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Biomedical subjects

Ioannis M Varkarakis

Publications and source records attributed to Ioannis M Varkarakis.

At least 19 recordsLinked to original sources
PubMed2006

Evaluation of findings during re-exploration for obstructive ileus after radical cystectomy and ileal-loop urinary diversion: insight into potential technical improvements.

OBJECTIVE: To retrospectively evaluate the findings during re-exploration for obstructive ileus after radical cystectomy (RC) and ileal conduit diversion. PATIENTS AND METHODS: During a 12-year period, 434 patients who had RC and ileal conduit diversion were retrospectively evaluated for the diagnosis of early (</=30 days after RC) or late abdominal re-exploration. The operative reports of patients requiring a second abdominal procedure were reviewed, evaluating in particular the reason for small bowel obstruction (SBO). In addition, the type of entero-enteric anastomosis and the retroperitonealization of the uretero-enteric anastomosis were compared between patients who required abdominal re-exploration for SBO and those who did not. RESULTS: Abdominal re-exploration for SBO was necessary for 14 (3.2%) and 32 (7.3%) patients in the early and late postoperative period, respectively. The most common reasons for SBO were anastomotic malfunction (1.4%) and malignant recurrence (2.8%). Adhesions were the second most common cause leading to ileus in both periods (1.1% and 2.3%, respectively). When there was no retroperitonealization of the uretero-enteric anastomosis, SBO occurred more often both early and late (P = 0.06). Early anastomotic malfunction leading to SBO was more common (but not statistically significant, P = 0.06) when the entero-enteric anastomosis was hand-sutured end-to-end. CONCLUSIONS: Anastomotic malfunction, bowel adhesions and internal hernias are responsible for SBO early after surgery. The above reasons, in addition to malignant recurrence, are the most common reasons for SBO in the late postoperative period.

Aged↗
PubMed2006

Is there a role for alpha1-blockers in treating double-J stent-related symptoms?

OBJECTIVES: To evaluate the effect of alfuzosin in improving symptoms in, and quality of life of, patients with indwelling double-J ureteral stents. METHODS: A total of 100 patients, 50 men and 50 women (mean age 54.2 years), with unilateral ureteral stone-related hydronephrosis, who had opted for conservative management with insertion of a double-J ureteral stent, were prospectively randomized into two groups. Group 1 included 50 patients who received 10 mg of alfuzosin, once daily for 4 weeks, and group 2 consisted of 50 patients who received placebo for the same period. All patients completed a validated Ureteral Stent Symptom Questionnaire (USSQ) 4 weeks after stent placement. RESULTS: The mean urinary symptom index score was 21.6 in group 1 and 28.1 in group 2 (P < 0.001). Stent-related pain was reported by 44% of patients in group 1 and 66% of patients in group 2 (P = 0.027). The mean pain index score was 14.6 in group 1 and 17.4 in group 2 (P = 0.047). The mean general health index score was statistically greater (P < 0.001) in group 1 compared with in group 2 (8 versus 11.4, respectively). Among sexually active patients, the mean sexual score was 2.3 in group 1 and 2.9 in group 2 (P = 0.017). CONCLUSIONS: Stent-related symptoms were present in 66% of the controls (group 2). Alfuzosin improved a subset of stent-related urinary symptoms and pain. Patients receiving alfuzosin had their sexual function and general health better preserved.

Adrenergic alpha-Antagonists↗
PubMed2006

Comparison of surgical performance during laparoscopic radical prostatectomy of two robotic camera holders, EndoAssist and AESOP: a pilot study.

