Ha Manzanilla-García

Emphysematous Pyelonephritis: Multicenter Clinical and Therapeutic Experience in Mexico

OBJECTIVE To analyze the outcomes of emphysematous pyelonephritis (EPN), the impact of different treatment modalities, and to determine risk factors associated with mortality. METHODS We retrospectively reviewed cases of EPN from 3 tertiary care institutions in Mexico. The diagnosis was confirmed with computed tomographic scan. Treatment was classified as follows: medical management (MM), minimally invasive, and surgical. Demographic, clinical, biochemical, and radiological characteristics were assessed and compared between survivors and nonsurvivors. Comparison was assessed using 1-way analysis of variance and chi-square. Univariate and multivariate logistic regression analyses were performed to determine prognostic factors. Main end point was mortality. RESULTS A total of 62 patients were included (49 women and 13 men), with a mean age of 53.9 years. The most common comorbidities were diabetes (69.3%) and hypertension (40.3%). Escherichia coli was the most common isolated microorganism (62.7%). MM was provided to 24.2%, minimally invasive treatment to 51.6%, open drainage to 19.3%, and emergency nephrectomy to 4.8%. Overall mortality was 14.5% and was similar among different treatment modalities (P=.06). Survivors were younger (P=.004), had lower creatinine (P=.002), and better estimated glomerular filtration rate (P=.007). In univariate analysis, age (P=.009), creatinine (P=.009), and need for nephrectomy (P=.03) were associated with mortality. In multivariate logistic regression analysis, creatinine (odds ratio 1.56, 95% confidence interval 1.03-2.35, P=.03) and nephrectomy (odds ratio 9.7, 95% confidence interval 1.007-93.51, P=.049) remained significant predictors of mortality. CONCLUSION EPN needs an aggressive MM and stepwise approach; nephrectomy should be the last resort of treatment. Creatinine level and need for nephrectomy are the strongest predictors of mortality according our analysis.

History of gonorrhea and prostate cancer in a population-based case–control study in Mexico

UNLABELLED We evaluated the association between a history of sexually transmitted diseases (STDs) and the risk for prostate cancer (PC) among Mexican males. METHODS PC incident cases (n=402) that were identified at six public hospitals in Mexico City were matched by age (±5 years) with 805 population controls with no history of PC. By face-to-face interview, we obtained information about sexual history, previous STDs, sociodemographic characteristics, and familial history of PC. An unconditional logistic regression model was used to estimate the risk for PC. RESULTS A total of 16.6% of men reported having had at least one previous STD, and the most frequently reported STD was gonorrhea (10.5%). After adjusting by PC familial history, the history of STD was associated with a two-fold greater risk of PC: odds ratio (OR)=2.67; 95% confidence interval (95% CI=1.91-3.73). When each STD was evaluated separately, only gonorrhea was associated with a significant increase in PC risk (OR=3.04; 95% CI=1.99-4.64). These associations were similar when we stratified by low-risk PC (Gleason <7) and high-risk PC (Gleason ≥7). CONCLUSION These results confirm that STDs, and particularly gonorrhea, may play an etiological role in PC among Mexican males, which is consistent with a previous report from a multiethnic cohort.

Efficacy of Tamsulosin, Oxybutynin, and their combination in the control of double-j stent-related lower urinary tract symptoms

ABSTRACT Introduction and objective Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent, indicate that these affect 73-90% of patients. We conducted a prospective, randomized study, to evaluate the efficacy of tamsulosin, oxybutinin and combination therapy in improving the urinary symptoms. Methods Patients who underwent ureteral stent placement after ureterolithotripsy (total 51), were randomized into three groups: Group I: Tamsulosin 0.4 mg. once per day(17 patients), Group II: Oxybutinin 5 mg. once per day (17 patients), Group III: Tamsulosin+ oxybutynin once per day (17 patients). All the groups received the drugs for three weeks and completed a Spanish validated Ureteral Stent Symptom Questionnaire (USSQ) at day 7 and 21. Results Repeated measures ANOVA showed mean urinary symptom index score was 22.3 vs. 15.5 in group three (p<0.001) at day 7 and 21 respectively. The mean work performance index was 6.6 vs 8.1 (p=0.049) favoring tamsulosin group, the mean sexual score was 0.5 vs 1.5 (p=0.03). Among additional problems the mean was 7.2 vs 6.2 (p=0.03). No significant difference was noted among pain and general health index. No side effects were reported. Conclusions Combination therapy with tamsulosin and oxybutynin improved irritative symptoms and work performance as well as sexual matters. Combination therapy should be considered for patients who complained of stent related symptoms.

