Biomedical subjects

Jorge García Rodríguez

Publications and source records attributed to Jorge García Rodríguez.

At least 19 recordsLinked to original sources

PubMed2006

Urinary CYFRA 21.1 is not a useful marker for the detection of recurrences in the follow-up of superficial bladder cancer.

OBJECTIVES: The objective of this prospective study is to establish an appropriate cutoff value of urinary CYFRA 21.1 assay and to assess its utility combined with voided cytology and/or haemoglobin dipstick in the follow-up of patients with superficial bladder cancer. METHODS: From December 2000 to November 2003, 446 patients in follow-up for superficial bladder cancer (Ta-T1) after transurethral resection of the bladder (TURB) were included in a prospective study. Voided urine specimens were collected 7-14 d before cystoscopy and/or TURB for CYFRA 21.1 (one sample), haemoglobin dipstick (one sample), and cytology (three samples). All samples were processed for CYFRA 21.1 and haemoglobin dipstick according to manufacturer instructions. A control group (n=185) was obtained from patients in follow-up after transurethral resection of superficial disease (without recurrences within the following 6 mo). There were 125 recurrent transitional tumours detected by cystoscopy (34 TaG1; 53 TaG2/T1G1-2; 23 Ta-1G3/Tis, and 15 T2-4). Receiver operator characteristic (ROC) curves were constructed and cutoff values were chosen. Sensitivity, specificity, PPV (positive predictive value), NPV (negative predictive value), and their 95% confidence intervals were calculated. RESULTS: ROC curve analysis based on the previously reported cutoff value of 4ng/ml for CYFRA 21.1 demonstrated a sensitivity and specificity of 43% and 68%, respectively. At a cutoff value of 1.5ng/ml, sensitivity was 73.8% with a low specificity (41%). Further lowering of the cutoff point below 1.5ng/ml did not demonstrate a significant increase in sensitivity. Therefore, this value was chosen as the most sensitive CYFRA 21.1 cutoff point during the rest of the study. Specificity increased when all the patients treated with pelvic radiotherapy or with UTI, urethral catheterisation, and intravesical instillations within 3 previous months were not included in our analysis. CYFRA 21.1 plus cytology and the combination of CYFRA 21.1, cytology, and haemoglobin dipstick demonstrated the highest overall sensitivities, and detected 91.3% of Ta-1G3 tumours and 93.3% of T2-4 tumours. However, there were one muscle-invasive tumour, two T1G3/Tis, three T1G2, and nine T1G1 neoplasms with negative combination of cytology and CYFRA 21.1 (1,5ng/ml). All these tumours were smaller than 2cm in size; most were single tumours. Nevertheless, there were 16 tumours larger than 0.5cm (0.5-2cm), and multiple neoplasms were endoscopically detected in 14 patients. Similar results were obtained through the combination of CYFRA 21.1 (cutoff: 1.5ng/ml), cytology, and haemoglobin dipstick. CONCLUSIONS: In our experience the low sensitivity of urinary CYFRA 21.1, even using lower cutoff values and/or a combination with cytology and/or haemoglobin dipstick, makes its application not very useful as a surveillance tool for superficial bladder carcinoma.

Antigens, Neoplasm↗

PubMed2006

[Neurosyphilis and bladder dysfunction].

OBJECTIVES: Syphilis is a systemic disease the course of which follows successive clinical stages. Central nervous system and spinal cord involvement on late phases may lead to bladder dysfunction. We report one case of neurosyphilis with associated bladder hyperreflexia. METHODS/RESULTS: 51-year-old male with the diagnosis of neurosyphilis consulting for voiding disorders with evidence of detrusor hyperactivity of neurogenic etiology on the urodynamic study. CONCLUSIONS: The differential diagnosis of neurogenic bladder in patients with psychiatric or neurological symptoms should include neurosyphilis. Etiologic diagnosis is obtained by cerebrospinal fluid examination, and the diagnosis of bladder dysfunction by urodynamic study.

Humans↗

PubMed2005

[Relationship between LUTS (lower urinary tract symptoms) and quality of life].

