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2.
Rev Clin Esp (Barc) ; 222(7): 377-384, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35537991

RESUMO

INTRODUCTION: This work aims to evaluate whether a clinical examination and measurement of N-terminal pro-brain natriuretic peptide can predict poor prognosis in outpatients with heart failure. PATIENTS AND METHODS: We carried out a retrospective study from 2010 to 2018 in 238 patients diagnosed with heart failure. At baseline, we evaluated the presence of pulmonary rales and bilateral leg edema (clinical congestion) together with N-terminal pro-brain natriuretic peptide ≥ 1500 pg/mL (hemodynamic congestion). Patients were classified into 4 groups depending on their congestion pattern: no congestion (G1) (n = 50); clinical congestion (G2) (n = 43); hemodynamic congestion (G3) (n = 73); and clinical and hemodynamic congestion (G4) (n = 72). The primary outcome was all-cause mortality at one year of follow-up. RESULTS: A total of 238 patients were included. The mean age was 82 years, 61.8% were women, and 20.7% had reduced left ventricular ejection fraction. Thirty patients died in the first year of follow-up (12.6%). After controlling for confounding variables (sex, recent discharge for heart failure, estimated glomerular filtration rate, and left ventricular ejection fraction), the independent risk of death in each group compared to G1 as the reference group was: G2: HR 4.121 (95%CI 1.131-15.019); G3: HR 2.511 (95%CI 1.007-6.263); and G4: HR 7.418 (95%CI 1.630-33.763). CONCLUSION: Congestion in outpatients with heart failure correlates with prognosis. Patients with both clinical and hemodynamic congestion had the highest risk of all-cause death at one year.


Assuntos
Insuficiência Cardíaca , Pacientes Ambulatoriais , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/diagnóstico , Hemodinâmica , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Volume Sistólico , Função Ventricular Esquerda
3.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29807784

RESUMO

INTRODUCTION: Preoperative 3D modelling enables more effective diagnosis and simulates the surgical procedure. MATERIAL AND METHODS: We report twenty cases of acetabular fractures with preoperative planning performed by pre-contouring synthesis plates on a 3D printed mould obtained from a computarized tomography (CT) scan. The mould impression was made with the DaVinci 1.0 printer model (XYZ Printing). After obtaining the printed hemipelvis, we proceeded to select the implant size (pelvic Matta system, Stryker®) that matched the characteristics of the fracture and the approach to be used. RESULTS: Printing the moulds took a mean of 385minutes (322-539), and 238grams of plastic were used to print the model (180-410). In all cases, anatomic reduction was obtained and intra-operative changes were not required in the initial contouring of the plates. The time needed to perform the full osteosynthesis, once the fracture had been reduced was 16.9minutes (10-24). In one case fixed with two plates, a postoperative CT scan showed partial contact of the implant with the surface of the quadrilateral plate. In the remaining cases, the contact was complete. CONCLUSIONS: In conclusion, our results suggest that the use of preoperative planning, by printing 3D mirror imaging models of the opposite hemipelvis and pre-contouring plates over the mould, might effectively achieve a predefined surgical objective and reduce the inherent risks in these difficult procedures.

4.
Rev Esp Cir Ortop Traumatol ; 60(3): 184-91, 2016.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26968375

RESUMO

INTRODUCTION: Revision total knee arthroplasty (TKA) is a common procedure with varying results depending on the cause. Our objective was to compare the clinical and radiological outcomes in patients undergoing aseptic revision versus revision due to prosthetic infection. MATERIAL AND METHODS: The study included 41 patients who underwent TKA revision with the same varus-valgus constrained implant. In all cases a clinical evaluation was performed including pain, range of motion (ROM), Knee Society Score (KSS), complications, as well as radiological study. A comparative analysis was performed on the pre- and postoperative results between septic and aseptic groups. The mean follow-up was 6 years. RESULTS: ROM had a mean increase of 17 degrees (p<.01). KSS and functional KSS improved significantly postoperatively. In the radiological study, joint interline and limb alignment were restored in all cases. Radiolucencies were found in 36.5% of cases; however they were unrelated to the appearance of loosening of the implant. There were complications in 29.2% of cases, mostly related to the surgical wound. Mobility, KSS, KSS functional and satisfaction at follow-up were better in the septic group. Implant survival was 95% at follow-up. CONCLUSION: Revision arthroplasty with constrained varus-valgus implant is safe, and has successful mid-term results despite the cause of the replacement procedure.


Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho/efeitos adversos , Falha de Prótese , Infecções Relacionadas à Prótese/cirurgia , Reoperação/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
5.
Rev Esp Cir Ortop Traumatol ; 60(1): 67-74, 2016.
Artigo em Espanhol | MEDLINE | ID: mdl-26091572

RESUMO

INTRODUCTION: The low incidence and histological heterogeneity of primary sarcomas located in the pelvis makes it difficult to find homogeneous cohorts. OBJECTIVE: To describe the life and functional prognosis depending on the histological type of sarcoma in a series of locally advanced high-grade pelvis located sarcomas treated by hemipelvectomy. METHODS: A descriptive epidemiological and functional study was conducted on 15 cases treated between 2006 and 2012. Survival analysis, functional assessment, and a comparative study by histological type were performed, comparing chondrosarcomas to other histological diagnoses. RESULTS: The most frequent histological type was chondrosarcoma (46%), and the most frequent location was P2 (periacetabular) (73%). An internal hemipelvectomy was performed in 66% of cases, with a higher incidence (83%) in chondrosarcomas. Overall two-year survival was 54%, with higher survival in the chondrosarcoma group (67%) than in the other sarcomas (43%). Functional status depended on the type of intervention, with no differences in histological type or the performance of the reconstruction. DISCUSSION AND CONCLUSIONS: Hemipelvectomy is a surgical procedure that is indicated for the treatment of locally advanced high grade pelvis located sarcomas, regardless of histological type. The incidence of limb preservation and overall survival is higher in chondrosarcomas compared to other sarcomas.


Assuntos
Neoplasias Ósseas/cirurgia , Hemipelvectomia , Ossos Pélvicos/cirurgia , Sarcoma/cirurgia , Adolescente , Adulto , Idoso , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Estudos de Casos e Controles , Condrossarcoma/mortalidade , Condrossarcoma/patologia , Condrossarcoma/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Ossos Pélvicos/patologia , Prognóstico , Estudos Prospectivos , Recuperação de Função Fisiológica , Sarcoma/mortalidade , Sarcoma/patologia , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
6.
Actas Urol Esp ; 40(3): 155-63, 2016 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26598800

RESUMO

INTRODUCTION: To prevent the overdiagnosis and overtreatment of prostate cancer (PC), therapeutic strategies have been established such as active surveillance and focal therapy, as well as methods for clarifying the diagnosis of high-grade prostate cancer (HGPC) (defined as a Gleason score ≥7), such as multiparametric magnetic resonance imaging and new markers such as the 4Kscore test (4KsT). By means of a pilot study, we aim to test the ability of the 4KsT to identify HGPC in prostate biopsies (Bx) and compare the test with other multivariate prognostic models such as the Prostate Cancer Prevention Trial Risk Calculator 2.0 (PCPTRC 2.0) and the European Research Screening Prostate Cancer Risk Calculator 4 (ERSPC-RC 4). MATERIAL AND METHODS: Fifty-one patients underwent a prostate Bx according to standard clinical practice, with a minimum of 10 cores. The diagnosis of HGPC was agreed upon by 4 uropathologists. We compared the predictions from the various models by using the Mann-Whitney U test, area under the ROC curve (AUC) (DeLong test), probability density function (PDF), box plots and clinical utility curves. RESULTS: Forty-three percent of the patients had PC, and 23.5% had HGPC. The medians of probability for the 4KsT, PCPTRC 2.0 and ERSPC-RC 4 were significantly different between the patients with HGPC and those without HGPC (p≤.022) and were more differentiated in the case of 4KsT (51.5% for HGPC [25-75 percentile: 25-80.5%] vs. 16% [P 25-75: 8-26.5%] for non-HGPC; p=.002). All models presented AUCs above 0.7, with no significant differences between any of them and 4KsT (p≥.20). The PDF and box plots showed good discriminative ability, especially in the ERSPC-RC 4 and 4KsT models. The utility curves showed how a cutoff of 9% for 4KsT identified all cases of HGPC and provided a 22% savings in biopsies, which is similar to what occurs with the ERSPC-RC 4 models and a cutoff of 3%. CONCLUSIONS: The assessed predictive models offer good discriminative ability for HGPCs in Bx. The 4KsT is a good classification model as a whole, followed by ERSPC-RC 4 and PCPTRC 2.0. The clinical utility curves help suggest cutoff points for clinical decisions: 9% for 4KsT and 3% for ERSPC-RC 4. This preliminary study should be interpreted with caution due to its limited sample size.


