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Biomedical subjects

C Selli

Publications and source records attributed to C Selli.

At least 73 records · Page 4Linked to original sources

Undiversion with ileocecal segment following high transureteroureterostomy.

A boy presenting with a small bladder and refluxing blind-ending ureteral stumps following multiple attempts at ureteral reimplantation and supravesical diversion with a high left-to-right transureteroureterostomy and right cutaneous ureterostomy underwent successful undiversion. Surgery consisted of bilateral ureterectomy and ileocecocystoplasty, with intussusception of the ileocecal valve and anastomosis of the ileal tail to the right renal pelvis.

Adolescent↗

Treatment of lower ureteral calculi with extracorporeal shock wave lithotripsy.

A group of 70 patients presenting with stones in the lower third of the ureter was treated with extracorporeal shock wave lithotripsy using a Dornier HM3 lithotriptor. For adequate radiological stone visualization a sitting position was used in 68 patients, while 2 with calculi overlying the sacroiliac joint required placement in the prone position. All but 1 patient had additional endoscopic maneuvers before treatment, consisting of the passage of a Zeiss sling around the stone in 40 and, when this was not possible, a ureteral stent in 29. The over-all success rate was 94.2 per cent (66 of 70 patients) with 3 patients having retained fragments and 1 requiring an open operation. The combination of new positioning techniques and relatively simple endoscopic maneuvers makes treatment of lower ureteral stones feasible and safe with the Dornier lithotriptor.

Adult↗

Conservative surgical treatment of renal cell carcinoma: clinical experience and reappraisal of indications.

During a 14-year period 36 patients who presented with renal cell carcinoma underwent conservative surgical treatment. The patients were divided into 3 groups according to treatment indications and condition of the contralateral kidney: group 1 included patients with a solitary kidney or bilateral tumors, group 2 patients had a damaged contralateral kidney and group 3 patients were without abnormalities of the contralateral kidney. Cumulative 6-year survival rates were 58 per cent for group 1, and 90 per cent for groups 2 and 3 combined. The over-all cumulative 6-year survival rate was 74 per cent. Based on these data extension of the indication for conservative surgical treatment seems to be justified in patients who present with low stage tumors and partial or potential damage to the contralateral organ.

Adult↗

Variations of cortisol hydroxylation and paracetamol metabolism in patients with bladder carcinoma.

We investigated the possibility that variations of the metabolism of xenobiotic compounds might be involved in the process of bladder carcinogenesis, by studying activation reactions (phase I) and detoxification reactions (phase II) of xenobiotic compounds in a group of patients with transitional cell carcinoma of the bladder and in a group of controls hospitalised with other diseases. As an indirect estimate of activating reactions (phase I) we measured cortisol hydroxylation, expressed as the ratio between urinary 6-beta-OH-cortisol and 17-OH-corticosteroids. Cortisol hydroxylation was not increased in the group of patients when compared with controls. The variations of phase II conjugating enzymes were followed indirectly by administering paracetamol and measuring the urinary excretion of its main metabolites over a period of 12 h. The variations in the metabolic conjugation of paracetamol were expressed as a percentage of each metabolite, or of unmodified paracetamol excreted in the urine, or as the ratio between a given metabolite and unmodified paracetamol. The data were analyzed with a logistic regression model, analysing the effects of possible confounding variables such as age, smoking, alcohol, blood nitrogen, blood creatinine, glutamic-pyruvic (SGPT), glutamic-oxalacetic transaminases (SGOT) and percent recovery of paracetamol in the urine. Statistical analysis showed that the excretion of mercapturate derivatives of paracetamol was significantly increased in the group of patients. The levels of glucuronic, sulphate and cysteine metabolites were not varied significantly. Since mercapturate derivatives are formed as a consequence of the formation of short-lived metabolites of paracetamol which react with protein, nucleic acids or glutathione, the increased excretion of mercapturic acid derivatives in cancer patients might be an indication of a higher capability of forming reactive molecular species from xenobiotic compounds. We suggest that this factor might play a role in the induction of bladder cancer.

Acetaminophen↗

Pancreatic late recurrence of bilateral renal cell carcinoma after conservative surgery.

