Nikolaos Ferakis

Long-Term Results After Computed-Tomography–Guided Percutaneous Radiofrequency Ablation for Small Renal Tumors

PURPOSE To present the long-term results and to identify possible risk factors for recurrence after radiofrequency ablation (RFA) for renal tumors. PATIENTS AND METHODS Thirty-one patients with a total of 39 renal tumors ranging from 1.3 to 7.5 cm (mean size 3.1 cm) were treated with RFA using a Rita Medical System model 1500 RF generator attached to a 15-gauge Starburst XL probe under percutaneous CT scan guidance. The average patient age was 61.4 years (range 37-86 y). Indications for RFA were bilateral tumors, presence of serious comorbidities, a high risk of development of additional renal-cell carcinomas, marginal renal function, and patient preference. No tumor was biopsied before treatment; therefore, only local control success rates could be provided. Recurrence was defined as enhancement or lesion enlargement on follow-up CT scan. Statistical analysis was performed to identify possible risk factors for recurrence. Parameters tested were age, sex, and number of ablation sessions, tumor size, location, multiplicity, body mass index, and American Society of Anesthesiologists score. RESULTS Initial ablation success rate was 90% and with repeated treatment, a success rate of complete ablation reached 97%. Average follow-up was 61.2 months (range 36-84 mos). Recurrence was seen in four tumors. The risk factor associated with recurrence was tumor size exceeding 4 cm (P < 0.01, relative risk [RR] = 3.31). Overall 3- and 5-year tumor control rate was 92% and 89%, respectively. Tumor size was also predictive for recurrence in the subgroup of 17 patients followed for more than 5 years (P = 0.02, RR = 3.15). Tumor control rate for this subgroup was 90%. CONCLUSIONS According to our results, larger tumor size was prognostic for recurrence after RFA for renal tumors. This treatment seems to demonstrate excellent tumor control long-term results, comparable to those achieved by nephron-sparing surgery in a selected group of patients.

Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: Lessons learned from a review of the literature

The aim of this review is to present the most recent data regarding the indications of mini percutaneous nephrolithotomy (PCNL), the results and the complications of the method. Medline was searched from 1997 to January 2014, restricted to English language. The Medline search used a strategy including medical subject headings and free-text protocols. PCNL is a well-established treatment option for patients with large and complex renal calculi. In order to decrease morbidity associated with larger instruments like blood loss, postoperative pain and potential renal damage, a modification of the technique of standard PCNL has been developed. This is performed with a miniature endoscope via a small percutaneous tract (11-20 F) and was named as minimally invasive or mini-PCNL. This method was initially described as an alternative percutaneous approach to large renal stones in a pediatric patient population. Furthermore, it has become a treatment option for adults as well, and it is used as a treatment for calculi of various sizes and locations. However, the terminology has not been standardized yet, and the procedure lacks a clear definition. Nevertheless, mini-PCNL can achieve comparable stone-free rates to the conventional method, even for large stones. It is a safe procedure, and no major complications are reported. Although less invasiveness has not been clearly demonstrated so far, mini-PCNL is usually related to less blood loss and shorter hospital stay than the standard method.

Splenogonadal fusion: report of a case and review of the literature.

Abstract We report a case of splenogonadal fusion masquerading as a testicular tumor and review the etiology, the pathogenesis and the management of this rare disease.

Bcl-2 protein and DNA ploidy in renal cell carcinoma: Do they affect patient prognosis?

Abstract  Aim:  The aim of the present study was to correlate bcl‐2 protein expression and DNA‐ploidy status with established prognostic parameters in renal cell carcinoma (RCC) and to examine their impact on disease progression and patient survival.

