First Report of the Root-Knot Nematode, Meloidogyne hispanica, Infecting Sunflower in Greece.

Severe plant stunting, chlorosis, and extensive root galling were observed on sunflower (Helianthus annus Pioneer Hi-bred PR64LE19, Dupont) in a commercial field at Agios Athanasios, Drama Province, northeastern Greece at the end of May 2013. Disease symptoms were observed about 1.5 months after planting, and were distributed in patches that covered approximately 2% of the whole cultivated area. Examination of the soil and root samples from selected infected plants revealed the presence of abundant root-knot nematodes. Juveniles, males, and females were extracted by sieving, decanting, and root dissection for identification using morphological traits. Nematode population densities ranging from 100 to 150 J2s per 100 cm3 of soil, and 150 to 3,000 eggs per g of fresh sunflower roots were observed. Identification was confirmed by perineal patterns of females and by sequencing of the D2-D3 expansion segments of 28S ribosomal RNA gene (1,3,4). All identification methods were consistent with typical Meloidogyne hispanica. Morphology of perineal patterns of females and measurements of the second-stage juveniles (J2s) matched those of the original description of M. hispanica (3). Alignment indicated that the D2-D3 sequence (GenBank Accession No. KF501128) was 99% homologous to other sequences of M. hispanica deposited in GenBank from Brazil, Portugal, and Spain (EU443606, EU443608, and GQ375158, respectively), differing in only one nucleotide. Phylogenetic analyses using maximum likelihood of this sequence placed the Meloidogyne sp. in a highly supported (100%) clade that included all M. hispanica sequences available from the GenBank database (4). Root-knot nematodes in general have been reported to cause economic losses in sunflower in Europe (2), but there are no reports of M. hispanica. M. hispanica was first found in Seville Province, southern Spain, infecting rootstocks of Prunus spp. (3). Its distribution has been confirmed worldwide on different agricultural crops. However, to our knowledge, this is the first report of M. hispanica infecting sunflower in Europe and the first report of this species on any crop for Greece. The identification of M. hispanica in sunflower is relevant because it may represent a threat for sunflower production in Greece. Research to develop sunflower varieties resistant to root-knot nematodes should now also consider M. hispanica along with other species of Meloidogyne. References: (1) K. R. Barker. Page 19 in: An Advanced Treatise on Meloidogyne. Vol. II, Methodology. K. R. Barker et al., eds. North Carolina State University Graphics, Raleigh, NC, 1985. (2) M. Di Vito et al. Nematol. Mediterr. 24:109, 1996. (3) H. Hirschmann. J. Nematol. 18:520, 1986. (4) B. B. Landa et al. Plant Dis. 92:1104, 2008.

Expression of E-cadherin in primary endometrial carcinomas: clinicopathological and immunohistochemical analysis of 30 cases.

INTRODUCTION: Decreased expression of E-cadherin has been associated with poorly differentiated endometrial carcinomas and poorer outcomes. AIM: The purpose of this study was to examine the distribution of E-cadherin immunohistochemical expression in specimens from primary endometrial carcinomas and its relation to classical clinicopathological prognostic factors. MATERIALS AND METHODS: Surgically-resected tissues of 30 patients with primary endometrial carcinomas were studied. Histological type and grade, depth of myometrial invasion, lymph-vascular space invasion, fallopian tube or ovarian invasion, and the presence of tumoral necrosis were evaluated. Immunohistochemical examination was performed on deparaffinized four-microm-thick sections. RESULTS: The mean age of patients was 65 years (+/- 11.41). The 63.54% of carcinomas were moderately/poorly differentiated. No statistical correlation was found between the score or intensity of E-cadherin immunohistochemical staining (strong or moderate positive expression) and the clinicopathological factors tested. CONCLUSIONS: The association of E-cadherin immunoreactivity with the standard clinicopathological factors seemed to be contradictory. The classical clinicopathological factors remain the most important prognostic parameters.

