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Id: lil-769747
Autor: Kim, Hyung Suk; Lee, Joong Sub; Jeong, Chang Wook; Kwak, Cheol; Kim, Hyeon Hoe; Ku, Ja Hyeon.
Título: Adjuvant chemotherapy for locally advanced upper tract urothelial carcinoma: updated results of the Seoul National university hospital experience
Fonte: Int. braz. j. urol;41(6):1067-1079, Nov.-Dec. 2015. tab, graf.
Idioma: en.
Projeto: Seoul National University Hospital.
Resumo: Objectives: The objective of this study was to update the long-term outcome in the treatment of locally advanced upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU) regarding the role of adjuvant chemotherapy. Materials and methods: Clinical data from 138 patients who underwent RNU for locally advanced UTUC (pT3/4 or pN+) were analyzed. Results: The adjuvant chemotherapy group comprised 66 patients, and other 72 patients did not receive adjuvant chemotherapy. Cisplatin-based chemotherapy was the most common regimen, depending on the patient's eligibility and renal function. The median follow-up period was 48.7 months (interquartile range: 29.2-96.9 months). The 3-and 5-year disease-specific survival (DSS) rates were 76.0% and 69.9% for the non-adjuvant chemotherapy group versus 74.6% and 54.5% for the adjuvant chemotherapy group (p=0.301, log-rank test). Overall survival (OS) rates for the same time period were 70.1% and 62.9% for the non-adjuvant chemotherapy group versus 73.8% and 53.2% for the adjuvant chemotherapy group (p=0.931, log-rank test). On multivariate analysis, adjuvant chemotherapy could not predict DSS and OS after surgery. When patients who received cisplatin-based adjuvant chemotherapy (n=59) were compared to those who did not receive adjuvant chemotherapy, similar results were found. Conclusions: There does not appear to be a significant DSS or OS benefit associated with adjuvant chemotherapy. Prospective randomized clinical trials are necessary to verify the effect of adjuvant chemotherapy on locally advanced UTUC.
Descritores: Antineoplásicos/uso terapêutico
Carcinoma de Células de Transição/tratamento farmacológico
Cisplatino/uso terapêutico
Neoplasias Ureterais/tratamento farmacológico
-Carcinoma de Células de Transição/patologia
Carcinoma de Células de Transição/cirurgia
Quimioterapia Adjuvante/métodos
Intervalo Livre de Doença
Hospitais Universitários
Estimativa de Kaplan-Meier
Análise Multivariada
Nefrectomia/métodos
Prognóstico
Estudos Retrospectivos
Seul
Fatores de Tempo
Neoplasias Ureterais/patologia
Neoplasias Ureterais/cirurgia
Limites: Idoso
Feminino
Seres Humanos
Masculino
Meia-Idade
Responsável: BR1.1 - BIREME


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Id: lil-741195
Autor: Souza, Paulo Victor Sgobbi de; Pinto, Wladimir Bocca Vieira de Rezende; Oliveira, Acary Souza Bulle.
Título: C9orf72-related disorders: expanding the clinical and genetic spectrum of neurodegenerative diseases / Distúrbios relacionados ao C9orf72: expandindo o espectro clínico e genético das doenças neurodegenerativas
Fonte: Arq. neuropsiquiatr;73(3):246-256, 03/2015. tab, graf.
Idioma: en.
Resumo: Neurodegenerative diseases represent a heterogeneous group of neurological conditions primarily involving dementia, motor neuron disease and movement disorders. They are mostly related to different pathophysiological processes, notably in family forms in which the clinical and genetic heterogeneity are lush. In the last decade, much knowledge has been acumulated about the genetics of neurodegenerative diseases, making it essential in cases of motor neuron disease and frontotemporal dementia the repeat expansions of C9orf72 gene. This review analyzes the main clinical, radiological and genetic aspects of the phenotypes related to the hexanucleotide repeat expansions (GGGGCC) of C9orf72 gene. Future studies will aim to further characterize the neuropsychological, imaging and pathological aspects of the extra-motor features of motor neuron disease, and will help to provide a new classification system that is both clinically and biologically relevant.

