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Sample records for extrapleural retroperitoneal approach

  1. Simultaneously anterior decompression and posterior instrumentation by extrapleural retroperitoneal approach in thoracolumbar lesions

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    Jain Anil

    2010-01-01

    Full Text Available Background: Anterior decompression with posterior instrumentation when indicated in thoracolumbar spinal lesions if performed simultaneously in single-stage expedites rehabilitation and recovery. Transthoracic, transdiaphragmatic approach to access the thoracolumbar junction is associated with significant morbidity, as it violates thoracic cavity; requires cutting of diaphragm and a separate approach, for posterior instrumentation. We evaluated the clinical outcome morbidity and feasibility of extrapleural retroperitoneal approach to perform anterior decompression and posterior instrumentation simultaneously by single "T" incision outcome in thoracolumbar spinal trauma and tuberculosis. Patients and Methods: Forty-eight cases of tubercular spine (n = 25 and fracture of the spine (n = 23 were included in the study of which 29 were male and 19 female. The mean age of patients was 29.1 years. All patients underwent single-stage anterior decompression, fusion, and posterior instrumentation (except two old traumatic cases via extrapleural retroperitoneal approach by single "T" incision. Tuberculosis cases were operated in lateral position as they were stabilized with Hartshill instrumentation. For traumatic spine initially posterior pedicle screw fixation was performed in prone position and then turned to right lateral position for anterior decompression by same incision and approach. They were evaluated for blood loss, duration of surgery, superficial and deep infection of incision site, flap necrosis, correction of the kyphotic deformity, and restoration of anterior and posterior vertebral body height. Results: In traumatic spine group the mean duration of surgery was 269 minutes (range 215-315 minutes including the change over time from prone to lateral position. The mean intraoperative blood loss was 918 ml (range 550-1100 ml. The preoperative mean ASIA motor, pin prick and light touch score improved from 63.3 to 74.4, 86 to 94.4 and 86 to 96 at

  2. Lateral parascapular extrapleural approach for single-stage excision of dumb-bell neurofibroma.

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    O'Reilly, G; Jackowski, A; Weiner, G; Thomas, D

    1994-01-01

    An excision of a T1 dumb-bell neurofibroma via a single-stage lateral parascapular extrapleural approach is described. The different surgical approaches that can be used to approach dumb-bell tumours are reviewed, together with the relevant literature.

  3. Minimal Access Posterior Approach for Extrapleural Thoracic Sympathectomy: A Cadaveric Study and Cases.

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    Raskin, Jeffrey S; Liu, Jesse J; Sun, Hai; Nemecek, Andrew; Balaji, Seshadri; Raslan, Ahmed M

    2016-09-01

    Operatively, video-assisted thoracoscopic sympathectomy (VATS) involves pleural entry and poses risk in small children and patients with pulmonary disease. A conventional posterior sympathectomy is more invasive than VATS. We investigated a cadaveric feasibility study of a minimal access posterior approach for endoscopic extrapleural sympathectomy and discuss this minimal approach in children with cardiac sympathectomy. A posterior endoscopic extrapleural approach for thoracic sympathectomy was performed using lightly embalmed cadavers; surgical corridor depth, width, and associated pleural violation were recorded. Two pediatric cases undergoing secondary prevention for breakthrough cardiac dysrhythmias using this approach are discussed: case 1, a 9-year-old girl with refractory long QT syndrome; and case 2, a 13-year-old boy with hypertrophic cardiomyopathy. The cadaveric study supported 100% identification of a craniocaudal-oriented sympathetic chain using an 18-mm tubular retractor, and a 10% pleural violation rate. There were no clinically significant pneumothoracies in either proof of concept cases. Minimal access posterior extrapleural sympathectomy is feasible to expose the sympathetic chain in the thoracic region with good visualization using either endoscopic or microscopic magnification. Single-position bilateral thoracic sympathectomy can be performed in pediatric patients with life-threatening ventricular arrhythmias. Based on the cadaveric study and the 2 preliminary cases, we believe that a posterior minimal access approach allows safe and effective access to the thoracic sympathetic chain for causes requiring sympathectomy using single positioning, with minimal risk of pneumothorax or Horner syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. [Diagnostic-therapeutic approach for retroperitoneal tumors].

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    Cariati, A

    1993-12-01

    After a careful review of the Literature, diagnostic and therapeutic strategies for Primary Retroperitoneal Tumours (PRT) are reported. The Author analyzes the experience of the Institute of Clinica Chirurgica "R" (Chief: Prof. E. Tosatti) as well as that of Anatomia Chirurgica (Chief: Prof. E. Cariati),--University of Genoa--in the management of PRT, stressing the importance of preoperative staging for a correct surgical approach.

  5. Robotic retroperitoneal partial nephrectomy: a four-arm approach.

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    Feliciano, Joseph; Stifelman, Michael

    2012-01-01

    Robotic partial nephrectomy is an effective alternative to laparoscopic partial nephrectomy. The 3-arm and 4-arm transperitoneal robotic approaches are well described in the literature. However, a retroperitoneal robotic technique has yet to be fully described. We report our technique and initial experience with robotic retroperitoneal partial nephrectomy with a novel 4-arm approach. We reviewed our current experience with the robotic retroperitoneal approach. Descriptive statistics on patient characteristics, operative parameters, and oncologic outcomes are reported. A total of 67 robotic-assisted partial nephrectomies were performed by one surgeon between October 2009 and October 2010. The 4-arm retroperitoneal approach was used in 8 patients (12%) with no complications. Median tumor size was 2cm. All were posterior renal tumors, with 5 located in the upper pole. The median operative time, warm ischemia time, estimated blood loss, and length of stay were 202 minutes, 18 minutes, 100cc, and 2 days, respectively. Pathology indicated renal cell carcinoma (RCC) in 7 patients with negative margins. The 4-arm robotic approach to retroperitoneal partial nephrectomy is safe, reproducible, and easily used. The fourth arm provides optimal traction on target tissues in key maneuvers and may decrease complications and positive margins secondary to impaired exposure.

  6. Retroperitoneal approach for recurrent benign multicystic peritoneal mesothelioma

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    Girish D. Bakhshi

    2013-01-01

    Full Text Available Benign multicystic peritoneal mesothelioma (BMPM is an uncommon lesion. It presents as a lump in abdomen or a finding seen on imaging modalities. Surgery is the primary modality of treatment. However, it has a high recurrence rate; this results in adhesions and subsequent surgeries difficult. We present a case of recurrent BMPM in a female operated twice earlier in a rural centre. Imaging modalities showed majority of the lesion in paracolic and retroperitoneal region. Hence, retroperitoneal approach for surgery was taken. This avoided previous surgical adhesions. A brief case report on this novel approach and review of literature is presented.

  7. Retroperitoneal approach for recurrent benign multicystic peritoneal mesothelioma.

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    Bakhshi, Girish D; Wankhede, Kishor R; Tayade, Mukund B; Bhandarwar, Ajay H; Gore, Sandeep T; Choure, Dayanand D

    2013-01-25

    Benign multicystic peritoneal mesothelioma (BMPM) is an uncommon lesion. It presents as a lump in abdomen or a finding seen on imaging modalities. Surgery is the primary modality of treatment. However, it has a high recurrence rate; this results in adhesions and subsequent surgeries difficult. We present a case of recurrent BMPM in a female operated twice earlier in a rural centre. Imaging modalities showed majority of the lesion in paracolic and retroperitoneal region. Hence, retroperitoneal approach for surgery was taken. This avoided previous surgical adhesions. A brief case report on this novel approach and review of literature is presented.

  8. Retroperitoneal haematoma and related organ injury--management approach.

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    Madiba, T E; Muckart, D J

    2001-05-01

    Retroperitoneal haematoma following blunt or penetrating trauma may arise from injuries to bone, major vascular structures, hollow viscera or solid organs. Clinical significance varies from inconsequential to fatal. Although the guidelines for exploration are clear-cut during laparotomy for associated intra-abdominal injuries, this is not the case with isolated retroperitoneal haematoma. Lateral and pelvic haematomas may be selectively explored and central haematomas always need exploration. All penetrating wound tracts should be explored, irrespective of the site of the haematoma, to exclude vital structural injury.

  9. Left retroperitoneal hydatid cyst disease and the treatment approach

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    Alper Avcı

    2013-12-01

    Full Text Available Hydatid disease is one of the oldest diseases known to mankind. In 85-95% of the cases, the liver and/or the lung are involved and in only 5-15% the cyst occurs at the other sites. Echinococcal cysts are mostly found in the liver (60%-70% of cases, followed by the lungs (10%-25%, spleen, ovaries, kidneys, brain, bones and heart, but rarely elsewhere in the body. 1-3 Retroperitoneal location of hydatid cyst is encountered rarely and only occasional case reports have appeared since Lockhart and Sapinza first reported this entity in 1958. 4-6 Primary retroperitoneal hydatid cyst is extremely rare. Hydatid disease in extrahepatic locations usually remains asymptomatic unless the cyst grows and produces.

  10. Two Case Reports and Actual Treatment Approachs of Retroperitoneal Fibrosis

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    Eymen Gazel

    2013-06-01

    Full Text Available Retroperitoneal fibrosis (RPF is a rare disease of unclear etiology, which is characterized by a chronic non specific inflammation of the retroperitoneum. This inflammation of the retroperitoneum may entrap and obstruct retroperitoneal structures, particularly the ureters. Patients with RPF show non specific clinical symptoms, including poorly localized back pain, general malaise, weight loss, anemia, features of renal failure and occasionally, mild fever. The early symptoms are non specific and an accurate diagnosis is often achieved only subsequent to urological obstruction or the occurrence of renal failure. Although a number of scientific journals devoted to RPF are present in the litera¬ture, there is no accepted diagnostic or therapeutic strategy for this disease. However, there are several therapeutic strate¬gies which have been proven to be effective. Hereby, we reported two cases of retroperitoneal fibrosis which had similar symptoms and findings but different responses to medical treatment .We aimed to discuss challanges of RPF%u2019s diagnosis and the treatment protocol.

  11. El neumotorax extrapleural en colombia

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    Llinas Olarte, Jorge E.

    2011-01-01

    Entusiasmados por los éxitos obtenidos con la cirugía del tórax en algunas formas de tuberculosis pulmonar, llegó a nuestras manos una pequeña revista médica francesa en donde los doctores Dreiffus y Hautfeuille hablaban del neumotórax extrapleural. Dicha comunicación era demasiado sintética para podernos dar uan cuenta exacta de su técnica, pero a pesar de ello apreciamos los enormes alcances que en el porvenir podría tener el desarrollo de este nuevo sistema y de inmediato nos pusimos a est...

  12. Retroperitoneal inflammation

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    ... page: //medlineplus.gov/ency/article/001255.htm Retroperitoneal inflammation To use the sharing features on this page, please enable JavaScript. Retroperitoneal inflammation is swelling that occurs in the retroperitoneal space. ...

  13. Extrapleural Inner Thoracic Wall Lesions: Multidetector CT Findings

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    Kim, Seung Soo; Kim, Young Tong; Jou, Sung Shik [Soonchunhyang University, Cheonan Hospital, Cheonan (Korea, Republic of)

    2010-06-15

    The extrapleural space is external to the parietal pleura in the thorax. The structures within and adjacent to this region include the fat pad, endothoracic fascia, intercostal muscles, connective tissue, nerves, vessels, and ribs. Further, the space is divided into the inner and outer thoracic wall by the innermost intercostal muscle. Extrapleural lesions in the inner thoracic wall are classified as air-containing lesions, fat-containing lesions, and soft tissue-containing lesions according on their main component. Air-containing lesions include extrapleural air from direct chest trauma and extrapleural extension from pneumomediastinum. Prominent extrapleural fat is seen in decreased lung volume conditions, and can also be seen in normal individuals. Soft tissue-containing lesions include extrapleural extensions from a pleural or chest wall infection as well as tumors and extrapleural hematoma. We classify extrapleural lesions in the inner thoracic wall and illustrate their imaging findings

  14. Suprainguinal retroperitoneal approach for the successful surgical treatment of meralgia paresthetica.

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    Alberti, Olaf; Wickboldt, Jürgen; Becker, Ralf

    2009-04-01

    Neurosurgical textbooks describe an infrainguinal approach as the standard or preferred option for the surgical treatment of meralgia paresthetica (MP), the most frequent entrapment neuropathy of the lower limb. However, inhomogeneous results led the authors to adopt a suprainguinal, retroperitoneal approach for decompression of the lateral femoral cutaneous nerve. In this paper the authors' aim was to study the outcome of patients harboring MP treated via this different surgical approach. The outcome of 55 consecutive patients who underwent surgery for MP via the suprainguinal retroperitoneal approach during a 15-year period was ascertained through postal questionnaires (in 47 patients) and follow-up visits (in 8 patients). The male to female ratio was 1:0.67, and the mean patient age was 50 +/- 12.9 years. The mean follow-up was 3.2 +/- 3.3 years. Seven of the patients underwent bilateral surgery. Intraoperatively the lateral femoral cutaneous nerve was consistently found in close anatomical relationship to the anterior superior iliac spine, although some variations regarding the diameter, number of branches, and underlying pathological entity were observed. Eighty-seven percent of patients showed improvement (21 patients) or complete remission (27 patients) of painful dysesthesia in the anterolateral thigh, and 13% (7 patients) remained unchanged. In addition 82% had improvement (31 patients) or complete remission (14 patients) of hypesthesia, leaving 18% with unchanged (9 patients) or worsened (1 patient) hypesthesia. In the patient-evaluated group 66% (31 of 47) were completely satisfied with the outcome, 23% (11 of 47) were partially satisfied, and 11% (5 of 47) were not satisfied with the outcome. Two cases each of recurrence, seroma, wound infection, and 1 case of hematoma requiring revision were encountered as complications. The suprainguinal retroperitoneal approach is a viable first-choice option for the surgical relief of MP.

  15. One-Step Posterior and Anterior Combined Approach for L5 Retroperitoneal Schwannoma Eroding a Lumbar Vertebra

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    Giancarlo D’Andrea

    2016-01-01

    Full Text Available We report the case of a large lumbar schwannoma eroding the vertebra and originating from spinal canal with invasion of the retroperitoneal space. We also review all the cases in literature reporting lumbar schwannomas eroding the vertebral bodies and invading the retroperitoneal space focusing on the surgical strategies to manage them. Spinal CT-scan revealed a 44 mm×55 mm inhomogeneous soft-tissue mass arising from the right L5-S1 neural foramen and its most anterior portion had a clear colliquative aspect. Magnetic resonance image showed a neoplastic lesion with homogeneous low signal in T1WI, heterogeneous signal in T2WI, and strong enhancement in postgadolinium examination. It developed as well in the retroperitoneal space, posteriorly to the iliac vein, up to the psoas muscle with wide erosion of the omolateral conjugate foramen. We performed a one-step combined approach together with the vascular surgeon because the lesion was too huge to allow a complete resection via a posterior approach and furthermore its tight relationship with the psoas muscle and the iliac vessels in the retroperitoneal space should be more safely managed via a retroperitoneal approach. We strongly suggest a 1-step surgery first approaching the dumbbell and the intraspinal schwannomas posteriorly achieving the decompression of the spinal canal and the cleavage of the tumor cutting the root of origin and the vascular supply and valuating the stability of the spine for potential artrodesis procedure. The patient must be then operated on via a retroperitoneal approach achieving the complete en bloc resection of the tumor.

  16. Retroperitoneal fibrosis and obstructive uropathy due to actinomycosis: case report of a treatment approach.

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    Yagmurdur, Mahmut Can; Akbulut, Sami; Colak, Aysel; Aygun, Cem; Haberal, Mehmet

    2009-01-01

    An actinomycotic retroperitoneal infection usually occurs in the presence of an intrauterine device (IUD). It can result in pelvic inflammatory disease and diffuse retroperitoneal fibrosis. A 39-year-old patient was admitted to the emergency unit with left flank pain. A computed tomography scan of the abdomen showed bilateral hydroureteronephrosis and a retroperitoneal malignant mass. Other tumors were excluded with a colonoscopy and an upper gastrointestinal endoscopy. Results of a fine needle aspiration biopsy showed fibrosis compatible with retroperitoneal mesenteritis. Double-J stents were placed in both ureters, and immunosuppressive therapy was started. The patient had clinical and radiologic responses to the therapy. A bilateral ureterolysis and sigmoid colon resection were done. The pathology report showed fibrosis and Actinomyces israelii infection. Parenteral and oral penicillins were administered. The probability of an Actinomyces infection in patients with retroperitoneal fibrosis should be kept in mind, especially in cases in which the patient has an intrauterine device.

  17. Thoracic Stent Graft Implantation for Aortic Coarctation with Patent Ductus Arteriosus via Retroperitoneal Iliac Approach in the Presence of Small Sized Femoral Artery

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    Ozge Korkmaz

    2016-01-01

    Full Text Available Endovascular stent graft implantation is a favorable method for complex aortic coarctation accompanied by patent ductus arteriosus. Herein, an 18-year-old woman with complex aortic coarctation and patent ductus arteriosus was successfully treated by endovascular thoracic stent graft via retroperitoneal approach. The reason for retroperitoneal iliac approach was small sized common femoral arteries which were not suitable for stent graft passage. This case is the first aortic coarctation plus patent ductus arteriosus case described in the literature which is treated by endovascular thoracic stent graft via retroperitoneal approach.

  18. Arterial embolization of an extrapleural hematoma from a dislocated fracture of the lumbar spine: a case report

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    Morita Seiji

    2009-06-01

    Full Text Available Abstract Background We present a report of a blunt-trauma patient who developed an atypical extrapleural hematoma with hemodynamic instability following a dislocation fracture of the first lumbar vertebra. We successfully treated her with arterial embolization (AE of the lumbar and intercostal arteries. Case report The patient, a 74-year-old woman, was injured in a traffic accident. At the scene of the accident, she was found to be alert, and her hemodynamic condition was stable. She arrived at our hospital complaining of lumbago. A thoracoabdominal computed tomography (CT scan with contrast enhancement showed a dislocation fracture of the first lumbar vertebra along with paravertebral and retroperitoneal hematomas. Therefore, we managed the patient conservatively with bed rest. However, 3 h after admission, her blood pressure suddenly decreased. A repeated thoracoabdominal CT scan showed enlargement of the right retroperitoneal hematoma with extravasation of the contrast medium into the right extrapleural space. Angiography was immediately performed, showing extravasation of the contrast media from the right intercostal (Th12 and lumbar arteries (L1. After arterial embolization (AE with gelatin-sponge particles, extravasation of the contrast medium ceased, and the patient's hemodynamic condition stabilized without massive fluid resuscitation. Conclusion The extrapleural hematoma reduced in size after AE, and almost disappeared on the 14th day of hospitalization. The lumbar spinal fracture was successfully repaired on day 16, and the patient was kept in the hospital to recuperate. We believe that AE is effective for the management of intractable bleeding following fractures of the spine.

  19. Doege-Potter syndrome presenting with hypoinsulinemic hypoglycemia in a patient with a malignant extrapleural solitary fibrous tumor: a case report

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    Schutt Robert C

    2013-01-01

    Full Text Available Abstract Introduction Doege-Potter syndrome is a paraneoplastic syndrome characterized by non-islet cell tumor hypoglycemia secondary to a solitary fibrous tumor. This tumor causes hypoglycemia by the secretion of a prohormone form of insulin-like growth factor II. We describe the diagnosis and management of Doege-Potter syndrome and the use of transarterial chemoembolization in a patient with a malignant extrapleural solitary fibrous tumor. Case presentation Our patient was a 64-year-old Caucasian woman who initially presented with urinary incontinence and was found to have a 14.5×9.0×9.0cm retroperitoneal solitary fibrous tumor compressing her bladder. Her tumor was surgically resected but recurred with multiple hepatic metastatic lesions. The hepatic metastases progressed despite systemic chemotherapy and treatment with doxorubicin transarterial chemoembolization. Her course was complicated by the development of recurrent fasting hypoglycemia, most likely secondary to Doege-Potter syndrome. Her hypoglycemia was managed with corticosteroid therapy and frequent scheduled nutrient intake overnight. Conclusions The rarity of hepatic solitary fibrous tumors and consequent lack of controlled trials make this report significant in that it describes the diagnostic approach to Doege-Potter syndrome, describes our experience with the use of doxorubicin transarterial chemoembolization, and presents management options for tumor-associated hypoglycemia in the case of extensive disease not amenable to surgical resection.

  20. Retroperitoneal less donor nephrectomy

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    A. Van Der Merwe

    2010-10-01

    Full Text Available Donor nephrectomy with laparo-endoscopic single site (LESS surgery has been reported via the transperitoneal approach. We describe a novel technique of retroperitoneal donor nephrectomy using a single surgical incision in the groin, below the abdominal skin crease or "bikini line". The LESS groin incision offers superior cosmesis, while the retroperitoneal approach has distinct advantages, such as the ability to identify the renal vessels early. The new procedure has been performed in two obese patients (body mass index 32 and 33 kg/m2, respectively. The operative times were 4 and 5 hours, warm ischemic times 135 and 315 seconds, blood loss 100 and 250 mL, and hospitalization 3 and 2 days, respectively. Retroperitoneal LESS donor nephrectomy through a single, inconspicuous groin incision is feasible and safe. Further evaluation of the technique in a larger patient cohort is indicated.

  1. Fibrosis retroperitoneal

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    Claudio Orlich-Castelán

    2005-07-01

    Full Text Available Se reporta el caso de una mujer de 61 años de edad, con antecedente de tuberculosis pélvica en la adolescencia, que se presentó con insuficiencia renal aguda y dolor lumbar y a quien se le diagnosticó fibrosis retroperitoneal. Se revisa la bibliografía reciente y los principales aspectos de esta enfermedadRetroperitoneal fibrosis. is an uncommon disease complicated by ureteral entrapment causing hydronephrosis and obstructive renal failure. We herein report a case recently diagnosed at our institution and review the literature on this topic

  2. Retroperitoneal Sarcomas.

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    Porpiglia, Andrea S; Reddy, Sanjay S; Farma, Jeffrey M

    2016-10-01

    Retroperitoneal sarcomas are rare tumors, representing only 15% of all sarcomas. The mainstay of therapy is surgical resection with negative margins. However, this is challenging because of the late presentation of many of these tumors and involvement with adjacent structures. Decisions on radiation therapy and chemotherapy should be made in a multidisciplinary setting at a tertiary referral center.

  3. Fibrosis retroperitoneal

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    Claudio Orlich-Castelán

    2005-07-01

    Full Text Available Se reporta el caso de una mujer de 61 años de edad, con antecedente de tuberculosis pélvica en la adolescencia, que se presentó con insuficiencia renal aguda y dolor lumbar y a quien se le diagnosticó fibrosis retroperitoneal. Se revisa la bibliografía reciente y los principales aspectos de esta enfermedad

  4. Partial nephroureterectomy in duplex renal system: preoperative 3D virtual rendering and retroperitoneal laparoscopic approach in children

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    Molinaro F.

    2013-10-01

    Full Text Available Introduction: the aim of this study is to presents the results of our preliminary series of 8 partial nephroureterectomy performed by retroperitoneoscopy using harmonic scalpel with a preoperative 3D virtual reconstruction of bidimensional magnetic resonance images in children affected by duplication of the renal system. Materials and methods: We perform a retrospective study in our Pediatric Surgery Unit from January 2007 to January 2012 of all children affected by duplication of the renal system treated by retroperitoneal laparoscopic approach. Images collected were reconstructed using IRCAD VR render software. Data include: sex, age at surgery, clinical and radiological features, surgical procedure, follow-up and complications. Results: retroperitoneal laparoscopic partial nephroureterectomy was performed in 8 children (6 males and 2 females. All patients had a non-functioning moiety of a duplex kidney and in addition recurrent urinary tract infections. Two cases were associated with ureterocele; of them in one case we performed a previous endoscopic incision of the obstructing ureterocele. All patients underwent radiological evaluation prior to surgery, by ultrasound, voididng cystourethrography, renal scintigraphy and contrast-enhanced MRI evaluations. Images collected were reconstructed using IRCAD VR render software. Patients were treated by a 3-4 trocars technique and parenchymal section was performed using harmonic scalpel. The mean operative time was 180 minutes; no cases required open conversion. The mean hospital stay was 5 days. The mean follow-up was 38 months. No cases of secondary atrophy of the lower pole were observed. Discussion: Volume rendering gives high anatomical resolution and it can be useful to guide the surgical procedure. Laparoscopic retroperitoneal partial nephrectomy is a safe and feasible procedure in children for experienced pediatric laparoscopic surgeons.

  5. Can surgical approach affect postoperative analgesic requirements following laparoscopic nephrectomy: Transperitoneal versus retroperitoneal? A prospective clinical study.

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    Savran-Karadeniz, Meltem; Kisa, Ilkay; Salviz, Emine-Aysu; Ozkan-Seyhan, Tulay; Tefik, Tzevat; Sanli, Oner; Tugrul, Kamil-Mehmet

    2017-07-01

    We performed this prospective clinical study to compare the postoperative recovery profile of our patients after transperitoneal (Group T) and retroperitoneal (Group R) laparoscopic nephrectomy approaches. Our primary hypothesis was that epidural analgesic consumption in Group R would be higher at the end of the first postoperative day. Forty-four patients scheduled for elective transperitoneal or retroperitoneal laparoscopic nephrectomies were enrolled. All patients in both groups received epidural catheter and general anesthesia induction. At the end of the operation, patients were given 10 ml 0.25% bupivacaine through epidural catheters and extubated. Postoperatively, patients started to receive a continuous infusion of 0.1% bupivacaine and 1μg/ml fentanyl 5ml/h with patient-controlled boluses of an additional 4ml through a patient controlled epidural analgesia (PCEA) device. They were prescribed IV tramadol 1mg/kg as a rescue analgesic VAS≥4). Total analgesic consumption from PCEA devices and VAS scores during the first 24 postoperative hours were recorded as well as number of patients who required analgesic rescue. Forty patients completed the study, 20 in each group. Total epidural analgesic consumption during the first 12 hours were significantly higher in Group R (p<0.05). Basal, postoperative 30 min, 2, 6 hours VASrest, VASmobilization and 12 h VASmobilization scores, and number of patients who required rescue analgesic at 0, 30 min in Group R were significantly higher than Group T (p<0.05). Retroperitoneal laparoscopic nephrectomy was found to be more painful and patients in this group required more epidural and analgesic rescue during the first 12 postoperative hours. ClinicalStudys.gov: (NCT02622893).

  6. [Retroperitoneal fibrosis].

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    Babski, Paweł; Wojtuń, Stanisław; Gil, Jerzy

    2007-05-01

    Retroperitoneal fibrosis is a rare clinical entity characterised by the presence of patologic collagen tissue in a retroperitoneal space. The fibrous mass covers abdominal organs causing their disfunctions. RPF was described at the begining of XX century but its etiology is not clear yet. Usually it causes an ureter obstuction and hydronephrosis, that is why most commonly is diagnosed by urologists and nephrologists. However, retroperitoneal fibrosis can be multifacial disease. In some patients localisation of fibrosis is atypical and manifestationns can be varied. Gastrological symptoms like jaundice, bowel obstuction, ascites can occure. Besides, some early signs of RPF are nonspecific and can imitate alarming symptoms of neoplasma, e.g.: weight loss, anemia, malaise, anorexia, fever. This force us to initiate gastrological investigation. The awareness of this disease is important. The early diagnosis and treatment improves prognosis and alows to avoid heavy complications. In typical cases radiology is often enough for diagnosis. However, histological examination is needed in many cases, especialy when patological mass is located atypical. A treatment is made up of farmacology and surgery. The first one is based on steroids, immunossuppressant and tamoxifen. Surgery is needed to eliminate organs obstruction.

  7. Extrapleural paravertebral CT guided fine needle biopsy of subcarinal lymph nodes

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    Tantawy, Wahid H., E-mail: tantawyw@yahoo.com [Radiology Department, Faculty of Medicine, Ain Shams University, Egypt Abbassyia square, Cairo (Egypt); El-Gemeie, Emad H. [Pathology Department, National Cancer Institute, Fom El Khalige Faculty of Medicine, Cairo University (Egypt); Ibrahim, Ahmed S., E-mail: asibrahima@gmail.com [Radiology Department, Faculty of Medicine, Ain Shams University, Egypt Abbassyia square, Cairo (Egypt); Mohamed, Mona A. [Radiology Department, Faculty of Medicine, Ain Shams University, Egypt Abbassyia square, Cairo (Egypt)

    2012-10-15

    Purpose: To report our experience in CT guided extrapleural paravertebral subcarinal lymph biopsy using a thin 25 gauge (25 G) thin needle without the need of injection of saline to widen the mediastinum. Materials and methods: Biopsy was performed using a 25 G needle which was advanced lateral to the vertebral body between the endothoracic fascia and the parietal pleura to gain access to subcarinal lymph nodes. One hundred and forty one patients were included in the study (74 females, 57 males). No artificial widening of the mediastinum using saline injection was required. The study was performed in the presence of a cytopathologist; sensitivity and specificity rates were calculated. Complications were documented for each case especially for pneumothorax and haemorrhage. Results: Cytopathological diagnosis was reached in all cases. All re-aspirations were done in the same session to reach a primary diagnosis at the time of the biopsy. Imunophenotyping study was done in 94 cases to confirm the primary diagnosis and to classify the malignant lesions. No pneumothorax was encountered. Small haematomas were noted in 5 cases (3.5%). Cytopathology showed a sensitivity of 97.2% and specificity of 100%. By adding immunophenotyping a 100% sensitivity and specificity was achieved. Conclusion: Fine needle aspiration cytology (FNAC) using a 25 gauge needle for subcarinal lymph nodes via a percutaneous extrapleural paravertebral CT guided approach is a safe, minimally invasive, and tolerable procedure yielding a high sensitivity and specificity rates without the need of artificial widening.

  8. Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication.

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    Wolf, Andrea S; Flores, Raja M

    2016-08-01

    The role of surgical resection in malignant pleural mesothelioma (MPM) is based on the principle of macroscopic resection of a solid tumor with adjuvant therapy to treat micrometastatic disease. Extrapleural pneumonectomy (EPP) and pleurectomy decortication (P/D) have been developed in this context. Cancer-directed surgery for MPM is associated with a 5-year survival rate of 15%. Evidence indicates that P/D is better tolerated by patients and suggests survival is no worse when compared with EPP. Although EPP is still performed in highly selected cases, the authors advocate radical P/D whenever possible for patients with MPM.

  9. Spinal cord ischemia resulting in paraplegia following extrapleural pneumonectomy.

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    Ural, Kelly; Jakob, Kyle; Lato, Scott; Gilly, George; Landreneau, Rodney

    2014-08-01

    A patient undergoing radical extrapleural pneumonectomy for epithelioid malignant mesothelioma developed acute paraplegia postoperatively related to long-segment spinal cord ischemia. The usual area of concern for this complication is the T9 to T12 area where the artery of Adamkiewicz is most likely to originate. In this patient, there was ligation of only upper thoracic, ipsilateral segmental arteries from the T3 to T6 level, yet he still developed paraplegia. Our hypothesis is variant mid-thoracic vascular anatomy. Previously unreported, to our knowledge, this should be understood as a rare complication of this surgery.

  10. [Renal angiomyolipoma complicated by retroperitoneal hematoma].

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    Rabii, R; Fekak, H; Moufid, K; Joual, A; Benjelloun, S; Khaleq, K; Idali, B; Harti, A; Barrou, L

    2002-07-01

    Renal angiomyolipoma (AML) is a benign tumor, they are generally asymptomatic or can manifested by abdominal pain, palpable mass or hematuria. We report an uncommoun case of 65 years old women who consulted for retroperitoneal hemorrhage by spontaneous rupture of renal AML with palpable mass. The ultrasound and CT abdominopelvic scan were performed in the preoperative diagnosis and showed a typical right renal AML with retroperitoneal hematoma. The right nephrectomy by transperitoneal approach was performed with a good follow-up. The histological examination confirmed the diagnosis for renal AML. About this case, the authors discuses the diagnosis and the management for AML with retroperitoneal hemorrhage.

  11. Robotic retroperitoneal surgery: a contemporary review.

    Science.gov (United States)

    Patel, Mayank; Porter, James

    2013-01-01

    Robotic-assisted renal surgery is being increasingly utilized for various kidney diseases; however, the majority of these are performed via a transperitoneal approach. Retroperitoneal robotic surgery is a relatively new technique, which allows direct access to the posterolateral surface of the kidney, as well as posterior hilar structures. In this review, we summarize the most recent publications and review our experience of retroperitoneal robotic surgery. Retroperitoneal robotic surgery has been successfully applied to radical nephrectomy, partial nephrectomy and pyeloplasty. The current series, although few, find this approach ideal for posterior and lateral renal masses, and technically feasible with the advances in robotic technology. The retroperitoneal approach has been shown to decrease operative times, narcotic need and permit quicker return of bowel function. Furthermore, there does not appear to be any increase in perioperative complications using this approach. The limited data using this technique offer an encouraging outlook on robotic retroperitoneal surgery. The retroperitoneal approach permits direct access to the renal hilum, no need for bowel mobilization and excellent visualization for posteriorly located renal disease.

  12. [Giant retroperitoneal liposarcoma].

    Science.gov (United States)

    Mezzour, Mohamed Hicham; El Messaoudi, Yasser Arafat; Fekak, Hamid; Rabii, Redouane; Marnissi, Farida; Karkouri, Mehdi; Salam, Siham; Iraki, Moulay Ahmed; Joual, Abdenbi; Meziane, Fathi

    2006-02-01

    The authors report a case of giant retroperitoneal liposarcoma. The diagnosis was suspected after scanography and magnetic resonance imaging and confirmed by the histological analysis of the extracted piece after surgical treatment. Postoperative evolution was favourable after one year without recurrence or distant metastasis. The authors discuss the pathologic and therapeutic aspects and the prognosis of retroperitoneal liposarcoma.

  13. Calcified retroperitoneal fibroma.

    Science.gov (United States)

    Illuminati, G; Bertagni, A; Montesano, G; Soda, G; Baiocchini, A; Melis, M; Vietri, F

    1997-01-01

    A case of 31-year-old male with a retroperitoneal tumor is described. Abdominal ultrasound revealed a left para-aortic calcific mass, adjacent to the left lobe of the liver and to the upper pole of the left kidney. A CT-scan of the abdomen showed the mass to originate from the left adrenal gland. At operation, a large, retroperitoneal mass, adherent to the left kidney and the spleen, but not infiltrating, was excised. Histologically the tumor was diagnosed as a calcified osteo-producing fibroma. Benign retroperitoneal tumors represent about 25% of all retroperitoneal neoplasm. This reported case represents a retroperitoneal tumor of slow growth and benign clinical course whose characteristic consists of the heavy calcifications which are normally absent in a fibroma type mass.

  14. Removal of intraosseous cartilaginous node originated from thoracic vertebrae via anterolateral ex-trapleural approach%经侧前方肋间隙胸膜外入路切除胸椎椎体后缘骨内软骨结节的胸椎管减压

    Institute of Scientific and Technical Information of China (English)

    黑龙; 袁海峰; 赵浩宁; 乔永东; 王自立; 丁惠强

    2014-01-01

    目的:探讨侧前方经肋间隙胸膜外入路手术切除胸椎椎体后缘骨内软骨结节治疗胸椎管狭窄症的方法和疗效。方法:2002年4月~2012年9月,对18例明确诊断为胸椎椎体后缘骨内软骨结节所致椎管狭窄症患者采用经侧前方肋间隙胸膜外入路减压内固定融合术治疗,男12例,女6例;年龄33~61岁,平均46岁。影像学证实均为单一节段椎体后缘骨内软骨结节,且不合并胸椎黄韧带骨化及后纵韧带骨化。病变节段:T7/82例,T8/94例,T9/105例,T10/117例。术前神经功能Frankel 分级:C 级6例,D级12例;JOA 评分6.6±1.3分。观察术后疗效和并发症发生情况。结果:18例患者均顺利完成手术,平均用时3.5h,平均出血量420ml (350~620ml),术后无气胸、胸腔积液等并发症发生;1例术后1周发生肺炎,5例术后第2天复查胸片时发现邻近肋骨骨折,均经保守治疗后痊愈。所有患者均获得随访,随访时间2~12年,平均6年。疗效参照Epstein标准评价,优15例,良2例,差1例,优良率94%(17/18)。术前Frankel分级为C级的患者1例无明显改善,1例改善至D级,4例改善为E级;12例D级患者均改善为E级。 JOA评分改善到9.4±1.6分,与术前比较有显著性差异(P<0.05)。术后1年复查CT见椎间植骨区表面有连续性骨小梁通过,末次随访时影像学检查未发现内固定断裂、松动和植骨不融合现象。结论:对于胸椎椎体后缘骨内软骨结节所致胸椎管狭窄症患者,采用经侧前方肋间隙胸膜外入路胸椎椎体后缘骨内软骨结节切除减压可取得较好的临床疗效,是一种安全有效的手术方式。%Objectives: To investigate the surgical method and its outcome of the removal of intraosseous cartilaginous node originated from thoracic vertebrae via anterolateral extrapleural approach. Methods: From April 2002 to September 2012, 18 cases

  15. Extrapleural pneumonectomy, photodynamic therapy and intensity modulated radiation therapy for the treatment of malignant pleural mesothelioma.

    Science.gov (United States)

    Du, Kevin L; Both, Stefan; Friedberg, Joseph S; Rengan, Ramesh; Hahn, Stephen M; Cengel, Keith A

    2010-09-01

    Intensity modulated radiation therapy (IMRT) has recently been proposed for the treatment of malignant pleural mesothelioma (MPM). Here, we describe our experience with a multimodality approach for the treatment of mesothelioma, incorporating extrapleural pneumonectomy, intraoperative photodynamic therapy and postoperative hemithoracic IMRT. From 2004-2007, we treated 11 MPM patients with hemithoracic IMRT, 7 of whom had undergone porfimer sodium-mediated PDT as an intraoperative adjuvant to surgical debulking. The median radiation dose to the planning treatment volume (PTV) ranged from 45.4-54.5 Gy. For the contralateral lung, V20 ranged from 1.4-28.5%, V5 from 42-100% and MLD from 6.8-16.5 Gy. In our series, 1 patient experienced respiratory failure secondary to radiation pneumonitis that did not require mechanical ventilation. Multimodality therapy combining surgery with increased doses of radiation using IMRT, and newer treatment modalities such as PDT , appears safe. Future prospective analysis will be needed to demonstrate efficacy of this approach in the treatment of malignant mesothelioma. Efforts to reduce lung toxicity and improve dose delivery are needed and provide the promise of improved local control and quality of life in a carefully chosen multidisciplinary approach.

  16. Idiopathic Retroperitoneal Hematoma

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    Tomoyuki Abe

    2010-09-01

    Full Text Available A 34-year-old female presented with sudden onset of severe abdominal pain in a flank distribution. A large mass was palpable in the right upper quadrant on physical examination. Abdominal contrast-enhanced computed tomography showed a well-defined, right-sided, retroperitoneal cystic lesion located between the abdominal aorta and the inferior vena cava (IVC. The tumor size was 55 × 58 mm, and it compressed the gallbladder and the duodenum. Upper gastrointestinal radiography revealed a stricture of the second portion of the duodenum by the tumor. T2-weighted magnetic resonance imaging showed that the whole part was hyperintense with hypointense rims, but the inner was partially hypointense. Based on the radiological findings, the preoperative differential diagnosis included retroperitoneal teratoma, Schwannoma, abscess, and primary retroperitoneal tumor. On laparotomy, the tumor was located in the right retroperitoneal cavity. Kocher maneuver and medial visceral rotation, which consists of medial reflection of the upper part of right colon and duodenum by incising their lateral peritoneal attachments, were performed. Although a slight adhesion to the IVC was detected, the tumor was removed safely. Thin-section histopathology examination detected neither tumor tissues nor any tissues such as adrenal gland, ovarian tissue, or endometrial implants. The final pathological diagnosis was idiopathic retroperitoneal hematoma; the origin of the bleeding was unclear. The patient was discharged without any complication 5 days after the operation.

  17. Recurrent thymoma in the retroperitoneal space: a rare case report

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    Jun Yang

    2015-06-01

    Full Text Available Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum and recurrences of thymoma generally are locally, and retroperitoneal recurrence is considered to be rare. A 46-year old Asian woman with invasive thymoma had undergone thymectomy 10 years ago. Computed tomography demonstrated a wellcircumscribed mass in the left retroperitoneal space. The patient had not any symptom including myasthenia gravis. Because on the anterior mediastinum area shows no sign of tumor recurrence and the mass adjacent to the vertebral body, neurogenic tumor was suspected. Surgical resection was performed using a retroperitoneal approach, which revealed the tumor adhering neighboring diaphragm. The tumor was histologically diagnosed to be type B1 thymoma according to the World Health Organization classification. The retroperitoneal mass was an unusual local recurrence after thymectomy. The patients whose had under invasive thymectomy should be evaluated carefully when finding retroperitoneal mass during follow-up.

  18. Schwannoma retroperitoneal maligno Malign retroperitoneal schwannoma

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    Rafael Pinilla González

    2009-12-01

    Full Text Available Los tumores del retroperitoneo son poco frecuentes y se clasifican según el tejido del que se originan. Se presenta el caso de una paciente con dolor en el hipocondrio derecho y tumor en esta zona, pérdida de peso y molestia dolorosa en la cara anterolateral del muslo derecho. En el examen físico se halló palidez cutáneo-mucosa y tumoración indolora en el hipocondrio y flanco derecho. El ultrasonido abdominal mostró una masa homogénea de 14,11 cm y la tomografía computarizada de abdomen permitió observar un tumor retroperitoneal derecho que rechazaba el riñón. El urograma excretor mostró rechazamiento anteromedial del riñón derecho. Se extirpó un tumor encapsulado con pocas adherencias peritumorales. Mediante estudio histológico se confirmó un tumor de células fusiformes con hipercromatismo y pleomorfismo nuclear, numerosas mitosis y áreas de necrosis y el diagnóstico de tumor maligno de la vaina de un nervio periférico.The retroperitoneal tumors are infrequent and are classified according to the original tissue. This is a case presentation of a patient presenting with pain in right hypochondrium and a tumor in this zone, weight loss and painful discomfort in the anterolateral face of right thigh. In physical examination we found cutaneous-mucous paleness and painless tumor in hypochondrium and right flank. Abdominal ultrasound (US showed a homogenous mass of 14,11 cm and abdominal computed tomography allows to see a right retroperitoneal tumor rejecting the kidney. Excretory urogram showed a anteromedial rejection of right kidney. An encapsulated tumor with a few peritumoral adherences was removed. By histological study it was possible to confirm a fusiform cells tumor with hyperchromatism and nuclear pleomorphism, numerous mitosis and areas of necrosis and in the diagnosis of malign tumor of the sheath of a peripheral nerve.

  19. Trajeto extrapleural, para-hilar da artéria torácica interna esquerda pediculada nos enxertos coronarianos The positioning of the internal thoracic artery extra-pleural and perihilar in coronary artery bypass grafting

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    Hermes de Souza Felippe

    2012-12-01

    Full Text Available Variante técnica relacionada ao posicionamento da artéria torácica interna esquerda pediculada extrapleural e para-hilar, evitando aderências ao mediastino anterior e protegendo o enxerto de possíveis lesões durante eventuais reoperações.The positioning of the internal thoracic artery extra-pleural and perihilar in coronary artery bypass grafting to avoiding anterior aderences and prevent unnecessary damage arterial.

  20. Surgical anatomy of the retroperitoneal spaces, Part V: Surgical applications and complications.

    Science.gov (United States)

    Mirilas, Petros; Skandalakis, John E

    2010-04-01

    Knowledge of the surgical anatomy of the retroperitoneum is crucial for surgery of the retroperitoneal organs. Surgery is essential for treatment of retroperitoneal pathologies. The list of these diseases is extensive and comprises acute and chronic inflammatory processes (abscess, injury, hematoma, idiopathic fibrosis), metastatic neoplasms, and primary neoplasms from fibroadipose tissue, connective tissue, smooth and striated muscle, vascular tissue, somatic and sympathetic nervous tissue, extraadrenal chromaffin tissue, and lymphatic tissue. The retroperitoneum can be approached and explored by several routes, including the transperitoneal route and the extraperitoneal route. The retroperitoneal approach to the iliac fossa is used for ectopic renal transplantation. Safe and reliable primary retroperitoneal access can be performed for laparoscopic exploration. The anatomic complications of retroperitoneal surgery are the complications of the organs located in several compartments of the retroperitoneal space. Complications may arise from incisions to the somatic wall, somatic nerves, blood and lymphatic vessels, lymph nodes, visceral autonomous plexuses, and neighboring splanchna.

  1. Endoscopic Retroperitoneal Adrenalectomy for Adrenal Metastases

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    Gintaras Simutis

    2014-01-01

    Full Text Available Objectives. To evaluate whether retroperitoneal approach for adrenalectomy is a safe and effective treatment for adrenal metastases (AM. Methods. From June 2004 to January 2014, nine consecutive patients with AM were treated with endoscopic retroperitoneal adrenalectomy (ERA. A retrospective study was conducted, and clinical data, tumor characteristics, and oncologic outcomes were acquired and analyzed. Results. Renal cancer was the primary site of malignancy in 44.4% of cases. The mean operative time was 132 ± 10.4 min. There were 5 synchronous and 4 metachronous AM. One patient required conversion to transperitoneal laparoscopic procedure. No mortality or perioperative complications were observed. The median overall survival was 11 months (range: 2–42 months. Survival rates of 50% and 25% were identified at 1 and 3 years, respectively. At the end of the study, 4 patients were alive with a mean observed follow-up of 20 months. No patients presented with local tumor relapse or port-site metastases. Conclusions. This study shows that ERA is a safe and effective procedure for resection of AM and advances the surgical treatment of adrenal disease. The use of the retroperitoneal approach for adrenal tumors less than 6 cm can provide very favorable surgical outcomes.

  2. Retroperitoneal Cystic Lymphangioma

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    Ş.Sevil Altunrende

    2010-03-01

    Full Text Available Abdominal cystic lymphangioma is a rare, benign, congenital tumor. It is an developmental abnormality of the lymphatic system. Males are relatively more affected and 90% of the cases are under 5 years of age. Multilocular cystic lesion with septations is seen on abdominal ultrasonography. As echogenicity can vary depending on the content of the cyst like cellular debris, hemorrhage or chylous, liquid-liquid or fat-liquid levels can be observed. Definitive treatment is total excision. Cyst aspiration is not an effective method and nearly always ends with recurrence. Computerized tomography and magnetic resonance imaging findings of sonographically detected retroperitoneal cystic lymphangioma in a newborn girl with abdominal distention are discussed in this paper. (The Medical Bulletin of Haseki 2010; 48: 47-9

  3. Retroperitoneal inflammatory myofibroblastic tumor

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    Bapsy Poonamalle P

    2005-10-01

    Full Text Available Abstract Background Inflammatory myofibroblastic tumor (IMT is a neoplasm of unknown etiology occurring at various sites. By definition, it is composed of spindle cells (myofibroblasts with variable inflammatory component, hence the name is IMT. Case presentation The present case is of a 46 years old woman presented with a history of flank pain, abdominal mass and intermittent hematuria for last 6 months. The initial diagnosis was kept as renal cell carcinoma. Finally, it turned out to be a case of retroperitoneal IMT. The patient was managed by complete surgical resection of the tumor. Conclusion IMT is a rare neoplasm of uncertain biological potential. Complete surgical resection remains the mainstay of the treatment.

  4. Biliary Duct-to-Duct Reconstruction with a Tunneled Retroperitoneal T-Tube During Liver Transplantation: a Novel Approach to Decrease Biliary Leaks After T-Tube Removal.

    Science.gov (United States)

    Navez, Julie; Mohkam, Kayvan; Darnis, Benjamin; Cazauran, Jean-Baptiste; Ducerf, Christian; Mabrut, Jean-Yves

    2017-04-01

    The benefit of placing a T-tube for duct-to-duct biliary reconstruction during orthotopic liver transplantation (OLT) remains controversial because it could be associated with specific complications, especially at the time of T-tube removal. While the utility of T-tube during OLT represents an eternal debate, only a few technical refinements of T-tube placement have been described since the report of the original technique by Starzl and colleagues. Herein, we present a novel technique of T-tube placement for duct-to-duct biliary reconstruction during OLT, using a tunneled retroperitoneal route. On the basis of our experience of 305 patients who benefitted from the reported technique, the placement of a tunneled retroperitoneal biliary T-tube appears to be safe and results in a low rate of biliary complications, especially at the time of T-tube removal.

  5. [Laparoscopic treatment of retroperitoneal fibrosis].

    Science.gov (United States)

    Joual, Abdenbi; Rabii, Redouane; El Mejjad, Amine; Fekak, Hamid; Debbagh, Adil; El Mrini, Mohamed

    2004-04-01

    The authors report a case of idiopathic retroperitoneal fibrosis (RPF) in a 38-year-old man presenting with obstructive acute renal failure. The initial management consisted of urinary diversion by bilateral double-J ureteric stenting. After restoration of normal renal function, CT urography demonstrated retroperitoneal fibrosis surrounding the two ureters. Surgical treatment was performed by laparoscopy using four trocars. The operation consisted of detachment of the ascending and descending colon followed by release of the ureters from the lumbar segment to the pelvic segment and finally intraperitonealization of the ureters. The operating time was six hours, the postoperative course was uneventful and the double-J stents were removed at the third week. Laparoscopic treatment of RPF is a treatment option providing all of the benefits of minimally invasive surgery. In the light of this case and a review of the literature, the authors describe the laparoscopic treatment of idiopathic retroperitoneal fibrosis.

  6. Displaced plaque in retroperitoneal adenopathy.

    Science.gov (United States)

    Al-Okaili, Riyadh N; Schable, Stephen I; Marlow, Troy J

    2002-08-01

    This study was designed to determine when to consider incidental retroperitoneal masses on the basis of a displaced calcified atheromatous abdominal aorta on lateral radiographs. We did a retrospective review of 143 normal abdominal helical computed tomography scans of individuals aged 50 years and older to measure the distance between the posterior aortic wall and anterior cortex of vertebral bodies from T12 through L3. The normal abdominal aorta maintains a close relationship to the vertebral column. The distance should not be more than 10 mm in men and 7.3 mm in women. Displacement of aortic calcified atheroma greater than these distances should prompt a search for a retroperitoneal mass.

  7. Differential routes of carboplatin administration influence lymphocyte apoptosis in retroperitoneal lymph nodes.

    Science.gov (United States)

    Huang, Yong-Wen; Zeng, Zheng; Li, Su; Liu, Ji-Hong

    2012-12-01

    We aimed to investigate carboplatin distribution in retroperitoneal lymph nodes and its effect on lymphocyte apoptosis following intravenous (IV), intra-arterial (IA), and retroperitoneal (RP) administration. Sixty-three healthy female canines were randomly assigned as IV, IA, or RP administration of carboplatin. At 0.5, 1, 2, 4, 8, 24, and 72 h after carboplatin treatment, retroperitoneal lymph nodes (n = 6 at each time point) were collected and high-performance liquid chromatography was employed to measure the carboplatin content. The differences in carboplatin pharmacokinetics of the three administration routes were compared. Terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) was carried out to measure the lymphocyte apoptosis of the retroperitoneal lymphocytes. The peak concentration of carboplatin in plasma following IV administration was the highest among all approaches; as to the peak time, RP administration was longer than the other two administrations. Concentration for carboplatin in the retroperitoneal lymph node was highest following IA administration at early time points, but at higher time points, concentration was significantly higher following RP administration. Penetration of carboplatin into the retroperitoneal space was higher following RP administration. Following RP administration, the level of apoptotic lymphocytes in the retroperitoneal lymph nodes was significantly greater than either IV or IA. Following RP administration of carboplatin, the concentration, area under the curve of carboplatin and the number of apoptotic lymphocytes were significantly higher than those following IV and IA administration. This suggests that RP administration of carboplatin is beneficial for the treatment of retroperitoneal lymph node metastasis.

  8. [A modified retroperitoneal approach to the kidney in patients with a highly deformed thorax: obtaining a wide operative field through subperiosteal resection of the 10th, 11th and 12th ribs].

    Science.gov (United States)

    Satoh, Yuji; Kanou, Takehiro; Takagi, Norito; Tokuda, Yuji; Uozumi, Jiro; Masaki, Zenjiro

    2005-07-01

    We herein report a technique which facilitates a retroperitoneal approach to the kidney in cases of highly deformed thorax due to kyphoscoliosis. The operation consists of a lumbar oblique incision with removal of the 11th rib, combined with the additional removal of the 12th and 10th ribs. Resection of the upper two ribs was performed subperiosteally, leaving the periosteum of the deep side untouched. However, the deep side periosteum of the 12th rib was incised caudal from the pleural margin in order to facilitate exposure of the diaphragm. The retroperitoneal space was entered through the tip of the 11th rib bed. The diaphragm was incised dorso-medially at a level 1 cm caudal from the lower margin of the pleura, to an extent necessary to enable the pleura together with the cranial diaphragm to be manoeuvred in an upward direction. Two cases with renal tuberculosis associated with high-grade kyphosis and one case with staghorn calculi accompanied with lordosis were operated on utilizing this technique. In the former two cases, the thoracic cage was in direct contact with the iliac bone and there was practically no space between the rib border and the iliac crest. This was also true of the third case, but the grade of deformity was not as extensive as in the former two cases. Removal of the 10th, 11th and 12th ribs could be achieved without injuring the pleura and a satisfactorily large operating field could thus be developed which enabled a simple nephrectomy to be performed without difficulty. The characteristic feature of the described approach is that resection of the 10th and 11th ribs is simply to facilitate manoevrability of the wound margin, without going through the rib bed. The technique could be advantageous in selected cases where there is a highly deformed thorax.

  9. Metastatic extrapleural malignant solitary fibrous tumor presenting with hypoglycemia (Doege–Potter syndrome

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    Andrew J. Degnan, MD, MPhil

    2017-03-01

    Full Text Available We report a rare case of metastatic malignant solitary fibrous tumor (SFT that presented with hypoglycemia because of insulin growth factor-2 production. Initial workup included computed tomography imaging that revealed a large, partially necrotic liver mass, a hypervascular pancreatic head lesion, and 2 renal lesions. Following hepatic resection, pancreatic head resection and nephrectomy, all these lesions demonstrated pathological findings that were consistent with SFT. The patient also had a history of an intracranial mass that had been previously resected and treated with gamma knife therapy at an outside institution, which was found to also be SFT. Six months after initial pancreatic head resection, the patient developed a new lesion involving the pancreatic tail that was found to represent recurrent metastatic SFT. This case emphasizes the highly aggressive nature of extrapleural SFT, while rare, and the role of imaging in follow-up for disease recurrence.

  10. Misleading diagnosis of retroperitoneal actinomycosis

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    Berchtenbreiter, C.; Bruening, R.; Reiser, M. [Inst. of Diagnostic Radiology, University Hospital Grosshadern, Ludwig Maximilians University, Munich (Germany); Auernhammer, A. [Medical Clinic II, Univ. Hospital Grosshadern, Ludwig Maximilians University, Munich (Germany)

    1999-07-01

    A 34-year-old woman presented with a left-sided suprarenal space-occupying lesion on sonography. Culture of material obtained during sonographic-guided puncture of the retroperitoneal lesion yielded a mixed flora of Actinomyces and Peptostreptococcus. Initially, a misleading diagnosis of an adrenal pheochromocytoma was initiated by highly positive metaiodobenzylguanidine scintigraphy after chemical chemistry vanillylmandelic acid (VMA) test showed elevated values for adrenaline and its derivatives. Retroperitoneal actinomycosis with yet unproven spread into thoracic and cervical compartments is a particular unusual presentation of an infection with these organisms. Because it may mimic subacute infections or malignant masses in terms of clinical and laboratory findings, radiological diagnosis of this entity may be difficult. The diagnosis was based on results of culture and the response of the patient to long-term penicillin-derivate therapy after surgical drainage of the suprarenal abscess formation. (orig.)

  11. Retroperitoneal lipomas: A case report.

    Science.gov (United States)

    van der Byl, G; Cerica, A; Sala, M G

    2012-12-01

    Lipomas are mesenchymal tumors characterized by the abnormal proliferation of adipocytes. We describe a case of retroperitoneal lipomas in a patient with chronic lymphatic leukemia, who was referred to our sonography unit for a regular (6-month) follow-up scan. She had no abdominal symptoms of note. The sonographic examination revealed two well-defined, hyperechoic, oval-shaped masses: the first situated between the posterior wall of the stomach, the duodenum, and the head of the pancreas; the second lying craniomedial to the left kidney. Neither of the masses exhibited intralesional vascularization on color Doppler imaging. Retrospective examination of previous CT scans revealed that the lesions had been present for the past 4 years. Their slow growth was consistent with the suspicion of retroperitoneal lipomas, and this diagnosis was confirmed by magnetic resonance imaging. CT and MRI are the imaging studies of choice for diagnosing retroperitoneal lipomas, but ultrasonography is ideal for the follow-up of these patients because it is repeatable and relatively low in cost.

  12. Fetal cyst reveling retroperitoneal enteric duplication

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    Imene Dahmane Ayadi

    2017-01-01

    Full Text Available Retroperitoneum is a very uncommon site of enteric duplication (ED. We report a new case of retroperitoneal ED cyst suspected in utero. Prenatal ultrasound showed an abdominal cystic mass. Noncommunicating retroperitoneal ED cyst measuring 70 mm × 30 mm was resected. Histopathologic examination confirmed the diagnosis.

  13. Retroperitoneal Schwannoma: A Rare Case

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    Murat Kalaycı

    2011-01-01

    Case Presentation. A 38-year-old woman was admitted to the emergency service with the complaints of progressive abdominal pain and nausea for the last 24 hours. Abdominal examination was compatible with acute abdomen. Acute appendicitis was diagnosed by CT. During CT evaluation, a round shaped soft-tissue mass at the retroperitoneal area inferior to the right kidney was detected, The mass was resected and histology revealed schwannoma. Conclusion. Rare tumoral lesions with benign course such as schwannoma can be detected incidentally.

  14. [Aspergillosis located on polycystic kidney treated with retroperitoneal nephrectomy].

    Science.gov (United States)

    Rabii, R; Hoznek, A; Salomon, L; Bourg, S; Chopin, D K; Abbou, C C

    2001-03-01

    We reported an uncommon case of 40 years old man, cardiac transplant recipient with chronic renal faillure who consulted for infected left polycystic renal. The serum creatinine level was 750 mmol/L, and urine culture isolated a E. Ecol germe. The abdominopelvic computed tomography showed a bilateral large polycystic renal cortex and suspected the infected cyst in lower pole of left kidney. The retroperitoneal laparoscopic nephrectomy was performed confirming a renal invasive aspergillosa. About this case we should have a high index of suspicion for fungal aetiology in kidney infection in transplant patients and the management of non functioning infected polycystic kidney can use laparoscopic retroperitoneal nephrectomy. This approach can offers a minimal morbidity and alternative to open surgery.

  15. The Retrograde and Retroperitoneal Totally Laparoscopic Hysterectomy for Endometrial Cancer

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    Eugenio Volpi

    2012-01-01

    Full Text Available Introduction. We retrospectively report our experience with the utilization of an original procedure for total laparoscopic hysterectomy based on completely retrograde and retroperitoneal technique for surgical staging and treatment of the endometrial cancer. The surgical, financial, and oncological advantages are here discussed. Methods. The technique used here has been based on a combination of a retroperitoneal approach with a retrograde and lateral dissection of the bladder and retrograde culdotomy with variable resection of parametrium. No disposable instruments and no uterine manipulator were utilized. Results. Intraoperative and postoperative complications were observed in 10% of the cases overall. Operative time length and mean haemoglobin drop value results were 129 min and 125 mL, respectively. Most patients were dismissed on days 3–5 from the hospital. Seventy-eight percent of the patients were alive with no evidence of disease at mean followup of 49 months. Conclusions. Our original laparoscopic technique is based on a retroperitoneal approach in order to rapidly control main uterine vessels coagulation, constantly check the ureter, and eventually decide type and site of lymph nodes removal. This procedure has important cost saving implications and the avoidance of uterine manipulator is of matter in case such as these of uterine malignancy.

  16. Retroperitoneal Cyst: An Uncommon Presentation of Filariasis

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    Senthil Ganesan

    2015-01-01

    Full Text Available Primary retroperitoneal parasitic cysts are rare. Here we report about a middle aged male patient from rural north India with a recent onset of central abdominal retroperitoneal lump, pain, and fever. After surgical resection due to diagnostic uncertainty, at histopathology, it turned out be a filarial cyst. After receiving a course of diethylcarbamazine, the patient is asymptomatic at 4 months’ follow-up.

  17. Atypical retroperitoneal extension of iliopsoas bursitis

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    Coulier, B.; Cloots, V. [Department of Diagnostic Imaging, Cliniques St. Luc, Rue St Luc 8, 5004, Bouge, Namur (Belgium)

    2003-05-01

    We report two rare cases of iliopsoas bursitis extending into the retroperitoneal space. The first lesion contained much gas, mimicking a retroperitoneal abscess, and the second was responsible for atypical inguinal pain. The diagnosis was made by contrast-enhanced CT in both cases and arthrography in the first case. Iliopsoas bursitis in these two patients, it is hypothesized, extended into the retroperitoneum, at least in part, by way of intraneural or perineural structures. (orig.)

  18. Giant primary retroperitoneal seminoma: A case report.

    Science.gov (United States)

    Jovanović, Milan; Janjusević, Natasa; Mirković, Darko; Vulović, Maja; Milev, Bosko; Mitrović, Miroslav; Trifunović, Bratislav

    2016-02-01

    Primary extragonadal seminomas are rare tumors. There have been only a few cases of the primary retroperitoneal seminomas reported in the literature up to date. We reported a 56-year-old man with giant primary retroperitoneal seminoma presented with the enlargement of the left side of the abdomen and deep venous thrombosis of the left leg. Computed tomography of the abdomen showed a large tumor occupying the left part of the retroperitoneal space with 23 x 13 cm in diameter. Firm tumor mass having 25 x 15 cm in diameter was surgically removed from the left retroperitoneum. The tumor adhered the tunica adventitia of the aorta and it was carefully resected from the aortic wall. The diagnosis of seminoma was made during histopathological examination. The patient underwent chemotherapy. Two years after finished chemotherapy the patient accepted left orchiectomy with the aim of eliminating the possibility of the occult malignancy of the testicle. Histopathological analysis of the testicular tissue was normal and the diagnosis of primary retroperitoneal seminoma was confirmed. CONCLUSION. Despite its small incidence in general population, the diagnosis of retroperitoneal seminoma should be considered in male patients with nonspecific symptoms and with retroperitoneal tumor mass.

  19. Surgical anatomy of the retroperitoneal spaces, Part IV: retroperitoneal nerves.

    Science.gov (United States)

    Mirilas, Petros; Skandalakis, John E

    2010-03-01

    We present surgicoanatomical topographic relations of nerves and plexuses in the retroperitoneal space: 1) six named parietal nerves, branches of the lumbar plexus: iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, obturator, femoral. 2) The sacral plexus is formed by the lumbosacral trunk, ventral rami of S1-S3, and part of S4; the remainder of S4 joining the coccygeal plexus. From this plexus originate the superior gluteal nerve, which passes backward through the greater sciatic foramen above the piriformis muscle; the inferior gluteal nerve also courses through the greater sciatic foramen, but below the piriformis; 3) sympathetic trunks: right and left lumbar sympathetic trunks, which comprise four interconnected ganglia, and the pelvic chains; 4) greater, lesser, and least thoracic splanchnic nerves (sympathetic), which pass the diaphragm and join celiac ganglia; 5) four lumbar splanchnic nerves (sympathetic), which arise from lumbar sympathetic ganglia; 6) pelvic splanchnic nerves (nervi erigentes), providing parasympathetic innervation to the descending colon and pelvic splanchna; and 7) autonomic (prevertebral) plexuses, formed by the vagus nerves, splanchnic nerves, and ganglia (celiac, superior mesenteric, aorticorenal). They include sympathetic, parasympathetic, and sensory (mainly pain) fibers. The autonomic plexuses comprise named parts: aortic, superior mesenteric, inferior mesenteric, superior hypogastric, and inferior hypogastric (hypogastric nerves).

  20. Post-chemotherapy robotic bilateral retroperitoneal lymph node dissection using a novel single-dock technique.

    Science.gov (United States)

    Stout, Thomas E; Soni, Samit D; Goh, Alvin C

    2016-12-01

    There have been no previous reports of post-chemotherapy robotic bilateral retroperitoneal lymph node dissection (RPLND) using a single-dock technique. One deterrent of robotic RPLND is that accessing bilateral retroperitoneal spaces requires patient reposition and surgical robot redocking, therefore increasing operative time. Herein we provide the first step-by-step description of a single-dock technique for robotic bilateral RPLND in the post-chemotherapy setting. We describe port placement and technique for robot positioning to optimize access to bilateral retroperitoneal spaces with a single dock. We also demonstrate the feasibility of sparing the inferior mesenteric artery when utilizing this approach. This single-dock approach was used on two patients at our institution who had residual paracaval masses following chemotherapy for metastatic testicular cancer. Mean operative time was 6 h, and neither patient had significant blood loss or suffered from any peri-operative complications.

  1. Systemic immunologic and inflammatory response after transperitoneal versus retroperitoneal laparoscopic donor nephrectomy: A prospective observational study.

    Science.gov (United States)

    Gogoi, Debojit; Pal, Dilip Kumar; Bera, Malay K

    2016-01-01

    Laparoscopic donor nephrectomy (LDN) can be performed via either transperitoneal or retroperitoneal approach. Very few studies have been carried out till now, comparing immunologic and inflammatory responses in donors after these two approaches. This is a prospective observational study. Selection of approach was decided by the operating surgeon. All patients underwent peripheral venous blood sampling preoperatively and 24 h postoperatively for the measurement of C-reactive protein (CRP), interleukein-6 (IL-6), total leukocyte count (TLC), blood urea nitrogen (BUN), and serum creatinine (SCr). Operative time, warm ischemia time, hospital stay, requirement of analgesia, and complications were also recorded. From February 2013 to January 2015, we performed 54 LDNs (38 transperitoneal and 16 retroperitoneal). There were 49 females and five males. Mean operative time was not significantly different in these two approaches, but warm ischemia time was significantly less in the retroperitoneal laparoscopic donor nephrectomy (RLN) group. Postoperative inflammatory markers' (IL-6, CRP, and TLC) levels, BUN, and SCr rise in both of these approaches, but there was no significant difference observed between these two approaches. RLN is a safe and effective approach to preserve a longer right renal vein. It combines the benefit of both hand assistance and retroperitoneal approach. Warm ischemic time is significantly less in RLN group.

  2. Systemic immunologic and inflammatory response after transperitoneal versus retroperitoneal laparoscopic donor nephrectomy: A prospective observational study

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    Debojit Gogoi

    2016-01-01

    Full Text Available Laparoscopic donor nephrectomy (LDN can be performed via either transperitoneal or retroperitoneal approach. Very few studies have been carried out till now, comparing immunologic and inflammatory responses in donors after these two approaches. This is a prospective observational study. Selection of approach was decided by the operating surgeon. All patients underwent peripheral venous blood sampling preoperatively and 24 h postoperatively for the measurement of C-reactive protein (CRP, interleukein-6 (IL-6, total leukocyte count (TLC, blood urea nitrogen (BUN, and serum creatinine (SCr. Operative time, warm ischemia time, hospital stay, requirement of analgesia, and complications were also recorded. From February 2013 to January 2015, we performed 54 LDNs (38 transperitoneal and 16 retroperitoneal. There were 49 females and five males. Mean operative time was not significantly different in these two approaches, but warm ischemia time was significantly less in the retroperitoneal laparoscopic donor nephrectomy (RLN group. Postoperative inflammatory markers′ (IL-6, CRP, and TLC levels, BUN, and SCr rise in both of these approaches, but there was no significant difference observed between these two approaches. RLN is a safe and effective approach to preserve a longer right renal vein. It combines the benefit of both hand assistance and retroperitoneal approach. Warm ischemic time is significantly less in RLN group.

  3. A Rare Case of Retroperitoneal Leiomyoma

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    Mahendru, Rajiv; Gaba, Geetinder; Yadav, Shweta; Gaba, Gurmeet; Gupta, Chinky

    2012-01-01

    Introduction. Leiomyoma uteri is one of the most common benign conditions for which women undergo hysterectomy every year. Fibroids found retroperitoneally are a rare entity, especially, primary retroperitoneal fibroid. Case Presentation. We report a case of 42-year-old para 1 who presented to our hospital with recurring retention of urine, lower abdominal and pelvic pain, and dyspareunia . Provisional diagnosis on the basis of examination and imaging was large subserosal fibroid with mild right-sided hydroureteronephrosis, due to pressure effect of the fibroid. Abdominal hysterectomy was done for the patient, and intraoperatively, a bulky uterus was found with multiple small fibroids on anterior and posterior walls, and a large fibroid approx. 10 × 8 cm was found arising from the posterior surface at the level of internal os retroperitoneally, which was confirmed by histopathology as leiomyoma. Conclusion. Retroperitoneal fibroids are rare neoplasms and treatment is surgical removal. Preoperative imaging can only give provisional diagnosis and can be misguiding. Final diagnosis of retroperitoneal fibroid can be made only intraoperatively. PMID:22900220

  4. A Rare Case of Retroperitoneal Leiomyoma

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    Rajiv Mahendru

    2012-01-01

    Full Text Available Introduction. Leiomyoma uteri is one of the most common benign conditions for which women undergo hysterectomy every year. Fibroids found retroperitoneally are a rare entity, especially, primary retroperitoneal fibroid. Case Presentation. We report a case of 42-year-old para 1 who presented to our hospital with recurring retention of urine, lower abdominal and pelvic pain, and dyspareunia . Provisional diagnosis on the basis of examination and imaging was large subserosal fibroid with mild right-sided hydroureteronephrosis, due to pressure effect of the fibroid. Abdominal hysterectomy was done for the patient, and intraoperatively, a bulky uterus was found with multiple small fibroids on anterior and posterior walls, and a large fibroid approx. 10×8 cm was found arising from the posterior surface at the level of internal os retroperitoneally, which was confirmed by histopathology as leiomyoma. Conclusion. Retroperitoneal fibroids are rare neoplasms and treatment is surgical removal. Preoperative imaging can only give provisional diagnosis and can be misguiding. Final diagnosis of retroperitoneal fibroid can be made only intraoperatively.

  5. Port-site transversus abdominis fascia closure reduced the incidence of incisional hernia following retroperitoneal laparoscopic nephrectomy.

    Science.gov (United States)

    Takei, A; Sazuka, T; Nakamura, K; Nihei, N; Ichikawa, T

    2016-10-01

    The incidence of incisional hernia after laparoscopic surgery is reportedly 0-5.2 %; there are only a few reports of that following retroperitoneal laparoscopic nephrectomy. We evaluated the incidence of and risk factors for incisional hernia after retroperitoneal laparoscopic nephrectomy, and the efficacy of our novel prophylaxis technique. A total of 207 renal cell carcinoma patients who underwent laparoscopic nephrectomy at Chiba University Hospital were retrospectively enrolled in this study. We compared the incidences of incisional hernia following the transperitoneal vs. retroperitoneal approaches, and, among the latter group, the incidences with vs. without use of our prophylaxis method. Also among the retroperitoneal-approach group, we evaluated selected patient characteristics as potential hernia risk factors. The rate of incisional hernias was 14 (8.7 %) after 161 retroperitoneal laparoscopic nephrectomies and one (2.2 %) after 46 transperitoneal laparoscopic nephrectomies (P = 0.132). For those undergoing the retroperitoneal approach, 14 (11.3 %) hernias were identified in 124 non-prophylaxed patients and none in 37 prophylaxed patients. Transversus abdominis fascia closure was a statistically significant factor for reducing the incidence of incisional hernia after retroperitoneal laparoscopic nephrectomy (P = 0.0324): rectus abdominis muscle thickness ≤7 mm and perioperative blood loss >100 ml were statistically significant independent risk factors, by multivariate analysis. To prevent incisional hernia after retroperitoneal laparoscopic nephrectomy in the patients with risk factors, it is useful to close the transversus abdominis fascia at the port sites from inside the surgical cavity, through the open specimen-removal trocar port site, under direct observation.

  6. [Retroperitoneal perforations of the colon. Apropos of 2 cases].

    Science.gov (United States)

    Jurczak, F; Likholatnikov, D; Courant, O; Hamy, A; Visset, J; Paineau, J

    1994-01-01

    The retroperitoneal perforation of the colon is rare and our observations illustrate its two modes of revelation: a retroperitoneal suppuration; it must be traited quickly in order to decrease the mortality. Note that the abscess of the thigh is exceptional. Retroperitoneal perforations during colonoscopy whose treatment (initially medical) become surgical if there is no clinical improvement.

  7. Laparoscopic resection of retroperitoneal benign neurilemmoma

    Science.gov (United States)

    Park, Joon Seong; Kang, Chang Moo; Yoon, Dong Sup; Lee, Woo Jung

    2017-01-01

    Purpose The aim of this study was to verify that laparoscopic resection for treating retroperitoneal benign neurilemmoma (NL) is expected to be favorable for complete resection of tumor with technical feasibility and safety. Methods We retrospectively analyzed 47 operations for retroperitoneal neurogenic tumor at Yonsei University College of Medicine, Severance Hospital and Gangnam Severance Hospital between January 2005 and September 2015. After excluding 21 patients, the remaining 26 were divided into 2 groups: those who underwent open surgery (OS) and those who underwent laparoscopic surgery (LS). We compared clinicopathological features between the 2 groups. Results There was no significant difference in operation time, estimated blood loss, transfusion, complication, recurrence, or follow-up period between 2 groups. Postoperative hospital stay was significantly shorter in the LS group versus the OS group (OS vs. LS, 7.00 ± 3.43 days vs. 4.50 ± 2.16 days; P = 0.031). Conclusion We suggest that laparoscopic resection of retroperitoneal benign NL is feasible and safe by obtaining complete resection of the tumor. LS for treating retroperitoneal benign NL could be useful with appropriate laparoscopic technique and proper patient selection.

  8. Retroperitoneal liposarcoma associated with small plaque parapsoriasis

    OpenAIRE

    Polichetti Paolo; Sgueglia Monica; Blasi Sara; Tartaglia Francesco; Tromba Luciana; Berni Alberto

    2007-01-01

    Abstract Background Extremely rare cases of paraneoplastic syndromes or ectopic production of proteins associated with liposarcoma are reported in literature. Production of Granulocyte-Colony Stimulating Factor, alpha-fetoprotein, paraneoplastic pemphigus and leucocytosis, Acrokeratosis paraneoplastica (Bazex's syndrome) are reported. The present report describes a case of retroperitoneal liposarcoma associated with small plaque parapsoriasis. Our search in the English literature of such a ki...

  9. [Retroperitoneal fibrosis and multiple myeloma: fortuitous association?].

    Science.gov (United States)

    Sinapi, I; Caers, J; Connerotte, T; Koutaissoff, S; Lambert, M

    2010-05-01

    We report a 59-year-old man presenting with retroperitoneal fibrosis (RF) associated with IgG lambda multiple myeloma. Recent clinical and immunohistochemical findings suggest that RF might be a particular expression of plasma cell/lymphoid dyscrasia, and that this association is not merely fortuitous. We review the pathophysiological evidence supporting this hypothesis.

  10. The development of a retroperitoneal dissection model.

    Science.gov (United States)

    Yousuf, Aisha A; Frecker, Helena; Satkunaratnam, Abheha; Shore, Eliane M

    2017-10-01

    Knowledge of ureteric anatomy is essential for ureteric injury prevention in laparoscopic gynecologic surgery. Rates of injury increase with limited surgical experience and reduced surgical volume. Currently, there are no low-fidelity or high-fidelity simulation models for teaching and practicing ureteric dissection. Our goal was to design a laparoscopic simulation model for retroperitoneal anatomy with high face validity that is low-cost and easily reproducible. A low-fidelity 3-dimensional simulation model was developed that represents key anatomic structures encountered during retroperitoneal dissection and ureteric identification. Materials, construction steps, and costs were determined. The models were trialed by expert laparoscopic surgeons. Demographic information that included age, gender, surgical experience, and complex laparoscopic case volumes was collected. Face validity was assessed with a 5-item Likert-scale. The total cost of 1 model ranged from $65 to $75. The majority of the materials that were used were reusable, except for 2 components that cost dissection (n=7; 100%), for assessing a learner's ability before performing in the operating room (n=6; 86%), was low-cost (n=7; 100%), and was easily reproducible (n=6; 86%). This unique model fills a gap in laparoscopic simulation training. No other low- or high-fidelity models for laparoscopic retroperitoneal ureteric dissection have been identified in the literature. This simulation model is low-cost, easily reproducible, closely resembles retroperitoneal dissection during laparoscopic gynecologic surgery, and can be used for education and assessment. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Large benign retroperitoneal tumour in pregnancy.

    Science.gov (United States)

    Berczi, Csaba; Osvath, Peter; Flasko, Tibor

    2015-01-01

    A 31-year-old female was in the 13th week of pregnancy when an abdominal ultrasound examination revealed a large retroperitoneal tumour. Magnetic resonance imaging was carried out and the imaging described a 10-cm mass in diameter extending from the right kidney. Given that the patient was in her first trimester and that there was a suspicion of malignancy, further surgical exploration of the tumour was warranted. During the operation, the tumour was removed, but nephrectomy was not necessary. Histologic analysis of the resected tumour showed a mucinous cystic adenoma, and no signs of malignancy were present. Following the surgery, the pregnancy was otherwise uneventful and further complications did not occur. This case illustrates that surgery is recommended in patients with a retroperitoneal tumour early during a pregnancy, when a malignancy cannot be excluded.

  12. Lymphoplasmacytic Sclerosing Pancreatitis and Retroperitoneal Fibrosis

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    Nigel K. F. Koo Ng

    2008-01-01

    Full Text Available Although cases of lymphoplasmacytic sclerosing pancreatitis (LSP associated with idiopathic retroperitoneal fibrosis have been reported, the association is rare. We describe a 74-year-old man who presented with obstructive jaundice and weight loss. Nineteen months earlier, he had been diagnosed with idiopathic retroperitoneal fibrosis and treated with bilateral ureteric stents. Initial investigations were suggestive of a diagnosis of LSP, however, a malignant cause could not be ruled out. He underwent an exploratory laparotomy and frozen sections confirmed the diagnosis of LSP. An internal biliary bypass was performed using a Roux loop of jejunum, and the patient made an uneventful recovery. This case illustrates the difficulty in distinguishing LSP from pancreatic carcinoma preoperatively.

  13. Paraneoplastic retinopathy associated with retroperitoneal liposarcoma

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    Mineo Kondo

    2010-03-01

    Full Text Available Mineo Kondo1, Kumiko Mokuno2, Ai Uemura1, Shu Kachi1, Makoto Nakamura1, Atsuya Kondo3, Hiroko Terasaki11Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan; 2Department of Ophthalmology, 3Department of Urology, Kariya Toyota General Hospital Kariya, JapanAbstract: We report a case of paraneoplastic retinopathy associated with a retroperitoneal liposarcoma. A 42-year-old man was referred to our hospital with complaints of night blindness and blurred vision in the peripheral field. Electroretinograms showed a progressive amplitude reduction in his both eyes. Abdominal magnetic resonance imaging showed a large retroperitoneal mass, and pathologic examination revealed a dedifferentiated liposarcoma. Western blot analysis showed an antiretinal antibody in the serum of our patient, and his serum reacted with the photoreceptors of a bovine retina. To the best of our knowledge, this is the first case of paraneoplastic retinopathy associated with a liposarcoma.Keywords: paraneoplastic retinopathy, retroperitneal liposarcoma, electroretinogram, cancerassociated retinopathy

  14. Retroperitoneal abscess: an extra-abdominal manifestation.

    Science.gov (United States)

    Mallia, Alvin James; Ashwood, Neil; Arealis, George; Galanopoulos, Ilias

    2015-01-09

    Retroperitoneal abscesses are unusual occurrences with occult and insidious presentations. There is often a lack of abdominal signs, leading to delays in drainage and high mortality rates. We report a case of thigh emphysema in an 88-year-old patient with diabetes. Prior to admission the patient reported a vague 4-week history of left thigh pain and an inability to fully weight bear. She presented to our emergency department with sepsis and acute kidney impairment. An X-ray of her left femur revealed widespread gas between muscular planes. A retroperitoneal abscess involving the left renal fossa, psoas, iliacus and upper thigh muscles was revealed on an urgent CT scan. The patient was transferred to intensive care unit (ICU) and underwent an emergency drainage. Despite ICU the patient died 2 days after admission.

