Renal-sparing surgery for renal and transitional cell carcinoma.
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Carcinoma, Renal Cell↗
Biomedical subjects
R K Lawson
Publications and source records attributed to R K Lawson.
Chromosomal defects in renal cell carcinoma.
Numerous chromosomal defects have been identified in hereditary and sporadic renal cell carcinoma (RCC) tumor cells. Current data indicate that visible, and/or submicroscopic lesions on the 3p are fundamental to RCC development; other chromosomal abnormalities are identified less frequently and may be secondarily involved in RCC production in some cases. Oncogenesis may be initiated via inactivation of suppressor allele pairs, or through activation of oncogenes via translocation to areas of increased gene expression, migration to a chromosomal breakpoint, or gene amplification.
Carcinoma, Renal Cell↗
Color Doppler ultrasonography in the evaluation of the acute scrotum.
Color Doppler ultrasonography was used to assess 20 patients with the acute onset of scrotal pain. Patients were categorized into 3 groups according to the initial clinical impression of the examining physician: ischemia, inflammation or trauma. Color Doppler ultrasonography correctly predicted the need for surgery in 8 of 9 operated patients (89%) and correctly predicted the outcome in all 11 nonoperated patients (100%). The anatomical resolution possible, as well as information regarding blood flow made color Doppler ultrasonography a useful tool in the assessment of acute scrotal processes.
Acute Disease↗
Color Doppler sonography in the evaluation of the adult acute scrotum.
Color Doppler sonography (CDS) was used to evaluate 35 adult males with acute scrotal discomfort. Correlative nuclear scintigraphy was performed in 15 patients. Surgical correlation was available in 10 patients with clinical follow-up in the remaining 25. The complete absence of intratesticular color flow was used as our criterion for testicular ischemia. This was found to be 100% sensitive and 100% specific in 8 patients with surgically confirmed testicular ischemia. Spontaneous detorsion was noted in one patient with hyperemia demonstrated by color imaging. Increased color flow was found in 20 patients with the clinical impression of scrotal inflammation. Nuclear scintigraphy and color Doppler imaging had 100% agreement in 15 patients. Color Doppler sonography is a useful and highly accurate diagnostic method in the evaluation of patients with the acute scrotal syndrome. Color flow imaging is comparable to nuclear scintigraphy in the diagnosis of testicular ischemia.
Acute Disease↗
Chronic effects of focused electrohydraulic shock waves on renal function and hypertension.
The chronic effects of focused electrohydraulic shock waves were studied in a minipig model. Fifteen animals underwent a unilateral nephrectomy and compensatory renal hypertrophy was allowed to take place over a minimum of six months. Baseline studies were then carried out consisting of 1) serum creatinine, blood urea nitrogen, and plasma renin levels 2) intra-arterial blood pressure measurement and 3) 3H-inulin clearance. Ten of the animals then underwent 8 shockwave treatments (2500 shocks per treatment), alternately to the upper and lower pole of the kidney, at two weeks intervals. A total of 20,000 shock waves were administered to each minipig over the four month period. The five control pigs underwent sham procedures. The renal function and blood pressure evaluations were then repeated. No significant decrease in renal function was noted in the experimental animals when compared to the controls. In addition, renin mediated hypertension was not observed despite the excessive number of total shock waves delivered to the kidney.
Animals↗
Development and testing of second generation extracorporeal shock-wave lithotriptor.
The Northgate SD-3 extracorporeal shock-wave lithotriptor is a second generation device that utilizes an ultrasound-guided computer-assisted system for calculus localization. Focused electrohydraulic shock waves are generated in a movable membrane-covered ellipsoidal reflector. Pressure wave characteristics and energy output of the SD-3 and the Dornier HM-3 were tested and found to be comparable. The ultrasound unit was capable of identifying radiolucent calculi as well as calculus fragments 2-3 mm in size. The computer-assisted aiming system was found to be accurate to within 1 mm. The overall successful calculus fragmentation rate using an animal model was 80 percent with an 87.5 percent rate following machine modifications resulting in increased energy output.
Animals↗
Benign prostatic hyperplasia and growth factors.
