SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A 49 year old black female patient with progressive systemic sclerosis (scleroderma), multiple organ system involvement, uremia and malignant hypertension, was treated with maintenance hemodialysis and bilateral nephrectomy. Bilateral nephrectomy controlled refractory hypertension and appeared to alter the natural course of systemic sclerosis.
Serum prolactin (PRL) levels and PRL binding activity in microsomal membranes from kidneys and adrenals were measured in control, water-deprived, unilaterally nephrectomized, and salt-loaded male rats. Unilateral nephrectomy and water deprivation increased serum prolactin levels significantly. Unilateral nephrectomy did not alter PRL binding activity in the kidneys, but significantly increased it in the adrenal glands. Salt loading had no effect on serum prolactin levels or PRL binding in the kidneys; but significantly increased PRL binding in the adrenal glands. Inhibition curves and tests of cross reactivity with LH, FSH, TSH, and GH showed that binding of PRL to its receptors in the kidneys and adrenals was specific. These observations suggest that PRL has a role in salt and water metabolism and that PRL receptors in the kidney and adrenals participate in this regulatory system.
OBJECTIVE: To report the long-term follow-up of a matched comparison of radical nephrectomy (RN) and nephron-sparing surgery (NSS) in patients with single unilateral renal cell carcinoma (RCC) and a normal contralateral kidney. PATIENTS AND METHODS: Between August 1966 and March 1999, 1492 and 189 patients with unilateral RCC and a normal contralateral kidney underwent RN and NSS, respectively. Patients with renal impairment, previous nephrectomy, bilateral or multiple RCCs, metastasis, and familial cancer syndromes were excluded. A total 164 patients in each cohort were matched according to pathological grade, pathological T stage, size of tumor, age, sex, and year of surgery. The Kaplan-Meier method and stratified Cox proportional hazards model were used to estimate and compare overall, cancer-specific, local recurrence-free, and metastasis-free survival and survival free of chronic renal insufficiency. The 2 groups were evaluated for early (< or = 30 days) complications and proteinuria at last follow-up. RESULTS: At last follow-up, 126 RN patients (77%) and 130 NSS patients (79%) were alive with no evidence of disease. There was no significant difference observed between patients who had RN and those who had NSS with respect to overall survival (risk ratio, 0.96; 95% confidence interval [CI], 0.52-1.74; P = .88) or cancer-specific survival (risk ratio, 1.33; 95% CI, 0.30-5.95; P = .71). At 10 years, similar rates of contralateral recurrence (0.9% for RN vs 1% for NSS) and metastasis (4.9% for RN vs 4.3% for NSS) were seen in each group, whereas the rate of ipsilateral local recurrence for patients who underwent RN and NSS was 0.8% and 5.4%, respectively (P = .18). There was no significant difference in the early complications between the RN and NSS groups. However, patients who underwent RN had a significantly higher risk for proteinuria as defined by a protein/osmolality ratio of 0.12 or higher (55.2% vs 34.5%; P = .01). At 10 years, the cumulative incidence of chronic renal insufficiency (creatinine > 2.0 mg/dL at least 30 days after surgery) was 22.4% and 11.6%, respectively, for the RN and NSS groups (risk ratio, 3.7; 95% CI, 1.2-11.2; P = .01). CONCLUSIONS: This retrospective study of patients with unilateral RCC and a normal contralateral kidney suggests that NSS is as effective as RN for the treatment of RCC on long-term follow-up. The increased risk of chronic renal insufficiency and proteinuria after RN supports use of NSS.
Angiomyolipoma (AML), a benign renal tumor, has various clinical forms, and the nature of AML is not sufficiently understood because of few reports of long-term observation. We report a 57-year-old female without tuberous sclerosis who developed multiple pulmonary AML 26 years after a right nephrectomy for renal AML. A computed tomogram demonstrated multifocal round lesions with lipid-like density throughout both lung fields. An open lung biopsy revealed a histological diagnosis of pulmonary AML. An abdominal computed tomogram was also compatible with splenic AML. She has been in good health for 12 years since the lung biopsy over the 38 years since the nephrectomy. This case suggests that multicentric AML can recur at distant organs even after long-term silence in a patient who has a past history of renal AML.
Metastasis of renal cell carcinoma to the head and neck, especially the larynx, is an extremely rare event. Most previously reported cases have involved a presenting laryngeal lesion that lead to the discovery of an underlying primary renal cell carcinoma. Even more unusual is the occurrence of an isolated laryngeal metastasis revealing itself years after nephrectomy, with an interim of undetected recurrence. We believe this case to be the first reported example of an isolated supraglottic laryngeal renal cell carcinoma metastasis occurring 7 years after radical nephrectomy. Local excision of such isolated lesions seems to offer a favorable prognosis.