As doenças neurodegenerativas representam um grupo heterogêneo de condições neurológicas envolvendo fundamentalmente síndromes demenciais, doenças do neurônio motor e distúrbios de movimento. Relacionam-se, em sua maioria, a processos fisiopatológicos distintos, destacadamente nas formas familiares em que a heterogeneidade clínica e genética são exuberantes. Na última década, muito conhecimento se acumulou a respeito da genética das doenças neurodegenerativas, tornando-se bastante importante nos casos de doenças do neurônio motor e de demência frontotemporal as expansões de repetições do gene C9orf72. Esta revisão aborda os principais aspectos clínicos, radiológicos e genéticos relativos aos fenótipos relacionados à expansão de repetição do hexanucleotídeo (GGGGCC) no gene C9orf72. Estudos futuros vão objetivar a caracterização dos aspectos neuropsicológicos, de imagem e patológicos dos achados extra-motores da doença do neurônio motor e ajudarão a fornecer um novo sistema de classificação relevante em termos clínicos e biológicos.
Descritores: Carcinoma de Células de Transição/secundário
Carcinoma de Células de Transição/cirurgia
Pelve Renal
Neoplasias Renais/patologia
Neoplasias Renais/cirurgia
Excisão de Linfonodo/métodos
Neoplasias Ureterais/secundário
Neoplasias Ureterais/cirurgia
Limites: Feminino
Seres Humanos
Masculino
Tipo de Publ: Comentário
Responsável: BR1.1 - BIREME


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Araujo, Thelma Leite de
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Id: lil-731219
Autor: Cavalcante, Tahissa Frota; Araújo, Thelma Leite de; Oliveira, Ana Railka de Souza.
Título: Efeitos da sondagem nasogástrica em pacientes com acidente cerebrovascular e disfagia / Effects of nasogastric catheterization in patients with stroke and dysphagia / Efectos de la cateterización nasogástrica en pacientes con accidente cerebrovascular y disfagia
Fonte: Rev. bras. enferm;67(5):825-831, Sep-Oct/2014. tab.
Idioma: pt.
Resumo: O estudo teve por objetivo analisar os efeitos da sondagem gástrica em pacientes com acidente vascular cerebral e disfagia. Revisão sistemática da literatura, realizada em seis bases de dados, com os descritores stroke e intubation, gastrointestinal. Foram encontrados 120 estudos e selecionados três ensaios clínicos. Os resultados apontaram diferentes desfechos, entre os quais: aumento do nível sérico de albumina (gastrostomia), prognóstico ruim e risco de morte (gastrostomia), aumento das falhas no tratamento devido a bloqueio, deslocamento e reinserção da sonda nasogástrica, e aumento da incidência de hemorragia gastrointestinal (sonda nasogástrica). A partir dos resultados obtidos nesta revisão sistemática, ressaltam-se as seguintes evidências: a sondagem nasogástrica deve ser adotada precocemente como um método de alimentação enteral; as falhas do tratamento são mais comuns naqueles que utilizam a sonda nasogástrica como método de alimentação; os resultados relacionados à melhora do estado funcional dos pacientes foram semelhantes, independente do método de terapia nutricional empregado.

This study aimed to analyze the effects of gastric intubation in patients with stroke and dysphagia. A systematic literature review was performed in six databases, using the keywords stroke and intubation, gastrointestinal. One hundred and twenty studies were found, from which three clinical trials were selected. The results showed different outcomes, including: increased serum albumin level (gastrostomy), poor prognosis and risk of death (gastrostomy), increased treatment failures because of blocking, displacement and reinsertion need of the nasogastric tube, and increased incidence of gastrointestinal bleeding (nasogastric tube). From the results obtained in this systematic review, we emphasize the following evidences: a nasogastric catheter should be adopted as a method of early enteral feeding; treatment failures are more common in those who use nasogastric tube-feeding; outcomes related to improved functional status of patients were similar, regardless of the method of nutritional therapy used.