  15. Pelvic compartment syndrome caused by retroperitoneal hematoma of pelvic fracture

    Institute of Scientific and Technical Information of China (English)

    ZHANG Feng-qi; ZHANG Ying-ze; PAN Jin-she; PENG A-qin; WANG Hui-juan

    2005-01-01

    @@ Retroperitoneal hematoma is an obligatory complication in pelvic ring fracture.1 In most cases, the bleeding originates from venous vessels of the presacral plexus, small arteries and veins from fracture fragments. External fixation of the pelvis can control blood loss by reducing diastasis and dramatically decreasing the volume of the pelvis. But this tamponade effect can not prevent the presence of hematoma in the adjoining retroperitoneal space. It is well known that complication of retroperitoneal hematoma is infection and sepsis.

  16. Haemoperitoneurn Secondary to Rupture of Retroperitoneal Variceal

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    M. Molina-Perez

    1997-01-01

    Full Text Available A 45-year-old alcoholic male patient presented with hypovolemic shock and intense anemia (Hemoglobin 04.7 g/dl, and was operated on. A bleeding retroperitoneal varix located near the right colon was responsible for the clinical picture and was sutured. After operation the patient developed haemodynamic instability and pneumonia a situation which was reverted with intensive medical therapy. The patient is now doing well.

  17. The Value of Surgery for Retroperitoneal Sarcoma

    Science.gov (United States)

    Gholami, Sepideh; Jacobs, Charlotte D.; Kapp, Daniel S.; Parast, Layla M.; Norton, Jeffrey A.

    2009-01-01

    Introduction. Retroperitoneal sarcomas are uncommon large malignant tumors. Methods. Forty-one consecutive patients with localized retroperitoneal sarcoma were retrospectively studied. Results. Median age was 58 years (range 20–91 years). Median tumor size was 17.5 cm (range 4–41 cm). Only 2 tumors were <5 cm. Most were liposarcoma (44%) and high-grade (59%). 59% were stage 3 and the rest was stage 1. Median followup was 10 months (range 1–106 months). Thirty-eight patients had an initial complete resection; 15 (37%) developed recurrent sarcoma and 12 (80%) had a second complete resection. Patients with an initial complete resection had a 5-year survival of 46%. For all patients, tumor grade affected overall survival (P = .006). Complete surgical resection improved overall survival for high-grade tumors (P = .03). Conclusions. Tumor grade/stage and complete surgical resection for high-grade tumors are important prognostic variables. Radiation therapy or chemotherapy had no significant impact on overall or recurrence-free survival. Complete surgical resection is the treatment of choice for patients with initial and locally recurrent retroperitoneal sarcoma. PMID:19826633

  18. The Value of Surgery for Retroperitoneal Sarcoma

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    Sepideh Gholami

    2009-01-01

    Full Text Available Introduction. Retroperitoneal sarcomas are uncommon large malignant tumors. Methods. Forty-one consecutive patients with localized retroperitoneal sarcoma were retrospectively studied. Results. Median age was 58 years (range 20–91 years. Median tumor size was 17.5 cm (range 4–41 cm. Only 2 tumors were <5 cm. Most were liposarcoma (44% and high-grade (59%. 59% were stage 3 and the rest was stage 1. Median followup was 10 months (range 1–106 months. Thirty-eight patients had an initial complete resection; 15 (37% developed recurrent sarcoma and 12 (80% had a second complete resection. Patients with an initial complete resection had a 5-year survival of 46%. For all patients, tumor grade affected overall survival (=.006. Complete surgical resection improved overall survival for high-grade tumors (=.03. Conclusions. Tumor grade/stage and complete surgical resection for high-grade tumors are important prognostic variables. Radiation therapy or chemotherapy had no significant impact on overall or recurrence-free survival. Complete surgical resection is the treatment of choice for patients with initial and locally recurrent retroperitoneal sarcoma.

  19. Ormond's disease or secondary retroperitoneal fibrosis? An overview of retroperitoneal fibrosis

    Energy Technology Data Exchange (ETDEWEB)

    Heckmann, M.; Uder, M.; Kuefner, M.A.; Heinrich, M.C. [Universitaetsklinikum Erlangen (Germany). Radiologisches Inst.

    2009-04-15

    Retroperitoneal fibrosis represents a rare inflammatory disease. About two thirds of all cases seem to be idiopathic (= Ormond's disease). The remaining one third is secondary and may be ascribed to infections, trauma, radiation therapy, malignant diseases, and the use of certain drugs. Up to 15 % of patients have additional fibrotic processes outside the retroperitoneum. The clinical symptoms of retroperitoneal fibrosis are non-specific. In sonography retroperitoneal fibrosis appears as a retroperitoneal hypoechoic mass which can involve the ureters and thus cause hydronephrosis. Intravenous urography and MR urography can demonstrate the typical triad of medial deviation and extrinsic compression of the ureters and hydronephrosis. CT and MRI are the modalities of choice for the diagnosis and follow-up of this disease. The lesion typically begins at the level of the fourth or fifth lumbar vertebra and appears as a plaque, encasing the aorta and the inferior vena cava and often enveloping and medially displacing the ureters. In unenhanced CT, retroperitoneal fibrosis appears as a mass that is isodense with muscle. When using MRI, the mass is hypointense in T1-weighted images and of variable intensity in T2-weighted images according to its stage: it may be hyperintense in early stages, while the tissue may have a low signal in late stages. After the administration of contrast media, enhancement is greatest in the early inflammatory phase and minimal in the late fibrotic phase. Dynamic gadolinium enhancement can be useful for assessing disease activity, monitoring response to treatment, and detecting relapse. To differentiate retroperitoneal masses, diffusion-weighted MRI may provide useful information. (orig.)

  20. Liposarcoma retroperitoneal gigante. Reporte de caso (Giant retroperitoneal liposarcoma. Case report

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    Eduardo Reyna-Villasmil

    2015-01-01

    Full Text Available Soft tissue sarcomas represent less than 1% of all human neoplasms. One-third of malignant tumors that arise in the retroperitoneum are sarcomas and liposarcoma is the most common retroperitoneal sarcoma and is known to grow to giant sizes, slow progress and few late symptoms. We report the case of a 40 year old woman with a giant retroperitoneal liposarcoma. A laparotomy was performed and a multilobulated tumor of 20 centimeters of diameter arising from retroperitoneum. The histological features were suggestive of pleomorphic liposarcoma weighing 8.5 Kilograms

  1. First case of 18F-FACBC PET/CT-guided salvage retroperitoneal lymph node dissection for disease relapse after radical prostatectomy for prostate cancer and negative 11C-choline PET/CT: new imaging techniques may expand pioneering approaches.

    Science.gov (United States)

    Schiavina, Riccardo; Concetti, Sergio; Brunocilla, Eugenio; Nanni, Cristina; Borghesi, Marco; Gentile, Giorgio; Cevenini, Matteo; Bianchi, Lorenzo; Molinaroli, Enrico; Fanti, Stefano; Martorana, Giuseppe

    2014-01-01

    We present the first case of salvage retroperitoneal lymph node dissection based on the results of (18)F-FACBC PET/CT performed for a prostate-specific antigen relapse after radical prostatectomy. The patients underwent (11)C-choline PET/CT, which turned out negative, while (18)F-FACBC PET/CT visualized two lymph node metastases confirmed at pathological examination. Preliminary clinical reports showed an improvement in the detection rate of 20-40% for (18)F-FACBC in comparison with (11)C-choline, rendering the (18)F-FACBC the potential radiotracer of the future. Salvage surgery for prostate cancer is a fascinating but controversial approach. New diagnostic tools may improve its potential by increasing the assessment and the selection of the patients.

  2. Retroperitoneal Paraganglioma – a rare cause of arterial hypertension

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    Isabel Silva

    2017-03-01

    Full Text Available Paragangliomas are rare neuroendocrine tumours, most commonly found in adults. These differ from pheochromocytomas in that their location is extra-adrenal, and they are responsible for about 1% of arterial hypertension aetiologies. We report the case of a 30-year-old female whose past medical history was unremarkable. However, her arterial hypertension led to further examination in search of secondary aetiologies, in which a retroperitoneal mass and an increase in levels of catecholamines were detected; findings that led to the final diagnosis of paraganglioma. A multidisciplinary team, whose approach was to use pharmacological alpha-adrenergic blocking agents and a surgical resection of the lesion, treated the patient. The patient is clinically well but will continue to be monitored as an outpatient, and genetic testing is being encouraged.

  3. Masas retroperitoneales en el período perinatal Retroperitoneal masses in the perinatal period

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    Nelda María Castagnaro Rosini

    2011-03-01

    to illustrate the imaging findings based on our experience. Material and Methods: Retrospective study about the etiology of retroperitoneal masses in newborns based on x-ray analysis, ultrasound and clinical findings of 487 infants who underwent abdominal ultrasound between January 2008 and December 2009. A total of 47 newborns with a diagnosis of retroperitoneal mass were selected. Patients with prenatal ultrasound diagnosis of intraabdominal retroperitoneal mass and those with palpable abdominal mass on their physical examination in the neonatal period were included in this sample. Infants with gastrointestinal and intraperitoneal abdominal pathology were excluded. Results: Of all the study patients (n= 47, 42 had renal masses (89%, and 5 retroperitoneal extrarenal masses (11%. Among the former, the prevalent diseases were hydronephrosis in 36 cases (76%, and multicystic renal dysplasia in 4 (9%. Moreover, there was only 1 case of congenital mesoblastic nephroma, and 1 case of autosomal recessive polycystic disease. Among the latter, there were 3 infants with adrenal hemorrhage (6%, and 2 with neuroblastoma (4%. Conclusion: The incidence of perinatal retroperitoneal masses in the studied population was 9.65%, in agreement with the literature. It highlights the importance of prenatal US to define the obstetric behavior and the coordination between pre- and postnatal ultrasound in order to achieve the best diagnostic approach. In our casuistic, a diagnosis was reached through US in 94% of the cases. CT plays a crucial role in both defining the surgical procedure in congenital mesoblastic nephroma and staging neuroblastomas.

  4. CT characteristics of primary retroperitoneal neoplasms in children

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    Xu Yufeng; Wang Jichen [Department of Radiology, Peking University First Hospital, No. 8, Xishike Street, Xicheng District, Beijing 100034 (China); Peng Yun [Imaging Center, Beijing Children' s Hospital Affiliated to Capital Medical University, 56, Nanlishi Road, Xicheng District, Beijing 100045 (China); Zeng Jinjin, E-mail: jzeng5567@yahoo.co [Imaging Center, Beijing Children' s Hospital Affiliated to Capital Medical University, 56, Nanlishi Road, Xicheng District, Beijing 100045 (China)

    2010-09-15

    Primary retroperitoneal neoplasms are uncommon in children. Retroperitoneal neoplasms are either mesodermal, neurogenic, germ cell ectodermal or lymphatic in origin. In general, primary retroperitoneal neoplasms in children have different spectrum and prevalence compared to those in adults. Neuroblastoma, rhabdomyosarcoma, benign teratoma and lymphoma are the common retroperitoneal neoplasms. In this review, the clinical and CT futures of common retroperitoneal neoplasms in children are described. Coarse, amorphous, and mottled calcification are very common in neuroblastoma. Paraganglioma tends to show marked and early enhancement and may present with clinical symptoms associated with the excess catecholamine. Sarcomas are often very large and have heterogeneous appearance. Imaging cannot be reliably used to identify the type of retroperitoneal sarcomas due to overlapped radiographic features. In children, lipoblastoma is the most common lipomatous tumor in the retroperitoneum. The percentage of visible fat in tumor varies depending on the cellular composition of the lesion. The CT characteristics of teratoma are quite variable, which may be cystic, solid, on a combination of both. Typically teratoma appears as a large complex mass containing fluid, fat, fat-fluid level, and calcifications. Lymphoma is often homogeneous on both enhanced and unenhanced CT scans. Necrosis and calcification are rare on CT. In conclusion, making a final histological diagnosis of retroperitoneal tumor base on CT features is not often possible; however, CT can help to develop a differential diagnosis and determine the size and extent of the retroperitoneal neoplasms.

  5. Pancreatic liposarcoma: case report with review of retroperitoneal liposarcomas.

    Science.gov (United States)

    Elliott, T E; Albertazzi, V J; Danto, L A

    1980-04-01

    A case report of a large pancreatic liposarcoma is presented showing a five-year survival with aggressive surgical excision as the only treatment. The medical literature of the subject is reviewed. This is the only reported case of retroperitoneal liposarcoma which is limited to the pancreas. A discussion of the current types of treatment for retroperitoneal liposarcomas is included.

  6. Retroperitoneal abscesses in two western lowland gorillas (Gorilla gorilla gorilla).

    Science.gov (United States)

    Hahn, Alicia; D'Agostino, Jennifer; Cole, Gretchen A; Raines, Jan

    2014-03-01

    This report describes two cases of retroperitoneal abscesses in female western lowland gorillas (Gorilla gorilla gorilla). Clinical symptoms included perivulvar discharge, lameness, hindlimb paresis, and general malaise. Retroperitoneal abscesses should be considered as part of a complete differential list in female gorillas with similar clinical signs.

  7. Unusual Cause of Acute Abdomen—Ruptured Retroperitoneal Paraganglioma

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    Kwok-Kay Yau

    2008-01-01

    Full Text Available Ruptured retroperitoneal paraganglioma is a rare cause of acute abdomen. Its clinical presentation and laparoscopic features have seldom been reported in the literature. Herein, we report a case of ruptured retroperitoneal paraganglioma that presented as acute abdomen, and its subsequent management.

  8. Quiste retroperitoneal: Reporte de un caso

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    Néstor Moisés Tineo Araque

    2010-01-01

    Full Text Available Los quistes retroperitoneales son tumoraciones benignas o malignas originadas en el espacio retroperitoneal, la gran mayoría de ellos presentan características de benignidad, predominan en el sexo femenino y se clasifican fundamentalmente en base a su tejido de origen. El tratamiento depende de la histopatología, sin embargo la mayoría de los autores coinciden en realizar resección quirúrgica. Se presenta el caso de paciente femenina de 48 años de edad quien acude a consulta por presentar dolor persistente en hemiabdomen derecho, a la evaluación paraclínica con ultrasonido abdominal se evidenció tumor quístico en flanco derecho de 12 por 14 centímetros. La tomografía axial computarizada reportó imagen retroperitoneal que se extiende desde la fosa ilíaca derecha hasta hipocondrio derecho. Se realizó laparotomía exploradora, hallándose quiste de retroperitoneo de 15 por 20 centímetros con cápsula definida y de contenido líquido (de consistencia gelatinosa que se clasifica posteriormente como un hamartoma retroperitoneal. Debido a su baja incidencia, el conocimiento y estudio de este tipo de patología se ha visto truncada en la práctica médica, razón por la cual es de difícil diagnóstico trayendo como consecuencia que en muchos casos el paciente es ingresado a quirófano con un diagnóstico errado.

  9. Multimodality Local Therapy for Retroperitoneal Sarcoma

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    Paryani, Nitesh N.; Zlotecki, Robert A.; Swanson, Erika L.; Morris, Christopher G. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); Grobmyer, Stephen R.; Hochwald, Steven N. [Department of General Surgery, University of Florida College of Medicine, Gainesville, FL (United States); Marcus, Robert B. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); University of Florida Proton Therapy Institute, Jacksonville, FL (United States); Indelicato, Daniel J., E-mail: dindelicato@floridaproton.org [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); University of Florida Proton Therapy Institute, Jacksonville, FL (United States)

    2012-03-01

    Purpose: Soft-tissue sarcomas of the retroperitoneum are rare tumors comprising less than 1% of all malignancies. Although surgery continues as the mainstay of treatment, the large size of these tumors coupled with their proximity to critical structures make resection with wide margins difficult to achieve. The role and timing of radiotherapy are controversial. This study updates our institutional experience using multimodality local therapy for resectable retroperitoneal sarcoma and identifies prognostic factors impacting disease control and survival. Methods and Materials: Between 1974 and 2007, 58 patients with nonmetastatic retroperitoneal sarcoma were treated with surgery and radiation at University of Florida. The median age at radiotherapy was 57 years old (range, 18-80 years). Forty-two patients received preoperative radiotherapy and 16 received postoperative radiotherapy. Nineteen patients received 1.8 Gy once daily and 39 patients received 1.2 Gy twice daily. Variables analyzed for prognostic value included age, grade, kidney involvement, histology, de novo versus recurrent presentation, tumor diameter, margin status, radiotherapy sequencing (preoperative vs. postoperative), total radiation dose, fractionation scheme, and treatment era. Results: The 5-year overall survival, cause-specific survival, and local control rates were 49%, 58%, and 62%, respectively. Nearly two-thirds of disease failures involved a component of local progression. On multivariate analysis, only margin status was significantly associated with improved 5-year local control (85%, negative margins; 63%, microscopic positive margins; 0%, gross positive margins; p < 0.0001) and 5-year overall survival (64%, negative margins; 56%, microscopic positive margins; 13%, gross positive margins; p = 0.0012). Thirty-one Grade 3 or greater toxicities were observed in 22 patients, including two treatment-related deaths (3%). Conclusion: For retroperitoneal sarcoma, local control remains a

  10. Quiste retroperitoneal: Reporte de un caso

    OpenAIRE

    2012-01-01

    Los quistes retroperitoneales son tumoraciones benignas o malignas originadas en el espacio retroperitoneal, la gran mayoría de ellos presentan características de benignidad, predominan en el sexo femenino y se clasifican fundamentalmente en base a su tejido de origen. El tratamiento depende de la histopatología, sin embargo la mayoría de los autores coinciden en realizar resección quirúrgica. Se presenta el caso de paciente femenina de 48 años de edad quien acude a consulta por presentar dol...

  11. Retroperitoneal abscess: an extra-abdominal manifestation

    OpenAIRE

    Mallia, Alvin James; Ashwood, Neil; Arealis, George; Galanopoulos, Ilias

    2015-01-01

    Retroperitoneal abscesses are unusual occurrences with occult and insidious presentations. There is often a lack of abdominal signs, leading to delays in drainage and high mortality rates. We report a case of thigh emphysema in an 88-year-old patient with diabetes. Prior to admission the patient reported a vague 4-week history of left thigh pain and an inability to fully weight bear. She presented to our emergency department with sepsis and acute kidney impairment. An X-ray of her left femur ...

  12. Giant Mature Primary Retroperitoneal Teratoma in a Young Adult: Report of a Rare Case and Literature Review

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    Walid Sasi

    2014-01-01

    Full Text Available Teratomas are neoplasms of the embryonic tissues that typically arise in the gonadal and sacrococcygeal regions of adults and children. Primary adult retroperitoneal teratomas are rare and demand challenging management options. We report a case of a unilateral primary retroperitoneal mature cystic teratoma mimicking an adrenal mass in a 28-year-old female patient. Complete resection of the mass was performed by a laparotomy approach. Because of the risk of malignancy, follow-up radiographic studies were performed to ensure the oncologic efficacy of resection. The patient remains free of recurrence to date.

  13. [Retroperitoneal sarcoma: report of 6 cases].

    Science.gov (United States)

    Joual, A; Faik, H; Rabii, R; Hafiani, M; Bennani, S; el Mrini, M; Benjelloun, S

    2000-06-01

    Retroperitoneal soft tissue sarcomas (RPS) are uncommon tumors. The diagnosis is frequently made later in the evolution of the disease due to the absence of specific symptomatology. Surgery with total resection of the tumor is the treatment of choice, but is only possible in 38 to 75% of cases. Six cases of RPS have been retrospectively reviewed; the mean time to diagnosis was 5 months; diagnosis was established via CT scan, which determined the retroperitoneal tumor location and its relationship to the neighboring organs. The most common symptoms were the presence of an abdominal mass and accompanying abdominal pain; signs of urinary and vascular compression were not found until later. Surgery with total resection was performed in 4 cases, and with partial resection in 2 cases. The histological findings were as follows: 3 liposarcomas, 2 rhabdomyosarcomas, and 1 fibrosarcoma. Tumor recurrence developed in 2 cases (liposarcomas), necessitating further surgery and complete resection. Two patients were lost to follow-up. RPS are characterized by locoregional relapse and metastases. Disease outcome depends on the histological type, tumor grade, and on the possibility of carrying out complete resection.

  14. Retroperitoneal liposarcoma associated with small plaque parapsoriasis

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    Polichetti Paolo

    2007-07-01

    Full Text Available Abstract Background Extremely rare cases of paraneoplastic syndromes or ectopic production of proteins associated with liposarcoma are reported in literature. Production of Granulocyte-Colony Stimulating Factor, alpha-fetoprotein, paraneoplastic pemphigus and leucocytosis, Acrokeratosis paraneoplastica (Bazex's syndrome are reported. The present report describes a case of retroperitoneal liposarcoma associated with small plaque parapsoriasis. Our search in the English literature of such a kind of association did not reveal any case reported. Case presentation A 74 year male patient was admitted to our hospital because of the presence of an abdominal mass in right iliac fossa. He also complained of a two-year history of psoriasiform eruptions. The CT scan showed a retroperitoneal pelvic mass. Therefore surgical resection of the tumor was performed. After surgery, the skin eruptions disappeared completely in seven days and so a diagnosis of parapsoriasis syndrome was done. Conclusion Parallel disappearing of skin eruptions after surgery, typical clinical picture and not specific histology of the cutaneous lesions suggest the diagnosis of small plaque parapsoriasis. Therefore we propose to add Small Plaque Parapsoriasis to the list of paraneoplastic syndromes associated to liposarcoma.

  15. Retroperitoneal Gastrointestinal Type Schwannoma Presenting as a Renal Mass

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    Susan J. Hall

    2015-11-01

    Full Text Available Retroperitoneal schwannomas are extremely rare, and unreported in Urology. Often thought to be malignant from imaging the diagnosis is often delayed until Histology. We report a case of retroperitoneal schwanoma thought to be a malignant renal mass. Seventy three year old lady presented with abdominal pain. Imaging showed a mass attached to the renal pelvis thus she underwent a radical nephrectomy. Histology reported retroperitoneal schwannoma. Malignant forms are rare however treatment for these is surgical excision. Awareness of the existence of these tumors may help in avoiding unnecessary radical surgeries by opting for biopsy preoperatively.

  16. Giant retroperitoneal liposarcoma: A very rare case report

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    R S Mohil

    2014-01-01

    Full Text Available Soft-tissue sarcomas are very rare entity, seen in <1% of all malignancies. Sarcoma accounts for about one-third of all retroperitoneal malignancies. Management of retroperitoneal sarcoma is challenge for surgeons because of its rare presentation and no standard guidelines for it. A 65-year-old male presented to surgery out-patient department with the complaints of abdominal distention and pain in abdomen since 3 years. On imaging, he was diagnosed as case of retroperitoneal tumor and managed by radical surgery including resection of the tumor with left kidney, spleen, and descending colon. Postoperative period was uneventful.

  17. Surgical anatomy of the retroperitoneal spaces, Part III: Retroperitoneal blood vessels and lymphatics.

    Science.gov (United States)

    Mirilas, Petros; Skandalakis, John E

    2010-02-01

    In this article, we discuss the surgical anatomy of the blood vessels and the lymphatic vessels and lymph nodes found in the retroperitoneum. Retroperitoneal blood vessels include the aorta and all its branches--parietal and visceral--from the diaphragm to the pelvis, and the inferior vena cava and its tributaries. The retroperitoneal lymphatics form a very rich and extensive chain. As a general rule, lymphatics follow the arteries and named lymph nodes are found at the root of the arteries. Retroperitoneal nodes of the abdomen comprise the inferior diaphragmatic nodes and the lumbar nodes. The latter are classified as left lumbar (aortic), intermediate (interaorticovenous), and right lumbar (caval). These nodes surround the aorta and the inferior vena cava. Around the aorta lie the paraortic nodes, preaortic nodes (include celiac, superior mesenteric, inferior mesenteric nodes collecting lymph from the splanchna supplied by the homonymous arteries), and retroaortic nodes. Similarly, around the vena cava lie the paracaval, precaval, and retrocaval nodes. Pelvic nodes include the common iliac, external and internal iliac, obturator, and sacral nodes.

  18. Thoracoscopic extrapleural Nuss procedure versus traditional intrapleural Nuss procedure: a case control study%胸膜外Nuss手术与Nuss手术对比研究

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    陈诚豪; 曾骐; 张娜; 于洁

    2011-01-01

    Objective To compare the safety and feasibility of thoracoscopic extrapleural Nuss procedure with traditional intrapleural Nuss procedure. Methods Total 252 patients with pectus excavatum received Nuss surgery from July 2008 to June 2009 in Beijing children' s hospital. Patients had following condition were excluded; (1) recurrent pectus excavatum; (2) complicated with other diseases, and need simultaneous surgery; (3) older than 13-year-old; (4) extensive depression, and need two Nuss bar; or (5) extreme severe or severe unsymmetric. 131 cases were selected in our study and they were randomly divided into two groups, thoracoscopic extrapleural Nuss procedure ( n = 62 ) and traditional intrapleural Nuss procedure ( n =69). Perioperative information, postoperative complications, effectiveness and the location of the Nuss bar were compared between two groups. Results All the 131 patients had completed the procedure successfully. There were no significant differences in age, Haller index; surgical effects, operation time, blood loss, and hospital stay, between two groups. Postoperative complications between the two groups are not significant. 131 patients were followed up from 14 to 26 months, and no recurrence and long-term complications occurred. About more than half cases of extrapleural Nuss procedure group were break the pleural into thoracic cavity. Conclusion Both extrapleural and intrapleural Nuss procedure are safe and effective for pectus excavatum, but extrapleural Nuss procedure have no advantage to the intrapleural Nuss procedure, also it' s hard to observe the other side of thoracic cavity during the surgery, and not easy to grasp and to promote.%目的 前瞻性对比胸膜外Nuss手术和Nuss手术的安全性和可行性.方法 2008年7月至2009年6月252例行Nuss手术者,排除漏斗胸复发、有合并症同期手术、大于13岁、广泛凹陷使用双支撑架和极重度和严重非对称性者,余131例随机分两组,62

  19. Contemporary Management of Retroperitoneal Soft Tissue Sarcomas.

    Science.gov (United States)

    Olimpiadi, Yuliya; Song, Suisui; Hu, James S; Matcuk, George R; Chopra, Shefali; Eisenberg, Burton L; Sener, Stephen F; Tseng, William W

    2015-08-01

    Management of retroperitoneal soft tissue sarcomas (RP STS) can be very challenging. In contrast to the more common extremity STS, the two predominant histologic subtypes encountered in the retroperitoneum are well-differentiated/dedifferentiated liposarcoma and leiomyosarcoma. Surgery remains the mainstay of treatment for RP STS. Preoperative planning and anticipation of the need for resection of adjacent organs/structures are critical. The extent of surgery, including the role of compartmental resection, is still controversial. Radiation therapy may be an important adjunct to surgery to provide locoregional disease control; this is currently being evaluated in the preoperative setting in the EORTC STRASS trial. Systemic therapy, tailored to the specific histologic subtype, may also be of benefit for the management of RP STS. Further investigation of novel therapies (e.g., targeted therapies, immunotherapy) is needed. Overall, multi-institutional collaboration is important moving forward, to continue to better understand and optimize management of this disease.

  20. A patient with combined mediastinal, mesenteric and retroperitoneal fibrosis.

    Science.gov (United States)

    Graal, M B; Lustermans, F A

    1994-06-01

    We report a patient with combined mediastinal, mesenteric and retroperitoneal fibrosis who first presented with signs of a superior vena cava syndrome. She was successfully treated with corticosteroids. The aetiology, clinical picture, and possible therapy of idiopathic fibrosclerosis are discussed.

  1. Primary retroperitoneal mucinous cystadenocarcinoma: report of two cases

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    Villavicencio-Valencia Verónica

    2007-01-01

    Full Text Available Abstract Background Retroperitoneal cystadenocarcinomas are rare lesions, the majority of cases presented as one-patient reports. Methods We present two cases of retroperitoneal cystadenocarcinoma, both in women of reproductive age: one with aggressive behavior, and the remaining case, with a more indolent clinical evolution. Results One case presented as pelvic tumor, was treated with surgical resection of the disease, but manifested with recurrent disease a few months later despite use of chemotherapy. The second case involved a patient with diagnosis of abdominal tumor; during laparotomy, a retroperitoneal tumor was found and was totally removed. At follow-up, the patient is disease-free with no other treatment. Conclusion The behavior and treatment of retroperitoneal cystadenocarcinoma are controversial. We suggest aggressive surgery including radical hysterectomy and bilateral salpingoopherectomy with adjuvant chemotherapy in these cases.

  2. Giant Primary Retroperitoneal Teratoma in an Adult: A Case Report

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    Poonam Mathur

    2010-01-01

    Full Text Available Teratomas are bizarre neoplasms derived from embryonic tissues that are typically found only in the gonadal and sacrococcygeal regions of adults. Retroperitoneal teratomas are rare and present challenging management options. We report here the case of a histologically unusual retroperitoneal tumor detected on computed tomography during the workup of abdominal pain in a 32-year-old male. The evaluation and treatment of this condition and a review of the literature are included in this paper.

  3. Measurement of visceral fat: should we include retroperitoneal fat?

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    Chi-Sheng Hung

    Full Text Available OBJECTIVE: Whether retroperitoneal fat should be included in the measurement of visceral fat remains controversial. We compared the relationships of fat areas in peritoneal, retroperitoneal, and subcutaneous compartments to metabolic syndrome, adipokines, and incident hypertension and diabetes. METHODS: We enrolled 432 adult participants (153 men and 279 women in a community-based cohort study. Computed tomography at the umbilicus level was used to measure the fat areas. RESULTS: Retroperitoneal fat correlated significantly with metabolic syndrome (adjusted odds ratio (OR, 5.651, p<0.05 and the number of metabolic abnormalities (p<0.05. Retroperitoneal fat area was significantly associated with blood pressure, plasma glycemic indices, lipid profile, C-reactive protein, adiponectin (r =  -0.244, P<0.05, and leptin (r = 0.323, p<0.05, but not plasma renin or aldosterone concentrations. During the 2.94 ± 0.84 years of follow-up, 32 participants developed incident hypertension. Retroperitoneal fat area (hazard ration (HR 1.62, p = 0.003 and peritoneal fat area (HR 1.62, p = 0.009, but not subcutaneous fat area (p = 0.14 were associated with incident hypertension. Neither retroperitoneal fat area, peritoneal fat area, nor subcutaneous fat areas was associated with incident diabetes after adjustment. CONCLUSIONS: Retroperitoneal fat is similar to peritoneal fat, but differs from subcutaneous fat, in terms of its relationship with metabolic syndrome and incident hypertension. Retroperitoneal fat area should be included in the measurement of visceral fat for cardio-metabolic studies in human.

  4. Chronic Low Back Pain due to Retroperitoneal Cystic Lymphangioma

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    Asieh Sadat Fattahi

    2014-03-01

    Full Text Available Abdominal cystic lymphangioma is a rare benign neoplasm. Less than 1% of lymphangiomas is in the retroperitoneum. Lymphangioma is mostly asymptomatic. Chronic symptoms were reported in retroperitoneal type more than others. Acute symptoms due to complications like infection, cyst rupture or hemorrhage may occur. We report an 18-years-old girl with low back pain from 6 months ago with huge pelvic mass and diagnosis of retroperitoneal cystic lymphangioma.

  5. Chronic Low Back Pain due to Retroperitoneal Cystic Lymphangioma

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    Asieh Sadat Fattahi

    2014-03-01

    Full Text Available   Abdominal cystic lymphangioma is a rare benign neoplasm. Less than 1% of lymphangiomas is in the retroperitoneum. Lymphangioma is mostly asymptomatic. Chronic symptoms were reported in retroperitoneal type more than others. Acute symptoms due to complications like infection, cyst rupture or hemorrhage may occur. We report an 18-years-old girl with low back pain from 6 months ago with huge pelvic mass and diagnosis of retroperitoneal cystic lymphangioma.

  6. Incidental diagnosis of a retroperitoneal schwannoma in a patient with chronic leukemia undergoing prostatic biopsy.

    Science.gov (United States)

    Autieri, Domenico; Pastore, Antonio Luigi; Silvestri, Luigi; Leto, Antonino; Ripoli, Andrea; Palleschi, Giovanni; Porta, Natale; Petrozza, Vincenzo; Carbone, Antonio

    2012-12-30

    We present a case of retroperitoneal schwannoma incidentally diagnosed in a patient undergoing surgical drainage of a pelvic abscess as a complication of a prostatic biopsy. A 50-year-old male, suffering from lymphatic leukemia, came to our observation due to lichen ruber planus and ejaculatory pain. The patient underwent a trans-perineal ultrasound-guided biopsy of the right seminal vesicle and of a hypoechoic area documented by ultrasonography. 48 hours after the procedure, the patient had developed: cold sores, shortness of breath with dyspnea, and high fever (40°C). The patient was hospitalized, underwent an emergency CT which documented a right presacral and pararectal liquid mass (abscess). The patient underwent emergency laparotomy and drainage of the abscess. The lesion histological examination revealed a retroperitoneal schwannoma with inflammatory phenomena and hyperplasic lymphadenitis. The retroperitoneal schwannoma is a silent disease whose only clinical manifestation coincides with the compression of adjacent anatomical structures. In many cases, the symptoms, even if present, as in this case (ejaculatory pain with compression of the seminal vesicle), are non-specific, thus delaying diagnosis and the therapeutic approach.

  7. Giant retroperitoneal abscess following necrotizing pancreatitis treated with internal drainage

    Institute of Scientific and Technical Information of China (English)

    Ludmil Marinov Veltchev; Manol Anastasov Kalniev

    2009-01-01

    BACKGROUND: Retroperitoneal abscess is a dangerous complication of the inflammatory process in organs. The pancreas reacts by enzymatic autodigestion and inflammation to external and internal factors: alcohol abuse, trauma, biliary stones, and viral infections. Chronic pancreatitis and formation of pseudocysts are late complications. The diffuse spread of pancreatic inflammation may form a retroperitoneal phlegmon. A better outcome is the limitation of the process by capsule formation-retroperitoneal abscess. METHODS: A 62-year-old man, with a history of alcohol abuse, was admitted for intermittent abdominal pain, fever, and significant weight loss. Previous medical consultations (laboratory tests, US, CT) confirmed chronic pancreatitis with pseudocyst formation. A new CT depicted a giant retroperitoneal abscess. RESULTS: After preoperative preparation with antibiotics, laparotomy and internal drainage-longitudinal cystoje-junostomy with Roux-en-Y loop were performed. At the 8th postoperative day the patient was in good condition. CONCLUSIONS: Giant retroperitoneal abscess is a dangerous pathology with significant mortality and morbidity. Diagnosis strongly necessitates operative intervention in order to evacuate and drain the space. These conditions include one internal drainage (in the GI tract) with the stomach, duodenum, or jejunum, which does not cause early and late GI discomfort and will gradually liquidate the cavity. We propose internal drainage with Roux-en-Y jejunal loop as the only method for accomplishing these conditions in cases of giant retroperitoneal abscesses.

  8. Retroperitoneal Necrotizing Fasciitis Masquerading as Perianal Abscess - Rare and Perilous.

    Science.gov (United States)

    Amaranathan, Anandhi; Sahoo, Ashok Kumar; Barathi, Deepak; Shankar, Gomathi; Sistla, Sarath Chandra

    2017-01-17

    Necrotizing fasciitis is one of the uncommon presentations of a rapidly spreading subcutaneous tissue infection. Although the actual cause is unclear in many cases, most of them are due to the rapid proliferation of microorganisms. Retroperitoneal necrotizing fasciitis is extremely rare. It is a potentially lethal infection that requires immediate and aggressive surgical care. Early diagnosis is the key to a better prognosis. The possibility of retroperitoneal necrotizing fasciitis should be suspected in patients with symptoms of sepsis that are disproportionate to clinical findings. The rapid deterioration of the patient also gives a clue towards the diagnosis. We report a 35-year-old male with perianal abscess who had been progressed to retroperitoneal necrotizing fasciitis. The patient was managed successfully with aggressive debridement and drainage after laparotomy. Appropriate antibiotics were used to combat the sepsis. The patient recovered well at follow up, three months after discharge. Another patient, a 45-year-old male with a retroperitoneal abscess, progressed to retroperitoneal necrotizing fasciitis, and extra peritoneal drainage and debridement was done. Antibiotics depending upon the culture and sensitivity were used to control sepsis. But the patient succumbed to death 45 days after surgery due to uncontrolled sepsis. Necrotizing fasciitis of any anatomical site needs aggressive surgical care with early intervention. But retroperitoneal necrotizing fasciitis needs an extra effort for diagnosis. After diagnosis, it needs timely surgical intervention and appropriate antibiotic therapy for the recovery of the patients.

  9. A Case of Huge Retroperitoneal Ganglioneuroma

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    Ali Akbarzadeh Pasha

    2009-01-01

    Full Text Available "nIntroduction: Ganglioneuroma is a rare, benign, fully differentiated tumor that contains mature schwann cells, ganglion cells, fibrous tissue and nerve fibers. This tumor has no immature elements, atypia, mitotic figures, intermediate cells or necrosis. This lesion can occur almost anywhere along the paravertebral sympathetic ganglia and sometimes in the adrenal medulla. This tumor can arise de novo and result from the maturation of a ganglioneuroblastoma or neuroblastoma; it may also develop within a neuroblastoma treated by chemotherapy. Metastasis is exceedingly rare. "nCase Presentation: The patient is a 7 year-old-girl living in Bam, Iran, presented with an abdominal mass 6 months ago. Physical examination revealed a very large, firm and painless abdominal mass in the right side of the abdomen with extension to the left side. She was otherwise well. In sonography, a very large heterogeneous retroperitoneal mass was seen arising on the right side crossing the midline. Dimensions were at least 170×160 mm. The right kidney and liver were displaced downward and upward, respectively. No liver metastasis or ascites was seen. In the colour Doppler ultrasonography, the lesion was hypervascular with a low resistance flow. The aorta was completely encased and displaced anteriorly but not invaded. Urinary VMA, bone marrow aspiration and biopsy were normal. A poor quality noncontrast CT scan revealed no more information than sonography (a hypodense noncalcified mass. The patient had tolerated two periods of chemotherapy with the impression of neuroblastoma without tissue diagnosis. Spiral CT scan performed at Pasteur hospital in Bam revealed a very large hypervascular hypodense retroperitoneal mass with complete encasement of the aorta and a large vessel originating from the aorta. The right kidney and liver were displaced downward and upward, respectively and the bowel loops were displaced to the left side. Sonography-guided needle biopsy was

  10. Development and evaluation of a retroperitoneal dialysis porcine model.

    Science.gov (United States)

    Okhunov, Zhamshid; Yoon, Renai; Perez Lanzac, Alberto; Sgroi, Michael; Lau, Wei Ling; Del Junco, Michael; Ordon, Michael; Drysch, Austin; Hwang, Christina; Vernez, Simone L; Fujitani, Roy; Kabutey, Nii-Kabu; Kalantar-Zadeh, Kamyar; Landman, Jaime

    2016-08-01

    We attempted to create a surgical model to evaluate the retroperitoneal space for the ability to transfer solutes through the retroperitoneal membrane. Our dual objectives were to develop a technique to assess the feasibility of retroperitoneal dialysis (RPD) in a porcine model. We incorporated two 35-kg Yorkshire pigs for this pilot study. In the first animal, we clamped renal vessels laparoscopically. In the second animal, we embolized renal arteries. In both animals, we dilated the retroperitoneal space bilaterally and deployed dialysis catheters. We measured serum creatinine (Cr), urea, and electrolytes at baseline 6 hours before the dialysis and every 4 hours after. We successfully created retroperitoneal spaces bilaterally and deployed dialysis catheters in both animals. In the first animal, dialysate and plasma Cr ratio (D/P) on the left and right side were 0.43 and 0.3, respectively. Cr clearance by 40 minutes of dialysis treatment was 6.3 mL/min. The ratio of dialysate glucose at 4 hours dwell time to dialysate glucose at 0 dwell time (D/D0) for left/rights sides were 0.02 and 0.02, respectively. kt/Vurea was 0.43. In the second animal, D/P Cr for left/right sides were 0.34 and 0.33, respectively. kt/Vurea was 0.17. We euthanized the pigs due to fluid collection in the peritoneal space and rapid increase of serum Cr, urea, and electrolytes. We demonstrated the feasibility of creation of a functionally anephric porcine model with successful development of retroperitoneal spaces using balloon inflation. Notwithstanding minimal clearance and limited diffusion capacity in this experiment, additional studies are needed to examine potential use of retroperitoneal space for peritoneal dialysis.

  11. Gestational trophoblastic neoplasia with retroperitoneal metastases: A fatal complication

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    Dimopoulos Athanassios-Meletios

    2010-12-01

    Full Text Available Abstract Background Gestational Trophoblastic Neoplasia (GTN is a pathologic entity that can affect any pregnancy and develop long after the termination of the pregnancy. Its course can be complicated by metastases to distant sites such as the lung, brain, liver, kidney and vagina. The therapeutic approach of this condition includes both surgical intervention and chemotherapy. The prognosis depends on many prognostic factors that determine the stage of the disease. Case Report We present a woman with GTN and retroperitoneal metastatic disease who came to our department and was diagnosed as having high risk metastatic GTN. Accordingly she received chemotherapy as primary treatment but unfortunately developed massive bleeding after the first course of chemotherapy, was operated in an attempt to control bleeding but finally succumbed. Conclusion This case demonstrates that GTN, while usually curable, can be a deadly disease requiring improved diagnostic, treatment modalities and chemotherapeutic agents. The gynaecologist should be aware of all possible metastatic sites of GTN and the patient immediately referred to a specialist center for further assessment and treatment.

  12. Isolated Retroperitoneal Hydatid Cyst Invading Splenic Hilum

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    Safak Ozturk

    2014-01-01

    Full Text Available Introduction. Hydatid disease (HD is an infestation that is caused by the larval stage of Echinococcus granulosus. The liver is affected in approximately two-thirds of patients, the lungs in 25%, and other organs in a small proportion. Primary retroperitoneal hydatid cyst is extremely rare. The most common complaint is abdominal pain; however, the clinical features of HD may be generally dependent on the location of the cyst. Case Presentation. A 43-year-old female was admitted with the complaint of abdominal pain. Her physical examination was normal. Computed tomography (CT revealed a 17 × 11 cm cystic lesion, with a thick and smooth wall that is located among the left liver lobe, diaphragm, spleen, tail of the pancreas, and transverse colon and invading the splenic hilum. Total cystectomy and splenectomy were performed. Pathological examination was reported as cyst hydatid. Discussion. Cysts in the peritoneal cavity are mainly the result of the spontaneous or traumatic rupture of concomitant hepatic cysts or surgical inoculation of a hepatic cyst. Serological tests contribute to diagnosis. In symptomatic and large hydatid peritoneal cysts, surgical resection is the only curative treatment. Total cystectomy is the gold standard. Albendazole or praziquantel is indicated for inoperable and disseminated cases. Percutaneous aspiration, injection, and reaspiration (PAIR technique is another nonsurgical option.

  13. Retroperitoneal liposarcoma presenting a indirect inguinal hernia.

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    Noguchi H

    2001-02-01

    Full Text Available A 60-year-old man was admitted to our hospital with a right inguinal swelling that had been growing in size without any pain for 7 months. We diagnosed the growth as a right inguinal hernia and operated on him. The growth, however, was found to be a tumor it situated along the spermatic cord and testicular vessels. We diagnosed it as a lipoma. The tumor was resected near part of the internal inguinal ring. Histopathological diagnosis showed well-differentiated liposarcoma of the sclerosing type. Postoperative computed tomography (CT revealed a large residual tumor in the retroperitoneum. We believed that the tumor was a retroperitoneal liposarcoma and that it developed in the inguinal region. The residue of the liposarcoma was resected onto the right inguinal tract. A periodic follow up has been performed and no evidence of recurrence or metastasis has been seen in the 4 years and 9 months since the second surgery. No adjuvant therapy was performed. Inguinal liposarcomas are relatively rare and in most cases these tumors are thought to originate in the spermatic cord. The origin of the tumor is believed to be the retroperitoneum.

  14. ROLE OF ULTRASOUND IN EVALUATION OF RETROPERITONEAL LESIONS

    Directory of Open Access Journals (Sweden)

    Harshita Pant

    2016-07-01

    Full Text Available BACKGROUND The retroperitoneum contains the adrenals, kidneys and ureters, the duodenal loop, pancreas, great vessels with their branches and associated lymph node chains, ascending and descending portions of the colon including the caecum, the retroperitoneal sonographic images are frequently degraded by bowel gas, thick muscles, fat, ribs, the lower lungs. AIMS AND OBJECTIVES To study the various features of retroperitoneal lesions by ultrasonography and assess its role. MATERIALS AND METHODS Fifty patients presenting with signs and symptoms suggestive of retroperitoneal pathology were evaluated over a period of 12 months using machine Siemens Sonoline Omnia/Siemens Sonoline G50 with 3.5 MHz convex and 5-10 MHz multifrequency linear transducer. OBSERVATIONS The maximum numbers of cases–17 (34% were of renal origin. This was followed by pancreatic lesion - 14 cases (28%, USG correctly detected 46 out of 50 cases thus having an accuracy of 92% for the detection and evaluation of retroperitoneal lesions. CONCLUSIONS Ultrasound provides a safe, quick, reliable, non-invasive and cost effective tool for screening for retroperitoneum. We recommend ultrasound as the primary diagnostic tool for various retroperitoneal lesions.

  15. Primary retroperitoneal mucinous cystadenocarcinoma. A case report and review of the literature

    DEFF Research Database (Denmark)

    Jørgensen, L J; Vibits, H

    1991-01-01

    A case of a primary retroperitoneal mucinous cystadenocarcinoma in a 38-year-old female is presented. The literature concerning primary retroperitoneal cystadenocarcinomas is reviewed and it is concluded that close postoperative follow-up is necessary.......A case of a primary retroperitoneal mucinous cystadenocarcinoma in a 38-year-old female is presented. The literature concerning primary retroperitoneal cystadenocarcinomas is reviewed and it is concluded that close postoperative follow-up is necessary....

  16. Retroperitoneal fibrosis: a rare vascular and immune entity disclosed by chronic lombalgia.

    Science.gov (United States)

    Blanc, Gaelle; Girard, Nicolas; Alexandre, Christian; Vignon, Eric

    2007-10-01

    Retroperitoneal fibrosis is a rare inflammatory and fibrotic process in the retroperitoneal peri-aortic tissues, associated with ureters and other abdominal organs' entrapment. Here we report an original observation of a 55-year-old patient presenting with chronic lombalgia disclosing idiopathic retroperitoneal fibrosis. After one-year follow-up, treatment with corticosteroids led to a complete clinical, biological, and radiological response. Pathogenesis and therapeutic options in idiopathic retroperitoneal fibrosis are discussed.

  17. Retroperitoneal hematoma after manual reduction of indirect inguinal hernia.

    Science.gov (United States)

    Xu, Xiequn; Hong, Tao; Li, Binglu; Liu, Wei; Zheng, Chaoji; He, Xiaodong

    2013-07-01

    This report presents the case of a 59-year-old man with sudden severe pain in the right lower abdomen after manually reducing the right indirect inguinal hernia who had bilateral indirect inguinal hernia for 5 years. A subsequent contrast computed tomography scan with contrast of the abdomen and pelvis revealed a significant extensive retroperitoneal hematoma at the abdomen and pelvis of the right side. There was contrast leaked out, which was suspected from inferior epigastric artery. He underwent successful laparotomy. The bleeding ruptured inferior epigastric artery at the interior side of the deep inguinal ring was found, the deep inguinal ring was avulsed, ligature of the inferior epigastric artery and removal of the retroperitoneal hematoma were done, and the patient was discharged from hospital on the seventh postoperative day. This is the first report in the literature on retroperitoneal hematoma caused by manual reduction of indirect inguinal hernia.

  18. Spilled gallstones mimicking a retroperitoneal sarcoma following laparoscopic cholecystectomy.

    Science.gov (United States)

    Kim, Bum-Soo; Joo, Sun-Hyung; Kim, Hyun-Cheol

    2016-05-07

    Laparoscopic cholecystectomy has become a standard treatment of symptomatic gallstone disease. Although spilled gallstones are considered harmless, unretrieved gallstones can result in intra-abdominal abscess. We report a case of abscess formation due to spilled gallstones after laparoscopic cholecystectomy mimicking a retroperitoneal sarcoma on radiologic imaging. A 59-year-old male with a surgical history of a laparoscopic cholecystectomy complicated by gallstones spillage presented with a 1 mo history of constant right-sided abdominal pain and tenderness. Computed tomography and magnetic resonance imaging demonstrated a retroperitoneal sarcoma at the sub-hepatic space. On open exploration a 5 cm × 5 cm retroperitoneal mass was excised. The mass contained purulent material and gallstones. Final pathology revealed abscess formation and foreign body granuloma. Vigilance concerning the possibility of lost gallstones during laparoscopic cholecystectomy is important. If possible, every spilled gallstone during surgery should be retrieved to prevent this rare complication.

  19. Treatment of severe acute pancreatitis through retroperitoneal laparoscopic drainage

    Institute of Scientific and Technical Information of China (English)

    Chun Tang; Baolin Wang; Bing Xie; Hongming Liu; Ping Chen

    2011-01-01

    A treatment method based on drainage via retroperitoneal laparoscopy was adopted for 15 severe acute pancreatitis (SAP) patients to investigate the feasibility of the method.Ten patients received only drainage via retroperitoneai laparoscopy,four patients received drainage via both retroperitoneal and preperitoneal laparoscopy,and one patient received drainage via conversion to laparotomy.Thirteen patients exhibited a good drainage effect and were successfully cured without any other surgical treatment.Two patients had encapsulated effusions or pancreatic pseudocysts after surgery,but were successfully cured after lavage and B ultrasound-guided percutaneous catheter drainage.SAP treatment via retroperitoneal laparoscopic drainage is an effective surgical method,resulting in minor injury.

  20. [The assesment of significance of the retroperitoneal lymph node dissection in proximity of metastatic tumor with main vessels in patients with germ cell testicular tumors].

    Science.gov (United States)

    Tereshin, O S; Zotov, S P; Vazhenin, A V; Mamonova, A O

    2013-01-01

    The therapeutic approach should be defined more exactly in proximity of residual retroperitoneal metastases of germ cell testicular tumor and main vessels (left after chemotherapy). The data of 29 (24%) patients were analyzed over a period of time since 2003 till 2011. The general survival was 82% in the group without lymph node dissection (17 patients) in median observation of 27.5 months. The proximity with main vessels was registered in half of the cases in the group of operated patients (12 people), a single vascular reconstruction was required. The general survival was 97% in median observation for 35 months. The involvement of main vessels of retroperitoneal space significantly complicated the retroperitoneal lymph node dissection, but didn't have negative prognostic value.

  1. A retroperitoneal foregut duplication cyst: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yong Woon; Lee, Jin Hee; Byun, Kyung Hwan; Kim, Byung Ki; Sohn, Kyung Sik; Kee, Se Kook; Jeon, Jin Min [Pochon CHA University, Kumi CHA Hospital, Kumi (Korea, Republic of); Yun, Young Kook [College of Medicine, Kyungpook National University, Daegu (Korea, Republic of)

    2006-01-15

    Retroperitoneal foregut duplication cyst is an extremely rare congenital malformation. Pathologically, this lesion contains both gastric mucosa and respiratory type mucosa; radiologically, it is often challenging to differentiate it from the other cystic neoplasms that present a similar appearance. We report on a case of retroperitoneal foregut duplication cyst that was lined by both gastric and pseudostratified ciliated columnar epithelium, and it was also accompanied by a pancreatic pseudocyst. Initially, it presented with peripancreatic and intrapancreatic cystic masses in an asymptomatic 30-year-old man, and this man has since undergone surgical resection.

  2. A huge renal capsular leiomyoma mimicking retroperitoneal sarcoma

    Directory of Open Access Journals (Sweden)

    Lal Anupam

    2009-01-01

    Full Text Available A huge left renal capsular leiomyoma mimicking retroperitoneal sarcoma presented in a patient as an abdominal mass. Computed tomography displayed a large heterogeneous retro-peritoneal mass in the left side of the abdomen with inferior and medial displacement as well as loss of fat plane with the left kidney. Surgical exploration revealed a capsulated mass that was tightly adherent to the left kidney; therefore, total tumor resection with radical left nephrectomy was performed. Histopathology ultimately confirmed the benign nature of the mass. This is the largest leiomyoma reported in literature to the best of our knowledge.

  3. Marked Retroperitoneal Lymphadenopathy in Hairy Cell Leukemia: A Case Report

    Directory of Open Access Journals (Sweden)

    R.E. Shackelford

    2013-09-01

    Full Text Available Hairy cell leukemia (HCL is uncommonly associated with lymphadenopathy, while retroperitoneal lymphadenopathy is extremely uncommon. We report on a patient with a 12-year history of HCL who developed painless jaundice and ascites, accompanied by positional discomfort with persistent nausea. Computed tomography examination revealed 2 large retroperitoneal masses, which at autopsy consisted of HCL with focally intermixed pancreatic and peripancreatic tissue. Lymphadenopathy was not identified above the diaphragm or below the aortic bifurcation. No vasculitis or an unusual HCL histology was identified. As previous reports, our findings suggest that HCL with massive lymphadenopathy has a specific site predilection, but it is not necessarily accompanied by vasculitis or an unusual histology.

  4. Synchronous transperitoneal laparoscopic resection of right retroperitoneal schwannoma and left kidney monotypic PEComa in the presence of a duplicated inferior vena cava (IVC).

    Science.gov (United States)

    Yang, Bo; Wang, Linhui; Wu, Zhenjie; Li, Mingmin; Wang, Huiqing; Sheng, Jing; Huang, Jun; Liao, Songbai; Sun, Yinghao

    2012-07-01

    A 21-year-old female presented with a retroperitoneal mass in the right side and a centrally located renal mass in the left kidney with an aberrant vascular anatomy of a double inferior vena cava. The 2 tumors were radically excised by a transperitoneal laparoscopic approach in one session. Histopathologic examination revealed the right retroperitoneal lesion to be a schwannoma and the renal mass to be a cluster of monotypic neoplasms with perivascular epithelioid cell differentiation (PEComas). The latter is a rare tumor.

  5. Laparoscopic retroperitoneal live donor right nephrectomy for purposes of allotransplantation and autotransplantation.

    Science.gov (United States)

    Gill, I S; Uzzo, R G; Hobart, M G; Streem, S B; Goldfarb, D A; Noble, M J

    2000-11-01

    We report the technique of and initial experience with retroperitoneal laparoscopic live donor right nephrectomy for purposes of renal allotransplantation and autotransplantation. A total of 5 patients underwent retroperitoneoscopic live donor nephrectomy of the right kidney for autotransplantation in 4 and living related renal donation in 1. Indications for autotransplantation included a large proximal ureteral tumor, a long distal ureteral stricture and 2 cases of the loin pain hematuria syndrome. In all cases a 3-port retroperitoneal laparoscopic approach and a pelvic muscle splitting Gibson incision for kidney extraction were used. In patients undergoing autotransplantation the same incision was used for subsequent transplantation. All procedures were successfully accomplished without technical or surgical complications. Total mean operating time was 5.8 hours and average laparoscopic donor nephrectomy time was 3.1 hours. Mean renal warm ischemia time, including endoscopic cross clamping of the renal artery to ex vivo cold perfusion, was 4 minutes. Average blood loss for the entire procedure was 400 cc. Radionuclide scan on postoperative day 1 confirmed good blood flow and function in all transplanted kidneys. Mean analgesic requirement was 58 mg. fentanyl. Mean hospital stay was 4 days (range 2 to 8), and convalescence was completed in 3 to 4 weeks. In the occasional patient requiring renal autotransplantation live donor nephrectomy can be performed laparoscopically with renal extraction and subsequent transplantation through a single standard extraperitoneal Gibson incision, thus, minimizing the overall operative morbidity. Furthermore, these data demonstrate that live donor nephrectomy of the right kidney can be performed safely using a retroperitoneal approach with an adequate length of the right renal vein obtained for allotransplantation or autotransplantation.

  6. Retroperitoneal and transperitoneal laparoscopic cryotherapy for small renal masses.

    Science.gov (United States)

    Domínguez, A; Bellido, J A; Muñoz-Rodríguez, J; Abascal-Junquera, J M; Hannaoui, N; Banús, J M

    2015-11-01

    Cryotherapy is a minimally invasive ablative technique that is considered an alternative to conventional surgery for preserving renal function in small renal tumors and in selected cases. We present our results from laparoscopic renal cryotherapy. We retrospectively analyzed 17 renal tumors diagnosed in 16 patients treated with cryotherapy. The patients' mean age was 66 years (43-80). The mean tumor size was 1.8cm (0.7-3.7cm). Cryotherapy with double-freeze cycle was performed laparoscopically in all cases (10 by transperitoneal approach and 7 by retroperitoneal approach). Perioperative biopsies were performed on all patients and were positive for malignancy in 10 cases (59%). The mean stay was 2.8 days. The mean operative time was 162 minutes. Only 1 case reverted to open surgery due to bleeding. One patient required a blood transfusion in the immediate postoperative period. The majority of complications were Clavien-Dindo grades I and II. Some 76.5% of the patients had no complications. After a mean follow-up of 31 months (6-102), 1 patient died from nontumor-related causes, and 12 patients (75%) still show no evidence of local recurrence or progression. One patient had tumor persistence and therefore underwent partial nephrectomy at 6 months. One patient had a metachronous recurrence in the same kidney at 36 months, and another patient had a recurrence at 23 months. Laparoscopic renal cryotherapy is a safe and feasible technique and is a good alternative to surgery for selected renal tumors. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Robot - assisted laparoscopic retroperitoneal lymph node dissection in testicular tumor

    Science.gov (United States)

    Torricelli, Fabio C. M.; Jardim, Denis; Guglielmetti, Giuliano B.; Patel, Vipul; Coelho, Rafael F.

    2017-01-01

    ABSTRACT Introduction and objective Retroperitoneal lymph node dissection (RPLND) is indicated for patients with non-seminomatous germ cell tumor (NSGCT) with residual disease after chemotherapy. Although the gold standard approach is still the open surgery, few cases of robot-assisted laparoscopic RPLND have been described. Herein, we aim to present the surgical technique for robot-assisted laparoscopic RPLND. Patient and method A 30 year-old asymptomatic man presented with left testicular swelling for 2 months. Physical examination revealed an enlarged and hard left testis. Alpha-fetoprotein (>1000ng/mL) and beta-HCG (>24.000U/L) were increased. Beta-HCG increased to >112.000U/L in less than one month. The patient underwent a left orchiectomy. Pathological examination showed a mixed NSGCT (50% embryonal carcinoma; 30% teratoma; 10% yolk sac; 10% choriocarcinoma). Computed tomography scan revealed a large tumor mass close to the left renal hilum (10x4x4cm) and others enlarged paracaval and paraortic lymph nodes (T2N3M1S3-stage III). Patient was submitted to 4 cycles of BEP with satisfactory response. Residual mass was suggestive of teratoma. Based on these findings, he was submitted to a robot-assisted RPLND. Results RPLND was uneventfully performed. Operative time was 3.5 hours. Blood loss was minimal, and there were no intra- or postoperative complications. The patient was discharged from hospital in the 1st postoperative day. Pathological examination showed a pure teratoma. After 6 months of follow-up, patient is asymptomatic with an alpha-fetoprotein of 2.9ng/mL and an undetectable beta-HCG. Conclusion Robot-assisted laparoscopic RPLND is a feasible procedure with acceptable morbidity even for post chemotherapy patients when performed by an experienced surgeon.

  8. A retroperitoneal neuroendocrine tumor in ectopic pancreatic tissue.

    Science.gov (United States)

    Okasha, Hussein Hassan; Al-Bassiouni, Fahim; El-Ela, Monir Abo; Al-Gemeie, Emad Hamza; Ezzat, Reem

    2013-07-01

    Ectopic pancreas is the relatively uncommon presence of pancreatic tissue outside the normal location of the pancreas. We report a case of abdominal pain due to retroperitoneal neuroendocrine tumor arising from heterotopic pancreatic tissue between the duodenal wall and the head of the pancreas. Patient underwent surgical enucleation of the tumor.

  9. Primary retroperitoneal Merkel cell carcinoma: Case report and literature review

    Science.gov (United States)

    Quiroz-Sandoval, Osvaldo A.; Cuellar-Hubbe, Mario; Lino-Silva, Leonardo S.; Salcedo-Hernández, Rosa A.; López-Basave, Horacio N.; Padilla-Rosciano, Alejandro E.; León-Takahashi, Alberto M.; Herrera-Gómez, Ángel

    2015-01-01

    Background Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma that affects elderly patients and typically arises in sun-exposed skin. The disease is very rare and only few cases present with no apparent skin lesion. In the retroperitoneum there are only two cases reported in the literature. Case presentation We report a case of a 54-year-old Mexican male with MCC, which presented as a large retroperitoneal mass. Pathological and immunohistochemical analysis of the transabdominal CT-guided biopsy specimen revealed a MCC. The patient underwent preoperative chemotherapy followed by a laparotomy and the mass was successfully excised. Discussion There are two possible explanations for what occurred in our patient. The most plausible theory is the retroperitoneal mass could be a massively enlarged lymph node where precursor cells became neoplastic. This would be consistent with a presumptive diagnosis of primary nodal disease. Moreover, metastasis to the retroperitoneal lymph nodes has been reported as relatively common when compared to other sites such as liver, bone, brain and skin. The less probable theory is the non-described “regression” phenomena of a cutaneous MCC, but we are not found a primary skin lesion. Conclusion Preoperative chemotherapy and excision of the primary tumor is the surgical treatment of choice for retroperitoneal MCC. We propose that further studies are needed to elucidate the true efficacy of chemotherapy in conventional and unconventional patients with MCC. PMID:26708276

  10. Idiopathic retroperitoneal fibrosis: A challenging case in a rare disease

    Directory of Open Access Journals (Sweden)

    Charat Thongprayoon

    2014-01-01

    Full Text Available Context: Retroperitoneal fibrosis is a rare but severe disease. The diagnosis is usually late when a patient is evaluated for renal insufficiency. Untreated cases may develop serious complications or advance to end-stage renal disease. Case Report: We report a 66-year-old man who presented with worsening kidney function. He was successfully given the diagnosis of idiopathic retroperitoneal fibrosis. Prednisone (1 mg/kg per day was initiated. The patient′s symptoms continued to improve at 1 month with stable kidney function. Conclusion: Clinicians should have high index of suspicion for retroperitoneal fibrosis when patients present with an elevated erythrocyte sedimentation rate (ESR or C-reactive protein (CRP and renal insufficiency from obstructive uropathy. The diagnosis of retroperitoneal fibrosis is primarily made from imaging by computed tomography (CT scan. Biopsy should be performed in patients who do not have typical findings on CT scan and to exclude the possibility of immunoglobulin G4 (IgG4-related disease.

  11. Clinical outcomes of ERCP-related retroperitoneal perforations.

    Science.gov (United States)

    Guerra, Francesco; Giuliani, Giuseppe; Coletta, Diego; Bonapasta, Stefano Amore; Levi Sandri, Giovanni Battista

    2017-04-01

    Endoscopic retrograde cholangiopancreatography (ERCP)-related perforations represent rare but often severe conditions. While lesions with intraperitoneal perforation have an almost imperative indication to surgery, whether or not to manage retroperitoneal perforations surgically is still an area of debate. The aim of the present work was to review the available clinical evidence on the operatively and medically treated ERCP-related retroperitoneal perforations. From MEDLINE/PubMed databases 137 patients with retroperitoneal perforation were included from 12 studies that met the selection criteria for data investigation and analysis. Twenty-four patients were treated by prompt surgery; 113 were primarily managed conservatively and about 20% of these patients required surgery subsequently. Overall, the morbidity and mortality were 15.4% and 6.6%, respectively. Although most patients with retroperitoneal perforation may benefit from a non-operative management, a considerable number of patients fail to respond to medical treatment and require surgery afterwards. Identifying those patients who are at highest risk of poor outcome after conservative treatment should be considered a research priority.

  12. A Giant Retroperitoneal Abscess Mimicking Incarcerated Inguinal Hernia

    Directory of Open Access Journals (Sweden)

    Naciye Sinem Gezer

    2015-06-01

    Full Text Available An 82-year-old man was admitted to the emergency room with an acute left-sided groin pain and scrotal swelling. He has suffered from a groin hernia for two years. Abdominal x-ray demonstrated air-fluid levels in the left upper quadrant suggesting an intestinal obstruction (Figure 1. Abdominal computed tomography (CT scan was obtained with an initial diagnosis of an incarcerated inguinal hernia. However, it showed multiple perirenal abscesses and a giant-sized retroperitoneal abscess extending from the retroperitoneal space into the scrotum through the inguinal canal (Figure 2 and 3. Retroperitoneal abscesses are most frequently seen in the 3rd to 6th decades of life (1. Gram-negative bacteria, most commonly E. coli, are the cause of infection which usually develops secondary to pyelonephritis, urinary stasis or immune suppression. The onset of clinical manifestations of the infection, including flank, abdomen and groin pain, chills, fever, tachycardia, weakness and anorexia are often insidious (2,3. Laboratory findings include leukocytosis, increased serum creatinine levels and pyuria. The literature emphasizes the possibility of diagnostic delay and postponed treatment of retroperitoneal abscess due to the fact that its prodrome phase may be long.

  13. Demonstration of the route of embryo migration in retroperitoneal ectopic pregnancy using contrast-enhanced computed tomography.

    Science.gov (United States)

    Liang, Changhu; Li, Xueli; Zhao, Bin; Du, Yinglin; Xu, Shifeng

    2014-03-01

    Retroperitoneal abdominal pregnancy is exceptionally rare. An unusual retroperitoneal pregnancy has a high risk of severe bleeding. Abdominal ultrasonography and whole abdominal computerized tomography scanning should be performed for the early diagnosis of ectopic pregnancy. A case of retroperitoneal ectopic pregnancy located very close to large retroperitoneal blood vessels and treated with resection is presented. Many unusual features of retroperitoneal ectopic pregnancy were highlighted as providing further evidence in support of the main proposed embryo migration mechanism via lymphatic vessels.

  14. [DESCRIPTION OF A RETROPERITONEAL ACCESS ROUTE TO THE VESSELS OF THE SPLEEN FOR SPLENORENAL ARTERIAL AND VENOUS ANASTOMOSIS].

    Science.gov (United States)

    Gil-Vernet Vila, José María

    2014-01-01

    To perform arterial or venous spleno-renal anastomoses, surgeons have so far systematically used the transperitoneal way whic is burdened by a high mortality an morbility percentage. On the basis of anatomo-surgical considerations, a retroperitoneal approach has been found reaching the hilus of the spleen via the lumbar region; the first arterial spleno-renal anastomosis by this way was performed in 1972 and the first venous spleno-renal anastomosis due to portal hipertension also by this way was performed in 1974, the alter proving to be the least aggresive by avoiding damaging the páncreas, the most surgical and direct for reaching the splenic vessels thereby enabling a better exposure and an easier performing of the anastomoses. By being retroperitoneal, the loss or infección of the ascitic liquid in the cirrhotic patient is prevented.

  15. Lateral retroperitoneal transpsoas interbody fusion in a patient with achondroplastic dwarfism.

    Science.gov (United States)

    Staub, Blake N; Holman, Paul J

    2015-02-01

    The authors present the first reported use of the lateral retroperitoneal transpsoas approach for interbody arthrodesis in a patient with achondroplastic dwarfism. The inherent anatomical abnormalities of the spine present in achondroplastic dwarfism predispose these patients to an increased incidence of spinal deformity as well as neurogenic claudication and potential radicular symptoms. The risks associated with prolonged general anesthesia and intolerance of significant blood loss in these patients makes them ideal candidates for minimally invasive spinal surgery. The patient in this case was a 51-year-old man with achondroplastic dwarfism who had a history of progressive claudication and radicular pain despite previous extensive lumbar laminectomies. The lateral retroperitoneal transpsoas approach was used for placement of interbody cages at L1/2, L2/3, L3/4, and L4/5, followed by posterior decompression and pedicle screw instrumentation. The patient tolerated the procedure well with no complications. Postoperatively his claudicatory and radicular symptoms resolved and a CT scan revealed solid arthrodesis with no periimplant lucencies.

  16. Retroperitoneal fibrosis associated with immunoglobulin g4-related disease in the differential diagnosis in retroperitoneal tumors. Case report.

    Science.gov (United States)

    Ruiz Mar, Gabriela; Cárdenas Serrano, Óscar E; Roldan García, Jorge; Cañavera-Constantino, A; Menéndez Trejo, Víctor M; Chapa Azuela, Óscar

    2017-07-19

    The patient was a 55-year-old woman with a 4-month history of pain in left flank that irradiated to the lumbar region. Computed tomography revealed a cystic tumor in the retroperitoneal region that compresses the ureter and left renal pelvis in contact with pancreatic body and tail. Surgery was performed and the definitive pathological report diagnosed nodular retroperitoneal fibrosis associated with IgG4; Ki67-positive in germinal centers (5%) and IgG4-positive (40 plasma cells in 3 fields of 40x) by immunohistochemistry. Retroperitoneal fibrosis is a rare disease, that develops gradually and has an excellent response to steroid management. Surgical treatment is reserved for cases that compromise adjacent structures. Thus, identifying it when studying a retroperitoneal tumor leads to better prognosis and survival. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  17. Primary retroperitoneal seminoma - embryology, histopathology and treatment particularities.

    Science.gov (United States)

    Gîngu, Constantin Virgil; Mihai, Mihaela; Baston, Cătălin; Crăsneanu, Mugurel Alexandru; Dick, Alexandru Vladimir; Olaru, Vlad; Sinescu, Ioanel

    2016-01-01

    Retroperitoneal seminoma is a very rare form of cancer, with embryological origin represented by primordial germ cells from the urogenital ridges left behind during the fetal development. Extragenital germ cell tumors can also occur in the mediastinum or the pineal gland. The aim of this paper is to outline the particularities and draw embryological, histopatological and treatment conclusions regarding extragonadal germ cell tumors. A 43-year-old patient without any additional pathology was admitted for anemia of unknown etiology. The clinical examination revealed through deep abdominal palpation a mass in the left flank, and normal testes. Thoraco-abdomino-pelvic computed tomography (CT) scan showed a large retroperitoneal tumor adjacent to the great vessels in the left lumbo-iliac region. The blood work revealed just a low hemoglobin and hematocrit. With the established diagnosis of retroperitoneal tumor, radical surgical removal was decided. During the surgery, we were required to dissect a large solid encapsulated tumor mass from the aorta and the common iliac artery, starting at the renal pedicle all the way to the left iliac bifurcation. The surgical access was obtained through a transperitoneal left subcostal incision prolonged pararectally. Histopathological and immunohistochemical studies revealed a seminoma of the usual type. After the histological findings, the patient's tumor markers were investigated (LDH - lactate dehydrogenase, βHCG - beta-human chorionic gonadotropin, αFP - alpha-fetoprotein), all values being within normal ranges. In addition, the left testicle was thoroughly reexamined, clinically, through ultrasound and magnetic resonance imaging (MRI) scans, and no abnormalities were observed. After the surgery, the patient followed three courses of chemotherapy (BEP - Bleomycin, Etoposide and Cisplatin). The CT scan done 24 months after surgery found no signs of local or distant tumor recurrence. The patient entered a follow-up schedule

  18. Retroperitoneal sarcomas: A single center experience; Sarcomes retroperitoneaux: experience d'un centre

    Energy Technology Data Exchange (ETDEWEB)

    Ben Hassouna, J.; Slimane, M.; Damak, T.; Chargui, R.; Ben Bachouche, W.; Oukad, M.; Bouzaine, H.; Bouzid, T.; Mtallah, M.; Khomsi, F.; Gamoudi, A.; Hechiche, M.; Dhiab, T.; Rahal, K. [Institut Salah Azaiz, Service de Chirurgie Carcinologique, Tunis (Tunisia)

    2008-09-15

    Purpose: To analyse the management and clinical outcome of patients treated for retroperitoneal soft tissue sarcoma and to identify prognosis factors. Patients and method: This is a retrospective study of 20 adults; 11 women and nine men treated between 1980 and 2000 in our institution. Results: There were seven lipo sarcomas and 13 leiomyo-sarcomas. The mean tumor size was 26 cm. Three patients underwent a complete resection (R0), 14 patients an incomplete resection (R1/R2) with microscopic or macroscopic tumour remained after surgery. Only three patients had a surgical biopsy. Median follow-up was 18 months. Overall survival rates was 45%, 10% at two and five years, respectively. Among the following factors, sex, age, symptom duration, tumor size, histologic type, histologic grade, resection type, mitotic index, necrosis extension, histologic differentiation, and A.J.C.C. stage, only mitotic index factor (scale 1,2 versus scale 3) significantly influenced patient survival (p = 0.02). Conclusion: This study re-emphasizes the poor outcome of patients with retroperitoneal sarcoma. Survival rates appeared low when compared with other studies. These results incite for a more aggressive approach. (authors)

  19. Retroperitoneal decortication of simple renal cysts vs decortication with wadding using perirenal fat tissue: results of a prospective randomized trial.

    Science.gov (United States)

    Porpiglia, Francesco; Fiori, Cristian; Billia, Michele; Renard, Julien; Di Stasio, Andrea; Vaccino, Davide; Bertolo, Riccardo; Scarpa, Roberto Mario

    2009-06-01

    OBJECTIVES To evaluate, in a pilot prospective randomized trial, the safety, effectiveness and radiological recurrence of retroperitoneal renal cyst decortication compared with retroperitoneal decortication with wadding using perirenal pedicled fat tissue. PATIENTS AND METHODS From March 2004 to December 2007, 40 patients with simple renal cysts were enrolled and randomized; 22 (group A) had a simple retroperitoneal decortication (SRD) and 18 (group B) a decortication with wadding of the cyst using perirenal fat tissue (RDCW). The following variables were recorded: age, gender, side, size on ultrasonography/computed tomography (CT), location, operative duration, blood loss, complications, pathology, presence or absence of flank pain, hypertension, urinary tract compression or urinary infection. The primary endpoint of this trial was to evaluate and compare the efficacy of both treatments. Secondary endpoints were safety and pain, hypertension and the resolution of urinary tract obstruction. RESULTS In all, 40 cysts were treated; there were no bilateral cysts. The mean (sd) size on CT was 11.9 (1.84) cm in group A and 12.8 (1.25) cm in group B (P = 0.1). All the procedures were completed laparoscopically and no conversion was necessary. There were no intraoperative complications. The mean (range) hospital stay was 3.4 (3-6) days. There was no statistically significant difference between the groups for all variables assessed. There was a radiological recurrence in three patients (14%) in group A, but none in group B (all successful). CONCLUSION To be completely successful, with maximum safety and to prevent recurrences in the treatment of renal cysts, RCDW is recommended when a retroperitoneal approach is chosen, especially if the cyst is located anteriorly. When symptom relief is considered, RCDW duplicates the results obtained with SRD.

  20. Minimally Invasive Necrosectomy Techniques in Severe Acute Pancreatitis: Role of Percutaneous Necrosectomy and Video-Assisted Retroperitoneal Debridement

    Directory of Open Access Journals (Sweden)

    Jennifer A. Logue

    2015-01-01

    Full Text Available Consensus advocating a principle of early organ support, nutritional optimisation, followed ideally by delayed minimally invasive intervention within a “step-up” framework where possible has radically changed the surgical approach to complications of acute pancreatitis in the last 20 years. The 2012 revision of the Atlanta Classification incorporates these changes, and provides a background which underpins the complexities of individual patient management decisions. This paper discusses the place for delayed minimally invasive surgical intervention (percutaneous necrosectomy, video-assisted retroperitoneal debridement (VARD, and the rationale for opting to adopt a percutaneous approach over endoscopic or laparoscopic approaches in different clinical situations.

  1. Autoimmune pancreatitis metachronously associated with retroperitoneal fibrosis with IgG4-positive plasma cell infiltration

    Institute of Scientific and Technical Information of China (English)

    Terumi Kamisawa; Pong Yui Chen; Yuyang Tu; Hitoshi Nakajima; Naoto Egawa

    2006-01-01

    Retroperitoneal fibrosis is an uncommon disorder characterized by the formation of a dense plaque of fibrous tissue in the retroperitoneum, and its etiology remains unknown. Autoimmune pancreatitis is a rare type of chronic pancreatitis characterized by fibrosis with abundant infiltration of IgG4-positive plasma cells and lymphocytes and obliterative phlebitis in the pancreas. We present a case of autoimmune pancreatitis that developed 10 mo after the occurrence of retroperitoneal fibrosis. Histological findings of the resected retroperitoneal mass were marked periureteral fibrosis with abundant infiltration of IgG4-positive plasma cells and lymphocytes and obliterative phlebitis.These findings suggest a common pathophysiological mechanism for retroperitoneal fibrosis and autoimmune pancreatitis in this case. Some cases of retroperitoneal fibrosis might be a retroperitoneal lesion of IgG4-related sclerosing disease.

  2. Retroperitoneal schwannoma mimicking metastatic seminoma:case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Shi-Qiang Zhang; Song Wu; Kai Yao; Pei Dong; Yong-Hong Li; Zhi-Ling Zhang; Xian-Xin Li

    2013-01-01

    If a testicular cancer pat ient has a mass in the retroperitoneum,a metastasis is often the first suspicion,probably leading to improper diagnosis and overtreatment.Here we report a case of retroperitoneal schwannoma mimicking metastatic seminoma.A 29-year-old man,who had a history of seminoma,presented with a single retroperitoneal mass suspected to be a metastasis.Because the patient refused radiotherapy,3 cycles of cisplatin,etoposide,and bleomycin were offered.Post-chemotherapy computed tomography scan revealed persistence of the retroperitoneal mass,with no change in tumor size or characteristics.Subsequently,retroperitoneal lymph node dissection was performed.The dissected tissue contained negative lymph nodes but a single mass in the attached fat.Pathology revealed retroperitoneal schwannoma,which was confirmed by immunohistochemistry.Thus,clinicians should be aware of retroperitoneal schwannoma and its distinction from metastatic seminoma to avoid misdiagnosis and ensure proper treatment.

  3. Retroperitoneal Pararenal Mass; Castleman Disease: A Case Report

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    Alper Ozorak

    2016-05-01

    Full Text Available Castleman%u2019s disease is a heterogeneous group of lymphoproliferative disorders with unknown etiology presenting with lymphadenopathy. Although Castleman%u2019s Disease may occur anywhere along the lymphatic chain, the mediastinum is the most common location (70%. We represent 36-year-old male patient with homogeneous retroperitoneal mass that interrelated with renal hilum of the right kidney in abdominal tomography. Surgical complete resection performed and histopathological diagnosis of the resected tissue was hyaline-vascular type of Castleman%u2019s disease It is histologically and prognostically distinct from malignant lymph-node hyperplasia. Although Castleman%u2019s disease is rare condition, it should always be kept in mind in the differential diagnosis of retroperitoneal tumors.

