A Complex Renal Cyst: It Is Time to Call the Oncologist?

Introduction. Hydatid disease is a cyclozoonotic parasitic infestation caused by the cestode Echinococcus granulosus. The cysts mainly arise in the liver (50 to 70%) or lung (20 to 30%), but any other organ can be involved, in abdominal and pelvic locations, as well as in other less common sites, which may make both diagnosis and treatment more complex. Isolated renal involvement is extremely rare. Case Presentation. We report a rare case of isolated renal hydatid disease in a 71-year-old man with a history of vague abdominal pain, anemia, fever, and microhematuria. Ultrasonographic examination revealed a complex cyst in the right kidney, including multiple smaller cysts with internal echoes. A magnetic resonance scan of the abdomen confirmed the findings, and hydatid cyst disease was diagnosed. Right nephrectomy was performed, and microscopic examination confirmed the diagnosis of hydatid cyst. Albendazole, 10 mg/kg per day, was given for 4 weeks (2 weeks preoperatively and 2 weeks postoperatively). Conclusion. Isolated primary hydatidosis of the kidney should always be considered in the differential diagnosis of any cystic renal mass, even in the absence of accompanying involvement of liver or other visceral organs

Primary headaches in children: clinical findings on the association with other conditions.

The aim of the present study is to report on the frequency of some comorbidities in primary headaches in childhood. Two hundred and eighty children (175 males and 105 females; ratio 1.7:1), aged 4 to 14 years, affected by primary headaches were consecutively enrolled in this study. In direct interviews, parents and children gave information about the association of their headaches with different conditions including asthma and allergic disorders, convulsive episodes, sleep disorders and increased body weight, affections some time associated in the literature to headache as comorbidities. In addition, anxiety and depression, attention deficit/hyperactivity disorder, tics, learning disabilities and obsessive-compulsive disorders, using psycho-diagnostic scales were evaluated. Two hundred and eighty children matched for age, sex, race and socio-economic status, were used as controls. No significant association of primary headaches was found with asthma and allergic disorders, convulsive episodes, sleep disorders and increased body weight. Overall behavioral disorders were more common in children who experienced headache than in controls. A significant association of primary headache was found with anxiety and depression (p value <0.001), but not with the other psychiatric disorders. Primary headaches in children are not associated with most of the psychiatric and systemic conditions herein investigated. On the contrary, there was a significant association with anxiety and depression, as frequently reported in adults

Contemporary urologic minilaparoscopy : indications, techniques, and surgical outcomes in a multi-institutional European cohort

OBJECTIVES: To provide an analytical overview of contemporary indications, techniques, and outcomes of urologic minilaparoscopy (ML) in multiple European centers. METHODS: Data of patients who had undergone a minilaparoscopic urologic procedure at nine European institutions between 2009 and 2012 were retrospectively gathered. Surgical procedures were classified as upper or lower urinary tract and as ablative or extirpative and reconstructive. The main surgical outcome parameters were analyzed and relevant operative data related to the surgical technique were recorded. RESULTS: Overall, 192 patients (mean age 45.25±17.8 years) were included in the analysis. Most of them were nonobese (mean body mass index [BMI] 24.7±3.6?kg/m(2)) at low estimated surgical risk (mean American Society of Anesthesiologists [ASA] 1.69±0.68). Indications for surgery were mostly nononcologic (132 cases, 68.8%). Most of the procedures were done in the upper urinary tract (133 cases, 69.2%) and were mostly with a reconstructive intent (109 cases, 56.7%). Overall operative time was 132.7±52.3 minutes with an estimated blood loss of 60.9±47.6?mL while the mean hospital stay was 5±2.1 days. Most of the postoperative complications were low Clavien grade (1 and 2), with only one (0.5%) grade 3 and one (0.5%) grade 4 complications recorded. CONCLUSIONS: A broad range of common procedures can be safely and effectively performed with ML techniques. By duplicating the principles of standard laparoscopy, but potentially offering less surgical scar and trauma, ML can be regarded as a viable option when looking for a virtually "scarless" surgery

Laparoscopic and robotic ureteral stenosis repair: a multi-institutional experience with a long-term follow-up

