Use of Perirectal Hyaluronic Acid Spacer Prior to Radiotherapy in a Pediatric Patient With Bladder Rhabdomyosarcoma: A Case Report.

Rhabdomyosarcoma (RMS) treatment involves surgery, chemotherapy, and radiotherapy. A radioprotective space between the bladder/prostate and rectum reduces postradiation complications, as reported in adult patients. Describe pediatric preradiotherapy perirectal hyaluronic acid (HA) spacer injection for bladder/prostate RMS. We present a case of a 17-month-old male with bladder/prostate RMS. Before radiotherapy, an HA spacer was injected peri-rectally. Under general anesthesia, a transrectal ultrasound was positioned and 1mL of HA spacer was injected into the perirectal space. No complications were reported at 6-month follow-up. This is the first report of pre-radiation therapy spacer injection for pediatric bladder/prostate RMS.

Disorders in the function of Sertoli cells and arrest in the differentiation of gonocytes in patients with cryptochidism and microlithiasis.

PURPOSE: This study aimed to correlate the presence of microlithiasis (ML) in cryptorchidism (CO) patients with the functionality of Sertoli cells and the arrest of gonocyte differentiation. METHODS: Testicular biopsies were obtained from 21 inguinal CO pediatric patients and were classified in two groups as follows: patients with ML and those without ML. In both groups, the number of Sertoli cells/seminiferous cords and their functionality were determined, considering the concentrations of inhibin B. In addition, the area and the histological alterations of seminiferous epithelium were evaluated. The arrest of gonocyte differentiation was determined by immunoreactivity to SALL4, AP2É£, PLAP and POU5F1. RESULTS: We found a statistical correlation between the presence of ML with the alterations in the functionality of Sertoli cells without reflecting in the differentiation of the gonocytes. CONCLUSION: The study of this population suggests that the association between CO and ML shows a malfunction of the Sertoli cells without necessarily causing arrest in the differentiation of gonocytes in these patients.

IgG4-Related Autoimmune Prostatitis: Is It an Unusual or Underdiagnosed Manifestation of IgG4-Related Disease?

IgG4-related disease (IgG4-RD) encompasses a wide range of extrapancreatic manifestations. Albeit some are relatively well known, others such as autoimmune prostatitis remain poorly described. We present a 61-year-old Latin-American male with autoimmune pancreatitis (AIP) who presented with lower urinary tract symptoms (LUTS), normal prostate specific antigen (PSA) test, and prostate enlargement attributed to benign prostatic hyperplasia (BPH). He underwent a transurethral resection of the prostate (TURP) after which symptoms were resolved. On histopathology, prostatic stroma had a dense inflammatory infiltrate rich in plasma cells and lymphocytes; immunohistochemical morphometric assessment showed >10 IgG4-positive plasma cells/high power field (HPF). The diagnosis of IgG4-related prostatitis was postoperatively. We compared the patient characteristics with those of previous reports on Asian patients. Shared findings included prostate enlargement, LUTS (symptoms that can be confused with BPH), and PSA within normal limits or mild elevations. IgG4-related prostatitis is rarely considered as a preprocedural diagnosis, even in patients with evidence of IgG4-RD. Involved prostate zones include mainly central and transitional zones and less frequently the peripheral. Currently, there is insufficient data about the natural history and outcome. Whether steroids, transurethral resection, or both are the treatment of choice needs to be elucidated.

The role of ischemia in the deterioration of renal function after partial nephrectomy.

