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Biomedical subjects

J M Rodríguez Luna

Publications and source records attributed to J M Rodríguez Luna.

At least 19 recordsLinked to original sources
PubMed2004

[Primary testicular lymphoma. Report of a new case and review of the literature].

Primary testicular lymphoma is an uncommon testicular tumour that accounts for no more than 9% of all testicular tumours in those series with higher incidence; testicular lymphoma as haematopoietic tumours are also rare accounting for just 1% of all lymphomas; but due to their highly malignant histopathology they may become highly aggressive tumours. Patient age at presentation is over 60 years old which makes it the most frequent tumour for this age group. There is no standard protocol to treat this malignancy due to lack of extensive series. We contribute one case and make a literature review discussing the current therapeutic trends for this disease.

Humans↗
PubMed1996

[Treatment of complex fistula and urinary stenosis in renal transplantation].

OBJECTIVES: Urological complications in renal transplantation occasionally denote the failure of a technique intended to provide the patient on hemodialysis a significant improvement of quality of life. Our experience in the management of these complicated cases which could not be resolved by conventional measures is described. METHODS: Since the transplantation program began, our department has performed 530 renal transplants. There have been 40 fistulae (7.5%) and 23 stenoses (4.3%) of graft urinary tract. All the foregoing complications had been treated by endourological procedures (nephrostomy or ureteral stent) and/or simple ureteral reinsertion. There were 5 unresolved or recurrent fistulae (0.9%) and 2 stenoses (0.4%) that were repaired using the recipient's ipsilateral urinary tract (6 pyeloureterostomies and 1 pyelopyelostomy). RESULTS: Good results were achieved in all of the cases with adequate urinary tract function. CONCLUSIONS: Urological complications following renal transplantation can be successfully treated by surgical correction (pyeloureterostomy or pyelopyelostomy).

Constriction, Pathologic↗
PubMed1995

[Endourologic treatment of uretero-ileal stenosis].

OBJECTIVES: Ureterointestinal stricture represents a serious problem whose management has traditionally been by open surgery. Endourological treatment is an alternative that is generally free from the complications of open surgery, but with a lower success rate. The efficacy of endourological treatment is analyzed in 14 cases of ureteroileal stricture (12 patients) and the different treatment options are discussed. METHODS: Ureteroileal stricture was managed endourologically in 9 of 13 cases (69%) by dilatation (6 cases), incision+dilatation (2 cases) and stenting (1 case). RESULTS: Of the 6 cases submitted to dilatation, 3 recurred at 6 months, 2 remained patent at 18 and 24 months, respectively, and 1 was lost to follow up because the patient underwent reimplantation (40% success rate). The two cases submitted to incision are patent at 18 and 19 months, respectively. CONCLUSIONS: The overall success rate for endourological treatment of ureteroileal stricture is 28% (4/14 cases) at 19 months mean follow up.

Aged↗
PubMed1995

[Intraluminal invagination technic for the incision of ureterointestinal stenosis].

OBJECTIVE: This paper describes the endoscopic incision of uretero-ileal anastomotic strictures by a combined approach (percutaneous antegrade and endoscopic retrograde) using the intraluminal invagination technique over a balloon dilatation catheter. METHODS: The different steps of the surgical procedure of incision of the stenotic segment of different techniques of ureteroileal diversion (Bricker, Camey, ureterosigmoidostomy) are described in detail. Endoscopic images and those from the image intensifier are shown. RESULTS: Of the 6 cases described herein, incision was achieved in 5 and in 1 case stenting of the stenotic segment could not be achieved. CONCLUSIONS: Intraluminal invagination of the stenotic segment considerably facilitates endoscopic incision.

Catheterization↗
PubMed1994

[Diagnostic yield of Echo-Doppler in dysfunction of the grafted kidney].

