, since endoscopical and radiological methods can erroneously show a neoplasm. A 65-year-old male patient with hematuria, submitted to ultrasonography and cystoscopy, revealed a bladder superficial papillary formation. A TURB was performed and the histological study showed a superficial bladder cancer (T1-G1-2). After a second hematuria episode with stranguria a new bladder formation was diagnosed and resected; the histological study revealed a bladder pseudosarcoma. The absolute benignity of the lesion and the slight difference in the symptomatology between urothelial carcinoma and pseudosarcoma are underlined. Furthermore, the importance of histopathology to obtain an accurate diagnosis is stressed. The difficulty of a preoperative diagnosis without histopathological examination is pointed out.

Urokinase receptor-dependent and -independent p56/59(hck) activation state is a molecular switch between myelomonocytic cell motility and adherence

Anchorage-independent myelomonocytic cells acquire adherence within minutes of differentiation stimuli, such as the proteolytically inactive N-terminal fragment of urokinase binding to its cognate glycosylphosphatidylinositol (GPI)-anchored receptor. Here, we report that urokinase-treated differentiating U937 monocyte-like cells exhibit a rapid and transient inhibition of p56/59(hck) and p55(fgr) whereas no changes in the activity of other Src family kinases, such as p53/56(lyn) and p59(fyn) were observed. U937 transfectants expressing a kinase-defective (Lys267 to Met) p56/59(hck) variant exhibit enhanced adhesiveness and a marked F-actin redistribution in thin protruding structures. Conversely, urokinase as well as expression of wild-type or constitutively active (Tyr499 to Phe) p56/59(hck) stimulates the directional migration of uninduced U937 cells. Accordingly, expression of constitutively active or kinase inactive p56/59(hck) selectively prevents urokinase receptor-dependent induction of either adhesion or motility, indicating that a specific activation state of p56/59(hck) is required for each cell response. In conclusion, modulation of the intracellular p56/59(hck) tyrosine kinase activity switches cell motility towards adherence, providing a mutually exclusive mechanism to regulate these properties during monocyte/macrophage differentiation in vivo.

PED/PEA-15 gene controls glucose transport and is overexpressed in type 2 diabetes mellitus

We have used differential display to identify genes whose expression is altered in type 2 diabetes thus contributing to its pathogenesis. One mRNA is overexpressed in fibroblasts from type 2 diabetics compared with non-diabetic individuals, as well as in skeletal muscle and adipose tissues, two major sites of insulin resistance in type 2 diabetes. The levels of the protein encoded by this mRNA are also elevated in type 2 diabetic tissues; thus, we named it PED for phosphoprotein enriched in diabetes. PED cloning shows that it encodes a 15 kDa phosphoprotein identical to the protein kinase C (PKC) substrate PEA-15. The PED gene maps on human chromosome 1q21-22. Transfection of PED/PEA-15 in differentiating L6 skeletal muscle cells increases the content of Glut1 transporters on the plasma membrane and inhibits insulin-stimulated glucose transport and cell-surface recruitment of Glut4, the major insulin-sensitive glucose transporter. These effects of PED overexpression are reversed by blocking PKC activity. Overexpression of the PED/PEA-15 gene may contribute to insulin resistance in glucose uptake in type 2 diabetes.

[Gastrointestinal carcinoids and carcinoid syndrome: classification, diagnosis and therapy]

Historically, carcinoids have long been known as a morphologically distinct class of rare intestinal tumors which behave less aggressively than the more common intestinal adenocarcinomas. In recent decades refined methods in pathology improved our knowledge on the diffuse neuroendocrine system, leading to some confusion in classification and nomenclature of carcinoids. The World Health Organization (WHO) classification of endocrine tumors has cleared the definition of carcinoids. The Authors report on 7 cases of midgut carcinoid tumors and 1 case of carcinoid syndrome focusing on the newer approaches to the diagnosis, localization, and role of surgery and peptide therapy.

[Blind-ending branch of bifid ureter: apropos of a case]

The Authors report on a case of blind-ending ureter. A young woman (29 years old) underwent surgery because of recurrent urinary tract infections and left loin pain. The operation consisted in a radical resection of the blind branch together with Coen's operation for the coexistence of vesicoureteral reflux. Authors' goal was to review the international Literature on this rare pathology pointing out their opinion on the existing terminology which is still far from being clear and definite.

