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Pattaras JG, Moore RG, Landman J, Clayman RV, Janetschek G, McDougall EM, Docimo SG, Parra RO, Kavoussi LR. Incidence of postoperative adhesion formation after transperitoneal genitourinary laparoscopic surgery. Urology 2002; 59:37-41. [PMID: 11796277 DOI: 10.1016/s0090-4295(01)01474-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To evaluate adhesion formation after urologic laparoscopy, a multi-institutional review was conducted among adult patients who underwent a second procedure after an initial transperitoneal laparoscopic procedure. Adhesion formation after abdominal surgery remains a major cause of postoperative morbidity. Peritoneal adhesions result in hospitalizations and interventions that result in healthcare costs of more than 1 billion dollars annually. The risk of adhesion formation from transperitoneal genitourinary laparoscopy in adults has not been previously studied. METHODS Twenty-seven patients (mean age 45.5 years, range 24 to 71) were identified who underwent a second laparoscopic procedure after their initial urologic laparoscopic procedure was performed. The mean time between the procedures was 11.4 months (range 8 days to 38 months). At the time of the repeated laparoscopy or open surgery, the peritoneal cavity was examined and mapped for type (grade), extent (length), and location of any adhesions at the operative and trocar sites. The adhesions were graded as 0, no adhesions; 1, flimsy; 2, dense; and 3, cohesive. The extent was graded as 0, no adhesions; 1, less than 2 cm; 2, 2.1 to 10 cm; 3, greater than 10.1 cm. RESULTS Overall, adhesions occurred in 6 (22.2%) of 27 patients. Operative site adhesions occurred in only 3 (8.2%) of 34 possible operative sites (gastric augmentation cystoplasty, renal cyst ablation, nephropexy). Trocar site adhesions occurred in 4 (3.5%) of 114 possible sites (two nephrectomies, one cyst decortication, and one orchiectomy). All adhesions were classified as grade 1 and extent 1, except for a single grade 2, extent 2 adhesion. In most patients, retroperitonealization occurred with minimal or no scarring noted. None of the patients developed symptoms as a result of the adhesion formation. CONCLUSIONS Although intraperitoneal adhesions do occur with adult urologic laparoscopy, the incidence is low. Also, in the few patients who do form adhesions, they are flimsy and short. This evidence, when contrasted with the available data on adhesion formation after open surgery, suggests that transperitoneal laparoscopic approaches to genitourinary surgery may have advantages over traditional open transperitoneal approaches by lowering the incidence and severity of adhesion formation.
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Affiliation(s)
- John G Pattaras
- Department of Urology, Emory University, Atlanta, Georgia, USA
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402
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403
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404
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Yngve A, Warm D, Landman J, Sjöström M. A European Master's Programme in Public Health Nutrition. Public Health Nutr 2001; 4:1389-91. [PMID: 11918487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Effective population-based strategies require people trained and competent in the discipline of Public Health Nutrition. Since 1997, a European Master's Programme in Public Health Nutrition has been undergoing planning and implementation, by establishing initial quality assurance systems with the aid of funding from the European Commission (DG SANCO/F3). Partners from 17 European countries have been involved in the process. A European Network of Public Health Nutrition has been developed and accredited by the European Commission.
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Affiliation(s)
- A Yngve
- Unit for Preventive Nutrition, Department of Biosciences, Karolinska Institute, Huddinge, Sweden.
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405
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Collyer WC, Landman J, Olweny EO, Andreoni C, McDougall EM, Clayman RV. Assessment of optimal balloon size for rupture of the ureteropelvic junction and mid-ureter in a porcine model. J Endourol 2001; 15:937-42. [PMID: 11769850 DOI: 10.1089/089277901753284170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Balloon dilation potentially represents a safer and simpler technique for the treatment of ureteropelvic junction (UPJ) obstruction and ureteral strictures. Using a porcine model, we sought to establish the optimal balloon size for endoballoon rupture of the UPJ and ureter. MATERIALS AND METHODS The efficacy of endoballoon rupture of the proximal and middle ureter with 24F, 30F, and 36F balloon catheters was compared in 19 female minipigs. At the proximal ureter, the effect of the rate of dilation also was evaluated for each balloon size. Extravasation of methylene blue-stained contrast material was assessed with retrograde pyelograms and direct laparoscopic vision. After acute sacrifice, the dilated segments were evaluated histologically with hematoxylin and eosin and Masson's trichrome staining. RESULTS At the proximal ureter, free extravasation of contrast was observed in 61% of the rapid inflation and 72% of the slow inflation trials; contained extravasation was noted in 28% of the rapid inflation and 17% of the slow inflation trials. Except for two of the 24F slow inflation trials, all of the proximal ureteral trials produced at least one full-thickness tear into the periureteral fat. Grossly, the tears appeared linear with various lengths and no consistent orientation. Rapid inflation and increasing balloon size tended to produce a ureterotomy with less damage to the ureter surrounding the tear. At the mid-ureter, none of the balloon sizes consistently produced a transmural tear. CONCLUSIONS Rapid dilation and use of a 36F balloon capable of maintaining a low profile after inflation may result in a cleaner proximal ureterotomy with less distortion of the untorn neighboring proximal ureter. Both 36F and 30F balloons consistently produced a full-thickness proximal ureterotomy in normal porcine tissue. For mid-ureteral strictures, balloon dilation to even 36F may fail to create a suitable ureterotomy. However, it must be noted that dysplastic or scarred tissue may respond differently to dilation than the more elastic normal porcine tissues used in this study.
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Affiliation(s)
- W C Collyer
- Department of Surgery (Urology), Washington University School of Medicine, St. Louis, Missouri 63110, USA
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406
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Collyer WC, Landman J, Olweny EO, Andreoni C, Kerbl K, Bostwick DG, Clayman RV. Comparison of renal ablation with cryotherapy, dry radiofrequency, and saline augmented radiofrequency in a porcine model. J Am Coll Surg 2001; 193:505-13. [PMID: 11708507 DOI: 10.1016/s1072-7515(01)01050-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Needle ablative therapy has recently generated a lot of interest in the urologic community. We compare renal lesions produced in a porcine model using three forms of needle ablative energy: cryoablation (CR), dry radiofrequency (RF), and saline augmented radiofrequency (SARF). STUDY DESIGN In 10 farm pigs, under ultrasonographic guidance, 40 laparoscopic renal lesions were produced: 825-mm CR lesions were produced with 2.4-mm cryoprobes (Endocare Inc, Irvine, CA), after 1-mL preinfusions of 14.6% saline, 12 SARF lesions were created with 22-gauge needles (2 mL/minute 14.6% saline, 50 W 510 kHz RF for 60 seconds), 12 RF lesions were created with a 2-cm array LeVeen electrode and an RF2000 generator using impedance limited 30 to 60 W double activations (Radiotherapeutics Corp, Mountain View, CA), and 8 RF lesions were produced using 22-gauge needles and double 10 W activations with the RF2000 generator. Eight animals were sacrificed after 1 week for acute pathology. An additional two animals were sacrificed at 8 weeks to provide chronic pathology results for the LeVeen dry RF and SARF modalities. RESULTS CR produced a regular 18- to 22-mm zone of complete necrosis bordered by a 1.5- to 2.5-mm zone of partial necrosis. Acutely, LeVeen RF and single-needle RF produced lesions 25 to 45 mm and 6 to 10 mm wide, respectively. Acutely, SARF produced irregular cone-shaped lesions 15 to 31 mm wide. Only one of eight acute LeVeen RF lesions showed complete necrosis; none of the four 8-week LeVeen RF lesions displayed complete necrosis. Two of the four 8-week SARF lesions displayed complete necrosis. The remainder of the LeVeen RF, single-needle RF, and SARF lesions showed early, indeterminate tubular damage with relative glomerular sparing and bands of complete necrosis (0.5 to 1.5 mm) and inflammation (0.5 to 2 mm) at the periphery. Only CR could be consistently monitored with laparoscopic ultrasonography. CONCLUSIONS Renal cryoablation produces well-defined, completely necrotic lesions that can be monitored reliably with ultrasonography. Longer followup may be required to characterize the full extent of renal necrosis produced by RF, but in the short run, none of the RF modalities reliably produced 100% necrosis in all cases.
