A novel combination of triple metachronous malignancies of the kidney, oropharynx and prostate. A case report

Synchronous or metachronous malignancies are a rare event, with an incidence rate that increases with age. The present study reports the case of a 70-year-old Caucasian male who was referred to the outpatient office of the Urology Unit, Sapienza University of Rome (Latina, Italy) due to lower urinary tract symptoms. An abdominal ultrasound investigation was performed that demonstrated the presence of a right renal mass. The patient underwent right radical nephrectomy, which resulted in the definitive diagnosis of clear cell type renal cell carcinoma. The patient was eventually diagnosed with triple primary metachronous cancer consisting of renal clear cell carcinoma, prostate adenocarcinoma and squamous cell carcinoma of the oropharynx (palatine tonsil). To the best of our knowledge, this combination of primary neoplasms has not previously been documented

Combined laparoscopic pyelolithotomy and endoscopic pyelolithotripsy for staghorn calculi. Long-term follow-up results from a case series

Purpose: Staghorn renal stones are a challenging field in urology. Due to their high recurrence rates, particularly those associated with an infective process, a complete removal is the ultimate goal in their management. We report our experience with a combined approach of laparoscopic pyelolithotomy and endoscopic pyelolithotripsy, the stone clearance rate, and long-term, follow-up outcomes. Methods: From June 2012 to October 2014, nine adult patients with large staghorn renal calculi (mean size, 7.2 cm; range, 6.2–9.0 cm) underwent a combined laparoscopic and endoscopic approach. The technique comprised laparoscopic pyelolithotomy and holmium-YAG laser stone fragmentation with the use of a flexible cystoscope introduced through a 12 mm trocar. Results: The average operative time was 140 min (range, 90–190 min). The mean estimated hemoglobin loss was 0.6 mmol/l (range 0.5–0.7 mmol/l). None of the patients required an open- surgery conversion. The mean hospital stay was 4 days (range, 2–6 days). A computed tomography urogram control at 6 months of follow up did not show any stone recurrence. Conclusions: Laparoscopic pyelolithotomy combined with endoscopic pyelolithotripsy could be a therapeutic option in cases where mini-invasive procedures, that is, extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, and percutaneous nephrolithotomy (PCNL) have failed. This technique has a high stone-clearance rate (75–100%) comparable with open surgery and PCNL. However, it could be technically demanding and should be performed by skilled laparoscopy surgeons

Prospective study to compare antibiosis versus the association of N-acetylcysteine, D-mannose and morinda citrifolia fruit extract in preventing urinary tract infections in patients submitted to urodynamic investigation

