Challenging the maximum flow rate: a new index of voiding dysfunction in men with benign prostatic enlargement

OBJECTIVES

To present the theoretical development and clinical relevance of a new index of voiding dysfunction (D) based purely on free uroflow (FF), to assist in the management of patients with benign prostatic enlargement (BPE), and to compare its merits against the maximum flow rate (Q_max).

PATIENTS AND METHODS

In the Valentini‐Besson‐Nelson (VBN) micturition model for men, two variables characterize urethral obstruction, i.e. the prostatic urethral counter‐pressure pucp and the detrusor force coefficient k. D can be obtained from a FF assuming a normal detrusor (k = 1). Clinically, multiple FF from patients entered in a double‐blind pharmacological trial provided variations of D over time. D values were also compared before and after transurethral resection of the prostate (TURP).

RESULTS

In 137 patients with BPE from several institutions, D was more precise than Q_max because D is independent of volume and of perturbations of short duration during the flow. The change in D was proportionate to the invasiveness of treatment; the mean (sd ) decrease after TURP was 14.6 (8.7) cmH₂O, vs 8.1 (5.4) cmH₂O after 90 days of α‐blocker intake. Retrospectively, the range of D fitted with the clinician’s decision, i.e. pharmacological trial (16–31 cmH₂O) vs TURP (27–46 cmH₂O; P < 0.001).

CONCLUSION

The new index (D), deduced from the VBN analysis of only FF, is responsive to treatment. This simple calculation offers an insight into the voiding status of a patient with BPE beyond that obtained by Q_max alone.     

Radiotherapy in gastric cancer: a systematic review of literature and new perspectives

Gastric cancer is still a major problem for oncologists. Surgery is the main therapeutic approach; a complete surgical resection is usually necessary to offer potentially curative therapy to patients with adenocarcinoma of the stomach. However, many patients with more locally advanced tumors will experience local and distal recurrences. When a recurrence occurs, only palliative therapy is possible. In operable gastric cancer, both the extent of surgery and the value of adjuvant treatment remain subject to considerable international controversies. To improve local control, surgeons address the role of standardized surgery and of more extended surgery. Radiotherapy appears to improve local control and survival in the adjuvant arms, but perspective randomized trials are scarce and reported over many years. Retrospective experience demonstrated a low local recurrence rate, but was affected by large heterogeneity. However, evidence published in the last few years, improved radiotherapy technologies, better knowledge of the at-risk areas (enabling smaller radiotherapy volumes) and growing interest in neoadjuvant approaches support the role of radiotherapy in gastric cancer.     

Valproic acid induces apoptosis, p16INK4A upregulation and sensitization to chemotherapy in human melanoma cells

It is known that melanoma develops as a consequence of multifactorial alterations. To date several studies indicate the effective implication of p16 as a tumor suppressor gene with a major role in either the development or progression of human melanoma. Deregulation of melanoma cell growth has been widely associated with mutations in the p16-cyclin D/cdk4-pRb pathway. Recently anticancer therapies are focused on restoration of p16 CDK inhibitory function and other proteins unregulated in melanoma cell cycle pathway (e.g., c-myc, p27). A combined strategy for restoration of normal homeostasis in the melanoma skin with targeted delivery of apoptosis-inducing agents does not seems to be far obtained. New class of antitumoral agents are emerging: histone deacetylase (HDAC) inhibitors have attracted much interest because of their ability to arrest cell growth, induce cell differentiation, and in some cases, induce apoptosis of cancer cells. Recently, attention has been focused on the ability of HDAC inhibitors to induce perturbation in cell cycle regulatory protein (e.g., p21(CIP1)) and down-regulation of survival signalling pathway. In the present study, we have examined the effect of valproic acid (VPA) on M14 human melanoma cell line. Here we observed that VPA induces cell cycle arrest and apoptosis sensitising melanoma cells to cis-platin and etoposide treatment. IC(50) dose (2.99 mM) of VPA was able to induce G(1) arrest (up to 75%) in association with upregulation of p16, p21 and cyclin-D1 related to Rb ipo-phosphorilation. In addition VPA activated apoptosis (50%) in M14 cells, when given alone or in combination with antitumoral agents. The ability of valproic acid to reestablished the G(1) pathway in melanoma cells suggests a potential application of VPA in melanoma therapeutic protocols.     

What elderly cancer patients want to know? Differences among elderly and young patients

The aims of our study were: (1) to evaluate the information needs of Italian elderly cancer patients (age ⩾65 years), (2) to compare them with those of young patients (age 18–40 years). Between June 2004 and February 2005 we asked 122 elderly (mean age 72 years) and 52 young (mean age 33 years) cancer patients naïve for treatment to fill in two self-administered questionnaires exploring their needs for information and their psychological distress. The needs for information of elderly patients differed significantly from those of the young patients (p<0.0001); on contrast, both groups showed a similar psychological distress and the same reasons for seeking further information. Our results demonstrate that, more frequently than expected, Italian elderly cancer patients do not want complete information on their disease. Assessing to what extent elderly patients require information is essential for giving them tailored information. Copyright © 2006 John Wiley & Sons, Ltd.     

Lung transplantation for cystic fibrosis in Italy

Lung transplantation (LT) is the only effective form of therapy for cystic fibrosis (CF) associated with end-stage pulmonary failure. In Italy, the management of CF is regulated by national law, which has instituted regional centers for care and follow-up of all CF patients. LT has been performed since 1992 in only nine LT certified centers. The structured national organization has led to a unified database for LT for CF. As of December 2006, 197 bilateral LT (96 male and 94 female patients; 7 retransplants) have been performed. Of these, four had also liver or heart and liver transplantation, and three are long-term survivors. Overall median survival is 7 years. Mean age at transplantation is 26.5 years, and the mortality on the waiting list is 33.6%. Patients listed for transplant either received a suitable donor within a mean of 10 months or died within a mean of 5.5 months. The most frequent cause of death is bronchiolitis obliterans syndrome (BOS). Our nationwide database indicates the excellent results obtained by LT in FC. Still, mortality on the waiting list remains a challenge and long-term outcome is limited by BOS.