1,721,069 research outputs found
Paraganglioma of the prostate in a young adult
No full textExtraadrenal pheochromocytomas, or paragangliomas, are rare and potentially malignant tumors that may occur in extraadrenal chromaffin tissue. The determination of malignant or benign represents the crucial point once the diagnosis has been established. We report a case of a 33-year-old man with an incidental paraganglioma involving the prostate. He underwent nerve-sparing radical retropubic prostatectomy and monolateral lymphadenectomy. Urinary continence was complete on postoperative day 5, and the patient had intercourse 2 weeks after surgery. The follow-up was at 24 months with no evidence of recurrent disease on clinical examination or body scan evaluation
Re: Vincent Cloutier, Umberto Capitanio, Laurent Zini, et al. Thirty-Day Mortality after Nephrectomy: Clinical Implications for Informed Consent. Eur Urol 2009;56:998-1005
No full textSalvage immunotherapy with subcutaneous recombinant interleukin 2 (rIL-2) and alpha-interferon (A-IFN) for stage D3 prostate carcinoma failing second-line hormonal treatment
No full textImplications of prostate-specific antigen doubling time as indicator of failure after surgery or radiation therapy for prostate cancer
No full textObjectives: To review the methodology of PSA doubling time (PSA DT) calculations and the implications of PSA DT for the follow-up of prostate cancer patients curatively treated with surgery or radiation therapy. Methods: A literature search of the most recent articles on PSA DT (those published after 2000) led to the selection of six studies with the largest and best-documented cohorts of patients treated with surgery or irradiation with curative intent. Results: PSA kinetics, in the form of PSA DT, is the most effective parameter for identifying patients at significant risk for mortality specific to prostate cancer. Thresholds of 3, 6, and 12 mo have shown prognostic significance both in surgical and radiation series, notwithstanding differences in treatment selection, definition of biochemical recurrence, and methods of DT calculation. Conclusions: In retrospective studies, PSA DT is a reliable predictor of prognosis; however, prospective validation studies are needed to determine the cut points of PSA DT. Optimal time intervals for calculation and optimal thresholds are still to be determined
A Multimodal Perioperative Plan for Radical Cystectomy and Urinary Intestinal Diversion: Effects, Limits and Complications of Early Artificial Nutrition
No full textPurpose: We evaluated the effects of early parenteral and enteral postoperative nutritional support on the restoration of normal bowel function, on the protein depletion that follows cystectomy and on observed complications. Materials and Methods: Immediate parenteral nutrition was initiated after surgery. It was progressively shifted to the enteral route through a needle catheter jejunostomy inserted at surgery. Results: A total of 28 patients with a mean age of 74.2 years (range 55 to 82) were enrolled into the study. Disease was pathologically confined to the bladder in 22 patients, locally advanced in 3 and extravesical in 3. Urinary diversions included an ileocolonic pouch in 15 patients and an orthotopic ileal reservoir in 13. Of the 28 patients 15 (53.6%) completed the protocol, whereas 13 (46.4%) did not. Median time to peristalsis and spontaneous passage of flatus was postoperative day 2 (range 2 to 5) and median time to normal diet resumption was postoperative day 4 (range 3 to 8). No significant differences were observed between patients who completed the protocol and those who did not with regard to the restoration of normal bowel function, and total protein, serum albumin and lymphocyte count. Minor complications were observed in 9 patients and major complications developed in 4. Conclusions: Early postoperative artificial nutrition did not affect the return of bowel function or postoperative protein depletion. Different strategies for more effective nutritional support will be explored in further studies
Multimodal Perioperative Plan for Radical Cystectomy and Intestinal Urinary Diversion. I. Effect on Recovery of Intestinal Function and Occurrence of Complications
No full textObjectives: To discuss a multimodal perioperative plan aimed at reducing postoperative ileus and complications associated with radical cystectomy and urinary reconstruction. Methods: The protocol consisted of preoperative, intraoperative, and postoperative measures. The clinical parameters assessed were the time to the return of bowel movements, the presence and duration of postoperative ileus, the presence and duration of an intolerance to oral feeding, the interval to re-institution of a regular diet, and complications. The biochemical parameters (serum total protein and albumin levels and lymphocyte counts) were also assessed. A sample of 40 patients treated before the implementation of this protocol was included for comparison. Results: A total of 71 patients, mean age 74 years and American Society of Anesthesiologists status 2 and 3, consecutively underwent radical surgery for bladder cancer and were evaluable for results and complications. Urinary diversion was a heterotopic neobladder in 27 patients (38%), orthotopic in 23 (32.3%), and an ileal conduit in 21 (29.5%). Bowel movements returned after a median of 2 days (range 1 to 6), intolerance to oral feeding was observed in 17 (23.9%) of 71 patients, and the median time to re-institution of a regular diet was 4 days (range 3 to 9). The complication rate was 26.7%, and the mortality rate was 4.2%. No effects were observed on postoperative protein depletion. In the historical group, the median time to diet resumption was 8 days (range 7 to 12). Conclusions: A short time to the resumption of normal intestinal function and a low incidence of postoperative ileus after cystectomy was observed. However, the incidence of postoperative protein depletion was unaffected. Additional studies should address this subject
[Immunotherapy with subcutaneous recombinant IL-2 and interferon combined with surgery in advanced stage carcinoma of the kidney]
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