BACKGROUND: The abuse of antimicrobical drugs has increased the resistance of microorganisms to treatments, thus to make urinary tract infections (UTIs) more difficult to eradicate. Among natural substances used to prevent UTI, literature has provided preliminary data of the beneficial effects of D-mannose, N-acetylcysteine, and Morinda citrifolia fruit extract, due to their complementary mechanism of action which contributes respectively to limit bacteria adhesion to the urothelium, to destroy bacterial pathogenic biofilm, and to the anti-inflammatory and analgesic activity. The purpose of this study was to compare the administration of an association of D-mannose, N-acetylcysteine (NAC) and Morinda citrifolia extract versus antibiotic therapy in the prophylaxis of UTIs potentially associated with urological mini-invasive diagnostics procedures, in clinical model of the urodynamic investigation. METHODS: 80 patients eligible for urodynamic examination, 42 men and 38 women, have been prospectively enrolled in the study and randomised in two groups (A and B) of 40 individuals. Patients of group A followed antibiotic therapy with Prulifloxacine, by mouth 400 mg/day for 5 days, while patients of the group B followed the association of mannose and NAC therapy, two vials/day for 7 days. Ten days after the urodynamic study, the patients were submitted to urine examination and urine culture. RESULTS: The follow up assessment didn't show statistical significant difference between the two groups regarding the incidence of UTI. CONCLUSIONS: The association of mannose and NAC therapy resulted similar to the antibiotic therapy in preventing UTIs in patients submitted to urodynamic examination. This result leads to consider the possible use of these nutraceutical agents as a good alternative in the prophylaxis of the UTI afterwards urological procedures in urodynamics.BACKGROUND: The abuse of antimicrobical drugs has increased the resistance of microorganisms to treatments, thus to make urinary tract infections (UTIs) more difficult to eradicate. Among natural substances used to prevent UTI, literature has provided preliminary data of the beneficial effects of D-mannose, N-acetylcysteine, and Morinda citrifolia fruit extract, due to their complementary mechanism of action which contributes respectively to limit bacteria adhesion to the urothelium, to destroy bacterial pathogenic biofilm, and to the anti-inflammatory and analgesic activity. The purpose of this study was to compare the administration of an association of D-mannose, N-acetylcysteine (NAC) and Morinda citrifolia extract versus antibiotic therapy in the prophylaxis of UTIs potentially associated with urological mini-invasive diagnostics procedures, in clinical model of the urodynamic investigation. METHODS: 80 patients eligible for urodynamic examination, 42 men and 38 women, have been prospectively enrolled in the study and randomised in two groups (A and B) of 40 individuals. Patients of group A followed antibiotic therapy with Prulifloxacine, by mouth 400 mg/day for 5 days, while patients of the group B followed the association of mannose and NAC therapy, two vials/day for 7 days. Ten days after the urodynamic study, the patients were submitted to urine examination and urine culture. RESULTS: The follow up assessment didn't show statistical significant difference between the two groups regarding the incidence of UTI. CONCLUSIONS: The association of mannose and NAC therapy resulted similar to the antibiotic therapy in preventing UTIs in patients submitted to urodynamic examination. This result leads to consider the possible use of these nutraceutical agents as a good alternative in the prophylaxis of the UTI afterwards urological procedures in urodynamics

TOpic: rare and special cases, the real "Strange cases"

Introduction: The bladder hernia represents approximately 1-3% of all inguinal hernias, where patients aged more than 50 years have a higher incidence (10%). Many factors contribute to the development of a bladder hernia, including the presence of a urinary outlet obstruction causing chronic bladder distention, the loss of bladder tone, pericystitis, the perivesical bladder fat protrusion and the obesity

HADES RV Programme with HARPS-N at TNG. XIII. A sub-Neptune around the M dwarf GJ 720 A

Context. The high number of super-Earth and Earth-like planets in the habitable zone detected around M-dwarf stars in recent years has revealed these stellar objects to be the key to planetary radial velocity (RV) searches. Aims: Using the HARPS-N spectrograph within The HArps-n red Dwarf Exoplanet Survey (HADES) we have reached the precision needed to detect small planets with a few Earth masses using the spectroscopic radial velocity technique. HADES is mainly focused on the M-dwarf population of the northern hemisphere. Methods: We obtained 138 HARPS-N RV measurements between 2013 May and 2020 September of GJ 720 A, classified as an M0.5 V star located at a distance of 15.56 pc. To characterize the stellar variability and to distinguish the periodic variation due to the Keplerian signals from those related to stellar activity, the HARPS-N spectroscopic activity indicators and the simultaneous photometric observations with the APACHE and EXORAP transit surveys were analyzed. We also took advantage of TESS, MEarth, and SuperWASP photometric surveys. The combined analysis of HARPS-N RVs and activity indicators let us address the nature of the periodic signals. The final model and the orbital planetary parameters were obtained by simultaneously fitting the stellar variability and the Keplerian signal using a Gaussian process regression and following a Bayesian criterion. Results: The HARPS-N RV periodic signals around 40 days and 100 days have counterparts at the same frequencies in HARPS-N activity indicators and photometric light curves. We thus attribute these periodicities to stellar activity; the first period is likely associated with the stellar rotation. GJ 720 A shows the most significant signal at 19.466 ± 0.005 days with no counterparts in any stellar activity indices. We hence ascribe this RV signal, having a semi-amplitude of 4.72 ± 0.27 m s−1, to the presence of a sub-Neptune mass planet. The planet GJ 720 Ab has a minimum mass of 13.64 ± 0.79 M⊕, it is in circular orbit at 0.119 ± 0.002 AU from its parent star, and lies inside the inner boundary of the habitable zone around its parent star. Based on observations collected at the Italian Telescopio Nazionale Galileo (TNG), operated on the island of La Palma by the Fundación Galileo Galilei of the INAF (Istituto Nazionale di Astrofisica) at the Spanish Observatorio del Roque de los Muchachos of the Instituto de Astrofísica de Canarias, in the framework of the HArps-n red Dwarf Exoplanet Survey (HADES)