Assuntos
Neoplasias da Próstata/patologia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Detecção Precoce de Câncer , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Neoplasias da Próstata/prevenção & controle , Medição de Risco
7.
Actas Urol Esp ; 31(8): 825-30, 2007 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-18020206

RESUMO

INTRODUCTION: Owing to the different results from the series that evaluate the behavior of the bladder cancer according to the age at the moment of the diagnosis, our objective is based on valuing the characteristics and behaviour according to age of appearance. METHODS: A retrospective study of bladder cancer diagnosed in our area during decade 1993-2003, distributed in 3 intervals of age and some characteristics and behaviour are valued. RESULTS: Elderly patients present greater tumors, non differentiated and with greater rate of progression to infiltrated. Moreover the age, the pathological stage and the tumorlike degree appear as independent significant factors in the multivariant study. CONCLUSIONS: In our experience, the patients greater than 70 years present neoplasms of similar clinical characteristics, although pathologically more aggressive, with greater percentage of progression and worse survival.


Assuntos
Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia , Fatores Etários , Idoso , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
Actas Urol Esp ; 30(8): 749-53; discussion 753, 2006 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-17078571

RESUMO

OBJECTIVES: To analyse the progress of T1a and T1b prostate cancer diagnosed in our hospital. MATERIAL AND METHODS: Retrospective study of 40 patients in T1a-T1b clinical stage diagnosed with prostate adenocarcinoma in our hospital, from 1986 to 1999. A restaging biopsy was performed on the 16 T1a patients after initial diagnosis and control. A radical prostatectomy was performed on the 24 T1b patients. They were all monitored every six months with rectal exam and PSA. We analysed biological and/or clinical progression, time to progression, mortality caused by the tumour and survival. RESULTS: None of the 16 patients with T1a clinical stage presented tumour progression, with a median follow-up of 90 months. 12,5% of the 24 T1b cases presented tumour progression, with a median follow-up of 70 months. Cancer-specific mortality was one patient (4,16 %) in the T1b group. CONCLUSIONS: Observation and follow-up with PSA and rectal exam appears to be a good option for T1a clinical stage, given the good prognosis. Our results show that patients with T1a clinical stage and good prognostic factors could be at a similar risk of suffering from a new prostate cancer as the normal population, although prospective studies are required to validate these results. T1b cases require active treatment and closer monitoring.


Assuntos
Adenocarcinoma/patologia , Adenocarcinoma/terapia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Idoso , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prostatectomia , Estudos Retrospectivos
9.
Actas Urol Esp ; 30(8): 763-71, 2006 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-17078573

