Renal angiomyolipoma with extension into renal vein.
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Adult↗
Biomedical subjects
K K Chen
Publications and source records attributed to K K Chen.
The significance of tumour grade in predicting disease progression in stage Ta transitional cell carcinoma of the urinary bladder.
OBJECTIVE: To determine the significance of tumour grade in predicting disease progression in stage Ta transitional cell carcinoma (TCC) of the urinary bladder. PATIENTS AND METHODS: From August 1975 to January 1991, 140 patients (121 men and 19 women, mean age 64.2 years, range 30-83) with stage Ta TCC of the urinary bladder were treated at the Veterans General Hospital-Taipei by transurethral resection and post-operative adjuvant intravesical chemotherapy. There were 48 patients (34%) with grade 1, 78 patients (56%) with grade 2 and 14 patients (10%) with grade 3 tumours. Disease progression and muscle invasion were assessed during a mean follow-up of 74.3 months and related to grade, urine cytology and the number and location of tumours. RESULTS: A total of 10 patients (7%) had tumour recurrence which invaded the muscle, of whom one had grade 1, six had grade 2 and three had grade 3 tumours. The patient with a grade 1 tumour developed muscle invasion within 16 months of surgery. The mean interval to the development of muscle invasion was 49.2 months in patients with grade 2 and 39.4 months with grade 3 tumour. In patients with stage Ta TCC, a grade 3 tumour was more likely to progress to muscle invasion (21%) than was a grade 1 (2.1%; P < 0.05) or grade 2 (7.7%; P < 0.05) tumour. One patient with a grade 2 and one patient with grade 3 tumour developed distant metastases without muscle invasion. Overall, the disease progression rate was 8.6% (12/140) in stage Ta TCC. Disease progression was more common with grade 3 (28.5%) than with grade 2 (9.0%; P < 0.05) and grade 1 (2.1%; P < 0.05) tumours. CONCLUSION: Tumour grade may be used to predict disease progression after resection of stage Ta urinary bladder cancer. A higher grade of tumour was associated with a higher incidence of disease progression.
Administration, Intravesical↗
Laparoscopic ligation of bilateral spermatic varices under epidural anesthesia.
Feasibility and safety of laparoscopic ligation of bilateral internal spermatic varices under epidural anesthesia were assessed in 11 patients. Another 11 patients undergoing the same procedure under ventilation-assisted anesthesia served as controls. Patients in both groups belonged to the American Society of Anesthesia functional class I. Arterial blood analyses were obtained (1) in the horizontal supine position; (2) in the 15 degrees Trendelenburg position; (3) at 15 min after carbon dioxide pneumoperitoneum insufflation, and (4) at 15 min after desufflation in the supine position. In the epidural anesthesia group arterial blood parameters and respiratory rate remained stable in the Trendelenburg position. After intraperitoneal insufflation of carbon dioxide for 15 min, the arterial carbon dioxide level increased from 40.1 +/- 2.2 to 42.1 +/- 2.6 mm Hg, the respiratory rate increased from 17.0 +/- 1.4 to 20.6 +/- 1.2/min, the blood pH value decreased from 7.386 +/- 0.027 to 7.355 +/- 0.034, all values showing statistically significant differences. These changes returned to the preinsufflation level 15 min after release of the pneumoperitoneum. The above-mentioned parameters remained unchanged under the pneumoperitoneum by assisted ventilation in the control group. The mean time of surgery was similar in both groups: 82 and 90 min for the groups having general and epidural anesthesia, respectively. All laparoscopic procedures were accomplished successfully under general anesthesia. However, failure to ligate the internal spermatic varices occurred in 3 patients under epidural anesthesia, mainly due to patient intolerance to abdominal distension. The operation was continued under intubated general anesthesia for relaxing the abdominal muscle to provide an adequate working space. In 8 patients being successfully operated under epidural anesthesia, 5 experienced mild but tolerable abdominal distension; 2 complained of shoulder pain intraoperatively. Although laparoscopic ligation of internal spermatic varices could be accomplished in some patients under epidural anesthesia, it carried a high failure rate, more intraoperative morbidity, and significant arterial blood gas alterations. Routine ventilation-assisted anesthesia is suggested for therapeutic laparoscopy even for an easy procedure such as the ligation of the internal spermatic varices.
