79 results on '"Sáenz Medina, J."'
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2. Editorial comment on the article entitled “How to measure intra-renal pressure during flexible URS: historical background, technological innovations and future perspectives”
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Sáenz Medina, J., primary
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- 2024
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3. Nox1-derived oxidative stress as a common pathogenic link between obesity and hyperoxaluria-related kidney injury
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Sáenz-Medina, J., Muñoz, M., Sanchez, A., Rodriguez, C., Jorge, E., Corbacho, C., Izquierdo, D., Santos, M., Donoso, E., Virumbrales, E., Sanchez, A., Ramil, E., Coronado, M. J., Prieto, D., and Carballido, J.
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- 2020
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4. A review of the pathophysiological factors involved in urological disease associated with metabolic syndrome
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Sáenz Medina, J. and Carballido Rodríguez, J.
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- 2016
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5. Prognostic factors of spontaneous expulsion in ureteral lithiasis
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Sáenz Medina, J., Alarcón Parra, R.O., Redondo González, E., Llanes González, L., Crespo Martínez, L., Fernández Montarroso, L., Durán Poveda, M., and Páez Borda, A.
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- 2010
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6. Relational database for urinary stone ambulatory consultation. Assessment of initial outcomes
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Sáenz Medina, J., Páez Borda, A., Crespo Martinez, L., Gómez Dos Santos, V., Barrado, C., and Durán Poveda, M.
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- 2010
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7. Nox1-derived oxidative stress as a common pathogenic link between obesity and hyperoxaluria-related kidney injury
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Sáenz-Medina, J., primary, Muñoz, M., additional, Sanchez, A., additional, Rodriguez, C., additional, Jorge, E., additional, Corbacho, C., additional, Izquierdo, D., additional, Santos, M., additional, Donoso, E., additional, Virumbrales, E., additional, Ramil, E., additional, Coronado, M. J., additional, Prieto, D., additional, and Carballido, J., additional
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- 2019
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8. Aspectos fisiopatológicos implicados en la patología urologica asociada al síndrome metabólico. Revisión bibliográfica
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Sáenz Medina, J., primary and Carballido Rodríguez, J., additional
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- 2016
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9. Respuesta inmunohumoral durante la nefrectomía abierta y laparoscópica de donante vivo: Modelo porcino experimental
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Sáenz Medina, J., Asuero de Lis, M.S., Villafruela Sanz, J., Correa Gorospe, C., Cuevas, B., Galindo Álvarez, J., Páez Borda, A., Linares Quevedo, A.I., Marcén Letosa, R., Pascual Santos, J., and Burgos Revilla, F.J.
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Laparoscopia ,Respuesta inmunohumoral ,Nefrectomía ,Laparoscopy ,Immune response ,Nephrectomy - Abstract
Introducción: Se ha demostrado la menor agresividad quirúrgica provocada por el abordaje laparoscópico, en base a la medición de diversos marcadores de estrés postquirúrgico, entre los que se encuentran distintas interleuquinas (IL) y la proteína C reactiva (PCR). La endotelina 1 (ET-1) es un vasoconstrictor potente producido en el endotelio renal escasamente analizado en el curso de la cirugía laparoscópica. El objetivo del trabajo es analizar comparativamente la respuesta inmunohumoral inducida por las nefrectomías laparoscópica y abierta en un modelo experimental porcino, en base a la cuantificación de la PCR, las IL-2, 10, el factor de necrosis tumoral alfa (TNF alfa), y la ET-1. Material y métodos: Se analizan comparativamente dos grupos de cerdos de 25-40 Kg, un grupo CONTROL (N=10) y grupo LAPAROSCÓPICO (N=10), a los que se les realiza una nefrectomía abierta o laparoscópica respectivamente. Se determinó en sangre venosa periférica los niveles de PCR, IL-2, IL-10, TNF α y ET-1. Las determinaciones analνticas se realizaron en los momentos: basal, postcirugνa, 1, 3, 5, y 7 días postquirúrgico. Resultados: El análisis comparativo de ambos grupos demuestra un aumento estadísticamente significativo de la PCR (1,44±0,88 vs 1,32 ± 0,14 mg/dl, p=0,046), TNF α (131,14± 41,37 vs 57,19± 23,71 pg/ml, p>0,001) y ET-1 (0,91± 0,49 vs 0,56 ± 0,5 fmol/ml, p=0,001) del grupo abierto en comparaciσn con el grupo control, asν como una elevación de la IL-2 en el grupo laparoscópico. Conclusiones: La respuesta inmunohumoral inducida por la nefrectomía abierta es superior a la de la nefrectomía laparoscópica en el curso de la donación. La importancia de este hecho en el síndrome isquemia reperfusión o la función inmediata del injerto no está claramente establecida. Introduction: It’s been demonstrated laparoscopic access determines a lower surgical stress, by measurement of several markers as different interleuquines (IL) or C- reactive protein (CRP). Endothelin 1 (ET-1) is a powerful vasoconstrictor produced in renal endothelium scarcely studied in laparoscopy. The objective of this study is to analyze immune response during laparoscopic and open donor nephrectomy, in a porcine experimental model by means of measuring IL-2, 10, tumoral necrosis factor α (TNFα), CRP and ET-1. Methods: Twenty pigs underwent left nephrectomy, 10 by laparoscopy and 10 by open approach in an experimental model. Both groups were monitorized IL-2, 10, TNF α ET-1 at basal, immediately post surgery, first, third, fifth and seventh days after procedure. Results: The comparative analysis between groups demonstrated a significant increase in levels of CRP (1,44 ± 0,88 vs 1,32 ± 0,14 mg/dl, p=0,046), TNF α (131,14 ± 41,37 vs 57,19 ± 23,71 pg/ml, p>0,001) and ET-1 (0,91 ± 0,49 vs 0,56 ± 0,5 fmol/ml, p=0,001) of open nephrectomy group, as a higher levels of IL-2 in laparoscopic group. Conclusions: Open donor nephrectomy determines a higher immune response than laparoscopic approach. The importance of this fact over the ischemia-reperfusion syndrome or the immediate function of graft is not clearly established.
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- 2008
10. Modelos experimentales para la investigación y el entrenamiento en trasplante renal
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Sáenz Medina, J., Asuero de Lis, M.S., Correa Gorospe, C., Cuevas, B., Gómez Dos Santos, V., Linares Quevedo, A.I., Páez Borda, A., Castillón Vela, I., Marcén Letosa, R., Pascual Santos, J., and Burgos Revilla, F.J.
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Trasplante renal ,Modelos experimentales ,Renal transplantation ,Experimental models - Abstract
Introducción y objetivos: Se presenta una revisión sobre las diferentes características y el uso de los distintos modelos experimentales utilizados para el trasplante renal (TR). Esta revisión incluye las cualidades, así como sus semejanzas a los humanos, de las especies más frecuentemente utilizadas. Se revisan las aportaciones de los diferentes modelos al entrenamiento de las diferentes técnicas quirúrgicas como la laparoscopia o la microcirugía. Se repasan sus contribuciones al estudio y la investigación en campos como los efectos hemodinámicos o inmunológicos del neumoperitoneo, las técnicas de donante a corazón parado o las diferentes formas de preservación de los injertos. Por último, se realiza una revisión de los diferentes modelos utilizados para la investigación de los distintos protocolos de inmunosupresión así como el xenotrasplante. Introduction and objetives: An update on aspects and use of different experimental models applied in kidney transplant research is presented . This paper includes qualities, as long as similarities between most frequently used animal models and human clinical standards. Contributions of those models based on microsurgical or laparoscopic techniques are revised. The physiological consequences (hemodynamic, immunologic) of surgical technique (laparoscopy), applied in experimental models as long as non-heart beating organ donor models and organ preservation methods are also reviewed. Finally, an update of those models applied in research in prothocols of either immunosupression or xenotransplant is done.
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- 2008
11. Adecuación de las derivaciones desde Atención Primaria a un Servicio de Urología
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Páez Borda, A., Redondo González, E., Ríos González, E., Linares Quevedo, A., Sáenz Medina, J., and Castillón Vela, I.
