Post-chemotherapy residual mass in stage IIC seminomatous testicular tumor

Introduction The management of patients with residual masses following chemotherapy for advanced seminoma remains a difficult problem with no clear guidelines. While most patients with advanced seminoma achieve a complete or partial response with cisplatin based chemotherapy1, a significant number will reveal a residual mass on follow up CT scan or MR imaging2,3. Management options for post chemotherapy residual mass in a case of seminoma include close observation, radiation therapy and excisional surgery. While 80 to 85% of residual masses represent either fibrosis or necrotic tissue needing no further therapy, 10 to 15% may contain viable tumor which, if not recognized and effectively treated, may be lethal. A case of a stage II seminoma with post chemotherapy residual mass is presented and contemporary literature on this topic is reviewed

Early surgical results with intent to treat by radical retropubic prostatectomy for clinically localized prostate cancer

Aims: To evaluate the early cancer control rates, morbidity and mortality in men undergoing radical retropubic prostatectomy (RRP) for clinicallylocalized adenocarcinoma prostate.Methods: Patient\u27s characteristics, operative data, progressive-free survival rates, morbidity and mortality were analyzed for 23 men with clinical T1-2 prostate cancer who underwent surgery with an intent to treat by RRP between December 1997 to July 2001.Results: Patient\u27s mean age was 63 +/- 6.2 years (range 51 to 76 years) with American Society of Anesthesiology (ASA) status I in 4%, II in 65% and III in 31%. Two third of the patients had lower urinary tract obstructive symptoms, followed by hematuria (9%) and back pain (4%). Clinical stages were T1b in 4%, T1c in 9%, T2a in 17%, T2b in 22% and T2c in 48% of the patients. Mean pre-operative serum prostate specific antigen (PSA) was 25 +/- 29 ng/ml (1.1 to 99.3). Bilateral pelvic lymphnode disection(PLND) and RRP was performed in 20 cases (nerve-sparing RRP 5 cases). In 3 cases with gross lymph node metastasis at frozen section, only bilateral orchidectomy was done. The mean operative time was 270 +/- 65 minutes and mean blood loss was 1097 +/- 654 mls. Packed cell transfusions were nil in 26%, 1-2 units in 44%, 3-4 units in 26% and 5 units in 4% of the patients who underwent RRP. The mean length of hospital stay was 10.2 +/- 1 days. Out of 20 patients who underwent RRP, 65% of tumors were confined to the specimen, 20% had seminal vesicle invasion and 15% had nodal metastasis. There was no peri-operative mortality while 2 patients developed epididymo-orchitis and 1 had myocardial ischemia (without infarction). Overall 87% of the patients were fully continent and 13% had mild to moderate stress urinary incontinence. The mean time of return of continence was 11.5 +/- 11.6 weeks. Two of the 3 patients (66%) with follow up information and having undergone nerve-sparing RRP are potent. At a mean follow up of 19.4 +/- 13 months (range 3-45 months), 20 of 23 total patients (87%) and 17 of 20 RRP patients (85%) remained free of disease recurrence with PSA \u3c or = 0.4 ng/ml. Conclusion: Our early results confirm the excellent potential for cancer control and low morbidity of radical prostatectomy for men with localizedprostate cancer. These results are in conformity with the vast Western experience. Long-term results will be provided

Surgical ligation of scrotal varicocele for male factor infertility is a valid option of treatment

Objective: To evaluate the role of surgical ligation of scrotal varicocele for treatment of male factor infertility. Methods: We studied 60 patients who presented with infertility and were also found to have scrotal varicocele. Patients with other probable causes contributing to infertility were excluded. Diagnosis was made by clinical examination and scrotal ultrasonography. All the patients underwent either laparoscopic varicocelectomy or open retroperitoneal high ligation of the testicular veins. Operative time and hospital stay was recorded. All patients were evaluated for postoperative improvement of semen parameters and development of any postoperative complication. The results were analyzed by commercially available software. Results: During the study period 5 patients were lost to follow up and were excluded. The rest of patients (n=55) were young, with age ranging from 20-35 years (Mean age 27.8 years, SD +/- 4.38). All patients had unilateral left sided varicocele; two patients (3.6%) had grade I varicocele, 21 patients (38.2%) had grade II varicocele and 32 patients (58.2%) had grade III varicocele. Statistically significant improvement in sperm density (p value \u3c 0.05), sperm activity (p value \u3c 0.05) and sperm morphology (p value \u3c 0.05) was observed after the surgical ligation. The mean operative time was 54.88 minutes (SD + 13). The mean hospital stay in laparoscopic procedure was 33.4 (SD + 15.3). Minor complications were noted in 13 patients and included superficial wound infection in 3 patients, 6 patients exhibited testicular pain and persistence of varicocele in 4 patients. Conclusion: Surgical ligation of scrotal varicocele is asafe and effective mode of treatment of male factor infertility in selected population

Adding Robustness in Dynamic Preemptive Scheduling

In this paper we introduce a robust earliest deadline scheduling algorithm for deal ing with hard aperiodic tasks under overloads in a dynamic realtime environment The algorithm synergistically combines many features including dynamic guarantees graceful degradation in overloads deadline tolerance resource reclaiming and dy namic reguarantees A necessary and sucient schedulability test is presented and an ecient On guarantee algorithm is proposed The new algorithm is evaluated via simulation and compared to several baseline algorithms The experimental results show excellent performance of the new algorithm in normal and overload conditions Static realtime systems are designed for worst case situations Assuming that all the assumptions made in the design and analysis are correct we can say that the level of guarantee for these systems is absolute and all tasks will make their deadlines Unfortunately static systems are not always possible becaus

Incidental prostate cancer: the importance of complete prostatic removal at cystoprostatectomy for bladder cancer

Patients with invasive bladder cancer could be at a higher risk for a second malignancy such as an unsuspec- ted prostate cancer. We report a case of muscle-invasive transitional cell carcinoma of the urinary bladder with incidental adenocarcinoma of prostate, and review the literature to highlight the importance of complete prostatic removal to prevent residual disease

MP-03.08: Predictors of blood transfusion in percutaneous nephrolithotomy (PCNL)

introduction: In the developing world with less than optimal health care facili- ties, the urologist is inundated with large volume renal calculus disease. PCNL is realized as an important modality for treat- ment. Bleeding and possible transfusion related risks remain a major concern dur- ing PCNL. This study attempts to identify factors predicting blood transfusion re- quirement in our patients undergoing this procedure. Methods: The study period was from 1988 to May 2006. Data was collected from available records on 326 PCNLs performed in 316 patients. Two hun- dred and thirty two procedures were included in the analyses. Patient related variables studied were: Age, gender, co- morbids (Diabetes, hypertension, renal impairment, ischemic heart disease), pre operative hemoglobin, Serum Creatinine, type of stone shape, Stone burden and history of prior urinary tract infection whereas the procedure related variables included were: operative time, Stone fragmentation device used, Size of the amplatz sheath used, Numbers of punc- tures performed and the Calyx ap- proached. These were studied for asso- ciation with blood transfusion requirement using stepwise multivariate regression analysis using SPSS. Results: The estimated blood loss in terms of mean Hemoglobin drop was Conclusion: Female gender, chronic re- nal failure, stag horn stones, and stone fragmentation with ultrasound were found to be significant factors predicting blood loss in this study