PubMed Health⌕ Search

Biomedical subjects

C D Vera Donoso

Publications and source records attributed to C D Vera Donoso.

At least 19 recordsLinked to original sources
PubMed2005

[Cell cycle and apoptosis mechanisms implicated in intravesical chemotherapy resistances in superficial bladder cancer].

It is well documented the effectiveness of intravesical chemotherapy following transurethral resection to prevent recurrences of superficial bladder cancer. But it is also known that efficacy may be limited by tumour cell resistance to one or several of the drugs available for instillation. In addition to the genetically determined unicellular mechanisms classically described in the literature such as glycoprotein P-170 expression (mdr-1), overexpression of Bcl-2 or glutation S-transferase activity, it has been recently shown that multicellular mechanisms may also be involved in drug resistance. Multicellular resistance can only be demonstrated in three-dimensional cultures and fails to be shown in monolayers or cell suspensions. This is explained by the fact that cell-to-cell and cell-to-stroma adhesion limits drug penetration and by the variable susceptibility to cytotoxicity determined by oxygen and tissue proliferation gradients. A better understanding of the molecular mechanisms involved in drug resistance is necessary to increase intravesical chemotherapy effectiveness. Current research includes improving drug penetration, searching resistance reversing agents and developing in vitro chemosensitivity tests to identify drug resistance.

Apoptosis↗
PubMed2004

[Study of the angiogenesis as prognostic factor of pT1G3 bladder tumours].

INTRODUCTION AND OBJECTIVES: Angiogenic activity has been considered like prognostic factor in several solid tumors. This activity can be analysed by two ways: immunohistochemical determination of molecules that activate/inhibit angiogenesis or quantitive measure of microvascular density (MD). Our objective is to determine the prognostic value of Vascular Endothelial Growth Factor (VEGF) and Microvascular Density (MD) in pT1G3 bladder tumours. MATERIAL AND METHODS: We have studied retrospectively 83 patients with pT1G3 tumors treated by TUR + endovesical instillations with a follow up of 3 years at least. We analysed VEGF expression monoclonal antibody No. 360P. To determine MD we have marked vessels with FVIII antibody and detected "hot spots" areas. The number of microvessels is quantited by a digital image analyser excluding those that have more than 50 micras of diameter. We established the correlation of these findings with recurrence, progression and survival by using Chi-square test and Kaplan-Meier curves (log-rank). RESULTS: Average follow up was 58 +/- 28 months. We have established like cut-off 50% of tumor cells (VEGF) and 30 microvessels/fields (MD). Chi-square test did not show correlation with survival neither recurrence but it was positive for progression p(VEGF) 0.048 and p(DM) 0.021. Kaplan Meier curves determined significative differences only for free of progression time respect to MD (p 0.038). CONCLUSIONS: We did not find statistically significant value for recurrence nor survival. Just MD reached prognostic value for progression. More studies and multivariant analysis are required to determine the clinical utility of MD, specially in order to make more aggressive therapeutic options in this kind of patients.

Follow-Up Studies↗
PubMed2001

[PSA:alpha 1-antichymotrypsin ratio/total PSA in the diagnosis of prostatic cancer in the range of total PSA from 4 to 10 ng/ml].

