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Background/aim: To evaluate the diagnostic accuracy of the urinary SelectMDx test in the diagnosis of clinically significant prostate cancer (csPCa) in men enrolled in an active surveillance (AS) protocol., Patients and Methods: From July 2015 to July 2018, 125 men with very low-risk PCa were enrolled in the AS protocol; all patients underwent confirmatory transperineal saturation biopsy (SPBx). In the presence of PI-RADS score ≥3, a targeted MRI/TRUS fusion-guided biopsy was added to SPBx. Post-digital rectal examination urine was collected in 45/125 (36%) patients before SPBx; the genetic urine analysis was performed using a biomarker-based risk score model, the SelectMDx, that measured mRNA levels of distal-less homeobox 1 (DLX1) and homeobox C6 (HOXC6)., Results: A total of 9/45 (20%) patients were reclassified as csPCa (7 cases=Grade Group 2; 2 cases=Grade Group 3); sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of mpMRI vs. SelectMDx in the diagnosis of csPCa were equal to 66.6 vs. 55.6%, 87.7 vs. 65.8%, 54.5 vs. 27.8%, 92.3 vs. 87%, 84.9 vs. 70.3%, respectively., Conclusion: SPBx combined with MRI/TRUS fusion biopsy significantly outperformed the diagnostic accuracy of SelectMDx (70.3%) in the diagnosis of csPCa in men enrolled in AS., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Aim: To evaluate the accuracy of multi-parametric pelvic magnetic resonance imaging (mpMRI) in diagnosing prostate cancer (PCa) in men with initial biopsy microfocal cancer., Patients and Methods: From January 2012 to July 2014, 40 patients before undergoing repeat transperineal saturation prostate biopsy (SPBx; median, 28 cores) for the presence of a microfocal PCa were submitted to 3.0-Tesla mpMRI., Results: A T1c clinical stage PCa was found in 23 (57.5%) patients submitted to SPBx; mpMRI was positive in 16/40 (40%) cases and in 11 of them a clinically significant PCa was found. On the contrary, the 12 men with negative mpMRI had a quantitative histology suitable for clinically insignificant cancer. Diagnostic accuracy of mpMRI in diagnosing significant PCa was equal to 100%., Conclusion: Multi-parametric pMRI should be suggested in the re-evaluation of microfocal cancer as a selection approach of patients at risk for clinically significant PCa., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Introduction: Multiparametric pelvic magnetic resonance imaging (mpMRI) accuracy in prostate cancer (PCa) diagnosis was evaluated., Materials and Methods: From June 2011 to December 2013, 168 patients (median 65 years) with negative digital rectal examination underwent repeat transperineal saturation biopsy (SPBx; median 28 cores) for persistently high or increasing PSA values, PSA >10 ng/ml or PSA values between 4.1-10 o r 2.6-4 ng/ml with free/total PSA < 25% and < 20%, respectively. All patients underwent mpMRI using a 3.0 Tesla scanner equipped with surface 16 channels phased-array coil and lesions suspicious for PCa were submitted to additional targeted biopsies., Results: A T1c PCa was found in 66 (39%) cases; SPBx and mpMRI-suspicious targeted biopsy diagnosed 60 (91%) and 52 (78.8%) cancers missing 6 (all of the anterior zone) and 14 cancers (12 and 2 of the lateral margins and anterior zone), respectively; in detail, mpMRI missed 12 (18.1%) PCa charaterized by microfocal (1 positive core with greatest percentage of cancer and Gleason score equal to 5% and 6, respectively) disease at risk for insignificant cancer. The diameter of the suspicious mpMRI lesion was directly correlated to the diagnosis of PCa with poor Gleason score (p < 0.05); detection rate of cancer for each suspicious mpMRI core was 35.3%. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive value of mpMRI in diagnosing PCa was 75.7%, 82.5%, 71.8%, 78.9%, 87.9%, respectively., Conclusion: Multiparametric pMRI improved SPBx accuracy in diagnosing significant anterior PCa; the diameter of mpMRI suspicious lesion resulted significantly predictive of aggressive cancers.

