Biomedical subjects
Publications and source records attributed to A Kostakopoulos.
We report our early experience with a new device for endoscopic stone disintegration: the Swiss lithoclast. This device was used to treat 200 patients with stones in kidney, ureter, and bladder. Its effectiveness was 100% when the stone could be approached irrespective of size or composition, and no complication was encountered.
A study of 4,247 shockwave lithotripsy treatment was performed to identify and analyze the risk factors for the development of post-extracorporeal shock-wave lithotropsy hematomas. The Dornier HM-3 and HM-4 lithotriptors were used. We recognized 23 hematomas in 23 patients (0.54%). Various factors were examined to identify the certain predisposing risk factors. There was no correlation of sex, age, stone number, stone size, stone location, number of shock waves and voltage used with the occurrence rate of hematoma. We found that patients with pre-existing hypertension and especially those with poor control of it had a significantly increased incidence of perinephric hematoma.
This study was designed to evaluate the efficacy of local block of the obturator nerve to avoid it's stimulation during transurethral resection (TUR) or tumors localised on the lateral bladder wall. Forty-five patients were studied, in whom the TUR operations were performed under spinal anaesthesia. The patients were divided into two groups: in the first group a local block of the obturator nerve was done, while the second group served as controls, and the stimulation of the nerve was avoided by reduction of the electrocoagulation voltage, incomplete bladder filling and resections of smaller ships. In the first group no stimulation was observed while in 5 patients of the second group was not possible to totally resect the tumor due to the persistent stimulation of the obturator nerve. In conclusion the local block of the obturator nerve is an effective method to avoid it's stimulation, easily performed and without complications.
PURPOSE: The safety and efficacy of extracorporeal shock wave lithotripsy (ESWL*) in patients with an aortic aneurysm were assessed. MATERIALS AND METHODS: Five patients with an aortic aneurysm and symptomatic renal (4) or upper ureteral (1) lithiasis underwent ESWL with either an HM3 or HM4 lithotriptor. RESULTS: The procedure was well tolerated in all patients. The stone was fragmented completely in the 4 patients with renal lithiasis, while 1 with ureteral lithiasis also required ureteroscopic extraction of the stone fragments. CONCLUSIONS: For patients with symptomatic renal stones and an aortic aneurysm ESWL may be the treatment of choice.
We report our experience on performing ureteroscopic procedures using local anaesthesia with or without intravenous analgesia. During a two year period 334 ureteroscopic procedures were performed in our hospital. 159 of them were begun but only 138 completed without the use of general or regional anaesthesia. In 9 patients ureteroscopy was performed with lindocaine jelly in the urethra only, and in 129 with additional intravenous analgesia Fentanyl, a synthetic morphine derivative, was used for intravenous analgesia. Ureteroscopy was performed for stone fragmentation or extraction in 119 patients for taking away a double J catheter which showed migration into ureter in 8 and for diagnostic purposes in 11. Ureteric lesions were observed in 7 patients (5%). The findings suggest that ureteroscopy when performed without general or regional anaesthesia does not increase the risk of complications or compromise the results of treatment.
We report our experience in the treatment of Fournier's gangrene. Ten male patients suffering from necrotising fasciitis of the genitalia were treated by extensive surgical debridement and broad spectrum antibiotic administration. Four were alcoholic and six diabetic. The possible cause was perirectal abscess in 3 cases, urethral stricture in two, traumatic urethral catheter insertion in two, epidydimo-orchitis in one and finally herniorraphy in another case. An average of 2.3 operations was required per patient and the average hospital stay was 38.1 days. Three of them underwent bilateral orchidectomy, two colostomy and a suprapubic catheter was inserted in four cases. Four patients developed acute renal failure and three adult respiratory distress syndrome. Three patients died. Reconstruction using skin flaps was necessary in 4 patients. We conclude that Fournier's gangrene is a true urologic emergency, potential lethal, which requires aggressive antibiotic and surgical treatment.
A case is presented of total uterine prolapse accompanied by moderate bilateral hydroureteronephrosis which was diagnosed after evaluation for fever of unknown origin.
