Vaginal pedicled flap for closure of vesicovaginal fistula.

A 22-year-old woman presented with chronic urinary tract infections and was found to have an ectopic ureter. Repair involved ligation of the distal ectopic ureter via a vaginal approach. She developed an iatrogenic vesicovaginal fistula which was repaired with a vaginal pedicled flap.

Carcinogenesis. The fate of intestinal segments used in urinary reconstruction.

The actual mechanism for risk of developing cancer in intestinal segments used for urinary diversion remains uncertain. The clinical and laboratory experiences are reviewed in this article. The pathogenesis is multifaceted, involving initiators and promoters of carcinogenesis. Molecular genetic technology may provide the key to decoding the mechanisms involved.

Elevated alpha-fetoprotein secondary to Hodgkin's lymphoma.

We describe the case of a 26-year-old man with an elevated level of alpha-fetoprotein who had no evidence of intragonadal or extragonadal germ cell tumor. The patient was found to have Hodgkin's lymphoma within an anterior mediastinal mass. We review the significance of elevated alpha-fetoprotein levels and discuss the clinical relevance of this unusual presentation of a possible primary Hodgkin's lymphoma.

Bilateral primary non-Hodgkin's lymphoma of the testis.

We report the case of a 72-year-old man with bilateral testicular masses that, on histologic section, were found to be synchronous non-Hodgkin's lymphomas. Workup was negative for systemic disease, indicating the possibility of bilateral primary testicular lymphomas. We discuss the evaluation and treatment of this lesion and review the literature concerning this subject.

Recurrence of a nonseminomatous germ cell tumor 9 years postoperatively: is surveillance alone acceptable?

We report on a patient who underwent left radical orchiectomy for a nonseminomatous germ cell tumor and was placed into a surveillance program only to experience recurrence 9 years later. The deficiencies with surveillance protocols, including inadequate followup, imaging study difficulties, possible higher mortality with relapse of carcinoma during the surveillance period, and increased cost and labor for longer surveillance protocols are discussed. Methods of distinguishing patients at low and high risk of relapse are still evolving and further studies are required.

Use of dynamic two-dimensional transesophageal echocardiography for renal cell carcinoma with cavoatrial tumor thrombus.

Renal cell carcinoma with inferior vena caval tumor thrombus extending to the level of the right atrium occurs in about 1% of all cases. Dynamic two-dimensional transesophageal echocardiography is a minimally invasive safe technique that can demonstrate preoperatively the cephalad extent of the cavoatrial tumor thrombus with an accuracy that appears equal to or better than that of any other method currently available. When used intraoperatively, it provides invaluable data to aid in the anesthetic and surgical management of the patient, obviating the need for and potential risk of placing a Swan-Ganz pulmonary artery catheter before complete removal of the tumor thrombus.

Intussusception secondary to Meckel's diverticulum. A challenging diagnosis in adolescence.

A 14-year-old male was found to have an intussusception secondary to an invaginating Meckel's diverticulum. He was initially referred for crampy abdominal pain and diarrhea, and inflammatory bowel disease was suspected. The etiology of most intussusceptions is unknown; however, both in adolescence and adulthood they may be initiated by a lead point. This paper presents, analyzes, and discusses an intussusception caused by a Meckel's diverticulum as a lead point and the difficulty in making a preoperative diagnosis.