Trends in surgical and ablative treatment of localised renal cell carcinoma: A review of publication trends over 16 years (2000-2015).

Objective: To investigate the bibliometric (publication) trends in surgical and ablative treatment of localised renal cell carcinoma (RCC) over a period of 16-years, from 2000 to 2015, as publication trends reflect clinical practice and new innovations. Material and methods: We performed a systematic review using PubMed over a 16-year period from 2000 to 2015 for all published papers on surgical and ablative management of renal tumours. Data were further analysed in two time periods, period-1 (2000-2007) and period-2 (2008-2015). Results: During the last 16 years a total of 2415 papers were published on surgical (n = 1662, 69%) and ablative (n = 753, 31%) management of RCC. This included partial nephrectomy (PN; n = 1662, 69%), cryoablation (CA; n = 405, 17%), and radiofrequency ablation (RFA; n = 348, 14%). When comparing the two time periods for PN, during period-2, the change was +189% (P < 0.001), +69% (P = 0.004) and +4600% (P < 0.001) for open PN, laparoscopic PN and robotic PN, respectively. Regarding ablative techniques, a change of +109% (P = 0.002) and +78% (P = 0.036) was seen for CA and RFA, respectively. There was also a significant rise in percutaneous CA when compared to laparoscopic CA (P < 0.002). Conclusions: There has been a rise in all forms of PN and ablative techniques over the last 16 years. This rise has been particularly steep for robotic PN potentially reflecting a change in surgical practice. Abbreviations: CA: cryoablation; CC: correlation coefficient; MIS: minimally invasive surgery/surgical; NSS: nephron-sparing surgery; (L)(O)(R)PN: (laparoscopic) (open) (robotic) partial nephrectomy; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RFA: radiofrequency ablation; RN: radical nephrectomy; SRM: small renal mass.

A randomized controlled trial of nephrostomy placement versus tubeless percutaneous nephrolithotomy.

PURPOSE: We established whether totally tubeless percutaneous nephrolithotomy with no nephrostomy or ureteral stent is a safe management technique. MATERIALS AND METHODS: Patients were randomized to have a nephrostomy placed (group 1 control) or none (group 2 treatment). A total of 25 patients were randomized to each group. Cases were considered uncomplicated and suitable for randomization if there was no significant bleeding or residual stone load, the pelvicaliceal system was intact and there was no evidence of a residual ureteral stone. The primary outcome measure was length of stay, and secondary outcomes were analgesic requirements and postoperative complications such as bleeding, infection or ureteral obstruction. Hospital readmission rates and stone clearance rates were also recorded. RESULTS: Mean stone size was 21.6 vs 17.5 mm. There were no transfusions in either group. Hemoglobin change was 2.03 vs 1.18 gm/dl and mean creatinine increase was 0.029 vs -0.111 mg/dl. There were no differences in hemorrhage, infection and serum parameters. There were no readmissions in either group. Mean length of stay was 3.4 vs 2.3 days (p <0.05). CONCLUSIONS: This trial demonstrates that percutaneous nephrolithotomy without nephrostomy or stent is a safe and well tolerated procedure in selected patients. Length of stay was reduced with no major complications in either group. We believe that totally tubeless percutaneous nephrolithotomy may be considered an accepted standard of care for selected cases and it is possible to reserve placement of a nephrostomy tube or internal ureteral stent for specific indications.

Totally tubeless percutaneous nephrolithotomy.

PURPOSE: To establish if totally tubeless percutaneous nephrolithotomy (PCNL) is a safe management technique. PCNL is a well-established option for upper tract stones. The procedure traditionally concludes with the placement of a nephrostomy drainage tube but in those patients in whom there has been minimal blood loss and complete stone clearance, it may not be necessary to place a nephrostomy. PATIENTS AND METHODS: Totally tubeless PCNL was performed in uncomplicated cases, when there was no significant bleeding or residual stone load, an intact pelvicaliceal system, and no evidence of a residual ureteral stone. RESULTS: 100 procedures were analyzed during a 10-year period from 1996 to 2006. The mean stone size was 15.9 mm (range 7-40 mm). Mean residual stone load was 1.74 mm (range 1-10 mm). Access was considered difficult in 2%. Transfusion rate was 1% with a mean fall in hemoglobin of 1.4 g/dL ([-0.4] - [+5.6] g/dL), and a mean rise in creatinine level of 0.3 micromol/L ([-43] - [+52] micromol/L). The minor sepsis rate was 5%, and the major sepsis rate was 1%. The readmission rate was 1%. The mean length of stay was 2.9 days (range 1-10 d). Secondary treatment was required in 5%, and stone clearance rate at 3 months was 90%. CONCLUSION: This study demonstrates that PCNL without nephrostomy or stent is a safe and well-tolerated procedure in selected patients. It is the authors' belief that totally tubeless PCNL may be considered an accepted standard of care for selected patients, and it is possible to reserve placement of a nephrostomy tube or internal ureteral stent for specific indications.

