Mixed epithelial and stromal tumor of the kidney: A case report.

Mixed epithelial and stromal tumor (MEST) is a rare neoplasm of the kidney, affecting mostly women at menopausal age. While few cases of malignant transformation have been described in the literature, MEST is usually considered a benign tumor with minimal risk of local recurrence or distance metastases. The current study presents a case of a 18-year old male patient with a cystic tumor of the left kidney incidentally diagnosed on magnetic resonance imaging of the heart performed for other reasons. The patient underwent a partial nephrectomy, with perioperative course being uneventful. The pathology report revealed MEST of the kidney. No local recurrence nor disease progression have been observed in the patient during the one-year follow-up period. The present case report is evidence that may help in developing guidelines on the management of patients with benign renal masses.

What is the damage? Testicular germ cell tumour survivors deficient in testosterone at risk of metabolic syndrome and a need for medical intervention.

Testicular germ cell tumours (TGCT) survivors are coping with late treatment sequelae. Testosterone deficiency may contribute to earlier onset of metabolic syndrome. The study aimed to assess connections between serum testosterone concentrations and metabolic disorders as well as body composition in TGCT survivors. 336 TGCT patients with over two years of complete post-treatment remission were divided into three groups: definite testosterone deficiency (< 8 nmol/L), 'grey zone' (8-12 nmol/L) and normal testosterone (> 12 nmol/L; control group) to assess differences in metabolism. Univariate and multivariate analyses were performed. The multivariate analysis assessed the risk of metabolic disorders and changes in body composition with regard to testosterone concentrations adjusted for age, smoking history, clinical stage, type of treatment and follow-up period. 14% of patients presented with definite testosterone deficiency; 46% were in the 'grey zone'. On multivariate analysis, low testosterone levels were related to hyperglycemia, hypercholesterolemia, hypertriglyceridemia, inflammatory processes, procoagulant state and obesity. The odds ratio (OR) for the onset of metabolic syndrome was 2.87 (95% CI 1.74-4.73, p < 0.001) for the 'grey zone' patients and 7.92 (95% CI 3.76-16.70, p < 0.001) for those with definite testosterone deficiency. Testosterone concentrations were independently associated with metabolic disorders in TGCT survivors. Testicular cancer survivors often have lower testosterone and metabolic disorders. Apart from recurrence, follow-up should focus on promoting a healthy lifestyle, preventing and managing late effects.

Autonomous screening of groundwater remediation technologies in the subsurface using the In Situ Microcosm Array (ISMA).

The groundwater remediation industry continues to progress towards less expensive, more sustainable in situ remedies. However, in situ treatment requires site-specific performance data that can be difficult or impossible to obtain using conventional laboratory microcosm studies. To improve the representativeness of laboratory scale treatability studies, and aid in remedial technology implementation, we developed the In Situ Microcosm Array (ISMA). This autonomous diagnostic device enables the deployment of 10 flow-through sediment columns within a standard 10-cm groundwater-monitoring well. Suspended at the desired aquifer depth, the fully encapsulated ISMA meters groundwater directly from the aquifer to microcosms containing competing remedial technologies. Field demonstrations of the instrument were performed in two aquifers contaminated, respectively, with trichloroethylene and hexavalent chromium, and with perchlorate. A cost assessment positions ISMA deployment costs within the range of conventional laboratory treatability studies. Results demonstrate the ISMA's utility to perform cost-effective, high-throughput, screenings of multiple intervention strategies in the field, without impacting the subsurface environment examined.

Assessment of quality of life in patients surgically treated for penile cancer: Impact of aggressiveness in surgery.

