Biomedical subjects

R Cabello Benavente

Publications and source records attributed to R Cabello Benavente.

12 recordsLinked to original sources

PubMed2006

[Volume determinations of the whole prostate and of the adenoma by transrectal ultrasound: correlation with surgical specimen].

OBJECTIVE: We evaluated whether preoperative transrecta ultrasound (TRUS) mesaurements of the transition zone (TZ) and total prostate volumen predict real prostatic weight. MATERIAL AND METHODS: We compare estimated TRUS volumes with surgical specimen weight, in surgically treated patients with localized prostate cancer (group A, n = 33) or benign prostatic hyperplasia (group B, n = 37). The volume was calculated by the ellipsoid formula. Both measurements were compared with surgical specimen weight, assuming 1 as specific prostate weight. RESULTS: Group A: mean prostate measured volume was 38.6 cc. (SD 22.7), mean RP specimen weight was 54,2 g (SD 27.2) (p = 0.001). Total estimated prostate volume underestimated prostatectomy specimen weight by 29%. In order to adequate the estimated volume to the specimen weight, we calculated the formula: estimated prostate weight = 0.95 x prostatic measured volume + 17,657 (p = 0.005). Group B: mean TZ measured volume was 62.8 cc. (SD 23.3), mean adenomectomy specimen weight was 79.9 g (SD 45.9) (p = 0.001). TZ estimated volume underestimated adenomectomy specimen weight by 21%. In order to adequate the estimated volume to the specimen weight, we calculated the formula: estimated TZ weight = 1.67 x TZ measured volume - 24,768 (p = 0.04). CONCLUSIONS: We found significative differences between TRUS measured volumes and real weight of surgical specimen. These differences could be corrected by simple formulas that allow to minimize the observed underestimations.

Aged↗

PubMed2006

[Opened vs. laparoscopic radical nephrectomy in renal adenocarcinoma cost comparison].

PURPOSE: To undertake a cost comparison (cost minimization) between transperitoneal laparoscopic and opened nephrectomy in renal adenocarcinoma treatment. METHOD: Retrospective study on the first 26 patients submitted to LN without intra or postoperative complications in the period 2002-2003, using as control 22 patients treated with ON with the same characteristics and in the same period. Demographic variables were evaluated (age, sex, tumor size, etc.), intraoperative (operative time and fungible material used) and postoperative (length of stay in Postanaesthesic Care Unit, Acute Pain Unit needs and hospital stay). Our Hospital costs plus those imputed during year 2003 to the Urology Service, as well as the cost of fungible material for the same year were applied, carrying out a comparison of costs between both groups. RESULTS: There were no differences between the demographic variables between both groups except in the tumor, bigger size in the opened nephrectomy (p=0,001). Transperitoneal laparoscopic was 29,4% globally more expensive than opened nephrectomy. The transperitoneal laparoscopic intraoperative cost (operating room, anesthesia and fungibles) the exceeded in 151,6% to that of the opened nephrectomy, whereas in the opened nephrectomy the postoperative cost was a 63 % higher than in the transperitoneal laparoscopic cases. CONCLUSIONS: Transperitoneal laparoscopic in our Center is more expensive than opened nephrectomy due to a major occupation of operating room and that the specific fungible material used at the surgical act has a very high cost. It would be necessary to drastically reduce surgical time and decrease fungible material expenses, thus transperitoneal laparoscopic procedure could be competitive in our Hospital.

Adenocarcinoma↗

PubMed2006

[Urinary undiversion; Bricker to Studer. With regard of two cases].

We present two cases of urinary undiversion from an ileal loop (Bricker) to an orthotopic neobladder. Due to miss adaptation to the stoma, two patients demanded reconversion to a continent urinary diversion. We proceed to change their urinary diversion to an ileal neobladder (Studer), one by open surgery and the other by laparoscopic surgery. In both cases immediate postoperative went uneventful. Both patients are continent, satisfied with their new situation, and without metabolic complications. Urinary undiversion from an ileal conduit to an orthotopic neobladder is technically feasible by open or laparoscopic surgery. It is a valid alternative for patients with complications due to their urinary diversion or miss adaptation to the cutaneous stoma.

Humans↗

PubMed2005

[Evolution of the clinical, echographic and pathological characteristics of patients with indication of transrectal ultrasound and prostate biopsy between 1994 and 2003].

