Gustafssonmcbride5507

A 53-year-old man was diagnosed with prostate cancer with multiple bone metastasis. Therefore androgen deprivation therapy was initiated. After treatment with denosumab injection for bone metastasis, hypocalcemia and hypophosphatemia occurred. Despite treatment for hypocalcemia with vitamin D and calcium lactate,his serum calcium and phosphate levels were refractory to treatment. The etiology of hypophosphatemia was investigated,and the level of serum fibroblast growth factor 23 (FGF23) was abnormally elevated. Three months after the first measurement of FGF23,the patient died of prostate cancer. Severe hypophosphatemia is a typical manifestation of tumor-induced hypophosphatemic osteomalacia (TIO),which is a paraneoplastic condition, mediated by FGF23 overexpression in most cases. His osteoblastic metastasis,however,did not meet the disease criteria of osteomalacia. Several reports have suggested that excessive FGF23 may mediate both severe hypophosphatemia and aggressive castrationresistant prostate cancer characteristics. Management of serum FGF23 may be a novel therapeutic strategy for castration-resistant prostate cancer with hypophosphatemia.A 67-year-old male came to our department with complaints of urinary retention and gross hematuria. The prostate specific antigen (PSA) level in the serum was elevated to 69.5 ng/ml. Thus a transperineal prostate biopsy was performed. The patient was diagnosed with prostate cancer, and lung and bone metastases were also revealed. Treatment for metastatic prostate cancer was performed for approximately 5 years with combined androgen blockade therapy followed by enzalutamide, docetaxel, estramustine, Ra-223 dichloride, estradiol, and then enzalutamide reintroduction. Thereafter, the patient presented with bilateral breast nodules and we referred him to our breast surgery department. Breast needle biopsy findings revealed breast metastasis from prostate cancer, that was not primary breast cancer. The patient underwent a bilateral mastectomy.A 69-year-old man presented with gross hematuria. Cystoscopy revealed a large papillary tumor occupying the bladder. Magnetic resonance imaging showed a large bladder tumor more than 8cm in maximum diameter,suspected to be muscle-invasive disease. We performed the 1st transurethral resection of bladder tumor (TURBT) for the main purpose of pathological confirmation. Histopathological findings of the resected specimens showed urothelial carcinoma,low grade pTa. We performed subsequent treatments with TURBT twice,resulting in complete resection. The histopathological findings showed the same results as those of the 1st TURBT conclusively,which was consistent with non-muscle-invasive bladder cancer. He received intravesical instillation of pirarubicin eight times in total and has remained free from recurrence for more than 26 months after the final TURBT.A 66-year-old woman underwent concurrent chemoradiotherapy (CCRT) for stage IIA cervical cancer. However, two recurrent masses were detected at the vaginal stump 6 years after CCRT, and we performed laparoscopic total pelvic exenteration to obtain a complete cure. Because the terminal ileum appeared white secondary to the effects of radiotherapy, we constructed an ileal conduit using the ileum, approximately 40 cm toward the mouth from the ileocecum. We performed transperineal resection of the vagina and urethra and intersphincteric resection as anal-preservation surgery along with transverse colostomy. We used a right short gracilis myocutaneous flap to reconstruct the pelvic floor and perineum. The operation time was 816 min, and the estimated blood loss was 1,168 ml. On histopathological examination of the resected specimen, the parauterine tissue showed a positive surgical margin. Patients with recurrent cervical cancer after CCRT show poor prognosis. Complete resection with a negative margin is associated with more favorable prognosis in patients with recurrent pelvic masses. Compared with an open procedure, laparoscopic pelvic exenteration is safe and feasible in these patients. Selection of an optimal surgical approach, urinary diversion, and pelvic floor reconstruction is important for complete resection and prevention of perioperative complications.A 41-year-old female who suffered local recurrence of cervical cancer after receiving chemoradiotherapy underwent radical hysterectomy, radical vaginal resection, and pelvic and paraaortic lymph node dissection. After surgery, bilateral hydronephrosis due to right ureteral stenosis and left uretero-vaginal fistula occurred. We therefore placed a bilateral ureteral stent. Thereafter, we continued to replace the bilateral ureteral stent once every 3 months, but the replacement of the right ureteral stent became impossible three years after the initial placement. We thus performed bilateral upper urinary tract reconstruction using an ileal ureter with the aim of both eliminating the left ureteral vaginal fistula and resolving the right ureteral stricture.A 76-year-old male was previously found to have a renal cyst at the center of the right kidney, on a computed tomography (CT)scan for examination of another disease. The patient was admitted to the hospital because of fever. The CT scan showed an enlarged mass at the center of the right kidney and an increase in the density of peripheral fat tissue, suggesting an infection of the right renal cyst. In spite of conservative treatment with antibiotics, CT scan on the sixth day of admission revealed an increase in the size of the mass, and penetration in the ascending colon was suspected. An ultrasound-guided abscess puncture was performed, and a pigtail catheter (PC)was placed. Injection of contrast agent through the PC showed communication with the colon. The fistula site was identified using colon fiberscopy, and it was clipped. PC was removed after