Search

Inflammatory Bowel Disease (IBD), which includes both Crohn's Disease (CD) and Ulcerative Colitis (UC), is a chronic idiopathic inflammatory disorder affecting the gastrointestinal tract. Extraintestinal manifestations (EIM) are common in patients with IBD, and occur in 6-47% of patients with CD or UC. EIM can involve organs other than the gastrointestinal tract such as skin, eyes, joints, biliary tract and kidneis. Renal and urinary involvement particularly occurs in 4-23% of patients with IBD. Among the renal complications of IBD, seconfary amyloidosis (AA-type, AAA) is a rare but serious complication. renal amyloidosis has been proven to be the most common lethal manifestation of IBD-associated amyloidosis, since renal involvement rapidly leads to end-stage renal failure. A few studies suggest that AAA is more prevalent in CD than in UC, mainly occurring in male patients with an extensive long-lasting and penetrating ddisease pattern. The therapeutic approaches of IBD-associated AAA are based both on control of the chronic inflammatory process that causes the production and storage of serum amyloid A (SAA), which is a precursor of the amyloid, as well as on destabilizing amyloid fibrils so that they can no longer maintain their pleated sheet configuration; however, in patients with end-stage renal disease, the only therapeutic options still available are hemodyalisis and renal transplantation. Whether effective treatment exists for AAA remain controversial.

Introduction: BCG maintenance for at least one year is the best regimen for prevention of recurrence and progression in high risk non muscle invasive bladder cancer (NMIBC), undergoing conservative approach. Noteworthy, a relevant number of patients do not complete the planned treatment interruption. Study aim was to analyze retrospectively the reasons of treatment. Patients and Methods: Consecutive patients affected by T1G3 BC, undergoing BCG maintenance for one year, according to the SWOG schedule (3 weekly instillations at 3, 6, 12 months) were included in this study. Connaught BCG (81 mg/50 ml) was given starting 1430 days after TUR. If toxicity occurred, treatment was postponed up to two weeks. No dose reduction was considered. The patients’ compliance with the treatment was analyzed. Results: Out of 160 patients, 148 (92.5%) completed the induction cycle. In 10 (6.3%) more patients a recurrence was detected. In 15 (9.4%) patients induction only was planned due to personal difficulties. In 123 patients (76.8%) maintenance for one year was planned. However, 8 patients never started and 67 (54.4%) completed only one year maintenance: 6 (4.8%) interrupted for toxicity and 9 (7,3%) for recurrence. Compliance decreased from 84.5% at 3 to 57,7% at 12 months, 56 (45.6%) patients not completing one-year. In particular 109 patients (83.8%) completed the maintenance at 3 and 88 (67.2%) at 6 months. Noteworthy, mild grade I BCG toxicity, not requiring therapy on urologists’ opinion, was recorded in 91 (74%) out of 123 patients in whom maintenance was planned. Main limit was the retrospective nature of the study. Conclusion: Maintenance interruption was due to moderate-severe toxicity in only 5% of the patients. The poor patient’s compliance was probably multifactorial, partially related to grade I toxicity, not taken into appropriate account by the urologists. A correct and periodical counselling with the patients undergoing BCG maintenance regimen could ameliorate the compliance to BCG.

Donna di 46 anni con ritenzione urinaria acuta e stipsi. Presentava piccola vescicola sul dorso del piede sinistro quale unica manifestazione di localizzazione di virus Herpes Zooster a livello sacrale S1. Viene riportato l'esame urodinamico e le risultanze dei test sierologici seriati specifici per l'infezione da virus Varicella Zooster. La paziente è guarita a seguito di terapia specifica con Acyclovir. Il caso riportato dimostra che anche il segmento sacrale S1 contribuisce al controllo della dinamica minzionale

The preferred surgical treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP) is represented by proctocolectomy with ileal pouch-anal anastomosis (IPAA). However, patients with UYC who have undergone IPAA are prone to develop several complications, which include surgery related/mecchanical complications; inflammatory or infectious disoreders; dysplasia or neoplasia; and systemic or metabolic disorders. Pouchitis, which is defined as the acute and/or chronic inflammation of the ileal reservoir, represent the most common long-term adverese sequela after IPAA. Gut microbiota play a pivotal role in the initiation and disease progression of pouchitis. Pouchitis can be classified according to the activity of the disease, the duration of the symptoms, the pattern of the disease or response to antibiotic therapy. Patients with IPAA for UC tend to experience a variety of symptoms that may eventually lead to pouch excision thereby necessitating the construction of a permanent ileostomy. To date, the ethiology, the diagnosis and the medical management of pouchitis represent a clinical challenge. In fact pouchitis range from a disease with an acute antibiotic-responsive presentation to a chronic antibiotic-refractory form, with subsequent different disease mechanism and clinical course. A tridimensional and multidisciplinar approach, including endoscopy, histology, and laboratory testing is widely helpful to identify the diferent phenotypes of the disease and to manage correctly its treatment.

