Biomedical subjects
Publications and source records attributed to E Merimsky.
A 75-year-old patient with metastatic renal cell carcinoma was treated with recombinant interferon alpha-C and thereafter developed a neurologic syndrome of dementia, ataxia, confusional state, loss of concentration ability and cortical blindness. CT scan findings were compatible with leukoencephalopathy, which is reported as being a toxic effect of interferon.
Three cases of renal cell carcinoma in a congenital solitary kidney are presented. Treatment with recombinant interferon alpha-C was administered in two cases. A subjective response occurred in one case. The literature is reviewed with respect to treatment options and prognostic factors.
Recombinant interferon alpha-C is a new strain of the alpha interferon family. It was given to 33 patients with measurable metastatic renal cell carcinoma of whom 31 were evaluable. Protocol consisted of 3 million U/d for 2 weeks, then 3 million U/m2 every other day until progression. No complete response was observed. Three patients (9.7%) had partial response for a mean duration of 5.6 months and eight patients (25.8%) were stabilized for a mean of 4.3 months. Responsive sites were mainly lung, bone, and kidney, while side effects were generally mild. better results were observed in previously nephrectomized patients who had not received chemotherapy or hormonotherapy for recurrent or metastatic disease (p less than 0.05), and also in patients with a brief disease-free interval and short delay from presenting symptoms of the primary tumor until interferon treatment (p less than 0.05). Median survival was significantly longer in responders than in progressors (p less than 0.05). We suggest that the efficacy of recombinant interferon alpha-C in a low-dose regime versus other types of interferon as first-line therapy for inoperable, metastatic, or locally recurrent renal cell carcinoma should be investigated in a prospective, controlled, randomized study.
A case is reported of a patient with carcinoma of the prostate and perineal tumor implant five years after perineal needle biopsy. This is the second case of the rare complication in which the implant appeared years after the biopsy. He was treated with wide excision of the tumor.
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A survey was done on 39 nephrectomized patients who underwent our routine radionuclide kidney study including blood flow imaging at various periods postoperation. Perfusion of varying degree was demonstrated in the area of the nephrectomized kidney in 17 patients showing equal or less activity than the actual kidney. This so-called phantom kidney was reproducible in the same patient and was found four weeks to ten years after nephrectomy. Thirteen phantom kidneys were found on the left side and four on the right. Seven were after simple nephrectomy, four after radical nephrectomy, and six after nephroureterectomy. Besides being a source of error in interpretation in kidney imaging, the appearance of this residual postnephrectomy blood flow is difficult to explain, particularly in the cases of radical nephrectomy.
The paraneoplastic syndromes are not well known among physicians, especially in connection with the bladder carcinoma. They can be first presentation of the malignancy, or be the early sign of disease recurrency. All paraneoplastic syndromes including bladder carcinoma can be grouped into 3: the endocrine-hormonal, the neuro-musculo-cutaneous and the hematologic-connective tissue groups. We discuss the frequency of presentation of each group, as appearing in the literature.
The importance of Kaposi's Sarcoma, known for over a century, resides in its relation to AIDS. The localisation on the shaft of the penis is very rare even in the generalised forms, more so when the lesion is primary and localized. The basic lesion appears as a reddish-violet nodule. The authors report a case of a primary Kaposi's Sarcoma in a 58 year-old patient where the tumor appeared as a pedunculated 2 X 2 cm lesion with a necrotic surface. The tumor was excised. A search for internal foci of KS was negative. The complete cure was proven by decreased lymphocyte proliferative responses and defective natural-killer cell activity.
We report a case of bilateral metachronous xanthogranulomatous pyelonephritis (XGP) in a hemodialyzed patient with end-stage renal failure due to bilateral nephrolithiasis. The XGP was initially diagnosed by computed tomographic (CT) scan, and right nephrectomy was performed. The patient remained clinically stable for the next year. Involvement of the contralateral kidney was again confirmed by CT examination. Both kidneys showed histologic changes compatible with XGP. A coexisting nephrogenic adenoma of the bladder has been attributed to chronic urinary tract infection.
The presence of a varicocele was confirmed in 121 of 123 patients complaining of scrotal pain or infertility, in whom radionuclide scanning was performed. In the first 29 patients (retrospective study), a high ligation of the internal spermatic vein was performed. In 94 patients, a percutaneous venography was done via the jugular vein followed by embolization by Gianturco coils (occluding spring embolus, Cook Group Company, USA) in 84 of them. In eight patients, due to technical difficulties during the embolization trial, a high ligation was performed at a later date. Eleven patients underwent embolization after failed high ligation. A posttreatment follow-up radionuclide study revealed recurrences in two of the 95 patients who underwent embolization. Embolization can be performed on an outpatient basis with minimal risks. Reembolization is feasible, and it in no way prevents a further high ligation should this be necessary.
Chronic irradiation cystitis may cause fibrosis and weakening of the detrusor, with greater susceptibility of the bladder wall to endoscopic trauma. We lately treated a patient with chronic irradiation cystitis who sustained recurrent bladder perforation, one after electrohydraulic lithotripsy and the other--following cystoscopy. The first event was handled surgically and the second one in a conservative approach. We hereby report on the case and comment on the etiology.
Five years after prostate resection and hormonal treatment for carcinoma of prostate a 76 year old patient presented with bone and lung metastases and dilatation of left upper collecting system. After castration a double J stent was inserted in the ureter. Two years later he was admitted for alteration in general condition related to cholecystitis. A standard radiograph showed the catheter fractured into four pieces, although no urinary signs had been reported during this 2-year period. Cholecystectomy was performed and the patient reviewed 6 weeks later: urography showed good functioning of the kidney and the absence of obstruction of the collecting system. The process of fragmentation continued and a bladder calculus developed on fragments falling into bladder: it was extracted by lithotripsy. The patient was asymptomatic and refused further investigation or treatment. This case is one of several reported in the literature and silicone or C-flex should be substituted for polyethylene.
Circular prolapse of the urethral mucosa in the elderly female is rarely reported in the literature, but is a common clinical entity. During the years 1972-1983 thirteen women with urethral prolapse were operated upon in our department, in all of whom differentiation of the benign lesion from malignancy could not be done on clinical grounds only. The following survey is meant to draw attention to the entity and its clinical implications.
Three new cases of a rare benign proliferative lesion of the urothelium (nephrogenic adenoma) are hereby added to the existent 58 reported cases. All 3 lesions occurred in the bladder. Two of the 3 cases presented with a history of surgical interventions on the bladder, and the third patient had a history of chronic cystitis and pyelonephritis, and was on chronic dialysis. Diagnosis was made on histologic examination of cystoscopic biopsy of the lesions. Transurethral resection and/or fulguration was the treatment of choice. There was no recurrence of the lesions on follow-up cystoscopic examination.
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During the years 1980-82 seven patients with renal carbuncles successfully underwent conservative treatment with antibiotics alone. Early diagnosis was made using excretory urography and nephrotomography, ultrasound and computerized tomography scan. Follow-up studies showed a normal kidney in six of the seven patients. One patient had a clinical remission, but ultrasound follow-up showed a small area in the right kidney with a few low-level echoes, representing focal scarring.
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A case of secondary anuria following the insertion of a double pigtail stent to treat an anuria due to a tumoral obstruction of the ureter is presented. Washing of the stent through a second ureteral catheter parallel to it proved the patency of the stent. Diuresis ensued at last by the administration of diuretics and leaving both the stent and the ureteral catheter in place. The literature is reviewed and discussed.