University Vita-Salute Research Articles

Enhanced depth imaging optical coherence tomography findings associated with serous retinal detachment in preeclampsia

Preeclampsia is characterized by hypertension, proteinuria, and edema occurring in the second half of pregnancy. The main ocular manifestations are related to dysfunction of both retinal and choroidal circulation [1, 2]. Similarly to hypertensive retinopathy, cotton wool spots, hemorrhages, edema, papilloedema, serous retinal detachment and lesions of the retinal pigment epithelium (RPE) may develop in preeclampsia. Fluorescein angiography shows areas of choroidal hypoand nonperfusion (Elschnig spots) in preeclamptic women with serous retinal detachment [3, 4]. It has been proposed that intense spasm of the choroidal arterioles may be responsible for choroidal ischemia, resulting in increased vascular permeability, and subsequently, accumulation of serous fluid in the subretinal space [4]. We investigate the changes in the outer retina and choroid by means of enhanced depth imaging (EDI) [5] spectral-domain optical coherence tomography (SD-OCT) in a preeclamptic women with serous retinal detachment. A 38-year-old woman developed hypertension (190/ 110 mmHg), proteinuria, and generalized edema in the 35th week of pregnancy. Two days after undergoing a cesarean section, the patient was referred to our department for impairment of vision in both eyes. Best-corrected visual acuity was 20/25 in the right eye (RE) and 20/80 in the left eye (LE). Fundus biomicroscopy showed a peripapillary serous retinal detachment bilaterally, with involvement of the LE macula. Blue fundus autofluorescence (b-FAF) showed inhomogeneous increased autofluorescence in the peripapillary area, while near-infrared fundus autofluorescence (nirFAF) revealed peripapillary areas of hypoautofluorescence together with focal points of intensely decreased nir-FAF (Fig. 1). EDI SD-OCT scans through the areas of abnormal autofluorescence and the macula showed peripapillary serous retinal detachment bilaterally with focal RPE elevations, and serous macular detachment in the LE (Fig. 2). Choroidal thickness in the scan passing through the macula was 475 lm RE, 361 lm LE subfoveally, and 263 lm RE, 367 lm LE in the peripapillary area (Fig. 2) (increased compared with reference values) [5]. Two weeks later, BCVA improved to 20/20 in both eyes, and fundus biomicroscopy revealed disappearance of serous retinal detachment. b-FAF still showed increased autofluorescence in the peripapillary area, while nir-FAF revealed almost complete disappearance of both peripapillary areas of hypoautofluorescence and focal points of decreased nir-FAF (Fig. 1). EDI SD-OCT scans confirmed the disappearance of serous retinal detachment in both eyes, and showed persistence of focal RPE elevations (Fig. 2). Choroidal thickness in the scan passing through the macula was unchanged subfoveally, while decreased to 186 lm RE, 284 lm LE in the peripapillary area (Fig. 2). Previous reports have documented, by time domain OCT, the presence of serous retinal detachment in preeclamptic women [6]. To the best of our knowledge this is the first case study to describe the SD-OCT features of serous retinal detachment in preeclampsia. SD-OCT revealed focal RPE elevations in the peripapillary areas of abnormal FAF (both b-FAF and nir-FAF) suggesting compromised fluid transport (choroid-RPE-retina) in the acute phase of the disease, which persisted also after the resolution of both serous retinal detachment and focal L. Querques G. Querques (&) F. Loperfido R. Lattanzio F. Bandello Department of Ophthalmology, University Vita Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy e-mail: giuseppe.querques@hotmail.it

Germline TSC1 mutations are permissive for T lymphocyte development and homeostasis in Tuberous Sclerosis individuals.

