Preservation of renal function utilizing hypothermic circulatory arrest in the treatment of distal thoracoabdominal aneurysms (types III and IV).

Although left heart bypass and hypothermia are often used in the performance of type I and type II thoracoabdominal aneurysms (TAAs), most of these more distal aneurysms are done utilizing the clamp and sew technique. Renal failure occurs between 8.6% to 39% in recent series of patients following surgery for type III and IV TAAs.

Bladder-anal reflex.

Aims: The purposes of this study were to evaluate the bladder-anal reflex (BAR) latency in asymptomatic women and determine the pathway of the reflex using selective anesthesia and neuromuscular block.

Methods: Urinary incontinence, voiding dysfunction, and pelvic organ prolapse are common problems in women. Evaluation of pelvic nerve function often augments the clinical assessment of these women.

Dynamic evaluation of female pelvic organ prolapse by extended proctography.

More accurate preoperative assessment by DCP or MR imaging hopefully should reduce the incidence of operative failure. These techniques help the surgeon to plan the different components of pelvic reconstructive surgery and, importantly, whether a transvaginal or transabdominal approach will be required. The current trend is toward the transabdominal route.

Major complications in 213 laparoscopic nephrectomy cases: the Indianapolis experience.

Purpose: We assessed the incidence of and analyzed factors that may help prevent major complications and open conversion during laparoscopic nephrectomy at our institutions.

Materials And Methods: We retrospectively analyzed all laparoscopic nephrectomies performed between August 1, 1999 and July 31, 2001. Data were stratified for nephrectomy type, intraoperative and postoperative complications.

Manual specimen retrieval without a pneumoperitoneum preserving device for laparoscopic live donor nephrectomy.

Purpose: We present a novel method of kidney retrieval based on a modified Pfannenstiel incision and insertion of the assistant hand into the abdominal cavity without a device for pneumoperitoneum preservation. This maneuver is performed as the last step in pure laparoscopic live donor nephrectomy. Also, we assessed the effect of this technique on warm ischemia time compared with the standard laparoscopic bag retrieval technique.

Topiramate-induced nephrolithiasis.

Topiramate is a recently developed antiepileptic medication that is becoming more widely prescribed because of its efficacy in treating refractory seizures. Urologists should be aware that this medication can cause metabolic acidosis in patients secondary to inhibition of carbonic anhydrase. In addition, a distal tubular acidification defect may result, thus impairing the normal compensatory drop in urine pH.

Endoloop-assisted laparoscopic partial nephrectomy.

Purpose: To determine the safety and feasibility of Endoloop-assisted laparoscopic partial nephrectomy in a large-animal model.

Materials And Methods: Twelve female Yucatan mini-pigs underwent either left (N = 6) or right (N = 6) transperitoneal laparoscopic lower-pole nephrectomy following cinching of a 1-0 Vicryl suture loop (Endoloop) proximal to the resected lower pole until ischemic discoloration was achieved. The ischemic lower pole was excised with Endo-scissors and the lower pole removed using a laparoscopic bag.

Effect of radiographic contrast material exposure on spiral CT attenuation of renal calculi.

Rationale And Objectives: The authors performed this study to determine whether exposure of renal calculi to radiographic contrast material has an effect on the attenuation values at computed tomography (CT) performed with varying collimation widths.

Materials And Methods: Renal calculi (23 stones of various composition) were scanned with 1-, 3-, and 10-mm collimation. Stones were then exposed to a solution of radiographic contrast material for 5 minutes, washed with water, and rescanned 36 hours later.

Left ventricular assist system recipients exposed to bovine thrombin preparations have a higher frequency of antiphospholipid antibodies than nonexposed recipients.

After left ventricular assist system (LVAS) placement, recipients often develop antiphospholipid antibodies (aPL) that are associated with thrombosis. Fibrin glue containing a bovine thrombin preparation is used routinely in LVAS placement surgery. We investigated whether exposure to the thrombin preparation is responsible for stimulating aPL development in LVAS recipients.

Holmium laser enucleation for prostate adenoma greater than 100 gm.: comparison to open prostatectomy.

