Anatomic Considerations for Radical Retropubic Prostatectomy in an Achondroplastic Dwarf

This is the first report of a radical retropubic prostatectomy (RRP) in an achondroplastic dwarf. We highlight the pelvic anatomy, precluding laparoscopic or robotic prostatectomy, and making open surgery extremely difficult. We review relevant literature regarding general, urological, and orthopedic abnormalities of achondroplasia (ACH) and present a clinical case. No reports of RRP in achondroplastic dwarfs exist, with only one case of an abandoned RRP due to similar pelvic anatomy in a patient with osteogenesis imperfecta. Significant lumbar lordosis found in ACH results in a short anteroposterior dimension, severely limiting access to the prostate. We present a case of a 62-year-old achondroplastic dwarf who had Gleason 3+4 disease on transrectal ultrasound-guided biopsy in four from 12 cores. Surgery was difficult due to narrow anteroposterior pelvic dimension, but achievable. Histological analysis revealed multifocal prostate cancer, with negative surgical margins and no extraprostatic extension. RRP in ACH patients, although possible, should be approached with caution due to the abnormal pelvic dimensions, and discussions regarding potential abandonment of surgery should be included during informed consent. This case highlights the preoperative use of computed tomography to assist in the surgical planning for patients with difficult pelvic anatomy

Do psychological factors play a crucial role in sport performance? – Research on personality and psychological variables of athletes in Hungary

Contemporary research aims to investigate background factors that contribute to successful sport performance. Of these factors the psychological well-being and mental health status should be underlined that have gained a significant role, particularly in the frames of sport psychological counseling. The aim of the present study is to seek for interrelations of psychological variables and sport performance of young athletes, and to reveal what advantages might be utilized in younger ages to strengthen sport performance. No gender differences were found in sport performance; while age showed significant difference. The findings indicated differences of the investigated psychological variables by age and gender. Regression analyses were employed to test how psychological factors predict successfulsport performance. The analyses strengthened the role of age and gender specific factors that should be considered during sport psychological counseling. The benefits should be highlighted in young age in order to ensure more successful performance in adulthood

Anatomic Considerations for Radical Retropubic Prostatectomy in an Achondroplastic Dwarf

This is the first report of a radical retropubic prostatectomy (RRP) in an achondroplastic dwarf. We highlight the pelvic anatomy, precluding laparoscopic or robotic prostatectomy, and making open surgery extremely difficult. We review relevant literature regarding general, urological, and orthopedic abnormalities of achondroplasia (ACH) and present a clinical case. No reports of RRP in achondroplastic dwarfs exist, with only one case of an abandoned RRP due to similar pelvic anatomy in a patient with osteogenesis imperfecta. Significant lumbar lordosis found in ACH results in a short anteroposterior dimension, severely limiting access to the prostate. We present a case of a 62-year-old achondroplastic dwarf who had Gleason 3+4 disease on transrectal ultrasound-guided biopsy in four from 12 cores. Surgery was difficult due to narrow anteroposterior pelvic dimension, but achievable. Histological analysis revealed multifocal prostate cancer, with negative surgical margins and no extraprostatic extension. RRP in ACH patients, although possible, should be approached with caution due to the abnormal pelvic dimensions, and discussions regarding potential abandonment of surgery should be included during informed consent. This case highlights the preoperative use of computed tomography to assist in the surgical planning for patients with difficult pelvic anatomy

Spermatocytic seminoma with sarcoma: an indication for adjuvant chemotherapy in localized disease.

Spermatocytic seminoma (SCS) with sarcoma is an extremely rare testicular tumor with only 11 cases previously described in the literature. We present the 12th case of SCS with sarcoma in a 29-year-old male. SCS itself is an uncommon germ cell tumor with a relatively indolent clinical course that mostly affects males around the fifth decade of life. Sarcomatous differentiation of SCS occurs in 5% to 6% of cases and correlates with a higher possibility of metastatic disease and a poor prognosis. Clinically, this tumor manifests as a slow-growing testicular mass often with an accelerated period of secondary growth. After a concise review of the literature, we conclude that SCS with sarcoma should be treated by radical inguinal orchidectomy with strong consideration given to adjuvant chemotherapy

Nephrectomy for a renal metastasis of undiagnosed hepatocellular carcinoma arising from an orthotopic liver transplant undertaken for cryptogenic cirrhosis.

