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Biomedical subjects

Georg Bartsch

Publications and source records attributed to Georg Bartsch.

At least 163 records · Page 9Linked to original sources
PubMed2003

The intravesical ureter in children with vesicoureteral reflux: a morphological and immunohistochemical characterization.

PURPOSE: We investigated intravesical ureteral endings using immunohistochemical methods to study general morphology, smooth muscle architecture and collagen composition in children with vesicoureteral reflux. MATERIALS AND METHODS: Samples were obtained from 29 ureterorenal units in children with a mean age of 52.3 months undergoing reflux surgery. Routine histological paraffin embedded sections were stained with hematoxylin and eosin, and Masson trichrome to assess general morphology. Staining for actin, myosin and desmin was performed to evaluate the presence, allocation and architecture of the ureteral smooth muscle wrap. In addition, indirect immunohistochemical methods were used to study the collagen composition of the ureteral wall and CD68 was used for macrophage labeling as a marker of tissue remnant scavenging. All investigations were done using high power field magnification for quantification. In addition, age matched, nonrefluxing ureteral specimens served as controls. RESULTS: Smooth muscle alpha-actin, myosin and desmin expression were extensively decreased in all specimens pertaining to the ureteral ending. This distal part showed a high degree of muscle atrophy and degeneration as well as a disordered fiber arrangement associated with increased extracellular matrix collagen accumulation. In addition, CD68 positive macrophages were significantly increased. In contrast to these observations, the proximal intravesical portion of the ureter showed intact morphology and arrangement of the muscular coat. CONCLUSIONS: Refluxing intravesical ureteral endings showed dysplasia, atrophy and architectural derangement of smooth muscle fibers. Consequently symmetrical contraction of the distal ureteral smooth muscle coat creating the active valve mechanism to protect reflux is not achievable.

Antigens, CD↗
PubMed2002

In vivo administration of vascular endothelial growth factor (VEGF) and its antagonist, soluble neuropilin-1, predicts a role of VEGF in the progression of acute myeloid leukemia in vivo.

Recent findings implied that the progression of hematologic malignancies, like that of solid tumors, is dependent on neovascularization. Recent studies on patients with acute myeloid leukemia (AML) showed increased levels of leukocyte-associated vascular endothelial growth factor (VEGF) and neovascularization of the bone marrow. Murine (32D, M1) and human (HEL, U937, and UKE-1) leukemic cell lines and freshly isolated leukemic cells were analyzed for the expression of VEGF and VEGF receptor mRNA. The expression of VEGF and VEGF receptors KDR and neuropilin-1 (NRP-1) was detected in these cells. In a murine chloroma model, delivery of VEGF(165) using microencapsulation technology resulted in enhanced tumor growth and vascularization, whereas treatment with a VEGF antagonist soluble NRP-1 (sNRP-1) inhibited tumor angiogenesis and growth. In a systemic leukemia model, survival of mice injected with adenovirus (Ad) encoding for Fc-sNRP-1 (sNRP-1 dimer) was significantly prolonged as compared with mice injected with Ad-LacZ. Further analyses showed a reduction in circulating leukemic cells and infiltration of liver and spleen as well as bone marrow neovascularization and cellularity. Taken together, these results demonstrate that angiogenic factors such as VEGF promote AML progression in vivo. The use of VEGF antagonists as an antiangiogenesis approach offers a potential treatment for AML. Finally, our novel in vivo drug delivery model may be useful for testing the activities of other peptide antiangiogenic factors.

Acute Disease↗
PubMed2002

Interleukin-6 regulates androgen receptor activity and prostate cancer cell growth.

