No abstract

Burch colposuspension is considered to be the gold standard for the surgical treatment of genuine stress incontinence in women. Short-term cure rates are as high as 90%. (Jarvis, 1994). The long-term (10 or more years) cure rate of 62% in this study confirms the time dependent decline in efficacy.

O varian cancer remains one of the comm onest causes of death in women within the 40± 70 year age group and it is known that bilateral oophorectomy is still the only available method of prevention of ovarian cancer. This practice should be reviewed if the rate of compliance with H orm one replacem ent therapy (HRT ) after a bilateral oophorectomy is as poor as it is suggested in the general population.Hormone replacem ent therapy alleviates vasomotor s ym ptom s and protec ts ag ainst osteoporosis and cardiovascular disease. There is also recent evidence that it may delay the onset of and decrease the risk of A lzheim er's disease (Tang et al., 1996).A ll pat ie nts at B ene nd en H o spital w ho had undergone bilateral oophorectomy and hysterectomy from January 1993 to August 1995 (and so had a m inimum of 2 years follow up) were identi® ed. Exclusion criteria included, wom en aged over 65 at the time of hysterectomy, wom en having a hysterectomy for m alignan t disease, the presence of severe endometriosis and all with a contraindication to hormone replacement therapy. The women were than contacted, to assess their use of hormone replacement. ResultsO ut of 266 patients identi® ed, 207 patients replied. The m edian age of the patients who responded was 50 years, with a range of 35 to 65 years. One hundred and ninety (91´8% ) of the women were taking HRT at the time of the survey and of these 68 (35´7% ) had changed preparations at som e time.Thirty-six (17´4% ) patients were already taking HRT before hysterectomy. The m ajority (65´6% ) used oral H RT. On discharge from hospital, 20 (9´7% ) patients were prescribed oral oestrogens, 126 (60´7% ) patients received oestrogen patches and 61 (29´6% ) patients had oestradiol implants inserted.

BACKGROUND: Chromophobe (Chr RCC) is a distinctive entity of Renal Cell Carcinoma (RCC) arising from cortical portion of collecting duct of kidneys with an incidence of 3-5% (1). Localized Cromophobe RCC suggests a better prognosis than other type of RCC but there is a poorer outcome with sarcomatoid features or metastatic disease (1). Renal cell carcinoma is one of the few tumors known to metastasize to the pancreas (2). Metastatic pancreatic cancer is rare, accounting for approximately 2% of all pancreatic malignancies, and most cases arise from renal cell carcinoma (3). Of patients with pancreatic metastases, 12% present with synchronous extra pancreatic metastasis, and they have a poor prognosis. Chromophobe RCC presenting as obstructive jaundice and gastric outlet obstruction has been cited infrequently in literature (3). The purpose of this paper is two: first, a rare case ChRCC with atypical presentation with obstructive jaundice, gastric outlet obstruction and pancreatic metastasis. Second, multidisciplinary treatment involving General surgeon, Medical Gastroenterologist, Surgical Gastroenterologist, Urologist, Interventional Radiologist and a Medical oncologist. CASE PRESENTATION: A 43 years old female presenting with features of obstructive jaundice and gastric outlet obstruction in surgical outpatient. A multidisciplinary management approach found Metastatic ChRCC the cause for gastrointestinal manifestation. CONCLUSIONS: ChRCC can be local invasion or metastatic. There are multiple sites where metastases can occur. There are many specific investigations to confirm RCC and concomitant gastric outlet obstruction (GOO), obstructive jaundice and pancreatic secondaries. This patient was diagnosed early after presentation of acute symptoms, decompression of biliary system done early by PTBD, Radical nephrectomy done with Portahepatis node which was causing obstructive jaundice and gastric outlet obstruction. Frozen section biopsy from pancreas and liver secondaries were positive for ChRCC. After surgery patient recovered without any immediate or late post-operative complications. Started on chemotherapy and doing well after 6 months follow up.