The appearance of solitary late metastases of renal cell carcinoma has seldom been documented. A female patient, who 13 years previously underwent left radical nephrectomy and right lower polar resection for bilateral simultaneous renal cell carcinoma, presented with a solitary pancreatic metastasis which was successfully treated with pancreaticoduodenectomy. The major points of interest of this report are the occurrence of a primary bilateral tumor, the initial treatment with conservative surgery and the site of late recurrence. The diagnostic and prognostic implications of late metastases of renal tumors are discussed.

Carcinoma, Renal Cell↗

Treatment of large renal calculi with extracorporeal shock wave lithotripsy monotherapy.

One hundred and twenty patients with large renal calculi (greater than 3 cm), who had not undergone previous stone-debulking procedures, were treated with extracorporeal shock wave lithotripsy (ESWL) monotherapy using a Dornier HM3 lithotripter. Stones were divided into four categories according to Rocco's classification: 20 C2, 25 C3, 51 C4 and 24 C5. Repeated treatments were necessary in 13 patients, while planned two-stage treatments were performed in 8. Pretreatment adjunctive endourological maneuvers (except for the placement of ureteral stents for visualization of 37 contrast-negative stones) were used in 16 cases (13.3%) and posttreatment maneuvers in 20 (16.6%). Open surgery was necessary in 6 patients, including one nephrectomy. Complete elimination of all concrements was documented in 74 patients (61.6%): 63 within 3 months and 11 within 6-12 months. The stone-free rates for different categories were: 80% for C2, 64% for C3, 58.8% for C4 and 50% for C5. The stone-free rate for contrast-negative calculi was 83.7% (31/37), and for radiopaque ones 51.8% (43/83) (p less than 0.001). It is concluded that ESWL monotherapy is an adequate treatment choice for some categories of large radiopaque stones and for all radiolucent ones.

Adult↗

Incidental finding of renal cell carcinoma with histological regressive aspects in a pregnant woman.

A renal cell carcinoma was incidentally discovered with sonography in a 32-year-old pregnant woman. Magnetic resonance imaging was used to provide further information about tumor stage without causing adverse effects on the fetus. The patient underwent radical nephrectomy at the third month of pregnancy and subsequently delivered a normal full-term child. Pathology revealed regressive aspects which can be possibly ascribed to high progesterone levels during pregnancy.

Adult↗

Characterization of cells from invaded lymph nodes in patients with solid tumors. Lymphokine requirement for tumor-specific lymphoproliferative response.

The specific immune response against the malignant cells was investigated in patients with urinary bladder or larynx cancer. Lymphocytes from lymph nodes that drain the tumor site were tested for their proliferative and cytotoxic capacities against autologous malignant cells isolated from the primary tumor. In no occasion was a proliferative or a cytotoxic response observed. However, when the lymph node cell suspensions were depleted of cells expressing both OKM1 and Leu-7 markers by rosetting with the appropriate mAbs, a proliferative response could be observed. The lymphocytes responded to autologous tumor cells only if IL-2 was added to the cultures. IL-2 alone induced some cell proliferation, which was not, however, comparable to that observed in response to both IL-2 and tumor cells. A panel of allogeneic tumor cells consistently failed to stimulate OKM1-, Leu-7- cells in vitro. Response to autologous tumor cells was not caused by HLA-encoded molecules, as occurs in the autologous mixed lymphocyte reaction, since OKM1-, Leu-7- cells failed to be stimulated by autologous non-T cells. A proliferative response was observed only with cells from lymph nodes that had been classified as invaded by malignant cells according to histopathologic criteria. Cells from noninvaded lymph nodes consistently failed to respond. Cells stimulated with autologous tumor cells could be expanded in short-term lines by continuous addition of IL-2 and malignant cells. One of these lines, which comprised mainly T8+ cells, was stimulated to proliferate only by autologous tumor cells, and its proliferative response was inhibitable by anti-class I and not by anti-class II mAbs. This line showed lytic capacities against autologous malignant targets, while it was inefficient against all of the other allogeneic cells tested. In another set of experiments, the mechanisms whereby exogenous IL-2 had to be added to the cultures to sustain a proliferative response against neoplastic cells were investigated. When cocultured with autologous malignant cells, OKM1-, Leu-7- lymphocytes expressed IL-2 receptors, as could be assessed by anti-Tac fluorescent staining. Under these culture conditions, these cells did not produce IL-2, and no proliferation was observed. Addition of purified IL-1 to the cultures induced IL-2 production and cell proliferation. It is concluded that metastatic lymph nodes contain a T cell population that can be detected in a proliferative assay when both suppressor cells are removed and the appropriate molecular signals are supplied.

