Biomedical subjects

A Paez Borda

Publications and source records attributed to A Paez Borda.

At least 19 recordsLinked to original sources

PubMed1999

[Mid-term results of a program for the monitoring of superficial bladder tumors].

OBJECTIVE: To identify the medium-term clinical prognostic factors for recurrence and progression in superficial bladder tumors and to analyze the efficacy and safety of the surveillance program. METHODS: 135 patients with primary superficial bladder tumor (Ta: 57, T1: 76, Tx: 2, grade I: 51, grade II: 70, grade III: 12, unknown grade: 2) were evaluated by cystoscopy/cytology alternately with ultrasound/cytology during the first two years, and by ultrasound and cytology yearly after the third year. The influence of tumor characteristics (stage, grade, size and number) and patient age and sex on tumor recurrence and progression were analyzed. The disease-free interval was expressed through an actuarial curve. The relationships between the annual recurrence rate and disease-free interval, and tumor and patient characteristics were analyzed. The influence of each variable in the presence of the other covariables was determined by multivariative analysis using a logistic regression model. RESULTS: The recurrence rate was 51.3% and the progression rate was 2.75%. The mean recurrence rate was 0.59 and the mean disease-free interval was 16.2 months. Tumor grade, size and number significantly influenced recurrence. Tumor size and number influenced the annual recurrence rate. Similarly, tumor number and size were associated with a shorter disease-free interval. Logistic regression analysis showed a relationship between tumor number and recurrence (relative risk = 2.7), and identified tumor size as a characteristic of a high recurrence rate (relative risk = 3.3). None of the factors could predict a higher risk for tumor progression. CONCLUSIONS: The estimation of the risk factors shows a wide intra and interindividual variability. It might therefore be necessary to establish them for each institution. In the medium-term, surveillance can be considered effective in terms of the recurrence rate and safe in terms of the progression rate.

Disease Progression↗

PubMed1997

[Limitations of ultrasonography in the clinical course monitoring of bladder tumors].

Ultrasonography is a fairly innocuous test in the follow-up of bladder tumours. Its results, however, can not be superposed to those of cystoscopy. This study aims to identify the risk factors for failure of transabdominal ultrasonography in the FU of bladder tumors. The influence of the primary tumour, sex and age of patients on the ability of ultrasonography to detect relapses was analyzed. Chi square and Student's t tests were used to associate the characteristics of primary tumours and patients to the results of ultrasonography. Student's t test was used to estimate the effect of diagnostic oversight in terms of annual recurrence rate and progression. The characteristics of primary tumours where relapse was detected or overlooked had no influence on the results of ultrasound follow-up as neither did age and sex. No differences were detected in recurrence rate of patients with anticipated (0.57) or overlooked (0.58) tumours. Although differences in progression rates (4.76% and 9% for overlooked and identified tumours, respectively) were substantial, they did not reach statistical significance. There are no features in the original tumour or the patient to anticipate the failure of ultrasound monitoring. Multiple and/or small relapses are overlooked more frequently that single and/or large ones, and tumours located in lateral walls, base and dome may be unnoticed. In spite of oversights, alternate ultrasound/cystoscopic monitoring does not compromise the outcome of the disease.

Aged↗

PubMed1997

[Analysis of the reliability of ultrasonic estimates of the posturination+ residue].

OBJECTIVES: The most precise procedure for the measurement of residual urine volume is bladder catheterization; nevertheless, it takes real associated morbidity. Our objective is to define the accuracy of bladder ultrasonography when residual volume estimation is performed. METHODS: Thirty patients were studied. Ultrasound estimation of residual volume was undertaken with Simpson's method V = (pi/6) x L x T x AP. Obtained values were contrasted with the post-catheterization registered ones. RESULTS: The mean ultrasound estimated residual urine volume was 82.1 ml., versus 156.5 after catheterization. The mean difference was 74.4 ml. (significant, p < 0.001). Correlation coefficient was 0.93. Regression equation was calculated, a well as the corrected formula that, according to the outputs of our study, offers greater reliability in the estimate of the aforementioned volume. Ultrasound sensitivity when proper estimation of volumes equal or greater to 100 cc. is carried out was only 47%, opposite to the elevated specificity (100%) for this purpose. CONCLUSIONS: Transabdominal ultrasound underestimates, to a large extent, the values of residual urine volume. We consider that ultrasound estimation of residual volume constitutes an alternative to be kept in mind; nevertheless, the formula to calculate this volume through bladder diameters introduces an important error and so, it should be corrected.