the closure of the fistula was confirmed by imaging. This is a rare case of renocolic fistula caused by an infected renal cyst, which was diagnosed by colon fiberscopy, and was treated by clipping the fistula.A 74-year-old woman was transported to an emergency room of a general hospital with sudden left flank pain. After examination, the pain was attributed to left hydronephrosis resulting from left retroperitoneal fibrosis (RF). The pain and renal function improved after left ureteral stenting. Four months after the transportation, she was referred to our hospital for further examination. Her renal function deteriorated again despite successful release of ureteral obstruction. Consequently, the left kidney developed end-stage renal dysfunction at 15 months after symptom onset. Pathological examination of the left dysfunctional kidney removed by laparoscopic surgery to avoid infectious pyelonephritis revealed numerous IgG4-positive plasma cells invading the renal parenchyma. The pathological findings suggested that the renal dysfunction was due to IgG4-related tubulointerstitial nephritis (IgG4-TIN) rather than ureteral obstruction. In the case of RF with decreased renal function, not only retroperitoneal lesion biopsy but also renal biopsy should be considered to diagnose IgG4-TIN and start steroid treatment if necessary.A 70-year-old man complaining of pain in his right leg presented to the Department of Orthopedics in our hospital. X-ray findings revealed calcifications around the left kidney. selleck screening library He was referred to our department for further examination. Computed tomography revealed a tumor 3 cm in diameter with calcifications and an obscure border that was located on the caudal side of the pancreas, anterior to the left iliopsoas muscle and at the left side of the aorta. Magnetic resonance imaging showed that the tumor had comparatively low intensity in diffusion-weighted images and the cell density was not high. The contrast of the tumor by enhanced computed tomography was weak, and we had difficulty judging whether the tumor was benign or malignant. Each tumor marker, immunity factor, and hormone-like catecholamine were within the normal range. We considered the retroperitoneal tumor with calcifications as Castleman disease or tumor of nerve origin. It is believed that most retroperitoneal tumors are malignant. We performed laparoscopic surgery to resect the retroperitoneal tumor. Histopathological diagnosis was a primary retroperitoneal venous malformation. Vascular malformation derived from the retroperitoneum is rare. Furthermore, very few cases of venous malformation in the retroperitoneum have been reported.An 83-year-old man with left lower back pain was found to have a 5 cm mass in contact with the right adrenal gland and a 12 mm left ureteral stone by abdominal plain computed tomography. An abdominal plain magnetic resonance imaging T2-weighted image revealed a heterogeneous high signal mass in the right adrenal gland. Pheochromocytoma, adrenal carcinoma, and retroperitoneal neurogenic tumor were suspected. Tumor markers and endocrine examinations were within standard values. Laparoscopic right adrenalectomy was performed. A 4×3.6 cm, 62 g solid tumor was found in contact with right adrenal gland. Histopathologically, hobnail-like vascular endothelial cells were found in the tumor, but no malignant findings such as multi-layered vascular endothelial cells and nuclear atypia were observed. This tumorwas diagnosed to be an anastomosing hemangioma.Robot-assisted laparoscopic radical prostatectomy (RARP) is becoming the standard treatment procedure for localized prostate cancer. The main complications associated with RARP include urinary incontinence and sexual dysfunction. In addition, acute urinary retention (AUR) after urethral catheter removal is sometimes seen. Early catheter removal is a risk factor for AUR, and administration of alphablockers before catheter removal reduces the occurrence of AUR. However, the ideal management of AUR after RARP is not known. Here we report the clinical course and treatment after AUR. We performed 279 RARPs at our institution, and AUR developed in 11 cases. In all cases, urination status was improved after placement of a urinary catheter or intermittent catheterization. Later, urethral stricture was seen in 2 out of 11 cases. Ourstudy suggests that when AUR is observed afterRARP, catheterur ination should be initially performed. If urinary retention recurs, a urinary catheter should be placed with administration of alpha-blockers. The catheter is removed after about 3 days, and administration of analgesics is effective for reducing the pain on urination. If urination status is not improved, evaluation of the urethral stricture should be considered.

Mirror hand syndrome is a very rare congenital deformity, also called cubital dimelia, characterized by the absence of the thumb, as well as the duplication of the fingers in a symmetrical image and, in some cases, with a duplication of the bones of the forearm.

The current treatment consists of a thumb reconstruction through thumb pollicization, although there are alternatives such as rotating osteotomy, syndactylization or conservative treatment. In this article we present the case of a girl with a non-classic bilateral mirror hand, the clinical and radiological findings, the bilateral surgical technique in two surgical times with six months of difference and two years follow-up.

Complete mobility arches, as well as a good hand holding function were achieved with metacarpophalangeal thumb flexion 0-40o, interphalangeal 5-45o and abduction-adduction 0-50o. We achieved a complete opposition of the new thumb with respect to the other fingers. The strength of the clamp between the fingers was 75.2% of the normal force for her given age, while the strength of the lateral clamp of 66.