As it is known, paraplegic and quadriplegic patients are at an increased risk for urolithiasis. We have studied the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in 15 patients with spinal cord dysfunction who were treated in our ESWL unit. A total of 23 treatments were performed. The number of shock waves ranged between 1500 and 3000 per treatment. Only 1 and 3 patients were stone-free at one-month and 3-month follow-up, respectively. Ten of 15 patients with long-term follow-up of 6 to 20 months were stone-free. The remaining 5 patients with residual fragments had staghorn calculi or stones larger than 2.5 cm. We conclude that ESWL is an effective and well tolerated method for this population but the fragment clearance is delayed and below that for unselected patients.
A rare case of multilocular primary renal cell carcinoma (two sites in each kidney) in a 48-year-old woman is presented. The preoperative diagnosis was based on the computerized tomography findings. The patient underwent bilateral total nephrectomy and subsequently maintained renal dialysis.
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The influence of various prostatic manipulations, including digital rectal examination, cystoscopy, transrectal ultrasonography and transrectal needle biopsy, on the serum prostatic-specific antigen (PSA) levels in 170 men, were examined. We found that digital rectal examination, cystoscopy and transrectal ultrasonography had no significant effect on PSA levels, except for transrectal needle biopsy, which caused an immediate increase of serum PSA in 96.2% of the patients lasting more than 2 weeks in 42.3% of the cases. In conclusion, serum PSA determination after digital rectal examination, after cystoscopy and after transrectal ultrasonography is accurate and reliable. On the other hand, we must wait about 6 weeks after needle biopsy before measuring PSA in the serum of patients with prostatic diseases.
In this study we present our experience from the application of the bladder neck suspension as modified by Raz on 37 patients. All patients had severe genuine stress incontinence. Twenty of them had undergone previous surgery for the same problem, and 16 patients had had a previous hysterectomy. In addition 15 patients had a small cystocele. In all cases, the Raz procedure was performed by the same surgical team. The follow-up ranged from 8-32 months (mean follow-up 15.4). The overall success rate was 86.5%. Patients with no history of previous surgery and all patients with cystocele were cured. The 5 failures occurred in patients with previous surgery and hysterectomy. The complications were few. It is concluded that the Raz bladder neck suspension is a safe and effective method for the treatment of stress incontinence, especially in cases with cystocele or failure after primary treatment.
Serum selenium levels of 160 healthy Greeks were determined by Zeeman-effect background-corrected atomic absorption spectrometry. Mean value for 101 men (70.7 +/- 16.2 micrograms/L) tended to be higher, but not statistically significant, compared to the mean value for 59 women (64.9 +/- 14.7 micrograms/L). When the subjects were divided into various age groups there appeared to be some increase as a function of age. Compared to the extensive literature data on serum Se levels for various countries healthy Greeks proved to be at the lower concentration range. The scarce, but conflicting literature data on serum Se values for Greeks is discussed.
Two hundred twenty asymptomatic males, aged 55 to 75 years old, underwent transrectal ultrasonography of the prostate as part of a screening examination. Fifteen prostate adenocarcinomas were detected, 5 of which were nonpalpable. The biopsies were performed under sagittal ultrasound guidance. Serum prostatic specific antigen and prostatic acid phosphatase levels were also obtained from each patient. Nine of the patients were staged as B2, one patient as D2, 4 patients as A1 and one as A2. The use of transrectal ultrasonography as a screening tool must be further evaluated in a multicenter trial with a large number of patients.
We report one case of an epidermoid cyst of the testis in a 15 year-old boy. Pre-operative testicular ultrasound may help to establish the diagnosis without resorting to orchiectomy. In such a selected case local excision alone should be considered adequate without violating accepted surgical principles.
A case is presented of a woman aged 78 with a primary location of amyloidosis of the bladder. The clinical symptoms and the cystoscopy initially suggested a vesical carcinomatous infiltration.
We report a rare case of primary transitional cell carcinoma in a man aged 56 years old. Approximately 600 cases of primary carcinoma of the male urethra have been accumulated until today (1). The 30 to 50 per cent of these neoplasms originate in the anterior urethra and only the 15 per cent are of the transitional cell type (2).
This a rare case of malignant adrenal schwannoma in a woman aged 38 years old without family history of neurofibromatosis. A diagnosis is impossible before surgery.