RESUMO

OBJECTIVES: To evaluate the data of progression and survival in 43 patients who underwent cystectomy with stage pT0 according to classification TNM-2002. MATERIALS AND METHODS: between 1988 and 2003 in our center had realized 420 cystectomies, 43 patients (10.2%) had not tumor in the cystectomy specimen. RESULTS: In these 43 cases the initial clinical stage (in the transuretral resection of bladder) was T1 in 10 cases (23,3 %), T2 in 31 cases (72%) and T3 in 2 cases. As far as the degree 24 patients presented G2 (55.8%) and 19 (44.2%) were G3. Median time from the transuretral resection to the cistectomy was of 44 days at a median follow-up of 89.3 months. Progression-free survival in the 43 patients was of 180,6 months, but during the follow-up it appeared progression in 7 patients, with disease free survival at 36 months (3-126), since the date of the cistectomia. During the follow up, 5 patients died. When we analyzed the cancer-specific survival according to tumor stage, for the T2 with an average cancer-specific survival is of 180 months, decreasing to 35 months considerably for T3. Similar it happens with the degree of differentiation, significantly diminishing as it advances the degree, with an average of cancer-specific survival for the G3 at 122.6 months. In the same way it happens with pathological positive lymph nodes in the radical cistectomy, with a cancer-specific survival of 188 months when it is N0 and of 54 months if the adenopathy was positive (N+). CONCLUSION: In our experiencie urothelial carcinoma pT0 present a prolonged free period of disease (medium of 180 months). The associated factors of risk to a smaller free period of disease are high degree of differentiation (G3, 116 months), the infiltration of deep layers in the transuretral resection (T3, 32 months) and the ganglionary affectation (pN+ 45 months).


Assuntos
Cistectomia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia , Cistectomia/métodos , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/mortalidade
10.
Actas Urol Esp ; 30(8): 829-31, 2006 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-17078581

RESUMO

It is known the greater probability appearance of malignancy injuries in patients with renal graft due to its inmunosupresión. We expose a case in which after thirteen years of correct operation of the renal transplant a tumor is diagnosed of accidental form by means of ultrasonography of graft's control. It was demonstrated by percutaneous biopsy that it was a carcinoma to papilar and later transplanctectomy was made. We raised a reflection about the novo tumors on renal graft given to the high number of patients with funcionante transplant during long years and the little evidence in Literature, proposing a possible registry of such valuing its behavior and comparing it with the well-known ones on native kidneys without inmunosupresión situation.


Assuntos
Carcinoma Papilar/etiologia , Neoplasias Renais/etiologia , Transplante de Rim/efeitos adversos , Adulto , Feminino , Humanos , Fatores de Tempo
11.
Actas Urol Esp ; 29(2): 230-3, 2005 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-15881925

RESUMO

There are extreme situations in the clinical treatment of intractable hematuria (fortunately not a common disease nowadays), in which even benign process may represent a serious risk to the life of the patient and where certain aggressive procedures like cystectomy have to be considered. Our objective in this paper is to review the different existing therapeutic alternatives for the treatment of an intense type of hematuria which does not yield to continuous saline serum irrigation. This study is partly based on a recent real clinical case in which, after the administration of cyclophosphamide to a young patient with recurrent and intense hematuria, the excretion was controlled through intravesical alum irrigation of thus avoiding cystectomy, a very aggressive surgical procedure with many after-effects.


Assuntos
Antineoplásicos Alquilantes/efeitos adversos , Ciclofosfamida/efeitos adversos , Cistite/induzido quimicamente , Hematúria/induzido quimicamente , Adjuvantes Imunológicos/administração & dosagem , Adulto , Compostos de Alúmen/administração & dosagem , Cistite/tratamento farmacológico , Hematúria/tratamento farmacológico , Humanos , Masculino , Irrigação Terapêutica , Resultado do Tratamento
13.
Actas Urol Esp ; 28(5): 377-80, 2004 May.
Artigo em Espanhol | MEDLINE | ID: mdl-15264680

RESUMO

Primary prostate transitional cell carcinoma is a very uncommon tumor, that represents about 1% of all prostate tumours. In our institution, only six patients have been diagnosed with pure transitional cell prostate carcinoma until 2002. Bladder origin of the neplasic was ruled out in all cases. We report a study about the progression and survival of prostate transitional cell carcinoma. These prostatic tumours carry a poor prognostic (median survival is 4.6 months) with a strong tendency to metastatic spread. Therefore, we suggest a radical prostatectomy (without cystectomy) when it rules out bladder origin tumour.