OBJECTIVES: Nephron-sparing surgery (NSS ) has been considered throughout history for patients with solitary kidney, bilateral renal tumors, impaired renal function (RF), and hereditary renal cancer. However, recently the indications for Partial Nephrectomy (PN ) have extended and include patients with a healthy contralateral kidney. NSS has evolved in a great way during the last decade, specifically in terms of oncological indications, and in the renal ischemia time used with the goal to maintain as much renal function as possible. This change is secondary to a better understanding of renal cancer histology, the equivalence in oncological outcomes between radical and PN, and finally the impact of chronic kidney disease (CKD ) as a cause of cardiovascular complications and mortality.The main purpose of our study is to review the role of ischemia in NSS. METHODS: A literature review was performed focusing on NSS, risk factors of renal damage, types of ischemia, as well as its effect on RF, and ischemia time. CONCLUSIONS: Renal ischemia has been considered for a long time as the main factor related with postoperative Renal Function (RF) in patients with NSS. Furthermore it is one of the few modifiable factors that directly depend on the surgeon. The ischemia time limit, both in warm and cold, is not well established and is a controversial issue that is still on debate till now. At this moment, there is evidence that considers the impact of ischemia only in acute or early stages. Also other factors have emerged and seem to have greater effect on RF, mainly in the long-term, leaving ischemia in second place. These factors are the quantity and quality of the remaining renal parenchyma. More studies are needed to support this rising concept and to clarify the real part that ischemia plays.

Papel de la isquemia en el deterioro de la función renal tras nefrectomía parcial / The role of ischemia in the deterioration of renal function after partial nephrectomy

OBJETIVO: Históricamente se ha considerado la Cirugía Renal Conservadora (CRC) en pacientes con riñón solitario, tumores bilaterales, alteración en la función renal y cáncer renal hereditario. Sin embargo en la actualidad las indicaciones de nefrectomía parcial se han extendido a pacientes con riñón contralateral sano. La CRC ha evolucionado de manera muy importante en la última década, específicamente en términos de indicaciones oncológicas y en el tiempo de isquemia renal utilizado con el objetivo de mantener la función renal posible. El objetivo principal de este estudio es realizar una revisión del papel que tiene la isquemia en la CRC. MÉTODOS: Se llevó a cabo una revisión de la literatura enfocada en CRC, factores de riesgo de daño renal, tipos de isquemia así como su duración y efecto sobre la Función Renal (FR). CONCLUSIONES: La isquemia renal ha sido considerada durante muchos años como el principal factor asociado con la FR postoperatoria en pacientes intervenidos de CRC. A su vez, es uno de los pocos factores modificables que dependen directamente del cirujano. El tiempo límite de isquemia, tanto caliente como fría, no está bien establecido. En la actualidad existe evidencia que considera el impacto de la isquemia limitado solamente a etapas tempranas o agudas. Asimismo han surgido otros factores que parecen tener mayor efecto sobre la FR, principalmente a largo plazo, dejando a la isquemia en un segundo plano. Dichos factores son la cantidad y calidad del parénquima renal residual. Se requieren más estudios que refuercen este concepto emergente y que nos aclaren el papel real de la isquemia (AU)

OBJECTIVES: Nephron-sparing surgery (NSS) has been considered throughout history for patients with solitary kidney, bilateral renal tumors, impaired renal function, and hereditary renal cancer. However, recently the indications for Partial Nephrectomy (PN) have extended and include patients with a healthy contralateral kidney. NSS has evolved in a great way during the last decade, specifically in terms of oncological indications, and in the renal ischemia time used with the goal to maintain as much renal function as possible. This change is secondary to a better understanding of renal cancer histology, the equivalence in oncological outcomes between radical and PN, and finally the impact of chronic kidney disease (CKD) as a cause of cardiovascular complications and mortality. The main purpose of our study is to review the role of ischemia in NSS. METHODS: A literature review was performed focusing on NSS, risk factors of renal damage, types of ischemia, as well as its effect on renal function, and ischemia time. CONCLUSIONS: Renal ischemia has been considered for a long time as the main factor related with postoperative Renal Function (RF) in patients with NSS. Furthermore it is one of the few modifiable factors that directly depend on the surgeon. The ischemia time limit, both in warm and cold, is not well established and is a controversial issue that is still on debate till now. At this moment, there is evidence that considers the impact of ischemia only in acute or early stages. Also other factors have emerged and seem to have greater effect on RF, mainly in the long-term, leaving ischemia in second place. These factors are the quantity and quality of the remaining renal parenchyma. More studies are needed to support this rising concept and to clarify the real part that ischemia plays (AU)

