Retroperitoneal "Triton" tumor.

Malignant Triton tumor is a malignant peripheral nerve sheat tumor with rhabdomioblastic differentiation. These tumors are frequently associated with Neurofibromatosis type 1, sporadic cases being exteremly rare. Retroperitoneal localization have the most unfavorable prognois due to delayed diagnosis but also due to relation to adjacant organs. Preoperative diagnosis is inaccurate, but core needle biopsy gives more promising results. Aggressive surgical management remains the most effective modality since adjuvant forms of treatment like irradiation or chemotherapy do not have reproducible results. We present a 60-year-old female patient in whom a retroperitoneal presacral mass was postoperatively diagnosed as Triton tumor. At time of diagnosis, no visible metastases were present. The posterior pelvic exenteresis was performed. Intended chemotherapy was never started since multiple pulmonary, hepatic and splenic metastases were diagnosed only a month after surgery, with rapid lethal outcome. This case demonstrates the bad prognosis of malignant retroperitoneal tumors. Diagnostic tools such as refined biopsy techniques or cytogenetic analysis might help in differentiating patients who will benefit from radical surgery.

Diagnosis of prostate cancer in Serbia.

PURPOSE: A rising incidence of prostate cancer is noticed in USA and Europe, which might be due to better diagnostic procedures and screening programs started in some countries. We still lack epidemiological studies confirming the same trend in our country, but the rising number of patients in whom radical prostatectomy is performed is an indirect proof of bigger recruitment of patients with prostate cancer. The purpose of this study was to establish the most appropriate diagnostic protocol for detection of prostate cancer in our unscreened population. MATERIALS AND METHODS: Transrectal ultrasound (TRUS) -guided biopsies of the prostate were performed in 229 patients. Biplanar transrectal probe with needle channel was used. Six to 10 tissue cores were obtained from each patient. RESULTS: The mean patients' age was 67.12 years (range 42-88). All patients had serum prostatic specific antigen (PSA) estimation before biopsy, which ranged from 0.41 to 1550 ng/ml (mean 50.83), with 146 (63.8%) patients having PSA level greater than 10 ng/ml. Free (F) PSA was performed in 120 (52.4%) patients; the range of F to total (T) PSA ratio was 0.02 to 0.74 (mean > 0.13). Digital rectal examination (DRE) was positive in 65% of the patients. The mean prostate volume was 40.5 ml (range 11-140). Cancer was diagnosed in 99 (43.2%) patients, prostate cancer in situ (PIN) alone was diagnosed in 37 (16.2%), chronic prostatitis in 73 (31.9%), while benign prostatic hyperplasia (BPH) was found in 20 (8.7%) patients. CONCLUSION: The cancer detection rate in our patients was high. In a lot of patients the biopsy was needed only for histological proof, not as a staging tool, the intention of which is the selection of patients with localized prostate cancer amenable to curative treatment. There is still reluctance to use PSA as a sole indication for biopsy, positive DRE still being mandatory. With such a policy we are missing a lot of curable prostate cancer cases, thus increasing the cost of treatment. A national policy including screening should be considered.

[Quality of life in patients with renal carcinoma]. / Kvalitet zivota kod bolesnika sa karcinomom bubrega.

First line treatment of renal cell carcinoma (RCC) is radical nephrectomy. In patients with metastasis or with local recurrence adjuvant immunohaemiotherapy is necessary. Interferon alpha is used with or without Interleukin 2 in combination with cytostatics. Immunotherapy induces some adverse effects which might compromise the treatment. The aim of this pilot study was to asses the effect of interferon on the quality of life in patients with RCC previously treated with radical nephrectomy. The originally made questionnaire was used to measure the impact of the treatment on quality of life of 15 patients. It was that Interferon did not alter significantly the quality of life in examined patients.

[Current knowledge on cryopreservation of spermatozoa, ovum cells and zygotes]. / Dosadasnja saznanja o kriokonzervaciji spermatozoida, jajnih celija i zigota.

CELL INJURIES DURING FREEZING AND THAWING: The aim of various cryopreservation procedures is to minimize cell injuries during the freeze-thaw cycle (cryoinjuries). Generally, the cell damage during freezing and thawing procedures may be the results of: (a) extensive cellular dehydration (solution effect) and/or (b) intracellular ice crystallization/recrystallization (mechanical cell damage). Two independent mechanisms are involved. They can act simultaneously, leading to cytolysis. The first one is expressed primarily during low rate freezing, and the second one during rapid freezing. Thus, determination and use of the optimal cooling velocity, specific for each type of isolated cells, should be considered. Finally, a higher degree of cell destruction has been documented when the transition period from liquid to solid phase (release of the fusion heat) is prolonged. CRYOPROTECTIVE AGENTS: For successful cell cryopreservation, cryoprotectants are needed. They decrease the osmotic gradient and the vapor pressure difference between the intra- and extracellular area. Adequate choice of the most suitable type and concentration of cryoprotective agent is important for the required cell recovery after thawing. There are several well known protocols for obtaining cryopreservation of isolated cells using different cryoprotectants. Glycerol, dimethyl sulfoxide (DMSO) and propanediol sucrose are commonly used as cryoprotectants, though in different concentrations. Glycerol, a trihydric alcohol, is a clear, colorless fluid. Pharmacologically, it is relatively inert. DMSO is a colorless liquid with a sulphur-like smell and has several medical uses. It is highly polar and dissolves many water- and lipid-soluble substances. DMSO given intravenously may cause nausea, vomiting, local vasospasm and an objectionable garlic-like odor and taste. HUMAN SPERM, OVA AND EMBRYOS CRYOPRESERVATION: Despite the fact that cryopreservation procedures of spermatozoa, ova and embryos are already in routine clinical use, some questions related to the optimal cooling velocity during controlled-rate freezing and the choice of the most effective, either penetrating (glycerol, dimethyl sulfoxide) and/or non-penetrating (hydroxyethyl starch) cryoprotective agent at the appropriate concentration are not resolved.