Incidence of Prostate Cancer in Sicily: Results of a Multicenter Case-Findings Protocol

OBJECTIVE

To establish the incidence of prostate cancer (PCa) in Sicily in patients who entered an early detection protocol.

METHODS

From February 2002 to February 2004, 16,298 subjects aged 40-75 entered the protocol. Patients with suspicious DRE, PSA>10 ng/ml, PSA<or=2.5 ng/ml, from 2.6 to 4 ng/ml or from 4.1 to 10 ng/ml with F/T PSA of <or=15%, <or=20% and <or=25% respectively underwent needle biopsy according to an extensive protocol.

RESULTS

3266 patients were eligible for biopsy; PSA was <or=4 in 12.7% and <or=10 ng/ml in 63.9% of patients. A PCa was found in 1171 cases (36.9%) with a relationship between PCa incidence and PSA and age respectively (chi2-test, p<0.0001); 51.8% of patients with PCa had a PSA<10 and 8.8% a PSA<4 ng/ml; 49% were clinically staged as T1c. The estimated odds ratios for each age group showed increased risk for PCa in the fourth decade with PSA between 2.6 and 4 ng/ml (12.5 times higher) and in the fifth decade with PSA between 4.1 and 10 ng/ml (6.2 times higher).

CONCLUSIONS

Age and serum PSA levels are the major risk factors for PCa. On their basis it is possible to modulate the most suitable timing for early diagnosis in individual patients.

Deep venous thrombosis in patients undergoing salvage radical cystectomy

OBJECTIVE

The possible occurrence of venous thrombosis in tumor-bearing patients had already been reported by Trousseau in the past century. The blood clotting alterations in cancer-bearing patients can cause Deep Venous Thrombosis (DVT), especially in those patients with disseminated metastases. Anti-tumor chemotherapy can increase the risk of thrombosis. Herein we report our past experience on a sample of patients who underwent pelvic surgery to treat infiltrating bladder tumors.

METHODS

We have retrospectively analyzed the records of patients with infiltrating bladder tumors who underwent salvage radical cystectomy.

RESULTS

We observed the highest incidence of DVT (33.3%; 3 out of 9) in those patients with a higher risk due to anesthesia and an absolute need for extensive surgery. One of our patients died of pulmonary embolism.

CONCLUSION

The diagnosis of DVT and Pulmonary Embolism is not always easy to achieve and all possible tests must be performed whenever possible (e.g. clinical examination, hematological test, etc.).

The relationship between wine consumption and cardiovascular risk: from epidemiological evidence to biological plausibility

Epidemiological studies have suggested that cardiovascular disease morbidity and mortality can be decreased by moderate alcohol consumption. Several recent studies have also separately assessed the relative risk associated with different types of alcoholic beverages. The evidence obtained strongly suggests, although does not prove, that there is a major beneficial effect from drinking a low-moderate amount of wine. A meta-analysis has recently been performed on 19 of these studies, selected on the basis of the availability of specific information on the relative risk associated with wine consumption. The results indicate a negative association of moderate (up to 300 ml per day) wine consumption with the risk of cardiovascular events. Although some cardioprotective effects of alcoholic beverages are probably due to ethanol-induced elevation of HDL cholesterol, lowering of fibrinogen plasma levels and, perhaps, of platelet aggregation, it is reasonable to speculate that the cardiovascular protective effects of wine, observed in French and in other populations, may be attributed in part to the antioxidant, vasorelaxant, and antithrombotic properties of its polyphenolic components.

Platelet/polymorphonuclear leukocyte interaction: P-selectin triggers protein-tyrosine phosphorylation-dependent CD11b/CD18 adhesion: role of PSGL-1 as a signaling molecule

