Value of three-dimensional volume rendering images in the assessment of the centrality index for preoperative planning in patients with renal masses.

AIM: To evaluate the precision of the centrality index (CI) measurement on three-dimensional (3D) volume rendering technique (VRT) images in patients with renal masses, compared to its standard measurement on axial images. MATERIALS AND METHODS: Sixty-five patients with renal lesions underwent contrast-enhanced multidetector (MD) computed tomography (CT) for preoperative imaging. Two readers calculated the CI on two-dimensional axial images and on VRT images, measuring it in the plane that the tumour and centre of the kidney were lying in. Correlation and agreement of interobserver measurements and inter-method results were calculated using intraclass correlation (ICC) coefficients and the Bland-Altman method. Time saving was also calculated. RESULTS: The correlation coefficients were r=0.99 (p<0.05) and r=0.99 (p<0.05) for both the CI on axial and VRT images, with an ICC of 0.99, and 0.99, respectively. Correlation between the two methods of measuring the CI on VRT and axial CT images was r=0.99 (p<0.05). The two methods showed a mean difference of -0.03 (SD 0.13). Mean time saving per each examination with VRT was 45.5%. CONCLUSIONS: The present study showed that VRT and axial images produce almost identical values of CI, with the advantages of greater ease of execution and a time saving of almost 50% for 3D VRT images. In addition, VRT provides an integrated perspective that can better assist surgeons in clinical decision making and in operative planning, suggesting this technique as a possible standard method for CI measurement.

Male-to-female transsexualism: technique, results and 3-year follow-up in 50 patients.

AIM: To evaluate the functional and cosmetic results of male-to-female gender-transforming surgery. PATIENTS AND METHODS: Between May 2001 and April 2008 we performed 50 male-to-female gender-transforming surgeries. All patients had been cross-dressing, living as women, and receiving estrogen and progesterone for at least 12 months, which was sufficient for breast development and atrophy of the testes and prostate to occur. This hormonal therapy was suspended 1 month before the operation. RESULTS: The mean operative time was 190 min and the mean depth of the vagina was 10 cm. On follow-up, the most common complication (10%) was shrinkage of the neovagina, which could be corrected by a second surgical intervention. Of the 50 patients, 45 (90%) were satisfied with the esthetic results; 42 patients (84%) reported having regular sexual intercourse, 2 of whom had pain during intercourse. Of the 50 patients, 35 (70%) reported achieving clitoral orgasm. CONCLUSION: Male-to-female gender-transforming surgery can assure satisfactory cosmetic and functional results, with a reduced intra- and postoperative morbidity. Nevertheless the experience of the surgeon and the center remains central to obtaining optimal results.

Acinar cell carcinoma of the pancreas. A histologic, immunocytochemical and ultrastructural study.

A rare case of acinar cell carcinoma of the pancreas is presented. Because of its unusual solid growth pattern, correct diagnosis required electron microscopic analysis and the demonstration of intracellular amylase by immunohistochemical stains. The presence of pleomorphic electron-dense cytoplasmic granules containing fibrillary internal structures is confirmed in this ultrastructural study. The differential diagnosis of acinar cell carcinoma from other neoplasms involving the pancreas, including neuroendocrine tumours, poorly-differentiated adenocarcinomas and neoplasms of putative acinar cell derivation, is discussed.

Ultrastructural observations on the microvasculature in advanced gastric carcinomas.

The ultrastructural features associated with vascular permeability in 9 cases of advanced gastric carcinomas were studied, and compared with that of control non-neoplastic mucosa. Tumour microvasculature showed features in common with those of control mucosa, including complete basal lamina, well-developed interendothelial junctions, fenestrations and caveolae. Some tumour blood vessels showed endothelial cell swelling accompained by luminal narrowing and perivascular fibrosis. In 2 out of 9 cases, there were endothelial attenuation with numerous fenestrations and vesiculo-vacuolar organelles. The vesiculo-vacuolar organelle is a recently described cytoplasmic structure found in the endothelial cells lining tumour microvessels and normal venules and which provides an important pathway for extravasation of circulating macromolecules. Our ultrastructural data suggest that advanced gastric carcinomas share with experimental tumour models in vivo only some morphologic features associated with hyperpermeability including fenestration, endothelial attenuation and vesiculo-vacuolar organelles. The implications of perivascular fibrosis on the delivery of immune cells to gastric carcinomas are discussed.

