Surgical treatment of retroperitoneal fibrosis with omentoplasty.

The main goal of surgery for retroperitoneal fibrosis is to free the ureters from sclerotic tissue and pressure them from further extension of the disease; the omentum may be used as an efficient barrier against recurrence of fibrosis. We present 11 patients with idiopathic retroperitoneal fibrosis treated with ureterolysis and omentoplasty - in four patients the procedure was performed bilaterally, in seven the omentum was used to protect only one ureter, but in six there was a surgical or functional solitary kidney. Out of 15 ureters, residual dilatation was observed only in two, with marked clinical improvement in all patients. Mean follow-up was 51 months.

A randomized controlled trial to assess safety, tolerability, and antepartum viral load with increased lopinavir/ritonavir dosage in pregnancy.

HIV mother-to-child transmission (MTCT) is significantly reduced if antepartum viral load (apVL) is<50 copies/mL. Pharmacokinetic studies suggest increasing the dosage of lopinavir/ritonavir (LPV/r) in pregnancy. It is important to assess tolerance, safety, and rate of patients presenting a apVL<50 copies/mL when treating with increased dose of LPV/r during pregnancy. Confirmed HIV-infected pregnant women with a fetus at a gestational age of 14-33 weeks were randomly assigned to receive LPV/r 400/100 or 600/150 mg b.i.d. plus two nucleoside analogues (NRTIs). Treatment was discontinued in the case of alanine transaminase (ALT) of grade III elevation or higher, glucose, or triglycerides. Thirty-two women were randomized to the LPV/r 400/100 mg dose, and 31 women were randomized to the 600/150 mg dose. Overall, 9.4% of the women receiving the conventional dose, and 17.2% receiving the increased dose, discontinued treatment because of adverse events (p=0.29). The rates of gastrointestinal (GI) symptoms, laboratory abnormalities, preterm delivery, and low birth weight were similar in both groups. There were no cases of HIV MTCT. Among the women with a baseline VL>50 copies/mL assigned to the conventional dose group, 45% (95% confidence interval [CI] 62.5-27.5%) had a apVL>50 copies/mL compared with 10.5% (95% CI 21.6-0.6%) of those assigned to the increased dose group (p=0.01). There was no significant difference found for the patients with a baseline VL<50 copies/mL. In pregnant women with a baseline VL>50 copies/mL, it may be warranted to initiate LPV/r dosing at 600/150 mg, whereas the conventional dose is sufficient for pregnant women with a baseline VL<50 copies/mL.

Hyperlipidemic acute pancreatitis: a possible role of antiretroviral therapy with entecavir.

In most cases clinical profile of acute hyperlipidemic pancreatitis is a preexisting lipoprotein abnormality associated to second risk factors such as alcohol abuse, diabetes mellitus or medications that can induce hypertrygliceridemia. We report a case of a young male affected by chronic hepatitis B virus infection admitted to Emergency Department due to acute abdominal pain, vomiting and fever. The patient was in antiretroviral treatment with entecavir; moreover he was affected by diabetes mellitus and he presented a past history of alcohol abuse. Laboratory tests demonstrated hyperglycemia, severe metabolic acidosis and hypertriglyceridemia, whereas abdominal computed tomography scan revealed peripancreatic edema: hyperlipidemic pancreatitits was supposed and the patient was admitted to the intensive care unit. Considering its possible role in the pathogenesis of pancreatitis, entecavir was interrupted and total of 3 sections of plasmapheresis were performed, allowing clinical resolution and prevention of pancreatic damage. The possible pathogenetic role of entecavir is discussed.

Efficacy and safety of quinine-artesunate in an HIV-positive patient with severe falciparum malaria.

Severe falciparum malaria is a medical emergency that is associated with a high rate of mortality, even when treated in an Intensive Care Unit. Until recently, intravenous quinine was the standard treatment; however, artemisin derivatives are now regarded as the first-line treatment for multidrug-resistant falciparum malaria. Although several studies have demonstrated the superiority of Artesunate, this drug is not licensed in many countries. This article describes the case of an HIV-positive patient, who returned from Africa and presented with 10% parasitemia and clinical signs of severe falciparum malaria; this individual was successfully treated with a combination of artesunate and quinine. Artesunate was imported from the foreign market, and written consent for its administration was obtained in advance. Parasite clearance was rapidly achieved; however, on day IV, the patient developed acute respiratory distress syndrome that required mechanical ventilation. The patient was extubated on day XIV and discharged on day XXV. Due to its rapid action, artesunate was likely responsible for the good clinical outcome in this case; however, in order to clarify the role of this new combination therapy, further studies are required.

Paraurethral leiomyoma in women.

Two rare cases of paraurethral leiomyoma in women are presented. Physical examination and cystourethrography with previous cytourethroscopy revealed the seat of the masses. Surgical approach by means of incision of the anterior vaginal wall allowed for the complete enucleation of the tumors.

Grade 2 urethroprostatic papillary urothelial carcinoma with positive urinary cytology.

A rare case of papillary urothelial grade 2 carcinoma of the prostate and urethra in a patient with a previous papillary neoplasm of the bladder is reported. The tumor caused hematuria and prostatic enlargement suspicious for cancer. Urinary cytology was diagnostic.

[Our experience in the surgical treatment of oncocytoma of the kidney]. / Notre expérience dans le traitement chirurgical de l'oncocytome du rein.

Five patients, two men and three women age range 38 to 84 years, were treated for oxyphil cell adenoma of the kidney. Clinical signs were present in three cases and tumor size varied between 7 and 15 cm. Treatment was by nephrectomy in 4 cases and ablation of adenoma in the fifth patient, the tumor being located in the only functioning kidney in the latter. Close follow up surveillance for 32 months failed to detect any recurrence. Clinical and pathologic features of this neoplasm and therapeutic choice in these cases are discussed below. Although radical surgery has been employed in the past as principal therapy, more precise pre- and perioperative diagnosis should allow more frequent use of conservative surgery: partial nephrectomy or tumor excision.