ABSTRACT
La cirugía ambulatoria presenta un incremento constante, tanto en los procedimientos que se llevan a cabo como en las unidades capacitadas para su realización. Uno de los aspectos esenciales en su desarrollo es la mejoría permanente de los cuidados prequirúrgicos que reciben los pacientes. Entre ellos, ocupa un lugar destacado la profilaxis antitrombótica y, si bien la incidencia global de la enfermedad tromboembólica venosa en este grupo de pacientes no es muy elevada, se recomienda valorar en todos los pacientes los factores de riesgo trombótico personales y los relacionados con el procedimiento quirúrgico. Según esta valoración, los pacientes se podrán estratificar en bajo o moderado/alto riesgo trombótico, recomendándose aplicar las medidas de tromboprofilaxis adecuadas en cada caso: medidas generales solas o en combinación con tromboprofilaxis farmacológica y/o mecánica. En el presente documento multidisciplinar de consenso, actualización de las recomendaciones de la Asociación Española de Cirugía Mayor Ambulatoria (ASECMA) publicadas en 2011, se establecen las recomendaciones y sugerencias específicas para cada uo de los grupos de riesgo, aplicando los niveles de evidencia hallados en la literatura (AU)
In the past decade, ambulatory surgery has experienced a continuous increase, both in the types of procedures that are performed, as in the number of units qualified for outpatient surgery. One of the essential aspects in this development is the permanent improvement in the perioperative care that patients receive. In this regard, antithrombotic prophylaxis is of outstanding importance. Although the overall incidence of venous thromboembolism in these patients is not very high, the assessment of thrombosis risk factors, both personal and procedure related, is recommended. According to this risk assessment, patients may be stratified into low, moderate or high thrombotic risk categories. Therefore, thromboprophylaxis should be tailored to that risk: general measures alone, or combined with mechanical or pharmacological thromboprophylaxis. This multidisciplinary consensus document the recommendations of the Spanish Association of Major Ambulatory Surgery (ASECMA) published in 2011, and sets out evidence-based recommendations and specific suggestions for the each risk group (AU)
Subject(s)
Humans , Thromboembolism/prevention & control , Anticoagulants/therapeutic use , Ambulatory Surgical Procedures/methods , Premedication/methods , Preoperative Care/methods , Heparin, Low-Molecular-Weight/therapeutic use , Venous Thromboembolism/prevention & control , Practice Patterns, Physicians'ABSTRACT
El crecimiento de la glándula prostática es un hecho universal que aumenta con la edad, hasta el punto que, la hiperplasia del tejido prostático está presente en el 90 porciento de los varones mayores de 80 años, es por tanto una patología inherente al envejecimiento. La hipertrofia benigna de próstata se ha relacionado con múltiples factores de riesgo, de los cuales los más importantes son la edad y la presencia de testículos funcionantes. La clínica es muy variable tanto en su presentación como en la intensidad de los síntomas, no existiendo ninguno específico de esta patología. Serán la clínica y la exploración física las que nos orientarán en el diagnóstico de esta enfermedad; siendo el tacto rectal la prueba más importante. El tratamiento de estos pacientes depende de varias consideraciones; el médico y el paciente optarán según éstas por una pauta expectante, tratamiento farmacológico con fitoterapia, bloqueantes alpha o Finasteride, o bien cirugía. El papel del médico de familia es fundamental en la detección inicial del proceso (AU)
Subject(s)
Signs and Symptoms , Prostatic Hyperplasia/diagnosis , Prostatic Hyperplasia/therapyABSTRACT
Presentation of our experience in the early diagnosis of prostate cancer in patients with signs and symptoms of prostatism. Over a one year period (96-97), 316 patients underwent biopsy based on clearly defined criteria according to the diagnostic algorithm used in our centre: suspicious DRE and/or PSA > or = 10 ng/mL, and in patients with PSA between 4 and 10 ng/mL in the presence of suspicious TRU or when DPSA was > or = 0.15. The ratio of the 136 (43%) prostate cancer diagnosed relative to biopsy +/- was 1:1.32. It is concluded that early diagnosis in a selected population is useful and shows good diagnostic yield. The diagnostic algorithm used is more than acceptable with 43% positive biopsies and a good ratio between biopsy +/-. With a cutoff of 0.15 DPSA is a good method to improve PSA significance in patients in the difficult PSA range of 4 to 10 ng/mL.
Subject(s)
Prostatic Neoplasms/diagnosis , Aged , Algorithms , Biopsy, Needle , Humans , Male , Middle Aged , Prostate-Specific Antigen/blood , Prostatic Neoplasms/blood , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , UltrasonographyABSTRACT
Contribution of a case report of a male patient presenting with single left supraclavicular adenopathy of initially unknown origin and histologic pattern of neuroendocrine nature, finally traced to the prostate. It is believed that in any male over 45 diagnosed with carcinoma of unknown origin in the supradiaphragm lymph nodes, prostate carcinoma metastasis should also be ruled out using PSA immunostaining and by measuring serum PSA, serum alkaline phosphatase and DRE.
