Vesical telangiectasias as a cause of macroscopic hematuria in systemic sclerosis.

A 36-year-old female with diffuse cutaneous systemic sclerosis (dcSSc) developed macrohematuria due to vesical telangiectasias that was responsive to diathermocoagulation of the vasal lesions. This is the first report of a patient with dcSSc and vesical telangiectasias leading to severe macrohematuria that was successfully treated with diathermocoagulation.

[Retroperitoneal lymphadenectomy for testicular cancer and genito-sexual conditions: retrospective study]. / Curage lymphonodal rétropéritonéal pour cancer du testicule et troubles génito-sexuels: une étude rétrospective.

OBJECTIVES: The aim of this study was to evaluate retrospectively the preservation of fertility in a number of patients with testis or funicle tumour treated with retroperitoneal lymph node dissection (RPLND). MATERIAL AND METHODS: Between 1983 and 1998, 41 patients with testis or funicle cancer (mean age 29 years, range 18-58) underwent RPLND at our institution. Clinical staging included abdominal CT scan, chest X-rays and serum tumour markers (alpha FP, beta HCG, LDH). RPLND was performed bilaterally in 14 patients and unilaterally in 13 patients (6 right and 7 left). The nerve sparing technique was used in 14 cases. Ejaculation was evaluated in 39 patients (2 patients died of metastases before the study). Mean follow up was 64 months (range 5-182). Semen was available for 21 patients before RPLND and for 19 patients after RPLND. The "t Student" test was used to compare the semen parameters before and after surgery. RESULTS: Bilateral RPLND caused loss of ejaculation in 67% of the patients (8/12). Unilateral right and left RPLND allowed to maintain ejaculation in 100% (6/6) and 57% (4/7) of cases respectively. Nerve sparing procedure preserved ejaculation in 100% of the patients (14/14). After RPLND, both mean total sperm count and mean motility rate were not significantly changed (143 +/- 124 x 10(6) vs 128.2 +/- 72 x 10(6) p > 0.05; 40.7 +/- 17.6 vs 48 +/- 15.5%, p > 0.05). The survival rate of the patients treated with RPLND was 95%. None of the patients treated with unilateral (en bloc or nerve sparing) RPLND had relapse. CONCLUSION: The evolution of surgical technique has notably reduced the andrological complications of the RPLND without affecting the oncological results.

Sonographic appearance of aggressive angiomyxoma of the bladder.

Aggressive angiomyxoma is a rare, benign but locally aggressive mesenchymal neoplasm. We report the sonographic findings in a case of histologically proven aggressive angiomyxoma of the bladder. Sonography revealed a solid polypoid mass 2 cm in diameter with sharply demarcated borders, a heterogeneous echotexture, and a slightly hyperechoic rim.

Management of renal angiomyolipoma: a report of 53 cases.

OBJECTIVE: To evaluate the clinical, therapeutic and prognostic aspects of renal angiomyolipoma (AML) in patients either monitored by clinical and radiological follow-up or treated by surgical therapy. PATIENTS AND METHODS: Fifty-three patients with renal AML were divided in two groups; 33 patients in group 1 were monitored by annual clinical and ultrasonographic follow-up and 20 in group 2 were treated with surgical therapy. Two patients had tuberous sclerosis (TS) with synchronous bilateral and multiple lesions. Apart from the patients with TS, there were 38 lesions in group 1 and 25 in group 2. The mean (range) follow-up of group 1 was 60.2 (12-164) months. RESULTS: In group 1, the diagnosis was most often incidental, after ultrasonography performed for symptoms unrelated to AML. In group 2, the suspicion of a malignant renal lesion, and spontaneous tumour rupture with bleeding and perirenal haematoma, were the main indications for surgical treatment. The mean lesion diameter was significantly greater in group 2 (5.4 cm) and in symptomatic patients (8.1 cm). In group 1, 92% of renal AMLs showed no radiographic changes, serious complications or new renal or extrarenal lesions during the follow-up. Only three lesions grew, after 22, 85 and 164 months, respectively. Of the 20 patients in group 2, 14 underwent conservative surgery. CONCLUSION: Small (<4 cm) isolated AMLs, detected incidentally, showed a low risk of developing during long-term follow-up. Such patients may be followed conservatively by ultrasonography every 2 years. Spontaneous perinephric haemorrhage is related to the size of the lesion. When surgery is indicated (by symptoms or diagnostic doubt), a conservative procedure can be performed in most of cases.

Randomized comparison of goserelin acetate versus mitomycin C plus goserelin acetate in previously untreated prostate cancer patients with bone metastases.

In a prospective trial conducted by the Gruppo Onco Urologico Piemontese, newly diagnosed prostate cancer patients with bone metastases were randomized to receive goserelin (3.6 mg subcutaneously every 4 weeks) or goserelin plus mitomycin at 14 mg/m2 i.v. every 6 weeks. Treatment was planned to be continued until progression. The study was interrupted because of inadequate accrual rate when 63 patients had been recruited. A long-term follow-up (median, 47 months), performed to counterbalance the limited number of patients included, revealed no difference in time to progression and overall survival between the study treatments. However, 56.5% of assessable patients allocated to the chemotherapy arm presented a > or =90% reduction of prostate-specific antigen levels compared with 36.3% in the goserelin group, and previously elevated levels normalized in 73.9% versus 45.4%. Non-progressing patients received 5-7 cycles of mitomycin C with acceptable toxicity, but the cytotoxic treatment was interrupted early in all cases within the first year due to cumulative myelotoxicity. In conclusion, the results, although inconclusive, fail to support a clear advantage in terms of cost/benefit of chemotherapy plus hormone therapy over hormone treatment alone in advanced prostate cancer with bone involvement.

