Gynecologic-tract sparing extra peritoneal retrograde radical cystectomy with neobladder

OBJECTIVE: We report on a series of female patients with transitional cell carcinoma of the bladder who underwent extraperitoneal retrograde radical cystectomy sparing the female reproductive organs with neobladder creation. MATERIALS AND METHODS: 14 female patients between the ages of 45 and 72 years who underwent gynecologic-tract sparing cystectomy (GTSC) with neobladder between 1997 and 2002 were retrospectively reviewed. Our surgical technique is also described. Radical cystectomy is accomplished by a retrograde method sparing the uterus, adnexa, vagina and distal urethra. An orthotopic neobladder was constructed using small bowel or sigmoid colon, brought extraperitoneally, and anastomosed to the distal urethra. RESULTS: Operating time ranged from 4.5 to six hours with a mean of 5.3 hours. Ten patients were able to void satisfactorily while four required self-catheterization for complete emptying of the bladder. Seven patients were continent day and night and another 7 reported varying degrees of daytime and nighttime incontinence. One patient died of metastases and another of pelvic recurrence. There were no urethral recurrences. Patient satisfaction with the procedure was high. CONCLUSIONS: Gynecologic-tract sparing cystectomy with orthotopic neobladder is a viable alternative in female patients with muscle invasive traditional cell carcinoma of the bladder, providing oncological safety with improved quality of life. Our extraperitoneal technique, which is an extension of our successful experience with retrograde extraperitoneal radical cystectomy in men, minimizes intraoperative complications and simplifies the management of post-operative morbidity with the neobladder.

[Antiepileptic drugs effect on vitamin D status of epileptic children]

As epilepsy and seizure disorders are common in children, antiepileptic drugs are used more commonly in this age group than in adults. This study was carried out in order to determine the vitamin D and calcium status of children receiving antiepileptic drugs and evaluation of effects of these drugs on vitamin D and calcium metabolism. Sixty epileptic children and adolescents visiting Children's Neurology Clinic who were taking antiepileptic drugs and had inclusion criterions were selected as simple sampling from July 2005 to June 2006. Thirty age and sex matched normal children and adolescents were considered as control group. Serum levels of 25OHD3, calcium and alkaline phosphatase is compared between groups. Serum levels of 25OHD3 [P<0.001], calcium [P<0.001] and alkaline phosphatase [P<0.001] were significantly different between groups. Ten percent of patients had serum 25OHD3 level below lower normal limit. There was a reverse correlation between duration of drug therapy and serum level of 25OHD3 [r=-0.345, P=0.011]. Antiepileptic drug treatment in children results in reducing serum 25OHD3 and calcium levels and increases bone turnover. With longer duration of treatment serum 25OHD3 level decreases more

Mandibuloacral dysplasia in an Iranian girl

Mandibuloacral dysplasia [MAD] is a rare autosomal recessive syndrome. Less than 25 families have been reported, most of which are Italian. Here, we describe a new patient of Iranian origin, born to consanguineous parents