5-Fluorouracil cardiotoxicity complicating treatment of stage IIB cervical cancer--case report

A 31-year-old female was found to have FIGO Stage IIB squamous cell carcinoma of the cervix. The patient began her prescribed radiation therapy and 5-fluorouracil radio-sensitizing chemotherapy. During the first day of infusion, she began having severe shortness of breath. Cardiac evaluation revealed acute congestive heart failure with a cardiac ejection fraction of 19%. Radiation was continued without chemotherapy. Four years later, the patient is alive and well with an ejection fraction of 53%.     

Endometriosis of ureter-induced recurrent urinary tract infections in a premenopausal woman--case report

Endometriosis of the urinary tract is infrequent. The ureters and kidneys are the least usual place of localization. Endometriosis of the ureter often leads to silent loss of renal function due to delayed diagnosis. We report a case of a premenopausal female with endometriosis of the left distal ureter, presenting an infection of the urinary tract and having reported previous incidents of menorrhagia and left flank renal pain with automatic recession. Pharmacological treatment was applied with a satisfactory outcome. A short review of the literature is presented.     

Penile cancer--case report and literature review

Penile cancer occurs quite seldom, mostly in men around 60 years of age. However penile squamous cell carcinoma is also observed in younger men. Etiology remains unclear but we can recognize some risk factors such as poor hygiene for example. The authors report a case of a patient who refused treatment in early stages of the disease and was treated only after disease progression. Applied surgical treatment, unfortunately proved to be insufficient and the patient was transferred to complete therapy at the oncology department. This case inspired us to recall the basic diagnostic and therapeutic methods used at the time of diagnosis of the penile tumor     

Function of the lower urinary tract in patients after treatment of cervical cancer

OBJECTIVES: Irritation of lower urinary tract--bladder and urethra--is seen as a common risk factor for radiotherapy treatment. Is it possible to reduce miction disorders and urinary incontinence? DESIGN: Functional assessment of the lower urinary tract in women treated with surgery and radiotherapy. MATERIALS AND METHODS: Authors evaluated 25 patients diagnosed with uterus neck cancer treated with surgery or radiotherapy during 1998-2001. Urodynamic assessment was based on uroflowmetry, residual urine volume measurement and cystometry results. RESULTS: Lower urinary tract ailments were present in all 25 patients, in 2 of them they were only temporary--during recovery after surgery. During miction symptoms were reported by 23 patients, 20 patients reported symptoms between mictions. During and after treatment all patients reported the increase in symptoms and changes of urodynamics parameters. CONCLUSIONS: Function of the lower urinary tract are disturbed whilst radiotherapy treatment of uterus neck cancer. Functional diagnostics is important in oncological treatment design and should be evaluated separately for each patients.     

The management of ectopic breast cancer--case report

Ectopic breast tissue occurs when the mammary ridge fails to resolve during embryonic development. Ectopic breasts, either supernumerary or aberrant, have an incidence of 6%. Ectopic breast tissue is however hardly mentioned in the literature. Also benign and malignant alterations in these "breasts" are under-reported. The lifetime risk of women being diagnosed with breast cancer is 13%. It should be recommended that these "breasts" be included in the screening. Due to the unawareness this is generally not happening. The present article describes a case of ectopic breast cancer and discusses therapeutic management. A subcutaneous mass along the 'milk line' should be examined carefully and any suspicious lesions should be approached according to the guidelines for the management of symptomatic breast disease. Ipsilateral prophylactic mastectomy has no role in the management of a single ectopic breast cancer tissue.     

