[Prostate cancer: Quality assessment of clinical management in the Midi-Pyrenean region in 2011]. / Cancer de la prostate : qualité de la prise en charge en Midi-Pyrénées en 2011.

OBJECTIVES: Assessing the quality of the clinical management of prostate cancer in the Midi-Pyrenean region in 2011. METHODS: The study population was randomly selected among new cases of prostate cancer presented in Multidisciplinary Team Meeting (MTM) in 2011. The indicators defined with the professionals have evaluated the quality of the diagnostic care, when treatment started and at the time of the MTM. RESULTS: Six hundred and thirty-three new patients were included (median age at diagnosis=69years, min: 48; max: 93). In diagnostic period, 92% of patients had a prostate biopsy. Performing a pelvic MRI, an abdomino-pelvic CT and bone scintigraphy concerned respectively 53%, 55% and 61% of intermediate or high-risk patients. The Gleason score, surgical margins and pathological stage were included in over 98% patient records treated by radical prostatectomy. A PSA assay in 3months after prostatectomy was found in 59% of surgical patients. The MTM was performed before treatment to 83% of patients. About three-quarters of surgical patients with stage pT≥3 or pN1 or with no healthy margins were discussed in MTM after surgery. CONCLUSION: Most of the studied indicators reach a high level. However, the lower level of realization of complementary examinations may question about their real place, accessibility and traceability. LEVEL OF EVIDENCE: 4.

[Mechanisms of castration resistance: Intratumoral hypoxia stimulates the androgen receptor expression]. / Mécanismes de résistance à la castration : l'hypoxie intratumorale stimule l'expression du récepteur aux androgènes.

PURPOSE: Tumor hypoxia and its biological consequence lead to microenvironment adaptation of tumor initiation, promotion and progression. The aim of the study was to observe the influence of hypoxia on the expression of the androgen receptor (AR), using an original model of multicellular spheroids obtained from castration-resistant prostate tumor cells. MATERIAL: Two human castration-resistant prostate cancer cell lines have been used to generate multicellular tumor spheroids (MTS). The conditions and duration of incubation modulated the final size of the MTS and the intrinsic hypoxia gradient. The expression of AR was studied by immunohistochemistry (IHC) and secretion of PSA measured in the culture medium. RESULTS: The IHC expression of AR was characterized by a decreasing gradient from the periphery to the center of MTS (less intense in central hypoxic zone), corresponding to a nuclear translocation of activated AR. This result was proportionally correlated with the duration of hypoxic incubation period. Hypoxia caused significant increase in AR expression at 6h of oxygen deprivation. This activation of AR was correlated with transcriptional activity increase of target genes, including increased secretion of PSA. CONCLUSION: This demonstration of activation, increased expression and increased transcriptional activity of AR by hypoxia is the first to have been made with an original model of hypoxia, closer to reality than previous models, i.e. close to tissue hypoxia observed in primary prostate cancer. LEVEL OF EVIDENCE: 4.

[Single procedure treatment of complex nephrolithiasis: about a modern series of anatrophic nephrolithotomy]. / Traitement en un temps de la lithiase rénale complexe : à propos d'une série moderne de néphrotomies bivalves.

PURPOSE: Advances in endourology have significantly reduced indications of open surgery in the treatment of staghorn calculi. However, in our experience, open surgery is still the treatment of choice in some cases. This study presents the results of a series of selected patients and discusses the results in terms of efficacy and morbidity. MATERIALS: A cohort of 26 patients underwent anatrophic nephrolithotomy by lombotomy to treat a complex staghorn calculus. RESULTS: The mean stone size was 68,5mm, 70% were complete staghorn calculi. The operative time was 100minutes. Blood loss was 225mL, with a postoperative transfusion rate of 15.4%. The hospital stay was 8.4 days. The stone free rate following the procedure was 92%. The creatinine clearance (MDRD) at 3 months was improved from 5.9mL/min/m(2) on average over the entire series. CONCLUSION: There are clearly still indications for open surgery in staghorn stones management, with good results in this contemporary series on both stone removal and nephronic preservation. Yet, it appears that this technique is no longer taught. LEVEL OF EVIDENCE: 5.

