Biomedical subjects

M Grasso

Publications and source records attributed to M Grasso.

At least 109 records · Page 6Linked to original sources

PubMed1996

Human cytomegalovirus early infection, acute rejection, and major histocompatibility class II expression in transplanted lung. Molecular, immunocytochemical, and histopathologic investigations.

The present study aimed to investigate the relationship between acute rejection and human cytomegalovirus (HCMV) infection, as well as the coexpression of HLA-DR and immediate-early (IE) viral antigens, in 143 transbronchial biopsies and bronchoalveolar lavage fluids of 32 lung transplant recipients. We investigated the occurrence of morphologically overt viral infection with conventional histopathology, the expression of IE antigens with single labeling immunohistochemistry, the coexpression of IE antigens and HLA-DR molecules with double labeling techniques, and the presence of viral IE genes with polymerase chain reaction. Histopathologic study showed overt viral infections (12.6%) in 18 of the 143 biopsies; 8 were in a context of pneumonia and 10 were localizations without surrounding inflammatory cells; immunohistochemistry showed IE viral antigen expression in 31 (21.67%); PCR detected viral IE genes in 73/143 lavage fluids and biopsies (51%). The double labeling immunohistochemical technique showed that most IE antigen-expressing, noncytopathic cells were either HLA-DR negative in areas without infiltrates, or HLA-DR positive in those areas where inflammatory infiltrates were consistent, in the absence of viral cytopathy, with acute rejection. The results indicate that, in transplanted lung, the frequency of morphologically occult HCMV infection (as detected by immunohistochemically and/or PCR) is much higher than that of morphologically overt viral infection. The occurrence of inflammatory infiltrates (consistent with acute rejection) around morphologically occult infected cells and the possible lack of inflammation around both early- and late-infected cells suggest that in biopsies with occult infection the infiltrates should be attributed to allograft reaction. This conclusion would be in keeping with the coexpression of HLA-DR and HCMV IE in infiltrate-rich biopsies that are consistent with acute rejection, as well as with the absence of HLA-DR expression in IE antigen-positive cells in infiltrate-free-areas.

Acute Disease↗

PubMed1996

Muscle relaxation in Parkinson's disease: a reaction time study.

We tested the hypothesis that the relaxation reaction time in Parkinson's disease (PD) is delayed, as a sign of disorder in the control of voluntary motoneuron derecruitment. We compared, in the triceps brachii muscle, the reaction times (RTs) of the onset (O-RT) of electromyographic (EMG) activity during initiation of a contraction with the RTs of the termination of EMG tonic activity during full relaxation (R-RTs). Fourteen patients with idiopathic PD and 10 normal controls were examined. Mean R-RTs for all controls were 30 ms shorter than mean O-RTs. Mean R-RTs for all patients were approximately 70 ms longer than mean O-RTs. In two untreated patients levodopa therapy improved both O-RT and R-RT, but the difference between the two was unchanged. There was no correlation between EMG level and R-RT or between peak force and O-RT in either controls or patients. O-RT and R-RT were correlated with the bradykinesia score. In some patients, bursts of late activity were recorded after the R-RT; the duration of this activity was correlated with the duration and staging of the disease and with bradykinesia and rigidity scores. The reversed latency of onset and termination of muscle contraction in PD suggests an abnormality in the inhibitory spinal mechanisms, possibly stemming from a defect in the pathways descending to the spinal cord.

Aged↗

PubMed1996

Unilateral displacement of lower limb evokes bilateral EMG responses in leg and foot muscles in standing humans.

During upright stance, foot dorsiflexion induced by the movement of a supporting platform elicits a short- (SLR) and a medium-latency response (MLR) in both the soleus and the flexor digitorum brevis muscles; foot plantarflexion elicits a MLR in the tibialis anterior. The SLR is the counterpart of the stretch reflex, but no general agreement exists about the origin of the MLR, though recent results suggest that it is transmitted through group II afferent fibres. Animal studies have shown that group II fibres impinge on interneurones projecting contralaterally as well as ipsilaterally, whereas group I fibres impinge on interneurones which project mainly ipsilaterally. Therefore, we compared the changes in amplitude and latency of the SLRs and MLRs in the right and left limb during postural perturbations induced while subjects maintained both feet on the platform (both-on condition) or while they maintained only one foot on the platform and the other on firm ground (one-on condition). Under the both-on condition, the pattern of EMG responses described above occurred bilaterally. Under the one-on condition, both SLRs and MLRs occurred in the displaced leg. However, whereas the SLRs did not change in amplitude compared with the both-on condition, the MLRs decreased in amplitude to about 50%. MLRs were also present in the non-displaced leg. They were not preceded by any SLR but showed a further decrease in size with respect to the corresponding responses in the perturbed leg. Latency of the MLRs of the perturbed leg increased by about 5 ms passing from the both-on to the one-on condition. In the latter condition, a further increase of 5 ms was observed in the nonperturbed leg with respect to the displaced one. The occurrence of the MLRs but not of the SLRs in the contralateral non-displaced leg is in keeping with the notion that crossed neural pathways fed by spindle group II afferent fibres subserve the MLRs. The changes in latency of the MLRs under the one-on condition compared with both-on give a cue about the synaptic delays along the neural circuit and the time taken by the afferent impulses to cross the spinal cord.

