ABSTRACTS OF THE 21st ANNUAL MEETING OF THE ITALIAN ...

incidence and characteristics of delirium in patients >70 years
old hospitalized for elective surgical urology care. Patients
and Methods: For this study, which is ongoing, elderly
patients for which a surgical urology procedure has been
planned are enrolled. A complete evaluation by geriatrician
with CGA, urologist, and anesthesiologist is applied before
hospital admission. During hospitalization nurses apply a
confusion assessment method daily to define the incidence
and clinical characteristics of delirium. Follow-up is planned
at one and three months and one year after discharge to
evaluate global health and, specifically, functional and
cognitive status. Results: The study includes 37 patients,
(81% male, 19% female, mean age 78.1±4.5 years). Among
them, 33% were affected by benign prostatic hyperplasia;
22%, 26%, 15% by prostate, blood and kidney cancer,
respectively, and 4% with a non-cancerous urinary tract
obstruction. Mean anesthesiologist ASA score was 2.14±0.77,
41% of patients underwent general anesthesia and 59% spinal
anesthesia. Overall, cognitive performance was mildly
impaired (MMSE: mean 24.6±4.3); 17% of patients
developed post-surgical delirium; in this sub-sample, the basal
mean MMSE score was significantly lower, whereas no
significant differences were found with respect to basal scores
of depression and disability domains. Conclusion: In our
sample, the incidence of delirium was lower than expected.
This may be due the selected population having low comorbidity,
mild cognitive decline and a low rate of
complications after the surgical procedure. It was not possible
to fulfill the purpose of the study completely, but we feel
confident that future sample enlargement will allow the
definition of a risk-profile population that might benefit from
specific programs devoted firstly to preventing the
development of delirium and secondly to early treatment.
1 Inouye SK: Delirium in older persons. N Engl J Med
354(11): 1157-1165, 2006.
2 Inouye SK, Bogardus ST, Charpentier PA et al: A multicomponent
intervention to prevent delirium in hospitalized
older patients. N Engl J Med 340(9): 669-676, 1999.
18
MANAGEMENT OF SMALL RENAL CANCER
IN A CONTEMPORARY SERIES OF PATIENTS
WITH VON HIPPEL-LINDAU DISEASE
Paolo Destefanis1 , Barbara Lucatello2 , Mauro Maccario2 ,
Andrea Veltri3 , Barbara Pasini4 , Mariateresa Carchedi1 ,
Andrea Buffardi1 , Francesco Travaglini1 ,
Antonino Battaglia1 , Alessandro Bisconti1 ,
Andrea Bosio1 , Beatrice Lillaz1 and Dario Fontana1 1Divisione Universitaria di Urologia 2, 2S.C.D.U. Endocrinologia, Diabetologia e Metabolismo and 3Istituto di
1820
ANTICANCER RESEARCH 31: 1807-1956 (2011)
Radiologia, Ospedale San Giovanni Battista Molinette,
Torino, Italy;
4 Dipartimento di Genetica, Biologia e Biochimica, Università
degli Studi di Torino, Torino, Italy
Background: Von Hippel-Lindau (VHL) disease is an
autosomal dominant, inherited syndrome that occurs in 1 in
35,000 births. VHL is characterized by the development of
retinal and CNS hemangioblastomas, pheochromocytomas,
pancreatic neuroendocrine tumors, clear-cell renal carcinomas
(RCC) and renal cysts. In particular, RCC occurs in
approximately 40% of patients affected by VHL disease and
is often bilateral and multifocal. The treatment of these
patients, which usually relies on nephron-sparing surgery, is
often very complex. The introduction of minimally invasive
techniques can simplify and improve the management of renal
lesions in these patients. We report our results in a recent
series of patients in a multidisciplinary clinical care center,
established at our hospital. Patients and Methods: From
January 2000 to October 2010 a total of 22 patients affected
by VHL disease were followed at our center. Twelve patients
(57%) experienced at least one RCC before or during the
follow-up period. Patients were preferentially offered
percutaneous radiofrequency ablation (RFA). A lesion size
greater than 4 cm at a site unreachable percutaneously was
considered to be a contraindication to treatment. Cystic
carcinomas were not considered a contraindication. The
following data were retrospectively reviewed: medical history
before coming to our center, features of the lesions (size,
location and number), co-morbidities, oncological follow-up
and renal function before and after the treatment. Results:
From January 2000 to October 2010 a total of thirteen lesions
were treated in eight patients. Another patient recently
experienced two small lesions (12 and 10 mm) that are still on
‘wait and see’. The mean age was 44 (range 19-65) years. Six
patients had a history of previous contralateral radical
nephrectomy and five patients had already undergone one or
more partial nephrectomies. Eight lesions were easily treated
with percutaneous RFA. The mean size of the lesion was 2.57
(range 1.5-3.5) cm. No complications were recorded. In one
patient, a lesion of the upper pole of the left kidney, not
percutaneously reachable, was treated through a laparoscopic
RFA procedure. The other four patients underwent open partial
nephrectomy (1 patient) or radical nephrectomy (3 patients).
All patients that underwent RFA achieved a complete response
and no worsening of renal function was recorded. No
recurrence was recorded, with a mean follow-up for RFAtreated
lesions of 32.7 (range 5-76) months. Discussion and
Conclusion: Patients affected by VHL disease require a
multidisciplinary approach for the various and severe
manifestations of this syndrome. RCC in VHL occurs in
younger patients, and is very frequently multifocal, bilateral
and recurrent. For these reasons, oncological safety should not