Anesthesia, Epidural↗
Adjuvant methotrexate, vinblastine and cisplatin chemotherapy for invasive transitional cell carcinoma: Taiwan experience.
PURPOSE: The feasibility of adjuvant cisplatin, methotrexate and vinblastine chemotherapy was evaluated in Taiwanese patients with invasive transitional cell carcinoma at high risk for recurrence. MATERIALS AND METHODS: We assigned 56 patients with high risk transitional cell carcinoma (vascular or lymphatic invasion in the primary tumor, poorly differentiated stage P2, P3, P4 or N+ and M0) to receive adjuvant chemotherapy after radical urological surgery. The chemotherapy consisted of 40 mg./m.2 methotrexate and 4 mg./m.2 vinblastine on days 1 and 8, and 100 mg./m.2 cisplatin on day 2 given in 6 courses at 21-day intervals. RESULTS: Median followup was 44 months. An average of 4.63 cycles of chemotherapy was administered. The median actual survival was 44 months, and the 1 and 3-year survival probabilities were 92% and 50%, respectively. The median disease-free survival was 15.5 months, and the 1 and 3-year disease-free survival probabilities were 66% and 28%, respectively. Only 5 (9%) and 1 (2%) patients had grades 3 and 4 leukopenia, respectively, and none died of sepsis. CONCLUSIONS: The use of adjuvant cisplatin, methotrexate and vinblastine chemotherapy in patients with invasive transitional cell carcinoma at high risk for recurrence is feasible with tolerable toxicity but randomized controlled trials will be required to assess the benefit.
Antineoplastic Combined Chemotherapy Protocols↗
Dynamic infusion cavernosometry and cavernosography (DICC) in the evaluation of vasculogenic impotence.
BACKGROUND: This study was conducted to find more accurate physiological assessment of the penile vascular status in impotent patients. METHODS: Twenty-two males, aged 25-76 years (mean 54.0 years) with possible underlying vascular causes of impotence, had dynamic infusion cavernosometry and cavernosography (DICC) examination to ascertain the arterial and/or venous insufficiency in the penis. Prostaglandin E1 20 micrograms was injected intracavernously in this 4-phase study. RESULTS: No side effect or complication was noted during or after the examination in all 22 patients. During the phase 1 test, the mean resting intracavernous pressure (ICP) was 6.8 +/- 3.6 mmHg and the mean plateau ICP after PGE1 injection was 47.2 +/- 23.9 mmHg. The mean ratio of plateau ICP to mean arterial pressure was 50.2 +/- 23.4%. In the phase 2, the mean ICP determined 30 seconds after cessation of saline infusion without and with perineal compression was 65.3 +/- 26.8 mmHg and 129.1 +/- 26.2 mmHg, respectively. The mean ICP decay from 150 mmHg was 84.7 +/- 26.8 mmHg. The mean systolic pressure of each cavernous artery, 87.6 +/- 18.9 mmHg and 93.6 +/- 17.6 mmHg in left and right side, respectively, was found during phase 3 evaluation. The mean ratio of systolic pressure of each cavernous artery to brachial artery (cavernous-brachial index, CBI) was 70.1 +/- 12.7% and 75.1 +/- 11.5% in left and right side, respectively. Six patients with CBI greater than 75% had normal Doppler duplex sonography (diameter of cavernous artery greater than 0.9 mm and peak flow velocity greater than 25 cm/sec). Cavernosography in phase 4 evaluation showed venous leakage in 20 of 22 patients (90.9%) with ICP decay greater than 60 mmHg. Two patients with ICP decay less than 45 mmHg were found to have no venous leakage. CONCLUSIONS: The cavernous-brachial index is usually less than 75% in penile arterial insufficiency. The patients with ICP decay from 150 mmHg greater than 60 mmHg would have penile venous leakage demonstrated in the cavernosography. The results of cavernosometry are highly correlated with cavernosography. Our results suggest that DICC may provide a good examination for more physiological assessment and accurate diagnosis of vasculogenic impotence.
