James D. Daughtry

Pulmonary Embolus Presenting as the Initial Manifestation of Renal Cell Carcinoma

Recent literature suggests that pulmonary embolus secondary to renal cell carcinoma may by more common than previously suspected. Renal tumors are known for their ability to metastasize early, often before the primary lesion is apparent. A patient with renal cell carcinoma and having massive pulmonary tumor embolus is presented. Attention was called to the occult tumor by the identification of clear cell carcinoma in the pulmonary embolic material. Pulmonary embolectomy and surgical extirpation of the primary tumor resulted in long-term survival.

Ileal Conduit and Cystectomy: A 10-Year Retrospective Study of Ileal Conduits Performed in Conjunction with Cystectomy and with a Minimum 5-Year Followup

AbstractA 10-year retrospective study was done on 55 patients with primary carcinoma of the bladder who underwent cystectomy with ileal conduit urinary diversion. The 5-year survival rate was 52 per cent for patients with stages O, A and Bl tumors, 45 per cent for those with stages B2 and C tumors and 0 per cent for those with stage D tumors. Patients with squamous cell carcinoma had the worst prognosis, with no patients surviving more than 2 years.Operative mortality rate was 8.9 per cent and all deaths occurred in patients undergoing radical cystectomy and pelvic lymphadenectomy. The operative mortality in this group was 16 per cent, versus no mortality in 24 patients undergoing simple cystectomy. Since no patient with positive pelvic nodes lived more than 20 months postoperatively there appears to be little justification in recommending routine pelvic lymphadenectomy in patients with operable bladder carcinoma.We believe that preoperative radiation added to the morbidity rate and increased the incidenc...

Balloon dilatation of urethral strictures

Balloon dilatation of the urethra in 9 male patients with either post-inflammatory or post-traumatic strictures was successfully performed. This procedure is primarily indicated in those patients with unsatisfactory results using conventional dilatation with metal sounds. A flexible endoscope was used for guide wire passage and fluoroscopic guidance for positioning the balloon and assuring complete dilatation of the urethral strictures or vesical neck contracture. In this manner, dilatation to 36 F can be performed in a relatively atraumatic manner with minimal discomfort.

Complications of renal cyst exploration versus renal mass aspiration

This report presents a comparison of the complications of surgical exploration with unroofing and renal cyst puncture. Two hundred fifty-five patients were operated on, with a mortality rate of 1 per cent and a morbidity rate of 28 per cent. The complications in 63 patients examined by mass aspiration included a morbidity rate of 6.4 per cent and no mortality. The possibilities of over-looking carcinomas through cyst aspiration are weighed against the demonstrated morbidity of surgical exploration and found to be much less significant. The authors recommend that an asymptomatic renal mass that radiographically appears to be a cyst and is unaccompanied by urine changes or clinical stigmata of renal neoplasia be treated by cyst aspiration and not subjected to surgical exploration.

Palatal metastases in renal cell carcinoma

Renal cell carcinoma may metastasize early in its course and sometimes before the primary lesion becomes apparent. Two cases of renal cell carcinoma with the initial manifestation of metastases to the roof of the mouth are presented. The mode of metastases to the palate is discussed.

Pulmonary embolus presenting as initial manifestation of renal cell carcinoma

Pulmonary emboli from renal cell carcinoma may be more common than previously suspected. A case is reported of renal cell carcinoma presenting with a massive pulmonary embolus. Pulmonary embolectomy followed by radical nephrectomy with venocavotomy and tumor thrombectomy was successfully performed.

Balloon dilation of prostatic urethra

Retrograde balloon catheter dilation of the prostatic urethra was performed for the management of bladder outlet obstruction secondary to prostatic hyperplasia. Of the 55 patients in our series, 43 were treated entirely as outpatients and 12 were inpatients for unrelated conditions. The patient selection was limited to older, high-risk patients who were poor surgical candidates for transurethral resection of the prostate or suprapubic prostatectomy because of underlying medical problems. Twenty-two of these patients had Foley catheters for relief of their outflow obstructions. The procedures were performed under local anesthesia or intravenous sedation. Successful results were noted in 46 of 55 patients with relief of symptoms for up to twenty-six months. In 9 cases the procedures were unsuccessful and transurethral resection of the prostate was required.

Multilocular cysts of kidney: A diagnostic dilemma

Multilocular cyst of the kidney is a rare pathologic entity occurring in both children and adults. Although diagnosis cannot be firmly established preoperatively, the use of intravenous pyelography, angiography, ultrasonography, and delta scan may aid in its diagnosis. Because of the difficulty in accurate diagnosis and the documented association with renal neoplasia, we recommend exploration and possible nephrectomy as the treatments of choice.

A Case of a Giant Pheochromocytoma

A case of a large pheochromocytoma weighing 1,150 gm. is reported. The surgical approach to this massive tumor is discussed. Early recognition of the various clinical and metabolic manifestations of the tumor are important objectives in the cure of this potentially lethal neoplasm.

Pneumocalyx following percutaneous nephrostolithotomy.

We present an interesting and unusual case of persistent gas within the renal collecting system occurring two days after percutaneous nephrostolithotomy.