Single-Layer Sutures in Abdominal Cavity Surgery.

The aim of our study was to evaluate of short-term outcomes of 4210 patients who underwent open abdominal surgery with used either single-layer, absorbable, or continuous sutures. Seromuscular anastomosis were presented (without mucosa). Fluid therapy: GDT and zero-balance GDT were also discussed. Anastomosis leakage developed in 6 patients. They were treated by creating a stoma. Simultaneously, septic shock was treated. Re-anastomoses were performed after some time and after sepsis was suppressed. Results of treatment with use of double-layer sutures, which was is use before 1978, were presented. Analysis of 536 patients treated at the same time was conducted and 53 patients with anastomosis leakage was identified. Out of this group, 2 patients survived. Based on the literature review, the methods for performing anastomosis. Attention was paid to the advantages of single layer over multi-layer sutures: effectiveness, simplicity and lower cost of treatment. The occurrence of mechanical ileus was less frequently observed since ceasing to employ peritoneoplasty, and preoperational preparation of gastrointestinal tract in patients had a beneficial influence on their postoperative course. Postoperative complications were discussed mainly based on additional examinations such as TC and MRI. The attention was focused on the importance of medical observation and clinical examination by an experienced surgeon in order to identify postoperative complications. Antibiotic treatment in cases of postoperative complications was presented, as well as fluid therapy: GDT, zero-balance GDT and the procedures employed in cases of complications such as: anastomosis leakage, mechanical ileus, inter-peritoneal abscess. Anastomotic stenosis was not observed in this group of patients.

Internal optical urethrotomy is the treatment of choice in stenosis of the bladder neck after open prostate adenectomy.

INTRODUCTION: Open adenomectomy of the prostate, although performed less frequently, is still indicated in patients with prostate adenoma > 100 ml. AIM: This study assessed the frequency of isolated bladder neck stenosis after surgery and the effectiveness of internal optical urethrotomy as monotherapy and in combination with transurethral resection in the treatment of this complication. MATERIAL AND METHODS: One thousand five hundred thirty-eight Millin's operations and 381 trans-vesical adenomectomies were performed in patients with prostate adenoma. In 50 patients, the circular hemostatic suture was applied using the de la Peña technique because of bleeding after surgery. The retrospective analysis compared the incidence of isolated bladder neck stenosis depending on the type of surgery. RESULTS: Isolated bladder neck stenosis or narrowing of the neck combined with partial stenosis of the site after adenomectomy occurred in 0.52% (8/1539) of patients after Millin's operation and in 1.05% of patients (4/381) after trans-vesical adenomectomy. All strictures of the bladder after trans-vesical surgery occurred within 12 month after the procedure, and 25% of stenoses after Millin's operation occurred many years after the surgery. Internal optical urethrotomy as monotherapy or in combination with scar resection resulted in recovery after one treatment in 16 out of 17 patients. CONCLUSIONS: Internal optical urethrotomy as monotherapy or in combination with scar resection was effective in nearly all patients with bladder neck stenosis.

Fournier's Gangrene: Clinical Presentation of 13 Cases.

BACKGROUND Fournier's gangrene (FG) is a fulminant form of infective, polymicrobial, necrotizing fasciitis of the perineal, genital, and perianal regions. It commonly affects men, but women and children may also develop this type of tissue necrosis. MATERIAL AND METHODS This study is a retrospective analysis of the management of 13 cases of Fournier's gangrene, diagnosed from among about 45 000 patients (men, women, and children) treated in the Department of General, Oncological, and Functional Urology (Medical University of Warsaw) from 1995 to 2013. All patients with Fournier's gangrene underwent adequate surgical debridement of the necrotic tissues. Additional procedures (suprapubic cystostomy and orchiectomy) were necessary in 10 out of 13 (77.0%) patients. Seven out of 13 (53.8%) patients required subsequent reconstructive surgery of the scrotum. RESULTS All 13 patients were males, with a median age of 59.6 years (range: 42-68 years). The average hospital stay was 31.9 days (range: 16-46 days). None of our patients died due to Fournier's gangrene. Bacteriological cultures of samples from the wounds showed polymicrobial flora, including the following genera of aerobes and anaerobes: Escherichia, Proteus, Klebsiella, Moraxella, Gemella, Enterococcus, Streptococcus, Staphylococcus, Bacteroides, Pseudoflavonifractor, Parabacteroides, Porphyromonas, Prevotella, Peptoniphilus, Peptostreptococcus, Actinomyces, Collinsella, and Lactobacillus. CONCLUSIONS Favorable outcome of FG treatment with low morbidity and no mortality can be achieved with rapid diagnosis, urgent surgical debridement of all necrotic tissues, and broad-spectrum empirical antimicrobial therapy, usually with combined antibiotics, against aerobic and anaerobic bacteria. Prevention of uroseptic shock by treating localized infection is compulsory.

