Predictors of viable germ cell tumor in postchemotherapeutic residual retroperitoneal masses

The aim of this study was to identify predictors of viable germ cell tumor [GCT] in postchemotherapeutic residual retroperitoneal masses. The pertinent clinical and pathologic data of 16 male patients who underwent postchemotherapeutic retroperitoneal lymph node dissection [PC-RPLND] at King Faisal Specialist Hospital and Research Centre between 1994 and 2005 were reviewed retrospectively. It was found that all patients received cisplatin-based chemotherapy for advanced testicular GCT. Out of the 16 male patients, 2 [13%], 8 [50%], and 6 [37%] had viable GCT, fibrosis, and teratoma, respectively. Ten [10] of the patients with prechemotherapeutic S1 tumor markers did not have viable GCT, and two of the six patients who had prechemotherapeutic S2 tumor markers have viable GCT. All tumor marker levels normalized after chemotherapy even in patients with viable GCT. Four patients had vascular invasion without viable GCT. Furthermore, four patients had more than 60% embryonal elements in the original pathology, but only 1 had viable GCT at PC-RPLND. Four of the five patients with immature teratoma had teratoma at PC-RPLND but no viable GCT; however, out of the four patients with mature teratoma, one had viable GCT and two had teratoma at PC-RPLND. Of the two patients with viable GCT, one had 100% embryonal cancer in the original pathology, prechemotherapeutic S2 tumor markers, history of orchiopexy, and no vascular invasion; the other patient had yolk sac tumor with 25% embryonal elements and 40% teratoma in the original pathology, and prechemotherapeutic S2 tumor markers. None of the clinical or pathological parameters showed a strong correlation with the presence of viable GCT in PC-RPLND. However, patients with >/= S2 may be at higher risk to have viable GCT. Further studies are needed to clarify this

Complex regional pain syndrome in a child: first case report from Kuwait

Complex regional pain syndrome [CRPS] has been reported in adults for many years. It is a rare disorder in children, probably due to under-diagnosis. The etiology of CRPS remains unclear. The prognostic indicator in adults as well as in children is early recognition and treatment. CRPS should be included as part of the differential diagnosis of limb pain in children. The purpose of this report is to help pediatricians recognize CRPS promptly and to provide timely care and prevent any functional impairment

Pattern of management of urologic cancer in Saudi Arabia

To compare the current uro-oncologic practice pattern in Saudi Arabia with the standard of care practice and to identify obstacles in our health care system that prevent offering such a treatment. We surveyed 247 practicing urologists in Saudi Arabia using a designed questionnaire. This questionnaire contains 19 questions focusing on management of bladder and renal cancers. Of the 247 contacted urologists, 86 completed the questionnaire. Seventy six percent see more than 10 bladder cancer cases/year and 83% used rigid cystoscope for diagnosis under general anesthesia. Eighty two percent perform over 10 bladder tumor resections/year; however, 90% of them perform less than five cystectomies/year, if any. Seventy nine percent had intravesical therapy available at their hospitals and majority of them use it after resection in selected patients. Fifty percent preferred re-resection within 2-4 weeks for T1 and/or G3 tumors and majority of them [86%] perform cystectomy for muscle invasive disease and ninety six percent perform ileal conduit. Thirty four percent see over 10 renal cancers/year. Forty nine percent perform radical nephrectomy for less than 4 cm renal masses and for more than 4 cm, only 9% do laparoscopic nephrectomy while the majority preferred open technique although 77% of the hospitals participated in this survey have a urologist capable of doing laparoscopy. A significant number of urologists in Saudi Arabia do not apply some of the well-accepted standard practices in urologic cancer. To improve this, we need to work on our referral system and establish education and training programs to make the urologist familiar with the new modalities of treatment