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Biomedical subjects

A Sousa Escandón

Publications and source records attributed to A Sousa Escandón.

At least 19 recordsLinked to original sources
PubMed2002

[Massive bilateral adrenal hemorrhage after conservative tumor surgery in the isthmus of a horseshoe kidney].

OBJECTIVE: To present a fatal case of massive bilateral suprarrenal haemorrhage (MBSH) after partial nephrectomy. CLINICAL CASE: An 82 year old male treated with oral anticoagulants was diagnosed by means of CT scan and arteriography of having an avascular tumor located at the isthmus of a horseshoe kidney. A tumorectomy with safety surgical margins was performed; It was diagnosed of having a renal adenocarcinoma, which was almost completely necrotic. During the postoperative period, the patient presented abdominal pain, nausea, fever, hypotension and severe respiratory distress. Biochemical studies showed mild hyponatremia and azotemia, accompanied by anemia, leucocytosis and thrombocytosis. An abdominal CT scan demonstrated a MBSH, which produced the patients death soon afterwards. DISCUSSION: Tumoral pathology of horseshoe kidneys presents important topographic and anatomopathologic differences with respect to non-fused kidneys. MBSH is a rare complication of many stress processes especially if an anticoagulant treatment coexists. The treatment has to be initiated as soon as we suspect MBSH, which should be confirmed by hormonal determinations and/or the presence of hyperdense suprarenal lesions at the CT scan.

Adenocarcinoma↗
PubMed2000

Unusual retrovesical masses in men.

Retrovesical masses in men not related to prostatic carcinoma or hyperplasia is an uncommon pathology. Rare masses or unusual manifestations of those common diseases are a diagnostic dilemma. We review our experience in three unusual retrovesical masses in men: carcinosarcoma filling a giant bladder diverticulum; cystic prostatic carcinoma; and acquired cystic dilatation of the seminal vesicle associated with a prostatic carcinoma that obstructed and invaded the vesicle. We report the imaging findings and review the literature. In our experience, the imaging findings are usually not specific for doing a precise diagnosis and biopsy procedures are necessary.

Aged↗
PubMed2000

[Mucinous carcinoma of the prostate: critical review of Elbadawi's criteria].

OBJECTIVES: We present our experience on prostatic mucinous adenocarcinoma and at once we practice an actualization and a critical review of Elbadawi's criteria. METHODS: After reviewing 206 prostatic carcinomas diagnosed in our hospital, we describe one case that fulfill criteria for being considered a prostatic mucinous adenocarcinoma. We also carry out a wide literature review trying to define anew the including criteria of this tumour by the light of modern knowledge and technology. CONCLUSIONS: We think that for accepting a tumour as a prostatic mucinous adenocarcinoma, this have to fulfill the following criteria: 1. "More than 25% of a significative tumoral sample is mucinous pattern and present, single or clustered, tumour cells floating in immunohistochemically probed, acidic and neutral, mucin lakes". 2. "Tumour is Gleason 3-4 cribiform pattern with direct transition to colloid areas and usually coexist with classic adenocarcinoma but papillary growth patterns should be excluded. Tumour may contain a moderate proportion of signet-ring cells". 3. "Immunohistochemical staining for PSA have to be strongly positive in both, cribiform and mucinous, areas". 4. "Those PSA nonreactive, or only focally positive, mucinous adenocarcinomas, could be labeled as prostatic only when local or distant mucinous carcinomas are ruled out".

Adenocarcinoma, Mucinous↗
PubMed2000

Carcinosarcoma in a bladder diverticulum. A case report and literature review.

Carcinosarcoma of the bladder is a rare neoplasm composed of a mixture of malignant epithelial and mesenchymal components. The presentation and clinical course of an infiltrating carcinosarcoma located in a bladder diverticulum coexisting with prostatic adenocarcinoma in a 69-year-old man are described. We believe this to be the fifth report of true carcinosarcoma appearing in a bladder diverticulum.