Tumor testicular metacrónico 19 años después

Resumen Los tumores testiculares germinales son los tumores solidos mas comunes en los adolescentes y adultos jovenes entre los 15 y 35 anos. Los tumores testiculares bilaterales son raros, la incidencia de un segundo tumor testicular contralateral en pacientes con antecedente de tumor germinal es del 1% al 5% publicada en las grandes series. Se han identificado diversos factores de riesgo como la historia familiar, criptorquidia, disgenesia gonadal, infertilidad, atrofia testicular, trauma escrotal. Se sabe que el antecedente de tumor testicular germinal es el principal factor para el desarrollo de tumores testiculares contralaterales. Aproximadamente el 50% de las lesiones metacronicas aparecen en un periodo de 5 anos, se ha reportado que hasta el 23% de los pacientes presenta tumor metacronico mas de 10 anos despues. Presentamos un caso clinico de un paciente con tumor testicular metacronico, despues de 19 anos de la orquiectomia radical.

Pancreatitis posterior a resección transuretral de próstata

Resumen La pancreatitis aguda post-reseccion transuretral de prostata (RTUP) es una complicacion reportada con poca frecuencia, dicha situacion puede condicionar retraso en el diagnostico si no se considera como posibilidad, lo que requiere identificar el cuadro clinico (dolor abdominal localizado en epigastrio de moderada a gran intensidad), la determinacion de enzimas pancreaticas y la toma de estudios de imagen a tiempo. Se reportan 2 casos de paciente que desarrollan pancreatitis aguda post-RTUP, los cuales presentan evolucion torpida con falla multiorganica, que condiciona la muerte de ambos pacientes.

Estudio comparativo en el manejo laparoscópico transperitoneal y lumboscópico de quistes renales

Resumen Introduccion Los quistes renales sintomaticos requieren manejo quirurgico. Objetivo Comparar los resultados en el manejo de quistes renales mediante abordaje laparoscopico transperitoneal y lumboscopico. Material y metodo Estudio prospectivo, descriptivo, longitudinal, en pacientes con diagnostico de quiste renal Bosniak I sintomatico. Se dividen en 2 grupos: grupo 1, laparoscopia transperitoneal y grupo 2, lumboscopia. Variables: sangrado transoperatorio, dias de estancia hospitalaria y edad. Resultados Veintiocho pacientes, grupo 1: 19 pacientes, y grupo 2: 9 pacientes. Grupo 1, medias: edad 52 anos, tamano del quiste 6.6 cm, dias de estancia 1.26, sangrado transoperatorio 20.5 mL. Grupo 2, medias: edad 63 anos, tamano del quiste 7.3 cm, dias de estancia 1.11, sangrado transoperatorio 20 mL. Se encontro diferencia estadisticamente significativa en la edad (p=0.01), no asi en el tamano del quiste (p=0.3), dias de estancia (p=0.3) y sangrado transoperatorio (p=0.9). No hubo complicaciones. Discusion Se han publicado buenos resultados con el manejo laparoscopico de los quistes renales, sin embargo son series pequenas y con poco seguimiento. En la literatura se reportan promedios de sangrado transoperatorio de 70-150 cc, siendo menor en nuestro estudio (20 cc); asi como promedios de 3 dias de estancia, encontrandonos por debajo (1.2 dias). Conclusion Nuestro estudio nos aclara y aporta que no existen diferencias estadisticamente significativas entre ambos abordajes; este dependera de la localizacion del quiste, asi como la preferencia y experiencia del cirujano.