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Biomedical subjects

Murali K Ankem

Publications and source records attributed to Murali K Ankem.

13 recordsLinked to original sources
PubMed2006

Examination of laparoscopic retrieval bag washings for malignant cells after hand-assisted laparoscopic radical nephrectomy and intact specimen removal.

OBJECTIVES: Port site metastases after hand-assisted laparoscopic radical nephrectomy have been described in the literature. There is no uniform agreement among urologists regarding the use of a retrieval bag before intact specimen removal. The aim of this study was to determine whether LapSac renal extraction bag washings contain malignant cells. METHODS: We prospectively obtained washings from the LapSac retrieval bag after hand-assisted laparoscopic radical nephrectomy and intact specimen removal for renal cell carcinoma. In 30 consecutive cases, after removal of the kidney specimen from the LapSac, the LapSac was irrigated with 50 mL sterile Hank's balanced salt solution. These washings were sent for cytologic examination. Cytologic evaluation was performed with a Thin Prep and the Papanicolaou method. RESULTS: We performed 30 hand-assisted laparoscopic radical nephrectomies for suspected renal cell carcinoma with the above protocol. One specimen was benign and one showed transitional cell carcinoma; these were excluded from the study. Six specimens were stage T1a, 17 were T1b, 1 was T2, 2 were T3a, and 2 were T3b. Histopathology revealed 27 specimens with clear cell renal cell carcinomas with Fuhrman grades from 1 to 4; 1 specimen showed chromophobe renal cell carcinoma. Margins were negative in all cases, and there were no gross or microscopic tumor violations. The cytologic results from 27 cases were negative and in 1 case with T3b renal cell carcinoma the LapSac washings were positive for malignant cells. CONCLUSIONS: The preliminary findings from our study show that low-stage, low-grade tumors removed laparoscopically with minimal manipulation do not exfoliate cells into their LapSac retrieval bags.

Carcinoma, Renal Cell↗
PubMed2006

Magnetic resonance imaging findings after laparoscopic renal cryoablation.

OBJECTIVES: To assess the magnetic resonance imaging (MRI) appearance of renal masses after laparoscopic cryoablation. METHODS: Between October 2000 and June 2004, 33 patients underwent laparoscopic cryoablation of 34 renal masses, 24 of whom (25 renal masses, size range 1.5 to 3.7 cm, mean 2.4) were followed up with MRI postoperatively. Postoperative MRI was done at 1, 3, and 6 months after ablation and every 6 months thereafter using a 1.5-T MRI scanner. T1-weighted dual-phase, coronal T1-weighted fat-saturated, and T2-weighted coronal and axial MRI was done before contrast administration. Postenhancement images were obtained in the coronal and axial planes during the arterial, venous, and delayed phases. RESULTS: Patient follow-up data were available for at least 6 months and up to 48 months for 18 patients. On the first follow-up MRI study, six lesions had increased in size, five had decreased in size, and seven showed no change. Of the 18 patients, 7 had peripheral rim enhancement within 3 months of follow-up. Four resolved. One patient developed rim enhancement at 7 months postoperatively. Subsequent images revealed lesion enlargement with heterogeneous enhancement. Biopsy was positive for renal cell carcinoma. One patient developed nodular enhancement at 10 months with a decrease in lesion size. Watchful waiting was chosen because the patient had significant medical comorbidities. CONCLUSIONS: Peripheral rim enhancement is a common finding on MRI immediately after laparoscopic renal cryoablation. Rim enhancement with an increase in lesion size or nodular enhancement is of more concern than rim enhancement alone. More data are necessary to understand the progression of renal lesions after cryoablation.

Aged↗
PubMed2005

Third prize: Prostaglandin E(2)-3 receptor is involved in ureteral contractility in obstruction.

