Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemia
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Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemia Juza Chen and Avi Bery Director of Sexual Dysfunction Clinic Department of Urology Tel-Aviv Sourasky Medical Center Sackler Faculty of Medicine Tel-Aviv University Moscow 2010
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Renal replacement therapy (RRT) refers to life-supporting treatments for renal failure and includes hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. The choice of RRT depends on factors like the patient's cardiovascular status, availability of resources, and clinical considerations. Common complications include those related to vascular access and electrolyte imbalances. RRT aims to correct fluid overload, metabolic abnormalities, and remove waste through diffusion or convection.
Renal transplant
Kidney transplantation is the most effective therapy for end-stage renal disease. The transplanted organ can come from a live or deceased donor. Immunosuppressive medications are used to prevent rejection and include corticosteroids, calcineurin inhibitors, mTOR inhibitors, and antimetabolites. Common post-transplant complications include acute rejection, infections like cytomegalovirus, and chronic allograft dysfunction.
Basics of Continuous Renal Replacement Therapy
A very simple yet comprehensive presentation to understand the concept of CRRT and its implementation in Intensive Care Unit. Intended for the very beginners in ICU. After going through the presentation you will be able to say "Now I know it!"
Renal replacement therapy for internists
This document summarizes a randomized controlled trial that compared the effects of early versus late initiation of continuous renal replacement therapy (CRRT) at different clearance rates in critically ill patients with acute kidney injury (AKI). The trial involved 106 patients randomized to either: 1) Early high-volume CRRT with a clearance of 72-96 L/day, 2) Early low-volume CRRT with a clearance of 24-36 L/day, or 3) Late low-volume CRRT initiated when BUN was >100 mg/dL with a clearance of 24-36 L/day. The primary outcomes were 28-day mortality and renal recovery. There was no significant difference in 28-day mortality between the
Renal replacement therapy in intensive care
The document discusses renal replacement therapies in critical care, including various classification systems for acute kidney injury, the incidence and outcomes of AKI in ICU patients, and evidence around different renal replacement modalities. It notes that while there is no definitive evidence of superiority between therapies, higher therapy doses are associated with better outcomes. The document also explores using renal replacement therapies for blood purification beyond just solute clearance, such as for removing cytokines.
Post operative complications of renal transplant
Urinary complications after kidney transplantation include urine leaks, urinary obstruction, and hematomas. Urinary obstruction most commonly occurs within the first 6 months after transplantation at the site where the ureter is implanted into the bladder, due to issues like ischemia, rejection, or technical errors. Infections are also common after transplantation, especially in the first few months and from 1-6 months post-op when opportunistic infections may develop. Other complications include lymphoceles, renal artery stenosis, infarction, renal vein thrombosis, calculi, and neoplasms. Prolonged immunosuppression also increases cancer risks.
Renal replacement therapy
This document provides an overview of renal replacement therapy and kidney transplantation. It discusses the history of dialysis and transplantation, including the first documented cases. It then describes different types of dialysis therapy including hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. The basics of kidney transplantation are outlined, including donor and recipient selection criteria and common post-transplant complications. Immunosuppressive medications and their role in preventing rejection are also summarized.
Principles of organ transplant and Renal transplant
This document provides an overview of organ transplant principles. It defines different types of transplants and discusses transplant immunology, including graft rejection. The key principles covered are pre-operative (patient selection, counseling, informed consent), intra-operative (organ procurement and preservation), and post-operative (assessment, immunosuppression, follow up). Complications and ethical considerations are also mentioned. Overall, the document outlines the major concepts and steps involved in organ transplantation.
Proteinuria
The document discusses proteinuria and different types of kidney diseases that can cause protein in the urine. It begins by defining normal and abnormal levels of protein in urine and discusses microscopic albuminuria. It then describes different types of proteinuria including tubular, overflow and glomerular. Within glomerular proteinuria it distinguishes between selective, non-selective and microscopic albuminuria. Common causes of nephrotic syndrome like minimal change disease, focal segmental glomerulosclerosis and membranous nephropathy are outlined. Diagnostic testing and treatment options for minimal change disease are also summarized.