Adult↗

PubMed1997

[Renal hematoma as a result of internal ureteral catheterization].

INTRODUCTION AND OBJECTIVE: Urinary catheterization by means of an internal ureteral catheter in an usual procedure that may present complications. In this article we presented a case of perforation and later renal subcapsular hematoma after the placement of a "double-J" catheter. CONCLUSIONS: This complication, although rare, should be kept in mind. The manner of avoiding it is to maintain the tightness of the guidewire while inserting the ureteral catheter. Usually, the consequences are not life-threatening and are solved with conservative treatment. The administration of LFRE should be delayed until the resolution of the hematoma.

Adult↗

PubMed1997

[Antimicrobial prophylaxis in urology].

UNLABELLED: Antimicrobial prophylaxis in surgery has proven to be effective in controlled randomized trials. Usage in Urology is known at least since the '30s although its effectiveness has only become known since 1979. METHODS: Review of literature related to surgical antibiotic prophylaxis, more specifically urological surgery, basically from 1991 to 1995, but without overlooking those papers that have become classics due to their impact. RESULTS AND CONCLUSIONS: Efficacy of antimicrobial prophylaxis in urological surgery is nowadays beyond all doubt. Usage is indicated in the presence of sterile urine and dosage must be short, in single dosis in the immediate pre-operative or within 24 hours after the procedure. However, there is a number of issues that deserve to be treated in more detail for better understanding. Those are the establishment of adequate prophylactic regimes in renal transplantation and the use of antimicrobials based on their pharmacokinetic characteristics to optimize the prophylactic purpose.

Anti-Bacterial Agents↗

PubMed1996

[Erectile dysfunction: clinical course with intracavernous PGE1].

OBJECTIVES: The results achieved with PGE1 therapy in 66 patients with erectile dysfunction in our self-injection program are presented. METHODS: Patients with severe conditions (cancer, infectious disease, renal and hepatic failure, etc.), psychological or hormonal disorders were discarded from the study. All patients were tested with PGE1, the dose was adjusted according to individual response, the patient was instructed how to inject the vasoactive drug and included in the self-injection program. Statistical analysis of the data was performed using the chi-square and the Student 't' test. RESULTS: The mean follow-up was 9.8 months (range 1-39). Twenty-five patients (37%) withdrew from the program. Six patients (9%) received another treatment due to pain or poor response. A penile prosthesis was implanted in five patients and one patient was treated with a vacuum erection device. Although not statistically significant, local pain was associated with a shorter follow-up. Prolonged erection was also observed but did not influence the length of follow-up. CONCLUSIONS: Local pain has been associated with a shorter follow-up. A small number of non-responders warranted another therapy.

Alprostadil↗

PubMed1995

[Transrectal ultrasonography technique in stress urinary incontinence in women].

OBJECTIVES: This study describes the use of transrectal ultrasound as an alternative to cystography in the assessment of female stress urinary incontinence. The procedure and the different parameters that must be evaluated are also described herein. METHODS: The patients were evaluated in the standing position and saggital sections were obtained with a transrectal transducer. The bladder was filled with saline and the test was done at rest using the Valsalva maneuver with or without a bladder catheter. RESULTS: In these patients with female stress urinary incontinence, bladder neck movement was dorsal and caudad, the most important observation being bladder neck descent. Furthermore, we found an increased posterior urethrovesical angle. CONCLUSIONS: Transrectal US is an alternative imaging technique in the assessment of patients with stress urinary incontinence that is easy to learn and avoids exposure of the patients to radiation.