OBJECTIVE: To evaluate the usefulness of the ratio PSA:alpha-1-antichymotrypsin/total PSA (C/T) in the diagnosis of prostate cancer in the range of total PSA between 4 and 10 ng/mL. MATERIAL AND METHODS: By using home-made ELISAs we have determined plasmatic concentrations of total PSA and complex PSA:alpha-1-ACT in 300 patients with total PSA between 4-10 ng/mL. All samples were obtained before any manipulation that could interfere the PSA levels. RESULTS: By prostatic biopsy 85 patients (28.3%) were diagnosed of prostate cancer (CaP) and 215 (71.6%) of benign prostatic hyperplasia (BPH). The mean values of the complex PSA:alpha-1-ACT (4.2 ng/mL in the BPH patients vs 5.0 ng/mL in the CaP patients) and of the C/T ratio (0.70 vs 0.82, respectively) showed significant differences between both groups (p = < 0.0001). The total PSA did not show differences (6.1 ng/mL vs 6.0 ng/mL; p = 0.79). From all three parameter evaluated, the ratio C/T had the biggest area under the ROC (0.884) and statistically significant differences in comparison with total PSA (0.490; p = < 0.001) and the complex PSA:alpha-1-ACT (0.696: p = < 0.001). Therefore, by using a ratio C/T > 0.62 to decide the performance of a biopsy, 27% of the patients with BPH could have avoided this procedure with a 100% sensitivity. Increasing the ratio to 0.68 the specificity is 47% and the sensitivity is 95.2%. Rectal examination did not have influence on the cut-off, sensitivity, specificity and area under the ROC of the ratio C/T. CONCLUSIONS: Our results confirm that the ratio C/T improve the diagnostic capacity of the total PSA between 4-10 ng/ml. Moreover, the rectal examination does not influence the selection of ratio C/T cut-off suggestives of CaP neither the diagnostic efficacy.

Aged↗
PubMed2001

[Factors affecting the PSA:alpha 1 antichymotrypsin/total PSA ratio].

OBJECTIVES: To evaluate the influence of several factors, including age, prostate volume, total PSA (PSA-T), clinical stage and Gleason on the PSA:alpha 1ACT/PSA-T (C/T) ratio. MATERIAL AND METHODS: Using in-house assays, we measured plasma levels of PSA-T and PSA:alpha 1ACT complex in 622 patients with benign prostate hyperplasia (BPH) (455 with hystological confirmation and 167 with clinical evidence of absence of malignance) and in 255 patients with prostate cancer (CaP), and determined the correlation between different parameters. RESULTS: In BPH patients, PSA-T and PSA:alpha 1ACT significantly increased with age. There was a positive correlation between age and PSA-T (r = 0.161, p < 0.0001) and PSA:alpha 1ACT (r = 0.141, p = 0.001). In contrast, the C/T ratio remained constant and below 70% in all decades. Similar results were obtained in CaP patients. In BPH patients, there was a positive correlation between prostate volume and PSA-T and PSA:alpha 1ACT, but not with the C/T ratio. In CaP patients, however, there was a negative correlation between prostate volume and the C/T ratio. An excellent correlation was found between PSA-T and PSA:alpha 1ACT, and a good correlation between PSA-T and the C/T ratio and between PSA:alpha 1ACT and C/T ratio. A multiple regression analysis showed that, in HBP and CaP patients, PSA-T and PSA:alpha 1ACT complex were the only parameters that significantly and independently influenced the C/T ratio. CONCLUSIONS: The C/T ratio is independent of age, prostate volume, Gleason and clinical stage. Therefore, these factors need not to be considered when using the C/T ratio.

Adult↗
PubMed2000

[Primary transitional carcinoma of the prostatic ductus].

Primary prostate transitional cell carcinoma is a very rare tumour originating in the transitional epithelial cells of the intraprostate periurethral ductus. Only 17 of 829 patients diagnosed with prostate carcinoma were found to have the transitional cell variety. Eight (8) of those had pure transitional cell carcinoma and 9 a mixed presentation of acinar adenocarcinoma and transitional cell ductal carcinoma. Bladder origin of the tumour was ruled out in all cases. We report a retrospective study on the clinical behaviour of prostate transitional cell carcinoma. Compared to acinar carcinomas, few differences were found when age, symptoms, physical findings and imaging diagnosis were evaluated. Clinical presentation, DRE, PSA, metastatic spread and presence of supravesical obstructive uropathy where also studied to establish a diagnosis. Radiotherapy was the most frequently used therapeutical approach. Mean survival is 26.6 months (4-60 months) and there has been 11 death up to now. Compared to acinar forms, this tumour shows a hormone-resistant, aggressive biological behaviour with poor prognosis. Early diagnosis and radical surgery are the only options available to increase life expectancy for these patients.

