Biomedical subjects

Manuel A Penalver

Publications and source records attributed to Manuel A Penalver.

6 recordsLinked to original sources

PubMed2005

Sigmoid impaction secondary to urinary stones: case report and review of literature.

BACKGROUND: This is the first case report of a Miami pouch sigmoid fistula developing passage of urinary stones resulting in the presentation of constipation secondary to impaction. CASE REPORT: A 49-year-old woman who developed a recurrence of invasive squamous cell cervical carcinoma 1 year after pelvis radiation. She then underwent anterior pelvic exenteration and creation of a Miami pouch. Approximately 14 years after the primary radiation therapy and 13 years after the creation of the exenterative procedure, the patient developed a Miami pouch sigmoid fistula. The decision was made at this time to repair the fistula and remove the urinary stones from the sigmoid colon. Postoperatively, the patient remained continent using intermittent catheterization of the pouch and there was no evidence of recurrence of the cancer. CONCLUSION: Conservative management of urinary reservoir complications should always be considered before surgical intervention is attempted. When indicated, surgical management should not be delayed.

Carcinoma, Squamous Cell↗

PubMed2004

The gastrointestinal complications of the Miami Pouch: a review of 77 cases.

OBJECTIVES: To describe the gastrointestinal (GI) complications associated with the Miami Pouch (MP), a continent ileocolonic urinary reservoir. METHODS: A retrospective chart review of patients who underwent a MP from 1988 to 1997 at the University of Miami, School of Medicine, was employed. Data was analyzed in terms of early and late (beyond 6 weeks) GI complications resulting directly from the operation. RESULTS: Seventy-seven patients underwent a MP, a form of continent urinary diversion. Seventy-two patients (93.5%) were previously radiated. The perioperative mortality rate was 11.7%. Twenty (26%) patients developed a GI complication (17 late and 3 early), and 5 (6.5%) were directly as a result of the MP. Twelve recto-vaginal and 1 recto-neo-vaginal fistulas were identified. All but one was considered as late. Three (3.9%) patients developed colo-MP fistulas (3, 5, and 14 months). All three patients failed conservative management and required reoperation. Two patients developed enterocutaneous fistulas (3 and 5 months). One patient developed breakdown of the ileotransverse colon anastomosis on postoperative day 12 and required reoperation with bowel resection and an ileostomy. She expired from intraabdominal sepsis. Finally, 1 patient developed short bowel syndrome secondary to an expanding hematoma in the small bowel mesentery. CONCLUSIONS: . The GI complication rate attributed directly to the MP is low (6.5%). Prompt recognition is the key to successful management of these complications. The majority of these complications are considered as late and do not occur in the immediate postoperative period. Conservative management of GI-MP fistulas is not successful and necessitates reoperation.

Adult↗

PubMed2004

Conversion of an incontinent urinary conduit to a continent urinary reservoir (Miami Pouch).

OBJECTIVE: External urinary or gastrointestinal appliances can impair a patient's quality of life. We report on the feasibility of converting an incontinent colonic urinary diversion to a continent urinary reservoir (Miami Pouch). CASE: We describe the case of a 66-year-old white female with a history of stage Ib(2) cervical cancer treated by radical abdominal hysterectomy and adjuvant radiation therapy. The patient developed severe radiation cystitis with a neurogenic bladder and bilateral ureteral obstruction. After failing conservative management, a urinary diversion with a transverse colon conduit was performed. The patient remained without evidence of disease for 2 years and led an active lifestyle with regular tennis games. After 7 months of an external appliance for the urinary conduit, the patient presented to the University of Miami for conversion to a continent urinary mechanism which would not require an appliance. We performed an exploratory laparotomy, conversion of a transverse colon conduit to a continent ileo-colonic urinary reservoir (Miami Pouch). There were no postoperative complications. The patient remains disease-free and performs self-catheterization with no need for an external appliance. The patient has been able to resume an active life including sports. CONCLUSIONS: Successful conversion of an incontinent urinary conduit to a continent urinary reservoir is possible in a select case resulting in a perceived improvement of quality of life.

