Laparoscopic Staging of Early Ovarian Cancer: Results of a Multi-Institutional Cohort Study

Background  

Minimal access surgery to stage early ovarian cancer (EOC) is still regarded as investigational among many gynecologic oncologists. Reporting outcome data from large cohorts is currently the only practical way to further define the appropriateness of minimally invasive surgery for EOC patients. We sought to investigate the safety, adequacy, and outcome of laparoscopic staging of EOC by using a multi-institutional sample.     

Simvastatin treatment in subjects at high cardiovascular risk modulates AT1R expression on circulating monocytes and T lymphocytes

OBJECTIVE: Angiotensin II, through the activation of angiotensin II type 1 receptors, plays a crucial role in atherosclerosis. Statins may interfere with the effects of angiotensin II. METHODS: We have investigated the expression of angiotensin II type 1 receptor, angiotensin II type 2 receptor and angiotensinogen on circulating monocytes and T-lymphocytes from subjects at high risk for vascular events before and during simvastatin treatment, and healthy controls. In-vitro experiments were also performed to assess the ability of simvastatin to interfere with angiotensin II signalling. RESULTS: In comparison with controls, high-risk subjects had similar angiotensin II type 1 receptor expression on the cell membranes but significantly higher angiotensin II type 1 receptor mRNA levels at least in monocyte subsets whereas their expression on T cells was similar. Angiotensin II type 2 receptor mRNA expression was higher than controls in both monocytes and T lymphocytes. No differences were observed in angiotensinogen expression on monocytes while T lymphocytes of high-risk subjects show higher expression. One-month treatment of high-risk subjects with simvastatin resulted in a reduction of angiotensin II type 1 receptor mRNA without affecting angiotensin II type 2 receptor whereas angiotensinogen mRNA expression was reduced at least in monocytes. Incubation in vitro with simvastatin reduces the expression of angiotensin II type 1 receptor mRNA levels on monocytes from untreated subjects. CONCLUSION: Simvastatin induces down-regulation of the angiotensin II type 1 receptor, interferes with angiotensin II activity in immune cells and contributes to the anti-inflammatory profile of statins that can explain the therapeutic effects of these drugs.     

Evaluation of heart rate changes in the aged. An ambulatory electrocardiography study. Arrhythmias in the aged

The Holter examinations of 111 subjects aged more than 65 who then underwent dynamic ecg were investigated in order to assess the clinical significance of cardiac arrhythmias in geriatric age. Group A was formed of 53 patients with no clinical signs of cardiovascular diseases. Thirty-two patients with clinical evidence of ischaemic cardiopathy made up Group B and 26 with arterial hypertension formed Group C. The Holter examinations were evaluated in accordance with current guidelines, considering the basic rhythm, heart rate, pulse formation and conduction disturbances and supraventricular and ventricular hyperkinetic arrhythmias. Sinus base rhythm was present in most cases whereas atrial fibrillation was noted in a similar percentage in the three groups, whether or not cardiovascular disease was present. Supraventricular and ventricular hyperkinetic arrhythmias were extremely common in the elderly and made no discrimination between patients with ischaemic cardiopathy or hypertension and the clinically healthy; for example, ventricular tachycardia was observed in 10.6% of Group A subjects, in 7.1% of Group B and 8.6% of Group C. To conclude, the clinical significance of heart rhythm changes in the elderly remains obscure because in most subjects they are not related to the presence of cardiovascular disease.     

Pharmacological Mechanisms of Clinically Favorable Properties of a Selective β1‐Adrenoceptor Antagonist,Nebivolol

