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Sami Arap

Publications and source records attributed to Sami Arap.

At least 37 records · Page 2Linked to original sources
PubMed2004

Laparoscopic nephrectomy for wilms tumor after chemotherapy: initial experience.

PURPOSE: We describe 2 cases of laparoscopic nephrectomy for unilateral Wilms tumor in children who underwent preoperative chemotherapy. MATERIALS AND METHODS: Two children with unilateral nonmetastatic Wilms tumor included in the International Society of Pediatric Oncology 2001 protocol were preoperatively treated with vincristine/actinomycin D and subsequently underwent laparoscopic nephrectomy and lymph node sampling. A 5 and 10 mm trocar transperitoneal approach was used in each case. The tumor was extracted without morcellation through a 4 cm Pffannensteil incision. RESULTS: The 2 tumors were completely removed as well as lymph node samples. Intraoperative bleeding was minimal (50 ml). The postoperative period was free of complications and patients were discharged home after 3 days. CONCLUSIONS: Laparoscopic nephrectomy for Wilms tumor is feasible in children after chemotherapy. It is a safe procedure and it allows the complete surgical approach required to treat this tumor. Longer followup is necessary to evaluate long-term results and more cases are necessary to compare the results of laparoscopic techniques with those of open surgical procedures.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2004

Surgery for adrenal tumours with thrombus in the supra-diaphragmatic infra-atrial inferior vena cava, with no cardiopulmonary bypass.

OBJECTIVES: To assess the result of surgery for adrenal neoplasia with thrombus in the supra-diaphragmatic infra-atrial inferior vena cava. PATIENTS AND METHODS: Five patients with adrenal cortex carcinoma and three with phaeochromocytoma were reviewed. All the thrombi were removed through a right thoracophrenolaparotomy in the fifth intercostal space, with clamping of the intrathoracic portion of the inferior vena cava, with no cardiopulmonary bypass. In the first two cases the thrombi were removed in a second surgical procedure after resecting the tumours. In the other six the complete procedure was done in one surgical stage. RESULTS: There were no surgery-related deaths. The major complications after surgery were pulmonary atelectasis, acute renal failure, a large retroperitoneal collection, deep vein thrombosis and pulmonary embolism, each in one patient. Of the five patients with adrenal cortex carcinoma one is still alive after 15 years with no evidence of disease, one is alive with pulmonary metastases 15 months after surgery and the other three died from widespread disease after 5, 12 and 15 months. Of the three patients with phaeochromocytoma, two show no evidence of the disease 2.5 and 11 years later and one died from myocardial infarction, with no evidence of the disease, 9 years later. CONCLUSION: Thrombi from adrenal neoplasia in the supra-diaphragmatic infra-atrial inferior vena cava may be removed with no need for cardiopulmonary bypass and cardiac arrest, thus avoiding the associated morbidity and high cost.

Adenocarcinoma↗
PubMed2003

Trends in male contraception.

Methods that are available for male contraception, namely coitus interruptus, condoms, and vasectomy, have been used since the 19th century. With the exceptions of a few improvements of these methods, no major progress has been made with respect to introducing new male contraceptives since then. It is extremely urgent to develop new, safe, effective, and reversible male contraceptive methods. Among all male contraceptive methods that are being investigated, the hormonal approach is the closest to clinical application. Hormonal contraception provides pregnancy protection by means of spermatogenic suppression. Androgen-progestin regimens currently represent the best available hormonal combination for induction of a profound suppression of spermatogenesis. Further development of new steroids is mandatory for increasing the choices of available contraceptive formulations and to optimize long-term safety of these regimens.

Androgens↗
PubMed2003

Measuring male infertility: epidemiological aspects.

