Biomedical subjects
L Ibarz Servio
Publications and source records attributed to L Ibarz Servio.
[Supraselective embolization of renal pseudoaneurysm caused by an abdominal stab wound].
OBJECTIVE: To report the results of conservative management of post-traumatic (abdominal stab wound) pseudoaneurysm with arteriovenous fistula in segmental artery of left kidney and secondary persistent hematuria in an HIV positive patient. METHODS/RESULTS: A supraselective left renal arteriography revealed a pseudoaneurysm. We performed embolization of the aneurysmal artery with coils and fibrin particles. Resolution of the hematuria was immediately achieved with no side effects or significant complications. CONCLUSIONS: In our view, supraselective embolization is the first option in the treatment of post-traumatic renal artery aneurysms due to its low morbidity and limited aggressiveness.
[New compound needle for percutaneous renal puncture].
OBJECTIVE: We have developed a needle for direct percutaneous access in order to introduce the flexible wire with a single puncture, without creating two parallel tracks, thereby affording a lower morbidity than the conventional technique. METHOD: The needle consists of an internal and an external device, with different lengths and diameters, that let us first create the access to the urinary tract with the inner device and then dilate with the outer device in order to introduce the metallic wire with a single puncture, sliding the outer over the inner device. RESULTS: We can achieve the same number of percutaneous accesses with less morbidity since less punctures are required to create the track. CONCLUSION: This is a useful needle for any type percutaneous access.
[Barcelona pouch. An external continent urinary diversion].
OBJECTIVES: To describe a new technique for external continent urinary diversion based on the Vesica Ileale Padovana technique (VIP) with a continent hydraulic valve, which obviates the need for external permanent collecting urinary systems. METHODS: An ileal neobladder was created following the VIP technique to which we added a modified Benchekroun continent hydraulic valve utilizing mechanical sutures. RESULTS: A continent heterotopic neobladder was achieved. The technique was easy to perform and permitted preservation of the upper urinary tract due to the pouch's low internal pressures. CONCLUSIONS: In our view, this technique is a valid alternative in patients unamenable to orthotopic diversion and are able to perform self-catheterization.
[Characteristics of bladder leiomyoma in our setting].
OBJECTIVES: To determine the incidence, form of presentation, symptoms, diagnostic methods and treatment most commonly used, and prognosis of leiomyoma of the bladder in our setting. METHODS: We conducted a retrospective, multicenter analysis of the last 700 cases submitted to surgery for a bladder tumor that was found to be leiomyoma of the bladder. We reviewed the Spanish literature of the last twenty years for the following variables: patient age, sex, presenting symptoms, incidental finding or not, value of the tests performed, treatment, follow-up and prognosis. RESULTS: Leiomyoma of the bladder accounted for 0.43% of the bladder tumors diagnosed at three urological centers. Apart from the three cases described, ten additional cases are reviewed. Forty-six percent were incidentally discovered. US proved to be the best diagnostic method. Treatment was frequently by open surgery. The prognosis was excellent; there has been no recurrence at 22 months' mean follow-up. CONCLUSIONS: Leiomyoma of the bladder is a benign tumor with little or no clinical symptoms or signs, often discovered incidentally during US and accounts for 0.5% of the cases that had undergone surgery for a bladder tumor.
[Biochemical effects of potassium citrate in the treatment of calcium oxalate lithiasis].
The serum and urinary biochemical changes observed one month and six months after oral potassium citrate therapy (600 mEq/day) in 119 patients with calcium oxalate calculi were compared with those of 16 untreated cases with lithiasis. The patients that received treatment were previously divided into two groups: group A comprised 61 hypocitraturic patients and group B comprised 58 patients with other urinary disorders who were normo or hypocitraturic. The urinary pH increased by approximately half a point in both treated groups. In group A calciuria increased slightly from 180 +/- 8 to 216 +/- 10 mg/24 h but remained within the normal ranges. Creatinuria, oxaluria, uricosuria and diuresis showed no changes. Citraturia increased very significantly in both groups and more markedly in the hypocitraturic group of patients (from 198 +/- 13 to 476 +/- 35 mg/24 h). The LRC (lithogenic risk coefficient = Ca/Cit x Diu) dropped by 50%. The patients tolerated the treatment regimen well; of the 119 treated patients, only 11 abandoned treatment due to GI intolerance.
