A. Guarneri

A New Technique for Augmentation Phalloplasty: Albugineal Surgery with Bilateral Saphenous Grafts—Three Years of Experience

OBJECTIVES Penile augmentation surgery is a highly controversial issue due to the low level of standardisation of surgical techniques. The aim of the study is to illustrate a new technique to solve the problem of enlarging the penis by means of additive surgery on the albuginea of the corpora cavernosa, guaranteeing a real increase in size of the erect penis. METHODS Between 1995 and 1997, 39 patients who requested an increase in the diameter of their penises underwent augmentation phalloplasty with bilateral saphena grafts. The patients considered eligible for surgery were patients with either hypoplasia of the penis or functional penile dysmorphophobia. All the patients included in our study presented normal erection at screening. The average penis diameter in a flaccid state and during erection was found to be 2.1cm (1.6-2.7 cm) and 2.9 cm (2.2-3.7 cm), respectively. Before surgery the patients were informed of the experimental nature of the surgical procedure. The increase in volume of the corpora cavernosa was achieved by applying saphena grafts to longitudinal openings made bilaterally in the albuginea along the whole length of the penis. RESULTS No major complications and specifically no losses of sensitivity of the penis or erection deficiencies occurred during the post-operative follow-up period. All the patients resumed their sexual activity in 4 months. A measurement of the penile dimensions was carried out 9 months after surgery. No clinical meaningful increases in the diameter of the flaccid penis were documented. The average penis diameter during erection was found to be 4.2 cm (3.4-4.9) with post-surgery increases in diameter varying from 1.1 to 2.1cm (p<0.01). CONCLUSIONS The penile enlargement phalloplasty technique with albuginea surgery suggested by the authors definitely is indicated for increasing the volume of the corpora cavernosa during erection. Albuginea surgery with saphena grafts has been found to be free from aesthetic and functional complications with excellent patient satisfaction.

Long-term followup after extracorporeal shock wave lithotripsy treatment of kidney stones in solitary kidneys

A total of 64 treatments by the Dornier HM3 lithotriptor was performed on 52 solitary kidneys with stones. A slight increase but no significant variations in serum creatinine was noted in 15 patients without obstruction just after treatment (p greater than 0.05). No significant increases in serum creatinine were found even at the short-term, mid-term and long-term followup. After 12 to 56 months hypertension developed in only 1 previously normotensive patient. Of 37 patients at mid-term followup (12 to 24 months) 62% were stone-free, 24% had passable fragments, 8% had recurrent stones and 5% had regrowth of the residual fragments. At long-term followup (24 to 56 months) 50% of 26 patients were stone-free, 19% had dust or passable fragments, 19% had recurrences and 11% had regrowth of the residual fragments. The demonstrated effectiveness, small number of complications at the short-term followup, lack of sequelae at the long-term followup and relatively small number of recurrences confirm that extracorporeal lithotripsy is not only effective but also safe. It can be proposed as the treatment of first choice even when the stone is in a single remaining kidney.

Inguinal orchidectomy for testicular cancer

Inguinal orchidectomy (IO) is the standard indication for testicular cancer; 95% of testicular tumours are of germ-cell origin and with the exception of mature teratoma in children, they are all malignant. There is a large variety of non-germ cell tumours, the most frequent being malignant lymphomas and gonadal stromal tumours, especially Leydig cell tumours. The great majority of Leydig cell tumours are of benign behaviour, and most of them are treated with conservative surgery [1]. Conservative surgery is also allowed in monorchidic patients, usually for a contralateral second germ-cell tumour. Indications for conservative surgery are: Wellfunctioning residual testis and a cancerous nodule of < 2 cm in maximum diameter, not close to the rete testis. Resection margins must be in healthy tissue and at least three marginal and one distant biopsy should be taken [2]. Postoperative radiotherapy (18–20 Gy in 2 weeks) is given to patients with concomitant carcinoma in situ [2].

Why Doesn't High-Dose Chemotherapy Improve Survival, as Was Expected, in Advanced or Relapsed Germ Cell Tumours?