Adult↗
Recurrence rate and risk factors for urinary calculi after extracorporeal shock wave lithotripsy.
PURPOSE: We determined the recurrence rate after extracorporeal shock wave lithotripsy (ESWL*) and evaluated its associated risk factors, such as patient sex and age, volume of daily water intake, related diseases, family history of urinary calculi, number, burden and location of stones, residual stones after ESWL, serum uric acid level before ESWL and so forth. MATERIALS AND METHODS: We conducted a retrospective study of 841 patients who underwent ESWL for primary treatment of urinary calculi between 1985 and 1987. Charts were reviewed for stone characteristics, outcomes and associated laboratory data. Followup 6 to 9 years later was done by mail and telephone interviews. RESULTS: Followup data were available for 436 patients (52%). Overall, stones recurred in 51% of the 436 patients at a mean followup of 7.1 years. Late recurrences were common, and were noted in as many as 70% of the patients after 9 years. This rate is greater than what has been previously reported after other treatments. Cox regression analysis indicated that the major risk factors associated with recurrence were male gender (relative risk 1.406, p < 0.05) and multiple stones (relative risk 1.777, p < 0.05). CONCLUSIONS: The frequent late recurrences support the speculation that ESWL might lead to greater recurrence rates. Therefore, the cost-effectiveness of ESWL versus other modalities for stone removal warrants more long-term evaluation.
Adolescent↗
Urinary bladder endometriosis: a report of two cases.
Endometriosis of the urinary tract is uncommon, and the most common site of involvement is urinary bladder. Two cases of endometriosis of urinary bladder are presented. The first patient, a 39-year-old woman, complained of dysuria during menstruation and the other 37-year-old woman suffered from intermittent gross hematuria. Pre-operative examinations included ultrasonography, computed tomography and cystoscopic biopsy. Case 1 was in premenopausal status, but the serum estrogen level of case 2 was in postmenopausal status because she was given no exogenous estrogen after previous bilateral salpingo-oophorectomy. Endometriosis of urinary bladder rarely occurs in postmenopausal woman without exogenous estrogen replacement. Case 1 received danazole treatment after transurethral resection of bladder tumor and case 2 received partial cystectomy after transurethral resection of bladder tumor. The patients were followed 36 and 4 months, respectively, and the symptoms kept improving during this period.
Adult↗
Adrenal cortical carcinoma with tumor thrombus invasion of inferior vena cava.
A case of adrenal cortical carcinoma with inferior vena cava (IVC) involvement is presented. Ultrasonography, computed tomography, and venacavography all presumptively showed a large mass over the upper pole of the left kidney with tumor thrombus in the IVC. However, aortography demonstrated that this mass was receiving its blood supply from the left inferior phrenic artery, aorta, and left renal artery. Radical surgery, including resection of the tumor and its adjacent organs (kidney, distal pancreas, spleen) and the tumor thrombus in the IVC, with the aid of cardiopulmonary bypass, was performed. We emphasize that adrenal cortical carcinoma can have tumor thrombi invading the IVC, and in such cases we suggest radical surgical removal of the tumor and the thrombus.
Adrenal Cortex Neoplasms↗
Direct needle insufflation for pneumoretroperitoneum: anatomic confirmation and clinical experience.
