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Objectives: Malignant and normal tissues are known to have different electromagnetic properties, and various attempts have been made to use these information for diagnostic purposes. A nonlinear tuneable oscillator (Trimprob TM ) generating extremely low energy multiple electromagnetic fields has been developed for non-invasive analysis of electromagnetic anisotropy in humans. Objective of this study was to evaluate the feasibility of prostate cancer detection using the TRIMprob TM and to evaluate its diagnostic accuracy. Methods: 757 men were evaluated with the TRIMprob TM between July 2002 and May 2003 in a prostate unit. The TRIMprob TM was moved over the surface of the patient's perineum while standing, normally dressed, in front of the system receiver. A single operator, blinded to the patient status, conducted the tests. Nonlinear resonance was analysed at 465, 930 and 1395MHz. Results: Analysis of resonance values at 465MHz showed a significant difference between controls, patients with benign prostatic hyperplasia and patients with prostate cancer. In our study population, a sensitivity of 95.5% and specificity of 42.7% for the diagnosis of prostate cancer with a positive and negative predictive value of 63.6% and 89.8% was found. Conclusions: The results of this study confirm the possibility of electromagnetic detection of cancer. An extracorporeal scan by the TRIMprob TM can identify patients at risk for prostate cancer, and recognise those in whom the risk is extremely low. The results of the present study represent a proof-of-concept, which may open a new field of medicine.

The amino acid sequence of ERp57, which functions in the endoplasmic reticulum together with the lectins calreticulin and calnexin to achieve folding of newly synthesized glycoproteins, is highly similar to that of protein disulfide isomerase (PDI), but they have their own distinct roles in protein folding. We have characterized the domain structure of ERp57 by limited proteolysis and N-terminal sequencing and have found it to be similar but not identical to that of PDI. ERp57 had three major protease-sensitive regions, the first of which was located between residues 120 and 150, the second between 201 and 215, and the third between 313 and 341, the data thus being consistent with a four-domain structure abb'a'. Recombinant expression in Escherichia coli was used to verify the domain boundaries. Each single domain and a b'a' double domain could be produced in the form of soluble, folded polypeptides, as verified by circular dichroism spectra and urea gradient gel electrophoresis. When the ability of ERp57 and its a and a' domains to fold denatured RNase A was studied by electrospray mass analyses, ERp57 markedly enhanced the folding rate at early time points, although less effectively than PDI, but was an ineffective catalyst of the overall process. The a and a' domains produced only minor, if any, increases in the folding rate at the early stages and no increase at the late stages. Interaction of the soluble ERp57 domains with the P domain of calreticulin was studied by chemical cross-linking in vitro. None of the single ERp57 domains nor the b'a' double domain could be cross-linked to the P domain, whereas cross-linking was obtained with a hybrid ERpabb'PDIa'c polypeptide but not with ERpabPDIb'a'c, indicating that multiple domains are involved in this protein-protein interaction and that the b' domain of ERp57 cannot be replaced by that of PDI.

During the last year we have observed 57 patients aged over 70 years, affected by infiltrating bladder carcinoma. Cystectomy prevents haemorrhagic, septic and obstructive complications of the neoplastic bladder, with a better quality of life, but, except in the initial stages, is probably not able to heal the patient. Cystectomy is however the most effective therapeutic option and with an adequate preparation it is possible to operate elderly patients without serious complications.

Between June 1989 and May 1991, 11 patients with locally advanced and metastatic bladder cancer were treated by modified M-VAC regimen. After four or more courses of neo-adjuvant chemotherapy, the responders underwent to enlarged cystectomy. Patient's age ranged from 37 to 63 years (average 54 years). Four patients had T3NOMO disease, four had T3-4N1–2MO stage and three distant metastases. M-VAC regimen was modified according to the following schedule: MTX 30 mg/M2 on days 1 and 15, Vinblastin 3 mg/M2 on days 2 and 15, Doxorubicin 30 mg/M2 and Cisplatin 80 mg/M2 on day 2. Cisplatin infusion was preceded and followed by 2 liters of hydration fluid. Antiemetic regime with Ondansetron and Dexamethasone was instituted. All patients were evaluated for toxicity and response and six underwent 6–18 months of follow-up. 1 patient had significant increase of serum creatinine and, another had acute anemia. We observed 7 PR (65%) and 4 stable disease. In 2 cases of lung and liver localization metastases regressed completely. In 6 cases radical cystectomy was performed only and in 4 cases external beam radiation and cystectomy were performed after the chemotherapy. At 6, 7, 12, 16 months of follow-up 4 patients had no evidence of disease.

