12 research outputs found

    Factores pronósticos clínico patológicos de progresión tras prostatectomía radical

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    Introducción: En cáncer de próstata constituye uno de los principales problemas de salud a nivel mundial por incidencia, mortalidad y gasto sanitario. Por ende, un manejo individualizado de la enfermedad se hace necesario con objeto de garantizar a cada paciente el mejor tratamiento en el momento más adecuado. En este sentido, el conocimiento de los factores pronósticos que puedan predecir eventos adversos de la enfermedad, nos ayudarán en la toma de decisiones clínicas. Objetivos: El objetivo principal de este trabajo contempla la identificación de factores pronósticos, clínicos y patológicos, de progresión tras prostatectomía radical, en pacientes de nuestro entorno sanitario. Como objetivos secundarios se analizará la variabilidad interobservador en el estudio histopatológico del grado tumoral, la infra/sobre gradación y estadificación de la biopsia frente a la pieza quirúrgica y el valor pronóstico de los nuevos grupos ISUP 2014 en nuestra institución. Material y Métodos: Para ello, se realiza un estudio de cohorte retropsectivo, incluyendo un total de 306 pacientes intervenidos de prostatectomía radical laparaoscópica entre 2004-2010, con un seguuimiento medio de 93 meses. Se analiza la asociación de: edad, nivel de PSA, densidad de PSA, estadio clínico, volumen tumoral, score Gleason, estadio patológico, márgenes quirúrgicos, invasión linfovascular, infiltración perineural y afectación ganglionar con la progresión bioquímica y metastásica. Se realiza análisis univariante, bivariante, regresión logística y determinaciones de funciones de supervivencia mediante Kaplan-Meyer y regresión de cox. Resultados: El estadiaje clínico, el nivel de PSA, el score Gleason de la biopsia prostática y el número de cilindros positivos, se muestran como factores preoperatorios pronósticos independientes de progresión bioquímica. El score Gleason de la pieza quirúrgica, el estadiaje patológico y la infiltración perineural, se comportan como factores postoperatorios pronósticos independientes de progresión bioquímica. El estadiaje clínico, el nivel de PSA, el score Gleason de la biopsia y el porcentaje de afectación tumoral, son factores preoperatorios pronósticos independientes de supervivencia libre de progresión bioquímica. El score Gleason de la pieza quirúrgica, el estadiaje patológico, la infiltración perineural y la multifocalidad de los márgenes quirúrgicos, se presentan como factores postoperatorios pronósticos independientes de supervivencia libre de progresión bioquímica. El estadiaje clínico, el score Gleason de la pieza quirúrgica, el estadiaje patológico, la invasión perineural y la invasión linfovascular se asocian al riesgo de padecer progresión metastásica

    Transperineal vascular grafts

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    Varias situaciones clínicas de etiologías distintas, onco-urológicas, infecciones protésicas, traumatismos con graves pérdidas de sustancia, etc. pueden requerir la revascularización de la extremidad por áreas vasculares alejadas de la zona inguinal. El bypass cruzado fémoro-femoral con tunelización transperineal es una técnica de recurso fiable y válida en estas situaciones donde no podemos obtener con seguridad un aporte sanguíneo por vía ortoanatómica. En este artículo sistematizamos sus características técnicas y las indicaciones de este inusual bypass con el objetivo de que esté presente en el arsenal terapéutico de aquellos cirujanos vasculares que se enfrentan a situaciones de emergencia.Several clinical situations of different etiologies, onco-urologic, graft infections, groin traumatism with loss of substance, etc. may require urgent revascularization away from the groin area. The femoro-femoral bypass with transperineal tunneling technique is a reliable and valid resource in these situations where we cannot get safe blood supply via orthoanatomic ways. This article systematize their technical characteristics and indications of this unusual bypass in order to be present in the armamentarium of vascular surgeons those facing emergencies

    Everolimus safety and efficacy for renal angiomyolipomas associated with tuberous sclerosis complex: A Spanish expanded access trial

