"If not, why not?". I fattori umani nella pratica medico-chirurgica

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Capnography and the Bispectral Index—Their Role in Pediatric Sedation: A Brief Review

Sedation in children is increasingly emerging as a minimally invasive technique that may be associated with local anaesthesia or diagnostic and therapeutic procedures which do not necessarily require general anaesthesia. Standard monitoring requirements are not sufficient to ensure an effective control of pulmonary ventilation and deep sedation. Capnography in pediatric sedation assesses the effect of different drugs on the occurrence of respiratory failure and records early indicators of respiratory impairment. The Bispectral index (BIS) allows the reduction of dose requirements of anaesthetic drugs, the reduction in the time to extubation and eye opening, and the reduction in the time to discharge. In the field of pediatric sedation, capnography should be recommended to prevent respiratory complications, particularly in spontaneous ventilation. The use of the BIS index, however, needs further investigation due to a lack of evidence, especially in infants. In this paper, we will investigate the role of capnography and the BIS index in improving monitoring standards in pediatric sedation

Urologic surgery in gynecologic oncology: a large single-institution experience

The increasing tendency to a tailored treatment in gynecologic oncology has required the extension of the intervention to other non-gynecological structures, as the urinary district. Moreover the role of the urological surgery in gynecologic oncology is still not completely explored. The objective of the study is to evaluate the occurrence of urological procedures in gynecologic oncology surgery

Benign prostatic hyperplasia: correlations between receptor density and binding affinity of alpha(1)-adrenoceptors and several clinical parameters.

The aim of the study was to determine whether relations do exist between the concentration and activity of alpha(1)-adrenoceptors, both inside the prostatic adenoma and the periurethral zone corresponding to the bladder neck, and clinical and biological parameters such as symptoms, evaluated by the American Urological Association (AUA) score, age, weight of the prostate, PSA, and the flow rate. Twenty patients with symptomatic benign prostatic hyperplasia were selected for an open prostatectomy. One gram of tissue was dissected from inside the adenoma and 1 g from the periurethral zone corresponding to the bladder neck. The alpha(1)-adrenoceptors were evaluated for the apparent dissociation constant (K(d)) and the maximal number of binding sites (B(max)). A correlation seems to exist between receptor density inside the adenoma and the bladder neck and an inverse correlation between receptor density and the AUA total symptoms score. Finally, a highly significant difference was found in patients with an AUA score of 15. No relationship was found between receptor binding affinity and the considered clinical parameters

An introduction to biomaterials in urology

Aim of this paper is to provide a brief introduction on the biomaterials used in urology, discussing issues of biocompatibility and biomaterials available for use. Information will moreover be provided on basic elements of Tissue engineering and Regenerative medicine, rapidly advancing technologies that could finally shift in the next future from the laboratory to clinical practice, with special interest to possible urological application

Penile curvature: an update for management from 20 years experience in a high volume centre

Our aim was to review the literature and discuss about penile curvature in order to have an update for management after 20 years experience in the field.Penile curvature may be congenital or acquired. Congenital penile curvature is a relatively uncommon condition that may present in late adolescent or early adult life. The incidence is estimated to be 0.6 %. On the other side, acquired penile curvature has an overall prevalence of 0.5-13%. Three main factors seem to increase the risk of developing an acquired penile curvature, often related to Peyronie's disease: penile traumatism, genetic and familiar conditions and a history of diseases of the genital tract. In treating Peyronie's disease, no medical therapy is fully effective, and surgery remains the gold standard in cases of severe deformity and/or erectile disfunction. Peyronie's disease is associated with significant psychological stress for patients and their partners. Appropriate treatment should be individualized and tailored to the patient's goals and expectations. There is not the 'best' surgical technique and outcomes are satisfactory when proper treatment decisions are made

The Risk of Chronic Kidney Disease Associated With Urolithiasis and its Urological Treatments: a Review

