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R Cortadellas Angel

Publications and source records attributed to R Cortadellas Angel.

At least 19 recordsLinked to original sources
PubMed2006

[Immunohistochemical expression of p53, p21, p16, and cyclin D1 in superficial bladder cancer. A tissue microarray study].

INTRODUCTION AND OBJECTIVES: To retrospectively assess the relationship between immunohistochemical expression of p53, p21, p16, and cyclin D1, with recurrence, progression and survival in superficial bladder cancer. METHODS: 163 patients undergoing transurethral resection for superficial bladder cancer between February 1995 and March 2004. Tumor samples were included in a tissue microarray support that was serially sectioned for immunohistochemical staining. Grade and stage associations for each marker were evaluated by the Chi-square test. Assessment of the relationship with recurrence, progression, and survival Kaplan-Meier curves and log-rank test were used. RESULTS: There were no statistically significant differences in marker expression depending on tumor grade and stage, with the exception of Cyclin D1, that was significantly different depending on tumor stage (p=0.030). p21 expression was related to tumor recurrence (p=0.035), progression (p=0.008) and survival (p=0.034). p16 expression was also related to recurrence (p=0.048) and survival (p=0.047), but not to tumor progression (p=0.116). p53 and Cyclin D1 were not statistically associated with tumor recurrence, progression or survival. CONCLUSIONS: In our experience, only p16 and p21 may be useful in the management of superficial bladder tumors, as they are predictors of recurrence and survival in Ta and T1 patients.

Adult↗
PubMed2005

[Results and complications of TVT procedure in the surgical treatment of female stress incontinence].

OBJECTIVES: To evaluate the efficacy and safety of Tension-free vaginal tape (TVT) for treatment of female stress urinary incontinence (SUI). To determine the mid-term outcome of TVT performed during other pelvic floor reconstructive procedures. PATIENTS AND METHODS: 100 women with SUI undergoing TVT procedure under spinal anesthesia from January 2000 to November 2002 were studied. 76 women were treated with TVT alone. 24 patients were treated with TVT and pelvic floor reconstruction: we repaired 24 cystoceles grade II-III, 3 rectoceles and 4 concomitant vaginal histerectomies. RESULTS: Mean age was 49.3 years (range 35-78). Mean parity: 2 (range 0-6) and mean operative time was 38 minutes (range 20 to 50). The postoperative hospital stay was 24 hours for women treated with TVT alone. Only 1 patient (1%) need bladder catheterization during 7 days due to urinary retention. Mean followup was 18 months (range 12-48). Objective cure rate was 95%. In our study the rate of de novo post-operative urge symptoms (16%) was the most frequent complication. Bladder injury was the most grave problem and it happened in 1 patient (1%). CONCLUSION: The results confirm the feasibility and safety of TVT for treatment of SUI. Moreover, TVT procedure is economical and efectiveness. Pelvic floor defects, benign uterine disorders and SUI can be safely treated with TVT and vaginal procedures during the same surgical time.

Adult↗
PubMed2004

[Doxazosin in the gastrointestinal therapeutic system (GITS) formulation and trial without catheter after acute urinary retention due to BPH. Dose increase action on recovery effect].

OBJECTIVE: Prospective and randomised study to assess the effectiveness of doxazosin in sustained release formulation in Acute Urinary Retention (AUR) treatment due to benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: The trial was carried out with a cohort of 40 males who had all suffered their first attack of AUR caused by BPH. Twenty were randomly selected and treated for 7 days with 4 mg of sustained release doxazosin before removing the catheter. The patients not treated that could not spontaneously urinate were also administered 4 mg of doxazosin. Finally, all the patients that still had a catheter due to unsuccessful removal were treated with 8 mg of doxazosin and the percentage of patients responding to treatment was assessed. The predictive value of the response to treatment for age, IPSS, QoL, retained urine volume, prostate volume and the evolution time of the prostratism was determined by means of logistic regression analysis. RESULTS: 82.5% of the patients (33/40) could urinate after removal of the catheter. 84.8% (28/33) were treated with doxazosin (21 with 4 mg and 7 with 8 mg). In the first attempt at removal, 60% of the patients (12/20) treated with 4 mg of doxazosin could spontaneously urinate, while only 25% (5/20) of those not treated, p=0.02. Similarly, 60% of the patients (9/15) treated with 4 mg of doxazosin in the second attempt could spontaneously urinate. Fifty per cent (7/14) of the patients still with a catheter, after the treatment with 4 mg of doxazosin, could urinate with 8 mg. In the logistic regression analysis, none of the variables analyzed allowed us to predict the response to the treatment. CONCLUSION: The treatment for 7 days with 4 mg of sustained release doxazosin shows greater success when removing the catheter after suffering AUR due to BPH. With this treatment, 60% of the patients could spontaneously urinate again. By increasing the dose to 8 mg, the catheter can be removed in half the patients that did not initially respond. Before removing the catheter it is not possible to predict which patients would be able to spontaneously urinate.

