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Molina Vazquez M.E.,Complejo Hospitalario Universitario la Coruna
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2010

Dysfunctional voiding syndrome in children is characterized by a pattern of dysfunctional bladder emptying due to an active contraction of the external sphincter during micturition. Diagnosis is based on electromyographic and flowmetry results. The treatment is focused on relaxing the external sphincter during micturition where biofeedback is the treatment of choice. By the moment there are still centres without this possibility, alpha blockers are an alternative. To determine the efficacy of alpha blockers as an alternative to biofeedback as a therapeutic possibility. We included a total of 17 children with dysfunctional voiding syndrome and carried out a retrospective study. We registered age, symptoms at diagnosis, presence of associated urologic problems, flowmetry results pre and post-treatment, type of treatment used and its effectiveness comparing patients treated with alpha blockers and those who are starting to deal with biofeedback. There were 12 girls and 5 boys. The mean age at diagnosis was 4.9 years old, 88% of these children related enuresis, diurnal urinary incontinence and urgency, 57% of them had also urinary infections, 63% constipation, 36% had psychosocial problems. Ten patients were treated with alpha-antagonists: 6 with Tamsulosin and 4 with Doxazosin. They followed this treatment an average of 5.8 months, range between 2 and 12 months. Five patients were treated with biofeedback. All cases had an abnormal pelvic electromyography. Patients treated with alpha-blockers achieved a 70% of electromyographic improvement with a 70% of recurrence. In children treated with biofeedback we got improvement in 80% with no recurrence. After alpha blocker therapy, maximum flow rates and average flow values were better but not statistically significant, this difference was significant with biofeedback. A patient treated with Tamsulosin left treatment due to hypotension, 2 patients left Doxazosin because of dizziness. Alpha-blockers are effective in the treatment of dysfunctional voiding syndrome with a high percentage of recurrence. They can be an alternative to biofeedback but this one is the effective and definitive treatment. Source

Diaz-Rubio E.,Charles III University of Madrid | Gomez-Espana A.,Hospital Reina Sofia | Massuti B.,Hospital General | Sastre J.,Charles III University of Madrid | And 21 more authors.
Oncologist | Year: 2012

Purpose. The aim of this phase III trial was to compare the efficacy and safety of bevacizumab alone with those of bevacizumab and capecitabine plus oxaliplatin (XELOX) as maintenance treatment following induction chemotherapy with XELOX plus bevacizumab in the first-line treatment of patients with metastatic colorectal cancer (mCRC). Patients and Methods. Patients were randomly assigned to receive six cycles of bevacizumab, capecitabine, and oxaliplatin every 3 weeks followed by XELOX plus bevacizumab or bevacizumab alone until progression. The primary endpoint was the progression-free survival (PFS) interval; secondary endpoints were the overall survival (OS) time, objective response rate (RR), time to response, duration of response, and safety. Results. The intent-to-treat population comprised 480 patients (XELOX plus bevacizumab, n = 239; bevacizumab, n = 241); there were no significant differences in baseline characteristics. The median follow-up was 29.0 months (range, 0-53.2 months). There were no statistically significant differences in the median PFS or OS times or in the RR between the two arms. The most common grade 3 or 4 toxicities in the XELOX plus bevacizumab versus bevacizumab arms were diarrhea, hand-foot syndrome, and neuropathy. Conclusion. Although the noninferiority of bevacizumab versus XELOX plus bevacizumab cannot be confirmed, we can reliably exclude a median PFS detriment >3 weeks. This study suggests that maintenance therapy with singleagent bevacizumab may be an appropriate option following induction XELOX plus bevacizumab in mCRC patients. © AlphaMed Press. Source

del Carmen Martinez-Ballesta M.,CSIC - Center of Edafology and Applied Biology of the Segura | Bou G.,Complejo Hospitalario Universitario la Coruna | Carvajal M.,CSIC - Center of Edafology and Applied Biology of the Segura
Phytochemistry Reviews | Year: 2013

