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1.
In Vivo ; 36(1): 510-521, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34972756

RESUMO

BACKGROUND/AIM: Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare subtype of renal cell carcinoma and generally considered a low-grade renal epithelial neoplasm. However, MTSCC with distant metastases often shows a poor prognosis. This is the first reported case of cytoreductive nephrectomy after nivolumab plus ipilimumab combination treatment. CASE REPORT: A 26-year-old man had a 72-mm tumor at the left kidney with multiple osteolytic bone metastases. A biopsy of the renal tumor and bone metastases resulted in the diagnosis of MTSCC of the kidney with bone metastases. After nivolumab plus ipilimumab combined treatment, he underwent cytoreductive nephrectomy. The excised specimen showed higher PD-L1 expression in the spindle components than in the tubular components, but CD4- and CD8-positve T-cells showed greater infiltration in the tubular components than the spindle components. CONCLUSION: Combination immunotherapy of nivolumab and ipilimumab may be an effective treatment option for metastatic MTSCC of the kidney.


Assuntos
Adenocarcinoma Mucinoso , Neoplasias Ósseas/secundário , Ipilimumab/uso terapêutico , Neoplasias Renais , Nivolumabe/uso terapêutico , Adenocarcinoma Mucinoso/tratamento farmacológico , Adenocarcinoma Mucinoso/cirurgia , Adulto , Procedimentos Cirúrgicos de Citorredução , Humanos , Rim , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/cirurgia , Masculino , Nefrectomia
2.
Ann R Coll Surg Engl ; 104(1): 28-34, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34972499

RESUMO

INTRODUCTION: Training a fellow has a cost in time and effort for the surgeon and their team. Their relative inexperience may also negatively affect the patient. The aim of this study was to determine and quantify the impact of a fellow on a regional robotic-assisted partial nephrectomy service and on perioperative outcomes. MATERIALS AND METHODS: We reviewed the prospectively collected data for 522 patients who had undergone robotic-assisted partial nephrectomy since 2015 during the tenure of six fellows. Perioperative outcomes for three groups were compared: group A (no fellow participation), group B (some participation) and group C (fellow completed entire operation). We also reviewed progression over 12 months. RESULTS: Demographics were similar in all groups apart from the percentage of men, which was lower in group C (p < 0.05). Operative time was 27 minutes longer for group B (p < 0.001). Warm ischaemia time was significantly shorter for group A but the difference was only four minutes (p < 0.001). Length of stay was slightly shorter for group C compared with the other groups (p < 0.01). Trifecta achievement was greatest for group A (p < 0.001). There were no perioperative deaths in any group and positive margins, complications and readmissions were low and similar in all groups. Towards the end of their fellowship, fellows performed more operations independently. CONCLUSION: There is a measurable, but small, negative impact of a fellow on a robotic-assisted partial nephrectomy service, which reduces with experience. With appropriate supervision and patient selection, a fellow can be taught robotic-assisted partial nephrectomy without affecting patient safety or treatment outcome.


Assuntos
Bolsas de Estudo , Nefrectomia , Procedimentos Cirúrgicos Robóticos , Cirurgiões , Idoso , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Isquemia Quente
3.
Int J Surg ; 97: 106194, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34958968

RESUMO

BACKGROUND: High quality studies and reviews on the management of small renal masses (SRM) are lacking. This review aims to compare oncological outcomes in patients undergoing ablative therapies (AT) or partial nephrectomy (PN) for T1a or T1b SRM. MATERIAL AND METHODS: Medline, EMBASE, Cochrane CENTRAL and conference proceedings were searched on the 15th July 2020 for comparative studies respective to our research question. The ROBINS-I tool and the GRADE approach were used to assess any risk of biases and certainty of evidence in the included studies. The review is registered on PROSPERO. RESULTS: 1,748 records were retrieved. 32 observational studies and 1 RCT integrating 74,946 patients were included. Patients undergoing AT patients are significantly older than PN patients (MD 5.70, 95%CI 3.83-7.58). In T1a patients, AT patients have significantly worse overall survival (HR 1.64, 95%CI 1.39-1.95). Local recurrence-free survival is similar with PN in patients with longer than five-years follow up (HR 1.54, 95%CI 0.88-2.71). AT patients also have similar cancer-specific survival (CSS), metastasis-free survival, disease-free survival, significantly fewer post-operative complications (RR 0.72, 95%CI 0.55-0.94), and a smaller decline in estimated glomerular filtration rate post-operatively (MD: -7.42, 95%CI -13.1 to -1.70) compared to those undergoing PN. Evidence contradicts in T1b patients for oncological outcomes. CONCLUSIONS: AT have similar long-term oncological durability; lower rates of complications and superior kidney function preservation compared to PN. Given the low quality of evidence, AT is a reasonable alternative to PN in frail and co-morbid patients. Long-term high-quality studies are needed to confirm the potential benefits of AT, especially in T1b patients. PROSPERO REGISTRATION: CRD42020199099.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Carcinoma de Células Renais/cirurgia , Taxa de Filtração Glomerular , Humanos , Rim , Neoplasias Renais/cirurgia , Nefrectomia/efeitos adversos , Resultado do Tratamento
4.
Int Braz J Urol ; 48(1): 110-119, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34528773

