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Biomedical subjects

J M Gil-Vernet

Publications and source records attributed to J M Gil-Vernet.

At least 19 recordsLinked to original sources

Invasive bladder cancer in women.

A total of 84 radical cystectomies were performed for invasive bladder cancer in 67 men (79.8%) and 17 women (20.2%). The present study investigated the possible sex-dependent differences in the pattern of invasive bladder cancer. More than 40% of the women presented lower urinary tract syndrome alone or with haematuria, giving a clinical picture similar to acute cystitis. This caused an average time-lag in diagnosis of 18.5 months in the women and 8 months in the men. There was a higher frequency of non-transitional cell carcinoma in the women (17.6%) than in the men (2.9%). We found statistically significant differences (p < 0.005) in tumor grade: 35.2% of the women had low grade tumors, compared to 7.4% of the men. However, no significant differences in staging or survival rate were found when comparing the two sexes. This leads us to believe that bladder cancer is less aggressive in women.

Adult

Alpha-interferon and oral fluorouracil in the treatment of unremovable and/or metastatic renal cancer.

We present the results obtained in a study of the pharmacological action (phase II) of alpha-interferon and oral fluorouracyl administered in our 2-year study (Feb. 1988-Feb. 1990) in 10 patients suffering from surgically unremovable or metastatic renal cancer. Our results were: 1 patient with complete regression of lung metastasis; 5 with progressive disease within 3-4 months from beginning of treatment and 2 deaths with stable disease after 4-5 months. Two patients abandoned treatment and their disease progressed within 4-5 months.

Adult

[Total parenteral nutrition. A 1-year experience with 96 patients].

In 1987, ninety-six surgical patients, of whom 44 were premature or newborn babies and 52 were infants or older children, received total parenteral nutrition (T.P.N.) at our hospital. A peripheral venous line was utilized on forty patients in the first group and only on 9 in the second group. The excellent results yielded by T.P.N. are self-evident from the low mortality showed by these patients. Thirty-three out of the 44 neonates and premature infants with serious surgical problems survived, being noteworthy the occurrence of just 3 deaths within a series of 13 necrotizing enterocolitis. In the series of 52 infants and older children, composed of 13 digestive patients (with 5 liver transplants), 6 tumoral, 9 neurologic, 4 renal (2 transplantations), 18 cardiac, 1 thoracic and 1 burnt, only 9 patients died. The average duration of T.P.N. was 10 days in the group of premature and newborn infants and 6 days for the nursing infants and older children, save for the 8 patients in whom the treatment had to be prolonged for a few months. We conclude that T.P.N., when applied in time and of short duration should entail no risk at all. In neonate and premature infant a peripheral vein shall be the route of choice. In the nursing infant and older child a central venous line is preferable, if possible the superior vena cava or its major tributary veins.

Humans

[Oncocytoma and calcification. A rare association].

The oncocytoma constitutes 3-6% of the kidney neoplasiae. The authors report one case of calcified kidney tumor, Its presentation as a calcified kidney mass is exceptional and is not present in the largest series of calcified kidney tumors. The calcification prognosis is much debated, even more in the case of oncocytoma due to the very limited series available. For calcified kidney tumor, the oncocytoma should be included as one of the differential diagnosis, even if it is not very frequent.

Adenoma

Descent of the right renal vein.

A new operation is described, in which the right renal vein outlet is moved to a lower level on the vena cava, helping to decrease the distance between the kidney and the bladder. This procedure permits treatment of extensive obstructive wounds of the pyeloureteral junction or lumbar ureteral junction, caused by lithiasis and ureteral and renal operations, that cannot be treated with conventional operations. Renal circulation is not altered with this procedure. The operation is simple, does not cause complications and provides excellent results.

Constriction, Pathologic

New approach to the splenic vessels.

The transperitoneal approach is used systematically for an arterial or a venous splenorenal anastomosis. However, this approach is associated with high morbidity and mortality rates. Because of our anatomical and surgical findings we have used the retroperitoneal approach to the splenic hilus by means of the lumbar region. The first splenorenal arterial anastomosis with this approach was done in 1972. The approach has proved to be less aggressive since it avoids the danger of damaging the pancreas, it is a more direct approach to the splenic vessels and it provides better exposure and facilitates the anastomosis. In addition, the loss or infection of ascitic fluid in cirrhotic patients is avoided with this approach, as well as intraoperative hemorrhaging caused by the great surplus circulation. There has been neither mortality nor complications in the 13 cases of arterial and venous splenorenal anastomoses that we have done with this method.

Humans

Minimum nephrostomy.

A new type of nephrostomy is described with the following main characteristics: it uses a small multiperforated Silastic tube; its crosswise location allows perfect drainage of all of the calyces and the pelvis; it does not become obstructed nor move from its position; and it causes minimum traumatization of the renal parenchyma. It has a double purpose: its serves as a drain and safety measures as well as being used for the treatment of renal infection.

Drainage

New developments in the surgical treatment of renovascular arterial hypertension.

Surgery of the renal artery and its branches has not developed at the same rate as the progress made in arterial hypertension renovascular studies. Therefore, the percentage of cure is still low, the mortality rate high and the complications frequent. Based on the experiences in renal allo- and autotransplants, on the progress achieved in different fields, such as extracorporeal kidney surgery, on a new way of approach to the spleen's hilus, on the development of microsurgery and on a better knowledge of the biopathology of vascular grafts, new orientations for this type of surgery are supported. No matter which technique is followed, renal hypothermia by arterial perfusion, elimination of the diseased arterial segment, placement of the kidney in the continuity of another arterial system (auto-or splenorenal transplants), substitution of the transperitoneal approach by the retroperitoneal one, and, in complicated cases, the practice of ex situ arterial reconstruction surgery, is considered fundamental. Statistics, following these guidelines, are presented, which indicates that there were no deaths and that the percentage of success is higher than with classic revascularization surgery.

Blood Vessel Prosthesis

Cyclophosphamide (CP) substituting azathioprine after renal transplantation.

Eighteen patients received CP substituting AZ after renal transplantation following evidence of hepatitis. We have compared graft evolution before and after treatment with CP. Twelve patients showed no modification in graft evolution. In four patients the renal function decreased but it did not seem attributable to the change of the drug. Two patients showed intolerance attributable to the change of the drug. In one patient who received CP instead of AZ since the data of the transplant onwards, with no evidence of hepatic lesion, renal function decreased but this did not seem attributable to the use of the drug. The dose of CP in renal transplantation is discussed. We conclude that CP is a good substitute for AZ in renal transplanted patients. Adequate doses seemed to range between 0.7 and 1 mg/kg/day.

Azathioprine

Extracorporeal renal surgery. Work bench surgery.

In cases in which renal repair through conventional in situ surgery is not possible, we have proceeded to remove the organ outside of the human body and placed in on a work bench where exsitu repair is aided by microsurgery, x-ray films, and image amplifiers. In most cases the damaged kidney has recovered its function and a grave problem has been solved. Extracorporeal surgery means a new tactical solution to extreme situations.

Child