Proteinuria how to approach final
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
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From renal failure to renal transplant updated oct 13
From renal failure to renal transplant updated oct 13
THE DANGEROUS TRIAD - OBESITY, DIABETES & HYPERTENSION - IS SURGERY THE SINGL...
THE DANGEROUS TRIAD - OBESITY, DIABETES & HYPERTENSION - IS SURGERY THE SINGL...
Continuous renal replacement therapy in icu Crrt 2
Continuous renal replacement therapy in icu Crrt 2
Principles of organ transplant and Renal transplant
Principles of organ transplant and Renal transplant
Similar to Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemia
Management of Renal Cell Carcinoma ppt.pptx
Management Guidelines with evidence for management of Renal cell carcinoma
Various Trials included
Guidelines included
Advances in the management of pancreatic cancer
1) Advances in the management of pancreatic cancers including improved preoperative assessment using CT, MRI, EUS and PET scans to determine resectability.
2) Surgical approaches to resectable pancreatic cancer including pylorus-preserving versus standard Whipple procedure and debates around extent of lymphadenectomy.
3) Outcomes have modestly improved with resection rates around 20%, operative mortality of 9% and 5 year survival of 12%, though pancreatic cancer prognosis remains poor.
Nss and mit final
1. Nephron sparing surgery (NSS), also known as partial nephrectomy, aims to remove renal tumors while preserving as much healthy kidney tissue as possible.
2. NSS has similar oncologic outcomes as radical nephrectomy but offers advantages like preserving renal function and reducing risks of chronic kidney disease.
3. While NSS was historically more complex and risky than radical nephrectomy, advances in surgical techniques like laparoscopic and robotic partial nephrectomy have reduced risks and made NSS a viable option for more patients with renal cell carcinoma.
Intraoperative diagnosis of perhilar cholangiocarcinoma
A review of current data on the necessity to perform an intraoperative diagnosis before liver resection for perihilar cholangiocarcinoma
Presentazione pancreatite e vlc sic versione 1
This document describes a study examining the use of laparoscopic cholecystectomy for patients with mild biliary pancreatitis. The study reviewed 220 patients over an 11-year period who underwent laparoscopic cholecystectomy after symptoms improved. Common bile duct stones were identified in 23.1% of patients. The procedure had acceptable morbidity and mortality rates. It allowed for high rates of common bile duct clearance in a single surgery. Outcomes were better than alternative approaches like preoperative ERCP. The results support laparoscopic cholecystectomy as a viable option for treating mild biliary pancreatitis.
approach to Urothelial carcinoma of upper tract in horse shoe kidney
Upper tract urothelial carcinoma arising in a horseshoe kidney presents unique treatment challenges. The patient underwent right heminephrectomy for a T1 low-grade tumor, with subsequent recurrences in the bladder and ureter. Close follow-up is important given the high risk of recurrence in UTUC, particularly in the bladder due to field cancerization effects. While adjuvant therapies have unclear benefits, intravesical BCG may help prevent recurrence in selected cases. Complete surgical resection remains the mainstay of treatment for UTUC in horseshoe kidneys.
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This document discusses the management of small renal masses (SRMs). Key points include:
1. SRMs are detected more frequently due to increased use of imaging and are usually less than 4cm.
2. Goals for managing early stage renal cell carcinoma include cancer survival, preserving renal function, and avoiding treatment morbidity.
3. Treatment options for SRMs include radical nephrectomy, partial nephrectomy, thermal ablation, and active surveillance. Partial nephrectomy is the gold standard.
4. Cryoablation and radiofrequency ablation are emerging minimally invasive techniques for treating SRMs but long term data on oncologic outcomes is still lacking.
