Open partial nephrectomy with no clamping of the pedicule: a good surgical option in treatment of renal cancer.

AIM: The aim of the present work was to describe authors' surgical experience using the partial nephrectomy technique without intraoperatory pedicle clamping for masses even up to 4 cm of size. METHODS: The study enrolled 96 patients with an average age of 59.7 years, who underwent partial nephrectomy without pedicle clamping. The average dimensions of the masses treated were 3.7x3x3.8. In preoperative and in postoperative time creatinine, hemoglobine, hematocrit and platelets were monitored. The follow-up was of 1-3-6 months. At the third month postoperatively a renal US scan was performed, together with a control CT scan and at the sixth month of follow-up the patients underwent also a control Tc99/DMSA renal scintigraphy in back, front, oblique and right posterior oblique left rear projections. RESULTS: Surgery and anesthesia time have been respectively of 1 h 51 min e 2 h 30 min. In the postoperative time the average values were: creatinine 1.46 ng/mL (±0.45), hemoglobin: 11.25 g/dL (±1.6), hematocrit: 36.4 % (±3), platelets: 205 x 103 (±45 x 103). At follow-up at 1-3-6 months the average values were: creatinine 1.16 ng/dL (±0.66), hemoglobin 14.13 g/dL (±0.13), hematocrit 42.43% (±1.03), platelets 204 x 103 U/L (±1.66 x103). After six months the renal function demonstrated intraparenchymal homogeneous distribution of the drug in all the patients, with a 7% of difference of relative uptake by the operated kidney than the healthy controlateral one. CONCLUSION: The partial nephrectomy without intraoperative pedicle clamping can be a good therapeutic option for the treatment of kidney cancer for masses even up to 4 cm of size. The follow-up should be longer to assess oncological results.

[An exploratory study of the relation between cerebrovascular accidents and personality structures]. / Estudio exploratorio de la relación entre los accidentes cerebrovasculares y las estructuras de personalidad.

INTRODUCTION: In recent years the psychological aspects linked with cerebrovascular accidents (CVA) have often been studied from the consequences they generate. AIMS. To explore the type of relation that exists between CVA and personality structures as a premorbid risk factor (RF), including their possible relation to the characteristics of brain injury. PATIENTS AND METHODS: 97 patients who were admitted to hospital consecutively for a first CVA were evaluated and a follow up was carried out on 38 of them. In the acute episode and in the follow up we collected data about their medical history, from studies using neuroimaging and from a semi structured interview which was administered to the patient or a relative. RESULTS: A predominance of personality traits similar to those of type A personality was found. These traits are grouped in the following structures: moody (depressive), over adapted, logical (obsessive) and suspicious distrustful (paranoid), with a clear predominance of traits of low tolerance to frustration, irritability, lack of care for or abuse of the body, exigency, perfectionism, rigidity, magical thought and illness understood as being weakness or bad luck and health as a must be . Depressive states, with or without anxiety, were also found with significant frequency. None of these states or reactions was associated to any kind of brain injury in particular, both in their type and in their topography. CONCLUSIONS: Results show a tendency that is similar to studies with heart patients and with patients with CVA that have already been published and can be grouped under the denomination of type A personality . Therefore, type A personality can be considered as a factor linked to vascular diseases involving at least two territories (heart and brain). It remains to be ascertained whether the brain territory is only a RF or a necessary or sufficient condition. Psychological evaluation of the subjects at risk or already affected by a CVA is relevant and to be taken into account in both prevention and therapy and rehabilitation.

[Urologic complications of diverticulosis of the colon]. / Complicanze urologiche nella diverticolosi del colon.

In this paper the complications of colonic diverticulosis are reported, on the basis of two clinical cases personally observed. In the first case, a 68 year-old man, the typical symptomatology with pneumaturia, cloudy urine and watery diarrhea suggested a uro-colonic fistula, therefore a fistula between sigma and bladder, caused by a perforate diverticulum, has been diagnosed by means of cystography and barium enema. In the second case, a 64 year-old woman, the irritative symptomatology, hematuria and endoscopic picture suggested a vesical neoplasia. An accurate examination with abdominal TAC and barium enema, showed a perforate diverticulum between uterus and bladder, without affecting the bladder lumen. The surgical treatment required, in both cases, a left hemicolectomy, a minimal bladder resection in the first case, and a greater one in the second case. During the discussion, the main etiopathogenetic causes of uro-colonic fistulae together with the variants in the onset symptomatology, have been stressed.

Prostatic carcinosarcoma.

A unique case of carcinosarcoma of the prostate in a 66-year old man is presented. The patient underwent a total prostatectomy under the diagnosis of prostatic carcinoma. Despite adjuvant radiotherapy, the patient died about 3 months after the operation. The surgically resected primary tumor was composed of two histologically distinct elements, an adenocarcinoma and sarcoma with various mesodermal components. These elements were intimately intermingled and transitional forms were often noted. The sarcomatous portion contained areas of chondromatous differentiation. The pathogenesis of this complex neoplasm is discussed.

[A case of adrenal neoplasm]. / Su un caso di neoplasia del surrene.

Pheocromocytoma is a rare adrenal tumor. Generally its size is reduced and it is one of the causes of arterial hypertension. The authors present a case of giant pheocromocytoma, without arterial hypertension, and particularly they write about the used diagnostic and therapeutic management.

[Large inguino-scrotal bladder herniation]. / Voluminosa ernia inguino-scrotale vesicicale.