El objetivo del estudio fue analizar los efectos de la intubación gástrica en pacientes con accidente cerebrovascular y disfagia. Se llevó a cabo una revisión sistemática de la literatura en seis bases de datos, utilizando-se las palabras clave accidente cerebrovascular y intubación, gastrointestinal. Entre 120 estudios identificados, fueran seleccionados tres ensayos clínicos. Los resultados mostraron diferentes desfechos, incluyendo: aumento del nivel de albúmina sérica (gastrostomía); mal pronóstico y riesgo de muerte (gastrostomía); aumento de los fracasos del tratamiento debido a obstrucción, desplazamiento y necesidad de reinserción de la sonda nasogástrica; y aumento de la incidencia de hemorragia gastrointestinal (sonda nasogástrica). A partir de los resultados obtenidos, destacamos las siguientes evidencias: se deben adoptar catéteres nasogástricas como método de alimentación enteral temprana; fracasos del tratamiento son más comunes en aquellos que utilizan la alimentación con sonda nasogástrica; los resultados relacionados con la mejora del estado funcional de los pacientes fueron similares, independientemente del método de terapia nutricional utilizado.
Descritores: Antineoplásicos/administração & dosagem
Cisplatino/administração & dosagem
Neoplasias Ureterais/tratamento farmacológico
-Antimetabólitos Antineoplásicos/administração & dosagem
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem
Floxuridina/administração & dosagem
Infusões Intravenosas
Metástase Linfática
Pacientes Ambulatoriais
Urotélio
Neoplasias Ureterais
Neoplasias Ureterais/secundário
Limites: Seres Humanos
Masculino
Idoso
Tipo de Publ: Relatos de Casos
Responsável: BR1.1 - BIREME


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Srougi, Miguel
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Id: lil-731132
Autor: Dip, Nelson; Reis, Sabrina T.; Abe, Daniel K.; Viana, Nayara I.; Morais, Denis R.; Moura, Caio M.; Katz, Betina; Silva, Iran A.; Srougi, Miguel; Leite, Katia R. M..
Título: Micro RNA expression and prognosis in low-grade non-invasive urothelial carcinoma
Fonte: Int. braz. j. urol;40(5):644-649, 12/2014. tab.
Idioma: en.
Resumo: Purpose To analyze a possible correlation between a miRNA expression profile and important prognostic factors for pTa urothelial carcinomas (UC), including tumor size, multiplicity and episodes of recurrence. Materials and Methods Thirty low-grade non-invasive pTa bladder UC from patients submitted to transurethral resection were studied, in a mean follow-up of 17.7 months. As controls, we used normal bladder tissue from five patients submitted to retropubic prostatectomy to treat benign prostatic hyperplasia. Extraction, cDNA and amplification were performed for 14 miRNAs (miR-100, -10a, -21, -205, -let7c, -143, -145, -221, -223, -15a, -16, -199a and -452) using specific kits, and RNU-43 and -48 were used as endogenous controls. Statistical tests were used to compare tumor size, multiplicity and episodes of recurrence with miRNAs expression profiles. Results There was a marginal correlation between multiplicity and miR-let7c over-expression. For all others miRNA no correlation between their expression and prognostic factors was found. Conclusion We did not find differences for miRNAs expression profiles associated with prognostic factors in tumor group studied. The majority of miRNAs are down-regulated, except miR-10a, over-expressed in most of cases, seeming to have increased levels in tumor with more unfavorable prognostic factors. More studies are needed in order to find a miRNA profile able to provide prognosis in pTa UC to be used in clinical practice. .
Descritores: Carcinoma/genética
MicroRNAs/análise
Neoplasias Ureterais/genética
Neoplasias da Bexiga Urinária/genética
-Análise de Variância
Estudos de Casos e Controles
Carcinoma/patologia
Regulação para Baixo
Expressão Gênica
Perfilação da Expressão Gênica
Recidiva Local de Neoplasia/genética
Recidiva Local de Neoplasia/patologia
Prognóstico
Valores de Referência
Estatísticas não Paramétricas
Carga Tumoral/genética
Biomarcadores Tumorais/análise
Neoplasias Ureterais/patologia
Neoplasias da Bexiga Urinária/patologia
Limites: Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Responsável: BR1.1 - BIREME


