Biomedical subjects
Publications and source records attributed to M Ghadouane.
Metastasis involvement of the testis form prostatic carcinoma is rare. Seventy cases have been reported between 1938 and 1990. We report another case treated by transurethral resection of the prostate, bilateral orchiectomy and nonsteroid androgens and a review of the literature is presented.
PURPOSE: To evaluate the results obtained by rigid ureteroscopy to treat ureteral calculi. MATERIALS AND METHODS: Between May 1998 and September 2000, 63 patients underwent 67 rigid ureteroscopies (URS) with three endoscopic retreatments and one bilateral URS, for 48 distal, ten mid and nine proximal ureteral calculi. RESULTS: After URS 77.6% of the patients were free of the stones. Success rate was respectively 85.4%, 60% and 55.5% in distal, mid and proximal uretero. Morbidity was 10.4% and there have been one stricture treated by endoscopy. CONCLUSION: Our series demonstrates that rigid URS is safe and effective procedure to treat distal, ureteral calculi. Thus, it should be considered a treatment of choice for distal ureteral calculi.
Malignant mesothelioma of the tunica vaginalis is a rare and aggressive tumor. It appears that surgery have a high value in the treatment. We report a case of malignant mesothelioma of the tunica vaginalis in 65 years old patient and a review of the literature is presented.
Paratesticular rhabdomyosarcoma is a rare and highly aggressive tumor. The authors discuss the diagnosis and therapeutic problems raised by this lesion and report three cases with a review of the literature.
The authors report a case of sarcomatoid carcinoma of the prostate in a 49-year-old patient. The clinical symptoms were dominated by dysuria and frequency. Digital rectal examination showed a very large, hard and irregular prostate. Serum PSA was normal. Transrectal ultrasonography and abdominopelvic computed tomography showed a heterogeneous mass occupying the vesico-prostatic junction. The patient underwent cystoprostatectomy. Histological examination of the cystoprostatectomy specimen revealed a tumour composed of spindle cells expressing epithelial markers on immunohistochemical analysis and concluded on a diagnosis of sarcomatoid carcinoma of the prostate. The patient died seven months after cystoprostatectomy.
Cowper's syringocele, dilatation of bulbo-urethral glands, is a rare disease, usually congenital. The authors report two cases of perforated syringocele and analyse the clinical, radiological and therapeutic aspects of this disease.
Spontaneous subcapsular haematoma (SCH) of the kidney is a rare condition, secondary to kidney tumours in more than 50% of cases. Nephrectomy is justified in the presence of tumour or uncontrolled haemorrhage. When the aetiology cannot be determined, thin-slice CT follow-up of the patient's kidney can be performed. The authors report 5 cases of SCH of the kidney. A retropelvic aneurysm was responsible for the haematoma in one case; polyarteritis nodosa was the cause of bleeding in another case and the aetiology could not be determined in two cases. All patients were managed surgically. Nephrectomy was performed in 3 cases and simple evacuation of the haematoma was performed in 2 cases.
The authors report the case of a 45-year-old patient who presented with a left latero-aortic paraganglioma associated with gastric schwannosarcoma. Treatment consisted of resection of the chromaffin tumour and the gastric tumour, with a favourable course at last follow-up. The authors review the literature on this subject.
Emphysematous pyelonephritis is rare. It is exceptionally associated with urolithiasis with obstruction of the collecting system. It is generally observed in female diabetic patients. It is caused by gas-producing bacteria. We report a case in which emphysematous pyelonephritis was caused by an acinetobacter, associated with pelvic ureteral junction lithiasis. Drainage and nephrectomy were necessary to overcome this life threatening situation.
OBJECTIVES: Analysis of the treatment of a series of patients with adrenal cortical carcinoma. MATERIAL AND METHODS: This series consists of 22 patients (15 women and 7 men) with a mean age of 35 years (range: 23 to 58 years). 55% of patients had a non-secreting tumour; 45% of tumours were associated with excessive hormonal secretion. The tumour was located on the right side in 12 cases and on the left side in 11 cases (the tumour was bilateral in 1 case). Ultrasound and CT were sufficient for localization of the tumour. The patients were classified as stage I: 3 cases, stage II: 2 cases, stage III.: 8 cases, stage IV: 9 cases, according to MacFarlane's classification. RESULTS: Adrenalectomy was performed in 18 patients. Two patients died during the operation and another 8 died within the first four years. Eight patients are currently alive, including 7 with no signs of recurrence; one patient presented a large local recurrence 39 months after adrenalectomy. CONCLUSION: Surgery remains the only effective treatment at the present time. The diagnosis of adrenal cortical carcinoma must be made as early as possible.
