ELNATED LACTATE DEHYDROGENASE ISOENZYME I AS A TUMOUR MARKER IN PATIENTS WITH GERM CELL TESTICULAR TUMOURS

In a series of 50 patients with testicular tumours evaluated prior to orchidectomy, 12 out of 19 with pure seminoma and seven out of 31 with non-seminomatous or mixed seminomatous and non-seminomatous germ cell tumours had elevated plasma lactate dehydrogenase isoenzyme 1 concentrations. In contrast. seven of the 19 seminoma patients had elevated serum human chorionic gonadotrophin (hCG) concentrations and 25 of the 31 non-seminomatous and mixed seminomatous and non-seminomatous gem cell tumour patients had elevations of hCG and/or α-fetoprotein. Using these three markers, 12 out of 19 seminoma patients and 27 out of 31 non-seminomatous or mixed seminomatous and non-seminomatous tumour patients were positive for one or more of these tumour markers.     

CLINICAL EXPERIENCE WITH YOLK SAC TUMORS AND TERATOMA IN CHILDREN

Between 1971 and 1993, 12 children with testicular germ cell tumors were treated at the Department of Urology, Faculty of Medicine, Kyoto University. Seven patients had yolk sac tumors and 5 had mature teratoma. Of the 7 patients with yolk sac tumors, 6 had stage I and 1 had stage III tumors. Initial management of the stage I tumors consisted of high orchiectomy in 5 patients and high orchiectomy plus retroperitoneal lymph node dissection in 1 patient. Of these 6 patients, 4 were cured by surgery alone but lung metastases developed in the other 2 patients. One of them was salvaged with thoracotomy and chemotherapy but the other died of tumor. The patient with stage III tumor had bulky tumor spread to lung and retroperitoneum, but seems to have been cured by chemotherapy followed by resection of the residual mass although follow-up is still inadequate (14 months). Six of the 7 patients (85.7%) are alive 13 months to 21 years after diagnosis. Five patients with mature teratoma were treated by high orchiectomy or, more recently, enucleation and all are alive 4 months to 22 years after surgery.     

PYOGENIC LIVER ABSCESS: A REVIEW OF 10 YEARS’ EXPERIENCE IN MANAGEMENT

Background : Over the past 15 years, diagnostic and interventional radiology techniques have allowed accurate localization of liver abscesses and image-guided percutaneous drainage. This review examines whether these technical advances improve clinical results and discusses the selection of treatment for patients with liver abscesses. Methods : Ninety-eight patients were treated for pyogenic liver abscess (PLA) at the Royal Prince Alfred Hospital, Sydney, between January 1987 and June 1997. The hospital records were examined and clinical presentation, laboratory, radiological and microbiological findings were recorded. Associations between these findings and failure of initial non-operative management were determined using odds ratios with 95% confidence intervals. Independent predictors were then determined by logistic regression. This analysis was repeated to determine factors associated with mortality. Results : Cholelithiasis and previous hepatobiliary surgery were the most frequently identifiable causes of PLA, each responsible in 15 patients. All 98 patients were treated with intravenous antibiotics and in 13 patients this was the only therapy. Of the remaining 85 patients, six proceeded straight to laparotomy and 79 had percutaneous drainage, of whom 15 required subsequent laparotomy. Factors predicting failure of initial non-operative management were unresolving jaundice, renal impairment secondary to clinical deterioration, multiloculation of the abscess, rupture on presentation and biliary communication. The overall hospital mortality rate was 8%. Conclusion : Pyogenic liver abscess remains a disease with significant mortality. Image-guided percutaneous drainage is appropriate treatment for single unilocular PLA. Surgical drainage is more likely to be required in patients who have abscess rupture, incomplete percutaneous drainage or who have uncorrected primary pathology.     