  4. Giant recurrent retroperitoneal liposarcoma presenting as a recurrent inguinal hernia

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    Ajay H. Bhandarwar

    2011-11-01

    Full Text Available Retroperitoneal liposarcoma presenting as an inguinal hernia is a rare entity. We present the first case of Giant recurrent liposarcoma presenting as a recurrent inguinal hernia in a 40-year-old male. Physical examination showed an irreducible lump in the right inguinal region and a scar in the right lumbar and right inguinal region. Computed tomography (CT scan of abdomen revealed it to be a retro peritoneal mass extending into the right inguinal region along and involving the cord structures. Wide local excision of the tumour with right orchidectomy and inguinal hernioplasty was performed. Histo-pathology confirmed it to be a liposarcoma. Patient received postoperative radio therapy. Follow up of two years has shown him to be disease free. Retroperitoneal liposarcoma can grow along cord structures into the inguinal canal and mimic an irreducible indirect inguinal hernia.

  5. Retroperitoneal fibrosis - the state-of-the-art.

    Science.gov (United States)

    Runowska, Marta; Majewski, Dominik; Puszczewicz, Mariusz

    2016-01-01

    Retroperitoneal fibrosis (RPF) is a rare disease, hallmarked by inflammation and deposition of fibrous tissue around the abdominal aorta. This process may spread contiguously and involve adjacent structures, leading to many complications, among which the most frequent and most severe is ureteral obstruction. The condition usually has idiopathic origin (idiopathic retroperitoneal fibrosis - IRF), but can also develop secondarily to a number of factors. The etiology of the disease remains unclear. Current research suggests that about half of the cases of IRF may be a symptom of a recently discovered, clinically heterogeneous immunoglobulin G4-related disease (IgG4-RD). Corticosteroids are the first-line treatment for IRF, but effective attempts to use immunosuppressants are also made. This paper presents the current state of knowledge on the etiopathogenesis, clinical presentation, diagnosis and therapeutic possibilities in different forms of RPF. Based on the latest research, an analysis of the relationship between IRF and IgG4-RD was performed.

  6. Retroperitoneal calcifying fibrous tumor mimicking an adrenal tumor.

    Science.gov (United States)

    Prochaska, Erica C; Sciallis, Andrew P; Miller, Barbra S

    2016-06-01

    Establishing the etiology of a retroperitoneal tumor may be difficult due to close proximity of multiple organs. Evaluation of retroperitoneal tumors often leads to surgery, many times to obtain a definitive diagnosis and rule out malignancy. Calcifying fibrous tumors (CFT) are very rare soft tissue tumors occurring most often in young patients. They are most often found arising in the thoracic cavity, mediastinum, abdominal cavity and extremities and usually have a benign clinical course. Macrocscopically, the tumors are well circumscribed and firm with a white-tan appearance. Histologically, CFT comprised a hypocellular proliferation of bland spindle cells, densely hyalinized collagen, chronic lymphoplasmacytic inflammation and dystrophic calcifications. Other considerations in the pathologic differential diagnosis include solitary fibrous tumor and inflammatory myofibroblastic tumor.

  7. Hidatidosis retroperitoneal secundaria a quiste hidatídico de localización hepática Retroperitoneal hydatidosis secondary to hepatic hydatid cyst

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    Katherina A Vizcaychipi

    2012-12-01

    Full Text Available La hidatidosis es una enfermedad de distribución mundial, producida por un platelminto parásito del género Echinococcus. El caso que se presenta corresponde a una paciente con una tumoración fluctuante en el espacio retroperitoneal lumbar, secundaria a un quiste hepático. El diagnóstico inicial de certeza fue dado por el hallazgo de ganchos rostelares de protoescólices en el líquido aspirado de un absceso. Este trabajo describe el cuadro clínico, el diagnóstico y el tratamiento médico-quirúrgico de esta paciente. Se analiza cómo la elaboración de un diagnóstico certero requiere de un análisis adecuado de los antecedentes epidemiológicos, las manifestaciones clínicas, los estudios de imágenes y las pruebas de laboratorio, ya que el conjunto de estos datos confirman el caso.Hydatid disease in a worldwide zoonosis. It is caused by a parasitic platyhelminth of the genus Echinococcus. We present a patient with a fluctuating lumbar tumor in the retroperitoneal space, secondary to a hepatic cyst. The initial diagnosis was made by identification of rostellar hooks from protoscoleces in the fluid aspirated from the abscess. We herein describe the clinical manifestations, diagnosis and medical and surgical treatment of this unusual case and conclude that the development of an accurate diagnosis required a proper analysis of the patient's epidemiological history, clinical manifestations, imaging studies and laboratory tests. A multidisciplinary approach and differential diagnosis is paramount to be able to establish a cause of the disease to deliver appropriate treatment.

  8. Dedifferentiated retroperitoneal liposarcoma presenting as right inguinal hernia: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Myung; Lee, Su Lim; Ku, Young Mi [Dept. of Radiology, Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu (Korea, Republic of); Choi, Moon Hyung [Dept. of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2016-01-15

    Retroperitoneal liposarcomas usually present as painless, slow-growing abdominal masses. When masses grow large enough to compress surrounding structures, symptoms may occur. Retroperitoneal liposarcoma clinically manifesting as inguinal hernia is a very rare entity; only 11 cases have been reported. Herein, we present radiographic features of a 37-year-old male with a painless palpable mass in the right groin that was identified as dedifferentiated retroperitoneal liposarcoma herniated through the right inguinal canal.

  9. Retroperitoneal endodermal sinus tumor patient with palliative care needs

    Directory of Open Access Journals (Sweden)

    Surbhi Kashyap

    2016-01-01

    Full Text Available This article is a case reflection of a personal encounter on the palliative care treatment required after the removal of a complicated case of a primary extra-gonadal retro-peritoneal endodermal sinus tumor (yolk sac tumor. This reflection is from the perspective of a recently graduated MD student who spent one month with an Indian pain management and palliative care team at the Institute Rotary Cancer Hospital (IRCH, All India Institute of Medical Sciences (AIIMS, New Delhi

  10. [Retroperitoneal fibrosis with eye-drops containing timolol].

    Science.gov (United States)

    Delorme, E; Vial, T; Rabilloud, M; de Carlan, H; Evreux, J C

    1990-01-01

    Retroperitoneal fibrosis occurred in a 62-year-old man who had been treated during 4 years eye-drops containing timolol. The disease was diagnosed after a sudden episode of nephritic colic. The recovery was progressive and uneventful. No corticosteroid therapy was used. Six months later the patient remained free of symptoms. Although an idiopathic origin could not be excluded, the causal relationship with timolol treatment is likely due to the chronology of events and the lack of other causes.

  11. Pulmonary hyalinizing granuloma and retroperitoneal fibrosis in an adolescent

    Energy Technology Data Exchange (ETDEWEB)

    Young, Adam S.; Binkovitz, Larry A.; Adler, Brent H. [Columbus Children' s Hospital, Children' s Radiological Institute, Columbus, OH (United States); Nicol, Kathleen K. [Columbus Children' s Hospital, Department of Pathology, Columbus, OH (United States); Rennebohm, Robert M. [Columbus Children' s Hospital, Department of Rheumatology, Columbus, OH (United States)

    2007-01-15

    We describe a 15-year-old boy who developed pulmonary hyalinizing granuloma (PHG) and retroperitoneal fibrosis (RPF). His PHG and RPF were not associated with histoplasmosis or tuberculosis and appeared to represent idiopathic autoimmune phenomena. This is the first reported case of PHG in a pediatric patient and the fourth reported co-occurrence of PHG and RPF. The use of F-18 fluorodeoxyglucose positron emission tomography in the diagnostic and follow-up evaluation of PHG is reported. (orig.)

  12. Recent Progress in the Management of Retroperitoneal Sarcoma

    Directory of Open Access Journals (Sweden)

    Rona Cheifetz

    2001-01-01

    Full Text Available Retroperitoneal sarcomas (RPS are rare tumours that typically present late and carry a poor prognosis even following grossly complete resection. In an attempt to improve the outlook for patients with RPS, sarcoma specialists have employed various adjuvant therapies, including extermal beam radiation, intraoperative radiation, brachyradiation and systemic chemotherapy. This article reviews the presentation and prognosis of RPS, and focuses on the results of new treatment strategies compared with conventional management.

  13. A Huge Cystic Retroperitoneal Lymphangioma Presenting with Back Pain

    Science.gov (United States)

    Kubachev, Kubach; Abdullaev, Elbrus; Babyshin, Valentin; Neronov, Dmitriy; Abdullaev, Abakar

    2016-01-01

    Retroperitoneal lymphangioma is a rare location and type of benign abdominal tumors. The clinical presentation of this rare disease is nonspecific, ranging from abdominal distention to sepsis. Here we present a 73-year-old female patient with 3-month history of back pain. USG and CT revealed a huge cystic mass which was surgically excised and appeared to be lymphangioma on histopathology. PMID:27843456

  14. Giant Primary Mature Retroperitoneal Teratomain in Adult Male Patient

    OpenAIRE

    R. Ebrahimian; D. Tasa

    2015-01-01

    Introduction: Teratomas are congenital tumors consisting of derivatives from the ectoderm, endoderm and mesoderm germ cell layers. A teratoma is considered to be a non-seminomatous germ cell tumor and is typically located in either the sacrococcygeal region or in the gonads. Giant retroperitoneal teratomas in adults are even rarer, with only a few cases previously described in the literature. Case report: A 35-year-old male patient with severe nausea and vomiting was taken to the emergency wa...

  15. Retroperitoneal unicentric Castleman's disease (giant lymph node hyperplasia: case report

    Directory of Open Access Journals (Sweden)

    Jaques Waisberg

    Full Text Available CONTEXT AND OBJECTIVE: Castleman's disease, or giant lymph node hyperplasia, is a rare disorder of the lymphoid tissue that causes lymph node enlargement. It is considered benign in its localized form, but aggressive in the multicentric type. The definitive diagnosis is based on postoperative pathological findings. The aim here was to describe a case of retroperitoneal unicentric Castleman's disease in the retroperitoneum. CASE REPORT: A 61-year old white male with weight loss and listlessness presented with moderate arterial hypertension and leukopenia. Abdominal tomography revealed a 5 x 4 x 5 cm oval mass of low attenuation, with inner calcification and intense enhancement on intravenous contrast, located in the retroperitoneal region, between the left kidney and the aorta, at the renal hilus. Exploratory laparotomy revealed a non-pulsatile solid oval mass situated in the retroperitoneum, adjacent to the left renal hilus. The retroperitoneal lesion was removed in its entirety. Examination of frozen samples revealed benign lymph node tissue and histopathological examination of the surgical sample revealed hyaline-vascular giant lymph node hyperplasia (Castleman's disease. The patient was discharged on the 12th day without significant events. Two months after the operation, the patient was readmitted with severe cardiac insufficiency, acute renal failure and bronchopneumonia, which progressed to acute respiratory insufficiency, sepsis and death.

  16. Retroperitoneal Non-functioning Paraganglioma: A Case Report

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    Faten Limaiem

    2013-06-01

    Full Text Available Retroperitoneal paragangliomas are relatively rare endocrine tumours derived from the extra-adrenal paraganglia of the autonomic nervous system. They can be functional when they secrete catecholamines or non-functional. The diagnosis of a paraganglioma is infrequently made preoperatively unless the tumour is functional. In this paper, the authors report a new case of non-functional paraganglioma. A 54-year-old woman with a past medical history of viral hepatitis, presented with vague abdominal pain of five years' duration. On examination, no abdominal mass was palpable and her blood pressure was 100/60 mm Hg. Abdominal computed tomography scan demonstrated a well-defined hypervascular retroperitoneal mass of heterogeneous density in the left para-aortic region measuring 3cm in diameter. As paraganglioma was suspected preoperatively, serum and urine cathecholamine levels were performed and were within normal range. Complete surgical excision of this mass was performed. Histological examination of the surgical specimen coupled with immunohistochemical study was consistent with the diagnosis of pararganglioma. Retroperitoneal paragangliomas are most commonly benign with good prognosis, but can be locally invasive and metastasize as well. The possibility for malignant transformation of paragangliomas makes surgical excision the treatment of choice. [J Interdiscipl Histopathol 2013; 1(3.000: 168-171

  17. Spontaneous retroperitoneal hemorrhage after hemodialysis involving anticoagulant agents

    Institute of Scientific and Technical Information of China (English)

    Wen-xing FAN; Song-min HUANG; Ping FU; Zheng-xu DENG; Fang LIU; Rong-bo LIU; Ling HE; Bogati AMRIT; Li ZANG; Jing-wen LI; Xian-rong LIU

    2012-01-01

    In this paper,we described the symptoms and treatment of a patient with diabetic nephropathy accompanied by spontaneous retroperitoneal hemorrhage after hemodialysis.An elderly female patient with diabetic nephropathy presented with severe pain,numbness,and an increasing swelling in the left hip and left thigh after six sessions of hemodialysis involving the use of an antiplatelet drug and an anticoagulant agent.Her hemoglobin decreased to 46 g/L.An abdominal ultrasound showed a hematoma in the left retroperitoneal space,and computed tomography (CT) findings revealed a 6 cm×8 cm×10 cm hematoma in the left psoas muscle.After aggressive supportive therapy [the administration of packed red blood cell transfusion,carbazochrome sodium sulfonate injection,and continuous venovenous hemofiltration (CWH)],the patient's vital signs stabilized and her hemoglobin increased to 86 g/L.Repeat CT showed that the hematoma had been partially absorbed after two weeks.Eventually,the patient was discharged with stable vital signs.Physicians should be aware of the possibility of spontaneous retroperitoneal hemorrhage,particularly in patients with diabetic nephropathy undergoing hemodialysis involving the use of anticoagulant agents.

  18. “颠簸疗法”治疗腹膜后脓肿%The"mild vibration therapy"for the treatment of retroperitoneal abscess

    Institute of Scientific and Technical Information of China (English)

    钟记华; 王斌; 梁惠文; 徐伟熙

    2013-01-01

      目的探讨腹膜后脓肿引流的有效方法。方法回顾性分析1998年—2012年我院收治13例腹膜后脓肿行腹膜后置管引流患者的临床资料。结果“颠簸疗法”的引流效果优于常规引流组,且治愈时间也短于常规引流。结论“颠簸疗法”治疗腹膜后脓肿可以取得较好的临床疗效。%Objective The present study aims to investigate the effectiveness of various approaches of retroperitoneal abscess drainage. Methods The clinical data obtained from the patients, who underwent retroperitoneal abscess drainage with retroperitoneal catheters between 1998 and December 2012,were reviewed retrospectively. Results The difference in the efficacies between the “jolt therapy”group and the conventional drainage group was statistically significant(P<0.05),i.e. the patients in the“jolt therapy”group presented better therapeutic outcomes than those in the conventional drainage group. Conclusion In the treatment of retroperitoneal abscess,“jolt therapy” was proved to produce relatively better therapeutic outcomes.

  19. A case of retroperitoneal liposarcoma after delivery with expression of estrogen receptor: Report of a case

    Directory of Open Access Journals (Sweden)

    Hiroaki Kasashima

    2015-01-01

    Conclusion: Retroperitoneal liposarcoma has a high local recurrence rate due to the difficulty in complete surgical resection; therefore, additional hormone therapy is important for improving the prognosis.

  20. Concomitant mediastinal and extrarenal retroperitoneal angiomyolipomas in a patient who previously underwent ipsilateral radical nephrectomy

    Directory of Open Access Journals (Sweden)

    Carl Sheng-Chen Wen

    2014-12-01

    Full Text Available The association of the tuberous sclerosis complex with angiomyolipoma (AML arising from the retroperitoneum and mediastinum has not been reported in the literature. We present the first case in which a patient presented with a combined retroperitoneal extrarenal and posterior mediastinal AML. Interestingly, the ipsilateral retroperitoneal AML emerged 15 years after radical nephrectomy for the left renal AML.

  1. Simpatectomia lombar por pneumoretroperitonioscopia (SLPR Retroperitoneal endoscopic lumbar sympathectomy

    Directory of Open Access Journals (Sweden)

    Wander Eduardo Sardinha

    2007-12-01

    Full Text Available CONTEXTO: A simpatectomia ainda encontra indicação no tratamento de várias doenças, tais como a insuficiência arterial periférica crônica aterosclerótica grau IV (Fontaine sem condições de revascularização, úlceras hipertensivas e o fenômeno de Raynaud acompanhado de lesões tróficas. A cirurgia clássica é realizada através do acesso retroperitoneal, mas também pode ser realizada por meio de técnicas minimamente invasivas. OBJETIVO: Este trabalho tem o objetivo de mostrar os resultados da simpatectomia lombar por pneumoretroperitonioscopia. MÉTODOS: Trinta e um pacientes foram submetidos a simpatectomia lombar por pneumoretroperitonioscopia (22 homens e nove mulheres, com média de idade de 48 anos (41-70. Vinte eram pacientes com insuficiência arterial periférica crônica, sem possibilidade de revascularização, todos com lesões (necroses ou úlceras; sete pacientes eram portadores de tromboangeite obliterante; três tinham úlcera hipertensiva; e um apresentava fenômeno de Raynaud secundário. As cirurgias foram realizadas por pneumoretroperitoneoscopia, sendo feita a exérese do segundo ao quarto gânglio da cadeia lombar. RESULTADOS: Não houve complicações intra-operatórias, havendo necessidade de apenas uma conversão para cirurgia convencional por dificuldade técnica. A duração média do procedimento foi de 103 minutos e o tempo médio de internação foi de 2 dias. CONCLUSÃO: A simpatectomia pode ser realizada por pneumoretroperitonioscopia com as vantagens de uma cirurgia minimamente invasiva.BACKGROUND: Sympathectomy can still be performed in the treatment of many diseases, such as chronic atherosclerotic peripheral arterial disease stage IV without conditions of revascularization, hypertensive ulcer and necrosis associated with Raynaud phenomenon. The classical treatment is performed through retroperitoneal access, but can also be performed through minimally invasive techniques. OBJECTIVE: This study

  2. A large tuberculous abscess mimicking a retroperitoneal cystic mass: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kwang Suk; Cha, Seung Hwan; Ahn, Ji Hyun; Cho, Mi Yeon [Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju (Korea, Republic of)

    2015-03-15

    Large cystic masses originating from the retroperitoneal space are rare, and cystic tumors are often considered preferentially in the differential diagnosis. However, it is difficult to make a correct diagnosis. A 55-year-old man presented with a palpable abdominal mass. A computed tomography (CT) scan detected a mass mimicking a large cystic tumor in the retroperitoneal space anterior to the psoas muscle. The mass had an enhanced outer margin, an irregular inner margin, and several surrounding necrotic lymph nodes. However, histopathologic examination followed by an exploratory laparotomy confirmed that the mass was consistent with a tuberculous (TB) abscess. A retroperitoneal TB abscess without spinal or active pulmonary TB is very rare. To the best of our knowledge, there are no published reports of a retroperitoneal TB abscess confirmed by both CT scan and surgical pathology in the Korean literature. We report a rare case of a huge retroperitoneal TB abscess that can mimic a cystic tumor.

  3. Gastroesophageal cancer and retroperitoneal fibrosis: Two case reports and review of the literature.

    Science.gov (United States)

    Peixoto, Renata D'Alpino; Al-Barrak, Jasem; Lim, Howard; Renouf, Daniel

    2013-03-15

    Retroperitoneal fibrosis secondary to malignant disease is a rare condition associated with a dismal prognosis. We herein present the first ever reported case of retroperitoneal fibrosis related to esophageal adenocarcinoma in a 63-year-old patient who developed bilateral ureteral obstruction due to extensive retroperitoneal fibrosis 18 mo after having completed neoadjuvant chemoradation followed by surgery for a pT3N0 adenocarcinoma of the distal esophagus. We also report the case of a previously healthy woman who presented with bilateral ureteral obstruction and diffuse narrowing of the common biliary duct and was found to have extensive retroperitoneal fibrosis as a consequence of metastatic gastric adenocarcinoma. Both patients had poor performance status and were unsuitable for palliative chemotherapy. This paper shows that urinary and biliary obstructive symptoms might represent retroperitoneal fibrosis as a consequence of gastroesophageal malignancy.

  4. Retroperitoneal Lipoma Presenting with Nutcracker-Like Phenomenon

    Directory of Open Access Journals (Sweden)

    Seiichi Saito

    2013-01-01

    Full Text Available Retroperitoneal lipoma presenting with a nutcracker-like phenomenon is extremely rare. I experienced a case of a 65-year-old man presenting with left flank pain and macrohematuria intermittently for 3 years. Computed tomography revealed a lipoma at the left pedicle of the kidney, 30 mm in diameter, causing a curving of the left renal artery and dilatation of the left renal vein. This patient was treated successfully by retroperitoneoscopic resection of the lipoma. There have been no symptoms for 10 years after the operation.

  5. [Unilateral spontaneous adrenal hematoma: an unusual cause of retroperitoneal hemorrhage].

    Science.gov (United States)

    Vendrell, J R; Alcover, J; Alcaraz, A; Llopis, J; Gutierrez, R; Barranco, M A; Carretero, P

    1996-01-01

    Presentation of one case of spontaneous retroperitoneal haemorrhage in a 72 year-old male, his first symptom being a left retrothoracic pain of sudden onset. The supplementary studies performed (ultrasound, CAT and MNR) pointed to the adrenal gland as the origin of the haemorrhage. Faced eith the uncertainty of the etiological diagnosis, a left supra-renalectomy was conducted which confirmed the pathological anatomy of the piece and the presence of massive haematoma of the suprarenal gland with no other pathological data. The clinical, diagnostic and therapeutical aspects are discussed.

  6. Retroperitoneal ancient schwannoma: Review of clinico-radiological features

    Energy Technology Data Exchange (ETDEWEB)

    Loke, T.K.L.; Lo, K.K.L.; Lo, J.; Chan, J.C.S. [United Christian Hospital, Kwun Tong, (Hong Kong). Department of Diagnostics Radiology; Yuen, N.W.F. [United Christian Hospital, Kwun Tong, (Hong Kong). Department of Histopathology

    1998-05-01

    A case is reported here of an ancient schwannoma in the retroperitoneum. The findings of abdominal ultrasound and CT in a patient with a retroperitoneal ancient schwannoma are presented, and the clinical and radiological features of this unusual tumour are reviewed. The presence of a large, well-delineated complex cystic mass in the deep soft tissues should raise the possibility of an ancient schwannoma. It is important to recognize these tumours as benign with excellent prognosis so as to avoid unnecessary radical surgery. Copyright (1998) Blackwell Science Pty Ltd 12 refs., 2 figs.

  7. [Hibernoma: brown fat retroperitoneal tumor. Report of a pediatric case].

    Science.gov (United States)

    Collado, Laura; Sierre, Sergio; Bosalec, Andrea; Lipsich, José

    2011-12-01

    Hibernoma is a rare benign tumor of soft tissue, composed of brown fat. This tissue is predominant in hibernating animals and hence its name. Because of its rarity in Pediatrics and difficult diagnosis, we report a 3 month-old patient with a diagnosis consistent with an abdominal tumor. Ultrasound and computed tomography exams showed an infiltrative retroperitoneal tumor, with hypervascular and lipomatous features. After tumor excision, histopathological exam confirmed the diagnosis of hibernoma or brown fat tumor. This presentation describes the characteristics of this type of tumor, rare in children, and reviews the fatty tumors, according to their frequency in pediatric patients.

  8. Survival analysis of pure seminoma at post-chemotherapy retroperitoneal lymph node dissection.

    Science.gov (United States)

    Rice, Kevin R; Beck, Stephen D W; Bihrle, Richard; Cary, K Clint; Einhorn, Lawrence H; Foster, Richard S

    2014-11-01

    Viable seminoma encountered at post-chemotherapy retroperitoneal lymph node dissection for pure testicular seminoma is rare due to the chemosensitivity of this germ cell tumor. In this study we define the natural history of viable seminoma at post-chemotherapy retroperitoneal lymph node dissection. The Indiana University testis cancer database was queried from 1988 to 2011 to identify all patients with primary testicular or retroperitoneal pure seminoma and who were found to have pure seminoma at post-chemotherapy retroperitoneal lymph node dissection. Clinical characteristics were reviewed and survival analysis was performed. A total of 36 patients met the study inclusion criteria. All patients received standard first line cisplatin based chemotherapy and 17 received salvage chemotherapy. The decision to proceed to retroperitoneal lymph node dissection was based on enlarging retroperitoneal mass and/or positron emission positivity in the majority of cases. Seven patients had undergone previous retroperitoneal lymph node dissection. Additional surgical procedures were required in 19 patients to achieve a complete resection. The 5-year cancer specific survival rate was 54%. However, only 9 of 36 patients remained continuously free of disease and of these patients 4 received adjuvant chemotherapy. Mean time from post-chemotherapy retroperitoneal lymph node dissection to death was 6.9 months. Second line chemotherapy, reoperative retroperitoneal lymph node dissection and earlier era of treatment were associated with poorer cancer specific survival. A total of 36 patients with pure seminoma were found to have viable pure seminoma at post-chemotherapy retroperitoneal lymph node dissection. While 5-year cancer specific survival was 54%, these surgeries are technically demanding and only a minority of patients achieves a durable cure from surgery alone. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights

  9. Extrapleural Nuss procedure for the correction of pectus excavatum under choledochoscope%应用胆道镜观察胸膜外入路Nuss手术治疗漏斗胸的临床分析

    Institute of Scientific and Technical Information of China (English)

    尤振兵; 郭伟; 徐达夫; 嵇建; 朱卫国; 褚红军

    2010-01-01

    应用胆道镜观察胸膜外入路行Nuss手术治疗小儿漏斗胸11例.其中男9例、女2例;年龄3~15岁,平均年龄6岁.无术中和术后并发症,失血量5~20 ml.矫形效果10例"优秀",1例"良好".提示,用胆道镜观察胸膜外入路Nuss手术具有便于观察、微创、符合生理等优点,是一种值得推广的治疗漏斗胸的手术方法.%From Oct 2006 to Dec 2008, 11 children (9 boys and 2 girls) aged 3 - 15 ( mean 6 yearyears) with pectus excavatum underwent extrapleural Nuss procedure under choledochoscope. No compcomplication was observed during and after operation. The blood loss during operation was 5-20 ml. Postoperative evaluation showed that the score of 10 cases was "excellent" and 1 was "good". The results indicate that extrapleural Nuss procedure under choledochoscope, has advantages of low complication and minimal invasion,can be widely used in clinic practice.

  10. Benign retroperitoneal schwannoma presenting as colitis: A case report

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    We report a case of a patient presenting with clinical, radiological and endoscopic features of colitis due to a compressive left para-aortic mass. Total open surgical excision was performed, which resulted in complete resolution of colitis. Histopathology and immunohistochemistry revealed benign retroperitoneal schwannoma. These neural sheath tumors rarely occur in the retroperitoneum. They are usually asymptomatic but as they enlarge they may compress adjacent structures, which leads to a wide spectrum of nonspecific symptoms, including lumbar pain, headache, secondary hypertension, abdominal pain and renal colicky pain. CT and MR findings show characteristic features, but none are specific. Schwannoma can be isolated sporadic lesions, or associated with schwannomatosis or neurofibromatosis type Ⅱ (NF2). Although they vary in biological and clinical behavior, their presence is, in nearly every case, due to alterations or absence of the NF2 gene, which is involved in the growth regulation of Schwann cells. Both conditions were excluded by thorough mutation analysis. Diagnosis is based on histopathological examination and immunohistochemistry. Total excision is therapeutic and has a good prognosis. Schwannomatosis and NF2 should be excluded through clinical diagnostic criteria. Genetic testing of NF2 is probably not justified in the presence of a solitary retroperitoneal schwannoma.

  11. Torsion of the Retroperitoneal Kidney: Uncommon or Underreported?

    Directory of Open Access Journals (Sweden)

    Michael Sosin

    2014-01-01

    Full Text Available Vascular torsion in a renal allograft after placement in the retroperitoneum is rare and has only been reported twice in the literature. It is an extrinsically mediated process that occurs at the vascular pedicle resulting in graft compromise and potential loss. Rapid diagnosis and immediate surgical intervention may salvage allograft function. Herein, we present a unique case of a 42-year-old male that developed renal allograft torsion following a second kidney transplant placed in the retroperitoneum. Immediate detorsion did not resolve allograft dysfunction, and a biopsy revealed acute cellular mediated rejection. After antithymocyte globulin treatment, allograft function was salvaged. A review of the current literature shows that the incidence, morbidity, and long term allograft function of intraperitoneal and extraperitoneal torsion are different. As such, torsion of the retroperitoneal kidney demonstrates encouraging allograft salvage rates. Only the third case reported to date, this serves as a contribution to the growing body of literature in retroperitoneal renal torsion and reviews the risks, medication considerations, diagnostic tests, and treatment modalities in a unique disease process.

  12. Clitoris metastasis from a retroperitoneal leiomyosarcoma: A case report

    Science.gov (United States)

    Cokmert, Suna; Demir, Lutfiye; Akyol, Murat; Bayoglu, Ibrahim Vedat; Can, Alper; Unek, Ilkay Tugba; Bolat, Filiz Aka

    2014-01-01

    Leiomyosarcoma is a rare form of cancer commonly found in the retroperitoneum, uterus, stomach, small intestine and vascular tissue. Surgery with a wide margin of resection is the most effective treatment. Nevertheless, metastasis is common and generally occurs within the first 3 years. The liver and lungs are the most common sites of metastasis in leiomyosarcoma. Other sites of metastasis include bone, spleen, soft tissues and brain. Metastatic tumours of the clitoris are extremely rare. As cited in the literature, the most common cancers that metastasize to the clitoris are breast, bladder, renal and gastric. Here, we report a case of a clitoral mass in a 64-year-old woman who received an operation for retroperitoneal leiomyosarcoma 4 years prior. Mass resection was performed. The pathological diagnosis was a leiomyosarcoma metastasis. The patient also presented with brain and lung metastases at the time of the clitoral metastasis. This is the first case of clitoral and brain metastases originating from a retroperitoneal leiomyosarcoma. PMID:24527400

  13. Retroperitoneal fibrosis – the state-of-the-art

    Science.gov (United States)

    Majewski, Dominik; Puszczewicz, Mariusz

    2016-01-01

    Retroperitoneal fibrosis (RPF) is a rare disease, hallmarked by inflammation and deposition of fibrous tissue around the abdominal aorta. This process may spread contiguously and involve adjacent structures, leading to many complications, among which the most frequent and most severe is ureteral obstruction. The condition usually has idiopathic origin (idiopathic retroperitoneal fibrosis – IRF), but can also develop secondarily to a number of factors. The etiology of the disease remains unclear. Current research suggests that about half of the cases of IRF may be a symptom of a recently discovered, clinically heterogeneous immunoglobulin G4-related disease (IgG4-RD). Corticosteroids are the first-line treatment for IRF, but effective attempts to use immunosuppressants are also made. This paper presents the current state of knowledge on the etiopathogenesis, clinical presentation, diagnosis and therapeutic possibilities in different forms of RPF. Based on the latest research, an analysis of the relationship between IRF and IgG4-RD was performed. PMID:27994271

  14. Retroperitoneal perforation of the duodenum from biliary stent erosion.

    Science.gov (United States)

    Miller, George; Yim, Duke; Macari, Michael; Harris, Marsha; Shamamian, Peter

    2005-01-01

    Endoscopically placed biliary stents have supplanted surgical decompression as the preferred treatment option for patients with obstructive jaundice from advanced pancreatic cancer. An unusual complication of indewelling biliary stents is duodenal perforation into the retroperitoneum. We describe the case of a patient with end-stage pancreatic cancer who presented with an acute abdomen from erosion of a previously placed bile duct stent through the wall of the second portion of the duodenum. Although our patient presented with advanced symptoms, clinical presentations can vary from mild abdominal discomfort and general malaise to overt septic shock. Definitive diagnosis is best made with computed tomography (CT) imaging, which can detect traces of retroperitoneal air and fluid. Treatment options vary from nonoperative management with antibiotics, bowel rest, and parenteral alimentation in the most stable patients to definitive surgery with complete diversion of gastric contents and biliary flow from the affected area in patients with clinical symptoms or radiologic evidence suggesting extensive contamination. Complications of management can include duodenal fistulization, residual retroperitoneal or intrabdominal abscess, and ongoing sepsis. This report highlights the salient issues in the presentation, diagnosis, and modern management of patients with this rare complication of indwelling biliary stents.

  15. Angiomiolipoma renal masivo como causa de sangrado retroperitoneal espontáneo Massive renal angyomiolipoma as a cause of spontaneous retroperitoneal bleeding

    Directory of Open Access Journals (Sweden)

    Lilia M. Uriburu

    2008-09-01

    Full Text Available Introducción: El angiomiolipoma (AML es un tumor renal benigno, compuesto por una cantidad variable de tejido adiposo, músculo liso y vasos sanguíneos; que habitualmente crece dentro del espacio perinéfrico y suele complicarse con hemorragia intratumoral y menos frecuentemente perinéfrica y retroperitoneal, la cual se encuentra condicionada por el tamaño de la lesión. Objetivos: Evaluar dentro de las diferentes causas de sangrado retroperitoneal espontáneo al AML masivo, en confrontación con otras causas. Material y Métodos: Se estudiaron 3 pacientes con AML masivo previamente desconocidos y sangrado retroperitoneal. Dos de ellos fueron estudiados con resonancia magnética, en secuencias de T1 SE, T2 TSE con supresión grasa, T1 TSE con supresión grasa sin y con gadolinio. Uno fue estudiado con tomografía computada (TC pre y post administración de contraste EV. Resultados: De los 3 pacientes estudiados, todos presentaron masas renales cuyos tamaños variaron entre 10 y 26 cm. de diámetro mayor, las cuales presentaron sangrado intratumoral y retroperitoneal de jerarquía. Conclusión: El AML masivo como causante de hemorragia retroperitoneal espontánea es por lo tanto una patología a tener en cuentaIntroduction: The angyomiolipoma (AML is a benign renal tumor formed by a variable amount of adipose tissue, soft tissue and blood vessels; it generally grows within the perinephric space and it usually may complicate with intra-tumoral bleeding and less frequently with perinephric and retroperitoneal bleeding, which is conditioned by the size of the lesion. Objectives: To evaluate according to the different causes of spontaneous retroperitoneal bleeding the massive AML in contrast to other causes. Material and Methods: Three patients with massive AML who presented retroperitoneal bleeding were studied. Two of them were studied by MRI with T1 and T2 sequences, after and before the administration of gadolinium, with fat supression

  16. Retroperitoneal "triton" tumor. Report of a case and review of literature

    Directory of Open Access Journals (Sweden)

    Palacios Acosta José Martín

    2014-07-01

    Full Text Available The triton tumor was described in 1932 by Masson, as a peripheral nerve sheath malignancy with rabdomioblástica differentiation. The retroperitoneal location is extremely rare, only nine cases have been reported in children. The clinical picture depends on the size of the tumor and the organs involved, their retroperitoneal location is usually asymptomatic. The mainstay of treatment is the surgical excision of the tumor. We report the case of a child with retroperitoneal location of the tumor. A complete resection of it was performed. The patient had an uneventful postoperative course. He is currently under control. There is no evidence of relapse.

  17. Intra-operative haemodynamic volatility in a patient undergoing retroperitoneal cyst excision

    Directory of Open Access Journals (Sweden)

    Thrivikrama Padur Tantry

    2012-01-01

    Full Text Available Excision of a suspected retroperitoneal, duodenal duplication cyst was performed in a pre-operatively normotensive patient under combined epidural and general anaesthesia. Intraoperatively, the cystic tumour was discovered to be a retroperitoneal mass, free from duodenal or adrenal origin. Development of severe arrhythmias, ST segment changes and hypertensive spikes during cyst handling and dissection suggested the possibility of a catecholamine-secreting tumour. These were managed effectively with pharmacological agents. Subsequently, histopathology of the specimen revealed a paraganglioma. Vasoactive tumour has to be suspected in every patient undergoing anaesthesia for retroperitoneal cystic lesion.

  18. Femoral nerve dysfunction after retroperitoneal hemorrhage: pathophysiology revealed by computed tomography.

    Science.gov (United States)

    Reinstein, L; Alevizatos, A C; Twardzik, F G; DeMarco, S J

    1984-01-01

    In three patients receiving anticoagulation therapy who developed retroperitoneal hemorrhage computed tomography (CT) clearly localized the resulting hematoma in each case. Three distinct syndromes are described. A hemorrhage within the iliacus muscle resulted in femoral nerve dysfunction. A large hemorrhage within the iliacus muscle which extended into the psoas muscle produced both femoral and obturator nerve dysfunction. A retroperitoneal hemorrhage extrinsic to both the iliacus and psoas muscles did not produce peripheral nerve dysfunction. The pathophysiology of peripheral nerve dysfunction in retroperitoneal hemorrhage is reviewed in detail.

  19. Idiopathic retroperitoneal fibrosis causing unilateral ureteral and sigmoid colon obstruction

    Science.gov (United States)

    Yan, Ting; Wang, Yujuan; Liu, Zhijun; Zhang, Xiaolei; Wu, Qian; Xi, Mingrong

    2017-01-01

    Abstract Objective: The present report aimed to present a unique case of idiopathic retroperitoneal fibrosis (RPF) presenting features of unilateral ureteral and sigmoid colon obstruction. RPF is a rare disorder with unclear etiology. Case report: A 43-year-old female had a 10-day history of lower right abdominal and lumbar pain. Gynecological examination, ultrasound, and computed tomography (CT) were all suggestive of right ovarian tumor. An enhanced CT showed right-sided hydronephrosis. The patient was diagnosed as having ovarian cancer. Ten days after hospitalization, a right intraureteral stent with a double-J catheter was inserted. Upon exploring the abdomen, unyielding RPF was encountered. A partial sigmoidectomy and colostomy were performed. Postoperative pathological results suggested idiopathic RPF. She received steroid treatments. Conclusion: RPF is a rare disease that can be misdiagnosed. Our understanding about its presentation has to be improved and it should be considered as a differential diagnosis for patients presenting with abdominal diseases. PMID:28207528

  20. Transformação carcinomatosa de endometriose retroperitoneal

    Directory of Open Access Journals (Sweden)

    João Augusto dos Santos Martines

    2012-08-01

    Full Text Available Os autores apresentam o caso de uma paciente de 45 anos de idade, portadora de dor abdominal crônica, sendo evidenciada massa retroperitoneal cuja biopsia por agulha revelou tratar-se de endometriose. Submetida a ooforectomia bilateral. A paciente evoluiu, durante 4 anos, sem controle do quadro álgico, com perda de peso e aumento das dimensões da massa tumoral. A exérese cirúrgica total da massa tumoral não foi possível devido às aderências às estruturas vasculares. O pós-operatóriofoi complicado com quadro séptico evoluindo a óbito. O resultado anatomopatológico fornecido pela autópsia foi de adenocarcinoma de padrão endometrióide.

  1. Retroperitoneal extra-adrenal paraganglioma: a rare but important diagnosis.

    LENUS (Irish Health Repository)

    Ahmad, S

    2012-01-31

    BACKGROUND: Extra-adrenal paragangliomas of the retroperitonium are infrequently diagnosed. Their malignant behaviour cannot be predicted on initial clinical and histological assessment. These tumours have higher propensity for subsequent metastasis compared with pargangliomas at other sites. AIM: We aim to describe a case report of an incidental finding of left retroperitoneal paraganglioma in a young man who presented with right flank pain. We also aim to emphasize the importance of diagnosis and the malignant potential of these tumours. METHOD: Patient\\'s clinical notes, operative findings, imaging studies and laboratory investigations including histology results were reviewed. A literature search was done to look into the incidence, presentation, follow-up plan and treatment options for these tumours. CONCLUSION: Surgical resection is the only available curative option for extra-adrenal paragangliomas. Metastasis is observed years after surgery, hence long-term follow-up is required.

  2. Postoperative External Beam Radiotherapy for Retroperitoneal Soft Tissue Sarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Na Yong; Kim, Il Han; Choi, Jin Hwa; Park, Charn Il [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2008-09-15

    To evaluate the clinical outcomes and prognostic factors in retroperitoneal soft tissue sarcomas treated by postoperative radiotherapy. The records of 23 patients with retroperitoneal soft tissue sarcomas, who underwent postoperative radiotherapy between 1985 and 2003, were analyzed. The median follow-up period was 77 months (range, 8-240 months). A total of 21 patients presented with primary disease, and two patients presented with recurrent disease. Liposarcomas and leiomyosarcomas represented 78% of the diagnosed tumor cases. Moreover, 17 cases were of high grade (grade 2 or 3). The median tumor size was 13 cm (range, 3-50 cm). Complete excision was achieved in 65% of patients. The median radiation dose was 50.4 Gy (range, 45.0 to 59.4 Gy), with conventional fractionation. The 5-year overall, local recurrence-free, and distant metastasis-free survival rates were 68%, 58%, and 71%, respectively. Eleven patients experienced local recurrence, while 9 patients experienced distant metastasis. The most common site for distant metastasis was the liver. A univariate analysis revealed that adjacent organ invasion and age (>60 years) as the significant risk factors contributing to the prediction of poor overall survival. Moreover, multivariate analyses indicated that adjacent organ invasion remained significantly associated with a higher risk of death. In addition, patient age (>60 years) was the other identified risk factor for local recurrence by univariate and multivariate analyses. Except for one case of grade 3 diarrhea, no patient suffered grade 3 or higher complications. Our results were comparable to previous reports in that adjacent organ invasion and patient age (>60 years) were significant predictors of poor survival and tumor recurrence, respectively.

  3. Laparoscopic resection of a residual retroperitoneal tumor mass of nonseminomatous testicular germ cell tumors

    NARCIS (Netherlands)

    Ozturk, Cigdem; van Ginkel, Robert J.; Krol, Ruby M.; Gietema, Jourik A.; Hofker, Hendrik S.; Hoekstra, Harald J.

    Resection of a residual retroperitoneal tumor mass (RRRTM) is standard procedure after combination chemotherapy for metastatic nonseminomatous testicular germ cell tumors (NSTGCT). At the University Medical Center Groningen, 79 consecutive patients with disseminated NSTGCT were treated with

  4. Diffuse abdominal pain, nausea and vomiting due to retroperitoneal fibrosis: a rare but often missed diagnosis.

    Science.gov (United States)

    Netzer, P; Binek, J; Hammer, B

    1997-10-01

    Retroperitoneal fibrosis is a rare chronic inflammatory disease usually involving the ureters, retroperitoneal vessels and nerves; however, any intestinal organ may also be involved. In recent years, a few successful immunosuppressive treatments of this disease have been described and surgery can, therefore, probably be avoided in most cases. We report here on a case of secondary retroperitoneal fibrosis with compression and midline deviation of the ureters and impaired renal function which was probably caused by ergotamine abuse because of migraine. The patient complained of diffuse abdominal pain, nausea and vomiting. After immunosuppressive treatment with azathioprine and prednisone for a year, we observed a complete resolution of the retroperitoneal mass on computed tomography, although renal function remained impaired. Eleven months after the cessation of treatment, the patient had not relapsed.

  5. Spontaneous Retroperitoneal Hemorrhage in a Mediastinal Tumor in a Patient With Polymyositis: A Case Report

    Directory of Open Access Journals (Sweden)

    Tzu-Jung Fang

    2008-08-01

    Full Text Available Spontaneous retroperitoneal hemorrhage is a lethal cause of acute abdomen that is most frequently related to drugs, coagulopathy and intra-abdominal tumors. In patients with polymyositis and dermatomyositis, acute abdomen is attributed to intestinal vasculitis causing ischemia, ulceration or perforation. Spontaneous retroperitoneal hemorrhage, however, has rarely been reported in patients with polymyositis. We report the case of a 65-year-old woman with newly diagnosed polymyositis and suspected thymoma who suffered from spontaneous retroperitoneal hemorrhage. She experienced two massive retroperitoneal hemorrhage episodes within 24 hours, which resulted in shock and required emergent angiographic embolization. There was no evidence of tumor, vasculitis or aneurysm from abdominal angiography and computed tomography.

  6. Organ Preservation in a Case of Retroperitoneal Ganglioneuroma: A Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Santosh Kumar

    2016-01-01

    Full Text Available The retroperitoneum is a closed space harbouring vital organs including the great vessels, kidneys and adrenal glands, ureters, and the ascending and descending colon. Surgical management of retroperitoneal pathologies may need multiorgan resection in order to achieve complete surgical resection while preservation of surrounding organs should be attempted, especially in case of benign tumors. We present a case of 15-year-old girl with an 11 × 6 × 5 cm retroperitoneal ganglioneuroma displacing the right kidney, renal vein, and ureter and abutting the IVC which was excised in toto preserving the right kidney and ureter with careful dissection around the great vessels. We also attempt to review the various surgical options available while dealing with these benign retroperitoneal tumors which are often detected incidentally and usually surround important retroperitoneal organs and vessels.

  7. CT and MRI features and pathological charateristics of retroperitoneal localized Castleman’s disease

    Institute of Scientific and Technical Information of China (English)

    王春

    2014-01-01

    Objective To analyze the CT and MRI findings and pathological characteristics of retroperitoneal localized Castleman’s disease and discuss the diagnostic and differential value of CT and MRI.Methods CT,MRI and clinical data of retroperitoneal localized Castleman’s disease,proved by surgery and pathology,13 patients were reviewed.Among them,all the 13 cases received CT,and4 cases received MRI examination.Results Among the

  8. Pigmented villonodular synovitis of the hip presenting as a retroperitoneal mass

    Energy Technology Data Exchange (ETDEWEB)

    Kallas, K.M. [Center for Diagnostic Imaging, Waite Park, MN (United States); Vaughan, L. [Div. of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA (United States); Haghighi, P. [Dept. of Pathology, University of California, San Diego, CA (United States); Veterans Affairs Medical Center, San Diego, CA (United States); Resnick, D. [Veterans Affairs Medical Center, San Diego, CA (United States); Department of Radiology, University of California, San Diego, California (United States)

    2001-08-01

    We present an unusual case of diffuse pigmented villonodular synovitis (PVNS) of the hip presenting as a large retroperitoneal mass in an asymptomatic 39-year-old man. Initial imaging characteristics and findings on core needle biopsy suggested soft tissue sarcoma. However, incisional biopsy showed findings of PVNS. The patient underwent radical synovectomy and total joint replacement, with no change in the large retroperitoneal component after 15 months of follow-up. (orig.)

  9. Extra-Gastrointestinal Stromal Tumor of Retroperitoneal Origin: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Seung Joon; Kim, Hyung Sik; Park, Yul Ri; Choi, Hye Young [Dept. of Radiology, Gachon Medical Center, Gachon University of Medicine and Science, Incheon (Korea, Republic of)

    2012-03-15

    Extragastrointestinal stromal tumors (EGIST) are relatively rare, and cases originating in the retroperitoneum even rarer. We report a 60-year-old woman who presented with an EGIST originating in the retroperitoneum. Computed tomography results demonstrated a soft tissue mass on the right side of the retroperitoneum. The tumor abutted the duodenum, head of the pancreas, and right kidney. The mass was surgically proven to be a retroperitoneal tumor and histopathologically proven to be a retroperitoneal EGIST.

  10. A Case of Advanced Unicentric Retroperitoneal Castleman's Disease, Associated With Psoriasis

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Mohagheghi

    2017-05-01

    Full Text Available We present here a 32-year-old male with advanced lately diagnosed, right sided retroperitoneal mass, which had been already treated due to progressive muco-cutaneous lesions clinically consistent with psoriasis, during recent four years. The advanced retroperitoneal mass resected surgically and reported as hyaline-vascular castleman disease with a dense focus of coarse calcification, on histopathology. Association of psoriasis and castlman disease is discussed in this case report. 

  11. IVC filter limb penetration of the caval wall during retroperitoneal surgery/lymph node dissection.

    LENUS (Irish Health Repository)

    Goh, Gerard S

    2012-12-01

    Optional inferior vena cava (IVC) filters are being increasingly used for protection against pulmonary embolism in patients with deep vein thrombosis where anticoagulation is contraindicated. We describe two cases during retroperitoneal surgery where the IVC filters were found to have perforated the cava wall and were subsequently removed intra-operatively. Cava wall penetration by filter limbs poses a significant danger during retroperitoneal lymph node dissection and filters should be removed preoperatively.

  12. Extra-pleuric coaxial system for CT-guided percutaneous fine-needle aspiration biopsy (FNAB) of small (≤20 mm) lung nodules: a novel technique using multiplanar reconstruction (MPR) images.

    Science.gov (United States)

    Capasso, Raffaella; Nizzoli, Rita; Tiseo, Marcello; Pedrazzi, Giuseppe; Brunese, Luca; Rotondo, Antonio; De Filippo, Massimo

    2017-02-01

    The aim of the study is to present the diagnostic feasibility, usefulness, and safety of a novel technique for coaxial CT-guided fine-needle aspiration biopsy of small (≤20 mm in diameter) lung nodules. A 18-gauge (G) (1.2 × 40 mm) needle is inserted through the skin in the depth of the thoracic wall tissues remaining outside the pleura. Its positioning is planned and adjusted using multiplanar reconstruction (MPR) images along the 18-G guide needle axis tracing a reference outline extended from the needle tip to the target nodule. When the insertion of the 18-G extra-pleuric needle (EPN) proves to be precise, a 22-G Chiba needle is then passed through the outer 18-G EPN until it reaches the thoracic lesion for the sampling procedure. Patient population included 153 males and 94 females, with a mean age of 61.3 ± 21.6 years. Mean nodule diameter was 14.1 ± 2.2 mm. The lesion depth from pleural plane ranged from 0 mm to 127 mm. An average of 1.29 aspirates were performed per lesion. The most common complication was pneumothorax in 27 cases; there were no cases of PNX requiring chest tube insertion. Intrapulmonary bleeding along the needle track was observed in 32 patients. Exploiting the advantage of MPR images, our novel technique of extra-pleuric coaxial system with a 18-G EPN allows the operator to multiple samplings of small (≤20 mm) target lesions in various locations with a thinner (22-G Chiba) needle, thus reducing the degree of pleural, parenchymal, or adjacent organs damage.

  13. Retroperitoneal Necrotizing Fasciitis Masquerading as Perianal Abscess – Rare and Perilous

    Science.gov (United States)

    Amaranathan, Anandhi; Barathi, Deepak; Shankar, Gomathi; Sistla, Sarath Chandra

    2017-01-01

    Necrotizing fasciitis is one of the uncommon presentations of a rapidly spreading subcutaneous tissue infection. Although the actual cause is unclear in many cases, most of them are due to the rapid proliferation of microorganisms. Retroperitoneal necrotizing fasciitis is extremely rare. It is a potentially lethal infection that requires immediate and aggressive surgical care. Early diagnosis is the key to a better prognosis. The possibility of retroperitoneal necrotizing fasciitis should be suspected in patients with symptoms of sepsis that are disproportionate to clinical findings. The rapid deterioration of the patient also gives a clue towards the diagnosis. We report a 35-year-old male with perianal abscess who had been progressed to retroperitoneal necrotizing fasciitis. The patient was managed successfully with aggressive debridement and drainage after laparotomy. Appropriate antibiotics were used to combat the sepsis. The patient recovered well at follow up, three months after discharge. Another patient, a 45-year-old male with a retroperitoneal abscess, progressed to retroperitoneal necrotizing fasciitis, and extra peritoneal drainage and debridement was done. Antibiotics depending upon the culture and sensitivity were used to control sepsis. But the patient succumbed to death 45 days after surgery due to uncontrolled sepsis. Necrotizing fasciitis of any anatomical site needs aggressive surgical care with early intervention. But retroperitoneal necrotizing fasciitis needs an extra effort for diagnosis. After diagnosis, it needs timely surgical intervention and appropriate antibiotic therapy for the recovery of the patients. PMID:28229030

  14. Does negative retroperitoneal CT in adolescents with paratesticular rhabdomyosarcoma preclude the need of retroperitoneal lymph node dissection?; A tomografia de retroperitoneo normal em adolescentes com rabdomiossarcoma paratesticular afasta necessidade de linfadenectomia?

    Energy Technology Data Exchange (ETDEWEB)

    Damazio, Eulalio [Hospital Lucano, Teresina (PI) (Brazil); Caran, Eliana [Instituto de Oncologia Pediatrica, Universidade Federal de Sao Paulo - UNIFESP, Sao Paulo, SP (Brazil); Ortiz, Valdemar; Macedo Junior, Antonio, E-mail: macedo.dcir@epm.br [Departamento de Urologia, Universidade Federal de Sao Paulo - UNIFESP, Sao Paulo, SP (Brazil)

    2011-07-01

    We report on a 16-year-old male with paratesticular rhabdomyosarcoma who underwent retroperitoneal lymph node dissection due to a stage I tumor (normal retroperitoneal computed tomography). The surgical finding was three enlarged nodes, positive for metastatic disease. Patient was referred to adjuvant chemotherapy. This case suggests that the Intergroup Rhabdomyosarcoma Study Group IV protocol is subject to questions regarding adolescents with paratesticular rhabdomyosarcoma, and that negative retroperitoneal CT does not preclude the need of lymph node dissection. (author)

  15. Three cases of retroperitoneal schwannoma diagnosed by EUS-FNA

    Institute of Scientific and Technical Information of China (English)

    Taiki Kudo; Hiroshi Kawakami; Masaki Kuwatani; Nobuyuki Ehira; Hiroaki Yamato; Kazunori Eto; Kanako Kubota; Masahiro Asaka

    2011-01-01

    Schwannomas are peripheral nerve tumors that are typically solitary and benign. Their diagnosis is largely based on surgically resected specimens. Recently, a number of case reports have indicated that retroperitoneal schwannomas could be diagnosed with endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)We report the diagnosis of three cases of schwannoma using EUS-FNA. Subjects weree two males and one fe-twomale,ages 22, 40, and 46 years, respectively, all of whom were symptom-free. Imaging findings showed well-circumscribed round tumors.However, as the tumors could not be diagnosed using these findings alone, EUS-FNA was performed. Hematoxylin-eosin staining of the resulting tissue fragments revealed bland spindle cells with nuclear palisading. There was no disparity in nuclear sizes.Immunostaining revealed S-100 protein positivity and all cases were diagnosed as schwannomas. Ki-67 indexes were 3%-15%,2%-3%,and 3%, respectively. No case showed any signs of malignancy.As most schwannomas are benign tumors and seldom become malignant, we observed these patients without therapy. All tumors demonstrated no enlargement and no change in characteristics.Schwannomasa are almost always benign and can be observed following diagnosis by EUS-FNA.

  16. Rare case of deep pelvic retroperitoneal mature cystic teratoma

    Directory of Open Access Journals (Sweden)

    Shalini Mahana Valecha

    2013-06-01

    Full Text Available Mature cystic retroperitoneal teratomas are typically rare childhood tumours. Less than 20% of these occur in adults more than 30 yrs of age. Our adult patient presented with such a tumour, which had grown to a disproportionately large extent. It was deeply embedded in the true pelvis extending laterally to the pelvic wall and inferiorly till the ischiorectal fossa and was adherent to the surrounding structures displacing all. A provisional diagnosis was made after MRI scan and patient was posted for exploratory laparotomy. After extensive blunt and sharp dissection, the cyst wall could be separated from the surrounding structures and successfully excised. Histopathology confirmed the diagnosis. Being such a rare tumour, it is essential to have a high degree of suspicion in such cases that can be supported by advanced imaging modality. Early diagnosis and complete surgical removal are the mainstay of management that provide an excellent prognosis for such patients. [Int J Reprod Contracept Obstet Gynecol 2013; 2(3.000: 460-462

  17. Surgical management of 143 patients with adult primary retroperitoneal tumor

    Institute of Scientific and Technical Information of China (English)

    Yuan-Hong Xu; Ke-Jian Guo; Ren-Xuan Guo; Chun-Lin Ge; Yu-Lin Tian; San-Guang He

    2007-01-01

    AIM: To analyze the surgical management of adult primary retroperitoneal tumors (APRT) and the factors influencing the outcome after operation.METHODS: Data of 143 cases of APRT from 1990 to 2003 in the First Affiliated Hospital of China Medical University were evaluated retrospectively.RESULTS: A total of 143 cases of APRT were treated surgically. Among them, 122 (85.3%) underwent complete resection, 16 (11.2%) incomplete resection,and 3 (3%) surgical biopsies. Twenty-nine (20.2%)underwent tumor resection plus multiple organ resections. Ninety-five malignant cases were followed up for 1 mo to 5 years. The 1-year, 3-year, and 5-year survival rates of the patients subject to complete resection was 94.9%, 76.6% and 34.3% and that of patients with incomplete resection was 80.4%, 6.7%,and 0%, respectively (P < 0.001). The Cox multi-various regression analysis showed the completeness of tumor,sex and histological type were associated closely with local recurrence.CONCLUSION: Sufficient preoperative preparation and complete tumor resection play important roles in reducing recurrence and improving survival.

  18. [A case of seronegative spondylarthropathy with iritis and retroperitoneal fibrosis].

    Science.gov (United States)

    Takahashi, M; Ishikawa, A; Kondo, H

    1999-02-01

    In 1985 a 41-year old male visited a local hospital because of congestion in the bulbar conjunctiva, which was diagnosed as iritis. In August 1990, right coxalgia and arthralgia of metatarsophalangeal joints appeared, with recurrence of iritis. In October, stiffness in the hands and arthralgia of proximal interphalangeal joints also started. In July 1991, the right coxalgia worsened, resulting in walking difficulty. He was admitted to the Kitasato University Hospital. He presented with bilateral iritis, polyarthritis with limited ranges of motion and sacroilitis. The Schober's test was positive at 3 cm. Serological tests for rheumatoid factor and HLA-B 27 were negative. Abdominal computer tomographic scan revealed low density lesion around the aorta. PSL 10 mg was initiated, and iritis and arthritis remitted. Progression of the periaortic lesion was not observed during the subsequent 5 years. In this case, iritis preceded limited ranges of motion in the vertebrae and sacroilitis. From these findings, seronegative spondylarthropathy with peripheral arthritis was diagnosed. The periaortic lesion seen in this case probably corresponds to chronic periaortitis recently reported as a subset of idiopathic retroperitoneal fibrosis. The two lesions observed in the present case may be interpreted as caused by inflammation of the connective tissue initially either at the vertebrae or around the aorta, which had advanced to involve the other lesion.

  19. Giant Primary Mature Retroperitoneal Teratomain in Adult Male Patient

    Directory of Open Access Journals (Sweden)

    R. Ebrahimian

    2015-07-01

    Full Text Available Introduction: Teratomas are congenital tumors consisting of derivatives from the ectoderm, endoderm and mesoderm germ cell layers. A teratoma is considered to be a non-seminomatous germ cell tumor and is typically located in either the sacrococcygeal region or in the gonads. Giant retroperitoneal teratomas in adults are even rarer, with only a few cases previously described in the literature. Case report: A 35-year-old male patient with severe nausea and vomiting was taken to the emergency ward of Hamadan Be’sat Hospital. He had not been feeling well, and had suffering from abdominal pain for a month. A physical examination showed some concretion in the right side of his abdomen. A CT scan of his abdomen and pelvis with IV and oral contrast re-vealed that the concretion was formed by aggregates of solid, cystic, and calcareous compo-nents. It compressed stomach and caused the rotation of the stomach around its longitudinal axis. Conclusion: Following the diagnosis, we performed a laparotomy and respected a concretion with dimension 20?25?22cm. Interestingly, we found out all mature tissues within the con-cretion in the pathology examination of an adequate sample (such as trachea, bone, GI lu-men…. (Sci J Hamadan Univ Med Sci 2015; 22 (2: 165-169

  20. Large solitary retroperitoneal echinococcal cyst: A rare case report

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Echinococcal disease remains a problem within some endemic areas. Echinococcal cysts usually involve the liver and lungs,but any other organ can potentially be involved.Extrahepatic localization is reported in14%-19% of all cases of abdominal hydatid disease. We report the case of a large echinococcal cyst localized in the lower pelvis. A 28-year-old woman was admitted to a surgical ward with lower abdominal pain and discomfort lasting for a month. Ultrasonography and computed tomography scanning revealed a large retroperitoneal cystic mass (9 cm×4 cm) in contact with the left ovary and leftureter. There were no cysts in any other location.Serological tests were positive for Echinococcus. The patient was operated on and the entire cyst was excised intact. Histopathological results confirmed the diagnosis of chinococcosis.ntihelminthics were administered postoperatively and the patient was discharged after 6 d,and is now being closely followed up. Total cystectomy when possible represents the treatment of choice for large extrahepatic echinococcal cysts.

  1. Invasive lobular carcinoma of the breast presenting as retroperitoneal fibrosis: a case report

    Directory of Open Access Journals (Sweden)

    Al-Haddad Sahar

    2010-06-01

    Full Text Available Abstract Introduction Invasive lobular carcinoma of the breast represents approximately 6.3% of mammary malignancies. Distant metastasis of invasive lobular carcinoma to the peritoneum or retroperitoneum has been reported fairly frequently. Case presentation We report the case of a 59-year-old Caucasian-Canadian woman with invasive lobular carcinoma of the breast presenting with retroperitoneal fibrosis and bilateral ureteral obstruction. Intra-operative pathology consultation did not reveal malignancy. The diagnosis, however, was confirmed on permanent sections by histological appearance in addition to immunohistochemistry. To the best of our knowledge, this is the first reported case of invasive lobular carcinoma of the breast presenting with retroperitoneal fibrosis. Conclusion In a case of unexplained ureteric obstruction and retroperitoneal fibrosis, more comprehensive physical examination and additional ancillary studies may be warranted to rule out malignancy as an underlying etiology. This case also emphasizes that intra-operative frozen section consultation cannot always be fully relied upon to exclude a malignancy as the etiology of retroperitoneal fibrosis. Moreover, in permanent histopathology sections, immunohistochemistry testing can be of value to rule out metastatic disease where the morphology is not salient. There is a need for a thorough physical examination of patients with retroperitoneal fibrosis, including the breast and gynecological organs.

  2. Effect of Cross-Sex Hormonal Replacement on Antioxidant Enzymes in Rat Retroperitoneal Fat Adipocytes

    Science.gov (United States)

    Velázquez Espejel, Rodrigo; Cabrera-Orefice, Alfredo; Uribe-Carvajal, Salvador; Pavón, Natalia

    2016-01-01

    We report the effect of cross-sex hormonal replacement on antioxidant enzymes from rat retroperitoneal fat adipocytes. Eight rats of each gender were assigned to each of the following groups: control groups were intact female or male (F and M, resp.). Experimental groups were ovariectomized F (OvxF), castrated M (CasM), OvxF plus testosterone (OvxF + T), and CasM plus estradiol (CasM + E2) groups. After sacrifice, retroperitoneal fat was dissected and processed for histology. Adipocytes were isolated and the following enzymatic activities were determined: Cu-Zn superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione-S-transferase (GST), and glutathione reductase (GR). Also, glutathione (GSH) and lipid peroxidation (LPO) were measured. In OvxF, retroperitoneal fat increased and adipocytes were enlarged, while in CasM rats a decrease in retroperitoneal fat and small adipocytes are observed. The cross-sex hormonal replacement in F rats was associated with larger adipocytes and a further decreased activity of Cu-Zn SOD, CAT, GPx, GST, GR, and GSH, in addition to an increase in LPO. CasM + E2 exhibited the opposite effects showing further activation antioxidant enzymes and decreases in LPO. In conclusion, E2 deficiency favors an increase in retroperitoneal fat and large adipocytes. Cross-sex hormonal replacement in F rats aggravates the condition by inhibiting antioxidant enzymes. PMID:27630756

  3. A case of testicular tumor with uncommon clinical course: testicular lesion that was initially not palpable led to a wrong diagnosis of huge retroperitoneal hematoma due to trauma

    OpenAIRE

    沖, 守; 由井, 康雄; 吉田, 和弘; 秋元, 成太

    1984-01-01

    A case of testicular tumor with uncommon clinical course is presented. Although the patient underwent abdominal trauma and was diagnosed as having retroperitoneal hematoma, a retroperitoneal bulky tumor was revealed at surgery. After that left orchiectomy was performed because the testicular swelling gradually developed. The retroperitoneal tumor was confirmed to be a secondary lesion metastasized from left testicular carcinoma.

  4. Primary retroperitoneal transitional cell carcinoma presenting as a dumb-bell tumour.

    Science.gov (United States)

    Basu, S; Ansari, M; Gupta, S; Kumar, A

    2009-11-01

    We report a retroperitoneal transitional cell carcinoma arising from the primitive urogenital remnants of a 56-year-old married Indian woman. She presented with a huge cystic mass in the hypogastrium and right iliac fossa, which extended into the right thigh as a massive dumb-bell tumour. On exploration, it was found not to be arising from any known retroperitoneal structure. The mass was excised, and the histopathology confirmed transitional cell carcinoma with positive margins. Though she received postoperative chemotherapy with cyclophosphamide, adriamycin and cisplatin, she developed extensive local recurrence and hepatic secondaries, and succumbed to the disease after ten months of follow-up. We highlight the rarity of the disease, its atypical presentation as a cystic dumb-bell lump, its diagnostic challenges and aggressive behaviour, and review the literature on primary retroperitoneal transitional cell carcinomas.

  5. Massive Retroperitoneal Hemorrhage as an Initial Presentation of a Rare and Aggressive Form of Multiple Myeloma

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    Aydah Alawadhi

    2016-01-01

    Full Text Available Multiple myeloma, a plasma cell neoplasm, presents most commonly with anemia, hypercalcemia, renal failure, and bone pain. Only few cases of clinical aggressive presentation associated with bleeding were reported in the medical literature. The reported cases included gastrointestinal bleeding and cardiac tamponade. Spontaneous retroperitoneal haemorrhage as initial presentation has not been so far reported. We hereby report a case of a 64-year-old female who was found to have catastrophic hemorrhage in the retroperitoneal region that extended into intrathecal space causing cord compression. The case posed a significant diagnostic and management dilemma. This case emphasizes the need to think broadly and include multiple myeloma in the diagnosis of unexplained massive retroperitoneal bleeding.

  6. Surgical anatomy of the retroperitoneal spaces--part I: embryogenesis and anatomy.

    Science.gov (United States)

    Mirilas, Petros; Skandalakis, John E

    2009-11-01

    Embryologically, the retroperitoneal (extraperitoneal) connective tissue includes three strata, which respectively form the internal fascia lining of the body wall, the renal fascia, and the covering of the gastrointestinal viscera. All organs, vessels, and nerves, that lie on the posterior abdominal wall, along with their tissues and surrounding connective and fascial planes, are collectively referred to as the retroperitoneum. The retroperitoneal space is the area of the posterior abdominal wall that is located between the parietal peritoneum and the fascia. Within the greater retroperitoneal space, there are also several small spaces, or subcompartments. Loose connective tissue and fat surround the anatomic entities, and, to a variable degree, occupy the subcompartments. The multilaminar thoracolumbar (lumbodorsal) fascia begins at the occipital area and terminates at the sacrum.

  7. Retroperitoneal primitive neuroectodermal tumor in an adult: A rare case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Kavita Mardi

    2016-01-01

    Full Text Available Primitive neuroectodermal tumor (PNET and Ewing's sarcoma (EWS are small round cell tumors occurring mainly in children and adolescents. Their occurrence in adults is rare. The abdominal cavity and retroperitoneal PNET/EWS are also relatively rare, grow rapidly in size, compressing surrounding organs/large vessels, and make surgical resection difficult. We report one such rare occurrence of a retroperitoneal PNET in 41-year-old male who presented with abdominal pain and constipation. Contrast enhanced computed tomography abdomen showed large lobulated necrotic hypodense enhancing lesion extending from epigastrium to hypogastrium and involving entire abdomen. Excision of retroperitoneal mass with omentectomy was done. Microscopic examination revealed a malignant small round cell tumor with homer wright rosettes and the tumor cells were positive for CD99.

  8. Retroperitoneal liposarcomas: a representative literature review occasioned by a rare case of laterelapse abdominal liposarcoma.

    Science.gov (United States)

    Pisani, Michela; Al-Buheissi, Salah; Whittlestone, Tim

    2016-05-24

    Soft tissue sarcomas (STS) are rare and heterogeneous tumours representing approximately 0.7%-1% of all adult tumours. In the adults and among the retroperitoneal sarcomas (RPS), Liposarcoma (LS) is the most common variant accounting for 12% -20% of all sarcomas and up to 45% of sarcomas at retroperitoneal localization. A rare case of LS relapsed after 15 years is giving the occasion to review the published literature and emphasise the followings concepts: 1) Despite extensive surgery remains the mainstay of treatment for localized STS at present, anatomical complexity and occult localization result in local recurrence in the majority of patients; 2) The role of imaging and tumour markers is still limited; 3) Indefinite prolonged surveillance is a key point of treatment; 4) Referral to tertiary centres with dedicated Retroperitonal Surgeons and Oncology expertise is mandatory.

  9. Primary retroperitoneal teratomas in children: A single institution experience

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    Aggarwal S

    2010-01-01

    Full Text Available Objective: This study aims to highlight the clinical features, investigations and treatment outcome of retroperitoneal teratomas (RPT in children. Materials and Methods: A total of eight patients (six males and two females, age range between 6 months−10 years of RPT admitted in the department of Paediatric Surgery, PGIMS, Rohtak, between 1996−2008, were studied. The patients were investigated with hematology, x-ray, ultrasound, and computerised tomography (CT of abdomen and serum alpha-fetoprotein levels in pre and postoperative period. All patients underwent complete surgical resection. In one patient, the tumour had malignant component (yolk sac and was given postoperative chemotherapy. Postoperative follow-up included serum alpha-fetoprotein in addition to clinical examination and radiological assessment to detect recurrences. Results: The tumours were located on both sides in almost equal proportion (four on right, three on left, and one bilateral]. All tumours could be excised completely preserving the kidneys in all patients. But in one patient injury to inferior vena cava (IVC occurred which was repaired successfully. Majority (7 out of 8 were histological benign, and in one yolk sac tumour was malignant component which needed chemotherapy. All children were on follow-up and one patient with malignancy lost to follow-up after three cycles of chemotherapy. In rest there was no tumour recurrence. Conclusion: RPT are rare paediatric neoplasms. As majority are benign, a complete excision preserving the kidneys, is usually curative. Serum alpha-fetoprotein is a reliable method of assessing recurrence. Malignancy in the tumour may warrant further chemotherapy.

  10. Retroperitoneal Lymph Node Dissection as First-Line Treatment of Node-Positive Seminoma.

    Science.gov (United States)

    Hu, Brian; Shah, Swar; Shojaei, Sepehr; Daneshmand, Siamak

    2015-08-01

    The long-term morbidity associated with treating advanced seminoma can be significant. Retroperitoneal lymph node dissection (RPLND) has established oncologic efficacy in treating germ cell tumors with minimal long-term toxicity. We describe our experience with RPLND as a front-line treatment of lymph node-positive seminoma. We reviewed our institutional review board-approved testicular cancer database to find the patients with pure seminoma and isolated retroperitoneal lymph node disease who had undergone primary RPLND. The clinical and pathologic variables were obtained. The follow-up data were used to determine recurrence and death. Four patients with a mean age of 37 years were identified. All patients had normal tumor markers and retroperitoneal lymphadenopathy measuring 1.1, 1.5, 1.8, and 5.5 cm before RPLND. Of the 4 patients, 3 had had seminoma diagnosed at orchiectomy and 1 (with a 5.5-cm retroperitoneal lymphadenopathy and a burned out primary testicular mass) had had seminoma diagnosed at RPLND after 2 nondiagnostic retroperitoneal biopsies. All patients had undergone nerve-sparing, template, extraperitoneal RPLND and were discharged home after 3 days. An average of 3 positive lymph nodes were found. Of the 4 patients, 3 had pathologic stage IIA and 1 stage IIB disease, with no patient undergoing adjuvant therapy. At a mean follow-up period of 25 months, no patient had experienced disease recurrence, and none had died. All patients maintained antegrade ejaculation, and no long-term complications had developed. Our small series has demonstrated encouraging oncologic efficacy for RPLND as a primary treatment of retroperitoneal lymph node-positive seminoma. A multi-institutional phase II trial of RPLND for stage IIA seminoma is being developed. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Effect of retroperitoneal lymphadenectomy on prognosis of patients with epithelial ovarian cancer

    Institute of Scientific and Technical Information of China (English)

    王泽华; 熊宙芳; 王世宣

    2003-01-01

    Objective To evaluate prognostic factors which have an influence on overall survival and to assess the rational application of retroperitoneal lymphadenectomy in patients with epithelial ovarian cancer. Methods The data of 131 patients treated between January 1990 and December 1998 in Union Hospital and Tongji Hospital were analyzed retrospectively. Survival was calculated using the Kaplan-Meier method and comparisons were performed using Log-rank test. Independent prognostic factors were identified by the Cox proportional hazards regression model. Results Univariate analysis showed that age, general conditions, menopausal status, stage, pathological types, location of the tumor, residual tumor and retroperitoneal lymphadenectomy were prognostic factors. Multivariate analysis showed that age, stage, residual tumor, retroperitoneal lymphadenectomy and the number of courses of chemotherapy were the most important prognostic factors. The survival rate could not be improved through retroperitoneal lymphadenectomy in the patients in early stage, advanced stage with residual tumor >2 cm or those with mucinous adenocarcinoma (P>0.05). Among patients in advanced stage cancer with a residual tumor ≤2 cm, 5-year survival was 65% and 30% for patients who did and did not undergo lymphadenectomy, respectively (P<0.01). Among patients with serous adenocarcinoma, 5-year survival was 61% and 31% for patients who did and did not undergo lymphadenectomy, respectively (P<0.01). Conclusions The prognosis of the patients with epithelial ovarian cancer may be influenced by age, stage, residual tumor, retroperitoneal lymphadenectomy and the number of courses of chemotherapy. Although retroperitoneal lymphadenectomy could improve the survival rate, it should be carried out selectively.

  12. Retroperitoneal fibrosis: A rare cause of both ureteral and small bowel obstruction

    Institute of Scientific and Technical Information of China (English)

    Faisal Aziz; Srinivasulu Conjeevaram; Than Phan

    2006-01-01

    Retroperitoneal fibrosis (RPF) is a rare condition of unclear etiology. It can cause ureteral obstruction. We present the unique case of a 54 years old female, who initially presented with spontaneous perforation of the cecum. Upon exploring the abdomen, the classical glistening white, unyielding retroperitoneal fibrosis was encountered. A right hemicolectomy was performed.Subsequently, the patient presented with bilateral ureteral obstruction, and later on with small bowel obstruction. Ureteral obstruction was treated with stents,and small bowel obstruction was treated with bypass.To our knowledge no case of idiopathic RPF presenting with features of both bilateral ureteral and small bowel obstruction has been reported in the literature.

  13. Retroperitoneal Malignant Mesenchymoma: A Case of Mesenchymal Mixed Tumor with Osteosarcoma, Leiomyosarcoma, Liposarcoma and Fibrosarcoma

    Science.gov (United States)

    Choi, Jung Eun; Yoo, Won Jong; Chung, Myung Hee; Sung, Mi Sook; Lee, Hae Giu; Park, Il Young; Kim, Jeana

    2002-01-01

    Malignant mesenchymoma is an interesting but very rare tumor in which malignant differentiation has occurred twice or more. We report a case of retroperitoneal malignant mesenchymoma consisting of osteosarcoma, leiomyosarcoma, liposarcoma and fibrosarcoma. Abdominal CT showed a large retroperitoneal mass with two separate and distinct parts, namely an area of prominent calcification and one of clearly enhancing solid components. The mass contained histologically distinct tumorous components with no histologic admixure at the interfaces. The densely calcified nodule corresponded to osteosarcoma, and the non-calcified clearly enhancing nodules to leiomyosarcoma, liposarcoma and fibrosarcoma. PMID:12514345

  14. Primary retroperitoneal mucinous cystadenoma: Report of a case and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Sheng-Lei Yan; HO Lin; Chien-Long Kuo; Hurng-Sheng Wu; Ming-Ho Huang; Yueh-Tsung Lee

    2008-01-01

    Primary retroperitoneal mucinous cystadenomas (RMCs) are very rare and their biological behavior and histogenesis remain speculative.An accurate preoperative diagnosis of these tumors is difficult because no effective diagnostic measures have been established.We describe a 29-year-old woman with abdominal pain and a palpable mass.Computed tomography (CT) of the abdomen revealed a retroperitoneal cystic mass which was resected successfully at laparotomy.Histopathological examination of the resected mass confirmed the diagnosis of RMC.There was no evidence of disease 2 years after surgery.

  15. The management of retroperitoneal lymphadenopathy in spermatocytic seminoma of the testicle.

    Science.gov (United States)

    Sharmeen, Farhana; Rosenthal, Michael H; Howard, Stephanie A H

    2014-01-01

    Spermatocytic seminoma is an extremely rare clinically and pathologically distinct subtype of testicular cancer that infrequently metastasizes and typically yields a good prognosis. While retroperitoneal lymphadenopathy in the typical testicular cancer patient often harbors metastatic disease, in a patient with spermatocytic seminoma this finding should be viewed with suspicion, and pathologic confirmation of metastatic disease is essential. We present a 49-year-old man with spermatocytic seminoma and retroperitoneal and mesenteric lymphadenopathy who was found to have concurrent low-grade lymphoma. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Retroperitoneal neoplasm with perivascular epithelioid cell differentiation:A case report and review of literature

    Institute of Scientific and Technical Information of China (English)

    Min Zhao; Jin Huang; Jin Wang

    2013-01-01

    The retroperitoneal neoplasm with perivascular epithelioid cel differentiation (PEComa) is an extremely rare path-ological entity. In this article, we reported one case of a 45-year-old woman who was admitted to our hospital (The Second People’s Hospital of Hefei, China) for retroperitoneal neoplasm with perivascular epithelioid cel dif erentiation. The B ultra-sonic examination showed echopoor in the region of cavitas pelvis. The histologic characteristics and immunohistochemical phenotype both revealed the neoplasm with perivascular epithelioid cel differentiation.

  17. [Retroperitoneal germinal tumor: extragonadal or burned out phenomenon of testicular primary? Presentation of a clinical case].

    Science.gov (United States)

    Borrego Hernándo, J; Guinda Sevillano, C; Laguna Pes, M P; Zazo, A; Gimeno, A; Cuesta, R; Amigo, A

    1998-02-01

    Clinical record case of a retroperitoneal seminoma with "burned-out" phenomenon in the testicular primary, in a 38 year old male with no background of interest who consults for a picture of left nephritic colic. The ipsilateral testis study detects a fibrotic area with hyalinosis and hemosiderin deposits, although there are no tumoral debris, compatible with the "burned-out" phenomenon. Management is through surgery plus a chemotherapy protocol. Discussion of the diagnostic algorithm of retroperitoneal tumours and the literature on extragonadal germinal tumours.

  18. Extra adrenal retroperitoneal paraganglioma associated with duplication of inferior vena cava

    Directory of Open Access Journals (Sweden)

    parangama chatterjee

    2008-09-01

    Full Text Available

    Retroperitoneal paragangliomas arise from specialized neural crest cells symmetrically distributed along the aorta in association with the sympathetic chain. If this tissue aggregates in the adrenal medulla pheochromocytoma may arise. When it remains in the paraaortic sites it could develop into extra-adrenal, retroperitoneal paraganglioma. We report a case of extra-adrenal paraganglioma in the renal hilum intimately related to the left side of a double inferior vena cava. To the best of our knowledge such an association has never been described before. The clinical significance of this venous anomaly is reviewed.

  19. MYCOBACTERIUM INTRACELLULARE INFECTION CAUSING A RETROPERITONEAL MASS IN A BINTURONG (ARCTICTIS BINTURONG).

    Science.gov (United States)

    Adamovicz, Laura; Kennedy-Stoskopf, Suzanne; Talley, Ashley; Cullen, John M; Cohen, Eli B; Bizikova, Petra; Grunkemeyer, Vanessa

    2017-06-01

    A 19-yr-old castrated male binturong ( Arctictis binturong ) with a history of recurrent pyogranulomatous panniculitis, lymphangitis, and dermatitis was presented for evaluation of hyporexia and tenesmus. A large caudal abdominal mass was palpated on physical examination. On ultrasound, the mass encircled and obstructed the left ureter, resulting in hydroureter and hydronephrosis. The animal was euthanized, and necropsy revealed a large retroperitoneal pyogranuloma with acid-fast organisms identified in both the mass and the perineal skin. The acid-fast organisms within the retroperitoneal mass were identified as Mycobacterium intracellulare by PCR. This case represents an unusual presentation of M. intracellulare in a novel species.

