Biomedical subjects
Publications and source records attributed to J M Osca García.
Presentation of an uncommon form of distant primary dissemination of renal adenocarcinoma (RA) 5 years after radical surgery, the subcutaneous metastasis. The patient underwent surgical resection of metastasis, and later developed early pulmonary, mediastinal and new skin metastasis. A review is made of the incidence, therapeutical approach and prognostic value of skin metastasis due to RA.
An "in vitro" experimental line was designed to study the dependence of the canine detrussor's contractile activity on extracellular calcium, or whether on the contrary there are intracellular sources of this element. If dependence from extracellular calcium could be demonstrated, the capacity of calcium channel blockers to block the input the this ion would be studied. The conclusions arrived at were: 1. Ach- and KCl-induced activity is dependent from extracellular calcium. 2. This activity is also sensitive to the action of calcium channel blockers. 3. Calcium channel blockers block Ach-activated calcium channels completely, but only partially dose activated by KCl. 4. While the activity induced by Ach and resistant to action from calcium channel blockers is probably due to calcium released from the intracellular reservoirs, the activity induced by KCl and resistant to the calcium channel blockers action can be better explained by the activation of the transmembrane channels which cannot be blocked by this agents.
Presentation of a review on nine patients (10 renal units) with urinary by-pass and renoureteral lithiasis who underwent shock wave extracorporeal lithotrity in our hospital. The justification for the by-pass was an infiltrant vesical tumour in 6 patients, myelomeningocele in 2, and vesicourethral trauma in the remaining one. All cases were being treated for a Bricker-type by-pass except the last one (bilateral ureterosigmoidostomy). Outcome of treatment was: absence of residual lithiasis in 6, minimal residues in 1 (2 renal units), failure in 1. The remaining patient suffered anaphylactic shock induced by the latex in the ureteral catheter placed prior to lithotrity which caused the patient's death.
An evaluation was made on the risk of having a second primary neoplasia following vesical tumor diagnosis. All patients attended the 'Hospital La Fe' and had been diagnosed between 1984 and 1993. A total of 238 vesical tumours were studied, 45 (15.9%) with associated second neoplasia; in 34 cases the vesical tumour was the first one to be diagnosed. The number of tumors seen was compared to expected figures, according to the appropriate incidence rates by age, sex and tumour type, taken out from the Spanish section of the 1987 edition of "Cancer Incidence in Five Continents". An increase over the expected values of second neoplasias for lung, prostate, kidney and bone cancer was found. Sixty percent developed concurrently (within 6 months from initial diagnosis). Most vesical tumours were infiltrant, thus conditioning both the prognosis and the second neoplasia. The likely factors implied in this phenomenon are discussed.
The unspecific granulomatous prostatitis (GP) is a rare prostate disease. Its relevance lies on the common confusion with prostate carcinoma. Review of 21 cases of unspecific GP, two of which had previously undergone transurethral resection of the prostate. Forty-eight percent of patients developed urinary tract infection prior to GP diagnosis. In 13 patients (62%), prostate carcinoma was suspected after rectal examination of the prostate and transrectal ultrasound. Diagnosis was achieved by histopathology after prostate biopsy and transurethral resection (100%). Prostate Specific Antigen (PSA) was within the normal ranges in all cases that it was performed (six), with the exception of one patient who developed prostate cancer. During follow-up, four patients developed prostate cancer (19%) with an average presentation time of 5.5 years after GP diagnosis.
Leiomyosarcoma of the prostate is a very uncommon malignant tumor arising from the smooth muscle cells of the prostate gland. We report on a 72-year-old patient who underwent surgery for benign prostatic hyperplasia. The pathological analysis following retropubic resection, however, revealed a leiomyosarcoma and an extended cystectomy and pelvic tumorectomy were performed after preoperative radiotherapy. The patient is alive with local recurrence at four years follow up.