Event Abstract Back to Event Germline TSC1 mutations are permissive for T lymphocyte development and homeostasis in Tuberous Sclerosis individuals. Karolina Pilipow1, 2*, Veronica Basso2, Nicola Migone3 and Anna Mondino2 1 Vita-Salute San Raffaele University, Italy 2 San Raffaele Scientific Institute, Italy 3 University of Turin, Department of Genetics, Biology and Biochemistry, Italy Antigen recognition on the surface of antigen presenting cells initiate a variety of intracellular signals critical for naïve T cells to commit to proliferate and differentiate. Others and we have shown the TSC/mTOR axis to be critical in coordinating cell quiescence, proliferation and fate determination. Blocking mTOR by Rapamycin, or genetic inactivation of components of the mTOR Complex (mTORC) or TSC1, unbalances mTORC1 and mTORC2 regulation, impacting on cell quiescence, proliferation and differentiation. In humans, germline mutations of TSC1 predispose to Tuberous Sclerosis Complex disease, an autosomal dominant disorder characterized by multifocal hamartomatosis. Whether such mutations impact on T cell functions in these individuals was unknown. To this aim we analyzed subset representation, phenotype and function of T cells from two independent families with characterized mutations of TSC1 in parallel to T cells from healthy volunteers and to mouse T cells with mono- or bilallelic deletion of Tsc1 (from T-lineage restricted Tsc1+/- and Tsc1-/- mice). We found that heterozygosis of Tsc1/TSC1 is sufficient for proper hamartin expression and both homeostatic and TCR-induced mTORC1 and mTORC2-dependent signaling in mice and human T cells. In contrast, loss of Tsc1/TSC1 following biallelic genetic inactivation and shRNA-induced down-regulation unbalanced mTORC-dependent FOXO1/3 regulation, leading to loss of mitochondrial potential apoptotic cell death. Thus, while heterozygosis of Tsc1/TSC1 is sufficient for proper T lymphocyte development and homeostasis, its more severe loss is incompatible with both mouse and human T cell survival. Acknowledgements The authors wish to thank TSC subjects and their family for support, members of the San Raffaele Scientific Institute for suggestions, Dr Rossella Galli for Tsc1 fl/fl mice, Dr Ruggero Pardi for CD4cre mice and Dr Vincenzo Calautti (Dulbecco Telethon Institute, Molecular Biotechnology Center, University of Turin) for the help with TSC1 shRNA. This work was supported by the Associazione Italiana Ricerca sul Cancro. KP benefited of fellowships from the San Raffaele Vita-Salute University and FIRC. Keywords: T lymphocytes, Intracellular signaling, TSC/mTOR, intrinsic apoptosis, Tuberous Sclerosis Complex Disease Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Adaptive Immunity Citation: Pilipow K, Basso V, Migone N and Mondino A (2013). Germline TSC1 mutations are permissive for T lymphocyte development and homeostasis in Tuberous Sclerosis individuals.. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.00976 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 27 Jun 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Karolina Pilipow, Vita-Salute San Raffaele University, Milan, Italy, kpilipow@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Karolina Pilipow Veronica Basso Nicola Migone Anna Mondino Google Karolina Pilipow Veronica Basso Nicola Migone Anna Mondino Google Scholar Karolina Pilipow Veronica Basso Nicola Migone Anna Mondino PubMed Karolina Pilipow Veronica Basso Nicola Migone Anna Mondino Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Commentary on “Early salvage radiation therapy does not compromise cancer control in patients with pT3N0 prostate cancer after radical prostatectomy: Results of a match-controlled multi-institutional analysis”. Briganti A, Wiegel T, Joniau S, Cozzarini C, Bianchi M, Sun M, Tombal B, Haustermans K, Budiharto T, Hinkelbein W, Di Muzio N, Karakiewicz PI, Montorsi F, Van Poppel H., Department of Urology, Vita-Salute

Commentary on “Early salvage radiation therapy does not compromise cancer control in patients with pT3N0 prostate cancer after radical prostatectomy: Results of a match-controlled multi-institutional analysis”. Briganti A, Wiegel T, Joniau S, Cozzarini C, Bianchi M, Sun M, Tombal B, Haustermans K, Budiharto T, Hinkelbein W, Di Muzio N, Karakiewicz PI, Montorsi F, Van Poppel H., Department of Urology, Vita-Salute

The Number of Cores Taken in Patients Diagnosed with a Single Microfocus at Initial Biopsy is a Major Predictor of Insignificant Prostate Cancer

