Andreas Mues

Introduction: Cryoablation is an acceptable treatment option for small renal cortical neoplasms. Unlike extirpative interventions, intraoperative needle biopsy is the only pathologic data for ablated tumors. It is imperative that sampled tissue accurately captures pathology. We studied the optimal intraoperativeneedle core biopsy protocol for small RCN during laparoscopic renal cryoablation. Methods: Patients with RCN<4cm underwent intraoperative biopsy during LCA. Four biopsy cores were taken per tumor, 2 before and 2 after LCA by using both a standard and modified technique. Standard technique: needle biopsy device was deployed after insertion into therenal tissue at a depth of 5mm. Modified technique: needle biopsy device was deployed 1mm outside of the renal tissue. Biopsies were examined and compared with reference standard pathology. Percentage agreement was calculated across biopsy types and time points. Logistic regression was used to identify factors impacting biopsy accuracy. Results: Thirty patients with 33 RCNs underwent LCA. The mean patient age was 69.1±8.0yrs, and mean tumor size was 2.3±0.7cm. No significant bleeding resulted from biopsies. A definitive diagnosis was made in 31/33 RCNs. Ten tumors were benign, 21 were malignant, and 2 were nondiagnostic. Biopsy length was significantly longer using the standard vs. modified technique with mean lengths of 9.3mm vs. 7.0mm, respectively. Highest agreement was seen in preablation biopsies. A significant association with agreement was seen for younger age and larger tumor size. Conclusions: Younger age and larger tumor size were associated with improved accuracy. Preoperative sampling resulted in superior accuracy and the standard technique resulted in significantly longer cores. Use of preablation standard biopsy technique may result in the most accurate pathologic diagnosis for patients undergoing cryoablation for small RCNs. © 2011 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.

Nature deserves a closer look when dealing with globalization. After giving an introduction on humanities’ views on nature and the ambiguity of this keyword, contemporary public perceptions and empirical findings from the Nature Awareness Studies are presented, followed by a reflection on human-nature relationship in former times. The analysis of the global turn in the understanding on nature then focuses on what goes beyond the change in human-nature relationship already induced by industrialization: environmental damage and loss of nature in the course of globalization require internationally concerted measures, and the term biodiversity is analyzed in its function as a new label for nature in the course of international negotiations and policy-making. Benefits and disadvantages of this major shift in communication and understanding of nature are discussed here.