Extragonadal germ cell tumors: clinicopathologic findings, staging and treatment experience in 14 patients

Extragonadal germ cell tumors (EGCT) are a rare group of neoplasms histologically identical to testicular counterparts. Fourteen cases of primary mediastinal and retroperitoneal germ cell tumors were treated with chemotherapy and radiotherapy between 1987 and 1999 in Ankara Oncology Hospital. There were 9 (64%) complete remissions (CR),one (7%) partial remission (PR) and 2 (14%) stable diseases (SD). The remaining 2 patients were lost due to dissemination of disease. The median duration of response was 19 months. Our modified chemotherapeutic results were similar to original doses of PVB and BEP but toxicity was less. The neccesity of a uniform staging system and treatment programs are discussed.     

What is the best predictor of postoperative erectile function in patients who will undergo coronary artery bypass surgery?

PURPOSE: The aim of this prospective study was to evaluate the impact of extracorporeal circulation and cross clamping period on erectile function in patients undergoing coronary artery bypass surgery (CABS). MATERIALS AND METHODS: A total of 50 patients undergoing CABS were evaluated in this prospective study. Before and 6-12 months after the CABS, patients were interviewed for erectile dysfunction (ED) using the International Index of Erectile Function (IIEF). Scoring the IIEF domain of erectile function allowed the classification of each patient as having no (26-30), mild (17-25), moderate (11-16) or severe (0-10) ED. Patients with normal, mild and moderate ED score were designated as group A, B and C, respectively. Patients were classified in 2 groups to evaluate the impact of extracorporeal circulation and cross clamping period on erectile function in patients undergoing CABS. Patients who had no change in ED score in group A and patients who had recovery in group B were included in group1. Patients who had impaired ED score in group A and group B were included in group 2. All patients were also interviewed for sociodemographic and relevant medical history. Sociodemographic data were age, job, marital status, alcohol, narcotic and smoking habit. Medical risk factors were diabetes, hypertension and psychiatric disorders. RESULTS: The mean age of patients included in the study were 46,6 (range 31-55). After the operation, 3 (7.5%) of 41 patients in group A had moderate, 1 (2.5%) had mild and 37 (90%) had no change in ED score. In group B, 2 (28%) of 7 patients had moderate, 4 (57%) had recovery in ED score, 1 had no change in ED score. There were only 2 patients in group C and 1 had severe, the other one had mild ED after the operation.The mean operation period was 234.8 m inutes in group 1 and 280 min in group 2. Cross clamping period and extracorporeal circulation of patients in group 1 and 2 were 33.2, 41.6 min and 54.7, 64.6 min, respectively. The groups were not statistically different with regard to mean operation, cross clamping and extracorporeal circulation period. CONCLUSION: Preoperative erectile function seems to be the best predictor of postoperative erectile function in patients who will undergo CABS.     

Diagnosis of epiphrenic esophageal diverticulum by computed tomography

Epiphrenic diverticulum is typically demonstrated by computed tomography examination as a thin walled, air or air-fluid filled structure communicating with the esophagus. However, those not associated with a distal esophageal obstruction (stricture, achalasia) may remain contracted in resting state and thus may not be visible. Occasionally the diverticulum may have to be differentiated from mediastinal abscess or tumors and even hiatus hernia.