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At least 1,261 records · Page 70Linked to original sources
PubMed1997

Partial nephrectomy in a cystic partially differentiated nephroblastoma.

Cystic partially differentiated nephroblastoma (CPDN) is a rare neoplastic disorder consisting of a well-demarcated cystic lesion of the kidney where blastemal or other embryonic cells are present in the septa of the cysts. Magnetic resonance imaging can detect the cystic character of the lesion and will produce imaging features that are highly suggestive of either CPDN or cystic nephroma (CN) (synonym: multilocular cyst of the kidney), a benign entity. Although malignant potential exists in CPDN, all cases reported to date have had a favorable prognosis after surgery alone. Partial nephrectomy is considered safe, and the treatment of choice in the newborn period. We report a case of CPDN in a newborn that was successfully treated with partial nephrectomy. More than five years after nephron sparing surgery, the involved kidney shows normal anatomical structure except for a diminished upper pole, no evidence of tumor recurrence and good renal function.

Cysts↗
PubMed1997

Image-directed color Doppler ultrasound evaluation of the single kidney after unilateral nephrectomy in adults.

Renal adaptations occur in the single kidney. The kidney of 21 unilaterally nephrectomized adults was studied with image-directed color Doppler ultrasound (ICDU) and compared with 35 age-matched controls. Kidney volume, standardized kidney volume, hypertrophy, both intrarenal- and main renal artery-resistive indexes were quantified, correlated to each other and correlated to renal function. The influence of age, sex, or time since nephrectomy was also studied. There was a mean hypertrophy of approximately 20%. Intrarenal resistances lay within normal limits for age. There was no correlation between renal function, size, and hemodynamics. Age, sex, and time since nephrectomy had a limited influence on renal adaptations.

Adaptation, Physiological↗
PubMed1976

Radical partial renal irradiation. an alternative to partial nephrectomy in bilateral Wilms' tumor.

A 6-year-old girl with simultaneous bilateral Wilms' tumor was treated with a radical nephrectomy on the side of more extensive involvement, followed by postoperative renal bed irradiation (3500 rads over 32 days) and radical partial renal irradiation (4000 rads over 35 days) to the contralateral disease. Concurrent and subsequent adjuvant actinomycin-D and vincristine were given. She has remained disease-free for over 5 years after primary therapy, with satisfactory renal function. This case report suggest that radical partial renal irradiation may be an alternative to partial nephrectomy in the management of the lesser involved kidney in some patients with bilateral Wilms' tumor.

Child↗
PubMed1993

Localized renal cell carcinoma treated by radical nephrectomy. Influence of pathologic data and the importance of DNA ploidy pattern on disease outcome.

BACKGROUND: The course of patients with renal cell carcinoma may be considerably different. Approximately 50% with presumed localized disease have metastases after nephrectomy. Pathologic stage at diagnosis, histologic grade, and histologic type have been considered the most important predictors of prognosis. Nevertheless, subsets of patients within a specified stage and grade may have considerable differences in disease progression and survival. METHODS: Flow cytometric nuclear DNA analysis was used to study pathologic Stage I or II renal cell carcinoma in 54 patients who underwent radical nephrectomy between 1974 and 1983. RESULTS: Sixty-three percent of the tumors were diploid, and 37% aneuploid. A DNA diploid pattern was more common among Stage I tumors than Stage II tumors (69% versus 33%; P < 0.04). Progression occurred in 31% of the diploid tumors, whereas among the aneuploid group the progression rate reached 59% (P < 0.06). Considered as a single indicator, DNA ploidy pattern was strongly associated with patient survival. Ten years after surgery 79% of the patients who had diploid tumors and 50% of those with aneuploid tumors were alive (P < 0.02). CONCLUSIONS: Nuclear DNA ploidy may serve as an important prognostic variable for patients with early stage renal cell carcinoma.

Adolescent↗
PubMed1976

Bilateral nephrectomy prior to renal transplantation.

Bilateral nephrectomy was performed in 53 patients on regular haemodialysis. The indications were pyelonephritis in 30, polycystic kidneys in 6, glomerulnephritis in 7, uncontrollable hypertension in 9 and horseshoe kidney in 1. In 87 per cent of cases the operation was carried out as a separate procedure prior to transplantation. The mortality was 9 per cent and the postoperative complications included hypotension, clotting of arteriovenous shunts, pneumonia and subphrenic abscess. As a result of our experience we have revised our indications for bilateral nephrectomy which now are pyelonephritis only when associated with persistent bacteriuria or ureteric reflux, polycystic kidneys and uncontrollable hypertension.

Adolescent↗
PubMed2004

Hand-assisted laparoscopic live donor nephrectomy.

