RESUMO
Choriocarcinoma of the bladder was diagnosed in a 54-year-old woman presenting with macroscopic hematuria 17 years following evacuation of a molar pregnancy. The patient was treated by cystoscopic transurethral tumor resection followed by three courses of triple-agent chemotherapy and total abdominal hysterectomy with bilateral salpingo-oophorectomy. Six months later a gradual rise in beta-human chorionic gonadotropin levels led to the diagnosis of recurrent bladder tumor at the site of the previous tumor. The patient underwent a conservative partial cystectomy, and 12 months postoperatively there was no evidence of disease. It is unclear whether the patient developed a primary urinary bladder choriocarcinoma or late metastatic disease from the previous molar pregnancy.
Assuntos
Coriocarcinoma/secundário , Mola Hidatiforme/patologia , Neoplasias da Bexiga Urinária/secundário , Neoplasias Uterinas/patologia , Coriocarcinoma/diagnóstico , Coriocarcinoma/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/terapia , Gravidez , Fatores de Tempo , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/terapiaRESUMO
For the past five years we have used a double-balloon device for extraovular instillation of prostaglandin solution for termination of midtrimester pregnancy. In 340 consecutive cases a success rate of 91% (abortions within 24 hours) was achieved, with a mean instillation-to-abortion interval of 17.5 +/- 6.5 (SD) hours in nulliparas versus 12.8 +/- 6.1 in multiparas (P < .005). The instillation of continuous, low-dose prostaglandin solution into the extraovular space resulted in very few side effects and no complications. Furthermore, the technique was used successfully in women who had undergone one or more cesarean sections in the past. The use of prostaglandin E2 (PGE2) resulted in shorter instillation-to-abortion intervals than did prostaglandin F2 alpha (P < .01); 500 micrograms/h of PGE2 solution was needed in nulliparas, whereas 250 sufficed in multiparas.
Assuntos
Aborto Induzido/instrumentação , Prostaglandinas E/administração & dosagem , Administração Intravaginal , Adolescente , Adulto , Método Duplo-Cego , Desenho de Equipamento , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Prostaglandinas F/administração & dosagem , Fatores de Tempo , Resultado do TratamentoRESUMO
Two patients with myxedema coma and extreme hyponatremia associated with the syndrome of inappropriate secretion of antidiuretic hormone are described. Both recovered following i.v. hypertonic saline, furosemide and thyroxine. A review of 22 cases from the literature suggests that this therapeutic approach could improve the poor prognosis in this condition.