  20. Laparoscopic and open postchemotherapy retroperitoneal lymph node dissection in patients with advanced testicular cancer – a single center analysis

    Directory of Open Access Journals (Sweden)

    Busch Jonas

    2012-05-01

    Full Text Available Abstract Background The open approach represents the gold standard for postchemotherapy retroperitoneal lymph node dissection (O-PCLND in patients with residual testicular cancer. We analyzed laparoscopic postchemotherapy retroperitoneal lymph node dissection (L-PCLND and O-PCLND at our institution. Methods Patients underwent either L-PCLND (n = 43 or O-PCLND (n = 24. Categorical and continuous variables were compared using the Fisher exact test and Mann–Whitney U test respectively. Overall survival was evaluated with the log-rank test. Results Primary histology was embryonal cell carcinomas (18 patients, pure seminoma (2 cases and mixed NSGCTs (47 patients. According to the IGCCCG patients were categorized into “good”, “intermediate” and “poor prognosis” disease in 55.2%, 14.9% and 20.8%, respectively. Median operative time for L-PCLND was 212 min and 232 min for O-PCLND (p = 0.256. Median postoperative duration of drainage and hospital stay was shorter after L-PCLND (0.0 vs. 3.5 days; p 500 ml was almost equally distributed (8.6% vs. 14.2%: p = 0.076. No significant differences were observed for injuries of major vessels and postoperative complications (p = 0.758; p = 0.370. Tumor recurrence occurred in 8.6% following L-PCLND and in 14.2% following O-PCLND with a mean disease-free survival of 76.6 and 89.2 months, respectively. Overall survival was 83.3 and 95.0 months for L-PCNLD and O-PCLND, respectively (p = 0.447. Conclusions L-PCLND represents a safe surgical option for well selected patients at an experienced center.

  1. Intestinal duplication and retroperitoneal teratoma in child hoof: a case report; Duplicacao intestinal e teratoma retroperitoneal na infancia: relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Atzingen, Augusto Castelli Von; Bazzano, Felix Carlos Ocariz; Tiburzio, Nicolas Biagione; Grande, Rogerio Mendes; Juntolli Netto, Joao Diniz [Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, MG (Brazil). Hospital das Clinicas Samuel Libanio (HCSL)]. E-mail: augvonatzingen@bol.com.br; augvonatzingen@hotmail.com

    2007-07-01

    The authors present a case of intestinal duplication and retroperitoneal teratoma in a 7-year-old patient with evident mass and abdominal pain to explain; that it was submitted to study conventional X-ray, ultrasonography, computed tomography and subsequent exploiting laparotomia. The anatomopathological study verified intestinal duplication and ripe teratoma. In the existent medical literature it was not found any similar case. (author)

  2. [Factors predictive of retroperitoneal lymph node metastasis in endometrial cancer].

    Science.gov (United States)

    Urzal, Cecília; Sousa, Rita; Baltar, Vítor; Correia, Paulo; Cruz, Eugénia; Pereira da Silva, Daniel

    2014-01-01

    Introdução: Tem sido sugerido que o estadiamento completo possa ser omitido com segurança em doentes com carcinoma do endométrio e baixo risco de metástases ganglionares. Os objectivos do nosso trabalho foram a exploração do significado prognóstico de factores patológicos para disseminação ganglionar pélvica e para-aórtica e a validação do algoritmo da Clínica Mayo, de forma a identificar as doentes em que a linfadenectomia possa ser dispensada.Material e Métodos: Efectuámos um estudo retrospectivo incluindo 208 doentes, para a avaliação de variáveis tumorais patológicas e metástases ganglionares. A análise estatística foi realizada através dos testes qui-quadrado, exacto de Fisher e t de Student.Resultados: A invasão miometrial > 50% (p citologia peritoneal positiva (p = 0,03) constituíram preditores significativos de disseminação ganglionar retroperitoneal. A metastizaçãoganglionar pélvica foi preditiva de metastização ganglionar para-aórtica (p < 0,001).Discussão: O algoritmo da Clínica Mayo identificou as doentes sem metástases nos gânglios pélvicos ou para-aórticos com um valor preditivo negativo de 98,4% (61/62). A combinação de invasão miometrial ≤ 50% e ausência de invasão cervical ou linfovascular apresentou um valor preditivo negativo de 98,8% (79/80).Conclusão: Apesar de os critérios da Clínica Mayo predizerem uma probabilidade muito reduzida de metástases ganglionares retroperitoneais, a combinação de invasão miometrial ≤ 50% e ausência de invasão cervical ou linfovascular teria evitado a linfadenectomia num número superior de mulheres.

  3. Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

    Energy Technology Data Exchange (ETDEWEB)

    Baldini, Elizabeth H., E-mail: ebaldini@partners.org [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Boston, Massachusetts (United States); Wang, Dian [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); Haas, Rick L.M. [Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Catton, Charles N. [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Indelicato, Daniel J. [Department of Radiation Oncology, University of Florida Medical Center, Jacksonville, Florida (United States); Kirsch, David G. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Roberge, David [Department of Radiation Oncology, Centre Hospitalier de l' Université de Montreal, Montreal, Quebec (Canada); Salerno, Kilian [Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, New York (United States); Deville, Curtiland [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Sidney Kimmel Cancer Center, Washington, DC (United States); Guadagnolo, B. Ashleigh [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); O' Sullivan, Brian [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Petersen, Ivy A. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Le Pechoux, Cecile [Department of Radiotherapy, Institut Gustave-Roussy, Villejuif (France); Abrams, Ross A. [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); DeLaney, Thomas F. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2015-07-01

    Purpose: Evidence for external beam radiation therapy (RT) as part of treatment for retroperitoneal sarcoma (RPS) is limited. Preoperative RT is the subject of a current randomized trial, but the results will not be available for many years. In the meantime, many practitioners use preoperative RT for RPS, and although this approach is used in practice, there are no radiation treatment guidelines. An international expert panel was convened to develop consensus treatment guidelines for preoperative RT for RPS. Methods and Materials: An expert panel of 15 academic radiation oncologists who specialize in the treatment of sarcoma was assembled. A systematic review of reports related to RT for RPS, RT for extremity sarcoma, and RT-related toxicities for organs at risk was performed. Due to the paucity of high-quality published data on the subject of RT for RPS, consensus recommendations were based largely on expert opinion derived from clinical experience and extrapolation of relevant published reports. It is intended that these clinical practice guidelines be updated as pertinent data become available. Results: Treatment guidelines for preoperative RT for RPS are presented. Conclusions: An international panel of radiation oncologists who specialize in sarcoma reached consensus guidelines for preoperative RT for RPS. Many of the recommendations are based on expert opinion because of the absence of higher level evidence and, thus, are best regarded as preliminary. We emphasize that the role of preoperative RT for RPS has not been proven, and we await data from the European Organization for Research and Treatment of Cancer (EORTC) study of preoperative radiotherapy plus surgery versus surgery alone for patients with RPS. Further data are also anticipated pertaining to normal tissue dose constraints, particularly for bowel tolerance. Nonetheless, as we await these data, the guidelines herein can be used to establish treatment uniformity to aid future assessments of efficacy

  4. [Laparoendoscopic single-site retroperitoneal adrenalectomy:a report of 7 cases].

    Science.gov (United States)

    Gao, Yi; Chen, Ming; Xu, Dan-feng; Liu, Yu-shan; Cui, Xin-gang; Yao, Ya-cheng; Ren, Ji-zhong; Che, Jian-ping; Chen, Jie; Wang, Jun-kai; Chen, Lu; Li, Yao; Gan, Si-shun; Ye, Jian-qing

    2011-07-12

    To summarize our preliminary clinical experiences of laparoendoscopic single-site (LESS) retroperitoneal adrenalectomy. Since October 2009 to January 2011, the investigators have performed LESS retroperitoneal adrenalectomy for 7 patients with adrenal tumors. A waist axillary midline incision of around 2 - 3 cm was made and a single incision for inserting a homemade port. Cambridge endo flexible laparoscopic instrument and other common laparoscopic accessories were used during the surgical procedures. LESS retroperitoneal adrenalectomies were technically successful in 6 cases with no extra skin incisions, no conversion into an open procedure or standard laparoscopy. Conversion to standard laparoscopy (3 ports) was inevitable in one case. The reason for conversion was due to tumor size (6 cm). No perioperative complication occurred. The mean operative duration was 139 min (95 - 200 min), the mean volume of blood loss 96 ml (30 - 350 ml) and the mean hospital stay 5 d (3 - 8 d). LESS retroperitoneal adrenalectomy is technically feasible and safe for the treatment of small adrenal tumors.

  5. Primary retroperitoneal mucinous tumor of low malignant potential in a Persian woman.

    Directory of Open Access Journals (Sweden)

    Hayedeh Haeri

    2014-09-01

    Full Text Available Primary retroperitoneal mucinous tumor (PRMT of low malignant potential (border line is an uncommon neoplasm with fewer than 50 reported cases. Uncertain diagnostic imaging results make diagnosis of its origin difficult, preoperatively. Later treatment planning and prognosis would be affected by exact diagnosis of the tumor origin. This study presents a case of Persian woman with diagnostic, histological and immunohistochemical specifications.

  6. Retroperitoneal Laparoscopic Nephroureterectomy for Tuberculous Nonfunctioning Kidneys: a single-center experience

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    Xiquan Tian

    2015-04-01

    Full Text Available Purpose To present our surgical techniques and experiences of retroperitoneal laparoscopic nephroureterectomy for the treatment of tuberculous nonfunctioning kidneys. Materials and Methods From March 2005 to March 2013, a total of 51 patients with tuberculous nonfunctioning kidney underwent retroperitoneal laparoscopic nephroureterectomy at our medical center. The techniques included early control of renal vessels and dissection of the diseased kidney along the underlying layer outside the Gerato’s fascia. The distal ureter was dissected through a Gibson incision and the entire specimen was removed en bloc from the incision. Patient demographics, perioperative characteristics and laboratory parameters as well as postoperative outcome were retrospectively reviewed. Results Retroperitoneal laparoscopic nephroureterectomy was successfully performed in 50 patients, whereas one case required conversion to open surgery due to non-progression of dissection. The mean operating time was 123.0 minutes (107-160 minutes and the mean estimated blood loss was 134 mL (80-650 mL.The mean postoperative hospital stay was 3.6 days (3-5days and the mean return to normal activity was 11.6 days (10-14days. Most intra-operative and post-operative complications were minor complications and can be managed conservatively. After 68 months (12-96 months follow-up, the outcome was satisfactory, and ureteral stump syndrome did not occur. Conclusions Retroperitoneal laparoscopic nephroureterectomy as a minimally invasive treatment option is feasible for treatment of tuberculous nonfunctioning kidneys.

  7. Staphylococcus aureus aortitis and retroperitoneal fibrosis: A case report and literature review

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    Marta Yague

    2016-01-01

    Full Text Available An infected aortic aneurysm is a process with high mortality rate. Survival is dependent on an early diagnosis and surgical management. This case report details a rare presentation of aortitis with persistent methicillin-sensitive Staphylococcus aureus (MSSA bacteremia, which initially presented as retroperitoneal fibrosis and was ultimately fatal.

  8. Robot-assisted laparoscopic retroperitoneal lymph node dissection for stage IIIb mixed germ cell testicular cancer after chemotherapy.

    Science.gov (United States)

    Lee, Sang Hyub; Kim, Dong Soo; Chang, Sung-Goo; Jeon, Seung Hyun

    2015-07-01

    Laparoscopic retroperitoneal lymph node dissection, especially when performed with the da Vinci Surgical System (Intuitive Surgical), has shown excellent cosmetic results with similar oncologic outcomes to those of open surgery. In this study, we present a case of robot-assisted retroperitoneal lymph node dissection performed in an 18-year-old man who was diagnosed with a stage IIIb mixed germ cell tumor and who was initially treated with radical orchiectomy, followed by chemotherapy. This case shows that robot-assisted retroperitoneal lymph node dissection is technically feasible, safe, and cosmetically favorable, even when performed on patients with high-stage disease or after chemotherapy.

  9. Clinical study of a new approach to thoracolumbar surgery

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    LIU Gang; ZHAO Jian-ning; Akira Dezawa

    2008-01-01

    Objective: The conventional approaches for treatment of thoracolumbar diseases require extensive surgical exposure, often leading to postoperative pain and morbidity. Thoracoscopic-assisted surgery in these regions usually requires an extended recovery period due to the placement of drainage. We developed an innovative retro-peritoneal-extrapleural approach to thoracolumbar involvement by an extra-diaphragmatic technique using dedicated instruments. Neither incision nor reconstruction of the diaphragm was necessary. Exposure to the lateral part of the thoracolumbar vertebrae could be achieved without crus resection. This study is aimed to evaluate the clinical outcomes of this new surgical procedure. Methods: A total of 9 cases (5 cases of thoracolumbar fracture-dislocation, 1 each of spinal infection, tumor, thoracolumbar scoliosis and ossification of posterior longitudinal ligament) were subjected to the study. The average of the patients was 52.3 years. The results were com pared with the control group consisting of thoracoscopic surgery subgroup (5 patients, mean age 52.1 years) and conventional surgery subgroup (12 patients, mean age 61.3 years). Results: Compared with the control group, the average period of bed confinement and mean intra- and post-operative blood loss decreased significantly. Pulmonary complications were avoided in all cases. The surgical time was shortened, postoperative pain was reduced, and early postoperative ambulation became possible. Conclusion: The diaphragm-preserving retroperito-neal-extrapleural approach that we developed is a valid minimally invasive alternative for the treatment of thora-columbar diseases.

  10. Combined management of retroperitoneal sarcoma with dose intensification radiotherapy and resection: Long-term results of a prospective trial.

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    Smith, Myles J F

    2014-01-07

    Late failure is a challenging problem following resection of retroperitoneal sarcoma (RPS). We investigated the effects of preoperative XRT plus dose escalation with early postoperative brachytherapy (BT) on long-term survival and recurrence in RPS.

  11. Castleman Disease in the Kidney and Retroperitoneum Mimicking Renal Cell Carcinoma with Retroperitoneal Lymphadenopathy: A Case Report

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    Ko, Hee Sun; Woo, Ji Young; Hong, Hye Suk; Jung, Ah Young; Yang, Ik; Lee, Yul [Dept. of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul (Korea, Republic of)

    2012-09-15

    Castleman disease, or angiofollicular lymph node hyperplasia, is a fairly rare benign tumor of lymphoid origin with unknown etiology. Castleman disease arises mostly in the mediastinum, and some cases of renal and retroperitoneal involvement have been reported. However, Castleman disease that simultaneously involves the kidney and regional lymph nodes has not been reported in radiologic literature. We report a case of renal and pararenal Castleman disease, mimicking renal cell carcinoma with retroperitoneal lymphadenopathy.

  12. Gigantic retroperitoneal hematoma as a complication of anticoagulation therapy with heparin in therapeutic doses: a case report

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    Daliakopoulos Stavros I

    2008-05-01

    Full Text Available Abstract Introduction Spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present as a rare life-threatening event characterized by sudden onset of bleeding into the retroperitoneal space, occurring in association with bleeding disorders, intratumoral bleeding, or ruptures of any retroperitoneal organ or aneurysm. The spontaneous form is the most infrequent retroperitoneal hemorrhage, causing significant morbidity and representing a diagnostic challenge. Case presentation We report the case of a patient with coronary artery disease who presented with transient ischemic attack, in whom anticoagulant therapy with heparin precipitated a massive spontaneous atraumatic retroperitoneal hemorrhage (with international normalized ratio 2.4, which was treated conservatively. Conclusion Delay in diagnosis is potentially fatal and high clinical suspicion remains crucial. Finally, it is a matter of controversy whether retroperitoneal hematomas should be surgically evacuated or conservatively treated and the final decision should be made after taking into consideration patient's general condition and the possibility of permanent femoral or sciatic neuropathy due to compression syndrome.

  13. Retroperitoneal abscess and acute acalculous cholecystitis after iatrogenic colon injury: report of a case

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    Dong, Chengwei; Wang, Yuxu; Hu, Sanyuan; Du, Futian; Ding, Wei

    2015-01-01

    Acute acalculous cholecystitis has a high mortality rate due to the difficulties in early diagnosis and high rate of complications like empyema, gangrene and perforation. We report a case of 20-year-old male with acute severe pancreatitis, acute renal failure and acute peripancreatic fluid collection who was transferred to our department after blood filtration treatment in ICU. After percutaneous catheter drainage for 20 hours, the patient got a high fever. Computed tomography revealed retroperitoneal colon injury. In this case, percutaneous catheter drainage was performed again and the pus cavity was flushed regularly, after which the patient’s state gradually improved. Unpredictably, septic shock appeared on the 51st day. Repeated computed tomography revealed acute acalculous cholecystitis and abscess formation. After percutaneous transhepatic gallbladder catheterization and drainage, the patient got better gradually. Three months later the retroperitoneal catheter was removed. Four months later, ultrasound examination showed normal gallbladder and the catheter was removed. PMID:26131252

  14. Retroperitoneal Leiomyosarcoma Presenting as Lower Gastrointestinal Bleeding: A Case Report and Review of the Literature

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    Dominic G. Ventura

    2011-01-01

    Full Text Available We report the first known case of a retroperitoneal leiomyosarcoma that presented with an endoscopically defined source of gastrointestinal bleeding in the colon. A 68-year-old male with a history of diverticulosis, hypertension, and hypercholesterolemia who complained of a 3-month history of abdominal pain, nausea, and intermittent hematochezia presented for evaluation of large volume hematochezia and lightheadedness. Colonoscopy revealed left-sided diverticulosis and rectal varices without stigmata of recent bleed. CT scan showed a 26 × 20 × 13 cm heterogeneous retroperitoneal mass and multiple hypodense hepatic lesions. Liver biopsy revealed leiomyosarcoma. In summary, although surgery is the mainstay of treatment, resectability has not improved significantly. Early recognition and aggressive surgery are keys to long-term survival.

  15. Massive retroperitoneal ganglioneuroma presenting with small bowel obstruction 18 years following initial diagnosis.

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    Cronin, E M P

    2012-02-03

    BACKGROUND: Ganglioneuroma is a rare tumour of neural crest origin, which arises from maturation of a neuroblastoma. While previously considered to be non-functioning, they are now known to be frequently endocrinologically active. AIMS AND METHODS: We report a case of a massive retroperitoneal ganglioneuroma presenting with small bowel obstruction in an adult, 18 years after initial diagnosis. Urinary dopamine levels were elevated, but other catecholamines were within normal limits. This is the first report in the English-language literature of a retroperitoneal ganglioneuroma presenting with or causing intestinal obstruction. We also review the metabolic, radiological, and histological features of these tumours. Relevant publications were identified from a Medline search using the MeSH headings \\'ganglioneuroma\\

  16. Retroperitoneal Pleomorphic Lipo sarcoma Mimicking Adrenal Cancer in F-18 FDG PET/CT

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    Yoon, Minki; Kim, Seogjoon [Good Samaritan Hospital, Pohang (Korea, Republic of)

    2010-09-15

    Lipo sarcoma is the second most common type of soft tissue sarcoma, but pleomorphic lipo sarcoma is the least common subtype. We present the case of a 42-year-old man who had experienced intermittent left flank pain for a month. A large soft-tissue mass was detected by ultrasonography in a local clinic, and he was referred for further evaluation. Positron emission tomography/computed tomography (PET/CT) with F-18 fluoro-2-deoxy-D-glucose (F-18 FDG) showed intense uptake in the retroperitoneal mass, which mimicked an adrenal cancer. The patient underwent left radical nephroadrenalectomy, and the tumor was revealed to be a pleomorphic lipo sarcoma upon pathological examination. When there is a large retroperitoneal mass with intense F-18 FDG activity, the possibility of a pleomorphic lipo sarcoma should be considered.

  17. Acute retroperitoneal bleeding due to inferior mesenteric artery aneurysm: Case report

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    Ferrón JA

    2010-06-01

    Full Text Available Abstract Background Visceral artery aneurysms (VAA, although uncommon, are increasingly being detected. We describe a case of spontaneous retroperitoneal hemorrhage from a ruptured IMA aneurysm associated with stenosis of the superior mesenteric artery (SMA and celiac trunk, successfully treated with surgery. Methods A 65-year-old man presented with abdominal pain and hypovolemic shock. Abdominal CT scan showed an aneurysm of the inferior mesenteric artery with retroperitoneal hematoma. In addition, an obstructive disease of the superior mesenteric artery and celiac axis was observed. Results Upon emergency laparotomy a ruptured inferior mesenteric artery aneurysm was detected. The aneurysm was excised and the artery reconstructed by end-to-end anastomosis. Conclusions This report discusses the etiology, presentation, diagnosis and case management of inferior mesenteric artery aneurysms.

  18. Rare Aggressive Behavior of MDM2-Amplified Retroperitoneal Dedifferentiated Liposarcoma, with Brain, Lung and Subcutaneous Metastases

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    Ben Salha, Imen; Zaidi, Shane; Noujaim, Jonathan; Miah, Aisha B.; Fisher, Cyril; Jones, Robin L.; Thway, Khin

    2016-01-01

    Dedifferentiated liposarcoma (DDL) is a histologically pleomorphic sarcoma, traditionally defined as well-differentiated liposarcoma with abrupt transition to high grade, non-lipogenic sarcoma. It can occur as part of recurrent well-differentiated liposarcoma, or may arise de novo. DDL most frequently occurs within the retroperitoneum, and while it is prone to local recurrence, it usually has a lower rate of metastasis than other pleomorphic sarcomas. We describe a case of retroperitoneal dedifferentiated liposarcoma in a 63-year-old male, who showed MDM2 amplification with fluorescence in situ hybridization, which displayed unusually aggressive behavior, with brain, lung and subcutaneous soft tissue metastases. As previous reports of metastatic liposarcoma have largely grouped DDL in with other (genetically and clinically distinct) liposarcoma subtypes, we highlight and discuss the rare occurrence of brain metastasis in MDM2-amplified retroperitoneal liposarcoma.

  19. Retroperitoneal Abscess Formation as a Result of Spilled Gallstones during Laparoscopic Cholecystectomy: An Unusual Case Report

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    Grigoris Chatzimavroudis

    2012-01-01

    Full Text Available One of the complications of laparoscopic cholecystectomy for gallstone disease that seems to exceed that of the traditional open method is the gallbladder perforation and gallstone spillage. Its incidence can occur in up to 40% of patients, and in most cases its course is uneventful. However in few cases an abdominal abscess can develop, which may lead to significant morbidity. Rarely an abscess formation due to spilled and lost gallstones may occur in the retroperitoneal space. We herein report the case of a female patient who presented with clinical symptoms of sepsis six months following laparoscopic cholecystectomy. Imaging investigations revealed the presence of a retroperitoneal abscess due to retained gallstones. Due to patient’s decision to refuse abscess’s surgical drainage, she underwent CT-guided drainage. The 24-month followup of the patient has been uneventful, and the patient remains in good general condition.

  20. Giant retroperitoneal lipoma: a case report Lipoma gigante do retroperitônio: relato de caso

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    Carlos Augusto Real Martinez

    2003-12-01

    Full Text Available BACKGROUND: Retroperitoneal lipoma is an extremely rare neoplasm. AIMS: The authors report a case of giant retroperitoneal lipoma in a 32-year-old white female, with a history of pain and an abdominal mass over a 2-year period. Total abdominal ultrasonography and barium enema showed a large mass located in the retroperitoneal space behind the ascending colon. Laparotomy showed a large encapsulated tumor measuring 20 x 13 x 10 cm and weighing 3.400 g. The histological study revealed a benign neoplasm of fatty cells. CONCLUSION: The patient remains well 17 years after surgery, without recurrentce of the disease.RACIONAL: O lipoma é a neoplasia mesenquimal mais freqüente, raramente localizada no retroperitônio. Na maioria das vezes, o diagnóstico diferencial pré-operatório com os lipossarcomas de baixo grau de malignidade é difícil de ser estabelecido. OBJETIVO: Apresentar um caso de lipoma gigante retroperitoneal em mulher de 32 anos que há 2 anos apresentava história de dor e tumor abdominal palpável. A ultra-sonografia abdominal e o enema opaco mostraram grande massa localizada no retroperitônio, que deslocava o ceco e o cólon ascendente. A laparotomia mostrou tumor encapsulado com 20 x 13 x 10 cm e 3.400 g de peso. O estudo histopatológico mostrou presença de lipoma retroperitonial. A paciente encontra-se bem, sem recidiva da doença, 17 anos após a cirurgia.

  1. Classification of acute pancreatitis based on retroperitoneal extension: Application of the concept of interfascial planes

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    Ishikawa, Kazuo [Osaka Prefectural Senshu Critical Care Medical Center, 2-24 Rinku-Ourai-Kita, Izumisano-shi, Osaka 598-0048 (Japan)]. E-mail: ishikawa@sccmc.izumisano.osaka.jp; Idoguchi, Koji [Osaka Prefectural Senshu Critical Care Medical Center, 2-24 Rinku-Ourai-Kita, Izumisano-shi, Osaka 598-0048 (Japan)]. E-mail: idoguchi@sccmc.izumisano.osaka.jp; Tanaka, Hiroshi [Department of Traumatology and Acute Critical Care Medicine, Osaka University Hospital, 2-15 Yamada-Oka, Suita-shi, Osaka 565-0871 (Japan)]. E-mail: tanaka@hp-emerg.med.osaka-u.ac.jp; Tohma, Yoshiki [Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, 3-4-13 Nishi-Iwata, Higashiosaka-shi, Osaka 578-0947 (Japan)]. E-mail: tohma@nmcam.jp; Ukai, Isao [Department of Traumatology and Acute Critical Care Medicine, Osaka University Hospital, 2-15 Yamada-Oka, Suita-shi, Osaka 565-0871 (Japan)]. E-mail: isaoukai@nifty.com; Watanabe, Hiroaki [Osaka Prefectural Senshu Critical Care Medical Center, 2-24 Rinku-Ourai-Kita, Izumisano-shi, Osaka 598-0048 (Japan)]. E-mail: hiwatana@sccmc.izumisano.osaka.jp; Matsuoka, Tetsuya [Osaka Prefectural Senshu Critical Care Medical Center, 2-24 Rinku-Ourai-Kita, Izumisano-shi, Osaka 598-0048 (Japan)]. E-mail: matsuoka@sccmc.izumisano.osaka.jp; Yokota, Jyunichiro [Osaka Prefectural Senshu Critical Care Medical Center, 2-24 Rinku-Ourai-Kita, Izumisano-shi, Osaka 598-0048 (Japan)]. E-mail: jyokota@sccmc.izumisano.osaka.jp; Sugimoto, Tsuyoshi [Ryokufukai Hospital, 1-16-13 Setoguchi, Hirano-ku, Osaka-shi, Osaka 547-0034 (Japan)]. E-mail: ts-sugi@ryokufukai.or.jp

    2006-12-15

    Objective: This study aimed to provide a classification system for acute pancreatitis by applying the principle that the disease spreads along the retroperitoneal interfascial planes. Materials and methods: Medical records and computed tomography (CT) images of 58 patients with acute pancreatitis treated between 2000 and 2005 were reviewed. The retroperitoneum was subdivided into 10 components according to the concept of interfascial planes. Severity of acute pancreatitis was graded according to retroperitoneal extension into these components. Clinical courses and outcomes were compared with the grades. The prognostic value of our classification system was compared with that of Balthazar's CT severity index (CTSI). Results: Retroperitoneal extension of acute fluid collection was classified into five grades: Grade I, fluid confined to the anterior pararenal space or retromesenteric plane (8 patients); Grade II, fluid spreading into the lateroconal or retrorenal plane (16 patients); Grade III, fluid spreading into the combined interfascial plane (8 patients); Grade IV, fluid spreading into the subfascial plane beyond the interfascial planes (15 patients); and Grade V, fluid intruding into the posterior pararenal space (11 patients). Morbidity and mortality were 92.3% and 38.5% in the 26 patients with Grade IV or V disease, and 21.9% and 0% in the 32 patients with Grade I, II, or III disease. Morbidity and mortality were 86.7% and 33.3% in patients with disease classified 'severe' according to the CTSI, and 37.5% and 9.4% in patients with disease classified 'mild' or 'moderate'. Conclusion: Classification of acute pancreatitis based on CT-determined retroperitoneal extension is a useful indicator of the disease severity and prognosis without the need for contrast-medium enhanced CT.

  2. Primary retroperitoneal melanoma presented in a rare extracutaneous site for malignant melanoma

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    Mohamed Alsharedi

    2016-10-01

    Full Text Available Malignant melanoma, as the name implies, is a malignant tumor of melanocytes, found in the skin, eyes, meningeal lining and the mucosal epithelium of the aero-digestive and genitourinary tracts. Malignant melanoma is typically skin malignancy, which rarely presents at extracutaneous site. Here we present a rare case of primary retroperitoneal melanoma and review the findings in comparison with other cases described in literature.

  3. Acute torsion of a retroperitoneal renal transplant mimicking renal vein thrombosis.

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    Winter, Thomas C; Clarke, Andrea Lynn; Campsen, Jeffrey

    2013-09-01

    When imaging a renal transplant, the combination of absent flow in the main renal vein and reversed diastolic flow in the intrarenal arteries is considered highly suggestive of renal vein thrombosis. We present a case of torsion of a transplant kidney presenting with identical findings. Renal transplant torsion in general is a rare entity, previously described only in intraperitoneally placed organs; this case is the first that we are aware of with torsion occurring in a retroperitoneally placed graft.

  4. A Rare Cause of Acute Urinary Retention: Retroperitoneal Ganglioneuroma and Concurrent Mediastineal Schwannoma

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    Salih Budak

    2013-04-01

    Full Text Available The underlying prior cause at the old male patients refered with acute urinary retention is frequently benign prostatic hypertrophy and urethral pathologies. Acute urinary retention can develop with obstruction as well as neurogenic causes. Neurogenic tumors develops from the cells which takes its origin from the neural crest and they can be seen every neural tissue. In this study rarely seen retroperitoneal ganglioneuroma which causes acute urinary retention and coexisting asymptomatic mediastineal schwannoma case is presented.

  5. Retroperitoneal margin involvement by adenocarcinoma of the caecum and ascending colon: what does it mean?

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    Scott, N; Jamali, A; Verbeke, C; Ambrose, N S; Botterill, I D; Jayne, D G

    2008-03-01

    Circumferential margin involvement (CRM) is a powerful predictor of local recurrence, distant metastasis and patient survival in rectal cancer. In this study, we aimed to determine the frequency of retroperitoneal margin involvement in right colon cancer and describe its relationship to tumour stage and outcome of surgical treatment. Two hundred and twenty-eight consecutive resections for adenocarcinoma of the ascending colon and caecum were identified between 1998 and 2006. Tumour involvement of the posterior retroperitoneal surgical resection margin (RSRM) was recorded and correlated with tumour stage, grade and clinical outcome. RSRM positive patients were compared with CRM positive rectal tumours resected in the same surgical unit. Nineteen of 228 right hemicolectomies (8.4%) showed tumour involvement of the RSRM (defined as CRM positive rectal cancers. Retroperitoneal surgical resection margin involvement by caecal and ascending colon carcinoma is a marker of advanced tumour stage and associated with a high incidence of synchronous and metachronous distant metastasis. More aggressive surgery to obtain a clear margin or postoperative radiotherapy to the tumour bed is likely to benefit only a minority of patients.

  6. Asymptomatic diaphragmatic rupture with retroperitoneal opening as a result of blunt trauma

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    Narci Adnan

    2010-01-01

    Full Text Available Blunt traumas of the abdomen and thorax are important clinical problems in pediatric ages. Severity of trauma may not always be compatible with the patients′ clinical situation. A 2-year-old male child was admitted to our emergency clinic as a result of tractor crash accident. Physical examination of the child was normal. The abdominal and thoracic ultrasonography (USG examination performed in the emergency clinic was normal. In thoracic computed tomography (CT scan of the patient, there was irregularity of the right diaphragmatic contour that was described as micro perforation-rupture (the free air was just in the perihepatic and retroperitoneal area, which was not passing through the abdomen. The patient was followed-up for 1 week in the hospital with a diagnosis of retroperitoneal diaphragmatic rupture. It is not appropriate to decide the severity of trauma in childhood on the basis of clinical findings. Although severe trauma and sustaining radiological examinations, the patients′ clinical pictures may be surprisingly normal, as in our patient. In such cases, there may not be any clinical symptom. CT scan examination must be preferred to USG for both primary diagnosis and follow-up of these patients. According to the current literature, there is no reported case with retroperitoneal rupture of the diaphragm.

  7. Cytomorphology of Erdheim-Chester disease presenting as a retroperitoneal soft tissue lesion

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    Bibianna Purgina

    2011-01-01

    Full Text Available Erdheim-Chester disease (ECD is a rare, multisystem disorder of macrophages. Patients manifest with histiocytic infiltrates that lead to xanthogranulomatous lesions in multiple organ systems. The cytologic features of this disorder are not well characterized. As a result, the cytologic diagnosis of ECD can be very challenging. The aim of this report is to describe the cytomorphology of ECD in a patient presenting with a retroperitoneal soft tissue lesion. A 54-year-old woman with proptosis and diabetes insipidus was found on imaging studies to have multiple intracranial lesions, sclerosis of both femurs and a retroperitoneal soft tissue mass. Fine needle aspiration (FNA and a concomitant core biopsy of this abnormal retroperitoneal soft tissue revealed foamy, epithelioid and multinucleated histiocytes associated with fibrosis. The histiocytes were immunoreactive for CD68, CD163, Factor XIIIa and fascin, and negative for S100, confirming the diagnosis of ECD. ECD requires a morphologic diagnosis that fits with the appropriate clinical context. This case describes the cytomorphologic features of ECD and highlights the role of cytology in helping reach a diagnosis of this rare disorder.

  8. Prospective assessment of MRI for imaging retroperitoneal metastases from testicular germ cell tumours

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    Sohaib, S.A. [Department of Radiology, Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey (United Kingdom)], E-mail: aslam.sohaib@rmh.nhs.uk; Koh, D.M. [Department of Radiology, Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey (United Kingdom); Barbachano, Y. [Department of Computing and Statistics, Royal Marsden Hospital, Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey (United Kingdom); Parikh, J.; Husband, J.E.S. [Department of Radiology, Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey (United Kingdom); Dearnaley, D.P.; Horwich, A.; Huddart, R. [Department of Academic Urology Unit, Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey (United Kingdom)

    2009-04-15

    Aim: To determine the sensitivity of magnetic resonance imaging (MRI) in the detection of retroperitoneal lymph nodes in patients with testicular germ cell tumours (TGCT). Methods and materials: A prospective study of 52 patients (mean age 34 years, range 18-54 years) was performed. Imaging of the retroperitoneum was performed using multidetector computed tomography (CT) and 1.5 T MRI systems. The CT and MRI images were read independently by three observers. The number, size, and site of enlarged nodes ({>=}10 mm maximum short axis diameter) were recorded. Retroperitoneal nodal detection on MRI was compared to CT. Results: Twenty-two (42%) of the 52 patients had no retroperitoneal disease; in remaining 30 patients 51 enlarged nodes were identified. On a per patient basis readers 1, 2, and 3 identified nodal disease in 28 of 29, 29 of 30, and 24 of 30 patients, respectively, using MRI compared to CT. Thus for experienced radiologists (readers 1 and 2) MRI is comparable to CT for nodal detection (i.e., this study excludes MRI being inferior to CT with 80% power and 5% type 1 error). Conclusion: MRI offers an alternative method for staging the retroperitoneum in young patients being followed for TGCT and has the major advantage of avoiding exposure to ionizing radiation.

  9. Curved Needles in CT-Guided Fine Needle Biopsies of Abdominal and Retroperitoneal Small Lesions.

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    De Filippo, Massimo; Saba, Luca; Rossi, Enrica; Nizzoli, Rita; Tiseo, Marcello; Pedrazzi, Giuseppe; Brunese, Luca; Rotondo, Antonio; Rossi, Cristina

    2015-12-01

    To demonstrate the advantages of using curved needles in fine needle aspiration (FNA) with CT-guided, for analyzing abdominal and/or retroperitoneal small lesions which are impossible to reach with conventional non-surgical biopsy techniques, particularly in cases in which the cytology sample was not possible to obtain by means of US or CT guide with axial images. An authorization for CT-guided FNA in patients with neoplasms is not required by the institutional review board of our Institute. From April 2012 to November 2014, the study included retrospectively 25 patients (16 M, 9 F) who underwent CT-guided FNA of abdominal and/or retroperitoneal small lesions (biopsy procedure because of the interposition of anatomical obstacles. Patients with suspected lymphomas or sarcomas, pediatric patients and patients with bleeding diathesis were excluded. Cytology reports were used for evaluating suitability. The biological material was considered to be suitable for cytological study, with a diagnostic value in all 25 cases, finding in particular: out of 23 neoplastic lesions (85%), 21 were malignant (90.2%) and 2 were benign (8%). 2 out 25 were non-neoplastic benign lesions (8%). No procedural complications arose in any of the cases (0%). Using curved needles, there is an effective improvement in CT-guided FNA of abdominal and retroperitoneal small lesions which are difficult to achieve with conventional CT or ultrasound guide.

  10. Case report of subcutaneous entomophthoromycosis with retroperitoneal invasion Relato de caso de entomoftoromicose subcutânea com invasão retroperitoneal

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    Leonora Maciel de Souza Vianna

    2005-08-01

    Full Text Available The authors describe a case of entomophthoromycosis in a previously healthy patient, who presented with an abscess in the right buttock. After surgical drainage it evolved into a retroperitoneal tumor. The patient improved clinically after resection of the mass and ketoconazole treatment. The histopathological analysis showed the Splendore-Hoeppli phenomenon, suggesting Basidiobolus ranarum infection, a zygomycosis generally restricted to the subcutaneous tissue, with rare gastrointestinal involvement.Os autores descrevem um caso de entomoftoromicose em paciente previamente saudável, que apresentou abscesso em nádega direita, evoluindo, após drenagem cirúrgica, para tumoração retroperitoneal. Após ressecção da massa, o paciente obteve melhora clínica, em uso de cetoconazol. A análise histopatológica evidenciou fenômeno de Splendore-Hoeppli, sugerindo infecção por Basidiobolus ranarum, uma zigomicose geralmente restrita ao tecido subcutâneo, com raro comprometimento gastrintestinal.

  11. Image-Guided Fine Needle Cytology with Aspiration Versus Non-Aspiration in Retroperitoneal Masses: Is Aspiration Necessary?

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    Rajiv Kumar Misra

    2015-03-01

    Full Text Available Background: Although using fine needle cytology with aspiration (FNC-A for establishing diagnoses in the retroperitoneal region has shown promise, there is scant literature supporting a role of non-aspiration cytology (FNC-NA for this region. We assessed the accuracy and reliability of FNC-A and FNC-NA as tools for preoperative diagnosis of retroperitoneal masses and compared the results of both techniques with each other and with histopathology. Methods: Fifty-seven patients with retroperitoneal masses were subjected to FNC-A and FNC-NA. Smears were stained with May-Grunwald Giemsa and hematoxylin and eosin stain. An individual slide was objectively analysed using a point scoring system to enable comparison between FNC-A and FNC-NA. Results: By FNC-A, 91.7% accuracy was obtained in cases of retroperitoneal lymph node lesions followed by renal masses (83.3%. The diagnostic accuracy of other sites by FNC-A varied from 75.0%–81.9%. By FNC-NA, 93.4% diagnostically accurate results were obtained in the kidney, followed by 75.0% in adrenal masses. The diagnostic accuracy of other sites by FNC-NA varied from 66.7%–72.8%. Conclusions: Although both techniques have their own advantages and disadvantages, FNC-NA may be a more efficient adjuvant method of sampling in retroperitoneal lesions.

  12. Idiopathic retroperitoneal fibrosis with particular perirenal and intrarenal extension associated with left renal artery stenosis. The atheromatous periaortitis with retroperitoneal fibrosis suggests a pathogenic relationship between atherosclerosis and fibrosis?

    Science.gov (United States)

    Gluhovschi, Gheorghe; Bozdog, Gheorghe; Miclaus, Gratian; Puscasiu, Tudor; Gluhovschi, Cristina; Bob, Flaviu; Velciov, Silvia; Petrica, Ligia; Trandafirescu, Virginia; Gadalean, Florica

    2011-02-01

    We present a case of idiopathic retroperitoneal fibrosis (RPF) in a female patient of 45 years, obese (BMI = 39 kg/sqm), hypertensive since 2005, with diabetes mellitus treated with diet and diabetes insipidus in whom, during a routine control, the following has been found: serum creatinine 1.74 mg/dl, and an inflammatory syndrome associated with fever. Spiral-CT (Multi-slice-Sensation 64) scan shows retroperitoneal fibrosis in relation with periaortitis that affects the thoracic and abdominal aorta. RPF is extending perirenally and at the level of the renal hilum with subsequent calyceal dilations (hydrocalycosis) associated with left renal artery stenosis. The particularity of the case is represented by the perirenal and intrarenal evolution of fibrosis with left renal artery stenosis with moderate impairment of renal function reversible under treatment with Tamoxifen. This case, with chronic periaortitis subsequent to an extended aortic atherosclerosis with retroperitoneal fibrosis can be representative for the pathogenic relationship between atherosclerosis and fibrosis.

  13. Post traumatic retroperitoneal fibrosis as a cause of low-back pain Fibrosis retroperitoneal postraumática como causa de dolor lumbar

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    A.M. Hidalgo-Ovejero

    2011-12-01

    Full Text Available We present the case of a male patient with post traumatic retroperitoneal fibrosis whose main clinical expression was low-back pain. Diagnosis was established using CAT-scan and MRI, which revealed a large mass of soft tissue that almost entirely enveloped the abdominal aorta. Treatment with 40 mg of prednisone every 24 hours was established. This dose was reduced gradually, and progressive remission of clinical signs and symptoms was achieved, with a significant improvement of subsequent imaging-test results. Treatment was continued for one year. Two and a half years later the patient remains symptom-free, with no recurrence of his condition.Se presenta el caso de un paciente varón afecto de una fibrosis retroperitoneal postraumática, a cuyo diagnóstico se llegó a partir de dolor lumbar como síntoma principal. El diagnóstico se efectuó en base a los estudios mediante CT y RM, los cuales demostraron una gran masa de tejido de partes blandas que rodeaban la aorta. El tratamiento consistió en dosis de prednisona que inicialmente se instauró a 40 mg cada 24 horas, y posteriormente se fue reduciendo de forma gradual hasta la remisión de los signos y síntomas, y consecuentemente de los estudios de imagen. El tratamiento con corticoides se mantuvo durante un año. Dos años y medio el paciente está libre de síntomas sin recidiva de su proceso.

  14. Common bile duct obstruction due to fibrous pseudotumor of pancreas associated with retroperitoneal fibrosis:A case report

    Institute of Scientific and Technical Information of China (English)

    Mei-Fen Zhao; Yu Tian; Ke-Jian Guo; Zhi-Gang Ma; Hai-Hui Liao

    2004-01-01

    One 63-year-old woman, who presented with cholestatic jaundice due to common bile duct compression produced by primary retroperitoneal fibrosis, is studied. The patient was operated six years ago because of hydronephrosis,when the disease was first diagnosed. Magnetic resonance cholangiopancreatography (MRCP) revealed the presence of extrahepatic bile duct obstruction, which once was considered to be pathognomonic of pancreatic cancer. CTscan demonstrated the change of retroperitoneal fibrosis around left kidney, atrophy of right kidney, and obstruction of extrahepatic bile duct (pancreatic head). An explorative laparotomy was performed, and the retroperitoneum and pancreas were grayish-white and hard, the fibrotic pancreatic head compressed the common bile duct. Bile duct stricture was managed by Rouxen-Y hepatocholangio-jejunostomy.To the best of our knowledge, few similar cases of retroperitoneal fibrosis have been reported.

  15. Retroperitoneal ganglioneuroma in children: CT and MRI features with histologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Cai Jinhua, E-mail: cjh710506@tom.co [Department of Radiology, Children' s Hospital, Chongqing Medical University, Chongqing 400014 (China); Zeng Yan [Department of Radiology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010 (China); Zheng Helin; Qin Yong [Department of Radiology, Children' s Hospital, Chongqing Medical University, Chongqing 400014 (China); Kaiyong, T. [Department of Pathology, Children' s Hospital, Chongqing Medical University, Chongqing 400014 (China); Zhao Jiannong [Department of Radiology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010 (China)

    2010-09-15

    Objective: To demonstrate the CT and MRI features with histologic correlation of retroperitoneal ganglioneuromas in children. Methods: The diagnostic images (seventeen CT scans and five MR scans) in 17 children with retroperitoneal ganglioneuroma confirmed by operation and histopathology were retrospectively reviewed, and correlated to the histologic findings. Results: All tumors presented as an oval-shaped, well-defined mass on both CT and MR images. On unenhanced CT images, calcification was detected in six masses (35.3%), and predominantly low attenuation with the CT value ranged from 22 to 38 HU (mean 29.5 HU) in all the tumors. The tumors with CT value less than 30 HU had a relatively larger amount of myxoid stroma on histopathologic sections than those with CT value more than 30 HU. Tumors showed homogeneous low signal intensity on T1-weighted images and inhomogeneous high signal intensity with interlaced or nodular low signal intensity on T2-weighted images. The post-contrast enhancement on both CT and MR images was lacking or slight in early phase, but moderate or marked in late phase. The inhomogeneous high signal intensity on T2WI, as well as the delayed enhancement corresponded to a large amount of myxoid stroma and a relatively small number of cellular components in tumors. Conclusion: An oval shape, well-defined margin, low attenuation on CT, inhomogeneous hyperintensity on T2WI, and delayed moderate or marked enhancement are typical features of retroperitoneal ganglioneuroma in children. The imaging features correlated well to the histologic findings.

  16. The role of CT in pelvic fracture. CT finding of retro-peritoneal hematoma and indication of transcatheter arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Igarashi, Tsuneo; Hoshikawa, Yoshikazu; Saeki, Mitsuaki; Nakajima, Yasuo [St. Marianna Univ., Kawasaki, Kanagawa (Japan). School of Medicine

    1998-10-01

    Although retro-peritoneal hematoma accompanying a pelvic fracture has been treated by arterial ligation formerly, it is associated with a high mortality rate and a transcatheter arterial embolization has now become the first choice of treatment. Meanwhile, the usefulness of computed tomography (CT) in traumatized patient has been reported frequently. Our hospital also employs CT positively as an examination following plain radiography in the cases with pelvic fracture. However, while indication of angiography is seen in several reports, the amount of retro-peritoneal hematoma as an index has not been reported. In the present study, we examined 112 patients given CT at the time of examination at the emergency center of our hospital between April 1, 1988, and June 30, 1997, and classified the amount of retro-peritoneal hematoma on CT into 5 groups to discuss indication of angiography. In the cases with moderate or massive amount of retro-peritoneal hematomas, cases with shock state exceeded 60% and the amount of hematoma was considered to reflect the circulation profile to a certain extent. As the amount of retro-peritoneal hematoma increased, the number of cases given embolization also increased; embolization was performed in 29 cases (61.7%) among those which had moderate or massive amount of hematoma. From the above findings, it was predicted that the amount of retro-peritoneal hematoma could be one of the deciding factors for indication of angiography. However, as there are cases falling into a shock state due to gradual increase of hematoma or associated with injuries in other organs, careful observation is needed for the cases judged out of indication. (author)

  17. Diffuse, retroperitoneal mesenteric and intrahepatic periportal plexiform neurofibroma in a 5-year-old boy

    Energy Technology Data Exchange (ETDEWEB)

    Fenton, L.Z. [Dept. of Radiology, The Children' s Hospital, Denver, CO (United States); Foreman, N. [Dept. of Oncology, The Children' s Hospital, Denver, CO (United States); Wyatt-Ashmead, J. [Dept. of Pathology, The Children' s Hospital, Denver, CO (United States)

    2001-09-01

    We present a case of plexiform neurofibroma involving the retroperitoneum, mesentery, and liver in a 5-year-old boy who underwent evaluation for extent of a palpable left neck mass. The mass had intrathoracic extension with great vessel encasement and extension into the abdomen. Abdominal CT revealed a diffuse low-attenuation non-enhancing mass encasing the retroperitoneal vessels with serpiginous extension into the liver along the portal vein. This spread pattern of plexiform neurofibroma is an unusual manifestation of neurofibromatosis in a young child. (orig.)

  18. Idiopathic retroperitoneal fibrosis associated with Hashimoto's thyroiditis in a patient with a single functioning kidney

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    Byung Sun Kim

    2013-12-01

    Full Text Available Retroperitoneal fibrosis (RPF is a rare disease characterized by the presence of fibroinflammatory tissue around the abdominal aorta and ureteral entrapment in most cases. Idiopathic RPF is frequently reported in association with autoimmune diseases; however, there have been few reports of idiopathic RPF associated with Hashimoto's thyroiditis. Here, we report a case of idiopathic RPF with Hashimoto's thyroiditis in a patient with a single functioning kidney, which was successfully treated by corticosteroid therapy and transient intraureteral stent insertion with a double-J catheter.

  19. Retroperitoneal and pelvic infections complications; Les manifestations genito-urinaires de la maladie de Crohn

    Energy Technology Data Exchange (ETDEWEB)

    Schmutz, G.R.; Racette, R.; Chapuis, F. [Sherbrooke Univ., PQ (Canada); Regent, D. [Centre Hospitalier Universitaire, 54 - Nancy (France); Hannequin, F. [Centre Medical Mgen, 67 - Strasbourg (France); N`Guyen, D. [Clinique Adassa, 67 - Strasbourg (France)

    1995-12-31

    Retroperitoneal and pelvic infections complications are the major types of genito-urinary complications in Crohn`s disease. CT has been shown to be a sensitive, non invasive method of documenting these infectious complications. On the other hand, conventional studies are more sensitive than CT to detect genitourinary fistulae. Some complications may manifest few or no symptom as urinary obstruction and nephrolithiasis, detected easily by sonography. For these reasons, it is important for radiologists to be aware of the genito-urinary complications of Crohn`s disease. (authors). 42 refs., 20 figs.

  20. Retroperitoneal migration of a self-inflicted ballpoint pen via the urethra

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    Jose Cury

    2006-04-01

    Full Text Available Numerous accounts documenting the introduction of foreign bodies into the urinary bladder have been reported. These foreign bodies are typically self-inserted via urethral but migration from adjacent organs by an ulcerative process and penetrating injuries are also reported. However, "contrary" migration of a self-inflicted vesical foreign body to the retroperitoneum was not previously reported in literature. We report here a case of a ballpoint pen self-inserted via urethral by a female patient, which was identified in retroperitoneal position years later.

  1. [Giant retroperitoneal hematoma in the peripartum of a normal delivery, "expectative attitude"].

    Science.gov (United States)

    Vanlieferinghen, S; Piketty, M; Blumental, Y; Jouannic, J-M; Desfeux, P; Benifla, J-L

    2011-03-01

    We describe a case involving spontaneous retroperitoneal hematoma complicating a normal delivery in a context of a Disseminated Intravascular Coagulation (DIVC) at the end of the pregnancy. Given the defaced symptomatology, an abdomino-pelvic scanner and an examination with a general anaesthesia made it possible to diagnose and to monitor the hematoma in intensive care. The correction of the hemostasis troubles and of the anemia, without another invasive intervention, allowed a return to home at the eighth day. The pathophysiological mechanisms underlying development and practicable treatments of this post-partum hematoma are discussed.

  2. Nitrogenous subcutaneous emphysema caused by spray application of fibrin glue during retroperitoneal laparoscopic surgery.

    Science.gov (United States)

    Matsuse, Shinji; Maruyama, Atsushi; Hara, Yoshiki

    2011-06-01

    We report a case of a patient treated by retroperitoneoscopic partial nephrectomy who developed nitrogenous subcutaneous emphysema (SCE) as a complication. The use of a nitrogen gas-pressured fibrin tissue adhesive applied as a spray caused excessively increased pressure in the closed retroperitoneal space and resulted in widespread SCE with protracted clinical course. To the best of our knowledge, this is the first report of nitrogenous SCE associated with pneumoperitoneum. The clinical significance of nitrogenous SCE is emphasized, and the risks associated with the use of fibrin glue as a spray during laparoscopic surgery are discussed.

  3. [Retroperitoneal laparoscopic nephrectomy in children younger than nine years-old: state of the art

    OpenAIRE

    Moreira-Pinto, J.; Osório, A.,; Pereira, J.; Enes, C.; J. Ribeiro-Castro; Reis, A

    2011-01-01

    Introdução e Objectivos: Em Portugal, a experiência em retroperitoneoscopia pediátrica é escassa. Os autores apresentam a primeira série portuguesa de nefrectomias realizadas por esta via, em crianças com idade inferior a nove anos, e uma revisão da literatura sobre o tema. Material e Métodos: Análise retrospectiva dos processos das crianças submetidas a nefrectomia laparoscópica retroperitoneal (NLR), de Janeiro de 2009 e Dezembro de 2009, num Departamento de Cirurgia Pediátri...

  4. Klippel-Trenaunay syndrome with hemimegalencephaly, retroperitoneal lymphangioma and double inferior vena cava.

    Science.gov (United States)

    Vurucu, S; Battal, B; Kocaoglu, M; Akin, R

    2009-05-01

    Klippel-Trenaunay syndrome (KTS) is a rare disorder characterised by congenital vascular hamartomas, limb hypertrophy, lymphangiomas and atresia of lymph vessels with non-pitting oedema. A 6-year-old girl with KTS was referred to our hospital for evaluation of intractable seizures. In addition to findings consistent with KTS, we also found hemimegalencephaly, retroperitoneal lymphangioma and double inferior vena cava. All of these associations in the same patient with KTS are unique in the English literature. We report on the multidedector CT and MRI features of such an unusual case.

  5. Idiopathic retroperitoneal fibrosis involving a unilateral renal sinus: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seul Bi; Yoon, Jung Hee; Kim, Seung Ho; Lee, Ye Daum; Kim, Suk Jung; Lim, Yun Jung; Jung, Hyun Kyung; Lee, Jin Soo [Dept. of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

    2016-06-15

    Idiopathic retroperitoneal fibrosis (RPF) is a rare disease entity and its etiology is uncertain. We report two similar cases which showed an uncommon presentation of idiopathic RPF. A 66-year-old woman and an 80-year-old man presented with incidental findings of left renal pelvic mass-like lesions. Computed tomography revealed a soft tissue density mass replacing the left renal pelvis, which was suspicious for renal pelvic cancer, and the diagnosis of idiopathic RPF was surgically confirmed. To the best of our knowledge, a few cases of idiopathic RPF presenting with features of a localized unilateral renal pelvic mass mimicking renal pelvic cancer have been reported.

  6. Retroperitoneal composite pheochromocytoma-ganglioneuroma : a case report and review of literature

    Science.gov (United States)

    2013-01-01

    Abstract Composite pheochromocytoma/paraganglioma is a rare tumor with elements of pheochromocytoma/paraganglioma and neurogenic tumor. Most were located in the adrenal glands, and extra-adrenal composite pheochromocytoma is extremely rare. Only 4 cases in the retroperitoneum have been described in the online database PUBMED. Here, we report a case of retroperitoneal extra-adrenal composite pheochromocytoma and review the related literature. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1700539911908679 PMID:23587063

  7. Successful Management of Gastrointestinal Haemorrhage Associated with Ischaemic Colonic Ulceration in Acute Pancreatitis with Video Assisted Retroperitoneal Debridement

    Directory of Open Access Journals (Sweden)

    Yogesh Puri

    2011-05-01

    Full Text Available Context Colonic involvement is an uncommon but potentially lethal complication of severe acute pancreatitis and has received little attention in the surgical literature. Such complications can range from localized colonic pathology to widespread ischaemic pancolitis. Treatment options have historically been limited to resection of the affected segment. Case report We describe the successful role of video assisted retroperitoneal pancreatic debridement in the management of two cases presenting with major gastrointestinal haemorrhage due to localised colonic ulceration on the background of acute necrotising pancreatitis. Conclusion Video assisted retroperitoneal debridement should be considered early in the management of local colonic complications associated with severe acute necrotising pancreatitis.

  8. Primary retroperitoneal teratoma and crossed fused renal ectopia with turner's syndrome -a case report-

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yun Jung; Hong, Ki Ung [St. Francisco General Hospital, New York (United States)

    1988-02-15

    In 1938, Turner described a clinical entity in phenotype females characterized by sexual infantilism, congenital webbed neck and cubitus valgus. After then, the occurrence of renal anomalies in patients with Turner's syndrome has been recognized. Associated crossed fused renal ectopia is very rare. Primary retroperitoneal teratoma is also rare and usually during childhood. The authors report a case of primary retroperitoneal teratoma and crossed fused renal ectopia with Turner's syndrome (mosaic type). The clinical, pathological and radiographical findings are reviewed.

  9. RETROPERITONEAL NECROTIZING FASCIITIS WITH ADNEXITIS PRESENTING AS ACUTE ABDOMEN IN A 40 YEAR UNMARRIED FEMALE PATIENT: A CASE REPORT

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    Sribatsa Kumar

    2014-12-01

    Full Text Available Retroperitoneal Necrotizing Fasciitis is a rare variant of Necrotizing fasciitis (NF which is fulminant and potentially lethal. Although NF is a common occurrence in Indian Subcontinent due to low standard of living and poor hygiene Necrotizing fasciitis of retroperitoneum is extremely rare and only few cases have been reported till now. Herein we report a case of a 40yr unmarried female patient presenting to emergency department for acute abdomen and on exploratory laparotomy it was found out to be a case of extensive retroperitoneal necrotizing fasciitis with pregangrenous right ovary and adjacent fallopian tube.

  10. [Retroperitoneal dedifferentiated liposarcoma extending into the iliocostal muscle and the quadratus lumborum muscle accompanied with bone formation: case report].

    Science.gov (United States)

    Matsuura, H; Sakurai, M; Arima, K

    2001-12-01

    A 72-year-old man with back pain on the left side was admitted. Imaging analysis revealed a retroperitoneal mass and a mass in the left iliocostal muscle and the left quadratus lumborum muscle. The two masses could not be resected en bloc, and were resected separately. The clinicopathological findings of these tumors revealed dedifferentiated liposarcoma. The primary dedifferentiated liposarcoma appeared to have originated from the retroperitoneal space extending into the iliocostal muscle and the quadratus lumborum muscle. Then the mass was thought to have formed accompanied with osteogenesis.

  11. La linfadenectomía retroperitoneal para el cáncer testicular

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    Jaime Gutiérrez-Góngora

    2001-03-01

    Full Text Available Históricamente, los pacientes diagnosticados con enfermedad neoplásica testicular B (II han sido tratados con una disección primaria de ganglios retroperitoneales con la opción de aplicar quimioterapia adyuvante. Recientemente, varios autores han optado por la quimioterapia como tratamiento primario con la linfadenectomía retroperitoneal reservada para los pacientes que no lograban una remisión completa después del tratamiento con quimioterapia. El objetivo de este trabajo es definir por qué la linfadenectomía retroperitoneal (LR es realizada siempre en el Servicio de Urología del Hospital San Juan de Dios en el tratamiento del cáncer testicular de células germinales no seminomatosas estadio clínico A (I y B (II. Se presenta el sustento científico que avala esta práctica y se hace una breve reseña del estadiaje, del procedimiento quirúrgico utilizado.

  12. A Rare Coexistence of Retroperitoneal Pararenal Castleman's Disease with Focal Nodular Hyperplasia

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    Theodosios Theodosopoulos

    2013-01-01

    Full Text Available Castleman's disease is a distinct form of lymph node hyperplasia divided into a solitary and a multicentric type. The solitary type occurs most commonly in the mediastinum and is usually asymptomatic. We present a patient with Castleman's disease of the hyaline-vascular solitary type located in the retroperitoneum. The patient was a 38-year-old male, who presented to our hospital with fever. The imaging workup revealed a retroperitoneal mass, measuring 4 × 6 cm, located lateral to the aorta, inferior to the left renal artery and vein, and posterior to the left testicular vein. At workup, a solid hepatic lesion, 3 cm in diameter, located in the left lobe of the liver, segment IV, was also identified. Both lesions were surgically excised. The retroperitoneal tumor had the features of angiofollicular hyperplasia (Castleman's disease, hyaline-vascular type, whereas a diagnosis of focal nodular hyperplasia was made for the hepatic lesion. The patient is well at fourty months followup postoperatively. Surgical excision is the treatment of choice for unifocal Castleman's disease.

  13. Spontaneous retroperitoneal hematoma associated with anticoagulation therapy and antiplatet therapy: Two centers experiences

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    Abdulmuttalip Simsek

    2014-12-01

    Full Text Available Background: To analyze the characteristics of the patients with diagnosis of spontaneous retroperitoneal hematoma associated with anticoagulation therapy and antiplatet therapy. Methods: From January 2006 to March 2013, 9 patients (6 from Haseki Training and Research Hospital - Urology Department and 3 from Istanbul Medical Faculty - Gynecology and Obstetric Department were included in the study. Patients charts including sex, age, comorbidities, main complaint, and medication intake were examined. Also initial hemoglobin level, initial International Normalized Ratio level, red blood cells and fresh frozen plasma units transfused were evaluated. Results: Median age was 60 year-old. Abdominal pain and flank pain were common symptoms. Eight patients were taking only anticoagulation therapy, 2 only antiplatet therapy and 1 both anticoagulation and antiplatet therapy. Median initial hemoglobin value was 9,0 g/dL and median International Normalized Ratio level was 3.2 Patients were evaluated by abdominal ultrasonography or abdominal computer tomography. Seven patients were treated conservatively. Only one patient died because of septic shock with a mortality ratio of 11%. Conclusion: Despite benefits of anticoagulation and antiplatet theraphy these agents have serious side-affects as retroperitoneal hemorrhage in elderly patients taking multi-drug medication.

  14. Malignant retroperitoneal teratoma in a young girl: a rare case report

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    Maneesha Anil Patwardhan

    2014-02-01

    Full Text Available Of all primary retroperitoneal teratomas, less than four percent occur in children and 90% are benign. Here we report a case of malignant retroperitoneal teratoma (dermoid in a 15 year old girl who presented to our hospital - Acharya Vinoba Bhave Rural Hospital (AVBRH. She presented with a tender, large, irregular mass with variegated consistency in the entire left side of abdomen crossing midline. Ultrasound of abdomen suggested a complex intra-abdominal mass with septations and lobulations. It was not feasible to use other imaging modalities for evaluation due to poor socio-economic status and illiteracy. Patient underwent exploratory laparotomy with tumor resection along with left kidney and part of the descending colon which was densely adhered to tumor. Histopathological examination of tumor was suggestive of immature teratoma. Post operative recovery was uneventful and patient was discharged from the institution. Tissue adherence which can be observed in both benign and malignant form of teratomas, requires extended surgery for removal of adhered organ for the completeness of surgery and good prognosis. [Int J Res Med Sci 2014; 2(1.000: 362-364

  15. Multidetector Computed Tomography Features in Differentiating Exophytic Renal Angiomyolipoma from Retroperitoneal Liposarcoma

    Science.gov (United States)

    Wang, Qiushi; Juan, Yu-Hsiang; Li, Yong; Xie, Jia-Jun; Liu, Hui; Huang, Hongfei; Liu, Zaiyi; Zheng, Junhui; Saboo, Ujwala S.; Saboo, Sachin S.; Liang, Changhong

    2015-01-01

    Abstract This study aims to evaluate the multidetector computed tomography (CT) imaging features in differentiating exophytic renal angiomyolipoma (AML) from retroperitoneal liposarcoma. We retrospectively enrolled 42 patients with confirmed exophytic renal AML (31 patients) or retroperitoneal liposarcoma (11 patients) during 8 years period to assess: renal parenchymal defect at site of tumor contact, supply from branches of renal artery, tumoral vessel extending through the renal parenchyma, dilated intratumoral vessels, hemorrhage, non–fat-containing intratumoral nodules with postcontrast enhancement, calcification, renal sinus enlargement, anterior displacement of kidneys, and other associated AML. Renal parenchymal defect, renal arterial blood supply, tumoral vessel through the renal parenchyma, dilated intratumoral vessels, intratumoral/perirenal hemorrhage, renal sinus enlargement, and associated AML were seen only or mainly in exophytic renal AML (all P value < 0.05); however, non–fat-attenuating enhancing intratumoral nodules, intratumoral calcification, and anterior displacement of the kidney were more common in liposarcoma (all P value < 0.05). AMLs reveal renal parenchymal defect at the site of tumor contact, supply from renal artery, tumoral vessel extending through the renal parenchyma, dilated intratumoral vessels, intratumoral and/or perirenal hemorrhage, renal sinus enlargement, and associated AML. Non–fat-attenuating enhancing intratumoral nodules, intratumoral calcifications, and anterior displacement of kidney were more commonly seen in liposarcoma. PMID:26376398

  16. C. T. criteria of the differential diagnosis in primary retroperitoneal masses

    Energy Technology Data Exchange (ETDEWEB)

    Pistolesi, G.F.; Procacci, C.; Caudana, R.; Bergamo Andreis, I.A.; Manera, V.; Recla, M.; Grasso, G.; Florio, C.

    1984-05-01

    This personal series of 44 primary retroperitoneal masses (P.R.P.M.) studied by C.T. is analyzed. The reliability of C.T. in the identification (44/44), characterization (43/44) and origin evaluation (41/44) of P.R.P.M. has been absolutely satisfactory. In particular, those criteria of C.T. diagnosis which may be utilized in the evaluation of the origin of upper abdominal masses are thoroughly described. The evaluation of the involvement (non invasive; invasive) of adjacent viscera has been achieved in 22/38 P.R.P.M. verified at operation. The evaluation of tumour resectability has been less reliable due to the high incidence of under-diagnosis (60% in our personal experience). C.T. may be used in addition as an aid to different diagnostic techniques (percutaneous guided needle biopsy) or to therapy (drainage of retroperitoneal abscesses). C.T. is absolutely necessary in the follow-up of P.R.P.M. after surgery, radiotherapy or chemotherapy.

  17. A rare case of retroperitoneal malignant triton tumor invading renal vein and small intestine

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    Mijović Žaklina

    2013-01-01

    Full Text Available Introduction. Malignant Triton tumor is a very rare malignant peripheral nerve sheath tumor with rhabdomyosarcomatous differentiation. Most of those tumors occur in patients with von Recklinghausen’s disease or as a late complication of irradiation and commonly seen in the head, neck, extremities and trunk. Case report. We reported retroperitoneal malignant Triton tumor in a 57-year-old female patient. Skin lesions were not present, and there was no family history of neurofibromatosis or previous irradiation. The presented case is one of a few recorded in the specialized literature that occurs in the retroperitoneal space in sporadic form. In this case, tumor consisted of a multilobular mass was in close relation with the abdominal aorta and inferior vena cava and involved the renal vein with gross invasion of the small intestine. The patient underwent total resection of the tumor and left nefrectomy was performed. The small intestine 10 cm in length was also resected and end-to-end anastomosis was conducted. The postoperative course was uneventful and the patient was discharged from the hospital ten days after the surgery. Conclusion. Diagnostically, it is crucial to recognize this uncommon histological variant because malignant Triton tumor has a worse prognosis than classic malignant peripheral nerve sheath tumor does. The use of the immunohistochemistry is essential in making the correct diagnosis. Only appropriate pathological evaluation supported by immunostaining with S-100 protein and desmin confirmed the diagnosis. Aggressive surgical management treatment improves the prognosis of such cases with adjuvant radiotherapy.

  18. Retroperitoneal necrotizing fasciitis presenting with peritonism in a 33-year-old Nepalese man: a case report

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    Giri Smith

    2012-02-01

    Full Text Available Abstract Introduction Retroperitoneal necrotizing fasciitis is a rare, fulminant, and potentially lethal complication of intra-abdominal suppuration. A retroperitoneal origin is very rare and very few cases have been reported in the literature. To the best of our knowledge, this case is only the fourth case reported of successful management following retroperitoneal necrotizing fasciitis. Case presentation A 33-year-old Tamang man presented to our facility with a history of five days of fever and vomiting and eight days of severe left loin pain. On examination, he had features of peritonism. A laparotomy was performed, revealing extensive necrotizing fasciitis of the retroperitoneum extending to the anterior abdominal wall. Our patient survived following extensive debridement of the necrotic tissues and supportive care. Conclusions Retroperitoneal necrotizing fasciitis can rarely present with features of peritonism, and hence should be included as a possible differential diagnosis for anyone presenting with peritonism. Although a fatal condition, early intervention and aggressive management can save the life of a patient.

  19. Massive retroperitoneal hematoma as a complication of anticoagulation therapy in a patient treated in a pulmonary intensive care unit

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    Stjepanović Mihailo

    2015-01-01

    Full Text Available Introduction. Retroperitoneal hematoma may occur as a result of trauma, but also from rupture of arterial aneurysms (aortic or iliac, surgical complications, tumors or anticoagulation therapy. Case report. We presented a patient on permanent anticoagulation therapy. On the day of admission to our institution, the patient had the value of his INR 5.57 which required immediate suspension of the therapy. The main symptom in this patient was pain in the right inguinal canal with propagation along the right leg, which was indicated in clinical picture of spontaneous retroperitoneal haematoma. After three days the fall of hemoglobin occurred, so the additonal diagnostics was done. A computed tomography of the abdomen was performed showing well limited, large retroperitoneal hematoma (213 x 79 x 91 mm. Transfusion of concentrated red blood cells was performed twice with satisfactory correction of hemoglobin level, and four units of fresh frozen plasma. The patient was hemodynamically stabilized and discharged after a two-month long intensive care unit treatment, with the advice to use low-molecular weight heparin 2 x 0.4 mg subcutaneusly, due to persistent arrhythmia. Conclusion. In patients on anti-coagulation therapy regular monitoring of the anticoagulant status is extremely important, because of the possibility of fatal complications development, such as retroperitoneal hematoma.

  20. Massive retroperitoneal hematoma as a complication of anticoagulation therapy in a patient treated in a pulmonary intensive care unit.

    Science.gov (United States)

    Stjepanović, Mihailo; Buha, Ivana; Raljević, Snezana; Babić, Uroš; Savić, Milan; Mašković, Jovana; Roksandić, Marina; Marić, Dragana

    2015-06-01

    Retroperitoneal hematoma may occur as a result of trauma, but also from rapture of arterial aneurysms (aortic or iliac), surgical complications, tumors or anticoagulation therapy. We presented a patient on permanent anticoagulation therapy. On the day of admission to our institudon, the patient had the value of his INR 5.57 which required immediate suspension of the therapy. The main symptom in this patient was pain in the right inguinal canal with propagation along the right leg, which was indicated in clinical picture of spontaneous retroperitoneal haematoma. After three days the fall of hemoglobin occurred, so the additonal diagnostics was done. A computed tomography of the abdomen was performed showing well limited, large retroperitoneal hematoma (213 x 79 x 91 mm). Transfusion of concentrated red blood cells was performed twice with satisfactory correction of hemoglobin level, and four units of fresh frozen plasma. The patient was hemodynamically stabilized and discharged after a two-month long intensive care unit treatment, with the advice to use low-molecular weight heparin 2 x 0.4 mg subcutaneusly, due to persistent arrhythmia. In patients on anticoagulation therapy regular monitoring of the anticoagulant status is extremely important, because of the possibility of fatal complications development, such as retroperitoneal hematoma.

  1. Laparoscopic treatment for retroperitoneal hyaline-vascular type localized Castleman's disease (LCD) in the iliac vessel region.

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    Le, Aiwen; Shan, Lili; Wang, Zhonghai; Dai, Xiaoyun; Xiao, Tianhui; Zhuo, Rong; Yuan, Rui

    2015-01-01

    To improve the understanding, diagnostic levels, and therapeutic levels of retroperitoneal hyaline vascular type LCD in the iliac vessel region. Diagnostic and therapeutic processes of 4 patients with retroperitoneal LCD in the iliac vessel region were retrospectively analyzed. The median ages of the research patients was 31.3 years old, Pelvic vascular dual-source computed tomography (CT) indicated an abnormal pelvic irregular cloddy intensity shadow with heterogeneous densities and punctate calcified lesions. The enhanced scanning showed significantly enhanced lesions and multiple tortuous vascular images inside and around the lesions. Patients' preoperative diagnoses were all "pelvic mass with unknown characteristics", and retroperitoneal masses were successfully stripped off after the laparoscopic surgery. Intra operative findings indicated 1 mass located at the left obturator nerve, 1 at the left internal iliac artery, and 2 at the right external iliac artery. The postoperative pathological reports suggest a diagnosis of Castleman's disease. Retroperitoneal LCD in the iliac vessel region is generally asymptomatic. Preoperative imaging data may help with the diagnosis, but a confirmed diagnosis depends on the results of the pathological examination. Iliac artery embolization is performed prior to laparoscopic mass stripping if the masses have abundant blood supply, while lymphadenectomy is also applied to those with enlarged lymph nodes.

  2. A Giant Retroperitoneal Liposarcoma Encasing the Entire Left Kidney and Adherent to Adjacent Structures: A Case Report

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    Sung Don  Oh

    2016-06-01

    Full Text Available Retroperitoneal liposarcoma is a rare tumor. The dimension and weight of liposarcoma are variable; those over 20 kg are called ‘giant liposarcoma’. Herein, we report giant retroperitoneal liposarcoma measuring 45 cm in diameter and 25 kg in weight encasing the entire left kidney and adherent to adjacent structures. A 71-year-old woman presented for a regular checkup. Image study revealed a huge mass probably indicative of retroperitoneal liposarcoma encasing the entire left kidney and adherent to adjacent structures. We performed an organ-preserving surgical removal. The pathologic report was liposarcoma. At postoperative month 16, a follow-up CT revealed a locally recurrent tumor. The patient underwent surgical removal of the newly discovered mass. After the second surgery, the patient underwent regular follow-up CT for approximately 12 months, and to date, there has been no evidence of tumor recurrence. High-grade liposarcoma shows sensitivity to radiation therapy. However, the toxic effect of radiation therapy limits this option by treatment modality. The use of chemotherapy is also controversial. As a result, complete resection is the gold standard treatment. Here, we report a giant retroperitoneal liposarcoma encasing the entire left kidney and adherent to adjacent structures, describe successful organ-preserving surgical removal and discuss prognosis.

  3. Ultrasound and ultrasound guided biopsy, CT and lymphography in the diagnosis of retroperitoneal metastases in testicular cancer

    DEFF Research Database (Denmark)

    Damgaard-Pedersen, K; von der Maase, H

    1991-01-01

    A retrospective study of bipedal lymphography (BL), computed tomography (CT) and ultrasonography (US) of retroperitoneal lymph nodes has been carried out in 95 patients with newly diagnosed testicular cancer. Twenty-one patients had abnormal lymph nodes at the time of staging. The diagnostic...

  4. Nonpalpable testicular pure seminoma with elevated serum alpha-fetoprotein presenting with retroperitoneal metastasis: a case report.

    Science.gov (United States)

    Iwatsuki, Shoichiro; Naiki, Taku; Kawai, Noriyasu; Etani, Toshiki; Iida, Keitaro; Ando, Ryosuke; Nagai, Takashi; Okada, Atsushi; Tozawa, Keiichi; Sugiyama, Yosuke; Yasui, Takahiro

    2016-05-05

    Patients with a primary pure seminoma in the testis who have elevated serum alpha-fetoprotein are rare and should be treated as patients with nonseminomatous germ cell tumors. However, nonpalpable testicular tumors in this condition have never been reported. We describe a case of nonpalpable pure testicular seminoma with elevated serum alpha-fetoprotein presenting retroperitoneal metastasis. A 29-year-old Asian man was referred to our hospital with right flank pain. Computed tomography showed a mass located between his aorta and inferior vena cava, but a testicular tumor was not detected. His serum levels of lactate dehydrogenase, alpha-fetoprotein, and DUPAN-2 were high. Although no tumor or nodule was palpable in his testis, ultrasonography revealed multiple low echoic lesions in his right testicular parenchyma. He was diagnosed with right testicular cancer with retroperitoneal lymph node metastasis and underwent right high orchiectomy. A pathological examination revealed pure seminoma and no nonseminomatous components were found in the specimen. Three courses of induction systemic chemotherapy (cisplatin, etoposide, and bleomycin) normalized his serum alpha-fetoprotein and DUPAN-2 levels. Three additional courses of chemotherapy (etoposide and bleomycin) were performed, and treatment was completed with laparoscopic retroperitoneal lymph node dissection. Pathology of the dissected specimen showed fibrous and necrotic tissue with no viable cells. He is alive without recurrence 54 months after orchiectomy. We report a case of pure testicular seminoma with elevated serum alpha-fetoprotein and DUPAN-2 presenting retroperitoneal metastasis. We recommend an ultrasound examination of bilateral testes when large retroperitoneal tumors are detected in young men, even if a mass is not palpable in the scrotum.

  5. Effect of body mass index on retroperitoneal laparoscopic partial nephrectomy in Chinese patients

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    Zheng ZHAO

    2014-01-01

    Full Text Available Objective To compare the perioperative clinical characteristics of patients with different body mass index (BMI undergoing retroperitoneal laparoscopic partial nephrectomy. Methods The clinical data of 409 patients (male 261, female 148, aged 15-81(50.1±12.2 years, having received retroperitoneal laparoscopic partial nephrectomy from June 2005 to June 2012 in the Department of Urology, First Hospital of Peking University were retrospectively analyzed. The BMI of these 409 patients was 15.6-37.1(25.1±3.6kg/m2. According to the BMI values, these 409 patients were divided into nonobese group (BMI<28kg/m2, n=322 and obese group (BMI≥28kg/m2, n=87, and the perioperative clinical data of the two groups were compared. Results The operative time and length of stay of obese group (147.0±61.6min, 14.2±8.1d were longer than those of nonobese group (130.0±47.9min, 11.7±5.3d, P=0.018, P=0.000, respectively. The hospital cost of obese group (32 444.2±16 584.8 Yuan was higher than that of nonobese group (28 239.7±6485.7 Yuan, P=0.000. The incidence of intraoperative and postoperative complications of obese group (11.5%, 6.9% was similar to those of nonobese group (6.2%, 3.7%, P=0.106, P=0.201, respectively. There was no significant difference between the two groups in age, warm ischemia time, collecting system repair rate, blood loss, tumor location and size, or the tumorous property (benign or malignant. Conclusions Retroperitoneal laparoscopic partial nephrectomy is safe for obese patients, and the incidence of perioperative complication is similar to that for nonobese patients, but the operative time is longer than that of nonobese patients, implying that the operative difficulty would be increased with an increase in BMI. DOI: 10.11855/j.issn.0577-7402.2013.12.09

  6. Outcome of pancreaticoduodenectomy with extended retroperitoneal lymphadenectomy for adenocarcinoma of the head of the pancreas

    Institute of Scientific and Technical Information of China (English)

    YANG Yin-mo; WAN Yuan-lian; TIAN Xiao-dong; ZHUANG Yan; HUANG Yan-ting

    2005-01-01

    Background Nowadays, there is a remarkable rise in resectability rate of periampullary adenocarcinoma and the mortality and morbidity of the pancreaticoduodenectomy procedure have been reduced remarkably, while the 5 year survival rates of patients with carcinoma of the head of the pancreas are still below 25%. We conducted this retrospective study to evaluate the clinical outcome of radical pancreaticoduodenectomy with extended retroperitoneal lymphadenectomy as a surgical therapy for adenocarcinoma of the head of the pancreas.Methods Twenty cases with adenocarcinoma of the head of the pancreas were treated by standard pancreaticoduodenectomy (removing only the peripancreatic lymph nodes en bloc with the tumour) from 1994 to 1997, and 46 cases with the same disease underwent extended retroperitoneal lymphadenectomy associated with standard pancreaticoduodenectomy from 1998 to 2002. The patients for whom there were insufficient follow-up data, or who had received postoperative adjuvant therapy, were excluded from the analysis. Clinical and pathological parameters of both groups were reviewed. The postoperative morbidity, mortality and survival data were compared statistically. Results Demographic and histopathological characteristics were similar in the two groups of patients. Performance of the extended lymphadenectomy lengthened the procedure. The mean total number of lymph nodes resected was significantly higher in the radical group (P< 0.05). Of the 46 cases in the radical group, 26% (12/46) had metastatic adenocarcinoma in the resected retroperitoneal lymph nodes. There was one perioperative death in the standard group, and two in the radical group. Postoperative diarrhoea and lymphatic leakage were only observed in the radical group. Transfusion requirements and postoperative morbidity rates did not differ between the two groups. The 1-, 2- and 3-year survival rates were 63%, 32% and 21% respectively in the standard group, and 66%, 38% and 21% in the radical

  7. Retroperitoneal oblique corridor to the L2-S1 intervertebral discs in the lateral position: an anatomic study.

    Science.gov (United States)

    Davis, Timothy T; Hynes, Richard A; Fung, Daniel A; Spann, Scott W; MacMillan, Michael; Kwon, Brian; Liu, John; Acosta, Frank; Drochner, Thomas E

    2014-11-01

    accessed from an oblique angle consistently with gentle retraction of the iliac vessels. This study supports the potential of an MIS oblique retroperitoneal approach to the L2-S1 discs.