OBJECTIVES: To evaluate the impact of the lower urinary tract symptoms (LUTS) included in the IPSS on the quality of life and to determine the relationship between quality of life or total IPSS score and treatment. METHODS: Retrospective review of the IPSS questionnaire in 125 male patients who had consulted for LUTS between January 2001 and December 2003. Results were included in an Access database. Statistical analyses were done with the SPSS 11.0 software. RESULTS: 17% of the patients showed severe symptoms in accordance to the IPSS score. In the quality of life evaluation grouped into two categories, 88% referred good or indifferent quality of life. In the evaluation of the association between IPSS individual questions and quality of life there was a significant association for all questions. Patients reporting worse quality of life had a 6 times higher risk of receiving treatment. With a mean follow-up of two years, 91% of patients who were not on treatment continued without it. CONCLUSIONS: The most severe symptoms are, the worse the quality of life. The independent parameters that most influenced decision to start treatment were quality of life and total IPSS. Frequency, weak stream and hesitation may explain quality of life on each patient.

Adult↗

PubMed2005

[Spontaneous regression of venous thrombus in a case of renal carcinoma].

OBJECTIVES: To report the first case of spontaneous regression of renal vein and inferior vena cava thrombus in a patient with renal clear cell carcinoma. METHODS/RESULTS: We describe the case of a woman with the diagnosis of renal mass with venous thrombus of the renal vein and inferior vena cava. Extension studies before radical nephrectomy showed regression of the thrombus which was confirmed during nephrectomy. CONCLUSIONS: Spontaneous regression of clear cell renal carcinoma metastases is estimated below 1 % of the cases. This is the first case report of regression of a tumoral thrombus of the renal vein and inferior vena cava.

Aged↗

PubMed2004

[Renal cell carcinoma with late lung and ocular metastases].

OBJECTIVES: We report one case of ocular and lung metastases seven years after radical nephrectomy for renal cell carcinoma. METHODS: The case of a 45-year-old male patient who underwent radical nephrectomy for a localized renal cell carcinoma (T2N0M0) in 1995 was found in a review of malignant renal neoplastic pathology. RESULTS: Seven years later he presented with a lung metastasis requiring neumonectomy, and an ocular metastasis requiring enucleation. He is currently receiving systemic treatment with interferon and interleukin. CONCLUSIONS: Clinical presentation and evolution of metastasic renal carcinoma is very variable, a difference with other neoplasias. Ocular localization is exceptional and may appear long time after primary tumor; clinically, it may be asymptomatic or present with sudden sight loss. MRI, CT scan and retinal examination are the diagnostic methods employed, and treatment may be surgery, brachytherapy or radiotherapy depending on location and size of the lesion.

Carcinoma, Renal Cell↗

PubMed2004

[Treatment of a cavernous hemangioma of the bladder by endoscopical resection].

OBJECTIVES: We report three cases of bladder hemangioma. METHODS: Three cases of cavernous hemangioma of the bladder with pathologic confirmation treated by endoscopical resection. RESULTS: There is no evidence of recurrence in either patient after resection. CONCLUSIONS: The endoscopical treatment of small bladder hemangiomas is an effective treatment.

Adult↗

PubMed2004

[Cystic hamartoma of the renal pelvis: unfrequent finding].

OBJECTIVES: This cystic hamartoma of the renal pelvis is a very unfrequent benign tumor. We report one case emphasizing its histology and performed a bibliographic review. METHODS: Mid age female patient with the incidental diagnosis of a renal mass taking up the pelvis. RESULTS: A radical nephrectomy was performed with the pathologic report of cystic hamartoma of the renal pelvis. CONCLUSIONS: It is a cystic renal tumor with well-defined histologic and immunohistochemical criteria, and it probably does not involve any danger for the patient's live.

Female↗

PubMed2004

[Bladder metastasis of renal carcinoma].

OBJECTIVES: We report the case of a patient who had underwent surgery for a clear cell renal carcinoma 2 years before presenting with metastasic extension to bladder on follow-up. METHODS: Radiological finding of a bladder mass during follow-up after nephrectomy. RESULTS: TURBT was carried out with the pathologic report of clear cell carcinoma, compatible with a primary renal origin. CONCLUSIONS: Bladder is a very rare place for metastasis from kidney tumors. Prognosis will depend on the time of appearance of such metastases.

Aged↗

PubMed2004

[Obstructive urethral angioleiomyoma].

OBJECTIVES: To report one case of urethral angioleiomyoma because of the rare site, and to review its main characteristics. METHODS: We report one case of male urethra angioleiomyoma presenting with obstructive symptoms. RESULTS: We performed excision and end to end anastomosis of a small bulbar urethra stenosis. Pathology reported angioleiomyoma. CONCLUSIONS: Angioleiomyoma is a benign tumor arising from smooth muscle within blood vessel walls. It is extremely rare in the urethra. It is more common in females. Recurrence and metastasis are exceptional. It shows scarce or moderate cellularity with predominance of fusiform cells. They may express smooth muscle vimentin, desmin, and actin. The best therapeutic option is resection.

