Increased mammary uptake on 111In pentetreotide scintigraphy.

The normal scintigraphic features of 111In pentetreotide include uptake in the pituitary, thyroid, liver, spleen, kidneys, urinary bladder, gallbladder, and bowel. In premenopausal women, faint activity can be seen in the breasts. We present 2 cases of symmetrical, markedly increased mammary uptake. Our hypothesis to explain this pattern of uptake is an upregulation of the somatostatin type 2 receptor caused by high blood levels of estradiol during pregnancy. Estradiol levels during the menstrual cycle could therefore explain the variable degree of uptake commonly seen in premenopausal women.

[Manually-assisted laparoscopic donor nephrectomy]. / Handassistierte laparoskopische Spendernephrektomie.

The number of patients suffering from terminal renal failure awaiting kidney transplantation has continued to increase. Since the number of available cadaver donor kidneys has largely remained unchanged, a special publicity campaign achieved that almost one-half of the kidneys transplanted in Basle come from live donors. We performed a laparoscopic live donor nephrectomy in 14 patients between March 1998 and August 1999. Despite good experience regarding transplant function and patient satisfaction, the hand-assisted technique was introduced in 1999 because of the long average operating time of 230 min (200-270) and warm ischemia time of 7.5 min (4-9). In the 33 operations performed up to now, the average operating time and warm ischemia time could be significantly reduced to 185 min (135-240) and 2.4 min (1.5-4), respectively. Most recently, the technique of retroperitoneoscopic live donor nephrectomy was successfully employed in 4 patients and could possibly represent the method of choice for the future.

Imaging findings in idiopathic pelvic fibrosis.

Two patients presented with ureteric obstruction, and voiding symptoms and constipation, respectively, and were examined by means of intravenous urography and computed tomography. One patient was additionally examined by means of MR tomography. After CT (performed in both patients) and MRT (performed in one patient) had shown a diffuse, contrast-enhancing, infiltrating process in the small pelvis with infiltration of adjacent organs and vessels, surgical biopsy proved the diagnosis of idiopathic pelvic fibrosis. Extension of retroperitoneal fibrosis below the pelvic rim is very rare. Clinical symptoms of pelvic fibrosis are variable and imaging findings may lead to a broad list of differential diagnoses. We present two patients with idiopathic pelvic fibrosis and discuss radiological findings and differential diagnoses of this rare disease.

Urinary level of nuclear matrix protein 22 in the diagnosis of bladder cancer: experience with 130 patients with biopsy confirmed tumor.

PURPOSE: We prospectively evaluated the value of nuclear matrix protein 22 (NMP22dagger) and cytology in the diagnosis of bladder cancer. MATERIALS AND METHODS: We analyzed NMP22 in voided urine from 235 patients before cystoscopy. Of the patients 130 had transitional cell carcinoma of the bladder and subsequently underwent surgery. In a subset of 200 patients bladder washout samples for cytology were collected during cystoscopy. The cutoff for NMP22 was 10.0 units per ml. For cytology only high grade atypia was considered positive. RESULTS: Histology showed 77 superficial (pTa, pTis) and 53 invasive (pT1 or greater) tumors. Sensitivity of NMP22 was 51% and specificity was 83%. NMP22 sensitivity was 36% for superficial tumors and 73% for invasive transitional cell carcinoma. Overall sensitivity of cytology was 52% and specificity was 89%. Cytology sensitivity was 38% for superficial tumors and 83% for invasive transitional cell carcinoma. NMP22 sensitivity for grades 1, 2 and 3 tumors was 30%, 56% and 68%, respectively. Cytology sensitivity for grades 1, 2 and 3 tumors was 30%, 50% and 91%, respectively. Combined NMP22 and cytology had a sensitivity of 70%. CONCLUSIONS: NMP22 has sensitivity and specificity similar to those of cytology from bladder washout samples. Particularly in low stage and low grade tumors both tests show the same disappointing sensitivity. Because of a false-negative rate of 49%, NMP22 cannot replace cystoscopy in clinical practice, as the danger of missing NMP22 negative tumors is too high to rely on its results in an individual patient.

Life-threatening spontaneous retroperitoneal bleeding: a rare complication of oral anticoagulation.

In a patient on oral anticogulation with sudden onset of loin pain, the possibility of spontaneous bleeding in the retroperitoneum must be considered in the differential diagnosis of renal colic. This rare pathology can be life-threatening, and rapid diagnosis with ultrasound and computerized tomography of the abdomen must be made. If the patient is hemodynamically stable, a conservative approach is justified. Otherwise, emergency nephrectomy may be needed. As patients become older and indications for anticoagulant therapy become more common, we will probably have to face more of these rare bleeding complications in the future. We report such a case.

[General features and strategy in the diagnosis of prostatic carcinoma]. / Aspetti generali e strategia nella diagnosi del carcinoma della prostata.