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Affiliation(s)
- W C Collyer
- Department of Surgery (Urology), Washington University School of Medicine, St. Louis, MO, USA
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407
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Abstract
Ureteral access with the flexible ureteroscope remains a challenge for the urologist. The routine use of a newly developed, site-specific ureteral access sheath facilitates entry into the ureter for fragmentation and basket extraction of ureteral and renal calculi. The step-by-step technique of ureteral access with the Access Sheath is described.
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Affiliation(s)
- M Monga
- Department of Urology, University of Minnesota Medical School, Minneapolis, USA
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408
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Affiliation(s)
- Jaime Landman
- Division of Urology, Washington University Medical Center, 4360 Children’s Place, Box 8242, St. Louis, Missouri 63110
| | - Ralph V. Clayman
- Division of Urology, Washington University Medical Center, 4360 Children’s Place, Box 8242, St. Louis, Missouri 63110
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409
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Rehman J, Landman J, Sundaram C, Clayman RV. Missed anterior crossing vessels during open retroperitoneal pyeloplasty: laparoscopic transperitoneal discovery and repair. J Urol 2001; 166:593-6. [PMID: 11458074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
PURPOSE Extrinsic ureteropelvic junction obstruction due to anterior crossing segmental renal vessels is present in more than 50% of patients in adulthood. In this situation the ureter must usually be dismembered and transposed anterior to the crossing vascular structures, where it is anastomosed to the renal pelvis. Via the open retroperitoneal approach there may be a limited view of the anterior surface of the ureteropelvic junction and, hence, anterior crossing vessels may possibly be missed. We describe 2 patients with ureteropelvic junction obstruction in whom anterior vessels were missed during open retroperitoneal repair. Laparoscopic transperitoneal secondary pyeloplasty with posterior displacement of the crossing renal vessel was performed in each case. MATERIALS AND METHODS Two patients presented with symptomatic congenital ureteropelvic junction obstruction after failed endopyelotomy in 1 and failed open retroperitoneal procedures in both. Preoperatively spiral computerized tomography angiography with a ureteropelvic junction protocol revealed crossing vessels in the 2 cases. This finding was confirmed at transperitoneal laparoscopic pyeloplasty. The ureter and renal pelvis were transposed anterior to the crossing vessels and 2 rows of running sutures were placed to complete the anastomosis. RESULTS The 2 laparoscopic procedures were completed successfully. The anterior crossing vessels were preserved in each case. Currently the patients are asymptomatic and furosemide washout renal scan was normal. CONCLUSIONS Spiral CT angiography reliably delineates the renal vascular anatomy in patients with ureteropelvic junction obstruction. This study may be valuable before planned open retroperitoneal ureteropelvic junction obstruction repair. Laparoscopic pyeloplasty may successfully manage anterior crossing vessels associated with secondary ureteropelvic junction obstruction.
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Affiliation(s)
- J Rehman
- Department of Surgery (Division of Urologic Surgery), Washington University School of Medicine, St. Louis, Missouri, USA
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410
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Rehman J, Landman J, Andreoni C, McDougall EM, Clayman RV. Laparoscopic bilateral hand assisted nephrectomy for autosomal dominant polycystic kidney disease: initial experience. J Urol 2001; 166:42-7. [PMID: 11435819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
PURPOSE The laparoscopic technique for bilateral nephrectomy in patients with autosomal dominant polycystic kidney disease is technically difficult. The procedure may be more acceptable if alterations to the technique made it safer and easier to perform. We describe our initial experience with, and the feasibility and potential benefits of hand assisted laparoscopic nephrectomy for approaching these large kidneys in patients with autosomal dominant polycystic kidney disease. MATERIALS AND METHODS This approach was successfully applied in 3 patients with end stage renal disease due to autosomal dominant polycystic kidney disease. After obtaining transumbilical pneumoperitoneum ports were placed in the umbilicus (12 mm.), sub-xiphoid in the midline (12 mm.) and subcostal in the midclavicular line on each side (12 mm.). The table was tilted 40 degrees away from the planned side of initial nephrectomy with the patient in the half lateral position. A 7 cm. midline incision was made that incorporated the umbilical port and a commercially available hand assistance device was positioned. One surgeon hand was inserted into the abdomen to serve as a retractor/blunt dissector, while the other operated the electrosurgical instruments. The right hand was inserted for left nephrectomy and the left hand was inserted for right nephrectomy. The laparoscope was passed via the sub-xiphoid port and the instruments were placed through the ipsilateral subcostal laparoscopic port. Nephrectomy was completed and the specimen was removed through the hand port incision by draining the cysts as they were exposed to view via the midline incision. When dissection was difficult, an additional port was placed in the anterior axillary line at the umbilical level. Some cysts were ruptured or aspirated to decrease overall kidney size and make extraction possible via the 6 to 7 cm. midline incision. RESULTS All procedures were successfully completed. Mean operative time for bilateral hand assisted laparoscopic nephrectomy was 5.5 hours (range 4.5 to 6.6). Estimated blood loss was 200 cc or less. Patients resumed oral intake on postoperative day 1. The mean amount of parenteral analgesics required postoperatively was decreased. Mean hospital stay was 4.3 days but it was 3 days when considering nephrectomy only. Patients returned to normal activity after an average of 2 weeks. There was sustained resolution of preoperative discomfort based on pain analog scales. At 1 month or less all patients recorded absent pain. They uniformly noticed improved preoperative pulmonary and gastrointestinal symptoms CONCLUSIONS Hand assisted laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease makes bilateral nephrectomy a reasonable option. The bilateral procedure may be performed as rapidly as laparoscopic only, unilateral nephrectomy in these cases. The advantages of the hand assisted approach include using tactile sensation to facilitate dissection, rapid blunt finger dissection, hand retraction and the application of immediate tamponade when needed. This procedure provides the benefits of minimal intraoperative blood loss, minimal postoperative pain, brief hospital stay and rapid convalescence in this group of patients at high risk.
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Affiliation(s)
- J Rehman
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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411
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Mukamel MN, Weisman Y, Somech R, Eisenberg Z, Landman J, Shapira I, Spirer Z, Jurgenson U. Vitamin D deficiency and insufficiency in Orthodox and non-Orthodox Jewish mothers in Israel. Isr Med Assoc J 2001; 3:419-21. [PMID: 11433634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND The modest clothing that Orthodox Jewish women wear exposes very little of their skin to sunlight. Under these conditions they may develop vitamin D deficiency, even in sunny Israel. OBJECTIVES To determine and compare the vitamin D nutritional status in Jewish orthodox mothers to that of non-orthodox mothers who live in the same metropolitan area in Israel. METHODS 25-Hydroxyvitamin D was measured by competitive protein-binding radioassay in the sera of 341 Jewish Israeli mothers (156 orthodox and 185 non-orthodox). The sera were obtained 48-72 hours after childbirth during the late summer of 1998 and the spring of 1999. RESULTS The mean (SD) serum concentration of 25-OHD was significantly (P < 0.002) lower (13.5 +/- 7.5 ng/ml) in the orthodox than in the non-orthodox mothers (18.6 +/- 9.6 ng/ml). Vitamin D deficiency (< 5 ng/ml) and insufficiency (< 10 ng/ml) were more common in the orthodox mothers (5.1% and 32.7% respectively) than in the non-orthodox mothers (2.7% and 13%, respectively). In subgroups of mothers supplemented with 400 units of vitamin D daily during pregnancy, vitamin D deficiency and insufficiency were less common (2.2% and 13%, respectively) in orthodox and non-orthodox mothers (0% and 8.1%, respectively). Vitamin D insufficiency was more common in the winter than in the summer only among non-orthodox mothers. CONCLUSIONS The high prevalence of vitamin D deficiency and insufficiency in Israeli mothers raises the question whether vitamin D supplements should be given to pregnant women in Israel, at least to orthodox mothers.
