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J C Angulo

Publications and source records attributed to J C Angulo.

At least 19 recordsLinked to original sources
PubMed2000

[Usefulness of the percentage of free prostatic specific antigen in the differential diagnosis between benign prostatic hyperplasia and prostate cancer].

BACKGROUND: PSA (prostatic specific antigen) is the most used tumor marker to monitor prostate cancer (PC). It is an acceptably sensitive test. Molecular forms of PSA give a chance to improve its specificity. We have evaluated the usefulness of the ratio free PSA/total PSA (f-PSA/t-PSA%) to diagnose prostate cancer, in the range between 4 and 20 ng/ml; i.e. the interval in which values overlap for patients with PC and benign prostatic hyperplasia (BPH) in our environment. PATIENTS AND METHODS: Prospective study on 269 patients, 73 with PC and 196 with BPH. Both t-PSA and f-PSA were determined using microparticles enzyme immune assay (MEIA) with AXSYM (Abbott) analyzer. RESULTS: Statistically significant differences were evidenced in f-PSA/t-PSA% for patients with PC vs. BPH; but that did not happen for t-PSA values. Sensitivity and specificity values were established for different cut-off points. ROC curve analysis proved diagnostic efficacy was better for f-PSA/t-PSA% than for t-PSA. CONCLUSIONS: f-PSA/t-PSA percentage is a useful tool for the differential diagnosis between PC and BPH. A ratio lower than 12% selects a population with high risk of cancer. A percentage over 18% is useful to avoid or delay the indication of biopsy.

Adult↗
PubMed1999

In vivo proton magnetic resonance spectroscopy of diseased prostate: spectroscopic features of malignant versus benign pathology.

In vivo Proton Magnetic Resonance Spectroscopy appears potentially useful for non-invasive discrimination between benign prostatic hyperplasia (BPH) and prostate carcinoma (PC). Aiming to delimit the range within which spectra from one or the other pathology should occur, and establish extreme spectroscopic features of malignant versus benign prostate disease, we performed endorectal proton MR spectroscopy on 20 patients severely affected of either benign prostatic hyperplasia (BPH) (n = 10) or prostate cancer (PC) (n = 10). They were selected on the basis of the large volume and homogeneity of their lesions, which were histologically confirmed after spectroscopy. Consequently, high-quality short-TE proton spectra with well-resolved metabolite signals, and practically free of volume averaging issues were obtained in all cases. Apart from the typical citrate, creatine, and choline signals of prostate spectra, both BPH and PC spectra showed a peak centered at 3.6 ppm which was assigned to myo-inositol. The intensity of this contribution was found significantly increased in PC cases compared to BPH. Possible relationships between neoplastic transformation and the metabolic pathways in which myo-inositol participates are discussed. Average spectroscopic profiles were calculated for both advanced pathologies, and showed obvious differentiated features. In quantitative terms, the ratio of citrate to choline peak areas as well as that of creatine to myo-inositol appeared as the most convenient to discriminate between advanced PC cases (both ratios below 1.0) and advanced BPH cases (both ratios above 1.0).

Aged↗
PubMed1999

The value of comparative volumetric analysis of urinary and blood erythrocytes to localize the source of hematuria.