Prostate cancer (PCa) is the most commonly diagnosed cancer in men as well as the second leading cause of cancer death. Age, family history and race are proved risk factors for developing a PCa. Prostate specific antigen (PSA) in combination with the digital rectal examination (DRE) has proven to be an essential element in early prostate cancer detection. Enthusiasm for using transrectal ultrasound (TRUS) alone to identify early prostate cancer has not been demonstrated with longer follow-up. The major role of TRUS today is to ensure accurate wide-area sampling of prostate tissue in men with PCa suspicion. This is best accomplished by targeted biopsy of TRUS-suspicious lesions and systematic biopsy of areas without hypoechoic lesions. Urologists recommend digital rectal examination and a PSA blood test annually starting at age 50.

[Staging and therapeutic options in local prostatic carcinoma]. / Stadiazione e opzioni terapeutiche nel carcinoma prostatico localizzato.

Since the introduction of prostate specific antigen (PSA) into widespread use in clinical practice for early detection of prostate cancer (PCa), in combination with digital rectal examination (DRE), there has been a marked increase in the incidence of localized, potentially curable, disease coupled with a simultaneous decline in regional and metastatic prostate cancer in the least years. After the diagnosis of adenocarcinoma of the prostate has been histologically confirmed, an accurate assessment of the stage--or extent--of the disease should be made. We will provide a critical assessment of the currently employed PCa staging modalities. Therapeutic options in locally defined PCa are analyzed. Intracapsular PCa (T1a-T2b N0 M0) is preferably managed by radical prostatectomy, "insignificant" cancers may be treated by watchful waiting. The outcome of irradiation is not as predictable as radical surgery. Neoadjuvant treatment with radical prostatectomy in locally advanced PCa is probably not as efficient as believed; in some instances the value of adjuvant treatment is undecided. As it seems irradiation in conjunction with androgen deprivation can equal efficacy of surgery.

[Sexual male dysfunction]. / La disfunzione sessuale maschile.

Disorders of libido, erection orgasm and ejaculation are the most important reasons for male sexual dysfunction (MSD), because of organic reasons, medical therapies and social stressing factors, MSD is increasingly evaluated more precisely and it is not limited on erectile dysfunction any longer. With the appearance of the first oral acting substance on the market and the presence of media a great pressure arose to the medical doctors to do prescriptions. Therefore, it is very important to have consultation, diagnostics and treatment of the MSD done with elaborated medical criteria.

[Transurethral thermotherapy of the prostate--a very promising treatment method for benign prostatic hyperplasia]. / Transurethrale Thermotherapie der Prostata (TUMT)--Eine vielversprechende Behandlungsmethode der benignen Prostatahyperplasie.

Transurethral resection of the prostate remains the most common method for the treatment of benign prostatic hyperplasia (BPH). Due to unsatisfactory results in about 18% of the patients new methods to treat BPH have been developed. We evaluated 45 patients 6 and 12 months after transurethral microwave thermotherapy using the Prostatron device with Prostasoft 2.5 software. There was a significant improvement of the urinary symptoms and of the quality of life index from 18 to 9.5 and from 3.2 to 1.6 points, respectively. Urinary flow rate improved from 8.8 to 12.1 ml/sec and residual urine was reduced from 101 to 52 ml. The treatment was well tolerated and side effects were minimal. High-energy transurethral microwave thermotherapy is an effective and safe minimal invasive alternative to treat BPH in selected patients. As no anesthesia is required transurethral microwave thermotherapy can also be offered to high risk and elderly patients.

[Hematuria]. / Hämaturie.

Hematuria is an important symptom to be taken seriously and to be investigated quickly and thoroughly. One can distinguish between gross and microscopic hematuria as well as between initial, total and terminal hematuria. The most common cause of hematuria is bladder infection. However, because of the grave consequences bladder cancer has to be excluded. Family doctors have many tools to investigate the urine, i.e. urinary sticks, microscopic urine analysis, urine culture as well as sonography of the urinary bladder. If suspicion of bladder cancer arises further investigations by an urologist using cystoscopy, intravenous or retrograde pyelogram and sonography must be considered. Treatment of bladder cancer consists in transurethral resection of the tumor, local or systemic chemotherapy or radical cystectomy.

[Mesenteric infarct in acute mesenteric vein thrombosis]. / Mesenterialinfarkt bei akuter Mesenterialvenenthrombose.

Mesenteric venous thrombosis is an infrequent but distinct form of intestinal ischemia. We report 2 cases of acute mesenteric venous thrombosis, treated successfully by carrying out intestinal resection and postoperative anti-coagulation (Heparin, Sintrom). Both patients were diagnosed in the operating room. Improvements in computed tomography may identify patients earlier in their clinical course, heparin has both a primary therapeutic role in early disease and a postoperative adjunctive role in advanced disease. With such care, these patients can expect an acceptable prognosis.

Ophthalmic needles. An engineering analysis.

Mechanical engineering formulas to predict the amount of flex and the bend strength expected for surgical needles are presented. Bend strength measurements were made on ophthalmic needles produced from two different materials and several shapes. The agreement between the data derived by measurement and the theoretical predictions is excellent. The force required to penetrate porcine corneas is also measured. A needle strength/penetration force ratio was developed from the data presented in this paper. This ratio reveals that needles produced from smaller wire sizes, if optimally designed, can perform as well as existing larger needles.