Evidence suggests that human semen quality may have been deteriorating in recent years. Most of the evidence is retrospective, based on analysis of data sets collected for other purposes. Measures of male infertility are needed if we want to monitor the biological capacity for males to reproduce over time or between different populations. We also need these measures in analytical epidemiology if we want to identify risk indicators, risk factors, or even causes of an impaired male fecundity-that is, the male component in the biological ability to reproduce. The most direct evaluation of fecundity is to measure the time it takes to conceive. Since the time of conception may be missed in the case of an early abortion, time to get pregnant is often measured as the time it takes to obtain a conception that survives until a clinically recognized pregnancy or even a pregnancy that ends with a live born child occurs. A prolonged time required to produce pregnancy may therefore be due to a failure to conceive or a failure to maintain a pregnancy until clinical recognition. Studies that focus on quantitative changes in fecundity (that does not cause sterility) should in principle be possible in a pregnancy sample. The most important limitation in fertility studies is that the design requires equal persistency in trying to become pregnant and rather similar fertility desires and family planning methods in the groups to be compared. This design is probably achievable in exposure studies that make comparisons with reasonable comparable groups concerning social conditions and use of contraceptive methods.

Female↗
PubMed2003

Bilateral giant renal angiomyolipoma associated with hepatic lipoma in a patient with tuberous sclerosis.

OBJECTIVE: To report a case of bilateral giant renal angiomyolipoma associated with tuberous sclerosis, with successful treatment, and to review the literature concerning angiomyolipoma treatment. CASE REPORT: Patient with tuberous sclerosis and angiomyolipoma diagnosed by ultrasonography during her pregnancy. At that time, the angiomyolipoma on the right side was 9 cm in diameter. Conservative management was selected during her pregnancy. The patient returned 7 years later, with a 24.7 x 19.2 x 10.7 cm tumor on the right side and another of 13 x 11.5 x 6.5 cm on the left side, in addition to multiple small angiomyolipomas. A nephron-sparing surgery with tumoral enucleation was performed on the right side, and after 3 months, the tumor on the left side was removed. Renal function in the post-operative period was preserved, and contrast medium progression was uniform and adequate in both kidneys. CONCLUSION: We conclude that an angiomyolipoma larger than 4 cm should be removed surgically, since they have a greater growth rate and pose a risk of hemorrhage. Resection of smaller tumors is safe and has decreased morbidity. Tumoral enucleation is an effective treatment method that preserves kidney function.

Adult↗
PubMed2003

Adrenocortical tumors: results of treatment and study of Weiss's score as a prognostic factor.

PURPOSE: The differential diagnosis between benign and malignant adrenal cortical tumors circumscribed to the gland is controversial. One hundred and seven patients with adrenal cortex tumors (excluding those with primary hyperaldosteronism) were studied to assess the 5-year survival rate of adults, children, patients stratified by pathological stage, and patients stratified according to Weiss's score of <3 or >3. METHODS: The patients were evaluated both clinically and biochemically. One hundred and five patients underwent surgery and were classified pathologically as stages I, II, III, or IV. The tumors were weighed, measured, and classified according to Weiss's criteria and divided into 2 groups: <3 and >3. RESULTS: After 5 years, the survival rate was 77.5% for the whole group, 74.61% for the adults, 84.3% for the children, 100% for stage I, 83.9% for stage II, 33% for stage III, and 11.7% for stage IV groups. Additionally, after 5 years, 100% of the patients with tumors with Weiss's score <3 were alive compared to 61.65% of those with Weiss's score >3. The average weights of the tumors of score <3 and >3 were 23.38 g 41.36 g and 376.3 538.76 g, respectively, which is a statistically significant difference. The average sizes of tumors of Weiss's score <3 and >3 were 3.67 2.2 cm and 9.64 5.8 cm, respectively, which is also a statistically significant difference. CONCLUSIONS: Weiss's score may be a good prognostic factor for tumors of the adrenal cortex. Additionally, there was a statistically significant difference between the average weight and size of tumors with benign behavior (Weiss's score <3) and those with malignant behavior (Weiss's score >3).

Adenoma↗
PubMed2003

Laparoscopic adrenal surgery in a Brazilian center.