  8. Retroperitoneal Malignant Peripheral Nerve Sheath Tumor Replacing an Absent Kidney in a Child

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    Samin Alavi

    2013-01-01

    Full Text Available Malignant peripheral nerve sheath tumors (MPNSTs are nonrhabdomyosarcoma soft tissue sarcomas with rare occurrence in children specially in the retroperitoneum. We describe a young child who presented with an abdominal mass. Both ultrasound and computed tomography revealed a large right-sided abdominal mass in the anatomic place of right kidney, while no kidney or ureter was observed at that side. He underwent surgical resection of the tumor with a primary impression of Wilms tumor. To the authors’ knowledge, this is the first case of retroperitoneal malignant peripheral nerve sheath tumor and absent kidney. This case suggests the very rare probability of association of MPNSTs in children with genitourinary tract anomalies such as renal agenesis.

  9. Giant retroperitoneal fetus-in-fetu: An unusual cause of respiratory distress

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    Singh Satyendra

    2007-01-01

    Full Text Available Fetus-in-fetu (FIF is a rare congenital condition in which a vertebrate fetus is incorporated within its host, a newborn or an infant. We report an interesting case of FIF presenting as an abdominal mass with respiratory distress in a 4-month-old girl, and review the existing literature. An ultrasound abdomen showed a right sided cystic mass containing multiple calcifications. Laparotomy revealed a well-encapsulated right retroperitoneal mass above the right kidney with two rudimentary limbs attached to an amniotic bag by an umbilical cord. Excision of the capsule revealed a yellowish fluid and an incompletely developed fetus covered by vernix caseosa. Pathologic examination showed an irregular fetiforme mass, weighing 1200 gm, with two rudimentary limbs, encephalus, stomach, duodenum, bowel, bone, cartilage, bone marrow, upper and lower respiratory tissue, and spleen. Complete excision of the FIF was performed. The postoperative period was uneventful and the patient was discharged on the seventh postoperative day.

  10. Spontaneous Retroperitoneal Hemorrhage in a Patient with Prolymphocytic Transformation of Chronic Lymphocytic Leukemia

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    Gwynivere A. Davies

    2013-01-01

    Full Text Available Prolymphocytic transformation of chronic lymphocytic leukemia is a rare but recognized entity. We present the case of a 76-year-old gentleman with a previous diagnosis of chronic lymphocytic leukemia who presented with fatigue, fever, and a white blood cell count of 500 000 with prolymphocytes on peripheral blood examination. Chlorambucil and dexamethasone were initiated. He developed progressive anemia during his admission with no clear cause on initial CT examination. Bilateral hip pain began several days later and he was unfortunately diagnosed with a large spontaneous retroperitoneal hemorrhage postmortem. This condition is rare and generally occurs in those receiving therapeutic anticoagulation or dialysis, with known bleeding disorders or vascular malformation, none of which were present in our patient. Pathology revealed marked leukemoid engorgement of the vessels of many organs with prolymphocytes. We discuss the potential etiologies and relationships between these critical diagnoses.

  11. Endovascular aortic graft infection resulting in retroperitoneal abscess: report of a case

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    Salvatore Di Somma

    2010-06-01

    Full Text Available Infection is a rare complication of aortoiliac endovascular procedures, with an incidence inferior to 0.5%, and it may result in a retroperitoneal abscess potentially evolving to sepsis and gastrointestinal bleeding. In more than 50% of cases endovascular aortoiliac prosthetic grafts infection occur months or years after the procedure. The growing number of endovascular procedures, and as the actually midterm follow up in most cases, septic sequelae will no doubt continue to occur with increased frequency and may represent an emerging problem in the ED for the emergency physician. Endovascular graft infection begins with unspecific clinical manifestations. An high index of suspicion in any patient with an aortic stent graft presenting prolonged or recurrent fever and or abdominal or back pain and a low threshold for obtaining CT scan should increase the clinician’s ability to make a timely diagnosis in the ED setting.

  12. Retroperitoneal laparoscopic pyelolithotomy versus extra corporeal shock-wave lithotripsy for management of renal stones

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    Chander Jagdish

    2010-01-01

    Full Text Available Aim: The purpose of this study was to evaluate the role of retroperitoneal laparoscopic pyelolithotomy (RPPL and its comparison with extra corporeal shock wave lithotripsy in the management of renal calculi. Materials and Methods: The study was carried out in the Department of surgery, Maulana Azad Medical College, New Delhi, India. The study included 86 cases of solitary renal calculi in the retroperitoneoscopic (RPPL group and 82 cases in the shock wave lithotripsy (SWL group. The parameters compared were stone clearance, hospital stay, number of postoperative visits, mean time to resume normal activities, number of man days lost, and analgesic requirement. Results : The RPPL group showed better stone clearance, fewer hospital visits, low analgesic requirement, fewer number of man days lost, and early resumption of normal activities, as compared to the SWL group. Conclusions : Shock wave lithotripsy, being a noninvasive modality, is an established procedure all over the world. However RPPL achieves comparable or better results in high volume centers.

  13. CT-Guided Radioactive {sup 125}I Seed Implantation Therapy of Symptomatic Retroperitoneal Lymph Node Metastases

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    Wang, Zhongmin, E-mail: wzm0722@hotmail.com [Shanghai Jiaotong University School of Medicine, Department of Nuclear Medicine, Renji Hospital (China); Lu, Jian; Gong, Ju; Zhang, Liyun [Shanghai Jiaotong University School of Medicine, Department of Radiology, Ruijin Hospital Luwan Branch (China); Xu, Yingjia [Shanghai Jiao Tong University, Department of Cardiology, Shanghai Chest Hospital (China); Song, Shaoli [Shanghai Jiaotong University School of Medicine, Department of Nuclear Medicine, Renji Hospital (China); Chen, Kemin [Shanghai Jiaotong University School of Medicine, Department of Radiology, Ruijin Hospital (China); Liu, Fenju [Soochow University, School of Radiation Medicine and Public Health (China); Gang, Huang, E-mail: huanggang0722@hotmail.com [Shanghai Jiaotong University School of Medicine, Department of Nuclear Medicine, Renji Hospital (China)

    2013-04-12

    PurposeThis study explored the clinical efficacy of CT-guided radioactive {sup 125}I seed implantation in treating patients with symptomatic retroperitoneal lymph node metastases.MethodsTwenty-five patients with pathologically confirmed malignant tumors received CT-guided radioactive {sup 125}I seed implantation to treat metastatic lymph nodes. The diameter of the metastatic lymph nodes ranged from 1.5 to 4.5 cm. Treatment planning system (TPS) was used to reconstruct the three-dimensional image of the tumor and then calculate the corresponding quantity and distribution of {sup 125}I seeds.ResultsFollow-up period for this group of patients was 2–30 months, and median time was 16 months. Symptoms of refractory pain were significantly resolved postimplantation (P < 0.05), and Karnofsky score rose dramatically (P < 0.05). Most patients reported pain relief 2–5 days after treatment. Follow-up imaging studies were performed 2 months later, which revealed CR in 7 patients, PR in 13 patients, SD in 3 patients, and PD in 2 patients. The overall effective rate (CR + PR) was 80 %. Median survival time was 25.5 months. Seven patients died of recurrent tumor; 16 patients died of multiorgan failure or other metastases. Two patients survived after 30 months follow-up. Two patients reported localized skin erythema 1 week postimplantation, which disappeared after topical treatment.ConclusionsCT-guided radioactive {sup 125}I seed implantation, which showed good palliative pain relief with acceptable short-term effects, has proved in our study to be a new, safe, effective, and relatively uncomplicated treatment option for symptomatic retroperitoneal metastatic lymph nodes.

  14. Radiotherapy combined with surgical treatment for retroperitoneal neoplasms: a meta-analysis

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    Chang QIU

    2015-06-01

    Full Text Available Objective To systematic review the prognosis of radiotherapy combined with surgery for the treatment of retroperitoneal neoplasms. Methods Articles concerning randomized clinical trials (RCTs in which radiotherapy (pre-, intraand post-operation in combination with surgery was compared with surgery alone were retrieved by searching Cochrane Library ( Jun 2014, Medline ( Jan 1950–June 2014, Chinese Biomedical Literature Database ( Jan 1994–Jun 2014, Chinese Science and Technology Periodicals Database ( Jan 1994–Jun 2014, China National Knowledge Infrastructure ( Jan 1994–Jun 2014 and Wanfang Database ( Jan 1997–Jun 2014 in English and Chinese languages. The selection/inclusion criteria and exclusion criteria were ascertained by reviewing the relevant literature. The quality of data of RCTs were assessed by two researchers independently. The Stata 12.0 was used to analyze the data to calculate or extract the hazard ratio (HR and 95%CI. Descriptive analysis was used for the articles which are not suitable for meta-analysis. Results The appropriate articles were selected. A analysis of nine articles (including 1 Chinese paper and 8 English papers suggests that the combination of radiotherapy and surgery for RCTs is more effective than surgery alone (Merge HR=0.57, 95%CI: 0.40-0.74, P=0.000, and there was a statistically significant difference between two groups. Conclusion Retroperitoneal neoplasm patients should receive appropriate radiotherapy at the same time of surgery to improve the prognosis and elevate the survival rate. DOI: 10.11855/j.issn.0577-7402.2015.05.10

  15. Predictors of viable germ cell tumor in postchemotherapeutic residual retroperitoneal masses

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    Khalid Al Othman

    2014-01-01

    Full Text Available Objective: The aim of this study was to identify predictors of viable germ cell tumor (GCT in postchemotherapeutic residual retroperitoneal masses. Materials and Methods: The pertinent clinical and pathologic data of 16 male patients who underwent postchemotherapeutic retroperitoneal lymph node dissection (PC-RPLND at King Faisal Specialist Hospital and Research Centre between 1994 and 2005 were reviewed retrospectively. It was found that all patients received cisplatin-based chemotherapy for advanced testicular GCT. Results: Out of the 16 male patients, 2 (13%, 8 (50%, and 6 (37% had viable GCT, fibrosis, and teratoma, respectively. Ten (10 of the patients with prechemotherapeutic S1 tumor markers did not have viable GCT, and two of the six patients who had prechemotherapeutic S2 tumor markers have viable GCT. All tumor marker levels normalized after chemotherapy even in patients with viable GCT. Four patients had vascular invasion without viable GCT. Furthermore, four patients had more than 60% embryonal elements in the original pathology, but only 1 had viable GCT at PC-RPLND. Four of the five patients with immature teratoma had teratoma at PC-RPLND but no viable GCT; however, out of the four patients with mature teratoma, one had viable GCT and two had teratoma at PC-RPLND. Of the two patients with viable GCT, one had 100% embryonal cancer in the original pathology, prechemotherapeutic S2 tumor markers, history of orchiopexy, and no vascular invasion; the other patient had yolk sac tumor with 25% embryonal elements and 40% teratoma in the original pathology, and prechemotherapeutic S2 tumor markers. Conclusion: None of the clinical or pathological parameters showed a strong correlation with the presence of viable GCT in PC-RPLND. However, patients with ≥S2 may be at higher risk to have viable GCT. Further studies are needed to clarify this.

  16. RETROPERITONEAL LYMPH NODE DISSECTION AFTER INDUCTION CHEMOTHERAPY IN METASTATIC TESTICULAR NON-SEMINOMA

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    V. B. Matveev

    2010-01-01

    Full Text Available Objective: to evaluate the outcome of retroperitoneal lymph node dissection (RLND in disseminated testicular non-seminoma patients with residual metastases after induction chemotherapy. Material and methods. The RLND performed in 1983 to 2007 were analyzed in 367 testicular non-seminoma patients with residual retroperitoneal masses after ineffective induction chemotherapy. The median age was 26.06.9 years. Orchidectomy was performed in all patients. Category N1 was regarded in 12 (3.3% patients, N2 in 79 (21.5%, N3 in 238 (64.9%, Nx in 38 (10.4%. Distant metastases were present in 133 (36.2% cases. The baseline tumor marker level was elevated in 328 (89.4% patients (S1 in 169 (46.0%, S2 in 108 (29.4%, S3 in 51 (13.9%, Sx in 39 (10.6%. According to the IGCCCG prognostic model, 149 (40.6% patients were classified as good prognostic group, 100 (27.2% as moderate, 77 (21.0% as poor ones; the prognostic group was not defined in 41 (11.2% cases who had started treatment at another facility due to data unavailability. After orchifuniculectomy, all patients received induction cisplatin-based chemotherapy which resulted in tumor shrinkage <50% in 70 (19.1%, 51-90% in 166 (45.2%, and >90% - in 29 (7.9% cases. The response was not properly assessed in 102 (27.8% cases. CT scan revealed residual retroperitoneal masses after chemotherapy in all patients (<2 cm - 52 (14.2%, 2-5 cm - 166 (45.2%, >5 cm - 149 (40.6%. The tumor markers level remained elevated following chemotherapy in 70 (19.1% cases. All patients underwent RLND (complete in 295 (80.4% cases. Radical RLND demanded resection of adjacent organs in 22 (5.9% cases. Extraretroperitoneal metastases were removed simultaneously with retroperitoneal tumor in 22 (5.9% patients. Postoperative chemotherapy was administered in 100 (27.2% cases. The median followup was 82.1 (3-188 months. Results. Complications developed in 31 (8.5% of the 367 of patients. Mortality rate was 0.6% (2/367 cases. Resection of

  17. RETROPERITONEAL LYMPH NODE DISSECTION AFTER INDUCTION CHEMOTHERAPY IN METASTATIC TESTICULAR NON-SEMINOMA

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    V. B. Matveev

    2014-07-01

    Full Text Available Objective: to evaluate the outcome of retroperitoneal lymph node dissection (RLND in disseminated testicular non-seminoma patients with residual metastases after induction chemotherapy. Material and methods. The RLND performed in 1983 to 2007 were analyzed in 367 testicular non-seminoma patients with residual retroperitoneal masses after ineffective induction chemotherapy. The median age was 26.06.9 years. Orchidectomy was performed in all patients. Category N1 was regarded in 12 (3.3% patients, N2 in 79 (21.5%, N3 in 238 (64.9%, Nx in 38 (10.4%. Distant metastases were present in 133 (36.2% cases. The baseline tumor marker level was elevated in 328 (89.4% patients (S1 in 169 (46.0%, S2 in 108 (29.4%, S3 in 51 (13.9%, Sx in 39 (10.6%. According to the IGCCCG prognostic model, 149 (40.6% patients were classified as good prognostic group, 100 (27.2% as moderate, 77 (21.0% as poor ones; the prognostic group was not defined in 41 (11.2% cases who had started treatment at another facility due to data unavailability. After orchifuniculectomy, all patients received induction cisplatin-based chemotherapy which resulted in tumor shrinkage <50% in 70 (19.1%, 51-90% in 166 (45.2%, and >90% - in 29 (7.9% cases. The response was not properly assessed in 102 (27.8% cases. CT scan revealed residual retroperitoneal masses after chemotherapy in all patients (<2 cm - 52 (14.2%, 2-5 cm - 166 (45.2%, >5 cm - 149 (40.6%. The tumor markers level remained elevated following chemotherapy in 70 (19.1% cases. All patients underwent RLND (complete in 295 (80.4% cases. Radical RLND demanded resection of adjacent organs in 22 (5.9% cases. Extraretroperitoneal metastases were removed simultaneously with retroperitoneal tumor in 22 (5.9% patients. Postoperative chemotherapy was administered in 100 (27.2% cases. The median followup was 82.1 (3-188 months. Results. Complications developed in 31 (8.5% of the 367 of patients. Mortality rate was 0.6% (2/367 cases. Resection of

  18. Imaging findings of perirenal epithelioid angiomyolipoma mimicking a malignant retroperitoneal tumor: A case report with imaging findings

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    Kim, Jung Youn; Woo, Ji Young; Shin, Mi Kyoung; Lee, Yul; Hwang, Ji Young; Kim, Hee Yeong [Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul (Korea, Republic of); Park, Sung Bae [Dept. of Surgery, Kangwon National University Hospital, Chuncheon (Korea, Republic of)

    2016-09-15

    Epithelioid angiomyolipoma (EAML) is an uncommon, variant type of angiomyolipoma with a possibility of metastatic transformation and distant spread. Angiomyolipomas, including epithelioid variant type, are mostly renal in origin. EAML originating from extrarenal location is very rare and imaging findings are not well described. Herein, we reported a very rare case of EAML arising from the perirenal space that mimicked a malignant retroperitoneal tumor, in a 39-year-old female.

  19. Massive retroperitoneal hemorrhage from a giant renal angiomyolipoma treated by selective arterial embolization with an Amplatzer Vascular Plug II

    OpenAIRE

    Teichgräber, Ulf KM; de Bucourt, Maximilian

    2012-01-01

    We report on a 36-year-old Caucasian woman who presented to the emergency department with post-traumatic retroperitoneal bleeding diagnosed by computed tomography. After clinical stabilization of the patient, selective arterial embolization was performed. The angiomyolipoma's feeding artery was successfully treated with an 8-mm Amplatzer Vascular Plug Type II. The upper pole of the left kidney, which was supplied by a separate upper renal artery, was conserved. Consequently, the renal angiomy...

  20. Cardiac surgery in a patient with retroperitoneal fibrosis and heart valvulopathy, both due to pergolide medication for Parkinson's disease

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    Prokakis Christos

    2009-11-01

    Full Text Available Abstract Retroperitoneal fibrosis is best described as a chronic inflammatory process which may be idiopathic, but can rarely be brought about by medications, such as pergolide, used for treating Parkinson's disease. Pergolide can produce a fibrotic process in heart valves, resulting in valve insufficiency in up to 25% of cases. Herein we describe the case of a 68-year-old man who received pergolide for 2 years for Parkinson's disease. The patient developed retroperitoneal fibrosis resulting in renal failure from ureteral obstruction necessitating ureteral stenting, as well as significant aortic and mitral valve insufficiency. He successfully underwent surgery for combined aortic valve, mitral valve and ascending aorta replacement because of severe valve insufficiency and dilated (d = 5.8 cm ascending aorta. Retroperitoneal fibrosis improved with pergolide cessation and corticosteroid treatment. This is the second case reported in the literature, of a patient who had double valve and ascending aorta replacement surgery because he suffered from this rare but serious adverse effect of dopamine agonists used for managing Parkinson's disease.

  1. Cardiac surgery in a patient with retroperitoneal fibrosis and heart valvulopathy, both due to pergolide medication for Parkinson's disease.

    Science.gov (United States)

    Apostolakis, Efstratios E; Baikoussis, Nikolaos G; Tselikos, Dimitrios; Koniari, Ioanna; Prokakis, Christos; Fokaeas, Eleftherios; Karanikolas, Menelaos

    2009-11-13

    Retroperitoneal fibrosis is best described as a chronic inflammatory process which may be idiopathic, but can rarely be brought about by medications, such as pergolide, used for treating Parkinson's disease. Pergolide can produce a fibrotic process in heart valves, resulting in valve insufficiency in up to 25% of cases. Herein we describe the case of a 68-year-old man who received pergolide for 2 years for Parkinson's disease. The patient developed retroperitoneal fibrosis resulting in renal failure from ureteral obstruction necessitating ureteral stenting, as well as significant aortic and mitral valve insufficiency. He successfully underwent surgery for combined aortic valve, mitral valve and ascending aorta replacement because of severe valve insufficiency and dilated (d = 5.8 cm) ascending aorta. Retroperitoneal fibrosis improved with pergolide cessation and corticosteroid treatment. This is the second case reported in the literature, of a patient who had double valve and ascending aorta replacement surgery because he suffered from this rare but serious adverse effect of dopamine agonists used for managing Parkinson's disease.

  2. An Extremely Rare and Unusual Case of Retroperitoneal and Pelvic Metastasis from Squamous Cell Carcinoma of Vallecula

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    Abhishek Purkayastha

    2016-06-01

    Full Text Available We report an extremely rare and unusual case of retroperitoneal and pelvic metastasis from primary squamous cell carcinoma of vallecula. Generally carcinoma oropharynx metastasizes to lungs, liver and bone while retroperitoneal and pelvic metastasis is rarely heard of. To the best of our knowledge this case is one of the scantly reported cases ever of this kind in the world.  A 60-year-old male presented with dysphagia and hoarseness of voice of four month duration.  Computed tomography (CT scan face and neck showed growth right vallecula. Biopsy of lesion showed squamous cell carcinoma. Metastatic work up was negative. He received definitive chemo-radiation. Patient during follow up presented with dyspepsia, abdominal discomfort and weight loss. Whole body positron emission tomography (WB PET scan revealed retroperitoneal and pelvic lymph node deposits which were confirmed as metastasis of squamous cell carcinoma by CT guided fine needle aspiration cytology (FNAC. Patient was exhibited palliative chemotherapy but his general condition deteriorated and he finally succumbed to his metastatic illness. This case is being reported to highlight its extreme rarity, the diagnostic and therapeutic challenges it presented and its overall dismal prognosis.

  3. Laparoscopic Retroperitoneal Lymph Node Dissection in the Extremely Obese Patient: Technical Insight Into Access and Port Placement

    Science.gov (United States)

    Sherwood, Jennifer B.; Gettman, Matthew T.; Cadeddu, Jeffrey A.

    2003-01-01

    Purpose: We report on laparoscopic retroperitoneal lymph node dissection (RPLND) in a morbidly obese patient to discuss the associated technical steps for satisfactory completion of staging lymphadenectomy. Methods: A laparoscopic RPLND was performed using a modified template on the left side. Initially, 4 ports were placed with the patient in the supine position. Three were placed 3 cm to the left of midline and one in the anterior axillary line, at the level of the umbilicus. During the operation, successful bowel retraction necessitated placement of 2 additional ports in the anterior axillary line (just above the pelvis and off the tip of the 12th rib). Using these 6 trocar sites, the dissection was completed, and 44 lymph nodes were obtained. Results: Laparoscopic retroperitoneal lymph node dissection was accomplished in an extremely obese patient with acceptable morbidity by using prudent modification of standard techniques. Conclusion: If access and port placement limitations are overcome, the benefits of laparoscopy in the obese are clear. This report serves as a signpost that laparoscopic retroperitoneal lymph node dissection for testes cancer can also be accomplished using modification of standard techniques. PMID:14558718

  4. Fast access and early ligation of the renal pedicle significantly facilitates retroperitoneal laparoscopic radical nephrectomy procedures: modified laparoscopic radical nephrectomy

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    Yang Qing

    2013-01-01

    Full Text Available Abstract Background The objective of this study was to develop a modified retroperitoneal laparoscopic nephrectomy and compare its results with the previous technique. Methods One hundred retroperitoneal laparoscopic nephrectomies were performed from February 2007 to October 2011. The previous technique was performed in 60 cases (Group 1. The modified technique (n = 40 included fast access to the renal pedicle according to several anatomic landmarks and early ligation of renal vessels (Group 2. The mean operation time, mean blood loss, duration of hospital stay conversion rate and complication rate were compared between the groups. Results No significant differences were detected regarding mean patient age, mean body mass index, and tumor size between the two groups (P >0.05. The mean operation time was 59.5 ± 20.0 and 39.5 ± 17.5 minutes, respectively, in Groups 1 and 2 (P P P >0.05. Conclusions Early ligature using fast access to the renal vessels during retroperitoneal laparoscopic radical nephrectomy contributed to less operation time and intraoperative blood loss compared with the previous technique. In addition, the modified technique permits the procedure to be performed following the principles of open radical nephrectomy.

  5. Mycophenolate mofetil combined with steroids: New experiences in the treatment of idiopathic retroperitoneal fibrosis

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    Obrenčević Katarina

    2007-01-01

    Full Text Available Background/Aim. Idiopathic retroperitoneal fibrosis (IRF is an uncommon disease characterized by a retroperitoneal fibrotic tissue that often involve the ureters, leading to the obstructive nephropathy and variable impairment of renal function. Findings strongly suggest an autoimmune etiology. Surgery, medical treatment with immunosuppressive drugs, or a combination of both are proposed. The optimal treatment has not been established yet. The aim of this study was to present our experience with combined immunosuppressive therapy of IRF, steroids (S and mycophenolate mofetil (MMF. Methods. We prospectively followed four patients with IRF from January 2004 to December 2006. Three patients had an active disease with bilateral hydronephrosis. In the two of them acute renal failure was presented, and ureteral catheters were inserted in one in order to manage ureteral obstruction. One patient has came to our unit with a relapse of IRF and incipient chronic renal failure after the prior therapy with ureterolysis and immunosuppressive drugs (azathioprine and tamoxifen. All patients received steroids and MMF. Two patients were treated with intravenous methylprednisolone pulses (250 mg each, for three consecutive days, followed by oral prednisone 0.5 mg/kg/day. The other two patients received oral prednisone at the same dose. Prednisone was gradually tappered to a maintenance dose of 10 mg/kg/day. Simultaneously, all patients received MMF, initially 1 g/day with the increase to 2 g/day. Results. After four weeks of the therapy all symptoms disappeared, as well as a hydronephrosis with a decrease of erythrocyte sedimentation rate and Creactive protein (CRP to normal level in all patients. Three patients remain in remission untill the end of the follow up. One patient had a relapse because of stopping taking the therapy after six months. He was treated by oral prednisone 0.5 mg/kg/day, which was gradually decreased. After twelve weeks hydronephrosis

  6. Developing retroperitoneal anaplastic carcinoma with choriocarcinoma focus after ovarian non-gestastional choriocarcinoma: Case report

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    Nikolić Branka

    2012-01-01

    Full Text Available Introduction. Choriocarcinoma is a malignant form of gestational trophoblastic neoplasm (GTN. It is a rare event but also a curable malignancy. In the majority of instancies it developes after any gestational event. In some cases it developes as non-gestational extrauterine malignancy. Prognosis of choriocarcinoma is poor when invasion and metastases appear early and spread fast. This form of choriocarcinoma can lead to incurable and letal outcome. Case report. We presented a 20-year-old patient with abdominal and retroperitoneal malignancy - anaplastic carcinoma combined with choriocarcinoma metastases in. Tumor developed three months after left adnexectomy which had been done because of adnexal tumor. Choriocarcinoma was immunohistochemicaly confirmed in adnexal masses. Two courses of chemotherapy, metotrexate + folic acid (MTX+FA regimen, were administrated. The initial serum beta human chorionic gonadotropin level stayed unknown as well as the last one after the treatment. The patient came from the other country and was hospitalized because of pelvic and abdominal pain and palpable abdominal masses in hypogastrium with progressive anemia. The human chorionic gonadotropin level was 38 mIU/L. Tumor biopsy was done and choriocarcinoma metastases were immunohistochemicaly confirmed with predominant anaplastic carcinoma. Five day course of MTX + cyclophosphamide regimen was administrated and the patient was prepared for operative treatment. Relaparotomy was perforemed and tumor completely exceeded. Tumor mass mostly developed retroperitonely and partialy in abdominal cavity infiltrating intestinal wall with rupture of sigmoid colon. Anaplastic carcinoma, with large fields of necrosis and bleeding, was confirmed after histological examination. Immunohistochemical examination excluded choriocarcinoma in tumor mass. After 20 blood units transfusion, one course of chemotherapy and tumor excision, the patient left hospital on the 9th postoperative day

  7. [Sudden motor and sensorial loss due to retroperitoneal hematoma during postoperative periods: a case report].

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    Şen, Pelin; Gültekin, Havva Gül; Caymaz, İsmail; Özel, Ömer; Türköz, Ayda

    A 68 year-old male patient was hospitalized for radical prostatectomy. He had no abnormal medical history including neurological deficit before the operation. Prior to general anesthesia, an epidural catheter was inserted in the L3-4 interspace for intraoperative and postoperative analgesia. After surgery for nine hours, he developed confusion and flaccid paralysis of bilateral lower extremities occurred. No pathology was detected from cranial computed tomography and diffusion magnetic resonance imaging no pathology was detected. His thoracic/lumbar magnetic resonance imaging. Intraabdominal pressure was shown to be 25mmHg, and abdominal ultrasonography revealed progression in the inflammation/edema/hematoma in the perirenal region. The Bromage score was back to 1 in the right foot on the 24th hour and in the left foot on the 26th hour. Paraplegia developed in patients after epidural infusion might be caused by potentiated local anesthetic effect due to retroperitoneal hematoma and/or elevated intra-abdominal pressure. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  8. Rapid Decline of Follicular Lymphoma-Associated Chylothorax after Low Dose Radiotherapy to Retroperitoneal Lymphoma Localization

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    Lien Van De Voorde

    2014-01-01

    Full Text Available Chylothorax is caused by disruption or obstruction of the thoracic duct or its tributaries that results in the leakage of chyle into the pleural space. A number of interventions have been used to treat chylothorax including the treatment of the underlying disease. Lymphoma is found in 70% of cases with nontraumatic malignant aetiology. Although patients usually have advanced lymphoma, supradiaphragmatic disease is not always present. We discuss the case of a 63-year-old woman presenting with progressive respiratory symptoms due to chylothorax. She was diagnosed with a stage IIE retroperitoneal grade 1 follicular lymphoma extending from the coeliac trunk towards the pelvic inlet. Despite thoracocentesis and medium-chain triglycerides (MCT, diet chylothorax reoccurred. After low dose radiotherapy (2×2 Gy to the abdominal lymphoma there was a marked decrease in lymphadenopathy at the coeliac trunk and a complete regression of the pleural fluid. In this case, radiotherapy was shown to be an effective nontoxic treatment option for lymphoma-associated chylothorax with long-term remission of pleural effusion.

  9. Retroperitoneal Sarcoma Involving Unilateral Double Ureter: Management, Treatment and Psychological Implications

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    Vito Leanza

    2014-05-01

    Full Text Available The case of a 45-year-old woman who was admitted to our university hospital for polymenorrhea, weight gain and pain in the left iliac region is reported. An abdominal ultrasound revealed a 9.5 × 5.2-cm, hypoechoic and inhomogeneous mass located on the left side of the pelvis and behind the ovary. The patient underwent surgery. The pelvic mass was firmly anchored to the small intestine, colon, sigma and uterine fundus. After removing the adhesions, double ureters, which had been incorporated in the mass, were observed on the left side. Resection of the unilateral double ureters was necessary in order to remove the entire mass, and thereafter, a left salpingoophorectomy was performed. A histological examination showed a malignant retroperitoneal mass. Termino-terminal ureteral anastomosis with two double-J stents was carried out. Total hysterectomy with preservation of the right adenexum and regional lymphadenectomy was performed. The purpose of this case report is to discuss the physical and psychological implications related to the combination of two rare entities: leiomyosarcoma and a double ureter located within the mass. A literature review on the clinical management and psychological aspects from a female cancer patient's perspective undergoing surgery with the aforementioned disorders will be discussed.

  10. Conservative management of a retroperitoneal hemorrhage following a ruptured renal angiomyolipoma in pregnancy.

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    Gyimadu, Adam O; Kara, Ozgur; Basaran, Derman; Esinler, Ibrahim

    2011-02-01

    Retroperitoneal hemorrhage following ruptured renal angiomyolipoma is usually managed surgically or by embolization. But when the same episode occurs in pregnancy, surgery which predisposes to preterm delivery and its subsequent sequelae, the unknown influences of radiation exposure on the fetus makes the management of such cases very challenging. A 21-year-old woman was seen in the emergency unit at the 25th week of her pregnancy with complaints of sudden onset left flank pain radiating to the back, nausea and hematuria. Abdominal magnetic resonance imaging (MRI) revealed masses consistent with angiomyolipoma in the upper pole of the left kidney with evidence of recent bleeding and the center of the right kidney measuring 11.5 × 9.5 cm and 3.5 cm, respectively. The patient received three units of red blood cell concentrate due to fall in hematocrit level resulting in hemodynamically stable condition until term. At term, an infant weighing 3510 g was delivered through elective cesarean section. To avoid iatrogenic preterm delivery and unnecessary fetal exposure to radiation, conservative management of ruptured angiomyolipoma in pregnancy may be considered as a treatment option in hemodynamically stable patients.

  11. Tissue expander placement and adjuvant radiotherapy after surgical resection of retroperitoneal liposarcoma offers improved local control.

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    Park, Hyojun; Lee, Sanghoon; Kim, BoKyong; Lim, Do Hoon; Choi, Yoon-La; Choi, Gyu Seong; Kim, Jong Man; Park, Jae Berm; Kwon, Choon Hyuck David; Joh, Jae-Won; Kim, Sung Joo

    2016-08-01

    Given that retroperitoneal liposarcoma (LPS) is extremely difficult to completely resect, and has a relatively high rate of recurrence, radiotherapy (RT) is the treatment of choice after surgical resection. However, it is difficult to obtain a sufficient radiation field because of the close proximity of surrounding organs. We introduce the use of tissue expanders (TEs) after LPS resection in an attempt to secure a sufficient radiation field and to improve recurrence-free survival.This study is a retrospective review of 53 patients who underwent surgical resection of LPS at Samsung Medical Center between January 1, 2005, and December 31, 2012, and had no residual tumor detected 2 months postoperatively. The median follow-up period was 38.9 months.Patients were divided into 3 groups. Those in group 1 (n = 17) had TE inserted and received postoperative RT. The patients in group 2 (n = 9) did not have TE inserted and received postoperative RT. Finally, those in group 3 (n = 27) did not receive postoperative RT. Multivariate analysis was performed to identify the risk factors associated with recurrence-free survival within 3 years. Younger age, history of LPS treatment, and RT after TE insertion (group 1 vs group 2 or 3) were significantly favorable factors influencing 3-year recurrence-free survival.TE insertion after LPS resection is associated with increased 3-year recurrence-free survival, most likely because it allows effective delivery of postoperative RT.

  12. Perioperative Endocrine Therapy for Patients with Cushing's Syndrome Undergoing Retroperitoneal Laparoscopic Adrenalectomy

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    Xiaobo Cui

    2012-01-01

    Full Text Available Objectives. To investigate the efficacy and safety of perioperative endocrine therapy (PET for patients with Cushing’s syndrome (CS undergoing retroperitoneal laparoscopic adrenalectomy (RLA. Methods. The novel, simplified PET modality of 82 patients who underwent RLA procedures for CS were studied. Clinical manifestations were observed for all patients on days 1 and 5 postoperatively, and clinical data, such as blood pressure (BP, levels of serum cortisol, adrenocorticotropin (ACTH, blood glucose, and electrolytes, were acquired and analyzed. Results. Supraphysiological doses of glucocorticoid were administered during the perioperative period, and the dosage was reduced gradually. In all 82 cases, the RLAs were performed successfully without any perioperative complication, such as steroid withdrawal symptoms. The patient’s symptoms and signs were improved quickly and safely during the hospital days. The serum cortisol and potassium levels were rather stable on days 1 and 5 postoperatively, and most were within the normal range. The clinical manifestations, serum levels of cortisol, ACTH, and potassium in most patients restored to normal gradually after several months (mean, 6.7 ± 1.2 months, except for one patient undergoing bilateral adrenalectomy. Conclusions. This perioperative endocrine therapy for patients with Cushing’s syndrome (mainly for adrenocortical adenoma undergoing retro-laparoscopic adrenalectomy is both effective and safe.

  13. Laparoscopic Partial Nephrectomy: Is It Worth Still Performing the Retroperitoneal Route?

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    Idir Ouzaid

    2012-01-01

    laparoscopic partial nephrectomy versus RLPN (retroperitoneal. Patients and Methods. From 1997 to 2009, a retrospective study of 153 consecutive patients who underwent TLPN or RLPN for suspicious renal masses was performed. Complications, functional and oncological outcomes were compared between the 2 groups. Results. With a mean followup of 39 and 32 months, respectively, 66 and 87 patients had TLPN and RLPN, respectively. Tumor location was more often posterior in the RLPN and more often anterior in the TLPN. Mean operative time and mean hospital stay were longer in the TLPN group with 190±85 min versus 154±47 (=0.001 and 9.2±6.4 days versus 6.2±4.5 days (<0.05, respectively. Transfusion and urinary fistulas rates were similar in the 2 groups. After 3-year followup, chronic kidney failure occurred in 6 and and 4% (=0.67 in after TLPN and RLPN, respectively. After 3-year followup, recurrence free survival was 96.7% and 96.6% (=0.91 in the TLPN and RLPN groups, respectively. Conclusion. Our study confirmed that TLPN had longer operative time and hospital stay than RLPN. The complication rates were similar. Furthermore, mid-term oncological and functional outcomes were similar.

  14. [Severe Acute Myocardial Infarction during Induction Chemotherapy for Retroperitoneal Germ Cell Tumor : A Case Report].

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    Sakka, Shotaro; Kawai, Koji; Tsujimoto, Ippei; Kurobe, Masahiro; Ichioka, Daishi; Kantori, Shuya; Kojima, Takahiro; Suetomi, Takahiro; Jouraku, Akira; Miyazaki, Jun; Hoshi, Tomoya; Nishiyama, Hiroyuki

    2016-09-01

    A 37-year-old man presented at our hospital. Pathological examination of a right orchiectomy specimen, radiographic examination, and tumor marker profile resulted in a diagnosis of retroperitoneal nonseminomatous germ cell tumor (intermediate risk according to IGCC classification). Laboratory testing revealed mild elevation of low density lipoprotein cholesterol. Induction chemotherapy with bleomycin, etoposide and cisplatin (BEP) was started, but he complained of chest pain on day 10 of the second cycle of BEP. We immediately started cardiac monitoring. One hour later, he suffered cardiac arrest due to ventricular fibrillation. Fortunately, sinus rhythm was restored after defibrillation. A diagnosis of acute myocardial infarction (AMI) with total occlusion at the mid-portion of the left anterior descending coronary artery was established by coronary angiography. After percutaneous transluminal coronary angioplasty was successfully performed, he recovered uneventfully. The induction chemotherapy was re-started 19 days after AMI. To avoid endothelial damage by bleomycin, we elected to treat with etoposide, ifosfamide, and cisplatin (VIP). After two further courses of VIP, the patient underwent resection of retoperitoneal tumor and achieved complete remission. The patient has remained disease-free during 3 years follow up without recurrence of AMI.

  15. Rare complication after a transrectal ultrasound guided prostate biopsy: a giant retroperitoneal hematoma.

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    Chiancone, Francesco; Mirone, Vincenzo; Fedelini, Maurizio; Meccariello, Clemente; Pucci, Luigi; Carrino, Maurizio; Fedelini, Paolo

    2016-05-24

    Common complications related to transrectal ultrasound (TRUS) guided prostatic needle biopsy are hematuria, hematospermia, and hematochezia. To the best of our knowledge, we report the second case of a very large hematoma extending from the pelvis into the retroperitoneal space in literature.A 66-year-old man with a serum prostate-specific antigen (PSA) of 5.4 ng/ml was admitted to our department for a TRUS-guided prostatic needle biopsy. Laboratory values on the day before biopsy, including coagulation studies, were all normal. The patients did not take any anticoagulant drugs. No immediate complications were encountered. Nevertheless, 7 hours after the biopsy, the patient reached our emergency department with severe diffuse abdominal pain, hypotension, tachycardia, and confusional state. He underwent an ultrasonography and then a computed tomography (CT) scan that showed "a blood collection in the pelvis that extending to the lower pole of left kidney associated with a focus of active contrast extravasation, indicating active ongoing prostate bleeding." Consequently, he underwent a diagnostic angiography that showed no more contrast extravasation, without the need of embolization. Management of hematoma has been conservative and hematoma was completely reabsorbed 4 months later.

  16. Total retroperitoneal laparoscopic nephroureterectomy with bladder-cuff resection for upper urinary tract transitional cell carcinoma.

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    Fang, Zhenqiang; Li, Longkun; Wang, Xiangwei; Chen, Wei; Jia, Weisheng; He, Fan; Shen, Chongxing; Ye, Gang

    2014-12-01

    Open nephroureterectomy (ONU) and bladder cuff resection (ONU-BCR) has been the gold standard of surgical treatment for upper urinary tract transitional cell carcinoma (UUT-TCC). The aim of this study is to introduce a modified total retroperitoneal laparoscopic nephroureterectomy (LNU) with bladder-cuff resection (LNU-BCR) method for treating UUT-TCC and compare its clinical efficacy with ONU-BCR. Sixty-five patients with UUT-TCC, who underwent ONU-BCR (n = 36) or LNU-BCR (n = 29) between January 2008 and June 2012, were analyzed in this retrospective study. Perioperative data as well as incidence of disease recurrence at the primary site or distant metastasis was compared in patients with at least 6 months follow-up. As compared with patients with ONU-BCR, the patients with LNU-BCR had significantly shorter operative time, lower estimated blood loss, shorter time to oral intake, lower analgesic dose, shorter duration of analgesic use, shorter duration of incision drainage tube, shorter time to ambulation out of bed and reduced postoperative hospital stay (all, p ONU-BCR with the advantages of reduced invasiveness, bleeding and hospitalization.

  17. Clinical Analysis of 81 Cases of Benign Retroperitoneal Schwannoma%81例良性腹膜后神经鞘瘤临床分析

    Institute of Scientific and Technical Information of China (English)

    李强; 高春涛

    2006-01-01

    Objective: To analyze the clinical manifestations of retroperitoneal schwannoma in order to improve the diagnosis and treatment of this rare disease. Methods: Between January 1951 and September 2004, 81 patients with retroperitoneal schwannoma were retrospectively analyzed. Results: All cases received operative therapy. Sixty cases (74.1%) received a total resection; 12 cases (14.9%) subtotal resection, and 9 cases (11.1%) exploration. During the surgical operation, a single tumor was found in 77 cases (95.1%), and multiple tumors in 4 cases (4.9%). Most of the retroperitoneal schwannomas located beside the spine. The tumor was a fusiform, round or oval mass that was sharply circumscribed and encapsulated. Pathologic results showed all 81 cases were benign schwannoma. In the 4 cases of multiple tumors,2 (2.5%) were diagnosed as double-primary tumors associated with ascending colon adenocarcinoma and lung squamous-cell cancer. One case recurred postoperatively. Conclusion: Retroperitoneal schwannoma was rare and preoperative diagnosis was difficult. Most of retroperitoneal schwannoma were benign and the surgical treatment was the first choice.

  18. Pancreatitis autoinmune asociada a fibrosis retroperitoneal: evolución tras dos años de seguimiento Autoimmune pancreatitis associated with retroperitoneal fibrosis: outcome after 24 months of follow-up

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    M. Romero

    2008-10-01

    Full Text Available Introducción: la pancreatitis autoinmune es un tipo de pancreatitis crónica caracterizado por un infiltrado linfoplasmocitario y una elevación de IgG e IgG4, que se ha descrito asociada a diversas manifestaciones extrapancreáticas y enfermedades autoinmunes, lo cual apoya la teoría de un mecanismo autoinmune fisiopatólogico de base. Caso clínico: presentamos el caso de un varón que debutó simultáneamente con una pancreatitis autoinmune asociada a fibrosis retroperitoneal y lesión de la vía biliar extrapancreática, con respuesta total tras tratamiento con corticoides durante 4 meses y ausencia de recurrencia tras 24 meses de seguimiento. Discusión: la pancreatitis autoinmune es un tipo de pancreatitis crónica que probablemente forme parte de un proceso sistémico autoinmune, cuyas manifestaciones extrapancreáticas más frecuentes son la fibrosis retroperitoneal y las lesiones de la vía biliar extrapancreática. Su correcto diagnóstico e inicio precoz del tratamiento puede favorecer la resolución completa de las lesiones, principalmente en los casos de bajo grado de actividad, con menor probabilidad de recurrencia.Introduction: autoimmune pancreatitis is a kind of chronic pancreatitis characterized by the presence of lymphoplasmacytic infiltration and severely elevated serum IgG and IgG4, which has been associated to many extrapancreatic lesions and other autoimmune disorders, leading to the theory of an autoimmune mechanism involved in the pathogenesis of this disease. Case report: we report the case of a man who simultaneously presented with autoimmune pancreatitis associated with retroperitonal fibrosis, and a lesion of the extrapancreatic bile duct, with total response to corticosteroid treatment for 4 moths and absence of recurrence after 24 months of follow-up. Discussion: autoimmune pancreatitis is a kind of chronic pancreatitis that is probably a part of a systemic autoinmune disease, with retroperitoneal fibrosis and

  19. Primary retroperitoneal mucinous cystadenoma with a sarcoma-like mural nodule: an immunohistochemical study with histogenetic considerations and literature review.

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    Demirel, Dilaver; Gun, Ismet; Kucukodaci, Zafer; Balta, Ahmet Ziya; Ramzy, Ibrahim

    2013-01-01

    Primary retroperitoneal mucinous cystadenomas (PRMCs) are extremely rare tumors and their association with sarcoma-like mural nodules (SLMNs) has not been described thoroughly. The aim of this study is to characterize the gross and microscopic features and the immunohistochemical profile of the first case of PRMC with SLMN and to discuss the differential diagnosis of SLMNs. The literature related to primary retroperitoneal mucinous tumors is reviewed in an attempt to clarify the histogenesis of the epithelial and sarcomatoid components of the associated mural nodules. A 34-yr-old woman presented with a 14-cm retroperitoneal cystic lesion with a 6-cm mural nodule. An immunohistochemical study with a panel of 19 antibodies and a histochemical study for mucin stains were performed. The epithelial component of the PRMC showed positive staining for cytokeratin (CK) 7, CK AE1/3, epithelial membrane antigen, carcinoembryonic antigen, and calretinin. The neoplasm was not immunoreactive for CK 20, CK 5/6, and the other antibodies used in this study. In addition, it stained positively for mucin by mucicarmine, periodic acid-Schiff, and Alcian blue. The stromal cells of the cyst showed estrogen receptor positivity. SLMN cells were negative for all CKs and other epithelial markers used in the study, but they showed diffuse positive staining for vimentin and CD68, and positive staining for Ki-67 was demonstrated in 25% of these cells. The immunohistochemical and histochemical profiles of PRMC were similar to those of ovarian mucinous neoplasms and the mesothelium. The formation of SLMNs seems to be related to subepithelial hemorrhage and some reactive epithelial changes near the mural nodules. The specific immunohistochemical and morphologic features of SLMNs are helpful in differentiating them from malignant mural nodules, including true sarcomas, osteoclast-rich undifferentiated carcinomas, and carcinosarcomas. Such a differentiation is critical in view of its significant

  20. Radical pancreatoduodenectomy combined with retroperitoneal nerve,lymph,and soft-tissue dissection in pancreatic head cancer

    Institute of Scientific and Technical Information of China (English)

    SHAO Qin-shu; YE Zai-yuan; LI Shu-guang; CHEN Kan

    2008-01-01

    Background Recent studies have revealed that the reason for the low surgical resection rate of pancreatic carcinoma partly lies in its biological behavior,which is characterized by neural infiltration.This study aimed to investigate the clinical significance of radical pancreatOduodenectomy combined with retroperitoneal nerve,lymph,and soft-tissue dissection for carcinoma of the pancreatic head.Methods Forty-six patients with pancreatic head cancer were treated in our hospital from 1995 to 2005.The patients were divided into two groups:radical pancreatoduodenectomy combined with retroperitoneal nerve,lymph and soft-tissue dissection (group A,n=25) and routine Whipple's operation (group B,n=21).There were no significant differences between the two groups in relation to age,gender and preoperative risk factors,and perioperative conditions,pathological data and survival rates were studied.Results There were no significant differences in tumor size,surgical procedure time,postoperative complications,and time of hospitalization.However,the number and positive rate of resected lymph nodes in group A were significantly higher than those in group B (P<0.05).The 1-and 3-year survival rate in group A were 80% and 53%,respectively,which was higher than those in group B (P<0.05).There were significant differences in the survival rates between patients with and without nerve infiltration in group A (P<0.05).Conclusions Radical pancreatoduodenectomy combined with retroperitoneal nerve,lymph and soft-tissue dissection,can effectiveoly remove the lymph and nerve tissues that were infiltrated by tumor.Meanwhile,this method can reduce the local recurrence rate so as to improve the long-term survival of patients.

  1. Open surgery versus retroperitoneal laparoscopic nephrectomy for renal tuberculosis: a retrospective study of 120 patients

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    Su Zhang

    2016-11-01

    Full Text Available Background Laparoscopic renal surgery has been widely used in the treatment of renal diseases. However, there is still little research about its application in addressing renal tuberculosis. The purpose of this study is to retrospectively investigate the surgical results of laparoscopic and open surgery for nonfunctional tuberculous kidneys. Methods Between May 2011 and June 2016, 120 nephrectomies were performed in patients with a nonfunctional tuberculous kidney. Of these, 69 patients underwent retroperitoneal laparoscopic nephrectomy, and 51 patients underwent open nephrectomy. Data about the patients’ characteristics and surgical outcomes were collected from their electronic medical records. Outcomes were compared between these two groups. Results Our results showed that a number of renal tuberculosis patients presented no significant symptoms during their disease. Lower urinary tract symptoms (LUTS were the most common at a rate of 73/120, followed by flank pain or accidently discovery (66/120, urine abnormality (30/120 and fever (27/120. Patients who underwent open surgery were similar to laparoscopic patients with regard to sex, BMI, location, previous tuberculous history, grade, anemia, adhesion, hypertension, diabetes and preoperative serum creatinine level, but were generally older than laparoscopic patients. There were no significant differences between open and laparoscopic surgery in estimated blood loss, transfusion, postoperative hospital days and perioperative complication rate. However, the median operation time of laparoscopic operation was much longer than open surgery (180 [150–225] vs 135 [120–165] minutes, P < 0.01. Seven of the 69 laparoscopic operations were converted to open surgery because of severe adhesions. Conclusion Laparoscopic nephrectomy is as an effective treatment as open surgery for a nonfunctional tuberculous kidney, although it requires more time during the surgical procedure. No significant

  2. Open surgery versus retroperitoneal laparoscopic nephrectomy for renal tuberculosis: a retrospective study of 120 patients.

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    Zhang, Su; Luo, You; Wang, Cheng; Xiong, Hu; Fu, Sheng-Jun; Yang, Li

    2016-01-01

    Laparoscopic renal surgery has been widely used in the treatment of renal diseases. However, there is still little research about its application in addressing renal tuberculosis. The purpose of this study is to retrospectively investigate the surgical results of laparoscopic and open surgery for nonfunctional tuberculous kidneys. Between May 2011 and June 2016, 120 nephrectomies were performed in patients with a nonfunctional tuberculous kidney. Of these, 69 patients underwent retroperitoneal laparoscopic nephrectomy, and 51 patients underwent open nephrectomy. Data about the patients' characteristics and surgical outcomes were collected from their electronic medical records. Outcomes were compared between these two groups. Our results showed that a number of renal tuberculosis patients presented no significant symptoms during their disease. Lower urinary tract symptoms (LUTS) were the most common at a rate of 73/120, followed by flank pain or accidently discovery (66/120), urine abnormality (30/120) and fever (27/120). Patients who underwent open surgery were similar to laparoscopic patients with regard to sex, BMI, location, previous tuberculous history, grade, anemia, adhesion, hypertension, diabetes and preoperative serum creatinine level, but were generally older than laparoscopic patients. There were no significant differences between open and laparoscopic surgery in estimated blood loss, transfusion, postoperative hospital days and perioperative complication rate. However, the median operation time of laparoscopic operation was much longer than open surgery (180 [150-225] vs 135 [120-165] minutes, P treatment as open surgery for a nonfunctional tuberculous kidney, although it requires more time during the surgical procedure. No significant differences in other surgical outcomes were observed.

  3. Combined Modality Management of Retroperitoneal Sarcomas: A Single-Institution Series of 121 Patients

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    Bishop, Andrew J.; Zagars, Gunar K. [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); Torres, Keila E.; Hunt, Kelly K.; Cormier, Janice N.; Feig, Barry W. [Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas (United States); Guadagnolo, B. Ashleigh, E-mail: aguadagn@mdanderson.org [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); Department of Health Services Research, MD Anderson Cancer Center, Houston, Texas (United States)

    2015-09-01

    Purpose: The purpose of this study was to investigate local control, survival outcomes, and complication rates of patients treated with aggressive surgery and radiation therapy (RT) for retroperitoneal sarcomas (RPS). Methods and Materials: We reviewed the medical records of 121 consecutive patients treated for RPS with surgery and RT between 1965 and 2012. The most common histology was liposarcoma (n=42; 35%). The median follow-up was 100 months (range: 20-467 months). Eighty-six patients (71%) were treated for initial presentation of RPS, and 35 patients (29%) presented with and were treated for RPS recurrence. RT was preoperative in 88 patients (73%; median dose: 50.4 Gy) and postoperative in 33 patients (27%; median dose: 55 Gy). Results: Five-year local control and overall survival rates were 56% and 57%, respectively. Two factors were associated with higher risk of any intra-abdominal recurrence at 5 years: positive or uncertain margins (58% vs 30% for negative margins, P<.001; hazard ratio [HR]: 2.7; 95% confidence interval [CI]: 1.6-4.8) and disease recurrence after previous resection (76% vs 31% for de novo RPS, P<.001; HR: 4.4; 95% CI: 2.5-7.5). The 10-year complication rate was 5%, and RT-related complications were associated with postoperative RT (P<.001) and RT dose of ≥60 Gy (P<.001). Conclusions: Intra-abdominal RPS recurrence continues to be a significant challenge despite the use of aggressive surgery and radiation therapy. Given the complications associated with postoperative radiation therapy, we recommend that preoperative radiation therapy is the preferred strategy when combined modality therapy is recommended.

  4. Retroperitoneal Sarcoma Target Volume and Organ at Risk Contour Delineation Agreement Among NRG Sarcoma Radiation Oncologists

    Energy Technology Data Exchange (ETDEWEB)

    Baldini, Elizabeth H., E-mail: ebaldini@partners.org [Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Abrams, Ross A. [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); Bosch, Walter [Department of Radiation Oncology, Washington University, St. Louis, Missouri (United States); Roberge, David [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, Quebec (Canada); Haas, Rick L.M. [Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam (Netherlands); Catton, Charles N. [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Indelicato, Daniel J. [Department of Radiation Oncology, University of Florida Medical Center, Jacksonville, Florida (United States); Olsen, Jeffrey R. [Department of Radiation Oncology, Washington University, St. Louis, Missouri (United States); Deville, Curtiland [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Chen, Yen-Lin [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Finkelstein, Steven E. [Translational Research Consortium, 21st Century Oncology, Scottsdale, Arizona (United States); DeLaney, Thomas F. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Wang, Dian [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States)

    2015-08-01

    Purpose: The purpose of this study was to evaluate the variability in target volume and organ at risk (OAR) contour delineation for retroperitoneal sarcoma (RPS) among 12 sarcoma radiation oncologists. Methods and Materials: Radiation planning computed tomography (CT) scans for 2 cases of RPS were distributed among 12 sarcoma radiation oncologists with instructions for contouring gross tumor volume (GTV), clinical target volume (CTV), high-risk CTV (HR CTV: area judged to be at high risk of resulting in positive margins after resection), and OARs: bowel bag, small bowel, colon, stomach, and duodenum. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. Results: Ten radiation oncologists contoured both RPS cases, 1 contoured only RPS1, and 1 contoured only RPS2 such that each case was contoured by 11 radiation oncologists. The first case (RPS 1) was a patient with a de-differentiated (DD) liposarcoma (LPS) with a predominant well-differentiated (WD) component, and the second case (RPS 2) was a patient with DD LPS made up almost entirely of a DD component. Contouring agreement for GTV and CTV contours was high. However, the agreement for HR CTVs was only moderate. For OARs, agreement for stomach, bowel bag, small bowel, and colon was high, but agreement for duodenum (distorted by tumor in one of these cases) was fair to moderate. Conclusions: For preoperative treatment of RPS, sarcoma radiation oncologists contoured GTV, CTV, and most OARs with a high level of agreement. HR CTV contours were more variable. Further clarification of this volume with the help of sarcoma surgical oncologists is necessary to reach consensus. More attention to delineation of the duodenum is also needed.

  5. Retroperitoneal liposarcoma; The role of adjuvant radiation therapy and the prognostic factors

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hong Seok; Yu, Jeong Il; Lim, Do Hoon; Kim, Sung Joo [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2016-09-15

    To evaluate the benefit of adjuvant radiation therapy (RT) for retroperitoneal liposarcoma (RPLS) following gross tumor removal. We reviewed 77 patients with primary RPLS surgically treated between January 2000 and December 2013. Cases with gross residual disease were excluded. Tumor grade was evaluated according to the French Federation of Cancer Centers Sarcoma Group (FNCLCC) system. Adjuvant RT was delivered to 32 patients (42%) using external beam RT alone. Median follow-up time was 36 months (range, 5 to 169). Among 77 patients, 33 (43%) presented with well-differentiated, 31 (40%) with de-differentiated, 8 (10%) with myxoid/round and 4 (5%) with pleomorphic morphology. The RT group included less well-differentiated subtype than surgery group (28% vs. 53%). During follow up, 34 patients (44%) showed local recurrence. Local recurrence rate was lower in the RT group (38%) compared to the surgery group (49%). The 3-year local control rate (LC) was 55.6%, and the 3-year overall survival (OS) was 82.1%. Tumor histology and FNCLCC grade were significantly associated with local recurrence. There was no statistical significance of adding adjuvant RT in LC (p = 0.312). However, patients with tumor histology other than well-differentiated subtype showed marginally decreased local recurrence rate after adjuvant RT (3-year LC, RT 43.9% vs. no RT 35.3%; p = 0.087). RPLS patients receiving RT experienced less local recurrence. We suggest that the addition of adjuvant RT may be related to improvement of LCs, especially in patients with non-favorable histologic subtypes.

  6. Comparison of retroperitoneal liposarcoma extending into the inguinal canal and inguinoscrotal liposarcoma.

    Science.gov (United States)

    Rhu, Jinsoo; Cho, Chan Woo; Lee, Kyo Won; Park, Hyojun; Park, Jae Berm; Choi, Yoon-La; Kim, Sung Joo

    2017-10-01

    This study was designed to analyze differences between retroperitoneal liposarcoma (RLPS) extending into the inguinal canal and inguinoscrotal liposarcoma. We retrospectively reviewed the records for patients who were managed for inguinal liposarcoma at Samsung Medical Center, a tertiary hospital, between January 1998 and December 2016. Patient data on demographics, tumour location, surgery, adjuvant therapy, histology, recurrence and death were collected. We used Mann-Whitney, Fisher exact and Kaplan-Meier log-rank tests to analyze differences between groups. Seven of 179 (3.9%) patients with abdominal liposarcoma had inguinoscrotal liposarcoma, and 6 of 168 (3.6%) patients with RLPS had extension to the inguinal canal. No differences were observed between groups in sex (p > 0.99), mean age (49.7 ± 6.4 yr v. 52.1 ± 12.5 yr, p = 0.37), laterality (p > 0.99) or scrotal involvement (40.0% v. 66.7%, p = 0.57). The RLPS group had significantly larger tumours than the inguinoscrotal group (27.9 ± 6.8 cm v. 7.8 ± 4.2 cm, p = 0.001). Postoperative complications were significantly more common in the RLPS group (n = 4, 83.3%); patients in the inguinoscrotal group experienced no postoperative complications (p = 0.021). Log-rank tests showed that the groups had no statistical differences in disease-free survival (p = 0.94) or overall survival (p = 0.10). However, inoperable disease-free survival was significantly poorer in the RLPS group (p = 0.010). Although initial signs and symptoms can be similar, RLPS extending into the inguinal canal was associated with significantly higher morbidity and mortality than inguinoscrotal liposarcoma.

  7. Evaluation of CT findings for the differentiation of benign from malignant primary retroperitoneal tumors

    Institute of Scientific and Technical Information of China (English)

    Zhu Zheng; Zhao Xinming; Zhao Yanfeng; Yang Lei; Zhao Jing; Dai Jingrui; Zhou Chunwu

    2014-01-01

    Background Benign and malignant primary retroperitoneal tumors (RT) have different pathological manifestations,and overlapping imaging characteristics.This study aimed to evaluate the value of computed tomography (CT) for differentiating benign from malignant RT.Methods One hundred and ninety-four patients with clinical and radiographic data were evaluated retrospectively following surgical resection of primary RT.There were 38.1% (n=74) benign lesions and 61.9% (n=120) malignant lesions.Categorical variables were tested with a chi-square test or Fisher's exact test for the diagnostic indexes and sensitivity and specificity of CT characteristics.Results In univariate analysis,the differences in ill-defined margins,irregular surfaces,long diameter >6.75 cm,short diameter >6.25 cm,and solid or mixed texture had statistical significance; the sensitivity and specificity were 44.2% and 91.9%,70.0% and 62.2%,68.8% and 60.7%,59.7% and 74.2%,87.5% and 35.1%,respectively.In multivariate analysis,a combination of all the above indexes was the best model for differentiating malignant tumors,resulting in the most accurate diagnosis of malignancies with a sensitivity of 77.2% and a specificity of 81.1% (P<0.0001) when the score was 4.The differences in other findings including CT attenuation,number,and calcification had no statistical significance.The unique characteristics included the spotted enhancement (mottled high density)in schwannoma (P<0.0001),adipose tissue in liposarcoma (P<0.0001)and paravertebral location in neurogenic tumors (P<0.0001).Conclusions More accurate differential diagnosis of primary RT can be made through comprehensive analysis of the combined diagnostic indexes of CT.Some specific characteristics of CT can assist in preoperative planning.

  8. 腹膜后纤维化的影像学表现%Imaging manifestation of retroperitoneal fibrosis

    Institute of Scientific and Technical Information of China (English)

    倪瑞军

    2009-01-01

    腹膜后纤维化(Retroperitoneal fibrosis,RPF)临床少见,现有文献仅笼统提及RPF分布于腹膜后,侵犯以腹主动脉(Abdominal aorta,AO)为主的空腔脏器,其详细分布及形态特点未见有文献专门论述。本文主要分析RPF这方面的特点。

  9. Complete recovery after the removal of an ectopic testicle in a case of primary reninism and retroperitoneal hemangioma

    Institute of Scientific and Technical Information of China (English)

    Bernhard Glodny; Alexandar Tzankov; Germar-Michael Pinggera; Johannes Petersen; Ralf Herwig

    2006-01-01

    A 32-year-old man recovered completely from hypokalemic hypertension that had been caused by primary reninism after the ablation of an ectopic left testis, epididymis and ductus deferens. For several years, severe hypertension has been resistant to treatment, even the concurrent administration of up to seven antihypertensive agents. In this case,cryptorchidism was associated with an indirect inguinal hernia and an open peritoneo-vaginal process on both sides,aplasia of the posterior wall of the inguinal canal on the right side, an umbilical hernia, and a retroperitoneal tendrillar hemangioma.

  10. Ginkgo biloba Extract Improves Insulin Signaling and Attenuates Inflammation in Retroperitoneal Adipose Tissue Depot of Obese Rats

    Directory of Open Access Journals (Sweden)

    Bruna Kelly Sousa Hirata

    2015-01-01

    Full Text Available Due to the high incidence and severity of obesity and its related disorders, it is highly desirable to develop new strategies to treat or even to prevent its development. We have previously described that Ginkgo biloba extract (GbE improved insulin resistance and reduced body weight gain of obese rats. In the present study we aimed to evaluate the effect of GbE on both inflammatory cascade and insulin signaling in retroperitoneal fat depot of diet-induced obese rats. Rats were fed with high fat diet for 2 months and thereafter treated for 14 days with 500 mg/kg of GbE. Rats were then euthanized and samples from retroperitoneal fat depot were used for western blotting, RT-PCR, and ELISA experiments. The GbE treatment promoted a significant reduction on both food/energy intake and body weight gain in comparison to the nontreated obese rats. In addition, a significant increase of both Adipo R1 and IL-10 gene expressions and IR and Akt phosphorylation was also observed, while NF-κB p65 phosphorylation and TNF-α levels were significantly reduced. Our data suggest that GbE might have potential as a therapy to treat obesity-related metabolic diseases, with special interest to treat obese subjects resistant to adhere to a nutritional education program.

  11. RESULTS OF SECOND-LOOK LAPAROTOMY WITH EXTENSIVE DISSECTION OF RETROPERITONEAL LYMPH NODE IN OVARIAN CANCER PATIENTS

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: To evaluate retrospectively the results of extensive lymphadenectomy during second-look laparotomy on patients with ovarian cancer. Methods: A total of 63 patients with ovarian malignancies received second-look laparotomy (SLL). Retroperitoneal lymph nodes, including pelvic and para-aortic lymph nodes below the level of left renal vein, were extensively dissected. Results: Of the 63 patients, residual tumor was found in 24 (38.0%) on SLL. The frequency of residual tumor was positively correlated with the clinical stage and with the amount of tumor left after initial debulking but not with degree of differentiation of tumor cells. Lymph node metastasis(LNM) was pathologically confirmed in 19 cases (30.2%), of which no residual tumor was found in 8 patients. Tumor recurred in only 4 of the 39 patients (10.3%) with negative SLL. The overall 3- and 5-year survival rate were 75.0% and 68.0%, respectively. Conclusion: Extensive retroperitoneal lymph node dissection was recommended during SLL. It favored a decrease in recurrence rate in ovarian cancer patients negative on SLL.

  12. Retroperitoneal bronchogenic cyst presenting paraadrenal tumor incidentally detected by {sup 18}F-FDG PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Ye Ri; Choi, Ji Youn; Lee, Sang Mi; Kim, Yeo Joo; Cho, Hyun Deuk; Lee, Jeong Won; Jeon, Youn Soo [Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of)

    2015-03-15

    A follow-up 18F-fluorodeoxyglucose ({sup 18}F-FDG) PET/CT scan of a 57-year-old asymptomatic male who had undergone total thyroidectomy for thyroid cancer revealed a 5.0 x 4.0-cm, well-defined, ovoid-shaped mass around the left adrenal gland without definite FDG uptake. On the adrenal CT scan, the left paraadrenal tumor showed high attenuation on the precontrast scan without enhancement. The average Hounsfield unit (HU) was 58.1 on the precontrast scan and 58.4 on the postcontrast scan. The patient underwent laparoscopic adrenalectomy for resection of the left paraadrenal tumor. The final histopathologic examination revealed a bronchogenic cyst. Although retroperitoneal bronchogenic cysts are rare, they should be considered in the differential diagnosis of retroperitoneal cystic tumors. The preoperative diagnosis is difficult, but a contrast-enhanced CT scan or {sup 18}F-FDG PET/CT scan may be useful for differentiating hyperattenuated cysts from other soft tissue masses.

  13. Laparoscopic anterior versus endoscopic posterior approach for adrenalectomy : a shift to a new golden standard?

    NARCIS (Netherlands)

    Vrielink, O M; Wevers, K P; Kist, J W; Borel Rinkes, I H M; Hemmer, P. H. J.; Vriens, M. R.; de Vries, J; Kruijff, S.

    PURPOSE: There has been an increased utilization of the posterior retroperitoneal approach (PRA) for adrenalectomy alongside the "classic" laparoscopic transabdominal technique (LTA). The aim of this study was to compare both procedures based on outcome variables at various ranges of tumor size.

  14. Solitary Bone Plasmacytoma Progressing into Retroperitoneal Plasma Cell Myeloma with No Related End Organ or Tissue Impairment: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Gargi Tikku

    2014-09-01

    Full Text Available Solitary bone plasmacytomas and plasma cell myeloma are clonal proliferations of plasma cells. Many patients with solitary bone plasmacytomas develop plasma cell myeloma on follow-up. We present a case of a 70-year-old man who presented with fracture and a lytic lesion in the subtrochanteric region of the left femur and was assigned a diagnosis of solitary bone plasmacytoma. He received local curative radiotherapy. However, 4 months later his serum M protein and β2-microglobulin levels increased to 2.31 g/dL and 5.965 mg/L, respectively. He complained of abdominal fullness and constipation. Ultrasound and non-contrast CT imaging revealed multiple retroperitoneal masses. Colonoscopic examination was normal. Biopsy of the a retroperitoneal mass confirmed it to be a plasmacytoma. Repeat hemogram, blood urea, serum creatinine, skeletal survey, and bone marrow examination revealed no abnormalities. This is an unusual presentation of plasma cell myeloma, which manifested as multiple huge extramedullary retroperitoneal masses and arose from a solitary bone plasmacytoma, without related end organ or tissue impairment and bone marrow plasmacytosis. The patient succumbed to his disease 8 months after the appearance of the retroperitoneal masses. This case highlights the importance of close monitoring of patients diagnosed with solitary bone plasmacytoma with increased serum M protein and serum β2-microglobulin levels, so that early therapy can be instituted to prevent conversion to plasma cell myeloma.

  15. Intraperitoneal and retroperitoneal carbon dioxide insufflation evoke different effects on caval vein pressure gradients in humans: evidence for the starling resistor concept of abdominal venous return.

    Science.gov (United States)

    Giebler, R M; Behrends, M; Steffens, T; Walz, M K; Peitgen, K; Peters, J

    2000-06-01

    The authors hypothesized that intraperitoneal and retroperitoneal carbon dioxide insufflation during surgical procedures evoke markedly different effects on the venous low-pressure system, induce different inferior caval vein pressure gradients at similar insufflation pressures, and may provide evidence for the Starling resistor concept of abdominal venous return. Intra- and extrathoracic caval vein pressures were measured using micromanometers during carbon dioxide insufflation at six cavity pressures (baseline and 10, 15, 20, and 24 mmHg and desufflation) in 20 anesthetized patients undergoing laparoscopic (supine, n = 8) or left (n = 6) or right (n = 6) retroperitoneoscopic (prone position) surgery. Intracavital, esophageal, and gastric pressures also were assessed. Data were analyzed for insufflation pressure-dependent and group effects by one-way and two-way analysis of variance for repeated measurements, respectively, followed by the Newman-Keuls post hoc test (P < 0.05). Intraperitoneal, unlike retroperitoneal, insufflation markedly increased, in an insufflation pressure-dependent fashion, the inferior-to-superior caval vein pressure gradient (P < 0.00001) at the level of the diaphragm. In contrast to what was observed with retroperitoneal insufflation, transmural intrathoracic caval vein pressure increased at 10 mmHg insufflation pressure, but the increase flattened with an insufflation pressure of more than 10 mmHg, and pressure decreased with an inflation pressure of 20 mmHg (P = 0.0397). These data are consistent with a zone 2 or 3 abdominal vascular condition during intraperitoneal and a zone 3 abdominal vascular condition during retroperitoneal insufflation. Intraperitoneal but not retroperitoneal carbon dioxide insufflation evokes a transition of the abdominal venous compartment from a zone 3 to a zone 2 condition, presumably impairing venous return, supporting the Starling resistor concept of abdominal venous return in humans.

  16. The value of {sup 18}F-FDG PET/CT in the assessment of active idiopathic retroperitoneal fibrosis

    Energy Technology Data Exchange (ETDEWEB)

    Moroni, Gabriella; Longhi, Selena; Messa, Piergiorgio [Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Division of Nephrology, Milan (Italy); Castellani, Massimo; Martinelli, Isabella; Gerundini, Paolo [Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Department of Nuclear Medicine, Milan (Italy); Balzani, Aurora; Bonelli, Nicola [Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Department of Radiology, Milan (Italy); Dore, Roberto [University of Pavia, Institute of Radiology, IRCCS Foundation, San Matteo Medical Center, Pavia (Italy)

    2012-10-15

    The different stages in idiopathic retroperitoneal fibrosis (IRF) are generally assessed by assay of inflammatory markers and analysis of contrast-enhanced CT images of the retroperitoneal mass. We investigated the potential role of {sup 18}F-FDG PET/CT in this clinical setting. {sup 18}F-FDG uptake was assessed visually and semiquantitatively (using maximum standardized uptake values, SUVmax) in images of the abdominal mass in 22 patients prospectively enrolled from June 2008 to December 2010 who underwent a total of 33 PET/CT studies. The accuracy in discriminating active from inactive disease was calculated assuming as reference a biochemical instrumental evaluation of patients with IRF mostly based on the level of inflammatory indices and contrast enhancement (CE) of the mass at the time of each PET study. In particular, the relationship between SUVmax and CE, the latter calculated from the change in radiodensity (Hounsfield units) between the basal and postcontrast venous portal phases, was evaluated on a three-point scale (0 <20 HU, 1 20-30 HU, 2 {>=}30 HU). SUVmax and CE scores were correlated with the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. The value of PET/CT in assessing the variation of disease activity over time was also investigated by analysing the changes in metabolic volume (MV) of the retroperitoneal lesion between repeat patient studies. PET/CT accurately discriminated (93.9 %) active from inactive disease. Significant agreement (p < 0.01) was observed between visual and semiquantitative analysis of {sup 18}F-FDG uptake, and CE score. A significant correlation (p < 0.01) was found among SUVmax, CRP levels (rho = 0.54) and ESR (rho = 0.55). Corresponding variations in MV and CE score were observed in patients with multiple studies (p < 0.01; rho = 0.68). {sup 18}F-FDG PET/CT may be considered an alternative imaging method for the assessment of different stages of IRF. (orig.)

  17. An uncommon clinical presentation of retroperitoneal non-Hodgkin lymphoma successfully treated with chemotherapy: A case report

    Institute of Scientific and Technical Information of China (English)

    Chiara Fulignati; Pietro Pantaleo; Greta Cipriani; Marianna Turrini; Rosalia Nicastro; Roberto Mazzanti; Bruno Neri

    2005-01-01

    We report the case of apetient affedted by an extra-nodal non-Hodgkin lymphoma presenting as a unique, large retroperitoneal mass with an unusual clinical presentation mimicking gastric peptic or neoplastic disease. The patient was successfully treated with a first generation therapy, CHOP modified regimen (cyclophosphamide 600 mg/m2 intravenously on d 1, epirubicin 55 mg/m2 intravenously on d 1, vincristine 1.2 mg/m2 intravenously on d 1, prednisone 60 mg/m2 on d 1-5), and a complete response was achieved. The (18)F-fluorodeoxyglucose positron emission tomography was used to assess the therapy outcome. A brief review of literature is provided.

  18. Stroke volume variation and pleth variability index to predict fluid responsiveness during resection of primary retroperitoneal tumors in Hans Chinese.

    Science.gov (United States)

    Fu, Q; Mi, W D; Zhang, H

    2012-02-01

    Respiration variation in arterial pulse pressure (ΔPP) and pulse oximetry plethysmographic waveform amplitude (ΔPOP) are accurate predictors of fluid responsiveness in mechanically ventilated patients. We hypothesized that stroke volume variation (SVV) and pleth variability index (PVI) can predict fluid responsiveness in mechanically ventilated patients during major surgical procedures in Hans Chinese. This prospective study consisted of fifty-five Hans Chinese patients undergoing resection of primary retroperitoneal tumors (PRPT). During the surgical procedures, hemodynamic data [central venous pressure (CVP), cardiac index (CI), stroke volume index (SVI), SVV, and PVI] were recorded before and after volume expansion (VE) (8 ml•kg-1 of 6% hydroxyethyl starch 130/0.4). Fluid responsiveness was defined as an increase in SVI ≥ 10% after VE. Four patients were excluded from analysis for arrhythmia or obvious hemorrhage during VE. Baseline SVV correlated well with baseline PVI and the changes in SVV was correlated with the changes in PVI (p Chinese.

  19. [Correlation of cytologic and pathohistologic findings in ultrasonically-guided thin-needle biopsy of abdominal and retroperitoneal organs].

    Science.gov (United States)

    Bokun, R; Tatomirović, Z; Lakić-Trajković, Z; Lisanin, L; Pesić, V; Zica, D; Lukac, S; Kupresanin, S; Spasić, V; Ilić, S; Dimitrijević, J

    1997-01-01

    The ultrasonically guided fine needle biopsy is cheap, very sensitive and specific method for the diagnosis of nonpalpable deep-seated lesions. During 1992 in the institute of Radiology of Military Medical Academy in Belgrade 87 biopsies of abdominal and 81 biopsies of retroperitoneal organs were performed for the cytological and histopathologic analysis. Deficient material was obtained in 15.4% of the cases. A good correlation between cytologic and histopathologic findings was observed, with diagnostic concordance in 90.8%. In 9 cases with falsely positive cytological diagnosis at the first examination, the diagnosis of malignancy was later confirmed by other diagnosis procedures. Diagnostic difficulties and the significance of adequate biopsy were particularly stressed.

  20. Anesthetic management of a patient with 10 l of blood loss during operation for a retroperitoneal mass

    Directory of Open Access Journals (Sweden)

    Xueqin Zhu

    2015-04-01

    Full Text Available Bleeding is a common problem during resection of a retroperitoneal mass. Massive bleeding may occur in case of injury of an adjacent major vessel or organ. This case report describes a successful anesthetic management of a patient with 10 l of blood loss within three hours surgery. A 44-year-old woman who underwent an operation for resection of a retroperitoneal mass, went to a hypovolemic shock, due to acute life-threatening intra-operative bleeding, and was successfully rescued with a combination of measures, including control of surgical bleeding, supportive treatment with rapid fluid infusion, massive transfusion of blood products and administration of intravenous vasoactive agents for maintaining tissue perfusion and oxygenation, utilizing intraoperative autologous blood salvaged via cell saver, as well as prevention and treatment of complications. The patient received a total of 22 units of Packet Red Blood Cells (PRBCs, 18 units of Fresh Frozen Plasma (FFP, 10 units of cryoprecipitate, 3750 ml of her own salvage blood. Postoperatively, she was transferred to the intensive care unit (ICU with mechanical ventilator support, where she received another 5.4 units of FFP, 10 units of cryoprecipitate. The patient developed features of early acute lung injury such as fever and hypoxemia, and was managed successfully with mechanical ventilator support for a few days. At a three-month follow-up, the patient was doing very well. This paper explores the pathogenesia, implications, prevention and treatment of the transfusion-associated complications such as acidosis, hypothermia, electrolyte abnormalities, and transfusion-related acute lung injury (TRALI. Particular attention is given to the prevention of secondary coagulopathy of the patient requiring massive blood transfusion. This case study presents a good reference for similar anesthetic scenario in the future.

