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Potretzke AM, Mohapatra A, Larson JA, Benway BM. Transmesenteric robot-assisted pyeloplasty for ureteropelvic junction obstruction in horseshoe kidney. Int Braz J Urol 2017; 42:626-7. [PMID: 27286132 PMCID: PMC4920586 DOI: 10.1590/s1677-5538.ibju.2015.0315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 07/17/2015] [Indexed: 11/23/2022] Open
Affiliation(s)
- Aaron M Potretzke
- Washington University School of Medicine, Division of Urologic Surgery, St. Louis, MO, USA
| | - Anand Mohapatra
- Washington University School of Medicine, Division of Urologic Surgery, St. Louis, MO, USA
| | - Jeffrey A Larson
- Washington University School of Medicine, Division of Urologic Surgery, St. Louis, MO, USA
| | - Brian M Benway
- Urology Academic Practice, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Potretzke AM, Park AM, Bauman TM, Larson JA, Vetter JM, Benway BM, Desai AC. Is extended preoperative antibiotic prophylaxis for high-risk patients necessary before percutaneous nephrolithotomy? Investig Clin Urol 2016; 57:417-423. [PMID: 27847915 PMCID: PMC5109791 DOI: 10.4111/icu.2016.57.6.417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/06/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The goal of this study was to compare the rate of systemic inflammatory response syndrome (SIRS) in high-risk patients undergoing percutaneous nephrolithotomy (PCNL) between patients who received 7, 2, or 0 days of preoperative antibiotics. MATERIALS AND METHODS We retrospectively reviewed a series of consecutive PCNLs performed at our institution. Patients with infected preoperative urine cultures were excluded. High-risk patients were defined as those with a history of previous urinary tract infection (UTI), hydronephrosis, or stone size ≥2 cm. Patients were treated with 7, 2, or 0 days of preoperative antibiotic prophylaxis prior to PCNL. All patients received a single preoperative dose of antibiotics within 60 minutes of the start of surgery. Fisher exact test was used to compare the rate of SIRS by preoperative antibiotic length. RESULTS Of the 292 patients identified, 138 (47.3%) had sterile urine and met high-risk criteria, of which 27 (19.6%), 39 (28.3%), and 72 (52.2%) received 7, 2, and 0 days of preoperative antibiotics, respectively. The 3 groups were similar in age, sex, and duration of surgery (p>0.05). There was no difference in the rate of SIRS between the groups, with 1 of 27 (3.7%), 2 of 39 (5.1%) and 3 of 72 patients (4.2%) meeting criteria in the 7, 2, and 0 days antibiotic groups (p=~1). CONCLUSIONS Extended preoperative antibiotic prophylaxis was not found to reduce the risk of SIRS after PCNL in our institutional experience of high-risk patients. For these patients, a single preoperative dose of antibiotics is sufficient.
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Affiliation(s)
- Aaron M Potretzke
- Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Alyssa M Park
- Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Tyler M Bauman
- Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jeffrey A Larson
- Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Joel M Vetter
- Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Brian M Benway
- Urology Academic Practice, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alana C Desai
- Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA
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Potretzke AM, Knight BA, Potretzke TA, Larson JA, Bhayani SB. Is Ureteroscopy Needed Prior to Nephroureterectomy? An Evidence-Based Algorithmic Approach. Urology 2015; 88:43-8. [PMID: 26545850 DOI: 10.1016/j.urology.2015.08.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/18/2015] [Accepted: 08/27/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop an evidence-based approach to the diagnostic workup of suspicious upper urinary tract lesions. METHODS The PubMed database was searched using the following terms with a filter for English language: "upper tract urothelial carcinoma" and "upper tract transitional cell carcinoma," along with the following corresponding terms: "cost," "epidemiology," "diagnosis," "ureteroscopy," and "workup." A total of 404 articles were returned, and 33 were reviewed in full based on relevance. RESULTS Computed tomography urogram is both sensitive and specific (96% and 99%). Cytology is utilized for its specificity (89%-100%). Ureteroscopy and biopsy of an upper tract lesion can be helpful in equivocal cases but can pose challenges in terms of yield and eventual pathologic upstaging. Due to the high sensitivity and specificity of other noninvasive tests, ureteroscopy can be obviated in select cases. We assess the available evidence and devise an algorithm for the evaluation of an upper tract urothelial carcinoma lesion. CONCLUSION Ureteroscopy can be omitted as part of the diagnostic workup in appropriately selected cases of upper tract urothelial carcinoma.
