El uso de adhesivo tisular de albúmina-glutaraldehído sérico bovino (BioGlue (R)) para el cierre del lecho tumoral después de una nefrectomía parcial abierta / The use of bovine serum albumin-glutaraldehyde tissue adhesive (BioGlue (R)) for tumor bed closure following open partial nephrectomy

Objetivos: Informar sobre los resultados del uso del adhesivo tisular de albúmina-glutaraldehído sérico bovino (BioGlue(R)) para el cierre del lecho tumoral en cirugía abierta de preservación de nefronas (CCN). Materiales y métodos: La cohorte incluyó a 255 pacientes con masa renal que se sometieron a CCN abierta. Se utilizó abordaje mediante lumbotomía, con hipotermia in situ y enucleación del tumor. Para el cierre del lecho tumoral utilizamos el sellante BioGlue(R) para el relleno del lecho tumoral, sin suturar los bordes. Resultados: La media de edad de los pacientes fue de 65,4 años. El 5,1% de los pacientes tenía insuficiencia renal crónica preoperatoria. El diámetro medio de la masa renal fue de 4,2 ± 1,6cm y la puntuación media de nefrometría R.E.N.A.L fue 8,0 ± 1,6. El tiempo medio de isquemia fue 21,8±7,6. La pérdida de sangre media estimada fue de 42 ± 82ml, y solo 2 pacientes requirieron transfusión de sangre. Se registraron pérdida de orina y pseudoaneurisma en 2 pacientes y en uno, respectivamente. Ninguna de las operaciones se convirtió a nefrectomía radical. El cambio medio entre la eGFR postoperatoria y preoperatoria (Δ = -1,7 ml/min) fue insignificante en un seguimiento medio de 30,1 ± 29,6 meses. La tasa de supervivencia libre de recurrencia a 10 años fue del 99%, y la tasa de supervivencia global a 10 años fue del 85%. Conclusiones: El uso de BioGlue(R) para hemostasia después de CCN es una alternativa factible y segura a la sutura clásica. Su uso permite un resultado funcional satisfactorio y podría reducir potencialmente el tiempo de isquemia

Objectives: To report the results of the use of Bovine Serum Albumin-Glutaraldehyde tissue adhesive (BioGlue(R)) for tumor bed closure in open nephron-sparing surgery (NSS). Materials and methods: The cohort included 255 patients with enhancing renal mass who underwent open NSS. We used open flank approach, with in-situ hypothermia and enucleation of the tumor. For tumor bed closure, we used the BioGlue(R) sealant for tumor bed filling, without suturing the edges. Results: Mean patients' age was 65.4 years. 5.1% of patients had pre-operative chronic renal failure. Mean renal mass diameter was 4.2 ± 1.6cm and mean R.E.N.A.L nephrometry score was 8.0 ± 1.6. Mean ischemia time was 21.8 ± 7.6. Mean estimated blood loss was 42 ± 82ml and only two patients required blood transfusion. Urine leak and pseudo-aneurysm were recorded in two and one patient, respectively. None of the operations were converted to radical nephrectomy. The average change between post-operative and pre-operative eGFR (Δ = -1.7ml/min) was insignificant in a mean follow-up of 30.1 ± 29.6 months. The 10-year recurrence-free survival rate was 99% and the 10-year overall survival rate was 85%. Conclusions: The use of BioGlue(R) alone for hemostasis after NSS is a feasible and safe alternative to classical suturing. Its use enables satisfactory functional outcome and could potentially reduce ischemia time

The use of bovine serum albumin-glutaraldehyde tissue adhesive (BioGlue®) for tumor bed closure following open partial nephrectomy. / El uso de adhesivo tisular de albúmina-glutaraldehído sérico bovino (BioGlue®) para el cierre del lecho tumoral después de una nefrectomía parcial abierta.

OBJECTIVES: To report the results of the use of Bovine Serum Albumin-Glutaraldehyde tissue adhesive (BioGlue®) for tumor bed closure in open nephron-sparing surgery (NSS). MATERIALS AND METHODS: The cohort included 255 patients with enhancing renal mass who underwent open NSS. We used open flank approach, with in-situ hypothermia and enucleation of the tumor. For tumor bed closure, we used the BioGlue® sealant for tumor bed filling, without suturing the edges. RESULTS: Mean patients' age was 65.4 years. 5.1% of patients had pre-operative chronic renal failure. Mean renal mass diameter was 4.2±1.6cm and mean R.E.N.A.L nephrometry score was 8.0±1.6. Mean ischemia time was 21.8±7.6. Mean estimated blood loss was 42±82ml and only two patients required blood transfusion. Urine leak and pseudo-aneurysm were recorded in two and one patient, respectively. None of the operations were converted to radical nephrectomy. The average change between post-operative and pre-operative eGFR (Δ=-1.7ml/min) was insignificant in a mean follow-up of 30.1±29.6 months. The 10-year recurrence-free survival rate was 99% and the 10-year overall survival rate was 85%. CONCLUSIONS: The use of BioGlue® alone for hemostasis after NSS is a feasible and safe alternative to classical suturing. Its use enables satisfactory functional outcome and could potentially reduce ischemia time.

