Biomedical subjects
Publications and source records attributed to R Ravi.
During the past 5 years, three patients with adenocarcinoma of the urachus were treated at our hospital. Abdominal ultrasonography helped clinch the diagnosis in all cases. All patients underwent surgical excision of the neoplasm with partial cystectomy. The clinical, radiological, and histological findings, as well as the pathogenesis of this rare neoplasm are discussed along with the surgical management.
Seven patients with advanced seminoma of the testis (stages II C and III) were treated with 3 induction cycles of VAB-6 chemotherapy. Three patients had complete remission after chemotherapy and are alive disease free at 32, 38, and 40 months with no additional treatment. Four patients were subjected to retroperitoneal lymph node dissection for residual retroperitoneal masses measuring 2-4 cm after chemotherapy, which revealed fibrosis in 2 patients and metastatic seminoma in the other 2. Patients with metastatic residual masses were given postoperative radiation therapy to the retroperitoneum and are alive disease free at 33 and 34 months, while those with fibrosis are alive disease free at 30 and 52 months, respectively, with no additional treatment.
We report our experience of immediate reconstruction of the groin using the deep inferior epigastric artery (DIEA) myocutaneous flap following 32 consecutive ilioinguinal block dissections for groin metastases in patients with penile carcinoma. All groin wounds healed primarily, resulting in a short postoperative hospital stay. Transferring one or both DIEA flaps did not lead to any significant functional disability.
We report our experience of 30 continent urinary reservoirs (CURs) after radical cystectomy. The patients ranged in age from 35 to 70 years. There were 22 males and 8 females. Pre-operative urograms showed normal upper tracts in 22 patients, unilateral hydronephrosis in 4 and bilateral hydronephrosis in 4. The first 20 patients had a standard CUR procedure and the last 10 had a modified CUR. The mean operative time, blood loss and post-operative stay were 6.6 h, 900 ml and 25 days respectively for standard CURs and 5.7 h, 825 ml and 21 days respectively for the modified CURs. Post-operative, urinary leaks from the caecostomy site occurred in 2 patients (1 of which was fatal) while 3 other patients had prolonged ileus, burst abdomen and intestinal obstruction probably due to non-demonstrable urinary leaks. All 5 complications occurred in the first 20 patients. Upper tract status was evaluated in 28 patients 3 months after surgery and showed normal upper tracts in 19 patients, improvement in 6 (35%) and worsening in 3 (12.5%). Pouchograms showed no reflux in 25 patients, unilateral reflux in 2 and bilateral reflux in 1. Complete continence was achieved in 25 patients--2 of them had revision surgery, giving a success rate of 89% with a follow-up of 6 to 48 months (median 24). The remaining 3 patients were incontinent.
Rhinosporidiosis is a chronic infection which is endemic in India and Sri Lanka. Penile involvement in rhinosporidiosis is rare and we report one such case. The pathology, treatment and possible etiology of the condition are reviewed.
The swing-phase motion of the shank of an above-knee prosthesis has been modelled mathematically. An inexpensive endoskeletal prosthesis was designed using the Jaipur foot and conduit pipes with a hinge joint for the knee. Results of field trials and the modelling indicate that a very simple above-knee prosthesis can give near normal gait at "normal" walking speeds on flat surfaces. The swing of the shank is most sensitive to the timing of toe-off.
An unusual case of bilateral synchronous parotid metastases from renal cell carcinoma presenting seven years after nephrectomy is reported. The patient underwent bilateral superficial parotidectomy and is alive free of disease three and half years after the metastatectomy.
Fifteen children, 14 males and 1 female with a mean age of 4.9 years, were treated for rhabdomyosarcoma of the bladder and the prostate, between 1976 and 1985. In 14 patients, the disease was limited to the pelvis, while one had pulmonary metastases. The lesions were trigonal in 12 patients and involved the prostate in the other three. Eleven patients received vincristine-Adriamycin-cyclophosphamide (VAC) chemotherapy, followed by radiation therapy. Four of these 11 patients required cystoprostatectomy for residual or persistent disease. Of the remaining four patients, two underwent radical cystoprostatectomy, one partial cystectomy and the patient with pulmonary metastases received only chemotherapy. Six patients were alive at 5 years (40% 5-year survival). Six patients died of local relapse within 18 months, one patient died of an unknown cause, while two patients were lost to follow-up free of disease after 2 years.
In node negative patients of invasive penile carcinoma, prophylactic lymphadenectomy is associated with considerable morbidity, while a "wait and watch" policy is associated with up to 20% cancer related mortality in many series. In between, selective node biopsies, including sentinel node biopsies, have been suggested to stage these patients. However, these procedures are unreliable and associated with high false negative rates. The inguinal pick procedure was devised by us to stage these patients more accurately. It is more elaborate that the previously described selective biopsies and includes biopsy of all identifiable nodes in the inguinal region, including the sentinel node area. In our experience of the procedure in 52 patients with invasive penile carcinoma, it was positive in 5 patients (9.6%). However, 7 of the 47 patients with negative result developed inguinal recurrences and 3 other patients developed distant metastases on follow up. The 5-year disease free survival of inguinal pick positive and negative patients was 100% and 82.9%, respectively. The sensitivity of the procedure in detecting regional spread in these patients was only 72%. Thus, the inguinal pick, though associated with no morbidity, can be meaningful only if it is positive and a negative result does not guarantee absence of regional metastases in node negative patients of invasive penile carcinoma.
Signet-ring cell carcinoma of the urachus and bladder is a rare lesion. Its histological picture is unique and similar to linitis plastica of stomach. The tumor arises through metaplasia of the totipotent transitional epithelium lining the urachus. It is a highly malignant tumor with propensity for local invasion and distant metastasis, and carries a uniformly poor prognosis. Herein we report one such rare case of urachal carcinoma who is free of disease for 2 years after surgical treatment.
A total of 63 patients with 85 bladder tumors were evaluated with excretory urography (IVU), ultrasonography and urine cytology, before being subjected to cystosocopy and biopsy. An attempt was made to evaluate accuracy of detection by different modalities, individually and combined together. Untrasonography and IVU detected 90 percent and 75 percent of tumors respectively while cytology was positive in 63 percent patients. Ultrasonography was superior to IVU, and, Urinary cytology, despite its low catch, could detect few cases where both the previous mentioned modalities had failed. Larger tumors situated on posterior and lateral walls were consistently detected by ultrasonography. Tumor staging by ultrasonography correlated well with final staging in infiltrating tumors. Thus it is concluded that the two non-invasive procedures, sonography and urine cytology must be routinely used for evaluation of fresh cases and in follow up of bladder tumors.
Using a simulation approach, the number of womanyears that can be saved by preventing cancer of the uterine cervix was estimated. Probabilities of developing cervical cancer in the lifetime were also estimated. The number of years saved varied from 42 in the women aged between 20 and 24 years to 2 years in women aged 70 years and above. Probabilities of developing cervical cancer in the lifetime varied from 5.2% in women aged between 20 and 24 years to 0.6% in women aged 70 years and above. The results indicate that a noticeable incidence starts only after 35 years of age and about 90% of the total years can be saved by preventing the disease in women aged between 35 and 64 years.
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Arteriovenous fistulae affecting the proximal portions of the superior mesenteric vessels are extremely rare. We are reporting one such fistula which occurred in a young male as a sequel to a stab in the epigastrium. The arteriovenous fistula was successfully treated by percutaneous steel coil embolization.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.