Biomedical subjects

J A Virseda Rodríguez

Publications and source records attributed to J A Virseda Rodríguez.

At least 19 recordsLinked to original sources

PubMed2006

[Growing incidence in renal cell carcinoma].

OBJECTIVES: To analyze the change in the behavior of renal cell carcinoma for its presentation, treatment, histology and mortality during a 17 year period. MATERIAL AND METHOD: Retrospective study on 212 patients diagnosed with renal cell carcinoma in our Department from the year 1988 up to 2004, analyzing the clinical and demographic data and comparing them to each other according to two periods: 1988-1996 and 1997-2004. RESULTS: An increase has been appreciated in the incidence of renal tumors in the second period and in a same way an increase in the incidental diagnosis and in the practice of nephron sparing surgery. Clear cell type was the most frequent in both periods and tumoral size was higher in the first period than in second. TNM stage I was the most frequent, although in first period it was higher percentage of stage IV. Cause-specific mortality has increased in the last years. CONCLUSION: An increase is appreciated in the incidence of renal cell tumors. Although the diagnosis is in earlier stages, a descent in the mortality has not been found.

Carcinoma, Renal Cell↗

PubMed2006

[Giant adrenal myelolipoma: hypertension, renal failure and spontaneous rupture].

Adrenal myelolipoma is a rare, benign, slow-growing tumor composed of adipose tissue and hematopoietic elements. It is usually diagnosed incidentally, although there are reports of patients with symptoms and descriptions of retroperitoneal hemorrhage due to rupture of large tumors. The condition has been associated with obesity, high blood pressure and adrenal dysfunction. We present a patient with retroperitoneal hemorrhage due to spontaneous rupture of a myelolipoma, hypertension, and renal failure secondary to nephroangiosclerosis.

Adrenal Gland Neoplasms↗

PubMed2005

[Problem-based learning in urology training. The Faculty of Medicine of the Universidad de Castilla-La Mancha model].

Ongoing changes in the social, economic, technological and scientific realms have generated new needs and led various organizations to suggest that educational institutions should reorient their educational strategies toward developing effective professionals with the skills to meet these needs. These "modern" strategies include problem-based learning, in which the student seeks and selects information, analyzes the data obtained, integrates both prior and newly acquired knowledge, and, finally, offers diagnostic and therapeutic options to resolve the problem posed, as would occur in professional practice. With this approach, prior skills and practical experience form the foundation of learning. Problem-based learning incorporates some aspects of cognitive psychology, a model that mainly centers on the nature of the knowledge structures found in active memory, the processes involved in information storage and retrieval and the various factors that activate these processes. At the Faculty of Medicine of the Universidad de Castilla-La Mancha, urology is part of a core subject (Medical and Surgical Pathology II) taught in the fifth year of coursework together with nephrology. Each course includes approximately 75 students, divided into five groups. The rotation lasts six weeks, with students spending a mean of two hours a day on theory (nephrology and/or urology) and the remaining time on rotations in the various activities: three weeks in nephrology and three weeks in urology. Upon completion of the rotation, the students write a combined theoretical examination with 100 multiple-choice questions (50 on urology) and take a practical skills examination. At the end of the course, another practical test consisting of an objective, structured clinical examination is taken, in which standard patients are used and the professor directly assesses the level of skills acquired with a "real" case.

Academic Medical Centers↗

PubMed2005

[Entero-neobladder ileal fistula: two cases report].

Fistulas between the orthotopic reservoir and the gastrointestinal tract have low incidence (1.5-2%). Simptomatology is variable, but it's frecuent to find fecaluria. Among 90 new intestinal bladders we show two fistule of new bladder to ileo, with nest postoperatory diagnosis, using retrograde cystografy; one was resolved with next postoperative treatment and the other with open surgery.

Aged↗

PubMed2004

[Surgery of large residual mass after chemotherapy in advanced testicular germ cell tumor].

