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J C Angulo

Publications and source records attributed to J C Angulo.

At least 37 records · Page 2Linked to original sources
PubMed1996

Primary cisplatin, methotrexate and vinblastine aiming at bladder preservation in invasive bladder cancer: multivariate analysis on prognostic factors.

PURPOSE: Although radical cystectomy is the standard therapy for invasive bladder cancer, cisplatin based multi-drug chemotherapy has proved to be effective for advanced transitional cell urothelial carcinoma. The potential for bladder preservation with neoadjuvant chemotherapy is currently under investigation. MATERIALS AND METHODS: A phase 2 protocol is presented for conservative treatment of muscle invasive transitional cell carcinoma of the bladder consisting of primary cisplatin, methotrexate and vinblastine chemotherapy followed by reevaluation for bladder sparing surgery and surveillance. A total of 61 patients completed the protocol with a mean followup of 41.4 months. RESULTS: Initial complete response to chemotherapy associated with tumor stage, size and configuration was noted in 20 patients (33%). Bladder preservation, intended only for the complete response group, was achieved in 16 patients (26%) but only 11 (18%) were alive with the bladder intact at study closure. Disease-free 5-year survival rate was 47% (95% confidence interval 65 to 26%). Tumor stage (p = 0.0007), size (p = 0.0003), response to chemotherapy (p = 0.002), patient age (p = 0.039) and tumor grade (p = 0.048) influenced survival. Multivariate analysis revealed response to chemotherapy (beta = 0.988, p = 0.034) and tumor size (beta = 0.978, p = 0.042) to be the only independent predictors. CONCLUSIONS: Induction of cisplatin, methotrexate and vinblastine chemotherapy is helpful in identifying patients with a greater chance for survival among those with locally advanced bladder cancer. However, a bladder preservation strategy based on this therapy is only of limited success.

Aged↗
PubMed1996

[Secondary neoplasm in patients with bladder carcinoma. A case-control study].

Presentation of a case-control study on 755 subjects with the purpose of defining whether the development of a neoplasia on any organ and of any histological type, either synchronous or metachronous, occurs more frequently in patients who already have vesical carcinoma (338 cases) versus other populations of similar epidemiological characteristics comprising subjects who do not present that condition (417 controls). The evaluation of the difference between both groups establishes a cause-effect relationship expressed in terms of an odds ratio of 2:11 which allows to claim that presence of a second neoplasia is more frequent in patients with vesical carcinoma (p < 0.001). The paper also includes a discussion on the distribution to organs and systems. Once the cases with urothelial site (renal pelvis, ureter or urethra) are excluded, prostate adenocarcinoma is the most frequent form associated to vesical carcinoma, followed at a distance by renal adenocarcinoma, epidermoid carcinoma of the larynx and bronchopulmonary carcinoma. Cumulative incidence of secondary neoplasias, including tumours diagnosed synchronically is 12% at 54 months.

Adult↗
PubMed1995

Timing and competition in networks representing ambiguous figures.

The duration of perception for eye rivalry and the Necker cube was obtained during continuous presentation of the stimuli. The frequency histograms support the idea of continuous competition between the neural representations of both percepts. They also suggest that when a percept is installed there is a relative refractoriness for changing the percept that is modeled by a sigmoid equation. This refractoriness lasts a few seconds. The duration of the perceptions was modified by the instruction to the subjects. Results are discussed in terms of a simple competition model, a temporal segmentation hypothesis, and the possible top-down influences. These are considered useful mechanisms for selecting relevant information in a serial processor and for maintaining perception, cognitive evaluation, and action of a given context in the same time epoch.

Adult↗
PubMed1995

Muscularis mucosa differentiates two populations with different prognosis in stage T1 bladder cancer.