Hypertrichosis in Becker's nevus: effective low-fluence laser hair removal.

Becker's nevus is cosmetically bothersome both due to the hyperpigmentation and due to the hypertrichosis which can accompany it, particularly in males. Laser hair removal can be considered, but the pigmented background of the Becker's nevus makes the treatment more challenging. Fifteen patients with Becker's nevus underwent eight sessions of hair removal with low-fluence high-repetition-rate diode lasers (808-810 nm). All participants experienced significant hair reduction at 6 and 12 months. No adverse events were reported. The study supports the use of low fluence with high-repetition-rate diode laser hair removal as a safe and effective method for the management of hypertrichosis in Becker's nevus.

Treatment of verrucous epidermal nevus: experience with 71 cases.

OBJECTIVE: The aim of this study was to evaluate the clinical results of 71 cases with verrucous epidermal nevus (VEN) treated by cryotherapy or CO2 laser. METHODS: The files and photographs of patients with VEN who were treated in the laser unit of a tertiary hospital between January 2005 and December 2011 were evaluated. Pretreatment and 12-month follow-up photographs were evaluated using a 5-point scale: 'excellent' (75-100% clearance), 'good' (50-75% clearance), 'fair' (25-50% clearance), 'poor' (<25% clearance) or 'worse'. RESULTS: Of 71 patients, 62 responded well to cryotherapy alone, and 9 facial VEN required CO2 laser treatment. Small VEN required relatively few treatments (mean 3.4) with 90% scoring 'excellent' and 10% scoring 'good'. Larger VEN required more treatments (mean 7.4) and did not respond as well, with 71% scoring 'excellent', 14% scoring 'good' and 14% scoring 'fair'. CONCLUSION: Our experience suggests that cryotherapy is the ideal treatment for small facial VEN, while ablation by CO2 laser should be considered an option for resistant facial lesions.

DNA methylation profiles delineate epigenetic heterogeneity in seminoma and non-seminoma.

BACKGROUND: It remains important to understand the biology and identify biomarkers for less studied cancers like testicular cancer. The purpose of this study was to determine the methylation frequency of several cancer-related genes in different histological types of testicular cancer and normal testis tissues (NT). METHODS: DNA was isolated from 43 seminomas (SEs), 14 non-SEs (NSEs) and 23 NT, and was assayed for promoter methylation status of 15 genes by quantitative methylation-specific PCR. The methylation status was evaluated for an association with cancer, and between SEs and NSEs. RESULTS: We found differential methylation pattern in SEs and NSEs. MGMT, VGF, ER-ß and FKBP4 were predominately methylated in NSEs compared with SEs. APC and hMLH1 are shown to be significantly more methylated in both subtypes in comparison with NT. When combining APC, hMLH1, ER-ß and FKBP4, it is possible to identify 86% of the NSEs, whereas only 7% of the SEs. CONCLUSIONS: Our results indicate that the methylation profile of cancer-associated genes in testicular cancer correlates with histological types and show cancer-specific pattern for certain genes. Further methylation analysis, in a larger cohort is needed to elucidate their role in testicular cancer development and potential for therapy, early detection and disease monitoring.

Are port wines stains a feature of tuberous sclerosis?

BACKGROUND: Tuberous sclerosis complex is a multisystem inherited disorder characterized by the development of tumour-like growths in brain, skin and other organs. Although cutaneous vascular anomalies are not considered a common manifestation, we have encountered co-occurrence of port wine stains and tuberous sclerosis. OBJECTIVE: To assess the prevalence of port wine stain in patients with previously diagnosed tuberous sclerosis. METHODS: All cases diagnosed with tuberous sclerosis at two tertiary care centres from 2000 to 2009 were reviewed. Cases with clinically documented port wine stains were included for evaluation. RESULTS: Of 24 patients diagnosed with tuberous sclerosis, three (12.5%) had clinically evident port wine stains. The prevalence of port wine stains in this series of tuberous sclerosis patients was significantly higher than the 0.3% prevalence of port wine stain in the general population. CONCLUSION: Port wine stain rate in this population was significantly greater than the expected rate. Further studies are needed to assess the frequency of port wine stains in tuberous sclerosis and to clarify whether the finding should be added to the list of cutaneous features of tuberous sclerosis.