OBJECTIVE: The aim of this paper is to evaluate the evolution in the clinical, echographic and pathological characteristics of patients undergoing transrectal ultrasound and prostate biopsy over a 10 year period (1994-2003). MATERIAL AND METHODS: Patients undergoing a first biopsy of the prostate between 1994-2003 were studied retrospectively. Since the biopsy criteria have changed several times over this period, results were analysed for four different periods: 1994-1997, 1998, 1999-2003 (the latter was further divided into two periods--1999-2001 and 2002-2003--to observe the temporal evolution with the same biopsy criteria). Patients were assigned to risk groups according to D'Amico. RESULTS: We observed that individuals referred for biopsy and those diagnosed with prostate cancer (PC) had a lower mean age (p=0.0001 and p=0.01), there were more patients with a PSA from 4.1-10 ng/ml (p=0.0001 and p=0.0001), more patients had no significant DRE findings (p=0.0001 and p=0.0001) or ultrasound findings (p=0.0001 and p=0.0001). The incidence of cancer diagnosis has decreased from 39.4% to 34.3% (p=0.03). There was an increased incidence of score 7, at the expense of a decline in scores 5-6 and 8-10 and disappearance of score 2-4 (p=0.0001). Patients assigned to the low risk group increased from 9% to 18.1%, those assigned to the intermediate risk group from 20.2% to 43.1% and there was a reduction in those assigned to the high risk group from 70.7% to 38.7% (p=0.0001). Analysis of the final two time periods revealed that the evolution of the series remained the same except for a decrease in age at biopsy and diagnosis of cancer. CONCLUSIONS: Nowadays, the risk factors of patients with an indication of biopsy have less weight than ten years ago. We currently diagnose patients with PC with more favourable prognostic factors. However, the price we pay for this earlier diagnosis is reflected in a less effective biopsy, a larger proportion of the population without PC having to experience the physical complications and psychological stress of a biopsy, a greater number of patients having to undergo a second biopsy and, therefore, a greater and more costly use of resources to diagnose PC.

Adenocarcinoma↗

PubMed2005

[Parameters with possible influence in PSA adjusted for transition zone volume].

OBJECTIVE: To evaluate the effect of age, digital rectal examination results and prostatic volume on PSA value adjusted to transition zone (PSA-TZ) in the detection of prostatic cancer. MATERIAL AND METHODS: Data of 243 patients with serum PSA of 4 to 20 ng/ml who underwent biopsy because of prostatic cancer suspicion are analyzed. In this population, cancer was detected in 62 cases (24.8%). Total prostatic volume and transition zone volume were calculated by transrectal echography applying the ellipsoid formula. RESULTS: Applying lineal regresion analysis, it was found no correlation between age and PSA-TZ (Pearson coefficient 0.00). By dividing these patients among those with normal rectal examination (84%) and those with suspicious digital rectal examination (16%), cutoff values of PSA-TZ were found to be not different by ROC curves analysis for 95% sensitivity varying specificity only among 24 and 26% between these two groups of patients. Prostatic size (< or = or >40 cc) showed that, for obtaining the same 95% sensitivity in the detection of cancer, PSA-TZ value would require to be modified, being 0.17 in large prostates (> 40 cc) and 0.25 in small prostates (< or =40 cc). CONCLUSIONS: The utility of PSA-TZ as a potential predictor parameter of prostatic cancer did not need to be modified with respect to age or to data of digital rectal examination. However, for supporting sensivity of its best cutoff value, PSA-TZ would need to be modified with respect to total prostatic volume.

Aged↗

PubMed2005

[Primary seminal vesicle abscess: diagnosis and treatment by transrectal ultrasound].

A 38 years old man with the only past medical history of bilateral orchiopexy 15 years ago is diagnosed of left primary seminal vesicle abscess. The patient is sent to our emergency service with an ultrasound finding of either dilated vas deferent or seminal vesicle abscess with hiperecogenic material inside it. The examination was performed after a 5 month history of purulent ejaculation. The diagnose of seminal vesicle abscess is confirmed by TRUS and, in the same procedure, drainage of the abscess was completed by needle-aspiration puncture. After this treatment the patient stay 12 hours at the observation room with intravenous antibiotics and is discharged home with oral antibiotics. We are interested in this case because of the low incidence of this pathology and the easy diagnosis and treatment by TRUS.

Abscess↗

PubMed2004

[Incidence and significance of "atypical acinar proliferation" in transrectal prostatic biopsies].

OBJECTIVE: To determine the incidence of atypical acini in our series, the percentage of prostate cancer and other suspicious or preneoplastic lesions in the successive biopsies and to establish a follow up strategy in these patients. MATERIAL AND METHOD: A total of 117 patients diagnosed with isolated atypical acini or associated with high grade PIN were obtained from our database, 75 (64%) of these were submitted to at least a second biopsy of the gland. The age, PSA, digital rectal examination (DRE), prostate volume, ultrasound nodule and previous pathological diagnosis were compared with the pathology results of the successive biopsies of the gland. RESULTS: Incidence of atypical acini was 4%. A total of 46.7% of patients undergoing a repeat biopsy presented prostate cancer. We did not find significant differences in the clinical variables studied between patients with or without a definite cancer diagnosis. Patients initially diagnosed with acinar atypia with associated high grade PIN presented a higher incidence of cancer in the repeat biopsy than patients with isolated acinar atypia (p=0.007). A total of 94.3% of all neoplasms diagnosed were detected in the 2nd and 3rd biopsy. CONCLUSIONS: Patients with atypical acini are at high risk of having prostate cancer not detected in the first biopsy. They should, therefore, undergo a second biopsy as soon as possible. There is only a very small probability of detecting cancer after the 3rd biopsy.

Aged↗

PubMed2004

[Giant bizarre scrotal leiomyoma].

