Retroperitoneal ancient schwannoma: case report and analysis of clinico-radiological findings.

Ancient schwannoma is a rare subtype of typical schwannoma, with histological predominance of degenerative findings. We report the second case of retroperitoneal ancient schwannoma (occurred in a 45-year-old female referred to our institution for an unremitting right lumbar pain) and pinpoint clinical, radiological, prognosis and therapeutic aspects of this tumor.

Histological changes following two-step flap gastrocystoplasty in rats.

INTRODUCTION: A gastric segment used to increase bladder capacity can undergo considerable changes over time, as can all intestinal segments implanted in the urinary tract and in contact with urine. This experimental study reports the differences between the histological alterations observed in the gastric patch transposed in the bladder both with its own pedicle and after deafferentation from the stomach. MATERIALS AND METHODS: A group of 30 young male Sprague-Dawley rats underwent gastrocystoplasty. Survivors were divided into 3 groups: gastrocystoplasty alone (8 rats); gastrocystoplasty with vascular deafferentation at 15 days (7 rats), and at 2 months (8 rats). 5 rats were used as controls. Urinary pH was evaluated during a 6-month follow-up. RESULTS: Histology showed that early devascularization hindered the fusion of the two mucosae in the junctional area but reduced papillary hyperplasia (p = 0.013) of the gastric mucosa. No changes were observed in urinary pH after patch devascularization. CONCLUSIONS: Vascular deafferentation creates a gastric flap on the bladder which, even if it does not prevent urinary acidification, reduces the frequency of histologically detected changes susceptible for transformation into neoplasms.

Roach's mathematical equations in predicting pathological stage in men with clinically localized prostate cancer.

AIMS AND BACKGROUND: The therapeutic choice in patients with clinically localized prostate cancer depends on preoperative clinical stage. Diagnostic instruments currently available for such an evaluation--considered separately--have not shown enough efficacy. Roach has recently introduced three simple mathematical equations that--on the basis of prostate-specific antigen and the biopsy Gleason score--are aimed at calculating the definitive pathological stage. We retrospectively analyzed our radical prostatectomy data base to assess the accuracy of the equations in predicting the final stage in patients with clinically localized prostate cancer. METHODS STUDY DESIGN: The study included 173 patients who had undergone radical retropubic prostatectomy at our Institution. Patients were divided into 25 groups, depending on preoperative PSA and the biopsy Gleason score. The risk of extracapsular neoplastic growth, seminal vesicle involvement and lymph node involvement was calculated for each group by means of Roach's equations. On the basis of definitive histological examinations, we compared the expected risk to the observed risk. RESULTS: The observed risk fell within the interval of expected risk in 16 of 17 groups (94%) regarding the evaluation of extracapsular growth, in 15 of 17 (88%) regarding the analysis of seminal vesicle involvement, and in 14 of 17 (82%) regarding the evaluation of lymph node involvement. Therefore, the observed event was in agreement with the expected event in 45 of 51 groups (88%). CONCLUSIONS: The equations represent a practical and effective instrument for preoperative clinical staging in patients with localized prostate cancer. By means of these mathematical formulas, one can assess the correct prognosis and--above all--plan the best therapeutic approach.

Adult testicular pure yolk sac tumor.

Here we describe the clinical, ultrasonographic and histological features of a rare pure adult yolk sac tumor detected in the right testis of a 44-year-old male. Due to the rarity of this neoplasm (less than 10 cases have been reported), there is no unanimous consensus for therapy following inguinal orchiectomy. We believe that nerve-sparing retroperitoneal lymph node dissection could be potentially curative and useful for future interpretations of this tumor's potential evolution.

Scrotal extraperitoneal hernia of the ureter: case report and literature review.

Ureteral herniation is a rare, often misdiagnosed event and serious surgical complications are possible. Until 1992, 128 cases of ureteral herniation were reported and in 54 (42%) the inguino-scrotal region was involved. From an anatomical and pathogenic standpoint, two types of uretero-inguinal hernias can be identified: paraperitoneal (more frequent, acquired, always presenting a peritoneal hernia sac, frequently associated with other herniated abdominal structures) and extraperitoneal (very uncommon, congenital, never associated with a true peritoneal sac, always composed only of the ureter). We describe a new case of scrotal extraperitoneal ureteral hernia and review the current urological, surgical and radiological literature to analyze the main clinical characteristics of this pathology and its ideal treatment.

[Experimental microsurgical gastrocystoplasty] . / La gastrocistoplastica sperimentale microchirurgica.

BACKGROUND: Stomach tract used for bladder augmentation decreases urinary pH and produces the syndrome of dysuria and hematuria; gastric mucosa in contact with urine may develop prominent histopathological changes including proliferative lesions. The aim of this study was to investigate in an experimental model the possibility of detecting the factors involved in the mucosal damage. METHODS: Thirty-five Sprague Dawley rats randomly underwent microsurgical gastrocystoplasty or sham operation (5 controls). During operation elliptical gastric patch was isolated with its gastroepiploic vascular pedicle, bladder was opened with midline incision and anastomosis performed. Urine was aspirated from the bladder for culture, pH and electrolytes evaluation; venous blood was samples for electrolytes, BUN and creatinine. Mean follow-up time was 6 months. RESULTS: Of the 30 rats subjected to gastrocystoplasty 23 survived (77%). All of cultures were negative, the urinary pH decreased after operation and increased gradually two months later. Urinary sodium and potassium ions concentrations increased significantly in gastrocystoplasty (p < 0.05). There were no significant changes in serum electrolytes or renal function. CONCLUSIONS: This experimental model was useful to investigate the effects related to the presence of gastric mucosa in the urinary tract.

Hyperbaric oxygen therapy in the treatment of Fournier's disease in 11 male patients.