The Management of Pancreatic Trauma in the Modern Era
The Management of Pancreatic Trauma in the Modern Era
Surgical Clinics of North America
Volume 87, Issue 6 (December 2007)
Renal cell carcinoma: MAnagement guidelines
The document discusses the management of renal cell carcinomas (RCC) associated with genetic syndromes. It notes that for von Hippel-Lindau syndrome, smaller tumors less than 3 cm are observed while larger tumors greater than 3 cm are removed. For hereditary papillary RCC, surgery is emphasized to remove larger lesions and observe smaller ones due to the indolent nature of type 1 papillary RCC. For hereditary leiomyomatosis RCC, delayed intervention is not recommended due to the aggressive nature of the tumors, and wide local excision is recommended even for tumors under 3 cm. The document also discusses staging, treatment options including radical nephrectomy and minimally invasive approaches, management
Amesur
This document summarizes the role of interventional radiology in liver transplantation. It discusses how transjugular intrahepatic portosystemic shunt placement and percutaneous treatments can help support transplant candidates by managing complications like ascites or liver tumors while patients wait for a donor liver. The document also outlines how radiology assists in preoperative evaluation and treatment of complications after transplantation through procedures like angioplasty and stent placement.
CURRENT TRENDS IN Renal cell carcinoma
1) Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults. It accounts for 2-3% of all adult cancers.
2) Presentation and risk factors include sporadic and familial cases, with peak incidence in the 6th and 7th decades of life. Half of cases are now discovered incidentally.
3) Treatment depends on stage and includes surgery such as partial or radical nephrectomy, thermal ablation, immunotherapy, targeted therapy, and radiation. Localized RCC is typically treated with surgery while advanced RCC utilizes systemic therapies.
Carcinoma of the pancreas
Pancreatic cancer is the sixth leading cause of cancer death in the UK and the fourth leading cause in the US. It most commonly affects men over age 70. The majority (85%) are ductal adenocarcinomas that infiltrate locally and metastasize to the liver and peritoneum. Diagnosis involves imaging like CT scans and tumor marker tests. Surgical resection is the only potentially curative treatment but is only possible in 15-20% of cases due to late stage at presentation. Adjuvant chemotherapy may provide a survival benefit. Palliative options are aimed at relieving jaundice, gastric outlet obstruction, and pain. Prognosis remains poor with less than 5% of patients surviving 5
Acs0522 procedures for benign and malignant biliary tract disease-2005
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
Acs0522 Procedures For Benign And Malignant Biliary Tract Disease 2005
This document discusses procedures for benign and malignant biliary tract diseases. It describes common operations to treat biliary tract diseases, emphasizing details of operative planning and technique. Key points include:
- Thorough preoperative imaging is important to define anatomy accurately.
- Biliary obstruction can cause secondary issues like infection, renal dysfunction, impaired immunity, and malnutrition, so these should be addressed preoperatively if possible.
- Exposure of the hepatoduodenal ligament and porta hepatis is critical during open procedures. Adhesions may require specific dissection techniques.
- Biliary anastomoses generally heal well if blood supply is preserved, tension is avoided, and sutures are placed
Thermal Ablation of Renal Tumors under Ultrasound Guidance and Conscious Seda...
Purpose: Computed tomography (CT) guidance and general anesthesia have recently been recommended as the approach of choice for percutaneous ablation of small renal cell carcinoma (RCC), whereas ultrasound (US) guidance and conscious sedation have been tagged as inadequate. Aim of the study was to assess the safety and effectiveness of percutaneous thermal ablation of small RCC under ultrasound (US)-guidance and conscious sedation. Methods: The records of 74 patients with small RCC (≤5 cm), who underwent US-guided thermal ablation under conscious sedation were retrospectively reviewed. Conscious sedation was usually induced by means of intravenous bolus of midazolam 50–100 μg/kg plus continuous infusion of a 25 μg/mL solution of remifentanil at a rate of 0.05 μg/kg/min. Technical success, technical efficacy, local tumor progression (LTP), primary and secondary efficacy rates, complication rate, and 1-, 3-, and 5-year survival rates were analyzed.
recent advances in hepatobiliary and GI surgery
1. Advances in surgical techniques, devices, and perioperative management have led to reduced operative times, blood loss, morbidity, and mortality associated with hepatic resection.
2. Liver functional reserve assessment and meticulous planning are important for safe hepatic resection. Surgical portal decompression is more effective than TIPS for variceal bleeding in low-risk patients.
3. RFA has limitations for HCC treatment and is not an independent therapy; transplantation or resection are preferred when possible. Bioartificial liver devices show promise for bridging patients to transplantation or regeneration.
