Biomedical subjects
Publications and source records attributed to M Rigabert Montiel.
We report a case on circumcavum ureter without obstruction or type two, according the Batenson and Atkinson's classification, in a forty-nine year old man. It was diagnosticated for a gross haematuria and renoureteral pain, because of a simultaneous urinary tract infection. We emphasize its absence of the typical morphology and obstruction signs. After twelve months the patient is still asymptomatic, without any medical or surgical treatment.
OBJECTIVE: The aim of this study is to know if the use of oral Tegafur associated to intravesical mitomycin is effective in the prevention of the relapses of Ta bladder tumors. METHOD: This is a prospective study in which we compare the recurrence rate and the disease-free interval of 2 groups of 40 patients each one, the first of them treated after the TUR with oral Tegafur and intravesical mitomycin, and the second with intravesical mitomycin alone. Tolerance of Tegafur was also studied. RESULTS: The group of the Tegafur presented a descent of the relapse rate and a continuation of the time free of illness; but it was not statistically significant. The tolerance to the drug was good, without important adverse effects. CONCLUSIONS: Tegafur seems an useful drug in the prevention of the recurrence of superficial bladder tumors, although it will be necessary bigger studies to reach statistically valid conclusions.
INTRODUCTION AND OBJECTIVES: In BPH there is a growth of both glandular and stromal components. Most of adrenoceptors sites are in the fibromuscular stroma. So the higher is the stromal/epithelial ratio, the more effective will alpha-blockers be. There in an indirect way of stimating this ratio without performing a biopsy. Bearing in mind that PSA is produced by the prostatic epithelium, the lower PSA density (PSAd), the higher the stromal/epithelial ratio and the higher alpha-blocker activity. We pretend to study if PSAd is useful for predicting the response to alpha-blockers in BPH. MATERIAL AND METHODS: We studied 75 patients suffering from prostatism and diagnosed of bladder outlet obstruction secondary to BPH through IPSS symptom score, digital rectal examination, PSA, uroflowmetry, and transrectal ultrasound. All of them received Alfuzosin, 5 mg twice daily during 3 months, and then were evaluated again with IPSS and uroflowmetry. RESULTS: A statistically significant improvement was appreciated of the two studied parameters and in both groups of patient with regard to the pretreatment situation. A statistically significant better answer was also appreciated in the group of patient with smaller PSAd in comparison with the higher PSAd patients. CONCLUSIONS: Our results show that PDAd is usefu to estimate the stroma/epithelium ratio, and therefore the clinical response to alpha-blockers.
OBJECTIVE: To describe an additional case of simple syringocele of Cowper's glands and review the literature. METHODS: An additional case of simple syringocele of Cowper's glands is presented and the literature over the last 10 years is reviewed. RESULTS/CONCLUSIONS: The treatment most commonly utilized is marsupialization to the urethra by endoscopy. The foregoing was performed in our patient with satisfactory results.
OBJECTIVE: To report an uncommon case of basal cell carcinoma of the penis. METHODS: A case of basal cell carcinoma of the penis is presented. This has been the only case of this tumor type detected in our setting. The literature is briefly reviewed. RESULTS/CONCLUSIONS: Basal cell carcinoma of the penis is rare. To date only 20 cases have been reported in the literature. To our knowledge, no case of distant metastasis has been documented. Diagnosis by gross examination may be difficult due to the broad polymorphism of this lesion and must be confirmed by histological analysis.
OBJECTIVE: To report a case of giant fibroepithelial polyp of the ureter and review the literature with special reference to the diagnosis and treatment of this benign condition. METHODS: A young male patient with a nonfunctioning left kidney caused by a giant fibroepithelial polyp of the ureter is presented. The diagnostic methods and treatment options are discussed. RESULTS: Following the diagnosis of obstructive uropathy with loss of left renal unit function, a left nephroureterectomy was performed which revealed a giant polypoid mass. CONCLUSION: Fibroepithelial polyp of the ureter is a benign condition that is difficult to diagnose with current endoscopic techniques. Endoscopy should be the first therapeutic option if loss of renal function is not irreversible.