Interleukin-6 (IL-6) is a multifunctional cytokine which is involved in regulation of growth of various malignant tumors. IL-6 binds to its receptor, which is composed of a ligand-binding and a signal-transducing subunit and activates pathways of signal transducers and activators of transcription and mitogen-activated protein kinases (MAPKs). In prostate cancer cells, IL-6 induces divergent proliferative responses. Serum levels of IL-6 are elevated in patients with therapy-resistant carcinoma of the prostate. We have investigated whether IL-6 interacts with the androgen signaling pathway in prostate cancer cells. In DU-145 cells, transiently transfected with androgen receptor (AR) cDNA, IL-6 caused ligand-independent and synergistic activation of the AR. Nonsteroidal antagonists of the AR down-regulated AR activity induced by IL-6. In LNCaP cells, IL-6-induced expression of the AR-regulated prostate-specific antigen gene. Inhibitors of protein kinase A and C and MAPK down-regulated IL-6-induced AR activity. IL-6 expression in human prostate tissue was studied by immunohistochemistry. In benign prostatic tissue, IL-6 immunoreactivity was confined to basal cells. In prostate intraepithelial neoplasia and in cancer tissue, atypical intraluminal and cancer cells expressed IL-6. The expression of IL-6 receptor was demonstrated in benign and malignant tissue in both epithelium and stroma. In the authors' laboratory, IL-6-inhibited proliferation of parental LNCaP cells. A new LNCaP subline was generated to investigate changes in signal transduction which might occur after prolonged treatment with IL-6. In the subline LNCaP-IL-6+, IL-6 neither reduced a number of cells nor caused G1 growth arrest. IL-6 receptor expression declined during long-term IL-6 treatment. However, IL-6-up-regulated AR expression and was capable of inducing AR activity in LNCaP-IL-6+ cells. Parental LNCaP cells do not express IL-6. In contrast, IL-6 mRNA and protein expression were detectable in high passages of LNCaP-IL-6+ cells. Thus changes in signal transduction occur in prostate cancer cells after prolonged IL-6 treatment

Cell Differentiation↗
PubMed2002

Screening with low PSA cutoff values results in low rates of positive surgical margins in radical prostatectomy specimens.

BACKGROUND: In the literature, positive margins in radical prostatectomy specimens, the rate of which ranges between 7% and 46%, are associated with adverse patient survival. The aim of the present study was to determine the predictive value of preoperative serum prostate specific antigen (PSA) values for the rate of positive margins in radical retropubic prostatectomy. METHODS: The study included a cohort of 845 patients who underwent radical retropubic prostatectomy between October of 1993 and December of 1999. All patients were stratified in groups on the basis of their preoperative PSA values: PSA group I, 0-1.99 ng/ml; PSA group II, 2-3.99 ng/ml; PSA group III, 4-5.99 ng/ml; PSA group IV, 6-7.99 ng/ml; PSA group V, 8-9.99 ng/ml; and PSA group VI, >10 ng/ml. For each group, the pathologic stage, Gleason score, and the incidence of positive margins were analyzed. For statistical analysis, the Mann Whitney U-test was used. RESULTS: Our data show a significantly higher rate of organ-confined prostate cancers and a significantly lower rate of positive surgical margins in patients with preoperative total PSA values of less than 4 ng/ml compared with patients with higher preoperative total PSA levels. CONCLUSION: As tumor stage and surgical margin status after radical prostatectomy are important predictors of the likelihood of PSA recurrence, which necessitates additional therapy, these findings support the concept of PSA screening by using low PSA cutoff levels.

Adult↗
PubMed2002

Human monocyte-derived dendritic cells are deficient in prostaglandin E2 production.

Monocyte-derived dendritic cells (moDCs) are increasingly used in clinical settings to stimulate tumor immunity. Prostaglandin E2 (PGE2), which is a member of the eicosanoid family of oxygenated arachidonic acid derivatives generated through the action of cyclooxygenases (COXs), is frequently used to enhance the tumor necrosis factor-alpha-induced terminal maturation of moDCs. We show here that one effect of interleukin (IL)-4, which is used together with GM-CSF to generate moDCs, is the suppression of endogenous PGE2 production in moDCs. IL-4 inhibits the cytoplasmic form of phospholipase A2, the enzyme that specifically liberates arachidonic acid from membrane phospholipids. Although moDCs failed to mobilize endogenous arachidonic acid, they converted exogenous arachidonic acid into PGE2 in a COX-1- and COX-2-dependent fashion. IL-4-mediated suppression of PGE2 biosynthesis in human moDCs explains the previously reported maturation-enhancing effect of exogenous PGE2. The general suppression of eicosanoid biosynthesis may, however, limit the immunological efficacy of moDCs generated with IL-4.

