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Biomedical subjects

S Fernandez

Publications and source records attributed to S Fernandez.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Prognostic markers for prostate cancer].

Careful consideration of therapy for prostate cancer needs an accurate analysis of prognostic markers to estimate success and benefit for the patient. Prognosis of prostate cancer is determined by the proportion of high grade cancer, many usually utilized prognostic characteristics were rejected by multivariate analysis as no independent prognostic information was delivered. For planning therapy it is crucial to estimate the proportion of high grade cancer as exact as possible. A standardized biopsy technique combined with a quantified analysis of the biopsy cores is most helpful to achieve this goal. The prognostic value of molecular biological and other factors is object of research, only a combination of some of these factors could be demonstrated so far to be superior to the estimation of the proportion of high grade cancer. However, at present their routine use in daily practise is precluded by a high technical and financial expense.

Biomarkers, Tumor↗
PubMed2000

[Mixed squamous epithelial and adenocarcinoma of the female urethra. A case report].

We report a case of mixed squamous-cell carcinoma with adenocarcinoma of the female urethra. A 37 year old women who presented with a 3-month' history of obstructive voiding symptoms. Clinical investigation showed a urethra tumor of 2.5 x 3.5 cm. Needle biopsy revealed a grade 3 carcinoma. Staging resulted in local cancer disease, a 2.5 x 3.5 cm tumor surrounding the whole urethra with protruding the trigonum. We performed urethrectomy with resection of the bladderneck and cystoneostomy. During bladderneck resection we performed regional staging lymphadenectomy of the obturator lymph nodes. Histological investigation revealed a mixed squamous-cell carcinoma with adenocarcinoma and undifferentiated carcinoma of the urethra. Periurethral tissue showed lymphangiosis carcinomatosa with negative lymph nodes. To exclude involvement of regional superficial lymph nodes we subsequently performed modified inguinal lymphadenectomy without evidence of advanced cancer disease.

Adult↗
PubMed2000

[Postoperative function and aspects of the quality of life after Schröder-Essed technique of penile straightening].

The Schröder-Essed technique is a standard technique for correction of penile curvature. Although it has been described as a simple and rapid technique offering low morbidity, no data are available on long-term follow-up and life quality of the operated patients. In a retrospective analysis we investigated functional results and life quality (LQ) using a detailed questionnaire. From January 1994 to January 1999, 40 patients (median age 26) underwent correction of penile curvature using a slightly modified Schröder-Essed technique. We used a self-established questionnaire investigating functional and cosmetic aspects and LQ. Complete follow-up data are available in 31/40 (77.5%) patients (congenital curvature, 19 patients; Peyronie's disease, 12 patients). Median follow-up is 22 months. Degree of angulation before surgery was estimated at < 45 degrees in 5 patients, 45-90 degrees in 22 patients, and > 90 degrees in 4 patients. In 21/31 patients (67.7%) cohabitation was not possible or discomfortable. Impaired LQ due to penile curvature was reported by 26/31 patients (83.8%). After surgery, the cosmetic result was considered as good or sufficient in 25 patients. Cohabitation was possible in 25/31 patients (80.6%). Penile shortening (> 2 cm) was reported by six patients. Significant improvement of life quality was reported by 15 patients. Among the 12 patients with Peyronie's disease, 6 mentioned postoperative impaired rigidity. In two patients with Peyronie's disease penile curvature recurred. This simple operation technique offers good functional and cosmetic results. Particularly patients with congenital curvature reported good or excellent results. Patients with Peyronie's disease have to be informed about the risk of disease recurrence. Other operation techniques should be considered for these patients.

Adolescent↗
PubMed2000

Dominant T cells in idiopathic nephrotic syndrome of childhood.

BACKGROUND: Because of several studies, idiopathic nephrotic syndrome (INS) of childhood is suspected to have an immunologic pathogenesis with T cells playing a major role. To investigate this hypothesis further, we studied the diversity of the CDR3 region of the T-cell receptor (TCR) beta-chain from peripheral T cells isolated from patients with INS. METHODS: The study was performed over a three-year period to obtain longitudinal data on the repertoire of peripheral T cells. mRNA from peripheral mononuclear cells (PBMCs) of seven INS patients and two healthy controls (NHD) was prepared and analyzed for CDR3 length polymorphism of TCR beta-chain by spectratyping. RESULTS: All INS patients presented individually skewed spectratype histograms in at least one Vbeta-family. Patients suffering from a frequent relapsing course of INS or a focal global sclerosis showed some alterations to persist in all samples isolated in the observation period (up to 3 years). In addition, sequence analyses of the beta-chain of the TCR CDR3 region confirmed clonal expansion of peripheral T cells in those patients who had displayed spectratype alterations. CONCLUSIONS: The data give strong evidence for an direct involvement of CD8+ T cells in the complicated course of INS.