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Affiliation(s)
- Aaron M Potretzke
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - B Alexander Knight
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Theodora A Potretzke
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey A Larson
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Sam B Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO.
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Abstract
Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) commonly affect older men. Age-related changes associated with metabolic disturbances, changes in hormone balance, and chronic inflammation may cause BPH development. The diagnosis of BPH hinges on a thorough medical history and focused physical examination, with attention to other conditions that may be causing LUTS. Digital rectal examination and urinalysis should be performed. Other testing may be considered depending on presentation of symptoms, including prostate-specific antigen, serum creatinine, urine cytology, imaging, cystourethroscopy, post-void residual, and pressure-flow studies. Many medical and surgical treatment options exist. Surgery should be reserved for patients who either have failed medical management or have complications from BPH, such as recurrent urinary tract infections, refractory urinary retention, bladder stones, or renal insufficiency as a result of obstructive uropathy.
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Affiliation(s)
- Eric H Kim
- Washington University School of Medicine, St. Louis, Missouri 63110; , ,
| | - Jeffrey A Larson
- Washington University School of Medicine, St. Louis, Missouri 63110; , ,
| | - Gerald L Andriole
- Washington University School of Medicine, St. Louis, Missouri 63110; , ,
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Knight BA, Potretzke AM, Larson JA, Bhayani SB. Comparing Expert Reported Outcomes to National Surgical Quality Improvement Program Risk Calculator-Predicted Outcomes: Do Reporting Standards Differ? J Endourol 2015; 29:1091-9. [DOI: 10.1089/end.2015.0178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- B. Alexander Knight
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Aaron M. Potretzke
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey A. Larson
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sam B. Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Zargar H, Rogers C, Bhayani S, Allaf M, Larson JA, Barod R, Mass A, Johnson MH, Stifelman M, Kaouk JH. MP63-06 TRIFECTA OUTCOMES OF ROBOTIC PARTIAL NEPHRECTOMY FOR T1B RENAL MASSES: A MULTI-INSTITUTIONAL ANALYSIS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Brockman JA, Potretzke AM, Larson JA, Vetter J, Figenshau RS, Bhayani SB, Benway BM. PD18-09 THE ROLE OF THE ASSISTANT DURING ROBOT-ASSISTED PARTIAL NEPHRECTOMY: DOES EXPERIENCE MATTER? J Urol 2015. [DOI: 10.1016/j.juro.2015.02.694] [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: 11/25/2022]
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Larson JA, Kaouk JH, Stifelman MD, Rogers CG, Allaf ME, Potretzke A, Marshall S, Zargar H, Ball MW, Bhayani SB. Nonmodifiable factors and complications contribute to length of stay in robot-assisted partial nephrectomy. J Endourol 2014; 29:422-9. [PMID: 25286232 PMCID: PMC6943947 DOI: 10.1089/end.2014.0424] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introduction/Objective: Robotic-assisted partial nephrectomy (RPN) offers a mean length of stay (LOS) of 2 to 3 days. The purpose of this study is to determine the impact of modifiable and nonmodifiable risk factors on hospital LOS after RPN. Patients and Methods: We retrospectively reviewed our prospectively maintained database to identify all patients undergoing RPN for localized tumors at five US centers from 2007 to 2013. Patient and tumor characteristics were compared among hospital LOS groups. Associated factors were modeled using univariate and multivariate cumulative logistic regression to determine factors predictive of hospital LOS. Results: One thousand five hundred thirty-two patients were grouped into LOS 1 to 3 days (1298, 84.1%), LOS=4 days (133, 8.6%), and LOS >4 days (110, 7.2%). Patient demographics were similar between groups. Patients in the LOS=4 and LOS >4 day groups were more likely to have a higher Charlson comorbidity index score (mean 2.2, 3.1 and 3.8; p<0.001), higher nephrometry score (mean 7.1, 7.6, 7.8; p=0.0002), and larger tumors (mean 2.9, 3.6 and 3.5 cm; p<0.0001) than those in the LOS 1 to 3 day group. Significant differences in complication rates were observed when comparing LOS 1–3 (116, 8.9%), LOS=4 (40, 30%), and LOS >4 (59, 54%). According to the Clavien–Dindo classification of surgical complications, 11 grade 3 and 11 grade 4 complications occurred in patients with an LOS of 4 or more days (p<0.0001). Postoperative transfusion, deep vein thrombosis, pulmonary embolism, atrial fibrillation, dyspnea/atelectasis, ileus, and acute renal failure each significantly predicted a hospital LOS >4 days (p<0.001). Conclusion: 15.8% of patients undergoing RPN have an LOS of 4 days or more. Longer LOS was independently associated with higher Charlson index, nephrometry score (nonmodifiable factors), and perioperative complications (potentially modifiable). These data may be useful in perioperative counseling and payer precertification.