[Familial aspects of prostatic carcinoma. Personal experience and review of the literature]. / Studio sulla familiarità del carcinoma della prostata. Esperienza personale e revisione della letteratura.

The familial trend of prostate carcinoma has been highlighted by a number of important studies in which the authors underlined the increased risk that brothers and sons of patients with this disease might be affected by prostate carcinoma. These studies also underline the importance of two significant risk factors in determining the presence of disease: early onset and number of relatives already affected. In this anamnestic-type survey of two sample groups, one with prostate carcinoma and the other a control group, the authors attempt to make a general confirmation of the assertions made by other authors. Even if based on a relatively small series of patients, the results of this study are fully comparable to those reported by other authors.

[Unusual case of calcified renal fibroma]. / Un raro caso di fibroma renale calcifico.

The renal fibroma is an extremely rare event that takes its origin from parenchima, from the peri-renal tissues or from the renal capsule. A case of renal fibroma of a rarely met medullary origin is described.

[Validity of PSA density of the transition zone in the diagnosis of prostate cancer]. / Validità del PSA density della zona di transizione nella diagnosi di cancro della prostata.

One hundred four patients (mean age 70.6 years) with prostatic specific antigen (PSA) values between 4 and 10 ng/ml (average 7.9 ng/ml), and with no suspects for neoplasia by digital rectal examination (DRE) and transrectal ultrasound (TRUS) were studied. In all patients PSA density for the entire prostate (PSAD) and PSA density for the transition zone (PSAT) were calculated. TRUS was performed using a 5 MHz probe. Prostate and transition zone volumes were obtained by ellipsoid formula. Aim of the study was to evaluate the PSAT predictivity for prostate cancer compared to the PSAD. Sixteen out of 104 patients (15.4%) had histologically confirmed prostate cancer, and 88 (84.6%) had benign prostatic hyperplasia. When cut-off for PSAD was 0.15 ng/ml/cc, specificity and sensitivity were respectively 75% and 68% with positive and negative predictive values of 54% and 17%; when cut-off for PSAT was 0.34% ng/ml/cc, sensitivity and specificity were respectively 100% and 68% with positive and negative predictive values of 60% and 18%. Our results, according to the literature data, suggest that PSAT seems to have a higher predictivity for prostate cancer than PSAD, providing an optimization for the employ of prostatic biopsy, especially for those patients with PSA values between 4 and 10 ng/ml.

[Therapeutic considerations on a case of mixed teratoma of the testis with seminomatous component]. / Considerazioni terapeutiche su un caso di teratoma misto del testicolo con componente seminomatosa.

The Authors present a case of mixed teratoma of the testis with seminomatous cells, occurred in a teenager. Performed the preoperative oncological staging, the patient was submitted to trans-inguinal left orchifunicolectomy. The presence of cells originated by the three embryonal layers, of stroma distributed in a periepithelial fashion and big cells with clear cytoplasm, permitted to formulate the hystological diagnosis of mixed teratoma, mature and immature, associated with seminomatous cells. The observation of this case offer the opportunity for prognostic and therapeutic considerations.

[Endoscopic therapy of ureterocele: description of a case]. / Terapia endoscopica dell'ureterocele: descrizione di un caso.

Ureterocele is a cystic dilatation of the terminal intravesical ureter; the therapeutic options are different and correlated on upper and lower urinary tract anatomy. The goals of treatment include control of infection, protection of ipsilateral and controlateral renal units and maintenance of vesicoureteral continence. The endoscopic approach is still debated; many authors report a higher risk of post-operative vesticoureteral reflux and further surgery. When the intravescical ureterocele is associated with the upper pole of a duplex system a small endoscopic transverse incision as definitive treatment has gained support in more than 90% of cases. We report a case of intravesical ureterocele with a complete duplex system, in a young woman treated by endoscopic incision as "smiling mouth" with good results of 6 months follow-up.

Hand-assisted laparoscopic living-donor nephrectomy versus open surgery: evaluation of surgical trauma and late graft function in 82 patients.