Bioaccumulation of persistent organic pollutants in female common dolphins (Delphinus delphis) and harbour porpoises (Phocoena phocoena) from western European seas: geographical trends, causal factors and effects on reproduction and mortality.

Concentrations of polychlorinated biphenyls (PCBs) in blubber of female common dolphins and harbour porpoises from the Atlantic coast of Europe were frequently above the threshold at which effects on reproduction could be expected, in 40% and 47% of cases respectively. This rose to 74% for porpoises from the southern North Sea. PCB concentrations were also high in southern North Sea fish. The average pregnancy rate recorded in porpoises (42%) in the study area was lower than in the western Atlantic but that in common dolphins (25%) was similar to that of the western Atlantic population. Porpoises that died from disease or parasitic infection had higher concentrations of persistent organic pollutants (POPs) than animals dying from other causes. Few of the common dolphins sampled had died from disease or parasitic infection. POP profiles in common dolphin blubber were related to individual feeding history while those in porpoises were more strongly related to condition.

Organochlorine residues in harbour porpoise and bottlenose dolphins stranded on the coast of Scotland, 1988-1991.

The organochlorine (OC) residues, chlorobiphenyls (CBs), DDT and its metabolites, dieldrin, hexachlorobenzene and technical chlordane mixtures have been determined in the blubber of harbour porpoise and bottlenose dolphins from around the north and east coasts of Scotland as a result of strandings and bycatches between 1988 and 1991. The concentrations of OCs range from some of the lowest values reported at 280 micrograms kg-1 for t-CBs, 145 micrograms kg-1 for t-DDT and 71 micrograms kg-1 for dieldrin to some of the highest values, 23,000 micrograms kg-1 for t-CBs, and 10,200 micrograms kg-1 for t-DDT. OC levels were correlated with the age and sex of the sample of harbour porpoise and bottlenose dolphins from the Moray Firth area. The study confirms that the concentration of these compounds is highly dependent on co-factors of age and sex, and that data from single or small numbers of animals may be of limited value in comparing information on organochlorine residues in mammals within or between regions.

Evidence of infectious diseases in harbour porpoises (Phocoena phocoena) hunted in the waters of Greenland and by-caught in the German North Sea and Baltic Sea.

The pathological, microbiological and serological findings in harbour porpoises hunted in Greenlandic waters were compared with the findings in animals accidentally caught in fishing gear in the German North Sea and Baltic Sea. The body condition of the Greenlandic animals was good, whereas nine of 23 German harbour porpoises were moderately to markedly emaciated. Both groups were infested with parasites. In the Greenlandic animals parasitism of the aural peribullar cavity with Stenurus minor, of the liver and pancreas with Orthosplanchnus mironovi, of the lungs with Halocercus species and of the subcutaneous and mammary tissue with Crassicauda species was generally associated with a mild inflammatory response. No diseases associated with bacteria were identified in any of the Greenlandic harbour porpoises. In the porpoises from the German North Sea and Baltic Sea, parasites were present in the aural peribullar cavity (S minor), liver (Campula oblonga), first and second gastric compartment (Anisakis simplex) and in the lungs (Pseudalius inflexus and Torynurus convolutus). Moderate to marked pulmonary parasitism and suppurative pneumonia, not observed in the Greenlandic porpoises, were present in 11 and 10, respectively, of the 23 German porpoises. The suppurative pneumonia was attributed to bacterial infection with beta-haemolytic streptococci and Escherichia coil var haemolytica. Four Greenlandic and 10 German porpoises had positive porpoise morbillivirus-specific antibody titres suggesting that the virus was circulating in both populations.

Intercomparison studies on distribution and coassociations of heavy metals in liver, kidney, and muscle of harbor porpoise, Phocoena phocoena, from southern Baltic Sea and coastal waters of Denmark and Greenland.

