ABSTRACT
Introducción y objetivo Los factores más estudiados en pacientes tratados mediante prostatectomía radical robótica son antígeno prostático específico (PSA) y las características patológicas de la biopsia y la pieza de prostatectomía. Los factores asociados a la técnica quirúrgica han sido poco estudiados y con resultados controvertidos. El objetivo es identificar todos los factores posibles de la cirugía y su relación con la supervivencia libre de enfermedad (SLE) y de metástasis. Pacientes y métodos Estudio prospectivo aprobado por el Comité de Ética, en pacientes intervenidos de prostatectomía radical robótica desde enero del 2009 con seguimiento mínimo de cinco años. Analizamos como posibles factores pronósticos: el cirujano, el tiempo quirúrgico, la pérdida sanguínea, el acceso fascial, las técnicas de continencia, la preservación de la fascia, las bandeletas neurovasculares, el cuello vesical, la uretra, la curva de aprendizaje y las complicaciones quirúrgicas. Realizamos comparaciones univariables y emparejadas de supervivencia mediante la estimación de Kaplan-Meier y long-rank tests. El nivel de significancia para comparaciones múltiples se estableció con ajuste False Discovery Rate (p ajustada [padj]). Resultados Cohorte de 667 pacientes con mediana de seguimiento de 69 meses. En el análisis univariante, el cirujano (padj = 0,018), la conservación de ligamentos puboprostáticos (padj = 0,02), la preservación de fascia endopélvica (padj = 0,001) y realizar suspensión parauretral (padj < 0,001) son factores de mal pronóstico para la SLE. La preservación de la fascia también afecta negativamente a la supervivencia libre de metástasis (SLM) (padj = 0,04). Las cirugías previas abdominales, la próstata, el tiempo de intervención, el sangrado, el tipo de uretra residual, el lóbulo medio, el acceso fascial, la conservación de bandeletas o cuello vesical, no tienen significancia estadística (AU)
Introduction and objective The most frequently studied factors in patients treated by robotic radical prostatectomy are PSA and pathological features of the biopsy and prostatectomy specimen. Studies on the factors associated with the surgical technique are scarce and with controversial results. The objective is to identify all possible surgical factors and their relationship with disease-free and metastasis-free survival. Patients and Method Prospective study approved by the Ethics Committee, including patients who underwent robotic radical prostatectomy since January 2009 with a minimum follow-up of 5 years. Surgeon, surgical time, blood loss, fascial access, continence techniques, preservation of the fascia, neurovascular bundles, bladder neck, urethra, learning curve and surgical complications, were analyzed as possible prognostic factors. We performed univariate and matched comparisons of survival using Kaplan-Meier estimation and long-rank tests. The significance level for multiple comparisons was established with False Discovery Rate-adjustment (adjusted p). Results Cohort of 667 patients with a median follow-up of 69 months. In univariate analysis, surgeon (adjp = 0.018), preservation of puboprostatic ligaments (adjp = 0.02), preservation of endopelvic fascia (adjp = 0.001) and performing periurethral suspension (adjp < 0.001) are poor prognostic factors for disease-free survival. Fascia preservation also negatively affects metastasis-free survival (adjp = 0.04). Previous abdominal surgeries, prostate, surgical time, blood loss, type of residual urethra, middle lobe, fascial access, fascia or bladder neck preservation, have no statistical significance. Conclusions The surgeon and specific aspects of the surgical technique are determining factors in disease-free survival. Preservation of the fascia is the only factor that negatively affects metastasis-free survival (AU)
Subject(s)
Humans , Male , Prostatectomy/methods , Robotic Surgical Procedures , Prostatic Neoplasms/mortality , Prostatic Neoplasms/surgery , Disease-Free Survival , Neoplasm Metastasis , Follow-Up Studies , Prospective Studies , PrognosisABSTRACT
Aunque alcanzar la filosofía del hospital sostenible desde el punto de vista de su respeto por el medio ambiente puede considerarse un gran valor, si bien todavía poco desarrollado en el ámbito sanitario, no cabe duda de que cada vez, con mayor frecuencia, ésta va a ser una preocupación que va a conllevar la realización de acciones solidarias desde el punto de vista ecológico. Este trabajo presenta un plan de acción ambiental para un hospital, que tiene como objetivo general encauzar las actividades del hospital hacia un modelo de sostenibilidad global, en la que las afecciones al medio ambiente se vean minimizadas y como objetivos específicos conocer sus problemas ambientales, asegurar la calidad ambiental, prevenir riesgos, etc. Se presenta el plan de acción ambiental elaborado, así como los resultados obtenidos en el primer año de aplicación (AU)
Subject(s)
Humans , Sustainable Development , Financial Management, Hospital/organization & administration , Ecological DevelopmentABSTRACT
Contribution of one case of malignant testicular mesothelioma. A highly malignant tumour the diagnosis and specific treatment of which is not clearly defined. The correct diagnosis should be based on a series of features not only clinical (quick re-accumulation of liquid in the inverted hydrocele) but also gross (multiple paratesticular nodes) and microscopic, supported by immunohistochemical techniques. The latter is based both in ruling an adenocarcinoma out (CEA-, LeuM1-, Vimentine- to tumoral cells), and in the reactivity of more specific antigens (CAM5.2(K-8)+ and Vimentine+ to stromal cells). The choice treatment is inguinal orchiectomy with adjuvant chemotherapy. No standard chemotherapeutical approaches have been defined.