Expression of bone morphogenetic protein-2 and -7 in urinary bladder cancer predicts time to tumor recurrence.

INTRODUCTION: Urinary bladder cancer patients who have undergone transurethral resection of bladder tumor (TURBT) are at risk of recurrence. This study aims to correlate the level of bone morphogenetic protein (BMP) expression with urothelial carcinoma invasiveness, TNM stage and time to recurrence after TURBT. MATERIAL AND METHODS: In 33 specimens of healthy transitional epithelium and 42 of urothelial carcinoma, BMP2, BMP4 and BMP7 expression was determined by real-time polymerase chain reaction. Patients who underwent TURBT were followed up for 1 year. RESULTS: BMP2 and BMP7 were downregulated in infiltrating urothelial carcinoma, the relative expression being 0.76 (p = 0.04) and 0.28 (p = 0.025) respectively, while BMP4 was downregulated in non-invasive tumors. High expression of BMP2 and BMP7 correlated with prolonged time to recurrence (log-rank: p = 0.01 and p = 0.03 respectively). CONCLUSIONS: Low expression of BMP2 and BMP7 is associated with shorter time to recurrence. The BMP expression levels are not indicative of tumor stage.

Fournier's gangrene--current concepts.

Fournier's gangrene (FG) is a rapidly progressive form of infective necrotising fasciitis of the perineal, genital, or perianal regions, leading to thrombosis of the small subcutaneous vessels and necrosis of the overlying skin. It is believed that the occurrence of the disease in women is underreported and may be unrecognised by some clinicians. Fournier's gangrene is a life-threatening condition, constituting an urological emergency. Many patients with Fournier's gangrene have medical or surgical conditions, which are predisposing factors to this disease or its more severe or fatal course. These comprise diabetes mellitus, hypertension, alcoholism and advanced age. Recent reports in the literature point to changes in the epidemiology of FG, comprising an increasing age of patients. Several authors reported that the mean age of FG patients is at present 53-55 years. Prognosis in FG patients is based on FGSI (Fournier's gangrene severity index) score. Despite the progress in medical care for FG patients, the mortality rate reported in the literature remains high--most often 20-40%, but ranges from 4% to 80%. The most common isolates cultured from FG lesions are both Gram-positive and Gram-negative, as well as strictly anaerobic bacteria. Recently community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as an etiological agent of FG with severe clinical course and even fulminant sepsis. Rarely FG may have a fungal etiology, being caused by yeast-like fungi Candida spp. or by moulds. Antibiotics should be administered parenterally and in doses high enough to reach an effective concentration in the infected tissues.

Nested variant of urothelial carcinoma of renal pelvis - a case report.

We report a case of an 80-year-old woman with a very rare subtype of urothelial carcinoma - nested variant of urothelial carcinoma mimicking physiological von Brunn's nests. Optimal treatment of NVUC has not been determined due to the small number of cases, as well as the lack of randomized and follow-up studies. In our case the right retroperitoneal nephroureterectomy was chosen.

Are chondroclasts and osteoclasts identical?

Brief characteristics of cells termed "osteoclasts" and "chondroclasts" are outlined and reasons to consider them as the same cell type, able to resorb calcified matrix, are discussed.

Lack of usefulness of ureteral reconstruction with free bladder mucosa flap in dogs confirmed by microangiography.

