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OBJECTIVE: The aim of the present paper is to review findings from the most relevant studies and evaluate the potential of new drugs in treatment of metastatic urothelial cancer. METHODS: Studies were identified by searching MEDLINE and Pubmed databases up to 2009 using both medical subject heading (Mesh) and a free text strategy with the name of known individual chemotherapeutic drug and the following key words: 'muscle-invasive bladder cancer', 'urothelial/transitional carcinoma', 'chemotherapeutics drugs and agents'. At the end of our research in literature we selected 63 articles and we have considered only studies in which almost 30 patients were enrolled. RESULTS: Radical cystectomy with pelvic lymph node dissection is the gold standard of treatment for clinically localized muscle-invasive bladder cancer. While more extensive lymph node dissection may have both prognostic and therapeutic significance, effective systemic therapies that eliminate micrometastases may improve outcome. Perioperative chemotherapy can be administered before (neoadjuvant) or after (adjuvant) cystectomy to eradicate subclinical disease and to improve survival. CONCLUSION: The challenge remains as to how to integrate all of the relevant knowledge and data in a systematic manner so that researchers can gain the knowledge needed to devise the best therapeutic and diagnostic strategies. Future improvements in the treatment of advanced bladder cancer will rely not only on the optimization of currently available cytotoxic agents but also on the biologic profile of individual patient tumors and the appropriate therapies that target molecular aberrations unique to this malignancy.

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OBJECTIVE: Stone disease in children differs in pathogenesis, presentation and in treatment from adults. In recent years, big changes on its management have occurred. We reviewed our experience on upper tract urinary calculi in paediatric age. MATERIAL AND METHODS: Patients observed for upper tract urinary stones from June 2002 to June 2008 were reviewed. Bladder-urethral calculi were excluded. Presenting symptoms had a wide range: macro- or micro-hematuria, recurrent abdominal or flank pain, or non-specific symptoms such as irritability and failure to thrive. Renal and urinary tract ultrasonography, plain abdomen X-ray were performed in case of suggestive symptoms. Spiral CT without contrast was recommended to better define the stone disease. Metabolic evaluation is mandatory for any child presenting history of urinary calculi or nephrocalcinosis. Idiopathic hypercalciuria has been recognized as predominant ethiological factor of paediatric nephrolithiasis, excluding stones correlated with urinary tract malformations (up to 45%). RESULTS: In a 6-year period, 232 patients, aged 19 months to 18 years, were treated: 195 children (60.8%), mean age 8.3 years, underwent ESWL. Re-do treatments were 233 (2.3 ESWL/patient), with 77% stone free rate. Percutaneous nephrolithotomy (PCNL) was adopted in 33 patients, mean age 13.4 years, with 2 re-treatments. Stone clearance was 74% after single treatment, increased to 88% by secondary ESWL. Blood transfusion was needed in 7 cases (16%). Retrograde ureterolithotripsy (ULT) was performed in 96 patients presenting ureteral stones, for a total of 99 procedures. Stone free rate was 99%, as 1 pushed up stone required subsequent ESWL. No ureteral perforation or other significant complications occurred. Medical treatment was offered as ancillary therapy or to prevent recurrences, according to the metabolic results and the stone biochemistry. CONCLUSIONS: Stone treatment in children is changing dramatically, thanks to progressive transfer of procedures from adult patients and recent advances in miniaturized new technologies. Surgical approach to renal and urinary tract stones in childhood was recently moving from open surgical procedures (nephrolithotomy, ureterolithotomy, cystolithotomy), to less invasive procedures, such as ESWL and endoscopic approaches, as ULT and PCNL. Mini-invasive procedures present high efficacy and safety, also in young children, but require appropriate instrumentation and specific experience.

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Este trabalho investigou a presença de ansiedade e depressão em estudantes universitários que, simultaneamente, mantinham atividade profissional, buscando verificar possíveis correlações entre estes sintomas com o desconforto físico no trabalho. Os dados foram coletados através do Inventário de Depressão de Beck (BDI - Beck Depression Inventory) e o Inventário de Ansiedade Traço - Estado (IDATE). Foram avaliados 104 indivíduos sendo 85 (81,7 por cento) do sexo feminino. A idade média da amostra foi de 20,64 +/- 7,86 anos. Do total dos indivíduos estudados, 65 (62,5 por cento) praticavam atividade física regular e 77 (74 por cento) queixavam-se de alguma forma de desconforto físico. Os escores das escalas de ansiedade e de depressão foram comparados a partir da divisão da amostra em dois grupos segundo diferentes critérios. O fato de praticar ou não esportes ou ser do sexo feminino ou masculino não se associou a escores diferentes em nenhuma das escalas. Os indivíduos com desconforto em membros superiores apresentaram escores mais elevados em todas as três escalas. O desconforto em região lombar relacionou-se com escores maores de depressão e ansiedade-estado. Escores mais elevados de depressão também foram encontrados entre aqueles indivíduos com desconforto em região cervical e em membros inferiores. Indivíduos com maiores níveis de ansiedade traço foram encontrados entre aqueles com desconforto em geral, desconforto em membros inferiores e aqueles que trabalhavam com digitação. As implicações destes achados para a melhora do conforto nas situações de trabalho e estudo são discutidas (AU)