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Eficiencia Clínica ,Gestión clínica ,Diagnóstico ,Clinical efficiency ,Diagnostics ,Management - Abstract
Objetivo: Valorar indirectamente el grado de adhesión de los médicos de Atención Primaria (AP) a un protocolo de derivación consensuado con Atención Especializada (AE) sobre diez motivos de consulta urológica. Material y métodos: Se analizaron todas las derivaciones al servicio de urología llevadas a cabo durante un período de 19 meses por 135 médicos adscritos a 10 centros de AP (CAP). El urólogo juzgó como "confome" o "no conforme al protocolo" la derivación. Se compararon los porcentajes de adecuación de las derivaciones desde cada CAP. Se exploraron las diferencias en la adecuación de las derivaciones procedentes de cada CAP en función del problema de salud. La relación entre el número de derivaciones y el número de canalizaciones adecuadas se exploró mediante un modelo de regresión lineal. Resultados: El análisis tuvo lugar sobre 2841 derivaciones. El 57,2% de esas derivaciones se ajustó al protocolo. No se detectaron diferencias significativas en los porcentajes de derivaciones ‘conforme al protocolo’ en relación a los CAP. Se detectaron diferencias significativas entre CAP en las derivaciones por cólico nefrítico e incontinencia urinaria. Se detectó una relación entre el número de pacientes remitidos y el número de remisiones "no conforme al protocolo" (r²=0,86). Conclusiones: La adecuación al protocolo fue escasa. Algunos problemas de salud deberían de ser revisados a nivel local; la mayoría de los motivos de derivación (de modo particular la microhematuria) deberían de revisarse en todos los CAP. Objetive: To indirectly address the adequacy of referrals from general practitioners (GP) to specialized care taking into account a previously agreed protocol on ten urological topics. Materials & methods: The study analyzed all referrals to the Urology department originated in 10 primary care centres (135 GPs involved) throughout a 19-month period. Adequacy of 2841 referrals was checked. The urologist judged the referral as compliant (adequate) or not compliant (inadequate) with the terms of the protocol. Compliance per primary care centres was compared. Also referral adequacy corrected per centre and clinical topic was compared. The relationship between "absolute number of referrals" and "adequate referrals" was tested using a linear regression model. Results: 57.2% of the referrals were inadequate. Overall, no significant differences were detected between primary care centres. Nevertheless significant differences between centres were evident in terms of referrals due to renal colic and female urinary incontinence. 70% (94/135) of the GPs complied with the protocol in, at least, 50% of the cases. A strong association between "absolute number of referrals" and "adequate referrals" was evident (r²=0.86). Conclusions: Overall compliance with the protocol was modest. While no significant differences between centres were detected in terms of adequacy of referrals certain conditions have to be locally revisited; most of the topics (particularly microhematuria) have to be revisited in every center.
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- 2007
12. Modificaciones de los parámetros hemodinámicos y de los distintos flujos vasculares periféricos en modelo experimental porcino de nefrectomía laparoscópica
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Sáenz Medina, J., Asuero de Lis, M. S., Galindo Alvarez, J., Villafruela Sanz, J., Correa Gorospe, C., Cuevas Sánchez, B., Linares Quevedo, A. I., Páez Borda, A., Pascual Santos, J., Marcén Letosa, R., and Burgos Revilla, J.
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Laparoscopia ,Modelo porcino ,Nefrectomía ,Laparoscopy ,Nefrectomy ,Pig model - Abstract
Objetivo: Se ha demostrado que la hiperpresión abdominal y la utilización del neumoperitoneo con CO2, provocan cambios en los aparatos cardiovascular y respiratorio, atribuibles a dos factores: alteraciones en el gasto cardiaco (GC) e hipercarbia. Otras alteraciones derivadas de estos hechos son los cambios en las resistencias vasculares sistémicas (RVS), la tensión arterial (TA), la presión venosa central (PVC), cambios vasculares como las alteraciones en el flujo sanguíneo renal (FSR), flujo carotídeo (FAC), flujo portal (FP) y flujo de la arteria hepática (FAH). Nuestro objetivo es analizar las modificaciones hemodinámicas producidas por el neumoperitoneo sobre los FSR, FC, FP y FAH en modelo experimental porcino. Métodos: Se analizan comparativamente dos grupos de cerdos, un grupo CONTROL (N=10) y grupo LAPAROSCÓPICO (N=10), a los que se les realiza una nefrectomía abierta o laparoscópica respectivamente. En ambos grupos se canaliza la vena yugular externa derecha y la arteria femoral y se monitoriza el GC, la PVC, la TA, las RVS (calculada mediante la fórmula RVS=(TA-PVC)*80/GC); estas determinaciones se realizan en los momentos: basal, 5, 30, 60 minutos y postcirugía. Mediante sonda electromagnética alrededor del vaso, se registran los FSR, FC, FP y FAH a los 30 minutos de iniciada la intervención quirúrgica. Resultados: El análisis comparativo de ambos grupos demuestra un aumento del GC en el grupo laparoscópico, cuya diferencia fue máxima a los 30 minutos (4,33 + 0,73 vs 8,54 + 1,26 l/min, p< 0,001); un descenso de las RVS (1118,81 + 302,52 vs 663,37 + 81,45 dinas x s x cm-5 p
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- 2007
13. Pseudoquiste adrenal: Aportación de un nuevo caso y revisión de la literatura
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Sáenz Medina, J., Esteban Peris, A., Linares Quevedo, A.I., Vallejo Herrador, J., Castillón Vela, I., and Páez Borda, A.
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Adrenal tumor ,Quiste suprarrenal ,Adrenal Pseudocyst ,Pseudoquiste suprarrenal ,Tumor suprarrenal ,Adrenal cyst - Abstract
Los pseudoquistes adrenales son las lesiones quísticas mas frecuentes de la glándula suprarrenal, si bien constituyen una rara entidad. Se detectan cada vez con mas frecuencia en estudios radiológicos como incidentalomas. Se presenta el caso de una paciente con pseudoquiste adrenal izquierdo no funcionante y asintomático. Se realiza revisión de la literatura y se estudian las diferentes actitudes diagnósticas y terapéuticas. Adrenal pseudocyst is the commonest type of benign lesions of adrenal gland althought is a very rare entity. Most of them are found as "incidentalomas" during imaging studies. A case of a patient with a left non-functioning and asymptomatic adrenal pseudocyst is reported. The diagnostic and therapeutic options are discussed and the literature is reviewed.
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- 2006
14. Renal metastasis of hepatocellular carcinoma
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Sanz Mayayo, E., Mayayo Dehesa, T., Gómez García, I., Sáenz Medina, J., Rodríguez-Patrón Rodríguez, R., and Escudero Barrilero, A.
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Hepatocarcinoma ,Hepatocellular carcinoma ,Renal metastasis ,Metástasis renal ,urologic and male genital diseases - Abstract
OBJETIVO: Presentar el caso de una metástasis renal solitaria secundaria a hepatocarcinoma. MÉTODO: Describimos el caso de un paciente de 51 años que en ecografía abdominal se descubre incidentalmente una masa renal izquierda y una masa hepática. En el TAC se objetivó la masa renal izquierda de 17 cm de diámetro con posible afectación de vena renal izquierda y una masa hepática en lóbulo derecho. La PAAF guiada por TAC de ambas masas demostró en hígado celularidad maligna compatible con hepatocarcinoma, y en riñón celularidad maligna compatible con carcinoma renal o suprarrenal. Se indicó tratamiento quirúrgico con nefrectomía radical izquierda más hepatectomía derecha. RESULTADO: El análisis histopatológico de la pieza mostró hepatocarcinoma trabecular moderadamente diferenciado con metástasis ganglionar y renal izquierda. OBJECTIVE: To report the case of a solitary renal metastasis secondary to hepatocellular carcinoma. METHODS: We report the case of a 51 year old patient who on abdominal ultrasonography was revealed a left renal tumour and a hepatic mass incidentally. A TAC showed the left renal tumor measuring 17 cm in size, possible involvement of left renal vein and a tumour mass in the right lobe of the liver. A TAC guided fine needle punction aspiration biopsy demonstrated a malignant hepatic lesion compatible with hepatocarcinoma, and malignant renal cells compatible with renal or adrenal carcinoma. Left radical nephrectomy and right hepatectomy was performed. RESULTS: Histopathologic study confirmed the diagnosis of moderately differentiated trabecular hepatocarcinoma with lymph node and left renal metastasis.