Assuntos
Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/terapia , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/terapia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida
14.
Actas Urol Esp ; 28(10): 781-4, 2004.
Artigo em Espanhol | MEDLINE | ID: mdl-15666524

RESUMO

A 64 years-old man is treated in our hospital presenting a big tumor in glans penis. During the surgical act, another neoplasm is detected in the urethra. The microscopic study showed a concomintant epidermoid carcinoma of glans penis and urethra with non-affected tissue between both tumors.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Primárias Múltiplas , Neoplasias Penianas , Neoplasias Uretrais , Carcinoma de Células Escamosas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Penianas/patologia , Neoplasias Uretrais/patologia
15.
Actas Urol Esp ; 27(9): 662-77, 2003 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-14626675

RESUMO

We want to make in this article, a deep review of our experience in kidney transplantation since the moment we started the technique in 1986 to the end of the year 2000. We also want to make a compilation of the most important points of the surgical technique, patients selection criteria, and the most common and uncommon complications that can appear in kidney transplantation, analizing our results all along this time.


Assuntos
Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios
16.
Actas Urol Esp ; 27(1): 65-7, 2003 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-12701502

RESUMO

We want to present a case of postraumatic hematoma in a tumoral kidney. The diagnosis of the hematoma was made by abdominal scanner but not the tumor type. It was necessary the chirurgycal review and pathological study to demonstrate an angiomyolipoma as the cause of the kidney hematoma.


Assuntos
Angiomiolipoma/complicações , Hematoma/complicações , Nefropatias/complicações , Neoplasias Renais/complicações , Rim/lesões , Idoso , Feminino , Hematoma/etiologia , Humanos , Nefropatias/etiologia
17.
Actas Urol Esp ; 26(2): 139-42, 2002 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-11989429

RESUMO

Mucous cystadenomas are benign epithelial tumours with great mucous content inside. Despite being non-malignant, they acquired great size, compressing and displacing important structures and organs of the zone, with theirs unlucky outcomes. Surgical exeresis is very difficult, being almost impossible its total exeresis, showing great frequency of relapse. We present an appendix mucous cystadenoma case in a 54 years old patient.


Assuntos
Neoplasias do Apêndice , Cistadenoma Mucinoso , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/cirurgia , Cistadenoma Mucinoso/diagnóstico , Cistadenoma Mucinoso/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
18.
Actas Urol Esp ; 26(1): 46-9, 2002 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-11899740

RESUMO

Localized amyloidosis of the urethra is a rare pathological entity. Biopsy is required to make the appropriate diagnosis. Although localized therapy is available for obstructing, symptomatic lesions, asymptomatic lesions may be followed with conservative management and spontaneous regression has been reported. An appropriate medical evaluation should be performed to determine the presence of systemic amyloidosis.


Assuntos
Amiloidose/diagnóstico , Doenças Uretrais/diagnóstico , Adulto , Humanos , Masculino
19.
Actas Urol Esp ; 25(6): 452-4, 2001 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-11512515

RESUMO

Nephrogenic adenoma is a rare urothelial neoformation. It is well known the association to infective diseases and stones; the most common localization is in the bladder. We report the case of a young male without previous disease who showed a nephrogenic adenoma in the urethra, it was managed with transurethral resection and surveillance.


Assuntos
Adenoma/diagnóstico , Neoplasias Uretrais/diagnóstico , Adolescente , Humanos , Masculino , Urotélio
20.
Actas Urol Esp ; 25(4): 295-8, 2001 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-11455832

RESUMO

We report a case of female 24 years old who had a blunt abdominal trauma. The immediate consequence was the radiological evidence of a left kidney abolition, secondary to a renal artery thrombosis. The treatment was conservative, and there was not a surgical procedure.


Assuntos
Traumatismos Abdominais/complicações , Artéria Renal , Trombose/etiologia , Ferimentos não Penetrantes/complicações , Adulto , Feminino , Humanos
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