OBJECTIVES: Robotic camera holders provide steady camera movement and view during laparoscopic surgery. We compared two such robots, EndoAssist and AESOP, by evaluating timed setup and surgical performance during laparoscopic radical prostatectomy (LRP). METHODS: We prospectively collected data for 20 patients undergoing LRP using either the EndoAssist or AESOP. AESOP was mounted to the surgical bed and controlled by an experienced assistant using a hand-held remote control. The EndoAssist device was placed over the patient's right shoulder. Its movements were executed by the surgeon using a head-mounted optical emitter with brief head movements detected by a sensor mounted atop the surgeon's video monitor. The robot setup time and LRP operative steps were timed and compared between the two cohorts. RESULTS: The time for robot setup favored AESOP over the EndoAssist (2.0 minutes versus 5.3 minutes, P = 0.001). The time for accomplishing vas deferens and seminal vesicle dissection favored the EndoAssist (23 minutes versus 33 minutes, P = 0.04). However, no statistically significant difference was found in the efficiency of task performance between the two robots in any of the other 11 steps measured. CONCLUSIONS: The EndoAssist appears to be equally efficient to the assistant-controlled AESOP robot with respect to surgical performance during LRP. The advantages of the EndoAssist include its accurate response and ability to provide the surgeon with complete control of the desired operative view without relying on an assistant. Its disadvantages include its large profile, lack of a table-mounted design, and the need for pedal activation. Additional modifications are needed to improve the efficiency and design of this novel robotic device further.

Humans↗
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

Pain control requirements for percutaneous ablation of renal tumors: cryoablation versus radiofrequency ablation--initial observations.

PURPOSE: To retrospectively compare the pain control requirements of patients undergoing computed tomography (CT)-guided percutaneous radiofrequency (RF) ablation with those of patients undergoing CT-guided percutaneous cryoablation of small (< or = 4-cm) renal tumors. MATERIALS AND METHODS: The study was HIPAA compliant and received institutional review board exemption; informed consent was not required. Medical and procedure records of patients who underwent RF ablation and cryoablation of renal tumors from June 19, 2003, to February 28, 2004, were retrospectively reviewed for clinical data, tumor characteristics, and anesthesia information. During the study period, 10 men (mean age, 66.5 years) underwent cryoablation of 11 renal lesions, and 14 patients (11 men, four women; mean age, 68.1 years) underwent RF ablation of 15 renal tumors. Analgesic and sedative requirements during the procedure were compared. Standard anesthesia consisted of 5 mL of 1% lidocaine injected locally, and conscious sedation consisted of 50 microg of fentanyl and 1 mg of midazolam administered intravenously. The Fisher exact test and Student t test were used to compare clinical factors and drug requirements between the two groups. RESULTS: There was no difference in terms of patient demographics, tumor diameter, or distribution of central versus noncentral lesions between the two groups. Cryoablation was associated with a significantly lower dose of fentanyl (165.0 microg [RF group] vs 75.0 microg [cryoablation group]; P < .001) and midazolam (2.9 mg [RF group] vs 1.6 mg [cryoablation group]; P = .026). In the RF group, one patient required general anesthesia, one patient required supplemental narcotics (5 mg of oxycodone) and sedatives (1 mg lorezapam), and one patient became apneic for a brief interval after receiving additional narcotics for pain during the procedure. An additional RF session was terminated early in one patient because of pain, and further medication could not be administered owing to bradycardia. No patients in the cryoablation group required any additional or alternate anesthetics. CONCLUSION: Image-guided percutaneous cryoablation of small (< or = 4-cm) renal lesions appears to require less analgesia than RF ablation. Prospective trials with validated pain scales are needed to examine this further.

Aged↗
PubMed2005

Adenomatoid of the adrenal gland.

Adenomatoid tumors are common in the genital tract but rare in the adrenal gland. These tumors can be difficult to diagnose when present in extragenital sites. This type of adrenal tumor lacks specific radiographic features and can be confused preoperatively with more common adrenal gland tumors. We present the case of a 54-year-old man with an incidental right adrenal mass with calcified components and elevated urinary levels of homovanillic acid that was found to be an adenomatoid tumor of the adrenal gland.

Adenomatoid Tumor↗
PubMed2005

Comparison of erbium:yttrium-aluminum-garnet and holmium:yttrium-aluminum-garnet lasers for incision of urethra and bladder neck in an in vivo porcine model.

