[Giant bladder carcinosarcoma].
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Carcinosarcoma↗
Biomedical subjects
C Llorente Abarca
Publications and source records attributed to C Llorente Abarca.
[Amyloidosis secondary to xanthogranulomatous pyelonephritis: a case report and review of the literature].
Xanthogranulomatous pyelonephritis (XGP) is a rare entity characterized by the formation of inflammatory renal masses rich in macrophages loaded with lipids. It is usually secondary to repeated urinary infections and urinary obstruction due to stones, which produce slow destruction of the renal parenchyma, requiring nephrectomy. It may sometimes be associated to secondary amyloidosis that leads to the appearance of a nephrotic syndrome. We have conducted a search in the Medline database between the years 1967 and 2003 and we only found 6 cases in adults and 3 cases in pediatric patients with amyloidosis secondary to xanthogranulomatous pyelonephritis. During this same period, there are more than 570 citations that include more than 1,000 patients with isolated XGP, so that we estimate that amyloidosis that complicates a XGP should be less than 1% of all the XGP cases. We present a case of XGP in a 51 year old female patient associated to amyloidosis that initiated with nephrotic syndrome, analyzing the clinical characteristics of the 9 previous cases. We compared their clinical characteristics with those of 51 patients with xanthogranulomatous pyelonephritis without amyloidosis of a large classical series in order to characterize this clinical picture better.
Amyloidosis↗
[Proceedings in the implantation of a laparoscopic radical prostatectomy program].
OBJECTIVE: To describe our proceedings in the implatation of our laparoscopic radical prostatectomy program (LRP). METHODS: Our working agenda and step-oriented implementation of our LRP program are shown. RESULTS: Four main steps were scheduled to acomplish this goal. These were: Preparatory phase, programed open conversion, development and analysis. Overlapping of each of these phase occured although their major content run on a time-basis. After basic skills acquisition and updating of our equipment we moved into the fixed-time open conversion we allowed us to progresively improve our performance without putting our patients into risks. Operative time of this phase exceeds that of our open cases in 63 minutes and no major complications took place. A rapid decrease in the operative time was noted after the first 15 cases (197' vs 264'). CONCLUSION: Implantation of a program of LRP can be done safely with a pre-planned program tailored to the needs and characteristics of each group and institution.
Humans↗
[Giant renal oncocytoma].
Renal oncocytoma is a benign neoplasms arising from cells of the distal renal tubule. They acount for 3-7% of all renal tumors. most are incidental findings. Differential diagnosis with renal cells carcinoma is often difficult. Here we report a case of big renal oncocytoma as an incidental finding while performing an abdominal ultrasound in a patient with low abdominal pain. We also review the diagnostic an therapeutic approach in this kind of malignancies.
Adenoma, Oxyphilic↗
[Treatment with sildenafil of cold glands syndrome after inflatable penile prosthesis].
OBJECTIVE: To evaluate the effect of sildenafil on the response of glans penis during sexual intercourse in patients with penile prosthesis who show cold glans syndrome symptoms. MATERIAL AND METHODS: Fourteen patients who had undergone three-piece inflatable penile prosthesis implantation were evaluated. In spite of the normal functioning of the device all of them complained of a degree of dissatisfaction during SI due to a lack of engorgement in the glans penis. The patients were advised to have a dose of 100 mg VO sildenafil about 45 minutes before activating the PP and starting SI. All of them followed this scheme at least three times. They ticked questions 7, 8, 13 and 14 of the International Index of Erectile Function (IIEF) questionnaire with/without having had sildenafil. RESULTS: Twelve out of thirteen patients (85.7%) indicated a more pleasant SI on sildenafil. It was related to an increase in penile glans engorgement and sensitivity. The scores obtained in the IIEF questions showed a significant increase on taking sildenafil. The partners also talked of a more comfortable SI that they related to a less painful penetration. Sildenafil-related morbidity was not found. CONCLUSIONS: Sildenafil could be used to improve functional results of the penile prosthesis in those patients with CGS and seems to increase satisfaction during SI.
Body Temperature↗
[The prostate cancer in the community of Madrid in 2000 I.- Incidence].
OBJECTIVE: To know the incidence in the year 2000 of prostate cancer in the Autonomous Community of Madrid and its breakdown by Health Areas. MATERIAL AND METHOD: Study of histologically confirmed prostate cancer case reports and retrospective data acquisition for 2000 in the Autonomous Community of Madrid, both from Public and Private Health Care hospitals. RESULTS: Gross incidence of prostate cancer in the Autonomous Community of Madrid was 100.4 cases per 100,000 males. The incidence adjusted for the Spanish, European and Worldwide population was 120.1, 103.5 and 68.6 cases per 100,000 males, respectively. Mean age at diagnosis was 70 +/- 7.8 (40-94) years, median of 70 years. The age group with higher incidence was 70 to 79 years. CONCLUSIONS: The incidence of prostate cancer in the Autonomous Community of Madrid is lower than that in the US but higher than in most countries or regions in the EU. The different way of using PSA testing in the Health Areas of the Autonomous Community may explain the differences seen in terms of incidence by Area.