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Affiliation(s)
- M N Mukamel
- Bone Disease Unit, Tel Aviv Sourasky Medical Center, Israel
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412
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Abstract
OBJECTIVES To identify lessons from and gaps in research on diet-disease links among former migrants in the United Kingdom (UK). RESULTS Migrant status and self-identified ethnicity do not match so these terms mask differences in social, nutritional and health status within and between population groups. Some former migrants differ in causes of death from the general population, e.g.: fewer coronary heart disease deaths among Caribbean-born; fewer cancer deaths among Caribbean, South Asian- and East African-born adults. Irish- and Scottish-born have higher mortality from all causes. Experience of risk factors differ also, e.g.: higher prevalences of hypertension and diabetes in Caribbean- and South Asian-born adults than representative samples of the general population; obesity and raised waist-hip circumference ratios in South Asian, African-Caribbean and some Irish-born adults. Former migrants experience long-term disadvantage, associated with more self-defined illness and lower reported physical activity. Nutrient intake data from the few, recent, small-scale studies must be interpreted with caution due to methodological diversity. However, second generation offspring of former migrants appear to adopt British dietary patterns, increasing fat and reducing vegetable, fruit and pulse consumption compared with first generation migrants. CONCLUSIONS There is insufficient evidence on why some former migrants but not others experience lower specific mortality than the general population. Dietary intake variations provide important clues particularly when examined by age and migration status. Majority ethnic and younger migrant groups could raise and sustain high fruit and vegetable intakes but lower proportions of fat, by adopting many dietary practices from older migrants. Objective measures of physical activity and longitudinal studies of diets among different ethnic groups are needed to explain diversity in health outcomes and provide for evidence-based action.
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Affiliation(s)
- J Landman
- Queen Margaret University College, Edinburgh, UK.
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413
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Abstract
BACKGROUND AND PURPOSE One of the most challenging aspects of laparoscopic surgery is intracorporeal suturing and knot tying. A loss of depth perception and tactile sense and visual obstruction make placing accurate and well-tied knots a difficult and time-consuming task. Two devices conceived to ease the task of suturing and knotting while presumably speeding performance are the Suture Assist (SA; Ethicon Endo-Surgery) and EndoStitch (ES; US Surgical/Tyco). We set out to objectively assess suture placement accuracy and knot speed and strength of these two suturing devices and conventional laparoscopic suturing (CS). MATERIALS AND METHODS To date, six surgeons with laparoscopic experience were trained on the three suturing techniques. A pelvic trainer was set up with a freshly marked and incised swine renal pelvis and ureter. Each surgeon placed four sutures of 2-0 polyester suture with each technique (repeated on three separate occasions) with five half-hitches for a total of 216 knots. Time, strength, and accuracy were measured for each suture/knot placement. The knot distance was then measured from the marked target using calipers and carefully dissected from the tissue. Each knot was individually tested on a Monsanto Model 10 tensiometer, whereby slippage, strength, and breakage points were determined. RESULTS The mean times (min:sec) and accuracy (millimeters) were as following: CS 5:08 and 0.457, ES 2:45 and 0.660, and SA 2:40 and 0.508. The difference in time was found to be statistically significant (P < 0.001), while the difference in accuracy was not. Only 182 of 216 knots were able to be included for analysis because of either a small knot lumen or device failure. Device failures necessitating intervention were encountered only with the SA, which had a misfire rate of 9.7% (7 of 72). The mean knot strength was measured at 41.1 N for CS, 57.3 N for SA, and 28.0 for ES. Knot break percentage (breakage) was calculated as 50.8% for CS, 20.7% for ES, and 95% for SA. CONCLUSION Preliminary results show that each of the laparoscopic suturing devices has distinct advantages over conventional intracorporeal suturing and tying. Decreased times and comparable, if not greater, knot strengths may translate into improved laparoscopic suturing/tying performance for laparoscopic intracorporeal suturing devices.
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Affiliation(s)
- J G Pattaras
- Division of Urology, Saint Louis University, St Louis Missouri 63112, USA
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414
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Rehman J, Landman J, Kerbl K, Clayman RV. Laparoscopic repair of diaphragmatic defect by total intracorporeal suturing: clinical and technical considerations. JSLS 2001; 5:287-91. [PMID: 11548837 PMCID: PMC3015446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The use of laparoscopy in urology is increasing. Tumor of the kidney or adrenal gland and, in some cases, metastatic disease can involve the diaphragm. We describe the application of laparoscopic suturing techniques in the case of diaphragmatic involvement with a renal tumor. METHODS After resection of the tumor and a small area of the diaphragm, a chest tube was placed under laparoscopic guidance. The tube was kept clamped until the end of the procedure. Decreasing intraabdominal pneumoperitoneum pressure made suturing easier with less tension on the edges of the diaphragmatic incision. Nonabsorbable interrupted horizontal mattress sutures were placed to close the diaphragmatic defect. RESULTS The repair was uneventful; no intraoperative complications occurred. Extubation was done at the end of the procedure in the operating room. The chest tube was removed on postoperative day 2, and the patient was discharged on postoperative day 3. CONCLUSIONS Laparoscopic repair of the diaphragm should be commensurate with traditional open surgical principles. In this regard, it is essential that surgeons interested in performing "advanced" laparoscopic oncologic surgery become facile in laparoscopic suturing.
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Affiliation(s)
- J Rehman
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri 63110, USA
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415
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Oda J, Landman J, Bhayani S, Figenshau RS. Concomitant laparoscopic hand-assisted radical nephrectomy and open radical prostatectomy using a single lower midline incision. Urology 2000; 56:1056. [PMID: 11113763 DOI: 10.1016/s0090-4295(00)00809-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The hand-assist technique offers the urologic surgeon several advantages. The technique provides the novice laparoscopist a logical segue into minimally invasive surgery by literally allowing one hand to remain in the realm of open surgery. Hand-assist access affords the laparoscopist the use of tactile sensation and blunt manual dissection and retraction. We describe an additional benefit of the hand-assist technique. In clinical situations in which more than one procedure is required, a properly positioned hand-assist device will avoid the need for two large incisions. We present simultaneous hand-assisted laparoscopic radical nephrectomy and open radical prostatectomy performed through a single midline incision.
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Affiliation(s)
- J Oda
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA
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416
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Landman J, Lento P, Hassen W, Unger P, Waterhouse R. Feasibility of pathological evaluation of morcellated kidneys after radical nephrectomy. J Urol 2000; 164:2086-9. [PMID: 11061932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PURPOSE The indications for laparoscopic nephrectomy have grown to include renal malignancy. Although morcellation of these specimens has been described, to our knowledge we present the first systematic review of the feasibility and validity of pathological evaluation of these tumors with regard to grade and stage. MATERIALS AND METHODS Nine formalin fixed and 5 fresh intact radical nephrectomy specimens were evaluated by 2 pathologists before and after high speed electrical tissue morcellation. The ability to distinguish tissue histology, and tumor size, stage and grade were compared. Impermeability of the laparoscopy sack after morcellation was also evaluated using indigo carmine stained normal saline placed in the used sack. RESULTS The 9 preserved specimens included 7 renal cell carcinomas and 2 oncocytomas, while 4 of the 5 fresh specimens were renal cell carcinoma and 1 was oncocytoma. Overall tumor size was 2 to 7 cm. (mean 4.9). The 4 fresh renal cell carcinomas were of the clear cell type. Comparison of pathological evaluation after morcellation by another pathologist revealed identical histology, grade and stage for each tumor. Four cases of perinephric fat invasion (3 fixed and 1 fresh specimens) were identified after morcellation. Only tumor size was not assessed after morcellation. Laparoscopy sack integrity was confirmed in 13 of 14 cases. In 1 case involving a formalin fixed specimen a gross defect in the laparoscopy sack was demonstrated after morcellation. CONCLUSIONS Morcellation of radical nephrectomy specimens in vitro did not alter the determination of histology, grade or local invasiveness of tumor. For all fresh tissue and remarkably for all but 1 formalin fixed tissue specimen the laparoscopy sack remained intact. Preliminary data from this in vitro model imply that limited in vivo morcellation of radical nephrectomy specimens may be performed without sacrificing staging information.
