Biomedical subjects
Publications and source records attributed to T Hanus.
Simultaneous tumourous duplicity of an adrenal pheochromocytoma and papillocarcinoma of the urinary bladder is obviously more frequent than publications on the condition. It involves however a serious medical problem and calls for a non-standard therapeutic approach. The author presents the case-history of a 52-year-old male smoker.
So far only about 20 cases were published on abscesses of the seminal vesicles and only two patients suffered also from agenesis of one kidney. The presented case-history pertains to a patient with a history of haemospermia and a cystically dilated formation in the region of the posterior urethra on ascendent urethrocytography. The solution was surgery-revision and extirpation.
Renal oncocytomas are infrequent solid tumours of the renal parenchyma. Usually they are diagnosed incidentally. As to treatment conservative surgery predominates. The authors submit their experience with the treatment of eight patients during the past two years where they performed five times transperitoneal nephrectomy and three times resection of the tumour.
A primitive neuroectodermal tumour (PNET) of the minor pelvis is a rare malignant small-cell tumour developing from the neural groove. It metastatizes into the lungs, bones, liver and brain. Treatment involves radical surgical extirpation followed by chemotherapy and actinotherapy. The author presents the case-history of PNET of the pelvis minor in a 33-year-old woman.
Urinary diversion following cystectomy on account of carcinoma of the bladder are pretentious surgical operations involving the risk of early and late complications. The authors made a retrospective analysis of 198 cases. Death during the early postoperative period was recorded in 3 patients (2x ileus and 1x pulmonary embolism). Other early complications were dehiscence of the intestinal anastomosis (3x), dehiscence of the skin would/3x) and pneumonia (3x). Clinically relevant late complications were ileus due to adhesions (4x), stenosis of the ureteroenteric anastomosis (21 ureteroenteric units and urolithiasis (6x). Metabolic acidosis was recorded frequently (19x). Complications were more frequent in patients with advanced disease and in a poor biological state.
BACKGROUND: The continent reservoir is an ideal urinary diversion in patients after cystectomy. The artificial closing mechanism construction in these reservoirs is rather complicated and the results are uncertain. The objective of the present work is to assess own experience with a relatively simple rectosigmoid reservoir created by a method described by M. Fisch. METHODS AND RESULTS: Since 1992 till 1995 the sigma-rectum detubularized reservoir was performed in 30 patients. The intricating bladder cancer was an indication for the operation in 27 patients and the other bladder diseases in 3 patients. The patients age ranged from 18 to 75 years. Diurnal continence was achieved in all 30 patients. 12 of them have to awake during the night to evacuate the reservoir 1 to 3 times. CONCLUSIONS: Sigma-rectum pouch is a good form of cintinent diversion in such patient, which are not suitable for orthoscopic neobladder because of oncologic limitation or bad general conditions. The patients tolerate the procedure very well, heal and adapt quickly to new evacuating mechanisms.
Since 1993 till 1995 cystectomy preserving the urethra in twelve female patients with infiltrating bladder cancer was performed. The patients age ranged form 32 to 72 years. The female urethra sparing radical cystectomy includes removal of the bladder together with the uterus and ovaries and resection of the anterior vaginal wall. The condition for preserving of the function of the urethra is its integrity including corresponding innervation and intact pelvic floor. The neobladder is made of a detubularized ileal segment and anastomosed with the urethra. Diurnal continence was achieved in 11 patients, one of them has so called hypercontinence with residual volume of 300 ml. One patient suffers from stress incontinence. The functional characteristics of the orthotopic neobladder in the operated females are very favourable. The risk of further affliction of the retained urethra with an urothelial tumor is possible to influence by a choice of selected patients for the overmentioned procedure.
Interstitial cystitis (IC) is a complex of painful mictional symptomatology of unknown etiology. Is occurs more frequently in women. By cystoscopy the ulcerative and non-ulcerative form is differentiated. A typical diagnosis symptom are glomerulations during cystoscopy under general anaesthesia. There are diagnostic criteria which rule out IC. Histopathologically the following are differentiated: classical IC with proliferation of mastocytes in the detrusor, detrusor myopathy and eosinophil cystitis. Treatment includes intervesical instillation of various substances, transurethral procedures or supratrifonal cystectomy, incl. enterocystoplasty.
The degree of obstruction of the upper urinary pathways is assessed from the relative pressure value which is calculated by subtracting the intravesical pressure from the intrapelvic one. The intrapelvic pressure is measured after puncture of the renal pelvis by perfusion manometry. By using a contrast substance it is possible to perform at the same time antegrade pyeloureterography. The author presents experience assembled with 20 patients.
At present, the attention of reconstructive surgery is focused on continent reservoirs constructed from detubulized intestinal segments. Based on two-year experience, the authors present an analysis of the results obtained from 26 patients with continent ileal or ileocecal neovesica. These operations improve the quality of life and guarantee more safety. In most cases, the function of the neovesica approximates the natural physiological condition. The authors also discuss the economical aspect as regards the high cost of materials needed for ureteroileostomy--annual expenditure on flanges and bags (firm Pfizer) per 1 person amounts to 32,000 Czechoslovak crowns fco. The continent neovesica does not narrow the therapeutical spectrum of urinary deviations, on the contrary, it extends them, which is why the authors prefer to use it.
Treatment results of 74 secondary megaureters in 48 children (25 males and 23 females with one segmental and 73 total megaureters) are presented. The left side prevailed over the right one (ratio 1.4:1.0); the lesion was bilateral in 54%. Forty-two children (88%) were treated surgically. Eleven megaureters (15%) were modelled. and 2 megaureters had to be reoperated. The follow-up period ranged between 7 months and 9.5 years. Urinary infection was reduced from 80 to 54%, chronical renal failure was reduced from 65 to 54%, and the occurrence of arterial hypertension remained unchanged. Excellent results were achieved in 27%, they were satisfactory in 60% and poor in 13% of the megaureters.
The authors present an account of urodynamic findings in 14 patients after replacement of the urinary bladder by a detubulized ileocoecal or ileal segment sutured in the shape of a pouch. An ileocoecal pouch (so-called Mainz pouch) was anastomized in nine patients to the urethra and in three it was led into the umbilicus by an ileal valve. Through this valve the patients are intermittently catheterized. In two patients an ileal neovesica stitched to the urethra was created. After a 1-12-months interval following operation the authors evaluate the urinary flow (average 12 ml/s), the residue after micturition (0-170 ml), the intravesical pressure at rest (mean 17 cm H2O), the compliance of the neovesica (mean 47 ml/cm H2O), the urethral closing pressure (mean 51 cm H2O) and continence. This type of replacement meets the demands of a large-volume, low-pressure reservoir, it has also a satisfactory evacuating ability and ensures satisfactory continence.
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Report of corticoadrenaloma in three children (1 malignant and 2 benign tumors). These 3 cases are analysed in comparison with the 72 cases found in the medical literature. From the whole series, it can be concluded that these tumors are rare, and occur predominantly in females and in very young children. Clinically, the secreting forms with rich and variable symptomatology contrast with the tumoral forms usually asymptomatic. The diagnosis between benign and malignant tumors remains difficult in cytopathological studies. In benign form, the treatment is always surgical and is successful. In malignant form, surgical treatment must be completed by chemotherapy, but the prognosis is definitively better if the tumor could be entirely removed.
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