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1.
Medicine (Baltimore) ; 99(27): e20986, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629713

RESUMO

RATIONALE: Cerebral carbon dioxide embolism (CCDE) is a rare cause of stroke and is a recognized life-threatening complication.CCDE may result from direct intravascular CO2 insufflation during surgery. Due to the lack of typical clinical manifestations, the disease is often missed or mistaken for another condition. The clinical signs and symptoms depend on the speed and volume of embolized gas entering the blood and the patient's condition. In particular, patent foramen ovale has been found to be associated, in rare cases, with the intraoperative entry of gas into the arterial system. PATIENT CONCERNS: In this report, we present the case of a 35-year-old woman with kidney cancer who underwent laparoscopic right partial nephrectomy. DIAGNOSIS: After the laparoscopic surgery, the patient was initially diagnosed with acute cerebral infarction. INTERVENTIONS: The patient was treated according to the standard method for treatment of acute cerebrovascular disease. OUTCOMES: Three days after the laparoscopic procedure, the patient gained consciousness, and she was discharged without any neurologic sequelae on postoperative day 12. LESSONS SUBSECTIONS AS PER STYLE: Due to the low incidence and sudden occurrence of CCDE, there is a strong likelihood of missed diagnosis or misdiagnosis, and it is; therefore, important to be aware of the risk. The findings from this report would be highly useful as a reference to clinicians in the future.


Assuntos
Dióxido de Carbono/efeitos adversos , Embolia Aérea/etiologia , Insuflação/efeitos adversos , Embolia Intracraniana/etiologia , Laparoscopia/efeitos adversos , Adulto , Dióxido de Carbono/sangue , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Embolia Intracraniana/diagnóstico por imagem , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Nefrectomia/efeitos adversos
2.
Intern Med ; 59(11): 1427-1431, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32475908

RESUMO

A 65-year-old woman presented to a hospital with complaints of dyspnea and lumbar pain. Chest computed tomography (CT) showed left pleural effusion. Thoracentesis showed pleural effusion with elevated levels of amylase. Enhanced CT showed fluid accumulation from the thoracic crus of the diaphragm to the left iliopsoas muscle. Based on the postoperative notes following left nephrectomy performed 29 years ago, we suspected that the internal pancreatic fistula had resulted from the postoperative scar. Conservative management was performed. However, occlusion of the pancreatic fistula failed. Subsequently, she underwent pancreatic body tail spleen merger resection, and the pleural effusion disappeared.


Assuntos
Nefrectomia/efeitos adversos , Fístula Pancreática/etiologia , Fístula Pancreática/cirurgia , Derrame Pleural/etiologia , Derrame Pleural/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Idoso , Amilases/sangue , Exsudatos e Transudatos , Feminino , Humanos , Japão , Fístula Pancreática/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Semin Vasc Surg ; 32(3-4): 106-110, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32553122

RESUMO

Renal artery aneurysm (RAA) is defined as a localized saccular or fusiform dilation of the renal vasculature that exceeds 50% of the adjacent artery diameter. RAAs are rare in the general population and account for <1% of all peripheral aneurysms. Incidental diagnosis of RAA has increased due to the widespread clinical application of visceral duplex ultrasound scanning and computed tomography imaging. While the diagnosis of RAA before or during pregnancy is rare, pregnancy increases the risk of rupture significantly during the third trimester, with associated high mortality rates for both mother and fetus. The rarity of pregnancy-related RAAs contributes to our limited knowledge of their natural history, morphologic features, criteria for intervention, and treatment options. This review compiles opinions of published articles to provide an updated overview of RAA in pregnancy and aid clinicians in the management of this rare but serious vascular condition. An RAA 1.5 cm in diameter requires open or endovascular treatment in a woman planning to become pregnant or who is pregnant.


Assuntos
Aneurisma/terapia , Implante de Prótese Vascular , Embolização Terapêutica , Procedimentos Endovasculares , Nefrectomia , Complicações Cardiovasculares na Gravidez/terapia , Aneurisma/diagnóstico por imagem , Aneurisma/mortalidade , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Embolização Terapêutica/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Nefrectomia/efeitos adversos , Nefrectomia/mortalidade , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/mortalidade , Medição de Risco , Fatores de Risco , Stents , Resultado do Tratamento
4.
Int J Clin Oncol ; 25(8): 1551-1561, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32504136

