RESUMEN

We assessed the accuracy of T2-weighted (T2w) and dynamic contrast-enhanced (DCE) 1.5-T magnetic resonance imaging (MRI) in localizing prostate cancer before transrectal ultrasound-guided repeat biopsy. Ninety-three patients with abnormal PSA level and negative prostate biopsy underwent T2w and DCE prostate MRI using pelvic coil before repeat biopsy. T2w and DCE images were interpreted using visual criteria only. MR results were correlated with repeat biopsy findings in ten prostate sectors. Repeat biopsy found prostate cancer in 23 patients (24.7%) and 44 sectors (6.6%). At per patient analysis, the sensitivity, specificity, positive and negative predictive values were 47.8%, 44.3%, 20.4% and 79.5% for T2w imaging and 82.6%, 20%, 24.4% and 93.3% for DCE imaging. When all suspicious areas (on T2w or DCE imaging) were taken into account, a sensitivity of 82.6% and a negative predictive value of 100% could be achieved. At per sector analysis, DCE imaging was significantly less specific (83.5% vs. 89.7%, p < 0.002) than T2w imaging; it was more sensitive (52.4% vs. 32.1%), but the difference was hardly significant (p = 0.09). T2w and DCE MRI using pelvic coil and visual diagnostic criteria can guide prostate repeat biopsy, with a good sensitivity and NPV.

Asunto(s)

Biopsia/métodos , Medios de Contraste/farmacología , Imagen por Resonancia Magnética/métodos , Próstata/patología , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/cirugía , Anciano , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad

RESUMEN

The objective of this study was to retrospectively evaluate the results of radiofrequency ablation (RFA) of renal tumors with an impedance-based system using an expandable multitined electrode. Twenty-two patients (30 tumors) were treated with RFA over a 7-year period, percutaneously (16 tumors) or intraoperatively (14 tumors). Follow-up imaging was performed at 1-3, 6, and 12 months and yearly thereafter. Twenty-seven of 30 tumors (19/22 patients) showed no residual tumor on the first imaging control. Two residual tumors were successfully ablated by a second RFA procedure. Our mean follow-up period was 35 months (range, 3-84 months). Two tumors that had been completely ablated based on imaging criteria recurred 11 and 48 months after RFA. One was treated by partial nephrectomy. The other one was not treated because the patient developed bone metastases. One patient had nephrectomy because of an RFA-induced ureteropelvic junction stricture. Nine patients (11 sessions) had a pyeloperfusion of cooled saline during RFA. None developed symptomatic complications, even though in three patients the ablation zone extended to the closest calyx (3-5 mm from the tumor). We conclude that RFA of renal tumors is promising, but serious complications to the collecting system must be taken into consideration. Prophylactic per-procedural cooling of the collecting system is feasible but needs further assessment.

Asunto(s)

Carcinoma de Células Renales/cirugía , Ablación por Catéter/instrumentación , Complicaciones Intraoperatorias/prevención & control , Neoplasias Renales/cirugía , Pelvis Renal , Perfusión/métodos , Adulto , Anciano , Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/patología , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Electrodos , Diseño de Equipo , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Humanos , Hipotermia Inducida/métodos , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Proyectos Piloto , Probabilidad , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento

RESUMEN

The authors report two cases of hepatic cirrhosis complicated by portal hypertension with splenorenal venous shunt presenting with left renal tumour that was treated by left radical nephrectomy with preservation of the shunt.

