Is there still a place for retroperitoneal lymph node dissection in clinical stage 1 nonseminomatous testicular germ-cell tumours? A retrospective clinical study.

BACKGROUND: Primary retroperitoneal lymph node dissection (RPLND) ultimately lost its role as the standard management of clinical stage (CS) 1 nonseminomatous (NS) testicular germ cell tumours (GCTs) in Europe when the European Germ Cell Cancer Consensus Group released their recommendations in 2008. Current guide-lines recommend surgery only for selected patients but reasons for selection remain rather ill-defined. We evaluated the practice patterns of the management of CS1 patients and looked specifically to the role of RPLND among other standard treatment options. METHODS: We retrospectively evaluated the treatment modalities of 75 consecutive patients treated for CS1 NS at one centre during 2008-2017. The patients undergoing RPLND were selected for a closer review. Particular reasons for surgery, clinical features of patients, and therapeutic outcome were analyzed using descriptive statistical methods. RESULTS: Twelve patients (16%) underwent nerve-sparing RPLND, nine surveillance, 54 had various regimens of adjuvant chemotherapy. Particular reasons for surgery involved illnesses precluding chemotherapy (n = 2), patients´ choice (n = 4), and teratomatous histology of the primary associated with equivocal radiologic findings (n = 6). Five patients had lymph node metastases, two received additional chemotherapy. Antegrade ejaculation was preserved in all cases. One patient had a grade 2 complication that was managed conservatively. All RPLND-patients remained disease-free. CONCLUSIONS: Primary RPLND is a useful option in distinct CS1 patients, notably those with concurrent health problems precluding chemotherapy, and those with high proportions of teratoma in the primary associated with equivocal radiological findings. Informed patient's preference represents another acceptable reason for the procedure. RPLND properly suits the needs of well-selected patients with CS1 nonseminoma and deserves consideration upon clinical decision-making.

[Intravesical explosion with rupture of the bladder wall during transurethral resection]. / Blasenperforation durch intravesikale Knallgasexplosion.

A 74-year-old patient underwent transurethral electroresection for a bladder tumor located at the anterior wall close to the air bubble. Intraoperatively, an explosion occurred. Computed tomography documented laceration of the anterior bladder wall with numerous small gas bubbles dispersed in the perivesical area. The etiology of intravesical explosions is based on formation of hydrogen during electroresection. Hydrogen by itself is not explosive; a blast will occur only when atmospheric oxygen is admixed and then ignited by sparks from electroresection. To prevent such a complication, care must be taken not to activate the resection loop within the air bubble of the bladder.

[Does summer smog damage the nasal mucosa and contribute to bacterial rhinitis?]. / Schädigt Sommersmog die Nasenschleimhaut und trägt zur Entstehung von bakterieller Rhinitis bei?

Smog in hot summers contains noxious agents resulting from the combustion of fossil fuels whose levels are highest in industrial areas. Reactions of the oxygen radical of ozone with sulfur dioxides, nitrous oxides, hydrocarbons and the water molecules of the nasal mucous membrane presumably support the formation of acids such as H2SO4 or HNO3 (from H2SO3 or HNO2 [3, 4]). Acid corrosion seems to damage the mucous membrane, leading to local erosions, bleeding, and necrotic changes. The collapsed local defense system and necrotic mucosa are an ideal culture medium for a wide spectrum of pathogenic bacteria. Main signs of tissue pathology are bleeding spots or pustules, nasal congestion, degenerative mucositis, pruritus, as well as epipharyngeal and pharyngeal irritation. Therapy is possible with topical or oral antibiotics. Prophylaxis includes avoiding touching the mucous membranes and reducing outdoor activity on hot summer days. Further clinical and scientific examination would be helpful in determining additional explanations.