PubMed Health⌕ Search

Biomedical subjects

D Lanigan

Publications and source records attributed to D Lanigan.

13 recordsLinked to original sources
PubMed1994

A comparative analysis of grading systems in renal adenocarcinoma.

While the histological grade of a renal cell carcinoma is of prognostic significance there is poor concordance amongst pathologists in the use of these grading systems. Many grading systems have been described, but none has achieved widespread acceptance. The objective of this study was to assess the degree of interobserver variation amongst four experienced pathologists in their use of four commonly applied grading systems. The pathologists reviewed a series of 88 cases of renal cell carcinoma. Grades were detailed on a proforma which consisted of a breakdown of each grading system. Cohen's kappa was calculated for each pair of observers for each system. The mean kappa scores for each system were compared using the Tukey honestly significant differences method. Mean kappa was highest for the grading system of Syrjanen and Hjelt and this grading system also had a higher mean kappa than two of the other systems tested. The most striking feature of the results was the degree to which the pathologists differed in their assessments. The grading system of Syrjanen and Hjelt was shown to be subject to less interobserver variability than other commonly used classifications and we are of the opinion that it should become the standard method.

Adenocarcinoma↗
PubMed1993

Endosonographic monitoring of transurethral cryoprostatectomy.

Cryoprostatectomy, the use of subzero temperatures to ablate prostate tissue gained favour in the 1960s because of its speed and lack of haemodynamic effects. It fell from use because the freezing process could not be monitored and this led to a high incidence of local complications. We have performed transrectal real time ultrasound in 12 patients undergoing cryoprostatectomy. In all the freezing process was easily visualized as an advancing hyperechoic 'iceball' with distal acoustic shadowing. Monitoring allowed maximum prostate ablation without breaching the prostatic capsule. There were no significant complications and all but one patient gained symptomatic relief. Ultrasound at 1 month showed a heterogeneous echo pattern with very little cavity formation but by 3 months a significant cavity was seen. This study demonstrates that it is possible to monitor the freezing process during transurethral cryoprostatectomy. This, theoretically, should significantly reduce the local complications encountered in previous studies.

Aged↗
PubMed1993

Pharmacological manipulation of acute cyclosporin ischemic renal injury with trimetazidine.

Cyclosporin has had a major impact on organ transplantation, but associated nephrotoxicity is a significant problem. Renal hypothermia, a known anti-ischemic maneuver, limits cyclosporin-ischemic renal failure. Pharmacological manipulation with an anti-ischemic agent, such as trimetazidine, may prevent cyclosporin nephrotoxicity. We tested this hypothesis in a canine single kidney model of cyclosporin-enhanced ischemic renal failure. Trimetazidine treatment was associated with significantly better biochemical and histological markers of renal function and structure. Trimetazidine may have a role to play in protecting against cyclosporin nephrotoxicity in clinical renal transplantation.

Animals↗
PubMed1993

c-myc expression in renal carcinoma: correlation with clinical parameters.

There is evidence that c-myc is expressed in renal carcinomas and that it is associated with histological grade. This study reports on the clinical correlations of oncogene expression and clinical features of the disease. Tissue sections from 97 patients (95 primary and 12 secondary cancers) were immunostained with a c-myc oncoprotein antibody. The tumours were scored for extent and intensity of nuclear and cytoplasmic staining. Ninety patients were suitable for follow-up study. High levels of expression correlated significantly with increasing T category and nuclear grade, as well as with venous invasion. No correlation with nodal involvement, the presence of metastases, tumour architecture or cell type was found. The extent of nuclear staining was related to survival (although not to recurrence), but in a multivariate analysis did not provide independent prognostic information. It was concluded that semiquantitative assessment of levels of c-myc oncoprotein does not provide clinically useful prognostic information.

Adult↗
PubMed1993

Ploidy and prognosis in renal carcinoma.