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Affiliation(s)
- J Landman
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA
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417
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Landman J, Collyer WC, Olweny E, Andreoni C, McDougall E, Clayman RV. Laparoscopic renal ablation: an in vitro comparison of currently available electrical tissue morcellators. Urology 2000; 56:677-81. [PMID: 11018638 DOI: 10.1016/s0090-4295(00)00710-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Morcellation with the Cook high-speed electrical laparoscopic (HSEL) morcellator in an impermeable nylon/plastic sack (LapSac) has remained unchanged since its inception nearly one decade ago. Sack deployment and specimen entrapment remain relatively difficult, and morcellation with this device is expensive and relatively slow. As such, in an effort to facilitate specimen entrapment and morcellation, we adapted two currently available electrical morcellators (the Steiner gynecologic morcellator and the electrical prostate morcellator [EPM]) for renal morcellation and compared them with the HSEL morcellator. METHODS All morcellation was performed through a simulated abdominal wall under direct laparoscopic vision. Ten porcine kidneys were ablated with each of the following techniques: HSEL morcellation in a LapSac; HSEL morcellation in a fluid-filled LapSac; Steiner morcellation in an insufflated Endocatch sack; and EPM morcellation in a fluid-filled Endocatch sack. A modified laparoscopic trocar was constructed and used for the Steiner and EPM morcellation. The time to complete morcellation, morcellation product size, and entrapment sack integrity were evaluated for each technique. Cost data for each morcellator are also presented. RESULTS The mean morcellation time for the Steiner, HSEL dry, HSEL wet, and EPM morcellation was 6.0, 15.9, 14.7, and 26.0 minutes, respectively. The mean fragment size for these morcellators was 2.97, 0.65, 0.62, and 0.013 g, respectively. A single entrapment sack perforation was documented in a LapSac during routine HSEL morcellation. CONCLUSIONS Renal morcellation with all three morcellators is feasible. The Steiner morcellator combined with an Endocatch resulted in more rapid morcellation and larger morcellation products.
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Affiliation(s)
- J Landman
- Department of Surgery, Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA
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418
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Landman J, Collyer W, Carlin B, Clayman RV, Figenshau RS. Laparoscopic Autoaugmentation of the Urinary Bladder: Literature Review and State of the Art. ACTA ACUST UNITED AC 2000. [DOI: 10.1089/10926410050167413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jaime Landman
- Division of Urology, Department of Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - William Collyer
- Division of Urology, Department of Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Bruce Carlin
- Division of Urology, Department of Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Ralph V. Clayman
- Division of Urology, Department of Surgery; Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Robert S. Figenshau
- Division of Urology, Department of Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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419
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Shalhav AL, Landman J, Afane J, Levi R, Clayman RV. Laparoscopic adrenalectomy for primary hyperaldosteronism during pregnancy. J Laparoendosc Adv Surg Tech A 2000; 10:169-71. [PMID: 10883996 DOI: 10.1089/lap.2000.10.169] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Laparoscopic adrenalectomy was performed early in the second trimester of pregnancy in a woman with an aldosteronoma causing hypertension (254/154 mm Hg). The patient was later delivered of a healthy baby. With suitable precautions and timing, major laparoscopic surgery can be performed safely during pregnancy.
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Affiliation(s)
- A L Shalhav
- Department of Surgery (Urology), Washington University School of Medicine, St. Louis, Missouri 63110, USA
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420
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Landman J, Chang Y, Kavaler E, Droller M, Liu BCS. Sensitivity and Specificity of NMP-22, Telomerase, and BTA in the Detection of Human Bladder Cancer. J Urol 1999. [DOI: 10.1016/s0022-5347(05)68878-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J. Landman
- Department of Urology, Mount Sinai School of Medicine, New York, New York
| | - Y. Chang
- Department of Urology, Mount Sinai School of Medicine, New York, New York
| | - E. Kavaler
- Department of Urology, Mount Sinai School of Medicine, New York, New York
| | - M.J. Droller
- Department of Urology, Mount Sinai School of Medicine, New York, New York
| | - B. C.-S. Liu
- Department of Urology, Mount Sinai School of Medicine, New York, New York
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421
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Landman J, Bar-Chama N. Initial experience with processed human cadaveric allograft skin for reconstruction of the corpus cavernosum in repair of distal extrusion of a penile prosthesis. Urology 1999; 53:1222-4. [PMID: 10367857 DOI: 10.1016/s0090-4295(98)00638-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe our initial experience with the novel application of processed human cadaveric allograft skin in reconstruction of a damaged corpus cavernosum associated with distal extrusion of a penile prosthesis. The material was evaluated for ease of reconstruction, adequacy of repair, and outcome. Human processed dermis allograft requires no intraoperative harvesting, is technically easy to fashion, and offers adequate tensile strength in the reconstruction of damaged corpora cavernosa. This initial experience with processed human cadaveric dermis in reconstruction of damaged corpora cavernosa is encouraging. Further evaluation to define the long-term efficacy and scope of application of this material in urologic reconstructive procedures is warranted.
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Affiliation(s)
- J Landman
- Department of Urology, Mount Sinai School of Medicine, New York, New York 10029, USA
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422
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Landman J, Chang Y, Kavaler E, Droller MJ, Liu BCS. Sensitivity and Specificity of NMP-22, Telomerase, and BTA in the Detection of Human Bladder Cancer. J Urol 1999. [DOI: 10.1097/00005392-199906000-00088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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423
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Abstract
As disasters and conflict increase, a higher proportion of total food aid is given as humanitarian aid. Most food aid is in the form of cereals, primarily wheat. The main donors are the USA and the EU, but there is an increase in the numbers of donors, including non-governmental organizations, buying food rather than using surpluses. Alongside the greater diversity and complexity of food aid, there is more controversy about policy and practice. If disasters are development failures, emergency food aid must be a step in the continuum from relief to rehabilitation. Comparisons of the seventeen countries that were major recipients of food aid (> 10,000 t) in 1997, show diversity in social development, dietary pattern, number of refugees, relative food inadequacy and wasting (i.e. % standard weight-for-height > 2 SD). In the absence of information of consistent quality, what influences the scale of emergency aid is unclear and susceptible to politicization, so that need and supply may not be matched. Local considerations seem to be as important as external food aid for the nutrition of the recipients. Challenges for the future include assuring the nutritional quality of rations to solve deficiency problems. The implications for the professional public health nutritionist working on emergency food provision include continuing professional development to enhance the technical expertise necessary to design appropriate feeds or rations. These public health nutritionists, more than others, require a grounding in social science theories that underpin management, ethics of professionalism and the politics of food aid.
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Affiliation(s)
- J Landman
- Centre for Nutrition and Food Research, Queen Margaret College, Edinburgh, UK.
