Biomedical subjects
Publications and source records attributed to E Maganto.
We present a case of colovesical fistula secondary to vesical gangrene. Precipitating factors were diabetes and vesical distension caused by the obstruction of an indwelling catheter. This complication is an exceptional outcome in gangrenous cystitis and it requires emergency surgical treatment.
Congenital cyst of the seminal vesicle is a rare anomaly related with developmental anomaly of the mesonephric duct that is frequently associated with unilateral malformation of the upper urinary tract. New imaging techniques (ultrasound, CT, MRI) have allowed us to rediscover and study seminal vesicle disorders and its adjacent area. These techniques have afforded a better definition of cyst characteristics, its contents and anatomic relations, thus permitting more effective surgical treatment.
To determine the efficacy of preoperative radiotherapy, we used the following index: change in the clinical relative to the pathological state. We analyzed the series of our department, which was comprised of 175 patients who had undergone radical cystectomy. The P/T ratio was obtained in 138; it dropped in 26 (19%), remained unchanged in 57 (41.3%), and increased in 55 (40%). Analysis of the disease-free interval and survival by Kaplan and Meier's method showed a significantly higher difference for the patient groups with tumor Po + P less than T and P = T than for those with P greater than T, and there were no significant differences between the Po + P less than T and P = T patient groups. However, analysis of the TLE and survival curves for group P = T by comparing the three treatment regimens utilized showed no evidence that preoperative radiotherapy prolongs both parameters. The same finding was observed for the group whose P was greater than T. Evidently, prognosis is good for the group whose P dropped. However, we do not believe that it is ascribably to the beneficial effects of radiotherapy on the tumor. We believe that this is mainly due to the fact that, by definition, patients with more aggressive tumors are excluded. In our series, P3 and P4 tumors are classed under the groups whose P is "equal to" or "greater than".
We analyzed the course of 170 patients, 136 of whom underwent bilateral lymphadenectomy. Data was obtained to define N of the TNM classification in 126 patients. The remaining patients (10 whose pathologic work-up was unavailable; 32 who did not undergo lymphadenectomy) were classified as Nx. Metastasis was diagnosed during follow-up in 60% of those with positive lymph nodes. In our view, metastasis was already present in these patients prior to the surgical procedure. The survival rate is significantly higher for the patient group without lymphatic spread compared to the group with negative lymph nodes and Nx. Evaluation of the patient group without lymphatic spread revealed a higher survivorship for those who received 2,000 rads (24%) prior to cystectomy compared to those who received 4,500 rads (17%) and those who received no irradiation (12%). However, there is a lower incidence of metastasis for the patient group submitted to surgery alone (50%) compared to those that received preoperative radiotherapy (73% and 67% for those treated with 2,000 and 4,500 rads, respectively). Furthermore, preoperative radiotherapy did not reduce the mortality rate which was 83% for those who received no radiotherapy, 73% for those who received 2,000 rads, and 75% for those who received 4,500 rads. However, it may seem contradictory that a radiation dose of 2,000 rads appears to be more effective in these patients than a dose of 4,500 rads which is theoretically closer to the ideal dose for treatment of node involvement. Patients with positive lymph nodes must be treated with chemotherapy as soon as they have recovered from the surgical procedure since 3 out of 5 patients have undetected micrometastases.
The value of urinary fibrinogen degradation products (EPD) as a biological marker of bladder cancer has been studied. An increase in FDP was found in 75% of bladder cancer patients, independent of the fact that they had active tumours or that they were disease free. A high correlation between the amount of the increase and the grade, local invasiveness, and risk of recurrence of the tumour has been established. The assessment of urinary FDP is considered as a valuable screening and follow-up test in patients with bladder neoplasms.
The evolution of 168 patients, 136 of which underwent bilateral lymphadenectomy is analyzed in this paper. In 126 cases it was possible to obtain all the data in order to define N within the T.N.M. rating. With regard to the remaining patients 10, of which we lack the anatomopathological report, and 32 which did not undergo lymphadenectomy, are included under item Nx. During follow-up, metastasis was diagnosed in 60% node-positive patients. We believe it to have been already present at the time of undergoing surgery. Survival was significantly higher in the group without node dissemination than in both negative-nodes and Nx groups. When assessing the nodular dissemination group, patients treated with 2000 rad prior to cystectomy showed higher survival rates: 36% vs 22% and 11% for groups treated with 4500 rad and no radiotherapy. respectively. Metastatic percentage, however, was lower for the group managed with surgery alone (50%) than those treated with pre-operative radiotherapy (73% and 67% with 2000 and 4500 rad, respectively), on the other side, it would seem a contradiction that a 2000 rad dosage should be more effective than a 4500 rad dosage for this group of patients, since theoretically, the latter is closer to the ideal dosage to eradicate the nodular disease. Since 3 of 5 patients have micrometastasis, which we are yet unprepared to detect, all positive-node patients should receive chemotherapy immediately after recovery from surgery.
A clinical case of a clear-cells renal tumour, located in the left kidney, with occupation of renal vein by a 7.7 cm thick tumoral thrombus, not affecting the cava vein lumen is presented. CAT and selective left renal venography were the exploratory means which provided the diagnosis. In the study of renal vein affectation by tumoral thrombus, the CAT accuracy can be equal to that of venography, the latter being indicated in dubious cases.
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In this paper, we present a case of traumatic sectioning of the isthmus in a patient with multiple injuries, suffering from a horse-shoe-shaped kidney, which is extremely rare, according to the review of the literature which we have carried out. In view of the scanty incidence of kidney fusions and the difficulty sometimes involved in classifying them and in their surgical treatment, we shortly comment on the consequences which traumatisms may have on this kind of kidney malformation.
A study is made of 15 patients with monotopic coralliform stones, suffering from simultaneous, contralateral, renoureteral lithiasis. There are certain special features in these patients which we consider to be sufficient to distinguish them as a separate group amond cases of lithiasis in general and coralliform stones in particular. The high percentage of septic complications observed in these patients demand special treatment within the field of urinary lithiasis.
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