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O Bielsa

Publications and source records attributed to O Bielsa.

At least 19 recordsLinked to original sources
PubMed2003

[Comparative study of the effect of complete prolonged neoadjuvant hormonal blockade versus standard hormonal blockade].

INTRODUCTION: Radical prostatectomy is considered as a curative treatment option in clinically localised prostate cancer patients. Therapy failure is related to positive surgical margins and/or extracapsular extension. The use of neoadjuvant combined androgen blockade (CAB) withdrawal therapy, mainly in cT2 disease, has been shown to decrease positive margin rates. However, CAB therapy remains controversial since there is no proof that this approach confers any benefit in relation to biochemical and clinical disease-free survival. Increasing negatives surgical margins and lower tumour volume (TV) with prolonged CAB therapy has been recently reported. AIM: To analyse the effect of 6 months neoadjuvant CAB therapy in front of 3 months in clinically localised prostate cancer patients submitted to radical prostatectomy. PATIENTS AND METHODS: The pathological stage and TV in forty-two patients treated by 6 months in front of thirty-four patients treated by 3 months were studied. The relationship of clinical stage and initial PSA concentration were analysed. RESULTS: TV was significantly lower in 6 months treated patients (0.97 cc vs. 0.48 cc, p = 0.05). The lowest TV was observed in cT1 patients, but significant differences only were observed in cT2 (1.5 cc vs. 0.86 cc, p = 0.04). No relationship between TV and PSA was obtained. No differences in the incidence of organ-confined disease were seen depending of the CAB length (47% vs. 43%, p = NS). However, increasing incidence of specimen-confined disease was observed in 6 months treated patients (56% vs. 74%, p = 0.05). CONCLUSION: The duration of neoadjuvant CAB can affect both TV and surgical margin status. Lower TV and increasing incidence of specimen-confined disease with 6 months CAB treatment were observed. Patients with palpable disease may be more benefited by this treatment option.

Androgen Antagonists↗
PubMed2003

A longer duration of neo-adjuvant combined androgen blockade prior to radical prostatectomy may lead to lower tumour volume of localised prostate cancer.

OBJECTIVES: To analyse tumour volume (TV) in clinically localised prostate cancer patients treated with neo-adjuvant combined androgen blockade (CAB) therapy prior to radical prostatectomy. PATIENTS AND METHODS: Two hundred consecutive patients treated between 1996 and 2000 were retrospectively analysed. Fifty patients underwent radical prostatectomy alone and 45 were treated with CAB for 1-3 months, 83 for 4-6 months and 22 for more than 6 months before surgery. Logistic regression analysis was performed to identify the strongest independent prognosticator of organ-confined disease. RESULTS: No evidence of residual cancer was found in 11 specimens (5.6%). Regarding TV, 20 specimens showed less than 0.1cc, 33 between 0.1 and 0.49cc and 86 more than 0.5cc. Smaller TV was found in CAB-treated patients. Significant correlation was observed between treatment duration and TV. In logistic regression analysis, only CAB duration and TV were significantly correlated with organ-confined disease. CONCLUSIONS: Prominent regressive features and lower TV were found after neo-adjuvant CAB. It seems that more prolonged treatment may lead to greater tumoural regression. Only tumour burden and length of CAB therapy were independent variables significantly correlated with pathologically localised prostate cancer.

Androgen Antagonists↗
PubMed2001

Renal cell carcinoma with syncytial giant cell component.

We report a case of clear cell renal cell carcinoma in which a prominent multinucleated giant cell component was intermingled with clear, granular, and spindle cells. Histological, ultrastructural, cytometric, and cytogenetic features of giant cells were similar to those of mononucleated cells in the tumor, and therefore they were not from stromal or osteoclast derivation. These giant cells had homogeneous, finely granular, abundant cytoplasm, often with scalloped cell borders, and contained from 5 to more than 50 nuclei, all of them very similar in size and shape, with prominent central nucleoli. Occasionally, surrounding inflammatory cells were also engulfed in the cytoplasm. This syncytial appearance was more similar to that of some giant cell carcinomas from the lung than to the pleomorphic giant cells often encountered in high grade renal cell tumors. Although the patient is alive and free of disease 6 years after diagnosis, a longer follow-up will be required to assess the potential prognostic influence of this peculiar histological appearance.

Carcinoma, Giant Cell↗
PubMed2001

Bone metaplasia in a case of bilateral renal cell carcinoma.

We present a case of synchronous, bilateral renal cell carcinoma with osseous metaplasia. In renal cell carcinoma, bone can originate through two different processes: osseous differentiation or osseous metaplasia. The case we report here represents the second process. We discuss pathological differential diagnosis and prognosis of the infrequent tumor.

Aged↗
PubMed1998

Cystic renal cell carcinoma: pathological features, survival and implications for treatment.

