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Classification of rhabdomyosarcomas and related sarcomas
INTERNATIONAL
456
A nonrandomized prospective study was instituted to evaluate the urologic outcomes of a cohort of children who were at risk for urologic deterioration on the basis of bladder-sphincter dyssynergia and/or high filling or voiding pressures. Those at risk were observed until deterioration occurred, or were placed on prophylactic intermittent catheterization with or without anticholinergic medication. Of 44 children at risk, 35 with follow-up by observation alone had urinary tract deterioration. Only three of 20 at risk and treated with prophylactic intermittent catheterization had deterioration with time. Proactive bladder treatment significantly reduced the incidence of upper urinary tract deterioration and the need for surgical intervention.-George W. Holcomb, Jr Urinary Diversion in Bladder Exstrophy and Incontinent Epispadias: 25 Years of Experience. R. Stein, M. Fisch, M. Stockle, et al. J Urol154:1177-1181, (September), 1995.
To determine the optimal surgical approach in achieving complete urinary continence with preservation of the upper urinary tract in the exstrophy-epispadias complex, the records of patients were reviewed. From 1968 to July 1994, 115 patients with bladder exstrophy/incontinent epispadias were treated. Follow-up was available for 104, and two died of causes unrelated to urinary diversion. The mean follow-up period is 16.7 years. In 43 of the 102 patients, surgery was performed primarily (urinary diversion in 39, modified Young-Dees procedure in 1, sling plasty in 3). In another 59 patients, urinary diversion was done after therapy elsewhere (bladder closure/bladder neck reconstruction in 34, failed urinary diversion with incontinence in 22). Urinary diversion was performed in 49 patients, a Young-Dees procedure in seven, and genital reconstruction alone in three. The present continence rates are 96% for the rectal reservoir, 97% for the Mainz pouch I, and 67% for the modified Young-Dees augmentation. Upper tracts have remained stable, and no bowel neoplasms have developed. Rectal reservoirs represent the authors’ urinary diversion of choice. After failed reconstruction/insufficient anal sphincter a Mainz pouch I is constructed, and when the upper tract has deteriorated a colon conduit is created.-George W Holcomb, Jr Renal Transplantation in Patients With Posterior Urethral Valves: Favorable Long-Term 0utcome.J.A. Connolly, B. Miller, and P.N. Bretan. J Urol154:1153-1155, (September), 1995.
The authors assessedthe long-term efficacy of renal transplantation in patients with posterior urethral valves. The outcome for 23 patients with posterior urethral valves who underwent renal transplantation since 1979 was reviewed. The mean age of the patients at the time of transplantation was 16.3 years. Graft survival was 69% at 5 years and 63% at 10 years. Seven patients with follow-up of 7 years or more had a mean serum creatinine level of 1.5 mg/dL. Three patients (13%) demonstrated significant bladder dysfunction postoperatively. The authors conclude that renal transplantation into a valve bladder is not associated with an abnormally high rate of failure. Deterioration of graft function secondary to lower urinary tract dysfunction is uncommon, the majority of patients being able to use the unmodified native bladder as a receptacle for the transplanted kidney.-George W. Holcomb, Jr Advances and E.M.
in Urological Laparoscopy. I.S. Gill, R.V: Clayman, McDougall. J Urol154:1275-1294, (October), 1995.
The authors provide an in-depth critical review comparing laparoscopic and open urologic procedures. More than 200 articles on laparoscopic urology were reviewed. All laparoscopic procedures were divided into clinically established, clinically anecdotal, and laboratory procedures. Comparisons between the laparoscopic and
ABSTRACTS
open method were analyzed carefully. Five clinically established procedures were identified. In general, the laparoscopic procedures were as efficacious but less morbid and with less convalescence than their open counterparts. However, none was less costly. Despite the time-consuming and costly nature of laparoscopy, the decreased morbidity and brief convalescence that are the hallmarks of minimally invasive surgery are evident and well documented. Further dissemination of laparoscopic skills through postgraduate urology training programs and during urology residency is of utmost importance.-George W. Holcomb, Jr NEOPLASMS Surgery for Chemotherapy.