Acute Disease↗
PubMed2004

[Histopathologic validation of the tissue-microarray technology of urothelial cancer. Our experience].

INTRODUCTION: The array technology offers: a big advance to clinic and basic investigator, it provides a variety of technics (immunohistochemistry, FISH, proteomics) to understand the molecular mechanisms of cancer. It offers scale economy in reagents versus the conventional methods. Array most be ratified because the sample is so reduced. MATERIAL AND METHODS: 52 consecutive cases have been chosen from paraffin blocks of bladder and ureteral cancer which are 5-7 years old, a tissue array has been made; disks have been arranged in lines and columns, in an aleatory way, in order to guide it's reading. It has been evaluated by a pathologist with any relation to specimen selection. RESULTS: 87 sheets ha been obtained. Number 1 has been dyed with HE. Has been discrepancy in 27% of sample's stage. Has not been a discrepancy in histopathologic diagnostic. There is no sample's representation in 11 points (17%). DISCUSSION: Our results offer good results in sample's validation. The sample's antigenicity of tissue is conserved. Array sample's represent a 97%, similarly to all unit of conventional sections of the specimen.

Humans↗
PubMed2004

[Analysis of medical/surgical complications of cutaneous ileostomy].

OBJECTIVE: Our objective is to carried out a descriptive study about medical-surgical complications and alterations about quality of life in stoma patients secondary to bladder tumour. PATIENTS AND METHOD: The series are composed of 67 patients. The mean age was 70.3 years. We analyse the following variable: early and late medical-surgical complications, the body mass index (BMI) change and the alteration of quality of life. RESULTS: The most frequent early complication is the ischemic necrosis (7%) without posterior repercussion. The late complications in frequency order are: peristomal dermatitis (18%), plane stoma (12%), peristomal hernia (12%), stenosis (9%) and granuloma (6%). The BMI changes don't conditionate a increase in the complications. The psychological adaptation is good in 92%, although the majority affirm a little changes in life-style, but they don't have a repercussion on quality of life. CONCLUSIONS: In this series we estimate a low incidence of complications. The preoperative counsel and the posterior following by the stoma care nurse-surgeon team, play a fundamental role on psychological adaptation after surgery.

Aged↗
PubMed2003

[Cystoscopic impression versus histologic diagnosis in bladder tumors. Do they coincide?].

OBJECTIVE: How quality control in a university hospital and immediatly after to resents publications; we planed to evaluation of the correlation of cystoscopy impression with the histologic diagnosis after of transurethral resection (TUR). MATERIAL AND METHODS: To give more truthfulness to the study, we requested to all department member's, that to base in your experience to describe the endoscopic characteristic of the next bladder tumors groups: superficial and low-grade GI-II Ta, superficial and high-grade GIII Ta and high grade and/or T1-< T2. In a total of 172 patients, we evaluated the initial cystoscopy impression and we to compared it with histologic diagnosis after to TUR. RESULTS: In 172 tumors the cystoscopy classifed in 69 cases how superficial and low grade GI-II Ta-T1, 40 how superficial and high grade and 55 how high grade and/or invasive tumors GIII T1-< T2. When, we compared it with the histologic diagnosis, the cystoscopy to coincided in 46 de 69 cases (66.6%) (PNS) with the group of low-grade GI-II Ta-T1 in 13 of 40 (32.5%) (P < 0.005) with the group of superficial high grade GIII Ta and 45 of 51 (88.2%) (PNS) with the group of GIII T1 and/or invasive tumors. In 15 of 172 the endoscopic description its not conclusive. And finally in 12 cases the histologic diagnosis were normal. CONCLUSIONS: In order of this results, we to consider that in a university hospital is essential the histologic diagnosis before any therapeutic decision, because the initial cystoscopy impression have a low correlation with the histologic diagnosis. We are disagreement with recent publication that propose the outpatient cystoscopy with fulguration to base only to the cystoscopy impression.

