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Introduction and Objectives. Bladder cancer is one of the most common malignancies in Europe. Many risk factors for bladder cancer have been identify, with tobacco smoking and exposure to environmental and occupational carcinogens being the most important ones. The objective of this study was to identify the risk factors associated with the development of bladder cancer among patients that underwent radical cystectomy. Materials and Methods. The study included 391 patients that underwent radical cystectomy from January 2017 to December 2018 in our center. According to their smoking status, patients were grouped into non-smokers (patients that didn't smoke any cigarette in the last 10 years), smokers (patients that did smoke in the last 6 months) and ex-smokers (patients that have more than 6 months and less than 10 years since they have quit smoking). Other risk factors analyzed were hereditary factors, history of external beam radiation therapy and exposure to occupational carcinogens. Results. The median age of the patients was 69 years old with 308 men (78.77%) and 83 women (21.23%) included. 170 patients were classified as smokers (43.48%), while 131 patients were ex-smokers (33.50%) and 90 patients were non-smokers (23.02%). The prevalence of occupational carcinogens exposure was 10.74%. Hereditary risk factors associated with the development of bladder cancer were identified in 17 patients (4.35%). External beam radiation therapy was identified as a risk factor in 27 patients (6.90%). Current smokers were more frequently diagnosed with T3b and T4a, while N1 and N2 lymph node stages were more often diagnosed among smokers and ex-smokers. Conclusions. Bladder cancer is a common malignancy that has a big impact on health systems and will continue to be so, due to the high prevalence of its most important risk factor, tobacco smoking. In our study, smoking was the most important risk factor, with a prevalence of 77% among patients that were classified as current smokers and ex-smokers. Prevention of smoking needs to be highlighted and cessation programs must be developed in order to lower the incidence of bladder cancer. More measures for increasing safety at work must be taken in order to decrease the exposure to occupational carcinogens. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Cystatin C could be used as a reliable alternative marker to creatinine in estimating glomerular filtration rate (GFR), even in kidney transplant recipients. The aim of our study was to evaluate the clinical and biological determinants of glomerular filtration rate estimated with cystatin C (CysC) in kidney transplant recipients, at 3 months after kidney transplantation. Materials and Methods. We performed a prospective observational study on 44 consecutive kidney transplant patients, followed for 3 months after kidney transplantation. Cystatin C was measured by latex enhanced immunoturbidimetric assay (EuroLyser). Results. Thirty patients (68.2%) out of 44 had an estimated GFRCysC less than 60 ml/min/1.73m2. Patients with estimated GFRCysC < 60 ml/min/1.73m2 tended to be older (33.4 ± 11 vs 40.6 ± 12 years, p = 0.06), were more frequently males (35.7% vs 80%, p = 0.004) and presented significantly decreased levels of pretransplant total cholesterol (208± 32.7mg/dl vs 175.8 ± 54.6 mg/dl, p= 0.04). By multivariate binary logistic regression, recipient male gender (OR: 5.59; 95% CI: 1.06-29.53; p= 0.04) and pretransplant total cholesterol levels (OR: 0.97; 95% CI: 0.95-0.99; p= 0.02) were independently associated with estimated GFRCysC < 60 ml/min/1.73m2 at 3 months after transplantation and recipient age had a near-significant trend (OR: 1.08; 95% CI: 0.98-1.18; p= 0.07). Conclusions. In conclusion, we found that recipient male gender and pretransplant total cholesterol levels were independent determinants of glomerular filtration rate estimated with cystatin C in kidney transplant recipients, at 3 months after kidney transplantation [ABSTRACT FROM AUTHOR]

Introduction Idiopathic retroperitoneal fibrosis (IRF) is a rare benign pathology, consisting of fibrous inflammatory tissue formation in the retroperitoneal space, surrounding main vessels and often involving nearby anatomic structures, such as the ureters, leading to obstruction and renal function impairment. Diagnosis is challenging, based upon high clinical suspicion, correct differential diagnosis and imagistic evaluation. Biopsy is required to confirm the non-malignant nature of the retroperitoneal mass. Medical immunosuppressive treatment is reasonable for moderate disease, whereas surgical treatment is indicated in advanced stage. Follow-up is mandatory but there is no consensus upon a surveillance schedule. Material and Methods We present a case of a male patient treated for a left retroperitoneal tumour destructive for the left renal unit, which was partially removed alongside the kidney, and turned up to be IRF and consequently immunosuppressive therapy was administered with 5 years normal follow-up. 8 years after the first event, IRF recurred on the right side of the retroperitoneum, obstructing the solitary kidney. Ureterolysis with omental wrapping was performed with optimal results and immunosuppressive therapy was reinitiated, with good response and normal check-ups to present day. Results and Conclusions IRF can prove to be a real challenge, as knowledge on its origin, optimal diagnostic, treatment and follow-up protocols is still building up. It is a potentially curable disease if managed correctly. Bilateral ureterolysis in unilateral disease could be taken into consideration from the start as late recurrence can occur. Follow-up should be conducted for a long period of time, maybe for the rest of the patient's life. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to review current imaging techniques used for diagnostic, disease monitoring and follow-up of idiopathic retroperitoneal fibrosis (IRF), as to provide the reader with up to date information that can be useful in clinical practice. We conducted a PubMed search for original articles, literature reviews and series reports published in English in the past 16 years regarding IRF, mainly focusing on imagistic study of the disease and selected 52 articles which we found most relevant. Today, CT and MRI seem to be the wise choice and the right combination of imaging techniques, with reasonable accessibility of the method and widespread use in clinical practice, but we reviewed all imagistic methods that might be of use, in order to provide the reader with an overview of current information regarding this topic. [ABSTRACT FROM AUTHOR]

