Velis, J.M. (José María)
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- Recipient and donor risk factors for surgical complications following kidney transplantation(2012) Romero-Vargas, L. (Luis); Barba-Abad, J.F. (Javier Fermín); Velis, J.M. (José María); Tienza, A. (Antonio); Robles-Garcia, J.E. (José Enrique); Algarra, R. (Rubén)Objective. The aim of this study was to evaluate recipient and donor risk factors that are related to surgical complications after renal transplantation. Material and methods. In total, 419 kidney transplantations were analysed with regard to the influence of recipient and donor risk factors on the main postoperative surgical complications. Results. The mean follow-up for the entire group was 72.8 months (± 54.2 SD). Vascular complications were independently associated with donor age; and urological complications with recipient age >65 years and cyclosporine rather than tacrolimus therapy. Wound complications were independently associated with recipient age, preoperative dialysis time, recipient body mass index (BMI) and cyclosporine rather than tacrolimus therapy. Collections were independently associated with retransplantation, type 2 diabetes mellitus and wound complications. Overall surgical complications were associated with donor age and delayed graft function. In terms of severity, grade I complications were independently associated with recipient age and surgical revision, grade II with recipient age >50 years, grade III with recipient BMI, and grade IV with donor age. Conclusions. Recipient characteristics are the primary determinants of wound, urological and minor (Clavien grades I, II and III) complications; however, graft or donor characteristics are the primary risk factors for vascular, overall and major (Clavien grade IV) surgical complications.
- Identification of mutations associated with acquired resistance to sunitinib in renal cell cancer(UICC, 2019) Brich, S. (Silvia); Patiño-García, A. (Ana); Pio, R. (Rubén); Lozano, M.D. (María Dolores); Colecchia, M. (Maurizio); Agorreta, J. (Jackeline); Perez-Gracia, J.L. (Jose Luis); Minucci, S. (Saverio); Elgendy, M. (Mohamed); Rodriguez-Ruiz, M.E. (María Esperanza); Renne, S.L. (Salvatore Lorenzo); Fusco, J.P. (Juan Pablo); Diez-Valle, R. (Ricardo); Velis, J.M. (José María); Gurpide, A. (Alfonso); Andueza, M.P. (Maria P.); Calvo-Alonso, A. (Alfonso); Melero, I. (Ignacio); Abengozar-Muela, M. (Marta); Guruceaga, E. (Elizabeth); Echeveste, J.I. (José I.); Pascual, J.I. (Juan Ignacio); Segura, V. (Víctor); Miñana, B. (Bernardino); Fernandez-Sanmamed, M. (Miguel)Sunitinib is one of the most widely used targeted therapeutics for renal cell carcinoma (RCC), but acquired resistance against targeted therapies remains a major clinical challenge. To dissect mechanisms of acquired resistance and unravel reliable predictive biomarkers for sunitinib in RCC, we sequenced the exons of 409 tumor-suppressor genes and oncogenes in paired tumor samples from an RCC patient, obtained at baseline and after development of acquired resistance to sunitinib. From newly arising mutations, we selected, using in silico prediction models, six predicted to be deleterious, located in G6PD, LRP1B, SETD2, TET2, SYNE1, and DCC. Consistently, immunoblotting analysis of lysates derived from sunitinib-desensitized RCC cells and their parental counterparts showed marked differences in the levels and expression pattern of the proteins encoded by these genes. Our further analysis demonstrates essential roles for these proteins in mediating sunitinib cytotoxicity and shows that their loss of function renders tumor cells resistant to sunitinib in vitro and in vivo. Finally, sunitinib resistance induced by continuous exposure or by inhibition of the six proteins was overcome by treatment with cabozantinib or a low-dose combination of lenvatinib and everolimus. Collectively, our results unravel novel markers of acquired resistance to sunitinib and clinically relevant approaches for overcoming this resistance in RCC.