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Id: lil-723968
Autor: Sverrisson, E.F.; Kim, T.; Espiritu, P.N.; Sexton, W.J.; Pow-Sang, J.M.; Dhillon, J.; Spiess, P.E..
Título: The merits of cytology in the workup for upper tract urothelial carcinoma - a contemporary review of a perplexing issue
Fonte: Int. braz. j. urol;40(4):493-498, Jul-Aug/2014. tab, graf.
Idioma: en.
Resumo: Introduction The importance of upper tract cytology for evaluating tumors is unclear. We correlated upper tract cytology with histologic findings in patients who underwent nephroureterectomy for upper tract urothelial carcinoma (UTUC) at a single tertiary care referral center. Materials and Methods 137 patients underwent nephroureterectomy between 2004 and 2012. 18 patients were excluded (benign tumors, atrophic kidneys with the remaining 119 patients serving as our study population). Upper tract cytology from the renal pelvis and/or ureter were retrospectively reviewed and analyzed with final pathology data in the remaining patients with UTUC. Results 57% (68/119) had preoperative upper tract cytology collected. 73% (50/68) patients had abnormal cytology (positive, suspicious) with a sensitivity of 74% (which increased to 90% if atypical included), specificity of 50% and a positive predictive value of 98%. High grade tumors were more common than expected (77% high grade vs. 20% low grade). Abnormal cytology did not predict T stage or tumor grade. Interestingly, positive upper tract cytology was found in all of the UTUC CIS specimen. Conclusions Upper tract cytology has been utilized to support the diagnosis of upper tract urothelial carcinoma. Our data demonstrates that abnormal cytology correlates well with the presence of disease but does not predict staging or grading in these respective patients. .
Descritores: Carcinoma/patologia
Pelve Renal/patologia
Ureter/patologia
Neoplasias Ureterais/patologia
-Biópsia
Pelve Renal/citologia
Gradação de Tumores
Estadiamento de Neoplasias
Valor Preditivo dos Testes
Reprodutibilidade dos Testes
Estudos Retrospectivos
Ureter/citologia
Limites: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Responsável: BR1.1 - BIREME


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Id: lil-699116
Autor: Abel, E. Jason; Fisher, Mark B.; Matin, Surena F.; Kamat, Ashish M.; Dinney, Colin P.; Grossman, H. Barton.
Título: Delayed Ureterectomy after Incomplete Nephroureterectomy for Upper Tract Urothelial Carcinoma: Pathologic Findings and Outcomes
Fonte: Int. braz. j. urol;39(6):817-822, Nov-Dec/2013. tab, graf.
Idioma: en.
Resumo: Objectives To evaluate the pathologic findings and outcomes after distal ureterectomy for a retained ureteral segment following incomplete nephroureterectomy for urothelial carcinoma of the renal pelvis or ureter. Materials and Methods After IRB approval, an institutional database identified patients who underwent distal ureterectomy for a retained ureteral segment after assumed complete nephroureterectomy for urothelial carcinoma of the upper ureter or renal pelvis. Clinical and pathologic variables were analyzed. Results From January 1993 to July 2007, 12 patients were identified with median age at the time of ureterectomy of 60.5 years (41-85 years). Initial approach to surgery was open in 9 patients and laparoscopic in 3 patients. The median time from nephroureterectomy to distal ureterectomy was 23.5 months (range 2-66). At the time of initial surgery, pathologic stage was Ta, T1, T2, and T3 in 3,4,1, and 4 patients respectively. Initial pathology was urothelial carcinoma; grade 2 in 6 patients and grade 3 in six patients. Pathology from the subsequent surgery demonstrated urothelial carcinoma in the retained ureteral segment in 8 patients, dysplasia or atypia in 3 patients, and 1 patient with chronic inflammation. Local recurrence in 2 patients was present in a segment of ureter discontinuous with the bladder after laparoscopic nephroureterectomy. Three patients (25%), all with initial grade 3 renal pelvis lesions, developed metastatic disease. Conclusions Tumor recurrence in a retained ureteral segment after incomplete nephroureterectomy is a significant problem and may contribute to intravesical recurrence or metastatic disease. Complete, en bloc resection is imperative to minimize these risks. .
Descritores: Carcinoma de Células de Transição/patologia
Carcinoma de Células de Transição/cirurgia
Nefrectomia/métodos
Neoplasias Ureterais/patologia
Neoplasias Ureterais/cirurgia
-Gradação de Tumores
Recidiva Local de Neoplasia
Estadiamento de Neoplasias
Fatores de Risco
Fatores de Tempo
Ureter/patologia
Ureter/cirurgia
Limites: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Tipo de Publ: Estudos de Avaliação
Responsável: BR1.1 - BIREME