Antigens, Surface↗

Caval extension of renal cell carcinoma. Results of surgical treatment.

Twenty-eight patients with renal cell carcinoma extending to the vena cava underwent surgical treatment consisting of radical nephrectomy and removal of tumor thrombus, which was at the level of the renal veins in 23 cases, the hepatic veins in 4, and extending above the diaphragm in 1 case. In 7 patients lymph nodes were invaded, and 8 had both positive nodes and extrarenal tumor diffusion discovered at surgery. The mean survival was 41.7 months for patients with only venous extension of the tumor, 16 months for patients with positive nodes, and 10.2 months for those with both nodal and extrarenal tumor diffusion.

Adult↗

Periurethral neurofibroma.

A periurethral neurofibroma presenting as a midline perineal mass was removed in a three-year-old boy. An immunohistochemical study of S-100 protein distribution within the tumor tissue was performed.

Child, Preschool↗

Simultaneous bilateral adrenal involvement by renal cell carcinoma: experience with 3 cases.

We report 3 cases of renal cell carcinoma and synchronous bilateral adrenal metastases discovered preoperatively with computerized tomography and other imaging techniques. Surgical treatment consisted of radical nephrectomy through a transperitoneal approach, with adjunctive lower polar resection in a patient with bilateral renal tumors, and contralateral adrenalectomy. Subsequent steroid treatment was given.

Adrenal Gland Neoplasms↗

Posterior urethroplasty in children.

A series of 33 posterior urethral strictures in children is presented. The etiology was traumatic in 31 cases and iatrogenic in 2. Complex strictures were treated by a transpubic approach (20 cases) or by a posterior scroto-urethral inlay (1 case). Simple strictures were directly treated via the perineum: by a push-in technique (6 cases); by end-to-end anastomosis (3 cases); by a skin pedicled tube urethroplasty (1 case); by free skin graft (1 case), and by endoscopic urethrotomy (1 case). The use of omentum, employed in 19 cases, is considered a necessary step in transpubic urethroplasty. Favorable results were observed in 18 out of 20 transpubic procedures, in 8 out of 9 perineal urethroplasties and in 3 out of 4 other techniques, with an overall success rate of 87.8%.

Adolescent↗

Elective treatment of ureteral stones with extracorporeal shock wave lithotripsy.

Extracorporeal shock wave lithotripsy was used as an elective treatment in 128 ureteral stones. Of the 108 with adequate follow-up, 88% were successfully disintegrated. Ureteral catheters proved to be particularly useful for more precise stone localization and as a mechanical means to push the calculi inside the renal cavities or to create a fluid interface around them, in order to increase the efficiency of the shock waves. When ureteral catheters were used a success rate of 95.5% was observed, as opposed to 82.8% when stents were not used (p less than 0.05).

Follow-Up Studies↗

Urethral trauma: radiological aspects and treatment options.

Experience with treatment of 38 patients in an early phase with urethral trauma is presented. The site of injury was the penile urethra in three cases, the bulbous urethra in seven, and the prostatomembranous urethra in 28. Different surgical procedures were used, according to the site and the extent of urethral damage and the presence of associated lesions. All patients with penile and bulbous urethral trauma were cured and only one has diminished sexual potency, while in the posterior urethral group nine were cured, and 19 developed strictures requiring further surgical treatment. Total impotence developed in 17 and partial impotence in one patient. Another case presents urinary urge incontinence.

Humans↗

Arteriovenous fistula associated with renal cell carcinoma: demonstration by magnetic resonance imaging.

Two cases of arteriovenous fistula associated with renal cell carcinoma were studied using multiple techniques, including magnetic resonance imaging (MR). These techniques clearly delineated the vascular abnormalities without the use of a contrast agent; they also demonstrated the extent of the tumors. Data derived from MR were confirmed upon surgical exploration and were useful in planning the approach to the kidney.

Adult↗