A giant primary thyroid fibrosarcoma in an octogenarian.

We present an 89-year-old patient who was suffering from severe dyspnoea and mild dysphagia due to tracheal and esophagus compression by a giant goitre. The patient was euthyreotic. A total thyroidectomy was successfully performed. The pathology examination revealed fibrosarcoma G1, which is an extremely rare tumor of the thyroid.

In situ revascularisation with silver-coated polyester prostheses and arterial homografts in patients with aortic graft infection--a prospective, comparative, single-centre study.

OBJECTIVE: The aim of our study was to evaluate the effectiveness of in situ revascularisation with the use of arterial homografts and silver-coated prostheses in the treatment of aortic graft infection. MATERIALS: A total of 77 consecutive patients (74 males, three females, mean age: 58 years), hospitalised between 2001 and 2008, were enrolled into the study. Patients were assigned to three groups: group 1 (n = 24)--fresh arterial homograft with subsequent immunosuppression, group 2 (n = 26)--fresh arterial homograft without immunosuppression and group 3 (n = 27)--silver-coated prosthesis. METHODS: The course of infection was assessed by scintigraphy with (99m)Technetium-labelled leucocytes, Duplex-Doppler ultrasound, angio-computed tomography (CT) and microbiological examination. RESULTS: The mean follow-up was 22.8 (±10.1) months. There was a significant decrease in leucocyte accumulation around the graft among all groups (group 1: p = 0.012, group 2: p = 0.006 and group 3: p = 0.021). The postoperative mortality rate in groups 1,2 and 3 was 8%, 23% and 11%, respectively. The postoperative morbidity was 35% in group 2, 16% in group 1 and 7% in group 3. CONCLUSION: Our study suggests that silver-coated prostheses can be as effective as arterial allografts in the treatment of infections of vascular prostheses.

Haemorrhagic cystitis as a complication after allogenic bone marrow transplantation.

OBJECTIVE: The main objective of the following work is to present our own material and the ways in which we have dealt with haemorrhagic cystitis (HC) following allogenic bone marrow transplantation in children. MATERIALS AND METHOD: From 1994 to 2002, allogenic transplantation of haematopoietic cells was performed in 129 children at the Oncological and Haematological Child Clinic, Wroclaw University of Medicine. The procedure was carried out in patients with neoplastic diseases. In 33 cases, HC symptoms of various intensity were observed. The intensity of the symptoms was evaluated according to Arthur's four-point scale. To confirm the diagnosis USG was carried out in each case. Special attention was given to the ultrasonographic structure of the bladder wall. Cartoni's technique was followed in the examination. RESULTS: Out of 129 children who underwent allogenic transplantation of haematopoietic cells 33 (20.75 %) revealed HC symptoms. The symptoms occurred between the 2nd and the 124th day after transplantation (mean 29 days). The treatment included antiviral medicines, estrogens, reduction of immunosuppression and mechanical urological procedures. The children diagnosed with 2nd grade disease and higher were catheterised and diuresis was forced by the administration of larger amounts of liquids intravenously. Antihaemorrhagic drugs and vitamin K were also given. Blood was substituted if needed as were blood derivatives. Eighteen children with massive haematuria with clots underwent catherisation with a suprapubic catheter so as to continuously rinse the bladder. In 8 cases tamponade of the bladder occurred. The clots were removed from the bladder during cystoscopy under general anaesthesia. Twelve children died from HC. This amounts to 36 % of all the cases identified as HC and 9 % of all the children who underwent allogenic marrow transplantation. CONCLUSIONS: In conclusion it must be emphasised that HC in children after allogenic transplantation of haematopoietic cells is an extremely severe disease, which, if not cured, is terminal. The decision whether to perform embolisation of internal iliac arteries or to remove the bladder when non-radical methods have been exhausted, is worth considering.

Malignant tumours in a horseshoe kidney in children: a diagnostic dilemma.

INTRODUCTION: Although malignant tumours in a horseshoe kidney are fairly common, both diagnosis and treatment are often difficult. The most frequently described tumour in children with this anomaly is nephroblastoma, but renal cell carcinoma and others can also occur. More than a hundred such cases have been presented in the English literature on the subject since Hildebrandt described nephroblastoma in a horseshoe kidney for the first time in 1895. Many of the articles report diagnostic and therapeutic problems. AIM: Our intention is to describe five more cases from our own experience. The cases involve malignant tumours in a horseshoe kidney. MATERIAL: Three children suffered from nephroblastoma, the other two had RCC. The tumours were particularly noted out of a total of 500 cases of nephroblastoma and 22 cases of other malignant tumours treated in Poland between 1993 and 2000. We also report here the treatment outcome of one case treated 30 years ago in our Clinic. CONCLUSION: Diagnostic and surgical procedures involved in the treatment of malignant tumours in the horseshoe kidney are complex and challenging. Only a few oncological centers cooperating with child urologists can provide comprehensive and effective treatment.

Extrarenal Wilms tumour.

INTRODUCTION: Nephroblastoma is one of the most common solid tumours in children. It also is the most frequent tumour found in the kidneys. In 5 % of cases it affects both kidneys at the same time. About 70 - 80 new cases of Wilms tumour are registered in Poland annually, usually in patients aged from 1 to 7 years. Extrarenal Wilms tumours are extremely rare. Due to its rarity, series with more cases are based upon material collected from many clinical centers. AIM: We would like to present a case of a boy in whom we diagnosed nephroblastoma in the retroperitoneal space 14 years after he had completed a complex therapy for bilateral Wilms tumour. CONCLUSION: The development of an extrarenal tumour 14 years after complex treatment for bilateral nephroblastoma is related to the survival of metanephros located outside the kidney.