1,720,969 research outputs found
Use of transperineal fine needle aspiration of seminal vesicles to retrieve sperm in a man with obstructive azoospermia
No full textOBJECTIVE:
To report the successful and feasible use of transperineal fine needle aspiration of seminal vesicles (FNASV) for sperm retrieval in obstructive azoospermia.
DESIGN:
Case report.
SETTING:
Outpatient care in institutional clinic.
PATIENT(S):
A 31-year-old man with obstructive azoospermia due to a middle prostatic müllerian cyst.
INTERVENTION(S):
Transperineal FNASV using a coaxial 17-gauge TruGuide needle.
MAIN OUTCOME MEASURE(S):
Feasibility of sperm retrieval suitable for future in vitro fertilization.
RESULT(S):
Transperineal FNASV made it possible to aspirate 11 mL of fluid with a sperm count of 100 million/mL and 15% motility. This sample was cryopreserved for in vitro fertilization using intracytoplasmic sperm injection.
CONCLUSION(S):
Transperineal FNASV using a coaxial needle may be a further method for sperm retrieval to add to the repertoire of assisted reproduction technologies
Short-term outcome after high-intensity focused ultrasound in the treatment of patients with high-risk prostate cancer
No full textOBJECTIVE: To assess the short-term outcome in patients with high-risk prostate
cancer treated by transrectal high-intensity focused ultrasound (HIFU).
PATIENTS AND METHODS: From April 2003 to November 2004, 30 patients with
high-risk prostate cancer were enrolled in this prospective study; all had
transurethral resection of the prostate before transrectal HIFU treatment, using
the Ablatherm device (EDAP, Lyon, France) during the same session, associated
with hormonal therapy with luteinizing hormone-releasing hormone analogues. After
the procedure, all the patients were evaluated every 3 months by physical
examination, prostate-specific antigen (PSA) assay and a continence
questionnaire. The follow-up schedule also included a transperineal prostate
biopsy 6 months after the treatment. All the patients had a minimum follow-up of
12 months.
RESULTS: The HIFU treatment took a median (interquartile range, IQR) of 140
(100-160) min. No complications were reported during treatment. The mean (IQR)
hospitalization was 2.2 (1-4) days, and the suprapubic drainage tube was removed
after 12 (7-18) days. The complications after treatment were: urinary tract
infections in five patients (16%), stenosis of the intraprostatic and membranous
urethra in three (10%), and secondary infravesical obstruction in four (13%). At
12 months after the procedure, 28 patients (93%) were continent. Seven of the 30
men (23%) had a positive prostate biopsy. At the 1-year follow-up only three of
the 30 patients with high-risk prostate cancer had a PSA level of >0.3 ng/mL.
CONCLUSIONS: HIFU is a modern, minimally invasive therapy for prostate cancer,
often used in selected patients with localized disease. The present results show
that HIFU was also feasible in patients with high-risk prostate cancer. The low
complication rates and favourable functional outcome support the planning of
further larger studies in such patients. The oncological efficacy of HIFU should
be assessed in further studies with a longer follow-up
Incidental adrenal pheochromocytoma. Report on 5 operated patients and update of the literature.
No full textINTRODUCTION: Adrenal masses discovered by imaging techniques for reasons
unrelated to adrenal diseases are called incidentalomas with pheochromocytomas
accounting for about 20%. The aim of this study was to report on our experience
of 5 patients operated for incidentally discovered adrenal pheochromocytoma and
update the literature concerning this subject.
PATIENTS AND METHODS: From September 1976 to December 2000 we operated on 28 for
adrenal incidentaloma, and pheochromocytoma was detected in 5 patients (19%).
Average age was 61.4 years (range 54-65). All patients underwent adrenal hormonal
as well as imaging investigation. Preoperative care for pheochromocytoma was
performed in 3 patients. All patients were followed up.
RESULTS: Average tumor diameter, as detected by CT, was 5.5 cm (range 3-10).
Urinary 24/h excretion of VMA resulted elevated in 2 cases (40%). Two patients
during adrenalectomy developed paroxysmal hypertension which was readily
controlled by intravenous administration of nitroprussiate and trandate.
Postoperative outcome was uneventful. Average tumor size, as detected by
pathology, resulted 8.9 cm (range 3-12). Mean follow-up was 60.4 months (range
32-122) and overall survival rate was 60%. Three patients are alive and
disease-free and 2 died after a follow-up of 32 and 36 months for reasons
unrelated to the primary disease.
CONCLUSIONS: Every incidentally discovered adrenal mass should be investigated
for pheochromocytoma since accounting for about 20%. Undetected pheochromocytomas
undergoing surgery without preoperative care for avoiding cardiovascular
disturbances confer a high risk for morbidity and mortality, especially in
pregnancy and childhood. Nonfunctional and small tumors sized 3 cm or lesser may
be closely followed up by imaging and hormonal investigation. Surgery is
indicated when tumors are functional or larger than 3 cm. Actually, laparoscopy
is the new gold-standard in treating adrenal pheochromocytomas. Adrenal sparing
surgery as well as autotransplantation of adrenal tissue are both effective and
safe in treating patients with bilateral pheochromocytomas, thus improving
quality of life since avoiding lifelong steroid dependency. When managed
appropriately, the outlook for pheochromocytoma is excellent with a free survival
rate of 92% and 80% at 5 and 10 years respectively. Unfortunately, malignant
pheochromocytomas are still difficult to trea
Adrenal extramedullary hematopoiesis: report on a pediatric case and update of the literature.