- What is the impact of post‐radical prostatectomy urinary incontinence on everyday quality of life? Linking Pad usage and International Consultation on Incontinence Questionnaire Short‐Form (ICIQ‐SF) for a COMBined definition (PICOMB definition)(Wiley, 2021) Barbas-Bernardos, G. (Guillermo); Díez-Caballero, F. (Fernando); Boville, G.A. (Guillermo Andrés); Fata, F.R. (Fernando Ramón) de; Rosell, D. (David); Miñana-López, B. (Bernardino); Doménech-López, P. (Pablo); Gutierrez, C. (Cristina); Torres, M. (Marcos); Colombas, J. (J.); Velis, J.M. (José María); Guillen-Grima, F. (Francisco); Villacampa, F. (Felipe); Pascual-Piedrola, J.I. (Juan Ignacio); García-Cortés, Á. (Ángel); Chiva-San-Román, S. (Santiago); Hevia, M. (Mateo); Merino, I. (Imanol); Robles-Garcia, J.E. (José Enrique); Ancizu-Marckert, J. (Javier)Aims: To identify the definition for urinary continence (UC) after radical prostatectomy (RP) which reflects best patients' perception of quality of life (QoL). Methods: Continence was prospectively assessed in 634 patients, 12 months after RP using the International Consultation on Incontinence Questionnaire Short‐Form (ICIQ‐SF) and the number of pads employed in a 24‐hour period (pad usage). We used the one‐way ANOVA technique with posthoc pairwise comparisons according to Scheffé's method (homogeneous subsets) for assessing the degree of QoL deficit related to urinary incontinence (UI). Results: The continence prevalence is 64.4%, 74.1%, 88.3%, and 35.8% using “0 pads,” “1 safety pad,” “1 pad,” and “ICIQ score 0” definitions, respectively. Pad usage is moderately strongly associated with ICIQ 1, 2, and 3 (ρ = 0.744, 0.677, and 0.711, respectively; p < 0.001). Concordance between classical UC definitions is acceptable between “0 pads—ICIQ score 0” (K = 0.466), but poor for “1 safety pad” and “1 pad” (K = 0.326 and 0.137, respectively). Patients with “0 pad usage” have better QoL related to urine leakage than patients with “1 safety pad” or “1 pad” (1.41 vs. 2.44 and 3.11, respectively; p < 0.05). There were no significant differences found regarding QoL between patients with ICIQ score 0 and ICIQ score 2 (1.01 vs. 1.63; p = 0.63).Conclusions: Pad usage and the ICIQ‐SF's answers provide useful information. We propose a combined definition (0 pads and ICIQ score ≤2) as it is the definition with the least impact on daily QoL.
- Carcinomas renales con rasgos sarcomatoides y rabdoides: estudio clínico-patológico de 74 casos(2018) Dolezal, P. (P.); Velis, J.M. (José María); Panizo, A. (Ángel); Pardo-Mindan, F.J. (Francisco Javier); Queipo, F.J. (Francisco Javier); Beorlegui, C. (Carmen); Sola, J.J. (Jesús Javier)Fundamento. Nuestro objetivo fue comparar las variables clínico-patológicas de los carcinomas renales (CCR) con fenotipos sarcomatoide y rabdoide. Material y métodos. Se revisaron 1.258 CCR de pacientes consecutivos nefrectomizados entre 1988 y 2015, y se seleccionaron aquellos con ≥1% de cambio sarcomatoide y/o rabdoide. Se clasificaron como sarcomatoide o rabdoide según el fenotipo predominante, considerándose componente desdiferenciado la suma del porcentaje de ambos. Se recopilaron: sexo y edad de los pacientes, síntomas y existencia de metástasis al diagnóstico, parámetros del protocolo de CCR del Colegio Americano de Patólogos, patrón de crecimiento tumoral, invasión perineural, porcentaje de necrosis tumoral y características del infiltrado inflamatorio. Se describieron mediante la media/mediana o el porcentaje y se compararon mediante t de Student/U de MannWhitney o χ2 /F de Fisher. Resultados. Se identificaron 45 CCR con predominio sarcomatoide (3,6%) y 29 con rabdoide (2,3%); los primeros mostraron mayor componente indiferenciado e invasión perineural respecto a los CCR con rasgos rabdoides (27,5 vs. 13,5%; p=0,003 y 28,9 vs. 3,4%, p=0,006, respectivamente), mientras que estos mostraron doble frecuencia de inflamación neutrofílica (44,8 vs. 22,2%, p=0,04) y surgieron más frecuentemente sobre un CCR de alto grado (55,9 vs. 90,5%, p<0,001). Conclusiones. Los CCR con fenotipos sarcomatoide y rabdoide compartieron características clínico-patológicas, excepto para componente desdiferenciado, invasión perineural, inflamación neutrofílica y origen en CCR de alto grado. Esta similitud sugiere la presencia de un mecanismo común, la transición epitelio-mesénquima, con una expresión morfológica doble que, de confirmarse, podría suponer la posibilidad de seleccionar pacientes para tratamiento o seguimiento a partir de sus características moleculares.
- Variante plasmocitoide del carcinoma urotelial: a proposito de un caso(Gobierno de Navarra. Departamento de Salud, 2013) Barba-Abad, J.F. (Javier Fermín); Zudaire-Bergera, J.J. (Juan Javier); Velis, J.M. (José María); Tienza, A. (Antonio); Queipo, F.J. (Francisco Javier); Sola, J.J. (Jesús Javier)Plasmacytoid urothelial carcinoma is an extremely rare pathological finding. We report our experience of one case. A 60 year old male with hematuria of two years evolution, with frequency and dysuria. A tumor was found and he received surgical treatment by TURB at first. The pathology result was a plasmacytoid urothelial carcinoma. Subsequently a radical cystectomy with urinary diversion was performed. The patient received follow-up until his death.