A CASE OF TESTICULAR TERATOMA LOCATED IN THE OPPOSITE SIDE OF THE UPPER ABDOMINAL WALL

We report a case of a testicular teratoma located in the opposite side of the upper abdominal wall. A 2-year-old boy presented with a non-palpable right testis and underwent right inguinal exploration for right cryptorchidism. During surgery, the tumor was found in the opposite side of the upper abdominal wall across the midline. Histological investigation of the tumor revealed a mature teratoma occurring in the intra-abdominal testis. No such case has been previously reported.     

PRIMARY ADRENAL TUMOURS – A TEN-YEAR EXPERIENCE

The experience of 31 patients with primary adrenal turnours seen in one teaching hospital over a 10–year period is reviewed. There were 10 patients who had benign cortical adenomas; 11 had adrenal cortical carcinomas, and 10 had phaeochromocytomas, one of which was malignant. During the review period, a primary adrenal mass was discovered in 5% of 2951 autopsies performed in the study institution. The diagnosis and management of these uncommon turnours is reviewed.     

CAVERNOUS HAEMANGIOMA OF THE EPlDlDYMlS MIMICKING A TESTICULAR MALIGNANCY

A case of testicular adnexal haemangioma which presented as a large solid mass with a recent increase in size — thereby mimicking a malignancy — is presented. This paper also includes an overview of benign vascular neoplasms of the testis.     

MORTALITY TRENDS IN THE SURGICAL MANAGEMENT OF CHRONIC PEPTIC ULCERATION: 25 YEARS‘ EXPERIENCE

This study is of the results of surgical management of bleeding chronic peptic ulceration at Prince Henry's Hospital, retrospective for the periods 1951 to 1960 and 1961 to 1970 and prospective for 1972 to 1977. During the latter five years all patients were admitted from the community to a haematemesis and melaena unit with a defined policy of management and prospective data recording for computer analysis. There was a continuing improvement in mortality over this 25-year period, especially with duodenal ulcer. No clear distinction could be made between conservative surgery and partial gastrectomy in terms of reduced surgical mortality in duodenal ulcer. Bleeding gastric ulcer remains a difficult problem, with a current surgical mortality of 21%.     

儿童脾切除的认识和体会

目的探讨有关儿童脾切除术前及术后的相关情况。方法回顾性分析了2001年4月至2004年9月脾切除患儿的资料,共有28例,其中男性16例,年龄最大14岁,最小15月,平均7．8岁,地中海贫血2例、球形红细胞增多症8例、脾肿大3例、ITP 10例、脾亢2例、外伤性脾破裂2例、门脉高压症1例,腹腔镜脾切除15例,开腹手术13例,急诊手术2例,择期手术26例。分别比较开腹组与腹腔镜组择期脾切除,通过）（2检验（P〈0．05）两者有显著差异。结果所有患者均顺利完成脾切除术,其中20例患者术后有不同程度的血小板计数升高,平均术后一周血小板升高至高峰。3例患儿有轻至中度的激素反应。腹腔镜组术后平均住院5d,天腹组术后平均住院10d。所有患者术后定期口服或肌注广谱抗菌素,随访1月～3年,无近、远期并发症,效期并发症,效果良好。结论儿童脾脏切除需要有一定的手术指征,术前应详细评估,术后应有效监测。腹腔镜下脾切除优点多值得推广。     

FAMILIAL TESTICULAR CARCINOMA: IN SEARCH OF GENETIC TRIGGERS

Two cases of testicular tumours in non-twin brothers of a cancer-prone family are described. Cytogenetic studies of these two patients and human leucocyte antigen (HLA) typing of the family failed to identify any genetic defects. The authors propose using linkage analysis for further genetic studies but would require additional families for this to be performed.     