Polymorphonuclear leukocyte (PMN) adhesion to activated platelets is important for the recruitment of PMN at sites of vascular damage and thrombus formation. We have recently shown that binding of activated platelets to PMN in mixed cell suspensions under shear involves P-selectin and the activated beta2-integrin CD11b/CD18. Integrin activation required signaling mechanisms that were sensitive to tyrosine kinase inhibitors.1 Here we show that mixing activated, paraformaldehyde (PFA)-fixed platelets with PMNs under shear conditions leads to rapid and fully reversible tyrosine phosphorylation of a prominent protein of 110 kD (P approximately 110). Phosphorylation was both Ca2+ and Mg2+ dependent and was blocked by antibodies against P-selectin or CD11b/CD18, suggesting that both adhesion molecules need to engage with their respective ligands to trigger phosphorylation of P approximately 110. The inhibition of P approximately 110 phosphorylation by tyrosine kinase inhibitors correlates with the inhibition of platelet/PMN aggregation. Similar effects were observed when platelets were substituted by P-selectin-transfected Chinese hamster ovary (CHO-P) cells or when PMN were stimulated with P-selectin-IgG fusion protein. CHO-P/PMN mixed-cell aggregation and P-selectin-IgG-triggered PMN/PMN aggregation as well as P approximately 110 phosphorylation were all blocked by antibodies against P-selectin or CD18. In each case PMN adhesion was sensitive to the tyrosine kinase inhibitor genistein. The antibody PL-1 against P-selectin glycoprotein ligand-1 (PSGL-1) blocked platelet/PMN aggregation, indicating that PSGL-1 was the major tethering ligand for P-selectin in this experimental system. Moreover, engagement of PSGL-1 with a nonadhesion blocking antibody triggered beta2-integrin-dependent genistein-sensitive aggregation as well as tyrosine phosphorylation in PMN. This study shows that binding of P-selectin to PSGL-1 triggers tyrosine kinase-dependent mechanisms that lead to CD11b/CD18 activation in PMN. The availability of the beta2-integrin to engage with its ligands on the neighboring cells is necessary for the tyrosine phosphorylation of P approximately 110.

Effect of trans-resveratrol, a natural polyphenolic compound, on human polymorphonuclear leukocyte function

1. Polymorphonuclear leukocytes (PMN) may contribute to the pathogenesis of acute coronary heart disease (CHD). 2. Epidemiological and laboratory evidence suggests that red wine, by virtue of its polyphenolic constituents, may be more effective than other alcoholic beverages in reducing the risk of CHD mortality. 3 The aim of the present study was to investigate the effects of trans-resveratrol (3,4',5-trihydroxy-trans-stilbene), a polyphenol present in most red wines, on functional and biochemical responses of PMN, upon in vitro activation. 4. trans-Resveratrol exerted a strong inhibitory effect on reactive oxygen species produced by PMN stimulated with 1 microM formyl methionyl leucyl phenylalamine (fMLP) (IC50 1.3+/-0.13 microM, mean+/-s.e.mean), as evaluated by luminol-amplified chemiluminescence. 5. trans-Resveratrol prevented the release of elastase and beta-glucuronidase by PMN stimulated with the receptor agonists fMLP (1 microM, IC50 18.4+/-1.8 and 31+/-1.8 microM), and C5a (0.1 microM, IC50 41.6+/-3.5 and 42+/-8.3 microM), and also inhibited elastase and beta-glucuronidase secretion (IC50 37.7+/-7 and 25.4+/-2.2 microM) and production of 5-lipoxygenase metabolites leukotriene B4 (LTB4), 6-trans-LTB4 and 12-trans-epi-LTB4 (IC50 48+/-7 microM) by PMN stimulated with the calcium ionophore A23187 (5 microM). 6. trans-Resveratrol significantly reduced the expression and activation of the beta2 integrin MAC-1 on PMN surface following stimulation, as revealed by FACS analysis of the binding of an anti-MAC-1 monoclonal antibody (MoAb) and of the CBRM1/5 MoAb, recognizing an activation-dependent epitope on MAC-1. Consistently, PMN homotypic aggregation and formation of mixed cell-conjugates between PMN and thrombin-stimulated fixed platelets in a dynamic system were also prevented by transresveratrol. 7. These results, indicating that trans-resveratrol interferes with the release of inflammatory mediators by activated PMN and down-regulates adhesion-dependent thrombogenic PMN functions, may provide some biological plausibility to the protective effect of red wine consumption against CHD.

The fascial muscle valve in continent ileal pouches: Preliminary results

This study aims at assessing a new type of continent cutaneous valve in terms of simplicity of construction and durability. The technique consists of making an ileal pouch with approx. 45 cm of detubularised intestine with the proximal 5 cm, reduced in calibre, anastomised to the skin through a fascial-muscle tunnel, thereby creating an unusual continence device. After 6 months, 2 of the 3 patients who were operated with this technique are continent and satisfied with the reservoir.