Laparoscopic cryotherapy for small renal masses: Current State.

OBJECTIVES: To provide an up-to-date review of the available literature on laparoscopic cryotherapy for small renal masses (SRMs) including technique description, indications and outcomes. METHODS: A systematic literature search was conducted in March 2012, using MEDLINE and EMBASE via Ovid databases, to identify studies on laparoscopic cryotherapy for SRMs published during the last 10 years. Only English-language and human-based full manuscripts reporting case series studies with >20 participants, patient characteristics, efficacy and safety data were included. RESULTS: No randomised controlled trials (RCTs)were identified. In total, 27 full reports addressing laparoscopic cryoablation (LCA) for SRMs were selected. The number of patients per study ranged from 20 to 144. Mean age of treated patients across the series ranged from 62 to 73 years. Mean size of renal tumors ranged from 2.7 to 4 cm, being in most cases <3 cm. The number of cryoprobes used for cryoablation ranged from 1 to 6, and only 10 series described the use of 17-gauge (1.47 mm) third-generation needles. Overall, more than 55% of all ablated lesions were pathologically confirmed RCC. Mean follow-up ranged from 9 to 93 months. Only 7 series presented a long-term follow-up of more than 36 months. Most studies were limited by a relatively short follow-up. At least four urologic groups reported intermediate- and long-term outcomes. Persistence rates ranged from 0% to 17% and recurrence rates ranged from 0% to 14%. Overall complication rates ranged from 0% to 40%. CONCLUSIONS: Retrospective observational data and a few prospective series on LCA of SRMs show acceptable oncological 3- to 5-year outcomes with a low recurrence rate. It has proven to be a safe procedure with an overall low complication rate. It is mainly indicated for SRMs in elderly patients affected by co-morbidity and high surgical risk bearing tumours in the anterior valve of the kidney or in contact with the ureter or neighbouring organs.

Crioablacion laparoscopica de pequeñas masas renales: Estado actual / Laparoscopic cryotherapy for small renal masses: current state

OBJETIVO: Presentar una revisión actualizada de la literatura disponible sobre crioablación laparoscópica de pequeñas masas renales (SRMs), incluyendo descripción de la técnica, indicaciones y resultados. MÉTODOS: Se realizó una revisión de la literatura hasta marzo de 2012, utilizando las bases de datos MEDLINE y EMBASE vía Ovid, para identificar estudios sobre crioablación laparoscópica de SRMs publicados durante los últimos 10 años. Sólo se incluyeron manuscritos en inglés y estudios basados en humanos, que reportaron series con más de 20 participantes, características de los pacientes, eficacia y seguridad del procedimiento. RESULTADOS: No se identificaron ensayos clínicos aleatorizados (RCTs). En total, se seleccionaron 27 trabajos originales sobre crioablación laparoscópica (LCA) de SRMs. El número de pacientes por estudio osciló entre 20 y 144. La edad media de los mismos a lo largo de las series osciló entre 62 y 73 años. El tamaño medio de los tumores renales osciló entre 2,7 y 4 cm, siendo en la mayoría de los casos ≤3 cm. El número de crioagujas utilizadas para crioablación osciló entre 1 y 6, mientras que sólo en 10 series se describió la utilización de crioagujas de tercera generación de 17 gauge (1,47 mm).En total, más del 55% de las lesiones tratadas resultaron carcinoma de células renales (RCC) confirmado por el análisis anatomopatológico. El seguimiento medio de los pacientes osciló entre 9 y 93 meses. Sólo 7 series presentaron un seguimiento a largo plazo superior a 36 meses. La mayoría de los estudios resultaron limitados por un seguimiento relativamente corto. Al menos cuatro grupos de investigación reportaron resultados a intermedio y a largo plazo. Las tasas de persistencia tumoral oscilaron entre 0% y 17%, mientras que las tasas de recidiva oscilaron entre 0% y 14%. La tasa global de complicaciones osciló entre 0% y 40%(AU)

