Computed axial tomography pancreatitis: an atypical asymptomatic postoperative disease without serum or urinary enzyme evaluation.

A case report of atypical postoperative pancreatitis following radical prostatectomy without any clinical symptoms is presented. The patient was asymptomatic in the postoperative period with regards to pancreas disease. Serum lipase, serum amylase and urinary amylase were normal. There was no history of alcoholism or biliary disease. The diagnosis was made by a CAT scan performed for an unrelated indication. The patient was followed for 17 months postoperatively. The pancreas CAT scan appearance returned to normal. No definitive treatment was given.

Malignant teratoma of the testicle: diagnosis suggested by preoperative ultrasonography.

A 22-year-old white man was found to have malignant teratoma of the testicle (nonseminomatous germ cell testicular tumor), which had been suggested by ultrasonography. Modified template retroperitoneal lymphadenectomy with nerve sparing showed no microscopic metastatic tumor.

Cervical cancer radiation injury to the urinary bladder and ureters: management by cecal augmentation to a previous ileal augmentation cystoplasty.

A case report of the management of severe post cervical carcinoma pelvic radiation injuries is presented. Management was accomplished by detubularized ileal augmentation cystoplasty followed by cecal augmentation to the detubularized ileal augmentation 4 years later when bilateral ureteral obstruction developed. The development of a vesicouterine fistula required the creation of a large bowel cecal conduit for cutaneous urinary diversion utilizing the cecal augmentation antireflux segment.

Genitourinary problems in the elderly patient.

Dramatic advances across several fronts have provided a marked improvement in the quality of life for the elderly urologic patient. Radical surgery for cancer is much safer than in the past, and our focus is on preservation of function or complete functional reconstruction. In other areas we strive to continue to deliver excellent treatment while minimizing patient morbidity. This is seen most dramatically in the treatment of urinary stone disease. Ongoing work in patients with BPH promises to provide similar benefits to this population in the coming years. At the same time, we must remember that our abundance of therapeutic options imposes a responsibility to individualize treatment so as to best serve each patient.

Clinicopathologic significance of cathepsin B immunostaining in transitional neoplasia.

Fifty Stage heterogeneous urinary bladder carcinomas were immunostained for cathepsin B, a lysosomal endoproteinase putatively associated with tumor invasion. Neoplastic cell CB immunoreactivity was strongly correlated to both grade (I/II--42% positive versus III--68% positive, P = 0.01) and invasion beyond the lamina propria (Ta/T1--42% positive versus T2/T3--68% positive, P = 0.02). Most low grade, papillary tumors displayed a granular cytoplasmic staining pattern, compatible with lysosomal distribution, in contrast to high grade tumors, in which diffuse staining was present in the cytoplasm. Staining was also accentuated at the advancing front of invading tumors and in angiolymphatic tumor emboli. Non-neoplastic mononuclear inflammatory cells, particularly those at the host-tumor interface, displayed variable, sometimes intense staining. Strong tumor-cell CB was more frequent among recurrent TCC than in patients who remain free of disease (55% versus 29%, n = 18, T2-3, cystectomy, 5-yr min. follow-up). We conclude these observed staining patterns and grade/stage associations are compatible with an important biological role for CB in facilitating host invasion in some bladder tumors. Levels and/or distribution of CB may also be of potential value in defining clinically aggressive tumor subsets.

Gastrocystoplasty without opening the stomach.

We describe a modification of gastrocystoplasty using the GIA stapler to harvest the segment for augmentation without opening the stomach. This simplification reduces operative time and blood loss without introducing complication specific to it and has been successfully used in our first 5 patients.