http://hdl.handle.net/10171/197 2013-06-18T04:36:59Z http://hdl.handle.net/10171/22961 Title: Adrenalectomía laparoscópica por metástasis metácrona. Experiencia en 12 casos Author(s) : Pascual-Piedrola, J.I. (Juan Ignacio); Rincon-Mayans, A. (Anibal); Tolosa-Eizaguirre, E. (Egoitz); Barba, J.F. (Javier Fermín); Romero-Vargas, L. (Luis); Rosell, D. (David) Abstract: To assess the peroperative and oncological results of laparoscopic adrenalectomy for an isolated metastasis. MATERIAL AND METHODS: A retrospective, descriptive study was conducted of 12 laparoscopic adrenalectomies performed for metastases out of a total of 40 adrenalectomies performed from May 1998 to April 2009. The primary tumor was pulmonary in 7 patients, renal in 3, and colonic in 2. Demographic data collected included median age, operating time, blood loss, complications, tumor size, and length of hospital stay. The Kaplan-Meier method was used to analyze survival. RESULTS: Operating time was 150 min (range, 90-206). Peroperative bleeding was 60 ml (range, 15-150). Peroperative complications occurred in 3% of patients. Tumor size was 4.5 cm (range, 1.3-8.5). No positive margins were seen in the resected specimens. Hospital stay was 3 days (range 3-5). Actuarial survival was 55.6% at 23 months (range, 2-38) with mean and median follow-up times of 20.9 and 23 months. CONCLUSIONS: In selected patients, laparoscopic adrenalectomy for metastasis is a safe procedure with oncological results superimposable to those of open surgery. 2009-12-31T23:00:00Z http://hdl.handle.net/10171/22959 Title: Complicaciones quirúrgicas en el trasplante renal y su influencia en la supervivencia del injerto Author(s) : Barba, J.F. (José Fermín); Rincon-Mayans, A. (Anibal); Tolosa-Eizaguirre, E. (Egoitz); Romero-Vargas, L. (Luis); Rosell, D. (David); Robles, J.E. (José Enrique); Zudaire, J.J. (Juan Javier); Berian-Polo, J.M. (José María); Pascual-Piedrola, J.I. (Juan Ignacio) Abstract: Objectives: To analyze surgical complications in kidney transplantation and their influence on graft survival. Materials and methods: A retrospective analysis was made of the early and late surgical complications occurring in 216 consecutive kidney transplants performed at our institution and their influence on graf tsurvival. Results: At least one surgical complication occurred in 82(38%)of the 216 transplantations, and 68(31%)required some type of repeat surgery,23 in the early post operative period and 45 more than 3 months after surgery. Mean follow–up was 48 months(SD þ/ 33.4), and median follow–up 48 months(range,0–166months). No recipient or donor factor spredisposing to surgical complications were found. Graft survival was significantly shorter in patients with surgical complications [3-and 5-year survival rates of 86%(95%CI83%–89%)and 78%(95%CI73%–82%)as compared to 92% (95%CI90%–94%)and 88%(95%CI85%–91%),p:0.004].Early repeat surgery, venous thrombosis, and wound infection were among the complications having an independent influence on graft survival. A multivariate analysis of graft survival in the whole groups howed early repeat surgery to bea factor with an independent prognostic value (OR:4.7;95%CI2.2–10,po0.0001). Delayed function and donor age older than 60 years were the other independent influential factors. Conclusion: Surgical complications have an influence on graft survival.Then eed for early repeat surgery, delayed function, and donor age older than 60 years are independent predictors of graft survival. 2009-12-31T23:00:00Z http://hdl.handle.net/10171/22920 Title: Factores influyentes en el tiempo hasta la progresión bioquímica después de prostatectomía radical Author(s) : Barba, J. (Joaquín); Brugarolas, X. (X.); Tolosa-Eizaguirre, E. (Egoitz); Rincon-Mayans, A. (Anibal); Romero-Vargas, L. (Luis); Rosell, D. (David); Robles, J.E. (José Enrique); Zudaire, J.J. (Juan Javier); Berian-Polo, J.M. (José María); Pascual-Piedrola, J.I. (Juan Ignacio) Abstract: INTRODUCTION: We assessed the time-influencing clinical-pathological factors for biochemical progression of an equal series of patients from a single institution. MATERIALS AND METHODS: Retrospective analysis of 278 patients with biochemical progression following prostatectomy. We considered biochemical progression to be PSA>0.4 ng/ml. We performed the trial using the Cox model (univariate and multivariate) and