  1. IgG4-related retroperitoneal fibrosis: A case report and literature review%IgG4相关性腹膜后纤维化病例报告并文献复习

    Institute of Scientific and Technical Information of China (English)

    王聪; 赵忺; 田建立; 巩路

    2015-01-01

    Clinical data of one patient diagnosed as IgG4-related retroperitoneal fibrosis was analyzed."IgG4" and "retroperitoneal fibrosis" were used as the key words to search literatures from PubMed and Wanfang Database.Clinical data of 27 cases with IgG4 retroperitoneal fibrosis,including clinical manifestation,diagnostic basis,therapeutic method and prognosis,which were retrieved through literatures,were analyzed.A 82-year-old male patient presented with urinary tract obstruction and renal insufficiency.Imaging examination revealed a retroperitoneal irregular lump shadow,and showed chronic inflammation of soft tissues in posterior peritoneum with fibrosis by biopsy pathology.The IgG4-positive plasmocyte infiltration was found by immunohistochemical method.The serum level of IgG4 was significantly increased,which was in accord with IgG4-related retroperitoneal fibrosis.After treatment with methylprednisolone,retroperitoneal lump shadow was obviously dissipated.The serum level of IgG4 became normal.27 cases with IgG4-related retroperitoneal fibrosis were searched through literature retrieval,with 19 confirmed cases,3 suspected cases,and 5 suspicious cases.Male accounted for 92.6% (25/27),and the average age was 67.6 years old.The cases with the involvement of extraperitoneal organs accounted for 37.0% (10/27).The misdiagnosis rate was 55.6% (15/27).23 cases took effective therapy with glucocorticoids.IgG4-related retroperitoneal fibrosis is an orphan disease,which can be misdiagnosed easily.The diagnosis is made with histopathological examination and determination on the serum level of IgG4.The therapy with glucocorticoids is effective.

  2. Peptide receptor radionuclide therapy with lutetium-177 DOTATATE in a case of recurrent extradrenal retroperitoneal malignant paraganglioma with nodal and bone metastasis

    Directory of Open Access Journals (Sweden)

    Koramadai Karuppusamy Kamaleshwaran

    2015-01-01

    Full Text Available Extra-adrenal retroperitoneal paragangliomas (PGLs are rare tumors causing considerable difficulty in both, diagnosis and treatment. They can be unicentric or multicentric, tend to be locally invasive and therefore have a high incidence of local recurrence. PGLs shows somatostatin receptor positivity, which can be imaged with technetium-99m (Tc-99m-hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC and can be treated with lutetium-177 (Lu-177 DOTATATE. We present a case of recurrent unresectable retroperitoneal PGL with nodal and bone metastases in a 27-year-old male, 6 months postsurgery detected with Tc-99m-HYNIC-TOC and was administered with peptide receptor radionuclide therapy using Lu-177 DOTATATE.

  3. Femoral neuropathy due to retroperitoneal bleeding. A red herring in medicine complicates anticoagulant therapy and influences the Russian Communist Revolution (Crown Prince Alexis, Rasputin).

    Science.gov (United States)

    Willbanks, O L; Willbanks, S E

    1983-02-01

    Femoral neuropathy occurs when occult retroperitoneal bleeding impinges on the appropriate nerve roots. The syndrome involves the acute onset of groin and thigh pain with characteristic flexion and external rotation of the hip. It may mimic other conditions such as acute arterial occlusion. Thorough knowledge of the anatomy of the femoral nerve explains the clinical features and leads the clinician to suspect the occurrence of this syndrome. Three cases have been reviewed that exhibited this condition as a result of retroperitoneal bleeding, a complication of systemic heparin therapy. The hemophilia that afflicted Alexis, the Crown Prince of Russia and son of Tsar Nicholas and Tsarina Alexandra, resulted in this clinical syndrome. The consequences enabled the sinister starets, Gregory Rasputin, to become intimately involved with the royal family, influencing the response of the Tsar to the political events in Russia, thereby playing an important role in setting the stage for the 1917 Russian communist revolution.

  4. Tratamiento quirúrgico de un aneurisma micótico en paciente con riñón en herradura por vía retroperitoneal

    Directory of Open Access Journals (Sweden)

    Ricardo Muñoz-García

    2013-01-01

    Full Text Available Presentamos el caso de un paciente de 73 años diagnosticado de un aneurisma de aorta abdominal micótico que presenta un riñón en herradura. El paciente fue intervenido por vía retroperitoneal, realizándose resección del aneurisma, con postoperatorio irregular, pero finalmente siendo dado de alta sin incidencias y asintomático.

  5. Diagnostic Value of Multislice Computed Tomography and Magnetic Resonance Imaging in the Diagnosis of Retroperitoneal Spread of Testicular Cancer: A Literature Review

    Energy Technology Data Exchange (ETDEWEB)

    Hansen, J. (Dept. of Medical Physics, Aarhus Univ. Hospital, Aarhus Sygehus, Aarhus (Denmark)); Jurik, A.G. (Dept. of Radiology, Aarhus Univ. Hospital, Aarhus Sygehus, Aarhus (Denmark))

    2009-11-15

    Testicular cancer is the most frequent malignant disorder in men aged 15-35 years. Generally, diagnosing and follow-up include computer tomography (CT) examinations to detect possible retroperitoneal spread (abdomen and pelvis), resulting in at least eight CT examinations. This patient group is thereby exposed to a non-neglectable radiation dose, increasing the risk of future radiation-induced secondary cancer. This is especially problematic in potentially surgically cured patients with stage 1 testicular cancer. Thus, it can be beneficial to substitute CT with magnetic resonance imaging (MRI), provided there is valid evidence that the diagnostic value of MRI is at least comparable to current multislice CT (MSCT). The purpose of this study was to analyze whether there is evidence to recommend a substitution of MSCT with MRI in the diagnosis of retroperitoneal spread of testicular cancer. A literature search on the diagnostic accuracy, specificity, and sensitivity of MSCT and MRI in the diagnosis of retroperitoneal spread of testicular cancer was performed in the following databases: PubMed, EmBase, and ISI Web of Science. The search was limited to include the period from 2000 to September 2008, and to human and English-language publications. Forty-four publications were obtained for formal review (27 from PubMed, 15 from EmBase, two from ISI Web of Science). None of the publications reviewed encompassed diagnostic specificity and sensitivity of MSCT, and they lacked systematic comparison of MSCT and MRI. Only one study included sensitivity and specificity of MRI compared to single-slice CT. Both methods had a sensitivity and a specificity of approximately 70%. The literature review did not reveal valid data regarding diagnostic accuracy of MRI compared with MSCT for diagnosing retroperitoneal spread of testicular cancer. A prospective blinded comparative study is needed to provide valid evidence

  6. Study on the influence of retroperitoneal laparoscopic surgery for the body antioxidant capacity and pain stress state of patients with localized renal carcinoma

    Institute of Scientific and Technical Information of China (English)

    Yang-Tao Xu; Yan Pan; Zhi-Qing Sun; Chen-Xi Liu

    2016-01-01

    Objective:To study and analyze the influence of retroperitoneal laparoscopic surgery for the body antioxidant capacity and pain stress state of patients with localized renal carcinoma. Methods:A total of 56 patients with localized renal carcinoma in our hospital from January 2014 to August 2015 who were treated with surgery were divided into two groups according to the differences of surgery, 28 cases in control group were treated with open surgery, 28 cases in observation group were treated with retroperitoneal laparoscopic surgery, then the related indexes of antioxidant capacity and pain stress state of two groups before the surgery and at first, fifth and tenth day after the surgery were compared. Results:The related indexes of antioxidant capacity and pain stress state of two groups before the surgery all had no significant differences, while the related indexes of antioxidant capacity and pain stress state of observation group at first, fifth and tenth day after the surgery were all better than those of control group, the differences were all significant. Conclusion:The influence of retroperitoneal laparoscopic surgery for the body antioxidant capacity and pain stress state of patients with localized renal carcinoma is more active, so it is more suitable for the treatment of localized renal carcinoma.

  7. Case of H syndrome with massive skin involvement, retroperitoneal fibrosis and Raynaud's phenomenon with a novel mutation in the SLC29A3 gene.

    Science.gov (United States)

    Fujita, Etsuko; Komine, Mayumi; Tsuda, Hidetoshi; Adachi, Akimasa; Murata, Satoru; Kamata, Yasuyuki; Minota, Seiji; Ohtsuki, Mamitaro

    2015-12-01

    We describe a case of H syndrome with massive skin involvement, retroperitoneal fibrosis and Raynaud's phenomenon. A 48-year-old man with parents of a consanguineous marriage, first appeared with decreased urine output, skin sclerosis on his inner thighs and short stature (142 cm, 47 kg). The patient had suffered from hearing loss since the age of 1 year, and his secondary sexual characteristics had not developed. Computed tomography showed periaortic fibrosis, bilateral ureteral stenosis, hydronephrosis and sclerosis of the germinal cords. A biopsy from the retroperitoneal mass revealed remarkable fibrosis with chronic inflammatory cells. Biopsies from the skin lesion showed thick collagen bundles through the dermis and lymphohistiocytic infiltration with numerous plasma cells. Serum inflammatory markers, such as C-reactive protein, vascular endothelial factor, transforming growth factor-β and soluble interleukin-2 receptor, were elevated. Prednisolone was effective in treating skin lesions and in lowering serum inflammatory markers. After a long period of follow up, genomic DNA of the patient was obtained, and we identified a homozygous mutation in exon 5, c.625G>A, which caused transition of glycine to arginine, p.Gly208Arg, in the patient, but not in DNA samples from another 50 healthy individuals. This is the first case of H syndrome with Raynaud's phenomenon and retroperitoneal fibrosis, and the first Japanese case of H syndrome reported in the English published work with a novel mutation in the SLC29A3 gene.

  8. Small bowel toxicity after high dose spot scanning-based proton beam therapy for paraspinal/retroperitoneal neoplasms

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, R.A.; Albertini, F.; Koch, T.; Ares, C.; Lomax, A.; Goitein, G. [Paul Scherrer Institute PSI, Villigen (Switzerland). Center for Proton Therapy; Vitolo, V. [Fondazione CNAO, Pavia (Italy); Hug, E.B. [Paul Scherrer Institute PSI, Villigen (Switzerland). Center for Proton Therapy; ProCure Proton Therapy Centers, New York, NY (United States)

    2013-12-15

    Purpose: Mesenchymal tumours require high-dose radiation therapy (RT). Small bowel (SB) dose constraints have historically limited dose delivery to paraspinal and retroperitoneal targets. This retrospective study correlated SB dose-volume histograms with side-effects after proton radiation therapy (PT). Patients and methods: Between 1997 and 2008, 31 patients (mean age 52.1 years) underwent spot scanning-based PT for paraspinal/retroperitoneal chordomas (81 %), sarcomas (16 %) and meningiom (3 %). Mean total prescribed dose was 72.3 Gy (relative biologic effectiveness, RBE) delivered in 1.8-2 Gy (RBE) fractions. Mean follow-up was 3.8 years. Based on the pretreatment planning CT, SB dose distributions were reanalysed. Results: Planning target volume (PTV) was defined as gross tumour volume (GTV) plus 5-7 mm margins. Mean PTV was 560.22 cm{sup 3}. A mean of 93.2 % of the PTV was covered by at least 90 % of the prescribed dose. SB volumes (cm{sup 3}) receiving doses of 5, 20, 30, 40, 50, 60, 70, 75 and 80 Gy (RBE) were calculated to give V5, V20, V30, V40, V50, V60, V70, V75 and V80 respectively. In 7/31 patients, PT was accomplished without any significant SB irradiation (V5 = 0). In 24/31 patients, mean maximum dose (Dmax) to SB was 64.1 Gy (RBE). Despite target doses of > 70 Gy (RBE), SB received > 50 and > 60 Gy (RBE) in only 61 and 54 % of patients, respectively. Mean SB volumes (cm{sup 3}) covered by different dose levels (Gy, RBE) were: V20 (n = 24): 45.1, V50 (n = 19): 17.7, V60 (n = 17): 7.6 and V70 (n = 12): 2.4. No acute toxicity {>=} grade 2 or late SB sequelae were observed. Conclusion: Small noncircumferential volumes of SB tolerated doses in excess of 60 Gy (RBE) without any clinically-significant late adverse effects. This small retrospective study has limited statistical power but encourages further efforts with higher patient numbers to define and establish high-dose threshold models for SB toxicity in modern radiation oncology. (orig.)

  9. Comparison of intensity-modulated radiotherapy with conventional conformal radiotherapy for postoperative retroperitoneal soft tissue; Etude theorique d'une radiotherapie postoperatoire avec modulation d'intensite d'un sarcome retroperitoneal

    Energy Technology Data Exchange (ETDEWEB)

    Musat, E.; Kantor, G.; Caron, J.; Lagarde, P.; Laharie, H.; Angles, J.; Gilbeau, L. [Centre Regional de Lutte Contre le Cancer, Institut Bergonie, Dept. de Radiotherapie, 33 - Bordeaux (France); Stoeckle, E. [Centre Regional de Lutte Contre le Cancer, Institut Bergonie, Dept. de Chirurgie, 33 - Bordeaux (France); Bui, B.N. [Centre Regional de Lutte Contre le Cancer, Institut Bergonie, Dept. de Medecine, 33 - Bordeaux (France)

    2004-08-01

    External postoperative radiation therapy for retroperitoneal sarcoma is an example of treatment using large fields for complex shaped volumes of irradiation, Prescribed dose is limited by tolerance of adjacent organs at risk (OAR). From a recent case treated by conventional conformal radiotherapy (3D-CRT), we evaluate the benefit of five theoretical IMRT plans. Criteria used are calculated from DVH related to delineated PTV and OAR, IMRT should permit to enhance the prescribed dose without increasing dose in the OAR (especially residual kidney, spinal cord and small bowel). This theoretical study show the feasibility of a dose escalation from a treatment dose of 45 Gy delivered by 3D-CRT up to a planning dose of 54 Gy calculated by IMRT with: - for the PTV: an improvement of the dose homogeneity about 5% (range 2 %) and moreover the coverage factor (CF) about 13% (range 9 6%); - for the OAR: an improvement of the protection factor (PF) about 20% (range 11-24%); - and thus an improved conformity index (CI = CF x PF) about 25% (range 15-32%). (author)

  10. Retroperitoneal exposure of lumbar intervertebral disc in New Zealand white rabbits%经腹膜后入路暴露新西兰大白兔腰椎间盘

    Institute of Scientific and Technical Information of China (English)

    赵新刚; 石健; 侯铁胜

    2007-01-01

    目的:人体显露腰椎体和椎间盘多采用前方入路,本实验采用腹膜后入路暴露新西兰大白兔腰椎,验证此方法的可行性.方法:实验于2005-04/2006-04于解放军第二军医大学长海医院动物中心实验室进行实验,选用30只生后6个月健康新西兰大白兔,雌雄不拘,体质量2.5kg.购自解放军第二军医大学长海医院动物中心(许可证号码:SCXK(沪)2002-0006).实验过程中对动物的处置符合动物伦理学标准,实验经过由解放军第二军医大学长海医院实验动物伦理委员会批准.采用腹膜后入路对实验兔的腰椎进行暴露,起开皮肤后,沿背最长肌与腹外斜肌之间的交界处向后钝性分离,逐步暴露至腰椎间盘.观察指标:①手术暴廣效果.②术后一般情况(进食、尿便、活动情况,手术切口愈合及死亡情况).结果:纳入实验兔30只均进入结果分析.①暴露效果:手术选用右侧腹膜后入路,术中麻醉满意,兔腰椎侧方显示良好,暴露过程一般在75 min内可以完成,术中出血较少.未发生腹膜破裂.②术后一般情况:手术动物约于术后1 h内苏醒,继续给予静脉输液补充血容量,补液后将动物放置入饲养笼内单独饲养,允许动物自由活动.手术当日禁食、水,术后1 d动物食量下降,第3天开始恢复食量,第4天基本恢复至正常食量.所有动物均成活至术后4周,活动自如,无瘫痪发生,无尿便失禁.有1只实验兔术后手术切口裂开,给予清创重新缝合后切口愈合,其余动物手术切口愈合良好.无动物死亡.结论:腹膜后入路是暴露新西兰大白兔腰椎的良好手术入路,手术操作简单,并发症少.%AIM:In human being,the exposure of lumbar Intervertebral discs usually requires the anterior transperitoneal or lateral retroperitoneal approaches. To study the feasibility of retropedtoneal approach to the lumbar spine in the New Zealand white rabbits.METHODS: The experiment was carried

  11. CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

    Institute of Scientific and Technical Information of China (English)

    Chang-Jing Zuo; Pei-Jun Wang; Cheng-Wei Shao; Min-Jie Wang; Jian-Ming Tian; Yi Xiao; Fang-Yuan Ren; Xi-Yan Hao; Min Yuan

    2004-01-01

    AIM: To explore the feasibility of computed tomography (CT)-guided percutaneous ethanol injection (PEI) using a disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes.METHODS: CT-guided PEI was conducted using a disposable curved needle in 26 malignant liver tumors smaller than 5 cm in diameter and 5 lymph node metastases of liver cancer in the retroperitoneal space. The disposable curved needle was composed of a straight trocar (21G) and stylet, a disposable curved tip (25 G) and a fine stylet. For the tumors found in deep sites and difficult to reach, or for hepatic masses inaccessible to the injection using a straight needle because of portal vein and bile ducts, the straight trocar was used at first to reach the side of the tumor. Then, the disposable curved needle was used via the trocar. When the needle reached the tumor center, appropriate amount of ethanol was injected. For relatively large malignant liver tumors,multi-point injection was carried out for a better distribution of the ethanol injected throughout the masses. The curved needle was also used for treatment of the metastasis in retroperitoneal lymph nodes blocked by blood vessels and inaccessible by the straight needle.RESULTS: All of the 26 liver tumors received 2 or more times of successful PEI, through which ethanol was distributed throughout the whole tumor mass. Effect of the treatment was monitored by contrast-enhanced multi-phase CT and magnetic resonance imaging (MRI) examinations three months later. Of the 18 lesions whose diameters were smaller than 3 cm, the necrotic change across the whole mass and that in most areas were observed in 15 and 3 tumors,respectively. Among the 8 tumors sizing up to 3 cm, 5 were completely necrotic and 3 largely necrotic. Levels of tumor seromarkers were significantly reduced in some of the cases.In 5 patients with metastases of liver cancer in retroperitoneal lymph nodes who received 1 to 3

  12. 腹膜后纤维化诊治1例%Diagnosis and treatment of retroperitoneal fibrosis:A case report

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    Objective To improve the understanding of retroperitoneal fibrosis. Methods A patient with retroperitoneal fibrosis, an IgG4-related sclerosing disease was reported. Its clinical characteristics, diagnosis and treatment were analyzed. The patient visited our department due to left lumbar pain for 1 year and left lower extremity numbness for 3 months. Abdominal CT showed an occupying disease in retroperitoneal iliac fossa and unclear left kidney. The retroperitoneal tumor and the involved sigmoid colon were excised. Fistulization was performed for descending colon with the involved left ureter partly removed. Results The patient was recovered and discharged. The patient was diagnosed with chronic inflammation of sigmoid colon tumor and mucositis with fibrous tissue hyaline degeneration in colon serous layer accompanying massive inflammatory cell infiltrative nodules. Conclusion Progressive retroperitoneal fibrous tissue proliferation due to unknown causes is a local manifestation of systemic immune system diseases. Surgical excision is a reliable procedure for the removal of compression caused by the lesion, followed by glucocorticoid hormone and immunosuppressive therapy.%  目的提高对腹膜后纤维化罕见疾病的认识水平。方法报告并分析1例腹膜后纤维化IgG4相关硬化性疾病特征及诊治经过。患者左腰部疼痛1年,左下肢麻木3个月来诊。腹部CT考虑左侧腹膜后髂窝处占位性病变,左肾显示不清。行腹膜后肿物切除,受侵乙状结肠切除,降结肠造瘘,受侵左侧输尿管部分切除术。结果患者术后顺利恢复出院,病理为乙状结肠及肿块结肠黏膜慢性炎,结肠浆膜层及壁外见增生之纤维组织玻璃样变伴多量慢性炎细胞浸润结节。结论病因不明的腹膜后广泛进行性纤维组织增生是全身性免疫系统疾病的一种局部表现,手术切除病变解除压迫是治疗的可靠手段,后续治疗可尝试糖皮质激素、免疫抑制剂等。

  13. Flexible Ureteroscopy versus Retroperitoneal Laparoscopic Ureterolithotomy for the Treatment of Proximal Ureteral Stones >15 mm: A Single Surgeon Experience.

    Science.gov (United States)

    Tugcu, Volkan; Resorlu, Berkan; Sahin, Selcuk; Atar, Arda; Kocakaya, Ramazan; Eksi, Mithat; Tasci, Ali Ihsan

    2016-01-01

    To compare safety and effectiveness of flexible ureteroscopy (F-URS) and laparoscopic retroperitoneal ureterolithotomy (L-RU) in treatment of proximal ureteral stones larger than 15 mm. This study included 103 patients treated with L-RU (Group I), and 80 patients treated with F-URS (Group II) due to proximal ureteral stones larger than 1.5 cm, in a single center. Patients' characteristics and procedure-related parameters including success rate, operation time, hospital stay, postoperative visual analogue scale (VAS) scores, auxiliary procedures, and complications were compared between Groups I and II. It was seen that both methods were effective in the treatment of large ureteral stones; however, R-LU provided a higher stone-free rate (100 vs. 87.5%), a lower complication rate (10.6 vs. 23.7%), and a shorter operation time (65.4 vs. 75.1 min). On the other hand, patients treated with F-URS had less postoperative pain, a shorter hospital stay, a faster return to daily activities. For treatment of large proximal ureteral stones, L-RU provides significantly higher success and lower retreatment rate compared with F-URS. Our results also indicate that R-LU, which has been regarded as an invasive procedure is not as invasive as it is thought to be, and it must be kept in mind that F-URS may cause complications despite its noninvasive nature. © 2015 S. Karger AG, Basel.

  14. Retroperitoneal sclerosing PEComa with melanin pigmentation and granulomatous inflammation-A rare association within an uncommon tumor

    Directory of Open Access Journals (Sweden)

    Bharat Rekhi

    2012-01-01

    Full Text Available PEComa, defined as a perivascular epithelioid cell tumor, displays a wide clinicopathological spectrum. Lately, a sclerosing PEComa has been identified as its distinct variant, but with limited documentation, in view of its rarity. Herein, we describe an uncommon case of a 53-year-old lady, who was referred to us with pain abdomen. Radiological imaging disclosed a well-defined, hypodense retroperitoneal mass. The excised tumor was a round, encapsulated soft tissue mass measuring 7 cm with a tan-brown cut surface. Microscopy showed uniform, epithelioid cells with clear cytoplasm, focal melanin pigmentation and mild nuclear atypia, arranged in sheets and nests around capillary-sized vessels in a dense sclerotic stroma. Additionally, co-existing epithelioid granulomas were noted. On immunohistochemistry (IHC, tumor cells were diffusely positive for HMB45; focally for desmin and smooth muscle actin (SMA, while negative for EMA, CD10, S100-P, Melan A, CD34, AMACR and CK MNF116. This case reinforces sclerosing PEComa as an uncommon, but a distinct clinicopathological entity and exemplifies diagnostic challenge associated with it; necessitating application of IHC markers for its correct identification. Presence of melanin pigment and granulomatous inflammation in the present tumor constitute as novel histopathological findings in a sclerosing PEComa.

  15. Use of the novel hemostatic textile Stasilon® to arrest refractory retroperitoneal hemorrhage: a case report

    Directory of Open Access Journals (Sweden)

    Jones Samuel W

    2010-01-01

    Full Text Available Abstract Introduction Stasilon® is a novel hemostatic woven textile composed of allergen-free fibers of continuous filament fiberglass and bamboo yarn. The development of this product resulted from controlled in vitro thrombogenic analysis of an array of potentially hemostatic textile materials and it has been cleared for both external and internal use by the United States Food and Drug Administration for the arrest of hemorrhage. The goal of the study was to assess the hemostatic and adhesive properties of Stasilon® in the setting of life-threatening refractory hemorrhage. Case presentation A 39-year-old Caucasian man presented with severe necrotic pancreatitis that failed multiple aggressive attempts to control associated bleeding with electrocautery, suture ligation, and sequential anatomic packing with cotton-based sponges. Subsequent retroperitoneal packing with Stasilon® produced a non-adherent wound-dressing interface and resulted in the achievement of persistent hemostasis in the operative field. Conclusion In our patient, Stasilon® was demonstrated to be effective in the arrest of refractory hemorrhage.

  16. Successful Re-resection for Locally Recurrent Retroperitoneal Liposarcoma at Four Years After Ex Vivo Tumor Resection and Autotransplantation of the Liver: A Case Report.

    Science.gov (United States)

    Kobayashi, T; Miura, K; Ishikawa, H; Soma, D; Zhang, Z; Yuza, K; Hirose, Y; Takizawa, K; Nagahashi, M; Sakata, J; Kameyama, H; Kosugi, S; Wakai, T

    2016-05-01

    Surgical resection should be considered for isolated locally recurrent retroperitoneal liposarcomas. We experienced a case of successful re-resection for locally recurrent retroperitoneal liposarcomas 4 years after ex vivo tumor resection and autotransplantation of the liver. A 75-year-old man was admitted to our hospital. His diagnosis was local recurrence of liposarcomas. He had previously undergone ex vivo tumor resection and autologous orthotopic liver transplantation for a retroperitoneal tumor 4 years earlier. The resected tumor size was 23.5 × 15.5 × 12.5 cm. The tumor was revealed by means of histopathologic study to be a myxoid liposarcoma. Follow-up computerized tomography showed 2 recurrent tumors in the retropancreatic and para-aortic lesions. Although adhesion was severe within the operative field, we successfully performed complete en bloc re-resection of each recurrent tumor. The operative time was 250 minutes, and blood loss was 300 mL. The resected tumor sizes were 3.9 × 3.2 × 1.5 cm and 4.5 × 3.3 × 3.0 cm. The tumors were revealed by means of histopathologic study to be dedifferentiated liposarcomas. Postoperative complications included intestinal obstruction and colocutaneous fistula formation, both of which were treated surgically. The patient was discharged in an ambulatory state at 80 days after re-resection of the recurrent tumors. At the time of writing, he was alive with no evidence of recurrence, 14 months after re-resection and 62 months after primary ex vivo tumor resection. This is the first case of successful surgical re-resection for locally recurrent liposarcoma after ex vivo tumor resection and autotransplantation of the liver.

  17. Outcome of Resection and Chemotherapy versus Chemotherapy Alone for Retroperitoneal Recurrence of Testicular Cancer Involving the Inferior Vena Cava: A Retrospective Cohort Study of 22 Consecutive Patients.

    Science.gov (United States)

    Illuminati, Giulio; Calio, Francesco G; Angelici, Alberto M; Pizzardi, Giulia; Pasqua, Rocco; Masci, Federica; Vietri, Francesco

    2016-07-01

    Optimal treatment strategy for retroperitoneal recurrence of testicular cancer involving the inferior vena cava (IVC) is uncertain. The purpose of this study was to validate the hypothesis that surgical resection, en-bloc with the involved segment of IVC and its subsequent reconstruction followed by chemotherapy, would yield better oncologic results than chemotherapy alone. Two consecutive series of patients with retroperitoneal recurrence of testicular cancer involving the IVC, treated with surgical resection plus chemotherapy (group A, n=14) or chemotherapy alone (group B, n=8) were retrospectively reviewed. The mean duration of follow-up was was 65 months (range=8-184). Operative mortality and morbidity in group A, response to chemotherapy in group B, disease-specific survival and quality adjusted life-years (QALY) for both groups, were primary end-points of the study. Postoperative mortality and morbidity (group A) were, respectively, nil and 14%. In group B, two patients (25%) fully responded to chemotherapy and remained free from disease progression. Disease-specific survival at 3 and 5 years was 81% and 54% in group A and 36% in group B both at 3 and 5 years, respectively (p=0.02). QALY was 3.92 in group A and 0.77 for both 3 and 5 years in group B, respectively, (p=0.031). En bloc resection of retroperitoneal recurrence of testicular tumors invading the IVC, followed by chemotherapy, allows a better survival rate compared to chemotherapy alone. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  18. Long-term oncological outcome after post-chemotherapy retroperitoneal lymph node dissection in men with metastatic nonseminomatous germ cell tumour.

    Science.gov (United States)

    Fléchon, Aude; Tavernier, Emmanuelle; Boyle, Helen; Meeus, Pierre; Rivoire, Michel; Droz, Jean-Pierre

    2010-09-01

    To determine whether conformity to standard recommendations of retroperitoneal lymph node dissection (RPLND) after chemotherapy for testicular and primary retroperitoneal nonseminomatous germ cell tumours (NSGCT) and completeness of surgical excision have an effect on oncological outcome. This was a retrospective study of patients with testicular and primary retroperitoneal NSGCT, with initial involvement of RPLNs, treated between June 1992 and December 2002 in one institution. We reviewed the clinical, surgical and histological charts of 151 such patients who had a RPLND after first-line platinum-based chemotherapy. The recommendations used to define conformity to RPLND standards were: the indication based on initial and residual lymph node size, shrinkage, extension of dissection and completeness of resection. RPLND conformed to standard recommendations in 70 of the 151 (46%) patients. Conformity was complete for the surgeon who operated on 48 patients and was 26% of the others. Fifteen patients (10%) relapsed in the retroperitoneum, 14 of whom had initial lymph nodes of > or =5 cm. Two patients (3%) relapsed in the group of 70 patients with conformed and complete RPLND, vs 13 (16%) in the 81 with conformed but incomplete resection or with non-conformed and complete or incomplete RPLND. After a median (range) follow-up of 77 (1.3-186.5) months 132 patients were alive with no evidence of disease, 18 died and one was alive with progressive disease. The limitations of this study were the relatively few patients and that it was retrospective. There was conformity of RLNPD to the recommendations, and completeness of resection, in half of the patients operated; this might have an effect on oncological outcome. Our data suggest that patients should be treated in tertiary centres.

  19. Endurance training increases leptin expression in the retroperitoneal adipose tissue of rats fed with a high-sugar diet.

    Science.gov (United States)

    de Queiroz, Karina Barbosa; Guimarães, Juliana Bohnen; Coimbra, Cândido Celso; Rodovalho, Gisele Vieira; Carneiro, Cláudia Martins; Evangelista, Elísio Alberto; Guerra-Sá, Renata

    2014-01-01

    The presence of leptin receptors in white adipose tissue (WAT) suggests a type of peripheral control during the development of obesity and other metabolic disorders. Both diet composition and exercise influence serum leptin; however, the effect of their combination on long-term WAT leptin metabolism is unknown. In this study, rats fed with standard or high-sugar diets (HSD) were simultaneously subjected to running training for 4- and 8-week periods, and the retroperitoneal WAT (rWAT) was evaluated for adipocyte cell size, lipid and catecholamine content, Lep, OB-Rb and Ucp2 mRNA transcription levels, and circulating leptin and non-esterified fatty acids (NEFA). The HSD groups displayed a higher adiposity index and rWAT weight, Lep mRNA and protein upregulation, and a period-dependent effect on OB-Rb mRNA expression. Exercise decreased serum leptin and upregulated the OB-Rb mRNA levels. However, in rats fed with an HSD, the increase in OB-Rb mRNA and reduction in catecholamine levels resulted in a high level of adiposity and hyperleptinemia. The combination of training and an HSD decreases the NEFA levels and upregulating the Ucp2 mRNA expression in the 4-week period, while downregulating the Ucp2 mRNA expression in the 8-week period without changing the NEFA levels. Our results suggest that an HSD induces an increase in leptin expression in rWAT, while reducing adipocytes via leptin-mediated lipolysis after an 8-week period. In exercised rats fed an HSD, TAG synthesis and storage overlaps with lipolysis, promoting fat store development and Lep mRNA and plasma protein upregulation in adult rats.

  20. Retrospective Analysis of Postchemotheraphy Retroperitoneal Lymph Node Dissection (PC-RPLND Results in Patients with Non-Seminomatous Testicular Cancers

    Directory of Open Access Journals (Sweden)

    Hasan Soydan

    2015-03-01

    Full Text Available Objective Resection of residual masses after chemoteraphy in patients with nonseminomatous testicular cancer is recommended. In our study, we evaluated the patients’ data underwent post chemotherapy retroperitoneal lymph node dissection (PC-RPLND. Materials and Methods Patients with advanced staged tumors and Non-seminomatous germ cells and having residual mass after chemotherapy whose tumor markers returned to normal were selected in the study. Pre-chemotherapy mass size, postchemoterapy mass size, decrease rate in the mass size, prognostic factors of local tumor, International Germ Cell Collaborative Clasification (IGCCC risk groups, and teratoma existence in primary pathology, PC-RPLND pathologies were compared for fibrozis, teratoma or viable tumor presence. In addition, patients with and without intraoperative complications were compared in terms of the same parameters. Comparisons were conducted using Statistical Packages for the Social Sciences (SPSS 16.0 and p<0.05 was considered statistically significantResults Twenty six patients were included in the study. Respectively 4 (15% viable tumors, 14 (54% teratoma, 8 (31% necrosis were observed in patients after PC-RPLND. No significant differences were observed in PC-RPLND pathology results in IGCCC risk groups depending on presence of teratoma in primary tumor or existence of more than 50% embryonal carcinoma after orchiectomy pathology. Teratoma in 6 of 8 patients with no decrease in the mass rate and viable tumor in 2 patients were detected. More than 90% reduction rate in the mass was detected in only one patient whose PC-RPLND pathology result was necrosis.There were no significant variations between complication developed and undeveloped patients in terms of mass size and live tumor existence. Conclusion Our data is consistent with the current literature. The mass size decrease rate, teratoma presence in orchiectomy material, IGCCC risk groups and local prognostic factors are not

  1. Spontaneous Retroperitoneal Hemorrhage (Wunderlich Syndrome due to Large Upper Pole Renal Angiomyolipoma: Does Robotic-Assisted Laparoscopic Partial Nephrectomy Have a Role in Primary Treatment?

    Directory of Open Access Journals (Sweden)

    Achilles Ploumidis

    2013-01-01

    Full Text Available Spontaneous rapture with consequent retroperitoneal hemorrhage (Wunderlich’s syndrome is the complication mostly feared from large renal angiomyolipomas (RAMLs. In hemodynamic stable patients, minimal invasive therapies have superseded open surgery as the mainstay of treatment, with contemporary cases mostly treated by selective arterial embolization. Robotic-assisted laparoscopic partial nephrectomy (RALPN is an established minimal access treatment that has been used in the past for benign and malignant lesions of the kidney in the elective setting, but rarely in urgent situations as primary treatment. We present a case of a ruptured RAML in a young female treated effectively by RALPN.

  2. 原发性腹膜后脂肪肉瘤再手术36例临床分析%Primary retroperitoneal liposarcoma reoperation of 36 cases

    Institute of Scientific and Technical Information of China (English)

    游建; 金鑫; 何鑫; 肖飞; 李鸣

    2012-01-01

    Objective To investigate the primary retroperitoneal liposarcoma reasons for re-operation, strategy and operation points. Methods From June 2000 to June 2010 36 re-operation cases of retroperitoneal liposarcoma were retrospectively analyzed Results The main reasons of primary retro-peritoneal liposarcoma reoperation are incomplete surgical resection and tumor biological characteristics. The 5-year survival rate for complete resection and incomplete resection was 79. 3% and 34. 5% respectively. Bleeding and intestinal fistula were the major complications after reoperation. Conclusion The reasons of reoperation of primary retroperitoneal liposarcoma are variable. Reoperation is the effective strategy for recurrent cases. Intraoperative complete resection is the key of reoperation success.%目的 探讨原发性腹膜后脂肪肉瘤再手术的原因、处理策略及手术要点.方法 对2000年6月至2010年6月间36例腹膜后脂肪肉瘤再手术的临床资料进行回顾性分析.结果 原发性腹膜后脂肪肉瘤再手术的主要原因是手术切除不彻底和肿瘤的生物学特性.完全切除与不完全切除5年生存率分别为79.3%和34.5%.再手术后并发症以出血及肠瘘为主.结论 原发性腹膜后脂肪肉瘤再手术既有肿瘤本身原因,也与手术相关.再次手术治疗是治疗该病术后复发病例的积极手段.把握好手术时机、术中彻底切除是再手术成功的关键.

  3. Clinical significance of complement as a biomarker of disease activity in 4 cases of IgG4-related disease with retroperitoneal fibrosis.

    Science.gov (United States)

    Kihara, Mari; Sugihara, Takahiko; Hosoya, Tadashi; Miyasaka, Nobuyuki

    2013-01-01

    Hypocomplementaemia is frequently observed in IgG4-related diseases, however the clinical significance is unclear. We describe herein the clinical courses of 4 patients with IgG4-related disease with hypocomplementaemia. Our cases showed autoimmune pancreatitis, retroperitoneal fibrosis, Mikulicz's disease, interstitial lung disease, lymphadenopathy and mesenteric fibrosis around the aorta. A decrease in serum complement preceded deterioration of the disease and clinical improvement was observed in accordance with normalisation of serum complement. These clinical courses suggest that serum complement is a biomarker of the disease activity.

  4. CT诊断创伤性盆腔腹膜后血肿的价值探讨%CT Diagnosis of Traumatic Pelvic Cavity Retroperitoneal Hematoma

    Institute of Scientific and Technical Information of China (English)

    张书忠

    2014-01-01

    目的研究CT诊断创伤性盆腔腹膜后血肿临床应用价值。方法65例创伤性盆腔腹膜后血肿患者依次使用CT诊断、X线诊断与手术探查,详细记录三种诊断临床结果,然后对三种诊断临床结果进行对比分析。结果CT诊断总诊断正确率为93.85%,较X线显著高12.31%(<0.05),较手术探查显著低6.15%(<0.05);CT在骨盆骨折与大血管损伤诊断率为100%;而对单纯性盆腔腹膜后血肿的诊断准确率最低,其为85.71%。结论CT诊断创伤性盆腔腹膜后血肿诊断效果较好,值得临床推广应用。%Objective To study the CT diagnosis of traumatic pelvic cavity retroperitoneal hematoma clinical application value.Methods 65 cases of traumatic pelvic cavity retroperitoneal hematoma patients were used for diagnosis of CT,X line diagnosis and operation,a detailed record of three clinical diagnosis results,and then the three diagnostic clinical results.Results The positive rate of diagnosis of CT total diagnosis was 93.85%,significantly more X line 12.31% ( <0.05),significantly lower operation was 6.15% ( <0.05);CT in the fracture of pelvis and vascular damage diagnosis rate was 100%;while on the simple pelvic retroperitoneal hematoma diagnosis accurate rate of the lowest,85.71%.Conclusion The effect of CT diagnosis of hematoma bet er diagnosis of traumatic pelvic cavity retroperitoneal,worthy of clinical application.

  5. A DIFFERENT TECHNIQUE OF PRIMARY INDIRECT INGUINAL HERNIA REPAIR BY INSERTING A SYNTHETIC MESH INTO THE PRE AND RETROPERITONEAL SPACES TO WRAP THE PERITONEAL REFLECTION: PRELIMINARY REPORT

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    Professor Aydın Altan

    2010-01-01

    Full Text Available In most methods of indirect inguinal hernia repair, the region of the sac stump remains a potential site of recurrence. A different technique that covers the site of the indirect sac stump is presented. Anterior parietal peritoneum is reflected posteriorly in the inguinal canal. In cases with Gilbert type I-II inguinal hernia, after the indirect sac is removed, the pre and retroperitoneal spaces in this region are dissected. A synthetic mesh is placed into these spaces, lateral to the inferior epigastric vessels. The posterior wall of this type hernia is intact. In cases with Gilbert type III inguinal hernia, either posterior wall repair is accomplished by using one of the tissue approximation techniques after placing a mesh in the region of the sac stump, or the entire peritoneal reflection in the inguinal canal is wrapped with a mesh after dissecting the pre and retroperitoneal spaces. This technique was performed in five patients. Of five patients, mesh was inserted on the region of stump in three (Gilbert I and II and along the entire peritoneal reflection in two (Gilbert III. There were no postoperative complications such as seroma and pain and no recurrence till follow-up. This technique effectively wraps the peritoneal reflection and may prevent recurrences in primary indirect inguinal hernia, but it needs to be performed in a large number of cases for further evaluation.

  6. [A case of possible retroperitoneal metastasis of breast cancer successfully treated with oral S-1 and cyclophosphamide therapy after TC therapy].

    Science.gov (United States)

    Yoneyama, Kimiyasu; Takeshita, Toshio; Suzuki, Hiroshi; Morise, Masaki; Suzuki, Tetsutarou; Kishi, Shinya; Tsutsui, Atsuko; Matsumoto, Akiko

    2011-03-01

    We report a case of possible retroperitoneal metastasis of breast cancer successfully treated with oral S-1 and cyclophosphamide therapy after docetaxel and cyclophosphamide (TC) therapy. A 57-year-old woman with a history of bilateral breast cancer showed an increase in tumor markers during treatment with oral anastrozole as postoperative adjuvant therapy 4 years after her second cancer surgery. After careful examination, the patient was diagnosed as having multiple bone metastases and her medication was changed to oral letrozole. After 3 months, the patient developed left back pain and was referred to our hospital. CT scanning showed an enhanced mass in the region from the left perirenal and posterior pararenal spaces to the left psoas major muscle and the anterior aspect of the left iliacus muscle, suggesting retroperitoneal metastasis. TC therapy was performed and, as a result, tumor markers decreased and the mass disappeared on CT imaging. After discontinuation of TC therapy, the tumor markers increased again, following which oral S-1 and cyclophosphamide therapy were administered, and the tumor markers decreased. At the time of this writing, the patient is still undergoing therapy, and no recurrence has been observed. We concluded that oral S-1 and cyclophosphamide therapy were useful in the present case and were associated with few adverse effects.

  7. 后腹腔镜下腹膜后淋巴结清扫术七例报告%Extroperitoneal laparoscopic retroperitoneal lymph node dissection(report of 7 cases)

    Institute of Scientific and Technical Information of China (English)

    韩辉; 周芳坚; 陈晓峰; 李永红; 叶云林; 秦自科; 刘卓炜; 涂画

    2008-01-01

    Objective To investigate the techniques of laparoscopic retroperitoneal lymph node dissection(LRPLND)through extraperitoneal approach. Methods Seven non-seminomatous germ cell testicular tumor(NSGCT)patients of clinical stage Ⅰ underwent LRPLND through extraperitoneal approach.The average age was 31(27-39 years old),the average weight was 62 kg(weight 58-72 kg).Pathological examination revealed 2 testis mixed carcinoma(major of embryonal carclnoma and seminoma),2 yolk sac tumor,1 ehoriocarcinoma,2 teratoma with seminoma.Two of them were in right side,and 5 in left.All the chest X-ray,abdominal CT and bone scanning of them were normal before operation.All patients were general anesthetized.Three or 4 trocars were placed,from 2 of them two gasbags were used to expand the retroperitoneal space at volume of 800-900 ml.The retroperitoneal fat was cleared off from the surface of Gerota's fascia to iliac fossa and the plane spance betwwwn anterior rena fascia and posterior peritoneum was separated In the same way the Plane between dorsal renal and the surface of psoas major and quadratus lumborum unto iliae lossa was exposed.Abdominal aorta or vena cava was exposed,then divided and dissected free from surfaee of psoas maior.The conflux of renal vein and testicular vein at the deep face of renal artere(left)was exposed,then testicular vein was ligated and divided it at its end.Fat and lymph tissue between ureter and vessels was dissected to the crotch of abdominal aorta or inferior vena cava.The primary inguinal incision of testectomy was then excided.Normal antegrade ejaculation recovered in 1 month postoperatively. Results The initial 2 operations were converted to open way as the peritoneum were penetrated largely.The other 5 operations were successful.The average operating time was 285 min(245-350 min),intraoperative blood loss was 100-250 ml.Four patients'pathologic results accorded with clinical staging,and 2 positive lymph nodes were found in the other one

  8. Pyrosequencing-Based Assays for Rapid Detection of HER2 and HER3 Mutations in Clinical Samples Uncover an E332E Mutation Affecting HER3 in Retroperitoneal Leiomyosarcoma.

    Science.gov (United States)

    González-Alonso, Paula; Chamizo, Cristina; Moreno, Víctor; Madoz-Gúrpide, Juan; Carvajal, Nerea; Daoud, Lina; Zazo, Sandra; Martín-Aparicio, Ester; Cristóbal, Ion; Rincón, Raúl; García-Foncillas, Jesús; Rojo, Federico

    2015-08-17

    Mutations in Human Epidermal Growth Factor Receptors (HER) are associated with poor prognosis of several types of solid tumors. Although HER-mutation detection methods are currently available, such as Next-Generation Sequencing (NGS), alternative pyrosequencing allow the rapid characterization of specific mutations. We developed specific PCR-based pyrosequencing assays for identification of most prevalent HER2 and HER3 mutations, including S310F/Y, R678Q, L755M/P/S/W, V777A/L/M, 774-776 insertion, and V842I mutations in HER2, as well as M91I, V104M/L, D297N/V/Y, and E332E/K mutations in HER3. We tested 85 Formalin Fixed and Paraffin Embbeded (FFPE) samples and we detected three HER2-V842I mutations in colorectal carcinoma (CRC), ovarian carcinoma, and pancreatic carcinoma patients, respectively, and a HER2-L755M mutation in a CRC specimen. We also determined the presence of a HER3-E332K mutation in an urothelial carcinoma sample, and two HER3-D297Y mutations, in both gastric adenocarcinoma and CRC specimens. The D297Y mutation was previously detected in breast and gastric tumors, but not in CRC. Moreover, we found a not-previously-described HER3-E332E synonymous mutation in a retroperitoneal leiomyosarcoma patient. The pyrosequencing assays presented here allow the detection and characterization of specific HER2 and HER3 mutations. These pyrosequencing assays might be implemented in routine diagnosis for molecular characterization of HER2/HER3 receptors as an alternative to complex NGS approaches.

  9. IgG4相关性腹膜后纤维化CT诊断%Diagnosis of IgG4-related retroperitoneal fibrosis

    Institute of Scientific and Technical Information of China (English)

    田芳; 朴雪梅; 周自明; 常时新; 丁永生

    2012-01-01

    Objective: To study and summarize the clinical features and the imaging manifestations of IgG4-related retroperitoneal fibrosis and to improve the understanding of IgG4-related sclerosing disease. Methods: A case of IgG4-related retroperitoneal fibrosis was reported,including clinical features,laboratory reports,imaging manifestations and pathological results,and relative literatures were reviewed. Results: The disease had no distinctive clinical features. Symptoms include vague pain in the lower back or abdomen,anorexia,fatigue,fever and weight loss. The imaging manifestation was soft tissue mass. The level of serum IgG (especially IgG4) was strikingly high. The histological manifestation in the involved organs showed diffuse infiltration of lymphoplasma cells and fibrosis. Abundant IgG4-positive plasma cells could be found and the treatment with glucocorticoid was effective. Conclusion:IgG4-related retroperitoneal fibrosis lacks specifity. It is essential to improve its understanding to avoid misdiagnosis.%目的:总结IgG4相关腹膜后纤维化的临床表现及影像特点,提高时IgG4相关的硬化性疾病的认识.方法:报告1例IgC4相关腹膜后纤维化的临床表现、实验室检查、影像学资料、病理结果等,并复习相关文献.结果:该病临床症状无明显特异性,可有腹痛、背痛、疲乏、食欲下降等,影像表现为腹膜后肿块,该病与自身免疫性胰腺炎关系密切,血清IgG尤其是IgG4显著升高;受累脏器组织学表现为弥漫性淋巴浆细胞漫润和纤维化,大量IgG4阳性浆细胞;糖皮质激素治疗有效.结论:IgG4相关腹膜后纤维化临床症状缺乏特异性,极易误诊或漏诊,需提高对该病的认识.

  10. [Retroperitoneal Tumor: Neurofibroma.

    Science.gov (United States)

    Lada, Paul Eduardo; Marriot, Daniela; Sanchez Tasonne, Carlos; Sanchez, Martin; Caballero, Fabian; Massa, Martin

    2016-01-01

    The neurofibroma is a benign tumor that grows from the sheath of the peripheral nerves, which is often localized on superficial tissues, especially in isolated forms. The neurofibromas can be of two types, localized or diffuse, the last one closely related to Von Recklinghausen disease or NF-1. We described a 37 years old male e patient, 37 years without symptoms, and the computed tomography scan (CT), and magnetic resonance imaging showed a tumor in proximity to the right kidney, the psoas muscle, the spine and compressing the cava vein, but cannot be accurately determinate the invasion of these structures. We review the differential diagnosis, therapeutic and the management of this disease in this clinical case.

  11. Primary retroperitoneal mature cystic teratoma with focal enteric type adenocarcinoma in a post-partum woman: report of a case with literature review.

    Science.gov (United States)

    Hong, Wei; Dumoff, Kimberly L; Torigian, Drew A; Bing, Zhanyong

    2013-02-11

    Teratomas are characterized by containing tissue from all three germinal cell layers. Occasionally, somatic type malignancies develop within a mature cystic teratoma. We reported here a rare case of enteric type adenocarcinoma, with associated dysplastic epithelial precursor lesion, arising within a mature cystic teratoma in the retroperitoneum of a 30-year-old woman status post vaginal delivery 11 weeks earlier. The mass is 17.5 cm and cystic. A polypoid mass component measuring 4.7×4.2×2.5 cm was located inside the cystic component. Microscopically, the majority of the specimen was a mature cystic teratoma with all three germinal cell layers. The polypoid mass component was an adenocarcinoma with an adjacent dysplastic epithelial precursor lesion. The adenocarcinoma was diffusely positive for CK20 and CDX-2, and focally positive for CD7, indicating enteric differentiation. A brief review of retroperitoneal mature cystic teratomas with associated somatic type malignancy was performed.

  12. Primary retroperitoneal mature cystic teratoma with focal enteric type adenocarcinoma in a post-partum woman: report of a case with literature review

    Directory of Open Access Journals (Sweden)

    Zhanyong Bing

    2013-02-01

    Full Text Available Teratomas are characterized by containing tissue from all three germinal cell layers. Occasionally, somatic type malignancies develop within a mature cystic teratoma. We reported here a rare case of enteric type adenocarcinoma, with associated dysplastic epithelial precursor lesion, arising within a mature cystic teratoma in the retroperitoneum of a 30-year-old woman status post vaginal delivery 11 weeks earlier. The mass is 17.5 cm and cystic. A polypoid mass component measuring 4.7x4.2x2.5 cm was located inside the cystic component. Microscopically, the majority of the specimen was a mature cystic teratoma with all three germinal cell layers. The polypoid mass component was an adenocarcinoma with an adjacent dysplastic epithelial precursor lesion. The adenocarcinoma was diffusely positive for CK20 and CDX-2, and focally positive for CD7, indicating enteric differentiation. A brief review of retroperitoneal mature cystic teratomas with associated somatic type malignancy was performed.

  13. Retroperitoneal fibromatosis:1 case report with literature review%腹膜后纤维瘤病1例报告并文献复习

    Institute of Scientific and Technical Information of China (English)

    代海涛; 刘昌茂; 夏安; 熊鹰; 呙林杰; 刘远华; 郑江; 陈益

    2015-01-01

    目的:探讨腹膜后纤维瘤病临床特点。方法:报道1例腹膜后纤维瘤病侵袭输尿管致严重血尿的诊治,并复习有关文献。结果:术中发现腹膜后右侧输尿管末端有一直径6cm 实性肿瘤,固定于盆壁,与髂外动静脉致密粘连,包裹右侧输尿管末端,上段输尿管扩张。行肿瘤大部切除术+输尿管再植术,切除肿瘤大部分为肌瘤样组织,中间坏死形成囊腔,与输尿管相通;术中快速冰冻片报告梭形细胞肿瘤,良恶性待定;术后病理报告为腹膜后纤维瘤病,免疫组化:CD34(-)、CD117(-)、Dog -1(-)、SMAS -100(-)、Vimentin (+)、Desmin(-)、NSE(-)。结论:腹膜后纤维瘤病是一种十分罕见的软组织肿瘤,可以因发生位置不同而以不同临床症状就诊,提高对这一肿瘤的认识可以减少误诊。%Objective:To investigate the clinical features of retroperitoneal fibromatosis.Methods:Describing and reporting the diagnosis and treatment of a case of retroperitoneal fibromatosis,which was invasive to the right ureter, caused severe hematuria.The literature had been reviewed and discussed.Results:There was a 6cm solid tumor,fixed on the pelvic wall,external iliac vein with dense adhesions,parcel right ureter end,with upper ureteral dilatation.We underwent tumor subtotal +ureteral reimplantation.Most of the tumor were fibroid tissue,necrosis intermediate forma-tion of cysts,which interlinked ureter.Intraoperative frozen section slice reported spindle cell tumors.Postoperative pa-thology reported retroperitoneal fibromatosis.Immunohistochemistry:CD34(-),CD117(-),Dog -1(-),SMAS -100(-),Vimentin(+),Desmin(-),NSE(-).Conclusion:Retroperitoneal fibromatosis is a very rare soft tissue tumor which can occur different clinical symptoms.To improve the understanding of this tumor can reduce misdiagnosis.

  14. Retroperitoneal neoplasms within the perirenal space in infants and children: Differentiation of renal and non-renal origin in enhanced CT images

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    Wu Yinghua [Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041 (China); The Secondly Clinical Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu 610041 (China); Song Bin, E-mail: cjr.songbin@vip.163.co [Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041 (China); Xu Juan [Department of Radiology, The Fourth People Hospital, Sichuan Province, Chengdu 610015 (China); Chen Weixia [Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041 (China); Zhao Xiaofei; Jia Rui [The Secondly Clinical Medicine College, Chengdu University of Traditional Chinese Medicine, Chengdu 610041 (China); Wu Bi; Li Zhenlin [Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041 (China)

    2010-09-15

    Purpose: To retrospectively demonstrate the specific CT findings of retroperitoneal neoplasms to diagnosis and differential diagnosis renal and non-renal tumors within the perirenal space in infants and children. Materials and methods: We retrospectively reviewed the clinical data and CT images of 42 consecutive patients with surgically and pathologically proven retroperitoneal neoplasms within the perirenal space. The patients were divided into renal tumors group (n = 16) and non-renal tumors group (n = 26). The former included nephroblastoma (n = 15) and renal lymphoma (n = 1), while the latter included neuroblastoma (n = 12), retroperitoneal teratoma (n = 6), adrenal ganglioneuroma (n = 4), retroperitoneal lymphoma (n = 2), ectopic pheochromocytoma (n = 1) and adrenal cortical carcinoma (n = 1). The clinical information of these patients and the major CT imaging findings which were related to lesion localization in the two groups were compared and statistically analyzed using Pearson Chi-Square Test and Risk Estimate. Results: The mean diameter of tumors was 9.82 {+-} 6.13 cm (n = 42 range: 2.3-32 cm). The demographic data and chief clinical symptoms between the renal tumor group and the non-renal tumor group showed no statistically significant differences (P > 0.05). 30.8% (8/26) of non-renal tumor patients presented elevated urinary vanillylmandelic acid (VMA) level, while no patient showed elevated VMA in renal tumor group (P < 0.05). Some CT imaging signs of the renal tumors including 'crescent sign' (odds ratio, OR = 52), 'beak sign' (OR = 84), 'embedded organ sign' (OR = 84), and 'prominent feeding artery sign' (OR = 36) showed significantly higher incidence when compared to the non-renal tumors (P < 0.001). The sign of 'renal displacement and renal axis rotation' (OR = 0.059) was seen in 23 of 26 (88.5%) non-renal tumors, but in only 5 of 16 (31.3%) renal tumors (P < 0.001). The sign of &apos

  15. Spontaneous combined rupture of a pelvicalyceal cyst into the collector system and retroperitoneal space during the acquisition of computed tomography scan images: a case report

    Directory of Open Access Journals (Sweden)

    Marques Diogo

    2012-11-01

    Full Text Available Abstract Introduction Pelvicalyceal cysts are common findings in autopsies and can manifest with a variety of patterns. These cystic lesions are usually a benign entity with no clinical significance unless they enlarge enough to cause compression of the adjacent collecting system and consequently obstructive uropathy. Few cases of the spontaneous rupture of pelvicalyceal renal cysts have been published and to the best of our knowledge there is no report of a combined rupture to collector system and retroperitoneal space documented during a multiphase computed tomography. Case presentation We report a case of a ‘real-time’ spontaneous rupture of a pelvicalyceal cyst into the collecting system with fistulization into the retroperitoneum. The patient was a 78-year-old Caucasian man with a previous history of renal stones and a large pelvicalyceal renal cyst who was admitted to our Emergency department with acute right flank pain. A multiphase computed tomography was performed and the pre-contrast images demonstrated a right pelvicalyceal renal cyst measuring 12.0 × 6.1cm in the lower pole causing moderate dilation of the upper right renal collection system. In addition, a partially obstructive stone on the left distal ureter with mild left hydronephrosis was noted. The nephrographic phase did not add any new information. The excretory phase (10-minute delay demonstrated a spontaneous rupture of the cyst into the pelvicalyceal system with posterior fistulization into the retroperitoneal space. Conclusion In this case study we present time-related changes of a rare pelvicalyceal cyst complication, which to the best of our knowledge has fortunately not been previously documented. Analysis of the sequential images and comparison with an earlier scan allowed us to better understand the physiopathological process of the rupture, the clinical presentation and to elaborate hypotheses for its etiopathogenesis.

  16. Management of idiopathic retroperitoneal fibrosis%原发性腹膜后纤维化19例报告

    Institute of Scientific and Technical Information of China (English)

    李晓东; 孙光; 刘晓强; 刘硕

    2009-01-01

    Objective To discuss the therapeutic methods of idiopathic retroperitoneal fibrosis (IRF). Methods Nineteen cases of IRF were reviewed.The main clinical menifestation included lamber pain and nephrohydrosis,nausea,loss of appetite,body weight descend,hypourocrinia,percussion tenderness over kidney region.The imaging showed soft tissue mass behind the peritoneum,which surrounded the abdominal aorta,and wrapped the ureter and inferior vena cava.There were 9 cases treated by open surgery,in 7 of which ureterolysis and placement into abdominal cavity were performed,and in the other 2 cases kidney fistulation was undertaken because of failure of ureterolysis.In 10 cases endoscopic stent of double J stent was taken.Glueocortieoid was given in 17 patients.Results Seventeen cases were followed up from 5 to 81 months.Six cases with ureterolysis were followed up,whose symptom disappeared and renal function recovered or kept slowly increasing state.In 2 cases undertaken kidney fistulation,urinary tract infection took place repeatedly after 3 months and 7 months respectively from operation.And 1 case needed hematodialysis therapy.There were 9 cases undertaken ureterai stent combined with prednisone were followed up,in whom hydronephrosis relieved obviously and serum Cr averaged 103±48μmol/L when keeping the double J stent.In 3 cases hydronephrosis recurred after removing the stent. Conclusions Ureterolysis and placement into abdominal cavity is the valid treatment of IRF.The way of endoscopic stent combined prednisone treated IRF is simple,which effect is satisfied in short term.%目的 提高原发性腹膜后纤维化患者临床治疗效果.方法 原发性腹膜后纤维化患者19例.临床表现腰腹部疼痛、恶心、食欲不振,乏力、体重下降、尿量减少,体检发现双肾积水肾区叩击痛等.影像学检查表现为腹膜后软组织肿块,沿腹主动脉前方及两侧分布,包绕输尿管和下腔静脉.行开放手术9例,其中双输

  17. Observation of the therapeutic efficacy of stereotactic radiotherapy in 44 cases of retroperitoneal metastatic tumor%X线立体定向放射治疗44例腹膜后转移癌近期疗效观察

    Institute of Scientific and Technical Information of China (English)

    席青松; 于世英; 胡广原

    2006-01-01

    Objective: To investigate the therapeutic effects of stereotactic radiotherapy for retroperitoneal metastatic tumor.Methods: From August 1997 to October 2004,44 patients with retroperitoneal metastatic tumors were treated with stereotactic radiotherapy.The planning target volume was encompassed by 90%-95% isodose line.Fractional dose was from 6 Gy to 8 Gy,and they were treated 2-3 times per-week and 4-8 times in all.The total radiation doses of PTV were from 32 Gy to 48 Gy.Results: After the radiotherapy,the pain was obviously relieved in 81.8% patients.Three months after completion of radiotherapy passed and then,abdominal CT was performed to evaluate the results.The whole effective rate was 81.8% [CR 27.7% (12/44)and PR 54.5% (24/44)],and six months after radiotherapy,CR was 27.7% (12/44) and PR was 59.1% (26/44).The middle survival time was 12 months.Conclusion: It is suggested that stereotactic radiotherapy for retroperitoneal metastatic tumor is a safe and effective method.

  18. Surgical manipulation of major blood vessels invaded by retroperitoneal tumors%腹膜后肿瘤累及腹部大血管的处理

    Institute of Scientific and Technical Information of China (English)

    田文

    2009-01-01

    腹膜后肿瘤出现症状就诊时,肿瘤通常发展的比较大且多已累及重要血管.腹膜后肿瘤所累及重要血管外科处理的关键是提高肿瘤切除率.首先应用CT、MRI及数字减影血管造影等影像学方法 判断腹膜后肿瘤所累及重要血管的情况.良好显露为控制和处理血管出血创造了必要条件,增加了手术安全性.血管阻断前应行局部或全身肝素化,有些重要的血管需行修复和重建.自体血管的使用已日渐成熟,人工血管和补片的使用为手术提供了便利.重建时要注意恢复血管功能及防止血管损伤和术后血栓形成.%When the retroperitoneal tumor patients with clinic symptoms seek medical treatment, the tumors are usually large and involve major blood vessels. The correct surgical manipulation of major blood vessels invaded by retroperitoneal tumors is important to raise the resection rate. The examination of CT, MRI and DSA (digital subtration angiography) can help preoperative evaluation and preparation for major blood vessels resection and reconstruction. Good vessel exposing plays a necessary part in vessel resection and reconstruction. Before controling bleeding and vessel reconstruction, local or systemic heparinization should be necessary. Some important vessels need to repair and reconstruction. Now using autologous blood vessels for vessel reconstruction has been more common, artificial blood vessels and mesh greatly facilitate reconstruction. It should be paid attention to vascular function reconstruction, preventing postoperative vascular injury and thrombosis.

  19. Comparison of Three-Dimensional (3D) Conformal Proton Radiotherapy (RT), 3D Conformal Photon RT, and Intensity-Modulated RT for Retroperitoneal and Intra-Abdominal Sarcomas

    Energy Technology Data Exchange (ETDEWEB)

    Swanson, Erika L. [Department of Radiation Oncology, University of Florida, Gainesville, Florida (United States); Indelicato, Daniel J., E-mail: dindelicato@floridaproton.org [Department of Radiation Oncology, University of Florida, Gainesville, Florida (United States); University of Florida Proton Therapy Institute, Jacksonville, Florida (United States); Louis, Debbie; Flampouri, Stella; Li, Zuofeng [University of Florida Proton Therapy Institute, Jacksonville, Florida (United States); Morris, Christopher G.; Paryani, Nitesh [Department of Radiation Oncology, University of Florida, Gainesville, Florida (United States); Slopsema, Roelf [University of Florida Proton Therapy Institute, Jacksonville, Florida (United States)

    2012-08-01

    Purpose: To compare three-dimensional conformal proton radiotherapy (3DCPT), intensity-modulated photon radiotherapy (IMRT), and 3D conformal photon radiotherapy (3DCRT) to predict the optimal RT technique for retroperitoneal sarcomas. Methods and Materials: 3DCRT, IMRT, and 3DCPT plans were created for treating eight patients with retroperitoneal or intra-abdominal sarcomas. The clinical target volume (CTV) included the gross tumor plus a 2-cm margin, limited by bone and intact fascial planes. For photon plans, the planning target volume (PTV) included a uniform expansion of 5 mm. For the proton plans, the PTV was nonuniform and beam-specific. The prescription dose was 50.4 Gy/Cobalt gray equivalent CGE. Plans were normalized so that >95% of the CTV received 100% of the dose. Results: The CTV was covered adequately by all techniques. The median conformity index was 0.69 for 3DCPT, 0.75 for IMRT, and 0.51 for 3DCRT. The median inhomogeneity coefficient was 0.062 for 3DCPT, 0.066 for IMRT, and 0.073 for 3DCRT. The bowel median volume receiving 15 Gy (V15) was 16.4% for 3DCPT, 52.2% for IMRT, and 66.1% for 3DCRT. The bowel median V45 was 6.3% for 3DCPT, 4.7% for IMRT, and 15.6% for 3DCRT. The median ipsilateral mean kidney dose was 22.5 CGE for 3DCPT, 34.1 Gy for IMRT, and 37.8 Gy for 3DCRT. The median contralateral mean kidney dose was 0 CGE for 3DCPT, 6.4 Gy for IMRT, and 11 Gy for 3DCRT. The median contralateral kidney V5 was 0% for 3DCPT, 49.9% for IMRT, and 99.7% for 3DCRT. Regardless of technique, the median mean liver dose was <30 Gy, and the median cord V50 was 0%. The median integral dose was 126 J for 3DCPT, 400 J for IMRT, and 432 J for 3DCRT. Conclusions: IMRT and 3DCPT result in plans that are more conformal and homogenous than 3DCRT. Based on Quantitative Analysis of Normal Tissue Effects in Clinic benchmarks, the dosimetric advantage of proton therapy may be less gastrointestinal and genitourinary toxicity.

  20. Extra gonadal non-seminomatous germ cell tumour and PET-T.D.M. with {sup 18}F-F.D.G.: about one case of primitive retroperitoneal choriocarcinoma; Tumeurs germinales non seminomateuses extragonadiques et TEP-TDM au F-18 FDG: a propos d'un cas de choriocarcinome retroperitoneal primitif

    Energy Technology Data Exchange (ETDEWEB)

    Cimarelli, S.; Deshayes, E.; Mognetti, T.; Desuzinges, C. [Service de medecine nucleaire, centre Leon-Berard, Lyon, (France); Biron, P. [departement d' oncologie, centre Leon-Berard, Lyon, (France); Rivoire, M. [departement de chirurgie, centre Leon-Berard, Lyon, (France); Giammarile, F. [service de medecine nucleaire, hopital Lyon-Sud, (France)

    2009-05-15

    The non-seminomatous germinal tumors represent 60% of the germinal tumors, the most frequent cancer for young men.The positron computed tomography/computed tomography (PET/T.D.M.) with {sup 18}F fluorodeoxyglucose seems full of promises for the initial evaluation and the early evaluation of chemotherapy. for this type of tumor. In 1 to 5% of cases these tumors are extra gonadal. We present the case of a twenty three years old man with a retroperitoneal primitive choriocarcinoma with numerous metastases for whom the metabolic imaging was useful. We discuss the interest of this examination in this rare pathology. For the extra gonadal non-seminomatous germinal tumors the PET-F.D.G. seems bring information useful for the determination of the viable character of a post-chemotherapy residual mass, especially when the anatomical imaging show results discordant with the clinico biological data. (N.C.)

  1. Surgical technique: Retroperitoneoscopic approach for adrenal masses in children.

    Science.gov (United States)

    Yankovic, F; Undre, S; Mushtaq, I

    2014-04-01

    Laparoscopic adrenalectomy is considered to be the standard of care for the surgical excision of adrenal masses. The transperitoneal laparoscopic and retroperitoneoscopic approaches are described. Both are safe and as effective as open adrenalectomy, with the added benefit of the minimally invasive approach. It can be utilized for patients requiring surgery for a phaeochromocytoma, adrenal adenoma, adrenal adenocarcinoma, Cushing's syndrome, neuroblastoma, and an incidentaloma. Relative contraindications include previous surgery of the liver or kidney, large tumours (>8-10 cm in diameter) or coagulation disorders. Although the transperitoneal route is used more widely, the retroperitoneal approach provides direct access to the adrenal gland and easy visualization of the adrenal vein. It avoids also colonic mobilization, minimizes the risk of injury to hollow viscera, and the potential risk of adhesion formation. However, the reversed orientation of the kidney and hilum, combined with a significantly smaller working space, may make this approach difficult to master.

  2. Retroperitoneal Lymphangioma in Children:a Report of 11 Cases%小儿腹膜后淋巴管瘤(附11例报告)

    Institute of Scientific and Technical Information of China (English)

    李建仁; 房志勤; 杨明洁; 叶祖萍; 詹江华; 王学文

    1992-01-01

    小儿腹膜后淋巴管瘤罕见.天津儿童医院1974~1990年共收治11例.囊肿小时很少有症状,囊肿达一定大小或合并感染出血时可出现消化道功能障碍.本病易被误诊为腹膜后囊性畸胎瘤和胰腺囊肿.B型超声榆查诊断意义很大,手术切除是唯一的治疗方法.%Elevee cases of retroperitonel lymphangioma were treated in Tianjin Children's Hospital from 1974 to 1990.67% of the patients were below 5 years of age.Symptom was rare while the cyst was small.Abdominal pain,vomiting and lose appetite occured in patient with big cyst.The diagnosis relied on plain X-ray,IVP, upper gastrcintestinal radiography, especially the B-ultrasonography.Retroperitoneal lymphangioma should be differentiated from retrcperitoneal cystic teratoms and pancreatic cyst.The authors suggest that surgical excision would be the treatment of choice.

  3. Extensive retroperitoneal and right thigh abscess in a patient with ruptured retrocecal appendicitis: An extremely fulminant form of a common disease

    Institute of Scientific and Technical Information of China (English)

    Chi-Hsun Hsieh; Yu-Chun Wang; Horng-Ren Yang; Ping-Kuei Chung; Long-Bin Jeng; Ray-Jade Chen

    2006-01-01

    As a disease commonly encountered in daily practice,acute appendicitis is usually diagnosed and managed easily with a low mortality and morbidity rate.However, acute appendicitis may occasionally become extraordinarily complicated and life threatening. A56-year-old man, healthy prior to this admission, was brought to the hospital due to spiking high fever, poor appetite, dysuria, progressive right flank and painful swelling of the thigh for 3 d. Significant inflammatory change of soft tissue was noted, involving the entire right trunk from the subcostal margin to the knee joint. Painful disability of the right lower extremity and apparent signs of peritonitis at the right lower abdomen were disclosed. Laboratory results revealed leukocytosis and an elevated C-reactive protein level. Abdominal CT revealed several communicated gas-containing abscesses at the right retroperitoneal region with mass effect, pushing the duodenum and the pancreatic head upward, compressing and encasing inferior vena cava,destroying psoas muscle and dissecting downward into the right thigh. Laparotomy and right thigh exploration were performed immediately and about 500 mL of frank pus was drained. A ruptured retrocecal appendix was the cause of the abscess. The patient fully recovered at the end of the third post-operation week. This case reminds us that acute appendicitis should be treated carefully on an emergency basis to avoid serious complications.CT scan is the diagnostic tool of choice, with rapid evaluation followed by adequate drainage as the key to the survival of the patient.

  4. A low-protein, high-carbohydrate diet increases fatty acid uptake and reduces norepinephrine-induced lipolysis in rat retroperitoneal white adipose tissue.

    Science.gov (United States)

    Santos, Maísa P dos; França, Suélem A de; Santos, José Tiago F dos; Buzelle, Samyra L; Bertolini, Gisele L; Garófalo, Maria Antonieta R; Kettelhut, Isis C do; Frasson, Danúbia; Chaves, Valéria E; Kawashita, Nair H

    2012-03-01

    A low-protein, high-carbohydrate (LPHC) diet for 15 days increased the lipid content in the carcass and adipose tissues of rats. The aim of this work was to investigate the mechanisms of this lipid increase in the retroperitoneal white adipose tissue (RWAT) of these animals. The LPHC diet induced an approximately two- and tenfold increase in serum corticosterone and TNF-α, respectively. The rate of de novo fatty acid (FA) synthesis in vivo was reduced (50%) in LPHC rats, and the lipoprotein lipase activity increased (100%). In addition, glycerokinase activity increased (60%), and the phosphoenolpyruvate carboxykinase content decreased (27%). Basal [U-¹⁴C]-glucose incorporation into glycerol-triacylglycerol did not differ between the groups; however, in the presence of insulin, [U-¹⁴C]-glucose incorporation increased by 124% in adipocytes from only control rats. The reductions in IRS1 and AKT content as well as AKT phosphorylation in the RWAT from LPHC rats and the absence of an insulin response suggest that these adipocytes have reduced insulin sensitivity. The increase in NE turnover by 45% and the lack of a lipolytic response to NE in adipocytes from LPHC rats imply catecholamine resistance. The data reveal that the increase in fat storage in the RWAT of LPHC rats results from an increase in FA uptake from circulating lipoproteins and glycerol phosphorylation, which is accompanied by an impaired lipolysis that is activated by NE.

  5. Fluorescence-guided surgery of retroperitoneal-implanted human fibrosarcoma in nude mice delays or eliminates tumor recurrence and increases survival compared to bright-light surgery.

    Directory of Open Access Journals (Sweden)

    Fuminari Uehara

    Full Text Available The aim of this study is to determine if fluorescence-guided surgery (FGS can eradicate human fibrosarcoma growing in the retroperitoneum of nude mice. One week after retroperitoneal implantation of human HT1080 fibrosarcoma cells, expressing green fluorescent protein (GFP (HT-1080-GFP, in nude mice, bright-light surgery (BLS was performed on all tumor-bearing mice (n = 22. After BLS, mice were randomized into 2 treatment groups; BLS-only (n = 11 or the combination of BLS + FGS (n = 11. The residual tumors remaining after BLS were resected with FGS using a hand-held portable imaging system under fluorescence navigation. The average residual tumor area after BLS + FGS was significantly smaller than after BLS-only (0.4 ± 0.4 mm(2 and 10.5 ± 2.4 mm(2, respectively; p = 0.006. Five weeks after surgery, the fluorescent-tumor areas of BLS- and BLS + FGS-treated mice were 379 ± 147 mm(2 and 11.7 ± 6.9 mm(2, respectively, indicating that FGS greatly inhibited tumor recurrence compared to BLS. The combination of BLS + FGS significantly decreased fibrosarcoma recurrence compared to BLS-only treated mice (p < 0.001. Mice treated with BLS+FGS had a significantly higher disease-free survival rate than mice treated with BLS-only at five weeks after surgery. These results suggest that combination of BLS + FGS significantly reduced the residual fibrosarcoma volume after BLS and improved disease-free survival.

  6. 腹膜后局限性Castleman病20例临床诊治及预后分析%Surgical treatment and prognosis analysis of localized retroperitoneal Castleman disease: a study of 20 cases

    Institute of Scientific and Technical Information of China (English)

    汤坚强; 杨尹默; 熊焰; 万远廉; 朱学骏

    2009-01-01

    目的 探讨腹膜后局限性Castleman病的临床特征、诊治策略及影响预后的因素,提高伴副肿瘤性天疱疮(PNP)的Castleman病的诊治水平.方法 回顾性分析1993年1月至2009年5月在北京大学第一医院普通外科接受手术治疗的20例腹膜后Castleman病患者的临床资料,并将13例腹膜后Castleman病伴PNP患者的临床资料与同期7例单纯腹膜后Castleman病患者进行比较,分析两者在发病特点、部位、实验室检查、手术策略、病理特征及外科治疗效果的不同.结果 (1)本组腹膜后Castleman病多见于中青年(中位年龄36岁),发病部位多位于肾旁(14/20,70%)及髂窝(4/20,20%),左侧腹膜后多见,病理分型以透明血管型为主,腹膜后Castleman病合并PNP组的性别、年龄、肿瘤发病部位、大小及病理分型与单纯腹膜后Castleman病组无明显区别(P>0.05);(2)本组腹膜后Castleman病合并PNP患者较易合并闭塞性细支气管炎(8/13),有血清肿瘤标志物癌胚抗原或CA242升高现象(3/8);(3)本组腹膜后Castleman病常有包膜,与邻近脏器边界清晰,手术较为容易,但合并PNP的腹膜后Castleman病的生物学行为有恶性倾向及伴发子灶特征,有侵及邻近血管及术后局部复发可能;(4)Kaplan-Meier及Log-Rank生存分析显示,腹膜后Castleman病合并PNP患者5年生存率为42.8%,平均生存时间30个月,明显低于单纯腹膜后Castleman病组(P<0.05),是否合并闭塞性细支气管炎以及肿瘤能否根治切除是影响腹膜后Castleman病患者预后的重要因素.结论 腹膜后Castleman病伴PNP具有独特的临床特征,早期诊断和切除肿瘤、及时终止致病抗体的产生,是成功治愈的关键.%Objective To investigate the clinical characteristics,surgical treatment and prognosis analysis of localized retroperitoneal Casfleman disease (CD),and to improve the level of diagnosis and treatment of retroperitoneal Castleman disease with paraneoplastic

  7. Laparoscopic anterior versus endoscopic posterior approach for adrenalectomy: a shift to a new golden standard?

    Science.gov (United States)

    Vrielink, O M; Wevers, K P; Kist, J W; Borel Rinkes, I H M; Hemmer, P H J; Vriens, M R; de Vries, J; Kruijff, S

    2017-08-01

    There has been an increased utilization of the posterior retroperitoneal approach (PRA) for adrenalectomy alongside the "classic" laparoscopic transabdominal technique (LTA). The aim of this study was to compare both procedures based on outcome variables at various ranges of tumor size. A retrospective analysis was performed on 204 laparoscopic transabdominal (UMC Groningen) and 57 retroperitoneal (UMC Utrecht) adrenalectomies between 1998 and 2013. We applied a univariate and multivariate regression analysis. Mann-Whitney and chi-squared tests were used to compare outcome variables between both approaches. Both mean operation time and median blood loss were significantly lower in the PRA group with 102.1 (SD 33.5) vs. 173.3 (SD 59.1) minutes (p < 0.001) and 0 (0-200) vs. 50 (0-1000) milliliters (p < 0.001), respectively. The shorter operation time in PRA was independent of tumor size. Complication rates were higher in the LTA (19.1%) compared to PRA (8.8%). There was no significant difference in recovery time between both approaches. Application of the PRA decreases operation time, blood loss, and complication rates compared to LTA. This might encourage institutions that use the LTA to start using PRA in patients with adrenal tumors, independent of tumor size.

  8. Intensity modulated radiotherapy as adjuvant post-operative treatment for retroperitoneal sarcoma: Acute toxicity; Radiotherapie avec modulation d'intensite dans le traitement postoperatoire des sarcomes retroperitoneaux: profil de toxicite aigue

    Energy Technology Data Exchange (ETDEWEB)

    Paumier, A.; Roberti, E.; Le Pechoux, C. [Departement de radiotherapie, institut de cancerologie Gustave-Roussy, 114, rue edouard-Vaillant, 94805 Villejuif (France); Bonvalot, S.; Rimareix, F. [Departement de chirurgie generale, institut de cancerologie Gustave-Roussy, 114, rue edouard-Vaillant, 94805 Villejuif (France); Beaudre, A.; Lefkopoulos, D. [Unite de physique, institut de cancerologie Gustave-Roussy, 114, rue edouard-Vaillant, 94805 Villejuif (France); Terrier, P. [Departement de biologie et de pathologie medicales, institut de cancerologie Gustave-Roussy, 114, rue edouard-Vaillant, 94805 Villejuif (France); Domont, J.; Le Cesne, A. [Departement de medecine oncologique, institut de cancerologie Gustave-Roussy, 114, rue edouard-Vaillant, 94805 Villejuif (France)

    2011-08-15

    Purpose. - To assess the acute toxicity of intensity modulated radiotherapy as post-operative adjuvant treatment for retroperitoneal sarcoma. Patients and methods. - Patients who received adjuvant intensity modulated radiotherapy from January 2009 to September 2010 were retrospectively reviewed. Results. - Fourteen patients entered the study (seven primary tumours and seven relapses). All tumours were liposarcoma and had macroscopically complete resection, epiploplasty was systematically realized. Median tumour size was 21 cm (range: 15-45), median planning target volume was 580 cm{sup 3} (range: 329-1172) and median prescribed dose was 50.4 Gy (range: 45-54). Median follow-up was 11.5 months (range: 2-21.4). Acute toxicity was mild: acute digestive toxicity grade 1-2 occurred in 12/14 patients (86%). However, there was no weight loss of more than 5% during radiotherapy and no treatment interruption was required. Two months after completion of radiotherapy, digestive toxicity grade 1 remained present in 1/14 patients (7%). One case of grade 3 toxicity occurred during follow-up (transient abdominal pain). Three relapses occurred: two were outside treaded volume and one was both in and outside treated volume. Conclusions. - Intensity modulated radiotherapy in the postoperative setting of retroperitoneal sarcoma provides low acute toxicity. Longer follow-up is needed to assess late toxicity, especially for bowel, kidney and radio-induced malignancies. (authors)

  9. Contemporary reappraisal of the efficacy of adjuvant chemotherapy in resected retroperitoneal sarcoma: Evidence from a nationwide clinical oncology database and review of the literature.