Adult↗

PubMed1996

Experience with the holmium laser as an endoscopic lithotrite.

OBJECTIVES: To study, in a clinical series, the safety and efficacy of holmium laser energy applied as an endoscopic lithotrite. METHODS: Over a 2-year period, patients with urinary tract calculi were treated endoscopically with the holmium laser lithotripter, and data were gathered prospectively. Holmium lasers with maximum outputs of 15, 25, and 60 W were used. Various low water density, quartz fiber delivery systems were developed for specific applications. In addition, various combinations of endoscopes and laser fibers were employed. RESULTS: A total of 63 patients with 75 calculi were treated. All calculi were cleared endoscopically. Minimal variation in laser efficiency was noted with different stone compositions, including cystine. Thirty-three of 34 ureteral calculi were treated to completion in one sitting (97%). Twenty-nine renal stone burdens were treated with the holmium laser, 26 of which were treated solely in a retrograde fashion. Of the latter, 23 (88.5%) required only a single sitting. Complications from holmium laser energy, including ureteral stricture disease, were not encountered in this series. Patients with complex, large stone burdens were treated to completion without sequelae. The combination of the actively deflectable, flexible ureteroscope and 200-microns fiber facilitated clearance of 18 lower-pole caliceal calculi. Three patients with partial staghorn stone burdens averaging 30 mm in diameter were treated ureteroscopically. Chronic urinary infections that were problematic preoperatively completely resolved after therapy. All 12 patients who had large bladder calculi with a mean diameter of 55.8 mm were treated to completion in one sitting. CONCLUSIONS: Holmium laser energy is uniquely suited to treat all urinary calculi safely and effectively.

Adolescent↗

PubMed1996

Laparoscopic complications in markedly obese urologic patients (a multi-institutional review)

OBJECTIVES: Significant obesity is considered to be a relative contraindication to laparoscopic surgery. This study reviews the complications encountered in massively obese patients undergoing urologic laparoscopic surgery. METHODS: Body mass index (BMI) was used as an objective index to indicate massive obesity. Eleven institutions compiled retrospective data on 125 patients having a BMI greater than 30. Procedures performed included 76 pelvic lymph node dissections, 14 nephrectomies, 7 bladder neck suspensions, and 28 miscellaneous procedures. RESULTS: For the group as a whole, the mean BMI was 35.1 (range 30.1 to 57.2). Mean operative time was 202 minutes (range 60 to 480). Conversion to open surgery occurred in 15 of the 125 patients (12%). Complication rates (minor and major) were 22% (27 occurrences in 125 patients) intraoperatively and 26% (33 occurrences in 125 patients) postoperatively. The major complications included 2 trocar injuries to abdominal wall vessels, 1 bladder injury, 3 peripheral nerve injuries, 1 dysrhythmia, 1 deep vein thrombosis, 1 wound seroma, 1 nephrocutaneous fistula, 1 incisional hernia, and 1 death. CONCLUSIONS: In this review, complication rates for urologic laparoscopic surgery on massively obese patients were higher than in the general population undergoing laparoscopic surgery (0.3% to 21%).

Adolescent↗

PubMed1996

Combined molecular and cytogenetic analysis for the rapid diagnosis of fragile X syndrome.

The fragile X mutation is the result of an abnormal expansion of a CGG repeat sequence in the FMR-1 gene. Molecular techniques enable the detection of the mutation and also of the exact length of this DNA sequence, allowing the classification of the tested subjects as normal, carrier or affected. We propose a protocol of analysis that combines a method of non-radioactive PCR, Southern blotting and cytogenetic testing. This protocol can be used for screening programme of selected groups of mentally retarded individuals and for prevention studies in families at risk.

