ABSTRACT
OBJECTIVE: To assess survival length and quality of life in patients with a percutaneous nephrostomy (PN) for malignant tumour and postrenal anuria. PATIENTS AND METHODS: Case records were analysed of 50 patients (39 men, eleven women; mean age 65.6 years) with postrenal anuria due to malignancy who had undergone ultrasound-directed PN under local anaesthesia for urinary drainage. Particular attention was paid to the course of the disease from nephrostomy until death. RESULTS: Survival time after PN ranged from 4 days to 16 months, averaging 4.3 months. 26 patients (52%) had died after 3 months, 41 (82%) after 6 months. The patients had spent on average 44.5% of their remaining life in hospital. After an initial improvement in their state, cancer-produced pain and complications soon set in and often required operative intervention. CONCLUSION: The achieved prolongation of survival time did not always meet the patient's own wishes. Detailed explanation and information to patient and family before PN is therefore urgently required.
Subject(s)
Gastrointestinal Neoplasms/complications , Liposarcoma/complications , Nephrostomy, Percutaneous , Prostatic Neoplasms/complications , Retroperitoneal Neoplasms/complications , Ureteral Obstruction/etiology , Ureteral Obstruction/surgery , Urinary Bladder Neoplasms/complications , Uterine Neoplasms/complications , Adult , Age Factors , Aged , Aged, 80 and over , Female , Gastrointestinal Neoplasms/mortality , Humans , Liposarcoma/mortality , Male , Middle Aged , Prostatic Neoplasms/mortality , Quality of Life , Retroperitoneal Neoplasms/mortality , Time Factors , Urinary Bladder Neoplasms/mortality , Uterine Neoplasms/mortalitySubject(s)
Aldehydes/metabolism , Aldehydes/toxicity , Allyl Compounds/metabolism , Allyl Compounds/toxicity , Carcinogens/metabolism , Carcinogens/toxicity , DNA Adducts/biosynthesis , DNA/drug effects , DNA/metabolism , Ketones/metabolism , Ketones/toxicity , Mutagens/metabolism , Mutagens/toxicity , Animals , MiceABSTRACT
Since the addition of ultrasonography and computerized tomography to the diagnostic tools used for the recognition of renal tumor masses, detection of renal cell carcinomas has been much earlier and more reliable than formerly. Between July 1981 and June 1990, 335 patients without distal metastases underwent radical nephrectomy for renal cell carcinoma. In only 2.6% of the patients were adrenal metastases found, exclusively with stage pT3 tumors. The results of this review suggest that the adrenal gland need not be removed with the radical nephrectomy specimen in the case of tumors staged T1 or T2 if the adrenal CT scan is normal.
Subject(s)
Adrenal Gland Neoplasms/surgery , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Adrenal Gland Neoplasms/secondary , Adrenalectomy , Adult , Aged , Aged, 80 and over , Carcinoma, Renal Cell/diagnosis , Carcinoma, Renal Cell/pathology , Diagnostic Imaging , Female , Humans , Kidney Neoplasms/diagnosis , Kidney Neoplasms/pathology , Male , Middle Aged , Neoplasm Invasiveness , NephrectomyABSTRACT
A 62-year-old patient had complained of recurring colicky pain in the right renal bed, seven days before he was admitted as an inpatient. Macrohaematuria was an accompanying sign during one of these attacks. Sonography revealed right urinary obstruction of medium severity; the right kidney could not be demonstrated by urography. Since CT did not yield any clue, retrograde ureteropyelography was performed. An obstructive tumour of the right ureter was identified. This tumour, which had a length of 3.5 cm and a width of 1.2 cm, was completely resected by ureteronephrectomy. Examination revealed an extraskeletal mesenchymal chondrosarcoma of predominantly intraluminal growth, and a tumour-free external ureteral wall. A chondrosarcoma at this site has not been reported as yet. Pathogenesis may be ascribed either to degeneration of an existing chorista or to the development of a pluripotent tumour parent cell.