Arachidonic Acid↗
PubMed2002

Voiding cystourethrography using the suprapubic versus transurethral route in infants and children: results of a prospective pain scale oriented study.

PURPOSE: We determined the advantages and disadvantages of different types of contrast medium injection into the bladder for imaging children during evaluation for urinary tract infection in regard to child behavior and distress during urethral catheterization or suprapubic puncture. MATERIALS AND METHODS: From December 2000 to September 2001 we prospectively compared transurethral catheter and suprapubic voiding cystourethrography in children with a history of urinary tract infection. A total of 65 children with a mean age of 33.8 months were entered into the study, of whom 32 underwent transurethral catheterization and 33 underwent suprapubic puncture with topical anesthesia. Each child was evaluated, particularly in regard to discomfort and pain using an objective pain score that measures stress and pain during a medical procedure. RESULTS: Objective pain score recording showed a mean pain score plus or minus SD of 4.25 +/- 1.3 in the transurethral catheterization and 3.03 +/- 1.21 in the suprapubic puncture groups. Correlation studies of age in the 2 groups also showed a significant impact of age on the objective pain score. In the transurethral group the score increased with age (p <0.001), whereas in the suprapubic group it decreased with age (p <0.001). CONCLUSIONS: The current study shows that the suprapubic puncture technique with topical anesthesia was well tolerated and associated with a low pain score independent of patient age. Transurethral catheterization was also tolerated but it was associated with a low pain score only in the younger age group. Thus, we recommend that voiding cystourethrography in children older than 24 months should be done via the suprapubic route.

Anesthetics, Local↗
PubMed2002

Correlation between inflammatory cells (T and B lymphocytes, macrophages) in prostate biopsies and elevated PSA levels in a PSA screening population.

OBJECTIVES: To investigate the relationship between inflammatory cells in prostate biopsies and total serum prostate-specific antigen (PSA) levels in a screening population. METHODS: In the study, transrectal ultrasound-guided prostate biopsy specimens from 49 patients were assessed. All patients undergoing biopsy had elevated serum PSA levels (as defined by the biopsy criteria of the Tyrol PSA Screening Project) and/or abnormal findings on digital rectal examination. The prostate biopsy specimens were histologically negative for carcinoma. Immunohistologic characterization of the inflammatory cells was performed using CD3, CD4, and CD8 antibodies for the detection of T lymphocytes, CD20 antibodies for B lymphocytes, and CD68 antibodies for macrophages. The percentage of inflammatory cells and their distribution in stromal and glandular tissue was estimated using morphometric methods. RESULTS: Inflammatory cells in the stroma contained significantly larger numbers of T lymphocytes than B lymphocytes and macrophages. T lymphocytes were also predominant in the glandular region. A significant positive correlation was found between the relative volume (vol%) of macrophages and total PSA levels (P <0.05) and a significant negative correlation between the percent free PSA levels and the relative volumes of T and B lymphocytes. CONCLUSIONS: The results indicate a significant positive correlation between total PSA levels and macrophages and a significant negative correlation between percent free PSA levels and T and B lymphocytes. No statistically significant correlation was found between total serum PSA levels and the presence of inflammatory cells in the stromal and glandular compartment. Additional studies are needed to compare the amount and types of inflammatory cells with the stage and grade of prostate cancer in positive biopsies and radical prostatectomy specimens.

Adult↗
PubMed2002

Laparoscopic pyeloplasty for UPJ obstruction with crossing vessels: contrast-enhanced color Doppler findings and long-term outcome.

