In vivo and in vitro evidence that intrinsic upper- and lower-limb skeletal muscle function is unaffected by ageing and disuse in oldest-old humans.

AIM: To parse out the impact of advanced ageing and disuse on skeletal muscle function, we utilized both in vivo and in vitro techniques to comprehensively assess upper- and lower-limb muscle contractile properties in 8 young (YG; 25 ± 6 years) and 8 oldest-old mobile (OM; 87 ± 5 years) and 8 immobile (OI; 88 ± 4 years) women. METHODS: In vivo, maximal voluntary contraction (MVC), electrically evoked resting twitch force (RT), and physiological cross-sectional area (PCSA) of the quadriceps and elbow flexors were assessed. Muscle biopsies of the vastus lateralis and biceps brachii facilitated the in vitro assessment of single fibre-specific tension (Po). RESULTS: In vivo, compared to the young, both the OM and OI exhibited a more pronounced loss of MVC in the lower limb [OM (-60%) and OI (-75%)] than the upper limb (OM = -51%; OI = -47%). Taking into account the reduction in muscle PCSA (OM = -10%; OI = -18%), only evident in the lower limb, by calculating voluntary muscle-specific force, the lower limb of the OI (-40%) was more compromised than the OM (-13%). However, in vivo, RT in both upper and lower limbs (approx. 9.8 N m cm(-2) ) and Po (approx. 123 mN mm(-2) ), assessed in vitro, implies preserved intrinsic contractile function in all muscles of the oldest-old and were well correlated (r = 0.81). CONCLUSION: These findings suggest that in the oldest-old, neither advanced ageing nor disuse, per se, impacts intrinsic skeletal muscle function, as assessed in vitro. However, in vivo, muscle function is attenuated by age and exacerbated by disuse, implicating factors other than skeletal muscle, such as neuromuscular control, in this diminution of function.

A comparison of Telos™ stress radiography versus Rolimeter™ in the diagnosis of different patterns of anterior cruciate ligament tears.

INTRODUCTION: Our knowledge on anterior cruciate ligament (ACL) pathomechanics has increased. The diagnosis of partial ACL tears must be accurate in order to adjust the operative planning to anatomic status and injury severity. Instrumented measurement of knee laxity is a useful preoperative tool to quantify anterior tibial translation and several laximetry tests are available. Yet, their accuracy remains to be established. HYPOTHESIS: Clinical examination combined to instrumented laximetry with Telos™ 15 kg and/or Rolimeter™ would increase their sensitivity and specificity in the diagnosis of various ACL injury patterns. MATERIALS AND METHODS: One hundred and seventy-seven patients were prospectively included. The ACL status was validated by arthroscopy. Around 69.5% had a complete ACL tear and 30.5% had a partial ACL tear. RESULTS: Gross laxity with positive clinical tests was associated with complete ACL tears. Mean side-to-side difference was significantly greater with both laximetry methods in complete versus partial ACL tears. Laximetry results among different types of partial tears were not significantly different. Telos™ results were consistent with gross laxity confirmed by pivot-shift test, while this was not recorded with Rolimeter™. Gross laxity with clinical tests and anterior tibial translation more than 5mm with Telos™ were substantially associated with complete ACL tears. DISCUSSION: The combination of standard clinical examination with Telos™ was more accurate than with Rolimeter™ in the preoperative identification of the ACL injury pattern. Applying additional diagnostic tools can help the surgeon to preoperatively diagnose partial or complete ACL ruptures and propose an injury-specific surgical treatment. LEVEL OF EVIDENCE: Level III (case-control study).

[Adrenalectomy and radical nephrectomy due to renal carcinoma]. / Surrenalectomia e nefrectomia radicale per carcinoma renale. Considerazioni.

BACKGROUND: Surgery remains the only effective treatment for renal carcinoma. According the current surgical procedure, both the neoplastic kidney with its perirenal tissue and the Gerota fascia with adrenal gland must be removed. In the last years, the utility of routine adrenalectomy for kidney cancer surgery has been questioned and some authors now recommend this procedure just in selected cases. METHODS: In order to provide a contribution to this debate, 350 cases of nephrectomy after renal carcinoma have been reviewed. In all, 185 adrenalectomy have been performed and neoplastic involvement of adrenal gland has been identified just in 9 cases (4.9%), suggesting a rarity of tumor progression to adrenal gland at the time of surgery. RESULTS: Moreover, neoplastic involvement of adrenal gland has been shown in just 3 cases at preoperatively CT scan. CONCLUSIONS: The conclusion is drawn that adrenal gland may be retained in surgery for radical nephrectomy after renal carcinoma. Adrenalectomy may be recommended in doubtful cases, especially in upper pole localization and in large tumours.

