Biomedical subjects

A Cicco

Publications and source records attributed to A Cicco.

35 records · Page 2Linked to original sources

PubMed2001

[Retroperitoneal laparoscopic surgery and carcinogenic risk].

OBJECTIVE: To retrospectively evaluate the development of metastasis at trocar sites, local recurrence and distance metastases associated with retroperitoneal laparoscopic surgery performed in the context of a malignant tumour. METHODS: From 1994 to 1999, 228 retroperitoneal laparoscopic surgical operations were performed in our centre. Fifty six operations (24.6%) were performed for malignant tumours and comprised 41 radical nephrectomies and 8 partial nephrectomies for renal tumour and 7 nephro-ureterectomies for upper urinary tract tumours. The pathological stage and surgical margins were correlated with TNM 1997 stage. Postoperative data were obtained by physical and radiological examination performed one month and three months after the operation and then every six months. Metastases at the trocar site, local recurrences and distant metastases were investigated. The specific progression-free survival was calculated according to the Kaplan-Meier method. RESULTS: The mean follow-up was 24.9 +/- 13.85 months. All patients had tumour-free surgical margins. No trocar site metastasis was observed. For retroperitoneal laparoscopic radical nephrectomies: one patient developed a local recurrence with liver metastases 9 months after the operation (pT3G2) and died 19.7 months after the operation. One patient with a pT3G3M+ renal tumour at the time of diagnosis died 23.1 months after radical nephrectomy with no signs of local recurrence. For laparoscopic retroperitoneal nephro-ureterectomies: one patient with a pT3G3 lesion developed a local recurrence at 12.1 months and died 26.6 months after surgery. One patient with a pT1G2 tumour developed bone metastases at 9 months and died 29 months after the operation. The recurrence-free survival at 54 months was 91% for radical nephrectomies, 71% at 30 months for nephro-ureterectomies and 100% at 49 months for partial nephrectomies. CONCLUSION: Malignant tumours of the upper urinary tract can be managed by retroperitoneal laparoscopy. The short-term results suggest that this surgical technique is not associated with an increased risk of trocar site metastases or local recurrence and that recurrence-free survival rates comparable to those reported in series of conventional surgery.

Follow-Up Studies↗

PubMed2001

Experience with retroperitoneal laparoscopic adrenalectomy in 115 procedures.

PURPOSE: Laparoscopic adrenalectomy has become an effective option for removing small adrenal tumors. We evaluated the retroperitoneal approach with regard to operative complications, morbidity and hospital stay. MATERIALS AND METHODS: Between January 1995 and March 2000 we performed a total of 115 laparoscopic adrenalectomies via the retroperitoneal approach, including 70 on the left and 45 on the right side, in 64 women and 42 men 17 to 74 years old (mean age 49.3) with adrenal neoplasms. Average adrenal tumor size was 31 mm. (range 10 to 65). All procedures required 4 trocars and mean operative time was 118 minutes (range 45 to 240). RESULTS: There were no patient deaths. The conversion rate to open surgery was 0.8% and estimated blood loss was 77 ml. (range 0 to 550). At a mean followup of 23.4 months, morbidity was 15.5% with intraoperative vascular injury in 3 cases (3.4%) and postoperative complications in 12.1%, including wound infection, deep hematoma, parietal dehiscence and severe pneumopathy. Average hospital stay was 4 days and mean duration of analgesic requirement was 2 days (range 1 to 5). CONCLUSIONS: The retroperitoneal approach to laparoscopic adrenalectomy appears to be minimally invasive and safe for adrenal tumors not larger than 5 cm.

Adolescent↗

PubMed2001

Early removal of the catheter after laparoscopic radical prostatectomy.

PURPOSE: We prospectively tested the safety of routine removal of the catheter as early as 2 to 4 days after laparoscopic radical prostatectomy. MATERIALS AND METHODS: Between March 1998 and March 2001, 228 patients underwent laparoscopic radical prostatectomy for clinically organ confined prostate cancer. The last 113 consecutive patients were included in a prospective study according to gravitational cystography performed 2 to 4 days postoperatively. If no leak was seen the catheter was removed. If a leak was apparent the catheter was left indwelling for another 6 days and cystography was repeated. RESULTS: Cystography 2 to 4 days postoperatively showed an anastomosis without a leak in 96 (84.9%) patients who subsequently had the catheters removed. There were 28 patients who had the catheter removed on postoperative day 2, 28 day 3 and 40 day 4. In 17 (15.1%) patients an anastomotic leak was observed, and the catheter was not removed at that time. Of the 96 patients in whom the catheter was removed early 10 (10.4%) had urinary retention that necessitated re-catheterization. This procedure was performed without the need for cystoscopy. After the catheter was removed all patients were able to void 24 hours later. Median followup was 7 months (range 1 to 15) and showed continence rates greater than 93%. No anastomotic stricture, pelvic abscess or urinoma developed in any patient. CONCLUSIONS: Patients who undergo laparoscopic radical prostatectomy can have the catheter safely removed 2 to 4 days postoperatively without a higher risk of incontinence, stricture or leak related problems.