Five carbon- and nitrogen-bearing species in a hot giant planet's atmosphere

The atmospheres of gaseous giant exoplanets orbiting close to their parent stars (hot Jupiters) have been probed for nearly two decades. They allow us to investigate the chemical and physical properties of planetary atmospheres under extreme irradiation conditions. Previous observations of hot Jupiters as they transit in front of their host stars have revealed the frequent presence of water vapour and carbon monoxide in their atmospheres; this has been studied in terms of scaled solar composition under the usual assumption of chemical equilibrium. Both molecules as well as hydrogen cyanide were found in the atmosphere of HD 209458b, a well studied hot Jupiter (with equilibrium temperature around 1,500 kelvin), whereas ammonia was tentatively detected there and subsequently refuted. Here we report observations of HD 209458b that indicate the presence of water (H2O), carbon monoxide (CO), hydrogen cyanide (HCN), methane (CH4), ammonia (NH3) and acetylene (C2H2), with statistical significance of 5.3 to 9.9 standard deviations per molecule. Atmospheric models in radiative and chemical equilibrium that account for the detected species indicate a carbon-rich chemistry with a carbon-to-oxygen ratio close to or greater than 1, higher than the solar value (0.55). According to existing models relating the atmospheric chemistry to planet formation and migration scenarios, this would suggest that HD 209458b formed far from its present location and subsequently migrated inwards. Other hot Jupiters may also show a richer chemistry than has been previously found, which would bring into question the frequently made assumption that they have solar-like and oxygen-rich compositions.Comment: As part of the Springer Nature Content Sharing Initiative, it is possible to access a view-only version of this paper by using the following SharedIt link: https://rdcu.be/cifr

HADES RV programme with HARPS-N at TNG. XIV. A candidate super-Earth orbiting the M-dwarf GJ 9689 with a period close to half the stellar rotation period

Context. It is now well-established that small, rocky planets are common around low-mass stars. However, the detection of such planets is challenged by the short-term activity of host stars. Aims: The HARPS-N red Dwarf Exoplanet Survey programme is a long-term project at the Telescopio Nazionale Galileo aimed at monitoring nearby, early-type, M dwarfs, using the HARPS-N spectrograph to search for small, rocky planets. Methods: A total of 174 HARPS-N spectroscopic observations of the M0.5V-type star GJ 9689 taken over the past seven years have been analysed. We combined these data with photometric measurements to disentangle signals related to the stellar activity of the star from possible Keplerian signals in the radial velocity data. We ran an MCMC analysis, applying Gaussian process regression techniques to model the signals present in the data. Results: We identify two periodic signals in the radial velocity time series, with periods of 18.27 and 39.31 d. The analysis of the activity indexes, photometric data, and wavelength dependency of the signals reveals that the 39.31 d signal corresponds to the stellar rotation period. On the other hand, the 18.27 d signal shows no relation to any activity proxy or the first harmonic of the rotation period. We, therefore, identify it as a genuine Keplerian signal. The best-fit model describing the newly found planet, GJ 9689 b, corresponds to an orbital period of Pb = 18.27 ± 0.01 d and a minimum mass of MP sini = 9.65 ± 1.41 M⊕. Table A.1 is only available in electronic form at the CDS via anonymous ftp to cdsarc.u-strasbg.fr (ftp://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/cat/J/A+A/651/A93 Based on observations made with the Italian Telescopio Nazionale Galileo (TNG) operated by the Fundación Galileo Galilei (FGG) of the Istituto Nazionale di Astrofisica (INAF) at the Observatorio del Roque de los Muchachos (La Palma, Canary Islands, Spain)