The treatment of ureteral strictures represents a challenge due to the variability of aetiology, site and extension of the stricture; it ranges from an end-to-end anastomosis or reimplantation into the bladder with a Boari flap or Psoas Hitch. Traditionally, these procedures have been done using an open access, but minimally invasive approaches have gained acceptance. The aim of this study is to evaluate the safety and feasibility and perioperative results of minimally invasive surgery for the treatment of ureteral stenosis with a long-term follow-up. Data of 62 laparoscopic (n\uc2&nbsp;=\uc2&nbsp;36) and robotic (n\uc2&nbsp;=\uc2&nbsp;26) treatments for ureteral stenosis in 9 Italian centers were reviewed. Patients were followed according to the referring center\ue2\u80\u99s protocol. Laparoscopic and robotic approaches were compared. All the procedures were completed successfully without open conversion. Average estimated blood loss in the two groups was 91.2\uc2&nbsp;\uc2\ub1\uc2&nbsp;71.9\uc2&nbsp;cc for the laparoscopic and 47.2\uc2&nbsp;\uc2\ub1\uc2&nbsp;32.3\uc2&nbsp;cc for the robotic, respectively (p\uc2&nbsp;=\uc2&nbsp;0.004). Mean days of hospitalization were 5.9\uc2&nbsp;\uc2\ub1\uc2&nbsp;2.4 for the laparoscopic group and 7.6\uc2&nbsp;\uc2\ub1\uc2&nbsp;3.4 for the robotic group (p\uc2&nbsp;=\uc2&nbsp;0.006). No differences were found in terms of operative time and post-operative complications. After a median follow-up of 27\uc2&nbsp;months, the robotic group yielded 2 stenosis recurrence, instead the laparoscopic group shows no cases of recurrence (p\uc2&nbsp;=\uc2&nbsp;0.091). Minimally invasive approach for ureteral stenosis is safe and feasible. Both robotic and pure laparoscopic approaches may offer good results in terms of perioperative outcomes, low incidence of complications and recurrence

Fracture Reactivation and Magma Intrusion: The Case of the 1989 Fissure System at Mt Etna, Italy

Fracture Reactivation and Magma Intrusion: The Case of the 1989 Fissure System at Mt Etna, Italy FALSAPERLA Susanna1, Fabrizio CARA2, Antonio ROVELLI2, Marco NERI1, Boris BEHNCKE1, Valerio ACOCELLA3 1 Istituto Nazionale di Geofisica e Vulcanologia, Sezione di Catania, Piazza Roma 2, 95123, Catania, Italy 2 Istituto Nazionale di Geofisica e Vulcanologia, Sezione di Roma1, Via di Vigna Murata 605, 00143 Roma, Italy 3 Dipartimento Scienze Geologiche Roma Tre. L. S.L. Murialdo 1, 00146 Roma, Italy We focus on the role of a dry (without lava emission) fracture system, consisting of extension fractures and normal faults, which opened at Mt Etna, Italy, during the 1989 flank eruption. The NNW-SSE fracture system is located on the mid-upper SE flank of the volcano, and has experienced significant seismic activity during the past two decades. By using excellent documented records of seismic and volcanic activity on 24 November 2006 (the latter encompassing Strombolian activity, lava fountaining, ash fallout, pyroclastic flows, and lava emission from multiple vents at the Southeast Crater), we analyze the interaction between seismic radiation and the afore-mentioned fracture system. Our results highlight the importance of this system in controlling the polarization properties of seismic waves 17 years after its formation. In addition, the SE end of the 1989 fracture zone extends into several active faults, suggesting that they represent a single long structure, which plays an important role in the volcano-tectonic dynamics of Etna. Finally, this study shows how fracture reactivation can also occur by means of magma intrusion, strongly controlling the transfer of magma within a volcanic edifice.PublishedBesse, Clermont-Ferrand, Franceope

Fracture Reactivation and Magma Intrusion: The Case of the 1989 Fissure System at Mt Etna, Italy