RESUMO

INTRODUCTION: Nephrometric scores play an interesting role in nephron sparring surgery (NSS) planning. The aim of this study is to evaluate if R.E.N.A.L. score (RS) is capable to predict the occurrence of adverse events in laparoscopic NSS. MATERIALS AND METHODS: We prospectively studied 150 laparoscopic NSS between 2015 and 2018 to evaluate the relationship between RS and incidence of adverse events. Clavien 3 or superior complications, warm ischemia time (WIT) over 30 minutes, tumor violation, positive surgical margins (PSM) and necessity of amplification of renal parenchyma during the resection of the masses to obtain free margins were considered as adverse events. We compared each item of the RS isolated and divided the patients between low risk and high risk. RESULTS: Adverse results occurred in 48 cases (32%). Amplification of the margin of resection was observed in 28 cases (19%). WIT exceeded 30 minutes in 9 cases (6.1%), complications Clavien 3 or superior occurred in 13 cases (9%) and PSM were detected en 6 cases (4%). Comparing the patients with adverse outcomes and each item of the RS we did not find any statistical difference, but when divided into high risk and low risk, we found that patients in the high risk group had a higher tendency to present ad-verse results - 25.84% vs. 44.26% (p=0.03). CONCLUSIONS: RS system is a good way to predict adverse outcomes in NSS, especially in cases over 7. Further studies should focus on robotic approach and patient's characteristics other than the masses' aspects.


Assuntos
Neoplasias Renais , Laparoscopia , Humanos , Neoplasias Renais/cirurgia , Nefrectomia/efeitos adversos , Néfrons/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
7.
Urol Clin North Am ; 49(1): 39-56, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34776053

RESUMO

While cadaveric dissection has stood the test of time because of its widely accepted educational value by experienced surgeons, the introduction advances in 3D printing and biomaterial technologies could potentially provide alternative tools for surgical training. This novel concept in simulation (physical reality) would encompass all the benefits of cadavers in terms of realism and clinical relevance without any of its ethical, infection, safety, and financial concerns.


Assuntos
Neoplasias Renais/cirurgia , Impressão Tridimensional , Treinamento por Simulação/métodos , Procedimentos Cirúrgicos Urológicos/educação , Biópsia , Cadáver , Educação à Distância , Humanos , Hidrogéis , Aprendizagem , Masculino , Fenômenos Mecânicos , Modelos Anatômicos , Nefrectomia/educação , Modelagem Computacional Específica para o Paciente , Próstata/patologia , Prostatectomia/educação , Estudos de Validação como Assunto
8.
JSLS ; 25(4)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34949909