The intention of this paper is to analyze the correlation between two techniques used to measure prostatic volume: transrectal ultrasound with planimetry and transabdominal vesicoprostatic ultrasound. A total of 44 patients have been subjected to transrectal ultrasound, where prostatic volume was determined by planimetry. With this simultaneous technique, patients were performed a vesico-prostatic ultrasound with estimation of volume, achieved by measuring the prostatic diameters and then applying the ellipsoid formula. There were no statistically significant differences between mean values of prostatic volumes as calculated by either technique, both showing a strong correlation (r = 0.817). During transrectal planimetry, the three prostatic diameters were measured and, using a multiple regression study, the influence they have on the changes of prostate's volume was noted. It was observed that it is the transverse, but essentially the longitudinal diameter, the ones which explain those changes (Sig T = 0.0012 and 0.0000, respectively).
Contribution of one case of spontaneous bilateral perirenal haematoma (SBPH) in a patient infected with the human immunodeficiency virus (HIV). The haematoma etiology was a nodose panarteritis (NPA). Etiological diagnosis was established by arteriography, but abdominal computerized tomography (CT) and renal ultrasound scans were useful diagnostic tools. A relationship between human immunodeficiency virus and NPA pathoetiology is suggested and commented upon.
Review of patients treated for tumours of the upper urinary tract (UUTT) in our hospital during the 1969-1992 period. The characteristics studied were: stage (TNM 1987), grade (OMS), associated vesical tumour, location of primitive tumour, size, number, surgery performed and presence of tumoral relapse. Cox's regression model was used for the analysis of prognostic factors with survival time as the response variable. The sample has 92 patients (78% men and 22% women), average age 64 years. The tumours were: 46 pyelitic, 36 ureteral and 10 mixed. Stage distribution was: 13 pTa (14%), 41 pT1 (45%), 16 pT2 (17%), 15 pT3 (17%), 3 pT4 (7%); grade distribution: 22 grade I (24%), 54 grade II (59%) and 16 grade III (17%) 48% cases presented associated vesical tumour and 15% relapsed. The sample's median survival was 81 months and survival probability at 5 and 10 years was 52% and 45%. A significant association with survival time was shown by: stage, grade, sex and renal annulment. The multivariant analysis selected: 1) stage; 2) renal annulment and 3) sex. The predictive power of staging is indisputable, thus becoming the first selected variable. Renal annulment and sex factors add independent information on evolution. The information provided by the tumour's grade highly correlates to that of the stage, and therefore it was not selected in the multivariant analysis.
The risk of suffering a second primary neoplasia after bearing a prostate cancer has been evaluated. The study patients attended the Hospital La Fe and were diagnosed between 1984 and 1992. There was a total of 223 prostate neoplasias, 22 of which had associated a second neoplasia and in 12 cases, corresponding to seven tumoral locations, prostate cancer was the first pathology to be diagnosed. Tumours observed were compared to those expected, according to the incidence rates appropriate for each age group and tumoral type, taken from the Spanish section of "Cancer Incidence in Five Continents", 1987. An excess of second neoplasias for vesical, kidney, CNS, bone and lymphoma tumours was found. In most cases, the second tumour was diagnosed between 6 to 12 months after diagnosis of prostate cancer. The patient's prognosis is dependent of the second neoplasia. The possible mechanisms of these associations are discussed in the light of state-of-the-art knowledge.
The ultimate mechanism of action for all substances with the ability of modifying the activity of smooth muscle is an increased or decreased intracellular concentration of Ca2+. This report presents an "in vitro" study where the dependency on extracellular Ca2+ for the spontaneous activity of the detrusor muscle was investigated, and also the changes that calcium channel blockers can exert on it. The study concludes that the tonic component of the spontaneous activity depends on the Ca2+ intracellular deposits while the physical activity depends on Ca2+ entry from extracellular space. This entry of Ca2+ from the outside is not inhibited by the action of Ca2+ channel blocking agents.