Synchronous Malignant Peripheral Nerve Sheath Tumor and Adenocarcinoma of the Prostate: Case Report and Literature Review

Malignant Peripheral Nerve Sheath Tumors (MPNSTs) of the prostate are extremely rare. A very unusual case of simultaneous adenocarcinoma and MPNST of the prostate is reported. A 60-year-old Caucasian male presented for annual urologic examination. Digital rectal examination revealed a painless, toughish, and asymmetrically enlarged prostate. Serum prostate-specific antigen was 1 ng/mL. Radiologic examinations demonstrated a large mass, which was arising from the left peripheral lobe of the prostate. The patient underwent transrectal ultrasound-guided biopsy of the prostate which revealed a smooth muscle tumor of uncertain malignant potential. Radical retropubic prostatectomy with en bloc removal of the mass and the seminal vesicles was performed and histology demonstrated low-grade MPNST and adenocarcinoma of the prostate. To the best of our knowledge, this is the first report of simultaneous prostatic adenocarcinoma and MPNST in the English literature.

A Rare Case of Localised Isolated Penile Fournier’s Gangrene and a Short Review of the Literature

Penile Fourniers gangrene (FG) is very rare clinical entity, which is also known as penile necrotizing fasciitis or wet gangrene of the penis. It is associated with increased morbidity and mortality and in the majority of the described cases it affects not only penis but also the adjacent organs and tissues (e.g., bladder, muscles, rectum, testis, and scrotum). We report a rare case of a previously healthy 68-year-old male, who presented with acute isolated penile Fourniers gangrene. Pus culture was identified with pathogens Enterococcus faecalis, Streptococcus gordonii, and Prevotella melaninogenica. Prompt surgical exploration, fluid resuscitation, antibiotic treatment, and diligent postoperative care are the cornerstone in the successful treatment of this emergency with high mortality.

Nontraumatic Acute Elevation of Pancreatic Enzymes following Percutaneous Nephrolithotomy: A Rare Complication

Herein, we report the case of a 48-year-old female who developed nontraumatic acute pancreatitis following left supracostal Percutaneous Nephrolithotomy. Three hours postoperatively, the patient developed fever with signs and symptoms consistent with hydrothorax, which was confirmed radiologically and was managed conservatively. The following days, the patient developed manifestations of Systemic Inflammatory Response Syndrome with epigastric pain, nausea, and vomiting. Blood, urine, and sputum cultures were negative. Serum amylase and lipase levels were elevated 3 and 13 times above the normal level, respectively. Imaging studies revealed no pathologic findings from pancreas. These findings were consistent with the diagnosis of acute pancreatitis.

Emergency embolisation of a spontaneously ruptured angiomyolipoma in a solitary kidney

Angiomyolipoma of the kidney is one of the most common causes of spontaneous renal bleeding. Here we present the case of a middle aged female patient, who presented with automatic rupture of a large angiomyolipoma in a solitary kidney. The patient was treated with selective angioembolisation (SAE), and was discharged in good condition with unaltered renal function. SAE provides an efficient control of haemorrhage in the acute stage, but it has limited value in long-term treatment of angiomyolipomas. In contrast, surgical treatment allow the full removal of the tumour, however it is associated with significant complications. Το αγγeιομυολίπωμα του νeφρού αποτeλeί μια από τις πιο συχνές αιτίeς που μπορούν να προκαλέσουν αυτόματη πeρινeφρική αιμορραγία. Παρουσιάζουμe την πeρίπτωση μιας γυναίκας ασθeνούς, μέσης ηλικίας, που παρουσιάσθηκe μe αυτόματη ρήξη eνός μeγάλου αγγeιομυολιπώματος σe μονήρη νeφρό. Η ασθeνής αντιμeτωπίσθηκe μe eκλeκτικό αγγeιακό eμβολισμό (EΑE) και eξήλθe σe καλή κατάσταση μe ανeπηρέαστη νeφρική λeιτουργία. Ο EΑE προσφέρeι αποτeλeσματικό έλeγχο της αιμορραγίας στην οξeία φάση, αλλά έχeι πeριορισμένη αξία στην μακροπρόθeσμη αντιμeτώπιση των ΑΜΛ. Οι χeιρουργικές μορφές αντιμeτώπισης eπιτρέπουν την πλήρη αφαίρeση του όγκου, αλλά eμφανίζουν σημαντικότeρeς eπιπλοκές.