Adult↗
[The prostate cancer in the community of Madrid in 2000. II Presentation and diagnosis].
OBJECTIVE: To know the presentation form, diagnostic method and clinical stage at the time of diagnosis in subjects with prostate cancer (PC) in the Autonomous Community of Madrid in 2000. MATERIAL AND METHOD: Data from 1745 patients with histologically confirmed prostate cancer obtained from 15 Hospitals participating in the study was analysed. The variables studied were: associated disease, reason for visiting the hospital, digital rectal examination (DRE), PSA, diagnostic method, graded Gleason score, tests performed in the tumoral extension study and tumour staging. The qualitative variables are given in percentages of the overall number and the quantitative variables are expressed as the median, standard deviation, maximum and minimum values and 25%, 50% (median) and 75% percentiles. RESULTS: 67% cases had an associated disease. In most (75%) patients the reason for visiting the hospital was prostatic syndrome. DRE revealed that 42.7% has no tumour. At the time of diagnosis half the patients had PSA levels lower than or equal to 11 ng/ml. Transrectal ultrasound-guided biopsy was used for diagnosis in 93% subjects. The most commonly reported Gleason scores were 6 (31.3%) and 7 (28.7%). In 75% subjects the disease was considered to be clinically limited to the prostate, in 12.5% locally advanced and in 12.5% metastatic. CONCLUSIONS: Most patients came to the hospital because of symptoms not related to PC. Transrectal ultrasound-guided biopsy is confirmed as the choice technique for PC diagnosis. When a comparison is made to historical series in our Autonomous Community a pattern of earlier diagnosis can be seen.
Adult↗
[Prostate cancer in the Community of Madrid in the year 2000. III. Study of tumor extent].
OBJECTIVE: To identify a potential relationship between two variables, risk of metastasis and use of imaging techniques, in an extension study in prostate cancer patients diagnosed in the Autonomous Community of Madrid in 2000. MATERIAL AND METHODS: 1,127 patients with available data on the tumour extension study were analysed. Performance and non performance of bone scans and CTs were correlated to risk variables for developing metastasis as described in the literature (PSA, Gleason and stage) and to therapy administered. RESULTS: The proportion of patients with risk variables for metastasis when bone scans were performed was between 7% to 14% greater than in patients with no variables. No differences were seen for CTs based on risk variables. With matching risk variables, more imaging techniques were used in patients receiving radiotherapy that in those managed with prostatectomy. CONCLUSION: Based on current recommendations imaging techniques were used in excess in the extension study in patients with no risk variables for metastasis. Conduct of a further study in the Autonomous Community seems advisable to confirm the likelihood of implementing such recommendations considering our prevalence of metastatic disease.
Adenocarcinoma↗
[Prostate cancer in the Community of Madrid in the year 2000. IV. Treatment].
OBJECTIVE: To know the therapeutic options used in patients diagnosed with prostate cancer in the Autonomous Community of Madrid in 2000. MATERIAL AND METHODS: The study was conducted on 1,745 patients referred by hospitals taking part in the study. Data on treatment used was available for 1,104 (63%) patients. Treatment modality was correlated to clinical stage and patient age. RESULTS: Most frequent choice was hormone therapy (35%) followed by radical prostatectomy (34%) and radiotherapy (25%). Prostatectomy was most commonly used in patients with localised (42.3%) disease while hormone therapy was preferred for locally advanced (45.6%) or disseminated (94%) disease. There are significant differences in therapeutic indications between the various Health areas participating in the survey. Median age of patients with localised and locally advanced disease was lower in patients managed with prostatectomy (65 and 64 years, respectively) than in those managed with radiotherapy (70 and 69 years, respectively). CONCLUSION: The therapeutic modality indicated by urologists in the Madrid Autonomous Community for managing patients with prostate cancer generally meets with literature recommendations.
Adenocarcinoma↗
[Computer-controlled isolated kidney hypothermic perfusion system].
OBJECTIVE: To evaluate at the laboratory a self-designed computer-controlled kidney perfusion system. A vacuum powered tubular pump with active valves developed by our group is used. This pump is able to produce a flow and pressure patterns very similar to the pulse wave in the human circulatory system. BASIC PROCEDURES: This is an experimental study performed with mini-pig kidneys. After transperitoneal bilateral nephrectomy, both organs are sorted either to immediate perfusion or to perfusion after a period of 24 hours of cold storage in Eurocollins solution. The system is able to record continuously perfusion pressure, flow and intrarenal resistance. RESULTS: A progressive decrease in renal vascular resistance along with an increase in the flow value were observed during the procedures. These dynamic changes become evident both in immediate and deferred renal perfusions. CONCLUSIONS: Computer-controlled kidney perfusion system provide us the opportunity of recording in real time renal microcirculatory state modifications during a perfusion. Vascular system seems to be actively modified by the perfusion. This fact should be researched in the next future.