PURPOSE: Health-related quality of life (HRQoL) evaluations are being increasingly used for clinical assessment of cancer treatment outcomes. For a patient, not only is life expectancy important, but also a general sense of sustained global health. Intuitively, the more disfiguring the treatment, the more pronounced could be the deterioration in the QoL. We aimed to compare various aspects of QoL in three groups of patients surgically treated for penile cancer by local excision, partial penectomy, or total penectomy. METHODS: HRQoL was assessed in 51 patients surgically treated for penile cancer. Total penectomy, partial penectomy, or wide local excision was performed in 11, 27, and 13 patients, respectively. The EORTC QLQ-C30 questionnaire was used for HRQoL assessment. Relations between the patients and their partners were also assessed. RESULTS: Statistically significant negative correlation was found between aggressiveness of the surgical procedure and both, assessment of global health status (p = 0.04) and physical functioning (p = 0.047). The more aggressive the surgery, the lower was the patients' assessment of their QoL. Among the patients who maintained their partner relations postsurgery, 58.9% declared that their relations postoperatively were not inferior compared to those preoperatively. There was no statistically significant effect of the surgery type on relations with female partners (p = 0.619). CONCLUSION: The magnitude of disfigurement caused by surgical treatment of penile cancer had a significant impact on the selected QoL domains assessed by the EORTC QLQ C-30 questionnaire. There was no correlation between the scope of surgical intervention and partner relations.

Quality of life in penile carcinoma patients - post-total penectomy.

INTRODUCTION: Total amputation, as a treatment for advanced penile cancer, significantly debilitates the patient's quality of life and sexual function. The aim of the study was to assess the quality of life in patients who had undergone total penectomy. MATERIAL AND METHODS: The questionnaires EORTC QLQ C-30, SES, CMNI, and a modified IIEF-15 questionnaire, were sent to 11 patients. RESULTS: A total of 10 patients returned the questionnaires completed. The results of the overall quality of life, the median result in individual domains, as assessed by the EORT QLQ C-30 questionnaire, were clearly lower than the reference results. There were statistically significant differences in the results of the QLQ C-30, concerning the role-functioning domain in relation to age (p = 0.008) and education (p = 0.032), in the domain of emotional functioning in relation to education (p = 0.008) and in the domains of physical functioning in relation to the partner relationship (p = 0.032). A significant number of patients were sexually inactive. Sexual activity as defined by touching the area of the pubic symphysis at the scars of the penis, touching and fondling perianal areas or the scrotum and watching things/people that cause excitement was observed in 2/10, 1/10 and 2/10 of patients respectively. In 5/6 of these patients, partnership relationships did not deteriorate, including one patient for whom the relationship actually improved. CONCLUSIONS: The results obtained indicate that total amputation of the penis significantly affects one's sex life and overall quality of life. However, this does not have negative implications in terms of partnership relations, self-assessment or the evaluation of masculinity.

Simultaneous determination of chlorinated ethenes and ethene in groundwater using headspace solid-phase microextraction with gas chromatography.

Widespread contamination of groundwater by chlorinated ethenes and their biological dechlorination products necessitates the reliable monitoring of liquid matrices; current methods approved by the U.S. Environmental Protection Agency (EPA) require a minimum of 5 mL of sample volume and cannot simultaneously detect all transformative products. This paper reports on the simultaneous detection of six chlorinated ethenes and ethene itself, using a liquid sample volume of 1 mL by concentrating the compounds onto an 85-µm carboxen-polydimenthylsiloxane solid-phase microextraction fiber in 5 min and subsequent chromatographic analysis in 9.15 min. Linear increases in signal response were obtained over three orders of magnitude (∼0.05 to ∼50 µM) for simultaneous analysis with coefficient of determination (R(2)) values of ≥ 0.99. The detection limits of the method (1.3-6 µg/L) were at or below the maximum contaminant levels specified by the EPA. Matrix spike studies with groundwater and mineral medium showed recovery rates between 79-108%. The utility of the method was demonstrated in lab-scale sediment flow-through columns assessing the bioremediation potential of chlorinated ethene-contaminated groundwater. Owing to its low sample volume requirements, good sensitivity and broad target analyte range, the method is suitable for routine compliance monitoring and is particularly attractive for interpreting the bench-scale feasibility studies that are commonly performed during the remedial design stage of groundwater cleanup projects.

