Biomedical subjects

J Virseda Rodríguez

Publications and source records attributed to J Virseda Rodríguez.

9 recordsLinked to original sources

PubMed2005

[Urachal pathology: an overview review and report of three clinical cases].

With the use of these two clinical cases (cyst and urachal adenocarcinoma) we did an overview of the urachal pathology. The urachus cyst is usually asyntomathic, it's detected randomly when we do other diagnostic tests or when we have any complications. The urachal adenocarcinoma is a rare pathology, it usually exhibit hematuria and we need to follow the same diagnostic tools as we use in vesical tumors (cystoscopy and transurethral vesical resection). Adenocarcinoma of the dome of the bladder is the main differential diagnosis. Partial cystectomy is the first choice treatment. Quimiotheraphy and radiotheraphy offer poor results.

Adenocarcinoma↗

PubMed1999

[Artificial sphincter implantation in women with urinary incontinence using a combined abdomino-vaginal approach].

OBJECTIVE: The artificial sphincter has been utilized for urinary incontinence due to intrinsic sphincteric insufficiency, with good fixation of the urethra and a maximum urethral closing pressure of 20-30 cms H2O, or after failed attempts at correction using other techniques. This procedure is difficult to perform since the patients have generally undergone several operations and it is necessity to prepare the cleavage between the urethra and vagina. We propose a modified combined vaginal and suprapubic approach of the technique described by Appell and Abbassian in 1988 for enhanced exposure of the urethra and bladder neck and easy access. METHODS: The modified combined abdominovaginal approach has been utilized in 18 females aged 16-62 years since 1995. RESULTS: 16 patients were continent (88%). One patient (5.5%) required removal of the artificial sphincter due to infection. Another patient (5.5%) has mild incontinence and requires 2 pads a day. Four patients (22%) with detrusor instability are receiving anticholinergics. Three patients (16%) with an underlying neurogenic incontinence require intermittent catheterization. Fourteen patients (77.7%) have type III stress urinary incontinence. We performed the Kelly procedure in 10 patients (55.5%), the Marshall-Marcetti-Kranz in 7 (38.8%), Gittes in 3 (16.6%), and 2 patients (11.1%) had a sling procedure. Two techniques were simultaneously performed in some patients. CONCLUSIONS: Although the number of patients in this series is small, the fact that only one case required removal of the artificial spincter due to infection indicates that this is a useful alternative approach that significantly facilitates implantation of the artificial sphincter in these patients.

Abdomen↗

PubMed1998

[Suprarenal surgical pathology. Experience of 10 years and review of the literature].

OBJECTIVES: Our experience with 34 patients who underwent surgery of the adrenal gland over the last 10 years is presented. The most important clinical and pathological aspects are analyzed, particularly from the perspective of surgery, and the literature on the different pathologies observed in our series is reviewed. METHODS: A retrospective study was conducted to analyze the clinical features, analytical and hormonal data, imaging technique findings, types of anesthesia, surgical approaches, intra and postoperative morbidity and mortality, course of the disease, and pathological diagnosis. RESULTS: 53% were female. Mean age was 48.8 years. Left-sided involvement was more prevalent (70.7%). The most common pathology was adrenal adenoma (21 pts), followed by metastasis (4), cysts-pseudocysts (4), primary carcinoma (2), pheochromocytoma (1), etc. Hyperaldosteronism (16 pts) was the most common hormonal disorder; 2 patients had Cushing's syndrome, 2 virilizing syndrome, 1 pheochromocytoma, and 13 patients had a nonfunctioning tumor (3 were incidentalomas). The mean size and weight were 5.6 cm and 21.1 gm, respectively. Adenomas were the smallest tumors and those that weighed the least (mean 2.5 cm; 11.5 gm). Primary carcinomas were the largest tumors (mean 18 cm; 52 gm). US and CT were diagnostic in 56% and 100% of the cases and indicated the size of the mass correctly in 75% and 77%, respectively. Special anesthetic was required in 31%; nitroprusside, phenoxybenzamine, labetolol, corticosteroids and spironolactone were administered according to the hormone disorder. Lumbotomy via the 11th or 12th rib was the most common approach (58.7%), followed by the subcostal and transpleuro-diaphragmatic approach (14.7%, 11.7%, respectively), etc. The mean operating time was 162.2 min; adenoma of the adrenal gland required the shortest operating time (133.06 min), while carcinoma of the adrenal gland required the longest (405 min). Some type of intraoperative event arising from the hormonal disorder was observed in 44.2% of the patients. At 45.1 months mean follow-up, 70.5% of the patients were asymptomatic, arterial hypertension persisted in 11.7% and there were 5 deaths (all cases had a malignant tumor). CONCLUSIONS: The incidence of adrenal gland disease in our series is not unlike that reported in the literature. CT and complementary US are the diagnostic imaging techniques of choice. CT, moreover, has demonstrated a higher specificity. The surgical approach utilized was based on the pathological condition for which surgery had been indicated. The posterolateral and transpleurodiaphragmatic approaches were utilized for small tumors and no remarkable events were observed during the procedure. The anterior and combined approaches were utilized for large or bilateral tumors or obese patients. Our morbidity rate is not unlike that reported in the literature and basically depends on the chronic disease of the patient, type of hormonal disorder and size or malignant nature of the tumor.

