0000000000021658
AUTHOR
Peter C. Black
NEPHRON SPARING SURGERY FOR CENTRAL RENAL TUMORS: EXPERIENCE WITH 33 CASES
Purpose: Nephron sparing surgery is standard treatment for small, peripherally located renal cell carcinoma. In patients with a solitary kidney, bilateral tumors or impaired renal function nephron sparing surgery provides the only option to nephrectomy and subsequent hemodialysis or transplantation. We retrospectively investigated the value of nephron sparing surgery for centrally located renal cell carcinoma. Materials and Methods: Between 1969 and 1997, 311 renal tumor enucleations were performed at our institution. The tumor was centrally located in 33 cases. The indication for enucleation was elective in 7 cases and imperative in 26, including bilateral tumor in 16 (metachronous in 9 an…
Pilotstudie zur sonogra- phischen Fr�herkennung des Nierenzellkarzinoms
Die zunehmende Zahl der zufallig mit der Ultraschalluntersuchung entdeckter, kleiner, asymptomatischer Nierenzellkarzinome, wirft die Frage der Praktikabilitat und Effektivitat einer systematisierten Screeninuntersuchung des Nierenzellkarzinoms mittels Sonographie auf. Vor diesem Hintergrund wurde eine Machbarkeitsstudie im Rahmen des Fruherkennungsprogramms des Bundesministeriums fur Gesundheit initiiert. Methodik: In 2 Stadten, Mainz und Wuppertal, wurde ein Fruherkennungsprogramm fur das Nierenzellkarzinom etabliert, bei dem allen Einwohnern (Alter uber 40 Jahre) eine kostenlose Ultraschalluntersuchung der Nieren angeboten wurde. Das Screening unterteilte sich in 2 Phasen (Laufzeit 1 Jah…
Nephron-sparing surgery of renal cell carcinoma with a normal opposite kidney: long-term outcome in 180 patients
Abstract Objectives. To investigate the long-term outcome of an organ-saving approach for renal cell carcinoma (RCC) with a normal opposite kidney (elective indication). Methods. Since 1979, 180 patients have undergone nephron-sparing surgery at our institution for RCC in the presence of a normal contralateral kidney. The mean age was 56 years (range 23 to 83), and the mean follow-up was 4.7 years (maximum 14.8). Most of these tumors were found incidentally, with a mean tumor diameter on ultrasound of 3.3 cm (range 1.0 to 8.6). Results. The postoperative course was unremarkable in 173 patients. Postoperative bleeding was encountered in 4 patients and urinary extravasation in an additional 3…
URINARY DIVERSION AND ORTHOTOPIC BLADDER SUBSTITUTION IN CHILDREN AND YOUNG ADULTS WITH NEUROGENIC BLADDER: A SAFE OPTION FOR TREATMENT?
Combined pharmacotherapy, clean intermittent catheterization and infection prophylaxis is currently the gold standard of treatment for neurogenic bladder. However, as the adolescent gains independence from parental supervision, the intervals of clean intermittent catheterization compliance with medical treatment and regularity of followup examinations may decrease, and neurological and/or orthopedic status may change. This situation sometimes leads to failure of conservative treatment, resulting in incontinence and/or deterioration of the upper urinary tract. A multidisciplinary team was established at our institution 30 years ago to assess all aspects of care for patients with neurogenic b…
Vaginal Reconstruction Using the Bladder and/or Rectal Walls in Patients with Radiation-Induced Fistulas
Abstract Objective. In irreparable or recurrent vesicovaginal fistulas and cloacal defects following high-dose irradiation therapy for gynecological malignancies, urinary diversion is the last resort to achieve a socially acceptable solution. In a select group of young and tumor-free patients, additional vaginal reconstruction may be indicated. Multiple operative procedures are available, but the results are often disappointing in the previously irradiated area. Materials and methods. In six such patients with large radiogenic vesicovaginal defects ( n = 5) or a cloacal fistula ( n = 1), a continent reservoir using the transverse colon with an umbilical stoma was performed. At the end of th…
Colon pouch (Mainz pouch III) for continent urinary diversion after pelvic irradiation
Abstract Objectives. Urinary diversion after previous pelvic irradiation is challenging. The use of irradiated bowel in particular is associated with an increased rate of early and late complications. We therefore performed continent cutaneous urinary diversion using exclusively nonirradiated bowel segments in this group of patients. Methods. A continent colon pouch for urinary diversion was performed in 44 female patients after pelvic irradiation. The indications were irreparable vesical fistula in 20, local recurrence of gynecologic tumors in 22, and radical cystectomy for bladder cancer in 2 patients. Depending on the length of the nonirradiated bowel segment, a transverse-ascending colo…
DHH is an independent prognosticator of oncologic outcome of clear cell renal cell carcinoma.