Blotting, Southern↗

PubMed1996

Polymorphism of angiotensin-converting enzyme gene in sarcoidosis.

Sarcoidosis is the disease in which increased levels of serum Angiotensin-converting enzyme (sACE) are most often detected. It has recently been shown that the deletion (D) or the insertion (I) of a 250bp-DNA fragment in the ACE gene accounts for three main ACE genotypes (i.e., II, ID, and DD) and for 47% of total phenotypic variance in sACE level. The aim of our work was to investigate whether or not patients with sarcoidosis have an increased incidence of those ACE genotypes coding for highest sACE levels and to investigate whether or not sACE level in sarcoidosis is related to ACE genotypes. We studied 61 unrelated patients with sarcoidosis (test group) and 80 unrelated healthy control subjects (control group). The ACE I and D alleles were detected with polymerase chain reaction on genomic DNA. In the control group we found an ACE genotype distribution that agreed with the Hardy-Weinberg proportion. The ACE genotype distribution was not significantly different in the test group. There was no correlation between ACE genotype and roentgenologic stage of sarcoidosis. Plotting the sACE level in the control group against ACE genotype, we found a trend of increasing mean sACE value according to the order II < ID < DD. The same trend for ACE genotype was found in the test group, in which it also paralleled the trend of sACE values plotted against roentgenologic stage, according to the order Stage I < Stage II < Stage III. We conclude that in sarcoidosis the ACE genotype distribution is not altered. The trends for increasing sACE values in sarcoidosis according to both ACE genotype and roentgenologic stage would suggest that both mechanisms play a role in determining sACE level.

Adult↗

PubMed1995

Selective depression of medium-latency leg and foot muscle responses to stretch by an alpha 2-agonist in humans.

1. In standing humans, toe-up rotation of a platform induces a short-latency (SLR) and a medium-latency response (MLR) in both soleus (Sol) and flexor digitorum brevis (FDB) muscles. Toe-down rotation evokes a MLR in the tibialis anterior (TA). The SLR is the counterpart of the monosynaptic stretch reflex, but the origin of the MLR is still debated. By means of tizanidine (an alpha 2-adrenergic receptor agonist) we tested the hypothesis that the MLR is relayed by group II afferent fibres, since animal data indicate that tizanidine or stimulation of monoaminergic brainstem centres decrease the excitability of spinal interneurones supplied by those fibres. In addition, we compared the effect of the drug on these responses with that induced by stabilization of posture. 2. Eight subjects received tizanidine (150 micrograms kg-1 orally) or placebo, in a single-blind design. Platform rotations were delivered prior to administration and for 3 h afterwards. Both TA- and FDB-MLRs decreased in size, starting from about 1 h after tizanidine administration. Sol-SLR was unaffected. Response latencies were unchanged. Placebo induced no changes in any response. In each subject, the extent of TA-MLR depression induced by holding onto a frame and by tizanidine was superimposable. 3. The selective effect of tizanidine on MLR supports the notion that it is relayed through group II afferent fibres. The similar effects of holding and tizanidine on the response suggests that it is modulated by monoaminergic centres.

Adrenergic alpha-Agonists↗

PubMed1995

Comparison of coronary lesions obtained by directional coronary atherectomy in unstable angina, stable angina, and restenosis after either atherectomy or angioplasty.

The present study investigated the incidence of the histopathologic lesions and of growth factor expression in a consecutive series of directional coronary atherectomy (DCA) samples from 40 unstable angina pectoris patients without prior acute myocardial infarction and compared the findings with those obtained in DCA samples from 18 patients with stable angina without previous infarction and 18 patients with restenosis. We investigated coronary thrombosis, neointimal hyperplasia, and inflammation. For unstable angina, we correlated the angiographic Ambrose plaque subtypes with the histopathologic findings. The immunophenotype of plaque cells and the growth factor expression were assessed with specific antibodies for cell characterization and for the expression of basic fibroblast and platelet-derived AA and AB growth factors and receptors. The incidence of coronary thrombosis was 35% in patients with unstable angina, 17% in those with stable angina, and 11% in patients with restenosis. Neointimal hyperplasia was found in 38% of unstable angina cases, in 17% of stable angina cases, and in 83% of restenosis cases. Inflammation without thrombus or accelerated progression occurred in 20% of unstable angina and 6% of stable angina samples. In 52% of unstable angina cases, inflammation coexisted with thrombosis and/or neointimal hyperplasia. In the unstable angina group, 71% of the plaques with thrombus had a corresponding angiographic pattern of complicated lesions. The growth factor expression, reported as percentage of cells immunostaining with different growth factor antibodies, was highest in restenosis, followed by unstable angina and stable angina lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Leber's hereditary optic neuropathy (LHON)-related mitochondrial DNA sequence changes in italian patients presenting with sporadic bilateral optic neuritis.