OBJECTIVES: To evaluate, in the present long-term follow-up study, contrast-enhanced color Doppler imaging (CDI) findings and the clinical outcome of patients with crossing vessels at the obstructed ureteropelvic junction (UPJ), who underwent laparoscopic pyeloplasty. In a previous study, contrast-enhanced CDI proved capable of detecting crossing vessels at the UPJ. METHODS: A total of 23 patients, who had undergone laparoscopic pyeloplasty and displacement of crossing vessels for UPJ obstruction at least 2 years before this study (mean 27 months), underwent contrast-enhanced CDI, intravenous urography, and renography. Contrast-enhanced CDI was performed using intravenously administered Levovist to assess the displacement of the vessels relative to the UPJ. All patients completed analog follow-up pain scales and quality-of-life assessment questionnaires. RESULTS. Contrast-enhanced CDI revealed a cranial displacement (mean 1.3 cm) of the crossing vessels from the UPJ in all 23 cases. Intravenous urography showed a decrease in the degree of hydronephrosis, with a success rate of 100% in low-grade and 86% in high-grade hydronephrosis. The split renal function improved from 39.7% to 48.1%. Analog pain scale measurements demonstrated a mean improvement in pain of 92% (range 73% to 100%) and a mean quality-of-life score of 94 (range 78 to 100). CONCLUSIONS: Our series of patients with crossing vessels at the UPJ treated by laparoscopic pyeloplasty showed an excellent long-term successful outcome. Contrast-enhanced CDI allows for preoperative detection, as well as postoperative assessment, of the displacement of the crossing vessel. We recommend that the presence of a crossing vessel be routinely determined preoperatively, because it may influence the choice of treatment modality and thereby the clinical outcome.

Adolescent↗
PubMed2002

Complexed prostate-specific antigen for early detection of prostate cancer in men with serum prostate-specific antigen levels of 2 to 4 nanograms per milliliter.

Complexed PSA (cPSA) has been shown to improve specificity in the detection of prostate cancer over that of total PSA (tPSA) testing in men with tPSA values greater than the cutoff value of 4.0 ng/mL. However, recent studies have reported a 25% incidence of prostate cancer in men with tPSA values in the 2.5- to 4.0-ng/mL range. We performed a multicenter study of cPSA in a population of men who underwent prostate biopsies because of elevated PSA levels or abnormal digital rectal examination (DRE). As part of this study, we sought to assess the clinical value of cPSA in comparison to tPSA, the free/tPSA ratio (f/tPSA) and the complexed/tPSA ratio (c/tPSA) in early detection of prostate cancer in men with tPSA values in the range of 2 to 4 ng/mL. The study was performed at 7 centers. Sera were drawn from men who underwent biopsy procedures consisting of >10 prostate tissue cores. Receiver operating characteristic (ROC) analysis was performed from the results of patients with tPSA values in the range of 2 to 4 ng/mL, including men with suspicious as well as unremarkable findings on DRE. Sera were collected and tested with the Bayer tPSA and cPSA assay and the Beckman free PSA and tPSA assays. ROC analysis was performed for all samples in the 2- to 4-ng/mL PSA range. At biopsy, 158 men had no evidence of malignancy and 57 (26.5%) were diagnosed with prostate cancer. ROC analysis indicated that the area under the curve (AUC) for cPSA was 0.64, which was statistically significantly greater than that achieved for tPSA (AUC, 0.57; P <0.0001). The AUC for f/tPSA and c/tPSA were 0.60 and 0.63, respectively, which was not statistically significantly different from that of tPSA or cPSA (P >or=0.252). A cutpoint of 2.5 ng/mL for tPSA and 2.1 ng/mL for cPSA provided a specificity of 20.3% and 34.2%, respectively, and sensitivity levels of 86%. Using cutpoints of 25% for f/tPSA and 74% for c/tPSA provided a specificity of 11.0% and 21.5%, respectively, and sensitivity levels of 97%. In all, >92% of the cancers treated with radical prostatectomy were organ confined, and the histologic grading of the tumors ranged from moderately to poorly differentiated with Gleason scores from 5 to 9. These data confirm that there is a high incidence of clinically significant prostate cancer in men with tPSA levels <4.0 ng/mL. Measurement of cPSA proved useful in stratifying men with tPSA values in the 2- to 4-ng/mL range into high- and low-risk groups for prostate cancer. The use of cPSA as a single test was found to enhance detection of prostate cancer over that of testing with tPSA and PSA ratios in men with tPSA values in the range of 2 to 4 ng/mL.