OBJECTIVE: We evaluated and quantified surgical trauma and late graft function in cases of hand-assisted laparoscopic living-donor nephrectomy (HALLDN) versus open living-donor nephrectom (OLDN). METHODS: This study is a retrospective nonrandomized single-center analysis. Between 1995 and January 2008, 82 patients with end-stage renal disease received kidney transplantations from living donors. Open living-donor nephrectomy was performed in 37 donors, and 45 underwent laparoscopic hand-assisted nephrectomy. Demographic data and perioperative and postoperative data, such as markers of acute phase (C-reactive protein; serum amyloid A) and biochemical markers of glomerular filtration (serum creatinine, serum cystatin C), were compared at serial time points. RESULTS: The mean operative times for HALLDN and OLDN were 165 min and 195 min, respectively. The average warm ischemia time was 45 seconds for laparoscopy and 87 seconds for open surgery. The evaluation of acute phase markers demonstrated a minimally invasiven nature of laparoscopy, with same late graft function compared with open surgery. CONCLUSION: When the surgery was performed by experienced surgeons, hand-assisted living- donor nephrectomy showed shorter operative and warm ischemia times than open surgery, offering at least the same functional results and decreasing surgical complications compared with a completely laparoscopic technique.

Pre-surgical finasteride therapy in patients treated endoscopically for benign prostatic hyperplasia.

INTRODUCTION: Transurethral resection of the prostate is considered the standard technique for patients with moderate or severe lower urinary tract symptoms related to benign prostatic hyperplasia (BPH). Pathologically BPH is characterized by an increased proliferation of stromal and acinar cells, sustained by increased vascularization (neoangiogenesis). Recent studies have also shown that finasteride reduces angiogenesis and prostatic bleeding associated with BPH. Reducing the volume as a final step in reducing neoangiogenesis could thus represent a fundamental advance in limiting intra- and postoperative bleeding in patients undergoing transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Our study included 60 patients undergoing TURP between January 2001 and January 2002. Of the patients, 30 received pretreatment with finasteride while 30 did not undergo any pretreatment (control group). In all the patients we evaluated the degree of peri-surgical bleeding, intended as a reduction in hemoglobin values in the 24 h following surgery. RESULTS AND CONCLUSIONS: In the group of patients pretreated with finasteride, blood loss, evaluated as a reduction in hemoglobin values, was minimal, and none of the patients required blood transfusion. The average hemoglobin loss in the 24 h following surgery was 0.9%. In the control group (average age 67 years), 4 patients (12%) required blood transfusion. The loss of hemoglobin was 2.36%. Finasteride, therefore, seems to play a fundamental role in the pretreatment of TURP patients, since by reducing dihydrotestosterone synthesis, it interacts with endothelial growth factors, thus reducing angiogenesis and preventing bleeding.

Focal parietal cell differentiation in a well-differentiated (intestinal-type) early gastric cancer.

A well-differentiated (intestinal-type) early gastric cancer characterized by multifocal areas containing adenocarcinoma cells with eosinophilic cytoplasm is presented. The electron microscopy revealed that cytoplasmic eosinophilia was mainly due to the presence of numerous mitochondria. In addition, individual cells showed features of preparietal cell differentiation such as numerous mitochondria, tubulovesicles, intracellular canaliculi and rare mucin granules. There were also adenocarcinoma cells with a pyloric gland (mucopeptic) differentiation as revealed by the presence of granules with a dense protein core eccentrically located in the mucus matrix. These ultrastructural data suggested a gastric epithelial cell differentiation. The implications with regard to the classification and histogenesis of this tumor are discussed.

Unexpected cytological diagnosis of two cases of echinococcosis.

The Authors report two cases of hydatid cysts localized in the soft tissues of the thigh and in para-renal region respectively. In both cases the cystic nature of the lesion was revealed by echography while the common serologic and hematologic preoperative tests did not show pathologic values. The working diagnosis was traumatic or developmental lesion and the patients were undergone to fine needle aspiration (FNA) cytology which permitted to make the unexpected diagnosis of hydatid cysts. The enzyme linked immunosorbent assay for echinococcus, done at the time in monitoring the disease, was positive only in one case. Although the routine use of FNA cytology for the diagnosis of echinococcosis should be discouraged, this procedure may represent a real aid in the definitive diagnose of clinically unsuspected hydatid cysts.

Pneumaturia in a patient with ectopic vas deferens opening in the bladder and agenesis of the ipsilateral seminal vesicle. Case report.

Ectopia of the vas deferens (EVD) combined with agenesis of the seminal vesicle, is a rare congenital abnormality. We describe a case of EVD with agenesis of the ipsilateral seminal vesicle, presenting with pneumaturia and frequent urinary tract infection.