Systemic immunologic and inflammatory response after laparoscopic versus open nephrectomy: a prospective cohort trial.

PURPOSE: To compare the dynamics of systemic inflammatory indices during laparoscopic nephrectomy (LN) and standard open donor nephrectomy. PATIENTS AND METHODS: Participants in this cohort study were 54 adults without a history of renal surgery and no evidence of urinary tract infection who underwent transperitoneal LN (n=29) and open donor nephrectomy (n=25, control group). We recorded demographic characteristics, intraoperative parameters, and changes 24 hours postoperatively in systemic inflammatory and immunologic values (body temperature, concentrations of white blood cell count [WBC], C-reactive protein [CRP], interleukin [IL]-6, and tumor necrosis factor [TNF]-α), and compared the mean changes between groups. RESULTS: Mean age was older in the LN group (45.6 vs 30.9 years; P<0.0001), and mean operative time was significantly shorter (83.1 min vs 101.6 min; P=0.004). Mean postoperative increase in IL-6 and body temperature in LN was significantly less than in control: For IL-6, 15.87 vs 29.09 pg/mL, P=0.03; for body temperature, +0.22°C vs +0.71°C, P=0.001). Mean postoperative increases in levels of other inflammatory markers (CRP, TNF-α, WBC) did not differ significantly. No statistical correlation was found between operative time and changes in IL-6, CRP, TNF-α, WBC, or body temperature. CONCLUSION: Based on the smaller increase in serum IL-6 as the most important indicator of surgical stress, the surgical trauma-induced immune dysfunction may be less intense after LN than open surgery. This may explain the smooth convalescence after LN.

Role of viruses in renal cell carcinoma.

To determine whether viral infections are related to renal cell carcinoma (RCC), we studied 49 patients with RCC (29 patients were males with age ranging from 30 to 81 years and a mean of 57.5 years; 20 patients were females with age ranging from 36 to 70 years with a mean of 58.4 years) and 16 non-neoplastic kidney patients as controls. Tissues specimens from study patients and controls were examined by nested polymerase chain reaction (PCR) to determine the presence of DNA of several viruses including human papilloma virus (HPV), Epstein-Barr virus (EBV), and polyoma viruses (BKV and JCV). Our results revealed that 7 of 49 (14.29%) RCC tissue specimens had HPV DNA compared with none of 16 non-cancer control subjects. Regarding the HPV types, all the positive results were high-risk HPV types (type 16 in three and 18 in four patients). The present study suggests that HPV infection, especially high-risk types, is associated with RCC. However, more studies are necessary to demonstrate the molecular oncogenic processes involved in this association.

Comparison of immediate renal dysfunction in split and partial liver transplantation versus full size liver transplantation in Shiraz transplant centre.

BACKGROUND: Renal dysfunction (RD) is a common complication following liver transplantation. Postoperative renal function after split liver transplant (SLT) and (partial living related liver transplant) (LRLT) has not been well studied yet. MATERIAL/METHODS: Renal function immediately after surgery was analyzed retrospectively in 32 patients that received SLT and LRLT. Serum creatinine (SCr) was measured before surgery, and, after transplantation daily during the first week and at 14, 21, and 28 days after transplantation. Patient's medical records were reviewed to find clinical data;Model for end-stage liver disease (MELD) score, Child-Turcotte-Pugh score (CTP) class, the length of surgery, length of anhepatic phase, hospital and ICU admission, incidence of acute rejection, renal dysfunction, and sepsis. These data compared between groups. RESULTS: Length of surgery and anhepatic phase was longer in SLT and LRLT group (P<0.05). The incidence of acute rejection, reoperation, and complication such as sepsis was higher in SLT and LRLT group than FSLT group (P<0.05). There were no significant difference between groups with respect to MELD, CTP score, the need for transfusions, the length of admission to the hospital and ICU. Immunosuppression regimens were similar in both groups. RD developed in 25.8% of SLT and LRLT patients, but in only 9.5% of FSLT patients (p=0.063). The requirement for RRT in SLT and LRLT group (12.5%) was greater than that in the FSLT group (2.3%); P=0.20. CONCLUSIONS: Although the number of patients studied was small, our data suggests a higher incidence of RD in patients receiving SLT and LRLT.

Urethral catheter traction reduces bleeding compared with suturing of prostatic vesical junction during suprapubic prostatectomy: a randomized clinical trial study.

OBJECTIVES: To determine whether catheter traction during suprapubic prostatectomy can be beneficial in reducing intraoperative and postoperative bleeding. METHODS: A total of 156 patients with lower urinary tract symptoms who had indications for open prostatectomy were enrolled in the study from September 2004 to January 2006. Of the patients, 78 underwent open prostatectomy with suturing at the prostatic vesical junction (group 1) and 78 were treated with urethral catheter traction to control bleeding (group 2). The duration of operation, duration of hospital stay, intraoperative blood loss, hemoglobin decrease, and weight of resected prostate were recorded in both groups. Three months later, we followed up patients with the International Prostate Symptom Score questionnaire, maximal flow rate measurement, and cystoscopic examination. RESULTS: The mean operative time was 59 +/- 7 minutes and 40 +/- 9 minutes (P = .015) and the mean hospital stay was 3.7 +/- 0.24 days and 4.4 +/- 0.46 days (P = .09) in groups 1 and 2, respectively. The mean blood loss during surgery was 279 +/- 155 mL and 219 +/- 139 mL (P = .04) and the mean hemoglobin decrease was 2.3 +/- 1.4 g/dL and 1.6 +/- 1.5g/dL (P = .04) in groups 1 and 2, respectively. The mean weight of the prostate was not significantly different statistically between the 2 groups at 63 +/- 23 g and 64 +/- 19 g in groups 1 and 2, respectively (P = .8). The urethrocystoscopy examination at 3 months postoperatively revealed bladder neck contractures in 6.41% of the patients in group 1 and 3.85% in group 2. CONCLUSIONS: The results of our study have shown that urethral catheter traction diminishes bleeding compared with suturing at the prostatic vesical junction during suprapubic prostatectomy.