Combination of Superselective Arterial Embolization and Radiofrequency Ablation for the Treatment of a Giant Renal Angiomyolipoma Complicated with Caval Thrombus.

This is a case of a 78-year-old male patient with multiple angiomyolipomas of a solitary right kidney. The largest of these tumors (maximum diameter: 13.4 cm) caused significant extrinsic compression of the inferior vena cava complicated by thrombosis of this vessel. Treatment of thrombosis with anticoagulants had been ineffective and the patient had experienced a bleeding episode from the largest right renal angiomyolipoma, which had been treated by transarterial embolization in another institution, 4 months prior to our intervention. Our approach included superselective transarterial embolization of the dominant, right kidney angiomyolipoma with hydrogel microspheres, which was combined, 20 days later, with ultrasonographically guided radiofrequency ablation. Both interventions were uneventful. Computed tomography 2 months after ablation showed a 53% reduction in tumor volume, reduced space-occupying effect on inferior vena cava, and resolution of caval thrombus. Nine months after intervention the patient has had no recurrence of thrombosis or hemorrhage and no tumor regrowth has been observed. The combination of superselective transarterial embolization and radiofrequency ablation seems to be a feasible, safe, and efficient treatment of large renal angiomyolipomas.

Elderly and prostate cancer screening.

PURPOSE: To discuss the issue of screening for prostate cancer in elderly individuals. The impact of life expectancy on the choice of treatment in both patients and health care providers has been investigated as well. MATERIALS AND METHODS: We identified studies published from 1990 onwards by searching the MEDLINE database of the National Library of Medicine. Initial search terms were "localized prostate cancer" and "early stage prostate cancer" combined with "elderly patients, life expectancy, palliative, curative, quality of life, watchful waiting, radical prostatectomy, brachytherapy, and external beam radiotherapy". RESULTS: Despite the decrease in prostate carcinoma-specific mortality, the use of prostate-specific antigen (PSA) has been shown to increase the prostate cancer detection rate with a shift to detection at earlier and less invasive pathological stages, overriding concerns about over-diagnosis and over treating. However, PSA screening is mainly offered to younger individuals, and older patients are more likely to have progressive disease and high-risk prostate cancer at diagnosis. Given that PSA screening diagnoses mainly curable, early prostate cancer, screening decision could be offered to otherwise healthy elderly patients who are likely to benefit from aggressive treatment. CONCLUSION: Prostate-specific antigen screening is not officially recommended and most scientific associations promote shared decision making. While PSA screening decision is currently based on physician's judgment, it is clear that a strict age cut-off of 75 years reduces over-screening, but also prohibits screening in healthy older men with a long life expectancy.

Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience.

PURPOSE: To compare the efficacy and safety of the electromagnetic lithotripter in the treatment of pediatric lithiasis to that of the earlier electrohydraulic model. MATERIALS AND METHODS: Two groups of children with lithiasis aged between 10 and 180 months who underwent extracorporeal shock wave lithotripsy (ESWL). In the first group (26 children), ESWL was performed by using the electrohydraulic MPL 9000X Dornier lithotripter between 1994 and 2003 while in the second group (19 children) the electromagnetic EMSE 220 F--XP Dornier lithotripter was used from April 2003 to May 2006. RESULTS: In the first group, 21/26 children (80.7%) were stone free at first ESWL session. Colic pain resolved by administration of an oral analgesic in 6 (23%), brief hematuria (<24 h) resolved with increased fluid intake in 5 (19.2%), while slightly elevated body temperature (<38°C) occurred in 4 (15.3%). Four children (15.3%) failed to respond to treatment and were treated with ureteroscopy. In the second group 18/19 children were completely stone free at first ESWL session (94.7%). Complications were infrequent and of minor importance: colic pain treated with oral analgesic occurred in 1 (5.26%), brief hematuria (<24 h), resolved with increased fluid intake in 4 (21%) and slightly elevated body temperature (<38° C) monitored for 48 hours occurred in 6 (31.5%). Statistical analysis showed that electromagnetic lithotripter is more efficacious and safer than the earlier electrohydraulic model. CONCLUSIONS: Technological development not only has increased efficacy and safety of lithotripter devices in treating pediatric lithiasis, but it also provided less painful lithotripsy by eliminating the need for general anesthesia.

Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience

PURPOSE: To compare the efficacy and safety of the electromagnetic lithotripter in the treatment of pediatric lithiasis to that of the earlier electrohydraulic model. MATERIALS AND METHODS: Two groups of children with lithiasis aged between 10 and 180 months who underwent extracorporeal shock wave lithotripsy (ESWL). In the first group (26 children), ESWL was performed by using the electrohydraulic MPL 9000X Dornier lithotripter between 1994 and 2003 while in the second group (19 children) the electromagnetic EMSE 220 F-XP Dornier lithotripter was used from April 2003 to May 2006. RESULTS: In the first group, 21/26 children (80.7 percent) were stone free at first ESWL session. Colic pain resolved by administration of an oral analgesic in 6 (23 percent), brief hematuria (< 24 h) resolved with increased fluid intake in 5 (19.2 percent), while slightly elevated body temperature (< 38°C) occurred in 4 (15.3 percent). Four children (15.3 percent) failed to respond to treatment and were treated with ureteroscopy. In the second group 18/19 children were completely stone free at first ESWL session (94.7 percent). Complications were infrequent and of minor importance: colic pain treated with oral analgesic occurred in 1 (5.26 percent), brief hematuria (< 24 h), resolved with increased fluid intake in 4 (21 percent) and slightly elevated body temperature (< 38°C) monitored for 48 hours occurred in 6 (31.5 percent). Statistical analysis showed that electromagnetic lithotripter is more efficacious and safer than the earlier electrohydraulic model. CONCLUSIONS: Technological development not only has increased efficacy and safety of lithotripter devices in treating pediatric lithiasis, but it also provided less painful lithotripsy by eliminating the need for general anesthesia.

The phenomenon of multifocality does not affect the biologic behavior of histologic prostate carcinoma.

BACKGROUND: The affect of multifocality on the biologic behavior of histologic prostate carcinoma is a controversial issue. The aim of this study was to determine if tumor multifocality influences the prognosis of patients with prostatic cancer. MATERIAL/METHODS: Samples consisted of 264 autopsy tissues from men older than 40 years of age and less than 98 years of age who died (between August 2002 and December 2005) of diseases other than clinically diagnosed prostate carcinoma. The entire prostate and seminal vesicles were sectioned, tinted, and fixed in acetic acid. Specimens were immersed in formalin, serial sectioned at a thickness of 4 mm, postfixed, resectioned at a thickness of 2 mm, dehydrated, cleared in xylene, and immersed in paraffin. Two expert pathologists examined the sections. RESULTS: Most latent carcinomas (61%) were multifocal and were composed of 2 or more foci. Ninety percent of distinct foci were found to originate from the peripheral zone. Multifocality was more common among larger prostates, and large tumors were almost exclusively multifocal. Half of these had a total volume less than 1 cm3 and a Gleason score of 2 to 6; there was a clear correlation between tumor volume and Gleason score. Heterogeneity of Gleason grade in multifocal tumors was proportional to the number of foci. No statistically significant difference was observed with respect to capsular penetration or perineural or vascular invasion of multifocal tumors compared to those of unifocal tumors. CONCLUSIONS: Despite relative heterogeneity, the biologic behavior of multifocal tumors is not different from that observed in unifocal histologic tumors.

The effects of lovastatin on conventional medical treatment of lower urinary tract symptoms with finasteride.

OBJECTIVE: To explore whether or not statins have any impact on the progression of components of benign prostatic hyperplasia (lower urinary tract symptoms severity, prostate volume and serum prostate specific antigen (PSA) when combined with other agents inhibiting growth of prostate cells. MATERIALS AND METHODS: This was a preliminary, clinical study. Eligible patients were aged > 50 yrs, with International Prostate Symptom Score (IPSS) between 9 and 19, total prostate volume (TPV) >40 mL, and serum PSA > 1.5 ng/mL. Patients were divided in two groups: those with and those without lipidemia. After selection, eligible BPH patients with lipidemia (n = 18) were prescribed lovastatin 80 mg daily and finasteride 5 mg daily, while eligible patients without lipidemia (n = 15) were prescribed only finasteride 5 mg daily. IPSS, TPV and serum PSA were evaluated at end point (4 months). RESULTS: There was no difference between the two groups on the primary end point of mean change from baseline in IPSS (p = 0.69), TPV (p = 0.90) and PSA (p = 0.16) after 4 months of treatment. CONCLUSIONS: Short-term lovastatin treatment does not seem to have any effect on IPSS, TPV and PSA in men with prostatic enlargement due to presumed BPH.