INTRODUCTION: Obstructive uropathy in pregnant women is a relatively common condition. It can be difficult to assess due to the frequency with which physiologic dilation of the upper urinary tract is seen in pregnant women. PATIENTS AND METHOD: Over the past 3 years 40 pregnant women with symptomatic obstructive uropathy were seen in our service. RESULTS: Most pregnant women responded to conservative treatment (pain killers and antibiotics). In the remaining group, instrumentation was necessary through the urinary route: double J ureteral catheterism (10 patients: 6 due to uterine compression and 4 to lithiasis), percutaneous nephrostomy (4 patients: 2 due to ureteral catheter obstruction impossible to replace, and two due to urinary sepsis), or ureterorenoscopy (1 patient with lithiasis). CONCLUSIONS: The single most common cause for obstructive uropathy in our experience is ureteral compression due to a gravid uterus. Choice therapy in most cases is conservative treatment. When in spite of conservative treatment signs and symptoms persist, urinary by-pass with antibiotic prophylaxis must be performed. Ureterorenoscpy as a diagnostic and therapeutical approach should be taken into consideration in pregnant women with ureteral lithiasis. Incidence of pre-term labour was not higher than usual.
Trauma of the penis is relatively uncommon. Not many centres and even less urologists have extensive experience in the comprehensive management of this type of injury. Revision of the series accrued in our hospital over 20 years, in each case explaining the mechanism of occurrence, treatment applied and results obtained.
OBJECTIVE: To compare the efficacy and safety of two analgesics (tramadol and ketorolac) for initial emergency treatment of renal colic. METHODS: A prospective study on 48 patients randomly assigned to treatment with ketorolac 30 mg i.m. and tramadol 1 mg/kg s.c. Pain intensity was evaluated by a simple analogic scale ranging from 0-4 (0 = no pain, 1 = mild, 2 = moderate, 3 = severe and 4 = very severe pain). Statistical analyses were performed with Student's test and the chi square test for numerical and qualitative data, respectively. RESULTS: No significant differences were found for the overall efficacy (> 80%) or side effects in both groups. However, a difference was found between both groups for pain score 15 minutes post-injection, which showed i.m. ketorolac to be more effective. CONCLUSION: Both ketorolac (30 mg i.m.) and tramadol (1 mg/kg s.c.) are effective in the initial treatment of renal colic. Both drugs have an efficacy greater than 80% when used separately and almost 100% when used in combination. The analgesic effect of ketorolac is observed earlier than that of tramadol.
A 48-year-old woman was diagnosed with right renal vein thrombosis (RVT) 2 weeks after a laparoscopic cholecystectomy. The patient had none of the major risk factors for RVT or deep vein thrombosis. She was treated with long-term anticoagulation. Complete dissolution of the thrombi was reached 1 month after diagnosis.
OBJECTIVE: Bladder stones have been observed more frequently in patients undergoing bladder augmentation or substitution than in the normal population. We analyzed the etiological factors influencing bladder stone formation in patients submitted to the foregoing procedures. METHODS: Between December 1986 and October 1994, 12 augmentation cystoplasties with detubularized ileum or colon (group I) and 24 substitution ileocystoplasties (group II) were performed. None of the patients were known to have urinary stone formation. The possible causes of bladder stone formation were analyzed in both patients groups. The patients were evaluated for urinary infection, post micturition bladder residue, urinary pH, and stone forming metabolic alterations in blood or urine. The latter consisted in determining the blood levels of creatinine, calcium, uric acid and phosphorus and the 24-hr urine levels of calcium uric acid, phosphorus, creatinine, urea, oxalic acidi citric acid and magnesium. The statistical analysis consisted of an unweighted logistic regression test and a chi square test between each of the above variables and the existence of bladder stones. RESULTS: In group I, 10 patients revealed recurrent urinary infections, 0 showed a significant post-micturition bladder residue, a pathologically alkaline pH was observed in 2 and the metabolic study of blood and urine revealed alterations in 9 patients. In group II, 18 patients revealed recurrent urinary infection, 13 patients had post-micturition bladder residue, a pathologically alkaline pH was observed in 1, and the metabolic study of blood and urine revealed alterations in 13 patients. The statistical analysis using the unweighted logistic regression test showed no significant relation between any of the parameters and the presence of stones, for the substitution group pr augmentation group. However, the chi-square test to determine the relation between the different varikables and the existence of stones, showed a statistically significant relation between an elevated urinary pH, recurrent urinary infection, post-micturition bladder residue and bladder stone formation for groups I. Concerning the type of suture employed, some degree of relation between the use of non-resorbable suture and stone formation was found, although it was not statistically significant. CONCLUSION: We can therefore conclude that urinary pH, recurrent urinary infection annd post-micturition bladder residue, and probably use of nonreabsorbable suture, are among the etiological factors that we should avoid and treat in order to prevent the formation of bladder stones in patients undergoing augmentation or substitution cystoplasty.
Traditionally, right varicoceles have been considered a rare entity nearly always secondary to a neoplastic or retroperitoneal disease. There are other possible etiologies for right varicoceles such as the venous disease of the large veins and visceral malposition syndromes. This paper presents one case report of right varicocele as the only clinical sign of situs inversus. Revision of the literature and nomenclature of these syndromes.
