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Background: Metformin-associated lactic acidosis (MALA) is a severe complication of drug administration with significant morbidity and mortality. So far no study in large population areas have examined the incidence, clinical profile and outcome of acute kidney injury (AKI)-MALA patients admitted in intensive care units (ICUs) and treated by renal replacement therapy (MALA-RRT). Methods: Retrospective analysis over a 6-year period (2010-2015) in Piedmont and Aosta Valley regions (5,305,940 inhabitants, 141,174 diabetics treated with metformin) of all MALA-RRT cases. Results: One hundred and seventeen cases of AKI-MALA-RRT were observed (12.04/100,000 metformin treated diabetics, 1.45% of all RRT-ICU patients). Survival rate was 78.3%. The average duration of RRT was 4.0 days at mean dialysis effluent of 977 mL/kg/day. At admission most patients were dehydrated, and experienced shock and oliguria. Conclusion: Our data showed that MALA-RRT is a common complication, needing more prevention. Adopted policy of early, extended, continuous and high efficiency dialysis could contribute to an observed high survival rate. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=471917.

The purpose of this analysis was to obtain clinical experience on the possible antitumoral prophylactic activity of the fluoroquinolone pefloxacin against transitional cell carcinoma of the bladder. This inhibitory effect has been observed in vitro. During 1993, a controlled trial to test the antibacterial prophylactic activity of pefloxacin was conducted on 40 patients with superficial bladder cancer who underwent transurethral resection and various adjuvant intravesical treatments. Recurrence rate, interval between first observation and first recurrence, and disease progression were retrospectively compared with those of a group of 44 patients treated with cefotetan during 1992. The two groups were comparable in terms of age, disease characteristics, and adjuvant intravesical antitumoral prophylaxis. After a follow-up of more than 30 months, recurrences were observed in 43.2% and 22.5% of patients treated with cefotetan and pefloxacin, respectively, and the disease-free interval was 13.5 months for cefotetan and 20.2 months for pefloxacin. These differences were both statistically significant. Clinical observations, although not collected within a prospective controlled study, suggest that the fluoroquinolone pefloxacin may have some antitumoral prophylactic activity against superficial bladder cancer, thus indirectly supporting experimental data. Controlled clinical trials should be performed.

Total PSA assay is a well established procedure for biochemical evaluation and management of PCa which usefulness in its diagnosis is limited by its weak specificity with regard to BPH. Recently the assay of Free-PSA and the calculation of Free/Total-PSA Ratio has been suggested to improve the specificity of PSA in the range of concentrations between 2.5 and 20 ng/mL. We evaluated the diagnostic performance of PSA-Ratio among untreated patients with PSA levels ranging from 2.5 to 20 ng/mL and histological diagnosis of PCa or BPH. As the ROC curves analysis showed PSA-Ratio is the better parameter to discriminate between PCa and BPH: PSA-Ratio could be employed to enhance the diagnostic performance of PSA alone in PCa diagnosis.