小儿伤寒肠穿孔45例诊治体会

本文报告小儿伤寒肠穿孔４５例，其中男２９例，女１６例。年龄３－１４岁，平均９．８岁。入院前误诊１４例，治愈３９例，死亡６例，并发肠瘘６例。结果提示：小儿伤寒肠穿孔以学龄期儿童发病率最高，穿孔多发生在伤寒病病程的第２、３周，部位多在距回盲瓣５０ｃｍ内的回肠肠系膜对侧缘。     

FIFTEEN-YEAR EXPERIENCE OF TESTICULAR NEOPLASM IN A REGIONAL CENTRE

Background: During a 15-year period from 1980 to 1995, 63 patients from the Geelong region of Victoria presented with germ cell neoplasm. Methods : In this retrospective review performed by studying hospital records, treating specialists' notes and by telephone interviews, 61 of 63 patients were identified. Results: A tumour incidence of four cases per 100 000 male population per year with an overall cancer-specific survival of 95% is demonstrated. Follow-up ranged from 18 months to 15 years. The incidence of seminoma was 30%; patients with seminoma presented at a later stage than those with non-seminoma. Conclusions: The present study demonstrates the increasing incidence of testicular tumour in the Geelong region, and the excellent prognosis of this disease with management outside of the tertiary referral centre.     

FUNDOPLICATION IN CHILDREN: EXPERIENCE WITH 106 CASES

Background: Gastro-oesophageal reflux (GOR) is a physiological problem in infancy that can become pathological and life-threatening in certain cases. Fundoplication has been shown previously to be effective in the control of this problem when medical therapy fails. Methods: A retrospective review of the hospital records and the Department of Paediatric Surgery database was carried out, in order to demonstrate the Prince of Wales Children Hospital's (POWCH) experience with 106 fundoplications between February 1989 and March 1993. Results: There was a failure rate of 7.5% and a long-term mortality rate of 7.8%. The children most at risk of mortality and morbidity are shown to be the neurologically impaired. The special problems associated with these children as compared with neurologically normal children with pathological GOR are discussed and the literature reviewed. Conclusion: Fundoplication is shown to be a safe operation that can be life-saving in certain circumstances.     

SACROCOCCYGEAL TERATOMA IN CHILDREN: A DIAGNOSTIC CHALLENGE

Sacrococcygeal teratoma is relatively rare. Its characteristic appearance, location and size usually leave little doubt as to the diagnosis, but the less obvious ones may occasionally give rise to diagnostic difficulty. Four cases of sacrococcygeal teratoma in children are reported. One neonate presented with a large protuberant swelling at the sacrococcygeal area, with no diagnostic difficulty. The second neonate presented with a small paraxial sacral swelling with an overlying haemangioma. The third patient presented with a small tail-like appendage at the natal cleft. A properly performed rectal examination in both the second and third patients disclosed the diagnosis. The fourth patient presented with an anocutaneous fistula and partial sacral agenesis with no external sacrococcygeal swelling. The diagnosis was confirmed with computerized tomography. While the diagnosis of the protuberant sacrococcygeal teratoma presents no difficulty, that of the less obvious cases requires a high index of clinical suspicion. A properly performed rectal examination supplemented with appropriate imaging allows the diagnosis to be made.     

Non Seminomatous Germ Cell Tumour of a Solitary Testis in a 70-year-old Man: A Rare Case

We report a rare case of a 70-year-old patient who presented with undifferentiated malignant teratoma arising from a solitary testis. The literature review highlights the rarity of such tumour in this age group, and this may represent the oldest reported patient with non seminomatous germ cell tumour of testicle.     

BLADDER TUMOURS IN CHINESE: A 6 YEAR STUDY

Specimens from 334 Chinese patients who underwent surgical treatment for bladder tumours over a 6 year period were studied retrospectively. Transitional cell carcinoma (TCC) accounted for 91.3% of all the bladder tumours. The male to female ratio was 3:1 and the mean age was 69 years. Papillary TCC, which represented 67.5% of all TCC, were more often of a lower grade compared to non-papillary tumours. The staging of tumours was done for the 102 cystectomy specimens with TCC only. Among these, 28% were superficial while 72% were muscle-invasive and the papillary TCC usually presented at an earlier stage. Infiltration into the prostate gland was identified in 11% of male patients while coexisting adenocarcinoma of the prostate was observed in another 4.2%. Other types of carcinoma were uncommon. Squamous cell carcinoma, adenocarcinoma and small cell carcinoma accounted for 2.7, 1.8 and 0.6% of all bladder tumours, respectively. A rare case of sarcomatoid carcinoma was also found, but no true sarcoma was documented in this series. Benign lesions included five inverted papillomas, three nephrogenic adenomas, two paragangliomas and one haemangioma.     

