Renal cell carcinoma with IVC and atrial thrombus: a single centre's 10 year surgical experience.

UNLABELLED: Renal cell carcinoma (RCC) propagates into the IVC in 4% of cases with 1% extending into the right atrium. Radical surgical resection remains the definitive curative/palliative treatment in those without significant metastases. The aim was to review our experience in patients with different levels of IVC involvement, cardiopulmonary bypass (CPB) and perioperative/long term outcomes. PATIENTS AND METHODS: From 2001 to 2012, 24 radical nephrectomies with IVC thrombectomy were performed. A retrospective chart review was undertaken to record demographics, presenting symptoms, duration of surgery, peri-operative transfusion, CPB and peri-operative complications, tumour grade/stage, and patient survival. RESULTS: We identified 24 patients (18 male, Age median 59 range 35-78). The commonest presenting symptoms were weight loss, pain and haematuria. The majority of tumours were right sided (n = 17) with 8 having lung metastases at presentation. Thrombus level was 16 (infradiaphragmatic), 2 (supradiaphragmatic), 6 (intra-atrial). 15 patients required sternotomy for vascular control and 9 required CPB both with a significantly longer operative time compared (6.1 ± 3.5 vs. 7.2 ± 1.2 vs. 3.5 ± 1.1 h, respectively). Peri-operative complications (n = 21) included cardiopulmonary, renal, gastrointestinal and septic problems. There were 2 peri-operative deaths. Blood transfusion was significantly less in those not requiring sternotomy or CPB using the "Cell Saver" device. The majority were Fuhrman grade 3 (n = 16) and clear cell type (n = 14). Overall 3-year survival was 100% (Laparotomy only), 40% (sternotomy + cross-clamp), and 20% (CPB). CONCLUSIONS: IVC thrombectomy has significant morbidity and requires careful patient selection and a multi-disciplinary approach to optimise patient outcomes. In this series, the level of IVC thrombus and requirement for CPB directly affects patient morbidity and outcome.

Artritis aguda secundaria a bacilo de Calmette-Guérin intravesical en el cáncer de vejiga / Acute Arthritis Secondary to Intravesical Bacillus Calmette-Guérin for Bladder Cancer

Introducción: Tratamos de identificar la prevalencia, presentación, tratamiento y pronóstico de la artritis aguda secundaria al tratamiento de los bacilos de Calmette-Guérin (BCG) intravesicales en el cáncer de vejiga. Métodos: Se realizó una revisión estructurada y sistemática de la literatura en lengua inglesa relacionada con BCG y artritis reactiva en pacientes con cáncer de vejiga. Se extrajeron los datos relativos a la prevalencia, presentación, manejo y pronóstico .Resultados: Se obtuvieron 23 informes de casos individuales y 4 artículos de revisión. Treinta y nueve pacientes -31 (80%) eran hombres y 8 (20%) mujeres-fueron descritos en estas publicaciones; también identificamos un paciente de nuestra institución. Aunque las estimaciones de prevalencia de la artritis reactiva oscilan entre el 0,5 y 1,0% de todos los pacientes con cáncer de vejiga que recibieron BCG, la verdadera prevalencia sigue siendo poco clara. La poliartritis (68%) y la fiebre (58%) fueron los síntomas más comunes. Entre los pacientes que presentaban dolor en las articulaciones, las rodillas (41%), los tobillos (26%) y las muñecas (19%) fueron las más afectadas. El tiempo de presentación más frecuente fue inmediatamente después de la cuarta instilación de un curso de inducción de 6 semanas (25%). La terapia inicial en el 100% de los pacientes fue la interrupción del BCG. Otros tratamientos incluyeron fármacos antiinflamatorios no esteroideos (AINE) (25%), esteroides (8%), medicamentos antituberculosos (8%) y una combinación de AINE, esteroides y medicamentos antituberculosos (20%). Conclusiones: La artritis reactiva es una complicación poco frecuente, pero potencialmente grave, del tratamiento con BCG intravesical en el cáncer de vejiga, que se presenta típicamente con poliartritis y fiebre durante la inducción. Los tratamientos más comunes incluyen la suspensión inmediata de BCG y la terapia antiinflamatoria sistémica. Se necesitan más estudios para determinar la prevalencia, la fisiopatología y el pronóstico a largo plazo (AU)

