[Why do alkaline phosphatases increase?].
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Biomedical subjects
J Sánchez Rodríguez
Publications and source records attributed to J Sánchez Rodríguez.
[Effect of complete androgen block before radical prostatectomy for cancer of the prostate].
OBJECTIVE: To evaluate the efficacy of complete androgen deprivation in downstaging advanced localized prostate cancer prior to radical prostatectomy. The study evaluated positive margins, prostate volume, PSA and histological changes. METHODS: We evaluated 22 patients with stage T2 (13 pts, 59%) and T3 (13 pts, 59%) prostate cancer treated with complete androgen deprivation for at least 3 months prior to radical prostatectomy. RESULTS: PSA levels dropped in 97% (51.1-1.4 ng/dl) after treatment (p < 0.001); 20 (90%) had PSA < 3 ng/dl, including 3 cases (14%) with positive nodes; 2 cases (9%) with pT2 tumor had PSA > 3 ng/ml. The mean prostate volume dropped 33% from 52.6 to 35.2 cc (p < 0.001). Of the 22 cases, only one T2 (4%) was staged down; 10 (45.5%) had positive margins versus 17 (53%) of the control group (p > 0.05). The Gleason score increased in 19 (86%) and 90% had cytoplasmic vacuolization and pyknosis with moderate nuclear lysis in 50%. CONCLUSION: Neoadjuvant treatment significantly reduces PSA levels and prostate volume. The decrease in PSA levels, however, does not appear to have a direct correlation with the final pathologic stage. Tumor stage changed slightly in patients with T2 tumors and no response was observed in those with T3. Patients receiving neoadjuvant therapy had a slight advantage with respect to positive margins. The histological findings were suggestive of cellular lysis.
Adenocarcinoma↗
[Spontaneous rupture of transplanted kidney. Experience with 500 transplants].
We reviewed a series of 500 transplants and found 21 (4.1%) cases of graft rupture. All the renal grafts had been harvested from cadavers. Hemodialysis was required in 18 (85%), acute rejection developed in 12 and acute tubular necrosis in 12 (3 were related to percutaneous maneuvers for biopsy or PCN). All cases developed acute pain and oligoanuria. No significant difference was observed relative to ischemia time or HLA typing. Concerning immunosuppression and graft rupture, a significant difference was observed for the group that received low dose CsA combined with triple therapy (3 rupture grafts, 14.2%) versus the high dose CsA and steroid treated group (11 ruptured grafts, 52.3%), p < 0.01. Twenty grafts had ruptured within the first 15 days following transplantation and one at 8 months. Graft removal was warranted in 8 (38%) and conservative surgery in 12 (57%). Two grafts (16%) were lost and 1 patient (4.7%) died without undergoing surgery. Graft rupture is a severe complication that warrants immediate surgical management. Conservative surgery is a valid alternative in those cases with a viable graft.
Adolescent↗
[Idiopathic retroperitoneal fibrosis: combined steroid and endourologic treatment].
Review of 7 patients with idiopathic retroperitoneal fibrosis (IRF), treated with a combination of corticosteroids (6-methyl-prednisolone) and endourological procedures. The presentation symptom was lumbar pain in all 7 cases. Mean creatinine (Cr) levels were 5.4 mg/dl, with mean erythrocyte sedimentation rate (ESR) of 114. Three (43%) patients were positive to rheumatoid factor (RF) and had raised IgG. Definite diagnosis was achieved in all cases by CAT, including puncture biopsy in 1; all 7 (100%) cases were bilateral. With an average follow-up of 3 years, clinical evolution is satisfactory in all 7 cases. Mean control Cr is 1.2 mg/dl and mean ESR 19. CAT showed disappearance of fibrotic plaque in all cases. One patient relapsed when maintenance therapy was discontinued but responded again to a new therapy course. No steroid therapy-related complications were seen. The association of conservative steroid therapy and endourological procedures is a very low morbidity, sensible alternative in the management of benign retroperitoneal fibrosis where CAT and MNR are the primary diagnostic techniques.
Adult↗
[Endoscopic cervicotomy in post-prostatectomy sclerosis of the bladder neck].
We treated 23 patients with bladder neck sclerosis following treatment of prostatic adenoma by TUR (20 patients, 87%) and adenomectomy (3 patients, 14%). All patients entered a protocol for bilateral longitudinal bladder neck incision (cervicotomy) and injection of orgotein in the area of incision. Of these, 21 patients were evaluable; 18 (85%) had no recurrence, symptoms remained unchanged without ring in 2 (10%) and there was 1 (5%) recurrence. The results achieved by this simple technique combined with local antiinflammatory therapy make it the treatment of choice for this pathological condition.
Aged↗
[Renal carcinoma with tumor thrombus in the vena cava and auricle. Experience and review].
OBJECTIVES: To report on our experience in the treatment of renal cell carcinoma with vena caval or right atrial extension, with special reference to the level of involvement and the surgical technique indicated for each case. METHODS: From early 1975 to April, 1997, 212 patients underwent surgery for renal cell carcinoma. Of these, 15 patients (11 male, 4 female), aged 27 to 73 years, had a tumor thrombus extending to the inferior vena cava. The tumor was located in the right kidney in 11 patients and in the left kidney in 4 patients. The tumor thrombus was infrahepatic in 10 cases, it extended beyond the suprahepatic veins in 3 cases, and 2 cases showed right atrial extension. The 10 patients with infrahepatic caval thrombus underwent radical nephrectomy with cavotomy and thrombus removal. In the remaining 5 patients with suprahepatic or atrial extension, thrombus removal was performed via cardiopulmonary by-pass with hypothermic circulatory arrest, with the assistance of a team of cardiac surgeons. RESULTS: Pathological staging showed 2 T3cNoMo, 1 T3bNoMo and 2 T3bN1Mo in the patients who underwent cardiopulmonary bypass. There were 5 T3bNoMo, 2 T3bN2Mo, 1 T3bN2M1, 1 T4NoMo and 1 T4N1M1 in the group of patients with infrahepatic thrombus. There were two postoperative deaths. The overall survival rate was poor. Six patients are alive at 3-26 months' follow-up and 9 have died from disease progression. Patients with lymph node involvement or metastasis at the time of diagnosis had a worse survival rate. CONCLUSIONS: Surgical treatment of renal cancer with vena caval extension is specially difficult depending on the level of involvement, which must therefore be determined with precision. MRI is an effective and noninvasive technique. Tumors with thrombus below the suprahepatic veins can be managed by the direct approach with cavotomy. The use of cardiopulmonary bypass is advocated for tumors with suprahepatic caval or atrial extension. Tumors with caval-atrial extension have a negative influence on survival.
Adult↗