Management of adult Leydig-cell testicular tumors: assessing the role of laparoscopic retroperitoneal lymph node dissection

BACKGROUND AND PURPOSE: Leydig-cell tumors represent <5% of malignant testicular tumors in adults. Orchiectomy is curative in approximately 90% of cases; however, the remaining men can develop metastases refractory to chemotherapy and radiation. We evaluated the role of laparoscopic retroperitoneal lymph node dissection (RPLND) in adult Leydig-cell tumors. PATIENTS AND METHODS: Between 1999 and 2001, laparoscopic RPLND was performed with four transperitoneal ports within a unilateral template for six patients with pure Leydig-cell tumors. Presenting signs and symptoms, operative time, blood loss, intraoperative complications, postoperative complications, length of hospitalization, pathology reports, ejaculatory function, and survival were reviewed retrospectively. RESULTS: Laparoscopic RPLND was successful, without open conversions or reinterventions. Two vascular injuries occurred during dissection; additional intraoperative complications were not observed. Postoperatively, one patient developed erysipelas, but no other postoperative complications were recorded. The mean operative time was 190 minutes, and the mean length of hospitalization was 4.3 days. Pathologic analysis of lymph nodes revealed no evidence of metastatic Leydig-cell tumor. At 12 months' mean follow-up (range 3-29 months), no recurrences have been identified. CONCLUSIONS: Laparoscopic RPLND is a safe, minimally invasive procedure for Leydig-cell tumors. Additional clinical experience is required to evaluate its effectiveness for pathologic stage II tumors and to determine if a therapeutic advantage can be realized with a protocol employing laparoscopic RPLND for adult Leydig-cell tumors.     

Anesthetic management for surgery of patients with metastatic brain tumors associated with lung tumors

We had four patients who received anesthesia for metastatic brain tumors. All patients were complicated with primary lung tumors which had caused several respiratory problems. Respiratory failure and intratracheal hemorrhage from lung tumors were the severest complications during and after the operation. Two patients suffered from pneumonia at early postoperative stage and died of respiratory failure within eighty days after the operation. We consider that these preoperative findings of atelectasis and hemosputum are important signs that could predict those severe complications. To avoid postoperative respiratory complications in patients with atelectasis, the anesthetist should perform careful perioperative management such as active preoperative pulmonary physical therapy and should choose anesthetics which do not affect postoperative consciousness and respiration, and should perform intensive postoperative respiratory care. To prevent pulmonary hemorrhage, the fiberoptic bronchoscopy is useful for the diagnosis and the therapy. We also consider that the long operation aggravates postoperative complications. Planning of operation and performing operative procedure in a shortest time possible are also important.     

Resection procedures in liver tumors--intraoperative dilemmas and complications

Liver resection surgery for tumors has many dilemas and possible intraoperative complications that surgeon has to deal with during his work. Objectives of this work was to, according to our experience, and pointing to a certain anatomical and technically essential moments, makes possible easier decission making concerning the indications, with safer work. Also, we wanted to suggest how to deal with possible complications during the operations.     

Urologic complications of pelvic irradiation

We evaluated 964 patients who had undergone radiation therapy for malignant disease of the pelvic viscera during a 5-year period and who ahd been followed for 5 to 10 years after completion of treatment. Therapy had been given for gynecological tumors in 493 cases, genitourinary tumors in 240 cases, bowel tumors in 172 cases and various other malignant tumors in the pelvis in 59 cases. The incidence of cystitis, hematuria, ureteral obstruction and fistula formation was determined for each group. There were 203 urological complications, an incidence of 21 per cent, but only 25 of these complication (2.5 per cent) could be ascribed to the effects of radiation alone, the remainder being associated with persistent or recurrent tumor. Approximately 20 per cent of the patients had some abnormalities detected in the pre-treatment excretory urogram. The development of urologic complications was related to the radiation dosage and previous bladder operations.     

成人骶尾部肿瘤34例诊治体会

目的探讨骶尾部肿瘤的诊治经验。方法收集我院2004年6月至2007年6月间诊治的34例成人骶尾部肿瘤资料,分析其诊断方法、手术方式、术后病理特点。结果全部病例获手术切除;术后5～8d出院,未发生手术并发症,无死亡病例;28例获随访1～3年,无肿瘤复发。结论骶尾部肿瘤缺乏特异性的临床表现,诊断主要依靠影像学检查,经骶尾部人路多可满足手术要求。     

腹腔镜左侧结肠良恶性肿瘤手术的临床分析

目的:探讨腹腔镜左侧结肠肿瘤切除术的临床应用价值。方法:回顾性分析2008年3月至2009年12月新华医院肛肠外科收治之54例腹腔镜下左侧结肠的良恶性肿瘤切除的临床资料。结果:全部病例均顺利完成手术,无重大术中并发症发生。平均手术时间(160±35)min;术后并发症8例,其中切口感染6例,淋巴漏1例,性功能障碍1例。病人平均住院天数为9.5 d。所有病例随访至今,无切口种植,无局部复发,无远处转移及死亡病例。结论:腹腔镜左侧结肠肿瘤切除是临床上较安全可靠的手术方式。     

Left ventricular papillary fibroelastoma—a case report

Cardiac Papillary fibroelastomas are rare benign tumors. They may be incidental discoveries during echocardiography or may present with cardioembolic complications. Surgical resection is strongly advocated.     

