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R Peschel

Publications and source records attributed to R Peschel.

At least 19 recordsLinked to original sources
PubMed2001

Laparoscopic retroperitoneal lymph node dissection.

PURPOSE: Retroperitoneal lymph node dissection is the most sensitive and specific diagnostic modality for detecting occult lymph node metastases in clinical stage I testicular tumor. In stage II disease, residual tumors after chemotherapy have to be removed surgically. To reduce the morbidity of these procedures we have replaced open surgery by laparoscopy. PATIENTS AND METHODS: Between August 1992 and December 1999 125 patients underwent laparoscopic RPLND (stage I: 76 pts., stage II: 49 pts.) RESULTS: Laparoscopic RPLND could be completed as planned in all but two patients in whom bleeding required conversion to open surgery. Once the learning curve had been overcome, mean operative time decreased significantly from 476 to 219 min for stage I and averaged 226 min in stage IIB disease. Only minor postoperative complications occurred such as asymptomatic lymphoceles (7 pts.) and chylous ascites (6 pts.). Mean post-op hospital stay was 3.3 and 3.5 days, respectively (stages I and II). Mean followup is currently 46 months for stage I and 35 months for stage II tumors. Over this period a single retroperitoneal recurrence was observed (stage I), which, however, was not due to surgical failure, but to false negative histologic findings. All other patients have remained free of relapse. CONCLUSIONS: Laparoscopic RPLND is a demanding procedure with a long and steep learning curve. It has proved feasible also after chemotherapy. The diagnostic accuracy of laparoscopic RPLND was as good as that of the open procedure, while the morbidity is significantly lower. Tumor control was not compromised by the laparoscopic approach.

Adolescent↗
PubMed2000

Dosimetric effects of edema in permanent prostate seed implants: a rigorous solution.

PURPOSE: To derive a rigorous analytic solution to the dosimetric effects of prostate edema so that its impact on the conventional pre-implant and post-implant dosimetry can be studied for any given radioactive isotope and edema characteristics. METHODS AND MATERIALS: The edema characteristics observed by Waterman et al (Int. J. Rad. Onc. Biol. Phys, 41:1069-1077; 1998) was used to model the time evolution of the prostate and the seed locations. The total dose to any part of prostate tissue from a seed implant was calculated analytically by parameterizing the dose fall-off from a radioactive seed as a single inverse power function of distance, with proper account of the edema-induced time evolution. The dosimetric impact of prostate edema was determined by comparing the dose calculated with full consideration of prostate edema to that calculated with the conventional dosimetry approach where the seed locations and the target volume are assumed to be stationary. RESULTS: A rigorous analytic solution on the relative dosimetric effects of prostate edema was obtained. This solution proved explicitly that the relative dosimetric effects of edema, as found in the previous numerical studies by Yue et. al. (Int. J. Radiat. Oncol. Biol. Phys. 43, 447-454, 1999), are independent of the size and the shape of the implant target volume and are independent of the number and the locations of the seeds implanted. It also showed that the magnitude of relative dosimetric effects is independent of the location of dose evaluation point within the edematous target volume. It implies that the relative dosimetric effects of prostate edema are universal with respect to a given isotope and edema characteristic. A set of master tables for the relative dosimetric effects of edema were obtained for a wide range of edema characteristics for both (125)I and (103)Pd prostate seed implants. CONCLUSIONS: A rigorous analytic solution of the relative dosimetric effects of prostate edema has been derived for a class of edema characterized by Waterman et al. The solution proved that the dosimetric effects caused by the edema are universal functions of edema characteristics for a given isotope. It provides an efficient tool to examine the relative dosimetric effects of edema for any given edema characteristics and for any isotopes that may be considered for prostate implants.

Brachytherapy↗
PubMed2000

Association of SRD5A2 genotype and pathological characteristics of prostate tumors.