PURPOSE: We evaluate comparative volumetric analysis of blood and urinary red blood cells (RBCs) to identify the source of hematuria. Comparative volumetric analysis is defined as the difference between mean corpuscular erythrocyte volume in peripheral blood (MCVB) diluted in urine supernatant after centrifugation and mean corpuscular volume of urinary erythrocytes (MCVU). The potential of MCVB-MCVU to distinguish the origin of hematuria is compared to MCVU alone. The fundamental hypothesis is that RBCs that can go through the glomerulus will be smaller than those from the collecting system or lower urinary tract, thus having a smaller MCVU and larger difference between MCVB and MCVU. MATERIALS AND METHODS: A prospective detailed urological evaluation was performed on 210 patients with glomerular or nonglomerular hematuria detected by urinary sediment, clinical radiological evaluation, endoscopy, cytology and sometimes bladder or renal biopsy. After evaluation 24 cases with an uncertain source of hematuria were excluded from study. Specialized urinalysis, volumetric analysis and clinical investigation were performed in a blind fashion. MCVU and MCVB-MCVU were registered for every patient. The Technicon H-3 system with angle laser scattering dual system allowed measurement of mean corpuscular volume in a minimal number of RBCs, and resuspension of RBC pellets in the same urinary supinate avoided effects of osmolarity and pH on RBC size and shape. Reproducibility in assessing the index was tested in 50 cases in which comparative volumetric analysis was repeated on 2 consecutive days. Unpaired t test was performed, and a threshold value of MCVB-MCVU with maximum sensitivity and specificity to detect glomerular hematuria was identified. The potential of urinary and comparative volumetric analysis to distinguish the source of hematuria was evaluated and compared by receiver operating characteristics curve analysis. RESULTS: Hematuria was nonglomerular in 53 (28.4%) and glomerular in 133 (71.6%) patients. Mean MCVB-MCVU was significantly different for nonglomerular (0.6 fl.) and glomerular (30.5 fl.) sources (p<0.0001). There was a correlation between repeat independent measures of MCVU and MCVB-MCVU. The highest positive predictive value to detect a glomerular origin is desirable so that unnecessary investigation can be obviated without the risk of missing a nonglomerular source. With a limit of 16 fl. specificity and positive predictive value were 98 and 99%, respectively. Receiver operating characteristics curve analysis to localize the source of hematuria revealed significant differences in favor of comparative volumetric analysis versus urinary volumetric analysis alone. CONCLUSIONS: MCVB-MCVU using the Technicon H-3 system is a useful noninvasive and accurate method to locate the source of hematuria. A value of 16 fl. or greater practically rules out a nonglomerular origin and obviates further urological investigation. We have incorporated this investigation in our diagnostic algorithm for hematuria.

Adolescent↗
PubMed1998

Isolated retrovesical and extrarenal retroperitoneal hydatidosis: clinical study of 10 cases and literature review.

PURPOSE: Isolated extrarenal retroperitoneal echinococcal cyst is a rare manifestation of hydatid disease. We review the clinical findings of a series of isolated retrovesical and retroperitoneal hydatid cysts in an endemic area, with special emphasis on diagnostic pitfalls. MATERIALS AND METHODS: A retrospective 15-year review in a rural area of central Spain (600,000 population), with a global incidence of hydatidosis of 10 new cases per 100,000 population per year, revealed 10 patients (0.1 cases per 100,000 per year) with surgically treated primary extrarenal retroperitoneal echinococcosis and absence of other hydatid cysts in any organ. Clinical, radiological and laboratory data are analyzed. The literature of the last 15 years on hydatid disease with a primary retroperitoneal and retrovesical location is reviewed. RESULTS: A total of 42 cases of isolated retrovesical (25) and retroperitoneal (17) hydatidosis was compiled. Male predominance of 2.5:1 was noted and age ranged from 8 to 79 years (mean 42.2 +/- 5.4). The most frequent presentation was a palpable mass in 29% of the cases followed by flank pain in 24%, frequency in 17% and urinary retention in 14% of the cases. Hydatiduria of the urinary tract was present in 9.5% of the cases. Different serological investigations were performed in 45% of the cases with positive results in 68%. The lesion had been surgically removed in all cases. Therapy and followup of each patient were analyzed. CONCLUSIONS: An isolated retrovesical, retroperitoneal or even retrocrural cyst can be the unique manifestation of hydatid disease. Although difficult, preoperative diagnosis is desirable for the selection of a surgical approach and prevention of allergic reactions and operative spillage. A diagnostic algorithm and several therapeutic guidelines are proposed.

Adolescent↗
PubMed1998

One-incision nephroureterectomy endoscopically assisted by transurethral ureteral stripping.

