Catania, Italy
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Pepe F.,Santo Bambino Hospital | Pepe P.,Cannizzaro Hospital
Archives of Gynecology and Obstetrics | Year: 2013

Purpose: Color Doppler ultrasound (CDU) accuracy of kidneys and bladder in the diagnosis and treatment of hydronephrosis and/or renal colic in pregnancies was evaluated. Methods: Between January 2010 and September 2012, 234 pregnant women asymptomatic in 204 cases and with unilateral renal colic in 30 (median 26 years) were evaluated. A CDU of the urinary tract was performed using a sonograph GE Logiq 500 PRO with a multifrequency (3-5 MHz) convex probe. The following parameters were evaluated: resistive index (RI) of the arciform arteries of both kidneys and bilateral ureteric jets. A renal RI > 0.70 and/or a 10 % difference between the kidneys and an asymmetric and/or reduced ureteric jet from the ureteric orifices were considered as diagnostic of obstructive uropathy. Results: Overall incidence of hydronephrosis was equal to 27 % (63 out 234 cases); the incidence of hydronephrosis, RI > 0.70 and abnormal ureteric jet in asymptomatic vs symptomatic pregnant women was equal to 30.9 vs 50 %, 16.1 vs 50 %, 3 vs 60 % (p < 0.05), respectively. In the 63 pregnancies with asymptomatic hydronephrosis RI and ureteric jet evaluation were abnormal in 39 (19.1 %) and 6 cases (3 %), respectively. In the 30 pregnancies with renal colic conventional ultrasound vs CDU, findings were abnormal in 15 (50 %) vs 20 (66.7 %) (p = 0.015) cases, respectively. Conclusions: Color Doppler ultrasound in pregnancies with hydronephrosis and/or renal colic improves conventional ultrasound accuracy; in fact, CDU adds a functional evaluation of the urinary tract when combined with clinical findings allows performing the appropriate management. © 2013 Springer-Verlag Berlin Heidelberg.

Pepe P.,Cannizzaro Hospital | Aragona F.,Cannizzaro Hospital
Urology | Year: 2013

Objective: To evaluate clinical complications after transperineal prostate biopsy in patients undergoing 12 vs 18 vs more than 24 cores. Methods: From February 2002 to December 2012, 3000 patients (median age, 66 years) underwent transperineal prostate biopsy after an abnormal result on a digital rectal examination, prostate-specific antigen (PSA) level >10 ng/mL, PSA values between 4.1 and 10, 2.6 and 4, and <2.5 ng/mL with free/total PSA ≤25%, ≤20%, and ≤15%, respectively. Of these, 915 (30.5%), 1330 (48.5%), and 630 patients (21%) underwent 12, 18, and >24 needle cores under antibiotic prophylaxis. Prostate biopsy-related complications were evaluated within 15 to 20 days after the prostate biopsy. The number of patients who needed hospital admission or an emergency department visit (EDV) was recorded. Results: Prostate cancer was found in 1150 (38.3%) patients. Side effects after the biopsy occurred in 40.2% of the patients, and the complications were directly correlated with the number of needle cores: 31.5% with 12 cores, 41.8% with 18 cores, and 57.4% with >24 cores (P =.001). Overall hospital admission and EDV were 1.2% and 9.1% and occurred, respectively, in 1% and 6% (12 cores) vs 1.3% and 9.6% (18 cores) vs 1.6% and 14.4% (>24 cores) of the patients. The most frequent complication that needed hospital admission vs EDV was urinary tract infection (0.7%) vs acute urinary retention (6.7%), respectively. No patients developed sepsis. Conclusion: Clinical complications after transperineal prostate biopsy occurred in 40.2% of the patients, but only 1.2% required hospital admission. The number of needle cores (12 vs 18 vs >24) significantly correlated with increased onset of side effects. © 2013 Elsevier Inc. All Rights Reserved.

