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Biomedical subjects

P Cárcamo

Publications and source records attributed to P Cárcamo.

At least 19 recordsLinked to original sources
PubMed1997

Excision and anastomotic repair for urethral stricture disease: experience with 150 cases.

PURPOSE: To analyze the results of a series of end-to-end urethroplasties performed in our service from 1968 to 1995 and of the factors contributing to failure. MATERIAL AND METHODS: 150 men (mean age 35.9 years) with urethral stricture disease underwent excision of the stricture and end-to-end anastomosis; in 95 it was the first attempt at repair while in 55 it was a secondary attempt. Eighty-two patients (54.6%) had a trauma-related stricture; of them, 56 followed a pelvic ring fracture with posterior urethra distraction defect, 24 (16%) had inflammatory strictures, 26 (17.3%) iatrogenic, 9 (6%) congenital, and 9 (6%) of unknown etiology; 81 (54%) were located in the bulbous urethra, 9 (6%) in the penoscrotal junction and 2 (1.3%) in the penile urethra. Ninety-one (60.6%) of the strictures or obliterative defects measured between 1 and 3 cm, 42 (28%) less than 1 cm and only 16 (10.6%) more than 3 cm. A perineal approach was used in 138 of the cases, while combined abdominoperineal route was necessary in 12; of these, 5 were children. The follow-up has ranged from 6 to 168 months (mean 44.4). The results were classified as good, fair (some re-stricturing, not needing treatment) and poor (recurrence). RESULTS: One hundred and twenty-six (84%) good outcomes, 10 (6.6%) fair, 14 (9.3%) poor. The factors influencing success or failure were: (1) primary or secondary character of the operation; (2) etiology; (3) length, and (4) location. Postoperative early complications consisted of 2 wound infections and 2 hematomas; as late complications, 1 chordee, 2 incontinence, 7 erectile dysfunction (in previously potent patients). The 14 patients considered as failures were operated again, all successfully; in 4 of them, a repeat excision and end-to-end anastomosis was performed, elevating the final success rate of the series to 93.3%. CONCLUSION: Excision and anastomotic repair represent the optimal mode of stricture repair for single lesions located from the penoscrotal junction to the membranous part of the urethra.

Anastomosis, Surgical↗
PubMed1993

Genitourinary malakoplakia.

Between 1973 and 1991, 13 patients with malakoplakia (MKP) have been diagnosed and treated. The lesions involved all sites in the genitourinary tract; 2 patients had multiple and 11 had single lesions. Treatment was based on 2 criteria: (a) pharmacological treatment with trimethoprim-sulphamethoxazole and/or ascorbic acid and/or bethanechol chloride; (b) excision of the MKP lesion either endoscopically or by open surgery. Two patients died (1 from multiple MKP and the other from a myocardial infarct); the remainder did well. The pathogenic, diagnostic and therapeutic aspects of the disease are discussed.

Aged↗
PubMed1993

[Necrotizing vasculitis in the bladder].

The necrotizing lesion that affects the small and medium-sized arteries, commonly known as polyarteritis nodosa (PAN), usually have a systemic and variable involvement. Urothelial involvement at the level of the two ureters has been rarely described. We report a case of necrotizing vasculitis localized to the bladder that had manifested clinically as gross hematuria.

Aged↗
PubMed1992

[The imaging diagnosis of adrenal tumors].

From 1967 to 1991 we have diagnosed and treated 73 adrenal tumors in 63 patients: 12 pheochromocytomas, 24 adrenal cortical adenomas, 15 hyperplasias, 16 carcinomas, 3 myelolipomas, 2 cysts and 1 neuroblastoma. We conducted a retrospective study to analyze the preoperative images obtained by different diagnostic techniques and attempted to correlate tumor size and site with the results of the histological analysis of the surgical specimen. Nephrotomography with pneumoretroperitoneum and IV Nephrotomography were useful in detecting the increase of the size of the gland in 10 of 25 cases submitted to these procedures (40%). Arteriography as second or third technique of choice confirmed the presence of an adrenal tumor in 15 of the 21 cases evaluated by this procedure (70%). US and CT detected 94% (31/33) and 100% (33/33) of the cases, respectively. Fourteen cases were incidentally discovered by CT (7) and US (7). A direct relationship between tumor size and degree of malignancy could be established since the carcinomas had a mean diameter of 7 cm (range 5 to 12 cm). Concerning the histologic nature of the disease, specific images were found in 3 cases of adrenal myelolipoma (hyperechoic on US and of low density similar to fat on CT) and 2 cysts (anechoic with posterior band evidenced on us and liquid on CT). Radioisotopes were also utilized for tumor localization and there was positive uptake of I-131-IMBG in 2 cases of adrenal pheochromocytoma; 1 extra-adrenal (left lateral aortic paraganglioma) and 1 case of malignant adrenal pheochromocytoma with metastasis to the lungs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Gland Neoplasms↗
PubMed1990

Bacillus Calmette-Guerin versus doxorubicin versus thiotepa: a randomized prospective study in 202 patients with superficial bladder cancer.