Wilms’ Tumour: The Effect of Neoadjuvant G.P. Hadley andA. T. Bosenberg. Pediatr Surg
Int
l&362-365, (July), 1995. The authors present a group of 101 patients treated between 1984 and 1992 for Wilms’ tumor. The patients had had either primary surgery or preoperative chemotherapy with or without radiotherapy. The authors note that because patients in some parts of the world present very late in the disease and may have other complicating medical problems, not all cases are suitable for primary surgery. Since 1990 they have adopted a policy of routine neoadjuvant chemotherapy in all patients. They report that patients who had preoperative chemotherapy had a lower incidence of intraoperative complications. They believe that it also facilitated the resection. Histological grading was not affected by the chemotherapy.-Prem Puri Classification mas. WA.
of Rhabdomyosarcomas Newton, Jr, E.A. Gehan,
B.L.
and Related SarcoWebber, et al. Cancer
76:1073-1085, (September), 1995. Pediatric Oncology Group, Pediatric Intergroup Statistical Center, The Children’s Cancer Group, The National Cancer Institute, The International Society for Pediatric Oncology, The GermanItalian Cooperative Soft Tissue Sarcoma Study, and the Intergroup Rhabdomyosarcoma Pathology Center present a new classification for rhabdomyosarcoma and related soft tissue sarcomas of childhood. The new classification is referred to as “International Classification of Rhabdomyosarcoma” (ICR). Four groups are identified in the classification. Botryoid and spindle cell rhabdomyosarcoma are in the superior prognosis group. Embryonal rhabdomyosarcoma is in the intermediate prognosis group. Undifferentiated sarcoma and alveolar rhabdomyosarcoma are in the third group, which is the poor prognosis group. The fourth group includes rhabdomyosarcoma with rhabdoid features and those tumors whose prognosis is not presently evaluable. The authors stress that the new classification is reproducible and predictive of outcome. They strongly urge that this new system be used by pathologists and cooperative study groups to facilitate classification of rhabdomyosarcoma and other soft tissue tumors in patients treated in accordance with multiinstitutional study.-Mark Silen Characteristics of Follicular Tumors and Nonneoplastic Thyroid Lesions in Children and Adolescents Exposed to Radiation as a Result of the Chernobyl Disaster. Y Nikijorov, C. Heffess, A. Korzenko, et al. Cancer 76:900-909, (September), 1995.
Malignant and benign thyroid neoplasms are known to occur in patients exposed to high levels of radiation. Many people were exposed to such radiation in April 1986, following the accident at the nuclear power station in Chernobyl. The authors review the findings of 60 children and adolescents (aged 7 to 18 years) who underwent thyroidectomy after radiation exposure from the Chernobyl accident. Morphological changes in the thyroid tissue of
456
A nonrandomized prospective study was instituted to evaluate the urologic outcomes of a cohort of children who were at risk for urologic deterioration on the basis of bladder-sphincter dyssynergia and/or high filling or voiding pressures. Those at risk were observed until deterioration occurred, or were placed on prophylactic intermittent catheterization with or without anticholinergic medication. Of 44 children at risk, 35 with follow-up by observation alone had urinary tract deterioration. Only three of 20 at risk and treated with prophylactic intermittent catheterization had deterioration with time. Proactive bladder treatment significantly reduced the incidence of upper urinary tract deterioration and the need for surgical intervention.-George W. Holcomb, Jr Urinary Diversion in Bladder Exstrophy and Incontinent Epispadias: 25 Years of Experience. R. Stein, M. Fisch, M. Stockle, et al. J Urol154:1177-1181, (September), 1995.
To determine the optimal surgical approach in achieving complete urinary continence with preservation of the upper urinary tract in the exstrophy-epispadias complex, the records of patients were reviewed. From 1968 to July 1994, 115 patients with bladder exstrophy/incontinent epispadias were treated. Follow-up was available for 104, and two died of causes unrelated to urinary diversion. The mean follow-up period is 16.7 years. In 43 of the 102 patients, surgery was performed primarily (urinary diversion in 39, modified Young-Dees procedure in 1, sling plasty in 3). In another 59 patients, urinary diversion was done after therapy elsewhere (bladder closure/bladder neck reconstruction in 34, failed urinary diversion with incontinence in 22). Urinary diversion was performed in 49 patients, a Young-Dees procedure in seven, and genital reconstruction alone in three. The present continence rates are 96% for the rectal reservoir, 97% for the Mainz pouch I, and 67% for the modified Young-Dees augmentation. Upper tracts have remained stable, and no bowel neoplasms have developed. Rectal reservoirs represent the authors’ urinary diversion of choice. After failed reconstruction/insufficient anal sphincter a Mainz pouch I is constructed, and when the upper tract has deteriorated a colon conduit is created.-George W Holcomb, Jr Renal Transplantation in Patients With Posterior Urethral Valves: Favorable Long-Term 0utcome.J.A. Connolly, B. Miller, and P.N. Bretan. J Urol154:1153-1155, (September), 1995.