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Affiliation(s)
- Jeffrey A Larson
- 1 Division of Urology, Washington University School of Medicine , Saint Louis, Missouri
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Ball MW, Gorin MA, Bhayani SB, Rogers CG, Stifelman MD, Kaouk JH, Zargar H, Marshall S, Larson JA, Rahbar HM, Trock BJ, Pierorazio PM, Allaf ME. Preoperative predictors of malignancy and unfavorable pathology for clinical T1a tumors treated with partial nephrectomy: a multi-institutional analysis. Urol Oncol 2014; 33:112.e9-14. [PMID: 25499258 DOI: 10.1016/j.urolonc.2014.11.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 01/20/2023]
Abstract
PURPOSE To determine preoperative predictors associated with renal cell carcinoma (RCC) and unfavorable pathology in small renal masses treated with partial nephrectomy (PN). MATERIALS AND METHODS PN records from 5 centers were retrospectively queried for patients with a clinically localized single tumor <4 cm on imaging (clinical T1a). Between 2007 and 2013, 1,009 patients met the inclusion criteria. Unfavorable pathology was defined as any grade III or IV RCC or tumors upstaged to pathologic T3a disease. Logistic regression models were used to determine preoperative characteristics associated with RCC and with unfavorable pathology. RESULTS A total of 771 (76.4%) patients were found to have RCC and 198 (19.6%) had unfavorable pathology. On multivariate, bootstrap-adjusted logistic regression analysis, factors associated with the presence of malignancy were imaging tumor size ≥ 3 cm (odds ratio [OR] = 1.46; P = 0.040), male sex (OR = 1.88; P<0.0001), and nephrometry score ≥ 8 (OR = 1.64; P = 0.005). These same factors were independently associated with risk of unfavorable pathology: size ≥ 3 cm (OR = 1.46; P = 0.021), male sex (OR = 2.35; P<0.0001), and nephrometry score ≥ 8 (OR = 1.49; P = 0.015). The c statistic was 0.62 for the predicting malignancy and 0.63 for unfavorable pathology. CONCLUSIONS In this multi-institutional cohort, male sex, imaging tumor size ≥ 3 cm, and nephrometry score ≥ 8 were predictors of RCC and adverse pathology following PN. These factors may assist in risk stratification and selective renal mass biopsy before decision making. Further studies are necessary to validate these findings.
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Affiliation(s)
- Mark W Ball
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Michael A Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sam B Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Michael D Stifelman
- Department of Urology, New York University, Langone Medical Center, New York, NY
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Susan Marshall
- Department of Urology, New York University, Langone Medical Center, New York, NY
| | - Jeffrey A Larson
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Haider M Rahbar
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Bruce J Trock
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD
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Mobley JM, Kim EH, Larson JA, Figenshau RS, Vetter JM, Johnson MH, Bhayani SB. Patients with Pathologically Proven Renal Disease Have Similar Declines in Renal Function Following Robot-Assisted Partial Nephrectomy. J Endourol 2014; 28:1429-34. [DOI: 10.1089/end.2014.0228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Jonathan M. Mobley
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri
| | - Eric H. Kim
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey A. Larson
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri
| | - Robert S. Figenshau
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri
| | - Joel M. Vetter
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Sam B. Bhayani
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri
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Potretzke AM, Larson JA, Bhayani SB. Re: R. Houston Thompson, Tom Atwell, Grant Schmit, et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol 2015;67:252-9. Eur Urol 2014; 67:e19-20. [PMID: 25269382 DOI: 10.1016/j.eururo.2014.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 09/09/2014] [Indexed: 01/20/2023]
Affiliation(s)
- Aaron M Potretzke
- Washington University School of Medicine, Division of Urology, St. Louis, MO, USA
| | - Jeffrey A Larson
- Washington University School of Medicine, Division of Urology, St. Louis, MO, USA
| | - Sam B Bhayani
- Washington University School of Medicine, Division of Urology, St. Louis, MO, USA.