Aged↗

PubMed2003

[Utility of computerized tomography in determining the extent of infiltrating bladder tumors: our experience].

OBJECTIVES: To evaluate the reliability of bladder transitional cell carcinoma (TCC) staging, comparing findings on computerized tomography (CT) with pathologic results after radical cystectomy. METHODS: We retrospectively review 115 consecutive patients with bladder TCC undergoing radical cystectomy. Preoperative CT findings were compared with pathology results obtained after cystectomy and lymphadenectomy. RESULTS: We found that as a whole CT showed a tendency to local overstaging of 27.8% for tumours infiltrating bladder wall only, and understaging of 36.5% Regarding lymph nodes involvement, CT overstaged 4.6% of patients and understaged 23.8%. CT was capable to detect only 7.15% pN positive cases. CT was unable to detect the only patient with intra-abdominal metastatic involvement. CONCLUSIONS: Abdomino-pelvic CT has real limitations to detect extra vesical extension and lymph node metastasis in patients with bladder TCC.

Abdominal Neoplasms↗

PubMed2003

[Extra adrenal pheochromocytoma. Report of two cases].

OBJECTIVES: To review two cases of extra adrenal pheochromocytoma. METHODS: We present two cases: a 75-year-old patient with history of high blood pressure and intravesical tumor compatible with urinary bladder paraganglioma, and a 59-year-old patient with a retroperitoneal tumor arising from para-aortic ganglia. RESULTS: Diagnosis was made by CT scan and transurethral resection in the first case, all posterior extension studies were negative; in the second case retroperitoneal exeresis surgery was performed after CT scan. CONCLUSIONS: Extra adrenal pheochromocytomas are catecholamine producing tumours, which determines their clinical features; treatment should be surgical. A bibliographic review about this disease is performed.

Adrenal Gland Neoplasms↗

PubMed2003

[Assessment of the Gleason score in biopsies and specimens of radical prostatectomy].

OBJECTIVES: To evaluate the similarity between Gleason grade on prostate biopsies and their final result after radical prostatectomy. METHODS: We retrospectively review the medical records of 129 patients who underwent radical prostatectomy. Mean PSA value was 10.7 ng/ml. The relationships between pathological reports of biopsies and radical prostatectomy specimens, and other variables such as PSA were established. RESULTS: Globally, 72 cases (55.8%) were in the same risk group by grade on biopsy and surgical specimen. Biopsy result was understaged in 48 cases (37.2%) and overstaged in 9 cases (7%). We found biopsy understaging in 42 cases (60%) in the low grade group, 6 cases (10.9%) in the intermediate grade group, and 50% in the high grade group, although in this latter the number of cases was very low. CONCLUSIONS: Overall biopsy understaging was 37.2%, being much more evident in low grade tumors (60%). It seems that understaging was greater when PSA > 10 ng/ml, although differences were not significant.

Biopsy↗

PubMed2003

[Giant bladder diverticulum presenting as inferior vena cava syndrome].

OBJECTIVES: To report the case of a giant bladder diverticulum clinically presenting with symptoms of inferior vena cava compression. METHODS: Patient under study because of inferior limbs edema who underwent ultrasound that found a giant bladder diverticulum. RESULTS: Diverticulectomy plus adenomectomy were performed. CONCLUSIONS: Acquired giant bladder diverticula are very rare; they should be treated surgically to avoid possible complications.

Aged↗

PubMed2003

[A new case of bladder endometriosis in a patient with a history of Cesarean section].

OBJECTIVES: To report one new case of endometriosis in a patient with history of caesarean section. METHODS: It is the case of a female patient presenting with voiding symptoms and hematuria, with a bladder tumor on ultrasound. RESULTS: After TUR of a retro trigonal tumor pathology report showed bladder endometriosis. Treatment was completed with hormone therapy, being the patient relapse free at one year follow-up. CONCLUSIONS: History of caesarean section is one of the possible etiologies of bladder endometriosis.

Adult↗

PubMed2003

[Non-obstructive azoospermia: 2 new cases of Sertoli cell only syndrome].

