Biomedical subjects

R Esteban Artiaga

Publications and source records attributed to R Esteban Artiaga.

6 recordsLinked to original sources

PubMed1999

[Progression and prognosis of in situ carcinoma of the bladder treated with BCG].

OBJECTIVES: In situ carcinoma (isT) of the bladder is a poor prognostic tumour with a natural progressive evolution. Treatment with BCG achieves a significant improvement in survival. This paper analyses our experience in the management of isT patients with endovesical BCG. MATERIAL AND METHODS: Between 1983 and 1997 the Urology Unit in the Móstoles Hospital saw 636 patients with transitional carcinoma of the bladder. Of these, 498 (78%) were surface tumours, and 138 (22%) were infiltrant. isT: 80 patients (13%), 14 of which were primary (17%), 37 associated to a surface tumour (46%), and 29 to infiltrant tumours (36%). All surface tumours: isT was present in 51 patients (10%) 44 of which were managed with 2 courses of BCG Connaught (81 mg), for 6 weeks each followed by vesical reassessment. Quarterly follow-up was conducted during a 2-year period. Patients not managed with BCG were treated with radical cystectomy. An analysis was made of patients without complete response to BCG, as well as actuarial analysis of disease-free survival (DFS), survival until progression (SUP) and specific survival (SS). All possible prognostic factors are analyzed: sex, focal isT (a single focus) or diffuse isT (more than one focus). Primary or secondary isT and association to G1, G2 or G3 tumours. RESULTS: In all 44 patients managed with BCG: males 37 (84%), females 7 (16%), primary 14 (32%), focal 22 (50%), diffuse 22 (50%). Six patients died (5 because of the tumour). Mean follow-up of living patients: 3.7 years (0.5-7.5 years). After the 2 BCG courses, 36 (82%) showed complete response. Thirteen patients (30%) had no complete response during follow-up, and 11 (85%) continued to progression. In total 7 patients underwent cystectomy. Of 5 patients directly cystectomized due to persistence of isT or T1G3 tumour at monitoring after BCG, 2 (40%) had infiltrant tumour and one (20%) nodular metastasis. Three patients with persistent isT or T1G3 after BCG were not initially cystectomized: two that were treated with other endovesical therapies because of their age progressed, and the third one underwent a third BCG course and required cystectomy due to tumour persistency. 5-year DFS: 56%, being diffuse isT vs. focal isT (p = 0.0206) was an unfavourable prognostic factor. 5-year SUP: 63%, no significant prognostic factor. 5-year SS: 79%, being a female was an unfavourable prognostic factor (p = 0.0201). CONCLUSIONS: Based on our results and the analysis of the literature we recommend treatment with 2 BCG courses of all isTs of the bladder that present some of the following factors: Diffuse cancer associated to T1G3, involvement of prostatic urethra or overexpression of p53 over 20%. In the rest of vesical tumours, one BCG course followed by a second one if lack of response to the first. After failure of both BCG courses, cystectomy must be performed in both groups.

Adult↗

PubMed1997

[Meconial hydrocele].

Presentation of one case of meconial hydrocele, a very infrequent disease that should be taken into account in all newborns presenting intrascrotal mass. Ultrasonography performed to a 29 year-old female during the 36th week of pregnancy, demonstrated in the fetus the presence of an enlarged right hemiscrotum with homogenous material inside, which was diagnosed as an intrascrotal haematoma due to a likely intrauterine spermatic cord torsion. After eutocic delivery, within one month from birth the newborn developed signs and symptoms which were compatible with acute scrotum and the emergency surgical exploration showed meconial hydrocele secondary to patency of peritoneal-vaginal duct with associated inguinal hernia. The causes, forms of presentation, differential diagnoses and therapeutical options of meconial peritonitis, a rare condition with favourable evolution in most cases, are analyzed showing that, under certain circumstances, treatment is controversial.

Female↗

PubMed1997

[Clinical course of superficial transitional carcinoma of the bladder without poor prognostic factors].

