Biomedical subjects
Publications and source records attributed to G Chechile.
A granuloma caused by a forgotten laparotomy gauze (gauzoma) was suspected in a patient with general symptoms, a well-defined pararenal mass on computed tomography and a history of retroperitoneal surgery, and was subsequently confirmed at surgery. The image diagnosis of retained surgical sponges is briefly reviewed.
During vesical carcinogenesis a variety of genetic alterations such as oncogene mutation or loss of suppressor genes have been detected. Codon 12 mutation of the c-K-ras gene has been seen with a high frequency in several human neoplasias but its participation in the development of vesical cancers has not been fully dilucidated. Using the DNA restriction fragments polymorphism (RFLP) technique enhanced by a polymerase chain reaction (PCR) a study has been made of codon 12 mutation at the c-K-ras gene in 55 patient with vesical cancer undergoing surgery between 1991 and 1992. The tumoral stage was superficial (Ta-Tl) in 24 cases, infiltrant (T2-T4) in 28 cases and unknown in 3 cases. Two patients (3.6%) showed codon 12 mutation at the c-K-ras gene. One case was a fast evolving infiltrant tumour (T2-T3) which caused death of the patient after 4 months while the other case was a surface tumour (G2Ta) which relapsed early, the pathological anatomy revealing a stage T2-T3 squamous carcinoma. Our results suggest that codon 12 mutation at the c-K-ras gene is not a meaningful genetic change in the genesis of vesical cancer. Its emergence, however, appears to be related to a more aggressive tumoural behaviour.
Between 1980 and 1990, 5,949 cases of Benign Prostate Hyperplasia (BPH) were detected at the Puigvert Foundation. One thousand of them were randomized for analysis, and it was found that in 347 the indication for surgery was acute urine retention (AUR). During the initial visit the symptoms, their duration, creatinine values, correlation between creatinine and: 1) patients over 70 years, 2) relationship to prostate size, 3) distention of the upper urinary tract, 4) vesical lithiasis, 5) urinary infection, 6) complications, and 7) mortality were analyzed. Discussion of results, comparing these to other series and trying to find evolution differences between these patients and those operated by elective surgery. In our series, we only found statistically significant differences when correlating the high values of creatinine with the prostate size and the upper urinary tract distension.
We reviewed 623 patients who underwent trans-urethral resection of the prostate (TURP) and 18 (2.8%) developed bladder neck contracture (BNC), in most cases symptomatic. Sclerosis appeared between 2 and 100 months after TURP (mean 9 months, median 19 months). Most were small prostates at the time of resection, with a mean resected weight of 10.5 g (SD 5.9), although there were no statistically significant differences between patients with and without contracture. Patients have been followed for a mean of 44.5 months. Three patients were not operated: two were asymptomatic and another one died one month postoperatively due to unrelated causes. The overall success rate was 75% and cold knife incision of the bladder neck accounted for a 90% success rate. Cold knife incision provides good long term satisfaction in patients with post-operative BNC. The difficulties in the study of this complication are analyzed.
Three types of antibiotic prophylactic regimens were evaluated versus a control without prophylaxis (group A: 3,912 cases) in urologic surgery. The antibiotic regimens were: group B = cefazolin 1 g/12 h/3 days (3,660 cases); group C = cefonicid 1 g/24 h/3 days (2,076 cases), and group D = cefonicid 1 g single dose (3,169 cases). The parameters used were the comparison of the corresponding rates of postsurgical sepsis and operative wound infections. Numeric investigations for the validity of a retrospective study (unpaired data) were performed: homogenicity test, relative risk point estimate and confidence limits (95%), and etiological fraction point estimate and confidence limits (95%). Chi-square for other purposes were performed. Endoscopic handling was considered homogeneous (same infective risk), while open surgery was heterogeneous (p < 0.001). In order to avoid probable bias, a correction factor was used. Although in different degrees, prophylaxis significantly reduced the morbidity of surgical wound infections (p < 0.001; etiological fraction > 90%). The differences (p < 0.01) between groups B and C/D were attributed to pharmacokinetic causes (short T 1/2 of cefazolin). To obtain the maximum protective effect, the use of antibiotics with a T 1/2 of > 4 h is suggested. There was no resistant mutans in previously sensitive strains. However, a significant selection of intrinsically resistant strains was observed. Monodose offers at lest the same advantages as multiple-dose therapy. In addition, the monodose selected in a lesser proportion both the resistant strains (p < 0.001) and the number of microbial associations (p < 0.01).
A total of 458 patients underwent ileal conduit urinary diversion between 1970 and 1984. An end stoma was constructed in 44% of the patients and a Turnbull loop stoma in 56%. The median interval between appliance changes for all patients was 5 days. Patients with an end stoma had a longer median interval between appliance changes than those with a loop stoma. A total of 51 patients had 66 complications. Operations for stomal revisions were required in 5.5% of the patients. There was no difference in interval until initial complication between the end and loop stoma groups, although the end stoma was more prone to ischemic complications than the loop stoma. We conclude that the ileal conduit stoma constructed in an end or loop fashion yielded clinically equivalent long-term function.
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We reviewed the records of 292 patients with prostatic cancer who had been submitted to transurethral resection (TUR) to elucidate the role of endoscopic surgery in the diagnosis and treatment of this condition. Re-staging TUR permits differentiation between stage A1 and A2 tumors. Of 20 patients classified as having stage A1 tumors, 4 were reclassified as A2 tumors and benefitted from subsequent radical therapy. Endoscopic surgery permitted correction of ureteral obstruction in those with advanced prostatic cancer. In 9 patients with obstructive anuria, percutaneous nephrostomy combined with TUR of the trigone and placement of a double-J catheter achieved ureteric patency; 22% of the patients were alive at 5 years. In 18 patients with obstructive anuria from prostatic cancer (4 stage C, and 14 stage D), TUR of the trigonal angle and placement of a catheter for internal diversion combined with hormone therapy (9 cases) achieved a drop in creatinine levels (9 cases) and a mean survival of 2 years. Patient quality of life was good and no hospitalization was required. TUR affords a fast and safe solution in patients with bladder obstruction from acute (33 cases; 18 stage C and 15 stage D) or chronic (219 patients with advanced prostatic adenocarcinoma, and 16 with transitional cell carcinoma of prostate) urinary retention. In 103 cases, we utilized a technique similar to that employed for resection of benign prostatic hypertrophy; vesicoureteral "funneling" was performed in 132 cases, and a urethral prosthesis was placed in 5. Our results do not corroborate the role ascribed to TUR in tumor dissemination. Of 113 patients submitted to TUR, 38% presented late metastases (mean 33 months). In 80% of the cases, TUR succeeded in eliminating bladder obstruction between 1 to 96 months (mean 21 months), with a very low operative mortality rate (0.8%) and a 44% survival rate for a mean follow-up of 3 years.
The operative mortality and early and late complications were analyzed in 241 patients submitted to cystectomy for bladder cancer over a 7.5-year period. Of these, 92% were males and 8% females; mean patient age was 60 years. Preoperative radiotherapy of 2,500-6,000 rads was given to 114 patients. There were 33 (13.7%) operative deaths; the incidence being statistically significantly higher for those who had previously received radiotherapy. Early complications presented in 39% of the cases, and 44% had late complications. The complication rates were not influenced by preoperative radiotherapy.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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