Biomedical subjects

R A Medina López

Publications and source records attributed to R A Medina López.

18 recordsLinked to original sources

PubMed2004

[Adrenal metastases of Ewing's sarcoma. Report of one case].

Adrenal metastases are more frequent than primary adrenal carcinoma. The most frequent are, in this order: breast and lung cancer, stomach and kidney carcinomas, adrenal gland contralateral tumors and melanoma. Less frequent are tumours of the bladder, colon, esophagus, gall bladder, liver, pancreas, prostate, stomach and uterus. The rest of the tumours rarely spread toward adrenal glands. The metastases to the adrenal glands caused by sarcomas are rare and normally they happen in the contest of a massive metastases affecting several organs at the same time. We present a case of a patient affected by adrenal metastases of Ewing's sarcoma who has been referred to us for surgical treatment because it is a unique metastases (there is no sing of more illnesses in other organs at the time of the exploration).

Adrenal Gland Neoplasms↗

PubMed2004

[Carcinosarcoma of the bladder: report of our cases and review of the literature].

Carcinosarcomas of the bladder are rare. As a result, the natural history of them and the best methods of treatment remain uncertain. These tumors tend to be rapidly growing, invasive and recur locally. We reviewed our experience with four patients presenting between 1995 and 2002. Epidemiology findings, clinical aspects, histological features, diagnostic methods, treatment and survival are discussed in relation to literature.

Aged↗

PubMed2004

[Analysis of renal neoplasms in adult patients under 40].

OBJECTIVES: To analyze within our sample population the number of patients under 40 receiving surgery as a result of renal neoplasm; to describe the characteristics of these patients and compare them with those of adult patients over 40. PATIENTS AND METHODS: We have revised the clinical history of the 379 patients with renal neoplasm who have undergone surgery in our Service from January 1986 through June 2003. Patients were divided into two groups. Group I, formed by 36 subjects (9.5%) < or = 40. Group II includes 343 patients (90.5%) over 40. Data were included in a database created using the software programme Access and were subsequently analysed using the statistical package SPSS. A descriptive analysis was performed and life expectancy was calculated for both groups using the Kaplan-Meier survival curve. RESULTS: 7.3% of the total number of renal cell carcinomas included in our series occurs in patients of or under 40. No significant differences have been observed as regards the distribution per sexes, laterality, size, incidental occurrence, clinical symptoms, anatomopathology, staging or surgical technique employed. However, we have observed differences as regards cancer-specific survival rate after 5 years, being 94.74% in the case of group I and 68.64% in group II (log-rank 0.0338). CONCLUSIONS: The number of patients < or = 40 undergoing surgery as a result of renal cell carcinoma in the sample under study matches other series already published. No statistically significant difference has been observed as regards staging among patients under and over 40. Differences do exist as regards cancer-specific survival rate. In the case of our patients, irrespective of the age group to which they were ascribed, it is more common to diagnose a renal neoplasm incidentally than through the clinical manifestations.

Adolescent↗

PubMed2004

[Retroperitoneal malignant fibrous histiocytoma].

We report a new case of retroperitoneal tumor: a malignant fibrous histiocytoma, in its less aggressive histologic type, the mixoid variety. This is a recently isolated histologic presentation from other sarcomas, with a low incidence, non-specific clinic findings and poor prognosis due to its tendency to reappear and to produce metastasis.

Aged↗

PubMed2004

[Retroperitoneal neurilemmona].

Schwannoma is an uncommon tumor arising from neural sheath of peripheral nerves. Histological findings showing Antoni A and B zones are the main diagnostic features. We report a new case of a retroperitoneal located one, which is not its most usual place to appear, in a 60 year old male, presenting left flank pain. He received surgical treatment, having a satisfactory evolution.

Humans↗

PubMed2003

[Predictive model for prostate cancer in patients with biopsy indication].