Cystoscopy↗
PubMed2001

[Effect of antibiotic treatment on PSA and percentage of free PSA in patients with biochemical criteria of prostatic biopsy].

INTRODUCTION: PSA serum level measurement in the most important tool in the early diagnosis of prostate cancer patients. However, it is recognised it low specificity is due mainly to prostatic benign diseases. Although it is known that inflammation can contribute on this lack of specificity, there is disagreement in the effect of no symptomatic prostatic inflammatory focus on total PSA and percent free PSA serum levels. AIM: To analyse the biological variability in total PSA and percent free PSA serum levels in patients with biochemical criteria of prostatic biopsy and to compare them with the antibiotic induced variability in a previous urinary infections cohort patients. PATIENTS AND METHODS: We analysed 60 patients with previous urinary infections, normal digital rectal examination and PSA between 4 and 20 ng/ml. We measured total PSA and percent free PSA serum levels. Thirty were treated with 3 weeks of ofloxacin and following a new marker determination. Sextant ultrasound guided prostatic biopsy was performed in all cases. RESULTS: 45 patients demonstrated BPH (29 with prostatitis) and 15 prostate cancer (T1c). Significant variations were found on total PSA serum levels (6.97 ng/ml vs 5.82 ng/ml, p = 0.001) and percent free PSA (14.73% vs 17.77%, p = 0.01) only in treated patients. These differences were significant in BPH and BPH with prostatitis patients but not in prostate cancer patients. Treated patients trend was to decrease PSA (13 treated patients shown PSA < 4 ng/ml vs 2 control patients) and to increase percent free PSA. The median variation of percent free PSA was higher than total PSA and was not influenced by PSA level or prostatic volume. Taking 25 as cut-off of percent free PSA, 18.3% of prostatic biopsies could be avoided in the first determination and 20% in the second. Adding the total PSA reduction, 56% of prostates biopsies in the treated patients could be avoided. CONCLUSIONS: Biochemical criteria of prostatic biopsy could be modified in patients with previous urinary infections due to higher variations on serum markers than those explained by biological variations. These variations could be induced by the antibiotic treatment. These results suggested that the inflammatory focus could influence on total PSA and percent free PSA serum levels.

Anti-Bacterial Agents↗
PubMed2001

[Vesico-sphincter dysfunction in 108 cases of multiple sclerosis].

OBJECTIVE: To study vesicosphincteric dysfunction in 108 patients with multiple sclerosis. METHODS: We reviewed the clinical records of 108 patients with multiple sclerosis and analyzed those with voiding symptoms ascribable to multiple sclerosis. These patients underwent complete urodynamic assessment and complementary tests according to their symptoms. The Blaivas classification was used for the clinical classification of multiple sclerosis. RESULTS: 64 of the 108 patients presented voiding symptoms ascribable to multiple sclerosis (59.2%). The clinical features presented as episodes in 75% and were progressive in 25% of the cases. In 6% of the patients, the voiding symptoms were the first symptoms of multiple sclerosis. Urodynamic assessment showed detrusor hyperreflexia in 73% of the patients, hyporeflexia in 14%, and 13% showed normal urodynamics. All complications were infective; no patient showed upper urinary tract complications. CONCLUSIONS: Vesicosphincteric dysfunction in multiple sclerosis is frequent. Most of the patients present bladder hyperreflexia. The urological complications are usually infective. Involvement of the upper urinary tract is rare.

Adult↗
PubMed2000

[Predictive factors of locally advanced disease in patients with prostatic cancer treated with neoadjuvant hormone therapy and radical prostatectomy].

AIM: To analyze the predictors of local adverse pathological findings (positive surgical margins and seminal involvement) in prostate cancer patients treated with neoadjuvant hormonotherapy and radical prostatectomy. PATIENTS AND METHODS: We studied seventy-eight patients treated with neoadjuvant androgen blockade prior to radical prostatectomy between 1995 and 1998. Age, PSA, prostate volume determined by transrectal ultrasound and/or magnetic resonance imaging, clinical stage, Gleason score, duration of blockade, pathological stage and tumoral volume were analyzed. RESULTS: 34.6% of patients (27/78) had adverse pathology (odds: 0.53). No significant differences were found in age, PSA, prostate volume, duration of blockade and Gleason score between organ-confined and locally advanced patients. Differences were found in tumor volume (p = 0.0001) but this was not different in order to positive or negative digital rectal examination (p = 0.5334). The efficacy for predicting pathological adverse findings was represented by ROC curves (PSA: 0.628, clinical stage: 0.612 and Gleason score: 0.545). Predictive table of extracapsular disease for different PSA levels, clinical stage and Gleason score were developed. No variable predicted positive margins in logistic regression model. CONCLUSIONS: Clinical variables do not predict locally advanced disease in prostate cancer patients treated with neoadjuvant androgen blockade. This is associated with higher tumor volumes. The probability of positive margins or seminal involvement increases with PSA level and Gleason score.