OBJECTIVES: Ureteral endoscopic surgery has been proposed as the first step of nephroureterectomy, either open or laparoscopic, to obviate the low abdominal incision. We present our experience with a technique of one-incision nephroureterectomy endoscopically assisted by transurethral ureteral stripping. METHODS: Standard nephrectomy is performed after placement of a Chevassu ureteral catheter. The lumbar ureter is sectioned and the catheter tip tied to the top of the distal portion of the ureter, which is later intussuscepted when the catheter is pulled out. Transurethral resection through the muscular wall and into the perivesical fat is performed around the everted ureteral orifice, and the bladder spontaneously closes with an indwelling Foley catheter. Since 1989, we have used this technique in 21 patients with urothelial malignancies of the renal pelvis or calyces (15 patients), renal cell carcinoma (2 patients), renal cholesteatoma (1 patient), or reflux nephropathy (3 patients). RESULTS: Two patients required a low abdominal incision for removal of retained ureter after unsuccessful stripping. The rest underwent this procedure without complications or adverse effects. Mean follow-up was 44.6 +/- 11.4 months (range 4 to 76). Three patients presented with bladder tumor but no recurrences were detected in the resected area of the bladder or the retroperitoneum. CONCLUSIONS: Endoscopically assisted nephroureterectomy allows removal of an adequate cuff of bladder with the distal ureter and generally obviates extending the incision or performing a second one. It can be an attractive option in selected cases, without apparent risk of neoplastic urine contamination in the retroperitoneum.

Endoscopy↗
PubMed1998

[Comparison among patients considered candidates for radical prostatectomy in academic institutes in different countries].

OBJECTIVE: Radical prostatectomy is performed in potentially curable prostatic cancers, but surgical indication might somehow depend on the idiosyncrasies of a population. Herein we compare the characteristics of patients undergoing radical prostatectomy in teaching University Hospitals of different countries. METHODS: We conducted a retrospective review on 250 consecutive patients who underwent radical prostatectomy before January 1997 in five teaching University Hospitals in Europe (Spain, Sweden, Switzerland, Turkey) and the United States (Detroit, MI). Clinicopathological data were recorded and compared, and a questionnaire investigated whether patient and physician attitudes towards surgery differed. RESULTS: The number of surgeries per month at each institution ranged from 0.9 to 10 and the proportion of newly diagnosed patients that undergo surgery from 0.14 to 0.36. The Kruskal-Wallis test revealed both median age and preoperative prostate-specific antigen (PSA) levels were different between groups. Similarly, despite standardized surgery and histologic work-up, differences in the detection of extracapsular invasion and the rate of detectable PSA after surgery were observed between institutions. Diagnosis in the Swedish and Swiss groups was more often based on digital rectal examination, while the rest were more confident with transrectal ultrasound. Doctors at some institutions were more inclined to recommend radical surgery, either by not mentioning or disapproving other therapeutic strategies. The proportion of patients who said they would elect surgery again ranged from 72% to 92%, and the proportion of doctors who said they would perform surgery again ranged from 78% to 100%. Patients' and doctors' degree of satisfaction with the decision made were also different. CONCLUSIONS: (i) Candidates for radical prostatectomy in teaching hospitals of several countries are different. Might therefore have practical implications on the design of clinical trials and the interpretation of the results of treatment. (ii) Patient and physician acceptance of surgery varies according to countries and is more established firm in those countries where it is more frequently performed.

Adult↗
PubMed1997

Renal echinococcosis: clinical study of 34 cases.