Humans↗

PubMed2001

[Biphosphonates in the treatment of bone metastasis of prostatic cancer].

Bone metastases are common in patients with prostate carcinoma and they are the most frequent cause of skeletal morbidity. Most of these metastases ar osteocloritic, but it has been shown that the abnormal osteoblastic bone formation is preceded by osteoclastic activity which appears to be associated with bone pain providing the rationale for using biphosphonates as palliative therapy. In a recent study, soledronate has been shown to be effective in patients with osteoblastic bone destruction. This is the first time any bisphosphonate reduces skeletal morbidity.

Bone Neoplasms↗

PubMed2001

[Tendinopathy associated with fluoroquinolones: individuals at risk, incriminated physiopathologic mechanisms, therapeutic management].

The use of fluoroquinolones in urology has grown considerably over recent years. Unfortunately, although these molecules are not associated with severe life-threatening complications, they have nevertheless been associated with tendon lesions responsible for functional disability. The frequency of these complications is probably underestimated. There is a variable lag-time (3 to 5 days) between introduction of the antibacterial and onset of pain. The symptom most frequently reported is pain over the tendon affected and the tendons most frequently affected are those submitted to high constraints. Bilateral lesions are present in 66% of cases. Although Pefloxacin is associated with the highest frequency of tendon complications (2.7% versus 0.2-0.3% for other fluoroquinolones), the duration of treatment appears to be important in every case, with a peak frequency after a fortnight of treatment. Although these complications were considered for a long time to be associated with patients presenting certain risk factors (age, steroid therapy, renal failure), they can also occur suddenly, in young adult sportsmen or non-sportsmen, with no known tendon disease. Several hypotheses have been proposed to explain the development of these cases of tendinopathy: immuno-allergic mechanisms, direct toxicity of the molecule on collagen fibres, cell-mediated oxidative aggression, or tendon necrosis due to vascular mechanisms. The outcome remains favourable in 75% of cases of tendinitis and in 49% of cases for tendon rupture. Contraindications must therefore be identified and the duration of treatment must be adapted, as the functional handicap can be long and particularly severe.

Anti-Infective Agents↗

PubMed2000

Laparoscopic radical prostatectomy: preliminary results.

OBJECTIVES: To evaluate our preliminary experience with laparoscopic radical prostatectomy. The indications for laparoscopy are currently being extended to complex oncologic procedures. METHODS: Forty-three men underwent laparoscopic radical prostatectomy. We used five trocars. The surgical technique replicates the steps of traditional retropubic prostatectomy, except that the rectoprostatic cleavage plane is developed transperitoneally at the beginning of the procedure. In the first 10 patients, we performed the vesicourethral reconstruction with interrupted sutures; in the remaining 33 patients, we performed it with two hemicircumferential running sutures. The specimen was removed through the umbilical port site. RESULTS: Once the developmental phase with the first 10 patients was concluded, the median operating time was 4.3 hours without pelvic lymphadenectomy, and the median postoperative bladder catheterization was 4 days. Two (4.7%) of 43 patients underwent transfusion. Twelve patients (27.9%) had positive surgical margins; all patients had a postoperative prostate-specific antigen level of less than 0.1 ng/mL at 1 month. Rectal injury occurred in 1 patient, requiring colostomy, and 4 patients had urethrovesical anastomotic leakages requiring surgical repair. One month postoperatively, 36 patients (84%) were fully continent (no leakage). Six patients had had erections, and four stated they had had sexual intercourse. CONCLUSIONS: Laparoscopic radical prostatectomy has evolved to a fully standardized and reproducible procedure. The short-term oncologic and functional efficacy rates are equivalent to those for open surgery. The operating time is reasonable once the learning curve is over, and postoperative morbidity is diminished. Because of the improved visual accuracy, permitting more precise dissection, this technique has the potential to become an important advancement in urologic surgery.

Aged↗

PubMed2000

Extraperitoneal laparoscopic repair of ureteropelvic junction obstruction: initial experience in 15 cases.