Aged↗
PubMed2000

[Incidental diagnosis of bladder carcinoma].

OBJECTIVE: To analyze the prognostic factors of incidentally diagnosed bladder carcinomas with special reference to the complementary diagnostic tests. METHODS: 308 cases of carcinoma of the bladder were reviewed. These were divided into two groups: those that had been diagnosed on the basis of the clinical features and those that had been incidentally detected. The prognostic factors of size, grade, histological type, and pathological stage were analyzed. RESULTS: Local tumor stage was the only statistically significant prognostic factor. 14.7% of the superficial and 3.6% of the infiltrating carcinomas had been incidentally diagnosed. Ultrasound was the most frequently utilized diagnostic method (87.2%). CONCLUSIONS: In our series, the incidentally diagnosed carcinoma of the bladder has a higher probability of being a superficial lesion than those that are symptomatic and therefore the prognosis is better. Since ultrasound was the most frequently utilized diagnostic method, it might be advisable to assess the bladder in patients undergoing abdominal ultrasound evaluation.

Carcinoma, Transitional Cell↗
PubMed1998

[Management of hyposalivation caused by oxybutynin chloride in the treatment of the unstable bladder].

OBJECTIVE: To know the incidence of adverse reactions from Oxybutynin Chloride, with special reference to salivary hyposecretion and to evaluate the effectiveness of the different alternatives employed to solve it. MATERIAL AND METHOD: 144 adult patients with signs and symptoms of voiding urgency and detrusor-hyperactivity incontinence, who were treated with Oxybutynin 5 to 15 mg/day. Hyposecretion of several exocrine glands was evaluated using a questionnaire that included subjective and objective parameters. For managing purposes, patients were divided into 3 groups: 1) General measures; 2) Therapy with sialagogues; and 3) Replacement therapy with artificial saliva. RESULTS: 42% patients treated with Oxybutynin developed mild-to-moderate hyposialism. 26% had severe hyposialism, always related to high dose Oxybutynin. 6% skin dryness, 3% eye dryness and 2% dryness in all the above glands (dry syndrome). Regarding treatment, most patients with mild-to-moderate hyposialism were managed with simple general measures. In severe hyposialism, both sialagogues (Eledoisine) and artificial saliva (Bucalsone) were resolutive in over 90% cases. CONCLUSIONS: Oxybutynin is an effective drug to stop detrusor hyperactivity, but it has a high rate of anticholinergic adverse reactions. There is a number of effective therapeutic options available to alleviate these effects, which allow the patient to continue with the treatment.

Adult↗
PubMed1997

[Autoplastic closure of vesicovaginal fistulae with posterosuperior bladder flap (Gil-Vernet operation)].

OBJECTIVE: To describe our experience in the treatment of vesico-vaginal fistula with autoplastic closure using a postero-superior vesical flap. Also, to discuss the technical details of the procedure. MATERIAL AND METHOD: Between 1985 and 1996, 15 patients with vesico-vaginal fistulae secondary to gynaecological surgery were operated. The fistula was considered complex in 5 patients based on previous attempts for surgical closure, number of openings or because they were located in the posterior gradient of the vesical neck. In all cases, autoplastic closure of the fistula was done with a vesical flap through an extraperitoneal abdominal approach. RESULTS: In 100% cases closure of the fistula was achieved at the first surgical attempt. There was no need to interpose vascular tissue between the bladder and the vagina to secure closure of fistula. Post-operatively, 5 patients showed decreased vesical capacity which was recovered within six months; two patients had non-obstructive post-surgical vesical instability. No patient had changes in the mechanism of urinary continence.

Adult↗
PubMed1997

[Early diagnosis by opportunistic screening in cancer of the prostate. Results of a 1-year protocol. Comparison with historical data].