Fracture Reactivation and Magma Intrusion: The Case of the 1989 Fissure System at Mt Etna, Italy FALSAPERLA Susanna1, Fabrizio CARA2, Antonio ROVELLI2, Marco NERI1, Boris BEHNCKE1, Valerio ACOCELLA3 1 Istituto Nazionale di Geofisica e Vulcanologia, Sezione di Catania, Piazza Roma 2, 95123, Catania, Italy 2 Istituto Nazionale di Geofisica e Vulcanologia, Sezione di Roma1, Via di Vigna Murata 605, 00143 Roma, Italy 3 Dipartimento Scienze Geologiche Roma Tre. L. S.L. Murialdo 1, 00146 Roma, Italy We focus on the role of a dry (without lava emission) fracture system, consisting of extension fractures and normal faults, which opened at Mt Etna, Italy, during the 1989 flank eruption. The NNW-SSE fracture system is located on the mid-upper SE flank of the volcano, and has experienced significant seismic activity during the past two decades. By using excellent documented records of seismic and volcanic activity on 24 November 2006 (the latter encompassing Strombolian activity, lava fountaining, ash fallout, pyroclastic flows, and lava emission from multiple vents at the Southeast Crater), we analyze the interaction between seismic radiation and the afore-mentioned fracture system. Our results highlight the importance of this system in controlling the polarization properties of seismic waves 17 years after its formation. In addition, the SE end of the 1989 fracture zone extends into several active faults, suggesting that they represent a single long structure, which plays an important role in the volcano-tectonic dynamics of Etna. Finally, this study shows how fracture reactivation can also occur by means of magma intrusion, strongly controlling the transfer of magma within a volcanic edifice

Evidence of Fracture Reactivation integrating Volcanological, Structural, and Seismic Data Recorded at Mt. Etna, Italy

We merge volcanological, structural, and volcanic tremor data to shed light on a fissure system opened on the upper SE flank of Mt. Etna, Italy, in 1989. The system propagates to about 6 km from the Southeast Crater (SEC), and although it is formed by dry (non-eruptive) NNW-SSE fissures, it was active throughout several eruptive episodes after 1989, such as in 1991-1993 and (at least in part) in 2001, 2004-2005, and 2006. Particularly, we focus our attention on a paroxysmal eruptive episode on 24 November 2006, which encompassed different eruptive styles, such as lava fountaining and effusion, and violent Strombolian explosions, involving several eruptive vents on and near the SEC. This event was documented by detailed field and aerial surveys and remote video cameras. The characteristics of the seismic radiation are analyzed considering: frequency content, wavefield properties, and centroid location of the volcanic tremor source. The synoptic analysis of volcanic phenomena and volcanic tremor data document that: i) an aborted intrusion of magma rose to ~2000 m above sea level in the late evening of 24 November, along the NNW-SSE direction from below the SEC towards the 1989 fracture system, ii) the fissures opened in 1989 strongly affected, approximately 17 years after their formation, the modality of propagation of the seismic energy radiation within the upper volcanic edifice. Besides the role played by the 1989 system on the properties of seismic radiation in 2006, the present study allows to postulate probable links between contiguous fault systems in the upper SE flank of Mt. Etna. Based on the structural framework on a volcano-wide scale, our results do indeed sketch out a hitherto unknown continuity of some faults affecting the southeastern flank, which might also shed some light onto the complex phenomenon of flank instability in the eastern sector of the volcano

Comparison of the Airway Anatomy between Infants and Three Pediatric Simulators: A Radiological Study on Premature Anne, Infant AM Trainer and Simbaby Manikins

Background: Training is required to achieve proficiency in airway management. Simulators are of utmost importance not only for the purpose of training novices, but also for evaluating newer airway devices and techniques. Growing evidence supports inadequate anatomic airway reproduction in adult and pediatric manikins. Methods: We conducted an observational study comparing 17 radiological anatomic airway measurements obtained via the computed tomography of three commercially available manikins with the same measurements obtained from a population of newborns/infant (range: 0–3 months) undergoing magnetic resonance imaging for diagnostic purposes. According to the reference (mean and standard deviation (SD) of the pediatric population), each manikin measurement was defined as adequate, partially adequate or inadequate (difference between means: ≤±1, 1.0–1.96 or >1.96 SD, respectively). The primary outcome was the number of measurements with an adequate reproduction of airways. Results: We included 27 pediatric patients (21 ± 19 days, 48% males, 46.6 ± 3.5 cm, 2.7 ± 0.5 Kg and 12.6 ± 2.9 kg/m2). All manikins had n = 11/17 measurements with inadequate airway anatomic reproduction. The three measurements with more adequate reproduction were the height of the soft palate, retropalatal airspace volume and tongue volume (adequate in two manikins, and partially adequate in the remaining one). Conclusions: In three manikins commonly used for training in pediatric airways, static dimensions do not seem anatomically correct in relation to those of pediatric patients. Such inaccuracies may introduce biases in airway device development as well as in training