Eight consecutive patients with stage III or bulky stage II germ cell tumors were treated with 4 cycles of cisplatin, etoposide and bleomycin combination chemotherapy (PEB). 3 patients were in complete remission (CR) after surgery of residual masses. 5 patients received 2–4 additional courses of P.V.I. (cisplatin, vinblastine and iphosphamide) chemotherapy and had complete remission (3 cases after surgery of residual masses). No residual tumor was found in 2 cases at surgery (25%). In the present series 3 patients had extrapulmonary disease, 2 retroperitoneal lymphnodes larger than 10 cm. and pulmonary disease. 1 patient had previous incomplete RPND. After a median follow-up period of 30 months (15–37) all the patients are disease-free with normal levels of AFP and beta HCG. In conclusion we repeat that intensive combination chemotherapy is the key for successful surgery of residual malignancy in patients with disseminated testicular cancer. Second-line of chemotherapy is more favourable than early surgery, in our opinion, for treatment of far-advanced disease.

Intraoperative autotransfusion is the ideal method for restoring blood loss during surgical procedures. In the last few years the confirmation of damage due to transfusion of stored blood, plus risingcosts, led to a revaluation of this procedure. From March 1990 to December 1991, 18 patients underwent intraoperative autotransfusion during radical prostatectomy for carcinoma stage B, utilizing a Dideco Autotrans BT 795 processor. Recovered blood was washed by physiological solution, centrifuged and filtered for air bubble and aggregate elimination, then reinfused. Average recovered blood rate was 853 ml (640-1087), the retransfused rate was 557 ml (410-727). Preoperative Ht rate was between 38.6% and 42.7% (average 40.8%); in the immediate post operative period (4–6 hours after procedure) Ht rate was between 34.3% and 38.6% (average 36.8%). No stored blood was required. We propose a wider utilization of this procedure for safety and lower cost.

Renal cysts are frequently recognised by urological assessment. The management of these cysts is performed by echoguided percutaneous puncture and drainage, by sclerosing with alcohol or antimitotic agents or by open surgery. Laparoscopy is a safe and reliable procedure for treatment of cryptorchid testicle, varix ligation and staging of lymph nodes in prostatic cancer. From 2/92 to 3/93, we treated in our center, 4 patients with renal cysts. The patients were placed in a contro-lateral position. The Verress needle is inserted at the edge of the rectus muscle. The first Trocar is placed 5 cm above the needle. The following trocars are placed in the hemiabdomen related to the cyst. The cyst was freed and resected. In 3 cases the procedure was successful. In the last one, laparoscopy failed because of damage to the speen. The patients were mobilized within 1 day and discharged within 3 days.

Percutaneous debulking and subsequent ESWL treatment has proved a successful approach to complex stones. Out of 232 patients treated with PCNL from March 1984 to March 1992, 102 (45%) were managed by PCNL debulking and ESWL or EPL (Extracorporeal piezoelectric lithotripsy). Recently (Zingonia period 1988–1992) only 21 patients with bulky or staghorn stones were treated by combination therapy. In our series, there were 1.3 sessions of PCNL and 1.8 sessions of ESWL for each patient. We report a high frequency of retained stone fragments (45% at 3 months follow-up). Out of 21, 3 patients underwent further ESWL procedures because the fragments were conglobed. No complications occurred in present series. In the one case we observed a rise in serum creatinine. In our opinion debulking PCNL and ESWL is the treatment of choice in the following cases: burden pyelitic stones, staghorn stones larger than 3 cm. and smaller than 5 cm., partial staghorn filling renal pelvis and 1 calyx; short length of calyces; pyelitic portion exceeding caliceal mass; infected stones in working kidney, stone in solitary kidney larger than 2 cm and hard; previous surgery.

Varicocele is frequently a contributing factor in male infertility. We performed outpatient laparoscopic varicocelectomy in 13 patients (15 varices) with clinically evident varicocele and persistent oligo-asthenospermia. Identification and preservation of the spermatic artery was easy in all cases. Mean interval to resumption of preoperative activity levels was 3 days. The procedure decreases post-operative morbidity.