Clear cell sarcoma of the kidney with invasion of the inferior vena cava.

OBJECTIVE: We present a case of clear cell sarcoma of the kidney (CCSK) in 53-year-old white man who was treated with surgery. This case represents the oldest patient with CCSK published in the English literature. METHODS: Right radical nephrectomy with lymphadenectomy and thrombectomy was performed. RESULTS: Histological findings indicated a CCSK. Tumor cells showed positive vimentin staining. CONCLUSION: CCSK is considered a rare and highly malignant renal tumor. The malignant nature may relate not only to the biological features of these tumor cells, but also to the high resistance against radiation and chemotherapy. The treatment of CCSK has been a subject of controversy.

Opsoclonus-myoclonus syndrome as a paraneoplastic manifestation of renal cell carcinoma. a case report and review of the literature.

Opsoclonus is a rare but distinctive disorder of ocular motility, characterized by irregular, continual and conjugated chaotic saccades of the eyes. It is increased with eye closure and fixation, and it persists during sleep. Opsoclonus appears more commonly in children and in half of such cases in association with neuroblastoma. In adults the most frequent causes are idiopathic (50%) and paraneoplastic (20%). Among the second group, different types of tumors involving a wide variety of organs have been reported. Opsoclonus when accompanied by other symptoms of central nervous system involvement (head, appendicular myoclonus and truncal ataxia) constitutes a clinical picture, known as opsoclonus-myoclonus syndrome. We report the case of a young patient affected by renal cell carcinoma associated with opsoclonus-myoclonus syndrome which did not respond to medical therapy but dramatically improved after cancer ablation.

[Rare renal tumors (neoplasms other than conventional renal cell carcinoma). Clinico-pathologic aspects and review of the literature]. / Tumori renali rari (neoplasms other than conventional renal cell carcinoma). Aspetti clinico-patologici e revisione della letteratura.

The clinical and pathological findings in 94 patients with surgically confirmed renal neoplasm from 1990 to 1998 have been retrospectively reviewed and a literature review is made. The heterogeneous group of rare renal tumours has been particularly considered: renal oncocytoma and oncocytomatosis, renal angiomyolipoma and renal medullary fibroma; chromophobe renal cell carcinoma (RCC), papillary RCC, multiple primary malignant RCC, hereditary RCC, renal sarcoma and sarcomatoid RCC, renal malignant fibrous histiocytoma, renal hemangiopericytoma and renal lymphoma.

Immunohistochemical evaluation of the safety of transurethral electrovaporization of the prostate and its clinical results.

Short term follow up studies on transurethral electrovaporization (TUEVP) have shown a relative low morbidity over TURP. The use of high power current has been claimed as a source of possible damage on the neuronal structures surrounding the prostate. The aims of our study were to assess longer follow up results as well as the safety of this technique. Over an 18 month mean follow up period symptom relief remained relatively stable. Postoperative dysuria was detected in a higher percentage of patients and was seen for a longer period in comparison with previous reports. Immunohistochemical staining performed using S-100 and NF monoclonal antibodies showed anatomical integrity of the prostatic neuronal fibres surrounding the vaporization edge. In conclusion, although the effectiveness and safety of TUEVP are confirmed by the present study, the occurrence of a significant rate of long-lasting postoperative irritative symptoms must be taken into account.

[Biophysical principles of tissue electrovaporization]. / Fondamenti biofisici dell'elettrovaporizzazione dei tessuti.

The principles of electrosurgery are based upon well defined physical grounds, explaining the type and extent of the lesions induced by the electric current. Technological evolution has led to the creation of dedicated equipment, allowing efficient use of electrosurgical cutting and coagulation of tissues, both in open and endoscopic surgery. Electrovaporization is the thermal effect obtained when an alternating high power-high frequency current (300 W, 400-500 kHz) is applied to the tissue using an electrode with particular geometric aspects. The main feature is the presence of higher and lower current density zones. The first induce electrovaporization, whilst the second produce simultaneous hemostatic coagulation of the rims. New effective vaporizing electrodes have been recently introduced into clinical practice. Their use in the endoscopical treatment of bladder outlet obstructions, a stimulating alternative to standard resection or laser applications, is currently under evaluation.

[Renal multifocal carcinoma with adrenal gland metastasis in a patient previously treated with radical nephrectomy: what kind of therapy. Review of the literature]. / Carcinoma renale multifocale con metastasi surrenaliche multiple in paziente già sottoposto a nefrectomia radicale dell'adelfo: quale terapia? Revisione della letteratura.

