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[Adrenal carcinoma: 7 year disease free survival after complete primary tumor resection and repeated resection of local-regional and distant recurrences. Review after one case with poor initial life expectancy].

OBJECTIVES: We report the case of a female patient with adrenal carcinoma who had undergone surgery and presented with local-regional and distant recurrences, emphasizing the importance of the aggressive surgical treatment to achieve long-term survival which is unexpected sometimes. Currently, it represents the gold standard and all cases should be reported to stimulate other groups to work in this line. METHODS/RESULTS: We report the case of a 29-year-old female patient who consulted for left flank pain, being diagnosed of an adrenal tumor by radiological tests; she underwent surgical excision of a left adrenal carcinoma (stage II). Later on she presented with local-regional recurrences (2 times) and distant metastases (liver) undergoing excision in three procedures. Currently, the patient is alive and free of disease 7 years after diagnosis. CONCLUSIONS: Adrenal cancer recurrences have been considered lethal in the short-term. Nevertheless, an aggressive surgical approach of local recurrences and metastasic disease may significantly prolong patient's survival and, sometimes, leave the patient disease free several years after the diagnosis of the primary tumor.

Adrenal Gland Neoplasms↗

Transurethral resection of benign prostatic hyperplasia using a vaporizing resecting loop, UROloop.

New electrosurgical instruments for the treatment of benign prostatic hyperplasia (BPH) have been developed during the past few years. We determined the efficacy and safety of transurethral prostatectomy (TUR-P) using a new electrosurgical device (UROloop) for the treatment of BPH. Twenty-four patients, with a mean age of 67.7 years, with BPH underwent TUR-P using the UROloop between April 1996 and March 1997. We evaluated the pre- and postoperative symptom scores and urodynamic parameters of the patients. The International Prostate Symptom Score (IPSS) was used for symptom scoring. The urodynamic parameters included peakflow rates (PFR) and postvoid residual urine (PVR). The average preoperative IPSS score for all patients was 15.4 +/- 1.4. The IPSS score was significantly improved to 4.3 +/- 0.24 at 12 weeks after the TUR-P (p = 0.0002). The average PFR was increased by 117% at 12 weeks postoperatively. The average preoperative PVR of 65.4 ml was reduced to 15.2 ml postoperatively. The changes in the urodynamic parameters were statistically significant. No severe complications were observed in the present study. The changes in the serum sodium and hemoglobin levels were small. This study revealed significantly sustained clinical improvement with minimal morbidity. The results of the present study also confirmed the usefulness of the new endoscopic treatment for BPH.

Aged↗

Salvage resection after previous laryngeal surgery: total laryngectomy with en bloc resection of the overlying cervical skin.

OBJECTIVE: To evaluate the effectiveness of extended total laryngectomy for the treatment of recurrences of laryngeal cancer. DESIGN: We conducted a retrospective clinical study of patients who had undergone extended total laryngectomy and were seen over a 15-year period. The follow-up period ranged from 3 to 15 years. SETTING: Academic tertiary referral medical center. PATIENTS: We observed 15 patients who were affected by a recurrence of laryngeal cancer that extended to the overlying soft tissue. All patients were male. The mean age was 61.5 years. Thirteen patients had previously undergone partial laryngeal surgery, and 2 patients had undergone radiation therapy, without success. INTERVENTION: All patients underwent total laryngectomy extending to the soft tissue, including the overlying skin. RESULTS: Five of the 15 patients died of local recurrence, and 1 patient died of massive postoperative hemorrhaging. An actuarial survival rate of 60% was observed at 5 years. CONCLUSION: Total laryngectomy extending to the soft tissues seems to be an effective procedure for treating local recurrences of laryngeal cancer after partial laryngectomy or failure of radiation therapy.

Carcinoma, Squamous Cell↗