Search

The usefulness of Prostate Specific Antigen (PSA), tactile rectal examination (TRE) and transrectal ultrasound (TRU) for the diagnosis of prostate cancer (PCa) was studied in 114 patients who came in for an evaluation of their mictional symptoms. Patients underwent random ultrasound-guided transrectal biopsies following findings of abnormal TRE and/or serum PSA concentrations > 5 ng/ml. Of the total series, 71% presented TRE abnormalities and 52% presented hypoechoic areas in the TRU (only ones to be considered suspicious). Also, 26%, 23% and 51% of patients presented normal (0-5 ng/ml), intermediate (5-10 ng/ml), and high (> 10 ng/ml) concentrations of serum PSA. Incidence of PCa was 31%. Based on the individual tests, both positive and negative predictive values were higher for serum PSA concentrations > 10 ng/ml. By combining the tests results, the diagnosis percentage was also higher with PSA levels > 10 ng/ml. Positive predictive value was 81% in patients with all three tests positive, 73% with suspicious TRE and high PSA and 70% with suspicious TRU and high PSA. Our results corroborate the superiority and efficacy of random biopsies over selective biopsies of hyperechoic areas. Nevertheless, of 21 patients with negative prostate biopsies who underwent TUR or retropubical adenomectomy, 28% had PCa. These findings indicate that random biopsies are associated with a percentage of false negatives which varies depending on the features of the sample being studied. In conclusion, PSA is the ideal complement to TRE, and the association of these two tests constitutes the best indication for an ultrasound-guided random prostate biopsy, with independence of any TRU findings.

Presentation of our experience on the clinico-pathological staging of clinically localized prostate cancer (PCa) in 38 patients undergoing staging lymphadenectomy, 34 of which were treated with radical prostatectomy. From total number of patients, 37% were correctly staged, 60% were under-staged and only 3% were over-staged. A total of 11 patients (29%) presented nodular metastasis at the time of lymphadenectomy. Out of the 34 patients undergoing radical prostatectomy, 10 (29%) had microscopical invasion of prostatic capsule and seminal vesicles infiltration. The likelihood of nodes affectation in patients with prostatic capsule invasion and seminal vesicles infiltration was 60% and 70%, respectively. Mean PSA was significantly higher in patients with advanced disease as compared to those with disease localized in the prostatic gland. Also, mean PSA was significantly higher in patients with prostatic capsule invasion and seminal vesicles infiltration. The analysis by logistic regression identified pre-operative PSA as the only variable significantly correlated to the patient's final pathological stage.

Review of our experience in the diagnosis and treatment of 44 patients with inferior vena cava tumoral thrombosis (IVCTT), associated or not to other neoplastic processes: 34 hypernephroma, 2 cava leiomyosarcoma, 1 paratesticular rhabdomyosarcoma and 1 biphasic synovial sarcoma. Twenty-five patients with hypernephroma and tumor thrombi in the ipsilateral renal vein only were excluded from the analysis since this fact did not change the usual therapeutic approach. In the 19 remaining patients, concomitantly to the primary tumour exeresis a thrombectomy was performed, using cavotomy with proximal and distal clamping in 11 patients and cardiopulmonary by-pass, deep hypothermia and cardiocirculatory arrest in 8 patients. The paper analyzes the radiological investigations performed in order to reach a IVCTT diagnosis, and reviews the related literature.

A case of urothelial carcinoma in pelvic ectopic kidney is described. The low incidence of both pathologies and their rare association justifies the description.

Presentation of the results obtained from the study of 64 patients with T2-4 stage vesical carcinoma, treated with radical cystectomy, local lymphadenectomy, with and without complementary radiotherapy, with and without neoadjuvant chemotherapy. The univariate study of 19/64 patients with microscopic nodular disease revealed a significant relationship with the pathological stage but not with the clinical stage. The multivariate study demonstrated that the most relevant prognostic factors are a decrease in tumoral stage (P) and the presence of vascular and/or lymphatic involvement in the TUR-biopsy. The analysis of survival confirms the poor prognosis of patients with metastatic nodular involvement, in spite of the association of pelvic radiotherapy or neoadjuvant chemotherapy to the treatment.

One case of paratesticular embryonal rhabdomyosarcoma (RMS), affected during its evolution by a tumoral thrombus in the inferior vena cava. This unusual association forced the use of a cardiopulmonary by-pass, profound hypothermia and circulatory arrest, in order to carry out complete exeresis of the damage. Also, revision of the literature emphasizing that today's therapeutical approach for RMS should essentially be multidisciplinary.

We report a case of hyperammonemia and transient blindness following transurethral prostatic resectin. Glicine and ammonia metabolism are reviewed. Water intoxication may not account for these symptoms.

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.