Prospective, randomized study in 96 patients undergoing urologic endoscopic surgery to assess the efficacy of two antimicrobials, pefloxacin and ceftriaxone, in the prevention of urinary tract infections. The disease most frequently prompting surgery was vesical tumour and prostate adenoma. All patients had sterile pre-operative urine. Drugs were given endovenously two hours prior surgery in one single dose. Prophylactic efficacy was measured through urine culture before removal of the catheters. Incidence of bacteriuria greater than 100,000 colonies/ml was 20% for the pefloxacin group compared to 15.2% for ceftriaxone. These differences were not statistically significant (Squared-chi test). These results show that pefloxacin is as effective as ceftriaxone in the prophylaxis of endoscopic urological surgery. A single dose schedule was not entirely suitable to reduce post-operative bacteriuria.
Review of one case of Burkitt's lymphoma in a 60 year-old male diagnosed with a renal tumour based on the symptomatology, intravenous urography (IVU), ultrasound and CT. In spite of the chemotherapy applied, the patient died 31 days after hospitalization. Burkitt's lymphoma is an infrequent tumour in our setting and renal invasion is rarely observed. The tumour's nature is neither revealed by IVU or ultrasound, CT being the most appropriate imaging technique showing a mass of decreased density that surrounds and infiltrates the tumour. The therapeutical approach for renal tumours is the same as for Burkitt's lymphoma. Besides the rarity of Burkitt's lymphoma, our patient was an atypical case for the age of presentation, early stage of renal invasion and fulminant evolution.
Presentation of one case of a 40 year-old, homosexual, AIDS diagnosed male with extrapulmonary tuberculosis (lymphatic nodes) and prior history of gonococcal urethritis, brain toxoplasmosis, molluscum contagiosum and pneumonia by Pneumocystis carinii. A purpura-type lesion with inflammatory features appeared in the foreskin which was diagnosed as primary Kaposi's sarcoma of the penis. The article explains the clinical signs and symptoms, laboratory data, histological findings, and it reviews the literature.
Primary adenocarcinoma of the bladder is a rare tumor type. Histologically it can be mucinous, signet ring cell or clear cell. When diagnosed, it is in the advanced stages and carries a poor prognosis because of its aggressive nature. We report on 9 cases with primary adenocarcinoma of the bladder (2 signet ring cell and 7 mucinous tumors). Those with the advanced stage had a mean survival of 13 months. Of the remaining 4, one survived up to 6 years. This patient had a medium stage tumor and had undergone radical treatment.
Idiopathic granulomatous orchitis is a rare testicle lesion of unknown etiology. This paper illustrates 10 cases studying their presentation, location, ultrasound and histological diagnosis and therapy. A testicular injury background and self-immune reaction appear as likely causes of this entity. Differential diagnosis with testes malignant tumours can only be reached after orchiectomy and a subsequent histological examination.
Between 1980 and 1991, 504 transplantations were performed in our hospital. All patients received pre-surgical therapy with antibiotics. The total incidence of surgical wound infection was 15 cases (3%). After reviewing all parameters that could have been involved in the development of these infections, it become apparent that diabetes mellitus, more than one transplant in the same patient, development of haematoma in the wound and presence of urinary fistulae were statistically significant (p < 0.05). On the other hand, the use of the different immunosuppressive regimes (azathioprin and cyclosporin) and acute tubular necrosis showed no statistical significance (p > 0.05); also, no relationship was found between infection and acute graft rejection.
Four cases with high flow priapism are described herein. Patient evaluation included intracavernal blood-gasmetry, echo Doppler, selective arteriography of the pudendal artery. Three patients had a previous history of trauma and one patient was on psychotropics. The alpha-agonist drugs and the different shunt techniques did not achieve detumescence. Two embolization procedures of the internal pudendal artery were performed with good long-term results. The other two cases achieved spontaneous detumescence. No complications or secondary erectile dysfunction were observed.