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Hypertension and renal tumours: Diagnosis and management
INTERNATIONAL
713
ABSTRACTS
of urinary diversion. However, many patients are reluctant to give up the life-style that ureterosigmoidostomy offers and prefer an alternative that permits retention of the basic features of the procedure. To satisfy these demands, a technique has been developed in which an intussuscepted segment of small bowel is interposed between the colon and the ureters. This operation has allowed salvage of an obstructed ureterosigmoidostomy in six patients and has given such good results that it has been done as a primary procedure in one. In addition to its use for the salvage of existing ureterosigmoidostomies, the operation permits primary ureterosigmoidostomy to be done in patients with dilated ureters. It may even lessen the risk of colon cancer by separating the urothelium from the colonic mucosa.-George W. Holcornb, Jr NEOPLASMS Management of Synchronous Bilateral Wilms’ Tumor: Brazilian Wilms’ Tumor Study Group Experience With 14 Cases. W. Alfer, Jr, B. DeCamargo, and M.D. Assuncao. J Urol 150:1456-1459,
(November), 1993. The Brazilian Wilms’ Tumor Study Group registered 16 cases of synchronous bilateral Wilms’ tumor since 1986, 14 of which were available for analysis. Most patients were treated according to a prospective trial in which bilateral renal preservation was emphasized. Overall survival was 79% (11 of 14) and both kidneys were preserved in 57% (8 of 14). Of the 14 patients, five had undergone at least three surgical procedures. Of the ten cases in which pathological reports were available for review, residual disease was documented in five; however, none had relapsed.-George W. Holcomb, Jr Hypertension and Renal Tumours: Diagnosis and Management. H.K. Simpson, P.S. Malone, D.M. Gn@hs, et al. Pediatr Surg
Int 8:502-504, (September),
1993.
The authors report on five consecutively treated patients (age 2-34 months) with renal tumors (4 Wilms’, 1 congenital mesoblastic nephroma) who were found to have hypertension. Preoperative renin levels were measured in three patients; two had significant elevation (135 and 35.4 nAI/mL) and the other had marginal elevation (5.3 nAI/mL). All the patients were treated preoperatively with antihypertensive agents to stabilize the blood pressure. Nephrectomy was performed in each case after the blood pressure had become stable. Intraoperatively, the patients were monitored using central venous and arterial lines. Postoperatively, four patients did not require antihypertensive treatment. One patient continued to have persistent hypertension requiring treatment, but subsequently it was possible to withdraw the treatment. The authors believe that there may be a higher incidence of hypertension in patients with renal tumors if blood pressures are recorded carefully and repeatedly. Once the blood pressure is stabilized, nephrectomy with perioperative monitoring is a safe procedure.-R. Surana
Infantile Hepatic Haemangioendothelioma: An Association With Hemihypertrophy. M. Davenport, G. Mieli-Vergani, and E.R. Howard. Pediatr Surg Int 8:505-506, (September), 1993.
A S-month-old girl presented with hemihypertrophy of the right arm, leg, facial asymmetry, and with moderate hepatomegaly. An ultrasound scan showed multiple areas of decreased reflectivity throughout the liver and a pancreatic cyst. Selective arteriography showed a large right hepatic artery with multiple areas of increased vascularity principally involving the right lobe of the liver. The alfa-fetoprotein level was elevated for her age. The diagnosis of hemangioendothelioma was established from the frozen section taken during diagnostic laparotomy. The right hepatic artery was ligated and cholecystectomy performed. The pancreatic cyst was aspirated. Several bilateral ovarian cysts were noted during laparotomy. At the follow-up examination at 10 months of age, the patient was well, and no hepatomegaly was noted. She still has obvious hemihypertrophy. According to the authors, this is the first report of an association between hemihypertrophy and hepatic hemangioendothelioma. The authors also emphasize the importance of confirming the histological diagnosis in the management of hepatic tumors because both the arteriogram and elevated alfafetoprotein levels had suggested a hepatoblastoma.-Prem Puri Congenital Hemangiopericytoma: An Unusual Vascular Neoplasm of Infancy. P.V Bailey T.R. Weber. T.F. Tracy, Jr, et al.
Surgery 114:936-941, (November), 1993. Five cases of congenital hemangiopericytoma were seen in infants, and all occurred in females. The mean age at diagnosis was 7 weeks, and the lesions were initially located in the neck, parotid, axilla, and retroperitoneum. One neck lesion was detected prenatally by ultrasonography. Each patient underwent an en-bloc resection, and the diagnosis of hemangiopericytoma was established only after histological examination of the specimen. In one child with a neck lesion, intrathoracic and intracranial metastases developed 28 months after the original resection. Despite chemotherapy, she died of progressive disease. One child had residual tumor because of adjacent neurovascular structures. She was treated with vincristine, actinomycin D, doxorubicin, and cyclophosphamide, without significant decrease in the size of the mass.--Thomas F. Tracy, Jr Benign Fibrous Testicular Pseudotumors in Children. T.S. Vates, C. Ruemmler-Fisch, P.C. Smilow, et al. J Urol 150:1886-1888.