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- 2003
15. Factores predictivos para la expulsión de la litiasis ureteral
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Sáenz Medina, J., primary, Alarcón Parra, R.O., additional, Redondo González, E., additional, Llanes González, L., additional, Crespo Martínez, L., additional, Fernández Montarroso, L., additional, Durán Poveda, M., additional, and Páez Borda, A., additional
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- 2010
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16. Una base de datos relacional para consulta de litiasis urinaria. Evaluación inicial de resultados
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Sáenz Medina, J., primary, Páez Borda, A., additional, Crespo Martinez, L., additional, Gómez Dos Santos, V., additional, Barrado, C., additional, and Durán Poveda, M., additional
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- 2010
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17. Respuesta inmunohumoral durante la nefrectomía abierta y laparoscópica de donante vivo: Modelo porcino experimental
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Sáenz Medina, J., primary, Asuero de Lis, M.S., additional, Villafruela Sanz, J., additional, Correa Gorospe, C., additional, Cuevas, B., additional, Galindo Álvarez, J., additional, Páez Borda, A., additional, Linares Quevedo, A.I., additional, Marcén Letosa, R., additional, Pascual Santos, J., additional, and Burgos Revilla, F.J., additional
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- 2008
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18. Modelos experimentales para la investigación y el entrenamiento en trasplante renal
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Sáenz Medina, J., primary, Gómez Dos Santos, V., additional, Linares Quevedo, A.I., additional, Páez Borda, A., additional, Castillón Vela, I., additional, Asuero de Lis, M.S., additional, Correa Gorospe, C., additional, Cuevas, B., additional, Marcén Letosa, R., additional, Pascual Santos, J., additional, and Burgos Revilla, F.J., additional
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- 2008
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19. Adecuación de las derivaciones desde Atención Primaria a un Servicio de Urología
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Páez Borda, A., primary, Redondo González, E., additional, Ríos González, E., additional, Linares Quevedo, A., additional, Sáenz Medina, J., additional, and Castillón Vela, I., additional
- Published
- 2007
- Full Text
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20. Modificaciones de los parámetros hemodinámicos y de los distintos flujos vasculares periféricos en modelo experimental porcino de nefrectomía laparoscópica
- Author
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Sáenz Medina, J., primary, Asuero de Lis, M. S., additional, Galindo Alvarez, J., additional, Villafruela Sanz, J., additional, Correa Gorospe, C., additional, Cuevas Sánchez, B., additional, Linares Quevedo, A. I., additional, Páez Borda, A., additional, Pascual Santos, J., additional, Marcén Letosa, R., additional, and Burgos Revilla, J., additional
- Published
- 2007
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21. Adecuación de las derivaciones desde Atención Primaria a un Servicio de Urología
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Páe Borda, A., primary, Redondo González, E., additional, Río González, E., additional, Linares Quevedo, A., additional, Sáenz Medina, J., additional, and Castillón Vela, I., additional
- Published
- 2007
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22. Pseudoquiste adrenal: Aportación de un nuevo caso y revisión de la literatura
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Sáenz Medina, J., primary, Esteban Peris, A., additional, Linares Quevedo, A.I., additional, Vallejo Herrador, J., additional, Castillón Vela, I., additional, and Páez Borda, A., additional
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- 2006
- Full Text
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23. Metástasis renal de hepatocarcinoma
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Sanz Mayayo, E., primary, Mayayo Dehesa, T., additional, Gómez García, I., additional, Sáenz Medina, J., additional, Rodríguez-Patrón Rodríguez, R., additional, and Escudero Barrilero, A., additional
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- 2003
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24. Neuromodulación de raíces sacras posteriores en el tratamiento de la disfunción miccional crónica
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Linares Quevedo, A.I., primary, Jiménez Cidre, M.A., additional, Fernández Fernández, E., additional, Perales Cabanas, L., additional, Briones Mardones, G., additional, Pozo Mengual, B., additional, Sáenz Medina, J., additional, and Escudero Barrilero, A., additional
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- 2002
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25. Cuerpos extraños uretro-vesicales
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Briones Mardones, G., primary, Jiménez Cidre, M., additional, Sáenz Medina, J., additional, Pozo Mengual, B., additional, Sanz Miguelañez, J.L., additional, and Cruz Guerra, N., additional
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- 2001
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26. Laparoscopic Boari Flap ureteral reimplantation,Reimplante ureteral laparoscópico con flap de boari
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Castillón-Vela, I., Del Pozo Jiménez, G., Turo Antona, J., Vázquez Alba, D., Sáenz Medina, J., and Joaquin Carballido Rodriguez
27. Priapism secondary to chronic myeloid leukemia: Utility of initial treatment with cavernous lavage plus adjuvant methoxamine,Priapismo secundario a leucemia mieloide crónica: Valor del tratamiento inicial con lavado cavernoso más metoxamina adyuvante
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Cruz Guerra, N. A., Ramos, L. C., ANA ISABEL LINARES QUEVEDO, Sáenz Medina, J., Pozo Mengual, B., and Allona Almagro, A.
28. Cardiovascular and Cerebrovascular Morbidity in Patients with Urolithiasis: An Epidemiological Approach Based on Hospitalization Burden Data from 1997 to 2021.
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Sáenz-Medina J, Gómez Dos Santos V, Rodríguez-Monsalve M, Muriel-García A, Durán-Poveda M, Gómez Del Val A, Burgos Revilla J, and Prieto D
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Background: Patients with kidney stones (KSFs) are known to have a heightened risk of coronary heart disease (CHD) or stroke. The objective of the present study was to describe the natural history of these complications through the longitudinal analysis of the hospitalizations due to kidney stones in Spain from 1997 to 2021. Methods : A retrospective longitudinal observational study was developed based on nationwide hospitalization data (minimum basic data base). Three different analyses were carried out. In the first step, the prevalence of coronary or cerebrovascular events in kidney stone hospitalizations was compared with the hospitalization burden of CHD or strokes related to the general population. In the second step, a survival analysis of the kidney stones-hospitalized patients using the Kaplan-Meier method was conducted. In the third step, a Cox regression was used to assess the influence of the classical comorbidities in the development of the lithiasic patients-cardiovascular disease. Results : Kidney stone-hospitalized patients exhibit a significantly higher risk of CHD (OR = 14.8 CI95%: 14.7-14.9) and stroke (OR = 6.7 CI95%: 6.6-6.8) compared to the general population across in all age groups, although they had less cardiovascular risk factors. A total of 9352 KSFs (1.5%) developed a coronary event within an average time of 78.8 months. A total of 2120 KSFs (0.33%) suffered a stroke in an average time of 71.1 months. Diabetes, hypertension, hyperlipidemia, and being overweight were identified as risk factors for developing CHD and stroke using a univariate and multivariate analysis. Conclusions : Our study confirms previous studies in which kidney stones must be considered as a risk factor for developing CHD or cerebrovascular disease. Preventive strategies should target patients with kidney stones and classical risk cardiovascular factors to mitigate modifiable conditions associated with cardiovascular diseases.
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- 2024
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29. Activation of mitoK ATP channels induces penile vasodilation and inhibits mitochondrial respiration and ROS production: Role of NO.
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Gómez Del Val A, Contreras C, Muñoz M, Sáenz-Medina J, Mohamed M, Rivera L, Sánchez A, and Prieto D
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- Male, Rats, Animals, Reactive Oxygen Species metabolism, Adenosine Triphosphate, Respiration, Vasodilation, Nitric Oxide metabolism, Potassium Channels
- Abstract
Objective: Mitochondrial ATP-sensitive K
+ (mitoKATP ) channels are involved in neuronal and cardiac protection from ischemia and oxidative stress. Penile erection is a neurovascular event mediated by relaxation of the erectile tissue via nitric oxide (NO) released from nerves and endothelium. In the present study, we investigated whether mitoKATP channels play a role in the control of penile vascular tone and mitochondrial dynamics, and the involvement of NO., Methods: The effect of the selective mitoKATP activator BMS191095 was examined on vascular tone, on mitochondrial bioenergetics by real-time measurements with Agilent Seahorse and on ROS production by MitoSOX fluorescence in freshly isolated microarteries., Results: BMS191095 and diazoxide relaxed penile arteries, BMS191095 being one order of magnitude more potent. BMS191095-induced relaxations were reduced by mechanical endothelium removal and by inhibitors of the nitric oxide synthase (NOS) and PI3K enzymes. The NO-dependent component of the relaxation to BMS191095 was impaired in penile arteries from insulin resistant obese rats. The blockers of mitoKATP channel 5-HD, sarcolemma KATP (sarcKATP ) channel glibenclamide, and large conductance Ca2+ -activated K+ (BKCa ) channel iberiotoxin, inhibited relaxations to BMS191095 and to the NO donor SNAP. BMS191095 reduced the mitochondrial bioenergetic profile of penile arteries and attenuated mitochondrial ROS production. Blockade of endogenous NO impaired and exogenous NO mimicked, respectively, the inhibitory effects of BMS191095 on basal respiration and oxygen consumed for ATP synthesis. Exogenous NO exhibited dual inhibitory/stimulatory effects on mitochondrial respiration., Conclusions: These results demonstrate that selective activation of mitoKATP channels causes penile vasodilation, attenuates ROS production and inhibits mitochondrial respiration in part by releasing endothelial NO. These mechanisms couple blood flow and metabolism in penile arterial wall and suggest that activation of vascular mitoKATP channels may protect erectile tissue against ischemic injury., Competing Interests: Declaration of competing interest The authors declare no conflict of interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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30. Hospitalization Burden of Patients with Kidney Stones and Metabolic Comorbidities in Spain during the Period 2017-2020.
