Left renal pelvic tumor 32 years after calyco-ileo-vesiconeostomy

This is a case report of left renal pelvic tumor found 32 years after left calico-ileo-vesiconeostomy. The patient has undergone right nephrectomy for absence of renal function at 26 years-old and left urinary reconstruction was performed using the intestine for pyelo-ureteral junction obstruction at 28 years old because of bilateral congenital hydronephrosis. Later he was treated for recurrent left renal stone with percutaneous nephrolithotripsy, nephrolithotomy and extracorporeal shock wave lithotripsy. When he was 56 years old, macrohematuria appeared. He received left nephrectomy under the diagnosis of left renal pelvic tumor.     

Psychosocial adjustments 5 years after burn injury

The present study investigates factors influencing the quality of life and social reintegration of burn victims. A study concept was developed to assess the functional and aesthetic long-term outcomes of burn victims. Objective data from a clinical examination was correlated with subjective data from completed questionnaires. The success of social rehabilitation was documented and an indicative profile of life quality evaluated. This profile could prompt early intervention if found necessary. Ninety-two patients were examined 5.4+/-1.1 years after trauma in relation to three factors: physical functions, localization of the burn injuries and extent of the body surface area burned. Physical functioning allows the best predictions for successful rehabilitation, because all areas of life quality are affected by it. Localization of burns in the face and hands creates disadvantages in social reintegration. Of less value in prediction is the extent of the body surface area burned, which is only closely linked to occupational rehabilitation and directly correlates to physical functional limitations. Our correlation showed, that even slight functional limitations were linked to severe depressions, similar to the values found with patients with serious functional impairment. Interdisciplinary cooperation between plastic surgeons and psychosomatic specialists will optimize early intervention with patients exposed to social maladaptation.     

Total hip replacement after tumor resection--30 years experience

The authors report their experience with 161 cemented total hip replacements after tumor resections around the hip implanted between 1971 and 2001 in patients from aged 10 to 79 years. At first, the long stem Protek module was used and since 1980 the Czech made long stem Poldi endoprosthesis has been implanted. A cemented UHMW polyethylene cup has been used with both stems. 66 THR were implanted for primary tumors from which 47 were malignant. 3 Protek and 2 Poldi stems fractured. Early dislocation was common with standard cups; therefore the authors recommend anti-luxation cups with higher rims in all surgeries to enable early ambulation. They also observed better long-term results with the cup slightly in varus. Multiple reimplantations are to be expected when THR is implanted before skeletal maturation, but they are not a problem. The Poldi model is an excellent cost effective solution, especially for secondary malignant tumors around the hip. In the sixties hemiarthroplasty was usually the only chance for a good functional salvage after tumor resections of the proximal femur. Since the seventies special long stems have been developed. Continuous follow up of these surviving patients is important for further development of this special field of endoprosthetics.     

Metachronous testicular tumor developing eight years after retroperitoneal extragonadal germ cell tumor

Abstract:   A 30 year-old man was admitted to our hospital with a chief complaint of left flank pain. Computed tomography revealed a retroperitoneal tumor. Levels of lactic dehydrogenase, human β-chorionic gonadotropin, α-fetoprotein, DUPAN-2 and carbohydrate antigen 19–9 were elevated. No abnormal findings were present according to palpation and ultrasonography of the testes. The patient was diagnosed as having a retroperitoneal extragonadal germ cell tumor (EGCT) considering the elevated markers. Resection of the tumor, two cycles of neoadjuvant and one cycle of adjuvant chemotherapy (cisplatin and etoposide) were performed. The surgical specimen showed total necrotic tissue. Eight years later, the patient noticed an enlargement of his left testicle. The tumor felt elastic and firm on his left testis. Neither distant metastasis nor lymph node metastasis was present according to computed tomography. Left high orchiectomy was performed and histology revealed seminoma. Twenty-three cases have been reported previously about metachronous testicular tumor developing after retroperitoneal EGCT. We report the 24th case.     

Testicular germ cell tumor seven years after a retroperitoneal germ cell tumor.

A 44-year-old male was diagnosed in August 1980 as having a retroperitoneal germ cell tumor (classic seminoma with anaplastic areas). After treatment with cisplatin-based chemotherapy, he reached complete clinical and pathological remission. Eighty-eight months later, in December 1987, he was diagnosed as having a testicular mixed germ cell tumor (embryonal carcinoma with anaplastic seminoma areas) after right orchiectomy. The potential mechanisms by which the latter tumor could have developed are discussed.     