CONCLUSIONES: Los datos de estudios observacionales y retrospectivos así como los de algunas series prospectivas, demostraron aceptables resultados oncológicos a 3 y 5 años y una baja tasa de recidiva. La LCA demostró ser un procedimiento seguro con una baja tasa global de complicaciones. Está indicada principalmente en el tratamiento de SRMs en pacientes añosos con alta comorbilidad y elevado riesgo quirúrgico, albergando tumores en la valva anterior del riñón o en contacto con el uréter u órganos vecinos(AU)

OBJECTIVES: To provide an up-to-date review of the available literature on laparoscopic cryotherapy for small renal masses (SRMs) including technique description, indications and outcomes. METHODS: A systematic literature search was conducted in March 2012, using MEDLINE and EMBASE via Ovid databases, to identify studies on laparoscopic cryotherapy for SRMs published during the last 10 years. Only English-language and human-based full manuscripts reporting case series studies with >20 participants, patient characteristics, efficacy and safety data were included. RESULTS: No randomised controlled trials (RCTs) were identified. In total, 27 full reports addressing laparoscopic cryoablation (LCA) for SRMs were selected. The number of patients per study ranged from 20 to 144. Mean age of treated patients across the series ranged from 62 to 73 years. Mean size of renal tumors ranged from 2.7 to 4 cm, being in most cases <3 cm. The number of cryoprobes used for cryoablation ranged from 1 to 6, and only 10 series described the use of 17-gauge (1.47 mm) third-generation needles. Overall, more than 55% of all ablated lesions were pathologically confirmed RCC.Mean follow-up ranged from 9 to 93 months. Only 7 series presented a long-term follow-up of more than 36 months. Most studies were limited by a relatively short follow-up. At least four urologic groups reported intermediate- and long-term outcomes. Persistence rates ranged from 0% to 17% and recurrence rates ranged from 0% to 14%. Overall complication rates ranged from 0% to 40%(AU)

CONCLUSIONS: Retrospective observational data and a few prospective series on LCA of SRMs show acceptable oncological 3- to 5-year outcomes with a low recurrence rate. It has proven to be a safe procedure with an overall low complication rate. It is mainly indicated for SRMs in elderly patients affected by co-morbidity and high surgical risk bearing tumours in the anterior valve of the kidney or in contact with the ureter or neighbouring organs(AU)

Prostatic peripheral nerve distribution may impact the functional outcome of nerve-sparing prostatectomy.

PURPOSE: To study microscopic patterns of remaining peripheral nerves (PN) after nerve-sparing (NS) radical prostatectomy (RP) and possible consequences for nerve preparation. METHODS: Specimens from 27 patients (7 = non-NSRP, 20 = unilateral NS) were examined. Sections were investigated for PN content by immunoassaying. 120 whole-mounted slides were divided into four sectors, and extracapsular nerves were counted; the mean posterior/anterior ratio was calculated. Calculated ratios were correlated with the respective volumes of prostatic tissue (PV). After dividing the patient cohort into two subgroups, shared by the median value of the posterior/anterior nerve ratios, the absolute PN contents on the anterior surface of the NS sides were compared. RESULTS: Anatomical posterior nerve percentage in non-NS aspects ranged from 0.0-100.0 to 26.7-94.6% with a mean of 66.60 ± 25.4% and 68.83 ± 16.0% (>/<200 µm, respectively). Individual ratios from two nerve categories showed significant correlation (P < 0.008). Mean posterior ratios were 83.04/79.68 and 39.21/56.00, respectively. After unilateral NS, 3.17-fold (2.25 vs. 0.71 nerves, P = 0.05) and 2.26-fold (21.54 vs. 9.53, P = 0.08) nerve fibers were resected in the anterior area in comparison with type A. After unilateral NS, the variation impact on the anterior nerve content of the NS side could be demonstrated. CONCLUSIONS: The amounts of nerves localized on the anterior prostate after RP vary interindividually. Saving only a minor part of the anterior areas may have an impact on the quantity of excised nerves adjacent to the specimen and impair postoperative functional results. Especially for those patients without a major posterolateral bundle distribution, surgeons should adapt the procedure and start nerve preservation more anteriorly to maximize the probability of satisfactory postoperative functional results.