Bladder neck cysts: Report on 2 cases

– Bladder neck cysts arise from a central degeneration of von Brunn nidi and are found casually during ultrasound, explaining obstructive symptomatology of which the patient sometimes complains. Endorectal ultrasound is essential for identifying this pathology and for a differential diagnosis between the various cystic formations of the prostate and the urogenital sinus. This paper reports two recent clinical cases related to this pathology.

Salvage cystectomy

– Radical cystectomy is still the best treatment today for patients with infiltrating bladder cancer, despite it being burdened by a high mortality rate at five years in the most aggressive forms and by a high possibility of metastasisation. In symptomatic patients after radiotherapy for actinic cystitis (also recurring), and in patients over seventy years old in poor general condition with locally advanced neoplastic forms, salvage cystectomy and “palliative” cystectomy respectively are in our opinion the only methods capable of guaranteeing an acceptable residual quality of life. This work consists of a retrospective analysis of the 9 patients (2 women and 7 men) who, between 1994 and 1996, underwent salvage and/or palliative cystectomy. We report a low rate of intra-operative complications and mortality in the immediate post-operative period. Early and late complications were at an acceptable level.

Different requirement of intracellular calcium and protein kinase C for arachidonic acid release and serotonin secretion in cathepsin G-activated platelets

Previous studies have shown that platelet stimulation with cathepsin G rapidly results in cytoplasmic calcium ([Ca2+]i) increase and activation of protein kinase C (PKC). To elucidate the relationship between these two biochemical events and their relative contribution to the regulation of platelet response to cathepsin G, arachidonic acid (AA) release and serotonin (5HT) secretion were studied. Platelets made Ca2+-depleted and -permeable by treatment with A23187 were compared to intact platelets to better dissociate calcium changes from other receptor-stimulated events. AA release elicited by cathepsin G in intact platelets was prevented by the Ca2+ chelator BAPTA; in Ca2+-depleted, -permeable platelets AA was released in direct response to added Ca2+ and was not increased by simultaneous stimulation with cathepsin G. In intact platelets, PKC inhibition by Ro 31-8220 or PKC induction with PMA either enhanced or reduced, respectively, cathepsin G-induced AA release. Both BAPTA and Ro 31-8220 prevented 5HT secretion from intact platelets; however, in Ca2+-depleted, -permeable platelets, cathepsin G was able to evoke 5HT secretion and p47 phosphorylation independently of [Ca2+]i increase, both effects being hampered by Ro 31-8220. Ca2+ and PKC therefore regulate PLA2 activity and 5HT secretion in cathepsin G-stimulated platelets in a different manner: the former is mainly triggered by [Ca2+]i increase, while PKC represents the major factor in determining dense granule secretion.

Platelet/polymorphonuclear leukocyte interaction in dynamic conditions: evidence of adhesion cascade and cross talk between P-selectin and the beta 2 integrin CD11b/CD18

Adhesion between platelets and polymorphonuclear leukocytes (PMN) is a key event in thrombosis and inflammation. Double color fluorescence-activated cell sorter (FACS) analysis was used to determine the extent and kinetics of adhesion of thrombin-activated platelets to resting or activated PMN when mixed cell populations were incubated in dynamic conditions. Activated platelets bound very rapidly to PMN. Mixed cell conjugates reached a maximum at 1 minute and were reversible within 10 minutes. Platelet/PMN adhesion required both Ca2+ and Mg2+ and was markedly increased by the presence of Mn2+. The latter made mixed cell conjugates stable up to 10 minutes. Adhesion of platelets required metabolic activity of PMN and was abolished by tyrosine kinase inhibitors. Furthermore, adhesion of platelets to PMN resulted in binding of a monoclonal antibody (MoAb 24) known as beta 2 integrins "activation reporter." When PMN were activated by exogenous stimuli, the adhesion of platelets was markedly increased: fMLP induced a rapid and transient effect, while PMA resulted in a slower, but stable, increase in mixed conjugates formation. The hypothesis that activated PMN beta 2 integrins are able to bind a counter-receptor on platelets was directly demonstrated by the increase of mixed cell conjugates following PMN treatment with KIM127 and KIM185, two anti-CD18 antibodies able to induce the active conformation of beta 2 integrins. Consistently, two other anti-CD18, as well as an anti-CD11b inhibitory antibody abolished platelet/PMN adhesion. PMN beta 2 integrin activation was not the only mechanism for activated platelet/PMN adhesion to occur: indeed, this phenomenon could also be inhibited by two anti-P-selectin antibodies. Resting platelets did not adhere to resting PMN, but markedly adhered to fMLP- or PMA-activated PMN. Resting platelet/fMLP-activated PMN adhesion was abolished by anti-CD18 antibodies, but not by anti-P-selectin antibodies. In conclusion, activated platelet/PMN interaction can be modeled as an adhesion cascade involving a P-selectin-dependent recognition step and a functional signal. The latter proceeds through tyrosine kinase activation and enables a beta 2 integrin-dependent adhesion to a not yet identified counter-receptor constitutively expressed on platelet surface.