Treatment for testicular tumours has progress in such a manner in the last years that high cure percentages can at present be achieved. After chemotherapy, in most cases, residual mass can appear. In this cases surgery is considered a viable therapeutic option although it implies an advanced surgical training since it is a complex technique and implies serious implications. We submit the case of a patient who presented a large residual mass from a testicular germ cell tumour after being treated with orquiectomía and chemotherapy. Surgery was performed resulting in total and radical extirpation of residual mass.

Adult↗

PubMed2004

[Nephron-sparing surgical treatment in renal tumors].

OBJECTIVE: A retrospective study on the nephron-sparing surgical treatment in patients with renal tumors, and in addition a literature review on the subject. MATERIAL AND METHODS: Since January 1988 until February 2002, 44 partial nephrectomies have been carried out in our unit because of renal tumors in 43 patients. The clinical protocols of these 43 patients have been reviewed, with an analysis of various clinical-pathological parameters, and utilizing in this analysis percentages, central tendency measures and dispersion and confidence intervals. RESULTS: The average age of the patients was 55.8 years (19-76), and 29 patients were males. Elective partial nephrectomy was carried out in 79.5% of the patients, while in the rest they were submitted to imperative surgery for various causes. The diagnosis of the tumors was mostly as an incidental finding upon carrying out some diagnostic test by another cause (68.2%). In the symptomatic cases, the most common presentation was the combination of pain and hematuria (11.4%). Histopathological study revealed malignant neoplasms in 88.7%, most of them (61.4%) clear cell carcinomas. A Furhman grade 2 was observed in 76.3% of tumors. The average size of the renal masses was of 4.53 cm (1,5-11). As a whole, 61.5% were pT1, 33.3% were pT2 and only one case was pT3. Operative complications were observed in 11.4% of the cases and postoperative complications in 25%. No patient showed local or distant recurrence, and all of them survived disease-free. A patient died after 74 months of the surgery for causes not related to the disease. Average follow-up was 49.77 months (1-168). CONCLUSIONS: Renal nephron-sparing surgery is such a valid therapeutic option as radical nephrectomy in selected patients with renal tumors, since the cancer-specific survival is 100%, which means that this can be considered a therapeutic indication even in patients with healthy contralateral kidney.

Adult↗

PubMed2004

p53 Gene mutations in superficial bladder cancer.

OBJECTIVES: To assess the presence of p53 gene mutations in superficial tumors of the urinary bladder (transitional cell carcinoma) and their relationship to classic prognostic factors for cancer recurrence and progression. To analyze the implication of these mutations on the P53 protein structure. MATERIALS AND METHODS: Observational, cross-sectional study of 90 consecutive patients, 60 with superficial transitional cell carcinoma (pTa and pT1) and 30 without neoplastic disease (control group). Samples of bladder tumor and control normal mucosa were analyzed by polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) to detect p53 mutations in exons 5-9. Automatic sequencing was used to characterize the mutations and their effect on the P53 protein was analyzed. Bivariate analysis was used to assess the association with other prognostic factors. RESULTS: PCR-SSCP found no mutations in any control group patient, whereas 38.3% of patients with superficial transitional cell carcinoma had one or more mutations in the exons analyzed. Thirty mutations were sequenced; all were point mutations and 86.67% were considered relevant for the P53 structure. A total of 93.3% of the mutations were located in highly conserved regions and 73.3% in mutational hot spots. The highest cell differentiation grades and pT1 stage were associated with a higher incidence of p53 gene mutations. Previous recurrences and other tumor-related histological variables were not associated with a higher percentage of mutations. CONCLUSION: Mutations at p53 did not appear in healthy bladder mucosa and were significantly more frequent in pT1 and high-grade (G-II and G-III) tumors. All mutations detected were point mutations and most caused considerable P53 structural abnormalities, implying major repercussions on P53 function. These data suggest that certain p53 mutations may have prognostic value, even though they were not associated with other classic recurrence and tumor progression parameters. Future analyses of the progress of patients with superficial bladder transitional cell carcinoma and mutated p53 will help clarify this aspect.

