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Purpose: Vascular access surveillance in hemodialysis is today an important challenge for nephrologist. Low blood flow is a risk factor for development of thrombosis of native fistula or graft. The aim of the study is to evaluate the correspondence between flow measurement by thermodilution and Color Doppler, and to identify flow rate values using the Blood temperature monitor (BTM) method in the case of stenosis. Methods: We evaluated 29 patients on chronic hemodialysis. The evaluation of blood flow with BTM were performed during the first hour of the hemodialysis session. All patients underwent a color doppler of vascular access within 10 days from the BTM measurements. Results: The mean vascular access flow calculated with BTM resulted 1142 ± 700 ml/min and there was a correlation with color doppler data 1199 ± 644 ml/min (p=0,0001 r=0,829). The flow of patients with hemodynamically significant stenosis was 332 ± 92 ml/min with a minimum value of 270 ml/min and a maximum value of 440 ml/min. Conclusion: the correspondence between thermodilution and color doppler support the implementation of intradialitic evaluation of the vascular access blood flow with the BTM method. Thermodilution allows to identify earlier patients with high risk of vascular access failure and the need for further diagnostic and therapeutic investigations.

Evaluation Of The Psychophysical Well-Being In The Compliance Of Women With Autosomal Dominant Policystic Kidney Disease: An Observational Study BACKGROUND: Autosomal dominant polycystic kidney disease is the most common inherited renal disease and affects less than 1 every 400-1,000 people. There are many effective treatments, including blood pressure management, physical activity, low sodium diet and hydration. Therapeutic education is part of a patient’s care and treatment. This approach is an essential strategy in order to face the current healthcare scenario, in which the number of people affected by chronic diseases is progressively increasing. OBJECTIVES: This article aims to analyze the effect of therapeutic education in patients with ADPKD, the level of adherence to pharmacological therapy and their compliance to dietetic and lifestyle recommendations as part of a nursing-led education. METHODS: This is a prospective, longitudinal, observational pilot study. The following measurements were used: Kidney Disease Quality of life - Short Form, Hospital Anxiety and Depression Scale, Body Uneasiness Test. At the T0 visit, a nurse selected patients and carried out a personalized educational intervention with the aims of adhering to drug therapies, monitoring blood pressure and dietary behavior (physical activity and water intake). At the T1 visit, patients performed psychological tests. At the T2 visit, the following evaluations were performed: a psychological interview together with the delivery and evaluation of the tests performed, an interview with the nurse to evaluate the adherence to the prescriptions, and a control of parameters such as physical activity, diet, water intake, drug therapy, and blood pressure. RESULTS: Therapeutic education can have a positive impact on patients’ health by improving adherence to the pharmacological therapy, diet and lifestyle. CONCLUSIONS: Therapeutic education improve the patient’s knowledge, treatments and correct behaviors as well as promotes an independent management of the disease. Through an educational intervention, the patient acquires the ability and the awareness to modify the wrong behaviors and to guarantee a balance between his needs and the pathology, thus improving the quality of life.

Novel strategy in living donor kidney transplantation to outcome biological barriersLiving donor kidney transplantation (LKD) is considered the best type of transplant for end-stage renal disease p...

La diagnosi precoce della Sindrome di Klinefelter (SK) si e resa sempre piu necessaria per garantire un adeguato trattamento della patologia e una prevenzione delle sue possibili complicanze. Un indubbio vantaggio della diagnosi precoce e quello di poter effettuare un monitoraggio periodico del paziente, cosi da individuare eventuali variazioni del quadro clinico e applicare i necessari accorgimenti terapeutici.