PURPOSE: Optimal tissue oxygenation, as obtained by hyperbaric oxygen therapy, potentiates or restores the host's bactericidal mechanisms and wound healing activity in patients afflicted by serious synergeic aerobic and anaerobic infections of the cutaneous and subcutaneous tissues. Furthermore, hyperbaric oxygen therapy has a direct toxic effect on anaerobic bacteria. We describe our experience with hyperbaric oxygen therapy in the treatment of 11 patients with Fournier's syndrome. MATERIALS AND METHODS: The average age of our patients was 59.5 years; the most common predisponsing condition was diabetes. All patients were treated with antibiotic therapy and hyperbaric oxygen therapy (minimum 5 and maximum 24 cycles, consisting of 90 minutes 2.5 atmosphere absolute pressure). Furthermore, 6 of these patients underwent surgical débridement of the wounds and 3 patients underwent delayed reconstructive surgery. RESULTS: The results we obtained with hyperbaric oxygen therapy as an adjunctive measure for the treatment of these infections were excellent; our mortality rate for Fournier's disease was 0. Moreover, no complications whatsoever were observed. Furthermore, the 3 patients who underwent delayed corrective surgery presented with well healed tissues and their operations were not complicated by infections or other pathological conditions. CONCLUSIONS: We believe that our findings, although limited in number, underline the excellent results that can be obtained with hyperbaric oxygen therapy as an adjunct treatment in Fournier's disease.

Fluoroscopically guided skinny-needle aspirative biopsy in normal and suspected lymph nodes in urologic cancer.

The authors present their experience with transperitoneal thin-needle biopsy of the retroperitoneal lymph nodes. This method is a means of improving lymphographic diagnosis in suspected lymph node metastases, the small contrast defects serving as a sign. The high rate of false-negative results makes its use unadvisable in patients with negative lymphography where the sample cannot be aimed at but is multiple and randomized.

[Histological follow-up after implantation of grains of I-125 for prostatic cancer]. / Contrôles histologiques après implant de grains d'I125 pour cancer de la prostate. Rapport préliminaire.

The authors report a preliminary study of 12 cases of carcinoma of the prostate confined to the prostate (T1, T2, T3, NO, MO) treated by pelvic lymphadenectomy and the implantation of grains of I 125 in the prostatic tissue. Irradiation continued for six months, providing most dose of 100 Gy in the prostate. Interstitial irradiation caused not only the destruction of tumour cells but also "radiation prostate" lesions with vascular obliteration which itself caused sufficient impairment of the vitality of the prostatic tissue for any residual tumour to disappear with a frequency which increased with the time elapsing between the follow up prostatic biopsy and the implantation of radioactive iodine. Experience remains limited but the initial figures given here suggest the validity of continuing along these lines.

[Endo-urological techniques. New applications in two cases]. / De nouvelles indications à l'application des techniques endo-urologiques. Présentation de deux cas.

Two new indications for the application of endo-urological techniques are reported. One case involved recanalization of stenosis at the ureterovesical junction, while in the other case a double J ureteral endoprosthesis was extracted by the transnephropyelostomy percutaneous route.

[Percutaneous embolization of renal cancer. Clinical evaluation (author's transl)]. / Embolizzazione percutanea dell'adenocarcinoma renale. Valutazione clinica di tre anni di applicazione.

The authors deal with 17 cases of renal adenocarcinoma treated with preventive embolization, widened nephrectomy and total parenteral nutrition, as well as one case of palliative definitive embolization in a patient who could not be operated. The most remarkable clinical aspects turned out to be in the easier and safer maneuverability under surgery, a decrease in mortality during and after the operation, reduced consumption of blood units, and a better which were treated only with purely surgical therapy.

[Therapeutic occlusion of the hypogastric arteries with isobutyl-2-cyanoacrylate in vesical and prostatic cancer (author's transl)]. / Occlusione arteriosa terapeutica delle arterie ipogastriche con isobutil-2-cianoacrilato nelle neoplasie vescicali e prostatiche.

The authors refer their clinical experience of the use of embolization of the hypogastric arteries in cases of serious haemorrhage of the bladder and prostate. The immediate results in the 14 cases observed are decidedly positive, especially considering the serious conditions of certain neoplastic patients, which ruled out alternative surgical treatment. Nevertheless, even when the embolization technique has been correctly used, the possibility exists that bleeding may start up again after some time, and this is always caused by the revascularization of the neoplasia.

[Therapeutic angiographic occlusion with a modified autologous clot. Case report]. / L'occlusione angiografica terapeutica con coagulo autologo modificato. Contributo casistico.

Therapeutic arterial embolization with autologous clot is readily applied in urology. The procedure is particularly effective in those cases where a temporary blockage of the artery is required, enough to cause a definitive haemostasis in noble parenchymas sensitive to ischaemia. However this method is not limited only to poor risk patients ("life-threatening"); it may be preferable to surgical operation, as in the case studied, of postraumatic, intraparenchymal arterovenous fistula. In their presentation, the authors also take into consideration several technical side-effects, helping towards correct execution.

[Transluminal angioplasty of the renal artery for renovascular hypertension (author's transl)]. / Angioplastie transluminale de l'artère rénale pour hypertension rénovasculaire.

The authors report an interesting case of dilatation of renal artery stenosis by inflation of the balloon of a catheter engaged in the stenosed arterial lumen inserted percutaneously under arteriographic control. The patient's hypertension responded within a few hours and plasma renin levels in the systemic circulation became normal within a few days. This result was stable at 2 months. In the opinion of the authors, this technique of percutaneous transluminal angioplasty, initially used for arterial obstructions of the lower limbs, carotid and coronary obstructions, should find a wide field of application in the area of renovascular hypertension.