OBJECTIVES: The feasibility and safety of direct needle insufflation to create pneumoretroperitoneum was assessed by an imaging study and clinical experience. METHODS: A total of 10 patients without previous retroperitoneal surgery or diseases received computed tomography scans of the retroperitoneum 2 cm above the iliac crest. Distances between quadratus lumborum and colon (Q-C distance) were measured in the supine and lateral positions. Changes of Q-C distance were calculated when the patient was changed from the supine to the lateral position. Operative charts on 38 retroperitoneoscopic procedures were collected prospectively to assess complications related to direct needle insufflation, which was performed by inserting a 14 G Veress needle blindly along the posterior axillary line 2 cm above the iliac crest. RESULTS: Q-C distance increased from 8.7 to 27.3 mm (left side) and 4.6 to 18.1 mm (right side) when the patient was changed from the supine to the lateral position, both P values < 0.05. An average distance of 23 mm between colon and quadratus lumborum was found when patients were lying laterally. The misplacement of a Veress needle was encountered in 1 patient, in which a prefascia insufflation resulted in conversion of the endoscopic procedure. Needle puncture caused no visceral or great vessel injury. CONCLUSIONS: Significant anterior movement of the colon was found when patients were changed from the supine to the lateral position. It provided a window for inserting the Veress needle blindly into the retroperitoneum. The high success rate (97%) and low complication rate of direct needle insufflation were found in actual clinical applications. We considered needle insufflation a safe and effective method of establishing a pneumoretroperitoneum for any retroperitoneoscopic procedure.
Adult↗
Femoral neuropathy after pelvic surgery.
Femoral neuropathy is an uncommon complication following pelvic surgery. We report on 2 cases of femoral nerve injury after pelvic surgery: 1 patient received radical cystectomy due to invasive transitional cell carcinoma of the urinary bladder, and the other patient had a transurethral resection of the bladder and received exploration and biopsy of a tumor mass over the right sacroiliac joint area. Pathogenesis and prevention of the complication of femoral neuropathy are discussed in the following report.
Aged↗
The subjective assessment and pressure-flow study of outcome of surgical treatment for patients with prostatism and high voiding pressure.
BACKGROUND: In 1992, the International Continence Society (ICS) began to conduct an international multicenter study to correlate the symptoms and urodynamics in patients with BPH. Our institute was invited to participate this ICS-BPH study, and the preliminary (phase I) results have revealed poor correlation between preoperative symptoms and parameters of the pressure-flow study. This phase II study continued the phase I ICS-BPH study to assess the changes of subjective symptoms and objective parameters of pressure-flow study before and after TURP. METHODS: Fifty-two patients with prostatism, aged from 56 to 80, were evaluated using the ICS-BPH questionnaire, free urine flow rate and pressure-flow study. According to the criteria of maximum urine flow rate (Qmax) 15 ml/sec and voiding intravesical pressure at Qmax (Pves at Qmax) 100 cm H2O, low flow-high pressure (LFHP) was proved in 20 patients (38%), high flow-high pressure (HFHP) in 22 (42%), low flow-low pressure (LFLP) in 3 (6%), and high flow-low pressure (HFLP) in 7 (14%). Transurethral resection of the prostate (TURP) was performed for 33 of 42 patients with high voiding pressure (LFHP and HFHP groups). RESULTS: The weight of the TURP specimen was 28 +/- 6.3 gm. Sixteen patients repeated the questionnaire and pressure-flow study 9.0 +/- 2.1 months after surgery. Both irritative and obstructive symptom scores decreased in 15 (94%) of the 16 patients (p < 0.001). The opening intravesical pressure (openPves) and Pves at Qmax improved from 136 +/- 34 and 124 +/- 30 cm H2O preoperatively to 89 +/- 25 and 94 +/- 22 cm H2O postoperatively respectively (p < 0.004). However, UFRmax, 16.7 +/- 6.0 ml/sec preoperatively and 19.3 +/- 6.4 postoperatively, showed no statistical difference. If the HFHP and LFHP groups were compared separately, the degree of improvement in symptomatology or parameters of pressure-flow study was similar, although changes in HFHP group appeared more evident. UFRmax in LFHP group changed significantly from 11.9 +/- 2.8 preoperatively to 22.1 +/- 6.7 ml/sec postoperatively. For the patients with high flow obstruction (HFHP group), although UFRmax did not increase after TURP, the symptom score, openPves and Pves at Qmax, decreased as much as the LFHP group did. CONCLUSIONS: Based on the analysis of the pressure flow study, TURP not only offers an advantage to the patient with classical obstruction (LFHP group), but also to patients with high flow obstruction (HFHP group). However, this does not suggest that a pressure-flow study should be performed routinely for a male with prostatism. It is advised only for patients with Qmax > 15 ml/sec but exhibiting typical symptoms.