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Sáenz-Medina J, San Román J, Rodríguez-Monsalve M, Durán M, Carballido J, Prieto D, and Gil Miguel Á
- Abstract
Nephrolithiasis has become an increasing worldwide problem during the last decades. Metabolic syndrome, its components, and related dietary factors have been pointed out as responsible for the increasing incidence. The objective of this study was to evaluate the trends in the hospitalization rates of patients with nephrolithiasis, hospitalization features, costs, and how metabolic syndrome traits influence both the prevalence and complications of lithiasic patients. An observational retrospective study was conducted by analyzing hospitalization records from the minimum basic data set, including all patient hospitalizations in Spain in which nephrolithiasis has been coded as a main diagnosis or as a comorbidity during the period 2017-2020. A total of 106,407 patients were hospitalized and coded for kidney or ureteral lithiasis in this period. The mean age of the patients was 58.28 years (CI95%: 58.18-58.38); 56.8% were male, and the median length of stay was 5.23 days (CI95%: 5.06-5.39). In 56,884 (53.5%) patients, kidney or ureteral lithiasis were coded as the main diagnosis; the rest of the patients were coded mostly as direct complications of kidney or ureteral stones, such as "non-pecified renal colic", "acute pyelonephritis", or "tract urinary infection". The hospitalization rate was 56.7 (CI95%: 56.3-57.01) patients per 100,000 inhabitants, showing neither a significant increasing nor decreasing trend, although it was influenced by the COVID-19 pandemic. The mortality rate was 1.6% (CI95%: 1.5-1.7), which was higher, if lithiasis was coded as a comorbidity (3.4% CI95%: 3.2-3.6). Metabolic syndrome diagnosis component codes increased the association with kidney lithiasis when age was higher, reaching the highest in the eighth decade of life. Age, diabetes, and hypertension or lithiasis coded as a comorbidity were the most common causes associated with the mortality of lithiasic patients. In Spain, the hospitalization rate of kidney lithiasis has remained stable during the period of study. The mortality rate in lithiasic patients is higher in elderly patients, being associated with urinary tract infections. Comorbidity conditions such as diabetes mellitus and hypertension are mortality predictors.
- Published
- 2023
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31. Differential contribution of renal cytochrome P450 enzymes to kidney endothelial dysfunction and vascular oxidative stress in obesity.
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Muñoz M, López-Oliva E, Pinilla E, Rodríguez C, Martínez MP, Contreras C, Gómez A, Benedito S, Sáenz-Medina J, Rivera L, and Prieto D
- Subjects
- Amidines pharmacology, Animals, Aryl Hydrocarbon Hydroxylases metabolism, Cytochrome P-450 CYP2J2 metabolism, Cytochrome P-450 CYP4A metabolism, Cytochrome P450 Family 2 metabolism, Hydrogen Peroxide metabolism, Hydroxyeicosatetraenoic Acids antagonists & inhibitors, Hydroxyeicosatetraenoic Acids metabolism, Kidney blood supply, Male, Obesity physiopathology, Rats, Zucker, Reactive Oxygen Species metabolism, Renal Artery drug effects, Renal Artery physiopathology, Steroid 16-alpha-Hydroxylase metabolism, Sulfaphenazole pharmacology, Vasodilation drug effects, Rats, Cytochrome P-450 Enzyme System metabolism, Endothelium, Vascular metabolism, Kidney metabolism, Obesity metabolism, Oxidative Stress, Renal Artery metabolism
- Abstract
Arachidonic acid (AA)-derived cytochrome P450 (CYP) derivatives, epoxyeicosatrienoic acids (EETs) and 20-hidroxyeicosatetranoic acid (20-HETE), play a key role in kidney tubular and vascular functions and blood pressure. Altered metabolism of CYP epoxygenases and CYP hydroxylases has differentially been involved in the pathogenesis of metabolic disease-associated vascular complications, although the mechanisms responsible for the vascular injury are unclear. The present study aimed to assess whether obesity-induced changes in CYP enzymes may contribute to oxidative stress and endothelial dysfunction in kidney preglomerular arteries. Endothelial function and reactive oxygen species (ROS) production were assessed in interlobar arteries of obese Zucker rats (OZR) and their lean counterparts lean Zucker rats (LZR) and the effects of CYP2C and CYP4A inhibitors sulfaphenazole and HET0016, respectively, were examined on the endothelium-dependent relaxations and O
2 - and H2 O2 levels of preglomerular arteries. Non-nitric oxide (NO) non-prostanoid endothelium-derived hyperpolarization (EDH)-type responses were preserved but resistant to the CYP epoxygenase blocker sulfaphenazole in OZR in contrast to those in LZR. Sulfaphenazole did not further inhibit reduced arterial H2 O2 levels, and CYP2C11/CYP2C23 enzymes were downregulated in intrarenal arteries from OZR. Renal EDH-mediated relaxations were preserved in obese rats by the enhanced activity and expression of endothelial calcium-activated potassium channels (KCa ). CYP4A blockade restored impaired NO-mediated dilatation and inhibited augmented O2 - production in kidney arteries from OZR. The current data demonstrate that both decreased endothelial CYP2C11/ CYP2C23-derived vasodilator H2 O2 and augmented CYP4A-derived 20-HETE contribute to endothelial dysfunction and vascular oxidative stress in obesity. CYP4A inhibitors ameliorate arterial oxidative stress and restore endothelial function which suggests its therapeutic potential for the vascular complications of obesity-associated kidney injury., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2022
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32. Activation of AMP kinase ameliorates kidney vascular dysfunction, oxidative stress and inflammation in rodent models of obesity.
- Author
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Rodríguez C, Sánchez A, Sáenz-Medina J, Muñoz M, Hernández M, López M, Rivera L, Contreras C, and Prieto D
- Subjects
- AMP-Activated Protein Kinases metabolism, Animals, Inflammation metabolism, Kidney metabolism, Mice, Obesity metabolism, Oxidative Stress, Phosphatidylinositol 3-Kinases metabolism, Rats, Rats, Zucker, Renal Artery, Rodentia metabolism, Vasodilation, Adenylate Kinase metabolism, Endothelium, Vascular metabolism
- Abstract
Background and Purpose: Obesity is a risk factor for the development of chronic kidney disease independent of diabetes, hypertension and other co-morbidities. Obesity-associated nephropathy is linked to dysregulation of the cell energy sensor AMP-activated protein kinase (AMPK). We aimed here to assess whether impairment of AMPK activity may cause renal arterial dysfunction in obesity and to evaluate the therapeutic potential of activating renal AMPK., Experimental Approach: Effects of the AMPK activator A769662 were assessed on intrarenal arteries isolated from ob/ob mice and obese Zucker rats and then mounted in microvascular myographs. Superoxide and hydrogen peroxide production were measured by chemiluminescence and fluorescence, respectively, and protein expression was analysed by western blotting., Key Results: Endothelium-dependent vasodilation and PI3K/Akt/eNOS pathway were impaired in preglomerular arteries from genetically obese rats and mice, along with impaired arterial AMPK activity and blunted relaxations induced by the AMPK activator A769662. Acute ex vivo exposure to A769662 restored endothelial function and enhanced activity of PI3K/Akt/eNOS pathway in obese rats, whereas in vivo treatment with A769662 improved metabolic state and ameliorated endothelial dysfunction, reduced inflammatory markers and vascular oxidative stress in renal arteries and restored redox balance in renal cortex of obese mice., Conclusion and Implications: These results demonstrate that AMPK dysregulation underlies obesity-associated kidney vascular dysfunction and activation of AMPK improves metabolic state, protects renal endothelial function and exerts potent vascular antioxidant and anti-inflammatory effects. The beneficial effects of vascular AMPK activation might represent a promising therapeutic approach to the treatment of obesity-related kidney injury., (© 2021 The Authors. British Journal of Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)
- Published
- 2021
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33. Urolithiasis Develops Endothelial Dysfunction as a Clinical Feature.