Aged↗
PubMed1999

[Mucinous prostate adenocarcinoma initially presented as an intestinal subocclusive picture].

Mucinous prostate adenocarcinoma is an infrequent tumour, with no more that 50 cases described to date. This paper contributes a new case of the entity. Rather than on the rarity of the tumour, the interest in our case focuses in the unusual nature of its clinical presentation. It initially appeared as a presumable rectoanal neoplasia but the pathoanatomical examination discovered the prostatic origin of the tumoration.

Adenocarcinoma, Mucinous↗
PubMed1998

[Assessment of the tunica muscularis mucosae of the bladder wall: necropsy study].

INTRODUCTION: The bladder has traditionally been considered to lack a muscularis mucosae (MM). However in the last decade a number of studies based on biopsies or neoplastic cystectomy specimens have report the presence of a MM. Likewise, and based on the existence of such structure proposals have been made to subclassify T1 superficial bladder tumors into T1a/T1b or T1a/T1b/T1c. MATERIALS AND METHODS: A homogeneous analysis was made of the presence of a MM in 20 necropsies of fetuses and newborns of either sex, without urological pathology. Seven different locations of the bladder wall were evaluated following intracavitary formalin fixation. A total of 140 bladder locations were thus histologically evaluated. The presence of a MM was appraised according to the patterns established by Ro et al. (1987). RESULTS: A focal pattern was the most common presentation (62.14%) followed by a discontinuous pattern. In 32 of the 140 bladder locations (23.6%) no MM could be visualized. The location that most often exhibited a MM was the anterior bladder wall. No relations was observed between age or sex and the presence or absence of a MM. It is concluded that MM distribution in the bladder is heterogeneous and random, with a predominantly focal pattern. The MM structure was only detected over 7.78% of the mucosal surface of the bladder. DISCUSSION: In recent years a modification of the TNM system has been proposed, based on the presence of infiltration of the bladder MM (T1a/T1b). The results of the present study suggest that such a classification would not very realistic since the the MM is irregular in its presentation. Nevertheless, and wherever possible, that pathologist should specify the level of infiltration of superficial bladder tumors with respect to the MM, in view of the prognostic and therapeutic implications.

Cadaver↗
PubMed1995

[The evolution over time (1960-1990) of mortality and the ratio of males in bladder cancer in Spain].

A time series on the evolution of mortality and the masculinity attribute in vesical cancer in Spain (1960-1990) was prepared. The specific rates by age and sex by 100,000 inhabitants were calculated. To attain standardization the same study population was taken as the reference population. Overall mortality rates due to vesical cancer have increased progressively in a linearly ascending trend, though the slope in men is sharper that in women. The females cohort approaches that of males, but with a difference between them of 30 years. By age groups, the higher increase has occurred in those over 75-year old (113% men, 77% women). The masculinity attribute presents variations depending on the age group and decade considered (1.4-10.9). It is possible to establish three groups by masculinity attribute: 20-44 years (average 1.91), 45-69 years (average 7.8) and over 70 years (average 6.3).

Adult↗
PubMed1995

[Extracorporeal shockwave lithotripsy in single kidneys. Our experience].

Forty patients with renal lithiasis in single kidney were treated with extracorporeal shock wave lithotrity in our unit. Nine patients required emergency urinary by-pass, because of original picture of obstructive anuria, and in another 21 cases a double-J catheterism was conducted as prophylaxis prior to lithotrity. Treatment was carried out with analgesia and ambulatory, except for 10 patients with calculi of less than 10 mm where by-pass was not performed, and who were kept in preventive hospitalization for 24 hours. Average of sessions per patients was 1.59 (range 1-7). After 6 months follow-up there are 24 free renal units (60%), 12 (30%) with debris that can be expelled, failure in 4 (10%): 2 with debris that can be expelled and 2 which were not fragmented. Renal function has not deteriorated during follow-up, except for 2 patients with obstructive uropathy, that subsequently normalized following resolution of the condition. No significant differences were found in the treatment of calculi of less than 10 mm with or without double-J. ESWL is considered to be the choice approach for lithiasis in patients with one single kidney, due to is efficacy and low morbidity, safety in the ambulatory environment, even for calculi of less than 10 mm with no urinary by-pass.