We report the second interim analysis of data from a randomized prospective trial comparing the prophylactic effect of 15 courses of 50 mg. doxorubicin, 50 mg. thiotepa or 150 mg. bacillus Calmette-Guerin instilled intravesically against recurrences and progression of superficial transitional cell bladder cancer. Of 202 enrolled patients 176 currently are evaluable with a mean follow-up of 3 years (range 3 to 97 months). The number of patients with recurrences was significantly lower in the bacillus Calmette-Guerin arm (9 of 67) compared to the doxorubicin (23 of 53, p equals 0.002) and thiotepa (20 of 56, p equals 0.003) arms. The over-all recurrence index per 100 patient-months also was lower for the bacillus Calmette-Guerin versus the thiotepa and doxorubicin groups (0.53 versus 1.55 and 1.7, respectively). Bacillus Calmette-Guerin also was superior in preventing recurrences and progression of high risk tumors, that is stage T1, grade 3 or multiple growths, associated or not with carcinoma in situ. In the stage T1 category 19 of 32 (60%) tumors recurred under treatment with doxorubicin, 11 of 33 (33%) with thiotepa and 6 of 49 (12%) with bacillus Calmette-Guerin. Toxicity to intravesical bacillus Calmette-Guerin was higher compared to the other drugs but it was not limiting: bladder irritability and malaise occurred in 42% of the patients, granulomatous cystitis in 16.4% and bladder contraction in 1.4% (1 of 64). The latter complication occurred in a patient whose stage T1m grade 2 tumors had recurred 3 times, who underwent 3 transurethral bladder resections within 15 months and who had received thiotepa for 4 months after having been removed from the study 11 months after entry. Three patients in the doxorubicin group (5.6%) underwent radical cystectomy for local urothelial progression. One patient (1.8%) in the same group died of distant progression. Our preliminary results suggest that at the dose, periodicity and duration used in the study bacillus Calmette-Guerin is significantly superior to the chemotherapeutic agents doxorubicin and thiotepa for the prophylaxis of recurrence and retardation of progression in superficial transitional cell bladder tumors.

Administration, Intravesical↗
PubMed1989

Intravesical therapy comparing BCG, adriamycin, and thiotepa in 200 patients with superficial bladder cancer: a randomized prospective study.

This report presents the second interim analysis of data from a randomized prospective trial that compares the prophylactic effect of 15 intravesical instillations of 50 mg Doxorubicin (ADM), 50 mg of Thiotepa (TTPA), or 150 mg of Bacillus Calmette-Guérin (BCG) against recurrence and progression of superficial transitional cell bladder cancer. Of 202 enrolled patients, 176 patients are currently evaluable after a mean follow-up of 3 years (range, 3-97 months). The number of patients with recurrence was significantly lower in the BCG group (9/67) than in the ADM group (23/53, p = 0.002) or the TTPA group (20/56, p = 0.003). The overall recurrence index per 100 patient-months was also significantly lower for the BCG group (BCG vs. ADM, p = 0.07; BCG vs. TTPA, p = 0.001; TTPA vs. ADM, not significant). BCG was superior in preventing recurrence and progression of high risk tumors (T1, G2-3, multiple growth, and tumors associated with carcinoma in situ). The recurrence in this group of high risk tumors was for ADM treated patients 12/17, for TTPA treated patients 10/17 and for BCG treated patients 5/23 (BCG vs. ADM, p = 0.002; BCG vs. TTPA, p = 0.016; TTPA vs. ADM, not significant). Toxicity of intravesical BCG was higher than that of the other drugs, but not limiting the treatment. Bladder irritability occurred in 42% of the patients, granulomatous cystitis in 16.4%, and bladder contraction in 1.5% of the patients. Two patients of the ADM group (2/53 = 3.8%) underwent radical cystectomy for local urothelial progression. One patient (1.9%) in the same group died of distant metastases. The preliminary results suggest that BCG is significantly superior to the chemotherapeutic agents ADM and TTPA when used as an adjuvant intravesical therapy in superficial bladder cancer.

Administration, Intravesical↗
PubMedDate not supplied

[Management of injury of the solitary kidney].

Two cases of renal trauma are described herein. The diagnostic work up revealed the patients had solitary kidney. Trauma was classified as grade 1 and 2 and a conservative approach was adopted. The patient with grade 2 trauma was submitted to surgery one month following treatment. Preservation of the renal unit was achieved in both patients. Patient follow up at 16 years revealed no complications or sequelae from the injury. The diagnostic and therapeutic aspects of renal trauma in patients with solitary kidney are discussed.

Accidents↗
PubMedDate not supplied

[Evaluation of extravesical ureteroneocystostomy in kidney transplantation].

The present study evaluates extravesical ureteroneocystostomy, the technique used for reconstruction of the urinary tract in 120 kidney transplants. The urological complications ascribable to this technique were observed in 10% (12/120) and consisted of urinary extravasation (10), and ureteric obstruction (2). The treatment of the foregoing complications, which was successful in 8 cases, is described. The indications and advantages afforded by this technique in renal transplantation are discussed.

Evaluation Studies as Topic↗