The value of tumour ploidy status as a prognostic indicator in renal carcinoma is disputed. In this retrospective study the DNA content of 90 primary and 10 secondary renal cell carcinomas was measured using flow cytometry. Data on recurrence and survival were available in all cases. Tumours were staged according to the TNM system and histological grade was based on nuclear morphology. Formalin-fixed, paraffin-embedded material was processed using standard techniques. Multiple samples were examined in 19 cases. Of the primary tumours, 52 were diploid, 24 were aneuploid and 6 were tetraploid; 8 patients had uninterpretable histograms. Ploidy of the secondary tumours was similar to that of their respective primaries. Aneuploidy correlated with higher grade but not with TNM category and, although associated with an increased risk of death, did not provide independent prognostic information. Heterogeneity of ploidy was found in 6 of the 19 cases where more than 1 sample was assessed. It was concluded that tumour DNA content in renal carcinoma is weakly linked to outcome, is subject to sample error and does not provide accurate prognostic information as a single independent variable.

Adult↗
PubMed1993

Comparison of flow and static image cytometry in the determination of ploidy.

AIMS: To compare the efficiency of flow cytometry and computed image cytometry; and to see if a reliable set of guidelines regarding interpretation of histograms could be drawn up. METHODS: The two methods were applied to a series of 111 formalin fixed renal cell carcinomas. Data generated by both methods were compared. RESULTS: The methods agreed in 85 cases. Hypodiploidy was detected by computed image cytometry in seven cases in which flow cytometry had shown only an aneuploid peak. Aneuploidy in seven in which the corresponding flow cytometry histogram was diploid. There was an overlap in the second peak proportions on flow cytometry histograms between those classed as diploid or tetraploid by computed image cytometry. In six cases the flow cytometry histograms had unacceptably high coefficients of variation and in all of these cases computed image cytometry demonstrated aneuploidy. CONCLUSIONS: Computed image cytometry is particularly useful for clarifying difficult areas in flow histograms--specifically, high coefficients of variation, high G2M phase, as well as possible near diploid aneuploidy and hypodiploidy.

Carcinoma, Renal Cell↗
PubMed1993

A modified papaverine test and the use of venous constriction in erectile dysfunction.

A simple technique employing a penoscrotal tourniquet in the investigation and management of impotence due to venous leakage is described. Fifteen patients were investigated using a constriction band and intracorporeal injection of papaverine. Colour doppler ultrasound studies demonstrated that the tourniquet abolished venous leakage in 11 cases and there was a close correlation between clinical and ultrasonographic findings. Most of the patients with venogenic impotence found the device to be of therapeutic benefit. The technique is simple and provides reliable clinical information about the likely cause of erectile failure and is an effective and acceptable aid to treatment in correctly selected cases.

Adult↗
PubMed1992

The current status of embolization in renal cell carcinoma--a survey of local and national practice.

The current role of renal embolization in carcinoma of the kidney is uncertain. In order to assess surgeons' opinion of its usefulness a questionnaire was circulated to all general urologists practising in Britain and Ireland. Also, a series of cases in which the technique was employed (n = 35) was reviewed and compared with a similar group who were not embolized (n = 40). There was a 71% response to the survey. The principal findings were that all but five urologists believe that embolization should not be used routinely in the management of renal cell carcinoma. Thirty-five per cent stated that they felt it has a role in management of symptoms in metastatic or inoperable tumours. The review of both series of patients in our unit shows that embolization (using 95% ethanol infused via a balloon occlusion catheter) did not reduce peroperative blood loss and did significantly increase hospital stay. There were no deaths in this series, and morbidity was confined to 'post-embolization syndrome' in 16 cases. We believe that in those cases where embolization is indicated, alcohol infusion via a balloon occlusion catheter is a safe and efficient method.

Attitude of Health Personnel↗
PubMedDate not supplied

Clear cell sarcoma of the kidney in an adult.

An adult case of clear cell sarcoma of the kidney is described. The clinical, histological, immunohistochemical and electron microscopical features of the tumour are described.

Adult↗