Prognostic factors in patients undergoing lymphadenectomy for squamous cell carcinoma of the penis.

INTRODUCTION: Penile cancer is rare, and data on prognostic factors of the disease are scarce. The aim of the study was to assess prognostic factors in patients undergoing lymphadenectomy for penile cancer. MATERIAL AND METHODS: Ninety-eight men who underwent lymphadenectomy for penile cancer were enrolled in the study. Progression-free survival and overall survival were assessed. RESULTS: Five-year progression-free survival and overall survival were 0.6651 (95% CI: 0.5151-0.7783) and 0.5516 (95% CI: 0.4412-0.6488), respectively. Multivariate analysis showed that the factors that reduce progression-free survival include delay of lymphadenectomy by more than 3 months after diagnosis (p = 0.045) and involvement of non-inguinal lymph nodes (N0 vs. affected lymph nodes other than superficial inguinal, p = 0.0004; superficial inguinal vs. others, p = 0.001). Factors deteriorating overall survival include high grade (G1 vs. G2, p = 0.0072, and G1 vs. G3, p = 0.0347), more than one lymph node affected (p = 0.001) and crossing the lymph node capsule (p = 0.034). CONCLUSIONS: The factors worsening the prognosis in patients with penile cancer after lymphadenectomy include delayed lymphadenectomy, involvement of lymph nodes other than the superficial inguinal, involvement of more than one lymph node, crossing the lymph node capsule, and high grade.

Does pharmacological castration as adjuvant therapy for prostate cancer after radiotherapy affect anxiety and depression levels, cognitive functions and quality of life?

INTRODUCTION: Adjuvant hormonotherapy for prostate cancer patients after radical radiotherapy has a well-established value. However, the impact of such treatment on the patients' quality of life remains to be elucidated. OBJECTIVE: The objective is to assess the impact of adjuvant hormonotherapy with luteinizing hormone-releasing hormone analogue after radical radiotherapy on anxiety and depression levels, cognitive function, sexual function and quality of life of prostate cancer patients. MATERIAL AND METHODS: Two groups of patients were tested: men treated with adjuvant hormonotherapy (88 patients) and men without hormonotherapy (61 patients). Anxiety, depression and cognitive functions were evaluated. Patients answered questions addressing problems linked to hormonal equilibrium. The patients rated their mental status, physical status, quality of life and quality of their relationship. RESULTS: There were no statistically significant differences between patients on hormonotherapy and without hormonotherapy in the level of anxiety and depression (p = 0.844 and p = 0.954) as well as in cognitive function (p = 0.661). Satisfactory sexual performance was preserved in 9/65 patients (14%) on hormonotherapy and the same was applied to 19/49 patients (39%) without hormonotherapy. The difference was statistically significant (p = 0.003). Hormonotherapy was associated with decreased libido (p = 0.031), hot flushes (p < 0.001) and sweating (p < 0.001). No statistically significant differences were found between the groups in the self-rated physical and psychological well-being (p = 0.476 and p = 0.597), quality of life (p = 0.622) and quality of relationship (p = 0.064). CONCLUSIONS: Adjuvant hormonotherapy enhances neither anxiety nor depression, does not impair cognitive function but has a negative effect on the patients' sexual function. It does not worsen self-rated quality of relationship and quality of life.

An incidentally diagnosed prostatic ductal adenocarcinoma.