Aged↗
The time for serum testosterone to reach castrate level after bilateral orchiectomy or oral estrogen in the management of metastatic prostatic cancer.
OBJECTIVE: To understand the time for serum testosterone to reach castrate level after bilateral orchiectomy or oral estrogen in the management of metastatic prostatic cancer. METHODS: A total of 20 consecutive patients with adenocarcinoma of the prostate with bony metastasis were enrolled in this study. Their mean age was 72.8 years old (range, 57 to 82 years). Pretreatment serum testosterone levels were obtained in all men. Thirteen men were treated with bilateral orchiectomy. Immediately after removal of testes, serial blood samplings for serum testosterone levels were drawn every fifteen minutes for the first two hours, then hourly for another sixteen hours. Seven men were treated with oral estrogen diethylstilbestrol (DES), 3 mg per day. Serum testosterone levels were checked on a weekly basis for two months, and then biweekly for another two months. RESULTS: Castration time of bilateral orchiectomy ranges from three to twelve hours (mean, 8.6 hours). The biological half-life of serum testosterone was from thirty to sixty minutes (mean, 45 minutes). Castration time of oral estrogen (DES) was from twenty-one to sixty days (mean, 38.3 days). CONCLUSIONS: Bilateral orchiectomy and oral estrogen were both effective ways of castration for patients with bony metastatic prostatic cancer. Bilateral orchiectomy provides a more rapid castration and is one hundred seven times faster than oral estrogen in reaching castrate level.
Adenocarcinoma↗
The association of aldosterone-producing adrenal adenoma in a patient with autosomal dominant polycystic kidney disease.
We report a young female with autosomal dominant polycystic kidney disease associated with right adrenal adenoma. Refractory hypertension and hypokalemia were the findings that led to this diagnosis. The diagnostic approach included plasma potassium and aldosterone levels, plasma renin activity, captopril test, saline infusion test, NP-59 scintigraphy, computed tomography, and magnetic resonance imaging. Adrenalectomy completely normalized hypertension and hypokalemia in this patient.
Adenoma↗
Effectiveness of shunting in patients with normal pressure hydrocephalus predicted by temporary, controlled-resistance, continuous lumbar drainage: a pilot study.
From 1984 to 1992 15 consecutive cases of normal pressure hydrocephalus were included in this pilot study. A series of tests included CT of the brain, grading of the cognitive mental state with the mini-mental state examination; urodynamic studies, and gait evaluation. These tests were carried out on admission, and repeated on day 1, day 3, and day 5 after controlled-resistance, continuous lumbar drainage (CRCLD). During this period, eight patients showed significant improvements of cognitive mental state, urodynamic studies, or gait and were regarded as CRCLD responders; the remaining seven patients were regarded as CRCLD non-responders. The CRCLD was routinely removed on day 6 after the drainage procedure and a ventriculoperitoneal (VP) or a lumboperitoneal (LP) shunt was randomly selected for each patient. The tests were repeated one week after shunting and a year later. All the CRCLD responders continued to benefit from shunting at one week and one year after the procedure irrespective of the type of shunting they received. By comparison, none of the CRCLD non-responders showed any improvement a year after the shunting. In conclusion, CRCLD proved to be a safe and effective way to predict the effectiveness of shunting in patients with normal pressure hydrocephalus.
Aged↗
Prediction of lymphatic spreading in prostatic cancer by prostate-specific antigen and Gleason's score.
