Biomedical subjects
X Game
Publications and source records attributed to X Game.
[Dedifferentiation of mature teratomas secondary to testicular cancer: report of 2 cases].
The authors report two cases of adenocarcinomatous dedifferentiation of a recurrent mature teratoma arising 3 and 20 years after the initial resection. This is a rare event, occurring after macroscopically or microscopically incomplete resection of a mature teratoma. The nature of this recurrence was difficult to determine prior to histological examination. However, PET scan suggests the diagnosis of malignant teratoma in the presence of increased uptake by the lesion. These tumours have a poor prognosis. Treatment consists of complete resection of the tumour mass. The possibility of long-term malignant dedifferentiation of a teratoma therefore requires prolonged and regular life-long surveillance of patients presenting a mature teratoma after chemotherapy for non-seminomatous germ cell tumour of the testis.
[Secondary biological recurrence after radical prostatectomy: multivariate analysis of prognostic clinical, biological, and histologic factors].
OBJECTIVES: To define the clinical, laboratory and histological variables associated with secondary elevation, after an undetectable phase, of PSA after radical prostatectomy. MATERIALS AND METHODS: This was a prospective study of 83 consecutive patients undergoing retropubic radical prostatectomy with an undetectable postoperative PSA at 3 months. The predictive value of five preoperative criteria (age, total PSA, Gleason score on biopsies, positive apical biopsies, clinical stage) and four postoperative criteria (pathological stage, Gleason score on the operative specimen, positive margins, follow-up) for secondary laboratory progression was studied by univariate and multivariate analysis. RESULTS: With a median follow-up of 36 months, the laboratory recurrence rate was 19%. Laboratory recurrence was associated with a biopsy Gleason score greater than or equal to 7 (p = 0.04), a high pathological stage (p = 0.03), a high histological score (Gleason > or = 7) (p < 0.01) and positive margins (p = 0.04). Logistic regression identified a Gleason score on the operative specimen greater than or equal to 7 to be the only element predictive of secondary laboratory progression. CONCLUSION: The concept of positive margins or high pathological stage is insufficient to identify the risk of laboratory progression after radical prostatectomy. The Gleason score, which evaluates tumour aggressiveness, the risk of micrometastases or periprostatic extension, therefore appears to be more useful.
[Periurethral collagen injections: results after 2 years in 25 patients with severe urinary incontinence].
OBJECTIVES: To study the efficacy and safety of periurethral collagen injection in the treatment of severe urinary incontinence. PATIENTS AND METHODS: From 1994 to 1998, 25 periurethral collagen injections were performed in 25 women with a mean age of 65 years presenting with urinary incontinence classified as grade III in 17 cases and grade II in 9 cases, under local anaesthesia in 5 cases, spinal anaesthesia in 10 cases and general anaesthesia in 10 cases. Twenty patients were treated for recurrent incontinence. One injection was performed in 20 cases and two injections were performed in 5 cases. None of the patients presented disorders of pelvic muscles. The preoperative urodynamic assessment did not reveal any cases of detrusor instability, and showed a mean urethral closure pressure of 35 cm H2O. A skin test was performed in each case at least 30 days before the injection. RESULTS: The mean hospital stay was 2.75 days. The mean quantity of collagen injected was 5.7 ml. With a mean follow-up of 24 months, 33% of patients were continent, 39% were improved and 28% were considered to be failures. No complications were observed. CONCLUSION: Due to its safety, this method can be proposed in outpatients with good results, in patients of all ages, either as first-line treatment or for recurrent incontinence, as, in the case of failure, this technique does not comprise subsequent treatment by another operation.
[Treatment of chronic urinary retention after surgical treatment of urinary incontinence with bladder neck transurethral resection].
OBJECTIVE: To evaluate the efficacy and safety of transurethral resection of the overcorrected posterior lip of the bladder neck in patients with chronic urinary retention after repair of incontinence. MATERIAL AND METHODS: Transurethral bladder neck resection was performed in 26 women with a median age of 59 years. Incontinence repair consisted of a Burch procedure in eight cases, a Raz procedure in eight cases, a Marshall-Marchetti-Krantz procedure in five cases, an aponeurotic sling in three cases and a synthetic sling in two cases. The median preoperative maximum urine flow rate was 11.5 ml/s and the median residual urine was 150 ml. Preoperative cystourethrography and cystoscopy revealed overcorrection of the bladder neck in each case. RESULTS: With a median follow-up of 39 months, 65.5% of patients were cured (resolution of symptoms, maximum urine flow rate greater than 15 ml/s and residual urine less than 50 ml), 23% were improved and 11.5% were considered to be failures. No complications or secondary urinary incontinence were observed. Patients not cured by this technique were treated by urethrolysis in three cases, Uroflow stent in one case and section of a Raz cervicocystopexy suture in one case. CONCLUSION: Transurethral bladder neck resection can be used as first-line treatment for chronic urinary retention after repair of incontinence, as it is an effective, rapid, minimally invasive technique not associated with any morbidity. Urethrolysis can always be performed in the case of failure.
Bladder cancer arising in a spina bifida patient.
We report the case of a 52-year-old patient with spina bifida, neurologic bladder, and a history of recurrent urinary tract infections (UTIs) in whom a bladder cancer was incidentally discovered. Cytology, cystoscopy, and cystography showed nonspecific, extensive inflammatory lesions. Cystography demonstrated a complex of diverticulae and cellules. Pathologic examination of a diverticulectomy specimen revealed a grade III pT3b transitional and squamous cell carcinoma. Because of the similar disease causation (recurrent UTIs, stones, and indwelling catheterization), we suggest extension of the guidelines proposed for patients with spinal cord injuries (ie, annual serial bladder biopsies) to patients with nontraumatic neurogenic bladder.
[Large-cell calcifying Sertoli cell tumors: apropos of a case and review of the literature].
The authors report the case of a 22-year-old man presenting with a tumour of the lower pole of the left testis, present for 4 months, which proved to be a calcified Sertoli large cell tumour, an extremely rare group of sex cord tumours of the testis presenting specific clinical and histological features. These tumours are usually benign, occur during the first two decades of life and can be associated with dysplastic complexes or endocrinopathies (Carney's complex, Peutz-Jeghers syndrome). They present either in the form of bilateral, multifocal tumours in the context of a pathological association, or in the unilateral form, without association. Several malignant forms with metastases have been described. Conventional treatment is transinguinal radical orchidectomy.