Comparing open and robotic salvage radical prostatectomy after radiotherapy: predictors and outcomes.

INTRODUCTION: In the present study, we aim to provide more evidence about benefits of salvage radical prostatectomy (SRP). Our main objective is to assess prostatic-specific antigen control and postoperative urinary incontinence in open and robotic approaches as primary outcomes. MATERIALS AND METHODS: After the Institutional Review Board approval (IRB00010193), we retrospectively analyzed 76 consecutive patients who underwent open or robot-assisted SRP for locally relapsed prostate cancer between 2004 and 2019 at the Urology Department of Hospital Italiano de Buenos Aires, Argentina. Data were collected from our electronic medical record and prospective database.Postoperative variables, such as urinary incontinence, erectile function preservation, and vesicourethral anastomosis stricture development, were analyzed. RESULTS: Before SRP, 59 patients (76.6%) were treated with 3D external beam radiotherapy, 11 (14.3%) with brachytherapy, and 6 (7.8%) with intensity-modulated radiotherapy. Fifty patients underwent open SRP, and 26, robot-assisted SRP. Comparing surgical approaches, the global incontinence rate was 34.2% versus 9.1% in open versus robot-assisted approach, respectively (p: 0.01).Vesicourethral anastomosis stricture occurred in six patients (8.7%), all in the open approach group (p: 0.07). Five patients of 69 (7.2%) preserved erectile function with/without use of phosphodiesterase 5 inhibitors. Two patients in the open approach group needed blood transfusion. Estimated 2-year biochemical recurrence-free survival rate in the open approach group and robot-assisted group was 67% (95% confidence interval: 53.7-80.3) and 60.9% (95% confidence interval: 40.5-81.3), respectively, with no statistical difference (log-rank test p: 0.873). CONCLUSIONS: Robot-assisted SRP is a reliable procedure to treat local recurrences after external beam radiotherapy or brachytherapy, reducing the risk of anastomotic strictures and blood loss and improving continence outcomes.

Ephrin-B1 Is a Novel Biomarker of Bladder Cancer Aggressiveness. Studies in Murine Models and in Human Samples.

Bladder cancer (BC) is the ninth most common cancer worldwide, but molecular changes are still under study. During tumor progression, Epithelial cadherin (E-cadherin) expression is altered and ß-catenin may be translocated to the nucleus, where it acts as co-transcription factor of tumor invasion associated genes. This investigation further characterizes E-cadherin and ß-catenin associated changes in BC, by combining bioinformatics, an experimental murine cell model (MB49/MB49-I) and human BC samples. In in silico studies, a DisGeNET (gene-disease associations database) analysis identified CDH1 (E-cadherin gene) as one with highest score among 130 BC related-genes. COSMIC mutation analysis revealed CDH1 low mutations rates. Compared to MB49 control BC cells, MB49-I invasive cells showed decreased E-cadherin expression, E- to P-cadherin switch, higher ß-catenin nuclear signal and lower cytoplasmic p-Ser33-ß-catenin signal, higher Ephrin-B1 ligand and EphB2 receptor expression, higher Phospho-Stat3 and Urokinase-type Plasminogen Activator (UPA), and UPA receptor expression. MB49-I cells transfected with Ephrin-B1 siRNA showed lower migratory and invasive capacity than control cells (scramble siRNA). By immunohistochemistry, orthotopic MB49-I tumors had lower E-cadherin, increased nuclear ß-catenin, lower pSer33-ß-catenin cytoplasmic signal, and higher Ephrin-B1 expression than MB49 tumors. Similar changes were found in human BC tumors, and 83% of infiltrating tumors depicted a high Ephrin-B1 stain. An association between higher Ephrin-B1 expression and higher stage and tumor grade was found. No association was found between abnormal E-cadherin signal, Ephrin-B1 expression or clinical-pathological parameter. This study thoroughly analyzed E-cadherin and associated changes in BC, and reports Ephrin-B1 as a new marker of tumor aggressiveness.

