OBJECTIVES: To determine the tolerability, persistenceand satisfaction of patients with overactive bladder syndrome (OAB) treated with transdermal oxybutynin (OXY-TDS).METHODS: Observational, retrospective, multicenter study, in patients with OAB who had started treatment with OXY-TDS at least 12 months before their inclusion. Tolerability was evaluated by number, severity criteria, resolution type of adverse reactions, and cognitive function with Mini-Mental State Examination (MMSE), at 1 year of treatment. The patients who remained under treatment during the observation period were considered persistent. Patient satisfaction was evaluated using an ad hoc questionnaire.RESULTS: The clinical history of 105 patients was evaluated. 92.4% were women. The mean age of all the patients was 59.4 ± 11.8 years. After 12 months of treatment, dry mouth was present in 5.7% of patients and 27.6% had mild or moderate adverse reactions in the area of application. The persistence in treatment was 55.2%. The use of the OXY-TDS was considered comfortable or very comfortable by 92.9% of patients.CONCLUSIONS: The study performed in patients with OAB shows that OXY-TDS provides low incidence of systemic adverse effects, including dry mouth, high persistence, improved adherence rates and high satisfaction of patients after one year of treatment.
OBJECTIVES: To analyze surgery for renal cancer with venous thrombus at different levels, perioperative complications and prognostic factors associated to overall, cancer-specific and disease-free survival. MATERIAL AND METHODS: Retrospective analysis of 42 cases of renal cancer with venous thrombus performed between 2005 and 2015. The level reached by the thrombus was established according to the Mayo Clinic classification. Postoperative complications were staged according to Clavien-Dindo classification.RESULTS. Most frequent in males. Mean age 65.7 years. 16.6% were tumors with level II thrombus. Subcostal approach was performed in 58.9%. Extracorporeal circulation with cardiac arrest and hypothermia was established in 2 patients. Resection of metastatic disease was performed in 3 patients during radical nephrectomy. Reoperation was 2.3% while, perioperative mortality was 4.7%. 30% presented with metastases at diagnosis. Twenty patients progressed at 15.5 months (3-55). Overall survival was 60 months. The cancer-specific mortality was 75%. Disease-free survival was 30% at 55 months.CONCLUSIONS. Surgical treatment of renal cancer with venous thrombus requires a multidisciplinary management. The surgical technique varies according to the level reached by the venous thrombus. Tumor stage is the most important prognostic factor. Thrombus level influences prognosis, with longer survival for patients with tumor thrombus confined to the renal vein (pT3a) in comparison to tumors with thrombus in the atrium (pT3c).
Bifid Spine is a multisystem malformation incurable and transmissible with a lot of important sequelae, some of them with treatment and some other avoidable. They affect and limit not only health but social-work life too.The main objective must be prevention. The primary prevention, meaning not occurrence, could be done by recognizing the possible etiologic factors that affect the population. This is a responsibility of health policies based in scientific evidences and expert’s opinions. Secondary prevention would be to make efforts to decrease the consequences and improve newborns with bifid spine life`s quality and life expectancy. Actually, persons born with bifid spine, have a long-term life expectancy with specific necessities during their lives. The first two years of life are very important. During their adolescence and adult life, risk increases if any social-health aspect is abandoned giving up follow and self-care from the pediatrics coordinated assistance team, as it follows its natural evolution. It will cause totally avoidable complications.A patient with bifid spine is basically a person, not a group of diseases. It is essential to have a holistic and total look for each person with bifid spine and not consider the patient like a collection of troubles treated with different non coordinated specialities. The individual intervention of each medical doctor could damage and it could be better if they work coordinated for a long time. This strategy would allow improved efficiency (cost/efficacy) and quality of assistance.Every effort done and the objectives reached in childhood can be improved with the multidisciplinary coordinated assistance, but it can be lost if it does not continue during all life. It may cause a serious and evitable damage in life quality with loss of spent health resources.
OBJECTIVES: We performed thisprospective clinical study to compare the postoperativerecovery profile of our patients after transperitoneal(Group T) and retroperitoneal (Group R) laparoscopicnephrectomy approaches. Our primary hypothesis wasthat epidural analgesic consumption in Group R wouldbe higher at the end of the first postoperative day.METHODS: Forty-four patients scheduled for electivetransperitoneal or retroperitoneal laparoscopicnephrectomies were enrolled. All patients in both groupsreceived epidural catheter and general anesthesiainduction. At the end of the operation, patients were given 10 ml 0.25% bupivacaine through epiduralcatheters and extubated. Postoperatively, patients startedto receive a continuous infusion of 0.1% bupivacaineand 1μg/ml fentanyl 5ml/h with patient- controlledboluses of an additional 4ml through a patient controlledepidural analgesia (PCEA) device. They were prescribedIV tramadol 1mg/kg as a rescue analgesic (VAS≥4).Total analgesic consumption from PCEA devices andVAS scores during the first 24 postoperative hours wererecorded as well as number of patients who requiredanalgesic rescue.RESULTS: Forty patients completed the study, 20 in eachgroup. Total epidural analgesic consumption duringthe first 12 hours were significantly higher in GroupR (p<0.05). Basal, postoperative 30 min, 2, 6 hoursVASrest, VASmobilization and 12 h VASmobilizationscores, and number of patients who required rescueanalgesic at 0, 30 min in Group R were significantlyhigher than Group T (p<0.05).CONCLUSION: Retroperitoneal laparoscopicnephrectomy was found to be more painful and patientsin this group required more epidural and analgesicrescue during the first 12 postoperative hours.ClinicalStudys.gov: (NCT02622893)
OBJETIVE: We report a case of acquired renal cystic disease associated with renal dialysis and end-stage renal disease. The patient suffered the two major complications related with acquired renal cystic disease; hemorrhage and renal carcinoma. METHODS: Our case is a patient with acquired renal cystic disease, single kidney after surgery for renal clear cell carcinoma four years earlier, who developed a Wünderlich syndrome (WS).RESULTS: The histological study of the nephrectomy specimen showed a renal papillary carcinoma in the context of acquired renal cystic disease after surgery for a WS.CONCLUSIONS: Renal hemorrhage is a serious complication that can lead to a fatal outcome. Patients undergoing dialysis should be monitored actively due to the risk of developing acquired renal cystic disease and associated complications.
OBJETIVE: To describe the adult type granulosa cell testicular tumors (classified as sex cordstromal tumor) due to their behavior, hardly known with a small number of cases reported. METHOD: We report a new case of a 59-year-old man presenting an adult type granulosa cell tumor of the testis (AGCTT), painless, with a 3.3 centimeter intratesticular heterogeneous mass on ultrasound, with solid and cystic areas. Serum tumor markers and extension study were negative. RESULTS: Histologic and inmunohistochemical studies confirmed an AGCTT, similar to its ovarian counterpart. CONCLUSION: AGCTT are rare neoplasms with unpredictable behavior. Their metastatic potential has been described, reason why they need a long follow-up; however, they usually have a good prognosis.