Age of Onset↗
PubMed2000

Mediterranean diet and age with respect to overall survival in institutionalized, nonsmoking elderly people.

BACKGROUND: In studies from Italy and Greece, a Mediterranean dietary pattern was shown to favorably affect life expectancy in the elderly population. This pattern is thought to reduce the risk of cancer in addition to being cardioprotective. OBJECTIVE: The objective of this study was to evaluate the interactive effects of the Mediterranean diet and age with respect to survival after controlling for several other variables that could be considered as confounders: age, sex, body mass index, albumin concentration, physical activity, self-assessment of health, and dieting in response to chronic conditions. DESIGN: This was a cohort study involving 161 nonsmoking elderly subjects (74 subjects aged <80 y and 87 subjects aged > or =80 y) living in Spain. The subjects were followed up for > or =9 y. Diet was assessed with a semiquantitative food-frequency questionnaire. RESULTS: A diet score based on 8 characteristics of the traditional diet in the Mediterranean region was associated with a significant reduction in overall mortality in elderly subjects aged <80 y but not in subjects aged > or =80 y. A unit increase in the diet score predicted a 31% reduction in mortality in subjects aged <80 y (95% CI: 7%, 57%). CONCLUSION: Efforts to promote adherence to the Mediterranean dietary pattern appear to be worthwhile in persons aged <80 y, in whom the diet predicts survival, but we do not have any available evidence that such a diet benefits subjects aged > or =80 y.

Aged↗
PubMed1999

[Perioperative incidence of transfusions after allogenic kidney transplantation].

The requirement of blood transfusions was evaluated in a two compartment (retrospective/prospective) study in our renal transplantation program. Between July 1st, 1993 and December 31st, 1994 (observation period 1) we retrospectively investigated 110 patients with end stage renal disease and anemia undergoing kidney transplantation. Between January 1st, 1995 and December 31st, 1996 (observation period II) the requirement of blood transfusions was followed prospectively in 134 patients after allogenic renal transplantation. The amount of blood drawn for preoperative diagnostic investigations was in observation period 1 significantly higher (280 ml) than in observation period II (150 ml) (p = 0.02). For postoperative diagnostic tests in observation period II significantly less blood (240 ml) was needed than in observation period 1 (510 ml) (p = 0.01). The intraoperative blood loss was similar in both periods (170 ml vs. 190 ml; p = 0.6). The need for closer graft observation was the reason for significantly increased amount of blood transfusions in patients with delayed graft function. The number of blood transfusions was significant lower in patients with primary graft function (p = 0.0001). There was no correlation between blood transfusions and the use of ATG/OKT3, surgical complications and reoperations. With an improved management of blood drawing for diagnostic tests after allogenic kidney transplantation the number of perioperative blood transfusions can be reduced significantly.

Adolescent↗
PubMed1999

Early prostate-specific antigen relapse after radical retropubic prostatectomy: prediction on the basis of preoperative and postoperative tumor characteristics.