Urological involvement of hepatocellular carcinoma (HCC) is rare; HCC arising in an orthotopic liver transplant (OLT) is exceptionally rare. Here we report the case of a 70-year-old man who was incidentally found to have metastatic HCC in the right kidney arising from his OLT undertaken for cryptogenic cirrhosis 10 years previously. Adding to the complexity of this case was the lack of an obvious liver primary HCC at the time of the radical nephrectomy, thus making the final diagnosis all but impossible. We believe this report represents the first report of HCC metastasizing to the kidney after OLT and adds to the few reports in the literature of HCC arising in transplanted livers

Não factores psicológicos desempenham um papel crucial no desempenho esportivo? - Investigação sobre personalidade e psicológicos variáveis de atletas na Hungria

ABSTRACT: Contemporary research aims to investigate background factors that contribute to successful sport performance. Of these factors the psychological well-being and mental health status should be underlined that have gained a significant role, particularly in the frames of sport psychological counseling. The aim of the present study is to seek for interrelations of psychological variables and sport performance of young athletes, and to reveal what advantages might be utilized in younger ages to strengthen sport performance. No gender differences were found in sport performance; while age showed significant difference. The findings indicated differences of the investigated psychological variables by age and gender. Regression analyses were employed to test how psychological factors predict successful sport performance. The analyses strengthened the role of age and gender specific factors that should be considered during sport psychological counseling. The benefits should be highlighted in young age in order to ensure more successful performance in adulthood.RESUMEN: La investigación contemporánea tiene como objetivo investigar los vairables explicativas que contribuyen al rendimiento deportivo exitoso. De estos factores vale la pena destacar el bienestar mental y el estado de salud psicológica que han ganado un papel importante, sobre todo en los marcos de asesoramiento psicológico de deporte. El objetivo del presente estudio es la búsqueda de interrelaciones de variables psicológicas y el rendimiento deportivo de los atletas jóvenes, y revelar qué ventajas podrían ser utilizadas con los más jóvenes para fortalecer el rendimiento deportivo. No se encontraron diferencias de género en el rendimiento deportivo; mientras que la edad mostró diferencias significativas. Los resultados indicaron diferencias en las variables psicológicas estudiadas por edad y género. Se utilizó análisis de regresión para probar cómo los factores psicológicos predicen el rendimiento exitoso. El análisis demostró el papel de los factores específicos de edad y género que deben ser considerados durante el asesoramiento psicológico de deporte. El trabajo psicológico debe comenzar a edades tempranas para garantizar el rendimiento mas exitoso a la edad adultaRESUMO: A investigação contemporânea tem procurado identificar os factores basilares que contribuem para um desempenho desportivo de sucesso. Deste factores, o bem-estar psicológico e o estado de saúde mental devem ser enfatizados tendo ganho um papel significativo, particularmente nas abordagens relativas ao aconselhamento psicológico no âmbito desportivo. O objectivo do presente estudo é identificar interrelações entre as variáveis psicológicas e o desempenho desportivo em jovens atletas e revelar quais as vantagens que podem ser utilizadas por estes jovens para potenciar a sua performance desportiva. Não se verificaram diferenças de género na performance desportiva; enquanto o contrário se verificou relativamente à idade. Estes resultados indicam diferenças nas variáveis psicológicas investigadas tendo em conta o género e a idade. Foram efectuadas análises de regressão para testar como os factores psicológicos predizem uma performance de sucesso. Os resultados enfatizam o papel da idade e do género como factores específicos que devem ser considerados durante o aconselhamento psicoló- gico desportivo. Os benefícios devem ser reforçados nos jovens de forma a garantir uma performance de sucesso na prática desportiva adulta

Effectiveness of epidural versus alternate analgesia for pain relief after radical prostatectomy and correlation with biochemical recurrence in men with prostate cancer.

OBJECTIVES: Our objectives were to analyze the effectiveness of epidural anesthesia in patients who underwent open retropubic radical prostatectomy (RRP) at our institution over the past decade, and to examine subsequent oncologic outcomes, comparing those receiving with those not receiving epidural anesthesia. METHODS: A comprehensive database of all patients undergoing RRP from November 1996 to December 2006 was analyzed; 354 patients underwent RRP at our institution and were divided into those receiving or not receiving an epidural. An independent pain management team scoring technical success found epidural technique to be consistent. Oncological outcome was an endpoint of our study, comparing both analysis groups. We classed prostate-specific antigen (PSA) recurrence after RRP as a serum PSA ≥ 0.2 ng/mL at any stage of postoperative follow-up. Complications were recorded to 30 days using the modified Clavien system, and full statistical analyses were undertaken. RESULTS: Records were available for 239 men; we observed a decreased trend in the use of epidural for pain management, along with a decrease in average hospital stay and an overall epidural success rate of 64%. When dividing data into RRP with and without epidural, we found a median hospital stay of 7 days for patients receiving an epidural compared with 6 days for those not receiving an epidural. The differences were statistically significant (P < 0.048) and remained so after adjusting for complications (P < 0.0001). Regarding oncological outcome, PSA recurrence was further analyzed in this cohort. Percentage of recurrence was higher (14.8%) for patients receiving an epidural than for the non-epidural group (4.8%). The differences were statistically significant (P = 0.012). CONCLUSION: Epidural analgesia increased length of hospital stay and technical problems related to the epidural. Furthermore, men receiving an epidural showed an increased recurrence of PSA. In light of our findings, epidurals are probably not indicated for men undergoing RRP. However, as minimally invasive techniques are becoming more widespread, and epidural analgesia is being used less frequently, large randomized controlled trials to definitively support our hypotheses are unlikely to be undertaken