Laparoscopically assisted orchiopexy extended mobilization of intra-abdominal testis

The medical files of ten patients with 12 undescended testes who underwent laparoscopic orchiopexy were reviewed. Notably, the peritoneum overlying the internal spermatic vessels was mobilized along with the underlying vessels [unskeletonized] to guard against undue traction, spasm or inadvertent damage of such fragile vessels. The results indicated that in nine cases, adequate length of the spermatic vessels was obtained laparoscopically with attached joined peritoneal strip sufficient to accomplish scrotal positioning of the testes as a one-stage procedure without the need to section the spermatic vessels. Division of the spermatic vessels was restored in three cases where the testicle was retained high, lateral to the external iliac artery of the ipsilateral side. It was concluded that not only one-stage tension-free orchiopexy can be readily performed by laparoscope but also careful handling of the testicular vessels precludes the possibility of jeopardizing the blood supply of the newly located testes, hence testicular atrophy

Effect of hemodialysis on protein C and antithrombin III

The effect of hemodialysis on natural coagulation inhibitors including protein C [PC] and antithrombin III [AT III] had been studied. Plasma PC and AT III levels measured in 20 uremic patients on maintenance hemodialysis immediately before and after dialysis treatment. These values were compared with those obtained from 20 matched healthy controls. Functional activities of PC was determined by coagulometric method and functional activities of AT III was determined by amidolytic method. Both the functional activities of PC and AT III in uremic patients were significantly lower than those of controls. No significant change in the level of AT III was observed with dialysis, but a progressive increase of functional activity of PC was documented with hemodialysis. On the luisis of this study, the risk of thrombosis may increase due the decrease in AT III levels. However, this effect may be compensated by the increase in PC activity, possibly due to the removal of an inhibitory substance on PC activity

TUR followed by systemic chemotherapy then local radiation therapy with adjunct cisplatinum in locally advanced bladder cancer- a preliminary report

Between February, 1989 and September, 1991, 15 patients with proved diagnosis muscle-invading transitional cell carcinoma of the urinary bladder were enrolled in a treatment protocol in Jeddah Cancer Center consisting of: maximal transurethral tumour resection followed by 4 cycles of systemic chemotherapy using M-VAC regimen then combined full dose external-beam irradiation and two extracisplatinum doses. Only 14 patients completed the previous protocol. All evaluable patients showed a complete clinical response at the end of the planned combined approach [with a response rate of 100 percent] which has been successfully maintained for a median follow-up period of 15 months [range from 6 to 31 months]. Toxicity was acceptable and manageable. This preliminary report suggests that the combined multi-modality therapy is highly effective in locally advanced bladder cancer. Longer follow-up is still required to conclude whether this approach can become an alternative to radical cystectomy in such cases