A great deal of work has been accomplished in the attempt to determine the cause of benign prostatic hyperplasia (BPH). Early work by morphologists suggests that BPH starts as a stromal disease and that the hyperplastic stroma secretes a substance that stimulates the growth of epithelial cells. The quantitative morphometric data also suggest that BPH is primarily a stromal disease. Experimental embryology data have shown that the basic fibroblast growth factor, bFGF, is involved in early embryogenesis and is the primary inducer of mesodermal tissue. Work in mouse embryos has shown that a powerful inducer for prostatic epithelial growth is elaborated by the urogenital mesenchyme. Both of these findings fit the hypothesis that stromal hyperplasia may be initiated by a growth factor and that a second growth factor stimulates epithelial growth. Work in our laboratory has established that bFGF is the primary growth factor present in human BPH. We have also found that bFGF is synthesized by prostate fibroblasts and bFGF may be in higher concentration in the periurethral tissues of BPH. At this time, no definite link between growth factors and hyperplastic growth of the prostate has been established. However, circumstantial evidence has lead us to formulate several hypothesis regarding the role of growth factors in BPH. Hopefully, these hypothesis will be of some assistance in guiding future work on growth factors and BPH.
Fibroblast Growth Factors↗
Renal transplantation in a child with primary oxalosis.
Primary hyperoxaluria (oxalosis) is an autosomal recessive disorder due to an inherited deficiency of the peroxisomal alanine:glyoxylate aminotransferase characterized by increased production and urinary excretion of oxalate and glycolate resulting in renal failure due to oxalate deposition. Because of the risk of continuing oxalate deposition in the transplanted kidney, oxalosis had been considered a contraindication for transplantation. A 5-year-old boy with oxalosis, maintained on peritoneal dialysis, received a haploidentical qiving-related transplant. The preoperative management included donor-specific transfusions and daily hemodialysis to remove a maximum amount of oxalate. The immunosuppression consisted of azathioprine and prednisone. Aggressive fluid management including noncalciuric diuretics (hydrochlorothiazide) kept urine output high. Pyridoxine, magnesium, neutral phosphate and sodium benzoate were used to prevent deposition of oxalate in the transplanted kidney. Two acute rejection episodes responded to steroid boluses. A kidney biopsy during the second rejection episode confirmed the diagnosis but also revealed oxalate deposits in the transplanted kidney. More than 4 years after transplantation, the patient has catch-up growth and his serum creatinine is 1.4 mg/dl. In conclusion, oxalosis is not an absolute contraindication to renal transplantation. Transplantation can be performed successfully utilizing living-related donor kidneys and aggressive medical management. The risks of deterioration of function and oxalate deposition in the transplant kidney are offset by improvement in quality of life.
Azathioprine↗
Cultured human prostate-derived fibroblasts produce a factor that stimulates their growth with properties indistinguishable from basic fibroblast growth factor.
Fibrostromal proliferation is believed to be important in the development of benign prostatic hyperplasia (BPH). We found that a mitogen for cultured mesodermal-derived cells was present in extracts of BPH tissue. The mitogen was identified as basic fibroblast growth factor (bFGF). Previous studies did not determine the cell population(s) responsible for bFGF production in the prostate. This information is important to the understanding of the role of bFGF in the etiology of BPH. Human prostate-derived fibroblasts (PF) were initiated in culture. Recombinant bFGF and PF lysates stimulated tritiated thymidine uptake by quiescent PF cells. Greater than 90% of the mitogen in PF lysates bound to heparin-Sepharose and had the same elution profile and apparent molecular weight as bFGF isolated from BPH tissue. The growth factor in PF lysates competed with recombinant iodinated bFGF for binding to antiserum to (1-24)bFGF. Cultured PF incorporated 35S-methionine into protein that was precipitated by antiserum to bFGF. The apparent molecular weight of the radiolabeled protein, about 17,000, was similar to authentic bFGF. The observations are consistent with the interpretation that cultured PF synthesize a growth factor that stimulates their growth with properties that are indistinguishable from bFGF.
Cell Survival↗
Juxtaglomerular cell tumor with elevation of serum erythropoietin.
Juxtaglomerular cell tumor of the kidney is an uncommon neoplastic cause of surgically curable hypertension. We report a case of erythrocytosis due to elevated serum erythropoietin with a renin secreting juxtaglomerular cell tumor.