BACKGROUND AND PURPOSE: The laparoscopic approach to the adrenal gland was first reported in 1992. Since then, many publications about this issue have come from Europe, Japan, and North America. We reviewed our 7-year experience with laparoscopic adrenal surgery. This is the first large series presented from Latin America. PATIENTS AND METHODS: Laparoscopic adrenalectomy was carried out in 61 female and 33 male patients between January 1994 and February 2001. Their ages ranged from 1 to 72 (42.8 +/- 16.4 years) years. Ten patients (10.6%) were 20 years or younger, 10 (10.6%) had unilateral tumors >4 cm, 22 (23.4%) had a Body Mass Index >/= 30, and 10 (10.6%) had had previous open upper abdominal surgery. The size of the lesion ranged from 1 to 9 cm (2.9 +/- 4 cm). Ninety-seven operations were performed, of which 91 were unilateral and 6 were bilateral, adding up to 103 adrenalectomies. Among the 97 procedures, the lateral transperitoneal approach was employed in 94 cases, whereas a lateral retroperitoneal approach enabled 3 adrenalectomies. RESULTS: Unilateral procedures lasted 117 +/- 43.7 minutes (range 45-250 minutes); bilateral procedures lasted 186 +/- 91.6 minutes (range 100-345 minutes). Five operations (5.1%) were converted to open surgery. Twenty patients (21.3%) suffered complications, 8 (8.5%) being intraoperative and 12 (12.8%) postoperative. Six cases (6.4%) were considered major complications. No deaths occurred. The blood transfusion rate was 4.2%. The hospital stay averaged 6.1 +/- 15.3 days (range 1-140 days). The follow-up period was 17 +/- 12.6 months (range 1-60 months). CONCLUSIONS: Laparoscopic adrenalectomy is feasible and has excellent results in properly selected patients.

Adolescent↗
PubMed2003

Induction of spermatogenesis in azoospermic men after varicocele repair.

BACKGROUND: The purpose of this study was to assess the treatment outcome after varicocele repair in azoospermic men and to correlate this outcome with the testicular histology patterns. METHODS: Medical records of 15 azoospermic men who underwent testis biopsy and microsurgical repair of clinical varicocele between July 1999 and November 2000 were reviewed. All patients had at least two semen analyses showing azoospermia taken before the surgery and two semen analyses post-operatively. Hypospermatogenesis was identified in four, maturation arrest in six, and germ cell aplasia in five men. RESULTS: Induction of spermatogenesis was achieved in seven men (47%). Of these, four had germ cell aplasia and three had maturation arrest. The improvement in sperm concentration and motility in patients with germ cell aplasia ranged from 1.8 to 7.9 x 10(6)/ml, and from 32 to 76% respectively. Of these seven patients with improvement in semen quality, five relapsed into azoospermia 6 months after the recovery of spermatogenesis (four germ cell aplasia and one maturation arrest). One patient with maturation arrest established a pregnancy. CONCLUSIONS: Azoospermic patients may have an improvement in semen quality following varicocelectomy. Semen samples should be cryopreserved after an initial improvement following varicocelectomy, as relapse to a state of azoospermia may occur.

Adult↗
PubMed2003

Comparative study of sclerotherapy with phenol and surgical treatment for hydrocele.

PURPOSE: We compared the efficiency, side effects and effects on spermatogenesis of sclerotherapy with phenol and surgical treatment for hydrocele. MATERIALS AND METHODS: A total of 67 patients (80 hydroceles) were randomly divided into 2 groups of 40 hydroceles each. One group underwent phenol sclerotherapy and the other underwent hydrocelectomy. Spermiograms were done before, 6 and 12 months after treatment in patients able to ejaculate. RESULTS: In the sclerotherapy group 47.5%, 30%, 12.5%, 5% and 2.5% of the hydroceles were cured with 1 to 5 injections, respectively, but 2.5% were not cured even with 6 injections. There were no complaints of localized pain or infection in these cases. All patients returned to normal activity on the same day. In the hydrocelectomy group 97.5% and 2.5% of hydroceles were cured with 1 and 2 operations, respectively. There was pain postoperatively in 73.5% of the patients and localized infection in 5%, while 62.5% required an average of 4.5 days of rest and were absent from work for 10 days. There was no significant statistical alteration in spermatozoid concentration in the preoperative, and 6 and 12-month postoperative counts in the groups (p = 0.385). CONCLUSIONS: Sclerotherapy for hydrocele with phenol is as efficacious as hydrocelectomy, while causing less morbidity and similar effects on spermatogenesis.