The authors describe a case of voluminous inguinoscrotal bladder erniation. They write about the subjet with the help of the literature and above all they show the possible dangers of a vesical underestimated injury.

[Rupture of the upper urinary tract during renal colic. Two cases]. / Rottura dell'alta via escretrice in corso di colica renale.

The rupture of the upper urinary tract is an uncommon event. The authors describe 2 cases during renal colic and they write, particularly, about the diagnostic and therapeutic aspects of this pathology.

Influence of dietary manipulation on incidence of atopic disease in infants at risk.

Of 5,500 newborn infants whose family histories were screened, 900 were found to have anamnestic risk. Cord-blood IgE was evaluable in 4,677 of these newborns, of which 394 had levels > or = 1 IU/mL; 84 infants had both anamnestic risk and elevated cord-blood IgE levels. Parents of infants with anamnestic risk were informed of their child's risk of atopy. Additionally, for 391 infants at two of the three participating hospitals, a preventive diet was prescribed that recommended breastfeeding for the first 6 months of life, with maternal diet restricted to no more than 200 dL of cow milk per day, no more than one egg per week, and no tomato, fish, shellfish, nuts, or foods allergenic to the mother. Only soy formula was recommended, and introduction of solid foods was also carefully prescribed. Furthermore, doctors recommended against exposure to tobacco smoke, animal allergens, and early entrance into daycare. Evaluable infants whose parents complied with the prescribed diet were found to have a lower incidence of atopy during the first year of life (13.3%, n = 158) than infants whose parents had ignored the prescribed diet (54.7%, n = 86) or infants whose parents were offered no dietary recommendations (28.9%, n = 218). Differences between the compliant group and the two groups with unrestricted diets were significant, indicating that this prescribed diet may protect against or delay onset of food allergies during the first year of life.

Best's multiple vitelliform degeneration.

Best's disease with multifocal lesions is rare. The authors describe four cases of multifocal vitelliform disease. The fluorescein angiographic features of macular and extramacular lesions are considered. Different stages of evolution may be present between central and extramacular lesions.

The shapes and sizes of closed, pressurized random walks.

Two-dimensional cell-like membranes acted on by osmotic pressure differentials are represented by closed, unrestricted random walks. The treatment omits excluded-volume effects, and the pressure that is imposed thus favors an oriented area, so that the shriveled configuration of a vesicle with excess external pressure is inaccessible in this model. Nevertheless, the approach has the decided advantage of yielding analytic expressions in a complete statistical analysis. Results are presented for the average square of the radius of gyration, the asphericity, and the probability distribution of the principal components of the radius of gyration tensor. The analysis is done in both the constant-pressure and constant-area ensembles.

[Role of the markers PAP-PSA in the diagnosis of cancer of the prostate]. / Ruolo dei markers PAP-PSA nella diagnostica del cancro della prostata.

The Authors report their personal experience relating to diagnostic screening for prostatic carcinoma using serum assays for specific markers of this tumour: prostatic acid phosphatase (PAP) and prostatic specific antigen (PSA). They underline the importance of high serum values of these substances, especially in tumors in an advanced state, and point out that these markers can play a role both in the diagnosis and in the follow-up of prostatic carcinoma.

Oral anticoagulant therapy control: evidence that INR expression improves the inter-laboratory comparability of results--the Bologna oral anticoagulant control exercise.

The aims of the present study were: 1) interlaboratory normalization of prothrombin time (PT) testing for anticoagulant therapy control through calibration of customary thromboplastins against international reference materials, and 2) "on field" validation of the advantages offered by expression of results as International Normalized Ratio (INR) as opposed to percentage activity. PT tests were carried out over 8 days on the same normal subjects (16) and patients on oral anticoagulants (48) in the 9 laboratories of the Bologna area. The use of customary thromboplastins and coagulometers was maintained in all labs throughout the study. The main results were: 1) the interlaboratory CV of the prothrombin ratios obtained for each sample with all customary thromboplastins (5 different brands) was 15%, but was reduced to levels of 5.8 to 8.9 when using constant thromboplastin brands and batches; 2) the International Sensitivity Index (ISI) values obtained in the different labs were only slightly influenced by the use of different coagulometers; 3) comparable ISI values were obtained through direct calibration with the international reference material and through intermediate calibration with a locally selected standard; 4) use of INR values instead of percentage activity greatly reduced interlaboratory variability and significantly improved uniformity of anticoagulation level measurements, thus reducing the possibility of erroneous prescriptions. The Bologna exercise is therefore of educational value for laboratory and community doctors of the area in understanding and accepting the INR system.

The shapes of random walks.

A theoretical description of the shape of a random object is presented that is analytically simple in application but quantitatively accurate. The asymmetry of the object is characterized in terms of the invariants of a tensor, analogous to the moment-of-inertia tensor, whose eigenvalues are the squares of the principal radii of gyration. The complications accompanying ensemble averaging because of random processes are greatly reduced when the object is embedded in a space of high dimensionality, d. Exact analytical expressions are presented in the case of infinite spatial dimensions, and a procedure for developing an expansion in powers of l/d is discussed for linear chain and ring-type random walks. The first two terms in such an expansion lead to results for various shape parameters that agree remarkably well with those calculated by computer simulation. The method can be extended to yield an approximate, but extremely accurate, expression for the probability distribution function directly. The theoretical approach discussed here can, in principle, be used to describe the shape of other random fractal objects as well.