The authors assessedthe long-term efficacy of renal transplantation in patients with posterior urethral valves. The outcome for 23 patients with posterior urethral valves who underwent renal transplantation since 1979 was reviewed. The mean age of the patients at the time of transplantation was 16.3 years. Graft survival was 69% at 5 years and 63% at 10 years. Seven patients with follow-up of 7 years or more had a mean serum creatinine level of 1.5 mg/dL. Three patients (13%) demonstrated significant bladder dysfunction postoperatively. The authors conclude that renal transplantation into a valve bladder is not associated with an abnormally high rate of failure. Deterioration of graft function secondary to lower urinary tract dysfunction is uncommon, the majority of patients being able to use the unmodified native bladder as a receptacle for the transplanted kidney.-George W. Holcomb, Jr Advances and E.M.
in Urological Laparoscopy. I.S. Gill, R.V: Clayman, McDougall. J Urol154:1275-1294, (October), 1995.
The authors provide an in-depth critical review comparing laparoscopic and open urologic procedures. More than 200 articles on laparoscopic urology were reviewed. All laparoscopic procedures were divided into clinically established, clinically anecdotal, and laboratory procedures. Comparisons between the laparoscopic and
ABSTRACTS
open method were analyzed carefully. Five clinically established procedures were identified. In general, the laparoscopic procedures were as efficacious but less morbid and with less convalescence than their open counterparts. However, none was less costly. Despite the time-consuming and costly nature of laparoscopy, the decreased morbidity and brief convalescence that are the hallmarks of minimally invasive surgery are evident and well documented. Further dissemination of laparoscopic skills through postgraduate urology training programs and during urology residency is of utmost importance.-George W. Holcomb, Jr NEOPLASMS Surgery for Chemotherapy.
Wilms’ Tumour: The Effect of Neoadjuvant G.P. Hadley andA. T. Bosenberg. Pediatr Surg
Int
l&362-365, (July), 1995. The authors present a group of 101 patients treated between 1984 and 1992 for Wilms’ tumor. The patients had had either primary surgery or preoperative chemotherapy with or without radiotherapy. The authors note that because patients in some parts of the world present very late in the disease and may have other complicating medical problems, not all cases are suitable for primary surgery. Since 1990 they have adopted a policy of routine neoadjuvant chemotherapy in all patients. They report that patients who had preoperative chemotherapy had a lower incidence of intraoperative complications. They believe that it also facilitated the resection. Histological grading was not affected by the chemotherapy.-Prem Puri Classification mas. WA.
of Rhabdomyosarcomas Newton, Jr, E.A. Gehan,
B.L.
and Related SarcoWebber, et al. Cancer
76:1073-1085, (September), 1995. Pediatric Oncology Group, Pediatric Intergroup Statistical Center, The Children’s Cancer Group, The National Cancer Institute, The International Society for Pediatric Oncology, The GermanItalian Cooperative Soft Tissue Sarcoma Study, and the Intergroup Rhabdomyosarcoma Pathology Center present a new classification for rhabdomyosarcoma and related soft tissue sarcomas of childhood. The new classification is referred to as “International Classification of Rhabdomyosarcoma” (ICR). Four groups are identified in the classification. Botryoid and spindle cell rhabdomyosarcoma are in the superior prognosis group. Embryonal rhabdomyosarcoma is in the intermediate prognosis group. Undifferentiated sarcoma and alveolar rhabdomyosarcoma are in the third group, which is the poor prognosis group. The fourth group includes rhabdomyosarcoma with rhabdoid features and those tumors whose prognosis is not presently evaluable. The authors stress that the new classification is reproducible and predictive of outcome. They strongly urge that this new system be used by pathologists and cooperative study groups to facilitate classification of rhabdomyosarcoma and other soft tissue tumors in patients treated in accordance with multiinstitutional study.-Mark Silen Characteristics of Follicular Tumors and Nonneoplastic Thyroid Lesions in Children and Adolescents Exposed to Radiation as a Result of the Chernobyl Disaster. Y Nikijorov, C. Heffess, A. Korzenko, et al. Cancer 76:900-909, (September), 1995.
Malignant and benign thyroid neoplasms are known to occur in patients exposed to high levels of radiation. Many people were exposed to such radiation in April 1986, following the accident at the nuclear power station in Chernobyl. The authors review the findings of 60 children and adolescents (aged 7 to 18 years) who underwent thyroidectomy after radiation exposure from the Chernobyl accident. Morphological changes in the thyroid tissue of