Phosphorylation of human pro-urokinase on Ser138/303 impairs its receptor-dependent ability to promote myelomonocytic adherence and motility

Serine phosphorylation of human pro-urokinase (pro-uPA) by A431 human carcinoma cells results in a catalytically active molecule with reduced sensitivity to plasminogen activator inhibitor type 1. We mapped the phosphorylated seryl residues by analyzing the in vivo phosphorylation state of engineered pro-uPA variants carrying a COOH-terminal poly-histidine tag. Stably transfected A431 cells do not incorporate radioactive phosphate into tagged pro-uPA in which the serines 138 and 303 have been replaced with glutamic residues, although endogenous nontagged pro-uPA is 32P-labeled on A and B chains. Moreover, the catalytic-independent ability of the mono- and di-substituted "phosphorylation-like" variants to bind to the GPI-anchored urokinase receptor (uPAR) and promote adherence of differentiating U937, HL-60, and THP-1 myelomonocytic cells was examined. We found that glutamic residues as well as the naturally occurring phosphoserines at positions 138 and 303 abolish proadhesive ability, although they do not interfere with receptor binding. In addition, pro-uPA carrying Glu138/303 lacks the capability to induce a chemotactic response of THP-1 cells. The exclusive presence of Glu138 reduces pro-uPA proadhesive and chemotactic ability by 70-80%, indicating that a phosphoserine residue at the same position plays a major inhibitory role of myeloid cell response to pro-urokinase. The di-substitution does not affect pro-uPA ability to interact with vitronectin or to enhance binding of urea-denatured vitronectin to uPAR. However, unlike wild-type tagged pro-uPA, the di-substituted variant does not induce receptor polarization in pre-adherent U937 cells. Taken together, the data support the possibility that pro-uPA phosphorylation on Ser138/303 can modulate uPAR transducing ability.

[Nephrogenic metaplasia. A particular clinical and anatomopathologic entity]

Two cases of nephrogenic adenoma are presented. The authors consider nephrogenic metaplasia as a reaction to inflammatory agents and point out the importance of differential diagnosis with nephrogenic adenocarcinoma, in which a different surgical procedure is requested.

[Renal microcarcinomas: a particular clinical entity]

According to the possibility of an early diagnosis, related to diagnostic imaging and predictive indexes such as DNA and vascular permeability, in the presence of a low grade-low stage tumor, and with the support of the Literature, the Authors hypothesize an increasing applicability of conservative surgery in the management of small renal carcinomas.

[Ambulatory phlebectomy: our experience]

The Authors report their experience of out-patient phlebectomy. Over a period of 5 years they have examined 186 patients (156 females, 30 males): 166 had micro- and extra-saphenic varicosities, while 20 had recurrent varices. Patients with ostium failure were excluded. Muller's out-patient phlebectomy implies an accurate mapping of varicosities, local anaesthesia, microincisions which are only exceptionally sutured. The Authors consider that an accurate elastic pressure bandage is indispensable and useful in order to improve the dynamics of the PVC and to avoid haemorrhages. Such a surgical technique bears aesthetic, economic and haemodynamic advantages.

[Male infertility due to varicocele: their diagnosis and treatment. Our experience]

The Authors have examined, over a period of two years, 110 patients presenting with varicocele and infertility. Varicocele has an incidence of 40% in male sterility, causing oligozoospermia and asthenospermia. Patients first underwent non-invasive tests such as Doppler and echo-Doppler tests. According to the Authors experience, Doppler speedometry is decisive for the diagnosis of both idiopathic and subclinical varicocele, for the post-operative control of microsurgical anastomosis, and for the intra-operative detection of accessory spermatic veins. The surgical technique used by the Authors is the modified Palomo technique, but other techniques are investigated as well. Post-operative results, concerning both spermiogram and relapses are also evaluated.