OBJECTIVE: Attemp to determine the probability of developing prostate carcinoma taking into acc age, digital rectal examination and PSA once a transrectal biopsy has been indicated, so that both doctors and patients have mor information to face such pathology. MATERIAL AND METHODS: Retrospective study of 633 biopsies, taken into acc the patient's age, digital rectal examination, PSA level and histology. The data were included in a database created with Access and were put a logistic regression by mens the software program SPSS. RESULTS: Once the biopsy is indicated, digital rectal examination is the parameter offesing a higher discriminatory valuer with an odd ratio of 5.9 (CI 95%, 3.9-8.9). The mathematical model obtained shows a sensitivity level of 57% and a level of specificity of 84%. Pre-test probability is 36%, the probability post-test increasing up to 70%, and a negative predictive value of 77% and a positive predictive value of 67%. CONCLUSIONS: The mathematical model obtained individually determines the probability of suffering from prostatic carcinoma. Moreover, using this model the probabilities obtained re more precise than those derived from the fact of fulfilling the criteria for a prostatic biopsy. Once a biopsy is indicated, the rectal examination becomes the parameter with a higher predictive value of PC, irrespective of PSA and age. The PPV of the model is higher than of the PSA or the digital recta examination used separately.

Adenocarcinoma↗

PubMed2003

[Effects of water diuresis on the urinary ph of patients under relapsing lithiasis].

INTRODUCTION: It has been observed that in healthy individuals the increase in urinary flow induced by water overload may be enough to alter the urinary Ph to obtain values considered safe in the prophylaxis of lithogenesis. The aim of the present paper is to determine the effects of water diuresis on the urinary Ph of patients suffering from relapsing lithiasis. MATERIAL AND METHOD: 26 patients were included in the present study. The urinary Ph of all patients was measured along two consecutive days, at 8.30 and again at 12.30, under normal conditions (the first day) and once they had received a water load equivalent to 1.5% of their weight (the second day). RESULTS: The altered mean value of the Ph induced on the first day by the circadian rhythm showed a mean of 0.13 units of Ph, which lacks statistical significance (p > 0.05). However, on the second day we obtained a value of 0.42, which is statistically significant (p < 0.01). The normal tendency after the water overload was towards a positive increase of the Ph in those patients whose urine showed a preload Ph value < 6.1, whereas those individuals with a preload Ph value > 6.48 suffered negative increases. CONCLUSIONS: The increase of diuresis induced by water load proved enough to provoke an increase of urinary Ph when its baseline value is < 6.1, or either a decrease when its baseline value is > 6.48. In both cases, Ph values ranged between 6-6.5 which are considered safe values in the prophylaxis of lithogenesis. The more separated the baseline urinary Ph is from the 6.1-6.48 range, the greater the effect of the water load.

Adult↗

PubMed2001

[Kluyvera ascorbata. Case report of a patient with Crohn's disease].

For the not frequent, we contributed a new case of infection urinary produced by the I generate Kluyvera. We make a bibliographical review, clinical expression of the same and we insisted in a series of peculiarities, you like the appearance give because of the treatment pharmacologic and their intestinals.

Adult↗

PubMed2001

[Incidental diagnosis of renal carcinoma. Does it imply a better prognosis?].

OBJECTIVE: We present 267 patients undergoing surgery for renal carcinoma, comparing the incidental tumour and symptomatic tumour with different parameters and evaluating the prognostic significance of the incidental diagnosis. MATERIAL AND METHODS: Of the 267 patients, 110 (41.2%) were diagnosed incidentally. The different variables analysed were: age, sex, tumour size, if unilateral or bilateral, histological type, stage, degree of cellular differentiation and survival. The mean follow-up period was of 43.32 mos in the symptomatic patients and 41.85 mos in the patients diagnosed incidentally. The data obtained was analysed with the SPSS statistic pack. RESULTS: No significant difference was detected between both groups in regards to age, sex, if unilateral or bilateral and histological type. Comparing tumour size, a statistic difference was observed with slices at 6 cm. When analysing the stage and degree of cellular differentiation, a significant difference is found with tumours diagnosed incidentally presenting better differentiation and a lower stage at the moment of diagnosis. Survival after 5 yrs was of 65.7% for symptomatic patients in comparison to 81.7% for the incidental group, which implies high statistical signification (log rank = 0.0018). CONCLUSIONS: In our series no significant differences were detected between incidental and symptomatic tumours when comparing age, sex, anatomic side and histological type. Significant differences were indeed detected in relation to size, degree of cellular differentiation, tumour stage and survival.