Adolescent↗

PubMed1998

[Wilms tumor in adults. Case description].

OBJECTIVE: To report a case of adult Wilms' tumor, a kidney tumor that is more common in children and has a scanty incidence in adults. METHODS/RESULTS: A case of Wilms' tumor in a young male, aged 16 years, is described. The patient underwent partial surgical resection initially and nephrectomy due to tumor recurrence, with postoperative chemotherapy and radiotherapy. CONCLUSIONS: Although approximately 200 cases of adult Wilms' tumor have been reported in the literature, few meet currently accepted diagnostic criteria. The diagnosis of adult Wilms' tumor based on the findings of currently available diagnostic methods is only presumptive until the surgical specimen is analyzed. Most cases are treated as renal tumor and it is the findings of the pathological analysis that defines its nature and the need for chemotherapy and/or radiotherapy, as well as long-term follow-up. The application of therapeutic protocols for children to adults has not obtained the same percentage of cure or prognosis, although a large multicenter study is warranted to confirm the foregoing.

Adolescent↗

PubMed1995

[Survival of patients with upper urothelial tumor].

OBJECTIVE: A descriptive analysis of 35 patients with transitional cell carcinoma of the upper urinary tract is presented. The actuarial survival was analyzed to determine which circumstances associated with superficial bladder cancer had a prognostic significance. METHODS: The records of 35 patients with upper urothelial tumor diagnosed from 1987 to 1993 were retrospectively analyzed. A descriptive statistical analysis was performed on all the variables. Correlation was determined by Pearson's Xi2 test, Yates' and Fisher's exact test. McNemar's test was used to determine which diagnostic method had the highest yield. The actuarial survival data were analyzed with the Kaplan-Meier and Mantel-Haenzel test. RESULTS: Patient mean age was 67.74 yrs, mean follow up was 26.83 months, 40% were ureteral tumors, 25.7% were pelvic tumors, 60.6% were superficial tumors and 62.6% were GI and GII, 48.5% were associated with bladder tumors and no correlation was found between the grade and stage of bladder relapses and the upper urinary tract tumors. Intravenous urography demonstrated function was abolished in 45.5%. Cytology gave the highest diagnostic yield (84.6%). Nephroureterectomy with perimeatal cystectomy was the surgical technique most frequently used (57.1%). To date, 71.4% of the patients have survived. Significantly women demonstrated the most undifferentiated cellular grade (p < 0.001), although no prognostic value was found for sex. 95% of the patients with non-infiltrating tumor stages and 95% of the patients with GI-GII tumors survived, whereas 61.5% of the patients with infiltrating tumors and 58.3% of those with GIII tumors did not survive (p < 0.002). Evidently, the grade of cellular differentiation and the stage of infiltration were interrelated (p < 0.002). Analysis of the actuarial survival data showed that the probability of survival after 24 months (mean follow up) was 67.07% and the probability of reaching 74 months (maximum follow up) was 60.04%. CONCLUSIONS: After a comparative analysis of the survival with the Mantel-Haenzel test, it was found that the grade of cellular differentiation (p < 0.001) and stage of infiltration (p < 0.01) had significant differences in the survival curves.

Actuarial Analysis↗

PubMed1995

[The posterior transpleural-diaphragmatic approach in adrenal pathology].

