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Hinojosa-González DE, Saffati G, Kronstedt S, La T, Chiu C, Wahlstedt E, Jones JA, Kadmon D, Badal J, Taylor JM, Slawin JR. Comparison of peritoneal interposition flaps and sealants for prevention of lymphocele after robotic radical prostatectomy and pelvic lymph node dissection: a systematic review, meta-analysis, Bayesian network meta-analysis, and meta-regression. J Robot Surg 2024; 18:177. [PMID: 38630430 DOI: 10.1007/s11701-024-01918-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024]
Abstract
Lymphocele is one of the most common complications after radical prostatectomy. Multiple authors have proposed the use of vessel sealants or peritoneal interposition techniques as preventive interventions. This study aimed to aggregate and analyze the available literature on different interventions which seek to prevent lymphocele through a Bayesian Network. A systematic review was performed to identify prospective studies evaluating strategies for lymphocele prevention after robot assisted laparoscopic prostatectomy + pelvic lymph node dissection. Data was inputted into Review Manager 5.4 for pairwise meta-analysis. Data was then used to build a network in R Studio. These networks were used to model 200,000 Markov Chains via MonteCarlo sampling. The results are expressed as odds ratios (OR) with 95% credible intervals (CrI). Meta-regression was used to determine coefficient of change and adjust for pelvic lymph node dissection extent. Ten studies providing data from 2211 patients were included. 1097 patients received an intervention and 1114 patients served as controls. Interposition with fenestration had the lowest risk of developing a lymphocele (OR 0.14 [0.04, 0.50], p = 0.003). All interventions, except sealants or patches, had significant decreased odds of lymphocele rates. Meta-analysis of all the included studies showed a decreased risk of developing a lymphocele (OR 0.42 [0.33, 0.53], p < 0.00001) for the intervention group. Perivesical fixation and interposition with fenestration appear to be effective interventions for reducing the overall incidence of lymphocele.
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Affiliation(s)
- David E Hinojosa-González
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA.
| | - Gal Saffati
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
| | - Shane Kronstedt
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
| | - Troy La
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
| | | | - Eric Wahlstedt
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jeffrey A Jones
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Dov Kadmon
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Justin Badal
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Jennifer M Taylor
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Jeremy R Slawin
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
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Hinojosa-Gonzalez DE, Nolazco JI, Saffati G, Kronstedt S, Jones JA, Kadmon D, Badal J, Slawin JR. Oncologic Outcome of the Extent of Pelvic Lymph Node Dissection During Radical Prostatectomy: A Systematic Review, Meta-analysis, and Network Analysis. Eur Urol Focus 2024:S2405-4569(24)00002-6. [PMID: 38242825 DOI: 10.1016/j.euf.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/13/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
CONTEXT Some authors propose extended pelvic lymph node dissection (ePLND) to enhance diagnostic and therapeutic outcomes in patients with localized prostate cancer. However, recent evidence found no difference in biochemical recurrence (BCR). OBJECTIVE To stratify and analyze available evidence on ePLND and its impact on BCR in patients with localized prostate cancer. EVIDENCE ACQUISITION We systematically reviewed the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify studies up to November 2023. We identified original articles that presented statistical comparisons through Cox regressions reported as hazard ratio (HR) or survival curve data reported as Kaplan-Meier curve differences in BCR in patients undergoing radical prostatectomy and stratified by the extent of lymph node dissection for localized prostate cancer. EVIDENCE SYNTHESIS We identified 12 studies, with two being randomized controlled trials (RCTs). The RCTs showed no benefit of ePLND with an HR of 1.03 ([0.92, 1.14], p = 0.61). A combined analysis with the ten retrospective studies revealed a notable reduction in BCR with an HR of 0.68 ([0.52, 0.88], p = 0.003). A subgroup analysis based on the extent of dissection demonstrated that studies focusing on the more conservative extended template of dissection did not show significant BCR benefit (HR 0.97 [0.72, 1.32], p = 0.86). In contrast, dissections that expanded the anatomical extent showed decreased BCR (HR 0.56 [0.41, 0.75], p < 0.0001). A Bayesian network analysis highlights significant differences in BCR reduction between different dissection approaches, indicating the potential benefits of specific dissection templates. CONCLUSIONS Available literature on the extent of pelvic lymph node dissection needs to be improved in quality and varying definitions of the ePLND template. Dissection of the common iliac nodes may be beneficial. PATIENT SUMMARY There is a potential benefit in removing more lymph nodes during radical prostatectomy. However, more research is needed to determine whether this strategy benefits certain patient groups.
