Biomedical subjects

Johan Poulsen

Publications and source records attributed to Johan Poulsen.

8 recordsLinked to original sources

PubMed2006

Positional anatomy of vessels that may be damaged at laparoscopy: new access criteria based on CT and ultrasonography to avoid vascular injury.

BACKGROUND AND PURPOSE: To study the relations of major blood vessels (aortoiliac bifurcation and iliocaval confluence) and the inferior epigastric arteries to the umbilicus and the anterior superior iliac spine (ASIS) planes and to apply this information to define ideal, anatomically based locations for primary and secondary laparoscopic port insertions to minimize vascular injuries. MATERIALS AND METHODS: Two hundred randomly selected postcontrast CT images of the abdomen and pelvis were assessed by two radiologists. The position of the umbilicus (mobile point), ASIS (fixed point), and relations with the great vessels were measured. The angle of the umbilicus with the aortic bifurcation, theta (theta), was calculated using trigonometric principles. The position and course of the inferior epigastric arteries (IEA) was analyzed in 103 patients with color Doppler ultrasonography. RESULTS: The median distance of the aortoiliac bifurcation was 8 mm (interquartile range [IQR] 28.8 mm] and that of the iliocaval venous confluence 25 mm (IQR 32 mm) below the umbilicus. The aorta divided 48 mm (IQR 16 mm) and the iliac veins joined 33 mm (IQR 9 mm) above the ASIS plane. The angle of the umbilicus to the aortoiliac bifurcation in the sagittal plane had a range of 14 degrees to 34 degrees with a median of 21.6 degrees . The median distance from the right IEA to the midline at the umbilicus was 4.75 cm (IQR 0.7 cm), and the same distance in the ASIS plane was 4.8 cm (IQR 0.7 cm). The distance of the IEA to the midline did not exceed 6 cm in any patient on either side or in either plane. CONCLUSION: The position of the umbilicus should not be relied on for access planning. The relation between the level of the ASIS and the aortic bifurcation is more consistent. The ideal primary port entry (or Veress needle site) is at the ASIS plane in the midline, and the ideal lateral port entry is in the same plane >6 cm from the midline. If the umbilicus is to be used, a Hasson insertion is desirable, but if a Veress needle is used at the umbilicus, an angle of 45 degrees in the sagittal plane should be used.

Adult↗

PubMed2006

Retroperitoneal dismembered pyeloplasty: initial experiences.

AIM: To review the results of our first 40 cases of retroperitoneal dismembered pyeloplasty and to compare them with series of open and other minimally invasive treatments of pelviureteric junction (PUJ) obstruction. Also to compare our first 20 cases with the second 20 cases to see if there was an improvement in results with experience. METHODS: A retrospective review of the first 40 laparoscopic pyeloplasties performed by a single lead surgeon at two institutions was performed. The diagnosis of PUJ obstruction was confirmed with an intravenous urogram as well as a renogram prior to surgery. A retroperitoneal, dismembered pyeloplasty was routinely performed with three or four ports. All patients were followed up with an intravenous urogram, renogram and review of symptoms at 4 months and annual renogram after that. RESULTS: Average operation time was 236 min and this appeared to decrease with experience. Two cases had to be converted to open operations. The mean hospital stay was 3.4 days. Out of the 40 patients, 34 have had successful laparoscopic operations with total symptomatic relief as well as radiologically proven deobstruction. There were four major complications with 3 patients going on to have redo open pyeloplasty operations. There were seven minor complications. CONCLUSIONS: In our experience, retroperitoneal dismembered pyeloplasty is an effective and safe means of treating PUJ obstruction. Our results seem to be comparable with series of open pyeloplasty and other laparoscopic series and are better than some other minimally invasive techniques.

Adolescent↗

PubMed2006

Prostate tissue and leukocyte levels of n-3 polyunsaturated fatty acids in men with benign prostate hyperplasia or prostate cancer.

