Biomedical subjects

Christopher Nguan

Publications and source records attributed to Christopher Nguan.

4 recordsLinked to original sources

PubMed2006

Laparoscopic management of advanced renal cell carcinoma with level I renal vein thrombus.

OBJECTIVES: To present our series of laparoscopic radical nephrectomy in patients with level I tumor thrombus. The existence of renal vein tumor thrombus presents a technical challenge in securing hilar control during the resection of a renal mass. To our knowledge, this experience represents one of the largest series of laparoscopic nephrectomy for renal cell carcinoma associated with a macroscopic renal vein thrombus. METHODS: From April 2002 to June 2004, 12 patients (8 men and 4 women) were diagnosed with renal masses. In addition to computed tomography, cavography and magnetic resonance imaging were used to determine the levels of tumor thrombi preoperatively in those who had suspicious involvement of the renal vein on computed tomography. RESULTS: Laparoscopic nephrectomy was performed in a standard fashion. Hand-assisted laparoscopic nephrectomy was used in 6 cases involving large tumors with bulky hilar adenopathy. All renal veins were stapled using an endoscopic vascular stapler. Intraoperative laparoscopic ultrasonography was used to delineate the extent of the vein thrombus in 4 cases to enable proper stapler positioning. No intraoperative complications occurred, and 2 cases were electively converted to open nephrectomy. The postoperative narcotic requirements and hospitalization times were low. Pathologic examination of the tumor specimens demonstrated negative resection margins in all patients. CONCLUSIONS: In carefully selected patients, laparoscopic resection of renal masses with level I renal vein thrombi is feasible. Because of technical considerations that may be identified intraoperatively, early conversion to open nephrectomy should be anticipated. Long-term results regarding oncologic control continue to be assessed.

Carcinoma, Renal Cell↗

PubMed2006

Comparison of laparoscopic and open nephrectomy for adult polycystic kidney disease: operative challenges and technique.

OBJECTIVES: Autosomal dominant polycystic kidney disease an inherited systemic disorder is characterized by the development of multiple cysts in the kidneys and other organs. When nephrectomy is indicated, the laparoscopic approach is challenging due to the massive size of these kidneys. We present our technique and evaluate the surgical outcomes of laparoscopic versus open nephrectomy for patients with such condition. MATERIALS AND METHODS: A retrospective review was done for six laparoscopic and six open nephrectomies performed by two laparoscopic surgeons in two university hospitals between January 2004 and December 2004. Preoperative, intraoperative, and postoperative data are presented. A standard subcostal incision was used for the open cases while for the laparoscopic approach a 3-4-port transperitoneal laparoscopic approach was used to dissect the involved kidney, which is then removed intact or morcellated through pfannenstiel, midline, or expanded port site incision. RESULTS: The laparoscopic patients had a longer operative time with one major complication compared to the open group. On the other hand laparoscopic group achieved minimal blood loss, less narcotic requirement and a shorter hospital stay. No conversion to open required in the laparoscopy group. At a median follow up of 1 year no long-term complications reported in either groups. CONCLUSIONS: Laparoscopic nephrectomy for polycystic kidney disease is a feasible and safe alternative to open approach. In addition to low morbidity, other advantages of laparoscopic surgery also achieved in this subset of patients such as the ability to remove the dissected kidney through a small incision, reduced postoperative pain, short hospital stay, and excellent cosmesis.

Adult↗

PubMed2005

A prospective, double-blind, randomized cross-over study evaluating changes in urinary pH for relieving the symptoms of interstitial cystitis.

OBJECTIVE: To provide evidence for the clinical efficacy of changes in urinary pH on the pain associated with interstitial cystitis (IC). PATIENTS AND METHODS: A prospective, randomized, double-blind cross-over study was conducted with 26 women with IC between 2000 and 2002, consisting of cross-over instillations of urine at physiological pH (5.0), and neutral buffered pH (NaH(2)PO(4) buffered to pH 7.5). The outcome measured was the subjective symptom of pain assessed using a visual analogue scale at baseline, after the initial instillation of solution, at washout, and after the crossover instillation. Data were analysed using repeated-measures analysis of variance. RESULTS: There was no statistically significant difference between the mean (sd) change from baseline pain scores after instilling neutral buffered solution, at 0.50 (2.78), and acidic solution, at 0.33 (3.43) (P = 0.85). Secondary outcomes were analysed, including baseline variability and treatment-order effects; neither were significantly different between the groups. CONCLUSIONS: There was no statistically significant difference in subjective pain scores on instilling urine at physiological pH or sodium-phosphate buffered saline in these patients with IC. Further work is required to define the role, if any, of urinary pH in the pathophysiology and treatment of IC.

Acetic Acid↗

PubMed2002

A case of spontaneous perirenal hemorrhage secondary to polyarteritis nodosa.

A case report of a patient who develops a spontaneous perinephric hemorrhage secondary to polyarteritis nodosa (PAN) is described. The diagnosis of PAN was delayed in this patient somewhat due to a previously unrecognized relation to a recent perihepatic hemorrhage. Unenhanced CT findings in this case were nonspecific, but follow up angiography demonstrated characteristic subsegmental and interlobular renal artery aneurysms. Spontaneous perinephric hemorrhage is an uncommon complication of PAN however an elevated level of suspicion regarding the diagnosis of a systemic vasculitis should be considered in any case of spontaneous renal, hepatic, or gastrointestinal hemorrhage.

Aneurysm↗