BACKGROUND: Hand-assisted laparoscopic donor nephrectomy (HLDN) may have advantages over laparoscopic donor nephrectomy, such as shorter learning curve, operation and warm ischaemia times. The aim of this study was to evaluate the feasibility and safety of HLDN. METHODS: Between January 2000 and October 2002, 50 consecutive HLDN procedures were performed through a low transverse abdominal incision, 23 right sided and 27 left sided. RESULTS: The median age of the donors was 44 years. No HLDN required conversion to an open procedure. The median operating time for HLDN was 153 min. The median warm ischaemia time was 3 (range 1.0-4.5) min and the median blood loss was 50 (range 20-500) ml in both left- and right-sided procedures. Eight patients suffered ten minor complications during their admission. The duration of hospital stay was 5 days for donors. Three recipients developed graft failure owing to acute rejection, renal vein thrombosis and ischaemic necrosis. CONCLUSION: Both left- and right-sided HLDN procedures were feasible and safe through a low transverse abdominal incision.

Adult↗
PubMed2005

Comparison of predictive accuracy of four prognostic models for nonmetastatic renal cell carcinoma after nephrectomy: a multicenter European study.

BACKGROUND: The objective of the current study was to compare, in a large multicenter study, the discriminating accuracy of four prognostic models developed to predict the survival of patients undergoing nephrectomy for nonmetastatic renal cell carcinoma (RCC). METHODS: A total of 2404 records of patients from 6 European centers were retrospectively reviewed. For each patient, prognostic scores were calculated according to four models: the Kattan model, the University of California at Los Angeles integrated staging system (UISS) model, the Yaycioglu model, and the Cindolo model. Survival curves were estimated by the Kaplan-Meier method and compared by the log-rank test. Discriminating ability was assessed by the Harrell c-index for censored data. The primary end point was overall survival (OS), and the secondary end points were cancer-specific survival (CSS) and disease recurrence-free survival (RFS). RESULTS: At last follow-up, 541 subjects had died of any causes, with a 5-year OS rate of 80%. The 5-year CSS and RFS rates were 85% and 78%, respectively. All models discriminated well (P < 0.0001). The c-indexes for OS were 0.706 for the Kattan nomogram, 0.683 for the UISS model, and 0.589 and 0.615 for the Yaycioglu and Cindolo models, respectively. The Kattan nomogram was found to improve discrimination substantially in the UISS intermediate-risk patients. CONCLUSIONS: The current study appears to better define the general applicability of prognostic models for predicting survival in patients with nonmetastatic RCC treated with nephrectomy. The results suggest that postoperative models discriminate substantially better than preoperative ones. The Kattan model was consistently found to be the most accurate, although the UISS model was only slightly less well performing. The Kattan model can be useful in the UISS intermediate-risk patients.

Adolescent↗
PubMed1979

Spontaneous regression of a pulmonary metastasis after nephrectomy for renal cell carcinoma.

Regressions of metastases following nephrectomy for renal cell carcinoma are rare. Most reported cases have involved pulmonary metastases. Hormonal and immunological mechanisms have been postulated. A case is described of a pulmonary metastasis which regressed after nephrectomy and which failed to recur despite the later appearance of new sites of pulmonary metastases. The literature is reviewed.

Adenocarcinoma↗
PubMed1987

Evaluation of sapphire tip Nd:YAG laser fibers in partial nephrectomy.

Sapphire tips for Nd:YAG lasers fibers have been introduced recently. The increased energy density improves the cutting effect while, reportedly, preserving the hemostatic properties of Nd:YAG laser energy. The capacity of sapphire tip laser fibers to facilitate partial nephrectomy was tested in mongrel dogs. No advantage for this technique was demonstrated compared to standard methods of partial nephrectomy.

Animals↗
PubMed1988

Partial nephrectomy using the Nd:YAG laser: a comparison of the 1.06 mu and 1.32 mu lasers employing different delivery systems.

A comparative study of the 1.06 mu and the 1.32 mu Nd:YAG laser using a variety of delivery systems (focusing handpiece, freehand GI quartz fiber, or frosted laser scalpel) was undertaken to determine the usefulness of these modalities in performing partial nephrectomies in dogs. Variables evaluated included total operative time, total joules expended, estimated amount of blood loss, and extent of renal tissue damage. The contact laser scalpel provided the greatest precision and speed, but no hemostasis, and is therefore inappropriate for parenchymal renal surgery. Evaluation of the other delivery systems showed no discernible differences in the extent of renal damage that could be attributed to either wavelength or wattage used. The usual depth of acute renal damage ranged from 1.0 mm to 1.8 mm when the tissue was fixed immediately after completing the polar nephrectomy, but the damage had extended to 3.0 mm when tissue was examined after 6 weeks. No consistent differences in extent of cellular damage could be demonstrated between the renal cortex and medulla. The lens system inherent in the focusing handpiece limited the total power (60 watts) that could be employed and surgery proceeded at a slower pace and required a greater expenditure of energy. Likewise, the maximal power that could be applied using the 1.32 mu laser was 25 watts and surgery also proceeded at a slower pace.(ABSTRACT TRUNCATED AT 250 WORDS)

Aluminum Silicates↗
PubMed1994

Partial nephrectomy with a combined CO2 and Nd:YAG laser: experimental study in pigs.