ETView tracheoscopic ventilation tube for surveillance after tube position in patients undergoing percutaneous nephrolithotomy.

BACKGROUND: Tracheal tube (TT) displacement during general anaesthesia may result in life-threatening complications and continuous direct vision of the position of the tube may enable safer management. The ETView tracheoscopic ventilation tube (TVT) is a single-use TT incorporating a video camera and a light source in its tip. The view from the tip appears continuously on a portable monitor in the anaesthetist's vicinity. This study was designed to test the ETView TVT in monitoring the TT position during general anaesthesia. METHODS: In this prospective study, the ETView TVT was used to ventilate the lungs of 30 adult patients undergoing percutaneous nephrolithotomy (PCNL), which required changing patient position three times. During surgery, the anaesthetist followed the carinal view on the ETView TVT portable monitor. Tube movement within 1 cm was recorded, as was the need for repositioning of the tube when the carina was not seen on the camera monitor. RESULTS: During anaesthesia, tiny movements synchronous with heart beats and lung ventilation were observed. Tube movement of 1 cm was detected in eight (26%) patients. In two (7%) patients, the carina was no longer viewed after moving to the lithotomy position and the tube was repositioned. None of the events was associated with changes in oxygen saturation, end-tidal CO(2), or airway pressure. CONCLUSIONS: We found that the ETView TVT facilitated surveillance of tube position by providing a clear high-quality view of the carina, throughout PCNL with several changes of patient position.

Multimodality imaging of direct ureteric involvement in non-Hodgkin's lymphoma using PET/CT, CT urography and antegrade CT pyelography.

Positron emission tomography/computed tomography (PET/CT), CT urography (CTU) and antegrade CT pyelography (ACTP) findings of ureteric involvement in non-Hodgkin's lymphoma (NHL) are presented. PET/CT performed for restaging in a patient with a 2-year history of Stage 4 NHL showed increased 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG) activity in a distended ureteric segment. CTU and ACTP, performed to further evaluate PET/CT findings, demonstrated diffuse, irregular and concentric thickening of the affected ureteric walls, accompanied by severe irregular narrowing of affected ureteric lumen. Tissue sampling using percutaneous CT-guided biopsy revealed NHL involvement of the ureter. To the best of our knowledge, this is the first report of PET/CT, CTU and ACTP findings of ureteric NHL.

Effect of percutaneous nephrolithotripsy on renal function: assessment with quantitative SPECT of (99m)Tc-DMSA renal scintigraphy.

PURPOSE: To measure the effect of PCNL on global and regional renal function using quantitative single-photon emission CT (SPECT) measurement of Tc-dimercaptosuccinic acid (DMSA) uptake by the kidneys (QDMSA). PATIENTS AND METHODS: A series of 47 male and 41 female patients with a mean age of 47 +/- 16 years were studied by sequential QDMSA examinations before and 1.5 to 24 months after PCNL. Among the 67 patients (76%) in whom PCNL was performed using upper- or lower-pole access, the function of the affected and nonaffected poles of the treated kidney was calculated separately. RESULTS: There was no statistically significant difference in the uptake by the treated kidneys before versus after PCNL (11.9% +/- 5% v 11.6% +/- 5%; t = 0.9; P = 0.368). The total functional volume of the treated kidney was slightly decreased, from 235 cc +/- 62 cc to 224 cc +/- 59 cc (t = 2.7; P = 0.011). The percent of the injected isotope dose per cubic centimeter of tissue of the treated kidney was not affected (0.051 +/- 0.02 v 0.053 +/- 0.02; t = 0.86; P = 0.296). Regional assessment revealed a statistically significant decrease in the functional volume at the PCNL port of entry (91 cc +/- 30 cc v 82 cc +/- 27 cc; t = 2.64; P = 0.013). Regarding the percent of the injected dose per cubic centimeter of renal tissue, no statistically significant difference was found between the area of the kidney that underwent PCNL and the untreated area of the same kidney (0.049 +/- 0.02 v 0.05 +/- 0.02; t = 0.693; P = 0.494). The function of the contralateral kidneys remained unchanged (13.4% +/- 5.2% v 13.6% +/- 4.8%; t = 0.68; P = 0.5). CONCLUSIONS: Despite the statistically significant decrease in the functional volume of the surgically treated region, neither total percent uptake nor percent of injected dose were reduced significantly. Further studies with long-term follow-up of treated kidneys are required.