The enzyme product of SRD5A2, 5alpha-reductase type II, is responsible for converting testosterone to the more metabolically active dihydrotestosterone. Therefore, SRDSA2 may be involved in the development or growth of prostate tumors. To examine the effects of allelic variants in the gene SRDSA2 on the presentation of prostate tumors, we studied a sample, primarily Caucasian, of 265 men with incident prostate cancer who were treated by radical prostatectomy. We assessed the relationship of the A49T and V89L polymorphisms at SRD5A2 with clinical and pathological tumor characteristics of these patients. We found no association of V89L genotypes with any of the characteristics studied. The presence of the A49T variant was associated with a greater frequency of extracapsular disease [odds ratio (OR), 3.16; 95% confidence interval (CI), 1.03-9.68] and a higher pathological tumor-lymph node-metastasis (pTNM) stage (OR, 3.11; 95% CI, 1.01-9.65). In addition, the A49T variant was overrepresented in two poor prognostic groups, which have been correlated with reduced rates of biochemical disease-free survival. One group included men with at least two of the following poor prognostic variables: (a) stage T3 tumor; (b) PSA level >10; and/or (c) Gleason score, 7-10 (OR, 3.46; 95% CI, 1.04-11.49). The second group included men with positive margins and high Gleason score (OR, 6.28; 95% CI, 1.05-37.73). Our results suggest that the A49T mutation may influence the pathological characteristics of prostate cancers and, thus, may affect the prognosis of these patients.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed2000

Laparoscopic retroperitoneal lymph node dissection.

INTRODUCTION: Retroperitoneal lymph node dissection (RPLND) is the most accurate method for evaluating the presence of retroperitoneal metastases from clinical Stage I nonseminomatous testicular tumors. We have introduced laparoscopy to reduce the morbidity of open RPLND, which is too high for a diagnostic procedure. As the next step, we replaced open surgery with the laparoscopic approach for Stage IIb tumors to remove residual tumor after chemotherapy. TECHNICAL CONSIDERATIONS: One prerequisite for laparoscopic RPLND is free access to the retroperitoneum, which can be achieved by wide dissection of the colon and duodenum. The borders of the dissection are the same as with open surgery, and complete dissection can be achieved. Bipolar coagulation and the harmonic scalpel have proved very helpful in achieving adequate hemostasis, a crucial point. Venous lesions can be sealed with fibrin glue. CONCLUSIONS: Laparoscopic RPLND is superior to open surgery with regard to morbidity and complication rates, and operative times are equal once enough experience has been collected. The diagnostic accuracy is the same for both methods, and tumor control is not compromised by the laparoscopic approach. The only drawback of laparoscopy is the long and steep learning curve.

Humans↗
PubMed2000

Laparoscopic pyeloplasty.

Laparoscopic pyeloplasty must be compared with open surgery in terms of efficacy and with endopyelotomy in terms of morbidity. All of the series published so far show that the results of laparoscopic pyeloplasty equal those of open surgery. Laparoscopy is associated with a lower morbidity; therefore, it is preferable to open surgery. The morbidity of endopyelotomy is also low, at least when it is performed in a retrograde fashion. The results of endopyelotomy are poor if UPJ obstruction is caused by crossing vessels. In addition, endopyelotomy in this clinical setting carries the risk of hemorrhage. Most adults with symptomatic UPJ obstruction present with crossing vessels at the UPJ. These patients benefit from laparoscopy, and endopyelotomy should be reserved for patients with true intrinsic stenoses. For this reason, preoperative investigation using contemporary imaging techniques is of crucial importance to be able to select the most appropriate surgical method for a given patient. Laparoscopic dismembered pyeloplasty is technically feasible but difficult. The authors prefer nondismembered techniques that yield equally good results in selected patients. Nondismembered pyeloplasty as described by Fenger is easy to perform and well suited for laparoscopy.

Adolescent↗
PubMed2000

Partial laparoscopic adrenalectomy for aldosterone-producing adenoma: short-and long-term results.