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Affiliation(s)
| | - Jose I Nolazco
- Division of Urology, Brigham and Women's Hospital, Boston, TX, USA
| | - Gal Saffati
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Shane Kronstedt
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey A Jones
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Dov Kadmon
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Justin Badal
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Jeremy R Slawin
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Scovell JM, Pastuszak AW, Slawin J, Badal J, Link RE, Lipshultz LI. Author Reply. Urology 2017; 99:202. [DOI: 10.1016/j.urology.2016.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pastuszak AW, Moon YM, Scovell J, Badal J, Lamb DJ, Link RE, Lipshultz LI. Poor Sleep Quality Predicts Hypogonadal Symptoms and Sexual Dysfunction in Male Nonstandard Shift Workers. Urology 2016; 102:121-125. [PMID: 27988267 DOI: 10.1016/j.urology.2016.11.033] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 10/26/2016] [Accepted: 11/19/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate the impact of sleep quality in hypogonadal symptoms and sexual function in men working nonstandard shifts. MATERIALS AND METHODS Men treated at a single andrology clinic between July and October 2014 completed questionnaires assessing sleep quality, hypogonadal symptoms (Androgen Deficiency in the Aging Male [ADAM/qADAM]), and sexual function (International Index of Erectile Function [IIEF]). Serum hormone levels were assessed at the time of survey completion. RESULTS One hundred eighty-two men were identified as working nonstandard shifts (work that starts before 7 a.m. or after 2 p.m., rotates, or regularly includes hours outside of the standard 7 a.m. to 6 p.m. workday) with a mean ± SD age of 41.1 ± 10.8 years. Of men working nonstandard shifts, those with better sleep quality had fewer hypogonadal symptoms and better sexual function. Multivariate regression analysis revealed significant linear associations between sleep quality and qADAM score (P = .008), positive ADAM responses (P = .003), and IIEF score (P = .0004). When comparing individual groups, men who were "very satisfied" (n = 60) with sleep quality had higher qADAM scores than men who were "somewhat dissatisfied" (P = .02), and men who were "very dissatisfied" had significantly lower IIEF scores than men who were "very satisfied" (P = .001) and "somewhat satisfied" (P = .005). No associations between sleep quality and mean serum testosterone, free testosterone, estrogen, dehydroepiandrosterone, follicle-stimulating hormone, and luteinizing hormone levels were observed. CONCLUSION Men who work nonstandard shifts and have poor sleep quality are at increased risk for hypogonadal symptoms and sexual dysfunction.
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Affiliation(s)
- Alexander W Pastuszak
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Division of Male Reproductive Medicine and Surgery, Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX.
| | | | - Jason Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Division of Male Reproductive Medicine and Surgery, Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
| | | | - Dolores J Lamb
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Division of Male Reproductive Medicine and Surgery, Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX; Department of Cell and Molecular Biology, Baylor College of Medicine, Houston, TX
| | - Richard E Link
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Division of Male Reproductive Medicine and Surgery, Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
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Cuesta-Lasso M, Vieira-Barros A, Dolz-Marco R, Roig-Revert MJ, Badal J, Amselem L, Díaz-Llopis M, Gallego-Pinazo R. Intravitreal therapies for non-neovascular age-related macular degeneration with intraretinal or subretinal fluid. ACTA ACUST UNITED AC 2016; 92:101-106. [PMID: 27912913 DOI: 10.1016/j.oftal.2016.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/30/2016] [Accepted: 10/01/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the efficacy of intravitreal therapies in cases of atrophic age-related macular degeneration (AMD) with subretinal or intraretinal fluid. METHODS A retrospective review was made of the clinical charts of patients diagnosed with atrophic AMD with subretinal or intraretinal fluid. Fundus photographs and spectral-domain optical coherence tomography images were examined, and an analysis was made on the presence of fluid and its density. Neovascularisation was ruled out by fluorescein and/or indocyanine green angiography. RESULTS The study included 14 eyes from 13 patients with a mean age of 72.64 years and a mean follow-up of 80.5 weeks. Intraretinal fluid was observed in 6 eyes (42.9%), while subretinal fluid was shown in 8 eyes (57.1%), with high density in 4 eyes (28.5%), and low density in 4 eyes (28.5%). Snellen best-corrected visual acuity improved from 0.37 at baseline to 0.56 at the final visit (P=.002). Central subfield thickness (microns) significantly decreased (P<.001) from 291.0 at baseline to 228.9 at the final visit. Eight eyes received ranibizumab, 5eyes received bevacizumab, and one case received triamcinolone. CONCLUSIONS Cases of atrophic AMD may present with subretinal or intraretinal fluid in the absence Neovascularisation. Further studies are required to analyse the value of this finding as a risk factor of developing advanced forms of AMD, as well as the efficacy of intravitreal therapies.
