Biomedical subjects

Guilherme C Lima

Publications and source records attributed to Guilherme C Lima.

8 recordsLinked to original sources

PubMed2006

Clinical sequelae of radiographic iceball involvement of collecting system during computed tomography-guided percutaneous renal tumor cryoablation.

OBJECTIVES: Percutaneous renal tumor cryoablation is being evaluated as a treatment option for small renal tumors. However, when tumors are located centrally, involvement of the collecting system by the radiographic iceball can occur. We reviewed our series of computed tomography (CT)-guided percutaneous renal tumor cryoablation to identify those cases in which there appeared to be involvement of the collecting system by the radiographic iceball and to determine any clinical sequelae of such involvement. METHODS: Retrospective review of the medical records identified 6 patients who had undergone CT-guided percutaneous renal tumor cryoablation with evidence of collecting system involvement. Measurements of the tumor size, size of the radiographic iceball, and the size of the immediate postprocedure "cryozone" (region of apparent treatment on contrast-enhanced CT) were obtained from the preprocedure, intraprocedure, and immediate postprocedure CT scans. Follow-up imaging was obtained beginning at 3 to 6 months. RESULTS: Six patients were identified who met the inclusion criteria and had at least 3 months of documented follow-up. Despite the apparent involvement of the collecting system during the cryoablation procedure, no patient developed clinical signs or symptoms or radiographic evidence of a urine leak or fistula formation. Furthermore, no evidence of ureteral narrowing or stricture formation has been found to date, with a mean follow-up of 167.7 days (range 90 to 288). CONCLUSIONS: We observed no clinically appreciable urine leaks despite what appeared to be obvious involvement of the collecting system by the radiographic iceball. However, care should be exercised to avoid this insult when possible until additional research has confirmed its safety.

Adult↗

PubMed2006

Reinstatement of continuous ambulatory peritoneal dialysis after transperitoneal laparoscopic nephrectomy.

OBJECTIVES: To assess the early reinstatement of continuous ambulatory peritoneal dialysis (CAPD) after transperitoneal radical nephrectomy. METHODS: The medical records of the 3 patients who were using CAPD before laparoscopic radical nephrectomy were retrospectively reviewed. All 3 were reinstated on CAPD during the second postoperative week. RESULTS: In these 3 patients, the mean hospital stay was 6 days (range 3 to 9), and CAPD was reinitiated 12.7 days (range 10 to 14) after laparoscopic surgery. During the interim between surgery and reinstituting CAPD, all 3 patients underwent hemodialysis (HD) in the hospital and were discharged to local outpatient HD centers. No difficulties were associated with the transition to CAPD, and no complications had occurred after the reinstatement of regular CAPD regimens at a mean follow-up of 11 months (range 10 to 13) in this group of patients. CONCLUSIONS: The results of this study have shown that CAPD can be reinstated within 2 weeks of laparoscopic transperitoneal radical nephrectomy without short-term complications.

Adult↗

PubMed2006

Intraoperative conversion of laparoscopic partial nephrectomy.

PURPOSE: To assess the incidence of conversion from laparoscopic partial nephrectomy (LPN) to open surgery or laparoscopic radical nephrectomy (LRN) when liberal selection criteria are utilized. PATIENTS AND METHODS: A retrospective review of medical records was done for all patients scheduled for LPN at our institution from January 2000 through March 2004. The preoperative risk factors, intraoperative course, and pathologic outcomes of patients who were converted to LRN were compared with those of the cohort of patients who underwent LPN as originally scheduled. RESULTS: Among the 257 operations that started as LPN, 35 (13.6%) were converted to LRN and 4 (1.6%) to open surgery. Age, tumor size, operating time, and hypertension were significantly higher in patients requiring conversion in than those who underwent completed LPN. Patients over the age of 70 had a 3.8-fold higher risk of requiring conversion, and, independent of age, patients with tumor>4.0 cm had a 4-fold increase in the likelihood of conversion to LRN. CONCLUSION: Of the preoperatively determined factors compared across the cohort of patients who underwent LPN and the cohort of patients converted to LRN, only tumor size and patient age were predictive of an increased risk of conversion. Other variables, including sex, side of affected kidney, clinical stage, ASA score, comorbidity with hypertension or diabetes mellitus, and surgeon were not significant in predicting conversion.