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Pompeo, Antônio Carlos Lima
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Id: lil-699115
Autor: Juliano, Cesar Augusto Braz; Carlos, Alexandre Stievano; Costa Junior, Renato Meirelles Mariano; Tobias-Machado, Marcos; Pompeo, Antonio Carlos Lima.
Título: Laparoendoscopic single-site nephroureterectomy for morbid obese patients
Fonte: Int. braz. j. urol;39(6):895-896, Nov-Dec/2013.
Idioma: en.
Resumo: Since the first laparoendoscopic single-site (LESS) surgery report in urology in 2007 (1) (Rane A e Cadeddu JA), the few reports of LESS extraperitoneal access in the literature were mainly described for less complex cases. The aim of this video is to demonstrate the feasibility of LESS extraperitoneal access in a morbid obese patient presenting a malignant tumor in the renal pelvis. The patient is positioned in 90-degree lateral decubitus. An incision is made below the abdominal skin crease on the left side of the patient and the anterior rectus fascia is vertically incised with manual dissection of the extra/retroperitoneal space. We use an Alexis® retractor to retract the skin maximizing the incision orifice. Three trocars (12, 10 and 5 mm) are inserted through a sigle-port. The pedicle was controlled “en bloc” with a vascular stapler and the bladder cuff treated by the conventional open approach through the same incision. Operative time was 126 minutes with minimal blood loss. The pathology reported high grade papillary urothelial carcinoma in the pelvis (pT3N0M0) and in the ureter (pTa). LESS extraperitoneal nephroureterectomy is feasible and safe, even in more complex cases. It is a good alternative for morbid obese patients and for patients with synchronous distal ureteral tumors for whom an open approach to the bladder cuff is proposed to avoid incisions in two compartments of the abdominal wall.
Descritores: Carcinoma Papilar/cirurgia
Laparoscopia/métodos
Obesidade Mórbida/cirurgia
Neoplasias Ureterais/cirurgia
-Parede Abdominal/cirurgia
Biópsia
Carcinoma Papilar/patologia
Estudos de Viabilidade
Nefrectomia/métodos
Duração da Cirurgia
Reprodutibilidade dos Testes
Resultado do Tratamento
Neoplasias Ureterais/patologia
Limites: Feminino
Seres Humanos
Meia-Idade
Tipo de Publ: Relatos de Casos
Responsável: BR1.1 - BIREME


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Id: lil-676270
Autor: Branco, Anibal Wood; Stunitz, Luciano; Nichele, Sandro; Douat, Paulo Henrique; Luiz, Murilo; Nassif, Lucas Tha.
Título: Intravesical and transperitoneal laparoscopy in the management of tumor in the residual ureter
Fonte: Int. braz. j. urol;39(2):291-292, Mar-Apr/2013.
Idioma: en.
Descritores: Carcinoma de Células de Transição/cirurgia
Laparoscopia/métodos
Neoplasias Ureterais/cirurgia
-Duração da Cirurgia
Resultado do Tratamento
Limites: Idoso
Seres Humanos
Masculino
Tipo de Publ: Relatos de Casos
Responsável: BR1.1 - BIREME