We report three cases of retroperitoneal liposarcoma. Two patients required multiple surgical excisions for locoregional relapse diagnosed by surveillance based on CT-scan. One patient had radiotherapy. With the literature review we discuss the pathologic and therapeutic aspects of these lesions.
The authors report a case of adrenal ganglioneuroma in a 25 year old woman. This rare and benign tumor is localized in the adrenal gland in 20% of cases. Considerations on diagnosis, pathogenesis and management are discussed.
The authors analyse of a series of 26 patients (17 females and 9 males) with a mean age of 32 years (range: 18 to 55 years) operated for adrenal phaeochromocytoma. All patients were hypertensive. The laboratory assessment (assay of blood catecholamines and urinary catecholamine metabolites) performed in more than 2/3 of cases confirmed the diagnosis in more than 80% of cases. The topographic diagnosis was facilitated by computed tomography. Fifteen patients received preoperative treatment with alpha-blockers or calcium channel blockers. Various incisions were used, but a lumbar incision was the most frequent. Blood pressure was controlled postoperatively in 24 patients. Two patients died 1 and 2 postoperatively. New diagnostic modalities (CT, MRI) have facilitated the diagnosis and the site of localization of phaeochromocytomas, thereby improving the choice of incision. Patient-specific preoperative preparation and appropriate anaesthesia facilitate successful adrenal gland surgery.
An accessory scrotum associated with perineal lipoma is extremely rare. We report a case of a median lipoma of the perineum in an accessory scrotum. The literature is reviewed.
We report a case of congenital dermoid cyst of the conus medullaris without associated dysraphic lesion treated surgically. An 18-year-old man had a one-year history of bladder sphincter disorders and more recent acute renal failure with urinary tract infection. The diagnosis of intramedullary tumor was provided by myelo CT and MRI confirmed by histology. At 10-month follow-up, the postoperative course was good.
Spinal dermoid cysts are congenital lesions. Neurological symptoms are related to the affected area of the vertebral canal. The commonest type involves the sacrococcygeal area. Lesions of the cauda equina are found which result in sciatic pain, paresis of the bladder and rectum, flaccid paresis of the legs, and/or sphincter disturbances. The histology is typical and benign. The images on CT and MR provide diagnosis. We report a case of spinal dermoid cyst revealed by chronic urinary retention.
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PURPOSE: The management of tuberculous spondylitis remains much debated in countries with great tuberculous prevalence; the attitude in front of vertebral focus is divided between exclusive conservative treatment versus surgical treatment. The authors report their experience about surgical treatment of tuberculous spondylitis. MATERIAL AND METHODS: Twenty nine out of thirty one adults underwent surgery for tuberculous spondylitis, between january 1988 and july 1994. The average age was 29 years (range 18 to 65 years). Five patients presented radicular syndrome. The operative indications were mechanical in 20 cases, neurologic and mechanical in 5 cases, etiological and mechanical in 4 cases. Anterior approach was performed in 26 cases, posterior approach in 3 cases. A disc sequestrectomy and/or resection associated to pus evacuation and skeletal graft was performed in 24 cases. Fixation of the graft by screwed plate was used in 3 cases. Antituberculous treatment was instituted in all cases. RESULTS: The average duration of time spent in hospital was 29 days. The average follow-up was 15.61 months (range: 8 months to 5 years). Short and mean-term outcome was marked by a fistula in 3 cases. These patients underwent a second procedure; they had a good evolution. The long term outcome showed that all patients were considered as cured (functional and neurological results were satisfactory); all patients obtained fusion. Stability was achieved after 3 to 5 months. DISCUSSION: In our context, we prefer surgical treatment. Spine tuberculous is usually seen at an advanced anatomical and clinical stage with major destruction of several vertebras. CONCLUSION: Surgery allows to assert the diagnosis, to treat a compression, to evacuate pus, to treat or at less to avoid worsening of a deformation, and to reduce treatment duration.