The effects of lovastatin on conventional medical treatment of lower urinary tract symptoms with finasteride

OBJECTIVE: To explore whether or not statins have any impact on the progression of components of benign prostatic hyperplasia (lower urinary tract symptoms severity, prostate volume and serum prostate specific antigen (PSA) when combined with other agents inhibiting growth of prostate cells. MATERIALS AND METHODS: This was a preliminary, clinical study. Eligible patients were aged > 50 yrs, with International Prostate Symptom Score (IPSS) between 9 and 19, total prostate volume (TPV) > 40 mL, and serum PSA > 1.5 ng/mL. Patients were divided in two groups: those with and those without lipidemia. After selection, eligible BPH patients with lipidemia (n = 18) were prescribed lovastatin 80 mg daily and finasteride 5 mg daily, while eligible patients without lipidemia (n = 15) were prescribed only finasteride 5 mg daily. IPSS, TPV and serum PSA were evaluated at end point (4 months). RESULTS: There was no difference between the two groups on the primary end point of mean change from baseline in IPSS (p = 0.69), TPV (p = 0.90) and PSA (p = 0.16) after 4 months of treatment. CONCLUSIONS: Short-term lovastatin treatment does not seem to have any effect on IPSS, TPV and PSA in men with prostatic enlargement due to presumed BPH.

Associations between coronary heart disease, obesity and histological prostate cancer.

OBJECTIVE: The present study investigates the possible associations between coronary heart disease and histological prostate carcinoma in autopsy material. MATERIAL AND METHOD: The material of our study, were 116 men between 55 years and 98 years of age, who died in the period of August 2002-January 2005. The initial segment of the aorta and the prostate glands of all cadavers were removed while the initial 30 mm of the left and right coronary arteries and the peripheral zone of the prostate gland underwent pathologic examination. RESULTS: Of all subjects examined 71.8% had pathological findings suggesting advanced coronary heart disease. Twenty out of 116 cadavers were found with histological carcinoma in their prostate specimen. Among subjects positive for prostate cancer, 12 had died of cardiovascular diseases, while 16 had macroscopic evidence of advanced coronary artery obstructive disease, a finding that was confirmed on pathologic examination. Although most of the subjects had atheromatous lesions on the coronary arteries, the percentage of men with prostate cancer, which had advanced atheromatosis, was greater when compared to those of subjects without prostate cancer. The relation between the coronary artery obstructive disease severity and the presence of latent prostate cancer was statistically significant (P = 0.02). No statistically significant correlation was obtained between body mass index and the presence of prostate cancer. CONCLUSIONS: Our results indicate that there could be an association between coronary artery obstructive disease and prostate cancer, however due to the relatively low sample further studies are needed in order to confirm such findings.

Dietary intake in immigrant Arabian pregnant women.

OBJECTIVE: We examined the intake of dietary micronutrients of immigrant Arabian pregnant women in Greece, in order to investigate the possible factors influencing food intake and affecting the overall nutritional profile. METHODS: A dietary assessment of 497 immigrant Arabian pregnant women, admitted to the Obstetrics and Gynecology Department, Outpatient Clinic, Tzaneion General Hospital, Piraeus city, Vyronas Health Center, and Alexandras General Hospital, Athens, Greece was performed between August 2002 and August 2005, along with a comparison of micronutrient intake with the latest dietary recommendations. We carried out blood analysis, and measurements of serum micronutrients in all participants. RESULTS: Four hundred and sixty-seven out of 497 (94%) women followed the traditional Arabian diet, and did not use drug medication or supplements during gestation. The mean dietary intakes of vitamin E, vitamin B12, vitamin C, zinc, calcium and phosphorus in the 2nd and 3rd trimesters were similar to the respective values of the Dietary Reference Intake, while the mean dietary intake of vitamin D was relatively low. The mean intakes of folic acid and iron were lower than the respective values, while the mean intakes of vitamin A and magnesium was slightly higher. The results of the laboratory tests were normal in 470 women (94.5%) except those regarding iron deficiency anemia, which was relatively common. CONCLUSION: Our findings suggest that apart from iron and folic acid supplementation, no further changes would be necessary in the dietary patterns of immigrant Arabian pregnant women, since their traditional nutritional habits seem to provide all micronutrients in sufficient quantities.