Patients with a single microfocus of prostate cancer at initial biopsy represent the ideal candidates for active surveillance. We investigate whether the number of cores taken affects the concordance rate between microfocus of prostate cancer and the confirmation of a pathologically insignificant prostate cancer at radical prostatectomy. Data were analyzed from 233 patients with a single microfocus of prostate cancer at initial transrectal prostate biopsy (a single focus of Gleason 6 involving 5% or less of the core) subsequently treated with radical prostatectomy. The chi-square test, cubic spline analyses and logistic regression analyses were used to depict the relationship between the number of cores taken and the probability of confirming the presence of an indolent disease (pathologically confirmed insignificant prostate cancer defined as radical prostatectomy Gleason score 6 or less, tumor volume 0.5 ml or less and organ confined disease). Overall 65 patients (27.9%) showed pathologically confirmed insignificant prostate cancer at radical prostatectomy. The rate of pathologically confirmed insignificant prostate cancer was 3.8%, 29.6% and 39.4% in patients who underwent biopsy of 12 or fewer cores, 13 to 18 cores and 19 or more cores, respectively (p <0.001). After adjusting for the available confounders, age (p = 0.04), number of cores taken (p <0.001) and prostate specific antigen density (p <0.02) were independent predictors of pathologically confirmed insignificant prostate cancer. Of patients diagnosed with a single microfocus of prostate cancer the number of biopsy cores taken was a major independent predictor of having pathologically confirmed insignificant prostate cancer at radical prostatectomy. Therefore, when active surveillance is considered as a possible alternative in patients with microfocus of prostate cancer, the number of cores taken should be taken into account in decision making.

Ask the Experts: Treating diabetic retinopathy: developments and challenges

Francesco Bandello is Full Professor and Chairman at the Department of Ophthalmology University Vita-Salute, Scientific Institute San Raffaele (Milan, Italy). He is President Elect of EURETINA, Vice-President of Academia Ophthalmologica Europea and Vice-President of EuroLam. He is Associate Editor of the European Journal of Ophthalmology and a former board member of the Club Jules Gonin and Macula Society. He is a a member of the Academia Ophthalmologica Internationalis and Accademia Nazionale di Medicina. Professor Bandello is co-author of five books. He serves as a peer reviewer for grant applications for the National Eye Institute and has authored or co-authored over 159 articles, which are mainly related to retinal diseases. Rosangela Lattanzio is on the staff of the Department of Ophthalmology, S. Raffaele Hospital, University Vita Salute of Milano; she is head of Medical Retina Service-Vasculopathies, researcher for many clinical projects and principal investigator or co-investigator of several clin...

A research institute at a turning point

A research institute at a turning point

Spectral domain OCT versus time domain OCT in the evaluation of macular features related to wet age-related macular degeneration

BackgroundThe aim of this study was to compare the agreement between spectral domain optical coherence tomography (SD OCT) and time domain stratus OCT (TD OCT) in evaluating macular morphology alterations in wet age-related macular degeneration (AMD).MethodsThis retrospective study was performed on 77 eyes of 77 patients with primary or recurring subfoveal choroidal neovascularization secondary to AMD. All patients underwent OCT examination using Zeiss Stratus OCT 3 (Carl Zeiss Meditec Inc, Dublin, CA) and Opko OTI Spectral SLO/OCT (Ophthalmic Technologies Inc, Toronto, Canada). In all radial line scans, the presence of intraretinal edema (IRE), serous pigment epithelium detachment (sPED), neurosensory serous retinal detachment (NSRD), epiretinal membrane (EM), inner limiting membrane thickening (ILMT), and hard exudates (HE) were evaluated. The degree of matching was quantified by Kappa measure of agreement.ResultsThe percentage distribution of TD OCT findings versus SD OCT findings was: IRE 36.3% versus 77.9%, sPED 57.1% versus 85.7%, NSRD 38.9% versus 53.2%, EM 10.5% versus 26.3%, ILMT 3.8% versus 32.4%, and HE 6.4% versus 54.5%. The agreement was as follows: sPED: kappa value 0.15; NSRD: kappa value 0.61; IRE: kappa value 0.18; EM: kappa value 0.41; ILMT: kappa value 0.02; HE: kappa value 0.06.ConclusionThe agreement in the evaluation of macular lesions between the two techniques is poor and depends on the lesion considered. SD OCT allows better detection of the alterations typically related to choroidal neovascularization such as IRE, PED, ILM thickening, and HE. Consequently its use should be strongly considered in patients with wet AMD.