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Abstract
The incidence of renal cell carcinoma continues to increase with utilization of diagnostic abdominal imaging with migration towards a proportionally greater detection of small renal masses (SRM). Robot-assisted partial nephrectomy (RAPN) has become an attractive minimally invasive treatment modality for SRM's due to the technical advantages and shortened learning curve compared to laparoscopic partial nephrectomy (LPN) while preserving comparable perioperative outcomes. With advances in ablative approaches for stage I renal cell carcinoma (RCC) and controversy surrounding the role of extirpative surgery for SRM's, systematic understanding of the complications associated with RAPN has become even more imperative. This review aims to summarize and evaluate the contemporary literature, compile reported intraoperative complications, describe conventional and nephron-sparing surgery (NSS) specific postoperative complications, and assess factors associated with an increased likelihood for perioperative complications following RAPN.
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Affiliation(s)
- Eric H Kim
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, Saint Louis, MO, 63110, USA,
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Mobley JM, Kim EH, Larson JA, Figenshau RS, Vetter JM, Johnson MH, Bhayani S. Patients with Pathologically Proven Renal Disease Have Similar Declines in Renal Function Following Robot-Assisted Partial Nephrectomy. J Endourol 2014. [DOI: 10.1089/end.2014-0228.ecc14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Larson JA, Johnson MH, Bhayani SB. Application of Surgical Safety Standards to Robotic Surgery: Five Principles of Ethics for Nonmaleficence. J Am Coll Surg 2014; 218:290-3. [DOI: 10.1016/j.jamcollsurg.2013.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 11/05/2013] [Accepted: 11/06/2013] [Indexed: 10/26/2022]
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Murali D, Barnhart TE, Vandehey NT, Christian BT, Nickles RJ, Converse AK, Larson JA, Holden JE, Schneider ML, Dejesus OT. An efficient synthesis of dopamine transporter tracer [¹⁸F]FECNT. Appl Radiat Isot 2012. [PMID: 23208243 DOI: 10.1016/j.apradiso.2012.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A simple synthesis of the dopamine transporter ligand [(18)F]FECNT with high radiochemical yield and short synthesis time, suitable for routine production is reported. Reaction of 2β-carbomethoxy-3β-(4-chlorophenyl)nortropane with [(18)F]2-fluoroethyl triflate ([(18)F]FEtOTf) at room temperature for 4 min provided [(18)F]FECNT in 84% decay corrected radiochemical yield. Since [(18)F]FEtOTf was prepared from [(18)F]2-fluoroethyl bromide that was isolated from its starting material, formation of unwanted side products and the amount of expensive precursor used could be greatly reduced. The overall radiochemical yields of [(18)F]FECNT were 40% (n=29) and the total synthesis time was ca. 100 min. The average specific activity of [(18)F]FECNT was 377.4 GBq/μmol (10.2 Ci/μmol).
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Affiliation(s)
- D Murali
- Department of Medical Physics, University of Wisconsin-Madison, Madison, 1111 Highland Ave, 1005 WIMR, Madison, WI 53705, United States.
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Chen G, Larson JA, Ogagan PD, Shen B, Wang J, Roppolo JR, de Groat WC, Tai C. 124 POST-STIMULATION INHIBITORY EFFECT ON REFLEX BLADDER ACTIVITY INDUCED BY ACTIVATION OF SOMATIC AFFERENT NERVES IN THE CAT FOOT. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.172] [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: 11/27/2022]
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Tai C, Larson JA, Ogagan PD, Chen G, Shen B, Wang J, Roppolo JR, de Groat WC. Differential role of opioid receptors in tibial nerve inhibition of nociceptive and nonnociceptive bladder reflexes in cats. Am J Physiol Renal Physiol 2012; 302:F1090-7. [PMID: 22237803 DOI: 10.1152/ajprenal.00609.2011] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Naloxone (an opioid receptor antagonist) was used to examine the role of opioid mechanisms in bladder reflexes and in somatic afferent inhibition of these reflexes by tibial nerve stimulation (TNS). Experiments were conducted in α-chloralose-anesthetized cats when the bladder was infused with saline or 0.25% acetic acid (AA). The bladder volume was measured at the first large-amplitude (>30 cmH(2)O) contraction during a cystometrogram and termed "estimated bladder capacity" (EBC). AA irritated the bladder, induced bladder overactivity, and significantly (P < 0.0001) reduced EBC to 14.3 ± 1.9% of the saline control. TNS (5 Hz, 0.2 ms) at 4 and 8 times the threshold (T) intensity for inducing an observable toe movement suppressed AA-induced bladder overactivity and significantly increased EBC to 41.5 ± 9.9% (4T, P < 0.05) and 46.1 ± 7.9% (8T, P < 0.01) of the saline control. Naloxone (1 mg/kg iv) completely eliminated TNS inhibition of bladder overactivity. Naloxone (0.001-1 mg/kg iv) did not change EBC during AA irritation. However, during saline infusion naloxone (1 mg/kg iv) significantly (P < 0.01) reduced EBC to 66.5 ± 8.1% of the control EBC. During saline infusion, TNS induced an acute increase in EBC and an increase that persisted following the stimulation. Naloxone (1 mg/kg) did not alter either type of inhibition. However, naloxone administered during the poststimulation inhibition decreased EBC. These results indicate that opioid receptors have different roles in modulation of nociceptive and nonnociceptive bladder reflexes and in somatic afferent inhibition of these reflexes, raising the possibility that opioid receptors may be a target for pharmacological treatment of lower urinary tract disorders.