[A case of renal infarction: clinical and anatomic contribution]

A case of renal infarction presenting with acute abdomen is reported. Due to the extended renal damage nephrectomy was performed. Macroscopic appearance of the kidney (prevalent cortical vascular infarction) and of the surrounding tissues (retroperitoneal edema and abdominal ascites) suggested a comparison with epidemic haemorrhagic fever. Vascular supply to the kidney, in such cases, depends on the perforating arteries which may increase in number and size.

Preparation and characterization of four new variously deacetylated lysogangliosides, breakdown products of GM1

Four new deacylated lysogangliosides were obtained through alkaline hydrolysis of either C18 or C20 sphingosine homologues of GM1. By this procedure, both the fatty acids residue and the N-acetyl group of sialic acid were removed to give mono-N-acetyl-lysoGM1 (C18 and C20); the additional loss of the N-acetyl group of the acetylgalactosamine moiety gave de-N-acetyl-lysoGM1 (C18 and C20) with three free amino groups. The structures of four deacetylated lysogangliosides were unambiguously characterized by chemical analysis and 1H and 13C NMR spectroscopy as well as by negative ion FABMS. The aim of this study was to isolate pure breakdown products of gangliosides, enabling the evaluation of the mechanism of action of glycosphingolipids through their cleavage and identification of structures of potential pharmacological activity. These new substances were prepared as candidates to influence eicosanoid production and the mechanisms dependent on protein kinase C and phospholipase A2.

[Ultrasonography and the kidney: a screening method?]

The Authors retrospectively analyzed 733 hepatic U.S. involving non symptomatic urologic patients. The study detected 23 renal cysts, 3 lithiasis (with associated hydronephrosis in two) and 3 kidney neoplasms. It is concluded that U.S. represents a reliable and useful screening method for renal carcinoma, therefore it should be routinely adopted.

[Formation of calculi on a double J catheter]

A case of lithiasis due to indwelling double J ureteral stent is described. Pathogenesis and possibilities of prevention are discussed.

[Adjuvant chemotherapy in carcinoma of the bladder: current results and prospects]

Adjuvant chemotherapy is one of the latest and more promising modality of cancer treatment within the multidisciplinary approach to neoplasms. This paper illustrates the biological rationale as well as preliminary evaluation of its effectiveness for bladder carcinoma.

[Treatment of stenosis of the posterior urethra using Sachse's urethrotome]

The authors suggest to treat the stenosis of the posterior urethra with a technique able to prevent relapses as much as possible. For this reason they recommend the improved technique of Sachse as the more suitable, avoiding, though, irritative stimuli (resections and indwelling catheters).

[Thyroid cancer and its incidence in nodular thyroid diseases: our experience]

The authors report their experience with 453 cases of thyroid nodules observed over a period of 5 years. The intention was to determine the incidence of malignant lesions. A female prevalence of the nodular pathology was clearly evident (7.2%), with a maximum incidence between the 3rd and 6th decade. Among malignant tumors (14.2%) the following histologic types were most frequently found: papillary adenocarcinoma (5.7%), follicular adenocarcinoma (2.7%), occult cancer (2.7%), anaplastic cancer (2.3%). Up to the 4th decade female prevalence was clearly evident (Max in the 3rd decade; F/M ratio = 6.5); then an increased male incidence was registered bringing to a reduction of the F/M ratio (1.5 in the 5th and 6th decade) and to its inversion in the 7th decade (M/F = 1.25).

[Risk factors and multicentricity of vascular atherosclerotic disease. Our experience]

The objective of this study is the identification of the most important risk factors of atherosclerosis and the determination of its multicentricity, the goal being an efficient primary and secondary prevention of this disease. Over the course of eight years, at the Department of Diagnosis and Surgical Physiopathology of Peripheral Vascular Diseases, 829 subjects with atherosclerosis were examined, of whom 513 males and 316 females between 18 and 85 years old, as well as to 200 healthy control subjects. The risk factors in consideration were: age, sex, hypertension, diabetes, lipoidoproteinosis, smoking, alcohol and coffee intake. From the data obtained it was revealed that smoking represents the most important risk factor for atherosclerosis (65% of the cases, 40% of the controls), followed in decreasing order by hypertension (31% of the cases, 6% of the controls), diabetes (26% of the cases, 2% of the controls), lipoidoproteinosis (15% of the cases, 6% of the controls). Furthermore 21% of the subjects drank coffee and 28% ingested alcoholic beverages, compared with, respectively 19% and 24% of the controls. In 70% of the cases the presence of atherosclerotic lesions were found in more than one vascular region. Atherosclerosis has a multifactorial etiology as there exists a correlation between the predisposition of the patient to acquire the disease and environmental factors. It is difficult to distinguish the determining effects of a single risk factor, because often many risk factors are tightly interrelated in the same individual; a nearly direct relationship clearly exists between the number and entity of the risk factors and the clinical picture of the patient examined.(ABSTRACT TRUNCATED AT 250 WORDS)