Preoperative Erectile Function Represents a Significant Predictor of Postoperative Urinary Continence Recovery in Patients Treated With Bilateral Nerve Sparing Radical Prostatectomy

The association between baseline functional status and urinary continence recovery after radical prostatectomy remains controversial. We tested the hypothesis that baseline erectile and urinary function predicts urinary continence recovery after bilateral nerve sparing radical prostatectomy. The study included 752 patients with prostate cancer treated with bilateral nerve sparing radical prostatectomy between 2003 and 2009. All patients had preoperative functional and oncological data available, including age at surgery, body mass index, prostate specific antigen, and erectile and urinary function. Preoperatively erectile and urinary function was assessed by the erectile function domain of the International Index of Erectile Function and the International Prostatic Symptoms Score. Urinary continence was defined as wearing no pads. Univariate and multivariate Cox regression models were used to test the association between predictors and urinary continence recovery after surgery. At a mean postoperative followup of 30.7 months (median 29, range 1 to 80) 611 patients (81.3%) had recovered urinary continence. Overall the urinary continence recovery rate at 1 and 3 years was 73.9% and 82.2%, respectively. On univariate Cox regression analysis patient age and the preoperative score on the erectile function domain of the International Index of Erectile Function were significantly associated with urinary continence recovery (each p ≤ 0.04). On multivariate analysis age at surgery and the preoperative erectile function domain of the International Index of Erectile Function were the only independent predictors of urinary continence recovery after bilateral nerve sparing radical prostatectomy (each p ≤ 0.04). Age and preoperative erectile function should be considered for urinary continence predictions after bilateral nerve sparing radical prostatectomy and for accurate patient counseling before surgery. Preoperative erectile function might be a marker of pelvic vascular disease, which may affect the status of the external urinary sphincter.

Sentinel lymph node and prognostic factors in gastric cancer

We would like to respond to the letter by Hanisch and Batsis entitled ‘‘Sentinel lymph node biopsy in laparoscopic surgical oncology’’ [1] in which some interesting concerns have been raised regarding the association of minimally invasive surgery and sentinel lymph node (SLN) navigation procedure described in our case report published in the September issue of Surgical Endoscopy [2]. In fact, there are several reservations in the application of SLN mapping in gastric cancer. Unexpected anatomical skip metastases might be accounted for by aberrant drainage routes from the primary lesion [3]. Unneglectable false-negative rates have been reported due to a number of factors. The most common one is the obstruction of lymphatic vessels due to cancer invasion. In these cases, the tracer is not able to reach the initial SLN and will be deviated to second tier or false SLNs. Other risk factors associated with false-negative SLN are surgeon inexperience, male gender, and a small number of SLNs (B3) [4]. The limitations of SLN navigation have been overcome with the restriction of its indication to early-stage cases, the introduction of technical improvements like the combination of dye-guided and radio-guided methods, and sentinel lymphatic basin dissection [5]. Some Eastern authors have proposed testing the SLN navigation association with conservative visceral resection such as function-preserving gastrectomy, endoscopic mucosal resection, or endoscopic submucosal dissection [6, 7]. This way, the morbidity and functional disturbances related to not only the extended lymphadenectomy but also to total or subtotal gastric resection are avoided. The attempts to reduce the adverse effects and invasiveness of early gastric cancer surgery are also translated in the association of SLN navigation with the laparoscopic procedure [8]. Such proposals should be substantiated by more consistent data. Reading carefully the letter of Hanisch and Batsis, it is possible to surmise that they did not see the possible operational or methodological caveats of our laparoscopic SLN navigation. Their final intention was not to discuss the conceptual limitations of the SLN procedure. The ultimate topic that they were trying to address was the lack of reliable prognostic markers in gastric cancer that would enable the correct modulation of surgical radicality in early-stage disease. They conclude that basic and translational research on genomics and epigenetics would provide not only the understanding of mechanisms underlying the tumor progression but also more robust predictive factors of long-term oncological outcome of gastric cancer. Gastric carcinogenesis is a multistep process involving genetic and epigenetic alteration of protein-coding proto-oncogenes and tumorsuppressor genes. Single nucleotide variants (SNVs), present as either germline or somatic point mutations, are essential drivers of tumorigenesis and cellular proliferation in many human cancer types because they were proven to be involved in DNA repair and tumor suppression [9]. Recent discoveries have shed new light on the involvement of a class of noncoding RNA known as microRNA (miRNA) in gastric cancer [10]. Genes coding these miRNAs have been characterized as novel protooncogenes and tumor-suppressor genes based on findings that these miRNAs control malignant phenotypes of gastric cancer cells. In this sense, miRNA dysregulation promotes cell-cycle progression [11], confers resistance to apoptosis [11, 12], and enhances invasiveness and metastasis [13]. Moreover, several miRNAs have also been shown to E. Orsenigo (&) S. Kusamura C. Staudacher Department of Surgery, University Vita-Salute San Raffaele, Via Olgettina, 60-20132 Milan, Italy e-mail: orsenigo.elena@hsr.it