A total of 58 patients have undergone bilateral pelvic lymphadenectomy as a staging procedure for clinically localized adenocarcinoma of the prostate. Of these, 19 patients (33%) had pelvic lymph node involvement. When a cutoff value of 50 ng/ml was used, the preoperative prostate-specific antigen (PSA) value had a positive predictive value of 57% for pelvic lymph node metastasis. Of the patients with PSA < 20 ng/ml, only 1 (4%) had evidence of lymph node metastasis. None of the patients with well-differentiated tumor (Gleason 2-4) had lymphatic spreading. In contrast, 82% of patients with poorly differentiated tumor (Gleason 8-10) had positive pelvic lymph nodes. Those patients with high PSA (> or = 20 ng/ml) and high Gleason's score (> or = 8) had the highest incidence of nodal extension (90%).
Aged↗
Secondary hypertension due to renin secreting tumor: a case report.
We report a 20-year-old female with severe hypertension, hypokalemia, hyperaldosteronism and elevated level of plasma renin activity (PRA). The clinical diagnosis of renin secreting tumor of left kidney was made before surgery by the lateralization of plasma renin activity via selective renal venous blood sampling and CT scan of kidney. Prompt normalization of blood pressure and decrease of PRA and aldosterone levels were found after surgical removal of the tumor. The pathological findings showed a juxtaglomerular cell tumor.
Adenocarcinoma↗
Histopathological changes in Kock pouch.
To investigate whether tumour recurrence or histological changes occur in the Kock pouch, periodic endoscopy with biopsy of the pouch was performed in 15 patients 6 to 66 months after radical cystectomy and urinary diversion for invasive bladder cancer. Endoscopy was undertaken 1 to 4 times in each patient (a total of 37 times in all patients). During endoscopy, random biopsies were taken from the pouch wall, and from the afferent and the efferent nipples. The histological changes were graded as: (1) villous atrophy (grade 0 to 3, 0: nearly normal; 1: shortening, villi/crypt of Lieberkuhn [length] between 1.5 and 4.0; 2: moderate flattening, villi/crypt < 1.5; and 3: almost complete disappearance of villi); (2) fibrosis; and (3) chronic inflammation (grade 0 to 3, based on the amount of fibrous tissue and inflammatory cell infiltration in the lamina propria, respectively). There was no dysplasia or malignant tumour in the Kock pouch in any of the 15 patients. The histology of the ileum changed in terms of villous atrophy, fibrosis and chronic inflammation in the lamina propria and thickening of the muscularis mucosa. The same grade of villous atrophy of the pouch wall, the afferent and the efferent nipples was only found in 3 patients. More fibrosis and less chronic inflammation in the lamina propria were found at the efferent nipple than at the afferent nipple or pouch wall in 8 patients and 5 patients, respectively. Thickening of the muscularis mucosa was found in 13 of 15 patients (86.7%). In conclusion, there was no dysplasia or recurrent tumour in the Kock pouch in patients who were followed for up to 66 months. Various grades of histological changes of the ileum in terms of villous atrophy, fibrosis and chronic inflammation of the lamina propria, and thickening of the muscularis mucosa were found in the pouch wall, and in the afferent and efferent nipples. More fibrosis and less chronic inflammation were commonly observed at the efferent nipple than at the afferent nipple or pouch wall. The degree of histological changes varied even among patients followed over the same period after operation. The time to progression of villous atrophy also varied. The histological changes in some patients were dissimilar even at the same site of the Kock pouch.
Aged↗
Long-term stone regrowth and recurrence rates after extracorporeal shock wave lithotripsy.
We reviewed 1055 patients with symptomatic urinary calculi treated by extracorporeal shock wave lithotripsy (ESWL) monotherapy to determine the long-term stone regrowth and recurrence rates as correlated with the pre-treatment stone burden, site and multiplicity. Long-term follow-up (mean 75.8 months) was available in 94 patients, representing 106 renal units. The recurrence of stone was defined as reappearance of stone on follow-up plain abdominal radiographs. The regrowth of stone was defined as stone regrowing larger than one-third of the original residual size. A stone-free rate of 53% was achieved. The overall stone regrowth and recurrence rates were 26 and 15% respectively. It was concluded that the stone recurrence rate after ESWL was not influenced significantly by the stone size or the multiplicity, but that the regrowth rate was. Stone recurrence and regrowth rates after ESWL were both influenced by the stone location.
Adult↗