Bellini duct (collecting duct) carcinoma of the kidney.

Carcinoma of the collecting ducts, or Bellini carcinoma, is a rare renal tumour and, unlike most renal cell carcinomas, it derives from distal tubules. It displays highly aggressive behaviour and has a poor prognosis. In this study, the authors present three cases which they observed over the past three years.

Renal adenocarcinoma with lung metastasis in an adolescent.

OBJECTIVE: The finding of a renal adenocarcinoma in a young patient is a rare occurrence. We report on a case of renal adenocarcinoma with lung metastases arising in an 18-year-old girl with non-specific symptoms and normal blood chemistry and urinary analysis. RESULTS AND CONCLUSION: We underscore the aggressive nature of the tumour which grew asymptomatically, giving rise to lymph node and pulmonary metastases.

Comparison between ultrasonography and computerized tomography in the identification of small-sized renal carcinomas.

OBJECTIVES: The increased detection of such small-sized carcinomas has brought a number of new problems regarding the surgical approach to be adopted. We review our experience with 34 patients with small-sized renal carcinomas, comparing the US and CT data with histological findings. METHODS: In a series of 150 cases of renal carcinoma, small sized carcinomas were diagnosed in 34 patients. All patients were examined by US and CT. RESULTS AND CONCLUSION: Five patients presented bifocal carcinomas. CT identified 100% of the small-sized carcinomas, failing only to identify the smaller carcinomas measuring less than 1 cm in diameter in the bifocal carcinoma cases, whereas US identified only 78.3% of the cases. The authors, moreover, mention the problem of multifocal tumours as an argument against performing a partial nephrectomy in the presence of two normally functioning kidneys, and believe it is advisable to reserve such conservative surgery for a selected number of cases.

[Adrenal involvement in renal carcinoma. Diagnostic value of computerized tomography]. / Coinvolgimento surrenalico nel carcinoma renale. Valore diagnostico della Tomografia Computerizzata.

PURPOSE: We investigated the sensitivity and specificity of computed tomography (CT) in the detection of ipsilateral involvement of the adrenal glands by renal cancer. MATERIAL AND METHODS: We reviewed 350 cases of radical nephrectomy for renal cancer; the adrenal gland had been removed during nephrectomy in 185 cases. RESULTS: Histology confirmed adrenal gland involvement from renal cancer in 9 cases, namely 4 metastatic nodules and 5 cases of direct tumor invasion. Adrenal involvement was identified by preoperative CT in 3 cases only: the gland was undetectable in 2 of them, being masked by a large tumor mass, while it appeared normal on CT images in the 4 patients with metastatic nodules. CONCLUSIONS: An adrenal gland appearing normal during preoperative CT assessment of renal cancer is not very likely to be involved by cancer (2.4% of cases in our series), while a gland missed at CT is very likely involved because it may be masked by a large tumor.

[Echographic assessment of cutaneous neoplasms]. / Valutazione ecografica delle neoplasie cutanee.

A hundred and fifteen skin tumors were evaluated by means of US. Three variables were considered for each lesion--i.e., borders, echostructure and thickness--and the results compared with histology. High agreement was observed in melanomas: in these tumors, indeed, thickness is well known to be relevant for both surgical planning and prognosis. US scans with a 10 MHz transducer allowed the accurate assessment of borders and structure only in certain, mainly benign, kinds of skin tumors--e.g., angiomas, pilomatrixomas, sebaceous cysts and lipomas--, but also in lymphomas. On the contrary, most malignant neoplasms exhibit hypoechoic structure and borders from clear-cut to blurred. Finally, US proved to be highly reliable in demonstrating lesion thickness before surgery. High agreement was once again observed with histology relative to this variable: thickness (in mm) was the same in 30% of cases, overestimated by US (mean: 0.3 mm) in 44% of cases and underestimated by US (mean: 0.15 mm) in 26% of cases. Particularly, in 41 melanomas, histology-US agreement rate was 44% for the Breslow index, with r = 0.95 and 88% for the Clark index.

Small renal-cell carcinomas: clinical and imaging features.