OBJECTIVES: Contrary to previous belief, the existence of a muscularis mucosa in the human urinary bladder has now been well described. Although the degree of development of this structure seems variable, it can frequently be used to differentiate two levels within the subepithelial connective tissue: the lamina propria and the submucosa. The present study evaluates whether this morphologic feature is potentially useful for the identification of two populations with Stage T1 bladder cancer: those with tumor invasion confined to the lamina propria (pT1A) and those with tumors infiltrating into the submucosa (pT1B). METHODS: A series of 170 Stage T1 papillary bladder tumors was analyzed pathologically to identify the level of subepithelial connective tissue invasion. Both the reproducibility of such a differentiation and its prognostic implication were evaluated using Kaplan-Meier survival estimates and the Cox regression model. RESULTS: In specimens from transurethral resection, categorization into T1A or T1B could be performed in 98 of 170 cases (58% of specimens). Such differentiation proved to be of prognostic value with significantly different 5-year survivals between the two subcategories (pT1A [n = 50] vs pT1B [n = 49]) (log-rank, P < 0.02). Cox's regression analysis of pT1 subcategory and grade was performed in the 99 cases in which the differentiation between pT1A/pT1B could be made. This demonstrated that the depth of subepithelial connective tissue invasion was an independent prognostic factor (P < 0.05). CONCLUSIONS: The depth of tumor infiltration can be assessed in a considerable proportion of Stage T1 bladder neoplasms. The present study validates the prognostic significance of such a distinction both by Mantel-Haenszel life table method and Cox's regression analysis.

Actuarial Analysis↗
PubMed1995

Adenocarcinoma of the rete testis.

To date, no studies have evaluated adenocarcinoma of the rete testis statistically, because reports have been limited to single cases or series of 2 cases only. Univariate and multivariate analyses on disease-free survival have been performed after combining all data available in the literature with our own. Information about disease-free survival has been collected in 38 patients. As many as 40% of them died within the first year of diagnosis. Three and 5-year disease-free survival was 49% and 13%, respectively. We have not detected any difference in survival between age groups or side of the lesion. Similarly, statistical difference cannot be proved between survival of tumors with nodular infiltrating or cystic growth pattern, although it has been suggested that these two varieties represent different tumor types from a gross and microscopic morphologic point of view. Univariate analysis reveals that tumor stage, tumor size, and therapy may have an influence on survival. Tumors that are organ-confined and small lesions (testicular mass < 5 cm in maximum diameter) behave definitely better than those disseminated at diagnosis or of a bigger size. Surprisingly, tumor size is not associated with tumor stage or histologic growth pattern (nodular infiltrating versus predominantly cystic). With regard to therapy, cases in which RPLND has been performed as part of the therapy behave better in univariate analysis, while patients who receive radiation do worse. Most probably these facts reflect that patients with clearly advanced disease where local control cannot be achieved by surgery tend to undergo palliative treatment by radiation. On the other hand, RPLND tends to be performed in patients in whom there is no evidence of distant spread. Therefore, it would really be the primary stage that would set the prognosis rather than the consequent treatment, and neither radiation therapy nor RPLND would be true independent variables. Similarly, no significant difference is observed when patients receive chemotherapy. Cox's regression analysis reveals size of the testicular tumor as the only independent predictor of survival. Stage at diagnosis does not have an influence by itself and neither does any form of therapy. In this sense, the negative effect of radiotherapy is eliminated. We are aware that the results drawn from a literature review are far from ideal, but there is not enough evidence to suggest an optimal sequence of treatment for this rare malignancy. To date, no effective chemotherapy has been found. Whenever the tumor is resectable, there appears to be merit in an RPLND.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenocarcinoma↗
PubMed1995

The prognostic significance of vascular invasion in stage T1 bladder cancer.

Transurethral resection specimens from 170 T1 bladder carcinomas were reviewed for the presence of vascular (blood vessel and/or lymphatic) invasion by tumour cells. Such a finding was noted in 17 cases (10%), and occurred most frequently in high grade tumours. Tumour recurrence was documented in 11 of these cases (65%), including seven patients who showed progression to more invasive disease (T2-T4) and six patients (55%) who died of disease. Five-year survival for cases without vascular invasion was 81% versus 44% for those with. This was a statistically significant difference (log-rank, P = 0.004). Neoplasms of high grade (grades 2 to 3), without a papillary configuration, and exceeding 5 cm were associated with vascular invasion (chi-squared; P < 0.001, P = 0.043, and P = 0.061 respectively). In multivariate analysis vascular invasion proved to be an independent prognostic factor (Cox's regression, P = 0.015). We therefore stress the clinical relevance of a thorough evaluation of the state of vascular invasion in stage T1 bladder cancer.

Aged↗
PubMed1995

Giant Müllerian duct cyst mimicking prostatic malignancy.