BACKGROUND AND PURPOSE: We previously found that prostaglandin (PG) E2 contracts acutely obstructed ureters while relaxing normal ureters. This study investigated the procontractile effects of the PG EP3 receptor in PGE(2)-mediated contractility in obstructed and normal porcine ureters. MATERIALS AND METHODS: We created unilateral ureteral obstruction laparoscopically using titanium clips in farm pigs; the contralateral ureters were dissected as sham controls. Ureters were harvested 48 hours post-obstruction, cut into 5-mm segments, and suspended in water-jacketed tissue baths in Krebs buffer. Tissues were equilibrated for 1 hour, and spontaneous contractile rates were recorded. After 2 hours of incubation in Krebs (controls) or pertussis toxin (G(alpha)i signaling-protein inhibitor [EP-3 blockade]) 500 ng/mL, a concentration- response curve (10(-9) M-10(-5) M) to PGE(2), PGF(2), sulprostone (EP 3 agonist), or 0.01% ethanol (vehicle) was created (N = 4). RESULTS: In the normal ureters, PGE(2) relaxed both pertussis toxin-treated and control tissues. In obstructed segments, PGE(2) increased contractions by 60%; this was reversed by pertussis toxin to a 67% reduction in contractile rate. In both obstructed and contralateral segments, sulprostone induced contractility in the controls; this was attenuated by pertussis toxin. The PGF(2) produced a contractile effect in both the controls and the pertussis toxin-treated segments, demonstrating the selectivity of pertussis toxin for EP3 receptors. CONCLUSION: Our data indicate that the EP3 receptor is involved in hypercontractility during ureteral obstruction. However, it may not be the sole factor behind the condition-dependent effect of PGE(2).

Animals↗
PubMed2004

Routine pouchograms are not necessary after continent urinary diversion.

OBJECTIVES: Pouchograms are routinely performed before catheter removal after continent urinary diversion at our institution. Our aim was to determine the necessity of pouchograms based on a review of our experience. METHODS: A retrospective review of patient records and radiographic studies was done for patients undergoing radical cystectomy and continent urinary diversions between 1991 and 2001. RESULTS: Seventy-two patients underwent continent urinary diversion (orthotopic, n = 59; cutaneous, n = 13) during the study period. All underwent pouchogram postoperatively (median 22 days; range 20 to 27). Six patients (8.3%) had a demonstrable radiographic leak; in 5 of the 6 patients, the urine leak was suspected on clinical grounds. Three patients (4.7%) developed urosepsis after pouchogram. CONCLUSIONS: Our findings indicate that routine pouchograms before pouch activation after continent urinary diversion may not be necessary.

Adult↗
PubMed2004

Clinical utility of dual active deflection flexible ureteroscope during upper tract ureteropyeloscopy.

OBJECTIVES: To evaluate the clinical utility of a dual active deflection ACMI DUR-8 Elite ureteroscope in a referral endourology practice. METHODS: Retrospective chart review was performed on 54 consecutive patients who underwent flexible ureteroscopy by a single surgeon (S.Y.N.) from February to July 2003. Cases in which standard flexible ureteroscopes alone could complete the procedure, cases in which standard flexible ureteroscopy could not complete the procedure and the DUR-8 Elite ureteroscope did, and cases in which both ureteroscopes failed to complete the procedure were analyzed. RESULTS: A total of 54 procedures were performed on 37 patients. Three cases were not analyzed because they were distal ureter procedures. Of the remaining 51 procedures, 6 were removed from analysis because they were second-look procedures. When classified by diagnosis, 27 patients had stones (79.4%), 5 had cancer (14.7%), and 1 had hematuria (2.9%). The global success rate was 91.1%. The average use rate of the DUR-8 was 28.9%, and the success rate using the DUR-8 Elite was 69.2% in those cases in which it was necessary. Of the 13 cases in which the DUR-8 was used, 61.5% were for lower pole pathologic findings. The DUR Elite use and success rate in the lower pole was 57.1% and 75%, respectively. A statistically significant association was found between the diagnosis and procedure location (P = 0.00128). CONCLUSIONS: Our preliminary data indicate that the dual deflecting DUR-8 Elite ureteroscope may be helpful in cases in which the single deflection flexible instruments fail to access and treat upper urinary tract pathologic findings.

