43 research outputs found
Chronic, nonspecific, postinfectious, retroperitoneal fibrosis and ureteral obstruction
ABSTRACT
Introduction: Two cases of severe ureteral obstruction following nonspecific, postinfectious, chronic retroperitoneal
fibrosis are described, which both originated by a primitive intestinal pathology.
Patients: This complication was observed in two women: first, 65 years old, submitted for ulcerative colitis to a
total proctocolectomy, with ileo-pouch-anal anastomosis, complicated by an anastomotic fistula; and second,
66 years old, operated with an extended left hemicolectomy, for an adenocarcinoma of the recto-sigmoid colon
complicated with a vaginal fistula. In these cases, computerized tomography demonstrated a unilateral hydronephrosis,
secondary to a complete obstruction of the ureter; a subsequent nephro-ureterectomy became necessary.
Histology demonstrated nonspecific inflammatory lesions.
Discussions: Postinfectious, chronic inflammation of the retroperitoneum acts on the ureteral and peri-ureteral
tissues, inducing an inflammatory and then a fibrotic process.
Conclusions: We underline the opportunity of a precocious and radical treatment of every retroperitoneal
infection.
Keywords: Intestinal fistula, Retroperitoneal fibrosis, Retroperitoneal infection, Ureteral obstructionINTRODUCTION:
Two cases of severe ureteral obstruction following nonspecific, postinfectious, chronic retroperitoneal fibrosis are described, which both originated by a primitive intestinal pathology.
PATIENTS:
This complication was observed in two women: first, 65 years old, submitted for ulcerative colitis to a total proctocolectomy, with ileo-pouch-anal anastomosis, complicated by an anastomotic fistula; and second, 66 years old, operated with an extended left hemicolectomy, for an adenocarcinoma of the recto-sigmoid colon complicated with a vaginal fistula. In these cases, computerized tomography demonstrated a unilateral hydronephrosis, secondary to a complete obstruction of the ureter; a subsequent nephro-ureterectomy became necessary. Histology demonstrated nonspecific inflammatory lesions.
DISCUSSIONS:
Postinfectious, chronic inflammation of the retroperitoneum acts on the ureteral and peri-ureteral tissues, inducing an inflammatory and then a fibrotic process.
CONCLUSIONS:
We underline the opportunity of a precocious and radical treatment of every retroperitoneal infection
Effect of green tea catechins in patients with high-grade prostatic intraepithelial neoplasia: Results of a short-term double-blind placebo controlled phase II clinical trial
Background and study objective: Several studies suggest a protective role of green tea catechins against prostate cancer (PCa). In order to evaluate the efficacy of green tea catechins for chemoprevention of PCa in patients with high-grade prostate intraepithelial neoplasia (HG-PIN) we performed a phase II clinical trial. Methods: Sixty volunteers with HG-PIN were enrolled to carry out a double-blind randomized placebo-controlled phase II clinical trial. Treated group took daily 600 mg of green tea catechins (Categ Plus®) for 1 year. Patients were screened at 6 and 12 months through prostatic biopsy and measurements of prostate-specific antigen (PSA). Results: Despite the statistically significant reduction of PSA observed in subjects who received green tea catechins for 6 and 12 months, we did not find any statistical difference in PCa incidence between the experimental groups neither after 6 nor after 12 months. However, throughout the one-year follow-up we observed very limited adverse effects induced by green tea catechins and a not significant improvement in lower urinary tract symptoms and quality of life. Conclusions: Although the small number of patients enrolled in our study and the relatively short duration of intervention, our findings seems to deny the efficacy of green tea catechins. However, results of our clinical study, mainly for its low statistical strength, suggest that the effectiveness of green tea catechins should be evaluated in both a larger cohort of men and longer trial
Renal Cell Carcinoma with venous neoplastic thrombosis: A ten years review
Purpose: To review the 10-year experience of our urological unit in the surgical management of renal cell carcinoma (RCC) with neoplastic tumor thrombosis focusing on postoperative survival. Materials and Methods: We underwent a retrospective analysis of the patients treated for this pathology during the last decade 2002-2012, stratifying them by tumor thrombus level and histological subtype. Kaplan-Meyer curves were used to assess survival. Results: Overall, 67 patients underwent surgery for RCC with neoplastic tumoral thrombosis in the period under review. 60 were clear cell RCC, 4 were urothelial papillary tumors of the renal pelvis and 3 were rare histotypes, as a nefroblastoma, a spinocellular tumor of the renal pelvis and an unclassifiable renal carcinoma. Thrombus level was I in 40 cases, II in 17, III in 2 and IV in 8 patients. We report the main postoperative complications and our survival data, with mean follow up of 36 months. Tumor stage is the most important variable in predicting survival. Patients with N0M0 disease had 70% survival at 36 months, instead of 20% for those with primitive metastatic tumor. Conclusion: Our survival results fit with the main reports in literature and our surgical management was completely in keeping with international guidelines. We did not observe relevany post-operative complications, except of hemorrhagic ones that occurred in 6 patients (9% of total) and were always successfully managed. Eighteen patients (26.87% of total) underwent caval filter positioning, without evidence of complications during its positioning or removal. Life expectancy was particularly low for the cases of RCC without clear cell histotype (7 cases in our series, 10.4% of total) that always was less than one year from surgery
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries
Confocal Laser Endomicroscopy for Bladder Cancer Detection: Where Do We Stand?
