Search

Objective: To report the urological complications after simultaneous renal and pancreatic transplantation., Design: Retrospective study., Setting: Teaching hospital, Italy., Subjects: 143 consecutive patients having simultaneous renal and pancreatic transplantation by one of three techniques. 33 segmental pancreas with duct occlusion, 77 whole pancreas with bladder diversion, and 33 enteric diversion with systemic (n = 26) or portal venous drainage (n = 7). Urological complications were related to the pancreatic transplant, to the renal transplant, or unrelated to the transplant., Main Outcome Measures: Morbidity., Results: After occlusion of the duct and enteric diversion, there were no urological complications related to the pancreatic transplant. On the other hand, among the 77 patients with pancreatic drainage into the bladder, urological complications were common (56/77; 73%). Complications related to the renal transplant were recorded in 6/33 (18%), 26/77 (34%) and 12/33 (36%), respectively. Complications unrelated to the transplant occurred in 6/77 patients (8%) in the bladder drainage group. Five patients after bladder drainage required cystoenteric conversion., Conclusions: Enteric diversion is a safe alternative to bladder diversion and results in significantly fewer urological complications.

The prognosis of differentiated carcinoma of the thyroid has been reported to be extremely favourable. Previous studies have concluded that lymph node metastasis do not affect survival rates in patients with differentiated thyroid carcinoma. Therefore, nodal metastasis has not been evaluated as a prognostic factor in recent definitions of risk groups. To determine the significance of nodal disease, we reviewed 219 consecutive patients with differentiated thyroid cancer (191 papillary, 14 follicular and 14 Hurtle cell carcinomas). Fifty-five patients were treated with modified neck dissection and all of them received adjuvant radioiodine. There were recurrences in 25 patients (11.4%), with follow-up ranging from 6 months to 14 years. Systemic disease occurred synchronously in two patients, and four patients died of thyroid carcinoma.

Considerable controversy exists about the most appropriate treatment for thyroid cancer. In this report the authors present their experience of 189 patients, all of whom had a total thyroidectomy between June 1980 and December 1993. The age of the patients ranged from 11 to 78 years (mean age: 42 years), there were 144 women and 45 men. Histological types were: 146 papillary, 16 medullary, 10 follicular, eight Hurtle, six insular and three undifferentiated. Coexistent lesions included: 22 thyroiditis, 17 adenomas, one Graves' disease and 22 benign goitre. Fifty-six (29.6%) patients had multifocal papillary cancer (bilateral in 45 cases). Surgical complications included 20 cases of transient recurrent laryngeal nerve palsy, 16 cases of transient and one of permanent hypoparathyroidism, and one respiratory obstruction due to bilateral recurrent laryngeal nerve palsy that required temporary tracheostomy. Two patients were reoperated on due to bleeding. Ninety per cent of patients were discharged within 3 days of thyroidectomy. One hundred and fifty patients were evaluated for 131I treatment by a standardized dosimetry procedure 4 weeks after surgery. Dosimetry was also used to calculate therapeutic 131I doses. Seventy-six patients did not show a 131I uptake above background levels, 56 underwent therapeutic 131I, while in the 18 patients who showed an abnormal uptake of 131I it was decided not to give the therapeutic dose. The authors conclude that total thyroidectomy can be performed with a minimum of permanent disability in patients with malignant thyroid tumours. The theoretical and practical advantages of this kind of surgical strategy make it the treatment of choice for thyroid cancer.

Seventy cases of ureteropelvic junction obstruction, bilateral or unilateral, were followed prospectively throughout gestation and postnatally for an average of 2.3 years. Cases of ureteropelvic junction obstruction with a renal pelvis dilated less than 1 cm uniformly did well; those with a pyelectasis more than 2 cm, both bilateral and unilateral, had a favorable outcome in approximately three-quarters. Surprisingly, pelvis dilatation between 1-2 cm had a better outcome if bilateral than if unilateral.