OBJECTIVE: To assess the results of retroperitoneal lymph node dissection (RPLND) of residual masses in patients with disseminated non-seminomatous germ cell tumour treated with cisplatin-based chemotherapy, both in terms of extension of surgery, morbidity and survival. PATIENTS AND METHODS: Retrospectively, all patients treated for non-seminomatous germ cell tumour at the University Hospital of Antwerp were studied from January 1987 till December 1997. In patients with non-seminomatous testicular cancer more than stage I, the 'wait and see' strategy changed and patients were treated with chemotherapy. Patients were assessed at the end of chemotherapy and if a residual masses persisted, a RPLND was performed. If possible, a nerve-sparing lymphadenectomy was performed. Extension of surgery, morbidity and survival were analysed. RESULTS: Sixty patients had a non-seminomatous germ cell tumor of the testis and were analysed. The median follow-up was 78 months (range: 13-144 months). Thirteen patients with stage I disease were treated with orchiectomy only and none of these patients had recurrent disease. Forty-seven patients were treated with cisplatin-based chemotherapy. A complete response was observed in sixteen patients (34%), while 31 patients (66%) achieved a partial response and were treated with a RPLND. Fifteen patients underwent RPLND above the level of the renal trunk. In two patients malignant cells or fibrotic tissue were found above the renal trunk and bilateral. In five patients viable tumour cells were found in the region below the renal trunk. Sixteen patients underwent RPLND below the level of the renal trunk, of which nine had a unilateral resection, containing viable tumour in two patients. Operative mortality was 0%. One patient died six months after RPLND due to metastatic disease. In two patients, an important retroperitoneal bleeding occurred. Resection of adherent organs was performed in two patients. Long term sexual problems were reported by thirteen patients (65%) with bilateral lymphadenectomy versus two patients (18%) in the unilateral group. The survival of the patients treated with a RPLND was 97% and in the whole group of patients with a non-seminomatous testicular cancer 98%. CONCLUSION: RPLND has a place in the treatment of patients with non-seminomatous testicular cancer after chemotherapy in case of residual masses. Although mortality is low, morbidity is acceptable. In a limited number of patients there was a need of resection of adherent organs when a resection above the renal trunk was performed.

Adult↗

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Laparoscopic adrenalectomy with the aid of the AESOP 2000 robot.

The authors describe a left adrenalectomy for Cushing's disease with the aid of an AESOP (Automated Endoscopic System for Optimal Positioning) 2000 voice controlled robot. This device facilitated the procedure by producing a constant, stable picture allowing the operative team to concentrate principally on the dissection.

Adenoma↗

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Improved ventilatory function after combined operation for pulmonary emphysema and lung cancer.

BACKGROUND: Smoking is the leading cause of both lung cancer and emphysema. Therefore, some patients with stage I and II disease will present with contra-indications to resection including a predicted postoperative FEV1 of less than 0.81 or a VO2max of less than 10 ml/kg/min. Recently, lung volume reduction surgery (LVRS) has re-emerged in the management of emphysema with excellent results. METHODS AND PATIENTS: 2 patients are reported with lung cancer in the left lower lobe and emphysematous destruction in both upper lobes. They, respectively, had a predicted postoperative FEV1 of 0.9211 and 0.6851. No metastases were present. Pre-operatively, a COPD index of 0.9 and 0.7 was calculated. A left lower lobectomy together with volume reduction of the left upper lobe was performed through a standard posterolateral thoracotomy. RESULTS: Pathological examination showed, respectively, stage IIb and stage Ib disease. The postoperative course was uneventful and 3 months later a FEV1 of 1.441 for patient 1 and 1.041 for patient 2 were recorded. CONCLUSION: These findings suggest that pulmonary function criteria for pulmonary resection have to be revised when patients can undergo simultaneous lung cancer resection and LVRS. The pre-operatively calculated COPD index can be used to predict which patients may not have a decrease in ventilatory function.

Aged↗

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Rectovaginal fistulas.

The treatment of rectovaginal fistulas is controversial. The choice of the technique used for repair depends on many factors. Therefore the classification, etiology and treatment are discussed, in order to help decision making in the management of this troublesome disease.

Female↗

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Congenital right-sided diaphragmatic hernia in an elderly patient. A case report.

Congenital diaphragmatic hernia is a rare condition in adulthood. It is even more exceptional when located on the right side. We describe a case of right-sided congenital diaphragmatic hernia in a 74-year old woman. The diagnosis was only made when the patient developed an acute intestinal obstruction after a laparotomy for a gynaecological benign tumour. The treatment of this condition is discussed. In our opinion, in elderly, the advantages of an elective operation in asymptomatic congenital diaphragmatic hernia have to outweigh the risks of the operation. However, if the patient shows symptoms of pulmonary dysfunction or motility disorders of the gut, or even when he has to undergo a laparotomy for a different reason, we advise to repair the hernia in order to prevent complications.

