Biomedical subjects
C Rioja Sanz
Publications and source records attributed to C Rioja Sanz.
[Retroperitoneal fibrosis caused by pancreatitis in an HIV+ patient].
Retroperitoneal fibrosis is a rare inflammatory disease, in which the fibrosis plate leads to the compression of the affected structures. There are several causes of retroperitoneal fibrosis like specific and unspecific inflammatory diseases. In the specific group of retroperitoneal fibrosis we find the one due to pancreatitis. We do present a rare case of retroperitoneal fibrosis caused by a pancreatitis in a HIV+ patient.
[Analysis of our series of kidney transplants: urologic complications and survival].
PURPOSE: To review our series of 416 renal transplants, with special reference to the surgical complications and their management. METHODS: From June, 1986 to October 1997, we are performed 416 heterotopic renal transplants, harvested from cadavers. Reconstruction of the urinary tract reconstruction was by ureteroneocystostomy in practically all the cases. RESULTS: There were some urological complications in 80 patients (19.2%). The most common urological complication was obstruction of the urinary tract arising from stenosis (3.3%), lymphocele (4.3%) and clotting (1.2%). 78.1% of these urological complications were resolved by endourological techniques. Urinary fistula was observed in 12 cases (2.8%). Vascular complications in 22 (6.9%), lithiasis in 5 (1.2%), and eventrations in 11 (2.6%). The treatment of these complications is described. The actuarial survival rates were 87.8% and 77.3% at one and five years respectively for the graft, and 92.4% and 83.5% for the patients. CONCLUSIONS: Our surgical complication rate in patients undergoing renal transplantation was 19.2%. The most common complication was urinary tract obstruction from stenosis (3.3%), lymphocele (4.3%) and clotting (1.6%); 78.1% of these obstructive complications were resolved by endourologic techniques. Percutaneous drainage and esclerotherapy of the lymphoceles resolved 66.6% of them. Renal biopsy performed with a 14G needle caused 5 severe hemorrhagic complications. There were no complications when an 18G needle was utilized.
[Primary retroperitoneal hydatidosis].
Genitourinary involvement by the Echinococcus granulosus larvae (urinary hydatidosis) ranks third in order of frequency after liver and lung involvement. The finding of a primary hydatidic cyst with retroperitoneal location is an uncommon fact. This paper presents once case of this infrequent disease. A revision of the different etiopathogenic mechanisms, as well as diagnostic and therapeutic approaches is made.
[Cervico-urethro-suspension by the Raz's technique in the treatment of stress urinary incontinence in women].
Presentation of our results in the treatment of urinary exertional incontinence in women using Raz's cervicourethral suspension. From January 1991 through December 1995, 87 patients were operated (mean age: 55.64 years; range 36-74). Mean follow-up was 29.4 months. Recovery from incontinence or permanence of minimal occasional leaks due to major exertion were rated as good results and were achieved in 75 cases (86.20%). Percentage of success in patients with mild incontinence was 93.33%; 88.88% in moderate incontinence; and 58.33% in severe incontinence, differences being statistically significant (p < 0.01). No statistical significance was found relative to age, prior incontinence corrective surgery, hysterectomy or association with urgency incontinence. Prior to surgery, 21 patients also had a component of urgency incontinence which disappeared post-surgery in 18 (85.71%) cases. De novo urgency incontinence appeared in 4 (6.06%) cases. Complications seen were 3 vesical perforations (3.44%). 1 urethrovaginal perforation (1.15%), 2 enterocele (3.44%) and 24 patients with transient urinary retention (27.58%). We believe this technique offers long-term successful results with a moderate morbidity rate.
[Retroperitoneal cystic mass. Giant exophytic gastric leiomyosarcoma].
Presentation of an unusual case of pre-operatively non-striated retroperitoneal cystic mass confirmed to be a gastric leiomyosarcoma after pathoanatomical study. Considering the rarity of the case, we reviewed the literature as well as the epidemiological, clinical, pathoanatomical and surgical characteristics of gastric leiomyosarcomas which, as in the present case, can appear as retroperitoneal mass.