OBJECTIVES: This study was undertaken to distinguish between patients who will and will not benefit from a retropubic radical prostatectomy (RRP) for clinically localized prostatic carcinoma (PCa) on the basis of preoperative and postoperative tumor characteristics. METHODS: Data of 318 consecutive patients who underwent RRP for clinically localized PCa were reviewed. Preoperative characteristics used included clinical stage, findings on transrectal ultrasonography, prostate-specific antigen (PSA) values, Gleason grade, number of positive biopsies, number of biopsies containing any Gleason grade 4 and/or 5 cancer, and number of biopsies with predominant (>50% of cancerous tissue) Gleason grade 4 and/or 5 cancer. Postoperative characteristics included pathologic stage, Gleason grade, margin status, cancer volume, and volume of Gleason grade 4 and/or 5 cancer. The impact on biochemical relapse after RRP were calculated by Cox regression and CART (classification and regression tree) analysis to establish low, intermediate, and high risk of recurrence. RESULTS: Of patients who underwent RRP, 66% showed no evidence of relapse after a follow-up of 42 months. All preoperative and postoperative characteristics showed a significant association with biochemical relapse. Cox regression of preoperative characteristics showed the number of positive biopsies with predominant Gleason grade 4 and/or 5 cancer to be the most accurate predictor of failure (p < 0.0001), followed by the number of positive biopsies and PSA. CART analysis distinguished between four risk groups on the basis of the same characteristics as in the Cox regression. The low-risk group consisted of 232 patients (75.1%) and the high-risk group of 17 patients (5.5%); corresponding Kaplan-Meier curves showed a 2-year PSA-free survival rate of 97% for the low-risk group and 20% for the high-risk group. Cox regression of postoperative characteristics recognized the volume of Gleason grade 4 and/or 5 as the characteristic with the strongest association with biochemical failure. CART analysis distinguished between four risk groups, using the volume of high-grade cancer as the most influential characteristic. The corresponding Kaplan-Meier curves showed for the low-risk group (n = 79; 29.6%) a PSA-free survival rate of 96% after 42 months and for the high-risk group (n = 47; 17.6%) a 21% PSA-free survival rate after 42 months. CONCLUSION: For preoperative and postoperative estimation of biochemical recurrence after RRP, a quantitative analysis of high-grade cancer, expressed by the number of preoperative biopsy cores containing high-grade cancer and the volume of cancer, proved to be the best predictor of relapse. CART analysis might be useful in advising patients for their best therapy options. However, defined characteristics of risk groups should be evaluated with new prospective data before they are used routinely.

Adenocarcinoma↗
PubMed1999

Rectourinary fistula repair using the Latzko technique.

PURPOSE: We report our experience with the Latzko technique for rectourinary fistula repair after radical retropubic prostatectomy and cystoprostatectomy. MATERIALS AND METHODS: We performed 7 fistula repairs in 6 patients. The 1-stage procedure was based on a technique for vesicovaginal fistula closure with denudation of the rectal mucosa and multilayer closure of the fistulous tract. RESULTS: Closure was successful in all patients, although 1 had to undergo the procedure twice. There were no postoperative complications. CONCLUSIONS: The Latzko procedure is effective for rectourinary fistula repair and associated with minimal morbidity.

Humans↗
PubMed1998

Basic and acidic regions flanking the HMG domain of maize HMGa modulate the interactions with DNA and the self-association of the protein.

The maize HMGa protein is a typical member of the family of plant chromosomal HMG1-like proteins. The HMG domain of HMGa is flanked by a basic N-terminal domain characteristic for plant HMG1-like proteins, and is linked to the acidic C-terminal domain by a short basic region. Various derivatives of the HMGa protein were expressed in Escherichia coli and purified. The individual HMG domain can functionally complement the defect of the HU-like chromatin-associated Hbsu protein in Bacillus subtilis. The basic N-terminal domain which contacts DNA enhances the affinity of the protein for linear DNA, whereas it has little effect on the structure-specific binding to DNA minicircles. The acidic C-terminal domain reduces the affinity of HMGa for linear DNA, but does not affect to the same extent the recognition of DNA structure which is an intrinsic property of the HMG domain. The efficiency of the HMGa constructs to facilitate circularization of short DNA fragments in the presence of DNA ligase is like the binding to linear DNA altered by the basic and acidic domains flanking the HMG domain, while the supercoiling activity of HMGa is only slightly influenced by the same regions. Both the basic N-terminal and the acidic C-terminal domains contribute directly to the self-association of HMGa in the presence of DNA. Collectively, these findings suggest that the intrinsic properties of the HMG domain can be modulated within the HMGa protein by the basic and acidic domains.

Animals↗
PubMed1998

4-hydroxynonenal, a lipid peroxidation product, impairs glutamate transport in cortical astrocytes.

