[A case of extra-adrenal pheochromocytoma treated with alpha-methyl-p-tyrosine].
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One hundred eighty-four diagnostic aspirations performed on 169 patients were reviewed (1) to define the decision process regarding which guidance method (sonography v computed tomography) should be used on any given patient, and (2) to determine, once a guidance method was chosen, its accuracy and complication rate. Sonographic guidance (84%) proved to be an effective method for obtaining a correct diagnosis in 98% (110/112) of cystic masses and 79% (34/43) of solid masses. Computed tomography (16%) was used when sonography could not identify the mass or when the mass was small, deeply located, and often solid. Computed tomographic guidance provided a correct diagnosis in 100% (13/13) of cystic masses and 81% (13/16) of solid masses.
In conclusion, it can be seen that coexistent intra-abdominal pathology and aortic aneurysms demands an individualized approach to determine a treatment plan for a given patient. Life expectancy must be balanced against the risk of a complication developing in either the treated or untreated condition as well as the potential for increased morbidity associated with combined procedures. If combined procedures are performed, they must be undertaken only if the aneurysm resection has gone smoothly. Efforts must be directed at protecting the prosthetic graft from direct contamination that may accompany the secondary procedure. In general, the symptomatic lesion should be treated first. If both conditions are asymptomatic, the relative risks and benefits of treatment must be balanced against the probability that one or both of the conditions will become symptomatic.
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Concomitant neoplasm and abdominal aortic aneurysm (AAA) is not a rare clinical association and can pose problems if antiblastic treatment is required. The literature shows lack of consensus owing to the fact that AAA can modify the liquid load and the hemodynamic setting so that chemotherapy toxicity profile becomes important and hydration overload increases the AAA-breakage risk. We have analyzed the possibility of treatment with a non-critical water load related chemotherapy in these patients, and if it can offer benefit it terms of overall survival (OS) and quality of life (QL). We concluded that in chemotherapy the presence of AAA does not have to be excluded first, if such critical parameters such as response to chemotherapy AAA-breakage risk vascular and extravascular toxicity do not compromise the OS and QL of the patients.
BACKGROUND: It is unclear whether there is a benefit to resection of primary gastrointestinal carcinoid neoplasm with hepatic metastases. We investigated whether primary tumor resection in this setting led to a significant difference in outcomes. METHODS: A retrospective review of patients with abdominal carcinoid neoplasms between 1995 and 2006 was performed. Data collected on patients with proven carcinoid liver metastases at initial diagnosis included whether the primary neoplasm was resected, time to progression of liver metastases, and status at last follow-up. Progression-free survival and survival were calculated by the method of Kaplan-Meier and compared by the log-rank test. RESULTS: There were 84 patients, 60 of whom had their primary neoplasm resected. The resected group had a greater median progression-free survival of 56 months, compared with 25 months for the primary nonresected group (P < .001). Median survival time for the resected group was longer at 159 months, compared with 47 months for the nonresected group (P < .001). CONCLUSIONS: Resection of the primary neoplasm is associated with better progression-free survival and overall survival in patients with abdominal carcinoid neoplasms. Therefore, localization and resection of the primary neoplasm should be considered, even among patients in whom the primary neoplasm is asymptomatic.
There were 36 patients with testicular tumors who underwent abdominal staging by ultrasonography, computed tomography or both before removal and pathologic examination of the retroperitoneal lymph nodes. Results showed that ultrasonography and computed tomography are accurate in predicting retroperitoneal metastases in more than 80 per cent of the patients, although computed tomography is more accurate and specific. The 1 falsely negative result with both methods occurred in a patient with microscopic (pathologic stage IIA) retroperitoneal disease. The falsely positive results with either technique were found in patients with borderline enlargement of the nodes (1 to 1.5 cm). Either computed abdominal tomography or abdominal ultrasonography is recommended for pre-treatment staging of testicular tumors.
The direct spread of intraabdominal disease via peritoneal folds is clearly demonstrated with computed tomography (CT). This extensive network of peritoneal folds can be conceptualized as the subperitoneal space. These subperitoneal communications within the abdomen are described and demonstrated by CT scans and a schematic drawing. Direct spread of disease within and between abdominal compartments is illustrated with selected clinical cases stressing the CT imaging method.
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