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Sample records for subtotal nephrectomy role

  1. Effects of maternal subtotal nephrectomy on the development of the fetal kidney: A morphometric study.

    PubMed

    Kondo, Tomohiro; Kitano-Amahori, Yoko; Nagai, Hiroaki; Mino, Masaki; Takeshita, Ai; Kusakabe, Ken Takeshi; Okada, Toshiya

    2015-11-01

    The present study was designed to explore if maternal subtotal (5/6) nephrectomy affects the development of fetal rat kidneys using morphometric methods and examining whether there are any apoptotic changes in the fetal kidney. To generate 5/6 nephrectomized model rats, animals underwent 2/3 left nephrectomy on gestation day (GD) 5 and total right nephrectomy on GD 12. The fetal kidneys were examined on GDs 16 and 22. A significant decrease in fetal body weight resulting from maternal 5/6 nephrectomy was observed on GD 16, and a significant decrease in fetal renal weight and fetal body weight caused by maternal nephrectomy was observed on GD 22. Maternal 5/6 nephrectomy induced a significant increase in glomerular number, proximal tubular length, and total proximal tubular volume of fetuses on GD 22. Maternal 5/6 nephrectomy resulted in an increase in the number of apoptotic cells in the metanephric mesenchyme of the kidney on GD 16, and in the collecting tubules on GD 22. These findings suggest that maternal 5/6 nephrectomy stimulates the development of the fetal kidney while suppressing fetal growth.

  2. Cardiovascular parameters in rat model of chronic renal failure induced by subtotal nephrectomy.

    PubMed

    Svíglerová, J; Kuncová, J; Nalos, L; Tonar, Z; Rajdl, D; Stengl, M

    2010-01-01

    Chronic renal failure (CRF) is associated with high incidence of cardiovascular complications. To clarify pathogenesis of CRF numerous animal models have been developed. The aim of our work was to describe methodology of subtotal surgical renal ablation in rat and to characterize some biochemical and cardiovascular parameters of this animal model. Male rats underwent 5/6 surgical nephrectomy or sham operations in two steps. The following parameters were measured on day 10 and in week 10 after the surgery: plasma concentrations of creatinine and urea, blood pressure, resting heart rate, chronotropic response to atropine and metipranol, heart ventricles weight, contraction parameters and action potential duration in the left ventricle. Increased serum concentrations of creatinine and urea, decreased creatinine clearance, polyuria and alteration of the remnant kidney tissue were found in CRF rats. Changes in cardiovascular parameters identified after subtotal nephrectomy resembled alterations of cardiovascular system in uremic patients and included hypertension, elevated resting heart rate, diminished parasympathetic cardiac tone, hypertrophy of the left ventricle associated with weakened force of contraction, prolonged contraction and relaxation and shortening of action potential duration. These data suggest that the present model can be a useful tool in the study of CRF and its cardiovascular complications.

  3. Subtotal nephrectomy inhibits the gastric emptying of liquid in awake rats

    PubMed Central

    da Graça, José Ronaldo Vasconcelos; Parente, Cynara Carvalho; Fiúza, Robério Ferreira; da Silva, Pedro Alberto Freitas; Mota, Bruno Teixeira; Salles, Luiz Derwal; Silva, Camila Meirelles de Souza; da Silva, Moisés Tolentino Bento; de Oliveira, Ricardo Brandt; dos Santos, Armenio Aguiar

    2015-01-01

    Homeostasis of blood volume (BV) is attained through a functional interaction between the cardiovascular and renal systems. The gastrointestinal tract also adjusts its permeability and motor behavior after acute BV imbalances. We evaluated the effect of progressive nephron loss on gut motility. Male Wistar rats were subjected or not (sham) to 5/6 partial nephrectomy (PNX) in two steps (0 and 7th day). After further 3, 7, or 14 days, PNX and sham operation (control) rats were instrumented to monitor mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), and blood collection for biochemical analysis. The next day, they were gavage fed with a liquid test meal (phenol red in glucose solution), and fractional dye recovery determined 10, 20, or 30 min later. The effect of nonhypotensive hypovolemia and the role of neuroautonomic pathways on PNX-induced gastric emptying (GE) delay were also evaluated. Compared with the sham-operated group, PNX rats exhibited higher (P < 0.05) MAP and CVP values as well as increased values of gastric dye recovery, phenomenon proportional to the BV values. Gastric retention was prevented by prior hypovolemia, bilateral subdiaphragmatic vagotomy, coelic ganglionectomy + splanchnicectomy, guanethidine, or atropine pretreatment. PNX also inhibited (P < 0.05) the marker's progression through the small intestine. In anesthetized rats, PNX increased (P < 0.05) gastric volume, measured by a balloon catheter in a barostat system. In conclusion, the progressive loss of kidney function delayed the GE rate, which may contribute to gut dysmotility complaints associated with severe renal failure. PMID:25677547

  4. Gender differences in the development of uremic cardiomyopathy following partial nephrectomy: Role of progesterone.

    PubMed

    Drummond, Christopher A; Buddny, George; Haller, Steven T; Liu, Jiang; Yan, Yanling; Xie, Zijian; Malhotra, Deepak; Shapiro, Joseph I; Tian, Jiang

    2013-01-31

    Gender difference has been suggested as a risk factor for developing cardiovascular and renal diseases in humans and experimental animals. As a major sex hormone, progesterone was reported to compete with cardiotonic steroid binding to Na/K-ATPase. Our previous publication demonstrated that cardiotonic steroids (e.g., marinobufagenin) play an important role in the development of experimental uremic cardiomyopathy. We also observed that the putative mineralocorticoid antagonists, spironolactone and its major metabolite canrenone, antagonize binding of cardiotonic steroids to Na/K-ATPase in a competitive manner and also ameliorate experimental uremic cardiomyopathy induced by partial nephrectomy. In the following studies, we noted that progesterone displayed competitive inhibition of cardiotonic steroid binding to Na/K-ATPase and partially inhibited collagen synthesis induced by marinobufagenin in cultured cardiac fibroblasts. Therefore, we sought to examine whether female rats displayed less uremic cardiomyopathy than male rats when subjected to partial nephrectomy. Although partial nephrectomy caused the induction of smaller increases in blood pressure of female rats, they appeared to be similarly susceptible to cardiac remodeling induced by partial nephrectomy in terms of hypertrophy and fibrosis as age-matched male rats. The possible explanations for our findings are therefore discussed. PMID:24404431

  5. Gender differences in the development of uremic cardiomyopathy following partial nephrectomy: Role of progesterone

    PubMed Central

    Drummond, Christopher A; Buddny, George; Haller, Steven T; Liu, Jiang; Yan, Yanling; Xie, Zijian; Malhotra, Deepak; Shapiro, Joseph I; Tian, Jiang

    2013-01-01

    Gender difference has been suggested as a risk factor for developing cardiovascular and renal diseases in humans and experimental animals. As a major sex hormone, progesterone was reported to compete with cardiotonic steroid binding to Na/K-ATPase. Our previous publication demonstrated that cardiotonic steroids (e.g., marinobufagenin) play an important role in the development of experimental uremic cardiomyopathy. We also observed that the putative mineralocorticoid antagonists, spironolactone and its major metabolite canrenone, antagonize binding of cardiotonic steroids to Na/K-ATPase in a competitive manner and also ameliorate experimental uremic cardiomyopathy induced by partial nephrectomy. In the following studies, we noted that progesterone displayed competitive inhibition of cardiotonic steroid binding to Na/K-ATPase and partially inhibited collagen synthesis induced by marinobufagenin in cultured cardiac fibroblasts. Therefore, we sought to examine whether female rats displayed less uremic cardiomyopathy than male rats when subjected to partial nephrectomy. Although partial nephrectomy caused the induction of smaller increases in blood pressure of female rats, they appeared to be similarly susceptible to cardiac remodeling induced by partial nephrectomy in terms of hypertrophy and fibrosis as age-matched male rats. The possible explanations for our findings are therefore discussed. PMID:24404431

  6. The role of laparoscopic nephrectomy in pediatric xanthogranulomatous pyelonephritis: a case report.

    PubMed

    F Brown, James; Chamberlain, Jennifer C; Roth, Christopher C

    2013-01-01

    Xanthogranulomatous pyelonephritis (XGP) is a rare chronic renal infection characterized by the destruction of renal parenchyma. Traditional treatment involves open radical nephrectomy, which is challenging due to the inflammatory process associated with XGP. More recently, laparoscopic nephrectomy has been employed successfully in adult XGP. We present a case of a six-year-old female child with XGP who was successfully treated by laparoscopic nephrectomy with minor complications. Our case demonstrates the safety and feasibility of laparoscopic nephrectomy for childhood XGP, indicating that it should be considered a management option in such cases. PMID:23533930

  7. Transplant nephrectomy

    PubMed Central

    Akoh, Jacob A

    2011-01-01

    About 10% of all renal allografts fail during the first year of transplantation and thereafter approximately 3%-5% yearly. Given that approximately 69 400 renal transplants are performed worldwide annually, the number of patients returning to dialysis following allograft failure is increasing. A failed transplant kidney, whether maintained by low dose immunosuppression or not, elicits an inflammatory response and is associated with increased morbidity and mortality. The risk for transplant nephrectomy (TN) is increased in patients who experienced multiple acute rejections prior to graft failure, develop chronic graft intolerance, sepsis, vascular complications and early graft failure. TN for late graft failure is associated with greater morbidity and mortality, bleeding being the leading cause of morbidity and infection the main cause of mortality. TN appears to be beneficial for survival on dialysis but detrimental to the outcome of subsequent transplantation by virtue of increased level of antibodies to mismatched antigens, increased rate of primary non function and delayed graft function. Many of the studies are characterized by a retrospective and univariate analysis of small numbers of patients. The lack of randomization in many studies introduced a selection bias and conclusions drawn from such studies should be applied with caution. Pending a randomised controlled trial on the role of TN in the management of transplant failure patients, it is prudent to remove failed symptomatic allografts and all grafts failing within 3 mo of transplantation, monitor inflammatory markers in patients with retained failed allografts and remove the allograft in the event of a significant increase in levels. PMID:24175187

  8. The role of embolization in the management of tumour recurrence after radical nephrectomy.

    PubMed

    Akhtar, Kashif; Lee, George; Khan, Masood; Mitchell, Adam; Livni, Naomi; Christmas, Timothy

    2010-01-01

    This article presents the case of a 56-year-old woman who developed a tumour recurrence following radical nephrectomy. This was invading the descending colon and causing severe gastrointestinal haemorrhage. Angiography revealed neovascularization from T11 and T12 intercostal arteries, which were successfully embolized percutaneously.

  9. The role of the assistant during robot-assisted partial nephrectomy: does experience matter?

    PubMed

    Potretzke, Aaron M; Knight, Brent A; Brockman, John A; Vetter, Joel; Figenshau, Robert S; Bhayani, Sam B; Benway, Brian M

    2016-06-01

    The objective of this study was to evaluate surgical outcomes with respect to the experience level of the bedside assistant during robot-assisted partial nephrectomy. A retrospective review was conducted of a prospectively maintained database of 414 consecutive robot-assisted laparoscopic partial nephrectomies performed by experienced robotic surgeons at our institution from April 2011 to September 2014. A senior-level assistant was defined as a resident in his or her post-graduate year (PGY) 4 or 5, or a fellow. Junior-level assistants were considered to be PGY-2, PGY-3, or a nurse first assistant. Multivariate analyses were performed using linear, Poisson, and logistic regression models. There were 115 junior-level cases and 299 senior-level cases. On univariate analysis, the experience level of the assistant had no impact on operative time (168 for junior level vs. 163 min for senior level, p = 0.656). Likewise, there were no differences between the junior- and senior-level groups with regard to warm ischemia time (21.3 vs. 20.9 min, p = 0.843), negative margin status (111/115 (96.5 %) vs. 280/299 (93.6 %), p = 0.340), or postoperative complications (17/115 (14.8 %) vs. 35/299 (11.7 %), p = 0.408). After multivariate analysis, operative time was associated with increased body mass index and tumor size (both p < 0.001), but not with resident experience level (p = 0.051). Estimated blood loss and postoperative complications were also not associated with the PGY of the assistant (p = 0.488 and p = 0.916, respectively). Despite common concern, the PGY status of a physician trainee serving as the bedside assistant does not appear to influence the outcomes of robot-assisted partial nephrectomy at a high-volume center. PMID:27039192

  10. Robotic partial nephrectomy: current technique and outcomes.

    PubMed

    Wang, Liang; Lee, Benjamin R

    2013-09-01

    Over the past decade, management of the T1 renal mass has focused on nephron-sparing surgery. Robotic partial nephrectomy has played an increasing role in the technique of preserving renal function by decreasing warm ischemia time, as well as optimizing outcomes of hemorrhage and fistula. Robot-assisted partial nephrectomy is designed to provide a minimally-invasive nephron-sparing surgical option utilizing reconstructive capability, decreasing intracorporeal suturing time, technical feasibility and safety. Ultimately, its benefits are resulting in its dissemination across institutions. Articulated instrumentation and three-dimensional vision facilitate resection, collecting system reconstruction and renorrhaphy, leading to decreased warm ischemia time while preserving oncological outcomes. The aim of the present review was to present our surgical sequence and technique, as well as review the current status of robot-assisted partial nephrectomy.

  11. Cytoreductive nephrectomy for metastatic renal cell carcinoma.

    PubMed

    Chery, Lisly J; Karam, Jose A; Wood, Christopher G

    2016-09-01

    The incidence of renal cell carcinoma is increasing, with up to one-third of patients presenting with metastatic disease. Combination therapy is used to prolong survival in patients with metastatic renal cell carcinoma, which carries a poor prognosis. Although two pivotal phase 3 trials have demonstrated the efficacy of immunotherapy after cytoreductive nephrectomy for metastatic disease, for now, targeted therapy has replaced immunotherapy as the preferred systemic treatment in these patients. Two ongoing phase 3 trials are evaluating the role of cytoreductive nephrectomy prior to targeted therapy. Proper patient selection is paramount in achieving successful outcomes. PMID:27673288

  12. Lipoic acid does not improve renal function markers in 5/6 nephrectomy model: possible role of Nrf2 inactivation.

    PubMed

    Lo, Sze M; Dal Lin, Fernando T; Soares, Maria F; Hauser, Aline B; Pecoits-Filho, Roberto; Nakao, Lia S

    2016-01-01

    Chronic kidney disease (CKD) progression and complications are associated with increased oxidative stress, as well as with Nrf2 inactivation. Lipoic acid (LA) has been considered an inducer of Nrf2 antioxidant response. We tested whether oral administration of LA provides beneficial effects in experimental CKD in rats. Wistar rats underwent 5/6 nephrectomy (CKD group) or sham laparotomy. Seven days later, CKD group was divided into three subgroups that received: (i) LA continuously in the drinking water (100 mg/kg/day), (ii) LA by gavage every other day (100 mg/kg), or (iii) no LA treatment. LA treatment lasted until day 60. Plasma urea and creatinine, 24 h-proteinuria, glomerulosclerosis, interstitial fibrosis/tubular atrophy, and Nrf2 activation were analyzed. All parameters measured were significantly altered in the untreated CKD group, compared with the sham group, as expected. Oral LA administration, either in the drinking water or by gavage, did not improve significantly any parameter, comparing the treated-groups with the untreated CKD group. These results indicate that oral LA administration for 53 days was ineffective to reactivate Nrf2 in the remnant kidney of uremic rats, likely preventing improvements in biochemical and histopathological markers of renal function.

  13. Robot-assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy.

    PubMed

    Shiroki, Ryoichi; Fukami, Naohiko; Fukaya, Kosuke; Kusaka, Mamoru; Natsume, Takahiro; Ichihara, Takashi; Toyama, Hiroshi

    2016-02-01

    Nephron-sparing surgery has been proven to positively impact the postoperative quality of life for the treatment of small renal tumors, possibly leading to functional improvements. Laparoscopic partial nephrectomy is still one of the most demanding procedures in urological surgery. Laparoscopic partial nephrectomy sometimes results in extended warm ischemic time and severe complications, such as open conversion, postoperative hemorrhage and urine leakage. Robot-assisted partial nephrectomy exploits the advantages offered by the da Vinci Surgical System to laparoscopic partial nephrectomy, equipped with 3-D vision and a better degree in the freedom of surgical instruments. The introduction of the da Vinci Surgical System made nephron-sparing surgery, specifically robot-assisted partial nephrectomy, safe with promising results, leading to the shortening of warm ischemic time and a reduction in perioperative complications. Even for complex and challenging tumors, robotic assistance is expected to provide the benefit of minimally-invasive surgery with safe and satisfactory renal function. Warm ischemic time is the modifiable factor during robot-assisted partial nephrectomy to affect postoperative kidney function. We analyzed the predictive factors for extended warm ischemic time from our robot-assisted partial nephrectomy series. The surface area of the tumor attached to the kidney parenchyma was shown to significantly affect the extended warm ischemic time during robot-assisted partial nephrectomy. In cases with tumor-attached surface area more than 15 cm(2) , we should consider switching robot-assisted partial nephrectomy to open partial nephrectomy under cold ischemia if it is imperative. In Japan, a nationwide prospective study has been carried out to show the superiority of robot-assisted partial nephrectomy to laparoscopic partial nephrectomy in improving warm ischemic time and complications. By facilitating robotic technology, robot-assisted partial nephrectomy

  14. Living donor nephrectomy.

    PubMed

    Jacobs, S C; Flowers, J L; Dunkin, B; Sklar, G N; Cho, E

    1999-03-01

    The need for more organs for kidney transplantation is increasing. Cadaver sources for these organs are stable, therefore living donation must increase if the need is to be met. Less perfect kidneys are now being transplanted. The pool of potential donors is being expanded. The process of kidney donation is being made easier in an effort to increase the number of donors. The donor work-up is being streamlined. Laparoscopic donor nephrectomy has been introduced, and appears to be promising as a technique of lessening donor pain and suffering, while maintaining excellent graft results.

  15. Laparoscopic donor nephrectomy.

    PubMed

    Deger, S; Giessing, M; Roigas, J; Wille, A H; Lein, M; Schönberger, B; Loening, S A

    2005-01-01

    Laparoscopic live donor nephrectomy (LDN) has removed disincentives of potential donors and may bear the potential to increase kidney donation. Multiple modifications have been made to abbreviate the learning curve while at the same time guarantee the highest possible level of medical quality for donor and recipient. We reviewed the literature for the evolution of the different LDN techniques and their impact on donor, graft and operating surgeon, including the subtleties of different surgical accesses, vessel handling and organ extraction. We performed a literature search (PubMed, DIMDI, medline) to evaluate the development of the LDN techniques from 1995 to 2003. Today more than 200 centres worldwide perform LDN. Hand-assistance has led to a spread of LDN. Studies comparing open and hand-assisted LDN show a reduction of operating and warm ischaemia times for the hand-assisted LDN. Different surgical access sites (trans- or retroperitoneal), different vessel dissection approaches, donor organ delivery techniques, delivery sites and variations of hand-assistance techniques reflect the evolution of LDN. Proper techniques and their combination for the consecutive surgical steps minimize both warm ischaemia time and operating time while offering the donor a safe minimally invasive laparoscopic procedure. LDN has breathed new life into the moribund field of living kidney donation. Within a few years LDN could become the standard approach in living kidney donation. Surgeons working in this field must be trained thoroughly and well acquainted with the subtleties of the different LDN techniques and their respective advantages and disadvantages. PMID:16754618

  16. Rectal mucocoele following subtotal colectomy for colitis.

    PubMed

    Appleton, N; Day, N; Walsh, C

    2014-09-01

    We present a unique case of a rectal mucocoele affecting a patient several years after his subtotal colectomy for ulcerative colitis. This was secondary to both a benign anorectal stenosis and a benign mucus secreting rectal adenoma. This case highlights the importance of surveillance in such patients.

  17. Chylous ascites as a complication of laparoscopic donor nephrectomy.

    PubMed

    Caumartin, Yves; Pouliot, Frédéric; Sabbagh, Robert; Dujardin, Thierry

    2005-12-01

    Laparoscopic living donor nephrectomy (LLDN) is a minimally invasive technique for kidney procurement and was developed with the hope of reducing the disincentives associated with live renal donation. Compared with open donor nephrectomy (ODN), this alternative has many advantages including less postoperative pain and earlier return to work. Unfortunately, these benefits are sometimes negated by postoperative complications. Among these, chylous ascites (CA) is a rare but serious problem that is usually managed conservatively. We report the case of a living donor who developed CA refractory to initial conservative management and surgical treatment. We also discuss the role of surgery in the treatment of CA following LLDN. PMID:16297058

  18. [Subtotal colectomy with ceco-rectal anastomosis].

    PubMed

    Messinetti, S; Giacomelli, L; Pulcini, A; Fabrizio, G; Finizio, R; Granai, A V

    1994-01-01

    A case of subtotal colectomy cecoproctostomy for multiple lesions of the colon is introduced. This procedure has advantages over ileoproctostomy because it spares the terminal ileum, ileocecal junction and cecum. Due to the high incidence of bowel movements after the ileoproctostomy operation, the authors recommend cecoproctostomy as a valid choice in a selectioned group of patients with multiple or extended lesions that spares cecum and rectum.

  19. Subtotal splenectomy for splenomegaly in cirrhotic patients

    PubMed Central

    Chu, Haibo; Liu, Xiaofang; Zhao, Jianhua; Xu, Yongbo; Wang, Lei; Wang, Tao; Guo, Wenjun; Zhang, Shengming; Zhu, Xiaoji

    2014-01-01

    Background: In recent years, the spleen has become to be recognized as the “control center” of the immune-metabolic-endocrine network. However, It is controversial that splenomegaly due to portal hypertension is treated by subtotal splenectomy. The aim of this study was to evaluate the distribution of fibrous tissue, morphology of cells as well as splenic size, hemodynamics, hematological and immunological indexes in the residual spleen after subtotal splenectomy. This information may help finding the basis for the operation of subtotal splenectomy. Methods: Ten cases of splenomegaly due to portal hypertension were investigated. Two groups were created: Splenomegaly and Residual spleen. Control group was 10 cases of trauma-induced splenic rupture. Samples were sliced, and morphological changes were observed under light microscopy and electron microscopy. Indexes of splenic size, hemodynamics, hematology and immunology of the spleen were measured. Results: Under light microscopy, the number of collagen fibers and elastic fibers was increased, and the number of reticular fibers was decreased in the residual spleen and splenomegaly groups. Under electron microscopy, the ultrastructure of endothelial cells, lymphocytes, macrophages, and reticular cells in the residual spleen group were noticeably improved more than in the splenomegaly group. Flow volume in the residual spleen and portal vein decreased obviously, with number of platelet rising to normal, and there was no significant difference in the indexes of immunology. Conclusion: After subtotal splenectomy, the residual spleen will not experience a high-pressure environment, and the fibrosis of splenic tissue and remodelling of corpuscular morphology will cease. PMID:25197369

  20. Effects of low protein intake on the development of the remaining kidney in subtotally nephrectomized immature rats: apoptosis and epidermal growth factor.

    PubMed

    Mino, Masaki; Nakamura, Jun; Nakamuta, Nobuaki; Morioka, Hiroshi; Morikawa, Yoshio; Okada, Toshiya

    2007-03-01

    Effects of low protein intake on the development of the remaining kidney in subtotally (5/6) nephrectomized immature rats were examined. Three week-old weaning rats were kept on a diet containing either 12% (Lp rats) or 18% (Np rats) protein for 4 or 8 weeks after subtotal nephrectomy. Blood urea nitrogen (BUN) concentration was determined at 2, 4, 6, and 8 weeks after 5/6 nephrectomy. At 4 or 8 weeks after the operation, glomerular sclerosis and tubulointerstitial damage were assessed by a standard semiquantitative analysis and were expressed as the glomerular sclerosis index (GSI) and interstitial fibrosis score (IFS), respectively. The localization of DNA fragmented cells in the kidney was examined by the terminal deoxynucleotidyl transferase (TdT) -mediated d-UTP-biotin nick end labeling (TUNEL) method and the localization of the epidermal growth factor (EGF) by immunohistochemical methods. BUN concentration was significantly lower in the Lp rats compared with that in the Np rats. Both 4 and 8 weeks after subtotal nephrectomy, GSI and incidence of TUNEL positive cells in the distal tubules were significantly lower in the Lp rats than in the Np rats. Four weeks after the operation, IFS was significantly lower in the Lp rats than in the Np rats. Four and 8 weeks after the operation, EGF positive cells in the distal tubules were more observed in the Lp rats than in the Np rats. These findings reveal that protein restriction is effective in preventing renal tubular scarring in immature rats and that EGF is involved in the process of this prevention.

  1. [Laparoscopic partial nephrectomy: technique and outcomes].

    PubMed

    Colombo, J R; Gill, I S

    2006-05-01

    The indication of laparoscopic partial nephrectomy (LPN) has evolved considerably, and the technique is approaching established status at our institution. Over the past 5 years, the senior author has performed more than 450 laparoscopic partial nephrectomies at the Cleveland Clinic. Herein we present our current technique, review contemporary data and oncological outcomes of LPN.

  2. Partial nephrectomy: an option in calculus disease?

    PubMed

    Timoney, A G; Payne, S R; Walmsley, B H; Vinnicombe, J; Abercrombie, G F

    1988-12-01

    Thirty-seven patients treated by partial nephrectomy for calculus disease between 1971 and 1986 were reviewed retrospectively. Of the 25 patients available for analysis, 20% developed immediate surgical complications, 20% had residual post-operative stone and 33% developed true ipsilateral stone recurrence during the period of follow-up. Our results from partial nephrectomy for calculus disease are compared with the results of treatment by percutaneous nephrolithotomy and extracorporeal shockwave lithotripsy. It was concluded that partial nephrectomy should be reserved for situations where stone disease is associated with anatomical abnormalities which cannot be treated by the newer modalities of stone management.

  3. Partial nephrectomy in a patient with dwarfism.

    PubMed

    Farber, Nicholas J; Dubin, Justin; Parihar, Jaspreet; Han, Chris; Lasser, Michael S

    2016-08-01

    We describe the case of a 50-year-old male with achondroplastic dwarfism who presents with a renal mass in his left kidney concerning for renal cell carcinoma. The patient successfully underwent a robotic partial nephrectomy, which revealed a T1a renal cell carcinoma. The tumor was excised successfully without any intraoperative complications demonstrating that a robotic partial nephrectomy is technically both safe and effective in patients with achondroplastic dwarfism. PMID:27544562

  4. Palpation thyroiditis following subtotal parathyroidectomy for hyperparathyroidism

    PubMed Central

    Madill, Elizabeth M; Cooray, Shamil D

    2016-01-01

    Summary Thyrotoxicosis is an under-recognised but clinically important complication of parathyroidectomy. We report a case of a 37-year-old man with tertiary hyperparathyroidism who initially developed unexplained anxiety, diaphoresis, tachycardia, tremor and hyperreflexia one day after subtotal parathyroidectomy. Thyroid biochemistry revealed suppressed thyroid stimulating hormone and elevated serum free T4 and free T3 levels. Technetium-99m scintigraphy scan confirmed diffusely decreased radiotracer uptake consistent with thyroiditis. The patient was diagnosed with thyrotoxicosis resulting from palpation thyroiditis. Administration of oral beta-adrenergic antagonists alleviated his symptoms and there was biochemical evidence of resolution fourteen days later. This case illustrates the need to counsel patients about thyroiditis as one of the potential risks of parathyroid surgery. It also emphasises the need for biochemical surveillance in patients with unexplained symptoms in the post-operative period and may help to minimise further invasive investigations for diagnostic clarification. Learning points Thyroiditis as a complication of parathyroidectomy surgery is uncommon but represents an under-recognised phenomenon. It is thought to occur due to mechanical damage of thyroid follicles by vigorous palpation. Palpation of the thyroid gland may impair the physical integrity of the follicular basement membrane, with consequent development of an inflammatory response. The majority of patients are asymptomatic, however clinically significant thyrotoxicosis occurs in a minority. Patients should be advised of thyroiditis/thyrotoxicosis as a potential complication of the procedure. Testing of thyroid function should be performed if clinically indicated, particularly if adrenergic symptoms occur post-operatively with no other cause identified. PMID:27482385

  5. Renal parenchymal histopathology predicts life-threatening chronic kidney disease as a result of radical nephrectomy.

    PubMed

    Sejima, Takehiro; Honda, Masashi; Takenaka, Atsushi

    2015-01-01

    The preoperative prediction of post-radical nephrectomy renal insufficiency plays an important role in the decision-making process regarding renal surgery options. Furthermore, the prediction of both postoperative renal insufficiency and postoperative cardiovascular disease occurrence, which is suggested to be an adverse consequence caused by renal insufficiency, contributes to the preoperative policy decision as well as the precise informed consent for a renal cell carcinoma patient. Preoperative nomograms for the prediction of post-radical nephrectomy renal insufficiency, calculated using patient backgrounds, are advocated. The use of these nomograms together with other types of nomograms predicting oncological outcome is beneficial. Post-radical nephrectomy attending physicians can predict renal insufficiency based on the normal renal parenchymal pathology in addition to preoperative patient characteristics. It is suggested that a high level of global glomerulosclerosis in nephrectomized normal renal parenchyma is closely associated with severe renal insufficiency. Some studies showed that post-radical nephrectomy severe renal insufficiency might have an association with increased mortality as a result of cardiovascular disease. Therefore, such pathophysiology should be recognized as life-threatening, surgically-related chronic kidney disease. On the contrary, the investigation of the prediction of mild post-radical nephrectomy renal insufficiency, which is not related to adverse consequences in the postoperative long-term period, is also promising because the prediction of mild renal insufficiency might be the basis for the substitution of radical nephrectomy for nephron-sparing surgery in technically difficult or compromised cases. The deterioration of quality of life caused by post-radical nephrectomy renal insufficiency should be investigated in conjunction with life-threatening matters.

  6. Hand-assisted laparoscopic living-donor nephrectomy as an alternative to traditional laparoscopic living-donor nephrectomy.

    PubMed

    Buell, Joseph F; Hanaway, Michael J; Potter, Steven R; Cronin, David C; Yoshida, Atsushi; Munda, Rino; Alexander, J Wesley; Newell, Kenneth A; Bruce, David S; Woodle, E Steve

    2002-11-01

    The benefits of laparoscopic living-donor nephrectomy (LDN) are well described, while similar data on hand-assisted laparoscopic living-donor nephrectomy (HALDN) are lacking. We compare hand-assisted laparoscopic living-donor nephrectomy with open donor nephrectomy. One hundred consecutive hand-assisted laparoscopic living-donor nephrectomy (10/98-8/01) donor/recipient pairs were compared to 50 open donor nephrectomy pairs (8/97-1/00). Mean donor weights were similar (179.6 +/- 40.8 vs. 167.4 +/- 30.3 lb; p = NS), while donor age was greater among hand-assisted laparoscopic living-donor nephrectomy (38.2 +/- 9.5 vs. 31.2 +/- 7.8 year; p < 0.01). Right nephrectomies was fewer in hand-assisted laparoscopic living-donor nephrectomy [17/100 (17%) vs. 22/50 (44%); p < 0.05]. Operative time for hand-assisted laparoscopic living-donor nephrectomy (3.9 +/- 0.7 vs. 2.9 +/- 0.5 h; p < 0.01) was longer; however, return to diet (6.9 +/- 2.8 vs. 25.6 +/- 6.1 h; p < 0.01), narcotics requirement (17.9 +/- 6.3 vs. 56.3 +/- 6.4h; p < 0.01) and length of stay (51.7 +/- 22.2 vs. 129.6 +/- 65.7 h; p < 0.01) were less than open donor nephrectomy. Costs were similar ($11072 vs. 10840). Graft function and 1-week Cr of 1.4 +/- 0.9 vs. 1.6 +/- 1.1 g/dL (p = NS) were similar. With the introduction of HALDN, our laparoscopic living-donor nephrectomy program has increased by 20%. Thus, similar to traditional laparoscopic donor nephrectomy, hand-assisted laparoscopic living-donor nephrectomy provides advantages over open donor nephrectomy without increasing costs. PMID:12482153

  7. Transvaginal Route for Kidney Extraction in Laparoscopic Donor Nephrectomy

    PubMed Central

    Berber, Ibrahim; Cakir, Ulkem; Gurkan, Alihan

    2014-01-01

    Background and Objectives: The aim of this retrospective study was to compare conventional laparoscopic living-donor nephrectomy with transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy in terms of feasibility and reproducibility. Methods: A total of 115 consecutive female patients who underwent laparoscopic living-donor nephrectomy (n = 70) or transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy (n = 45) were included and compared in terms of operative characteristics, as well as donor and recipient outcomes. Results: No significant difference was observed between the laparoscopic living-donor nephrectomy and transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy groups in terms of mean duration of warm and cold ischemia, operation time, length of hospital stay, arterial anastomoses, visual analog scale pain scores, serum creatinine levels, and receiver outcomes, whereas a significantly higher number of venous anastomoses was noted in the laparoscopic living-donor nephrectomy group than in the transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy group (P = .029). Conclusions: Transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy seems to be a feasible and reproducible alternative to conventional laparoscopic living-donor nephrectomy in female donors provided the viability of the vagina as an organ retrieval route. PMID:25419107

  8. Elective subtotal splenectomy. Indications and results in 33 patients.

    PubMed Central

    Guzzetta, P C; Ruley, E J; Merrick, H F; Verderese, C; Barton, N

    1990-01-01

    Elective subtotal splenectomy was performed in 33 patients (30 children and 3 adults) between 1981 and 1989. Indications for the procedure were (1) prevention of azathioprine-induced neutropenia (n = 20); (2) Type I Gaucher disease (n = 9); and (3) cholesteryl ester storage disease, chronic myelogenous leukemia, thalassemia major, and splenic cyst in one patient each. There were no operative deaths, no reoperations for bleeding, and 30 of 33 (91%) patients had a functioning splenic remnant documented by a postoperative radionuclide spleen scan. One patient developed neutropenia without evidence of viral infection that required temporary cessation of azathioprine and the patient with thalassemia major had only transient improvement in transfusion requirements. All other patients (94%) had control of the underlying condition for which the operation was performed. We conclude that subtotal splenectomy is a safe, effective therapy for a variety of nontraumatic conditions. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. PMID:2294841

  9. Gastric tube ulcer perforating the pericardium after subtotal esophagectomy.

    PubMed

    Nikolić, Igor; Stancić-Rokotov, Dinko; Macan, Jasna Spicek; Korusić, Andelko; Mikecin, Verica; Duzel, Viktor

    2013-06-01

    Subtotal esophagectomy with retrosternal transposition of the gastric tube to the neck was performed in a 62-year-old patient with squamous cell carcinoma of the proximal third of the esophagus. He developed a salivatory fistula in the early postoperative period that healed spontaneously. Five months later, the patient developed partial stenosis of the esophagogastric anastomosis which required recervicotomy and excision, after numerous failed dilatation attempts. Eighteen months later, the patient presented to the hospital for severe pain in the upper abdomen. Clinical work-up revealed pericardial perforation by the gastric tube ulcer necessitating emergent surgery and gastric tube removal. We present a patient who developed both early and late complications of subtotal esophagectomy with gastric tube transposition as well as a review of the literature.

  10. [Bilateral stage nephrectomy as a preparation for kidney transplantation].

    PubMed

    Mayer, P; Bauer, H W; Land, W

    1982-03-01

    The indication for nephrectomy prior to kidney transplantation has changed. Contrary to the formerly in nearly all transplantation centres practiced one-time two-sided nephrectomy, at present the removal of the patient's own kidneys prior to transplantation is done only if strictly indicated. In contrast to other transplantation centres which, if indicated, still today carry out bilateral nephrectomy prior to transplantation is done only if strictly indicated. In contrast to other transplantation centres which, if indicated, still today carry out bilateral nephrectomy prior to transplantation, since 1977 the transplantation centre of Munich prefers the two-time bilateral nephrectomy. Technique, surgical approach, indication and results of our method are presented. In the course of the discussion the disadvantages of the one-time bilateral nephrectomy are opposed to the advantages of the two-time method.

  11. Laparoscopic partial nephrectomy and wedge resection.

    PubMed

    Kozlowski, P M; Winfield, H N

    2000-12-01

    Partial nephrectomy is a more challenging operation than radical or simple nephrectomy, primarily because of the risk of complications such as bleeding. This problem is even more troublesome with minimally invasive approaches because of the dearth of effective hemostatic instruments and supplies. The location of the lesion determines whether a transperitoneal or a retroperitoneal route will be employed. Centrally located or anterior renal lesions generally are approached transperitoneally whereas peripheral lateral or posterior lesions are accessed by retroperitoneoscopy. The Harmonic Scalpel with slow cutting and high coagulation settings is useful for incising the renal capsule and parenchyma. The argon beam coagulator is helpful to stop any persistent bleeding. The few reported series of laparoscopic partial nephrectomy indicate considerably longer operative times than are needed for open surgery and hospitalization of upwards of 5 days, largely to monitor drainage and urine leakage. It is hoped that this advanced laparoscopic technique will become more user friendly with further developments in techniques and instrumentation to provide patients with the expected benefits of minimally invasive surgery.

  12. Robot-Assisted Subtotal Pancreas-Preserving Duodenectomy

    PubMed Central

    Gheza, Federico; Raimondi, Paolo; D'Ugo, Stefano; Calatayud, David; Giulianotti, Pier C.

    2012-01-01

    Background: Angiodysplasia of the duodenum is a rare disorder, often requiring surgical resection. Technical difficulties have made the use of the minimally invasive approach uncommon. Herein, we present a subtotal pancreas-preserving duodenectomy using robotic assistance. Methods: The patient is a 60-y-old female with a long medical history including chronic gastrointestinal bleeding due to angiodysplasia with intermittent melena, and requiring multiples blood transfusions. A capsule endoscopy and double-balloon upper endoscopy showed angiectasis, which appeared to be limited to the third and fourth portion of the duodenum and the proximal loops of the jejunum. Despite multiple endoscopic cauterizations, the patient continued to require blood transfusion for several years. The patient underwent a robot-assisted subtotal pancreas-preserving duodenectomy. Results: The operation lasted 420 min with minimal blood loss. The postoperative course was uneventful. The pathology report showed multiple small bowel mucosal and submucosal distorted and dilated vasculature, consistent with angiodysplasia. At 2-mo follow-up, the patient was totally asymptomatic. A barium swallow study showed contrast passed antegrade through the duodenojejunostomy with no evidence of obstruction, stricture, or leakage. Conclusion: The use of robotic assistance to perform a subtotal pancreas-preserving duodenectomy for the treatment of benign duodenal disease, such as angiodysplasia, is feasible and safe. The technical advantages include a high degree of freedom offered by the robotic instruments, as well as enhanced visualization, which allows for precise microdissection and microsuture, thereby preserving the benefits of minimally invasive surgery. The use of robotic technology allows for a wider range of indications for minimally invasive surgery. PMID:23484581

  13. Laparoscopic partial nephrectomy in a horseshoe kidney.

    PubMed

    Molina, Wilson R; Gill, Inderbir S

    2003-12-01

    A 68-year-old man with an incidentally found 2-cm complex enhancing cystic right renal mass in the right moiety of a horseshoe kidney was treated with a three-port retroperitoneal laparoscopic approach. The tumor was completely excised with cold Endoshears, and Surgicel bolsters were tightly buttressed into the resection bed with 0 Vicryl sutures. The warm ischemia time was 31 minutes. To our knowledge, this is the initial case of retroperitoneal laparoscopic partial nephrectomy in a horseshoe kidney. Three-dimensional CT with volume rendering in a video format provides the necessary information about the number, location, and extrarenal anatomy of the renal artery and vein.

  14. Consequences of partial and subtotal colectomy in the rat.

    PubMed Central

    Masesa, P C; Forrester, J M

    1977-01-01

    Rats were subjects to right hemicolectomy (including removal of the caecum), left hemicolectomy or subtotal colectomy. Body weight resumed and maintained a rate of increase very similar to that in control rats. After hemicolectomy, food intake showed no change. Faecal weight increased by about one-third after right hemicolectomy, but did not increase after left hemicolectomy. After right hemicolectomy, the remaining--that is, downstream--portion of the colon showed increase in weight, and so did the (upstream) small intestine, in which the increase involved all three-thirds of its length and was predominantly mucosal. No such changes in the remaining colon or in small intestine were found after left hemicolectomy. After subtotal hemicolectomy, rats ate 30-40% more food than control rats, and faecal weight increased 60% at three months after operation. Study of energy intake and output indicated diminished absorption. All three-thirds of the small intestine showed increase in weight, predominantly mucosal in the upper two-thirds and predominantly seromuscular in the lowest third; villi were taller at all levels. Evidence suggests that the increase in food intake is not due to cessation of coprophagy, and that the small intestine changes are not due solely to increased food intake and occur when the colon is bypassed but not removed. PMID:838400

  15. Dietary protein alters tubular iron accumulation after partial nephrectomy.

    PubMed

    Nankivell, B J; Tay, Y C; Boadle, R A; Harris, D C

    1994-04-01

    Reactive oxygen species (ROS) have been implicated in progression of disease in the rat remnant kidney (RK) model of chronic renal failure. Substantial amounts of iron accumulate in proximal tubular lysosomes of RK and could damage tubules by ROS generation. The effect of dietary protein intake on ROS, tubular damage and iron accumulation assessed by energy dispersive analysis was determined in RK (5/6 nephrectomy, N = 12) and sham-operated kidneys (SO, N = 10). In RK, mean lysosomal iron concentration, urinary iron and protein excretion and morphological damage were increased and GFR decreased. Dietary protein loading (40% vs. 12%) increased the number of iron-containing lysosomes (P < 0.05) and the mean lysosomal iron (P < 0.02) in proximal tubular cells after four weeks. In RK, high protein diet increased renal weight (P < 0.01), numerical density of iron-containing lysosomes and tubular damage (both P < 0.05). ROS generation, assessed by tissue and plasma malondialdehyde (MDA), was also increased (both P < 0.05). Plasma MDA correlated with tubular iron accumulation (r = 0.75). In RK fed a high protein diet (N = 18) treatment with the iron-chelator desferrioxamine reduced serum iron, urinary volume, and tubular iron accumulation and damage compared to controls (P < 0.01). In summary, in RK dietary protein manipulation altered urinary iron and protein excretion, proximal tubular iron accumulation, renal cortical ROS generation and ultrastructural damage. Desferrioxamine treatment reduced tubular lysosomal iron and ultrastructural damage. These results suggest a role for tubular iron as a determinant of tubular injury associated with dietary protein loading in rats with partial nephrectomy.

  16. An Ultrasonic Clamp for Bloodless Partial Nephrectomy

    NASA Astrophysics Data System (ADS)

    Lafon, Cyril; Bouchoux, Guillaume; Murat, François Joseph; Birer, Alain; Theillère, Yves; Chapelon, Jean Yves; Cathignol, Dominique

    2007-05-01

    Maximum conservation of the kidney is preferable through partial nephrectomy for patients at risk of disease recurrence of renal cancers. Haemostatic tools are needed in order to achieve bloodless surgery and reduce post surgery morbidity. Two piezo-ceramic transducers operating at a frequency of 4 MHz were mounted on each arm of a clamp. When used for coagulation purposes, two transducers situated on opposite arms of the clamp were driven simultaneously. Heat delivery was optimized as each transducers mirrored back to targeted tissues the wave generated by the opposite transducer. Real-time treatment monitoring with an echo-based technique was also envisaged with this clamp. Therapy was periodically interrupted so one transducer could generate a pulse. The echo returning from the opposite transducer was treated. Coagulation necroses were obtained in vitro on substantial thicknesses (23-38mm) of pig liver over exposure durations ranging from 30s to 130s, and with acoustic intensities of less than 15W/cm2 per transducer. Both kidneys of two pigs were treated in vivo with the clamp (14.5W/cm2 for 90s), and the partial nephrectomies performed proved to be bloodless. In vitro and in vivo, wide transfixing lesions corresponded to an echo energy decrease superior to -10dB and parabolic form of the time of flight versus treatment time. In conclusion, this ultrasound clamp has proven to be an excellent mean for achieving monitored haemostasis in kidney.

  17. Ex vivo partial nephrectomy and autotransplantation for renal cell cancer after laparoscopic renal harvest.

    PubMed

    Sokoloff, Mitchell H; Chien, Gary W; Thistlewaite, J Richard; Harland, Robert; Shalhav, Arieh L

    2004-06-01

    Laparoscopic partial nephrectomy is an alternative to the open approach. For centrally located tumors, open extracorporeal partial nephrectomy has been used. We report 2 cases of laparoscopic nephrectomy for the purpose of extracorporeal partial nephrectomy and autotransplantation for renal cell cancer.

  18. Chylous ascites secondary to laparoscopic donor nephrectomy.

    PubMed

    Shafizadeh, Stephen F; Daily, Patrick P; Baliga, Prabhakar; Rogers, Jeffrey; Baillie, G Mark; Rajagopolan, P R; Chavin, Kenneth D

    2002-08-01

    Live donor renal transplantation offers many significant advantages over cadaveric donor transplantation. Yet living donation continues to be underused, accounting for less than 30% of all donor renal transplants. In an attempt to remove the disincentives to live donation, Ratner et al. developed laparoscopic donor nephrectomy (LDN). LDN is gaining acceptance in the transplant community. The overriding concern must always be the safety and welfare of the donor. To this end, potential complications of LDN must be identified and discussed. We present a patient who developed the complication of chylous ascites from LDN. To improve the laparoscopic technique further, a discussion of its successes and complications needs to be encouraged. To this end, we present chylous ascites as a potential complication after LDN. We also offer suggestions to minimize the likelihood of this complication. PMID:12137847

  19. Laparoscopic nephrectomy in a hemophilia B patient

    PubMed Central

    Szopiński, Tomasz; Szczepanik, Andrzej B.; Sosnowski, Roman; Szczepanik, Anna M.

    2016-01-01

    Surgery in patients with hemophilia is a serious challenge. It requires a comprehensive approach, as well as careful postoperative monitoring. We present here the first case of a transperitoneal laparoscopic radical nephrectomy (TLRN) for renal cell carcinoma, of the clear-cell type, performed in a hemophilia B patient. The level of factor IX clotting activity before surgery and on postoperative days 1–6 was maintained at 65–130% and at 30–40% on subsequent days until healing of the post-operative wound was achieved. The intraoperative and postoperative courses were uneventful. TLRN can therefore be considered safe and effective for renal cell carcinoma. In hemophilia patients, the TLRN procedure requires proper preparation, as well as adequate substitution therapy for the deficient coagulation factor provided by a multidisciplinary team in a comprehensive center. PMID:27729993

  20. Comparison of Acute and Chronic Pain after Open Nephrectomy versus Laparoscopic Nephrectomy

    PubMed Central

    Alper, Isik; Yüksel, Esra

    2016-01-01

    Abstract We evaluated postoperative pain intensity and the incidence of chronic pain in patients with renal cell carcinoma undergoing laparoscopic or open radical nephrectomy. In this prospective study, 27 laparoscopic nephrectomy (Group LN) and 25 open nephrectomy (Group ON) patients were included. All patients received paracetamol infusion and intramuscular morphine 30 minutes before the end of the operation and intravenous patient controlled analgesia with morphine postoperatively. Data including patients’ demographics, visual analog scale (VAS) pain scores at postoperative 0.5, 1, 2, 4, 6, 12, and 24 hours, postoperative morphine consumption, analgesic demand, analgesic delivery, number of patients requiring rescue analgesics, side effects because of analgesic medications, and overall patient satisfaction were recorded and compared between the two groups. Two and 6 months after the operation, patients were evaluated for chronic postsurgical pain (CPSP). Postoperative average VAS pain scores were not different between the two groups. However, only at 2 hours postoperatively, pain score was significantly higher in Group ON than in Group LN. In both groups, the highest pain scores were recorded at 30 minutes and 1 hour after surgery. Ninety-six percent of group ON patients and 88% of group LN patients required additional analgesia in the early postoperative period (P = 0.33). Postoperative morphine consumption and analgesic demand were found to be similar between the two groups. CPSP at 2 months after surgery was observed in 4 out of 25 patients (16%) in the ON group and 3 out of 27 patients (11.1%) in the LN group (P = 0.6). Chronic pain at 6 months after surgery was observed in 1 ON patient (4%) and 1 LN patient (3.7%, P = 0.9). This study demonstrated that postoperative acute pain scores were not different after laparoscopic or open nephrectomy and patients undergoing laparoscopic or open nephrectomy were at equal risk of developing CPSP. Pain

  1. Protective Effect of RNase on Unilateral Nephrectomy-Induced Postoperative Cognitive Dysfunction in Aged Mice

    PubMed Central

    Gan, Lu; Dong, Yuanlin; Zhu, Tao; Ma, Gang; Li, Tao; Zhang, Xiyang; Li, Qian; Cheng, Xu; Wu, Chaomeng; Yang, Jing; Zuo, Yunxia; Liu, Jin

    2015-01-01

    Postoperative cognitive dysfunction (POCD) is a common complication after surgery, especially for elderly patients. Administration of RNase has been reported to exhibit neuroprotective effects in acute stroke. However, the potential role of RNase on POCD is unknown. Therefore, we sought to investigate whether RNase treatment could mitigate unilateral nephrectomy induced-cognitive deficit in aged mice. In the present study, twelve-month-old mice were administered RNase or an equal amount of normal saline perioperatively. All mice underwent Morris Water Maze (MWM) training 3 times per day for 7 days to acclimatize them to the water maze before surgical operation, and testing on days 1, 3 and 7 after surgery. We found that perioperative administration of RNase: 1) attenuated unilateral nephrectomy-induced cognitive impairment at day 3 after surgery; 2) reduced the hippocampal cytokines mRNA production and serum cytokines protein production at day 1 and day 7 (for MCP-1) after surgery, and; 3) inhibited hippocampal apoptosis as indicated by cleaved caspase-3 western blot and TUNEL staining at day 1 after surgery. In addition, a trend decrease of total serum RNA levels was detected in the RNase treated group after surgery compared with the untreated group. Further, our protocol of RNase administration had no impact on the arterial blood gas analysis right after surgery, kidney function and mortality rate at the observed days postoperatively. In conclusion, perioperative RNase treatment attenuated unilateral nephrectomy-induced cognitive impairment in aged mice. PMID:26225860

  2. Effects of nephrectomy on respiratory function and quality of life of living donors: a longitudinal study

    PubMed Central

    Moraes, Karen; Paisani, Denise M.; Pacheco, Nathália C. T.; Chiavegato, Luciana D.

    2015-01-01

    BACKGROUND: A living donor transplant improves the survival and quality of life of a transplant patient. However, the impact of transplantation on postoperative lung function and respiratory muscular strength in kidney donors remains unknown. OBJECTIVE: To evaluate pulmonary function, respiratory muscle strength, quality of life and the incidence of postoperative pulmonary complications (PPCs) in kidney donors undergoing nephrectomy. METHOD: This prospective cohort enrolled 110 consecutive kidney donors undergoing nephrectomy. Subjects underwent pulmonary function (using spirometry) and respiratory muscular strength (using manovacuometry) assessments on the day prior to surgery and 1, 2, 3 and 5 days postoperatively. Quality of life (measured by the SF-36) was evaluated preoperatively and 30 days postoperatively. PPCs were assessed daily by a blinded assessor. RESULTS: Donors exhibited a decrease of 27% in forced vital capacity, 58% in maximum inspiratory capacity and 51% in maximum expiratory pressure on the 1stpostoperative day (p<0.001) but this improved over days 2, 3 and 5 but had not returned to preoperative levels. Patient quality of life was still impaired at 30 days with regards to functional capacity, physical role, pain, vitality and social functioning (p<0.05) but these parameters improved slowly. None of the patients developed PPCs. CONCLUSION: Kidney donors submitted to nephrectomy exhibited a reduction in pulmonary function, respiratory muscular strength and quality of life, most of which were improving toward pre-surgical levels. PMID:26443973

  3. Myringoplasty for anterior and subtotal perforations using KTP-532 laser.

    PubMed

    Gerlinger, Imre; Ráth, Gábor; Szanyi, István; Pytel, József

    2006-09-01

    A retrospective study was performed on patients who underwent myringoplasty for either anterior or subtotal perforations over an 8-year period (from 1994 till 2004). We used the KTP-laser assisted anterior anchoring technique combining with anterior "pull-back" method. Patients' ages ranged from 6-62 years (median 36.5). The mean follow-up period was 2.8 years (minimum 6 months). The audiological results were analysed with the "Pytel software", which was developed in our department. As for the procedure, the drum remnant was freed from the malleus handle with the use of the laser and elevated out of it's sulcus anterior-superiorly. Large fascia graft was fashioned with a split of 4-5 mm in the middle of one edge. The graft was placed using the underlay technique medial to the handle of the malleus. A pull-back tunnel was created at the border of the anterior quadrants to further facilitate the survival of the graft. In this series the graft taking rate was 100%. Reperforation due to an undersized fascia was observed in one case. Post-operative audiological results indicated no bone conduction threshold elevation in any frequencies. Using the laser, cochlear trauma can be prevented, double fixation of the drum prevents lateralisation and blunting. Wide canalplasty makes both the approach and the follow-up very easy. Thorough soft tissue and bone work is advantageous from the fascia taking rate point of view.

  4. Evaluation of voice and speech following subtotal reconstructive laryngectomy.

    PubMed

    Pastore, A; Yuceturk, A V; Trevisi, P

    1998-01-01

    Subtotal reconstructive laryngectomy (SRL) can be used to preserve voice in the treatment of selected laryngeal carcinomas. This study was designed to analyze both voice and speech results achieved after SRL in 14 male patients, aged from 48 to 73 years. Surgery was performed between 1983 and 1993. Fundamental frequencies, ranges of frequency, intensities, and intensity ranges were established using an S.I. 80 Philips AAC 600 Audio Active Comparative Language System. Five prolonged vowels and six phonetically balanced sentences were recorded on a tape positioned at a distance of 30 cm from the mouth of each patient during a 3-min recording time. The recorded material was then evaluated by a panel of ten trained listeners who were asked to consider the qualitative parameters and perceptual characteristics of voice and speech according to a scorecard modified from one devised by Voiers and Formigoni. Although a decrease was determined in Fundamental Frequency and intensity of the voice when compared to normal values, the quality and perception of speech were found to be satisfactory. The verbal message could be understood almost exactly by means of constant sonority, correct articulation and improved pneumophonic coordination. These values demonstrate that the new voice achieved after SRL is less sonorous and allows for understandable and socially acceptable speech. PMID:9783136

  5. [Pneumothorax during right-sided nephrectomy in a heifer].

    PubMed

    Nuss, K; Muggli, E; Gerspach, C; Schramm, S; Dettwiler, M; Bach, F; Ringer, S

    2016-01-01

    A 250-kg heifer had signs of colic attributable to urolithiasis of the right kidney. Medical treatment did not result in resolution of clinical signs, and nephrectomy was carried out. The surgery was started with the heifer standing, and the 13th rib was resected. However, during blunt dissection of the kidney, air suddenly entered the pleural space and the heifer had acute severe dyspnoea. The hole in the pleural cavity was sutured and a chest drain was placed. Inhalation anaesthesia was then induced and nephrectomy could be completed without further complications. The heifer was discharged 11 days postoperatively, and was healthy and had been integrated into the herd 12 months after surgery. Pneumothorax must be considered a possible complication of rib resection in right-sided nephrectomy in cattle.

  6. [Pneumothorax during right-sided nephrectomy in a heifer].

    PubMed

    Nuss, K; Muggli, E; Gerspach, C; Schramm, S; Dettwiler, M; Bach, F; Ringer, S

    2016-01-01

    A 250-kg heifer had signs of colic attributable to urolithiasis of the right kidney. Medical treatment did not result in resolution of clinical signs, and nephrectomy was carried out. The surgery was started with the heifer standing, and the 13th rib was resected. However, during blunt dissection of the kidney, air suddenly entered the pleural space and the heifer had acute severe dyspnoea. The hole in the pleural cavity was sutured and a chest drain was placed. Inhalation anaesthesia was then induced and nephrectomy could be completed without further complications. The heifer was discharged 11 days postoperatively, and was healthy and had been integrated into the herd 12 months after surgery. Pneumothorax must be considered a possible complication of rib resection in right-sided nephrectomy in cattle. PMID:26526735

  7. Five-sixth Nephrectomy in Female Common Marmosets(Callithrix jacchus) as a Chronic Renal Failure Model

    PubMed Central

    Yamaguchi, Itaru; Myojo, Kensuke; Sanada, Hiroko; Takami, Atsuko; Suzuki, Yui; Imaizumi, Minami; Takada, Chie; Kimoto, Naoya; Saeki, Koji; Yamate, Jyoji; Takaba, Katsumi

    2014-01-01

    To assess the relevance and availability of subtotal nephrectomized common marmoset monkeys as a chronic renal failure (CRF) model, we observed for 26 weeks the pathophysiological condition of female marmosets subjected to five-sixth surgical nephrectomy (5/6Nx) by a two-step surgical method. The 5/6Nx marmosets showed a significant increase in serum levels of urea nitrogen, creatinine and cystatin-C immediately after 5/6Nx surgery. These renal disorder parameters subsequently tended to decrease with the passage of time but remained higher than the control levels by the end of the study. Hyperplastic parathyroid glands, a high turnover state of osteodystrophy in the femoral bone with higher serum ALP activity and anemia with hypocellularity of bone marrow were evident. The 5/6Nx marmosets showed a stable CRF condition for a long time and some characteristic disorders similar to those observed in CRF patients. These diagnostic aspects might be a species-specific anatomical and physiological signature, reflecting the nutritional condition. The CRF model using 5/6Nx marmosets might become a useful method of evaluating the unique mechanism of CRF development. PMID:25378803

  8. Training techniques in laparoscopic donor nephrectomy: a systematic review.

    PubMed

    Raque, Jessica; Billeter, Adrian T; Lucich, Elizabeth; Marvin, Michael M; Sutton, Erica

    2015-10-01

    The learning curve to achieve competency in laparoscopic donor nephrectomy (LDN) is poorly outlined. Online databases were searched for training in LDN. Abstracts and manuscripts were excluded if they did not address introduction of a laparoscopic technique for donor nephrectomy. Relevant manuscripts were reviewed for surgical technique, use of animal models, co-surgeons, surgeon specialty and training, institution type/volume, and assessment of training method. Forty-four met inclusion criteria, with 75% describing the evolution from open to LDN. Eighty-two percent were from academic centers, and 36% were from centers performing <25 donor nephrectomies each year. The learner was an attending surgeon 80% of the time, mostly urologists with prior laparoscopy or open nephrectomy experience. The learning curve, defined by decreased operating time, averaged 35 cases. Improved intra-operative, patient, and recipient outcomes were observed for centers performing ≥50 LDNs annually. The United Network of Organ Sharing requires 15 cases as surgeon or assistant to be certified as the primary LDN surgeon. This falls below the described learning curve for LDN. The assessment of training and competency for LDN is heterogeneous, and objective learner-based metrics could help surgeons and institutions reach a quality standard for performing this operation. PMID:26179472

  9. Conservative management of renal artery pseudoaneurysm following partial nephrectomy

    PubMed Central

    Dukic, I; Ali, Z; Shackley, D

    2014-01-01

    A bleeding renal artery pseudoaneurysm is a recognised complication occurring after partial nephrectomy. The bleeding is usually suspected when a patient presents with haematuria following the procedure and the reported management is with radiologically guided embolisation. We report a case of renal artery pseudoaneurysm successfully managed conservatively, giving another potential management option in non-torrential haemorrhage. PMID:24780659

  10. Cecal volvulus following laparoscopic nephrectomy and renal transplantation.

    PubMed

    Eng, Mary; Ravindra, Kadiyala

    2009-01-01

    Cecal volvulus is a rare cause of bowel obstruction that carries a high mortality. Recent surgery is known to be a risk factor for the development of cecal volvulus. We present a case of cecal volvulus following laparoscopic nephrectomy and renal transplantation.

  11. Prospective study on laser-assisted laparascopic partial nephrectomy

    NASA Astrophysics Data System (ADS)

    Sroka, Ronald; Hennig, Georg; Zilinberg, Katja; Khoder, Wael Y.

    2012-02-01

    Introduction: Developments in laparoscopic partial nephrectomy (LPN) opened a demand for surgical tools compatible with laparoscopic manipulations to make laser assisted technique safe, feasible and reproducible. Warm ischemia and bleeding during laparoscopic partial nephrectomy place technical constraints on surgeons. Therefore it was the aim to develop a safe and effective laser assisted partial nephrectomy technique without need for ischemia. Patients and methods: A diode laser emitting light at 1318nm in cw mode was coupled into a bare fibre (core diameter 600 μm) thus able to transfer up to 100W to the tissue. After dry lab experience, a total of 10 patients suffering from kidney malformations underwent laparoscopic/retroperitoneoscopic partial nephrectomy. Clinically, postoperative renal function and serum c-reactive protein (CRP) were monitored. Laser induced coagulation depth and effects on resection margins were evaluated. Demographic, clinical and follow-up data are presented. Using a commercial available fibre guidance instrument for lanringeal intervention, the demands on an innovative laser fibre guidance instrument for the laser assisted laparoscopic partial nephrectomy (LLPN) are summarized. Results: Overall, all laparascopic intervention were succesfull and could be performed without conversion to open surgery. Mean operative time and mean blood loss were comparable to conventional open and laparascopic approaches. Laser assisted resection of the kidney tissue took max 15min. After extirpation of the tumours all patients showed clinical favourable outcome during follow up period. Tumour sizes were measured to be up 5cm in diameter. The depth of the coagulation on the removed tissue ranged between <1 to 2mm without effect on histopathological evaluation of tumours or resection margin. As the surface of the remaining kidney surface was laser assisted coagulated after removal. The sealing of the surface was induced by a slightly larger coagulation

  12. Risk Factors for Postoperative Hemorrhage After Partial Nephrectomy

    PubMed Central

    Jung, Saebin; Min, Gyeong Eun; Chung, Benjamin I.

    2014-01-01

    Purpose To evaluate the frequency and clinical characteristics of postoperative hemorrhage as a complication of partial nephrectomy. Materials and Methods The demographics, physical statistics, tumor size, R.E.N.A.L. nephrometry score, operative method, warm ischemic time, and presence of postoperative hemorrhage and its severity and method of intervention were examined in 300 partial nephrectomy patients in two medical centers (Stanford Medical Center and Kyung Hee University Medical Center) between March 2000 and March 2012. Results Of the 300 subjects, 13 (4.3%) experienced postoperative hemorrhage severe enough to require intervention more invasive than transfusion (Clavien grade III or higher). Univariate analysis of the bleeding and nonbleeding groups showed that whereas age, ischemic time, tumor size and stage, body mass index, American Society of Anesthesiologists class, and operative method did not differ significantly, the exophyticity (E) score was significantly higher for severe postoperative hemorrhage (p=0.04). However, multivariate analysis showed none of the factors to differ significantly. In most of the cases requiring intervention, selective embolization was sufficient, but in one case explorative laparotomy and nephrectomy were required. Clinical characteristics varied significantly among severe hemorrhage cases, with time of onset ranging from the first to the 30th postoperative day and symptoms presenting in a diverse manner, such as gross hematuria and pleuritic chest pain. Computed tomography and angiographic findings were consistent with either arteriovenous fistula or pseudoaneurysms. Conclusions Severe hemorrhage after partial nephrectomy is rare. Nonetheless, with the great variability in presenting symptoms and time of onset after surgery, surgeons should exercise great vigilance during the postoperative care of partial nephrectomy patients. PMID:24466392

  13. Subtotal epiglottectomy for the management of epiglottic retroversion in a dog.

    PubMed

    Mullins, R; McAlinden, A B; Goodfellow, M

    2014-07-01

    A six-year-old male neutered Yorkshire terrier was evaluated for severe, acute-onset, inspiratory dyspnoea. Laryngoscopy revealed retroversion of the epiglottis with intermittent occlusion of the rima glottidis during inspiration. The dog underwent both temporary and permanent epiglottopexy procedures that were unsuccessful. Subtotal epiglottectomy was performed and resulted in permanent resolution of dyspnoea without evidence of dysphagia or aspiration. This case highlights potential complications associated with management of this condition as well as describing the successful use of subtotal epiglottectomy in the dog.

  14. Comparison of angiographic and clinical outcomes of coronary stenting of chronic total occlusions versus subtotal occlusions.

    PubMed

    Moussa, I; Di Mario, C; Moses, J; Reimers, B; Di Francesco, L; Blengino, S; Colombo, A

    1998-01-01

    The objective of this study was to assess the short- and long-term outcome of patients undergoing coronary stenting for chronic total occlusions compared with a control patient population with nonocclusive stenoses. A total of 789 consecutive patients (1,043 lesions) underwent coronary stenting using a high-pressure stent optimization technique. The study population was divided into total occlusion group (94 consecutive patients [95 lesions] with chronic total occlusions) and subtotal occlusion group (695 consecutive patients [948 lesions] with nonocclusive stenoses). There was no difference in post-procedure angiographic minimum lumen diameter (3.13 +/- 0.48 vs 3.15 +/- 0.57 mm, p = 0.72) and minimum intrastent cross-sectional area by intravascular ultrasound (7.31 +/- 2.06 vs 7.64 +/- 2.53 mm2, p = 0.26) between the total and subtotal groups, respectively. Subacute thrombosis occurred in 2 patients (2.1%) in the total group compared with 9 patients (1.3%) in the subtotal group (p = 0.63). Angiographic restenosis occurred in 27% vs 22% (p = 0.40) and repeat angioplasty in 15% vs 13% (p = 0.62) in the total and subtotal groups, respectively. Thus, coronary stenting of chronic total occlusions after successful recanalization could be performed with a high success rate. In addition, the incidence of stent thrombosis, angiographic restenosis, and the need for target lesion revascularization is comparable to that of an unselected cohort of patients with nonocclusive stenoses.

  15. Achieving zero ischemia in minimally invasive partial nephrectomy surgery.

    PubMed

    Hou, Weibin; Ji, Zhigang

    2015-06-01

    Widespread application of the minimally invasive partial nephrectomy (MIPN) techniques like laparoscopic and robotic partial nephrectomy, has been limited by concerns about prolonged warm ischemia. So techniques aiming at performing have been actively explored. A systemic review of literatures on the MIPN without hilar clamping was performed and related methods were summarized. There are mainly seven methods including selective/segmental renal artery clamping technique, selective renal parenchymal clamping technique, targeted renal blood flow interruption technique, laser supported MIPN, radio frequency assisted MIPN, hydro-jet assisted MIPN, and sequential preplaced suture renorrhaphy technique that have been undergoing enthusiastic investigation for achieving MINP without hilar clamping. All of these emerging techniques represent the exploring work to achieve a zero ischemia MIPN for small renal tumors of different characteristics. Though not perfect for any of the technique, they deserve a further assessment during their future experimental and clinical applications.

  16. [Aspergillosis located on polycystic kidney treated with retroperitoneal nephrectomy].

    PubMed

    Rabii, R; Hoznek, A; Salomon, L; Bourg, S; Chopin, D K; Abbou, C C

    2001-03-01

    We reported an uncommon case of 40 years old man, cardiac transplant recipient with chronic renal faillure who consulted for infected left polycystic renal. The serum creatinine level was 750 mmol/L, and urine culture isolated a E. Ecol germe. The abdominopelvic computed tomography showed a bilateral large polycystic renal cortex and suspected the infected cyst in lower pole of left kidney. The retroperitoneal laparoscopic nephrectomy was performed confirming a renal invasive aspergillosa. About this case we should have a high index of suspicion for fungal aetiology in kidney infection in transplant patients and the management of non functioning infected polycystic kidney can use laparoscopic retroperitoneal nephrectomy. This approach can offers a minimal morbidity and alternative to open surgery.

  17. Robot-assisted laparoscopic partial nephrectomy during pregnancy.

    PubMed

    Park, Sung Yul; Ham, Won Sik; Jung, Hyun Jin; Jeong, Wooju; Kim, Won Tae; Rha, Koon Ho

    2008-09-01

    We present a case of a 36-year-old pregnant woman with renal cell carcinoma who underwent a successful robot-assisted laparoscopic partial nephrectomy (RLPN) at 14 weeks gestational age. The operative time, including da Vinci™ setup, was 165 min. The warm ischemic time was 28 min, and the estimated blood loss was 100 ml. The final pathologic evaluation was conventional-type renal cell carcinoma with Fuhrman nuclear grade 3, stage T1a disease with a negative margin. The remainder of the pregnancy was uneventful. Although previous cases of laparoscopic nephrectomy performed during pregnancy have been reported, this is the first case in which it has been performed using robotics. RLPN during pregnancy can be a safe and feasible alternative to open and laparoscopic surgery. PMID:27628260

  18. Energy sources for laparoscopic partial nephrectomy--critical appraisal.

    PubMed

    Rubinstein, Mauricio; Moinzadeh, Alireza; Colombo, Jose R; Favorito, Luciano A; Sampaio, Francisco J; Gill, Inderbir S

    2007-01-01

    Laparoscopic partial nephrectomy (LPN) has emerged as a viable alternative for the conventional open nephron-sparing surgery (NSS). So far, an adequate renal parenchymal cutting and hemostasis, as well as caliceal repair remains technically challenging. Numerous investigators have developed techniques using different energy sources to simplify the technically demanding LPN. Herein we review these energy sources, discussing perceived advantages and disadvantages of each technique.

  19. Laparoscopic repair of left lumbar hernia after laparoscopic left nephrectomy.

    PubMed

    Gagner, Michel; Milone, Luca; Gumbs, Andrew; Turner, Patricia

    2010-01-01

    Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair.