The study's goal is to analyze the usefulness of Eco-Doppler in the knowledge of renal graft hemodynamics and the description of its dysfunction. 234 examinations were performed in 110 patients. Acceleration, mean rate (MR), maximum systolic rate (MXSR) and minimal diastolic rate (MNDR), as well as resistance index (RI) and pulsatility index (PI) were determined in the external iliac, renal, segmentary, interlobular and arcuate arteries. RI and PI, as well as MXSR and the acceleration are higher in the extra-parenchymatous versus the intra-parenchymatous beds. Peak MR and MNDR values are reached in the renal artery. Termino-lateral to external iliac arterial anastomosis conditions higher MXSRs in the renal artery as opposed to termino-terminal to hypogastric artery (p < 0.05). In the arcuate artery, RI > 0.8 is reached in 51.6% of acute tubular necrosis (ATN), 46.9% of acute rejections (CR), 46.3% of chronic rejection (AR), 21% of grafts with cyclosporin-induced nephrotoxicity (NFX) and 12.5% of normal functioning kidneys isolated chance analysis with Eco-Doppler does not distinguish between AR and ATN. A dysfunctional graft with an RR in the arcuate artery of nearly 9.7 suggests NFX, but AR with interstitial predominance cannot be ruled out.

Acute Disease↗
PubMed1994

[Surgical complications in 479 renal transplantations].

Exposition of results obtained from the review of the surgical complications found in a series of 479 renal transplantations performed between 1978 and 1992 in our centre, although some of them lack clinical relevance. There was fluid accumulation in 69 patients, distributed between 31 perirenal haematoma. 17 lymphocele, 13 urinoma, 5 perirenal abscesses and 3 mixed. 27.7% required no action. Frequency of renal rupture was 18 cases, 9 due to acute rejection and 9 to vascular thrombosis. Incidence of urinary obstruction was 4.8% with 5.8% of urinary fistula. With regard to the surgical wound, 9 infections, 7 haematomas, 1 eventration and 1 necrotizing fasciitis were observed. Vascular complications consisted in 10 arterial thrombosis, 10 venous thrombosis, 5 mixed thrombosis and 31 arterial stenosis. Treatment instituted for the various cases, its evolution, and an statistical study of risk factors are illustrated.

Adolescent↗
PubMed1993

[Laparoscopic transplantectomy of renal graft. Experimental model].

Renal transplant nephrectomy carries a high morbidity and mortality. Conceptually, graft removal by laparoscopy is a logical less invasive alternative. We have developed an experimental model for renal autotransplantation in the pig, with laparoscopic graft removal eight weeks following autotransplantation. Although the clinical indication for laparoscopic nephrectomy of a failed graft will provoke controversy, a nonfunctioning renal graft with intolerance and no rupture or infection late post-transplantation theoretically could be the indication for this procedure.

Animals↗
PubMed1993

[Treatment of recurrent bladder surface tumors with laser Nd:Yag: a single-year experience].

Management of surface vesical tumours using laser photocoagulation has proven to be a safe and effective method. The technique can be performed under anaesthetic sedation and in the outpatient clinic environment thus allowing a considerable cost saving and the reduction of hospital's waiting lists. Throughout 1990, 47 patients with relapsing vesical tumours were treated in 55 sessions. Most cases were performed on ambulatory patients with a low complications rate and an estimated saving of 18,326,400 pesetas as compared to transurethral resection.

Adult↗
PubMed1992

[Extracorporeal arterial reconstructive surgery in complex vasculo-renal pathology].

Herein we describe a case of a 23-year-old male patient with severe hypertension that was refractory to medication, a hypoplastic left kidney and complex renovascular disease. Patient evaluation revealed stenosis of the right renal artery and saccular aneurysms of its three branches. Treatment with converting enzymes was discarded due to the risk of azotemia and the complex vascular disease advised against percutaneous transluminal angioplasty. He was therefore submitted to ex situ vascular repair (bench surgery) using the hypogastric artery with its three branches and autotransplantation in the right iliac fossa. The foregoing procedure achieved excellent results. The arterial pressure and overall renal function returned to normal 15 days postoperatively. In our view extracorporeal surgery is the procedure of choice in patients with complex renovascular disease involving the small branches of the renal artery.

