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Biomedical subjects

J E Robles

Publications and source records attributed to J E Robles.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Prognostic value of local vascular infiltration in infiltrating transitional carcinoma of the bladder].

The present retrospective study analyzes the evolution and survival of 79 patients with bladder infiltrant transitional carcinoma (T2-T3), which were treated with radical cystectomy and bilateral ilio-obturating lymphadenectomy. Pre-operative radiotherapy (57/79) and neo-adjuvant chemotherapy (24/79) was used as supplementary therapy. The univariate analysis showed the relationship between tumour vascular infiltration (TVI) and presence of nodes micrometastasis (p = 0.002). The variables with greater forecast power in the multivariate analysis for survival were a decline in the post-radio and/or neo-adjuvant chemotherapy tumoral stage (p = 0.000) and TVI (p = 0.001). Survival decreased significantly in patients with TVI (p = 0.008), this finding denoting a worse prognosis than the presence of nodular micrometastasis (p = 0.01).

Actuarial Analysis↗
PubMed1991

Superficial bladder cancer: survival and prognostic factors.

Two hundred and seventeen consecutive patients with superficial bladder cancer stages Ta-T1 were analyzed for survival and prognostic factors. The overall 5-year survival was 88 +/- 5.3%. Factors that impacted significantly on survival were: grade of anaplasia (GI 92 +/- 5.9% vs. GII 87 +/- 7.5% vs. GIII 68 +/- 20.7%; p = 0.01); increasing grade of anaplasia (98 +/- 1.9% vs. 55 +/- 15.6%; p less than 0.0001); progression in tumor stage (100% vs. 58 +/- 12.5%; p less than 0.0001); index of recurrences greater than 0.7 (100% vs. 71 +/- 10%; p less than 0.0001); the presence of urothelial dysplasia (98 +/- 1.7% vs. 77 +/- 9.8%; p less than 0.05); inflammatory infiltrate (90 +/- 7% vs. 83 +/- 7.3%; p less than 0.01), and residual tumor post-TUR (89 +/- 5.5% vs. 68 +/- 18.6%; p less than 0.001). Tumor stage did not impact on survival (p greater than 0.05). Using multivariate statistical analysis only the grade of anaplasia (p less than 0.0001) and increasing grade of anaplasia (p = 0.001) demonstrated significant prognostic value. Eight percent of patients died because of tumor progression. Of these patients, 87% were T1 and had concomitant urothelial dysplasia. Twenty-five percent had carcinoma in situ and the mean index of recurrence was 1.59. Seventy-five percent of patients dying because of tumor progression developed muscle-infiltrating cancer (greater than or equal to T2GIII) and 25% developed previously metastatic spread without evidence of local progression (T1GIII).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intravesical↗
PubMed1991

Renal cell carcinoma: vena caval invasion and prognostic factors.

Ninety-one consecutive patients with renal cell carcinoma stages pT1-4/N0-3/V0-2/M0 were analyzed for survival rates. The overall 5-year survival was 57%. Factors which made an impact on 5-year survival rates were: (1) grade of anaplasia (GI: 72%, GII: 42%, GIII: 22%; p = 0.0001); (2) pathological stage (pT1-2: 86%, pT3: 30%; p = 0.0000); (3) perinephric fat invasion (pT1-2: 86%, pT3a: 61%; p = 0.01); (4) nodal involvement (N0: 69%, N1: 11%; p = 0.0000), and (5) venous invasion (V0: 72%, V1-2: 30%; p less than 0.01). There were no differences in survival rates between V1 and V2 tumors (p greater than 0.05). Using multivariate statistical analysis we found that grade of anaplasia and venous invasion contained dire prognostic information (p = 0.0000). Among patients with stage pT3b, those without perinephric fat invasion or nodal involvement had a better survival rate than those with capsular infiltration (p less than 0.01) and a significantly better rate than those with perinephric fat invasion and nodal involvement (p less than 0.01). Moreover, there were no differences between stages pT3b with venous invasion only and stages pT1-2 (p greater than 0.05). Patients with venous invasion developed distant metastases with a significantly higher frequency than those without (p = 0.01). The prognostic impact of venous invasion is unclear yet, but is probably related to perinephric fat invasion and nodal involvement. Until further data are collected, the radical approach with complete removal of the thrombus remains the treatment of choice for localized renal cell carcinoma with vena caval extension.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Secondary carcinoma of the penis. A report of three new cases.

Metastatic tumors of the penis are rare. They are usually secondary to primaries of the genitourinary and gastrointestinal tracts. Surgical therapy of lesions involving the corpora cavernosa can result in prolonged survival. However, rarely does the metastasis represent a true solitary event. We report 3 new cases with primary tumors in the bladder.