RESUMO

Objectives: The da Vinci SP® Surgical System received U.S. Food and Drug Administration approval for urological procedures in 2018. Here, we describe the first experience performing single-port robot-assisted donor nephrectomy (RADN) using the da Vinci SP® surgical system, present 90-day clinical outcomes, and discuss tips for operative success. Methods: Seven consecutive patients underwent single-port RADN at a single institution between September 1, 2020 and March 31, 2021. Surgery was performed through a single, 60 mm Pfannenstiel incision with a 12 mm periumbilical assistant port for suction and vascular stapling. Donor characteristics, operative details, 90-day donor clinical outcomes, and recipient renal function were retrospectively evaluated. Results: Four female and three male patients successfully underwent single-port RADN without conversion to standard multiport or open approach. Six cases were left-sided. Estimated blood loss for each procedure was ≤ 50 mL. Mean operative time, warm ischemia time, and extraction time were 218.3 minutes (standard deviation [SD]: 16.3 minutes), 5 minutes 4 seconds (SD: 56 seconds), and 3 minutes 37 seconds (SD: 38 seconds). Mean pre-operative creatinine and estimated glomerular filtration rate were 0.79 mg/dL and 107.3 mL/min/1.73m2, respectively. At six week's follow up, they were 1.22 mg/dL and 66.1 mL/min/1.73m2. Average pain score at 48 hours postoperatively was 1.7/10. There were no Clavien-Dindo grade ≥ III complications within 90 days. All recipients experienced immediate and sustained return of renal function post-transplant. Conclusion: Single-port RADN is a technically feasible and safe procedure with the da Vinci SP® system and can confer acceptable functional and cosmetic outcomes. Future studies are needed to define long-term outcomes and compare with previously established techniques for donor nephrectomy.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Feminino , Humanos , Rim/fisiologia , Masculino , Nefrectomia , Estudos Retrospectivos
9.
Zhonghua Yi Xue Za Zhi ; 101(46): 3794-3798, 2021 Dec 14.
Artigo em Chinês | MEDLINE | ID: mdl-34895419

RESUMO

Objective: To explore the safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy in the treatment of renal tumors. Methods: The 65 patients with renal tumors undergoing laparoscopic microwave ablation combined with partial nephrectomy from November 2017 to May 2021 were retrospectively analyzed. There were 46 males and 19 females. The average age was (56.6±14.1) years. The mean body mass index was (25.7±3.3) kg/m2. The tumors located in the left kidney in 30 cases and the right kidney in 35 cases. The ECOG score was 0 in 59 patients and 1 in 6 patients. The mean maximum diameter of the tumors was (2.3±1.0) cm(1.0-5.0 cm). According to R.E.N.A.L. scoring, 41 cases were of low difficulty (4-6 points), 23 cases of medium difficulty (7-9 points) and 1 case of high difficulty (10-12 points). The renal tumors were ablated by laparoscopic microwave ablation, then followed by partial nephrectomy. Postoperative complications were observed and the prognosis was assessed by CT or MRI. Results: The mean duration of operation was (76.6±19.4) min (40-120 min). The median intraoperative blood loss was 20 ml(5-50 ml). The median duration of postoperative hospitalization was 4 d(3-6 d). Complications of Clavien grade Ⅰ were found in 11 patients (fever, nausea and vomiting, lumbar pain), and no complications were grade Ⅱ or above. Postoperative pathology showed that no positive margin was found, and 46 cases of clear cell renal cell carcinoma (AJCC stage: T1a stage 42 cases, T1b stage 4 cases; WHO/ISUP classification: 21 cases of grade 1, 23 cases of grade 2, 2 cases of grade 3); 2 cases of type 1 papillary renal cell carcinoma (stage T1a, grade 1); 1 case of type 2 papillary renal cell carcinoma (T1b stage, grade 2); 2 cases of renal chromophobe carcinoma (all stage T1a); 1 case of low-grade malignant potential multilocular cystic renal tumor; 2 cases of adenocarcinoma (combined with the postoperative history of rectal cancer, metastasis was considered); 6 cases of renal angiomyolipoma; 2 cases of eosinophiloma; 1 case of papillary adenoma; 1 case of benign renal cyst and 1 case of renal hemangioma with calcification. The median follow-up was 24 months (1-42 months). Sixty-three patients survived and two died (one due to heart disease and one due to metastatic colorectal cancer). According to postoperative imaging, there were no signs of tumor recurrence or metastasis in other cases. Blood tests were performed regularly, and no significant abnormalities occurred. Conclusions: The safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy for the treatment of renal tumor is satisfactory, such as less intraoperative bleeding, fewer complications, less effect on renal function and postoperative pathology, providing a potential option for renal tumor treatment.


Assuntos
Angiomiolipoma , Neoplasias Renais , Laparoscopia , Adulto , Idoso , Feminino , Humanos , Neoplasias Renais/cirurgia , Masculino , Micro-Ondas , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Nefrectomia , Estudos Retrospectivos
10.
Tech Vasc Interv Radiol ; 24(4): 100774, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34895706

RESUMO

Kidney cancer accounts for 2% of cancer related deaths. Historically, a patient with a solid renal mass would undergo surgery without biopsy given the previously low diagnostic yield of biopsy and the fear of tumor seeding. This led to a high rate of resection for benign masses. With the rising incidence of renal masses discovered on imaging, improvements in biopsy technique and advancements in pathologic evaluation of biopsy samples of renal masses, renal mass biopsy now plays an important role in selected patients with renal masses. Coaxial core needle biopsy is the preferred technique with a low rate of complications and a high diagnostic yield. This article will discuss indications, methods, utility, limitations and complications of renal mass biopsy.