Brain arteriovenous malformations and seizures: an Italian study.

OBJECTIVE: To evaluate seizures as first clinical manifestation of brain arteriovenous malformations (AVMs), in relation to angioarchitectural features of these vascular anomalies. METHODS: We performed a prospective observational study, collecting records of patients with AVMs consecutively admitted to the Neurological and Neurosurgery Units of Perugia University and to the Neurosurgery Unit of Terni Hospital, during a 10-year period (1 January 2002 to 1 June 2012). Two groups of patients, with or without seizures as AVM first presentation, were analysed to identify differences in demographic and angiographic features. A multivariate logistic regression model was also developed. RESULTS: We examined 101 patients with AVMs, 55 male and 46 female. Seizures were the initial clinical manifestation in 31 (30.7%) patients. We found a significant difference (p<0.05) between two groups of patients, with or without seizures as AVM first presentation concerning location, side, topography and venous drainage. A multivariate logistic regression model showed that clinical presentation with seizures was correlated with a location in the temporal and frontal lobes, and with a superficial topography. The strongest association (OR 3.48; 95% CI 1.77 to 6.85) was observed between seizures and AVM location in the temporal lobe. CONCLUSIONS: Vascular remodelling and haemodynamic changes of AVMs might create conditions for epileptogenesis. However, here we show that malformations with specific angiographic characteristics are more likely to be associated with seizures as first clinical presentation. Location is the most important feature related to epilepsy and in particular the temporal lobe might play a crucial role in the occurrence of seizure.

Sedative effects of essential oils obtained from Baccharis uncinella.

CONTEXT: Essential oils (EOs) have been reported to possess pharmacological properties, of which those related to the central nervous system have been especially attributed to mono- and sesquiterpenes. Baccharis uncinella DC. (Asteraceae) is used by the Laklaño Indians (Santa Catarina, Brazil) for sedative purposes. Interestingly, the species does not seem to be used medicinally elsewhere in Brazil. OBJECTIVE: This study was designed to compare the composition and sedative properties of B. uncinella EOs obtained closer (BU-SC) and farther (BU-PR) to the Laklaño Indian Reserve. MATERIALS AND METHODS: BU-SC and BU-PR obtained by hydrodistillation were analyzed by CG-MS. Mice treated with BU-SC and BU-PR (50 and 100 mg/kg) were evaluated regarding pentobarbital-induced sleeping time, body temperature, and locomotion. RESULTS: BU-SC presents a higher monoterpene/sesquitherpene ratio (0.31); α-pinene (6.42%), limonene (7.21%), caryophyllene (26.13%), spathulenol (13.39%) and caryophyllene oxide (13.26%) were identified as major components. BU-PR presents a low monoterpene/sesquitepene ratio (0.004); spathulenol (32.93%), caryophyllene oxide (27.78%), viridiflorol (5.29%) and α-cadinol (2.42%) were identified as the main components. Both samples significantly (p < 0.05, ANOVA) decreased locomotion and body temperature, as well as increased sleeping time. The hypnotic activity was sensitive to the differences in monoterpene composition. CONCLUSIONS: In comparison with a sample collected in Paraná State, B. uncinella EO collected closer to the Laklaño Indians possess a composition that better justifies the claimed sedative properties. The study confirms the value of traditional information to guide bioactivity assessment in medicinal plants, and gives notice to the ecological factors that can interfere with the conclusions of such assessments.

[Prospective study of the results of ureterointestinal anastomosis in 100 patients after the Hautmann ileal neobladder with double chimney]. / Étude prospective chez 100 patients des résultats de la technique d'anastomose urétéro-iléale en double cheminée dans la néovessie de Hautmann.