Mortality reduction in cardiac anesthesia and intensive care: results of the first International Consensus Conference

There is no consensus on which drugs/techniques/strategies can affect mortality in the perioperative period of cardiac surgery. With the aim of identifying these measures, and suggesting measures for prioritized future investigation we performed the first International Consensus Conference on this topic. The consensus was a continuous international internet-based process with a final meeting on 28 June 2010 in Milan at the Vita-Salute University. Participants included 340 cardiac anesthesiologists, cardiac surgeons, and cardiologists from 65 countries all over the world. A comprehensive literature review was performed to identify topics that subsequently generated position statements for discussion, voting, and ranking. Of the 17 major topics with a documented mortality effect, seven were subsequently excluded after further evaluation due to concerns about clinical applicability and/or study methodology. The following topics are documented as reducing mortality: administration of insulin, levosimendan, volatile anesthetics, statins, chronic β-blockade, early aspirin therapy, the use of pre-operative intra-aortic balloon counterpulsation, and referral to high-volume centers. The following are documented as increasing mortality: administration of aprotinin and aged red blood cell transfusion. These interventions were classified according to the level of evidence and effect on mortality and a position statement was generated. This International Consensus Conference has identified the non-surgical interventions that merit urgent study to achieve further reductions in mortality after cardiac surgery: insulin, intra-aortic balloon counterpulsation, levosimendan, volatile anesthetics, statins, chronic β-blockade, early aspirin therapy, and referral to high-volume centers. The use of aprotinin and aged red blood cells may result in increased mortality.

Preoperative Criteria to Select Patients for Bilateral Nerve-sparing Robotic-assisted Radical Prostatectomy

To date, no study has analyzed the predictors of potency recovery in a robot-assisted laparoscopic radical prostatectomy (RALP) series. A novel risk stratification for erectile function recovery after retropubic radical prostatectomy (RRP) has been proposed recently by Briganti et al. from the University Vita-Salute San Raffaele in Milan, Italy. To evaluate the potency rate in a series of consecutive patients who underwent bilateral nerve-sparing RALP, to identify the preoperative predictors of erectile function recovery, and to validate the risk-group stratification of Briganti et al. The clinical records of all patients who underwent RALP for clinically localized prostate cancer between April 2005 and April 2009 were prospectively collected in the Prostate Cancer Padua Database. For the present study, we extracted all consecutive cases receiving a bilateral nerve-sparing technique with a minimum follow-up > or =12 months. Twelve-month potency rate after RALP, defined as an International Index of Erectile Function 6 (IIEF-6) score > or =18. Data showed that 129 out of 208 enrolled patients (62%) were potent 12 months after surgery. Age (hazard ratio [HR]: 2.8; P < 0.001), Charlson score (HR: 2.9; P = 0.007), and baseline IIEF-6 score (HR: 0.8; P < 0.001) were independent predictors of potency recovery at multivariate analysis. According to Briganti et al.'s risk-group stratification, the 12-month potency rate following RALP was 81.9% in the low-risk group, 56.7% in the intermediate-risk group, and 28.6% in the high-risk group (P < 0.001). In the era of robotic surgery, the key point for the success of the nerve-sparing technique remains the accurate selection of patients. Age < or =65 years, absence of associated comorbidities, and good preoperative erectile function are the most important preoperative factors to select those patients for whom bilateral nerve-sparing RALP can achieve the best results.