Adult↗
PubMed1990

[New protocol for local staging in bladder carcinoma. Ultrasonographic, cytological and histopathological correlation].

The diagnostic error using classical methods in the staging of bladder tumors has been reported to range from 20 to 50%. With the advent of new diagnostic imaging techniques (CT and MRI) the accuracy rate has increased from 62% to 83%. Forty-eight patients with bladder tumors were submitted to a protocol correlating ultrasound (US), cytological and histopathological findings. Tumor staging was also performed by CT in 10 patients and by MRI in 3. Transurethral ultrasound distinguished the superficial from the infiltrating bladder tumors in 100% of the cases. The accuracy rate for US was greater than that of CT (90% versus 70%) and MRI although the difference was not statistically significant with respect to MRI. When cold biopsy was combined with transurethral US, the correlation of overall staging (level of infiltration and degree of non-differentiation) was 85% for the superficial tumors and 82.3% for the infiltrating tumors. Furthermore, no significant difference was observed between the cytological analyses of urine from micturition or lavage. Cytologically, the number of positives increased with the degree of tumor non-differentiation. These findings show that transurethral US combined with cold biopsy permits determining the stage as well as the degree of non-differentiation of the tumor with minimum error, which is crucial in determining the approach to tumor management utilizing the new treatment protocols for bladder carcinoma.

Adult↗
PubMed1990

[Interventional echography].

We describe the different interventional ultrasonographic techniques available in our unit and report the results achieved in 254 puncture-aspiration of abdominal and retroperitoneal masses, 158 ultrasonically-guided nephrostomies, 36 percutaneous drainage of purulent or serous collections, 114 biopsies of orthotopic kidneys and 129 renal grafts. We analyze the techniques' safety as well as their complications.

Humans↗
PubMed1989

[Infiltrating transitional carcinoma of the bladder. Is the P/T ratio a reliable index to evaluate the effectiveness of preoperative radiotherapy on tumors of the bladder?].

To determine the efficacy of preoperative radiotherapy, we used the following index: change in the clinical relative to the pathological state. We analyzed the series of our department, which was comprised of 175 patients who had undergone radical cystectomy. The P/T ratio was obtained in 138; it dropped in 26 (19%), remained unchanged in 57 (41.3%), and increased in 55 (40%). Analysis of the disease-free interval and survival by Kaplan and Meier's method showed a significantly higher difference for the patient groups with tumor Po + P less than T and P = T than for those with P greater than T, and there were no significant differences between the Po + P less than T and P = T patient groups. However, analysis of the TLE and survival curves for group P = T by comparing the three treatment regimens utilized showed no evidence that preoperative radiotherapy prolongs both parameters. The same finding was observed for the group whose P was greater than T. Evidently, prognosis is good for the group whose P dropped. However, we do not believe that it is ascribably to the beneficial effects of radiotherapy on the tumor. We believe that this is mainly due to the fact that, by definition, patients with more aggressive tumors are excluded. In our series, P3 and P4 tumors are classed under the groups whose P is "equal to" or "greater than".

Carcinoma, Transitional Cell↗
PubMed1989

[Infiltrating transitional carcinoma of the bladder. Prognostic value of anatomopathologic staging and therapeutic possibilities].

The pathologic stage of the tumor is the most reliable parameter on which to make a diagnosis in patients with infiltrating transitional cell carcinoma of the bladder. Pathologic staging classed twelve as PO, 22 as P1, 28 as P2, 63 as P3, and 36 as P4. No significant difference exists as to survivorship in patients with P0, P1, and P2 tumors. However, when the foregoing 3 groups are considered as one single group, these present a significantly higher survival rate than that observed for tumor class P3 and P4. For the group comprised of patients with tumor class P0 + P1 + P2, the highest probability of survival corresponds to the group treated with 2,000 rads, and the lowest corresponds to the group treated with 4,500 rads, although the difference observed is not significant. The treatment regimen given to patients with tumor classes P3 and P4 was observed to have scant influence on patient survival. The same findings were observed with respect to the disease free intervals. Patients with P2 tumors showed a very good course regardless of the treatment regimen they received. Thus, the bladder may be preserved in those patients with a proven P2 tumor. When the tumor has spread to perivesical fat or regional lymphatics, systemic chemotherapy is warranted. This must be instituted immediately postoperatively regardless of the loco-regional regimen chosen because micrometastases are very likely to exist.