RESUMO

BACKGROUND: The objective of this study was to provide more definitive information about the prognostic impact of perioperative blood transfusion (PBT) on patients with surgically treated renal cell carcinoma (RCC). METHODS: A database of 4019 patients with clear cell RCC, all of whom underwent radical or partial nephrectomy as primary therapy as part of a multi-institutional Korean collaboration between 1988 and 2015, was analyzed retrospectively. PBT was defined as transfusion of allogeneic red blood cells during surgery or postsurgical period. Receipt of a PBT, as well as the amount and time of blood transfusion (BT), was compared. RESULTS: Overall, 335 (8.3%) patients received a PBT: 84 received postoperative BT, 202 received intraoperative BT, and 49 received both intraoperative and postoperative BT. Patients receiving a PBT had a poor preoperative immuno-nutritional status, and aggressive tumor characteristics. Multivariate analyses identified PBT as an independent predictor of recurrence-free survival and cancer-specific survival. Prognostic impact of PBT was restricted to those with locally advanced stage (pT3-4), and who underwent radical nephrectomy. Among patients who received a PBT, intraoperative (but not postoperative) BT was a prognostic factor for survival. Among patients who received intraoperative BT, those receiving three or more transfusion units had a significantly worse survival. CONCLUSION: Receipt of a PBT was an independent predictor of RFS and CSS in patients with surgically treated RCC, specifically locally advanced disease. Regarding the prognostic impact of timing or dose of PBT on survival, intraoperative BT and ≥ 3 pRBC units were associated with adverse oncological outcomes.


Assuntos
Carcinoma de Células Renais/cirurgia , Cuidados Intraoperatórios/métodos , Neoplasias Renais/cirurgia , Adulto , Idoso , Transfusão de Sangue , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nefrectomia/efeitos adversos , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
5.
Tunis Med ; 98(2): 131-137, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32395802

RESUMO

INTRODUCTION: The subdivision into two entities of papillary renal cell carcinoma (PRCC) was established on histological criteria. It's in fact possible to distinguish the two subtypes by the means of radiological and progressive data. The subtype 1 is associated with the favorable profile. The ultrasound and especially CT urography ensure an accurate diagnostic approach with substantial therapeutic and prognostic involvement. The aim of the study is to define the radiological features that distinguish the two subtypes of renal papillary carcinoma, and to study the radiological predictive factors of locoregional recurrence, metastases free survival and specific survival. METHODS: It's about a monocentric, retrospective study led between January 2005 and June 2017, gathering 49 cases of operated PRCC. The study concerned patients over the age of 18, who were diagnosed after anatomopathological examination of the operative specimen (enlarged nephrectomy or conservative surgery). Cases in which diagnosis was made by renal biopsy were excluded. The comparative study concerned ultrasound and CT scan data. Univariate and multivariate analysis were performed to determine factors having a prognostic value in terms of locoregional recurrence, metastases-free and specific survival. RESULTS: On the ultrasound, the subtype 1 tumors were significantly homogenous with regular contours. Tumors were globally spontaneously hypodense and hypo vascular in 97,8% of cases. Enhancement was significantly more heterogonous for subtype 2 (p=0,01). Intratumoral necrosis and adenomegalies were associated with subtype 2 (p=0,0001 and 0,005). The predictive factors of locoregional recurrence, metastases-free survival and specific survival in univariate analysis were the contours' aspect, moderate enhancement and the presence of adenomegalies. On multivariate analysis, only the irregular contours were retained for locoregional recurrence-free survival and specific survival. CONCLUSIONS: Significant differences between the PRCC subtypes were observed when studying the radiological data. Irregular contours, adenomegalies and enhancement degree seemed to predict the progression of PRCC after curative surgery.


Assuntos
Carcinoma de Células Renais/diagnóstico , Diagnóstico por Imagem/métodos , Neoplasias Renais/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Tratamento Conservador/efeitos adversos , Tratamento Conservador/métodos , Feminino , Humanos , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/etiologia , Estadiamento de Neoplasias , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Tomografia/métodos , Ultrassonografia/métodos , Adulto Jovem
6.
Isr Med Assoc J ; 22(4): 244-248, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32286029

RESUMO

BACKGROUND: Pancreatic injuries during nephrectomy are rare, despite the relatively close anatomic relation between the kidneys and the pancreas. The data regarding the incidence and outcome of pancreatic injuries are scarce. OBJECTIVES: To assess the frequency and the clinical significance of pancreatic injuries during nephrectomy. METHODS: A retrospective analysis was conducted of all patients who underwent nephrectomy over a period of 30 years (1987-2016) in a large tertiary medical center. Demographic, clinical, and surgical data were collected and analyzed. RESULTS: A total of 1674 patients underwent nephrectomy during the study period. Of those, 553 (33%) and 294 patients (17.5%) underwent left nephrectomy and radical left nephrectomy, respectively. Among those, four patients (0.2% of the total group, 0.7% of the left nephrectomy group, and 1.36% of the radical left nephrectomy) experienced iatrogenic injuries to the pancreas. None of the injuries were recognized intraoperatively. All patients were treated with drains in an attempt to control the pancreatic leak and one patient required additional surgical interventions. Average length of stay was 65 days (range 15-190 days). Mean follow-up was 23.3 months (range 7.7-115 months). CONCLUSIONS: Pancreatic injuries during nephrectomy are rare and carry a significant risk for postoperative morbidity.