Aged↗

PubMed2002

[Pheochromocytoma of the organ of Zuckerkandl. Apropos of a case].

INTRODUCTION: Extraadrenal pheochromocytomae represent 17-18% of pheochromocytomae, 85% of which are located infradiaphragmaticaly and generally wherever there is cromaffin tissue, as in this case, located at the organ of Zuckerkand. They can also appear in the context of family syndromes, i.e. phacomatosis and MEN (IIA and IIB). CLINICAL CASE: The authors present a case of pheochromocytoma located in the organ of Zuckerkand, diagnosed in the course of uncontroled HBP. Diagnosis was achieved by metanephrine determinations and radiological tests (ultrasound, CAT and MIBG). This patient was surgically treated by exeresis of the lession previous alpha and beta adrenergic blockade with phenoxybenzamine and propanolol. Currently this patient is asymptomatic with normal blood pressor and metanephrines blood levels. DISCUSSION: Extraadrenal pheochromocytomae are usually located in superior paraaortic infradiaphragmatic region. The grade of malignancy must be established by histopathological findings, local recidives and metastasis. After clinical suspicion and the finding of a retroperitoneal mass with ultrasound, CAT and/or MRI, MIBG must be performed to confirm the diagnosis as well as to leave out possible tumours at distance. Treatment is surgery previous blockade of cathecolamines secretion by the preoperative administration of alpha blockers, with or without beta blockers.

Endocrine Gland Neoplasms↗

PubMed2002

The impact of benign prostatic hyperplasia surgery on patients' quality of life.

OBJECTIVE: To assess the impact of surgical treatment of benign hyperplasia of the prostate on patients' quality of life (QoL). MATERIAL AND METHODS: The QoL of 181 patients was assessed by the health questionnaire SF-36. The measurement was carried out before and 6 months after surgery. RESULTS: After surgery, SF-36 scales improved their scores, fundamentally General Health (57.4%) and Physical Functioning (57.1%). 70.3% improved their physical component summary (PCS) and 49.1% their mental component summary (MCS). The improved PCS and MCS were not associated with the improved I-PSS or urine flow. The improved PCS was 2.2 times higher in patients who had previously scored under 44 in the PCS, 2.2 in patients who had scored over 25 in the I-PSS, and 2.9 times higher in patients without chronic diseases. With regard to MCS improvement, this was 17.1 times higher in patients who scored under 50 previously on the MCS, 3.1 in patients who scored over 4 on the IQL, 5.7 in patients without postoperative incontinence, and 3.3 times higher in patients who lived in urban areas. CONCLUSIONS: Improvement in QoL after surgery is noted more in physical than in psychological aspects. Although a reduction in the intensity of prostatic symptoms and an increase in urine flow values were noted postoperatively, the improvement QoL was not associated with improved symptoms or urinary flow.

Aged↗

PubMed2001

[Quality of life of patients after radical surgery of bladder cancer].