Assuntos
Neoplasias Renais , Nefrectomia , Biópsia , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia
11.
Urologiia ; (6): 35-39, 2021 Dec.
Artigo em Russo | MEDLINE | ID: mdl-34967162

RESUMO

AIM: To study the method of performing a kidney resection using a prolene mesh implant of medium rigidity and to substantiate the possibility of further application of this method of kidney resection in clinical practice in an experiment. Materials and research methods. The study is experimental. The study was carried out using pig models. In total 50 laboratory animals were included in the study. The operation of kidney resection was simulated using laboratory animals. In 25 cases, the kidney resection was performed according to the classical method, in other 25 cases, the kidney resection was performed according to the authors method of kidney resection using a prolene mesh implant. We studied the average time of surgery, the average weight of the postoperative scar, the pathological presentation of the area of kidney resection at various term after the operation. RESULTS: The average operation time was on average 3.1 minutes (5.7%) longer in the group of laboratory animals operated on with the use of a prolene mesh implant. The average weight of the postoperative scar zone is 1.7 grams (27%) higher in the group of laboratory animals operated on according to the classical hemostasis method of the renal resection area. Interpretation of the results of a histopathological study of the kidney resection area indicates the development of a taft connective tissue structure around the prolene implant of the "patch" type in the shape of strands of dense granulation tissue surrounded by foreign body granulomas. CONCLUSION: The use of a prolene implant when performing a kidney resection is a reliable method of hemostasis of the postoperative defect area, that gives a possibility to minimize cicatricial changes in the renal parenchyma without significant prolongation of the operation time.


Assuntos
Polipropilenos , Telas Cirúrgicas , Animais , Rim/cirurgia , Nefrectomia , Suínos
12.
Zhonghua Yi Xue Za Zhi ; 101(48): 3961-3965, 2021 Dec 28.
Artigo em Chinês | MEDLINE | ID: mdl-34954999

RESUMO

Objective: To investigate the safety and efficacy of retroperitoneal laparoscopic selective renal artery branch occlusion with nephron sparing surgery in patients with renal carcinoma of stage ≥ T1b. Methods: From July 2016 to September 2020, 35 patients with renal cancer ≥T1b underwent retroperitoneoscopic nephron sparing surgery in the First Affiliated Hospital of Shenzhen University. The surgical methods were retroperitoneoscopic nephron sparing surgery with total renal artery occlusion (group A) or selective renal artery branch occlusion (group B). Operation time, heat ischemia time, blood transfusion rate, positive margin rate, intraoperative blood loss, postoperative complications and length of hospital stay were compared between the two groups, and the total glomerular filtration rate (GFR) and the single-nephron glomerular filtration rate (sGFR) of the offected kidneys were compared between the two groups before, 3 months after and 12 months after surgery. Results: Among the 35 patients, 19 were male and 16 were female, aged (55.7±8.4) years and the body mass index is (24.6±3.1) kg/m2. The tumor diameter was (54.7±10.3) mm. The difference was statistically significant of operative time between group A and B [(103.5±14.3) vs (123.2±14.1) min,P=0.003]. There were no significant differences in thermal ischemia time, blood transfusion rate, positive margin, intraoperative blood loss, incidence of postoperative complications and length of hospital stay between the two groups (all P>0.05). The decrease of renal sGFR in the group A was significantly higher than group B at 3 months and 12 months after surgery [(23.1±3.6) vs (29.1±7.1) ml/min;(25.9±4.7) vs (30.7±7.2),both P<0.05]. Conclusion: Retroperitoneal laparoscopic selective renal artery branch occlusion and neon-sparing surgery for patients with ≥ T1b stage renal carcinoma is a safe and effective surgical method, which can well protect the renal function of patients in the early postoperative stage without increasing intraoperative blood loss and postoperative complications.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Laparoscopia , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/cirurgia , Masculino , Nefrectomia , Néfrons , Artéria Renal , Estudos Retrospectivos , Resultado do Tratamento
13.
J Int Med Res ; 49(12): 3000605211063713, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34939509

RESUMO

Extramedullary plasmacytoma (EMP) is a rare plasma cell neoplasm, with the majority (80-90% of cases) occurring in the upper aerodigestive tract. To our best knowledge, primary EMP from renal tissues is extremely rare. Herein, the diagnosis and treatment of a refractory primary EMP with renal involvement in a 53-year-old male patient is reported. The patient received radical nephrectomy followed by radiotherapy, and showed relapse 3 months after treatment. The cancer cells were sensitive to subsequent chemotherapy, however, the patient died of infection associated with the disease after almost 3.5 years following first presentation.