Assuntos
Carcinoma de Células Renais/cirurgia , Doença Iatrogênica , Neoplasias Renais/cirurgia , Nefrectomia/efeitos adversos , Pâncreas/lesões , Pancreatopatias/etiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/patologia , Estudos de Coortes , Tratamento Conservador/métodos , Feminino , Seguimentos , Humanos , Israel , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Pancreatopatias/mortalidade , Pancreatopatias/terapia , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Taxa de Sobrevida , Centros de Atenção Terciária
7.
PLoS One ; 15(4): e0227546, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32343697

RESUMO

We developed a preoperative assessment system to predict surgical workload in hand-assisted laparoscopic donor nephrectomy (HALDNx) using the normal-based linear discriminant rule (NLDR). A total of 128 cases of left HALDNx performed by a single operator were used as training data. Surgical workload was measured by operative time. The optimized model had 9 explanatory variables: age, total protein, total cholesterol, number of renal arteries (numberRA), 4 variables of perinephric fat (PNF), and thickness of subcutaneous fat. This model was validated using cross-validation and the .632 estimator to estimate discrimination rates with future test data. PNF and numberRA were the predominant factors affecting workload followed by the computed tomography value of PNF, body weight, and male sex. The estimated accuracy of the prediction system was 94.6%. The complication rate was 9.38% and did not correlate with surgical workload. We also made our program available online for constructing assessment functions from other cohort data. In conclusion, the surgical workload of HALDNx could be predicted with PNF and numberRA as the dominant risk factors.


Assuntos
Laparoscopia Assistida com a Mão/efeitos adversos , Modelos Estatísticos , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Idoso , Índice de Massa Corporal , Análise Discriminante , Feminino , Laparoscopia Assistida com a Mão/estatística & dados numéricos , Humanos , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Rim/cirurgia , Curva de Aprendizado , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Nefrectomia/estatística & dados numéricos , Duração da Cirurgia , Segurança do Paciente , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Período Pré-Operatório , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Medição de Risco/métodos , Fatores de Risco , Coleta de Tecidos e Órgãos/métodos , Coleta de Tecidos e Órgãos/estatística & dados numéricos , Tomografia Computadorizada por Raios X , Carga de Trabalho/estatística & dados numéricos , Adulto Jovem
8.
J Vasc Interv Radiol ; 31(4): 564-571, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32127324

RESUMO

PURPOSE: To assess use of stereotactic body radiotherapy (SBRT) for stage I renal cell carcinoma (RCC) and compare outcomes with thermal ablation and partial nephrectomy (PN). MATERIALS AND METHODS: The 2004-2015 National Cancer Database was investigated for histopathologically proven stage I RCC treated with PN, cryoablation, radiofrequency (RF) or microwave (MW) ablation, or SBRT. Patients were propensity score-matched to account for potential confounders, including patient age, sex, race, comorbidities, tumor size, histology, grade, tumor sequence, administration of systemic therapy, treatment in academic vs nonacademic centers, treatment location, and year of diagnosis. Overall survival (OS) was evaluated with Kaplan-Meier plots, log-rank tests, and Cox proportional hazards models. RESULTS: A total of 91,965 patients were identified (SBRT, n = 174; PN, n = 82,913; cryoablation, n = 5,446; RF/MW ablation, n = 3,432). Stage I patients who received SBRT tended to be older women with few comorbidities treated at nonacademic centers in New England states. After propensity score matching, a cohort of 636 patients was obtained with well-balanced confounders between treatment groups. In the matched cohort, OS after SBRT was inferior to OS after PN and thermal ablation (PN vs SBRT, hazard ratio [HR] = 0.29, 95% confidence interval [CI] 0.19-0.46, P < .001; cryoablation vs SBRT, HR = 0.40, 95% CI 0.26-0.60, P < .001; RF/MW ablation vs SBRT, HR = 0.46, 95% CI 0.31-0.67, P < .001). Compared with PN, neither cryoablation nor RF/MW ablation showed significant difference in OS (cryoablation vs PN, HR = 1.35, 95% CI 0.80-2.28, P = .258; RF/MW ablation vs PN, HR = 0.64, 95% CI 0.95-2.55, P = .079). CONCLUSIONS: Current SBRT protocols show lower OS compared with thermal ablation and PN, whereas thermal ablation and PN demonstrate comparable outcomes.