Adult↗

PubMed2005

Small cell carcinoma of epididymis: multimodal therapy.

Extrapulmonary small cell carcinoma is an infrequent tumor that can occur in various organs. Although a few sporadic reports about extrapulmonary small cell carcinoma have been published, much remains to be uncovered about the clinical features, optimal treatment, and natural history. We present a case of small cell carcinoma of the epididymis with retroperitoneal recurrence, an exceedingly rare tumor with behavior and treatment not well characterized. Multimodal therapy with chemotherapy and retroperitoneal lymph node dissection was necessary to manage this aggressive disease.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2005

Laparoscopic retroperitoneal lymph node dissection after prior open retroperitoneal lymphadenectomy and chemotherapy.

Laparoscopic retroperitoneal lymphadenectomy for testicular cancer is a challenging surgical procedure. Several factors can increase the difficulty, including prior chemotherapy or open surgery. We present a case of a laparoscopic "redo" postchemotherapy nodal dissection to treat a residual retroperitoneal mass in a patient with non-seminomatous germ cell tumor. This approach allowed rapid recovery, and at 2.5 years after surgery no evidence of tumor recurrence was seen.

Adult↗

PubMed2005

Laparoscopic ureteral reimplantation: a simplified dome advancement technique.

Laparoscopic Boari flap reimplantation has been used to treat long distal ureteral strictures. This technique requires extensive bladder mobilization and complex intracorporeal suturing. This demonstrates a novel laparoscopic bladder dome advancement approach for ureteral reimplantation. This technique obviates the need for bladder pedicle dissection and simplifies the required suturing.

Humans↗

PubMed2005

Laparoscopic renal-adrenal surgery in patients on oral anticoagulant therapy.

PURPOSE: Patients requiring chronic anticoagulation are theoretically at increased risk for hemorrhage or thromboembolism perioperatively. Experience with laparoscopic renal/adrenal surgery in patients on chronic warfarin is limited. We assessed hemorrhagic/thromboembolic complications in this group of patients. MATERIALS AND METHODS: The records of 787 patients undergoing laparoscopic renal/adrenal surgery were retrospectively reviewed. A total of 25 patients on chronic oral anticoagulation with warfarin were identified. The indications for warfarin therapy as well as perioperative management were reviewed. Clinical parameters, including operative time, estimated blood loss, hemorrhagic/thromboembolic complications and transfusions, were documented and compared with those in patients not receiving chronic anticoagulation. RESULTS: Atrial fibrillation (56% of cases) and a prosthetic mitral valve (28%) were the most frequent indications for chronic anticoagulation. Bridging anticoagulation with unfractionated heparin was the most frequent management method (68% of cases). Patients with anticoagulation were older (p <0.001) and hospitalized longer (<0.001) than those without anticoagulation. Operative time, estimated blood loss and the conversion rate were not significantly different between the groups. However patients on chronic warfarin significantly more often required transfusion (24% vs 5.2%, p <0.005) and had more postoperative bleeding episodes (8% vs 0.9%, p <0.05) than patients not on chronic anticoagulation. No thromboembolic events occurred in the anticoagulated group, while 3 occurred in the nonanticoagulated group (p = 1). CONCLUSIONS: Laparoscopic renal/adrenal surgery in patients requiring chronic anticoagulation therapy can be performed safely. The risk of intraoperative bleeding is not increased, although the incidence of postoperative bleeding as well as transfusions is higher.

Administration, Oral↗

PubMedDate not supplied

Refining the laparoscopic retroperitoneal lymph node dissection for testicular cancer.

Since its initial description, the laparoscopic retroperitoneal lymph node dissection has evolved considerably, from a purely diagnostic tool performed to stage germ cell testicular cancer to a therapeutic operation that fully duplicates the open technique. Herein, we describe the current technique employed at our institution, along with illustrations of all surgical steps, and delineate the refinements of the technique over time.

Humans↗