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Environmental sustainability of viticulture is negatively affected by prolonged droughts. In limestone dominated regions, there is limited knowledge on grapevine water status and on methods for accurate evaluation of actual water demand, necessary to appropriately manage irrigation. During a dry vintage, we monitored plant and soil water relations in old and young vines of Istrian Malvasia on Karst red soil. The vineyard with young vines was additionally subdivided into two areas, based on their soil type, 1) karst silty-clay loam, and 2) mixture of crushed rocks and karst silty-clay loam (stony soil). Seasonal changes in exploited water resources were estimated via analysis of oxygen isotope composition (δ 18 O) of rainfall, deep soil water, and xylem sap. We hypothesized that plants are able to thrive during drought thanks to the water stored in deep soil layers, while they rely less on superficial soil horizons. Our results show that vines growing on karstic substrates have deep roots securing the use of stable water sources during summer, with consequent favourable plant water status. In fact, both young and mature vines approached the threshold of severe water stress, but never surpassed it, as midday leaf water potentials were >-1.3MPa in all study sites. Vines roots showed flexible water uptake, i.e. the ability to absorb water from deep or shallow soil horizons during drought and after late-summer thunderstorms, which was particularly evident in vines growing on the stony soil. In fact, precipitations of 20mm were enough for plant water status recovery, due to fast infiltration. On the other hand, at least 50mm of rainfall were necessary to induce water status recovery in more compact soil (karst silty-clay loam). Our findings provide new knowledge on the rooting depth and water needs of vines growing on shallow soils overlying fractured limestone bedrock., (Copyright © 2019. Published by Elsevier B.V.)

Due to intrinsic characteristics of aquifers groundwater frequently passes between various types of aquifers without hindrance. The complex connection of underground water paths enables flow regardless of administrative boundaries. This can cause problems in water resources management. Numerical modelling is an important tool for the understanding, interpretation and management of aquifers. Useful and reliable methods of numerical modelling differ with regard to the type of aquifer, but their connections in a single hydrodynamic model are rare. The purpose of this study was to connect different models into an integrated system that enables determination of water travel time from the point of contamination to water sources. The worst-case scenario is considered. The system was applied in the Soča/Isonzo basin, a transboundary river in Slovenia and Italy, where there is a complex contact of karst and intergranular aquifers and surface flows over bedrock with low permeability. Time cell models were first elaborated separately for individual hydrogeological units. These were the result of numerical hydrological modelling (intergranular aquifer and surface flow) or complex GIS analysis taking into account the vulnerability map and tracer tests results (karst aquifer). The obtained cellular models present the basis of a contamination early-warning system, since it allows an estimation when contaminants can be expected to appear, and in which water sources. The system proves that the contaminants spread rapidly through karst aquifers and via surface flows, and more slowly through intergranular aquifers. For this reason, karst water sources are more at risk from one-off contamination incidents, while water sources in intergranular aquifers are more at risk in cases of long-term contamination. The system that has been developed is the basis for a single system of protection, action and quality monitoring in the areas of complex aquifer systems within or on the borders of administrative units., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objectives: The role of cytoreductive nephrectomy (CN) in the treatment of patients harboring metastatic renal cell carcinoma (mRCC) has become controversial since the emergence of effective targeted therapies. The aim of our study was to compare the overall survival (OS) between CN and non-CN groups of patients presenting with mRCC in the era of targeted drugs and to assess these outcomes among the different Memorial Sloan-Kettering Cancer Center (MSKCC) and The Eastern Cooperative Oncology Group (ECOG) performance status subgroups., Methods and Materials: A total of 351 patients with mRCC at diagnosis recruited from 18 tertiary care centers who had been treated with systemic treatment were included in this retrospective study. OS was assessed by the Kaplan-Meier method according to the completion of a CN. The population was subsequently stratified according to MSKCC and ECOG prognostic groups., Results: Median OS in the entire cohort was 37.1 months. Median OS was significantly improved for patients who underwent CN (16.4 vs. 38.1 months, P<0.001). However, subgroup analysis demonstrated that OS improvement after CN was only significant among the patients with an ECOG score of 0 to 1 (16.7 vs. 43.3 months, P = 0.03) and the group of patients with good and intermediate MSKCC score (16.8 vs. 42.4 months, P = 0.02). On the contrary, this benefit was not significant for the patients with an ECOG score of 2 to 3 (8.0 vs. 12.6 months, P = 0.8) or the group with poor MSKCC score (5.2 vs. 5.2, P = 0.9)., Conclusions: CN improves OS in patients with mRCC. However, this effect does not seem to be significant for the patients in ECOG performance status groups of 2 to 3 or poor MSKCC prognostic group., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: We analyzed renal cell carcinoma (RCC) brain metastasis (BM) risk factors and compared BM occurrence in metastatic RCC (mRCC) treated with or without anti-angiogenic agents (AA)., Methods: Data from all consecutive metastatic RCC patients (patients) treated in a french cancer center between 1995 and 2008 were reviewed. Patients had histologically confirmed advanced RCC without synchronous BM at the time of metastasis diagnosis. AA were sorafenib, sunitinib and bevacizumab. We also included patients treated with mTor inhibitors, temsirolimus and everolimus, as they also demonstrated anti-angiogenic activities. Characteristics of the two groups treated with or without AA were compared with a Fisher exact test. Impact of AA on overall survival (OS) and cumulative rate of brain metastasis (CRBM) was explored by Kaplan-Meier method., Results: One hundred and ninety-nine patients with advanced RCC were identified, 51 treated with AA and 148 without AA. The median follow-up duration was 40 months. BM occurred in 35 patients. Characteristics between AA treated and non-AA treated groups were unbalanced and favoring better prognostic factors in AA treated group. Median OS was 24 months. AA treatment was not associated with a lower CRBM (HR = 0.58 [0.26-1.30], P = 0.187). Median survival free of BM was 11.8 months, CI95% (4.95-18.65) in the group without AA treatment and 28.9 months in the AA group, CI95% (18.64-39.16). Alkaline phosphatase (AP) was an independent prognostic factor for BM (P = 0.05). In multivariate Cox model, after adjustment to AP, AA did not improve the CRBM (aHR = 0.53 [0.22-1.32])., Conclusion: In this retrospective study, AA did not decrease significantly the CRBM. Elevated AP was a predictive factor for BM in mRCC.