There are approximately 30 case reports in the literature of synchronous bilateral upper tract urothelial carcinoma (UTUC) without bladder involvement[1-11]. Surgical treatment, eitheropen, laparoscopic or robotic approach, remains the standard therapy, but choosing the appropriate technique is crucial in this situation. Some patients with low-risk disease may benefit from a more conservative approach (e.g., endoscopic ablation, segmental resection), in order to preserve the renal function. No specific guidelines for management have so far been formulated, given the rarity of disease. We present the case of a patient with synchronous bilateral UTUC, involving renal pelvis, in which we decided radical nephrectomy on one side and a conservative intervention on the contralateral side, with very good clinical and functional results. The challenges in diagnosis and surgical management of such a case are highlighted and various available treatment options are presented. [ABSTRACT FROM AUTHOR]

Introduction and objectives. Kidney transplantation improves survival and quality of life for the recipients and although not a direct concern of the patient it is the most cost-effective treatment for end-stage renal disease compared to chronic dialysis. Lymphocele is one of the most common complications in kidney transplant recipients and may affect as many as 26% of them. Materials and methods. We evaluated retrospectively the occurrence of lymphocele in a series of 1542 consecutive kidney transplants performed in our center between 1st of July 1997 and 31st of December 2014. Lymphocele were diagnosed by ultrasonography and computed tomography. Results. The incidence of lymphoceles after kidney transplantation in our center was 1.23% (19 cases). The indication for treatment ware local symptoms, graft dysfunction or both. In eight cases percutaneous drainage guided by ultrasonography and sclerotherapy with povidone-iodine was an efficient therapy. In 11 cases open surgery was the therapy of choice and consisted in large fenestration into the peritoneal cavity in six cases or associated with ureterocystoneostomy in five cases. Conclusions. Lymphoceles after kidney transplantation can be treated by ultrasound-guided drainage associated with sclerotherapy with the inconvenience of a longer hospital stay and a recurrence rate up to 40%, or by open or laparoscopic surgical intervention with large fenestration into the peritoneal cavity, associated or not with ureterocystoneostomy. Taking into account that we did not notice any recurrence or complication after open surgery, we consider that open fenestration into the peritoneal cavity is the method of choice for the treatment of lymphoceles after renal transplantation. [ABSTRACT FROM AUTHOR]

Introduction. Prostate cancer may express great variety in clinical behavior, from an indolent evolution to lethal disease. According to preoperative d'Amico criteria it is appreciated that patients with localized prostate cancer, PSA > 20 ng/ml, Gleason score of 8 to 10 are classified at high risk for recurrence of symptomatic or asymptomatic metastatic disease. The Scandinavian Prostate Cancer Group 4 (SPCG-4) and Prostate Intervention Versus Observation Trial (PIVOT) trials generated new coordinates in the means of the right moment and treatment option in prostate cancer. Objective. The aim of this study was to determine the number of patients restaged in the means of risk stratification after pathologic results from the radical prostatectomy specimen. Materials and methods. 218 patients with prostate cancer were enrolled in a prospective study between June 2011 and January 2014, after obtaining the informed consent. All cases underwent open retropubic radical prostatectomy in our Center. Results. Of the 29 pts staged preoperatively as cT1c, 21 were staged as pT2 postoperatively, the rest being staged as pT3. From the preoperative group staged cT2, after surgery and pathology, one case is staged pT1, 40 pts pT3, one case pT4 and only 48 pts staged pT2, the same as before surgery. For cT3 stage, 61 pts were actually pT3, representing 55,5% of the cT3 group, and 28% of the total number of pts in the study, as 36 pts were reassigned to other risk groups. Of the two cT4 cases, one was actually pT4 and one pT3. Of the preoperative 2-6 Gleason group, 34,6% were reassigned to the intermediate risk group, and 4,8% were restaged as high risk. Of the initial intermediate risk group, 43 were actually intermediate risk, 17 pts were reassigned to low risk Gleason 2-6 group, and the remaining 11 were Gleason 8 and 9. Preoperatively high risk pts were restaged as follows: 17,3% reassigned to low risk group, 21,7% intermediate risk,the remaining 61 % maintaining in the high risk group. Conclusions. For cT1c, 27,6% of the cases areoverstaged after pathology report, as for cT2 the proportion being even higher, of 45,5%, which explains the high risk of progression without surgical treatment for this stage. According to statistical data, cT3 stage isthen placed in an inferior risk group in 34% of cases. Regarding the number of initially overstaged patients (based upon cT), 16% of the study group are overstaged preoperatively, of which 33 pts fall in the cT3 stage, this being probably the result of insufficient information from the preoperative panel consisting of transrectal ultrasound, serum PSA, digital rectal examination and Gleason score from the biopsy specimens. [ABSTRACT FROM AUTHOR]