Assuntos
Mieloma Múltiplo , Plasmocitoma , Humanos , Rim , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Nefrectomia , Plasmocitoma/diagnóstico por imagem , Plasmocitoma/cirurgia
14.
Pan Afr Med J ; 40: 91, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34909079

RESUMO

Urogenital tuberculosis is little suspected and known by clinicians. Colorenal fistulas, although rare, are complex forms of renal tuberculosis occurring in patients with advanced-stage disease. They generally occur in the ascending and descending colon. We here report the clinical case of a 58-year-old female patient presenting to the Emergency Department with severe acute left pyelonephritis. Abdominal CT scan objectified left pyonephrosis with left colorenal fistula. The patient had poor clinical, biological outcome despite resuscitation measures and antibiotic treatments. Urgent left nephrectomy was performed with disconnection and drainage of colorenal fistula. Histology showed renal tuberculosis. The patient received antibacillary drugs according to 2ERHZ/4RH guidelines. The treatment of this type of TB should be adequate to avoid recurrences that could be more complicated to manage.


Assuntos
Fístula , Pielonefrite , Tuberculose Renal , Drenagem , Feminino , Humanos , Pessoa de Meia-Idade , Nefrectomia , Tuberculose Renal/complicações , Tuberculose Renal/diagnóstico , Tuberculose Renal/cirurgia
15.
BMC Surg ; 21(1): 443, 2021 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-34963464

RESUMO

PURPOSE: To explore the effect of tumor thrombus growing against the direction of venous return (GADVR) tumor thrombus on the choice of surgical approach, the impact on the complexity of the surgery and the prognosis. METHODS: We retrospectively analyzed the clinicopathological data of 213 patients, who underwent surgery in a single center of Peking University Third Hospital between January 2016 and June 2020. For right renal cell carcinoma (RCC) and venous tumor thrombus (VTT), imaging revealed a filling defect in the left renal vein, which was significantly enhanced in enhanced imaging, suggesting that the tumor thrombus grew against the direction of venous return into the left renal vein. For left RCC and VTT, at least one of the left renal vein branches has tumor thrombus. The branches include the left adrenal vein, the left gonadal vein (testicular vein or ovarian vein), and the left ascending lumbar vein. The patients were divided into two groups according to whether they were GADVR tumor thrombus, and we compare the clinicopathological characteristics of GADVR tumor thrombus and non-GADVR tumor thrombus. Univariate and multivariate Cox regression analyses were performed to explore the risk factors that affect the prognosis of patients with RCC and VTT. Kaplan-Meier plots were conducted to evaluate the effect of GADVR on progression-free survival (PFS). RESULTS: Compared with non-GADVR tumor thrombus, patients with GADVR tumor thrombus had a higher proportion of open surgery (76.2% vs. 52.1%, P = 0.035), a higher proportion of tumor thrombus adhering to the inferior vena cava (IVC) vessel wall (81% vs. 45.8%, P = 0.002), a higher proportion of segmental resection of the IVC vessel wall (61.9% vs. 15.6%, P < 0.001); higher preoperative serum creatinine value (110.0 µmol/L vs. 91.0 µmol/L, P = 0.015), a higher proportion of tumor thrombus combined with bland thrombus (non-tumor thrombus) (57.1% vs. 19.8%, P < 0.001). In terms of surgical complexity, patients with GADVR tumor thrombus had a longer median operation time (379 min vs. 308 min, P = 0.038), more median surgical blood loss (1400 mL vs. 600 mL, P = 0.018), and more postoperative complications (52.4% vs. 30.7%, P = 0.045). Multivariate Cox regression analysis showed that GADVR tumor thrombus, symptoms, postoperative serum creatinine, distant metastasis, sarcomatoid feature, pathological type, lymph node dissection were independent risk factors for PFS. Patients with GADVR tumor thrombus's median survival time was 14.0 months, while patients with non-GADVR tumor thrombus were 32.0 months (P = 0.016). GADVR tumor thrombus is an independent risk factor for PFS in patients with RCC and VTT. CONCLUSION: GADVR tumor thrombus is a characteristic feature of tumor thrombus, with an incidence of 9.9%. It has a higher proportion of open surgery and higher surgical complexity, which is an independent risk factor for PFS.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Trombose , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/cirurgia , Nefrectomia , Prognóstico , Estudos Retrospectivos , Trombose/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
16.
Sci Rep ; 11(1): 24479, 2021 12 29.
Artigo em Inglês | MEDLINE | ID: mdl-34966177

