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Biomedical subjects

G Escribano Patiño

Publications and source records attributed to G Escribano Patiño.

At least 19 recordsLinked to original sources
PubMed1996

[Laparoscopic bilateral nephrectomy of native kidney in kidney transplantation carriers].

Severe vesicouretheral reflux sometimes causes terminal renal failure which then requires renal transplantation. In these patients it may be necessary to perform bilateral nephrectomy when associated to serious hypertension or urinary infections with a significant clinical impact. This paper presents the clinical picture of a patient with a corpse renal transplantation, due to terminal renal failure secondary to reflex nephropathy, in whom it was necessary to perform bilateral nephrectomy due to the uncommon urinary infections requiring hospitalization for treatment. The bilateral nephrectomy was done through transperitoneal laparoscopic approach, using seven points for trocars introduction. The procedure lasted 4 hours and the patients was discharged within 48 hours with no complications. Accumulate experience in the use of laparoscopy in urology has allowed this technique to be feasible. After designing the experimental model, our group has had the chance to accomplish laparoscopic nephrectomies in humans. We believe that this is the first case of bilateral nephrectomy conducted in our country using the laparoscopic approach.

Female↗
PubMed1996

[New perspectives in the preservation of kidney grafts].

OBJECTIVES: Graft preservation, together with overcoming the immunological barrier responsible for graft rejection, are the most important problems of organ transplantation. The different solutions to the foregoing problems are briefly analyzed. METHODS/RESULTS: The literature on graft rejection and preservation is briefly reviewed, highlighting the most outstanding developments. The availability of cyclosporine in the early eighties significantly enhanced the results of immunosuppression and made it less aggressive for graft recipients. The use of liquids for hypothermic preservation of the donor organ, with the advantages and disadvantages it entailed, was a major advancement in cold ischemia. Different solutions (Eurocollins, Wisconsin, HTK) were developed to reduce metabolic derangements from the time the organ was harvested until it was transplanted, with the aim of permitting immediate graft function in order to reduce the incidence of acute tubular necrosis. Further insight into the histological lesions caused by ischemia, the endothelial lesion and its role in tubular dysfunction have led different groups to use pulsatile perfusion once again, particularly since non-heartbeating donor programs were developed. CONCLUSIONS: Although the advancements in the preservation of renal grafts have permitted extending the cold ischemia time beyond 24 hours, the incidence of tubular necrosis continues to be significant. The foregoing, together with the development of renal transplant programs for non-hearbeating donor kidneys, have emphasized the need for further knowledge and understanding of graft viability and early function.

Humans↗
PubMed1995

[Subcapsular renal hematoma following shock wave lithotripsy].

OBJECTIVES: The present study analyzed the incidence of subcapsular hematoma of the kidney (SH) following extracorporeal shock wave lithotripsy (ESWL), its management and the possible risk factors that influence the development of this condition. METHODS: We received the records of 1600 patients submitted to 2250 ESWL sessions. SH was evaluated according to the following parameters: clinical features, diagnostic methods, management, follow up and the patient -and ESWL- related factors that influence the development of this condition. RESULTS: Five cases of SH were found (0.22% incidence), which had been diagnosed by ultrasound (US). Eighty per cent had sustained lumbar pain and a fall in hemoglobin values. The patients were managed conservatively and US follow up evaluation was done. At six months, resolution was almost complete with no sequelae. No patient had any of the risk factors described in the literature (hypertension, concomitant urinary tract infection or coagulation disorders) or changes in the ESWL unit standards. CONCLUSIONS: Although SH following ESWL is uncommon, sustained lumbar pain and a fall in hemoglobin values are risk factors that should be taken into account and corroboration and follow up by US should be done. Unless complications present, the patients should be managed conservatively.

Adult↗
PubMed1995

[Spontaneous bladder rupture with no apparent reason, a peculiar clinical occurrence].

OBJECTIVES: Herein we describe a case of spontaneous rupture of the bladder presenting with uncommon clinical features that led to difficulty in making the diagnosis. The literature on similar cases in briefly reviewed. METHODS/RESULTS: A case of rupture of the bladder arising from no apparent cause is described. Oliguria and abdominal pain were the presenting features and analysis disclosed renal failure. CONCLUSIONS: Rupture of the bladder may cause acute renal failure and acute abdomen and should therefore be included in the diagnostic algorithms of both disease entities.

Aged↗
PubMed1995

[Malignant neoplasms in kidney transplant recipients].

