Sahar Kohanim

Elective Laparoscopic Partial Nephrectomy in Patients with Tumors >4 cm

OBJECTIVES To assess the perioperative outcomes of elective laparoscopic partial nephrectomy to treat renal tumors in patients with tumor burdens > 4 cm compared with those with tumor burdens of < or = 4 cm. METHODS A retrospective review of medical records was performed for all patients who had undergone laparoscopic partial nephrectomy for renal tumors from January 2000 to March 2005. The preoperative risk factors (ie, sex, age, American Society for Anesthesiologists score), perioperative course (ie, operative time, estimated blood loss, warm ischemia time, intraoperative and postoperative complications, transfusion rate, intraoperative biopsy of surgical margins, length of hospitalization), and pathologic outcomes (ie, tumor stage, type, and grade) were collected and compared between the patients in the 2 cohorts. RESULTS Patients with larger tumors had significantly more complications (37.0% vs 21.8%, P = .039) and a significantly longer hospitalization (4.1 vs 3.0 days, P = .026). For those with malignant tumors > 4 cm compared with those with malignant tumors of < or = 4 cm, the complication rate was 33.3% and 11.6% (P = 0.006) and the length of hospitalization was 4.5 and 3.2 days (P = .055), respectively. No other differences were noted between the 2 groups stratified by tumor size. CONCLUSIONS Laparoscopic partial nephrectomy is an oncologically feasible option for tumor burdens > 4 cm in the greatest dimension to provide a nephron-sparing option for patients in whom individually selected lesions can be isolated.

Immunosuppressive property of dried human amniotic membrane.

Purpose: To report the immunosuppressive property of dry human amniotic membrane (dHAM). Methods: Mouse splenocytes harvested from Balb/c mice were stimulated using functional-grade anti-CD3e antibodies for 4 days either with or without either of 2 commercial types of dHAM (Ambiodry 1 & 2, IOP Inc., Costa Mesa, Calif., USA) added to the culture media. The cell proliferation assay was performed to analyze the extent of splenocyte proliferation. Results: dHAMs significantly suppressed mouse splenocyte proliferation compared to control. The suppression by dHAM with intact amniotic epithelium (Ambiodry 2) was significantly stronger than dHAM without epithelium (Ambiodry 1). Conclusion: The immunosuppressive property of dHAM was demonstrated using an alloreactive splenocyte proliferation assay.