RATIONALE: The high prevalence of Prostate Cancer (PC) and long survival of patients with advanced disease, added to the high cost of palliative treatment (hormone therapy), versus the existence of curative therapies at earlier stages, fully justify the campaigns for early diagnosis. The objective of the study was to increase the number of cases diagnosed at local stages, using an opportunistic screening methodology. METHODS: All male patients between 50-70 years of age, seen over one year in Urology and primary care in CAP-Barceloneta because of urinary symptomatology, were included in a screening program. This cohort were performed total PSA determination and digital rectal examination. When digital rectal examination was suspicious and/or PSA values higher than 4 ng/ml, they underwent echo-guided prostate biopsy. RESULTS: A total of 595 male were seen; 43.9% met the inclusion criteria; 39.4% were rated as suspicious, neoplasia being confirmed in 51% of these. Prevalence of PC in this cohort was 20.1%, half of them in local stage. CONCLUSIONS: Populational screening in PC has proven to be ineffective from a health care standpoint, as opposed to opportunistic screening. Overdiagnosis was not significant, although there were more cases diagnosed in organ-confined stages, this is, eligible for curative therapy; thus, hormone therapy and the resulting morbidity were significantly decreased; quality of life of patients under curative treatment was improved; there was a large reduction of health care costs and, although it will have to be further confirmed in large multicentre series, we believe survival was improved.

Aged↗
PubMed1997

[Epidemiologic data of uro-oncologic pathology in a urology service of a university general hospital. Comments regarding cancer of the prostate].

Data from 92, 93 and 94 tumoral records is analyzed based on the first visit system, staging at time of diagnosis, intervals between visits and management. After finding data unsatisfactory, a program for health care improvement is developed in order to secure diagnosis at earlier stages which may allow for curative radical treatment. The program was implemented in 1995. Results are communicated, and compared with those from previous years; the effectiveness of the program is verified.

Humans↗
PubMed1996

[Results of a prospective study of chemoprophylaxis with alternating mitomycin-C and BCG: complete response and recurrence and progression index].

OBJECTIVES: The high incidence of recurrence in superficial urothelial cancer warrants the use of chemoprophylaxis; however, the results achieved to date have been unsatisfactory. The present study investigated the possibility of reducing the incidence of recurrence of superficial urothelial cancer post-TUR and disease progression. METHODS/RESULTS: 99 patients were treated with monthly instillations of mitomycin-C and BCG alternately for one year, which commenced three weeks following TUR. The incidence of recurrence and progression were 15.3% and 5.10%, respectively. Treatment was well-tolerated and there were minimum side effects. CONCLUSIONS: Chemoprophylaxis with alternating mitomycin-C and BCG therapy in patients with superficial urothelial cancer achieves good results. It is well-tolerated and few side effects were observed.

Adjuvants, Immunologic↗
PubMed1995

[An analysis of the anomalies, pathologies and iatrogenic diseases in the kidney graft: an evaluation of bench surgery].

OBJECTIVES: This study analyzes the anomalies, pathologies and iatrogenic lesions of renal grafts, their impact on graft viability and the possibilities of repair. METHODS: From 1980 to 1983, 315 kidneys were available for transplantation; 50 were from living donors and 265 from cadavers. Of the 265 cadaver grafts, our staff harvested 173 and 92 came from other centers. Of these, 113 (42.6%) presented anomalies, pathologies or iatrogenic lesions requiring surgical repair. RESULTS: 13 kidneys were not suitable for transplantation due to pathologies. Sixty-one grafts presenting anomalies and pathologies, and 38 with iatrogenic lesions were repaired by bench surgery. CONCLUSIONS: Although there was a high incidence of anomalies, pathologies or iatrogenic lesions (42.6%), repair by bench surgery permitted transplantation of these grafts and only 6 (3.01%) allografts required subsequent removal, which is a low incidence considering that a higher percentage of kidneys are lost due to family refusal (19%) or as a result of legal problems.

Cadaver↗
PubMed1993

[Urinary tract involvement as the first clinical manifestation of adenocarcinoma of the colon].

A patient with a previous history of left renal colic and no evidence of passing calculi was admitted to hospital for exacerbation of the urinary condition. The IVP and US evaluation revealed a ureteral stop which appeared to be extrinsic on retrograde uretero-pyelography. Surgery disclosed a large urinoma in the lumbar fossa. The compromised ureteral segment was removed and the pathological analysis of the surgical specimen revealed infiltration from adenocarcinoma. A primary tumor was sought early postoperatively due to irregular constipation referred by the patient. Finally, adenocarcinoma of the sigmoid colon was found. Only 8 similar cases of urinoma from extravasation due to ureteral obstruction secondary to a tumor have been reported in the literature up to 1982.

Adenocarcinoma↗