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The authors describe a case of developing local tumor metastases after laparoscopy. In the second week after laparoscopy metastases developed at the place of the penetration of the pneu-needle and the trocar by the mediation of ascites containing malignant cell groups. This form of metastatisation seems to be extremely rare.
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The natriuretic effect of atrial natriuretic peptide (ANP) is blunted in certain clinical disorders such as congestive heart failure and liver cirrhosis, despite the elevated plasma ANP levels. These sodium-retaining states are characterized by increased activity of the renal sympathetic nerves. Recent studies have shown higher levels of circulating and urinary catecholamines in cancer patients. We hypothesized that the increased adrenergic activity may be responsible for ascites formation in patients with peritonitis carcinomatosa (PC). The objective of this study was to determine the renal responses to endogenous ANP in patients with PC. Patients, hospitalized at our institute for PC, were examined using renal clearance studies for 2 h. Non-cancer patients were also examined as control subjects. Statistical analysis was performed using Wilcoxon's rank sum test. The results showed that absolute and fractional sodium excretions were markedly lower in patients with PC (54 +/- 16 microEq/min, means +/- SE, p < 0.0005; 0.55 +/- 0.15%, p < 0.005) than in control patients (166 +/- 14 microEql/min; 1.14 +/- 0.09%, respectively). Plasma ANP concentration was increased in patients with PC (34.7 +/- 8.4 pg/ml, p < 0.001) in comparison with control patients (13.3 +/- 2.0 pg/ml). Plasma and urinary levels of norepinephrine were significantly higher in cancer patients (0.36 +/- 0.10 ng/ml, p < 0.05; 125 +/- 20 ng/dl GF, p < 0.05) than in the controls (0.17 +/- 0.02 ng/ml; 73 +/- 13 ng/dl GF). These results suggest that increased renal sympathetic nerve activity may contribute to the attenuation of the natriuretic effect of ANP in patients with PC.
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A rare case of "gliomatosis peritonei" is reported in a 16 year-old girl suffering from an adult ovarian teratoma with high-differentiated glia structures without malignancy. The histological grading of the primary tumor and its metastasis in the omentum majus seems to be contradictory to the ovarian-tumor-staging recommended by FIGO. The biological dignity of high-differentiated gliametastasis of an adult teratoma evidently allows a minimum of treatment because of good prognosis of this disease.
Percutaneous CT-guided biopsies were carried out in 350 patients; on 291 occasions, 14- or 18-gauge and, on 59 occasions, an 0.95 mm cutting biopsy cannula was employed. Using the 14- and 18-gauge needles, a histological diagnosis was possible in 191 cases, a sensitivity of 82.7%. The 0.95 mm cannulas proved successful in 39 of the 59 punctures, producing a markedly lower sensitivity of 66.2%. The most common cause of an incorrect biopsy with large needles was bad position of the needle, whereas the small needles provided inadequate material. Complications which, however, did not require treatment, occurred in 5 patients (1.4%).
The value of computed tomography for staging and for observing the course of ovarian carcinomas was analysed in 56 patients in whom the diagnosis had been verified by laparotomy. Ct achieved correct staging in 85% of cases. The ability of CT to demonstrate a variety of abnormalities varies; ascites and pleural effusions were shown in 100%, lymph node metastases in 90%, infiltration of the recto-sigmoid and terminal ileum in 70-80%, sub-capsular liver metastases in 70%, involvement of the omentum in 70%, of the peritoneum in 65% and of the mesentery in 35%. A 'second-look' operation remains necessary in order to confirm complete remission after chemotherapy, since CT is only rarely able to show residual tumours smaller than 1 1/2-2 cm.
The value of visceral arteriography is discussed in relation to four hepatoblastomas, two vascular hamartomas of the liver, one inactive islet cell tumour of the pancreas and two malignant intraperitoneal tumours. Although non-invasive methods, such as computer tomography, sonography and scintigraphy are valuable, angiography is an important part of the pre-operative diagnosis of visceral tumours during childhood.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.