OBJECTIVE: To analyze the impact of surgery for bladder cancer on the patient's quality of life. METHODS: The SF-36 questionnaire was utilized to assess the quality of life of 53 cystectomized patients. Sociodemographic data, associated and surgery-related morbidity, type of urinary diversion, anatomopathological stage and current oncological status were analyzed. RESULTS: Patient mean age was 64.3 years. There were 46 males (86.8%), 33 (62.3%) had no schooling, 32 (68.1%) were social class IV and 35 (66.0%) had chronic associated conditions. External urinary diversion had been performed in 28 (52.8%) and bladder substitution in 21 (39.6%) patients. The early complication rate was 37.7% (n = 20) and the late complication rate was 86.8% (n = 46). Tumor stage was < or = pT2 in 28 cases (52.8%). Age correlated inversely with Physical Performance (r = -0.324; p = 0.018). Patients with chronic conditions had a lower score for Physical Performance, Vitality and SFI. Patients with tumor stage < or = pT2 scored higher for Physical Performance (p = 0.034), Vitality (p = 0.046), Mental Health (p = 0.036), Emotional Role (p < 0.05) and MSI (p < 0.05). Those with postoperative complications had a worse score for Physical Performance (p = 0.031), Vitality (p = 0.027), Emotional Role (p = 0.014), Mental Health (p = 0.012) and MSI (p = 0.015). The SF-36 showed no differences between the types of urinary diversion except that patients that had undergone orthotopic bladder substitution had a higher score for Physical Performance (p = 0.014) and FSI (p = 0.045). CONCLUSIONS: Although the quality of life of cystectomized patients is worse than that of the general population, it is better in younger patients without chronic associated conditions, no postoperative complications, lower tumor stage and those submitted to orthotopic bladder substitution.

Aged↗

PubMed2000

[Structural changes in the ileal mucosa of urinary conduits].

OBJECTIVES: To study the changes found in the terminal ileum mucosa in contact with urine in patients with skin ureteroileostomy following cystectomy due to infiltrant carcinoma of the bladder. MATERIAL AND METHODS: 21 biopsies of gut mucosa were performed in as many patients. Measurements included height of intestinal villi (average values -AV-: 350-300 mu), height of crypts (AV: 70-100 mu), crypt/villus ratio (AV: 0.2), goblet cells/enterocytes ratio, presence of lymphangiectasis and inflammatory infiltrate. Also the existence of lab changes were measured with ionogram and venous gasometry. RESULTS: Mean age of patients was 65.2 years +/- 7.4 SD. Males 66.7%. Time of evolution with urinary by-pass was 59.5 months +/- 53.2 SD. Mean height of villi 178.2 mu +/- 70.2 SD, mean height of crypts 290.9 mu +/- 114.4 SD and mean crypt/villus ratio 4.2 +/- 9.2 SD. Submucous inflammatory infiltrate was mild in 57.1%, moderate in 23.8%, and severe in 19.0%. Only 2 cases had lymphangiectasis images. Goblet cells/enterocytes ratio was 3.3 +/- 1.3 SD. No correlation was seen between time of evolution of urinary by-pass with the various changes in gut mucosa or between degree of mucosal atrophy and existence of metabolic disorders. CONCLUSIONS: Changes in the terminal ileum mucosa in patients with skin ureteroileostomy-like urinary by-pass are characterised by a marked atrophy of intestinal villi with increased crypt length, increased crypt/villus ratio and presence of mild-to-moderate inflammatory infiltrate. There is also an increase of goblet cells in detriment of enterocytes. All these changes are independent from the time of evolution of patients with urinary by-pass.

Aged↗

PubMed2000

[Prostatic symptoms problems after surgery of benign hyperplasia of the prostate].