OBJECTIVE: To compare the levels of n-3 polyunsaturated fatty acids (PUFAs) in leukocytes and prostate tissue in men with prostate cancer or benign prostatic hyperplasia (BPH), as dietary intake of n-3 PUFAs has been linked to the risk of prostate cancer; the prostate-specific antigen (PSA) level was also compared to prostate tissue levels of n-3 PUFAs. PATIENTS AND METHODS: Prostate tissue was obtained and leukocytes isolated from 20 men with prostate cancer and 35 with BPH. The n-3 PUFAs alpha-linolenic acid (ALA), eicosapentanoic acid (EPA) and docosahexaenoic acid (DHA) were measured in prostate tissue and in peripheral blood leukocytes using gas chromatography. PSA levels were measured in all of the men. RESULTS: There was a strong positive correlation between EPA and DHA in leukocytes and in prostate tissue (EPA: r = 0.80, DHA: r = 0.53, both P < 0.001) in all the men, whereas there was no association between the content of ALA in leukocytes and in prostate tissue (r = -0.15). Men with BPH had similar levels of ALA in leukocytes and in prostate tissue, but men with prostate cancer had more ALA in prostate tissue than in leukocytes. The PSA level was significantly positively correlated with ALA level in prostate tissue (r = 0.42, P < 0.01) but there was no significant correlation between PSA level and EPA and DHA levels. There were no significant correlations between PSA level and n-3 PUFA levels in leukocytes. CONCLUSION: Dietary intake of the marine n-3 PUFAs reflected in EPA and DHA levels in leukocytes are also reflected in EPA and DHA levels in prostate tissue in men with and without prostate cancer. However, there is a discrepancy between the levels of ALA in leukocytes and in prostate tissue, with higher levels in men with prostate cancer. This is in accordance with the strong positive association between PSA and ALA levels in prostate tissue. This study therefore does not support the hypothesis that intake of marine n-3 PUFAs might protect against prostate cancer, but lends support to the deleterious role of ALA in the development of prostate cancer.

Aged↗

PubMed2005

Laparoscopic nephrectomy.

OBJECTIVE: To present our experience of laparoscopic nephrectomy or nephroureterectomy performed over a 4-year period in terms of feasibility and complications. MATERIAL AND METHODS: A total of 103 patients (58 females, 45 males; median age 58 years) underwent laparoscopic nephrectomy or nephroureterectomy between 1 October 1999 and 1 October 2003. The indications were renal cell cancer (n = 39), transitional cell cancer (n = 23), end-stage pyelonephritis (n = 26), end-stage hydronephrosis (n = 11) and renovascular hypertension (n = 4). Ninety-eight patients were operated on transperitoneally and five retroperitoneally. All procedures were done in the lateral position. RESULTS: Seven procedures had to be converted to open procedures for the following reasons: poor visualization of the renal hilum (n = 5); bleeding from a splenic laceration (n = 1); and difficulty finding the kidney via a retroperitoneal approach (n = 1). The median operating time was 190 min, which decreased with experience. The median blood loss was 150 ml. There were two major complications (one small bowel perforation and one port-site herniation, both necessitating re-exploration) and seven minor complications (five infections, one case of temporary hip pain and one of surgical emphysema). Conclusions. Laparoscopic nephrectomy is a technically demanding procedure with the risk of serious complications, especially in the initial learning phase. However, after gaining experience the procedure can be performed with an acceptable operating time, minimal morbidity and a short hospital stay. Laparoscopic nephrectomy should be the standard procedure in most cases, both malignant and benign, with the possible exception of tumours > 10 cm. In order to expand the use of the technique, it is important to focus specifically on laparoscopic training in the education of trainee urologists.

Adolescent↗

PubMed2005

Prostate-specific antigen testing in general practice: a survey among 325 general practitioners in Denmark.

