Biomedical subjects
Publications and source records attributed to L Picurelli.
Case report of a vesicovaginal fistula caused by the long-standing presence of a foreign body in the vagina. A routine examination verified the subsequent incontinence but it was only under general anaesthesia when a completely calcified plastic stopper was found in the vaginal fundus.
Secondary hypertension (20%) is the result of specific causes and is susceptible of cure. It is uncommon, however, that in the same patient several pathological conditions which a priori could individually cause increased pressure values should coexist. A presentation if made of a patient with arterial hypertension, the study of which demonstrated the existence of homolateral adrenal tumour (corticoadenoma), renal tumour (angiomyolipoma), as well as proximal stenosis and small distal aneurism of the renal artery upper branch. An explanation is given here of the diagnostic evolution showing the images obtained, including a debate of the methodology followed and treatment performed.
Presentation of one case of prostate carcinoma of "signet ring" cells. Review of its clinical evolution, explaining the histological and histochemical findings, so as to contribute more data with regard to prognosis and composition of those cells. Update and comparison of various authors' views, which are explained for discussion.
Testicle metastasis from prostate cancer is uncommon and often a casual finding during necropsy or after androgen suppressive orchidectomy. A new, asymptomatic case is analyzed, illustrating the various dissemination pathways that could explain this type of metastasis, according to several authors. Also, a description and histological corroboration of the case are included.
We report on a patient with a benign retroperitoneal schwannoma whose course had been followed clinically and pathologically for 11 years. The clinical features, diagnosis, prognosis, and treatment of this uncommon tumor type are discussed.
We have determined serum Fe concentrations in 75 patients whose post-surgical anatomo-pathological diagnostic was: 25 cases with prostate benign hyperplasia, 25 cases where besides hyperplasia there was also an associated chronic prostatitis and 25 cases of moderately differentiated prostatic adenocarcinoma stage D according to the Jewett classification. No patient had received prior medication nor had associated metabolic pathology. Serum Fe concentration was significantly decreased in the cases with prostatic adenocarcinoma. The methodology used for these determinations is presented, discussing the possible pathogenic hypothesis explaining this finding together with the clinical consequences.
Using Atomic Absorption Spectrophotometry (AAS), Fe, Cu, Mg and Zn tissue concentrations were determined in 100 prostates with anatomopathological diagnosis of benign hyperplasia (25 cases), hyperplasia-associated prostatitis (25 cases), adenocarcinoma (25 cases) and normal gland (25 cases). Also at the same time, serum concentrations of the same elements were determined in order to correlate both results and see whether there was a relationship between them. A subsequent statistical study of the results was made looking for significant differences between the anatomopathological groups considered. Also a correlation study of these ions was conducted using Pearson's correlation coefficient(r). This report describes in detail the methodology used to conduct the present study, from tissue obtention through AAS determinations. According to the results obtained, prostatic adenocarcinoma shows in this study a Zn tissue concentration sensibly lower than that seen in hyperplasia, prostatitis and normal tissue. Also, Mg concentration is lower than in the other groups. In eutrophic prostatic tissue, Mg tissue concentrations were higher than in hyperplastic tissue and prostatitis, while Cu and Fe concentrations were lower as compared with the mentioned pathologies. These results have been compared to other series, and the biochemical assessment of the findings disclosed for discussion.
Ten cases of penoscrotal gangrene seen in our department over the last 8 years are presented. In 80% of patients causative factors of the gangrenous process were demonstrated and were equally distributed between urology and colorectal pathologies. The most commonly associated pathology was diabetes mellitus affecting up to 50% of our patients. Two or more germs were isolated from the necrotic-purulent material for cultures, mainly E. coli (90%) and Proteus mirabilis (50%) as aerobic organisms, and Bacteroides fragilis (40%) in the anaerobic group. Despite emergency surgical therapy and high doses of broad spectrum antibiotics, mortality in our series was about 20%.
Long-term results obtained in 54 surgical procedures to correct effort urinary incontinence performed in 49 patients with this pathology are reviewed. One group was treated with suprapubic urethrovesical suspension with the Marshall-Marchetti-Krantz technique; the other group with endoscopic suspension of the neck of the bladder, with the Stamey technique and the third group with sling techniques. The authors conclude that any of the surgical techniques achieving a correct reposition of urethrovesical anatomy, rising the posterior urethra to its primitive anatomical bed, obtain a similar success rate.
We present a series of cases of complex renal lithiasis, in which we carried out temporary internal urinary bypassing, prior to extracorporeal lithotripsy, by means of the retrograde insertion of a double-J urethral catheter, studying the time of stay, the presence or not of contamination in the catheter and its relationship with the calcifications found in them. We also carried out a metabolic-functional study of each patient, determining the urinary pH and the serum and urinary calcium, phosphorous and uric acid concentrations, and observing their possible influence on the above-mentioned complications. Of the 25 catheters studied, we observed calcification in 11 cases (44%). In these we observed urealytic germs (Proteus and Pseudomonas), without finding modifications of urinary pH. We observed no relationship between the calcium deposits and serum and urinary calcium, phosphorous and uric acid concentration.
Percutaneous nephrostomy (PCN) is currently one of the procedures of choice for emergency drainage of the upper urinary tract. Moreover, it permits morphologic and functional diagnostic possibilities as well as a wide variety of new and frequently definitive therapeutic procedures. We report on 58 PCN procedures performed in 55 patients from May 1983 to February 1989. PCN was indicated for complicated or uncomplicated uni- or bilateral supravesical obstruction, with infection and/or azotemia. All patients submitted to PCN for complicated obstruction with infection and/or azotemia showed a marked clinical and analytical improvement. Apart from resolving this emergency, it reduced the morbidity and mortality rate of subsequent surgical treatment of the underlying cause of obstruction because patient status was markedly improved. The major complications, retroperitoneal hematoma and sepsis, were rare. We frequently observed that the catheter had come out or become obstructed in our series. PCN affords the following advantages: it can be performed with local anesthesia; it is a simple technique; there are no absolute contraindications; its morbidity and mortality rates are low; and, it can be easily converted into a permanent procedure. In our view, all the foregoing advantages, as well as its therapeutic and morphologic and functional diagnostic possibilities, make PCN one of the procedures of choice in emergency treatment of upper urinary tract obstruction.
We present a case of pyelorenal calcification on double-J ureteral catheter, which made endoscopic extraction impossible. We review the literature and describe the incidence, methods of diagnosis and treatment of this complication, as well as the means used to avoid it.
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