[Extracorporeal shockwave lithotripsy on a clam shell fragment lodged in the ileocecal valve].
Herein we describe what may be the first case of ESWL used in the treatment of mechanical ileus caused by a fragment of clam shell lodged in the terminal ileum. The 66-year-old patient was referred by the emergency department with symptoms and signs of upper GI tract obstruction. ESWL with the modified Dornier HM3 was performed under neuroleptoanalgesia with the patient in the prone decubitus position. 1700 shock waves at 20 Kv were used to achieve fragmentation and restore intestinal transit, thus avoiding surgery.
[Extracorporeal shock-wave lithotripsy in horseshoe kidney].
Presentation of our experience in the use of extracorporeal shock wave lithotripsy (ESWL) for the treatment of lithiasis that occurred in 34 renal units from 28 patients with horseshoe kidneys. All patients but one were placed in supine decubitus with the calculus positioned in F2. A total of 47 sessions were performed for 34 treatments apart from 3 ureteroscopies for ureteral voiding. The results of the follow-up is absence of lithiasis in 13 renal units, debris of less than 3 mm in six, non-removable debris in 13 cases and relapse in two.
[Subjectivity and objectivity in transperineal biopsy and transrectal prostatic aspiration cytology].
Transperineal biopsy (TPB) together with transrectal aspirative cytology (TRAC) was performed in 50 prostates, 28 carcinomas and 22 no malignant pathologies. Both techniques were compared both objectively as subjectively. With TPB in 3.5% of carcinomas and in 13.6% of benign pathologies not enough sampling material was obtained to perform the diagnoses. With TRAC these figures were respectively 3.5% and 9%. With the viable samples TPB sensibility was 100% being TRAC 96.3%. Specificity was 100% for both techniques. With TPB, 40% of the biopsies labelled as "dubious obtention of enough material to perform diagnoses", were finally insufficient; on TRAC this rate was 11%. In the three cases of insufficient sampling material with TRAC only aspirative punction had been performed. We think it is necessary to perform more than one punction in TRAC. TRAC is, for its lack of complications, efficacy, and because it is easy to perform, the preferred technique versus TPB.
[Extracorporeal shockwave lithotripsy in patients with coagulation disorders].
During treatment of renal lithiasis with extracorporeal shock wave lithotripsy (ESWL) hemorrhagic events, especially renal hematoma, may present. A coagulation study is warranted in order to institute hemotherapy for blood factor deficiencies. We reviewed the records of 4,000 patients that had undergone ESWL. Of these, 17 (12 males, 5 females) presented coagulation disorders. The bleeding diatheses were due to platelet deficiency in 6 cases, plasma defects in 5, platelet and plasma disorders in 2, and capillary wall defects in 5 cases. The underlying cause was hepatosplenic disease in 12 cases, iatrogenic in 1, connectivopathy and corticoids in 2, and capillary purpura of unknown cause in 2 cases. Due to this protocol, no patient presented hemorrhage or hematoma from shock wave-induced lesions. These results show that a complete coagulation study must be performed in order to institute the necessary measures in patients with disorders of hemostasis due to the high risk of hematoma repeatedly reported in the literature.
[Treatment of ureteral lithiasis using the laser].