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    Background: Renal angiomyolipomas (AML) are usual manifestations of tuberous sclerosis complex (TSC) that may cause aneurism-related haemorrhages and renal impairment. Everolimus has emerged as an alternative to surgery/embolization. We provide further insight into everolimus safety and efficacy for TSC-related AML. Methods: This was a Spanish expanded access trial including patients aged ≥18 years with TSC-related AML. They received 10 mg everolimus once daily until AML progression, unacceptable toxicity, death/withdrawal, commercialisation for TSC-related AML, or 1 year after first patient enrolment. The primary outcome was dose-limiting safety according to grade 3/4 adverse events, serious adverse events, or adverse events leading to treatment modification. Secondary outcomes included overall safety and efficacy. Results: Nineteen patients were enrolled and received everolimus for a median of 6.6 (5.3-10.9) months. Eleven (57.9 %) remained on 10 mg/day throughout the study and eight (42.1 %) required treatment modifications due to adverse events; none permanently discontinued treatment. Adverse events were overall grade 1/2 and most frequently included aphthous stomatitis/mucosal inflammation, hypercholesterolaemia/hypertriglyceridaemia, urinary tract infection, hypertension, dermatitis acneiform, and insomnia. Four (21.1 %) patients experienced grade 3 adverse events, none was grade 4, and only one (5.3 %) was serious (pneumonia). AML volume was reduced ≥30 % in 11 (57.9 %) patients and ≥50 % in 9 (47.4 %); none progressed. Right and left kidney sizes decreased in 16 and 14 patients, respectively. Conclusions: These findings support the benefit of everolimus for renal AML due to a manageable safety profile accompanied by reduced AML and kidney volumes. Trial registration: EudraCT number 2012-005397-63; date of registration 22 Nov 2012.This work was funded by Novartis Farmacéutica S.A., which was involved in study design, data analysis and interpretation, and writing of the manuscrip

    Isolation and characterization of myogenic precursor cells from human cremaster muscle

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    Human myogenic precursor cells have been isolated and expanded from a number of skeletal muscles, but alternative donor biopsy sites must be sought after in diseases where muscle damage is widespread. Biopsy sites must be relatively accessible, and the biopsied muscle dispensable. Here, we aimed to histologically characterize the cremaster muscle with regard number of satellite cells and regenerative fibres, and to isolate and characterize human cremaster muscle-derived stem/precursor cells in adult male donors with the objective of characterizing this muscle as a novel source of myogenic precursor cells. Cremaster muscle biopsies (or adjacent non-muscle tissue for negative controls; N=19) were taken from male patients undergoing routine surgery for urogenital pathology. Myosphere cultures were derived and tested for their in vitro and in vivo myogenic differentiation and muscle regeneration capacities. Cremaster-derived myogenic precursor cells were maintained by myosphere culture and efficiently differentiated to myotubes in adhesion culture. Upon transplantation to an immunocompromised mouse model of cardiotoxin-induced acute muscle damage, human cremaster-derived myogenic precursor cells survived to the transplants and contributed to muscle regeneration. These precursors are a good candidate for cell therapy approaches of skeletal muscle. Due to their location and developmental origin, we propose that they might be best suited for regeneration of the rhabdosphincter in patients undergoing stress urinary incontinence after radical prostatectomy.We thank patients and medical personnel for their generous involvement in the study. We also acknowledge the help of Biodonostia Animal and Experimental Operations Facility. This work was supported by grants from Ministerio de Economia y Competitividad (RTC-2015-3750-1) and Instituto de Salud Carlos III (PI13/02172, PI16/01430) to A.I., co-funded by the European Union (ERDF/ESF, 'Investing in your future'). N.N.-G. received a studentship from the Department of Education, University and Research of the Basque Government (PRE2013-1-1168). A.L.M. was funded by grants from FIS (PI17/01841 and PI14/00436), CIBERNED and the Basque Government (2015/11038, RIS3 2017222021 and BIO16/ER/022). M.F.L.-C. was supported by the Servicio Andaluz de Salud from the Consejeria de Salud de la Junta de Andalucia, grant PI 0222-2014, co-funded by the European Union (ERDF/ESF). I.M.A was funded by grants from Ministerio de Economia y Competitividad (PEJ-2014-P-01215 and FJCI-2016-28121)

    Cell Therapy Clinical Trials for Stress Urinary Incontinence: Current Status and Perspectives.