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Affiliation(s)
- M Cuesta-Lasso
- Servicio de Oftalmología, Complejo Asistencial Universitario de León , León, España
| | - A Vieira-Barros
- Serviço de Oftalmologia, Centro Hospitalar Entre Douro e Vouga, Santa María da Feira, Portugal
| | - R Dolz-Marco
- Instituto de Investigaciones Sanitarias La Fe, Hospital Universitario y Politécnico La Fe, Valencia, España; RETICS RD160008 Enfermedades Oculares. Prevención, Detección precoz, Tratamiento y Rehabilitación de las Enfermedades Oculares, Madrid, España
| | | | - J Badal
- Servicio de Oftalmología, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, España
| | - L Amselem
- Servicio de Oftalmología, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, España
| | - M Díaz-Llopis
- Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - R Gallego-Pinazo
- Instituto de Investigaciones Sanitarias La Fe, Hospital Universitario y Politécnico La Fe, Valencia, España; RETICS RD160008 Enfermedades Oculares. Prevención, Detección precoz, Tratamiento y Rehabilitación de las Enfermedades Oculares, Madrid, España; Unidad de Mácula, Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España.
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Scovell JM, Pastuszak AW, Slawin J, Badal J, Link RE, Lipshultz LI. Impaired Sleep Quality is Associated With More Significant Lower Urinary Tract Symptoms in Male Shift Workers. Urology 2016; 99:197-202. [PMID: 27639796 DOI: 10.1016/j.urology.2016.05.076] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 05/16/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the association between sleep quality and severity of lower urinary tract symptoms (LUTS) in men working nonstandard shifts, a population at risk of poor sleep quality. METHODS Men who presented to a single andrology clinic between July and October 2014 and worked nonstandard shifts completed the International Prostate Symptom Score (IPSS) and responded to questions regarding their work habits, sleep quality, and physical or cognitive function. We assessed the relationship between age, sleep quality, physical or cognitive function, and severity of LUTS. RESULTS A total of 228 men with a mean ± standard deviation age of 41.8 ± 5.7 (range 21-76) years reported working nonstandard shifts, with the majority working these shifts for more than 1 year (81%). Men with difficulties falling asleep reported more severe LUTS than men who did not have difficulty falling asleep (IPSS score 9 vs 6, P <.001). Men who reported difficulty staying asleep or falling back asleep after awakening also reported more severe LUTS (IPSS scores 6 vs 13, P = .004; 5 vs 13, P <.001, respectively). Men with a decreased sense of well-being or decreased physical or cognitive function also reported more severe LUTS (IPSS score 6 vs 9, P <.0010; 6 vs 10, P = .016, respectively). All findings were independent of subject age. CONCLUSION Men working nonstandard shifts who have difficulty falling asleep, staying asleep, and falling back asleep report more severe LUTS than men without similar sleep difficulties. Men with a decreased sense of well-being or decreased physical or cognitive function also report worse LUTS. These findings implicate sleep quality as a possible risk factor for LUTS symptom severity.
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Affiliation(s)
- Jason M Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
| | - Alexander W Pastuszak
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX.
| | - Jeremy Slawin
- Department of Urology, NYU Langone Medical, New York, NY
| | | | - Richard E Link
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
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Pastuszak AW, Moon YM, Scovell J, Badal J, Lamb DJ, Link RE, Lipshultz LI. MP47-01 POOR SLEEP QUALITY PREDICTS HYPOGONADAL SYMPTOMS AND SEXUAL DYSFUNCTION IN MALE NON-STANDARD SHIFT WORKERS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Pastuszak AW, Scovell J, Badal J, Chandrashekar A, Hakky TS, Ramasamy R, Lamb DJ, Lipshultz LI. PD39-06 IMPAIRED SLEEP QUALITY PREDICTS MORE SIGNIFICANT LOWER URINARY TRACT SYMPTOMS IN MALE SHIFT WORKERS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Erectile dysfunction has been explored as a condition secondary to elevated prolactin; however, the mechanisms by which elevated prolactin levels cause erectile dysfunction have not yet been clearly established. We here present a patient with a history of prolactinoma who suffered from persistent erectile dysfunction despite testosterone supplementation and pharmacological and surgical treatment for the prolactinoma. Patients who have had both prolactinemia and erectile dysfunction have been reported in the literature, but we find no report of a patient with persistent erectile dysfunction in the setting of testosterone supplementation and persistent hyperprolactinemia refractory to treatment. This case provides evidence supporting the idea that suppression of erectile function occurs in both the central and peripheral nervous systems independent of the hypothalamic-pituitary-gonadal axis.
