Aortic endograft thrombosis after colorectal surgery in lithotomy position.

Aortic endograft limb occlusion is a serious complication after endovascular abdominal aortic aneurysm repair. We describe a yet unreported cause of endograft limb occlusion, the lithotomy position. Two patients with abdominal aortic aneurysm and colorectal cancer underwent an initial endovascular repair followed by cancer resection in the lithotomy position.

Prognostic implications of echocardiography in advanced heart failure.

Purpose Of Review: The growing epidemic of systolic congestive heart failure mandates strategies to identify accurately people with high morbidity and mortality. Echocardiography remains the most widely available noninvasive tool for the assessment of cardiac structure, function, and hemodynamics. Clinical data paired with echocardiographic analysis in patients with systolic heart failure obtained from a variety of investigations have allowed for the evaluation of this modality as a prognostic tool.

Evaluation of platelet deposition and neointimal hyperplasia of heparin-coated small-caliber ePTFE grafts in a canine femoral artery bypass model.

Introduction: Bypass graft failure due to acute thrombosis and intimal hyperplasia remains a major challenge in small-diameter vascular prosthetic graft reconstruction. Heparin has been shown to prevent thrombus formation and inhibit intimal antithrombotic in animal studies. In this study, we evaluated the effect of small-caliber heparin-coated expanded polytetrafluoroethylene (ePTFE) grafts on platelet deposition and intimal hyperplasia in a canine model of femoral artery bypass grafting.

Structure-function analysis of the estrogen receptor alpha corepressor scaffold attachment factor-B1: identification of a potent transcriptional repression domain.

Scaffold attachment factor-B1 (SAFB1) is a nuclear matrix protein that has been proposed to couple chromatin structure, transcription, and RNA processing. We have previously shown that SAFB1 can repress estrogen receptor (ERalpha)-mediated transactivation. Here we present a structure-function study showing that transactivation is mediated via an intrinsic and transferable C-terminal repression domain (RD).

Some considerations for management of choledochal cysts.

Background: There are five types of choledochal cysts, which are anomalies that involve intrahepatic or extrahepatic bile ducts, or both. These lesions are found most frequently in patients who are Asian, female, infants but are recognized with increasing frequency in adults.

Methods: We have managed 16 patients with this anomaly.

Initial report of retroperitoneoscopic renal surgery in a patient with factor VIII deficiency (classic hemophilia).

Bleeding disorders are generally considered absolute contraindications to laparoscopic surgery. We believe laparoscopic/retroperitoneoscopic renal surgery is an optimal choice in patients with hemophilia, because it minimizes tissue trauma. We present a case of successful retroperitoneoscopic renal surgery in a patient with factor VIII deficiency with a perinephric abscess that failed less invasive treatments.

Evaluation of hemodynamics: comparison of vacuum and mechanical stabilization in the beating heart.

Background: Hemodynamic instability remains a prominent concern for surgeons performing coronary surgery without cardiopulmonary bypass. The purpose of this study was to further elucidate the mechanism of hemodynamic instability by comparing vacuum stabilization to mechanical stabilization.

Methods: Four 60-kg swine were placed under general anesthesia.

Rare case of metastatic prostate adenocarcinoma to the pituitary.

We report a rare case of metastatic prostate adenocarcinoma to the pituitary gland. The patient had lung and bone metastases when he presented with bitemporal hemianopsia. He was also receiving total androgen blockade at that time.

Association of p53 and p21 expression with clinical outcome in patients with carcinoma in situ of the urinary bladder.

Objectives: To determine whether p53 and p21 expression in bladder carcinoma in situ (CIS) with or without papillary disease can predict disease recurrence, progression, and survival.

Methods: Immunohistochemical staining for p53 and p21 was carried out on paraffin-embedded tumor specimens from 47 and 39 patients, respectively, who had CIS with or without Ta or T1 disease, but without muscle-invasive cancer. Immunoreactivity was categorized as either positive (reactivity in 10% or more CIS cells) or negative.

Association of plasma urokinase-type plasminogen activator and its receptor with clinical outcome in patients undergoing radical cystectomy for transitional cell carcinoma of the bladder.

Objectives: The urokinase plasminogen activation (uPA) system plays an important role in tumor invasion and metastasis by mediating proteolysis, adhesion, and migration of tumor cells. We tested the hypothesis that preoperative plasma levels of uPA and its specific receptor, uPAR, would predict cancer stage and prognosis in patients with transitional cell carcinoma of the bladder.

Methods: The study group consisted of 51 patients who underwent radical cystectomy for muscle-invasive cancer or Tis, Ta, or T1 transitional cell carcinoma refractory to intravesical therapy and 44 men without cancer.

Endothelial lipase is a major genetic determinant for high-density lipoprotein concentration, structure, and metabolism.

High-density lipoprotein (HDL) protects against atherosclerosis. Endothelial lipase (EL) has been postulated to be involved in lipoprotein, and possibly HDL, metabolism, yet the evidence has been scarce and conflicting. We have inactivated EL in mice by gene targeting.

Prostate adenocarcinoma presenting with inguinal lymphadenopathy.

