Biomedical subjects

M Vírseda Chamorro

Publications and source records attributed to M Vírseda Chamorro.

At least 19 recordsLinked to original sources

PubMed2006

[Scrotal leiomyosarcoma with bone metastasis].

A case of scrotum leiomyosarcoma is presented in a 87 year-old patient. It debuts as a painless lesion in left hemiescrotum, of one year of evolution. Bony metastasis were observed in the moment of the diagnosis. We carried out a literature revision proving the rarity of this lesion type (only 27 cases have been described), and that, contrary to another leiomiosarcomas type, their aggressive evolution is not habitual in this localization.

Aged, 80 and over↗

PubMed2006

[Hepatitis C as a risk factor of diabetes mellitus type 2].

INTRODUCTION: Hepatitis C virus (HCV) has been implicated as a risk factor for the development of diabetes mellitus, type 2 (DM2). Our aim is to check if HCV infection in our patients is a risk for the development of DM2. In that case, we study if the possible pathogenic mechanism could be related with an increase in iron deposits. PATIENTS AND METHOD: A consecutive series of 305 patients that attended to our service for measurement of anti-HCV antibodies was collected. HCV-antibodies were identified by second generation ELISA and confirmed by immunoblot. We detected viral RNA in 56% of these patients by polymerase chain reaction. The control group was made up of 137 patients. In every case, we analyzed the plasma levels of glucose, ferritin and other biochemical parameters. RESULTS: We found 13% of diabetics in the patient with viral RNA, 9.3% in the infected patients without RNA and 3.9% in the controls. The average of the ferritin level for the infected patients was 256 mg/l and for the controls was 151 mg/l (p = 0.01). The diabetic patients had ferritin levels of 346 mg/l and non-diabetic patients had 218 mg/l (p = 0.038). The presence of HCV-antibodies showed a 2.78 odds ratio for diabetes risk. DISCUSSION: Our results showed a relationship between HCV infection and diabetes mellitus type 2, so that the percentage of diabetics increased parallelly with the degree of viral activity and the variable "presence of HCV-antibodies" was the one that most contributed to the risk. Although our results would support the role of the iron metabolism in the development of diabetes, follow-up studies of a cohort of patients infected by HCV would be necessary to contrast this statement.

Diabetes Mellitus, Type 2↗

PubMed2005

[A comparative study of the renal damage produced after the extracorporeal shock wave lithotripsy according to the lithiasis location].

INTRODUCTION: The Extracorporeal shock waves lithotripsy (ESWL) is fundamental in the treatment of lithiasis. However, there are evidences that it can produce renal damage. The objective of our study is to determine the degree of affectation of the glomerular and tubular function after ESWL, and the influence of the lithiasis location on the type of renal damage. MATERIAL AND METHODS: A prospective longitudinal study was carried out in 14 patients with normal renal function subjected to ESWL. We determined the basal level, and the levels at the 24 hours, at the 4th and the 10th day post ESWL of: microalbuminuria (MA) (that values the glomerular function), and N-acetyl glucosamide (NAG) and alanine aminopeptidase (AAP), (that value the tubular function). RESULTS: The basal levels of of MA, NAG and AAP didn't show significant differences in connection with the localization of the stones. A significant increase was observed of the three parameters only 24 hours post ESWL. No significant differences were observed between the variation of the microalbuminuria levels, AAP and NAG and the treatment in relation to the localization of the stones. CONCLUSIONS: It exists a glomerular and tubular damage after ESWL. This damage is not related with the pelvic or calicial location of the stones. In patient with previous normal renal function, the renal damage recovers at the 4th day post ESWL.

Adult↗

PubMed2000

[Urinary incontinence in menopause].

OBJECTIVE: To determine if menopause increases the risk of developing bladder hyperactivity or stress urinary incontinence. METHODS: A case control study was conducted on 111 women, 57 with bladder hyperactivity and 54 controls without hyperactivity, and 55 cases with stress urinary incontinence and 55 controls without stress urinary incontinence. The results were analyzed by multivariant logistic regression for the influence of age. RESULTS: A relationship was found between age and menopause and the risk of developing stress urinary incontinence. No relationship was found between bladder hyperactivity and age or menopause. Age was found to be a negative factor of menopause in regard to the risk of developing stress urinary incontinence. CONCLUSIONS: The risk of developing stress urinary incontinence in menopausal women decreases with age and disappears after age 52.

Case-Control Studies↗

PubMed1999

[Female urinary incontinence: clinical-urodynamic correlation].