OBJECTIVES: To evaluate, in an animal model, differences in wound healing and scar formation in healthy urethra and bladder neck incised with the erbium (Er):yttrium-aluminum-garnet (YAG) and holmium (Ho):YAG lasers. METHODS: In each of 18 domestic pigs, three 1-cm-long incisions were made, two at the bladder neck and one in the mid-urethra, using either the Er:YAG laser (9 pigs) or the Ho:YAG laser (9 pigs). In each laser group, 3 animals were killed on postoperative days 0, 6, and 14. The width of collateral damage, as evidenced by coagulation necrosis and granulation tissue at the wound base, and the incision depth were evaluated during tissue analysis. RESULTS: The collateral damage with the Er:YAG laser at postoperative day 0, 6, and 14 was 20 +/- 5, 900 +/- 100, and 430 +/- 100 microm, respectively. The collateral damage with the Ho:YAG laser was 660 +/- 110, 2280 +/- 700, and 1580 +/- 250 microm, respectively. The amount of granulation tissue was significantly less (P <0.05) at all time points with the Er:YAG laser. Similarly, the incision depths for the Er:YAG and Ho:YAG laser at postoperative day 6 (1100 +/- 200 microm versus 1500 +/- 300 microm, respectively) and 14 (670 +/- 140 microm versus 1240 +/- 140 microm, respectively) were also significantly less (P <0.05) for the Er:YAG laser group, indicating faster healing of the wound created. CONCLUSIONS: In this in vivo animal study, incisions in the urethra and bladder neck made with the Er:YAG laser healed faster and with less scar formation than incisions made with the Ho:YAG laser.

Aluminum↗
PubMed2005

Primary renal carcinoid tumor with liver metastases detected with somatostatin receptor imaging.

If the final pathologic examination reveals a carcinoid tumor of the kidney, additional evaluation to rule out another occult primary tumor site is necessary. If the primary origin of the tumor is confirmed to be from the kidney, additional evaluation is required for the detection of metastasis. Renal carcinoid tumors are extremely rare; however, both primary and metastatic renal carcinoid tumors have been reported. We report a case of a 40-year-old woman with primary carcinoid of the kidney and metastatic disease in the liver not evident by computed tomography and magnetic resonance imaging but identified by somatostatin receptor scintigraphy.

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

Percutaneous radio frequency ablation of renal masses: results at a 2-year mean followup.

PURPOSE: We describe our experience with and results of percutaneous computerized tomography guided radio frequency ablation (RFA) for small (less than 4 cm) renal tumors at a 2-year mean followup. MATERIALS AND METHODS: A total of 49 patients (60 renal tumors) with a mean age of 63.9 years underwent percutaneous RFA. Indications for RFA were severe comorbidities or previous abdominal surgery precluding operative management, or hereditary conditions predisposing to multiple tumor recurrence. Persistent enhancement on initial followup imaging was considered incomplete treatment and all such patients underwent biopsy and were offered repeat RFA. Enhancement or enlargement on subsequent imaging was considered tumor recurrence and these patients were counseled regarding further therapy. RESULTS: Three patients (4 tumors) were excluded from evaluation due to death from unrelated causes or loss to followup. A total of 46 patients (56 tumors) were available for evaluation at a mean followup of 27.5 months (range 12 to 48). Six tumors were incompletely treated with the first RFA and successfully treated with a second session. Recurrences after successful initial treatment were seen in 3 of 46 patients. These recurrences developed 24, 25 and 31 months following RFA, respectively, and all occurred in patients with a central tumor of 3.0 cm or greater. Overall local control was achieved in 94.6% of tumors (53 of 56). CONCLUSIONS: RFA is an emerging alternative treatment modality for small renal tumors. Larger (greater than 3.0 cm) central tumors represent unique technical challenges, making these tumors more prone to recurrence. Long-term followup is needed to establish the oncological durability of this technique.