Adolescent↗
PubMed1994

Spontaneous rupture of a neobladder.

The spontaneous rupture of neobladder is an extremely rare entity of which there only exists one formerly reported case in the world literature. It is far more common after enterocystoplasty for augmentation (19 reported cases). We describe here the spontaneous rupture of a neobladder 8 months after performing cystectomy and bladder replacement by an enterocystoplasty in order to treat a bladder carcinoma. In this case the patient showed symptoms and signs of acute peritonitis. The diagnosis was carried out using a cystogram and the treatment consisted of a laparotomy with closure of the perforation and drainage of the peritoneal cavity.

Carcinoma, Transitional Cell↗
PubMed1994

[Treatment of metastatic prostatic cancer with monthly injections of leuprolide acetate depot].

Seventy-two patients were admitted in a multicentre trial with the purpose of assessing the clinical efficacy and safety of the hormonal control and tolerance of leuprolide acetate in a once-a-month depot injection formulation for the treatment of disseminated prostate cancer. During a 1-year follow-up, there were ten withdrawals for different reasons. At baseline and at 6 months of treatment the following parameters were evaluated: clinical examination, routine blood analysis, PAP, PSA, LH and testosterone, as well as bone scan. LH and testosterone determinations were repeated at 2, 4, 8, 12, 16, 20 and 24 weeks. Testosterone reached castration levels within the second week and was maintained until the end of the study. In agreement with the NPCP criteria, 65 patients were assessed as: complete response 3%, partial response 40%, disease stabilization 36%, and progression 21%. In summary, a once-a-month injection of leuprolide acetate offers a safe and effective alternative to surgical castration.

Adenocarcinoma↗
PubMed1994

[Neo-adjuvant M-VAC in the treatment of infiltrating bladder tumors].

Between June 1987 and December 1990, systemic chemotherapy following an M-VAC protocol was applied to 38 patients with infiltrant vesical carcinoma (T2-T4). Eight of them (21.05%) were excluded for treatment response evaluation (four due to withdrawal and four to severe toxicity, one of whom died). Of the 30 evaluable patients, 63.3% (19 patients) showed complete response (pT0) after three complete courses of chemotherapy. Of this group, 11 have relapsed within an average interval of 21 +/- 18 months, 5 cases infiltrant (three with cystectomy) and 6 superficial. Mean survival of these 11 patients was 32.9 +/- 16.3 months. Of those showing complete response, 4 (13.3%) developed systemic tumoral progression in an average time of 12.5 +/- 4.2 months, to the point of being impossible to perform any kind of rescue surgery, with a mean survival of 13 +/- 4.5 months. In five patients, 16.6% of sample, stage at post-MVAC biopsy was lower than the initial one, requiring a new TUR (survival, 25.2 +/- -- months). Of these, 4 relapsed with 3 requiring rescue surgery. The remaining 6 patients in the sample (20%) showed no response to chemotherapy, and radical surgery was indicated which was only possible in three of them (survival, 14 +/- 6.8 months). The poor results of this series question the effectiveness of the MVAC protocol for chemotherapy in infiltrant vesical tumours. Only in low stages (T2) good results are observed, while in other cases it delays radical surgery, presumably curative if performed timely.

Aged↗
PubMed1994

[Non-specific granulomatous prostatitis. Relationship and differential diagnosis with prostatic cancer].

