A cost-minimization analysis of oncology home care versus hospital care.

We compared the costs of patient care for two groups of 10 oncology patients. The test group was treated at home and had access to 24 h telephone support, and the control group was treated in hospital, either as inpatients or as outpatients. Direct variable costs were provided by health insurance companies. The time invested by the health-care staff was recorded. The amount of time devoted to patients was more uniform in hospital than in the patients' homes, which suggests that patients at home received a less generic, more specific form of care. The nurses spent four times as long caring for home care patients as for hospital patients. The total cost of home care was 64% of that of hospital care, although this difference was not significant. The mean daily costs were three times lower at home than in hospital. All direct costs, except laboratory tests, were lower at home. Pharmaceutical costs were six times lower at home. Telephone support for home oncology care was cost saving and avoided 27 nursing home visits, which represented 35 working hours and Pta270,000 in savings to the health insurance companies.

[Aponeurotic suspension of the bladder neck as elective treatment of minimal stress urinary incontinence in women]. / Suspensión aponeurótica del cuello vesical como tratamiento electivo de la incontinencia urinaria a mínimos esfuerzos en la mujer.

To correct urine incontinence at minimal exertion in woman, most especially in those who have undergone unsuccessful vaginal techniques, we advice the aponeurotic suspension of the vesical cervix, with anchorage, in fixed tissue (Cooper's ligament or ischiopubic branch) in order to avoid displacement of the supporting band and new drops of the vesical cervix, with incontinence relapse in the long run. Since 1983 this procedure has been performed in 400 women, with various degrees of urinary incontinence on exertion, 140 of whom had previously undergone other procedures. Our results have been completely successful in 383 patient who at year from surgery no longer presented urinary incontinence of any degree. These good results lead us to recommend this procedure as the most suitable to solve urinary incontinence at minimal exertion, relapses and that associated to feeling of urgency in many occasions.

The usefulness of ethylephrine (Efortil-R) in the treatment of priapism and intraoperative penile erections.

We present our experience in the treatment of 8 patients with priapism after intravenous injection of vasoactive drugs, and of 15 patients with persistent erections in the course of transurethral cystoscopy surgery. All of them were treated with intracavernous injection of 10 mg ethylephrine (1 ml Efortil-R). The results were satisfactory in all cases. In one patient we had to draw 75 ml blood and give another 10 mg dose of ethylephrine. We have not observed secondary effects of drug administration except two local haematomas with spontaneous resolution. We consider that this treatment is very useful in the management of patients with persistent erections or priapism because of the excellent results obtained without adverse effects.

Lasertripsy in the treatment of ureteral lithiasis.

UNLABELLED: We submit our experience with laser treatment for ureteral lithiasis. We used the laser Candela MDL 2000 for the treatment of 62 lithiases (40 at the pelvic ureter, 16 at the iliac ureter and 6 at the lumbar ureter) in 58 patients. A semi-rigid Dretler or Gautier multiscope were used. Of the 62 calculi complete fragmentation was not achieved in 4 and they were ascended to the renal pelvis for subsequent ESWL. In 51% of the patients the ureteral catheter was left for 24 hours, and a double-J stent was used in two cases. COMPLICATIONS: 2 simple perforations of the ureter that were solved by means of a double-J stent; occasionally petechiae on the ureteral wall and two cases of rupture of the laser fibre tip that was easily removed with a forceps.

Comparative study between the use of a treatment with hyperthermia through the rectal approach versus the urethral approach for benign prostatic hyperplasia.

200 patients suffering from benign prostatic hyperplasia were treated with hyperthermia: 100 cases through the rectal approach and 100 through the urethral approach. Subjective symptoms were assessed as well as nycturia and objective data, urinary flow and postmicturition residue before treatment and 6 months after treatment. In the group of 100 patients treated rectally, the subjective symptoms and nycturia improved in 76; urine flow improved in 63, postmicturition residue decreased in 32 and the vesical catheter could be removed in 5 out of 8 patients. With the urethral approach, 77 patients out of 100 presented an improvement in their symptoms, nycturia improved in 53; urine flow improved in 28; the urine residue was decreased in 40 and the vesical catheter could be removed in 10 out of 16 patients who required it previously. Although slightly better results seem to be achieved with the use of rectal hyperthermia, as concerns nycturia and micturition flow, we prefer the urethral approach for its higher degree of convenience, easier handling, shorter time of treatment and reasonable effectiveness.