Adolescent↗
PubMed2003

Surgical complications of graft nephrectomy in the modern transplant era.

PURPOSE: Transplant nephrectomy has been considered a hazardous procedure throughout transplantation history. Better surgical techniques and clinical treatment of patients have improved the results of this surgery in the last decades. We report the surgical complications of nephrectomy of early and late failed kidneys performed at a referral center. MATERIALS AND METHODS: The charts of 70 consecutive patients who underwent graft nephrectomy between May 1994 and April 2002 were reviewed regarding surgical complications. Patients were divided into 2 groups according to the timing of graft removal. Early nephrectomy group 1 included 23 procedures performed in the first 60 days after transplantation and late nephrectomy group 2 included 47 performed after that interval. Groups were compared concerning outcome, blood loss and amount of blood transfused in the perioperative period, and the incidence of surgical complications according to the surgical technique, immunosuppressive regimen and timing of surgery. RESULTS: Mean blood loss was 434 ml (range 20 to 3,000) in group 1 and 546 (range 60 to 2,200) in group 2 (p = 0.02). Nine group 1 patients (39.1%) and 22 in group 2 (46.8%) received blood transfusion in the perioperative period (p = 0.62). The mean amount of blood transfused was 516.7 ml in group 1 and 436.3 ml in group 2 (p = 0.36). Four and 2 minor surgical complications occurred in groups 1 and 2 (17.4% and 4.3%, respectively, p = 0.09). Seven major complications were noted in group 2 (14.9%), while there were none in group 1 (p = 0.05). Three complications (25%) occurred in patients who received antirejection globulins or methylprednisolone and 1 (9.1%) developed when these agents were not administered (p = 0.33). The incidence of surgical complications after intracapsular and extracapsular nephrectomy was 20% and 17.6%, respectively (p = 0.58). Mean blood loss and the mean amount of blood transfused was 638 and 525 ml for intracapsular nephrectomy and 383 and 350 ml for extracapsular nephrectomy, respectively, respectively. Surgical complications occurred in 3 patients who received mycophenolate mofetil (23.1%) and in 6 (17.6%) who did not received this drug (p = 0.48). CONCLUSIONS: Blood loss and surgical complication rates were higher in late failed graft nephrectomies. Surgical complications in intracapsular vs extracapsular nephrectomies were similar but blood loss and transfusions were higher for intracapsular nephrectomy. Acute rejection treatment, or prophylaxis with methylprednisolone or globulins increased the incidence of surgical complications.

Adolescent↗
PubMed2002

CpG hypermethylation of promoter region and inactivation of E-cadherin gene in human bladder cancer.

Several studies have shown that E-cadherin expression is lost during malignant transformation. We hypothesized that CpG methylation in the promoter region may inactivate the expression of the E-cadherin gene in human bladder cancer. Normal and bladder cancer samples from 51 patients were compared in terms of E-cadherin gene expression and methylation status by immunohistochemistry, methylation-specific polymerase chain reaction (MSP), and bisulfite genome-sequencing techniques. Ten different CpG sites (nt 863, 865, 873, 879, 887, 892, 901, 918, 920, and 940) in the promoter region were studied. Thirty-five of 51 (69%) bladder cancer samples lacked E-cadherin expression, whereas only six of 51 (12%) normal bladder samples lacked E-cadherin immunoreactivity. MSP analysis of bladder cancer samples suggested that 43 of 51 (84%) showed methylation of the promoter region, whereas only 12 of 51 (24%) normal bladder samples showed hypermethylation. Sodium bisulfite genome-sequencing analysis revealed that of 10 CpG sites, two sites (nt 892 and nt 940) showed 100% methylation in all the cancer samples analyzed. Other CpG sites were partially methylated (47-91%). Normal tissue showed only 12% methylation (range, 1-33%) on various CpG sites. Also supporting these data, E-cadherin-negative bladder cancer cell lines restored expression of the E-cadherin gene after treatment with the demethylating agent 5-aza-2'-deoxycytidine. The present study showed that CpG hypermethylation was an important mechanism of E-cadherin gene inactivation in bladder cancer and also that specific CpG sites consistently presented higher methylation levels than others. These findings may provide a better strategy for the diagnosis and management of bladder cancer.