OBJECTIVES: The diversity of the pathologies involving the adrenal gland have led to a variety of surgical approaches to these bodies. The deep anatomic location of the adrenals limits the surgical field. The most direct approach is the posterior lumbar, described by Young in 1936. In our experience, the posterior transpleurodiaphragmatic lumbar approach, described by Novick in 1989, has proved to be very useful for resection, particularly of the right adrenal, and does not increase the morbidity of the procedure. Our results are presented herein. METHODS: The posterior transpleurodiaphragmatic approach was utilized in 11 patients; 9 had functioning adrenal adenoma (7 Conn's primary hyperaldosteronism, and 2 Cushing's syndrome), 1 had a nonfunctioning adrenal adenoma of 5 cms and 1 had adrenal metastasis from carcinoma of unknown origin. RESULTS: There were minor postoperative complications (2 seroma, 1 paralytic ileus and 1 limited atelectasis) that were resolved without difficulty. CONCLUSIONS: The posterior transpleurodiaphragmatic access to the adrenal gland is a useful procedure. It requires no thoracic tube or retroperitoneal drainage, muscle incisions are minimal resulting in less discomfort postoperatively, early recovery and shorter hospitalization. For all the foregoing reasons, this surgical approach must be taken into account together with the oblique lumbar approach with resection of the 11th or 12th posterior lumbar ribs, through the pleura and the diaphragm or not, or the laparoscopic approach currently being developed.

Adenoma↗

PubMed1993

[Prostatic melanosis].

We report a case of prostatic melanosis in a 68-year-old patient. Although uncommon, some authors have reported an incidence of 4-10% for benign pigmented lesions of the prostate. It is important to distinguish this from the blue nevus where melanin deposits only involve the prostatic stroma. We discuss the theories explaining the origin of melanin in the prostate and its presence in the epithelium. The gross and microscopic findings of these conditions are described.

Aged↗

PubMedDate not supplied

[Sexual activity and surgery of benign prostatic hyperplasia].

OBJECTIVE: To analyze the sexual activity of patients before and after surgery for BPH and to determine the factors influencing sexual activity after prostatectomy. METHODS: The sexual activity of 189 patients were evaluated before and 6 months after surgery for BPH. Sociodemographic variables, severity of prostatic symptoms (IPSS), quality of life (SF-36) and surgery-related data were also analyzed. RESULTS: Before surgery, 59% of the patients had sexual activity; 70.9% of patients < 70 years old and 41.6% of those > 70. Of the patients with associated chronic pathologies, 45.5% had no sexual activity and complained of vascular and CNS problems (50% in both cases). A higher proportion of patients with IPSS > or = 20 showed changes in sexual activity (42.3%). The SF-36 quality of life scores for General Health (p = 0.0018), Physical Performance (p < 0.01) and Vitality (p = 0.007) were higher in patients who preserved sexual activity. After surgery, 5.6% of previously active patients reported no sexual activity and 66.2% of those who had no sexual activity prior to surgery recovered sexual potency. Maintenance or recovery of sexual activity after surgery was associated with a better quality of life prior to surgery, basically in the SF-36 Health Survey for Vitality (p < 0.0001), Social Function (p = 0.006), General Health (p = 0.009) and Mental Summary Index (p = 0.005), an improvement in the IPSS score (p = 0.02) and the absence of postoperative complications (p = 0.016). CONCLUSION: Sexual activity in patients with BPH is higher in the younger patients with no associated pathologies, milder prostatic symptoms and better quality of life. A high percentage of patients with no sexual activity prior to surgery reported recovery of sexual potency after surgery. Sexual activity after surgery is associated with a better quality of life before surgery, basically in the mental aspects, improvement of prostate symptoms and the absence of postoperative complications.

Aged↗

PubMedDate not supplied

[Adenocarcinomas of the urachus].

Tumors of the urachus account for 1% of all malignant bladder tumors and 20-39% of primary adenocarcinoma of the bladder. We report 4 cases (3 males, 1 female) of urachal adenocarcinoma. One of the patients had a signet ring cell tumor. The most common clinical sign was a suprapubic mass followed by hematuria. In three cases, cystoscopy revealed a mass at the level of the bladder dome. The IVP was normal in all but one patient in whom a filling defect at the level of the dome was evidenced by the cystogram. In one patient, CT revealed a fistulous track between the bladder and the tumor mass. Treatment was by surgery in all of the cases. Supratrigonal cystectomy and en bloc resection of the anterior infraumbilical abdominal wall was performed in 3 cases, followed by wide cystoplasty using intestine in 2 cases. One patient underwent radical cystectomy and Bricker urinary diversion. Two patients are alive and disease-free at 2 and 10 years, respectively. The other two patients have died; one following operation for high gastrointestinal hemorrhage, and the other at two years from generalized metastasis. The clinical findings reported in the literature, the diagnostic protocols and treatment of these tumor types are discussed.

Adenocarcinoma↗