Ductal adenocarcinoma of the prostate was initially described in 1967 by Melicow and Patcher. It was given the erroneous name endometrioid carcinoma, however, further studies confirmed the prostatic origin of this tumor. Currently DAP is classified as a histological variant of prostatic carcinoma. Compared with "classic" acinar carcinoma of the prostate, DAP is a rare histological finding. It's prevalence in prostatectomy and biopsy specimens varies from less than 1% for pure ductal adenocarcinoma up to 5% for mixed DAP. Because of its typical periurethral location, the tumor usually manifests itself clinically with urinary obstruction, urinary urgency, urinary frequency and hematuria. DAP is associated with more aggressive natural history and worse prognosis than pure AA - patients presented at more advanced stage, with poorly differentiated and distant disease. DAP has a tendency to spread to regional lymph nodes, axial skeleton, and visceral organs. We report a case of a 90-year old man who presented to our clinic with acute urinary retention and gross hematuria. He underwent suprapubic transvesical adenomectomy to diminish the urinary obstruction. The pathological examination of the specimens revealed a dominant focus of DAP, which was located near the intraprostatic urethra and a coexisting, smaller component of "classic" acinar adenocarcinoma.

Can Stress Enhance Phytoremediation of Polychlorinated Biphenyls?

Phytoremediation-plant-facilitated remediation of polluted soil and groundwater-is a potentially effective treatment technology for the remediation of heavy metals and certain organic compounds. However, contaminant attenuation rates are often not rapid enough to make phytoremediation a viable option when compared with alternative treatment approaches. Different strategies are being employed to enhance the efficacy of phytoremediation, including modification to the plant genome, inoculation of the rhizosphere with specialized and/or engineered bacteria, and treatment of the soil with supplementary chemicals, such as surfactants, chelators, or fertilizers. Despite these efforts, greater breakthroughs are necessary to make phytoremediation a viable technology. Here, we introduce and discuss the concept of integrating controlled environmental stresses as a strategy for enhancing phytoremediation. Plants have a diverse suite of defense mechanisms that are only induced in response to stress. Here, we examine some stress-response mechanisms in plants, focusing on defenses involving physiological changes that alter the soil microenvironment (rhizosphere), and outline how these defense mechanisms can be co-opted to enhance the effectiveness of phytoremediation of polychlorinated biphenyls and other contaminants.

Mucinous tubular and spindle cell carcinoma.

A case of a 30-year-old female patient diagnosed with mucinous tubular and spindle cell carcinoma (MT&SCC) of her left kidney of the basis of an abdominal ultrasound scan performed when nonspecific pain is presented. The histopathology report revealed a classic type of MT&SCC. Photographs of histopathological samples are shown. Nephrectomy was applied as sole treatment. A follow-up of six years confirmed surgery to be a sufficient approach. The discussion presents a review of up to date world literature concerning the histopathological features, prognosis, and treatment of MT&SCC.

Urinary incontinence after radical prostatectomy - experience of the last 100 cases.

Radical prostatectomy (RP) is a recognized treatment method of organ-confined prostate cancer. Among post-surgery complications, urinary incontinence is a major one. The aim of this study was to determine the incontinence rate after RP and to analyze factors that might affect it. Between March 2007 and December 2008, 132 RP's were performed at Warsaw Cancer Center. A questionnaire to assess the condition before and after RP was developed by the authors and sent to all treated patients. The questionnaire focused on health status information, function in urinary domain, rate of returning to "normal" activity level as before RP and satisfaction from the treatment. The median age of patients was 62 years. Out of 132 patients 102 subjects (77.2%) responded to the questionnaire. Of all responders, 35 patients (34.3%) reported total urinary continence after RP. After RP 35(34.3%) patients reported total urinary continence and in 55(53.9%) patients urinary incontinence of medium degree was present. In 12 (11.8%) patients significant urinary incontinence developed. The most common cause of urine dripping (82% of patients with any degree of urinary incontinence) was associated with abdominal muscle pressure. No statistically significant association between urinary incontinence and adjuvant radiotherapy after RP or the surgeon performing the RP was found (>0.79, >0.803). Radical prostatectomy carries a certain risk of complications. We observed an 88.2% rate of significant (total and moderate degree) urinary continence. The adjuvant radiotherapy and surgeons, who performed the RP, did not affect the rate of incontinence.