OBJECTIVE: To evaluate the impact of surgical therapy for benign prostatic hyperplasia on the problems caused by prostatic symptoms to patients. MATERIAL AND METHODS: 122 patients were evaluated with regards to the issues arising from prostatic symptoms through the Symptom Problem Index (SPI) questionnaire. Symptoms intensity (I-PSS questionnaire) and flow data were analyzed. Measurements were performed prior and six months after surgery. RESULTS: Mean age 68.8 +/- 6.9 SD years. In 46.3% cases a surgical approach was decided upon based only on symptoms. After surgery, I-PSS score improvement was seen in 91.0%, 78% stated they were delighted or very satisfied with their symptoms and 70% showed peak flow improvement. SPI score prior to surgery was 15.9 +/- 6.7 SD and after surgery 4.3 +/- 5.7 SD (p < 0.0001). Worse rated symptoms after surgery are still nycturia, urgency, and pollakiuria; obstructive symptoms were better tolerated than irritative symptoms. Interestingly, there is also greater tolerance of nycturia (p < 0.001) relative to the previous problem. A higher tolerance of prostatic symptoms with surgery correlates with an improvement of scores in irritative symptoms (r = 0.888; p < 0.0001), and even more with improvement of obstructive symptoms (r = 0.925; p < 0.0001). Tolerance increased with improved scores in I-PSS questionnaire (r = 0.644; p = < 0.0001), in patients with previous higher I-PSS (r = 0.333; p < 0.001), worse IQL quality of life (r = 0.215; p < 0.018), and worse previous tolerance to prostatic symptoms (r = 0.690; p < 0.001), in younger patients (r = -0.179; p = 0.05) and in the absence of problems with the development of sexual activity and post-operative complications, basically urinary incontinence. CONCLUSIONS: The problems suffered by patients as a result of symptoms after surgery show greater improvement than the symptoms intensity and is greater in patients with worse pre-operative clinical condition and those previously more concerned with their symptoms. It should be highlighted the lower repercussion from nycturia after the procedure and the fact that irritative symptoms are less well tolerated. On the other hand, the frequent changes in sexual activity caused by this procedure result in symptoms being less well tolerated, as it also happens with the possible existence of post-operative urinary incontinence.

Aged↗

PubMed2000

An unusual retroperitoneal cystic tumor.

This report describes a case of textiloma (term given to an inflammatory swelling caused by a retained textile foreign body) in a 60-year-old patient who had undergone surgery for a perforated gastroduodenal ulcer 17 years earlier. On examination the presence of a large mass was detected on the left hypochondria. A CT scan confirmed a cystic tumor with images suggesting detritus or necrosis in its lower part, as well as calcifications. Transperitoneal midline laparotomy was performed with extension by thoracophrenolaparotomy. Splenectomy was necessary. Macroscopic examination showed a spherical mass. After opening the tumor, retained surgical gauze was found. The histopathological diagnosis was granulomatosis reaction to a foreign body.

Cysts↗

PubMed1999

[The Conn syndrome. The clinical and surgical aspects of 18 cases of adrenal adenoma].

OBJECTIVES: Presentation of a series of 18 patients who underwent surgery of aldosterone-producing adrenal adenoma (Conn's syndrome) over the last 10 years. Assessment of the most significant clinical and pathological aspects from a surgical point of view. METHODS: Retrospective study evaluating a broad range of features: clinical, analytical, hormonal, imaging, types of anaesthesia, approaches, technique used, intra and post-operative morbidity and mortality, evolution and pathoanatomical diagnosis. RESULTS: The most frequent clinical data of primary hyperaldosteronism were: 94.4% volume-dependent HBP, 50% headaches and dizziness, 27.8% epistasis and/or episodes of angor or acute myocardial infarction, and 22.2% heart failure. The biochemical study and hormonal testing evidenced: hypokalemia in 88.9%, metabolic alkalosis 66.7% and hypernatremia in 61.1%. Mean aldosterone levels were 517.5 pg/mL, and urinary levels 85.9 mcg/day. Resting plasma renin activity (PRA) < 0.2 ng/mL/h in 77.8% cases and positive aldosterone stimulation test in 61.1%: captopril test positive. Imaging diagnosis was based in CAT which was conclusive in 88.9% and ultrasound which was diagnostic in 27.8% cases. The surgical approach was: lumbotomy (over the 11th or 12th rib) in 14 patients and transpleurodiaphragmatic in all remaining patients. The intraoperative complications reported were placement of endothoracic tube due to iatrogenic pneumothorax in two occasions. Duration of the procedure (mean 136.1 min) and post-operative hospitalization (mean 7.76 days), as well as post-surgery follow-up for up to 96 months were also studied. At final time point there was 66.7 asymptomatic patients, 33.3% cases of HBP, and no deaths. CONCLUSIONS: Primary hyperaldosteronism due to adrenal adenoma is an uncommon reason for HBP, but in most cases can be cured with surgery. Biochemical and hormonal testing is determinant to research a diagnosis. Ultrasound and CAT are essential for imaging diagnosis, and occasionally NMR can be of help. Lumbotomy is considered the choice approach for these small tumours as it is a familial technique for urologists with a low complications rate.