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424
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Boyeldieu D, Vu-Thien H, Dollfus C, Bounetta M, Ballerini P, Gerota I, Moissenet D, Landman J, Tourniaire B, Leverger G. [Klebsiella oxytoca septicemia following platelet transfusion]. Pathol Biol (Paris) 1999; 47:405-7. [PMID: 10418009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Two fractions of a three-day-old apheresis platelet collection from a known habitual donor were transfused to two children with thrombocytopenia and bleeding. Both patients developed evidence of severe infection during the transfusion. One died despite intensive care and antimicrobial therapy. The other, whose transfusion was cut short, recovered. A Klebsiella oxytoca strain was recovered from the two transfusion bags, from a third unused bag, and from blood samples from the patient who died. Genotyping results established that all these isolates were identical. Tests for K. oxytoca were negative on the batches of blood donation material, the bottle of antiseptic used, and throat and stool specimens from the donor and phlebotomists. The most likely hypothesis is that the donor developed transient asymptomatic bacteremia during the 136-minute-long collection procedure and that the organism subsequently grew in the platelet collections, which were kept at 20-24 degrees C with agitation for three days before being used.
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Affiliation(s)
- D Boyeldieu
- Service de Microbiologie, Hôpital d'Enfants Armand Trousseau, Paris, France
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425
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Abstract
Voided urine from patients with bladder cancer and from control patients with either hematuria or with no urologic conditions were examined for telomerase activity in order to explore the possibility that this activity could be used as a marker for the detection of bladder cancer. This assay was found to have an overall sensitivity in detecting bladder cancer of 85% (88/104) with 79% (23/29) grade 1 tumors, 84% (32/38) grade 2 tumors, 87.5% (28/32) grade 3 tumors, and 100% (5/5) carcinoma in situ testing positive. This compared favorably with urinary cytology which had an overall sensitivity of 51% and sensitivities of 13%, 44%, 82%, and 100% for grades 1, 2, 3 tumors and carcinoma in situ, respectively. The specificity of telomerase in patients with benign causes of hematuria was 66%, and in normal volunteers without urologic conditions, it was 100%. Assessment of nuclear matrix protein suggested comparable sensitivity and specificity. Evaluation of bladder tumor antigen showed less sensitivity for low-grade disease and less specificity, as it was influenced by inflammation and instrumentation. Telomerase thus seems to be a means whereby low-grade tumors may be detected in examination of voided urine and may offer an advantage in monitoring for recurrent disease.
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Affiliation(s)
- M J Droller
- Department of Urology, Mount Sinai Medical Center, New York, NY 10029-6574, USA
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426
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Abstract
OBJECTIVES The recent introduction of novel molecular markers into clinical urology has created a need to evaluate the efficacy and utility of these potential markers. The ideal assay for bladder cancer should be noninvasive, sensitive, specific, and cost-effective. We compared the Matritech nuclear maxtrix protein (NMP)-22 assay, telomerase activity, and the Bard bladder tumor antigen (BTA) assay for the detection of human bladder cancer. METHODS A single voided urine sample was obtained from patients with hematuria without bladder cancer and from patients with known bladder cancer before any treatment. Approximately 50 to 100 mL of voided urine sample was collected and aliquotted for the various assays. The results were compared to single cytologic results and ultimately to pathologic findings. RESULTS In 47 patients with bladder cancer, the overall sensitivity was 81% for NMP-22, 80% for telomerase, 40% for BTA, and 40% for cytology. For Ta tumors (n = 31), sensitivity was 81% for NMP-22, 70% for telomerase, 32% for BTA, and 26% for cytology. For T1 or higher stage tumors (n = 13), sensitivity was 82% for NMP-22, 91% for telomerase, 64% for BTA, and 64% for cytology. The remaining 3 patients had carcinoma in situ (CIS). When tumors were stratified by tumor grade, grade I tumors (n = 16) were detected at 69% with NMP-22, 65% with telomerase, 13% with BTA, and 6% with cytology. Grade II tumors (n = 14) were detected at 86% with NMP-22, 72% with telomerase, 36% with BTA, and 36% with cytology. Grade III tumors (n = 14) were detected at 93% with NMP-22, 93% with telomerase, 79% with BTA, and 79% with cytology. Patients with CIS (n = 3) were detected at 67% with NMP-22, 100% with telomerase, 33% with BTA, and 67% with cytology. In 30 patients with hematuria but without bladder cancer, the overall specificity of the assays was 77% for NMP-22, 80% for telomerase, 73% for BTA, and 94% for cytology. CONCLUSIONS In the population tested, NMP-22 and the telomerase assays gave similar sensitivity and specificity for the detection of bladder cancer, and appear to offer a greater sensitivity than the BTA assay and/or conventional cytology.
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Affiliation(s)
- J Landman
- Department of Urology, Mount Sinai School of Medicine, New York, New York 10029, USA
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427
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Laporte JP, Lesage S, Portnoï MF, Landman J, Rubinstein P, Najman A, Gorin NC. Unrelated mismatched cord blood transplantation in patients with hematological malignancies: a single institution experience. Bone Marrow Transplant 1998; 22 Suppl 1:S76-7. [PMID: 9715897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We report on six cases of unrelated UCB transplant in adult patients with hematological malignancies: three chronic myelocytic leukemias and three acute leukemias. Their median age and body weight were respectively: 28 years (range 15.5-40) and 55.5 kg (range 46-90). The cord blood units were from the New York Blood Center. The median number of nuclear cells provided, evaluated before thawing, was 2.1 x 10(7)/kg (range 1 x 10(7)/kg-4.7 x 10(7)/kg). The degree of HLA disparity was 1/6: two patients, 2/6: three patients, 3/6: one patient. The patients received a pretransplant regimen including total body irradiation. They were given graft-versus-host disease prophylaxis which consisted of cyclosporin A and corticosteroids. They were all given a combination of G-CSF and erythropoietin. The median time of white blood cell and platelet reconstitution were respectively 24 days (range 12-43) and 60 days (range 23-90). All the patients had a full chimerism. A grade I acute GVHD was observed in four patients and two patients do not have any GVHD. No chronic GVHD has been observed yet. Three patients died from toxicity. Three patients are alive and well in complete remission at 2 years, 1 year and 11 months post-graft.
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Affiliation(s)
- J P Laporte
- Department of Hematology, Hôpital St Antoine, Paris, France
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428
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Abstract
OBJECTIVES To describe how the Nutrition Society developed public health nutrition as a profession between 1992 and 1997, and to analyse the influences propelling on this professionalization. DESIGN Qualitative case study. SETTING Britain. RESULTS The Nutrition Society of Britain consulted with various stakeholders (such as dietitians, researchers, professionals and practitioners and educators from the UK, and latterly from mainland Europe) to build a consensus about the definition, roles and functions of public health nutritionists and the need for, and scope of, this new profession. Building on this consensus, the Society developed a curriculum in line with British national nutrition policy. Analysis shows that the design and philosophy of the curriculum is explicitly international and European in orientation, in keeping with the tradition of the discipline and the Society. The curriculum is designed in terms of specialist competencies in public health nutrition, defining competency so that registered public health nutritionists are advanced practitioners or leaders: this is in keeping with contemporary trends in professional education generally and as expressed by the UNU/IUNS and at Bellagio, in nutrition in particular. CONCLUSIONS Despite a unique relationship with British state and policy, this case of professionalization contributes to contemporary international inter- and intraprofessional debates about the nature of public health nutrition and is consistent with professional educational theory.
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Affiliation(s)
- J Landman
- Department of Dietetics and Nutrition, Queen Margaret College, Edinburgh, UK.