Carcinoma, Transitional Cell↗
PubMed1989

[Transitional infiltrating carcinoma of the bladder. Local recurrence and metastases. Analysis of 175 cases treated with radical cystectomy].

Although much has been written on transitional cell carcinoma of the bladder, little has been reported on its metastasis. We reviewed the records of 175 patients, 4 of whom died postoperatively. All patients had been followed until their death and the surviving patients recently evaluated. Sixteen patients were lost after a long follow-up. Most of the metastases were diagnosed within 18 months after the cystectomy. Sixty-one percent of the patients presented bony metastases. The risk of metastasis is greater for sessile tumors, and increases with the degree of vesical wall infiltration, anaplasia and lymph node involvement. Evidence of lymph node involvement is not necessary for metastasis to exist. There were significantly fewer patients who died with metastasis in the patient group that did not receive preoperative radiotherapy in comparison with the other two patient groups. Of the 11 patients who revealed no evidence of tumor in the surgical specimen, 2 metastasized, indicating that metastasis was present prior to cystectomy. Treatment with cytostatic agents is the only effective therapy against distant metastasis. In our view, all patients with a tumor invading perivesical fat or who present lymph node involvement, regardless of tumor stage, should receive chemotherapy after cystectomy as early as patient condition permits.

Carcinoma, Transitional Cell↗
PubMed1989

[Transitional infiltrating carcinoma of the bladder significant in its spread to regional lymph nodes].

We analyzed the course of 170 patients, 136 of whom underwent bilateral lymphadenectomy. Data was obtained to define N of the TNM classification in 126 patients. The remaining patients (10 whose pathologic work-up was unavailable; 32 who did not undergo lymphadenectomy) were classified as Nx. Metastasis was diagnosed during follow-up in 60% of those with positive lymph nodes. In our view, metastasis was already present in these patients prior to the surgical procedure. The survival rate is significantly higher for the patient group without lymphatic spread compared to the group with negative lymph nodes and Nx. Evaluation of the patient group without lymphatic spread revealed a higher survivorship for those who received 2,000 rads (24%) prior to cystectomy compared to those who received 4,500 rads (17%) and those who received no irradiation (12%). However, there is a lower incidence of metastasis for the patient group submitted to surgery alone (50%) compared to those that received preoperative radiotherapy (73% and 67% for those treated with 2,000 and 4,500 rads, respectively). Furthermore, preoperative radiotherapy did not reduce the mortality rate which was 83% for those who received no radiotherapy, 73% for those who received 2,000 rads, and 75% for those who received 4,500 rads. However, it may seem contradictory that a radiation dose of 2,000 rads appears to be more effective in these patients than a dose of 4,500 rads which is theoretically closer to the ideal dose for treatment of node involvement. Patients with positive lymph nodes must be treated with chemotherapy as soon as they have recovered from the surgical procedure since 3 out of 5 patients have undetected micrometastases.

Carcinoma, Transitional Cell↗
PubMedDate not supplied

[Infiltrating transitional carcinoma of the bladder (4). Our approach to stage pT2 and critique of other risk factors. Multifactorial analysis].

From the analysis of our experience with pT2 and pT3a tumours it could be deduced that the former have better prognosis. The papillary appearance, invasion in a wide front and extent, whether with good or moderate differentiation, in T2 are signs of good prognosis, as well as the non-existence of unilateral dilation or an effaced kidney. Considering the good evolution obtained with radical cystectomy only, these patients should be recruited for study in order to see whether evolution with bladder preservation is similar. Patients with pT2 tumours should not be included in protocols to evaluate the efficacy of adjuvant therapies used with surgery. The evolution is not equivalent to that expected in tumours of deeper invasion.

Antineoplastic Agents↗