Astrocytes possess plasma membrane glutamate transporters that rapidly remove glutamate from the extracellular milieu and thereby prevent excitotoxic injury to neurons. Cellular oxidative stress is increased in neural tissues in a variety of acute and chronic neurodegenerative conditions. Recent findings suggest that oxidative stress increases neuronal vulnerability to excitotoxicity and that membrane lipid peroxidation plays a key role in this process. We now report that 4-hydroxynonenal (HNE), an aldehydic product of membrane lipid peroxidation, impairs glutamate transport in cultured cortical astrocytes. Impairment of glutamate transport occurred within 1-3 h of exposure to HNE; FeSO4, an inducer of membrane lipid peroxidation, also impaired glutamate transport. Vitamin E prevented impairment of glutamate transport induced by FeSO4, but not that induced by HNE, consistent with HNE acting as an effector of lipid peroxidation-induced impairment of glutamate transport. Glutathione, which binds and thereby detoxifies HNE, prevented HNE from impairing glutamate transport. Western blot, immunoprecipitation, and immunocytochemical analyses using an antibody against HNE-protein conjugates provided evidence that HNE covalently binds to many different astrocytic proteins including the glutamate transporter GLT-1. Data further suggest that HNE promotes intermolecular cross-linking of GLT-1 monomers to form dimers. HNE also induced mitochondrial dysfunction and accumulation of peroxides in astrocytes. Impairment of glutamate transport and mitochondrial function occurred with sublethal concentrations of HNE, concentrations known to be generated in cells exposed to various oxidative insults. Collectively, our data suggest that HNE may be an important mediator of oxidative stress-induced impairment of astrocytic glutamate transport and may thereby play a role in promoting neuronal excitotoxicity.

Aldehydes↗
PubMed1998

Improvement of ureteroileal anastomosis in continent urinary diversion with modified Le Duc procedure.

PURPOSE: Ureteroileal stricture after urinary diversion often has deleterious effects on the upper ureteral tract. A common ureteral implantation technique described by Le Duc et al has recently been criticized for a high rate of ureteral stricture. We assessed the rate of upper urinary tract dilatation and deterioration in 60 consecutive patients who underwent continent urinary diversion and ureteroileal anastomosis with a modified Le Duc procedure. MATERIALS AND METHODS: A total of 60 patients underwent continent urinary diversion with an ileal neobladder (Hautmann). Ureteroileal implantation was performed using a modified Le Duc technique. Followup was performed prospectively for a median of 32 months. The clinical end point was postoperative development of upper urinary tract dilatation, or an increase in preoperative dilatation confirmed by excretory urography or furosemide isotope nephrography. RESULTS: Nonneoplastic deterioration of the upper urinary tract was noted in 4 of 117 renoureteral units (3.4%). No permanent decrease in renal function or increase in pyelonephritic episodes was noted. CONCLUSIONS: The modified Le Duc technique is simple and safe for ureteroileal anastomosis and has a low complication rate.

Adult↗
PubMed1998

Initial disturbances of consciousness and resultant impaired awareness in Spanish patients with traumatic brain injury.

The purpose of this prospective, between-subjects study was to look at impaired awareness cross-culturally in patients with traumatic brain injury (TBI) and to relate impaired awareness after injury to the initial estimates of disturbed consciousness at time of injury. The study was conducted in community and inpatient and outpatient rehabilitation centers in Barcelona and Madrid. Participants were 30 persons with primarily moderate to severe TBI who could complete a written questionnaire concerning their functioning and 28 age- and gender-matched controls. A Spanish translation of the Patient Competency Rating Scale (PCRS) was administered to each participant. Relatives or significant others also completed this scale on each participant using the relative's version (PCRS-R). Difference scores, obtained by subtracting PCRS-R from PCRS-P (PCRS-P minus PCRS-R), were used as a marker of impaired awareness. Individuals with TBI were rated (by self and significant others) as being less competent than controls. Forty percent of Spanish patients with TBI who suffered severe injuries tended to overestimate their behavioral competencies. The PCRS-P minus the PCRS-R difference scores tended to correlate with admitting Glasgow Coma Scale (GCS) scores and retrospective estimates of posttraumatic amnesia (PTA). Initial disturbances of consciousness, one measure of severity of brain injury, appeared to relate to later measures of impaired self-awareness in Spanish patients with TBI. Non-brain-injured controls did not tend to report levels of competency that differed from their relatives' reports.

Adult↗
PubMed1997

[Femoral arteriovenous fistula and transplant malfunction after allogeneic kidney transplantation. A case report].

This case report deals with the clinical history of a 52-year-old woman who suffered from delayed graft function and ischaemic pain after a technically successful renal transplantation. The past history of the patient revealed that coronary catheters had repeatedly been used for investigation and treatment of myocardial infarctions. The clinical investigation reported here revealed a typical auscultatory result with an arteriovenous (AV) fistula in the right upper limb. After performing a digital arterial angiography, an AV fistula between the femoral artery and vein was demonstrated. Operative occlusion of the fistula increased the perfusion of the kidney graft and the right limb. The patient recovered without wound infection and could leave the hospital with the transplanted kidney functioning well. This case report demonstrates that persistence of AV fistulas after angiographic investigations is rare. Operative occlusion of these lesions should be performed before kidney transplantation to avoid steal phenomena and disturbed would healing.