OBJECTIVES: To determine the diagnostic utility of the urinary symptoms and physical examination in the urodynamic diagnosis of the type of female urinary incontinence. METHODS: A descriptive longitudinal study was conducted in 100 women undergoing urodynamic evaluation. The patients were asked about the urinary symptoms and were evaluated by physical examination and cystomanometry. RESULTS: A statistically significant correlation was found for age and clinical type of urinary incontinence. A strong trend was observed for clinical type of urinary incontinence and cystocele grade, and the urodynamic type of incontinence. A low sensitivity was found for the clinical type in relation to the urodynamic type of incontinence. CONCLUSIONS: Urinary incontinence clinical data do not permit determination of the urodynamic type of incontinence.

Female↗

PubMed1999

[Evaluation of new intraurethral occlusive depot (ORIS FEMININO) in the management of female stress urinary incontinence].

OBJECTIVE: To determine the utility and safety of an intraurethral device (Oris Femenino) in the management of female stress urinary incontinence. METHODS: A prospective clinical study was conducted on 54 female patients, mean age 46.4 years, with stress urinary incontinence. The degree and severity of the incontinence was determined before and one month after treatment with the intraurethral device. The reasons for the dropouts were analyzed and the rehabilitative effects two months after treatment had been completed were evaluated in 22 patients. RESULTS: 83% of the patients who completed the study referred positive results. A significant improvement was demonstrated for the degree of incontinence as well as the number of absorbent pads used. Age and severity of incontinence inversely correlated with positive results. A correlation between the absence of a previous urethropexy and positive results was also found. The dropout rate was 44% (24 patients) and was chiefly due to symptomatic bacteriuria in 14 cases and the difficulty in fixation and degree of incontinence. A statistically significant reduction was found in the number of pads used in the group of patients evaluated two months after treatment had been completed. CONCLUSIONS: The intraurethral device analyzed in this study significantly reduced urinary incontinence. This method appears to be more effective in younger women who are not severely incontinent and have not previously undergone urethropexy. The intraurethral device appears to have some rehabilitative effect on the perineal muscle. Symptomatic bacteriuria was found to be the main disadvantage.

Female↗

PubMed1999

[Toward a simplified method of classifying urinary incontinence in the elderly based on a multivariate analysis of 948 cases].

OBJECTIVE: The present study analyzes the main clinical types of urinary incontinence in the elderly population and its clinical-urodynamic correlation to facilitate definitive diagnosis. METHODS/RESULTS: The study was conducted in 948 elderly patients (382 male, 566 female; mean age 72.4 years) with urinary incontinence. Patient clinical and urodynamic records were reviewed. The most common clinical types were urge-incontinence (56.4%) and incontinence with coughing associated with urge-incontinence (32.3%); the latter type was the most common in women. The most frequent urodynamic diagnoses were isolated bladder instability (29.9%), followed by obstruction (15.6%) and stress incontinence (14%). CONCLUSIONS: The most common symptom in bladder instability was urge-incontinence, while incontinence with coughing was found to be the most common symptom in urinary stress incontinence. A significant correlation was found between the postvoid residual urine and the main urodynamic diagnoses. Multivariate analysis showed that classification by clinical types of incontinence together with measurement of residual urine can facilitate diagnosis, although this approach has a low sensitivity for the main forms of isolated incontinence. The mixed forms require a urodynamic study.

Aged↗

PubMed1999

[Evidence-based and science-based medicine].

Routine medical practice is an admixture of scientific knowledge, uncontrasted physiopathological deduction and intuition based on personal experience. Evidence-based medicine is a new approach to medical practice that is based on appropriately contrasted data and includes the following steps: 1) accurately define the problem we are dealing with, 2) investigate the medical literature efficiently, and 3) select the best, relevant studies and apply the corresponding norms to the evidence. In turn, the application of the corresponding norms to the evidence includes the following aspects: 1) determine if the results of the study are valid; i.e., evaluate the scientific quality of the article, 2) determine the magnitude of the results; i.e., establish is they are clinically relevant, and 3) evaluate their application to the point at issue; i.e., test the external validity of the study. The drawbacks of evidence-based medicine include its insufficient concern for basic research, its disregard for physiopathological hypotheses, and the naïve inductivism of epidemiology-based medical practice. Undoubtedly, evidence-based medicine provides advantages for the medical practice and underscores the importance of data and statistical procedures. This new paradigm, however, should not set aside the traditional, hypothetical-deductive approach.

