obstruction. Laboratory and clinical factors that might influence prognosis were reviewed to attempt to externally validate the previously identified factors and model for risk stratification. RESULTSThe median (range) age of the 49 patients identified was 71 (36-91) years, and the median survival was 174 (14-602) days. Tumours were of urological origin in 66% of patients. Patients with prostate cancer had nephrostomy tubes indwelling for a mean of 279 days, vs 190 days ( P = 0.07) for patients with tumours not of prostatic origin. A serum albumin level of > 30 g/L ( P ≤ 0.001), serum sodium < 135 mmol/L ( P = 0.019) and three or more events related to dissemination of cancer ( P = 0.04) were factors associated with a significantly shorter mean survival. Complications related to the nephrostomy tube were experienced by 39% of patients. The model proved useful in stratifying these patients into different risk groups ( P = 0.002). CONCLUSIONConsistent with a previous report we showed that a low serum albumin level and events related to metastatic disease were indicative of a poor prognosis. We also found that a low serum sodium level might be associated with a worse prognosis. We externally validated a model for stratifying patients into different prognostic groups. Palliative decompression is associated with significant morbidity. KEYWORDS
What ' s known on the subject? and What does the study add? Renal angiomyolipomas (AMLs) were fi rst described in 1900 by Grawitz when he published a description of a large renal tumour composed of fat, muscle and blood vessels. Over the subsequent 100 years a lot has been discovered about the AML of the kidney. Initially, it was thought to be a hamartoma, an abnormal proliferation of tissues that are normally present in the kidney. More recent studies and observations have led to these lesions being classed a form of neoplasm of the renal parenchyma.The present paper is a review of the presenting features of renal AMLs, as well as an overview of how they are diagnosed and some of the diffi culties in diagnosis. It is aimed as a brief overview of the presenting features and diagnostics of renal AMLs. We hope it will be useful to refresh the knowledge of practicing urologists and as a study aid for training urologists. Abstract• Renal angiomyolipomas ( AMLs ) are usually easy to diagnose with imaging alone. They have unique characteristics on ultrasonography, computerised tomography and magnetic resonance imaging that usually allow AMLs to be differentiated from other renal masses.• If this is not possible on imaging criteria then biopsy can be performed and AMLs have unique immunohistochemical staining that allows them to be accurately differentiated from other renal tumours.
Dupuytren's disease (DD) is a progressive fibromatosis that causes the formation of nodules and cords in the palmar aponeurosis leading to flexion contracture of affected fingers. The etiopathogenesis is multifactorial with a strong genetic predisposition. It is the most frequent genetic disorder of connective tissues. We have collected clinical data from 736 unrelated individuals with DD who underwent surgical treatment from Germany and Switzerland. We evaluated a standardised questionnaire, assessed the importance of different risk factors and compared subgroups with and without positive family history. We found that family history clearly had the strongest influence on the age at first surgery compared to environmental factors, followed by male sex. Participants with a positive family history were on average 55.9 years of age at the first surgical intervention, 5.2 years younger than probands without known family history (p = 6.7 × 10(-8) ). The percentage of familial cases decreased with age of onset from 55% in the 40-49 years old to 17% at age 80 years or older. Further risk factors analysed were cigarettes, alcohol, diabetes, hypertension, and epilepsy. Our data pinpoint the importance of genetic susceptibility for DD, which has long been underestimated.
Argon plasma coagulation may be safe and effective for the treatment of duodenal adenomas, but further research is required. Progression of adenomas is slow and perhaps no treatment is required.
PurposeInguinal hernia repair is one of the most frequently performed operations in general surgical practice. A variety of techniques have been used in the past with different results. The aim of the present study is to report our experience of inguinal hernia repair using the Kugel patch and to measure the frequency of postoperative recurrence and chronic groin pain. MethodologyData were recorded prospectively from a series of 333 inguinal hernia repairs performed between January 2004 to December 2006 using the Kugel patch technique. Wound infection, seroma, haematoma urinary retention, 6-month recurrence and chronic groin pain were the outcome measures. ResultsThe Kugel patch hernia repairs were performed in 284 patients during the 3-year period. There were no recurrences or chronic groin pain within 6 months of the 333 repairs. There was only one reported wound infection. The average operating time for bilateral hernia repair was 40.5 minutes (SD 8.8). Recurrent hernias took an average of 26 minutes (SD6.2) to repair whilst unilateral hernias took an average of 23 minutes (SD 6.8). 5 (1.8%) of the 284 patients had urinary retention. The average operating time for 136 direct procedures was 27 minutes compared with 25 minutes for the 148 indirect procedures (p = 0.096, t-test). ConclusionIn this prospective series the Kugel hernia repair is associated with no post hernia repair groin pain and no recurrence within 6 months of the procedure. It is inexpensive compared with laparoscopic repair, and allows the surgeon to cover all potential defects with one piece of mesh. PurposeTo review the experience with laparoscopic splenectomy, to determine it's efficacy for treating immune thrombocytopaenic purpura (ITP) and to highlight key technical issues with the operation. MethodologyAll splenectomies performed between 1992 and 2005 were identified from the Otago Surgical Audit and the clinical notes reviewed, including the laboratory records for follow-up data related to the haematologic cases. ResultsThere were 289 splenectomies performed over the 13 year period. The indications were trauma (111, 38%), haematologic disease (93, 32%), incidental (40, 14%) splenic malignancy (39, 13%), and other (8, 3%). Of the 68 patients with ITP, 49 (72%) had a lateral laparoscopic splenectomy (LLS) with no conversions, a 5% complication rate and one mortality. Based on platelet counts and the requirement for maintenance steroids there was a complete response in 44 (68%) patients at >6 months, a partial response in 16 (24%) and no response in 5 (8%) patients. A short video presentation will highlight the key steps for the safe and efficient performance of the LLS, including patient and port positioning, the use of ultrasonic dissection, splenic pedicle stapling, and morcellation. The indications for hand-port assisted laparoscopic and open splenectomy will be discussed. ConclusionsThe LLS is the preferred approach to splenectomy for all but massive splenomegaly and can be performed safely with careful attention to key technical issue...
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