OBJECTIVES: We report 2 cases of Sertoli cell only syndrome and perform a bibliographic review. METHODS: Clinical and pathologic study of 2 male patients 33 and 37-year-old respectively who presented with infertility. RESULTS: Testicular biopsy, the most important diagnostic test in the study of infertile men, showed bilateral Sertoli cell only syndrome. CONCLUSIONS: The Sertoli cell only syndrome is an entity in which seminiferous tubules show a total absence of germ cells with Sertoli cells alone. Etiology is unknown in most cases. Testicular biopsy is performed in these azoospermic men to rule out tubular obstruction or abnormalities of the spermatogenesis. Assisted reproduction techniques are a therapeutic option, making genetic counselling necessary due to the risk of transmission of the genetic defects that cause male infertility.

Adult↗

PubMed2003

[A chicken bone as cause of Fournier gangrene].

OBJECTIVES: Fournier's gangrene is a synergistic infective necrotizing fascitis, which involves perianal, perineal and genital regions, with rapid evolution and severe prognosis. We perform a literature review and report a recent case. METHODS: We report the case of a male patient who presented with scrotal pain and history of excretion of a chicken bone in a bowel movement. RESULTS: Despite aggressive surgery and wide spectrum antibiotic, the prognosis severe and the mortality is high. CONCLUSIONS: Rapid and accurate diagnosis remains the key to achieving a successful outcome. Early, wide and repeated debridement procedures reduce the mortality.

Foreign-Body Migration↗

PubMed2002

[Spontaneous retroperitoneal hemorrhage caused by a pheochromocytoma].

OBJECTIVE: To report the case of an adrenal pheochromocytoma presenting as a retroperitoneal haemorrhage. METHODS: 53 year old patient without previous medical history who presents with a spontaneous retroperitoneal haemorrhage. RESULTS: CT-scan was performed showing a retroperitoneal collection. The patient underwent emergency adrenalectomy with a final histopathologic diagnosis of pheochromocytoma. CONCLUSION: Pheochromocytomas can occasionally present as Wünderlich's syndrome, needing radical surgery as treatment for its resolution.

Abdomen, Acute↗

PubMedDate not supplied

[Urinary BTA-TRAK in the follow-up of superficial transitional-cell bladder carcinoma].

OBJECTIVE: To determine the efficacy of urinary BTA-TRAK as a marker in monitoring superficial transitional cell carcinoma of the bladder and to compare urine cytology with urinary sediment testing. METHODS: 700 consecutive determinations using BTA-TRAK to monitor unselected patients that had undergone surgery for transitional cell carcinoma of the bladder were analyzed. Cystoscopy, urinary sediment and urine cytology were performed during follow-up. Urography was performed yearly or when tumor of the upper urinary tract was suspected. (positive cytology or hematuria with no bladder tumor). Cystoscopy was performed a few days after determination of BTA-TRAK and voiding urine cytology and urinary sediment analyses (considered positive when microhematuria was observed) were both requested. RESULTS: Of the 700 determinations, 95 (13.6%) were urothelial carcinomas (93 bladder, 2 upper urinary tract) that had been discovered during patient monitoring. Of the 93 bladder tumors, 39 were Ta (37 TaG1 and 2 TaG2), 29 T1 (4 T1G1, 20 T1G2 and 5 T1G3), 5 Tis and 20 muscle-infiltrating tumors (progression from T2-4 during monitoring). The sensitivity of urine cytology to detect urothelial tumor was 41.1% and the specificity was 97.3%. The urine cytologies were negative in 48.4% and inflammatory in 9.5% of the tumors. The sensitivity was 19% in low grade tumors. The sensitivity of urinary sedimentation testing to detect urothelial tumor (microhematuria) was 40% and the specificity was 96.7%. When associated with pyuria, it was considered to be a urinary infection or urothelial inflammatory condition, which was observed in 10.6% of the cases. Considering the proposed normal reference value for BTA-TRAK (< or = 14 U/ml), we have found a sensitivity of 62.1% and a specificity of 68.4%. A logistic regression model was developed, including BTA-TRAK, urinary sedimentation and cytology, to identify the independent variables that are useful for tumor detection during follow-up of superficial carcinoma of the bladder in this series. The combination of three variables showed an odds ratio of 18.5 (8.9-38.5) for urinary cytology, 11.8 (5.9-23.5) for urinary sedimentation and an odds ratio for BTA-TRAK that did not fall within the equation. CONCLUSIONS: Although overall the sensitivity of BTA-TRAK is higher than that of urine cytology and urinary sedimentation testing, it provides no additional information than that obtained from the combination of urine cytology and urinary sedimentation testing in the detection of tumor recurrence during monitoring for superficial bladder cancer.

Antibodies, Monoclonal↗