Introduction: Confocal laser endomicroscopy (CLE) is a relatively new technology that allows for a real-time in situ microscopic characterization of tissue lesions, being able to discriminate between low- and high-grade ones. After a first period of slow diffusion caused by technological limitations and elevated costs, CLE applications are rapidly spreading in different branches of medicine, and there is mounting evidence of its advantages for the management of different tumors such as bladder cancer (BCa), from both a diagnostic and a clinical point of view. In this systematic review (SR), we evaluate the state-of-the-art CLE for BCa management. Material and methods: We performed an SR and quality assessment analysis of the current literature in this regard following the PRISMA guidelines. All data were independently verified by two different authors and discrepancies were solved by a third author. Moreover, a quality-assessment analysis according to QUADAS-2 criteria was performed to evaluate the studies selected for SR. Results: A total of 158 articles were retrieved; of which 79 were rejected and 38 were removed as duplicates. After article selection, seven prospective studies were assessed for data extraction. These accounted for 214 patients overall, with a correspondence rate between CLE and histopathological examination ranging from 54.6 to 93.6%. Regarding quality assessment, three out five prospective studies have at least a high risk of bias in one QUADAS-2 domain, whereas the applicability always has a low risk of bias. Conclusion: Despite actual technical limitations, the preliminary results of this appealing technology are encouraging and should prompt further investigations
Confocal Laser Endomicroscopy for Bladder Cancer Detection: Where Do We Stand?
Introduction: Confocal laser endomicroscopy (CLE) is a relatively new technology that allows for a real-time in situ microscopic characterization of tissue lesions, being able to discriminate between low- and high-grade ones. After a first period of slow diffusion caused by technological limitations and elevated costs, CLE applications are rapidly spreading in different branches of medicine, and there is mounting evidence of its advantages for the management of different tumors such as bladder cancer (BCa), from both a diagnostic and a clinical point of view. In this systematic review (SR), we evaluate the state-of-the-art CLE for BCa management. Material and methods: We performed an SR and quality assessment analysis of the current literature in this regard following the PRISMA guidelines. All data were independently verified by two different authors and discrepancies were solved by a third author. Moreover, a quality-assessment analysis according to QUADAS-2 criteria was performed to evaluate the studies selected for SR. Results: A total of 158 articles were retrieved; of which 79 were rejected and 38 were removed as duplicates. After article selection, seven prospective studies were assessed for data extraction. These accounted for 214 patients overall, with a correspondence rate between CLE and histopathological examination ranging from 54.6 to 93.6%. Regarding quality assessment, three out five prospective studies have at least a high risk of bias in one QUADAS-2 domain, whereas the applicability always has a low risk of bias. Conclusion: Despite actual technical limitations, the preliminary results of this appealing technology are encouraging and should prompt further investigations
Renal Cell Carcinoma with venous neoplastic thrombosis: A ten years review
Purpose: To review the 10-year experience of our urological unit in the surgical management of renal cell carcinoma (RCC) with neoplastic tumor thrombosis focusing on postoperative survival. Materials and Methods: We underwent a retrospective analysis of the patients treated for this pathology during the last decade 2002-2012, stratifying them by tumor thrombus level and histological subtype. Kaplan-Meyer curves were used to assess survival. Results: Overall, 67 patients underwent surgery for RCC with neoplastic tumoral thrombosis in the period under review. 60 were clear cell RCC, 4 were urothelial papillary tumors of the renal pelvis and 3 were rare histotypes, as a nefroblastoma, a spinocellular tumor of the renal pelvis and an unclassifiable renal carcinoma. Thrombus level was I in 40 cases, II in 17, III in 2 and IV in 8 patients. We report the main postoperative complications and our survival data, with mean follow up of 36 months. Tumor stage is the most important variable in predicting survival. Patients with N0M0 disease had 70% survival at 36 months, instead of 20% for those with primitive metastatic tumor. Conclusion: Our survival results fit with the main reports in literature and our surgical management was completely in keeping with international guidelines. We did not observe relevany post-operative complications, except of hemorrhagic ones that occurred in 6 patients (9% of total) and were always successfully managed. Eighteen patients (26.87% of total) underwent caval filter positioning, without evidence of complications during its positioning or removal. Life expectancy was particularly low for the cases of RCC without clear cell histotype (7 cases in our series, 10.4% of total) that always was less than one year from surgery
Morphological and functional analysis of a cohort of patients undergoing orthotopic ileal neobladder
INTRODUCTION: This study was conducted between January 2001 and December 2013 to evaluate patient's outcomes after radical cystectomy and orthotopic ileal neobladder from a morphological and functional point of view at a median follow-up of 2 years.
MATERIALS AND METHODS: A total of 48 eligible patents were included. We first report our technical modifications to Studer's neobladder. Sequently, after a medium follow-up of two years, we assessed morphology of the reservoir and voiding functionality of this patients cohort, submitting them to specific questionnaires and to uroflowmetry.
RESULTS: Early and late postoperative data are available for 36 patients. From the morphological follow-up, 2 years after surgery, six patients had hydroureteronephrosis for vescico-ureteral reflux in four cases (11% of total) and uretero-neobladder anastomosis stenosis in the other two (5.6% of total). Neobladder shape always remained spherical, with a relative right lateralization in eight cases (22.2%). Regarding the nine patients subjected to uroflowmetry, seven (77.7%) highlighted the lack of postvoid residual urine, with a maximum urinary flow rate within the normal range in six of them.
DISCUSSION: Improvements in surgical technique may help to reduce complications rate. From uroflowmetry analysis, we can observe that the mean filling pressure following surgery was relatively stable and urinary flow rate was mostly satisfactory. In patients without postvoid residual urine, all referred absence of daily incontinence and good quality of life.
CONCLUSION: From this morpho-functional evaluation, our orthotopic Studer-modified ileal neobladder seems an ideal solution for urinary diversion, presenting functional features similar to native bladder and assuming a well-defined morphology, not changing in time