Adult↗
PubMed2002

Can volume measurement of the prostate enhance the performance of complexed prostate-specific antigen?

We assessed whether volume-based complexed prostate-specific antigen (cPSA) indices could enhance prostate cancer detection in men with serum total PSA (tPSA) between 2.5 and 10.0 ng/mL. Between December 1998 and April 2000, cPSA assay was measured in 480 men who underwent transrectal ultrasound-guided prostate biopsies at 7 institutions. We compared the usefulness of cPSA and its indices with the ratio of free PSA (fPSA) to tPSA (percent fPSA) for early detection of prostate cancer. Overall, 168 men (35%) had cancer. In the 341 men with tPSA between 4.01 and 10.0 ng/mL at approximately 90% sensitivity and areas under the receiver operating characteristics curve, the performances of volume-based parameters were significantly better (P <0.05) than those of tPSA and cPSA. In the 139 men with tPSA between 2.5 and 4.0 ng/mL, at 90% sensitivity, the specificity of the ratio of cPSA to tPSA (percent cPSA) was best, followed by cPSA density (cPSAD). In the 101 men with the history of a previous prostate biopsy, at approximately 90% sensitivity, the specificity of cPSAD was significantly better than those of tPSA and percent fPSA (P <0.05). In the 371 men with a total prostate volume of >or=30 cm(3) at approximately 90% sensitivity, the specificity of the cPSAD was significantly better than that of tPSA, percent fPSA, and cPSA (P <0.05). In the 109 men with a total prostate volume of <30 cm(3), at 90% sensitivity the specificity of cPSA and cPSAD was better than that of percent fPSA. In conclusion, volume-based cPSA can modestly enhance the performance of cPSA.

Humans↗
PubMed2002

Long-term experience with carboplatin monotherapy for clinical stage I seminoma: a retrospective single-center study.

OBJECTIVES: To evaluate the long-term oncologic efficacy and morbidity of carboplatin monotherapy, which was introduced at our department 11 years ago for the treatment of Stage I seminoma. Radiotherapy is the standard treatment of patients with clinical Stage I seminoma. Carboplatin has been advocated as a treatment alternative to avoid the late side effects of radiotherapy and the high recurrence rate of surveillance strategies. METHODS: From February 1990 until August 2001, 108 patients received two adjuvant cycles of single-agent carboplatin (400 mg/m2 body surface on days 1 and 22) 2 weeks after high inguinal orchiectomy. To assess for myelosuppression, complete blood counts were performed at least once a week until the nadir occurred after the second treatment cycle. RESULTS: During a mean follow-up period of 59.8 months (range 6 to 134), 2 patients (1.85%) developed a recurrence (retroperitoneal tumor) within the first year. Both patients received cisplatin-based salvage chemotherapy. At last follow-up, all patients were alive without any evidence of disease. Carboplatin treatment was well tolerated by all patients and was associated with only mild gastrointestinal side effects. Leukopenia was noted in 32 patients (29.6%); 21 (19.4%) of these patients had World Health Organization (WHO) grade 1, 8 (7.4%) had grade 2, 3 (2.8%) had grade 3, and none had grade 4. No patient developed neutropenic fever. Thrombocytopenia was observed in 48 patients (44.4%); of these patients, 38 (35.2%) had WHO grade 1, 5 (4.6%) had grade 2, 2 (1.9%) had grade 3, and 3 (2.8%) had grade 4. CONCLUSIONS: From an oncologic standpoint, two cycles of carboplatin monotherapy was highly effective and very well tolerated by all patients.