Pepe P.,Cannizzaro Hospital | Aragona F.,Cannizzaro Hospital
World Journal of Urology | Year: 2014

Purpose: Detection rate for prostate cancer (PCa) and complications following transperineal prostate biopsy (TPBx) were reported. Methods: From January 1991 to December 2012, 4,000 men underwent TPBx; from 1991 to 2001, the patients underwent biopsy for suspicious DRE or PSA values >4 ng/mL; moreover, from 2002, the indications were abnormal DRE, PSA >10 ng/mL, PSA values between 4.1 and 10, 2.6 and 4 and <2.5 ng/mL with F/T PSA <25, <20 <15 %, respectively. In case of initial biopsy, the number of needles cores increased from 6 (1991-1996) to 12 (1997-2012) and 18 cores (2002-2012); in case of repeat biopsy, since 2005 a saturation biopsy (SPBx) with >24 cores was performed. Results: Overall, PCa, normal parenchyma, HGPIN and ASAP were found in 1,379 (34.5 %), 2,400 (60 %), 175 (4.4 %) and 46 (1.1 %) patients, respectively; in case of initial TPBx, the scheme at 18 showed a greater PCa detection in comparison with scheme at 6-12 cores (p < 0.05). In case of repeat biopsy, a higher detection of microfocus of cancer was found performing a SPBx; moreover, 15 % of cancers were localized in the anterior zone. Incidence of hemospermia and urinary retention were correlated with the number of needle cores resulting equal to 30.4 versus 11.1 % in case of SPBx (p < 0.05); moreover, none developed sepsis. Conclusions: Transperineal prostate biopsy (TPBx) resets the risk of sepsis; moreover, in case of repeat SPBx, the transperineal approach detects a high number of significant PCa localized in the anterior zone (15 % of the cases). © 2013 Springer-Verlag Berlin Heidelberg.

Pepe P.,Cannizzaro Hospital | Garufi A.,Cannizzaro Hospital | Priolo G.,Cannizzaro Hospital | Pennisi M.,Cannizzaro Hospital
Clinical Genitourinary Cancer | Year: 2015

Introduction The aim of this study was to evaluate multiparametric pelvic magnetic resonance imaging (mpMRI) accuracy in prostate cancer (PCa) diagnosis. Patients and Methods From June 2011 to March 2014, 100 patients (median age, 64 years) with negative digital rectal examination underwent repeat transperineal saturation biopsy (SPBx; median, 29 cores) for persistent prostate-specific antigen (PSA) values between 4.1 and 10 ng/mL with free/total PSA ≤ 25%. All patients underwent mpMRI using a 3.0-Tesla scanner (ACHIEVA; Philips) 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 37 (37%) of cases; SPBx and mpMRI targeted biopsy diagnosed 34 (34%) and 29 (29%) cancers, missing 3 (all of the anterior zone) and 8 cancers (7 and 1 of the lateral margins and anterior zone, respectively); in detail, mpMRI missed 8 (21.7%) PCa characterized by minimal histological disease at risk for insignificant cancer. The diameter of the mpMRI suspicious lesion was significantly correlated with the diagnosis of PCa with poor Gleason score (P =.005). The detection rate of cancer for each mpMRI core was 40.7%; moreover, mpMRI would have spared 31 (31%) unnecessary SPBx. Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive value of mpMRI in diagnosing overall cancer versus significant PCa was 82.6% versus 81.3%, 82.2% versus 100%, 77.8% versus 78.9%, 65.4% versus 55.8%, and 95.5% versus 100%, respectively. Conclusion mpMRI targeted biopsy improved diagnosis of significant anterior zone PCa, missing cancers at risk for clinically insignificant disease; moreover, the diameter of the lesion on mpMRI was significantly predictive of aggressive PCa. © 2015 Elsevier Inc.

The prevalence of sacroiliac Joint (SIJ) disease as a cause of LBP is considered to range from 21% to 25%. Nevertheless, SIJ instability is frequently underestimated. Although conventional surgery has been used for several years in an attempt to stabilize the SIJ, a new percutaneous system has been proposed for articular fusion. Recently a new "one-step" fixation procedure has been proposed. We describe the case of a patient with painful SIJ instability treated with a fully CTguided technique in simple analogue sedation.