RESUMO

Systematic registration and examination of biopsy-related data in Central and Eastern Europe are scarce, while the health condition of the population is worse compared to other more developed countries. We aim to create a database and analyze the distribution and temporal variation of the renal biopsy diagnoses in Hungary, including the effect of the recent coronavirus pandemic. The diagnoses were standardized according to the recommendation of the European Renal Association. Native biopsy samples processed between January 1, 2006, and December 31, 2020, were analyzed. During the 15 years, 2140 native kidney biopsies were performed. The number of samples increased from 24.5 to 57.9 per million person-years and the median age from 37 to 51 years (p < 0.0001). The predominance of glomerular diseases was stable. The most frequent glomerulopathy was IgA nephropathy (21.5%), followed by focal segmental glomerulosclerosis (17.7%), and membranous nephropathy (15.7%). Trends showed the rise of ANCA-associated vasculitis. During the coronavirus pandemic, there was a decrease in the number of kidney biopsies and the proportion of membranous nephropathies. The diagnostic trends in our database showed increasing biopsy rates among the elderly and the growing frequencies of age-related diseases, which emphasizes the importance of altering medical focus according to demographic changes in this area.


Assuntos
Nefropatias/epidemiologia , Nefropatias/patologia , Rim/patologia , Adulto , Distribuição por Idade , Biópsia/métodos , Feminino , Glomerulonefrite/patologia , Glomerulonefrite Membranosa/patologia , Humanos , Hungria/epidemiologia , Incidência , Nefropatias/complicações , Masculino , Pessoa de Meia-Idade , Nefrectomia , Estudos Retrospectivos
17.
Hinyokika Kiyo ; 67(10): 443-447, 2021 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-34742168

RESUMO

A woman in her seventies complained of chest pain during exertion and visited a local hospital. Computed tomographic scan showed right renal cell carcinoma with inferior vena cava (IVC) tumor thrombus extending above the diaphragm, and the patient was referred to our hospital. She was diagnosed with right renal cell carcinoma cT3cN0M0, with level IV IVC thrombus by Mayo classification. Axitinib and pembrolizumab were administered against intractable advanced renal cell carcinoma. The dose of axitinib was reduced due to grade 3 liver dysfunction. Right nephrectomy together with IVC thrombectomy was performed because the primary lesion had shrunk, and the level of IVC thrombus had become level III. The pathological results were clear cell carcinoma, pT3c, G3, Fuhrman grade3, INFA, v1, and ly0. Axitinib and pembrolizumab might be a presurgical option against an intractable renal cell carcinoma with an IVC thrombus.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Axitinibe/uso terapêutico , Carcinoma de Células Renais , Neoplasias Renais , Trombose , Idoso , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/cirurgia , Nefrectomia , Trombectomia , Trombose/tratamento farmacológico , Trombose/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
18.
Hinyokika Kiyo ; 67(10): 449-452, 2021 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-34742169

RESUMO

A 71-year-old man was referred to our hospital for treatment of a 2 cm-sized right renal mass incidentally found by computed tomography (CT) and was diagnosed with right renal cell carcinoma cT1aN0M0. Contrast-enhanced CT revealed that the aorta was completely occluded below the inferior mesenteric artery origin, and Leriche syndrome was diagnosed. CT angiography showed several collateral arteries along the abdominal wall. A robot-assisted laparoscopic partial nephrectomy was performed to treat renal cell carcinoma. Preoperatively, we marked the collateral arteries using ultrasonography to avoid injury during trocar insertion. We did not observe any decrease in blood flow in the right leg during the operation. The pathological diagnosis was clear cell renal cell carcinoma. Leriche syndrome is a chronic occlusive disease involving the infrarenal aorta and the iliac arteries. Since lower limb blood flow is dependent on collateral circulation, it is important to avoid injuring the collateral arteries during surgery.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Laparoscopia , Síndrome de Leriche , Robótica , Idoso , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Síndrome de Leriche/complicações , Síndrome de Leriche/diagnóstico por imagem , Síndrome de Leriche/cirurgia , Masculino , Nefrectomia
19.
Hinyokika Kiyo ; 67(10): 453-457, 2021 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-34742170