- Priapismo maligno: un caso manejado de forma conservadora(Gobierno de Navarra. Departamento de Salud, 2013) Velis, J.M. (José María); Tienza, A. (Antonio); Hernandez, M.D. (M. D.); Merino, I. (Imanol); Robles-Garcia, J.E. (José Enrique); Algarra, R. (Rubén)Priapism is an urological emergency which requires investigation, especially to differentiate between ischemic and non-ischemic priapism. Initial management is carried out through aspiration and gasometry of blood from the corpus cavernosum. We report the case of a 69-year-old patient with urothelium carcinoma of the bladder T2 G3 and metastasis in urethra/corpus cavernosum who requested an emergency consultation because of edema and a penile erection lasting several days. Due to the poor prognosis and the imaging test, a conservative management was carried out.
- Carcinoma de células renales: factores pronóstico influyentes en la supervivencia y modelos de riesgo(Universidad de Navarra, 2022-04-05) Velis, J.M. (José María); Pascual-Piedrola, J.I. (Juan Ignacio); Robles-Garcia, J.E. (José Enrique)El carcinoma renal supone alrededor de un 2-3% de todos los tumores diagnosticados y de causas de muerte por cáncer en el mundo, con unas proporciones de incidencia generalmente más elevados en países desarrollados1 . Anualmente, se diagnostican unos 295.000 nuevos casos de cáncer renal y se registran alrededor de 134.000 muertes por esta causa a nivel mundial2,3. En estados Unidos se diagnostican unos 63.000 nuevos casos y unas 14.000 muertes por año4 , mientras que en Europa suponen unos 84.000 nuevos casos y unas 35.000 muertes por año5 . Es más frecuente en varones que en mujeres (en razón de 2:1 de nuevos casos). Según datos de la SEOM (sociedad española de oncología médica), en España se diagnostican unos 6500 nuevos casos y unas 2300 muertes por año. La mayor incidencia de carcinoma renal se da en la República Checa con una proporción de 22,1 y 9,9 nuevos casos por cada 100.000 habitantes en hombres y mujeres respectivamente, en el periodo entre 2003-20076 . La incidencia es muy alta en los países Bálticos y de Europa del Este, aunque las razones son desconocidas. La incidencia global ha ido aumentando en la última década, mientras que la mortalidad ha ido en descenso. Esta divergencia es particularmente evidente en países desarrollados. Por ejemplo, un análisis de la base de datos de Estados Unidos (SEER: Survillance, Epidemiology, and EndResults), indica que el aumento de la incidencia en carcinoma de células renales se produce a expensas de tumores pequeños y localizados, probablemente, en parte al menos, por
- Perforación duodenal espontánea en paciente intervenido de prostatectomía radical(Gobierno de Navarra. Departamento de Salud, 2012) Romero, L.M. (L.M.); Barba-Abad, J.F. (Javier Fermín); Velis, J.M. (José María); Tienza, A. (Antonio); Berian-Polo, J.M. (José María); Algarra, R. (Rubén)Radical prostatectomy is a well known treatment for prostate cancer, with a low incidence of early postoperative complications. Our case is a 54 year old patient diagnosed with prostate adenocarcinoma, Gleason score 3+3=6 with 8 ng/ml of PSA, treated by retropubic prostatectomy, who suffered spontaneous perforation of the duodenum. We chose a conservative management, resolved in 30 days. When dealing with a surgical patient all kinds of complications must be taken into account by performing the minimum tests that will enable a sure diagnosis to be achieved. The usual treatment is surgery or conservative management, depending on the case and the patient.
- Case of emphysematous pyelonephritis in kidney allograft: Conservative treatment(Journal de l association des urologues du Canada, 2014) Zudaire-Bergera, J.J. (Juan Javier); Velis, J.M. (José María); Tienza, A. (Antonio); Pascual-Piedrola, J.I. (Juan Ignacio); Hevia, M. (Mateo); Merino, I. (Imanol); Robles-Garcia, J.E. (José Enrique); Algarra, R. (Rubén)Emphysematous pyelonephritis is an acute necrotizing infection with gas in the kidney and perinephric space that carries a bad prognosis. Apart from its predisposing clinical entities, diabetes mellitus and immune-incompetence are quite common in patients with this infection. We report a case of a 53-year-old kidney transplant recipient diabetic male, suffering from recurrent fever, abdominal pain and nausea episodes. Immediate broad-spectrum antibiotics were administered and percutaneous drainage was performed after the diagnosis. The bacteria involved were Stahpylococcus epidermidis and Escherichia coli. After 4 weeks of antibiotic treatment and abscesses drainage, the case was resolved. Consecutives urine cultures and ultrasonographies confirm the complete resolution of the disease. We discuss the predisposing factors, clinical presentation and management.