Introduction: Kidney transplantation is considered the "gold-standard" replacement therapy for patients with end stage renal disease because it offers a better quality of life and longer survival compared to dialysis. The rate of chronic graft loss is still considerable despite significant improvements in short and long term graft survival and patients may be suitable candidates for retransplantation. However, retransplantation is a high-risk procedure because of limited surgical options performed on highly sensitized patients, and higher rate of graft failure. The aim of this study was to evaluate urological complications of renal retransplantation in our center. Materials and Methods: We evaluated retrospectively the outcomes of kidney retransplantation performed in our center between 1st of July 1997 and 31st of December 2014. A total of 1542 consecutive kidney transplantation were performed and 78 patients were candidates for a second transplant. Renal grafts were obtained in 34 cases (43.5%) from cadaveric and in 44 cases (56.5%) from living-related donors. Among these 78 cases of retransplantation, the most common identified causes of end-stage renal disease were chronic glomerulonephritis (30.7%), diabetic nephropathy (16.7%) and systemic lupus erythematosus (6.4%). In 20.5% of retransplanted cases (N=16) recipients were at high immunologic risk compared with 3.89% (N=60) from the first kidney transplantation group (p < .05). Receptor average age was 37.2±9.8 y. o. with a male to female ratio 1.51/1. Donors mean age 48.2±16.4 y. o. with a ratio 1.17/1. Results: The overall incidence of urological complications in kidney retransplanted patients was 6.4% (five cases). Ureteral leakage was the most common complication recorded in three cases (3.8%), all in the first month postoperatively. Other urological complications identified in the retransplanted group were ureteral stenosis (one case - 1.3%) and lymphocele (one case - 1.3%). Conservative treatment (prolonged vesical catheterization) was successful in one case with a small anastomotic fistula. In the other cases of ureteral leakage and stenosis open surgery was needed, consisted in resection of the affected segment and stented ureterocystoneostomy. Lymphocele was successfully treated by US guided percutaneous drainage. Conclusions: Urological complication rate for kidney retransplantation was acceptable and comparable with the first transplant group (p>.05). Although the number of patients retransplanted in our center was low, results from this study encourage us to consider retransplantation as the best choice for patients after previous graft failure. [ABSTRACT FROM AUTHOR]

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Background. Renal angiomyolipomas are rarely associated with tuberous sclerosis. Occasionally, their spontaneous rupture can be life-threatening and require immediate medical care. Objective. To analyze the cases of renal angiomyolipoma with cutaneus phenotype treated in our center. Design, Settings and Participants. A retrospective evaluation was made of 12 patients with renal angiomyolipomas with cutaneus phenotype treated in our center, between June 2000 and June 2010. Measurements. We assessed the size of the tumors and the biological constants at the admission, the treatment chosen in each case and their evolution during the therapy. Results and limitations. Average age at diagnosis: 34.2 year, 4 men and 8 women. Mean follow-up: 71.8 months. Initial symptoms, tumor size, treatment and evolution of these patients were evaluated. 8 patients (66.6%) were symptomatic at admission, complaining gross hematuria, mild abdominal pain and meteorism; 2 emergency admittance for acute abdominal pain with muscular defense. On physical examination, all patients presented bulky plaquelike lesions consistent with sebaceous adenoma, mainly on the face, forehead and upper extremities. Laboratory results at admissions displayed a mean Hb level of 7.2 g/dL and a mean creatinine level of 1.8 mg/dL (0.6-3.1 mg/dL). Contrast enhanced abdominal CT was performed at all patients, who revealed bilalteral AML in 8 cases (66.6%), Wunderlich's syndrome in 3 cases (25%). Mean tumor size was 8.3 cm (2.4-21.4 cm). None of the patients with renal lesions <3.4 cm were symptomatic at admittance. All the patients had severe mental retardation and presented on the CT scan calcified densities in cerebral ventricles. The treatment consisted in conservatory approach in 6 cases (50%), total unilateral nephrectomy in 2 cases, partial nephrectomy in 2 cases and selective arterial embolization in 2 cases. Conclusions. Because of the severe mental retard, the history was difficult to obtain and the treatment could be delayed. The correlation with the paraclinic parameters is usually the most important in these cases. We suggest a regular monitoring in cases with small and asymptomatic lesions. Both surgery and SAE offer good results when performed on an elective basis, but the surgical approach is to first line of treatment in cases with Wunderlich's syndrome. Multiplicity, bilaterality and an increased size of the lesions appear to be high risk factors for renal rupture. [ABSTRACT FROM AUTHOR]