Riassunto Obiettivi Scopo del presente lavoro e valutare gli effetti dei farmaci antidepressivi triciclici sul cavo orale. Materiali e metodi Un questionario sulle abitudini igieniche orali e alimentari e stato somministrato e un esame clinico parodontale e un test salivare sono stati eseguiti in 30 pazienti in terapia cronica con antidepressivi triciclici (gruppo test) e 30 pazienti che non assumevano farmaci (gruppo controllo). I test t di Student e Chi quadrato di Pearson sono stati adoperati per valutare le differenze statistiche tra i gruppi e il livello di significativita e stato posto per p Risultati I pazienti del gruppo test hanno mostrato un livello piu alto (p 0,05). Il gruppo test ha evidenziato una maggiore xerostomia al test salivare, una ridotta durata di spazzolamento e un minore uso della tecnica di spazzolamento corretta. Conclusioni Il differente status parodontale osservato nei pazienti in terapia con antidepressivi triciclici potrebbe essere dovuto alle diverse abitudini igieniche orali e in parte all’azione antimuscarinica di questi farmaci e alla conseguente xerostomia.

Nulla è cambiato, negli ultimi 10 anni, per quanto riguarda la penetranza della dialisi peritoneale. A mio avviso, motivazioni di carattere sociale e organizzativo sono alla base di questo scarso risultato. Questi punti deboli sono insiti nella metodica. La percentuale di pazienti che può beneficiare della dialisi peritoneale è più o meno quella che è effettivamente raggiunta.

Il carcinoma corticosurrenalico (CCS) e un tumore raro e molto aggressivo. Al momento attuale non sono stati individuati approcci terapeutici personalizzati, ad eccezione della terapia con mitotane guidata dal dosaggio plasmatico del farmaco. L’intervento chirurgico radicale e l’unico approccio potenzialmente curativo. L’obiettivo del presente articolo e rivedere le conoscenze attuali relative alla diagnosi, alla gestione dei pazienti dopo chirurga radicale e alla gestione delle forme di malattia avanzata.

Infertility is defined as the inability of a sexually active non-contracepting couple to achieve spontaneous pregnancy in one year. Factors of male infertility are present in 50% of infertile couples. Azoospermia is defined as the absence of sperm in the ejaculate, even after centrifugation of the sample, and affects 10%-15% of the infertile male population. Therefore, it represents a pathological condition of primary importance in the context of infertility management. Any assisted reproductive procedure must first refer to the availability of a suitable number of good quality gametes. As regards sperm collection, if ejaculated semen is not suitable or available, it may be taken from the seminal duct or directly from the testicular parenchyma with different methodologies and techniques, which can be divided into percutaneous techniques and open surgical (TeSE and ESA) or microsurgical (micro-TeSE) techniques. The purpose of this work is to evaluate and compare the retrieval rate in infertile patients suffering from azoospermia and treated with the various surgical techniques.

Introduction Premature ejaculation (PE) is a sexual dysfunction with high prevalence. According to some reports, it is present in about 20-30% of the male population. Since 2009 PE has been treated with a novel inhibitor of serotonin re-uptake, Dapoxetine, which has been reported to be specifically active for PE. Materials and Methods 59 patients have been selected among the patients affected by PE observed at the outpatient department of Urology and Andrology of the “Paolo Giaccone” University Policlinic Hospital of Palermo. Diagnosis was confirmed unequivocally in all patients, who were suitable for drug treatment and accepted to participate in the study. They were divided in 2 groups: one receiving Dapoxetine (41 patients), another (18 patients) receiving Citalopram. Patients were followed up by telephone at monthly intervals, in order to compare compliance, efficacy and side effects. Results Compliance to treatment was obtained in 56% of patients treated with Dapoxetine and in 61% of those treated with Citalopram. In the Dapoxetine group side effects were reported in 14.6% versus 38.4% in the Citalopram group. Benefit from the treatment was reported in 82% and 69.2%, respectively.

