Evangelos Mazaris

Problems faced by relatives caring for cancer patients at home.

The care of patients suffering from advanced cancer is not limited in the hospital setting. It continues at home where the burden of care is borne by specific individuals. The aim of the present study was to survey and record the various problems faced by those who care for cancer patients at home. The study was conducted in our hospital during the summer of 2007. All participants completed, during a personal interview, a questionnaire which covered pathologic, social, psychological, spiritual/religious and financial problems. Seventy-six carers returned fully completed questionnaires. The most frequent problems reported were: anxiety regarding the patients future (61.8%), troublesome symptoms such as pain (54%), increased economic burden-financial difficulty (51.3%), problems with patients feeding (50%), unhappiness or depression (48,7%), emotional upset (47.4%), worsening of the patients behaviour and personality (38.2%), difficulty of establishing a positive attitude regarding their current status (34.2%), transport to hospital (32.9%), assistance from the wider family circle (25%). Taking care of cancer patients at home creates several problems among carers. Many of them remain undetected. The acknowledgement and recognition of these problems by health-care professionals might contribute to finding solutions in order to assist the difficult task of these individuals.

Penile fractures: immediate surgical approach with a midline ventral incision

To present our experience with immediate surgical treatment of penile fractures, using a midline ventral incision, as the choice of either immediate surgical or conservative treatment in penile fractures, as well as the type of surgical incision, remains controversial.

Use of nonsteroidal anti-inflammatory drugs after radical retropubic prostatectomy: a prospective, randomized trial.

OBJECTIVES To assess the efficacy and safety of nonsteroidal anti-inflammatory drugs (NSAIDs) administered after radical retropubic prostatectomy (RRP). METHODS One hundred patients undergoing open RRP by one surgeon were divided randomly and prospectively into two groups of 50 patients, each receiving systematically either an NSAID (lornoxicam) or paracetamol for postoperative analgesia. Opiates were administered if needed for breakthrough pain. Parameters potentially correlated with postoperative bleeding, such as preoperative and postoperative hemoglobin (Hb) differences, estimated blood loss, number of transfusions, and drain output were recorded. Furthermore, the degree of pain was assessed daily with a visual analogue scale score until discharge from hospital. RESULTS After procedures with similar estimated blood loss, postoperative bleeding was not more in the NSAIDs group, as evidenced by similar transfusion rates (P <or=1), similar postoperative Hb values (P >0.05), and Hb drop after the procedure. No patient required re-exploration for bleeding; drain output when elevated was never attributed to postoperative bleeding. Pain control as evaluated by the visual analogue scale pain score was adequate with the use of NSAIDs and not statistically different from the non-NSAIDs group during postoperative days 1 and 4 and onward. Pain control with lornoxicam was even better on postoperative days 2 and 3 (P <or=0.05). CONCLUSIONS Nonsteroidal anti-inflammatory drugs administered after open RRP are safe and effective. They do not increase the risk of bleeding and offer improved analgesia.

Percutaneous renal cryoablation: current status

Over the last 13 years, renal cryoablation has emerged as a promising technique for the treatment of solid renal tumors. The improvement in imaging modalities such as ultrasound, computed tomography and MRI, as well as the introduction of thinner probes, has led to the spread of the minimally invasive percutaneous approach. We review the historical background of percutaneous renal cryoablation (PRC), present its basic principles, mention the contemporary clinical data and outcomes of this technique and suggest future directions for its wider application in renal tumors. Early results have demonstrated that it may offer an alternative for the treatment of small renal masses with the advantages of minimal complications, spared renal function, decreased overall costs and equivalent oncologic efficacy. Long-term results are required in order to apply this minimally invasive technique to a broader spectrum of patients.

Renal colic due to spontaneous perirenal haematoma secondary to antiplatelet medication: two case reports.

We present two cases of spontaneous unilateral perirenal haematoma, following the administration of antiplatelet medication. Both patients reported no history of trauma. One patient was managed conservatively whereas the second patient needed an urgent nephrectomy. A spontaneous haematoma is a rare diagnosis that is easy to be missed. It is important to have a high index of suspicion as a prompt diagnosis can improve the morbidity and mortality of patients. The causes of spontaneous perirenal haematoma are quite varied and a bleeding diathesis can only be accepted as a cause only when all other causes have been excluded.

Inflammatory Myofibroblastic Bladder Tumor in a Patient with Von Recklinghausen's Syndrome

Myofibroblastic tumor, also known as inflammatory pseudotumor or pseudosarcoma, is a benign tumor with mesenchymal origin. Bladder location is very uncommon. We report the case of a 58-year-old man with a history of von Recklinghausens disease who complained for painless macroscopic hematuria 5 months after suprapubic prostatectomy. The radiograph evaluation revealed a bladder tumor, and the pathologic examination following a transurethral resection showed inflammatory myofibroblastic tumor of the bladder. The patient finally underwent a radical cystectomy due to the uncertain pathogenesis of inflammatory myofibroblastic tumor as well as the rarity of cases published on bladder tumors in Von Recklinghausens patients.

A new nonsurgical technique for managing zipper injuries

Zipper injuries are highly distressing to patients and often difficult to manage. Several management techniques are described in the literature. Many are complex and laborious, requiring sophisticated instruments in skilled hands, or even rely on a formal operation. This new technique involves the release of entrapped penile skin from a zipper by cutting the zipper tape and teeth immediately superior and inferior to the zipper connector and using a needle holder to pull the zipper apparatus apart following the application of lubrication and appropriate use of local analgesia. This novel technique is quick, nontraumatic and requires readily available equipment. It has been used successfully in two patients who were ineligible for a circumcision.

Surgery illustrated--focus on details: A novel method of scrotal orchidopexy: description of the technique and short-term outcomes.

Testicular torsion is an urgent urological condition requiring prompt surgical intervention. The aim of surgery is assessment of testicular viability, manual detorsion of the testicle and scrotal orchidopexy to prevent recurrence of the torsion in the future. The surgical approach to this condition has developed over the years, yet there is an on-going debate about the technique of orchidopexy. Various methods have been described, all of which have certain disadvantages: a possibility of recurrence, chronic scrotal discomfort, negative effect on fertility and possibly an increased risk of carcinogenesis. We are proposing a new technique of scrotal orchidopexy, which reliably secures the testicle whilst avoiding breaching the tunica albuginea and thus damage to testicular parenchyma. DESCRIPTION OF THE TECHNIQUE

A novel method of scrotal orchidopexy: description of the technique and short-term outcomes: FOCUS ON DETAILS

Testicular torsion is an urgent urological condition requiring prompt surgical intervention. The aim of surgery is assessment of testicular viability, manual detorsion of the testicle and scrotal orchidopexy to prevent recurrence of the torsion in the future. The surgical approach to this condition has developed over the years, yet there is an on-going debate about the technique of orchidopexy. Various methods have been described, all of which have certain disadvantages: a possibility of recurrence, chronic scrotal discomfort, negative effect on fertility and possibly an increased risk of carcinogenesis. We are proposing a new technique of scrotal orchidopexy, which reliably secures the testicle whilst avoiding breaching the tunica albuginea and thus damage to testicular parenchyma. DESCRIPTION OF THE TECHNIQUE

Postradical cystectomy bowel perforation caused by a drainage tube: a case report

IntroductionOpen drains are frequently placed in the abdominal cavity to prevent the collection of fluid or blood following major surgery.Case presentationWe describe a case of perforation of the large bowel caused by the drain tube placed in a 74-year-old patient who had undergone radical cystectomy for invasive bladder cancer.