    Science.gov (United States)

    Datta, Jashodeep; Ecker, Brett L; Neuwirth, Madalyn G; Geha, Rula C; Fraker, Douglas L; Roses, Robert E; Karakousis, Giorgos C

    2017-06-01

    While margin-negative resection remains the cornerstone of therapy for retroperitoneal sarcoma (RPS), the impact of adjuvant chemotherapy (AC) on overall survival (OS) remains poorly understood. The National Cancer Data Base was queried for patients undergoing curative-intent resection of primary non-metastatic RPS (2004-2013). Multivariable modeling identified factors associated with AC receipt. Cox regression identified covariates associated with OS, and AC and surgery alone (SA) cohorts were matched 1:1 by propensity scores based on these covariates. In the propensity-score matched cohort, OS was compared by Kaplan-Meier estimates. Results from this analysis were presented in the context of a review of the existing literature on the impact of AC in resected RPS. Of 3892 resected RPS patients, 90.0% and 10.0% received SA and AC, respectively. Predictors of AC receipt included younger age, non-Caucasian race, hospital location, histologic grade, adjacent organ invasion, and histologic subtype. The propensity score-matched cohort comprised 767 patients (SA n = 377; AC n = 390); at a median follow-up of 59.2 (IQR 35.0-85.3) months, median OS of the propensity-matched cohort was 53.6 (IQR 22.4-119.5) months. Utilization of AC was associated with significantly worse long-term survival (median OS: 47.8 vs. 68.9 months, p = 0.017; HR 1.30, 95% CI 1.05-1.61). AC was not associated with improved OS in margin-positive (R1/R2) resection, high-grade (G2/G3) and larger (>10 cm) tumors, or in any histologic subtype. Albeit not statistically significant, there was a trend toward improved OS with AC in spindle cell (HR 0.37, 95% CI 0.10-1.38), giant cell (HR 0.82, 95% CI 0.32-2.13), and synovial (HR 0.26, 95% CI 0.05-1.33) sarcoma. Data from a large nationwide oncology database and review of the existing literature do not support adjuvant chemotherapy regimens following curative-intent resection of RPS, even in subgroups at high risk of failure (e.g., R1/R2 resection

  10. 特发性腹膜后纤维化16例临床分析%Clinical features of 16 patients with idiopathic retroperitoneal fibrosis

    Institute of Scientific and Technical Information of China (English)

    张伟; 薛峰; 侯峰; 邵乐平; 刘丽秋

    2016-01-01

    目的 探讨特发性腹膜后纤维化(iRPF)临床特点、诊疗及转归,以提高临床诊断率,减少漏诊和误诊.方法 回顾分析在青岛大学附属医院住院确诊的16例iRPF患者,其中包括9例IgG4相关腹膜后纤维化患者.结果 iRPF多见于中老年男性,肾功能衰竭合并腰腹疼痛、体重减轻是最常见的临床表现.IgG4-RPF患者与非IgG4-RPF患者Hb、SCr、ESR、CRP组间比较差异无统计学意义.所有患者均存在CT或MRI下腹膜后软组织密度影;IgG4-RPF患者同时还可发现颌下腺、深部淋巴结、胰腺、胆管、胸腺、肾间质、甲状腺等多器官受累.病理学检查发现全部IgG4-RD患者不同受累器官均显示相同特点的改变,且其IgG4阳性的浆细胞计数、IgG4 +/IgG阳性浆细胞计数比例、席纹状纤维化例数较非IgG4-RPF患者有显著的统计学差异.8例行皮质类固醇和免疫抑制剂治疗;6例行药物及手术联合治疗;2例单纯手术治疗.所有接受皮质类固醇治疗的患者病情均缓解,其中2例停药后复发;但单纯外科治疗患者反复发作.结论 特发性腹膜后纤维化与IgG4-RD疾病谱有交集,但临床特点及普通影像学检查无法做出鉴别,需要进一步病理学检查.激素及免疫抑制剂对两者治疗均有效并可减少复发.%Objectives The aim of this investigation is to explore clinical features,diagnosis,treatment and sequelae of idiopathic retroperitoneal fibresis (iRPF),and to serve for improvement of clinical diagnosis and treatment.Methods Retrospective analysis were done in 16 cases with iRPF in the affiliated hospital of Qingdao University,including 9 patients with IgG4-related RPF.Results iRPF was more common in middle-aged and old males.The most common clinical presentations were renal failure,abdominal pain,and body weight loss.There were no significant differences of Hb,Scr,ESR and CRP between the IgG4-RPF and non-IgG4-RPF patients.CT or MRI scans showed

  11. 骨盆骨折并发腹膜后血肿的诊治策略%Diagnosis and treatment strategies of pelvic fracture complicated with retroperitoneal hematoma

    Institute of Scientific and Technical Information of China (English)

    张明柱

    2013-01-01

    目的:探讨骨盆骨折并发腹膜后血肿的诊断与治疗策略。方法:2006年1月~2012年5月,采用中西医结合疗法诊治骨盆骨折并发腹膜后血肿患者51例,男36例,女15例;年龄18~57岁,中位数35岁;受伤至就诊时间30min~5d。合并其他部位骨折21例,肾挫裂伤4例,小肠破裂8例,肝脏破裂4例,脾脏破裂8例。并发症尿道断裂11例,膀胱破裂9例,直肠破裂1例,结肠破裂4例,髂静脉破裂2例。结果:本组治愈46例,死亡5例。死亡原因为多发伤、伤势过重,发生失血性休克及弥漫性血管内凝血,导致多器官功能衰竭。术后并发粘连性肠梗阻5例,经非手术治疗后治愈;并发膀胱阴道瘘1例,盆腔脓肿1例,均经再次手术后治愈。结论:骨盆骨折并发腹膜后血肿是一种严重复杂的外伤,常合并腹盆腔脏器及大血管损伤,而使临床表现多样化,误诊率高,死亡率高。详细询问病史,仔细反复腹部检查,进行诊断性腹腔穿刺,综合运用B超、CT、X线检查,可提高诊断的正确率。尽早明确诊断,尽快纠正休克,积极处理骨盆骨折和合并的脏器损伤,必要时剖腹探查迅速控制出血,是提高抢救成功率的关键,而术中血肿是否探查因血肿部位及动态而异。%Objective: To investigate the diagnosis and treatment strategies of retroperitoneal hematoma complicated with pelvic fracture. Methods:From January 2006 to May 2012, treated 51 patients in the integrative medicine, 36 males and 15 females;aged 18 to 57 years, with a median age of 35 cases;injuries to treatment time 30 minites to 5 days. Combined with other fractures in 21 cases, 4 cases of renal contusion, rupture of small intestine in 8 cases, 4 cases of ruptured liver, spleen rupture in 8 cases. Complicated with urethral rupture in 11 cases, 9 cases of bladder rupture, rupture of one case of rectal, colon rupture in 4 cases

  12. Retroperitoneal local CastLeman's disease: 4 case reports and literature review%腹膜后局限性CastLeman病4例报告并文献复习

    Institute of Scientific and Technical Information of China (English)

    杨冬园; 周四维

    2013-01-01

    目的:报告偶然发现的4例腹膜后局限性CastLeman病,并结合文献复习,以提高对该疾病的认识及诊疗水平.方法:回顾性分析4例术前未能明确诊断的后腹膜占位性病变病例,经手术切除,术后病理证实为较少见的局限性CastLeman病.结果:4例均经手术完整切除肿瘤,未行辅助治疗,随访7个月~4年2个月,4例患者均无瘤存活,未见肿瘤复发.结论:腹膜后CastLeman病临床症状不典型,术前实验室及影像学检查无特异性,常易误诊.手术探查切除肿瘤为首选治疗方法,疗效较好,最终明确诊断有赖于病理学检查.%Objective: We reported the incidentally found 4 cases of retroperitoneal the local CastLeman's disease and undertook a literature review to improve the diagnosis and treatment of the disease. Method: Retrospectively analyzed 4 cases with retroperitoneal mass which failed to confirm the diagnosis before surgery. After surgical resection, the pathological results were local CastLemans disease. Result: All 4 cases received complete surgical resection of the tumor. No adjuvant therapy was administrated. Follow-up ranged form 4 months to 4 years and 2 months. No recurrence was observed. Conclusion: Retroperitoneal CastLeman's disease has no typical clinical findings. It may pose a diagnose dilemma because of its lack of specific lab test and distinguish radiographic features. Surgical exploration to remove the tumor is the preferred treatment with fair outcome. Eventually confirming diagnosis depends on the pathological examination.

  13. Retroperitoneal laparoscopic nephron-sparing surgery for renal tumor : report of 15 cases%后腹腔镜保留肾单位肾脏肿瘤切除术(附15例报告)

    Institute of Scientific and Technical Information of China (English)

    梁平; 吴刚; 叶锦; 王鹏; 江军; 靳风烁

    2008-01-01

    目的 探讨后腹腔镜行保留肾单位肾脏肿瘤切除术的手术可行性及疗效.方法 2007年3月至2008年8月,15例肾脏局限性肿瘤患者采用后腹腔镜保留肾单位肾脏肿瘤切除术.术中用bulldog血管钳阻断肾脏血流,用超声刀在距离肿瘤边缘2~10 mm处进行切除,肿瘤床随机切取三处组织送冰冻病理检查.结果 15例手术均顺利完成,无一例中转开放.平均手术时间110 min,术中平均阻断肾血流时间26 min,术中平均出血量200 ml,平均术后住院时间9 d.术中切缘组织病理切片均为阴性.术后随访2~14个月肿瘤无复发.结论 后腹腔镜保留肾单位肾脏肿瘤切除术治疗肾脏肿瘤技术可行,安全有效,其远期疗效尚有待长期随访.%Objective To valuate the clinical effect of retroperitoneal laparoscopic nephron-sparing surgery. Methods From March 2007 to May 2008, 15 patients with local renal tumors underwent retroperitoneal laparoscopic partial nephrectomy by a single surgeon. Hilar control was achieved with bulldog clamps. Hook-cautery is used to circumscribe the tumor for resection by scoring the renal capsule circumferentially with a 2-10 mm margin around the tumor. Specimens are randomly extracted through tumor edges and immediately given to pathological frozen sections. The operative time, blood loss, postoperative stay, complications and the time of complete convalescence were recorded. Results Mean operative time was 110 minutes and mean time of hilar control was 26 minutes. Mean blood loss was 200ml. Mean postoperative stay was 9 days. Final pathological evaluation revealed negative positive margins in these cases. During 2-14 months follow-up there was no local recurrence. Conclusions Retroperitoneal laparoscopic partial nephrectomy for small renal tumors can be performed safely and effectively. Extended follow-up period is required to determine its long-term functional and oncological outcomes.

  14. 超声内镜在腹膜后占位性病变诊断中的应用%Application of endoscopic ultrasonography in the diagnosis of retroperitoneal occupying lesion

    Institute of Scientific and Technical Information of China (English)

    王越华; 谢丛华; 丁祥武

    2011-01-01

    目的 评价超声内镜(endoscopic ultrasonography)在腹膜后占位性病变定性诊断中的应用价值.方法 回顾性分析26例因腹膜后占位病变在本院行超声内镜介导下细针穿刺抽吸活检术(endoscopic ultrasonography guided fine needle aspiration,EUS-FNA)患者的病理诊断情况.结果 26例患者中24例有明确病理结果,组织学诊断率为92.3%.本组患者均未发生出血、感染、腹腔内脏器损伤等并发症.病理诊断为良性肿瘤8例,占33.3%;恶性16例,占66.7%.2例因取材较少无明确病理学诊断,8例患者避免了手术治疗.结论 对于腹膜后占位的定性诊断,EUS-FNA具有并发症少、诊断率高的优点,值得临床推广.%Objective To evaluate the endoscopic ultrasonography (EUS) in the qualitative diagnosis of retroperitoneal space-occupying lesions. Methods Twenty-six patients with retroperitoneal space-occupying lesions were examined by endoscopic ultrasonography guided fine needle aspiration (EUS-FNA).All lesions were confirmed by pathology. Results Of all the twenty-six patients, twenty-four had definite pathological diagnosis, the rate of histodiagnosis was 92. 3%. There was no complications such as hemorrhage, infection or the injury of abdominal viscera. Eight patients were diagnosed as benign tumors, the rate of it was 33.3%; sixteen patients were diagnosed as malignant tumors, the rate of it was 66. 7%. Two patients had no definite pathological diagnosis because of insufficient biopsy material. Eight patients avoided operation due to the diagnosis of benign tumors. Conclusion EUS-FNA has the advantage of few complication and high diagnostic rate, so it is valuable in qualitative diagnosis of the retroperitoneal space-occupying lesions.

  15. Malacoplakia of probable retroperitoneal origin.

    Directory of Open Access Journals (Sweden)

    Kumon,Hiromi

    1979-12-01

    Full Text Available A case of extravesical malacoplakia, the first case in Japan, is described in detail. The patient was a 61-year-old woman with a right flank mass. Radiologically, the mass was thought to be of the renal origin. Surgically, however, the tumor was found attached not only to the cortical surface but extended to the retroperitoneum and psoas muscle. Pathological examination confirmed the lesion to be malacoplakia characterized by the presence of von Hansemann cells and Michaelis-Gutmann bodies.

  16. Mixed Capillary Venous Retroperitoneal Hemangioma

    Directory of Open Access Journals (Sweden)

    Mohit Godar

    2013-01-01

    Full Text Available We report a case of mixed capillary venous hemangioma of the retroperitoneum in a 61-year-old man. Abdominal ultrasonography showed a mass to be hypoechoic with increased flow in color Doppler imaging. Dynamic contrast-enhanced computed tomography revealed a centripetal filling-in of the mass, located anterior to the left psoas muscle at the level of sacroiliac joint. On the basis of imaging features, preoperative diagnosis of hemangioma was considered and the mass was excised by laparoscopic method. Immunohistochemical studies were strongly positive for CD31 and CD34, and negative for calretinin, EMA, WT1, HMB45, Ki67, synaptophysin, and lymphatic endothelial cell marker D2–40. Histologically, the neoplasm was diagnosed as mixed capillary venous hemangioma.

  17. Comparison of standard and individually planned infradiaphragmatic field in irradiation of retroperitoneal and pelvic lymph nodes; Standard- versus individuell geplantes Bestrahlungsfeld bei Radiotherapie infradiaphragmaler Lymphknotenstationen

    Energy Technology Data Exchange (ETDEWEB)

    Nevinny-Stickel, M.; Ennemoser, S.; Lukas, P. [Universitaetsklinik fuer Strahlentherapie - Radioonkologie, Innsbruck (Austria); Bangerl, I.; Zur Nedden, D. [Universitaetsklinik fuer Radiodignostik 2, Innsbruck (Austria)

    1998-07-01

    Purpose: In prophylactic irradiation of infradiaphragmatic lymphatic nodes, the width of the paraaortic and pelvic field is given by a line joining the tips of the transverse processes of the 11th thoracic to the 4th lumbar vertebra from where the field boundary follows a straight line to the most lateral point of the acetabulum as seen in simulation film. Another way to build the field border is to project the lateral contours of the large abdominal vessels from T1-weighted coronal MR images of the abdomen on the simulator radiographs and add a 2-cm margin along the vessels delineated. In our study, we compared both methods as to full enclosure of paraaortic and pelvic lymphatics or nodal miss. Material and Methods: Abdominal CT scans of 81 patients with involvement of paraaortic lymph node regions were examined with maximum lymph node sizes of 2.5 cm. The distance from the center of the appropriate vertebra to the lateral lymph node contour referring to the transverse process as well as to the outside contour of the aorta on the left and the vena cava on the right side, respectively, the iliac vessels were measured from T12 through S1. At the level of the hip joint the measurement point was given by the caput femoris. Results: Our measurements prove that 10% of the lymph nodes were found lateral from the transverse processes of the thoracic and lumbar vertebras and 12% outside the 2-cm safety margin from the lateral contour of the large abdominal vessels. Conclusion: Our data show, that the customary fields for infradiaphragmatic lymphatic nodes have so far not been able to enclose all retroperitoneal and pelvic lymph nodes with certainty. (orig.) [Deutsch] Zielsetzung: Bei der adjuvanten Bestrahlung infradiaphragmaler Lymphknotenstationen wird die Feldgrenze entweder durch die Wirbelkoerperquerfortsaetze bzw. durch die Verbindungslinie zwischen dem Querfortsatz des Lendenwirbelkoerpers 4 und dem Dach des Acetabulums gebildet oder durch massstabsgerechte

  18. 腹膜后间隙孤立性纤维性肿瘤的CT表现与病理对照%The Correlation Between CT Findings and Pathology in Retroperitoneal Solitary Fibrous Tumor

    Institute of Scientific and Technical Information of China (English)

    胡建平; 李银官; 曹代荣; 王行富; 刘颖

    2013-01-01

    Objective To investigate the CT findings and pathological features of retroperitoneal solitary fibrous tumor (SFT). Methods The CT findings of 7 patients (5 males and 2 females, mean age 54. 7 years. ) with retroperitoneal solitary fibrous tumor confirmed by surgical pathology were retrospectively analyzed and compared with pathology, including 3 cases with benign SFT, 3 cases with malignant SFT, 1 case with lipomatosis SFT. All patients received plain CT scanning, 6 of them received enhanced CT scanning. Results (1) Among 7 cases, the lesions of the 4 cases located at pelvic extrap-eritoneal space and the others located at abdominal retroperitoneal space. (2) On unenhanced CT, the lesions appeared as well circumscribed heterogeneous soft tissue masses with focal areas of low attenuation. On enhanced CT, the lesions showed marked, heterogeneous enhancement with dilated vessels in the arterial phase and persistent and prolonged enhancement in the parenchyma phase. Areas of necrosis or cystic did not enhance. The lesions of malignant SFT were accompanied with extensive hemorrhage and necrosis. (3) On histopathological results, the tumors were composed of spindle cells with abundant collagen fibers and thin walled branching vessels,on immunohistochemical results, except one case with malignant SFT was negative for CD34 and CD99, all other cases were positive for CD34, bcl 2, CD99 and vimentin. Conclusion The CT appearance of retroperitoneal solitary fibrous tumor has some characteristics without specific features. The final diagnosis is still depended on pathology and immunohistochemistry.%目的 探讨腹膜后间隙孤立性纤维性肿瘤(SFT)的CT表现及病理特征.方法 回顾性分析7例经手术病理证实的腹膜后间隙SFT患者的CT表现及病理,包括良性SFT 3例,恶性SFT 3例,脂肪瘤型SFT1例.男5例,女2例,平均年龄54.7岁.6例行平扫与增强,1例平扫.结果 (1)7例中,盆部腹膜外间隙4例,腹腔腹膜后间隙3例.(2)CT表

  19. Overlap of Post-obstructive Diuresis and Unmasked Diabetes Insipidus in a Case of IgG4-related Retroperitoneal Fibrosis and Tuberoinfundibular Hypophysitis: A Case Report and Review of the Literature.

    Science.gov (United States)

    Sasaki Yatabe, Midori; Watanabe, Kimio; Hayashi, Yoshimitsu; Yatabe, Junichi; Morimoto, Satoshi; Ichihara, Atsuhiro; Nakayama, Masaaki; Watanabe, Tsuyoshi

    The clinical picture of IgG4-related disease (IgG4-RD) is diverse because various organs can be affected. We describe the case of a 56-year-old man with acute renal failure and tuberoinfundibular hypophysitis due to IgG4-RD. Steroid therapy lowered the serum IgG4 level and ameliorated renal dysfunction, bilateral hydronephrosis and retroperitoneal fibrosis. However, polyuria from post-obstructive diuresis and unmasked central diabetes insipidus ensued. The patient's polyuria continued despite the administration of a therapeutic dose of glucocorticoid; the patient's pituitary swelling and anterior pituitary dysfunction were partially ameliorated. The pituitary swelling recurred seven months later. In patients with IgG4-RD, the manifestation of polyuria after steroid therapy should prompt suspicion of post-obstructive diuresis and the unmasking of central diabetes insipidus.

  20. Overlap of Post-obstructive Diuresis and Unmasked Diabetes Insipidus in a Case of IgG4-related Retroperitoneal Fibrosis and Tuberoinfundibular Hypophysitis: A Case Report and Review of the Literature

    Science.gov (United States)

    Sasaki Yatabe, Midori; Watanabe, Kimio; Hayashi, Yoshimitsu; Yatabe, Junichi; Morimoto, Satoshi; Ichihara, Atsuhiro; Nakayama, Masaaki; Watanabe, Tsuyoshi

    2017-01-01

    The clinical picture of IgG4-related disease (IgG4-RD) is diverse because various organs can be affected. We describe the case of a 56-year-old man with acute renal failure and tuberoinfundibular hypophysitis due to IgG4-RD. Steroid therapy lowered the serum IgG4 level and ameliorated renal dysfunction, bilateral hydronephrosis and retroperitoneal fibrosis. However, polyuria from post-obstructive diuresis and unmasked central diabetes insipidus ensued. The patient's polyuria continued despite the administration of a therapeutic dose of glucocorticoid; the patient's pituitary swelling and anterior pituitary dysfunction were partially ameliorated. The pituitary swelling recurred seven months later. In patients with IgG4-RD, the manifestation of polyuria after steroid therapy should prompt suspicion of post-obstructive diuresis and the unmasking of central diabetes insipidus. PMID:28049999

  1. The Experience of Diagnosis and Treatment of Pelvic Fractures Combined Retroperitoneal Hematoma%骨盆骨折合并腹膜后血肿的诊治体会

    Institute of Scientific and Technical Information of China (English)

    翁德雨; 陈福扬

    2014-01-01

    目的:探讨骨盆骨折合并腹膜后血肿的诊断和治疗,提高诊治率。方法:回顾分析2005年1月~2014年1月收治的盆骨折合并腹膜后血肿患者45例,男35例,女10例;年龄35.5±15.7岁,受伤时间30分钟~4天。多发伤22例,其中脑外伤3例,肝破裂2例,脾破裂5例,尿道断裂4例,其他部位骨折8例。结果:本组治愈41例,死亡4例。死亡原因为合并脑外伤脑疝形成1例,多发伤发生失血性休克2例,术中打开腹膜后血肿至大出血1例。结论:骨盆骨折合并腹膜后血肿是临床死亡率较高的复杂外伤,常合并脑外伤、腹腔脏器及大血管损伤,具有临床表现复杂、误诊致死率高的特点。应动态行B 超、CT等影像学检查,尽早做出诊断,及时抗休克,积极处理骨盆骨折和合并的脏器损伤,根据血肿部位及大小的动态变化决定是否行手术治疗。%Objective:To explore experience of diagnosis and treatment of pelvic fractures combined retroperitoneal hematoma , improve the rate of diagnosis and treatment .Methods:retrospective analysis in January 2005 to January 2014 , 45 patients of pelvic fractures com-bined retroperitoneal hematoma , 35 cases of male , 10 cases of female;Age is among 35.5 ±15.7 years, injury time is about 30 min to 4 days.Polytrauma 22 cases, including 3 cases of traumatic brain injury , 2 cases of hepatic rupture in , 5 cases of splenic rupture in , 4 cases of urethral rupture , 14 cases of other parts fracture .Results:18 cases cured , 4 cases died .Cerebral hernia 1 death case caused by traumatic brain injuries , , 2 multiple trauma death cases caused by uncontrolled hemorrhagic shock .1 case caused by open incurrently retroperitoneal hematoma to bleeding .Conclusion:pelvic fractures combined retroperitoneal hematoma is complexity clinical symptoms and trauma mortality is higher ,often with brain injury , abdominal viscera and major vascular injury

  2. The safety of tumorectomy combined with intraoperative radiotherapy in the treatment of retroperitoneal tumor%腹膜后肿瘤手术联合术中放疗的安全性研究

    Institute of Scientific and Technical Information of China (English)

    黄晓辉; 李沛雨; 张勇; 张楠; 马林

    2011-01-01

    目的 研究腹膜后肿瘤手术联合术中放疗的安全性.方法 以2009年7月-2010年7月收治的经腹部CT和(或)MRI确诊为腹膜后肿瘤的患者为研究对象,除外以下病例:(1)术后病理证实肿瘤组织来源于淋巴造血系统、泌尿生殖系统;(2)术前CT和(或)MRI已发现肿瘤病变范围广泛,腹膜后多处受累.保留病变局限于腹膜后单一区域的患者.共筛选出符合入选标准者62例,将其分为两组:联合治疗组(n=30),行腹膜后肿瘤切除联合术中放疗;对照组(n=32),单纯行腹膜后肿瘤切除术.比较两组术前术后白细胞计数变化、胃肠功能恢复时间、切口拆线时间及并发症情况.结果 联合治疗组与对照组在术前术后白细胞计数变化、胃肠功能恢复时间、切口拆线时间及并发症的差异无统计学意义(P>0.05).结论 手术联合术中放疗治疗腹膜后肿瘤安全性好,且不增加术后并发症风险.%Objective To study the safety of tumorectomy combined with intraoperative radiotherapy in the treatment of retroperitoneal tumor. Methods The patients diagnosed as retroperitoneal tumor by abdominal CT and/or MRI since July 2009 to July 2010 were chosen as the objects with the exclusion of the following conditions: 1) pathologically confirmed lymphoma, hematopoietic system tumor, and urogenital system tumor: 2) tumor was found to involve a wide area or with multiple lesions in retroperitoneal space as shown by preoperative CT and/or MRI. Sixty-two patients were found to have localized tumor, and they were divided into two groups:combined treatment group ( n= 30) and control group ( n=32). The patients in combined treatment group underwent total excision of the tumor followed by intraoperative radiotherapy; in control group the patients underwent tumorectomy only. The changes in pre- and post-operative white blood cell count, recovery of gastrointestinal function, wound healing and incidence of complications were compared

  3. Renal trauma: kidney preservation through improved vascular control-a refined approach.

    Science.gov (United States)

    McAninch, J W; Carroll, P R

    1982-04-01

    Indications for renal exploration, nephrectomy, or renal repair for patients with renal trauma continue to be a subject of controversy. The present survey evaluates the results of two series of patients from a single hospital having had renal exploration for injury: Series I (1964-1973) 185 patients previously reported; and Series II (1977-1981), 190 patients. The indications for renal exploration were generally the same in each series. In Series II we used a uniform technique for control of the renal artery and vein before entering Gerota's fascia and exploring the kidney. When renal explorations were required, nephrectomy rates were reduced by this technique to 18% (seven of 39) in Series II, compared to 56% (19 of 34) in Series I. Comparison of the two series indicates that renal salvage can be improved by a consistent approach to evaluation, specific indications for retroperitoneal exploration, and vascular control before opening the retroperitoneum. Results of repair show that renography or partial nephrectomy was performed successfully in 82% of operated cases. All nephrectomies in series II were done because of massive renal destruction or as life-saving procedures for hemorrhage. No patient in Series II having had renal repair needed reoperation or had delayed hemorrhage, urine extravasation, retroperitoneal abscess, or hypertension. Although both time periods had comparable numbers of renal injury and comparable numbers of renal explorations, attention to the above criteria made possible significant improvement in kidney salvage.

  4. A new understanding of the anatomic structure of posterior abdominal wall in retroperitoneal laparoscopic renal surgery%后腹腔镜下肾脏手术解剖标志的应用研究

    Institute of Scientific and Technical Information of China (English)

    蔡伟; 李宏召; 张旭; 孙圣坤; 董隽; 史立新; 宋勇; 祝强

    2012-01-01

    目的 复习和再认识后腹腔镜下后腹壁解剖结构的形态和位置关系,建立和确认后腹腔镜下肾脏手术的解剖标志,提高后腹腔镜手术操作水平. 方法 2010年1-8月,对35例后腹腔镜下肾脏手术进入后腹腔和控制肾动脉之前的操作过程进行分步解剖技术研究,记录后腹壁解剖标志的形态和位置毗邻关系,分析验证各解剖标志与肾、肾门和肾动脉的关系. 结果 后腹腔镜下可见后腹壁由膈肌的腰部、腰方肌和腰大肌以及外侧弓状韧带、内侧弓状韧带和膈肌脚构成,这些肌肉和韧带在肾门背侧附近交界移行.内侧弓状韧带横行向脊柱方向指向肾门附近,膈肌脚的弧形部分与肾动脉走行成镜像状态.35例术中均可以观察到这些解剖结构,按此标志定位肾和肾门,35例均可直接到达肾门解剖分离肾动脉和静脉. 结论 后腹壁肌肉和韧带的位置和形态相对固定,在腹腔镜下清晰可见,可以作为后腹腔镜下肾脏手术的解剖标志.参考后腹壁的肌肉和韧带解剖标志定位肾脏,解剖分离肾门和肾动脉是有效的实用操作技术.%Objective To provide reliable technical method by identifying referential anatomic landmarks for retroperitoneal laparoscopic renal surgery,with respect to the renal hilum and renal artery.Methods The regional anatomy of the posterior abdominal wall was studied in 35 cases of retroperitoneal laparoscopic renal surgery from January to August 2010.These included 27 cases of renal cancer,6 cases of renal pelvis cancer and 2 cases of renal tuberculosis.Distended the retroperitoneal space using balloon dilation along with sharp and dull dissection.We recorded the forms and positions of the posterior abdominal cavity's anatomical landmarks and evaluated the relationship between each anatomical landmark with respect to the renal hilum and renal artery.Results The perirenal fascia posterior layer and perinephric fat on the renal

  5. Surgical methods and clinical effects of anatomical retroperitoneal laparoscopy radical ne-phrectomy%后腹腔镜下解剖性根治性肾切除术的手术方法及临床效果

    Institute of Scientific and Technical Information of China (English)

    种庆贵; 宋爱君; 郭艳

    2014-01-01

    目的:介绍后腹腔镜下解剖性根治性肾切除术的手术方法及临床效果。方法对187例肾癌患者实施后腹腔镜下解剖性根治性肾切除术。其中左侧103例,右侧84例;肿瘤最大径2.0~8.2 cm,平均4.6 cm;所有患者均常规制备后腹腔间隙,按顺序分别进入相对无血管解剖层面进行分离,腰大肌为背侧标志,膈肌为肾上极后侧标志,肾上腺为肾上方内侧标志,腹膜为腹侧标志,下腔静脉与腹主动脉是内侧的标志,髂血管是 Gerota 筋膜锥尖部的解剖标志。结果所有手术均获成功,无中转开放手术,术中无明显并发症发生。手术时间90~150 min,平均110 min;出血60~100 ml,平均75 ml;恢复饮食和下床活动时间分别为 l.3 d 和1.2 d;术后3~7 d 出院。142例患者术后随访6~42个月,其中1例出现腹膜后淋巴结转移,余经 B 超及胸片检查未见局部复发或远处转移。结论后腹腔镜下解剖性根治性肾切除术具有解剖层次清楚,术中出血少,术野清晰,疗效确切,并发症少,恢复快等优点,为需要根治性肾切除术的患者提供了更好的选择。%Objective To introduce the technique and clinical effect of anatomical retroperitone-al laparoscopy radical nephrectomy. Methods A total of 187 patients underwent anatomical retroperito-neal laparoscopy radical nephrectomy. Among them,103 cases of tumor located in the left kidney and 84 cases located in the right kidney. The maximum diameter of tumor was 2. 0 to 8. 2 cm,with an average di-ameter of 4. 6 cm. Retroperitoneal space was created routinely at lateral decubitus position. Relatively bloodless planes were orderly entered for exposure and separation of the kidney outside Gerota’s fascia. In the first place,the greater psoas was identified as the dorsal marker. Then the diaphragmatic muscle was identified as the posterior mark of the upper pole of the kidney,and the adrenal gland as

  6. 腹腔镜下腹膜后淋巴结清扫术七例报告%Laparoscopic retroperitoneal lymph node dissection (report of 7 cases)

    Institute of Scientific and Technical Information of China (English)

    袁建林; 张运涛; 秦卫军; 杨力军; 武国军; 刘飞; 王福利

    2009-01-01

    Objective To study the clinical efficacy of laparoscopic retroperitoneal lymph node dissection (LRPLND) for stage Ⅱ nonseminomatous testicular cancer. Methods Seven patients (mean ages 28 years, 4 had the tumors on the left side and 3 on the right) underwent LRPLND during 1 to 4 weeks after orchiectomy for clinical stage Ⅱ nonseminomatous testicular cancer. The dissection-al boundaries included the ipsilateral ureter laterally, the renal vessels superiorly, abdominal aorta and the bifurcation of the iliac artery inferiorly. The operative time, intraoperative blood loss, intra-or postoperative complications, tumor markers and ejaculation were observed. Results LRPLND was completed in all patients. Operative time ranged from 140 to 220 min (mean 180 min). Intraoperative blood loss ranged from 80 to 127 ml (mean 95 ml) and no transfusions were required. No intra- or postoperative complications occurred because of the procedure. At 2 weeks after operation, serum al-pha fetoprotein decreased from (15 to 1247 μg/L) to (2 to 8 μg/L), and beta human chorionic gona-dotropin decreased from (5 to 59 μg/L) to (0.5 to 2.5 μg/L). All patients recovered ejaculation dur-ing 10 to 12 weeks after operation. After a mean follow-up period of 21 months (range 12 to 26), no disease recurrence or metastasis was observed. Conclusion LRPLND is a safe, effective, minimally invasive procedure in the management of stage Ⅱ nonseminomatous testicular cancer patients.%目的 探讨腹腔镜下腹膜后淋巴结清扫术治疗Ⅱ期睾丸非精原细胞瘤的临床效果.方法 Ⅱ期睾丸非精原细胞瘤患者7例.平均年龄28岁.肿瘤位于左侧4例、右侧3例.根治性睾丸切除术后1~4周行腹腔镜下腹膜后淋巴结清扫术.清扫范围上至同侧肾静脉水平,下至同侧髂总血管分叉处,外至同侧输尿管内侧,内至腹主动脉.观察手术时间、出血量、围手术期并发症、术后肿瘤标志物,患者术后射精功能等情况. 结果 7

  7. 后腹腔镜治疗肾囊性疾病36例临床分析%Clinical analysis of treating renal cystic diseases with retroperitoneal laparoscopy:a report of 36 cases

    Institute of Scientific and Technical Information of China (English)

    方文革; 关超; 徐卫强; 许海斌; 谷明利; 郭园园; 谢海龙

    2011-01-01

    Objective:To explore the operation method and observe the efficacy of treating renal cystic diseases by retroperitoneal laparoscopy. Methods:Thirty-six patients with renal cystic diseases were treated with retroperitoneal laparoscopic cyst decompression,including:32 cases with simple renal cyst,3 cases with polycystic kidney and 1 case with parapelvic cyst. Results:The operations were successfully in all 36 patients without changing to opening operation. The operation time of simple renal cyst was 30 -90 min, polycystic kidney was 90 - 120 min and parapelvic cyst was 110 min. The blood loss of simple renal cyst was < 30 ml, the two others were <50 ml. The hospital stay was 3 -6 days,6 -8 days and 7 days respectively. Patients were followed up for 3 - 12 months,all cases were no recurrence. In 3 cases with polycystic kidney,lumbar pain was relieved. The renal function of 1 patient with renal insufficiency was got better. The pressure of 1 patient with high blood pressure preoperative was decreased to normal level. Thirty-six cases were no severe complications. Conclusions: Retroperitoneal laparoscopic cyst decompression is an optimum method for treating renal cystic diseases with the advantages of good curative effect, minimal trauma, rapid recovery and short hospitalization, it will be worthy of clinical recommendation.%目的:探讨后腹腔镜治疗肾囊性疾病的手术技巧,并观察临床疗效.方法:应用后腹腔镜去顶减压术治疗肾囊性疾病36例,其中单纯性肾囊肿32例,多囊肾3例,肾盂旁囊肿1例.结果:36例手术均获成功,无一例中转开放手术.手术时间单纯性肾囊肿30~90 min,多囊肾90~120 min,肾盂旁囊肿约110 min.单纯性肾囊肿出血<30 ml,多囊肾和肾盂旁囊肿出血<50 ml.住院时间单纯性肾囊肿3~6天,多囊肾6~8天,肾盂旁囊肿7天.随访3~12个月无复发病例;3例多囊肾患者术后腰部胀痛缓解,1例肾功能不全患者术后肾功能明显改善,1例术

  8. 腹腔镜姑息性肾切除15例手术分析%Retroperitoneal Laparoscopic Palliative Resection of Kidney with a Report of 15 Cases

    Institute of Scientific and Technical Information of China (English)

    王鹏举; 刘冬蕾; 李凤月

    2011-01-01

    Objective: To discuss the technical detail of retroperitoneal laparoscopic palliative resection of kidney and evaluate its clinical effect. Method: Totally 15 cases received retroperitoneal laparoscopic palliative resection of kidney between 2005 and 2010. Malignant tumors were confirmed by B-ultrasound,IVU,X-ray and CT or MRI before operation in all the cases. None of renal pedicle lymphatic metastasis, distant metastasis,renal venous or inferior vena cava tumor thombus was found,and renal function of the uninfcted kidney was within the normal range. Renal neoplasms were all inT4N0M0. The operative time, intraoperative blood loss,perioperative complications and operative effect were evaluated. Result: All the operations were successful and effective. The operating time was 60-180 minutes, with an average of 90 minutes. The blood loss volume was 80-240 mL. The extubation time was 24-72 hours. The time for postoperative recove ry of intestinal function was 8 -48 hours. Postoperative ambulation time was 48-72 hours. None of the patients received blood transfusion or had obvious complication. After a follow-up of 3-36 months in 15 renal neoplasm cases. Conclusion: Retroperitoneal laparoscopic palliative resection of kidney is proved to be an effective procedure with minimal invasion and quicker recovery.%目的:探讨后腹腔镜姑息性肾癌切除术的技术要点和临床效果。方法:2005年至2010年采用后腹腔镜技术行姑息性肾癌切除术15例,术前均行B超、IVU、胸片、CT或MRI检查,证实肾脏实质恶性肿瘤,未发现肾蒂淋巴结转移、远处转移、肾静脉或腔静脉癌栓。临床分期为T4 N0M0,健侧肾功能正常。观察手术时间、术中出血量、术中术后并发症及手术效果。结果:手术均1次成功,手术时间60-180 min,平均90min,术中出血80-240mL,术中术后均未输血,引流管拔除时间24-72h,肠功能恢复时间18-48h,下床活动时间48-72h。所

  9. Operative coordination of robot assisted retroperitoneal laparoscopic partial nephrectomy%机器人辅助后腹腔镜肾部分切除术的手术配合

    Institute of Scientific and Technical Information of China (English)

    崔茜; 管春丽; 王涛

    2016-01-01

    Objective To investigate the nursing coordination for robot assisted retroperitoneal laparoscopic partial nephrectomy. Methods The nursing coordination for 117 cases of robot assisted retroperitoneal laparoscopic partial nephrectomy which were received and cured in the department of urology, chinese PLA general hospital from Dec. 2014 to Dec. 2015, was analysised. By means of preoperative interview and evaluate, adequate preparing of instruments and articles, reasonable layout of the operating room, standardized coordination during operation, postoperative nursing and interview, the patients pass through perioperative period successfully. Results Nursing coordination was successfully completed to the 117 cases, and the effect of medical coordination is satisfactory. No postoperative complication occurred by short term follow up. Conclusions Adequate preoperative preparation, reasonable layout of the operating room, skilled coordination during operation could improve the operating efficiency, which is the important link of successful operations.%目的:探讨机器人辅助后腹腔镜肾部分切除术的护理配合流程。方法对解放军总医院泌尿外科2014年12月至2015年12月的117例机器人辅助后腹腔镜肾部分切除术的护理配合进行分析,通过术前访视评估、器械及物品的充分准备、合理的手术间布局、术中精准化配合及术后护理及访视,使患者顺利度过围手术期。结果117例患者顺利完成,医护配合效果满意,短期随访无术后并发症发生。结论充分的术前准备,合理的手术间布局,熟练的术中配合能提高术者手术效率,手术顺利完成的重要环节。

  10. Radiation therapy of regional lymph nodes in the treatment of seminomas compared with retroperitoneal lymphadenectomy. A retrospective analysis of 161 patients; Die Strahlentherapie der regionaeren Lymphknotenstationen bei der Behandlung des Seminoms im Vergleich zur retroperitonealen Lymphadenektomie. Eine retrospektive Auswertung von 161 Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Warszawski, N. [Klinik fuer Strahlentherapie, Magdeburg Univ. (Germany); Schmuecking, M. [Klinik fuer Strahlentherapie, Magdeburg Univ. (Germany); Samtleben, M. [Klinik und Poliklinik fuer Urologie, Magdeburg Univ. (Germany); Gademann, G. [Klinik fuer Strahlentherapie, Magdeburg Univ. (Germany); Allhoff, E.P. [Klinik und Poliklinik fuer Urologie, Magdeburg Univ. (Germany)

    1996-05-01

    Hundred and sixty-one patients with seminoma of stage I and II were retrospectively analysed. They were treated at the University of Magdeburg between 1975 and 1991 by radiation therapy of regional lymph nodes or by retroperitoneal lymphadenectomy. After high semicastration, 98 patients were irradiated, 63 patients received a retroperitoneal lymphadenectomy. Twenty-one patients were treated by adjuvant chemotherapy, too. The 5-year survival-rates according to Kaplan-Meier were 96% for stage I, 85% for stage IIA, 92% for stage IIB, and 68% for stage IIC. The overall survival rates for all stages were 95% after 2 years, 92% after 5 years, and 89% after 10 years. Relapses located retroperitoneally occurred significantly more often after retroperitoneal lymphadenectomy (9.5%) compared with radiation therapy (2.0%), relapses outside the operation situs or radiation fields, respectively, were registrated at the same frequency (4.8% and 7.1%, respectively). Disease-free survival rates decreased significantly with increasing stage (p<0.001, Wilcoxon-test). Relapses increased from 4.1% for stage I up to 58.3% for stage IIC. After semicastration for primary treatment of seminomas radiation therapy of the regional lymph nodes is the treatment of choice. Retroperitoneal lymphadenectomy is obsolete. (orig./MG) [Deutsch] 161 Patienten mit einem histologisch gesicherten Seminom der Stadien I und II wurden von 1975 bis 1991 an der Universitaet Magdeburg behandelt und retrospektiv analysiert. Nach erfolgter hoher Semikastration erhielten 98 Patienten eine Strahlentherapie, 63 Patienten wurden einer retroperitonealen Lymphadenektomie unterzogen. 21 Patienten erhielten zusaetzlich eine adjuvante Chemotherapie. Die Fuenf-Jahres-Ueberlebensraten (Kaplan-Meier-Methode) betrugen 96% im Stadium I, 85% im Stadium IIA, 92% im Stadium IIB, 68% im Stadium IIC. Die Gesamtueberlebensraten fuer alle Stadien lagen nach zwei Jahren bei 95%, nach fuenf Jahren bei 92%, nach zehn Jahren bei 89%. Alle

  11. Viviperception on renal vessel variation by retroperitoneal laparoscopy a report of 525 cases%肾脏525例腹腔镜手术肾血管变异分析

    Institute of Scientific and Technical Information of China (English)

    宋刚; 张晓春; 周利群; 姚鲲; 张仲一; 龚侃; 李宁忱; 席志军; 吴士良; 宋毅

    2011-01-01

    目的 观察并分析腹腔镜肾脏手术肾血管变异情况,提高腹腔镜肾脏手术的安全性.方法 统计北京大学第一医院泌尿外科2004年1月至2008年6月接受腹腔镜肾切除术或肾部分切除术的525例患者.其中男316例,女209例,平均年龄(58±13)岁.手术均为腹膜后途径,通过术中腹腔镜的观察和操作,对肾脏动脉、静脉的变异情况进行记录和分析.结果 525例患者中有58例存在肾脏血管变异(11.0%,58/525).18例患者单侧具有2支肾动脉(3.4%,18/525),10例患者有2支肾静脉(1.9%,10/525),1例患者有3支肾静脉,3例患者同时具有双肾动脉、双肾静脉.25例患者有副肾动脉(4.8%,25/525),其中19例(76.0%,19/25)患者的副肾动脉走向肾上极.1例患者的左侧精索静脉与肾静脉直径相当,二者与腰静脉同时汇入下腔静脉.结论 肾动脉的变异较肾静脉常见.副肾动脉出现率较高,多走向肾上极.在腹腔镜肾脏手术中,应对肾血管变异引起高度重视.%Objective To study the variation of renal vessels with retroperitoneal laparoscopy so as to increase the safety of retroperitoneal laparoscopic surgeries.Methods A total of 525 patients underwent retroperitoneal laparoscopic nephrectomy or partial nephrectomy at our hospital between January 2004 and June 2008.There were 316 males and 209 females with a mean age of (58 ± 13) years old.The procedures were as follows:(1) patients lay on one side with their waist up and the retroperitoneal cavity was established with our institutional method;(2) gerota's fascia was separated widely along the ventral surface of major psoas muscle;(3) the tissues around renal arteries and veins were isolated by ultrasonic scalpel.Careful observation was performed to explore if there were duplicated or accessory renal vessels;(4) renal vessels were cut by Endo-GIA/Hem-o-lok or blocked by bulldog clamps;(5) whole or partial kidney was finally resected (remaining procedures omitted

  12. 单孔腹腔镜后腹膜淋巴结清扫术3例临床分析:附1年随访报告%Laparoendoscopic single-site retroperitoneal lymph node dissection: initial experience and 1-year follow-up

    Institute of Scientific and Technical Information of China (English)

    徐啊白; 李虎林; 郑少波; 赵国平; 申海燕; 刘春晓

    2012-01-01

    Objective To summarize our initial experience with laparoendoscopic single-site (LESS) retroperitoneal lymph node dissection (RPLND) for treatment of nonseminomatous testicular cancer. Methods From September 2010 to June 2011, 3 patients (aged 19-27 years) with right testicle enlargement and elevated alpha-fetoprotein level underwent right radical orchidectomy. Histopathological analysis revealed nonseminomatous germ cell tumor. LESS-RPLND was performed 3 weeks after orchiectomy. The homemade port was inserted through a 3-cm right pararectal incision in the right lower quadrant for unilateral RPLND using nerve-sparing technique and modified right-sided template removal similar to those in open RPLND. Results The operation was successfully performed with a mean operative time of 240 min and a mean estimated blood loss of 50 ml. No conversion to open or conventional laparoscopic surgery was required. No major perioperative complications were observed. For the first case, the number of lymph nodes obtained for final histopathological examination was 11, and two positive nodes were detected. For the other 2 cases, no positive nodes were detected. Chemotherapy was administered in the first case. Alpha-fetoprotein level decreased close to the baseline one week postoperatively and no relapse occurred in these cases 3 month after RPLND. Follow-up at 1 year after the surgery showed good tumor control and preservation of the sexual function. Conclusions LESS-RPLND is safe and feasible for treatment of nonseminomatous testicular cancer, and the pararectal incision provides an ideal surgical approach with good cosmetic result, but the long-term effect needs to be tested by further large population-based study.%目的 介绍单孔腹腔镜经腹膜外人路后腹膜淋巴结清扫术的手术方法和随访结果.方法 2010年9月~2011年6月,对3名非精原细胞瘤睾丸肿瘤患者行右侧睾丸切除术,术前甲胎蛋白(AFP)明显升高.术后3周左右行单孔腹

  13. 彩超对腹膜后肿大淋巴结良恶性的鉴别诊断价值%Ultrasound of the Retroperitoneal Lymph Nodes in the Differential Diagnosis of Benign and Malignant

    Institute of Scientific and Technical Information of China (English)

    孟亚新

    2012-01-01

      目的探讨超声诊断腹膜后肿大后淋巴结良恶性病变的声像图特征与临床实用价值.方法对48例(95枚)腹膜后淋巴结肿大的患者在行组织活检前应用彩超观察内部回声,血流特点,大小及其形态特征,多普勒测值(收缩期最大血流速度、舒张末期血流速度、阻力指数等改变)结果良性肿大淋巴结多呈椭圆形,内部回声尚均质,但结核性肿大淋巴结内见钙化强回声及液化,并破溃与周围组织粘连成团,界限不清,血流为零星,阻力指数在0.42~0.55,为低阻力型;恶性肿大淋巴结多呈类圆形及圆形,内部回声不均匀、稍低,边界欠规则,血流极其丰富,有者达包膜下,呈树枝状分布,走形迂曲,阻力指数0.59~0.79,为高阻力型.结论通过对淋巴结超声测值即大小及形态特征,结合内部回声,与周围组织关系,血流分布情况,阻力指数等改变,对淋巴结良恶性鉴别具有使用价值,可作为肿大淋巴结病因诊断的首选方法,并为进一步穿刺活检及超声造影提供依据.%  Objective To investigate the ultrasonic diagnosis of retroperitoneal lymph node enlargement of benign and malignant lesions after the sonographic features and clinical value. Methods 48 patients (95) patients with retroperitoneal lymph nodes biopsy of the line before the application of ultrasound observed internal echo, blood flow characteristics, size and morphology, Doppler values (systolic blood flow velocity, end diastolic velocity, resistance index change) Result Benign enlargement of the lymph nodes mostly oval, homogeneous internal echoes still, but the tuberculous lymph nodes were seen in hyperechoic calcification and liquefaction, and rupture into the surrounding tissue adhesion groups, ill-defined, blood flow is sporadic, resistance index of 0.42 to 0.55 for the low resistance type;malignant lymph nodes mostly oval and round, heterogeneous internal echo, lower boundary due to the rules

  14. Retroperitoneal laparoscopic partial nephrectomy in the treatment of early stage renal cell carcinoma%后腹腔镜下肾部分切除术治疗早期肾癌

    Institute of Scientific and Technical Information of China (English)

    陈敏丰; 齐琳; 祖雄兵; 陈湘; 陈智勇; 高宁; 张鹏; 涂磊

    2010-01-01

    目的 探讨后腹腔镜下肾部分切除术治疗早期肾癌的可行性及安全性.方法 肾癌患者65例.男45例,女20例.平均年龄52岁.临床分期均为T_1N_0M_0.肿瘤直径1.8~4.0 cm,单发.行后腹腔镜下肾部分切除术.术中用bulldog血管夹阻断肾动脉,距肿瘤边缘0.5~1.0 cm处完整切除肿瘤.结果 中转开放手术3例,改为根治性肾切除术1例.手术时间平均120(70~210)min,肾动脉阻断时间平均32(21~55)min,术中出血量平均60(20~200)ml,平均住院10.5(7~15)d.术后发生肾周血肿1例,尿瘘1例,保守治疗后痊愈.62例患者随访3~56个月,未见肿瘤复发.残肾功能良好.结论 后腹腔镜下肾部分切除术是治疗直径≤4 cm、局限性单发肾癌的有效方法.%Objective To evaluate the feasibility and the safety of retroperitoneal laparoscopic partial nephrectomy(LPN)for early stage renal cell carcinoma.Methods Retrospectively analyzed the medical records of 65 patients with single localized tumor.Fourty five cases were males and twenty cases were females.The mean age was 52 years.The clinical stage was T_1N_0M_0 in all patients.The renal artery was blocked with bulldog clamp and the tumor was resected with a margin of 5 to 10 mm of healthy renal parenchyma.Results Three patients required conversion to the open partial nephrectomy and one required conversion to the laparoscopic radical nephreetomy.The mean operative time was 120(70-210)min;the median warm-ischemia time was 32(21-55)min;the median overall estimated blood loss was 60(20-200)ml and the hospital stay was 10.5(7~15)d.During the follow-up of 3-56 months,All patients were alive without recurrence and had normal renal function.Conclusions Retroperitoneal laparoscopic partial nephrectomy is a treatment for early localized renal cell carcinoma.

  15. The Efficacy Assessment of Hem-o-lock in Retroperitoneal Laparoscopic Parapelvic Cyst Unroofing Operation%Hem-o-lock夹在腹膜后腹腔镜下肾盂旁囊肿去顶术中的疗效评估

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    Objective:To assess the efficacy of Hem-o-lock in retroperitoneal laparoscopic parapelvic cyst unroofing operation. Method:The retroperitoneal laparoscopic parapelvic cyst unroofing operation and griping each side of the wall by one Hem-o-lock had been operated in seven cases of parapelvic cyst.Result:Seven cases were operated successfully.The average time of all operations was 60 minutes.The average bleeding of all operations was 30 ml.The average time of inpatient after operation was 4.2 days.The time of postoperative follow-up was from 6 to 24 months and there was no recurrence in the seven cases.Conclusion:The retroperitoneal laparoscopic parapelvic cyst unroofing operation and griping each side of the wall by one Hem-o-lock could effectively reduce the rate of recurrence of cyst and safe and easy operating.%  目的:探讨 Hem-o-lock 夹在后腹腔镜肾盂旁囊肿去顶术中的疗效。方法:7例肾盂旁囊肿患者行后腹腔镜肾盂旁囊肿去顶+囊壁两侧各夹 Hem-o-lock 一枚。结果:7例手术均成功;手术时间平均60 min;术中出血量平均30 ml;术后住院时间平均4.2 d;7例术后随访6~24个月,均无复发。结论:后腹腔镜肾盂旁囊肿去顶+囊壁两侧各夹 Hem-o-lock 一枚可有效减少肾盂囊肿复发,且手术操作安全简单。

  16. Port-site metastasis as a primary complication following retroperitoneal laparoscopic radical resection of renal pelvis carcinoma or nephron-sparing surgery: A report of three cases and review of the literature

    Science.gov (United States)

    WANG, NING; WANG, KAI; ZHONG, DACHUAN; LIU, XIA; SUN, JI; LIN, LIANXIANG; GE, LINNA; YANG, BO

    2016-01-01

    The present study reports the clinical data of two patients with renal pelvis carcinoma and one patient with renal carcinoma who developed port-site metastasis following retroperitoneal laparoscopic surgery. The current study aimed to identify the cause and prognosis of the occurrence of port-site metastasis subsequent to laparoscopic radical resection of renal pelvis carcinoma and nephron-sparing surgery. Post-operative pathology confirmed the presence of high-grade urothelial cell carcinoma in two patients and Fuhrman grade 3 renal clear cell carcinoma in one patient. Port-site metastasis was initially detected 1–7 months post-surgery. The two patients with renal pelvis carcinoma succumbed to the disease 2 and 4 months following the identification of the port-site metastasis, respectively, whereas the patient with renal carcinoma survived with no disease progression during the targeted therapy period. The occurrence of port-site metastasis may be attributed to systemic and local factors. Measures to reduce the development of this complication include strict compliance with the operating guidelines for tumor surgery, avoidance of air leakage at the port-site, complete removal of the specimen with an impermeable bag, irrigation of the laparoscopic instruments and incisional wound with povidone-iodine when necessary, and enhancement of the body's immunity. Close post-operative follow-up observation for signs of recurrence or metastasis is essential, and systemic chemotherapy may be required in patients with high-grade renal pelvis carcinoma and renal carcinoma in order to prolong life expectancy. PMID:27313720

  17. Upregulation of Pnpla2 and Abhd5 and downregulation of G0s2 gene expression in mesenteric white adipose tissue as a potential reason for elevated concentration of circulating NEFA after removal of retroperitoneal, epididymal, and inguinal adipose tissue.

    Science.gov (United States)

    Dettlaff-Pokora, Agnieszka; Sledzinski, Tomasz; Swierczynski, Julian

    2016-11-01

    Elevated concentrations of circulating non-esterified fatty acids (NEFA) were reported in (a) humans with lipodystrophy, (b) humans following bariatric surgery, and (c) transgenic mice with reduced amounts of adipose tissue. Paradoxically, these findings suggest that the reduction of adipose tissue mass is associated with elevated circulating NEFA concentrations. To explain a molecular background of this phenomenon, we analyzed the effects of surgical removal of inguinal, epididymal, and retroperitoneal white adipose tissue (WAT) on (a) circulating NEFA concentrations, (b) expression of Pnpla2, a gene that encodes adipose triglyceride lipase (ATGL), genes encoding abhydrolase domain containing 5 (ABHD5) and G0/G1 switch 2 (G0S2), i.e., a coactivator and inhibitor of ATGL, respectively, and (c) expression of Lipe gene coding hormone-sensitive lipase (HSL) in mesenteric WAT. Reduction of adipose tissue mass resulted in an increase in circulating NEFA concentration, which was associated with (a) an increase in the expressions of Pnpla2 and Abhd5, (b) decrease in G0s2 expression, and (c) upregulation of Lipe expression, all measured on both mRNA and protein levels in mesenteric WAT of male rats. The rate of lipolysis in mesenteric WAT explants and isolated adipocytes from lipectomized rats was significantly higher than that from the controls. In conclusion, upregulation of Pnpla2 expression and activation of ATGL (due to an increase in ABHD5 and decrease in G0S2 levels), as well as a coordinated interplay of these genes with Lipe in mesenteric WAT, contribute, at least in part, to an increase in the concentration of circulating NEFA in rats with reduced fat mass.

  18. Clinical Characteristics of Malignant Lymphoma with Retroperitoneal Mass as the Primary Presentation%腹膜后肿块为首发症状的恶性淋巴瘤临床特点分析

    Institute of Scientific and Technical Information of China (English)

    金哈斯; 宫丽平; 倪美兰; 孟文霞; 林美雄; 母立新

    2012-01-01

    目的:探讨腹膜后肿块为首发症状的恶性淋巴瘤的临床特点、治疗及预后.方法:回顾性收集自2002年1月至2010年12月间收治的20例腹膜后肿块为首发症状的恶性淋巴瘤患者的临床资料,分析其病理活检方式、病理类型、免疫组化、分期、治疗效果、生存率等.研究手术、年龄、性别、分期、巨大包块、B症状、病理类型对近期疗效的影响.结果:20例患者中11例(55%)为弥漫大B细胞性淋巴瘤,4例(20%)为滤泡性淋巴瘤,2例(10%)为小淋巴细胞性淋巴瘤/慢性淋巴细胞白血病,1例(5%)为淋巴母细胞性淋巴瘤,1例(5%)为间变细胞淋巴瘤,1例(5%)霍奇金淋巴瘤.全组患者化疗后完全缓解7例(35%),部分缓解8例(40%);5例就诊后3个月之内早期死亡,9例起病后4~36个月之间疾病进展或复发死亡.全组患者中5年生存率仅20%.手术、病理类型、年龄、大包块、浸润周围器官广泛、静脉血栓形成、肝功能异常、B症状对近期疗效有明显影响.结论:腹膜后肿块为首发症状的恶性淋巴瘤缓解率和长期生存率较低,预后差.病理类型、手术、大包块、浸润周围器官、肝功能异常、静脉血栓形成、B症状对缓解率和长期生存率有明显影响.%Objective: To investigate the clinical characteristics,treatment outcomes and prognostic factors of patients with malignant lymphoma with primary retroperitoneal mas as the primary presentation. Methods: A total 20 cases of malignant lymphoma with primary retroperitoneal presentation lymphoma seen in our hospital from January 2002 to Decemter 2010 Biopsy method , tissue pathology, immunochemistry,treatmemt outcome and long time survival were analyzed retrospectively. The influences of age, sex, pathologic type, clinical stage, huge mass and B symptom were analyzed. Results: Among the 20 cases, 11 ( 55 % ) were diffuse large B cell lymphoma, 4 ( 20 % )were follicular lymphoma, 2 ( 10 % ) were B

  19. 后腹腔镜下肾部分切除术治疗肾肿瘤的疗效评价%Retroperitoneal laparoscopic partial nephrectomy for the treatment of renal tumor

    Institute of Scientific and Technical Information of China (English)

    邵鹏飞; 张炜; 王增军; 华立新; 顾民; 张炜; 徐正铨; 殷长军; 孟小鑫; 吕强; 李杰; 居小兵; 宋宁宏; 秦超; 徐东亮

    2010-01-01

    Objective To evaluate the technique and efficacy of retroperitoneal laparoscopic partial nephrectomy. Methods From June 2002 to December 2009, 113 cases of renal tumor received retroperitoneal laparoscopic partial nephrectomy. The age ranged from 26 to 73 years. The tumor located in left side in 51 cases and right side in 62 cases with the mean diameter of 3.7 cm(1.2-6.3cm). During the procedure, the renal artery was separated and then clamped with bulldog. The renal parenchymal was incised with cold endoscissor and the tumor was totally removed. Pelvicalyceal repairing and parenchymal hemostasis were then performed. Renal defect closure was achieved with running suture or horizontal mattress suture. Results All the procedures were completed successfully.There was no open conversion. The mean operation time was 85 min(60- 125 min), the mean warm ischemic time was 24 min(19-43 min). The pathology studies revealed 87 cases of clear cell carcinoma, 9 cases of papillary renal cell carcinoma, 7 cases of chromophobe cell carcinoma, 6 cases of perivascular epithelioid renal cell tumor and 4 cases of renal oncocytoma. The surgical margin was negative in all cases. There was no complication of urine leakage. Gross hematuria occurred in 2 cases.During 3-41 months of following up, there was no recurrence. Conclusion Retroperitoneal laparo-scopic partial nephrectomy is safe and effective for the treatment of renal tumor, which becomes an alternative treatment to open procedure.%目的 探讨后腹腔镜下肾部分切除术治疗肾肿瘤的手术方式和临床效果. 方法 2002年6月至2009年12月对113例肾癌患者行后腹腔镜下肾部分切除术.患者平均年龄52(26~73)岁.肿瘤位于左肾51例,右肾62例.肿瘤直径平均3.7(1.2~6.3)cm.临床分期T1a 98例,T1b15例.腔镜下阻断肾动脉,以冷刀切开肾实质完整切除肿瘤.行肾楔形切除84例,肾极切除22例,半肾切除7例.腔镜下重建肾盂肾盏,2-0可吸收线间断或连续缝

  20. CT and Angiography Features of Retroperitoneal Primitive Neuroectodermal Tumors%腹膜后原始神经外胚层肿瘤的CT及血管造影表现

    Institute of Scientific and Technical Information of China (English)

    罗小华; 宋彬; 庄雄杰; 吴秀蓉; 饶明月; 张海芳

    2011-01-01

    Objective To study the CT and angiography features of retroperitoneal primitive neuroectodermal tumors (PNET). Materials and Methods The CT and angiography appearances of 6 patients with PNET pathologically proved were analyzed retrospectively. Results Imaging data included plain and enhanced CT in 5 patients, plain CT in 1, and angiography in 4. CT images showed large solid -cystic mass in the retroperitoneum, with the maximum diameter of 17.0 cm. The tumors showed regular or irregular shape with well-defined or ill defined margins, with invasive growth or expansive growth. On plain CT, the tumors showed heterogeneous density with the CT value of 14 -47 HU. Different cystic and nec-rolic portions within tumors were observed in 3 cases,intratumoral hemorrhage were seen in 2 and calcification was found in 1. On contrast CT images, the tumors displayed slight or moderate heterogeneous contrast enhancement and CT value increased 13 -25 HU. 2 cases of renal vessels were surrounded. The findings of kidney invasion and renal vessels displacement were observed in 4 cases, hydronephrosis in 4,the left adrenal gland infiltration in 2, pancreas involvement in 1 ,the left psoas muscle invaded in 2,the left diaphragm encroached in 1 ,the ureter involvement in 1. Two renal arteries in ipsilateral kidney were appeared in 3 patients. Multiple retroperitoneal lymph nodes were observed in 2 cases and bilateral diaphragmatic and left cervical lymph nodes were seen in 1 case. On angiography, a globular hypovascular mass was found in 3 cases and block tumor stain was seen in 1. Conclusion The CT and angiography features of retroperitoneal PNET lack of specificity, and hard to identify it with other malignent tumors in the retroperitoneum.%目的 探讨腹膜后原始神经外胚层肿瘤(primitive neuroectodermal tumors,PNET)的CT及血管造影表现.资料与方法 回顾性分析6例经病理证实的腹膜后PNET的CT和血管造影表现.结果 6例中,5例

  1. The Optimal Approach for Laparoscopic Adrenalectomy through Mono Port regarding Left or Right Sides: A Comparative Study

    Directory of Open Access Journals (Sweden)

    Wooseok Byon

    2014-01-01

    Full Text Available Introduction. Several studies have shown the feasibility and safety of both transperitoneal and posterior retroperitoneal approaches for single incision laparoscopic adrenalectomy, but none have compared the outcomes according to the left- or right-sided location of the adrenal glands. Materials and Methods. From 2009 to 2013, 89 patients who received LAMP (laparoscopic adrenalectomy through mono port were analyzed. The surgical outcomes attained using the transperitoneal approach (TPA and posterior retroperitoneal approach (PRA were analyzed and compared. Results and Discussion. On the right side, no significant differences were found between the LAMP-TPA and LAMP-PRA groups in terms of patient characteristics and clinicopathological data. However, outcomes differed in which LAMP-PRA group had a statistically significant shorter mean operative time (84.13 ± 41.47 min versus 116.84 ± 33.17 min; P=0.038, time of first oral intake (1.00 ± 0.00 days versus 1.21 ± 0.42 days; P=0.042, and length of hospitalization (2.17 ± 0.389 days versus 3.68 ± 1.38 days; P≤0.001, whereas in left-sided adrenalectomies LAMP-TPA had a statistically significant shorter mean operative time (83.85 ± 27.72 min versus 110.95 ± 29.31 min; P=0.002. Conclusions. We report that LAMP-PRA is more appropriate for right-sided laparoscopic adrenalectomies due to anatomical characteristics and better surgical outcomes. For left-sided laparoscopic adrenalectomies, however, we propose LAMP-TPA as a more suitable method.

  2. 直肠癌及腹膜后肿瘤术中输尿管支架置入预防泌尿系并发症%Cystoscopic Ureteral Stent Placement the Prevention of Urinary Complications After Operation of Rectal Cancer and Retroperitoneal Tumor

    Institute of Scientific and Technical Information of China (English)

    曹广鑫; 王小林; 黄健; 江晓晖

    2014-01-01

    目的:探讨在高手术难度直肠癌及腹膜后肿瘤术中联合膀胱镜下输尿管支架置入预防泌尿系并发症的临床价值。方法9例高手术难度直肠癌及腹膜后肿瘤患者手术前均在膀胱镜下行单侧或双侧输尿管支架置入,复发性直肠癌、新辅助放化疗后直肠癌、后腹膜肿瘤均行R0或R1切除,晚期直肠癌伴梗阻行R2切除。术后3个月门诊膀胱镜下取出支架。结果术中均未发生输尿管切断、损伤、误扎,膀胱损伤,术后均未发生尿瘘、输尿管狭窄等并发症。结论高手术难度直肠癌及腹膜后肿瘤术中先行膀胱镜下输尿管支架置入简单易行,且对于预防泌尿系并发症有重要意义。%Objective To investigate the clinical value of intraoperative cystoscopic ureteral stent placement in the prevention of urinary complications of rectal cancer and retroperitoneal tumor treated with high difficulty opera-tion. Methods Nine cases of rectal carcinoma and retroperitoneal tumor treated with high difficulty operation re-ceived the intraoperative cystoscopic ureteral stent placement,recurrent rectal cancer,rectal cancer after neoadjuvant chemoradiotherapy and retroperitoneal tumor were executed the R0 or R1 resection,advanced rectal cancer with intes-tinal obstruction were executed the R2 resection. Cystoscopic ureteral stent was taken out in the three months after operation. Results There was no ureteral injury and bladder injury in operation,there was no urinary fistula and u-reteral stricture after operation. Conclusion Cystoscopic ureteral stent placement was simple and easy,can be used in the prevention of urinary complications rectal cancer and retroperitoneal tumor treated with high difficulty opera-tion.

  3. THE COMPARATIVE ASSESSMENT THE EFFECTIVENESS OF TREATMENT THE NERVE ROOT COMPRESS SYNDROME USING THE ANTERIOR AND POSTERIOR APPROACHES OF PATIENTS WITH COMBINED LATERAL LUMBAR STENOSIS

    Directory of Open Access Journals (Sweden)

    Ye. B. Kolotov

    2013-01-01

    Full Text Available Objective: to compare the therapeutic possibility of the decompressiveviedecompressive with stabilization surgeries using the standard posterior and anterior retroperitoneal approaches in patients with combination of inherent and obtaining lateral stenosis and to demonstrate the adequacy of using. At the main group we removed the herniated disc with stabilization using anterior and posterior approaches – 82 patients. The control group was treated by standard microdiscectomy – 40 patients. More excellent and good results were in the main group where decompression was combined with stabilization, and at the same group were less negative results. The decompressive-stabilizing surgery with anterior interbody fusion is a pathogenetic and technically adequate treatment for combined lateral stenosis.

  4. Retroperitoneal hematoma with bone resorption around the acetabular component after total hip arthroplasty: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Uchida Kenzo

    2012-09-01

    Full Text Available Abstract Introduction Vascular complications related to cup-fixating screws penetrating the medial acetabular wall during total hip arthroplasty are not uncommon but rarely are associated with serious adverse events in the late post-operative period. Case presentation We present the case of a 77-year-old Japanese woman who developed progressive extensive bone resorption and large hematoma in the acetabulum 13 years after total hip arthroplasty. On admission to our hospital, she was on oral warfarin (1.5mg/day for atrial fibrillation. About 5 months after the initiation of anticoagulant therapy, she suffered a major fall followed by massive subcutaneous and pelvic girdle bleeding, predominantly on the medial side of the right thigh, but a fracture or damage of total hip arthroplasty was not evident on an emergency orthopedic evaluation. One year after the accident, a routine follow-up examination showed an asymptomatic osteolytic lesion in the acetabulum on the right pelvis, and 2 years later our patient noticed progressive pain in her right hip during walking. A large osteolytic lesion was noted in the right acetabulum on a plain radiograph. On high-resolution computed tomography and magnetic resonance imaging, a huge granulomatous lesion in the acetabulum was suggestive of chronic hematoma in intrapelvic and extrapelvic gluteal regions. A closer computed tomography examination showed that one of the screws used for fixation of the acetabular component in the total hip arthroplasty had penetrated the acetabular bone and had reached the pelvic cavity. Surgery was performed in a single session by means of two approaches: anterior midline transperitoneal address to resect the low-density mass lesion followed by posterolateral acetabular implant re-settlement. Conclusions Though rare, total hip arthroplasty-related late vascular complications could be serious and potentially affect the limb and quality of life.

  5. 腹膜后囊性黑色素性神经鞘瘤一例报道并文献复习%Retroperitoneal Cystic Melanotic Schwannoma:A Case Report and Literature Review

    Institute of Scientific and Technical Information of China (English)

    何珏; 肖秋香

    2015-01-01

    Objective To investigate the clinicopathologic features of retroperitoneal cystic melanotic schwannoma in order to improve the level of diagnosis and treatment of such tumor.Methods Selected one patient with retroperitoneal cystic melanotic schwannoma who were admitted into the Department of Oncological Surgery of the First Affiliated Hospital of Gannan Medical University on March 17, 2014.We made a review about clinical data , imaging findings, pathological features and treatment methods , and we conducted a general analysis combining with domestic and overseas literatures .Results Due to the pain in the left rear waist , this 47-year-old male went to see a doctor.A tumor was found beside the psoas muscle of left side by enhanced CT scan , which was closely related to the left kidney.And it was removed by surgical operation.Macroexamination:this tumor was cystic with the size 15.0 cm ×10.0 cm ×10.0 cm, within which much sticky liquid like coffee can be seen.And the capsule wall was 1.0 cm thick, part of which was adhered to peripheral tissues of the left kidney.Examination by optical microscope: cyst wall included few tumor cells , and they were divided into nodular shape by fiber tissues; the tumor cells were fusiform and epithelioid, and much melanin deposition can be seen in the cytoplast.Immunohistochemistry: HMB45, Melan-A, S100, CD57 , Vimmentin and CollagenⅣ were ( +) .Ki -67 was 4% ( +) .Pathological diagnosis: it was a typical Retroperitonea cystic melanotic schwannoma.Conclusion Melanotic schwannoma is a rare soft tissue tumor with the features of neurilemma cells and melanocytes differentiation.Cystic melanotic schwannoma is rare and contains potential malignant biological behavior.And such patients need long -term follow-up.%目的:探讨腹膜后囊性黑色素性神经鞘瘤的临床病理特征,以提高对该肿瘤的诊治水平。方法赣南医学院第一附属医院肿瘤外科2014-03-17收治1例腹膜后囊性黑色素

  6. 单孔后腹腔镜手术在肾及肾上腺疾病中的应用(附33例报告)%Single-site Retroperitoneal Laparoscopy for Kidney and Adrenal Gland Diseases: Report of 33 Cases

    Institute of Scientific and Technical Information of China (English)

    陈志军; 李庆文; 薛胜; 常睿; 汪盛; 张青川; 刘贝贝; 王成勇

    2013-01-01

    目的 探讨利用自制单孔多通道装置及常规腹腔镜器械完成单孔后腹腔镜肾及肾上腺手术的可行性.方法 2011年8月~ 2012年3月,采用切口保护器+橡胶手套自制单孔多通道装置,利用常规腹腔镜器械完成33例单孔后腹腔镜手术,其中肾上腺肿瘤切除10例,肾癌根治性肾切除6例,肾囊肿去顶减压术12例,肾蒂淋巴管结扎术4例,肾盂成形术1例.结果 33例手术均顺利完成,其中1例肾盂成形术因术中缝合困难另增加-5 mm通道完成手术,无中转开放手术.住院时间4~9d,平均6d.术中术后未出现明显并发症.结论 自制单孔多通道后腹腔镜手术在治疗肾及肾上腺疾病方面安全可行,具有创伤小、切口美观等优点.自制单孔多通道装置制作使用方便,价格低廉.%Objective To summarize the feasibility of home-made single-site retroperitoneal laparoscopic surgery for kidney and adrenal gland diseases. Methods From August 2011 to March 2012, 33 patients underwent retroperitoneal laparoendoseopic single-site surgery ( LESS) by using a home-made single-port multichannel device and standard laparoscopic instruments. The procedures included adrenalectomy (10 cases) , radical nephrectomy (6 cases) , renal cyst unroofing (12 cases) , ligation of renal lymphatic vessels (4 cases) , and pyeloplasty (1 case). Results All the operations were successfully completed without conversion to open surgery, but a additional 5-mm trocar was used to assist the procedure in one case ( pyeloplasty) ; no intraoperative or postoperative complications occurred. The mean hospital stay was 6 days (4-9 days). Conclusions Retroperitoneal LESS is feasible, effective and safe for kidney and adrenal gland diseases, with good cosmetic outcomes. Home-made port is convenient to make and use while its cost is low.

  7. 后腹腔镜bulldog夹阻断肾动脉连续缝合行肾部分切除术24例分析%Retroperitoneal laparoscopic partial nephrectomy utilizing bulldog clamp blocking renal artery and continuous suture technique in 24 cases

    Institute of Scientific and Technical Information of China (English)

    王德林; 蒲军; 张尧; 杨军; 吴小候

    2011-01-01

    目的 评价后腹腔镜下bulldog夹阻断肾动脉连续缝合行肾部分切除术的临床疗效及价值.方法 回顾性分析24例后腹腔镜肾部分切除术患者的一般临床资料、手术结果及预后情况.结果 所有患者手术均成功,术中无输血及中转开腹手术,平均手术时间为143.3 min,平均热缺血时间为24 min;术后无继发出血、感染及漏尿,术后病理检查证实8例为肾透明细胞癌,16例为平滑肌脂肪瘤;随访2~36个月无转移、局部复发.结论 后腹腔镜下bulldog夹阻断肾动脉连续缝合行肾部分切除术治疗直径小于4.5 cm肾肿瘤安全、有效.%Objective To evaluate clinical efficacy and value of retroperitoneal laparoscopic partial nephrectomy utilizing bulldog clamp blocking renal artery and continuous suture technique. Methods 24 cases of retroperitoneal laparoscopic partial nephrectomy in patients were retrospectively analyzed, with the clinical data, surgical results, prognosis for their treatment. Results All operations were successful without intraoperative conversion and transfusion,and no post-operative bleeding,inflammation and leakage of urine was found. The average operative time was 143. 3 min,the average warm ischemia time was 24 min. Pathology showed 8 cases of renal cell carcinoma, 16 cases of angiomyolipoma. The follow-up time was 2-36 months without local recurrence and metastasis. Conclusion retroperitoneal laparoscopic partial nephrectomy for diameter less than 4. 5 cm renal tumor is safe and effective.

  8. Rare primary retroperitoneal teratoma masquerading as adrenal ...

    African Journals Online (AJOL)

    J.M. Ratkal

    investigation was found to have a right adrenal mass were collected. ... in children, but their prevalence in adults is exceedingly rare. The adrenal gland is ... tumors, the abdominal CT and chest X-ray images taken prior to surgery were.

  9. Delays in the management of retroperitoneal sarcomas

    DEFF Research Database (Denmark)

    Seinen, Jojanneke; Almquist, Martin; Styring, Emelie

    2010-01-01

    at the general practitioner, 36 days at local hospitals, and 55 days at the sarcoma centre. Conclusion. Centralization per se is not sufficient for optimized and efficient management. Our findings suggest that delays can be minimized by direct referral of patients from primary health care to sarcoma centers...... sarcoma in the southern Sweden health care region 2003-2009 were eligible for the study. Data on referrals and diagnostic investigations were collected from clinical files from primary health care, local hospitals, and from the sarcoma centre. Lead times were divided into patient delays and health care...... delays caused by primary health care, local hospitals, or procedures at the sarcoma centre. Results. Complete data were available from 33 patients and demonstrated a median patient delay of 23 days (0-17 months) and median health care delay of 94 days (1-40 months) with delays of median 15 days...

  10. Delays in the management of retroperitoneal sarcomas

    DEFF Research Database (Denmark)

    Seinen, Jojanneke; Almquist, Martin; Styring, Emelie

    2010-01-01

    at the general practitioner, 36¿days at local hospitals, and 55¿days at the sarcoma centre. Conclusion. Centralization per se is not sufficient for optimized and efficient management. Our findings suggest that delays can be minimized by direct referral of patients from primary health care to sarcoma centers...... sarcoma in the southern Sweden health care region 2003-2009 were eligible for the study. Data on referrals and diagnostic investigations were collected from clinical files from primary health care, local hospitals, and from the sarcoma centre. Lead times were divided into patient delays and health care...... delays caused by primary health care, local hospitals, or procedures at the sarcoma centre. Results. Complete data were available from 33 patients and demonstrated a median patient delay of 23¿days (0-17¿months) and median health care delay of 94¿days (1-40¿months) with delays of median 15¿days...

  11. Giant retroperitoneal lipomas--radiological case report.

    Science.gov (United States)

    Drop, Andrzej; Czekajska-Chehab, Elzbieta; Maciejewski, Ryszard

    2003-01-01

    A 72-years woman presented with a 4-weeks history of abdominal pain and sickness. Physical examination was normal except for a large, smooth, non-tender solid mass in the right upper quadrant. US demonstrated a 12 x 9 x 4-cm solid, homogeneous, hyperechogenic mass between the posterior abdominal wall and the right kidney and the right lobe of the liver. The primary diagnosis was established as Tumor hepatis. The CT showed a great mass of measurements between - 80 and - 100 Hounsfield units; it filled right half of the abdominal cavity, with focal intratumoral calcifications. The right lobe of the liver, gallbladder, the right kidney, and loops of the small intestine were dislocated and pressured to anterior abdominal wall. The lower pole of the tumor was located in right iliac fosse. It was easily dissected from the adjacent tissues and removed completely. The histopathological diagnosis was lipomas. The next case was a 60-years woman with a 2-months history of pain and gastrointestinal symptoms. US demonstrated a 13 x 12-cm solid, homogeneous, hyperechogenic mass in right epigastria, below the liver. The primary diagnosis was established as abdominal tumor. The CT showed lipomas with numerous septa and calcifications of measurements between -20 and -61 Hounsfield units filling the right half of the abdominal cavity. The right kidney and loops of the small intestine were dislocated to the left side. The root of the tumor seems to be connected with the mesentery of the small intestine. The patient was treated surgically and remains well under regular follow-up.

