Biomedical subjects
J M Banús Gassol
Publications and source records attributed to J M Banús Gassol.
[Preliminary results of a phase II randomized controlled trial comparing M-VAC and M-CAVI in patients with bladder cancer (T2-4 N0-1 M0)].
OBJECTIVES: The combination of carboplatin, methotrexate and vinblastine (M-CAVI) is an active and well-tolerated regimen for patients with bladder cancer who are ineligible for cisplatin-based regimens. We have prospectively randomized patients with locally advanced (T2-4 N0 M0) or locoregional (Tx N1 M0) bladder cancer suitable for subsequent surgical treatment to M-VAC or M-CAVI chemotherapy. METHODS: M-CAVI consisted of carboplatin (300 mg/m2 on day 1 and later adjusted to 4.5 mg/dl/min according to Calvert's formula), methotrexate (30 mg/m2 on days 1, 15 and 22) and vinblastine (3 mg/m2 on days 1, 15 and 22). After 3-4 cycles, the patients were assessed for surgical resection. RESULTS: To date, 60 patients have been included. There were 58 completely evaluable patients, 27 were randomized to M-VAC and 31 to M-CAVI. The overall response rates were similar for M-VAC (48%; confidence interval 95%, 26%-67%) and M-CAVI (45%; confidence interval 95%, 28%-62%). The pathological complete responses were similar for the M-VAC and M-CAVI regimens for both the group with locally advanced (27% vs 39%, p = NS) and locoregional (14% vs 14%, p = NS) bladder cancer. The median actuarial survival for the M-VAC treated group was 23 months and 18 months for the M-CAVI. M-VAC therapy was statistically significantly associated with more events of granulocytopenic fever, grade 2-3 nausea and vomiting, grade 2 alopecia and grade 3-4 mucositis. CONCLUSIONS: The results achieved in the 60 patients included in the study indicate that M-CAVI is better tolerated than M-VAC, although both treatment regimens have similar overall response rates, pathological response rates and survival in patients with locally advanced and locoregional bladder cancer.
[Two new Leydig cell testicular tumors presenting with gynecomastia in adults].
Presentation of two cases of Leydig cell tumor in adult patients who presented with gynecomastia, and slightly abnormal hormonal profiles. One patient had a non palpable tumor. The pathophysiology of this entity is commented, as well as the importance of the different modalities in its diagnosis.
[Percutaneous nephrolithotomy after extracorporeal lithotripsy for the treatment of complex renal lithiasis. Technical details and results].
The new therapeutic approach combining percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (ESWL) has become widely used instead of conventional surgery. The use of this combined treatment modality has been extended to complex renal calculi. In our view, the need to achieve complete removal of struvite stone fragments to cure infection and prevent subsequent stone formation has led to a change in our therapeutic approach. The present study describes several maneuvers to facilitate PNL and compares two treatment modalities: PNL to reduce stone volume + ESWL (an approach utilized by many) and ESWL + PNL for remaining stone fragments (our therapeutic approach). Our approach (ESWL followed by PNL) has enhanced our results in the treatment of complex renal calculi: 68.4% of the renal units were completely stone-free at the time of discharge from the hospital. Good results were achieved in 89.5%, if we include the renal units with stone fragments that could be spontaneously passed.
Renopleural fistula after percutaneous nephrolithotomy.
We present here a 42-year-old female who developed a renopleural fistula after a percutaneous nephrolithotomy through the 11th intercostal space of a calculus of the upper calyces of the right kidney. The fistula was resolved with a chest tube and a double-J ureteral catheter.
Vesicorenal reflux and upper urinary tract transitional cell carcinoma after transurethral resection of recurrent superficial bladder carcinoma.
Of 288 patients with superficial transitional cell carcinoma of the bladder vesicorenal reflux developed after transurethral resection in 26 per cent. This proportion was higher (77 per cent) when we considered only those tumors located near the ureteral orifices. There was a statistically significant relationship (p less than 0.001) between the development of upper urinary tract tumors and vesicorenal reflux (20 per cent of the patients with reflux and 0.9 per cent without reflux had a tumor), which corresponds to a 22-fold greater risk in the former group. Close followup is advised, since 1 of 5 patients with reflux after transurethral resection may have upper urinary tract transitional cell carcinoma.
