The Journal of urology
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The Journal of urology · Oct 2007
Review Comparative StudyContrast medium induced nephropathy in urological practice.
Contrast medium induced nephropathy is the third cause of in-hospital acute renal failure. The first studies in this area were done with reference to urological practice only. Although various guidelines on the management of contrast medium induced nephropathy were provided by the European Society of Urogenital Radiology, more recently many investigators have focused their attention on contrast medium use in interventional vascular radiology and cardiology. We critically reviewed the literature to clarify the impact of contrast medium induced nephropathy in urology and the possible prophylactic measures against it. ⋯ The general approach to the recognition and prevention of contrast medium induced nephropathy in patients at risk should be extended to urological clinical practice since no definitive evidence based data are available regarding contrast medium induced nephropathy management in urological patients. Moreover, these patients can frequently present with the most significant risk factor for contrast medium mediated kidney damage, that is preexisting acute or chronic renal failure. Controlled trials are needed to establish the incidence of contrast medium induced nephropathy in diagnostic or interventional procedures in uroradiology.
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The Journal of urology · Oct 2007
Randomized Controlled TrialPlasminogen activation inhibitor-1 improves the predictive accuracy of prostate cancer nomograms.
We tested whether the addition of preoperative circulating plasminogen activator inhibitor type I levels improves the accuracy of standard preoperative and postoperative models for prediction of biochemical recurrence after radical prostatectomy. ⋯ Preoperative circulating plasminogen activator inhibitor type I is a predictor of biochemical recurrence, and it enhances the accuracy of preoperative and postoperative nomograms. After external validation these nomograms may assist clinical decision making regarding treatment choice and followup as well as identification of patients at high risk for biochemical recurrence who may benefit from neoadjuvant and/or adjuvant treatment.
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The Journal of urology · Oct 2007
Incidence of increased creatine kinase and its effect on kidney function in hand assisted laparoscopic kidney donors and their recipients.
Rhabdomyolysis is a rare cause of acute renal failure following laparoscopic donor nephrectomy. The incidence of rhabdomyolysis is not well known and to our knowledge the amount of creatine kinase elevation resulting in renal damage is unknown. We evaluated the incidence of increased creatine kinase, risk factors for increased creatine kinase and its effect on renal function in a series of patients undergoing hand assisted laparoscopic donor nephrectomy. ⋯ Creatine kinase elevation occurs in a small but significant number of patients. Operative time was an independent risk factor for increased creatine kinase. Although creatine kinase had no significant effect on short-term creatinine, there was an increase in the percent change in donor creatinine. Finally, the long-term significance of increased creatine kinase without clinical symptoms is unknown.
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The Journal of urology · Oct 2007
Comparative StudyAssociation of procedure volume with radical cystectomy outcomes in a nationwide database.
Studies of national databases yield important information about expected outcomes after radical cystectomy and factors that influence patient morbidity and mortality. We examined the hospital characteristics associated with outcomes after radical cystectomy in a cohort study using results from a single, high volume academic institution as well as a nationwide data set of academic institutions. ⋯ Even among academic medical centers hospitals with a higher volume of cystectomies in 2002 to 2005 were associated with improved outcomes, including decreased mortality, shorter length of stay and lower rehospitalization rates. These data may provide a framework for self-assessment and help establish criteria for performance evaluation.
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The Journal of urology · Oct 2007
Clinical safety of a viral vector based prostate cancer vaccine strategy.
The primary objective of this phase I study was to evaluate the clinical safety of a vaccine using recombinant vaccinia virus (prime) and recombinant fowlpox virus (boost) in combination with granulocyte-macrophage colony-stimulating factor in patients with prostate cancer. The vaccines contained transgenes for prostate specific antigen, a triad of co-stimulatory molecules and a tumor antigen whose amino acid sequence had been modified to enhance its immunogenicity. Secondary end points were immunological and clinical responses, changes in prostate specific antigen velocity, and the kinetics of vaccinia virus clearance from the vaccination site, serum, peripheral blood mononuclear cells, urine and saliva. ⋯ Based on the safety and preliminary immunogenicity results of this trial we recommend initiating a randomized, phase II study of prostate specific antigen/triad of co-stimulatory molecules vaccines in patients with less advanced prostate cancer.