Total cystectomy for bladder carcinoma: Denonvilliers fascia as a landmark.
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Biomedical subjects
Publications and source records attributed to A Steg.
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86 patients presenting with upper tract urothelial tumor were investigated by conventional X-ray techniques and urinary cytology. Pyelography, intravenous or retrograde, was diagnostic in 85% of the cases and urinary cytology in 43%. Pyelography can stage correctly 80% of the infiltrating tumors, and urinary cytology 66% of the high grade lesions. Altogether 97% of the high grade infiltrating tumors can be accurately staged preoperatively on the basis of pyelography and urinary cytology. In the future retrograde brush biopsy and CAT scanning should optimize these figures.
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One-hundred and five hydrostatic distensions of the bladder (HDB) were carried out in 89 patients. The technique is simple, and complications were uncommon: 3 cases of bacteraemia and 4 cases of ruptured bladder. No death was recorded. The main indication was tumour of the bladder (76 patients). Satisfactory results, with reduction or complete disappearance of the lesions, were obtained in superficial, non-infiltrating tumours, but in type B tumours invading the vesical muscle failures were almost constant. Eight patients with pronounced reduction of bladder capacity were also treated by HDB with varying results depending upon the underlying cause. Two out of 3 patients with severe frequencies and normal-size bladder were relieved by the treatment. HDB was also successfully used in 2 patients with intractable vesical haematuria.
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Out of 190 staghorn calculi submitted to conservative surgical treatment, 20 were selected for deliberate nephrolithotomy on the basis of previous stone surgery, shape of stone or of kidney pelvis. Stone clearance was achieved in 80% of the cases. 1 patient died of pulmonary embolus; a massive secondary hemorrhage was successfully treated by transcatheter arterial embolization. Marked loss of renal function occurred three times on previously heavily scarred kidneys. Nephrolithotomy should be considered only when local conditions preclude extended pyelocalicotomy.
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Twenty one patients suffering from carcinoma of the prostate, confirmed histologically and previously untreated, received treatment in the form of 17 beta-estradiol administered percutaneously. At a dose of 6 mg of estradiol per day, testosterone levels fell to a mean of 1 ng/ml. No change in lipids, lipoproteins nor cholinesterase were detected.
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