Aim: The prostate-specific antigen (PSA) nadir and long-term outcome in patients with pT3b prostate cancer were evaluated., Patients and Methods: From July 2000 to December 2012, in 100 patients (median age=62 years) with pT3b prostate cancer following radical retropubic prostatectomy (RRP) preoperative and pathological findings predictive of PSA nadir (≤0.2 vs. >0.2 ng/ml) were retrospectively evaluated; moreover, biochemical recurrence-free survival (bRFS), cancer specific survival (CSS) and overall survival (OS) in patients who underwent watchful waiting (16 cases), adjuvant (84 cases) and salvage (10 cases) therapy were recorded., Results: A PSA nadir >0.2 ng/ml was correlated with node involvement, Gleason score ≥9, cT2, PSA >20 ng/ml, positive surgical margins and total cancer percentage >20%. At a median follow-up of 90 months (range=10-155 months) bRFS, OS and CSS were 92%, 96% and 80%, respectively., Conclusion: Radical retropubic prostatectomy combined with adjuvant and salvage treatments demonstrated a satisfactory outcome for pT3b prostate cancer.

Introduction: Erectile dysfunction (ED) incidence following repeat saturation prostate biopsy (SPBx) was evaluated., Materials and Methods: From January 2011 to June 2012 295 patients underwent repeat transperineal SPBx (median 28 cores) under sedation. The indications for biopsy were: abnormal DRE, PSA > 10 ng/mL or included between 4.1-10 with free/total PSA < 25%. All patients were prospectively evaluated with the 5-item version of the International Index of Erectile Function (IIEF-5) at baseline and 1, 3 and 6 months from SPBx., Results: 100/200 men with benign histology and normal sexual activity completed the study; median IIEF-5 score before and after SPBx was equal to 18.3 (baseline) vs 17.8 (1 month later) vs 18 (3 months later) vs 18.1 (6 months later) (p > 0.05); in detail, 1 month from biopsy 5 (5%) men referred a mild ED that disappeared at 3 and 6 months evaluation., Conclusions: Repeat transperineal SPBx under sedation did not significantly worsened erectile function; the minimal risk of temporary post-biopsy ED could be previously discussed (not emphasised) with potent patients.

In patients undergoing plastic surgery, donor sites were treated with soft pads of freeze-dried N-carboxybutyl chitosan to promote ordered tissue regeneration. Compared to control donor sites, better histoarchitectural order, better vascularization and the absence of inflammatory cells were observed at the dermal level, whilst fewer aspects of proliferation of the malpighian layer were reported at the epidermal level. Accordingly, N-carboxybutyl chitosan leads to formation of regularly organized cutaneous tissue and reduces anomalous healing.

The effect of halothane-100% oxygen anesthesia on oxygen consumption was studied in 10 dogs subjected to surface-induced deep hypothermia with 30 minutes of circulatory arrest. The results were compared with previous oxygen consumtion data under ether-100% oxygen anesthesia. Low cardiac output, especially during the rewarming period, low PaO2, and a large arteriovenous oxygen difference during rewarming were significantly different in the halothane group, despite identical oxygen consumption in both groups. These differences could not elucidate the exact cause of postoperative motor disturbances associated with 30 minutes of circulatory arrest in the halothane group. The possibility that there was higher oxygen consumption under halothane anesthesia is discussed.

To facilitate perfusion rewarming without the use of total body heparinization or an oxygenator following open-heart correction with surface hypothermia, we divised a pump circuit. The circuit, totally primed with 100 c.c. of saline, consists of polyurethane-polyvinyl-graphite (PPG) coated Tygon tubes (with one end tapered by heat treatment) and a copper-coil heat exchanger. A roller pump was used to achieve partial bypass from the left atrium to the ascending aorta with flow rates up to 70 c.c. per kilogram per minute. Experiments in dogs resulted in rapid rewarming, immediate return of cardiac function, and hematologic alterations similar to those noted during surface rewarming. The safety of the method was also demonstrated. Prothrombin time, partial thromboplastin time, and platelet values returned to control levels upon rewarming, and no thromboemboli or bleeding problems were noted. Six clinical experiences were accumulated. Details of the method, hematologic and blood chemical analyses in dogs, and the first clinical trial in a 3-month-old infant with transposition of the great vessels are reported.