Arteriovesical fistula: a complication of bladder trauma.
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Biomedical subjects
Publications and source records attributed to S Al-Askari.
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Studies to detect ultrastructural changes in testicular tissues after a fifteen-minute exposure to ultrasonic waves were done in 10 men undergoing bilateral orchiectomies for prostatic carcinoma. Examination of Sertoli cells and germ cells in different stages of differentiation failed to reveal significant differences between exposed and control testes.
Surgical extirpation of the primary tumor together with the involved regional nodes has been considered ineffective treatment for locally disseminated prostatic carcinoma. We retrospectively reviewed our experience with 42 patients with Stage D1 disease who underwent radical prostatectomy and bilateral pelvic lymphadenectomy and who had a follow-up of one to thirteen years (mean 5 years). The following variables affecting survival and tumor progression were analyzed: (1) tumor grade and local extent; (2) number of positive lymph nodes, and (3) adjuvant therapy. The overall five- and ten-year survival was 79.5 per cent and 28 per cent compared with the expected survival of an age-matched control group of 88 per cent and 28 per cent, respectively. The degree of tumor differentiation had no effect on prognosis, but local tumor bulk and the number of involved lymph nodes significantly changed the disease progression and survival rate. Patients with low local tumor bulk and one positive node survived as long as the age-matched male population group. Our data suggest that radical prostatectomy may represent a valuable treatment in selected patients with Stage D1 prostate carcinoma.
Quantitative computerized tomography (QCT) of vertebral bodies could reveal metastatic spread of prostatic cancer before such lesions are seen with standard examinations. Focal increase in the density of the spongious bone in face of normal bone scan and serum acid phosphatase is suggestive of metastasis, but certitude is gained only if further increase in density or structural bone changes are demonstrated on follow-up studies. QCT also may provide an objective measurement of tumor response to therapy.
Three hundred twenty-six patients treated at New York University from 1970 to 1982 were studied for survival in relationship to surgical stage, type of therapy, and pathologic characterization of the primary tumor. At the time of diagnosis 25.5 per cent of tumors were Stage I, 15 per cent Stage II, 28.5 per cent Stage III, and 31 per cent Stage IV. The retrospective study showed that patients with tumor confined within the capsule achieved the highest five- and ten-year survivals of 88 per cent and 66 per cent, respectively. Survivals decreased as tumor invaded perirenal fat (67% and 35%) or regional lymph nodes (17% and 5%). Tumor invasion into the renal vein alone did not significantly change five-year survival (84%) but lowered ten-year survival to 45 per cent. Patients with metastases at the time of nephrectomy did poorly regardless of site of metastases or kind of adjuvant therapy, except for those managed by surgical extirpation of the secondary lesion. Certain tumor characteristics were associated with a better prognosis, e.g., size below 5 cm in diameter, lack of invasion of collecting system, perirenal fat or regional lymph nodes, and predominance of clear or granular cells growing into a recognizable histologic pattern.
Radical nephrectomy and excision of metastases were performed in 21 patients with metastatic renal cell carcinoma. Followup was 12 years. Eight patients had metastases at the time of diagnosis and survived an average of 54 months, with 50 per cent alive 5 years postoperatively. Metastases developed after nephrectomy for localized disease in 13 patients. After extirpation of the secondary lesions these 13 patients survived an average of 38 months and 25 per cent were alive at 5 years. Survival varied with the length of time free of disease. Patients in whom metastases developed later than 2 years after nephrectomy survived 55 months compared to only 22 months for those in whom metastases developed earlier. Survival also was influenced by tumor aggressiveness (reflected by prognostic index number) and completeness of surgical excision of the secondary lesion.
A review of sixty-two technetium scrotal scans performed over a one-year period has led to a classification of pathologic states based on the degree of uptake of the radioactive isotope. Absent uptake, or a "cold" scan, is present only with testicular torsion, and rarely with avascular tumors. Increased uptake, or a "hot" scan, is most commonly seen with inflammatory conditions such as acute epididymitis and orchitis, and less commonly with tumor. "Mixed" scans can be associated with abscess, tumor with necrosis, trauma, and late torsion.