Female↗

PubMed2001

[Renal cancer: descriptive analysis of a series of 267 intervened cases].

OBJECTIVE: To present the results of a descriptive analysis of 267 surgically treated renal tumors. METHODS: From January 1986 to October 1999, 267 patients (153 males and 114 females) with renal tumor were treated in our department. All data were introduced into the Access data base program and analyzed using the SPSS software. Descriptive analysis was performed and life expectancy was calculated with the Kaplan-Meier survival curve. Mean follow-up was 42.72 months. RESULTS: 56.4% were in the right and 43.6% were in the left kidney. 41.2% of the cases were incidentally discovered. In the symptomatic patients, the most common presenting feature was hematuria (51.8%). Radical nephrectomy was performed in 94.2%, partial in 3.1% and tumor resection in 2.7%. The lumbar approach was used in 75.5% of the cases. In regard to the histology, 88.7% were carcinomas. Clear cell was the most frequent cell type (91.5%). By grade, 55.8% were GI, 32.9% GII and 11.3% were GIII. By stage (according to the 1992 TNM classification), 64.3% were stage I, 15.4% stage II, 17% stage III and 3.3% stage IV. 80.5% showed no vascular involvement. The 5-year overall survival was 71.93% (mean 114 months; median 167 months). Currently, 76% of the patients are alive. CONCLUSIONS: Distribution by sex in our series was different to that reported in most of the studies. The tumor was incidentally discovered in a high proportion of the cases. The lumbar access was the most widely used surgical approach. The overall survival is similar to that reported by other groups.

Adolescent↗

PubMed2000

[Vascular assessment before kidney transplantation. Role of computerized helical tomography].

OBJECTIVE: To present our experience with helical CT for vascular assessment prior to renal transplantation. METHODS: In our hospital, all candidates to renal transplantation are referred to the Urology Transplant Unit for previous assessment. For the past 3 years, patients with multiple arterial calcifications (non linear) have been evaluated by helical CT with three-dimensional reconstruction of the calcification densities, which provides an accurate representation of the lesion. RESULTS/CONCLUSIONS: Pretransplant evaluation has been fundamental for individualized planning of the renal transplant surgery. The use of helical CT is extending in our field and it has also been utilized in graft donor assessment. In our experience, the extent and thickness of arterial wall calcifications are accurately depicted by helical CT. These findings could have an important significance when making pre and perioperative decisions in renal transplantation.

Humans↗

PubMed1999

[An adrenal pseudocyst. A report of a new case].

We report the case of a female young woman with an incidental cystic lesion in the left adrenal gland while during a routine study by her gynecologist. The change of the aspect in the content of the lesion, its limit size and a not definitive study of punction went to the surgical act. This was made with preservation of both, adrenal and renal units. The pathological report was adrenal pseudocyst.

Adrenal Gland Diseases↗

PubMed1999

[Renal artery stenosis in the transplant patient].