OBJECTIVES: Surface carcinoma of the bladder shows a high incidence of tumour recurrence that require frequent examinations associated to potential morbidity. This paper analyses our series of patients with vesical tumours with no known unfavourable clinical prognostic factors, aiming to detect low risk groups where it may be feasible to change the usual follow-up criteria. MATERIAL AND METHODS: Between 1983 and 1996, 503 patients with vesical cancer, 388 of which 388 were primarily surface tumours, were monitored. The study analyzed 24 patients with surface transitional carcinoma with no unfavourable prognostic factor, i.e. Ta tumours, grade 1, single, under 1 cm, negative urine cytology and multiple negative vesical biopsies. This group was then compared to a control group comprising all other patients with surface tumours in our series (364 patients), and the prognostic factors were assessed based on the disease-free interval, progression-free interval, and overall and tumour-specific survival. Also the recurrence-free interval from the first endoscopic control at 3 months after transurethral resection, were studied according to Parmar's criteria. RESULTS: With a mean follow-up of 53 months, 37% patients in the study group have relapsed versus 41% in the control group (n = 0.9), after 2 years on average. Actuarial curves in the control group reveal statistical significance for higher degree tumours recurrence. No grade progression has occurred in the study group versus 9% in the control group. No patient evolved to T2 versus 5% in the control group; also in this group, 5% patients died because of their tumour versus none in the study group. The 24 patients in the study belong to group 1 in Parmar's low risk, while the remainder of patients in the control group ranked according to these criteria have demonstrated an unfavourable statistical significance (p < 0.01) in patients with early relapse. CONCLUSIONS: Good results obtained in the evolution of patients with surface tumours with no unfavourable prognostic factors are due to the strict monitoring they undergo in order to detect early relapses. However, 37% of recurrences in this group does not allow to modify the usual follow-up schedule. In our experience, Parmar's criteria does not contribute any benefit over classical criteria to evaluate prognostic factors in surface vesical cancer.

Actuarial Analysis↗

PubMed1997

[Evolution and prognostic factors of adenocarcinomas of the prostate metastasizing at diagnosis].

OBJECTIVES: In 30-40% patients, prostate adenocarcinoma is diagnosed already in the metastatic phase, a percentage that will depend on the number of patients with localized cancer that we are unable to detect. Hormonal suppression is the most widely accepted therapeutical option, although there are doubts on the value of rescue treatment after the hormone-refractive stage. This paper analyses those parameters as well as the main prognostic factors in a series of 135 patients with metastatic prostate cancer at diagnosis. MATERIAL AND METHODS: Between 1983 and 1996, 414 patients were diagnosed with prostate adenocarcinoma in the Urology Unit. Móstoles Hospital, 135 of which (32.6%) were metastatic at the time of diagnosis and were managed as follows: 113 (84%) were treated with maximum androgenic blockade (MAB). 13 (9.6%) with orchiectomy and antiandrogens, 5 (3.7%) with various treatments, and only 4 received symptomatic treatment. Of those treated with MAB, 97 (72%) continued treatment after the hormone-refractive stage and 16 (12%) were given stramustine phosphate instead of the antiandrogen. Response monitoring was done basically by means of serial PSA determination. The parameters analyzed included survival and the following potential prognostic factors: age, performance status, metastatic bone pain, tumour diagnosis based on number of metastasis, prior PSA level, Gleason, local stage, M1 type at diagnosis based on the 1992 TNM classification, and response to the various treatment applied. RESULTS: Mean age: 72 years. Over an average of 25 (0-127) months, 80 (59%) patients have died; mean follow-up of patients alive at end of study: 24 months (3-111). Lost to follow-up: 6 patients (4.4%). Up to 1991, the proportion of patients with metastasis was 48%; since 1992, 24%. Percentage of patients diagnosed due to clinical manifestations of the metastasis (25 patients) over these two periods increased, mean age decreased and the proportion of patients with highly aggressive tumours increased. Mean overall survival, 26 months: influential prognostic factors: diagnosis due to metastasis and Gleason greater than 7; very poor prognosis for those receiving no hormonal therapy, with no differences between drug versus surgical treatment. Tumour-dependent mean survival, 32 months; influential prognostic factors: performance status, metastatic bone pain, diagnosis due to metastasis and Gleason greater than 7; very poor prognosis for those receiving no hormonal therapy. Progression-free interval, 19 months; influential prognostic factors: metastatic bone pain, PSA higher or lower than 90. Gleason greater than 7 and local stage: no differences between treatments. Mean survival after progression, 6 months; influential prognostic factors: diagnosis due to metastasis, M1b versus M1c patients: increased survival in patients rescued with stramustine phosphate. CONCLUSIONS: The proportion of prostate adenocarcinomas with metastasis at diagnosis shows a trend to decrease, although the percentage of patients who are diagnosed by the sings and symptoms of their metastasis is increasing. These patients should be treated with pharmacological or surgical hormone-suppression. Rescue treatment with stramustine phosphate prolongs survival. Influential prognostic factors: Gleason greater than 7, metastatic bone pain, tumour extent and previous PSA.