There are several reasons why drugs may not reach therapeutic levels within cancer cells. Since the drug concentration in the cell is limited by the dosage that can be usually given, the increased number of target molecules means thatmany of the targets are not affected by the drug: There are just too many for the number of drug molecules present [1]. Consequently, oncologists thought that just increasing the dosage of active drugswould increase the cell kill. Therefore, as soon as autologous bone marrow transplantation became available, they started to give high-dose chemotherapy (HDCT) with stem cell support. The most-used drugs are etoposide and alkylating agents. Connolly andMcCaffrey [2] presented awell-written and well-documented review paper on HDCT supported by autologous stem cell transplant in advanced or relapsed male germ cell tumours (GCTs). They performed an accurate search in the English language literature of the last 20 yr for HDCT with SCT in first-line treatment for poor prognosis and in the salvage setting for relapse after failure of firstline standard chemotherapy. While several phase 2 studies claimed a therapeutic advantage of HDCT over conventional chemotherapy in high-risk patients, phase 3 trials failed to confirm such results. There were only two randomised studies for each clinical situation, and the authors correctly expressed some criticism. As for HDCT in the first-line treatment of poor-prognosis patients, the authors expressed some difficulties in interpreting the French study because of low dose intensity in the high-dose arm and the use of a nonstandard regimen (references 22 and 23 in Connolly and McCaffrey [2]). Furthermore, the phase 3 American study did not achieve the patient accrual and complete overall responses were not different in the two arms; however, in a subanalysis of patients with slow

GOLEM: Generator Of Life Embedded into MMOs

Massively Multi-player Online Role-Playing Games and Massively Multiplayer Online games are complex and costly system from both a game design and a technical point of view. Among their many issues, in this paper we tackle the problem of incrementing players thrill by supplying them plenty of freshly produced, unpredictable monsters. To achieve this goal we have designed, developed and tested GOLEM, a geneticbased approach to the evolution of new species of monsters for video games.

GHOST: a GHOst STory-writer

Often, small independent studios developing video games are forced to ask game or level designers to write stories for their products. Unfortunately, game writing requires a different set of skills than game design. Moreover, there is a shortage of interactive tools devoted to help non-writers to (learn how to) create compelling storylines for interactive media like video games. Our goal has been to design, implement and test a tool embedded into a game engine to help non-writers to create stories (for video games). Our solution, designed with the help of domain-experts, does not generate contents, but interactively helps the user to produce a solid narrative structure for a story, to avoid falling into banality or creating boring, repetitive tales.

Nephron Sparing Surgery with the Ultrasonic Scalpel: La Diagnosi Precoce ED IL Trattamento Conservativo Dei Tumori Del Rene

Surgical resection remains the cornerstone of treatment renal cell carcinoma. In the last 15 years a better understanding of tumor biology and the early diagnosis permitted an evolution of the surgical treatment towards a minimal invasive approach by nephron-sparing surgery. Together with absolute and relative indications, nephron-sparing surgery is performed also as an elective indication, in patients with small, localized, often incidental tumors and a normal controlateral kidney. The oncological outcome in these cases is identical with that of radical nephrectomy. In order to achieve a complete tumor resection with the maximal preservation of unaffected renal parenchyma, tumor enucleation is the best technique when feasible. With the use of the harmonic scalpel, clamping of the renal pedicle and renal ischemia can be avoided in most of the cases during enucleation of small tumors, while the thermal damage in the remaing renal parenchyma is minimal.

ATP Depletion: A Possible Role in the Pathogenesis of Uric Acid Nephrolithiasis in the Elderly

Undue acidity of the urine attributed to a deficiency in renal ammoniogenesis has been claimed to be prevalent in certain groups of patients who may form uric acid stones even in the absence of hyperuricosuria1.

Shock Wave Lithotripsy in the Treatment of Urinary Stones in Renoureteral Anomalies

Renoureteral anomalies can be seen as a pathogenetic factor of urolithiasis or simply as innocent bystanders revealed by symptomatic urolithiasis1. When ESWL was first attempted, these renoureteral anomalies were considered as absolute contraindications for this kind of treatment2. Nowadays, however, admission criteria for ESWL have been extended3. In the light of our own experience and of data from the literature we undertook the present review to examine whether these contraindications were still valid, with particular Reference to calculosis associated with renoureteral duplication, horseshoe kidney and pelvic renal ectopy; we also wanted to assess the eventual therapeutic alternatives.

Urinary Red Blood Cell Microscopic Morphology after ESWL: A Parameter of Glomerular Damage

It has been shown that shock waves can cause damage to the vascular structure of the kidneys and tubules and also to the renal glomeruli1. We undertook a study of the microscopic morphology of urinary erythrocytes in a group of patients who underwent extracorporeal shock wave lithotripsy (ESWL), to assess possible glomerular damage.