Adult↗
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↗
PubMed2005

Local steroid application during nerve-sparing radical retropubic prostatectomy.

OBJECTIVE: To evaluate the effect on potency rates after surgery of applying local steroids to the neurovascular bundles (NVBs) of the prostate after bilateral nerve-sparing radical retropubic prostatectomy (BNS-RRP). PATIENTS AND METHODS: Sixty potent men undergoing BNS-RRP for clinically localized prostate cancer were prospectively randomized equally into two groups. In group 1, 10 mL of betamethasone cream 0.1% was applied locally to both NVBs, and group 2 had only the usual BNS-RRP with no corticoid cream. Complications and potency were evaluated at 3, 6 and 12 months in all patients and compared between the groups. RESULTS: At 12 months, 57% and 60% of patients were potent in group 1 and 2, respectively; the respective mean International Index of Erectile Function (5-item) scores were 14.76 and 15.43 (P = 0.59). Potency rates at 3, 6 and 12 months were not significantly different between the groups, and the continence rates at 12 months were also similar, with 93% and 90% of patients in groups 1 and 2 being continent, respectively. Ten and five patients in groups 1 and 2, respectively, required a blood transfusion (P = 0.23). There were no fistulae, wound dehiscence or rectal perforations. One patient in group 2 presented 4 months after RRP with a bladder neck contracture. CONCLUSIONS: Local application of betamethasone does not improve or expedite the recovery of erectile function after BNS-RRP, but there were no complications associated with its use.

Betamethasone↗
PubMed2005

Use of external ureteral catheters and internal double J stents in a modified ileal neobladder for continent diversion: a comparative analysis.

INTRODUCTION: Open-ended straight ureteral stents are typically used for the support of the ureteroileal anastomosis during the creation of an orthotopic 'S-pouch' ileal neobladder. The use of double J stents as an alternative in this setting is evaluated. MATERIALS AND METHODS: Medical charts from 43 patients undergoing radical cystectomy with formation of an ileal 'S-pouch' neobladder were retrospectively evaluated. In 30 patients (group A), a 6-Fr open-ended straight ureteral catheter was used to stent the ureteroileal anastomosis, while a double J stent was used for the same reason in 13 patients (group B). The ureteral catheter was removed 15 days after the procedure while the double J stent 3 weeks postoperatively. Hospital stay, early and late complications were evaluated for both groups during a mean follow-up period of 22.5 and 19.6 months respectively. RESULTS: Stricture of the ureteroileal anastomosis was observed in 2 (6.6%) and 1 (7.6%) patient of groups A and B respectively. All complications presented with similar rates, except for an increased but not statistically significant incidence of urethrovesical anastomotic leakage and early urinary tract infections in group B. Hospital stay was significantly (p<0.005) shorter for patients of group B (9.9 vs. 15.2 days). CONCLUSIONS: The use of double J stents to support the ureteroileal anastomosis can be used as an alternative to open-ended ureteral stents. With double J stents a shorter hospital stay was achieved with similar complication rates but a higher incidence of upper urinary tract infections.

Aged↗
PubMed2004

Laparoscopic-assisted nephrectomy with inferior vena cava tumor thrombectomy: preliminary results.