肝移植5年后生存影响因素分析

目的评估我院肝移植患者长期生存情况,分析肝移植5年后生存质量的影响因素。方法回顾性分析2000年3月至2007年8月完成46例生存超过5年的肝移植病例,分析死亡原因、各种并发症情况。结果生存超过5年的46例患者中,死亡4例,其中胆道并发症2例,重症乙型肝炎1例,心肌梗塞1例,各种并发症:高脂血症8例,高血压7例,糖尿病3例,胆道并发症6例,乙肝复发3例,肾功能损害2例,心肌梗塞1例。结论胆道并发症、乙肝复发及免疫抑制剂副作用是影响肝移植5年后生存质量的主要因素,加强多学科长期临床随访指导,低剂量免疫抑制剂联合应用是提高肝移植5年后生存质量的重要因素。     

Migration of the Duraloc cup after 5 years

The Duraloc cup is a frequently used metal-backed, porous-coated, hemispherical, press-fit acetabular component. Published data on loosening rates are contradictory. In this study we investigated migration patterns with computer-assisted Einzel-Bild-Roentgen-Analyse (EBRA) of 67 Duraloc 100 cups. Cup migration and clinical scores were analysed over a 5-year follow-up period. Median total migration of the Duraloc 100 cup was 1.21 mm at 5 years. Seventy-five percent of implants were radiologically stable at 2 years and 90% at 4 years. One cup loosened aseptically at 60 months, requiring revision. Cup diameters > or = 54 mm migrated significantly more than cups < 54 mm in diameter (p = 0.029 at 4 years). There was a significant correlation between high polyethylene wear and further migrating cups within the first post-operative year (p = 0.035 at 12 months). Our analysis revealed significantly higher wear in males (p = 0.029 at 4 years). Radiological loosening at two years could be calculated using receiver-operating characteristic curve analysis, and 1.2 mm as an adequate threshold value (sensitivity = 100%, specificity = 89%).     

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1　病历简介病人女性 ,66岁。 5年前因胆囊结石在外院行腹腔镜胆囊切除术 (LC) ,术后反复出现上腹疼痛 ,伴恶心、呕吐。解痉药可缓解 ,多次行胆道超声及血生化检查 ,均未见异常。此症状持续 1年半后缓解 ,近 2年又出现上述症状 ,且较前次症状加重。无巩膜黄染 ,严重时解痉药甚至镇痛药仍不能缓解。入院后行血常规及生化检查 :血WBC 5 1×10 9/L ,血总胆红素 2 8 6μmol/L ,间接胆红素 2 1 7μmol/L ,碱性磷酸酶 3 0 9U/L ,谷丙转氨酶 161 5U/L。肝胆超声检查未见异常 (胆总管直径 0 7cm ,未见结石影 ) ,拟行ERCP检查 ,因病人对粘膜…     

Torsion of the contralateral testis 5 years after orchiopexy

We report a case of spermatic cord torsion in the contralateral testicle 5 years after surgical fixation. Since diagnosis of such a lesion is difficult a high degree of suspicion is necessary. If torsion is suspected exploration is mandatory. We strongly recommend the use of a nonabsorbable reaction-producing suture (for example silk) when an orchiopexy is performed, with the point of fixation being between the visceral tunica vaginalis and the dartos muscle.     

Ossifying fibromyxoid tumor of soft parts is disease free for 7 years after tumor resection

We reported a case of the ossifying fibromyxoid tumor of soft parts which occurred in the anterior chest wall in a 70-year-old Japanese woman. Radiographic examination revealed that it demonstrated a large oval mass with well-circumscribing shell-like margin. Macroscopic findings showed that the specimen revealed a multi-lobular structure with surrounding bone formation. Spindle or oval hypocellular fibroblastic cells in a myxoid background were observed in the histological examination. Those cells were positive for keratin and S-100 protein. On these bases, the tumor was diagnosed as an ossifying fibromyxoid tumor of soft parts. No local recurrence of the tumor has been observed at seven years postoperatively. As the histogenesis and the clinical characteristic of the tumor remained obscure, total tumor resection and regular clinical follow up has to be the appropriate management of the tumor at present.     

Metastatic lung tumor developing 15 years after resection of invasive thymoma

A 57-year-old man with myasthenia gravis had undergone extended thymothymomectomy for invasive thymoma and postoperative irradiation 15 years ago. At present, an abnormal shadow on his left lung field on chest X-ray and an elevated SCC-Ag level led us to suspect primary lung cancer (squamous cell lung cancer). He underwent left lower lobectomy and partial resection of the upper lobe. After the operation, this tumor was indentified pathologically as a thymoma. Comparing this tumor with the previous invasive thymoma, we concluded that the present lesion was a metastasis of the former thymoma. This case suggests that a metastatic lung tumor should be suspected when an abnormal shadow is detected on chest X-ray following extended thymothymomectomy for invasive thymoma.     

Outcome and quality of life 5 years after major trauma

BACKGROUND: This study aimed to determine quality of life after injury and identify factors potentially associated with outcome. METHODS: Five years after injury from blunt or penetrating trauma, patients received a questionnaire based on the SF-36 Health Survey. RESULTS: Two hundred five patients (83%) replied. Most were men, median age 39 years, 93% injured by blunt energy, median Injury Severity Score 14 (range 9-57). Mean SF-36 scores were significantly lower than in a matched reference group. Poor outcome was associated with: in-hospital days, intensive care days, surgical procedures, in-hospital major complications, age, recurrent injury, and inadequate information. Subjects reported considerable physical (68%) and psychologic (41%) disabilities. Near half reported need of improved follow-up care. Injury severity did not predict poor health-related quality of life 5 years later. CONCLUSION: Adequate information, sufficient pain management and follow-up by trauma specialist teams are needed. Certain factors can help identify patients in need of additional help and support.