[Conservative surgical treatment of renal carcinoma. Personal experience with 29 surgical excisions of tumors]. / Terapia chirurgica conservativa del carcinoma renale. Esperienza personale su 29 tumorectomie.

From 1980 to 1988, elective conservative surgery (tumorectomy by enucleo-resection) was performed for renal cell carcinoma at stage I in 29 patients. An accurate preoperative renal investigation was carried out to identify the exact extension of the tumor and to study all the parenchimal situation, through IVP, ultrasound, CT scanning and, particularly, conventional selective angiography. The operative technique employed was: lymphadenectomy, peri-pararenal fat extirpation, in situ tumor enucleation by circular incision of the renal capsule and blunt dissection of the renal parenchyma with 2 cm safety margin to the tumor; multiple biopsies in the "bed" of resection for histopathologic peroperative evaluation; careful examination of the pseudocapsule and surrounding renal tissue; hemostasis. Follow-up was 10-113 months (mean 40,34 months). 2 of 29 patients died for progression of disease (at 52nd and 16yh month from surgery, 2/29 died for non-neoplastic reasons; 25/29 pts are living without local recurrences or distant metastases. In the same period (1980-1988), radical nephrectomy was performed for renal tumors at stage I in 34 patients. In an average observation period of 49,67 months, 2/34 patients died for progression of disease; 3/34 pts died for non-neoplastic reasons. 1/34 patient is living with pulmonar metastases and 28/34 are living without evidence of cancer. From this study we have got the conclusion that elective renal-sparing excision of the tumor (with macro-micro examination of the abscission surfaces) should be considered as a curative treatment in the case of low stage single tumors smaller than 7 cm, peripherally located in renal cortex, with unbroken pseudocapsule.

Actinomycosis of bladder and intrauterine devices.

PIP: Vesical actinomycosis, though rare, is being discovered more among women who use IUDs. The case study is presented of a 32 year old woman with actinomycosis of the bladder. An analysis of the disease reveals that human actinomycosis is caused primarily by actinomyces israeli. It grows anaerobically and a number of strains are micro-aerophilic. Infection can begin principally in 3 ways: 1) when endogenous actinomyces penetrate damaged tissues following trauma, 2) other infections of foreign bodies, or 3) surgical manipulation. Pelvic actinomycosis is now being seen in women with IUDs. Urinary tract infection seldom occurs, and kidneys are affected more than ureters or the bladder. In appearance, vesical actinomycosis resembles a retropubic mass. It is possible that female organs, when confronted by a foreign body, may make it possible for the development of a undetectable actinomycotic pelvic infection. Treatment for actinomycosis is extensive antibiotic therapy with penicillin, tetracycline, clindamycin, or erythromycin. Surgery may be necessary when the disease produces a large mass and there's a need to drain abscesses, or to extirpate sinus tracts.^ieng

Inverted papilloma of the ureter: two cases of conservative therapy.

We report 2 cases of inverted urothelial papilloma of the ureter. The second case demonstrates inverted papilloma and papillary transitional cell carcinoma in a single polypoid lesion. Conservative therapy was performed and a follow-up 12 months later shows no evidence of recurrences.

Unilateral hydroureteronephrosis secondary to iliac aneurysm.

Iliac artery aneurysms may cause ureteral obstruction. We report 1 case of isolated external artery aneurysm in childhood. The patient was treated by ureterolysis with resection and grafting of the aneurysm.

Spontaneous disappearance and successive reappearance of renal cyst.

We report on a patient with a renal cyst which disappeared, reappeared ten years later, and then two years later the cyst was reduced in volume.

Os penis.

The presence of os penis in man is very rare. To date only 11 cases have been published. A close study of these cases shows their extreme heterogeneity. We think that the os penis should be considered as a heterotopic bone structure similar to that found in the animal world. To confirm this we present our personal case study.

Intravenous indoprofen in the management of renal colic.

Recent reports imply that the prostaglandin system is involved in the pathogenesis of pain due to renal colic, and prostaglandin-synthetase inhibitors have been proposed in the management of this condition. A dose-response study has therefore been performed in patients with renal colic, using two intravenous non-steroidal antiinflammatory drugs, indoprofen and lysine acetylsalicylate (ASA). Seventy-five inpatients (15 per group) were treated with three dose levels of indoprofen (100, 200 and 400 mg) or two dose levels of ASA (500 and 1500 mg) according to a double-blind, randomized, parallel-group design. The patients scored their pain at 15, 30, 60, 120 and 180 minutes after treatment; they also assessed the overall efficacy of treatment by means of a visual analogue scale. The results showed that, in terms of mean pain score, there was a prompt analgesic response in each treatment group, higher effects being obtained with increasing dose levels of both drugs. However, the statistical prerequisites for calculating a potency ratio between the drugs under study were satisfied only for a few variables, in which cases the relative potency of indoprofen to ASA varied between 7.1 and 8.8. The analysis of the frequencies of response, on the other hand, revealed for indoprofen a significant dose-effect regression, the higher dose of this drug giving a complete or nearly complete relief of pain in the majority of patients.