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At least 883 records · Page 49Linked to original sources
PubMed1995

A simplified version of the "Indiana pouch" technique for urinary diversion. Experience of the first 18 cases.

During the last 3 years, a modified technique of the continent urinary diversion, known as the "Indiana pouch" has been performed in 18 patients as part of pelvic exenteration. The narrowing of the ileum and/or the site of Bauchin valve was excluded from the procedure. In order to achieve anti reflux effect, ureters were implanted to the urinary reservoir by the "split cuff nipple" technique instead of tunnelling ureters. Sufficient urine continence and lack of urine reflux in the ureters indicated that satisfactory function could be achieved by the simplified technique. A quality of life questionnaire has suggested that most of our modified Indiana Pouch patients coped well. Operative technique, indications, operative results, and complications are discussed.

Adult↗
PubMed1994

[Tumors of the female urethra: difficulties in the early diagnosis].

There is no widespread agreement on the treatment of tumors of the female urethra due to their scant incidence. These are generally slowly growing tumors with no salient or specific symptoms and signs. They manifest late and can be misdiagnosed as urethral lesions mimicking a tumor, therefore a biopsy is warranted. For all the foregoing reasons, these tumors are diagnosed in the advanced stages, with a worse prognosis despite very aggressive therapies. Two such cases are described: one was a Grabstald stage C3 epidermoid carcinoma that was submitted to anterior pelvic exenteration and died at 6 months, and the other was a Grabstald stage D4 papillary adenocarcinoma that died a few days after a resection biopsy. Due to the lower incidence of urethral adenocarcinoma, we review the literature on this tumor type and highlight its greater predisposition to progression which carries a worse prognosis.

Adenocarcinoma, Papillary↗
PubMedDate not supplied

The place for surgery in central recurrences of invasive cancer of cervix uteri.

Between 1988 and 1991, at the Jules Bordet Institute in Brussels, 11 patients were submitted to a surgical treatment due to an uterus cervix central recurrence. The majority were of the epidermoid type. The primary stage of the lesion at the moment of diagnosis varied from stage Ib to stage IIIb lesions. Six of the eleven patients were not submitted to an adequate initial treatment. These recurrences appeared between the 4th and the 264th month after the initial treatment. The treatments, which were determined according to the site of recurrence, consisted of: an anterior pelvic exenteration for four patients, a total exenteration for one patient, for two of them a total hysterectomy with bilateral salpingo-oophorectomy and partial cystectomy, a cervix amputation for another one and finally, for the last three ones, a laparotomy with debulking or derivation colostomy. The mortality during and after the operation was nil but there were several short term complications. After a minimal 19 months follow-up we could see that three patients survived, one was generalized and seven died. Due to the scarce number of patients and pathological disparity of them, the authors reviewed the literature concerning this problem, in order to determine some guidelines for similar cases. In spite of its consequences, surgery seems to be the only valid solution to propose to these patients, not only to give them a chance to survive but also to improve their life quality.

Adult↗
PubMed1994

[Local recurrence of ureteral tumor histologically similar to malignant lymphoma: a case report].

A 65-year old man, who had had resection of a right ureter tumor two years earlier, was hospitalized with complaints of lower abdominal discomfort and hematuria. Pathological diagnosis of the ureteral tumor was grade 3 transitional cell carcinoma. Computed tomography and magnetic resonance imaging demonstrated a large tumor in the retrovesical space and recurrence of transitional cell carcinoma was suggested. Total pelvic exenteration was performed and pathological diagnosis of the tumor was undifferentiated carcinoma simulating malignant lymphoma. Immunohistochemical examinations revealed no antigens specific for the lymphoid cells or epithelial cells on the specimen. This tumor consisting of undifferentiated carcinoma was considered to be recurrence of transitional cell carcinoma with the diffuse pattern simulating malignant lymphoma proposed by Zukerberg et al.

Aged↗
PubMed1994

[Peritoneal dissemination of cecal cancer disappearing in a patient taking 5'-DFUR for 3 years].

A 51-year-old woman presenting with a left ovarian tumor underwent left oophorectomy and hysterectomy with intraperitoneal administration of cisplatin, cyclophosphamide, and 5-fluorouracil on December 13, 1989. Microscopically the tumor was well-differentiated adenocarcinoma. Postoperatively cecal cancer was detected. Laparotomy revealed multiple peritoneal dissemination on March 23, 1990, when palliative ileocecal resection was performed. Microscopy revealed several of the nodules to be adenocarcinoma and the cecal lesion well differentiated adenocarcinoma. The patient was then placed on 5'-deoxy-5-fluorouridine (800 subsequently 600 mg/day). In November, 1991, bright red blood per rectum led to the discovery of rectal cancer. On January 26, 1993, laparotomy revealed rectal tumor invading the bladder but the metastatic nodules on the peritoneum had disappeared. Thus pelvic exenteration was performed. The tumor was well-differentiated adenocarcinoma. The ovarian lesion may have been a metastasis from the cecal cancer, a so-called Krukenberg tumor. The rectal cancer was most likely to be asynchronous cancer. 5'-DFUR seemed effective in remitting the peritoneal dissemination.

