Biomedical subjects
Publications and source records attributed to M Ayed.
Signet ring cell adenocarcinoma of the bladder is a very rare tumor. It presents similar to the linitis plastica type of gastric adenocarcinoma. The authors report a new case and analyze the medical literature in order to specify the diagnostic problems and the histogenesis of this tumor.
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The authors report different techniques for surgical reconstruction of the sequelae of penile, scrotal and perineal gangrene. The repair of skin defects and the reconstruction of the scrotum requested several interventions. Where the scrotal skin loss was limited to a 1/2 of scrotum, the testis could be covered by mobilising the surrounding rim. When the disease was confined to the penis or inguinal region, skin cover has been provided by free grafts. More elaborate techniques of skin cover were necessary when the disease was extended to the whole scrotum: a fasciocutaneous flap from the thigh was used for reconstruction of the scrotum. The scrotal myocutaneous flap was used to cover skin and anterior urethral loss of tissue.
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The authors report 30 cases of uretero-vaginal fistulae collected in the department of Urology at Charles Nicolle's Hospital in Tunis. The majority of patients are multipare between 28 and 47 years old. The main causes remain gynecological and obstetrical procedures. The main motive of consultation was leaking of urine from the vagina; unfortunately the attendance to our clinic was late. IVP was performed in all cases; in 22 cases it showed a dilatation of the ureter, pelvis and calyces, on one side; in 3 cases it showed a non functional kidney and in 5 cases it was normal. Retrograde uretero-pyelography was performed for seven patients, twice in case of non functional kidney and five times after a normal IVP. In all cases it showed extravasation of contrast medium at the level of the fistula and the proximal portion of the ureter was not opacified. Treatment was by: reimplantation of the ureter in the bladder in 21 cases; end to end ureteric anastomosis in 5 cases; nephrectomy in 3 cases; in one case the fistulae healed by drainage. Control IVP was performed after a while and showed: success of the procedure in 15 cases; no change in 4 cases; an affected kidney in one case. Unfortunately diagnosis is never made at the time of surgery and this underlines the absolute necessity to check the ureter if there is any doubt about its integrity. In case of post operative complications it is important to request an IVP as soon as possible. In large fistulae reimplantation of the ureter by the Leadbetter-Politano technique, with fixation of the bladder to the psoas muscle, gave the best result in our hands. Postoperative follow up is necessary to detect any stenosis or reflux.
A new case of particular retroperitoneal lymphangioleiomyoma in a 56 year-old man is reported here. All cases reported to date have occurred in females. The mass was removed and the diagnosis was made by histopathology. The prognosis of localized retroperitoneal lymphangiomyoma is good. Diverse modes of therapy have been applied for lymphangiomyomatosis which multiple prognosis is doubtful.
The authors report 5 new cases of malakoplakia: 2 with kidney, 1 with prostatic and 2 with testicular involvement. The symptoms are not clinically specific, but pseudo-tumor forms are predominant. Four cases were treated by removal of the organ. Owing to a better understanding of its etiopathogenic mechanism, this disease can be treated by long-term antibiotic, cholinergic agonists and vitamin C therapy.
A case of idiopathic retroperitoneal fibrosis (IRF) in an 14 year old boy is presented. The diagnosis was mislead by the pelvic localization. One year after the biopsy and without any treatment, the scanner control shows the regression of the fibrotic plaque. The authors review the literature of this condition. They recall the principal clinic features of IRF in the children. A discussion of current diagnostic procedures and treatment is presented.
A retrospective study of 24 pheochromocytomas observed between 1974 and 1987 is reported. Hypertension is the most frequent sign. In 19 cases diagnosis of pheochromocytoma was confirmed by surgery. In 3 cases, preoperative diagnosis was "silent" adrenal tumor. Two had exploratory surgery for renal artery stenosis and renal tumor. Diagnostic strategy and its evolution with high sensitivity biochemical examinations and computed tomography was analysed.
Five "silent" adrenal tumors were reported. 3 of them were very large. Excision of tumor was enlarged to adjacent organs in 3 cases. On palpation a mass was felt in three cases, and in two cases the mass was accidentally discovered by ultrasound. Operation was performed with the diagnosis of adrenal mass in four cases. Microscopic examination revealed the tumor to be pheochromocytoma in 3 cases and adrenal cortex mass in two cases. Malignancy is confirmed from metastasis. Treatment was only surgical. Since no reliable preoperative investigations are yet available to assess the nature of adrenal masses, their surgical excision is indicated for microscopic examination.
Twelve patients with idiopathic retroperitoneal fibrosis, between 1973 and 1988 are reviewed. Their mean age at presentation was 41 years. The different and particularly confusing clinical manifestations (ejaculation disorders, pelvic or abdominal or abdominal mass) are discussed. The diagnosis, which was based on pyelography and retrograde pyelography, is now established much more clearly by means of ultrasound examination and CT scan. In case of diagnostic problems, ultrasound or scan guided fine needle biopsy can direct the diagnosis. However, the definitive diagnosis can only be determined by means of surgical exploration and biopsies, which were necessary in four cases. Surgical exploration was followed by surgical ureterolysis in two cases. In four cases, treatment was with corticosteroid therapy only. Five patients were treated by ureterolysis and steroid therapy. Spontaneous remission after biopsy in one case and ureterolysis alone in an another case has been followed by CT scan with a mean follow-up of 24 months. Results were satisfactory in 20 on 22 ureters treated by corticotherapy alone, surgery alone or both operation and steroid treatment with a mean follow-up of 56 months.
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The authors report 5 cases of prostato-rectal fistulae. Two men were treated by a posterior approach and two by an abdominal approach because of associated lesions. They review all of the techniques of approaching the prostato-rectal fistulas. The transsphincteric approach provides excellent exposure and reliable closure of prostato-rectal fistulas: the concern for possible anal incontinence is unfounded. Additional security can be obtained by performing a colostomy beforehand.
The isolated retroperitoneal cyst is rare. The hydatid cyst grow behind the posterior parietal peritoneum and have no connection with organs normally located within that space and lying next to them. Out of the 31 retroperitoneal tumors files collected over a five-year period, 25 are authentic primitive retroperitoneal tumors and 6 retroperitoneal hydatid cysts; 4 of which are isolated retroperitoneal localisations (neither pelvic subperitoneal localisation, nor multiple hydatic localisation are covered in this work). The abdominal mass is the most frequent sign, unfrequently concomitant with compressive syndrome. Diagnosis is based on urographic and echographic data. These data enabled a diagnosis to be reached in two cases and helped the diagnosis in one case. Surgery is the only treatment.
The scrotal masses are a frequent motive of consultation. The etiologic diagnosis of scrotal abnormalities is not always resolved by an accurate physical examination. From january 1985 to december 1987, 30 ultrasound examinations were performed. In the same period 245 patients were admitted for a scrotal mass. In a retrospective study the clinical diagnosis and ultrasound examination were compared with surgical and/or pathological findings, concerning 7 scrotal trauma, 8 hydrocele, 6 tumors, 4 epididymo-orchitis, 3 torsion, 1 epididymal cyst and 1 malacoplakia. The ultrasound findings correlated well in 85% of cases. Ultrasound examination appears to be an important complement to physical examination in trauma, large tumors and inflammatory lesions.
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