Female↗

PubMed1995

[Basic ideas on the diagnosis and treatment of burns of the male genitalia].

OBJECTIVES: The main characteristics of burn injuries of the male genitalia and the basic principles of treatment are described. METHODS/RESULTS: Of 77 patients in the Burns Unit of this hospital, 7 (9%) had lesions to the external genitalia. Four of these patients had superficial dermal (grade IIA), 2 had deep dermal (grade IIB) and one had total dermal or subdermal burn injuries (grade III-IV) to the genitalia. The superficial lesions were treated medically and deep burns required surgery. RESULTS: At one-year follow-up, no functional sequelae were observed except in the patient with total dermal burn injuries, who developed right testicular atrophy and azoospermia, but preserved erection and ejaculation. CONCLUSIONS: Burn injuries to the external genitalia are uncommon. These lesions do not often require surgical treatment, and usually heal spontaneously. Despite their dramatic appearance, cure with no cosmetic or functional sequelae is often the rule.

Adult↗

PubMed1995

[The relationship of PSA to age and prostatic volume in patients with benign prostatic hypertrophy].

Prostate specific antigen (PSA) is the most useful market for the diagnosis, staging and monitoring of prostate cancer. However, the effect of benign prostate hyperplasia on PSA levels is less well known. It has been reported that 20-45% of all adult males with BPH have PSA values over the normal range. To study this confounding factor we have analyzed the likely relationships between monoclonal PSA, age and prostate size as determined by ultrasound, in our series of 163 patients with BPH undergoing adenomectomy. Within the studied factors, the most conditioning parameter of PSA variability was prostate size. The correlation coefficient (r) was 0.61, with the determination coefficient (r2) being 0.037 (p < 0.001). Age correlation, although less important (r = 0.31), was statistically significant. Both variables were independent and resulted jointly in a correlation coefficient of 0.64. Also included is the mathematical formula used in our series to correlate PSA with age and prostate volume. Its application could mean an increased specificity of this tumoral marker.

Aged↗

PubMed1995

[Estimate of creatinine clearance with formulae: a valid option compared with conventional measurement?].

Determination of creatinine clearance is the most commonly used method to evaluate renal function, requiring collection of urine from a given period of time, usually 24 hours. Cockcroft and Gault developed a formula to estimate this parameter without urine samples, however some authors have shown the low reliability of this and similar nomograms. The present study is an attempt to evaluate the differences between the laboratory determination of this parameter and its evaluation using Cockcroft's equation. The study included 24 patients who had creatinine clearance determined through biochemical methods and with the formula proposed by Cockcroft. Mean clearance in the first instance was 81.4 mL/min and 65.5 mL/min in the second one. The estimated mean difference in creatinine clearance obtained by both methods was 16.4 mL/min. A significant difference between clearance determinations was found using the above methods and therefore it is concluded that the values obtained with Cockcroft's formula are hardly reliable since the method tends to subestimate creatinine clearance. Also, two new formulas were developed which correlate better with the results obtained in our series. To conclude, we recommend that creatinine clearance should be measured at the laboratory using serum and 24-hour creatinine determination.

Adult↗

PubMed1994

[Recurrent retroperitoneal malignant fibrous histiocytoma of myxoid type with mesocolon infiltration].

Malignant fibrous histiocytoma is an uncommon soft tissue sarcoma. If located in the retroperitoneum, abdominal pain is the predominant clinical feature. Like all primary tumors in this area, it is difficult to diagnosis early. A case of malignant myxoid retroperitoneal fibrous histiocytoma is described. Six years after it had been resected, the tumor recurred and infiltrated the mesocolon. The patient was submitted to intestinal resection. Although this tumor type carries a poor prognosis, patient survival is longer and there are less metastases.

Female↗

PubMed1994

["Supreme" dressing in the prevention of hematoma and edema in scrotal surgery].