The unspecific granulomatous prostatitis (GP) is a rare prostate disease. Its relevance lies on the common confusion with prostate carcinoma. Review of 21 cases of unspecific GP, two of which had previously undergone transurethral resection of the prostate. Forty-eight percent of patients developed urinary tract infection prior to GP diagnosis. In 13 patients (62%), prostate carcinoma was suspected after rectal examination of the prostate and transrectal ultrasound. Diagnosis was achieved by histopathology after prostate biopsy and transurethral resection (100%). Prostate Specific Antigen (PSA) was within the normal ranges in all cases that it was performed (six), with the exception of one patient who developed prostate cancer. During follow-up, four patients developed prostate cancer (19%) with an average presentation time of 5.5 years after GP diagnosis.

Aged↗
PubMed1994

[Is radical surgery indicated in patients with infiltrating bladder carcinoma and involved regional lymph nodes?].

To evaluate the efficacy of radical vesical surgery in Infiltrant Vesical Carcinoma affecting the regional nodes, a retrospective study of a group of 75 patients who underwent radical cystectomy and lymphadenectomy was conducted. Based on the degree of node affectation patients were classified as follows: 49 pN(-) (65.3); 22 pN(+) (29.3); and 4 pN(x) (5.3) in which the pathological anatomy was inconclusive. In the pN(-) group, 8 (8.16%) died during the immediate postoperative due to surgical complications. Of the remaining 45, 5 cases were lost to follow-up; 31 (63.26%) died (all of them as a result of the tumour (M+)); whereas 9 (18.36%) are still alive and disease-free. Overall mean survival is 35.91% 10.3 months (4-65 months). Of them, 3 (13.6%) were lost while in poor performance status; 13 (59.09%) died for neoplasia-related causes (M+), and only one (4.5%) is alive and disease free. In this group, neoadjuvant chemotherapy was used in 10 cases, neoadjuvant radiotherapy in 4 and adjuvant radiotherapy in 5. Local relapse was seen in 8 (36.6%) cases. In our experience, a clear improvement in quality of live and mean survival at one year (up to 65 months) was noted in patients with Vesical Infiltrant Carcinoma and regional node affectation. Such situation encourages the use of radical surgery when faced, during surgical examination, with node infiltration by neoplastic cells.

Adult↗
PubMed1990

[Primary superficial bladder carcinoma. Prognostic factors for recurrence].

To evaluate the risk of tumor recurrence, we have studied the prognostic significance of the clinical features and chemoprophylaxis following transurethral resection (TUR) in 155 patients with primary superficial bladder carcinoma (Ta, T1, Tis). Thiotepa, adriamycin and cisplatin instillations in the bladder were utilized. The mean follow-up was 44 months (range 6-106). Considering the first tumor recurrence as an indication of failure of chemoprophylactic therapy, thiotepa was shown to afford better control. The significance of each variable (age, sex, drug, tumor stage, grade, number and size) was determined for each individual patient relative to the risk of recurrence after TUR and prophylactic treatment and the significant variables were then subjected to multivariant analyses (multiple logistic linear regression). Tumor number, stage and the drug utilized were shown to be significant prognostic factors (p = 0.04, 0.04 and 0.008, respectively). Based on the results of the multivariant analyses, mathematical models of prediction were assigned combining the more favourable individual prognostic values. The use of the mathematical models obtained to calculate the recurrence risk for each individual patient allowed us to classify these cases as being at high, medium or low risk for tumor recurrence.

Administration, Intravesical↗
PubMedDate not supplied

[Bladder cancer: general and epidemiological aspects, histopathological diagnosis, clinico-pathological classification, diagnosis of metastasis and risk groups].

Carcinoma of the bladder is the sixth most frequent tumor worldwide. It is more prevalent in the male and has been associated with exogenous triggering factors such as smoking, aromatic amines, etc. Its classification into superficial or infiltrating tumor is a simplification since there are four groups by clinical behaviour that require different therapeutic approaches. The epidemiological, clinical and pathological aspects of carcinoma of the bladder reviewed.

Aged↗