OBJECTIVES: This study is a retrospective analysis of malignant tumors in renal transplant recipients. A review of the pertinent literature allowed us to develop a protocol for early diagnosis and treatment of tumors arising in this group of patients. METHOD: 171 renal transplants have been performed over a period of 4 years. The renal grafts had been harvested from cadavers (mean age 32.01 years). All recipients (mean age 44.3 years) were immunosuppressed with prednisone, azathioprine and cyclosporine A. RESULTS: Five "de novo" malignant tumors were detected in 4 patients (2.3%). The tumors were basal cell epithelioma of scalp and gastric adenocarcinoma in the same patient, lymphoma of the CNS, carcinoma of the breast and adenocarcinoma of the colon. The patient with a gastric adenocarcinoma died after a disease-free interval of 28 months, following treatment of the cutaneous lesion. The patient with lymphoma of the CNS had died before receiving treatment and the remaining 2 patients are disease-free at 12 and 6 months' follow-up. CONCLUSIONS: The possible role of viruses is underscored. Transplant recipients should be followed very closely since they are likely to develop a tumor, especially of skin and lips. The importance of gynecological and neurological assessment and control of native kidneys cannot be overemphasized. Performing an autopsy on donors can reduce the risk of transplanting tumors. Kidney transplantation should be delayed if the graft recipient has a tumor. Correct diagnosis and treatment will enhance the results in these patients.

Adolescent↗
PubMed1995

[Hemangioma of the adrenal gland].

Adrenal gland haemangioma is an uncommon tumour which finding usually occurs by chance. This paper presents one case of cavernous haemangioma in this location on which surgery was performed successfully. The basic aspects of the case are revised from a pathohistological and diagnostic point of view intended to attempt to suspect its presence preoperatively.

Adrenal Gland Neoplasms↗
PubMed1994

[Necrotizing vasculitis located exclusively in the bladder: report of a case].

Necrosing vasculitis and, within it, nodosa polyarteritis, is an infrequent entity characterized by the absence of pathognomonic signs and symptoms, but which can potentially affect the entire body. The initial description was made by Kussmaul and Maier in 1866. Sings and symptoms of this clinical picture are not frequently circumscribed to the urinary tract. We describe here one case of a particularly infrequent presentation, as a vesical mass with gross haematuria. The paper discusses the clinical picture, diagnosis and treatment of this process.

Humans↗
PubMed1994

[Retroperitoneal laparoscopic nephrectomy: a case report].

Presentation of the first exclusively retroperitoneal laparoscopic nephrectomy performed on a female patient diagnosed with chronic pyelonephritis in the right kidney who referred frequent discomfort in the ipsilateral lumbar fossa as well as sporadic urinary infections. The entire procedure was performed without entering the peritoneal cavity, creating a space in the retroperitoneum, using for that hydrostatic dilation following Gaur's recommendations and introducing in that space a total of 4 trocars. Surgery lasted 3 hours an 35 minutes, with a post-operative stay of 3 days; the anaesthetics used after surgery was minimum and patient's return to her usual daily activities was almost immediate after discharge. Considering our group's previous experience in laparoscopic nephrectomies, both in humans (another 3 cases) and experimental surgery (18 pigs), we believe retroperitoneal approach is a huge step ahead in urological laparoscopic surgery, since this is the typical approach in our specialty and allows a closer contact with the condition being treated. On the other hand, the combined retro- and transperitoneal accesses will involve-are already involving-a greater variety of laparoscopic techniques in urology.

Adult↗
PubMed1992

[Urethral sonography in the diagnosis and preoperative evaluation of urethral stenosis].

An area of spongiofibrosis can be found proximal and distal to all stenosis of the urethra. The severity of such spongiofibrosis as well as its length are in many instances decisive when choosing an adequate surgical approach. Conventional radiological diagnosis of stenosis of the urethra only shows the area of urethral stricture but is unable to inform on the fibrosis of the spongy body. Sonourethrography or urethral echography affords a dynamic tridimensional examination of the anterior urethra which provides accurate data on the length of the stenosis, as well as the extend and severity of the spongiofribosis. Sixteen patients diagnosed with stenosis of the urethra through sonourethrography were evaluated. This easy-to-perform investigation, allowed the identification of 4 patients with peristenotic intense spongiofibrosis, hypercongenital urethra, who underwent open urethroplastia. The urethra of another 3 patients showed normal echogenicity, but diminished elasticity, and were diagnosed as of moderate spongiofibrosis requiring extensive internal urethrotomy. We believe sonourethrography should become a procedure to be included as part of the routine pre-surgical investigation of the stenosis of the urethra due to its non-invasive nature, easiness to perform, and because it provides highly useful information which would allow a decreased number of re-stenosis following surgery of the urethral stenosis.

Fibrosis↗
PubMed1992

[A right kidney autotransplant after inferior cavectomy].

We investigated the feasibility of diverting blood supply from the right kidney after resection of the vena cava by autotransplantation to the right iliac fossa. The experiment was conducted in 10 mini-pigs that had previously undergone partial ligation of the vena cava to produce collateral circulation. Although a good collateral circulation had developed, it was not sufficient to drain the complementary venous supply (right kidney). All the animals developed venous thrombosis and, consequently, irreversible renal failure.