(December), 1993. Benign fibrous pseudotumors of the testicular tunics are rare in children, although there are 18 reported cases. The authors report two cases of benign fibrous pseudotumors that were managed with gonad-sparing surgery. The etiology, evaluation, and treatment of benign fibrous pseudotumors of the testis are discussed.-George IV Holcomb, Jr
713
ABSTRACTS
of urinary diversion. However, many patients are reluctant to give up the life-style that ureterosigmoidostomy offers and prefer an alternative that permits retention of the basic features of the procedure. To satisfy these demands, a technique has been developed in which an intussuscepted segment of small bowel is interposed between the colon and the ureters. This operation has allowed salvage of an obstructed ureterosigmoidostomy in six patients and has given such good results that it has been done as a primary procedure in one. In addition to its use for the salvage of existing ureterosigmoidostomies, the operation permits primary ureterosigmoidostomy to be done in patients with dilated ureters. It may even lessen the risk of colon cancer by separating the urothelium from the colonic mucosa.-George W. Holcornb, Jr NEOPLASMS Management of Synchronous Bilateral Wilms’ Tumor: Brazilian Wilms’ Tumor Study Group Experience With 14 Cases. W. Alfer, Jr, B. DeCamargo, and M.D. Assuncao. J Urol 150:1456-1459,
(November), 1993. The Brazilian Wilms’ Tumor Study Group registered 16 cases of synchronous bilateral Wilms’ tumor since 1986, 14 of which were available for analysis. Most patients were treated according to a prospective trial in which bilateral renal preservation was emphasized. Overall survival was 79% (11 of 14) and both kidneys were preserved in 57% (8 of 14). Of the 14 patients, five had undergone at least three surgical procedures. Of the ten cases in which pathological reports were available for review, residual disease was documented in five; however, none had relapsed.-George W. Holcomb, Jr Hypertension and Renal Tumours: Diagnosis and Management. H.K. Simpson, P.S. Malone, D.M. Gn@hs, et al. Pediatr Surg
Int 8:502-504, (September),
1993.
The authors report on five consecutively treated patients (age 2-34 months) with renal tumors (4 Wilms’, 1 congenital mesoblastic nephroma) who were found to have hypertension. Preoperative renin levels were measured in three patients; two had significant elevation (135 and 35.4 nAI/mL) and the other had marginal elevation (5.3 nAI/mL). All the patients were treated preoperatively with antihypertensive agents to stabilize the blood pressure. Nephrectomy was performed in each case after the blood pressure had become stable. Intraoperatively, the patients were monitored using central venous and arterial lines. Postoperatively, four patients did not require antihypertensive treatment. One patient continued to have persistent hypertension requiring treatment, but subsequently it was possible to withdraw the treatment. The authors believe that there may be a higher incidence of hypertension in patients with renal tumors if blood pressures are recorded carefully and repeatedly. Once the blood pressure is stabilized, nephrectomy with perioperative monitoring is a safe procedure.-R. Surana
Infantile Hepatic Haemangioendothelioma: An Association With Hemihypertrophy. M. Davenport, G. Mieli-Vergani, and E.R. Howard. Pediatr Surg Int 8:505-506, (September), 1993.
A S-month-old girl presented with hemihypertrophy of the right arm, leg, facial asymmetry, and with moderate hepatomegaly. An ultrasound scan showed multiple areas of decreased reflectivity throughout the liver and a pancreatic cyst. Selective arteriography showed a large right hepatic artery with multiple areas of increased vascularity principally involving the right lobe of the liver. The alfa-fetoprotein level was elevated for her age. The diagnosis of hemangioendothelioma was established from the frozen section taken during diagnostic laparotomy. The right hepatic artery was ligated and cholecystectomy performed. The pancreatic cyst was aspirated. Several bilateral ovarian cysts were noted during laparotomy. At the follow-up examination at 10 months of age, the patient was well, and no hepatomegaly was noted. She still has obvious hemihypertrophy. According to the authors, this is the first report of an association between hemihypertrophy and hepatic hemangioendothelioma. The authors also emphasize the importance of confirming the histological diagnosis in the management of hepatic tumors because both the arteriogram and elevated alfafetoprotein levels had suggested a hepatoblastoma.-Prem Puri Congenital Hemangiopericytoma: An Unusual Vascular Neoplasm of Infancy. P.V Bailey T.R. Weber. T.F. Tracy, Jr, et al.
Surgery 114:936-941, (November), 1993. Five cases of congenital hemangiopericytoma were seen in infants, and all occurred in females. The mean age at diagnosis was 7 weeks, and the lesions were initially located in the neck, parotid, axilla, and retroperitoneum. One neck lesion was detected prenatally by ultrasonography. Each patient underwent an en-bloc resection, and the diagnosis of hemangiopericytoma was established only after histological examination of the specimen. In one child with a neck lesion, intrathoracic and intracranial metastases developed 28 months after the original resection. Despite chemotherapy, she died of progressive disease. One child had residual tumor because of adjacent neurovascular structures. She was treated with vincristine, actinomycin D, doxorubicin, and cyclophosphamide, without significant decrease in the size of the mass.--Thomas F. Tracy, Jr Benign Fibrous Testicular Pseudotumors in Children. T.S. Vates, C. Ruemmler-Fisch, P.C. Smilow, et al. J Urol 150:1886-1888.
(December), 1993. Benign fibrous pseudotumors of the testicular tunics are rare in children, although there are 18 reported cases. The authors report two cases of benign fibrous pseudotumors that were managed with gonad-sparing surgery. The etiology, evaluation, and treatment of benign fibrous pseudotumors of the testis are discussed.-George IV Holcomb, Jr