Adult↗
PubMed2002

Complexed prostate-specific antigen as a staging tool: results based on a multicenter prospective evaluation of complexed prostate-specific antigen in cancer diagnosis.

Within a 7-site prospective evaluation of the Bayer complexed prostate-specific antigen PSA (cPSA) assay, we analyzed the ability of cPSA to predict extracapsular extension (ECE) before radical prostatectomy. Included in this analysis were 152 men diagnosed with cancer, who subsequently underwent radical prostatectomy. Sera were tested with the Bayer total PSA (tPSA) and cPSA assays, and the Beckman free PSA (fPSA) and tPSA assays. Treating surgical pathology result as a binary variable (organ confined vs ECE), mean tPSA, cPSA, fPSA/tPSA (f/tPSA) ratios, tPSA density (tPSAD), and cPSA density (cPSAD) were compared by receiver operating characteristic (ROC) curves and univariate analysis. In all, 28 men (18.4%) had pathologically identified ECE. Between those with and without ECE, significant differences were observed for tPSA (P = 0.0127), cPSA (P = 0.0120), tPSAD (P = 0.0001), and cPSAD (P = 0.0002), but not f/tPSA (P = 0.3774) or c/tPSA (P = 0.2882). All tested parameters except f/tPSA (P = 0.376) and c/tPSA (P = 0.288) predicted ECE (P <0.05) by logistic regression. The ROC area under the curve (AUC) was identical for tPSA and cPSA (0.621) and for tPSAD (0.692) and cPSAD (0.691). Kendall-tau correlation coefficients also demonstrated the strongest correlation with ECE for cPSAD and tPSAD. Either alone or as a tPSAD calculation, cPSA carries equivalent staging ability to tPSA. The use of f/tPSA appears to be less effective in staging than either cPSA or tPSA, whereas the use of either cPSAD or tPSAD provides maximal staging accuracy. Therefore, cPSA could be applied as an accurate predictor of ECE independently or in a nomogram along with other predictive variables.

Aged↗
PubMed2002

Anderson-Hynes dismembered pyeloplasty performed using the da Vinci robotic system.

INTRODUCTION: To evaluate and describe the use of the da Vinci robotic system in performing laparoscopic Anderson-Hynes pyeloplasty. TECHNICAL CONSIDERATIONS: Between June 2001 and February 2002, 9 patients underwent laparoscopic Anderson-Hynes pyeloplasty with the da Vinci telerobotic surgical system. The diagnosis was based on the presenting symptoms and radiologic imaging findings. The technique for da Vinci-assisted Anderson-Hynes pyeloplasty followed the same steps as for conventional laparoscopy. Three transperitoneal laparoscopic ports were required for the robotic system, and a fourth laparoscopic port was used by the assistant for retraction, suction, and introduction of suture. The operative time, suturing time, perioperative complications, and success rates were prospectively evaluated. The mean operative time was 138.8 minutes (range 80 to 215), and the mean suturing time was 62.4 minutes (range 40 to 115). No intraoperative complications or open conversions were required. The estimated blood loss was less than 50 mL in all cases. The mean length of hospitalization was 4.7 days (range 4 to 11). Postoperatively, 1 (11.1%) of 9 patients required open exploration to repair a defect in the renal pelvis. At a mean follow-up of 4.1 months (range less than 1 to 8), all procedures were successful on the basis of the subjective and radiographic data. CONCLUSIONS: All aspects of laparoscopic Anderson-Hynes pyeloplasty were performed using the da Vinci robotic system. da Vinci-assisted procedures resulted in favorable overall operative times, suturing times, perioperative complications, and available success rates, but additional clinical experience is required. Ongoing clinical application of robotic technology in a controlled scientific manner is needed to gauge the effectiveness of this method completely.