Adenoma↗

PubMed1998

[Retroperitoneal cystic mesothelioma and lymphangioma].

Retroperitoneal cysts are uncommon entities of difficult diagnosis because of their insidious symptomatology. Urinary apparatus involvement is quite often the mode of presentation and the reason for calling on the urologist. The origin of many of these retroperitoneal cysts remains practically unknown. Surgery with exeresis is the choice management method. Follow-up is necessary for cystic mesothelioma because of the highly frequent relapses. The outlook of hormonal conservative therapy for relapses appears as a future alternative to treatment.

Adult↗

PubMed1998

[Bilateral adrenal pheochromocytoma].

Presentation of one case of bilateral suprarenal pheochromocytoma as early clinical evidence of a type 2 MEN, which at the time of diagnosis was a bilateral lesion. The presentation form was a picture of shock with HBP. Labetalol i.v. was used for initial control and phenoxybenzamine in the pre-operative. Diagnosis was achieved by biochemical (metanephrine) and radiological (CAT) testing. The patient was managed with bilateral suprarenalectomy through a single, anterior incision and abdominal cavity examination. The investigation of the remaining conditions that conform this syndrome was continued and a familial routine study implemented.

Adrenal Gland Neoplasms↗

PubMed1998

[Ruptured syringocele of the Cowper's gland. Report of a case].

Contribution of the case report of an 18-year old patient who consulted for an early picture of haematuria with symptoms of mictional syndrome with a history of several years of urinary infection. After the urological study, the presence of a ruptured syringocele in Cowper's gland was documented in the retrograde and mictional uretrography. The treatment approach was the incision, widening the communication between the urethra and the syringocele; all manifestations disappeared after the endoscopic treatment. The etiology of syringoceles and cystic dilations of Cowper's duct and gland are usually congenital, and there is a likely association with the presence of Cobb's collar. There are four morphological types: simple, perforated, imperforated and ruptured. Most cases are asymptomatic, basically affecting children and adolescents. The usual manifestations are haematuria, symptoms of urinary infections and/or various symptoms of urethral obstruction. Diagnosis is achieved through uretrography and endoscopy. Treatment, when appropriate, is endoscopic through incision or syringocele marsupialization. In some cases, perineal incision and surgical resection of the syringocele with urethral closure has been performed.

Adolescent↗

PubMed1998

[Necrotizing pancreatitis following radical cystectomy for infiltrating bladder carcinoma].

Mortality from radical cystectomy is still high, in some series accounting for 1-10% deaths. Morbidity is even higher and can reach 50%. This paper contributes the case of a 66-year old male patient diagnosed with an infiltrant tumour of the bladder following TUR. The patient's background included prior surgery for gastroduodenal ulcus, alcohol consumption, and obesity. Following routine pre-operatory investigations, the patient underwent radical cystectomy using routine techniques and urinary by-pass via transcolonic ureterosigmoidostomy. Increased transaminases, leucocytosis, vomiting, jaundice and extended intestinal ileum were noted during the patient's post-operative period, while blood and urine amylase concentrations were moderately high. Following CAT study, laparotomy was performed and the diagnosed confirmed. The patient died on day 14 of surgery due to secondary pulmonary complications. Post-operative pancreatitis is a low-frequency, high-mortality acknowledged complication. Even though most cases are secondary to biliarypancreatic and surrounding pancreas area surgery, it has also been described in some instances of distant surgery such as the present case. Alcohol consumption, biliary lithiasis, prior cholecystectomy and diabetes are predisposing factors. High amylase values do not always accompany this condition. Early diagnosis and treatment are crucial for the patient's prognosis. Respiratory complications are the usual cause of death in these patients.

Cystectomy↗