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Affiliation(s)
- Changfeng Tai
- Department of Urology, University of Pittsburgh, 700 Kaufmann Bldg., Pittsburgh, PA 15213, USA.
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Chen G, Larson JA, Ogagan PD, Shen B, Wang J, Roppolo JR, de Groat WC, Tai C. Post-stimulation inhibitory effect on reflex bladder activity induced by activation of somatic afferent nerves in the foot. J Urol 2011; 187:338-43. [PMID: 22099982 DOI: 10.1016/j.juro.2011.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE We determined whether transcutaneous electrical stimulation of somatic afferent nerves in the foot of cats would induce a post-stimulation increase in bladder capacity. MATERIALS AND METHODS In 12 α-chloralose anesthetized cats electrical stimulation (5 Hz) was applied to the skin of the hind foot for 2, 30-minute periods via dual pad electrodes attached on the plantar and dorsal surfaces (combination 1 and 2) or at 2 sites on the plantar surface (combination 1 and 3). The post-stimulation effect was examined by repeat cystometrogram after 30-minute stimulation. In the control group of 12 cats isovolumetric contractions were allowed to continue during each 30-minute period without stimulation. RESULTS Stimulation inhibited isovolumetric rhythmic bladder contractions. Bladder capacity was not increased after the first 30-minute foot stimulation via electrodes 1 and 2 but it was significantly increased a mean ± SE of 47.5% ± 2.9% after the second 30-minute stimulation via electrodes 1 and 3. After inducing the post-stimulation effect the foot stimulation applied during cystometrograms via electrodes 1 and 2 or 1 and 3 elicited a further increase in bladder capacity (mean 23.26% ± 17.64% and 20.07% ± 18.59%, respectively). CONCLUSIONS Results show that the transcutaneous plantar electrical stimulation of somatic afferent nerves in the foot can induce a post-stimulation increase in bladder capacity, suggesting that an intermittent stimulation pattern rather than continuous stimulation might be effective as clinical application to treat overactive bladder symptoms.
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Affiliation(s)
- Guoqing Chen
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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Larson JA, Ogagan PD, Chen G, Shen B, Wang J, Roppolo JR, de Groat WC, Tai C. Involvement of metabotropic glutamate receptor 5 in pudendal inhibition of nociceptive bladder activity in cats. J Physiol 2011; 589:5833-43. [PMID: 22005674 DOI: 10.1113/jphysiol.2011.215657] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
This study used MTEP, a metabotropic glutamate receptor 5 (mGluR5) antagonist, to examine the role of mGluR5 in the neural control of the urinary bladder and in the inhibition of the micturition reflex by pudendal nerve stimulation (PNS). Experiments were conducted in 11 female cats under α-chloralose anaesthesia when the bladder was infused with either saline or 0.25% acetic acid (AA). AA irritated the bladder, induced bladder overactivity and significantly (P < 0.001) reduced bladder capacity to 14.9 ± 10.3% of the saline control capacity. MTEP (0.1-50 mg kg(-1), i.v.) significantly (P < 0.05) increased bladder capacity during saline distension but not during AA irritation. However, MTEP induced a transient inhibition of isovolumetric bladder contractions under both conditions. PNS (5 Hz), which was tested at the threshold (T) intensity for inducing a complete inhibition of isovolumetric bladder contractions and at an intensity of 3-4T, suppressed AA-induced bladder overactivity and significantly increased bladder capacity to 68.0 ± 31.3% at 1T (P < 0.05) and 98.5 ± 55.3% at 3-4T (P < 0.01) of the saline control capacity. MTEP dose dependently (0.1-50 mg kg(-1), i.v.) suppressed PNS inhibition of bladder overactivity at low intensity (1T) but not at high intensity (3-4T). During saline infusion PNS significantly (P < 0.05) increased bladder capacity to 167.7 ± 27.1% at 1T and 196.0 ± 37.4% at 3-4T. These inhibitory effects were not observed after MTEP (0.1-50 mg kg(-1), i.v.) which also increased bladder capacity. These results indicate that glutamic acid has a transmitter function in bladder and somato-bladder reflex mechanisms and raise the possibility that mGluR5 may be a target for pharmacological treatment of lower urinary tract disorders.