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Sáenz-Medina J, Martinez M, Rosado S, Durán M, Prieto D, and Carballido J
- Abstract
An increased risk of cardiovascular morbidity has been reported in lithiasic patients. In this context, endothelial dysfunction (ED), an earlier status of atherogenesis, has been identified in hyperoxaluria rat models of urolithiasis., Objective: The purpose of this study was to determine the endothelial vascular function in patients with urolithiasis in relation to systemic inflammatory, oxidative stress, and vascular function serum markers., Methods: A cross-sectional study was performed between 27 urolithiasic patients, matched for age and sex, with 27 healthy patients. Endothelial function was assessed by measuring flow-mediated dilation (Celermajer method). Fasting blood was collected to determine metabolic parameters (glucose and lipid profile), along with serum CRP, IL-6, MDA, ADMA, and VCAM-1., Results: Both the control and urolithiasis groups were homogenous in anthropometric, exploration, and general laboratory measures. Flow-mediated dilation (%FMD) was 11.85% (SE: 2.78) lower in the lithiasis group ( p < 0.001). No significant differences were achieved between groups when CRP, IL-6, MDA, ADMA, and VCAM-1 were compared, although slightly higher values of CRP, ADMA, and VCAM-1 were detected in the lithiasic group. A correlation was not reached in any of the serum markers when they were related to flow-mediated values, although a slight negative correlation trend was observed in MDA, VCAM-1, and IL-6 values., Conclusions: Endothelial dysfunction constitutes an important disorder related to urolithiasis patients. It must be considered as an early feature responsible for future cardiovascular events. Our study did not find a significant association between inflammatory, oxidative stress, endothelial serum markers, and flow-mediated dilation.
- Published
- 2021
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34. Activation of the AMP-related kinase (AMPK) induces renal vasodilatation and downregulates Nox-derived reactive oxygen species (ROS) generation.
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Rodríguez C, Contreras C, Sáenz-Medina J, Muñoz M, Corbacho C, Carballido J, García-Sacristán A, Hernandez M, López M, Rivera L, and Prieto D
- Subjects
- Adenosine Monophosphate, Adenylate Kinase, Animals, Humans, Hydrogen Peroxide, Kidney, Rats, Rats, Wistar, Reactive Oxygen Species, AMP-Activated Protein Kinases genetics, Vasodilation
- Abstract
AMP-activated protein kinase (AMPK) is a cellular energy sensor activated during energy stress to stimulate ATP production pathways and restore homeostasis. AMPK is widely expressed in the kidney and involved in mitochondrial protection and biogenesis upon acute renal ischemia, AMPK activity being blunted in metabolic disease-associated kidney disease. Since little is known about AMPK in the regulation of renal blood flow, the present study aimed to assess the role of AMPK in renal vascular function. Functional responses to the selective AMPK activator A769662 were assessed in intrarenal small arteries isolated from the kidney of renal tumour patients and Wistar rats and mounted in microvascular myographs to perform simultaneous measurements of intracellular calcium [Ca
2+ ]i and tension. Superoxide (O2 .- ) and hydrogen peroxide (H2 O2 ) production were measured by chemiluminescence and fluorescence and protein expression by Western blot. Activation of AMPK with A769662 increased AMPKα phosphorylation at Thr-172 and induced potent relaxations compared to AICAR in isolated human and rat intrarenal arteries, through both endothelium-dependent mechanisms involving nitric oxide (NO) and intermediate-conductance calcium-activated potassium (IKCa ) channels, as well as activation of ATP-sensitive (KATP ) channels and sarcoplasmic reticulum Ca2+ -ATPase (SERCA) in vascular smooth muscle (VSM). Furthermore, AMPK activator reduced NADPH oxidase 4 (Nox4) and Nox2-derived reactive oxygen species (ROS) production. These results demonstrate that A769662 has potent vasodilator and antioxidant effects in intrarenal arteries. The benefits of AMPK activation in rat kidney are reproduced in human arteries and therefore vascular AMPK activation might be a therapeutic target in the treatment of metabolic disease-associated kidney injury., Competing Interests: Declaration of competing interest All authors declare no competing interests., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)- Published
- 2020
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35. Differential contribution of Nox1, Nox2 and Nox4 to kidney vascular oxidative stress and endothelial dysfunction in obesity.
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Muñoz M, López-Oliva ME, Rodríguez C, Martínez MP, Sáenz-Medina J, Sánchez A, Climent B, Benedito S, García-Sacristán A, Rivera L, Hernández M, and Prieto D
- Subjects
- Animals, Antioxidants metabolism, Disease Susceptibility, Hydrogen Peroxide metabolism, Immunohistochemistry, Kidney metabolism, Kidney pathology, Male, Metabolomics, Models, Biological, NADPH Oxidase 1 metabolism, NADPH Oxidase 2 metabolism, NADPH Oxidase 4 metabolism, Obesity pathology, Rats, Reactive Oxygen Species metabolism, Renal Artery metabolism, Renal Artery physiopathology, Superoxides metabolism, Endothelium, Vascular metabolism, NADPH Oxidase 1 genetics, NADPH Oxidase 2 genetics, NADPH Oxidase 4 genetics, Obesity etiology, Obesity metabolism, Oxidative Stress
- Abstract
Oxidative stress-associated endothelial dysfunction is a key pathogenic factor underlying the microvascular complications of metabolic disease. NADPH oxidase (Nox) is a major source of oxidative stress in diabetic nephropathy and chronic kidney disease, despite Nox4 and Nox2 have been identified as relevant sources of vasodilator endothelial H
2 O2 .The present study was sought to investigate the role of Nox enzymes in renal vascular oxidative stress and endothelial dysfunction in a rat model of genetic obesity. Endothelial function was assessed in intrarenal arteries of obese Zucker rats (OZR) and their counterparts lean Zucker rats (LZR) mounted in microvascular myographs, and superoxide (O2 .- ) and H2 O2 production were measured. Impaired endothelium-dependent relaxations to acetylcholine (ACh) were associated to augmented O2 .- generation, but neither ROS scavengers nor the Nox inhibitor apocynin significantly improved these relaxant responses in renal arteries of OZR. Whereas NO contribution to endothelial relaxations was blunted, catalase-sensitive non-NO non-prostanoid relaxations were enhanced in obese rats. Interestingly, NADPH-dependent O2 .- production was augmented while NADPH-dependent H2 O2 generation was reduced, and cytosolic and mitochondrial SOD were up-regulated in kidney of obese rats. Nox4 was down-regulated in renal arteries and Nox4-dependent H2 O2 generation and endothelial relaxation were reduced in OZR. Up-regulation of both Nox2 and Nox1 was associated with augmented O2 .- production but reduced H2 O2 generation and blunted endothelial Nox2-derived H2 O2 -mediated in obese rats. Moreover, increased Nox1-derived O2 .- contributed to renal endothelial dysfunction in OZR. In summary, the current data support a main role for Nox1-derived O2 .- in kidney vascular oxidative stress and renal endothelial dysfunction in obesity, while reduced endothelial Nox4 expression associated to decreased H2 O2 generation and H2 O2 -mediated vasodilatation might hinder Nox4 protective renal effects thus contributing to kidney injury. This suggests that effective therapies to counteract oxidative stress and prevent microvascular complications must identify the specific Nox subunits involved in metabolic disease., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)- Published
- 2020
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36. Hydrogen peroxide derived from NADPH oxidase 4- and 2 contributes to the endothelium-dependent vasodilatation of intrarenal arteries.
- Author
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Muñoz M, Martínez MP, López-Oliva ME, Rodríguez C, Corbacho C, Carballido J, García-Sacristán A, Hernández M, Rivera L, Sáenz-Medina J, and Prieto D
- Subjects
- Aged, Animals, Female, Humans, Male, Middle Aged, Rats, Wistar, Arteries physiology, Endothelium, Vascular physiology, Hydrogen Peroxide metabolism, Kidney blood supply, NADPH Oxidase 2 metabolism, NADPH Oxidase 4 metabolism, Vasodilation
- Abstract
The role of NADPH oxidase (Nox)-derived reactive oxygen species in kidney vascular function has extensively been investigated in the harmful context of oxidative stress in diabetes and obesity-associated kidney disease. Since hydrogen peroxide (H
2 O2 ) has recently been involved in the non-nitric oxide (NO) non-prostanoid relaxations of intrarenal arteries, the present study was sought to investigate whether NADPH oxidases may be functional sources of vasodilator H2 O2 in the kidney and to assess their role in the endothelium-dependent relaxations of human and rat intrarenal arteries. Renal interlobar arteries isolated from the kidney of renal tumor patients who underwent nephrectomy, and from the kidney of Wistar rats, were mounted in microvascular myographs to assess function. Superoxide (O2 .- ) and H2 O2 production was measured by chemiluminescence and Amplex Red fluorescence, and Nox2 and Nox4 enzymes were detected by Western blotting and by double inmunolabeling along with eNOS. Nox2 and Nox4 proteins were expressed in the endothelium of renal arterioles and glomeruli co-localized with eNOS, levels of expression of both enzymes being higher in the cortex than in isolated arteries. Pharmacological inhibition of Nox with apocynin and of CYP 2C epoxygenases with sulfaphenazol, but not of the NO synthase (NOS), reduced renal NADPH-stimulated O2 .- and H2 O2 production. Under conditions of cyclooxygenase and NOS blockade, acetylcholine induced endothelium-dependent relaxations that were blunted by the non-selective Nox inhibitor apocynin and by the Nox2 or the Nox1/4 inhibitors gp91ds-tat and GKT136901, respectively. Acetylcholine stimulated H2 O2 production that was reduced by gp91ds-tat and by GKT136901. These results suggest the specific involvement of Nox4 and Nox2 subunits as physiologically relevant endothelial sources of H2 O2 generation that contribute to the endothelium-dependent vasodilatation of renal arteries and therefore have a protective role in kidney vasculature., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)- Published
- 2018
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37. Metabolic syndrome contributes to renal injury mediated by hyperoxaluria in a murine model of nephrolithiasis.