Carcinoma, Transitional Cell↗
PubMed2003

The surgical treatment of labial adhesions in pre-pubertal girls.

STUDY OBJECTIVE: A review of our experience with the surgical treatment of labial adhesions refractory to medical treatment. DESIGN: Retrospective review. SETTING: University tertiary care hospital same-day surgery center. PARTICIPANTS: Nine prepubertal females, age 3-6 yrs, presenting with thick, symptomatic labial adhesions refractory to medical management. INTERVENTION: All patients underwent surgical lysis of labial adhesions under general anesthesia. Adhesions were incised sharply and the cut edges were reapproximated with 7-0 chromic suture by a pediatric urologist (JGB). MAIN OUTCOME MEASURES: Duration of recurrence-free follow-up. RESULTS: No patient had recurrence in an average of 8.6 months of follow-up. Surgery was well tolerated in all cases. CONCLUSION: This technique effectively treats and prevents the recurrence of moderate to severe labial adhesions that are unresponsive to medical therapy.

Administration, Topical↗
PubMed2003

Comparison of recovery from postoperative pain utilizing two sling techniques.

PURPOSE: Bone anchors are used for suture fixation in a wide variety of reconstructive surgeries. They have been in use for pelvic floor reconstruction since 1992. Bone anchors provide a stable point of suture fixation in order to avoid tying over the mobile rectus fascia. The purpose of this study was to compare two sling techniques that utilize bone anchors with respect to recovery from postoperative pain, complete continence, operative time, and length of hospital stay. MATERIALS AND METHODS: A total of 64 women (mean age = 57) were treated for stress urinary incontinence secondary to intrinsic sphincter deficiency or hypermobility between March 1998 to August 2000. Group I (SPWS) consisted of 30 patients who underwent insitu vaginal wall sling with suprapubic placement of bone anchors in the pubic tubercle utilizing the Vesica system. Group II (TVCS) consisted of 34 patients who underwent cadaveric fascia sling with transvaginal placement of bone anchors behind the symphysis pubis utilizing the Precision-TAC system. Phone interviews were conducted by a third party who was blinded to the details of the surgical technique, to assess pain at various postoperative times as well as current level of continence. The pain assessment was done using the Verbal Pain Assessment Scale (VAS). Complete continence was defined as dryness with no pad use. RESULTS: Significant differences were discovered in both days to pain free state and operative time. No other differences were detected in continence or length of hospital stay. Based on the VAS, a pain free state was achieved for the TVCS group in 1.33 days and for the SPWS group in 9.7 days with p=0.00043. Mean operative time for the SPWS group was 96.9 minutes for the sling alone and 106.7 minutes when combined with cystocele repair. Mean operative time for the TVCS group was 75.36 minutes for the sling alone and 98.11 minutes when combined with cystocele repair. No patient in either group developed osteomyelitis, osteitis pubis, removal of the bone anchors for any reason, nor sling erosion. Seventy percent and 83.3% patients were completely dry (mean follow-up 12.5 months, range 3-30 months) in the SPWS and TVCS group, respectively. CONCLUSION: A pain free state is achieved faster in patients undergoing transvaginal placement of bone anchors compared to bone anchors placed suprapubically. Bone anchors used in sling procedures are safe and achieve acceptable short term continence rates.

Adult↗
PubMed2003

Urinary ascites secondary to forniceal rupture in a child with the Prune Belly Syndrome.

Despite adequate bladder catheterization, a neonate with Prune Belly Syndrome developed urinary ascites secondary to forniceal rupture. Treatment consisted of bilateral cutaneous pyelostomies. Even though most children with Prune Belly Syndrome respond to lower urinary tract drainage, a cutaneous pyelostomy may be necessary when the ureters are tortuous and do not drain adequately following bladder decompression.

Ascites↗
PubMed2002

Novel assay for determining DNA organization in human spermatozoa: implications for male factor infertility.