Clinical Medicine↗

PubMed1999

[Evidence-based medicine. Usefulness of isolated cystomanometry for the diagnosis of periurethral detrusor-sphincter dyssynergia in patients with suprasacral lesion].

OBJECTIVE: To determine the utility of cystomanometry alone in the diagnosis of periurethral detrusor-sphincter dyssynergia in patients with suprasacral spinal cord lesion. METHODS: Cystomanometry and selective electromyography were performed to evaluate the periurethral sphincter of 40 patients (16 female and 24 male; mean age 46.6 years) with suprasacral spinal cord injury diagnosed by neurological evaluation. RESULTS: The pre-test probability of having dyssynergia was 0.45. The post-test probability, with cystomanometrically demonstrated hyperreflexia, was 0.58. The likelihood ratio utilizing cystomanometry alone was 1.69. CONCLUSION: Cystomanometry alone is not useful in the diagnosis of periurethral detrusor-sphincter dyssynergia in patients with suprasacral spinal cord injury. Periurethral electromyography should be used in combination with the foregoing technique.

Adolescent↗

PubMed1998

[Neurobiology of erectile dysfunction in multiple sclerosis].

OBJECTIVE: To analyze the neurological alterations responsible for impotence in multiple sclerosis. METHODS: We conducted a pharmacologic erection test and a neuroandrologic profile study in 11 patients with multiple sclerosis and impotence. This study consisted in: bulbocavernosus EMG, S2-S4 evoked potentials, somatosensory potentials of pudendal nerve, electromyography of cavernous smooth muscle (SPACE), sympathetic skin response (SSR) and cystometry. RESULTS: The most frequent neurological lesion was complete suprasacral (7 cases; 64%) and parasympathetic (7 cases; 64%) lesions. The parasympathetic lesions were of the upper motor neuron type in 6 of the 7 cases (86%). Peripheral autonomic [sympathetic in 2 cases (18%); parasympathetic in 1 case (9%)] and pudendal lesions (3 cases; 27%) were also observed. CONCLUSIONS: The main cause of impotence in multiple sclerosis could be ascribed to a suprasacral lesion. Some cases also present peripheral autonomic lesions.

Adult↗

PubMed1998

[Neurobiology of ejaculation and orgasm disorders].

OBJECTIVE: To determine the neurologic alterations of patients with ejaculatory and orgasmic disorders. METHODS: A study of the neuroandrologic profile was performed in eight patients; 6 presented an ejaculation, one premature ejaculation and one presented an orgasm. The neuroandrologic profile consisted in performing selective electromyography of the bulbocavernosus muscle, recording of the S2-S4 evoked potentials, evoked somatosensory potentials of the pudendal nerve, electromyography of the smooth cavernous muscle (SPACE), sympathetic skin response and cystometry. RESULTS: The sympathetic lesion was more frequent in the cases with an ejaculation (four cases; 66%); a pudendal efferent lesion was demonstrated in one case (17%) and a suprasacral lesion in one case (16%). A pudendal afferent lesion was observed in the two cases with premature ejaculation (100%). Both cases with an orgasm had a pudendal afferent lesion (100%) and one of them also presented a sympathetic lesion (50%). CONCLUSIONS: An ejaculation appears to be caused by sympathetic, motor pudendal or suprasacral lesion. An altered perception of genital sensations due to lesion of the afferent pudendal pathway appears to be present in premature ejaculation. An orgasm could be ascribed to an alteration of the pudendal sensibility or to the absence of ejaculation.

Adult↗

PubMed1998

[Urodynamic models in the analysis of pressure-flow studies in the adult male].

OBJECTIVE: To determine which urodynamic model best describes lower urinary tract dynamics during the voiding phase. METHODS: A pressure-flow study was conducted in 211 adult males. The urodynamic data from the pressure-flow study were modelized to a multivariate analysis with a descriptive design. Three descriptive models of urethral resistance were proposed: a linear model that consisted of the detrusor pressure at the end of voiding and the pressure-flow plot slope, and two quadratic models with one parameter [urethral resistance average (URA)] or two parameters [opening detrusor pressure and passive urethral resistance ratio curvature (PURR)]. Bladder contractility was defined by two parameters: power at maximum flow rate (Pw) and maximum power/bladder surface (Wmax). Voiding volume was included in all models as control variable. The best model was defined as that which explains a higher percentage of observed maximum urinary flow rate, the most widely utilized datum in the urodynamic studies of the adult male. RESULTS: The model that consisted of the URA and Pw was found to be the best. We observed an interaction between URA and voiding volume (at higher voiding volume the decrease of the maximum urinary flow due to URA was found to be greater). CONCLUSIONS: The URA was found to be the parameter that best describes urethral pressure. Variations in the maximum urinary flow rate is better described by the Pw than by the Wmax.