PURPOSE: Hydatid disease, a cyclo-zoonotic parasitic infestation caused by the larval stage of the cestode Echinococcus granulosus, is prevalent worldwide. We reviewed the clinical findings of a large series of renal hydatidosis treated in an endemic area with special emphasis on diagnostic pitfalls. MATERIALS AND METHODS: A retrospective 15-year review in a rural area of central Spain (600,000 population), with a global incidence of hydatidosis of 10 new cases per 100,000 population per year, revealed 34 with renal echinococcosis treated surgically (3 to 4% of officially confirmed cases of hydatidosis). Clinical, radiological and laboratory data were analyzed. RESULTS: Renal hydatid disease mimicked other diseases. The combination of clinical history, imaging studies, and serological and urine investigation yielded a reliable pretreatment diagnosis in only 50% of cases and a presumptive diagnosis in 71%. Among imaging studies computerized tomography was the most valuable diagnostic examination. Moderate eosinophilia was found in half of the cases, while a third had scoleces in the urine. A diagnostic and therapeutic algorithm is presented. CONCLUSIONS: Preoperative diagnosis of renal hydatid disease is difficult even in an endemic zone. Imaging studies are suggestive but usually inconclusive, and the differential diagnosis with a renal tumor or complicated cyst may not be made without surgery. Renal sparing surgery is possible in a significant proportion of cases, particularly when preoperative diagnosis has been considered. Significant surgical morbidity can be expected, and the risk of anaphylaxis and hydatid seeding, although low, should not be overlooked.

Adolescent↗
PubMed1997

Successful conservative management of emphysematous pyelonephritis, bilateral or in a solitary kidney.

Emphysematous pyelonephritis, bilateral or in a solitary kidney, is a life-threatening condition that requires prompt diagnosis and early intervention. Reported mortality is high, despite desperate surgical measures often ending in loss of renal unit, but medical management, possibly combined with percutaneous drainage, is sometimes successful. We report two cases of emphysematous pyelonephritis, one bilateral and one in a solitary kidney, with successful conservative management. Predisposing factors were insulin-dependent diabetes mellitus and micronodular cirrhosis secondary to chronic alcoholism. Prompt sonographic diagnosis determined the success of conservative management. Escherichia coli was identified as causal factor. In the bilateral case the clinical picture improved within 48 h after control of diabetes and broad-spectrum antibiotic treatment. For the affected solitary kidney, percutaneous drainage and ureteric catheterization were required.

Anti-Bacterial Agents↗
PubMed1997

Comparison of digital rectal examination, transrectal ultrasonography, and multicoil magnetic resonance imaging for preoperative evaluation of prostate cancer.

OBJECTIVE: A prospective study was designed to compare the potentials of digital rectal examination (DRE), transrectal ultrasound (TRUS), and magnetic resonance imaging (MRI) using integrated endorectal and pelvic phased-array coils for preoperative estimation of tumor volume and local extent of prostate cancer. METHODS: Evaluation of 20 consecutive patients undergoing radical retropubic prostatectomy included DRE, TRUS with a 7.5-MHz transducer, and MRI on a 1.5-tesla GE Signa system. Step sections (5 mm) of the entire specimen were performed, and tumor volume and percentage of gland involved were calculated. RESULTS: DRE, TRUS, and endorectal and pelvic phased-array MRI showed 50, 75, and 95% of the cancers, respectively. There was a linear correlation on MRI between predicted tumor volume and pathological tumor volume (r = 0.82, p < 0.0001), but not between predicted volume on DRE or TRUS and real volume. The accuracy for detecting extracapsular penetration was 60% for DRE and TRUS and 79% for MRI. The accuracy for detecting seminal vesicle invasion was 60% for DRE, 66 for TRUS, and 89% for MRI. The negative predictive value for extracapsular and seminal vesicle extension was highest for MRI (85 and 93%, respectively). The accuracy for tumor location in the apex of the prostate was 30% for DRE, 47 for TRUS, and 89% for MRI. CONCLUSIONS: MRI with integrated endorectal and pelvic phased-array coils satisfactorily predicted tumor volume and tumor extent preoperatively. Multicoil MRI can assist in decision making as it is valuable in the definition of patients that may benefit from surgery and can be of help for evaluating the risk of a positive margin, especially in the apical resection.

Aged↗
PubMed1996

Malignant fibrous histiocytoma of the renal capsule and synchronous transitional cell carcinoma of the bladder.

The synchronous association of malignant fibrous histiocytoma (MFH) of the kidney and transitional cell carcinoma of the urinary bladder is reported. This constitutes the ninth case of MFH definitely arising from the renal capsule. Fever was its first clinical manifestation. Despite complete surgical removal, the tumor was rapidly fatal. The current literature about MFH of the kidney is extensively reviewed.

Aged↗