Angiography, Digital Subtraction↗
PubMed1997

[Occurrence of lymphoceles after allogeneic kidney transplantation and their therapy].

We conducted a prospective evaluation of 301 consecutive renal transplants to define the prevalence and therapy of lymphoceles following renal transplantation. Using a management scheme, we identified in 52 patients (17.3%) perirenal fluid collections. Using this management scheme, we treated 47/52 patients conservatively. Only 5 (1.7%) patients required internal marsupialization. We conclude that groin lympho cysts after renal transplantation can be successfully treated with conservative methods.

Adolescent↗
PubMed1997

Oil enriched diets and behavioral parameters in rats' recovery from early undernutrition.

The effect of oil enriched diets on sexual and exploratory behavior has been studied in male rats undernourished in utero and during lactation. At 20 days of age, for a period of 4 months, these animals were fed with 3 different diets: standard diet, standard diet enriched with 7% soybean oil, and standard diet enriched with 7% olive oil. A control group eating standard diet was also studied. Sexual behavior, open-field and nocturnal spontaneous locomotor activity were studied at 16-20 weeks of age. Undernutrition produced decreased body weight, and the experimental diets were not effective in growth recovery. Undernourished animals eating oil-enriched diets displayed lower nocturnal spontaneous locomotor activity, less time spent in central squares, and a lower number of rearing episodes than undernourished animals eating the standard diet; the number of peripheral squares entered was, however, significantly increased. Experimental groups eating oil diets showed a statistically significant increase in the number of ejaculating males and in the total number of ejaculations compared with experimental rats eating standard diet. These findings suggest that early undernutrition produces permanent behavioral alterations in male rats, but that the sexual behavior deficit could be reversed by feeding our oil-enriched diets from weaning. The diet enriched with soybean oil seems more effective in the rehabilitation of sexual behavior.

Animals↗
PubMed1996

Total Laparoscopic Hysterectomy

We analyzed our experience with laparoscopic hysterectomy and determined the most important factors that made it safe and reproducible. From January 1, 1994, to March 30, 1996, 68 laparoscopic hysterectomies were performed. The most frequent indication was uterine myomas. Average operating time decreased over the years from 6 hours in 1994 to 1.5 hours in 1996. The most important reasons for the long surgery time were surgeons' skills, uterine size, posterior wall leiomyomata, presence of adhesions, history of cesarean section, presence of deep infiltrating endometriosis with obliteration of the cul-de-sac, and equipment failure. We had no major intraoperative complications, except for a bladder injury in a woman who had had two cesarean sections, which was diagnosed and immediately repaired laparoscopically. Continuous training in endoscopic surgery, especially learning how to dissect the pelvic organs, the development of a trained team, adequate equipment, and appropriate patient selection were among the most important factors that allowed us to reach a safe level in performing this procedure.

Journal Article↗
PubMed1996

EMLA cream for renal extracorporeal shock wave lithotripsy in ambulatory patients.

The effectiveness of a Eutectic Mixture of Local Anaesthetics (EMLA cream) for pain control during renal extracorporeal shock wave lithotripsy (ESWL) was evaluated in a group of 20 patients who had not been able to tolerate a previous session without intravenous (i.v.) analgesia. EMLA cream (10 g) was applied on the skin over the area (64-100 cm2) where the shock waves were to be focussed. A second generation lithotriptor Siemens Lithostar was used. The following measurements were made: the shock wave (kV) maximum voltage, the number of successful stone fragmentations (SSF), the visual analogue scale score (0-10) for pain (VAS), and the tolerance scale score (1-4) for the tolerance for the procedure. Significantly higher voltage (17.9 +/- 0.6 kV vs. 16.2 +/- 0.8 kV), lower VAS scores (5.9 +/- 1.1 vs. 8.7 +/- 1.3), lower TS score (2.3 +/- 0.6 vs. 3.6 +/- 0.6) and a higher number of SSF (18 vs. 5) were found in those patients for whom EMLA cream was used. Intravenous analgesia was not needed in nine patients. Nine patients received fentanyl 0.05 mg, one 0.10 mg and another 0.15 mg. These favourable results were attributed both to the sequence of gradual voltage increments used and to the cutaneous analgesia produced by EMLA cream.

Ambulatory Care↗