Animals↗
[Hydrodynamic and biochemical effects of hypothermic perfusion of isolated kidney according to the type of pump].
OBJECTIVE: To study on isolated kidney perfusions by means of a self-designed computer-controlled organ perfusion system the hydrodynamic and biochemical effects of two types of pumps: a self-designed vacuum powered tubular pump and a classical roller pump. BASIC PROCEDURES: Experimental study performed on 12 right mini-pig kidneys. After transperitoneal bilateral nephrectomy, organs are perfused with Eurocollins solution in a randomised manner with one type of pump. The system records continuously perfusion pressure, flow and renal resistance. RESULTS: Medium renal vascular resistance was significantly lower in vacuum powered tubular pump perfusions. LDH level in the solution showed correlation with perfusion flow. CONCLUSIONS: Vacuum powered tubular pump increases renal flow and lowers renal vascular resistance significantly in comparison to roller pump. LDH level in the solution is related to good-quality hydrodynamic perfusion parameter values.
Animals↗
[A diagnostic algorithm based on transrectal echography in failure of surgery correcting stress urinary incontinence].
Transrectal ultrasound is a dynamic imaging diagnostic technique for the study of stress urinary incontinence (SUI). The highest efficiency is obtained in the study of failed corrective surgery of SUI. Our group studied 23 patients reporting clinical SUI after undergoing corrective surgery, 23.3% patients with transrectal ultrasound showed no condition that could justify it (bladder neck hypermobility, intrinsic sphincteral incompetence, calcification of suspension threads, urethra diverticulum...); 34.8% showed bladder neck hypermobility, indicative of failed corrective surgery; 34.8% showed presence of open urethra at rest, an echographic sign of intrinsic sphincteral incompetence; and in 4.3% cases the existence of intravesical calcifications of the suspension threads was diagnosed. Transrectal ultrasound can become the choice test to perform in this group of patients, leading to the performance of other diagnostic tests and offering an adequate customized solution for each patient's problem.
Algorithms↗
[Prostatic adenocarcinoma associated with incidental intestinal carcinoid].
The association of a carcinoid tumour with non-endocrine urologic neoplasms is an infrequent finding. This paper contributes one case of multiple primary neoplasm where a prostatic adenocarcinoma coexists with an intestinal carcinoid tumour in a 63-year old asymptomatic patient. Diagnosis of prostate cancer was achieved during a screening for this conditions whereas the intestinal carcinoid tumour was found in the extension study.
Adenocarcinoma↗
[A bladder nephrogenic adenoma. A case report].
OBJECTIVE: To report an additional case of nephrogenic adenoma of the bladder. METHODS/RESULTS: A case of nephrogenic adenoma of the urinary bladder in a 28-year-old female is described. Patient clinical history and diagnostic imaging findings are presented. CONCLUSIONS: Nephrogenic adenoma of the bladder is a rare benign tumor with specific histological features that has been associated with previous surgery, trauma, infections and lithiasis. Although it is currently not considered to be a premalignant lesion, its rate of recurrence is high (37%-49%). The treatment of choice is by transurethral resection and yearly cytological, ultrasound and cystoscopic follow-up evaluation to detect recurrence.
Adenoma↗
[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↗
[Analysis of prognostic factors in superficial bladder tumors].
OBJECTIVE: When the traditional prognostic factors (tumor grade, stage, size, number and cytological findings) are used as guidelines for intravesical therapy of superficial bladder tumors and the reported results are compared, it is not uncommon to find unexplainable differences. This study was conducted to determine the prognostic factors for tumor recurrence and progression before instituting any type of adjuvant therapy for superficial bladder tumors. METHODS: 81 consecutive patients with primary superficial bladder cancer (stage Ta-T1, grade 1-3) were entered into a surveillance protocol and controlled for a mean period of 14 months (range 3-44). Patient individual features (sex and age) and tumor characteristics (grade, stage, size, number, cytological findings) were analyzed to determine the risk of tumor recurrence and/or progression. RESULTS: Logistic regression analysis identified age as the only independent prognostic factor for recurrence, which was 6.37 fold (2-42) more frequent for subjects aged 65 years or older. Given the low progression rate (3 cases; 4.8%), a formal risk analysis could not be performed. CONCLUSION: The factors used to predict recurrence (tumor grade, stage, size, number and cytological findings) were not found to be independent in the present series. Certain predictors of tumor aggressiveness-such as age-, which could modify tumor biology, were found to predispose to tumor recurrence.
Adult↗
[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↗
[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↗