OBJECTIVES: To evaluate the feasibility and outcome of laparoscopic-assisted radical nephrectomy and inferior vena cava (IVC) tumor thrombectomy in patients with renal cell carcinoma and level I IVC tumor thrombus. METHODS: The clinical, operative, and pathologic data were retrospectively obtained from patients undergoing the above-mentioned procedure for renal tumors involving the IVC. This approach involved laparoscopic dissection of the kidney and renal vasculature/IVC. After renal artery ligation, an 8 to 12-cm incision was made from the tip of the 11th rib extending anteriorly toward the midline. Through this incision, a Satinsky vascular clamp was placed on the IVC in such a way as to include all the caval thrombus. The tumor thrombus was removed en bloc with the kidney and the cavotomy repaired with a running suture. RESULTS: Four obese patients underwent transperitoneal laparoscopic-assisted right nephrectomy with inferior vena cava (IVC) thrombectomy. The mean tumor size was 9 cm (range 6 to 13), with the thrombus extending 2 cm into the IVC in all cases. Patients had a mean body mass index of 32.8 (range 30.5 to 37.2) and a mean American Society of Anesthesiologists score of 2.8 (range 2 to 3). The mean operative time was 248 minutes (range 225 to 274). The mean estimated blood loss was 517 mL (range 250 to 900). No intraoperative or postoperative complications occurred. The mean hospital stay was 6.2 days (range 4 to 11, median 5). CONCLUSIONS: Laparoscopic-assisted nephrectomy and IVC thrombectomy is a difficult but feasible procedure. This approach allows a smaller incision than a typical open approach. Additional studies are needed to examine the advantages of this approach over a pure open approach.

Aged↗
PubMed2004

Pancreatic injuries during laparoscopic urologic surgery.

OBJECTIVES: To review our experience with pancreatic injury (PI) associated with urologic laparoscopy. PI associated with urologic laparoscopy is uncommon. METHODS: From January 1999 to April 2004, 890 laparoscopic operations for upper urinary tract pathologic findings were performed, of which 574 were left-sided procedures. We reviewed the medical records for recognized intraoperative or postoperatively documented PI and recorded the patient demographic data and intraoperative and postoperative management. RESULTS: Four PIs were identified, all associated with left-sided procedures. The overall rate of PI was 0.44%. Two injuries occurred during left radical nephrectomy (2.1%) and two during left adrenalectomy (8.6%). The mean tumor size was 6 +/- 3.4 cm. The diagnosis was made intraoperatively in 1 patient, postoperative midepigastric pain with elevated serum amylase levels was the clinical presentation in 2 patients, and the incidental finding of pancreatic tissue in the final pathologic specimen confirmed the injury in the fourth patient. A prolonged pancreatic fistula developed only in 1 case. Three patients were treated conservatively and computed tomography-guided drainage of a pancreatic collection was required in one. The mean hospital stay was 18 days (range 4 to 57). CONCLUSIONS: PI is uncommon but can result in significant morbidity. Intraoperative detection and repair can minimize sequelae. Management with conservative measures and percutaneous drainage is usually successful, although a prolonged postoperative course can be expected.

Humans↗
PubMed2004

Tumor capacitance: electrical measurements of renal neoplasia.

PURPOSE: Studies have demonstrated that biological tissues possess unique electrical properties. We evaluate the electrical properties of renal tumors using a specialized probe with the capability of measuring intra-tissue capacitance in an ex vivo model of fresh surgically excised tissue. MATERIALS AND METHODS: An electrical monitoring device was used to measure tissue capacitance at a frequency of 1 MHz on 34 ex vivo kidney specimens freshly obtained after surgical excision. Tissue capacitance was promptly measured in the excised tumor as well as surrounding normal parenchyma and fat. Dielectric permittivity in each tissue was calculated using the measured capacitance data. These data were compared and correlated to pathological findings. RESULTS: The final pathology on the 34 specimens revealed 28 renal cell carcinomas (RCC), 3 oncocytomas and 3 angiomyolipomas. In patients with RCC dielectric permittivity of tumor tissue was 1.43 +/- 0.39 times greater than that of surrounding normal parenchyma (p < 0.001). The average tumor-to-normal tissue dielectric permittivity ratio for RCC was significantly greater than that for angiomyolipoma (1.43 +/- 0.39 vs 0.73 +/- 0.77, p < 0.05) but similar to that for oncocytoma (1.43 +/- 0.39 vs 1.63 +/- 0.77, p = 0.39). CONCLUSIONS: Tissue capacitance measurements may be used to differentiate renal tumor from surrounding normal tissue. In vivo studies will ultimately determine the clinical use of this technology in localizing renal neoplasms and differentiating between malignant and benign tissues.

Adenoma, Oxyphilic↗