We invented a new surgical approach to the kidney through the flank to perform a radical nephrectomy for renal cell carcinoma. With the patient in usual lateral decubitus position keeping the dorsum vertical to the operating table, a skin incision is made over the XII rib from the posterior axillary line to the lateral edge of the rectus muscle. After the tip of XII rib is resected by about 5 cm, the retroperitoneal space is entered. Blunt dissection of the posterior aspect of Gerota's fascia from fasciae of the quadratus lumborum and psoas muscle is easily carried out with a liver retractor or intestinal spatula. The pulsating renal artery can be identified through Gerota's fascia when the renal hilus is exposed. Following ligation and division of the artery, renal vein is exposed. On the left side, adrenal, gonadal and occasionally lumbar veins are also ligated and severed in addition to the renal vein. Then, the kidney in Gerota's fascia is removed en bloc with perinephric adipose tissue and adrenal gland. Of 21 patients with renal cell carcinoma seen during 1 year and 3 months from June 1987, 11 underwent this operation, and other 10 patients transperitoneal radical nephrectomy because of the possible tumor extension into the renal vein, inferior vena cava or adjacent organ, the severe spinal deformity or metastases and the necessity of additional surgical procedures for concomitant benign intraperitoneal diseases. The blood loss was smaller and operating time was shorter significantly in the translumbar group than the evaluable transperitoneal group. None of those in the translumbar group received blood transfusion. As complications, pneumothorax due to pleural injury during operation and postoperative incisional hernia occurred each in one patient, but no other serious one was found. From the above results, this approach seems to be one of choices for the surgical treatment of renal cell carcinoma, as long as the tumor is not likely to extend to adjacent organs, ipsilateral nodes or the inferior vena cava.
In Japan, it has not accepted that kidneys were harvested from a heart beating cadaveric donor. We usually removed kidneys from a donor after a donor was in cardiac arrest. To minimize warm ischemia, we employed in situ perfusion of kidneys and new procedure alternate to evisceration technique in nephrectomy from a cadaveric donor. Our procedures for the harvest of the kidneys from the cadaveric donor were presented and the clinical result of our series were reported. The kidneys was promptly perfused with chilled Ringer's lactate solution through double balloon catheter placed into the aorta, just after cardiac function ceased. Bilateral nephrectomy was performed through a long midline incision from just beneath the xyphoid bone to the pubic bone. Upon entering the abdomen, the small bowel and mesentery were retracted to the right and the posterior parietal peritoneum was incised over the great vessels and through the ligament of Treitz. The peritoneal incision was extended around the right colon so the bowel can be retracted upward and the right kidney was exposed. Then, the peritoneal incision was performed around the left colon to explore the left kidney. Both ureters were transsected as far down toward the bladder as possible. The in situ perfusion was stopped. Thereafter, the superior mesenteric artery was transsected and the duodenum and the pancreas were retracted upward. The proximal vena cava and aorta were transsected at a 2-3 cm above the level of the left renal vein, and the distal vena cava and aorta at a 5-6 cm an below the level of the left renal vein. The kidneys and the great vessels were removed in en block.(ABSTRACT TRUNCATED AT 250 WORDS)
We report on a case of renal cell carcinoma in a functionally solitary kidney, treated by ex vivo partial nephrectomy and autotransplantation. A 62-year-old woman was admitted for examination of a left renal mass and right hydronephrosis, incidentally detected on echography and CT scan. The right hydronephrosis was caused by congenital ureteropelvic junction obstruction, associated with severely impaired renal function. A solid tumor was found in the left kidney, located in the upper pole and extending to the hilus, and was suspected to be renal cell carcinoma. The patient was treated by ex vivo partial nephrectomy of the left kidney followed by autotransplantation. The tumor was 35 x 55 x 40 mm in size and diagnosed histologically to be renal cell carcinoma. Hemodialysis was unnecessary since good urine output was obtained postoperatively from the transplanted kidney. The patient was discharged 3 months after surgery, following interferon-alpha therapy, with serum creatinine level of 1.4 mg/dl.
We report two cases of left nephrectomy and one case of left adrenalectomy with our new laparoscopic procedure. We treated the left renal vein first using trans-duodenal-recess approach. The left renal vein could be detected after an incision into the parietal peritoneum on the left side of the duodenojejunal flexure (duodenal-recess) was performed. When the nephrectomy was performed, the renal artery and vein were transected using endoGIA. When the left adrenalectomy was performed, the adrenal vein was clipped and divide after lysis of the left renal vein. Our new method allowed the renal vein to be treated first, so the remainder of the operation could be performed without the risk of bleeding.