Laparoscopic radical cystectomy: initial experience using the single-incision triangulated umbilical surgery (SITUS) technique.

INTRODUCTION: As could be demonstrated for simple and radical nephrectomy, single-incision triangulated umbilical surgery (SITUS) is an interesting alternative to laparoscopic single-site surgery. We present our initial experience with the SITUS technique in radical cystectomy. MATERIALS AND METHODS: Between September 2010 and September 2011, eight patients underwent SITUS radical cystectomy (SITUS Cx), pelvic lymph node dissection and extracorporeal urinary diversion. A cutaneous ureterostomy was performed in three, an ileum conduit in one and an ileal neobladder in four patients. Data were collected prospectively, including patients' characteristics, intraoperative parameters, pathological stage and postoperative outcome. RESULTS: Mean age of the patients was 67 years and the mean body mass index 24 kg/m(2). SITUS Cx was successfully completed in all patients without conversion to conventional laparoscopic or open surgery. Mean surgical time was 434 min and mean estimated blood loss 643 ml. No major intra- or postoperative surgical complications occurred. All patients recovered quickly reporting low postoperative pain levels. Mean hospital stay was 16 (7-24 days). Histopathological evaluation revealed a mean of 16 (6-33) retrieved lymph nodes and no positive margins. CONCLUSION: In the present experience, SITUS Cx proved to be feasible with surgical outcome comparable to conventional techniques. Because SITUS Cx combines the advantages of traditional laparoscopy (straight instruments and triangulation) with those of single-port surgery (superior cosmesis and minimal invasiveness), it presents an attractive alternative to other minimally invasive techniques.

Peritonitis due to iatrogenic colpotomy after large loop excision of the transformation zone (LLETZ) in a patient with cervical intraepithelial neoplasia III: our experience of a rare case with review of the literature.

A case of peritonitis as an unusual complication of LLETZ (large loop excision of the transformation zone) for the treatment of CIN III associated with unrecognized iatrogenic posterior colpotomy is presented. After the procedure, the patient developed fever 38.3 degrees C and diffused severe pelvic pain. The contributing factors, prevention and management of this complication are discussed. Also, the complications of cold knife cervical conization and LLETZ procedure are reviewed.

[Primary treatment for localized prostate cancer: evaluation of patients' quality of life]. / Patienten nach Primärtherapie eines klinisch lokal begrenzten Prostatakarzinoms: Evaluation der Lebensqualität.

BACKGROUND: Radical prostatectomy (RP) and percutaneous radiotherapy (RT) are viable options for the primary treatment of localized prostate cancer (PC). Given the comparable efficacy of both modalities quality of life (QOL) has been suggested as an additional decision criterion. In recent years several validated instruments have been introduced to assess QOL. Most of them allow for patient-based rating of QOL. AIM: Herein, we aim to compare QOL after RP and RT in our own cohort of patients in Tübingen using validated questionnaires. METHODS: In total, 165 patients who had been treated for PC in Tübingen were enrolled. Of those 100 men had RP and 65 had RT. The validated QOL questionnaires EORTC QLQ-C30 and EORTC QLQ-PR 25 were used for assessment. Statistical analyses focused on analyses of variance. RESULTS: Concordant to previous studies it could be shown that RP mainly creates voiding problems most importantly urinary incontinence but also erectile dysfunction. After RT, patients mainly complained about disturbed bowel function including diarrhea and proctitis as well as about urgency and frequency. RP patients had better PF2 Scale values than RT patients (p= 0.00357143). On DI scales RT patients yielded significantly poorer values than the RP group (p= 0.003333). CONCLUSION: Our data comply well with those from other international centers. QOL is an important yet underestimated variable in oncological research. Our investigations underline the importance of an interdisciplinary approach for the successful management of PC.