Eighteen Italian patients presenting with sporadic, bilateral, simultaneous, or sequential optic neuritis (ON) were evaluated for 14 base changes in mitochondrial DNA (mtDNA) previously found associated with Leber's hereditary optic neuropathy (LHON), aiming to identify at a molecular level LHON cases with nontypical phenotypes. During a 36-month follow-up, 11 ON patients developed clinical or laboratory features allowing diagnosis of clinically definite multiple sclerosis (MS). None was positive for any of the "primary" LHON-associated mutations. However, single or multiple "secondary" LHON-associated sequence changes at 4216/ND1, 4917/ND2, and 13708/ND5 were detected in ON and ON-MS patients. MS controls without visual failure as well as healthy control subjects harbored the same base changes at similar frequencies. In addition, coexistence of three sequence changes was found in two cases (1 ON-MS patient and 1 MS control patient). We also report finding two new neutral sequence base changes in the ND-4 gene which were identified by SSCP and confirmed by automated DNA sequence analysis. The results suggests that these secondary mutations do not contribute to MS susceptibility in these patients, but rather represent neutral mitochondrial DNA polymorphisms. In addition, whether there are biochemical abnormalities related to single and multiple secondary mtDNA sequence changes remain to be demonstrated.

Adult↗

PubMed1995

Early and late stretch responses of human foot muscles induced by perturbation of stance.

In eight subjects standing on a movable platform, surface EMG activity was recorded from the foot muscles extensor digitorum brevis (EDB) and flexor digitorum brevis (FDB) and from the leg muscles soleus (Sol) and tibialis anterior (TA) during perturbations of upright stance. Perturbations inducing foot dorsiflexion (upward tilt and backward translation) evoked a short-latency response (SLR) and a medium-latency response (MLR) to stretch in the physiological extensors FDB and Sol, and a long-latency response (LLR) in the physiological flexors EDB and TA. Perturbations inducing plantar-flexion (downward tilt and forward translation) evoked the MLR in EDB and TA, and the LLR in FDB and Sol. The latency of the FDB and Sol SLR was compared to that of the H and T reflexes evoked in the same muscles by electrical or mechanical stimulation, respectively. In both muscles, the T reflex and the SLR followed the H reflex at delays accounted for by the different stimulation mode, indicating that the SLR induced in both muscles by upward tilt and backward translation was a true autogenetic stretch reflex from spindle primaries. The time interval between the onset of SLR and of MLR was significantly greater for the FDB than the Sol muscle, suggesting that MLR is a spinal reflex travelling through slower peripheral afferent pathways than SLR. From these latency differences and from the distance between the muscles, we calculated in four subjects the conduction velocity of the afferent fibres presumably responsible for the MLR in FDB. This was about 29 m/s. LLRs were evoked in TA and EDB during upward tilt and backward translation, and in Sol and FDB during downward tilt, but not forward translation. LLRs did not adhere to a proximal-to-distal pattern, since these could appear earlier in the foot than in the leg muscles. All responses were modulated by perturbation type (tilt vs translation) and body posture (normal stance vs forward leaning). Both the large amplitude of the foot muscle responses and their temporal pattern indicate that the muscles acting on the toes play a major role in stabilising posture. Their action increases in amplitude and extends in time the foot-ground reaction force, thereby improving the efficiency of the superimposed action of the leg muscle responses.

Adult↗

PubMed1995

Cardiac immunocyte-derived (AL) amyloidosis: an endomyocardial biopsy study in 11 patients.

