Abstract Laparoscopic cystectomy and bilateral ureteric ligation were performed on a 52‐year‐old woman with end‐stage renal disease on hemodialysis (HD) for muscle‐invasive bladder cancer. Her volume of urine production was approximately 100 mL/day. Excisions of the bladder and uterus with ligation of the bilateral ureter were conducted completely laparoscopically. Total operative time was 280 min and the amount of blood loss was 60 mL. No complications were seen perioperatively and no adverse events regarding ureteric ligation arose. HD was performed on the second postoperative day. At a 12‐month follow‐up, the patient showed no evidence of disease.
Abstract Due to a number of evolving devices and modalities to treat the small, localized renal mass, the physician and patient have the opportunity to choose an appropriate therapy from several treatment options. Minimally invasive surgery to ablate a localized renal tumor is an alternative strategy to nephron‐sparing surgery for the small renal mass. Even though partial nephrectomy has been established as an optimal technique for nephron‐sparing surgery, patients who have comorbidities and renal insufficiency would potentially benefit from less invasive treatment. With respect to those concerns, several articles are discussed here regarding thermal ablative therapy for the small renal mass along with oncological outcomes and complications among these modalities compared to conventional procedures. In this review, a comprehensive PubMed search was conducted. For the purposes of reviewing the current status of thermal ablative modalities for the small renal mass, only articles written in English published from 1992 to 2009 were considered. Cryoablation and radiofrequency ablation are the most utilized and potentially promising therapies that are evolving as nephron‐sparing minimally invasive surgery for patients with a localized renal tumor. High‐intensity focused ultrasound, a relatively new modality to treat the renal mass, needs further study. All modalities require long‐term follow up with unified reporting methods in terms of patient selection, pre‐ and post‐treatment evaluation, treatment description, and analysis of outcome.
Methods: The age at the seizure onset of the 35 patients ranged from 0 to 1.8 years (mean 0.3). Eleven patients had normal developments prior to the onset of epilepsy. All patients had video-EEG monitoring, neuropsychological examination, MRI and inter-ictal ECD SPECT. Patients with resectable lesion on MRI were excluded. Age at surgery ranged from 0.4 to 4.6 years. Anterior corpus callosotomy was performed in 2 patients and total corpus callosotomy in 33 patients. The mean follow-up period was 3 years. For psychological test, Kinder Infant Developmental Scale was used during each follow-up. For assessment of post-operative change of developments, developmental velocity was used, which was calculated from the difference of developmental age before surgery and at each follow-up, divided by the number of follow-up months. Surgical outcome was categorized as seizure free, excellent (> 80% reduction in seizure frequency), good (> 50% reduction in seizure frequency) and poor (no signifi cant change). Results: During preoperative EEG-video monitoring, 21 patients showed single type of seizure and 14 had multiple types of seizure. Tonic spasm was recorded in all patients except 3, who had tonic seizure. Preoperative mean developmental quotient and developmental age was 20.6 and 5 months, respectively. MRI showed diffuse brain atrophy in 28 patients. Surgical outcome was seizure free in 9 (26%), excellent in 7 (20%), good in 10 (28%) and poor in 9 patients (26%). 74% of patients showed signifi cant improvements after the surgery. Pre-operative prognostic factors were analyzed between the “seizure free/excellent” group and “good/poor” group with multivariate analysis. Late onset of seizure (p<0.05), higher preoperative developmental quotient (p<0.05) and normal developments before the onset of epilepsy (p<0.001) are signifi cant predictive factors for seizure control. In “seizure free/excellent” group, developmental velocity was greater than “good/poor” group at the each followup point. Furthermore, in “seizure free/excellent” group, patients with preoperative developmental quotient greater than 20 showed signifi cantly higher developmental velocity (0.41) than those with lower developmental quotient (0.17) at the fi nal follow-up (p<0.05). Conclusion: Physiopathological mechanism of spasm is still unclear and controversial. Brainstem has been proposed as a generator of spasm. Our results support the primary involvement of cortical structures for spasms. 2 Corpus callosotomy was an effective and important therapeutic option in patients with West syndrome. Best results were obtained in patients who had late onset of epilepsy, higher developmental quotient and normal development before the onset of epilepsy. For postoperative improvements of psychomotor function, an early surgery is recommended before severe psychomotor delay develops. References
Cytopathic effects and local immune response were analyzed histologically in prostatic cancer (PCa) with in situ herpes simplex virus-thymidine kinase (HSV-tk)/ganciclovir (GCV) gene therapy (GT).Four high-risk PCa patients who received HSV-tk/GCV GT were investigated. After two cycles of intraprostatic injection of HSV-tk and administration of GCV, radical prostatectomy was performed. Formalin-fixed, paraffin-embedded sections were evaluated using immunohistochemistry. PCa with hormone therapy (HT, n=3) or without neoadjuvant therapy (NT, n=4) that were equivalent in terms of risk were also examined as reference. Immunoreactively-positive cells were counted in at least three areas in cancer tissue. Labeling indices (LI) were calculated as percentage values.ssDNA LI in GT increased, indicating apoptosis, as well as tumor-infiltrating lymphocytes and CD68-positive macrophages, compared with their biopsies. GT cases showed significantly higher numbers of single-stranded DNA (ssDNA) LI, CD4/CD8-positive T cells and CD68-positive macrophages including M1/M2 macrophages than HT or NT cases. However, there was no significant difference in CD20-positive B cells among the types of case. There were strong correlations between CD8+ T cells and CD68+ macrophages (ρ=0.656, p<0.0001) as well as CD4+ T cells and CD20+ B cells (ρ=0.644, p<0.0001) in PCa with GT.Enhanced cytopathic effect and local immune response might be indicated in PCa patients with HSV-tk/GCV gene therapy.
A 79-year-old male, who received hemodialysis due to bilateral nephroureterectomy and cysto-prostateurethrectomy. Five months later, an enlarged lymph node was found in the left of inguinal area. Abdominal computed tomography revealed a low density mass from the para-aortic lymph node to the left of inguinal area, suggesting lymph node metastasis of ureteral carcinoma. After 3 cycles of gemcitabinenedaplatin therapy, the size of lymph node metastasis decreased. This is a report of successful treatment of ureteral carcinoma with hemodialysis.
(Objectives) The influence and the interdependence of pathological and clinical factors on prognostic differences between renal cell carcinoma (RCC) with end-stage renal disease (ESRD) and RCC without ESRD after nephrectomy has remained unclear. We compare the clinicopathological features between RCC with and without ESRD.(Materials and Methods) From June 1993 to May 2000, 150 RCC patients who underwent nephrectomy were pathologically defined to have pT1 to pT3NXM0. The patients were followed for 1 to 84 months (median 30 months) after the surgery. Total of 16 patients with ESRD and 134 patients without ESRD were studied, and the differences of clinicopathological features between two groups were statistically compared.(Results) We compare the clinicopathological features between RCC with and without ESRD. Patients' age, tumor size, rate of incidental cancer, pathological T stage, and grade were not significantly different between two groups. The 5-year recurrence-free probability rate was significantly higher in patients without ESRD than in patients with ESRD (log-rank test: p=0.04). The status of ESRD, patients age and pathological T stage were significant predictors of recurrence when analyzed by Cox proportional hazards analysis (p=0.01, p=0.03 and p=0.02, respectively).(Conclusions) This study demonstrated that the ESRD is an independent prognostic factor in RCC patients after surgery. These results reflect that the patients with ESRD have higher risk of tumor progression. Therefore, early detection of tumors is particularly important in these patients by regular abdominal ultrasound or CT screening.
