Surgical repair of uretero-enteric strictures in patients with enteric conduit urinary diversion (incidence rate 4-8%) is difficult and has a high morbidity. With the development of endo-urologic ...techniques and ureteral catheters, long-term insertion of stents in the treatment of strictures has become possible and safe. We have performed long-term uretero-enteric stenting with 7-8 Fr double-J catheters in 5 patients with 6 strictures: 3 ureteroileal and 3 uretero-colic. In three cases (2 colonic conduits, 1 ileal conduit) the stent was inserted anterogradely following intercostal renal percutaneous punctures and dilatation of the stricture with teflon dilators (1 case), balloon catheter (1 case), or following the incision of the stricture (1 case). In one patient with a double uretero-enteric stricture of the ileal conduit, guide-wires were successfully inserted retrogradely which permitted subsequent high pressure dilatation of the uretero-ileal strictures with a 15 Fr balloon catheter. We used the same approach in another patient with a right uretero-colic stricture. The catheters were left indwelling for 7 to 35 months and were changed every 3 months with no remarkable observations other than 3 episodes of fever which quickly resolved with antibiotic treatment. Although is has been reported that uretero-enteric strictures are particularly refractory to endo-urologic treatment and a significant morbidity rate has been associated with long-term ureteral stenting, our results show that the approach was well-tolerated by all of the patients.
To describe a case of jejunal obstruction due to metastatic renal adenocarcinoma.
A 66-year-old male who underwent nephrectomy 23 months earlier developed jejunal obstruction due to metastasis of the ...renal adenocarcinoma. The literature is reviewed and the uncommon form and site of presentation of this case are underscored and the different treatments are discussed.
The endourological approach for utothelial tumors of the upper urinary tract (UUT) is a controversial issue of which there is little experience to date. However, the data reported in the series of ...other authors as well as our own series support its utilization. Of a total of 137 patients suspected of having UUT tumor, 66 patients underwent endourological management: 56 by ureteroscopy (URS) and 10 by percutaneous nephroscopy (PN). The presence of tumor was discarded in 26 patients, 10 underwent open surgery to treat the tumor, and the remaining 30 patients were primarily treated by URS (20), PN (9), or combined treatment (1). Overall, 30 of 111 patients (27%) were treated by endoscopy; 28 attempted cure and 2 were palliative procedures. Twenty-six of these 30 patients had a previous history of urothelial tumor, 7 had a single kidney, and in 5 patients the tumor had presented following cystectomy. Except for the T2 tumor submitted to palliative treatment and one case with diffuse carcinoma in situ, all tumors were TA-1, 20 were G1, 8 were G2, and were G3. Seven of the 30 patients had died after a mean follow-up of 28.4 months (range 3-117 months: 2 immediately postoperatively from pathological conditions unrelated to the operation (acute CVA, biliary sepsis), 1 from conditions unrelated to the urinary tract or tumor, 2 from disseminated bladder urothelial tumor, and 1 from disseminated primary adenocarcinoma of unknown origin. Currently, 23 patients (76.6%) are alive; of these, 7 (23.3%) have had tumor recurrence: 2 required treatment by nephroureterectomy but the remaining 5 patients were also treated endourologically with success. The progression index was 7% (2/28). Analysis of prognostic factors revealed a close correlation between the histologic grade of malignancy, malignant urinary cytology, and the frequency of tumor recurrence. Tumor recurrence was observed to be 60% in those with a positive cytology and only 17.6% in those with a negative cytology. G3 tumors recurred 50% of the time, G2 37.5%, and Go-1 22%. The frequency of tumor recurrence was also different in patients who had received adjuvant topical BCG or MMC therapy (20%) in comparison to those who received no adjuvant therapy (40% recurrence). On the other hand, no significant difference was observed relative to the technique utilized to treat the tumor: 3/12 (25%) of those who underwent electroresection or electrocoagulation and 6/16 (37.5%) of those submitted to Nd:YAG laser.
Fournier's gangrene is a necrotizing fasciitis involving the genitoperineal region caused by the synergistic action of aerobic and anaerobic pathogens. It is a rapidly progressing disease and carries ...a high mortality. Our experience with Fournier's gangrene is presented.
Herein we describe 11 cases of Fournier's gangrene that were diagnosed and treated from 1991 to 1996. The most important predisposing factor was diabetes mellitus and the most common triggering factor was a perianal condition.
The survival rate was high (81%) and can be ascribed to early diagnosis, aggressive and rapid surgical treatment with debridement, resection of the necrotic areas, drainage, simultaneous broad spectrum antibiotic therapy and frequent local treatment.
Klinefelter's syndrome is characterized by hypergonadotropic hypogonadism, 47,XXY karyotype, gynecomastia, azoospermia and testicular atrophy with hyalinization of seminiferous tubules and ...hyperplasia of Leydig cells. Some cases of Klinefelter's syndrome with unexplainably low levels of gonadotropins have been reported in the literature. Two additional cases of Klinefelter's syndrome with hypogonadotropic hypogonadism and absence of Leydig cells are described.
Four cases of renal oncocytoma that had been treated at our service from 1985 to 1990 are presented herein. The renal mass had been incidentally disclosed on the IVP (2 cases), abdominal ultrasound ...(1), and on palpation (1). An abdominal CT scan complemented the diagnostic work up. The diagnoses of oncocytoma (1 case) and renal carcinoma (3 cases) were made based on the scan findings. The 3 patients that had been diagnosed as having renal carcinoma were submitted to radical nephrectomy. The patient diagnosed as having oncocytoma underwent surgical enucleation of the tumor. Subsequent histological examination was diagnostic of oncocytoma in all four cases. Follow-up ranging from 15 to 55 months revealed all patients are asymptomatic and tumor-free. Currently attention has been focussed on this tumor type. The diagnostic and therapeutic controversies are discussed.
Renal adenocarcinoma is characterized by marked venotropism; 20-49% show extension into the main renal vein and 4-19% into the vena cava. The present study analyzes the different diagnostic methods ...to evaluate the vascular involvement by renal carcinoma and presents the results achieved by total segmental cavectomy with ligation of the left renal vein and without vena caval reanastomosis.
Three patients (two males, one female) underwent total segmental cavectomy with ligation of the left renal vein in our Service over the last 10 years. A bilateral subcostal approach with access to the large vessels was utilized in all three cases. The superior and inferior renal vena cava were exposed and the hepatic veins were ligated at the level of the intrahepatic segment. Incision of the vena cava was performed, the thrombus was removed and the renal vessels were ligated. The proximal and distal segments of the vena cava were ligated after cavectomy. In the third patient, intrahepatic extension of the thrombus required the use of a temporary filter for the proximal segment of the vena cava.
The early postoperative course was satisfactory; adequate renal function was maintained and no problems with venous return were observed. Of the diagnostic methods analyzed, MRI was found to be the most useful. A relationship was found between survival and the pathological stage and the presence or absence of lymph node metastasis.
Total segmental cavectomy without reanastomosis and with ligation of the left renal vein appears to be a feasible technique which achieves good results. MRI is the diagnostic method of choice in the evaluation of vascular tumor extension.
Cecal volvulus in Cornelia de Lange syndrome Cózar Ibáñez, A; Medina Cuadros, M; del Olmo Escribano, M ...
Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva,
01/2004, Letnik:
96, Številka:
1
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