The objective of this study was to investigate the spectrum of morphologic features in myocardial biopsy specimens from patients with cardiac immunocyte-derived (AL) amyloidosis. Cardiac involvement is the most important predictor of survival in AL amyloidosis. Myocardial biopsy remains the method of choice for diagnosing cardiac amyloidosis when noninvasive studies give equivocal results. Histologic, immunohistochemical, ultrastructural, and morphometric studies were made on myocardial biopsy specimens from 11 patients in whom the diagnosis of AL amyloidosis was based on the demonstration of a monoclonal immunoglobulinopathy and of amyloid deposits in tissues. Histopathologic study showed amyloid in 10 of the 11 biopsies. In one biopsy (Congo red negative), the diagnosis was made by ultrastructural identification of amyloid fibrils. In all patients, the deposits formed perimyocytic layers that measured up to 18 microns in thickness. These layers formed along the basement membranes, which were partially preserved in 5 patients and unrecognizable in 6. Interstitial nodular deposits were also present in 5 patients. Immunohistochemical studies for the characterization of the proteins in the amyloid deposits were diagnostic in 1 patient and confirmatory in 10. Nodular deposits, thick perimyocytic layers of amyloid and small myocyte diameters were associated with shorter survival of the patients. Small-vessel involvement and myofilament loss occurred in all patients. In conclusion, myocardial biopsy serves to (1) establish the diagnosis of cardiac amyloidosis; (2) characterize immunohistochemically the proteins in the amyloid fibrils and (3) assess the degree of myocyte damage and atrophy.

Adult↗

PubMed1995

Influence of aging on leg muscle reflex responses to stance perturbation.

The effect of age on latency and amplitude of leg muscle responses to stance perturbations was studied in 75 control subjects. They stood upright on a platform and were displaced by toe-up (upward tilt) and toe-down (downward tilt) platform rotations. Perturbations were induced during free and supported stance (holding on to a stable structure). Surface electromyograms (EMG) of the soleus (Sol) and tibialis anterior (TA) were recorded and latency and area of responses were measured. Body sway variables during stance with open or closed eyes were also recorded. Upward tilt evoked a short-latency response (SLR) in Sol and a long-latency response (LLR) in TA. Downward tilt evoked a medium-latency response (MLR) in TA and a LLR in Sol. This pattern of EMG responses was similar in both young and elderly subjects, although there were some differences in latency and amplitude. There was a significant relationship between latency of all responses and age. Slope of the regression lines of TA LLR, TA MLR, and Sol LLR was steeper than that of Sol SLR. Area of Sol SLR was unrelated to age, but a positive trend was identified in the other responses, significant for TA LLR. Under supported-stance condition, amplitude of TA MLR, TA LLR, and Sol LLR was decreased to a similar extent in both young and elderly subjects. There was a weak relationship between age and most body sway variables. A significant relationship was found between most sway variables and latency of Sol SLR and LLR, chiefly with eyes closed. Neither TA MLR nor LLR were significantly correlated with sway variables, but a trend was present for TA MLR with eyes closed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

Bilateral varicocele: impact of right spermatic vein ligation on fertility.

The most frequent cause of male infertility is left varicocele. The surgical or laparoscopic approach for spermatic vein ligation is considered the best method of treatment. The approach to a clinically significant left varicocele associated with a right varicocele (frequently of a smaller size) is not univocal. We analyzed the seminal responses obtained in 65 patients with bilateral varicocele (grades 2 to 3 on the left side and grade 1 on the right side) assigned randomly to undergo unilateral or bilateral ligation. There were no significant differences between the 2 groups with regard to seminal recovery.

Humans↗

PubMed1995

Submucosal calculi: endoscopic and intraluminal sonographic diagnosis and treatment options.

After shock wave lithotripsy and endoscopic lithotripsy, occasionally a patient has persistent ureteral fragments associated with ureteral obstruction. After lithotripsy, stone fragments may be embedded in the ureteral mucosa, and they may become completely submucosal and associated with obstruction. Others may be hidden in iatrogenic ureteral outpouchings, while still others may be extruded from the ureter entirely. We present 20 patients who were referred after previous treatment failed to clear fragments or who had residual obstruction. The majority of patients had failed endoscopic fragment retrieval or shock wave lithotripsy and were referred with ureteral obstruction. All patients were reevaluated by repeated upper tract endoscopy with small diameter endoscopes. As an adjunct to ureteral endoscopy, a 6F, 20 MHz. ultrasound probe was placed transureterally to determine the depth and location of stones. A total of 15 patients in this series had hyperechoic foci with shadowing consistent with submucosal or periureteral stone fragments. A decision for treatment was based upon the location as noted by sonographic and fluoroscopic visualization of intramucosal and submucosal fragments. Calculi more than 4 mm. from the lumen were not removed without evidence of obstruction. Multiple, small (speckled) fragments embedded in the mucosa were often associated with subsequent stricture. Solitary fragments within the wall of the ureter could be removed with relief of obstruction. The risk of embedding calculi submucosally during lithotripsy should be recognized. Submucosal fragments causing obstruction should be removed endoscopically. Totally extruded calculi may be left in situ safely.