Assuntos
Técnicas de Ablação/tendências , Carcinoma de Células Renais/radioterapia , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/radioterapia , Neoplasias Renais/cirurgia , Nefrectomia/tendências , Padrões de Prática Médica/tendências , Radiocirurgia/tendências , Técnicas de Ablação/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/patologia , Ablação por Cateter/tendências , Criocirurgia/tendências , Bases de Dados Factuais , Feminino , Humanos , Neoplasias Renais/epidemiologia , Neoplasias Renais/patologia , Masculino , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Lesões por Radiação/epidemiologia , Radiocirurgia/efeitos adversos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
9.
Transplant Proc ; 52(3): 722-730, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32143866

RESUMO

CONTEXT: Studies on the surgical outcome in living kidney donors mainly report perioperative complications with short follow-up. OBJECTIVE: The objectives of this study are to evaluate the long-term surgical outcome in living kidney donors and to identify donors with an increased risk for a complicated postoperative course. BASIC PROCEDURES: A prospectively collected database of 496 living kidney donors at the Department of General, Visceral, and Transplantation Surgery of the Ruprecht Karls University Heidelberg was retrospectively analyzed in a retrospective, observational single-center study. RESULTS: The median follow-up time was 37 months. The perioperative severe complication (Clavien-Dindo IIIb) rate was 2.8%, the early postoperative (PO) severe complication rate (1-3 months post operation) was 0.7%, and the late PO severe complication rate (> 3 months post operation) was 8.4%. In multivariate analyses, male sex was associated with higher overall perioperative complication rate (odds ratio [OR], 1.930; P = .005) as well as higher rate of late PO complications (OR, 2.243; P = .014). An increased body mass index was associated with a higher late and severe (Clavien-Dindo ≥ IIIb) PO complication rate (OR, 1.107; P = .009 and OR, 1.105; P = .008, respectively). CONCLUSIONS AND RELEVANCE: Long-term surgery-associated severe complications occur in 8.4% of kidney donors. Older age is associated with an increased operative time, greater intraoperative blood loss, and longer PO hospital stay. Male donors and donors with an increased body mass index have a higher risk for a complicated PO course after kidney donation. Within a shared decision-making process before living kidney donation, special awareness should be brought to these facts.


Assuntos
Transplante de Rim/métodos , Doadores Vivos , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Idoso , Índice de Massa Corporal , Feminino , Humanos , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
10.
Int J Clin Oncol ; 25(6): 1155-1162, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32065298

RESUMO

BACKGROUND: When local recurrence of renal cell carcinoma (RCC) occurs after nephron-sparing surgery (NSS) on the ipsilateral side, some surgeons hesitate to perform reoperative surgery because of possible difficulties. We aimed to evaluate the clinical outcomes of repeat partial nephrectomy (RePN) compared with those of initial partial nephrectomy (iPN) for RCC of a solitary kidney. METHODS: Until September 2017, 1671 patients with renal tumors underwent NSS. Of these, 79 patients who underwent NSS for sporadic RCC of a solitary kidney were included. Parameters were compared using the Mann-Whitney U, Pearson Chi-square, and Fisher exact tests. RESULTS: Eleven patients underwent RePN and 68 underwent iPN. The RePN group had a relatively smaller tumor size (p = 0.0432), longer operative time (p = 0.0432), and higher estimated blood loss (p = 0.0002) than the iPN group. No significant differences in the other clinical factors were found between the groups. The rates of perioperative complications greater than Clavien-Dindo grade II were 18.2% and 17.6% in the RePN group and iPN group, respectively. The mean decreasing rate of estimated glomerular filtration rate was not different between the groups at 3 and 6 months postoperatively. No significant differences were found in hemodialysis-free survival (p = 0.7392) and intrarenal recurrence-free survival (p = 0.4924) between the groups. CONCLUSIONS: The clinical outcomes of RePN were not significantly different compared with those of iPN for patients with sporadic RCC of a solitary kidney. RePN is technically feasible with acceptable complication and local recurrence rates with better postoperative kidney function.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Rim Único/cirurgia , Idoso , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Feminino , Taxa de Filtração Glomerular , Humanos , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Nefrectomia/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Diálise Renal , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
11.
Transplantation ; 104(3): 583-590, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32106202

RESUMO

BACKGROUND: Recipients of kidneys from living donors who subsequently develop end-stage renal disease (ESRD) also have higher graft failure, suggesting the 2 donor kidneys share risk factors that could inform recipient outcomes. Given that donor ESRD is rare, an earlier and more common postdonation outcome could serve as a surrogate to individualize counseling and management for recipients. Hypertension is a frequent event before donor ESRD; thus, early postdonation hypertension might indicate higher risk of graft failure. METHODS: We studied Scientific Registry of Transplant Recipients data to quantify the association between early postdonation hypertension and recipient graft failure using propensity score-weighted Cox proportional hazards regression. We also examined the association between postdonation systolic blood pressure and graft failure. RESULTS: Of 37 901 recipients, 2.4% had a donor who developed hypertension within 2 years postdonation. Controlling for donor and recipient characteristics, recipients whose donors developed hypertension had no higher risk for graft failure (adjusted hazard ratio [aHR] 1.03, 95% confidence interval [CI] 0.85-1.25, P = 0.72). This was consistent among subgroups of recipients at higher risk for adverse outcomes due to hyperfiltration: African American recipients (aHR 1.10, 95% CI 0.70-1.73, P = 0.68) and those with ESRD caused by hypertension (aHR 1.10, 95% CI 0.65-1.85, P = 0.73) or diabetes (aHR 0.80, 95% CI 0.56-1.13, P = 0.20). However, graft failure was associated with postdonation systolic blood pressure (per 10 mm Hg, aHR 1.05, 95% CI 1.03-1.08, P < 0.001). CONCLUSIONS: Although postdonation systolic blood pressure is associated with graft failure, the reported diagnosis of hypertension as determined by the requirement for blood pressure treatment early postdonation did not portend a higher risk of recipient graft failure in the same way as eventual postdonation ESRD.