Renal pseudoaneurysm after blunt renal trauma in a pediatric patient: management by angiographic embolization.

Renal pseudoaneurysm is a rare complication after blunt renal trauma. Only 18 cases have been reported in English-language published reports. We present a case of blunt renal trauma in an 11-year-old boy, complicated by delayed bleeding from a renal artery pseudoaneurysm. The patient was initially treated with conservative measures and was later treated with selective embolization of the pseudoaneurysm. The clinical presentation, management options, and clinical decisions are discussed.

Prognostic score for patients with localized renal cell carcinoma treated by nephrectomy.

OBJECTIVE: To evaluate the feasibility of using combined clinical and histomorphometric features to construct a prognostic score for the individual patient with localized renal cell carcinoma. PATIENTS AND METHODS: We studied 39 patients with pT1 and pT2 RCC who underwent radical nephrectomy between 1974 and 1983. Univariate and multivariate analyses were used to determine the association between various prognostic features and patient survival. RESULTS: The most important and independent predictors of survival were tumor angiogenesis (P = 0.009), nuclear DNA ploidy (P = 0.0071), mean nuclear area (P = 0.013), and mean elongation factor (P = 0.0346). Combination of these variables enabled prediction of outcome for the individual patient at a sensitivity and specificity of 78% and 89%, respectively. CONCLUSION: Our results indicate that no single parameter can accurately predict the outcome for patients with localized RCC. Combination of neovascularity, DNA content and morphometric shape descriptors enabled a more precise stratification of the patients into different risk categories.

Bladder cancer--genetic overview.

BACKGROUND: This article review the serial genetic changes which are responsible to the initiation and progression of bladder cancer. Knowledge of the exact genetic alteration has a direct implication on the development of knew more sensitive and specific tool for an early diagnosis and better prognosis calculations. CONCLUSION: Bladder cancer develop and progress through a series of genetic alterations. Understanding of the genetic mechanisms which lead to malignant transformation gave rise to the development of various genetic mechanisms which lead to malignant transformation gave rise to the development of various genetic tools providing better ability of early detection and more accurate prognosis prediction.

Update on genetic events in the pathogenesis of melanoma.

Melanoma is the most common fatal malignancy among young adults, and its incidence and mortality continue to increase at an alarming rate. Epidemiologic studies have clearly demonstrated roles for genetic predisposition and sun exposure in melanoma development. In the past few years, substantial information has been added to the body of evidence suggesting that inherited and somatic genetic events contribute to the pathogenesis of melanoma. This review focuses on recent advances in the understanding of the genetic events, particularly aberration of cell cycle control and transcriptional control mechanisms, implicated in the pathogenesis of melanoma.

Bone anchored sling for the treatment of post-prostatectomy incontinence.

PURPOSE: This ongoing study evaluates the safety and efficacy of a new minimally invasive sling procedure for treating post-prostatectomy incontinence. MATERIALS AND METHODS: A total of 16 men 56 to 74 years old (mean age 67) underwent the procedure using the Straight-In bone anchoring system. Time after prostatectomy was 1.5 to 5 years (mean 2.5). Of the 16 patients 14 had urodynamically confirmed stress urinary incontinence, while 2 had mixed incontinence with stress incontinence and detrusor instability. The procedure is performed with the patient in the lithotomy position using a perineal approach. Four miniature bone screws with pre-attached pairs of No. 1 polypropylene sutures are placed directly into the medial aspect of the inferior rami of the pubic bone. A pair of bone anchors is placed just below the symphysis on each side, and the second pair is inserted 3 to 4 cm. lower. To support the bulbar urethra a gelatin coated polyethylene terephthalate trapezoid shaped sling or cadaveric fascia lata is tied to the pubic bone using the 4 pairs of sutures attached to the bone anchors. Urethral resistance is increased to 30 to 50 cm. water above baseline pressure. RESULTS: Followup was 4 to 20 months (mean 12.2). Of the 14 men with the preoperative urodynamic diagnosis of genuine stress incontinence 12 were cured of incontinence, defined as subjectively dry with no or only 1 pad used daily for security without any episode of leakage, while 2 were improved subjectively with a decrease of 50% or more in pads daily. Two other patients with the preoperative diagnosis of mixed urinary incontinence were improved. Postoperatively urodynamic study in these patients revealed resolved stress incontinence but persistent urge urinary incontinence. They responded to anticholinergics and are completely dry. Intraoperative and postoperative complications were minimal with no erosion, infection or osseous complications. CONCLUSIONS: This new minimally invasive male sling procedure is safe and efficacious. Adjusting sling tension by measuring urethral resistance results in a low rate of over correction and failure. Further experience is needed to establish this procedure as treatment for post-prostatectomy incontinence.

