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Biomedical subjects

L A Rioja

Publications and source records attributed to L A Rioja.

9 recordsLinked to original sources
PubMed2003

Significance of protein p53 overexpression in the clinical course of high-risk superficial bladder cancer.

OBJECTIVES: This is a retrospective study in which the long-term biological behavior of 67 "high-risk" superficial bladder tumors and the prognostic relevance (prediction of disease recurrence and progression) of the determination of the p53 phenotype in these cases were studied. MATERIAL AND METHODS: 67 tumors with a "high-risk" of progression were selected from the 1,103 transurethral resections for bladder cancer carried out in 640 patients in this center between 1987 and 1992. These included 39 T1G3, 14 Tis (isolated or associated with Ta-T1, non-G3 tumors), and 14 Ta-T1, non-G3 tumors with submucosal lymphatic affection (L+). The median follow-up of these cases was 69.7 months. An immunohistochemical technique with monoclonal antibodies (DO-7) was used to detect the p53 phenotype in paraffin-fixed material. RESULTS: Tumor recurrence occurred in 31 patients (46.3%) and local or distant progression in 14 (20.9%). Radical cystectomy was carried out in 16 (23.9%) cases. p53 overexpression of > or =20% ("p53+") was detected in 40 tumors (59.7%). The rate of recurrence and progression, the disease and progression-free intervals, cancer-specific survival, disease-free survival and progression-free survival were similar in the 3 tumor groups (in all cases, p > 0.05). There were no significant differences in the overexpression of protein p53, using the standard cutoff point of 20% stained nuclei, on comparing the same variables in the whole group of 67 patients (in all cases, p > 0.05). CONCLUSION: The detection of protein p53 was not found to be of use in the retrospective prediction of disease progression or survival in "high-risk" superficial bladder cancer.

Aged↗
PubMed2002

Long-term follow-up of a randomized prospective trial comparing a standard 81 mg dose of intravesical bacille Calmette-Guérin with a reduced dose of 27 mg in superficial bladder cancer.

OBJECTIVES: To determine the efficacy of a three-fold reduced dose (RD, 27 mg) of intravesical bacille Calmette-Guérin (BCG) against the standard dose (81 mg) in patients with superficial bladder cancer, assessing recurrence, progression and differences in toxicity. PATIENTS AND METHODS: Five hundred patients with superficial bladder cancer (Ta, T1, Tis) were enrolled and randomly assigned to be treated after transurethral resection of all visible lesions with intravesical BCG Connaught strain (weekly x six and thereafter fortnightly x six) either with the standard or RD instillation. RESULTS: All but one of the 500 patients were evaluable for efficacy and toxicity (252 in the standard arm and 247 in the RD arm). The median follow-up was 69 months (maximum 104); 71 (28%) patients in the standard arm and 76 (31%) in the RD arm developed recurrences; the median time to recurrence has not yet been attained, but at 5 years the mean (sd) percentage of recurrence-free patients was 70.5 (3.12) and 70.4 (3.1) for the standard and RD arms, respectively. In patients presenting with multifocal tumours, the standard dose was more effective against recurrences than the RD (P=0.0151). In those with G3 and high-risk tumours overall, the superiority of the standard dose was marginal (P=0.060 and P=0.082). Twenty-nine (11.5%) tumours in the standard arm and 33 (13.3%) in the RD arm progressed to invasive disease; the median time to progression has not yet been attained, but the percentage of progression-free patients at 5 years was 88.8 (2.23) and 86.9 (2.31) for the standard and RD arms, respectively. The standard dose was more effective than the RD against progression only in patients with multifocal disease (P=0.048). Twelve (4.8%) cystectomies were performed in the standard and 15 (6.1%) in the RD arm. Currently, 106 (21.2%) patients have died, but only 38 (7.6%) from bladder cancer, i.e. 20 (7.9%) in the standard and 18 (7.5%) in RD arm. Overall the disease-specific death rate was lower for those patients who completed the scheduled treatment. The cause-specific survival at 5 years did not differ between the arms (P=0.76) but there was a trend toward better cause-specific survival for patients with multifocal tumours in the standard arm. Toxicity differed between the arms, significantly more patients having no toxicity in the RD arm, and fewer having delayed instillations or withdrawing. However, severe systemic toxicity occurred even in patients treated with the RD, in a similar proportion to those receiving the standard dose. CONCLUSION: Overall, the RD gave similar results for recurrence and progression but with significantly less toxicity. However, patients with multifocal tumours fared better with the standard dose and there was a trend towards better recurrence rates in patients with high-risk tumours. We recommend continuing to use the standard dose for high-risk tumours, while we consider the reduced dose safe and effective for intermediate-risk lesions and for maintenance schedules.