PURPOSE: We attempted to determine the results of the ureterointestinal anastomosis in the Hautmann orthotopic ileal neobladder. This study was conducted prospectively and focused on ureteral stricture, which occurs mainly during the 2 years after surgery. PATIENTS AND METHODS: Between January1999 and June 2009, a total of 100 consecutive patients (five women and 95 men) with bladder cancer underwent cystectomy followed by construction of a Hautmann neobladder. The median age of the patients was 62 (36-78) years. The mean follow-up was 63 (±28) months and included physical examination, serum creatinine values, urine cytology, CT scans and renal ultrasonography. RESULTS: A total of 197 renal units (RU) were included. In eleven RU, hydronephrosis was present preoperatively and improved postoperatively. In ten others RU, hydronephrosis persisted postoperatively without symptoms. The anastomotic stricture rate was 4%, concerning eight RU by seven patients. Five inflammatory strictures (2.5%) occurred early on the 5th, 6th, 8th and 13th postoperative weeks and were revealed by pyelonephritis. Three strictures were tumors in nature and were revealed by urine cytology and radiology on the 6th, 7th and the 14th month respectively. The five inflammatory strictures were treated with percutaneous nephrostomy, balloon dilatation and ureteral stenting. For three of these four patients, surgical reimplantation was necessary on the 4th, 5th and 7th months, like in the case of the three tumoral strictures. CONCLUSION: With a minimal 2 years follow-up, ureterointestinal anastomosis with double chimney had, in this study, a 4% rate of anastomotic stenosis. The surgical modification avoiding tension seemed to preserve ureteral vascularization.

Chemical meningitis: unusual presentation of a cerebellar astrocytoma: case report and review of the literature.

Chemical meningitis resulting from the spillage of the contents of a cystic tumor rarely constitutes the sole manifestation of a cranial or spinal tumor. The case of a man who initially had signs and symptoms of meningitis that on computed tomographic scan was shown to be a space-occupying cerebellar lesion is reported. Thirty-five cases of cranial and spinal tumors in which the presenting symptom was chemical meningitis are also reviewed.

Orbital schwannomas: report of nine cases and review of the literature.

The authors report 9 cases of orbital schwannoma out of a total of 148 orbital tumors operated. The computed tomography (CT) scan is considered superior to other methods used in the radiological work-up of endoorbital tumors because, in addition to being noninvasive, it gives direct visualization of the lesion and more precise localization both with respect to the muscular cone and tridimensionally. Unfortunately, preoperative diagnosis is not always possible solely on the basis of the CT scan because the enhancement of the tumor is not constant, thus making differential diagnosis with meningioma and cavernous angioma problematic. In addition, CT enables the surgeon to choose the best route for tumor removal. Operative results are good and are influenced by the use of microsurgical techniques.

The role of intraoperative ultrasound imaging in the surgical removal of intramedullary cavernous angiomas.

Five intramedullary cavernous angiomas were surgically removed after being localized by intraoperative ultrasound imaging. Two patients were men, and three were women; in three patients, the symptoms had an acute onset, whereas in the other two, it was gradual. The vascular malformation was localized in the dorsal tract in three patients and in the cervical tract in two. Intraoperative ultrasound imaging visualized the lesion, which appeared hyperechogenous in all cases, and showed its relationship with the surrounding anatomical structures. Surgical removal was always total and was confirmed by both intraoperative echography and postoperative magnetic resonance imaging. In our experience, intraoperative ultrasound imaging was useful for localizing intramedullary cavernous angiomas, especially in cases where the lesion did not appear on the posterior surface of the spinal cord. In this way, it was possible to limit posterior myelotomy and confirm radical tumor removal intraoperatively.

Surgical management of orbital cavernous angiomas: prognosis for visual function after removal.