  12. The clinical effect of retroperitoneal laparoscopic selectivity renal artery interrupted and renal artery interrupted on the treatment of T1a suprarenal epithelioma%后腹腔镜下高选择性肾动脉阻断与肾动脉全阻断治疗T1a期肾透明细胞癌的临床分析

    Institute of Scientific and Technical Information of China (English)

    赵剑锋; 奉友刚; 何俊

    2015-01-01

    目的 比较后腹腔镜下高选择性肾动脉阻断与肾动脉全阻断治疗T1a期肾透明细胞癌的有效性和安全性.方法 选择本院泌尿外科住院行肾部分切除术的患者42例,其中21例患者的肾门处理方式为高选择性肾动脉阻断治疗,作为高选择组,21例患者的肾门处理方式为肾动脉全阻断治疗,作为全阻断组.比较两组患者的肾动脉平均阻断时间、平均手术时间、平均术中出血量、平均术中输血率、手术切缘的阳性率、平均术后住院天数,术后并发症情况,术后患者的肌酐变化情况等.结果 高选择组患者在平均阻断时间、术后肌酐变化百分率等指标均明显优于全阻断组患者(P<0.05),手术时间明显长于全阻断组患者(P<0.05),而在平均术中出血量、平均术中输血率、手术切缘阳性率、平均术后住院天数、术后并发症等观察指标比较,两组患者间的差异无统计学意义(P>0.05).结论 与后腹腔镜下肾动脉全阻断治疗比较,后腹腔镜下高选择性肾动脉阻断治疗具有阻断时间短、术后肾功能损害小的特点,值得临床推广.%Objectives To compare the clinical effeot and safty between retroperitoneal laparoscopic selectivity renal artery interrupted and renal artery interrupted on the treatment of T1a suprarenal epithelioma.Methods Retrospective analysis of 42 T1 a suprarenal epithelioma patients in our hospital.Among them,21 patients treated with retroperitoneal laparoscopic selectivity renal artery interrupted were put into selective group,meanwhile,the rest 21 patients with retroperitoneal laparoscopic renal artery interrupted were renal artery interrupted group.Comparisons between two groups have been made in the renal pedical clamping,operation time,blood loss,rate of blood transfusion,postoperative hospital stay,incidence of complications and the rate of change about creatinine.Results Patients in selective group,which had longer

  13. Clinical Observation of Treatment of Retroperitoneal Lymph Node Metastasis by the Radiation Therapy of Gyro Rotary 60 Cobalt Radiation Treatment System%陀螺旋转式钴60放射外科治疗系统治疗腹膜后淋巴结转移瘤的近期疗效观察

    Institute of Scientific and Technical Information of China (English)

    李爽; 李贵新; 于金明; 邓军吉; 王文浩; 陈伟

    2013-01-01

    Objective To analyze the clinical observation of treatment of retroperitoneal lymph node metas -tasis by the radiation therapy of gyro rotary 60 cobalt radiation treatment system.Methods Thirty two patients with retro-peritoneal lymph node metastasis were treated with stereotactic radiotherapy in our department .The dose was 3~5Gy per fraction,the total dose of retroperitoneal were ranged from 35Gy to 50Gy,five times a week.The planned target volume was encompassed by more than 50%to 70%isodose line.Results The overall response rate(CR+PR) was 97.0%. Multivariate analysis showed that original illness ,radiotherapy dose and partial and complete response were related to i-dentified predictors of outcome,and the volume of radiotherapy,the size of metastatic-lymph node and tumor thrombi were not related to the outcome.Conclusion The radiation therapy of gyro rotary 60 cobalt radiation treatment system is a safe and effective treatment for retroperitoneal lymph node metastasis .It can be used as adjuvant therapy with the radia-tion therapy of gyro rotary 60 cobalt radiation treatment system .%  目的 探讨陀螺旋转式钴60放射外科治疗系统治疗腹膜后淋巴结转移瘤的近期疗效。方法 32例腹膜后淋巴结转移患者,给予陀螺旋转式钴60放射外科治疗系统治疗,50%~70%等剂量曲线覆盖整个靶区,单次周边剂量给予3~5Gy,周边总剂量35~50Gy。结果 32例中完全缓解(CR)24例,部分缓解(PR)7例,无变化(SD)1例。总有效率(CR+PR)为97.0%.多因素分析显示原发病、放疗剂量、症状缓解影响预后,而淋巴结转移大小、是否有癌栓、放疗体积与预后无关。结论 陀螺旋转式钴60放射外科治疗系统(简称陀螺刀)治疗腹膜后淋巴结转移瘤安全有效,可作为腹膜后淋巴结转移瘤的辅助性治疗手段。

  14. Robotic partial nephrectomy with cold ischemia and on-clamp tumor extraction: recapitulating the open approach.

    Science.gov (United States)

    Rogers, Craig G; Ghani, Khurshid R; Kumar, Ramesh K; Jeong, Wooju; Menon, Mani

    2013-03-01

    We describe a reproducible technique for achieving cold ischemia with intraoperative tumor assessment during robotic partial nephrectomy (RPN) that recapitulates the open approach: intracorporeal cooling and extraction (ICE). A total of seven patients underwent the ICE modification of RPN by transperitoneal (n=5) and retroperitoneal (n=2) approaches. A Gelpoint access port was used for the camera and assistant ports. Following hilar clamping, ice slush was introduced through the Gelpoint via syringes and applied over the kidney surface. The excised tumor was immediately extracted through the Gelpoint, allowing gross margin assessment by pathology during the renorrhaphy. RPN was achieved in all cases with successful introduction of ice slush and tumor extraction while on clamp. Median RENAL nephrometry score was 8 (range: 6-10), and there was one solitary kidney. Mean cold ischemia time was 19.6 min (range: 8-37) and mean estimated blood loss was 296.4 ml (range: 50-1000). Renal parenchymal temperatures 0.5°C during any procedures. Intraoperative assessment of the excised tumor showed adequate gross margins in all cases and final pathology confirmed negative surgical margins.

  15. Clinical observation of the subcutaneous emphysema due to retroperitoneal laparoscopic carbon dioxide pneumoperitoneum%腹膜后腔镜手术二氧化碳气腹并发皮下气肿临床观察

    Institute of Scientific and Technical Information of China (English)

    魏福生; 马龙先

    2015-01-01

    目的 探讨腹膜后腔镜手术中二氧化碳气腹并发皮下气肿对患者血流动力学、血气及麻醉苏醒的影响.方法 回顾分析87例择期行腹膜后腔镜肾癌根治手术患者,依据皮下气肿严重程度把患者分为3组:无皮下气肿患者组(A组,66例)、1级和2级的轻度皮下气肿患者组(B组,15例)、3级的重度皮下气肿患者组(C组,6例).B组和C组发生皮下气肿后行过度通气.分别于气腹前(T0)、气腹后30 min(T1)、气腹后60 min(T2)、气腹后90 min(T3)及手术结束时(T4)、拔管时、拔管后30 min监测患者血气、呼气末二氧化碳分压(end-tidal carbon dioxide partial pressure,PETO2)、心率(heart rate,HR)、平均动脉压(mean artery pressure,MAP),同时观察麻醉苏醒情况.结果 C组在T2~T4时间点的动脉血二氧化碳分压(partial pressureof carbon dioxide in artery,PaCO2)、PETCO2、HR、MAP值均显著高于A组(P<0.05),pH值均显著低于A组(P<0.05).C组患者术后呼唤睁眼时间[(16±6) min]显著长于A组[(11±3) min](P<0.05),定向力恢复时间[(30±7) min]显著长于A组[(23±6) min](P<0.05).C组拔管时PaCO2[(52±7) mmHg(1 mmHg=0.133 kPa)]显著高于A组[(45±4) mmHg](P<0.05),拔管后30 min的PaCO2[(48±7)mmHg]显著高于A组[(39±4) mmHg(P<0.05)].结论 后腹腔镜手术并发重度皮下气肿导致患者高碳酸血症,患者血压升高、HR加快,苏醒时间延长.%Objective To explore the effect of subcutaneous emphysema due to retroperitoneal laparoscopic carbon dioxide pneumoperitoneum on hemodynamic,arterial blood gas,and awakening time in patients undergoing nephrectomy surgery.Methods Eighty-seven patients with kidney cancer scheduled for radical nephrectomy surgery were retrospectively studied.Patients were divided into three groups according to the severity of subcutaneous emphysema:patients without subcutaneous emphysema group (group A,n=66),patients with grade 1 or 2 subcutaneous emphysema group (group B,n=15

  16. Clinical features and prognostic analysis of retroperitoneal fibrosis in 32 patients%腹膜后纤维化32例临床特点及转归分析

    Institute of Scientific and Technical Information of China (English)

    安乐美; 许玉峰; 张卓莉

    2012-01-01

    目的:通过对腹膜后纤维化临床特点及其影像学表现的分析,提高对该病的诊治水平.方法:收集北京大学第一医院风湿免疫科从2009年7月至2011年12月诊断为腹膜后纤维化的32例患者的临床资料,回顾性分析其临床表现,并对其CT/MRI下炎性-纤维包块进行测量和分期;同时观察治疗前后患者临床症状、急性期反应物、肾功能、影像学变化及D-J管拔除情况变化,分析急性期反应物变化与影像学变化之间的相关性.结果:32例患者中男21例,女11例,男女比例为1.91∶1,年龄30~78岁,平均60岁.首诊表现主要包括腹痛、腹胀、腰痛、体重减轻、下肢浮肿等.26例(81.25%)患者经超声检查发现有肾积水,所有患者均经CT/MRI检查发现腹膜后软组织影而确诊.32例患者均接受激素治疗,31例接受他莫昔芬治疗,8例接受免疫抑制剂治疗.随诊的18例患者均接受激素/免疫抑制剂/他莫昔芬治疗,其中13例患者置入D-J管,平均随访14个月.药物治疗后患者症状缓解,红细胞沉降率(erythrocyte sedimentation rate,ESR)和C反应蛋白(C-reactive protein,CRP)下降,肾功能较前改善,腹膜后纤维化包块较前明显缩小,D-J管平均置管时间为13.1个月,拔管率80%.平均治疗8.1个月后,ESR、CRP变化与CT/MRI腹膜后软组织左右径线变化的相关系数分别为0.50、0.66(P <0.05).结论:腹膜后纤维化临床表现多样且不特异,确诊主要依靠影像学检查.药物治疗可缓解患者症状,降低急性期反应物,改善肾功能和影像学表现,提高拔管率.治疗前后的ESR、CRP变化与CT/MRI软组织包块左右径线变化呈正相关.%Objective;To analyze the clinical features and imaging manifestations of retroperitoneal fibro-sis (RPF) for improving clinical diagnosis and treatment. Methods; The medical records of 32 cases from Jul. 2009 to Dec. 2011 with definite diagnosis of RPF were reviewed retrospectively, and

  17. 经后腹膜腔途径和经腹腔途径腹腔镜下根治性肾切除术安全性和疗效的Meta分析%Retroperitoneal laparoscopic radical nephrectomy versus transperitoneal laparoscopic radical nephrectomy: a meta-analysis of safety and efficiency

    Institute of Scientific and Technical Information of China (English)

    赵强; 张骞; 金杰

    2014-01-01

    目的 对经后腹膜腔途径与经腹腔途径腹腔镜下根治性肾切除术的相关文献进行Meta分析,以比较两种术式的安全性和疗效. 方法 检索2000年1月至2012年10月关于腹腔镜下根治性肾切除术的相关文献.国外文献选用Pubmed、Embase、Cochrane library数据库,以transperitoneal,retroperitoneal,laparoscopy,radical nephrectomy为关键词.国内文献选用中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库和万方中文数据库,以经腹腔、经后腹膜腔、根治性肾切除、腹腔镜作为关键词.由2名评价者共同评价纳入研究的质量,并采用Cochrane协作网提供的Revman 5.0统计软件对纳入文献进行Meta分析. 结果 共有9篇临床对照研究符合纳入标准,包括7篇国外文献和2篇中文文献,基线资料具有可比性.共纳入患者1 306例,其中经后腹膜腔途径组520例,经腹腔途径组786例.在手术时间(OR=16.23,95%CI 1.62~30.84)和术后并发症发生率(OR=2.44,95%CI 1.35 ~4.41)方面,经后腹膜腔途径显著优于经腹腔途径,差异均有统计学意义(P<0.05).在手术切口长度、术中出血量、住院时间、中转开放率、5年无复发生存率和5年总体生存率等方面两者比较差异均无统计学意义(P>0.05). 结论 经后腹膜腔途径腹腔镜下根治性肾切除术在手术时间和术后并发症方面显著优于经腹腔途径,但两种术式的疗效无显著差异,各中心可根据自身习惯选择手术方式.%Objective To compare the safety and efficiency of retroperitoneal laparoscopic and transperitoneal laparoscopic radical nephrectomy by meta-analysis.Methods A systematic review of the literature about laparoscopic radical nephrectomy was performed,searching Medline,Embase,Cochrane library,CBM,CNKI,VIP and Wan Fang database from January 2000 to October 2012.The key words were transperitoneal,retroperitoneal,laparoscopy,radical nephrectomy

  18. Observation and nursing of digital subtration angiography and embolization treatment in the patients with retroperitoneal tumor%腹膜后肿瘤患者血管造影及介入栓塞治疗的观察及护理

    Institute of Scientific and Technical Information of China (English)

    周静; 佘耀光; 杨亚南

    2014-01-01

    Objective To study the nursing of digital subtration angiography and embolization treatment in the patients with retroperitoneal tumor .Methods Clinical data of 74 patients with retroperitoneal tumor (74 patients underwent digital subtration angiography , 54 patients underwent digital subtration angiography and embolization treatment ) were analyzed retrospectively .Results Totals of 54 patients received angiography and positive cases were treated with interventional embolization .All of the 54 patients had no ectopic artery embolism , puncture site hemorrhage and infection , 23 cases had fever after embolization ,16 cases had different levels of low back pains;15 cases were abdominal pains , 4 cases were urinary retention .Conclusions Angiography can clearly display the tumor blood supply , peripheral blood vessels and organ relationships in retroperitoneal tumor . Interventional embolization can effectively reduce the bleeding during the operation and the size of tumor , so these methods can decrease the blindness and risk of operation .The key job of nursing is to prepare for operation before angiography and interventional embolization , closely observe the changes of patients after angiography and interventional embolization .%目的:探讨腹膜后肿瘤行血管造影及介入栓塞治疗的意义及护理措施。方法回顾性总结分析74例腹膜后肿瘤患者行血管造影及介入栓塞治疗后的相关指标,总结临床护理经验。结果54例患者动脉血管造影阳性,在介入导管室行PVA颗粒、明胶海绵颗粒、微钢圈栓塞等栓塞治疗;54例患者均未发生穿刺部位出血及感染,仅有3例出现局部淤血、淤斑,栓塞后发热23例,不同程度腰背酸痛16例,腹痛15例,尿潴留4例,无异位动脉栓塞等并发症。结论腹膜后肿瘤行血管造影能清晰地显示肿瘤血供来源与周围血管及器官的关系,介入栓塞能有效地减少术中出血,一定

  19. Report on one case of IgG4-related retroperitoneal fibrosis and literatures review for IgG4-related disease%IgG4相关性腹膜后纤维化一例及IgG4相关性疾病文献复习

    Institute of Scientific and Technical Information of China (English)

    牛强; 丁倩倩; 陈勤奋

    2013-01-01

    目的 探讨IgG4相关性腹膜后纤维化(IgG4-RRPF)和IgG4相关性疾病(IgG4-RD)的临床表现、诊断和治疗方法.方法 对1例IgG4-RRPF患者的临床资料进行回顾性分析,复习相关文献并介绍一个新的临床病种IgG4-RD.结果 患者,52岁,男性,以左下腹痛和左肾积液为表现,影像学显示左侧腰大肌内侧异常软组织影,PET-CT显示该软组织影脱氧葡萄糖代谢摄取增高,经肿块切取活检术,病理诊断符合IgG4-RD,诊断为IgG4-RRPF,予泼尼松治疗后症状缓解,肿块缩小.复习最新文献发现IgG4-RRPF即以往所称的特发性腹膜后纤维化(IRF).结论 IgG4-RRPF是IgG4-RD谱中的一种罕见类型,以腹膜后组织慢性炎症和显著纤维化为特征,常包绕输尿管或其他腹部脏器,血液学检查显示血清IgG4浓度升高(≥1.35 g/L),组织病理学检查显示明显淋巴细胞和IgG4+浆细胞浸润伴纤维化.一线治疗给予糖皮质激素.%Objective To explore the clinical manifestation,diagnosis and treatment of IgG4-related retroperitoneal fibrosis (IgG4-RRPF) and IgG4-related disease (IgG4-RD).Methods The clinical data of a case of IgG4-RRPF was analyzed retrospectively,the related literatures were reviewed,and a novel clinical entity IgG4-RD was introduced.Results The patient was a 52-year-old man with the complaint of left lower abdominal pain due to left hydronephrosis.CT and MRI revealed a soft tissue mass at the left psoas major muscle.PET-CT showed increased FDG uptake.After biopsy,the pathological diagnosis was consistent with IgG4-RD.The patient was diagnosed as IgG4-RRPF and treated with prednisone.The symptoms improved and retroperitonea] mass reduced.According to review the latest literatures,it is found that IgG4-RRPF was socalled idiopathic retroperitoneal fibrosis (IRF) formerly.Conclusion IgG4-RRPF is a rare disease in IgG4-RD spectrum,characterised by the presence of a retroperitoneal tissue,consisting of chronic inflammation and marked

  20. Retroperitoneal laparoendoscopic single-site donor nephrectomy using home-made single-port device:report of 11 cases%自制单孔设备经腹膜后入路腹腔镜活体供肾切取11例体会

    Institute of Scientific and Technical Information of China (English)

    祖强; 孙圣坤; 蔡伟; 杨素霞; 卢锦山; 张旭; 董隽

    2012-01-01

    Objective To investigate the feasibility and safety of retroperitoneal laparoendoscopic single-site (LESS) donor nephrectomy using home-made single-port device.Methods From January 2011 to June 2012,11 consecutive LESS left donor nephrectomies using home-made single-port device with conventional laparoscopic instrument were performed through retroperitoneal access in our center.Results The procedures were completed and no complications occurred in all donors.Mean operative time was 149.5 min.Estimated blood loss was 30-350 ml.Warm ischemia time was 2-4 min.The urine output was prompt in all cases.Recipient graft function was normal within 2 weeks.Donor hospital stay was 5-6 days after operation.Conclusion LESS donor nephrectomy using home-made single-port device in our initial experience is feasible and safe.It is also cost-effective and minimally invasive with conventional laparoscopic donor nephrectomy.This technique is a good option for living donor nephrectomy.%目的 探讨用自制单孔设备行经腹膜后入路腹腔镜亲属活体供肾切取术的安全性和可行性.方法 2011年1月到2012年6月间采用自制单孔多通道设备及常规腹腔镜操作器械,先后完成11例经腹膜后入路腹腔镜亲属活体供肾切取手术.结果 供肾均为左肾,平均手术时间为149.5 min,术中出血量为20~350 ml,供肾热缺血时间为2~4 min.供者术后5~6 d出院,未发生手术并发症.结论 采用自制单孔多通道设备完成经腹膜后入路腹腔镜活体供肾切取术在技术上是可行的 ;与传统腹腔镜供肾切取手术相比,手术创伤小,恢复快.

  1. Surgical anatomy of the retroperitoneal spaces part II: the architecture of the retroperitoneal space.

    Science.gov (United States)

    Mirilas, Petros; Skandalakis, John E

    2010-01-01

    The extraperitoneal space extends between peritoneum and investing fascia of muscles of anterior, lateral and posterior abdominal and pelvic walls, and circumferentially surrounds the abdominal cavity. The retroperitoneum, which is confined to the posterior and lateral abdominal and pelvic wall, may be divided into three surgicoanatomic zones: centromedial, lateral (right and left), and pelvic. The preperitoneal space is confined to the anterior abdominal wall and the subperitoneal extraperitoneal space to the pelvis. In the extraperitoneal tissue, condensation fascias delineate peri- and parasplanchnic spaces. The former are between organs and condensation fasciae, the latter between this fascia and investing fascia of neighboring muscles of the wall. Thus, perirenal space is encircled by renal fascia, and pararenal is exterior to renal fascia. Similarly for the urinary bladder, paravesical space is between the umbilical prevesical fascia and fascia of the pelvic wall muscles-the prevesical space is its anterior part, between transversalis and umbilical prevesical fascia. For the rectum, the "mesorectum" describes the extraperitoneal tissue bound by the mesorectal condensation fascia, and the pararectal space is between the latter and the muscles of the pelvic wall. Perisplanchnic spaces are closed, except for neurovascular pedicles. Prevesical and pararectal (presacral) and posterior pararenal spaces are in the same anatomical level and communicate. Anterior to the anterior layer of the renal fascia, the anterior interfascial plane (superimposed and fused mesenteries of pancreas, duodenum, and colon) permits communication across the midline. Thus parasplanchnic extraperitoneal spaces of abdomen and pelvis communicate with each other and across the midline.

  2. Narrative approaches

    DEFF Research Database (Denmark)

    Stelter, Reinhard

    2012-01-01

    as a narrative-collaborative practice, an approach that is based on phenomenology, social constructionism and narrative theory. Seeing narrative coaching as a collaborative practice also leads to reflecting on the relationship between coach and coachee(s) in a new way, where both parts contribute to the dialogue......Narrative coaching is representative of the new wave – or third generation – of coaching practice . The theory and practice of narrative coaching takes into account the social and cultural conditions of late modern society, and must be seen as intertwined with them. Some initial conceptualizations...... and coachee. The conceptual framework will be tested by presenting central results of a research project. The ideas discussed in this chapter expand upon earlier concepts of the narrative approach (mainly formulated by White in 2007) by integrating ideas from phenomenology and experiential approaches...

  3. Capability approach

    DEFF Research Database (Denmark)

    Jensen, Niels Rosendal; Kjeldsen, Christian Christrup

    Lærebogen er den første samlede danske præsentation af den af Amartya Sen og Martha Nussbaum udviklede Capability Approach. Bogen indeholder en præsentation og diskussion af Sen og Nussbaums teoretiske platform. I bogen indgår eksempler fra såvel uddannelse/uddannelsespolitik, pædagogik og omsorg....

  4. The transparaspinal approach: A novel technique for one-step removal of dumb-bell-shaped spinal tumors.

    Science.gov (United States)

    Singh, Deepak Kumar; Singh, Neha; Rastogi, Manu; Husain, Mazhar

    2011-07-01

    Complex dumb-bell spinal tumors are challenging surgical lesions. Combined antero-posterior exposures have traditionally been used in their management. This combined exposure has the disadvantage of a two-stage operation with transthoracic or retroperitoneal dissection. With better understanding of biomechanics of spine and evolution of microsurgical technique, there has been resurgence of single stage surgeries, among which the transparaspinal exposure provides the simplest and the most direct route for resection of dumb-bell tumors. A 16-year-old male was admitted with history of back pain with radiation to left lower limb for 6 months, progressive weakness of both lower limbs for two months, and hesitancy of micturition for 1 month. A clinical diagnosis of cauda-conus lesion was made. Radiological investigations revealed a complex dumb-bell spinal tumor extending from lower part of L2-L4 vertebra, with large paraspinal extension through left L3 intervertebral foramina. Tumor was successfully removed in one step using a transparaspinal approach. We discuss technical details of this novel approach along with limitations and possible complications.

  5. The transparaspinal approach: A novel technique for one-step removal of dumb-bell-shaped spinal tumors

    Directory of Open Access Journals (Sweden)

    Deepak Kumar Singh

    2011-01-01

    Full Text Available Complex dumb-bell spinal tumors are challenging surgical lesions. Combined antero-posterior exposures have traditionally been used in their management. This combined exposure has the disadvantage of a two-stage operation with transthoracic or retroperitoneal dissection. With better understanding of biomechanics of spine and evolution of microsurgical technique, there has been resurgence of single stage surgeries, among which the transparaspinal exposure provides the simplest and the most direct route for resection of dumb-bell tumors. A 16-year-old male was admitted with history of back pain with radiation to left lower limb for 6 months, progressive weakness of both lower limbs for two months, and hesitancy of micturition for 1 month. A clinical diagnosis of cauda-conus lesion was made. Radiological investigations revealed a complex dumb-bell spinal tumor extending from lower part of L2-L4 vertebra, with large paraspinal extension through left L3 intervertebral foramina. Tumor was successfully removed in one step using a transparaspinal approach. We discuss technical details of this novel approach along with limitations and possible complications.

  6. Pedagogical approaches

    DEFF Research Database (Denmark)

    Lund Larsen, Lea

    and their particular needs, which teachers must be aware of and deal with. Secondly, I propose a combination of adult learners’ characteristics with ‘teaching orientations’, as a basis for further research on teachers of adults’ professional development. Some of the competencies that teachers need can be taught...... in formal settings, but in most teaching settings, the teachers act alone and develop their pedagogical approaches/- teaching strategies with no synchronous sparring from a colleague. Adult learners have particular needs and characteristics that their teachers must be able to address (cf. Knowles......This paper is a part of an on-going qualitative empirical research project: “Teachers of adults as learners. A study on teachers’ experiences in practice”. Data is collected at a Danish Adult Education Centre. The aim of the study is to understand teachers’ learning experiences. The research...

  7. Cranial-to-caudal approach for radical lymph node dissection along the surgical trunk in laparoscopic right hemicolectomy.

    Science.gov (United States)

    Matsuda, Takeru; Iwasaki, Takeshi; Mitsutsuji, Masaaki; Hirata, Kenro; Maekawa, Yoko; Tanaka, Tomoko; Shimada, Etsuji; Kakeji, Yoshihiro

    2015-04-01

    Complete mesocolic excision with central vascular ligation is considered to contribute to superior oncological outcomes after colon cancer surgery [1]. For advanced right-sided colon cancer, this surgery sometimes requires lymph node (LN) dissection along the superior mesenteric vein (SMV), with division of the middle colic vessels, or their right branches, at origin [2]. Here, we present cranially approached radical LN dissection along the surgical trunk during laparoscopic right hemicolectomy. The omental bursa is first opened wide, and the gastrocolic trunk of Henle is exposed, using the right gastroepiploic vessels and the accessory right colic vein (ARCV) as landmarks. After division of ARCV, SMV and middle colic vein (MCV) are identified. After dividing MCV at its root, LN dissection along SMV is conducted in a cranial-to-caudal manner. Concurrently, the middle colic artery, or its right branch, is exposed and divided at origin. The transverse colon is then raised ventrally, and LN dissection along SMV using a cranial-to-caudal approach is again performed. The ileocolic and right colic vessels are divided at origin. The ascending and transverse mesocolon, including the pedicles, are then separated from the retroperitoneal tissues, pancreatic head, and duodenum, using a medial approach. The key characteristics in this procedure consist of easy access to pancreas, early division of ARCV and middle colic vessels at origin, and easy dissection along SMV. We performed a laparoscopic colectomy using this approach for 18 patients with right-sided colon cancer. The mean operative time and blood loss were 288 min and 83 ml, respectively. The mean number of harvested LNs was 24. There were 6 cases with positive LN metastasis. There were no recurrent cases at a median follow-up period of 24 months. We consider this approach to be safe and useful for radical LN dissection along SMV for right-sided colon cancers.

  8. 后腹腔镜肾切开取石与经皮肾镜取石术治疗复杂性肾结石的临床疗效比较%Efficacy of retroperitoneal laparoscopic nephrolithotomy vs.percutaneous nephrolithotomy in patients with complex renal calculi

    Institute of Scientific and Technical Information of China (English)

    王忆勤; 张爱军; 姚俊; 王照凡; 叶明; 杨超

    2016-01-01

    Objectives To compare the efficacy between retroperitoneal laparoscopic nephrolithotomy and percutaneous nephrolithotomy (PNL) in patients with complex renal calculi.Methods Clinical data for 126 patients with complex renal calculi from January2010 to December 2014 were reviewed.They were divided into laparoscopic group (n =54) underwent retroperitoneal laparoscopic nephrolithotomy and PNL group (n =72) underwent PNL.The condition related to surgery and indexes for therapeutic effects between the two groups were compared.Results All of the patients underwent surgery successfully and no perioperative death occurred.In the laparoscopic group,operative time was longer than that in the PNL group(P <0.05),and blood loss was less than that in the PNL group (P < 0.05).No difference in the hospital stay and rate of conversion between the two groups were found (P > 0.05).In the laparoscopic group,the rate of two-stage operation was higher than that in the PNL group(P <0.05),and intraoperative stone-free rate was lower than that in the PNL group (P < 0.05).After two-stage operation,the postoperative stone-free rate was 100%.Conclusions Laparoscopic biliary tract surgery for choledocholithiasis in elderly patients is safe and effective.But surgeons should grasp the operation indication flexibly and optimize the perioperative management.%目的 比较后腹腔镜肾切开取石与经皮肾镜取石术(PNL)治疗复杂性肾结石的临床疗效.方法 选取本院2010年1月至2014年12月收治的126例复杂性肾结石,其中行后腹腔镜肾切开取石术者54例(腹腔镜组),行PNL治疗72例(PNL组).比较两组患者的手术相关情况及疗效指标.结果 两组患者手术均顺利完成,无围手术期死亡病例.腹腔镜组的手术时间长于PNL组,但术中出血量小于PNL组,差异均有统计学意义(P<0.05).两组患者的住院时间和中转开放率比较,差异无统计学意义(P>0.05).腹腔镜组二期手术率高于PNL组,

  9. 后腹腔镜下聚丙烯网带经腰肌肾固定术治疗肾下垂(附15例报道)%Retroperitoneal laparoscopic nephropexy with Polypropylene mesh belt for nephroptosis (report of 15 cases)

    Institute of Scientific and Technical Information of China (English)

    胡阳军; 王丰; 汪波; 张杰; 龚仕旁; 闵霞

    2015-01-01

    目的 探讨后腹腔镜下聚丙烯网带经腰肌肾固定术治疗症状性肾下垂的可行性和疗效.方法 2008年12月以来对15例行立卧位IVU或CT检查确诊为肾下垂患者行后腹腔镜下游离肾脏,采用自行修剪聚丙烯网带绕肾脏中下极,经腰部肌群(腹内外斜肌、腰大肌、腰方肌)穿出,并于皮下与肌筋膜缝合固定.结果 15例手术均获成功,无中转开放.手术时间40~ 120rin,平均80min.术中术后无并发症发生.随访12~48个月,术后所有患者腰部酸痛症状较术前明显缓解.术前伴有肉眼血尿和反复出现尿路感染的患者,术后症状消失.术后复查IVU均提示患肾复位固定良好.结论 后腹腔镜下聚丙烯网带肾固定术治疗症状性肾下垂技术可行,创伤小,恢复快,安全有效,并发症少,操作简单,疗效确切,是治疗症状性肾下垂的有效术式,值得推广.%Objectives To explore the clinical feasibility and efficacy of retroperitoneal laparoscopic nephropexy with Polypropylene mesh belt for symptomatic nephroptosis.Methods RLN has been performed on 15 patients with symptomatic nephroptosis diagnosised by intravenous urographyin supine and upright positions or CT scan since December 2008.The kidney was mobilized retroperitoneoscopically,crossed the Waist muscle groups(Internal oblique、External oblique muscle of abdomen、Psoas muscle、Quadratus lumborum) and fixed to the Subcutaneous fascia with a Polypropylene mesh belt placed in the lower part of the kidney.Results A11 cases were successfu1 with no intraoperative or postoperative complications.Mean operative time was 80min(ranging from 40 to120 min).During 12 ~ 48 months follow-up,all patients had an obvious symptom remission of lumbago,no patient had further episodes of recurrent urinary tract infection and macroscopic hematuria.IVU revealed kidneys in the normal region and greatly improved.Conclusions Retroperitoneal laparoscopic nephropexy with Polypropylene mesh

  10. 放置斑马导丝的黄色导管在后腹腔镜下输尿管切开取石术中的应用%The application of yellow catheter placed with zebra urological guidewire in retroperitoneal laparoscopic ureteroli-thotomy

    Institute of Scientific and Technical Information of China (English)

    彭光旭

    2016-01-01

    Objective:To introduce a simple and applicable method of indwelling double J catheters in the surgery of retroperitoneal laparoscopic ureterolithotomy.Methods:30 patietns with ureteral calculi were selected.We adopted yellow catheter with zebra urological guidewire as the internal drainage device in laparoscopic ureterolithotomy,insert auxiliary propeller and double J catheters was implanted.Results:30 patients were all successfully completed catheterization and surgery in stage I.The average indwelling time was 3.5min.Conclusion:The placement of double J catheters is clear,with less complication,easy to obtain material,and the production process is simple and without expensive production cost.%目的:介绍后腹腔镜下输尿管切开取石手术中输尿管内放置双J管的一种简单、适用方法。方法:收治输尿管结石患者30例,采用放置斑马导丝的黄色导管作为后腹腔镜下输尿管切开取石中内引流装置,置入辅助推进器放置双 J 管。结果:30例皆Ⅰ期,成功完成置管和手术。置管时间平均3.5min。讨论:双 J 管安放位置确切,并发症少,材料就地可取,制作过程简单易学,无需花费大成本制作。

  11. Retroperitoneal laparoscopic nephron sparing surgery for the treatment of renal tumors: with a report of 12 cases%腹膜后腹腔镜保留肾单位手术治疗肾肿瘤的临床体会(附12例报告)

    Institute of Scientific and Technical Information of China (English)

    王安; 袁荫田; 刘鹏; 潘爱民; 韩多亮

    2013-01-01

    Objective:To evaluate the methods and clinical efficacy of retroperitoneal laparoscopic nephron sparing surgery for the treatment of renal tumors.Methods:Clinical data of twelve patients with renal tumor received retroperitoneal laparoscopic nephron sparing surgery were analyzed retrospectively.Bulldog clamps were used to clamp the renal artery.Cold scissor was used to resect tumors and Hem-o-lok was used for tightening thread after continuous suture instead of ligature when suturing the kidney parenchyma.The operative time,warm ischemia time,estimated blood loss,intraoperative and postoperative complications and the operative efficacy were recorded.Results:All the operations were successfully performed and no case was converted to open operation.The mean operative tine was (136 ± 28.0) min,mean warm ischemic time was (27 ± 7.9) min,and mean blood loss was (126 ± 83.1) ml.Pathological diagnosis was clear cell carcinoma in 10 cases,and angiomyolipoma in 2.One patient got anemia and low albumin,which was considered to be associated with hepatitis b and diabetes,and the albumin returned to normal after symptomatic treatment.There was no delayed hemorrhage or urinary leakage after surgery.The mean hospital stay was (11 ± 3.8) d.No severe postoperative complications were found,and no recurrence was found in all the patients during the mean follow-up of (12 ± 9.2) months.Conclusions:Retroperitoneal laparoscopic nephron sparing surgery for renal tumors has the advantages of definite effect,minimal invasion,quick recovery,and short hospital stay,surgeons who have skilled laparoscopic operation techniques can perform it as the first choice.%目的:探讨腹膜后腹腔镜保留肾单位手术治疗肾肿瘤的手术方法与临床疗效.方法:回顾分析为12例肾肿瘤患者行腹膜后腹腔镜保留肾单位手术的临床资料,术中用Bulldog夹钳夹肾动脉,冷剪刀剪除肿瘤,连续缝合并用Hem-o-lok收紧缝线,代替打结.观察手术时间、热

  12. Single-centre experience of retroperitoneoscopic approach in urology with tips to overcome the steep learning curve

    Directory of Open Access Journals (Sweden)

    Aneesh Srivastava

    2016-01-01

    Full Text Available Context: The retroperitoneoscopic or retroperitoneal (RP surgical approach has not become as popular as the transperitoneal (TP one due to the steeper learning curve. Aims: Our single-institution experience focuses on the feasibility, advantages and complications of retroperitoneoscopic surgeries (RS performed over the past 10 years. Tips and tricks have been discussed to overcome the steep learning curve and these are emphasised. Settings and Design: This study made a retrospective analysis of computerised hospital data of patients who underwent RP urological procedures from 2003 to 2013 at a tertiary care centre. Patients and Methods: Between 2003 and 2013, 314 cases of RS were performed for various urological procedures. We analysed the operative time, peri-operative complications, time to return of bowel sound, length of hospital stay, and advantages and difficulties involved. Post-operative complications were stratified into five grades using modified Clavien classification (MCC. Results: RS were successfully completed in 95.5% of patients, with 4% of the procedures electively performed by the combined approach (both RP and TP; 3.2% required open conversion and 1.3% were converted to the TP approach. The most common cause for conversion was bleeding. Mean hospital stay was 3.2 ± 1.2 days and the mean time for returning of bowel sounds was 16.5 ± 5.4 h. Of the patients, 1.4% required peri-operative blood transfusion. A total of 16 patients (5% had post-operative complications and the majority were grades I and II as per MCC. The rates of intra-operative and post-operative complications depended on the difficulty of the procedure, but the complications diminished over the years with the increasing experience of surgeons. Conclusion: Retroperitoneoscopy has proven an excellent approach, with certain advantages. The tips and tricks that have been provided and emphasised should definitely help to minimise the steep learning curve.

  13. Surgical Approaches for Stage IVA Thymic Epithelial Tumors.

    Science.gov (United States)

    Shapiro, Mark; Korst, Robert J

    2014-01-14

    Thymic epithelial tumors (TET) are rare mediastinal neoplasms that can metastasize to the pleural space (stage IVA). Complete surgical resection remains the backbone of therapy for patients with early stage TET, however, the role of surgery in the management of patients with stage IVA disease is not fully defined. Published reports in this regard are mainly small, retrospective, and uncontrolled, with unclear inclusion criteria. Surgical options to manage pleural disease include metastasectomy, extrapleural pneumonectomy, and metastasectomy/pleurectomy combined with heated intrapleural chemotherapy. The choice of the most appropriate surgical strategy needs to be individualized according to the quantity and location of disease, the patient's overall condition, as well as operator and institutional expertise. In the majority of cases, metastasectomy of pleural implants will be sufficient to achieve a complete resection. The available literature suggests that in selected patients with stage IVA TET, delivery of neoadjuvant chemotherapy followed by complete resection is a viable treatment option that can be associated with long-term survival.

  14. [Surgical closure of patent ductus arteriosus in premature neonates: Does the surgical technique affect the outcome?

    Science.gov (United States)

    Avila-Alvarez, Alejandro; Serantes Lourido, Marta; Barriga Bujan, Rebeca; Blanco Rodriguez, Carolina; Portela-Torron, Francisco; Bautista-Hernandez, Victor

    2017-05-01

    Surgical closure of patent ductus arteriosus in premature neonates is an aggressive technique and is not free of complications. A study was designed with the aim of describing our experience with a less invasive technique, the extra-pleural approach via a posterior minithoracotomy, and to compare the results with the classic transpleural approach. A retrospective cohort study was conducted on premature neonates on whom surgical closure of the ductus was performed during a ten-year period (March 2005 to March 2015). A comparison was made of the acute complications, the outcomes on discharge, and follow-up, between the extra-pleural approach and the classic transpleural approach. The study included 48 patients, 30 in the classical approach and 18 in the extra-pleural group. The demographic and pre-operative characteristics were similar in both groups. No differences were found between the 2 groups in the incidence of acute post-operative complications (56.6 vs. 44.4%), on the dependence on oxygen at 36 weeks (33.3 vs. 55.5%), or in hospital mortality (10 vs. 16.6%). As regards the short-term progress, the extra-pleural group required fewer days until the withdrawal of supplementary oxygen (36.3 vs. 28.9) and until hospital discharge (67.5 vs. 53.2), although only the time until extubation achieved a statistically significant difference (11.5 vs. 2.7, P=.03). The extra-plural approach by posterior minithoracotomy for the surgical closure of ductus in the premature infant is viable and could bring some clinical benefits in the short-term. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. A Novel CT-Guided Transpsoas Approach to Diagnostic Genitofemoral Nerve Block and Ablation

    Science.gov (United States)

    Parris, David; Fischbein, Nancy; Mackey, Sean; Carroll, Ian

    2010-01-01

    Background Inguinal hernia repair is associated with a high incidence of chronic postsurgical pain. This pain may be caused by injury to the iliohypogastric, ilioinguinal, or genitofemoral nerves. It is often difficult to identify the specific source of the pain, in part, because these nerves are derived from overlapping nerve roots and closely colocalize in the area of surgery. It is therefore technically difficult to selectively block these nerves individually proximal to the site of surgical injury. In particular, the genitofemoral nerve is retroperitoneal before entering the inguinal canal, a position that puts anterior approaches to the proximal nerve at risk of transgressing into the peritoneum. We report a computed tomography (CT)-guided transpsoas technique to selectively block the genitofemoral nerve for both diagnostic and therapeutic purposes while avoiding injury to the nearby ureter and intestines. Case A 39-year-old woman with chronic lancinating right groin pain after inguinal hernia repair underwent multiple pharmacologic interventions and invasive procedures without relief. Using CT and Stimuplex nerve stimulator guidance, the genitofemoral nerve was localized on the anterior surface of the psoas muscle and a diagnostic block with local anesthetic block was performed. The patient had immediate relief of her symptoms for 36 hours, confirming the diagnosis of genitofemoral neuralgia. She subsequently underwent CT-guided radiofrequency and phenol ablation of the genitofemoral nerve but has not achieved long-term analgesia. Conclusion CT-guided transpsoas genitofemoral nerve block is a viable option for safely and selectively blocking the genitofemoral nerve for diagnostic or therapeutic purposes proximal to injury caused by inguinal surgery. PMID:20546515

  16. Retroperitoneal laparoscopic partial nephrectomy combined with auxiliary small-incision and real-time B ultrasonic imaging in treatment of central renal cell carcinoma: a report of 12 cases%经后腹腔镜辅助小切口超声引导下中心型肾癌部分切除术12例报道

    Institute of Scientific and Technical Information of China (English)

    纪家涛; 王林辉; 刘冰; 徐斌; 孙颖浩

    2013-01-01

    目的 评价经后腹腔镜联合经腰小切口及超声辅助下行中心型肾癌保留肾单位手术的临床疗效,总结手术经验.方法 回顾性分析2010年8月至2012年3月12例经后腹腔镜联合经腰小切口及超声辅助下行保留肾单位手术治疗中心型肾癌患者的临床资料.男9例、女3例,平均年龄(56.2±2.8)岁;肿瘤平均直径(2.2±1.4) cm.术前均经超声、CT、MRI或CT动脉造影检查.患者全身麻醉后取健侧卧位,后腹腔镜常规方法游离出肾动脉、肾静脉及肾脏,切开腋后线与腋前线的两个Trocar之间的皮肤及肌肉,建立小切口,将超声探头从小切口置于肾表面,对肿瘤进行定位并标记手术切缘,放置冰屑于肾周,行肾动脉阻断或动、静脉阻断下保留肾单位手术.结果 12例手术均获成功,手术平均时间(124.5±5.8) min,术中平均热缺血时间(26.3±8.6) min,术中平均出血量(65.8±21.6) mL.切缘阴性率100%,平均手术切口(8.8±2.4) cm,术后平均住院时间(12.4±2.6)d;术后无并发症发生.随访平均(13.6±7.4)个月,未见肿瘤复发及转移.结论 后腹腔镜联合经腰小切口及超声辅助下对中心型肾癌行保留肾单位手术具有创伤小、出血少、热缺血时间短、恢复快的优点,是一种安全、有效的治疗方法,具有良好的临床应用前景.%Objective To evaluate the clinical efficiency of retroperitoneal laparoscopic partial nephrectomy combined with auxiliary small-incision and real-time B ultrasonic imaging in treatment of central renal cell carcinoma and to summarize the surgical experience. Methods The clinical data of 12 patients (9 males and 3 females) with central renal cell carcinoma, who were treated from Aug. 2010 to Mar. 2012, were retrospectively analyzed. The patients had a mean age of (56. 2 ± 2.8) years old and a mean tumor diameter of (2. 2 ± 1. 4) cm. The patients underwent preoperative ultrasonograpy, CT, MRI or CT angiography. The renal

  17. Retroperitoneal Paraganglioma Presenting as a Chest Pain: A Case Report

    Directory of Open Access Journals (Sweden)

    Parag Brahmbhatt

    2013-01-01

    Full Text Available Paragangliomas are very rare tumors derived from neuroendocrine cells of autonomic nervous system. Extra-adrenal paragangliomas account for only 10 to 15% of all paragangliomas and may present incidentally as a mass. Typical triad of fluctuating hypertension, headache, and sweating is not always present which makes the diagnosis difficult sometimes. Definitive diagnosis is usually made with histologic findings and surgery is the treatment of choice. We report a case of a 53-year-old male who presented with chest pain and vomiting.

  18. Anesthetic management of a case of retroperitoneal tumor

    Directory of Open Access Journals (Sweden)

    Seema Mishra

    2016-01-01

    Full Text Available We present a case of 50 year old female with a diagnosis of intraabdominal mass suffering from pemphigus vulgaris, myasthenia gravis, hypothyroidism, diabetes mellitus. Extra care to protect skin and mucus membranes from trauma during procedures is essential. Adrenocortical suppression following prolonged steroid therapy is another hazard to be tackled in the perioperative period.

  19. An atypical cause of retroperitoneal fibrosis: Case report and ...

    African Journals Online (AJOL)

    F. Cassim

    2016-12-24

    Dec 24, 2016 ... ... a diagnosis of exclusion. Treatment hinges on corticosteroids, but other immuno- ... inflammatory in nature, and later evolves into a fibrotic mass [1]. ... most important of these underlying causes that a treating physician must rule out is a ... 2 months [11]. There are many options that have been tried, each.

  20. Retroperitoneal Myelolipoma-related Cushing’s Syndrome

    Directory of Open Access Journals (Sweden)

    Betül Çavuşoğlu

    2016-12-01

    Full Text Available Myelolipoma (ML is a benign mesenchymal tumor that can be localized in the adrenal gland and may present as an extraadrenal tumor. Extraadrenal ML can secrete cortisole rarely and cause Cushing’s syndrome findings. Radiological imaging (magnetic resonance is important in identifying extraadrenal masses. Accurate diagnosis can be made by pathological investigation of the biopsy specimen taken from the mass. This case is presented to emphasize ML as a rare cause of Cushing’s syndrome.

  1. Squamous cell carcinoma arising from primary retroperitoneal mature teratoma.

    Science.gov (United States)

    Joseph, Leena D; Devi, M Kanmani; Sundaram, Sandhya; Rajendiran, S

    2007-05-01

    A 65 year old postmenopausal female presented with left sided abdominal pain. Sonogram revealed an intra-abdominal 7.4 x 5.7 cm heterogenous mass. On laparotomy, approximately 10 X 10 cm mesenteric mass was seen adherent to the descending colon. Multiple omental tumor deposits were also noted. Gross examination showed solid and cystic tumor with sebaceous material admixed with hair. Histopathology showed mature cystic teratoma with a spectrum of well to poorly differentiated squamous cell carcinoma with omental metastasis.

  2. Severity, Challenges, and Outcome of Retroperitoneal Hematoma in ...

    African Journals Online (AJOL)

    challenges, and outcome of RH in a low‑resource country such as Nigeria. ... trauma. Out of the 115 patients with complete record available, .... Thoraco ‑ abdominal pain. 2. 4.7 ..... of angiographic embolization for pelvic and visceral injuries.

  3. Retroperitoneal laparoscopic pyelolithotomy combined with holmium laser lithotripsy under flexible cystoscopy in treatment of complicated nephrolithiasis%后腹腔镜肾盂切开取石联合膀胱软镜钬激光碎石取石术治疗复杂性肾结石

    Institute of Scientific and Technical Information of China (English)

    肖亚; 付卫华; 张艮甫; 王平贤; 范明齐; 冯嘉瑜; 钟晓; 黄赤兵

    2014-01-01

    Objective To evaluate the efficacy and safety of retroperitoneal laparoscopic pyelolithotomy ( RLP) combined with holmium laser lithotripsy under flexible cystoscopy in the treatment of complicated nephrolithiasis. Methods The retrospective analysis was made on the clinical data of 37 patients who underwent RLP and holmium laser lithotripsy under flexible cystoscopy for complicated nephrolithiasis from January 2013 to January 2014. The clinic parameters involved basic data of patients,operational time,blood loss,post-operative hospital stay,the status of stone-free,perioperative complications,and the follow-up data of patients were observed. Results No patient was converted to open surgery. The mean stone size was (2. 8 ± 0. 9) cm in diameter,operational time was (89 ± 24) min,blood loss was (21. 3 ± 7. 7) mL,post-operative hospital stay was (6. 8 ± 1. 7) d,the stone removal rate in one session was 94. 6%. One case occurred urinary leakage,1 case occurred fever after operation,who were all recovered through conservative treatment. All cases were followed up at the sixth months after operation. Conclusion RLP combined with holmium laser lithotripsy under flexible cystoscopy is effective and safe for the treatment of com-plicated nephrolithiasis.%目的:分析后腹腔镜肾盂切开取石联合膀胱软镜钬激光碎石取石术治疗复杂性肾结石的有效性和安全性。方法2012年1月至2014年1月对37例复杂性肾结石患者行后腹腔镜下肾盂切开取石联合膀胱软镜钬激光碎石取石术;统计并分析患者基本资料、手术时间、术中出血量、术后住院时间、一期清石率、围手术期并发症、术后复查等情况。结果37例患者顺利完成手术。平均结石直径(2.8±0.9) cm,手术时间(89±24) min,术中出血量(21.3±7.7) mL,术后住院时间(6.8±1.7) d,一期清石率为94.6%,围手术期1例发热,1例尿漏,经保守治疗均痊愈。术后6个月对所有患者进行随访,肾功能

  4. Neurofibromatosis Ⅰ with bilateral malignant retroperitoneal tumor:a case report and literature review%Ⅰ型神经纤维瘤病合并双侧腹膜后恶性肿瘤1例报告并文献复习

    Institute of Scientific and Technical Information of China (English)

    张立进; 张士伟; 赵晓智; 刘光香; 孟凡青; 郭宏骞

    2015-01-01

    Objective To explore the clinical and pathological features of neurofibromatosis I combined with malignant peripheral nerve sheath tumor (MPNST) and malignant pheochromocytoma,as to improve the level of diagnosis and treatment of this disease.Methods Clinical data of 1 case of neurofibromatosis I with two different malignant tumors were retrospec-tively analyzed and relevant literature was reviewed.Results The operation was performed and bilateral retroperitoneal tumors were successfully removed.The pathological results showed that the left tumor was MPNST.Immunohistochemical stai-ning showed:S-100(+ ),Ki-67(+ ),SMA(-),HMB45(-).The right tumor was malignant pheochromocytoma.Immuno-histochemical staining showed:Syn(+ ),CgA(+ ),Ki-67(+ ).The skin nodules were proved to be neurofibroma.Six sessions of chemotherapy regimens of IVP were given to the patient a month later after the surgery.No tumor recurrence or metastasis was detected.Conclusions NeurofibromatosisⅠcombined with MPNST and malignant pheochromocytoma is a rare event.An appropriate surgery with adjuvant chemotherapy might be effective to some extent.But the prognosis of this disease is poor for it's high degree of malignancy.More relevant studies are needed for further observation.%目的 探讨Ⅰ型神经纤维瘤病合并恶性外周神经鞘瘤与恶性嗜铬细胞瘤的临床、病理学特征,提高对此类疾病的诊疗认知水平.方法 回顾性分析我院收治的1例Ⅰ型神经纤维瘤病合并不同性质恶性肿瘤的临床资料,总结归纳其临床及病理特征,并结合相关文献,分析此类疾病的相关特征及治疗预后.结果 本例患者成功施行双侧腹膜后恶性肿瘤切除术,术后左侧提示恶性外周神经鞘瘤,免疫组化示:S-100(+ ),Ki-67(+ ),SMA(-),HMB45(-),右侧示恶性嗜铬细胞瘤,免疫组化示:Syn(+ ),CgA(+ ),Ki-67(+ ),皮肤结节病理提示神经纤维瘤.术后1月后给予IVP化疗方案化疗6个疗程,随访半年余,未见

  5. Análise histológica da viabilidade do transplante autólogo de hemi-ovário em retroperitônio de ratos Histological analysis of the viability of half ovary autologous transplantation in retroperitoneal of rats

    Directory of Open Access Journals (Sweden)

    Armando José d'Acampora

    2004-08-01

    Full Text Available OBJETIVO: Analisar a presença de sinais morfológicos indicativos de restabelecimento da função ovariana em hemi-ovários autotransplantados em retroperitônio de ratos Wistar. MÉTODOS: Utilizou-se 48 animais, previamente ooforectomizados bilateralmente. Distribuídos em 6 subgrupos, de acordo com o tempo pós-operatório no qual foram submetidos a retirada das peças a serem histologicamente analisadas, sendo em seguida submetidos a sacrifício. As peças foram fixadas em formol a 10 % por 24 horas, a 4º C, sendo então incluídas em parafina. Foram obtidos de cada peça 5 cortes semi-seriados de 10 micrômetros de espessura, no sentido transversal do ovário. RESULTADOS: Os parâmetros morfométricos analisados foram a presença ou ausência de folículos ovarianos, neoformação vascular, corpos lúteos e tecido de granulação. Os resultados das análises demonstraram presença de folículos ovarianos em vários estágios de desenvolvimento, corpos lúteos e neoformação vascular em todos os grupos analisados. Demonstraram também presença de tecido de granulação (infiltrado inflamatório, predominando nos grupos experimentais com menor tempo de pós-operatório. CONCLUSÃO: Foi possível concluir então que os ovários implantados apresentavam características morfológicas de ovários viáveis, indicando que a implantação permitiu a manutenção dos mesmos no retroperitônio das ratas.PURPOSE: To observe the indicative morphological signs of restorable ovarian function in retroperitoneal half-ovaries transplant autologous in Wistar rats. METHODS: 48 bilaterally oophorectomized female Wistar rats were used. Distributed by 6 groups, according to pos-operative timing, which was done after total removal, from the selftransplanted anatomical region (ovary and psoas muscle The total ovaries were fixed in formalin during 24 hours, in 4º Celsius. The morphometric parameters useed in this work were the presence or absence of ovarian

  6. 后腹腔镜与传统开放手术治疗肾上腺肿瘤的随机对照研究%The efficacy of retroperitoneal laparoscopic and open surgery in the treatment of adrenal adenoma:a randomized controlled study

    Institute of Scientific and Technical Information of China (English)

    周东; 周小庆; 李朋; 朱旗欢

    2014-01-01

    目的:比较后腹腔镜与传统开放手术治疗肾上腺肿瘤的优缺点。方法将2005年1月至2010年12月接受治疗的120例肾上腺肿瘤患者,通过计算机产生随机数学表,按1∶1分配原则随机分为后腹腔镜组与开放手术组,比较2组的手术相关指标、术后恢复指标、术后处理情况、手术成功情况、并发症和随访情况。结果后腹腔镜组1例因拒绝接受腹腔镜手术,2例缺乏随访资料而脱落;开放手术组因2例转院,2例缺乏随访资料而脱落。后腹腔镜组(57例)和开放手术组(56例)的手术时间、术中出血量、输血例数分别为(89.6±18.4)min、(70.2±17.2)ml、8例和(124.2±27.3)min、(205.7±51.9)ml、20例;拔管时间、进食时间、下床时间、住院时间分别为(2.8±1.3) d、(1.7±1.1) d、(2.6±1.2) d、(6.2±3.1) d和(4.2±2.0)d、(2.9±1.4)d、(5.1±3.1)d、(13.5±5.4)d;术后镇痛例数、引流量分别为11例、(15.4±4.2)ml和43例、(45.1±12.7)ml;以上指标比较差异均具有统计学意义(P<0.01),2组的治疗费用比较差异无统计学意义( P>0.05)。开放手术组1年内无一例死亡和复发,后腹腔镜组有5例中转开腹,1年内1例死亡、2例复发。后腹腔镜组和开放手术组分别有2例(3.51%)和9例(16.07%)出现并发症,差异具有统计学意义( P<0.01)。结论与传统开放手术相比,后腹腔镜治疗肾上腺肿瘤,具有创伤小、并发症少和术后恢复快等优点,但仍存在手术失败和复发的可能,需要进一步提高泌尿外科医生的经验和操作技巧。%Objective To compare the advantages and disadvantages of retroperitoneal laparoscopic sur -gery and open surgery in treatment of adrenal adenoma , in order to provide the clinical evidence for the selection of surgical treatment of adrenal adenoma .Methods 120 cases undergoing

  7. Robot assisted laparoscopic excision of a paraganglioma: new therapeutic approach

    Directory of Open Access Journals (Sweden)

    G. Cochetti

    2014-04-01

    Full Text Available The Paraganglioma is the most common extra-adrenal pheochromocytoma arising from neural crest (1 (It will better to write: The paraganglioma is an extra-adrenal pheocromocytoma arising from the neural crest. 10% of pheocromocytomas are extra-adrenal and can arise form chromaffin tissue derived from primitive neuroectoderm. Minimally invasive techniques allow surgeons to perform the procedure without wide exposure and mobilization of intra abdominal organs. To our knowledge we present the third case of robotic excision of a retroperitoneal paraganglioma (2,3.

  8. A new surgical approach for da Vinci robot-assisted laparoscopic partial nephrectomy%达芬奇机器人辅助腹腔镜下肾部分切除术手术入路的新选择

    Institute of Scientific and Technical Information of China (English)

    梁朝朝; 周骏; 邰胜; 王建忠; 杨诚; 徐汉江; 徐凌凡; 施浩强; 郝宗耀

    2016-01-01

    目的 总结经腰腹联合入路机器人辅助腹腔镜下肾部分切除术的手术方法,探讨机器人辅助腹腔镜下肾部分切除术手术入路的新选择.方法 回顾性分析2015年6月至2016年1月收治的13例行经腰腹联合入路机器人辅助腹腔镜下肾部分切除术患者的临床资料,男7例,女6例.年龄26 ~ 74岁,平均48岁.肿瘤位于左肾8例,右肾5例.肿瘤直径2.5 ~4.5 cm,平均3.5 cm.其中1例患者左肾有2枚肿瘤,直径分别为1.5 cm和3.0cm.所有患者术前均行CT检查,考虑为肾细胞癌,其中3例行双肾血管三维成像.术前行胸部X线片检查排除远处转移.13例术前血肌酐均在正常范围,2例伴2型糖尿病,2例伴高血压病.13例均行经腰腹入路腹腔镜下肾部分切除术.结果 本组13例手术均顺利完成.手术时间80~140 min,平均100 min.术中热缺血时间15~28 min,平均22 min.术中出血40 ~120 ml,平均60 ml,无术中输血病例.术后病理诊断为肾透明细胞癌12例,肾血管平滑肌脂肪瘤1例,无切缘阳性病例.术后随访1~7个月,术后1、3个月复查肾功能均在正常范围,复查B超未见肿瘤残留和复发.结论 经腰腹联合入路腹腔镜下肾部分切除术有效地将经腹膜外与经腹途径结合起来,既发挥了经腹膜外手术处理血管的优势,又满足了机器人手术对空间的要求,使其优势得以充分发挥.%Objective To investigate the advantages of combination of retroperitoneal and peritoneal approach for robotic-assisted laparoscopic partial nephrectomy.Methods 7 male patients and 6 female patients,aging between 26-74,underwent robotic-assisted laparoscopic partial nephrectomy via combination of retroperitoneal and peritoneal approach between July 2015 and January 2016.Before surgery,8 cases were found the lesions on the left side and the other 5 cases were found the lesions on the right side.The mean diameter of tumor was 3.5cm (ranging from 2.5 to 4.5cm).Among them

  9. Complementary Health Approaches

    Science.gov (United States)

    ... on some complementary approaches, such as acupuncture and yoga, but there have been fewer studies on other approaches, so much less is known about them. The National Institutes of Health (NIH) is sponsoring research to learn more about ...

  10. Evaluating six soft approaches

    Directory of Open Access Journals (Sweden)

    Lene Sørensen

    2008-09-01

    Full Text Available The paper introduces and evaluates six soft approaches used in strategy development and planning. We take a planner’s perspective on discussing the concepts of strategy development and planning. This means that we see strategy development and planning as learning processes based on Ackoff’s interactive planning principles to be supported by soft approaches in carrying out the principles in action. These six soft approaches are suitable for supporting various steps of the strategy development and planning process. These are the SWOT analysis, the Future Workshop, the Scenario methodology, Strategic Option Development and Analysis, Strategic Choice Approach and Soft Systems Methodology. Evaluations of each methodology are carried out using a conceptual framework in which the organisation, the result, the process and the technology of the specific approach are taken into consideration. Using such a conceptual framework for evaluations of soft approaches increases the understanding of them, their transparency, and their usability in practice.

  11. The sustainable livelihoods approach

    DEFF Research Database (Denmark)

    Oelofse, Myles; Jensen, Henning Høgh

    2008-01-01

    food chain has on producers and their families, an analysis was conducted of the use of the Sustainable Livelihoods Approach (SLA). The SLA provides a holistic and integrative approach which researchers can use as the overriding frame for their research. The application of the approach is recommended...... as it enables us to maintain important elements of the sustainability vision, yet emphasises that a number of assets influence farmers' livelihoods and it maintains the focus on salience, legitimacy, and credibility in the research....

  12. Evaluating six soft approaches

    DEFF Research Database (Denmark)

    Sørensen, Lene Tolstrup; Vidal, Rene Victor Valqui

    2008-01-01

    's interactive planning principles to be supported by soft approaches in carrying out the principles in action. These six soft approaches are suitable forsupporting various steps of the strategy development and planning process. These are the SWOT analysis, the Future Workshop, the Scenario methodology......, Strategic Option Development and Analysis, Strategic Choice Approach and Soft Systems Methodology. Evaluations of each methodology are carried out using a conceptual framework in which the organisation, the result, the process and the technology of the specific approach are taken into consideration. Using...

  13. Evaluating Six Soft Approaches

    DEFF Research Database (Denmark)

    Sørensen, Lene Tolstrup; Valqui Vidal, René Victor

    2008-01-01

    's interactive planning principles to be supported by soft approaches in carrying out the principles in action. These six soft approaches are suitable forsupporting various steps of the strategy development and planning process. These are the SWOT analysis, the Future Workshop, the Scenario methodology......, Strategic Option Development and Analysis, Strategic Choice Approach and Soft Systems Methodology. Evaluations of each methodology are carried out using a conceptual framework in which the organisation, the result, the process and the technology of the specific approach are taken into consideration. Using...

  14. Intradural anterior transpetrosal approach.

    Science.gov (United States)

    Ichimura, Shinya; Hori, Satoshi; Hecht, Nils; Czabanka, Marcus; Vajkoczy, Peter

    2016-10-01

    The standard anterior transpetrosal approach (ATPA) for petroclival lesions is fundamentally an epidural approach and has been practiced for many decades quite successfully. However, this approach has some disadvantages, such as epidural venous bleeding around foramen ovale. We describe here our experience with a modified technique for anterior petrosectomy via an intradural approach that overcomes these disadvantages. Five patients with petroclival lesions underwent surgery via the intradural ATPA. The intraoperative hallmarks are detailed, and surgical results are reported. Total removal of the lesions was achieved in two patients with petroclival meningioma and two patients with pontine cavernoma, whereas subtotal removal was achieved in one patient with petroclival meningioma without significant morbidity. No patient experienced cerebrospinal fluid leakage. The intradural approach is allowed to tailor the extent of anterior petrosectomy to the individually required exposure, and the surgical procedure appeared to be more straightforward than via the epidural route. Caveats encountered with the approach were the temporal basal veins that could be spared as well as identification of the petrous apex due to the lack of familial epidural landmarks. The risk of injury to the temporal bridging veins is higher in this approach than in the epidural approach. Intradural approach is recommended in patients with a large epidural venous route, such as sphenobasal and sphenopetrosal vein. Navigation via bone-window computed tomography is useful to identify the petrous apex.

  15. Alternative Auditing Approaches

    Energy Technology Data Exchange (ETDEWEB)

    Kandt, Alicen J [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-09-15

    This presentation for the 2017 Energy Exchange in Tampa, Florida, offers information about advanced auditing technologies and techniques including alternative auditing approaches and considerations and caveats.

  16. Evaluating six soft approaches

    DEFF Research Database (Denmark)

    Sørensen, Lene Tolstrup; Vidal, Rene Victor Valqui

    2008-01-01

    's interactive planning principles to be supported by soft approaches in carrying out the principles in action. These six soft approaches are suitable forsupporting various steps of the strategy development and planning process. These are the SWOT analysis, the Future Workshop, the Scenario methodology......, Strategic Option Development and Analysis, Strategic Choice Approach and Soft Systems Methodology. Evaluations of each methodology are carried out using a conceptual framework in which the organisation, the result, the process and the technology of the specific approach are taken into consideration. Using...

  17. A Comparison on the Audiolingual Approach and the Communicative Approach

    Institute of Scientific and Technical Information of China (English)

    代海娜

    2015-01-01

    Audiolingual approach and communicative approach are two important approaches in language teaching.In this paper,some differences and both advantages and diadvantages will be discussed.Thus,to conduct the important usage of approachs in language teaching.

  18. The TLC Approach.

    Science.gov (United States)

    Welker, William A.

    2002-01-01

    Notes how the author has developed the Teaching and Learning Cues (TLC) approach, an offspring of textbook organizational patterns instruction that stresses the significance of certain words and phrases in reading. Concludes that with the TLC approach, students learn to appreciate the important role cue words and phrases play in understanding…

  19. Articulating Design Approaches?

    DEFF Research Database (Denmark)

    Kensing, Finn; Bødker, Keld; Simonsen, Jesper

    We are working on an approach for designing CSCW systems since we advocate the importance of generalizing from own work practice as designers and from studies of designers working under industrial conditions. We use the term approach as something in between commodified methods and isolated techni...

  20. Stuttering-Psycholinguistic Approach

    Science.gov (United States)

    Hategan, Carolina Bodea; Anca, Maria; Prihoi, Lacramioara

    2012-01-01

    This research promotes psycholinguistic paradigm, it focusing in delimitating several specific particularities in stuttering pathology. Structural approach, on language sides proves both the recurrent aspects found within specialized national and international literature and the psycholinguistic approaches dependence on the features of the…

  1. Ten practice redesign approaches.

    Science.gov (United States)

    Slayton, Val

    2013-01-01

    As healthcare delivery continues to evolve at a rapid pace, practices need to consider redesign approaches to stay ahead of the pack. From national policy and private payer initiatives to societal macro trends and the growing use of mobile technologies, delivering value, understanding customer needs, and assessing satisfaction are important elements to achieve and maintain success. This article discusses 10 practice redesign approaches.

  2. Modular Approach for Ethics

    Science.gov (United States)

    Wyne, Mudasser F.

    2010-01-01

    It is hard to define a single set of ethics that will cover an entire computer users community. In this paper, the issue is addressed in reference to code of ethics implemented by various professionals, institutes and organizations. The paper presents a higher level model using hierarchical approach. The code developed using this approach could be…

  3. Approaches to understand culture

    DEFF Research Database (Denmark)

    Rasmussen, Lauge Baungaard; Rauner, Felix

    1996-01-01

    Different approaches to understand the concept ofculture are presented and evaluated. The author'sconcept of culture is defined. Different aspectsof the concept are discussed.......Different approaches to understand the concept ofculture are presented and evaluated. The author'sconcept of culture is defined. Different aspectsof the concept are discussed....

  4. The TLC Approach.

    Science.gov (United States)

    Welker, William A.

    2002-01-01

    Notes how the author has developed the Teaching and Learning Cues (TLC) approach, an offspring of textbook organizational patterns instruction that stresses the significance of certain words and phrases in reading. Concludes that with the TLC approach, students learn to appreciate the important role cue words and phrases play in understanding…

  5. Life Span Developmental Approach

    Directory of Open Access Journals (Sweden)

    Ali Eryilmaz

    2011-03-01

    Full Text Available The Life Span Developmental Approach examines development of individuals which occurs from birth to death. Life span developmental approach is a multi-disciplinary approach related with disciplines like psychology, psychiatry, sociology, anthropology and geriatrics that indicates the fact that development is not completed in adulthood, it continues during the life course. Development is a complex process that consists of dying and death. This approach carefully investigates the development of individuals with respect to developmental stages. This developmental approach suggests that scientific disciplines should not explain developmental facts only with age changes. Along with aging, cognitive, biological, and socioemotional development throughout life should also be considered to provide a reasonable and acceptable context, guideposts, and reasonable expectations for the person. There are three important subjects whom life span developmental approach deals with. These are nature vs nurture, continuity vs discontinuity, and change vs stability. Researchers using life span developmental approach gather and produce knowledge on these three most important domains of individual development with their unique scientific methodology.

  6. Otoplasty: A graduated approach.

    Science.gov (United States)

    Foda, H M

    1999-01-01

    Numerous otoplastic techniques have been described for the correction of protruding ears. Technique selection in otoplasty should be done only after careful analysis of the abnormal anatomy responsible for the protruding ear deformity. A graduated surgical approach is presented which is designed to address all contributing factors to the presenting auricular deformity. The approach starts with the more conservative cartilage-sparing suturing techniques, then proceeds to incorporate other more aggressive cartilage weakening maneuvers. Applying this approach resulted in better long-term results with less postoperative lateralization than that encountered on using the cartilage-sparing techniques alone.

  7. Introducing Systems Approaches

    Science.gov (United States)

    Reynolds, Martin; Holwell, Sue

    Systems Approaches to Managing Change brings together five systems approaches to managing complex issues, each having a proven track record of over 25 years. The five approaches are: System Dynamics (SD) developed originally in the late 1950s by Jay Forrester Viable Systems Model (VSM) developed originally in the late 1960s by Stafford Beer Strategic Options Development and Analysis (SODA: with cognitive mapping) developed originally in the 1970s by Colin Eden Soft Systems Methodology (SSM) developed originally in the 1970s by Peter Checkland Critical Systems Heuristics (CSH) developed originally in the late 1970s by Werner Ulrich

  8. Flipped Classroom Approach

    Directory of Open Access Journals (Sweden)

    Fezile Ozdamli

    2016-07-01

    Full Text Available Flipped classroom is an active, student-centered approach that was formed to increase the quality of period within class. Generally this approach whose applications are done mostly in Physical Sciences, also attracts the attention of educators and researchers in different disciplines recently. Flipped classroom learning which wide-spreads rapidly in the world, is not well recognized in our country. That is why the aim of study is to attract attention to its potential in education field and provide to make it recognize more by educators and researchers. With this aim, in the study what flipped classroom approach is, flipped classroom technology models, its advantages and limitations were explained.

  9. Prognostic significance of systematic retroperitoneal lymphadenectomy in patients with epithelial ovarian cancer:a Meta-analysis%上皮性卵巢癌术中行系统性腹膜后淋巴结切除价值的荟萃分析

    Institute of Scientific and Technical Information of China (English)

    顾海风; 周云; 李咏雪; 欧玉兰; 刘继红

    2016-01-01

    [Abstract ] Objective To investigate the survival impact of systematic retroperitoneal lymphadenectomy ( SL) and unsystematic lymphadenectomy ( USL) in patients with epithelial ovarian cancer.Methods Randomized control trial (RCT) and observational studies about the effects of SL and USL on patients with epithelial ovarian cancer were searched in major online databases including PubMed, Embase, Web of Science, and Cochrane Library.The literature search was performed up to January 2016. The results were analyzed using RevMan 5.0 software.Results Totally 14 studies including 1 634 patients in SL group and 1 719 patients in USL group were enrolled.Three of the 14 studies were RCTs, and the other 11 were observational studies.Meta analysis showed that SL was a favorable factor for 5-year overall survival rate (5-OS) compared with USL[RR =0.89, 95% CI (0.81, 0.97), P =0.007].However, the efficacy of SL on increased 5-OS could not be determined in all type of studies owing to the result of RCTs [RR =0.99, 95% CI (0.85, 1.15), P =0.90], whereas SL improved 5-OS of patients in observational studies[RR =0.84, 95% CI (0.76, 0.93), P =0.001].Moreover, SL increased 5-OS in patients with early stage (FIGO Ⅰ -Ⅱ) disease comparing with USL[RR =0.78, 95% CI (0.61, 0.99), P =0.04], as well as it could improve 5-OS statistically in advanced stage (FIGO Ⅲ -Ⅳ) disease[RR =0.90, 95%CI (0.82, 0.99), P =0.03].But analysis on patients with optimal debulking surgery showed that SL could not improve 5-OS of these patients, regardless of early stage[RR =0.71, 95% CI (0.43, 1.17), P =0.18]or advanced stage[RR =1.01, 95% CI (0.90, 1.14), P =0.86].Conclusions The impact of SL on the survival of patients with epithelial ovarian cancer is still extremely controversial, which requires more relevant RCTs.In patients with optimal debulking surgery, SL could hardly improve the survival.%目的:探讨系统性腹膜后淋巴结切除(SL)和非系统性腹膜后淋巴结切除(USL)

  10. Revitalizing the setting approach

    DEFF Research Database (Denmark)

    Bloch, Paul; Toft, Ulla; Reinbach, Helene Christine

    2014-01-01

    ¿s everyday life. The supersetting approach argues for optimised effectiveness of health promotion action through integrated efforts and long-lasting partnerships involving a diverse range of actors in public institutions, private enterprises, non-governmental organisations and civil society......BackgroundThe concept of health promotion rests on aspirations aiming at enabling people to increase control over and improve their health. Health promotion action is facilitated in settings such as schools, homes and work places. As a contribution to the promotion of healthy lifestyles, we have.......DiscussionThe supersetting approach is a further development of the setting approach in which the significance of integrated and coordinated actions together with a participatory approach are emphasised and important principles are specified, all of which contribute to the attainment of synergistic effects and sustainable...

  11. The transformativity approach

    DEFF Research Database (Denmark)

    Holm, Isak Winkel; Lauta, Kristian Cedervall

    2017-01-01

    During the last five to ten years, a considerable body of research has begun to explore how disasters, real and imagined, trigger social transformations. Even if the contributions to this this research stems from a multitude of academic disciplines, we argue in the article, they constitute...... an identifiable and promising approach for future disaster research. We suggest naming it the transformativity approach. Whereas the vulnerability approach explores the social causation of disasters, the transformativity approach reverses the direction of the gaze and investigates the social transformation...... brought about by disasters. Put simply, the concept of vulnerability is about the upstream causes of disaster and the concept of transformativity about the downstream effects. By discussing three recent contributions (by the historian Greg Bankoff, the legal sociologist Michelle Dauber...

  12. Revitalizing the setting approach

    DEFF Research Database (Denmark)

    Bloch, Paul; Toft, Ulla; Reinbach, Helene Christine

    2014-01-01

    BackgroundThe concept of health promotion rests on aspirations aiming at enabling people to increase control over and improve their health. Health promotion action is facilitated in settings such as schools, homes and work places. As a contribution to the promotion of healthy lifestyles, we have.......DiscussionThe supersetting approach is a further development of the setting approach in which the significance of integrated and coordinated actions together with a participatory approach are emphasised and important principles are specified, all of which contribute to the attainment of synergistic effects and sustainable.......SummaryThe supersetting approach is a relevant and useful conceptual framework for developing intervention-based initiatives for sustainable impact in community health promotion. It strives to attain synergistic effects from activities that are carried out in multiple settings in a coordinated manner. The supersetting...

  13. Hormonal approach in Hirsutism

    OpenAIRE

    Abdullah, Nusratuddin

    2015-01-01

    Hinsutism is a clinical sign that primarily indicate androgen excess and open caused hy relatively benign junctional conditions. Hirsutism requires a careful and systematic clinical evaluation coztoleal with a rational approach to treatment. Initiate therapy only in patients who give informed consent after a complete explanation of the potential benejits and risks of a particular treatment and alternative approaches. The goals ofthe correct management of hirsutism are to ame...

  14. Sustainable fashion: New approaches

    OpenAIRE

    Niinimäki, Kirsi

    2013-01-01

    This publication is intended to be used as a source of inspiration for designers and companies, and all stakeholders whose interest lies in the area of sustainable fashion. While the strategies for sustainability are complex and approaches are many, this publication presents only a few ways to approach sustainable fashion. I hope the publication offers inspiration on how to make positive change in current practices and how to effect new mindsets, creating transformative fashion. Theoretica...

  15. The electronic approach VSCF

    Science.gov (United States)

    Hladky, Mark

    The advantages of the high-power electronic approach to variable speed constant frequency (VSCF) systems are examined. It is shown, in particular, how the inherent flexibility of the VSCF approach allows it to be configured for different applications, contributing to the evolution towards the more electric aircraft. The discussion covers criteria for selection, aircraft electric power system architectures, power level, performance, reliability, and maintainability. The future trends of the VSCF converter technology are also briefly discussed.

  16. Theoretical Approaches to Coping

    Directory of Open Access Journals (Sweden)

    Sofia Zyga

    2013-01-01

    Full Text Available Introduction: Dealing with stress requires conscious effort, it cannot be perceived as equal to individual's spontaneous reactions. The intentional management of stress must not be confused withdefense mechanisms. Coping differs from adjustment in that the latter is more general, has a broader meaning and includes diverse ways of facing a difficulty.Aim: An exploration of the definition of the term "coping", the function of the coping process as well as its differentiation from other similar meanings through a literature review.Methodology: Three theoretical approaches of coping are introduced; the psychoanalytic approach; approaching by characteristics; and the Lazarus and Folkman interactive model.Results: The strategic methods of the coping approaches are described and the article ends with a review of the approaches including the functioning of the stress-coping process , the classificationtypes of coping strategies in stress-inducing situations and with a criticism of coping approaches.Conclusions: The comparison of coping in different situations is difficult, if not impossible. The coping process is a slow process, so an individual may select one method of coping under one set ofcircumstances and a different strategy at some other time. Such selection of strategies takes place as the situation changes.

  17. Insights Through Performative Approaches

    Directory of Open Access Journals (Sweden)

    Martina Battisti

    2008-05-01

    Full Text Available This script aims to explore how performative approaches can be used to enhance the understanding of social situations by going beyond the presenting or outermost layer of a problem. The script evolves in six acts and focuses on a group of academics and consultants who meet to develop a theoretical understanding of performative approaches, to experiment with performative approaches by applying them to a consulting case, and finally to reflect on the learning experiences and the understanding of social situations implicit in the case. We found that with traditional scientific methods it may be difficult to understand the underlying—often unconscious—dynamics, emotions and resistances within social situations. Using performative approaches opens up the possibility to gain an understanding of the social situation beyond the rational and cognitive level. In particular, the use of creative approaches like painting, role-plays or fairy tales may allow new and alternative perspectives and interpretations of a social situation to emerge. The script concludes with practical implications for action research in the context of organizational consulting and development. URN: urn:nbn:de:0114-fqs0802444

  18. Personal Approaches to Career Planning.

    Science.gov (United States)

    DeMont, Billie; DeMont, Roger

    1983-01-01

    Identifies four approaches to career planning based on situational leadership theory: the network approach, self-help approach, engineering approach, and mentor approach. Guidelines for the selection of a planning method based on the nature of the work environment and personal preference are discussed. (JAC)

  19. Personal Approaches to Career Planning.

    Science.gov (United States)

    DeMont, Billie; DeMont, Roger

    1983-01-01

    Identifies four approaches to career planning based on situational leadership theory: the network approach, self-help approach, engineering approach, and mentor approach. Guidelines for the selection of a planning method based on the nature of the work environment and personal preference are discussed. (JAC)

  20. Approaching a Postcolonial Arctic

    DEFF Research Database (Denmark)

    Jensen, Lars

    2016-01-01

    This article explores different postcolonially configured approaches to the Arctic. It begins by considering the Arctic as a region, an entity, and how the customary political science informed approaches are delimited by their focus on understanding the Arctic as a region at the service...... of the contemporary neoliberal order. It moves on to explore how different parts of the Arctic are inscribed in a number of sub-Arctic nation-state binds, focusing mainly on Canada and Denmark. The article argues that the postcolonial can be understood as a prism or a methodology that asks pivotal questions to all...... approaches to the Arctic. Yet the postcolonial itself is characterised by limitations, not least in this context its lack of interest in the Arctic, and its bias towards conventional forms of representation in art. The article points to the need to develop a more integrated critique of colonial and neo...