A review of the history of lasertripsy from continuous to intermittent Nd:YAG, Alexandrite, or liquid-dye laser is undertaken. Certain calculi require intraureteral fragmentation owing to stone hardness or location. Within a period spanning 20 months, we have treated 350 patients (199 males, 151 females) utilizing dye laser through a very fine caliber 7.5 F ureteroscope. Twenty-six had bilateral calculi. The calculi were located in the upper third in 10% (37), middle third in 25% (93), and lower third in 65% (241). Complete fragmentation was achieved in 341 (93%), push up + ESWL was performed in 24 (6.4%), and two calculi (0.6%) required ultrasonic fragmentation. No patient required surgery and there were no severe complications.
[New ultrasonic images in patients with lithiasis after undergoing extracorporeal shock wave lithotripsy].
Evaluation and follow-up of patients submitted to extracorporeal shock wave lithotripsy (ESWL) by ultrasonography is a good adjunct to radiology. Plain x-ray and ultrasound imaging permit following the course of stone patients submitted to treatment by ESWL without recurring to IVP in most of the cases. One-thousand kidney units corresponding to 931 stone patients were submitted to ESWL. Patient evaluation by ultrasound was performed prior to and 24 hours after treatment. Ultrasonographic evaluation is important because it permits: 1. Detection of changes in size, number, and site of the hyperechogenic image. 2. Evaluation and follow-up of urinary tract dilatation. 3. Control of radiolucent calculi thereby avoiding repeated explorations using contrast medium. 4. Detection of possible perirenal hematoma post-ESWL. 5. Diagnosis of other renal or extrarenal disorders.
Treatment of lithiasis in the patient with a solitary kidney.
Extracorporeal shock wave lithotripsy (ESWL) has been the fundamental treatment applied to 88 patients with renal calculi in a solitary kidney. Epidemiological information is given, including lithiasis antecedents and associated pathologies as well as the etiology of the solitary kidney, location and size of stones. The initial treatment was ESWL in 83 patients, ureteroscopy in 2, surgery in 2, and percutaneous nephrolithotomy in 1. Three months after treatment in the ESWL group, 68 patients were completely free of stones and 15 had insignificant caliceal residual fragments. The rest of the patients were treated successfully using the above methods. The secondary complications of ESWL were colic pain (20 cases), fever (13 cases) and obstruction (9 cases).
[Leukocyte response in patients undergoing extracorporeal shockwave lithotripsy].
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Evaluation of renal damage in extracorporeal lithotripsy by shock waves.
Lithotrispy by shock waves is an alternative treatment to renal lithiasis surgery. On destruction of the stone, the pressure of shock waves produces renal microdamage. According to the current knowledge of renal physiopathology, we studied the variations of lactate dehydrogenase (LDH) and N-acetylglucosaminidase (NAG) levels in blood and urine of 44 patients with renal lithiasis (pelvic or calyceal) before and after treatment. We found a significant LDH and NAG increase in blood and an LDH increase in urine after lithotripsy. There was no correlation between the number of applied waves and enzymatic increase.
[New therapeutic possibilities in coralliform lithiasis: shockwave lithotripsy].
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[Treatment of male infertility with clomiphene citrate (author's transl)].
Ninety unselected male patients with infertility were treated with clomiphene citrate, 25 mg/day, taken on 20 consecutive days each month for a period of 3 to 12 months. The patients were divided into two groups according to sperm counts. In 39 cases of oligozoospermia with sperm counts above 10 million/ml, six pregnancies were obtained (15.4%) while a significant improvement of sperm counts occurred in 22 cases (56.4%). On the other hand, in 51 cases with azoospermia or oligozoospermia below 10 million/ml only three pregnancies occurred (5.9%) and two patients (3.9%) had significantly improved sperm counts. The indications and form of administration of clomiphene citrate are commented upon.
[Primary signet-ring cell bladder adenocarcinoma].
The authors report a case of primary adenocarcinoma of the bladder, a rare tumor that accounts for 0.5-2% of primary bladder tumors in a 69 years old male patient with a previous history of urothelial tumor that had been treated by TUR and intravesical chemotherapy. The tumor widely infiltrated adjacent structures and biopsy disclosed signet-ring cells. This condition was not amenable to treatment.