The authors report the outcome of surgical treatment in a group of 25 patients with cavernous angioma of the orbital cavity. In the majority of cases, good esthetic results were appreciable within a few days of surgery. However, the onset or deterioration of preexisting visual deficits, in spite of the complete preservation of the optic nerve in a third of these patients, draws attention to the need for accurate surgical timing.

Cerebral hydatidosis in childhood: a retrospective survey with emphasis on long-term follow-up.

We report the long-term outcome of surgery for cerebral hydatid cyst in 12 children. In only one child, who had been operated on for cardiac hydatidosis a year earlier, was the brain cyst known to be secondary. Of the 12 children, 10 had a single cyst and 2 had multiple cysts. Five single cysts were removed intact by "hydatid birth," two cysts--one single and one multiple--were removed after puncture and aspiration of the cyst fluid, and the other five--four single and one multiple--were accidentally ruptured in the course of the operation. One patient died of infection of the residual space, 2 died of intracranial recurrence of the parasite (7 and 22 months later, respectively), and one, the child with secondary cerebral echinococcosis, died 6 years later of systemic echinococcosis. Eight patients who had a mean follow-up of 28 years are still living and enjoy very good health, both general and neurological. This long-term follow-up with such good results confirms the usually primary character of cerebral hydatid disease, at least in children. The combination of patent ductus arteriosus and ingestion of unboiled animals' milk might well explain how primary cerebral hydatid disease develops in children.

Association between neuroepithelial tumor and multiple intestinal polyposis (Turcot's syndrome): report of a case and critical analysis of the literature.

We report a case of association of a brain tumor with multiple intestinal polyposis (Turcot's syndrome) and offer a critical analysis of the relevant literature with a view to revising the classification of the syndrome in relation to familial multiple polyposis and Gardner's syndrome. For this purpose, we considered only cases of intestinal polyposis associated with a primary neuroepithelial tumor (medulloblastoma, glioma, or glioblastoma) as originally described by Turcot. Differences emerged, depending on the central nervous system tumor type, which suggests that this neoplastic association may be classified as two distinct syndromes.

Long-term results of the surgical treatment of spinal dermoid and epidermoid tumors.

The clinical findings and the results of surgical treatment in 16 patients with spinal dermoid or epidermoid tumors are reported. In 9 patients the tumor capsule adhered so tightly to the nervous tissue that part of it was left in situ. In a follow-up study ranging from 5 to 30 years with a mean of 14.2 years only 1 patient had a recurrence of the tumor and 10 patients resumed a normal working life.

Epidermoid tumors of the 4th ventricle: report of seven cases.

Epidermoid tumors occur very rarely in the 4th ventricle. We discuss the history, clinical course, and the surgical results for seven patients. One patient had a remittal of symptoms, probably due to the emergence of the tumor from the 4th ventricle into the cisterna magna. Total removal of the capsule was possible only in the youngest patient. At present, four patients (mean follow-up, 6 years) enjoy good general and neurological health.

Microsurgical treatment of glossopharyngeal neuralgia: case reports.

Three patients with excruciating glossopharyngeal neuralgia underwent microsurgical operations in the posterior cranial fossa. In each patient, neurovascular compression was found involving the posteroinferior cerebellar artery and involving the 9th and 10th cranial nerves. In two of the patients, the compression was caused by arachnoiditis and in the other by an arterial loop. In each patient, neuralgia was successfully eliminated by microvascular decompression and by section of the upper rootlets of the vagus nerve. In one patient, partial section of the 9th cranial nerve was also performed. Because of the frequent involvement of the vagus nerve in the pathogenesis of this condition, open surgery should be preferable to percutaneous thermorhizotomy, which is unable to act selectively on the 10th cranial nerve.

Supratentorial dermoid cysts.

Supratentorial dermoid cysts are rare lesions. In eight cases presented here, the lack of recurrence after subtotal removal of the capsule and the good long-term prognosis are emphasized. This finding is in agreement with the literature. The frequent relationship of these lesions with the cavernous sinus suggests a vascular genesis in the development of intracranial dermoid cysts.