Malignant mixed Müllerian tumor with heterologous component arising in the fallopian tube--a case report

Primary malignant mixed Müllerian tumors (MMMTs) of the fallopian tube are rarities in gynecologic oncology with only 26 cases of MMMTs with a heterologous component reported thus far. We report a case of FIGO Stage II primary MMMT of the fallopian tube with a heterologous tumor portion in an 80-year-old woman presenting with abdominal discomfort at the time of primary diagnosis. After performance of total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy follow-up examination three months postoperatively did not show signs of disease recurrence. The patient finally presented six months after the initial diagnosis with extensive intraabdominal metastasis and died several days thereafter. The present report supports the aggressive nature of these neoplasms. The efficacy of chemotherapy and radiation remains to be defined in future studies.

Antegrade transpelvic endopyelotomy in primary obstruction of the ureteropelvic junction

The authors present a 5-year follow-up of endopyelotomy using a personal technique for cases of primary ureteropelvic junction obstruction. After percutaneous access has been gained via a lower calix, the technique involves wide opening of the renal pelvis and exploration of the peripelvic space before a 3- to 4-cm long sectioning of the ureter. The aim is to carry out all of the operation in full view and without the need for a large-caliber stent, in order to perform endopyelotomy also in pediatric patients or in presence of anomalous vessels. The follow-up demonstrates a good result in 80% of 46 patients aged 5 to 62 years; two patients underwent surgical repair. The authors think the antegrade transpelvic endopyelotomy is an endourologic operation whose results and feasibility parallel those of open surgery.

Colonoscopic control of uretero-enteric anastomoses in internal urinary diversion

Twenty-four patients with internal urinary diversion following total bladder ablation underwent colonoscopic control of the uretero-enteric anastomoses. The techniques performed were: rectal bladder with colostomy according to Mauclaire (11 patients); rectal bladder with abdomino-perineal pull-through according to Heitz-Boyer/Hovelacque (6); ureterosigmoidostomy (7). The uretero-enteric anastomoses were divided into 3 categories according to the colonoscopic appearance: "nipple-like", nearly flat and flat anastomosis. Urographic examinations were carried out in all patients and the results demonstrated that the "nipple-like" anastomosis was the most successful for the preservation of upper urinary tract integrity.

Staghorn calculi of the kidney: classification and therapy

Following the introduction of new techniques, the reclassification of staghorn calculi is indicated in order to establish the most suitable form of treatment. Of 269 patients with staghorn calculi treated over a 3-year period, 56% underwent extracorporeal shockwave lithotripsy (ESWL) monotherapy; 16% required open surgery and the remaining 28% underwent percutaneous nephrolithotripsy (PCNL) with ultrasound in association with ESWL. The latter group has been reviewed, taking into account invasiveness, results, complications and cost effectiveness. A combination of PCNL and ESWL was beneficial in patients in whom percutaneous access through a single tract removed more than 70% of the stone. As a result of these findings, the authors propose a revised classification of staghorn calculi.

Blood cellular and biochemical changes after extracorporeal shock wave lithotripsy

The present study deals with blood cell behaviour and related hematochemical changes occurring in man after exposure to extracorporeal shock wave lithotripsy (ESWL). The following parameters have been investigated, before and after treatment, in a longitudinal study carried out on 58 patients of our Center: RBC count, Ht, Blood Hb, Plasma Hb, autohemolysis after 72 hours, bilirubinemia, WBC count, platelet count, in vitro platelet aggregation, beta-TG, sideremia and urinary post-exposure transferrin concentration. After exposure to ESWL, with pulse numbers ranging from 350 to 3,000, 18-20 KV, direct and indirect evidences of hemolysis have been found when number of SW exceeded 1,000. The hemolysis rate in different models of in vitro exposure to ESWL of blood samples was also investigated. Increase of WBC count, and changes of the platelet in vitro aggregation patterns were also observed. Changes in sideremia values have been related to urinary loss of transferrin.

Analysis of urinary calculi using photon induced X-ray fluorescence (XRF)

Photon induced X-ray fluorescence has been employed to determine trace elements in urinary calculi. Twenty-one urinary stones, classified in four groups, have been analysed. Besides Ca, elements Fe, Zn and Pb were detected, and Cr and Mn were also detected in some cases. No clear differences were found between the four groups.

[Hemitrigonectomy: a personal technic]

The Authors show an operation of urological surgery, unusual in relation to the rather limited indications. The operation of hemitrigonectomy, although it is framed in the chapter of the partial resections of bladder, does not get an exact identity in literature; yet, it is peculiar for both technical problems and some basic expedients sheltering surgeons from various complications. Hemitrigonectomy, performed by the Authors in six cases in the last 3 years, supplied excellent anatomic and functional results, and was burdened by no relevant complications.