MRI-guided prostate biopsy detects clinically significant cancer: analysis of a cohort of 100 patients after previous negative TRUS biopsy.

PURPOSE: To investigate the positive biopsy rate of MRI-guided biopsy (MR-GB) in a routine clinical setting, identify factors predictive for positive biopsy findings and to report about the clinical significance of the diagnosed tumors. METHODS: Patients with at least one negative trans-rectal-ultrasound-guided biopsy (TRUS-GB), persistently elevated or rising serum prostate specific antigen (PSA) and at least one lesion suspicious for PCa on diagnostic 1.5 Tesla endorectal coil MRI (eMR) were included. Biopsies were carried out using a 1.5 Tesla MRI and an 18 G biopsy gun. Clinical information and biopsy results were collected; logistic regression analysis was carried out. Definite pathology reports of patients with diagnosis of PCa and subsequent radical prostatectomy (RP) were analyzed for criteria of clinical significance. RESULTS: One hundred patients were included, mean number of previous biopsies was 2 (range 1-9), mean PSA at time of biopsy was 11.7 ng/ml (1.0-65.0), and mean prostate volume was 46.7 ccm (range 13-183). In 52/100 (52.0%) patients, PCa was detected. Out of 52 patients, 27 patients with a positive biopsy underwent RP, 20 patients radiation therapy, and 5 patients active surveillance. In total, 80.8% of the patients revealed a clinically significant PCa. In univariate regression analysis, only serum PSA levels were predictive for a positive biopsy result. Number of preceding negative biopsies was not associated with the likelihood of a positive biopsy result. CONCLUSIONS: MR-GB shows a high detection rate of clinically significant PCa in patients with previous negative TRUS-GB and persisting suspicion for PCa.

Proteolytic matrix metallopeptidases and inhibitors in BCR-ABL1-negative myeloproliferative neoplasms: correlation with JAK2 mutation status.

BACKGROUND/AIMS: Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) share the same acquired lesion JAK2(V617F) and may exhibit substantial overlap. Variability in JAK activation and allele burden, complemented by host, genetic and non-genetic modifiers, determine the phenotype. The aim of this study was to investigate the presence of the JAK2 mutation in association with the ratio of metallopeptidases inhibitors (TIMPs) to tissue metallopeptidases (MMPs) in MPNs, where inhibitory rather than proteolytic activity in marrow microenvironment appears to predominate. METHODS: 94 patients with polycythemia vera, essential thrombocythemia and primary myelofibrosis, and 102 healthy individuals were evaluated. Allele-specific PCR and RFLP were used to detect JAK2 and genomic status. Serum concentrations of MMP and TIMP were measured by ELISA. The parameters were assessed with covariance analysis, and adjusted for gender, age and co-morbidity. RESULTS: Mutation frequency was 81.91%. Abnormal TIMP/MMP ratios were identified in all three diseases. JAK2 mutation was correlated with significant changes in TIMP concentrations. CONCLUSIONS: Identification of an abnormal TIMP/MMP ratio in all three diseases, regardless of the JAK2 status, indicates invariable marrow remodeling. In this particular group of patients, presence of a JAK2(V617F) mutation, being associated with even higher ratios, appears to be a concurring participant in bone marrow-reforming processes. Additional research may delineate correlates with the JAK2 allelic burden.

A novel intraoperative sensor for soft tissue balancing in total knee arthroplasty.