Assuntos
Rejeição de Enxerto/epidemiologia , Hipertensão/epidemiologia , Transplante de Rim/efeitos adversos , Nefrectomia/efeitos adversos , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Anti-Hipertensivos/uso terapêutico , Feminino , Seguimentos , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Incidência , Rim , Falência Renal Crônica/cirurgia , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Medição de Risco , Fatores de Risco , Transplantados/estatística & dados numéricos
12.
Eur J Radiol ; 124: 108853, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32007820

RESUMO

PURPOSE: To evaluate the image quality of early postoperative CT angiography with low contrast material and radiation dose using model-based iterative reconstruction (FIRST) for screening pseudoaneurysms after partial nephrectomy. METHODS: CT angiography was obtained before surgery using conventional iterative dose reduction reconstruction (AIDR 3D) with 120 kVp and 600 mgI/kg of contrast material and obtained after partial nephrectomy using FIRST with 80-100 kVp and 360 mgI/kg in 35 patients. Contrast-to-noise ratio, visual image quality scores using a 5-point scale, and longest length of the unaffected renal arteries on maximum intensity projection images were retrospectively compared between FIRST and AIDR 3D. RESULTS: No significant differences existed in contrast-to-noise ratio or image quality scores of the renal arteries between FIRST and AIDR 3D (25.8 ± 6.6 vs. 25.4 ± 7.0, p = 0.991 and 4.8 ± 0.4 vs. 4.5 ± 0.9, p = 0.515, respectively). Visualization scores and longest length of the peripheral renal arteries in FIRST were significantly superior to those of AIDR 3D (4.3 ± 0.8 vs. 3.5 ± 1.0, p < 0.001 and 100.4 ± 14.9 mm vs. 90.2 ± 15.7 mm, p = 0.010, respectively). The dose-length product with FIRST was significantly lower than that with AIDR 3D (566.1 ± 217.4 mGy.cm vs. 829.8 ± 324.9 mGy.cm, p < 0.001). CONCLUSION: FIRST can improve visualization of the peripheral renal arteries with contrast material and radiation dose reduced by approximately 30 % compared with AIDR 3D, which enables adequate evaluation of pseudoaneurysms after partial nephrectomy.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adulto , Idoso , Algoritmos , Falso Aneurisma/etiologia , Feminino , Humanos , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Artéria Renal/diagnóstico por imagem , Estudos Retrospectivos
13.
Urologe A ; 59(1): 32-39, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31915888

RESUMO

BACKGROUND: In the context of living donation, the protection of the donor and the outcome are very important aspects. However, the side selection of the donor nephrectomy is also decisive. In this work, the basics of side selection and the question of whether there are differences regarding the left-sided or right-sided donor nephrectomy are considered. MATERIALS AND METHODS: Living kidney donation data of our center between December 2004 and July 2019 were evaluated in terms of withdrawal side, complications and outcome, as well as the current literature in PubMed. Finally, the results from our center are compared with the current literature. RESULTS: During the investigation period, 152 live donations were carried out in our center. In these cases 66 patients had a left-sided and in 86 cases a right-sided donor nephrectomy. One transplant vein thrombosis occurred in each group. Complications and outcome were similar for the recipient in both groups. It was noticed in the current literature that generally more left-sided donor nephrectomies are performed, most likely due to the preference of the surgeon. Although a low significantly increased risk of transplant vein thrombosis after right-sided donor nephrectomy is described, all authors agree that right-sided donor nephrectomy is a safe procedure with good outcome. CONCLUSIONS: Our own results and the current literature show that the right-sided donor nephrectomy is a safe procedure with only a slightly increased risk of complications compared to the left side and therefore can be recommended. It is clearly safe for the donor and organ, with an equivalent outcome for the recipient. The results are also dependent on the experience of the surgeon.