Introduction: We sought to identify the prevalence, presentation, treatment, and prognosis of acute arthritis secondary to intravesical bacilli Calmette-Guérin (BCG) therapy for bladder cancer. Methods: We performed a structured, systematic review of the English language literature pertaining to BCG and reactive arthritis among bladder cancer patients. We extracted data pertaining to prevalence, presentation, management, and prognosis. Results: We extracted 23 individual case reports and 4 review articles. Thirty-nine patients-31 (80%) male and 8 (20%) female- were described in these publications; we also identified 1 patient from our institution. Although prevalence estimates of reactive arthritis range from0.5 to 1.0% of all bladder cancer patients receiving BCG, the true prevalence remains unclear. Polyarthritis (68%) and fever (58%) were the most common presenting symptoms. Among patients presenting with joint pain, the knees (41%), ankles (26%), and wrists (19%) were most often affected. The most common time of presentation was immediately following the 4th instillation of a 6-week induction course (25%). Initial therapy in 100% of patients was discontinuation of BCG. Other therapies included non steroidal anti-inflammatory drugs (NSAIDs) (25%); steroids(8%); anti-tubercular medications (8%); and combined NSAIDs, steroids, and anti-tubercular medications (20%). Conclusions: Reactive arthritis is an infrequent but potentially severe complication of intravesical BCG for bladder cancer that typically presents with polyarthritis and fever during induction. The most common treatments include immediate discontinuation of BCG and systemic anti-inflammatory therapy. Further studies are needed to determine prevalence, pathophysiology, and long-term prognosis (AU)

[Acute arthritis secondary to intravesical bacillus Calmette-Guérin for bladder cancer]. / Artritis aguda secundaria a bacilo de Calmette-Guérin intravesical en el cáncer de vejiga.

INTRODUCTION: We sought to identify the prevalence, presentation, treatment, and prognosis of acute arthritis secondary to intravesical bacilli Calmette-Guérin (BCG) therapy for bladder cancer. METHODS: We performed a structured, systematic review of the English language literature pertaining to BCG and reactive arthritis among bladder cancer patients. We extracted data pertaining to prevalence, presentation, management, and prognosis. RESULTS: We extracted 23 individual case reports and 4 review articles. Thirty-nine patients -31 (80%) male and 8 (20%) female- were described in these publications; we also identified 1 patient from our institution. Although prevalence estimates of reactive arthritis range from 0.5 to 1.0% of all bladder cancer patients receiving BCG, the true prevalence remains unclear. Polyarthritis (68%) and fever (58%) were the most common presenting symptoms. Among patients presenting with joint pain, the knees (41%), ankles (26%), and wrists (19%) were most often affected. The most common time of presentation was immediately following the 4th instillation of a 6-week induction course (25%). Initial therapy in 100% of patients was discontinuation of BCG. Other therapies included nonsteroidal anti-inflammatory drugs (NSAIDs) (25%); steroids (8%); anti-tubercular medications (8%); and combined NSAIDs, steroids, and anti-tubercular medications (20%). CONCLUSIONS: Reactive arthritis is an infrequent but potentially severe complication of intravesical BCG for bladder cancer that typically presents with polyarthritis and fever during induction. The most common treatments include immediate discontinuation of BCG and systemic anti-inflammatory therapy. Further studies are needed to determine prevalence, pathophysiology, and long-term prognosis.

Fistulization in a locally advanced case of squamous cell carcinoma of the prostate.

Squamous cell carcinoma of the prostate gland is very rare, constituting 0.5%-1% of all prostatic malignancies. Though it has a similar clinical presentation to prostate cancer, the tumor is more aggressive, spreading to bone, liver and lung. The median survival time is approximately 14 months. Diagnosis is exclusively by histology. Therapeutic options may include radical surgery, radiotherapy, chemotherapy, hormonal therapy or a combination of these treatments. We present a case of locally advanced squamous cell carcinoma of the prostate and comment on its management and subsequent disease related complication.

A review of the anatomical variations of the posterior tributaries of the left renal vein.

BACKGROUND: Variations of the posterior tributaries of the left renal vein (LRV) are frequently encountered during various urological and vascular procedures. This can be explained by the complex embryological and anatomical arrangements of these tributaries, as well as variations in their nomenclature. AIMS: To increase awareness of the anatomical variations of the posterior tributaries of the LRV. METHODS: Twenty-one kidneys were dissected. All anatomical variations of the posterior tributaries of the LRV were recorded. RESULTS: This study highlights lumbar tributaries are common on the left side. A single left lumbar tributary was found entering the posterior surface of the LRV in 10 out of 11 specimens. However, their drainage patterns showed varied anatomical configurations. CONCLUSION: This cadaveric study was aimed to draw attention to surgically important variations of the posterior tributaries of the LRV. Increased awareness among surgeons can considerably reduce the potential risk of vascular injuries during renal surgery.