Biomedical subjects

F A Ferrer

Publications and source records attributed to F A Ferrer.

25 records · Page 2Linked to original sources

PubMed1997

Bilateral laparoscopic adrenalectomy for adrenocorticotropic dependent Cushing's syndrome.

PURPOSE: We report our experience with bilateral laparoscopic adrenalectomy for total adrenal ablation in patients with Cushing's syndrome. MATERIALS AND METHODS: Four women (mean age 63 years) with Cushing's syndrome secondary to nonlocalized ectopic adrenocorticotropic hormone production in 3 and pituitary microadenoma after failed transsphenoidal ablation in 1 underwent bilateral transabdominal laparoscopic adrenalectomy. Preoperatively risk was III or IV according to the American Society of Anesthesiologists classification. RESULTS: In all cases bilateral laparoscopic adrenalectomy was successfully performed. Operative time ranged from 375 to 475 minutes (mean 404) and mean blood loss was 162 cc. All patients resumed oral intake on postoperative day 1, mean number of postoperative parentral narcotic doses was 2.25 and mean postoperative hospital stay was 5.75 days (range 3 to 8). Complications included an abdominal wall hematoma. All patients resumed baseline activity by postoperative day 14. CONCLUSIONS: Our experience in 4 cases of Cushing's syndrome suggests that bilateral laparoscopic adrenalectomy is a safe and effective alternative to open adrenalectomy. Further experience with this technique will likely decrease operative time, and confirm the benefit of a decreased hospital stay and convalescence.

Adrenalectomy↗

PubMed1997

Accuracy of renal ultrasound measurements for predicting actual kidney size.

PURPOSE: We attempted to evaluate the accuracy of renal ultrasound measurements for determining actual kidney size in a growing renal unit. MATERIALS AND METHODS: We evaluated 18 renal units in growing piglets weekly for 11 weeks on ultrasound. Measured parameters included length, transverse and anteroposterior dimensions, and volume. At 11 weeks final ultrasound measurements were obtained, animals were sacrificed and gross specimen measurements were made. Final ultrasound dimensions and serial measurements were correlated with actual size. Growth charts were constructed to evaluate variability between observations. RESULTS: Mean difference between final ultrasound renal length and actual size was 3.8 mm. (correlation coefficient 0.74). Serial length measurements were not more accurate than isolated measurements for predicting final length (correlation coefficient 0.34). Volume measurement was not more accurate than renal length. Analysis of individual growth charts revealed a significant week-to-week variation. CONCLUSIONS: Error in ultrasound measured kidney length can equal 1 or more years of growth in a child. Our results show that caution should be used when incorporating ultrasound measurements into surgical decision making.

Animals↗

PubMed1997

Vascular endothelial growth factor (VEGF) expression in human prostate cancer: in situ and in vitro expression of VEGF by human prostate cancer cells.

PURPOSE: A growing body of literature supports the role of angiogenesis in the development and spread of a variety of human cancers including prostate cancer (Pca). Angiogenesis is controlled by chemical signals known as angiogenic factors (AF) however, little is known about angiogenesis factors in prostate cancer. We evaluated the in situ and in vitro expression of vascular endothelial growth factor (VEGF), a potent angiogenic factor, in archival prostate cancer specimens and prostate cancer cell cultures during unstimulated and cytokine stimulated conditions. METHODS: Ex-vivo studies involved immunohistochemical analysis for VEGF expression and distribution in 25 archival specimens including, prostate cancer, benign prostatic hyperplasia (BPH) and normal prostate tissue. In-vitro studies utilized prostate cancer cells (DU-145) grown in culture and stimulated with cytokines thought to induce VEGF (i.e. IL-1 alpha, IL-1 beta, TNF-alpha and TNF-beta). Cell culture supernatants were analyzed by ELISA for VEGF levels. RESULTS: Immunohistochemical studies demonstrated that in 20 of 25 specimens prostate cancers cells stained positively for VEGF. BPH and normal prostate cells displayed little staining for VEGF. DU-145 prostate cancer cells produced low levels of VEGF in unstimulated conditions. Induction of DU-145 cells with cytokines resulted in differential stimulation whereby TNF was a potent inducer of VEGF, and IL-1 produced lesser but statistically significant increases in VEGF expression. CONCLUSIONS: Our immunohistochemical results indicate that significant levels of VEGF are present in prostate cancer, but not in BPH or normal prostate cells in-vivo. In-vitro studies suggest that differential regulation of angiogenesis factor expression by IL-1 and TNF occurs in prostate cancer. Identifying the angiogenesis factors involved in prostate cancer growth and understanding their regulation will lead to the development of anti-angiogenic strategies useful for diagnostic studies and therapeutic interventions.