Kidney-Pancreas Transplantation Does Not Improve Retinal Arterial Flow Velocities in Type 1 Diabetic Uremic Patients

Kidney-Pancreas Transplantation Does Not Improve Retinal Arterial Flow Velocities in Type 1 Diabetic Uremic Patients

Commentary on Pelvic Lymph Node Dissection in Prostate Cancer: Briganti A, Blute ML, Eastham JH, Graefen M, Heidenreich A, Karnes JR, Montorsi F, Studer UE, Department of Urology, Vita-Salute University, Milan, Italy

Pelvic lymph node dissection (PLND) is considered the most reliable procedure for the detection of lymph node metastases in prostate cancer (PCa); however, the therapeutic benefit of PLND in PCa management is currently under debate. To systematically review the available literature concerning the role of PLND and its extent in PCa staging and outcome. All of the existing recommendations and staging tools determining the need for PLND were also assessed. Moreover, a systematic review was performed of the long-term outcome of node-positive patients stratified according to the extent of nodal invasion. A Medline search was conducted to identify original and review articles as well as editorials addressing the significance of PLND in PCa. Keywords included prostate cancer, pelvic lymph node dissection, radical prostatectomy, imaging, and complications. Data from the selected studies focusing on the role of PLND in PCa staging, and outcome were reviewed and discussed by all of the contributing authors. Despite recent advances in imaging techniques, PLND remains the most accurate staging procedure for the detection of lymph node invasion (LNI) in PCa. The rate of LNI increases with the extent of PLND. Extended PLND (ePLND; i.e., removal of obturator, external iliac, hypogastric with or without presacral, and common iliac nodes) significantly improves the detection of lymph node metastases compared with limited PLND (lPLND; i.e., removal of obturator with or without external iliac nodes), which is associated with poor staging accuracy. Because not all patients with PCa are at the same risk of harboring nodal metastases, several nomograms and tables have been developed and validated to identify candidates for PLND. These tools, however, are based mostly on findings derived from lPLND dissections performed in older patient series. According to these prediction models, a staging PLND might be omitted in low-risk PCa patients because of the low rate of lymph node metastases found, even after extended dissections (<8%). The outcome for patients with positive nodes is not necessarily poor. Indeed, patients with low-volume nodal metastases experience excellent survival rates, regardless of adjuvant treatment. But despite few retrospective studies reporting an association between PLND and PCa progression and survival, the exact impact of PLND on patient outcomes has not yet been clearly proven because of the lack of prospective randomized trials. On the basis of current data, we suggest that if a PLND is indicated, then it should be extended. Conversely, in view of the low rate of LNI among patients with low-risk PCa, a staging ePLND might be spared in this patient category. Whether this approach is also safe from oncologic perspectives is still unknown. Patients with low-volume nodal metastases have a good long-term prognosis; to what extent this prognosis is the result of a positive impact of PLND on PCa outcomes is still to be determined.

Norepinephrine in fluid-refractory catecholamine-resistant cold shock: Are we sure?