The concentrations of selected metals such as Cd, Pb, Cu, Zn, Cr, Ni, Mn, and Fe were determined in liver, kidney, and muscle of harbor porpoise (Phocoena phocoena) from three geographical regions, i.e., the Baltic Sea and Danish and Greenland coastal waters. The concentrations of Cd in liver and kidney increased with age of the specimens analyzed. Significant interspatial variations in both hepatic and renal levels of Cd were also observed. Average hepatic levels of Cd in Baltic, Danish, and Greenland specimens were (age range) 0.05-0.09, 0.12-0.25, and 20.6-51.6 microg g(-1) dry weight, respectively. Such values for renal Cd were as follows: 0.55-0.71, 0.14-1.84, and 0.55-94.3 microg g(-1) dry weight. In contrast to Cd, concentrations of Cu in the liver and kidney of specimens from Baltic, Danish, and Greenland areas did not indicate such great interspatial variability. The average hepatic values amounted to (age range) 14.1-15.5, 22.1-63.6, and 16.3-25.9 microg g(-1) dry weight, and kidney contained on the average 7.83-8.80, 11.7-16.2, and 11.1-15.7 microg Cu g(-1) dry weight, respectively. The higher levels of hepatic and renal Cd in Greenland specimens than in Baltic ones could be explained by different food composition in the area studied. Baltic porpoises mainly feed on fish (cod, plaice) containing extremely low levels of muscle Cd, but an important diet component of Greenlandic individuals is squid, characterized by elevated levels of Cd.

Beware the BCG failures: a review of one institution's results.

OBJECTIVE: To review the outcome of all superficial transitional cell (TCC) bladder cancer treated with intravesical Bacille Calmette-Guerin (BCG) at one institution and, in particular, the prognosis for those patients who gained little benefit from BCG therapy. PATIENTS AND METHODS: The notes of 122 patients treated with BCG over a nine-year period were reviewed. The following details were recorded: time of diagnosis; time of decision to treat with BCG; results of cystoscopies before and after BCG; duration of follow up; time of progression if occurred, mortality and cause of death. RESULTS: Complete follow up data was available for 112 patients. At a median follow up of 23 months (range 3-107) 57 patients (51%) remained free of tumour, 30 (27%) had progressed and 18 (16%) had died of transitional cell carcinoma. There was a significant association between a positive initial check cystoscopy and subsequent progression (p<0.001) and disease specific mortality (p<0.001). Of the 35 patients who had a positive cystoscopy after BCG treatment 21 (60%) progressed and 14 (40%) died of transitional cell carcinoma compared with 9 (12%) and 4 (5%) of the 77 with a negative cystoscopy. Adjusted odds ratios for progression and death from TCC for patients with a positive initial check cystoscopy were 21 and 13, respectively. CONCLUSION: In our series the patients found to have tumour at the initial check cystoscopy following intravesical BCG had a poor prognosis. This should be remembered when considering treatment options and counselling patients. Follow up of all BCG patients need to be rigorous and protocols would help to unify the treatment patients receive.

Gas exchange and heart rate in the harbour porpoise, Phocoena phocoena.

The respiratory physiology, heart rates and metabolic rates of two captive juvenile male harbour porpoises (both 28 kg) were measured using a rapid-response respiratory gas analysis system in the laboratory. Breath-hold durations in the laboratory (12 +/- 0.3 s, mean +/- SEM) were shorter than field observations, although a few breath-holds of over 40 s were recorded. The mean percentage time spent submerged was 89 +/- 0.4%. Relative to similarly-sized terrestrial mammals, the respiratory frequency was low (4.9 +/- 0.19 breaths.min-1) but with high tidal volumes (1.1 +/- 0.011), enabling a comparatively high minute rate of gas exchange. Oxygen consumption under these experimental conditions (247 +/- 13.8 ml O2.min-1) was 1.9-fold higher than predicted by standard scaling relations. These data together with an estimate of the total oxygen stores predicted an aerobic dive limit of 5.4 min. The peak end-tidal O2 values were related to the length of the previous breath-hold, demonstrating the increased oxygen uptake from the lung for the longer dives. Blood oxygen capacity was 23.5 +/- 1.0 ml.100 ml-1, and the oxygen affinity was high, enabling rapid oxygen loading during ventilation.