Adenocarcinoma↗
PubMed1999

[Inguinal bladder hernia in the adult].

OBJECTIVE: To describe four additional cases of adult inguinal bladder hernia. METHODS: From 1986 to 1998, four cases of bladder inguinal herniation were diagnosed at our services. The etiology, diagnosis, treatment, associated conditions and complications are presented. RESULTS: Two cases had resulted from benign prostatic hyperplasia; one underwent TUR and the other was treated with alpha-blockers. The remaining two cases were due to prostatic carcinoma and were treated with hormone therapy. The bladder hernia was surgically repaired in three cases; the last patient refused surgery. CONCLUSIONS: A bladder hernia that is incidentally discovered during herniorrhaphy can be resolved without difficulty. However, problems may arise when an unsuspected bladder hernia is undetected due to preoperative bladder emptying and is included in the sutures of herniorrhaphy. When important bladder hernias are diagnosed preoperatively, surgical resolution is always indicated, as well as treatment by surgery or drugs of the urinary obstruction that contributed to the condition.

Aged↗
PubMed1999

[Artificial sphincter implantation in women with urinary incontinence using a combined abdomino-vaginal approach].

OBJECTIVE: The artificial sphincter has been utilized for urinary incontinence due to intrinsic sphincteric insufficiency, with good fixation of the urethra and a maximum urethral closing pressure of 20-30 cms H2O, or after failed attempts at correction using other techniques. This procedure is difficult to perform since the patients have generally undergone several operations and it is necessity to prepare the cleavage between the urethra and vagina. We propose a modified combined vaginal and suprapubic approach of the technique described by Appell and Abbassian in 1988 for enhanced exposure of the urethra and bladder neck and easy access. METHODS: The modified combined abdominovaginal approach has been utilized in 18 females aged 16-62 years since 1995. RESULTS: 16 patients were continent (88%). One patient (5.5%) required removal of the artificial sphincter due to infection. Another patient (5.5%) has mild incontinence and requires 2 pads a day. Four patients (22%) with detrusor instability are receiving anticholinergics. Three patients (16%) with an underlying neurogenic incontinence require intermittent catheterization. Fourteen patients (77.7%) have type III stress urinary incontinence. We performed the Kelly procedure in 10 patients (55.5%), the Marshall-Marcetti-Kranz in 7 (38.8%), Gittes in 3 (16.6%), and 2 patients (11.1%) had a sling procedure. Two techniques were simultaneously performed in some patients. CONCLUSIONS: Although the number of patients in this series is small, the fact that only one case required removal of the artificial spincter due to infection indicates that this is a useful alternative approach that significantly facilitates implantation of the artificial sphincter in these patients.

Abdomen↗
PubMed1992

[Calcified bladder oat cell associated with hypercalcemia and hypophosphoremia].

Description of a 69-year old male patient presenting calcified vesical tumour which, following a pathoanatomical study was shown to be an non-differentiated oat cell carcinoma associated to transitional carcinoma and adenocarcinoma. Biochemically it presented hypercalcemia and hypophosphoremia and the electron microscope study demonstrated the presence of neurosecretion granules. The immunohistochemical techniques were negative for protein S-100 and cytokeratins, but positive for the membrane epithelial antigen and the neuro-specific enolase. The patient was treated by transurethral resection and polychemotherapy, presenting an initially favourable response but dying 18 months later after widespread metastasis. These data are in agreement with those obtained from the literature review carried out with regard to clinical picture, pathoanatomical studies, aggressiveness and overall poor prognosis with this type of tumours. In our view, the tumour's mixed composition supports an origin of pluripotential cell (steam cell). Presence of neuroendocrine syndromes associated to oat cell vesical tumours is an unusual fact related to the tumour's hormonal secretion.

Adenocarcinoma↗
PubMed1992

[Idiopathic retroperitoneal fibrosis: combined steroid and endourologic treatment].