Pepe P.,Cannizzaro Hospital | Aragona F.,Cannizzaro Hospital
Prostate Cancer and Prostatic Diseases | Year: 2010

To evaluate prostate cancer (PCa) detection and incidence of pathologically insignificant PCa (pIPCa) tumour using percent-free PSA (%f-PSA) in patients with total PSA ≤ 10 ng ml-1. From February 2002 to October 2009, 14 453 patients (median 60.5 years) were enrolled in a case-finding protocol for the early diagnosis of PCa. Indications to biopsy were suspicious digital rectal examination; PSA > 10 ng ml-1; PSA ≤ 2.5 ng ml -1, included between 2.6-4 and 4.1-10 ng ml-1 with %f-PSA <15, <20 and <25%, respectively. A median of 18 and 26 cores in case of primary and repeated biopsy were determined; 2123 men underwent prostate biopsy, of whom 1589 (74.8%) had a PSA ≤10 ng ml-1. A PCa was found in 777 (36.6%) and in 35 (23.3%) patients at primary and repeated biopsy: 459 and 26 men had PSA ≤10 ng ml-1 and 419 and 26 patients underwent surgery, respectively, 244 (58.3%) and 18 (69.2%) had an organ-confined PCa with a pIPCa incidence equal to 1.4 and 7.7%, respectively. Cancer detection rate of 28.8% in patients with PSA ≤10 ng ml -1 associated with a low incidence of pIPCa should induce to introduce %f-PSA in screening programmes to reduce the risk of overdiagnosis. © 2010 Macmillan Publishers Limited All rights reserved.

Pepe P.,Cannizzaro Hospital | Aragona F.,Cannizzaro Hospital
Canadian Journal of Urology | Year: 2013

Introduction: To evaluate Prostate Cancer Prevention Trial (PCPT) risk calculator versus prostate cancer gene 3 (PCA3) score versus case-finding protocol accuracy in prostate cancer diagnosis in patients with prostate-specific antigen (PSA) below 10 ng/mL submitted to repeat saturation biopsy (SPBx). Materials and methods: From December 2010 to December 2011, 100 patients (median 66 years) underwent a SPBx (median 30 cores); the indications for repeat biopsy were those of a case-finding protocol: PSA values between 4.1 ng/mL-10 ng/mL or 2.6 ng/mL-4 ng/mL with F/T PSA ≤ 25% and ≤ 20%, respectively. All patients had negative digital rectal examination (DRE) and median PSA was 7.9 ng/mL. The performance of PCPT risk calculator (alone, combined with PSA free/total (F/T) or PCA3 score) and PCA3 score in comparison with the case-finding protocol results (alone or combined with PCA3 score) was retrospectively evaluated in terms of detection rate for cancer and number of avoided biopsies. Results: Prostate cancer was found in 28 (28%) patients; in the presence and absence of prostate cancer median PCA3 score was 57 versus 35 (p < 0.05). Using PCPT risk calculator (cut off probability of 25%) combined with PCA3 score no prostate cancer would be missed avoiding 8% of unnecessary biopsies. PCA3 score > 20 missed 7.2% of cancer; the case-finding protocol combined with PCA3 score > 35 would save 22% of avoidable biopsies, missing no cancer if all patients with PSA F/T ≤ 15% would undergo prostate biopsy irrespective of PCA3 values. Conclusions: PCA3 score improves PCPT risk calculator accuracy in prostate cancer diagnosis; moreover, PCA3 score combined with PSA F/T reduce number of unnecessary biopsies (about 20%). © The Canadian Journal Of Urology ™.