Ligament balancing during total knee arthroplasty (TKA) is a controllable and critical procedure necessary for the longevity of the prosthesis. Intraoperative knowledge of the magnitude and location of tibiofemoral forces, can guide the surgeon to an accurate balancing throughout the operation. We developed a novel sensor device in order to monitor tibiofemoral forces during TKA ligament balancing procedure. The device predicts loads with an error of ± 1.5%, following a linear trend of slope = 0.9933 and R(2) = 0.9987; while the location of load is predicted with a practically acceptable error of ± 0.5 mm. The device was subjected to a surgical validation with in situ application during simulated TKAs on composite and cadaveric knees, with a very satisfactory outcome and no operative time elongation. The device can be a useful intraoperative instrument for accurate TKA ligament balancing procedures based on objective and graphically demonstrated and recorded evidence.

Laparoscopic heminephroureterectomy for duplex kidney anomalies in the pediatric population.

OBJECTIVE: Despite increasing acceptance of laparoscopy in pediatric urology, few published data are available on laparoscopic heminephroureterectomy in patients with duplex kidney anomalies. In the present study, we report our own experiences with this technique. PATIENTS AND METHODS: From August 2003 to January 2006, five laparoscopic heminephroureterectomies were performed in four girls with a mean age of 41 (9-67) months. In all cases, a non-functioning upper pole with an obstructive (n=4) or refluxing (n=1) megaureter was found. The upper pole was resected laparoscopically en bloc with the megaureter using three to four trocars. RESULTS: Mean follow-up was 42.4 (+/-7.9) months. All procedures were performed successfully without conversion to open surgery with a mean operative time of 190 (170-210)min. Blood loss was minimal and no intraoperative complications occurred. Despite chronic inflammation in the resected specimens, the patients showed no clinical signs of infection postoperatively. The average length of hospital stay was 5.6 (4-7) days. All patients were followed using duplex sonography. CONCLUSIONS: These data demonstrate that, even in infants, laparoscopic heminephroureterectomy is feasible and associated with minimal morbidity, a better cosmetic result and a shorter hospital stay compared to open surgery. The main disadvantage of the laparoscopic approach is a longer operative time. Laparoscopic heminephroureterectomy is a technically demanding procedure and should be performed only in specialized centers.

[Effective pain relief facilitates exercise therapy : Results of a multicenter study with controlled-release oxycodone in patients with movement pain]. / Effektive Schmerzlinderung ermöglicht Bewegungstherapie : Ergebnisse einer Multicenterstudie mit retardiertem Oxycodon bei Patienten mit Bewegungsschmerz.

BACKGROUND: The efficacy and tolerability of oral controlled-release oxycodone in the therapy of musculoskeletal pain were analyzed in this observational study. PATIENTS AND METHODS: A total of 843 patients with severe to most severe pain in the musculoskeletal system were treated with controlled-released oxycodone for 4 weeks or up to a maximum of 6 months. Severity of pain, impairment in quality of life, and mobility associated with the pain were assessed before and during therapy with controlled-release oxycodone by a numerical rating scale (NRS 0-10). RESULTS: Pain intensity fell by an average of 65% within the first 4 weeks. Physical therapy was practicable in many patients only after implementation of a therapy regime with controlled-release oxycodone. Quality of life improved significantly under therapy with oxycodone, and the impairment of different aspects of life decreased by 50%. CONCLUSION: The therapy of pain of the musculoskeletal system with controlled-release oxycodone is efficient. An effective pain relief makes physical therapy practicable, reduces the impairment in different parts of life, and increases quality of life.

[Minimally invasive percutaneous nephrolitholapaxy (MIP)]. / Minimal-invasive perkutane Nephrolitholapaxie (MIP).