Aquaporins (AQPs) are integral membrane proteins that serve as selective pores through which water and small solutes cross the plasma membranes of many human tissue and cell types. They have been identified in epithelia and endothelia involved in fluid transport, such as kidney tubules and glandular epithelia, glial cells, epidermis, and adipocytes. The pathophysiological roles of these proteins and the primary and secondary involvement of AQPs are becoming apparent in diverse clinical disorders, from diabetes insipidus to various forms of edema. The advanced understanding of aquaporin biology, from the structural determinants of channel permeability to the assignment of their physiological function in different organs, will allow the use of AQPs as targets for the therapy of a wide array of diseases. In this review, the mode of action of clinically-effective plant formulae on human AQPs-related diseases at the molecular, cellular, and organism levels is explored. The use of pharmacological plant-derived compounds as a possible strategy in the therapy of diseases related to altered water homeostasis should stimulate debate and further research objectives. © 2013 Springer Science+Business Media Dordrecht. Source

Martin L.B.,Complejo Hospitalario Universitario la Coruna | Pereira P.P.,Complejo Hospitalario Universitario la Coruna | Lista F.S.,Service of Urology | Castanon L.B.,Complejo Hospitalario Universitario la Coruna
Archivos Espanoles de Urologia | Year: 2013

Objective: To report a case of a mesothelioma of the tunica vaginalis and to review the published literature. Methods/Results: A 61-year-old patient complained of one-month increase of right scrotum size with pain. An ultrasound showed a right hydrocele with a mass attached to the tunica vaginalis. He didn't refer any urological history or known exposure to asbestos. Blood levels of tumor markers (alpha-fetoprotein and beta-HCG) were within normal limits. We performed a radical inguinal orchiectomy with an en-bloc resection of the tunica vaginalis. The pathology described a potentially malignant biphasic mesothelioma. The patient has remained asymptomatic with negative extension studies after 10 years of follow up. Conclusions: Paratesticular mesotheliomas are rare tumors (approximately 250 cases reported) with uncertain etiology (only 30-40% are associated with asbestos exposure). The age range is between 50-70 years. Its presentation is usually as a scrotal mass with recurrent reactive hydrocele, which may delay early diagnosis. During surgery, intraoperative biopsy is recommended. It is important to do a differential diagnosis with other benign diseases. Treatment is only curative in early stages with radical orchidectomy and resection in-block of the tunica vaginalis. Despite being multidisciplinary, it is not curative in most cases due to rapid local and distant spread. Source

Martin L.B.,Complejo Hospitalario Universitario la Coruna | Valbuena L.,Complexo Hospitalario Universitario Of runa | Castanon L.B.,Complejo Hospitalario Universitario la Coruna
Archivos Espanoles de Urologia | Year: 2015

OBJECTIVE: To report two cases of urachal adenocarcinoma and to review the published literature. METHODS / RESULTS: We present a review of our urachal carcinoma cases from a third level hospital between 1990-2011 in an area of 520.000 inhabitants. Both cases were middle aged men, consulting for repeated urine infections, and abdominal mass with hematuria and mucous discharge through the urethra. They were treated initially with partial cystectomy and adjuvant treatment with chemotherapy in one case, and chemo and radiotherapy in the other. The first case died in 3 years and the other is still alive after 4 years of follow up. CONCLUSIONS: Urachal adenocarcinomas of the bladder are rare tumors the natural history of which has not changed during the last years. Open partial cystectomy with en bloc resection of the bladder dome, urachus and the umbilicus is the standard treatment in localized stages, although minimal invasive techniques appear to have the same oncological outcomes. Pelvic lymphadenectomy is advised. Most of the patients are diagnosed at an advanced local or metastatic stage. There is a need to improve diagnostic techniques for early treatment and to find new chemotherapy protocols that can help to improve these patients survival. Source

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