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Thirty-two female patients affected by urinary incontinence were enrolled for rehabilitative treatment (functional electro-stimulation by vaginal electrode performed three times a week for one month followed by biofeedback performed three times a week for one month). Complete clinical and urodynamic studies, urethrocystography in order to allow Blaivas and Olsson radiologic evaluation were performed. Echography of the bladder and urine cultures were done too. Patients with severe urogenital prolaxus and obesity, neurologic urinary disorders and surgery for incontinence, were excluded. The same patients were urodynamically reassessed at the end of the treatment and a detailed clinical evaluation was obtained from each patient. 78% of patients reported a considerable improvement in clinical symptoms and only 9% reported no improvement. Urodynamic findings showed an increase of maximum cystometric capacity in 6 patients, improvement of maximum urethral closure pressure and/or functional profile length in 17 patients. Disappearance or reduction of involuntary detrusor contractions were found in 2 out of 6 patients with unstable bladder.

Juvenile rheumatoid arthritis is a chronic disease, with the synovium as the target tissue. We made 594 US examinations of the knee in 240 children (mean age: 9 years) with juvenile rheumatoid arthritis. All patients underwent at least one US exam and 156 patients underwent many US examinations during 3 years' follow-up. In our series mean synovial thickness was 6 mm (range: 2.5-11 mm) while in normal subjects mean synovial thickness is 2.7 mm (range: 1-4.5 mm). The mean thickness of the suprapatellar bursa was 9 mm (range: 4-18 mm) versus 2.8 mm (range: 1-5 mm) in normal subjects. The mean length of the suprapatellar bursa was 27 mm (range: 13-44 mm) versus 14.3 mm (range: 8-23.5 mm) in normal children. Cartilage thickness was 3.3 mm (range: 1.2-5.8 mm) at the intercondylar notch, and 3 mm (range: 0.8-5.3 mm) at the femoral condyles. Cartilage thickness is 3.5 mm (range: 2-6 mm) at the intercondylar notch, and 3.2 mm (range: 1.8-5.4 mm) at the femoral condyles in normal subjects. The articular cartilage outline was blurred in 36% of patients with active knee involvement. A Baker cyst was found in 24 patients (10%). The mean volume was 3 ml (range: 1-40 ml). No tendinous alterations were observed. Changes in synovial membrane (synovial thickness), the presence of fluid in the suprapatellar bursa, and blurring of the articular cartilage outline showed statistically significant differences between juvenile rheumatoid arthritis patients with active knee involvement and subjects in clinical remission. On the contrary, articular cartilage thickening or thinning showed no statistically significant differences between juvenile rheumatoid arthritis patients with active knee involvement and subjects in clinical remission. In conclusion, US is a simple, rapid, inexpensive and accurate method for the staging and follow-up of joint inflammation in patients with juvenile rheumatoid arthritis of the knee.

A total of 60 patients with transitional cell carcinoma of the bladder G1-G2, pTa pT1 previously subjected to TUR, were randomised to receive Mitomycin-C (MMC) 30 mg for 12 months (A group) or Mitomycin-C 40 mg for 6 months (B group). The objective of this trial was to compare the prophylactic activity of MMC using two different dosages and treatments. All patients were evaluated with cystoscopy. Follow-up was of 24 months. The incidence of recurrence in the A group was 40% with a recurrence rate of 3.3. In the B group the incidence of recurrence was 27.6% with a recurrence rate of 2.2. One case of progression was present in the A group. The side effects were more frequent in the A group (37% vs 13.3%) and they were mainly due to chemocystitis. These data suggest that MMC 40 mg for 6 months appears to be superior to MMC 30 mg for 12 months in the prophylaxis of superficial bladder carcinoma.