Minimally invasive percutaneous nephrolithopaxy (MIP) was developed to combine the excellent stone-free rates of the conventional percutaneous nephrolithopaxy (PCNL) technique with the low morbidity of the miniaturized PCNL (Mini-Perc) and, at the same time, achieve a high level of patient comfort. The procedure is characterized not only by the diameter of the miniaturized 18-Fr Amplatz sheath that was adopted from the Mini-Perc but also by the following features: ultrasound-guided puncture of the kidney; single-step dilatation of the access tract; ballistic lithotripsy; a low-pressure irrigation system together with stone retraction by irrigation with a specially designed nephroscope sheath, for the so-called vacuum cleaner effect; and a sealed and tubeless access tract with primary closure of the channel independent of hemorrhage and without a second-look procedure.The results of the first 57 patients demonstrate primary stone-free rates of 92.9% with operating times averaging 62 (25-123) min. Severe complications, such as sepsis or bleeding requiring blood transfusion, did not occur. The high and predictable stone-free rate and a low morbidity comparable to that of ureteroscopy and extracorporeal shock-wave lithotripsy make MIP an attractive option for patients and urologists. The "vacuum cleaner effect" with quick removal of stone fragments reduces operating time and prevents new stone formation by avoiding residual fragments. The direct and primary closure of the access tract increases patient comfort and is justified by the reintervention rate of less than 8% in the presented cohort.The lack of a need for second-look nephroscopies, the vacuum cleaner effect, improved patient comfort without nephrostomy tubes, as well as surgery times comparable to that of traditional PCNL demonstrate a consequent evolution of the Mini-Perc. MIP therefore represents a promising and future-oriented module in modern stone therapy.

[MR aspect of the prostate in CPPS patients (chronic pelvic pain syndrome)]. / MR-Befundmuster der Prostata bei Patienten mit CPP Syndrom (chronic pelvic pain syndrome).

PURPOSE: To describe typical morphological patterns of abacterial prostatitis using magnetic resonance imagine (MRI) in chronic pelvic pain syndrome patients including spectroscopy. MATERIALS AND METHODS: 18 patients (age range between 25 and 67 years, average 46.2 years) with recurrent chronic pelvic pain syndrome for at least 3 months were evaluated clinically in the urological department and included if there were no suspicious findings from endorectal digital palpation and if their PSA values were < 5 ng/ml. A retrospective analysis of these 18 patients with 30 contrast-enhanced MRI investigations with endorectal coils in 28 of 30 cases was performed with a 1.5T MRI. T 2w signal intensity (SI) and spectroscopy data (9 / 18 patients) were acquired for the normal peripheral zone, the central zone, for the peripheral zone suspected of inflammation and for the muscle including SI ratios for the unaltered and the suspicious inflammatory peripheral zone. RESULTS: Typical MR patterns of signal alterations suspected of inflammation of CPPS patients were able to be detected as T 2w hypointense triangular, stringy (n = 12, 66.6 %) contrast-enhancing signal alterations without a nodular shape with well circumscribed margins of the capsula and without pericapsular signal alterations. In 6 patients changes also had a triangular but more homogeneous aspect (33.3 %). Three patients had an additional periurethral uptake (16.6 %). T 2w SI measurements and T 2w SI ratios showed much lower values for the peripheral zone suspected of inflammation as compared to the normal peripheral zone of the prostate (277.29 STD 77.5 to 432.9 STD 112.02 and 4.94 STD 1.47 to 7.58 STD 2.01 respectively). The spectroscopic analysis of the signal alterations suspected of inflammation showed normal Cholin+Creatin/Citrate SI ratio values in 3 patients (SI < 0.5), ratios suspected of low grade cancer in 3 patients (SI 0.5 and < 0.7) and ratios suspected of intermediate grade prostate cancer in 3 patients (SI > 0.7 and < 3.0). CONCLUSIONS: We saw typical MR patterns in CPPS patients. However, spectroscopy can mimic findings of cancer so that the knowledge of typical morphological patterns and a solid clinical evaluation play a major role in the diagnosis of CPPS.

Long-term bone marrow cultures (LTBMC) from essential thrombocythemia (ET) patients with or without JAK2617V>F mutation.