Aged↗

PubMed2002

Vaginal reconstruction at the time of pelvic exenteration: a surgical and psychosexual analysis of techniques.

OBJECTIVES: Vaginal reconstruction following pelvic exenteration is an important aspect of the physical and psychological rehabilitation of women after radical surgery for pelvic malignancies. The choice of techniques is vast, and proper patient and surgical selection is important for obtaining satisfactory functional and aesthetic results. The objective of this retrospective study is to review different techniques for vaginal reconstruction and report the complications and patient satisfaction associated with the different procedures. METHODS: Between January 1988 and April 2001, 104 pelvic exenterations were performed by the division of gynecologic oncology at the University of Miami, School of Medicine. Twenty-five (24%) patients underwent vulvo-vaginal reconstruction at the time of the exenteration. A retrospective chart review of the 25 patients was performed, and 9 patients were available and contacted for an interview. RESULTS: Twenty-four (96%) patients had received prior definitive radiation therapy. Overall, there were 9 complications (6 major and 3 minor) attributed to vaginal reconstruction, accounting for 36% perioperative morbidity. Seven of the nine (78%) patients interviewed reported successful vaginal intercourse at some point after their operation. All 5 surviving patients in the myocutaneous flap group were very satisfied with their sexual function and were sexually active at the time of their interview. CONCLUSIONS: Vaginal reconstruction at the time of pelvic exenteration is an important topic that should be discussed with the patient during the preoperative visit. Although the myocutaneous flaps are associated with longer operative times, they appear to be the preferred type due to decreased postoperative fistulae and better patient satisfaction.

Adult↗

PubMedDate not supplied

Molar gestations and hydropic abortions differentiated by p57 immunostaining.

Classification of molar gestations into complete and partial and their differentiation from hydropic abortions traditionally are accomplished by morphology alone. The process sometimes may be inaccurate or inconclusive. With the availability of p57 immunostaining it may be possible to objectively classify these lesions. We used p57 for the differential diagnosis of hydropic abortions and molar gestations and correlated the findings with the clinical outcome of patients in each category. First, 86 cases were originally classified by histomorphology into hydropic abortion (42) and molar gestations (23 complete and 21partial). Based on the pattern of p57 staining the cases were reclassified into 45 hydropic abortions, 15 partial moles and 26 complete moles (3 cases with previous diagnosis of complete mole based on morphology were reclassified as hydropic abortion). Clinical follow-ups ranged from 6-24 months and showed persistent trophoblastic disease in 8 cases (31%) of complete moles and 3 cases (20%) of partial moles (p = 0.47). No hydropic abortion cases demonstrated persistent trophoblastic disease. One patient with partial mole developed choriocarcinoma. This study confirms that p57 objectively distinguishes hydropic abortions from molar gestations (partial and complete moles). This differentiation is clinically relevant since patients with hydropic abortions do not need to be followed while patients with molar gestations do.

Abortion, Spontaneous↗

PubMedDate not supplied

Pelvic exenteration and reconstruction.

For the past six decades, pelvic extenteration has been utilized in the treatment of localized central pelvic recurrences after chemo/radiotherapy. The radicality of the procedure that includes resection of the bladder, vulva/vagina, and rectum, although with curative intent, results in comprehensive changes for the patient. For this reason, all patients should undergo extensive psychosocial counseling to prepare them for the changes in body image and lifestyle. Extirpation of the pelvic viscera has undergone a number of modifications since Brunschwig first described it in 1948 to maximize survivability and minimized anatomical distortion. Most of the advancements have been focused on the reconstructive phase after pelvic exenteration. A few select patients can be free of any external appliances such as a colostomy bag with utilization of a low colorectal anastomosis, and can maintain sexual intimacy with creation of a neovagina. In addition, reconstruction of the pelvic floor with omental flaps, dura mater grafts and myocutaneous flaps have decreased postoperative morbidity. In this article, we provide a review of pelvic exenteration in gynecologic oncology, emphasizing preoperative evaluation, surgical techniques and their postoperative management.

Female↗