BACKGROUND: There is a paucity of data addressing the blood supply in the surgically reconstructed ureter, and complete lack of microangiographic studies of the reconstructed ureter with the use of a free bladder mucosa flap. The present study evaluated the blood supply in the reconstructed dog ureter after a 5-centimeter segment resection, supplemented by a tube constructed from a free bladder mucosa flap. MATERIAL AND METHODS: Female mongrel dogs (n=29) were used in this study. Under general anaesthesia, a 5-centimeter autologous free bladder mucosa flap was used to construct a tube, which was afterwards grafted to replace a 5-centimeter ureter resection. After a period of 3 months (n=2) and after 1 year (n=2), microangiography was performed to assess the revascularization of the grafted ureter. RESULTS: In our study, we observed the continuity of the ureter, but the grafted reconstruction was narrowed by the cicatrization in about 86% (n=25) of cases. This resulted in the development of hydronephrosis, as described in previous publications. The ureteral wall was covered by a normal urothelium, but consisted of fibrous connective tissue, which failed to restore a regular (normal) coat. The reconstructed segment showed no smooth muscle cells. A few smooth monocytes were found only at the border with intact portions of the ureter. The microangiography performed at the end of the experiments showed no vascularization of the restored segment of the ureter. CONCLUSIONS: The experiments showed a whole regeneration of urothelium in the transected and reanastomosed ureters. However, there was no regeneration of the muscular coat and a complete lack of revascularization.

Nephrogenic adenoma of the urinary bladder: a report of three cases and a review of the literature.

BACKGROUND: Nephrogenic adenoma (NA) is a rare, benign disease of the urinary tract, usually as a response to chronic irritation or trauma. Its diagnosis, staging, and treatment are not well established. CASE REPORT: We report on 3 cases of nephrogenic adenoma of the urinary bladder treated in our hospital between February 2011 and December 2012 to assess our experience and clinical outcome updating and reviewing the literature concerning this issue. All patients had undergone previous open urosurgery. Two patients had kidney transplantation. Gross hematuria and microhematuria were found in 2 patients. One patient had recurrent urinary tract infection. One patient had NA associated with transitional cell carcinoma (TCC). Recurrent nephrogenic adenomas were diagnosed in 2 patients (time to disease relapse was 5 and 9 months). All nephrogenic adenomas and recurrent tumors were treated with transurethral resection. CONCLUSIONS: Although NA is a benign metaplastic lesion of the urothelium, its recurrence rate is relatively high, thus careful and regular follow-up is necessary. Endoscopic characteristics of NA are not specific and a definite diagnosis must be made after histological analysis of resected specimens.

Long-term preservation of Bone Morphogenetic Activity in stored demineralized murine incisors.

Demineralized bone or dentine implanted intramuscularly induce endochondral bone formation. This phenomenon, termed "bone induction" is triggered by non-collagenous signal molecules, named "Bone Morphogenetic Proteins" (BMPs), released from bone or dentine. Demineralization of bone/dentine prior their implantation facilitates the release of BMPs from the extracellular matrix allowing to reach a BMP threshold level needed to initiate the process of differentiation of mesenchymal cells towards an osteogenic/chondrogenic lineage. Unprocessed, mineralized tissues usually fail to induce cartilage/bone. Isolated BMPs are commercially available, and in clinical practice are an alternative for demineralized tissues, however, in many cases demineralized bone has advantages over soluble BMPs, as it combines both bone inducing principles and mechanical properties, a feature important for bridging bone fracture and filling bone defects. Demineralized bones are an inexpensive source of bone forming agents for bone-fracture healing or filling bone defects. In this report we demonstrated that storage of lyophilized demineralized murine incisors for 30 months does not deteriorate its osteoinductive potency and colonizing induced bone by bone marrow. Lyophylized incisors, stored for 0-30 months at refrigator were implanted intramuscularly and recovered, together with surrounding tissues at various time intervals ranging 10-450 days. Bone closely associated with implant was observed in about 87% of cases, regardless the storage duration. It is concluded that storage of demineralized and lyophilized incisor matrices for at least 30 months does not change their osteoinductive potency.