Aberrant HH signaling has proved important in the pathogenesis of several solid cancers. Limited in vitro analyses suggested an oncogenic role for HH in renal cell carcinoma. In this explorative study we sought to validate aberrant HH expression in patients with renal cell carcinoma.A tissue microarray was constructed from 140 radical nephrectomy specimens of patients with clear cell renal cell carcinoma. We performed immunohistochemistry for Ki67 and HH pathway biomarkers, including PTCH1, Smo, SHH, IHH, DHH, Gli1, Gli2 and Gli3. Staining intensity was measured by automated image processing and related to tumor stage and grade. The impact of biomarker expression on cancer specific survival…
Secondary thyroid carcinoma after treatment for childhood cancer
Background Second malignant neoplasms (SMNs) have become a primary concern in evaluating long-term effects of treatment in pediatric oncology. Thyroid carcinoma has proven to be a common SMN. Methods. In a multicenter study involving 58 hospitals in Germany, Austria and Switzerland, 18 of 239 (7.5%) SMNs documented following first malignant neoplasm (FMN) in childhood were thyroid carcinoma. Results. The age at diagnosis of FMN ranged from 1 to 15 years. Eleven patients were female. Six children had survived Hodgkin disease, seven acute leukemia, two Ewing sarcoma and three various other tumors. Fifteen of the 18 patients had been treated with radiotherapy to the head and neck region. The t…
RETRACTILE MESENTERITIS MIMICKING AN ADRENAL TUMOR
Retractile mesenteritis is a nonspecific inflammatory process involving the adipose tissue of the mesentery.1 It is a diagnostic challenge to identify this benign condition and, thus, avoid unnecessary surgery. Although approximately 100 cases have been published describing stomach and intestine involvement,z to our knowledge involvement of the urological organs has not been described previously. Consequently the urological literature lacks any information on this pathological entity. We report a rare case of retractile mesenteritis presenting as an adrenal tumor. were obtained and sent for frozen section, which revealed fibrotic tissue similar to retroperitoneal fibrosis. Due to the extens…
Orthotopic Mouse Models of Urothelial Cancer
Orthotopic mouse models of urothelial cancer are essential for testing novel therapies and molecular manipulations of cell lines in vivo. These models are either established by orthotopic inoculation of human (xenograft models) or murine tumor cells (syngeneic models) in immunocompromised or immune competent mice. Current techniques rely on inoculation by intravesical instillation or direct injection into the bladder wall. Alternative models include the induction of murine bladder tumors by chemical carcinogens (BBN) or genetic engineering (GEM).
Ultrasound-Guided Intramural Inoculation of Orthotopic Bladder Cancer Xenografts: A Novel High-Precision Approach
Orthotopic bladder cancer xenografts are essential for testing novel therapies and molecular manipulations of cell lines in vivo. Current xenografts rely on tumor cell inoculation by intravesical instillation or direct injection into the bladder wall. Instillation is limited by the lack of cell lines that are tumorigenic when delivered in this manner. The invasive model inflicts morbidity on the mice by the need for laparotomy and mobilization of the bladder. Furthermore this procedure is complex and time-consuming. Three bladder cancer cell lines (UM-UC1, UM-UC3, UM-UC13) were inoculated into 50 athymic nude mice by percutaneous injection under ultrasound guidance. PBS was first injected b…
The use of isolated caecal bowel segment in complicated vaginal reconstruction
Objective To report a one-stage procedure, using a segment of caecum, both to overcome failed previous procedures and for primary vaginal replacement in patients with congenital vaginal aplasia, where primary reconstruction often results in vaginal obstruction and fistula formation. Patients and methods The vagina was reconstructed using a 15-cm isolated caecal segment placed between the bladder and rectum and anastomosed to the introitus. Between 1985 and 1997 the technique was used in 17 patients (mean age 23 years). Indications included congenital malformations and vaginal loss through anterior exenteration or trauma. Seven of the 17 patients had undergone previous complex reconstruction…
Strategies for reconstruction after unsuccessful or unsatisfactory primary treatment of patients with bladder exstrophy or incontinent epispadias.
Following unsuccessful or unsatisfactory primary treatment in patients with the epispadias/exstrophy complex, the options for a surgical solution to preserve the upper urinary tract, to achieve complete continence, and to reconstruct the external and female internal genitalia are limited. We reviewed the records of the patients treated at our institution to determine a surgical compromise between ingenious operative constructions and patient desires, both of which are secondary to stabilization of renal function.From 1967 to December 1997, 128 patients with bladder exstrophy/epispadias complex were treated, of 80 whom had received previous unsuccessful or unsatisfactory treatment. Of these …