  20. Temporary Targeted Hemostasis to Facilitate Bloodless Partial Nephrectomy

    PubMed Central

    Harty, Niall J; Moinzadeh, Alireza; Flacke, Sebastian; Pettit, Jeffrey; Benn, James A.; Libertino, John A; Madras, Peter N

    2011-01-01

    Purpose Lumagel™, a non-toxic polymer may be administered intra-arterially under fluoroscopy to obtain a bloodless operative field during partial nephrectomy while maintaining normal circulation to uninvolved renal tissue. We extend previous robotic assisted techniques developed in the swine model to studies of laparoscopic and open partial nephrectomy conducted in pigs and calves, designed to encompass vessel diameters similar to those encountered in humans. Materials and Methods 10 Animals (7 pigs, 3 calves) underwent flow interruption to the kidney, 2 with cross-clamping of the main renal artery, the remaining with Lumagel. Other than the first pig and calf, all animals then underwent partial nephrectomy. Results and Conclusions Using Lumagel, targeted blood flow interruption was achieved while circulation to uninvolved renal tissue was maintained. Hemostasis lasted for 30 minutes or more. Surgical resection averaged 11 minutes (range 10–13) and 23.3 (range 9–40) in the open and laparoscopic groups, respectively. Estimated blood loss was negligible with the exception of two cases, one in which an error in angiographic assessment lead to an unoccluded vessel near the resection site and a second case where a guide wire was inadvertently passed through a vessel. Time to complete flow return as determined by direct visualization of the kidney and its corresponding angiogram averaged 7 and 2.5 minutes for Lumagel and arterial clamping, respectively. Lumagel provides reliable and reproducible intraluminal blood flow interruption and flow restoration in both main and segmental renal arteries. By providing blood free resection, techniques described may facilitate partial nephrectomy without global renal ischemia. PMID:22137714

  1. Is robotic partial nephrectomy convenient for solitary kidney?

    PubMed

    Kaouk, Jihad H; Malkoç, Ercan

    2016-09-01

    Nephron sparing surgery (NSS) is the gold standard treatment option for patients with a solitary kidney in order to preserve renal function. Open partial nephrectomy (OPN) has been long considered the standard care for NSS. Robotic partial nephrectomy (RPN) is being gradually used more commonly even for solitary kidney and complex tumors. There was no difference between RPN and OPN regarding the rate of intraoperative-postoperative complications and positive surgical margin (PSM) (RPN: 7.5%, OPN: 8%) for patients with solitary kidney who underwent partial nephrectomy for small renal masses. Warm ischemia time (WIT) in all of our studies was within the safe range of <25 minutes which is acceptable ischemia time for robotic approaches. More studies are needed in order to evaluate kidney function. In conclusion with increasing experience, solitary kidney tumors can be managed safely with robotic approach. For patients having complex tumors with a potential of WIT >25 minutes, administration of intracorporeal ice slush during surgery may be considered. PMID:27635284

  2. Laparoscopic Partial Nephrectomy for Renal-Cell Carcinoma During Pregnancy

    PubMed Central

    Yuruk, Emrah; Ucpinar, Burak; Binbay, Zerrin; Colakerol, Aykut; Muslumanoglu, Ahmet Yaser

    2016-01-01

    Abstract Background: The incidence of renal-cell carcinoma (RCC) is low during pregnancy. There are different approaches for timing of surgery and treatment modalities for RCC in pregnant women in the literature. To our knowledge, this is the first laparoscopic partial nephrectomy case in a pregnant woman. Case Presentation: Herein, we present a 34-year-old woman with a renal mass at her 14th gestational week. She was admitted to our clinic after a right renal mass was incidentally diagnosed during routine antenatal ultrasonography. MRI revealed a completely endophytic tumor of 6 × 6.5 × 6.5 cm, located in the upper half of the right kidney. We performed laparoscopic partial nephrectomy in our patient and the postoperative course was uneventful. Conclusion: This is the first presented laparoscopic partial nephrectomy case in a pregnant patient. Nephron-sparing surgeries can be performed laparoscopically in appropriate sized renal tumors in suitable pregnant patients. PMID:27579405

  3. Is robotic partial nephrectomy convenient for solitary kidney?

    PubMed Central

    Kaouk, Jihad H.; Malkoç, Ercan

    2016-01-01

    Nephron sparing surgery (NSS) is the gold standard treatment option for patients with a solitary kidney in order to preserve renal function. Open partial nephrectomy (OPN) has been long considered the standard care for NSS. Robotic partial nephrectomy (RPN) is being gradually used more commonly even for solitary kidney and complex tumors. There was no difference between RPN and OPN regarding the rate of intraoperative-postoperative complications and positive surgical margin (PSM) (RPN: 7.5%, OPN: 8%) for patients with solitary kidney who underwent partial nephrectomy for small renal masses. Warm ischemia time (WIT) in all of our studies was within the safe range of <25 minutes which is acceptable ischemia time for robotic approaches. More studies are needed in order to evaluate kidney function. In conclusion with increasing experience, solitary kidney tumors can be managed safely with robotic approach. For patients having complex tumors with a potential of WIT >25 minutes, administration of intracorporeal ice slush during surgery may be considered. PMID:27635284

  4. Laparoscopic nephrectomy for complete renal infarction due to post traumatic renal artery thrombosis.

    PubMed

    Gidaro, Stefano; Schips, Luigi; Cindolo, Luca; Ziguener, Richard

    2008-06-01

    We report a case of post traumatic thrombosis of the renal artery with renal infarction and associated liver injury. Conservative treatment was initially planned in consideration of the delayed diagnosis (> 3 hours), but the patient subsequently developed hypertension not controllable with anti-hypertensive drugs. He underwent laparoscopy with nephrectomy and liver injury repair. Hypertension resolved after nephrectomy without further medical treatment. Laparoscopic nephrectomy is not a standard procedure for renal trauma but it could be an option in selected patients.

  5. Effects of a chronic high salt intake on blood pressure and the kinetics of sodium and potassium transport in erythrocytes of young and adult subtotally nephrectomized Sprague-Dawley rats.

    PubMed

    Zicha, J; Kronauer, J; Duhm, J

    1990-03-01

    Erythrocyte Na+ and K+ transport mediated by the Na(+)-K+ pump, the Na+,K+ cotransport system and cation leaks, together with blood pressure, were determined in young and adult rats subjected to either chronic salt deprivation or chronic salt loading combined with subtotal nephrectomy. The kinetics of ion transport were studied in Na+ media as a function of extracellular K+, replaced by extracellular Rb+, and intracellular Na+ varied around the physiological range. A high salt intake increased blood pressure in young but not in adult subtotally nephrectomized rats. Erythrocyte Na+ or K+ contents of salt-deprived and salt-loaded rats did not differ. There were no major changes in Na+,K+ cotransport or cation leaks in salt-loaded rats. Chronic salt loading caused some alterations in the kinetics of the Na(+)-K+ pump, which were greater in young than in adult rats. The most pronounced change was a decreased affinity of the Na(+)-K+ pump for intracellular Na+, which was partially balanced by an increased maximal velocity. At physiological (in vivo) ion concentrations these kinetic alterations caused a slight reduction in total ouabain-sensitive Rb+ uptake [partly due to a decrease in intracellular K+:extracellular Rb+ (1:1) exchange] but no changes in Na+ net extrusion in salt-loaded rats. The erythrocyte Na+ and K+ transport systems showed no changes in intrinsic properties that would favour the development or maintenance of salt hypertension in young over adult rats if similar alterations occurred in tissues relevant for blood pressure control.

  6. Impact of failed allograft nephrectomy on initial function and graft survival after kidney retransplantation.

    PubMed

    Schleicher, Christina; Wolters, Heiner; Kebschull, Linus; Anthoni, Christoph; Suwelack, Barbara; Senninger, Norbert; Palmes, Daniel; Mersfeld, Bernadette

    2011-03-01

    The management of an asymptomatic failed renal graft remains controversial. The aim of our study was to explore the effect of failed allograft nephrectomy on kidney retransplantation by comparing the outcome of recipients who underwent graft nephrectomy prior to retransplantation with those who did not. Retrospective comparison of patients undergoing kidney retransplantation with (group A, n = 121) and without (group B, n = 45) preliminary nephrectomy was performed, including subgroup analysis with reference to patients with multiple (≥2) retransplantations and patients of the European Senior Program (ESP). Nephrectomy leads to increased panel reactive antibody (PRA) levels prior to retransplantation and is associated with significantly increased rates of primary nonfunction (PNF; P = 0.05) and acute rejection (P = 0.04). Overall graft survival after retransplantation was significantly worse in group A compared with group B (P = 0.03). Among the subgroups especially ESP patients showed a shorter graft survival after previous allograft nephrectomy. On the multivariate analysis, pretransplant graft nephrectomy and PRA >70% were independent and significant risk factors associated with graft loss after kidney retransplantation. Nephrectomy of the failed allograft was not beneficial for retransplant outcome in our series. Patients with failed graft nephrectomy tended to have a higher risk of PNF and acute rejection after retransplantation. The possibility that the graft nephrectomy has a negative impact on graft function and survival after retransplantation is worth studying further.

  7. A Comparison of Hand-Assisted and Pure Laparoscopic Techniques in Live Donor Nephrectomy

    PubMed Central

    Branco, Anibal Wood; Kondo, William; Filho, Alcides José Branco; de George, Marco Aurélio; Rangel, Marlon; Stunitz, Luciano Carneiro

    2008-01-01

    PURPOSE To compare hand-assisted laparoscopic donor nephrectomy and pure laparoscopic live donor nephrectomy techniques in live donor nephrectomy. METHODS In this retrospective study, we included all patients submitted to hand-assisted laparoscopic donor nephrectomy and pure laparoscopic live donor nephrectomy between May 2002 and December 2007. The operative data and post-operative courses were reviewed. Information was collected on the operative time, warm ischemia time, estimated blood loss, intra-operative complications, time to first oral intake, length of hospital stay, and post-operative complications. The data were analyzed using Student’s t –tests and Fisher exact tests as appropriate, with statistical significance defined as p < 0.05. RESULTS The means of the operative duration, warm ischemia time and intra-operative bleeding were 83 min, 3.6 min and 130.9 cc, respectively, for hand-assisted laparoscopic donor nephrectomy, and 78.4 min, 2.5 min and 98.9 cc, respectively, for pure laparoscopic live donor nephrectomy (p=0.29, p<0.0001 and p=0.08, respectively). Intra-operative complications occurred in 6% of patients submitted to hand-assisted laparoscopic donor nephrectomy and in 4.5% of those submitted to pure laparoscopic live donor nephrectomy (p=0.68). Only one patient from each group required conversion to open surgery; one person receiving hand-assisted laparoscopic donor nephrectomy had bleeding and one person receiving pure laparoscopic live donor nephrectomy had low carbon dioxide levels during the warm ischemia period. Compared with patients receiving hand-assisted laparoscopic donor nephrectomy, patients submitted to pure laparoscopic live donor nephrectomy were able to take their first meal earlier (12.5 vs. 9.2 hours, p=0.046), were discharged home sooner (2.8 vs. 1.4 days, p<0.0001) and had fewer post-operative complications (7.5% vs. 0.6%, p=0.04). CONCLUSIONS Pure laparoscopic live donor nephrectomy had some advantages over hand

  8. Robotic partial nephrectomy for caliceal diverticulum: a single-center case series.

    PubMed

    Akca, Oktay; Zargar, Homayoun; Autorino, Riccardo; Brandao, Luis Felipe; Laydner, Humberto; Samarasekera, Dinesh; Krishnan, Jayram; Noble, Mark; Haber, George-Pascal; Kaouk, Jihad H; Stein, Robert J

    2014-08-01

    The aim of this study is to examine the role of robotic partial nephrectomy (RPN) in the management of caliceal diverticula by assessing our single-center outcomes. Between July 2007 and July 2013, 7 of 670 patients underwent RPN procedures as a reason of caliceal diverticula. The indications for RPN in all cases were recurrent urinary tract infection and pain attributed to the diverticulum in addition to failed management by endourologic or extracorporeal shockwave lithotripsy (SWL) treatments. One patient with a calcified diverticulum and another with an unsuccessful SWL treatment underwent RPN without further endourologic intervention. The other five patients had a history of unsuccessful percutaneous nephrolithotomy (one case), ureteroscopy (URS) (two cases), and a combination of SWL+URS (two cases). No intraoperative or postoperative complications were observed. No patient was readmitted postoperatively. Unique features of the robotic platform facilitate the excision of diverticulum and subsequent kidney reconstruction for this benign, but complex pathology.

  9. Laparoscopic subtotal hysterectomy due to giant uterine fibroids: a case report.

    PubMed

    Ruan, J Y; Chen, H Q; Gong, Y H; Shi, G; Wang, H

    2016-01-01

    The laparoscopic subtotal hysterectomy (LSH) was given to a patient whose uterus was about seven-month pregnanacy because of fibroids. The biggest problem was the operation space and visual field was too narrow. Different from the usual procedure we do, we morcellated the uterus at the beginning to expand the space. Loop ligature of the uterine isthmus was adopted to block uterine ateries before morcellating the uterus. After the adnexa exposed totally, we started to cut off the round ligaments, proper ligaments and fallopian tubes like usual. It was the first time we did LSH for so giant uterus in our hospital, although which was usually suitable for the uterus smaller than four-month pregnancy. But if the uterine ateries can be blocked effectively at the beginning, the uterus can be morcellated and the space will be enlarged. The laparoscopic subtotal hysterectomy will also be completed successfully. PMID:27048036

  10. Should Subtotal Thyroidectomy Be Abandoned in Multinodular Goiter Patients From Endemic Regions Requiring Surgery?

    PubMed Central

    Yoldas, Tayfun; Makay, Ozer; Icoz, Gokhan; Kose, Timur; Gezer, Gulten; Kismali, Erkan; Tamsel, Sadık; Ozbek, Sureyya; Yılmaz, Mustafa; Akyildiz, Mahir

    2015-01-01

    The most convenient surgical procedure for benign thyroid diseases is still controversial. The aim of this study is to determine the recurrence rate and risk factors for recurrence after different thyroidectomy procedures in multinodular goiter patients. Patients were separated into two groups according to the detection of a recurrent nodule or not after thyroidectomy. Of the 748 patients, 216 (29%) had recurrence, while 532 had no recurrent nodule. The difference between surgical procedures described as subtotal (ST), near total (NT) and total thyroidectomy (TT) was statistically significant. Transient hypoparathyroidism was significantly higher in NT and TT, when compared to ST patients (P < 0.05). Young age, bilateral multinodular goiter and insufficient surgery are risk factors affecting recurrence for benign nodular thyroid disease. Currently, subtotal procedures should be discontinued and total or near total procedures should be preferred. Meanwhile, the probability of a higher risk of hypoparathyroidism should be kept in mind. PMID:25594634

  11. Laparoscopic subtotal hysterectomy due to giant uterine fibroids: a case report.

    PubMed

    Ruan, J Y; Chen, H Q; Gong, Y H; Shi, G; Wang, H

    2016-01-01

    The laparoscopic subtotal hysterectomy (LSH) was given to a patient whose uterus was about seven-month pregnanacy because of fibroids. The biggest problem was the operation space and visual field was too narrow. Different from the usual procedure we do, we morcellated the uterus at the beginning to expand the space. Loop ligature of the uterine isthmus was adopted to block uterine ateries before morcellating the uterus. After the adnexa exposed totally, we started to cut off the round ligaments, proper ligaments and fallopian tubes like usual. It was the first time we did LSH for so giant uterus in our hospital, although which was usually suitable for the uterus smaller than four-month pregnancy. But if the uterine ateries can be blocked effectively at the beginning, the uterus can be morcellated and the space will be enlarged. The laparoscopic subtotal hysterectomy will also be completed successfully.

  12. SIMPLIFIED TECHNIQUE FOR RECONSTRUCTION OF THE DIGESTIVE TRACT AFTER TOTAL AND SUBTOTAL GASTRECTOMY FOR GASTRIC CANCER

    PubMed Central

    ZILBERSTEIN, Bruno; JACOB, Carlos Eduardo; BARCHI, Leandro Cardoso; YAGI, Osmar Kenji; RIBEIRO-JR, Ulysses; COIMBRA, Brian Guilherme Monteiro Marta; CECCONELLO, Ivan

    2014-01-01

    Background Laparoscopic surgery has been increasingly applied to gastric cancer surgery. Gastrointestinal tract reconstruction totally done by laparoscopy also has been a challenge for those who developed this procedure. Aim To describe simplified reconstruction after total or subtotal gastrectomy for gastric cancer by laparoscopy and the results of its application in a series of cases. Methods In the last four years, 75 patients were operated with gastric cancer and two with GIST. Thirty-four were women and 43 men. The age ranged from 38 to 77 years with an average of 55 years. In two patients with GIST a total and a subtotal gastrectomy were performed. In the other 75 patients were done 21 total gastrectomies and 54 subtotal. In all cancers, gastrectomy with D2 lymphadenectomy was completed with at least 37 lymph nodes removed. Was used in these operations a modified laparoscopic technique proposed by the authors consisting in a latero lateral esophagojejunal anastomosis with linear stapler in TG as well in STG, and reconstruction of the digestive continuity also in the upper abdomen. Results The intraoperative and immediate postoperative course were uneventful, except for one case of bleeding due to an opening clip, necessitating re-intervention. The operative time was 300 minutes, with no difference between total or subtotal gastrectomy. The number of lymph nodes removed varied from 28 to 69, averaging 37. Postoperative staging showed one case in T4 N2 M0; 13 in T2 N0 MO; 27 in T2 N1 M0; 24 in T3 N1 M0 and 10 in T3 N2 M0. Complication in only one case was observed on the 10th postoperative day with a small anastomotic leakage in esophagojejunal anastomose with spontaneous closure. Conclusion The patient's evolution with no complications, no mortality and just one small anastomotic leakage with no systemic repercussions is a strong indication of the liability and feasibility of this innovative technical method. PMID:25004292

  13. Risk-adjusted outcomes in Medicare inpatient nephrectomy patients

    PubMed Central

    Fry, Donald E.; Pine, Michael; Nedza, Susan M.; Locke, David G.; Reband, Agnes M.; Pine, Gregory

    2016-01-01

    Abstract Without risk-adjusted outcomes of surgical care across both the inpatient and postacute period of time, hospitals and surgeons cannot evaluate the effectiveness of current performance in nephrectomy and other operations, and will not have objective metrics to gauge improvements from care redesign efforts. We compared risk-adjusted hospital outcomes following elective total and partial nephrectomy to demonstrate differences that can be used to improve care. We used the Medicare Limited Dataset for 2010 to 2012 for total and partial nephrectomy for benign and malignant neoplasms to create prediction models for the adverse outcomes (AOs) of inpatient deaths, prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day relevant readmissions. From the 4 prediction models, total predicted adverse outcomes were determined for each hospital in the dataset that met a minimum of 25 evaluable cases for the study period. Standard deviations (SDs) for each hospital were used to identify specific z-scores. Risk-adjusted adverse outcomes rates were computed to permit benchmarking each hospital's performance against the national standard. Differences between best and suboptimal performing hospitals defined the potential margin of preventable adverse outcomes for this operation. A total of 449 hospitals with 23,477 patients were evaluated. Overall AO rate was 20.8%; 17 hospitals had risk-adjusted AO rates that were 2 SDs poorer than predicted and 8 were 2 SDs better. The top performing decile of hospitals had a risk-adjusted AO rate of 10.2% while the lowest performing decile had 32.1%. With a minimum of 25 cases for each study hospital, no statistically valid improvement in outcomes was seen with increased case volume. Inpatient and 90-day postdischarge risk-adjusted adverse outcomes demonstrated marked variability among study hospitals and illustrate the opportunities for care improvement. This analytic design is applicable for comparing

  14. Risk-adjusted outcomes in Medicare inpatient nephrectomy patients.

    PubMed

    Fry, Donald E; Pine, Michael; Nedza, Susan M; Locke, David G; Reband, Agnes M; Pine, Gregory

    2016-09-01

    Without risk-adjusted outcomes of surgical care across both the inpatient and postacute period of time, hospitals and surgeons cannot evaluate the effectiveness of current performance in nephrectomy and other operations, and will not have objective metrics to gauge improvements from care redesign efforts.We compared risk-adjusted hospital outcomes following elective total and partial nephrectomy to demonstrate differences that can be used to improve care. We used the Medicare Limited Dataset for 2010 to 2012 for total and partial nephrectomy for benign and malignant neoplasms to create prediction models for the adverse outcomes (AOs) of inpatient deaths, prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day relevant readmissions. From the 4 prediction models, total predicted adverse outcomes were determined for each hospital in the dataset that met a minimum of 25 evaluable cases for the study period. Standard deviations (SDs) for each hospital were used to identify specific z-scores. Risk-adjusted adverse outcomes rates were computed to permit benchmarking each hospital's performance against the national standard. Differences between best and suboptimal performing hospitals defined the potential margin of preventable adverse outcomes for this operation.A total of 449 hospitals with 23,477 patients were evaluated. Overall AO rate was 20.8%; 17 hospitals had risk-adjusted AO rates that were 2 SDs poorer than predicted and 8 were 2 SDs better. The top performing decile of hospitals had a risk-adjusted AO rate of 10.2% while the lowest performing decile had 32.1%. With a minimum of 25 cases for each study hospital, no statistically valid improvement in outcomes was seen with increased case volume.Inpatient and 90-day postdischarge risk-adjusted adverse outcomes demonstrated marked variability among study hospitals and illustrate the opportunities for care improvement. This analytic design is applicable for comparing provider

  15. Robotic partial nephrectomy: a multi-institutional analysis.

    PubMed

    Rogers, C G; Menon, M; Weise, E S; Gettman, M T; Frank, I; Shephard, D L; Abrahams, H M; Green, J M; Savatta, D J; Bhayani, S B

    2008-09-01

    Laparoscopic partial nephrectomy for kidney tumors has demonstrated durable oncologic and functional outcomes. The feasibility of robotic partial nephrectomy (RPN) has been demonstrated in several small, single-institution studies. We performed a large, multi-institutional analysis to determine early oncologic results and perioperative outcomes after RPN. Between October, 2002 and September, 2007, 148 patients underwent RPN at six different centers by nine different primary surgeons for localized renal tumors. Medical and operative records were reviewed for clinical characteristics, pathologic findings, and follow-up information. A total of 148 patients underwent RPN. Mean tumor size was 2.8 cm. Renal hilar clamping was utilized in 120 patients, with a mean warm ischemia time of 27.8 min. Positive surgical margins were identified in six patients (4%), of which two had cautery artifact obscuring the margin after off-clamp cautery excision and one underwent completion radical nephrectomy with no evidence of cancer. There is no evidence of tumor recurrence at mean follow-up of 7.2 months (range 2-54 months) overall, and mean follow-up of 18 months (range 12-23 months) for patients with positive surgical margin. Complications occurred in nine patients (6.1%), including hematoma requiring drainage (n = 1), prolonged ileus (n = 3), pulmonary embolus (n = 2), prolonged urine leak (n = 2), and rhabdomyolysis (n = 1). Two patients underwent open conversion for failure to progress, one patient with morbid obesity and one patient with adhesions from prior ureterolithotomy. Mean hospital stay was 1.9 days. In this multi-institutional series of surgeons beginning their initial experience in RPN, the procedure is a feasible option for minimally invasive, nephron-sparing surgery, with immediate oncologic results and perioperative outcomes comparable with more mature laparoscopic series. PMID:27628250

  16. Laparoscopic donor nephrectomy: impact on an established renal transplant program.

    PubMed

    Shafizadeh, S; McEvoy, J R; Murray, C; Baillie, G M; Ashcraft, E; Sill, T; Rogers, J; Baliga, P; Rajagopolan, P R; Chavin, K

    2000-12-01

    The current disparity of viable organs and patients in need of a transplant has been an impetus for innovative measures. Live donor renal transplantation offers significant advantages compared with cadaveric donor transplantation: increased graft and patient survival, diminution in incidence of delayed graft function, acute tubular necrosis (ATN), and reduction in waiting time. Notwithstanding these gains live donors continue to be underutilized and account for only approximately one quarter of all renal transplants performed in the United States. It has been felt that inherent disincentives to live donation have slowed its growth. These include degree and duration of postoperative pain and convalescence, child care concerns, cosmetic concerns, and time until return to full activities and employment. In an attempt to curtail the disincentives to live donation, laparoscopic live donation (laparoscopic donor nephrectomy; LDN) was developed. The purpose of this study was to compare the results of our first 25 laparoscopic nephrectomies (performed over a 10-month period from September 1998 through July 1999) with the previous 25 standard open donor nephrectomies (ODNs) completed over the past 3 years. We conducted a retrospective review of all donor nephrectomies and recipient pairs performed over the past 3 years. End points included sex, operative time, length of stay, immediate and long-term renal function, and willingness to donate. There were no differences in demographics of the ODN versus the LDN group. The average length of stay was 2.48+/-0.72 days for the LDN versus 4.08+/-0.28 days for the ODN. ODN and LDN have comparable short- and long-term function with no delayed graft function and no complications. Growth of living donor transplant has increased from 16 per cent of all kidney transplants performed in 1995 to 23 per cent in 1999. We conclude that LDN is a viable alternative to the standard donor operation. LDN has had a positive impact on the donor pool

  17. Pediatric retroperitoneoscopic nephrectomy: An initial experience of 15 cases

    PubMed Central

    Maitra, Souvik; Khanna, Puneet; Baidya, Dalim Kumar; Pawar, Dilip Kumar; Baipai, Minu; Panda, Shasanka Shekhar

    2015-01-01

    Retroperitoneoscopic approach of nephrectomy in pediatric patients is a debatable issue from surgical point of view. Experience of anesthetic management of 15 such patients from a tertiary care teaching hospital has been described here. We found that capno-retroperitoneum increases end-tidal carbon-di-oxide, but normocapnea was achieved in the most of the patients. No significant hemodynamic changes were noted in any patients. However, subcutaneous emphysema was common, but self-limiting without any serious consequence. Postoperative pain after this procedure is usually manageable by nonopioid analgesics. PMID:25788784

  18. Diode laser supported partial nephrectomy in laparoscopic surgery: preliminary results

    NASA Astrophysics Data System (ADS)

    Sroka, Ronald; Hennig, Georg; Zillinberg, Katja; Khoder, Wael Y.

    2011-07-01

    Introduction: Warm ischemia and bleeding during laparoscopic partial nephrectomy place technical constraints on surgeons. Therefore it was the aim to develop a safe and effective laser assisted partial nephrectomy technique without need for ischemia. Patients and methods: A diode laser emitting light at 1318nm in cw mode was coupled into a bare fibre (core diameter 600 μm) thus able to transfer up to 100W to the tissue. After dry lab experience, a total of 8 patients suffering from kidney malformations underwent laparoscopic/retroperitoneoscopic partial nephrectomy. Clinically, postoperative renal function and serum c-reactive protein (CRP) were monitored. Laser induced coagulation depth and effects on resection margins were evaluated. Demographic, clinical and follow-up data are presented. Results: Overall interventions, the mean operative time was 116,5 minutes (range 60-175min) with mean blood loss of 238ml (range 50-600ml) while laser assisted resection of the kidney tissue took max 15min. After extirpation of the tumours all patients showed clinical favourable outcome during follow up period. The tumour size was measured to be 1.8 to 5cm. With respect to clinical safety and due to blood loos, two warm ischemia (19 and 24min) must be performed. Immediate postoperative serum creatinine and CRP were elevated within 0.1 to 0.6 mg/dl (mean 0.18 mg/dl) and 2.1-10 mg/dl (mean 6.24 mg/dl), respectively. The depth of the coagulation on the removed tissue ranged between <1 to 2mm without effect on histopathological evaluation of tumours or resection margin. As the surface of the remaining kidney surface was laser assisted coagulated after removal. The sealing of the surface was induced by a slightly larger coagulation margin, but could not measured so far. Conclusion: This prospective in-vivo feasibility study shows that 1318nm-diode laser assisted partial nephrectomy seems to be a safe and promising medical technique which could be provided either during open surgery

  19. Recurrent renal cell cancer: 10 years or more after nephrectomy.

    PubMed

    Abara, Emmanuel; Chivulescu, Iolanda; Clerk, Nilam; Cano, Pablo; Goth, Alexis

    2010-04-01

    Localized renal cell carcinoma (RCC) responds well to surgery. Patients often question how long they have to be on surveillance after their surgery. Several follow-up patterns have been described in the literature. Until 2009, no published established Canadian guidelines existed to assist Canadian health-care practitioners in the surveillance of these patients. We present 3 cases of RCC that recurred 10 years or longer after the initial nephrectomy. These cases emphasize the need for careful long-term follow-up, as recommended in the Canadian Urological Association guidelines. We also discuss the optimism of prolonged disease survival in the era of novel therapeutic agents that target angiogenesis. PMID:20368882

  20. Five-sixth Nephrectomy in Female Common Marmosets(Callithrix jacchus) as a Chronic Renal Failure Model: -A Longitudinal Course of Serum Biochemical, Hematological and Histopathological Changes-.

    PubMed

    Yamaguchi, Itaru; Myojo, Kensuke; Sanada, Hiroko; Takami, Atsuko; Suzuki, Yui; Imaizumi, Minami; Takada, Chie; Kimoto, Naoya; Saeki, Koji; Yamate, Jyoji; Takaba, Katsumi

    2014-10-01

    To assess the relevance and availability of subtotal nephrectomized common marmoset monkeys as a chronic renal failure (CRF) model, we observed for 26 weeks the pathophysiological condition of female marmosets subjected to five-sixth surgical nephrectomy (5/6Nx) by a two-step surgical method. The 5/6Nx marmosets showed a significant increase in serum levels of urea nitrogen, creatinine and cystatin-C immediately after 5/6Nx surgery. These renal disorder parameters subsequently tended to decrease with the passage of time but remained higher than the control levels by the end of the study. Hyperplastic parathyroid glands, a high turnover state of osteodystrophy in the femoral bone with higher serum ALP activity and anemia with hypocellularity of bone marrow were evident. The 5/6Nx marmosets showed a stable CRF condition for a long time and some characteristic disorders similar to those observed in CRF patients. These diagnostic aspects might be a species-specific anatomical and physiological signature, reflecting the nutritional condition. The CRF model using 5/6Nx marmosets might become a useful method of evaluating the unique mechanism of CRF development. PMID:25378803

  1. Laparoscopic live donor nephrectomy with vaginal extraction: initial report.

    PubMed

    Allaf, M E; Singer, A; Shen, W; Green, I; Womer, K; Segev, D L; Montgomery, R A

    2010-06-01

    The recent decrease in the total number of living kidney transplants coupled with the increase in the number of candidates on the waiting list underscores the importance of eliminating barriers to living kidney donation. We report what we believe to be the first pure right-sided laparoscopic live donor nephrectomy with extraction of the kidney through the vagina. The warm ischemia time was 3 min and the renal vessels and ureter of the procured kidney were of adequate length for routine transplantation. The donor did not receive any postoperative parenteral narcotic analgesia, was discharged home within 24 h and was back to normal activity in 14 days. The kidney functioned well with no complications or infections. Laparoscopic live donor nephrectomy with vaginal extraction may be a viable alternative to open and standard laparoscopic approaches. Potential advantages include reduced postoperative pain, shorter hospital stay and convalescence and a more desirable cosmetic result. These possible, but yet unproven, advantages may encourage more individuals to consider live donation. PMID:20553450

  2. Hand-Assisted Laparoscopic Donor Nephrectomy in Complete Situs Inversus

    PubMed Central

    Gahagan, John V.; Whealon, Matthew D.; Reddy, Uttam; Foster, Clarence E.

    2016-01-01

    Abstract Complete situs inversus is a rare congenital anomaly characterized by transposition of organs. We report a case of renal transplantation using a kidney from a living complete situs inversus donor. The recipient was a 59-year-old female with end-stage renal disease because of type 2 diabetes mellitus. The donor was the 56-year-old sister of the recipient with complete situs inversus. CT angiogram of the abdomen and pelvis showed complete situs inversus and an otherwise normal appearance of the bilateral kidneys with patent bilateral single renal arteries and longer renal vein in the right kidney. The patient was taken to the operating room for a hand-assisted laparoscopic right donor nephrectomy. The patient tolerated the procedure well and was discharged home in good condition on postoperative day 1. The recipient experienced no episodes of acute rejection or infection, with serum creatinine levels of 0.8–1.2 mg/dL. Laparoscopic donor nephrectomy in a patient with complete situs inversus remains a technically feasible operation and the presence of situs inversus should not preclude consideration for living kidney donation. PMID:27579434

  3. Open Mini-Flank Partial Nephrectomy: An Essential Contemporary Operation

    PubMed Central

    Mano, Roy

    2014-01-01

    Secondary to the widespread use of the modern imaging techniques of computed tomography, magnetic resonance imaging, and ultrasound, 70% of renal tumors today are detected incidentally with a median tumor size of less than 4 cm. Twenty years ago, all renal tumors, regardless of size were treated with radical nephrectomy (RN). Elective partial nephrectomy (PN) has emerged as the treatment of choice for small renal tumors. The basis of this paradigm shift is three major factors: (1) cancer specific survival is equivalent for T1 tumors (7 cm or less) whether treated by PN or RN; (2) approximately 45% of renal tumors have indolent or benign pathology; and (3) PN prevents or delays the onset of chronic kidney disease, a condition associated with increased cardiovascular morbidity and mortality. Although PN can be technically demanding and associated with potential complications of bleeding, infection, and urinary fistula, the patient derived benefits of this operation far outweigh the risks. We have developed a "mini-flank" open surgical approach that is highly effective and, coupled with rapid recovery postoperative care pathways associated with a 2-day length of hospital stay. PMID:25237456

  4. Hand-Assisted Laparoscopic Donor Nephrectomy in Complete Situs Inversus.

    PubMed

    Gahagan, John V; Whealon, Matthew D; Reddy, Uttam; Foster, Clarence E; Ichii, Hirohito

    2016-01-01

    Complete situs inversus is a rare congenital anomaly characterized by transposition of organs. We report a case of renal transplantation using a kidney from a living complete situs inversus donor. The recipient was a 59-year-old female with end-stage renal disease because of type 2 diabetes mellitus. The donor was the 56-year-old sister of the recipient with complete situs inversus. CT angiogram of the abdomen and pelvis showed complete situs inversus and an otherwise normal appearance of the bilateral kidneys with patent bilateral single renal arteries and longer renal vein in the right kidney. The patient was taken to the operating room for a hand-assisted laparoscopic right donor nephrectomy. The patient tolerated the procedure well and was discharged home in good condition on postoperative day 1. The recipient experienced no episodes of acute rejection or infection, with serum creatinine levels of 0.8-1.2 mg/dL. Laparoscopic donor nephrectomy in a patient with complete situs inversus remains a technically feasible operation and the presence of situs inversus should not preclude consideration for living kidney donation. PMID:27579434

  5. Survival after partial and radical nephrectomy for high-risk disease: A propensity-matched comparison

    PubMed Central

    Maurice, Matthew J.; Zhu, Hui; Kim, Simon; Abouassaly, Robert

    2016-01-01

    Introduction: Increasingly, partial nephrectomy has been applied to high-risk disease without evidence that its survival benefits can be extrapolated to this entity. We aimed to compare overall survival after partial vs. radical nephrectomy in patients with high-risk renal cell carcinoma. Methods: Using the National Cancer Data Base, we identified patients who underwent partial or radical nephrectomy for high-risk disease between 2003 and 2006. High-risk disease was defined as the presence of adverse pathological features within the primary tumour, namely high-grade or unfavourable histology, T3 stage, or both. After matching the partial and radical nephrectomy groups based on propensity scores, 1680, 276, and 76 patients with high-grade or unfavourable histology, T3 stage, or both adverse pathologic features, respectively, were available for analysis. Five-year overall survival was compared after partial vs. radical nephrectomy for each high-risk cohort using the Kaplan-Meier and log rank tests. Results: Partial nephrectomy was associated with a statistically significant improvement in five-year overall survival compared to radical nephrectomy for small tumours (median size 3.0 cm; interquartile range 2.1–4.5 cm) with high-grade or unfavourable histology (87% vs. 81%; p<0.01) or with pT3a stage (82% vs. 71%; p<0.01). For patients concomitantly harbouring both adverse pathologic features, no difference in survival was detected (p=0.21). Conclusions: Partial nephrectomy is associated with survival benefits in patients with adverse pathologic features, suggesting that renal preservation is not only safe, but also potentially beneficial for high-risk disease. Due to inherent selection bias associated with partial nephrectomy use, prospective validation of these findings is needed.

  6. National nephrectomy registries: Reviewing the need for population-based data.

    PubMed

    Pearson, John; Williamson, Timothy; Ischia, Joseph; Bolton, Damien M; Frydenberg, Mark; Lawrentschuk, Nathan

    2015-09-01

    Nephrectomy is the cornerstone therapy for renal cell carcinoma (RCC) and continued refinement of the procedure through research may enhance patient outcomes. A national nephrectomy registry may provide the key information needed to assess the procedure at a national level. The aim of this study was to review nephrectomy data available at a population-based level in Australia and to benchmark these data against data from the rest of the world as an examination of the national nephrectomy registry model. A PubMed search identified records pertaining to RCC nephrectomy in Australia. A similar search identified records relating to established nephrectomy registries internationally and other surgical registries of clinical importance. These records were reviewed to address the stated aims of this article. Population-based data within Australia for nephrectomy were lacking. Key issues identified were the difficulty in benchmarking outcomes and no ongoing monitoring of trends. The care centralization debate, which questions whether small-volume centers provide comparable outcomes to high-volume centers, is ongoing. Patterns of adherence and the effectiveness of existing protocols are uncertain. A review of established international registries demonstrated that the registry model can effectively address issues comparable to those identified in the Australian literature. A national nephrectomy registry could address deficiencies identified in a given nation's nephrectomy field. The model is supported by evidence from international examples and will provide the population-based data needed for studies. Scope exists for possible integration with other registries to develop a more encompassing urological or surgical registry. Need remains for further exploration of the feasibility and practicalities of initiating such a registry including a minimum data set, outcome indicators, and auditing of data.

  7. Molecular Survey of Cell Source Usage during Subtotal Hepatectomy-Induced Liver Regeneration in Rats

    PubMed Central

    Elchaninov, Andrey; Fatkhudinov, Timur; Usman, Natalia; Kananykhina, Evgeniya; Arutyunyan, Irina; Makarov, Andrey; Bolshakova, Galina; Goldshtein, Dmitry; Sukhikh, Gennady

    2016-01-01

    Proliferation of hepatocytes is known to be the main process in the hepatectomy-induced liver regrowth; however, in cases of extensive loss it may be insufficient for complete recovery unless supported by some additional sources e.g. mobilization of undifferentiated progenitors. The study was conducted on rat model of 80% subtotal hepatectomy; the objective was to evaluate contributions of hepatocytes and resident progenitor cells to the hepatic tissue recovery via monitoring specific mRNA and/or protein expression levels for a panel of genes implicated in growth, cell differentiation, angiogenesis, and inflammation. Some of the genes showed distinctive temporal expression patterns, which were loosely associated with two waves of hepatocyte proliferation observed at 2 and 7 days after the surgery. Focusing on genes implicated in regulation of the progenitor cell activity, we came across slight increases in expression levels for Sox9 and two genes encoding tumor necrosis factor-like cytokine TWEAK (Tnfsf12) and its receptor Fn14 (Tnfrsf12a). At the same time, no increase in numbers of cytokeratin 19-positive (CK19+) cells was observed in periportal areas, and no CK19+ cells were found in hepatic plates. Since CK19 is thought to be a specific marker of both cholangiocytes and the hepatic progenitor cells, the data indicate a lack of activation of the resident progenitor cells during recovery of hepatic tissue after 80% subtotal hepatectomy. Thus, proliferation of hepatocytes invariably makes the major contribution to the hepatic tissue recovery, although in the cases of subtotal loss this contribution is distinctively modulated. In particular, induction of Sox9 and TWEAK/Fn14 regulatory pathways, conventionally attributed to progenitor cell activation, may incidentally stimulate mitotic activity of hepatocytes. PMID:27631110

  8. Molecular Survey of Cell Source Usage during Subtotal Hepatectomy-Induced Liver Regeneration in Rats.

    PubMed

    Elchaninov, Andrey; Fatkhudinov, Timur; Usman, Natalia; Kananykhina, Evgeniya; Arutyunyan, Irina; Makarov, Andrey; Bolshakova, Galina; Goldshtein, Dmitry; Sukhikh, Gennady

    2016-01-01

    Proliferation of hepatocytes is known to be the main process in the hepatectomy-induced liver regrowth; however, in cases of extensive loss it may be insufficient for complete recovery unless supported by some additional sources e.g. mobilization of undifferentiated progenitors. The study was conducted on rat model of 80% subtotal hepatectomy; the objective was to evaluate contributions of hepatocytes and resident progenitor cells to the hepatic tissue recovery via monitoring specific mRNA and/or protein expression levels for a panel of genes implicated in growth, cell differentiation, angiogenesis, and inflammation. Some of the genes showed distinctive temporal expression patterns, which were loosely associated with two waves of hepatocyte proliferation observed at 2 and 7 days after the surgery. Focusing on genes implicated in regulation of the progenitor cell activity, we came across slight increases in expression levels for Sox9 and two genes encoding tumor necrosis factor-like cytokine TWEAK (Tnfsf12) and its receptor Fn14 (Tnfrsf12a). At the same time, no increase in numbers of cytokeratin 19-positive (CK19+) cells was observed in periportal areas, and no CK19+ cells were found in hepatic plates. Since CK19 is thought to be a specific marker of both cholangiocytes and the hepatic progenitor cells, the data indicate a lack of activation of the resident progenitor cells during recovery of hepatic tissue after 80% subtotal hepatectomy. Thus, proliferation of hepatocytes invariably makes the major contribution to the hepatic tissue recovery, although in the cases of subtotal loss this contribution is distinctively modulated. In particular, induction of Sox9 and TWEAK/Fn14 regulatory pathways, conventionally attributed to progenitor cell activation, may incidentally stimulate mitotic activity of hepatocytes. PMID:27631110

  9. Beginner Surgeon's Initial Experience with Distal Subtotal Gastrectomy for Gastric Cancer Using a Minimally Invasive Approach

    PubMed Central

    You, Yung Hun; Ahn, Dae Ho

    2015-01-01

    Purpose Minimally invasive gastrectomy (MIG), including laparoscopic distal subtotal gastrectomy (LDG) and robotic distal subtotal gastrectomy (RDG), is performed for gastric cancer, and requires a learning period. However, there are few reports regarding MIG by a beginner surgeon trained in MIG for gastric cancer during surgical residency and fellowship. The aim of this study was to report our initial experience with MIG, LDG, and RDG by a trained beginner surgeon. Materials and Methods Between January 2014 and February 2015, a total of 36 patients (20 LDGs and 16 RDGs) underwent MIG by a beginner surgeon during the learning period, and 13 underwent open distal subtotal gastrectomy (ODG) by an experienced surgeon in Bundang CHA Medical Center. Demographic characteristics, operative findings, and short-term outcomes were evaluated for the groups. Results MIG was safely performed without open conversion in all patients and there was no mortality in either group. There was no significant difference between the groups in demographic factors except for body mass index. There were significant differences in extent of lymph node dissection (LND) (D2 LND: ODG 8.3% vs. MIG 55.6%, P=0.004) and mean operative time (ODG 178.8 minutes vs. MIG 254.7 minutes, P<0.001). The serial changes in postoperative hemoglobin level (P=0.464) and white blood cell count (P=0.644) did not show significant differences between the groups. There were no significant differences in morbidity. Conclusions This study showed that the operative and short-term outcomes of MIG for gastric cancer by a trained beginner surgeon were comparable with those of ODG performed by an experienced surgeon. PMID:26819806

  10. SUBTOTAL GASTRIC RESECTION FOR PEPTIC ULCER—Preliminary Report of a Variation in Technique

    PubMed Central

    Nagel, Gunther W.

    1953-01-01

    Internists as well as surgeons agree that subtotal gastric resection is a satisfactory method of treatment for a selected group of patients with intractable or complicated peptic ulcer. A short historical review of the development of the operation is given. The importance of removing a large portion of the acid pepsin-secreting area of the stomach is stressed. A variation from the usual method of resection accomplishes this and at the same time leaves a satisfactory gastric pouch and lessens the incidence of the dumping syndrome. PMID:13032792

  11. Transumbilical pure single-port laparoscopic donor nephrectomy.

    PubMed

    Kim, Joo Mee; Jeong, Won Jun; Choi, Byung Jo; Yuk, Seung Mo; Hwang, Jeong Kye; Lee, Sang Chul

    2015-11-01

    Transumbilical single-port laparoscopic donor nephrectomy (SPLDN) is a novel, rapidly evolving, minimally invasive treatment modality for kidney transplantation. This method causes minimal parietal injury, has cosmetic advantages, and allows rapid recovery because of low postoperative pain and short hospital stay. Like other abdominal surgeries, when conducted by experienced laparoscopic surgeons, it can meet the same graft requirements as conventional laparoscopic surgery. Here, we report the first two cases of transumbilical SPLDN at Daejeon St. Mary's Hospital, The Catholic University of Korea. We used the umbilicus as a common path for laparoscopic procedures and as a route for specimen retrieval. The operating times were 230 and 265 minutes in cases 1 and 2, respectively. No intra- or postoperative complications were noted. In case 1, the wound length was 4 cm and duration of hospitalization was 2 days. In case 2, the wound length was only 2.5 cm, and the duration of hospitalization was only 1 day. PMID:26576409

  12. Radiation response of the monkey kidney following contralateral nephrectomy

    SciTech Connect

    Robbins, M.E.C.; Stephens, L.C.; Gray, K.N.

    1994-09-30

    The long-term functional and morphologic responses of the hypertrophied monkey kidney after unilateral nephrectomy to fractionated irradiation were assessed. The right kidney of 13 adult female rhesus monkeys was removed. Twelve weeks after unilateral nephrectomy (UN) the remaining kidney received fractionated doses of {gamma}-rays ranging from 35.2 Gy/16 fractions (F) up to 44 Gy/20 F. Glomerular filtration rate, effective renal plasma flow, blood urea nitrogen, serum creatinine, and hematocrit values were measured up to 107 weeks postirradiation (PI). The monkeys were killed and the remaining kidneys were removed 107 weeks PI or earlier when end-stage renal failure was exhibited. Glomeruli were scored for the presence/absence of several pathologic features including increased intercapillary eosinophilic material (ICE), ecstatic capillaries, and thrombi. The relative proportion of renal cortex occupied by glomeruli, interstitium, normal tubules or abnormal tubules was determined using a Chalkley point grid. These quantal dose response data were analyzed using a logistic regression model. Irradiation of the remaining kidney in UN monkeys resulted in a dose-dependent reduction in renal function and anemia. Glomerular dysfunction preceded tubular dysfunction. Animals receiving 44 Gy all manifested progressive clinical renal failure. Conversely, those receiving {le} 39.6 Gy showed stable, albeit impaired, renal function for the duration of the observation period of 107 weeks. Morphologically, the incidence of ICE, ecstatic glomerular capillaries, thrombi, and periglomerular fibrosis was significantly dose-related (p < 0.005). A significant (p < 0.001) dose-related increase in the relative proportion of renal cortex occupied by abnormal tubules was indicative of tubular injury. A highly significant (p < 0.001) dose-dependent increase in the proportion of abnormal to normal tubules was also seen. 27 refs., 4 figs., 2 tabs.

  13. Kidney retransplantation for BK virus nephropathy with active viremia without allograft nephrectomy.

    PubMed

    Huang, Jingbo; Danovitch, Gabriel; Pham, Phuong-Thu; Bunnapradist, Suphamai; Huang, Edmund

    2015-12-01

    BK virus nephropathy is an important cause of kidney allograft failure. Retransplantation has been successfully performed for patients with previous allograft loss due to BK virus nephropathy; however, whether allograft nephrectomy and viral clearance are required prior to retransplantation is controversial. Some recent studies have suggested that retransplantion can be successfully achieved without allograft nephrectomy if viremia is cleared prior to retransplant. The only published experience of successful retransplantation in the presence of active viremia occurred in the presence of concomitant allograft nephrectomy of the failing kidney. In this report, we describe a case of successful repeat kidney transplant in a patient with high-grade BK viremia and fulminant hepatic failure without concomitant allograft nephrectomy performed under the setting of a simultaneous liver-kidney transplant.

  14. [Retroperitoneal lymphocele occurring in a child after nephrectomy and treated by percutaneous drainage].

    PubMed

    Tlili-Graiess, K; Gharbi-Jemni, H; Kraiem, C; Harbi, A; Allegue, M; Jeddi, M

    1994-01-01

    Lymphocele is a rare complication of kidney surgery in pediatric practice. Recent treatment consists in long term percutaneous drainage. The case reported was diagnosed 9 years after nephrectomy and improved with 3 weeks percutaneous drainage.

  15. Gastric microbiota and predicted gene functions are altered after subtotal gastrectomy in patients with gastric cancer

    PubMed Central

    Tseng, Ching-Hung; Lin, Jaw-Town; Ho, Hsiu J.; Lai, Zi-Lun; Wang, Chang-Bi; Tang, Sen-Lin; Wu, Chun-Ying

    2016-01-01

    Subtotal gastrectomy (i.e., partial removal of the stomach), a surgical treatment for early-stage distal gastric cancer, is usually accompanied by highly selective vagotomy and Billroth II reconstruction, leading to dramatic changes in the gastric environment. Based on accumulating evidence of a strong link between human gut microbiota and host health, a 2-year follow-up study was conducted to characterize the effects of subtotal gastrectomy. Gastric microbiota and predicted gene functions inferred from 16S rRNA gene sequencing were analyzed before and after surgery. The results demonstrated that gastric microbiota is significantly more diverse after surgery. Ralstonia and Helicobacter were the top two genera of discriminant abundance in the cancerous stomach before surgery, while Streptococcus and Prevotella were the two most abundant genera after tumor excision. Furthermore, N-nitrosation genes were prevalent before surgery, whereas bile salt hydrolase, NO and N2O reductase were prevalent afterward. To our knowledge, this is the first report to document changes in gastric microbiota before and after surgical treatment of stomach cancer. PMID:26860194

  16. An unusual recurrent bilateral posterior mediastinal goiter after subtotal thyroidectomy: Case report

    PubMed Central

    Aziret, Mehmet; Topçuoğlu, Mehmet Şah; Özçelik, Cemal; Özkaya, Muharrem

    2014-01-01

    INTRODUCTION Surgical treatment of benign thyroid diseases need to be followed up closely, since recurrent thyroid nodules can be seen after subtotal thyroidectomy. Intrathoracic goiter (ITG) occurs in 10–30% of patients following subtotal thyroidectomy. In general these goiters are benign, having a malignant rate of only 2–22%. ITG grows slowly but steadily and in its process of development, it narrows the thoracic inlet by compressing the surrounding structures. Most of these can not located in the anterior mediastinum, others located in posterior retrovascular area. Bilateral posterior retrovascular goiters are very rare. PRESENTATION OF CASE We report a case involving a 61-year-old woman with history of gradual-onset dyspnea who was referred to us for evaluation of a large mediastinal mass. She had undergone bilateral thyroid lobectomy for a cervical goiter 10 years ago. The mass was removed successfully via median sternotomy without complication. The patient recovered well and was discharged in 1 week. DISCUSSION Most anterior mediastinal goiters can be resected through a transcervical approach, but if those extending beyond the aortic arch into the posterior mediastinum are better dealt with by sternotomy or lateral thoracotomy. CONCLUSION Bilateral recurrent posterior mediastinal and retrovascular large goiters are better resected via sternotomy rather than lateral thoracotomy. The reason for that are the possibility of injury to large vascular structures and the difficulty of their management through lateral thoracotomy when cardiopulmonary bypass needed. PMID:24973529

  17. Recurrence of Hypertrophic Abductor Digiti Minimi Muscle of the Foot After Subtotal Resection.

    PubMed

    Schmauss, Daniel; Harder, Yves; Machens, Hans-Guenther; Lohmeyer, Joern Andreas

    2016-01-01

    Soft tissue tumors of the foot are rare, and the diagnosis is often difficult. Surgery is indicated if pain, discomfort, or functional impairment is present or to rule out malignancy. We present the case of a 14-year-old female with a painless swelling at the lateral aspect of her right foot. After radiologic imaging, including ultrasonography and magnetic resonance imaging (MRI), we performed a subtotal resection of the abductor digiti minimi muscle, preserving its motor nerve. Four months later, recurrence of the soft tissue mass was observed. MRI revealed hypertrophy of the small muscles of the foot, including the abductor digiti minimi, quadratus plantae, and flexor digiti minimi brevis. Functional impairment resulted in complete excision of the remnant abductor digiti minimi muscle and partial excision of the flexor digiti minimi brevis muscle another 7 months later. Twelve months after the secondary surgery, neither clinical nor radiologic signs of a second recurrence were found. At the last follow-up visit, the patient was satisfied with the contour of her foot and not hindered at all during sporting activities. Our findings demonstrate that subtotal resection of a bulky muscle, preserving its motor nerve, can result in reactive hypertrophy of the remnant muscle part. The patient must be informed that partial excision of an innervated muscle could result in reactive hypertrophy and must be contrasted with radical muscle excision that might be more likely to result in functional impairment. PMID:25724471

  18. The use of subtotal petrosectomy in cochlear implant candidates with chronic otitis media.

    PubMed

    Szymański, Marcin; Ataide, Andre; Linder, Thomas

    2016-02-01

    Cochlear implants (CI) candidates with chronic otitis media require special attention and management. The need of opening of the inner ear creates potential routes of spread of infection to subarachnoid spaces and lead to meningitis. The aim of the study was to analyse the technique and complications of subtotal petrosectomy (SP) in cochlear implant candidates with chronic otitis media at three different CI centres. A retrospective study was carried out in three Territory Referral Hospitals. The centres follow Fisch's philosophy and surgical techniques of SP. The study group consisted of 19 patients, 4 men and 15 women, aged 12-82 years. All patients underwent SP with either primary or staged CI implantation. Indications for single or a staged management, difficulties during surgery and complications were analysed. Skin and muscle flap design in primary and revision cases as well as imaging follow-up strategy are discussed. In 14 patients implantation was performed in a single stage and in 5 cases in two stages. Follow-up ranged from 8 months to 10 years. All the patients use their implants and there were no major nor minor complications. The use of subtotal petrosectomy with cochlear implants is a safe and efficient technique when strict surgical steps and rules are applied. Closure of the external ear canal after previous meatoplasty can be challenging and extreme care dissecting the skin flaps is required. In patients with extensive cholesteatoma, active discharge from the ear with resistant bacteria or an "unstable" situation, the procedure can be staged.

  19. Primary Squamous Cell Carcinoma of the Remnant Stomach after Subtotal Gastrectomy

    PubMed Central

    Kim, Min Sung; Kim, Dong Hee; Park, Seulkee; You, Ji Young; Han, Joon Kil; Kim, Seong Hwan; Lee, Ho Jung

    2016-01-01

    Primary squamous cell carcinoma (SCC) of the stomach is a very rare disease. However, the pathogenesis, clinical characteristics, and prognosis of gastric SCC are controversial and remain to be elucidated. Herein, we report a case of primary gastric SCC of the remnant stomach after subtotal gastrectomy. A 65-year-old man was admitted to our hospital due to epigastric discomfort and dizziness. He had undergone subtotal gastrectomy 40 years previously for gastric ulcer perforation. Endoscopy revealed a normal esophagus and a large mass in the remnant stomach. Abdominal computed tomography revealed enhanced wall thickening of the anastomotic site and suspected metachronous gastric cancer. Endoscopic biopsy revealed SCC. Total gastrectomy was performed with Roux-en-Y esophagojejunostomy. A 10-cm tumor was located at the remnant stomach just proximal to the previous area of anastomosis. Pathologic examination showed well-differentiated SCC extended into the subserosa without lymph node involvement (T3N0M0). The patient received adjuvant systemic chemotherapy with 6 cycles of 5-FU and cisplatin regimen, and he is still alive at the 54-month follow-up. According to the treatment principles of gastric cancer, early detection and radical surgical resection can improve the prognosis. PMID:27433399

  20. [Renal cell carcinoma metastasis to the thyroid gland 15 years after nephrectomy].

    PubMed

    Mathiesen, Jes Sloth; Fleischer, Jens Geelmuyden; Godballe, Christian

    2015-01-26

    Renal cell carcinoma (RCC) metastasis to the thyroid gland is rare and can mimic primary thyroid carcinoma leading to diagnostic difficulties. We present a case of a 55-year-old female with RCC metastasis to the thyroid gland 15 years after nephrectomy. Diagnosis was made after total thyroidectomy. This case emphasizes the importance of considering metastasis in patients with increasing growth of the thyroid gland over a short period of time known with earlier RCC, even decades after nephrectomy. PMID:25612964

  1. Experience with sliding-clip splenorrhaphy for splenic injury during radical nephrectomy

    PubMed Central

    Giri, Subhasis K.; Abdelrahman, Mamoun; Flood, Hugh D.

    2015-01-01

    Introduction: We report our experience with sliding-clip splenorrhaphy (SCS), a novel splenic conservation technique, for iatrogenic splenic injury (ISI) during a left radical nephrectomy (RN). We also reviewed the literature on ISI. Methods: We retrospectively reviewed data from patients who had RN between January 2005 and December 2013 at our institution. The technique used was similar to sliding-clip renorrhaphy. Our Medline literature identified articles containing “splenic injury during nephrectomy,” “iatrogenic splenic injury.” “iatrogenic splenectomy,” and “splenorrhaphy.” Our primary outcome measures included incidence of splenic injury and splenic conservation rate and splenectomy. Results: Among the 370 RN, 140 were left sided. ISI injury occurred in 6 left RN (incidence 1.6% for all nephrectomies, 4.2% for left-sided nephrectomies). All 6 cases had open procedure and for the left-sided procedure. Splenic conservation was attempted in 4 patients using SCS and 3 out of 4 were successfully repaired. Altogether 3 patients had splenectomy (incidence 0.8% for all nephrectomies, 2.1% for left-sided nephrectomies). Our literature review revealed that the incidence of iatrogenic splenectomy during left nephrectomy varies from 1.3% to 13.2%. Conclusions: SCS is an acceptable novel splenic conservation technique due to its ease of use and success in selected patients with ISI. There is little evidence on the true incidence of ISI especially on splenic conservation during nephrectomy. Every attempt at splenic conservation is likely to improve immediate- and long-term patient outcomes. PMID:26279719

  2. Body mass index and comorbidity are associated with postoperative renal function after nephrectomy

    PubMed Central

    Reinstatler, Lael; Klaassen, Zachary; Barrett, Brittani; Terris, Martha K.; Moses, Kelvin A.

    2015-01-01

    ABSTRACT Purpose: To explore the association of body mass index (BMI) and comorbidity with renal function after nephrectomy. Materials and Methods: We retrospectively analyzed 263 patients submitted to partial or radical nephrectomy from 2000-2013. Variables assessed included BMI, Charlson Comorbidity Index (CCI), race, tobacco use, tumor histology, surgical approach, Fuhrman nuclear grade, and tumor (T) classification. Glomerular filtration rate (GFR) was estimated using the Cockroft-Gault equation, adjusted for gender. Logistic regression was performed and included all interaction terms. Results: Median follow-up was 19.6 months (IQR 5.2, 53.7). Median preoperative GFR was 86.2mL/min/1.73m2 and median postoperative GFR was 68.4mL/min/1.73m2. BMI (OR 1.07, 95%CI 1.02-1.11), CCI (OR 1.19, 95%CI 1.04-1.37), and radical nephrectomy (OR 3.09, 95%CI 1.51-6.33) were significantly associated with a decline in renal function of ≥25%. Conclusion: BMI and CCI are associated with postoperative decline in renal function after nephrectomy. Additionally, radical nephrectomy is significantly associated with decreasing renal function compared to partial nephrectomy. These findings highlight the importance of assessing patient comorbidity in the decision making process for patients presenting with a renal mass. PMID:26401862

  3. A Single Surgeon's Experience with Open, Laparoscopic, and Robotic Partial Nephrectomy.

    PubMed

    Klaassen, Zachary; Kohut, Robert M; Patel, Dhruti; Terris, Martha K; Madi, Rabii

    2014-01-01

    Objective. To report the perioperative outcomes of patients treated with partial nephrectomy by a single surgeon using three surgical modalities-open, laparoscopic, and robotic. Methods. Between August 2006 and February 2012, 106 consecutive patients underwent open partial nephrectomy (OPN) (n = 23), laparoscopic partial nephrectomy (LPN) (n = 48), and robotic partial nephrectomy (RPN) (n = 35) by a single surgeon. Clinical variables, operative parameters, and renal functional outcomes were analyzed. Results. Preoperative patient characteristics were similar except for baseline glomerular filtration rate (GFR), which was highest in the RPN group (P = 0.004). Surgery time was longest in the RPN group (244 minutes) and shortest in the OPN group (163 minutes, P < 0.0001). Patients who had OPN had the highest incidence of 30-day complications (30%), while the RPN approach had the lowest (14%, P = 0.008). Conclusions. When performed by a single surgeon, robotic partial nephrectomy appears to be associated with fewer complications than both open and laparoscopic partial nephrectomy. Kidney function was not affected by surgical approach.

  4. The renal tumor morphological characteristics that affect surgical planning for laparoscopic or open partial nephrectomy.

    PubMed

    Funahashi, Yasuhito; Murotani, Kenta; Yoshino, Yasushi; Sassa, Naoto; Ishida, Shohei; Gotoh, Momokazu

    2015-02-01

    The purpose of this study is to investigate the morphological characteristics of renal tumors which affect the surgeons' decision-making for the selection of open or laparoscopic partial nephrectomy. We included 147 patients who underwent partial nephrectomy for renal masses with elective indications in this study. Laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) were performed in 72 and 75 patients, respectively. Preoperative trans-sectional images were used to assess tumor characteristics such as tumor size, endophyticity, distance from the sinus, distance from the kidney equator, hilar designation, inside designation, and R.E.N.A.L. nephrometry score. Univariate logistic regression analyses demonstrated that tumor size, endophyticity, distance from the sinus, hilar designation, inside designation, and R.E.N.A.L. nephrometry score were associated with decision of laparoscopic partial nephrectomy. Among these factors, multiple regression analyses showed that endophyticity (odds ratio = 0.92, p = 0.007) and distance from the sinus (odds ratio = 1.201, p < 0.001) had statistically significant associations with the type of operation performed. ROC analyses demonstrated cut-off values of 16 mm for endophyticity (sensitivity 69%, specificity 77%) and of 4 mm for distance from the sinus (sensitivity 79%, specificity 65%) for predicting the selection of laparoscopic surgery. In conclusion, this study revealed that endophyticity and distance from the sinus were important for the surgical planning of partial nephrectomy.

  5. 5/6th nephrectomy in combination with high salt diet and nitric oxide synthase inhibition to induce chronic kidney disease in the Lewis rat.

    PubMed

    van Koppen, Arianne; Verhaar, Marianne C; Bongartz, Lennart G; Joles, Jaap A

    2013-07-03

    Chronic kidney disease (CKD) is a global problem. Slowing CKD progression is a major health priority. Since CKD is characterized by complex derangements of homeostasis, integrative animal models are necessary to study development and progression of CKD. To study development of CKD and novel therapeutic interventions in CKD, we use the 5/6th nephrectomy ablation model, a well known experimental model of progressive renal disease, resembling several aspects of human CKD. The gross reduction in renal mass causes progressive glomerular and tubulo-interstitial injury, loss of remnant nephrons and development of systemic and glomerular hypertension. It is also associated with progressive intrarenal capillary loss, inflammation and glomerulosclerosis. Risk factors for CKD invariably impact on endothelial function. To mimic this, we combine removal of 5/6th of renal mass with nitric oxide (NO) depletion and a high salt diet. After arrival and acclimatization, animals receive a NO synthase inhibitor (NG-nitro-L-Arginine) (L-NNA) supplemented to drinking water (20 mg/L) for a period of 4 weeks, followed by right sided uninephrectomy. One week later, a subtotal nephrectomy (SNX) is performed on the left side. After SNX, animals are allowed to recover for two days followed by LNNA in drinking water (20 mg/L) for a further period of 4 weeks. A high salt diet (6%), supplemented in ground chow (see time line Figure 1), is continued throughout the experiment. Progression of renal failure is followed over time by measuring plasma urea, systolic blood pressure and proteinuria. By six weeks after SNX, renal failure has developed. Renal function is measured using 'gold standard' inulin and para-amino hippuric acid (PAH) clearance technology. This model of CKD is characterized by a reduction in glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), hypertension (systolic blood pressure>150 mmHg), proteinuria (> 50 mg/24 hr) and mild uremia (>10 mM). Histological

  6. Use of preoperative embolization prior to Transplant nephrectomy

    PubMed Central

    Yeast, Carrie; Riley, Julie M.; Holyoak, Joshua; Ross, Gilbert; Weinstein, Stephen; Wakefield, Mark

    2016-01-01

    ABSTRACT Introduction After a failed transplant, management of a non-functional graft with pain or recurrent infections can be challenging. Transplant nephrectomy (TN) can be a morbid procedure with the potential for significant blood loss. Embolization of the renal artery alone has been proposed as a method of reducing complications from an in vivo failed kidney transplant. While this does yield less morbidity, it may not address an infected graft or refractory hematuria or rejection. We elected to begin preoperative embolization to assess if this would help decrease the blood loss and transfusion rate associated with TN. Materials and Methods We performed a retrospective analysis of all patients who underwent non-emergent TN at our institution. Patients who had functioning grafts that later failed were included in analysis. TN was performed for recurrent infections, pain or hematuria. We evaluated for blood loss (EBL) during TN, transfusion rate and length of hospital stay. Results A total of 16 patients were identified. Nine had preoperative embolization or no blood flow to the graft prior to TN. The remaining 7 did not have preoperative embolization. The shortest time from transplant to TN was 8 months and the longest 18 years with an average of 6.3 years. Average EBL for the embolized patients (ETN) was 143.9cc compared to 621.4cc in the non-embolized (NETN) group (p=0.041). Average number of units of blood transfused was 0.44 in the ETN with only 3/9 patients requiring transfusion. The NETN patients had average of 1.29 units transfused with 5/7 requiring transfusion. The length of stay was longer for the ETN (5.4 days) compared to 3.9 in the NETN. No intraoperative complications were seen in either group and only one patient had a postoperative ileus in the NETN. Conclusion Embolization prior to TN significantly decreases the EBL but does not significantly decrease transfusion rate. However, patients do require a significantly longer hospitalization with

  7. Subtotal gastrectomy with limited lymph node dissection is a feasible treatment option for patients with early gastric stump cancer.

    PubMed

    Irino, Tomoyuki; Hiki, Naoki; Nunobe, Souya; Ohashi, Manabu; Tanimura, Shinya; Sano, Takeshi; Yamaguchi, Toshiharu

    2014-08-01

    The de facto standard treatment for early gastric stump cancer (GSC) has been total gastrectomy combined with radical lymph node dissection. However, some patients could benefit if partial resection of the gastric stump is feasible. We investigated the feasibility of subtotal gastrectomy for early GSC as less invasive surgery. Subtotal gastrectomy was defined as a segmental resection of the gastric remnant including the anastomosis with limited lymph node dissection. A total of 66 patients with early GSC were enrolled and 24 patients (36.4 %) underwent subtotal gastrectomy (SG group). Clinicopathological characteristics were analyzed along with those of the other 42 patients (63.6 %) who underwent total gastrectomy (TG group). There were no significant differences between the two groups in the number of lymph nodes harvested (p = 0.880). Lymph node involvement was detected in 2 patients (8.3 %) in SG group and 5 patients (11.9 %) in TG group (p = 1.000). The previous disease (benign or malignant) and surgery (Billroth I or II) did not affect the rate of nodal involvement. The 5-year overall survival rate of SG group (94.7 %) was acceptable. Subtotal gastrectomy of the gastric remnant could be a feasible treatment option for patients with early gastric stump cancer when indicated.

  8. Prospective study of the changes in thyrotropin binding inhibitory immunoglobulins in Graves' disease treated by subtotal thyroidectomy or radioactive iodine

    SciTech Connect

    Teng, C.S.; Yeung, R.T.T.; Khoo, R.K.K.; Alagaratnam, T.T.

    1980-06-01

    The effects of subtotal thyroidectomy and radioactive iodine on thyroid-stimulating immunoglobulins, as measured by a receptor assay, more appropriately termed TSH binding inhibitory immunoglobulins (TBII), were studied in 74 patients with Graves' disease. Fourty-four patients received radioactive iodine therapy, while 30 were subjected to subtotal thyroidectomy. After radioactive iodine, more patients were TBII-positive (90.5% vs 81.8%) than before treatment, and the mean TBII index decreased dramatically, the maximum decrease being 3 months. The mean TBI index subsequently returned gradually to the pretreatment level. Subtotal thyroidectomy had a different effect on TBII activity. TBII indices were positive in 89.3% of these patients before any treatment but were positive in only 40% (12 patients) after antithyroid drugs had been given before surgery. After surgery, TBII indices remained positive in 7 patients, while the remaining 5 patients became TBII negative. Seventeen patients (56.7%) were TBII negative before operation and remained so after surgery. One patient who was TBII negative before operation became TBII positive 2 months after operation. Interestingly, postoperative relapse of hyperthyroidism occurred in 3 patients who were TIBII positive, while hypothyroidism occurred in patients who were TBII negative. Thus, the TBII activity after subtotal thyroidectomy might be an important factor in determining the outcome of surgery.

  9. Quality of life after subtotal gastrectomy for gastric cancer: Does restoration method matter? – A retrospective cohort study

    PubMed Central

    Smolskas, Edgaras; Lunevicius, Raimundas; Samalavicius, Narimantas Evaldas

    2015-01-01

    Introduction The aim of this study was to evaluate the impact on the quality of life (QoL) status of three gastrointestinal continuity restoration methods following a subtotal gastrectomy in patients with gastric cancer. Methods QoL data from 153 patients were obtained and evaluated in this retrospective cross-sectional case series study. A list of patients who responded to questionnaires on QoL was stratified into three arms based on which gastrointestinal continuity restoration method was used – Billroth I (n = 37), Roux-en-Y (n = 15), and Balfour (n = 101). Results The mean global health status scores for the patients following the Billroth I, Roux-en-Y and Balfour reconstructive surgery arms were 62 ± 20.09, 61 ± 24.08 and 56 ± 21.2, respectively, (p = 0.182). The mean scores of the functional scales were not lower than 60 in any of the patient groups. For physical, role, cognitive, social functional scales, the Billroth I method had the best mean QoL score. Comparisons of the global QoL, functional activities, and majority of the postgastrectomy symptom scores at different time points after the surgeries (6–12 months vs > 1 year) did not reveal major significant differences between the groups. However, the results highlighted trends and ranked the gastrointestinal continuity restoration methods over time. Conclusions The best QoL scores were obtained from the patients who underwent the Billroth I surgery. The Roux-en-Y method was better than the Balfour method 6–12 months after surgery. However, the Balfour method was better than the Roux-en-Y after one year. Further prospective randomized controlled trials are needed. PMID:26904188

  10. Iatrogenic Subtotal Stenosis of the Right Subclavian Artery Treated With Percutaneous Transluminal Angioplasty

    SciTech Connect

    Smeenk, Robert M.; Kock, Mark C. J. M.; Elgersma, Otto E. H.; Schnater, Marco J.

    2011-02-15

    This report describes a rare vascular complication of surgical placement of a marking clip and a possible approach to problem solving. A 55-year-old patient presented with loss of sensation in the fingers and loss of peripheral pulsations in the right arm 4 days after right upper lobectomy for a pT2N1 moderately differentiated adenocarcinoma of the lung. Duplex examination and computed tomography were performed the same day and showed a subtotal stenosis of the right subclavian artery, which was caused by the surgical placement of a metal clip to mark the surgical boundary. Selective angiography was subsequently performed. Percutaneous transluminal angioplasty (PTA) successfully dilated the stenosis and pushed the clip off. Flow in the right subclavian artery (RSA) was completely restored as were neurology and peripheral pulses. In conclusion, arterial stenosis by a surgical (marking) clip may be feasibly treated with PTA.

  11. Use of Percutaneous Ethanol Injection Therapy for Recurrent Secondary Hyperparathyroidism after Subtotal Parathyroidectomy

    PubMed Central

    Douthat, Walter G.; Cardozo, Gabriela; Garay, Gabriela; Orozco, Santiago; Chiurchiu, Carlos; de la Fuente, Jorge; de Arteaga, Javier; Massari, Pablo U.

    2011-01-01

    We evaluated the efficacy of percutaneous ethanol injection therapy (PEIT) as a therapeutic option for recurrence of secondary hyperparathyroidism after subtotal parathyroidectomy in ESRD patients. Six patients underwent PEIT. A mean of 1.3 ± 0.8 ethanol injections was performed. Nodular volume was 1.5 ± 1.7 cm3, and 2.8 ± 2.8 cm3 of ethanol was injected per patient. After ethanol injection PTH decreased significantly (1897 ± 754 to 549 ± 863 pg/mL (P < .01)). There was also a reduction in serum calcium, phosphorus and calcium-phosphorus product. A positive and significant correlation was found between nodular volume with ethanol injected and time from parathyroidectomy. Only one patient required hospitalization due to severe hypocalcaemia. In other two cases, local discomfort and temporary mild dysphonia were registered. PEIT is an effective treatment to control recurrences of secondary hyperparathyroidism postsubtotal parathyroidectomy. PMID:21716690

  12. Subtotal parathyroidectomy for primary hyperparathyroidism. Long-term results in 292 patients

    SciTech Connect

    Paloyan, E.; Lawrence, A.M.; Oslapas, R.; Shah, K.H.; Ernst, K.; Hofmann, C.