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    Stress urinary incontinence (SUI) affects 200 million people worldwide. Standard therapies often provide symptomatic relief, but without targeting the underlying etiology, and show tremendous patient-to-patient variability, limited success and complications associated with the procedures. We review in this article the latest clinical trials performed to treat SUI using cell-based therapies. These therapies, despite typically including only a small number of patients and short term evaluation of results, have proven to be feasible and safe. However, there is not yet a consensus for the best cell source to be used to treat SUI and not all patients may be suitable for these therapies. Therefore, more clinical trials should be promoted recruiting large number of patients and evaluating long term results

    New Perspectives on the Role of Liquid Biopsy in Bladder Cancer: Applicability to Precision Medicine

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    Bladder cancer (BC) is one of the most common tumors in the world. Cystoscopy and tissue biopsy are the standard methods in screening and early diagnosis of suspicious bladder lesions. However, they are invasive procedures that may cause pain and infectious complications. Considering the limitations of both procedures, and the recurrence and resistance to BC treatment, it is necessary to develop a new non-invasive methodology for early diagnosis and multiple evaluations in patients under follow-up for bladder cancer. In recent years, liquid biopsy has proven to be a very useful diagnostic tool for the detection of tumor biomarkers. This non-invasive technique makes it possible to analyze single tumor components released into the peripheral circulation and to monitor tumor progression. Numerous biomarkers are being studied and interesting clinical applications for these in BC are being presented, with promising results in early diagnosis, detection of microscopic disease, and prediction of recurrence and response to treatment

    Isolation and characterization of myogenic precursor cells from human cremaster muscle

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    Human myogenic precursor cells have been isolated and expanded from a number of skeletal muscles, but alternative donor biopsy sites must be sought after in diseases where muscle damage is widespread. Biopsy sites must be relatively accessible, and the biopsied muscle dispensable. Here, we aimed to histologically characterize the cremaster muscle with regard number of satellite cells and regenerative fibres, and to isolate and characterize human cremaster muscle-derived stem/precursor cells in adult male donors with the objective of characterizing this muscle as a novel source of myogenic precursor cells. Cremaster muscle biopsies (or adjacent non-muscle tissue for negative controls; N = 19) were taken from male patients undergoing routine surgery for urogenital pathology. Myosphere cultures were derived and tested for their in vitro and in vivo myogenic differentiation and muscle regeneration capacities. Cremaster-derived myogenic precursor cells were maintained by myosphere culture and efficiently differentiated to myotubes in adhesion culture. Upon transplantation to an immunocompromised mouse model of cardiotoxin-induced acute muscle damage, human cremaster-derived myogenic precursor cells survived to the transplants and contributed to muscle regeneration. These precursors are a good candidate for cell therapy approaches of skeletal muscle. Due to their location and developmental origin, we propose that they might be best suited for regeneration of the rhabdosphincter in patients undergoing stress urinary incontinence after radical prostatectomy

    Isolation and characterization of myogenic precursor cells from human cremaster muscle

    No full text
    Human myogenic precursor cells have been isolated and expanded from a number of skeletal muscles, but alternative donor biopsy sites must be sought after in diseases where muscle damage is widespread. Biopsy sites must be relatively accessible, and the biopsied muscle dispensable. Here, we aimed to histologically characterize the cremaster muscle with regard number of satellite cells and regenerative fibres, and to isolate and characterize human cremaster muscle-derived stem/precursor cells in adult male donors with the objective of characterizing this muscle as a novel source of myogenic precursor cells. Cremaster muscle biopsies (or adjacent non-muscle tissue for negative controls; N = 19) were taken from male patients undergoing routine surgery for urogenital pathology. Myosphere cultures were derived and tested for their in vitro and in vivo myogenic differentiation and muscle regeneration capacities. Cremaster-derived myogenic precursor cells were maintained by myosphere culture and efficiently differentiated to myotubes in adhesion culture. Upon transplantation to an immunocompromised mouse model of cardiotoxin-induced acute muscle damage, human cremaster-derived myogenic precursor cells survived to the transplants and contributed to muscle regeneration. These precursors are a good candidate for cell therapy approaches of skeletal muscle. Due to their location and developmental origin, we propose that they might be best suited for regeneration of the rhabdosphincter in patients undergoing stress urinary incontinence after radical prostatectomy
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