BACKGROUND AND PURPOSE: Laparoscopic surgery for adrenal gland tumors is the gold standard operative approach now. Adrenal-sparing surgery has special indications. We demonstrated the safety and feasibility of performing adrenal-sparing surgery by means of laparoscopy for aldosterone-producing adenoma (Conn's syndrome). PATIENTS AND METHODS: Between 1995 and 1999, seven patients with Conn's syndrome had laparoscopic adrenal-sparing resection of their tumors. These patients were followed up by means of radiology and biochemistry. RESULTS: All seven patients had successful laparoscopic surgery without complications. Most patients were discharged in 2 to 6 days (mean 3 days). At follow-up, the six patients investigated had normal blood pressure. No recurrences have been encountered with a median follow-up of 12 months in these six patients. CONCLUSIONS: Adrenal-sparing resection of tumors causing primary hyperaldosteronism is technically feasible by means of laparoscopy. This procedure has the advantage of keeping a greater reserve of normal adrenal tissue and of rapid postoperative recovery.

Adenoma↗
PubMed2000

Laparoscopic Fenger plasty.

BACKGROUND: At our department, adults presenting with hydronephrosis secondary to short intrinsic stenoses of the ureteropelvic junction (UPJ) or ventrally crossing vessels are treated with laparoscopic nondismembered pyeloplasty. We herein present our long-term results. PATIENTS AND METHODS: From August 1994 to September 1999, 34 female and 31 male patients presenting with 67 obstructed UPJs underwent laparoscopic nondismembered pyeloplasty. The patients' ages ranged from 11 to 77 (mean 35.6) years. Preoperatively, all patients were evaluated with intravenous urography and isotope scans. In addition, color Doppler ultrasonography was performed to identify crossing vessels at the UPJ. Prior to surgery, a stent was placed, which was left indwelling until 6 weeks after surgery. On the right side, the transperitoneal and on the left, the retroperitoneal approach was used. Following dissection of the UPJ, the obstructing vessels were displaced. The stenosis of the UPJ was corrected by either Fenger plasty (63 UPJs) or Y-V plasty (4 UPJs). Postoperative evaluation included color Doppler ultrasonography, intravenous urography, and isotope studies. RESULTS: The mean operative time was 123 minutes. No intraoperative complications were seen. In 79% of the patients, ventrally crossing vessels were found and displaced from the UPJ. Forty-eight patients have been available for follow-up, which currently ranges from 4 to 60 (mean 25) months. In the most recent nine patients, the position of the crossing vessels relative to the UPJ was also assessed postoperatively by means of color Dopper ultrasonography. The mean distance of the vessels from the UPJ was 1.5 cm. There was a single failure, in a 19-year-old woman who presented with infected hydronephrosis. Laparoscopic nondismembered pyeloplasty failed because the stenosis, which was aggravated by the infection, was too long. The success rate thus was 98%. CONCLUSIONS: At our department, laparoscopic nondismembered pyeloplasty is the preferred method for the management of UPJ obstruction, while dismembered pyeloplasty is performed in rare cases only.

Adolescent↗
PubMed2000

Dosimetric effects of needle divergence in prostate seed implant using 125I and 103Pd radioactive seeds.

In prostate seed implants, radioactive seeds are implanted into the prostate through a guiding needle with the help of a template and real-time imaging. The ideal locations of the guiding needles and the relative positions of the seeds in each needle are determined before the implantation under the assumption that the needles inserted at different locations will remain parallel. In actual implantation, the direction of the needle is subject variation. In this work, we studied how the dosimetry quality of an implant may be affected when the guiding needles deviate from its planned orientations. Needle divergence of varying degree was simulated on spherical models and actual patient implants. It was found that needle divergence degraded the dosimetric quality of an implant: The minimum target dose, the target dose coverage and therefore the tumor biological effective dose were quantitatively decreased as compared to the reference implant. The magnitude of degradation increased almost linearly with respect to the magnitude of needle divergence. For iodine-125 implants, the average reduction in minimum target dose was about 10% and 20% for needle divergence of standard deviation of 5(0) and 10(0), respectively. The dose coverage in the target was reduced by about 1% and 3% for needle divergence of standard deviation of 5(0) and 10(0), respectively. Implants designed with palladium-103 showed additional 5% reduction in minimum target dose while the effect on dose coverage was about the same as compared to the iodine-125 implants. The degree of dosimetry degradation was shown to be dependent on the size of target volume, the seed spacing used, the use of seeding margin, and on the actual configuration of needle orientations in a given implant. One needs to minimize the physical causes of needle divergence in order to minimize its impact on planned dosimetry. The study suggests that the displacement between a needle image and its planned grid point at the base of prostate should be kept less than 5 mm in order to minimize the reduction in D(min)(<5%) and the increase in cell-survival (< a factor of 10) from the planned dosimetry.