Acute Kidney Injury↗
PubMed1992

[Management of pancreatic lesions in urologic surgery].

Surgical trauma of the pancreas cauda can occur when the renal hilum is dissected during left radical nephrectomy, mainly when normal anatomy is altered by the tumoral or inflammatory pathology. This lesion can be appreciated during the surgical procedure or else a pseudocyst or pancreatic fistula can become evident post-operatively. The urologist's knowledge of what the correct management both intra-operatively and postoperatively of this pathology should include will lessen the significant morbidity it implies. Presentation of a series of 6 patients presenting pancreatic trauma during left radical nephrectomy. Comments on the pathophysiology of this disorder, intra-operative management and post-operative treatment, specifically emphasizing the use of Total Parenteral Nutrition and Momatostatin IV.

Aged↗
PubMed1989

[Incrusted alkaline cystitis. Physiopathological basis for treatment with acetohydroxamic acid].

Alkaline incrusting cystitis is an uncommon clinical condition that usually presents in the course of bladder disease. It has characteristic presenting features and is difficult to treat despite currently available therapeutic measures. Three such cases that had been diagnosed and treated at our department is described herein. The literature is reviewed and the pathologic mechanisms of this condition are analyzed.

Aged↗
PubMedDate not supplied

[Laparoscopic lymphadenectomy in the treatment of stage I non-seminomatous germ cell tumors].

OBJECTIVE: To review the role of laparoscopic lymphadenectomy for stage I nonseminomatous germ cell tumor of the testis. METHODS: The current literature on this subject is reviewed and the advantages and disadvantages of this technique are discussed. RESULTS/CONCLUSIONS: Although there is no agreement on the management of nonseminomatous germ cell tumors of the testis, some groups advocate performing retroperitoneal lymphadenectomy after orchidectomy, particularly for tumors with a high risk of dissemination. The laparoscopic approaches that were introduced basically in the 90's, have permitted performing surgical techniques with a low morbidity and a shorter recovery time. Laparoscopic retroperitoneal lymphadenopathy is one such technique. According to the experience of several groups, this technique has an acceptable operating time (approximately 5 hours), low complication rate and short hospital stay (2-5 days according to the different series). For those with experience in performing the laparoscopic approach, it is a therapeutic alternative that should be considered for this type of testicular tumor.

Germinoma↗
PubMedDate not supplied

[Echo-Doppler duplex combined with intracavernous injection of prostaglandin E1 in the diagnosis of impotence].

Sixty-two patients that had consulted for impotence were evaluated by intracavernal injection of prostaglandin E1 and duplex echo-Doppler. The internal diameter and the mean flow of the cavernosal arteries were determined by echo-Doppler in the flaccid state. Thereafter 20 micrograms of PGE 1 was injected intracavernously and the erectile response was evaluated clinically after 5 to 15 minutes. Another Doppler evaluation was performed during tumescence to study the changes of the internal diameter and the mean flow increase of the cavernal arteries. Twenty-nine patients (46.7%) achieved normal erection after intracavernal PGE 1 and the Doppler study was normal in all but 2 patients (3.2%). The remaining 33 patients (53.1%) failed to achieve normal erection following intracavernal injection of PGE 1. The Doppler study, however, was normal in 7 of these patients (11.2%), which indicates venous leak to be the underlying cause of impotence. There were minor complications (19.3%) presented a small hematoma at the site of injection and 12.9% referred moderate pain at the time of injection) and no patient has a sustained erection for more than 3 hours. The hemodynamic mechanisms and the current concepts relative to the neurologic aspects of erection are discussed. We believe duplex echo-Doppler combined with intracavernal PGE 1 to be a very reliable method in the diagnosis of impotence of a vascular origin. It can distinguish those patients that cannot achieve erection following intracavernal PGE 1 with a normal arterial tree whose impotence can be ascribed to venous leak.

Adult↗
PubMedDate not supplied

[Carcinoma of the penis: long-term follow-up].

Penis epidermoid carcinoma is responsible for about 1% of deaths by neoplastic diseases in developed countries. During a 5-10 years follow-up review, we found 14 patients, 9 of which started as localized stages in glans and/or prepuce. Lymph node affection was found in 9 cases, either at beginning of diagnosis or during follow-up. Lymphadenectomy, which demonstrated metastatic affection in 4 cases, was considered indicated in 6 patients. Two cases received inguinal chain radiotherapy and the remaining one underwent chemotherapy as first therapy. Percentage of actual survival rate, found after 5 years, among the 14 patients studied was 42.8% (6 cases), still unchanged after a 10-year follow-up. Five patients died due to their basic illness progression and 3 died of other tumour-unrelated processes. The paper analyzes the results obtained based on the literature reviewed, and discusses current therapy approaches for inguinal metastatic conditions.

Adult↗