using the Student's t-test to compare averages. RESULTS: With a mean follow-up of 4 (±3 DE) years, the univariate study showed a mean until progression for the Gleason score 2-6 in the biopsy of 824 days and 543 for the Gleason score 7-10 (p=0.003). For negative surgical margins, the mean was 920 days and 545 for positive margins (p=0.0001). In the case of a Gleason score 2-7 in the specimen, the mean was 806 days and 501 for a Gleason score 8-10 (p=0.001). Lastly, the mean for the cases with Ki-67 negative in the specimen (< 10%) was 649 days and 345 for Ki-67 positive (> 10%) (p=0.003). In the multivariate study, Ki-67 (OR 1.028; IC 95% 1-1.01; p=0.0001) and Gleason score 8-10 (OR 1.62; IC 95% 1.5-2.45; p=0.026) in the specimen, and initial PSA >10 ng/ml (OR 1.02; IC 95% 1.01-1.04; p=0.0001) were independent variables. Using these variables, we designed a predictive model with three groups. The time until the progression of each group was 1,081, 551 and 218 days respectively. CONCLUSION: The Gleason score 7-10 in the prostate biopsy, the presence of Ki-67, the positive margins and the Gleason score 8-10 in the specimen, and the initial PSA > 10 ng/ml are time-influencing factors until biochemical progression. Pathological Gleason score 8-10, PSA > 10 ng/ml and Ki-67 are independent factors. 2010-12-31T23:00:00Z http://hdl.handle.net/10171/22912 Title: Valor de la PET en la recurrencia del cáncer de próstata con PSA < 5 ng/ml Author(s) : Rioja-Zuazu, J. (Jorge); Rodriguez, M. (Macarena); Rincon-Mayans, A. (Aníbal); Sainz-Sansi, A. (Abel); Zudaire, J.J. (Juan Javier); Martinez-Monge, R. (Rafael); Richter, J.A. (José Ángel); Berian-Polo, J.M. (José María) Abstract: We intend to evaluate the usefulness of PET scans in diagnosing recurrent prostate cancer after a curative attempt using radical treatment. MATERIAL AND METHODS: 92 consecutive prostate cancer patients in biochemical progression following radical surgery (63) or radiation treatment (29) were studied with positron emission tomography (PET). In all cases two scans were performed in the same day (11C-choline and 18F-FDG). PET efficacy was evaluated both globally (by employing the results achieved with both 11C-choline and 18F-FDG) and using both radiotracers independently to detect recurrence in patients with biochemical progression. For this purpose, we used comparison of means for k-independent samples, 2 x 2 and 2 x X contingency tables and ROC curves. RESULTS: 1. Global PET: there is evidence of PET alteration regarding the PSA level (P=.003): the clinical stage (P=.01). There are no statistically significant PET alterations regarding the affected biopsy (uni or bilateral), surgical margins, pathological stage and time to progression. ROC curve PET-PSA is statistically significant (P< .0001) permitting calculation of different cut-off points, with a specificity of 91% (highest) for a PSA of 4.3 ng/ml. 2. PET 18FDG: the area under the ROC curve is statistically significant (P< .0001) with a specificity of 91% for a PSA of 6.51 ng/ml. 3. PET 11choline: the area under the ROC curve is statistically significant (P< .0001) with a specificity of 91% for a PSA of 5.15 ng/ml. CONCLUSIONS: PET is a useful tool for diagnosing prostate cancer recurrence after a curative attempt using radical treatment. 2008-12-31T23:00:00Z http://hdl.handle.net/10171/22873 Title: La incontinencia urinaria Author(s) : Robles, J.E. (José Enrique) Abstract: Urinary incontinence, understood as any involuntary loss of urine, constitutes an important medical and social problem. It can be classified as stress urinary incontinence, urgent urinary incontinence or mixed urinary incontinence. The proportions of these three types of urinary incontinence are difficult to establish and vary notably between sources, but they might be about 40, 33 and 20% respectively. Its diagnosis requires a correct clinical history and physical exploration, together with some complementary explorations. The first therapeutic step consists of hygienicdietary measures and behaviour modification techniques. Pharmacological treatment is specific for each type of urinary incontinence, using anticholinergics and inhibitors of serotonin reuptake. Finally, different surgical techniques have a role in cases where conservative treatments fail or when dealing with severe urinary incontinence. 2005-12-31T23:00:00Z