OBJECTIVES: Prostate-specific antigen (PSA) is a well-known and -utilized tumor marker for prostate cancer. Elevated PSA values are not specific for prostate cancer as they may be caused by other benign conditions. PSA testing is widely used by urologists and non-urologists. Interpretation of test results is difficult but important. Referral of patients for further work-up on suspicion of prostate diseases is mainly done by general practitioners (GPs). As the GP remains the gatekeeper between the patient and the urologist in terms of diagnosing prostate diseases, basic knowledge of PSA testing is crucial. The purpose of this study was to evaluate the basic use and knowledge of PSA testing and to give an estimate of the need for further education in PSA testing amongst GPs in our area. MATERIAL AND METHODS: A questionnaire regarding PSA testing and associated needs for education was mailed to all GPs in the Northern County of Denmark. Non-respondents were contacted by mail. RESULTS: Of the contacted GPs, 90% responded. Only 28% of GPs measured PSA in all males complaining of lower urinary tract symptoms (LUTS). Of patients seen as part of a general health check-up, PSA testing was done in 10%. The median PSA value for referral to urologists for further work-up was 5 ng/ml, but the decision was influenced by PSA value (79%), age (65%) and findings on digital rectal examination (DRE) (87%). Opportunistic screening for prostate cancer was done by 14% of GPs. Of the GPs who responded, 24% stated that they did not need any further education regarding PSA testing. CONCLUSIONS: The results of this study demonstrate that PSA testing is not standardized in our area. GPs do not test patients on the basis of recommendations provided by national or international societies. PSA testing is not used as a standard test in men with LUTS, and patients are not referred to urologists at a sufficiently low PSA level to improve the early diagnosis and work-up of patients with suspected prostate cancer. However, the decision of many GPs to refer patients to urologists for further work-up is influenced by the findings of a DRE, the age of the patient and the PSA value itself. Further education regarding PSA testing amongst GPs in our area would seem to be appropriate.

Adult↗

PubMed2005

Laparoscopic management of complicated urachal remnants.

OBJECTIVE: To report our experience with a laparoscopic approach to managing symptomatic urachal anomalies. PATIENTS AND METHODS: Five patients (median age 19 years, range 2-43) had a laparoscopic excision of a complicated urachal remnant between 2001 and 2004. Three ports were routinely used, although their positioning varied as our technique developed with experience. The urachal remnant was dissected from the umbilicus to the bladder dome and then removed intact. RESULTS: All five operations had no serious immediate complications and minimal blood loss. One patient developed a small peri-umbilical haematoma after surgery and another had a persistent umbilical discharge at follow-up, and required open excision of residual remnant tissue. CONCLUSIONS: The laparoscopic approach appears to be a safe and effective alternative to open surgery for this condition. Despite the slight risk of incomplete excision, the reduced morbidity of this procedure and better cosmetic result would appear advantageous.

Abdominal Pain↗

PubMed2003

[Herpes zoster as differential diagnosis of ureterolithiasis].

Patients with acute loin pain and microscopic hematuria may suffer from diseases rarely seen in the urological department. We describe a case where a patient with symptoms of a ureteral stone turned out to have herpes zoster. She was treated with aciclovir and recovered well without postherapetic sequelae.

Acute Disease↗

PubMed2003

Laparoscopic pelvic lymph node dissection allows significantly more accurate staging in "high-risk" prostate cancer compared to MRI or CT.

OBJECTIVE: To compare the accuracy of lymph node staging using pelvic MRI or CT to that of laparoscopic pelvic lymph node dissection (LPLND) in prostate cancer patients prior to radical radiotherapy. MATERIAL AND METHODS: A total of 55 consecutive patients at high risk of locally advanced disease [prostate-specific antigen (PSA) > 10 ng/ml, Gleason score 7 or worse on biopsy, normal (99m) Tc bone scan] underwent either a pelvic MRI (n = 42) or CT (n = 13) scan and subsequent LPLND. Preoperative staging was compared to the histology of the lymph node specimens obtained. RESULTS: A total of 20/55 (36.4%) patients had pelvic lymph node metastases confirmed by LPLND. MRI identified three patients (27.3%) with pelvic lymph node metastases and missed eight (72.7%) whilst CT identified none of nine patients with pelvic lymph node metastases. The groups with histologically-positive and -negative nodes had similar mean ages (63 vs 65 years; p = 0.52), Gleason scores (6.8 vs 6.5; p = 0.41) and PSA levels (43.1 vs 31.4 ng/ml; p = 0.56). CONCLUSION: The presence or absence of lymph node metastases has critical implications for the prognosis and treatment of prostate cancer. In this study both MRI and CT missed many cases of lymph node metastases in "high-risk" patients. While a positive scan seems likely to indicate nodal metastases, the low sensitivity in high-risk patients seems unacceptable if treatment decisions are to be based on accurate staging, and LPLND offers an alternative.

Aged↗