RESUMEN
Renal arteriovenous malformation is a rarely encountered disease characterized by the presence of a direct arteriovenous shunt between the renal artery and vein. This nosology was first described by Varela in 1928, and by 1997 the number of such cases amounted to slightly more than 200. Endovascular closure of a fistula seems to be an attractive method of treatment in view of low traumaticity and a short period of rehabilitation. However, as shown by our case report, this type of intervention in large-diameter fistulas may be associated with the development of life-threatening complications. In case of rupture of the renal capsule and/or arteriovenous aneurysm, radical nephrectomy, unfortunately, remains to be a method of choice. Described below is a case concerning treatment of a female patient presenting with bilateral arteriovenous malformations and the world's first emergency operation for a ruptured intraparenchymatous arteriovenous aneurysm using an extracorporeal technique.
Asunto(s)
Aneurisma Roto/cirugía , Fístula Arteriovenosa/cirugía , Malformaciones Arteriovenosas/cirugía , Procedimientos Endovasculares/métodos , Circulación Extracorporea/métodos , Riñón , Adulto , Aneurisma Roto/diagnóstico , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/etiología , Malformaciones Arteriovenosas/diagnóstico , Malformaciones Arteriovenosas/fisiopatología , Femenino , Humanos , Riñón/irrigación sanguínea , Riñón/cirugía , Procedimientos de Cirugía Plástica/métodos , Reoperación/métodos , Resultado del TratamientoRESUMEN
AIM: To develop the method for extracorporeal partial nephrectomy under pharmaco-cold ischemia without ureter intersection with orthotopic replantation of renal vessels for RCC. MATERIAL AND METHODS: The study included 37 patients with morphologically confirmed RCC pT1a-Т3bN0M0-1G1-3 with intraparenchymal and central location of the tumor in cases of single kidney, comorbidity of contralateral kidney and kidney on the side of lesion. RESULTS: Mean surgery time was 413.97±89.14 minutes. Mean time of warm ischemia was 8.39±4.75 minutes, cold ischemia - 151.41±41.29 minutes. Intraoperative and postoperative complications were detected in 3 (8.1%) and 18 (48.6%) patients respectively. CONCLUSION: Extracorporeal partial nephrectomy under pharmaco-cold ischemia without ureter intersection with orthotopic replantation of renal vessels for RCC is a relatively safe organ-sparing treatment. It provides resection of large tumors with any location under prolonged cold ischemia without ureter intersection.
Asunto(s)
Carcinoma de Células Renales , Isquemia Fría/métodos , Neoplasias Renales , Nefrectomía , Tratamientos Conservadores del Órgano/métodos , Complicaciones Posoperatorias , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/cirugía , Femenino , Tasa de Filtración Glomerular , Humanos , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Nefrectomía/efectos adversos , Nefrectomía/métodos , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Federación de RusiaAsunto(s)
Feocromocitoma/diagnóstico , Neoplasias de la Vejiga Urinaria/diagnóstico , Procedimientos Quirúrgicos Urológicos/métodos , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Feocromocitoma/cirugía , Tomografía Computarizada Espiral , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
Nine patients were operated on with the use of robotic complex. In 3 cases the nonorganic retroperitoneal pelvic tumor was removed, the 4 full-layer urinary bladder and ureteral orifice resections and simultaneous ureteral plasty together with ileal-obturatory lymphadenectomy (2 - cancer of the urinary bladder cervix, 1 - pheochromocytoma of the urinary bladder) and 2 ureterocele with complete ureter duplication and megaureter were performed. Technical aspects of the robotic layerwise resection of the neck of the urinary bladder were worked out. The operation time varied from 1 hour 45 minutes to 4 hours 45 minutes. The maximal blood loss was 100 ml. One patient developed the acute respiratory failure. The were no other postoperative complications. The postoperative hospital stay was 7-12 days.
Asunto(s)
Espacio Retroperitoneal/cirugía , Robótica/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pelvis , Resultado del TratamientoRESUMEN
We have investigated deletions of 3p14, 9p21, 9q34, 17p13 (TP53) loci, activating FGFR3 mutations in exon 9 and aberrant methylation of RASSF1, RARbeta, P16, P14, CDH1 genes with the aim of the molecular pathogenesis pathways analysis of bladder cancer. FGFR3 activating mutations and 9p21 deletions were observed significantly more frequent in the group of non-invasive bladder cancer pTa than in minimally-invasive cancers pT1 (p = 0.004 and 0.006 respectively). It was shown that groups of superficial and invasive bladder cancer are significantly differing in the frequency of 17p13 (p = 0.006) and 9q34 (p = 0.04) deletions and in aberrant methylation of the gene P16 (p = 0.02). We have revealed some differing molecular-genetic alterations in groups of superficial and invasive bladder cancers. Therefore we suppose that these two types of bladder cancer might have different pathways of development.