Lower urinary tract function after postoperative radiotherapy in the treatment of cervical cancer

OBJECTIVE: The aim of this study was the urodynamic assessment of lower urinary tract disturbance intensity (especially urinary incontinence) among irradiated women after the surgical treatment of cervical cancer. STUDY DESIGN: The analysis included 34 patients after radical hysterectomy and following radiotherapy for cervical cancer in clinical Stage Ib. Only patients without any previous urogynecological disorders were included. Urodynamic diagnostics was performed two weeks after oncological treatment termination. RESULTS: Urodynamic parameter changes were clearly present at all stages of functional diagnostics. The most remarkable changes included decreased bladder capacity (mean 196 ml) and residual urine volume (mean 19 ml). The mean value of maximal urine flow rate obtained from uroflowmetry was 26 ml/s, but for 20 women it was lower than 20 ml/s. Voiding time and flow time were abnormally delayed with the significant difference of five seconds. Bladder sensation points were increased and maximum cystometric capacity was decreased to 270 ml during filling cystometry. Bladder compliance was 28 ml/cm H2O on average; for the majority of patients it was below 20. Detrusor pressure was increased in 23 cases above 20 cm H2O and mean isometric pressure was 34 cm H2O. Urethral pressures were low, especially while taking effort. Urinary incontinence was diagnosed in 30% of the cases. CONCLUSIONS: The obtained results allow us to conclude that voiding disorders after combined radiotherapy and surgery are often and mainly apply to the detrusor muscle with the domination of functional disturbances. It seems that early quantitative and qualitative changes depend on combined therapy with a standard dose pattern. The presence of functional disorders after oncological treatment should be considered in the planning of prevention and further treatment. Urinary incontinence restricts patients' activity, affects the quality of their lives and is the cause of patient discomfort. Many patients suffering from lower urinary tract pathologies pose a therapeutic problem caused by lack of information.     

Bacterial adherence and immune response in recurrent urinary tract infection.

OBJECTIVE: To study the significance of bacterial adherence and humoral immune response in the pathogenesis of recurrent urinary tract infection in adult women. METHODS: The study population consisted of 30 women with recurrent urinary tract infection (UTI) and 30 healthy women as controls. Bacterial adherence to vaginal epithelial cells was studied. The concentration of serum and urine antibodies against mixed coliform antigen and clinical isolate was determined by enzyme-linked immunosorbant assay (ELISA). The surface hydrophobicity of the organisms was determined. Student's unpaired t-test and Pearson's correlation coefficient test were used in the statistical analysis. RESULTS: There was an increased adherence of bacteria to vaginal epithelial cells of women with recurrent UTI. The SIgA level in urine was low compared with other antibodies. There was good correlation between the level of free urinary IgG antibody and bacterial adherence. CONCLUSIONS: This study showed that increased receptivity of vaginal epithelial cells to pathogens and lower local immunity may play an important role in the pathogenesis of recurrent UTI in females.     

泌尿系统子宫内膜异位症的处理

摘要：泌尿系统子宫内膜异位症已有较多报道,其往往与深部浸润型子宫内膜异位症有关。泌尿系统子宫内膜异位症多伴有严重的泌尿系统症状。泌尿系统的症状往往伴随有子宫内膜异位症的妇科症状。该疾病的诊疗往往需要妇科与泌尿科医师的通力合作。药物治疗仅适用小部分患者,且有一定缺陷。手术治疗能达到病灶切除的满意效果,且患者预后较好,不易复发。     

妇科手术泌尿系损伤的诊断与防治

目的泌尿系损伤是妇科手术最常见的并发症之一。本研究探讨妇科手术中泌尿系损伤的诊断与治疗,以便及早诊断,及早治疗,避免肾功能受损。方法对北京大学人民医院2000年1月至2008年7月间妇科手术进行回顾性分析。结果妇科手术共13380例,共发生泌尿系损伤13例（0．09％）。13例中开腹手术9例／8072例,发生率为0．1％,其中恶性肿瘤6例均为输尿管损伤,良性疾病3例均为膀胱后壁损伤;腹腔镜手术4例／4684例,发生率为0．08％,均为妇科良性疾病,其中输尿管损伤1例,膀胱后壁3例。损伤部位包括输尿管骨盆入口处3例,下段5例,入膀胱壁内段1例。膀胱损伤4例,均位于膀胱后壁。2例术中发现,11例术后经测定引流液肌酐水平及影像学检查确诊,12例均经再次手术修补成功,1例放置输尿管支架3个月保守治疗成功。结论妇科手术泌尿系损伤中最常见的是恶性肿瘤手术,其次是腹腔镜手术,大多数患者经及早诊断、及时处理后,预后较好。