Biomedical subjects
Publications and source records attributed to Ahmed Ameur.
Bladder leiomyosarcoma is an uncommon tumour. Early diagnosis and aggressive surgical treatment are necessary to ensure patient survival. The authors report a case of bladder leiomyosarcoma treated by radical cystoprostatectomy and enterocystoplasty with a favourable outcome at 32 months. The author analyse the clinical and histological features and the treatment of this rare tumour.
OBJECTIVES: To describe our experience with a modified Denis technique for hemostasis in suprapubic prostatectomy. METHODS: We reviewed the charts of 78 patients who underwent suprapubic prostatectomy using a modified Denis technique between September 1996 and June 2001. After adenomectomy, we performed a bladder neck removable partition purse-string suture, and the prostatic fossa was drained. Patients were followed up for hemorrhagic complications and bladder neck strictures for 12 months. RESULTS: The mean intraoperative hemorrhage amount was 264 mL (range 160 to 510). The postoperative irrigating fluid volume was 2000 mL (range 500 to 4500), and the bladder irrigation duration was 24 hours in 70 patients (89.8%) and 48 hours in 8 patients (10.2%). Postoperative hemorrhage, measured by the prostatic fossa drain, was 0 mL in 48 patients and had a mean value of 55 mL (range 10 to 90) in 30 patients. No hemorrhagic complication was noted. None of our patients had transfusion, bladder clot formation, or late hemorrhage. One case (1.3%) of bladder neck stricture developed. CONCLUSIONS: This modified Denis technique is very effective and easy to perform and to learn. It has solved all our hemorrhagic problems in suprapubic prostatectomy.
Testicular infarction without torsion of the spermatic cord is a rare lesion, generally idiopathic and spontaneous. It may be exceptionally associated with certain risk factors (vasculitis, cholesterol emboli, malakoplakia, protein S or antithrombin III deficiency, etc.). It often simulates testicular tumour, leading to orchidectomy, which can be avoided, particularly in the case of segmental infarction, by applying conservative treatment. The authors report an original case of infarction of an inguinal ectopic testis without torsion. No cause was identified. In the light of this case and a review of the literature, the authors discuss the various aspects of this clinical entity.
Four cases of ureteropelvic junction syndrome associated with arterial hypertension were reported. The authors discuss the ethiopathogenic of hypertension, on the basis of these observations and a review of the literature. They conclude that union bilateral hydronephrosis can lead to hypertension and renal failure by both inappropriate production of renin and water chronic retention. The correction of ureteropelvic junction should return blood pressure to normal levels.
The authors present four cases of Buschke Loewenstein tumor. In three cases, the outcome was good despite areas of anaplasic change are seen in one of them. The outcome of the fourth patient was fatal because of multiples recurrences. Clinical features, diagnosis and treatment of this rare disease are discussed.
AIM: Hydatid disease is endemic in some countries, where it constitutes a real public health problem. It can affect any, but the kidney is a relatively rare site, representing 2% to 4% of all visceral sites. Renal hydatid cyst only presents at the stage of complications. Laboratory tests may suggest the diagnosis, which is confirmed by radiology. Renal hydatid cyst raises therapeutic problems making conservative surgery difficult. The objective of this paper is the find the best adapted treatment. MATERIAL AND METHOD: 34 consecutive cases of renal hydatid cyst (1980-2001) were observed in 23 men and 11 women with a mean age of 42 years (range: 15-73 years). The clinical features were dominated by pain (63%), a mass (26%), hydaturia (11.4%), haematuria (31.4%), prolonged fever (23%) and hypertension (3%). Intravenous urography performed in all patients showed calcifications in 5 cases, a mass syndrome in 11 cases and silent kidney in 2 cases. Abdominal CT, performed in 8 patients, was necessary whenever the diagnosis remained uncertain, particularly in the case of pseudoneoplastic cysts. However, ultrasonography, performed in 30 patients, remains the preferred diagnostic examination. RESULTS: Treatment consisted of resection of the prominent dome in 23 cases, pericystectomy in 5 cases, 1 partial nephrectomy and 6 total nephrectomies. An associated procedure was performed during the same operation (hepatic, peritoneal hydatid cyst) in 3 cases, and was deferred (pulmonary hydatid cyst) in 1 case. The postoperative course was marked by urinary fistula in 2 cases and suppuration of the residual cavity in 1 case, treated by ultrasound-guided aspiration-drainage. CONCLUSION: The resection of the prominent dome is the most adapted treatment whenever possible.
Retroperitoneal nerve sheath tumors (RNST), which include benign and malignant schwannomas and neurofibromas, are rare. A 71-year-old woman was complaining of flank pain. Ultrasonography and computed tomography revealed a retroperitoneal tumor measuring 22 x 15. It was successfully removed and extirpated through a midline laparotomy incision. It weighed 7 kgs. Histochemical and immunohistochemical staining of the tumor are useful for the diagnosis of solitary neurofibroma. After a two year follow-up, the patient is in good health, asymptomatic and without evidence of local recurrence.
Focal bacterial nephritis or lobar nephronia represents an acute localized non-liquefactive infection of the kidney caused by bacterial infection. This is an uncommon form of pyelonephritis that can affect both adults and children. Imaging techniques, particularly CT scan, are necessary for diagnosis and to distinguish it from other conditions (abscess or renal masses) that require a different treatment. The authors describe a case of acute lobar nephronia in a 24-year-old man.
Primary hyperaldosteronism represents less tha 1% of all causes of hypertension. We report one case of primary hyperaldosteronism which emphasizes the difficulty of distinguishing tumoral PHA from idiopathic PHA (bilateral adrenal hyperplasia), observed in a 57-year-old man. The diagnosis was suggested by marked hypokalemia, and was confirmed by hyperaldosteronaemia and low and poorly stimulated renin activity. Intravenous saline infusion failed to significantly suppress plasma aldosterone levels. Upright posture for 60 minutes suppressed plasma aldosterone concentration. A Computed tomography (CT) scan showed bilateral adrenal mass. Management consisted of total right adrenalectomy, and enucleation of adenoma from the opposite adenoma. The patient is normotensive 4 years after surgery.
Skin is an uncommon site of metastatic disease when compared to other organs or sites in the body. Occasionally, cutaneous metastasis may be the first clinical manifestation of a clinically silent, visceral malignancy of unknown origin. We report the case of a 25 year old man with a single perineal reddish nodule. Microscopic examination of the cutaneous nodule revealed the typical histologic features of a testicular tumor with metastases to liver and lungs. The patient died four month after the diagnosis due to complications of metastatic disease.
The authors report a case of benign tumor of the psoas muscle occurring in a 36-year-old man. The diagnosis was based on computed tomography and the patient underwent tumorectomy by an extrapoeritoneal approach. The authors emphasize the ratity f psoas tumors that are usually malignant and the advantage of computed tomography and percutaneous biopsy. Treatment must be incorporated into a multidisciplinary approach in which surgery plays a leading role and must be based on the treatment of soft tissue tumors.
Retro-iliac ureter is a rare congenital abnormality. The authors report a case of retro-iliac ureter associated with ipsilateral megaureter in a 38-year-old patient treated by section of the ureter at the ureterovesical junction, and dissection as far as the iliac pedicle and anterior repositioning of this pedicle, followed by ureterovesical reimplantation. Based on a review of the literature, this appears to be the first published case of this pathological association.