A Fortran computer algorithm has been used to analyze the nucleotide sequence of several structural genes. The analysis performed on both coding and complementary DNA strands shows that whereas open reading frames shorter than 100 codons are randomly distributed on both DNA strands, open reading frames longer than 100 codons ("virtual genes") are significantly more frequent on the complementary DNA strand than on the coding one.These "virtual genes" were further investigated by looking at intron sequences, splicing points, signal sequences and by analyzing gene mutations. On the basis of this analysis coding and complementary DNA strands of several eukaryotic structural genes cannot be distinguished. In particular we suggest that the complementary DNA strand of the human e{open}-globin gene might indeed code for a protein. © 1981 IRL Press Limited.

Computer programs, implemented on an Univac II00/80 computer system, for the identification and characterization of protein coding genes and for the analysis of nucleic acid sequences, are described. © 1984 IRL Press Limited.

Introduction: Does a correlation exist between smoking cessation and recurrence of non muscle invasive bladder carcinoma (NMI-BC) after TUR and adjuvant intravescical chemotherapy? Up today just few retrospective studies tried to answer this question. There is evidence that quitting decreases the risk of recurrence but nowadays it is still controversial how and how long it takes from quitting to reduce the risk (1-3). The aim of the present study is to compare the recurrence rate in smokers, non smokers and former smokers and in particular to evaluate if and how the decision of quitting at diagnosis could change the patients’outcome. Patients and Methods: We retrospectively analyzed the outcome in term of recurrence in patients affected by primary NMI-BC. Our population consisted of 373 patients, mean age of 66 (range 30-95) years. We considered as smokers the patients still smoking at the time of the diagnosis of primary NMI-BC, former smokers all the patients who quitted before diagnosis and never smokers all other patients. The smokers were divided into in current smokers continuing to smoke after diagnosis and ex smokers quitting only at diagnosis. The duration of smoking, the number of cigarettes per day and the clinical and pathological characteristic of the patients, were related to the recurrence rate. Results: Out of the 373 patients, 190 (50.9%) were smokers, 99 (26.5%) former smokers and 84 (22.5%) never smokers. Sixtyfive (17.4%) out of 190 smokers quitted at diagnosis. At 3 years 185 (49.6%) patients recurred. During follow up the recurrence rate increased from 11,3% at 3 months to 49.6% at 36 months. The recurrence rates at 3 and 6 months were higher in former smokers, 17.2% and 24.2% respectively, than in never smokers, 9.5% and 19% and smokers 9% and 21%. At one year, 75 (39.5%) smokers, 35 (35.3%) former smokers and 29 (34.5%) never smokers recurred. Among smokers at 3 months 5 (7.7%) ex smokers and 12 (9.6%) current smokers, (p=0.79) recurred; and at 6 months 13 (20%) and 27 (21.4%) recurred respectively (p=0.85). Similar results were observed at one year, with 23 (35%) ex smokers and 51 (40%) current smokers recurring (p=0.87) while at 3 years 29 (44.6%) ex smokers and 68 (54%) smokers (p=0.22) recurred. A progressive increase in recurrence rate, particularly in current smokers was observed, not reaching statistical significance due to the small numbers of our preliminary study. Discussion and Conclusion: In patients with non muscle invasive bladder cancer former smokers and smokers have similar recurrence rates. However to stop smoking at diagnosis reduces the risk of recurrence compared to patients continuing to smoke. The benefit however appears after 12 months only. References 1 Aveyard P, Adab P, Cheng KK et al: Does smoking status influence the prgnosis of bladder cancer? A systematic review. BJU Int 90: 228-239, 2002. 2 Serretta V, Morgia G, Altieri V et al: A 1-year maintenance after early adjuvant intravescical chemotherapy has a limited efficacy in preventing recurrence of intermediate risk non- muscle-invasive bladder cancer. Brit J Urol Int 106: 212-217, 2010. 3 Chen CH, Shun CT, Huang KH et al. Stopping smoking might reduce tumour recurrence in non muscle-invasive bladder cancer. BJU Int 100(2): 281-286, 2007.

Purpose We report the results in patients with obstructed upper pole ectopic ureters in duplex systems undergoing dismembered extravesical reimplantation of the upper pole ureter alone. Methods Between 01/2007 and 03/2012, 11 patients with an upper pole ectopic ureter (1 bilateral) diagnosed following the antenatal detection of hydronephrosis and showing preserved function on renal scintigraphy in a dilated upper moiety, underwent a dismembered reimplantation of the ectopic upper pole ureter as follows. The ureter was identified, separated from the lower pole ureter, and divided just above the bladder. The distal stump was suture closed, while the proximal segment was mobilized, tapered as necessary, and reimplanted using an extravesical technique. Results Twelve ectopic ureters were reimplanted. Median (range) patient age at surgery was 8 (3–48) months. Ureteral tapering was performed in 11 ureters, by infolding in 9 and using an excisional tailoring in the single case undergoing bilateral reimplantation. After a median (range) follow-up of 17 (6–50) months, all patients were asymptomatic. Eleven reimplanted ureters showed improving hydroureteronephrosis, no obstruction on diuretic scintigraphy, and no evidence of reflux on indirect radionuclide cystography. One reimplanted ureter developed worsening hydroureteronephrosis after excisional tailoring of the ureter and partial nephrectomy was performed. Conclusions Extravesical reimplantation of the upper pole ureter is an option in dilated upper pole ectopic ureters with good function. Separating the upper and lower pole ureters proximally to the bladder does not jeopardize the ureteral blood supply and allows leaving the lower pole ureter undisturbed. Excisional ureteral tailoring should be avoided.