Coexistence of orbital and retroperitoneal involvement in multifocal fibrosclerosis: case report.

OBJECTIVE: To report a rare case of multifocal fibrosclerosis involving the retrobulbar tissue and the retroperitoneum. METHODS: A 59-year-old man presented with bilateral exophthalmos, more serious in the right eye. Right orbital biopsy showed fibrous tissue with inflammatory cells. After the failure of the radiation therapy, a right orbital exenteration was required. Radiological examinations demonstrated a retroperitoneal mass involving the perirenal fat, the aorta, the presacral and the perivesical tissue. Renal function impaired. A left inferior calycoureterostomy and a surgically placement of a right JJ stent were performed. Histological examination of the retroperitoneal biopsies revealed fibrous connective tissue. RESULTS: After 9 years of follow up, there was no change in left visual or renal function (last creatinine: 1.3 mg/dl), and no symptoms or signs of recurrences. CONCLUSION: This case is the ninth to document the association of orbital pseudotumor and retroperitoneal fibrosis. It is important that both the ophthalmologist and the urologist are aware of the existence of this association, so that suitable treatment can be initiated without delay.

Major surgery (radical cystectomy with urethrectomy) in a patient with von Willebrand's disease type I. Reliability and limits of hemocoagulative tests.

Patients with bleeding disorders frequently need medical or surgical care. The case is reported of a man with von Willebrand's disease type I undergoing radical cystectomy with urethrectomy for multicentric bladder cancer with neoplastic involvement of prostatic urethra, who developed serious bleeding complications which can not be predicted with conventional coagulation in laboratory. The use of the thromboelastograph (TEG) in the critical postoperative period was decisive. The tracing alterations allowed to assess the clotting disorder, constantly counterbalancing the baseline deficit and the blood loss.

Sex steroids modulate NADPH-diaphorase expression in the postnatal adrenal neurons of the rat.

The rat adrenal gland contains nitric oxide-producing ganglion cells, contributing to its innervation. In a previous study postnatal number and morphology of these adrenal neurons were analyzed by NADPH-diaphorase histochemistry in the two sexes. A transient sex-related difference in the number of NADPH-diaphorase positive neurons per adrenal gland was found at postnatal day 10, when the number of stained neurons in males was nearly twice that found in females. In the present work we studied the effects of perinatal hormonal manipulation on the number of adrenal NADPH-diaphorase-positive neurons during the second postnatal week. The number of labeled adrenal neurons at postnatal day 10 was higher in females receiving perinatal androgen treatment than in control untreated females, and was similar to that of control untreated males. In contrast, in males that underwent perinatal deprivation of testosterone the number of labeled adrenal neurons was lower than in control males, and similar to that of control females. These differences were found in both the adrenal cortex and medulla. In males and in testosterone-treated females there was a higher proportion of stained multipolar neurons than in females and in androgen-deprived males. No intergroup differences were found in the size of stained neurons. Thus, we demonstrated that the postnatal difference in the number of NADPH-diaphorase-positive adrenal neurons in the two sexes is related to the epigenetic action of gonadal hormones during perinatal maturation.

Quality of life in prostate cancer patients.

INTRODUCTION: Quality of life (QL) assessment should be an essential part of clinical practice and should also be included in every clinical trial of prostate cancer. The term QL describes a person's overall well-being comprising not only physical functioning but also psychological and social dimensions. It is important to remember that QL can be affected by the disease as well as by the therapeutic treatment adopted. OBJECTIVES: To measure the impact on QL in 161 patients treated by radical prostatectomy performed from January 1980 to June 1995. To describe the QL results from a national epidemiological study on prostate cancer, and to review the assessment of QL in this setting. CONCLUSIONS: We found radical prostatectomy to have minimal overall impact on QL in patients informed of, and involved with all therapeutic decisions. Maintenance of sexual activity was considered to be of less importance than the attempt to cure the disease. The best method of assessment remains unclear but, minimally, a general questionnaire supplemented by specific questions on urinary-sexual symptoms should be administered at follow-up.

[Surgical interventions and andrological complications]. / Interventi chirurgici e complicanze andrologiche.

Several abdomino-Pelvic surgical procedures can cause ejaculatory failure or impotence. Retroperitoneal lymph node dissection for testis cancer is followed by loss of ejaculation if bilateral. In low stage cancers, monolateral procedure is associated with maintenance of ejaculation in most patients. Evaluation of seminal fluid before surgery is essential for cryopreservation and artificial insemination erectile impotence is consequent to section of "nervi erigentes" in pelvic surgery for cancer. Careful anatomic dissection can spare these nerves but oncologic radicality should be always kept in mind.