Subject(s)
Adenocarcinoma/pathology , Lymphatic Diseases/diagnosis , Neoplasms, Unknown Primary/diagnosis , Neuroendocrine Tumors/diagnosis , Prostatic Neoplasms/pathology , Adenocarcinoma/therapy , Aged , Biopsy , Clavicle , Combined Modality Therapy , Humans , Lymph Nodes/pathology , Lymphatic Diseases/therapy , Lymphatic Metastasis , Male , Neoplasms, Unknown Primary/therapy , Neuroendocrine Tumors/therapy , Prostate/pathology , Prostatic Neoplasms/therapyABSTRACT
Diagnosis of tumours during pregnancy is quite unusual, considering the low frequency of neoplasias in this period (1/1000 pregnancies) as well as the low incidence of bladder cancer in patients under 30, which makes the coincidence of both phenomena quite uncommon. The paper contributes the case of a 28-year old female diagnosed with bladder cancer during her pregnancy.
Subject(s)
Pregnancy Complications, Neoplastic/diagnostic imaging , Ultrasonography, Prenatal , Urinary Bladder Neoplasms/diagnostic imaging , Adult , Female , Humans , PregnancyABSTRACT
We report a case of small cell carcinoma of the urinary bladder in 71-year-old male patient. Oat cell of the urinary bladder is extremely uncommon, and up to date only 135 cases have been reported in word literature. Histologic, microscopic, and immunohistochemical characteristics are similar to oat cell carcinoma of the lung and other extrapulmonary oat cell carcinomas. We conclude this report with immunohistochemical study with PGP 9.5, neuron-specific enolase a synaptophisine.
Subject(s)
Carcinoma, Small Cell/pathology , Urinary Bladder Neoplasms/pathology , Aged , Humans , MaleABSTRACT
Urothelial inverted papilloma account for 2.2% of all urothelial tumours. The preferred location is the bladder; they occur singly and are generally benign, although the majority of authors agrees in treating this entity as a tumour of low aggressiveness. The report contributes four cases of inverted papilloma, three in male patients and the fourth in a female. One was located in the renal pelvis. A revision is made of the etiology, clinical signs and symptoms, diagnosis and treatment, as well as their relationship to surface carcinoma, as it occurs asynchronously in one of the cases described.
Subject(s)
Papilloma, Inverted/pathology , Urinary Bladder Neoplasms/pathology , Adult , Female , Humans , Kidney Pelvis/pathology , Male , Middle AgedABSTRACT
OBJECTIVE: To determine the intracavernous partial oxygen pressure in different etiological groups of erectile dysfunction: psychogenic (control group), arterial and veno-occlusive and the value of intracavernous gasometry as an indicator of the degree of severity of impotence. METHODS: A total of 16 patients were evaluated according to the diagnostic protocol utilized to determine the etiology of erectile dysfunction. Intracavernous blood samples were obtained during the initial phase of gasometry and PO2 was determined by standard gasometric methods. RESULTS: After injection of the vasoactive drug, the mean intracavernous PO2 was 92.4 +/- 1.27 for the control group, 62.2 +/- 0.85 for the group with arterial impotence, and 76.8 +/- 1.45 for the group with venous impotence, demonstrating a statistically significant difference (p < 0.01). CONCLUSIONS: Intracavernous gasometry, in combination with other diagnostic tests, is useful for evaluating the degree of severity of erectile dysfunction. The reduction in cavernous oxygen tension, which induces cavernous tissue fibrosis, can be considered to be a common mechanism in arterial and venous impotence.
Subject(s)
Impotence, Vasculogenic/diagnosis , Oxygen Consumption , Penis/blood supply , Adult , Alprostadil/administration & dosage , Humans , Impotence, Vasculogenic/blood , Impotence, Vasculogenic/etiology , Injections , Male , Middle Aged , Oxygen Consumption/drug effects , Partial Pressure , Penis/drug effects , Vasodilator Agents/administration & dosageABSTRACT
Presentation of an spontaneous vesical perforation secondary to vesical candidiasis in a patient with in-dwelling catheter due to BPH. Analysis of etiological factors, clinical signs and symptoms, diagnosis and management of both entities.
Subject(s)
Candidiasis/complications , Urinary Bladder Diseases/microbiology , Aged , Humans , Male , Rupture, SpontaneousABSTRACT
The incidence, presentation and clinical evolution of vesical tumours diagnosed in our Centre over the last 10 years (1986-1995) in patients under forty are examined. This retrospective study included 19 of the 643 neoplasias treated during that period; 7 of these in patients under 30 and 12 in patients over 31. Haematuria was the most frequent reason for visiting the Centre. At the time of diagnosis, all cases were surface tumours and none progressed to the infiltrant stage. Tumours in patients over 30 are characterised by a higher histological grade and greater relapse rate versus those in patients under 30. Therefore, age may be a favourable prognostic factor in patients under 30 versus the older group who follow a course more similar to the remainder of usual patients. Diagnosis and treatment of these neoplasias should be just the same as for tumours in older patients.