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429
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Abstract
BACKGROUND In an attempt to find a more sensitive and specific noninvasive assay for the detection of bladder carcinoma, the authors assayed exfoliated cells from patients' voided urine for the presence of telomerase, an enzyme that maintains a cell's chromosomal length and is thought to be active in the transformation of normal somatic cells into immortal human tumor cells. METHODS The authors used a polymerase chain reaction (PCR)-based telomeric repeat amplification protocol (TRAP) assay to determine the presence of telomerase activity in voided urine samples from patients with known but yet untreated bladder carcinoma (n = 104) and from patients with hematuria of benign causes (n = 47). For 88 of the patients with bladder carcinoma, cytology was determined independently of the telomerase results or the pathology findings. RESULTS Of the 104 bladder carcinoma specimens, 88 (85%) tested positive for the presence of telomerase. Seventy-nine percent (23 of 29) of the Grade 1 tumors, 84% (32 of 38) of the Grade 2 tumors, and 87.5% (28 of 32) of the Grade 3 tumors were positive for telomerase activity. Five patients with carcinoma in situ (100%) were also positive. Telomerase activity was not found in 31 of 47 patients with bladder calculi, benign urethral stricture, benign prostatic hyperplasia, or inflammation. In the 16 patients (34%) who did have a false-positive result when tested for telomerase, all had either chronic or severe inflammation, including 1 patient with an inverted papilloma, 1 patient with cystitis cystica, and 1 patient with cystitis glandularis. However, for 35 normal, healthy volunteers whose voided urine samples were also assayed for the presence of telomerase activity, none was found. By comparison, only 51% (45 of 88) of the cytology samples from patients with bladder carcinoma yielded positive findings, whereas 49% (43 of 88) resulted in false-negative readings for tumors. Only 13% (3 of 23) of the Grade 1 tumors, 44% (14 of 32) of the Grade 2 tumors, and 82% (23 of 28) of the Grade 3 tumors were diagnosed by cytology. All five patients with carcinoma in situ were positive for cytology as well as for telomerase activity. When cytology was compared with the PCR-based telomerase assay in determining the presence of bladder carcinoma, the difference in the overall detection rates (85% for telomerase vs. 51% for cytology) was significant (P < 0.001). Furthermore, when telomerase activity was compared with cytology for low grade lesions (Grades 1 and 2), the difference in the detection rates (82% for telomerase vs. 31% for cytology) was also significant (P < 0.001). CONCLUSIONS Urinary cytology yields poor results for low grade tumors. This study shows the possible application of the telomerase assay in detecting bladder carcinoma, in particular low grade tumors, in voided urine samples.
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Affiliation(s)
- E Kavaler
- Department of Urology, Mount Sinai School of Medicine, New York, New York 10029, USA
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430
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Landman J, Droller MJ. Risk factors in clonal development from superficial to invasive bladder cancer. Cancer Surv 1998; 31:5-15. [PMID: 15281314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Bladder cancer has classically been associated with exogenous risk factors, and a large literature has identified risk factors associated with the genesis of transitional cell carcinoma. Only recently have efforts been made to identify host factors and to evaluate possible changes in tumour presentation and biology, including grade and stage, in association with these risk factors. The available literature appears to demonstrate alterations in tumour biology associated with environmental carcinogens. Various studies have suggested a consistent upgrading of bladder cancer stage and grade as a result of cigarette smoking and high risk occupational exposures. It is important, however, that all factors associated with increased risk for bladder cancer be more extensively evaluated in assessing the validity of this concept.
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Affiliation(s)
- J Landman
- Department of Urology, Mount Sinai School of Medicine, New York, USA
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431
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Affiliation(s)
- Jaime Landman
- From the Department of Urology, Mount Sinai Medical Center, New York, New York
| | - Elizabeth Kavaler
- From the Department of Urology, Mount Sinai Medical Center, New York, New York
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432
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Landman J, Kavaler E, Waterhouse RL. Acquired methemoglobinemia possibly related to phenazopyridine in a woman with normal renal function. J Urol 1997; 158:1520-1. [PMID: 9302157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- J Landman
- Department of Urology, Mount Sinai Medical Center, New York, New York 10029-6574, USA
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433
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Abstract
Vertebrates have special structures at the ends of their chromosomes, known as telomeres, which are composed of 5- to 15-kb pairs of a guanine-rich hexameric repeat (TTAGGG)n. In normal somatic cells there is a progressive degradation of telomeres with aging. The cell can afford to lose only a finite number of these telomeres before significant sequences of the parent DNA are lost, resulting in chromosomal instability and cell death. However, germ-cell telomeres are maintained despite multiple rounds of replication. This suggests that they produce an enzyme that maintains their telomere length. This enzyme, a ribonucleoprotein, is called telomerase. In this review, we discuss the presence of telomerase activity in various human cancers and, in particular, in urologic tumors. We describe the potential clinical utility of detection of the presence of telomerase activity in cells from voided urine samples of patients with bladder cancer.
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Affiliation(s)
- J Landman
- Department of Urology, Mount Sinai School of Medicine, New York, NY 10029, USA
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434
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Vos P, De Winter K, Landman J, Bel A. 30 Correction of systematic patient set-up errors in 3D for head&neck treatments, based on digital portal imaging. Radiother Oncol 1996. [DOI: 10.1016/s0167-8140(96)80037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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435
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Landman J, Burgess A. Nutrition information and support for overseas members. Proc Nutr Soc 1995; 54:565-8. [PMID: 8524902 DOI: 10.1079/pns19950024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- J Landman
- Department of Dietetics and Nutrition, Queen Margaret College, Edinburgh
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436
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Abstract
In vitro determination of brain glucose metabolism in the temporal cortex from patients with Alzheimer's disease showed a marked decrease when compared with nondemented, age-matched control subjects. Additional determinations on normal human temporal cortex obtained at autopsy demonstrated an age-dependent decline in the rate of glucose use. These data provide an in vitro correlate for positron emission tomography studies that suggest decreased brain glucose use in Alzheimer's disease.
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Affiliation(s)
- R Swerdlow
- Department of Medicine, NYU Medical Center, NY 10016
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437
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Abstract
RATIONALE AND OBJECTIVES Iopromide is a nonionic monomeric contrast agent. Initial laboratory and clinical data have shown that it is relatively safe. Efficacy for excretory urography has been shown to be good, comparable with other low-osmolality agents. The authors attempted to confirm these impressions in a randomized, double-blind comparison with equivalent doses of ioversol and iopamidol. METHODS Two hundred adult patients undergoing excretory urography were studied. One hundred received iopromide, 40 received ioversol, and 60 received iopamidol (300 mg I/kg) as an intravenous bolus. Urographic films (obtained 1, 5, 15, and 20 minutes after the bolus, and postvoid) were interpreted by an observer blinded to contrast type. Visualization of renal parenchyma, pelvis and calyces, ureters, and bladder was independently assessed as excellent, good, poor, or nonvisualized. Vital signs were recorded before, 30 to 60 minutes after, and 24 hours after injection. Adverse reactions were sought, physical examinations were performed, and standard hematology and serum chemistry values were measured before and 1 day after injection; a 72-hour serum creatinine level was also measured. RESULTS Ninety-eight percent of visualization scores were good or excellent; no significant differences among iopromide, iopamidol, and ioversol were found, nor were there any significant differences among groups in vital signs. Only one patient experienced a contrast-related physical examination change (subcutaneous extravasation). No significant changes with regard to hematology or serum chemistry values were observed; there was no contrast-induced nephropathy. Mild adverse reactions were experienced by 10% of patients; there were no significant differences in reaction rates among contrast agents. CONCLUSIONS Iopromide at a dose of approximately 300 mg I/kg is safe and effective as an excretory urographic agent and is comparable in performance with ioversol and iopamidol.