Department of Cardiothoracic Anesthesia and Intensive Care, University Vita-Salute San Raffaele, Milan, Italy

External Validation of the Updated Partin Tables in a Cohort of French and Italian Men

To test the discrimination and calibration properties of the newly developed 2007 Partin Tables in two European cohorts with localized prostate cancer. Data on clinical and pathologic characteristics were obtained for 1,064 men treated with radical prostatectomy at the Creteil University Health Center in France (n = 839) and at the Milan University Vita-Salute in Italy (n = 225). Overall discrimination was assessed with receiver operating characteristic curve analysis, which quantified the accuracy of stage predictions for each center. Calibration plots graphically explored the relationship between predicted and observed rates of extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node invasion (LNI). The rates of ECE, SVI, and LNI were 28%, 14%, and 2% in the Creteil cohort vs. 11%, 5%, and 5% in the Milan cohort. In the Creteil cohort, the accuracy of ECE, SVI, and LNI prediction was 61%, 71%, and 82% vs. 66%, 92% and 75% for the Milan cohort. Important departures were recorded between Partin Tables' predicted and observed rates of ECE, SVI, and LNI within both cohorts. The 2007 Partin Tables demonstrated worse performance in European men than they originally did in North American men. This indicates that predictive models need to be externally validated before their implementation into clinical practice.

Radical Prostatectomy After Previous Prostate Surgery: Clinical and Functional Outcomes

Radical prostatectomy has progressively become an elective treatment for primary localized prostate cancer as well as for incidental or subsequent prostatic cancer after previous surgery for obstructive benign disease. This increased acceptance opens concerns about oncological and functional outcomes. Between July 1999 and August 2003, 109 patients underwent radical retropubic prostatectomy for prostate cancer as a second line approach after surgery for primary bladder outlet obstruction. Of these patients 88 had undergone previous transurethral resection of the prostate and 21 had undergone open prostatectomy. Incidental and delayed prostate cancer was detected in 71 and 38 cases, respectively. Perioperative and postoperative morbidity was evaluated in all patients, while postoperative functional outcomes were assessed by a subjective questionnaire in 43. As a second surgery, radical retropubic prostatectomy was generally more complex technically and it resulted in longer operative time compared to radical surgery in naïve patients. In contrast, early and delayed postoperative morbidity increased moderately. Complete urinary continence was documented in 32 (74%) and 37 patients (86%) at the 6 and 12-month follow-ups, respectively. In this patient cohort adequate erectile function was reported by 12%. Radical retropubic prostatectomy can be performed safely after previous prostate surgery for bladder outlet obstruction. However, a consistent surgical background in prostate surgery is needed to manage frequently unexpected difficulties. Candidates for second line prostate surgery should be informed that functional results are less predictable and satisfactory than those achieved after the same surgical approach in naïve patients.

Sedative effect of acupuncture during cataract surgery

To assess the effectiveness of acupuncture in reducing anxiety in patients having cataract surgery under topical anesthesia. Vita-Salute University of Milan and IRCCS H. San Raffaele, Milan, Italy. In a prospective randomized double-blind controlled trial, anxiety levels before and after cataract surgery in 3 groups (A = no acupuncture, B = true acupuncture starting 20 minutes before surgery, C = sham acupuncture starting 20 minutes before surgery) were compared using the Visual Analog Scale (VAS). Twenty-five patients scheduled for inpatient phacoemulsification were enrolled in each group. All surgeries were performed using topical anesthesia. Exclusion criteria were refusal to provide informed consent, use of drugs with sedative properties, psychiatric disease, pregnancy, knowledge of the principles of acupuncture, anatomic alterations, or cutaneous infections precluding acupuncture at the selected acupoints. Preoperative anxiety levels were significantly lower only in Group B (P = .001). Anxiety in Group B was significantly lower than in Group A (P = .001) and Group C (P = .037). Regarding postoperative anxiety, the mean VAS score was 39 +/- 5 in Group A, 19 +/- 3 in Group B, and 31 +/- 4 in Group C. The difference was significant only between Group A and Group B (P = .003). Acupuncture was effective in reducing anxiety related to cataract surgery under topical anesthesia.

Heart failure after Caesarean section for twin delivery

Heart failure after Caesarean section for twin delivery

Multicentric study comparing intravesical chemotherapy alone and with local microwave hyperthermia for prophylaxis of recurrence of superficial transitional cell carcinoma: Colombo R, Da Pozzo LF, Salonia A, Rigatti P, Leib Z, Baniel J, Caldarera E, Pavone-Macaluso M, Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan, Italy

Multicentric study comparing intravesical chemotherapy alone and with local microwave hyperthermia for prophylaxis of recurrence of superficial transitional cell carcinoma: Colombo R, Da Pozzo LF, Salonia A, Rigatti P, Leib Z, Baniel J, Caldarera E, Pavone-Macaluso M, Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan, Italy

Women's sexual dysfunction: a pathophysiological review.