We report a case of right common iliac artery fistula to the left ureter in a patient affected by an invasive bladder tumour treated with radical surgery, radiotherapy and neo-adjuvant chemotherapy. At the time of manifestation, our patient had indwelling catheters and presented an urinary tract infection. Diagnosis was established during autopsy. We feel that the cause of this complication is multifactorial.

Prognostic factors were studied in 91 patients with diagnosed renal adenocarcinoma in stages pT1-4/N0-3/V0-2/M0. All patients had been treated with radical surgery, extended nephrectomy with or without cardiopulmonary by-pass and extracorporeal circulation in those cases with suprahepatic tumoral thrombosis. The tumoral features which have a significant incidence on the patient's survival rate are the degree of cellular anaplasia, GI 72% vs GII 42% vs GIII 22% (p less than 0.0001); pathological stage, pT1-2 86% vs pT3 30% (p = 0.0000), perirenal fat invasion, pT1-2 86% vs pT3a 61% (p = 0.01); renal vein or cava vein invasion, V0 72% vs V1-2 30% (p less than 0.01) and gangliar affection. N0 69% vs N1-3 11% (p = 0.0000). Development of systemic disease is significantly high in pT3 stages (p = 0.0001), mainly in pT3a (p = 0.01), N1-3 (p less than 0.05) and/or V1-2 (p = 0.01). There is premature development of metastasis conditioning death before the second year o study in 90% of patients. In our opinion, patients with renal adenocarcinoma in stages pT3a/N0/M0, pT3b/N0/M0 and pT2-4/N1-3/M0 present a high potential risk of developing metastatic disease following radical surgery. These patients, as well as those with high degree tumours and presumably minimum residual disease, are candidates for supplementary therapy with lymphokine immunotherapy (rIL-2,FNT, alpha or gamma IF, etc) with or without adoptive cellular immunotherapy (LAK or TIL) following radical surgery, and extended nephrectomy plus tumoral thrombectomy, if required, with or without cardiopulmonary bypass.

A case is presented on the use of extracorporeal lithotrity by shock waves to treat vesical lithiasis, using the desk module of a Lithostar-PlusR (Siemens) lithotripter. This is an effective method without morbidity an adequate for ambulatory use, specially valuable in patients where the use of more invasive methods, or surgery can be contraindicated or when the patient refuses such methods.

The paper presents the results obtained from a study of 28 patients with high urothelial tumour, treated with radical surgery (total nephroureterectomy). Multivariable study of survival rates (Cox models) indicates that cellular differentiation is the most significant prognostic factor. Single variable study indicates that tumour stage has some significance mainly due to the large relationship to the degree of cellular anaplasty.

One hundred and twenty-three patients with a Ta/T2 stage vesical tumour were studied in order to identify the histological aspects associated to a tumoral behaviour particularly aggressive. The multivariate study demonstrates that those patients with a infiltrating tumour (T1-T2) or diffused urothelial dysplasia, have specially high possibilities to progress with regard to the degree of cell anaplasia (p less than 0.05); very close follow-up is needed in those patients. Likewise, patients presenting disseminated dysplastic lesions and with a history of previous urothelial tumours, progress to a new tumour stage with a significantly higher frequency (p less than 0.01); in those cases, radical surgery is the choice treatment.

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.

The by-pass technique with controlled cardiac arrest and hypothermia is probably the best method for an extirpation of intracava tumoral thrombi in renal tumours. The technique is easy to perform, represents a great help in the extirpation of thrombi regardless their size and location, and avoids massive bleeding.

We study retrospectively 123 cases of patients suffering from Ta/T1/T2 vesical tumour so as to evaluate the Disease Free Period as a predictive factor of relapse potential, capability of progression and survival. This parameter has no influence over the variables that define the progression of the tumour, but it has a close correlation with relapse potential; Annual Relapse Rate (p less than 0.001) and Mean Interval between Relapses (p less than 0.0001). We were not able to show any relationship between Disease-Free Period and Survival, however it defines those tumours which relapse due to tumoural persistence. These tumours progress in stage in 80% of cases and 75% of these do so with deep tumours.

We present a fresh case of Pelvic Lipomatosis in a non obese young male. We comment on the suggestive radiological findings as well as on the therapeutic options. Although considered traditionally as a benign entity, it may cause serious physiopathological alterations in neighbouring organs.

We present the results obtained from the study of 65 patients with vesical carcinoma stage T3 treated with radical surgery with or without supplementary radiotherapy, with or without supplementary chemotherapy. The multivaried study of survival (Cox's model) shows that it depends significantly on the surgical complications and on the pathological state at the time of the cystectomy. Univaried analysis indicates that patients with descent from post-radiotherapy stage and those subjected to IOR (intraoperative radiotherapy) have a significantly better survival than the rest and suggests that radiotherapy improves overall survival. Influence of supplementary treatment (radiotherapy, chemotherapy) in the survival of T3 bladder tumours subjected to radical surgery.