Assuntos
Transplante de Rim , Doadores Vivos , Nefrectomia/métodos , Coleta de Tecidos e Órgãos/efeitos adversos , Humanos , Laparoscopia , Nefrectomia/efeitos adversos , Coleta de Tecidos e Órgãos/métodos
14.
PLoS One ; 15(1): e0226581, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895931

RESUMO

BACKGROUND: Sarcopenia is defined as a low skeletal muscle volume. Recent studies have reported that sarcopenia is associated with a poor prognosis in various cancers. The purpose of this study is to evaluate the correlation between the psoas muscle volume and recurrence-free survival in patients with localized clear cell renal cell carcinoma (ccRCC). METHODS: A total of 316 male patients with localized ccRCC who underwent radical nephrectomy at Yokohama City University Hospital (Yokohama, JAPAN) and Kanagawa Cancer Center (Yokohama, JAPAN) between 2002 and 2018 were enrolled in this study. The psoas muscle index (PMI) was calculated by normalizing the psoas muscle area on the contralateral side of the tumor on axial CT, which was calculated at the level of L4 (mm2) divided by the square of the body height (m2). We divided patients into two groups based on the median PMI (409.64mm2/m2). RESULTS: The lower PMI group showed poorer recurrence-free survival (RFS) than the higher PMI group (p = 0.030). Regarding 5-year RFS, a lower PMI was a significant predictor of recurrence (p = 0.022, hazard ratio (HR): 2.306) and a multivariate analysis revealed that a lower PMI (4 cm (p = 0.044, HR: 2.341), and pathological stage >2 (p<0.001, HR: 3.660) were independent risk factors for poor RFS. CONCLUSIONS: The presence of sarcopenia (lower PMI) was found to be associated with poor RFS in male ccRCC patients. The PMI might serve as a measure of patient frailty and might be useful for prognostic risk stratification in ccRCC.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Nefrectomia/efeitos adversos , Músculos Psoas/patologia , Sarcopenia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/patologia , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/etiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/diagnóstico , Sarcopenia/etiologia , Taxa de Sobrevida , Adulto Jovem
15.
Transplant Proc ; 52(1): 67-72, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31889541

RESUMO

BACKGROUND: Hand-assisted laparoscopic donor nephrectomy (HALDN) has rapidly become the best alternative to open nephrectomy for living kidney donation. As more centers continue to adopt the laparoscopic technique, the safety of the initial transplants must be ensured while ascending the learning curve (LC). This study looks to determine the safety of HALDN and to describe the results of the LC in our center. METHODS: We conducted a retrospective review of 500 HALDNs performed in our center from July 2003 to July 2017. We analyzed demographic and perioperative characteristics and complications during the first postoperative month. We divided HALDNs into 2 groups: before and after completing the LC (50 nephrectomies). For each group, we assessed operating room time, estimated blood loss, length of stay, and complication and conversion rates. RESULTS: A total of 500 HALDNs were performed in the study period. Of those, 454 were analyzed in the 2 groups. The median operating room time was 2 hours, length of stay was 2 days, and blood loss was 50 cc. The overall rate of complication was 6.8%. There were significant differences between the 2 groups in operating time, blood loss, and length of stay (P < .05). No differences were found in terms of complication (P = .42) and conversion (P = .28) rates. CONCLUSION: There was a significant decrease in operating time, blood loss, and length of stay in patients who underwent laparoscopic donor nephrectomy by an experienced laparoscopist. However, no differences were found in complication and conversion rates, which suggests that improvement in surgical training can be accomplished without altering the donor safety.


Assuntos
Laparoscopia Assistida com a Mão/métodos , Nefrectomia/métodos , Coleta de Tecidos e Órgãos/métodos , Adulto , Feminino , Laparoscopia Assistida com a Mão/efeitos adversos , Humanos , Transplante de Rim , Curva de Aprendizado , Tempo de Internação , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
16.
Transplant Proc ; 52(1): 84-88, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31901325

RESUMO

BACKGROUND: The host-related risk factors for surgical difficulty of partial nephrectomy include the presence of thick and adherent adipose tissue surrounding the kidney (adherent perinephric fat [APF]). The kidney and perirenal fat must be isolated in donor nephrectomy. Thus, APF is an important surgery-related factor. We analyzed whether the Mayo adhesive probability (MAP) score is related to APF and surgical outcomes in laparoscopic single-site donor nephrectomy (LESS-DN). METHODS: Forty-six donors who underwent LESS-DN were selected. Determination of APF was based on a retrospective review of video-recorded surgical procedures during anterior perinephric fat dissection. The MAP score was evaluated from computed tomography images. Data regarding patient characteristics and operative outcomes were collected. We then examined the MAP score, APF, and related factors. RESULTS: Eleven patients (23.9%) had APF. The patients were divided into 2 groups (MAP score of 0 points and ≥ 1 point). The 2 groups showed significant differences in sex, age, body mass index, history of hypertension, and history of dyslipidemia. The operation time was significantly longer and the estimated blood loss volume was higher in patients with a MAP score of ≥ 1. Eight of 9 patients with a MAP score of ≥ 1 had APF. The only significant differences between patients with and without APF were in the body mass index, history of hypertension, and history of dyslipidemia. The operation time was significantly longer and the estimated blood loss volume was larger in patients with APF. CONCLUSIONS: The MAP score could be useful when predicting surgical difficulty in patients undergoing LESS-DN.