Biophysical Phenomena↗
PubMed2000

Laparoscopic surgery for stage T1 renal cell carcinoma: radical nephrectomy and wedge resection.

OBJECTIVES: Renal cell carcinoma (RCC) is likely to become one of the most important indications for laparoscopic surgery. We herein report our experience. METHODS: From April 1994 until April 1999, 98 patients presenting with RCC were treated laparoscopically by either radical nephrectomy (RN; n = 73) or wedge resection (WR; n = 25). The mean age was 62.3 years. The mean tumour diameters were 3.8 cm (RN) and 1.9 cm (WR). All tumours were clinical stage T1 lesions. The transperitoneal approach was used for RN in all patients. For WR either the transperitoneal or the retroperitoneal approach was used. In 15 patients, the adrenal gland was removed simultaneously. The specimen was entrapped in an organ bag and removed intact through a small muscle-splitting incision in the lower abdominal wall. RESULTS: RN: The mean operating time was 142 (range 86-230) min, the mean blood loss was 170 (range 0-1,500) ml, and the mean postoperative hospital stay was 7.4 (range 3-32) days. Minor complications occurred in 4.0% of the patients, while major complications were seen in 8.0% of them. WR: The mean operating time was 163.5 (range 90-300) min, the mean blood loss was 287 (range 20-800) ml, and the postoperative hospital stay was 8.0 (range 3-8) days. Minor complications: 4%, major complications: 8%. Histology revealed RCC stage T1 in 77 patients, stage T3a in 7, and stage T3b in 3 patients, oncocytoma in 2 patients, angiomyolipoma in 2, renal adenoma in 1, renal metastasis in 1, multilocular cysts in 4, and renal abscess in 1 patient. Over mean follow-up periods of 13.3 and 22.2 months for RN and WR, respectively, neither local recurrences nor metastases have been observed among patients with histologically confirmed RCC. CONCLUSIONS: Laparoscopic surgery for clinical stage T1 RCC is safe and efficient. Excellent tumour control can be achieved. However, longer follow-up periods will be necessary to confirm these results.

Adult↗
PubMed2000

Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous testicular carcinoma: long-term outcome.

PURPOSE: We report the long-term oncological efficacy and morbidity of laparoscopic retroperitoneal lymph node dissection for testicular carcinoma. MATERIALS AND METHODS: From August 1992 to September 1999, 73 consecutive patients underwent laparoscopic retroperitoneal lymph node dissection with modified unilateral template dissection. All lumbar vessels within the template were routinely transected in the initial 29 cases only. Patients with positive lymph nodes received 2 cycles of chemotherapy. RESULTS: Operative time ranged from 150 to 630 minutes (mean 221) in our most recent 28 cases. All but 2 operations were completed as planned for a conversion rate of 2.7%. Minor intraoperative complications developed in only 6.8% of cases. In our last 44 patients there was no major and only 1 minor (2.3%) postoperative complication. Mean postoperative hospitalization was 3.3 days. Ejaculation was preserved in all patients. Lymph nodes were positive in 19 cases (26%). Mean followup in 47 patients with pathological stage I disease was 43.3 months (range 7 to 84). We noted 1 retroperitoneal recurrence due to false-negative histological findings but there were no other relapses. At a mean followup of 42.7 months (range 6 to 86) 17 patients with pathological stage II carcinoma treated with 2 cycles of adjuvant chemotherapy were also free of disease. CONCLUSIONS: In our hands laparoscopic retroperitoneal lymph node dissection has not only proved its surgical efficiency, but also its oncological efficacy. Patient satisfaction is high. During long-term followup of more than 3 years not a single recurrence developed due to surgical failure.

Adolescent↗
PubMed1999

Optimum timing for image-based dose evaluation of 125I and 103PD prostate seed implants.