Asunto(s)

Hipertensión Portal/complicaciones , Hipertensión Portal/cirugía , Neoplasias Renales/complicaciones , Neoplasias Renales/cirugía , Nefrectomía/métodos , Derivación Esplenorrenal Quirúrgica , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

UNLABELLED: The purpose of this study was to evaluate the accuracy of prostate cancer localization with simple visual diagnostic criteria using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). A total of 46 consecutive patients with biopsy-proven prostate cancer underwent prostate 1.5 T MRI with pelvic phased-array coils before prostatectomy. Besides the usual T2-weighted sequences, a 30-s DCE sequence was acquired three times after gadoterate injection. On DCE images, all early enhancing lesions of the peripheral zone were considered malignant. In the central gland, only early enhancing lesions appearing homogeneous or invading the peripheral zone were considered malignant. Three readers specified the presence of cancer in 20 prostate sectors and the location of distinct tumors. Results were compared with histology; p < 0.05 was considered significant. For localization of cancer in the sectors, DCE imaging had a significantly higher sensitivity [logistic regression, odds ratio (OR): 3.9, p < 0.0001] and a slightly but significantly lower specificity (OR: 0.57, p < 0.0001). Of the tumors >0.3 cc, 50-60% and 78-81% were correctly depicted with T2-weighted and DCE imaging, respectively. For both techniques, the depiction rate of tumors >0.3 cc was significantly influenced by the Gleason score (most Gleason

Asunto(s)

Imagen por Resonancia Magnética/métodos , Neoplasias de la Próstata/patología , Anciano , Biopsia , Medios de Contraste , Compuestos Heterocíclicos , Humanos , Procesamiento de Imagen Asistido por Computador , Modelos Logísticos , Masculino , Persona de Mediana Edad , Compuestos Organometálicos , Prostatectomía , Neoplasias de la Próstata/cirugía , Sensibilidad y Especificidad

RESUMEN

OBJECTIVES: This study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (

Asunto(s)

Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Nefrectomía/métodos , Complicaciones Posoperatorias , Anciano , Carcinoma de Células Renales/patología , Progresión de la Enfermedad , Femenino , Humanos , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Nefronas , Estudios Prospectivos , Resultado del Tratamiento

RESUMEN

BACKGROUND: Local failure after prostatectomy can arise in patients with cancer extending beyond the capsule. We did a randomised controlled trial to compare radical prostatectomy followed by immediate external irradiation with prostatectomy alone for patients with positive surgical margin or pT3 prostate cancer. METHODS: After undergoing radical retropubic prostatectomy, 503 patients were randomly assigned to a wait-and-see policy, and 502 to immediate postoperative radiotherapy (60 Gy conventional irradiation delivered over 6 weeks). Eligible patients had pN0M0 tumours and one or more pathological risk factors: capsule perforation, positive surgical margins, invasion of seminal vesicles. Our revised primary endpoint was biochemical progression-free survival. Analysis was by intention to treat. FINDINGS: The median age was 65 years (IQR 61-69). After a median follow-up of 5 years, biochemical progression-free survival was significantly improved in the irradiated group (74.0%, 98% CI 68.7-79.3 vs 52.6%, 46.6-58.5; p<0.0001). Clinical progression-free survival was also significantly improved (p=0.0009). The cumulative rate of locoregional failure was significantly lower in the irradiated group (p<0.0001). Grade 2 or 3 late effects were significantly more frequent in the postoperative irradiation group (p=0.0005), but severe toxic toxicity (grade 3 or higher) were rare, with a 5-year rate of 2.6% in the wait-and-see group and 4.2% in the postoperative irradiation group (p=0.0726). INTERPRETATION: Immediate external irradiation after radical prostatectomy improves biochemical progression-free survival and local control in patients with positive surgical margins or pT3 prostate cancer who are at high risk of progression. Further follow-up is needed to assess the effect on overall survival.