OBJECTIVES: To present a novel assay for determining DNA organization in fertile human spermatozoa and establish morphometric parameters for these samples. The three-dimensional organization of DNA within a cell nucleus is intimately related to cellular function. For example, it has recently been demonstrated that normal sperm DNA organization may be necessary for successful in vitro fertilization in the mouse. METHODS: Semen from 12 fertile volunteers was tested for sperm DNA organization using our nuclear matrix stability assay. Sperm DNA then underwent computerized digital image analysis and standards of normal were established. RESULTS: Sperm DNA organization was constant in all samples tested. Normal parameters established included mean nuclear matrix diameter (9.17 +/- 1.59 microm), mean DNA halo diameter (20.56 +/- 2.53 microm), mean halo area (66.88 +/- 7.92 microm(2)), and mean nuclear matrix area (32.98 +/- 4.3 microm(2)). CONCLUSIONS: This assay may be used to determine DNA organization in a semen sample. Defining sperm DNA organization may be important clinically, because normal DNA organization is necessary for normal cellular function.

Adult↗
PubMed2002

Implications of radioactive seed migration to the lungs after prostate brachytherapy.

OBJECTIVES: To review the incidence and the impact of pulmonary seed migration after prostate brachytherapy on lung function. Isolated reports of seed migration to the lungs after prostate brachytherapy have been published; however, the clinical consequences of this pulmonary migration have not been adequately evaluated. METHODS: We performed a retrospective review of patients undergoing prostate brachytherapy from 1998 to 2000. Pulmonary imaging with chest x-ray was performed 15 to 90 days (median 45) after the procedure. The chest radiographs were reviewed by a single radiologist (V.S.D.), and patients with seed migration to the lungs were evaluated by a single pulmonologist (A.M.H.) using a questionnaire, chest radiography, and pulmonary function tests. Computed tomography of the prostate after seed implantation was performed to check seed position and dosimetry. Odds ratio, confidence intervals, chi-square tests, and logistic regression analysis were performed to evaluate the relationship between the type and number of seeds used, the incidence of pulmonary migration, and the effects on pulmonary function. RESULTS: A total of 83 patients underwent prostate brachytherapy during the study period and 58 patients underwent chest radiography. Seed migration occurred in 21 (36.2%) of 58 patients (95% confidence interval 23.8% to 48.6%). Thirty-four (0.71%) of 4755 seeds used migrated to the lungs. Nine patients had single seed migration to the right lung and three to the left lung. Nine patients had multiple (maximum of 4) and bilateral seed migration. No consistent relationship was found between seed migration and the type of seeds used (P = 0.24). Borderline statistical significance suggested an increased incidence of seed migration with an increasing number of implanted seeds (P = 0.054). Repeat chest radiography in 21 patients revealed no delayed migration at a median follow-up of 16 months. Clinical and pulmonary function testing revealed no consistent abnormality attributable to seed migration. CONCLUSIONS: Radioactive seed migration occurred in 36.2% of brachytherapy patients who had chest radiographs done in our series. Pulmonary seed migration may be influenced by the number of implanted seeds and does not appear to be influenced by the seed type. Additional study of this observed phenomenon is required. A thorough pulmonary workup failed to reveal any short-term harmful side effects; however, long-term follow-up is needed. Healthcare providers should discuss the possibility of pulmonary seed migration with patients with prostate cancer considering prostate brachytherapy.

Brachytherapy↗
PubMed2002

Management of urethral catheter knot in a neonate.

To accommodate the small size of the infant urethra, finer, more flexible tubes are often used for urinary catheterization in the pediatric intensive care units. These tubes have the ability to knot in the bladder, occasionally requiring surgical removal. The mechanism of knotting appears to result from excessive intravesical catheter coiling, and as the bladder decompresses the catheter tip can migrate through a coil thereby creating a knot. Review of the literature from 1975 to 2000 identified 19 cases of urethral catheter knotting in the pediatric bladder with two reports of prostatic urethral involvement. Herein, we describe the first reported instance of catheter knotting within the penile urethra and describe the surgical technique employed for its removal.

Catheters, Indwelling↗