Problems faced by relatives caring for cancer patients at home.

The care of patients suffering from advanced cancer is not limited in the hospital setting. It continues at home where the burden of care is borne by specific individuals. The aim of the present study was to survey and record the various problems faced by those who care for cancer patients at home. The study was conducted in our hospital during the summer of 2007. All participants completed, during a personal interview, a questionnaire which covered pathologic, social, psychological, spiritual/religious and financial problems. Seventy-six carers returned fully completed questionnaires. The most frequent problems reported were: anxiety regarding the patient's future (61.8%), troublesome symptoms such as pain (54%), increased economic burden-financial difficulty (51.3%), problems with patient's feeding (50%), unhappiness or depression (48,7%), emotional upset (47.4%), worsening of the patient's behaviour and personality (38.2%), difficulty of establishing a positive attitude regarding their current status (34.2%), transport to hospital (32.9%), assistance from the wider family circle (25%). Taking care of cancer patients at home creates several problems among carers. Many of them remain undetected. The acknowledgement and recognition of these problems by health-care professionals might contribute to finding solutions in order to assist the difficult task of these individuals.

Reducing the number of sutures for vesicourethral anastomosis in radical retropubic prostatectomy.

OBJECTIVES: To prospectively evaluate the outcome of using a two-suture technique for the vesicourethral anastomosis (VUA) during radical retropubic prostatectomy (RRP). MATERIALS AND METHODS: Two groups of 50 patients each underwent nerve-sparing RRP for localized prostate cancer by one surgeon. In one group, the vesicourethral anastomosis was performed using 2 Vicryl 2-0 stitches placed at the 3- and 9-o'clock positions and in the other group 6 Vicryl 2-0 stitches were placed at the 2-, 4-, 6-, 8-, 10- and 12-o'clock positions. The intraoperative and perioperative parameters analyzed were time to perform the VUA, time to remove the drain and hospitalization. The rate of incontinence, anastomotic stricture and erectile function were included in the outcome analysis. RESULTS: The anastomotic time differed statistically between the 2 groups (mean 3.3 minutes for the 2-suture group and 10.5 minutes for the 6-suture group, p < 0.0001) with similar periods of drain removal (mean 3.12 days for the 2-suture group and 3.45 days for the 6-suture group; p = 0.13) and hospitalization (mean 4.66 days for the 2-suture group and 5.3 days for the 6-suture group; p = 0.09). The functional outcome was excellent for the 2-suture group with no patient suffering from incontinence or anastomotic strictures 1 year postoperatively, while in the 6-suture group there were 2 patients (4%) suffering from incontinence (2 underwent sling procedure) and 1 patient suffered from anastomotic stricture. CONCLUSION: The low number of sutures in the 2-suture VUA technique reduces operating times, does not influence perioperative and intraoperative parameters and results in excellent functional outcome.

Bilateral spontaneous retroperitoneal bleeding in a patient on nimesulide: a case report.

INTRODUCTION: Spontaneous retroperitoneal bleeding is a rare but potentially life-threatening event of varied etiology. Herein we report a case of bilateral non-traumatic retroperitoneal hemorrhage. CASE PRESENTATION: A 50-year-old Greek man, who was on a non-steroidal anti-inflammatory agent (nimesulide) for ankylosing spondylitis, presented with a right retroperitoneal hematoma combined with contralateral subcapsular renal hematoma. Bleeding on his right side was successfully controlled by arterial embolization with coils, whereas the left renal hematoma was treated conservatively. His recovery period was uneventful. CONCLUSION: This is the first reported case of bilateral retroperitoneal bleeding in a patient receiving nimesulide for ankylosing spondylitis. The application of minimally invasive techniques resulted in the desired positive outcome with preservation of both renal units.

High-risk laparoscopic urologic surgery.

Currently, the majority of operations in the urologic field can be performed laparoscopically. Even in experienced hands, some operations are considered of increased risk either because of increased surgical difficulty of the specific case or because the patient per se is at risk due to associated comorbidities. Scope of this review is to present the existent experience regarding difficult laparoscopic urologic cases, along with points of technique, the product of the experience collected by performing such difficult laparoscopic cases. Knowledge of anticipated difficulties allows both patients and their surgeons to be better prepared. Patients have their expectations from laparoscopy realistically set, whereas urologists, especially those new to laparoscopy, realize their abilities and properly set their indications to achieve the best for their patients.