A giant müllerian duct cyst was initially interpreted as a seminal vesicle cyst. Associated prostatic malignancy was suspected because of raised tumour marker levels and lysis of pubic bone. Intraoperative vasography gave the correct diagnosis. Open partial transvesical excision of the cyst and suprapubic prostatectomy were performed. No malignancy was found in the surgical specimens and 2 years later the patient remains well.

Aged↗
PubMed1995

Leydig cell tumour in a man with human immunodeficiency virus.

We report a case of Leydig-cell testicular tumour in a 32-year-old intravenous drug abuser bearing HIV-infection and pulmonary tuberculosis. The testicular mass was initially interpreted as genital tuberculosis and the diagnosis was made by aspiration cytology. Radical orchiectomy was performed and pathology revealed a Leydig-cell tumour. Gynecomastia was found as a possible sign of endocrine activity. Although testicular malignancies in men with human immunodeficiency virus are increasingly reported, this is the first case of Leydig-cell neoplasia associated to HIV-infection.

Adult↗
PubMed1995

Combined therapy in a case of malignant mesothelioma of the tunica vaginalis testis.

Malignant mesothelioma of the tunica vaginalis testis is exceedingly rare. A new case mimicking hydrocele in a 47-year-old man is here reported. Clinical staging revealed scrotal cutaneous and funicular tumor invasion together with retroperitoneal adenopathies. Once visceral dissemination was ruled out, radical orchiectomy, left hemiscrotectomy and modified retroperitoneal lymph node dissection were performed. Adjuvant systemic chemotherapy and radiation were also administered. Histologically, an epithelial neoplasm with papillary pattern was evidenced. CAM 5.2 cytokeratin was positive in proliferating cells, but carcinoembryonic and Leu M1 antigens gave negative results. Three years later the patient is free of disease.

Combined Modality Therapy↗
PubMed1995

[Staging error in bladder carcinoma: anatomo-clinical correlation].

Presentation of clinico-pathological correlation in a series of patients with bladder carcinoma. All of them had a complete pathological and clinical staging following TNM guidelines (UICC 1987). Clinical evaluation consisted of a clinical examination, urography and/or ultrasound, cystoscopy, bimanual palpation under anaesthesia and biopsy. As an option, pelvic CAT, MRI and a bone scan were performed. In all cases a reliable pathological staging was obtained, either from cystectomy or complete TUR. Overall, there is a 66% clinico-pathological correlation (60% for Ta category, 78% for T1, 25% for T2, 57% for T3, and 74% for T4). There is a global error of 34% (40% of cases clinically considered Ta were invasive, 16% T1 were pT2 or more, 42% T2 were pT3 or more, and 10% T3 were pT4; while 6% of those considered T1 were pTa, 33% of T2 were pTa or pT1, 33% of T3 were pT2 or less, and 26% of T4 were pT3 or less). We therefore conclude that when T is lower the risk of being clinically understaged is greater, while higher T values increase the risk of clinical overstaging. From a practical point of view, the most severe errors are in the understaging of T2 and T3 (pT3-pT4) tumours and the overstaging of T2 (pT1) tumours. When cystectomy is performed, the risk of understaging is greater for tumours interpreted as T2-T3 while the risk of overstaging T4 tumours is lower. We conclude that, even when adequate staging of bladder cancer is attempted, pre-treatment tumour classification using the diagnostic methods currently available is far from satisfactory.

Adult↗
PubMed1995

[Conceptual review of simple renal ectopy and suggestion of a unifying embryogenetic hypothesis].

Proposal for a conceptual review of the theories currently used to explain the pathogenesis of single kidney ectopia. The inner mechanisms which generate this frequent anomaly in the positioning and rotation of the kidneys are far from being understood. Based on a critical review of the literature and our own observational findings, we believe the single kidney ectopia is a time-dependent embryo-development change model which can be used as a ¿chronopathy¿ paradigm.

Humans↗
PubMed1994

Burned-out tumour of the testis presenting as retroperitoneal choriocarcinoma.

A case of "burned-out" tumour of the testis in a 20-year-old man is reported. The tumour presented as widespread retroperitoneal metastases. Orchiectomy displayed a subalbugineal fibrous scar close to the rete testis. Diagnostic biopsy of the unresectable retroperitoneal tumour showed a choriocarcinoma. Although appropriate chemotherapy was promptly started, the patient died 7 months after the initial complaints.