BACKGROUND: We evaluated the intrarenal distribution of prostaglandin E2 (PGE2) and thromboxane B2 (TxB2) on the rats that underwent unilateral ureteral obstruction (UUO), unilateral nephrectomy (UNX) or sham operation. METHODS: Male Sprague-Dawley rats were divided into three groups; left ureteral obstruction (UUO), left nephrectomy (UNX) and sham-operation (Control). They were sacrificed at 1, 3, 6, 12, 24 hours and Day 2, Day 3, Day 5, Day 7 and Day 9 after surgery. Intrarenal distribution of eicosanoids were immunohistochemically detected on both kidneys of UUO rats, and on right kidneys of UNX and Control rats. RESULTS: PGE2: In the obstructed kidneys, immunostained PGE2 increased in medullary interstitium at one hour to 6 hours, and in glomeruli and cortical interstitium at 6 hours. An increase of immunostained PGE2 was observed again in cortical interstitium at Day 3 to 5, and in medullary interstitium at Day 2 to 5. In the intact opposite kidneys, expression of immunostained PGE2 increased in glomeruli at Day 5 to 7, and in medullary interstitium at Day 3 to 5. In UNX, immunostained PGE2 increased in the medullary interstitium of the remnant kidneys at 3 hours and Day 3 to 7. On the other hand, an increase of immunostained PGE2 observed in glomeruli and cortical interstitium of these kidneys at Day 5 to 7. TxB2: In the obstructed kidneys, immunostained TxB2 increased in glomeruli and cortical interstitium at 6 hours, and in medullary interstitium at 3 to 12 hours. Predominant expression of TxB2 was observed in medullary interstitium at 3 hours compared to PGE2. We also observed an increase of immunostained TxB2 in cortical interstitium at Day 3 to 5, and in medullary interstitium at Day 2 to 5. In the intact opposite kidneys, immunostained TxB2 increased in medullary interstitium at 3 hours and Day 3. In the remnant kidneys of UNX, an increase of immunostained TxB2 was demonstrated in glomeruli at 6 hours and Day 7, and in medullary interstitium at 3 to 6 hours and Day 3 to 7. CONCLUSION: In the obstructed kidneys, imbalance between PGE2 and TxA2 may contribute to the progression of renal injuries. The fact that expression patterns of these eicosanoids in the opposite kidneys of UUO different from that of the remnant kidneys of UNK, even though both were similarly associated with functional loss of contralateral kidneys, suggested that the opposite kidneys of UUO were affected by any additional factors different from that responsible for the remnant kidneys of UNK.
PURPOSE: Retroperitoneoscopic radical nephrectomy (RRN) has been performed at Yokohama City University Medical Center since May 2002. Three surgeons have become skilled in performing RRN without major complications. We investigated the outcomes of the surgery and attempt to clarify whether the technique we adopted is suitable to perform this procedure safely. PATIENTS AND METHODS: Between May 2002 and June 2003, 14 patients suspected of renal cell carcinoma underwent retroperitoneoscopic radical nephrectomy at Yokohama City University Medical Center. The surgical procedure is shown below. In a lateral position, a lumbar oblique incision 6 cm long is made to approach the retroperitoneal space. Under direct vision, the ureter is dissected and Gerota's fascia is dissected from the peritoneum and the psoas muscle to signalize the subsequent dissection line. After the dissection, hand port device was attached to the skin and three 12 mm trocars were placed. The subsequent procedures are performed by retroperitoneoscopic surgery with carbon dioxide insufflation. The isolated kidney was removed through the incision that was made initially. We investigated the outcomes of this procedure. RESULTS: The mean surgical duration was 244.4 minutes and mean blood loss was 217.9 ml. Conversion to open surgery was required in one case due to bleeding and in one case due to incomplete management of a small artery. Blood transfusion was not required in any case. There were no major complications during the perioperative period. CONCLUSIONS: The three operators have become skilled in performing RRN safely with this technique.
Of 133 consecutive renal transplants, 61 (46%) were living donor grafts recovered in an anterior-retroperitoneal approach. Donor demographics, operative-anesthetic care, length of stay (LOS), hospital charges, and complications were reviewed with donor and recipient follow-up of 4 to 40 months. Donors included 35 women and 26 men, ages 22 to 61 years (mean, 42.2); thirty-nine were living related and 22 were living unrelated donors. Pretransplant evaluation defined renal anatomy and function (minimal creatinine clearance, 75 cc/minute). Hospital admission occurred the morning of donation. Nephrectomy by the anterior-retroperitoneal approach (no rib resection) was followed by postoperative epidural pain control, early resumption of diet, progressive ambulation, and aggressive pulmonary care. Operating room time door-to-door averaged 2 hours, 43 minutes (range, 1 hour, 45 minutes-3 hours, 55 minutes). Donors were hospitalized for 2 (n = 7), 3 (n = 24), 4 (n = 19), and 5 to 8 (n = 11) days (mean LOS, 3.75; range, 2-8 days). The mean charge for donor hospitalization was $15,329 (range, $10,808-$29,579). One donor required transfusion; another was readmitted for wound drainage and pneumonia treated medically. All donors remain well with normal renal function. One early graft loss (3 days) occurred from arterial intimal dissection; all others gained life-sustaining function. Recipient (98%) and graft (92%) survival was excellent at 4 to 40 months. Anterior-retroperitoneal living donor nephrectomy is safe and effective, permitting hospital LOS of usually <4 days, early recovery, and no lasting complications. Excellent donor and recipient results from this procedure should compel critical assessment of techniques requiring more extensive operative exposure or more costly operating room and hospital approaches to donor surgical management.