Adenocarcinoma↗
PubMed1993

[Posterior perineal hernia. Report of a case and review of the literature].

We report a case of a seven months old female patient with diagnosis of generalized primary elastosis or cutis laxa, that also presented a posterior perineal hernia; it was treated with surgery (abdominal and perineal) and the postoperatory evolution was favorable. In the literature it had been reported around 100 cases of posterior perineal hernia; but most of them occurred in adults patients of the female sex, with a high proportion of pregnancy or as a result of radical cancer surgery like pelvic exenteration. This is the first case of posterior perineal hernia in the Hospital Infantil de Mexico Federico Gomez and the third founded in pediatric age in the literature.

Female↗
PubMed1993

Combined radical retropubic prostatectomy and proctosigmoidectomy for en bloc removal of locally invasive carcinoma of the rectum.

A novel technique of combined radical retropubic prostatectomy and restorative proctosigmoidectomy is described, and indications and expected complications are discussed. It is offered as an alternative to total pelvic exenteration for patients with carcinoma of the rectum exhibiting isolated extension to the prostate gland or seminal vesicles. This procedure obviates the need for urinary and fecal diversion and provides excellent exposure for optimal rectal dissection. Thus, it offers the opportunity for improved functional results without compromising the principles important for local tumor control.

Adenocarcinoma↗
PubMed1993

Therapy of vulvar carcinoma.

83 vulvar carcinoma patients were originally treated in the period between 1970 and 1990. 82 patients presented with squamous cell carcinoma. 70% of the patients were in Stage I or II. It was originally possible to operate on 74 of the 83 patients. A simple or partial vulvectomy was applied 17 times. A bilateral inguinal lymph node excision additionally took place in 6 cases. 51 patients were subjected to radical vulvectomy with inguinofemoral lymph node excision. In 13 cases, pelvic lymph node extirpation was also performed. A posterior pelvic exenteration was performed in 6 cases presenting extensive carcinoma involvement of the vulva. In the remaining 9 patients, either it was not possible to operate, or a nonradical operation could be performed. The primary morbidity, consisting of wound healing disturbances and infections, amounted to 50% in our group. We observed lymphedema in 47% of the cases, although it was clinically important in only 10%. We did not have any primary surgical mortality. The 5-year survival rate was 82% in our patients without inguinofemoral lymph node involvement and only 40% in lymph node metastatic cases. The absolute 5-year cure rate was 66%, or 69% corrected. To be able to give increased preference to less invasive methods an improved prevention and clarification procedure for physicians and patients is necessary.

Aged↗
PubMed1996

[Rhabdomyosarcoma of the bladder: a case report].

A 15-year-old man with the chief complaint of general fatigue was referred to our hospital on November 11, 1993. Bilateral percutaneous nephrostomy was performed for postrenal anuria. X-ray examinations revealed a huge intrapelvic tumor, and it was histopathologically diagnosed as rhabdomyosarcoma by transrectal needle biopsy. He was initially treated with combination chemotherapy regimen of vincristine, actinomycin-D and cyclophosphamide (VAC therapy). Pelvic exenteration was performed on December 15, 1993. Histopathological findings were alveolar rhabdomyosarcoma with degenerative change and partial necrosis. After the operation, he was given two course of VAC therapy. In May, 1994, brain metastasis occurred, so 4 courses of VAC therapy were administered. For a very short period, neurological symptoms improved, but he died of pneumonia on November 15, 1994.

Adolescent↗
PubMed1997

[Bladder carcinoma presenting with hypercalcemia: a case report].

A 47-year old woman was referred to our hospital with nausea, vomiting and the loss of body weight. Pelvic computed tomography and magnetic resonance imaging revealed an invasive bladder tumor on the left lateral wall, accompanied with calcification. Laboratory examination revealed marked hypercalcemia (20.6 mg/dl) and elevated serum parathyroid hormone-related protein-intact (29.9 pmol/l), which was apparently produced by the tumor. Treatment with pamidronate and colloid infusion resulted in normocalcemia. Anterior pelvic exenteration was performed. Histopathological diagnosis was transitional cell carcinoma > adenocarcinoma, G3, pT4pN2M0, stage IV. She died of cancer 7 months postoperatively.

Carcinoma, Transitional Cell↗
PubMed1997

[A case of uretero-aortic fistula].

We report a case of uretero-aortic fistula. A 69-year-old man with rectal cancer underwent a pelvic exenteration and a double--barreled cutaneous ureterostomy in the right lower abdomen. Stomal stenosis necessitated continuous indwelling of double J stents in the two ureters. Two years postoperatively, massive bleeding occurred during exchange of double J catheters. Occlusive ureterogram demonstrated a uretero-aortic fistula at the crosspoint between the left ureter and the aorta. The surgical repair consisted of closure of the aortic fistula, ligation of the left ureter proximal to the fistula and percutaneous left nephrostomy.

Aged↗
PubMed1997

[Pelvic recurrence of cancers of the uterine cervix. A study of a series of 49 cases].