Aged↗
PubMed1985

Transitional cell carcinoma of the anterior urethra.

We report a case of transitional cell carcinoma arising in the anterior urethra, a portion of the male urethra ordinarily lined by squamous epithelium. This is the 4th case of transitional cell carcinoma of the distal urethra to be reported. The neoplasm metastasized to superficial inguinal lymph nodes.

Aged↗
PubMed1985

Primary signet-ring cell carcinoma of the urinary bladder (linitis plastica).

In this paper we describe the 16th case in the English medical literature of signet-ring cell carcinoma of the bladder, which occurred in a 65-year-old man who developed widespread abdominal metastases. This case illustrates the characteristic diffuse infiltrative pattern of this neoplasm. In addition to light microscopy, ultrastructural studies were performed.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

[Urinary incontinence].

Urinary incontinence, understood as any involuntary loss of urine, constitutes an important medical and social problem. It can be classified as stress urinary incontinence, urgent urinary incontinence or mixed urinary incontinence. The proportions of these three types of urinary incontinence are difficult to establish and vary notably between sources, but they might be about 40, 33 and 20% respectively. Its diagnosis requires a correct clinical history and physical exploration, together with some complementary explorations. The first therapeutic step consists of hygienic-dietary measures and behaviour modification techniques. Pharmacological treatment is specific for each type of urinary incontinence, using anticholinergics and inhibitors of serotonin reuptake. Finally, different surgical techniques have a role in cases where conservative treatments fail or when dealing with severe urinary incontinence.

Humans↗
PubMedDate not supplied

[Molecular biology of bladder cancer].

OBJECTIVE: To analyze the factors that influence tumor progression and response to therapy. METHODS: The new prognostic factors involved in the progression of bladder tumors that have been described in the literature, such as tumor antigen expression, molecular growth factors, cell adhesion molecules, oncogenes, tumor suppressor genes and mechanisms of tumor angiogenesis, are reviewed. RESULTS/CONCLUSIONS: The etiopathogenesis of bladder cancer remains unknown and treatment is based on the clinical stage of the disease. The new tumor markers will permit a more individualized prognosis and treatment can be instituted according to the biological characteristics of the tumor.

Humans↗
PubMedDate not supplied

[Epidemiology of tumors of the renal parenchyma].

Renal cell carcinoma is responsible for about 2% of all cancer deaths in developed countries and represents 80-85% of all tumors of the kidney. Its etiology is still largely undefined. Its incidence varies among countries, with the highest rates in North Americans and Scandinavians. Its incidence is steadily rising in the last ten years. The location of the tumor suppressor gene on chromosome 3p has contributed to the understanding of tumor pathogenesis. Renal cell carcinoma occurs nearly twice as often in men as in women. Patients are generally more than 40 years old at diagnosis, usually in the fifth to seventh decade of life. This tumor is more common among urban than rural residents, but it was not a consistent association with education or socio-economic status. Recently large epidemiologic studies showed an increased risk of renal-cell cancer in relation to tobacco smoking, with a relative risk of about 2 for current smokers. Other established risk factors are elevated body mass index (mainly in women) and a family history of the disease. Occupational exposure to chemicals appears to have little significance, although associations with specific products, such as asbestos fibres, have been reported. Some relationship has been observed between renal-cell cancer and hypertension, use of anti-hypertensives and kidney diseases, although this issue remains open to discussion. Data are inconsistent on the role of nutrition, mainly for fats and proteins, while vegetable and fruit consumption seems to convey some protection on renal-cell cancer risk. The risk of renal-cell cancer was not materially elevated in relation to coffee, tea and alcohol intake and, in women, oral contraceptive use, hormone replacement therapy, and menstrual factors.

Age Factors↗
PubMedDate not supplied

[Cystic pyeloureteritis].

The pyelitis or cystic pyeloureteritis is a rare disease of unknown etiology. The clinic is unspecific and the treatment, medical and expectant. The importance of this disease consists of a correct differential diagnosis with other repletion defect imaging in the excretory tract and its frequent association to other diseases.

Diagnosis, Differential↗
PubMedDate not supplied

[Renal lithiasis due to indinavir].

Indinavir sulphate is a protease inhibitor that has been found to be extremely effective in increasing CD4+ cell counts and in decreasing HIV-RNA titers in patients with HIV and AIDS. However, patients receiving indinavir also have been noted to have a significant risk of developing urolithiasis. Indinavir has high urinary excretion with poor solubility in a physiologic pH solution. The typical symptoms of indinavir urolithiasis are similar to other forms of urolithiasis. Indinavir urolithiasis is unique in that computed tomography, which was once thought to be efficacious in identifying all urinary calculi, is not useful in imaging stones that are composed of pure indinavir. Indinavir urolithiasis generally responds to a conservative regimen of hydration, pain control, and temporary discontinuation of the medication. Only a minority of patients need surgical intervention.