Un nomogramma per la rapida elaborazione della PSAD

The selective PSA marker of prostatic tissue plays an important role in diagnosing prostatic carcinoma. It should be evaluated together with the digito-rectal exploration (EDR) and trans-rectal ultrasound. PSA density (PSAD) is a further parameter for indicating whether it is advisable or not to subject the patient to needle biopsy. We developed a nomograph for this purpose which allows rapid visual interpretation during trans-rectal ultrasound.

Valore della trasfusione di sangue autologo in regime di predeposito nella chirurgia di elezione

The risks associated with the transfusion of homologous blood, plus a chronic lack of blood, have led doctors and patients to consider auto-transfusion schedules. In our opinion the pre-operative collection of blood is of primary social importance, as it involves a low percentage of risk with acceptable costs and countless advantages, not least that of avoiding homologous transfusions. The aim of this work is to show that autologous blood collections and transfusions in elective surgery must be rationalised in order to avoid a high percentage of autologous bags remaining unused in low-risk operations and conversely patients being obliged to receive homologous blood in high-risk operations.

The endoperoxides/TxA2 analogue, U46619, inhibits human polymorphonuclear leukocyte function

The effects of the stable analogue of TxA2, U46619, on polymorphonuclear leukocyte (PMN) function were investigated. U46619, at micromolar concentrations, inhibited fMLP-stimulated aggregation, beta-glucuronidase release, and superoxide production. fMLP-induced LTB4 synthesis was also inhibited. U46619 did not modify intracellular Ca2+ increase induced by fMLP in Fura-2-loaded PMN, suggesting that early events of cell activation were not involved. In fact, U46619 also inhibited aggregation, beta-glucuronidase release, superoxide anion and LTB4 production induced by the calcium ionophore A23187. By comparison with the specific 5-lipoxygenase inhibitor, L-663,536, which prevented LTB4 synthesis without affecting degranulation, we excluded the impairment of PMN function by U46619 as a consequence of the reduction of this endogenous agonist. TLC separation of lipid extracts from [3H]-AA-loaded PMN, stimulated by A23187, showed significant reduction of the radioactivity associated with authentic free AA, suggesting that U46619 could interfere with mechanisms regulating AA release from membrane phospholipids. This suggestion is also supported by the observation that manoalide, a standard inhibitor of phospholipase A2, similarly to U46619, inhibits beta-glucuronidase release from stimulated PMN. Prostaglandin endoperoxides, produced by cells participating in inflammatory reactions, might therefore play a role in modulating PMN activities.

Antiplatelet activity of 2-(6-carboxyhexyl)-3-n-hexylcyclohexylamine (IBI P-05006), a thromboxane receptor antagonist