Retroperitoneal liposarcoma is a rare tumor in clinical practice, that is difficult to diagnose and treat. We present the case of a 64 years old female patient diagnosed by computed tomography imaging with a massive left renal tumor, after the emergence of an autopalpable mass within the abdominal left flank. The CT showed a large left renal mass without a clear limit from the adiacent structures (pancreas, spleen, colon). After a correct and complete surgical resection, a retroperitoneal dedifferentiated liposarcoma was histopathologicaly diagnosed, witch encapsulated the left kidney and adrenal gland without microscopic invasion of these structures. [ABSTRACT FROM AUTHOR]

Background/aim: Liver injury has been frequently reported in association with SARS-CoV-2 infection, but data are still lacking regarding the impact of pre-existing liver damage and neoplasia on SARS-CoV-2 infection outcome and vice-versa. This study aimed to assess the effects of SARS-CoV-2 infection on hepatocellular carcinoma (HCC) in chronic hepatitis C virus (HCV) infected patients, both in therapeutic-naïve and patients treated with direct acting antivirals., Patients and Methods: We conducted a retrospective cohort study on 21 patients with a personal history of HCV infection, that have been diagnosed with different forms of HCC and who were subsequently infected with SARS-CoV-2. Patients were monitored by liver function tests, tumoral markers, blood cell count, and coagulation profile periodically., Results: Solitary HCC nodules were predominant among the subjects who achieved sustained virologic response, while multinodular and infiltrative patterns were mostly prevalent among the treatment-naïve group. Most patients had mild and moderate COVID-19 infections., Conclusion: Within the current global pandemic crisis, cancer patients are highly vulnerable and in need of constant monitoring. Among patients with HCC, the ones with cured HCV infection may be at a lower risk of fatality than those with active HCV infection, when diagnosed with SARS-CoV-2 infection., (Copyright © 2021 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Psychiatric patient boarding in the emergency department (ED) is a ubiquitous problem associated with increased morbidity and mortality., Objective: We evaluate the effect of closing a public psychiatric facility in a major metropolitan area on the ED length of stay (LOS) of psychiatric patients., Methods: This was a retrospective chart review at two metropolitan EDs of all patients assessed to require inpatient psychiatric hospitalization. The time of arrival, time of disposition, time of transfer, insurance status, and accepting facility type were collected prior to and following the closure of a local inpatient psychiatric facility., Results: We analyzed a total of 1107 patients requiring inpatient psychiatric hospitalization, with 671 patients who presented prior to the closure of the closest public psychiatric facility and 436 patients that presented following the facility closure. Following hospital closure, patients with private insurance (620 min before, 771 min after) and Medicare/Medicaid (642 min before, 718 min after) had statistically significantly longer ED LOS, as well as patients transferred to a private psychiatric hospital (664 min prior, 745 min after). However, overall ED length of stay following hospital closure for transfer of all psychiatric patients requiring inpatient hospitalization was not found to be statistically significant (1017 min prior, 967 min after)., Conclusion: There was a statistically significant increase in ED LOS for patients with private insurance, Medicare/Medicaid, and for those patients transferred to a private psychiatric facility following closure of a public mental health hospital; however, overall, ED LOS was not increased for patients transferred to an inpatient psychiatric facility. This study highlights the significant impact that the closure of a single inpatient psychiatric facility can have on nearby EDs. We hope to bring attention to the need for increased psychiatric services during a time when there is a nationwide trend toward the reduction of available inpatient psychiatric beds., (Copyright © 2017 Elsevier Inc. All rights reserved.)

This paper proposes a method and an information technology tool aiming to support the ergonomics layout design of individual workstations in a given space (building). The proposed method shares common ideas with previous generic methods for office layout. However, it goes a step forward and focuses on the cognitive tasks which have to be carried out by the designer or the design team trying to alleviate them. This is achieved in two ways: (i) by decomposing the layout design problem to six main stages, during which only a limited number of variables and requirements are considered and (ii) by converting the ergonomics requirements to functional design guidelines. The information technology tool (ErgoOffice 0.1) automates certain phases of the layout design process, and supports the design team either by its editing and graphical facilities or by providing adequate memory support.