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Affiliation(s)
- J H Newhouse
- Department of Radiology, Columbia-Presbyterian Medical Center, New York, New York 10032
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438
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Tabone MD, Leverger G, Landman J, Aznar C, Boccon-Gibod L, Lasfargues G. Disseminated lymphonodular cryptococcosis in a child with X-linked hyper-IgM immunodeficiency. Pediatr Infect Dis J 1994; 13:77-9. [PMID: 8170740 DOI: 10.1097/00006454-199401000-00020] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- M D Tabone
- Unité d'Hématologie et d'Oncologie Pédiatrique Hôpital d'Enfants A. Trousseau, Paris, France
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439
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Socié G, Gluckman E, Raynal B, Petit T, Landman J, Devergie A, Brison O. Bone marrow transplantation for Fanconi anemia using low-dose cyclophosphamide/thoracoabdominal irradiation as conditioning regimen: chimerism study by the polymerase chain reaction. Blood 1993; 82:2249-56. [PMID: 8400273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Since 1976, patients grafted at the Hôpital Saint-Louis for Fanconi anemia (FA) without evidence of leukemic transformation have been given a uniform conditioning regimen that consisted of low-dose cyclophosphamide (Cy) and thoracoabdominal irradiation (TAI). The use of low-dose Cy raised the question of whether it is sufficient for the establishment of a complete hematopoietic chimerism in all patients. We therefore initiated a study of chimerism early during hematopoietic reconstitution after bone marrow transplantation (BMT) and thereafter in transplanted FA patients. Minisatellite probes were used after DNA amplification by the polymerase chain reaction (PCR). From July 1989 to October 1992, 24 consecutive patients underwent BMT for FA, 19 of whom were assessable for chimerism. Our results using this sensitive technique showed that, among these 19 patients, all but one successfully engrafted. Engraftment was complete early after BMT in 12. The persistence of a small proportion of recipient's cells was detected in six. This partial hematopoietic chimerism was demonstrated to be only transient in at least five of the six patients. The one patient who failed to engraft showed a recipient-type profile for circulating cells early posttransplantation, indicating autologous bone marrow recovery. A second graft in this patient was also rejected. For both transplantations, the patient was grafted from a matched, unrelated donor. Therefore, 17 of 17 patients successfully grafted and with complete follow up data presented complete hematopoietic chimerism, within the sensitivity limit of the method used. In conclusion, lowering the Cy dose in the conditioning regimen of patients with FA could still allow complete engraftment to occur, at least in patients with an identical sibling donor.
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Affiliation(s)
- G Socié
- Service de Greffe de Moëlle, Hôpital Saint-Louis, Paris, France
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440
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Méresse V, Vassal G, Michon J, De Cervens C, Courbon B, Rubie H, Perel Y, Landman J, Chastagnier P, De Valck C. Combined continuous infusion etoposide with high-dose cyclophosphamide for refractory neuroblastoma: a phase II study from the Société Française d'Oncologie Pédiatrique. J Clin Oncol 1993; 11:630-7. [PMID: 8478658 DOI: 10.1200/jco.1993.11.4.630] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Patients older than 1 year with stage IV neuroblastoma who fail to achieve complete remission (CRem) have a particularly poor long-term prognosis. In an attempt to improve the outcome of these refractory patients, we tested a new drug combination. PATIENTS AND METHODS Twenty-nine children with advanced neuroblastoma (27 stage IV and two stage III) were entered onto this phase II study. All were refractory to conventional chemotherapy and had measurable disease at the time of the trial. The regimen was a combination of high-dose cyclophosphamide (2 g/m2/d) on days 2, 3, and 4, and etoposide (VP16; 50 mg/m2/d) by continuous intravenous (IV) infusion on days 1 to 5. A pharmacokinetic study of VP16 was conducted in eight patients to determine whether the goal of persistent plasma levels between 1 and 5 micrograms/mL was achieved. RESULTS Patients received a median of two courses, for a total of 58 courses. The median interval between each course was 32 days. In the 28 assessable patients, the overall response rate was 43%, with one CRem and 11 partial remissions (PRems). No life-threatening complication was observed in these heavily pretreated patients. The median duration of neutropenia (< 5 x 10(9)/L) was 14 days, and that of thrombocytopenia (< 50 x 10(9)/L) was 11 days. The overall incidence of sepsis was 27%. Gastrointestinal toxicity was frequent, but mild. Electrolyte disturbance with antidiuretic hormone (ADH)-like syndrome occurred in eight courses, but resolved rapidly. Grade > or = 2 hemorrhagic cystitis was observed in three courses. No cardiac toxicity was observed. There were no treatment-related deaths. Pharmacokinetic analysis showed that mean steady-state plasma levels (Css) of VP16 were greater than 1 microgram/mL during all the courses. CONCLUSION This new drug combination appears to be effective in advanced neuroblastoma. Its toxicity remains manageable, with no life-threatening complications. Further evaluation in patients with less-advanced disease is warranted.
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Affiliation(s)
- V Méresse
- Service de Pédiatrie, Institut Gustave-Roussy, Villejuif, France
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441
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Abstract
Vitamin A deficiency associated with preterm delivery is not readily reversible using the recommended supplement of 1500 IU per day. It has been reported that 2000 IU of intramuscular vitamin A administered on alternate days for 28 days will correct the deficiency. The objective of this study was to compare this regime with the practice in our nursery of giving 5000 IU of vitamin A per day with the early introduction of feeds. The vitamin A status of ten preterm infants (mean gestation 30.5 weeks) who received intramuscular vitamin supplementation was compared with that of nine infants (mean gestation 30.7 weeks) given enteral vitamin A. Vitamin A status was evaluated on the 32nd day of life using plasma retinol and retinol-binding protein (RBP) concentrations and a modified relative dose response (RDR) test. Plasma retinol and RBP concentrations were similar in the two groups shortly after birth revealing vitamin A deficiency. By the 32nd day of life, plasma retinol and RBP concentrations had risen significantly in both groups and in 70% the modified RDR was normal. Differences between the groups were not observed irrespective of the method of vitamin A administration. None of the infants developed clinical or biochemical vitamin A toxicity. In most preterm infants who tolerate feeds, vitamin A deficiency can be corrected safely by supplementing the feeds with 5000 IU of vitamin A per day.
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Affiliation(s)
- J Landman
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
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442
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Affiliation(s)
- J Landman
- Department of Human Nutrition, University of Southampton
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443
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Socié G, Landman J, Gluckman E, Devergie A, Raynal B, Esperou-Bourdeau H, Brison O. Short-term study of chimaerism after bone marrow transplantation for severe aplastic anaemia. Br J Haematol 1992; 80:391-8. [PMID: 1581220 DOI: 10.1111/j.1365-2141.1992.tb08150.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chimaerism was studied early (2 weeks to 3 months) during haematopoietic reconstitution after bone marrow transplantation in 18 severe aplastic anaemia patients (acquired SAA: 14 patients; Fanconi anaemia: four patients). Fourteen patients received marrow from an identical sibling donor, one from the phenoidentical father and three from a matched unrelated donor. Peripheral blood cell DNA was first analysed by Southern blotting with a multilocus minisatellite probe (33.6.3) or a Y chromosome specific probe (pHY2.1). For all 14 patients grafted with a genotypically identical sibling donor, the post-graft DNA profile strictly matched the respective donor profile (minisatellite probe) or disclosed the Y chromosome specific band in the case of female patients grafted with a male donor. In contrast, for the one patient grafted in a mismatched situation and for two out of three patients grafted with a matched unrelated donor, the results indicated autologous bone marrow recovery. This difference between patients grafted with an identical sibling donor and those grafted in other situations is statistically significant (P less than 0.01). The 15 patients with circulating cells of donor origin were then studied by polymerase chain reaction amplification of the DNA samples. The three male patients with a female donor were studied by amplification of a Y chromosome specific sequence (DYZ1), allowing the detection of one male cell in 10(4) female cells. In all three cases, residual male nucleated cells were detected. The analysis was performed by amplification of the 33.6.3 minisatellite sequence for the 12 remaining patients. No residual recipient cells were detected within the sensitivity limit of the method which is 1% in that case. This suggests that detection of residual host cells depends on the sensitivity of the technique used.