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Affiliation(s)
- Jeffrey A Larson
- Department of Urology, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Larson JA, Tomaszewski JJ, Smaldone MC, Jackman SV. Robotic-assisted laparoscopic extravesical ureteroneocystostomy for management of adult ureteral duplication with upper pole prostatic urethral insertion. JSLS 2009; 13:458-61. [PMID: 19793496 PMCID: PMC3015980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 55-year-old male presented with progressive lower urinary tract symptoms and renal colic. The workup revealed a complete left ureteral duplication with a hydronephrotic upper pole moiety inserting into the prostatic urethra. Using a 5-port transperitoneal robotic-assisted laparoscopic technique, an extravesical upper pole ureteroneocystostomy was performed. Clinical follow-up and repeat imaging documented symptomatic and radiographic improvement. Robotic-assisted laparoscopic reconstructive techniques are feasible and efficacious in the management of adult ureteral anomalies.
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Roberts AD, Moore CF, DeJesus OT, Barnhart TE, Larson JA, Mukherjee J, Nickles RJ, Schueller MJ, Shelton SE, Schneider ML. Prenatal stress, moderate fetal alcohol, and dopamine system function in rhesus monkeys. Neurotoxicol Teratol 2004; 26:169-78. [PMID: 15019951 DOI: 10.1016/j.ntt.2003.12.003] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2003] [Revised: 11/26/2003] [Accepted: 12/01/2003] [Indexed: 10/26/2022]
Abstract
This study examined the striatal dopamine system integrity and associated behavior in 5- to 7-year-old rhesus monkeys born from mothers that experienced stress and/or consumed moderate levels of alcohol during pregnancy. Thirty-one young adult rhesus monkeys were derived from females randomly assigned to one of four groups: (1) control group that consumed isocaloric sucrose solution throughout gestation; (2) stress group that experienced prenatal stress (10-min removal from home cage and exposure to three random loud noise bursts, gestational days 90 through 145); (3) alcohol group that consumed alcohol (0.6 g/kg/day) throughout gestation; or (4) combined alcohol plus stress group that received both treatments. The subjects were assessed for striatal dopamine system function using positron emission tomography (PET), in which the dopamine (DA)-rich striatum was evaluated in separate scans for the trapping of [(18)F]-Fallypride (FAL) and 6-[(18)F]fluoro-m-tyrosine (FMT) to assess dopamine D2 receptor binding potential (BP) and DA synthesis via dopa decarboxylase activity, respectively. Subjects were previously assessed for non-matching-to-sample (NMS) task acquisition, with ratings of behavioral inhibition, stereotypies, and activity made after each NMS testing session. Subjects from prenatal stress conditions (Groups 2 and 4) showed an increase in the ratio of striatal dopamine D2 receptor BP and DA synthesis compared to controls (Group 1). An increase in the radiotracer distribution volume ratios (DVRs), which is used to evaluate the balance between striatal DA synthesis and receptor availability, respectively, was significantly correlated with less behavioral inhibition. The latter supports a hypothesis linking striatal function to behavioral inhibitory control.