ROLE OF DIAGNOSTIC LAPROSCOPY IN ABDOMINAL MALIGNANCIES.pptx
Laparoscopy provides accurate diagnosis and staging of abdominal malignancies through direct visualization of the peritoneal cavity and organs. It can detect occult metastases that may be missed on imaging, avoiding unnecessary laparotomies in nonresectable cases. Laparoscopic ultrasound further enhances staging by allowing visualization of deeply located liver lesions and lymph nodes. For several cancer types including pancreatic and hepatobiliary malignancies, laparoscopy with ultrasound routinely changes management by identifying inoperable cases.
Presentation1.pptx, radiological imaging of obstructive jaundice.
Ultrasonography is the initial test of choice to evaluate obstructive jaundice as it is non-invasive, inexpensive and highly sensitive. It can detect dilated bile ducts suggesting extrahepatic obstruction. MRCP and ERCP provide more detailed imaging of the biliary tree but ERCP allows for therapeutic interventions. Other options include CT, PTC and EUS which provide additional information but have greater risks or limitations. The cause of obstructive jaundice can be benign such as gallstones or malignancies involving the bile ducts, pancreas or gallbladder.
Metastatic liver disease (2)
This document discusses the management of metastatic liver tumors, focusing on colorectal liver metastases. Some key points:
- The liver is the most common site of metastasis from colorectal cancer. Surgical resection offers the only chance of cure or prolonged survival for resectable colorectal liver metastases, with 5-year survival rates of 40% for margin-negative resection.
- Factors associated with poorer prognosis include short disease-free interval, multiple tumors, bilobar involvement, large tumor size, and elevated CEA levels.
- Preoperative imaging with CT, MRI, and ultrasound is used to evaluate resectability and tumor extent. Laparoscopy can help identify unresectable disease.
Endoscopic therapy of biliary strictures post living donor
This document discusses biliary complications after liver transplantation. It begins by providing background on the evolution of liver transplantation and identifies biliary complications as a major issue.
It then discusses the incidence of various biliary complications like leaks, strictures and stones. Risk factors for anastomotic and non-anastomotic strictures are explained. The pathogenesis, presentations, diagnosis and management of both types of strictures is summarized.
Endoscopic therapy is identified as the primary treatment approach for anastomotic strictures while non-anastomotic strictures are more difficult to treat and have lower success rates with endoscopy. Future areas of research like new endoscopic tools and bioabsorbable stents are also mentioned.
Similar to Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemia (20)
Intraoperative diagnosis of perhilar cholangiocarcinoma
Intraoperative diagnosis of perhilar cholangiocarcinoma
approach to Urothelial carcinoma of upper tract in horse shoe kidney
approach to Urothelial carcinoma of upper tract in horse shoe kidney
PPT.pptxfhj iytd jhjkj hgf uykjjn khgyfu iuf tyyf uyu v ctrc67 v ciytr57i
PPT.pptxfhj iytd jhjkj hgf uykjjn khgyfu iuf tyyf uyu v ctrc67 v ciytr57i
The Management of Pancreatic Trauma in the Modern Era
The Management of Pancreatic Trauma in the Modern Era
Acs0522 procedures for benign and malignant biliary tract disease-2005
Acs0522 procedures for benign and malignant biliary tract disease-2005
Acs0522 Procedures For Benign And Malignant Biliary Tract Disease 2005
Acs0522 Procedures For Benign And Malignant Biliary Tract Disease 2005
Thermal Ablation of Renal Tumors under Ultrasound Guidance and Conscious Seda...
Thermal Ablation of Renal Tumors under Ultrasound Guidance and Conscious Seda...
ROLE OF DIAGNOSTIC LAPROSCOPY IN ABDOMINAL MALIGNANCIES.pptx
ROLE OF DIAGNOSTIC LAPROSCOPY IN ABDOMINAL MALIGNANCIES.pptx
Presentation1.pptx, radiological imaging of obstructive jaundice.
Presentation1.pptx, radiological imaging of obstructive jaundice.
Endoscopic therapy of biliary strictures post living donor
Endoscopic therapy of biliary strictures post living donor
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MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
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The Nervous and Chemical Regulation of Respiration
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
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7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
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Laparoscopic Partial Nephrectomy of Hilar Tumors with Cold Ischemia
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