Ureteric response to abdominal radiotherapy and metallic double-pigtail ureteric stents: a pig model.

OBJECTIVE: To examine the safety and compatibility of full-length metal ureteric stents with abdominal radiotherapy. MATERIALS AND METHODS: Four ureteric stents (Resonance(TM), Cook Urological, Ireland) (RS) and four RSs specially modified to contain thermocouples were placed unilaterally in eight pigs. The contralateral ureters of the same pigs served as their controls, and contained two polymeric ureteric catheters and two similar specially modified to contain thermocouples, while the remaining four control ureters remained intact. All pigs were exposed to abdominal radiotherapy. The dose rate was approximately 5.3 Gy/min and a total radiation dose of 10 Gy was administered. Throughout the treatment the temperature was monitored by the RSs and catheters containing the thermocouples. The pigs were killed at 1 day (four), 7 days (two) and 15 days (two) after treatment, and all ureters examined histologically. RESULTS: There was no statistically significant increase in RS and catheter temperature throughout the treatment in any of the treated pigs (P > 0.05). All histological lesions reported were due to radiation treatment. There were no differences in histology between the ureters containing RSs and controls. CONCLUSION: RS usage is unrelated to any increase in stent temperature during abdominal radiotherapy and does not cause any further deterioration in the histology of the ipsilateral ureter, additional to that caused by the initial treatment.

PTTG-1 (Securin) immunoexpression in meningiomas correlates with tumor grade and proliferation rate: potential use as a diagnostic marker of malignancy.

This study essentially aims to contribute to the immunohistochemical investigation of the use of pituitary tumor transforming gene (PTTG) as a marker of cell proliferation or advanced tumor grade in meningiomas of various WHO grades. In all, 51 cases were recovered in total, 21 Grade-I, 23 Grade-II and 7 Grade-III meningiomas. Mitotic index (MI), Ki-67/MiB-1 positivity percentage and PTTG expression were analyzed in correlation to each other as well as to the tumor WHO grades. All three biomarkers showed a high diagnostic significance and a strong association with WHO grades. In comparison, PTTG expression was on a par with the other two indices, and performed very well regarding identification of advanced grade tumors. PTTG may be considered an important diagnostic tool and serve in the future as a novel prognosticator of the biological behavior of all grade meningiomas as well as a useful high-risk patient selection tool.

Application of paclitaxel-eluting metal stents in renal artery of pig model.

BACKGROUND AND PURPOSE: Recent reports concerning coronary, carotid, and femoral vasculature have proposed the use of drug-eluting metal stents (MS) to improve clinical and angiographic outcomes. Based on these reports, we used paclitaxel-eluting MS within an animal renal artery lumen and compared the results with those using a bare-metal stent. MATERIALS AND METHODS: The experimental model in this study was the female pig renal artery. Ten pigs with weights ranging from 25 to 30 kg were used. Twenty stents were placed, two in each animal. The MS placement was randomly performed in either the right or left renal artery of each animal. In 10 arteries, a 3.5 x 18 mm R-stent (group A) was placed; in the remaining 10 arteries, a 3 x 32 mm paclitaxel-eluting coronary stent (T-stent, group B) was inserted. Patency was estimated with the use of digital subtraction angiography, CT angiography, and virtual endoscopy at 24 hours and 1 month poststent placement. RESULTS: The positioning of the MS was successful in all cases. The initial angiographic result was maintained 24 hours after the intervention. No stent migration was seen, except for one paclitaxel stent that was acutely occluded. The one-month patency rate, as demonstrated by angiography, CT angiography, and virtual endoscopy, was 70% (8 arteries) in group A and 90% (9 arteries) in group B. The thickness of the endothelium and of the muscular coat was statistically significantly less in group B compared with group A (P = 0.0352 and P = 0.0046, respectively). CONCLUSION: These preliminary experimental study results suggest that the paclitaxel-eluting MS is more efficient than the bare-metal stent when used within the pig renal artery. Further experimental and clinical studies are necessary to validate our preliminary encouraging results.

Deep sedation in GreenLight laser prostatectomy.

INTRODUCTION: Evaluation of ketamine and propofol combination for the performance of photoselective vaporization of prostate (PVP). PATIENTS AND METHODS: Twenty-six patients undergoing PVP for benign prostatic hyperplasia were included in the study. Co-morbidities were present in 24 patients. Midazolam 2 mg intravenous was administered for the induction to anesthesia. Propofol (10 mg/ml) and ketamine (1 mg/ml) were administered with the use of two pumps. An initial bolus dose of 0.03 ml/kg of propofol and 5 mg of ketamine was administered intravenously. The anesthesia was maintained by continuous infusion of 0.01 ml/kg/min of propofol and 2 ml/min of ketamine. Fentanyl was administered when deemed necessary. The level of sedation, peri-operative parameters and side-effects were recorded. RESULTS: The average periods from the induction of anesthesia and intraoperative infusion were 12.38 ± 5.84 min and 59.5 ± 22.15 min, respectively. Average propofol and total ketamine dose were 85.5 ± 10.62 µg/kg/min and 144.9 ± 45.62 mg, respectively. The average dose of fentanyl administered was 29.81 ± 27.40 µcg. An average period between the end of the infusion and the discharge to the urology clinic was 34.62 ± 22.89 min. Ten patients experienced nausea and five eventually vomited. Hallucinations were observed in five cases while visual disturbances in two patients. CONCLUSION: The combined use of ketamine and propofol for the performance of PVP proved to be an efficient method for anesthesia. The "deep sedation" provided by these drugs was not associated with significant side-effects. Moreover, the use of the above method is indicated in patients with significant co-morbidities that should undergo PVP.

Ectopic parathyroid adenoma located inside the hypoglossal nerve.

BACKGROUND: Intraneural parathyroid adenomas are extremely rare, with only 9 cases of intravagal adenomas reported. We report the first case of an ectopic parathyroid adenoma located within the hypoglossal nerve. METHODS AND RESULTS: A 62-year-old woman presented with a palpable nodule in the right submandibular area, reduced bone mass, and elevated calcium and parathormone levels. Preoperative investigation with neck ultrasound and MRI did not provide a definitive diagnosis, whereas sestamibi scan showed slightly increased radiotracer accumulation in the same area. Intraoperatively, the right hypoglossal nerve was found to course through the lesion and, despite the attempt to salvage it, most of its fibers were transected. Histopathology confirmed the presence of a parathyroid adenoma inside the trunk of a nerve. Postoperatively, calcium and parathormone levels decreased but right hypoglossal nerve paresis was noted. CONCLUSION: This unique case emphasizes the variability of parathyroid anatomy and the difficulties faced by the surgeon when treating this disease process.

Metallic double pigtail ureteral stent usage during extracorporeal shock wave lithotripsy in the swine model: is there any effect on the ureter?

PURPOSE: To examine the safety and compatibility of full-length metal ureteral stent usage with extracorporeal shock wave lithotripsy (SWL). METHODS: Four Resonance ureteral stents and four special Resonance ureteral stents modified to contain thermocouples were placed unilaterally in eight pigs, with contralateral ureter of each pig serving as its own control. All pigs were subjected to the same SWL protocol in both their ureters. In the animals containing the modified stents, ureter temperature was monitored during treatment. The animals were sacrificed on days 1 and 15 after treatment, and both their ureters were histologically examined. RESULTS: No statistically significant increase (mean increase of 0.5 degrees C, p > 0.05) of stent temperature was observed during treatment. No differences in histology were observed among ureters containing stents and control ureters at both days 1 and 15 after treatment. CONCLUSION: SWL appears to be harmless for the ipsilateral ureter.