Assuntos
Gordura Intra-Abdominal/diagnóstico por imagem , Nefrectomia/efeitos adversos , Aderências Teciduais/diagnóstico por imagem , Coleta de Tecidos e Órgãos/efeitos adversos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Índice de Massa Corporal , Feminino , Humanos , Gordura Intra-Abdominal/patologia , Gordura Intra-Abdominal/cirurgia , Rim/diagnóstico por imagem , Rim/patologia , Rim/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Aderências Teciduais/complicações , Aderências Teciduais/patologia , Coleta de Tecidos e Órgãos/métodos
17.
Radiology ; 294(3): 698-706, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31961239

RESUMO

Background Percutaneous microwave ablation (MWA) and laparoscopic partial nephrectomy (LPN) are two modalities indicated for early-stage renal cell carcinoma (RCC) with low extent of invasion. Purpose To compare the long-term results of percutaneous MWA and LPN in the treatment of cT1a RCC. Materials and Methods This retrospective study included 1955 patients with cT1a RCC treated with percutaneous MWA or LPN between April 2006 and November 2017. Propensity score matching was used. Oncologic outcomes were analyzed by using the Fine-and-Gray competing risk models. Results A total of 185 patients underwent percutaneous MWA (mean age, 63.2 years ± 15.2 [standard deviation]) and 1770 underwent LPN (mean age, 50.9 years ± 13.2). During the follow-up (median, 40.6 months), after propensity score matching, no difference was observed between local tumor progression (3.2% vs 0.5%, P = .10), cancer-specific survival (2.2% vs 3.8%, P = .24), and distant metastases (4.3% vs 4.3%, P = .76). Patients who underwent percutaneous MWA had worse overall survival (hazard ratio, 2.4; 95% confidence interval: 1.0, 5.7; P = .049 vs LPN) and disease-free survival (82.9% vs 91.4%, P = .003). Percutaneous MWA led to smaller drop in estimated glomerular filtration rate at discharge (6.2% vs 16.4%, P < .001), smaller estimated blood loss (4.5 mL ± 1.3 vs 54.2 mL ± 69.2), lower cost ($3150 ± 2970 vs $6045 ± 1860 U.S. dollars), shorter operative time (0.5 minute ± 0.1 vs 1.8 minutes ± 0.6), and shorter postoperative hospitalization time (5.1 days ± 2.6 vs 6.9 days ± 2.8) (all P < .001 vs LPN). There were fewer cases of fever in the percutaneous MWA group (16.2% vs 73.0%, P < .001). Conclusion There were no significant differences regarding oncologic outcomes and complications between percutaneous microwave ablation and laparoscopic partial nephrectomy for patients with cT1a renal cell carcinoma. Percutaneous microwave ablation led to smaller renal function change and lower blood loss. For patients who cannot be subjected to the risks of more invasive laparoscopic partial nephrectomy, percutaneous microwave ablation could be an alternative less invasive treatment option. © RSNA, 2020 Online supplemental material is available for this article.


Assuntos
Técnicas de Ablação , Carcinoma de Células Renais , Neoplasias Renais , Nefrectomia , Técnicas de Ablação/efeitos adversos , Técnicas de Ablação/métodos , Técnicas de Ablação/mortalidade , Idoso , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Rim/cirurgia , Neoplasias Renais/epidemiologia , Neoplasias Renais/mortalidade , Neoplasias Renais/cirurgia , Masculino , Micro-Ondas , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Nefrectomia/mortalidade , Complicações Pós-Operatórias , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
18.
Transplantation ; 104(3): e65-e74, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31895342

RESUMO

BACKGROUND: Understanding the outcomes and risks for live kidney donors (LD) is increasingly important; this study investigated all-cause mortality and morbidity outcomes of LD compared with a healthy cohort. METHODS: Live donor dataset was obtained from the UK Transplant Registry and a comparator nondonor cohort selected from The Health Improvement Network (THIN) database, a UK primary healthcare database. All LD from January 1, 2001, to December 31, 2013, were included, with follow-up until December 31, 2016. RESULTS: There were 9750 LD and 19 071 THIN participants. Median follow-up (interquartile range) for LD was 8.4 (6.0-11.3) years and for THIN was 5.4 (2.6-8.5) years. In up to 15 years, follow-up end-stage renal disease was observed in 1 LD versus 7 THIN (P = 0.280). Nine LD had estimated glomerular filtration rate of <30 mL/min/1.73 m versus 43 in THIN (P = 0.012), but no statistically significant difference in adjusted logistic regression analyses. Risk of diabetes mellitus, depression, and cardiovascular disease was significantly higher for THIN cohort in adjusted analyses. The risk of hypertension was higher for LD at 5 years but was not significantly different in fully adjusted analyses at 10 years. There were 68 deaths in LD and 485 in THIN over the follow-up period, with significant difference in mortality favoring LD (P < 0.001). CONCLUSIONS: The medium-term morbidity and mortality outcomes of live donors in comparison with a healthy cohort suggest that live donation is not associated with excess mortality, end-stage renal disease, or morbidity, in at least 10 years follow-up.