    1983-04-01

    Subtotal parathyroidectomy was performed in a consecutive series of 292 patients with primary hyperparathyroidism. We evaluated the long-term postoperative results during a period of 16 years. Patients ranged in age from 14 to 83 years and included 176 women and 116 men. Of these, 16% had a history of exposure to radiation in childhood or adolescence, while thyroid disease requiring some form of thyroidectomy coexisted in 91 (31%) of the patients. Histologic information on three or more parathyroid glands was obtained in 73% of the cases. We considered 285 patients (97.6%) cured after their first operation. The remaining seven patients (2.4%) had persistent hyperparathyroidism. However, five were cured after a sternum-splitting mediastinal exploration and one after a second neck exploration. The seventh remains hypercalcemic despite a subsequent mediastinal exploration. Temporary postoperative hypoparathyroidism occurred in 10% of our cases and permanent hypoparathyroidism in 1%. There have been no instances of recurrent hyperparathyroidism.

  13. Endobronchial Hamartoma Subtotally Occluding the Right Main Bronchus and Mimicking Bronchial Carcinoid Tumor

    PubMed Central

    Lococo, Filippo; Galeone, Carla; Lasagni, Luciano; Carbonelli, Cristiano; Tagliavini, Elena; Piro, Roberto; Zucchi, Luigi; Sgarbi, Giorgio

    2016-01-01

    Abstract Hamartomas are very rarely identified as an endobronchial lesion. Herein, we describe a peculiar case of a 55-year-old woman with persistent cough and increasing dyspnea and radiological detection of a solid lesion subtotally occluding the main right bronchus. Despite the radiological and radiometabolic (18-fluoro-2-deoxy-d-glucose positron emission tomography/computer tomography scan) features were highly suspected for bronchial carcinoid, the definitive diagnosis after endoscopic removal was indicative of an endobronchial hamartoma. When considering differential diagnosis of an endobronchial lesion, the physicians should take firmly in mind such rare entity and, accordingly, bronchoscopy and bronchoscopic biopsy should be done as first step in management of all cases presenting with endobronchial lesions. PMID:27082600

  14. Use of percutaneous ethanol injection therapy for recurrent secondary hyperparathyroidism after subtotal parathyroidectomy.

    PubMed

    Douthat, Walter G; Cardozo, Gabriela; Garay, Gabriela; Orozco, Santiago; Chiurchiu, Carlos; de la Fuente, Jorge; de Arteaga, Javier; Massari, Pablo U

    2011-01-01

    We evaluated the efficacy of percutaneous ethanol injection therapy (PEIT) as a therapeutic option for recurrence of secondary hyperparathyroidism after subtotal parathyroidectomy in ESRD patients. Six patients underwent PEIT. A mean of 1.3 ± 0.8 ethanol injections was performed. Nodular volume was 1.5 ± 1.7 cm(3), and 2.8 ± 2.8 cm(3) of ethanol was injected per patient. After ethanol injection PTH decreased significantly (1897 ± 754 to 549 ± 863 pg/mL (P < .01)). There was also a reduction in serum calcium, phosphorus and calcium-phosphorus product. A positive and significant correlation was found between nodular volume with ethanol injected and time from parathyroidectomy. Only one patient required hospitalization due to severe hypocalcaemia. In other two cases, local discomfort and temporary mild dysphonia were registered. PEIT is an effective treatment to control recurrences of secondary hyperparathyroidism postsubtotal parathyroidectomy.

  15. Severe hemorrhage complicating early transplant nephrectomy due to sepsis.

    PubMed

    Akoh, Jacob A; Rana, Tahawar

    2016-05-01

    Compared to the general population, transplant patients receiving immuno- suppression have an increased risk of wound and systemic infection that might lead to hemorrhage. We present a case of severe bleeding from the external iliac artery secondary to a pelvic abscess following renal transplantation and transplant nephrectomy. A 73-year-old man received an extended criteria donor organ from a 49-year-old person who died from systemic sepsis. The patient bled from the Carrel's patch while awaiting a computed tomographic scan- guided drainage of an infected peritransplant collection. At exploration, a nonviable allograft surrounded by about 1 L of thick pus was removed. Bleeding from a 2 mm hole in the Carrel's patch was repaired by prolene suture as the external iliac vessels could not be mobilized due to a frozen pelvis. The patient died 72 h later from a massive bleed confirmed at postmortem to have originated from the external iliac artery distal to the anastomosis. Diversion of blood flow away from an affected area (with or without excision of the infected vessels) through a bypass procedure probably represents the best option in avoiding such sequelae. PMID:27215254

  16. Visual enhancement of laparoscopic nephrectomies using the 3-CCD camera

    NASA Astrophysics Data System (ADS)

    Crane, Nicole J.; Kansal, Neil S.; Dhanani, Nadeem; Alemozaffar, Mehrdad; Kirk, Allan D.; Pinto, Peter A.; Elster, Eric A.; Huffman, Scott W.; Levin, Ira W.

    2006-02-01

    Many surgical techniques are currently shifting from the more conventional, open approach towards minimally invasive laparoscopic procedures. Laparoscopy results in smaller incisions, potentially leading to less postoperative pain and more rapid recoveries . One key disadvantage of laparoscopic surgery is the loss of three-dimensional assessment of organs and tissue perfusion. Advances in laparoscopic technology include high-definition monitors for improved visualization and upgraded single charge coupled device (CCD) detectors to 3-CCD cameras, to provide a larger, more sensitive color palette to increase the perception of detail. In this discussion, we further advance existing laparoscopic technology to create greater enhancement of images obtained during radical and partial nephrectomies in which the assessment of tissue perfusion is crucial but limited with current 3-CCD cameras. By separating the signals received by each CCD in the 3-CCD camera and by introducing a straight forward algorithm, rapid differentiation of renal vessels and perfusion is accomplished and could be performed real time. The newly acquired images are overlaid onto conventional images for reference and comparison. This affords the surgeon the ability to accurately detect changes in tissue oxygenation despite inherent limitations of the visible light image. Such additional capability should impact procedures in which visual assessment of organ vitality is critical.

  17. LESS living donor nephrectomy: Surgical technique and results

    PubMed Central

    Alessimi, Abdullah; Adam, Emilie; Haber, Georges-Pascal; Badet, Lionel; Codas, Ricardo; Fehri, Hakim Fassi; Martin, Xavier; Crouzet, Sébastien

    2015-01-01

    Purpose: We present the findings of 50 patients undergoing pure trans-umbilical laparo-endoscopic single-site surgery (LESS) living donor nephrectomy (LDN), between February 2010 and May 2014. Materials and Methods: Laparo-endoscopic single-site surgery LDN was performed through an umbilical incision. Different trocars were used, namely Gelpoint (Applied Mιdical, Rancho Santa Margarita, CA) SILS port (Covidien, Hamilton, Bermuda), R-port (Olympus Surgical, Orangeburg, NY) and standard trocars, inserted through the same skin incision but using separate fascial punctures. The standard laparoscopic technique was employed. The kidney was pre-entrapped in a retrieval bag and extracted trans-umbilically. Data were collected prospectively including questionnaires containing patient reported oral pain medication duration and time to recovery. Results: LESS LDN was successful in all patients. Mean warm ischemia time was 6.2 min (3–15), mean procedure time was 233.2 min (172–300), and hospitalization stay was 3.94 days (3–7) with a visual analogue pain score at discharge of 1.32 (0–3). No intraoperative complications occurred. The mean time of oral pain medication was 8.72 days (1–20) and final scar length was 4.06 cm (3–5). Each allograft was functional. Conclusion: Although challenging, trans-umbilical LESS LDN seems to be feasible and safe. Hence, LESS has the potential to improve cosmetic results and decrease morbidity. PMID:26229326

  18. Rapid cholesterol nucleation time and cholesterol gall stone formation after subtotal or total colectomy in humans.

    PubMed Central

    Makino, I; Chijiiwa, K; Higashijima, H; Nakahara, S; Kishinaka, M; Kuroki, S; Mibu, R

    1994-01-01

    Changes in biliary lipid composition, pH, ionised calcium, total and unconjugated bilirubin, and cholesterol nucleation time of gall bladder bile samples were examined in six patients who had undergone subtotal or total colectomy between five months and seven years previously, and values were compared with those in control patients with no gall stones. The colectomy group mainly comprised patients with ulcerative colitis and familial adenomatosis coli, in whom only a short length of the terminal ileum (mean (SEM) 2.25 (0.57) cm) had been resected. The reconstruction procedures were ileoanal anastomosis in two patients, terminal ileostomy in two, ileorectal anastomosis in one, and J shaped ileal pouch-anal anastomosis in one patient. The distributions of age, sex, and relative body weight were similar in the two groups. The gall bladder bile was lithogenic in the post colectomy group--these patients had a significantly increased cholesterol saturation index (p < 0.01) and rapid cholesterol nucleation time (p < 0.05) compared with the control group. A significant increase in the molar percentage of cholesterol and a decrease in that of total bile acid associated with significantly decreased secondary bile acids (p < 0.05) were observed in the post colectomy group. Gall stones formed in two of six patients after colectomy were cholesterol stones containing more than 80% cholesterol by dry weight. Total and unconjugated bilirubin, pH, and ionised calcium values were similar in the two groups. The results indicate that after total or subtotal colectomy the composition of gall bladder bile increases the risk of cholesterol gall stone formation. PMID:7829016

  19. The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial Nephrectomy

    PubMed Central

    Sivarajan, Ganesh; Taksler, Glen B.; Walter, Dawn; Gross, Cary P.; Sosa, Raul E.; Makarov, Danil V.

    2015-01-01

    Introduction The rapid diffusion of the surgical robot has been controversial because of the technology’s high costs and its disputed marginal benefit. Some, however, have suggested that adoption of the robot may have improved care for patients with renal malignancy by facilitating partial nephrectomy, an underutilized, technically challenging procedure believed to be less morbid than radical nephrectomy. We sought to determine whether institutional acquisition of the robot was associated with increased utilization of partial nephrectomy. Methods We used all payer data from 7 states to identify 21,569 nephrectomies. These patient-level records were aggregated to the hospital-level then merged with the American Hospital Association Annual Survey and publicly available data on timing of robot acquisition. We used a multivariable difference-in-difference model to assess at the hospital-level whether robot acquisition was associated with an increase in the proportion of partial nephrectomy, adjusting for hospital nephrectomy volume, year of surgery, and several additional hospital-level factors. Results In the multivariable-adjusted differences-in-differences model, hospitals acquiring a robot between 2001 and 2004 performed a greater proportion of partial nephrectomy in both 2005 (29.9% increase) and 2008 (34.9% increase). Hospitals acquiring a robot between 2005 and 2008 also demonstrated a greater proportion of partial nephrectomy in 2008 (15.5% increase). In addition, hospital nephrectomy volume and urban location were also significantly associated with increased proportion of partial nephrectomy. Conclusions Hospital acquisition of the surgical robot is associated with greater proportion of partial nephrectomy, an underutilized, guideline-encouraged procedure. This is one of the few studies to suggest robot acquisition is associated with improvement in quality of patient care. PMID:25494234

  20. Laparoscopic Partial Nephrectomy with Diode Laser: A Promising Technique

    PubMed Central

    Knezevic, Nikola; Maric, Marjan; Grkovic, Marija Topalovic; Krhen, Ivan; Kastelan, Zeljko

    2014-01-01

    Abstract Objective: The aim of this study was to evaluate application of diode laser in laparoscopic partial nephrectomy (LPN), and to question this technique in terms of ease of tumor excision and reduction of warm ischemia time (WIT). Background data: LPN is the standard operative method for small renal masses. The benefits of LPN are numerous, including preserving renal function and prolonging overall survival. However, reduction of WIT remains main challenge in this operation. In order to shorten WIT, many techniques have been developed, with variable results. Patients and methods: We performed a prospective collection and analysis of health records for patients who were operated on between March 2011 and August 2012. Inclusion criteria were single tumor ≤4 cm, predominant exophytic growth and intraparenchymal depth ≤1.5 cm, with a minimum distance of 5 mm from the urinary collecting system. Results: We operated on 17 patients. Median operative time was 170 min. In all but two patients, we had to perform hilar clamping. Median duration of WIT was 16 min. Pathohistological evaluation revealed clear cell renal cancer and confirmed margins negative for tumor in all cases. Median size of the tumor was 3 cm. Median postoperative hospitalization was 5 days. Average follow up was 11.5 months. There were no intraoperative complications. One postoperative complication was noted: perirenal hematoma. Conclusions: Laser LPN is feasible, and offers the benefit of shorter WIT, with effective tissue coagulation and hemostasis. With operative experience and technical advances, WIT will be reduced or even eliminated, and a solution to some technical difficulties, such as significant smoke production, will be found. PMID:24460067

  1. Postrenal transplant urinary leakage caused by segmental infarction of a renal allograft treated by partial nephrectomy.

    PubMed

    Salehipour, Mehdi; Roozbeh, Jamshid; Eshraghian, Ahad; Nikeghbalian, Saman; Salahi, Heshmatollah; Bahador, Ali; Malek-hosseini, Seyed Ali

    2011-04-01

    Kidney transplant is the final treatment for patients with end-stage renal disease. Urinary leakage is the most-common surgical complication early after transplant. Another complication in the early posttransplant period is segmental allograft infarction. We report a kidney recipient who developed urinary leakage secondary to a segmental infarction of the upper pole of the transplanted kidney 2 months after transplant. The patient was treated successfully by a partial nephrectomy of the infracted upper lobe of the kidney. Three months after the partial nephrectomy of the allograft, serum blood urea nitrogen and creatinine were normal, and the patient was able to partake in her daily activities. Partial nephrectomy in the context of infarction of a kidney allograft is safe and can be used in similar cases.

  2. Cystic local recurrence of renal cell carcinoma after laparoscopic radical nephrectomy in a hemodialysis patient.

    PubMed

    Ito, Kazuyo; Takagi, Toshio; Kondo, Tsunenori; Yoshida, Kazuhiko; Iizuka, Junpei; Kobayashi, Hirohito; Tomita, Eri; Hashimoto, Yasunobu; Tanabe, Kazunari

    2014-03-01

    Although local recurrence of renal cell carcinoma after laparoscopic radical nephrectomy is sometimes reported, cystic local recurrence of renal cell carcinoma has rarely been reported. We report the case of a 59-year-old man with hemodialysis who developed cystic local recurrence of renal cell carcinoma accompanied by acquired cystic disease of the kidney in the retroperitoneal space after laparoscopic radical nephrectomy. A cystic tumor of 5.1 cm in diameter occurred in the left retroperitoneal space 15 months after left laparoscopic radical nephrectomy, and enlarged to 7.2 cm in diameter with enhanced mass along the wall of the cyst 36 months after surgery. The cystic tumor was removed and showed local recurrence of renal cell carcinoma on pathological examination.

  3. Laparoscopic wedge resection and partial nephrectomy--the Washington University experience and review of the literature.

    PubMed

    McDougall, E M; Elbahnasy, A M; Clayman, R V

    1998-01-01

    Open partial nephrectomy is an accepted form of treatment for a variety of benign conditions and for localized renal cell carcinoma. To date, there is limited experience with the clinical application of laparoscopic partial nephrectomy and wedge resection for benign and malignant disease of the kidney. Herein, we report our clinical experience with laparoscopic partial nephrectomy and a review of the current literature. Twelve patients (27-81 years) have undergone laparoscopic wedge resection (3) or attempted polar partial nephrectomy (9) since 1993. In the group of 12 patients, 5 had a mass suspicious for a malignancy, 4 patients had symptomatic polar calyceal dilation with or without stone disease, and 3 patients had an atrophic or hydronephrotic upper pole moiety. Among the patients in the polar nephrectomy group, a third were converted to an open procedure. The remaining 6 patients had a mean operative time of 6.5 hours (5.7-8.3 hours). These patients resumed their oral intake on average 0.8 days postoperatively. In the 2 patients with a mass, the final pathology was oncocytoma (1), and xanthogranulomatous reaction in a renal cyst (1). Postoperative complications included a nephrocutaneous fistula which was endoscopically fulgurated, a retroperitoneal urinoma which was percutaneously drained, and a two-day bout of ileus. The mean hospital stay was 5.3 days (2-9). Their full convalescence was completed in a mean of 4.2 weeks (2-8). Three patients underwent a wedge resection for a superficial < 2 cm mass. The average operative time in this group was 3.5 hours (2-5.4). The mean time to resuming oral intake was 0.7 days (0.3-0.7). The final pathology was oncocytoma (1), oncocytic renal cell cancer (1), and old infarction (1); none of the patients had any complications. The mean hospital stay was 2.7 days (2-4). Convalescence was completed in 4 weeks (range 1-8). Laparoscopic wedge resection and polar partial nephrectomy are feasible, albeit currently tedious

  4. Description of a novel technique for suture ligation of the renal vessels during robotic nephrectomy.

    PubMed

    Patel, Manish N; Laungani, Rajesh; Shrivastava, Alok; Bhandari, Akshay; Spencer Krane, L; Menon, Mani; Rogers, Craig G

    2009-03-01

    Minimally invasive techniques are frequently used for surgical treatment of suspected malignant renal masses. We previously reported on our experience with robotic nephrectomy and the feasibility of performing suture ligation of the renal vessels using robotic needle drivers. We describe a novel technique for suture ligation of the renal vessels during robotic nephrectomy utilizing the robotic hook and a suture with loops at each end. Our technique for suture ligation of the renal vessels recapitulates the open technique without the need for exchanging the robotic working instruments for robotic needle drivers and without the need for endovascular staplers. PMID:27628449

  5. Subtotal Gastrectomy as “Last Resort” Consideration in the Management of Refractory Rumination Syndrome

    PubMed Central

    Cooper, Chad J.; Otoukesh, Salman; Mojtahedzadeh, Mona; Galvis, Juan M.; McCallum, Richard W.

    2014-01-01

    Rumination syndrome is a behavioral disorder resulting in effortless regurgitation of undigested food within minutes of meal intake that is subsequently either re-swallowed or ejected. It is commonly misdiagnosed, patients often undergo extensive testing and multiple therapies, many of which are directed at suspected gastroparesis. A 25-year-old Caucasian female initially presented to our care 1 year ago with a 4-year history of nausea and vomiting occurring in the immediate postprandial period, specifically within 15 minutes from oral intake. She had an extensive history of multiple diagnostic, therapeutic and surgical procedures over the previous 4 years which included cholecystectomy, botulin toxin injection into the pyloric sphincter, pyloroplasty, placement of a gastric stimulator and jejunal feeding tube with no sustained results. On a previous admission we determined the functional status of the stomach by obtaining full thickness gastric biopsies during a diagnostic laparoscopy. This revealed an adequate population number of cells of Cajal and myenteric neurons as well as normal stomach muscle. After 1 year of attempting “breathing relaxation techniques”, while being nutritionally maintained by nocturnal jejunostomy feedings, the patient presented again to our care with refractory nausea and vomiting and unable to work or function. Her weight was 90 lbs. She underwent a subtotal gastrectomy (80%) with Roux-en-Y reconstruction and continuation of jejunostomy feeding. The refractory nausea and vomiting significantly improved over the 4 weeks after discharge and breathing exercises were continued. On subsequent follow-up visits over a 6-month course, the refractory nausea and vomiting had resolved by more than 85% with and improvement in her BMI and quality of life.The recommended treatment of rumination syndrome is focused on breathing exercises and relaxation techniques to “distract” while eating. We believe our case is the first reported where a

  6. Laparoscopic Resection of Cholecystocolic Fistula and Subtotal Cholecystectomy by Tri-Staple in a Type V Mirizzi Syndrome

    PubMed Central

    Yetişir, Fahri; Şarer, Akgün Ebru; Acar, Hasan Zafer; Parlak, Omer; Basaran, Basar; Yazıcıoğlu, Omer

    2016-01-01

    The Mirizzi syndrome (MS) is an impacted stone in the cystic duct or Hartmann's pouch that mechanically obstructs the common bile duct (CBD). We would like to report laparoscopic subtotal cholecystectomy (SC) and resection of cholecystocolic fistula by the help of Tri-Staple™ in a case with type V MS and cholecystocolic fistula, for first time in the literature. A 24-year-old man was admitted to emergency department with the complaint of abdominal pain, intermittent fever, jaundice, and diarrhea. Two months ago with the same complaint, ERCP was performed. Laparoscopic resection of cholecystocolic fistula and subtotal cholecystectomy were performed by the help of Tri-Staple. At the eight-month follow-up, he was symptom-free with normal liver function tests. In a patient with type V MS and cholecystocolic fistula, laparoscopic resection of cholecystocolic fistula and SC can be performed by using Tri-Staple safely. PMID:26904324

  7. Tympanoplasty in subtotal perforation with graft supported by a slice of cartilage: a study with near 100 % results.

    PubMed

    Mundra, R K; Sinha, Richi; Agrawal, Richa

    2013-12-01

    The aim of this study is to evaluate the results of closure of subtotal perforation by tympanoplasty using underlay technique with the perichondrium/temporalis fascia graft supported by single cartilage slice anteriorly. Our hypothesis was that the cartilage support, single slice, offers an extremely reliable method for reconstruction of the tympanic membrane in cases of advanced middle ear pathology and Eustachian tube dysfunction. Retrospective and prospective study of patient undergoing tympanoplasty in subtotal perforation with graft supported by a slice of cartilage between March 2000 and October 2005. Intact perichondrium/temporalis fascia was placed as graft in subtotal perforation, supported by a slice of cartilage. Slice was placed anteriorly from hypotympanum to anterior part of attic. It does not obstruct Eustachian tube opening, as it is curved with concavity facing towards medial wall and lined by perichondrium without any raw area, which prevents adhesion formation. Hearing results were reported using four frequency (500, 1,000, 2,000 and 3,000) pure tone average air-bone gap. During the study period, perichondrium/temporalis fascia graft with support of cartilage slice was used for tympanic membrane reconstruction in 94 patients. Overall graft take rate was 98.94 %. In 95.74 % of patients of different types of tympanoplasty achieved hearing level of 30 dB or less. Complications included residual perforation in (1.06 %), infection or gaping of wound in 2 (2.13 %). Cartilage slice support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation (subtotal perforation, retraction pocket, cholesteatoma, anterior perforation of tympanic membrane). PMID:24427728

  8. Radiofrequency Ablation Versus Partial Nephrectomy in Treating Small Renal Tumors

    PubMed Central

    Yin, Xiaotao; Cui, Liang; Li, Fanglong; Qi, Siyong; Yin, Zhaoyang; Gao, Jiangping

    2015-01-01

    Abstract Radiofrequency ablation (RFA) has emerged as an alternative treatment to surgical partial nephrectomy (PN) in the treatment of small renal tumors (SRTs). But its safety and oncological efficacy are still controversial. We conducted this systematic review and meta-analysis to compare the peritoperative and oncological outcomes of RFA and PN in the treatment of SRTs. Pubmed, EMBASE, Cochrane CENTRAL, and Web of Science were searched to identify eligible studies that compared the RFA and PN in the treatment of SRTs. Twelve retrospective studies that compared RFA with PN in the treatment of SRTs met our selection criterion and were included in this meta-analysis. The pooled results indicated that the local recurrence rate (4.14% vs 4.10%, RR: 1.18, 95% CI: 0.68, 2.07, P = 0.550) and distant metastases rate (2.76% vs 1.89%, RR: 1.31, 95% CI: 0.70, 2.46, P = 0.686) were not significantly different between the RFA group and the PN group. In terms of perioperative outcomes, RFA was associated with shorter length of stay (LOS) (WMD: −2.02 days, 95% CI: −2.77, −1.27, P < 0.001), lower eGFR decline after treatment (WMD: −3.90, 95% CI: −6.660, −1.140, P = 0.006). However, the overall perioperative complication rate (7.5% vs 6.2%, RR:1.10, 95% CI: 0.64, 1.87, P = 0.740) and the major complication rate (3.7% vs 4.4%, RR: 0.83, 95% CI: 0.43, 1.60, P = 0.579) were both similar between RFA and PN groups. Compared with PN, RFA achieves an equal oncological outcome for SRTs with similar local recurrence rate and distant metastases rate. Additionally, RFA is associated with a similar perioperative complication rate, lower decline of eGFR, and shorter LOS. Therefore, RFA is an effective option in the treatment of SRTs for selected patients. PMID:26683944

  9. [Is subtotal resection of the colon actual for ulcerative colitis in the century of ileal reservoirs?].

    PubMed

    Vorob'ev, G I; Bolikhov, K V; Mikhaĭlova, T L; Kostenko, N V; Veselov, V V; Khachaturova, E A

    2010-01-01

    The authors describe results of surgical treatment of 112 patients operated for a severe resistant form of ulcerative colitis (UC). In 26 (23.2%) of observations the operations were performed for complications, in 65 (58%)--for hormone-resistent, and in 21 (18.8%)--for hormone-dependent forms of UC. In 80 (71.4%) cases subtotal resection of the colon with ileo- and sigmostomies was fulfilled, in 26 (23.2%) a single stage ablation of all large intestine was fulfilled with the formation of permanent ileostomy and in 5 (5.4%) of observations the first step was finished with the formation of a reconstructive-plastic reservoir anastomosis. The number of complications in the nearest postoperative period was in 12.8% of patients, lethality was 2.3%. The development of a strict strategy of treatment for severe forms of the disease including the present-day using conservative and surgical methods of treatment depending on the individual character of each patient with UC made it possible to minimize the number of postoperative complications and decrease lethality and also to restore anal defecation with good functional results in 30.1% of operated patients.

  10. SN-38-loaded nanofiber matrices for local control of pediatric solid tumors after subtotal resection surgery.

    PubMed

    Monterrubio, Carles; Pascual-Pasto, Guillem; Cano, Francisco; Vila-Ubach, Monica; Manzanares, Alejandro; Schaiquevich, Paula; Tornero, Jose A; Sosnik, Alejandro; Mora, Jaume; Carcaboso, Angel M

    2016-02-01

    In addition to surgery, local tumor control in pediatric oncology requires new treatments as an alternative to radiotherapy. SN-38 is an anticancer drug with proved activity against several pediatric solid tumors including neuroblastoma, rhabdomyosarcoma and Ewing sarcoma. Taking advantage of the extremely low aqueous solubility of SN-38, we have developed a novel drug delivery system (DDS) consisting of matrices made of poly(lactic acid) electrospun polymer nanofibers loaded with SN-38 microcrystals for local release in difficult-to-treat pediatric solid tumors. To model the clinical scenario, we conducted extensive preclinical experiments to characterize the biodistribution of the released SN-38 using microdialysis sampling in vivo. We observed that the drug achieves high concentrations in the virtual space of the surgical bed and penetrates a maximum distance of 2 mm within the tumor bulk. Subsequently, we developed a model of subtotal tumor resection in clinically relevant pediatric patient-derived xenografts and used such models to provide evidence of the activity of the SN-38 DDS to inhibit tumor regrowth. We propose that this novel DDS could represent a potential future strategy to avoid harmful radiation therapy as a primary tumor control together with surgery.

  11. Aspergillus Tracheobronchitis Causing Subtotal Tracheal Stenosis in a Liver Transplant Recipient

    PubMed Central

    Radunz, Sonia; Kirchner, Carmen; Treckmann, Jürgen; Paul, Andreas; Saner, Fuat H.

    2013-01-01

    Invasive aspergillosis is recognized as one of the most significant opportunistic infections after liver transplantation. Diagnosis of invasive aspergillosis in transplant recipients has been proven to be challenging, and optimal approach to the treatment of invasive aspergillosis is still controversial. We here present an unusual case of Aspergillus tracheobronchitis in the setting of liver transplantation. A 47-year-old female patient with persistent dry cough after liver transplantation developed respiratory insufficiency and was readmitted to the intensive care unit 55 days after liver transplantation. A CT scan revealed subtotal tracheal stenosis; bronchoscopy was performed, and extended white mucus coverings causative of the tracheal stenosis were removed. Microbiological assessment isolated Aspergillus fumigatus. The diagnosis was obstructive Aspergillus tracheobronchitis. The patient was started on a treatment of voriconazole 200 mg orally twice daily, adjusted to a trough level of 1–4 mg/L. For further airway management, a tracheal stent had to be implanted. The patient is alive and well 28 months after liver transplantation. Invasive aspergillosis should be considered a possible etiology in liver transplant patients presenting with unspecific symptoms such as persistent dry cough. Optimal strategies for improved and early diagnosis as well as prophylaxis need to be defined. PMID:23984170

  12. Safety and Effectiveness of Total Thyroidectomy and Its Comparison with Subtotal Thyroidectomy and Other Thyroid Surgeries: A Systematic Review.

    PubMed

    Padur, Ashwini Aithal; Kumar, Naveen; Guru, Anitha; Badagabettu, Satheesha Nayak; Shanthakumar, Swamy Ravindra; Virupakshamurthy, Murlimanju Bukkambudhi; Patil, Jyothsna

    2016-01-01

    Diseases associated with the thyroid gland are one of the most frequently seen endocrine disorders across the globe. Total thyroidectomy is currently the preferred treatment for many thyroid diseases. Controversies exist among surgeons regarding safety of total thyroidectomy due to the risk associated with it like postoperative hypoparathyroidism or recurrent laryngeal nerve damage. Since, in the recent years, the incidence of thyroidectomy is in increasing trend in south Indian population, this review aims to study the available data regarding the appropriateness and safety of total thyroidectomy and compares it with subtotal thyroidectomy and other thyroid surgeries. This is a retrospective comprehensive review of various articles and publications regarding total and partial thyroidectomy performed across the world. Many retrospective studies and few prospective studies suggest that the incidence of transient hypocalcemia is higher after total thyroidectomy than after subtotal thyroidectomy, but the incidence of other complications including recurrent laryngeal nerve palsy and postoperative hematoma is not significantly different between the two procedures. Hence in our review we found that total thyroidectomy is safe and cost effective with low complication rates and provides little significant advantage of being safer procedure compared to subtotal thyroidectomy. PMID:27006857

  13. Failure of subtotal arytenoidectomy to improve upper airway flow mechanics in exercising standardbreds with induced laryngeal hemiplegia.

    PubMed

    Belknap, J K; Derksen, F J; Nickels, F A; Stick, J A; Robinson, N E

    1990-09-01

    Upper airway flow mechanics and arterial blood gas measurements were used to assess the efficacy of subtotal arytenoidectomy for treatment of induced left laryngeal hemiplegia in horses. Measurements were collected with the horses at rest, and trotting or pacing on a treadmill (6.38 degrees incline) at speeds of 4.2 and 7.0 m/s. Experimental protocols were performed after right common carotid artery exteriorization (baseline), after left recurrent laryngeal neurectomy (LRLN), and after left subtotal arytenoidectomy. At baseline, increasing treadmill speed progressively increased peak inspiratory and expiratory flow (VImax and VEmax, respectively), peak inspiratory and expiratory transupper airway pressure (PuI and PuE, respectively), respiratory frequency (f), tidal volume (VT), minute volume (VE), and heart rate. Inspiratory and expiratory times (TI and TE, respectively) and arterial oxygen tension (PaO2) decreased with increased treadmill speed; inspiratory and expiratory impedance (ZI and ZE, respectively) did not change. After LRLN, VImax, f, and PaO2 significantly (P less than 0.05) decreased at exercise, whereas PuI, TI, and ZI significantly increased. Minute volume decreased at exercise after LRLN, but the changes were not significant; LRLN had no effect on VEmax, PuE, ZE, heart rate, arterial carbon dioxide tension (PaCO2), or VT. Subtotal arytenoidectomy did not improve upper airway flow mechanics or blood gas measurements impaired by laryngeal hemiplegia.

  14. Single-Stage Posterior Subtotal Corpectomy and Circumferential Reconstruction for the Treatment of Unstable Thoracolumbar Burst Fractures

    PubMed Central

    Jo, Dae-Jean; Kim, Ki-Tack; Kim, Sung-Min; Lee, Sang-Hun; Cho, Myung-Guk

    2016-01-01

    Objective To illustrate the technique of single-stage posterior subtotal corpectomy and circumferential reconstruction for the treatment of unstable thoracolumbar burst fractures and to evaluate the radiographical and clinical outcomes of patients treated using this technique. Methods 16 consecutive patients with unstable thoracolumbar burst fractures were treated with single-stage posterior subtotal corpectomy and circumferential reconstruction. The mean patient age was 54.8 years. The mean follower up period was 25 months. Five patients suffered from T12 fractures, 10 from L1, 1 from L2. The segmental kyphosis, neurologic status, visual analogue scale for back pain was evaluated before surgery and at follow up. Results The segmental kyphotic angle improved from 18.5 degrees before surgery to -9.2 degrees at the last follow up. The mean correction angle was 28.9 degrees. The mean surgical time was 255 minutes, and a mean intraoperative blood loss was 1073 mL. Intraoperative complications included two dural tears, and a superficial wound infection. There were no other severe complications. The mean visual analog scale of back pain decreased from a mean value of 6.6 to 2 at the last follow up. Conclusion The single-stage posterior subtotal corpectomy and circumferential reconstruction achieved satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion with less blood loss and complications. It is a safe and reliable surgical treatment option for unstable thoracolumbar burst fractures. PMID:26962417

  15. Safety and Effectiveness of Total Thyroidectomy and Its Comparison with Subtotal Thyroidectomy and Other Thyroid Surgeries: A Systematic Review

    PubMed Central

    Padur, Ashwini Aithal; Kumar, Naveen; Guru, Anitha; Badagabettu, Satheesha Nayak; Shanthakumar, Swamy Ravindra; Virupakshamurthy, Murlimanju Bukkambudhi; Patil, Jyothsna

    2016-01-01

    Diseases associated with the thyroid gland are one of the most frequently seen endocrine disorders across the globe. Total thyroidectomy is currently the preferred treatment for many thyroid diseases. Controversies exist among surgeons regarding safety of total thyroidectomy due to the risk associated with it like postoperative hypoparathyroidism or recurrent laryngeal nerve damage. Since, in the recent years, the incidence of thyroidectomy is in increasing trend in south Indian population, this review aims to study the available data regarding the appropriateness and safety of total thyroidectomy and compares it with subtotal thyroidectomy and other thyroid surgeries. This is a retrospective comprehensive review of various articles and publications regarding total and partial thyroidectomy performed across the world. Many retrospective studies and few prospective studies suggest that the incidence of transient hypocalcemia is higher after total thyroidectomy than after subtotal thyroidectomy, but the incidence of other complications including recurrent laryngeal nerve palsy and postoperative hematoma is not significantly different between the two procedures. Hence in our review we found that total thyroidectomy is safe and cost effective with low complication rates and provides little significant advantage of being safer procedure compared to subtotal thyroidectomy. PMID:27006857

  16. Comparison of transperitoneal laparoscopic nephrectomy outcomes in atrophic and hydronephrotic kidneys

    PubMed Central

    Gülpınar, Murat Tolga; Akçay, Muzaffer; Sancak, Eyüp Burak; Akbaş, Alpaslan; Tepeler, Abdulkadir; Reşorlu, Berkan; Armağan, Abdullah

    2015-01-01

    Objective To compare the results of transperitoneal laparoscopic nephrectomy in patients with atrophic and hydronephrotic kidneys. Material and methods Clinical data were collected from 35 patients who had undergone laparoscopic nephrectomies for atrophic or hydronephrotic non-functioning kidneys between January 2010 and March 2014. Comparative analysis was carried out between the two groups examining demographic characteristics, imaging modalities, etiology, operative times, port numbers, conversion to open surgery, complications, pre-and post-operative hemoglobin and creatinine values, transfusion rates and length of hospital stays. Results Laparoscopic nephrectomy was performed for atrophic kidneys in 20 (57%) patients and for hydronephrotic kidneys in 15 (42%) patients. In the atrophic group, 3 patients (15%) required transfusion because of bleeding but none of the patients required conversion to open surgery. In the hydronephrotic group one patient (6.6%) required transfusion and conversion to open surgery because of bleeding. Both of the groups were similar in terms of postoperative hospital stay but compared to the atrophic kidneys, hydronephrotic ones were associated with a longer total operative times (90.1 min vs. 73.6 min, p=0.03). Any serious complication (except for bleeding) and mortality were not encountered in both groups. Conclusion Laparoscopic nephrectomy is a safe and effective minimally invasive technique that can be used in atrophic and hydronephrotic non-functioning kidneys. PMID:26623146

  17. Transvaginal natural orifice transluminal endoscopic surgery-assisted minilaparoscopic nephrectomy: a step towards scarless surgery.

    PubMed

    Porpiglia, Francesco; Fiori, Cristian; Morra, Ivano; Scarpa, Roberto Mario

    2011-10-01

    The feasibility of a transvaginal hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy has already been demonstrated using standard laparoscopic ports through the abdominal wall. We evaluated the feasibility of a transvaginal NOTES-assisted minilaparoscopic nephrectomy (mLN). The patient is positioned in a semilumbotomy position with legs separated to allow for vaginal access. A 3.5-mm port is placed at the umbilicus for a 30° laparoscope; two 3.5-mm ports are placed in the flank in the same location as for a standard transperitoneal nephrectomy; and a 12-mm port is placed through the vagina, perforating the vaginal wall. Kidney dissection is performed following the steps of a traditional nephrectomy. The renal pedicle is dissected and secured with Hem-o-Lok clips through the vaginal access port. The specimen is then extracted through an extended incision in the posterior wall of the vagina. We treated five patients. The average operative time was 120 min, blood loss was 160 ml, and no complications were recorded. Our initial experience suggests that transvaginal NOTES-assisted mLN is feasible and appears to be safe. It is simpler than a pure NOTES procedure and ensures excellent cosmetic results.

  18. Hand-assisted robotic right donor nephrectomy in patient with total sinus inversus: A case report

    PubMed Central

    Gonzalez-Heredia, Raquel; Garcia-Roca, Raquel; Benedetti, Enrico

    2016-01-01

    Total situs inversus” is an infrequent congenital condition. The robot has been already proved as a safe and attractive approach for living donor neprectomies. We report here the first right donor nephrectomy in a patient with total sinus inversus that is performed using the Da Vinci platform. PMID:27085108

  19. Hypernephroma Presenting with Cutaneous Leukocytoclastic Vasculitis and Lupus Anticoagulant: Resolution after Nephrectomy

    PubMed Central

    Murray, Nigel P.; Ruíz, Amparo; Reyes, Eduardo

    2012-01-01

    Hypernephroma can present as a variety of paraneoplastic, nonmetastatic conditions, including vasculitis, and rarely a lupus-type anticoagulant. Nephrectomy leads to the resolution of the systemic complaints. Malignancy, in this case hypernephroma, can present as an immune-mediated paraneoplastic syndrome which resolves after removal of the underlying tumor. PMID:22919534

  20. Laparoscopic adrenalectomy for metachronous ipsilateral metastasis following nephrectomy for renal cell carcinoma

    PubMed Central

    Eret, Viktor; Ürge, Tomáš; Trávníček, Ivan; Chudáček, Zdeněk; Hes, Ondřej; Hora, Milan

    2013-01-01

    Introduction Although laparoscopic adrenalectomy (LA) is considered as a gold standard approach for adrenalectomy, there are minimal data describing options and outcomes of LA after previous ipsilateral nephrectomy (PIN). Aim To describe our results in a group of patients who underwent LA after PIN. Material and methods From August 2004 to October 2012 we performed at our institution 88 LA. Of this amount we performed 5 LA for metachronous metastasis of renal cell carcinoma (RCC) after PIN. This group was compared to a group without previous nephrectomy. Results The group comprised 4 men (80%) and 1 woman (20%); the mean age at the time of surgery was 66.8 ±8.5 (range: 60-77) years; the mean period between nephrectomy and adrenalectomy was 5.2 (range: 1.5-14) years; the operating time was longer in patients after PIN for 7 min; the mean blood loss was higher by 22 ml; duration of hospitalization was shorter by 1.3 days, paradoxically, compared with patients without PIN. There was no need for conversion to open surgery and we did not observe any other complications. Conclusions Laparoscopic adrenalectomy for metastasis of RCC after PIN is a technically feasible method in selected patients and it is associated with no significant differences in perioperative data in comparison with the group without prior nephrectomy. The patients benefit from minimally invasive surgery. The performance has required an experienced laparoscopic surgeon. PMID:24130636

  1. Simultaneous Native Nephrectomy and Kidney Transplantation in Patients With Autosomal Dominant Polycystic Kidney Disease

    PubMed Central

    Veroux, Massimiliano; Zerbo, Domenico; Basile, Giusi; Gozzo, Cecilia; Sinagra, Nunziata; Giaquinta, Alessia; Sanfiorenzo, Angelo; Veroux, Pierfrancesco

    2016-01-01

    Introduction To evaluate the feasibility of simultaneous unilateral nephrectomy with kidney transplantation and to determine the effect of this procedure on perioperative morbidity and mortality and graft and patient survival. Methods Between January 2000 and May 2015, 145 patients with autosomal dominant polycystic kidney disease (ADPKD) underwent kidney transplantation. Of those, 40 (27.5%) underwent concurrent ipsilateral native nephrectomy (group NT). Patients in group NT were compared with patients with ADPKD not undergoing concurrent nephrectomy (group NT-) and asymptomatic patients undergoing pretransplant nephrectomy (group PNT). Results The average follow-up was 66 months. The graft survival rate at 1 and 5 years was 95% and 87.5% versus 93% and 76.2% in the NT and NT- groups, respectively (P = .903 and P = .544, respectively); 1-year patient survival was 100% for NT and 97% for NT- patients (P = .288), whereas 5-year patient survival was 100% and 92% for NT and NT- groups, respectively (P = .128). After propensity score matching (34 patients per group) no significant differences were observed in 1-year (97.1% in NT and 94.1%; P = 1) and 5-year (88.2% in NT and 91.2% in NT-; P = 1) graft survival, and in 1-year (100% for both groups; P = 1) and 5-year (100% in NT and 94.1% in NT-; P = 1) patient survival. Perioperative mortality was 0% among NT and 1.2% among NT- patients, whereas perioperative surgical complications were similar in both groups. One- and 5-year graft and patient survival were similar between the NT and PNT groups, but patients in the PNT group had significantly lower levels of hemoglobin and residual diuresis volumes at the time of transplant. Moreover, PNT patients had a longer pretransplant dialysis and a longer time on the waiting list. Conclusions Simultaneous unilateral nephrectomy does not have a negative effect on patient and graft survival in patients with ADPKD and is associated with low morbidity. Pretransplant nephrectomy should

  2. Robotic nephrectomy for central renal tumors with intraoperative evaluation of tumor histology.

    PubMed

    Lieberman, Leedor; Barod, Ravi; Tapper, Alex; Kumar, Ramesh; Rogers, Craig

    2016-09-01

    Patients undergoing nephrectomy for central renal tumors suspicious for renal cell carcinoma (RCC) may carry a small risk of having transitional cell carcinoma (TCC) on final pathology, even in the absence of filling defects or abnormal cytology. We describe outcomes in such patients undergoing robotic nephrectomy for suspected RCC, with intraoperative specimen assessment to guide completion ureterectomy if TCC is present. Between September 2010 and August 2015, ten patients had central renal masses suspicious for RCC, which were not amenable to nephron-sparing surgery. Patients underwent a four-arm robotic nephrectomy technique using a GelPOINT(®) access port. Following hilar ligation, the ureter was divided between adjacent hem-o-lok clips, placed in an endocatch bag, and extracted through the GelPOINT incision for the frozen section analysis. If intraoperative assessment confirmed TCC, a robotic completion ureterectomy and a bladder cuff excision were performed. Of the ten patients with central tumors who underwent robotic nephrectomy for suspected RCC, four (40 %) had TCC on the frozen section analysis and underwent completion ureterectomy. Five patients had RCC, and one patient had an oncocytoma. Mean age was 63.1 years (49-76) and mean tumor size was 4.0 cm (1.9-7.6). Mean operating time was 246 min (135-328). All patients had negative margins. Mean length of stay was 2.5 days. No recurrences were documented at median 8.5 months follow-up. For patients undergoing robotic nephrectomy for central renal tumors, intraoperative specimen evaluation can help determine the need for minimally invasive completion ureterectomy. PMID:27146858

  3. A 23-year-old patient with secondary tumoral calcinosis: Regression after subtotal parathyroidectomy

    PubMed Central

    Niemann, Katharina E.; Kröpil, Feride; Hoffmann, Martin F.; Coulibaly, Marlon O.; Schildhauer, Thomas A.

    2016-01-01

    Introduction Tumoral calcinosis (TC) is a rare disorder defined by hyperphosphatemia and ectopic calcifications in various locations. The most common form of TC is associated with disorders such as renal insufficiency, hyperparathyroidism, or hypervitaminosis D. The primary (hereditary) TC is caused by inactivating mutations in either the fibroblast growth factor 23 (FGF23), the GalNAc transferase 3 (GALNT3) or the KLOTHO (KL) gene. Presentation of case We report here a case of secondary TC in end-stage renal disease. The patient was on regular hemodialysis and presented with severe painful soft-tissue calcifications around her left hip and shoulder that had been increasing over the last two years. Initially, she was treated with dietary phosphate restriction and phosphate binders. Because of high phosphate blood levels, which were not yet managed with dialysis and medical therapy, a subtotal parathyroidectomy (sP) was performed. This approach demonstrated significant response. Three months after surgery a rapid regression of the tumors was observed. Disscusion Regardless of the etiology, the two types of TC do not differ in their radiologic or histopathologic presentations but need to be diagnosed correctly to initiate targeted and effective treatment. Considering the primary TC, primary treatment is early and complete surgical excision. In case of secondary TC surgical excision of the tumoral masses should be avoid because of extensive complications. These patients benefit from sP. Conclusion After initial conservative therapy chronic kidney disease patients with TC might benefit from sP to avoid prolonged suffering and potential mutilations. PMID:27088846

  4. Laparoscopic modified subtotal cholecystectomy for difficult gall bladders: A single-centre experience

    PubMed Central

    Harilingam, Mohan Raj; Shrestha, Ashish Kiran; Basu, Sanjoy

    2016-01-01

    AIM: Laparoscopic cholecystectomy (LC) is considered the ‘gold standard’ intervention for gall bladder (GB) diseases. However, to avoid serious biliovascular injury, conversion is advocated for distorted anatomy at the Calot's triangle. The aim is to find out whether our technique of laparoscopic modified subtotal cholecystectomy (LMSC) is suitable, with an acceptable morbidity and outcome. PATIENTS AND METHODS: A retrospective analysis of prospectively collected data of 993 consecutive patients who underwent cholecystectomy was done at a large District General Hospital (DGH) between August 2007 and January 2015. The data are as follows: Patient's demographics, operative details including intra- and postoperative complications, postoperative stay including follow-up that was recorded and analysed. RESULTS: A total of 993 patients (263 males and 730 female) were included. The median age was 52*(18-89) years. Out of the 993 patients, 979 (98.5%) and 14 (1.5%) were listed for laparoscopic and open cholecystectomy, respectively. Of the 979 patients, 902 (92%) and 64 (6.5%) patients underwent LC ± on-table cholangiography (OTC) and LMSC ± OTC, respectively, with a median stay of 1* (0-15) days. Of the 64 patients, 55 (86%) had dense adhesions, 22 (34%) had acute inflammation, 19 (30%) had severe contraction, 12 (19%) had empyema, 7 (11%) had Mirizzi's syndrome and 2 (3%) had gangrenous GB. The mean operative time was 120 × (50-180) min [Table 1]. Six (12%) patients required endoscopic retrograde cholangiopancreatography (ERCP) postoperatively, and there were four (6%) readmissions in a follow-up of 30 × (8-76) months. The remaining 13 (1.3%) patients underwent laparoscopic cholecystectomy converted to an open cholecystectomy. The median stay for open/laparoscopic cholecystectomy converted to open cholecystectomy was 5 × (1-12) days. CONCLUSION: Our technique of LMSC avoided conversion in 6.5% patients and believe that it is feasible and safe for difficult GBs

  5. Ginger Essence Effect on Nausea and Vomiting After Open and Laparoscopic Nephrectomies

    PubMed Central

    Hosseini, Fatemeh Sadat; Adib-Hajbaghery, Mohsen

    2015-01-01

    Background: Some studies reported that ginger was effective in prevention or treatment of post-surgical nausea and vomiting; however, there are controversies. In addition, no study compared the effects of ginger on nausea and vomiting after open and laparoscopic nephrectomies. Objectives: The current study aimed to compare the effect of ginger essence on nausea and vomiting after open versus laparoscopic nephrectomies. Patients and Methods: A randomized, placebo trial was conducted on two groups of patients, 50 open and 50 laparoscopic nephrectomy. Half of the subjects in each group received ginger essence and the other half received placebo. Using a visual analogue scale the severity of nausea was assessed every 15 minutes for the first two post-operative hours and the sixth hour. Frequency of vomiting was counted until the sixth hour. The placebo subgroups were treated similarly. Descriptive statistics were employed. Chi-square and Fisher’s exact tests, paired and independent samples t-test and repeated measure analysis of variance were used to analyze the data. Results: Repeated measure analysis of variance showed that the type of surgery and the type of intervention as factors had significant effects on the nausea severity scores in the nine successive measurements (P < 0.001). In the first two post-operative hours, the mean vomiting episodes was 2.92 ± 0.70 in the subjects who underwent open surgery and received placebo while it was 0.16 ± 0.37 in patients with the same surgery but receiving ginger essence (P = 0.001). The mean vomiting episodes was 6.0 ± 1.33 in the subjects who underwent laparoscopic surgery and received placebo while it was 1.39 ± 0.78 in patients with the same surgery but receiving ginger essence (P = 0.001). Conclusions: Using ginger essence was effective in reducing nausea and vomiting not only in the subjects who underwent open nephrectomy but also in the subjects of laparoscopic nephrectomy. Using ginger essence is suggested as a

  6. Chylous ascites after nephrectomy without lymphadenectomy for malignant rhabdoid tumor of the kidney: A rare occurrence and literature review

    PubMed Central

    Einama, Takahiro; Okada, Tadao; Sasaki, Fumiaki; Todo, Satoru

    2009-01-01

    Chylous ascites (CA) is an extremely rare complication of abdominal surgery in children. This report describes a 4-month-old girl with malignant rhabdoid tumor of the kidney (MRTK), who developed CA after left nephrectomy without lymphadenectomy, and who was successfully treated conservatively with enteral therapy. The literature on CA after nephrectomy without lymphadenectomy for MRTK is reviewed herein, and the clinical problems of postoperative CA are discussed. PMID:20419024

  7. Experience with pyeloureterostomy associated with simple ligation of native ureter without ipsilateral nephrectomy in renal transplantation.

    PubMed

    Baquero, A; Ginsberg, P C; Kaschak, D; Raja, R; Schneeberg, A; Solish, L; Bannett, A D

    1985-03-01

    Ureteroneocystostomy was used as the primary method of urinary tract reconstruction in 282 allograft renal transplants at our center since 1965. A nonrefluxing anastomosis was incorporated whenever possible. Seven patients who suffered major urological complications involving the ureteroneocystostomy required pyeloureterostomy as the method of repair using the patient's distal native ureter. No ipsilateral nephrectomy was performed and simple ligation of the native ureter with nonabsorbable suture was accomplished. Of the 7 patients 3 suffered hydronephrosis of the native kidney. None of these patients had signs or symptoms secondary to acute and chronic ureteral occlusion. Our experience suggests that intentional ligation of the native ureter during pyeloureterostomy does not result in increased morbidity to the transplant patient, and that the need for ipsilateral nephrectomy with its own added morbidity may not be necessary.

  8. Renal transposition during minimally invasive partial nephrectomy: a safe technique for excision of upper pole tumors.

    PubMed

    Kaplan, Joshua R; Chang, Peter; Percy, Andrew G; Wagner, Andrew A

    2013-09-01

    Minimally invasive partial nephrectomy (MIPN) for upper pole masses, particularly for those located posteriorly, is challenging because of difficult visualization during tumor resection and renorrhaphy. Complete renal transposition facilitates access to and excision of upper pole renal masses during MIPN. Sixteen patients with upper pole renal masses underwent laparoscopic or robot-assisted partial nephrectomy with renal transposition from October 2009 to March 2012 with a mean follow-up of 22 months. Mean operative time was 242.6 minutes, and mean warm ischemic time was 14.7 minutes. No patient needed an intraoperative or postoperative blood transfusion. Five (31%) patients had a postoperative complication (four Clavien grade I, one Clavien grade II). There were no delayed complications, positive surgical margins, or tumor recurrences. Mean postoperative eGFR change within 3 months was -9.4%. These results show that complete renal transposition can be safely used to facilitate excision of upper pole tumors. PMID:23750561

  9. Auto localization and segmentation of occluded vessels in robot-assisted partial nephrectomy.

    PubMed

    Amir-Khalili, Alborz; Peyrat, Jean-Marc; Abinahed, Julien; Al-Alao, Osama; Al-Ansari, Abdulla; Hamarneh, Ghassan; Abugharbieh, Rafeef

    2014-01-01

    Hilar dissection is an important and delicate stage in partial nephrectomy during which surgeons remove connective tissue surrounding renal vasculature. Potentially serious complications arise when vessels occluded by fat are missed in the endoscopic view and are not appropriately clamped. To aid in vessel discovery, we propose an automatic method to localize and label occluded vasculature. Our segmentation technique is adapted from phase-based video magnification, in which we measure subtle motion from periodic changes in local phase information albeit for labeling rather than magnification. We measure local phase through spatial decomposition of each frame of the endoscopic video using complex wavelet pairs. We then assign segmentation labels based on identifying responses of regions exhibiting temporal local phase changes matching the heart rate frequency. Our method is evaluated with a retrospective study of eight real robot-assisted partial nephrectomies demonstrating utility for surgical guidance that could potentially reduce operation times and complication rates.

  10. Gastric metastasis of renal cell carcinoma 20 years after radical nephrectomy

    PubMed Central

    Akay, Ebru; Kala, Mehtap; Karaman, Hatice

    2016-01-01

    Renal cell carcinomas account for 2–3% of malignant neoplasms in adults. The lung, soft tissues and bone represent the most frequent sites of distant metastasis in renal cell carcinoma. Gastric metastasis is rare. Our case was a 72-year-old man with complaints of fatigue and loss of appetite. In history, he had unergone radical nephrectomy due to renal cell carcinoma in 1993. A polypoid lesion was observed in upper gastrointestinal endoscopy. Histopathology of gastric biopsy specimen was reported as renal cell carcinoma. In English literature, there are 50 cases diagnosed as gastric metastasis from renal cell carcinoma. To date, there are only 4 cases with extremely late gastric metastasis of renal cell carcinoma. Herein, we present a rare case which underwent radical nephrectomy due to renal cell carcinoma and found to have gastric metastasis at 20. year of his follow-up. PMID:27274897

  11. Single port laparoscopic donor nephrectomy: first case report in Ramathibodi Hospital.

    PubMed

    Attawettayanon, Worapat; Prasit, Sirianan; Sangkum, Premsant; Patcharatrakul, Suthep; Jirasiritham, Sophon; Khongcharoensombat, Wisoot

    2014-02-01

    The prevalence of patients with end stage renal disease (ESRD) is showing an increasing trend. At the same time, the waiting lists for cadaveric donor kidney transplantation continue to grow. Living donor kidneys may be an alternative for patients to receive kidneys for transplantation. However a wide gap exists between the numbers of living kidney donors and the numbers of recipients on waiting lists. Many considerations are involved in living organ donation, including cosmetic reasons. Laparoscopic living donor nephrectomy has become the technique of choice for kidney transplantation in many centers. The benefits of a laparoscopic technique compared with open surgery include reduced blood loss, less analgesic requirement, a shorter hospital stay, faster return to work, and fewer cosmetic effects. The next step in minimal invasive surgery is laparoendoscopic single port donor nephrectomy Early outcomes show this technique to be safe and cosmetically improved This procedure may be the answer to reduce the gap between numbers of kidney donors and waiting recipients. We report our first experience of single port laparoendoscopic left donor nephrectomy. A 48-year-old healthy Thai man wished to donate his kidney to his 18-year-old son who suffered from IgA nephropathy and ended up with ESRD. The operation took three hours. The estimated blood loss was 50 ml and no blood transfusion was required. The donor was discharged home safely without any complications. PMID:24765906

  12. [Retroperitoneal laparoscopic partial nephrectomy for treatment of cystic nephroma: one case report].

    PubMed

    Qiu, Min; Lu, Jian; Ma, Lu-lin; Yan, Ye; Zhang, Shu-dong

    2014-08-18

    The clinical features and pathologic findings of one case of cystic nephroma was reported,and the safety of treatment by retroperitoneal laparoscopic partial nephrectomy evaluated. The patient was a 20-year-old woman, and found left renal cyst for 1 year with pain in her left flank one month ago. The patient was diagnosed as complex renal cyst, then underwent retroperitoneal laparoscopic partial nephrectomy. In the operation, the tumor was located in the middle and lower part of her left kidney, with a number of small sample masses, and a solid mass near the renal parenchymal part. The operation time was 224 min, and the artery occlusion time was about 17 min. The blood loss was 20 mL, with no blood transfusion. The pathology was cystic nephroma. No operation complication was seen, nor was recurrence after a short-term follow-up. Cystic nephroma is a relatively rare benign lesion of the kidney. Retroperitoneal laparoscopic partial nephrectomy is a safe and effective way to treat cystic nephroma.

  13. Novel method of laparoendoscopic single-site and natural orifice specimen extraction for live donor nephrectomy: single-port laparoscopic donor nephrectomy and transvaginal graft extraction

    PubMed Central

    Jeong, Won Jun; Choi, Byung Jo; Hwang, Jeong Kye; Yuk, Seung Mo; Song, Min Jong

    2016-01-01

    Laparoscopic live donor nephrectomy (DN) has been established as a useful alternative to the traditional open methods of procuring kidneys. To maximize the advantages of the laparoendoscopic single-site (LESS) method, we applied natural orifice specimen extraction to LESS-DN. A 46-year-old woman with no previous abdominal surgery history volunteered to donate her left kidney to her husband and underwent single-port laparoscopic DN with transvaginal extraction. The procedure was completed without intraoperative complications. The kidney functioned well immediately after transplantation, and the donor and recipient were respectively discharged 2 days and 2 weeks postoperatively. Single-port laparoscopic DN and transvaginal graft extraction is feasible and safe. PMID:26878020

  14. Subtotal resection of the head of the pancreas combined with ductal obliteration of the distal pancreas in chronic pancreatitis.

    PubMed Central

    Kerremans, R P; Penninckx, F M; De Groote, J; Fevery, J

    1987-01-01

    Subtotal resection of the head of the pancreas combined with duct obliteration of the distal pancreas by prolamine was performed in 12 selected patients who had chronic alcohol-induced pancreatitis with most destruction in the proximal pancreas. The main indication for operation was intractable pain. There was no postoperative mortality but morbidity was high when no pancreaticojejunostomy was constructed. After a follow-up period of 32 months, lasting pain relief was obtained in 10 patients; pseudocyst formation occurred in three patients; calcification of the distal pancreas, absent before operation, was demonstrated in four of six patients; six of 11 nondiabetic patients became hyperglycemic either abruptly (1 patient) or progressively (5 patients); quality of life improved in most patients. This procedure preserves the stomach, duodenum, spleen, distal pancreas and common bile duct if possible. However, pancreatic ductal obliteration with prolamine does not prevent relapses of chronic pancreatitis. PMID:3827358

  15. Stein’s Double Cross-Lip Flaps Combined with Johanson’s Step Technique for Subtotal Lower Lip Reconstruction

    PubMed Central

    Roldán, J. Camilo

    2016-01-01

    Background: In a previous study, a single cross-lip flap (Abbe flap) combined with Johanson’s step technique for repair of defects of more than 2/3 of the lower lip was superior, in terms of aesthetic and functional outcome, compared with Bernard Webster–related techniques (cheek advancement). Herewith, a double cross-lip flap (Stein procedure) is proposed for repair of subtotal lower lip defects. A systematic review of the Stein procedure is provided. Methods: Two patients underwent a paramedian double cross-lip flap, preserving the aesthetic subunit philtrum column combined with the Johanson’s step technique. The aesthetic and functional outcomes and the surgical steps are demonstrated in the videos. An electromyographic study was performed 6 months and 4 years after surgery. A PubMed and a Google Scholar search were performed for the Stein procedure published in 1848. Results: Lip competence was achieved directly after sectioning of the cross-lip pedicles in both patients. Lips progressivity expanded in the first 6 months. No microstomia was observed. Electromyography showed successful reinnervation of the transplanted muscles at 6 months. Four years after surgery, the electromyographic findings were consolidated. Since 1975, 7 articles on the double cross-lip procedure have been published: 4 in English, 1 in French, and 2 in Japanese. None of those articles reported on any supplemental lower lip advancement or on any electromyographic study. Conclusions: The rationale of using 2 cross-lip flaps and a lip-cheek advancement according to Johanson seems to achieve functionally and aesthetically superior results compared with other techniques described for subtotal lower lip reconstruction. PMID:27014544

  16. Survival advantage of partial over radical nephrectomy in patients presenting with localized renal cell carcinoma

    PubMed Central

    2014-01-01

    Background Partial nephrectomy (PN) preserves renal function and has become the standard approach for T1a renal cell carcinoma (RCC). However, there is still an ongoing debate as to which patients will actually derive greater benefit from partial than from radical nephrectomy (RN). The aim of this study was to retrospectively evaluate the impact of the type of surgery on overall survival (OS) in patients with localized RCC. Methods Renal surgery was performed in 4326 patients with localized RCC (pT ≤ 3a N/M0) at six German tertiary care centers from 1980 to 2010: RN in 2955 cases (68.3%), elective (ePN) in 1108 (25.6%), and imperative partial nephrectomy (iPN) in 263 (6.1%) cases. The median follow-up for all patients was 63 months. Kaplan-Meier and Cox regression analyses were carried out to identify prognosticators for OS. Results PN was performed significantly more often than RN in patients presenting with lower tumor stages, higher RCC differentiation, and non-clear cell histology. Accordingly, the calculated 5 (10)-year OS rates were 90.0 (74.6)% for ePN, 83.9 (57.5)% for iPN, and 81.2 (64.7)% for RN (p < 0.001). However, multivariate analysis including age, sex, tumor diameter and differentiation, histological subtype, and the year of surgery showed that ePN compared to RN still qualified as an independent factor for improved OS (HR 0.79, 95% CI 0.66-0.94, p = 0.008). Conclusion Even allowing for the weaknesses of this retrospective analysis, our multicenter study indicates that in patients with localized RCC, PN appears to be associated with better OS than RN irrespective of age or tumor size. PMID:24885955

  17. Robot-assisted partial nephrectomy: current status, techniques, and future directions.

    PubMed

    Babbar, Paurush; Hemal, Ashok K

    2012-02-01

    Open partial nephrectomy for the treatment of small renal masses (SRMs) concerning for renal cell carcinoma has been increasingly utilized with the increased incidental detection of SRMs and the growing recognition of the benefits of renal preservation. Laparoscopic partial nephrectomy (LPN) is a minimally invasive technique that achieves comparable oncologic and improved morbidity outcomes when compared to the open procedure. However, LPN is a technically demanding procedure resulting in a long learning curve and a lack of widespread adoption. Robot-assisted partial nephrectomy (RAPN) overcomes many of the technical hurdles of the LPN and is now coming to the forefront for the minimally invasive surgical management of SRMs. To date, the short-term oncologic outcomes of RAPN have been comparable to the open operation while providing the improved morbidity outcomes of LPN. Although encouraging, we await the long-term oncologic results of this new and promising procedure. The current bottleneck is an issue of cost and reliance on a patient-side surgeon. Future developments in instrumentation, newer robots, cost reduction, more streamlined training, increased robotic experience, and adoption by more centers will lead to greater benefit for patients with SRMs requiring nephron-sparing surgery. This review will discuss techniques for RAPN and then delve into the current status of RAPN using parameters such as warm ischemia time, blood loss, hospital stay, oncological outcomes, complications, learning curve, and quality of life. There will be an exploration of potential disadvantages associated with RAPN followed by a look at evolving techniques in regard to this groundbreaking procedure.

  18. Robotic versus Open Partial Nephrectomy: A Systematic Review and Meta-Analysis

    PubMed Central

    Cai, Chen; Ye, Huamao; Lv, Chen; Yang, Qing; Sheng, Jing; Song, Shangqing; Qu, Le; Xiao, Liang; Sun, Yinghao; Wang, Linhui

    2014-01-01

    Objectives To critically review the currently available evidence of studies comparing robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN). Materials and Methods A comprehensive review of the literature from Pubmed, Web of Science and Scopus was performed in October 2013. All relevant studies comparing RPN with OPN were included for further screening. A cumulative meta-analysis of all comparative studies was performed and publication bias was assessed by a funnel plot. Results Eight studies were included for the analysis, including a total of 3418 patients (757 patients in the robotic group and 2661 patients in the open group). Although RPN procedures had a longer operative time (weighted mean difference [WMD]: 40.89; 95% confidence interval [CI], 14.39–67.40; p = 0.002), patients in this group benefited from a lower perioperative complication rate (19.3% for RPN and 29.5% for OPN; odds ratio [OR]: 0.53; 95%CI, 0.42–0.67; p<0.00001), shorter hospital stay (WMD: −2.78; 95%CI, −3.36 to −1.92; p<0.00001), less estimated blood loss(WMD: −106.83; 95%CI, −176.4 to −37.27; p = 0.003). Transfusions, conversion to radical nephrectomy, ischemia time and estimated GFR change, margin status, and overall cost were comparable between the two techniques. The main limitation of the present meta-analysis is the non-randomization of all included studies. Conclusions RPN appears to be an efficient alternative to OPN with the advantages of a lower rate of perioperative complications, shorter length of hospital stay and less blood loss. Nevertheless, high quality prospective randomized studies with longer follow-up period are needed to confirm these findings. PMID:24740259

  19. Laparoendoscopic single-site simple nephrectomy using a magnetic anchoring system in a porcine model

    PubMed Central

    Choi, Young Hyo; Lee, Hye Won; Lee, Seo Yeon; Han, Deok Hyun; Seo, Seong Il; Jeon, Seong Soo; Lee, Hyun Moo; Choi, Han Yong

    2016-01-01

    Purpose Magnetic anchoring devices may reduce the number of port sites needed in laparoscopic surgery. In this study, we prospectively assessed the feasibility of using a magnetic anchoring and guidance system (MAGS) in laparoendoscopic single-site (LESS) surgery performed by novices. Materials and Methods A total of 10 LESS simple nephrectomies were performed with or without MAGS in a nonsurvival porcine model by 6 operators with no previous LESS surgery experience. After installation of the homemade single port, an intra-abdominal magnet was fixed to the renal parenchyma with suturing and stabilized by an external magnet placed on the flank so that the position of the kidney could be easily changed by moving the external handheld magnet. The length of the procedure and any intraoperative complications were evaluated. Results Operative time (mean±standard deviation) was shorter in the group using the magnetic anchoring device (M-LESS-N) than in the group with conventional LESS nephrectomy (C-LESS-N) (63±20.8 minutes vs. 82±40.7 minutes, respectively). Although all nephrectomies were completed uneventfully in the M-LESS-N group, renal vein injury occurred during dissection of the renal hilum in two cases of C-LESS-N and was resolved by simultaneous transection of the renal artery and vein with an Endo-GIA stapler. Conclusions LESS-N using MAGS is a feasible technique for surgeons with no LESS surgery experience. Taking into account the 2 cases of renal vein injury in the C-LESS-N group, the application of MAGS may be beneficial for overcoming the learning curve of LESS surgery. PMID:27195320

  20. Clinical results of renal artery embolization to control postoperative hemorrhage after partial nephrectomy

    PubMed Central

    Jeon, Chang Ho; Yoon, Chang Jin; Byun, Seok-Soo; Lee, Sang Eun

    2016-01-01

    Background With the wider application of nephron-sparing surgery, there has been an increase in the occurrence of postoperative hemorrhage. However, despite such an increase, there are only a limited number of reports regarding renal artery embolization (RAE) for the management of postoperative bleeding after nephron-sparing surgery, especially after robot-assisted laparoscopic partial nephrectomy (RALPN). Purpose To evaluate the safety and clinical efficacy of transcatheter RAE for postoperative hemorrhage after open partial nephrectomy (OPN) and RALPN. Material and Methods A total of 29 patients (17 men, 12 women; age range, 31–70 years) who were referred to our hospital for postoperative hemorrhage after partial nephrectomy, between December 2003 and December 2014, were selected. We retrospectively reviewed patients’ clinical data, angiographic findings, embolization details, and clinical outcomes. Results Embolization was performed in patients who underwent OPN (25/29) and RALPN (4/29). The angiographic findings were as follows: renal artery pseudoaneurysm (n = 18), contrast extravasation (n = 8), and arteriovenous fistula (n = 3). Fiber-coated microcoil and n-butyl-2-cyanoacrylate (NBCA) was administered to the targeted bleeding renal arteries in 12 and 11 patients, respectively. In six patients, fiber-coated microcoil and NBCA were used concurrently. Technical and clinical successes were achieved in all patients (100%). Bleeding cessation was achieved in all patients, and no further relevant surgeries or interventions were required for hemorrhage control. There were no episodes of hemorrhagic recurrence during the follow-up period (median, 20 days; range, 7–108 days). Conclusion Angiography and RAE identified the origin of bleeding and could successfully preserve the residual renal function. PMID:27570638

  1. Impact of fellowship training on robotic-assisted laparoscopic partial nephrectomy: benchmarking perioperative safety and outcomes.

    PubMed

    Taylor, Abby S; Lee, Bruce; Rawal, Bhupendra; Thiel, David D

    2015-06-01

    To provide perioperative benchmark data for surgeons entering practice from formal robotic training and performing robotic-assisted laparoscopic partial nephrectomy (RAPN). Perioperative outcomes of the first 100 RAPN from a surgeon entering into practice directly from robotic fellowship training were analyzed. Postoperative complications were categorized by Clavien-Dindo grade. Surgical "trifecta scores" and Margin, Ischemia, and Complication (MIC) scoring were utilized to assess surgical outcomes. Statistical analyses were performed using SAS (version 9.2; SAS Institute, Inc., Cary, North Carolina). Median age of the cohort was 63 years (22-81 years), and 34 (34.3%) patients were over age 65. Forty-one (41.4%) patients had a BMI > 30. Thirteen (13.1%) had RENAL 10-12 tumors, 22 of which (22.2%) were >4 cm in size. Median warm ischemia time was 17 min, and 13 patients had resection without warm ischemia. Five patients were converted to open partial nephrectomy, and 1 patient was converted to laparoscopic nephrectomy. Twenty-one patients (21.2%) experienced a complication, 6 of whom had a major (Clavien grade 3 or higher) complication with one grade 5 complication. Operating room time decreased with experience, but surgical complications and hospital stay did not change with experience. MIC score of renal cell carcinoma (RCC) patients was 74.7%, while the surgical trifecta was reached in 71.3 % of RCC patients. Surgeons may enter practice directly from formal robotic training and perform RAPN with perioperative outcomes, surgical complications, surgical trifecta scores, and MIC scoring in line with those the most experienced robotic partial nephrectomists.

  2. Laparoscopic radical nephrectomy with inferior vena cava thrombectomy: highlight of key surgical steps

    PubMed Central

    Sim, A.; Todenhöfer, T.; Mischinger, J.; Fahmy, O.; Boettge, J.; Rausch, S.; Bier, S.; Aufderklamm, S.; Stenzl, A.; Gakis, G.; Schwentner, C.