PURPOSE/OBJECTIVE: Image-based dose evaluation of permanent brachytherapy implants for prostate cancer is important for optimal patient management after implantation. Because of edema caused by the surgical procedure in the implantation, if the dose evaluation is based on the images obtained too early after implantation, dose coverage will usually be underestimated. Conversely, if the images are obtained too late, the dose coverage will be overestimated. This study uses a biomathematical model to simulate edema and its resolution on 29 patients, so that the optimum time to obtain image scans and perform dose evaluation can be investigated and estimated. METHODS AND MATERIALS: Edema of a prostate and its resolution has been shown to follow an exponential function V(t) = V(0)(1 + deltaV[e-0.693t/Te - 1]) where deltaV is the initial relative increase in the prostate volume due to edema (and is related to edema magnitude), and Te (edema half-life) is the time for the edema to decrease by half in volume. In this study, edema was simulated by increasing the volume of preimplant prostate (obtained from ultrasound volume study) to a given magnitude of edema. Similarly, the locations of planned seeds were changed to their corresponding locations in the edematous prostate proportionally. The edema was then allowed to resolve according to the exponential function. The correct dose distribution was calculated by taking into account the dynamic variations of the prostate volume, seed locations, and source strengths with respect to time. Dose volume histograms (DVHs) were then generated from this dose distribution. The conventional postimplant DVHs, which assume the prostate volume and seed locations are as in the image scans and constant in time, were also calculated based on the simulated image scans for various days postimplantation. The conventional DVHs of prostate on various days after implantation were compared to the DVH calculated assuming dynamic conditions. The optimum timing for conventional postimplant dose evaluation was identified as the time at which a minimum difference between the conventional DVH and the dynamic model DVH was achieved. The analysis was done on 29 prostate seed implant patients for both 125I and 103Pd. The edema magnitude was assumed to be 30%, 40%, 50%, 75%, and 100% of original prostate volume, and the half-life of edema was assumed to be 4, 7, 10, 15, 20, and 25 days. In this study, the original volume of prostate varied from 17 cm3 to 91 cm3, and number of seeds in the implants varied from 57 to 119. RESULTS: The optimum timing was mainly dependent on the half-lives of edema and radionuclides, and varied slightly with edema magnitude, prostate volume, and number of seeds. It can be expressed as a function of edema half-life in the form of C0 + C1exp(-C2Te). However, if the dose evaluation was performed based on the image scans taken too early or too late, the error became larger, as the edema magnitude was larger. By averaging all 29 patients and various edemas, it was found that for 125I seed implants, if the postimplant dose evaluation is performed based on image scans taken between 5 and 9 weeks, the average error will be less than 5%, with a maximum possible error less than 10% in 80% coverage dose; for 103Pd seed implants, if the postimplant dose evaluation is performed based on image scans taken between 2 and 4 weeks, the average error will be less than 5%, with a maximum error less than 15% in 80% coverage dose. Because of edema, a conventional preimplant plan also overestimates dose coverage of prostate. On the average, a standard preimplant planning overestimates dose coverage by about 6% for 125I implants and 14% for 103Pd implants in our study. CONCLUSION: Based on the dynamic model, the optimum timing of image scans for postimplant dose evaluation of prostate seed implantation is 7 weeks postimplantation for 125I implants and about 3 weeks for 103Pd implants. (ABSTRACT TRUNCATED)

Brachytherapy↗
PubMed1999

Extracorporeal shock wave lithotripsy versus ureteroscopy for distal ureteral calculi: a prospective randomized study.

PURPOSE: We performed a prospective randomized study to determine appropriate first line treatment for distal ureteral stones. MATERIAL AND METHODS: Between January 1996 and October 1997, 80 patients with distal ureteral stones (40 smaller than 5 mm. and 40 larger than 5 mm.) were randomized and treated with extracorporeal shock wave lithotripsy or ureteroscopy with a 9.5 or 6.5F semirigid ureteroscope. RESULTS: Ureteroscopy was significantly better in terms of operative time, fluoroscopy time and time to achieve a stone-free state. The smaller the stones, the greater the difference between the 2 treatment modalities. CONCLUSIONS: For distal ureteral stones we recommend ureteroscopy as first line treatment.

