Optimum principal components for spatial filtering of EEG to detect imaginary movement by coherence.

Several techniques have been used to improve the signal-to-noise ratio to increase the detection rate of Event Related Potentials (ERPs). This work investigates the application of spatial filtering based on principal component analysis (PCA) to detect ERP due to left-hand index finger movement imagination. The EEG signals were recorded of central derivations (C4, C2, Cz, C1 and C3), positioned according to 10-10 International System. The optimal spatial filter was found by using the first principal component and the ERP detection was obtained by magnitude squared coherence technique. The best detection rate, by using original signal (without filtering), was obtained at C2 derivation, with 54.73% for significance level of 5%. For the same significance level, the detection rate of the filtered signal was drastically improved to 96.84%. Results suggest that spatial filter by using PCA might be a very useful tool in assisting the ERP detection for movement imagination for applications on brain machine interface.

[A 7-case anatomopathology revision in the presence of renal relapse after conservative therapy: implications on surgical technique].

Anatomopathology revision of the cases which underwent second surgery because of a renal neoplasm relapsing after conservative surgery, in order to find possible relations with the surgical technique. MATERIALS AND METHODS. At our institution, Nephron-sparing surgery (NSS) is currently indicated as elective technique for neoplasms smaller than 4cm in diameter. The technique involves the removal of the neoplasm with a margin of healthy parenchyma and with the perilesional fat. The patients are monitored with a first CT check after 4 months and then with ultrasound/CT checks every 6 months in the first 2 years and then once a year. In the present study we analyze the records of the cases in the period 1994-2005 undergoing a second operation for a renal tumor relapsing in the operated kidney after NSS. All specimens were reviewed by a single experienced uro-pathologist, who determined the size of the surgical margins and the relations between the seat of recidivism and the seat of the preceding enucleoresection. RESULTS. Seven cases with renal relapse were found out of 267 undergoing conservative surgery in the same period (incidence: 2.6%). The diagnosis had always been made lacking any other disease localizations at a complete re-staging; the average relapse latency was 19.4 months (8-46 months). In 5 cases the second tumor was found in the seat of the previous NSS: for these cases the minimum margin of the enucleoresection was lower than 3mm (median minimum margin: 1.6 mm). Differently, in the remaining 2 cases, both with a wider surgical margin (median minimum margin: 12.0 mm), the seat of the first and that of the second neoplasm were distant. In particular, in one case a multifocal relapse with a spread microvascular embolization was found, while in the other the two neoplasms showed a different histotype. DISCUSSION AND CONCLUSIONS. In the 5 cases with a little resection margin and relapsing tumor in the seat of the enucleoresection, the persistence of a peritumoral microscopic neoplastic disease can be assumed. In the other 2 cases showing a wider surgical margin the relapse can be attributed to the widespread microscopic multifocality in one case, and to the development of a second de novo neoplasm in the other case. The extension of the surgical margin seems then to have played a role in determining a relapse in the seat of enucleoresection.

[Nephron-sparing surgery versus radical nephrectomy in the treatment of renal cell carcinoma up to 7 cm].

To compare the oncological outcome of nephron-sparing surgery versus radical nephrectomy in renal cell carcinoma up to 7 cm by retrospectively reviewing our surgical experience. MATERIALS AND METHODS. Data collected from 1290 consecutive patients, who underwent surgery for renal carcinoma, have been stored since 1983 into a dedicated database. The cases with unilateral carcinoma up to 7 cm, pT1a/pT1b/pT3a N0/Nx M0, followed up for a minimum of 12 months if disease-free were reviewed. RESULTS. 732 patients were selected (mean follow-up: 72 months); 329 had a tumor less than 4 cm in diameter (182 cases of nephron-sparing surgery, 147 cases of nephrectomy), while for 403 of them the tumor was 4 cm or more (57 cases of nephron-sparing surgery, 346 cases of nephrectomy). The comparison between tumors less and equal to/more than 4 cm showed worse progression and disease-free survival rates for the latter, even though the type of surgery (nephron-sparing or radical) had no significant impact. Patients with extracapsular carcinoma ≥4 cm, treated with nephron-sparing surgery, had a particularly poor prognosis. CONCLUSIONS. The conservative management can be cautiously suggested for renal cancers up to 7cm, since the prognosis worsens proportionally with the diameter increase, with no statistical difference for both nephron-sparing and radical surgery. Nephron-sparing surgery proved to be the suitable treatment modality also for pT3a tumors measuring <4 cm, whereas when the tumor size increases, an adequate intraoperative evaluation of peritumoral tissues is essential to rule out fat infiltration. These results comply with the few similar studies available in literature, and suggest the possibility of designing a prospective study aiming at comparing conservative and radical surgery in the management of renal carcinoma up to 7 cm.

The collecting duct carcinoma of the kidney: a cytogenetical study.

