[Giant retroperitoneal hydatid cyst]. / Kyste hydatique rétropéritonéal géant.

Hydatidosis is an endemic, widely distributed anthropozoonosis, which involves the liver, lung and other organs [Int J Urol 13 (2006) 76-9]. We reported the case of a large retroperitoneal hydatid cyst, which is a rare situation [Hepatogastroenterology 48 (2001) 1037-9; Int Urol Nephrol 32 (2000) 41-6; J Urol (Paris) 94 (1988) 445-8]. Diagnosis was suspected with blood tests and radiological examinations. A wide incision in the right iliac fossa (such in renal graft) was performed. The cyst wall was excised partially. Before, during and following the operation, the patient was given albendazole tablets (15mg/kg per day) for 3 weeks (1 week before and 2 weeks after the surgery) with blood count and liver enzyme monitorization. Especially in the endemic areas, hydatid cyst should be remembered when evaluating cystic masses in the retroperitoneum. It can be treated successfully with surgery.

Preservation of prostate during radical cystectomy: evaluation of prevalence of prostate cancer associated with bladder cancer.

OBJECTIVES: To estimate the frequency and characteristics of prostatic lesions discovered incidentally in radical cystoprostatectomy specimens and to determine whether any factors would allow for the detection of prostate cancer preoperatively. METHODS: A total of 100 radical cystoprostatectomy specimens with orthotopic bladder reconstruction were performed for malignant bladder disease between 1990 and 2000. The mean patient age at surgery was 62 +/- 8 years (range 32 to 75). Digital rectal examination and prostate-specific antigen (PSA) assay were done routinely before surgery. During the 10-year study period, the same pathologist examined the prostatic tissues from radical cystoprostatectomy specimens using McNeal's technique on fine slices every 2.5 mm. RESULTS: The overall incidence of prostate cancer discovered incidentally in radical cystoprostatectomy specimens was 51%, of which 29% were microcancers (volume less than 0.5 cm3) and 22% were significantly larger (volume 0.5 cm3 or more). The mean Gleason score was 6. Of the tumors, 24% could be considered "clinically nonsignificant" (less than 0.5 cm3 and Gleason score less than 7). The mean preoperative PSA level was 4.13 +/- 1.36 ng/mL. Of 66 patients with a PSA level of less than 4 ng/mL (mean PSA 1.5 +/- 0.8) and a normal digital rectal examination before surgery, 50% had prostate cancer, of which 69% were microcancers. CONCLUSIONS: The prevalence of prostate cancer (51%) in our series is among the highest in published reports. Furthermore, our results stress that currently no factors are available to enable the detection of "clinically significant" prostate cancer preoperatively.

Laparoscopic excision of a single hepatic hydatid cyst.

Many reports have recently shown the feasibility of treating simple cysts, polycystic disease of the liver and biliary cysts by laparoscopy. Groups having experience in this kind of surgery stressed the contraindication to manage hydatid cysts of the liver laparoscopically. This reflects the primary concern regarding the possibility of cyst content spillage. This presentation aims to demonstrate the feasibility and safety of laparoscopic treatment of special types of hepatic hydatid cysts. A 26-year-old female Yemeni patient presented with atypical gall bladder dyspepsia. Abdominal ultrasound only showed chronic calcular cholecystitis. The patient was scheduled for laparoscopic cholecystectomy on the 18th of August 1992. On exploration a globular cyst about 12 cm hanging with a stalk from the under surface of the right lobe of the liver was noticed. The gall bladder was used to elevate the liver. Dissection of the mass from the surrounding structures was achieved. Puncture and suction of the germinal and laminated layers were done. The connecting stalk was doubly ligated with endoloops and cut in between. The patient made an uneventful recovery and was discharged 48 hours later. Hydatid cysts of the liver are dangerous to handle by laparoscopy. However whenever a case is met with where excision can be done, this could be achieved laparoscopically especially in pedunculated cysts. A device of 2 coaxial suckers is presented to procure laparoscopic management of hydatid cysts enough safety against "spillage of contents" as in open surgery.

Laparoscopic management of superior mesenteric artery syndrome.

Superior mesenteric artery syndrome (SMAS) is a rare clinical condition that should be considered in patients with long-standing abdominal complaints where endoscopic and conventional roentgenographical findings are often negative. It has been claimed that SMAS is caused by intermittent obstruction of the horizontal portion of the duodenum between the superior mesenteric artery and the spine and the aorta. The main target of this presentation is to present our experience in the laparoscopic management of 4 cases of documented SMAS after failure of medical treatment. The laparoscopic severing of the ligament of Treitz is a feasible and safe technique. It could bring about total relief of symptoms in three out of the four patients. The operative time rapidly decreased with the acquaintance of the field. The visualization (exposure) is quite satisfactory. the technique offers added precision and accuracy to the dissection manoeuvres. Recovery was uneventful and rapid with minimal needs for postoperative analgesia. We recommend the use of mini-endoshear (pediatric). Phases of dissection from the mesocolon and retro-pancreatically are presented. We stress the finding of the drainage of the inferior mesenteric vein into the superior mesenteric vein instead of the splenic vein. This could put the inferior mesenteric vein (looking as a fibrous band) in jeopardy. Also it reduces the area of access to the retropancreatic dissection. We raise the possibility of an etiological role of this anatomical variation to the duodenal compression and call upon the study of such a possibility. The importance to attain the proper retropancreatic space has been shown by the possibility of dissecting between the uncinate process and the rest of the pancreas. The psychological impact of a minimal invasive approach together with symptoms relief was quite rewarding.

Plasma vitamin A and beta-carotene in retinitis pigmentosa.

Plasma levels of vitamin A and beta-carotene were measured by spectrophotometry in 39 patients with genetically determined retinitis pigmentosa, No difference was found between the levels in these patients and the levels in a control group.