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Srougi, Miguel
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Id: lil-649439
Autor: Reis, Sabrina Thalita dos; Leite, Katia Ramos Moreira; Mosconi Neto, Alcides; Pontes Júnior, José; Viana, Nayara Izabel; Antunes, Alberto Azoubel; Dall'Oglio, Marcos Francisco; Srougi, Miguel.
Título: Immune expression of E-cadherin and α, β and γ-Catenin adhesion molecules and prognosis for upper urinary tract urothelial carcinomas
Fonte: Int. braz. j. urol;38(4):466-473, July-Aug. 2012. ilus, tab.
Idioma: en.
Resumo: INTRODUCTION: Cell adhesion molecules (CAM) are required for maintaining a normal epithelial phenotype, and abnormalities in CAM expression have been related to cancer progression, including bladder urothelial carcinomas. There is only one study that correlates E-cadherin and α-, β- and γ-catenin expression with prognosis of upper tract urothelial carcinomas. Our aim is to study the pattern of immune expression of these CAMs in urothelial carcinomas from the renal pelvis and ureter in patients who have been treated surgically. Our goal is to correlate these expression levels and characteristics with well-known prognostic parameters for disease-free survival. MATERIALS AND METHODS: We evaluated specimens from 20 patients with urothelial carcinomas of the renal pelvis and ureter who were treated with nephroureterectomy or ureterectomy between June 1997 and January 2007. CAM expression was evaluated by immunohistochemistry in a tissue microarray and correlated with histopathological characteristics and patient outcomes after a mean follow-up of 55 months. RESULTS: We observed a relationship between E-cadherin expression and disease recurrence. Disease recurrence occurred in 87.5% of patients with strong E-cadherin expression. Only 50.0% of patients with moderate expression and 0% of patients with weak or no expression of E-cadherin had disease recurrence (p = 0.014). There was also a difference in disease-free survival. Patients with strong E-cadherin expression had a mean disease-free survival rate of 49.1 months, compared to 83.9 months for patients with moderate expression (p = 0.011). Additionally, an absence of α-catenin expression was associated with tumors that were larger than 3 cm (p = 0.003). CONCLUSIONS: We demonstrated for the first time that immune expression of E-cadherin is related to tumor recurrence and disease-free survival rates, and the absence of α-catenin expression is related to tumor size in upper tract urothelial carcinomas.
Descritores: Caderinas/análise
Carcinoma/química
Cateninas/análise
Biomarcadores Tumorais/análise
Neoplasias Ureterais/química
Sistema Urinário/química
-Carcinoma/patologia
Moléculas de Adesão Celular/análise
Métodos Epidemiológicos
Imuno-Histoquímica
Prognóstico
Distribuição por Sexo
Fatores de Tempo
Análise Serial de Tecidos
Neoplasias Ureterais/patologia
Sistema Urinário/patologia
alfa Catenina/análise
beta Catenina/análise
gama Catenina/análise
Limites: Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Responsável: BR1.1 - BIREME


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Id: lil-616430
Autor: Pons Porrata, Laura María; Cruz de Oña, Andria de la; Ramírez Torres, Ángela; Mendoza Belett, Felipe Rogelio; Mahamadou Koita, Moussa.
Título: Diagnóstico imagenológico del tumor de uréter en un anciano / Image diagnosis of the urether tumor in an elderly
Fonte: Medisan;15(12), dic. 2011. ilus.
Idioma: es.
Resumo: Se presenta el caso clínico de un paciente de 71 años, a quien ingresado en el Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, se le diagnosticó, mediante exámenes imagenológicos, un tumor en el uréter distal izquierdo, que ocasionaba ureterohidronefrosis. Habiendo sido operado por esa causa, en el período posquirúrgico se complicó tan gravemente que falleció. El resultado de la necropsia confirmó la presencia de necrosis isquémica intestinal, trombosis mesentérica, ateromatosis aórtica, carcinoma transicional de uréter que infiltraba la vejiga, aneurisma trombosado de la aorta abdominal, tromboembolismo pulmonar e hipertrofia, así como dilatación cardíaca global.

The case report of a 71 year-old patient, admitted to Dr Juan Bruno Zayas Alfonso Teaching General Hospital from Santiago de Cuba, to whom a tumor in the left distal urether was diagnosed by means of image tests, which caused retherohydronephrosis, is presented. He had so many complications in the postsurgical period that he died due to that cause. The result of necropsy confirmed the presence of intestinal ischemic necrosis, mesenteric thrombosis, aortic atheromatosis, urether transitional carcinoma infiltrating the bladder, trombotic aneurysm of the abdominal aorta, lung tromboembolism and hypertrophy, as well as global heart dilation.
Descritores: Hidronefrose
Necrose
Neoplasias Ureterais
Neoplasias Ureterais
Fatores de Necrose Tumoral
Limites: Seres Humanos
Masculino
Idoso
Responsável: CU418.1 - Centro Provincial de Información de Ciencias Médicas de Santiago de Cuba



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