Background: Preliminary study of the feasibility of robot-assisted laparoscopy for deep pelvic endometriosis nodule resection., Patients and Methods: Between May 2009 and February 2010, we collected medical and surgical data about deep infiltrating endometriosis resections performed in our institution, using robot-assisted laparoscopy (DA VINCI Intuitive Surgical System(®))., Results: Six patients were included: four partial bladder and two uterosacral ligament resections. The median age was 29.5 years (24-48). All patients reported chronic pelvic pain, associated with urinary tract symptoms in case of bladder endometriosis. Before surgery, lesion mapping was performed using magnetic resonance imaging for all, and mechanical bowel preparation or double-j stenting were prescribed, depending on the endometriosis location. Surgical procedures median time was 173 minutes (156-244), and median length of stay was 3 days (2-5). Complete resection was possible in all cases. There was no conversion in classical laparoscopy or laparotomy, and no intraoperative complication. Pathology diagnosis of surgical pieces concluded to endometriosis lesion in all cases., Conclusion: This study shows the feasibility of the robot-assisted laparoscopy in the resection of deep pelvic endometriosis, without increasing of surgical timing, blood loss or intraoperative complications., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Several types of nephrological side-effects can occur during treatment with targeted therapy: high blood pressure, proteinuria, thrombotic microangiopathy, kidney failure, etc. Screening and treatment for high blood pressure, proteinuria and kidney failure are recommended during treatment with molecular targeted therapy (mainly for anti-VEGF). If BP is greater than 140/90mmHg on two measurements, it must be treated before the start of treatment. Self-measurement or ambulatory measurement of blood pressure is recommended. All antihypertensive drugs may be used apart from those, which interfere with cytochrome P450 (verapamil and diltiazem). Specialist advice (cardiology or nephrology) is recommended in the event of uncontroled hypertension. It is essential to monitor proteinuria with a urine strip test: if proteinuria is less than 2+ (grade 1), maintain treatment with molecular targeted therapy; if proteinuria is greater or equal to 2+ (grade2 or 3, confirmed by weight assay), specialist advice is required. Persisting proteinuria of grade2 or 3 requires nephrological monitoring. Thrombotic microangiopathy must be investigated in the event of hypertension greater than grade2 and/or proteinuria greater than 2+., (Copyright © 2011 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Purpose: The objective was to define the trends of PN use over time at six tertiary care European centers., Methods: Data were retrieved from institutional databases for patients treated with either PN or radical nephrectomy (RN) for stages T(1-2)N(0)M(0) renal cell carcinoma (RCC) between 1987 and 2007. For purpose of temporal trend analyses patients were divided into five equally sized groups according to the date of surgery. Categorical and multivariable logistic regression analyses assessed predictors of PN use., Results: Overall 597 (31.7%) patients were treated with PN. Overall, a 4.5-fold increase of PN was recorded. The absolute increases were 41.7-86.3%, 14.9-69.3% and 8.1-35.3% for lesions < or = 2 cm, 2.1-4 cm and 4.1-7 cm (chi-square trend test p<0.001), respectively. In multivariable logistic regression models, decreasing tumor size, younger age, more contemporary date of surgery, male gender and institutional PN rate represented independent predictors of the individual probability of treatment with PN. Lack of data from community hospitals limits the generalizability of our findings., Conclusion: Based on data from six tertiary care centers, the contemporary rate of PN ranges from 86 to 35% for renal masses < or = 2 cm to 4.1-7 cm and is indicative of excellent quality of care.

