Biomedical subjects

Eduardo Espejo Maldonado

Publications and source records attributed to Eduardo Espejo Maldonado.

12 recordsLinked to original sources

PubMed2006

[Metachronous adrenal metastasis in two patients undergoing radical nephrectomy for primary renal cell carcinoma].

OBJECTIVES: We report two exceptional cases of metachronous adrenal metastasis of renal cell carcinomas and perform a bibliographic review. After the evaluation of various features such as frequency, etiopathogenesis, diagnosis and follow-up of these patients we conclude that these metastases are rare, and they usually appear late in the evolution of patients with low stage renal cell carcinoma. RESULTS/CONCLUSIONS: Once reviewed the treatment and checked the absence of guidelines for the therapeutic management of these patients we propose surgery for the adrenal metastasis as well as adjuvant treatment with immunotherapy.

Adrenal Gland Neoplasms↗

PubMed2006

[Dorsal onlay urethroplasty with foreskin mucosa free graft (Barbagli's technique): preliminary results of our case series].

OBJECTIVES: We evaluate the indication and results in the treatment of complex urethral stenosis by the Barbagli's technique. METHODS: We retrospectively review 8 patients undergoing dorsal onlay urethroplasty with foreskin mucosa free graft. We analyze their preoperative characteristics. Mean stenosis length was 6.25 cm and the site was bulbar urethra in seven cases and penile in one. Mean preoperative flow was 8.78 ml/sec. We describe the technique and present our results. RESULTS: There are 87.5% of goods results (cure of the stenosis) with 22 months of mean follow-up. Only one patient required a second operation (end to end anastomosis) with good outcome. CONCLUSIONS: The dorsal onlay urethroplasty with foreskin mucosa free graft is an effective technique in long and complex urethral stenosis, and we consider it the technique of first choice in view of our results.

Foreskin↗

PubMed2004

[Malacoplakia within a female urethral diverticulum].

OBJECTIVES: We report one case of malakoplakia within a female urethral diverticulum. METHODS: 33-year-old patient who consulted for an asymptomatic vaginal tumor. Physical examination, blood and urine analysis and microbiology tests, as well as urethrocystoscopy and intravenous pyelogram were performed. With the diagnosis of urethral diverticulum we undertook surgical excision through a vaginal approach. RESULTS: Pathology revealed the typical characteristics of malakoplakia within the diverticular lumen. CONCLUSIONS: Malakoplakia is an infrequent inflammatory disease which involves the urinary tract in most cases. Urethra location is exceptional.

Adult↗

PubMed2003

[Left adrenal carcinoma with caval thrombosis].

OBJECTIVES: To review the epidemiology, classification, prognosis, and therapeutic options of adrenal cortical carcinoma, mainly those of functional tumors. METHODS AND RESULTS: 52-year-old male presenting with wasting syndrome and a big left adrenal tumor, as well as a possible inferior vena cava thrombus. The tumor was catalogued as non functional after functional studies. Surgical intervention was carried out including adrenal tumor excision, splenectomy, and cavotomy with thrombectomy of a tumoral thrombus coming from the left adrenal and renal veins. Infrarenal iliocaval thrombosis appeared during the postoperative period, requiring intensive anticoagulant therapy and ICU admission for control. Pathological diagnosis confirmed the existence of a high grade malignant adrenal cortical carcinoma. Patient died two months after surgery due to disease progression. CONCLUSIONS: Radiological tests are fundamental in the diagnosis of adrenal masses. In the case of big tumoral masses, it is important to rule out the existence of possible tumor thrombi in the adrenal vein territory, including the inferior vena cava.

Adrenal Cortex Neoplasms↗

PubMed2003

[Testicular microlithiasis and testicular cancer].