Subject(s)
Mesothelioma/diagnosis , Testicular Neoplasms/diagnosis , Humans , Male , Middle AgedABSTRACT
Description and differential diagnosis of lateral cysts of the prostate gland which during their growth may invade its central section. Most cases, sized below 0.8 cm, are diagnosed by accident. A symptomatic prostate cyst is, in fact, a very uncommon condition. Presentation of one case of prostate cystadenoma which presented as a low urinary obstruction in a middle-age adult subject.
Subject(s)
Cysts/diagnostic imaging , Prostatic Diseases/diagnostic imaging , Adult , Cysts/pathology , Cysts/surgery , Humans , Male , Prostate/diagnostic imaging , Prostate/pathology , Prostatectomy , Prostatic Diseases/parasitology , Prostatic Diseases/surgery , UltrasonographyABSTRACT
The stromal component of the urethral caruncle (UC) comprises a mixture of inflammatory, vascular, and fibrotic phenomena. Although mastocytes are cell elements known to appear in relation with chronic inflammation, there is no data in the literature explaining their significance in UCs or their ultrastructure relation with fibroblasts. We postulate that this special form of intercellular attachment could play a role in this condition's pathogenesis.
Subject(s)
Urethral Neoplasms/ultrastructure , Female , Humans , Menopause , Stromal Cells/ultrastructureABSTRACT
A case of recurrent emphysematous cystitis in a 44-year-old male diabetic is described. Treatment of the first episode had been effective and demonstrable radiologically. A recurrent episode of cystitis disclosed a neurogenic bladder, which had not been detected previously. The literature on the pathogenesis of this entity is briefly reviewed.
Subject(s)
Cystitis/etiology , Emphysema/etiology , Urinary Bladder, Neurogenic/complications , Adult , Humans , Male , Recurrence , Urinary Bladder, Neurogenic/diagnosisABSTRACT
Presentation of one case of bacterial acute focal nephritis (acute lobe nephrosis) in a parenterally drug-abuser, HIV-infected male. From the clinical point of view, the picture was interpreted as acute hepatitis, and the lesion was detected by ultrasound techniques. A right side location, relative lack of urological symptoms and coexistence of a chronic liver disease contributed to the diagnostic error. Failure of initial response to therapy with antibiotics coincided with the lesion migration. Eventually, the case evolved favourable with conservative treatment.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Nephritis/microbiology , AIDS-Related Opportunistic Infections/microbiology , Acute Disease , Adult , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/etiology , Bacterial Infections/microbiology , Diagnosis, Differential , Hepatitis/diagnosis , Humans , Male , Nephritis/diagnosis , Nephritis/drug therapy , Nephritis/etiology , Substance-Related Disorders/complicationsABSTRACT
We present two cases of angioma of the glans penis and we reviewed this disease entity from a clinical and therapeutic points of view, classically understood as a proliferative process of a malformative nature. However, both cases that are described can be interpreted as true vascular tumors of a benign nature.