- Author
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Sáenz-Medina J, Jorge E, Corbacho C, Santos M, Sánchez A, Soblechero P, Virumbrales E, Ramil E, Coronado MJ, Castillón I, Prieto D, and Carballido J
- Subjects
- Animals, Calcium Oxalate urine, Creatinine, Diet, Carbohydrate Loading adverse effects, Disease Models, Animal, Ethylene Glycol, Fructose, Humans, Hyperoxaluria blood, Hyperoxaluria etiology, Hyperoxaluria urine, Kidney Tubules pathology, Kidney Tubules physiopathology, Male, Metabolic Syndrome blood, Metabolic Syndrome etiology, Metabolic Syndrome urine, Nephrolithiasis blood, Nephrolithiasis chemically induced, Nephrolithiasis urine, Osteopontin metabolism, Rats, Rats, Sprague-Dawley, Renal Insufficiency blood, Renal Insufficiency etiology, Renal Insufficiency urine, Calcium Oxalate metabolism, Hyperoxaluria metabolism, Metabolic Syndrome metabolism, Nephrolithiasis metabolism, Renal Insufficiency metabolism
- Abstract
Metabolic syndrome (MS) individuals have a higher risk of developing chronic kidney disease through unclear pathogenic mechanisms. MS has been also related with higher nephrolithiasis prevalence. To establish the influence of MS on renal function, we designed a murine model of combined metabolic syndrome and hyperoxaluria. Four groups of male Sprague-Dawley rats were established: (1) control group (n = 10) fed with standard chow; (2) stone former group (SF) (n = 10) fed with standard chow plus 0.75% ethylene glycol administered in the drinking water; (3) metabolic syndrome group (MS) (n = 10), fed with 60% fructose diet; (4) metabolic syndrome + stone former group (MS + SF) (n = 10), 60% fructose diet and 0.75% EG in the drinking water. MS group showed a significant injury to renal function when hyperoxaluria was induced. It was demonstrated by a significant decrease of creatinine clearance (p < 0.001), with higher tubular damage (34.3%, CI 95% 23.9-44.7, p < 0.001), produced by deposition of crystals, and increased tubular synthesis of osteopontin as a response to tubular damage. Induction of hyperoxaluria in rats with MS causes severe morphological alterations with a significant impairment of renal function. This impairment is not produced in rats without MS. Therefore, this model can be useful for the study of the influence of MS in stone formation.
- Published
- 2018
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38. [Laparoscopic Boari Flap ureteral reimplantation.]
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Castilló-Vela I, Del Pozo Jiménez G, Turo Antona J, Vázquez Alba D, Sáenz Medina J, and Carballido Rodríguez J
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- Adult, Aged, Humans, Male, Middle Aged, Cystostomy methods, Laparoscopy, Replantation methods, Surgical Flaps, Ureter surgery, Ureterostomy methods
- Abstract
Objectives: To report our initial experience with laparoscopic Boari flap ureteral reimplantation and to review the main technical elements in ureteral reconstructive surgery., Methods: In a 10-year period we performed 23 laparoscopic ureteral reimplantations. Three cases required a Boari flap. Two patients presented ureteral stenosis above the iliac vessels and the third one a urothelial tumor of the pelvic ureter., Results: Two cases were completed laparoscopically; the third one was electively converted to open surgery to avoid prolonged OR time. Mean operative time was 276 minutes (270-290 min). There were no intraoperative complications. Mean hospital stay was 6.6 days. One patient presented postoperative UTI (Clavien 2). One patient developed with history of sever arteriopathy and aortorenal by pass developed ureteral stenosis proximal to the ureteral reimplantation eight months after the operation., Conclusions: Laparoscopic Boari flap ureteral reimplantation is an affective technique for ureteral reconstruction, safe and reproducible, reserved for cases of ureteral pathology in which the distance to bridge between the bladder and the ureteral stump is long.
- Published
- 2017
39. Review of the pathophysiological aspects involved in urological disease associated with metabolic syndrome.
- Author
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Sáenz Medina J and Carballido Rodríguez J
- Subjects
- Endothelium, Vascular physiopathology, Humans, Metabolic Syndrome complications, Metabolic Syndrome physiopathology, Urologic Diseases etiology, Urologic Diseases physiopathology
- Abstract
Introduction: Metabolic syndrome is a constellation of disorders that includes insulin resistance, central obesity, arterial hypertension and hyperlipidaemia. These disorders can have implications for the genitourinary apparatus., Objectives: To conduct a review on the pathophysiological aspects that explain the relationship between metabolic syndrome and sexual dysfunction, lower urinary tract syndrome, prostate cancer and stone disease., Methods: We performed a qualitative, narrative literature review through a literature search on PubMed of articles published between 1997 and 2015, using the terms pathophysiology, metabolic syndrome, endothelial dysfunction, lipotoxicity, mitochondrial dysfunction, kidney stones, hypogonadism, erectile dysfunction, lower urinary tract syndrome and prostate cancer., Synthesis of the Evidence: Metabolic syndrome constitutes an established complex of symptoms, defined as the presence of insulin resistance, central obesity, hypertension and hyperlipidaemia. Endothelial dysfunction secondary to lipotoxicity generates an inflammatory state, which involves renal cell metabolism, vascularisation of the pelvis and androgen production. These facts explain the relationship between metabolic syndrome, nephrolithiasis, lower urinary tract syndrome, hypogonadism and erectile dysfunction in men., Conclusions: Strategies such as proper diet, regular exercise, insulin treatment, testosterone-replacement therapy, therapy with antioxidants and free-radical inhibitors and urological treatments classically used for lower urinary tract syndrome have shown promising results in this syndrome., (Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2016
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40. Ureteroscopy for the treatment of urinary stones. Past, present and future.
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Sáenz Medina J and Pérez-Castro Ellendt E
- Subjects
- Equipment Design, Forecasting, Humans, Urologic Surgical Procedures instrumentation, Ureteroscopy trends, Urinary Calculi surgery
- Abstract
Objectives: Ureteroscopy has been considered one of the most revolutionary techniques in modern urology for the treatment of urinary stones. The developments of new ureteroscopes, ancillary techniques or fragmentation devices have contributed to that evolution. To describe the evolution of imaging systems, auxiliary techniques and fragmentation methods for treatment of urinary stones from its beginnings to present time, with special emphasis on the different trends in the technique for the nearest future., Methods: A bibliographic review is performed highlighting the development of technical details, and the impact on the results in terms of stone-free rate, and complications., Conclusions: Ureteroscopy has evolved into a first-line technique for the treatment of upper urinary tract stones. Technological advances in both imaging equipment and on different ancillary techniques and fragmentation methods have enabled improved stone free rates and decreased morbidity of the technique. Improvements in imaging systems, auxiliary instruments and fragmentation methods allow the treatment of stones progressively more complex.
- Published
- 2014
41. Renocolic fistula as a complication of radiofrequency in the treatment of renal cell carcinoma.
- Author
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Sáenz Medina J, Redondo González E, Hernández-Atance JM, Crespo Martínez L, Llanes González L, Rendón Sánchez D, and Páez Borda A
- Subjects
- Humans, Male, Carcinoma, Renal Cell surgery, Catheter Ablation adverse effects, Colonic Diseases etiology, Intestinal Fistula etiology, Kidney Diseases etiology, Kidney Neoplasms surgery, Urinary Fistula etiology
- Abstract
Method: Beyond postoperative suspicion, retrograde pyelogram was performed, the images of which are displayed, and demonstrated the fistula., Results: Treatment has been definitive nephrectomy after failed attempt to seal the fistula with suture and TachoSil., Conclusions: Although radiofrequency ablation can be a valid technique for treating small renal tumors in patients with high morbidity, it is not without significant complications as described in this case, despite the precautions taken.