An efficient compression can reduce the complications of an inadequate hemostasis following scrotal surgery. The main difference between the "sumo" and previously described compressive methods lies in the use of both pelvic brims as main loading points for the dressing. Similar features are provided by standard scrotal supports but the compression they are able to achieve is minimal compared to that of "sumo" dressing.

Bandages↗

PubMed1993

[Eosinophilic cystitis].

We report two cases of eosinophilic cystitis that had been diagnosed anatomo-pathologically after TUR. These patients had a previous history of low grade and stage superficial bladder tumor that had been treated by intravesical interferon after surgery. The literature is reviewed highlighting the etiopathogenic aspects, the possible relationship with immune allergic factors, clinical aspects, diagnosis and treatment.

Aged↗

PubMed1993

[True post-micturition urinary incontinence of the male].

Herein we describe 3 cases of male urinary incontinence that had consulted for intense dribbling at the end of voiding. The urodynamic study identified the true postmicturition urinary incontinence in the male, whose origin was ascribed to alterations in the terminal phase of voiding, arising from localized disorders in the posterior or anterior urethra. The major significance of the true postmicturition urinary incontinence in the male lies in the need to distinguish it from other types of urinary incontinence with more clinical importance.

Adult↗

PubMed1992

[Renal injury on a pathological kidney. Incidence, management, and results of treatment].

The present study reports our experience in the management of 13 patients with trauma to previously asymptomatic pathological kidney (11.6% of 112 cases of renal trauma treated over the period 1980-1990). The diagnostic difficulties and treatments, which are unlike those of trauma to normal kidney, are discussed and the literature reviewed. Hydronephrosis from ureteropelvic junction stenosis was the preexisting pathology that was frequently diagnosed (41.6%), followed by trauma to kidney with tumor (30.7%). Twelve (92%) patients underwent surgery: 2 (15.3%) were emergency and the rest were elective surgery. One patient with hilar sinus cysts received medical treatment. Conservative surgery was performed in 5 renal units (1 with bilateral involvement) and nephrectomy was performed in 8 patients (65.1%). The kidney with a tumor is more compromised by the renal injury. Furthermore, post trauma contusion/laceration of the tumor may present problems relative to tumor stage.

Adenocarcinoma↗

PubMed1991

[Spinal cord compression by epidural metastases of urologic tumors].

We report our experience of 5 consecutive cases of acute spinal cord compression from epidural metastasis of genitourinary tumors seen over a period of 14 months. Three patients developed paraplegia and the remaining two patients developed paraparesis of the lower extremities. Four patients underwent emergency decompression laminectomy and the remaining patient received spot radiotherapy to the metastatic vertebral lesion. The degree of neurologic deterioration and its rapid progression to the more severe forms have significantly influenced patient quality of life and survival. The literature is reviewed highlighting the epidemiological, physiopathological, clinical, diagnostic and therapeutic aspects of this condition.

Adenocarcinoma↗

PubMed1991

[Penile metastases. Report of 3 new cases and review of the national literature].

Penile metastasis from primary tumors at other sites are extremely rare. To our knowledge, Alonso Gorrea reported the first case in the Spanish literature in 1980. Since then, 20 cases have been reported. Three additional cases of penile metastasis from tumors at other sites are described herein. The pathogenesis, symptoms, prognosis and treatment of this tumor type are discussed.

Adenocarcinoma↗

PubMed1991

[Reliability of flowmetry as isolated urodynamic technique for the diagnosis of obstruction of the lower urinary tract in males].

A retrospective evaluation of flowmetry as single urodynamic technique in the diagnosis of lower urinary tract obstruction was performed in 130 male patients. A statistically significant difference was observed for maximum urinary flow minus mean urinary flow in the presence of obstruction. Analysis of the morphology of the flowmetry curve could orient the diagnosis of the underlying condition. Measurement of post-micturitional residual urine appears to have no statistical value. The detrusor pressure/urinary flow test continues to be the most reliable in the diagnosis of male lower urinary tract obstruction.

Adolescent↗