Long-term results of a randomized trial comparing banded versus standard laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Banded Roux-en-Y gastric bypass was designed to avoid or diminish weight regain in the long term. In 2008, we published the initial results of a pilot study design to comparatively evaluate surgical morbidity, mortality, and maximum weight loss in patients undergoing banded and unbanded laparoscopic Roux-en-Y gastric bypass (LRYGB). The present study analyzes the 5-year results. METHODS: A randomized, controlled trial was carried out in 60 morbidly obese patients who underwent LRYGB. Patients were divided in 2 groups. Half of the patients underwent the banded version of the LRYGB, and half underwent the unbanded version. The 5-year excess weight loss (EWL) and loss of body mass index (BMI) were comparatively analyzed. RESULTS: There were 58 females and 2 males with a mean preoperative BMI of 47±4.9 kg/m(2). A total of 21 patients with banded LRYGB and 22 with unbanded LRYGB completed 5-year follow-up. One patient died 3 years after surgery from metastatic melanoma. EWL at 5 years was 61.6%±19.6% versus 59.8%±15.9% (P = ns), and loss of BMI was 32.9%±5.2% versus 32.8%±4.3% (P = ns), respectively, for the banded and unbanded group. CONCLUSIONS: In this small study, there were no statistical differences in the EWL and the BMI lost at 5 years between the group of patients who underwent banded and unbanded LRYGB.

Pseudohyperplastic prostatic carcinoma in simple prostatectomy.

Pseudohyperplastic carcinoma (PHPC) is a prostatic neoplasm that can be easily mistaken for nodular hyperplasia or atypical adenomatous hyperplasia. To determine the frequency and clinicopathologic characteristics of PHPC, we reviewed 200 simple prostatectomy specimens. We found 3 cases (1.5%) of PHPC. The tumors were small and ranged in size from 4 to 6 mm. Two of them were erroneously diagnosed as benign glandular proliferations in the original interpretation. Their histologic aspect at low magnification showed nodules of well-differentiated medium-sized glands with cystic dilation in a tight arrangement that imparted a benign appearance. Corpora amylacea were found in 2 cases. However, the lining cells showed nucleomegaly and prominent nuclei in most of the neoplastic glands, and the high-molecular-weight keratin (34BE12) immunostain revealed absence of basal cells. α-Methylacyl-CoA-racemase was positive in 2 cases. In one case, a small focus of moderated acinar adenocarcinoma was found adjacent to the pseudohyperplastic glands facilitating the diagnosis. The 3 patients are disease-free 3 and 4 years after surgery probably because of the small size of the tumors; however, it must be emphasized that most PHPC are considered moderately differentiated and potentially aggressive neoplasms.

Maximal weight loss after banded and unbanded laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) leads to significant weight loss and correction of co-morbidities in most patients. Banded LRYGB was designed to enhance weight loss and avoid weight regain. METHODS: A randomized controlled pilot trial was designed to comparatively analyze the results and complications of banded (6.5 cm) and unbanded LRYGB. The present study was an interim analysis focused on morbidity, mortality, and maximal weight loss. RESULTS: The 60 patients were divided into 2 groups. Group 1 underwent unbanded LRYGB (n = 30) and group 2 underwent banded LRYGB (n = 30). No differences were found between the 2 groups in terms of age, gender, body mass index, or operative time. No significant differences were found in the percentage of excess weight loss and body mass index at 6, 12, and 24 months between the 2 groups. The frequency of complications was similar in both groups; 1 patient required band removal because of stenosis at the level of the mesh. CONCLUSION: The weight loss pattern in both groups was similar at 1 and 2 years postoperatively. Proper assessment of weight maintenance and late weight regain will require longer follow-up.

An unusual cause of bilioenteric anastomotic dysfunction after iatrogenic bile duct injury.

Roux en Y hepatojejunostomy is the surgery of choice for bile duct repair. Anastomotical dysfunction after reconstruction has several etiopathologies. Besides technical factors, ischemia of the duct is responsible for late obstruction. Bile colonization with secondary stones and sludge can also be identified as a cause. An unusual cause of anastomotical dysfunction secondary to ascaris biliary infestation after biliary reconstruction is reported herein. The patient had intermittent cholangitis and eosinophilia. At operation, the worm was found obstructing the anastomosis.