OBJECTIVES: To assess the incidence, clinicopathological features, prognosis and therapeutic options of cystic renal cell carcinoma (CRCC). PATIENTS AND METHODS: The clinical records and nephrectomy specimens from 206 patients with renal cell carcinoma (RCC) were reviewed after a minimum follow-up of 5 years. The mode of presentation, tumour size, growth pattern, nuclear grade, cytoplasmic appearance and pathological stage at presentation were compared with the outcome, as measured by disease-free and overall survival of the patients. RESULTS: From the 206 patients with RCC, 25 (12%) were classified as having CRCC; most of these cases (96%) occurred in male patients, as opposed to 64% in the remaining patients RCC (P = 0.0029). The clinical features at diagnosis were similar in both groups, although asthenia, anorexia and weight loss were uncommon in patients with CRCC (P = 0.045). Nuclear grade and pathological stage were usually lower in those with CRCC than in those with RCC (P = 0.0071 and P = 0.0033, respectively). Survival was significantly longer in patients with CRCC (P = 0.0342). CONCLUSIONS: CRCC is a type of RCC that is usually identified at earlier stages, has a slower growth rate, and is therefore associated with a better prognosis and longer survival than conventional RCC. The differential diagnosis between CRCC, cystic multilocular nephroma and cysts with a superimposed infectious or haemorrhagic process can be extremely difficult in imaging studies, and even in intra-operative frozen-section analysis. Because of this, and with the better prognosis of CRCC, a conservative surgical approach would be the treatment of choice whenever technically feasible.

Carcinoma, Renal Cell↗
PubMed1996

Reversible azoospermia in a patient treated with triazolam.

This is a report of a 26-year-old schizophrenic man treated with triazolam, levomepromazine, trifluoperazine and biperiden, who showed complete absence of spermatozoa in seminal analysis with normal plasma hormone levels. Sperm count reached 151 x 10(6)/ml after 6 months of triazolam withdrawal. A reversible effect of triazolam is suggested at the level of the germinal cells which are differentiating, without affecting the stem cells.

Adult↗
PubMed1996

[Disappearance of migraine crises in two patients with male infertility treated with human chorionic gonadotropin/human menopausal gonadotrophin].

Two patients aged 52 and 31 respectively, treated for male infertility with gonadotrophins (LCG/LMG), showed marked improvement of their migraine crises associated with a typical aura which had been present since puberty. Changes in the number, motility and morphology of the spermatozoids were seen in the seminogram. The plasma concentrations of FSH, LH, testosterone an 17-beta oestrodiol were within normal limits. After three months of empirical treatment with LCG/ LMG (to stimulate spermatogenesis) the migraine crises ceased and the patients are still free of migraine after 32 and 26 months respectively. The relationship between migraine and the sex hormones is discussed, in the context of current knowledge of the psysiopathology of migraine and the beneficial effects obtained after treatment with LCG/LMG. We have not found any reference in the literature to the use of gonadotrophins in the treatment of migraine with a typical aura.

Chorionic Gonadotropin, beta Subunit, Human↗
PubMed1992

[Percutaneous drainage of renal and perirenal abscesses].

The prevalence of renal and perinephritic abscesses has radically changed over the last few decades basically due to two causes: the efficacy of antibiotics and early diagnosis by echography and/or CAT. Between January 1986 and December 1990, 12 cases of renal abscesses have been diagnoses in our Unit which have been treated conservatively through therapy with antibiotics and lumbar percutaneous drainage. Only one case was resolved with antibiotics alone; all other 11 cases needed drainage, in spite of a improvement in the symptoms, which was performed by translumbar puncture. Drainage was effective in 10 cases and the cultures found 5 cases of E. coli, 4 cases of Staphylococcus aureus and 1 case of Gram(-) bacilli. In the two cases where percutaneous drainage was not effective abscesses were produced by fungi: C. albicans and Mucor mycosis which caused highly solid septum and sphacelus requiring in both cases the use of open surgery. Currently this disease no longer represents a serious problem, it has a minimal morbidity and no mortality; only the group of high risk immunosupressed patients (AIDS, HIV (+), ADVEP) shows an increase in the number of cases and management in these patients continues to be problematic.

Abscess↗
PubMed1991

[Selective embolization in the treatment of traumatic priapism with an arterio-cavernous fistula. Review of the literature].

The authors report a case of post-traumatic priapism due to laceration of the left cavernous artery. Blood gases on blood aspirated from the corpora cavernosa revealed the presence of "high-flow" priapism. Transfemoral arteriography confirmed the arteriocavernous fistula which was successfully treated by selective embolisation of the internal pudendal artery. The authors present a review of the literature on this subject with special reference to the diagnostic and therapeutic aspects.

Adolescent↗
PubMed1990

A new technical alternative in the surgery for retroperitoneal fibrosis: the Gore-Tex surgical membrane.

The case of a male patient with retroperitoneal fibrosis secondary to an abdominal aortic aneurysm which was surgically treated with success, is presented herein. What is considered technically new is the management of the ureters after surgical lysis. An expanded polytetrafluoroethylene Gore-Tex surgical membrane, initially developed for pericardial closure after open-heart surgery, was used to isolate the bifurcated aortofemoral graft from the duodenum and the ureters from the vascular prosthesis and surrounding retroperitoneal tissues. This is considered to be a simple and safe technique and a technical alternative when dealing with this complex situation. To date, there has been no other description of such a technique using this material. The potential value of this material to prevent reencasement in retroperitoneal fibrosis from other origins should be kept in mind.