A case of multiple adrenal metastases due to renal cells carcinoma, associated with a multifocal simultaneous renal cells carcinoma has been observed in a female patient previously submitted to radical contralateral nephrectomy for the same disease. In particular, stress is laid on computerized tomography scan diagnosis and surgical procedure.

[Renal agenesis and homolateral seminal vesicle cyst. Case report]. / Agenesia renale e cisti della vescicola seminale omolaterale. Caso clinico.

The authors present a case of renal agenesis and seminal vesicle cyst in a young man, diagnosed because of several micturion disorders partially cleared up with antibiotic therapy. We discuss about the diagnosis technique which includes Ultrasound Scanner, Computed Tomography, Magnetic Resonance and pelvic arteriography. Then we describe the surgical approach and finally we discuss about embryogenesis.

[Suspected spontaneous rupture of the ureter. Report of a clinical case]. / Sospetta rottura spontanea dell'uretere. Presentazione di un caso clinico.

A 57 year old man was admitted with left abdominal pain; radiological investigation showed a rupture of the left ureter. The authors discuss the diagnosis and the pathogenesis of ureteral rupture.

[The use of hemorrhage occluder pins in radical pelvic urologic surgery]. / L'uso degli Hemorrage Occluder Pins nella chirurgia pelvica urologica demolitiva.

The authors present the use of "Hemorrhage Occluder Pins" in pelvic urologic radical surgery, as a means of hemostasis for the retropubic venous plexus. The application technique and the bio-technological characteristics of the occluder pin are discussed.

[A case of priapism of the proximal corpora cavernosa]. / Su un caso di priapismo dei corpi cavernosi prossimali.

A young man presented with a little perineal mass that was found to be secondary to partial priapism of the proximal corpora cavernosa. This is a very rare condition with only 3 previously recorded cases in the urology literature. The patient made a good recovery and was able to resume sexual activity.

[A case of retroperitoneal leiomyosarcoma]. / Su un caso di leiomiosarcoma retroperitoneale.

The Authors present a case of retroperitoneal leiomyosarcoma, diagnosed because of the early symptomatic hydronephrosis due to the compression of the tumour on the lumbar ureter. Some general clinical aspects of retroperitoneal sarcomas are discussed too. In the case presented adjuvant therapy was not advised, because of the small volume of the tumour and the possibility of its complete excision.

Drug abuse treatment at the San Martin General Hospital, Buenos Aires.

The General Hospital facilitates the detection of users and abusers who seek care for other diseases. The research programme on drug abuse is operated at the Mental Health Department of the Hospital General San Martin, Medical School, Buenos Aires University. Characteristics of the population attended are described according to the age, sex, drugs of abuse, gateway drugs, places and ages, and other psychiatric diagnoses according to the DSM III. Finally, therapeutic resources are described: individual and family psychotherapies and family counselling.

AIDS and drug abuse: some aspects of psychiatric consultation.

Current research in Buenos Aires shows that approximately 35 per cent of intravenous users are HIV positive. These patients have behaviour disorders. Usually they are sent from one specialist to another, which increases their anxiety that originated in their suspicion of a serious prognosis. They are listened to when they discuss their disease but not enough when they try to talk about themselves as people with doubts about their future. Unconsciously physicians are trying to avoid involvement in the anxiety of the patient by means of a referral to a psychiatric consultation. The psychiatrist must handle this situation as a crisis in the doctor-patient relationship (both need help) to preventing further acts, additional anxiety and psychotic reactions. These patients need strong support not only because of the seriousness of the disease but also because of the situation of abstinence. Global treatment of a patient should be unified and managed by a physician with psychological training or assessed by one liaison psychiatrist, trying to avoid any split in the health team.

PIP: The rapidly rising number of HIV-infected intravenous drug users in Buenos Aires has produced unprecedented difficulties in the physician-patient relationship and a need for greater involvement on the part of mental health specialists. At present, 35% of these drug users are HIV-positive. When hospitalized for various medical complications of the virus, drug users often manifest acting out behaviors, denial of their addiction, and other psychopathic personality traits. They are likely to be noncompliant with treatment regimens and demanding of special treatment from hospital staff. In many cases, physicians seek to protect themselves from involvement with these difficult, highly anxious patients by making a referral to a psychiatrist. Although such a referral is usually appropriate, physicians should seek to work through the crisis in the physician-patient relationship and address psychosocial as well as medical issues. Failure on the part of the physician to navigate the initial disorganizing crisis and symbiotic stages can produce serious depression in the patient, a sense of abandonment, and a worsening of the medical condition.