ESWL as the treatment for lithiasis in horseshoe kidney.

Thirteen patients with lithiasis and horseshoe kidney were evaluated (4 cases with bilateral stones). Fifteen kidney units were treated with extracorporeal shock wave lithotripsy (ESWL), and in 2 cases, percutaneous nephrolithotomy (PCN) was used. The excellent results achieved with ESWL (80%) and the low incidence of complications (2 cases of nephritic colics and 1 case of acute pyelonephritis), lead us to propose ESWL as the therapy of choice for lithiasis in patients with horseshoe kidneys. PCN alone or in association with ESWL would be used in cases with large lithiasic masses. Conventional surgery would only be indicated in those cases which due to their high degree of complexity or difficult endourological access prevent the use of the above-mentioned techniques.

Renal allograft rupture: surgical treatment by renal corsetage with lyophilized human dura.

We report 5 cases of renal allograft rupture in which diagnosis was established early through clinical data, laboratory tests and echography. Immediate surgery confirmed the suspicion in all cases. Acute rejection was present in 4 patients and in 1 the previous surgical puncture from the perirenal collection demonstrated serohematic fluid with a biological character similar to that of lymph. This latter case seemed to confirm the suspicion that any process associated with edema in a kidney with obstructed lymphatic tracts (meticulous lymphatic ligatures during donor extraction) is capable of causing a rupture. Conventional surgical treatment is dangerous and insecure on an edematous and friable kidney, resulting in a nephrectomy rate of 55.7 per cent and a postoperative death rate of 8 per cent. Hematoma evacuation, hemostasis by local compression and tridimensional containment of the ruptured areas should be the principles of this operation. By means of renal corsetage with lyophilized human dura these principles can be achieved. This surgical technique, which is simple and secure, its variations and future possibilities are described. In 3 of our 5 patients corsetage with lyophilized human dura was applied. All 5 grafts have taken. Renal function is good in 3 cases and acceptable in 2 at followup between 2 and 15 months.

Renal artery stenosis in transplanted kidney: management and results in six patients.

Severe hypertension and a decrease of renal function, with or without oliguria, suggest renal artery stenosis in the transplanted kidney. 6 renal artery stenoses were observed in 100 transplanted kidneys followed up for more than 3 months. In 4 patients, percutaneous transluminal angioplasty was performed. 1 patient required a new percutaneous transluminal angioplasty 3 months later and a 2nd patient was submitted to surgery after 14 months. Surgery was performed in 2 more cases, with failure in 1. It seems that the endoarteric lesion during cold perfusion could be the main etiopathological factor, when associated with rejection episodes. Percutaneous transluminal angioplasty is the treatment of choice in the management of renal artery stenosis in transplanted kidneys. Surgery must be reserved when it fails.

[Incrusted cystitis]. / Cistitis incrustante.

Five cases are presented of incrusted, alkaline cystitis and the authors point out the pathogenic aspects and the etiology of this illness and comment upon the two forms of endoscopic presentation and the treatment of the general and local kinds.

Preliminary report of an immunological study in urological cancer.

In this study, 32 cases of cancer of the genito-urinary tract are discussed from the viewpoint of immunology. In eight cases treated surgically, there has been no evidence of recurrence over a period of 1-4 years. Those with a good immunological response have a satisfactory course. Patients with a good response have been treated by radical surgery depending on the stage of the tumour, whilst those with a poor response have been treated less radically by reduction of the tumour mass in the hope that a better response may develop. The authors of this report feel that the 'inhibition of the lymphocyte migration test' is a very important factor to evaluate in the study and immunological evolution of the patient. Also, and concerning cases with good immunological response, the poor results after surgery makes us consider the importance and value of blocking factors of the serum closely related to the B type lymphocytes.

Severe renal insufficiency and renovascular hypertension.

Investigation in a patient aged 46 years with decompensated heart failure and severe renal insufficiency demonstrated a small, poorly functioning right kidney and severe stenosis of the left renal artery. Cardiac decompensation was corrected and the left kidney revascularised by autotransplantation. Renal function recovered considerably (FG 75/min) and the severe hypertension was reduced. In hypertension patients by main renal artery stenosis, renal autotransplantation is recommended, since it is a safe method without technical difficulty and has given good results. The mutual dependence of hypertension and renal insufficiency is reviewed. When renal function is poor, revascularisation of the stenosed kidney will lead to recovery. The hypertension will usually improve but will always become more responsive to drug therapy.