Adenocarcinoma↗

PubMed1997

[Vesical endometriosis after cesarean section: diagnostico-therapeutic aspects].

Endometriosis is a benign condition with an aggressive behaviour defined by the presence of ectopic endometrial tissue, outside the uterus. It occurs in 15-20% women with child bearing potential. Most commonly it affects organs such as the ovaries, uterine ligaments, fallopian tubes, rectum and the cervico-vaginal region. Involvement of the urinary tract, however, is rare. It can be seen in just about 1% cases, vesical location being the most frequent of these presentations (84% cases). We describe one case of vesical endometriosis that developed after a cesarean section. The intra-operative findings confirmed the existence of infiltration of the detrusor muscle and the vesical mucosa by endometrial tissue from the area of the uterine incision. A discussion of the different diagnostic and therapeutic options is also included.

Adult↗

PubMed1997

[Epidemiologic indicators of adenocarcinoma of the prostate. Results on 436 patients].

OBJECTIVE: To conduct a populational study by analyzing the major epidemiological indicators in a group of 436 patients with prostate adenocarcinoma. MATERIAL AND METHODS: The population reference for the study involves a total of 396,294 people, of which 197,500 are male. Between 1983 and 1996, 436 patients were diagnosed with prostate adenocarcinoma in the Urology Service of Mostoles Hospital. Gleason Index has been used to determine the histological grade, while the 1992 TNM rating was used for staging purposes. Gleason rating is known for 395 patients, distribution being as follows: 26.6% with Gleason 2, 3 or 4; 44.6% with 5, 6 or 7 and 28.9% with 8, 9 or 10. T1 tumours accounted for 21.1% cases; T2: 45.6%; T3: 22.2% and T4: 11%. There were 58.3% M0: 32.8% M1 and 8.9% Mx tumours. Approach for local disease: radical prostatectomy or radiotherapy. Approach for disseminated disease; hormonal blockade. Deaths: 130 (29.8%); cancer related deaths: 91 (70%). Mean follow-up of survivors: 3.4 years (0.25-14 years). Major variables analyzed: age, incidence, prevalence, mortality, Gleason's evolution and overall and specific survival. RESULTS: Mean age: 71.3 years. Prior to 1990 there were 55.5% patients under 70 years old; in 1995-96 there are 39.4%. Incidence has increased up to 36.5% per 100,000 people/year in 1996. Mean mortality in 1993-1996: 5.6 per 100,000 people/year. Prevalence in 1996: 155 per 100,000 people/year. Family background for prostate cancer: 8%. Incidence of second tumours: 10.5%. Increased proportion of patients with moderate to high versus low Gleason grades. Overall survival at 5 years: 53%, at 10 years: 33%. Tumour related survival at 5 years: 65%; at 10 years: 48%. Older age, higher PSA, higher Gleason, advanced stages and metastasis are all unfavourable prognostic factors for both overall and specific survival (p = 0.000). Significant prognostic factors in multivariate analysis have been a higher Gleason grade and non metastatic tumour at diagnosis. CONCLUSIONS: Incidence of prostate adenocarcinoma has increased in our milieu, reaching 36.5 per 100,000 people/year in 1996, far from the figures in the US. Actual mortality in our series is somehow lower than data published in other national series. This condition shows very high prevalence rates which results in increasingly growing and highly significant economic costs.

Adenocarcinoma↗