Clinical results of combined epidural and general anesthesia procedure in radical prostatectomy management.

OBJECTIVES: Improvement of radical prostatectomy surgical technique remains an objective for urological practice. The aim of this study was to evaluate the potential benefit of intra and postoperative epidural versus general anesthesia alone. MATERIAL AND METHODS: The authors retrospectively analyzed 62 consecutive cases of patients who underwent radical retropubic prostatectomy over a 2-year period. The mean age was 65.5 years (51-75). Two groups were selected: group I = 19 patients, who received epidural anesthesia in association with general anesthesia and group II = 43 patients with general anesthesia alone. Both groups were similar for ASA score, Body Mass Index, prostate volume, tumor stage and Gleason score. Evaluation criteria were operative time, blood loss, postoperative pain (analgesics required) and length of hospital stay. Mono and multifactorial statistical analysis were performed. RESULTS: Operative time in group I was 189 mn versus 218 mn for group II (p = 0.01). Significant difference was found independent of surgical experience. Moreover, significant blood loss (p = 0.002) was observed: 971 ml in group I versus 1840 ml in group II. Also, less blood was transfused during surgery in group I: 0.84 blood units transfused versus 2.60 blood units in group II (p = 0.007). In both groups, hematocrit level remained stable during surgery. As regards postoperative pain, an improvement in required analgesic level was noted in group I during the initial 48 hours (p = 0.001 for day 1; p = 0.032 for day 2). Finally, mean hospital stay was only 9.3 days in group I and 12.4 days in group II (p = 0.005). CONCLUSION: Our study suggests that improved results can be obtained when epidural anesthesia is associated with general anesthesia in radical retropubic prostatectomy intra and postoperative management, with a significant reduction in morbidity.

CT diagnosed jejunal intussusception revealing metastatic renal cell carcinoma.

We report the case of a 77-year-old woman presenting with a jejunal intussusception as the primary symtom of metastatic renal cell carcinoma. Both lesions were demonstrated by abdominal CT which detected also pancreatic metastasis. This case emphasizes the significance of CT to diagnose intussusception and to characterize its cause.

Results of concomitant radio-chemotherapy for invasive bladder tumors.

INTRODUCTION: The aim of this study was to evaluate combined radiation and chemotherapy for invasive bladder tumors and to define possible biological prognostic factors. MATERIALS AND METHODS: Forty-five patients (mean age 75 years, range 68 to 86) were treated by deep bladder resection with combined radiation (5 courses of 10 Grays [Gys]) and chemotherapy (2 cycles of 100 mg of cisplatin over 7 weeks). Subsequent to the treatment, evaluations at 10 weeks, then 3 months, 6 months, and 12 months, and every year, included a clinical examination, Karnofsky evaluation, a cystoscopy with urinary cytology, and systematic deep bladder pathology biopsies after a computer tomography (CT) scan. In our series, DNA analysis and an immuno-histochemistry study of MiB1, p53, and MdR were also performed in the last 20 patients. RESULTS: At 6 months, progression of the disease was evaluated in 26% of cases; at 12 months, satisfactory local control was evaluated in 60% of cases. However, only 15 patients were in complete remission after a period of 2 years. Of these, only eight patients were in remission with more than 42 months follow-up. We observed aneuploid tumors in 30% of cases; these patients died after 6 months despite concomitant radio-chemotherapy. In our experience, the results of associated immuno-histochemistry markers was not really contributive. CONCLUSION: This therapeutic alternative may be useful in patients where a cystectomy cannot be performed. It not only permits bladder conservation, but also offers satisfactory, significant quality of life, even if survival rates remain uncertain.

p53 mutations in bladder tumors inactivate the transactivation of the p21 and Bax genes, and have a predictive value for the clinical outcome after bacillus Calmette-Guerin therapy.

PURPOSE: We analyze the relationship among p53 mutations, p21 and Bax activation as well as their clinical implication in clinical response to intravesical bacillus Calmette-Guerin (BCG) therapy in high grade bladder tumors. MATERIALS AND METHODS: We analyzed a prospective series of 60 superficial bladder tumors using functional assays in yeast which test the transcriptional competence of p53 and can be used to identify p21 and Bax status. BCG instillations were given after initial tumor resection to 26 patients with a high risk of bladder invasive disease (pT1G3 tumors in 24 and carcinoma in situ in 2). RESULTS: No p53 alteration was detected in cases of pTa tumors. In contrast, p53 mutations were detected in 16 of 24 patients (66%) with pT1 G3 tumors and in 2 with primary carcinoma in situ. These 18 mutant samples scored also mutant for transactivation of p21 and Bax reporter strain. In 26 bladder tumors treated with BCG instillations there was a statistical difference (p = 0.0075) in the response to BCG therapy between 18 tumors with and 8 without alterations using functional assays in yeast. CONCLUSIONS: The p53 mutations, using functional assay in yeast, inactivate the transcription of p21 and Bax genes, and based on these preliminary results could have a useful predictive value for BCG therapy response in bladder cancer.

[Pseudomyxoma extraperitonei. Report of 3 cases]. / Le pseudomyxome extrapéritonéal. A propos de 3 observations.

The authors report three additional cases of pseudomyxoma extraperitonei and describe the modalities of occurrence and evolution. Pseudomyxoma extraperitonei arises from spontaneous or accidental implantation of mucosal cells of the primary site. This inoculation is accompanied by the modification of glandular cells which survive by adapting themselves to the interstitial connective tissue environment, raising thus the ability of extensive involvement and tumor-like invasive behavior.

[Endoscopic treatment of prenatally diagnosed ureteroceles]. / Traitement endoscopique des urétérocèles de diagnostic anténatal.

INTRODUCTION: The authors report a series of 16 infants presenting with an antenatally diagnosed ureterocele, treated immediately, during the neonatal period, by endoscopic incision. The objective of this treatment is to ensure effective decompression of the ureterocele. MATERIAL AND METHODS: The immediate postnatal assessment revealed 17 ureteroceles, including 7 intravesical ureteroceles (with one bilateral form) and 10 ectopic ureteroceles. Endoscopic opening allowed collapse of all of the ureteroceles and usually ensured improvement of renal function. Vesicoureteric reflux was observed secondarily in 7 infants with an ectopic form of the disease, and was present primarily in two other patients. RESULTS: In patients with an intravesical form, endoscopic treatment was found to be effective on its own and no complementary procedure was required. In contrast, in ectopic forms, a second operation was required in 9 cases: presence of vesicoureteric reflux (8 cases) required resection of the ureterocele with vesical reconstruction and ureteric reimplantation according to Cohen's technique. In one case, total ureteronephrectomy was performed due to complete absence of function of the kidney concerned. CONCLUSION: Endoscopic opening, performed soon after birth, can be considered to be the first-line treatment of antenatally diagnosed ureteroceles. Its main complication remains the secondary development of vesicoureteric reflux Radiological surveillance therefore appears to be essential.