Adult↗
PubMed1994

HIV infection presenting as renal polyarteritis nodosa.

We present a case of renal vasculitis (polyarteritis nodosa) in a 36-year-old female prostitute having undetected HIV infection (AIDS-related complex) and chronic B-hepatitis. The pathogenesis and significance of the association between these entities are reviewed.

AIDS-Related Opportunistic Infections↗
PubMed1994

Pseudosarcomatous myofibroblastic proliferation of the bladder: report of 2 cases and literature review.

We report 2 cases of pseudosarcomatous myofibroblastic proliferations of the bladder unrelated to urological trauma. To our knowledge, these cases represent the longest followup (12 and 19 years, respectively) reported in the literature, which confirms the long-term benign nature of an entity that may be clinically and even pathologically mistaken as malignancy. A review of the literature revealed a female predominance (3:1), 50% of the cases manifested in the first 2 decades of life and mean age was significantly lower in male patients (p < 0.005). These facts suggest the existence of a hormonal factor in the pathogenesis of this entity. A predilection for fundus, and the posterior and lateral walls also is demonstrated. In light of the complex embryogenesis of the cloacal territory, it could be hypothesized that this lesion arises from embryonal mesenchymal remnants of the endodermally derived urinary tract.

Adolescent↗
PubMed1994

Small cell carcinoma of the urinary bladder. A clinicopathological study of six cases.

OBJECTIVE: To study the clinical, histological, and immunohistochemical findings of small cell carcinoma (SCC) of the urinary bladder, and also to delineate its behaviour in comparison with transitional cell carcinomas of the bladder. MATERIALS AND METHODS: A retrospective review of 552 patients with bladder cancer yielded six cases (1%) of small cell carcinoma which were histologically identical to pulmonary small cell anaplastic carcinoma. Clinical data and follow-up were collected. Aside from the conventional histological parameters, an immunohistochemical study with AE1-AE3 and Cam 5.2 keratins, epithelial membrane antigen, neuron-specific enolase, chromogranin, synaptophysin, ACTH, calcitonin, and prostatic specific antigen was performed. RESULTS: The clinical presentation did not differ from conventional transitional cell carcinoma, haematuria being the most frequent complaint (four cases). All the cases presented as flat tumours. On light microscopy, there were oat cell (four cases), intermediate (one case) and mixed oat-cell/intermediate (one case) variants. Three cases were associated with transitional cell carcinoma. Dysplastic changes were observed in the adjacent urothelium in one case only. At the time of diagnosis, all tumours were deeply invasive (pT3). Three cases were Stage III and three Stage IV, with involvement of regional lymph nodes and metastases to the liver (two cases) and lung (one case). Immunohistochemically, epithelial markers were variably expressed as AE1-AE3 keratin (5/6), Cam 5.2 keratin (2/6) and epithelial membrane antigen (3/6). Neuron specific enolase was demonstrated in every case. Chromogranin, however, was expressed in only one case. Synaptophysin, ACTH, calcitonin, and prostatic specific antigen all gave negative results. All the patients died of the disease and the overall length of survival was very poor (range 5-25 months, mean 13.3). CONCLUSION: Small cell carcinomas show the same histological patterns as their pulmonary counterpart. Immunohistochemistry reveals a wide spectrum of activity, enolase and keratins being the most constant. The present study confirms that the overall prognosis of this tumour is very poor.

Aged↗
PubMed1994

Extrarenal retroperitoneal angiomyolipoma.

The clinical and pathological findings in a patient with extrarenal angiomyolipoma arising in the perinephric space are presented. This location has been reported only rarely and sets forth some diagnostic and therapeutic difficulties that are also discussed.

Angiomyolipoma↗
PubMed1994

Lethal cytomegalovirus adrenalitis in a case of AIDS.

The clinico-pathologic report of a case of cytomegalovirus (CMV) necrotizing adrenalitis arising in an intravenous drug-abuser and HIV-infected young is presented. CMV urinary tract infection, genital Kaposi's, and demyelinating changes in central nervous system were associated findings.

AIDS-Related Opportunistic Infections↗