Bilateral pheochromocytoma after kidney transplantation in neurofibromatosis type 1.

We present the case of a 25-year-old male with a history of neurofibromatosis type 1 and bilateral pheochromocytoma 4 years after kidney transplantation that was successfully treated with simultaneous bilateral posterior retroperitoneoscopic adrenalectomy. Learning points: Hypertensive patients with NF1 should always be screened for pheochromocytoma. Pheochromocytoma is rarely associated with transplantation, but it must be ruled out in patients with genetic susceptibility. Posterior retroperitoneoscopic adrenalectomy (PRA) allows more direct access to the adrenal glands, especially in patients with previous abdominal surgeries.

von Hippel-Lindau mutants in renal cell carcinoma are regulated by increased expression of RSUME.

Renal cell carcinoma (RCC) is the major cause of death among patients with von Hippel-Lindau (VHL) disease. Resistance to therapies targeting tumor angiogenesis opens the question about the underlying mechanisms. Previously we have described that RWDD3 or RSUME (RWD domain-containing protein SUMO Enhancer) sumoylates and binds VHL protein and negatively regulates HIF degradation, leading to xenograft RCC tumor growth in mice. In this study, we performed a bioinformatics analysis in a ccRCC dataset showing an association of RSUME levels with VHL mutations and tumor progression, and we demonstrate the molecular mechanism by which RSUME regulates the pathologic angiogenic phenotype of VHL missense mutations. We report that VHL mutants fail to downregulate RSUME protein levels accounting for the increased RSUME expression found in RCC tumors. Furthermore, we prove that targeting RSUME in RCC cell line clones carrying missense VHL mutants results in decreased early tumor angiogenesis. The mechanism we describe is that RSUME sumoylates VHL mutants and beyond its sumoylation capacity, interacts with Type 2 VHL mutants, reduces HIF-2α-VHL mutants binding, and negatively regulates the assembly of the Type 2 VHL, Elongins and Cullins (ECV) complex. Altogether these results show RSUME involvement in VHL mutants deregulation that leads to the angiogenic phenotype of RCC tumors.

Histopatología y perfil molecular de un caso de sarcoma de Ewing prostático / Histopathology and molecular profile of a case of prostatic Ewing sarcoma

Reportamos un caso de sarcoma de Ewing prostático en un paciente de 33 años sin afectación ósea ni de partes blandas con evidencia de translocación en los genes EWS y FLI1 detectada por técnicas de hibridación fluorescente in situ (FISH). En la literatura actual se han reportado casos aislados, aunque no todos cuentan con estudios de biología molecular, consideradas en la actualidad indispensable para la realización del diagnóstico

We report a case of Ewing sarcoma localized in the prostate gland of a 33-year-old patient without bone or soft tissue involvement. Evidence of EWS and FLI1 gene translocation was detected by fluorescence in situ hybridization (FISH). This is an unusual case with an interesting clinical presentation; indeed, only a few cases have been reported to date and not all have the supporting biological studies now considered essential for the diagnosis

Helicopter Emergency Medical Services in Buenos Aires: An Operational Overview.

As part of the emergency medical care system, helicopter emergency medical services (HEMS) have a different crew composition from the traditional team. HEMS consist of a pilot, doctor, and firefighter with rescue skills and training in basic life support on board an air ambulance. This allows the adaptation to different environments and increases the varieties of air procedures normally performed. HEMS began operating relatively recently in Buenos Aires. Yet, in 3 years, its use grew to such an extent that in 2015 it tripled, and by 2016 the number of medical assists was 4 times greater than in 2014. Furthermore, over the 3-year study period, 92% to 95% of assisted victims were traffic accident casualties requiring primary care. The HEMS crew is informed about the availability of resources in the acute care general hospitals and can therefore transfer patients to the most appropriate trauma center in the shortest time. However, 75% to 85% of the time, the choice of destination is strongly influenced by the availability of a helipad and the operational safety that it provides.

[Histopathology and molecular profile of a case of prostatic Ewing sarcoma]. / Histopatología y perfil molecular de un caso de sarcoma de Ewing prostático.