    2016-01-01

    ABSTRACT Objective: Vascular involvement in the form of renal vein (RV) or inferior vena cava (IVC) thrombus can be seen in 4-10% of patients presented with RCC. In patients without presence of metastasis, surgical treatment in the form of radical nephrectomy remains the treatment of choice with 5-year survival rates of 45-70%. Open surgery is still the first treatment option of choice at the moment for RCC patients with IVC thrombus. Materials and Methods: In our study, we are reporting a case of patient with RCC and level I IVC thrombus treated with laparoscopy. Our patient is a 72 years old man with underlying co-morbidity of hypertension and chronic kidney disease (CKD) presented with right-sided RCC. The CT scan done showed a large right renal upper pole tumor measuring 8.4x5.2cm with level I IVC thrombus (Figure-1). There were no regional lymphadenopathy and the staging scans were negative. Results: The operative time was 124 minutes and blood loss was minimal. The patient was progressed to diet on POD 1 with bowel movement on POD 2. There was no significant change in the pre and post-operative glomerular filtration rate (GFR). The surgical drain was removed on POD2. The patient was discharged well on POD 5. There were no perioperative complications. The pathology was pT3bN0M0 Fuhrman grade II clear cell RCC. Conclusions: As a conclusion, laparoscopic radical nephrectomy and IVC thrombectomy is a complex and technically demanding surgery. With advancement of surgical skills as well as technology, more cases of minimally invasive laparoscopic radical nephrectomy and IVC thrombectomy can performed to improve the perioperative outcomes of carefully selected patients in a high volume center. PMID:27564306

  3. The late effect of subtotal thyroidectomy and radioactive iodine therapy on calcitonin secretion and bone mineral density in women treated for Graves' disease.

    PubMed

    Lowery, W D; Thomas, C G; Awbrey, B J; Rosenstein, B D; Talmage, R V

    1986-12-01

    This study was designed to evaluate the effect of subtotal thyroidectomy and/or radioactive iodine therapy on plasma immunocalcitonin (iCT) levels and bone densities in patients treated for Graves' disease. Forty-eight women whose ages ranged from 29 to 79 years (mean, 55 years) were evaluated. All were at least 10 years beyond treatment. Fourteen patients had undergone subtotal thyroidectomy, 22 had received radioactive iodine therapy, and 12 had received both. Serum calcitonin levels were measured with the patient fasting and at 30 minutes and 2 hours after the ingestion of 15 mg of calcium in orange juice. Single photon absorptiometry was used to measure bone mineral density of the middle and distal radius. The mean fasting plasma levels of iCT for patients undergoing subtotal thyroidectomy was 27 +/- 2 mumol/L; women treated with radioactive iodine, 26 +/- 2; women undergoing subtotal thyroidectomy followed by radioactive iodine, 24 +/- 2, and for normal control women, 48.5 +/- 4.7. The mean stimulated iCT level of each of the patient groups was significantly lower than that of the normal controls (p = 0.01). There were no significant differences among the groups. Although there was an increased loss of bone mineral density in postmenopausal patients, with age and race as covariates, the bone densities of the distal radius in women undergoing subtotal thyroidectomy and/or receiving radioactive iodine were not significantly lower than those of normal control subjects (p greater than 0.05). These findings are consistent with other observations that patients treated by thyroidectomy and/or radioactive iodine for Graves' disease have lower basal levels of calcitonin and decreased calcitonin response to a provocative stimulus. Whether this loss of calcitonin reserve is a significant factor in development of postmenopausal osteoporosis remains unanswered.

  4. Late effect of subtotal thyroidectomy and radioactive iodine therapy on calcitonin secretion and bone mineral density in women treated for Graves' disease

    SciTech Connect

    Lowery, W.D.; Thomas, C.G. Jr.; Awbrey, B.J.; Rosenstein, B.D.; Talmage, R.V.

    1986-12-01

    This study was designed to evaluate the effect of subtotal thyroidectomy and/or radioactive iodine therapy on plasma immunocalcitonin (iCT) levels and bone densities in patients treated for Graves' disease. Forty-eight women whose ages ranged from 29 to 79 years (mean, 55 years) were evaluated. All were at least 10 years beyond treatment. Fourteen patients had undergone subtotal thyroidectomy, 22 had received radioactive iodine therapy, and 12 had received both. Serum calcitonin levels were measured with the patient fasting and at 30 minutes and 2 hours after the ingestion of 15 mg of calcium in orange juice. Single photon absorptiometry was used to measure bone mineral density of the middle and distal radius. The mean fasting plasma levels of iCT for patients undergoing subtotal thyroidectomy was 27 +/- 2 mumol/L; women treated with radioactive iodine, 26 +/- 2; women undergoing subtotal thyroidectomy followed by radioactive iodine, 24 +/- 2, and for normal control women, 48.5 +/- 4.7. The mean stimulated iCT level of each of the patient groups was significantly lower than that of the normal controls (p = 0.01). There were no significant differences among the groups. Although there was an increased loss of bone mineral density in postmenopausal patients, with age and race as covariates, the bone densities of the distal radius in women undergoing subtotal thyroidectomy and/or receiving radioactive iodine were not significantly lower than those of normal control subjects (p greater than 0.05). These findings are consistent with other observations that patients treated by thyroidectomy and/or radioactive iodine for Graves' disease have lower basal levels of calcitonin and decreased calcitonin response to a provocative stimulus. Whether this loss of calcitonin reserve is a significant factor in development of postmenopausal osteoporosis remains unanswered.

  5. [Giant renal angiomyolipoma disclosed by mild lumbar trauma and treated with nephrectomy: report of a case].

    PubMed

    Rosselló Barbará, M; Mus Malleu, A; Rebassa Llul, M; Casals Armada, J

    2004-02-01

    A case of giant angiomyolipoma of the kidney discovered during the study of a light lumbar trauma is presented. Disseminated tuberous sclerosis lesions are demonstrated at the brain, cerebellum, liver and contralateral kidney. External cutaneous stigmas of this illness are shown at the face. The size of the viscera and the loss of function of the left kidney conditioned the nephrectomy. The piece weighed upon extracting 6300 g, without malignant signs. To the microscopic exam atrophic sclerosis for compression was demonstrated. The postoperative course was satisfactory. Actually his arterial tension is controlled by medical treatment.

  6. Solitary parotid metastasis 8 years after a nephrectomy for renal cell carcinoma

    PubMed Central

    Hussain, Faiz; Yedavalli, Nina; Loeffler, David; Kajdacsy-Balla, Andre

    2016-01-01

    Renal cell carcinoma is a common cancer, known for its aggressive behavior and ability to metastasize nearly every organ system in the body. While the cancer commonly spreads to a select few organs and metastasis usually develops within 5 years of diagnosis, there have been numerous case reports of atypical sites of metastasis and cases of relapse up to decades after treatment. We present a case a 65-year-old male who presented with right preauricular swelling 8 years after the initial diagnosis and right nephrectomy for clear cell renal cell cancer. We take a look at previous case reports with similar presentations. PMID:27609721

  7. Solitary parotid metastasis 8 years after a nephrectomy for renal cell carcinoma.

    PubMed

    Hussain, Faiz; Yedavalli, Nina; Loeffler, David; Kajdacsy-Balla, Andre

    2016-01-01

    Renal cell carcinoma is a common cancer, known for its aggressive behavior and ability to metastasize nearly every organ system in the body. While the cancer commonly spreads to a select few organs and metastasis usually develops within 5 years of diagnosis, there have been numerous case reports of atypical sites of metastasis and cases of relapse up to decades after treatment. We present a case a 65-year-old male who presented with right preauricular swelling 8 years after the initial diagnosis and right nephrectomy for clear cell renal cell cancer. We take a look at previous case reports with similar presentations. PMID:27609721

  8. Bilateral simultaneous single-port (LESS) laparoscopic nephrectomy (laparoendoscopic single site surgery)

    PubMed Central

    Page, Toby; Soomro, N. A.

    2010-01-01

    Minimal access surgery is rapidly expanding and currently single-port surgery is at the forefront of laparoscopy. Operating through a single port is technically demanding but through advances in camera design and instrument design, it is now gaining popularity. It offers minimal scar surgery as well as decreased postoperative pain and swift recovery. Here we present a case of bilateral simultaneous single-port laparoscopic nephrectomy (LESS) laparoendoscopic single site surgery in a 51-year-old man. Illustrating that LESS can be used by surgeons with laparoscopic skills outside of a few major international centers. PMID:21369399

  9. Renal artery stenosis and hypertension after abdominal irradiation for Hodgkin disease. Successful treatment with nephrectomy

    SciTech Connect

    Salvi, S.; Green, D.M.; Brecher, M.L.; Magoos, I.; Gamboa, L.N.; Fisher, J.E.; Baliah, T.; Afshani, E.

    1983-06-01

    Hypertension secondary to stenosis of the left renal artery developed in a thirteen-year-old male six years after completion of inverted Y irradiation (3,600 rad) for abdominal Hodgkin disease. Surgical treatment with nephrectomy resulted in control of the hypertension without the use of antihypertensive agents. We review the literature for this unusual complication of abdominal irradiation, and recommend that a 99mTc-DMSA renal scan, selective renal vein sampling for renin determinations, and renal arteriography be performed on any patient in whom hypertension develops following abdominal irradiation in childhood.

  10. Unilateral Ultrasound-Guided Transversus Abdominis Plane Block After Nephrectomy; Postoperative Pain and Use of Opioids

    PubMed Central

    Azawi, Nessn H.; Mosholt, Karina Sif Sondergaard; Fode, Mikkel

    2016-01-01

    Background Pain has a wide spectrum of effects on the body and inadequately controlled postoperative pain may have harmful physiologic and psychological consequences and increase morbidity. In addition, opioid anesthetic agents in high doses can blunt endocrine and metabolic responses following surgery and are associated with side effects including dizziness, nausea, vomiting, constipation, and respiratory depression. Objectives The current study aimed to investigate if unilateral ultrasound-guided transverse abdominal plane block (TAP-block) could reduce pain and postoperative use of patient requested analgesics following nephrectomy compared to local injection of the same ropivacaine dose in the surgical wound. Patients and Methods Retrospective chart reviews were performed in 42 consecutive patients who received TAP-block in conjunction with nephrectomy from November 2013 to August 2014 (group A). For comparison, data were used from 40 other nephrectomy patients registered as part of a previous study (group B). In this group the patients had received local ropivacaine injection in the surgical wound. On univariate analyses, the groups were compared by t-test and the Fisher exact test. Multivariate analyses were conducted by multiple linear regression. Results Mean surgical time was 162 minutes in group A and 92 minutes in group B (P < 0.0001). The means of visual analogue scale (VAS) were 3.05 and 1.55 in A and B groups, respectively (P = 0.001). The means of morphine consumption were 5.2 mg and 5.9 mg in groups A and B, respectively (P = 0.58); while the means of sufentanil use were 9.8 μg and 6.0 μg in groups A and B, respectively (P = 0.06). When controlling for age, tumor size and American society of anesthesiologists classification (ASA) score on multivariate analysis, TAP-block was associated with a significant increase in VAS (+1.4 [95% CI, 0.6 - 2.3], P = 0.001) and sufentanil use (+6.2 μg [95% CI, 2.3 - 10.2], P = 0.003). There was no difference in

  11. Bloodless Partial Nephrectomy Through Application of Non-Focused High-Intensity Ultrasound

    NASA Astrophysics Data System (ADS)

    Murat, François-Joseph; Lafon, Cyril; Gelet, Albert; Martin, Xavier; Cathignol, Dominique

    2005-03-01

    The goal of this study was to evaluate the hemostatic ability of a new interstitial applicator composed of a planar ultrasonic transducer with a reflector, during partial nephrectomy in a porcine model. The new applicator was designed to make effective use of all the acoustic energy to coagulate the renal tissue . Placement of the reflector opposite the transducer allows use of all the acoustic energy for coagulation. Despite the low transmission frequency, it is possible to work at a relatively weak intensity, with the aid of the reflector. As a result, intense cooling of the transducer is no longer needed. The transducer functions at a frequency of 3.78 MHz. A movable brass plate was mounted to the applicator, parallel to the transducer, to reflect energy that was not absorbed during ultrasound wave transmission. Additionally, the plate served to immobilize the kidney during the treatment. Our methodology was to expose the kidneys of 9 pigs through abdominal laparotomy. An initial series of experiments on 5 pigs allowed exposure conditions to be selected. Thermocouples were implanted in the kidneys after exposure at 15, 20, and 25 mm from the renal capsule surface. The remaining 4 pigs underwent ultrasound treatment with the applicator before a bilateral lower pole partial nephrectomy. The treatment consisted of juxtaposing elementary lesions (made at an intensity of 26 W/cm2 for 50 seconds) circumferentially in a subhilar location. The hemostatic efficacy was evaluated just after the shots and during the 30 minutes that followed the sectioning of the kidney's lower pole. In the event of persistent bleeding, an it was possible form an elementary lesion opposite the insufficiently treated zone. For an exposure duration of 50 seconds at 26 W/cm2, the lesions obtained covered the total thickness of the kidney, which varied between 22 and 36 mm. The temperatures observed within the treated tissues were 62°, 59°, and 58°C at 15, 20 and 25 mm respectively from the

  12. Clinical significance of preoperative thrombocytosis in patients who underwent radical nephrectomy for nonmetastatic renal cell carcinoma

    PubMed Central

    Choi, Jae Young; Ko, Young Hwii

    2016-01-01

    Purpose The aim of this study was to examine the association of preoperative thrombocytosis with the prognosis of patients with nonmetastatic renal cell carcinoma (RCC). Materials and Methods We conducted a retrospective analysis of 187 patients who underwent a radical nephrectomy for nonmetastatic RCC between July 1997 and June 2009. Thrombocytosis was defined as a platelet count≥400,000 µL, and patients were divided into 2 groups according to presence of preoperative thrombocytosis, and the cancer-specific survival rates and overall survival rates of the 2 groups after radical nephrectomy were compared. Results The mean age of the patients was 56.0±11.7 years and the mean follow-up period was 59.3±42.1 months; there were 20 patients with preoperative thrombocytosis. Thirty patients developed metastases and 9 patients died during the follow-up period. In Kaplan-Meier analysis using a univariate log-rank test, both cancer-specific survival rate (p=0.013) and overall survival rate (p=0.012) showed significant association with preoperative thrombocytosis. Controlling for pathological TNM stage, Fuhrman grade and tumor diameter, the Cox proportional hazards model for cancer-specific survival rates showed that preoperative thrombocytosis was an independent prognostic factor (p=0.025). Conclusions Preoperative thrombocytosis was associated with poorer prognosis in patients with nonmetastatic RCC. Thus, preoperative platelet count may be clinically useful for risk stratification of patients undergoing surgery for nonmetastatic RCC.

  13. Application of Long-Acting VLHL PAI-1 during Sutureless Partial Nephrectomy in Mice Reduces Bleeding

    PubMed Central

    Shahrour, Khaled; Keck, Rick; Jankun, Jerzy

    2015-01-01

    PAI-1 prevents lysis of blood clot by inhibiting the urokinase and tPA induced conversion of plasminogen to plasmin. VLHL PAI-1 protein mutant was created to extend half-life over 700 hours. The objective of this paper was to test VLHL PAI-1 effects on bleeding during partial nephrectomy in mice. All animals had a left partial nephrectomy after intravenous infusion of saline or tPA. The animals were divided into four groups. Group 1 was infused with saline and kidney was exposed to saline too; Group 2 was infused with saline and kidney was exposed to PAI-1. Group 3 was infused with tPA and kidney was exposed to saline, while Group 4 was infused with tPA and kidney was exposed to PAI-1. Preweighed gauze containing PAI-1 or saline was then applied to the kidney for 30 minutes. The gauze was afterward weighed and blood loss was measured by subtracting the preweight of gauze from the final weight. We have observed a statistically significant (P ≤ 0.05) reduction of bleeding in PAI-1-treated group in comparison to saline and tPA-treated groups. Based on these results we propose that VLHL PAI-1 can be used therapeutically in limiting the flow of blood from renal wounds. PMID:25883959

  14. Clinical significance of preoperative thrombocytosis in patients who underwent radical nephrectomy for nonmetastatic renal cell carcinoma

    PubMed Central

    Choi, Jae Young; Ko, Young Hwii

    2016-01-01

    Purpose The aim of this study was to examine the association of preoperative thrombocytosis with the prognosis of patients with nonmetastatic renal cell carcinoma (RCC). Materials and Methods We conducted a retrospective analysis of 187 patients who underwent a radical nephrectomy for nonmetastatic RCC between July 1997 and June 2009. Thrombocytosis was defined as a platelet count≥400,000 µL, and patients were divided into 2 groups according to presence of preoperative thrombocytosis, and the cancer-specific survival rates and overall survival rates of the 2 groups after radical nephrectomy were compared. Results The mean age of the patients was 56.0±11.7 years and the mean follow-up period was 59.3±42.1 months; there were 20 patients with preoperative thrombocytosis. Thirty patients developed metastases and 9 patients died during the follow-up period. In Kaplan-Meier analysis using a univariate log-rank test, both cancer-specific survival rate (p=0.013) and overall survival rate (p=0.012) showed significant association with preoperative thrombocytosis. Controlling for pathological TNM stage, Fuhrman grade and tumor diameter, the Cox proportional hazards model for cancer-specific survival rates showed that preoperative thrombocytosis was an independent prognostic factor (p=0.025). Conclusions Preoperative thrombocytosis was associated with poorer prognosis in patients with nonmetastatic RCC. Thus, preoperative platelet count may be clinically useful for risk stratification of patients undergoing surgery for nonmetastatic RCC. PMID:27617313

  15. Embolization of polycystic kidneys as an alternative to nephrectomy before renal transplantation: a pilot study.

    PubMed

    Cornelis, F; Couzi, L; Le Bras, Y; Hubrecht, R; Dodré, E; Geneviève, M; Pérot, V; Wallerand, H; Ferrière, J M; Merville, P; Grenier, N

    2010-10-01

    In autosomal polycystic kidney disease, nephrectomy is required before transplantation if kidney volume is excessive. We evaluated the effectiveness of transcatheter arterial embolization (TAE) to obtain sufficient volume reduction for graft implantation. From March 2007 to December 2009, 25 patients with kidneys descending below the iliac crest had unilateral renal TAE associated with a postembolization syndrome protocol. Volume reduction was evaluated by CT before, 3, and 6 months after embolization. The strategy was considered a success if the temporary contraindication for renal transplantation could be withdrawn within 6 months after TAE. TAE was well tolerated and the objective was reached in 21 patients. The temporary contraindication for transplantation was withdrawn within 3 months after TAE in 9 patients and within 6 months in 12 additional patients. The mean reduction in volume was 42% at 3 months (p = 0.01) and 54% at 6 months (p = 0.001). One patient required a cyst sclerosis to reach the objective. The absence of sufficient volume reduction was due to an excessive basal renal volume, a missed accessory artery and/or renal artery revascularization. Embolization of enlarged polycystic kidneys appears to be an advantageous alternative to nephrectomy before renal transplantation.

  16. Retroperitoneal laparoscopic nephrectomy and other procedures in the upper retroperitoneum using a balloon dissection technique.

    PubMed

    Rassweiler, J J; Henkel, T O; Stoch, C; Greschner, M; Becker, P; Preminger, G M; Schulman, C C; Frede, T; Alken, P

    1994-01-01

    This article describes a hydraulic balloon dissection technique. The retroperitoneum is developed via a small lumbodorsal incision between the edges of the musculus latissimus dorsi and musculus obliquus externus and then after visualization of its correct position the balloon catheter is filled with 500-1,200 ml of warm normal saline (according to patient size). The device consists of the finger of a surgeon's glove ligated around the end of a rigid bladder catheter. The balloon insufflation is maintained for 5 min to guarantee adequate hemostasis. Recently, we have replaced the balloon catheter by a balloon trocar sheath allowing direct endoscopic control of the hydraulic dissection. After retrieval of the balloon the CO2 insufflator is connected to the first trocar. All secondary trocars are placed under endoscopic control. The hydraulic dissection techniques also enable optimal creation of an effective pneumoperitoneum in children. Until now, we have used this technique for twelve procedures in the upper retroperitoneum including five nephrectomies, two nephroureterectomies, one tumor nephrectomy, one nephropexy, one renal cyst marsupialization and two renal biopsies. Up to now we have encountered no major complications. Three of the nephrectomized patients had undergone multiple previous abdominal surgical interventions. The retroperitoneal approach allows the surgeon to apply similar dissecting techniques as used in respective open procedures. It has become the routine approach for laparoscopic procedures in benign renal disease. This procedure can be performed even in cases with previous abdominal surgery.

  17. [A case of renal hypertension after pyelolithotomy cured by segmental nephrectomy].

    PubMed

    Konishi, T; Pak, K; Takayama, H; Tomoyoshi, T

    1985-12-01

    A case of renal hypertension after pyelolithotomy cured by segmental nephrectomy is reported. The patient, a 39-year-old man had had pyelolithotomy performed by the lumbodorsal approach at another hospital. Two months after operation he started to complain of headache and palpitation. The blood pressure was markedly high when he visited our hospital and peripheral plasma renin activity was also elevated. Urinalysis was normal except for slight proteinuria. The excretory urogram demonstrated cortical scarring in the lower portion of the left kidney. The renal scintigram demonstrated low uptake in this area, suggesting renal infarction. Renal arteriogram showed decreased vascularity in this area. Plasma renin activity was measured on the blood drawn from the renal vein of both sides and the ratio was about 2.4, and renin activity of the segmental renal vein from the left lower portion was elevated. Segmental nephrectomy of the lower pole was performed. The blood pressure three weeks after lower pole resection was estimated to be normal and renin activity returned to an almost normal level. Discussion was made on the cause of renal hypertension after renal surgery. In this case, it was suggested that renal hypertension is caused by subinfraction due to lesions of the dorsal renal artery in surgery for renal calculus. PMID:3832924

  18. Feasibility of quantitative diffuse reflectance spectroscopy for targeted measurement of renal ischemia during laparoscopic partial nephrectomy

    NASA Astrophysics Data System (ADS)

    Goel, Utsav O.; Maddox, Michael M.; Elfer, Katherine N.; Dorsey, Philip J.; Wang, Mei; McCaslin, Ian Ross; Brown, J. Quincy; Lee, Benjamin R.

    2014-10-01

    Reduction of warm ischemia time during partial nephrectomy (PN) is critical to minimizing ischemic damage and improving postoperative kidney function, while maintaining tumor resection efficacy. Recently, methods for localizing the effects of warm ischemia to the region of the tumor via selective clamping of higher-order segmental artery branches have been shown to have superior outcomes compared with clamping the main renal artery. However, artery identification can prolong operative time and increase the blood loss and reduce the positive effects of selective ischemia. Quantitative diffuse reflectance spectroscopy (DRS) can provide a convenient, real-time means to aid in artery identification during laparoscopic PN. The feasibility of quantitative DRS for real-time longitudinal measurement of tissue perfusion and vascular oxygenation in laparoscopic nephrectomy was investigated in vivo in six Yorkshire swine kidneys (n=three animals). DRS allowed for rapid identification of ischemic areas after selective vessel occlusion. In addition, the rates of ischemia induction and recovery were compared for main renal artery versus tertiary segmental artery occlusion, and it was found that the tertiary segmental artery occlusion trends toward faster recovery after ischemia, which suggests a potential benefit of selective ischemia. Quantitative DRS could provide a convenient and fast tool for artery identification and evaluation of the depth, spatial extent, and duration of selective tissue ischemia in laparoscopic PN.

  19. Laparoscopic nephrectomy: safe and comfortable surgical alternative for living donors and for good results of graft function.

    PubMed

    Rocca, X; Espinoza, O; Hidalgo, F; Gonzalez, F

    2005-10-01

    Laparoscopic nephrectomy for kidney donation from living related donors has the advantages of a less invasive surgical access, better cosmesis, and a shorter hospital stay for the donor. However, some workers have reported up to 10% life-threatening complications for the donor using this technique. The purpose of our study was to evaluate hand-assisted laparoscopic nephrectomy for living donors of kidney transplants in terms of graft function. Thirty donors who underwent open nephrectomy (ON) were compared with 27 who had hand-assisted nephrectomy (HALN). Surgery and ischemia times, hospital stay, bleeding, graft function, remaining kidney function, and complications were compared in both groups. Mean surgery time was 126.9 minutes for ON and 98 minutes for HALN (P = .0005), warm ischemia time was 3 minutes versus 6 for ON vs HALN, respectively (P = .02). Hospitalization stay was 6.3 days for ON versus 4.8 days for HALN (P = .0015). Differences in change in hematocrit and in serum creatinine levels were not significant; graft outcomes were also similar. Complications were minimal. We conclude that HALN is a valid, safe technique to obtain kidneys from living related donors, significantly reducing the hospital stay and allowing return to normal activities sooner, with risks falling within those reported in the literature. PMID:16298592

  20. A Randomized, Prospective, Parallel Group Study of Laparoscopic vs. Laparoendoscopic Single Site Donor Nephrectomy for Kidney Donation

    PubMed Central

    Aull, Meredith J.; Afaneh, Cheguevara; Charlton, Marian; Serur, David; Douglas, Melissa; Christos, Paul J.; Kapur, Sandip; Del Pizzo, Joseph J.

    2014-01-01

    Few prospective, randomized studies have assessed benefits of laparoendoscopic single site donor nephrectomy (LESS-DN) over laparoscopic donor nephrectomy (LDN). Our center initiated such a trial in January 2011, following subjects randomized to LESS-DN vs. LDN from surgery through 5 years post-donation. Subjects complete recovery/satisfaction questionnaires at 2, 6, and 12 months post-donation; transplant recipient outcomes are also recorded. 100 subjects (49 LESS-DN, 51 LDN) underwent surgery; donor demographics were similar between groups, and included a predominance of female, living unrelated donors, mean age of 47 years who underwent left donor nephrectomy. Operative parameters (overall time, time to extraction, warm ischemia time, blood loss) were similar between groups. Conversion to hand-assist laparoscopy was required in 3 LESS-DN (6.1%) vs. 2 LDN (3.9%; P=0.67). Questionnaires revealed 97.2% of LESS-DN vs. 79.5% of LDN (P=0.03) were 100% recovered by two months after donation. No significant difference was seen in satisfaction scores between the groups. Recipient outcomes were similar between groups. Our randomized trial comparing LESS donor nephrectomy to LDN confirms that LESS-DN offers a safe alternative to conventional LDN in terms of intra- and post-operative complications. LDN and LESS-DN offer similar recovery and satisfaction after donation. PMID:24934732

  1. Effects of Open versus Laparoscopic Nephrectomy Techniques on Oxidative Stress Markers in Patients with Renal Cell Carcinoma

    PubMed Central

    Mila-Kierzenkowska, Celestyna; Drewa, Tomasz; Woźniak, Bartosz; Szpinda, Michał; Krzyżyńska-Malinowska, Ewa; Rajewski, Paweł

    2013-01-01

    The aim of the study was to determine the concentration of lipid peroxidation products, the activity of selected antioxidant and lysosomal enzymes, and protease inhibitor in patients with renal cell carcinoma who underwent radical nephrectomy. The studied group included 44 patients: 21 of them underwent open surgery, while 23 underwent laparoscopy. Blood samples were collected three times: before treatment and 12 hours and five days after nephrectomy. In blood of participants, the concentration of thiobarbituric acid reactive substances (TBARS), the activity of catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx), and the activity of acid phosphatase (AcP), arylsulfatase (ASA), cathepsin D (CTSD), and α1-antitrypsin (AAT) were assayed. No statistically significant differences in investigated parameters were found between studied groups. Moreover, TBARS concentration and CAT, SOD, and GPx activity were not altered in the course of both types of surgery. Five days after both open and laparoscopic nephrectomy techniques, AAT activity was higher than its activity 12 hours after the procedure. The obtained results suggest that laparoscopy may be used for nephrectomy as effectively as open surgery without creating greater oxidative stress. Reduced period of convalescence at patients treated with laparoscopy may be due to less severe response of acute-phase proteins. PMID:23533691

  2. The evaluation of pulmonary function and blood gas analysis in patients submitted to laparoscopic versus open nephrectomy

    PubMed Central

    Koc, Ayfer; Inan, Gozde; Bozkirli, Fusun; Coskun, Demet; Tunc, Lutfi

    2015-01-01

    ABSTRACT Background: The aim of this study was to assess the early postoperative pulmonary function and arterial blood gases in patients who have undergone open versus laparoscopic nephrectomy. Materials and Methods: Forty patients were randomly assigned to undergo laparoscopic (LN, n=20) or open nephrectomy (ON, n=20). Pulmonary function tests including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), forced expiratory volume at 25% (FEF25), forced expiratory volume at 50% (FEF50), forced expiratory volume at 25% to 75% (FEF25–75), forced expiratory volume in 1 second (FIV1) and peak expiratory flow (PEF) were performed one day before the operation and on the postoperative day 1. The arterial blood gas analysis (pH, pCO2, pO2, SaO2) was made at breathing room preoperatively, in the recovery phase and on postoperative day 1. Results: All spirometric variables decreased after both open and laparoscopic nephrectomy on postoperative day 1. FEV1, FVC, FEF25 and FEF25–75 values decreased on postoperative day 1 (39.7%, 37.4%, 27.7%, 51.8% respectively) in the open surgery group and they were significantly lower in laparoscopic group (29.9%, 32.5%, 23.2%, 44.5% respectively). There were no significant differences in FEF50, PEF and FIV1 between the groups. The SaO2 and pO2 values also decreased in both groups. During early recovery, pH decreased while pCO2 increased significantly but they returned to preoperative values on postoperative day 1 in both groups. Conclusion: Laparoscopic nephrectomy is better than open nephrectomy considering pulmonary functions. PMID:26742981

  3. [Cosmesis and Body Image after Laparo-Endoscopic Single Site Donor Nephrectomy].

    PubMed

    Yanishi, Masaaki; Kinoshita, Hidefumi; Yoshida, Takashi; Takayasu, Kenta; Mishima, Takao; Yoshida, Kenji; Sugi, Motohiko; Kawa, Gen; Matsuda, Tadashi

    2015-07-01

    Using a questionnaire, we objectively assessed the body image of donors who underwent conventional laparoscopic donor nephrectomy (L-DN) or laparoscopic single-site donor nephrectomy (LESS-DN). Subjects were 15 patients who underwent an L-DN and 15 who underwent an LESS-DN. The questionnaire consisted of the Body Image Questionnaire (BIQ), including a Body Image Scale (BIS) and Cosmetic Scale (CS), and a Photo-Series Questionnaire (PSQ). A higher score indicated a more favorable assessment, and patient scores were compared. Subjects were also asked which procedure they preferred if they had to undergo donor nephrectomy again. Pain was assessed by comparing the number of times an analgesic was administered during hospitalization. The average BIS score was 18.7 points (out of 20) for patients who underwent an L-DN and 19.5 points for patients who underwent an LESS-DN ; those who underwent an LESS-DN had a significantly higher score (p=0.03). Patients who underwent an L-DN had a median CS score of 17.5 points (out of 24) while patients who underwent an LESS-DN had a median CS score of 19.1 points ; those who underwent an LESS-DN had a higher score, but the difference in average CS scores was not significant (p=0.123). The average PSQ score was 7.1 points for patients who underwent an L-DN and 8.8 points for patients who underwent an LESS-DN ; the higher score for LESS-patients was statistically significant (p=0.01). Patients who underwent an L-DN were administered an analgesic a median of 4 times during hospitalization (range : 3-10 times) while patients who underwent an LESS-DN were administered an analgesic a median of 2 times (range : 0-4 times), which was significantly less (p=0.01). Patients who underwent LESS-DN had a better body image and better cosmetic appearance than those who underwent LDN, thus indicating the usefulness of LESS-DN. However, a more prospective larger study needs to be performed. PMID:26278210

  4. Robot-assisted partial nephrectomy: analysis of the first 100 cases from a single institution.

    PubMed

    Tobis, Scott; Venigalla, Sriram; Knopf, Joy K; Scosyrev, Emelian; Erturk, Erdal N; Golijanin, Dragan J; Joseph, Jean V; Rashid, Hani; Wu, Guan

    2012-06-01

    Robot-assisted partial nephrectomy (RAPN) is an alternative to open and laparoscopic partial nephrectomy for small renal tumors. Our objectives were to report our experience and short-term outcomes from the first 100 cases of robot-assisted partial nephrectomy (RAPN) performed at a single institution, as well as to evaluate the effect of the learning curve and identify any factors associated with adverse perioperative outcomes. Patient records of the first 100 RAPN cases performed by three surgeons between October 2007 and March 2010 were retrospectively reviewed. The cases were divided into two groups to analyze a possible learning curve effect. Group 1 consisted of the first half (chronologically) of the cases performed by each surgeon, and Group 2 consisted of the second half. For the entire series, the median warm ischemia time was 24 min (range 11-49), mean length of follow-up was 13.4 months, and the median postoperative change in glomerular filtration rate (GFR) was -6.6 mL/min/1.73 m(2). Three patients had microscopically positive margins on final pathology, three intraoperative complications occurred, and 13 postoperative complications were recorded (10 Clavien grade IIIa or less). Median operative time was significantly longer in Group 1 (193 min) than in Group 2 (165 min, P = 0.003). Multivariate analysis identified male gender and cases done in Group 1 to be associated with increased operative time, while male gender and higher nephrometry scores were associated with increased blood loss. Tumor characteristics associated with greater reductions in GFR included higher nephrometry scores, endophytic tumors, and hilar tumors. In conclusion, RAPN appears to be safe and the major effect of the learning curve appears to be on operative time. Warm ischemia times are sufficiently low to prevent significant renal impairment, while male gender and higher nephrometry scores may be predictors of longer operative times and more intraoperative blood loss

  5. [Renal Cell Carcinoma: When is a Partial, Organ-preserving Nephrectomy Possible and Reasonable?].

    PubMed

    Padevit, Christian; Sauck, Anja; John, Hubert

    2016-06-22

    In Switzerland about 900 people a year are newly diagnosed with a kidney tumour. This is about 3 % of all cancer cases in this country. Because of the abundent diagnostic examinations carried out (MR, CT, US), kidney tumours are often coincidentally found. In recent years the organ-sparing therapy has moved to the foreground for kidney tumours of <4 cm. This is increasingly true for larger lesions of 4–7 cm diameter. Organ-sparing kidney surgery has replaced the radical nephrectomy for tumours up to 7 cm because of the superior post-op quality of Life and the total survival rate. In addition, the control of oncological parameters, maintenance of kidney function, low morbidity and reproducibility of the method are existant and can be achieved using this organ-sparing therapy.

  6. Chylous Ascites Requiring Surgical Intervention after Donor Nephrectomy — Case Series and Single Center Experience

    PubMed Central

    Aerts, Johan; Matas, Arthur; Sutherland, David; Kandaswamy, Raja

    2013-01-01

    Chylous ascites as a result of laparoscopic donor nephrectomy (LDN) is a rare complication which carries significant morbidity, including severe protein-calorie malnutrition and an associated immunocompromised state. We report a patient who underwent hand-assisted left LDN and subsequently developed chylous ascites. He failed conservative therapy including low-fat diet with medium-chain triglycerides (LFD/MCT) and oral protein supplementation as well as strict NPO status with intravenous (IV) total parenteral nutrition (TPN) and subcutaneous (SQ) somatostatin analogue administration. Laparoscopic re-exploration and intracorporeal suture ligation and clipping of leaking lymph channels successfully sealed the chyle leak. We review the literature to date including diagnosis, incidence, management options, psychosocial aspects and clinical outcomes of chylous ascites after LDN. PMID:19958336

  7. Chylous ascites requiring surgical intervention after donor nephrectomy: case series and single center experience.

    PubMed

    Aerts, J; Matas, A; Sutherland, D; Kandaswamy, R

    2010-01-01

    Chylous ascites as a result of laparoscopic donor nephrectomy (LDN) is a rare complication that carries significant morbidity, including severe protein-calorie malnutrition and an associated immunocompromised state. We report a patient who underwent hand-assisted left LDN and subsequently developed chylous ascites. He failed conservative therapy including low-fat diet with medium-chain triglycerides (LFD/MCT) and oral protein supplementation as well as strict NPO status with intravenous (IV) total parenteral nutrition (TPN) and subcutaneous (SQ) somatostatin analogue administration. Laparoscopic re-exploration and intracorporeal suture ligation and clipping of leaking lymph channels successfully sealed the chyle leak. We review the literature to date including diagnosis, incidence, management options, psychosocial aspects and clinical outcomes of chylous ascites after LDN.

  8. [Anesthetic Management of Laparoscopic Nephrectomy for a Renal Cancer Patient with Distal Myopathy of Rimmed Vacuole].

    PubMed

    Saito, Junichi; Noguchi, Satoko; Matsumoto, Anna; Jinushi, Kei; Kasai, Toshinori; Kitayama, Masato; Hirota, Kazuyoshi

    2015-02-01

    A 56-year-old male with distal myopathy of rimmed vacuoles underwent laparoscopic nephrectomy. Anesthesia was induced with propofol, remifentanil and ketamine. Tracheal intubation using McGRATH was uneventful without using muscle relaxants. Then ultrasound-guided right thoracic paravertebral (TPVB) block was performed using 20 ml 0.75% ropivacaine with 10 ml 2% lidocaine by 3 injections of 10 ml each at T9 to T11. General anesthesia was maintained with propofol, remifentanil and ketamine monitoring bispectral index. Good surgical condition and pneumoperitoneum were maintained without using muscle relaxants. His postoperative course was smooth and uneventful, even though a small amount of fentanyl was administrated to relieve wound pain. This case suggests that McGRATH and ultrasound-guided TPVB can be one of the options to avoid using muscle relaxants in patient with neuromuscular disease.

  9. Successful Pregnancy in a 31-Year-Old Peritoneal Dialysis Patient with Bilateral Nephrectomy

    PubMed Central

    Nazer, Ahmed; AlOmar, Osama; Al-Badawi, Ismail A.

    2013-01-01

    Frequency of pregnancy among childbearing age women with end-stage renal disease (ESRD) undergoing long-term periodic dialysis ranges from 1% to 7%. Although pregnancy in dialysis women with ESRD is considered a largely high-risk pregnancy, occurrence of successful pregnancy is not impossible with success rates approaching 70%. Rates of successful pregnancy are greatly impacted by early pregnancy diagnosis and preserved residual renal functions. Herein, to the best of our knowledge, we report the first case of successful pregnancy (despite late diagnosis at 14 weeks of gestation) in a 31-year-old peritoneal dialysis patient with bilateral nephrectomy and no whatsoever preserved residual renal function. Moreover, a literature review on pregnancy in dialysis patients is presented. PMID:24198990

  10. Microparticulate ICE slurry for renal hypothermia: laparoscopic partial nephrectomy in a porcine model.

    SciTech Connect

    Shikanov, S; Wille, M; Large, M; Razmaria, A; Lifshitz, D; Chang, A; Wu, Y; Kasza, K; Shalhav, A

    2010-10-01

    Previously, we described the feasibility of renal hypothermia using microparticulate ice slurry during laparoscopy. In the present study, we compared surface cooling with the ice slurry versus near-frozen saline or warm ischemia (WI) during laparoscopic partial nephrectomy (LPN) in a porcine model. We used a single-kidney porcine model. Animals in 5 equal groups (n = 6 each) underwent right laparoscopic complete nephrectomy. In Phase I, left LPN was performed under 90 minutes of ischemia and 90-minute renal cooling with either slurry (Slurry group 1) or saline (Saline group 1). No cooling was applied in the WI group. In Phase II, to simulate more extreme condition, ischemia time was extended to 120 minutes and cooling shortened to 10 minutes (Slurry group 2 and Saline group 2). The study endpoints were renal and core temperature during the surgery and serum creatinine at baseline and days 1, 3, 7, and 14 after the procedure. The ice slurry was easily produced and delivered. Nadir renal temperature (mean {+-} SD) was 8 {+-} 4 C in Slurry group 1 vs. 22.5 {+-} 3 C in Saline group 1 (P < .0001). Renal rewarming to 30 C occurred after 61 {+-} 7 minutes in Slurry group 2 vs. 24 {+-} 6 minutes in Saline group 2 (P < .0001). Core temperature decreased on average to 35 C in the Saline groups compared with 37 C in the Slurry groups (P < .0001). Serum creatinine did not differ between the Saline and Slurry groups in Phases I and II at any time point. Ice slurry provides superior renal cooling compared with near-frozen saline during LPN without associated core hypothermia.

  11. [Rhabdomyolysis after radical nephrectomy in the lateral decubitus position: report of 2 cases].

    PubMed

    Shibamori, Kosuke; Yamamoto, Takanobu; Matsuki, Masahiro; Matsuda, Yohei; Kato, Shuichi; Takei, Fumiyasu; Yanase, Masahiro

    2014-10-01

    Rhabdomyolysis is a rare perioperative complication, however, potentially lead to fatal outcome. We experienced 2 cases of rhabdomyolysis after radical nephrectomy and nephroureterectomy in the lateral decubitus position. (Case 1) A 40-years old man was seen in our hospital because of asymptomatic grosshematuria. Computed tomography revealed right renal pelvic cancer, cT3N0M0. Right radical nephroureterectomy, lymph node dissection, partial cystectomy was underwent, and the operation was finished without any trouble. At the post-operative day 1, serum creatinine level was elevated to the point of 4.2 mg/dl, and serum creatine kinase was 1,945 IU/l. Continuous hemodiafiltration (CHDF) was done at intensive-care unit (ICU), and serum creatinine and creatine kinase level were decreased. At the post-operative day 1, urine myoglobin level was prominently elevated (2,943.7 ng/ml), so we diagnosed acute renal failure due to rhabdomyolysis. (Case 2) A 40-years old man was incidentally pointed out of right renal tumor that was seen as renal cell carcinoma, cT1aN0M0. Open partial nephrectomy was underwent, and there was no trouble during the operation. After recovering from anesthesia, the patient felt left thigh pain strongly. Serum creatine kinase was 888 IU/L after the operation. At the postoperative day 1, serum creatine kinase level was markedly increased (31,138 IU/L). Serum creatinine level was 1.34 mg/dl. Urine and serum myoglobin level was prominently elevated (89,000 ng/ml and 8,634 ng/ml, respectively). We diagnosed it rhabdomyolysis, and he received large amount of fluid intravenously at intensive-care unit. Serum creatine kinase was peak out at the post-operative day 3 (20,709 IU/L), and hemodialysis was not performed. PMID:25757354

  12. Low-dose epidural dexmedetomidine improves thoracic epidural anaesthesia for nephrectomy.

    PubMed

    Zeng, X Z; Xu, Y M; Cui, X G; Guo, Y P; Li, W Z

    2014-03-01

    Thoracic epidural anaesthesia alone is an applied technique of anaesthesia for nephrectomy which has both advantages and limitations. Dexmedetomidine is a highly selective alpha2-adrenoreceptor agonist which has both central and peripheral analgesic properties. Forty patients undergoing nephrectomy were enrolled in this clinical trial and allocated randomly to two groups, a control group (C group) and a dexmedetomidine group (D group). The C group received epidural 0.75% levobupivacaine 12 ml with 1 ml of isotonic sodium chloride solution, while the D group received epidural 0.75% levobupivacaine 12 ml with 1 ml (0.5 µg/kg) of dexmedetomidine. Haemodynamic changes, onset time and duration of sensory and motor block, muscle relaxation score, verbal rating score for pain, sedation score and the total postoperative analgesic consumption were evaluated. Sensory blockade duration was longer in the D group than in the C group (P=0.01). The incidence of motor block and the muscle relaxation score were significantly higher in the D group compared with the C group (P=0.01). Compared with the C group, pain scores were significantly lower in the first four postoperative hours in the D group (two hours rest P=0.038; two hours activity P=0.009; four hours rest P=0.044; four hours activity P=0.003). The total amount of flurbiprofen analgesic was significantly lower in the D group compared with the C group (P=0.03). Epidural dexmedetomidine 0.5 µg/kg appears to intensify thoracic epidural anaesthesia with levobupivacaine.

  13. Partial blockade of neurotensin-induced hypotension in rats by nephrectomy captopril and saralasin. Possible mechanisms.

    PubMed

    Kérouac, R; St-Pierre, S; Manning, M; Rioux, F

    1983-04-01

    We have assessed the influence of acute bilateral nephrectomy, of captopril and saralasin, on the hypotensive activity of neurotensin (NT) and of various hypotensive drugs in pentobarbital-anesthetized rats. The results show that the hypotensive activity of NT and of compound 48/80 (C48/80), in contrast to that of histamine, of 5-hydroxytryptamine and of hexamethonium, is markedly reduced, especially for NT, in nephrectomized as compared to sham operated rats. The pretreatment of rats with captopril (10 mg kg-1, i.v.) or with saralasin (20 micrograms kg-1 min-1, i.v.) was found to inhibit significantly the hypotensive activity of NT and of C48/80. Adrenalectomy restored partially the hypotensive activity of NT in nephrectomized rats. The potent vasopressin antagonist [d(CH2)5 Tyr(Me)AVP] did not alter the refractoriness of nephrectomized rats to the hypotensive activity of NT. Neither nephrectomy nor saralasin were found to interfere with the ability of NT or of C48/80 to evoke an increase of plasma histamine level or of the hematocrit. The results were interpreted as an indication that NT produces part of its hypotensive effect in anesthetized rats by reducing the activity of the renin angiotensin system. The results also suggest that part of the refractoriness of nephrectomized rats to the hypotensive activity of NT could be due to the release of catecholamines from adrenal glands by NT. Endogenous vasopressin does not appear to contribute to the refractoriness of nephrectomized rats to the hypotensive action of NT.

  14. A 3D-elastography-guided system for laparoscopic partial nephrectomies

    NASA Astrophysics Data System (ADS)

    Stolka, Philipp J.; Keil, Matthias; Sakas, Georgios; McVeigh, Elliot; Allaf, Mohamad E.; Taylor, Russell H.; Boctor, Emad M.

    2010-02-01

    We present an image-guided intervention system based on tracked 3D elasticity imaging (EI) to provide a novel interventional modality for registration with pre-operative CT. The system can be integrated in both laparoscopic and robotic partial nephrectomies scenarios, where this new use of EI makes exact intra-operative execution of pre-operative planning possible. Quick acquisition and registration of 3D-B-Mode and 3D-EI volume data allows intra-operative registration with CT and thus with pre-defined target and critical regions (e.g. tumors and vasculature). Their real-time location information is then overlaid onto a tracked endoscopic video stream to help the surgeon avoid vessel damage and still completely resect tumors including safety boundaries. The presented system promises to increase the success rate for partial nephrectomies and potentially for a wide range of other laparoscopic and robotic soft tissue interventions. This is enabled by the three components of robust real-time elastography, fast 3D-EI/CT registration, and intra-operative tracking. With high quality, robust strain imaging (through a combination of parallelized 2D-EI, optimal frame pair selection, and optimized palpation motions), kidney tumors that were previously unregistrable or sometimes even considered isoechoic with conventional B-mode ultrasound can now be imaged reliably in interventional settings. Furthermore, this allows the transformation of planning CT data of kidney ROIs to the intra-operative setting with a markerless mutual-information-based registration, using EM sensors for intraoperative motion tracking. Overall, we present a complete procedure and its development, including new phantom models - both ex vivo and synthetic - to validate image-guided technology and training, tracked elasticity imaging, real-time EI frame selection, registration of CT with EI, and finally a real-time, distributed software architecture. Together, the system allows the surgeon to concentrate

  15. Isolated omental metastasis of renal cell carcinoma after extraperitoneal open partial nephrectomy: A case report

    PubMed Central

    Acar, Ömer; Mut, Tuna; Sağlıcan, Yeşim; Sag, Alan Alper; Falay, Okan; Selcukbiricik, Fatih; Tabak, Levent; Esen, Tarık

    2016-01-01

    Introduction Metachronous metastatic spread of clinically localized renal cell carcinoma (RCC) affects almost 1/3 of the patients. They occur most frequently in lung, liver, bone and brain. Isolated omental metastasis of RCC has not been reported so far. Case presentation A 62-year-old patient previously diagnosed and treated due to pulmonary sarcoidosis has developed an omental metastatic lesion 13 years after having undergone open extraperitoneal partial nephrectomy for T1 clear-cell RCC. Constitutional symptoms and imaging findings that were attributed to the presence of a sarcomatoid paraneoplastic syndrome triggered by the development this metastatic focus complicated the diagnostic work-up. Biopsy of the [18F]-fluorodeoxyglucose (+) lesions confirmed the diagnosis of metastatic RCC and the patient was managed by the resection of the omental mass via near-total omentectomy followed by targeted therapy with a tyrosine kinase inhibitor. Discussion Late recurrence of RCC has been reported to occur in 10–20% of the patients within 20 years. Therefore lifelong follow up of RCC has been advocated by some authors. Diffuse peritoneal metastases have been reported in certain RCC subtypes with adverse histopathological features. However, isolated omental metastasis without any sign of peritoneal involvement is an extremely rare condition. Conclusion To our knowledge, this is the first reported case of metachronously developed, isolated omental metastasis of an initially T1 clear-cell RCC. Constitutional symptoms, despite a long interval since nephrectomy, should raise the possibility of a paraneoplastic syndrome being associated with metastatic RCC. Morphological and molecular imaging studies together with histopathological documentation will be diagnostic. PMID:26874583

  16. Taking a Step Forward in Laparoscopic Donor Nephrectomy: Transvaginal Retrieval of Donor's Kidney.

    PubMed

    Tan, Ying Hao; Lim, Yu Ming Joel; Ng, Ying Woo; Tiong, Ho Yee

    2016-09-01

    Laparoscopic donor nephrectomy has been broadly recognized as the gold standard for kidney procurement used in kidney transplantation where it is not uncommon for donors to experience discomfort and aesthetic dissatisfaction over larger incision site. Natural orifice transluminal endoscopic surgery is a surgical approach that allows scarless intraabdominal operations through natural orifices, such as the vagina. In this case report, we describe the first case of transvaginal retrieval of donor's kidney at the National University Hospital, Singapore. A 51-year-old Malay lady with no significant medical history volunteered to a living-related kidney donor. Perioperative antibiotics were administered. A 12 mm Excel port was placed over the left iliac fossa with camera insertion. Two additional ports were inserted over the left rectus sheath edge and left costal margin under direct vision. An additional 5 mm port at the left loin was placed for lateral retraction. A vaginal probe was then inserted to facilitate posterior colpotomy and transection of the left uterosacral ligament. Pneumoperitoneum was subsequently maintained with a LiNA McCartney(®) Tube. A 15 mm Endocatch(®) bag was inserted for retrieval of the kidney. The left kidney was placed in the Endocatch bag after transection of the hilar vessels where the kidney was retrieved vaginally with ease. Colpotomy was closed vaginally using Vicryl-0 continuous suture. Total blood loss was noted as 50 mL with warm ischemia time being 7 minutes and the entire retrieval taking totally 20 minutes. Postoperative recovery was uneventful and the donor was discharged stable 3 days postoperation. The transplanted kidney retained normal graft function. Colpotomy retrieval for donor nephrectomy presents an innovative method for specimen retrieval with minimal disruption of donor anatomy. Doing away with laparotomy for kidney retrieval has indeed shown a reduction in recovery time, reduced postoperative pain, and

  17. Successful Embolization of a Renal Artery Pseudoaneurysm with Arteriovenous Fistula and Extravasations Using Onyx After Partial Nephrectomy for Renal Cell Carcinoma

    SciTech Connect

    Zelenak, Kamil; Sopilko, Igor; Svihra, Jan; Kliment, Jan

    2009-01-15

    Partial nephrectomy can be associated with vascular complications. Computed tomography (CT) with CT angiography is ideal for noninvasive imaging of this process. The treatment of choice is selective embolization. Successful transcatheter embolization of right renal subsegmental artery pseudoaneurysm with arteriovenous fistula and extravasations using Onyx was performed in a 66-year-old woman with macrohematuria 12 days after partial nephrectomy for renal cell carcinoma.

  18. Dissociable effects of subtotal lesions within the macaque orbital prefrontal cortex on reward-guided behavior.

    PubMed

    Rudebeck, Peter H; Murray, Elisabeth A

    2011-07-20

    The macaque orbital prefrontal cortex (PFo) has been implicated in a wide range of reward-guided behaviors essential for efficient foraging. The PFo, however, is not a homogeneous structure. Two major subregions, distinct by their cytoarchitecture and connections to other brain structures, compose the PFo. One subregion encompasses Walker's areas 11 and 13 and the other centers on Walker's area 14. Although it has been suggested that these subregions play dissociable roles in reward-guided behavior, direct neuropsychological evidence for this hypothesis is limited. To explore the independent contributions of PFo subregions to behavior, we studied rhesus monkeys (Macaca mulatta) with restricted excitotoxic lesions targeting either Walker's areas 11/13 or area 14. The performance of these two groups was compared to that of a group of unoperated controls on a series of reward-based tasks that has been shown to be sensitive to lesions of the PFo as a whole (Walker's areas 11, 13, and 14). Lesions of areas 11/13, but not area 14, disrupted the rapid updating of object value during selective satiation. In contrast, lesions targeting area 14, but not areas 11/13, impaired the ability of monkeys to learn to stop responding to a previously rewarded object. Somewhat surprisingly, neither lesion disrupted performance on a serial object reversal learning task, although aspiration lesions of the entire PFo produce severe deficits on this task. Our data indicate that anatomically defined subregions within macaque PFo make dissociable contributions to reward-guided behavior.

  19. Subtotal hepatectomy in swine for studying small-for-size syndrome and portal inflow modulation: is it reliable?

    PubMed Central

    Darnis, Benjamin; Mohkam, Kayvan; Schmitt, Zoé; Ledochowski, Stanislas; Vial, Jean-Paul; Duperret, Serge; Vogt, Catherine; Demian, Hassan; Golse, Nicolas; Mezoughi, Salim; Ducerf, Christian; Mabrut, Jean-Yves

    2015-01-01

    Background Small-for-size syndrome (SFSS) is a feared complication of extended liver resection and partial liver transplantation. Swine models of extended hepatectomy have been developed for studying SFSS and its different treatment options. Although portal inflow modulation (PIM) by splenectomy or splenic artery ligation (SAL) has been proposed in humans to prevent SFSS, such procedures have not yet been evaluated in swine. Objectives The present study was designed to evaluate modifications in splanchnic haemodynamics yielded by extended hepatectomy with and without PIM in swine. Methods Nineteen animals underwent 70% hepatectomy (H70, n = 7), 90% hepatectomy (H90, n = 7) or sham laparotomy (H0, n = 5). Haemodynamic measurements were performed at baseline, after hepatectomy and after PIM by SAL and splenectomy. Results Portal vein flow increased after both H70 (273 ml/min/100 g versus 123 ml/min/100 g; P = 0.016) and H90 (543 ml/min/100 g versus 124 ml/min/100 g; P = 0.031), but the hepatic venous pressure gradient (HVPG) increased only after H90 (10.0 mmHg versus 3.7 mmHg; P = 0.016). Hepatic artery flow did not significantly decrease after either H70 or H90. In all three groups, neither splenectomy nor SAL induced any changes in splanchnic haemodynamics. Conclusions Subtotal hepatectomy of 90% in swine is a reliable model for SFSS inducing a significant increase in HVPG. However, in view of the relevant differences between swine and human splanchnic anatomy, this model is inadequate for studying the effects of PIM by SAL and splenectomy. PMID:26227804

  20. A New Suggestion for the Radiation Target Volume After a Subtotal Gastrectomy in Patients With Stomach Cancer

    SciTech Connect

    Nam, Heerim; Lim, Do Hoon Kim, Sung; Kang, Won Ki; Sohn, Tae Sung; Noh, Jae Hyung; Kim, Yong Il; Park, Chan Hyung; Park, Chul Keun; Ahn, Yong Chan; Huh, Seung Jae

    2008-06-01

    Purpose: To compare treatment results between the use of two different radiation fields including and excluding remnant stomach and suggest new target volumes excluding remnant stomach after subtotal gastrectomy (STG) in patients with stomach cancer. Methods and Materials: We retrospectively analyzed 291 patients treated with adjuvant chemoradiotherapy after STG and D2 dissection at the Samsung Medical Center, Seoul, South Korea. Eighty-three patients registered from 1995 to 1997 underwent irradiation according to the INT 0116 protocol that recommended the inclusion of remnant stomach within the target volume (Group A). After this period, we excluded remnant stomach from the target volume for 208 patients (Group B). Median follow-up was 67 months. Results: Treatment failure developed in 93 patients (32.0%). Local and regional recurrence rates for Group A vs. Group B were 10.8% vs. 5.3% (p = not significant) and 9.6% vs. 6.3% (p = not significant), and recurrence rates for remnant stomach were 7.2% vs. 1.4% (p = 0.018), respectively. Overall and disease-free survival rates were not different between the two groups. Grade 3 or 4 vomiting and diarrhea developed more frequently in Group A than Group B (4.8% vs. 1.4% and 6.0% vs. 1.9%, respectively; p = 0.012; p < 0.001). Conclusion: Exclusion of remnant stomach from the radiation field had no effect on failure rates or survival, and a low complication rate occurred in patients treated excluding remnant stomach. We suggest that remnant stomach be excluded from the radiation target volume for patients with stomach cancer who undergo STG and D2 dissection.

  1. Acid-base equilibrium during capnoretroperitoneoscopic nephrectomy in patients with end-stage renal failure: a preliminary report.

    PubMed

    Demian, A D; Esmail, O M; Atallah, M M

    2000-04-01

    We have studied the acid-base equilibrium in 12 patients with end-stage renal failure (ESRF) during capnoretroperitoneoscopic nephrectomy. Bupivacaine (12 mL, 0.375%) and morphine (2mg) were given in the lumbar epidural space, and fentanyl (0.5 microg kg(-1)) and midazolam (50 microg kg(-1)) were given intravenously. Anaesthesia was induced by thiopental, maintained with halothane carried by oxygen enriched air (inspired oxygen fraction = 0.35), and ventilation was achieved with a tidal volume of 10 mL kg(-1) at a rate of 12 min(-1). This procedure resulted in a mild degree of respiratory acidosis that was cleared within 60 min. We conclude that capnoretroperitoneoscopic nephrectomy can be performed in patients with end-stage renal failure with minimal transient respiratory acidosis that can be avoided by increased ventilation.

  2. Acid-base equilibrium during capnoretroperitoneoscopic nephrectomy in patients with end-stage renal failure: a preliminary report.

    PubMed

    Demian, A D; Esmail, O M; Atallah, M M

    2000-04-01

    We have studied the acid-base equilibrium in 12 patients with end-stage renal failure (ESRF) during capnoretroperitoneoscopic nephrectomy. Bupivacaine (12 mL, 0.375%) and morphine (2mg) were given in the lumbar epidural space, and fentanyl (0.5 microg kg(-1)) and midazolam (50 microg kg(-1)) were given intravenously. Anaesthesia was induced by thiopental, maintained with halothane carried by oxygen enriched air (inspired oxygen fraction = 0.35), and ventilation was achieved with a tidal volume of 10 mL kg(-1) at a rate of 12 min(-1). This procedure resulted in a mild degree of respiratory acidosis that was cleared within 60 min. We conclude that capnoretroperitoneoscopic nephrectomy can be performed in patients with end-stage renal failure with minimal transient respiratory acidosis that can be avoided by increased ventilation. PMID:10866009

  3. Nephrectomy in an Asian small-clawed otter (Amblonyx cinereus) with pyelonephritis and hydronephrosis secondary to ureteral obstruction.

    PubMed

    Higbie, Christine T; Carpenter, James W; Armbrust, Laura J; Klocke, Emily; Almes, Kelli

    2014-09-01

    A 10-yr-old, captive, intact male Asian small-clawed otter (Amblonyx cinereus) with a history of bilateral nephrolithiasis was presented for acute-onset lethargy and inappetance of 5 days duration. On physical examination, the otter was about 8% dehydrated and a palpable fluid wave was present in the abdomen. An abdominal ultrasound revealed hydronephrosis of the left kidney and a hyperechoic structure present within the lumen of the left ureter, causing an obstruction. A urinalysis revealed struvite crystalluria, bacteriuria, and an elevated pH. Following 4 days of antibiotic therapy, a left ureteronephrectomy was performed. Upon opening the kidney to retrieve calculi, a large amount of purulent material was noted within the renal pelvis. To the authors' knowledge, this is the first documented case of a nephrectomy in an Asian small-clawed otter. Nephrectomy should be considered as a viable option for treatment of ureteral obstruction, hydronephrosis, or severe pyelonephritis. PMID:25314845

  4. Osteoprotective effects of osthole in a mouse model of 5/6 nephrectomy through inhibiting osteoclast formation.

    PubMed

    Li, Xiaofeng; Xue, Chunchun; Wang, Libo; Tang, Dezhi; Huang, Jian; Zhao, Yongjian; Chen, Yan; Zhao, Dongfeng; Shi, Qi; Wang, Yongjun; Shu, Bing

    2016-10-01

    The present study aimed to investigate the effects of osthole on osteoclast formation and bone loss in a mouse model of 5/6 nephrectomy. The mice in control and osthole groups were treated 1 month following 5/6 nephrectomy with either a placebo or osthole, respectively. At 2 months post‑nephrectomy, the L4 vertebrae were harvested. The bone mineral density (BMD) of cancellous bone was measured using micro‑CT and tartrate‑resistant acid phosphatase (TRAP) staining was performed to evaluate osteoclast formation. Immunohistochemistry staining and reverse transcription‑quantitative polymerase chain reaction were performed to detect the expression of nuclear factor of activated T‑cells, cytoplasmic‑1 (NFATc‑1), c‑Fos, cathepsin K, Trap, matrix metalloproteinase 9 (Mmp9), osteoprotegerin (Opg) and receptor activator for nuclear factor‑κB ligand (Rankl). Bone marrow cells were cultured with osthole, and osteoclast formation was shown by TRAP staining. Primary calvaria osteoblasts were cultured with osthole, and expression levels of Opg and Rankl were detected. Compared with the sham group, the BMD of mice in model group was significantly reduced. The numbers of osteoclasts and the expression levels of NFATc‑1, c‑Fos, cathepsin K and Mmp9 were significantly increased. Compared with the control group, the mice in the osthole group exhibited increased BMD of the L4 vertebrae, a reduction in osteoclast numbers and decreased expression levels of NFATc‑1, c‑Fos, cathepsin K and Mmp9. In vitro experiments also showed that osteoclast formation was decreased following treatment with osthole. Osteoprotegerin (Opg)/receptor activator for nuclear factor‑κB ligand (Rankl) was upregulated by osthole treatment in the L4 vertebrae and in primary cultures of calvarial osteoblasts. Osthole inhibited osteoclast formation and partially reversed the bone loss induced by 5/6 nephrectomy in mice through the upregulation of OPG/RANKL. PMID:27571745

  5. Pentosan polysulfate prevents glomerular hypertension and structural injury despite persisting hypertension in 5/6 nephrectomy rats.

    PubMed

    Bobadilla, N A; Tack, I; Tapia, E; Sánchez-Lozada, L G; Santamaría, J; Jiménez, F; Striker, L J; Striker, G E; Herrera-Acosta, J

    2001-10-01

    Five/six nephrectomy induces systemic and glomerular hypertension, glomerulosclerosis, proteinuria, and tubulointerstitial fibrosis. Polysulfate pentosan (PPS) decreases mesangial proliferation and extracellular matrix accumulation. The aim of this study was to determine whether PPS prevents glomerular hemodynamic changes and renal damage. Micropuncture studies were performed in three groups of eight male Wistar rats. Two groups included rats with 5/6 nephrectomy-one of which was treated with PPS in drinking water (100 mg/kg body wt) and the second of which received normal drinking water-and the third group consisted of normal rats that served as controls. Five/six nephrectomy produced systemic hypertension, a 50% reduction in GFR, and a 67% increase in single-nephron GFR due to elevated glomerular pressure and single-nephron plasma flow as well as proteinuria. Hypertension persisted in PPS-treated animals. Despite a similar reduction in GFR, PPS prevented the rise in single-nephron GFR, glomerular capillary hydrostatic pressure, and proteinuria. By morphometry, glomerular volume was increased by 46% and mesangial area by 94%. Fractional glomerular capillary area decreased by 24%. PPS prevented these changes. Tubular dilatation, epithelial cell atrophy, and increased interstitial area were largely prevented by PPS, as was the interstitial inflammatory infiltrate. These results suggest that the renal protection conferred by PPS was mediated both by prevention of glomerular hypertension as well as suppression of the inflammatory response. It was postulated that this was partly due to the preservation of a greater fraction of functional nephrons.

  6. Position of laparo-endoscopic single-site surgery nephrectomy in clinical practice and comparison (matched case-control study) with standard laparoscopic nephrectomy

    PubMed Central

    Eret, Viktor; Stránský, Petr; Trávníček, Ivan; Ürge, Tomáš; Ferda, Jiří; Petersson, Fredrik; Hes, Ondřej

    2014-01-01

    Introduction One way how to reduce morbidity and improve cosmesic of kidney surgery is single site laparoscopy. Relatively well described concept but without defined position in clincal practise. Aim To report of institutional experience with laparoendoscopic single-site surgery (LESS) nephrectomy (NE) and compare (matched case-control study) it with that of standard laparoscopic NE (LNE). Material and methods In the period 8/2011 to 10/2013, we performed 183 mini-invasive NE (132 tumours, 51 benign aetiology); 45 of them (24.6%) were LESS, the rest LNE. The main but not absolute indications for LESS were: non-obese men, and less advanced tumours. In 13 patients undergoing LESS-NEs (28.9%) there was a transumbilical approach. For the rest, a pararectal incision was performed and an accessory port was added in 31.1% (14) – 2/22 (9.1%) left sided, 12/23 (52.2%) right sided. Twenty-four LESS-NE were performed by a more experienced surgeon (mean operation time (MOT) 73.1 min), 21 LESS-NE by 4 other surgeons (MOT 132.8 min). These 24 were compared with 43 LNE done by the same surgeon before the period of LESS (1/2007–8/2011) and with similar characteristics of cases (body mass index (BMI) ≤ 35 kg/m2, less advanced tumour). Results We found no statistically significant differences in any of the parameters studied. The MOT 73.1 min vs. 75.0 min (p = 0.78), BMI 27.4 kg/m2 vs. 29.2 kg/m2 (p = 0.08), blood loss 54.7 vs. 39.2 (p = 0.47). Complications (4.2% vs. 11.6%) were only of internal character in origin. No conversion in either group. In LESS-NE, staplers were used more frequently (more expensive than clips) for division of renal hilar vessels (70.8% vs. 51.2%). The mean price of LESS-NE was €367 higher. Conclusions The LESS NE performed by an experienced surgeon is a safe and efficient method for the surgical treatment of both malignant and benign renal conditions in patients with BMI < 30 kg/m2 and with low-stage tumours. The LESS NE is more expensive compared

  7. Treatment of 5/6 nephrectomy rats with sulodexide: a novel therapy for chronic renal failure

    PubMed Central

    Li, Ping; Ma, Lin-lin; Xie, Ru-juan; Xie, Yuan-sheng; Wei, Ri-bao; Yin, Min; Wang, Jian-zhong; Chen, Xiang-mei

    2012-01-01

    Aim: Sulodexide, a glycosaminoglycan, could reduce albuminuria in diabetic patients. The aim of this study was to determine whether sulodexide could be used to treat chronic kidney failure in rats. Methods: Sixty Wistar rats undergone 5/6 nephrectomy, then were randomly divided into 4 groups: the model group, sulodexide group (sulodexide 5 mg/kg per day, im), irbesartan group irbesartan (20 mg/kg per day, ig) and sulodexide plus irbesartan group. Another 12 rats were enrolled into the sham operation group. After the treatments for 4, 8 and 12 weeks, urinary protein and serum creatinine levels were measured. After 12 weeks, serum cholesterin and triglycerides levels were measured, and the degrees of glomerular sclerosis and renal tubulointerstitial fibrosis were scored. The expression of aminopeptidase P (JG-12) in the renal tissue was examined using immunohistochemical staining. The renal expressions of endothelial nitric oxide synthase (eNOS) and tissue type plasminogen activator (tPA) were detected with RT-PCR and Western blot. Results: Proteinuria was markedly attenuated in the sulodexide-treated groups. After 4 and 8 weeks only the sulodexide-treated groups showed significant reduction in serum creatinine; while after 12 weeks all the three treatment groups showed significant reduction in serum creatinine. Furthermore, all the three treatment groups showed significant reduction in the scores of glomerular sclerosis and tubulointerstitial fibrosis. The glomerular expression of JG-12 was increased in both the sulodexide group and the sulodexide plus irbesartan group, but not in the irbesartan group. The eNOS mRNA and protein expression was decreased and the tPA mRNA and protein expression was significantly increased in the model group compared with Sham group. Sulodexide, irbesartan, and their combination reversed the decrease of eNOS expression but increased the tPA expression much more compared with model group. Conclusion: Sulodexide was similar to irbesartan

  8. Subtotal Gastrectomy With Billroth II Anastomosis Is Associated With a Low Risk of Ischemic Stroke in Peptic Ulcer Disease Patients

    PubMed Central

    Chen, Chien-Hua; Lin, Cheng-Li; Kao, Chia-Hung

    2016-01-01

    Abstract Duodenal diversion can ameliorate lipid and glucose metabolism. We assessed the risk of stroke after subtotal gastrectomy with Billroth II anastomosis (SGBIIA) in peptic ulcer disease (PUD). We identified 6425 patients who received SGBIIA for PUD between 1998 and 2010 from the Taiwan National Health Insurance Research Database as the study cohort; we frequency-matched them with 25,602 randomly selected controls from the PUD population who did not receive SGBIIA according to age, sex, index year, and comorbidities including hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease (COPD), and obesity. All patients were followed until the end of 2011 to determine the incidence of stroke. The incidence of stroke was lower in patients in the SGBIIA cohort than in those in the non-SGBIIA cohort (18.9 vs 22.9 per 1000 person-years, adjusted hazard ratio [aHR] 0.80, 95% confidence interval [CI] 0.72–0.89, P < 0.001). The risk of ischemic stroke (aHR 0.77, 95% CI 0.69–0.86, P < 0.001), rather than hemorrhagic stroke (aHR 1.00, 95% CI 0.78–1.28), was lower for the SGBIIA cohort than for the non-SGBIIA cohort according to the multivariable Cox proportional hazard regression analysis. The relative risk of ischemic stroke after SGBIIA was lower in men (aHR 0.77, 95% CI 0.69–0.86) than in women (aHR 0.80, 95% CI 0.65–0.99) and in patients aged ≥65 years (aHR 0.72, 95% CI 0.63–0.81) than in those of other age groups (≤49 years, aHR 0.82, 95% CI 0.48–1.39; 50–64 years, aHR 1.01, 95% CI 0.79–1.28). The relative risk of ischemic stroke after SGBIIA was also reduced in patients with comorbidities (aHR 0.84, 5% CI 0.75–0.95) rather than in those without comorbidities (aHR 0.81, 95% CI 0.59–1.12). SGBIIA is associated with a low risk of ischemic stroke for PUD patients, and its protective effect is prominent in men, patients aged ≥65

  9. 2509 living donor nephrectomies, morbidity and mortality, including the UK introduction of laparoscopic donor surgery.