Transurethral resection of the ureteral meatus invaded by carcinoma of the prostate: a new approach.
We present herewith our surgical procedure for the management of bilateral hydronephrosis and renal failure due to distal ureter infiltration by cancer of the prostate: transurethral resection of the ureteral meatus and intramural ureter or even extravesical ureter invaded by the carcinoma and placement of a double J catheter. We have performed this technique in 3 patients with good results.
Review of 31 vesicointestinal fistulas: diagnosis and management.
Review of 31 cases of enterovesical fistulas treated at the Departments of Urology and General Surgery during the period 1970-1982. In 20 cases (64.5%) the underlying cause was a carcinoma (overall colorectal neoplasm) and in 7 cases (23%) it was an inflammatory disease. Gouverneur's syndrome (suprapubic pain, frequency, dysuria, urinary pain and tenesmus) was present in 17 patients (54.8%). Pneumaturia and fecaluria were present in 18 and rectal micturition in only 5. The diagnosis was based on cystograms in 66.6% of the patients. Other explorations oriented us towards the location of the fistula but only confirmed it in a low percentage (10-30%). The treatment undertaken varied in each case depending on the etiology and the patient's condition: medical (3%), derivative and palliative surgery (23%) and radical surgery (68%).
[Percutaneous nephrolithotomy: technic and results].
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Management and treatment of eighteen rectourethral fistulas.
There is only rare and scanty literature explaining the different surgical techniques and results for rectourethral fistulas. Here we present a review of 18 patients with rectourethral fistula. In half of the cases Bevan-Mason repair was undertaken with success.
Physiopathology and surgical treatment of extravasated peritoneal fluid after transurethral resection.
We present 9 cases (0.57%) of vesicoprostatic perforation during transurethral resection of 1,562 consecutive operations done during the last 3 years in our urology department. We review the symptomatology, medical and surgical treatment from the point of view of the physiopathology of the intra-abdominal extravasated fluid. A new technique for the evacuation of the extravasate is presented ( multiperforated intraperitoneal catheter) because of its speed and ease of performance.
[New therapeutic alternative for complex renal lithiasis].
The combination of percutaneous nephrolitotomy and renal extracorporeal litothricy, is currently considered to be the best choice for the treatment of complex renal lithiasis. This procedure, however, quite frequently needs the use of adjuvant maneouvers (urethroscopy, catheterization, large number of sessions, etc.), and there is a considerable proportion of residual lithiasis. We present here our series using a new therapeutic sequence: first, we perform extracorporeal litothricy (ESWL) of calices not accessible to the nephroscope, followed by percutaneous nephrolitotomy which has revealed to be a simplification of the percutaneous surgical technique since it decreases the movements of the nephroscope and the use of ultrasounds. Calyceal lithiasis previously fragmented are then extracted through the nephrostomic channel and so no lithiatic paths are induced, the percentage of residual lithiasis being also lower.
[Early calculogenesis caused by ureolytic infection of the double-J ureteral catheter].
Stone formation in the double J ureteral catheter is an uncommon complication that generally appears in patients that are predisposed to stone formation and persistent infection of the urinary tract. We report on a 29-year-old female patient in whom stone formation was observed in both ends of the catheter, less than 3 months after it had been placed. Urine culture was positive for P. mirabilis. Percutaneous nephrolithotomy was warranted in the treatment of the pyelic stone and for removal of the double J catheter. We underscore the importance of doing urine cultures and radiologic control in this patient group and shortening the time the catheter is left indwelling.
[Are computers useful in daily medical practice?].
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[Anuria secondary to perianeurysmal fibrosis].
Presentation of one case of obstructive anuria secondary to perianeurysmal retroperitoneal fibrosis (PRF). Diagnosis was confirmed by abdominal ultrasound and CAT. The condition's initial treatment consisted in bilateral percutaneous nephrostomy. Following clinical stabilization of the patient, surgical resection of aorta aneurysm and ureterolysis with bilateral intraperitonealization was performed. A revision of the specific literature revealed 17 cases similar to ours. Clinical, diagnostic, and pathophysiologic aspects as well as recommended therapeutical procedures are analyzed.
[Current treatment of coraliform lithiasis evaluation of surgery, percutaneous techniques and shock wave lithotripsy].
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