Previous publications attempted to define normal and abnormal ranges in the measurement of pyloric length (L), breadth (D), muscle thickness (S), volume (V) and muscle index (MI). We examined with US 286 patients with suspected hypertrophic pyloric stenosis and investigated all the above diagnostic criteria. Normal and abnormal ranges were in agreement in all five measurements, though less apparent for pyloric volume and muscle index. The patients with borderline values were 46 (16%) for pyloric muscle thickness, 98 (34%) for breadth, 52 (18%) for length, but only 22 (7.7%) for pyloric volume and muscle index. Borderline patients received medical therapy with the antispasmodic drug metaclopramide hydrochloride and they were examined with US after 15 days. Only 8 of 22 borderline patients (36%) developed a typical hypertrophic pyloric stenosis. In the others, pyloric volume was reduced and the symptoms subsided. Pyloric parameters cannot be always measured accurately, but pyloric volume and muscle index measures better distinguish normal from abnormal findings. The formula for pyloric volume calculation is simpler than that for pyloric muscle index calculation and easier to memorize, also because no correction for body weight is necessary.

The oncocytic cell is an epithelial cell with granular eosinophilic cytoplasm extremely rich in mitochondria. It may be observed in different parenchymal tumors of the kidney: oncocytoma, granular cell carcinoma (oncocytic adenocarcinoma), clear cell adenocarcinoma. Renal oncocytoma, a benign tumor, is made up exclusively of regular oncocytic cells.In granular cell carcinoma (oncocytic adenocarcinoma), different aspects of malignancy are present as necrosis, cellular pleomorphism. In clear cell adenocarcinoma, on the contrary, it is possible to observe only some nests of oncocytic cells.The Authors underscore the presence of oncocytic cells in such different neoplasms and the possibility, especially in clear cell adenocarcinoma with nests of oncocytes, that needle biopsy or aspiration cytology from such an area can lead to a misdiagnosis.

Gastroesophageal reflux (GER) is a very common event in the pediatric patient. An accurate and atraumatic imaging technique must be used to differentiate normal from abnormal conditions. Sonography (US) appears to answer this purpose, as recently shown in the international literature. One hundred and seventy-eight patients with suspected GER were enrolled in this study; their age ranged 10 days to 15 years. They were examined with both US and barium swallow, in a double-blind trial. The patients were divided into three groups, according to GER severity, i.e., absent or physiologic GER, moderate GER and severe GER. We considered not only the number of reflux episodes, as related to patients' age, but also reflux volume, esophagus clearing time and possibly coexisting hiatal hernia or esophagitis. US and barium swallow results were in agreement in 93% of the cases. In the other cases US demonstrated more severe GER than barium meal. No statistically significant differences were observed in the various age groups. Since US is a relatively cost-effective, noninvasive and physiologic method which is widely available and uses no ionizing radiations, it can be recommended as the screening test of choice in symptomatic children and in the follow-up.

Unsuspected neoplastic disease of the ureteric stump was discovered in 4 of 47 patients (8.5%) undergoing cystectomy for bladder cancer between 1988 and 1990. Carcinoma in situ was found in one case; invasive cancer was present in 3 cases. Ureteric malignancy was found only in patients with undifferentiated bladder tumor or with a widespread involving of the upper tract of ureter and pelvis. No carcinoma in situ or tumor was discovered in the distal ureter in patients with localized transitional cell carcinoma of the bladder. This research emphasizes the low risk to constructing uretero-intestinal anastomosis with unsuspected tumor in the distal margin of ureter in patients with a transitional cell carcinoma of the bladder.

A retrospective review of 186 cases of transitional cell carcinoma of the bladder observed between 1987 and 1990 is described. Squamous metaplasia was present in 37 cases. This histological feature was especially found in association with poorly differentiated and invasive tumors: the presence of extensive areas of squamous metaplasia (metaplastic areas = or50% of neoplastic surface) was always found in association with high grade neoplasms. For these reasons the authors conclude that transitional cell carcinoma of the bladder showing squamous metaplasia is more aggressive than pure transitional cell carcinoma.

62 men with prostatic hypertrophy and bladder obstruction and 31 age matched women without lower urinary tract obstruction, underwent urodynamic testing which included uroflowmetry, gas cystometry, urethral pressure measurement: electromyography and pressure flow study was only performed to the patients with prostatic hypertrophy. No patient with neurological disease, diabetes mellitus, pelvic operation, neoplasm or stone of the bladder was admitted to the study. Involuntary detrusor contractions (unstable detrusor) were found in 74.2% of male patients and in 25.8% of female patients. In male patients aged over 72 the percentage was 81.8% while in the female patients of the same age was 60%. All the 62 male patients underwent prostatectomy. Two months after surgery, acystometry was done. Unstable detrusor was found in 63.1% of cases. Patients over 80 had a percentage of 100%. These data suggest obstructive prostatic hypertrophy as an important factor in development of involuntary bladder contractions, but the primary pathophysiological factor appears to be age of patients.