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Affiliation(s)
- Justin Badal
- Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ranjith Ramasamy
- Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Tariq Hakky
- Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Larry Lipshultz
- Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
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García-Arumí J, Martínez-Castillo V, Boixadera A, Blasco H, Marticorena J, Zapata MÁ, Macià C, Badal J, Distéfano L, Rafart JM, Berrocal M, Zambrano A, Ruíz-Moreno JM, Figueroa MS. Rhegmatogenous retinal detachment treatment guidelines. ACTA ACUST UNITED AC 2012; 88:11-35. [PMID: 23414946 DOI: 10.1016/j.oftal.2011.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 10/10/2011] [Indexed: 11/15/2022]
Abstract
This paper outlines general guidelines following the initial diagnosis of rhegmatogenous retinal detachment. These include preoperative evaluation, treatment, possible intra- and post-operative complications, retinal re-detachment, and all therapeutic options available for each case. Treatment of the traumatic retinal detachment is also described, due to its importance and peculiarities. Treatment or prophylactic guidelines are suggested for the different types of retinal detachment described. These are based on both the experience of the ophthalmologists that have participated in preparing the guidelines, and also on evidence-based grading linked to bibliographical sources. However, these guidelines should not be interpreted as being mandatory. Given that there is a wide spectrum of options for treatment of retinal detachment, the surgeons' experience with one or other surgical technique will be of utmost importance in obtaining the best surgical result. As guidelines, they are intended as an additional aid to the surgeon during the decision-making process, with the expectation that the final choice will still be left to the surgeon's judgment and past experience.
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Affiliation(s)
- J García-Arumí
- Departamento de Oftalmología, Universidad Autónoma de Barcelona, Barcelona, Spain.
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Calatayud M, Badal J, Bisbe L, Martin S, Puig J. Total regression of extensive conjunctival intraepithelial neoplasia with superficial corneal invasion treated with topical mitomycin C 0.02%. Case Reports 2009; 2009:bcr04.2009.1765. [DOI: 10.1136/bcr.04.2009.1765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Bardaji M, Roset F, Puig A, Badal J, Fernandez-Layos MJ. Cutaneous metastatic adenocarcinoma of gallbladder origin: report of a case and review of the literature. Hepatogastroenterology 1998; 45:930-1. [PMID: 9755983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In the English literature, there have only been seven reports of metastasis from cancer of the gallbladder to the skin. This is the report of a 75-year-old woman who developed cutaneous metastasis from an adenocarcinoma of the gallbladder which was confirmed histologically. We report the uncommon metastatic potential of gallbladder carcinoma to the skin.
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Affiliation(s)
- M Bardaji
- Department of Surgery, Hospital General de Manresa, Barcelona, Spain
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15
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Tapiz A, Vila D, Valdés V, Dorca E, Badal J, Marcos JM. [Cryptococcosis with exclusive cutaneous presentation in a patient with AIDS]. Rev Clin Esp 1994; 194:689-91. [PMID: 7984797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report an exclusively cutaneous case of cryptococcosis, which is exceptional. He was a 33 years old patient with the acquired immunodeficiency syndrome who presented with an ulcer-necrotic lesion at the nasal wings with a long and torpid evolution. Finally, culture and biopsy were diagnostic of cryptococcosis. We ruled out affection of other organs and the cryptococcal antigen was negative in serum and cerebrospinal fluid. The patient was treated with fluconazole and had a good clinical course. Its emphasized the scarcity of this form of presentation as well as the lack of specificity of its lesions and the necessity of ruling out other locations once the fungus is isolated in the skin. Diagnosis is simple through skin biopsy and culture. Its important to determine the cryptococcal antigen. We comment on the current approaches to treatment during acute and maintenance phases, after the appearance of the new imidazolic compounds such as fluconazole.
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Affiliation(s)
- A Tapiz
- Servicio de Medicina Interna, Hospital General de Manresa
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16
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Castella X, Villar T, Badal J, Pons R, Gilabert J, Torres C, Torner F. [Malignant Mediterranean boutonneuse fever. Septic shock of unknown origin?]. Rev Clin Esp 1991; 188:199-201. [PMID: 1784746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mediterranean Botonous Fever (MBF) is an infectious disease which provokes multisystemic vasculitis due to endothelial proliferation of rickettsia conorii. Its incidence, in our environment, has greatly increased during the last years being endemic in many large cities and their surrounding suburbs. In some cases its evolution is specially malignant resulting in septic shock, adult respiratory distress syndrome, and multiorgan failure. The purpose of this communication is to present a new case of malignant MBF with a bad evolution factor which has not been previously referred to, which is the persistence of vector ticks in the inoculation spot.
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Affiliation(s)
- X Castella
- Unidad Cuidados Intensivos, Centre Hospitalari-Unitat Coronaria Manresa, Barcelona
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Badal J. [Influence of insufflation of mineral spring gas upon the surface of lipids]. Fysiatr Revmatol Vestn 1977; 55:30-3. [PMID: 557440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Badal J. [Changes of weather and performance of the body]. Fysiatr Revmatol Vestn 1974; 52:152-6. [PMID: 4858051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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