Subject(s)
Adrenocortical Adenoma , Adrenocortical Carcinoma , Cushing Syndrome , HyperaldosteronismABSTRACT
Background and Objective: Reports in the literature regarding reconstruction of the lower urinary tract with orthotopic ilealneobladder post radical cystectomy for either non-transitional cell bladder tumors or other pelvic malignancies are rare. In suchcases, the reconstruction with orthotopic neobladder may represent a technical and therapeutic challenge, especially due topatients previous treatments like radiotherapy. To evaluate the feasibility and oncological results of the reconstruction ofurinary and gastrointestinal tracts in patients submitted to pelvic exenteration. Methods: From April 1995 to January 2004, 13patients with pelvic malignancies and non-transitional cell bladder tumors were submitted to pelvic exenteration. Bladderreconstruction was accomplished through orthotopic ileal neobladder in all cases. Seven patients had total pelvic exenterationwith anal sphincter-sparing procedure done as well as double-stapled colorectal anastomosis. Results: The mean age was 50years. In 6 patients late complications, such as hydronephrosis and urinary infection, were observed. No patient presented daytimeurinary incontinence after 6 months. During the follow-up period, no urethral recurrences were noted and all patientsremained with their functional neobladders. Two patients died of treatment-related causes and three died of cancer; sevenpatients are alive with no evidence of disease and one is alive with cancer. Overall and cancer-specific survival at 24 and 60months was 77.0% and 57%, respectively, and the mean of follow-up was 47% months (median 43 month). Conclusions:Urinary sphincter preservation and bladder reconstruction with orthotopic ileal neobladder with or without concomitant fecalsphincter preservation is a valuable option in patients with non-transitional cell bladder tumors or other pelvic malignancies thatrequire radical cystectomy for curative purposes.
Subject(s)
Humans , Gastrointestinal Tract , Pelvic Exenteration , Pelvic Neoplasms , Gastrointestinal Tract/surgeryABSTRACT
Introduçäo: Os autores analisam os efeitos do emprego endovenoso do Samário 153-EDTMP no tratamento de 35 pacientes portadores de adenocarcinoma de próstata refratário à hormonioterapia com metástases ósseas dolorosas. Material e métodos: Entre novembro de 1995 e março de 1998, 35 pacientes com metástase óssea de adenocarcinoma de próstata näo responsivo ao tratamento hormonal foram submetidos à aplicaçäo endovenosa do Samário 153-EDTMP (1,0 a 1,5 mCi/Kg de peso), com finalidade antiálgica. Sessenta porcento dos pacientes tinham pelo menos 20 metástases ósseas, 30 porcento usaram morfina e 68,5 porcento já haviam sido irradiados. Foram avaliadas a resposta à dor, a mielotoxicidade e os níveis de PSA após a aplicaçäo. Resultados: Verificou-se resposta completa à dor em 8 (24,2 porcento) e resposta parcial em 14 pacientes (42,4 porcento) dentre 33 pacientes avaliáveis, totalizando-se 66,6 porcento de resposta global à dor. O tempo de duraçäo de resposta variou de 30 a 60 dias nos casos de resposta completa e entre 20 a 90 dias nos casos de resposta parcial. A ocorrência de toxicidade medular ocorreu em 17 de 23 casos avaliáveis sendo predominantemente através de leucopenia e plaquetopenia sempre de regressäo espontânea, sendo que em nenhum caso a toxicidade foi letal. A queda parcial de PSA após a aplicaçäo ocorreu em 3 e a progressäo em 19 de 22 casos avaliáveis. O seguimento dos pacientes variou entre 7 e 903 dias (média 190 dias), com sobrevida global de 51,1 porcento aos 6 meses e de 20,9 porcento ao final de um ano. A sobrevida mediana foi de 6,2 meses. Conclusöes: Os resultados sugerem que o Samário é uma alternativa segura no tratamento paliativo do câncer de próstata hormônio refratário
Subject(s)
Humans , Male , Middle Aged , Adenocarcinoma/drug therapy , Prostatic Neoplasms/drug therapy , Radioisotopes , Samarium/administration & dosage , Neoplasm Metastasis , Pain/drug therapy , Radionuclide Imaging , Tomography, Emission-ComputedABSTRACT