KIDNEY TRANSPLANTATION IN CHILDREN: A SINGLE CENTER EXPERIENCE

PURPOSE: We reviewed our most recent 10-year experience with kidney transplantation in children to determine the morbidity and mortality of the procedure, and to identify factors that affected outcome. MATERIALS AND METHODS: A total of 107 renal transplants were done in 95 children 1 to 17 years old (mean age 10.9) during the 10-year period ending January 1, 1997. The 4 most common causes of end stage renal disease were renal dysplasia, reflux nephropathy, obstructive uropathy and systemic immunological diseases. Cyclosporine based immunosuppression was used in all but 2 recipients. After April 1991 antilymphocyte antibody induction, coagulopathy screening, systemic anticoagulation and cytomegalovirus prophylaxis were incorporated into the protocols. The effects of kidney source, recipient gender, recipient age, preformed anti-HLA antibody level, preemptive renal transplantation, cytomegalovirus risk, antilymphocyte antibody induction therapy and date of renal transplantation on kidney graft survival were examined with the log rank test. RESULTS: The 1-year graft and patient survival rates were 91 and 99%, respectively. The most common causes of graft failure were rejection and recurrence of primary renal disease. The only factors that significantly (p < 0.05) influenced graft survival were antilymphocyte antibody induction immunosuppression and kidney transplantation after April 1991. Three urological complications required surgical correction. Medical morbidity included hypertension in 48.6% of the cases, short stature in 46.6% and obesity in 58.9%. CONCLUSIONS: Pediatric renal transplantation can be done with acceptable morbidity, a low rate of technical complications and low mortality. Hypertension, chronic rejection and abnormal body habitus continue to be problematic.     

CYSTIC TUMOURS OF THE PANCREAS: A DIAGNOSTIC DILEMMA

Background : Cystic neoplasm of the pancreas is an uncommon entity that encompasses a range of tumours with varying potential for malignancy. These tumours are frequently misdiagnosed as pseudocysts and are inappropriately managed. Methods : A retrospective review was undertaken of 18 cases of cystic tumours of the pancreas over an 8-year period in two large hospitals in Singapore. Results : All patients were Asian, with a younger age group (mean 43.5 years) and a lesser degree of female predominance (3.5:1 ratio) compared to other series. Pain was the most common symptom. Pre-operative diagnosis using ultrasound and computed tomography was not diagnostic in half of the cases and misdiagnosed as pseudocyst in a sixth. There were five serous cystadenomas, four mucinous cystadenomas, two mucinous cystadenocarcinomas, one mucinous cystadenocarcinoma with cystic degeneration in a ductal adenocarcinoma, three Frantz tumours, one acinar cell tumour, one glucagonoma, and one benign epithelial cyst. Two-thirds of tumours were malignant or had the potential to become malignant. Resection was curative in all cases, and no recurrence was noted at a mean follow-up of 34.5 months. Conclusions : The difficulties with pre-operative diagnosis, the high incidence of tumours with potential malignancy, and the good outcome with resection, suggest that all suspected cystic tumours of the pancreas should be resected.     

15例小儿肝脏原发性恶性肿瘤诊治体会

目的 探讨小儿肝脏原发性恶性肿瘤的临床特征及诊治经验。方法 对15例小儿肝脏原发性恶性肿瘤患者临床资料回顾性分析，其中10例为小儿肝细胞癌，5例为肝母细胞瘤。结果 小儿肝细胞癌与小儿肝母细胞瘤在患者年龄，肿瘤大小，HBsAg和AFP阳性率，有无合并肝硬化．病理特征等方面有差异。结论 乙肝病毒感染是小儿肝细胞癌的重要病因小儿肝细胞癌与小儿肝母细胞瘤临床影像病理特征有差异；小儿肝脏原发性恶性肿瘤的有效治疗方式是手术切除。