Twenty-eight partial nephrectomies were performed on nine pigs with a simultaneous, coaxial CO2-Nd:YAG laser at power settings of 20 W and 40 W, or with a steel scalpel. A vascular pedicle clamp was used without renal cooling. The time for hemostasis was 4.5 +/- 3.2 min (mean +/- SD) with the laser and 6.4 +/- 2.5 min with the steel scalpel (P = 0.064). There was no difference in the total operation time (10.4 +/- 3.5 min with the laser vs. 11.0 +/- 3.2 min with the steel scalpel, P = 0.470). The mean blood loss with the laser was 17.5 +/- 6.7 g and 22.1 +/- 15.2 g with the steel scalpel (P = 0.299). The number of ligatures needed for complete hemostasis was 2.9 +/- 2.1 with the laser and 5.0 +/- 2.3 with the steel scalpel (P = 0.011). The average thermal damage was 0.23 +/- 0.10 mm. It is concluded that the simultaneous CO2-Nd:YAG laser method can be used in partial nephrectomy and it offers better hemostasis than the conventional technique. Further studies with different power levels are needed.

Aluminum↗
PubMed1994

Augmentation by converting enzyme inhibition of accelerated endothelin release from rat mesenteric arteries following nephrectomy.

We investigated the release of endothelin-1 (ET) from rat mesenteric arteries to clarify its pathophysiological role in the sustained hypertension of spontaneously hypertensive rats (SHR) following nephrectomy and the regulatory mechanism of the ET release which might be modified by vascular angiotensins and bradykinins. Nephrectomy increased the plasma level of ET and enhanced the ET release in both SHR and Wistar-Kyoto rats (WKY). CV-11974, an angiotensin II receptor antagonist, did not affect the ET release from arteries of nephrectomized rats. On the contrary, infusion of captopril, a converting enzyme inhibitor, further enhanced the ET release in both intact and nephrectomized rats. These findings suggest that the release of ET from mesenteric arteries may be regulated by bradykinins, but not by angiotensins. This pressor substance does not contribute to the sustained hypertension because the enhanced production of ET observed in both SHR and WKY. However, there is a possibility that the exaggerated responsiveness of vascular ET may in part account for local vascular tone and vascular remodeling in renal dysfunction.

Analysis of Variance↗
PubMed1992

Bilateral nephrectomy of the native kidneys reduces the incidence of arterial hypertension and erythrocytosis in kidney graft recipients treated with cyclosporin. Leuven Collaborative Group for Transplantation.

Since the use of cyclosporin (CsA) the incidence of post-transplant arterial hypertension and erythrocytosis has increased sharply. In a retrospective analysis of 707 consecutive first cadaveric kidney graft recipients treated with CsA as basic immunosuppression, the effect of bilateral native nephrectomy on arterial hypertension and erythrocytosis was studied. Patient and graft survival as well as kidney function of the 264 nephrectomized patients were identical to those of the 443 non-nephrectomized patients. In the nephrectomized patients the mean number of rejections during the first year was 0.62 +/- 0.88 versus 0.78 +/- 1.02 in the non-nephrectomized patients (P = 0.0285). At 1 year after transplantation, 65.8% of the non-nephrectomized patients needed hypotensive drugs versus 45.3% of the nephrectomized patients (P < 0.0001). Notwithstanding the use of more antihypertensive drugs, diastolic blood pressure in the former group was significantly higher than in the latter group (87 +/- 25 versus 83 +/- 10 mmHg; P < 0.02). During the first year 44 (9.9%) of the non-nephrectomized patients had haemoglobin levels higher than 17 g/dl versus only six (2.3%) of the nephrectomized patients (P < 0.0001). Comparable differences were also found up to 5 years after transplantation. These findings indicate that native nephrectomy is helpful in controlling arterial hypertension and erythrocytosis.

Blood Pressure↗
PubMed1989

Age factor in post-nephrectomy compensatory renal growth.

