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INTRODUCTION E OBJECTIVES. There are some evidences that the combination of EndoMRI and MRS might be able to limit the number of iterative biopsies in patients with negative biopsies of the prostate and a still rising PSA. The aim of this study is to evaluate the possible role of EndoMRI/MRS in patients with ASAP METHODS: From November 2005 to September 2008 we enrolled 28 consecutive patients diagnosed with ASAP at a TRUS-guided needle prostate biopsy. All patients underwent prostatic EndoMRI and MRS. A prostatic zone was classified as: suspicious for prostate cancer if low intensity signal was present on T2-weighted images and/or if the choline + creatine/citrate ratio was >0.86; equivocal or negative otherwise. A subsequent 12-core needle prostate biopsy was performed and supplementary biopsies were added in the suspicious zones. The results of MRI/MRS were then compared with histological findings. RESULTS: The combination of EndoMRI and MRS was suspicious for cancer in 70% of patients, equivocal in 23% and negative in 7%. Histological findings at re-biopsy included: prostate cancer in 35%, ASAP in 23%, BPH or prostatitis in 42%. In 78% of patients diagnosed with prostate cancer the combination MRI/MRS was suspicious and in 22% equivocal. In all patients the cancer was found in suspicious zones at MRI/MRS where targeted biopsies were performed. CONCLUSIONS: The combination of EndoMRI and MRS proved to have a good sensitivity but a poor specificity in identifying a concurrent prostate cancer among patients with ASAP The location of positive cores for prostate cancer was consistent with the suspicious zones at MRI/MRS. [ABSTRACT FROM AUTHOR]

To define the role of mitral regurgitation (MR) on sympatho-vagal balance in mitral valve prolapse (MVP) patients, we analyzed 41 ambulatory MVP symptomatic patients. Twenty-seven patients (4 males, 23 females, aged 34 +/- 3 years) had significative MR assessed color Doppler, while 14 patients (5 males, 9 females, aged 29 +/- 3 years) had no MR; 36 age- and sex-matched subjects were studied as controls (C). Spectral analysis of heart rate variability (HRV) was performed at rest and during sympathetic activation (tilt). In the whole group of MVP patients spectral components did not differ significantly from C at rest and during tilt. When patients were subdivided in relation to the presence (+) or absence (-) of MR, HRV revealed in MR+ patients at rest an increased high frequency (HF) and a diminished low frequency (LF) component (47 +/- 5 and 41 +/- 5 normalized units, nu) with respect to C (34 +/- 3 and 54 +/- 3 nu, p < 0.05, respectively). Viceversa during tilt, in MR+ patients it was possible to observe a LF increase greater than in C (delta LF: 36 +/- 4 versus 25 +/- 3 nu, p < 0.05). As HF component is currently interpreted as a marker of vagal modulation of HRV, our results suggest an increased vagal tone associated with MR possibly due to stimulation of atrial vagal receptors; moreover, an increased sympathetic responsiveness to tilt seems to characterize MR+ patients.

To determine whether clinical manifestations in patients with mitral valve prolapse (MVP) are associated with altered sympatho-vagal tone, 46 patients (mean age 27 +/- 6, range 20-45 years; 18 males and 28 females) were studied by power spectrum analysis of RR variability. Patients were divided in 2 groups, according to echocardiographic criteria: Group A: 11 patients with classical MVP; Group B: 35 patients with non classical MVP. These patients were compared with 30 healthy subjects (Group C) well matched for age, body surface area and heart rate. Our findings indicate that at rest there is a significant difference in the high-frequency component between Group A and Group C. Similarly, during the increase in sympathetic activity induced by 70 degrees head-up tilt all groups showed an increase in the low-frequency component, that was more evident in Group A. The data generated from our laboratory suggest that mitral regurgitation (Group A) is a probable cause of vagal tone increase and that there is an adaptive long-term mechanism towards sympathetic conditions. In addition, probably the normalization, demonstrable by the effect of sympathetic activity in tilt, can mask a dysfunction that may be differently evoked.

Recurrent calculi of the main bile way may be recurrent or residual. Recurrent stones are yellow-brown, crumbly and earthy and contain high quantities of calcium palmitate; residual stones, on the other hand, are firmer, round or berry-like, usually faceted and contain cholesterol, bilirubinate and carbonate of calcium (aragonite, vaterite, etc.) but never palmitate. Residual stones at times also present a peripheral "shell" presenting palmitate and this shows that a new component determined by bile changes is added to the cholesterol stone, which represents the central core, because of stasis and biliary infection. The distinction of calculi into residual and recurrent is also made on the basis of the classic morphologic and clinical criteria described in the literature, also and above all on the basis of specific, objective scientific criteria deriving from in-depth clinical study of the patient, the chemical study of the bile, morphological, mineralogical and structural study of the stone. The following are considered in particular: instrumental examinations made during hospitalisation and operation; pH, enzymatic activity (phospholipase, trypsin and amylase) and examination of bile cultures; morphological, microscopic examination (electronic scan microscopy) and mineralogical examination (X-ray diffractometry and infrared spectroscopy) of the calculus. A personal series of recurrent calculosis of the main biliary way is considered, special attention being paid to a case that was particularly interesting in relation to the fact lithiasic recurrence occurred just 10 months after the previous operation and the fact that biliary stasis was not determined by stenosis of the papilla which proved fully patent.

The urinary proteins determination was carried out after purification by gel filtration over Sephadex rosin. The proteins eluaded react with Biuret-reagent to establish the coloured copper-proteins complex. If proteins concentrations is inferior, the proteins can be determinated by the copper-proteins complex isolation with second gel filtration and titrating Cu++ with reactives: dietildithiocarbamate or the PAR (4-(2pyridyl-azo)resorcinol monosodium salt).

The CD curves study of the pyridyl-N-oxide derivatives of some adrenergic and anorexigenic amines showed that the sign of the Cotton effect can be related to their absolute configuration. The obtained results confirm the absolute configuration of fenfluramine and nor-fenfluramine and suggest that the levo isomer of ortoxine has R-configuration.