RESUMEN
STUDY TYPE: Prognosis (case series) Level of Evidence 4. OBJECTIVE: To estimate the relative risk of developing a second primary neoplasm, in particular lung cancer, after having non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS: Patients were included in the study if they had developed NMIBC between 1995 and 2003. All clinical data were extracted from the medical records of our institution's database. The interval between neoplasms, smoking habits, histological subtypes and survival were also analysed. Patient follow-up was >or=5 years. RESULTS: We found 231 patients with NMIBC, 39 of which had a second primary neoplasm: 10 lung cancer, one pancreas, one gastric, one pharynx, one liver, one parathyroid, one oesophageal, five basal cell carcinoma, three larynx, two colon, three rectal and 10 prostate. In patients with lung cancer, NMIBC was the first primary tumour. Overall, the median (range) interval between occurrence of NMIBC and lung cancer was 54.2 (8-168) months. For the relationship between the observed and expected cases of lung cancer, after normalizing our frequencies to the sex ratio and age of our group of patients, the risk of lung cancer was 10.27-fold higher in patients with NMIBC as compared with the general population of Catalonia (95% confidence interval 4.92-18.88). CONCLUSION: We consider that an annual examination for the detection and prevention of lung cancer must be included in clinical guides for patients with NMIBC. This proposal is reinforced by the finding that death in our group of patients with both tumours was always derived from lung cancer and not from bladder cancer.
Asunto(s)
Carcinoma de Células Transicionales , Detección Precoz del Cáncer , Neoplasias Pulmonares/diagnóstico , Neoplasias Primarias Secundarias/diagnóstico , Neoplasias de la Vejiga Urinaria , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Transicionales/mortalidad , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias Primarias Secundarias/mortalidad , Factores de Riesgo , Neoplasias de la Vejiga Urinaria/mortalidadRESUMEN
OBJECTIVES: To analyze the self-learning curve of a single surgeon with holmium laser enucleation of the prostate and to evaluate the safety, effectiveness, and outcome of the procedure after 2 years of experience. METHODS: The data from the first 125 patients who underwent holmium laser enucleation of the prostate were retrospectively analyzed. The patients were assessed preoperatively and at 1, 3, 12, and 24 months postoperatively. The patient evaluations included serum prostate-specific antigen measurement, peak urinary flow rate determination, postvoid residual volume measurement, and symptom scores. To assess the effect of the learning curve on the perioperative data and complications, the patients were divided into subgroups of 25 consecutive patients. RESULTS: The mean patient age was 71.4 years. The average prostate volume was 75.8 mL, and the mean weight of the enucleated tissue was 46.7 g. The average operative time was 109.8 minutes. The operative times and enucleation and morcellation efficiency rates improved significantly during the learning process. The mean hemoglobin loss was 1.7 g/dL. The median catheter time and hospital stay was 44 and 30 hours, respectively. Compared with baseline, at 1 year postoperatively, the median postvoid residual urine volume had declined by 99 mL, the mean peak urinary flow rate had increased by 19 mL/s, and the mean American Urological Association symptom score had decreased by 16.5 points. All changes observed were significant and regardless of the prostate size. Persistent stress urinary incontinence (4.8%) occurred with the first enucleations of large-size prostates. Other complications included bladder neck contracture (4%) in small-size prostates and bulbar urethra stricture (1.6%). CONCLUSIONS: Holmium laser enucleation of the prostate is a safe, reproducible and effective surgical modality. Case selection is necessary to avoid the morbidity associated with the first stages of the self-taught learning curve, mainly urinary incontinence.