Aim: To assess correlation between necrosis on imaging and pathology reports and prognostic value of tumour necrosis in chromophobe renal cell carcinoma (CRCC)., Methods: Cases were extracted from a prospective renal cancer registry set up in January 2000 containing 470 patients who had surgery for renal cancer in our institution. We reported the outcome of this series and assessed prognostic significance of clinical and pathologic characteristics. Retrospectively, imaging results and histologic slides of CRCC were analyzed and looked for presence and extent of any tumour necrosis and histologic subtype (eosinophilic versus clear variant). Agreement between necrosis diagnosed by CT-scan and histologic necrosis was given by the kappa coefficient., Results: Of the 470 patients from the database, 21 (4.5%) had CRCC. Their mean age (+/-SD) was 56.4 +/- 11.4 years (range 34-73). Mean tumour size (+/-SD) was 5.6 +/- 4.2 cm. After a mean follow-up of 22.5 months (range 1-80), 4 patients (19%) developed metastases. Tumour size, Fuhrman nuclear grade and presence of necrosis on imaging and on histology were significant prognostic factors for disease progression of CRCC (P < or = 0.01). The histologic subtype was not a prognostic factor. Necrosis assessed preoperatively by spiral CT-scan agreed well with histologic coagulative necrosis (kappa = 0.88). Necrosis extent on imaging and on pathology was not a prognostic factor for disease progression., Conclusion: Preoperative detection of tumour necrosis is possible. Tumour necrosis on imaging and on pathology provides a clinically useful information for the clinician to distinguish aggressive variant of CRCC.

Postoperative pituitary apoplexy is an exceptional but life-threatening complication. We report the case of a 62-year-old man who underwent a cystoprostatectomy under general anaesthesia. The immediate postoperative course was complicated by asthenia and an altered state of consciousness. A few days later, a homonymous followed by bitemporal hemianopia developed. A CT-scan and magnetic resonance imaging made the diagnosis o pituitary apoplexy. The treatment was a medical one, with rapid improvement in the patient's condition.

The purpose of this study was to evaluate strategies used for surgical management of renal cell carcinoma with a tumoral thrombus extension in the inferior vena cava (IVC). From January 2000 to December 2001, urological and vascular surgeons jointly undertook surgical treatment on 10 patients with renal cell carcinoma and tumor thrombus in the IVC. There were five women and five men, with a mean age of 60.2 years. The limit of thrombus extension, classified according to the Neves and Zincke system, was level I (renal) in one patient, level II (infrahepatic) in one, level III (retrohepatic) in three, and level IV (atrial) in five. Exposure was achieved by chevron bilateral subcostal laparotomy associated with sternotomy in three patients, bilateral subcostal laparotomy in six, and median sternolaparotomy in one. Radical nephrectomy associated with caval thrombectomy was performed in all patients. Cardiopulmonary bypass was used in four of the five level IV patients. The fifth patient was contraindicated for cardiopulmonary bypass. Transesophageal echography (TEE)-guided endoluminal occlusion of the unobstructed infradiaphragmatic IVC was performed in patients with level III thrombus. Clamping of the IVC was performed in patients with levels I and II thrombus. All procedures were assisted by continuous TEE surveillance. No intraoperative gas or tumor emboli were detected by TEE. The mean number of red blood cell units transfused during the course of hospitalization was 9.7 (range 2-22, median 9). One patient died of multiple organ failure on the day 28 after the procedure. The mean duration of hospitalization was 16 days. The mean duration of follow-up was 9.7 months. During follow-up, two of the remaining nine patients died due to tumor recurrence. Tumor recurrence was also detected in one of the seven surviving patients. Surgery for renal cell carcinoma with tumor thrombus in the IVC must be carried out in a specialized facility with the assistance of TEE surveillance and, in some cases, cardiopulmonary bypass. Operative treatment improves the prognosis of renal cell carcinoma with tumor thrombus in the IVC. In patients with level III thrombus, TEE-guided endoluminal occlusion of the unobstructed infradiaphragmatic IVC simplifies surgical management by obviating the need for exposure of the retrohepatic and supradiaphragmatic IVC.