A case of a duplicated collecting system with an ectopic ureter draining into the ipsilateral vas deferens is presented. The embryology of this entity is reviewed.
Fourteen patients with anaplastic seminoma were analyzed retrospectively. At the time of presentation anaplastic seminoma has similar prognosis stage for stage as the classic seminoma. However, the distinctive histologic findings and the high rates of local invasion and of elevations of serum beta-subunit human chorionic gonadotropin serve to distinguish anaplastic seminoma from the classic seminoma. These features, suggesting a possibly greater metastatic potential for anaplastic seminoma, warrant its continued identification as a distinct pathologic subtype.
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The other testicle was involved in 6 of 235 patients (2.69 per cent) with a history of testicular germ cell tumor. It occurred more often following seminoma (4 of 113, 3.5 per cent cases). The mean age at occurrence of the first tumor (twenty-five years) was earlier than expected, and the mean interval between tumors was 8.8 years. Accurate clinical staging of second tumors is impeded by alteration in the routes of metastatic dissemination, and treatment options are limited by previous therapy for the first tumor.
Forty-six patients with histologically proved adenocarcinoma of the prostate underwent pelvic lymphadenectomy after CAT scanning. The accuracy, specificity, and sensitivity of the CAT scan in detecting nodal metastasis were 70, 93 and 30 per cent, respectively; this compares favorably with pedal lymphangiography. Seventeen of the patients had radical prostatectomy. The accuracy, specificity, and sensitivity of the CAT scan in depicting local extent of the tumor were 47, 100, and 18 per cent, respectively; although low, no other clinical or biochemical method provides a better result.
A retrospective analysis of clinical and pathologic data of 100 patients with germ cell testicular tumors is presented. The presenting symptoms and their duration prior to orchiectomy are analyzed and categorized. The duration of symptoms correlated with the stage of disease for each tumor. Seventy-five per cent of locally invasive lesions were found in patients with Stage II or III disease.
A technique for ureteroileal anastomosis with an antireflux extraluminal seromuscular ureteral tunnel was evaluated in 9 dogs. Evidence will be presented to show that this approach is effective in preventing reflux while preserving the integrity of the renal units.
A retrospective analysis of 27 cases of primary carcinoma of the ureter is presented. The ages of the patients ranged from forty-two to eighty-three years, with the highest incidence between the fifth and seventh decades. Males were more frequently affected than females, and the tumors were usually found in the lower third of the ureter. Hematuria and flank pain were the presenting symptoms in the majority of cases. Poorly differentiated invasive tumors had poor prognosis when compared to well-differentiated noninvasive lesions. Total nephroureterectomy with excision of bladder cuff is the preferred treatment for ureteral carcinoma in view of the high rate of ipsilateral tumor recurrence.
Thirty patients with clinically localized prostatic carcinoma underwent extended pelvic lymph-adenectomy, including the presacral and presciatic (lateral sacral) areas. The first echelon of pelvic nodes to be involved by metastases was the external iliac, obturator, presacral and presciatic. The deep presacral-presciatic nodes were involved almost as often as the more superficial external iliac-obturator group. Metastases limited only to the deep pelvic nodes were found in 14 per cent of the cases.
Two cases of sacrococcygeal teratomas are presented. One case illustrates the long course of urologic problems produced by a "successful" removal of the tumor. The literature is reviewed, and the characteristics of this congenital tumor are discussed.
Three cases of anterior urethral valves, a rare congenital anomaly are reported. Anterior urethral valves probably represent an attempt at duplication of the urethra in the first twelve to fourteen weeks of intrauterine life. The most common type is cusp-like and most frequently located in the bulbar urethra. The presenting complaints are lower tract symptoms, and the diagnosis is usually made by a voiding urethrogram.