The authors review the clinical, pathological and imaging characteristics of 20 patients with histological confirmation of 23 renal-cell carcinomas measuring < or = 3 cm in size. All lesions were unilateral. All patients were submitted to CT investigations, which identified 20 tumours (86%) and failed to identify 3 small-sized neoplastic nodular formations (0.4, 0.4, 0.8 cm) in patients with double tumour localisation in the same kidney. 15 patients underwent ultrasonography (US) which detected 11 carcinomas out of 17 (65%); of the 6 tumours (in 4 patients) not detected by US, 4 were identified by CT; 2 of these patients were subsequently re-examined by US with identification of the tumour. US failed to detect the 2 small tumours unidentified by CT (the third patient did not undergo US). 17 patients had no renal symptoms, and identification of the tumour was an incidental finding. The increasingly widespread use of US and CT enables a large number of kidneys to be examined and thus permits identification of a greater number of small-sized kidney tumours, allowing early surgical intervention with a greater chance of success. The technical options in surgical therapy may be multiple, though the use of any operation other than nephrectomy tends to be limited by the possible presence of small neoplastic nodular formations in the same kidney, which may not be detectable by US or CT owing to their very small size.

[Intra-renal ultrasound and color Doppler: pathology or nephrologic significance]. / Eco e color Doppler intra-renale: patologia di interesse nefrologico.

Us-Doppler examination of the native kidney gives more detailed information on nephrological vascular disease. Since there is a close connection between renal functional units (nephrons) and vascular and interstitial compartments, alterations in intrarenal flow will obviously occur in all types of medical nephropathy, irrespective of the origin of the anatomopathological damage. Altered intrarenal flow occur with increased vascular impedance, in turn related to an increased resistance index (RI). In nephropathy with dilatation, the RI can distinguish obstructive from non-obstructive dilatation (high and normal RI, respectively). Personal experience of 80 kidneys with nonobstructive medical nephropathy has shown a good correlation between increased RI and deterioration of renal function, demonstrating that, renal function being equal, RI is higher in Vascular than Tubulo-interstitial and Glomerular nephropathies. For medical nephropathy of transplanted kidneys, Us-Doppler evaluation can be combined with conventional Doppler for diagnosing acute rejection. In this series, an elevated RI (0.90) is highly predictive of acute rejection (92% specificity) but has low sensitivity (30%). At the threshold value of RI = 0.80, sensitivity is 66% and specificity is 78%. However, it is considered that far more reliable information is obtained if Doppler examination is combined with conventional U.S. morphology.

Renal needle biopsy of the transplant kidney: vascular and urologic complications.

The authors reviewed the complications of 114 needle biopsies performed in 103 transplant kidneys. The diagnostic and therapeutic approach has changed markedly as a result of the introduction of Doppler ultrasound and the possibility of selectively embolizing fistula tracts. Macroscopic haematuria was the most frequent complication (5%); in one case it appeared 1 week after biopsy and was complicated with obstructive anuria due to a pyeloureteric clot. The incidence of arteriovenous fistulae was fairly low (0.9%); a selective renal angiography was performed, confirming the vascular lesion and allowing its selective embolization. Perirenal blood collections were also rare and the amounts were small.

[Renal angiomyolipoma: diagnostic approach and therapeutic up-date; report of 11 clinical cases]. / L'angiomiolipoma renale: orientamento diagnostico ed attualità terapeutiche; a proposito di 11 osservazioni cliniche.

Eleven cases of renal angiomyolipoma are reported. In all cases a correct preoperative diagnosis was made, using standards x-radiography, ultrasonography and computerized tomography. Small size AML do not generally require any surgery, while surgical procedures for larger AML vary depending on the size, associated diseases, other complicating factors. As a general rule, surgical treatment should be as conservative as possible.

[Renal-colonic-cutaneous fistula secondary to xanthogranulomatous pyelonephritis]. / Fistola reno-colon-cutanea secondaria a pielonefrite xantogranulomatosa.

The appearance of intestinal fistulas secondary to kidney disease is a rare occurrence. Even rarer are complex fistulas involving several organs or systems [correction of apparati]. In this study, the authors report on a case of reno-colo-cutaneous fistula which set in as a complication of xanthogranulomatous pyelonephritis.

[10 cases of xanthogranulomatous pyelonephritis]. / Considerazioni su 10 casi di pielonefrite xantogranulomatosa.

Xanthogranulomatous pyelonephritis (XGP) is a chronic inflammation of the kidney usually associated with renal stones, recurrent urinary tract infections or endocrine disorders. A correct preoperative diagnosis is rarely made, since no specific clinical or radiological pattern is known. Differential diagnosis must include renal tuberculosis and renal carcinoma. Ten cases of XGP are reported. Clinical findings, radiological and pathological features, biolaboratory abnormalities are discussed.

Leiomyomata of the oesophagus: report of four surgically-treated cases.

Four patients with leiomyoma of the upper or middle third of the oesophagus treated by surgical excision are reported. All operations were performed through a right thoracotomy with simple enucleation of the lesion. Two patients were asymptomatic. In one the tumour had a spiral configuration almost completely surrounding the lumen. No complications occurred. Early surgical treatment is advised although the tumour grows slowly.