[Value and sequence of the biopsy of the seminal vesicles and laparoscopic pelvic lymphadenectomy in the staging of cancer of the prostate].
OBJECTIVE: To establish the current indication in our milieu of seminal vesicles (s.v.) biopsy and laparoscopic pelvic lymphadenectomy in prostate cancer. MATERIAL AND METHODS: The prospective study of s.v. biopsy includes 128 patients. Overall efficacy of the technical procedure, incidence of seminal infiltration in relation to clinical staging, PSA, Gleason or the association of both are all analyzed. The second part of the project involves a retrospective statistical study applied to the lymphadenectomy series over a period of 10 years on 202 cases (69 laparoscopic and 133 open ceiling), analyzing several risk factors for nodular invasion. RESULTS: Seminal and nodular infiltration was related to clinical stage, PSA and Gleason. PSA > 20 and Gleason > or = 7 is clinically the most useful association for the diagnosis of seminal infiltration. Increased PSA and Gleason involved greater nodular infiltration; the optimal cut-off point is 40 and 7 respectively. CONCLUSIONS: S.V. biopsy should be performed in T3 stage or in earlier stages with PSA greater or equal to 20 and/or Gleason greater or equal to 7. If biopsy is tumour negative, laparoscopic lymphadenectomy should be performed at T3 stage (regardless of PSA or Gleason), and in < T3 with PSA greater or equal to 40, Gleason greater or equal to 8 and when Gleason is 7 and PSA > 20.
[Surgical complications in kidney transplantation. Analysis of our series (300 transplantations, 1986-1995)].
OBJECTIVES: To review our series of 300 renal transplants, with special reference to the surgical complications and their management. METHODS: From June, 1986 to August, 1995, we performed 300 heterotopic renal transplants harvested from cadavers. Reconstruction of the urinary tract was by ureteroneocystostomy in practically all of the cases. RESULTS: The overall surgical complication rate was 20.3%. The graft was lost in 2 cases (0.66%). The most common urological complication was obstruction of the urinary tract arising from stenosis (3.6%), lymphocele (5.3%) and clotting (1.6%); 78.1% of these obstructive complications were resolved by endourological techniques. Urinary fistula was observed in 9 cases (3%) and lymphocele in 16 (5.3%), which were resolved by percutaneous drainage and sclerotherapy in 81.2% of the cases. Vascular complications were observed in 14 cases (4.6%), lithiasis in 5 (1.66%) and eventration in 6 (2%). The treatment of these complications are described. The actuarial graft and patient survival rates were 90.9% and 84.7% at one and five years, respectively, for the graft and 93.5% and 89% for the patients. CONCLUSIONS: Our surgical complication rate in patients undergoing renal transplantation was 20.3%. The most common complication was urinary tract obstruction from stenosis (3.6%), lymphocele (5.3%) and clotting (1.6%); 78.1% of these obstructive complications were resolved by endourological techniques. Percutaneous drainage of the lymphocele combined with sclerotherapy achieved resolution in 81.2%. Renal biopsy performed with a 14 G needle caused 5 severe hemorrhagic complications. There were no complications when an 18 G needle was utilized.
Laparoscopic pelvic lymphadenectomy for prostatic cancer.
Development of laparoscopic techniques has converted lymphadenectomy into a real alternative to current laparotomy technique. The limitation of diagnostic imaging methods to know ganglion involvement in prostate cancer as well the high incidence of false negatives in frozen intrasurgical biopsies following open-surgery lymphadenectomy has pushed us since november of 1990 to develop laparoscopic lymphadenectomy with staging. This study analyses the diverse diagnostic imaging methods and continues with a precise description of the laparoscopic technique. The authors summarize the results of our series and finish the article with a review of the most controversial aspects as well as the diagnostic value, advantages and disadvantages with respect to open surgery techniques, complications and indications of this technique at the present moment.
[Biochemical evaluation of renal lesions produced by electrohydraulic shock waves].