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Affiliation(s)
- A D Roberts
- Department of Psychology, University of Wisconsin-Madison, Madison, WI 53706, USA
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Arvidson CG, Kirkpatrick R, Witkamp MT, Larson JA, Schipper CA, Waldbeser LS, O'Gaora P, Cooper M, So M. Neisseria gonorrhoeae mutants altered in toxicity to human fallopian tubes and molecular characterization of the genetic locus involved. Infect Immun 1999; 67:643-52. [PMID: 9916071 PMCID: PMC96367 DOI: 10.1128/iai.67.2.643-652.1999] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In an effort to identify potential cytotoxins expressed by Neisseria gonorrhoeae, we have identified a locus that, when mutated in the gonococcus, results in a significant increase in toxicity of the strain to human fallopian tube organ cultures (HFTOC). This locus, gly1, contains two open reading frames (ORFs) which are likely cotranscribed. ORF1 encodes a polypeptide of 17.8 kDa with a signal sequence that is recognized and processed in Escherichia coli and N. gonorrhoeae. The 15.6-kDa processed polypeptide has been observed in membrane fractions and filtered spent media from cultures of E. coli expressing gly1 and in outer membrane preparations of wild-type N. gonorrhoeae. The gly1 locus is not essential for bacterial survival, and it does not play a detectable role in epithelial cell adhesion, invasion, or intracellular survival. However, a gly1 null mutant causes much more damage to fallopian tube tissues than its isogenic wild-type parent. A strain complemented in trans for the gly1 mutation showed a level of toxicity to HFTOC similar to the level elicited by the wild-type parent. Taken together, these results indicate an involvement of the gly1 locus in the toxicity of N. gonorrhoeae to human fallopian tubes.
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Affiliation(s)
- C G Arvidson
- Department of Molecular Microbiology and Immunology, Oregon Health Sciences University, Portland, Oregon 97201, USA.
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Abstract
The traditional model of nursing, in which patients are discharged with a follow-up medical appointment, is no longer sufficient in the current healthcare environment. Primary nurses working in a 58-bed rehabilitation unit located in a 1,700-bed tertiary care medical center implemented a follow-up telephone call program to support the patient's transition from acute rehabilitation nursing care to community living. Patients discharged to home within a five-state area were called 2 weeks and 6 weeks after discharge. Notes on the telephone conversations were entered on a data collection form and later analyzed using Orem's self-care deficit theory (Orem, 1991). A total of 144 follow-up calls were made. During the first call (n = 105), 157 problems (1.5 per call) were noted, whereas 79 (2.0 per call) were identified during the second call (n = 39). Medication, safety, and bladder problems were most often cited as concerns by patients and caregivers after discharge. The most frequently used helping interventions during both the first and the second telephone calls were guiding and supporting.
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Abstract
OBJECTIVE To propose an answer to Medicine's confusion about what Type A Behavior is. METHOD To critically review early writings about Type A as well as current literature with a focus on five key articles which are frequently mentioned in medical and lay literature as containing relevant data undermining the Type A hypothesis. These five are critically evaluated for their definition of Type A, method of diagnosing Type A, nature of the cohort studied, and logic of their conclusions. RESULTS There is a failure in the literature to distinguish between Axis I symptoms and Axis II personality traits; the same term, Type A, being applied to quite different phenomena. CONCLUSIONS Type A should be defined as a Axis II Personality Disorder, and a new term, Stress Disorder (or Hostility Disorder) to the Axis I symptoms. This opens up endless possibilities in Medicine for Stress Disorder research, since Medicine can rightly argue that the research is to better treat the Stress Disorder disease, that precedes Coronary Artery disease.
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Affiliation(s)
- J A Larson
- Institute of Stress Medicine, Norwalk Hospital
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Abstract
The status of the blood-retinal barrier (BRB) in carriers of choroideremia and X-linked retinitis pigmentosa (XLRP) was determined by vitreous fluorophotometry (VF) and compared with that in female control subjects. Electroretinographic (ERG) amplitudes were measured to determine the overall functional integrity of retinal rods and cones. Comparison of the VF results showed an abnormal BRB in at least some carriers of XLRP, particularly those with peripheral fundus pigmentary changes, but not in carriers of choroideremia with even moderately extensive pigmentary changes. The abnormal BRB in XLRP carriers, with or without peripheral fundus pigmentary changes, was associated with at least moderate to moderately extensive reduction in scotopic ERG amplitudes, while the normal VF results in choroideremia carriers were associated with normal scotopic ERG amplitudes. However, in XLRP carriers, mild to modest reductions in ERG scotopic responses were seen in the presence of normal VF findings.
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Affiliation(s)
- M M Rusin
- Department of Ophthalmology, Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago 60612
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