- Published
- 2010
42. New directions for health care provision in the era of electronic health records.
- Author
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Páez Borda A, Redondo González E, Sáenz Medina J, Fernández Montarroso L, Marín Valero M, Juárez Ruperto N, Llanes González L, Crespo Martínez L, Rendón Sánchez D, Alvarez Ardura M, Gálvez Carbonell ML, Torres Toro P, del Río Fernández R, del Vigovega MS, and Serrano Balazote P
- Subjects
- Delivery of Health Care trends, Electronic Health Records
- Published
- 2009
43. An intervention to improve the adequacy of referrals from primary care to a department of urology.
- Author
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Páez Borda A, Sáenz Medina J, Redondo González E, Fernández Montarroso L, Marín Valero M, and López García-Franco A
- Subjects
- Humans, Hospital Departments, Primary Health Care, Referral and Consultation standards, Referral and Consultation statistics & numerical data, Urology
- Abstract
Introduction: This study analyses the effect of two interventions implemented in order to improve adherence to the terms of a protocol for referring patients from primary care to a urology department., Material and Method: A telephone counselling line for professionals was implemented, and joint training sessions were held (twice, at six-month intervals). The terms "appropriate" and "inappropriate" were used to identify referrals complying with the locally developed protocol and those that did not, respectively. Referral appropriateness at baseline (T0) was compared with that six months after the first (T1) and second (T2) meeting. Linear trend analysis was used to test for trends in adequacy across the study., Results: Appropriateness of 6,088 consecutive referrals was analysed. At T0, 58% of the referrals (2810/4841) were judged to be "appropriate". Adequacy improved significantly at T1 (70.6% vs. 58% at T0; chi2 < 0.001). At T2, 75.4% of the referrals met the terms of the protocol; the difference between results at T1 and T2 was not statistically significant (chi2 = 0.06). Overall (T0 vs. T2), a 17.4% improvement was confirmed (chi2 < 0.001). A trend toward more appropriate referrals was detected over time (Mantel-Haenszel test for linear trend, z = 9.62; p < 0.001). As the use of communication resources was anecdotal, mathematical analysis of its effect on adequacy could not be performed., Conclusions: Training activities are worthwhile for improving referral adequacy. Stable rates over time are possible. Using communication resources may be unnecessary if accessibility is guaranteed.
- Published
- 2009
44. [Immune response during laparoscopic and open living donor nephrectomy. An experimental pig model].
- Author
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Sáenz Medina J, Asuero de Lis MS, Villafruela Sanz J, Correa Gorospe C, Cuevas B, Galindo Alvarez J, Páez Borda A, Linares Quevedo AI, Marcén Letosa R, Pascual Santos J, and Burgos Revilla FJ
- Subjects
- Animals, Biomarkers blood, C-Reactive Protein analysis, Endothelin-1 blood, Interleukin-10 blood, Interleukin-2 blood, Kidney immunology, Swine, Tissue Donors, Tumor Necrosis Factor-alpha blood, Laparoscopy, Nephrectomy methods
- Abstract
Introduction: It's been demonstrated laparoscopic access determines a lower surgical stress, by measurement of several markers as different interleuquines (IL) or C-reactive protein (CRP). Endothelin 1 (ET-1) is a powerful vasoconstrictor produced in renal endothelium scarcely studied in laparoscopy. The objective of this study is to analyze immune response during laparoscopic and open donor nephrectomy, in a porcine experimental model by means of measuring IL-2, 10, tumoral necrosis factor alpha (TNFalpha), CRP and ET-1., Methods: Twenty pigs underwent left nephrectomy, 10 by laparoscopy and 10 by open approach in an experimental model. Both groups were monitorized IL-2, 10, TNF alpha, ET-1 at basal, immediately post surgery, first, third, fifth and seventh days after procedure., Results: The comparative analysis between groups demonstrated a significant increase in levels of CRP (1.44+/-0.88 vs 1.32+/-0.14 mg/dl, p=0.046), TNF alpha (131.14+/-41.37 vs 57.19+/-23.71 pg/ml, p>0.001) and ET-1 (0.91+/-0.49 vs 0.56+/-0.5 fmol/ml, p=0.001) of open nephrectomy group, as a higher levels of IL-2 in laparoscopic group., Conclusions: Open donor nephrectomy determines a higher immune response than laparoscopic approach. The importance of this fact over the ischemia-reperfusion syndrome or the immediate function of graft is not clearly established.
- Published
- 2008
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45. [Experimental models for research and training in renal transplant].
- Author
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Sáenz Medina J, Asuero de Lis MS, Correa Gorospe C, Cuevas B, Gómez Dos Santos V, Linares Quevedo AI, Páez Borda A, Castillón Vela I, Marcén Letosa R, Pascual Santos J, and Burgos Revilla FJ
- Subjects
- Animals, Biomedical Research methods, Kidney Transplantation education, Models, Animal
- Abstract
An update on aspects and use of different experimental models applied in kidney transplant research is presented . This paper includes qualities, as long as similarities between most frequently used animal models and human clinical standards. Contributions of those models based on microsurgical or laparoscopic techniques are revised. The physiological consequences (hemodynamic, immunologic) of surgical technique (laparoscopy), applied in experimental models as long as non-heart beating organ donor models and organ preservation methods are also reviewed. Finally, an update of those models applied in research in prothocols of either immunosupression or xenotransplant is done.
- Published
- 2008
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46. [Usefulness of cytokines as surgical aggression markers in the ischemia-reperfusion syndrome and post transplant renal function in an experimental model of laparoscopic vs. open renal autotransplantation].
- Author
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Linares Quevedo AI, Burgos Revilla FJ, Villafruela Sanz JJ, Zamora Romero J, Pascual Santos J, Marcén Letosa R, Cuevas Sánchez B, Sáenz Medina J, and Correa Gorospe C
- Subjects
- Animals, Swine, Cytokines blood, Kidney Transplantation adverse effects, Kidney Transplantation methods, Laparoscopy, Reperfusion Injury blood, Reperfusion Injury etiology
- Abstract
Objectives: To analyze the modifications induced by laparoscopic and open nephrectomies in living donor transplantation on cytokines, to evaluate operative trauma of different surgical techniques and the influence on ischemia/reperfusion syndrome and renal function., Methods: Thirty pigs underwent left nephrectomy, 15 by laparoscopy and 15 by open approach in an experimental autotransplantation model., Results: Serum level of IL-2, IL-6, IL-10 and tumor necrosis factor (TNF) were lower during laparoscopic than open nephrectomy: 6.8 +/- 0.6 vs 13.9 +/- 1.1 pg/ml for IL-2, 46.2 +/- 2.3 vs 84.4 +/- 2.5 pg/ml for IL-6, 26.1 +/- 2.4 vs 92.8 +/- 12.6 pg/ml for IL-10, and 17.6 +/- 2.1 vs 38.5 +/- 4.8 pg/ml for TNF. There was no association between renal blood flow (RBF) and cytokines levels during nephrectomy: IL-2 (p = 0.498), IL-6 (p = 0.117), IL-10 (p = 0.081) y TNF (p = 0.644). However, there was correlation between IL-10 and the decrease of RBF after transplantation: (R2 0.48; p = 0.02). Initial serum creatinine levels were correlated with RBF and IL-2 levels during nephrectomy (R = 0.831, R2 = 0.691, p = 0.025), and postransplantation RBF (R = 0.784, R2 = 0.614, p < 0.0001). Seventh day creatinine levels were correlated with postransplantation RBF (R = 0.537, R2 = 0.289, p = 0.002) and IL-2 levels during nephrectomy (R = 0.685, R2 = 0.469, p = 0.015)., Conclusions: Cytokine levels were higher during the open approach than laparoscopic procedure. High levels of RBF during nephrectomy and transplantation improve early graft function while low levels of RBF and high levels ol IL-2 during nephrectomy induce delayed graft function.
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- 2008
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47. [Adequacy of referral from primary care to a Department of Urology].