Adjuvants, Immunologic↗
PubMed2001

The use of neural networks and logistic regression analysis for predicting pathological stage in men undergoing radical prostatectomy: a population based study.

PURPOSE: Clinical under staging occurs in 40% to 60% of patients who undergo radical prostatectomy for prostate cancer. To decrease under staging several methods of predicting pathological stage preoperatively have been developed based on statistical logistic regression analysis and neural networks. To our knowledge none has been validated in our homogeneous regional patient population to date. We created logistic regression and neural network models, and implemented and adapted them into our practice. We also compared the 2 methods to determine their value and practicality in daily clinical practice. We present the results of our novel approach for predicting pathological staging of prostate adenocarcinoma. MATERIALS AND METHODS: Between 1986 and 1999, 600 white men from the Aragon region of Spain underwent surgery for prostate cancer; of whom 468 were selected for study. Predictive study variables included patient age, clinical stage, biopsy Gleason score and preoperative prostate specific antigen (PSA). The predicted result included in analysis was organ confined or nonorgan confined disease. Data were analyzed by multivariate logistic regression and a supervised neural network (multilayer perceptron and radial basis function). Results were compared by comparing the areas under the receiver operating characteristics curves. RESULTS: We generated 5 logistic regression models. The model created with clinical staging, Gleason biopsy score and PSA distributed in 5 categories (p <0.001) with an area under the receiver operating characteristics curve of 0.840 proved to be most predictive of pathological stage. Similarly of the 6 neural network models evaluated the radial basis function model, which included age, clinical stage, Gleason biopsy score and preoperative PSA distributed in 5 categories with an area under the curve of 0.882, proved the most predictive but not superior to the logistic regression model. The difference in the area under the curves in the 2 chosen models was 0.042 (p = 0.1). CONCLUSIONS: It is possible to generate useful predictive models of organ confined disease using logistic regression or neural networks with high indexes of clinical and statistical validity. However, using these variables neural networks did not prove to be better than logistic regression analysis. Therefore, better predictive variables must be identified, preferably nonlinear characteristics with respect to the probability of organ confined tumor, to generate better predictive models using neural networks.

Aged↗
PubMed1996

Value of PSA (prostate-specific antigen) in the detection of prostate cancer in patients with urological symptoms. Results of a multicentre study.

The aim of this multicentre study was to assess the usefulness of prostate-specific antigen (PSA) as a diagnostic procedure for prostate cancer in patients with urological symptoms, and compare it with digital rectal examination (DRE). The study included 2054 urological patients, aged over 50 years, and PSA levels were measured using an automated enzyme immunoassay. In the 680 cases with PSA levels > 3 micrograms/l and/or suspect DRE, transrectal ultrasound and prostate biopsy were also performed, leading to a diagnosis of cancer in 131 cases. The sensitivity of PSA was higher (95% and 73% for the cut-off values of 3 and 10 micrograms/l, respectively) than DRE (69%), both parameters being complementary. When DRE and PSA (> 10 micrograms/l) were combined, 118 cancers were diagnosed, with a PPV of 37%. We recommend using PSA and DRE in combination as a diagnostic procedure for prostate cancer in urological patients, since both methods are complementary.

Age Distribution↗
PubMed1993

[Antimicrobial prophylaxis in urethrocystoscopy. Comparative study].