Asunto(s)

Adenocarcinoma/radioterapia , Prostatectomía , Neoplasias de la Próstata/radioterapia , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Anciano , Terapia Combinada , Progresión de la Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Tasa de Supervivencia

RESUMEN

OBJECTIVES: To retrospectively evaluate the complications, urinary reservoir function and quality of life of patients with Hautmann ileal bladder after cystectomy for bladder urothelial carcinoma. METHODS: From 1994 to 2004, 87 patients with a mean age of 61.1 years underwent total cystoprostatectomy (n = 85 men) or radical cystectomy (n = 2 women) with Hautmann replacement enterocystoplasty. The mean follow-up was 40.7 months. Continence, quality of voiding, and quality of life were evaluated by self-administered questionnaires (continence questionnaire, DITROVIE score, I-PSS score). RESULTS: The early complication rate was 30.1%, including 6.9% related to the ileal bladder. The late complication rate was 33.6%, including 20.9% related to the ileal bladder. Four patients died during the perioperative period, 14 patients (17%) died from progression of their cancer and 7 patients (8%) died from an independent cause. One patient was lost to follow-up. Questionnaires were sent to 56 patients and 52 replies were received: 96.2% of patients were continent during the day, 53.8% were continent at night. 4.9% of patients performed self-catheterization for chronic urine retention, 90.4% of patients were satisfied with their replacement bladder and only 5.8% of patients had an altered quality of life. CONCLUSION: Despite a considerable morbidity rate and a significant nocturnal incontinence rate, the orthotopic Hautmann W-shaped ileal bladder does not appear to alter the patients' quality of life.

Asunto(s)

Reservorios Urinarios Continentes/efectos adversos , Reservorios Urinarios Continentes/fisiología , Adulto , Anciano , Femenino , Humanos , Íleon/trasplante , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Tiempo , Neoplasias de la Vejiga Urinaria/cirugía , Procedimientos Quirúrgicos Urológicos/métodos

RESUMEN

Our objectives were to determine time-enhancement curves of prostate cancer, peripheral zone, and adenoma at gadolinium-enhanced MR imaging, and to determine if a high-spatial/low-temporal dynamic imaging could be accurate in depicting prostate cancer, or if a higher temporal resolution (and a lower spatial resolution) should be favored. Thirty-nine patients with prostate cancer underwent MR imaging before radical prostatectomy by using T1- and T2-weighted axial images and a single-slice dynamic gadolinium-enhanced sequence (40 images; one image per 6 s; injection of 20 ml at 2 ml/s). After analysis of the pathologic specimens, four region-of-interest (ROI) cursors (cancer, peripheral zone, adenoma, and muscle) were retrospectively placed on dynamic images. Time-enhancement curves of the ROIs were obtained. The theoretical accuracy of a 30-s dynamic multislice MR sequence in depicting cancer within peripheral zone and adenoma (ROC curves) was calculated from these curves. On average, prostate cancer enhanced more and earlier than peripheral zone and adenoma, but there were great interindividual variations. For start delays ranging from 12 to 84 s, the areas under the ROC curves ranged from 0.602 to 0.698 for the depiction of cancer within adenoma and from 0.614 to 0.827 for the depiction of cancer within peripheral zone. The best results were obtained with a 36-s start delay. In conclusion, we found a 30-s scanning window which seems to allow a good depiction of cancer within peripheral zone. Because of largely overlapping enhancement patterns, cancer will probably not be depicted within adenoma by dynamic imaging, at least by using low temporal resolution.

Asunto(s)

Adenocarcinoma/diagnóstico , Imagen por Resonancia Magnética/métodos , Neoplasias de la Próstata/diagnóstico , Intensificación de Imagen Radiográfica , Adenocarcinoma/clasificación , Adenocarcinoma/cirugía , Anciano , Humanos , Masculino , Persona de Mediana Edad , Hiperplasia Prostática/clasificación , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/cirugía , Neoplasias de la Próstata/clasificación , Neoplasias de la Próstata/cirugía , Curva ROC , Factores de Tiempo , Resección Transuretral de la Próstata