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Páez Borda A, Redondo González E, Ríos González E, Linares Quevedo A, Sáenz Medina J, and Castillón Vela I
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- Clinical Protocols, Humans, Guideline Adherence statistics & numerical data, Hospital Departments, Primary Health Care, Referral and Consultation standards, Urologic Diseases, Urology
- Abstract
Objective: [corrected] To indirectly address the adequacy of referrals from general practitioners (GP) to specialized care taking into account a previously agreed protocol on ten urological topics., Materials & Methods: The study analyzed all referrals to the Urology department originated in 10 primary care centres (135 GPs involved) throughout a 19-month period. Adequacy of 2841 referrals was checked. The urologist judged the referral as compliant (adequate) or not compliant (inadequate) with the terms of the protocol. Compliance per primary care centres was compared. Also referral adequacy corrected per centre and clinical topic was compared. The relationship between "absolute number of referrals" and "adequate referrals" was tested using a linear regression model., Results: 57.2% of the referrals were inadequate. Overall, no significant differences were detected between primary care centres. Nevertheless significant differences between centres were evident in terms of referrals due to renal colic and female urinary incontinence. 70% (94/135) of the GPs complied with the protocol in, at least, 50% of the cases. A strong association between "absolute number of referrals" and "adequate referrals" was evident (r2=0.86)., Conclusions: Overall compliance with the protocol was modest. While no significant differences between centres were detected in terms of adequacy of referrals certain conditions have to be locally revisited; most of the topics (particularly microhematuria) have to be revisited in every center.
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- 2007
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48. [Modification of the hemodynamic parameters and peripheral vascular flow in a porcine experimental of model of laparoscopic nephrectomy].
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Sáenz Medina J, Asuero de Lis MS, Galindo Alvarez J, Villafruela Sanz J, Correa Gorospe C, Cuevas Sánchez B, Linares Quevedo AI, Páez Borda A, Pascual Santos J, Marcén Letosa R, and Burgos Revilla J
- Subjects
- Animals, Blood Circulation, Models, Animal, Regional Blood Flow, Swine, Hemodynamics, Laparoscopy, Nephrectomy methods, Pneumoperitoneum, Artificial
- Abstract
Objectives: It has been demonstrated that abdominal high-pressure and the use of CO2 pneumoperitoneum induce changes of the cardiovascular and respiratory systems, attributable to two factors: changes of the cardiac output (CO) and hypercarbia. Other modifications derived from these facts include changes of the systemic vascular resistances (SVR), blood pressure (BP), central venous pressure (CVP), vascular changes like modifications of the renal blood flow (RBF), carotid flow (CF), portal flow, and hepatic artery flow (HAF). Our objective is to analyze the hemodynamic modifications induced by pneumoperitoneum on renal blood flow, carotid flow, portal flow and hepatic artery flow in a porcine experimental model., Methods: We compared two groups of pigs: CONTROL group (n = 10) and LAPAROSCOPIC group (n = 10), undergoing open or laparoscopic nephrectomy respectively. In every case, catheters were inserted into the right external jugular vein and femoral artery and cardiac output, CVP, blood pressure and systemic vascular resistances (calculated as RVS = (BP/CVP)x 80/CO); these measurements were taken at the following times: baseline, 5, 30, 60 min. and postoperatively. Renal blood flow, carotid flow, portal flow and hepatic artery flow were registered by means of an electromagnetic probe around the vessel 30 minutes after the start of surgery., Results: Comparative analysis shows: an increase of cardiac output in the laparoscopic group, the difference which was maximal at 30 minutes (4.33 + 0.73 vs. 8 .54 + 1.26 l/min., p < 0.,001); a descent of the systemic vascular resistances (1118.81 + 302.52 vs. 663.37 + 81.45 dynes .s.cm5, p < 0.001) and an increase of blood pressure (66.5 + 11.52 vs. 80.25 + 2.49 mm Hg in the laparoscopic group. Flow analysis showed an increase of the carotid artery flow (125.73 + 41.69 vs. 291.7 + 51.52 ml/min., p < 0.001) and a decrease of portal flow (973.67 + 131.70 vs. 546.83 + 217.53 ml/min., p = 0.001) and hepatic artery flow (278.00 + 94.71 vs. 133.33 + 112.32 ml/min., p = 0.03) in the laparoscopic group. There were no significant differences in renal blood flow with the volume expansion used., Conclusions: Laparoscopic nephrectomy conditions an increase of carotid flow, probably secondary to the increase of cardiac output, and also a diminishment of hepatic perfusion, both arterial and portal. Nevertheless, volume expansion and the limitation of intra-abdominal pressure to 12 mm Hg enable to maintain similar renal blood flow in both groups.
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- 2007
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49. [Outpatient female stress urinary incontinence surgery: budget impact study].
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Castillón Vela IT, Redondo González E, Linares Quevedo AI, Vallejo Herrador J, Ríos González E, Sáenz Medina J, and Páez Borda A
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- Adult, Aged, Costs and Cost Analysis, Female, Humans, Middle Aged, Retrospective Studies, Suburethral Slings adverse effects, Urologic Surgical Procedures economics, Ambulatory Surgical Procedures economics, Suburethral Slings economics, Urinary Incontinence, Stress economics, Urinary Incontinence, Stress surgery
- Abstract
Objectives: The surgical procedures for the insertion of tension free vaginal tapes in the treatment of female stress urinary incontinence (SUI) are simple and can be done as outpatient operations. The aim of this study was to perform a budget study comparing TVT in an outpatient basis with transobturator tape (TOT) with hospital admission., Methods: Retrospective analysis of the medical records of 23 patients undergoing surgery for SUI between October 2004 and October 2005. 13 patients were treated by TVT in an outpatient basis (group 1, Department of Urology), 10 patients were treated by TOT with hospital admission (Group 2, Department of Gynaecology). Cost analysis was carried out by the construction of a Marcov model, incorporating the time sequence of the treatment, including adverse events and results. Variables considered for the analysis: number of visits, preoperative tests, operative time, tape cost, hospital stay, unpredicted visits in the first postoperative month at the outpatient clinics or emergency room, and hospital readmissions. Statistical analysis was performed with the G-Stat software. Student's t test was used to compare quantitative variables., Results: 11/13 patients (84.6%) in group 1 completed the day-surgery protocol. Mean surgical time was 61.7 min. (SD 16.2; 35-100) and 61.6 min. (SD 8.3; 50-73) for groups I and 2 respectively. Two cases in group 1 had perioperative complications (15.4%); no patient in group 2 had perioperative complications. Mean hospital stay was 1.3 days for group 1 (SD 0.85; 1-4) and 2.9 days for group 2 (SD 0.31; 2-3). Three patients in group 1 (23%) and 2 in group 2 (20%) presented postoperative complications. Mean cost per process was 4740 EUR for group 1 and 7099 EUR for group 2., Conclusions: SUI correction by tension free tapes as day surgery is a valid option which saves a substantial amount of resources.
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- 2007
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50. [Renal autotransplantation: a valid option in the resolution of complex cases].
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López-Fando Lavalle L, Burgos Revilla J, Sáenz Medina J, Linares Quevedo A, Vallejo Herrador J, De Castro Guerin C, Pascual Santos J, and Marcén Letosa R
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- Adult, Child, Humans, Retrospective Studies, Risk Factors, Kidney Diseases surgery, Kidney Transplantation adverse effects, Kidney Transplantation methods
- Abstract
Objectives: To analyze the current indications for renal autotransplantation, as well as the technical features, complications and long-term follow-up of the technique., Methods: From 1990 to 2005 we have performed autotransplantation in 10 patients, 7 adults and 3 children. The indication was established due to vascular pedicle pathology in 8 cases and ureteral lesion in 2. The cause of vascular pathology was: atherosclerotic stenosis (4), dysplastic stenosis (2), Takayasu's disease stenosis (1), and renal artery aneurysm (1). The patients with ureteral lesion had ureteral stenosis secondary to Crohn's disease in one case, initially solved by ureteral stent and subsequently obstructed by lithiasic encrustation, and ureteral avulsion in the other case. The vascular grafts employed in the 8 cases with vascular reconstruction were: hypogastric artery 7 cases, and sophena vein in one case. Ureteral reimplantation was necessary in 5 cases after bench surgery; in other five cases vascular reconstruction was performed without ureteral division. All grafts were perfused with 4 degrees C lactate ringer or Wisconsin solution and protected with surface cold ischemia. Ischemia times ranged from 42 to 89 minutes., Results: Nine kidneys (90%) functioned after autotransplantation, 8 of them had immediate function, and one had delayed graft function after a six-day period of acute tubular necrosis. The kidney with arterial stenosis secondary to Takayasu's disease never functioned. The cause of graft loss was renal vein thrombosis. Postoperative mortality was zero. After a mean follow-up of 72+/- 13 months mean serum creatinine is 1.6+- 0.4 mg/dl (1.1-2.4) and 70% (7/10) of the patients have normal blood pressure without antihypertensive medication., Conclusions: Currently, renal autotransplantation, with or without extracorporeal vascular reconstruction, is a complex technique with exceptional indications, but it allows recovering renal units with vascular pathology not amenable to angioplasty or in situ revascularization. It is also a valid alternative to ileal ureteral substitution in cases of extensive ureteral lesion.
- Published
- 2007
- Full Text
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