[Spinal cord ischemia following subrenal aortic clamping]

The paraplegia caused by an aortic clamping just below the Renal artery is a rare but very complication in aortic surgery. Such a complication is even rarer if we consider the few cases reported in literature following a reconstructive surgery for occlusive chronic diseases of aortiliac axes. The authors have studied the case of a patient bearing the syndrome of Leriche; this one had an aortic clamping below the kidney and soon after developed an acute ischaemic syndrome below the spinal medulla with flaccid paraparesis, anal and vesical sphincteric diseases and persistence of deep tactile sensibility. After a reconstruction of vascular anatomy of the medulla they emphasize the importance, in such a disease, of the "arteria radicularis magna" of Adamkievicz and its place of origin. After they discuss the severe physioopathologic moments that are connected: with the direct ischaemia following aortic clamping in the cases where the arteria radicularis magna rises at a level lower than the clamping itself; with the embolism or thrombosis caused by surgical manipulation peroperatively (it might be the cause of paraplegia more frequent in aneurysmectomia surgery); with the severe hypotension per- and post operatively for the existence of arteriosclerotic disease of the lumbar arteries. Finally they analyses preoperatively diagnostic possibilities and per operatively methods used in preventing this sort of complication.

[Urethrocystography with and without a chain in cervico-urethral diseases]

The Authors evaluate cystourethrography with and without chain as a method to study urethral diseases. Indications and complications are considered positively, because they allow an easy and safe control of the cases operated.

[A case of so-called prostatic hypertrophy with endovesical projection of the lateral lobes]

A case of benign prostatic hyperplasia with lateral lobes large involvement is reported. On the basis of their own experience and a review of the literature the role of hormonal synergism in the development of the condition is outlined.

Contact dermatitis to Alstroemeria

A study was carried out on 50 workers in a floriculture centre to evaluate the incidence of contact dermatitis to Alstroemeria. 3 subjects gave positive reactions to aqueous and ethanolic extracts of cut flowers, stems and leaves. By column chromatography, the allergen was isolated and its chemical structure identified as 6-tuliposide A by proton magnetic resonance and carbon-13 magnetic resonance. Only 6-tuliposide A was isolated from cut flowers, and this gave positive reactions when patch tested at 0.01%; a-methylene-gamma-butyrolactone at 10(-5) (v/v) was positive in the same 3 subjects. Other lactones (gamma-methylene-gamma-butyrolactone, alantolactone, isoalantolactone) were negative at all concentrations used.

[Combined surgical and medical treatment of pilonidal cysts and fistulae as prevention of recurrence]

The possibility of reducing the incidence of postoperative recurrences of pilonidal fistulas by using preoperative doses of Cephoxitine and primary surgical closure is described.

Preparation of 3-mercaptolactic acid and S-aminoethylmercaptolactic acid

A simple and accurate method is described for synthesis of 3-mercaptolactic acid and its derivative, S-aminoethylmercaptolactic acid. Some spectrometric data of compounds are reported as well as their melting points, some colorimetric reactions and thin layer chromatographic behaviour. S-Aminoethylmercaptolactic acid is also determined by amino acid analyzer.

Iridoids, XXIX - Sinuatol (6-O-alpha-L-rhamnopyranosylaucubin) from Verbascum sinuatum

From the aerial part of Verbascum sinuatum L. a new iridoid diglycoside III has been isolated and its structure elucidated as 6-0-alphaL-rhamnopyranosylaucubin.