OBJECTIVES: To assess the feasibility and results of retroperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction. METHODS: From September 1996 to January 1999, 15 patients underwent extraperitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction. Aberrant vessels were noted in 4 patients. Dismembered pyeloplasty was performed in 7 patients and nondismembered Fenger plasty in 7 patients. Pyeloplasty was not possible in 1 patient. RESULTS: Fourteen of the 15 procedures were successfully completed. The procedure was not possible in 1 patient who had already undergone endopyelotomy repair. The mean operating time was 178 minutes (range 100 to 250), and the mean postoperative hospital stay was 4.8 days (range 1 to 14). Postoperative complications occurred in 3 patients (two hematomas and one urinoma). Radiographic assessment by intravenous urography 3 months after the procedure showed good results. CONCLUSIONS: Retroperitoneoscopy, by providing easy and rapid access to the retroperitoneal space, seems to be a valuable alternative treatment for ureteropelvic junction obstruction.

Adolescent↗

PubMed2000

Vesicourethral anastomosis during laparoscopic radical prostatectomy: the running suture method.

Vesicourethral reconstruction is the most critical and time-consuming step of laparoscopic radical prostatectomy. We describe the use of two hemicircumferential running sutures that has significantly simplified the procedure in our last 30 patients. The vesicourethral reconstruction took 31 minutes on average. Six months postoperatively, 84% of the patients were fully continent, and no bladder neck stenosis had occurred. The economy of intracorporeal suturing provided by this novel method, together with geometric factors such as the optimal position of the trocars, contributes to the improvement of ergonomy, allowing the surgeon to decrease operating times.

Anastomosis, Surgical↗

PubMed2000

Carcinological risks and retroperitoneal laparoscopy.

PURPOSE: To determine the incidence of trocar site spillage, local recurrence, and metastatic disease associated with retroperitoneal laparoscopic tumor resection. METHODS: From 1994 to 1999, 228 retroperitoneal laparoscopic procedures were performed at our institution. Fifty-six procedures (24.6%) were for malignancies and comprised 41 radical nephrectomies and 8 partial nephrectomies for renal tumors, and 7 nephro-ureterectomies for renal pelvis tumors. The pathological stage and the status of surgical margins were noted according to the 1997 TNM classification. Postoperative follow-up data were obtained by means of physical and radiological examinations after 1 and 3 months, and then half-yearly. Trocar site seeding, local recurrence and metastatic disease were recorded. Kaplan-Meier actuarial analysis was used to determine the disease-free survival likelihood. RESULTS: The mean follow-up was 24.9+/-13.85 months. All the patients had tumor-free surgical margins. No laparoscopic trocar site recurrences were identified. For laparoscopic radical nephrectomy: one patient had a local recurrence with hepatic metastasis of a pT(3)G(2) tumor after 9 months and died 19.7 months after the procedure. One patient with a pT(3a)G(3)M+ tumor died 23.1 months after radical nephrectomy without any sign of local recurrence. For laparoscopic nephro-ureterectomy: one patient with a pT(3)G(3) tumor had a local recurrence 12.1 months after the procedure and died 26.6 months after surgery. One patient with a pT(1)G(2) renal pelvis tumor had bone metastasis at 9 months and died 29 months after the procedure. The Kaplan-Meier actuarial disease-free survival rate was 91% at 54 months for radical nephrectomy, 61% at 30 months for nephro-ureterectomy and 100% at 49 months for partial nephrectomy. CONCLUSION: Malignancies of the upper urinary tract can be managed by means of retroperitoneal laparoscopy. Short-term results suggest that this procedure is not associated with an increased risk of portsite or local recurrence, and that disease-free survival is equivalent to that obtained with open surgery.

Adult↗

PubMed2000

[Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case].

Robotics has been commonly employed in numerous industrial fields for several decades. However, the application of this technology to surgery is a recent innovation. It provides new possibilities for facilitating specific surgical tasks, especially in the field of laparoscopy. We report a case of laparoscopic radical prostatectomy completed with the help of a remotely controlled da Vinci robot. This system offered a user friendly surgical platform and enhanced surgical dexterity. Operating time was 420 minutes and the hospital stay was 4 days. The bladder catheter was removed after 3 days. One week later, the patient was fully continent. Pathologic examination showed a pT3a tumor, with negative margins. Robotically assisted laparoscopic radical prostatectomy is feasible. Further developments in this field of technology may have new applications in laparoscopic telesurgery.

Equipment Design↗

PubMed2000

[Mechanisms of action of BCG: towards a new individualized therapeutic approach?].

