Alfiero Costantini

Conservative Surgical Treatment of Renal Cell Carcinoma: Clinical Experience and Reappraisal of Indications

During a 14-year period 36 patients who presented with renal cell carcinoma underwent conservative surgical treatment. The patients were divided into 3 groups according to treatment indications and condition of the contralateral kidney: group 1 included patients with a solitary kidney or bilateral tumors, group 2 patients had a damaged contralateral kidney and group 3 patients were without abnormalities of the contralateral kidney. Cumulative 6-year survival rates were 58 per cent for group 1, and 90 per cent for groups 2 and 3 combined. The over-all cumulative 6-year survival rate was 74 per cent. Based on these data extension of the indication for conservative surgical treatment seems to be justified in patients who present with low stage tumors and partial or potential damage to the contralateral organ.

Experience with ureterocalyceal anastomosis

Experience with 10 cases of ureterocalyceal anastomosis is reported. Most cases involved scleroatrophic scarring of the pelvis after repeated stone surgery, and 1 case each for failed pyeloplasty, tuberculous stricture of the pelvis, transitional cell carcinoma of the pelvis and calyces, and ureteropelvic junction obstruction associated with renal malformation. Three patients had a solitary kidney. End-to-end ureterocalyceal anastomosis was performed in 5 patients; laterolateral in 1 case, and ureteropyelocalyceal anastomosis in the remaining 4. In 3 cases omentoplasty was also performed.

Measurement of testosterone and its 5-alfa-reduced metabolites in human prostatic tissue using isotope dilution mass spectrometry

5 alpha-Dihydrotestosterone (DHT) has been widely measured in human prostatic tissue using RIA since it is found to be involved in pathogenesis of human prostatic hyperplasia (BHP) and to be the best index for the follow-up of patients affected by prostatic cancer under endocrine treatment. A GC/MS method for the simultaneous determination of testosterone (T), dihydrotestosterone (DHT), 5 alpha-androstan-3 alpha,17 beta-diol (3 alpha-diol) and 5 alpha-androstan-3 beta-17 beta-diol (3 beta-diol) in prostatic tissue was developed based on the isotopic dilution technique. Trideuterated internal standards of each compound were previously synthesized in our laboratory. After previous extraction and purification on Sep-Pak C-18 cartridges and Lipidex DEAP columns, T and its metabolites were measured as heptafluorobutyric esters (HFB). Quantitative analysis was performed on a VG 7070 EQ mass spectrometer equipped with a fused silica capillary column using the Selected Ion Monitoring technique. Steroid values (means +/- SD; ng/g tissue) found in 9 human hypertrophic prostates were: T, 0.71 +/- 0.43; DHT, 4.46 +/- 1.41; 3 alpha-diol, 0.34 +/- 0.23; 3 beta-diol, 0.14 +/- 0.32.

Surgical treatment of vesicoureteral reflux with bilateral medialization of the ureteral orifices.

The technique of bilateral medialization of the ureteral orifices, as proposed by Gil-Vernet, has been used with minor modifications in a series of 14 patients for the surgical treatment of vesicoureteral reflux. Its major advantages are its technical simplicity and bilateral treatment in all cases.

The effect of cigarette smoke on aryl-hydrocarbon hydroxylase (AHH) activity of the human kidney

AHH activity was measured in kidney cortex biopsies obtained during surgery from patients with hydronephrosis and from unaffected portions of kidneys with renal cell carcinomas. AHH activity was slightly, but not significantly, higher in the group of non-smoking cancer patients when compared to non-smoking hydronephrotic subjects. Smoking induced a significant increase of AHH activity in the hydronephrotic kidneys but not in cancer kidneys, probably due to the higher baseline values and scatter in the cancer group. Pooling cancer and non-cancer kidneys, smokers had a higher AHH activity than non-smokers, this increase being dose-related.

Experience with Omentoplasty

A 6-year experience with omentoplasty is presented. During this period pedicled omentum was used in 145 procedures of reconstructive urologic surgery. On the basis of this experience the authors conclude that omentoplasty is an essential part in urological reconstructive surgery.

Altered 1-14C arachidonic acid metabolism in arterial wall from patients with renal cell carcinoma

The metabolism of 1-14C arachidonic acid (AA) by arterial wall in patients with renal cell carcinoma and in control patients undergoing nephrectomy was investigated by a high pressure liquid chromatography (HPLC) system. No differences in 1-14C AA uptake and in the total amount of metabolites were found between the two groups, whereas the amounts of cyclooxygenase and lipoxygenase pathway (COP and LOP) metabolites produced by patients with renal cell carcinoma were significantly lower and, respectively, higher than those produced by the control group. The COP/LOP ratio was 7.2 +/- 5.5 in the control group in comparison to 1.9 +/- 0.5 in renal cell carcinoma patients. The decrease in COP metabolites was due to a markedly reduced synthesis of prostacyclin (PGI2), with no changes in thromboxane B2 (TxB2), prostaglandin F2 alpha (PGF2 alpha) and prostaglandin E2 (PGE2) production. The changes in PGI2 and 12-hydroxy-eicosatetraenoic acid (12-HETE) (metabolite of LOP) vascular production were not related to tumor dimension. The decrease in PGI2 synthesis may represent a factor favoring metastasis and thrombosis in neoplastic patients.

Impairment of antipyrine metabolism in urinary tract cancer.

The metabolism of antipyrine was studied in 13 patients with cancer and bladder papillomas and in 11 control subjects, matched for interfering factors like smoking, diet, age and sex. The mean antipyrine half-life was significantly longer in patients with urinary tract cancer (14.7 ± 1.32 h SE) than in control subjects (11 ± 0.55 h SE) (P < 0.025); other clinical parameters did not vary.

Ex situ surgery of the kidney: experience with 20 autotransplantations.

The authors propose a classification of ex situ surgery of the kidney and present their clinical experience of 20 renal autotransplantations over a period of 6 years: 16 were performed for renovascular hypertension with 2 failures and 4 for recurrent staghorn calculi, with 1 stone recurrence. Based on their experience and on the literature they discuss the present status and the future implications of ex situ surgery of the kidney.

Extracorporeal Shock Wave Lithotripsy of Contrast-Negative Renal and Ureteral Stones

During a 32-month period, extracorporeal shock wave lithotripsy (ESWL) was used to treat 207 non-opaque calculi (187 radiolucent, 20 slightly radiopaque). Adequate radiological visualization was obtained with retrograde pyelography in 199 cases while intravenous pyelography was used when a ureteral stent could not be passed in eight cases. Three cases presented complications (two episodes of sepsis and one perirenal hematoma), and one patient had a rapid recurrence of a cystine stone. Intravenous alkalinization was begun during hospitalization and continued orally after discharge. Post-treatment particles present a greater surface area to alkaline urine than the original stone, accelerating the process of chemical dissolution. Of 182 patients with adequate follow-up, 154 (84.6%) became completely stone free.