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Physiopathology, diagnosis and therapy of TURP Syndrome.
No full textIn this article, the authors analyze a syndrome first described by Creevy in the
1940s, which may occur during a transurethral resection of the prostate (TURP).
The syndrome is characterized by cardiocirculatory and neurological problems due
to rapid changes in intravascular volume and plasma solute concentrations caused
by excess irrigating fluid absorption. This article reviews the available
literature and reports on the experience of our clinic, a specialist department
in the physiopathology, diagnosis, therapy and prevention of TURP syndrome
Trattamento chirurgico conservativo delle neoplasie renali
No full textTrattamento chirurgico conservativo delle neoplasie renal
Percutaneous, laparoscopic, and surgical treatment of idiopathic varicocele: analysis of costs
No full textExperience in the surgical treatment of Fraleyâ€TMs Syndrome
No full textOBJECTIVE: To report our 20-year experience with nephron-sparing surgery in the
treatment of Fraley's syndrome.
MATERIALS AND METHODS: From September 1976 to July 1996, 6 women, 18-43 years
old, underwent surgical treatment. All patients had been suffering debilitating
right flank pain for at least 6 months before the operation. Diagnosis was in
call cases made with the use of intravenous pyelography and renal arteriography,
which showed a vascular impression on the superior infundibulum with secondary
dilatation of the upper pole calyx. This was localized only on the right side in
5 cases, while in 1 it was bilateral though more severe on the right. Ipsilateral
nephroptosis was observed in 2 of the patients. In 2 cases in whom the superior
infundibulum was sufficiently long, an infundibulo-infundibulostomy with everted
flaps was performed. In a case in whom a short infundibulum was compressed
between a venous and an arterial branch, Fraley's infundibulopyelostomy was
carried out. In 1 patient in whom the infundibulum was compressed by the
anterior-superior segmental artery, a Heineke-Mikulicz-type infundibulorrhaphy
was combined to vasopexy. In the remaining 2 cases, the infundibulum was not cut:
in one case, a simple vasopexy of two vascular branches was carried out, while in
the other, a minor arterial branch was ligated and divided. In 4 patients,
nephropexy was also performed.
RESULTS: No significant intra- or postoperative complications were observed.
Follow-up averaged 102.5 months. Pain relief was complete in 5 cases, in whom
disappearance of the vascular impression was also radiologically demonstrated.
Only 1 patient, who underwent infundibulorrhaphy and vasopexy, experienced
occasional flank pain and urinary infection after the operation, with just a
slight improvement in the excretory urogram.
CONCLUSIONS: Surgical treatment of Fraley's syndrome is indicated only in
symptomatic and/or complicated cases; in relation to the type of obstruction and
the anatomy of the intrarenal structures, whether excretory or vascular, several
effective nephron-sparing techniques can be selected
The TURP Sindrome: importance of expiratory ethanol measurement and high serum levels of glycine.
No full textOBJECTIVE: In a prospective study it was our intention to evaluate the
reliability and the predictive value of expiratory ethanol for the early
detection of the occurrence of TURP syndrome and emphasize the role of the serum
levels of glycine in clinical manifestation.
METHODS: We studied 30 patients scheduled for elective traditional transuretral
resection of the prostate performed with subarachnoid anesthesia. Serum sodium
and glycine concentrations, serum osmolality and end-expiratory ethanol levels
were monitored at scheduled intervals. Continuous heart rate and blood pressure
monitoring was performed during the perioperative period in the operativing room
and, later, in the recovery room. Occurrence of cardiocirculatory, respiratory
and neurologic symptoms were recorded. Statistics included Bonferroni's t-test
and Fisher's exact test. A decision level plot for end-expiratory ethanol level
was performed for the choice of predictivity criterion.
RESULTS: In our population we identified three groups of patients: Group I (15
patients) in which no symptom was recorded; Group II (6 patients) in which
non-specific anesthesia-related symptoms occurred; Group III (9 patients) in
which TURP syndrome of various degree of severity was observed. In this group of
patients changes in serum sodium and glycine concentrations, serum osmolality and
end-expiratory ethanol levels were significantly different compared with the
other two groups. In regard to end-expiratory ethanol levels, we identified a
cut-off point at 0.05 mg/ml. In Group III two patients developed transient
blindness. These patients had the highest serum glycine concentrations (> 4000
mumol/ml). Mortality was nil.
CONCLUSIONS: Our data show the reliability and accuracy of end-expiratory ethanol
levels as a predictive test of the occurrence of TURP syndrome. Further, we
emphasize the role of serum glycine concentration in the occurrence of neurologic
symptoms related to the transurethral resection of the prostate
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Penetranting trauma to the scrotum and corpora cavernosa caused by gunshot: clinical case.
No full textThe authors describe a case of gunshot wound of the male genitalia by two
low-velocity bullets. The first bullet caused a lesion of the right testicle and
came out of the right hemiscrotum; the second one had penetrated the left gluteal
region with no exit wound. The penile ultrasound confirmed the presence of the
bullet at the root of the right corpus cavernosum. The patient underwent
exploratory surgery, drainage of the voluminous bilateral scrotal hematoma, and
suture of a laceration of the right-testicle cranial portion. Due to the absence
of active bleeding, voluminous hematoma and serious injuries in the corpus
cavernosum, no surgical removal of the bullet in the right corpus cavernosum was
required. The patient regained a normal sexual function 1 month after the
operation
Trattamento percutaneo, laparoscopico e chirurgico del varicocele idiopatico: analisi dei costi.
No full textModern imaging methods and preoperative management of pheochromocytoma: review of the literature and case report.
No full textOBJECTIVES:
To discuss the modern imaging techniques and preoperative management of pheochromocytoma and to report on one additional case.
METHODS:
A 66-year-old male with an incidentally discovered left adrenal mass is described. The adrenal medulla strongly accumulate 131 I-metaiodobenzylguanidine (MIBG). The patient underwent left adrenalectomy after preoperative therapy with alpha and beta-blockers. The recent literature on pheochromocytoma modern imaging techniques and preoperative management is reviewed.
RESULTS:
MIBG scintigraphy diagnosed a benign functioning adrenal pheochromocytoma, allowing preoperative medical management. Postoperative workup was unremarkable. Diagnosis of pheochromocytoma was confirmed by immunohistopathology. At 18 months follow-up, the patient is alive and disease-free.
CONCLUSIONS:
Incidentally discovered adrenal masses have to be investigated to detect malignancy and subtle hormonal overproduction. MIBG scintigraphy has a high specificity (100%) in detecting pheochromocytoma, metastasis, surgical residual tumor, local relapse and other adrenal crest tumors. Positive results of octreotide scintigraphy in detecting malignant pheochromocytoma have been reported. Currently, pheochromocytoma removal is a safe operation with mortality rates ranging from 0 to less than 3%. Preoperative alpha adrenergic blockage with phenoxybenzamine or prazosin is important in decreasing the operative risk. Beta-blockers may be necessary for cardiac arrhythmia. Intraoperative invasive monitoring of hemodynamic variables may be both diagnostic and therapeutic of inadequate preoperative management. Lifelong follow-up for patients with pheochromocytoma is important
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