A better knowledge of antitumour immunity and the mechanisms allowing the tumour to overcome the host's immune surveillance has led to progress in the understanding of the mechanisms of action of Bacille Calmette-Guérin (BCG), as the local intravesical immune response is intimately related to the interaction of three systems: the host (the patient), the BCG (mycobacteria) and the tumour. This interaction gives rise to a cascade of immunological events, some of which are essential to the protective action of BCG against relapse and tumour progression. The immune response to BCG is currently considered to comprise three phases. First of all, the BCG adheres to the urothelium and is then phagocytosed by antigen-presenting cells. This phase corresponds to early release of so-called inflammatory cytokines (IL1, IL6, IL8). These cytokines could be responsible for certain adverse effects, but could also participate in cytotoxic phenomena. The second phase consists of recognition of bacterial antigens by helper CD4 lymphocytes, which mainly release IL2 and IFNg (Th1 response). This cellular activation leads to the third phase: amplification of cytotoxic populations capable of killing tumour cells: CD8, gd lymphocytes, macrophages, NK, LAK, BAK cells. All these cells also produce cytokines, which participate in regulation of the immune response. The understanding of these mechanisms of action, urinary cytokine assays, a better definition of cytotoxic cells and their role, molecular analysis of the tumour and probably certain genetic characteristics of the host will allow the elaboration of more effective immunization protocols by defining an individualized therapeutic approach.

Adjuvants, Immunologic↗

PubMed1999

Retroperitoneal laparoscopic versus open radical nephrectomy.

PURPOSE: We analyze the retroperitoneal approach to laparoscopic radical nephrectomy in regard to feasibility, safety, morbidity and cancer control, and compare results and outcomes in patients who underwent retroperitoneal laparoscopic or open radical nephrectomy from 1995 to 1998. MATERIALS AND METHODS: The records of 58 consecutive patients with renal cancer who underwent radical nephrectomy from 1995 through 1998 were reviewed. Of the patients 29 underwent open radical nephrectomy (group 1) and 29 underwent retroperitoneal laparoscopic radical nephrectomy (group 2). Various parameters were compared and statistical analyses were performed. RESULTS: The 2 groups were similar in regard to age, gender and side of the tumor. Operative time was slightly shorter in group 1 (mean 121.4 versus 145 minutes in group 2, p = 0.047). Mean tumor size plus or minus standard deviation was larger in group 1 (5.71 +/- 2.01 versus 4.02 +/- 1.87 cm. in group 2). Group 2 patients had significantly less operative blood loss (mean 100.0 versus 284.5 ml. in group 1, p < 0.005) and used significantly less parenteral pain medication (p < 0.05). Postoperative hospital stay was significantly longer in group 1 (9.7 +/- 3.6 versus 4.8 +/- 2.0 days in group 2, p < 0.001), and the complication rate was higher (24 versus 8%, respectively). One group 1 patient died of renal cancer (pT2G2) after 14 months and local recurrence with hepatic metastasis occurred after 9 months in a group 2 patient with a pT3G2 tumor. CONCLUSIONS: Retroperitoneal laparoscopic nephrectomy for kidney cancer requires further assessment. It seems to have several advantages over open radical nephrectomy, and to be effective and safe for less than 50 cm. renal tumors but a risk of spillage cannot be ruled out for larger tumors.

Adult↗

PubMed1999

[Retrospective study of laparoscopic peritoneal radical nephrectomy].

OBJECTIVE: To analyse the results of laparoscopic radical nephrectomy in terms of feasibility, safety, morbidity and tumour control. MATERIAL AND METHODS: Between August 1993 and July 1998, 29 laparoscopic retroperitoneal radical nephrectomies were performed in 17 men and 12 women for renal tumours less than or equal to 90 mm in diameter. The working space was created by finger dissection without using a dilatation balloon. Four additional trocars were inserted under digital control. The renal pedicle was dissected first: the renal artery was clipped and the renal vein was sectioned by EndoGIA. After sectioning the ureter, the kidney was dissected with the perirenal fat and Gerota's fascia. The operative specimen was extracted in an impermeable endoscopy bag, without division, by enlarging the first trocar incision to 50 mm in order to avoid any parietal contact. RESULTS: The mean age of the patients was 61.3 years (range: 40 to 78 years). Radical nephrectomy was performed on 13 right kidneys and 16 left kidneys, with mean dimensions of 112.9 mm (range: 85 to 150 mm). The mean tumour diameter was 40.2 mm (range: 20 to 90 mm). The mean operating time was 145 min (range: 80 to 330 min) with a mean blood loss of 100 cc (range: 0 to 1000 cc). A mean daily dose of 2.8 g (range: 1 to 5 g) of parenteral paracetamol and a mean daily dose of 1.8 mg (range: 0 to 10 mg) of morphine hydrochloride were necessary postoperatively. The mean hospital stay was 4.8 days (range: 1 to 11 days). One intraoperative haemorrhage required open conversion and one colon injury was treated by temporary colostomy. One local recurrence with hepatic metastasis occurred 9 months after the operation in a patient operated for a Furhman grade II stage pT3 tumour with negative resection margins. CONCLUSION: Laparoscopic radical nephrectomy is currently under evaluation. This technique is feasible, and respects the principles of cancer surgery: primary control of renal vessels, en bloc extraction of the kidney with Gerota's fascia.