    PubMed

    Hadjianastassiou, V G; Johnson, R J; Rudge, C J; Mamode, N

    2007-11-01

    The worldwide expansion of laparoscopic, at the expense of open, donor nephrectomy (DN) has been driven on the basis of faster convalescence for the donor. However, concerns have been expressed over the safety of the laparoscopic procedure. The UK Transplant National Registry collecting mandatory information on all living kidney donations in the country was analyzed for donations between November 2000 (start of living donor follow-up data reporting) to June 2006 to assess the safety of living DN, after the recent introduction of the laparoscopic procedure in the United Kingdom. Twenty-four transplant units reported data on 2509 donors (601 laparoscopic, 1800 open and 108 [4.3%] unspecified); 46.5% male; mean donor age: 46 years. There was one death 3 months postdischarge and a further five deaths beyond 1 year postdischarge. The mean length of stay was 1.5 days less for the laparoscopic procedure (p < 0.001). The risk of major morbidity for all donors was 4.9% (laparoscopic = 4.5%, open = 5.1%, p = 0.549). The overall rate of any morbidity was 14.3% (laparoscopic = 10.3%, open = 15.7%, p = 0.001). Living donation has remained a safe procedure in the UK during the learning curve of introduction of the laparoscopic procedure. The latter offers measurable advantages to the donor in terms of reduced length of stay and morbidity. PMID:17868058

  10. Laparoscopic versus conventional live donor nephrectomy: experience in a community transplant program.

    PubMed

    Hawasli, A; Boutt, A; Cousins, G; Schervish, E; Oh, H

    2001-04-01

    Fifty-nine consecutive patients underwent live donor nephrectomy for transplantation. Twenty-nine patients (Group I) had open kidney procurement, and 30 patients (Group II) had laparoscopic procurement. The mean operative time in Group I was 2:30 hours (range 1:55-2:59), whereas in Group II it was 3:01 hours (1:54-5:21). All kidneys functioned immediately after transplantation. The average warm ischemia time was not calculated in Group I; it was 3.9 minutes (2-15) in Group II. Intraoperative complications occurred in two patients in Group II. One patient had bleeding from an accessory renal artery. The second patient had a tear in the splenic capsule. No ureteral complications occurred in either group. Postoperatively one patient in Group I developed incisional hernia, one developed pneumothorax, and two developed atelectasis. In Group II one patient developed pancreatitis, one developed flank ecchymosis, and two had suprapubic wound hematomas. Using the laparoscopic approach the hospital stay decreased from 4.1 to 1.27 days (69%) (P < 0.001) and return to work decreased from 28.4 to 14.8 days (49%) (P < 0.01). Live donation increased by 67 per cent. We conclude that the laparoscopic procurement of kidneys for transplantation compares well with the open method. It offers several advantages that may increase the living donor pool. PMID:11308000

  11. Serum prolactin levels in a uremic child: effects of bilateral nephrectomy and kidney transplantation.

    PubMed

    Rondeau, Geneviève; Merouani, Aïcha; Phan, Véronique; Deal, Cheri; Robitaille, Pierre

    2011-10-01

    Elevated levels of serum prolactin (PRL) are common and well described in patients with chronic renal failure. We report the case of a 4-year-old girl who also presented with premature thelarche and transient galactorrhea. Neither peritoneal dialysis nor hemodialysis reduced her extremely elevated levels of PRL, which fluctuated from time to time, probably reflecting variations in lactotroph secretion rate. Bilateral nephrectomy (BN) was eventually followed by a progressive and significant rise in PRL levels, suggesting that even uremic kidneys can eliminate PRL through tubular breakdown. Kidney transplantation was responsible for a very abrupt normalization of PRL serum levels, much faster than that observed for creatinine. This confirms animal studies suggesting that elimination of PRL occurs both through glomerular filtration and tubular breakdown. We hypothesized that the seemingly precocious puberty may have resulted from a combination of growth hormone therapy, elevated PRL and a rise in estrogens through the aromatization of adrenal androgens. This case illustrates the impact of dialysis, BN and kidney transplantation on PRL, providing new knowledge on renal PRL metabolism. PMID:25984175

  12. Unilateral nephrectomy elongates primary cilia in the remaining kidney via reactive oxygen species.

    PubMed

    Han, Sang Jun; Jang, Hee-Seong; Kim, Jee In; Lipschutz, Joshua H; Park, Kwon Moo

    2016-02-29

    The length of primary cilia is associated with normal cell and organ function. In the kidney, the change of functional cilia length/mass is associated with various diseases such as ischemia/reperfusion injury, polycystic kidney disease, and congenital solitary kidney. Here, we investigate whether renal mass reduction affects primary cilia length and function. To induce renal mass reduction, mice were subjected to unilateral nephrectomy (UNx). UNx increased kidney weight and superoxide formation in the remaining kidney. Primary cilia were elongated in proximal tubule cells, collecting duct cells and parietal cells of the remaining kidney. Mn(III) Tetrakis (1-methyl-4-pyridyl) porphyrin (MnTMPyP), an antioxidant, reduced superoxide formation in UNx-mice and prevented the elongation of primary cilia. UNx increased the expression of phosphorylated ERK, p21, and exocyst complex members Sec8 and Sec10, in the remaining kidney, and these increases were prevented by MnTMPyP. In MDCK, a kidney tubular epithelial cell line, cells, low concentrations of H2O2 treatment elongated primary cilia. This H2O2-induced elongation of primary cilia was also prevented by MnTMPyP treatment. Taken together, these data demonstrate that kidney compensation, induced by a reduction of renal mass, results in primary cilia elongation, and this elongation is associated with an increased production of reactive oxygen species (ROS).

  13. Unilateral nephrectomy elongates primary cilia in the remaining kidney via reactive oxygen species

    PubMed Central

    Han, Sang Jun; Jang, Hee-Seong; Kim, Jee In; Lipschutz, Joshua H.; Park, Kwon Moo

    2016-01-01

    The length of primary cilia is associated with normal cell and organ function. In the kidney, the change of functional cilia length/mass is associated with various diseases such as ischemia/reperfusion injury, polycystic kidney disease, and congenital solitary kidney. Here, we investigate whether renal mass reduction affects primary cilia length and function. To induce renal mass reduction, mice were subjected to unilateral nephrectomy (UNx). UNx increased kidney weight and superoxide formation in the remaining kidney. Primary cilia were elongated in proximal tubule cells, collecting duct cells and parietal cells of the remaining kidney. Mn(III) Tetrakis (1-methyl-4-pyridyl) porphyrin (MnTMPyP), an antioxidant, reduced superoxide formation in UNx-mice and prevented the elongation of primary cilia. UNx increased the expression of phosphorylated ERK, p21, and exocyst complex members Sec8 and Sec10, in the remaining kidney, and these increases were prevented by MnTMPyP. In MDCK, a kidney tubular epithelial cell line, cells, low concentrations of H2O2 treatment elongated primary cilia. This H2O2-induced elongation of primary cilia was also prevented by MnTMPyP treatment. Taken together, these data demonstrate that kidney compensation, induced by a reduction of renal mass, results in primary cilia elongation, and this elongation is associated with an increased production of reactive oxygen species (ROS). PMID:26923764

  14. Inferior Vena Cava Resection and Reconstruction for Tumoral Recurrence after Right Nephrectomy.

    PubMed

    Botianu, Pv-H; Chirtes, R; Marcu, C; Kosza, H; Stoian, M; Brusnic, O; Botianu, Amv; Dobre, A

    2016-01-01

    We report a 60 years old patient who was admitted for a local recurrence after a right nephrectomy performed 2 years ago (papillary renal carcinoma with areas of sarcomatoid differentiation - pT3a). CT scan showed a retroperitoneal mass with invasion of the inferior vena cava. We performed a complete en-bloque excision of the tumor with the infrarenal portion of the inferior vena cava and lympha-denectomy. The vascular reconstruction was performed by the interposition of a 20 mm diameter Dacron prosthesis. The postoperative course was complicated due to an episode of digestive bleeding (duodenal ulcer) which stopped after conservative treatment (antisecretory and hemostatics, including rFVIIa), but eventually favourable. At 6 months follow-up the patient presents no sign of tumoral relapse and a functional vascular prosthesis. The case is interesting due to the rarity of the surgical procedure and the indication. The surgical approach of the retroperitoneal tumors with vascular involvement is possible in centers with adequate technical endownment and human expertise. PMID:27604673

  15. A multimodal imaging framework for enhanced robot-assisted partial nephrectomy guidance

    NASA Astrophysics Data System (ADS)

    Halter, Ryan J.; Wu, Xiaotian; Hartov, Alex; Seigne, John; Khan, Shadab

    2015-03-01

    Robot-assisted laparoscopic partial nephrectomies (RALPN) are performed to treat patients with locally confined renal carcinoma. There are well-documented benefits to performing partial (opposed to radical) kidney resections and to using robot-assisted laparoscopic (opposed to open) approaches. However, there are challenges in identifying tumor margins and critical benign structures including blood vessels and collecting systems during current RALPN procedures. The primary objective of this effort is to couple multiple image and data streams together to augment visual information currently provided to surgeons performing RALPN and ultimately ensure complete tumor resection and minimal damage to functional structures (i.e. renal vasculature and collecting systems). To meet this challenge we have developed a framework and performed initial feasibility experiments to couple pre-operative high-resolution anatomic images with intraoperative MRI, ultrasound (US) and optical-based surface mapping and kidney tracking. With these registered images and data streams, we aim to overlay the high-resolution contrast-enhanced anatomic (CT or MR) images onto the surgeon's view screen for enhanced guidance. To date we have integrated the following components of our framework: 1) a method for tracking an intraoperative US probe to extract the kidney surface and a set of embedded kidney markers, 2) a method for co-registering intraoperative US scans with pre-operative MR scans, and 3) a method for deforming pre-op scans to match intraoperative scans. These components have been evaluated through phantom studies to demonstrate protocol feasibility.

  16. Factors Predicting Adhesion between Renal Capsule and Perinephric Adipose Tissue in Partial Nephrectomy.

    PubMed

    Kobayashi, Yasuyuki; Kurahashi, Hiroaki; Matsumoto, Yuko; Wada, Koichiro; Sasaki, Katsumi; Araki, Motoo; Ebara, Shin; Watanabe, Toyohiko; Nasu, Yasutomo

    2016-01-01

    In minimally invasive partial nephrectomy (MIPN), it is important to preoperatively predict the degree of difficulty of tumor resection. When severe adhesions occur between the renal capsule and perinephric adipose tissue, detachment can be difficult. Preoperative prediction of adhesion is thought to be useful in the selection of surgical procedure. Subjects were 63 patients of a single surgeon who had received MIPN between April 2008 and August 2013 at Okayama University Hospital. Of these patients, this study followed 47 in whom the presence or absence of adhesions between the renal capsule and perinephric adipose tissue was confirmed using intraoperative videos. Data collected included: sex, BMI, CT finding (presence of fi broids in perinephric adipose tissue), comorbidities and lifestyle. Adhesion was observed in 7 patients (14.9%). The mean operative time was 291.6 min in the adhesion group, and 226.3 min in the group without. The increased time in the adhesions group was significant (p<0.05). Predictive factors were a positive CT finding for fibroid structure and comorbidity of hypertension (p<0.05). In MIPN, difficulty of surgery can be affected by the presence of adhesion of the perinephric adipose tissue. Predicting such adhesion from preoperative CT is thus important.

  17. Vascular management during live donor nephrectomy: an online survey among transplant surgeons.

    PubMed

    Janki, S; Verver, D; Klop, K W J; Friedman, A L; Peters, T G; Ratner, L E; Ijzermans, J N M; Dor, F J M F

    2015-06-01

    In 2006, a survey from the American Society of Transplant Surgeons disclosed significant and sometimes fatal hemorrhagic events in live donor nephrectomies (LDN) related to failure of clips, leading to the contraindication of the Weck® Hem-o-lok® clip for control of the renal artery during LDN. A survey regarding vascular control techniques, their perceived safety ratings and their failures was sent to 645 European Society for Organ Transplantation members who profiled their profession as "surgeon" and selected "kidney" as organ type. Two hundred forty-three (41%) members responded, of whom 171 (63.3%) independently perform LDN. Their responses were analyzed. For arterial and venous vascular control, the GIA™ and TA™stapler are used most frequently, and were rated the safest. Of the 121 reported hemorrhagic events, slippage and dislodgement of clips occurred at least 58 times, while stapler malfunction occurred at least 40 times. One donor death from hemorrhage related to clip dysfunction was reported. Hemorrhagic complications of LDN with fatal and non-fatal outcomes still occur. Strikingly, many surgeons do not use the vascular closing technique that they consider most safe. Failure of non-transfixion techniques is associated with greater risks for the donor. Control of major vessels in LDN must employ transfixion techniques for optimal donor safety. PMID:25833120

  18. Cardiac arrest during radical nephrectomy due to a mass in the right ventricular outflow tract.

    PubMed

    Kim, Hee Young; Baek, Seung-Hoon; Yoon, Ji Uk; Lee, Dong Hoon; Byeon, Gyeong-Jo; Ahn, Ji Hye

    2016-09-01

    We report cardiac arrest due to obstruction of the right ventricular outflow tract (RVOT) caused by an RVOT mass that was not identified preoperatively. A 62-year-old woman with renal cell carcinoma (RCC) experienced deteriorating hypotension and bradycardia during radical nephrectomy. Hemodynamic stability was maintained on extracorporeal membrane oxygenation, and after surgery, she was transferred to the intensive care unit. On postoperative day 3, transthoracic echocardiography showed an intracardiac mass obstructing the RVOT, which caused severe functional pulmonary stenosis and moderate resting pulmonary hypertension. Despite maintaining extracorporeal membrane oxygenation, the patient died of cardiac arrest. Our findings suggest that it may be necessary to perform additional tests if RCC has invaded the renal vein and inferior vena cava or if a patient with RCC has abnormal cardiovascular symptoms without definite etiology for exclusion of cardiac metastasis or tumor thrombus. In addition, intraoperative transesophageal echocardiography might be the procedure of choice for the evaluation of these conditions because other diagnostic tests are difficult to perform during surgery. In conclusion, for patients with acute hemodynamic instability for whom other possible causes have been excluded, we recommend that anesthesiologists use transesophageal echocardiography to detect outflow tract obstruction or pulmonary thromboembolism and perform anesthetic management. PMID:27555152

  19. Budd-Chiari syndrome in urology: Impact on nephrectomy for advanced renal cell carcinoma

    PubMed Central

    Shirodkar, Samir P.; Soloway, Mark S.; Ciancio, Gaetano

    2011-01-01

    Objectives: Budd-Chiari syndrome (BCS) is a poorly understood entity in urology. It results from obstruction of the hepatic veins and the subsequent complications. It has been infrequently reported to be secondary to hepatic venous obstruction from invasion by an inferior vena cava (IVC) tumor thrombus in renal cell carcinoma (RCC). We report the largest known series of patients with RCC and BCS. Patients and Methods: Ten patients presented to a tertiary hospital with locally advanced RCC with IVC tumor thrombus. All were evaluated and had clinical or radiographic evidence of BCS. All underwent nephrectomy, IVC thrombectomy or ligation, and tumor removal from the hepatic veins. The perioperative and pathological factors were measured. These included estimated blood loss (EBL) and transfusions. Inpatient factors including duration of intubation, length of intensive care unit (ICU) stay, and overall length of stay (LOS) were recorded. The tumor-free status was evaluated. Results: The average age was 59 years. No intraoperative deaths occurred. Two intraoperative complications were noted. The mean EBL was 4244 cc; mean surgery length was 8 hours 12 minutes; and the mean ICU stay was nine days. The overall LOS averaged 13.25 days. One patient died postoperatively of sepsis and multisystem organ failure. One patient required reoperation for an abdominal wall hematoma caused by subcutaneous enoxaparin administration. Average follow-up was 28 months. Five patients are alive with no evidence of disease. Conclusions: Budd-Chiari syndrome is a rare entity in urology, with a potential for significant morbidity and mortality. Surgical excision of the primary tumor along with thrombectomy results in alleviation of BCS and improvement in the patient. PMID:22022058

  20. Cytokines induce small intestine and liver injury after renal ischemia or nephrectomy

    PubMed Central

    Park, Sang Won; Chen, Sean W.C.; Kim, Mihwa; Brown, Kevin M.; Kolls, Jay K.; D’Agati, Vivette D.; Lee, H. Thomas

    2010-01-01

    Patients with acute kidney injury (AKI) frequently suffer from extra-renal complications including hepatic dysfunction and systemic inflammation. We aimed to determine the mechanisms of AKI induced hepatic dysfunction and systemic inflammation. Mice subjected to AKI [renal ischemia reperfusion (IR) or nephrectomy] rapidly developed acute hepatic dysfunction and suffered significantly worse hepatic IR injury. After AKI, rapid peri-portal hepatocyte necrosis, vacuolization, neutrophil infiltration and pro-inflammatory mRNA upregulation were observed suggesting an intestinal source of hepatic injury. Small intestine histology after AKI demonstrated profound villous lacteal capillary endothelial apoptosis, disruption of vascular permeability and epithelial necrosis. After ischemic or non-ischemic AKI, plasma TNF-α, IL-17A and IL-6 increased significantly. Small intestine appears to be the source of IL-17A as IL-17A levels were higher in the portal circulation and small intestine compared to the levels measured from the systemic circulation and liver. Wild type mice treated with neutralizing antibodies against TNF-α, IL-17A or IL-6 or mice deficient in TNF-α, IL-17A, IL-17A receptor or IL-6 were protected against hepatic and small intestine injury due to ischemic or non-ischemic AKI. For the first time, we implicate the increased release of IL-17A from small intestine together with induction of TNF-α and IL-6 as a cause of small intestine and liver injury after ischemic or non-ischemic AKI. Modulation of the inflammatory response and cytokine release in the small intestine after AKI may have important therapeutic implications in reducing complications arising from AKI. PMID:20697374

  1. Simultaneous bilateral robotic partial nephrectomy: Case report and critical evaluation of the technique.

    PubMed

    Giberti, Claudio; Gallo, Fabrizio; Schenone, Maurizio; Cortese, Pierluigi

    2014-06-16

    We report our first simultaneous bilateral robot assisted partial nephrectomy (RAPN) in order to show and critically discuss the feasibility of this procedure. Materials and methods A 69-year-old male patient visited our department due to incidental finding of bilateral mesorenal small masses (2.5 cm on the right and 3.5 cm on the left) suspicious for malignancy. We started from the right side with patient in flank position. Port placement: 12-mm periumbilical camera port, two 8-mm robotic ports in wide ''V''configuration, additional 12 mm assistant port on the midline between the umbilicus and symphysis pubis. A right unclamping RAPN with sliding clip renorrhaphy was performed. The trocars were removed and the robot undocked. Without interrupting the anesthesiological procedures, the patient was reported in supine position and, after 180 degrees rotation of the surgical bed, was newly placed in contralateral flank position. Using both the previous periumbilical and midline ports, two other 8-mm robotic trocars were placed. The robot was then redocked and RAPN was also performed on the left side using the same previously reported technique. Results Total time: 285 min. Estimated blood losses: 150 cc. Postoperative period: uneventful. Pathological examination: bilateral renal cell carcinoma, negative surgical margins. Conclusions Our experience was encouraging and confirmed the feasibility and safety of this procedure. The planning of our technique was time and cost effective with cosmetic benefit for the patient. However, we think that an appropriate selection of the patients and a skill in robotic renal surgery are advisable before approaching this type of surgery.

  2. Robotic-assisted partial nephrectomy without using ureteral stent: a single center experience

    PubMed Central

    Özkan, Burak; Coşkuner, Enis Rauf; Yalçın, Veli

    2016-01-01

    Objective To share our results of robotic assisted partial nephrectomy (RAPN) we performed without using ureteral stent in a single center from Turkey. Material and methods Medical records of consecutive 45 patients (34 men and 11 women) who underwent RAPN for kidney lesions between March 2011 and December 2014 were retrieved, and evaluated. All the procedures were performed by a transperitoneal approach without using ureteral stent prior to surgery. Renal artery clamping was used in all cases and intraoperative ultrasonography was used in 2 cases. Results Patients undergoing RAPN had a mean tumor size of 4.42 cm (2–8) and a mean renal nephrometry score of 5.82 (4–11). The mean estimated blood loss was 250 mL (150–450 ml) and the mean operative time was 195 minutes (150–300). There was no statistical difference between the preoperative and postoperative serum creatinine levels at the first follow-up visit (0.9 vs. 0.95, p=0.087). Surgical margin positivity was not detected in any patient, and the mean surgical margin distance was calculated as 0.4 mm (0.2–10). In only 1 patient disease recurrence was detected at the 21st month of the the follow-up period, and no distant metastases was reported in our patients at a mean follow-up of 10 months (3–36 mos). Our complication rate was 11.1% and according to the Clavien system complications were as; grade 2 (3 patients), grade 3a (1 patient) and grade 3b (1 patient). Conclusion With appropriately selected patients and adequate surgical experience, RAPN performed without using ureteral stent is a safe and feasible method for localized renal tumors. PMID:27011873

  3. Simplifying Laparoscopic Nephrectomy: The Inferior Approach with En Bloc Stapling of the Renal Hilum

    PubMed Central

    Nadu, Andrei; Lindner, Uri; Ramon, Jacob

    2014-01-01

    Introduction: Laparoscopic nephrectomy (LN) is likely the most common laparoscopic procedure performed by general urologists without formal laparoscopic training. The traditional technique is cumbersome because it entails making an early approach to the hilum with the risk of bleeding and need for conversion. We perform a different technique that we believe is simpler to learn and to teach. It consists of a complete dissection of the inferior and posterior aspects of the kidney, followed by en bloc stapling of the renal hilum. The present report is a detailed description of our technique including outcomes and complications. Materials and Methods: Perioperative data of 129 consecutive patients who underwent LN between November 2003 and September 2007 were prospectively collected and retrospectively reviewed. Complications were reported using the Clavien classification system, and follow-up was performed according to our institution's protocol and included physical examination, blood count, blood chemistry, and renal function tests at every visit, in addition to abdominal computed tomography scan six months after surgery. Additional imaging was scheduled according to disease stage and grade. Results: Mean patient age, tumor size, and operative time were 63 ± 15.6 years, 6.3 ± 2.4 cm, and 128 ± 41.4 minutes, respectively. Median estimated blood loss was 0 mL (0.200). Conversion to open surgery occurred in 3.1% of patients, and 8% of the patients had a blood transfusion. Complications were recorded in 26% of the patients; 91% of them had Clavien grade scores of 1 or 2. Conclusion: We present a standardized technique for LN. Its main advantage is that postpones any manipulation of the hilum to a later step during the procedure when it is easy to identify and control. This decreases early bleeding and main vascular complications. PMID:25392654

  4. Can selective arterial clamping with fluorescence imaging preserve kidney function during robotic partial nephrectomy?

    PubMed Central

    McClintock, Tyler R.; Bjurlin, Marc A.; Wysock, James S.; Borofsky, Michael S.; Marien, Tracy P.; Okoro, Chinonyerem; Stifelman, Michael D.

    2015-01-01

    Objectives To compare renal functional outcomes in robotic partial nephrectomy (RPN) with selective arterial clamping guided by near infrared fluorescence (NIRF) imaging to a matched cohort of patients who underwent RPN without selective arterial clamping and NIRF imaging. Methods From April 2011 to December 2012, NIRF imaging-enhanced RPN with selective clamping was utilized in 42 cases. Functional outcomes of successful cases were compared with a cohort of patients, matched by tumor size, preoperative eGFR, functional kidney status, age, sex, body mass index, and American Society of Anesthesiologists score, who underwent RPN without selective clamping and NIRF imaging. Results In matched-pair analysis, selective clamping with NIRF was associated with superior kidney function at discharge, as demonstrated by postoperative eGFR (78.2 vs 68.5 ml/min per 1.73m2; P=0.04), absolute reduction of eGFR (−2.5 vs −14.0 ml/min per 1.73m2; P<0.01) and percent change in eGFR (−1.9% vs −16.8%, P<0.01). Similar trends were noted at three month follow up but these differences became non-significant (P[eGFR]=0.07], P[absolute reduction of eGFR]=0.10, and P[percent change in eGFR]=0.07). In the selective clamping group, a total of four perioperative complications occurred in three patients, all of which were Clavien I-III. Conclusion Utilization of NIRF imaging was associated with improved short-term renal functional outcomes when compared to RPN without selective arterial clamping and NIRF imaging. With this effect attenuated at later follow-up, randomized prospective studies and long-term assessment of kidney-specific functional outcomes are needed to further assess the benefits of this technology. PMID:24909960

  5. Comparing different treatment modalities for partial nephrectomies without ischemic period: laser, Hydro-Jet and RF

    NASA Astrophysics Data System (ADS)

    de Boorder, Tjeerd; Boeken Kruger, Arto; Klaessens, John; Grimbergen, Matthijs; Verdaasdonk, Rudolf

    2008-02-01

    The treatment of partial nefrectomies is usually performed under a warm ischemic period. Recently, various treatment modalities have become available to perform a partial nefrectomy without clamping off the blood circulation. We have studied three devices in laboratory setting, investigating the thermal and high speed imaging techniques in tissue models and consequently, applying the instruments in the clinic during open procedures especially looking at efficacy and blood loss. The continuous wave 2.0 micron laser of 70 W (Revolix, LISA laser) is used as a fiber delivered knife cutting through circulated tissue with controlled hemostasis for vessels up to 3 mm diameter. The 2 μm wavelength effectively vaporizes tissue water and coagulates the smaller vessels. The Hydro-Jet (ERBE, Germany) uses high pressure (20-80 bar) to ejects a water jet of 40 um diameter at high velocity (10-30 m/s). The parenchyma is resected while vessels are preserved. Consequently, the exposed vessels can be coagulated in a controlled way with minimal blood loss. The water jet showed to induce cavitation bubbles that resect the soft tissue from the matrix leaving the elastic microvessels intact. Various systems are based on bipolar RF technology. We are using the Habib device (Rita 1500X RF generator) to create a coagulation zone around the tumor. Subsequently, the tumor can be resected along the coagulation zone with minimal bleeding. The treatment modalities investigated, have their own advantages and, stand-alone or in combination, can facilitate laparoscopic partial nephrectomies without an ischemic period.

  6. Nephrectomy Type Was Not Associated with a Subsequent Risk of Coronary Heart Disease: A Population-Based Study.

    PubMed

    Chung, Shiu-Dong; Huang, Chao-Yuan; Wu, Sheng-Tang; Lin, Herng-Ching; Huang, Chung-Chien; Kao, Li-Ting

    2016-01-01

    Previous studies investigated the impacts of a partial nephrectomy (PN) or radical nephrectomy (RN) on cardiovascular events and death. However, the association between the type of nephrectomy (PN vs. RN) and cardiovascular disease is still equivocal. This retrospective cohort study aimed to compare the risk of coronary heart disease (CHD) between patients who underwent a PN and those who underwent an RN. We used data from the Taiwan Longitudinal Health Insurance Database 2005. In total, 60 patients who underwent a PN and 545 patients who underwent an RN were included. Each patient was tracked for 1-, 2-, 3-, and 5-year periods to identify those who were subsequently diagnosed with CHD. Cox proportional hazard regression analyses were used to calculate hazard ratios (HRs) for CHD during 1-, 2-, 3-, and 5-year follow-up periods between these two cohorts. For the 1-year follow-up period, the adjusted HR was 0.39 (95% CI: 0.05~2.90, p = 0.355) for patients who underwent a PN compared to those who underwent an RN. Additionally, the adjusted HRs of CHD in patients who underwent a PN for 2-, 3- and 5-year follow-up periods were 1.40 (95% CI: 0.62~3.16, p = 0.417), 1.09 (95% CI: 0.52~2.31, p = 0.814), and 1.02 (95% CI: 0.48~2.18, p = 0.961), respectively, compared to those who underwent an RN. We concluded that there was no significant difference in the risk of CHD between patients who underwent a PN and those who underwent an RN. PMID:27636094

  7. Comparison of the Width of Peritumoral Surgical Margin in Open and Robotic Partial Nephrectomy: A Propensity Score Matched Analysis

    PubMed Central

    Oh, Jong Jin; Lee, Jung Keun; Kim, Kwangmo; Byun, Seok-Soo; Lee, Sang Eun

    2016-01-01

    Background To compare the surgical margin status after open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN) performed in patients with T1a renal cell carcinoma (RCC). Methods This was a propensity score-matched study including 702 patients with cT1a RCC treated with partial nephrectomy (PN) between May 2003 and July 2015. Perioperative parameters, including surgical margin width after PN, were compared between two surgical methods. After determining propensity score for tumor size and location, the width of peritumoral surgical margin was investigated. Multivariate logistic analysis to predict peritumoral surgical margin less than 1mm was analyzed. Results The mean width of peritumoral surgical margin was 2.61 ± 2.15 mm in OPN group (n = 385), significantly wider than the 2.29 ± 2.00 mm of RPN group (n = 317) (p = 0.042). The multivariate analysis showed surgical methods was significant factors to narrow surgical margin less than 1mm (p = 0.031). After propensity score matching, the surgical margin width was significantly longer in OPN (2.67 ± 2.14 mm) group than RPN (2.25 ± 2.03 mm) group (p = 0.016). A positive resection margin occurred in 7 (1.8%) patients in the OPN group and 4 (1.3%) in the RPN group. During the median follow-up of 48.3 months, two patients who underwent OPN had tumor bed recurrence. Conclusions RPN may result in a narrower peritumoral surgical margin than OPN. Further investigation on the potential impact of such a phenomenon should be performed in a larger-scale study. PMID:27336438

  8. Nephrectomy Type Was Not Associated with a Subsequent Risk of Coronary Heart Disease: A Population-Based Study

    PubMed Central

    Huang, Chao-Yuan; Lin, Herng-Ching; Huang, Chung-Chien; Kao, Li-Ting

    2016-01-01

    Previous studies investigated the impacts of a partial nephrectomy (PN) or radical nephrectomy (RN) on cardiovascular events and death. However, the association between the type of nephrectomy (PN vs. RN) and cardiovascular disease is still equivocal. This retrospective cohort study aimed to compare the risk of coronary heart disease (CHD) between patients who underwent a PN and those who underwent an RN. We used data from the Taiwan Longitudinal Health Insurance Database 2005. In total, 60 patients who underwent a PN and 545 patients who underwent an RN were included. Each patient was tracked for 1-, 2-, 3-, and 5-year periods to identify those who were subsequently diagnosed with CHD. Cox proportional hazard regression analyses were used to calculate hazard ratios (HRs) for CHD during 1-, 2-, 3-, and 5-year follow-up periods between these two cohorts. For the 1-year follow-up period, the adjusted HR was 0.39 (95% CI: 0.05~2.90, p = 0.355) for patients who underwent a PN compared to those who underwent an RN. Additionally, the adjusted HRs of CHD in patients who underwent a PN for 2-, 3- and 5-year follow-up periods were 1.40 (95% CI: 0.62~3.16, p = 0.417), 1.09 (95% CI: 0.52~2.31, p = 0.814), and 1.02 (95% CI: 0.48~2.18, p = 0.961), respectively, compared to those who underwent an RN. We concluded that there was no significant difference in the risk of CHD between patients who underwent a PN and those who underwent an RN. PMID:27636094

  9. Changes in the Enzymic Capacity of the Rat Kidney and Heart Due to Unilateral Nephrectomy and Deoxycorticosterone Induced Hypertension

    PubMed Central

    Mangnall, D.; Bartley, W.

    1970-01-01

    Changes in the chemical and enzymic composition of the kidney and heart of rats after unilateral nephrectomy and deoxycorticosterone implantation were studied during the 3 week period following operation. The remaining kidney doubled in weight and the heart mass increased by 25 per cent during this time. The initial response in the kidney was an increase in protein and RNA, but after 6 days DNA also increased and approximately doubled by 21 days after operation. No increase in blood urea was observed from 3 days after operation to the end of the experimental period. In the hypertrophying kidney the enzymes NADH cytochrome “c” oxidoreductase, succinate cytochrome “c” oxidoreductase, pyruvate carboxylase, glucose-6-phosphate dehydrogenase, PEP carboxykinase and glutaminase all increased in specific activity with greatest increase usually having occurred by the sixth day after the nephrectomy. Cytochrome oxidase alone showed a decrease in specific activity. At the end of the experiment (21 days after the nephrectomy) the enzyme activities (with the exception of cytochrome oxidase) were between 130-280 per cent of the activities present in the 2 control kidneys. In contrast there was only about 80 per cent of the cytochrome oxidase activity as compared with the 2 control kidneys. The growth of the kidney is discussed with respect to attainment of compensation for removal of its partner. The initial response of the heart was an immediate increase in RNA, DNA and protein and mitochondrial enzymes, although increases in heart weight were not observed until after day 3. Glucose-6-phosphate dehydrogenase activity closely followed the growth of the heart. The changes are discussed in relation to growth of the heart. PMID:4321628

  10. Intraoperative Monitoring of Pulmonary Artery Physiology With Transesophageal Echocardiography in a Patient With an Extensive Pulmonary Aneurysm Undergoing Partial Nephrectomy.

    PubMed

    Plakke, Michael J; Maxwell, Cory D; Bottiger, Brandi A

    2016-09-01

    Surgical patients with pulmonary hypertension present a significant challenge to the anesthesiologist. Continuous perioperative monitoring of pulmonary artery (PA) pressure is recommended and most often accomplished with a PA catheter. Placement of a PA catheter may be difficult or contraindicated, and in these cases, transesophageal echocardiography is a useful alternative to monitor dynamic PA physiology. In this case, we used intraoperative transesophageal echocardiography to detect changes in peak PA pressure and guide clinical treatment in a patient with pulmonary hypertension and an extensive PA aneurysm undergoing partial nephrectomy. PMID:27580409

  11. Adjuvant treatment with interleukin-2- and interferon-alpha2a-based chemoimmunotherapy in renal cell carcinoma post tumour nephrectomy: Results of a prospectively randomised Trial of the German Cooperative Renal Carcinoma Chemoimmunotherapy Group (DGCIN)

    PubMed Central

    Atzpodien, J; Schmitt, E; Gertenbach, U; Fornara, P; Heynemann, H; Maskow, A; Ecke, M; Wöltjen, H H; Jentsch, H; Wieland, W; Wandert, T; Reitz, M

    2005-01-01

    We conducted a prospectively randomised clinical trial to investigate the role of adjuvant outpatient immunochemotherapy administered postoperatively in high-risk patients with renal cell carcinoma. In total, 203 renal carcinoma patients' status post radical tumour nephrectomy were stratified into three risk groups: patients with tumour extending into renal vein/vena cava or invading beyond Gerota's fascia (pT3b/c pN0 or pT4pN0), patients with locoregional lymph node infiltration (pN+), and patients after complete resection of tumour relapse or solitary metastasis (R0). Patients were randomised to undergo either (A) 8 weeks of outpatient subcutaneous interleukin-2 (sc-rIL-2), subcutaneous interferon-alpha2a (sc-rIFN-α2a), and intravenous 5-fluorouracil (iv-5-FU) according to the standard Atzpodien regimen (Atzpodien et al, 2004) or (B) observation. Two-, 5-, and 8-year survival rates were 81, 58, and 58% in the treatment arm, and 91, 76, and 66% in the observation arm (log rank P=0.0278), with a median follow-up of 4.3 years. Two, 5-, and 8-year relapse-free survival rates were calculated at 54, 42, and 39% in the treatment arm, and at 62, 49, and 49% in the observation arm (log rank P=0.2398). Stage-adapted subanalyses revealed no survival advantages of treatment over observation, as well. Our results established that there was no relapse-free survival benefit and the overall survival was inferior with an adjuvant 8-week-outpatient sc-rIL-2/sc-rIFN-α2a/iv-5-FU-based immunochemotherapy compared to observation in high-risk renal cell carcinoma patients following radical tumour nephrectomy. PMID:15756254

  12. [Laparoscopic robot-assisted partial nephrectomy with total ureterectomy in a symptomatic complete duplicated system: advantages of transperitoneal approach].

    PubMed

    Tostivint, V; Doumerc, N; Roumiguie, M; Beauval, J-B; Rischmann, P; Soulie, M; Galinier, P; Bouali, O

    2014-10-01

    We report the case of a laparoscopic robot assisted left upper polar partial nephrectomy with total ureterectomy performed in a teenager. A 14 year-old girl was referred to our institution for stress urinary incontinence. The morphological assessment (ultrasound scan and uro-MRI) showed a double collecting system with a complete ureteral duplication complicated by a dysplasia of the upper moiety of the duplex left kidney and a mega ureter. The surgery started on a lateral decubitus position by the upper polar partial nephrectomy and the ureter section behind superior polar renal vessels. The patient was placed in a supine position and the mega ureter was released and sectioned at the level of the distal adynamic segment in the left uterine parameter. The transperitoneal route was chosen as it provides a large workspace and allows the dissection of the ureters into their pelvic portion by a simple repositioning of the robot ports without additional incision and without any modification of the operative field. No intraoperative and postoperative complication was noticed. Laparoscopic robotic assisted surgery in pediatric urology is increasing, and to our knowledge, we reported this technique and surgery for the first time in France and in children. In the reported case, we showed that the robotic minimally invasive surgery in children is an innovative and safe technique for the treatment of symptomatic upper urinary tract malformations. PMID:25176144

  13. MDCT evaluation of potential living renal donor, prior to laparoscopic donor nephrectomy: What the transplant surgeon wants to know?

    PubMed

    Ghonge, Nitin P; Gadanayak, Satyabrat; Rajakumari, Vijaya

    2014-10-01

    As Laparoscopic Donor Nephrectomy (LDN) offers several advantages for the donor such as lesser post-operative pain, fewer cosmetic concerns and faster recovery time, there is growing global trend towards LDN as compared to open nephrectomy. Comprehensive pre-LDN donor evaluation includes assessment of renal morphology including pelvi-calyceal and vascular system. Apart from donor selection, evaluation of the regional anatomy allows precise surgical planning. Due to limited visualization during laparoscopic renal harvesting, detailed pre-transplant evaluation of regional anatomy, including the renal venous anatomy is of utmost importance. MDCT is the modality of choice for pre-LDN evaluation of potential renal donors. Apart from appropriate scan protocol and post-processing methods, detailed understanding of surgical techniques is essential for the Radiologist for accurate image interpretation during pre-LDN MDCT evaluation of potential renal donors. This review article describes MDCT evaluation of potential living renal donor, prior to LDN with emphasis on scan protocol, post-processing methods and image interpretation. The article laid special emphasis on surgical perspectives of pre-LDN MDCT evaluation and addresses important points which transplant surgeons want to know. PMID:25489130

  14. PD-L1 Expression in Clear Cell Renal Cell Carcinoma: An Analysis of Nephrectomy and Sites of Metastases

    PubMed Central

    Jilaveanu, L.B.; Shuch, B.; Zito, C. R.; Parisi, F.; Barr, M.; Kluger, Y.; Chen, L.; Kluger, H. M.

    2014-01-01

    Background: Expression of programmed death ligand (PD-L1/B7-H1/CD274) represents a mechanism of immune escape for renal cell carcinoma (RCC) cells. Drugs blocking PD-L1 or its receptor are in clinical development and early data suggests that tumor PD-L1 expression may predict response. Patients and Methods: A tissue microarray (TMA) consisting of four biopsy cores from 34 matched pairs of nephrectomy and metastatic sites of clear cell RCC was used to assess PD-L1 expression by quantitative immunofluorescence. Assessment of intra- and inter-tumor heterogeneity and primary and metastatic tumor expression was performed using a method of Automated Quantitative Analysis (AQUA). Results: The median AQUA scores were higher in metastatic than primary specimens (P < 0.0001). The correlation between PD-L1 expression in matched primary and metastatic specimens was weak (R= 0.24). Within a given tumor, variable PD-L1 staining heterogeneity was seen, however the degree of heterogeneity was similar in primary and metastatic sites (P = 0.482). Conclusions: The weak correlation between PD-L1 expression in primary and metastatic sites for a given patient suggests that expression in nephrectomy specimens cannot be used to select metastatic RCC patients for PD-L1 and PD-1 inhibitors. The intra-tumor heterogeneity seen in both primary and metastatic specimens indicates that a single core biopsy might not be sufficient to determine PD-L1 expression. PMID:24563671

  15. Long-term survival after renal transplantation: the influence of pretransplant bilateral nephrectomy.

    PubMed

    Douglas, James F; Craig, W J Colin

    2010-01-01

    The long-term survival of first successful renal transplants, along with overall patient survival, was studied retrospectively in 309 recipients at Belfast City Hospital between 1968 and 1986, of whom 155 had undergone prior bilateral nephrectomy (BN) and 154 had not (non-BN). The groups were comparable as regards mean age, gender, primary diagnoses, clinical status, pre-existing hypertension and pre-transplant dialysis and transfusion. There were 34 organs (BN 14, non-BN 20) from living related donors. Donor ages were comparable, as were histocompatibility findings. Recipients more than 60, with diabetic nephropathy, or with other co-morbidity were excluded. All recipients took azathioprine and low-dose steroid as maintenance antirejection, fewer than 3% switching to cyclosporine or other drugs during first graft survival. Mean BN graft survival was 15.9 years (95% CI 14.1-17.7) compared to 12.9 for non-BN (95% CI 11.3-14.5; p < 0.01). Mean BN patient survival was 19.4 years (95% CI 17.6-21.2) and non-BN was 14.9 years (95% CI 13.2-16.6; p < 0.01). Cumulative BN graft survival was 76.8% at 5 years, 61.6% at 10 years, and 37.4% at 20 years, compared to 67.1%, 53.5% and 27.0% for non-BN (p < 0.01). Overall BN patient survival was 84.5% at 5 years, 74.2% at 10 years and 51.6% at 20 years, with non-BN equivalents of 72.3%, 49.0% and 24.5%, respectively (p < 0.01). Long-term BN survivors also had less hypertension than non-BN (22.8% v 54.8% at 20 years; p < 0.05) which may be relevant to their better survival. Overall (BN plus non-BN) median graft (14.4 years) and patient (17.6 years) survival are testimony to the continuing long-term success of the low-dose steroid regime followed in Belfast from 1968 to 1986.

  16. GLI2 expression levels in radical nephrectomy specimens as a predictor of disease progression in patients with metastatic clear cell renal cell carcinoma following treatment with sunitinib

    PubMed Central

    Furukawa, Junya; Miyake, Hideaki; Fujisawa, Masato

    2016-01-01

    The aim of the present study was to investigate the role of the Hedgehog signaling pathway in the progression of metastatic clear cell renal cell carcinoma (m-ccRCC) as well as the molecular targets of sunitinib, an inhibitor of multiple tyrosine kinases. A total of 39 patients subjected to radical nephrectomy who were diagnosed with m-ccRCC and were subsequently treated with sunitinib were enrolled in the present study. The expression levels of the Hedgehog signaling proteins (GLI1, GLI2, cyclin D1, cyclin E and transforming growth factor-β) and major molecular targets of sunitinib [vascular endothelial growth factor receptor (VEGFR)-1 and −2, and platelet-derived growth factor receptor-α and -β] in primary RCC specimens were assessed by immunohistochemical staining. The expression levels of GLI2, VEGFR-1, VEGFR-2 and pre-treatment C-reactive protein as well as the Memorial Sloan-Kettering Cancer Center risk were identified as significant predictors of progression-free survival (PFS). Of these, only GLI2 expression was independently correlated to PFS according to multivariate analysis. Furthermore, treatment with sunitinib resulted in a marked inhibition of GLI2 expression in the parental human RCC ACHN cell line, but not in ACHN cells with acquired resistance to sunitinib. These findings suggested that GLI2 may be involved in the acquisition of resistance to sunitinib in RCC; thus, it may be useful to consider the expression levels of GLI2 in addition to conventional prognostic parameters when selecting m-ccRCC patients likely to benefit from treatment with sunitinib.

  17. GLI2 expression levels in radical nephrectomy specimens as a predictor of disease progression in patients with metastatic clear cell renal cell carcinoma following treatment with sunitinib

    PubMed Central

    Furukawa, Junya; Miyake, Hideaki; Fujisawa, Masato

    2016-01-01

    The aim of the present study was to investigate the role of the Hedgehog signaling pathway in the progression of metastatic clear cell renal cell carcinoma (m-ccRCC) as well as the molecular targets of sunitinib, an inhibitor of multiple tyrosine kinases. A total of 39 patients subjected to radical nephrectomy who were diagnosed with m-ccRCC and were subsequently treated with sunitinib were enrolled in the present study. The expression levels of the Hedgehog signaling proteins (GLI1, GLI2, cyclin D1, cyclin E and transforming growth factor-β) and major molecular targets of sunitinib [vascular endothelial growth factor receptor (VEGFR)-1 and −2, and platelet-derived growth factor receptor-α and -β] in primary RCC specimens were assessed by immunohistochemical staining. The expression levels of GLI2, VEGFR-1, VEGFR-2 and pre-treatment C-reactive protein as well as the Memorial Sloan-Kettering Cancer Center risk were identified as significant predictors of progression-free survival (PFS). Of these, only GLI2 expression was independently correlated to PFS according to multivariate analysis. Furthermore, treatment with sunitinib resulted in a marked inhibition of GLI2 expression in the parental human RCC ACHN cell line, but not in ACHN cells with acquired resistance to sunitinib. These findings suggested that GLI2 may be involved in the acquisition of resistance to sunitinib in RCC; thus, it may be useful to consider the expression levels of GLI2 in addition to conventional prognostic parameters when selecting m-ccRCC patients likely to benefit from treatment with sunitinib. PMID:27602218

  18. Comparison of Renal Function between Robot-Assisted and Open Partial Nephrectomy as Determined by Tc 99m-DTPA Renal Scintigraphy

    PubMed Central

    2016-01-01

    We compared postoperative renal function impairment between patients undergoing robot-assisted partial nephrectomy (RAPN) and those undergoing open partial nephrectomy (OPN) by using Tc-99m diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy. Patients who underwent partial nephrectomy by a single surgeon between 2007 and 2013 were eligible and were matched by propensity score, based on age, tumor size, exophytic properties of tumor, and location relative to the polar lines. Of the 403 patients who underwent partial nephrectomy, 114 (28%) underwent RAPN and 289 (72%) underwent OPN. Mean follow-up duration was 35.2 months. Following propensity matching, there were no significant differences between the two groups in tumor exophytic properties (P = 0.818) or nephrometry score (P = 0.527). Renal ischemic time (24.4 minutes vs. 17.8 minutes, P < 0.001) was significantly longer in the RAPN group than in the OPN group, while the other characteristics were similar. Multivariate analysis showed that greater preoperative renal unit function (P = 0.011) and nephrometry score (P = 0.041) were independently correlated with a reduction in glomerular filtration rate. The operative method did not correlate with renal function impairment (P = 0.704). Postoperative renal function impairment was similar between patients who underwent OPN and those who underwent RAPN, despite RAPN having a longer ischemic time. PMID:27134496

  19. An Unusual Case of Metastatatic Renal Cell Carcinoma Presenting as Melena and Duodenal Ulcer, 16 Years After Nephrectomy; a Case Report and Review of the Literature

    PubMed Central

    Geramizadeh, Bita; Mostaghni, AmirAhmad; Ranjbar, Zeinab; Moradian, Farid; Heidari, Mina; Khosravi, Mohammad Bagher; Malekhosseini, Seyed Ali

    2015-01-01

    Renal cell carcinoma comprises about 2% of adult tumors. The overall 10-year survival rate of patients with RCC after nephrectomy is about 18-27%. The incidence of metastasis of initial RCC is about 24-28%, but this rate after nephrectomy is as high as 51%. The most common site of recurrence is the lung, however liver and bone metastases are common. There are many reported cases with late metastasis, however isolated late metastasis in the gastrointestinal tract especially duodenum is very rare. Herein we report our experience with a case of gastrointestinal bleeding secondary to metastatic renal cell carcinoma to duodenum, 16 years after nephrectomy. To the best of our knowledge, about 30 of such cases have been reported in the English literature. Many of the previous cases have been part of disseminated disease and isolated duodenal metastasis is very rare. The longest reported duration between nephrectomy for renal cell carcinoma and duodenal metastasis has been 13 years, thus it seems our case to be also unique because of very late duodenal metastasis. PMID:25821299

  20. The Washington University Renorrhaphy for robotic partial nephrectomy: a detailed description of the technique displayed at the 2008 World Robotic Urologic Symposium.

    PubMed

    Bhayani, Sam B; Figenshau, Robert S

    2008-09-01

    Robotic partial nephrectomy is an emerging procedure. The Washington University Renorrhaphy involves robotic assistance, rapid closure of the collecting system, and renorrhaphy with sliding nonabsorbable clips. Bolsters are rarely used. Preliminary results have shown very short ischemic times with few complications. This communication offers a short video describing the renorrhaphy. PMID:27628249

  1. Urology residents experience comparable workload profiles when performing live porcine nephrectomies and robotic surgery virtual reality training modules.

    PubMed

    Mouraviev, Vladimir; Klein, Martina; Schommer, Eric; Thiel, David D; Samavedi, Srinivas; Kumar, Anup; Leveillee, Raymond J; Thomas, Raju; Pow-Sang, Julio M; Su, Li-Ming; Mui, Engy; Smith, Roger; Patel, Vipul

    2016-03-01

    In pursuit of improving the quality of residents' education, the Southeastern Section of the American Urological Association (SES AUA) hosts an annual robotic training course for its residents. The workshop involves performing a robotic live porcine nephrectomy as well as virtual reality robotic training modules. The aim of this study was to evaluate workload levels of urology residents when performing a live porcine nephrectomy and the virtual reality robotic surgery training modules employed during this workshop. Twenty-one residents from 14 SES AUA programs participated in 2015. On the first-day residents were taught with didactic lectures by faculty. On the second day, trainees were divided into two groups. Half were asked to perform training modules of the Mimic da Vinci-Trainer (MdVT, Mimic Technologies, Inc., Seattle, WA, USA) for 4 h, while the other half performed nephrectomy procedures on a live porcine model using the da Vinci Si robot (Intuitive Surgical Inc., Sunnyvale, CA, USA). After the first 4 h the groups changed places for another 4-h session. All trainees were asked to complete the NASA-TLX 1-page questionnaire following both the MdVT simulation and live animal model sessions. A significant interface and TLX interaction was observed. The interface by TLX interaction was further analyzed to determine whether the scores of each of the six TLX scales varied across the two interfaces. The means of the TLX scores observed at the two interfaces were similar. The only significant difference was observed for frustration, which was significantly higher at the simulation than the animal model, t (20) = 4.12, p = 0.001. This could be due to trainees' familiarity with live anatomical structures over skill set simulations which remain a real challenge to novice surgeons. Another reason might be that the simulator provides performance metrics for specific performance traits as well as composite scores for entire exercises. Novice trainees experienced

  2. Urology residents experience comparable workload profiles when performing live porcine nephrectomies and robotic surgery virtual reality training modules.

    PubMed

    Mouraviev, Vladimir; Klein, Martina; Schommer, Eric; Thiel, David D; Samavedi, Srinivas; Kumar, Anup; Leveillee, Raymond J; Thomas, Raju; Pow-Sang, Julio M; Su, Li-Ming; Mui, Engy; Smith, Roger; Patel, Vipul

    2016-03-01

    In pursuit of improving the quality of residents' education, the Southeastern Section of the American Urological Association (SES AUA) hosts an annual robotic training course for its residents. The workshop involves performing a robotic live porcine nephrectomy as well as virtual reality robotic training modules. The aim of this study was to evaluate workload levels of urology residents when performing a live porcine nephrectomy and the virtual reality robotic surgery training modules employed during this workshop. Twenty-one residents from 14 SES AUA programs participated in 2015. On the first-day residents were taught with didactic lectures by faculty. On the second day, trainees were divided into two groups. Half were asked to perform training modules of the Mimic da Vinci-Trainer (MdVT, Mimic Technologies, Inc., Seattle, WA, USA) for 4 h, while the other half performed nephrectomy procedures on a live porcine model using the da Vinci Si robot (Intuitive Surgical Inc., Sunnyvale, CA, USA). After the first 4 h the groups changed places for another 4-h session. All trainees were asked to complete the NASA-TLX 1-page questionnaire following both the MdVT simulation and live animal model sessions. A significant interface and TLX interaction was observed. The interface by TLX interaction was further analyzed to determine whether the scores of each of the six TLX scales varied across the two interfaces. The means of the TLX scores observed at the two interfaces were similar. The only significant difference was observed for frustration, which was significantly higher at the simulation than the animal model, t (20) = 4.12, p = 0.001. This could be due to trainees' familiarity with live anatomical structures over skill set simulations which remain a real challenge to novice surgeons. Another reason might be that the simulator provides performance metrics for specific performance traits as well as composite scores for entire exercises. Novice trainees experienced

  3. Using a Harmonic Scalpel “Drilling and Clamping” Method to Implement Zero Ischemic Robotic-assisted Partial Nephrectomy

    PubMed Central

    Hou, Chen-Pang; Lin, Yu-Hsiang; Hsu, Yu-Chao; Chen, Chien-Lun; Chang, Phei-Lang; Tsui, Ke-Hung

    2016-01-01

    Abstract Robot-assisted partial nephrectomy (RAPN) has gradually become a popular minimally invasive nephron-sparing surgical option for small renal tumors. Ischemic injury should be minimized because it impacts renal function outcomes following partial nephrectomy. Herein, the authors detail the technique and present initial perioperative outcomes of our novel harmonic scalpel “drilling and clamping” method to implement zero-ischemic RAPN. The authors prospectively collected baseline and perioperative data of patients who underwent zero ischemic RAPN performed by our harmonic scalpel “drilling and clamping” method. From April 2012 to December 2014, a total of 19 consecutive zero ischemic RAPN procedures were performed by a single surgeon. For 18 of the 19 patients, RAPN using our harmonic scalpel “Drilling and Clamping” method was successfully completed without the need for hilar clamping. The median tumor size was 3.4 cm (range: 1.8–6.2); operative time was 3.2 hours (range: 1.9–4.5); blood loss was 100 mL (range: 30–950); and postoperative hospital stay was 4 days (3–26). One patient required intraoperative blood transfusion. Two patients had intra or postoperative complications: 1 was converted to traditional laparotomy because of massive bleeding, whereas another had postoperative stress ulcer. Pathology confirmed renal cell carcinoma in 13 patients (63.2%), angiomyolipoma in 6 patients: (31.5%), and oncocytoma in 1 patient (5.3%). Mean pre- and postoperative serum creatinine (0.82 mg/dL and 0.85 mg/dL, respectively), estimated glomerular filtration rate (84.12 and 82.18, respectively), and hemoglobin (13.27 g/dL and 12.71 g/dL, respectively) were comparable. The authors present a novel zero-ischemic technique for RAPN. They believe that this technique is feasible and reproducible. PMID:26817867

  4. Total and subtotal amputation of lower limbs treated by acute shortening, revascularization and early limb lengthening with ilizarov ring fixation - a retrospective study.

    PubMed

    Kovoor, C C; George, V V; Jayakumar, R; Guild, A J; Bhaskar, D; Cyriac, A

    2015-10-01

    We present the results of 15 patients who sustained total or subtotal traumatic amputation of the lower limbs who were treated by acute limb shortening and stabilisation with external fixator, revascularization and early lengthening with Ilizarov ring fixator. The mean age of the patients was 28 years [5-38]. There were three females and 12 males. The mean Mangled Extremity Severity Score was 8.5 [range 6-11]. The mean amount of shortening done was 6.9cm [range 3-12.5] to enable revascularization and soft tissue repair. Three cases had to be amputated early because of failure of vascular repair. In the remaining 12 patients who were followed up the mean interval between revascularization and application of Ilizarov ring fixator was 4.7 weeks [range 3-10]. The mean follow up was 6.5 years [3-16 years]. Union occurred in all patients. Ten of the 12 patients returned to work and residual shortening was present in two cases. We conclude that whenever possible lower limb salvage should be undertaken.

  5. Multicenter Experience with Nonischemic Multiport Laparoscopic and Laparoendoscopic Single-Site Partial Nephrectomy Utilizing Bipolar Radiofrequency Ablation Coagulator

    PubMed Central

    Bazzi, Wassim M.; Allaf, Mohamad E.; Berkowitz, Jared; Atalah, Hany N.; Parekattil, Sijo; Derweesh, Ithaar H.

    2011-01-01

    Objective. To investigate feasibility of multiport and laparoendoscopic single-site (LESS) nonischemic laparoscopic partial nephrectomy (NI-LPN) utilizing bipolar radiofrequency coagulator. Methods. Multicenter retrospective review of 60 patients (46 multiport/14 LESS) undergoing NI-LPN between 4/2006 and 9/2009. Multiport and LESS NI-LPN utilized Habib 4X bipolar radiofrequency coagulator to form a hemostatic zone followed by nonischemic tumor excision and renorrhaphy. Demographics, tumor/perioperative characteristics, and outcomes were analyzed. Results. 59/60 (98.3%) successfully underwent NI-LPN. Mean tumor size was 2.35 cm. Mean operative time was 160.0 minutes. Mean estimated blood loss was 131.4 mL. Preoperative/postoperative creatinine (mg/dL) was 1.02/1.07 (P = .471). All had negative margins. 12 (20%) patients developed complications. 3 (5%) developed urine leaks. No differences between multiport and LESS-PN were noted as regards demographics, tumor size, outcomes, and complications. Conclusion. Initial experience demonstrates that nonischemic multiport and LESS-PN is safe and efficacious, with excellent short-term preservation of renal function. Long-term data are needed to confirm oncological efficacy. PMID:21747654

  6. Ex vivo comparison of the tissue effects of six laser wavelengths for potential use in laser supported partial nephrectomy

    NASA Astrophysics Data System (ADS)

    Khoder, Wael Y.; Zilinberg, Katja; Waidelich, Raphaela; Stief, Christian G.; Becker, Armin J.; Pangratz, Thomas; Hennig, Georg; Sroka, Ronald

    2012-06-01

    Laparoscopic/robotic partial nephrectomy (LPN) is increasingly considered for small renal tumors (RT). This demands new compatible surgical tools for RT-resection, such as lasers, to optimize cutting and coagulation. This work aims to characterize ex vivo handling requirements for six medically approved laser devices emitting different light wavelengths (940, 1064, 1318, 1470, 1940, and 2010 nm) amenable for LPN. Incisions were made by laser fibers driven by a computer-controlled stepping motor allowing precise linear movement with a preset velocity at a fixed fiber-tip distance to tissue. Optical parameters were measured on 200 μm tissue slices. Cutting quality depended on power output, fiber velocity and fiber-tip distance to tissue. Contact manner is suitable for cutting while a noncontact manner (5 mm distance) induces coagulation. Ablation threshold differs for each wavelength. Ablation depth is proportional to power output (within limit) while axial and superficial coagulation remains mostly constant. Increased fiber velocity compromises the coagulation quality. Optical parameters of porcine kidney tissue demonstrate that renal absorption coefficient follows water absorption in the 2 μm region while for other spectral regions (900 to 1500 and 1 μm) the tissue effects are influenced by other chromophores and scattering. Tissue color changes demonstrate dependencies on irradiance, scan velocity, and wavelength. Current results clearly demonstrate that surgeons considering laser-assisted RT excisions should be aware of the mentioned technical parameters (power output, fiber velocity and fiber-tip tissue-distance) rather than wavelength only.

  7. Total ureteral avulsion leading to early nephrectomy as a rare complication of simple lumbar discectomy; a case report

    PubMed Central

    Omidi-Kashani, Farzad; Mousavi, Seyed Mahdi

    2015-01-01

    Introduction: Lumbar discectomy constitutes the most common and probably easiest spine surgery but it is not without complications. The aim of this work is to report a case with total ureteral avulsion during lumbar discectomy due to careless advancement of the pituitary rongeur. Methods: A 59-year-old male presented with refractory left L5-S1 lumbar disc herniation. During the surgery, left sided total ureteral avulsion occurred. Early postoperative progressive abdominal pain was the main clue for further investigation and diagnostic work-up. Results: Abdominal ultrasonography, intravenous pyelography, and abdominal contrast-enhanced computed tomography (CT) detected a left ureteral injury. Although the injury was detected early, ureteral repair or renal autotransplantation was not possible and nephrectomy was finally indicated, due to a significant ureteral loss. Discussion: Careful use of discectomy instruments, avoidance of excessive advancement of pituitary rongeurs (more than 3 cm), and thorough knowledge of the relevant anatomy are critical in preventing ureteral injury. PMID:27163085

  8. Rare case of a strangulated intercostal flank hernia following open nephrectomy: A case report and review of literature

    PubMed Central

    Akinduro, Oluwaseun O.; Jones, Frank; Turner, Jacquelyn; Cason, Frederick; Clark, Clarence

    2015-01-01

    Introduction Flank incisions may be associated with incisional flank hernias, which may progress to incarceration and strangulation. Compromised integrity of the abdominal and intercostal musculature due to previous surgery may be associated with herniation of abdominal contents into the intercostal space. There have been six previously reported cases of herniation into the intercostal space after a flank incision for a surgical procedure. This case highlights the clinical picture associated with an emergent strangulated hernia and highlights the critical steps in its management. Presentation of case We present a case of a 79-year-old adult man with multiple comorbidities presenting with a strangulated flank hernia secondary to an intercostal incision for a right-sided open nephrectomy. The strangulated hernia required emergent intervention including right-sided hemi-colectomy with ileostomy and mucous fistula. Discussion Abdominal incisional hernias are rare and therefore easily overlooked, but may result in significant morbidity or even death in the patient.. The diagnosis can be made with a thorough clinical examination and ultrasound or computed topographical investigation. Once a hernia has become incarcerated, emergent surgical management is necessary to avoid strangulation and small bowel obstruction. Conclusion Urgent diagnosis and treatment of this extremely rare hernia is paramount especially in the setting of strangulation. PMID:26629848

  9. Ex vivo comparison of the tissue effects of six laser wavelengths for potential use in laser supported partial nephrectomy.

    PubMed

    Khoder, Wael Y; Zilinberg, Katja; Waidelich, Raphaela; Stief, Christian G; Becker, Armin J; Pangratz, Thomas; Hennig, Georg; Sroka, Ronald

    2012-06-01

    Laparoscopic/robotic partial nephrectomy (LPN) is increasingly considered for small renal tumors (RT). This demands new compatible surgical tools for RT-resection, such as lasers, to optimize cutting and coagulation. This work aims to characterize ex vivo handling requirements for six medically approved laser devices emitting different light wavelengths (940, 1064, 1318, 1470, 1940, and 2010 nm) amenable for LPN. Incisions were made by laser fibers driven by a computer-controlled stepping motor allowing precise linear movement with a preset velocity at a fixed fiber-tip distance to tissue. Optical parameters were measured on 200 μm tissue slices. Cutting quality depended on power output, fiber velocity and fiber-tip distance to tissue. Contact manner is suitable for cutting while a noncontact manner (5 mm distance) induces coagulation. Ablation threshold differs for each wavelength. Ablation depth is proportional to power output (within limit) while axial and superficial coagulation remains mostly constant. Increased fiber velocity compromises the coagulation quality. Optical parameters of porcine kidney tissue demonstrate that renal absorption coefficient follows water absorption in the 2 μm region while for other spectral regions (900 to 1500 and 1 μm) the tissue effects are influenced by other chromophores and scattering. Tissue color changes demonstrate dependencies on irradiance, scan velocity, and wavelength. Current results clearly demonstrate that surgeons considering laser-assisted RT excisions should be aware of the mentioned technical parameters (power output, fiber velocity and fiber-tip tissue-distance) rather than wavelength only.

  10. An 80-Year-Old Man With Dyspnea and Bilateral Pleural Effusions After Partial Nephrectomy for Renal Cell Carcinoma.

    PubMed

    Gupta, Anupam; Farokhi, Mahsan; Shah, Sapna; McGarry, Terence; Warshawsky, Martin; Epelbaum, Oleg

    2016-05-01

    An 80-year-old man presented because of superficial head trauma sustained after falling from bed. On review of systems, he reported worsening dyspnea on exertion, nonproductive cough, and weight loss over the preceding 2 to 3 months. There was no report of chest pain or leg swelling. He had a past medical history of hypertension, coronary artery disease, subclinical hypothyroidism, and renal cell carcinoma treated with partial right nephrectomy approximately 1 year before this presentation. Two months earlier he had been evaluated in the dermatology clinic for painful, dystrophic fingernails. At that time he was diagnosed with acropachy with onycholysis and suspected superinfection, and after failing to improve with vinegar soaks and topical antimicrobials, he underwent surgical nail removal on the second and fourth digits of the right hand. Histological examination of the operative specimens revealed dystrophic nails with negative fungal stains. His medications included levothyroxine, hydrochlorothiazide, and clopidogrel. He had never smoked and had done clerical work until retirement. He was originally from Colombia. PMID:27157230

  11. Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis

    PubMed Central

    Qi, Jin; Zhang, Peng; Wang, Yanan; Chen, Hao; Li, Yumin

    2016-01-01

    Background/Aims Total gastrectomy (TG) has shown to be superior regarding low risk of recurrence and readmission to distal subtotal gastrectomy (DG) for treatment of distal stomach cancer, but the incidence of postoperative morbidity and mortality in TG cannot be ignored. Therefore, we performed a meta-analysis to compare the effectiveness between TG and DG for distal stomach cancer. Methodology A search in PubMed, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Database through January 2016 was performed. Eligible studies in comparing of TG and DG for distal gastric cancer were included in this meta-analysis. Review Manager 5.2 software from the Cochrane Collaboration was used for the performance of meta-analysis and STATA 12.0 software for meta-regression analysis. Results Ten retrospective cohort studies and one randomized control trial involving 5447 patients were included. The meta-analysis showed no significant difference of postoperative mortality (RR = 1.48, 95%CI = 0. 90–2.44,p = 0.12), intraoperative blood loss (MD = 24.34, 95%CI = -3.31–51.99, p = 0.08) and length of hospital stay(MD = 0.76, 95%CI:-0.26–1.79, p = 0.15). TG procedure could retrieve more lymph nodes than DG(MD = 4.33, 95% CI = 2.34–6.31, p<0.0001). According to different postoperative complications, we performed subgroup analysis, subgroup analysis revealed that patients in TG group tended to have a higher rate of postoperative intra-abdominal abscess than DG procedure (RR = 3.41, 95% CI = 1.21–9.63,p<0.05). No statistical differences were found in leakage, intestinal obstruction, postoperative bleeding, anastomotic stricture and wound infection between the two groups (p>0.05). We pooled the data together, the accumulated 5-year Overall Survival rates of TG and DG groups were 49.6% (919/1852) vs.55.9%(721/1290) respectively. Meta-analysis revealed a favoring trend to DG procedure and there was a statistical difference between the two groups (RR = 0.91,95% CI = 0

  12. Subtotal Gastrectomy With Billroth II Anastomosis Is Associated With a Low Risk of Ischemic Stroke in Peptic Ulcer Disease Patients: A Nationwide Population-Based Study.

    PubMed

    Chen, Chien-Hua; Lin, Cheng-Li; Kao, Chia-Hung

    2016-04-01

    Duodenal diversion can ameliorate lipid and glucose metabolism. We assessed the risk of stroke after subtotal gastrectomy with Billroth II anastomosis (SGBIIA) in peptic ulcer disease (PUD). We identified 6425 patients who received SGBIIA for PUD between 1998 and 2010 from the Taiwan National Health Insurance Research Database as the study cohort; we frequency-matched them with 25,602 randomly selected controls from the PUD population who did not receive SGBIIA according to age, sex, index year, and comorbidities including hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease (COPD), and obesity. All patients were followed until the end of 2011 to determine the incidence of stroke. The incidence of stroke was lower in patients in the SGBIIA cohort than in those in the non-SGBIIA cohort (18.9 vs 22.9 per 1000 person-years, adjusted hazard ratio [aHR] 0.80, 95% confidence interval [CI] 0.72-0.89, P < 0.001). The risk of ischemic stroke (aHR 0.77, 95% CI 0.69-0.86, P < 0.001), rather than hemorrhagic stroke (aHR 1.00, 95% CI 0.78-1.28), was lower for the SGBIIA cohort than for the non-SGBIIA cohort according to the multivariable Cox proportional hazard regression analysis. The relative risk of ischemic stroke after SGBIIA was lower in men (aHR 0.77, 95% CI 0.69-0.86) than in women (aHR 0.80, 95% CI 0.65-0.99) and in patients aged ≥65 years (aHR 0.72, 95% CI 0.63-0.81) than in those of other age groups (≤49 years, aHR 0.82, 95% CI 0.48-1.39; 50-64 years, aHR 1.01, 95% CI 0.79-1.28). The relative risk of ischemic stroke after SGBIIA was also reduced in patients with comorbidities (aHR 0.84, 5% CI 0.75-0.95) rather than in those without comorbidities (aHR 0.81, 95% CI 0.59-1.12). SGBIIA is associated with a low risk of ischemic stroke for PUD patients, and its protective effect is prominent in men, patients aged ≥65 years, and those with comorbidities.

  13. Long-term effect of partial nephrectomy on biological parameters, kidney histology, and guanidino compound levels in mice.

    PubMed

    Al Banchaabouchi, M; Marescau, B; Van Marck, E; D'hooge, R; De Deyn, P P

    2001-12-01

    The long-term adverse consequences of early renal mass reduction in mice have not yet been investigated. The effects of partial surgical nephrectomy (NX) in 2-month-old mice on some biological parameters, on histopathologic and morphometric features of the kidney, and on urea and guanidino compound (GC) levels in plasma, urine, and brain were examined at 10 days, and 1, 2, 4, and 12 months postsurgery. Body weight, urinary volume, and plasma urea were most affected at 10 days and 12 months post-NX. NX-induced changes in the remaining renal tissue (including hypertrophy, glomerular mesangial expansion, and presence of protein casts) increased with age. As in human renal insufficiency, NX mice showed significantly higher plasma guanidinosuccinic acid (GSA) and creatinine (CTN) levels at all studied periods. The same tendency could be seen for most other plasma GCs examined, except for arginine (Arg), guanidinoacetic acid (GAA), and homoarginine (HA). As seen in human pathobiochemistry, the latter 2 compounds tended to be lower in NX mice in our follow-up study. Remarkably, and also similar to humans, NX mice excreted less GAA and more GSA than controls during the entire follow-up study. During the follow-up, excretion levels of GAA were unchanged in NX and sham-operated mice. In brain, GAA and gamma-guanidinobutyric acid (GBA) levels were always higher in NX mice with a tendency to respectively increase or decrease over time in NX as well as sham-operated mice. Although urea and GC metabolism were influenced by time post-NX and aging, the model was confirmed to display a mild stable chronic impairment of renal function. Histopathologic and morphometric changes of the kidney increased with age.

  14. Towards a standardised informed consent procedure for live donor nephrectomy: the PRINCE (Process of Informed Consent Evaluation) project—study protocol for a nationwide prospective cohort study

    PubMed Central

    Kortram, Kirsten; Spoon, Emerentia Q W; Ismail, Sohal Y; d'Ancona, Frank C H; Christiaans, Maarten H L; van Heurn, L W Ernest; Hofker, H Sijbrand; Hoksbergen, Arjan W J; Homan van der Heide, Jaap J; Idu, Mirza M; Looman, Caspar W N; Nurmohamed, S Azam; Ringers, Jan; Toorop, Raechel J; van de Wetering, Jacqueline; Ijzermans, Jan N M; Dor, Frank J M F

    2016-01-01

    Introduction Informed consent is mandatory for all (surgical) procedures, but it is even more important when it comes to living kidney donors undergoing surgery for the benefit of others. Donor education, leading to informed consent, needs to be carried out according to certain standards. Informed consent procedures for live donor nephrectomy vary per centre, and even per individual healthcare professional. The basis for a standardised, uniform surgical informed consent procedure for live donor nephrectomy can be created by assessing what information donors need to hear to prepare them for the operation and convalescence. Methods and analysis The PRINCE (Process of Informed Consent Evaluation) project is a prospective, multicentre cohort study, to be carried out in all eight Dutch kidney transplant centres. Donor knowledge of the procedure and postoperative course will be evaluated by means of pop quizzes. A baseline cohort (prior to receiving any information from a member of the transplant team in one of the transplant centres) will be compared with a control group, the members of which receive the pop quiz on the day of admission for donor nephrectomy. Donor satisfaction will be evaluated for all donors who completed the admission pop-quiz. The primary end point is donor knowledge. In addition, those elements that have to be included in the standardised format informed consent procedure will be identified. Secondary end points are donor satisfaction, current informed consent practices in the different centres (eg, how many visits, which personnel, what kind of information is disclosed, in which format, etc) and correlation of donor knowledge with surgeons' estimation thereof. Ethics and dissemination Approval for this study was obtained from the medical ethical committee of the Erasmus MC, University Medical Center, Rotterdam, on 18 February 2015. Secondary approval has been obtained from the local ethics committees in six participating centres. Approval in the

  15. Targeted Endovascular Temporary Vessel Occlusion with a Reverse Thermosensitive Polymer for Near-Bloodless Partial Nephrectomy: Comparison to Standard Surgical Clamping Techniques

    SciTech Connect

    Flacke, Sebastian; Harty, Niall J.; Laskey, Daniel H.; Moinzadeh, Alireza; Benn, James A.; Villani, Rosanna; Kalra, Aarti; Libertino, John A.; Madras, Peter N.