Aged↗

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Long-term results of surgical resection of lung metastases.

Between 1990 and 2000, 56 consecutive patients underwent lung resection for removal of metastatic disease. Mortality, disease-free interval, and overall survival were studied. Only patients with a complete follow-up were included and data were collected conform the protocol of the International Registry of Lung Metastases. The primary tumour in our series was an epithelial tumour in 25 patients (45%), sarcoma in 15 (27%), germ cell tumours in 11 (19%) and melanoma in 5. Operative mortality was 1.4% (1 out of 73 procedures). Germ cell tumours had the best survival (76% at 5 years), and melanoma the worst (0% at 5 years). Multivariate analysis showed that survival for patients who underwent 2 or more metastasectomies was surprisingly good with a 5-year survival rate of 46%. Survival was not related to disease-free interval, multiple lung metastases, or pneumonectomy. It is in accordance with some reports that a short disease-free interval, numerous lung metastases, or recurrence after the first metastasectomy should not preclude patients from operation.

Adolescent↗

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[Small intestinal ulceration and stenosis induced by non-steroidal anti-inflammatory agents].

UNLABELLED: We report a case who developed a small bowel ulceration in a long segment of distal duodenum and proximal jejunum, a few days after he had taken high doses of diclofenac. After a month, it was complicated by a stenosis of the same segment. Nonsteroidal antiinflammatory drugs have recently been recognised as a possible etiologic factor of small bowel ulcerations. Clinical findings are aspecific. Complications of small bowel ulcerations are: obstruction, perforation or bleeding. Those have to be treated by surgery. We proposed a physiopathologic model and correlated it with histological findings. CONCLUSION: careful prescription of those drugs has to be pursued and one should think about a small bowel ulceration in a patient with an abdominal syndrome, who takes non-steroidal antiinflammatory drugs.

Aged↗

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[Leiomyoma and leiomyosarcoma of the gastrointestinal system: experience with 5 patients and literature review].

Leiomyomas and leiomyosarcomas of the gastro-intestinal tract are quite uncommon tumours. Clinical findings are aspecific: abdominal pain and gastrointestinal bleeding. Diagnosis is made by X-ray with contrast, endoscopy and CT-scan. Although biopsies taken during endoscopy are considered to be useless, our experiences showed an accurate diagnosis with biopsies. Surgery is the only treatment. The aim is to reduce the mass of tumour as much as possible; second look operations with careful debulking enhances the survival in case of recidive. Resection of lymph-nodes is useless. Radiotherapy nor chemotherapy are proven to be useful. The grade of malignity determines the prognosis. The liver and the abdominal cavity are the predilected localisation for metastasis. Metastasis in lymph-nodes is uncommon. Five year survival is about 50%.

Aged↗

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[Heparin-associated thrombocytopenia].

Thrombocytopenia and heparin. Heparin associated thrombocytopenia (HAT), more specially type 2, is an important complication of anticoagulant treatment in clinical practice. Diagnosis may be difficult and requires special laboratory techniques. Platelet count should be performed every two days. Severe complications may occur in 23% of type 2 HAT patients and is associated with a high mortality. Until now there are no prophylactic measurements for high risk patients.

Female↗

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Icterogenic hepatocellular carcinoma and polygonal cell carcinoma with fibrous stroma (fibrolamellar hepatocarcinoma).

Hepatocellular carcinoma (HCC) associated with obstructive jaundice by direct invasion or migration of tumor tissue into the biliary system has been described as icterogenic hepatocellular carcinoma (IHCC) or icteric type hepatoma. Fifty-eight such cases have been reported in literature since 1947. Curative treatment and prognosis depend directly on early appearance of icterus and its correct interpretation. Recently, attention has been paid to polygonal cell carcinoma with fibrous stroma (PCFS) as a well differentiated, low grade and transient type of HCC, probably distinguishable from classic HCC by etiological and epidemiological features. The combination of IHCC and PCFS is very rare; to our knowledge only one such case has been reported yet. We had the opportunity to observe and treat such a case, which will be reported in this article and will be compared with cases described in the literature.

Adult↗

PubMedDate not supplied

Hazards of nasopharyngeal oxygen therapy: a case of iatrogenic stomach rupture.

Iatrogenic rupture of the stomach has been reported as a rare complication of nasopharyngeal oxygen therapy. A new case of this life-threatening condition is reported and diagnostic, therapeutic and preventive measures are briefly discussed.

Adult↗