Inflammatory Myofibroblastic Bladder Tumor in a Patient with Von Recklinghausen's Syndrome.

Myofibroblastic tumor, also known as inflammatory pseudotumor or pseudosarcoma, is a benign tumor with mesenchymal origin. Bladder location is very uncommon. We report the case of a 58-year-old man with a history of von Recklinghausen's disease who complained for painless macroscopic hematuria 5 months after suprapubic prostatectomy. The radiograph evaluation revealed a bladder tumor, and the pathologic examination following a transurethral resection showed inflammatory myofibroblastic tumor of the bladder. The patient finally underwent a radical cystectomy due to the uncertain pathogenesis of inflammatory myofibroblastic tumor as well as the rarity of cases published on bladder tumors in Von Recklinghausen's patients.

Effects of taxane-based chemotherapy on inhibin B and gonadotropins as biomarkers of spermatogenesis.

OBJECTIVE: To assess the effects of taxane-based chemotherapy on the male reproductive axis, and, therefore, its impact on spermatogenesis and fertility. DESIGN: Controlled clinical study. SETTING: Patients with cancer in an academic research environment. PATIENT(S): Forty male patients of reproductive age with cancer with solid tumor at diagnosis, who had been scheduled to receive taxane-based chemotherapy. INTERVENTION(S): The patients were given treatment with docetaxel or paclitaxel combined with gemcitabine or carboplatin. Blood sampling and testicular ultrasonography were performed before and after completion of chemotherapy. MAIN OUTCOME MEASURE(S): In all patients, serum levels of inhibin B, FSH, and LH were measured, and, in half of the patients, bilateral testicular volume was also measured. RESULT(S): There was a statistically significant decrease in serum inhibin B and increase in serum FSH in all patients after the completion of the taxane-based chemotherapy. The median LH levels did not exhibit a statistically significant increase after the last cycle. Bilateral testicular volume exhibited a statistically significant decrease in 19 out of 20 patients (95%) after completion of chemotherapy. CONCLUSION(S): Taxane-based chemotherapy induces the reduction of inhibin B and the reciprocal elevation of FSH, which are associated with significant gonadal damage in the early stages after completion of chemotherapy.

Postradical cystectomy bowel perforation caused by a drainage tube: a case report.

INTRODUCTION: Open drains are frequently placed in the abdominal cavity to prevent the collection of fluid or blood following major surgery. CASE PRESENTATION: We describe a case of perforation of the large bowel caused by the drain tube placed in a 74-year-old patient who had undergone radical cystectomy for invasive bladder cancer.

Reducing the number of sutures for vesicourethral anastomosis in radical retropubic prostatectomy

OBJECTIVE: To prospectively evaluate the outcome of using a two-suture technique for the vesicourethral anastomosis (VUA) during radical retropubic prostatectomy (RRP). MATERIAL AND METHODS: Two groups of 50 patients each underwent nerve-sparing RRP for localized prostate cancer by one surgeon. In one group, the vesicourethral anastomosis was performed using 2 Vicryl 2-0 stitches placed at the 3- and 9-o’clock positions and in the other group 6 Vicryl 2-0 stitches were placed at the 2-, 4-, 6-, 8-, 10- and 12-o’clock positions. The intraoperative and perioperative parameters analyzed were time to perform the VUA, time to remove the drain and hospitalization. The rate of incontinence, anastomotic stricture and erectile function were included in the outcome analysis. RESULTS: The anastomotic time differed statistically between the 2 groups (mean 3.3 minutes for the 2-suture group and 10.5 minutes for the 6-suture group, p < 0.0001) with similar periods of drain removal (mean 3.12 days for the 2-suture group and 3.45 days for the 6-suture group; p = 0.13) and hospitalization (mean 4.66 days for the 2-suture group and 5.3 days for the 6-suture group; p = 0.09). The functional outcome was excellent for the 2-suture group with no patient suffering from incontinence or anastomotic strictures 1 year postoperatively, while in the 6-suture group there were 2 patients (4 percent) suffering from incontinence (2 underwent sling procedure) and 1 patient suffered from anastomotic stricture. CONCLUSION: The low number of sutures in the 2-suture VUA technique reduces operating times, does not influence perioperative and intraoperative parameters and results in excellent functional outcome.