Imaging of benign complications of exostoses of the shoulder,pelvic girdles and appendicular skeleton

Exostoses are the most common benign bone tumors, accounting for 10 to 15% of all bone tumors. They develop at the bone surface by enchondral ossification and stop growing when skeletal maturity has been reached. At first, exostoses are covered by a smooth cartilage cap that progressively ossifies with skeleton maturity. Then they may regress, partly or even completely. Osteochondromas may be solitary or multiple, with the latter associated with hereditary multiple exostoses (HME). Exostoses develop during childhood and become symptomatic during the third decade of life in the case of solitary exostoses, or earlier, in case of HME. They stop growing after puberty, when the epiphyseal plates close. Most exostoses remain asymptomatic. Local complications, usually benign, may occur, such as fractures or mechanical impingements upon nearby structures. In rare cases, sarcomatous degeneration occurs. Most of these complications have been described in case reports. This article describes the imaging features of benign complications of exostoses of the shoulder, pelvic girdles and appendicular.     

Detection of multiple cardiac papillary fibroelastomas using transesophageal echocardiography

Papillary fibroelastomas are rare, benign cardiac tumors that may be associated with embolization, angina, and sudden death. We report a case of multiple papillary fibroelastomas diagnosed during life by transesophageal echocardiography. Surgical resection during mitral valve replacement for rheumatic mitral stenosis prevented the development of any of the life-threatening complications sometimes associated with this tumor.     

经腹腔途径腹腔镜肾上腺切除术的临床研究

目的 探讨经腹腔途径腹腔镜肾卜腺切除术的临床应用,疗效及安全性.方法 本组68例患者行经腹腔途径腹腔镜肾上腺切除术.记录手术时间、术中估计出血量、术中并发症、术后并发症、留置引流管时间、术后住院时间和术后病理等临床资料,并对结果进行分析.结果 68例手术均由腹腔镜完成,无转开放病例.平均手术时间(157.7±51..5)min,平均术中出血量(68.1±54.2)ml.术后留置引流时间(2.6±1.5)d,术后平均住院时间为(8.7±4.3)d.术后有2例(3.0%)引流管口愈合延迟.4例(6.0%)术区积液,没有经过外科干预恢复.随访期间患者对腹腔镜肾上腺切除术治疗反应良好.结论 经腹腔途径腹腔镜肾卜腺切除术是一种安全可行的治疗肾上腺肿瘤的手术方式.     

Successful patient outcome following surgery of carotid body tumor and temporary hypoglossal nerve dysfunction

Carotid body tumors, also known as paragangliomas or chemodectomas, are rare tumors. They are mostly benign slow-growing tumors arising from neural crest cells, but can give rise to complications because of their location and close relation to carotid vessels and cranial nerves. A 40-year male patient diagnosed with a carotid body tumor is discussed along with a review of cranial nerve complications associated with the management of carotid body tumors. This case highlights the complete recovery after a temporary hypoglossal nerve deficit following surgery. Another important aspect is that syncopal attacks might occur in carotid body tumors and early surgery is required to prevent complications.     

Neurological Complications of Childhood Malignancies

Between Jan 1982 to Jun 1994, 154 children with malignant non-central nervous system tumors, excluding leukemias and lymphomas, were admitted and treated at the UKMC. Fifty-one (33%) of these cases suffered with 64 neurological complications during the course of their diseases. Nine cases suffered with multiple neurological complications. Nervous system metastasis was the most common neurological complication (n = 24; 15.6%), which was followed by nervous system infection (n = 17; 11%). Twelve (7.7%) cases had treatment related peripheral or cranial neuropathies. Seven (4.5%) cases had new onset of grand-mall seizures. One case had paraneoplastic syndrome, one case had panhypopituitarism secondary to whole brain radiation, and one case had Horner's syndrome secondary to tumor removal. Ten cases suffered with neurological sequelae secondary to neurological complications. Three of these cases suffered with developmental delay and mental retardation. Fifty-one patients with neurological complications were followed for 9 to 102 months. While 30 (19.7%) patients were alive, 20 (13%) patients died and one case was lost during the analysis of the results. Neuroblastoma/ganglioneuroblastoma has the highest rate for causing neurological complication. In conclusion: neurological complications were seen on 33% of childhood solid malignant tumors. Nervous system metastasis had the worst prognosis and the most frequent neurological complication. Neurological complications did not increase the mortality rate, but one-third of surviving patients with neurological complications suffered with neurological sequelae.     