Instrumentation of lower urinary tract is a predisposing factor for the development of urinary infection. Incidence of infective complications following urethrocystoscopy has been evaluated in a multicenter, prospective, comparative and randomized study in 2,284 patients, who had a previous negative urine culture. Patients were randomized into two groups: one to be used as control and the other one to received antimicrobial prophylaxis prior to instrumentation (ceftriazone, 1 gr intramuscular). Clinical and microbiological responses were evaluated at 48-72 hours and 4 weeks after cystoscopy. Symptomatic bacteriuria was observed in 10.2% of patients in the control group and in 2.5% in the prophylaxis group (p < 0.000); asymptomatic bacteriuria in 3.02% and 1.52% (p > 0.05) and irritative syndrome with sterile urine in 2.93% and 2.60% (p > 0.05), respectively. Thus, the use of prophylaxis reduced the incidence of infective complications in these patients.

Adolescent↗
PubMed1991

Carcinoma of the prostate: general concepts.

The work of Huggins et al more than 40 years ago established the effectiveness of androgenic deprivation in the management of patients with disseminated prostatic cancer. The initial utilization of estrogens was considered appropriate until elevated cardiovascular risk was proven with higher doses. Orchidectomy continues to be an effective method of androgenic suppression, although disadvantages are seen to be its irreversible nature and possible psychologic impact on the patient. Luteinizing hormone-releasing hormone (LHRH) agonists can achieve plasma levels of testosterone similar to surgical castration with minimum inconvenience to the patient. Androgen antagonists act directly on the metabolism of the prostatic cell, obtaining a similar effect to that of castration, with maintenance of testosterone levels in the case of flutamide. The concept of total androgen blockade is one currently receiving attention. Although controversy still remains, it is thought that complete hormone blockade (for example, orchidectomy plus an anti-androgen) may improve survival.

Androgen Antagonists↗
PubMed1989

[Bilateral angiomyolipomas of the kidney in Bourneville's tuberous sclerosis].

We report on a 25-year-old patient diagnosed as having Bourneville tuberous sclerosis with a giant angiomyolipoma 16 X 12 cm. in diameter, and two small angiomyolipomas in the left kidney, multiple asymptomatic angiomas in the right kidney and two 1 cm. diameter angiomas in the liver. The presenting features were intense left-sided abdominal pain of sudden onset, frank hematuria, acute anemic syndrome, nausea and vomiting. Patient work up included x-ray of chest, abdomen, and skull, bilateral renal arteriography and ultrasound were diagnostic of Bourneville tuberous sclerosis with multiple bilateral renal angiomyolipomas. The hematologic and hemodynamic compromise and the almost completely absent intact parenchyma in her left kidney did not permit a conservative surgical procedure and the patient was submitted to a left nephrectomy. The patient had the following characteristic features of Bourneville's disease: epilepsy, intracranial calcifications on CT, sebaceous adenomas on face, fibromas under nails of left hand and foot, bony lesions in the form osteosclerosis and chylous pleural effusion. Her intelligence level was normal and no optic nerve phakomas were observed. The literature on angiomyolipoma and Bourneville's tuberous sclerosis is reviewed. The importance of using ultrasound and CT in combination to diagnose and follow up renal angiomyolipomas is highlighted. Treatment of angiomyolipomas must be based on two parameters: symptoms and size. Symptomatic angiomyolipomas warrant angiographic work up and selective arterial embolization or the most conservative surgical procedure possible (enucleation, partial nephrectomy). Asymptomatic angiomyolipomas warrant CT and/or ultrasound examination every 6 or 12 months depending on size.

Adenoma↗
PubMedDate not supplied

[Primary care physicians and prostatic disease. National survey. Members of the Spanish Council of Prostatic Health].

The paper presents the results of a survey distributed to 15,000 primary care physicians (PCP) asking about their management of prostate conditions. From the 3.265 surveys completed, the following information was obtained. The number of visits for "prostatism" is low, 3.92 + 3.99 per week. Most PCPs inquired for symptoms related to prostate conditions regardless the initial reason for the visit. 95% refer the patient directly to the urologist, either with no further investigation or after a diagnostic evaluation or initial therapy. Vegetable extracts are the pharmacological group most commonly used by PCPs. They would accept to monitor the patient's evolution, after diagnosis and treatment by the urologist, and always with the specialist's regular supervision. Most show little sensitivity toward prostatic conditions and are aware of slight of null urological education received during their graduation. They are by a majority also ready for a retraining in urology permitting them one active participation in this pathology.

Family Practice↗