Adolescent↗

PubMed1995

The case for primary endoscopic management of upper urinary tract calculi: I. A critical review of 121 extracorporeal shock-wave lithotripsy failures.

OBJECTIVES: To define those patients with upper urinary tract calculi who are more likely to have an unsuccessful outcome from extracorporeal shock-wave lithotripsy (ESWL). METHODS: A critical prospective analysis of 121 patients, referred to two university centers after ESWL had been exhausted as a treatment modality for upper urinary tract calculi, was performed. Patients were subdivided into the following groups: failure to clear fragments, failure to fragment, difficulty in calculus localization, and failure due to inherent upper urinary tract obstruction. Other important variables include the type of extracorporeal lithotriptor used, number of treatment sittings before referral, calculus location, calculus composition, patient body habitus, and the imaging leading to and associated with extracorporeal therapy. RESULTS: Large renal calculi (mean, 22.2 mm) and those within dependent or obstructed portions of the collecting system were frequently referred for endoscopic management after failed ESWL. Steinstrasse can be an extremely morbid complication from ESWL and in this series was associated with irreversible loss of renal function and ureteral stricture disease. Extracorporeal lithotripsy of infectious calculi can be associated with severe septic complication. Inadequate preoperative and intraoperative imaging and morbid obesity were also associated with failure. Second- and third-generation lithotriptors were represented in greater numbers than the Dornier HM-3 in this group of ESWL failures. CONCLUSIONS: ESWL remains the treatment of choice for moderately sized, uncomplicated renal calculi. Large calculi, those within obstructed or dependent portions of the collecting system, and those composed of calcium oxalate monohydrate, frequently fail ESWL. Training in the more technically challenging aspects of endoscopic lithotripsy must be encouraged.

Adolescent↗

PubMed1995

The case for primary endoscopic management of upper urinary tract calculi: II. Cost and outcome assessment of 112 primary ureteral calculi.

OBJECTIVES: To compare extracorporeal shock-wave lithotripsy (ESWL) with endoscopic lithotripsy to establish the more efficacious and cost-effective treatment for ureteral calculi. METHODS: The records of 112 patients with primary ureteral calculi treated at one center with either ESWL or endoscopic lithotripsy were retrospectively reviewed. Follow-up data at 1 and 3 months were obtained in all patients. Success was defined as complete clearance of a stone burden in the endoscopy group. In the ESWL group patients with a residual, asymptomatic 2-mm fragment were also considered successful treatments. The number of auxiliary procedures, retreatments, postoperative office visits, and imaging studies required before a patient was considered stone free was defined. The impact of these variables on global costs was carefully reviewed. RESULTS: Patients with ureteral calculi primarily treated with ESWL or ureteroscopic lithotripsy had stone-free rates after a single session of 45% versus 95% at 1-month follow-up, and 62% versus 97% at 3-month follow-up. Retreatment and auxiliary procedure rates were significantly higher in the ESWL group (31% versus 3%). The mean number of postoperative visits and imaging studies until a patient was stone free was also higher in the ESWL group (2.07 versus 1.13). Operative treatment costs were similar for both modalities, but overall costs weighed heavily against ESWL. CONCLUSIONS: ESWL remains the treatment of choice for moderately sized, uncomplicated renal calculi. In skilled hands, ureteroscopic lithotripsy is by far the most expeditious and cost-effective means of clearing a ureteral stone burden.

Costs and Cost Analysis↗

PubMed1995

Laparoscopic cutaneous ureterostomy: technique for palliative upper urinary tract drainage.

Extensive pelvic carcinomatosis often results in bilateral ureteral obstruction and renal parenchymal loss. Percutaneous nephrostomies can be used for palliative means but may be poorly tolerated. Laparoscopic techniques can be applied to obtain a more permanent urinary diversion. An elderly gentleman with extensive pelvic transitional cell carcinoma of the bladder and only one functioning renal unit underwent percutaneous nephrostomy tube placement in combination with palliative cytoreductive radiation therapy. Poor patient tolerance led to repetitive nephrostomy tube replacement. A cutaneous ureterostomy was chosen as a more permanent urinary diversion, and laparoscopic techniques allowed this to be accomplished expeditiously. At 18 months postoperatively, the patient's unstented cutaneous ureterostomy is functioning well, and the serum creatinine concentration remains normal.

Carcinoma, Transitional Cell↗