Adenocarcinoma↗

PubMed1999

Retroperitoneoscopic nephroureterectomy for renal pelvic tumors with a single iliac incision.

PURPOSE: Retroperitoneal laparoscopy, by providing direct access to the retroperitoneal cavity, is a useful approach to urological surgery. We applied this technique to nephroureterectomy in patients with tumors of the renal pelvis. MATERIALS AND METHODS: Between January 1995 and March 1997 we performed 4 retroperitoneal laparoscopic nephroureterectomies in patients with tumors of the renal pelvis. The patients were placed in the lateral decubitus position. Five trocars were used. Balloon dilation was not contributory. Radical nephrectomy was performed and the kidney was left in the retroperitoneal space. Via an iliac incision ureterectomy with a bladder cuff was performed and the specimen was removed (kidney and ureter) en bloc via this incision without opening the urinary tract. RESULTS: One right and 3 left nephroureterectomies were performed with an average operating time of 220 minutes (range 160 to 300). Average kidney size was 110 mm. (range 100 to 120). Average hospital stay was 5.7 days (range 5 to 7). Blood loss was minimal and postoperative analgesic requirements were moderate. Conversion to open surgery was never necessary. The morbidity rate was zero. The pathological stages were pT2 G2, pT3 G2, pT3G3 and pT3 G2-G3 N+. A local recurrence was observed in a patient with a pT3 G3 tumor. CONCLUSIONS: Nephroureterectomy can be performed by retroperitoneal laparoscopy. The perioperative morbidity and hospital stay are reduced. Further followup is required to evaluate long-term results in terms of cancer outcome.

Aged↗

PubMed1998

[Surgical aspects of renal transplantation in children].

Review of a series of 90 renal transplantations performed in 86 children revealed 3 cases of early or late mortality and 28 cases of major surgical complications, predominantly vascular (13 cases) and urological complications (12 cases). The time to onset, the diagnosis and the management of these complications are reviewed. This study again emphasizes the importance of graft selection (donor age) and the value of living related donor renal transplantation.

Adolescent↗

PubMed1998

[Embryologic hypotheses of prostatic ectopy: apropos of a case].

Events implicated in the development and the differentiation of the prostate gland are determinant to understand the pathology. Mc Neal's zonal anatomy is essential, the basis of which are found in the differences of embryonic origins. We describe a case of prostate ectopia, localized on the lateral aspect of the rectum. Final pathology report showed prostate adenoma. Different types of prostate ectopia have been described in the literature. Histological results showed that we can distinguish two types of ectopia: one which develops from the uro-genital sinus and the other from the mesonephrotic structures.

Choristoma↗

PubMed1990

Erythropoietin prevents chemotherapy-induced anemia: case report.

A thirty-seven year old male patient with heavily pretreated metastatic testicular carcinoma received escalating doses of recombinant human erythropoietin (EPO) before and throughout chemotherapy. Whereas previous chemotherapy regimens repeatedly caused anemic situations in this patient (hemoglobin (HB) 7.0 g/dl requiring multiple transfusions of red blood cells), EPO given as an i.v. bolus injection at escalating doses of 150 to 300 U/kg body weight (BW) twice/week, starting two weeks prior to the identical myelosuppressive treatment protocol, maintained HB at levels above 8.8 g/dl and thus obviated the need for erythrocyte transfusion. EPO was discontinued after 9 weeks of administration when the patient had achieved a hematocrit (HCT) of 41.1% and a HB of 12.7 g/dl. However, erythropoiesis continued to recover for the next 7 weeks reaching a HCT of 42.4% and a HB of 14.3 g/dl, although the next identical chemotherapy cycle had been given within this period. Along with the rise in HB, ferrokinetics changed significantly as measured by serum ferritin, which was reduced to one third at the end of EPO therapy after only 9 weeks (from 979 ng/ml to 320 ng/ml). No side effects due to EPO administration occurred. These data provide first evidence for efficacy of EPO in chemotherapy-induced anemia and may open new avenues for its clinical application.

Adult↗