BJU InternationalVolume 93, Issue 8 p. 1156-1164 Women's sexual dysfunction: a pathophysiological review A. Salonia, A. Salonia Departments of Urology, University Vita-Salute San Raffaele, Milan, Italy, andSearch for more papers by this authorR.M. Munarriz, R.M. Munarriz Boston University School of Medicine, Boston, MA, USA, andSearch for more papers by this authorR. Naspro, R. Naspro Departments of Urology, University Vita-Salute San Raffaele, Milan, Italy, andSearch for more papers by this authorR.E. Nappi, R.E. Nappi IRCCS S. Matteo, University of Pavia, Pavia, andSearch for more papers by this authorA. Briganti, A. Briganti Departments of Urology, University Vita-Salute San Raffaele, Milan, Italy, andSearch for more papers by this authorR. Chionna, R. Chionna University Vita-Salute San Raffaele, Milan, ItalySearch for more papers by this authorF. Federghini, F. Federghini IRCCS S. Matteo, University of Pavia, Pavia, andSearch for more papers by this authorV. Mirone, V. Mirone University Federico II, Naples, Italy, and Departments of Obstetrics/Gynaecology,Search for more papers by this authorP. Rigatti, P. Rigatti Departments of Urology, University Vita-Salute San Raffaele, Milan, Italy, andSearch for more papers by this authorI. Goldstein, I. Goldstein Boston University School of Medicine, Boston, MA, USA, andSearch for more papers by this authorF. Montorsi, Corresponding Author F. Montorsi Departments of Urology, University Vita-Salute San Raffaele, Milan, Italy, andF. Montorsi, Associate Professor of Urology, University Vita-Salute San Raffaele, Istituto Scientifico San Raffaele, Via Olgettina 60, 20132 Milano, Italy. e-mail: [email protected]Search for more papers by this author A. Salonia, A. Salonia Departments of Urology, University Vita-Salute San Raffaele, Milan, Italy, andSearch for more papers by this authorR.M. Munarriz, R.M. Munarriz Boston University School of Medicine, Boston, MA, USA, andSearch for more papers by this authorR. Naspro, R. Naspro Departments of Urology, University Vita-Salute San Raffaele, Milan, Italy, andSearch for more papers by this authorR.E. Nappi, R.E. Nappi IRCCS S. Matteo, University of Pavia, Pavia, andSearch for more papers by this authorA. Briganti, A. Briganti Departments of Urology, University Vita-Salute San Raffaele, Milan, Italy, andSearch for more papers by this authorR. Chionna, R. Chionna University Vita-Salute San Raffaele, Milan, ItalySearch for more papers by this authorF. Federghini, F. Federghini IRCCS S. Matteo, University of Pavia, Pavia, andSearch for more papers by this authorV. Mirone, V. Mirone University Federico II, Naples, Italy, and Departments of Obstetrics/Gynaecology,Search for more papers by this authorP. Rigatti, P. Rigatti Departments of Urology, University Vita-Salute San Raffaele, Milan, Italy, andSearch for more papers by this authorI. Goldstein, I. Goldstein Boston University School of Medicine, Boston, MA, USA, andSearch for more papers by this authorF. Montorsi, Corresponding Author F. Montorsi Departments of Urology, University Vita-Salute San Raffaele, Milan, Italy, andF. Montorsi, Associate Professor of Urology, University Vita-Salute San Raffaele, Istituto Scientifico San Raffaele, Via Olgettina 60, 20132 Milano, Italy. e-mail: [email protected]Search for more papers by this author First published: 06 May 2004 https://doi.org/10.1111/j.1464-410X.2004.04796.xCitations: 88Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume93, Issue8May 2004Pages 1156-1164 RelatedInformation