Crystallization↗
PubMedDate not supplied

[Urologic complications in 237 recipients of cadaveric kidney transplantation].

We describe the urological complications occurred in 237 patients undergoing cadaveric renal transplant in 13 years. Two techniques of extravesical ureterocystoneostomy were used. Thirty patients (13%) presented 35 (15%) urological complications: 23 (9.7%) urinary fistula and 12 (5.1%) ureteral stenosis. The vast majority (80%) were early complications (before 90 days): 82% fistulas and 18% stenosis. All early complications were identified as technical deficiencies; all late complications were obstructive in nature. A new ureteral reimplant was performed in 15 patients, with successful results in 14. Six patients underwent nephrectomy and pyelostomy, 2 of these required a second operation. Seven patients underwent endo-urological procedures with good results. Three patients undergoing conservative treatment for urinary fistula required surgical drainage of an infected urinoma. No statistical difference was observed in the survival rates of both the grafts and the patients presenting or not urinary complications.

Actuarial Analysis↗
PubMedDate not supplied

[Prophylactic antibiotic therapy in extracorporeal shock-wave lithotripsy: prospective, randomized study].

Two hundred patients that underwent ESWL were randomized into 4 groups in order to determine the benefits of antibiotic prophylaxis. All comparisons among groups were not statistically significant. Neither cephalosporin nor quinolone prophylaxis impacted significantly on bacteriuria rate after ESWL. Thus, in patients without infected stones, urinary tract obstruction and ancillary procedures ESWL could be performed without prophylactic antibiotic regimes.

Bacteriuria↗
PubMedDate not supplied

[Survival analysis in renal cell carcinoma with invasion of the vena cava].

Ninety-nine consecutive patients with renal cell carcinoma in stages pT1-4/N0-3/V0-2/M0 were analyzed. Overall 5 year survival was 61%. Factors with greater impact on survival were: 1) degree of anaplasia (DI 73%, DII 47%, DIII 27%; p = 0.0005), 2) pathological stage (pT1-2 87%, pT3 39%; p = 0.0000), 3) perirenal fat invasion (pT1-2 87%, pT3a 60%; p = 0.007), 4) node status (N0 72%, N1-3 17%; p = 0.0000) and 5) veins invasion (V0 74%, V1-2 35%; p = 0.005). No difference in survival between V1 and V2 (40% vs 33%; p0.05) tumours was found. A multivariable study showed that the degree of anaplasia and veins invasion have a significant and separate influence on survival (p = 0.0000). Among patients with vascular invasion, those with no perirenal fat invasion or node damage show better survival rates than patients with capsular infiltration (62% vs 40%; p) and perform significantly better than patients with capsular invasion and nodal implication (62% vs 30%; p). No survival differences were observed between pT3b stages with venous invasion only and pT1-2 stages (p0.05). Venous invasion is not in itself of prognostic relevance; the prognostic significance of vascular invasion is directly related to the presence of perirenal fat invasion and/or nodal implication.

Adult↗
PubMedDate not supplied

[Effect of time of vascular anastomosis and of hot and cold ischemia, on survival of cadaver renal graft].

A retrospective study was performed on our series of 240 primary cadaveric renal transplant recipients to dissect the influence of vascular anastomosis time, warm ischemia time and cold ischemia time on ultimate graft survival. 177 patients received conventional immunosuppression with Azatioprine and steroids, and 63 patients received Cyclosporine A therapy. The data was analyzed for sub-groups of ischemia time and comparisons were performed using the method of Tarone-Ware. The present study fails to demonstrate a detrimental effect of ischemic insults on graft survival. The use of Cyclosporine A in the pre and post-transplant, monitoring periodically serum cyclosporine levels and the use of renal allograft biopsy, allows the use of this agent without a high incidence of nefrotoxicity.

Adult↗
PubMedDate not supplied

[Urothelial tumor markers: update].

The story of the search for tumoral markers of urotelial neoplasias is reviewed. Its routine use is at present difficult due to its technical complexity. The use of new monoclonal antibodies is a promising aspect.

Antigens, Neoplasm↗
PubMedDate not supplied

[Prognostic value of initial function in graft and patient survival in cadaveric renal transplant; impact of cyclosporin A].

This paper presents our experience with 237 primary renal cadaveric transplants and analyzes related factors to Initial Non-Function, its influence on graft and patient survival as well as the impact of cyclosporin A on graft survival. Our study shows better graft survival rates in patients treated with cyclosporin A and in patients with Immediate Initial Function.

Adolescent↗