Blood Loss, Surgical↗
PubMed2002

An Escherichia coli-based oral vaccine against urinary tract infections potently activates human dendritic cells.

OBJECTIVES: To investigate the effects of Uro-Vaxom, an oral vaccine against Escherichia coli urinary tract infections, on human monocyte-derived dendritic cells (moDCs). Dendritic cells (DCs) are important antigen-presenting cells of the immune system. DCs are considered promising cellular adjuvants for inducing immunity against cancer or infectious diseases. METHODS: moDCs were generated in the presence of granulocyte-macrophage colony-stimulating factor and interleukin-4. Flow cytometric phenotyping, as well as the ability to stimulate T cells in an allogeneic mixed leukocyte reaction, was used to assess the effects of Uro-Vaxom on human moDCs. In addition, interferon-gamma and interleukin-4 production by T cells stimulated with Uro-Vaxom-activated moDCs were measured by intracellular fluorescence-activated cell sorter-staining at the single-cell level. RESULTS: Uro-Vaxom induced the terminal maturation of CD83+ moDCs in a dose-dependent manner. Phenotypic analyses revealed that Uro-Vaxom-activated moDCs displayed a phenotype of mature DCs with high levels of MHC molecules and increased levels of co-stimulatory molecules (CD80, CD86). Consistent with these findings, Uro-Vaxom-activated moDCs potently stimulated T-cell proliferation and interferon-gamma production in the allogeneic mixed leukocyte reaction. CONCLUSIONS: In DC-based immunotherapy, Uro-Vaxom could be used as a stimulant of DC maturation, which meets the standards of good manufacturing practice. In future preclinical studies, we will evaluate the effectiveness of a vaccination with Uro-Vaxom-activated moDCs. It could be an attractive treatment option in preventing recurrent E. coli urinary tract infections in predisposed individuals.

Adjuvants, Immunologic↗
PubMed2002

Laparoscopic retroperitoneal lymph node dissection: description of the nerve-sparing technique.

INTRODUCTION: Laparoscopic retroperitoneal lymph node dissection (RPLND) is associated with a more favorable postoperative recovery and decreased morbidity compared with open RPLND. To date, laparoscopic RPLND is used as a diagnostic tool for patients with clinical Stage I nonseminomatous germ cell tumor and as a diagnostic and therapeutic tool for patients with low-volume Stage II nonseminomatous germ cell tumor after chemotherapy. In an effort to further expand the therapeutic implications for laparoscopic RPLND, we describe a nerve-sparing technique for laparoscopic RPLND. TECHNICAL CONSIDERATIONS: In all cases, a four-port transperitoneal approach was used to perform a unilateral nerve-sparing technique. Laparoscopic nerve-sparing RPLND requires complete exposure of the retroperitoneum, similar to the standard procedure. A stepwise surgical approach is required for prospective identification of the sympathetic trunk and postganglionic nerve fibers. Identification and division of the lumbar veins is required for complete mobilization of the vena cava to facilitate dissection of the postganglionic nerves on the right side as they course dorsal to the vena cava. Meticulous dissection was required for preservation of the postganglionic nerves in the interaortocaval and para-aortic regions. CONCLUSIONS: Laparoscopic nerve-sparing RPLND is technically feasible. Performance of laparoscopic nerve-sparing RPLND decreases the potential morbidity associated with the standard laparoscopic technique further and may help expand the therapeutic potential for this minimally invasive procedure.

Humans↗
PubMed2002

Occurrence of polyorchidism in a young man.

Polyorchidism is an uncommon congenital anomaly of the genital tract defined as the presence of more than two testes. Polyorchidism is associated with maldescent testis, inguinal hernia, torsion, and an increased risk of malignancy. However, if a neoplasm is ruled out by ultrasonography, surgical exploration is not needed. We report a case of multiple testicular glands.

Adult↗