No. 54 patients with transitional cell carcinoma G1-2; pTa-pT1, were treated with intravesical therapy with Mitomycin C (MMC) (first group of 27 patients), and Interferon alfa 2a (IFN) (second group of 27 patients), following transurethral resection. The objective of this trial was to compare the prophylactic activity of these two drugs. All patients were evaluated with cystoscopy and urine cytology. Mean follow-up was for the first group of patients (MMC) of 10.4 months, for the second group (IFN) of 12 months. The incidence of recurrence in the first group (MMC) was 11.1% with a recurrence rate of 2.1. In the second group (IFN) the incidence of recurrence was 51.9% with a recurrence rate of 7.4. No case of progression evaluated by grade and stage was observed. The side-effects were more frequent in the MMC group and they were mainly due to chemocystitis. These data suggest that MMC appears to be superior to IFN in intravesical therapy of superficial bladder carcinoma.

A case of leiomyosarcoma arising from the wall of arterious renal vessel is described. While the origin of this neoplasm from the smooth muscle cells of the capsule, blood vessels or the pelvis of the kidney is well known, it is rarely possible to demonstrate the site of origin.

The author studied all of the 1361 male patients that had been hospitalized from December 1986 to September 1990 for chronic urinary retention to determine the incidence of urothelial tumor of the bladder. Sixty-nine (5.07%) were found to have primary urothelial carcinoma of the bladder. However, in another study group comprised of 433 males over 55 with no problems of obstruction, 0.23% had a bladder tumor. This study underscores the role of urinary stasis in the development of urothelial carcinoma of the bladder.

During the period 1988-1990, 683 patients with diagnosis of benign prostatic hyperplasia underwent transvesical prostatectomy. The purpose of the study was to establish the possible presence of incidental carcinoma of the prostate (ICP). Prostatic tissue was studied with sections taken every 0.5 cm. The incidence of ICP was 12.00%. The mean age of patients was 73.5 years. 60.98% of tumors classified T1a, 39.02% T1b. No case of G3 tumor was observed while 92.68% of neoplasms was classified G1 and 7.32% G2. 74.95% of tumoral nests into the prostatic tissue had a breadth about one millimetre.

The Authors report a retrospective review of 224 cases of transitional cell carcinoma of the bladder observed between 1986 and 1990. Squamous metaplasia was present in 45 case. This histological feature was found especially in association with poorly differentiated and invasive tumours: the presence of extensive areas of squamous metaplasia (metaplastic areas = or greater than 50% of neoplastic surface) was always found in association with high grade neoplasms and with a disease-free period shorter than transitional cell carcinoma. The Authors conclude that squamous metaplasia in transitional cell carcinoma of the bladder is a really unfavourable prognostic factor.

The Author presents a case of primary signet-ring cell carcinoma of the urinary bladder treated with radical cystectomy and died 17 months after surgery. Only 14 well documented cases have been previously published. Biological and clinical aspects of the neoplasm and its therapy are discussed too.

The Authors report their personal experience of pure squamous cell carcinoma of the bladder. Between 1984 and 1988 they have observed 389 tumors of the bladder; squamous cell carcinoma was present in fifteen cases (3.8%). Epidemiology, pathology (gross configuration of tumor, histologic grading, staging according to the criteria of the UICC of 1987), presenting symptoms, treatment and survival have been considered. The Authors underline the importance of a careful histologic examination of the vesical tumors.

Five cases of chronic perirenal hematoma are reported. Preoperative tests were performed to assess the malignant or benign nature of the lesions which were observed some time after the dramatic episode which marked their onset. The varying characteristics of the disease showed by different imaging techniques (urography, arteriography, US, CAT) are such that only surgery can remove all doubts in the majority of cases.

The Authors describe a case of simultaneous, contralateral, transitional cell carcinoma of the ureter in a 64-year-old man. Surgical conservative therapy was performed. The patient is well and free from recurrence 3-years after.