Purpose: Options for treatment of large (greater than 100 gm.) prostatic adenomas have until now been limited to open surgery or transurethral resection by skilled resectionists. Considerable blood loss, morbidity, extended hospital stay and prolonged recovery occur with open surgery for large prostatic adenomas.

Small-bowel obstruction: optimizing radiologic investigation and nonsurgical management.

Small-bowel obstruction is an old and common problem. Like most illnesses, its diagnosis and treatment continue to evolve. The radiologic approach to the investigation of small-bowel obstruction and the timing of surgical intervention have undergone considerable changes during the past decade.

Risk of early renal allograft failure is increased for patients with antiphospholipid antibodies.

Renal allograft thrombosis can cause transplant failure. Because antiphospholipid antibodies (aPA) are associated with thrombosis, we investigated pretransplant sera from patients with early renal allograft failure to determine if aPA were present. Fifty-six final cross-match (FxM) sera from patients whose transplant failed within 16 days were compared to FxM sera from the next sequential transplant patients.

Pharmacotherapy of systolic heart failure: a review of recent literature and practical applications.

Since the publication of the Agency for Health Care Policy and Research Guidelines for treatment of heart failure, a number of new agents have been investigated for this indication. beta-Blockers have now been shown to improve outcomes in mild to moderate heart failure when added to standard therapy. Angiotensin II receptor antagonists have also been investigated and show promise.

Current status of voice restoration following total laryngectomy.

Total laryngectomy is the surgical procedure traditionally used to treat patients with advanced-stage cancer of the larynx. The impairments resulting from removal of such a small organ are, indeed, profound. They include loss of voice and speech; altered respiration, necessitating a permanent breathing opening in the neck; and diminished sense of smell and taste.

Changes in platelet activation associated with left ventricular assist system placement.

Background: Thromboembolic and hemorrhagic complications are common in patients after left ventricular assist system (LVAS) placement. Platelet physiology may be involved in these complications.

Methods: Using flow cytometry, expression of CD62P and CD63 were analyzed as markers of platelet activation.

Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography.

Objective: This study compared dynamic MR imaging with fluoroscopic cystocolpoproctography for the detection and measurement of prolapse of pelvic organs.

Subjects And Methods: Ten patients underwent triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography with identical amounts of contrast material to opacify the bladder, vagina, and rectum. The dynamic MR imaging procedure included cine-loop presentation.

Comparison of the distribution of progenitor cells in G-CSF-mobilized peripheral blood and steady-state bone marrow after counterflow centrifugal elutriation.

Blood-derived progenitor cells obtained following mobilization with granulocyte colony-stimulating factor (MoPBSC) are increasingly being used as an alternative to bone marrow (BM) in allogeneic stem cell transplantation. The higher numbers of mature T lymphocytes in MoPBSC grafts may increase the risk of (chronic) graft-vs.-host disease.

Immunohistochemical analysis of vascular prostheses implanted with the left ventricular assist system.

Background: Dacron vascular prostheses are associated with thromboembolic complications and inflammatory responses; impregnation with bovine collagen reportedly stimulates additional inflammatory/immunologic complications. The Novacor (Baxter Healthcare Corp., Oakland, CA, USA) left ventricular assist system uses Dacron inflow and collagen-impregnated Dacron outflow prostheses.

Decreased antimicrobial resistance after changes in antibiotic use.

Vancomycin-resistant enterococci (VRE) and methicillin-oxacillin-resistant Staphylococcus aureus (MRSA) originally predominated in large medical centers; however, these isolates are now common in community hospitals and community clinics. No simple answer is available regarding control of antimicrobial-resistant bacteria, especially VRE and MRSA, as their numbers increase and pose a more serious threat to patient care. The source of colonization is often difficult to identify because of transport of patients among different locations on the continuum of care (e.

Female pelvic organ prolapse: diagnostic contribution of dynamic cystoproctography and comparison with physical examination.

Objective: The aim of this study was to assess the contribution of dynamic cystoproctography to the evaluation of female pelvic organ prolapse and to compare this contribution with that of physical examination.

Materials And Methods: The presence or absence of rectocele, enterocele, sigmoidocele, and cystocele on physical examination and on cystoproctography was retrospectively analyzed in 170 consecutive patients. For each of these diagnostic methods, organ prolapse was graded as small, moderate, or large on the basis of specific, defined measurements.