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Affiliation(s)
- G Socié
- Laboratoire d'Oncologie Moléculaire, URA 1158 CNRS, Institut Gustave Roussy, Villejuif, France
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444
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Blanche S, Caniglia M, Girault D, Landman J, Griscelli C, Fischer A. Treatment of hemophagocytic lymphohistiocytosis with chemotherapy and bone marrow transplantation: a single-center study of 22 cases. Blood 1991; 78:51-4. [PMID: 2070059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Twenty-two children with hemophagocytic lymphohistiocytosis were treated with a chemotherapy regimen consisting of VP16-213, corticosteroids, and intrathecal methotrexate. A sustained clinical and biologic complete remission was obtained in 15 children and a partial remission in one child; six children died early of opportunistic infection (n = 4) or of disease progression (n = 2). Of the 16 children who were placed in first remission, 10 received maintenance chemotherapy alone, while six underwent bone marrow transplantation (HLA matched in five, HLA mismatched in one). Of the children who received chemotherapy alone, only two are in long-term remission after cessation of treatment. The remaining eight patients relapsed after a mean period of 5.4 months (range 2 to 8 months). Further treatment using the same regimen induced second remissions of short duration; death occurred after a median period of 2.3 months (range 0.5 to 6 months). A total of nine patients received allogeneic bone marrow transplantation (BMT). Among the six children transplanted in remission, four are in long-term unmaintained remission, 1 to 6 years after HLA-matched BMT. However, the relapse that occurred in one patient 1 year post BMT is difficult to interpret because the donor, the patient's 5-year-old sister, also developed the disease 1 year later. An HLA-nonidentical BMT resulted in unmaintained remission for 1 year, with autologous hematologic reconstitution followed by disease relapse. HLA-nonidentical BMT failed in three other patients with active disease at time of transplant. The poor long-term results of chemotherapy alone justify the use of related HLA-matched BMT in complete remission.
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Affiliation(s)
- S Blanche
- Département de Pédiatrie, Hôpital des Enfants-Malades, Paris, France
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445
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Gafter U, Peleg D, Korzets A, Zevin D, Landman J, Goldman J, Levi J. Successful pregnancies in women on regular hemodialysis treatment. Isr J Med Sci 1990; 26:266-70. [PMID: 2380024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Successful pregnancies in women on regular hemodialysis treatment are infrequent but increasing. We present two such cases; both pregnancies were diagnosed early, and hemodialysis was intensified, leading to significant reductions in predialysis serum urea levels (70-100 mg/dl). One case was particularly unusual in that systemic lupus erythematosus was the underlying disease, and the patient had no residual renal function at the time of conception. Both patients delivered by cesarean section at 32 and 35 weeks, and their infants are well at ages 2 years and 18 months, respectively. The management and the complications associated with such pregnancies are discussed.
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Affiliation(s)
- U Gafter
- Department of Nephrology, Golda Medical Center (Hasharon), Petah Tikva, Israel
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446
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Hoffman HT, Subnani M, Cha M, Kidd L, Landman J, Tooley R, Carey TE. Calcium regulation of antigen expression on normal and malignant human squamous cells in vitro. Arch Otolaryngol Head Neck Surg 1990; 116:299-303. [PMID: 2306347 DOI: 10.1001/archotol.1990.01870030063010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In vitro, normal keratinocytes exhibit undifferentiated morphologic features and proliferate for multiple passages in low-calcium medium (less than or equal to 0.3 mmol/L) whereas, in high-calcium medium (greater than or equal to 1.0 mmol/L), these cells assume differentiation characteristics, begin to stratify, and eventually cease proliferating. In contrast, malignant keratinocytes grow well in high-calcium medium. Expression of pemphigus vulgaris antigen, a squamous cell marker, is altered on cultured normal keratinocytes by calcium. In this study we compared the effects of calcium levels on expression of cell surface antigens by UM-SCC-38, a human squamous carcinoma cell line, and normal keratinocytes cultured from newborn foreskin. Pemphigus, pemphigoid, beta 2-microglobulin antigens, as well as the epidermal growth factor receptor and the A9 germinal epithelial cell basement membrane squamous carcinoma antigen were examined. Pemphigus antigen was strongly expressed on normal and malignant cells in high-calcium but not low-calcium medium. Calcium concentration did not affect the expression of any of the other antigens tested. Thus, although calcium induces differentiation and eventual loss of proliferative capacity in normal but not malignant keratinocytes in vitro, we were unable to demonstrate differences in pemphigus vulgaris antigen expression that might be linked to the growth inhibitory effects induced by high calcium levels in nontransformed epithelial cells in culture.
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Affiliation(s)
- H T Hoffman
- Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor 48109-0506
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447
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Salloum E, Caillaud JM, Flamant F, Landman J, Lemerle J. Poor prognosis infantile fibrosarcoma with pathologic features of malignant fibrous histiocytoma after local recurrence. Med Pediatr Oncol 1990; 18:295-8. [PMID: 2162469 DOI: 10.1002/mpo.2950180408] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In a retrospective study of infants under 1 year of age treated at our institution over a 30-year period for soft tissue tumors, eight fibrosarcomas (FS) were seen, six of which were congenital. Therapy consisted of local excision (n = 3), radiotherapy (n = 1), surgery + radiotherapy (n = 1), surgery + chemotherapy (n = 1), and surgery + chemotherapy + radiotherapy (n = 2). Among these eight patients, four are alive in first complete remission (CR) with 13, 17, 23, and 27 years of follow-up. Of the remaining four patients, two had local recurrences and are still alive in CR after re-excision of the tumor, while the other two had both local and distant relapses and died. Interestingly, in the two patients who developed distant metastases, the pathologic pattern was that of malignant fibrous histiocytoma (MFH) at the time of local recurrence. To our knowledge, no similar cases of transitions between infantile FS known for its favorable outcome and MFH have been reported in this age group. The relevance of such transitions is difficult to assess. However, given the known metastatic potential of MFH, we believe that chemotherapy regimens currently used in the management of childhood soft tissue sarcomas should be used in similar cases.
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Affiliation(s)
- E Salloum
- Department of Pediatrics, Institut Gustave-Roussy, Villejuif, France
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448
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Straussberg R, Landman J, Sirota L, Dulitzky F, Bar-Ziv J. Teratoma of the head and neck in infancy. Isr J Med Sci 1989; 25:654-6. [PMID: 2592184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- R Straussberg
- Department of Neonatology, Golda Medical Center (Hasharon), Petah Tikva, Israel
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449
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Landman J, Weitz R, Dulitzki F, Shuper A, Sirota L, Aloni D, Bar-Ziv J, Gadoth N. Radiological colpocephaly: a congenital malformation or the result of intrauterine and perinatal brain damage. Brain Dev 1989; 11:313-6. [PMID: 2817296 DOI: 10.1016/s0387-7604(89)80059-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The term colpocephaly, meaning disproportional enlargement of the occipital horns of the lateral ventricles, was considered in the past to be a distinct congenital malformation acquired in early intrauterine life. During the last few years several cases were reported in whom a variety of intrauterine and perinatal causes could be associated with this radiological picture. We report on 9 children with radiological colpocephaly in whom intrauterine and/or perinatal injury to the developing brain seemed to be the cause of colpocephaly. It is evident from our observations that "radiological colpocephaly" is a non-specific finding caused frequently by CNS damage acquired during intrauterine and perinatal life.
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Affiliation(s)
- J Landman
- Department of Neonatology, Hasharon Hospital, Tel Aviv., Israel
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450
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Sirota L, Levi J, Landman J, Dulizky F. Myoglobinuric renal failure in a newborn after traumatic delivery. Isr J Med Sci 1988; 24:317-8. [PMID: 3403227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Fetal and neonatal asphyxia is the main cause of transient or acute renal failure (ARF) in neonates. Rhabdomyolysis and subsequent myoglobinuria have been rarely reported in neonates. We describe a case of ARF in a newborn infant in whom asphyxia, birth trauma and hypovolemic shock precipitated rhabdomyolysis which contributed to ARF.
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Affiliation(s)
- L Sirota
- Department of Neonatology, Golda Medical Center (Hasharon), Petah Tikya, Israel
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