OBJECTIVE: To check the possible relationship between testicular microlithiasis and testicular carcinoma in a patient in the one which previously we discovered a sonographic image of this condition. The etiopathogenesis, incidence and attitude are discussed. METHODS: A 23-year-old male with a psychomotor retardation secondary to a chromosomopathy presented with orchitis. Scrotal ultrasound discovered testicular microlithiasis, described as many hyperechoic images. Thirteen months later a testicular cancer was found in a new ultrasound. Radical orchiectomy was performed. Currently the patient is under intense follow-up. RESULTS: The histopathological study showed mature teratoma and intratubular germ cell neoplasm. CONCLUSIONS: The testicular microlithiasis has been related with benign and malignant testicular pathology. However, this presence it is not sufficiently clarified and the urologist's attitude to a patient with testicular microlithiasis but asymptomatic is not enough studied.

Adult↗

PubMed2003

[Acute prostatitis as the 1st symptom of brucellosis].

OBJECTIVES: To report a case of acute prostatitis as the first symptom of brucellosis. METHODS: 43-year-old patient who presented with a clinical picture of acute prostatitis and a febrile syndrome for seven days. Physical exam, blood and urine analysis and microbiological tests, and specific serologic studies were performed. RESULTS: Microbiological diagnosis was negative for bacteria, but Bengala pink (+), antibrucella serum agglutination (+) 1/320, and anti-Brucella Coombs test (+) 1/5120. Specific treatment was started with doxycyclin 100 mg b.i.d for 45 days and streptomycin 1 gr o.d for 15 days, with a positive outcome. CONCLUSIONS: The genitourinary tract is the second most frequent localization, being the testicle the most frequently affected organ, although it can also be localized in other areas of the urinary tract.

Acute Disease↗

PubMed2003

[Multicystic mesothelioma of the testicular tunica vaginalis].

OBJECTIVES: To report an exceptional case of multicystic mesothelioma of the testicular tunica vaginalis. METHODS: A 72-year-old male was referred for study of a scrotal mass. Physical examination, blood tests, and ultrasound were performed prior to surgical excision and pathologic study of the lesion. RESULTS: The ultrasound study showed a multilobar cystic lesion near the spermatic cord. Pathology reported multiple 3-4 mm cystic formations, with rudimentary papillae covered by a hyperchromatic epithelium and vimentin (+), CD 34 (+) immunophenotype. CONCLUSIONS: Multicystic mesothelioma is a rare form of mesothelioma, easy to recognize but infrequent. This tumor generally affects the peritoneal surface of the pelvis and abdomen; although other less frequent locations have been described testicular location is exceptional. We report the case of a patient presenting with a multicystic mesothelioma of the testicular tunica vaginalis and review the diagnosis, pathology and treatment options for this type of tumor.

Aged↗

PubMed2002

[Pelvic lipomatosis. Diagnostic and therapeutic considerations apropos of 3 cases].

OBJECTIVE: We report three cases of pelvic lipomatosis, and from them we discuss its diagnostic and therapeutic considerations. METHODS/RESULTS: Three patients, 71, 65 and 61 years old respectively, presented with irritative lower urinary tract symptoms. Intravenous pyelogram (IVP) and CT scan were performed as diagnostic procedures. After diagnosis an endoscopic evaluation including biopsies was performed to rule out tumours. All three underwent Bricker-Wallace II type urinary diversion resulting in good control of irritative symptoms. During follow-up one patient presented with an infiltrative bladder tumour. CONCLUSION: Pelvic lipomatosis is a rare disease; although traditionally has been considered benign it can result in urinary tract obstruction with severe physiopathological consequences. IVU and CT-scan are valuable to confirm the diagnosis. Lower urinary tract symptoms are controlled with urinary diversion without cystectomy but potential malignization of the bladder lesions should make us reconsider treatment.

Aged↗

PubMed2002

[Assessment of pelvic floor dysfunction. Terminology standardization].