Pepe P.,Cannizzaro Hospital | Aragona F.,Cannizzaro Hospital
Anticancer Research | Year: 2011

Aim. PCA3 score and PSA free/total (FIT) accuracy in PCa diagnosis at repeat saturation prostate biopsy (SPBx) in patients with PSA between 4 and 10 ng/mL was evaluated. Materials and Methods: From October 2009 to September 2011 74 men (median 64 years) with persistent high or increasing PSA values, negative DRE, median PSA values of 8.9 ng/mL and primary negative extended biopsy underwent a SPBx (median 28 cores) for persistent suspicion for PCa. Results: PCA3 >20 and >35, PSA F/T ≤15%, ≤20% and ≤25% identified 25, 21, 18, 23 and 26 out 27 cancer, respectively. PCA3 cut-off of 20 demonstrated the best accuracy with an AUC-ROC curve of 0.73. Conclusion: The NPV equal to 88.9% suggests to use PCA3 cut-off 20 as an exclusion tool; moreover, PCA3 cut-off of 35 combined with PSA F/T ≤15% allows to spare 32.4% of unnecessary repeat biopsies.

Pepe P.,Cannizzaro Hospital | Aragona F.,Cannizzaro Hospital
Urologia Internationalis | Year: 2011

Introduction: To evaluate if an inflammatory pattern at primary biopsy is associated with a lower risk for cancer in men submitted to repeated saturation prostate biopsy (SPBx). Methods: From January 2005 to January 2010, 320 patients, after a negative primary extended biopsy (median 18 cores), underwent SPBx by transperineal approach performing 27 cores (median). 210 (65.6%) patients had a normal parenchyma and 110 had an inflammatory pattern (34.4%) at primary biopsy (none of them complained of symptoms suggesting a diagnosis of acute prostatitis at the time of biopsy). Moreover, median prostate-specific antigen and abnormal digital rectal examination was equal to 7.3 ng/ml and 3.6% versus 8.2 ng/ml and 3.8%, respectively. Results: Prostate cancer (PCa) was found in 66 (20.5%) of 320 patients. Of these, 42 (63.6%) and 24 (36.4%; p = 0.007) had a histological diagnosis of chronic prostatitis and normal parenchyma at primary biopsy, respectively. Conclusions: An inflammatory pattern at primary biopsy is not associated with a decrease in PCa incidence at repeated SPBx; therefore, only an accurate clinical evaluation including more parameters (i.e. urinary PCA3) could hopefully select men who need to undergo rebiopsy in the presence of persistent suspicion of cancer. Copyright © 2011 S. Karger AG, Basel.

Galia A.,Cannizzaro Hospital
European journal of histochemistry : EJH | Year: 2012

One of the most common type of primary brain tumors in adults is the glioblastoma multiforme (GBM) (World Health Organization grade IV astrocytoma). It is the most common malignant and aggressive form of glioma and it is among the most lethal ones. Poly (ADP-ribose) polymerase 1 (PARP-1) gene, located to 1q42, plays an important role for the efficient maintenance of genome integrity. PARP-1 protein is required for the apoptosis-inducing factor (AIF) translocation from the mitochondria to the nucleus. PARP-1 is proteolytically cleaved at the onset of apoptosis by caspase-3. Microarray analysis of PARP-1 gene expression in more than 8,000 samples revealed that PARP-1 is more highly expressed in several types of cancer compared with the equivalent normal tissues. Overall, the most differences in PARP-1 gene expression have been observed in breast, ovarian, endometrial, lung, and skin cancers, and non-Hodgkin's lymphoma. We evaluated the expression of PARP-1 protein in normal brain tissues and primary GBM by immunohistochemistry. Positive nuclear PARP-1 staining was found in all samples with GBM, but not in normal neurons from controls (n=4) and GBM patients (n=27). No cytoplasmic staining was observed in any sample. In conclusion, PARP-1 gene is expressed in GBM. This finding may be envisioned as an attempt to trigger apoptosis in this tumor, as well as in many other malignancies. The presence of the protein exclusively at the nucleus further support the function played by this gene in genome integrity maintenance and apoptosis. Finally, PARP-1 staining may be used as GBM cell marker.

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