Simple enucleation for the treatment of renal angiomyolipoma

OBJECTIVES: To report on the role of simple enucleation for treating renal angiomyolipoma (AML) in a series of patients treated in our department. PATIENTS AND METHODS: We retrospectively reviewed the data of all 37 patients with a histopathological diagnosis of renal AML who had either radical nephrectomy (three) or nephron-sparing surgery by simple enucleation (34) between January 1986 and December 2005. Indications for intervention included either symptomatic AML or a tumour of >4 cm, regardless to the presence of symptoms or renal masses suspicious of malignancy. The patients' status was evaluated last in October 2006. RESULTS: The mean (sd, median, range) pathological tumour size was 5.2 (3.4, 4.8, 1.5-15) cm; five patients (15%) were affected by tuberous sclerosis. Simple enucleation was successful in all patients but in three (9%) a sharp dissection a few millimetres from the tumour was used during critical steps of the procedure where it seemed difficult to define the right plane of enucleation. Warm ischaemia was used in 79% of patients, with a mean ischaemic time of 11.2 min. Two patients (6%) required renal hypothermia. A simple parenchymal compression was used in five cases (15%). The mean (range) intraoperative blood loss was 170 (70-650) mL. None of the patients had postoperative bleeding requiring re-intervention but one (3%) required two units of blood after surgery. There were no major complications, e.g. prolonged acute tubular necrosis/chronic renal insufficiency and urinary leakage/urinoma, but two patients had urosepsis not associated with perirenal fluid collection and that required targeted antibiotic therapy. At a mean (median, range) follow-up of 56 (50.5, 10-120) months none of the patients had local tumour recurrence. Two patients had a small AML elsewhere in the operated kidney, detected 18 and 36 months after surgery, with a kidney recurrence rate of 6%. CONCLUSIONS: Our data confirm the optimum results of simple enucleation for renal AMLs; this technique provides excellent long-term local control and no patient had urinary leakage/fistula afterward.     

Physical activity of men with chronic prostatitis/chronic pelvic pain syndrome not satisfied with conventional treatments--could it represent a valid option? The physical activity and male pelvic pain trial: a double-blind, randomized study

PURPOSE: Chronic prostatitis/chronic pelvic pain syndrome is a major healthcare burden. Affected patient quality of life is poor and currently no investigated treatments have significant long-term benefit. We performed a preliminary investigation of the role of physical activity and its effects on select patients with chronic prostatitis/chronic pelvic pain syndrome. MATERIALS AND METHODS: Between 2002 and 2004 we recruited a volunteer sample of 231 eligible males 20 to 50 years old with chronic prostatitis/chronic pelvic pain syndrome who were unresponsive to conventional treatments and free of any contraindication for moderate intensity physical exercise. This group was screened and, if in accordance with study inclusion/exclusion criteria, patients were randomized into 2 groups. Participants were randomly assigned to the aerobic exercise group (52) and the placebo/stretching and motion exercises group (51). Main outcome measures were the Italian version of the National Institutes of Health Chronic Prostatitis Symptom Index, Beck Depression Inventory, State Anxiety Inventory-Y and a pain intensity visual analog scale administered at baseline, and 6 and 18 weeks. RESULTS: At 18 weeks 36 subjects (75%) in the aerobic exercise group vs 40 (81.63%) in the placebo/stretching and motion exercises group completed the 18-week program and evaluation. Differences between the 2 groups were found in total National Institutes of Health Chronic Prostatitis Symptom Index, pain and quality life impact subscales, and pain visual analog score (ANCOVA p = 0.006, 0.0009, 0.02 and 0.003, respectively). CONCLUSIONS: Improvements in the aerobic exercise group were significantly superior compared to those in the placebo/stretching and motion exercises group. Aerobic exercise represents a valid treatment option and it should be further investigated in a larger study with longer followup.     

The use of pre-contoured plates in the treatment of C2-C3 fractures of the distal humerus: clinical experience

Open reduction and internal fixation is the treatment of choice in distal humerus fractures. The aims of the treatment are to obtain anatomic reconstruction and restoration of the elbow’s geometry followed by stable internal fixation that allows immediate rehabilitation. The plates are pre-contoured to fit the natural anatomy of the elbow and in the case of complex fractures they provide a guide for the anatomic restoration of the distal humerus. The two plates are placed parallel with the screws locked together by interdigitation creating a fixed angle in the distal fragments that provides stability to the entire distal humerus. Using this method we obtained good results according to the Mayo Elbow Performance Score (MEPS) and we are able to reduce the incidence of complications. Our experience shows also that it can be useful to obtain an anatomical reduction of distal humeral fractures using the pre-contoured plates in a parallel position recovering the anatomical antiversion of the articular surface.     

Comparative efficacy of topical versus systemic teicoplanin in experimental model of wound infections

INTRODUCTION: Surgical site infections are the second most common cause of nosocomial infections and, typically, gram-positive pathogens are involved. MATERIALS AND METHODS: A mouse model was used to investigate the efficacy of different methods for the treatment of wound infections. A full thickness wound was established on the back subcutaneous tissue of adult male BALB/c mice. A small gauze was placed over each wound and then inoculated with 5 x 10(7) colony-forming units of Staphylococcus aureus. The study included a control group that did not receive any treatment and four contaminated groups treated, respectively, with: (1) drug-free Allevyn (Smith and Nephew Healthcare, Yorkshire, United Kingdom), (2) teicoplanin-soaked Allevyn, (3) drug-free Allevyn and daily intraperitoneal teicoplanin (7 mg/kg) and, finally, (4) teicoplanin-soaked Allevyn and daily intraperitoneal teicoplanin (7 mg/kg). Main outcome measures were quantitative bacterial culture, assessment of vascular endothelial growth factor (VEGF) plasma levels, histological examination with assessment of microvessel density, and of VEGF expression in tissue sections. RESULTS: Data analysis showed that strong inhibition of bacterial growth was achieved in any group treated with intraperitoneal teicoplanin. However, the highest inhibition of bacterial growth was obtained in the group that received teicoplanin-soaked Allevyn and intraperitoneal teicoplanin. Histological examination showed that each treatment modality was able to reduce the delay in wound repair. The most effective treatment appeared to be the local application of teicoplanin-soaked hydro gel foam. The tissue effects were associated with an increase in neovascularization and VEGF expression by endothelial cells and fibroblasts in the granulation tissue. Bacterial colonies also were reduced, especially when teicoplanin was given parenterally. CONCLUSIONS: Soaking a hydro cellular foam with an antistaphylococcal agents, such as teicoplanin, may be useful for the management of infected wounds.     

Re: prognostic relevance of capsular involvement and collecting system invasion in stage I and II renal cell carcinoma

Klatte and coworkers examined the prognostic relevance of capsular involvement with no invasion of the perinephric fat and collecting system invasion in a series of 519 patients with intracapsular renal cell carcinoma (RCC) treated with partial or radical nephrectomy and followed for a median of 49 mo (range: 1-199 mo).Capsular involvement and collecting system invasion were reported in 21.6% and 7.5% of patients, respectively. Capsular involvement was significantly associated with a higher nuclear grade and larger tumors, whereas collecting system invasion was significantly associated only with microvascular invasion. In addition, capsular involvement and collecting system invasion were not associated with each other, but had a significant impact on recurrence-free survival (p = 0.007 and p < 0.001, respectively). Interestingly, patients with capsular involvement had the same recurrence-free survival as patients diagnosed as having pT3a N0 M0 RCC. In multivariate analysis, both capsular involvement and collecting system invasion were independent predictors of recurrence-free survival with a reported risk ratio of 1.84 and 3.78, respectively.