Adult↗

PubMed1998

[Pressure-flow studies in the diagnosis of micturition disorders in the female].

OBJECTIVE: To determine the utility of the pressure-flow studies in the diagnosis of voiding dysfunction in women. METHODS: A case-control study was conducted on 80 women. These subjects were divided into two groups: 24 controls with a maximum flow percentile greater than or equal to 50 and no residual volume, and 56 cases with a maximum flow percentile less than or equal to 10. The clinically and statistically significant parameters of the pressure-flow study were entered into a multiple regression logistic equation as explanation variables of voiding dysfunction. RESULTS: The clinical variables that influenced voiding dysfunction were age and the presence of stress urinary incontinence. The urethral resistance average (URA) was found to be the only significant urodynamic parameter. Patients with stress urinary incontinence showed a lower probability of voiding dysfunction. Age and URA directly correlated with the probability of voiding dysfunction. CONCLUSIONS: The URA was found to be the only significant urodynamic parameter. The contractility parameters [power at maximum flow (Pw) and maximum power per bladder unit surface (Wmax)] were not found to be useful as detrusor contractility index in women.

Adult↗

PubMed1997

[Current status of the study of genital sympathetic evoked potentials in the assessment of impotence].

OBJECTIVE: To determine the usefulness of penile sympathetic skin response (PSSR) in the study of impotence. METHODS: The PSSR, hand sympathetic skin response (HSSR), filling videocystography and SPACE (single potential analysis cavernous electromyography) were performed in 39 patients referred for study of impotence. RESULTS: A relationship between not obtaining PSSR and an open bladder neck (60%) in the videocystography at filling, and between a closed bladder neck and obtained PSSR (81%) was demonstrated. The percentage of normal hand sympathetic potentials was similar for patients with obtained and not obtained PSSR. The relationship between the degree of activity of the SPACE and the type of PSSR could not be demonstrated. CONCLUSION: The determination of the PSSR allows us to evaluate the sympathetic cavernous innervation. This would obviate performing a filling videocystography in the study of the neuroandrologic profile in impotence. The information obtained by PSSR is independent of that obtained from SPACE, therefore both procedures complement each other in the neuroandrologic study of impotence.

Electromyography↗

PubMed1997

[Assessment of sensory thresholds of the penile dorsal nerve as screening technique for neurologic lesion in impotence].

OBJECTIVE: The present study was conducted to determine the usefulness of the perception and stimulation thresholds of the penile dorsal nerve in the diagnosis of neurogenic impotence. METHODS: A study was conducted to determine the neuroandrologic profile in 130 patients. According to the results of the neuroandrologic profile, they were classified as patients without neurogenic impotence (44 pts.; 34%) or with neurogenic impotence (86 pts.; 66%). The perception and stimulation thresholds (expressed in milliAmperes) were determined in all patients. Furthermore, the perineal sensation was clinically tested. Both thresholds were also studied in relation to a demonstrated neurologic lesion (sympathetic, parasympathetic, afferent pudendal, efferent pudendal and suprasacral lesions). RESULTS: Assessment of the perineal sensation demonstrated a high specificity and a low sensitivity in the diagnosis of neurogenic impotence. A significant difference was observed between both groups for the perception (confidence interval of difference between the neurogenic and non-neurogenic group; from 0.02 to 4.95 mA) and stimulation thresholds (from 2.0 to 11 mA). Morever, the stimulation threshold was significantly higher in patients with alteration of the perineal sensation). Significant differences in the perception threshold were also demonstrated between patients with and without demonstration of efferent lesion, and in the stimulation threshold between patients with and without demonstration of pudendal afferent, pudendal efferent and sympathetic lesion. These differences are attributed to the presence of mixed lesions. However, given the width of the interval of normal values, it was not possible to find a useful cut-off point in both sensory thresholds. It could only be determined that the maximum value of the perception threshold in healthy subjects should be less than 9.45 mA. CONCLUSION: The sensorial thresholds of the electrical stimulation of the penile dorsal nerve and the data from the physical examination of perineal sensation are not useful for the diagnosis of neurogenic impotence. It is necessary to carry out a complete neuroandrologic profile.

Adult↗

PubMed1997

[Evaluation of electromyography of the corpora cavernosa (single potential analysis of cavernous electric activity--SPACE) as a technique for studying impotence].