Nebivolol is a racemic mixture of d‐ and 1‐enantiomers. The drug is characterized by β₁‐adrenoceptor selectivity and long‐acting β₁‐blockade exerted predominantly by d‐enantiomer. Nebivolol is devoid of intrinsic sympathomimetic activity and has no relevant membrane stabilizing action. Antiproliferative properties of nebivolol were demonstrated in endothelial and smooth muscle cell cultures. Infusion of nebivolol causes a vasodilation in all vascular beds by endothelial‐dependent mechanism involving stimulation of β₃‐adrenoceptors as well as by endothelial‐independent mechanism. Nebivolol possesses not only direct vasodilator properties but also augments the action of endothelium‐dependent vasodilators. The antioxidant property of nebivolol can at least in part explain why treatment with this drug enhances eNOS activity and minimizes the reperfusion‐induced myocardial injury. The systemic effects of nebivolol in humans have an unusual hemodynamic profile. In contrast to traditional β‐adrenoceptor antagonists, nebivolol reduces preload and afterload due to systemic vasodilation and improves arterial distensibility. At 5 mg daily nebivolol effectively reduces systolic and diastolic blood pressure over a 24‐h period. During treatment with nebivolol arterial pressure follows the natural circadian rhythm. Trough‐to‐peak ratio for nebivolol is 0.9. It has been demonstrated in numerous placebo‐controlled studies that exercise tolerance is not reduced during nebivolol therapy. By chronic administration to patients with left ventricular dysfunction nebivolol increases myocardial contractility. Nebivolol produced no significant changes in lipid levels, insulin sensitivity or glucose tolerance. These findings make nebivolol a promising therapeutic tool for the treatment of arterial hypertension and chronic heart failure.     

HCV and HBV infection among multitransfused thalassemics from Eastern Sicily

Summary Serum specimens from 152 Sicilian multitransfused thalassemic subjects were tested for antibodies to hepatitis C virus (anti- HCV) and for HBV markers by enzyme linked immunoassay and with reference to anti-HCV, confirmed by recombinant immunoblot assay. A high rate (47%) of subjects was anti-HCV positive. HBsAg was found in 8% of patients and 55% had anti-HBs or anti-HBc antibodies or both. Contrary to HBV infection, anti-HCV seropositivity was related to the number of transfused units. The highest anti-HCV prevalence was observed between 16 and 20 years; 100% of persons older than 50 years had at least one marker of HBV infection. In conclusion, HCV and HBV are widespread among multitransfused thalassemics. Probably in our area, particularly during the pre-HBsAg screening era, several multitransfused patients were infected by HBV more readily than by HCV.

---

HCV- und HBV-Infektion bei ostsizilianischen Thalassämie-Patienten mit häufigen Bluttransfusionen

Zusammenfassung Die Seren von 152 Thalassämie-Patienten, die häufig Bluttransfusionen erhalten hatten, wurden auf Antikörper gegen Hepatitis-C-Virus und HBV-Marker getestet. Ein hoher Prozentsatz (47%) erwies sich als anti-HCV positiv, was mit RIBA bestätigt wurde. HBsAg wurde bei 8% der Patienten gefunden und 55% hatten anti-HBc-oder Anti-HBs-Antikörper. Die dominierende anti-HCV-Prävalenz stand in Beziehung zur Transfusionshäufigkeit und war zwischen dem 16. und 20. Lebensjahr am höchsten. Im Gegensatz dazu stand die HBV-Infektion nicht im Verhältnis zu der Anzahl der Bluttransfusionen; bei 100% der Patienten über 50 Jahre wurde mindestens ein HBV-Infektionsmarker beobachtet. Bei Thalassämie-Patienten sind HCV- und HBV-Infektionen verbreitet. Wahrscheinlich haben sich vor dem Beginn des HBsAg-Screening in den Blutbanken viele Patienten mit dem HB-Virus infiziert.

     

Alloplastic bladder substitution: are we making progress?

Radical cystectomy with lymphadenectomy and urinary diversion is the gold standard treatment for bladder cancer in organ-confined muscle-invasive disease and selected patients who have high-grade non-muscle-invasive disease or are non-responders to BCG. The main and most morbid complications of this challenging surgery are related to the use of bowel for urinary tract reconstruction. For this reason, many past projects were devoted to finding an alternative to the use of bowel. The aim of this review is to provide a summary of the evolution of alloplastic bladder substitution. A comprehensive review of the literature was performed using the Medline National Library of Medicine database and Google Scholar. Keywords used were cystectomy and intestine/bowel, replacement, bladder substitution, organ replacement, artificial bladder, alloplastic material, biomaterial, and tissue engineering. Various prostheses have been proposed for replacement of the urinary bladder, silicone being the most frequently used material. The first published model of an alloplastic bladder was described by Bogash et al. in late 1959, while the last, in 1996, was suggested by Rohrmann. Interprofessional collaboration, recent advances in technology, and tissue engineering may help in developing suitable bladder prostheses. Urologists as well as engineers and the industry need to give this matter serious attention.