Asunto(s)
Competencia Clínica , Terapia por Láser/métodos , Hiperplasia Prostática/cirugía , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Obstrucción del Cuello de la Vejiga Urinaria/cirugía , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Humanos , Terapia por Láser/efectos adversos , Láseres de Estado Sólido , Aprendizaje , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Pautas de la Práctica en Medicina , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/diagnóstico , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVES: To report the case of a patient diagnosed with tuberous sclerosis complex (TSC), describe its clinical features, diagnosis, and to attract attention on the fact that after 40 years of follow-up, the patient has presented practically all the manifestations described in the literature. METHODS: A 42-year-old man diagnosed with.TSC presented the emergency department due to left lumbar pain and self-limited gross hematuria. On clinical examination patient was haemodynamically stable, but with decrease in haemoglobin (6.8 g/dL). Abdominal CT scan showed a 20 cm diameter heterogeneous mass in the left kidney suggesting hemorrhage of an angiomyolipoma. RESULTS: Left radical nephrectomy was performed and the pathological study of the surgical specimen confirmed the diagnosis of angiomyolipoma. Inmunohistochemical staining was positive with HMB-45. CONCLUSIONS: To recommend that patients with TSC be evaluated by a multidisciplinary group of clinicians, including urologists, neurologists and dermatologists. As patients with TSC survive into adulthood they will require more intervention by the urologist. CT scan is usually enough for the diagnosis of angiomyolipomas. Complete nephrectomy is appropriate when the whole kidney has been replaced by angiomyolipoma. The identification of molecular markers (HMB-45) facilitates histopathological diagnosis.
Asunto(s)
Esclerosis Tuberosa/diagnóstico , Adulto , Estudios de Seguimiento , Humanos , Lactante , Factores de TiempoRESUMEN
OBJETIVOS: Presentar un caso singular de un paciente diagnosticado de esclerosis tuberosa, describirsus manifestaciones clínicas, diagnóstico, y llamar la atención sobre el hecho que, tras 40 años de seguimientoel paciente ha presentado prácticamente todas las manifestaciones descritas en la literatura.MÉTODOS: Hombre de 42 años de edad diagnosticadode esclerosis tuberosa que acude a urgencias por dolor lumbar izquierdo y hematuria macroscópica autolimitada.A la exploración física el paciente se presentabahemodinámicamente estable, pero con disminución de la hemoglobina (6.8g/ dL). El TAC abdominal mostrabauna masa heterogénea de 20 cm. de diámetro en el riñón izquierdo que sugirió hemorragia de angiomiolipoma. RESULTADOS: Se realizó nefrectomía radical izquierda y el estudio patológico de la pieza quirúrgica confirmó el diagnóstico de angiomiolipoma. El estudio inmunohistoquímicofue positivo para HMB-45.CONCLUSIONES: Recomendamos que los pacientes con esclerosis tuberosa sean evaluados por un grupo clínico multidisciplinar, que incluyan urólogos, neurólogosy dermatólogos. Como los pacientes con esclerosistuberosa llegan a la edad adulta requerirán más intervención por los urólogos. El TAC es normalmente suficiente para diagnosticar el angiomiolipoma. La nefrectomíatotal es apropiada cuando todo el riñón está reemplazado por el angiomiolipoma. La identificación de marcadores moleculares (HMB-45) facilita el diagnósticohistopatológico
OBJECTIVES: To report the case of a patient diagnosed with tuberous sclerosis complex (TSC), describe its clinical features, diagnosis, and to attract attention on the fact that after 40 years of follow-up, the patient has presented practically all the manifestations described in the literature.METHODS: A 42 year-old man diagnosed with TSC presented the emergency department due to left lumbar pain and self-limited gross hematuria. On clinicalexamination patient was haemodynamically stable, but with decrease in haemoglobin (6.8g/ dL). Abdominal CT scan showed a 20 cm diameter heterogeneous mass in the left kidney suggesting hemorrhage of anangiomyolipoma.RESULTS: Left radical nephrectomy was performed and the pathological study of the surgical specimen confirmed the diagnosis of angiomyolipoma. Inmunohistochemical staining was positive with HMB-45.CONCLUSIONS: To recommend that patients with TSC be evaluated by a multidisciplinary group of clinicians, including urologists, neurologists and dermatologists. As patients with TSC survive into adulthood they will requiremore intervention by the urologist. CT scan is usually enough for the diagnosis of angiomyolipomas. Complete nephrectomy is appropriate when the whole kidney has been replaced by angiomyolipoma. The identification of molecular markers (HMB-45) facilitates histopathological diagnosis