OBJECTIVE: To analyze the utility of data obtained by single potential analysis of cavernous electric activity (SPACE) in the study of impotence. METHODS: 127 patients with impotence were evaluated by neuroandrologic profile, SPACE, erection test post intracavernous injection of papaverine-phentolamine and a cystometrogram (CMG). RESULTS: The quantitative characteristics (duration, amplitude, number of phases) of the SPACE potentials were not useful in distinguishing between the different types of impotence. The qualitative characteristics (degree of activity, morphology, synchrony and coordination) during erection were significantly different between the non-neurogenic and neurogenic impotence. Significant differences were found in the qualitative characteristics (synchrony and coordination during erection) between patients with no demonstration of organic impotence and those with a negative erection test and no alterations in the neuroandrologic profile (vascular impotence). No relationship was found between the degree of activity of the SPACE and the presence or absence of voiding reflex in the CMG. CONCLUSION: SPACE is a useful technique in the study of impotence, although the interpretation of the data are more qualitative than quantitative. The CMG provides complementary data and should therefore continue to be included in the study of the neuroandrologic profile in impotence.

Adolescent↗

PubMed1997

[Neurobiology of postoperative impotence after rectal excision].

OBJECTIVE: The present study was conducted to determine the changes in the neuro-andrologic profile of patients with impotence following rectal ablative surgery. METHODS/RESULTS: The study comprised 18 patients who had undergone rectal surgery: abdominoperineal resection of the rectum (AP) in 12 cases (67%), anterior resection of the rectum (AR) in 6 cases (33%). The pharmacologic erection test was negative in 60% of the patients (56% of the AP cases and 67% of the RA cases; differences not significant). Sympathetic lesion was demonstrated in 67% of the patients (50% of the AP cases and 100% of the AR cases; significant difference). Parasympathetic lesion was demonstrated in 38% of the patients (56% of the AP and in none of the RA cases; tendency towards statistical significance). Pudendal lesion was demonstrated in 83% of the patients, although no significant differences concerning pudendal involvement were observed between both types of surgery (92% of the AP group and 67% of the RA group). The frequency of the pudendal lesion was significantly greater than the parasympathetic lesion and the sympathetic lesion tended to be significantly greater than the parasympathetic lesion in patients undergoing ablative rectal surgery. No significant differences were observed between the pudendal and the sympathetic lesion in these patients. No relationship was observed between the type of neurologic lesion and the results of the pharmacologic erection test. CONCLUSIONS: The type of neurological lesion appears to be related with the level of the rectal surgery. The sympathetic innervation would be more frequently compromised in anterior resection of the rectum. The parasympathetic innervation would be more frequently compromised in abdominoperineal resection. The pudendal innervation would be affected by both types of surgical techniques.

Aged↗

PubMed1997

[Usefulness of electromyographic techniques of the bulbocavernosus muscle in the diagnosis of neurogenic impotence].

OBJECTIVE: To analyze the utility of electromyographic study of the bulbocavernosus muscle. METHODS: 126 impotent patients were evaluated by physical examination and neuroandrologic profile. The physical examination consisted in an exploration of the anal tone and the bulbocavernosus reflex. The neuroandrologic profile consisted in selective electromyography of the bulbocavernosus muscle, the determination of the S2-S4 evoked potentials, somatosensory potential of the pudenal nerve, electromyography of cavernous smooth muscle (SPACE) sympathetic skin response and cystometry. RESULTS: The results of the bulbocavernosus electromyography and S2-S4 evoked potentials were different from the data obtained from the physical examination of the anal tone and the bulbocavernosus reflex. Selective bulbocavernosus electromyography showed a sensitivity of 57% and a specificity of 84%. The S2-S4 evoked potentials showed a sensitivity of 61% and a specificity of 100%. The diagnostic value of the S2-S4 evoked potentials increased at 39 msec cutoff (sensitivity = 66%; specificity = 95%). Exploration of the anal tone is very specific for neurologic lesion in impotence (93%), but has a low sensitivity (30%). The clinical bulbocavernosus reflex showed a good specificity (85%) and sensitivity (75%) in the diagnosis of pudendal efferent lesion, but is less useful in the diagnosis of neurogenic impotence. CONCLUSIONS: The highest diagnostic value was obtained with the S2-S4 evoked potentials. Selective electromyography of the bulbocavernosus muscle showed a moderate diagnostic value. Physical examination of peripheral pudendal innervation does not appear to be useful for screening for neurologic lesion in impotence because of its low sensitivity, which may be due to existing incomplete nervous lesions.

Autonomic Nervous System Diseases↗