Злокачественные опухоли мочеполовой системы при первично-множественных опухолях

Introduction. Primary multiple tumors (polyneoplasia) represent synchronous or consecutive and independent from each other development of two or more tumors. Frequency of urinary tract tumors composing primary multiple tumors is from 10 to 13,5%. There is a constant growing interest in primary multiple tumors due to the increase of patients with this kind of disease. Up to the present, many issues related to diagnostics and method choice to treat primary multiple tumors remain questionable.Materials and methods. In our research, 1632 patients with urinary tract tumors were treated in the N.N. Burdenko Main Military Hospital's Oncourology Department from December 1998 to December 2005. Out of them, 570 (34,9%) were patients with prostate cancer, 469 (28,8%) with bladder cancer, 442 (27,1%) patients with kidney tumors, and 78 (4,8%) with renal pelvis tumor. Out of all patients included in our research, 89 (5,6%) patients were with primary multiple tumors. In average, these patients were 69 years old. Out of them, 8 patients had tumors of three organs.Results. Nephrectomy (366) and/or kidney resection (114) were performed to patients with kidney tumors. Bladder transurethral resection, bladder resection, and cystectomy with various methods of urine derivation (118) (bilateral ureterocutaneostomia (86), Shtuder's plastic surgery of artificial bladder - 22, Bricker's formation of a urinary duct - 8, and 2 bladder plastic surgery with a skin-muscle graft) were performed to patients with bladder cancer. Prostatectomy (109), or hormonal therapy and radiotherapy were performed to patients with prostate cancer. 42% of patients were diagnosed with urinary system cancer as a part of primary multiple tumors in the first stage, 28% in the second, 18% in the third, and 12% in the forth. The group of patients with kidney tumor 42 (54%) had the largest amount of primary multiple tumors due to cancer of both kidneys 26 (33,8%). In one case, the second tumor was diagnosed 13 years after the first tumor had been diagnosed. During the first month after the first tumor had been diagnosed 42,7% (42), the second one was diagnosed. In a period from 3 to 6 months, the second tumor was diagnosed in 18,2% (16) cases. In cases when cancer was diagnosed for the first time, there were 45% (40) tumors of the first stage, 16% (15) of the second stage, 14,5% (12) of the third, and 24,5% (21) of the forth.Conclusion. Urinary tract tumors composing primary multiple tumors are not rare, and their diagnosis mainly is incidental. Results of treatment depend not only on the spread of tumor process but also on timely and appropriate combined treatment. Surgery treatment of synchronically diagnosed tumors has to be performed with one surgery, and not to be divided into several operations, because with this method, time factor is very important.

Кишечная пластика при раке мочевого пузыря

The results of surgical treatment of 79 patients with invasive bladder cancer treated with radical cystectomy with continent urinary diversion (ileal neobladder) between 1997 and 2005 were analyzed. The incidence of early and late complications was 12.7 and 15.5%, respectively; postoperative mortality was 2.5%. The reservoir volume was 250—300, 400—450, and 500—600 ml 3, 6, and 12 months after surgery, respectively. Spontaneous urination and day time continence was restored in 100%; partial nocturnal incontinence was noted in 11.7% of the patients. In the vast majority of cases, renal function was not impaired or improved. Thus, radical cystectomy with bladder substitution with low-pressure ileal reservoirs with anti-reflux ureteric implantation is the method of choice in treating invasive bladder cancer.

Review of Staphylococcus aureus infections requiring admission to a paediatric intensive care unit

Aims: To review clinical features and outcome of children with severe Staphylococcus aureus sepsis (SAS) presenting to a paediatric intensive care unit (PICU) with particular focus on ethnicity, clinical presentation, cardiac involvement, and outcome. Methods: Retrospective chart review of patients coded for SAS over 10 years (October 1993 to April 2004). Results: There were 58 patients identified with SAS over the 10 year study period; 55 were community acquired. This accounted for 4% of hospital admissions for SAS over this time; children with staphylococcal illness comprised 1% of all admissions to the PICU. Maori and Pacific children with SAS were overly represented in the PICU (81%) from a paediatric population where they contribute 21.6%. Musculoskeletal symptoms (79%) dominated presentation rather than isolated pneumonia (10%). An aggressive search for foci and surgical drainage of infective foci was required in 50% of children. Most children had multifocal disease (67%) and normal cardiac valves (95%); the few children (12%) presenting with methicillin resistant S aureus (MRSA) had community acquired infection. The median length of stay in the PICU was 3 (mean 5.8, SD 7.6, range 1–44) days. The median length of stay in hospital was 15 (mean 21, SD 22.7, range 2–149) days. Mortality due to SAS was 8.6% (95% CI 1.4–15.8%) compared with the overall mortality for the PICU of 6% (95% CI 5.3–6.7%). Ten children had significant morbidity after discharge. Conclusions: Community acquired SAS affects healthy children, is multifocal, and has high morbidity and mortality, in keeping with the high severity of illness scores on admission. It is imperative to look for sites of dissemination and to drain and debride foci. Routine echocardiography had low yield in the absence of pre-existing cardiac lesions, persisting fever, or persisting bacteraemia