Carcinoma in a post-diversionary bladder.
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Biomedical subjects
Publications and source records attributed to D Turini.
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Chronic renal artery occlusion must be suspected whenever a moderate hypertensive patient over 50 years of age presents increase of blood pressure refractory to treatment, sometimes causing heart failure or stroke. This suspicion is reinforced by the presence of renal insufficiency and of anatomical and/or functional lateralization of renal damage at intravenous pyelography.
2 cases of renal cell carcinoma associated with macroaneurysm of the renal artery are described. The association between these two lesions seems to be highly unusual, and its pathogenetic, diagnostic and surgical implications are discussed.
A nineteen year surgical experience with 35 patients requiring repair of ureteral defects is reported. Causes of ureteral damage are described, and the result of 18 patients treated with ileal ureter are compared with those of 17 cases where surgical procedures preserving urothelial continuity were used, such as bladder psoas hitch and renal autotransplantation. Significantly better results were observed with the latter techniques.
Two cases of renal leiomyosarcoma are described. At angiography both cases presented common findings consisting of: (1) central hypovascularity surrounded by peripheral tumor neovascularity and (2) oval-shaped areas that rapidly filled with contrast medium. This angiographic appearance, although not previously described in such tumors, cannot be claimed to offer a key to preoperative diagnosis because it may be found in the more common hypernephromas with central necrosis.
Experience with 10 cases of ureterocalyceal anastomosis is reported. Most cases involved scleroatrophic scarring of the pelvis after repeated stone surgery, and 1 case each for failed pyeloplasty, tuberculous stricture of the pelvis, transitional cell carcinoma of the pelvis and calyces, and ureteropelvic junction obstruction associated with renal malformation. Three patients had a solitary kidney. End-to-end ureterocalyceal anastomosis was performed in 5 patients; laterolateral in 1 case, and ureteropyelocalyceal anastomosis in the remaining 4. In 3 cases omentoplasty was also performed.
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Twelve kidneys were autotransplanted to the internal iliac vessels in 11 patients for the treatment of renovascular hypertension. The ureter had been left unresected in all but one case, where a transuretero-ureterostomy was performed. A radiographic study of the ureteral motility was obtained during the postoperative period recording images every 1.5 s with a spot-camera system. The ureters appeared to follow different courses, due to the different surgical procedures. In all but two cases the transport of urine was obtained through separate boluses, frequency and direction of peristalsis were within normal ranges, and significant dilation was never observed.
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Selective angiography of the hypogastric artery was performed in two patients presenting vaginal metastases from renal cell carcinoma, in order to better define the extent of the metastases. In other case left renal angiography revealed an unsuspected metastasis to the left ovary, fed by a middle perforating capsular artery.
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The authors present their clinical experience in conservative surgery for renal cell carcinoma, which was performed in two cases of simultaneous bilateral tumours, in a case of neoplasm in solitary kidney, in two cases of cancers with damaged contralateral kidney and in two cases of association between cyst and small tumour. All patients are alive and without evidence of residual or recurrent malignancy with a followup ranging between 6 months and 7 years. The pros and cons of the various surgical solutions are discussed.
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The effects of bladder distension on the production of prostaglandins (PGs) were studied in an isolated rabbit bladder preparation. Increasing bladder distensions induced a proportional release of PGs together with a parallel increase in endovesical pressure; pretreatment with indomethacin prevented both. Infusion of exogenous PGs into the arteries of bladders previously filled and treated with indomethacin produced a rise in endovesical pressure similar to that observed subsequent to distension of the untreated bladder. Our results suggest that PGs and particularly PGE2 play a role in the maintenance of vesical tone during distension.
Two hypertensive patients with elevated renin presenting with renal artery stenosis and ureteropelvic junction obstruction are reported. Nephrectomy was successful in 1 patient and the other patient was treated wiht renal autotransplantation and dismembered pyeloplasty. The diagnostic and therapeutic problems of coexistent renal lesions are discussed.
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