Evaluation of ureterocele with Doppler sonography.

Ureterocele is a common disorder characterized by cystic dilatation of the terminal submucosal portion of 1 or both ureters. Conventional imaging modalities for the diagnosis of ureterocele include intravenous urography and voiding cystourethrography; gray-scale sonography, augmented by color Doppler and spectral analysis studies, can be useful in diagnosing and managing this condition as well. We describe the diagnosis of ureterocele using transvaginal gray-scale and color Doppler sonography with spectral analysis in 2 women. Color Doppler sonography demonstrated urine flow into the bladder, and spectral analysis was used to measure the flow velocity. Together, these modalities can provide additional information about urinary flow dynamics, aid in implementing treatment for patients with ureterocele, and eliminate the need for invasive diagnostic procedures.

N-terminal sequences direct the autophosphorylation states of the FER tyrosine kinases in vivo.

p94(fer) and p51(ferT) are two tyrosine kinases which share identical SH2 and kinase domains but differ in their N-terminal regions. While p94(fer) is expressed in most mammalian cells, the accumulation of p51(ferT) is restricted to meiotic spermatocytes. Here we show that the different N-terminal tails of p94(fer) and p51(ferT) direct different autophosphorylation states of these two kinases in vivo. N-terminal coiled-coil domains cooperated to drive the oligomerization and autophosphorylation in trans of p94(fer). Moreover, the ectopically expressed N-terminal tail of p94(fer) could act as a dominant negative mutant and associated with the endogenous p94(fer) protein in CHO cells. This increased significantly the percentage of cells residing in the G0/G1 phase, thus suggesting a role for p94(fer) in the regulation of G1 progression. Unlike p94(fer), overexpressed p51(ferT) was not autophosphorylated in COS1 cells. However, removal of the unique N-terminal 43 aa of p51(ferT) or the replacement of this region by a parallel segment from p94(fer) endowed the modified p51(ferT) with the ability to autophosphorylate. The unique N-terminal sequences of p51(ferT) thus interfere with its ability to autophosphorylate in vivo. These experiments indicate that the N-terminal sequences of the FER tyrosine kinases direct their different cellular autophosphorylation states, thereby dictating their different cellular functions.

Long-term follow-up of the in-flowtrade mark intraurethral insert for the treatment of women with voiding dysfunction.

OBJECTIVE: The aim of the current study is to report the long-term follow-up of women treated with the In-Flowtrade mark device for periods longer than 1 year. Abstract METHODS: The efficacy of the intraurethral insert was evaluated in 92 women. Data regarding their urodynamic diagnosis, complications and satisfaction were collected. RESULTS: Early and late discontinuation of the device use was recorded in 52 patients (56.5%) and 19 patients (20.6%), respectively. Twenty-one patients (22.8%) are now being followed for more than 1 year with a follow-up time of 12-44 months (mean 24.6). Complications include device migration into the bladder (4 patients), asymptomatic bacteriuria (15 patients), and symptomatic urinary tract infections (4 cases, 1 of them pyelonephritis). In the 3 women who were sexually active before treatment, the use of the device did not preclude sexual intercourse, although mild dyspareunia was reported in 1 patient. Two patients complained of episodic inconvenience between their legs during walking. All patients were satisfied with the device and preferred it to previous treatment modalities used. The reasons for early and late discontinuation of treatment are described and discussed. CONCLUSIONS: The In-Flowtrade mark intraurethral insert can serve as a long-term treatment for the management of women with voiding difficulties. Women who continue treatment for a prolonged time are satisfied with the device use. Further studies comparing this treatment with other modalities are needed to support the role of the In-Flowtrade mark device in the management of women with voiding dysfunction.

Need for diagnostic screening of Herpes simplex virus in patients with nongonococcal urethritis.

The prevalence of various microorganisms known to cause nongonococcal urethritis, including herpes simplex virus (HSV), was evaluated. The findings suggest that HSV can be a significant etiological agent in nongonococcal urethritis (NGU) and that the necessary laboratory investigations should be performed for all patients with clinical symptoms of NGU.