In a retrospective investigation we found that the endogenous creatinine clearance (Ccr) of 35 nephrectomized patients was lower than that of normal people of comparable age with two intact kidneys. The Ccr level in the post-nephrectomy patients appeared to correlate with the age of the patients at the time of nephrectomy. The average Ccr value was 99.2 ml/min in the younger group, and 54.9 ml/min in the older group. Furthermore, we also found that the measurement of the remaining kidney in the younger group was larger than that of the matched control group, but no difference was found between the measurement of the remaining kidney in the older group and that of the matched control group. Therefore, we suggest that the remaining kidney in patients over 50 years of age may be described as "a low compensatory kidney". The results from an experimental study of Wistar rats indicated that the dry and wet weights of the remaining kidneys of the younger rats which had undergone neptrectomy were 1.53 X 10(-3) g/gwt, and 5.89 X 10(-3) g/gwt respectively, vs 1.05 X 10 g/gwt and 3.82 X 10(-3) g/gwt in older ones. In tissue culture using serum of younger nephrectomized rats, the amount of 3H-TdR incorporation into the monolayer cells of renal cortex was 1,405.4 CPM, whereas it was 1,025.4 CPM by using serum of older nephrectomized rats. In addition, the cells of renal cortices from both younger and older rats had a similar response to the same serum from nephrectomized rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Renal function remains after unilateral total and contralateral partial nephrectomy: an experimental study in pigs using 99mTc-DTPA.

Twelve nephrectomies (NEs) were performed in 12 pigs (11-17 kg). Total NE was performed on the left side and partial NE on the right side (lower third of the kidney), thus two-thirds of the total kidney volume was removed. Renal function was studied with 99mTc-diethylenetriaminepentaacetic acid (DTPA) renography and serum urea and creatinine levels preoperatively, and 1 and 2 weeks postoperatively. The pigs were imaged in each session for 30 min by collecting 10-s frames from a posteroanterior (PA) view of an anaesthesized animal. The injected activity was 37 MBq. Serial blood samples were taken from the subclavian vein at 0, 1, 2, 3, 5, 15, 25, 40, 60 and 120 min (six animals) after 99mTc-DTPA injection. The DTPA disappearance rate (DDR) was determined from these samples and in other cases (six animals) a blood sample at 20 min was used. The DDR was also determined from the dynamic gamma imaging data: Regions of interest (ROI) were upper body, spleen, heart and kidneys. The ROI analysis correlated well with the blood sampling data (r = 0.97, P < 0.0001). The reference values for pig DDRs were 0.99 +/- 0.08%/min. These values were 0.71 +/- 0.08%/min at 1 week postoperatively and 0.63 +/- 0.08%/min at 2 weeks. DTPA clearance rates were preoperatively 0.53 +/- 0.06 ml/s; at 1 week postoperatively 0.41 +/- 0.06 ml/s; and at 2 weeks 0.35 +/- 0.06 ml/s. There were no significant differences pre- and postoperatively in creatinine and urea concentrations. The DTPA clearance (ml/s) and disappearance rates (%/min) when determined per kidney area (cm2) increased significantly (P < 0.001 at both 1 and 2 weeks); in 11 of 12 animals the function of the resected right kidney was higher than the split function of the whole right kidney preoperatively. Unilateral nephrectomy initiates a functional adaptation or a growth response in the contralateral kidney to compensate for the loss of a renal mass. These data also indicate that two-thirds of the kidney volume in young pigs can be removed without danger.

Adaptation, Physiological↗
PubMed1993

Contact fibre Nd:YAG laser for partial nephrectomy: experimental study in pigs.

Thirty-two partial nephrectomies were performed without renal cooling on 13 pigs with a contact fibre Nd:YAG laser (10 W) or a steel scalpel with or without a vascular pedicle clamp. Nine pigs had a 2-week follow-up with an abdominal ultrasound 1 week postoperatively. The time for haemostasis was 6.9 +/- 5.2 min (mean +/- SD) with the laser and 9.1 +/- 5.8 min with the steel scalpel when the clamp was used (P = 0.028). There was no significant difference in the total operating time (13.2 +/- 4.5 min with the laser vs 12.6 +/- 4.6 min with the steel scalpel, P = 0.203). Intraoperative blood loss was similar in the two groups when the clamp was used. Clamping the renal pedicle decreased the blood loss by 61% in the laser group and 31% in the steel scalpel group. The number of ligatures used was significantly lower in the laser group (3.7 +/- 2.6) compared with the steel scalpel group (6.6 +/- 3.4) (P = 0.013). Five urinomas developed on the laser side and four on the steel scalpel side. These results indicate that the contact fibre Nd:YAG laser method can be used in partial nephrectomy, but it offers no definitive advantage over the conventional technique.

Aluminum↗
PubMed1981

Active and inactive renin in dog plasma before and after bilateral nephrectomy.

No significant amounts of inactive renin could be demonstrated by in vivo treatment (acidification or cryotreatment) of dog plasma obtained before and after bilateral nephrectomy. After bilateral nephrectomy, total and active renin were cleared from the plasma following similar disappearance curves, and dropped to half of their initial value within 30 min.

Animals↗