Squamous cell carcinoma of the eviscerated bladder: a case report.

This is a report of a squamous cell carcinoma of the eviscerated bladder in a 52-year-old-Thai man. He had a history of pelvic fracture and failed urethroplasty. The bladder mucosa was eviscerated out from cystostomy tract after the spontaneous dislodging of the cystostomy tube. Squamous cell carcinoma developed at the eviscerated bladder 5 years later. The treatment consisted of radical cystectomy and ileal conduit with combination of radiotherapy. The patient died 7 months after operation due to liver metastasis. Correction or excision of the eviscerated bladder can prevent this kind of cancer.

The organization of Kidney Transplantation Services at Ramathibodi Hospital: fourteen years experience on waiting list, kidney donors and kidney transplantation.

The Kidney Transplantation Program at Ramathibodi Hospital was established in 1985. By the end of 1998, there were 1,614 patients on the cumulative waiting list. The first kidney transplantation (KT) was started in 1986 by using kidney from living-related donor (LD) while cadaveric KT (CD-KT) was started in 1987. A total of 528 KT were done, 278 cases (52.7%) were CD-KT and 250 cases (47.3%) were LD-KT. Six patients had two kidney transplants. 278 kidneys were donated from 189 cadaveric donors. Fifty cadaveric donors (26.4%) were from Ramathibodi Hospital while the rest were from other hospitals and the Organ Donation Center, Thai Red Cross Society. For LD, 233 out of 250 (93.2%) were from living-related, more than 50 per cent of these donors were from siblings. 17 spousal donors have been accepted for KT at Ramathibodi Hospital since 1997. Concerning the recipient pools, 522 patients (32.3%) were transplanted, 123 patients (7.6%) died without KT, 111 patients (6.9%) underwent KT at other hospitals, and 78 patients (4.8%) changed to waiting lists at other hospitals. The rest were lost to follow-up. At present, only 265 patients are still actively waiting (send serum every month). The number of KT and living donors has gradually increased, whereas, the number of cadaveric donors has decreased. However, cooperation with the "Organ Donation Center" has improved the number of cadaveric donation in the last two years. Sufficient organ donations and an active working team will provide a good kidney transplant service for the patients.

Ileal interposition for the treatment of a long gap ureteral loss.

We retrospectively reviewed 10 patients (7 males and 3 females) who were treated with ileal interposition for long gap ureteral loss between 1989-1995. The mean patient age was 42 years old (35-52), mean ureteral gap was 18 cms (10-25). The etiology of ureteral loss included: 4 retroperitoneal fibrosis, 2 recurrent stone, 2 after pancreatitis and its complication and 2 after ureteral injury. The mean follow-up was 4 years (2-7). The post operative course was uneventful with no immediate and long term complications detected and there was no metabolic problem. Only asymptomatic bacteriuria in 5 cases (50%) was noted but it was not clinically significant.

Renal artery embolism: therapy with intra-arterial streptokinase infusion.

Two patients with acute renal artery embolism were reported. One patient had a history of rheumatic valvular heart disease and the other patient had hereditary cardiomyopathy. Both patients had atrial fibrillation on physical examination. Both patients presented with acute back pain and one patient had hematuria. The final diagnosis of acute renal artery embolism was made after one to three days of hospitalization and renal angiography was finally done documenting complete occlusion of the main branch of the renal artery on one side. Intra-arterial streptokinase infusion 5,000 unit per hour was given to both patients using an arterial pump for 17 hours to 30 hours with complete recanalization of the intrarenal branches and complete recovery of signs and symptoms of renal artery embolism although the renal scan still showed diminished renal function.