RESUMO

A 57-year-old woman was referred to our hospital with a palpable mass in the left lumbar area. Computerized tomography revealed a diffusely enlarged destructed left kidney with impacted ureteropelvic junction stones and intense inflammatory stranding of the perirenal fat. This infiltration extended into the subcutaneous tissue. Since she refused to undergo nephrectomy, we performed transurethral ureterolithotripsy (TUL) two times. Retrograde ureterography before the third TUL showed communication between the renal pelvis and the jejunum. We performed a left-sided nephrectomy with a wedge resection of the jejunum. This is a rare case of nephrocutaneous and enterorenal fistula caused by pyonephrosis.


Assuntos
Fístula , Pionefrose , Feminino , Fístula/cirurgia , Humanos , Rim , Pelve Renal , Pessoa de Meia-Idade , Nefrectomia , Pionefrose/complicações , Pionefrose/cirurgia
20.
Zhonghua Wai Ke Za Zhi ; 59(11): 912-917, 2021 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-34743453

RESUMO

Objective: To examine the clinical application effects of two-complex and one-plane technique for the renal artery dissected location in transperitoneal laparoscopic radical nephrectomy(LRN). Methods: Clinical data of patients diagnosed as renal tumor between January 2016 and December 2019 that treated with transperitoneal LRN and the two-complex and one-plane technique was performed to locate and dissect the renal arteries were analyzed retrospectively. A total of 206 qualified patients were enrolled, included 71 cases from Kaifeng Central Hospital and 135 cases from the First Affiliated Hospital of Zhengzhou University. There were 126 males and 80 females with median age of 54 years (range: 35 to 82 years). Renal tumor lived at left kidney in 102 cases and at the right in 104 cases, with a maximum tumor diameter of (6.8±2.5)cm (range: 3.0 to 12.7 cm). During the procession of transperitoneal LRN, The genital veins was followed to locate renal veins, soon the renal vein complex and renal lower pole complex and psoas major muscle plane that named as "two-complex and one-plane"anatomical markers were applied to the dissected location of renal arteries. The established application of two-complex and one-plane technique for renal artery location, and the anatomical features along with its locational time of renal artery, as well as vascular-related complications were recorded and analysed. The χ2 test or t test was used to compare the results of different lateral operations. Results: The surgical procedures were successful in all 206 patients. The operation time was (54.4±13.6) minutes (range:22 to 116 minutes), no injury to liver, spleen or intestine. Two-complex and one-plane technique was used to complete renal arteries location of 206 patients that accompanied with one or more arterial branch in the procession of transperitoneal LRN. Single renal artery branch was found in 163 cases, two or more renal artery branches were found in 43 cases, and 60 branches of accessory renal artery that in addition to the main trunks were detected in 14 cases (13.7%, 14/102) on left-side and 29 cases (27.9%, 29/104) on the right(χ²=6.251, P=0.012).The main branch of renal artery that directly been located inferior or posterior to renal vein in 165 cases, and the other 41 cases that born with higher-position of main branch been located through an upper"window-opening"of renal veins complex. Of the 60 accessory renal artery, 46 branch (76.6%, 46/60) been located inferior or posterior to renal veins, and the other 14 branch with higher-position (23.3%, 14/60) been located by a"window-opening"technique. The renal artery dissected location time was (21.2±9.4) minutes (range:11 to 43 minutes) in left-side and (17.5±9.3) minutes (range:9 to 32 minutes) in the right (t=2.840, P=0.005).The intraoprative bleeding was (51.8±25.2) ml (range:20 to 400 ml). There were 4 cases of vascular injury occured and treated with laporoscopy, only one need blood transfusion. Conclusions: The anatomical markers of renal vein complex and renal lower pole complex and psoas major muscle plane that can apply to locate various anatomical position types of renal artery in transperitoneal LRN effectively. The exactly application of two-complex and one-plane technique that could shorten the operational time of renal artery location and reduce the complications of vascular injury.


Assuntos
Neoplasias Renais , Laparoscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Artéria Renal/cirurgia , Estudos Retrospectivos
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