The authors present a biochemical study of the renal lesions produced during extracorporeal electrohydraulic shock wave lithotripsy (ESWL). The sequential variation (before and after ESWL) of various biochemical parameters of the blood and 24-hour urine was analysed in 50 patients. A significant increase of urinary N-Acetyl-Glucosaminidase (NAG), urinary NAG/urinary creatinine quotient, proteinuria, serum creatinine and potassium was detected during the 24 hours following ESWL. A significant fall in creatinine clearance, urinary osmolarity and uric acid clearance was also detected. A positive correlation was observed between these alterations, the number of shocks and the kilovoltage used. On the 7th and 15th days, no significant difference was observed compared to the baseline values before ESWL. This can be explained by the fact that the lesions caused by shock waves are already in the repair phase.
Laparoscopic pelvic lymphadenectomy in the staging of prostate cancer.
Lymphadenectomy provides sufficiently accurate information for the efficient staging of prostatic carcinoma. This paper provides a step-by-step guide to laparoscopic lymphadenectomy, based on the authors' experiences. Clinical staging of patients with neoplastic node involvement was also documented. Laparoscopic lymphadenectomy was found to be a highly efficient method for nodal staging of pelvic neoplastic pathology, similar to that reported in conventional surgery. The mean number of nodes obtained per case was determined to be 11.2. Of the 35 cases in which laparoscopic lymphadenectomy was performed, node involvement was evident in 23%, all of whom were negative by computerized tomography scan. Laparoscopic lymphadenectomy was concluded to be a minimally invasive surgical procedure, associated with few complications and a short hospital stay.
[Laparoscopic surgery instrumentation].
Today the urologist can perform many of the conventional surgical procedures by laparoscopic methods, which could not have been developed and improved without technological support. Industry has continued to provide solutions to each new requirement of laparoscopic surgery through more ergonomic materials and instruments. The different equipment and instruments for performing laparoscopic procedures are analyzed and described in the present article.
[Laparoscopic lymphadenectomy].
The limitations of the diagnostic imaging methods in determining lymph node involvement in pelvic tumors (prostatic cancer) and the high incidence of false negatives in the intraoperative frozen biopsies done during open lymphadenectomy have prompted us to develop laparoscopic staging lymphadenectomy since November, 1990. The different imaging and invasive diagnostic methods are briefly analyzed in the present article. The laparoscopic lymphadenectomy procedure is described in detail and a summary of our series is presented.
[Matrix stones].
We report a case of matrix stone in a patient with a previous history of infective staghorn stone for which the patient had previously undergone surgery to reduce stone volume and ESWL. The ureteral matrix stone had caused purulent intrarenal retention. Puncture nephrostomy and antibiotics resolved the foregoing condition and the calculus was successfully removed by ureteroscopy. The features of this uncommon disorder and the possibilities of endoscopic treatment are discussed.
[Laparoscopic ureterolithectomy. A new option].
An integral conception of patients with various diseases can benefit from the contemporary technological developments which allow to differentiated non-invasive approaches as diagnostic and therapeutical resources. This kind of patient has allowed further development of laparoscopic surgery in urology derived from the addition of reported conditions: obstructive prostate carcinoma, juxta-vesical gross lithiasis imbedded for 2 years, complexity of ureteroscopic access, large volume for extracorporeal lithotripsy and the need to know the extend of nodular affectation.
[Urologic laparoscopic surgery].
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[Laparoscopic nephrectomy: a case report].
Presentation and clinical picture outline of a patient who underwent transperitoneal laparoscopy-assisted nephrectomy. The procedure lasted 4 hours and the patient was discharged 72 hours later without incidence or complications. The paper describes the technique (presently unique and for selective indications), as well as the resources that the extensive laparoscopic experience of our group put into practice to perform the first successful laparoscopic nephrectomy in humans in our country.
[Renal transplantation: results].
Between June 1986 and December 1991, 125 kidneys were transplanted in our hospital. Survival results of patients per annum was 94%, 90% of which represent grafts. Regarding the complications occurred in our series the most frequent ones were medical followed by surgical [urological (4%), vascular (2.4%) and others derived from the surgical procedure (20%)]. It was necessary to perform 5 transplantectomies.