Review of 7 patients with idiopathic retroperitoneal fibrosis (IRF), treated with a combination of corticosteroids (6-methyl-prednisolone) and endourological procedures. The presentation symptom was lumbar pain in all 7 cases. Mean creatinine (Cr) levels were 5.4 mg/dl, with mean erythrocyte sedimentation rate (ESR) of 114. Three (43%) patients were positive to rheumatoid factor (RF) and had raised IgG. Definite diagnosis was achieved in all cases by CAT, including puncture biopsy in 1; all 7 (100%) cases were bilateral. With an average follow-up of 3 years, clinical evolution is satisfactory in all 7 cases. Mean control Cr is 1.2 mg/dl and mean ESR 19. CAT showed disappearance of fibrotic plaque in all cases. One patient relapsed when maintenance therapy was discontinued but responded again to a new therapy course. No steroid therapy-related complications were seen. The association of conservative steroid therapy and endourological procedures is a very low morbidity, sensible alternative in the management of benign retroperitoneal fibrosis where CAT and MNR are the primary diagnostic techniques.

Adult↗
PubMed1992

[A late lymphocele in a kidney transplant].

We report a case of peritransplant lymphocele that developed 11 years after the patient received the first renal graft. Initially, treatment was by percutaneous punction-aspiration and povidone-iodine sclerosis. The important (congruent to 3 liters/day) persistent fluid collection prompted us to resort to surgery (marsupialization) which achieved good results.

Adult↗
PubMed1991

Endoscopic treatment of vesicoureteral reflux following transurethral resection of a vesical carcinoma by Teflon injection.

We have treated 33 patients who presented with reflux in 40 ureters following transurethral resection (TUR) for bladder cancer. One or two injections of Teflon were made under the submucosal intramural ureter. Among the 32 ureters that could be correctly evaluated, we observed that vesicoureteral reflux disappeared in 18 (56.3%), and decreased the grade of reflux in 5 (15.6%). There were no modifications in the 9 remaining ureteral units (28.1%). Control urogram and/or sonogram scan were performed in all cases and demonstrating the absence of obstructive uropathy.

Adult↗
PubMed1990

[Diffuse capillary hemangioma of the bladder].

Hemangioma of the bladder is an uncommon, benign vascular tumor. To date, less than 100 cases have been reported in the literature. A case of diffuse capillary hemangioma involving the entire bladder is described herein. The patient had previously received radiotherapy and the condition developed into severe bladder retraction with massive vesicoureteric reflux. The patient underwent cystectomy preserving the prostate and seminal vesicles and an ileal neobladder was created using a segment of the sigmoid colon. A follow-up of more than 4 years evidenced good results. The literature is reviewed highlighting the diagnostic and therapeutic aspects of this condition.

Adult↗
PubMed1989

[Agenesis of the gallbladder. Statistic review of the Spanish literature and presentation of a new case].

Agenesis of the gallbladder and of the cystic duct is a rare anomaly of the biliary tree that courses symptomatically in one of three cases. This symptomatology can be explained in some of them only by a dyskinetic alteration of the Oddi sphincter, which would lead to long term choledochal distension with the corresponding biliary stasis and facilitate infection of the pooled bile juice, aside from possible alterations in bile composition and the choledochal mucosa. If this were the case, it could explain the mechanism of production of postcholecystectomy syndrome and residual choledochal lithiasis many years after cholecystectomy with normal peroperative cholangiography. A statistical study is made of the Spanish literature.

Epidemiology↗
PubMedDate not supplied

[Female urinary stress incontinence: transobsturator technique].

The wide use of retropubic TVT has been associated with various complications. To avoid these, alternative procedures have been developed and continence rates obtained with these new routes have been quite similar to those after classic TVT. In the transobsturator technique (TOT) described by Delorme and colleagues in 2001, the tape is inserted through the obturator foramens from outside to inside and is positioned without tension under the urethra. Another surgical technique allows the passage of a tape from inside to outside. The aim of this paper is to describe a new, simple surgical technique for the treatment of female urinary stress incontinence and to evaluate its feasibility.

Equipment Design↗