Cells, Cultured↗

PubMed1996

A comparison of open vs laparoscopic adrenalectomy.

BACKGROUND: To compare the outcome of patients who underwent laparoscopic transabdominal adrenalectomy (LA) with those who had open adrenalectomy (OA). METHODS: A retrospective review of consecutive adrenalectomies performed by a single surgical team at a university hospital. Outcome measurements were operative time, operative blood loss, procedure-related complications, postoperative stay, and return to regular activity. RESULTS: Twenty-nine adrenalectomies were done in 23 patients during a 54-month period. There were 12 OAs performed in nine patients and 17 LAs were done in 14 patients. Both groups were similar in their demographics and their indications for operation. All attempted LAs were successfully completed. The mean operative time was longer for LA than for OA (289 vs 201 min; p = 0.042). Resumption of oral intake (1.0 vs 3.0 days; p = 0.002), postoperative hospital stay (3.0 vs 7.9 days; p = 0.002), and return to regular activity (8.9 vs 14.6 days; p = 0.002) were significantly shorter after LA than after OA. There were no postoperative deaths and there was no difference in operative blood loss between the two groups. Procedure-related complications occurred in three patients having LA and in five patients having OA. CONCLUSIONS: Patients having LA had longer operative procedures but shorter hospital stays and faster return to normal activity than patients having OA. Procedure-related complications for LA were due to bleeding into the retroperitoneum or abdominal wall. Significant postoperative cardiac and respiratory complications occurred only in the OA group.

Adrenal Gland Diseases↗

PubMed1995

Cavernous hemangioma of the scrotum: a rare benign genital tumor of childhood.

Cavernous hemangioma is a benign congenital lesion that rarely involves the scrotum and primarily presents during childhood. We report a case of subcutaneous scrotal-perineal hemangioma in a boy initially believed to have an inguinal hernia. These lesions can be diagnostically and therapeutically challenging. Definitive treatment by en bloc excision is recommended. Special staining techniques may be required for accurate pathological diagnosis.

Genital Neoplasms, Male↗

PubMed1994

Partial nephrectomy in a metachronous multilocular cyst of the kidney (cystic nephroma).

Cystic nephroma, that is multilocular cyst, is an uncommon renal neoplasm once thought to occur only unilaterally. We report a rare case of bilateral metachronous cystic nephroma in a child, which was treated by partial nephrectomy. Because of its benign nature this lesion is best managed by nephron sparing surgery. Exploration of the contralateral kidney is not necessary if modern radiological techniques are used. Magnetic resonance imaging angiography is an excellent noninvasive method to assess renal vessels before partial nephrectomy. Periodic ultrasound or computerized tomography screening of the remaining renal unit is recommended.

Child, Preschool↗

PubMed1994

Noninvasive angiography in preoperative evaluation of complicated pediatric renal masses using phase contrast magnetic resonance angiography.

OBJECTIVES: To report a new technique called "phase contrast magnetic resonance angiography" (PC MRA) utilizing phase contrast magnetic resonance imaging, for assessing the renal vasculature in relation to complicated pediatric renal masses. METHODS: Three-dimensional phase contrast gradient refocused pulse sequences were obtained on four pediatric patients with complicated renal masses. Findings were compared to ultrasound and computed tomographic images and correlated with actual surgical anatomy. RESULTS: In all four cases PC MRA provided standard angiographic quality detail of the renal vascular anatomy. The PC MRA findings had a 100% correlation with surgical exploration and MRA proved to be approximately one third the cost of the standard angiographic technique. CONCLUSIONS: Our experience with the use of PC MRA in children suggests that it can be helpful in evaluating the vasculature of complicated pediatric renal masses. PC MRA utilizes current generation magnetic resonance units, is noninvasive, and does not require anesthesia. It may be especially useful in patients with hypersensitivity to contrast agents, in those with renal failure in whom contrast agents may be contraindicated, and is less expensive than standard angiography.

Child, Preschool↗