Mediastinal tumors in children: apropos of 2 cases

General anesthesia in patients with mediastinal tumors has specific problems that need careful evaluation before surgery. Sometimes, mediastinal masses may result in life threatening complications, such as upper airway obstruction, superior vena cava syndrome, cardiac or pulmonary artery compression and acute pulmonary edema. After a review of the literature related to death during general anesthesia in children with mediastinal tumors, we emphasize the importance of the agreement between oncologists, surgeons and anesthesiologists for a sound diagnosis of these patients. We report two patients which illustrate the possibility of airway obstruction during anesthesia. The first was a 13-year-old female with an anterior and mean mediastinal tumor who had severe respiratory complications during general anesthesia for biopsy of cervical lymphadenopathy . The second patient was a 2-year-old female with anterior mediastinal and paratracheal masses and severe respiratory compromise, who was operated under general inhalation anesthesia and spontaneous breathing for biopsy of supraclavicular lymphadenopathy, after a meticulous preanesthetic evaluation. In these patients, the anesthetic procedure is a challenge to the anesthesiologist. Inhalation induction in a half seated position is recommended, maintaining the patient with spontaneous ventilation with halogenated agents and avoiding muscle relaxants.     

Timing of percutaneous endoscopic gastrostomy tube placement in head and neck cancer patients.

Percutaneous endoscopic gastrostomy (PEG) is an effective method for providing alimentation in patients with upper aerodigestive tract carcinoma. Multiple complications of this procedure have been reported, ranging from leakage around the tube to tumor seeding of the abdominal cavity. This study was undertaken to determine whether the timing of PEG tube placement with respect to primary tumor extirpation led to a difference in the number and severity of observed complications. The medical records of 43 patients with head and neck carcinoma who had PEG tubes placed from 1995 to 1996 were retrospectively reviewed. Comparisons of timing of PEG tube placement, complication, location, and stage of the primary tumor were performed. In addition, the use of adjuvant therapy with respect to the time of PEG tube placement and complications was evaluated. Of these, 23% were done before and 30% during surgery at the time of primary tumor resection (9 of 13 were after primary removal). One patient had an intraabdominal abscess. Minor complications occurred in 15 of 43 patients (35%) and included granulation tissue at the PEG site, leakage, and tube displacement. Eight of the 9 patients who underwent intraoperative PEG after tumor resection had no complications. Patients who underwent PEG during or after surgery had significantly fewer complications than those who underwent preoperative PEG or had unresectable tumors (P = 0.038). The largest number of complications occurred in patients who underwent preoperative PEG (57%) followed by patients whose tumors were unresectable (31%). There was no statistical difference with regard to tumor location or postoperative x-ray therapy in PEG complications. This study demonstrates that PEG tube placement after tumor resection has the lowest incidence of postoperative complications. Performing PEGs intraoperatively after tumor resection can prevent the need for additional anesthesia to provide alimentation in patients with upper aerodigestive tract carcinoma.     

Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis

OBJECTIVE: To determine the treatment efficacy, safety, local tumor control, and complications related to radiofrequency ablation (RFA) in patients with cirrhosis and unresectable hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA: Most patients with HCC are not candidates for resection because of tumor size, location, or hepatic dysfunction related to cirrhosis. RFA is a technique that permits in situ destruction of tumors by means of local tissue heating. METHODS: One hundred ten patients with cirrhosis and HCC (Child class A, 50; B, 31; C, 29) were treated during a prospective study using RFA. Patients were treated with RFA using an open laparotomy, laparoscopic, or percutaneous approach with ultrasound guidance to place the RF needle electrode into the hepatic tumors. All patients were followed up at regular intervals to detect treatment-related complications or recurrence of disease. RESULTS: All 110 patients were followed up for at least 12 months after RFA (median follow-up 19 months). Percutaneous or intraoperative RFA was performed in 76 (69%) and 34 patients (31%), respectively. A total of 149 discrete HCC tumor nodules were treated with RFA. The median diameter of tumors treated percutaneously (2.8 cm) was smaller than that of lesions treated during laparotomy (4.6 cm). Local tumor recurrence at the RFA site developed in four patients (3.6%); recurrent HCC subsequently developed in other areas of the liver in all four. New liver tumors or extrahepatic metastases developed in 50 patients (45. 5%), but 56 patients (50.9%) had no evidence of recurrence. There were no treatment-related deaths, but complications developed in 14 patients (12.7%) after RFA. CONCLUSIONS: In patients with cirrhosis and HCC, RFA produces effective local control of disease in a significant proportion of patients and can be performed safely with minimal complications.     