No full text
Short-term outcome after high-intensity focused ultrasound in the treatment of patients with high-risk prostate cancer.
No full textIncidentally discovered adrenal myelolipoma. Report on 3 operated patients and update of the literature.
No full textINTRODUCTION AND OBJECTIVES: Adrenal myelolipomas are rare benign non functioning tumors which are mostly detected incidentally by imaging (8-15%). The aim of this study was to find out the clinical outcome of 3 patients operated for incidentally discovered adrenal myelolipoma as well as to update the literature concerning this topic. PATIENTS AND METHODS: During a 24 year period (1976-2000) we operated on 28 of 39 (72%) patients for incidentally discovered adrenal mass and pathology assessed 3 myelolipomas (11%). All patients were males and average age was 54.3 years (range 46-66). Myelolipoma was associated with arterial hypertension in 2 patients and BPH in 1. Patients underwent unilateral adrenalectomy. Results Myelolipomas, all unilateral, were right-sided in 2 cases (67%) and left sided in 1. Average tumor diameter, as detected by CT scan, resulted 10.3 cm range (3-17). Endocrine investigation was negative. Average tumor size, as detected by pathology, resulted 9.3 cm (range 3-14) and mean weight 653 gr (range 210-980). Histopathology assessed primary adrenal myelolipoma in all cases. Mean follow-up is 110.6 months (range 102-128) and all patients are alive and disease free. CONCLUSIONS: Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are effective in diagnosing adrenal myelolipomas in about 90% of cases. Fine needle aspiration (FNA) cytology under CT or US control has an important role in investigating as well as diagnosing undefined masses suspected of adrenal or extraadrenal myelolipoma thus avoiding unnecessary surgery. The increasing number of incidentally discovered adrenal myelolipomas arise the question of appropriate treatment modalities which range from watchful waiting to surgical removal. Small asymptomatic tumors sized less than 4 cm can be monitored expectantly. Tumors when symptomatic or larger than 4 cm should be removed since the risk of spontaneous rupture with retroperitoneal hemorrhage and life threatening shock. Bilateral adrenalectomy for large and symptomatic tumors implies lifelong substitution with hydrocortisone. Actually, laparoscopic adrenalectomy is the new gold standard in treating myelolipomas since both showing more effective postoperative recovery than open surgery as well as reducing the number of patients who undergo long and close follow up
Primary lymphoma of the kidney. Report of a case and update of the literature.
No full textOBJECTIVES: To report on a case of primary renal lymphoma (PRL) and update the
literature concerning this topic.
MATERIALS AND METHODS: A 48-year-old woman underwent surgery for the presumed
diagnosis of renal cell carcinoma with bilateral adrenal metastases.
RESULTS: The neoplasm was assessed as primary renal non-Hodgkin high grade
lymphoma, diffuse large B-cell type. Then the patient underwent polychemotherapy
according to the VACOP-B protocol. Unfortunately, 5 weeks later the patient was
lost since missing chemotherapy and follow-up.
CONCLUSIONS: PRL is a distinct pathological and clinical entity which is
extremely rare and highly aggressive since disseminating rapidly from its origin.
The disease usually affects adults with an average age of 60 years and slight
male preponderance; however it has also been reported in childhood. Etiology
factors for PRL are unknown. Several histogenetic theories of the disease have
been postulated since the kidney does not normally contain lymphoid tissue.
Investigators reported many classes of non-Hodgkin lymphoma which include large,
small, intermediate and mixed cell types with high, intermediate or low grade
histologies. The neoplastic lymphoid cells may express both B and T immunoblastic
phenotypes, primary renal Hodgkin lymphoma has also been reported. The disease
may present with progressive renal failure of either oliguric or non oliguric
type. Imaging studies in diagnosing and staging primary renal lymphomas include
ultrasound examination (US) and computed tomography (CT); there are also some
reports of magnetic resonance imaging (MRI). Total body bone scan and bone marrow
biopsy will complete disease clinical staging. Renal biopsy is important in
assessing the diagnosis of PRL as well as of acute renal failure for bilateral
lymphomatous infiltration of the kidneys. Up to now, there are no standard
treatment modalities for this entity since the small number of cases reported.
Multidrug chemotherapy is mandatory for high grade lymphoma and when the disease
is diagnosed preoperatively. High dose chemotherapy in the future may offer a
curative approach in primary bilateral renal disease and without end-stage renal
disease. Survival is extremely poor since 75% of patients die less than 1 year
after operation. Prognosis may be improved by early detection of disease and by
performing systemic chemotherap
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