Aorta, Abdominal↗
PubMed1990

[Oncocytoma and calcification. A rare association].

The oncocytoma constitutes 3-6% of the kidney neoplasiae. The authors report one case of calcified kidney tumor, Its presentation as a calcified kidney mass is exceptional and is not present in the largest series of calcified kidney tumors. The calcification prognosis is much debated, even more in the case of oncocytoma due to the very limited series available. For calcified kidney tumor, the oncocytoma should be included as one of the differential diagnosis, even if it is not very frequent.

Adenoma↗
PubMed1989

Prolonged anuria after failed percutaneous transluminal angioplasty in a kidney transplant patient solved by surgery.

We present the case of a 21-year-old transplanted female patient who presented with anuria due to a renal artery stenosis secondary to a failed percutaneous transluminal angioplasty. The interest is that, to our knowledge, it is the longest case (220 days) reported in the literature of anuria in these conditions solved by surgery with an immediate urine output recovery. We report the underlying pathophysiology.

Adult↗
PubMedDate not supplied

Massive renal infarction due to mucormycosis in an AIDS patient.

Isolated renal infection by Mucor spp. occurs very rarely, even in the immunocompromised host. The mortality of the different forms of mucormycosis reaches 75-100% in most series. Infection of the kidney is usually diagnosed post-mortem. Thus, when renal infection is recognized, aggressive treatment including surgery and amphotericin B is required. We present a case in which a massive left renal infarction was the unique manifestation of mucormycosis in an AIDS patient. Administration of amphotericin B and left nephrectomy were necessary to achieve satisfactory outcome.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Renal malakoplakia: report of a case with multifocal involvement.

The authors report the light microscopic and ultrastructural features in one case of malakoplakia involving the kidney, the urinary bladder, and the skin. The kidney was excised. Lesions of the urinary bladder and the skin regressed after topical treatment with cholinergic agonists and antimicrobial drugs. This case illustrates the pathogenesis of malakoplakia and the possibility that early lesions can be cured with medical therapy before extensive tissue destruction has taken place.

Bacteria↗
PubMedDate not supplied

Low-grade spindle cell carcinoma of the kidney.

The authors report a renal cell carcinoma composed largely of spindle cells of Fuhrman's nuclear grade II in which the bland appearance of the cells and low mitotic index were reminiscent of a benign or low-grade smooth muscle tumor. Keratin immunostaining was positive, but evidence of epithelial differentiation was obtained by electron microscopy. The tumor was an incidental finding and it did not invade the perirenal fat or the renal vein. Follow-up is only 24 months but the histological features suggest that the prognosis may be better than that of a classic sarcomatoid renal cell carcinoma.

Carcinoma↗
PubMedDate not supplied

Effect of antibiotic treatment on serum PSA and percent free PSA levels in patients with biochemical criteria for prostate biopsy and previous lower urinary tract infections.

BACKGROUND: Controversy exists as to the influence of inflammatory foci on total and free prostate-specific antigen (PSA) concentrations. The objective was to analyze the biological variations of PSA and percent free PSA (%f-PSA) in patients with biochemical criteria for prostate biopsy (PSA higher than 4 ng/mL and normal rectal examination) and compare them with the variation induced by antibiotic treatment in a cohort of patients with a history of lower urinary tract infections and no clinical evidence of prostatitis. METHODS: Ninety patients with a history of lower urinary tract infections, non-suspicious digital rectal examination and PSA between 4 and 20 ng/mL were analyzed. PSA concentration and %f-PSA were determined. Forty-five patients were treated with three weeks of ofloxacin, following which marker determination was repeated. All patients underwent ultrasound-controlled transrectal six-core prostate biopsy. RESULTS: Sixty-seven patients presented benign prostatic hyperplasia (BPH) (30 with prostatitic foci) and 23 cancer. Significant variations in PSA (6.97 ng/mL vs. 5.82 ng/mL, p=0.001) and %f-PSA (14.84% vs. 17.53%, p=0.01) were found only in the treated patients. These differences were significant for patients with BPH-associated prostatitic foci and not for patients with BPH or cancer. The tendency was for PSA to decrease (15 treated patients with PSA <4 ng/mL vs. six non-treated patients) and for %f-PSA to increase. The median variation of %f-PSA was greater than that of PSA. When the cutoff for %f-PSA was set at 25%, 18.9% of unnecessary biopsies after the first determination and 20% after the second could be avoided. By associating the reduction in PSA, up to 46% could be avoided in treated patients. CONCLUSION: Biochemical criteria for prostate biopsy may be modified in patients with a history of lower urinary tract infections due to variations greater than those explained by intraindividual biological variations, and may be influenced by the antibiotic treatment. These results suggest that subclinical inflammatory foci may influence PSA and %f-PSA.

Anti-Bacterial Agents↗