Adult↗
Amino-terminal sequence of a large form of basic fibroblast growth factor isolated from human benign prostatic hyperplastic tissue.
Homogenization of human benign prostatic hyperplastic tissue in high ionic strength alkaline buffer containing protease inhibitors resulted in the isolation of a 17,400 molecular weight growth factor. When tissue was homogenized in ammonium sulfate at pH 4.5 without protease inhibitors a smaller, 16,600 dalton, growth factor was isolated. Both growth factors reacted with antisera against synthetic peptides whose sequences corresponded to the amino-terminal (1-12), Internal (33-43) and carboxyl-terminal (135-145) portions of basic fibroblast growth factor (bFGF). This suggested that the smaller growth factor was not a truncated form of (1-146) bFGF and that the larger growth factor may contain additional sequences. Amino-terminal sequencing showed the larger growth factor to have the sequence: Ala-Ala-Gly-Ser-Ile-Thr-Thr-Leu-Pro-Ala-Leu-Pro-Glu-Asp-Gly-Gly-Ser-Gly- Ala-Phe-Pro-. These results show that the larger growth factor is an 8 amino acid extended from of (1-146) bFGF and it is likely that the smaller growth factor is a proteolytic cleavage product of the larger growth factor produced during the extraction procedure.
Amino Acid Sequence↗
Transcatheter renal artery embolization in treatment of ureterocutaneous fistula.
We report a case of a critically ill patient who had a ureterocutaneous fistula develop after placement of a Dacron bypass graft from the aorta to the right popliteal artery and the left femoral artery. We describe a successful nonsurgical method to terminate renal function in this patient, who was a poor operative risk.
Aorta, Abdominal↗
Posttransplant hypersplenism.
Posttransplant hypersplenism, manifested by leukopenia and azathioprine intolerance, can be diagnosed with a high degree of accuracy and promptly reversed by emergency splenectomy. Functioning cadaver kidney homograft survival rates in patients undergoing posttransplant splenectomy are equal to that of patients undergoing pretransplant splenectomy and are statistically superior (p less than 0.01) to recipients who have never had their spleens removed. However, mortality (21%) for posttransplant splenectomy is excessively high when compared to our mortality (1.3%) for pretransplant splenectomy.
Azathioprine↗
Prostatic osteoblastic factor.
Cell cultures of fetal rat osteoblasts and organ cultures of fetal rat calvaria were used to study the effects of extracts of prostatic tissue on bone cell growth. Extracts of bening prostatic hyperplasia, but not an undifferentiated prostatic carcinoma, stimulated the incorporation of 3H-thymidine and 14C-proline into fetal rat osteoblasts, calvaria, and skin fibroblasts. Extracts of well-differentiated prostatic cancer and normal postpubertal prostate also stimulated 3H-thymidine incorporation by fibroblasts. These findings support the hypothesis that a potentially unique factor found in prostatic tissue induces the osteoblastic response of bone to metastatic prostatic cancer.
Adenocarcinoma↗
An animal model for the growth of human tumor cell lines.
Newborn rats were thymectomized at less than 24 hr of age and received antilymphocyte serum and heterologous human tumor cells. This model allows the growth of large primary tumors with a high metastatic percentage. This model may be applicable to the study of a wide variety of genitourinary tumors.
Animals↗
Special problems in pediatric renal transplantation.
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Arm↗
Renal transplantation in pediatric patients.
Thirty-five transplants have been performed in 29 children, 1 week to 16 years old. Of these patients 79 per cent are surviving from 9 months to 14 years post-transplantation. Eighteen of these patients have required different surgical procedures for transplantation than adult patients. Immunosuppressive therapy has been essentially the same as in adult patients. A striking difference between the living related donor and the cadaver donor transplant functional survival as seen in this series is unexplained at the present time. Linear growth has been good in those children who have required minimal doses of corticosteroids to maintain adequate renal function.
Acute Kidney Injury↗
Renal transplantation in cystinosis.
Three children from 6 1/2 to 10 years old received kidney allografts from their parents 2 1/2 to 4 1/2 years ago. Renal function has been stable and the patients have been doing well. Studies of renal tubular function as well as morphologic studies by light and electron microscopy, and microdissection of renal tubules fail to reveal evidence of recurrent disease in the allografted kidneys.
Biopsy↗