We report a case of Ewing sarcoma localized in the prostate gland of a 33-year-old patient without bone or soft tissue involvement. Evidence of EWS and FLI1 gene translocation was detected by fluorescence in situ hybridization (FISH). This is an unusual case with an interesting clinical presentation; indeed, only a few cases have been reported to date and not all have the supporting biological studies now considered essential for the diagnosis.

Prostatectomía radical de rescate post radioterapia / Salvage radical prostatectomy after radiotherapy

OBJETIVO: Determinar los resultados oncológicos y funcionales obtenidos tras prostatectomía radical de rescate (PR-R) en pacientes recidivados post radioterapia (elevación del PSA en 3 oportunidades consecutivas hasta 2006, luego 2ng/ml sobre el nadir) por cáncer de próstata (CP), y analizar el impacto en la supervivencia libre de recaída bioquímica de diferentes variables pre y postoperatorias. MÉTODOS: Análisis retrospectivo de 29 casos tratados con PR-R, 23 técnica convencional y 6 asistidos por el sistema robótico da Vinci, entre agosto de 2004 y marzo de 2012 en el Hospital Italiano de Buenos Aires. Se intento realizar conservación neurovascular en pacientes cT1c con bajo volumen tumoral, gleason 7 o menor y anatomía quirúrgica favorable. Se objetivó el grado de incontinencia y erección postoperatoria. Se evaluó la supervivencia global y especifica por enfermedad así como también la supervivencia libre de recaída bioquímica (SLRB). Se comparó la SLRB entre grupos de acuerdo a variables pre y postoperatorias. RESULTADOS: No se registraron complicaciones ni lesiones a órganos vecinos, ni transfusiones de sangre. El 85,7 % presenta continencia normal (no utiliza paño). Ocho pacientes (27,5%) conservan su potencia con sildenafil. Hubieron 6 márgenes positivos para extensión tumoral, 44,8% de pT3a y 10,3% pT3b. Todos los pacientes se encuentran vivos al momento y 58.6% con por lo menos 1 año de seguimiento presentan un PSA con criterio de curación (menor de 0,02ng/ml). La recaída bioquímica fue del 41,3% y la SLRB estimada a 4 años fue del 51,7%. De los grupos analizados, tanto la presencia de un score de gleason preoperatorio ≥ 8 y la presencia de márgenes quirúrgicos positivos (MQP) influyeron de manera significativa en la SLRB tanto en el análisis univariado como en el multivariado (p=0,02 y 0,017, respectivamente). CONCLUSIONES: La PR-R es una cirugía desafiante y realizable con un índice de complicaciones aceptable, siendo una oportunidad de curación en pacientes con recidiva bioquímica tras radioterapia de próstata. La presencia de un score de gleason preoperatorio ≥ 8 y la presencia de MQP en la pieza aumentan las posibilidades de tener una recaída bioquímica a los cuatro años post PR-R

OBJECTIVES: To determine the oncological and functional results obtained after salvage radical prostatectomy (SRP) in patients with recurrence following radiotherapy (3 consecutive PSA rises after a nadir until the year 2006, then 2 ng/mL above nadir) for prostate cancer (PC), and to analyze the impact of different pre- and postoperative variables on biochemical recurrence-free survival (BCR-free survival). METHODS: Retrospective analysis of 29 cases treated with SRP, 23 cases of conventional technique and 6 cases assisted by the Da Vinci surgical system between August 2004 and March 2012 at the Hospital Italiano de Buenos Aires. There was an attempt to preserve neurovascular bundles in cT1c patients with low tumor volume, Gleason score 7 or less, and favorable surgical anatomy. The degrees of postoperative incontinence and erectile function were recorded. The overall survival, the disease-specific survival, and the BCR-free survival were assessed. The BCR-free survival was compared among groups in accordance with the pre- and post-operative variables. RESULTS. No complications, injury to nearby organs or blood transfusions were recorded. Of all the patients, 85.7% showed normal continence (no pads used). Eight patients (27.5%) preserved their potency with sildenafil. There were 6 positive margins for tumor extension, 44.8% of pT3a, and 10.3% pT3b. All patients are alive at present, and 58.6% with at least 1 year of follow-up have a PSA with recovery criteria (less than 0.02 ng/mL). The biochemical recurrence (BCR) was 41.3%, and the estimated 4-year BCR-free survival was 51.7%. Of the groups analyzed, the presence of a preoperative Gleason score ≥8 and the presence of positive surgical margins (PSMs) significantly influenced the BCR-free survival, both in the univariate as well as the multivariate analysis (p=0.02 and 0.017, respectively). CONCLUSIONS: SRP is a challenging and achievable surgery with an acceptable complication rate, and constitutes a chance to cure patients with biochemical recurrence following prostate radiotherapy. The presence of a preoperative Gleason score ≥8, and the presence of PSMs in the specimen increase the chances of a BCR after four years post-SRP

Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings.

PURPOSE: To describe the clinical, MRI, intraoperative, and histological features of mucoid degeneration of the anterior cruciate ligament (ACL). METHODS: This study included 10 patients (average age 47 years, range 19-69 years) who underwent surgery due to clinical diagnoses of mucoid degeneration of the ACL. All patients underwent preoperative magnetic resonance imaging (MRI) and were arthroscopically treated. RESULTS: All 10 patients reported preoperative posterior knee pain. MRI indicated a thickened ACL with increased signal on all sequences. Postoperatively, only six of 10 patients were confirmed by biopsy to have a mucoid degeneration of the ACL. An associated intraosseous tibial cyst or ganglion was observed only in patients with a definitive diagnosis of mucoid degeneration. CONCLUSIONS: Mucoid degeneration of the ACL can be suspected in patients with posterior knee pain associated with a thickened ACL. Associated findings such as an intraosseous tibial or ganglion cyst help to rule out differential diagnosis.

Direct 64-row MDCT venography in the diagnosis of an inferior vena cava leiomyosarcoma.

We report the usefulness of a technique called direct-MDCT venography in the diagnostic workup of a patient with an inferior vena cava leiomyosarcoma. The technique consists in the injection of contrast agent through both lower limbs achieving maximum enhancement in the inferior vena cava. Images are similar to those of the gold standard conventional cavography. To our knowledge, this is the first description of the direct-MDCT imaging appearance of an inferior vena cava leiomyosarcoma.

Polea A1 del pulgar. Anatomia, histologia y correlacion clinica en la tenosinovitis estenosante. Estudio clinico prospectivo / A1 pulley of the thumb. Anatomy, histology and clinical correlations in stenosing tenosynovitis. Prospective clinical study

Introducción: Este estudio fue realizado para definir laanatomía de la polea A1 del pulgar en pacientes con tenosinovitis estenosante y evaluar parámetros biomecánicos de ese dedo después de haber seccionado por completo la polea. Materiales y métodos: Se evaluaron prospectivamente 19 pacientes en quienes se seccionó la polea A1. Se midieron la flexoaducción, la flexión interfalángica y metacarpofalángica en los períodos prequirúrgico y posquirúrgico, así como las fuerzas de pinza-pulpejo y de pinza lateral, y se compararon con el lado sano contralateral. Resultados: Se identificaron tres tipos de poleas en el aspecto anterior de la vaina tendinosa del tendón. La flexión interfalángica, la fuerza de pinza-pulpejo y la fuerza de pinza lateral estaban disminuidas de manera significativapor la tenosinovitis estenosante. La sección de la poleaA1, que produjo una cuerda de arco del tendón flexorlargo del pulgar en promedio de 3,4 mm, fue eficaz paracorregir el déficit preoperatorio con respecto a la movilidad y la fuerza. Conclusiones: Aunque se identificaron tres tipos de poleas A1, los datos clínicos muestran que no existen diferenciasen cuanto a la movilidad y la fuerza después deseccionar por completo cualquiera de estos tipos cuandose las compara con el lado sano contralateral.