PURPOSE: Urolithiasis can impair kidney function. This literature review focuses on the risk of kidney impairment in stone formers, the specific conditions associated with this risk and the impact of urological surgery. MATERIALS AND METHODS: The PubMed and Embase databases were searched for publications on urolithiasis, its treatment, and the risk of chronic kidney disease (CKD), end-stage renal disease (ESRD) and nephrectomy in stone formers. RESULTS: In general, renal stone formers carry twice the risk of CKD or ESRD, and for female and overweight stone formers the risk is even higher. Patients with frequent urinary tract infections, struvite stones, urinary malformations and diversions, malabsorptive bowel conditions, and some monogenic disorders are at high risk of CKD/ESRD. Shock wave lithotripsy or minimally-invasive urological interventions for stones do not adversely affect renal function. Declines in renal function generally occur in patients with pre-existing CKD or with a large stone burden requiring repeated and/or complex surgery. CONCLUSIONS: Although the effect size is modest, urolithiasis may cause CKD thus it is mandatory to assess patients with renal stones for their risk of developing CKD/ESRD. We suggest that all guidelines dealing with renal stone disease should include assessing this risk

Test F+10 SP: un nuovo metodo angioscintigrafico per la diagnosi dell'uropatia ostruttiva

Scopo del lavoro Lo scopo del nostro studio è stato quello di valutare i risultati ottenuti nella diagnosi differenziale tra condizione di ostruzione e di non ostruzione in casi di dilatazione dell’alta via urinaria, confrontando il metodo della scintigrafia renale con paziente in clinostatismo ed iniezione di furosemide 15 minuti prima del radiofarmaco (test F-15 classico) e un nuovo protocollo con paziente in posizione seduta (SP=Sitting Position) ed iniezione di furosemide 10 minuti dopo quella del radiofarmaco (test F+10 SP). Materiali e metodi 34 pazienti con diagnosi ecografica di idronefrosi (in 7 casi bilaterale) sono stati sottoposti, con una settimana di intervallo, ai due esami angiofotoscintigrafici a confronto (F-5 classico ed F+10 SP). I tracciati sono stati analizzati tutti dallo stesso medico, non a conoscenza della storia clinica dei pazienti. I risultati sono stati classificati come: “normale”, “dilatazione non ostruttiva” (solo per test F+10 SP), “ostruzione”, “equivoco” e “non applicabile”. Risultati Nelle 68 unità renali arruolate nello studio, il test F+10 SP ha documentato condizione di normalità nel 30,8% dei casi (n=21), dilatazione senza ostruzione nel 30,8% (n=21) ed ostruzione nel 36,8% (n=25); un caso è risultato equivoco. Il test tradizionale F-15 ha documentato invece condizione di nomalità nel 51,5% dei casi (n=35), ostruzione nel 29,4% (n=20); non è stato applicabile nel 2,8% (n=2) ed è risultato equivoco nel 16,3% dei casi (n=11). Non sono state registrate complicanze con utilizzo del test F+10 SP mentre, durante il test F-15, 13 pazienti hanno lamentato senso di forte replezione vescicale, 1 ipotensione, 3 colica renale e 4 hanno abbandonato lo studio per il forte stimolo minzionale. Tutti i 20 renogrammi risultati “ostruiti” al test F-15 lo sono stati anche al test F+10 SP. Discussione Il metodo che proponiamo sembra risultare particolarmente vantaggioso nell’individuare l’eventuale ostruzione associata alla pielocalicectasia. Grazie infatti alla combinazione tra posizione seduta ed un ottimizzato utilizzo del Lasix, si è riusciti a diminuire sensibilmente la percentuale di esami refertati come “equivoci”, dal 16% del test classico a meno dell’1,5% del nuovo test (F+10 SP). Messaggio conclusivo Il test F+10 SP risulta ben tollerato dai pazienti e rappresenta uno degli strumenti più promettenti nella diagnosi differenziale tra ostruzione e non ostruzione nei casi di dilatazione delle alte vie urinarie