A 68-year-old male had received a left nephrectomy for renal cell carcinoma of the clear cell type in October, 1987. He had been given Interferon alpha (IFN alpha) for one year since then. He was referred to our hospital for bilateral abnormal shadows on the chest roentgenogram in December, 1997. He underwent a video-assisted thoracoscopic biopsy of bilateral lung in January, 1998, 11 years after his nephrectomy. The resected specimens contained a coin lesions measuring approximately 2 cm in diameter, and the lesions were microscopically diagnosed as a renal cell carcinoma of the clear cell type metastatic to the lung. The patient is doing well with no signs of re-recurrence five months after the resection of the metastatic lesion.
Transplanting a kidney graft harvested from a live donor has been proposed and used to shorten the waiting time of kidney transplant candidates and to increase the graft pool. Live donor renal transplants have demonstrated better results in term of graft survival rates, compared to renal transplants harvested from brain dead donor. Recently, laparoscopic live donor nephrectomy has been introduced to reduce the live procurement morbidity. This lower morbidity may result in increased acceptance of the donor operation. We initiated a program of laparoscopic live donor nephrectomy in January 1997 and up until June 1998, three cases were successfully performed in our department. The purpose of this paper was to report the first case of this program and its first year of follow-up.
BACKGROUND: Advances in laparoscopic instruments and video technology have made laparoscopic donor nephrectomy (LDN) feasible. We report our initial experience with this technique. METHODS: A retrospective review of 30 open donor nephrectomies and our first 30 LDNs was performed to assess donor and recipient outcome and resource usage. RESULTS: LDN was successfully completed in 26 donors (87%). The increased operative time and costs were balanced by less postoperative pain, earlier discharge, earlier return to normal activity and work, fewer incision problems, and less personal financial loss. Recipient outcome was not affected. CONCLUSION: LDN is technically feasible and safe, and recipient graft outcomes are equivalent. Convalescence is shortened, and there is less personal financial loss. LDN offers significant benefit to the donor and may result in increased organ donation.
The authors present a retrospective study of 46 patients with renal cell carcinoma treated by radical nephrectomy including ipsilateral adrenalectomy. CT scan showed a normal adrenal gland in all patients. Histology revealed the absence of adrenal metastasis in all patients. Ipsilateral adrenalectomy is not systematically required in radical nephrectomy.
A modified technique of laparoscopic radical nephrectomy for treatment of renal cell carcinoma makes surgery easier, faster, and safer in terms of tumor cell spillage. We report our experience with this procedure in 51 consecutive cases. A transperitoneal approach was used in all cases. The average patient age was 62 years. The solid renal mass diameter was between 2 and 9 cm. Extrafascial mobilization of the kidney included limited lymph node dissection. In six patients the adrenal gland was removed simultaneously. The specimen was removed intact through a small muscle-splitting incision in the lower abdominal wall. The procedure was successful without conversion to open surgery in all 51 patients. The average operating time was 125 minutes, and the average postoperative hospital stay was 7.2 days. Major complications were seen in 4% of patients. Neither local recurrences nor metastases were observed in the following 7.9 (1-19) months. In our experience, laparoscopic radical nephrectomy is safe and efficient. Removing the specimen intact through a small muscle-splitting incision reduces operating time, avoids tumor cell spillage, and allows exact pathological staging.
Accelerated hypertension with end stage renal failure not responsive to hemodialysis and ultrafiltration was an indication for bilateral nephrectomy in 22 patients, five of whom required the procedure as an emergency. Normotension occurred in every patient after removal of the kidneys, but hypertension returned in 12 persons after renal transplantation. Five of these required long term antihypertensive medication, and in an additional seven, some form of diuretic was necessary. There were no distinguishing features among those patients in whom post-transplant hypertension developed from those in whom it did not. In spite of severe accelerated hypertension in the patient with well documented chronic renal disease, prompt nephrectomy and renal transplantation were compatible, with an 86 per cent patient survival rate. Seventy-seven per cent of the kidneys functioned for an average of 29 months.