原发性十二指肠恶性肿瘤84例临床分析

目的：探讨十二指肠恶性肿瘤的常见临床表现、诊断及治疗。方法：回顾性分析1995～2002年84例原发性十二指肠恶性肿瘤的临床资料。结果：肿瘤主要分布于十二指肠第二段(61／84)，病理类型以腺癌为主(72／84)，位于乳头附近的肿瘤常引起胆道梗阻，其他部位的肿瘤主要表现为高位肠梗照或消化道出血。胃镜确诊率达到78．9％．十二指肠镜确诊率达到83％，CT确诊率达到84％。50例行胰十二指肠切除，20例行短路手术，7例行局部切除，手术切除率为70%(57/81)。胰十二指肠切除术并发症发生率18％，其他术式较少发生并发症。结论：十二指肠恶性肿瘤症状无特异性．内镜和CT是重要的诊断手段．胰十二指肠切除术是主要治疗术式。     

小肠肿瘤并发症的诊断和治疗

目的：探讨小肠肿瘤并发症的发生及其诊治。方法：回顾性分析1980年1月至2001年6月间收治的47例有并发症的小肠肿瘤的临床资料。结果：47例中恶性肿瘤33例（70％）。并发症包括出血17例、穿孔8例、肠套叠11例、肠梗阻8例、肠扭转1例、腹内疝1例、肠扭转加肠套叠1例。腹痛为主要症状。X线检查是主要诊断手段，B超、CT、MRI也有助于诊断。良性肿瘤行局部肠段切除，恶性肿瘤25例行根治性切除，7例行姑息性切除。2例死于术后全身衰竭。结论：小肠肿瘤早期诊断困难，多数因并发症就诊，外科手术是主要的治疗方法。     

Benign tumors of the esophagus]

The authors make an analysis of 30 observations of benign tumors of the esophagus (1979-1989). In 13 patients the tumors were found occasionally during the X-ray endoscopic examination, in 7 patients only the diagnosis was established on the basis of their complains, medical history and findings of an instrumental examination. A histological investigation has diagnosed leiomyoma in 10 patients, polyps in 7 patients and fibroma in 1 patient. Eighteen patients had single tumors, 2 patients had large tumors causing considerable obturation of the esophagus lumen. The endoscopic electroexcision was performed in 12 patients. No complications were noted. Only two patients were operated upon. Tumor enucleation was performed in 1 patients following laparotomy and gastrotomy. The other patient was subjected to resection of the esophagus after Torek followed by plasty of the large intestine. Long-term results were followed-up during 2-10 years. No recurrent tumors were noted. The endoscopic electroexcision of the benign esophageal tumors is the radical operation which is though to be the method of choice, especially for elderly patients with coexistent diseases.     

Transbasal approach to skull base tumors: evaluation and proposal of classification

A clinical study of the TBA was performed in 22 patients harboring tumors of the skull base. The follow-up ranged from 3 to 89 months (average, 30.5 months). The main complications were intracerebral hematoma, ptosis, and infection. One patient died (4.5%) because of an extradural hematoma. Eight patients died during the follow-up because of tumor complications. Among the survivals, the median of the Karnofsky index was 96.4. Based on this study, we propose a classification for the TBA, according to its extension.     

Evaluation of combined neurosurgical and trans-facial excision of extensive rhinosinus tumors infiltrating the anterior skull base

Rhino-sinusal tumors are rare, representing approximately 0.3% of all cancers and 3% of tumors of the upper respiratory and digestive tracts. In cases in which the tumor has infiltrated the anterior cranial base, the treatment of choice is a surgical resection by combined neurosurgical and transfacial approach giving the best possible exposition for the excision. The resection is associated with various reconstruction techniques according to the extent of the defect. Sixteen patients with rhino-sinusal tumors extending to the anterior cerebral cavity were operated at the ENT clinic of the CHUV in Lausanne between 1977 and 1997. The transfacial and neurosurgical combined approach is rarely curative (30% 5 years survival rate, 80% local recurrence during follow-up), but is still justified, given that its disabling side-effects are scarce. It offers an acceptable quality of life and prevents complications inherent to the natural development of tumors. Pre- or postoperative radio- and chemotherapy, as well as skull base reconstructions using bone grafts or a micro-anastomosed flap give rise to complications which worsen significantly the overall prognosis and should therefore be avoided as much as possible. Still, this heavy surgery remains indicated, because it prevents the numerous complications of the natural course of the disease and offers an acceptable quality of life with only few side-effects.