Approximately half of essential thrombocythemia (ET) patients and almost all with polycythemia vera (PV) bear the activating JAK2617V>F point mutation, which arises at the multipotent haemopoietic progenitor cell level. Although ET is mainly characterized by megacaryocyte proliferation, the cases that are positive for the JAK2617V>F mutation also show increased bone marrow cellularity and higher erythrocyte and granulocyte counts. After establishing short- and long-term bone marrow cultures we found that the frequency of committed haemopoietic progenitors in the bone marrow, was not increased in JAK2617V>F positive ET compared to the negative ones, whereas in long-term cultures (LTBMC) JAK2617V>F positive ET display a growth pattern more similar to that observed in LTBMC produced by PV marrow cells. Our data support the notion that JAK2617V>F positive ET and PV represents a continuum spectrum of alterations within the same disease.

[Use of a gelatine-thrombin matrix for closure of the access tract without a nephrostomy tube in minimally invasive percutaneous nephrolitholapaxy]. / Die Verwendung von Gelatine-Thrombin-Matrix zum Verschluss des Arbeitskanals bei der nephrostomielosen minimal-invasiven perkutanen Nephrolitholapaxie.

BACKGROUND: The spectrum of percutaneous stone treatment was significantly widened following the introduction of the miniaturized percutaneous nephrolitholapaxy. At the end of the procedure usually a nephrostomy tube was placed to avoid urine paravasation and prolonged bleeding. In this work the tube-less mini-PCNL with direct closure of the access tract was compared to traditional mini-PCNL with placement of the nephrostomy tube. PATIENTS AND METHODS: Twenty consecutive patients undergoing mini-PCNL with placement of a nephrostomy tube at the end of the procedure were compared to 20 consecutive patients with direct closure of the access tracts following percutaneous stone removal. Clinical data like decrease in Hb, complications, need for analgesics and duration of hospital stay were compared. RESULTS: Both groups underwent the procedure without complications. There was no need for blood transfusions. The difference in total analgetic dose was not statistically significant; however, patients in the nephrostomy group needed analgetics for a longer period of time. There was no difference in duration of hospital stay (3.2 days in the tube-less group versus 3.4 days in the nephrostomy group). The primary stone-free rate was higher in the group with direct closure of the access tract (95 versus 85%). CONCLUSIONS: Closure of the percutaneous access following mini-PCNL with a gelatine-thrombin-haemostatic sealant is a safe alternative to the commonly used nephrostomy tube and can help to reduce postoperative pain and patient discomfort.

Comparison of 11C-choline-PET/CT and whole body-MRI for staging of prostate cancer.

UNLABELLED: Aim of this study was to compare the diagnostic accuracy of positron emission tomography and computed tomography with (11)C-Choline (Cho-PET/CT) and whole body magnetic resonance imaging (WB-MRI) for diagnostic work-up of prostate cancer. PATIENTS, METHODS: We evaluated retrospectively 42 patients with untreated prostate cancer (n = 17), or increasing levels of prostate-specific antigen (PSA) after curative therapy (n = 25) who had been investigated by both Cho-PET/CT and WB-MRI. MRI, CT, and PET images were separately analyzed by experienced radiologists or nuclear medicine experts, followed by consensus reading. Validation was established by histology, follow-up, or consensus reading. RESULTS: 88/103 detected lesions were considered as malignant: 44 bone metastases, 22 local tumor, 15 lymph node metastases, 3 lung, and 3 brain metastases. One further lesion was located in the adrenal gland, which was a second tumor. Overall sensitivity, specificity and accuracy for Cho-PET/CT were 96.6%, 76.5%, and 93.3%, resp., and for WB-MRI 78.4%, 94.1%, and 81.0%, resp. 3 vertebral metastases had initially been missed by Cho-PET/CT and were found retrospectively. MRI identified 2 bone metastases and 1 lymph node metastasis after being informed about the results of Cho-PET/CT. CONCLUSIONS: Cho-PET/CT and WB-MRI both presented high accuracy in the detection of bone and lymph node metastases. The strength of MRI is excellent image quality providing detailed anatomical information whereas the advantage of Cho-PET/CT is high image contrast of pathological foci.