Biomedical subjects

Jose A Gonzalez

Publications and source records attributed to Jose A Gonzalez.

4 recordsLinked to original sources

PubMed2006

Clinicopathologic analysis of extracapsular extension in prostate cancer: should the clinical target volume be expanded posterolaterally to account for microscopic extension?

PURPOSE: We performed a complete pathologic analysis examining extracapsular extension (ECE) and microscopic spread of malignant cells beyond the prostate capsule to determine whether and when clinical target volume (CTV) expansion should be performed. METHODS AND MATERIALS: A detailed pathologic analysis was performed for 371 prostatectomy specimens. All slides from each case were reviewed by a single pathologist (N.S.G.). The ECE status and ECE distance, defined as the maximal linear radial distance of malignant cells beyond the capsule, were recorded. RESULTS: A total of 121 patients (33%) were found to have ECE (68 unilateral, 53 bilateral). Median ECE distance=2.4 mm [range: 0.05-7.0 mm]. The 90th-percentile distance = 5.0 mm. Of the 121 cases with ECE, 55% had ECE distance>or=2 mm, 19%>or=4 mm, and 6%>or=6 mm. ECE occurred primarily posterolaterally along the neurovascular bundle in all cases. Pretreatment prostrate-specific antigen (PSA), biopsy Gleason, pathologic Gleason, clinical stage, bilateral involvement, positive margins, percentage of gland involved, and maximal tumor dimension were associated with presence of ECE. Both PSA and Gleason score were associated with ECE distance. In all 371 patients, for those with either pretreatment PSA>or=10 or biopsy Gleason score>or=7, 21% had ECE>or=2 mm and 5%>or=4 mm beyond the capsule. For patients with both of these risk factors, 49% had ECE>or=2 mm and 21%>or=4 mm. CONCLUSIONS: For prostate cancer with ECE, the median linear distance of ECE was 2.4 mm and occurred primarily posterolaterally. Although only 5% of patients demonstrate ECE>4 to 5 mm beyond the capsule, this risk may exceed 20% in patients with PSA>or=10 ng/ml and biopsy Gleason score>or=7. As imaging techniques improve for prostate capsule delineation and as radiotherapy delivery techniques increase in accuracy, a posterolateral CTV expansion should be considered for patients at high risk.

Aged↗

PubMed2006

Bladder herniation through suprapubic incision for penile prosthesis.

To our knowledge, we present the first case of bladder herniation after insertion of an inflatable penile prosthesis. A 65-year-old man presented with a suprapubic bulge. He had his third inflatable penile prosthesis placed 1 year earlier. He had no voiding complaints but requested surgical intervention because the hernia was cosmetically undesirable. After the hernia sac was opened the majority of the bladder was found within it. The defect was repaired with Gore-Tex mesh and the reservoir replaced. One must consider bladder involvement in ventral hernias after penile prosthesis insertion, and a preoperative cystogram might assist in identifying hernia contents.

Aged↗

PubMed2003

Closure of a ureterocutaneous fistula with a covered stent-graft.

A 74-year-old woman developed retroperitoneal fibrosis after aortic surgery for a left common iliac artery aneurysm. On the 5th day after repair, a left groin ureterocutaneous fistula developed. Because of the presence of a hostile surgical bed, the fistula was treated with percutaneous nephrotomy and double J stent insertion. Despite proximal control for more than 1 year, the fistula persisted. She was referred to the interventional radiology department for exchange to a nephrostomy with ureteral embolization. Rather than perform embolization of the ureter, we successfully repaired the fistula with a covered stent-graft. The patient was seen again 1 year after stent-graft placement. Output continues to fluctuate but never exceeds 5 mL per day.

Aged↗

PubMed2002

Clinical and pathologic tumor size in renal cell carcinoma; difference, correlation, and analysis of the influencing factors.

OBJECTIVES: To investigate the relation between the clinical and pathologic size and to identify the factors that affect this relationship. The clinical size of the tumor is essential for choosing the appropriate treatment in renal cell carcinoma. The pathologic size, on the other hand, is an important prognostic indicator. METHODS: We reviewed the charts of 291 open nephrectomy patients treated for nonmetastatic renal cell carcinoma. Clinical size was defined as the largest diameter on contrast-enhanced computed tomography. Pathologic size was defined as the largest diameter on pathologic examination. The clinical and pathologic sizes were compared, and their correlation was analyzed. The effect of various clinical and pathologic factors on the percentage of the size difference (%Delta(size)) was analyzed. RESULTS: The mean clinical and pathologic size was 5.4 +/- 3.2 and 5.3 +/- 3.3 cm, respectively. The difference was not significant (P = 0.1679). The clinical and pathologic size also correlated highly (r = 0.9540; P <0.0001). The estimated blood loss, local tumor extension, and cell type had significant influence on the %Delta(size) (P = 0.0018, 0.0415, and 0.0079, respectively). Additionally, in approximately one half of the patients with the greatest size difference, features such as cystic masses, hemorrhage, pyelonephritis, localization near or invasion of the collecting system, cysts or dilated calices adjacent to the tumor, and multiple cysts within the kidney were present, which were identified as factors that might have influenced the accuracy of the clinical size. CONCLUSIONS: The overall accuracy of the clinical size and its correlation with the pathologic size was acceptable. However, the presence of the above-mentioned factors should be taken into consideration during the interpretation of clinical tumor size.

Carcinoma, Renal Cell↗