Electrolyte Disorders Induced by Antineoplastic Drugs.

The use of antineoplastic drugs has a central role in treatment of patients affected by cancer but is often associated with numerous electrolyte derangements which, in many cases, could represent life-threatening conditions. In fact, while several anti-cancer agents can interfere with kidney function leading to acute kidney injury, proteinuria, and hypertension, in many cases alterations of electrolyte tubular handling and water balance occur. This review summarizes the mechanisms underlying the disturbances of sodium, potassium, magnesium, calcium, and phosphate metabolism during anti-cancer treatment. Platinum compounds are associated with sodium, potassium, and magnesium derangements while alkylating agents and Vinca alkaloids with hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH). Novel anti-neoplastic agents, such as targeted therapies (monoclonal antibodies, tyrosine kinase inhibitors, immunomodulators, mammalian target of rapamycin), can induce SIADH-related hyponatremia and, less frequently, urinary sodium loss. The blockade of epidermal growth factor receptor (EGFR) by anti-EGFR antibodies can result in clinically significant magnesium and potassium losses. Finally, the tumor lysis syndrome is associated with hyperphosphatemia, hypocalcemia and hyperkalemia, all of which represent serious complications of chemotherapy. Thus, clinicians should be aware of these side effects of antineoplastic drugs, in order to set out preventive measures and start appropriate treatments.

Early exploratory intervention in scrotal trauma.

INTRODUCTION: The aim of our study is to assess the incidence of the surgical approach in scrotal trauma. MATERIALS AND METHODS: We retrospectively assessed both penetrating and blunt cases of scrotal trauma observed from 2002 to 2012. For each case we considered various parameters such as the age of the patient, whether the type of trauma was penetrating or blunt, whether or not a surgical approach was taken, whether or not there were polytrauma, whether or not an orchiectomy was performed, and how many days had elapsed since the first urological observation of the trauma. RESULTS: 43 cases of scrotal trauma were assessed, of which 39 were blunt traumas (90%) and four penetrating traumas (10%). The median age of all patients was 29 years (range 4-88). Of these patients, eight underwent surgical procedures, of which three were cases of penetrating scrotal trauma and five were cases of blunt trauma, with an average age of 20. We only found it necessary to carry out an orchiectomy in two of these patients, of which one was after penetrating trauma and the other after blunt trauma. Most of the blunt traumas did not require surgery (8 versus 35, p<0.05). CONCLUSIONS: In our case studies, in the majority of cases early exploratory intervention in scrotal trauma allows the testicle to be saved in its entirety or at least in part.