OBJECTIVES: To review the diagnosis and therapeutic management of scrotal wall smooth muscle tumors by reporting an illustrative case. To emphasize that despite their histological characteristics on presentation, compatible with malignancy, these tumors have a benign behaviour, even when their size is much bigger than the ones found in the review bibliography. METHODS: 75-year-old male who presented a big, very slowly growing, painless, mobile, hard, not adhered to deep layers, non transilluminating scrotal tumor. RESULTS: Pathology reported a giant bizarre scrotal leiomyoma. CONCLUSIONS: We emphasize the atypical characteristics of this case, which despite its compliance with almost all classical criteria establishing the malignant character of tumor lesions has a benign behaviour. It complies with the criterion that, accordingly to reviewed bibliography, seems to be the most important to determine it: the absence of mitosis. We also insist on the importance of an adequate diagnostic approach which guarantees a proper surgical approach, for which we think ultrasound is essential.

Aged↗

PubMedDate not supplied

[Hydrodynamic and biochemical adaptation to perfusion pressure profile in isolated hypothermic renal perfusion].

OBJECTIVES: To evaluate hydrodynamic, biochemical and pathologic consequences of positive forced pressure on hypothermic isolated renal perfusions in comparison to softly progressive administration of perfusion solution. MATERIAL AND METHOD: 16 hypothermic experimental pig renal perfusion o 180 min completed under constant flow conditions. A vacuum computer-controlled pump was used. A comparison was performed of the results obtained by two groups of organs (forced perfusion pressure -I.B.- and soft perfusion pressure -I.S.). RESULTS: Even though perfusion flor did not offer significant differences among both groups at the end of the procedure, I.B. group showed medium perfusion pressure and renal vascular resistance values significantly higher. Nitric oxide metabolites concentration was also greater in I.B. group. Finally, these kidneys showed more tubular cell aedema and glomerular shrinkage in comparison to I.S. group. CONCLUSIONS: Sharp and forced hypothermic perfusion of the isolated kidney don't increase flow perfusion values. Inversely, hydrodynamic and pathologic results are worst in comparison to soft and progressive organ perfusion.

Adaptation, Physiological↗

PubMedDate not supplied

[Nutcracker's syndrome: demostration with helicoidal TC with volumetric reconstruction "3D"].

The nutcracker's syndrome or phenomenom is defined as the left renal vein compression between the aorta and the superior mesenteric artery. Diagnosis is uncommon, not only due to its low frequency but for the dificulty to be suspected in usual findings as lumbar pain or hematuria. We present the case of a patient to whom we were able to show mentioned pathology with the helicoidal TC with volumetric reconstruction "3D" (VR).

Adult↗

PubMedDate not supplied

[Resolution of a case of arterial priapism secondary to bilateral arteriocavernous fistula with selective embolization using reabsorbible material].

Priapism is defined as persistent erection without sexual stimulus. The new classifications make a distinction between venooclusive low flow priapism, isquemic and arterial high flow priapism, non isquemic. The perineal or penis trauma are responsible the most of cases arterial priapism, formation of an arteriocavernous fistula. The diagnosis is clinical, blood gas analysis and colour Doppler ultrasonography of the corpora cavernosa confirmed the diagnosis. The arteriography with selective embolization constitutes a safe and effective therapeutic method. We report one case of arterial priapism secondary to bilateral arteriocavernous fistula resolved with selective embolization using reabsorbible material.

Absorbable Implants↗

PubMedDate not supplied

[Transdermal iontophoresis with dexamethasone and verapamil for Peyronie's disease].

OBJECTIVES: To evaluate the effects of transdermal iontophoresis with verapamil and dexamethasone in patients with Peyronie's disease of less than one year of evolution. MATERIAL AND METHODS: We have treated ten patients twice a week during six consecutive weeks using iontophoresis with a Miniphysionizer dispositive. This device generates a 2mA electric current during 20 min which triggers the transdermal penetration of medication. In every session dexamethasone 8 mg and verapamil 5mg were administered inside a small self-adhesive receptacle on the penile skin overlying the fibrosis plaque. To evaluate the efficacy, penile curvature was measured by Kelami's test, while the plaque size was assessed by penile ultrasound. Other parameters like pain, erectile function and ability for vaginal intercourse were recorded using questionnaires. Safety parameters were also assessed during treatment. RESULTS: No improvement or progression in penile curvature was evidenced in any of the patients. The hardness of the plaque was reduced in 5 patients, becoming impalpable in 2 of them. Decrease in plaque volume was observed by penile ultrasound in 6. Pain improved in 8 patients, disappearing in 6 of them. One patient recovered his erectile function at the end of the treatment; whereas 3 referred that their ability for intercourse enhanced while 2 reported that treatment improved their sexual life in general. We didn't record any significantly side effects, except for a transitory and slight dermal redness on the site of electrode placement. CONCLUSIONS: Transdermal iontophoresis is an effective treatment for pain control in early stages of Peyronie's disease. Efficacy in reducing penile curvature seems to be limited. Controlled clinical trials are needed, and perhaps reviewing indications in order to obtain more relevant clinical effects.

Adult↗