The lymphatic spread of prostate adenocarcinoma most often involves the iliac, obturator, and hypogastric nodes. Inguinal lymphadenopathy is very rare during the early stages of this disease, especially in the absence of pelvic lymphadenopathy or other metastases. We present a case of prostate adenocarcinoma with inguinal node involvement during the initial presentation, emphasizing the importance of a complete physical examination and the consideration of other concurrent diseases.

Correlation of preoperative levels of IGF-I and IGFBP-3 with pathologic parameters and clinical outcome in patients with bladder cancer.

Objectives: To test the hypothesis that plasma insulin growth factor (IGF)-I or IGF binding protein (BP)-3 levels would differ between patients with bladder cancer and healthy controls and whether preoperative plasma IGF-I or IGFBP-3 could predict the pathologic characteristics and clinical outcome of patients with bladder cancer undergoing radical cystectomy. The IGFs are mitogens that have been shown to play a significant role in regulating proliferation and differentiation of bladder cancer cells.

Methods: The study group consisted of 51 patients who underwent radical cystectomy (median follow-up 45.

Cyclooxygenase-2 is highly expressed in carcinoma in situ and T1 transitional cell carcinoma of the bladder.

Purpose: We describe cyclooxygenase-2 (COX-2) expression patterns in patients with carcinoma in situ and/or stage T1 transitional cell carcinoma. We determined whether expression is associated with clinical outcome in these patients.

Materials And Methods: Immunostaining for COX-2 was performed on paraffin embedded bladder biopsy specimens from 2 independent groups of patients without muscle invasive carcinoma, including 39 with carcinoma in situ and 34 with stage T1 tumors.

Medical malpractice and facial nerve paralysis.

Background: Iatrogenic facial nerve paralysis is a devastating surgical complication that occasionally results in litigation.

Objective: To analyze litigation trends to better understand the causes and outcomes of suits involving facial nerve paralysis to prevent future litigation and improve physician education.

Design: Retrospective review.

Multilayered small intestinal submucosa is inferior to autologous bowel for laparoscopic bladder augmentation.

Purpose: Bladder augmentation is most commonly performed with ileum. However, porcine small intestinal submucosa has been reported as a substitute for bowel for incorporation into the urinary tract. We assessed the feasibility and long-term 12-month results of laparoscopic bladder augmentation with ileum or multilayered small intestinal submucosa (Cook Biotech, Spencer, Indiana) in a porcine model.

Stone fragmentation during shock wave lithotripsy is improved by slowing the shock wave rate: studies with a new animal model.

Purpose: The current trend toward ungated shock wave lithotripsy means that more patients are being treated with shock waves delivered at a rapid rate (120 shock waves per minute or greater). However, no benefit of an increased shock wave rate has been shown and in vitro studies indicate that slowing the shock wave rate actually improves stone fragmentation. We tested the effect of the shock wave rate on stone comminution in a new animal model.

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.

Immunohistochemical detection of telomerase reverse transcriptase in colorectal adenocarcinoma and benign colonic mucosa.

Telomerase activity (TA) is increased in human cancers and cell lines and is thought to contribute to their immortality. High TA has been found to correlate with aggressive tumor behavior. The aim of this study was to determine whether increased TA in colorectal carcinoma (CRC) correlates with survival.

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.

Post-nerve-sparing prostatectomy, dose-escalated intensity-modulated radiotherapy: effect on erectile function.

Purpose: The advent of widespread prostate-specific antigen screening has resulted in more younger, potent men being diagnosed with early-stage, organ-confined prostate cancer amenable to definitive surgery. Nerve-sparing prostatectomy is a relatively new surgical advance in the treatment of prostate cancer. Very few data exist on the effect of postoperative radiotherapy (RT) on erectile function after nerve-sparing prostatectomy.

Training postgraduate urologists in laparoscopic surgery: the current challenge.

Purpose: We established a new mini-fellowship training model for teaching laparoscopic urological surgery to practicing urologists that provides a learning experience beyond that of a pelvic trainer or hands-on, animal laboratory based laparoscopic course. It provides the practitioner with clinical experience under mentor direct guidance and supervision before embarking on independent laparoscopic surgery at an individual hospital.

Materials And Methods: A mini-fellowship model was developed that consists of 3 phases, namely 1) completing a 2 to 3-day hands-on course in laparoscopy, including pelvic trainers and an animal model, 2) observing a clinical mentor perform 6 or more major renal laparoscopic cases and 3) performing 6 or more major renal procedures under mentor direct guidance in trainee patients at the mentor or trainee hospital after obtaining appropriate temporary privileges.

Angioplasty with stenting is effective in treating blue toe syndrome.

Blue toe syndrome is a manifestation of distal embolization associated with significant pain and risk of tissue loss. The recommended treatment options for this problem include endarterectomy or bypass with exclusion of the source of emboli. Although focal arterial stenosis can be effectively treated with angioplasty,it is unclear whether performing angioplasty in a lesion suspected of causing distal embolization might actually worsen the condition or what long-term effects this would have in preventing future embolization.