    2012-10-15

    Purpose: To determine whether reversible blood flow interruption to a randomly chosen target region of the kidney may be achieved with the injection of a reverse thermoplastic polymer through an angiographic catheter, thereby facilitating partial nephrectomy without compromising blood flow to the remaining kidney or adding risks beyond those encountered by the use of hilar clamping. Methods: Fifteen pigs underwent partial nephrectomy after blood flow interruption by vascular cross-clamping or injection of polymer (Lumagel Trade-Mark-Sign ) into a segmental artery. Five animals were euthanized after surgery (three open and two laparoscopic resection, cross-clamping n = 2), and 10 (open resection, cross-clamping n = 4) were euthanized after 6 weeks' survival. Blood specimens were obtained periodically, and angiogram and necropsy were performed at 6 weeks. Results: Selective renal ischemia was achieved in all cases. Surgical resection time averaged 9 and 24.5 min in the open and laparoscopic groups, respectively. Estimated blood loss was negligible with the exception of one case where an accessory renal artery was originally overlooked. Reversal of the polymer to a liquid state was consistent angiographically and visually in all cases. Time to complete flow return averaged 7.4 and 2 min for polymer and clamping, respectively. Angiography at 6 weeks revealed no evidence of vascular injury. Laboratory data and necropsies revealed no differences between animals undergoing vascular clamping or polymer injection. Conclusion: Lumagel was as effective as vascular clamping in producing a near bloodless operative field for partial nephrectomy while maintaining flow to the uninvolved portion of the affected kidney.

  16. Multiple renal abscesses leading to nephrectomy of the solitary kidney in a young female with type 1 diabetes and history of recurrent urinary tract infections

    PubMed Central

    Wańkowicz, Zofia; Grzywacz, Anna; Saracyn, Marek; Zieliński, Henryk

    2011-01-01

    This report presents the case of a young female suffered for many years from type 1 diabetes, complicated by recurrent urinary tract infections and urosepsis with multiple abscesses which led to right nephrectomy in 2002. The patient was hospitalised in our Department in June 2009 because of urosepsis in the course of multiple left renal abscesses and subsequent acute renal failure requiring hemodialysis. A dramatic decision of removing the solitary kidney was taken, and patient was included in a long-term renal replacement therapy programme in our Centre as a preparation to kidney and pancreas transplantation. PMID:22291780

  17. Spontaneous regression of multiple pulmonary nodules in a patient with unclassified renal cell carcinoma following laparoscopic partial nephrectomy: A case report

    PubMed Central

    UEDA, KOSUKE; SUEKANE, SHIGETAKA; MITANI, TOMOTARO; CHIKUI, KATSUAKI; EJIMA, KAZUHISA; SUYAMA, SHUNSUKE; NAKIRI, MAKOTO; NISHIHARA, KIYOAKI; MATSUO, MITSUNORI; IGAWA, TSUKASA

    2016-01-01

    Spontaneous regression of metastatic renal cell carcinoma (RCC) is rare, but well-documented in clear cell RCC. However, there are no reports on spontaneous regression of unclassified RCC. Since the radiological findings of pulmonary infarcts and inflammatory pseudotumors are similar to those of metastases from RCC, a definitive diagnosis is difficult without performing a histological examination. A 56-year-old woman underwent medical examination by a physician. An abdominal computed tomography (CT) scan revealed a 22-mm mass with a cystic area in the right kidney, as well as multiple enlarged lymph nodes in the common iliac, external iliac and groin areas, bilaterally. A chest CT revealed multiple pulmonary nodules bilaterally, the largest measuring 15 mm. Since the right renal tumor was suspected to be an RCC, laparoscopic partial nephrectomy was performed. The final pathological diagnosis of the renal tumor was unclassified RCC. One month following surgery, a CT scan revealed spontaneous regression of the pulmonary nodules. We herein present a rare case of spontaneous regression of pulmonary nodules in a patient with unclassified RCC following laparoscopic partial nephrectomy. To the best of our knowledge, this is the first case of spontaneous regression in unclassified RCC. PMID:27330764

  18. Radiofrequency Ablation Versus Partial Nephrectomy in Treating Small Renal Tumors: A Systematic Review and Meta-Analysis.

    PubMed

    Yin, Xiaotao; Cui, Liang; Li, Fanglong; Qi, Siyong; Yin, Zhaoyang; Gao, Jiangping

    2015-12-01

    Radiofrequency ablation (RFA) has emerged as an alternative treatment to surgical partial nephrectomy (PN) in the treatment of small renal tumors (SRTs). But its safety and oncological efficacy are still controversial. We conducted this systematic review and meta-analysis to compare the peritoperative and oncological outcomes of RFA and PN in the treatment of SRTs. Pubmed, EMBASE, Cochrane CENTRAL, and Web of Science were searched to identify eligible studies that compared the RFA and PN in the treatment of SRTs. Twelve retrospective studies that compared RFA with PN in the treatment of SRTs met our selection criterion and were included in this meta-analysis. The pooled results indicated that the local recurrence rate (4.14% vs 4.10%, RR: 1.18, 95% CI: 0.68, 2.07, P = 0.550) and distant metastases rate (2.76% vs 1.89%, RR: 1.31, 95% CI: 0.70, 2.46, P = 0.686) were not significantly different between the RFA group and the PN group. In terms of perioperative outcomes, RFA was associated with shorter length of stay (LOS) (WMD: -2.02 days, 95% CI: -2.77, -1.27, P < 0.001), lower eGFR decline after treatment (WMD: -3.90, 95% CI: -6.660, -1.140, P = 0.006). However, the overall perioperative complication rate (7.5% vs 6.2%, RR:1.10, 95% CI: 0.64, 1.87, P = 0.740) and the major complication rate (3.7% vs 4.4%, RR: 0.83, 95% CI: 0.43, 1.60, P = 0.579) were both similar between RFA and PN groups. Compared with PN, RFA achieves an equal oncological outcome for SRTs with similar local recurrence rate and distant metastases rate. Additionally, RFA is associated with a similar perioperative complication rate, lower decline of eGFR, and shorter LOS. Therefore, RFA is an effective option in the treatment of SRTs for selected patients. PMID:26683944

  19. Screening for celiac disease in Down’s syndrome patients revealed cases of subtotal villous atrophy without typical for celiFac disease HLA-DQ and tissue transglutaminase antibodies

    PubMed Central

    Uibo, Oivi; Teesalu, Kaupo; Metsküla, Kaja; Reimand, Tiia; Saat, Riste; Sillat, Tarvo; Reimand, Koit; Talvik, Tiina; Uibo, Raivo

    2006-01-01

    AIM: To investigate the prevalence of celiac disease (CD) as well as CD marker antibodies and susceptibility HLA-DQ haplotypes in 134 karyotyped Down’s syndrome (DS) patients. METHODS: Immunoglobulin A (IgA) and G (IgG) type anti-gliadin antibodies (AGA), IgA type anti-tissue transglutaminase (tTG) antibodies (anti-tTG) with antigen of guinea pig and human source were determined by enzyme-linked immunosorbent assay and endomysium antibodies (EMA) by indirect immunofluoresence test. HLA-DQA1*0501/DQB1*0201 (DQ2) was revealed by polymerase chain reaction. Celiac disease was diagnosed by revised ESPGHAN criteria. RESULTS: 41 % of DS patients had AGA, 6.0 % IgA anti-tTG with guinea pig antigen, and 3.0 % IgA EMA (all positive for anti-tTG with human tTG). Subtotal villous atrophy was found in 5 out of 9 DS patients who had agreed to small bowel biopsy. One of them had DQA1*0501/DQB1*0201 and anti-tTG and EMA i.e. typical for CD markers (this case also fulfilled the ESPGHAN diagnostic criteria), but other four lacked these markers. Three non-biopsied DS patients had also most probably CD because DQA1*0501/DQB1*0201 and IgA anti-tTG (EMA) were detected. Thus, the prevalence of CD among our DS patients population is 3.0 % (95 % of confidence interval [CI]: 0.1-5.9 %). CONCLUSION: We confirm the increased frequency of CD among DS patients. In addition, we have revealed a subgroup of patients with subtotal villous atrophy but without characteristic for CD immunological and genetic markers. Whether these cases represent CD (with atypical immunopathogenesis) or some other immune enteropathy, requires further investigations. PMID:16552815

  20. [Radical nephrectomy and thrombectomy in patients with renal cell cancer complicated by tumoral thrombosis of the renal vein and vena cava inferior].

    PubMed

    Rusyn, V I; Korsak, V V; Rusyn, A V; Boĭko, S O

    2013-01-01

    Surgical treatment was conducted in 81 patients, suffering renocellular cancer (RCC), complicated by a renal vein and vena cava inferior thrombosis. According to the Mayo clinic classification, the level of a tumoral thrombus spread was established: the 0 level--in 37 patients, the level I--in 19, the level II--in 17, the level III --in 6, and the level IV--in 2. There were substantiated the optimal surgical accesses and technique of radical nephrectomy and thrombectomy for RCC, complicated by a renal vein and vena cava inferior thrombosis. It is recommended to apply transabdominal accesses: the extended median laparotomic, bilateral subcostal of a "Chevron" or "Mercedes" type. There was shown, that the access choice depends on the level of the tumoral thrombus localization.

  1. Bilateral Nephrectomy for Autosomal Dominant Polycystic Kidney Disease and Timing of Kidney Transplant: A Review of the Technical Advances in Surgical Management of Autosomal Dominant Polycystic Disease.

    PubMed

    Dengu, Fungai; Azhar, Bilal; Patel, Shaneel; Hakim, Nadey

    2015-06-01

    Autosomal dominant polycystic disease is a multisystem inherited condition affecting the kidneys and is an important cause of end-stage renal disease. Patients with autosomal dominant polycystic disease experience symptoms related to size and cystic nature of their kidneys, which can be difficult to manage. Traditionally, the only surgical option for management was open bilateral/unilateral native nephrectomy, which carried with it significant morbidity and mortality. Therefore, it was deemed unsafe and rarely performed. However, surgery for autosomal dominant polycystic disease has evolved rapidly with the advent of minimally invasive surgery and improved medical management of end-stage renal failure patients. Laparoscopic and hand-assisted laparoscopic techniques have been adopted and have demonstrated reduced morbidity. The timing of this intervention in relation to transplant is controversial and presents a major challenge in managing this patient population.

  2. Generation of Chimeric “ABS Nanohemostat” Complex and Comparing Its Histomorphological In Vivo Effects to the Traditional Ankaferd Hemostat in Controlled Experimental Partial Nephrectomy Model

    PubMed Central

    Huri, Emre; Beyazit, Yavuz; Mammadov, Rashad; Toksoz, Sila; Tekinay, Ayse B.; Guler, Mustafa O.; Ustun, Huseyin; Kekilli, Murat; Dadali, Mumtaz; Celik, Tugrul; Astarci, Müzeyyen; Haznedaroglu, Ibrahim C.

    2013-01-01

    Purpose. Using the classical Ankaferd Blood Stopper (ABS) solution to create active hemostasis during partial nephrectomy (PN) may not be so effective due to insufficient contact surface between the ABS hemostatic liquid agent and the bleeding area. In order to broaden the contact surface, we generated a chimeric hemostatic agent, ABS nanohemostat, via combining a self-assembling peptide amphiphile molecule with the traditional Ankaferd hemostat. Materials and Methods. In order to generate ABS nanohemostat, a positively charged Peptide Amphiphile (PA) molecule was synthesized by using solid phase peptide synthesis. For animal experiments, 24 Wistar rats were divided into the following 4 groups: Group 1: control; Group 2: conventional PN with only 0.5 ml Ankaferd hemostat; Group 3: conventional PN with ABS + peptide gel; Group 4: conventional PN with only 0.5 ml peptide solution. Results. Mean warm ischemia times (WITs) were 232.8  ±  56.3, 65.6 ± 11.4, 75.5 ± 17.2, and 58.1 ± 17.6 seconds in Group 1 to Group 4, respectively. Fibrosis was not different among the groups, while inflammation was detected to be significantly different in G3 and G4. Conclusions. ABS nanohemostat has comparable hemostatic efficacy to the traditional Ankaferd hemostat in the partial nephrectomy experimental model. Elucidation of the cellular and tissue effects of this chimeric compound may establish a catalytic spark and open new avenues for novel experimental and clinical studies in the battlefield of hemostasis. PMID:23509463

  3. Generation of Chimeric "ABS Nanohemostat" Complex and Comparing Its Histomorphological In Vivo Effects to the Traditional Ankaferd Hemostat in Controlled Experimental Partial Nephrectomy Model.

    PubMed

    Huri, Emre; Beyazit, Yavuz; Mammadov, Rashad; Toksoz, Sila; Tekinay, Ayse B; Guler, Mustafa O; Ustun, Huseyin; Kekilli, Murat; Dadali, Mumtaz; Celik, Tugrul; Astarci, Müzeyyen; Haznedaroglu, Ibrahim C

    2013-01-01

    Purpose. Using the classical Ankaferd Blood Stopper (ABS) solution to create active hemostasis during partial nephrectomy (PN) may not be so effective due to insufficient contact surface between the ABS hemostatic liquid agent and the bleeding area. In order to broaden the contact surface, we generated a chimeric hemostatic agent, ABS nanohemostat, via combining a self-assembling peptide amphiphile molecule with the traditional Ankaferd hemostat. Materials and Methods. In order to generate ABS nanohemostat, a positively charged Peptide Amphiphile (PA) molecule was synthesized by using solid phase peptide synthesis. For animal experiments, 24 Wistar rats were divided into the following 4 groups: Group 1: control; Group 2: conventional PN with only 0.5 ml Ankaferd hemostat; Group 3: conventional PN with ABS + peptide gel; Group 4: conventional PN with only 0.5 ml peptide solution. Results. Mean warm ischemia times (WITs) were 232.8  ±  56.3, 65.6 ± 11.4, 75.5 ± 17.2, and 58.1 ± 17.6 seconds in Group 1 to Group 4, respectively. Fibrosis was not different among the groups, while inflammation was detected to be significantly different in G3 and G4. Conclusions. ABS nanohemostat has comparable hemostatic efficacy to the traditional Ankaferd hemostat in the partial nephrectomy experimental model. Elucidation of the cellular and tissue effects of this chimeric compound may establish a catalytic spark and open new avenues for novel experimental and clinical studies in the battlefield of hemostasis. PMID:23509463

  4. Assessment of survival of patients with metastatic clear cell renal cell carcinoma after radical cytoreductive nephrectomy versus no surgery: a SEER analysis

    PubMed Central

    Xiao, Wen-Jun; Zhu, Yao; Dai, Bo; Zhang, Hai-Liang; Ye, Ding-Wei

    2015-01-01

    Purposes To examine the factors related to the choice of cytoreductive nephrectomy (CN) for patients with metastatic clear cell renal cell carcinoma (mCCRCC), and compare the population-based survival rates of patients treated with or without surgery in the modern targeted therapy era. Materials and Methods From 2006 to 2009, patients with mCCRCC were identified from SEER database. The factors that affected patients to be submitted to CN were examined and propensity scores for each patient were calculated. Then patients were matched based upon propensity scores. Univariable and multivariable cox regression models were used to compare survival rates of patients treated with or without surgery. Finally, sensitivity analysis for the cox model on a hazard ratio scale was performed. Results Age, race, tumor size, T stage and N stage were associated with nephrectomy univariablely. After the match based upon propensity scores, the 1-, 2-, and 3-year cancer-specific survival rate estimates were 45.1%, 27.9%, and 21.7% for the no-surgery group vs 70.6%, 52.2%, and 41.7% for the surgery group, respectively (hazard ratio 0.42, 95%CI: 0.35-0.52, log-rank P<0.001). In multivariable Cox proportional hazard regression model, race, T stage, N stage and median household income were significantly associated with survival. Sensitivity analysis on a hazard ratio scale indicated that the hazard ratio might be above 1.00 only when the unknown factor had an opposite effect on survival which was 3-fold than CN. Conclusion The results of our study showed that CN significantly improves the survival of patients with metastatic CCRCC even in the targeted therapy era. PMID:26005970

  5. Cardiopulmonary bypass (CPB) has no significant impact on survival in patients undergoing nephrectomy and level III-IV inferior vena cava thrombectomy; a multi-institutional analysis

    PubMed Central

    Dall'Era, Marc A.; Durbin-Johnson, Blythe; Carballido, Joaquín A.; Chandrasekar, Thenappan; Chromecki, Thomas; Ciancio, Gaetano; Daneshmand, Siamak; Gontero, Paolo; Gonzalez, Javier; Haferkamp, Axel; Hohenfellner, Markus; Huang, William C.; Espinós, Estefania Linares; Mandel, Philipp; Martinez-Salamanca, Juan I.; Master, Viraj A.; McKiernan, James M.; Montorsi, Francesco; Novara, Giacomo; Pahernik, Sascha; Palou, Juan; Pruthi, Raj S.; Rodriguez-Faba, Oscar; Russo, Paul; Scherr, Douglas S.; Shariat, Shahrokh F.; Spahn, Martin; Terrone, Carlo; Vergho, Daniel; Wallen, Eric M.; Xylinas, Evanguelos; Zigeuner, Richard; Libertino, John A.; Evans, Christopher P.

    2016-01-01

    Purpose The impact of cardiopulmonary bypass (CPB) usage in level III-IV tumor thrombectomy on surgical and oncologic outcomes is unknown. We sought to determine the impact of cardiopulmonary bypass (CPB) on overall and cancer specific survival, as well as surgical complication rates, and immediate outcomes in patients undergoing nephrectomy and level III-IV tumor thrombectomy with or without CPB. Patients and Methods We retrospectively analyzed 362 patients with RCC and with level III or IV tumor thrombus from 1992 to 2012 in 22 US and European centers. Cox proportional hazards models were used to compare overall and cancer-specific survival between patients with and without CPB. Perioperative mortality and complications rates were assessed using logistic regression analyses. Results The median overall survival was 24.6 months in non-CPB patients and 26.6 months in CPB patients. Overall survival and cancer-specific survival (CSS) did not differ significantly in both groups, neither in univariate analysis nor when adjusting for known risk factors. In multivariate analysis, no significant differences were seen in hospital LOS, Clavien 1-4 complication rate, intraoperative or 30 day mortality, and CSS between both groups. Limitations include the retrospective nature of the study. Conclusions In our multi-institutional analysis, the use of cardiopulmonary bypass did not significantly impact cancer specific survival or overall survival in patients undergoing nephrectomy and level III or IV tumor thrombectomy. Neither approach was independently associated with increased mortality in the multivariate analysis. Higher surgical complications were not independently associated with the use of CPB. PMID:25797392

  6. Using a Harmonic Scalpel "Drilling and Clamping" Method to Implement Zero Ischemic Robotic-assisted Partial Nephrectomy: An Observation Case Report Study.

    PubMed

    Hou, Chen-Pang; Lin, Yu-Hsiang; Hsu, Yu-Chao; Chen, Chien-Lun; Chang, Phei-Lang; Tsui, Ke-Hung

    2016-01-01

    Robot-assisted partial nephrectomy (RAPN) has gradually become a popular minimally invasive nephron-sparing surgical option for small renal tumors. Ischemic injury should be minimized because it impacts renal function outcomes following partial nephrectomy. Herein, the authors detail the technique and present initial perioperative outcomes of our novel harmonic scalpel "drilling and clamping" method to implement zero-ischemic RAPN. The authors prospectively collected baseline and perioperative data of patients who underwent zero ischemic RAPN performed by our harmonic scalpel "drilling and clamping" method. From April 2012 to December 2014, a total of 19 consecutive zero ischemic RAPN procedures were performed by a single surgeon. For 18 of the 19 patients, RAPN using our harmonic scalpel "Drilling and Clamping" method was successfully completed without the need for hilar clamping. The median tumor size was 3.4 cm (range: 1.8-6.2); operative time was 3.2 hours (range: 1.9-4.5); blood loss was 100 mL (range: 30-950); and postoperative hospital stay was 4 days (3-26). One patient required intraoperative blood transfusion. Two patients had intra or postoperative complications: 1 was converted to traditional laparotomy because of massive bleeding, whereas another had postoperative stress ulcer. Pathology confirmed renal cell carcinoma in 13 patients (63.2%), angiomyolipoma in 6 patients: (31.5%), and oncocytoma in 1 patient (5.3%). Mean pre- and postoperative serum creatinine (0.82 mg/dL and 0.85 mg/dL, respectively), estimated glomerular filtration rate (84.12 and 82.18, respectively), and hemoglobin (13.27 g/dL and 12.71 g/dL, respectively) were comparable. The authors present a novel zero-ischemic technique for RAPN. They believe that this technique is feasible and reproducible. PMID:26817867

  7. Clear cell papillary renal cell carcinoma is the fourth most common histologic type of renal cell carcinoma in 290 consecutive nephrectomies for renal cell carcinoma.

    PubMed

    Zhou, Haijun; Zheng, Shaojiang; Truong, Luan D; Ro, Jae Y; Ayala, Alberto G; Shen, Steven S

    2014-01-01

    Clear cell papillary renal cell carcinoma (CCP-RCC) has recently been recognized as a distinct subtype of renal cell carcinoma (RCC) due to its unique morphologic, immunohistochemical, and genetic features and indolent clinical behavior. However, the incidence of this tumor in a nephrectomy series for renal mass has not been fully investigated. Twelve cases of CCP-RCC were identified from a total of 290 consecutive partial (n = 137) or radical nephrectomies (n = 153) for RCC from 2010 to 2012 in our hospital. In this series, CCP-RCC was the fourth most common (4.1%) kidney tumor following clear cell (conventional) (70%), papillary (16.6%), and chromophobe (5.9%) RCCs. The average age of the CCP-RCC patients was 58.2 years (range, 18-81 years), with an equal sex distribution. Four cases (33.3%) were associated with end-stage renal disease. Of the 12 CCP-RCCs, 9 presented as solitary tumors; 2 coexisted with clear cell RCC; and 1 with papillary RCC. The average size of tumors was 2.5 cm (range, 0.8-6.0 cm). All tumors were pT1 (10 pT1a and 2 pT1b). Two cases were initially misclassified as clear cell RCC. Strong positive cytokeratin 7 stain and negative stains with α-methylacyl-CoA racemase and RCC marker differentiate CCP-RCC from low-grade clear cell RCC with similar histologic features. We conclude that CCP-RCC is a common renal neoplastic entity, representing the fourth most common (4.1%) RCC. It can be easily misclassified due to its overlapping features with low-grade clear cell RCC. In equivocal cases, immunohistochemical stains with a small panel of markers (cytokeratin 7, α-methylacyl-CoA racemase, RCC marker, or CD10) are warranted in making the correct histologic classification. PMID:24182559

  8. Robotic-assisted laparoscopic radical nephrectomy using the Da Vinci Si system: how to improve surgeon autonomy. Our step-by-step technique.

    PubMed

    Davila, Hugo H; Storey, Raul E; Rose, Marc C

    2016-09-01

    Herein, we describe several steps to improve surgeon autonomy during a Left Robotic-Assisted Laparoscopic Radical Nephrectomy (RALRN), using the Da Vinci Si system. Our kidney cancer program is based on 2 community hospitals. We use the Da Vinci Si system. Access is obtained with the following trocars: Two 8 mm robotic, one 8 mm robotic, bariatric length (arm 3), 15 mm for the assistant and 12 mm for the camera. We use curved monopolar scissors in robotic arm 1, Bipolar Maryland in arm 2, Prograsp Forceps in arm 3, and we alternate throughout the surgery with EndoWrist clip appliers and the vessel sealer. Here, we described three steps and the use of 3 robotic instruments to improve surgeon autonomy. Step 1: the lower pole of the kidney was dissected and this was retracted upwards and laterally. This maneuver was performed using the 3rd robotic arm with the Prograsp Forceps. Step 2: the monopolar scissors was replaced (robotic arm 1) with the robotic EndoWrist clip applier, 10 mm Hem-o-Lok. The renal artery and vein were controlled and transected by the main surgeon. Step 3: the superior, posterolateral dissection and all bleeders were carefully coagulated by the surgeon with the EndoWrist one vessel sealer. We have now performed 15 RALRN following these steps. Our results were: blood loss 300 cc, console time 140 min, operating room time 200 min, anesthesia time 180 min, hospital stay 2.5 days, 1 incisional hernia, pathology: (13) RCC clear cell, (1) chromophobe and (1) papillary type 1. Tumor Stage: (5) T1b, (8) T2a, (2) T2b. We provide a concise, step-by-step technique for radical nephrectomy (RN) using the Da Vinci Si robotic system that may provide more autonomy to the surgeon, while maintaining surgical outcome equivalent to standard laparoscopic RN.

  9. [Role of surgery in treatment of hyperthyroidism].

    PubMed

    Martin, F; Caporal, R; Tran Ba Huy, P

    1999-09-01

    Hyperthyroidism is treated with antithyroid drugs, radioactive iodine or surgery. The aim of surgery is to obtain long-lasting euthyroidism with a minimal risk of recurrence, secondary hypothyroidism, and complications involving the recurrent nerve or the parathyroids. Depending on the etiology, total or partial resection is indicated in light of these objectives. According to the literature, surgery is not used as first intention treatment for Grave's disease, its role and indications remaining a question of debate. However, surgery is the treatment of choice for toxic nodules, current consensus favoring extracapsular total lobectomy. For multinodular toxic goiter, three are several surgical indications: failure of medical treatment, relapse after drug withdrawal, specific clinical or socioeconomic situations requiring rapid efficacy. Total lobectomy associated with subtotal contralateral hemithyroidectomy appears to be the most appropriate procedure. Surgery may also be indicated for treatment of pregnancy-, diabetes-, or amiodarone-induced hyperthyroidism. PMID:10519008

  10. The use of Haemostatic Agents does not impact the rate of hemorrhagic complications in patients undergoing partial nephrectomy for renal masses

    PubMed Central

    Abu-Ghanem, Yasmin; Dotan, Zohar; Kaver, Issac; Zilberman, Dorit E.; Ramon, Jacob

    2016-01-01

    Hemostatic agents(HAs) have gained increasing popularity as interventions to improve perioperative haemostasis and diminish the need for allogeneic red cell transfusion(PBT) despite a paucity of data supporting the practice. The aim of the current study is to examine the efficacy of HAs in reducing the rate of hemorrhagic complications during partial nephrectomy(PN). Data on 657 patients, who underwent elective PN between 2004–2013, were analyzed. The impact of HAs and SURGICEL was evaluated by comparing four sequential groups of patients: Group1 = Sutures alone, Group2 = sutures and HA, Group3 = sutures and SURGICEL, Group4 = both HA and SURGICEL. Complications included post-operative urinary leak(UL), PBT rate, delayed bleeding and post-operative renal failure. Results showed that the use of HAs did not engender a statistically significant difference in overall complications rate. Specifically, the addition of HAs did not reduce the rate of PBT, delayed bleeding or UL. Further analysis revealed that patients who received SURGICEL had significantly higher PBT rate and higher prevalence of UL cases. Addition of HAs to SURGICEL had no effect on the rate of these complications. In the current study, the use of HAs during open and laparoscopic PN did not reduce the rate of negative outcomes. Adequate suture renorrhaphy may be sufficient to prevent hemorrhagic complications. PMID:27572274

  11. Open Partial Nephrectomy for High-Risk Renal Masses Is Associated with Renal Pseudoaneurysms: Assessment of a Severe Procedure-Related Complication

    PubMed Central

    Kriegmair, M. C.; Mandel, P.; Rathmann, N.; Diehl, S. J.; Pfalzgraf, D.; Ritter, M.

    2015-01-01

    Objectives. A symptomatic renal pseudoaneurysm (RPA) is a severe complication after open partial nephrectomy (OPN). The aim of our study was to assess incidence and risk factors for RPA formation. Furthermore, we present our management strategy. Patients and Methods. Clinical records of consecutive patients undergoing OPN were assessed for surgical outcome and postoperative complications. Renal masses were risk stratified for tumor complexity according to the PADUA score. Uni- and multivariate analysis for symptomatic RPAs were performed using the t-tests and logistic regression. Results. We identified 233 patients treated with OPN. Symptomatic RPAs were observed in 13 (5.6%) patients, on average 14 (4–42) days after surgery. Uni- and multivariate analysis identified tumor complexity to be an independent predictor for symptomatic RPAs (p = 0.004). There was a significant correlation between RPAs and transfusion and the duration of stay (p < 0.001 and p = 0.021). Symptomatic RPAs were diagnosed with CT scans and successfully treated with arterial embolization. Discussion. Symptomatic RPAs are not uncommon after OPN for high-risk renal masses. A high nephrometry score is a predictor for this severe complication and may enable a risk-stratified followup. RPAs can successfully be located by CT angiography, which enables targeted angiographic treatment. PMID:26539549

  12. The lack of effect of a prophylactic dose of enoxaparin on thrombin generation in patients subjected to nephrectomy because of kidney cancer.

    PubMed

    Szczepański, M; Szostek, P; Pypno, W; Borówka, A

    2001-12-15

    It is assumed that major surgery, connected with extensive tissue dissection, brings about the release of tissue factor into circulation and subsequent activation of coagulation system. This activation results in the thrombin generation, which is supposed to be suppressed by the low-molecular-mass heparins (LMMH), administered to the surgical patients as the prophylaxis against postoperative venous thromboembolism. We have estimated the concentration of circulating thrombin-antithrombin (TAT) complex in patients subjected to transperitoneal nephrectomy and randomized into controls and who received 40-mg enoxaparin 12 h before and 12 h after the operation and then once daily for 7 days. We have observed a sharp rise of TAT concentration at the end of surgery and it corresponded to the simultaneous drop of antithrombin (AT) activity. TAT concentration gradually decreased and AT activity increased up to the end of observations on the seventh postoperative day, but there were no differences observed between the groups of patients. We have also observed a biphasic increase of plasmin-plasmin inhibitor (PPI) complex concentration in our patients. Again, there were no differences in PPI between the groups of patients. It is our conclusion that under the conditions of this study, the well-known prophylactic effect of enoxaparin against the venous thromboembolic complications was not mediated by the inhibition of intraoperative thrombin generation. The anti-inflammatory or biophysical influence of LMMH may be rather taken into account in surgical patients receiving prophylactic doses of these heparins.

  13. Limb ischemia, an alarm signal to a thromboembolic cascade - renal infarction and nephrectomy followed by surgical suppression of the left atrial appendage.

    PubMed

    Caraşca, Cosmin; Borda, Angela; Incze, Alexandru; Caraşca, Emilian; Frigy, Attila; Suciu, HoraŢiu

    2016-01-01

    We present the case of a 55-year-old male with mild hypertension and brief episodes of paroxysmal self-limiting atrial fibrillation (AF) since 2010. Despite a small cardioembolic risk score, CHA2DS2-Vasc=1 (Congestive heart failure, Hypertension, Age=75, Diabetes melitus, prior Stroke), the patient is effectively anticoagulated using acenocumarol. In December 2014, he showed signs of plantar transitory ischemia, for which he did not address the doctor. In early January 2015, he urgently presented at the hospital with left renal pain, caused by a renal infarction, diagnosed by computed tomography (CT) angiography. Left nephrectomy was performed with pathological confirmation. He was discharged with effective anticoagulation treatment. Within the next two weeks, he suffered a transitory ischemic event and a stroke, associated with right sided hemiparesis. On admission, AF was found and converted to sinus rhythm with effective anticoagulation - international normalized ratio (INR) of 2.12. Transthoracic echocardiography detected no pathological findings. Transesophageal echocardiography showed an expended left atrial appendage (LAA) with a slow blood flow (0.2 m÷s) and spontaneous echocontrast. Considering these clinical circumstances, surgical LAA suppression was decided on as a last therapeutic resort. Postoperative evolution was favorable; the patient is still free of ischemic events, one year post-intervention. Some morphological and hemodynamic characteristics of LAA may add additional thromboembolic risk factors, not included in scores. Removing them by surgical LAA suppression may decrease the risk of cardioembolic events. Intraoperative presence of thrombus makes it an indisputable proof. PMID:27516032

  14. Comparative Studies of the Proteome, Glycoproteome, and N-Glycome of Clear Cell Renal Cell Carcinoma Plasma before and after Curative Nephrectomy

    PubMed Central

    2015-01-01

    Clear cell renal cell carcinoma is the most prevalent of all reported kidney cancer cases, and currently there are no markers for early diagnosis. This has stimulated great research interest recently because early detection of the disease can significantly improve the low survival rate. Combining the proteome, glycoproteome, and N-glycome data from clear cell renal cell carcinoma plasma has the potential of identifying candidate markers for early diagnosis and prognosis and/or to monitor disease recurrence. Here, we report on the utilization of a multi-dimensional fractionation approach (12P-M-LAC) and LC–MS/MS to comprehensively investigate clear cell renal cell carcinoma plasma collected before (disease) and after (non-disease) curative nephrectomy (n = 40). Proteins detected in the subproteomes were investigated via label-free quantification. Protein abundance analysis revealed a number of low-level proteins with significant differential expression levels in disease samples, including HSPG2, CD146, ECM1, SELL, SYNE1, and VCAM1. Importantly, we observed a strong correlation between differentially expressed proteins and clinical status of the patient. Investigation of the glycoproteome returned 13 candidate glycoproteins with significant differential M-LAC column binding. Qualitative analysis indicated that 62% of selected candidate glycoproteins showed higher levels (upregulation) in M-LAC bound fraction of disease samples. This observation was further confirmed by released N-glycans data in which 53% of identified N-glycans were present at different levels in plasma in the disease vs non-disease samples. This striking result demonstrates the potential for significant protein glycosylation alterations in clear cell renal cell carcinoma cancer plasma. With future validation in a larger cohort, information derived from this study may lead to the development of clear cell renal cell carcinoma candidate biomarkers. PMID:25184692

  15. Adaptive ammoniagenesis in chronic renal failure.

    PubMed

    Dass, P D; Martin, D

    1990-01-01

    The role of gamma-glutamyltransferase (gamma-GT) in renal ammoniagenesis, glutamine (Gln), and glutathione (GSH) utilization was evaluated in the intact functioning rat kidney of subtotal nephrectomy (SNX) model of chronic renal failure (CRF). NH4+ derived from extracellular gamma-GT hydrolysis of Gln and GSH was differentiated from the intramitochondrial phosphate-dependent glutaminase by using acivicin, a gamma-GT-specific inhibitor. In the control (C) group Gln extraction accounted for 61% of total NH4+ production (sum of renal venous and urinary NH4+), but only 41% in SNX group. In the SNX group GSH extraction accounted for 10% of total NH4+ production, but only 1% in the C group. Acivicin inhibited 44% and 33% of total NH4+ production in SNX and C group respectively, as compared to baseline before acivicin. In CRF, gamma-GT a key enzyme of the gamma-glutamyl cycle plays a significant role in adaptive ammoniagenesis.

  16. Adrenocortical carcinoma: An extremely uncommon entity and the role of Immunohistochemistry in its diagnosis.

    PubMed

    Gogoi, G; Baruah, Manash P; Borah, P; Borgohain, M

    2012-12-01

    Adrenocortcal carcinoma is an extremely uncommon entity with an incidence of two in one millionth population. Here we present a 60 year gentleman with pain in abdomen, nausea, and backache, and weight loss. Contrast enhanced computed tomography (CECT) abdomen revealed a heterogenous well defined mass measuring (15 × 10.3 × 13) cm(3) on the left suprarenal region with central necrosis which extended medially up to the midline. Locally, the growth infiltrated the upper pole of left kidney. Initially, the differential diagnosis included that of renal cell carcinoma arising from upper pole of left kidney involving adrenal gland. The patient underwent left radical nephrectomy and left adrenalectomy. Histological evaluation could not differentiate it from of malignant pheochromocytoma, but immunohistochemistry confirmed it as adrenocortical carcinoma. This case highlights the crucial role of immunohistochemistry in establishing the diagnosis like tumors. PMID:23565434

  17. Unilateral Partial Nephrectomy with Warm Ischemia Results in Acute Hypoxia Inducible Factor 1-Alpha (HIF-1α) and Toll-Like Receptor 4 (TLR4) Overexpression in a Porcine Model

    PubMed Central

    Zhang, Zhiyong; Haimovich, Beatrice; Kwon, Young Suk; Lu, Tyler; Fyfe-Kirschner, Billie; Olweny, Ephrem Odoy

    2016-01-01

    Purpose Ischemia/reperfusion (I/R) during partial nephrectomy (PN) contributes to acute kidney injury (AKI), which is inaccurately assessed using existent clinical markers of renal function. We evaluated I/R-related changes in expression in hypoxia inducible factor 1α (HIF-1α) and toll-like receptor 4 (TLR4), within kidney tissue and peripheral blood leukocytes (PBL) in a porcine model of PN. Materials and Methods Three adult pigs each underwent unilateral renal hilar cross clamping for 180 min followed by a 15 min reperfusion. The contralateral kidney served as control. Biopsies of clamped kidneys were obtained at baseline (time 0), every 60 min during the hypoxic phase, and post-reperfusion. Control kidneys were biopsied once at 180 min. Peripheral blood was sampled at time 0, every 30 min during the hypoxic phase, and post-reperfusion. HIF-1α and TLR4 expression in kidney tissue and PBL were analyzed by Western blotting. I/R-related histological changes were assessed. Results Expression of HIF-1α in clamped kidneys and PBL was below detection level at baseline, rising to detectable levels after 60 min of hypoxia, and continuing to rise throughout the hypoxic and reperfusion phases. Expression of TLR-4 in clamped kidneys followed a similar trend with initial detection after 30–60 min of hypoxia. Control kidneys exhibited no change in HIF-1α or TLR-4 expression. I/R-related histologic changes were minimal, primarily mild tubular dilatation. Conclusions In a porcine model of PN, HIF-1α and TLR4 exhibited robust, I/R-related increases in expression in kidney tissue and PBL. Further studies investigating these molecules as potential markers of AKI are warranted. PMID:27149666

  18. Management of poor-risk metastatic renal cell carcinoma: current approaches, the role of temsirolimus and future directions.

    PubMed

    Porta, Camillo; Tortora, Giampaolo; Larkin, James M G; Hutson, Thomas E

    2016-02-01

    Targeted therapies have substantially improved outcomes in metastatic renal cell carcinoma (mRCC). As expected, poor-risk patients have the worst outcomes. Temsirolimus is currently the only agent licensed for treatment of poor-risk mRCC patients. It is associated with meaningful improvements in survival and quality of life, highlighting the importance of correctly stratifying risk in mRCC patients so they receive optimal treatment. Currently, data for other targeted therapies in poor-risk patients are relatively sparse. Optimizing outcomes in these patients is the subject of ongoing research, including studies of biomarkers and studies to elucidate the role of nephrectomy and neoadjuvant targeted therapy in poor-risk mRCC patients. The impacts of novel combinations including temsirolimus have also been explored to further improve outcomes.

  19. Pancreatic exocrine and endocrine function after subtotal pancreatectomy for nesidioblastosis.

    PubMed

    Dunger, D B; Burns, C; Ghale, G K; Muller, D P; Spitz, L; Grant, D B

    1988-02-01

    Pancreatic exocrine and endocrine function was assessed in seven patients 1 to 2 years after 95% pancreatectomy (group A) and three patients 9 to 11 years after 75% pancreatectomy (group B). In all cases surgery was undertaken for the treatment of hyperinsulinism and the histologic diagnosis was nesidioblastosis. The activities of pancreatic enzymes and bicarbonate concentrations were generally normal in group B, but were reduced in approximately half the children in group A. One child in group A had significant exocrine failure and poor weight gain. Blood glucose levels and fasting insulin levels were normal during a standard glucose tolerance test in all of the group B patients. One had a low fasting blood glucose level. In the group A patients three had low fasting glucose levels and one a frankly diabetic glucose tolerance test. C peptide and insulin levels were comparable but inappropriate insulin levels were noted in one patient, suggesting that the control of glucose-stimulated insulin release may remain abnormal. The results suggest that pancreatic function is not seriously impaired in the majority of patients 1 to 2 years after 95% pancreatectomy and that it is comparable to that noted in 75% pancreatectomy patients followed over a longer period of time.

  20. Voice estimation in patients after reconstructive subtotal laryngectomy

    PubMed Central

    2011-01-01

    Background Treatment of laryngeal cancers, may include surgery, radiotherapy, chemotherapy, or a combination. Total laryngectomy (TL) has been the standard surgical treatment. Partial laryngectomy procedures were performed, their advantage over TL is preservation of laryngeal functions. Methods The investigation was carried out on a group of 20 patients (3 female and 17 male), who underwent surgery according the techniques mentioned above. The methods of investigation were based on perceptual voice estimation (GRBAS), videolaryngostroboscopy, acoustic voice analysis, aerodynamic measure maximum phonation time, voice self-assessment (VHI). Results and Conclusions The perceptual voice estimation revealed a good phonation result in only 3 cases after using surgery with the Calearo method as well as the best results of MPT. The VHI reflected severe voice handicap in 2 patients (26 to 40 points). No statistically significant differences were observed between the values of the acoustic parameters in MDVP analysis after following operation -CHEP, Calearo, Sedlacek. PMID:22029703

  1. Renoprotective properties of pirfenidone in subtotally nephrectomized rats.

    PubMed

    Takakuta, Koji; Fujimori, Akira; Chikanishi, Toshihiro; Tanokura, Akira; Iwatsuki, Yoshiyuki; Yamamoto, Masanori; Nakajima, Hidenori; Okada, Masamichi; Itoh, Hiroyuki

    2010-03-10

    Renal fibrosis is the final common pathway of chronic kidney disease, and its progression predicts the degree of renal dysfunction. We investigated the renoprotective properties of pirfenidone in a remnant kidney model of chronic renal failure to determine its pharmacological potency compared to enalapril. Five-sixths nephrectomized rats were fed diet containing pirfenidone (approximately 700mg/kg/day) for 8weeks. Pirfenidone steadily inhibited the progression of proteinuria, but not to a significant degree. Pirfenidone prevented the elevation of plasma creatinine and blood urea nitrogen. At the end of the experiment, pirfenidone had reduced systolic blood pressure by means of its renoprotective effect. In a histological study, pirfenidone improved interstitial fibrosis in the renal cortex. These effects were supported by the suppression of the expression of TGF-beta and fibronectin in the mRNA of the kidney. In contrast, pirfenidone had little effect on the expression of alpha-smooth muscle actin, which is one of the proteins responsible for epithelial-mesenchymal transition. This property was confirmed by the TGF-beta-induced transdifferentiation observed in cultured normal rat kidney tubular epithelial NRK52E cells. These results suggest that pirfenidone improves the progression of chronic renal failure via its antifibrotic action, although pirfenidone has less effective TGF-beta-induced epithelial to mesenchymal transdifferentiation. PMID:20006961

  2. Management of Pediatric Myxopapillary Ependymoma: The Role of Adjuvant Radiation

    SciTech Connect

    Agbahiwe, Harold C.; Wharam, Moody; Batra, Sachin; Cohen, Kenneth; Terezakis, Stephanie A.

    2013-02-01

    Introduction: Myxopapillary ependymoma (MPE) is a rare tumor in children. The primary treatment is gross total resection (GTR), with no clearly defined role for adjuvant radiation therapy (RT). Published reports, however, suggest that children with MPE present with a more aggressive disease course. The goal of this study was to assess the role of adjuvant RT in pediatric patients with MPE. Methods: Sixteen patients with MPE seen at Johns Hopkins Hospital (JHH) between November 1984 and December 2010 were retrospectively reviewed. Fifteen of the patients were evaluable with a mean age of 16.8 years (range, 12-21 years). Kaplan-Meier curves and descriptive statistics were used for analysis. Results: All patients received surgery as the initial treatment modality. Surgery consisted of either a GTR or a subtotal resection (STR). The median dose of adjuvant RT was 50.4 Gy (range, 45-54 Gy). All patients receiving RT were treated at the involved site. After a median follow-up of 7.2 years (range, 0.75-26.4 years), all patients were alive with stable disease. Local control at 5 and 10 years was 62.5% and 30%, respectively, for surgery alone versus 100% at both time points for surgery and adjuvant RT. Fifty percent of the patients receiving surgery alone had local failure. All patients receiving STR alone had local failure compared to 33% of patients receiving GTR alone. One patient in the surgery and adjuvant RT group developed a distant site of recurrence 1 year from diagnosis. No late toxicity was reported at last follow-up, and neurologic symptoms either improved or remained stable following surgery with or without RT. Conclusions: Adjuvant RT improved local control compared to surgery alone and should be considered after surgical resection in pediatric patients with MPE.

  3. Prognostic factors in low grade (WHO grade II) gliomas of the cerebral hemispheres: the role of surgery.

    PubMed Central

    Scerrati, M; Roselli, R; Iacoangeli, M; Pompucci, A; Rossi, G F

    1996-01-01

    OBJECTIVE: To assess the role of surgery on survival of patients with grade II gliomas of the cerebral hemispheres. METHODS: One hundred and thirty one low grade hemispheric gliomas surgically treated (biopsied patients excluded) between 1978 and 1989 were retrospectively reviewed. Thalamic, basal ganglia, callosal, or ventricular location were not considered. All tumours were World Health Organisation (WHO) grade II gliomas: 42 fibrillary and 11 gemistocytic astrocytomas, 49 oligodendrogliomas, and 29 oligoastrocytomas. Patients' ages ranged from 14 to 63 (mean 32.9, median 34) years, Karnofsky performance from 0.50 to 0.90 (mean 80.7, median 80), and postsurgical follow up of the living patients from 24 to 190 (mean 97.02, median 93) months. Postoperative external radiotherapy was performed in 49 cases. RESULTS: The overall survival probability at five years was 97.1%, at eight years 76.1%, and at 10 years 62.7% (median survival time 144 months). The impact on survival of the following variables was analysed: age (< 20, 21-40, and > 40 years), Karnofsky score (80-100, 70 < or = 70), histology, tumour extension (T1 < 3 cm, T2 3-5 cm, T3 > 5 cm maximum diameter), extent of surgical resection (S1 radical, S2 subtotal < 10% residual tumour, S3 partial-10%-50% residual tumour), and radiotherapy (either performed or not). A significant positive association with survival at univariate analysis was found for the age group < 20 years (P = 0.003), for total and subtotal surgical resections (S1 and S2; P < 0.001) and for the non-irradiated patients (P = 0.0049), whereas a shorter survival probability was noticed for gemistocytic astrocytomas (P < 0.001) and for tumour extension > 5 cm (T3; P = 0.0193). Karnofsky performance did not show any significant association with survival. The most relevant factor affecting survival at the multivariate analysis was the extent of surgical resection, which resulted as the only variable retaining a significant value (P = 0.001, risk

  4. Challenging Roles

    ERIC Educational Resources Information Center

    Younker, Keith

    2006-01-01

    A veteran teacher with over 35 years experience, the author reflects on the events of September 11, 2001, and how the events of that day demonstrated that teachers fulfill many shifting roles in their students' lives. Here, he shares his own feelings of profound sadness for all the victims on that day, and discusses how the roles of teachers often…

  5. Role of Nox4 in murine models of kidney disease.

    PubMed

    Babelova, Andrea; Avaniadi, Despina; Jung, Oliver; Fork, Christian; Beckmann, Janet; Kosowski, Judith; Weissmann, Norbert; Anilkumar, Narayana; Shah, Ajay M; Schaefer, Liliana; Schröder, Katrin; Brandes, Ralf P

    2012-08-15

    Nox4 is a hydrogen peroxide-producing NADPH oxidase highly expressed in the kidney which has been linked to epithelial cell injury and diabetic-induced cellular dysfunction in cultured cells. The role of the enzyme for renal pathology in vivo, however, is unclear. To address this, three experimental animal models of renal injury (streptozotocin diabetes I, unilateral ureteral ligation (UUO), and 5/6 nephrectomy (5/6Nx)) were studied in either Nox4-inducible (Nox4(*/*)) or constitutive knockout (Nox4(-/-)) mice. Nox4 contributed more than 80% of diphenylene iodonium-sensitive H(2)O(2) formation of freshly isolated tubules determined by Amplex Red assay. In streptozotocin diabetes, acute deletion of Nox4 by tamoxifen-activated cre-recombinase increased albuminuria, whereas matrix deposition was similar between WT and Nox4(*/*) mice. Interestingly, renal Nox4 expression, mainly localized to tubular cells, decreased in the course of diabetes and this was not associated with a compensatory upregulation of Nox1 or Nox2. In the UUO model, renal expression of ICAM1, connective tissue growth factor, and fibronectin were higher in kidneys of Nox4(*/*) than control mice. Also in this model, levels of Nox4 decreased in the course of the disease. In the 5/6Nx model, which was performed in SV129 and SV129-Nox4(-/-) mice, no difference in the development of hypertension and albuminuria was found between the strains. Collectively, the first in vivo data of the kidney do not support the view that Nox4 is a main driver of renal disease. It rather appears that under specific conditions Nox4 may even slightly limit injury and disease progression.

  6. Curcumin ameliorates renal failure in 5/6 nephrectomized rats: role of inflammation.

    PubMed

    Ghosh, S S; Massey, H D; Krieg, R; Fazelbhoy, Z A; Ghosh, S; Sica, D A; Fakhry, I; Gehr, T W B

    2009-05-01

    TNF-alpha and NF-kappaB play important roles in the development of inflammation in chronic renal failure (CRF). In hepatic cells, curcumin is shown to antagonize TNF-alpha-elicited NF-kappaB activation. In this study, we hypothesized that if inflammation plays a key role in renal failure then curcumin should be effective in improving CRF. The effectiveness of curcumin was compared with enalapril, a compound known to ameliorate human and experimental CRF. Investigation was conducted in Sprague-Dawley rats where CRF was induced by 5/6 nephrectomy (Nx). The Nx animals were divided into untreated (Nx), curcumin-treated (curcumin), and enalapril-treated (enalapril) groups. Sham-operated animals served as a control. Renal dysfunction in the Nx group, as evidenced by elevated blood urea nitrogen, plasma creatinine, proteinuria, segmental sclerosis, and tubular dilatation, was significantly reduced by curcumin and enalapril treatment. However, only enalapril significantly improved blood pressure. Compared with the control, the Nx animals had significantly higher plasma and kidney TNF-alpha, which was associated with NF-kappaB activation and macrophage infiltration in the kidney. These changes were effectively antagonized by curcumin and enalapril treatment. The decline in the anti-inflammatory peroxisome proliferator-activated receptor gamma (PPARgamma) seen in Nx animals was also counteracted by curcumin and enalapril. Studies in mesangial cells were carried out to further establish that the anti-inflammatory effect of curcumin in vivo was mediated essentially by antagonizing TNF-alpha. Curcumin dose dependently antagonized the TNF-alpha-mediated decrease in PPARgamma and blocked transactivation of NF-kappaB and repression of PPARgamma, indicating that the anti-inflamatory property of curcumin may be responsible for alleviating CRF in Nx animals.

  7. Diminazene Aceturate Improves Cardiac Fibrosis and Diastolic Dysfunction in Rats with Kidney Disease

    PubMed Central

    Velkoska, Elena; Patel, Sheila K.; Griggs, Karen

    2016-01-01

    Angiotensin converting enzyme (ACE) 2 is a negative regulator of the renin angiotensin system (RAS) through its role to degrade angiotensin II. In rats with subtotal nephrectomy (STNx), adverse cardiac remodelling occurs despite elevated cardiac ACE2 activity. We hypothesised that diminazene aceturate (DIZE), which has been described as having an off-target effect to activate ACE2, would have beneficial cardiac effects in STNx rats. STNx led to hypertension, diastolic dysfunction, left ventricular hypertrophy, cardiac fibrosis, and increased cardiac ACE, ACE2, Ang II and Ang 1–7 levels. Cardiac gene expression of ADAM17 was also increased. In STNx, two-weeks of subcutaneous DIZE (15mg/kg/d) had no effect on blood pressure but improved diastolic dysfunction and cardiac fibrosis, reduced ADAM17 mRNA and shifted the cardiac RAS balance to a cardioprotective profile with reduced ACE and Ang II. There was no change in cardiac ACE2 activity or in cardiac Ang 1–7 levels with DIZE. In conclusion, our results suggest that DIZE exerts a protective effect on the heart under the pathological condition of kidney injury. This effect was not due to improved kidney function, a fall in blood pressure or a reduction in LVH but was associated with a reduction in cardiac ACE and cardiac Ang II levels. As in vitro studies showed no direct effect of DIZE on ACE2 or ACE activity, the precise mechanism of action of DIZE remains to be determined. PMID:27571511

  8. Interplay between transglutaminases and heparan sulphate in progressive renal scarring

    PubMed Central

    Burhan, Izhar; Furini, Giulia; Lortat-Jacob, Hugues; Atobatele, Adeola G.; Scarpellini, Alessandra; Schroeder, Nina; Atkinson, John; Maamra, Mabrouka; Nutter, Faith H.; Watson, Philip; Vinciguerra, Manlio; Johnson, Timothy S.; Verderio, Elisabetta A. M.

    2016-01-01

    Transglutaminase-2 (TG2) is a new anti-fibrotic target for chronic kidney disease, for its role in altering the extracellular homeostatic balance leading to excessive build-up of matrix in kidney. However, there is no confirmation that TG2 is the only transglutaminase involved, neither there are strategies to control its action specifically over that of the conserved family-members. In this study, we have profiled transglutaminase isozymes in the rat subtotal nephrectomy (SNx) model of progressive renal scarring. All transglutaminases increased post-SNx peaking at loss of renal function but TG2 was the predominant enzyme. Upon SNx, extracellular TG2 deposited in the tubulointerstitium and peri-glomerulus via binding to heparan sulphate (HS) chains of proteoglycans and co-associated with syndecan-4. Extracellular TG2 was sufficient to activate transforming growth factor-β1 in tubular epithelial cells, and this process occurred in a HS-dependent way, in keeping with TG2-affinity for HS. Analysis of heparin binding of the main transglutaminases revealed that although the interaction between TG1 and HS is strong, the conformational heparin binding site of TG2 is not conserved, suggesting that TG2 has a unique interaction with HS within the family. Our data provides a rationale for a novel anti-fibrotic strategy specifically targeting the conformation-dependent TG2-epitope interacting with HS. PMID:27694984

  9. Effects of methimazole on low-renal-mass hypertension: changes in blood pressure and pressor responsiveness to vasoconstrictors.

    PubMed

    Andrade, J L; Haro, J M; Castillo, M A; de Luna, J D; Vargas, F

    1992-01-01

    The administration of the antithyroid drug methimazole to rats via drinking water prevented the development of hypertension that usually accompanies subtotal nephrectomy and saline drinking (1% NaCl). In methimazole-treated rats, elevated blood pressure induced 5 weeks previously returned to normotensive levels. Pressor responsiveness to angiotensin, vasopressin and norepinephrine in unanesthetized rats was studied after prevention of hypertension in control, low-renal-mass hypertensive (LRM) and low-renal-mass methimazole-treated (LRM-M) rats, and in the reversion study in LRM and LRM-M rats. In LRM rats, responsiveness to vasoconstrictors was increased, whereas responsiveness to vasoconstriction was clearly reduced in LRM-M rats after prevention and reversion studies. These results suggest that (a) thyroid hormones are required in the early and established phases of LRM hypertension, and (b) the decreased pressor responsiveness to vasoconstrictors may play a role in the prevention and reversion of this type of hypertension following methimazole administration. However, the changes in pressor responsiveness may also be secondary to the reduction in blood pressure.

  10. Diminazene Aceturate Improves Cardiac Fibrosis and Diastolic Dysfunction in Rats with Kidney Disease.

    PubMed

    Velkoska, Elena; Patel, Sheila K; Griggs, Karen; Burrell, Louise M

    2016-01-01

    Angiotensin converting enzyme (ACE) 2 is a negative regulator of the renin angiotensin system (RAS) through its role to degrade angiotensin II. In rats with subtotal nephrectomy (STNx), adverse cardiac remodelling occurs despite elevated cardiac ACE2 activity. We hypothesised that diminazene aceturate (DIZE), which has been described as having an off-target effect to activate ACE2, would have beneficial cardiac effects in STNx rats. STNx led to hypertension, diastolic dysfunction, left ventricular hypertrophy, cardiac fibrosis, and increased cardiac ACE, ACE2, Ang II and Ang 1-7 levels. Cardiac gene expression of ADAM17 was also increased. In STNx, two-weeks of subcutaneous DIZE (15mg/kg/d) had no effect on blood pressure but improved diastolic dysfunction and cardiac fibrosis, reduced ADAM17 mRNA and shifted the cardiac RAS balance to a cardioprotective profile with reduced ACE and Ang II. There was no change in cardiac ACE2 activity or in cardiac Ang 1-7 levels with DIZE. In conclusion, our results suggest that DIZE exerts a protective effect on the heart under the pathological condition of kidney injury. This effect was not due to improved kidney function, a fall in blood pressure or a reduction in LVH but was associated with a reduction in cardiac ACE and cardiac Ang II levels. As in vitro studies showed no direct effect of DIZE on ACE2 or ACE activity, the precise mechanism of action of DIZE remains to be determined. PMID:27571511

  11. p-Cresyl sulfate promotes insulin resistance associated with CKD.

    PubMed

    Koppe, Laetitia; Pillon, Nicolas J; Vella, Roxane E; Croze, Marine L; Pelletier, Caroline C; Chambert, Stéphane; Massy, Ziad; Glorieux, Griet; Vanholder, Raymond; Dugenet, Yann; Soula, Hédi A; Fouque, Denis; Soulage, Christophe O

    2013-01-01

    The mechanisms underlying the insulin resistance that frequently accompanies CKD are poorly understood, but the retention of renally excreted compounds may play a role. One such compound is p-cresyl sulfate (PCS), a protein-bound uremic toxin that originates from tyrosine metabolism by intestinal microbes. Here, we sought to determine whether PCS contributes to CKD-associated insulin resistance. Administering PCS to mice with normal kidney function for 4 weeks triggered insulin resistance, loss of fat mass, and ectopic redistribution of lipid in muscle and liver, mimicking features associated with CKD. Mice treated with PCS exhibited altered insulin signaling in skeletal muscle through ERK1/2 activation. In addition, exposing C2C12 myotubes to concentrations of PCS observed in CKD caused insulin resistance through direct activation of ERK1/2. Subtotal nephrectomy led to insulin resistance and dyslipidemia in mice, and treatment with the prebiotic arabino-xylo-oligosaccharide, which reduced serum PCS by decreasing intestinal production of p-cresol, prevented these metabolic derangements. Taken together, these data suggest that PCS contributes to insulin resistance and that targeting PCS may be a therapeutic strategy in CKD. PMID:23274953

  12. Mild systemic thermal therapy ameliorates renal dysfunction in a rodent model of chronic kidney disease.

    PubMed

    Iwashita, Yoshihiro; Kuwabara, Takashige; Hayata, Manabu; Kakizoe, Yutaka; Izumi, Yuichiro; Iiyama, Junichi; Kitamura, Kenichiro; Mukoyama, Masashi

    2016-06-01

    Thermal therapy has become a nonpharmacological therapy in clinical settings, especially for cardiovascular diseases. However, the practical role of thermal therapy on chronic kidney disease remains elusive. We performed the present study to investigate whether a modified thermal protocol, repeated mild thermal stimulation (MTS), could affect renal damages in chronic kidney disease using a mouse renal ablation model. Mice were subjected to MTS or room temperature (RT) treatment once daily for 4 wk after subtotal nephrectomy (Nx) or sham operation (Sh). We revealed that MTS alleviated renal impairment as indicated by serum creatinine and albuminuria in Nx groups. In addition, the Nx + MTS group showed attenuated tubular histological changes and reduced urinary neutrophil gelatinase-associated lipocalin excretion approximately by half compared with the Nx + RT group. Increased apoptotic signaling, such as TUNEL-positive cell count and cleavage of caspase 3, as well as enhanced oxidative stress were significantly reduced in the Nx + MTS group compared with the Nx + RT group. These changes were accompanied with the restoration of kidney Mn-SOD levels by MTS. Heat shock protein 27, a key molecular chaperone, was phosphorylated by MTS only in Nx kidneys rather than in Sh kidneys. MTS also tended to increase the phosphorylation of p38 MAPK and Akt in Nx kidneys, possibly associated with the activation of heat shock protein 27. Taken together, these results suggest that modified MTS can protect against renal injury in a rodent model of chronic kidney disease.

  13. [Rhabdomyolysis following nephrectomy for pyonephrosis: a case report].

    PubMed

    Gakiya, M; Ogawa, Y

    1999-03-01

    A 33-year-old man with chronic alcoholism presented with left flank pain and a low-grade fever. He had a previous history of left renal calculi treated by extracorporeal shockwave lithotripsy 3 months previously at a local hospital. Since a stone was impacted at the ureteropelvic junction resulting in septic hydronephrosis, a D-J catheter was introduced to relieve the condition. He underwent fluid therapy with antibiotics. Elective pyelolithotomy was scheduled on day 10. However, persistent pyonephrosis necessitated the removal of the infected kidney. Hyperthermia over 40 degrees C continued after surgery and dark urine developed on postoperative day 2. Rhabdomyolysis was suspected because of myoglobulinemia with a high creatine phosphokinase level. Systemic cooling and treatment with fluid and diuretics saved his renal function. He survived episodic malignant hyperthermia and was discharged from intensive care unit on postoperative day 5.

  14. Root cause analysis following nephrectomy after extracorporeal shockwave lithotripsy (ESWL).

    PubMed

    Cahill, Katie; Cruz, Eneida; Guilbert, Mary Beth; Oser, Meg O'Toole

    2008-12-01

    An adverse event after a routine extracorporeal shockwave lithotripsy procedure set into motion a root cause analysis methodology to decipher why and how the event occurred and offer a solution to prevent it from happening again. The process of performing a root cause analysis is discussed in detail.

  15. Parcial Nephrectomies - results of 12 years from an Oncology Institution.

    PubMed

    Freitas, Rui; Cruz, Ricardo; Antunes, Luís; Araújo, Paulo; Silva, Pedro; Saraiva, Luis; Magalhães, Sanches; Moreira Silva, Vitor; Morais, António; Lobo, Francisco; Oliveira, Jorge

    2016-02-01

    Introdução: O diagnóstico de carcinoma de células renais tem vindo a aumentar nos últimos anos, sobretudo pelo seu diagnóstico incidental, e de forma paralela tem aumentado as indicações para cirurgia preservadora de nefrónios.Objectivos: Rever uma série de nefrectomias parciais de uma instituição oncológica em termos técnicos, sobrevida, variação da função renal. Material e Métodos: Análise retrospectiva de todos os doentes com neoplasia renal, submetidos a nefrectomia parcial na nossa instituição entre janeiro de 2000 e dezembro de 2012. Resultados: Foram realizadas 156 nefrectomias parciais, 85 em homens e 71 em mulheres, com média de idades de 62 '± 15 anos. A abordagem foi em 23 casos transperitoneal laparoscópica sendo nos restantes 133 por lombotomia. O tempo médio de isquemia foi < 25 minutos em todos os doentes. A taxa de complicações foi de 10,9%, a maioria grau 2 e 3 da escala de Clavien-Dindo. Os tumores tinham dimensões médias de 2,9 '± 1,4 cm e a margem cirúrgica estava focalmente atingida por tumor em 9,6% dos casos. Em termos histológicos, verificou-se em 26,2% dos casos a existência de carcinoma de células renais de células claras, sendo os oncocitomas a neoplasia benigna mais frequente com 14,7% do total. No seguimento dos doentes verificaram-se 4 casos de recidiva e um óbito pela doença. A variação média na taxa de filtração glomerular estimada foi de -5,3 mL/min por 1,73 m2 (p < 0,001). Não se verificou associação entre tempo de isquemia, índice de massa corporal, idade, score ASA, existência de complicações com este decréscimo da taxa de filtração glomerular. Discussão: Os casos de margens cirúrgicas positivas são ligeiramente superiores ao descrito na literatura, todavia não foram encontrados factores preditivos para tal e em última análise não foi encontrada recidiva tumoral ou qualquer influência na sobrevida destes doentes. Apesar de ter se ter verificado uma diminuição significativa da taxa de filtração glomerular, o tempo de isquemia quente foi muito reduzido e apenas cinco doentes apresentaram taxa de filtração glomerular de novo < 60 mL/min por 1,73 m2 e apenas dois iniciaram programa regular de hemodiálise. Um centro de grande volume cirúrgico parece ser necessário para optimização técnica e resolução de complicações. Conclusão: A série de nefrectomias parciais apresenta resultados de controlo oncológico e de preservação da função renal sobreponíveis aos de outras séries da literatura. Esta é uma técnica segura que apresenta bons resultados, justificando o seu crescimento.

  16. Preserved Nephrogenesis Following Partial Nephrectomy in Early Neonates

    PubMed Central

    Kirita, Yuhei; Kami, Daisuke; Ishida, Ryo; Adachi, Takaomi; Tamagaki, Keiichi; Matoba, Satoaki; Kusaba, Tetsuro; Gojo, Satoshi

    2016-01-01

    Reconstitution of total nephron segments after resection in the adult kidney has not been achieved; however, whether the neonatal kidney can maintain the capacity for neo-nephrogenesis after resection is unknown. We performed partial resection of the kidney in neonatal rats on postnatal days 1 (P1x kidney) and 4 (P4x kidney) and examined morphological changes and relevant factors. The P1x kidney bulged into the newly formed cortex from the wound edge, while nephrogenesis failure was prominent in the P4x kidney. Twenty-eight days post-resection, the glomerular number, cortex area, and collecting duct were preserved in the P1x kidney, whereas these parameters were markedly decreased in the P4x kidney. During normal development, Six2 expression and Six2+ nephron progenitor cells in the cap mesenchyme both rapidly disappear after birth. However, time course analysis for the P1x kidney showed that Six2 expression and Six2+ cells were well preserved in the tissue surrounding the resected area even 2 days after resection. In conclusion, our results indicate that kidneys in early neonate rats retain the capability for neo-nephrogenesis after resection; however, this ability is lost soon after birth, which may be attributed to a declining amount of Six2+ cells. PMID:27244673

  17. Nicotine exposure and the progression of chronic kidney disease: role of the α7-nicotinic acetylcholine receptor.

    PubMed

    Rezonzew, Gabriel; Chumley, Phillip; Feng, Wenguang; Hua, Ping; Siegal, Gene P; Jaimes, Edgar A

    2012-07-15

    Clinical studies have established the role of cigarette smoking as a risk factor in the progression of chronic kidney disease (CKD). We have shown that nicotine promotes mesangial cell proliferation and hypertrophy via nonneuronal nicotinic acetylcholine receptors (nAChRs). The α7-nAChR is one of the most important subunits of the nAChRs. These studies were designed to test the hypothesis that nicotine worsens renal injury in rats with 5/6 nephrectomy (5/6Nx) and that the α7-nAChR subunit is required for these effects. We studied five different groups: Sham, 5/6Nx, 5/6Nx + nicotine (Nic; 100 μg/ml dry wt), 5/6Nx + Nic + α7-nAChR blocker methyllicaconitine (MLA; 3 mg·kg(-1)·day(-1) sq), and Sham + Nic. Blood pressure was measured by the tail-cuff method, and urine was collected for proteinuria. After 12 wk, the rats were euthanized and kidneys were collected. We observed expression of the α7-nAChR in the proximal and distal tubules. The administration of nicotine induced a small increase in blood pressure and resulted in cotinine levels similar to those found in the plasma of smokers. In 5/6Nx rats, the administration of nicotine significantly increased urinary protein excretion (onefold), worsened the glomerular injury score and increased fibronectin (∼ 50%), NADPH oxidase 4 (NOX4; ∼100%), and transforming growth factor-β expression (∼200%). The administration of nicotine to sham rats increased total proteinuria but not albuminuria, suggesting direct effects on tubular protein reabsorption. These effects were prevented by MLA, demonstrating a critical role for the α7-nAChR as a mediator of the effects of nicotine in the progression of CKD.

  18. Axl tyrosine kinase protects against tubulo-interstitial apoptosis and progression of renal failure in a murine model of chronic kidney disease and hyperphosphataemia.

    PubMed

    Hyde, Gareth D; Taylor, Rebecca F; Ashton, Nick; Borland, Samantha J; Wu, Hon Sing Geoffrey; Gilmore, Andrew P; Canfield, Ann E

    2014-01-01

    Chronic kidney disease (CKD) is defined as the progressive loss of renal function often involving glomerular, tubulo-interstitial and vascular pathology. CKD is associated with vascular calcification; the extent of which predicts morbidity and mortality. However, the molecular regulation of these events and the progression of chronic kidney disease are not fully elucidated. To investigate the function of Axl receptor tyrosine kinase in CKD we performed a sub-total nephrectomy and fed high phosphate (1%) diet to Axl+/+ and Axl-/- mice. Plasma Gas6 (Axl' ligand), renal Axl expression and downstream Akt signalling were all significantly up-regulated in Axl+/+ mice following renal mass reduction and high phosphate diet, compared to age-matched controls. Axl-/- mice had significantly enhanced uraemia, reduced bodyweight and significantly reduced survival following sub-total nephrectomy and high phosphate diet compared to Axl+/+ mice; only 45% of Axl-/- mice survived to 14 weeks post-surgery compared to 87% of Axl+/+ mice. Histological analysis of kidney remnants revealed no effect of loss of Axl on glomerular hypertrophy, calcification or renal sclerosis but identified significantly increased tubulo-interstitial apoptosis in Axl-/- mice. Vascular calcification was not induced in Axl+/+ or Axl-/- mice in the time frame we were able to examine. In conclusion, we identify the up-regulation of Gas6/Axl signalling as a protective mechanism which reduces tubulo-interstitial apoptosis and slows progression to end-stage renal failure in the murine nephrectomy and high phosphate diet model of CKD.

  19. Operator roles in robotics

    SciTech Connect

    Lyman, J.; Madni, A.M.

    1984-01-01

    The authors suggest that operator roles in robotics can be classified under the categories of monitor, manager, and maintainer. With increasingly sophisticated applications of machine intelligence, however, these roles will require explicit and continuing reassessment. 5 references.

  20. Subtotal tongue necrosis in delayed diagnosed giant-cell arteritis: a case report.

    PubMed

    Biebl, Matthias Oliver; Hugl, Beate; Posch, Lydia; Tzankov, Alexandar; Weber, Florian; Perkmann, Reinhold; Fraedrich, Gustav

    2004-01-01

    Giant-cell arteritis (GCA) is a chronic systemic vasculitis of large- and medium-sized vessels, mainly affecting elderly patients. Headache, vision impairment, jaw claudication, and scalp tenderness are common symptoms. However, diagnosis can be difficult because GCA can affect almost every vascular pathway and lead to a variety of possible manifestations. We report the case of a belated diagnosed GCA, resulting in nearly complete necrosis of the mobile part of the tongue, visual impairment, and neurologic as well as intestinal ischemic symptoms. Aggressive immunosuppressive treatment resolved the symptoms, but the patient remained severely morbid because of bilateral necrosis of the mobile part of the tongue. In any case of unclear ischemic symptoms in an elderly patient, one must keep GCA in mind as the possible culprit disease.