RESUMEN

OBJECTIVE: To study the feasibility and the innocuity of the treatment by radiofrequency of small renal tumours. MATERIAL AND METHODS: From June 2000 to September 2001, 10 renal tumours in 6 patients were treated by radiofrequency. The mean age of the patients was 57 years. The mean tumour diameter was 20 mm. Indications for partial surgery were 3 solitary kidneys, one patient with chronic renal failure, one patient with Von Hippel Lindau disease and one patient in whom several angiomyolipomas were discovered in the right kidney. 4 patients were treated via a lumbar incision and 2 were treated percutaneously (one with ultrasound guidance and the other with computed tomography guidance). Patients were reviewed by imaging (CT and/or MRI) with injection of contrast agent to demonstrate complete devascularization of the tumour. RESULTS: Treatment lasted an average of 180 minutes. The intraoperative complication rate was 16%. The mean hospital stay was 9 days (4 days for the percutaneous route). Nine tumours (5 patients) were devascularized after a single session. One patient (treated via the percutaneous route under ultrasound guidance) showed persistence of tumour tissue (identified by CT). A second session, performed 4 months later, allowed complete devascularization of the tumour. The mean follow-up is 13 months. CONCLUSION: This study demonstrates the feasibility and safety in terms of renal function of radiofrequency treatment of small renal tumours. However further studies are necessary to precisely define the radiological criteria of tumour necrosis and to evaluate the long-term results of this method (outcome of necrotic tumour tissue, metastatic risk, cancer recurrence along the needle track in the case of a percutaneous approach). This treatment must be reserved for selected patients.

Asunto(s)

Ablación por Catéter , Neoplasias Renales/cirugía , Adulto , Anciano , Ablación por Catéter/instrumentación , Diseño de Equipo , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

A total of 140 pancreatic transplants have been performed in 132 insulin-dependent diabetic patients at lyon (France). Most cases received a double pancreatic and renal transplant. The duct obstruction technique was utilized in 113 segmental transplants. A total pancreatic transplant was performed in 27 patients, with duct obstruction in 27, Gl tract derivation in 14, urinary tract derivation in 11 and intraductal obstruction in 2 patients. Utilizing quadruple immunosuppression, the one year survival rate was 90% and the transplant survival was 60%

Asunto(s)

Humanos , Trasplante de Páncreas , Diabetes Mellitus/cirugía , Inmunosupresores/uso terapéutico , Análisis Actuarial , Trasplante de Riñón , Trasplante de Páncreas/efectos adversos , Trasplante de Páncreas/mortalidad , Rechazo de Injerto , Complicaciones Posoperatorias , Protocolos Clínicos

RESUMEN

Tres pacientes insuficientes renales terminales portadores de espina bífida y mielomeningocele consultaron en nuestro servicio por trasplante renal. En el primer caso la vejiga era utilizable pero el paciente presentaba una esclerosis importante del esfínter externo, motivando la realización de una esfinterotomía endoscópica. El trasplante renal fue efectuado en un paciente totalmente incontinente. Se utilizó en este paciente una prótesis enfinteriana AS 800. El examen urográfico efectuado 19 meses post-trasplante muestra a la urografía intravenosa una buena evacuación urinaria y la ausencia de repercusión sobre el tracto urinario superior. Dos pacientes presentaban una vejiga inutilizable en trasplante renal, el primer paciente presentaba al inicio del estudio una nefrectomía derecha y una derivación urinaria tipo conducto ileal, el segundo caso fue tratado mediante múltiples derivaciones externas; cistostomía nefrostomía bilateral y finalmente se efectuó una ileocistoplastía. La preparación al trasplante consistió en estos pacientes, en dejarlos anéficos, la remoción posterior del conducto ileal (pte. Nro. 2), la remoción de la ileocistopatía (pte. Nro. 3) y la realización del reservorio ileal continente según la técnica de Kock con algunas variantes. La evaluación efectuada a los 15 y 12 meses post-trasplante mostró una creatinina estable, una buena capacidad del reservorio, la ausencia de residuo post-evacuación, reflujo (-) y una urografía normal

Asunto(s)

Humanos , Masculino , Femenino , Trasplante de Riñón , Vejiga Urinaria Neurogénica , Ciclosporinas/uso terapéutico , Cateterismo Urinario/estadística & datos numéricos , Derivación Urinaria