OBJECTIVES: To record the findings from pelvic floor examination in an understandable way that permits the indication of a proper treatment. METHODS: We review classic classifications, as well as genital prolapse stages and degrees. We also record the POPQ examination system which is the established standard nowadays. RESULTS: Based on different classifications we intend to set up a systematic examination starting at the anterior segment, following with central and posterior compartments without forgetting pelvic floor descent, anal sphincter and pelvic floor muscles evaluation. CONCLUSIONS: The evaluation of pelvic floor defects is complex, complicating the pathologic diagnosis in order to determine the proper treatment. The various attempts to standardise classifications find problems. Nevertheless, a detailed history, a systematic examination and multidisciplinary cooperation will be able to correct this dysfunction.

Female↗

PubMed2002

[Urinary incontinence. Evaluation and classification methods].

OBJECTIVES: To evaluate different methods for clinical evaluation of female urinary incontinence. METHODS: A through bibliographic review has been carried out with special attention to the diagnostic tests of greater importance currently. Additionally we present the various female incontinence classifications. RESULTS: There is a growing interest in the use of questionnaires for subjective evaluation of symptoms. Among the objective tests for evaluation and quantification of the urine leaks the frequency/volume charts and the diaper test are very useful. Video-urodynamics and the late contributions from ultrasonography must be highlighted in the field of imaging tests. From the Urodynamics point of view, abdominal leak point pressure plays an interesting role in the diagnosis of female's urinary incontinence. CONCLUSIONS: After proper clinical evaluation, reasonable use of diagnostic tests and urologists experience will allow to set an exact diagnosis to offer the right treatment to the patients.

Female↗

PubMed2002

[Stress urinary incontinence. Integral repair of pelvic floor defects].

OBJECTIVES: To analyse the importance of complete pelvic floor defects correction at the time of female stress urinary incontinence treatment. METHODS/RESULTS: We review the basic principles in the treatment of genital prolapse. It is required to treat the anterior, central and posterior compartments. We describe the various anterior vaginal prolapse correction techniques and their basics depending on the association or not of urinary incontinence. The techniques for central compartment and posterior wall (rectocele) correction are also analysed. The recurrent vaginal dome prolapse and closure procedures are mentioned. CONCLUSIONS: We confront a multidisciplinary pathology in which urologists, gynaecologists, proctologists and pelvic floor physiotherapists can coexist and work together. Due to the variety of problems to be solved, it is necessary to standardise both the terminology and treatment, either surgical or not.

Female↗

PubMed2002

[Interstitial cystitis: update on pathogenesis, diagnosis, and treatment].

OBJECTIVES: Interstitial cystitis is a nosological entity of which many etiological, diagnostic and therapeutic features were unknown until recently, so that we had the objective to review new knowledge acquired during the last decade to offer an update in the disease. METHODS: A bibliographic review on interstitial cystitis is performed with special interest in national and international authors who have experience and large case series. RESULTS: Among the multiple etiopathogenical theories proposed in the past, the hypothesis to be highlighted, that is gaining strength, is the altered bladder urothelium permeability or hemato-urinary barrier alteration, with the aggression of toxic substances contained in urine in high concentrations like potassium. Epidemiologically, some authors think the disease is present in the population in a higher frequency than it is diagnosed, and it may be found in many women with the misdiagnosis of recurrent urinary tract infections. Regarding diagnosis, a new test is proposed to help clinical diagnosis: the potassium test, which consists in the endovesical instillation of this ion at high concentrations reproducing the symptoms. Finally, in the medical treatment it is demonstrated the efficacy of drug associations over monotheraphy (heparinoids, antihistaminic and antidepressant drugs), looking for the correction of the physiopathological abnormalities caused by the disease. Psicologic support and continuous information to the patient about the disease continue to be one of the mainstays of this multimodal therapy. New options like neural stimulation have appeared, although its results are not conclusive so that further studies must be done. CONCLUSIONS: New knowledge about interstitial cystitis allow us to better understand the chain of events happening in it. An early clinical diagnosis, now reinforced with a positive potassium test, is key to start medical treatment (drug combination) targeted to stop the pathogenic process, because it is more effective in the early phases of the disease. For that purpose, the Urologist must have this disease in mind.

Cystitis, Interstitial↗