Retroperitoneal ganglioneuroma encasing the celiac and superior mesenteric arteries.

Ganglioneuroma is a rare neoplasm arising from the sympathoadrenal neuroendocrine system and has anatomic distribution paralleling the sympathetic chain ganglia and the adrenal medulla. In some cases, ganglioneuroma is the end stage maturation of less-differentiated neoplasms such as neuroblastoma or ganglioneuroblastoma, but based on age at diagnosis (over 10 years of age) and anatomic location, many of these tumors appear to arise de novo. It must be included in the differential diagnosis of posterior mediastinal and retroperitoneal mass. We report a case of retroperitoneal ganglioneuroma involving the celiac axis and superior mesenteric arteries in a 40-year-old female.

Right laparoscopic donor nephrectomy: the Washington Hospital Center experience.

OBJECTIVES: To review 167 consecutive laparoscopic living donor nephrectomies performed at the Washington Hospital Center to determine whether the side of extraction, right versus left, affects the operative outcomes. METHODS: From January 2003 to June 2005, 167 consecutive patients (127 left and 40 right) underwent laparoscopic living donor nephrectomy. The right-sided and left-sided procedures were compared in the following categories: operative time, warm ischemia time, length of stay, and complications. RESULTS: The mean operative time for a right donor nephrectomy was 220 minutes versus 228 minutes for a left. The mean estimated blood loss was 115 mL for right donor nephrectomy versus 106 mL for the left. The corresponding mean warm ischemia times were 5.32 minutes and 4.91 minutes. The median length of stay was 3 days in both groups. Five minor and three major complications occurred, including 2 patients with recognized bowel injuries and 1 patient who required reoperation for a bladder injury. CONCLUSIONS: Historically, laparoscopic living donor nephrectomy has been performed solely on the left side because of the increased length of the left renal vein. However, in our experience, the operative parameters and postoperative results were equivalent in the right and left laparoscopic donor nephrectomy groups. Therefore, we recommend removal of the more appropriate kidney, regardless of side.

Does fibrin sealant decrease immediate urinary leakage following radical retropubic prostatectomy?

PURPOSE: We determined the effectiveness of fibrin sealant in decreasing postoperative urinary leakage following radical retropubic prostatectomy performed by 1 surgeon at Washington Hospital Center. MATERIALS AND METHODS: Between April and November 2003 our group treated 32 consecutive patients with prostate cancer with radical retropubic prostatectomy. The first 16 patients (control) underwent the Walsh described technique and the second group of 16 patients had an additional application of fibrin sealant around the urethro vesical anastomosis. Postoperative drain output was measured every 8 hours. The results of the 2 groups were compared. RESULTS: The Blake drain was removed after 4 nursing shifts (times 1 through 4) in 81% (13 of 16) of the control group and in 100% (16 of 16) of the fibrin sealant group. The fibrin sealant group had significantly less drainage output overall compared with the control group (p = 0.005). The drainage output from each group decreased with time at a significant rate independent of each other (p <0.001), and there was a larger difference (p = 0.04) in output between groups at times 1 and 2 compared with times 3 and 4. There was no relationship between the amount of urinary drainage and drain output. There was no immediate morbidity associated with the use of fibrin sealant. CONCLUSIONS: The application of fibrin sealant to the urethro vesical anastomosis during radical retropubic prostatectomy does decrease postoperative drain output. With earlier drain removal, patients would benefit from less discomfort and from skilled nursing requirements. In select patients early drain removal could accelerate discharge home.

Response of papillary renal cell carcinoma in a solitary kidney to high dose interleukin therapy.

Kidney cancer affects 36 000 Americans annually and is responsible for nearly 12 000 deaths every year in the US. Treatment with interleukin-2 (IL-2), the only FDA approved therapy for patients with advanced kidney cancer, is associated with a 10% complete response and a 12% partial response. To date, clear cell renal carcinoma has been the only histological type associated with response to IL-2-based therapy. In the current report, we describe a response to IL-2 therapy in a patient with type I papillary renal carcinoma.

Partial adrenalectomy: the National Cancer Institute experience.

OBJECTIVES: To report our experience of partial adrenalectomy and demonstrate whether adrenal function can be preserved in patients with hereditary adrenal pheochromocytoma. Total adrenalectomy has largely been used in the treatment of patients with hereditary adrenal pheochromocytomas. Adrenal cortical-sparing surgery is an alternative approach that aims to balance tumor removal with preservation of adrenocortical function. METHODS: From 1995 to 2004, 33 patients with hereditary pheochromocytoma presented with adrenal masses. Partial adrenalectomy (open or laparoscopic) was performed if normal adrenocortical tissue was evident on preoperative imaging or intraoperative ultrasonography. Various operative parameters, as well as postoperative function of the residual adrenal remnants, were determined. RESULTS: Of the 33 patients, 8 underwent open partial adrenalectomy and 25 laparoscopic partial adrenalectomy during a 10-year period. Ten patients underwent simultaneous, bilateral partial adrenalectomy and 8 underwent surgery on a solitary adrenal gland, 4 of whom received postoperative steroid replacement (stopped in 3 after 1 to 3 months). All other patients had normal catecholamine levels and remained tumor free by imaging at a mean follow-up of 36 months (range 3 to 102). CONCLUSIONS: Partial adrenalectomy can preserve adrenal function in patients with adrenal masses. The laparoscopic approach is technically safe and associated with less morbidity without compromising tumor removal. With careful surgical planning, especially in patients with tumors in solitary glands, adrenocortical function may be preserved, thereby avoiding the morbidity associated with medical adrenal replacement.

Metastatic renal cell carcinoma to contralateral ureter presenting as acute obstructive renal failure after radical nephrectomy.

Metastatic renal cell carcinoma commonly involves the lungs, bone, liver, adrenal glands, and brain. Less commonly affected organs include the gallbladder, thyroid, and pancreas. Even metastatic spread to the contralateral kidney and the bladder has been reported. Computed tomography is the standard imaging technique to evaluate for contralateral involvement. One of the disadvantages of computed tomography as a screening modality is its difficulty in identifying small ureteral lesions. We report a rare case of metastatic renal cell carcinoma in the contralateral ureter presenting as acute obstructive renal failure after radical nephrectomy.

Interstitial pneumonitis secondary to intravesical bacillus calmette-guerin for carcinoma in-situ of the bladder.

We report an 81-year-old male who developed severe interstitial pneumonitis on maintenance intravesical Bacillus Calmette-Guerin (BCG) for in-situ carcinoma of the bladder. The patient was treated with steroids and anti-tuberculin therapy with complete response. While there is no established standard of care for the treatment of interstitial pneumonitis, recent reports describe success with combination of corticosteroids and anti-tuberculin medications. We elected to follow this precedent and treated our patient with corticosteroids and antituberculin therapy with good outcome.

Interstitial pneumonitis secondary to intravesical bacillus calmette-guerin for carcinoma in-situ of the bladder

We report an 81-year-old male who developed severe interstitial pneumonitis on maintenance intravesical Bacillus Calmette-Guerin (BCG) for in-situ carcinoma of the bladder. The patient was treated with steroids and anti-tuberculin therapy with complete response. While there is no established standard of care for the treatment of interstitial pneumonitis, recent reports describe success with combination of corticosteroids and anti-tuberculin medications. We elected to follow this precedent and treated our patient with corticosteroids and anti-tuberculin therapy with good outcome.