Aged↗
PubMed2002

Schistosomal myelopathy: urologic manifestations and urodynamic findings.

OBJECTIVES: To describe the clinical and urodynamic features of patients with voiding dysfunction secondary to schistosomal myelopathy. Schistosomiasis mansoni is an endemic fluke infection in South America, the Caribbean, and Africa. In the United States and Europe, people may be infected mainly through travel to endemic areas and immigration of infected individuals. Clinical involvement of the spinal cord is a well-recognized complication of the disease. The typical manifestations are those of an acute transverse myelitis, with sudden onset of lower extremity neuropathy associated with bladder and bowel dysfunction. METHODS: We reviewed the records and urodynamic studies of 14 consecutive patients (10 men and 4 women, age range 23 to 49 years) with schistosomal myelopathy confirmed by cerebrospinal fluid serology for S. mansoni, who were referred for evaluation of voiding dysfunction during a 2-year period. At the time of the urologic evaluation, 9 patients had chronic neurologic and urinary symptoms and 5 had recent onset of acute symptoms. The voiding function history, urologic complications, and outcomes after therapy for schistosomiasis were reviewed. RESULTS: Of the patients with acute disease (5 patients), the urologic symptoms included urinary retention (3 patients) and incontinence (2 patients). Three of them had concurrent lower back pain and lower limb neurologic deficits. Urodynamic studies were performed in 3 patients and revealed bladder areflexia in 2 patients and detrusor hyperreflexia with external sphincter dyssynergia in 1 patient. The patients were started on clean intermittent catheterization and received praziquantel and corticosteroids. Three patients had complete resolution of their symptoms, one recovered normal voiding function but the neurologic deficits persisted, and one had no clinical improvement. All patients with chronic schistosomal myelopathy presented with lower limb neurologic deficits of varying degrees and urinary symptoms, including difficulty emptying the bladder (7 patients), urinary incontinence (6 patients), and urgency and frequency (2 patients). Laboratory and radiographic evaluation of patients with chronic disease revealed urinary tract infection in 5 patients, hydronephrosis in 2 patients, and bladder calculi in 2 patients. Urologic management consisted of antibiotics, clean intermittent catheterization, anticholinergic medication, and stone removal, as appropriate. In 1 patient, conservative treatment failed and that patient required ileocystoplasty. CONCLUSIONS: Schistosomal myelopathy is a potential cause of severe voiding dysfunction secondary to spinal cord disease. A high index of suspicion is paramount because early medical intervention can abort the progression of neurologic deterioration.

Acute Disease↗
PubMed2002

Treatment of Peyronie's disease by incomplete circumferential incision of the tunica albuginea and plaque with bovine pericardium graft.

OBJECTIVES: To study the surgical treatment of Peyronie's disease using a single incision in the tunica albuginea and fibrotic plaque and repair of the defect by bovine pericardium graft. METHODS: Between April 1999 and May 2001, 33 patients who had had symptoms of Peyronie's disease for more than 12 months and whose disease had been stable for more than 6 months underwent surgery. The reason for surgery was deformity of the penis that made sexual intercourse, even with erection, difficult or impossible. Two paraurethral incisions were made in Buck's fascia to separate the neurovascular bundle from the tunica albuginea. An incomplete circumferential incision, forked at the extremities, was made in the tunica albuginea and in the plaque at the point of maximal curvature, followed by a septal incision for the lengthening of the short side of the penis. A bovine pericardium graft was used to repair the defect in the tunica. All procedures were performed by a single surgeon (P.H.E.). The average follow-up time was 19.4 months (range 5 to 30). RESULTS: No rejection or retraction of the graft was observed. All patients maintained their state of preoperative erection, with the penis corrected in 87.9% of cases and with discrete curvature (less than 15 degrees ) in 12.1%. All recovered their ability to penetrate with no difficulty. In addition, an intraoperative average increase of 2.21 cm (range 1 to 4) occurred in the size of the penis. CONCLUSIONS: This procedure is effective for all types of penile deformity, regardless of the plaque characteristics.