Assuntos
Falência Renal Crônica/epidemiologia , Doadores Vivos/estatística & dados numéricos , Nefrectomia/efeitos adversos , Coleta de Tecidos e Órgãos/efeitos adversos , Adolescente , Adulto , Causas de Morte , Conjuntos de Dados como Assunto , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/etiologia , Transplante de Rim/métodos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Reino Unido/epidemiologia , Adulto Jovem
19.
Oncology ; 98(2): 117-122, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31715614

RESUMO

BACKGROUND: The treatment of kidney cancer usually involves surgery, and in some cases systemic therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to control postsurgical pain in patients undergoing nephrectomy for renal cancer. Nevertheless, the association between these drugs and adverse postsurgical outcomes, including deterioration of renal function, is not fully established. METHODS: This retrospective cohort study included patients >18 years old with kidney cancer undergoing nephrectomy between January 2006 and January 2018. The primary endpoint was to determine the impact of postsurgical analgesic therapy (NSAIDs vs. acetaminophen) on renal function and postsurgical complications. This study was approved by our scientific and bioethical committee. RESULTS: One hundred patients were included in the final analysis. Clear-cell renal-cell carcinoma was the most frequent histologic subtype. Adequate acute pain control was accomplished in 91% of the patients during hospitalization. Twenty percent of the patients presented postsurgical complications. Bleeding-related complications were the most frequent (9%), followed by surgical-site infection (6%) and acute renal injury (6%). The administration of NSAIDs was not related to any postsurgical complication in comparison with the use of acetaminophen (21.3 vs. 17.9%, respectively). The length of hospital stay did not differ between patients treated with NSAIDs and those treated with acetaminophen (the average stay was 4 days for both groups, p = 0.32). CONCLUSION: The use of NSAIDs was not related to acute kidney injury, postsurgical complications, or prolonged hospital stay in patients with renal cancer undergoing nephrectomy.


Assuntos
Analgésicos/efeitos adversos , Neoplasias Renais/complicações , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Idoso , Analgésicos/administração & dosagem , Biomarcadores , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/metabolismo , Prognóstico , Resultado do Tratamento
20.
Urology ; 135: 88-94, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31585198

RESUMO

OBJECTIVE: To compare perioperative and oncologic outcomes for patients with clinical T1b renal cell carcinoma following treatment with microwave ablation (MW), partial nephrectomy (PN), or radical nephrectomy (RN). METHODS: Comprehensive clinical and pathologic data were collected for nonmetastatic renal cell carcinoma patients with cT1b tumors following MW, PN, or RN from 2000 to 2018. Local recurrence-free, metastasis-free, cancer-specific and overall survival were estimated using Kaplan-Meier method. Prognostic factors for complications and survival were determined using logistic regression and Cox hazard models, respectively. RESULTS: A total of 325 patients (40 MW, 74 PN, and 211 RN) were identified. Patients treated with MW were older with higher Charlson comorbidity indices compared to surgical patients. Median length of hospitalization was shorter for MW compared to surgical patients (1 day vs 4 days, P <.0001). Post-treatment estimated glomerular filtration rate decreased by median 4.5% for MW compared to 3.2% for PN (P = .58) and 29% for RN (P <.001). Median follow-up was 34, 35, and 49 months following MW, PN, and RN, respectively. Estimated 5-year local recurrence-free survival was 94.5% for MW vs 97.9% for PN (P = .34) and 99.2% for RN (P = .02). Two patients recurred after MW and underwent repeat ablation without subsequent recurrence. No difference in 5-year metastasis-free survival or cancer-specific survival was found among MW, PN, or RN. Four (10%) MW patients had high-grade complication. Only prior abdominal surgery predicted high-grade complication (OR 6.29, P = .017). CONCLUSION: Microwave ablation is a feasible alternative to surgery in select comorbid patients with clinical T1b renal cell carcinoma.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Ablação por Radiofrequência/efeitos adversos , Idoso , Carcinoma de Células Renais/mortalidade , Intervalo Livre de Doença , Estudos de Viabilidade , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/mortalidade , Masculino , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Nefrectomia/métodos , Complicações Pós-Operatórias/etiologia , Ablação por Radiofrequência/métodos , Reoperação/estatística & dados numéricos
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