Assessing the currently used diagnostic and therapeutic modalities in patients with testicular cancer

To analyse the characteristics, natural behaviour, diagnostic modalities and treatment protocols of testicular cancer and their effect on prognosis. Forty patients with testicular cancer were admitted to Mansoura Urology and Nephrology Centre in Egypt between 1993 and 2006. All patients were subjected to history taking, systemic and local examination, laboratory tests either routine or specific tumour markers evaluation, e.g. Alpha-fetoprotein [AFP] and B-human chronic gonado tropin [BHCG] and radiological examination e.g scrotal U/S, abdominal U/S, Intravenous urography, computed tomography and x-ray and tomography. All patients were subjected to high inguinal orchiectomy and after histopathologic examination and staging, patients were subjected to radiotherapy, chemotherapy or retroperitoneal lymph node dissection [RPLND]. Then all patients were followed up for a mean duration of 3.1 +/- 0.9 years either clinically, by laboratory or radiogically. 24 patients out of 40 presented with testicular swelling. Other cases presented with manifestations of metastasis. Four patients had history of undescended testis, another four patients had a history of infertility [but no other risk factors could be detected]. All cases examined preoperatively for AFP and BHCG had elevated levels except only four cases of stage I seminoma had normal levels of AFP. Scrotal u/s showed that all seminomatous tumours were hyperechogenic and circumscribed while non seminomatous tumours were hyperechogenic +/- transonic areas. 16 patients had paraoratic lymph nodes in CT scanning of the abdomen and 12 of them were nonseminomatous type. Histopathology of the tumours after inguinal orchiectomy revealed 16 of them were seminomatous and 24 were non seminomatous type 12 of the seminomatous tumours were stage I and four were stage II, while only four of seminomatous type were stage I and the rest were stage II and III. All seminoma cases had postoperative radiotherapy while nonseminoma cases had chemotherapy regimen +/- RPLND. During follow up all stage I cases showed normalization of AFP and BHCG levels while other cases showed decreased levels but not to normal values. Follow up abdominal CT of seminoma cases was free, teratocarcinoma stage III had post treatment CT. Endodermal seminomatous and embryonal carcinoma showed post treatment decrease in sizes of mass. Mixed germ cell tumour showed no change in the size of mass after chemotherapy. Post treatment CXR and CT showed that positive cases of teratocarcinoma became free after chemotherapy while chest metastasis in mixed germ cell tumour and embryonal were resistant after chemotherapy. The early detection of risk factors, early presentation of the patient, accuracy of the currently used investigations, early recognition of treatment failure and ability to treat such failures make testicular tumours the most common curable cancer in young males

Open versus laparoscopic techniques in treatment of adrenal cyst: review of 19 cases

To study the effectiveness of laparoscopic management of adrenal cyst disease versus open surgery. Adrenal cysts are rare be benign lesions, mostly asymptomatic and nonfunctioning. Surgery is indicated when the cyst is functioning, the aspirate is haemorrhagic, cyst wall is irregular or if pheochromocytoma is suspected. 19 patients were admitted to Mansoura Urology and Nephrology Centre in Egypt between 1982 and 2005 with adrenal cyst disease and indicated adrenalectomy either surgically or laproscopically. Retrospective study on these cases as regarding the presentation, indication of intervention procedure, pre and postoperative complication and follow up. 10 cases had open adrenalectomy and 9 cases had laparoscopic transperitoneal adrenalectomy. The mean cyst size was 9.5 +/- 3.5 cm in the open technique while it was 8.3 +/- 3.9 in the laparoscopic technique. Hisopathology showed that 10 cases were haemorrhagic pseudocysts and 9 cases were endothelial cysts. The follow up showed that all cases were symptom free postoperatively without radiological evidence of recurrence. Only one case developed postoperative pulmonary infection and fever after laparoscopic adrenalectomy. Haemorrhagic pseudocysts presened 53%, while endothelial cysts presented 47% of cases. 84% of cases presented with ipsilateral upper quadrant abdominal pain. CT scanning succeeded to role out malignancy in 100% of our cases. Laparoscopic adrenalectomy is a safe and effective means of treatment with advantages of less blood loss, more cosmosis and less hospital stay over the open technique