BACKGROUND: Pelvic recurrence of cervical cancer is a life-threatening event for patients. The main therapeutic challenge is to locally control such relapses. We present our experience of the surgical treatment of pelvic cervical cancer relapses. PATIENTS AND METHODS: From July 1980 to January 1994, 49 patients underwent a surgical procedure for pelvic cervical cancer relapse. Forty four tumor relapses were localized in the pelvis and 5 were associated with distant metastases. Surgery was performed alone in 31 cases and in association with radiotherapy in 18 cases. Median follow-up was 34 months. RESULTS: The treatment was curative in 49% of cases. There was a significant correlation between the initial stage, the site of tumor relapse and surgical curability. Overall actuarial survival was 44% and 24% at 2 and 5 years, respectively. In the curative treatment group, actuarial survival was 71% and 47% at 2 and 5 years, respectively. There was a major surgical complication in 14 cases: 11 reoperations were performed. Thirteen patients are alive of whom 12 with no evidence of disease (median follow-up; 36 months). A local control was achieved in 53% of cases. Age and site of relapse significantly influenced survival. CONCLUSIONS: The results of this study are comparable with other surgical series despite our less favorable patient selection. For patients experiencing pelvic side-wall infiltration, surgical treatment is a worthwhile palliation in selected cases because it is often the only available therapeutic option.

Adult↗
PubMedDate not supplied

Ovarian metastases from carcinoma of the bilharzial urinary bladder.

A pathologic study of 135 cases of carcinoma of the bilharzial urinary bladder treated with radical anterior pelvic exenteration, including 60 cases examined by subserial sections of both ovaries, did not reveal a single incidence of ovarian metastases from bladder carcinoma. The same observation has been reported by some investigators examining the more aggressive forms of bladder carcinoma seen in Western countries. Based on these findings, we recommend that at least one ovary, the one away from the tumors, should be retained with an intact blood supply to avoid the distressing symptoms of menopausal syndrome. This is especially advisable in our patients where carcinoma of the bladder occurs at a younger age.

Age Factors↗
PubMed1997

[Primary transitional cell carcinoma of the prostate. An infrequent tumor].

Primary prostatic carcinoma accounts for 2% to 4.5% of all neoplasias to this organ, and it has been observed in 2.8% of all radical cystoprostatectomies performed in the Mayo clinic. It originates in the poorly differentiated reservoir cells of the prostatic periurethral ductus which explains why diagnosis is most often obtained in advanced stages (stromal involvement), thus limiting its management to radical surgery. This paper contributes one case report of a patient diagnosed by transrectal biopsy of a primary prostatic transitional carcinoma presenting with incoercible rectorrahges and urinary obstruction symptoms. Treatment was through pelvic exenteration, and urinary and gut by-pass.

Biopsy↗
PubMed1997

[Bladder pseudosarcoma in pediatrics: clinico-pathological features and treatment].

OBJECTIVES: To review the most common clinical signs and symptoms of inflammatory pseudotumor of the bladder in children and to distinguish this benign lesion from malignant neoplasms such as rhabdomyosarcoma and leiomyosarcoma. METHODS: Two cases os pseudosarcomatous tumor of the bladder in children are described. In the first patient, the tumor had appeared spontaneously in a 9-year-old boy. The second had developed in a 6-year-old girl and was considered to be reactive to prior surgery. The literature is reviewed and data from 16 cases of inflammatory pseudotumor of the bladder in patients under 16 years of age are also presented. RESULTS: The mean age at presentation was 8 years. The male-to-female ratio was 3:1. Hematuria (56%), dysuria (37%) and abdominal pain with a palpable mass (18%) were the most commonly described clinical manifestations. Tumor size ranged from 3 to 10 cm and they were frequently located in the lateral walls and base of the bladder. Histological analysis showed an inflammatory pseudosarcomatous reaction. Immunohistochemical analysis showed moderate staining for vimentin, mild staining for focal muscle actin and negative for keratin and S-100 protein. Patients were treated by local resection (7 pts), partial cystectomy (5 pts), radical cystectomy (2 pts) and pelvic exenteration (2 pts). The mean follow-up was 34 months. All patients that had been followed (14/16) were reported to be free of disease with no evidence of recurrences or metastases. CONCLUSIONS: Inflammatory pseudotumor of the bladder is an unusual benign tumor that is very rare in children. Long-term follow-up confirms the benign nature of the lesion and conservative management is therefore advocated. However, given its histological similarity to malignant tumors, a close follow-up is recommended.

Child↗
PubMed1998

[A case of clear cell adenocarcinoma of the female urethra].

Clear cell adenocarcinoma of the female urethra is a rare disease. We herein report the 23rd case of clear cell adenocarcinoma of the female urethra in Japan. A 75-year-old female visited our hospital because of pollakisuria. Pelvic CT revealed a 2.2 cm tumor surrounding the entire circumference of the urethra with pelvic lymph node metastases. Chest CT revealed mediastinal lymph node metastases. She underwent anterior pelvic exenteration and ileal conduit urinary diversion. Pathological diagnosis of the tumor was clear cell adenocarcinoma. She has been alive 11 months after surgery in spite of enlarged mediastinal lymph node metastases.

Adenocarcinoma, Clear Cell↗