Adult↗
PubMed1999

Laparoscopic retroperitoneal lymphadenectomy after chemotherapy for stage IIB nonseminomatous testicular carcinoma.

PURPOSE: We investigated laparoscopic retroperitoneal lymphadenectomy after chemotherapy for stage IIB testicular carcinoma in terms of operative feasibility, overall morbidity and tumor control. MATERIALS AND METHODS: Between February 1995 and April 1998, 24 patients underwent laparoscopic retroperitoneal lymphadenectomy following initial chemotherapy for stage IIB (2 to 5 cm.) solitary or unilateral lymph node metastases. Mean tumor diameter was 2.4 cm. before and 1.1 cm. after chemotherapy. Laparoscopic retroperitoneal lymphadenectomy was performed in all patients, including those with complete remission. RESULTS: Laparoscopic retroperitoneal lymphadenectomy could be completed as planned in all patients and there was no need for conversion to open surgery. Operative time was 150 to 300 minutes (mean 240). Blood loss was minimal and no blood transfusions were required. The only postoperative complications were chylous ascites (5 patients) which resolved with conservative management (low fat diet) and a small asymptomatic lymphocele. Histological examination revealed necrosis in 71%, mature teratoma in 25% and active tumor in 4% of patients. Antegrade ejaculation was preserved in all patients. Mean postoperative hospital stay was 4 days, return to normal activities between 1 and 3 weeks, and time to complete recovery between 5 and 10 weeks. All patients were well without evidence of disease at a mean followup of 24.4 months. CONCLUSIONS: Laparoscopic retroperitoneal lymphadenectomy after chemotherapy proved feasible in select patients presenting with solitary or unilateral lymph node metastases and was associated with a low morbidity. Tumor control was not compromised by the laparoscopic approach.

Adolescent↗
PubMed1998

Laparoscopic surgery for pheochromocytoma: adrenalectomy, partial resection, excision of paragangliomas.

PURPOSE: Surgical treatment of pheochromocytoma includes adrenalectomy, adrenal sparing surgery and excision of extraadrenal paragangliomas. We report our experience using laparoscopy for these procedures. MATERIALS AND METHODS: Between June 1992 and November 1997, 19 patients underwent laparoscopic surgery for pheochromocytoma. Of the patients 14 had solitary tumors, and 4 presented with bilateral pheochromocytomas and 1 or 2 additional paragangliomas. In 1 patient a recurrent pheochromocytoma was found in the contralateral adrenal following previous right adrenalectomy. One patient each had myocardiopathy, amaurosis and stroke secondary to severe hypertension. Two patients were pregnant. RESULTS: All solitary tumors were treated with laparoscopic adrenalectomy. Laparoscopic adrenal sparing surgery (4 cases, 2 bilateral) and bilateral adrenalectomy (1) were performed for multiple familial pheochromocytoma, and all paragangliomas were excised simultaneously. The pregnant patients underwent surgery at 16 and 20 weeks of gestation, respectively. All procedures were completed as planned. The rate of minor intraoperative and postoperative complications was 11% and 16%, respectively, and there were no major complications. In all patients the catecholamine levels returned to normal and no residual tumors were found at followup. None of the patients undergoing partial resection required steroid replacement therapy. CONCLUSIONS: In experienced hands, laparoscopic surgery for solitary and multiple pheochromocytoma and paraganglioma is feasible and safe, and does not increase the specific risks associated with pheochromocytoma surgery.

Adrenal Gland Neoplasms↗
PubMed1998

Correlation of medical dosimetry quality indicators to the local tumor control in patients with prostate cancer treated with iodine-125 interstitial implants.