  1. Subtotal Scapulectomy With Scapulothoracic Fusion and Local Tendon Transfer for Management of Chondrosarcoma.

    PubMed

    Schoch, Bradley; Shives, Thomas; Elhassan, Bassem

    2016-06-01

    Scapulectomy can dramatically alter glenohumeral function and the ability of patients to conduct activities of daily living. In oncologic cases, treatment of the tumor can compromise local musculature, making successful reconstruction difficult to achieve. Depending on the resection level, local musculature may be inadequate to restore shoulder range of motion and/or glenohumeral stability. Surgeons have attempted to address these issues via soft-tissue repairs, allograft replacement, and prosthetic replacement, with variable success. Outcomes are better when a greater portion of the scapula is preserved, thus saving functional rotator cuff muscle bellies. However, preservation of significant rotator cuff musculature is not routinely possible. To our knowledge, no authors in the English-language orthopaedic literature have reported on local tendon transfers as a technique to augment and reconstruct the rotator cuff in a patient with previous scapulectomy. PMID:27115794

  2. Apocynin Attenuates Cardiac Injury in Type 4 Cardiorenal Syndrome via Suppressing Cardiac Fibroblast Growth Factor-2 With Oxidative Stress Inhibition

    PubMed Central

    Liu, Yang; Liu, Yu; Liu, Xun; Chen, Jie; Zhang, Kun; Huang, Feifei; Wang, Jing-Feng; Tang, Wanchun; Huang, Hui

    2015-01-01

    Background Type 4 cardiorenal syndrome (CRS) refers to the cardiac injury induced by chronic kidney disease. We aimed to assess oxidative stress and cardiac injury in patients with type 4 CRS, determine whether the antioxidant apocynin attenuated cardiac injury in rats with type 4 CRS, and explore potential mechanisms. Methods and Results A cross-sectional study was conducted among patients with type 4 CRS (n=17) and controls (n=16). Compared with controls, patients with type 4 CRS showed elevated oxidative stress, which was significantly correlated with cardiac hypertrophy and decreased ejection fraction. In vivo study, male Sprague-Dawley rats underwent 5/6 subtotal nephrectomy and sham surgery, followed with apocynin or vehicle treatment for 8 weeks. Eight weeks after surgery, the 5/6 subtotal nephrectomy rats mimicked type 4 CRS, showing increased serum creatinine, cardiac hypertrophy and fibrosis, and decreased ejection fraction compared with sham-operated animals. Cardiac malondialdehyde, NADPH oxidase activity, fibroblast growth factor-2, and extracellular signal-regulated kinase 1/2 (ERK1/2) phosphorylation increased significantly in the 5/6 subtotal nephrectomy rats. These changes were significantly attenuated by apocynin. In vitro study showed that apocynin reduced angiotensin II–induced NADPH oxidase–dependent oxidative stress, upregulation of fibroblast growth factor-2 and fibrosis biomarkers, and ERK1/2 phosphorylation in cardiac fibroblasts. Importantly, the ERK1/2 inhibitor U0126 reduced the upregulation of fibroblast growth factor-2 and fibrosis biomarkers in angiotensin II–treated fibroblasts. Conclusions Oxidative stress is a candidate mediator for type 4 CRS. Apocynin attenuated cardiac injury in type 4 CRS rats via inhibiting NADPH oxidase–dependent oxidative stress-activated ERK1/2 pathway and subsequent fibroblast growth factor-2 upregulation. Our study added evidence to the beneficial effect of apocynin in type 4 CRS. PMID:26109504

  3. Role Discovery in Graphs

    SciTech Connect

    2014-08-14

    RolX takes the features from Re-FeX or any other feature matrix as input and outputs role assignments (clusters). The output of RolX is a csv file containing the node-role memberships and a csv file containing the role-feature definitions.

  4. Public Roles, Private Lives

    ERIC Educational Resources Information Center

    Lum, Lydia

    2008-01-01

    The role of a presidential spouse is very complex. Indeed, expectations vary among college governing boards and campus constituencies of what a presidential spouse's responsibilities should be. In this article, the author discusses the role of presidential spouses and how they balance their public roles with their private life.

  5. Influences on role expansion.

    PubMed

    Bullough, B

    1976-09-01

    Several factors are influencing role expansion for registered nurses, among them the shortage of primary care physicians, the federal government, the physician's assistant movement, the growing complexity of acute hospital care, educational reform, and the women's liberation movement. As state licensure statutes are revised to allow for role expansion, the changing laws themselves become a factor supporting the movement.

  6. Role Playing and Skits

    ERIC Educational Resources Information Center

    Letwin, Robert, Ed.

    1975-01-01

    Explores non-scripted role playing, dialogue role playing, sociodrama, and skits as variations of simulation techniques. Provides step-by-step guidelines for conducting such sessions. Successful Meetings, Bill Communications, Inc., 1422 Chestnut Street, Philadelphia, Pa. 19102. Subscription Rates: yearly (US, Canada, Mexico) $14.00; elsewhere,…

  7. Reconceptualizing Evaluator Roles

    ERIC Educational Resources Information Center

    Skolits, Gary J.; Morrow, Jennifer Ann; Burr, Erin Mehalic

    2009-01-01

    The current evaluation literature tends to conceptualize evaluator roles as a single, overarching orientation toward an evaluation, an orientation largely driven by evaluation methods, models, or stakeholder orientations. Roles identified range from a social transformer or a neutral social scientist to that of an educator or even a power merchant.…

  8. Expanded Roles for HRD.

    ERIC Educational Resources Information Center

    1998

    This document contains three papers from a symposium on expanded roles for human resource development (HRD). "The Roles of Consultants in Gainsharing Firms: Empirical Results" (Eunsang Cho, Gary N. McLean) reports findings that consultants are moderately involved at the separation, preparation, evaluation, and design stages and have low…

  9. High Fat High Cholesterol Diet (Western Diet) Aggravates Atherosclerosis, Hyperglycemia and Renal Failure in Nephrectomized LDL Receptor Knockout Mice: Role of Intestine Derived Lipopolysaccharide.

    PubMed

    Ghosh, Siddhartha S; Righi, Samuel; Krieg, Richard; Kang, Le; Carl, Daniel; Wang, Jing; Massey, H Davis; Sica, Domenic A; Gehr, Todd W B; Ghosh, Shobha

    2015-01-01

    A high fat meal, frequently known as western diet (WD), exacerbates atherosclerosis and diabetes. Both these diseases are frequently associated with renal failure. Recent studies have shown that lipopolysaccharide (LPS) leaks into the circulation from the intestine in the setting of renal failure and after WD. However, it is not clear how renal function and associated disorders are affected by LPS. This study demonstrates that circulatory LPS exacerbates renal insufficiency, atherosclerosis and glucose intolerance. Renal insufficiency was induced by 2/3 nephrectomy in LDL receptor knockout mice. Nx animals were given normal diet (Nx) or WD (Nx+WD). The controls were sham operated animals on normal diet (control) and WD (WD). To verify if LPS plays a role in exaggerating renal insufficiency, polymyxin (PM), a known LPS antagonist, and curcumin (CU), a compound known to ameliorate chronic kidney disease (CKD), was given to Nx animals on western diet (Nx+WD+PM and Nx+WD+CU, respectively). Compared to control, all other groups displayed increased circulatory LPS. The Nx+WD cohort had the highest levels of LPS. Nx group had significant renal insufficiency and glucose intolerance but not atherosclerosis. WD had intense atherosclerosis and glucose intolerance but it did not show signs of renal insufficiency. Compared to other groups, Nx+WD had significantly higher cytokine expression, macrophage infiltration in the kidney, renal insufficiency, glucose intolerance and atherosclerosis. PM treatment blunted the expression of cytokines, deterioration of renal function and associated disorders, albeit not to the levels of Nx, and was significantly inferior to CU. PM is a non-absorbable antibiotic with LPS binding properties, hence its beneficial effect can only be due to its effect within the GI tract. We conclude that LPS may not cause renal insufficiency but can exaggerate kidney failure and associated disorders following renal insufficiency.

  10. High Fat High Cholesterol Diet (Western Diet) Aggravates Atherosclerosis, Hyperglycemia and Renal Failure in Nephrectomized LDL Receptor Knockout Mice: Role of Intestine Derived Lipopolysaccharide

    PubMed Central

    Ghosh, Siddhartha S.; Righi, Samuel; Krieg, Richard; Kang, Le; Carl, Daniel; Wang, Jing; Massey, H. Davis; Sica, Domenic A.; Gehr, Todd W. B.; Ghosh, Shobha

    2015-01-01

    A high fat meal, frequently known as western diet (WD), exacerbates atherosclerosis and diabetes. Both these diseases are frequently associated with renal failure. Recent studies have shown that lipopolysaccharide (LPS) leaks into the circulation from the intestine in the setting of renal failure and after WD. However, it is not clear how renal function and associated disorders are affected by LPS. This study demonstrates that circulatory LPS exacerbates renal insufficiency, atherosclerosis and glucose intolerance. Renal insufficiency was induced by 2/3 nephrectomy in LDL receptor knockout mice. Nx animals were given normal diet (Nx) or WD (Nx+WD). The controls were sham operated animals on normal diet (control) and WD (WD). To verify if LPS plays a role in exaggerating renal insufficiency, polymyxin (PM), a known LPS antagonist, and curcumin (CU), a compound known to ameliorate chronic kidney disease (CKD), was given to Nx animals on western diet (Nx+WD+PM and Nx+WD+CU, respectively). Compared to control, all other groups displayed increased circulatory LPS. The Nx+WD cohort had the highest levels of LPS. Nx group had significant renal insufficiency and glucose intolerance but not atherosclerosis. WD had intense atherosclerosis and glucose intolerance but it did not show signs of renal insufficiency. Compared to other groups, Nx+WD had significantly higher cytokine expression, macrophage infiltration in the kidney, renal insufficiency, glucose intolerance and atherosclerosis. PM treatment blunted the expression of cytokines, deterioration of renal function and associated disorders, albeit not to the levels of Nx, and was significantly inferior to CU. PM is a non-absorbable antibiotic with LPS binding properties, hence its beneficial effect can only be due to its effect within the GI tract. We conclude that LPS may not cause renal insufficiency but can exaggerate kidney failure and associated disorders following renal insufficiency. PMID:26580567

  11. Role relationships: lesbian perspectives.

    PubMed

    Lynch, J M; Reilly, M E

    This questionnaire study of 140 lesbians, 70 couples who have lived together for one or more years, explores equality and role relationships. We predicted that lesbians would achieve partnerships characterized by equality and freedom from traditional butch-femme role playing. Financial sharing and decision-making were found to be characterized by high degrees of equality. Household responsibilities tended to be performed individually, but no role-playing was evident. Sexual intimacy items indicated less perceived equality than other areas. And overall, some partners were viewed as unequal. The variables of age, income, education, occupation, assets, and years living together did not explain the inequality observed.

  12. Roles within the Family

    MedlinePlus

    ... Spread the Word Shop AAP Find a Pediatrician Family Life Medical Home Family Dynamics Adoption & Foster Care ... Text Size Email Print Share Roles Within the Family Page Content Article Body Families are not democracies. ...

  13. Dad's Role in Breastfeeding

    MedlinePlus

    ... Text Size Email Print Share Dad's Role in Breastfeeding Page Content Article Body Let’s say you and ... you can be when the time comes. Successful nursing depends on a host of factors, many of ...

  14. Role-Playing Mitosis.

    ERIC Educational Resources Information Center

    Wyn, Mark A.; Stegink, Steven J.

    2000-01-01

    Introduces a role playing activity that actively engages students in the learning process of mitosis. Students play either chromosomes carrying information, or cells in the cell membrane. (Contains 11 references.) (Author/YDS)

  15. Nursing Reclaims its Role.

    ERIC Educational Resources Information Center

    Diers, Donna

    1982-01-01

    An attempt is made to explain the nurses' role: what the nurse is, what the nurse does, how the nurse is viewed by society, why nurses suffer burnout, nursing costs, and health care system reform. (CT)

  16. Sex Role and Pupil Role in Early Childhood Education.

    ERIC Educational Resources Information Center

    Lee, Patrick C.; Kedar, Gita

    This article analyzes the interaction between sex role and "pupil role" in the early childhood education setting. It postulates that teachers and schools have a demonstrated investment in socializing children to a passive, docile, and dependent role, beginning at the preschool level. This role, called "pupil role," corresponds closely to the…

  17. RIPK3-Mediated Necroptosis and Apoptosis Contributes to Renal Tubular Cell Progressive Loss and Chronic Kidney Disease Progression in Rats

    PubMed Central

    Zhu, Yongjun; Cui, Hongwang; Xia, Yunfeng; Gan, Hua

    2016-01-01

    Tubulointerstitial fibrosis (TIF) is caused by the progressive loss of renal tubular cells and the consequent replacement of the extracellular matrix. The progressive depletion of renal tubular cells results from apoptosis and necroptosis; however, the relative significance of each of these cell death mechanisms at different stages during the progression of chronic kidney disease (CKD) remains unclear. We sought to explore the mechanisms of renal tubular cell death during the early and intermediate stages of chronic renal damage of subtotal nephrectomied (SNx) rats. The results of tissue histological assays indicated that the numbers of necrotic dying cells and apoptotic cells were significantly higher in kidney tissues derived from a rat model of CKD. In addition, there was a significant increase in necroptosis observed by transmission electron microscopy (TEM) and an increase in the proportion of TUNEL-positive cells in kidney tissues from SNx rats compared with control rats, and necrostatin-1 (Nec-1) could inhibit necroptosis and reduce the proportion of TUNEL-positive cells. More importantly, we observed a significant increase in the incidence of necroptosis compared with apoptosis by TEM in vivo and in vitro and a significant increase in the proportion of TUNEL-positive tubular epithelial cells that did not express caspase-3 compared with those expressing cleaved caspase-3 in vitro. Furthermore, treatment with Nec-1 and zVAD strongly reduced necroptosis- and apoptosis-mediated renal tubular cell death and decreased the levels of blood urea nitrogen and serum creatinine and tubular damage scores of SNx rats. These results suggest that necroptotic cell death plays a more significant role than apoptosis in mediating the loss of renal tubular cells in SNx rats and that effectively blocking both necroptosis and apoptosis improves renal function and tubular damage at early and intermediate stages of CKD. PMID:27281190

  18. RIPK3-Mediated Necroptosis and Apoptosis Contributes to Renal Tubular Cell Progressive Loss and Chronic Kidney Disease Progression in Rats.

    PubMed

    Zhu, Yongjun; Cui, Hongwang; Xia, Yunfeng; Gan, Hua

    2016-01-01

    Tubulointerstitial fibrosis (TIF) is caused by the progressive loss of renal tubular cells and the consequent replacement of the extracellular matrix. The progressive depletion of renal tubular cells results from apoptosis and necroptosis; however, the relative significance of each of these cell death mechanisms at different stages during the progression of chronic kidney disease (CKD) remains unclear. We sought to explore the mechanisms of renal tubular cell death during the early and intermediate stages of chronic renal damage of subtotal nephrectomied (SNx) rats. The results of tissue histological assays indicated that the numbers of necrotic dying cells and apoptotic cells were significantly higher in kidney tissues derived from a rat model of CKD. In addition, there was a significant increase in necroptosis observed by transmission electron microscopy (TEM) and an increase in the proportion of TUNEL-positive cells in kidney tissues from SNx rats compared with control rats, and necrostatin-1 (Nec-1) could inhibit necroptosis and reduce the proportion of TUNEL-positive cells. More importantly, we observed a significant increase in the incidence of necroptosis compared with apoptosis by TEM in vivo and in vitro and a significant increase in the proportion of TUNEL-positive tubular epithelial cells that did not express caspase-3 compared with those expressing cleaved caspase-3 in vitro. Furthermore, treatment with Nec-1 and zVAD strongly reduced necroptosis- and apoptosis-mediated renal tubular cell death and decreased the levels of blood urea nitrogen and serum creatinine and tubular damage scores of SNx rats. These results suggest that necroptotic cell death plays a more significant role than apoptosis in mediating the loss of renal tubular cells in SNx rats and that effectively blocking both necroptosis and apoptosis improves renal function and tubular damage at early and intermediate stages of CKD.

  19. Role and Reference Grammar.

    ERIC Educational Resources Information Center

    Van Valin, Robert D., Jr.

    This paper discusses Role and Reference Grammar (RRG), which is a structuralist-formalist theory of grammar. RRG grew out of an attempt to answer two fundamental questions: (1) what would linguistic theory look like if it were based on the analysis of Lakhota, Tagalog, and Dyirbal, rather than on the analysis of English?; and (2) how can the…

  20. Adults Role in Bullying

    ERIC Educational Resources Information Center

    Notar, Charles E.; Padgett, Sharon

    2013-01-01

    Do adults play a role in bullying? Do parents, teachers, school staff, and community adult leaders influence bullying behavior in children and teenagers? This article will focus on research regarding all adults who have almost daily contact with children and teens and their part in how bullying is identified, addressed, and prevented. This article…

  1. Teachers' Interpersonal Role Identity

    ERIC Educational Resources Information Center

    van der Want, Anna C.; den Brok, Perry; Beijaard, Douwe; Brekelmans, Mieke; Claessens, Luce C. A.; Pennings, Helena J. M.

    2015-01-01

    This article investigates the link between teachers' appraisal of specific interpersonal situations in classrooms and their more general interpersonal identity standard, which together form their interpersonal role identity. Using semi-structured and video-stimulated interviews, data on teachers' appraisals and interpersonal identity standards…

  2. The Role of Definition.

    ERIC Educational Resources Information Center

    Keiser, Jane M.

    2000-01-01

    Addresses the role that mathematical definitions can play in the middle grades mathematics classroom and focuses on the concept of angle as it was introduced to 6th grade students. Describes a traditional approach and an alternative approach to teaching the concept of angle. Illustrates students' concept images of angle. (KHR)

  3. The role of laparoscopic surgery for renal calculi management.

    PubMed

    Kijvikai, Kittinut

    2011-02-01

    To date, most cases of renal calculi have been managed with extracorporeal shockwave lithotripsy and endoscopic procedures. However, for complex renal stone conditions, these minimally invasive procedures may require multiple operative sessions. Open surgery is usually reserved as a salvage procedure, although it is invasive in nature. Laparoscopic treatment is well accepted in renal surgery. For stone disease, it can duplicate open surgical techniques such as pyelolithotomy, pyeloplasty, anatrophic nephrolithotomy, caliceal diverticulectomy and nephrectomy. Although the laparoscopic techniques for stone treatment are quite challenging, it is both feasible and safe. Laparoscopic treatment is a viable option for large renal stone treatment with an excellent stone-free rate, especially when patients require their stones to be treated within a single session. However, it is more invasive in nature than endourology procedures and so should be reserved as the last resort option for renal stone management in the modern endourology era.

  4. Extending a Role Graph for Role-Based Access Control

    NASA Astrophysics Data System (ADS)

    Asakura, Yoshiharu; Nakamoto, Yukikazu

    Role-based access control (RBAC) is widely used as an access control mechanism in various computer systems. Since an organization's lines of authority influence the authorized privileges of jobs, roles also form a hierarchical structure. A role graph is a model that represents role hierarchies and is suitable for the runtime phase of RBAC deployment. Since a role graph cannot take various forms for given roles and cannot handle abstraction of roles well, however, it is not suitable for the design phase of RBAC deployment. Hence, an extended role graph, which can take a more flexible form than that of a role graph, is proposed. The extended role graph improves diversity and clarifies abstraction of roles, making it suitable for the design phase. An equivalent transformation algorithm (ETA), for transforming an extended role graph into an equivalent role graph, is also proposed. Using the ETA, system administrators can deploy efficiently RBAC by using an extended role graph in the design phase and a standard role graph in the runtime phase.

  5. Tribbles role in reproduction.

    PubMed

    Basatvat, Shaghayegh; Carter, Deborah Angela Louise; Kiss-Toth, Endre; Fazeli, Alireza

    2015-10-01

    Tribbles (TRIB) proteins, a family of evolutionary conserved psuedokinase proteins, modulate various signalling pathways within the cell. The regulatory roles of TRIB make them an important part of a number of biological processes ranging from cell proliferation to metabolism, immunity, inflammation and carcinogenesis. Innate immune system plays a pivotal role during the regulation of reproductive processes that allows successful creation of an offspring. Its involvement initiates from fertilization of the oocyte by spermatozoon and lasts throughout early embryonic development, pregnancy and labour. Therefore, there is a close cooperation between the reproductive system and the innate immune system. Evidence from our lab has demonstrated that improper activation of the innate immune system can reduce embryo implantation, thus leading to infertility. Therefore, control mechanisms regulating the innate immune system function can be critical for successful reproductive events.

  6. Effects of dietary phosphate on adynamic bone disease in rats with chronic kidney disease--role of sclerostin?

    PubMed

    Ferreira, Juliana C; Ferrari, Guaraciaba O; Neves, Katia R; Cavallari, Raquel T; Dominguez, Wagner V; Dos Reis, Luciene M; Graciolli, Fabiana G; Oliveira, Elizabeth C; Liu, Shiguang; Sabbagh, Yves; Jorgetti, Vanda; Schiavi, Susan; Moysés, Rosa M A

    2013-01-01

    High phosphate intake is known to aggravate renal osteodystrophy along various pathogenetic pathways. Recent studies have raised the possibility that dysregulation of the osteocyte Wnt/β-catenin signaling pathway is also involved in chronic kidney disease (CKD)-related bone disease. We investigated the role of dietary phosphate and its possible interaction with this pathway in an experimental model of adynamic bone disease (ABD) in association with CKD and hypoparathyroidism. Partial nephrectomy (Nx) and total parathyroidectomy (PTx) were performed in male Wistar rats. Control rats with normal kidney and parathyroid function underwent sham operations. Rats were divided into three groups and underwent pair-feeding for 8 weeks with diets containing either 0.6% or 1.2% phosphate: sham 0.6%, Nx+PTx 0.6%, and Nx+PTx 1.2%. In the two Nx+PTx groups, serum creatinine increased and blood ionized calcium decreased compared with sham control group. They also presented hyperphosphatemia and reduced serum parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) levels. Fractional urinary excretion of phosphate increased in Nx+PTx 1.2% rats despite lower PTH and FGF23 levels than in sham group. These biochemical changes were accompanied by a decrease in bone formation rates. The Nx+PTx 1.2% group had lower bone volume (BV/TV), higher osteoblast and osteocyte apoptosis, and higher SOST and Dickkopf-1 gene expression than the Nx+PTx 0.6% group. Nx+PTx 0.6% rat had very low serum sclerostin levels, and Nx+PTx 1.2% had intermediate sclerostin levels compared with sham group. Finally, there was a negative correlation between BV/TV and serum sclerostin. These results suggest that high dietary phosphate intake decreases bone volume in an experimental model of CKD-ABD, possibly via changes in SOST expression through a PTH-independent mechanism. These findings could have relevance for the clinical setting of CKD-ABD in patients who low turnover bone disease might be attenuated

  7. Expression of TLR4 protein is reduced in chronic renal failure: evidence from an experimental model of nephron reduction.

    PubMed

    Kacsó, Ina Maria; Borza, Gabriel Mircea; Ciuce, Cătălin C; Bîrsan, Andrei; Apostu, Raluca Cristina; Dindelegan, George Călin; Bondor, Cosmina Ioana; Potra, Alina Ramona; Netea, Mihai G; Cătoi, Cornel

    2015-01-01

    Toll-like receptor 4 (TLR4) signaling is involved in various acute and chronic renal lesions and contributes to inflammation and fibrosis in several organs; the latter are important determinants to the progression of chronic kidney disease (CKD). We aimed to assess TLR4 expression in progressive CKD and relate it to severity of kidney damage, using an experimental nephron reduction model. Male Wistar rats were subjected to subtotal nephrectomy using the ligation technique, after 12 weeks of observation, serum creatinine and proteinuria were determined, animals were sacrificed, glomerulosclerosis and interstitial scarring were quantified histologically, and TLR4 expression was assessed by immunohistochemistry. Sham-operated rats served as controls. Case animals had significantly higher creatinine, proteinuria, glomerulosclerosis and tubulointerstitial involvement. TLR4 expression was prominent in proximal tubes, less staining was observed on infiltrating inflammatory cells. Percentage of TLR4-positive tubes was reduced in the subtotal nephrectomy animals, when compared to controls (0.67±0.09 versus 0.79±0.07, p=0.003). Percentage of TLR4-positive tubes correlated inversely to markers of kidney damage: to proteinuria (r=-0.55, p=0.02), serum creatinine (r=-0.53, p=0.01); percentage of glomeruli with glomerulosclerosis (r=-0.54, p=0.01) and tubulointerstitial score (r=-0.36, p=0.01). As TLR4 staining appears in tubular casts only in nephrectomy animals, shedding from damaged tubular cells is a very likely explanation for the reduced TLR4 expression in the kidneys of subjects with experimental nephron reduction.

  8. Roles and Role Conflict of Women in Infertile Couples.

    ERIC Educational Resources Information Center

    Allison, Janet R.

    1979-01-01

    Explores the experience of role conflict for women in infertile couples. Findings lead to an understanding of infertility as part of an interactional system for dealing with potentially intolerable sources of role conflict. (Author)

  9. The Virgil role.

    PubMed

    Sobel, R

    1996-01-01

    The referral of a patient for subspecialty consultation and examination is but one facet of the primary care physician's involvement with his patient. Using examples from my practice, I argue that the term "gatekeeper" is an inadequate term for describing what the primary care physician does, or should do, for his patient. "Virgil Role" is offered as an alternative expression based on a proposed parallel between Dante's passage through the Inferno accompanied by his mentor-guide, Virgil, and a sick person's journey through his personal Hell of illness and the labyrinthine medical care system, guided by his physician.

  10. Neuroendocrine Role for VGF

    PubMed Central

    Lewis, Jo E.; Brameld, John M.; Jethwa, Preeti H.

    2015-01-01

    The vgf gene (non-acronymic) is highly conserved and was identified on the basis of its rapid induction in vitro by nerve growth factor, although can also be induced by brain-derived neurotrophic factor, and glial-derived growth factor. The VGF gene gives rise to a 68 kDa precursor polypeptide, which is induced robustly, relatively selectively and is synthesized exclusively in neuronal and neuroendocrine cells. Post-translational processing by neuroendocrine specific prohormone convertases in these cells results in the production of a number of smaller peptides. The VGF gene and peptides are widely expressed throughout the brain, particularly in the hypothalamus and hippocampus, in peripheral tissues including the pituitary gland, the adrenal glands, and the pancreas, and in the gastrointestinal tract in both the myenteric plexus and in endocrine cells. VGF peptides have been associated with a number of neuroendocrine roles, and in this review, we aim to describe these roles to highlight the importance of VGF as therapeutic target for a number of disorders, particularly those associated with energy metabolism, pain, reproduction, and cognition. PMID:25699015

  11. Gastrocystoplasty and Hematuria-dysuria Syndrome. What Role Plays Helicobacter Pylori? Case Report and Literature Review.

    PubMed

    Aponte, Hernán A; Clavijo, Rafael A; Quiroz, Yesica J; Dallos, Diego F; Ruiz, William N; Ramirez-Troche, Nelson E; Martin, Oscar Dario

    2015-05-01

    49 years male, who comes to the urology department, complaining of 8 months of lower abdominal pain, burning and oppressive type, of variable intensity reaching 9/10, which is occasionally exacerbated by urination, associated with intermittent gross hematuria, dysuria, refers no fever at any time. Patient with past medical history of bladder and right kidney Tuberculosis (TBC) 25 years ago, treated with a simple right nephrectomy and bladder augmentation with antrum segment of stomach, for low bladder capacity. Never showed any symptom during those 25 years lapsing time. PMID:26793505

  12. Gastrocystoplasty and Hematuria-dysuria Syndrome. What Role Plays Helicobacter Pylori? Case Report and Literature Review

    PubMed Central

    Aponte, Hernán A.; Clavijo, Rafael A.; Quiroz, Yesica J.; Dallos, Diego F.; Ruiz, William N.; Ramirez-Troche, Nelson E.; Martin, Oscar Dario

    2015-01-01

    49 years male, who comes to the urology department, complaining of 8 months of lower abdominal pain, burning and oppressive type, of variable intensity reaching 9/10, which is occasionally exacerbated by urination, associated with intermittent gross hematuria, dysuria, refers no fever at any time. Patient with past medical history of bladder and right kidney Tuberculosis (TBC) 25 years ago, treated with a simple right nephrectomy and bladder augmentation with antrum segment of stomach, for low bladder capacity. Never showed any symptom during those 25 years lapsing time PMID:26793505

  13. Dose refinement. ARAC's role

    SciTech Connect

    Ellis, J. S.; Sullivan, T. J.; Baskett, R. L.

    1998-06-01

    The Atmospheric Release Advisory Capability (ARAC), located at the Lawrence Livermore National Laboratory, since the late 1970's has been involved in assessing consequences from nuclear and other hazardous material releases into the atmosphere. ARAC's primary role has been emergency response. However, after the emergency phase, there is still a significant role for dispersion modeling. This work usually involves refining the source term and, hence, the dose to the populations affected as additional information becomes available in the form of source term estimates release rates, mix of material, and release geometry and any measurements from passage of the plume and deposition on the ground. Many of the ARAC responses have been documented elsewhere. 1 Some of the more notable radiological releases that ARAC has participated in the post-emergency phase have been the 1979 Three Mile Island nuclear power plant (NPP) accident outside Harrisburg, PA, the 1986 Chernobyl NPP accident in the Ukraine, and the 1996 Japan Tokai nuclear processing plant explosion. ARAC has also done post-emergency phase analyses for the 1978 Russian satellite COSMOS 954 reentry and subsequent partial burn up of its on board nuclear reactor depositing radioactive materials on the ground in Canada, the 1986 uranium hexafluoride spill in Gore, OK, the 1993 Russian Tomsk-7 nuclear waste tank explosion, and lesser releases of mostly tritium. In addition, ARAC has performed a key role in the contingency planning for possible accidental releases during the launch of spacecraft with radioisotope thermoelectric generators (RTGs) on board (i.e. Galileo, Ulysses, Mars-Pathfinder, and Cassini), and routinely exercises with the Federal Radiological Monitoring and Assessment Center (FRMAC) in preparation for offsite consequences of radiological releases from NPPs and nuclear weapon accidents or incidents. Several accident post-emergency phase assessments are discussed in this paper in order to illustrate

  14. Semantic Roles and Grammatical Relations.

    ERIC Educational Resources Information Center

    Van Valin, Robert D., Jr.

    The nature of semantic roles and grammatical relations are explored from the perspective of Role and Reference Grammar (RRG). It is proposed that unraveling the relational aspects of grammar involves the recognition that semantic roles fall into two types, thematic relations and macroroles, and that grammatical relations are not universal and are…

  15. Organizational Roles of University Committees

    ERIC Educational Resources Information Center

    Hobbs, Walter C.

    1975-01-01

    On the basis of relationships found empirically to hold among 20 organizational characteristics of university committees, two patterns are derived of the organizational roles which university committees play: the deliberative, collective decision-making role of member-dominated committees and the one-person advisory role of chairperson-dominated…

  16. The Many Roles of Fatherhood

    PubMed Central

    Henderson, Jim

    1992-01-01

    Recognition of the importance of fathers to children's development is increasing. Fathers play many roles: supporting the mother-infant relationship, nurturing, acting as mother surrogate, encouraging separation and individuation setting up care sexual identify and developing sex role, and encouraging the development of conscience. A fuller understanding of the role of fatherhood can help family physicians offering medical and preventive treatment.

  17. The Division of Family Roles.

    ERIC Educational Resources Information Center

    Ericksen, Julia A.; And Others

    1979-01-01

    Analyzes the marital role division between couples, in the Philadelphia area, concentrating on the division of household tasks, child care, and paid employment. Data support a marital power model with husband's income negatively related and wife's education positively related to shared roles. Blacks are more likely to share roles. (Author)

  18. The role of bracing.

    PubMed

    Briem, Kristin; Ramsey, Daniel K

    2013-03-01

    Regular exercise and weight reduction are not only important for maintaining general health, they are also strongly recommended conservative modalities for managing knee osteoarthritis (OA). The objective of this paper is to discuss the mechanics of knee joint loading and to review the most recent literature with respect to the functionality and efficacy of unloader braces for managing knee OA, specifically from the perspective of the middle-aged athlete. Evidence suggests valgus braces for medial compartment knee OA significantly reduce knee adduction angle measures and improve measures relating to medial knee joint loading, as well as gait symmetry and speed. Benefits were demonstrated during walking and during more demanding functional measures such as running and negotiating stairs. No studies have investigated the efficacy of bracing for relatively young athletic OA patients and, thus, the role of bracing for this population during sports remains unclear. PMID:23314263

  19. Climate's Role in Terroir

    NASA Astrophysics Data System (ADS)

    Jones, G. V.

    2012-12-01

    The marriage between a given winegrape cultivar planted in its ideal climate, over favorable topography and physical soil characteristics, combine to create the potential to produce fine wine. The French term terroir embodies this potential as a holistic concept that relates to both environmental and cultural factors that together influence the grape growing to wine production continuum. While the landscape, geology, soil, and climate strongly interact to influence the vine's balance of nutrients and water, climate is clearly of prevailing importance in that it limits where grapes can be grown at both the global and site scale. This talk will review the nature of climate's role in terroir through a discussion of the structure of climate in wine regions globally and how this structure influences cultivar suitability. Furthermore, the talk will use two of the most commonly planted red wine cultivars as examples - Pinot Noir and Cabernet Sauvignon - providing details on the historic, current, and future climate structure of wine regions growing these cultivars. In general the examination reveals that cool climate cultivars tend to have a narrower climate niche for high quality wine production, than do warmer climate cultivars, with less range of adaptation. Furthermore, the range of the climate suitability of these two cultivars shows that potentially new terroirs for each are waiting to be found.

  20. Role of Mitochondrial DNA Copy Number Alteration in Human Renal Cell Carcinoma †

    PubMed Central

    Lin, Chen-Sung; Lee, Hui-Ting; Lee, Ming-Huei; Pan, Siao-Cian; Ke, Chen-Yeh; Chiu, Allen Wen-Hsiang; Wei, Yau-Huei

    2016-01-01

    We investigated the role of mitochondrial DNA (mtDNA) copy number alteration in human renal cell carcinoma (RCC). The mtDNA copy numbers of paired cancer and non-cancer parts from five resected RCC kidneys after radical nephrectomy were determined by quantitative polymerase chain reaction (Q-PCR). An RCC cell line, 786-O, was infected by lentiviral particles to knock down mitochondrial transcriptional factor A (TFAM). Null target (NT) and TFAM-knockdown (TFAM-KD) represented the control and knockdown 786-O clones, respectively. Protein or mRNA expression levels of TFAM; mtDNA-encoded NADH dehydrogenase subunit 1 (ND1), ND6 and cytochrome c oxidase subunit 2 (COX-2); nuclear DNA (nDNA)-encoded succinate dehydrogenase subunit A (SDHA); v-akt murine thymoma viral oncogene homolog 1 gene (AKT)-encoded AKT and v-myc myelocytomatosis viral oncogene homolog gene (c-MYC)-encoded MYC; glycolytic enzymes including hexokinase II (HK-II), glucose 6-phosphate isomerase (GPI), phosphofructokinase (PFK), and lactate dehydrogenase subunit A (LDHA); and hypoxia-inducible factors the HIF-1α and HIF-2α, pyruvate dehydrogenase kinase 1 (PDK1), and pyruvate dehydrogenase E1 component α subunit (PDHA1) were analyzed by Western blot or Q-PCR. Bioenergetic parameters of cellular metabolism, basal mitochondrial oxygen consumption rate (mOCRB) and basal extracellular acidification rate (ECARB), were measured by a Seahorse XFe-24 analyzer. Cell invasiveness was evaluated by a trans-well migration assay and vimentin expression. Doxorubicin was used as a chemotherapeutic agent. The results showed a decrease of mtDNA copy numbers in resected RCC tissues (p = 0.043). The TFAM-KD clone expressed lower mtDNA copy number (p = 0.034), lower mRNA levels of TFAM (p = 0.008), ND1 (p = 0.007), and ND6 (p = 0.017), and lower protein levels of TFAM and COX-2 than did the NT clone. By contrast, the protein levels of HIF-2α, HK-II, PFK, LDHA, AKT, MYC and vimentin; trans-well migration activity (p = 0

  1. Role of Mitochondrial DNA Copy Number Alteration in Human Renal Cell Carcinoma.

    PubMed

    Lin, Chen-Sung; Lee, Hui-Ting; Lee, Ming-Huei; Pan, Siao-Cian; Ke, Chen-Yeh; Chiu, Allen Wen-Hsiang; Wei, Yau-Huei

    2016-01-01

    We investigated the role of mitochondrial DNA (mtDNA) copy number alteration in human renal cell carcinoma (RCC). The mtDNA copy numbers of paired cancer and non-cancer parts from five resected RCC kidneys after radical nephrectomy were determined by quantitative polymerase chain reaction (Q-PCR). An RCC cell line, 786-O, was infected by lentiviral particles to knock down mitochondrial transcriptional factor A (TFAM). Null target (NT) and TFAM-knockdown (TFAM-KD) represented the control and knockdown 786-O clones, respectively. Protein or mRNA expression levels of TFAM; mtDNA-encoded NADH dehydrogenase subunit 1 (ND1), ND6 and cytochrome c oxidase subunit 2 (COX-2); nuclear DNA (nDNA)-encoded succinate dehydrogenase subunit A (SDHA); v-akt murine thymoma viral oncogene homolog 1 gene (AKT)-encoded AKT and v-myc myelocytomatosis viral oncogene homolog gene (c-MYC)-encoded MYC; glycolytic enzymes including hexokinase II (HK-II), glucose 6-phosphate isomerase (GPI), phosphofructokinase (PFK), and lactate dehydrogenase subunit A (LDHA); and hypoxia-inducible factors the HIF-1α and HIF-2α, pyruvate dehydrogenase kinase 1 (PDK1), and pyruvate dehydrogenase E1 component α subunit (PDHA1) were analyzed by Western blot or Q-PCR. Bioenergetic parameters of cellular metabolism, basal mitochondrial oxygen consumption rate (mOCRB) and basal extracellular acidification rate (ECARB), were measured by a Seahorse XF(e)-24 analyzer. Cell invasiveness was evaluated by a trans-well migration assay and vimentin expression. Doxorubicin was used as a chemotherapeutic agent. The results showed a decrease of mtDNA copy numbers in resected RCC tissues (p = 0.043). The TFAM-KD clone expressed lower mtDNA copy number (p = 0.034), lower mRNA levels of TFAM (p = 0.008), ND1 (p = 0.007), and ND6 (p = 0.017), and lower protein levels of TFAM and COX-2 than did the NT clone. By contrast, the protein levels of HIF-2α, HK-II, PFK, LDHA, AKT, MYC and vimentin; trans-well migration activity (p = 0

  2. Does the uterine cervix become abnormally reinnervated after subtotal hysterectomy and what is the association with future trachelectomy?

    PubMed Central

    Yunker, Amanda; Curlin, Howard; Banet, Natalie; Fadare, Oluwole; Steege, John

    2015-01-01

    Objective To compare nerve fiber density in the cervices removed by trachelectomy from women with pelvic pain with those cervices removed for non-pain indications. Methods This is a retrospective cohort study from 2 university hospitals (Canadian Task Force classification II-2). Subjects who underwent trachelectomy during a 10-year time frame were identified. Two tissue sections were obtained from each preserved cervix specimen and stained for S100 antibody. The numbers of S100 immunoreactive peripheral nerve fibers were assessed in 6 high-powered fields (HPF) per tissue section (12 total HPF per patient). Information collected included patient characteristics and surgical findings. We excluded any patients with dysplasia/cancer and those without an available adequate specimen. Results We evaluated the cervix specimens from 35 patients who underwent trachelectomy for pain (n=25; group 1) and non-pain (n=10; group 2) indications, in addition to control cervices (n=15; group 3) from benign hysterectomies performed for non-pain indications. There were increased numbers of nerve fibers in trachelectomy patients with pain vs. those without pain (group 1 vs. group 2, p=0.02). There were also increased numbers of nerve fibers in both trachelectomy groups compared to control (group 1 vs group 3, p<0.01; group 2 vs group 3, p=0.04) Adjusted average cervical nerve counts/HPF were 17.8 (95% CI 13.2, 22.3) for pain-indicated trachelectomies, 11.5 (95% CI 4.8, 18.2) for non-pain, and 6.3 (95% CI 0.8, 11.8) for controls. Regardless of trachelectomy indication, adjusted average nerve counts/HPF were 17.7 (95% CI 13.4, 22.0) for patients with endometriosis and 14.6 (95% CI 12.2, 17.1) for patients without endometriosis. Conclusion Nerve fibers in the cervical stump after supracervical hysterectomy are significantly increased in women undergoing trachelectomy for pain indications, compared to those who underwent trachelectomy for non-pain indications and controls. Though not statistically significant, endometriosis may be an independent risk factor for increased nerve fibers. These histopathologic observations may support the idea that the cervix should be removed in women undergoing hysterectomy for chronic pelvic pain or endometriosis. PMID:25460319

  3. [Massive panniculectomy and bilateral subtotal mastectomy in a case of calciphylaxis: A case report and up date].

    PubMed

    Bennis, Y; Becquart, C; Aljudaibi, N; Patenotre, P; Guerreschi, P; Delaporte, E; Duquennoy-Martinot, V

    2015-12-01

    Calciphylaxis or calcific arteriolopathy is a rare, life-threatening obstructive pathology of the small cutaneous and subcutaneous vessels. It mainly affects patients with chronic renal failure but it also has been described in patients with normal renal function. The principal risks factors apart from renal failure and phosphocalcic metabolism imbalance are: the female sex, obesity, peripheral vascular disease, diabetes and oral anti-coagulation. We present a very rare case of abdominal, mammarian and upper thighs calciphylaxis in a patient with normal renal function. She presented a severe obesity with a recent important loss of weight and had been treated by oral anticoagulants for a long time. She benefited of a multidisciplinary approach with dermatologists, plastic surgeons and anesthesists permitting a recovery in fourteen weeks. Multidisciplinary approach is necessary but the place of the surgery is not well defined. We report a case in which early and wide surgical approach permitted to obtain a favourable evolution of the pathology. Then, we propose a therapeutic strategy after review of the literature.

  4. Late surgical complications of subtotal colectomy with antiperistaltic caeco-rectal anastomosis for slow transit constipation A critical analysis.

    PubMed

    Marchesi, Federico; Rapacchi, Chiara; Cecchini, Stefano; Sarli, Leopoldo; Tartamella, Francesco; Roncoroni, Luigi

    2016-01-01

    La stipsi grave da rallentato transito è stata negli ultimi anni definitivamente riconosciuta come una condizione potenzialmente chirurgica, e nuove varianti tecniche sono state proposte in alternativa alla colectomia totale con ileo-retto anastomosi con l’obiettivo di minimizzare il rapporto rischi-benefici per il paziente. In quest’ottica la colectomia subtotale con anastomosi ceco-rettale (SCCRA) rappresenta nella nostra esperienza una valida alternativa, riducendo, a parità di efficacia, l’incontinenza e l’urgency postoperatoria, grazie alla preservazione della valvola ileo-cecale e del reservoir cecale. Tuttavia, a fronte di una buona percentuale di successi, legati soprattutto al miglioramento della selezione dei pazienti, la chirurgia della stipsi da rallentato transito presenta tuttora un non trascurabile numero di insuccessi e di complicanze tardive, spesso imprevedibili, e correlate alle varianti tecniche adottate. Nello specifico caso della SCCRA, la preservazione di un segmento colico verosimilmente malfunzionante (il ceco) è stata imputata come possibile causa di recidiva di stipsi cosiccome origine di complicanze chirurgiche tardive (distensione cecale, volvolo). L’obiettivo di questo studio è di analizzare in maniera critica le complicanze tardive di SCCRA, esaminando i rischi specifici della procedura per identificare possibili misure di prevenzione. A tal fine sono stati valutati i dati di 43 pazienti aderenti al follow-up sottoposti a SCCRA presso il nostro Istituto. Sono stati inclusi i pazienti sottoposti a re-intervento per complicanza tardiva chiaramente correlata a SCCRA presso il nostro centro. Sono state identificate 3 complicanze tardive (7%): una distensione cecale, un volvolo ileo-cecale, un volvolo ileale. Tutti i pazienti sono stati trattati chirurgicamente con successo. Solo nel primo caso è stata identificata una evidente condizione predisponente: la presenza di una defecazione ostruita non risolta associata ad un’età avanzata può in questo caso aver contribuito a rendere severamente sintomatica una condizione (la distensione cecale) che nel resto dei pazienti è rara o comunque di modesta rilevanza clinica. Nel caso dei volvoli, la miglior misura preventiva è rappresentata da una tecnica chirurgica che miri ad una minor mobilizzazione possibile del moncone cecale. In conclusione si può affermare che le complicanze tardive specifiche di SCCRA correlate alla presenza di un moncone cecale disfunzionale o mobile possono essere prevenute da una attenta selezione dei pazienti e da una corretta tecnica chirurgica.

  5. [Our experience in the use of mechanical staplers in the execution of step-by-step subtotal gastrectomy].

    PubMed

    Limonta, M E; Girlando, M; Smurra, A; Crespi, G; Appiani, G; Gramazio, F P

    1990-03-01

    The Authors describe their reconstruction technique after a "step" gastric resection for peptic or neoplastic pathology. The use of staplers such as TA 30 or GIA for the duodenum is reported. After skeletonizing the lesser curve up to the cardias by sectioning the left gastric artery at its origin and up to the penultimate short vessel on the greater curve, the stomach is resected distally to this two points using a TA90 staplers. So it is possible to remove the greater part of the acid-secreting area in order to avoid ulcers of the anastomosis or of the gastric stump, and also to achieve a complete lymphadenectomy in case of neoplasm. Then a Roux-en-Y gastro-jejunal anastomosis is performed using an EEA28 circular stapler. The jejunal stump is closed with a TA30. Finally, a manual jejuno-jejunal anastomosis is made at least at 50 cm from the previous one. From November 1987 to January 1989, 13 patients were operated: 9 for peptic ulcer and 4 for antrum neoplasms. There were no complications during and after the operations. Mortality was 0%. The patient, usually starts eating on the 6th or 7th day after operation, and is discharged on the 10th day. After 6 months an EGD scopy is required: the 8 performed till now have demonstrated excellent anastomosis and no peptic lesions. Scintigraphic evaluations and pH monitoring are still in course to define the gastric stump acid secretion and the absence of biliary reflux.

  6. Models and role models.

    PubMed

    ten Cate, Jacob M

    2015-01-01

    Developing experimental models to understand dental caries has been the theme in our research group. Our first, the pH-cycling model, was developed to investigate the chemical reactions in enamel or dentine, which lead to dental caries. It aimed to leverage our understanding of the fluoride mode of action and was also utilized for the formulation of oral care products. In addition, we made use of intra-oral (in situ) models to study other features of the oral environment that drive the de/remineralization balance in individual patients. This model addressed basic questions, such as how enamel and dentine are affected by challenges in the oral cavity, as well as practical issues related to fluoride toothpaste efficacy. The observation that perhaps fluoride is not sufficiently potent to reduce dental caries in the present-day society triggered us to expand our knowledge in the bacterial aetiology of dental caries. For this we developed the Amsterdam Active Attachment biofilm model. Different from studies on planktonic ('single') bacteria, this biofilm model captures bacteria in a habitat similar to dental plaque. With data from the combination of these models, it should be possible to study separate processes which together may lead to dental caries. Also products and novel agents could be evaluated that interfere with either of the processes. Having these separate models in place, a suggestion is made to design computer models to encompass the available information. Models but also role models are of the utmost importance in bringing and guiding research and researchers. PMID:25871413

  7. Transitions in nursing leadership roles.

    PubMed

    Jobes, M; Steinbinder, A

    1996-01-01

    Today's turbulent, chaotic health care environment necessitates dramatic changes in the roles of nurse executives. These role changes are rapidly being cast upon individuals who are pressured to react, accept, and adapt quickly. Previously successful leadership styles no longer serve nurse executives as they assume nonoperational roles without line authority and power. No prescriptive strategies will be effective to assist nurse leaders in their new roles. One nurse executive's story of her own journey will be shared to illustrate how she is creating a successful transition.

  8. Role Model, Hero or Champion? Children's Views Concerning Role Models

    ERIC Educational Resources Information Center

    Bricheno, Patricia; Thornton, Mary

    2007-01-01

    Background: Claims that male role models can improve the behaviour and achievement of boys are familiar and persistent. However, research has not confirmed such a link; recent UK studies indicate that peers and relatives may be far more important to boys than their teachers. Given the seemingly relentless reference to male teachers as role models…

  9. Mediators of Stress and Role Satisfaction in Multiple Role Women.

    ERIC Educational Resources Information Center

    Hammond, Laura A.

    Women involved in multiple life roles comprise a large segment of society, yet little is known about how stressful and satisfying they find this lifestyle, or about what characteristics are related to feeling stressed or satisfied. The purpose of this study was to examine role and life satisfaction and stress in women involved in multiple life…

  10. Sex Role Attitudes and Sex Role Stereotyping: Recent Literature.

    ERIC Educational Resources Information Center

    New Jersey Research Bulletin, 1996

    1996-01-01

    This annotated bibliography profiles 17 publications examining sex role attitudes/sex role stereotyping from the perspectives of ethnicity, gender, and age. Cited in the section on ethnicity are studies of work satisfaction/family functioning among working-class Mexican-American women and cultural variations in sex typing by students in the United…

  11. Balancing Caregiving and Work: Role Conflict and Role Strain Dynamics

    ERIC Educational Resources Information Center

    Gordon, Judith R.; Pruchno, Rachel A.; Wilson-Genderson, Maureen; Murphy, Wendy Marcinkus; Rose, Miriam

    2012-01-01

    Positing role conflict as a bidirectional construct in which work interferes with caregiving (WIC) and caregiving interferes with work (CIW), this study investigated its antecedents (demands and support of caregiving and work) and consequences (role strain). A national sample of 583 women between the ages of 50 and 64 years identified using…

  12. Promoting Flexibility in Male Roles.

    ERIC Educational Resources Information Center

    Moody, Charles D., Comp.; Linn, Eleanor, Ed.

    1986-01-01

    In this publication issues are discussed which pertain to male roles and fatherhood. "From the Desk of the Director" (Charles D. Moody, Sr.) discusses the need for increased role flexibility for men in general and black men in particular. The lead article, "Equity: A Question in Balance" (D. Groves Dugger), delves into the causes and consequences…

  13. Classroom Roles and School Adjustment

    ERIC Educational Resources Information Center

    Van Rossem, Ronan; Vermande, Marjolijn M.

    2004-01-01

    The peer group is an important developmental context for children. In this paper we present a method to operationalize a child's integration into the classroom by their informal social classroom roles, which we obtained using a blockmodel analysis based on role equivalence. This method differs in several respects from the common socio-metric…

  14. ROLE TRANSITION IN CAREER DEVELOPMENT.

    ERIC Educational Resources Information Center

    MOMENT, DAVID

    ROLE TRANSITIONS IN ADULT CAREER DEVELOPMENT IS PRESENTED IN TERMS OF THE TECHNICAL, SOCIAL, AND DIRECTIVE ROLE ELEMENTS FOUND IN TWO STUDIES OF MANAGERIAL BEHAVIOR AND CAREER DEVELOPMENT. THE INDIVIDUAL'S LIFE SPACE IS THE BASIC FORMULATION OF THIS IDEA. THAT IS, MAJOR CHANGES IN THE CONFIGURATION OF THE INDIVIDUAL'S INTERPERSONAL NETWORK…

  15. Ten Roles for Teacher Leaders

    ERIC Educational Resources Information Center

    Harrison, Cindy; Killion, Joellen

    2007-01-01

    Teacher leaders assume a wide range of roles to support school and student success. Harrison and Killion describe 10 roles that teacher leaders can fulfill in their schools. As resource providers, they provide materials to help their colleagues. Instructional specialists help colleagues with instructional strategies, and curriculum specialists…

  16. Women's Role in Sustainable Development.

    ERIC Educational Resources Information Center

    Dawson, Leslie

    1996-01-01

    Given women's impact on resource management and consumption, we must improve our understanding of women's role in sustainable development. Women must be involved in sustainable development planning. This article examines the role of women as land stewards, and the effects of education of women on population growth in developing nations. Includes…

  17. Understanding medical practice team roles.

    PubMed

    Hills, Laura

    2015-01-01

    Do you believe that the roles your employees play on your medical practice team are identical to their job titles or job descriptions? Do you believe that team roles are determined by personality type? This article suggests that a more effective way to build and manage your medical practice team is to define team roles through employee behaviors. It provides 10 rules of behavioral team roles that can help practice managers to select and build high-performing teams, build more productive team relationships, improve the employee recruitment process, build greater team trust and understanding; and increase their own effectiveness. This article describes in detail Belbin's highly regarded and widely used team role theory and summarizes four additional behavioral team role theories and systems. It offers lessons learned when applying team role theory to practice. Finally, this article offers an easy-to-implement method for assessing current team roles. It provides a simple four-question checklist that will help practice managers balance an imbalanced medical practice team. PMID:26062328

  18. The Nephrology Clinical Research Nurse Role: Potential Role Conflicts.

    PubMed

    Micklos, Lisa

    2016-01-01

    Clinical research nursing is becoming more visible to nephrology professionals. As more nephrology practices and units are participating in clinical trials, clinical research nursing is gaining interest as a career niche among nephrology nurses. This unique specialty requires that nephrology clinical nurse nurses (CRNs) reconcile the roles of nurse as caregiver and nurse as researcher, which may result in a role conflict. Nephrology nurses should be aware that they may experience this role conflict when transitioning from patient care to a position as a clinical research nurse. These nurses can rely on the American Nurses Association's Code of Ethics for Nurses and the Oncology Nursing Society's Oncology Clinical Trials Nurse Competencies to help reconcile the potential role conflict. PMID:27501633

  19. Technology's Role in NASA's Future

    NASA Video Gallery

    NASA Chief Technologist Bobby Braun talks to NASA managers about the vital role technology research and development will play in NASA's future. Braun discusses how NASA will use new technologies to...

  20. Women's Role in Future Development

    ERIC Educational Resources Information Center

    Literacy Work, 1975

    1975-01-01

    Providing an overview of women's role in national and economic development, particularly in Africa and Asia, the article touches upon women's participation in employment, vocational training and education, agriculture, and other aspects of progress in developing nations. (MW)

  1. The Changing Role of Logarithms

    ERIC Educational Resources Information Center

    Thomas, F. H.

    1974-01-01

    With the advent of computers and electronic calculators, the role of logarithms in the curriculum is changing. An intuitive approach to logarithms, stressing the notion of isomorphism, is discussed. (SD)

  2. [The changing role of physicians].

    PubMed

    Siegrist, J

    2012-09-01

    Despite a very successful process of professionalisation during the past 150 years, today's physicians face several challenges urging them to adapt their traditional professional role and the patient-physician relationship inherent in this role. Among these challenges, a growing economic influence on physicians' practices, new demands from particular groups of patients (consumerism, role of the Internet etc.), and increasing inter-professional competition deserve special attention. New evidence of an association between a stressful work environment and physician's increased health risks provides additional support in favour of this notion. This contribution suggests potential directions of change of the physician's role by pointing to (a) a growing 'feminisation' of medicine, (b) an even stronger emphasis on patient needs and (c) extended teamwork and inter-professional cooperation.

  3. More than a decade after live donor nephrectomy: a prospective cohort study.

    PubMed

    Janki, Shiromani; Klop, Karel W J; Dooper, Ine M M; Weimar, Willem; Ijzermans, Jan N M; Kok, Niels F M

    2015-11-01

    Previously reported short-term results after live kidney donation show no negative consequences for the donor. The incidence of new-onset morbidity takes years to emerge, making it highly likely that this will be missed during short-term follow-up. Therefore, evidence on long-term outcome is essential. A 10-year follow-up on renal function, hypertension, quality of life (QOL), fatigue, and survival was performed of a prospective cohort of 100 donors. After a median follow-up time of 10 years, clinical data were available for 97 donors and QOL data for 74 donors. Nine donors died during follow-up of unrelated causes to donation, and one donor was lost to follow-up. There was a significant decrease in kidney function of 12.9 ml/min (P < 0.001) at follow-up. QOL showed significant clinically relevant decreases of 10-year follow-up scores in SF-36 dimensions of physical function (P < 0.001), bodily pain (P = 0.001), and general health (P < 0.001). MFI-20 scores were significantly higher for general fatigue (P < 0.001), physical fatigue (P < 0.001), reduced activity (P = 0.019), and reduced motivation (P = 0.030). New-onset hypertension was present in 25.6% of the donors. Donor outcomes are excellent 10 years post-donation. Kidney function appears stable, and hypertension does not seem to occur more frequently compared to the general population.

  4. Arterial lesions and hypertension induced by saline, unilateral nephrectomy, and deoxycorticosterone in spontaneously hypertensive SHR rats.

    PubMed

    Wexler, B C

    1979-07-01

    Male and female, 100 days old, spontaneously hypertensive rats (SHR) were divided into two major groups: intact and uninephrectomized, given either no treatment, 1p.100 saline drinking water, 1p.100 saline + Deoxycorticosterone (DOC), or DOC alone. The DOC (Percorten pivalate) was given subcutaneously 2 times weekly, at a dose level of 2 mg/rat for 8 weeks. At autopsy, the combination of DOC + saline caused: the greatest exacerbation of blood pressure, marked catabolism, adrenal hypertrophy and thymic involution, little increase in heart weight, but a marked increase in kidney weight, elevated triglyceride and free fatty acids, cerebral and myocardial necrosis, fibrinous hyalinization of the cerebral, coronary, mesenteric, renal, testicular and ovarian arteries, foci of aortic cartilaginous metaplasia, PAN, foci of hepatic necrosis, and extensive lipid depletion from the zonae glomerulosa. Circulating corticosterone levels were suppressed to below normal levels. Excursion of circulating CPK levels coincided with the finding of myocardial necrosis and cerebral damage. It is suggested that the genetically-mediated hypertension of SHR is programmed through abnormal activity of the hypothalamic-pituitary axis and the specific morphologic make-up of arterial lesions is dependent upon the variety of adrenal or gonadal steroids secreted and their conditioning effect on the arterial wall.

  5. Laparoscopic donor nephrectomy for the pediatric recipient population: Risk factors for adverse outcomes.

    PubMed

    Walther, Ashley E; Coots, Abigail C; Goebel, Jens W; Alonso, Maria H; Ryckman, Frederick C; Tiao, Greg M; Nathan, Jaimie D

    2015-12-01

    Kidney transplantation is the optimal treatment of ESRD in children. Some studies have reported inferior outcomes in recipients of LDN allografts who are ≤ 5 yr of age. We performed a retrospective review of pediatric recipient outcomes of 110 LDN allografts at our institution and examined predictors of adverse outcomes. Subgroup analysis was performed by dividing recipients into three age categories: 0-5 yr, 6-17 yr, and ≥ 18 yr. There was no significant difference between incidences of DGF or ARE between groups. Kaplan-Meier analysis demonstrated 100% allograft survival in 0- to 5-yr-old recipients, nearly reaching statistical significance (p = 0.07) for outcome superior to that of the two older age groups. Pretransplant HD was associated with increased risk of DGF (p = 0.05). Significant risk factors for ARE were recipient weight >15 kg (p = 0.033) and multiple renal arteries (p = 0.047). Previous ARE was associated with an increased risk of allograft failure (p = 0.02). LDN is not associated with increased risk of DGF, ARE, or allograft failure in the youngest recipients. These findings support an aggressive pursuit of preemptive transplantation even in the youngest pediatric allograft recipients. PMID:26329665

  6. More than a decade after live donor nephrectomy: a prospective cohort study.

    PubMed

    Janki, Shiromani; Klop, Karel W J; Dooper, Ine M M; Weimar, Willem; Ijzermans, Jan N M; Kok, Niels F M

    2015-11-01

    Previously reported short-term results after live kidney donation show no negative consequences for the donor. The incidence of new-onset morbidity takes years to emerge, making it highly likely that this will be missed during short-term follow-up. Therefore, evidence on long-term outcome is essential. A 10-year follow-up on renal function, hypertension, quality of life (QOL), fatigue, and survival was performed of a prospective cohort of 100 donors. After a median follow-up time of 10 years, clinical data were available for 97 donors and QOL data for 74 donors. Nine donors died during follow-up of unrelated causes to donation, and one donor was lost to follow-up. There was a significant decrease in kidney function of 12.9 ml/min (P < 0.001) at follow-up. QOL showed significant clinically relevant decreases of 10-year follow-up scores in SF-36 dimensions of physical function (P < 0.001), bodily pain (P = 0.001), and general health (P < 0.001). MFI-20 scores were significantly higher for general fatigue (P < 0.001), physical fatigue (P < 0.001), reduced activity (P = 0.019), and reduced motivation (P = 0.030). New-onset hypertension was present in 25.6% of the donors. Donor outcomes are excellent 10 years post-donation. Kidney function appears stable, and hypertension does not seem to occur more frequently compared to the general population. PMID:25865340

  7. Assessment of renal oxygenation during partial nephrectomy using DLP hyperspectral imaging

    NASA Astrophysics Data System (ADS)

    Best, Sara L.; Thapa, Abhas; Holzer, Michael S.; Jackson, Neil; Mir, Saad A.; Donnally, Chester J.; Wehner, Eleanor; Raj, Ganesh V.; Livingston, Edward; Cadeddu, Jeffrey A.; Zuzak, Karel J.

    2011-03-01

    Digital Light Processing (DLP®) hyperspectral imaging (HsI) is a non-invasive method used to construct a highly sensitive, real-time tissue oxygenation map through the measurement of the percentage of oxyhemoglobin. We have demonstrated that this technology can detect the oxyhemoglobin in the blood vessels on the surface of the kidney and we have used this to monitor renal perfusion during kidney cancer operations, where the blood supply to the kidney is interrupted for a period of time. This technology may allow us to "personalize" surgery based on the oxygenation profile.

  8. Objective assessment of gender roles: Gender Roles Test (GRT-36).

    PubMed

    Fernández, Juan; Quiroga, M Angeles; del Olmo, Isabel; Aróztegui, Javier; Martín, Arantxa

    2011-11-01

    This study was designed to develop a computerized test to assess gender roles. This test is presented as a decision-making task to mask its purpose. Each item displays a picture representing an activity and a brief sentence that describes it. Participants have to choose the most suitable sex to perform each activity: man or woman. The test (Gender Roles Test, GRT-36) consists of 36 items/activities. The program registers both the choices made and their response times (RTs). Responses are considered as stereotyped when the chosen sex fits stereotyped roles and non-stereotyped when the chosen sex does not fit stereotyped roles. Individual means (RTs) were computed for stereotyped and non-stereotyped responses, differentiating between domestic and work spheres. A "D" score, reflecting the strength of association between activities and sex, was calculated for each sphere and sex. The study incorporated 78 participants (69% women and 31% men) ranging from 19 to 59 years old. The results show that: (a) reading speed does not explain the variability in the RTs; (b) RTs show good internal consistency; (c) RTs are shorter for stereotyped than for neutral stimuli; (d) RTs are shorter for stereotyped than for non-stereotyped responses. Intended goals are supported by obtained results. Scores provided by the task facilitate both group and individual detailed analysis of gender role, differentiating the gender role assigned to men from that assigned to women, at the domestic and work spheres. Obtained data fall within the scope of the genderology and their implications are discussed.

  9. Transformative Learning in Managerial Role Transitions

    ERIC Educational Resources Information Center

    Isopahkala-Bouret, Ulpukka

    2008-01-01

    The purpose of this study is to investigate the nature of learning in work role transitions from specialist roles to managerial roles in a context of a large international technology organisation. Prior theorisation of learning in role transitions has been based on quantitative, psychologically-oriented studies prescribing different role and…

  10. Changing of the guard? A glance at the surgical representation in the Canadian renal transplantation community

    PubMed Central

    McGregor, Tom; Bjazevic, Jennifer; Patel, Premal; Koulack, Joshua

    2016-01-01

    Introduction: Renal transplant is the gold standard treatment for end-stage renal disease (ESRD), and the prevalence of both ESRD and renal transplant has been steadily increasing over the past decade. However, involvement of urology in renal transplant has been declining. We examine the current state of urology involvement in renal transplant programs across Canada. Methods: A telephone survey of all surgical transplant centres in Canada was performed. Information regarding the number of transplant surgeons, their individual training background, and their involvement in specific procedures, including open and laparoscopic living donor nephrectomy, deceased donor nephrectomy, and recipient renal transplant were collected. Results: There are 59 Canadian transplant surgeons, including 27 (46%) who completed a urology residency and 32 (54%) with a general surgery background. With regards to procedures performed, 58 (98%) perform recipient renal transplant surgery, 36 (61%) perform laparoscopic donor nephrectomy, and 17 (29%) perform open donor nephrectomy. There was no significant difference in the number of surgeons that perform renal recipient surgery, laparoscopic or open donor nephrectomies, and deceased donor nephrectomies between surgeons of the two different training backgrounds. Conclusions: The role of urology in Canadian renal transplant has declined significantly over the past decade. Given the medical and surgical complexity of renal transplant, along with the growing need for renal transplants, a multidisciplinary team approach is imperative. Strong urology involvement with the transplant team is crucial for optimal care of these complex patients. PMID:26858788

  11. Bioenergetic roles of mitochondrial fusion.

    PubMed

    Silva Ramos, Eduardo; Larsson, Nils-Göran; Mourier, Arnaud

    2016-08-01

    Mitochondria are bioenergetic hotspots, producing the bulk of ATP by the oxidative phosphorylation process. Mitochondria are also structurally dynamic and undergo coordinated fusion and fission to maintain their function. Recent studies of the mitochondrial fusion machinery have provided new evidence in detailing their role in mitochondrial metabolism. Remarkably, mitofusin 2, in addition to its role in fusion, is important for maintaining coenzyme Q levels and may be an integral player in the mevalonate synthesis pathway. Here, we review the bioenergetic roles of mitochondrial dynamics and emphasize the importance of the in vitro growth conditions when evaluating mitochondrial respiration. This article is part of a Special Issue entitled 'EBEC 2016: 19th European Bioenergetics Conference, Riva del Garda, Italy, July 2-6, 2016,' edited by Prof. Paolo Bernardi. PMID:27060252

  12. Antiviral Roles of Plant ARGONAUTES

    PubMed Central

    Carbonell, Alberto; Carrington, James C.

    2015-01-01

    ARGONAUTES (AGOs) are the effector proteins functioning in eukaryotic RNA silencing pathways. AGOs associate with small RNAs and are programmed to target complementary RNA or DNA. Plant viruses induce a potent and specific antiviral RNA silencing host response in which AGOs play a central role. Antiviral AGOs associate with virus-derived small RNAs to repress complementary viral RNAs or DNAs, or with endogenous small RNAs to regulate host gene expression and promote antiviral defense. Here, we review recent progress towards understanding the roles of plant AGOs in antiviral defense. We also discuss the strategies that viruses have evolved to modulate, attenuate or suppress AGO antiviral functions. PMID:26190744

  13. Teratomas of rare sites: a review of ten cases.

    PubMed

    Bhalla, S; Masih, K; Rana, R S

    1991-10-01

    Out of 267 cases of teratomas diagnosed in the department of pathology, Christian Medical College and Hospital, Ludhiana, Punjab from January 1980 to December 1989, 10 cases occurred in rare sites ie, 3 cases of teratoma in retroperitoneal space, 3 in the floor of the mouth, one each in mediastinum, thyroid, urinary bladder and kidney. None of these cases was clinically suspected as teratoma. One of the 3 teratomas of the retroperitoneal space and that of kidney were solid. Lesions of mediastinum and urinary bladder were solid as well as cystic. All these teratomas showed foci of immature elements. All other tumours were cystic and contained mature tissues only. Teratomas of the thyroid and kidney were treated with subtotal thyroidectomy and nephrectomy respectively, rest had surgical resection. One patient of immature retroperitoneal teratoma was lost to follow-up. All the others are alive and well for the period of 1 to 8 years. None had recurrence.

  14. Ectopic Ureter Accompanied by Duplicated Ureter: Three Cases

    PubMed Central

    Senel, Ufuk; Ozmen, Zafer; Sozubir, Selami

    2015-01-01

    We report cases of ectopic ureter accompanied by three types of ureteral duplication that had been diagnosed previously and treated for enuresis. Data from three female patients ranging in age from 1 to 10 years were evaluated. The ectopic ureter was observed on the left in one case, on the right in another and bilateral in the third case. Complete duplication was found in two cases, while the third had incomplete duplication. Ureteroneocystostomy was performed in one case and subtotal nephrectomy was carried out in the other two cases. Ureteroneocystostomy was performed for the ectopic ureter found in the opposite urinary system in one of the cases. Ectopic duplicated ureter should be considered in treatment-resistant enuresis and urinary tract infections and after a careful physical examination, imaging as well as function tests should be performed. PMID:26500949

  15. Perceived roles of oncology nursing.

    PubMed

    Lemonde, Manon; Payman, Naghmeh

    2015-01-01

    The Canadian Association of Nurses in Oncology (CANO) Standards of Care (2001) provides a framework that delineates oncology nursing roles and responsibilities. The purpose of this study was to explore how oncology nurses perceive their roles and responsibilities compared to the CANO Standards of Care. Six focus groups were conducted and 21 registered nurses (RNs) from a community-based hospital participated in this study. Transcripts were analyzed using qualitative inductive content analysis. Three themes were identified: (1) Oncology nurses perceive a gap between their defined roles and the reality of daily practice, as cancer care becomes more complex and as they provide advanced oncology care to more patients while there is no parallel adaptation to the health care system to support them, such as safe staffing; (2) Oncology nursing, as a specialty, requires sustained professional development and leadership roles; and (3) Oncology nurses are committed to providing continuous care as a reference point in the health care team by fostering interdisciplinary collaboration andfacilitating patient's navigation through the system. Organizational support through commitment to appropriate staffing and matching scope ofpractice to patient needs may lead to maximize the health and well-being of nurses, quality of patient care and organizational performance. PMID:26897865

  16. ISO 9000: The Librarian's Role.

    ERIC Educational Resources Information Center

    Dobson, Chris; Ernst, Carolyn

    1999-01-01

    Describes the special library's role in implementing ISO 9000 (i.e., a series of international quality-assurance standards developed by the International Organization of Standards). Topics discussed include document and data control, keeping the standards current, documentation of procedures, the ISO 9000 audit, and benefits for the library. (MES)

  17. Physiological Roles of Pneumococcal Peptidases

    PubMed Central

    Johnson, Mary K.

    1974-01-01

    A methionyl-specific dipeptidase from Streptococcus pneumoniae has been described. This enzyme and the pneumococcal tripeptidase have been shown to be intracellular, soluble, and constitutive. In addition to their function in cleavage of peptide nutrients, these peptidases may play a role in protein synthesis and turnover. PMID:4212242

  18. Sex Roles: Symposium V B.

    ERIC Educational Resources Information Center

    Lua, Sokhong; And Others

    Reported is an exploratory investigation of attitudes toward child-rearing practices in Malaysia, including an attempt to investigate and analyze the nature and extent of involvement of Malaysian fathers in child care. There is also an abstract of a study of the influence of child-rearing practices on marital role expectations in Bengali,…

  19. Role models face class expulsion.

    PubMed

    Sprinks, Jennifer

    There are plans to drop Mary Seacole and Florence Nightingale from the curriculum taught in schools, according to leaked reports. Here, nurse leaders protest that this would rob young people of valuable role models and undermine the image of the profession. It is also suggested that a person's contribution to society is more important than their personality. PMID:23427681

  20. Nonverbal Portrayal of Interpersonal Roles.

    ERIC Educational Resources Information Center

    York, Michael W.; And Others

    A study (one of a series) sought to identify interpersonal events related to implicit communication. Implicit communication is defined as nonverbal behavior which serves to transmit "subintended" information. The study explored whether interpersonal roles which account for part of the process of nonverbal communication (and which were identified…

  1. Childhood Obesity: The Caregiver's Role.

    ERIC Educational Resources Information Center

    Haschke, Bernadette

    2003-01-01

    Describes the role caregivers play in helping young children dealing with obesity. Examines: (1) causes of childhood obesity; (2) caregiver's position; (3) learning nutrition concepts; (4) preparing and serving healthy foods; (5) encouraging physical activity; (6) working with parents; and (7) assisting an obese child. (SD)

  2. Role of Bacteria in Oncogenesis

    PubMed Central

    Chang, Alicia H.; Parsonnet, Julie

    2010-01-01

    Summary: Although scientific knowledge in viral oncology has exploded in the 20th century, the role of bacteria as mediators of oncogenesis has been less well elucidated. Understanding bacterial carcinogenesis has become increasingly important as a possible means of cancer prevention. This review summarizes clinical, epidemiological, and experimental evidence as well as possible mechanisms of bacterial induction of or protection from malignancy. PMID:20930075

  3. The Role of the Unconscious.

    ERIC Educational Resources Information Center

    Roeper, Annemarie

    1995-01-01

    The role of the unconscious in educating students is considered, along with historical trends in educational philosophy and psychoanalysis at Roeper School (Michigan) for gifted students. The unconscious and creative drive of gifted students is seen as the bridge for explaining what would otherwise be incomprehensible reactions, behavior,…

  4. Ombudsman Roles for Social Workers

    ERIC Educational Resources Information Center

    Payne, James E.