OBJECTIVE: To analyze the sensitivity of renal ultrasonography and intravenous urography in renal trauma. METHODS: An extensive analysis on the sensitivity of IVP and US in the assessment of renal trauma was conducted using CT, renal selective arteriography or surgical exploration as the gold standard tests of reference to validate the initial diagnosis. RESULTS: IVP and US are useful techniques because of their high sensitivity in the diagnosis of renal trauma. The sensitivity of US decreases as the severity of the trauma increases (75% for grade I, 88.9% for grade II, 73.3% for grade III and 0% for grade IV), while that of IVP remains high for all degrees of severity (100% for grade I, 92% for grade II, 100% for grade III and 100% for grade IV). CONCLUSIONS: IVP and US were found to be useful techniques because of their high sensitivity in the diagnosis of blunt renal trauma. The sensitivity of US decreases as the severity of the trauma increases, while that of IVP remains high for all degrees of severity.
The aim of the present work is to try to know the clinical data that can provide directions on the attitude to take with patients who seek advise with a suspicion of renal traumatism, thus allowing to select those that may require complementary examination. This is a retrospective revision of 190 cases of renal trauma admitted in our hospital between 1971 and 1992. We rated 3 large syndrome groups based on the patient's major signs and symptoms. The first indication in 71 patients was haemorrhagic syndrome (shock or anaemia); 100 patients had microscopic or gross haematuria non-associated to anaemia; and 6 patients showed painful signs and symptoms. Existence of renal injury should be suspected in patients that came to the hospital with a background of trauma, microscopic or gross haematuria, shock with or without haematuria or intraabdominal lesions; the performance of complementary examinations is necessary in patients with evidence of gross haematuria, microscopic haematuria associated to shock or suspected associated extra-renal intra-abdominal lesions, or shock whether or not associated to haematuria.
OBJECTIVE: A case of erectile dysfunction in a patient with prolactinoma is described herein. METHODS/RESULTS: The literature on the incidence, diagnosis and therapeutic management of this condition is reviewed. Impotence may arise from several causes. It is widely accepted that 30-50% have an organic etiology, with vascular involvement being more prevalent than other causes (neurological, endocrinological, urological, iatrogenic, pharmacological, systemic diseases). Hyperprolactinemia, arising from a prolactinoma, is one of the endocrinological conditions causing impotence. In men, this endocrinological disorder is rarely accompanied by other clinical anomalies, such as gynecomastia, galactorrhea or signs of a pituitary tumor. The patient described herein presented with erectile dysfunction. During evaluation, he was found to be hyperprolactinemic. Subsequent assessment disclosed a pituitary adenoma. The patient was successfully treated with bromocriptine. CONCLUSION: Erectile dysfunction arising from hyperprolactinemia is uncommon. Serum prolactin levels, a lateral skull x-ray and CT/MRI are essential in the diagnosis and treatment of this condition. Treatment must be directed at the underlying cause. Bromocriptine has proved to be effective and carries a low risk of undesired effects.
The present work was intended to be a revision of our series of Eosinophilic Cystitis and we have found that, from one single anatomicopathological picture three different clinical pictures emerge with different treatments and prognosis. Group I is constituted by young people and children with a profuse background of atopy and parasitosis, which develop mictional syndrome and haematuria and show good response to steroids. Group II includes middle-aged women, with development of chronic recurrent cystopaty and a poor response to treatment. Group III comprises elderly patients with a history of vesical injury or chronic vesical irritation, with no separate clinical signs and symptoms and requiring no treatment.
Surgery, requiring the use of general orotracheal anaesthesia, has been the traditional treatment for many inguino-scrotal conditions. Over a number of years a gradual implementation of an alternative procedure consisting in the adoption of locoregional anaesthetic techniques has taken place, allowing to shorten hospital stays with the subsequent benefit for both the society at large, due of lower costs, and the patient through avoidance of general orotracheal anaesthetics and a faster discharge and return home. Based on these premises, 54 procedures were performed (16 inguinal varicocelectomies, 6 transinguineal orchiectomies, 21 hydrocelectomies, 3 spermatic cord cyst removals, 6 orchidopexy and 2 orchiectomies in patients diagnosed with testicular torsion). Our results demonstrate that this is an excellent technique which allows a ruled surgical procedure well tolerated by the patient and which allows to perform surgery without need of hospital stay.
Paratesticular vascular lesions are very uncommon. One of them, the epithelioid hemangioendothelioma, is a vascular tumour which grows around a vessel and in characterized for presenting epithelioid endothelial cells. Is very rare and it has good prognosis. This paper reports one case of paratesticular epithelioid hemangioendothelioma.