The treatment of prostate cancer by 125I interstitial implants has been extensively studied with mixed results by one institution or another. A recent study from Hahnemann [Int. J. Radiat. Oncol., Biol., Phys. 21,955-960 (1991)] reported results that were extremely poor compared to those reported in an earlier study at Yale [Int. J. Radiat. Oncol., Biol., Phys. 14, 1153-1157 (1988)] or those in an Eastern Virginia Study [Cancer 63, 2415-2420 (1989)]; differences in 5-yr survival rates being more than a factor of 2. Such large discrepancies from institution to institution led us to a reexamination of the dosimetry. This study analyzed quantitatively three-dimensional dosimetric parameters of 110 prostate cancer patients treated with 125I interstitial implants. The study searched for "cutoff" values in each parameter that divided the patients into two groups with statistically significant differences in the local recurrence-free survival rates. A comparison of the three-dimensional isodose surfaces of patients with favorable values in all of the parameters to those patients with all unfavorable parameters show how these characteristics translated into poor dose coverage and much inhomogeneity within the implant even for cases that met the traditional criteria for adequacy (160 Gy to the tumor volume). Patients in the favorable group had 10-yr survival rates higher by a factor of up to 2 compared to those in the unfavorable group. The strong correlation of three-dimensional volume-dose parameters to the local control rate observed in this study further emphasizes how important it is to assess the three-dimensional dosimetric adequacy of interstitial implants before deciding on their clinical efficacy. If implants are performed with appropriate attention to dosimetry parameters, excellent clinical results are obtained. On the other hand, if dosimetry parameters are not correct, the implant results can be poor.

Adenocarcinoma↗
PubMed1998

Laparoscopic nephron sparing surgery for small renal cell carcinoma.

PURPOSE: In recent years the detection rate for small renal tumors has increased due to the widespread use of advanced diagnostic imaging techniques, which in turn has increased the need for nephron sparing surgery. We investigate whether laparoscopic surgery is a suitable approach to partial resection of small renal tumors. MATERIALS AND METHODS: Between June 1994 and October 1996, 7 patients underwent laparoscopic wedge resection of the kidney for renal tumors up to 2 cm. in diameter. Hemostasis was achieved mainly by bipolar coagulation. In addition, the resection surface was cauterized with an argon beam coagulator and then sealed with fibrin glue. In 1 procedure a novel ultrasonic dissector was tested. RESULTS: All procedures could be completed as planned. The only intraoperative complication was a pneumothorax that resolved spontaneously within 2 days. There were no postoperative complications. Histological examination yielded stage pT1 grade I renal cell carcinoma in 3, stage pT1 grade II in 2 and multilocular cysts in 2 cases. All patients had negative surgical margins. Postoperatively, renal function as assessed by serum creatinine was unchanged. Neither local recurrences nor metastases were observed during a followup of 7 to 35 months. CONCLUSIONS: Our results indicate that laparoscopic partial nephrectomy is feasible for small renal cell carcinoma, and is associated with low morbidity and a low complication rate.

Adult↗
PubMed1997

New onset hypertension after extracorporeal shock wave lithotripsy: age related incidence and prediction by intrarenal resistive index.

PURPOSE: In a recent study we found an increased resistive index immediately after extracorporeal shock wave lithotripsy (ESWL) in patients older than 60 years, which suggests renovascular disturbance. The present 26-month followup study was undertaken to investigate the relevance of elevated resistive index levels and the incidence of new onset hypertension. MATERIALS AND METHODS: Of the initial 76 patients 57, including 20 of the 23 at risk patients 60 or greater years, group 3), were followed for more than 26 +/- 6 months after ESWL. Followup included 2 resistive index measurements by Doppler ultrasound of the treated and the contralateral kidney, at least 2 blood pressure measurements 1 week apart and excretory urography as well as determination of plasma renin activity in 9 patients. RESULTS: With 1 exception, elevated resistive index levels and hypertension were observed exclusively in patients older than 60 years. In these patients the resistive index ranged between 0.65 and 0.86 (mean plus or minus standard deviation 0.74 +/- 0.05, normal less than 0.7). This increase in resistive index was statistically significant (p < 0.0001). Compared to the levels obtained immediately after ESWL, the resistive index continued to increase in all 9 patients older than 60 years who had hypertension (45%), whereas in the normotensive patients the resistive index was either stable or decreased. There was a strong positive correlation (0.903) between pathological resistive index levels and blood pressure. CONCLUSIONS: Patients older than 60 years are at risk for disturbances of renal perfusion as assessed by the resistive index, and 45% of these patients have new onset hypertension within 26 months of treatment.

Adolescent↗