OBJECTIVE: To present our experience in the diagnosis and treatment of renal artery stenosis in kidney transplants. METHODS: A review of 601 renal transplants performed in adults showed 32 cases of renal artery stenosis. The diagnostic techniques utilized were arteriography in 18 patients, DIVAS in 15, echo-Doppler in 11 patients and MAG with captopril test on two occasions. RESULTS: Arterial hypertension was the most common symptom (92.8%), alone (53.1%) or in association with impaired renal function (43.7%). 46.8% of the cases could be managed by drug therapy. Percutaneous transluminal angioplasty was performed in 14 patients. Surgery was required on two occasions. CONCLUSIONS: The incidence of renal artery stenosis in our series of renal transplants in adults up to 1997 was 5.3%. Arterial hypertension with or without impairment of renal function was the most common symptom. Currently, echo-doppler and MAG with captopril test are the most widely utilized diagnostic techniques. Percutaneous transluminal angioplasty is the treatment of choice in renal artery stenosis when arterial hypertension is refractory to drug therapy. Good results are achieved in 57%, although it is not free from complications. In case of failure, revascularization surgery is the alternative approach.

Adult↗

PubMed1998

[Management of female stress urinary incontinence in a specialized unit].

Urinary exertional incontinence is a very common condition which requires a broad range of therapeutic options being available. Besides, the creation of specialised units in urology is now evident, one of the areas involved being Urogynaecology. To focus the issue of female urinary incontinence, the following should be considered: to begin with, treatment is not imperative, patients must be evaluated on a case-by-case basis, the least invasive principle must prevail, diagnosis must be early, and it should be taken into account that primary and secondary prevention is both possible and necessary. A working pattern was designed accordingly, to sustain therapeutic decisions, which consisted in a detailed anamnesis, complete examination and application of an established diagnostic-therapeutic algorithm. Even so, a therapeutic, medical or surgical decision will be chosen and patients will be monitored at one, four and sixteen months after completion of treatment. To achieve good results in the management of female urinary exertional incontinence it is essential to include a large number of patients. In fact, the key is to establish a close collaboration with the gynaecologists.

Clinical Protocols↗

PubMed1998

[Multilocular renal cysts. Clinical and therapeutic considerations].

OBJECTIVE: According to current concepts, multilocular renal cysts are the most benign type of embryonary tumors by contrast to wilm's tumor. Our experience with multilocular renal cyst is presented herein. METHODS: 12 patients (4 boys, 6 adult females and two males) were diagnosed and treated for multilocular renal cyst. One of the adult male patients had an adenocarcinoma located on one of the cysts. Ten patients underwent nephrectomy and two patients were treated by conservative surgery. RESULTS: At 9 years' mean follow-up, no tumor recurrence has been observed. CONCLUSIONS: In the adult patient, all segmental, large and multiloculated cystic masses with a homogeneous content that do not compromise the rest of the parenchyma or adjacent organs except by compression, are suggestive of a multilocular cyst. Conservative surgery is the most reasonable therapeutic option if the foregoing is suspected. This condition has a very good long-term prognosis.

Adolescent↗

PubMedDate not supplied

[The webbed penis. A report of a new case].

OBJECTIVE: To report an additional case of webbed penis or penis palmatus, an uncommon malformation caused by alterations that occur during the embryonic development of the external genitalia. METHODS: A 15-year-old by consulted for penile curvature. He was diagnosed as having webbed penis and phimosis, and was submitted to surgery. RESULTS/CONCLUSIONS: Z-plasty and circumcision achieved excellent results. He had no erectile anomalies following surgery.

Adolescent↗

PubMedDate not supplied

[Gonadoblastoma in Swyer syndrome].

Swyer's syndrome is a pure gonadal dysgenesis with female external genitalia. A likely complication is the appearance of tumour's dysgenetic gonads. This paper studies a case report of gonadoblastoma in a female patient with this syndrome.

Adolescent↗

PubMedDate not supplied

[Biofeedback as a therapeutic alternative in uncoordinated miction].

The Hinman Syndrome is known as an involuntary unsconscions contraction of the periurethral sphincter during micturition once neurologic disease and anatpmical obstruction are rejected. We report a case of a 23 years old man who was diagnosed of suffering from this syndrome. After the proper studies and left nephroureterectomy for ureterohydronephrosis secondary to long term massive vesicoureteral reflux, we proceeded to treat him with biofeedback and autocatheterisms. Six months after, the patient was asymptomatic with normal micturitions without residue.

Adult↗