Adult↗
PubMed2002

Persistent müllerian duct syndrome and prostate cancer.

A localized Gleason score 6 (3 + 3) prostate cancer was found in a 56-year-old man with bilateral cryptorchidism. Radical laparoscopic prostatectomy was performed. However, at the beginning of the procedure, a uterus, two fallopian tubes, and two intra-abdominal gonads were endoscopically identified. The müllerian rests were excised and the gonads biopsied. The histologic examination showed testicular tissue. The association of prostate cancer and persistent müllerian duct syndrome to our knowledge has not previously been reported. Prostate cancer is an androgen-dependent neoplasm, and patients with male pseudohermaphroditism have poor androgen production that should provide protection against it.

Adenocarcinoma↗
PubMed2002

Augmentation cystoplasty in renal transplantation: a good and safe option--experience with 25 cases.

OBJECTIVES: To assess the surgical and long-term results of renal transplantation in 25 patients with bladder dysfunction and augmentation cystoplasty. METHODS: We retrospectively reviewed the evolution and surgical outcome of 25 renal transplants in 24 recipients with augmentation cystoplasty. The mean patient age at transplantation was 27.6 years. The etiology of bladder dysfunction was neurogenic bladder with detrusor hyperreflexia (11 patients), tuberculosis (5 patients), vesicoureteral reflux (4 patients), posterior urethral valves (3 patients), and interstitial cystitis (1 patient). Seventeen transplants were from living donors. Augmentation cystoplasty was performed before transplantation in 21 patients. The bowel segments used in the augmentation cystoplasty included ileum in 16, ileocecal segments in 2, and sigmoid in 5 patients. The donor ureter was anastomosed to the native bladder in 16 patients, to the bowel segment in 6, and to the native ureter in 3. RESULTS: Twenty kidneys (80%) were functioning at a mean follow-up of 53.2 months (range 6 to 118). The mean serum creatinine was 1.56 mg/dL (range 0.7 to 2.6). Three patients died of unrelated causes and 1 of adenocarcinoma that originated at the vesicointestinal anastomosis. The actuarial graft survival at 1, 2, and 5 years was 96%, 92%, and 78%, respectively. Complications included symptomatic urinary infection, ureteral stenosis, and lymphocele. CONCLUSIONS: Augmentation cystoplasty is a safe and effective method to restore function in noncompliant bladders. Renal transplantation can be performed safely after augmentation cystoplasty.

Adolescent↗
PubMed2002

Laparoscopic adrenal surgery in children.

PURPOSE: The laparoscopic approach to the adrenal gland was first reported in 1992. Since then, more than 400 studies have been published, comprising hundreds of adults. There are few reports of laparoscopic adrenalectomy in the pediatric population. We reviewed our experience with laparoscopic adrenal surgery in children. MATERIALS AND METHODS: Laparoscopic adrenalectomy was performed in 8 girls and 5 boys 15 years or younger (mean age 6.3) between December 1994 and August 2001. The clinical diagnosis before surgery was virilizing tumor in 5 cases, nonfunctioning solid adrenal tumor in 3, Cushing's syndrome in 2, pheochromocytoma in 2 and Cushing's pituitary disease in 1. Unilateral adrenal lesions were 15 to 80 mm. at the longest axis (mean 41.4) on computerized tomography. RESULTS: Two of the 13 procedures (15.4%) were converted to open surgery. No deaths occurred. No patients presented with postoperative complications. Average operative time in unilateral nonconverted procedures was 107 minutes (range 25 to 195). Blood transfusion was required in 1 case (7.7%). Average hospital stay was 5.5 days (range 1 to 17). Average postoperative followup was 16 months (range 1 to 60). The final clinicopathological diagnosis was virilization in 4 cases, Cushing's syndrome in 2, pheochromocytoma in 2, neuroblastoma in 2, Cushing's pituitary disease in 1, teratoma in 1 and primary carcinoma in 1. CONCLUSIONS: Laparoscopic adrenalectomy is feasible and shows positive results in select pediatric patients.

Adolescent↗