Search

In previous case-reports of Essure microinsert perforation, the microinsert was successfully removed at laparoscopy. Herein is discussed the scenario of persistent pelvic pain over several years after an apparently successful laparoscopic retrieval of a perforating right-sided microinsert. In the interim, the patient underwent 2 unsuccessful exploratory laparotomy procedures in an attempt to retrieve additional microinsert fragments that had perforated the uterus. Successful management of Essure microinsert perforation in this patient ultimately required use of intraoperative fluoroscopy. Surgeons performing laparoscopy or laparotomy to retrieve Essure microinserts that have perforated should be aware that these are not always visible to the naked eye, and there should be a low threshold to use intraoperative fluoroscopy to ensure that all perforating fragments have been removed., (Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.)

On the first inertial-confinement-fusion ignition facility, the target capsule will be DT filled through a long, narrow tube inserted into the shell. microg-scale shell perturbations Delta m' arising from multiple, 10-50 microm-diameter, hollow SiO2 tubes on x-ray-driven, ignition-scale, 1-mg capsules have been measured on a subignition device. Simulations compare well with observation, whence it is corroborated that Delta m' arises from early x-ray shadowing by the tube rather than tube mass coupling to the shell, and inferred that 10-20 microm tubes will negligibly affect fusion yield on a full-ignition facility.

Transitional cell carcinoma of the upper urinary tract with inferior vena cava tumor thrombus is an unusual entity. We report the 16th such case and review the previous cases in the world literature. Preoperative diagnosis was correct in only 5 of the cases. This type of condition can be easily presumed to be renal cell carcinoma. Fifteen of the cases were managed with radical nephrectomy; 8 patients were managed with partial or complete resection of the vena cava due to adherence of the tumor thrombus to the vessel wall. Overall outcome was poor, with short postoperative survival. Correct preoperative diagnosis, although difficult, could allow more complete preoperative planning or appropriate nonoperative management.

Eight infants with histories of apnea and cyanosis were referred to the Southwest SIDS Research Institute for evaluation of apparent life threatening events (ALTE). All of the infants had been treated for colic with a 1:1 concentration of dimenhydrinate (Dramamine) and phenobarbital, hyoscyamine sulfate, atropine sulfate and scopolamine hydrobromide (Donnatal). The medication was pre-mixed by local pharmacists. A comprehensive work-up failed to reveal a cause for the ALTE in any infant. The Dramamine/Donnatal mixture was withdrawn and polygraphic evaluation was conducted. Cardiorespiratory abnormalities were identified in all eight infants and significant gastroesophageal reflux (GER) was documented in four. The possibility that colic medication contributes to cardiorespiratory instability and GER in vulnerable infants requires serious consideration and further evaluation.

To determine the usefulness of the Bosniak classification of cystic renal masses, the computed tomographic (CT) and ultrasound findings of 16 pathologically proven cystic renal masses were retrospectively reviewed. All imaging studies were reviewed and categorized utilizing the Bosniak classification without knowledge of the final pathologic diagnosis. There were no category I lesions (classical simple cyst), four category II (minimally complicated), seven category III lesions (more complicated), and five category IV lesions (probable malignant). All category II lesions were benign, all category IV lesions were malignant. Of the seven category III lesions, three were benign and four were malignant. We conclude that the Bosniak classification is extremely useful in the management of cystic renal masses.

A patient with extraosseous myxoid chondrosarcoma arising from the spermatic cord had nine local recurrences and ultimately two metastatic lung lesions over an eleven-year-period from the time of diagnosis.

We report on a patient with von Hippel-Lindau disease. Exploration revealed 15 solid tumors and 18 cysts filled with clear fluid throughout both kidneys. All solid tumors consisted of clear cells consistent with renal cell carcinoma. All cysts were lined with similar clear cells. The solid tumors contained areas of clear cells surrounding small cystic spaces and the large cysts appeared to be an exaggeration of this phenomenon. There is a place for radical ablative surgery in patients with multiple renal cell carcinomas in von Hippel-Landau disease. Unroofing and gross examination of apparently simple cysts may not be adequate to rule out the presence of carcinoma in these patients.

Peritonoscopy is a widely used procedure in diagnosis and surgery with few post-procedural complications. We report a case in which pneumoscrotum occurred as a procedural complication of peritonoscopy. Anatomic considerations are considered. The condition resolves without therapy, and only patient reassurance is indicated.

A retrospective review of blood types of patients undergoing retroperitoneal lymphadenectomy was performed and revealed a significant number of patients had type A blood. No known normal population has this high percentage of type A blood. We believe this may suggest a genetic predisposition of patients with Type A blood to have nonseminomatous germinal cell carcinoma.