Béla Tállai

Cancer-associated myositis: clinical features and prognostic signs.

Abstract: Idiopathic inflammatory myositis is characterized by progressive weakness of the proximal muscles. There is a higher risk of malignancy than in the normal population. The aim of this study was to evaluate the frequency of malignancy among 251 myositis patients. We also compared clinical and immunological characteristics of cancer‐associated myositis with primary myositis. There were no malignancies among polymyositis, overlap, or juvenile myositis patients. Twenty‐two of ninety dermatomyositis patients also had a malignant disease. Patients with cancer‐associated dermatomyositis were significantly older than primary myositis patients and had more severe cutaneous and muscle symptoms. Dysphagia and diaphragmatic involvement were more frequent among cancer‐associated patients, while extramuscular features were less frequent. After successful treatment of the malignancy, we were able to manage myositis symptoms. One‐year survival rate was significantly better in primary dermatomyositis patients. The subset of cancer‐associated myositis differs from primary myositis in many aspects of its clinical and immunological features. Prognosis and life expectancy in cancer‐associated myositis patients is determined by the underlying malignant disease. Therefore, age‐ and sex‐specific examinations for detection of an underlying malignancy are important in the management of patients with dermatomyositis.

Simultaneous bilateral percutaneous nephrolithotomy in children.

In the paediatric section, two papers relating to the upper urinary tract are presented. The first, from Hungary, describes simultaneous bilateral percutaneous nephrolithotomy in 13 patients, where it was deemed feasible; this is the first such report. Authors from London report on unilateral nephrectomy in patients with nephrogenic hypertension, and found that it was successful in normalising blood pressure in patients with renal hypertension with a normal contralateral kidney.

Prostate cancer underlying acute, definitive dermatomyositis: successful treatment with radical perineal prostatectomy

The idiopathic inflammatory myopathies are systemic autoimmune diseases characterized by chronic inflammation leading to progressive weakness of the proximal muscles. In 7–66% of cases of adult dermatomyositis different malignant tumours can promote the difficult cascade mechanisms at the cell level, leading to rapid weakness of skeletal muscles [1]. We report on a patient with all characteristic signs of acute, severe dermatomyositis associated with a low-grade, low-stage prostate cancer cured by radical perineal prostatectomy.

Percutaneous Ureterolithotomy: Direct Method for Removal of Impacted Ureteral Stones

PURPOSE We report 52 percutaneous urterolithotomies in 51 patients having large, impacted middle ureteral stones. Direct percutaneous stone removal can be performed as successfully as in cases of renal stones treated with percutaneous nephrolithotomy. METHODS The operation is performed under local anesthesia; therefore, the procedure is quicker and simpler than the laparoscopic or retroperitoneoscopic intervention. All patients became stone free. In two patients (4%), ultrasound disintegration was necessary; in the remaining cases, there was no need for any fragmentation: the stone was removed intact. A retroperitoneal drain was always left at the end of the procedure. With the exception of two cases, the ureter was always stented without closure of the ureteral incision. RESULTS Fever (> or = 38 degrees C) was observed in 15 patients (29%) for 2 days. Retroperitoneal hematoma 5 cm in diameter was seen in one patient. One patient had urine leakage through the retroperitoneal drain in the postoperative period for 18 days. Also, one patient came back 3 days after discharge with urine leakage through the percutaneous retroperitoneal tract. CONCLUSION Direct percutaneous ureterolithotomy is an effective way to remove impacted middle ureteral stones but is advisable only for endourologists with considerable experience.

Very Late Relapse of Testicular Tumour in Combination with Renal Cancer and Their Retroperitoneoscopic Removal

Late relapse of a testicular cancer is an uncommon occurrence. We report a case of late relapse of a testicular tumour combined with a renal cancer and their successful removal with retroperitoneoscopy. The 36-year-old patient underwent left orchiectomy, retroperitoneal lymph node dissection, and chemotherapy, because of mixed tumor including teratoma and embryonal carcinoma. 18 years after the successful primary therapy elevated serum alpha-fetoprotein level had been confirmed, then MRI and PET-CT scans demonstrated a 30 mm left renal mass and 22 mm retroperitoneal lymph node above the bifurcation of the left common iliac artery. We performed retroperitoneoscopic lymph node dissection and left renal tumour resection in the same session. The histology revealed embryonal carcinoma for the retroperitoneal lymph node and renal cell carcinoma for the left renal mass. We can conclude that late followup of patients with testicular tumour is important. Retroperitoneoscopy is feasible approach for the removal of retroperitoneal lymph node metastasis and resection of renal tumor.

Percutaneous Endoscopic Ureterolithotomy of Two Different Stones in a Single Session

The authors report a rare case of percutaneous endoscopic ureterolithotomy of 2 ureteral stones. Extracorporeal shock-wave lithotripsy (SWL) treatment of the renal stone was performed. The stone was crushed into 2 pieces, with 1 of them located in the upper part, and the other in the middle part of the ureter. Further SWL treatments and ureteroscopy were unsuccessful. The authors then decided to perform a percutaneous ureterolithotomy. In conclusion, percutaneous ureterolithotomy is a good choice of treatment, when ureteral stones cannot be removed by SWL or ureteroscopy.