Background: Nerve‐sparing techniques are commonly used in retroperitoneal lymph node dissection (RPLND) in patients with early stage testicular germ cell tumors to preserve postoperative ejaculation. ...The indications for nerve‐sparing procedures have been extended to patients who have residual retroperitoneal tumor postchemotherapy with an increase in the incidence of local recurrence. Here, we report on 26 Japanese men with advanced testicular cancer who underwent nerve‐sparing RPLND after partially successful chemotherapy.
Methods: Between January 1995 and December 2000, 26 patients with metastatic or recurrent testicular cancer underwent nerve‐sparing RPLND after chemotherapy. Eight patients had seminoma and 18 had non‐seminoma. Three patients received high‐dose chemotherapy with carboplatin (250 mg/m2 per day × 5 days), etoposide (300 mg/m2 per day × 5 days) and ifosfamide (1.5 g/m2 per day × 5 days) in combination with peripheral blood stem cell transplantation.
Results: In all cases, lumbar splanchnic nerves were preserved macroscopically during the operation, at least unilaterally. Twenty‐two patients (84.6%) achieved antegrade ejaculation during a mean follow‐up at 3.9 months (range: 1–7 months). Three patients have fathered children. Only one patient suffered a retroperitoneal recurrence during a median follow‐up at 25.8 months (range: 6–76 months).
Conclusion: Nerve‐sparing procedures for RPLND are appropriate for patients with metastatic testicular cancer, even after chemotherapy. The procedure preserves ejaculatory function in the majority of the patients without increasing the risk of local recurrence. Nerve‐sparing RPLND improves the quality of life in patients who require postchemotherapy RPLND to treat residual tumor.
Blood pumps for the cardiopulmonary support system with ECMO (extracorporeal membrane oxygenation) need a higher pump head. Existing single stage centrifugal pumps can generate the higher pump head ...with higher rotational speed of the impeller. However, the large shear stress due to the higher rotational speed can occur and lead to hemolysis. In order to realize a blood pump with higher pump head, higher anti-hemolysis and thrombosis performances, the basic study on the development of unprecedented multistage blood pump was conducted. In consideration of the application of the blood pump for pediatric patients, miniature two-stage centrifugal blood pump with the impeller's diameter of 40mm was designed and the performance was examined in experiments and computations. Some improvements for a multistage blood pump with higher anti-hemolysis and thrombosis performances were suggested.
For a cardiopulmonary support system with a membrane oxygenation such as a percutaneous cardiopulmonary support (PCPS) or an extracorporeal membrane oxygenation (ECMO), a blood pump needs to generate ...the pressure rise of approximately 200mmHg or higher, due to the high hydraulic resistances of the membrane oxygenation and of the cannula tubing. Using existent single stage rotary pumps with higher pressure rise result in the higher rotational speed of the pumps and possibly lead to the higher amount of hemolysis due to the larger shear stress acting on blood cells. In order to realize a blood pump with higher pressure rise, higher anti-hemolysis and thrombosis performances, the development of novel centrifugal blood pump consisting of two-stage has been conducted by the authors. As the conditions when the hemolysis and thrombosis occur are not clear and the type number of blood pumps is quite small, the design method of blood pumps has not been established yet. In the present paper, effective attempts to decrease the wall shear stress and to suppress the stagnation are introduced for the prevention of hemolysis and thrombosis in blood pumps. The hemolysis test was also carried out and it was clarified that the decrease of wall shear stress is effective as a guideline of design of blood pumps for improving the anti-hemolysis performance.
In cardiopulmonary support systems with a membrane oxygenation such as a percutaneous cardiopulmonary support (PCPS) or an extracorporeal membrane oxygenation (ECMO), blood pumps need to generate the ...pressure rise of approximately 200mmHg or higher, due to the high hydraulic resistances of the membrane oxygenation and of the cannula tubing. In order to realize the blood pump with higher pressure rise, higher anti-hemolysis and thrombosis performances, the development of novel centrifugal blood pump composed of two-stage has been conducted by the authors. In the present paper, effective attempts to decrease the wall shear stress and to suppress the stagnation are introduced for the prevention of hemolysis and thrombosis in blood pumps. The hemolysis test was also carried out and it was clarified that the decrease of wall shear stress is effective as a guideline of design of blood pumps for improving the anti-hemolysis performance.
In the cardiopulmonary support system with an ECMO (extracorporeal membrane oxygenation), a higher pump head is demanded for a blood pump. In order to realize a blood pump with higher pump head, ...higher anti-hemolysis and thrombosis performances, a study on the development of unprecedented multistage blood pump was conducted. In consideration of the application of the blood pump for pediatric patients, a miniature two-stage centrifugal blood pump with the impeller's diameter of 40mm was designed and the performance was examined in experiments and computations. Some useful knowledge for a design of the blood pump with higher anti-hemolysis and thrombosis performances was obtained.
Blood pumps for the cardiopulmonary support system with ECMO (extracorporeal membrane oxygenation) need a higher pump head. Existing single stage centrifugal pumps can generate the higher pump head ...with higher rotational speed of the impeller. However, the large shear stress due to the higher rotational speed can occur and lead to hemolysis. In order to realize a blood pump with higher pump head, higher anti-hemolysis and thrombosis performances, the basic study on the development of unprecedented multistage blood pump was conducted. In consideration of the application of the blood pump for pediatric patients, miniature two-stage centrifugal blood pump with the impeller's diameter of 40mm was designed and the performance was examined in experiments and computations. Some improvements for a multistage blood pump with higher anti-hemolysis and thrombosis performances were suggested.
A 40-year-old woman was referred to our hospital with right lower back pain as the chief complaint. Contrast-enhanced computed tomography (CT) showed a partially-solid tumor within a cyst measuring ...approximately 6 cm in diameter in the right renal hilum. The solid part was enhanced in the early phase and contrast medium was washed out earlier in the solid part than in the parenchyma in the equilibrium phase. Plain CT revealed partial cyst wall calcification. A soft tissue shadow approximately 10 mm in diameter in the dorsal inferior vena cava at the upper pole of the kidney and a solid tumor adjacent to the iliopsoas muscle and the kidney were detected. We performed radical nephrectomy and lymph node dissection with transperitoneal approach. The histopathological diagnosis was neuroendocrine tumor. Her clinical course has since been observed on an outpatient basis, for nearly 10 months to date, without any recurrence.
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