Objective: To evaluate the survival rate of patients with advanced prostate cancer in a univariate form, according to the preoperative and first postoperative determination of PSA levels. Materials and Methods: From February 1987 to June 1995, 92 patients were submitted to maximum blockage androgen (subcapsular and antiadrogen orchiectomy), independent of clinical symptons shown upon admission to the Cancer Hospital. The antiandrogens (ciproterone acetate and flutamide) were administered until the patient present progression of the disease. Results: The age of patients varied from 44 to 89, with a median of 70 years old. In the 6th, 36th and 60th months the global survival rate was 80 percent, 38 per cent and 20 per cent, respectively. The preoperative PSA ranged from 2 to 4017 ng/ml, with a median of 98 ng/ml (98 per cent had PSA greater than or equal to 10 ng/ml). The first postoperative PSA ranged from 1 to 3840 ng/ml, with a median of 20 ng/ml. There was a tendency towards a better survival rate only in patients with initial PSA from 2 to 99 ng/ml (p=0.06745). The survival rate of patients at 36 months after initial total blockage androgen, with first PSA level from 1 to 4, 5 to 49 and over 49 ng/ml was 72 per cent, 48 per cent and 8 per cent, respectively (p=0.00004). In the final examination, 34 (37 per cent) patients were considered stable and 58 (63 per cent) had disease progression. Conlusion: The PSA determination performed on the 30th postoperative day is important in the evaluation of advanced prostate cancer prognosis.
Subject(s)
Adult , Middle Aged , Humans , Male , Prostatic Neoplasms/blood , Prostate-Specific Antigen/blood , Cyproterone Acetate/therapeutic use , Flutamide/therapeutic use , Androgen Antagonists/therapeutic use , Postoperative Period , Prognosis , Prostatic Neoplasms/mortality , Prostatic Neoplasms/drug therapy , Severity of Illness Index , Aged, 80 and over , Preoperative Care , Orchiectomy , Survival Rate , Retrospective StudiesABSTRACT
A ocorrência do tumor carcinóide primário do rim é muito rara, com aproximadamente 37 casos relatados na literatura. O presente trabalho relata um caso deste tumor ocorrido em uma paciente de 54 anos de idade, que procurou o Hospital para tratamento de um sarcoma de partes moles. Durante a investigaçäo houve o achado incidental de um tumor renal e a paciente foi submetida à nefrectomia radical. O estudo morfológico e imuno-histoquímico mostraram tratar-se de um tumor carcinóide clássico. A paciente está bem, sem sinais de doença, cinco anos após a cirurgia. Uma breve revisäo da literatura é apresentada.
Subject(s)
Humans , Female , Middle Aged , Carcinoid Tumor/diagnosis , Carcinoid Tumor/surgery , Follow-Up Studies , Kidney Neoplasms/diagnosis , Kidney Neoplasms/surgery , NephrectomyABSTRACT
A radioterapia é empregada em várias neoplasias malignas pélvicas. Näo infreqüentemente, verifica-se complicaçöes actínicas em vários órgäos dos sistemas genital e urinário com intensidade variável. Nos casos mais graves, os pacientes mesmo com câncer controlado podem ter comprometidas de maneira significativa sua qualidade de vida e suas funçöes sexuais e reprodutivas. O risco da ocorrência de um segundo tumor primário, radioinduzido, deve ser lembrado. Os autores discutem de maneira individualizada essas complicaçöes, enfatizando aspectos de seu tratamento.
Subject(s)
Humans , Male , Female , Pelvic Neoplasms/radiotherapy , Radiation Injuries , Radiotherapy/adverse effects , Urogenital System/pathology , Urogenital System/radiation effectsSubject(s)
Humans , Male , Female , Middle Aged , Kidney Neoplasms/diagnosis , Kidney Neoplasms/therapy , Neoplasm Staging , PrognosisABSTRACT
A importância de se identificar o verdadeiro agente etiológico de certas afecçöes gastroduodenais, em especial as gastrites, vem conduzindo os pesquisadores ao campo da bacteriologia. A partir de 1983, o Campylobacter pyloridis, bactéria encontrada na luz gástrica, passou a ser freqüentemente citado como possível causador de gastrites e úlceras gastroduodenais. Aquisiçöes recentes neste campo como a descriçäo precisa da bactéria, sua fisiopatologia e sua sensibilidade a antibióticos, justificam sua apresentaçäo entre nós