We report a case of a 14-year-old girl with primary amenorrhoea and hyperprolactinaemia. One year treatment with cabergoline – a dopamine agonist – caused a significant reduction in serum prolactin (PRL) concentration without a normalisation of menstrual cycle. After our examination, Turner’s syndrome (45X0/46XY mosaicism) was diagnosed. Turner’s syndrome (TS) is characterised by short stature, streak gonads, infertility, and hearth and kidney malformations. The presence of Y chromosome fragments in patients with TS is known to increase the risk of gonadoblastoma. The patient underwent prophylactic gonadectomy and received substitutive estrogenic therapy.

In Italy, assisted reproduction is regulated by a variety of sources, the most important being Law 40/2004. The paper discusses how the tight legal framework allocates ample discretion to physicians who play a major role in various aspects of assisted reproduction – namely in implementing a gatekeeping role whenever a couple applies for access to assisted reproduction, in choosing the techniques that better suits the couple, and in performing preimplantation embryo testing aiming to select which embryo (or embryos) is suitable for implantation. The paper also highlights the professional, legal and ethical responsibility of physicians that arises whenever a couple seeks treatment for infertility or sterility.

Combined oral contraceptives are a safe and highly effective method of birth control, but they can also raise problems of clinical tolerability and/or safety in migraine patients. It is now commonly accepted that, in migraine with aura, the use of combined oral contraceptives is always contraindicated, and that their intake must also be suspended by patients suffering from migraine without aura if aura symptoms appear. The newest combined oral contraceptive formulations are generally well tolerated in migraine without aura, and the majority of migraine without aura sufferers do not show any problems with their use; nevertheless, the last International Classification of Headache Disorders identifies at least two entities evidently related to the use of combined oral contraceptives: exogenous hormone-induced headache and estrogen-withdrawal headache. As regards the safety, even if both migraine and combined oral contraceptive intake are associated with an increased risk of ischemic stroke, migraine without aura per se is not a contraindication for combined oral contraceptive use. Other risk factors (tobacco use, hypertension, hyperlipidemia, obesity and diabetes) must be carefully considered when prescribing combined oral contraceptives in migraine without aura patients, in particular in women aged over 35 years. Furthermore, the exclusion of a hereditary thrombophilia and of alterations of coagulative parameters should precede any decision of combined oral contraceptive prescription in migraine patients.

Pregnancy-related hypertension, intrauterine growth retardation, post-maturity and unfavorable local conditions are among the most frequent indications for labor induction. There are two competing strategies for the induction of labor in term pregnancies: formal induction with artificial rupture of the membranes and/or intravenous oxytocin on one side, and cervical ripening and induction with exogenous prostaglandins on the other. The use of prostaglandins in obstetrics relies on two pharmacological properties: the capacity of inducing the biochemical changes in the connective tissue of the cervix that lead to its maturation and the stimulation of the uterine smooth musculature. While the latter property is shared with oxytocin, the former offers great clinical advantages, in particular in those women that present an indication for labor induction but whose cervix, normally assessed with the use of the Bishop score, does not show “ripeness”, i.e. does not permit vaginal delivery. Since the acquisition cost of the prostaglandins is quite high, but the clinical benefit appears evident, several studies have analyzed the overall economical impact of their use, both as pre-induction cervical ripening agents and as induction drugs. When compared to a strategy of expectant management in term pregnancies without cervical ripeness, exogenous prostaglandin administration has proven to be more cost-effective and better accepted by the patients. Prostaglandins have also proven to be more cost-effective than oxytocin and/or amniotomy in women with an indication to labor induction and unripe cervix, due to the reduced number of induction failures and cesarean sections required with this strategy. The economical analyses that have compared oxytocin and prostaglandins in women with ripe cervices deliver more ambiguous data, but it appears that their cost-effectiveness is comparable. Furthermore, none of the reviewed studies has considered intangible costs, but it is a wide-spread opinion that induction with prostaglandins results in a more “natural” and less painful labor.

In this study we elected postmenopausal patients suffering from urgency/frequency syndrome. Estriol in the form of vaginal cream was applied for a total of fifteen weeks. The outcome was positive (cured or rimproved) in 89.3 of cases.