2-(6-Carboxyhexyl)-3-n-hexylcyclohexylamine (IBI P-05006) is a molecule with cytoprotective and antisecretory actions. Since its chemical structure resembles that of the prostanoid nucleus of thromboxane (Tx) A2, the possibility of antiplatelet activity was investigated. The aims of our study were to evaluate a possible inhibitory effect of IBI P-05006 on in vitro platelet aggregation induced by different stimuli and to characterize its mechanism of action. For this purpose, selected mechanisms of platelet function were evaluated. IBI P-05006 inhibited platelet aggregation induced by arachidonic acid or U46619, at concentrations ranging from 0.4 to 4 microM, dose dependently, without interfering with arachidonic acid metabolism. The possibility that the compound acts through adenylate cyclase stimulation was ruled out by measurement of cAMP levels, which were not increased. Receptor binding studies indicated competitive inhibition by IBI P-05006 of the binding of the ligand [3H]SQ29548 to the TxA2/(prostaglandin) PG-cyclic endoperoxides receptor with IC50 in the range of concentrations active on platelet aggregation. In conclusion, IBI P-05006 inhibits in vitro human platelet aggregation through a specific mechanism of competition for the TxA2/PG-cyclic endoperoxides receptor.

Synthesis of some guanylhydrazones and imidazolinylhydrazones as thromboxane-synthase and platelet aggregation inhibitors

The imidazolinylhydrazones of (3-pyridinyloxy)-acetaldehyde and of 6-[3-(2-formyl-pyridinyl)oxy]hexanoic acid were synthesized as cyclic analogues of the corresponding guanylhydrazones which were found to be selective inhibitors of human thromboxane-synthase. The benzene isosters were also prepared in order to define the importance of the ring nitrogen for the activity. Moreover, the guanyl- and imidazolinyl-hydrazones of two 6-[(3-pyridinyl)oxy]hexanoic acids showing in the 2 position an alkyl chain with an alpha, beta-unsaturated ketonic function were prepared. Imidazolinylhydrazones 7 and 18 are selective inhibitors of thromboxane-synthase, while the two guanylhydrazones 14 and 15 which do not affect prostanoid biosynthesis seemed to be antagonists at the thromboxane receptor.

Development of a mass spectrometric method to quantitate platelet activating factor in mouse urine

Platelet activating factor (PAF) is a lipid mediator of inflammation released by a variety of stimulated inflammatory cells. It may be involved in immune glomerulonephritis. Thus, its measurement in urine could give information on the mechanism of this disease. We present here a method to measure PAF in mouse urine, using gas-liquid chromatography-mass spectrometry (GLC-MS) in the selected ion recording (SIR) mode. Before instrumental analysis, the extracted and purified samples were hydrolyzed and derivatized with pentafluorobenzoyl chloride. Different experimental conditions are presented and discussed to corroborate the analytical findings. PAF levels in mouse urine were 2.08 +/- 0.46 ng/24 h. This procedure might represent a new experimental tool to establish the possible role of PAF as mediator of tissue damage in renal disease.

A gas chromatographic mass spectrometric assay for the determination of aphidicolin in plasma of cancer patients

A gas chromatographic-mass spectrometric (GC-MS) method is described for the determination of the novel anticancer agent aphidicolin in plasma. The extraction was carried out in a solvent mixture of hexane:isopropanol (10:1) and the external standard aphidicolane was added after evaporation of the organic phase. The residue was then redissolved in a derivatizing mixture containing bis(trimethylsilyl)trifluoracetamide as sililating agent, pyridine, and trimethylchlorosilane, and allowed to react at 80 degrees C for 2 h. After GC separation of the derivatized samples, selected ion recording analysis was done, monitoring the ions at mass 523.3 and 448.3 for aphidicolin and aphidicolane, respectively. The mean recovery +/- SD of aphidicolin from plasma was 73.5 +/- 11.6% in the range from 5 to 800 ng. This method was applied to determine aphidicolin plasma levels in three cancer patients in Phase I clinical trials of aphidicolin-17-glycinate administered as a 1-h iv infusion. Two patients received dose of 290 mg/m2 and the third received 435 mg/m2. Aphidicolin plasma levels at the end of infusion were very low, and the drug rapidly disappeared from plasma with a terminal (beta) half-life of 2 h.

Uremic vagal neuropathy: has parathyroid hormone a pathogenetic role?

Cardiac vagal reflexes were investigated in 19 dialysis patients, with the aim of verifying whether parathyroid hormone, proposed as an important uremic neurotoxin, plays a role in the development of uremic vagal neuropathy. The results indicate that parasympathetic control of heart function is frequently impaired in uremics. Plasma parathyroid hormone levels were significantly correlated with the time on dialysis. However, a correlation between autonomic disturbances and plasma parathyroid hormone concentrations was not found in this study.