OBJECTIVES: The Heidelberg classification of renal tumours identifies five histotypes of renal cancer, underlining for two of them (conventional and papillary renal cancers) a strict relation between the morphological aspect and the complement of alterations evidenced by the cytogenetic analysis of the neoplastic karyotype. Due to its low incidence, the collecting duct carcinoma (CDC) has not yet been characterized from a cytogenetic point of view. This study analyses the clinical, morphologic and cytogenetic features of the CDC observed and treated in our department. METHODS: From January 1995 to December 2002, among the 591 patients who underwent surgery for renal cancer, we observed 11 cases of CDC (prevalence 1.9%) treated either by radical (9 cases) or partial nephrectomy (2 cases). During radical nephrectomy a loco-regional lymphadenectomy was always performed. In the 9 cases observed after 1997, a complete cytogenetic analysis of the neoplastic karyotype was carried out. RESULTS: At pathological examination the disease was found to be confined to the renal capsule (TNM 1997 stage 1) in only 3 patients; venous neoplastic trombosis and nodal metastasis were present in 3 and 6 cases respectively; 2 patients showed distant metastases (lung, bone). Two of the patients affected with stage 1 tumours are still alive with no evidence of the disease at 48 and 88 months after surgery, while the third died following the systemic progression of a concomitant bladder carcinoma. One patient with stage 4 tumour (no. 11) is alive, but the follow up time is still limited (2 months). All the other 7 patients are dead after a mean survival time of 16.3 months (range 0-45). As for cytogenetic analysis, 2 CDCs didn't grow in culture and in one case no karyotype alterations were reported. In the remaining 6 cases hypodiploid stemlines and a homogeneous chromosome alteration pattern were observed, with multiple numerical and structural aberrations (mean 11.1, range 7-15) and the continuous involvement of chromosomes 1 and X or Y, both as traslocation and deletion/monosomy. Additional abnormalities of chromosomes 22 and 13 were found to be common but less frequent. CONCLUSIONS: The clinical behaviour of the CDC is aggressive and its prognosis is surely poor; surgical treatment seems to be curative only for organ-confined cancer, accounting for the minority of cases. This neoplasm is cytogenetically characterized by hypodiploid stemlines with common involvement of chromosome 1 and the autosomes.

Multitechnical pathological diagnosis in chromophobe renal cell carcinoma.

Two new cases of chromophobe renal cell carcinoma were diagnosed on the basis of their morphology and their karyotype complemented by flow cytometry. In one of these cases, however, all these investigations were not sufficient and additional histochemistry investigation had to be used to completely rule out other renal tumors such as oncocytoma, the prognosis of which is totally different.

[Multicenter study of penile cancer]. / Studio multicentrico sul cancro del pene.

The authors report the experience about diagnosis, treatment, results and follow-up on penile cancer of 15 department of urology of Lombardia region. The aim of the study is to find, through the historical experience, the better way to menage this rare cancer.

Surgery of lung metastases in renal cell carcinoma.

OBJECTIVE: To examine the impact on survival of pulmonary resection in the treatment of renal cell carcinoma that has metastasized to the lung. PATIENTS AND METHODS: From June 1986 to July 1991, 19 patients were submitted to synchronous or asynchronous lung metastasectomy. Histological examination confirmed the presence of lung metastases from renal cell carcinoma in 16 cases (six synchronous and 10 asynchronous with a mean disease-free interval of 23 months). In the other three cases, histological examination revealed tuberculomas, chondroid hamartoma and foci of anthracosis. RESULTS: To date, among the six patients with synchronous lung metastases, three have died, two are progressing and one has no evident disease after a mean survival of 24 months. Among the 10 patients who underwent surgical resection of metachronous lung metastases, one has died, three are progressing and six have no evident disease (mean survival time, 43 months). CONCLUSION: While the presence of synchronous lung metastases is an unfavourable prognostic factor even after surgical removal (five out of six patients died or are in progression shortly after metastasectomy), the results after surgery of asynchronous lung metastases are encouraging, although the real efficacy of this treatment is still to be confirmed.

[Retropubic adenectomy (Millin's technique). Our experience]. / Adenomectomia retropubica secondo Millin. Nostra esperienza.

From January 1983 to December 1993, on 1917 ptz who underwent to operations for BPH, 1532 pts (80%) had transurethral adenomectomy, and 385 pts (20%) had retropubic adenomectomy. The prostatic weight, obtained by ultrasound, is the factor which determines the kind of operations: transurethral adenomectomy if the prostate weight is lower than 50 gr, open surgery if it is more than 50 gr. In our experience about retropubic adenomectomy (Millin) we never had patient's death during operation or in the immediate post-operatively period. The early complications were 13.7%, and the late complications were 3.8%. The retropubic adenomectomy, when performed with right indications, is still valid.

[Structure, physiology and physiopathology of the ureter]. / Struttura, fisiologia e fisiopatologia dell'uretere.

The function of the ureter is to transport urine from the renal pelvis toward the bladder and to protect the renal parenchyma from distally generated backflow and back pressure. The ureter manifests peristaltic activity and can adapt its mechanical characteristics to diuresis amount. The changes in ureteral function resulting from obstruction are dependent on the degree and duration of obstruction. Even the rate of urine flow, the mechanical and anatomic properties of the ureter, the nature of disease process and the age of the patient influence the response of the ureter to obstruction. It is the purpose of this report to correlate the anatomic and physiologic properties of the ureter with normal and pathologic clinical situations.