    1972-01-01

    In Scandinavia the ombudsman has long been respected as a mediator who protects the rights of individual citizens and works to assure governmental agencies' fairness in dealing with them. This article examines the concept and considers various ombudsman roles for social workers in the United States. (Author)

  5. The Multiple Roles of Mentors

    ERIC Educational Resources Information Center

    Sanchez, Sabrina R.; Roegman, Rachel; Goodwin, A. Lin

    2016-01-01

    Teaching Residents at Teachers College (TR@TC) is an 18-month program that prepares teachers for high-needs schools in New York City in two areas: teaching English to speakers of other languages (TESOL) and teaching students with disabilities. Student teachers, called residents, spend a year working with a mentor teacher. Mentors play three roles:…

  6. Exploring Unique Roles for Psychologists

    ERIC Educational Resources Information Center

    Ahmed, Mohiuddin; Boisvert, Charles M.

    2005-01-01

    This paper presents comments on "Psychological Treatments" by D. H. Barlow. Barlow highlighted unique roles that psychologists can play in mental health service delivery by providing psychological treatments--treatments that psychologists would be uniquely qualified to design and deliver. In support of Barlow's position, the authors draw from…

  7. The Faculty Role in Budgeting.

    ERIC Educational Resources Information Center

    Meisinger, Richard J., Jr.; Dubeck, Leroy W.

    1984-01-01

    Specific roles faculty members can play in their institution's budget processes are discussed, and the general ends served by budgets are identified. Each of the dimensions of institutional character (e.g., size, mission) determines the ways in which participants in budgeting will interact. For example, broader faculty participation in budgeting…

  8. The Role of the Student.

    ERIC Educational Resources Information Center

    Halladay, D. W.; And Others

    Participation in some areas of university governance is recommended in these 4 statements as an acceptable student role. The first statement describes "legitimate student demands" as those concerned with the quality of the educational experience as they relate to the stated objectives, purposes, and resources of the institution. In the solution of…

  9. Gender Stereotypes and Social Roles.

    ERIC Educational Resources Information Center

    Eagly, Alice H.

    The reason that people think women and men differ in their general qualities may be that the two sexes tend to be observed in different social roles. To explore the sources of stereotypes about men and women several experiments were conducted. Most of the studies involved randomly selected college students who were presented with a description of…

  10. Divorce Mediator: A New Role

    ERIC Educational Resources Information Center

    Haynes, John M.

    1978-01-01

    In response to soaring divorce rates and liberalized divorce laws, the author proposes a new role for social workers--divorce mediator. Social work skills can be used to lessen the pain couples who are dissolving marriage at the same time that husband and wife are helped to face the future. (Author)

  11. Bureaucratic Control and Principal Role.

    ERIC Educational Resources Information Center

    Bezdek, Robert; And Others

    The purposes of this study were to determine the manner in which the imposition of increased bureaucratic control over principals influenced their allocation of time to tasks and to investigate principals' perceptions of the changes in their roles brought about by this increased control. The specific bureaucratic control system whose effects were…

  12. Pharmacists' Role in Health Care

    ERIC Educational Resources Information Center

    Maronde, Robert F.

    1977-01-01

    Pharmacists' contribution to the health care of the future in the future in the U.S. may have to be in the context of increasing the efficiency and effectiveness of health-care delivery. It is from the area of drug therapy, now poorly administered, that the pharmacist will have to justify his role in a cost-effective manner. (Author/LBH)

  13. The dynamics of role interaction.

    PubMed

    Barnett, E M

    1996-02-01

    Success in our respective business environments is not totally dependent on technical expertise; we must be able to also effectively interact with people. The necessity of successful leadership is assumed; however, we often fail to recognize the value of strategically subordinating ourselves to others. Both roles must be emphasized with the knowledge that preferred individual styles are valid.

  14. Transitioning between Work and Family Roles as a Function of Boundary Flexibility and Role Salience

    ERIC Educational Resources Information Center

    Winkel, Doan E.; Clayton, Russell W.

    2010-01-01

    This study investigates the manner in which people separate their work and family roles and how they manage the boundaries of these two important roles. Specifically, we focus on how role flexibility and salience influence transitions between roles. Results indicate that the ability and willingness to flex a role boundary and role salience are…

  15. The Effect of Role Ambiguity and Role Conflict on Performance of Vice Principals: The Mediating Role of Burnout

    ERIC Educational Resources Information Center

    Celik, Kazim

    2013-01-01

    Problem Statement: Role ambiguity and role conflict are considered issues that affect performance and lead to burnout. While numerous studies have analyzed role ambiguity or role conflict in relation to burnout or performance, few studies have studied all of these issues together. Since vice principals are expected to carry out a variety of…

  16. The role of oxygen free radicals in the development of chronic renal failure

    SciTech Connect

    Trachtman, H.; Wilson, D.; Rao, P.S. )

    1992-01-01

    This study examined whether there is increased production of oxygen free radicals during chronic renal failure. Rats subjected to 3/4 nephrectomy and sham operated controls were killed after 3 weeks. Lipid extracts of plasma and renal tissue were examined by HPLC and kidney specimens were also analyzed by EPR spectroscopy. The redox capacity of blood was assessed using nitroblue tetrazolium and plasma ascorbate levels were measured with HPLC. There was no detectable renal production of oxygen free radicals in rats with chronic renal failure. Kidney parenchymal content of other oxidants and the oxidant: reductant ratio were similar in control and uremic animals. The plasma redox capacity and ascorbate levels were elevated in uremic rats. The authors conclude that early in the course of chronic renal failure, there is not excessive production of oxygen free radicals. There is accumulation of reductants, primarily ascorbate, in the plasma of uremic animals.

  17. The current role of surgery in the management of residual disease.

    PubMed

    Christmas, T J; Mannion, E M; Bower, M

    1999-09-01

    The increasing interest in surveillance rather than primary retroperitoneal lymph node dissection for clinical stage I testis cancer has led to retroperitoneal lymph node dissection being performed mostly after chemotherapy for stage II-IV disease. In most centres residual masses of 2-3 cm or more are removed; those smaller than this are most likely to be necrotic. The aim is to remove all residual disease even if this necessitates nephrectomy or excision of adjacent vascular structures. Laparoscopic approaches are hazardous in these circumstances. Thoraco-abdominal surgical approaches enable excellent access to retroperitoneal masses and synchronous excision of ipsilateral pulmonary metastases and thoracic lymph nodes. Retroperitoneal lymph node dissection also appears to be worthwhile in chemotherapy-resistant disease ('desperation retroperitoneal lymph node dissection'), although the relapse rate is higher in this group.

  18. A Constructivist Look at Life Roles

    ERIC Educational Resources Information Center

    Brott, Pamelia E.

    2005-01-01

    The author reviews the literature related to life roles and describes a variety of techniques that can be used from a constructivist career counseling perspective. Seven counseling techniques are included: life space map, life line, life-space genogram, life roles circles, life roles assessment, life role analysis, and goal map. Framed from the…

  19. Sex-Roles: Why, What, and How.

    ERIC Educational Resources Information Center

    Schwartz, Lita Linzer

    The teaching of sex-role stereotyping issues in an educational psychology course for student teachers is discussed. Issues presented include influences on the learner, the teaching of sex roles and stereotypes in the elementary grades, the presence of role models at home and school, contributions of curriculum to sex-role stereotyping and the…

  20. Role of neuropeptides in cardiomyopathies.

    PubMed

    Dvorakova, Magdalena Chottova; Kruzliak, Peter; Rabkin, Simon W

    2014-11-01

    The role of neuropeptides in cardiomyopathy-associated heart failure has been garnering more attention. Several neuropeptides--Neuropeptide Y (NPY), vasoactive intestinal peptide (VIP), calcitonin gene related peptide (CGRP), substance P (SP) and their receptors have been studied in the various types of cardiomyopathies. The data indicate associations with the strength of the association varying depending on the kind of neuropeptide and the nature of the cardiomyopathy--diabetic, ischemic, inflammatory, stress-induced or restrictive cardiomyopathy. Several neuropeptides appear to alter regulation of genes involved in heart failure. Demonstration of an association is an essential first step in proving causality or establishing a role for a factor in a disease. Understanding the complexity of neuropeptide function should be helpful in establishing new or optimal therapeutic strategies for the treatment of heart failure in cardiomyopathies.

  1. Science role in countering terrorism

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    Geoscience expertise figures as a component of a new report on harnessing the U.S. science and technology community in the fight against terrorism.The National Research Council report, "Making the Nation Safer: The Role of Science and Technology in Countering Terrorism," proposes research agendas in a number of areas perceived to be vulnerable to terrorism. These areas include nuclear and radiological threats, toxic chemicals and explosive materials, information technology, energy systems, and cities and fixed infrastructure.

  2. Science role in countering terrorism

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    Geoscience expertise figures as a component of a new report on harnessing the U.S. science and technology community in the fight against terrorism.The National Research Council report, “Making the Nation Safer: The Role of Science and Technology in Countering Terrorism,” proposes research agendas in a number of areas perceived to be vulnerable to terrorism. These areas include nuclear and radiological threats, toxic chemicals and explosive materials, information technology, energy systems, and cities and fixed infrastructure.

  3. Teaching leadership with role theory.

    PubMed

    Holle, M L; Blatchley, M E

    1989-01-01

    A model based on Mintzberg's use of role theory to describe managerial functions was applied to nursing education. The model builds on interpersonal, informational, and decisional activities of managers (Mintzberg, 1978), and identifies nine subroles that are frequently carried out by managers in nursing. Organization of material using this structure has been well-accepted both by baccalaureate nursing students and by practicing nurses whose educational background in management concepts is limited.

  4. Mitigating earthquakes; the federal role

    USGS Publications Warehouse

    Press, F.

    1977-01-01

    With rapid approach of a capability to make reliable earthquake forecasts, it essential that the Federal Government play a strong, positive role in formulating and implementing plans to reduce earthquake hazards. Many steps are being taken in this direction, with the President looking to the Office of Science and Technology Policy (OSTP) in his Executive Office to provide leadership in establishing and coordinating Federal activities. 

  5. The developmental roles of FMRP.

    PubMed

    Till, Sally M

    2010-04-01

    FXS (Fragile X syndrome) is the most common genetically inherited form of cognitive impairment. The predominant cause of the syndrome is the loss of a single protein, FMRP (Fragile X mental retardation protein). Many of the cognitive and behavioural features found in Fragile X individuals emerge during childhood and are associated with abnormal organization of cortical connections. However, although FMRP is expressed as early as embryogenesis, relatively little is known about its roles during development or how this may influence FXS phenotypes in adulthood. The present review focuses specifically on the evidence for the functions of FMRP during embryonic and early postnatal development. The current knowledge of the role of FMRP in FXS will be briefly summarized before addressing how alterations in the formation and refinement of neuronal connections and synaptic function that result from the loss of FMRP may in turn influence behaviours that are expressed during the first few postnatal weeks. I will then briefly highlight some outstanding questions about the developmental roles of FMRP and their possible relationship to symptoms found in adults with FXS.

  6. Expanding roles for lipid droplets

    PubMed Central

    Welte, Michael A.

    2015-01-01

    Summary Lipid droplets are the intracellular sites for neutral lipid storage. They are critical for lipid metabolism and energy homeostasis, and their dysfunction has been linked to many diseases. Accumulating evidence suggests that the roles lipid droplets play in biology are significantly broader than previously anticipated. Lipid droplets are the source of molecules important in the nucleus: they can sequester transcription factors and chromatin components and generate the lipid ligands for certain nuclear receptors. Lipid droplets have also emerged as important nodes for fatty acid trafficking, both inside the cell and between cells. In immunity, new roles for droplets, not directly linked to lipid metabolism, have been uncovered, as assembly platforms for specific viruses and as reservoirs for proteins that fight intracellular pathogens. Until recently, knowledge about droplets in the nervous system has been minimal, but now there are multiple links between lipid droplets and neurodegeneration: Many candidate genes for Hereditary Spastic Paraplegia also have central roles in lipid-droplet formation and maintenance, and mitochondrial dysfunction in neurons can lead to transient accumulating of lipid droplets in neighboring glial cells, an event that may, in turn, contribute to neuronal damage. As the cell biology and biochemistry of lipid droplets are increasingly well understood, the next few years should yield many new mechanistic insights into these novel functions of lipid droplets. PMID:26035793

  7. About sleep's role in memory.

    PubMed

    Rasch, Björn; Born, Jan

    2013-04-01

    Over more than a century of research has established the fact that sleep benefits the retention of memory. In this review we aim to comprehensively cover the field of "sleep and memory" research by providing a historical perspective on concepts and a discussion of more recent key findings. Whereas initial theories posed a passive role for sleep enhancing memories by protecting them from interfering stimuli, current theories highlight an active role for sleep in which memories undergo a process of system consolidation during sleep. Whereas older research concentrated on the role of rapid-eye-movement (REM) sleep, recent work has revealed the importance of slow-wave sleep (SWS) for memory consolidation and also enlightened some of the underlying electrophysiological, neurochemical, and genetic mechanisms, as well as developmental aspects in these processes. Specifically, newer findings characterize sleep as a brain state optimizing memory consolidation, in opposition to the waking brain being optimized for encoding of memories. Consolidation originates from reactivation of recently encoded neuronal memory representations, which occur during SWS and transform respective representations for integration into long-term memory. Ensuing REM sleep may stabilize transformed memories. While elaborated with respect to hippocampus-dependent memories, the concept of an active redistribution of memory representations from networks serving as temporary store into long-term stores might hold also for non-hippocampus-dependent memory, and even for nonneuronal, i.e., immunological memories, giving rise to the idea that the offline consolidation of memory during sleep represents a principle of long-term memory formation established in quite different physiological systems.

  8. About Sleep's Role in Memory

    PubMed Central

    2013-01-01

    Over more than a century of research has established the fact that sleep benefits the retention of memory. In this review we aim to comprehensively cover the field of “sleep and memory” research by providing a historical perspective on concepts and a discussion of more recent key findings. Whereas initial theories posed a passive role for sleep enhancing memories by protecting them from interfering stimuli, current theories highlight an active role for sleep in which memories undergo a process of system consolidation during sleep. Whereas older research concentrated on the role of rapid-eye-movement (REM) sleep, recent work has revealed the importance of slow-wave sleep (SWS) for memory consolidation and also enlightened some of the underlying electrophysiological, neurochemical, and genetic mechanisms, as well as developmental aspects in these processes. Specifically, newer findings characterize sleep as a brain state optimizing memory consolidation, in opposition to the waking brain being optimized for encoding of memories. Consolidation originates from reactivation of recently encoded neuronal memory representations, which occur during SWS and transform respective representations for integration into long-term memory. Ensuing REM sleep may stabilize transformed memories. While elaborated with respect to hippocampus-dependent memories, the concept of an active redistribution of memory representations from networks serving as temporary store into long-term stores might hold also for non-hippocampus-dependent memory, and even for nonneuronal, i.e., immunological memories, giving rise to the idea that the offline consolidation of memory during sleep represents a principle of long-term memory formation established in quite different physiological systems. PMID:23589831

  9. [The biological role of sulfatides].

    PubMed

    Suchański, Jarosław; Ugorski, Maciej

    2016-01-01

    Sulfatides (3-O-sulfogalactosylceramides, sulfated galactocerebrosides, SM4) are esters of sulfuric acid with galactosylceramides. These acidic glycosphingolipids, present at the external leaflet of the plasma membrane, are synthesized by a variety of mammalian cells. They are especially abundant in the myelin sheath of oligodendrocytes in the central nervous system and Schwann cells in the peripheral nervous system. Studies using cerebroside galactosyltransferase-deficient mice revealed that sulfatides are responsible for proper structure and functioning of myelin. Large amounts of sulfatides are also found in the kidney, gastrointestinal tract, islets of Langerhans, and membranes of erythrocytes, thrombocytes and granulocytes. They are ligands for numerous proteins, but in most cases the biological role of such interactions is poorly understood. A notable exception is their binding by P- and L-selectins. Platelet sulfatides are major ligands for P-selectin, and this interaction is critical for the formation of stable platelet aggregates. Sulfatides also bind to chemokines, and seem to play a role in regulation of cytokine expression in human lymphocytes and monocytes. Aberrant metabolism of sulfatides, could cause several important human diseases. In this article, we describe the changes in sulfatide expression associated with such nervous disorders as metachromatic leukodystrophy (MLD), Parkinson's disease and Alzheimer's disease, and several types of cancer, e.g. colon cancer, kidney cancer, and ovarian cancer. We also discuss the involvement of sulfatides in cancer progression, diabetes and autoimmune and immune disorders such as multiple sclerosis. This acidic glycosphingolipids seem to play an important role in pathogenesis of infectious diseases, serving as receptors for binding various bacteria and viruses. PMID:27180966

  10. Macrophage Roles Following Myocardial Infarction

    PubMed Central

    Lambert, Jessica M.; Lopez, Elizabeth F.; Lindsey, Merry L.

    2010-01-01

    Following myocardial infarction (MI), circulating blood monocytes respond to chemotactic factors, migrate into the infarcted myocardium, and differentiate into macrophages. At the injury site, macrophages remove necrotic cardiac myocytes and apoptotic neutrophils; secrete cytokines, chemokines, and growth factors; and modulate phases of the angiogenic response. As such, the macrophage is a primary responder cell type that is involved in the regulation of post-MI wound healing at multiple levels. This review summarizes what is currently known about macrophage functions post-MI and borrows literature from other injury and inflammatory models to speculate on additional roles. Basic science and clinical avenues that remain to be explored are also discussed. PMID:18656272

  11. The role of the university.

    PubMed

    Starck, P L

    1987-01-01

    The role of the university, and particularly the health sciences university, in promoting positive health for women is twofold. First, the dissemination of existing knowledge raises awareness of special health needs and identifies gaps in the present research and literature base. Second, universities must project future needs of women in a rapidly changing society where such things as space travel may become commonplace. Reduction of the risk of debilitating disease and promotion of positive attitudes will enhance the quality of life for women. A logotherapeutic approach to choosing one's own attitudes toward life's challenges promotes successful coping in a dynamic society.

  12. The role of the university.

    PubMed Central

    Starck, P L

    1987-01-01

    The role of the university, and particularly the health sciences university, in promoting positive health for women is twofold. First, the dissemination of existing knowledge raises awareness of special health needs and identifies gaps in the present research and literature base. Second, universities must project future needs of women in a rapidly changing society where such things as space travel may become commonplace. Reduction of the risk of debilitating disease and promotion of positive attitudes will enhance the quality of life for women. A logotherapeutic approach to choosing one's own attitudes toward life's challenges promotes successful coping in a dynamic society. PMID:3120225

  13. Type A personality as a moderator of the effects of role conflict, role ambiguity and role overload on individual strain.

    PubMed

    Orpen, C

    1982-06-01

    The relations between three types of role stress (role ambiguity, role conflict, role overload) and three measures of individual strain were examined in a sample of 91 middle managers. Separate measures of psychological strain (anxiety, resentment, depression), physical strain (headaches, dizziness, shortage of breath, nausea, fatigue) were developed. In addition, the heart rate, blood pressure, and respiration rate of each subject was assessed. The relations between role conflict and physical strain and between role conflict and psychological strain were significantly positive and higher among Type A personalities than among Type B personalities. The relations between role stress and heart rate, blood pressure, and respiration rate were negligible and were not moderated by personality (Type A or Type B). The results highlight the important role of personality factors in determining how people react to different kinds of stress.

  14. Role of leptin in reproduction.

    PubMed

    Mantzoros, C S

    2000-01-01

    Leptin is a 16-kDa adipocyte-secreted protein the serum levels of which reflect mainly the amount of energy stores but are also influenced by short-term energy imbalance as well as several cytokines and hormones. Leptin, by binding to specific receptors, alters the expression of several hypothalamic neuropeptides that regulate neuroendocrine function as well as energy intake and expenditure. More specifically, accumulating evidence suggests that this hormone may serve to signal to the brain information on the critical amount of fat stores that are necessary for LHRH secretion and activation of the hypothalamic-pituitary-gonadal axis. Rising leptin levels have been associated with initiation of puberty in animals and humans and normal leptin levels are needed for maintenance of menstrual cycles and normal reproductive function. Moreover, circadian and ultradian variations of leptin levels are associated with minute to minute variations of LH and estradiol in normal women. Falling leptin levels in response to starvation result in decreased estradiol levels and amenorrhea in subjects with anorexia nervosa or strenuously exercising athletes. In addition, leptin has a potentially important role during pregnancy and in the physiology of the neonate. Finally, recent evidence suggests that leptin may influence ovarian steroidogenesis directly, but the exact role of intraovarian leptin action in the physiology and pathophysiology of the human reproductive system needs to be further elucidated.

  15. [Patients' increasing role in healthcare].

    PubMed

    Colombo, Cinzia

    2016-03-01

    Since the late '90s citizens have been increasingly involved in healthcare, thanks to a shift in access to healthcare information, greater patients' and citizens' awareness about their rights and needs, and a change in physicians' attitudes and behavior. At the same time, to ensure the sustainability of the national health services, patients' needs are increasingly being examined in relation to the services and interventions needed, and to foster informed demand by patients and citizens, and appropriate prescriptions by physicians. Nowadays, patients already have a section in an authoritative medical journal. Working with clinicians, they set research priorities and the outcomes to be studied. Especially in UK and USA, they are invited to participate in the design and development of trials and in deciding which trials should be funded. The situation varies widely in different countries, though involving citizens in healthcare decisions is a common mantra. Even when they consult a clinician, the patients' role has evolved. People ask for information more often and want an active part in decisions about their health. Physicians start to pay more attention to the person and the social context, feelings and emotions, and person-centered care has become a reference in the doctor-patient relationship. This article offers an overview of the changing roles of patients and citizens in healthcare.

  16. Role models for complex networks

    NASA Astrophysics Data System (ADS)

    Reichardt, J.; White, D. R.

    2007-11-01

    We present a framework for automatically decomposing (“block-modeling”) the functional classes of agents within a complex network. These classes are represented by the nodes of an image graph (“block model”) depicting the main patterns of connectivity and thus functional roles in the network. Using a first principles approach, we derive a measure for the fit of a network to any given image graph allowing objective hypothesis testing. From the properties of an optimal fit, we derive how to find the best fitting image graph directly from the network and present a criterion to avoid overfitting. The method can handle both two-mode and one-mode data, directed and undirected as well as weighted networks and allows for different types of links to be dealt with simultaneously. It is non-parametric and computationally efficient. The concepts of structural equivalence and modularity are found as special cases of our approach. We apply our method to the world trade network and analyze the roles individual countries play in the global economy.

  17. I am my (high-power) role: power and role identification.

    PubMed

    Joshi, Priyanka D; Fast, Nathanael J

    2013-07-01

    Research indicates that power liberates the self, but findings also show that the powerful are susceptible to situational influences. The present article examines whether enacting roles that afford power leads people to identify with the roles or, instead, liberates them from role expectations altogether. The results of three experiments support the hypothesis that power enhances role identification. Experiment 1 showed that enacting a particular role resulted in greater implicit and explicit role identification when the role contained power. In Experiment 2, infusing a role with power resulted in greater role identification and role-congruent behavior. Experiment 3 demonstrated that power resulted in greater role-congruent self-construal, such that having power in a close relationship caused participants to define themselves relationally, whereas having power in a group situation caused participants to embrace a collective self-construal. Implications for research on power, roles, and the self are discussed.

  18. I am my (high-power) role: power and role identification.

    PubMed

    Joshi, Priyanka D; Fast, Nathanael J

    2013-07-01

    Research indicates that power liberates the self, but findings also show that the powerful are susceptible to situational influences. The present article examines whether enacting roles that afford power leads people to identify with the roles or, instead, liberates them from role expectations altogether. The results of three experiments support the hypothesis that power enhances role identification. Experiment 1 showed that enacting a particular role resulted in greater implicit and explicit role identification when the role contained power. In Experiment 2, infusing a role with power resulted in greater role identification and role-congruent behavior. Experiment 3 demonstrated that power resulted in greater role-congruent self-construal, such that having power in a close relationship caused participants to define themselves relationally, whereas having power in a group situation caused participants to embrace a collective self-construal. Implications for research on power, roles, and the self are discussed. PMID:23613123

  19. The Teacher and Sex Role Stereotyping

    ERIC Educational Resources Information Center

    Juhasz, Anne McCreary

    1974-01-01

    In this article, selected research findings are presented on sex role learning, sex role stereotyping, in general and in the school setting, the effect of such stereotyping on the student, and some suggestions for the teacher. (Author/JA)

  20. Young Children's Conception of Status and Role.

    ERIC Educational Resources Information Center

    Corsaro, William A.

    1979-01-01

    Discusses young children's conceptions of status and role based on sociolinguistic analyses of spontaneous role play. Links developmental features of social knowledge to contextual features of children's interactive experiences. (Author/CK)

  1. Role Models and Sports: A Youthful Perspective.

    ERIC Educational Resources Information Center

    School Safety, 1989

    1989-01-01

    Research and numerous model programs suggest that sports play an important social role. Particularly among youth, sports and professional athlete role models help deter juvenile delinquency. Several athlete organizations have been established to aid youth. (SI)

  2. Utilizing Peer Mentor Roles in Learning Communities

    ERIC Educational Resources Information Center

    Rieske, Laura Jo; Benjamin, Mimi

    2015-01-01

    For a number of learning community programs, peer mentors provide an additional layer of staffing support. This chapter highlights peer mentor roles from a sample of programs and suggests important components for the construction of these roles.

  3. Current Perspectives on Women's Multiple Roles.

    ERIC Educational Resources Information Center

    Gilbert, Lucia Albino; Brownson, Chris

    1998-01-01

    The process of reproducing gender through discourses can inhibit role sharing and multiple roles for women. Two discourses influence the psyches of men and women to reproduce ideal types: women and men as equals and men as incompetent caregivers. (SK)

  4. Perspectives on role socialization of nurses.

    PubMed

    Christman, L

    1991-01-01

    Individuals enact roles according to their personal knowledge of the role and the expectations of others interacting with the role. This is especially evident in patient care, where depths of knowledge are crucial to outcomes. The pecking order of health care professionals is directly related to the knowledge levels of the role enactors. Nurses tend to be the proverbial low man on the totem pole.

  5. The management of hyperthyroidism. A surgeon's perspective

    SciTech Connect

    Falk, S.A. )

    1990-06-01

    Surgery for the treatment of hyperthyroidism is rapid and permanent, highly safe, and highly successful and has an important and complementary role with medical therapy and {sup 131}I. In Grave's disease cases total thyroidectomy, performed only if parathyroid glands are preserved, prevents recurrent hyperthyroidism. Bilateral subtotal thyroidectomy or total lobectomy with contralateral subtotal lobectomy are done if at least one parathyroid cannot be preserved on each side. In terms of recurrent laryngeal nerve preservation, all three operations are equally safe if the nerve is positively identified and traced throughout its course. 91 references.

  6. Changing Instructor's Roles in Virtual Worlds

    ERIC Educational Resources Information Center

    Berge, Zane L.

    2008-01-01

    Berge's Instructor's Roles Model categorized the instructor's roles as pedagogical, social, managerial, and technical. Developed more than a decade ago, this model described changing roles for instructors as they transitioned from in-person classrooms to teaching online. Today, as virtual worlds emerge and are being used as educational platforms,…

  7. Role Playing as a Group Intervention.

    ERIC Educational Resources Information Center

    Cabral, Rebecca J.

    1987-01-01

    Supports role playing as an effective intervention technique that has been broadly adapted for academic research and applied settings. Presents a classification scheme for organizing these diverse role-playing uses, in terms of intraindividual and intact group change. Suggests that research and implementation of role playing would be best served…

  8. Role Interaction: The Salt in the Soup.

    ERIC Educational Resources Information Center

    Kilbane-Flash, Marian T.

    This case study illustrates and expands upon the principle that innovation efforts involve both role change and change in role interrelationships, changes that (ideally) will be supportive of the innovation effort, but which may--if duplication, gaps among roles, or tension arise--weaken or destroy the effort. A planning effort in the Cleveland…

  9. Identifying Role Diffusion in School Counseling

    ERIC Educational Resources Information Center

    Astramovich, Randall L.; Hoskins, Wendy J.; Gutierrez, Antonio P.; Bartlett, Kerry A.

    2013-01-01

    Role ambiguity in professional school counseling is an ongoing concern despite recent advances with comprehensive school counseling models. The study outlined in this article examined role diffusion as a possible factor contributing to ongoing role ambiguity in school counseling. Participants included 109 graduate students enrolled in a…

  10. Educators' Perceptions of the School Nurse's Role.

    ERIC Educational Resources Information Center

    Greenhill, E. Dianne

    Objectives of a study of the role of the school nurse were (1) to clarify the role of the school nurse within a particular setting, (2) to identify perceptions of key school personnel concerning the nurse's role, and (3) to identify and compare areas of perceptual congruity-incongruity between school personnel and school nurses. The instrument…

  11. Thematic Role Properties of Subjects and Objects

    ERIC Educational Resources Information Center

    Kako, Edward

    2006-01-01

    This paper tests two claims about the thematic roles Agent and Patient: first, that they can be decomposed into more primitive features, as laid out in Dowty's (1991) Proto-Roles Hypothesis; and second, that these properties can be inferred directly from the grammatical roles subject and object. In Experiments 1 and 2, participants rated the…

  12. Restaurant Role-Play in Psychology

    ERIC Educational Resources Information Center

    Borya, Anthony

    2013-01-01

    Research methods is perceived as a technical and difficult topic by some students. Using role-play to teach it can make it more accessible, meaningful and engaging. Role-playing the familiar roles of customer and waiting staff at a restaurant and discussing the variables that may affect the size of tips can help students to learn some of the key…

  13. Appraising Gender Role Portrayals in TV Commercials.

    ERIC Educational Resources Information Center

    Kolbe, Richard H.; Langefeld, Carl D.

    1993-01-01

    Examines gender role orientations of characters in prime time television advertisements through the Bem Sex-Role Inventory (BSRI) completed by 426 college students (43.2% females). Results confirm the appropriateness of the scale for self- and person-perception ratings. Uses of the BSRI in gender role research are discussed. (SLD)

  14. Roles of Variables in Three Programming Paradigms

    ERIC Educational Resources Information Center

    Sajaniemi, J.; Ben-Ari, M.; Byckling, P.; Gerdt, P.; Kulikova, Y.

    2006-01-01

    Roles can be assigned to occurrences of variables in programs according to a small number of stereotypical patterns of use. Studies on explicitly teaching roles to novices learning programming have shown that roles are an excellent pedagogical tool for clarifying the structure and meaning of programs and that their use improves students'…

  15. Nature or Nurture? Gender Roles Scavenger Hunt

    ERIC Educational Resources Information Center

    Whalen, Shannon; Maurer-Starks, Suanne

    2008-01-01

    The examination of gender roles and stereotypes and their subsequent impact on sexual behavior is a concept for discussion in many sex education courses in college and sex education units in high school. This analysis often leads to a discussion of the impact of nature vs. nurture on gender roles. The gender roles scavenger hunt is an interactive…

  16. Conservation of Social Roles in Preschool Children.

    ERIC Educational Resources Information Center

    Jordan, Valerie Barnes

    The development of children's understanding of the permanence of various social roles was examined in 16 four- and 16 five-year-old children. A social role conservation battery consisting of 12 items on the permanence of self-identity, gender, child and sibling roles was given under three temporal conditions: the past (i.e., when you were a baby,…

  17. Role of Astrocytes in Epilepsy

    PubMed Central

    Coulter, Douglas A.; Steinhäuser, Christian

    2016-01-01

    Astrocytes express ion channels, transmitter receptors, and transporters and, thus, are endowed with the machinery to sense and respond to neuronal activity. Recent studies have implicated that astrocytes play important roles in physiology, but these cells also emerge as crucial actors in epilepsy. Astrocytes are abundantly coupled through gap junctions allowing them to redistribute elevated K+ and transmitter concentrations from sites of enhanced neuronal activity. Investigation of specimens from patients with pharmacoresistant temporal lobe epilepsy and epilepsy models revealed alterations in expression, localization, and function of astroglial K+ and water channels. In addition, malfunction of glutamate transporters and the astrocytic glutamate-converting enzyme, glutamine synthetase, has been observed in epileptic tissue. These findings suggest that dysfunctional astrocytes are crucial players in epilepsy and should be considered as promising targets for new therapeutic strategies. PMID:25732035

  18. Nanotechnology: role in dental biofilms.

    PubMed

    Bhardwaj, Sonia B; Mehta, Manjula; Gauba, K

    2009-01-01

    Biofilms are surface-adherent populations of microorganisms consisting of cells, water and extracellular matrix material Nanotechnology is promising field of science which can guide our understanding of the role of interspecies interaction in the development of biofilm. Streptococcus mutans with other species of bacteria has been known to form dental biofilm. The correlation between genetically modified bacteria Streptococcus mutans and nanoscale morphology has been assessed using AFMi.e atomic force microscopy. Nanotechnology application includes 16O/18O reverse proteolytic labeling,use of quantum dots for labeling of bacterial cells, selective removal of cariogenic bacteria while preserving the normal oral flora and silver antimicrobial nanotechnology against pathogens associated with biofilms. The future comprises a mouthwash full of smart nanomachines which can allow the harmless flora of mouth to flourish in a healthy ecosystem.

  19. The Role of Coherent Detection

    NASA Technical Reports Server (NTRS)

    Zmuidzinas, J.

    2004-01-01

    Many interesting astronomical objects, such as galaxies, molecular clouds, PDRs, star - forming regions, protostars, evolved stars, planets, and comets, have rich submillimeter spectra. In order to avoid line blending, and to be able to resolve the line shape, it is often necessary to measure these spectra at high resolution. This paper discusses the relative advantages and limitations of coherent and direct detection for high resolution spectroscopy in the submillimeter and far - infrared. In principle, direct detection has a fundamental sensitivity advantage. In practice, it is di.cult to realize this advantage given the sensitivities of existing detectors and reasonable constraints on the instrument volume. Thus, coherent detection can be expected to play an important role in submillimeter and far - infrared astrophysics well into the future.

  20. Syntexis and its petrogenetic role

    SciTech Connect

    Dobretsov, G.L.; Marin, Yu.B.

    1986-08-01

    The reality of syntexis or mixing of magmas is accepted by most petrologists at the present time. However, this process is mostly commonly ascribed an extremely limited role in the overall balance of magmatic petrogenesis, although earlier, at the turn of the century, the syntexis mechanism was assigned major petrogenetic significance. In recent years this petrological mechanism has again been invoked to explain a greater and greater number of magmatic formations. The present authors consider it necessary in addition to important aspects of the problem of syntexis: (1) not only the reality, but also the global petrogenetic significance of the process; and (2) the wide petrological possibilities of the mechanism of syntexis and its application in explaining the origin not only of rocks of the calcalkaline series, but also of alkaline-salic magmatic rocks with their associated metallogeny. 34 references.

  1. THE ROLE OF THE SCAPULA

    PubMed Central

    Voight, Michael L.

    2013-01-01

    Previously, the scapular musculature was often neglected in designing a rehabilitation protocol for the shoulder. In the past two decades a significant amount of research has been performed in order to help identify the role of the scapula in upper extremity function. Weakness of the scapular stabilizers and resultant altered biomechanics could result in: 1) abnormal stresses to the anterior capsular structures of the shoulder, 2) increased possibility of rotator cuff compression, and 3) decreased shoulder complex neuromuscular performance. This clinical commentary presents facts about the anatomy and biomechanics of the scapula and surrounding musculature, and describes the pathomechanics of scapular dysfunction. The focus is upon the assessment of dysfunction and retraining of the scapular musculature. Level of Evidence: 5 PMID:24175141

  2. [Role of RAS in prehypertension].

    PubMed

    Inaba, Shinji; Iwai, Masaru; Horiuchi, Masatsugu

    2008-08-01

    Hypertension has long been recognized as a major risk factor of several cardiovascular diseases. It is well known that the renin-angiotensin system(RAS) is involved in the pathogenesis of both hypertension and hypertensive end-organ damage. Untreated hypertension is self-accelerating condition through RAS stimulation. Activation of RAS contributes to the transition from borderline hypertension to established hypertension. Recently, "the Seventh Report of Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7)" proposed a new classification of borderline blood pressure levels, as "prehypertension". The therapeutic focus has begun to shift from the therapy of established hypertension to the prevention of hypertension. This review addressed the relationship between hypertension, prehypertension and the role of RAS. PMID:18700549

  3. Nurse managers: perceptions of their role.

    PubMed

    Coulson, M K; Cragg, C E

    1995-01-01

    A qualitative study on the role of the nurse manager was conducted based on interviews with nurse managers in an acute care teaching hospital. Role descriptions revealed many similarities to Mintzberg's (1973) model of management roles, but additional roles, related to the nurse manager's professional responsibilities were identified. Conflicts within and among roles and a strong need for support were themes that were identified throughout the interviews. Suggestions for improving the quality of worklife of the nurse manager and for further research are included.

  4. The Role of Postoperative Radiation Therapy in the Treatment of Meningeal Hemangiopericytoma—Experience From the SEER Database

    SciTech Connect

    Stessin, Alexander M.; Sison, Cristina; Nieto, Jaime; Raifu, Muri; Li, Baoqing

    2013-03-01

    Purpose: The aim of this study was to examine the effect of postoperative radiation therapy (RT) on cause-specific survival in patients with meningeal hemangiopericytomas. Methods and Materials: The Surveillance, Epidemiology, and End Results database from 1990-2008 was queried for cases of surgically resected central nervous system hemangiopericytoma. Patient demographics, tumor location, and extent of resection were included in the analysis as covariates. The Kaplan-Meier product-limit method was used to analyze cause-specific survival. A Cox proportional hazards regression analysis was conducted to determine which factors were associated with cause-specific survival. Results: The mean follow-up time is 7.9 years (95 months). There were 76 patients included in the analysis, of these, 38 (50%) underwent gross total resection (GTR), whereas the other half underwent subtotal resection (STR). Postoperative RT was administered to 42% (16/38) of the patients in the GTR group and 50% (19/38) in the STR group. The 1-year, 10-year, and 20-year cause-specific survival rates were 99%, 75%, and 43%, respectively. On multivariate analysis, postoperative RT was associated with significantly better survival (HR = 0.269, 95% CI 0.084-0.862; P=.027), in particular for patients who underwent STR (HR = 0.088, 95% CI: 0.015-0.528; P<.008). Conclusions: In the absence of large prospective trials, the current clinical decision-making of hemangiopericytoma is mostly based on retrospective data. We recommend that postoperative RT be considered after subtotal resection for patients who could tolerate it. Based on the current literature, the practical approach is to deliver limited field RT to doses of 50-60 Gy while respecting the normal tissue tolerance. Further investigations are clearly needed to determine the optimal therapeutic strategy.

  5. Psychiatrists' Perceptions of Role-Playing Games.

    PubMed

    Lis, Eric; Chiniara, Carl; Biskin, Robert; Montoro, Richard

    2015-09-01

    The literature has seen a surge in research on the mental health impacts of technologies such as Facebook, video games, and massively-multiplayer online role-playing games such as World of Warcraft, but little is known regarding the mental health impact of non-video role-playing games, such as Dungeons & Dragons. The present study examines how psychiatrists' perceive role-playing games and whether they play them. Psychiatrists at a tertiary care centre in Canada completed a questionnaire assessing history of playing role-playing games and whether they associate them with psychopathology. Forty-eight psychiatrists responded. Twenty-three percent have played a role-playing game over their lifetimes. Twenty-two percent believed there was an association between psychopathology and role-playing games. A majority of psychiatrists who responded do not associate role-playing games with psychopathology. Implications for clinical practice and future research are discussed. PMID:25589035

  6. Psychiatrists' Perceptions of Role-Playing Games.

    PubMed

    Lis, Eric; Chiniara, Carl; Biskin, Robert; Montoro, Richard

    2015-09-01

    The literature has seen a surge in research on the mental health impacts of technologies such as Facebook, video games, and massively-multiplayer online role-playing games such as World of Warcraft, but little is known regarding the mental health impact of non-video role-playing games, such as Dungeons & Dragons. The present study examines how psychiatrists' perceive role-playing games and whether they play them. Psychiatrists at a tertiary care centre in Canada completed a questionnaire assessing history of playing role-playing games and whether they associate them with psychopathology. Forty-eight psychiatrists responded. Twenty-three percent have played a role-playing game over their lifetimes. Twenty-two percent believed there was an association between psychopathology and role-playing games. A majority of psychiatrists who responded do not associate role-playing games with psychopathology. Implications for clinical practice and future research are discussed.

  7. Roles and Relationships in Student Teaching: A Role-Play Activity.

    ERIC Educational Resources Information Center

    Moses, Jeewa R.

    This role-play activity is designed for use by teacher educators in a general or content area methods class to help education majors become knowledgeable of role expectations in the student teaching experience and build good interpersonal role relationships. Students conduct library research and interviews concerning role expectations, use the…

  8. Reference Group Interaction and Sex Role Orientation: A Comparative Analysis by Sex and Mother's Achieved Role.

    ERIC Educational Resources Information Center

    Tomeh, Aida K.; Vasko, Catherine

    This paper examines the role of parents and friends (reference groups) in forming college students' sex-role orientations. Emphasis is placed on the mother's domestic, parental, and achieved (professional/occupational) role and on the mother's modeling transmission effect on her daughter's and son's sex-role attitudes. The hypothesis is that…

  9. From "Mentor" to "Role Model": Scaling the Involvement of STEM Professionals through Role Model Videos

    ERIC Educational Resources Information Center

    Ware, Jennifer; Stein, Sarah

    2013-01-01

    Mentors and role models can play a significant role in high school students' motivation to pursue specific careers later in life. Although the use of role models in the classroom is an important research topic, little research has been conducted on scaling up STEM role models reach through the use of video vignettes. This essay outlines a series…

  10. Role of carnitine in disease

    PubMed Central

    2010-01-01

    Carnitine is a conditionally essential nutrient that plays a vital role in energy production and fatty acid metabolism. Vegetarians possess a greater bioavailability than meat eaters. Distinct deficiencies arise either from genetic mutation of carnitine transporters or in association with other disorders such as liver or kidney disease. Carnitine deficiency occurs in aberrations of carnitine regulation in disorders such as diabetes, sepsis, cardiomyopathy, malnutrition, cirrhosis, endocrine disorders and with aging. Nutritional supplementation of L-carnitine, the biologically active form of carnitine, is ameliorative for uremic patients, and can improve nerve conduction, neuropathic pain and immune function in diabetes patients while it is life-saving for patients suffering primary carnitine deficiency. Clinical application of carnitine holds much promise in a range of neural disorders such as Alzheimer's disease, hepatic encephalopathy and other painful neuropathies. Topical application in dry eye offers osmoprotection and modulates immune and inflammatory responses. Carnitine has been recognized as a nutritional supplement in cardiovascular disease and there is increasing evidence that carnitine supplementation may be beneficial in treating obesity, improving glucose intolerance and total energy expenditure. PMID:20398344

  11. Role of LCAT in Atherosclerosis.

    PubMed

    Ossoli, Alice; Simonelli, Sara; Vitali, Cecilia; Franceschini, Guido; Calabresi, Laura

    2016-01-01

    Lecithin:cholesterol acyltransferase (LCAT) is the only enzyme capable of esterifying cholesterol in plasma, thus determining the maturation of high-density lipoproteins. Because it maintains an unesterified cholesterol gradient between peripheral cells and extracellular acceptors, for a long time, LCAT has been considered as a key enzyme in reverse cholesterol transport. However, despite the fact that it has been more than 50 years since the identification of LCAT, the role of this enzyme in the pathogenesis of atherosclerosis is still debated. A number of studies have been conducted in different animal models, with contradictory results. Studies in humans, in particular in the general population, in subjects at high cardiovascular risk, and in carriers of genetic LCAT deficiency in an excellent model to evaluate the correlation between the reduction of LCAT activity and atherosclerosis also gave conflicting results. This review provides a comprehensive overview of the controversial findings obtained in animals and humans, strengthening the necessity of further investigation to establish how LCAT could be regulated in a promising therapeutic strategy to reduce cardiovascular risk. PMID:26607351

  12. Differential Roles of PML Isoforms

    PubMed Central

    Nisole, Sébastien; Maroui, Mohamed Ali; Mascle, Xavier H.; Aubry, Muriel; Chelbi-Alix, Mounira K.

    2013-01-01

    The tumor suppressor promyelocytic leukemia (PML) protein is fused to the retinoic acid receptor alpha in patients suffering from acute promyelocytic leukemia (APL). Treatment of APL patients with arsenic trioxide (As2O3) reverses the disease phenotype by a process involving the degradation of the fusion protein via its PML moiety. Several PML isoforms are generated from a single PML gene by alternative splicing. They share the same N-terminal region containing the RBCC/tripartite motif but differ in their C-terminal sequences. Recent studies of all the PML isoforms reveal the specific functions of each. Here, we review the nomenclature and structural organization of the PML isoforms in order to clarify the various designations and classifications found in different databases. The functions of the PML isoforms and their differential roles in antiviral defense also are reviewed. Finally, the key players involved in the degradation of the PML isoforms in response to As2O3 or other inducers are discussed. PMID:23734343

  13. Roles of Lipids in Photosynthesis.

    PubMed

    Kobayashi, Koichi; Endo, Kaichiro; Wada, Hajime

    2016-01-01

    Thylakoid membranes in cyanobacterial cells and chloroplasts of algae and higher plants are the sites of oxygenic photosynthesis. The lipid composition of the thylakoid membrane is unique and highly conserved among oxygenic photosynthetic organisms. Major lipids in thylakoid membranes are glycolipids, monogalactosyldiacylglycerol, digalactosyldiacylglycerol and sulfoquinovosyldiacylglycerol, and the phospholipid, phosphatidylglycerol. The identification of almost all genes involved in the biosynthesis of each lipid class over the past decade has allowed the generation and isolation of mutants of various photosynthetic organisms incapable of synthesizing specific lipids. Numerous studies using such mutants have revealed that these lipids play important roles not only in the formation of the lipid bilayers of thylakoid membranes but also in the folding and assembly of the protein subunits in photosynthetic complexes. In addition to the studies with the mutants, recent X-ray crystallography studies of photosynthetic complexes in thylakoid membranes have also provided critical information on the association of lipids with photosynthetic complexes and their activities. In this chapter, we summarize our current understanding about the structural and functional involvement of thylakoid lipids in oxygenic photosynthesis.

  14. Atom-Role-Based Access Control Model

    NASA Astrophysics Data System (ADS)

    Cai, Weihong; Huang, Richeng; Hou, Xiaoli; Wei, Gang; Xiao, Shui; Chen, Yindong

    Role-based access control (RBAC) model has been widely recognized as an efficient access control model and becomes a hot research topic of information security at present. However, in the large-scale enterprise application environments, the traditional RBAC model based on the role hierarchy has the following deficiencies: Firstly, it is unable to reflect the role relationships in complicated cases effectively, which does not accord with practical applications. Secondly, the senior role unconditionally inherits all permissions of the junior role, thus if a user is under the supervisor role, he may accumulate all permissions, and this easily causes the abuse of permission and violates the least privilege principle, which is one of the main security principles. To deal with these problems, we, after analyzing permission types and role relationships, proposed the concept of atom role and built an atom-role-based access control model, called ATRBAC, by dividing the permission set of each regular role based on inheritance path relationships. Through the application-specific analysis, this model can well meet the access control requirements.

  15. Mentoring relationships and the levels of role conflict and role ambiguity experienced by novice nursing faculty.

    PubMed

    Specht, Jennifer A

    2013-01-01

    This study explored the effect of mentoring on the levels of role conflict and role ambiguity experienced by novice nursing faculty related to their transitions into academe using a descriptive, comparative design. It also measured the relationship between the quality of mentoring experiences of novice nursing faculty and their levels of role conflict and role ambiguity using a correlational design. P. Benner's (1984) novice to expert model was utilized as a framework for successful role transition. J. R. Rizzo, R. J. House, and S. I. Lirtzman's (1970) role conflict and role ambiguity scale was used to measure the levels of role conflict and role ambiguity experienced by novice nursing faculty. Results indicate that participants (n = 224) who were mentored have significantly lower levels of role conflict (M = 3.57) and role ambiguity (M = 3.02) than those who were not mentored (M = 4.62 and M = 3.90, respectively). Also significant, the higher the participants' reported levels of quality of mentoring experiences were, the lower their levels of role conflict and role ambiguity were. The results of this study indicate that mentoring eases the transition of novice nursing faculty from practice into academe by decreasing the degree of role ambiguity and role conflict that they experience.

  16. The neuromodulative role of earthing.

    PubMed

    Sokal, Paweł; Sokal, Karol

    2011-11-01

    Neuromodulation is a process of inhibition, stimulation, modification and regulation or therapeutic alteration of activity, electrically and chemically in the peripheral, central or autonomic nervous systems. Direct electric current or electric field alternates the function of nervous system. Coupling the human organism with the Earth directly or via a wire conductor changes the electric potential not only on the surface of the body but also inside it, changing the potential of electric environment of the human organism. Earthing refers to a direct contact with the Earth with bare feet or contact with the Earth with the use of conductive wire attached to the human body during sleeping, or daily activities. During earthing this electric potential equals to electric potential of the Earth and the value of it depends on location, time, atmospheric conditions, moisture of the surface of the Earth. The earthing which changes the density of negative charge in electric environment of the human body influences physiological processes. Our medical hypothesis states that contact with the Earth (earthing) directly or via a conductive wire plays role as a neuromodulative factor, probably primary, which enables the nervous system to be better adapted to the demands of organism and ambient environment. It helps to restore natural, electrical status of the electrical environment of the organism and thus the nervous system. Earthing generates immediate changes in electroencephalography (EEG), surface electromyography (SEMG), and somato-sensory evoked potentials (SSEPs). We hypothesize that earthing through its complex action on bioelectrical environment of human organism and alternations in electrolyte concentrations regulates correct functioning of the nervous system. Earthing significantly influences on the electrical activity of the brain.

  17. Project organization, roles and functions.

    PubMed

    1986-06-01

    This discussion of the roles and functions in the integrated project which provides services in maternal and child health, family planning; nutrition, environmental sanitation, and income-generating projects in the Philippines covers the functions of the National Coordinating Committee, the Provincial Coordinating Committee, the Municipal Coordinating Committee, implementing units, the teams of development workers (TDWs), and coordinating/monitoring units. The National Coordinating Committee provides general directions and guidelines for the implementation of the project through the POPCOM/JICA central staff based at the POPCOM central office in Metro Manila. Functions of the Provincial Coordinating Committee include: resolve problems arising from issues of coordination involving members of the TDWs; ensure participation of provincial units of the various participating ministries; provide guidelines on the delivery of integrated services by TDWs; monitor the activities of TDWs, the municipal coordinating committee, and its various units; and review and endorse the city/provincial integrated project work plan to the regional office. The Municipal Coordinating Committee recommends policies to the national coordinating committee through the provincial coordinating committee to strenthen project implementation in the municipalities. Its functions include: resolve problems arising from issues involving the members of the TDWs; regularly monitor the activities of the TDWs; and provide assistance to the TDWs in the implementation of guidelines. Actual implementation of the project is carried out by the local government, represented by the barangay captain. He is assisted by the TDWs which come from various participating ministries of the government. The TDWs are in effect the task force of the municipal mayor who assist the barangay captain in the delivery of services and the conduct of information, education, and communication campaigns. 3 units assist the various

  18. Great Expectations: How Role Expectations and Role Experiences Relate to Perceptions of Group Cohesion.

    PubMed

    Benson, Alex J; Eys, Mark A; Irving, P Gregory

    2016-04-01

    Many athletes experience a discrepancy between the roles they expect to fulfill and the roles they eventually occupy. Drawing from met expectations theory, we applied response surface methodology to examine how role expectations, in relation to role experiences, influence perceptions of group cohesion among Canadian Interuniversity Sport athletes (N = 153). On the basis of data from two time points, as athletes approached and exceeded their role contribution expectations, they reported higher perceptions of task cohesion. Furthermore, as athletes approached and exceeded their social involvement expectations, they reported higher perceptions of social cohesion. These response surface patterns-pertaining to task and social cohesion-were driven by the positive influence of role experiences. On the basis of the interplay between athletes' role experiences and their perception of the group environment, efforts to improve team dynamics may benefit from focusing on improving the quality of role experiences, in conjunction with developing realistic role expectations.

  19. Taxonomy of the nuclear plant operator's role

    SciTech Connect

    Kisner, R.A.; Fullerton, A.M.; Frey, P.R.; Dougherty, E.M.

    1981-01-01

    A program is presently under way at the Oak Ridge National Laboratory (ORNL) to define the functional design requirements of operational aids for nuclear power plant operators. A first and important step in defining these requirements is to develop an understanding of the operator's role or function. This paper describes a taxonomy of operator functions that applies during all operational modes and conditions of the plant. Other topics such as the influence of automation, role acceptance, and the operator's role during emergencies are also discussed. This systematic approach has revealed several areas which have potential for improving the operator's ability to perform his role.

  20. Contemplating a role for titanium in organisms.

    PubMed

    Zierden, Mark R; Valentine, Ann M

    2016-01-01

    Titanium is the ninth most abundant element in the Earth's crust and some organisms sequester it avidly, though no essential biological role has yet been recognized. This Minireview addresses how the properties of titanium, especially in an oxic aqueous environment, might make a biological role difficult to recognize. It further considers how new -omic technologies might overcome the limitations of the past and help to reveal a specific role for this metal. While studies with well established model organisms have their rightful place, organisms that are known avid binders or sequesterers of titanium should be promising places to investigate a biological role.

  1. Instructional or Managerial Leadership: The Principal Role!

    ERIC Educational Resources Information Center

    Jazzar, Michael

    2004-01-01

    "Instructional Or Managerial Leadership: The Principal Role" is a case study written to challenge the beliefs of graduate students preparing for educational leadership roles and educational leaders already in these positions as to the importance of the principal as an instructional leader. This case explores communication between superintendents…

  2. Sex Roles among Married and Unmarried Couples.

    ERIC Educational Resources Information Center

    Kotkin, Mark

    1983-01-01

    An investigation of sex roles among married and cohabitating couples showed: (1) that male career success, male career precedence, the decision to marry, and conventional allocation of household tasks are all concomitant and (2) that marriage crystallizes sex roles and behaviorally solidifies male career precedence, facilitating the husband's…

  3. Using Role Play to Debate Animal Testing

    ERIC Educational Resources Information Center

    Agell, Laia; Soria, Vanessa; Carrió, Mar

    2015-01-01

    The use of animals in biomedical research is a socio-scientific issue in which decision-making is complicated. In this article, we describe an experience involving a role play activity performed during school visits to the Barcelona Biomedical Research Park (PRBB) to debate animal testing. Role playing games require students to defend different…

  4. Male Acceptance of Female Career Roles.

    ERIC Educational Resources Information Center

    Hollender, John; Schafer, Leslie

    1981-01-01

    Forty-two White, male university students rated five written female role statements matched with videotaped females on an 11-point probability of marriage scale. Preference was given to family-oriented women with some career involvement. Results also indicated interaction among work roles, female physical attractiveness, and male self-esteem. (JCD)

  5. The role of language in science

    SciTech Connect

    Ford, A.; Peat, F.D. )

    1988-12-01

    It is argued that language plays an active role in the development of scientific thought. A research project is outlined which will investigate this hypothesis and, in addition, focus on such questions as the role of mathematics in science and the status of the genetic code.

  6. The Changing Roles of Arts Leadership

    ERIC Educational Resources Information Center

    Rushlow, Bonnie B., Ed.

    2005-01-01

    The role and expectations of the arts supervisor and administrator have expanded beyond managing personnel and programmatic activities to informing policy decisions. Legislation such as The No Child Left Behind Act, signed by President Bush in 2002, exacerbated this paradigm shift. Thus, the role of arts supervisors and administrators as leaders…

  7. Leisure Role of Public Libraries: User Views

    ERIC Educational Resources Information Center

    Hayes, Emma; Morris, Anne

    2005-01-01

    This is the second of two articles examining the leisure role of public libraries. The first article examined the leisure role of public libraries in the UK from a historical perspective. This examines the value of the public library service in providing leisure opportunities from a user point of view. The results demonstrate that public libraries…

  8. The Research Role of a National Center.

    ERIC Educational Resources Information Center

    Silberman, Harry F.

    The functional role of a national center for vocational education depends on the people doing the work; consequently, the center sets its own agenda when it makes personal decisions. A center's role should include two elements: in setting its own research agenda, a center should take a broad perspective on vocational education; and a center should…

  9. Role-Playing in Counselor Student Development

    ERIC Educational Resources Information Center

    Osborn, Debra; Costas, Lisa

    2013-01-01

    This study examined how role-plays impacted 27 counseling students' overall skills as measured by instructor ratings and self-ratings during practice triads in a microskills course. A Mann-Whitney U nonparametric test revealed no significant difference for scripted versus personal concerns role-plays. Students indicated a strong belief that…

  10. Roles for vitamin K beyond coagulation

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Recent interest in vitamin K has been motivated by evidence of physiological roles beyond that of coagulation. Vitamin K and vitamin K-dependent proteins may be involved in regulation of calcification, energy metabolism, and inflammation. However, the evidence for many of these proposed roles in the...

  11. Equality by Default: Women in Dual Roles

    ERIC Educational Resources Information Center

    Campbell, Ena

    1978-01-01

    The struggle for an Equal Rights Amendment (ERA) to the American Constitution is one of the most controversial issues of this era. Discusses the changing role of women amidst a fast-changing society, the styles of those opposing the women's revolution, the debate over women as persons, women in dual roles, and the implications of ERA for the world…

  12. Preterm labor: role of the nurse practitioner.

    PubMed

    Doyle, Jennifer; Silber, Angela

    2015-03-12

    The nurse practitioner may play a pivotal role in diagnosing preterm labor through risk assessment and physical exam. While treatment and management of preterm labor are usually beyond the nurse practitioner's scope of practice, they can play an important role in preventing preterm birth through assessment, action, or advocacy.

  13. Trends Affecting the Roles of Reference Librarians.

    ERIC Educational Resources Information Center

    Dawson, Alma; McCook, Kathleen de la Pena

    1996-01-01

    Reviews societal and general library trends and their effect on roles of library reference staff. Topics include demographic changes; economic trends; technological developments; shifting paradigms; contextual perceptions; technological competence; human dimensions, including the librarian's role as intermediary; and creativity and innovation.…

  14. Preparing Change Agents for Change Agent Roles.

    ERIC Educational Resources Information Center

    Sedlacek, James R.

    Seventy-seven Spanish- and Portuguese-speaking agricultural change agents from developing Central and South American countries responded to a questionnaire which sought perceptions of the roles in which the change agents felt they were involved and the roles for which they felt they were being trained. The agents were participating in training…

  15. Sex Role Sterotypes and Justice for Women.

    ERIC Educational Resources Information Center

    Feinman, Clarice

    1979-01-01

    Sexual sterotyping affects the incarceration of women, their treatment in prisons and jails, and their reception in the community following release. While women's organizations play a major role in improving conditions facing incarcerated women, they have perpetuated the sterotypes. Because of sex role sterotyping, we have denied justice to women.…

  16. Work and Family Roles and Psychological Distress.

    ERIC Educational Resources Information Center

    Voydnaoff, Patricia; Donnelly, Brenda W.

    1989-01-01

    Assessed through analysis of telephone interviews (N=630) extent to which women's higher levels of psychological distress can be explained by work and family role configurations, satisfactions, and strains. Found that, although a relationship existed between work and family roles and psychological distress, factoring in these variables did not…

  17. The Smallpox Threat: The School Nurse's Role

    ERIC Educational Resources Information Center

    Martin, Mary E.; Didion, Judy

    2003-01-01

    Today, with the threat of bioterrorism and war, there is a new dimension to the traditional role of the school nurse. The smallpox threat to public health will invoke the school nurse's role as an educator, liaison, and consultant in the community. This article discusses smallpox, the vaccination process, adverse effects, and postvaccination care.…

  18. Sex Role Stereotypes Are Alive and Well.

    ERIC Educational Resources Information Center

    Snodgrass, Sara E.

    Two studies, in late 1988 and early 1990, examined sex-role stereotypes held by northeastern liberal arts college students (N=719) and southern state university college students (N=145). The first study used the Personal Attributes Questionnaire (PAQ) and compared ratings of men and women with the traditional sex-roles represented by the PAQ in…

  19. Making a role for nurses in CCGs.

    PubMed

    Moore, Alison

    2016-07-13

    What do nurses in clinical commissioning groups (CCGs) do? The answer is lots, but their role and influence varies greatly between CCGs. In May, a report from NHS Clinical Commissioners (NHSCC) - the membership organisation of CCGs - highlighted the key responsibilities of nurses and the important contribution they make in what are often pressured and demanding roles (see tinyurl.com/CCG-nurses ).

  20. Higher Education Leadership Roles in Knowledge Processing

    ERIC Educational Resources Information Center

    Martin, Jeffery S.; Marion, Russell

    2005-01-01

    Purpose: To examine the critical roles of leadership in higher education and to define how such roles enable an environment that embraces the demands of a knowledge-based organization. Design/methodology/approach: Through interviews with executive leadership in several higher education institutions, the ontology of knowledge management was…

  1. Roles in Literacy Learning: A New Perspective.

    ERIC Educational Resources Information Center

    Tovey, Duane R., Ed.; Kerber, James E., Ed.

    Refining and better understanding the roles parents, teachers, administrators, and researchers play in helping children learn to process written language is the focus of this book. Part 1 considers the role of the parents and includes the following articles: "Learning to Read: It Starts in the Home" (David B. Doake): "Let's Read Another One"…

  2. Sex Role Socialization in Early Childhood.

    ERIC Educational Resources Information Center

    Katz, Lilian G.; And Others

    This paper reviews the theory and research related to the sex role socialization of young children, specifically addressing a range of theoretical and practical issues related to the implementation of the Women's Educational Equity Act. Section I examines the influence of the family on children's sex role development, focusing on differentiated…

  3. Role Strain in University Research Centers

    ERIC Educational Resources Information Center

    Boardman, Craig; Bozeman, Barry

    2007-01-01

    One way in which university faculty members' professional lives have become more complex with the advent of contemporary university research centers is that many faculty have taken on additional roles. The authors' concern in this article is to determine the extent to which role strain is experienced by university faculty members who are…

  4. Probation's role in offender mental health.

    PubMed

    Sirdifield, Coral; Owen, Sara

    2016-09-12

    Purpose The purpose of this paper is to examine how the role in offender mental health for the probation service described in policy translates into practice through exploring staff and offenders' perceptions of this role in one probation trust. In particular, to examine barriers to staff performing their role and ways of overcoming them. Design/methodology/approach Qualitative secondary analysis of data from semi-structured interviews with a purposive sample of 11 probation staff and nine offenders using the constant comparative method. Findings Both staff and offenders defined probation's role as identifying and monitoring mental illness amongst offenders, facilitating access to and monitoring offenders' engagement with health services, and managing risk. Barriers to fulfilling this role included limited training, a lack of formal referral procedures/pathways between probation and health agencies, difficulties in obtaining and administering mental health treatment requirements, problems with inter-agency communication, and gaps in service provision for those with dual diagnosis and personality disorder. Strategies for improvement include improved training, developing a specialist role in probation and formalising partnership arrangements. Research limitations/implications Further research is required to explore the transferability of these findings, particularly in the light of the recent probation reforms. Originality/value This is the first paper to explore how staff and offenders perceive probation's role in offender mental health in comparison with the role set out in policy.

  5. Role-Playing Methods in the Classroom.

    ERIC Educational Resources Information Center

    Chesler, Mark; Fox, Robert

    This book, one of three Teacher Resource Booklets on Classroom Social Relations and Learning developed at the Center for Research on Utilization of Scientific Knowledge at the University of Michigan, discusses the theoretical background of role playing and gives a step-by-step discussion of how to use role playing in the classroom. There are…

  6. Technological Dependency, Role Stress, and Strain.

    ERIC Educational Resources Information Center

    Caplan, Robert D.; Jones, Kenneth W.

    This study grew out of interest in how occupational role stress, moderated by personality, affects health--particularly in the area of coronary heart disease. People in organizations are now asking how occupational role demands and technological developments affect employee health. This study examined the effects of an impending shutdown of the…

  7. Adopting the Caregiver Role: A Family Legacy.

    ERIC Educational Resources Information Center

    Piercy, Kathleen W.; Chapman, Jeffery G.

    2001-01-01

    A qualitative study was done to investigate how adult children become caregivers to older parents with functional impairments and what roles their own children adopt in their family's care arrangement. Interviews revealed five influences on children and grandchildren's adoption of caregiver roles: expectations; family rules; religious training;…

  8. A Role Change Strategy: Decentralized Counseling.

    ERIC Educational Resources Information Center

    Sweet, Gilbert A.

    The debate over new counseling roles rages as some counselors are already adopting them. This paper describes alternative counseling-consulting interventions possible with teachers. It suggests a strategy for speeding the process of role change and encouraging counselor-teacher interaction. The strategy is that of decentralizing counseling offices…

  9. Students' Roles during Peer Response Sessions

    ERIC Educational Resources Information Center

    Lin, Sandra Sim Phek; Samuel, Moses

    2013-01-01

    This study examined the types of roles played by students during peer response sessions and investigated how the students' roles facilitated learning. This qualitative case study involved six Grade 10 mixed-proficiency level students from a secondary school in Malaysia. Data were collected through multiple sources. The findings indicated that the…

  10. Communication Roles in a Middle School.

    ERIC Educational Resources Information Center

    Rohland, Grace J.

    A three-phase study spanned five areas of interest: (1) the school as organization and social system, (2) roles and role behavior in organizations, (3) communication structure in organizations, (4) network analysis concepts, and (5) Fundamental Interpersonal Relations Orientation-Behavior (FIRO-B). In phase one of the study, staff members listed…

  11. Probation's role in offender mental health.

    PubMed

    Sirdifield, Coral; Owen, Sara

    2016-09-12

    Purpose The purpose of this paper is to examine how the role in offender mental health for the probation service described in policy translates into practice through exploring staff and offenders' perceptions of this role in one probation trust. In particular, to examine barriers to staff performing their role and ways of overcoming them. Design/methodology/approach Qualitative secondary analysis of data from semi-structured interviews with a purposive sample of 11 probation staff and nine offenders using the constant comparative method. Findings Both staff and offenders defined probation's role as identifying and monitoring mental illness amongst offenders, facilitating access to and monitoring offenders' engagement with health services, and managing risk. Barriers to fulfilling this role included limited training, a lack of formal referral procedures/pathways between probation and health agencies, difficulties in obtaining and administering mental health treatment requirements, problems with inter-agency communication, and gaps in service provision for those with dual diagnosis and personality disorder. Strategies for improvement include improved training, developing a specialist role in probation and formalising partnership arrangements. Research limitations/implications Further research is required to explore the transferability of these findings, particularly in the light of the recent probation reforms. Originality/value This is the first paper to explore how staff and offenders perceive probation's role in offender mental health in comparison with the role set out in policy. PMID:27548020

  12. The Changing Role of the Information Professional.

    ERIC Educational Resources Information Center

    Bearman, Toni Carbo

    1984-01-01

    Addresses seven changes in role of the information professional--role as part of information transfer chain, need to harness technology and management tools, shift to individual-oriented information services, need for new directions in education, changing image of information professional, ethical commitment, increased international awareness.…

  13. Opening Trade Barriers: Sex Role Awareness Tools.

    ERIC Educational Resources Information Center

    Goldstein, Rikki

    This manual consists of exercises to explore sex-role stereotyping as it affects work roles. They are intended to make young people aware of career opportunities in nontraditional fields. The 10 exercises include the following: values clarification; true-false quiz about sex characteristics and occupational requirements; character traits…

  14. Modelling Focused Learning in Role Assignment.

    ERIC Educational Resources Information Center

    Matessa, Michael; Anderson, John R.

    2000-01-01

    ACT-R is a theory of cognition that is capable of learning the relative usefulness of alternative rules. A model using this implicit procedural learning mechanism is described that explains results from a concept formation task created by McDonald and MacWhinney (1991), a role assignment created by Blackwell (1995), and a new role assignment…

  15. The Online School Librarian: Roles and Responsibilities

    ERIC Educational Resources Information Center

    Beck, Dennis

    2015-01-01

    Children across the United States of America are maturing in a media-saturated society. Unfortunately, this often results in poor content choices and evaluative skills. North American schools have attempted to address this problem through information literacy skills. One role key to teaching these skills is the role of the school librarian.…

  16. [Role of innate immunity in tolerance induction].

    PubMed

    Dolgikh, M S

    2015-01-01

    This review considers the role of innate immunity in mechanisms of transplant tolerance and rejection, analyse the role of innate immunity cells (dendritic cells-DC, NK, must and other cells) in these processes, and the pathes of creation of tolerogenic DC for transplant rejection therapy and tolerance.

  17. Licensed Practical Nurses' Sex Role Stereotypes.

    ERIC Educational Resources Information Center

    Wallston, Barbara Strudler; And Others

    1983-01-01

    Examined whether sex-role stereotypes would affect nurses' (N=32) attitudes toward simulations of male and female patients. Emotional style and patients' diagnosis were manipulated. Results showed significant sex-role differences and stereotypical attitudes. Male patients were rated more positively, and were more likely to possess traditional male…

  18. Development of Mentor Teacher Role Inventory

    ERIC Educational Resources Information Center

    Koc, Ebru Melek

    2011-01-01

    This study aimed to develop and investigate the validity and reliability of the Mentor Teacher Role Inventory (MTRI). A total of 1843 student teachers in the Distance English Teacher Training Program participated in the study. The 58 items of the Mentor Teacher Role Inventory underwent principal factor analysis, which revealed nine factors…

  19. Making a role for nurses in CCGs.

    PubMed

    Moore, Alison

    2016-07-13

    What do nurses in clinical commissioning groups (CCGs) do? The answer is lots, but their role and influence varies greatly between CCGs. In May, a report from NHS Clinical Commissioners (NHSCC) - the membership organisation of CCGs - highlighted the key responsibilities of nurses and the important contribution they make in what are often pressured and demanding roles (see tinyurl.com/CCG-nurses ). PMID:27406497

  20. Counseling Roles in the Public Employment System.

    ERIC Educational Resources Information Center

    Gordon, Jesse E.

    One answer to the question of what should be the role of the counselor is to be found in an interpretation of the kinds of roles counselors have developed out of their experience in making adjustments and adaptations to the realities of their work and to the problems that they have encountered. There are five interconnected functions in counseling…