Hypogonadism and Mortality in Aged Hospitalized Male Patients: A 5-Year Prospective Observational Study.

OBJECTIVE: To investigate the relationship between hypogonadism and mortality in aged hospitalized male patients. DESIGN: A 5-year prospective observational study was conducted. Gonadal function was assessed at hospital admission and mortality was registered in the follow-up period. PATIENTS AND METHODS: We studied all patients≥65 years admitted for any reason during 2010 and 2011. Serum T concentrations were quantified in all patients. Hypogonadism was defined by the presence of serum T levels<200 ng/dl. Number of deaths and all-cause and cardiovascular (CV) mortality were registered until December 31(st), 2014. RESULTS: During the study 150 patients were admitted and 103 (68.7%) of them died during follow-up. Hypogonadism was positively associated with mortality (P=0.036). The percentage of hypogonadal patients was significantly (P=0.02) higher in the group of patients who died in hospital compared with those who died after hospital discharge and those who survived. CV disease was the main cause of death in 52 patients (50.5%). Kaplan-Meier analysis showed a median survival time for all-cause mortality of 2.0 (0-16.5) months and 21.0 (5.0-33.2) months for patients with and without hypogonadism, respectively (P<0.001). Similar findings were found when analyzing mortality due to CV disease (P=0.009). Hypogonadism was a strong independent predictor for all-cause (adjusted multivariate analysis, HR 3.35; 1.55-7.23, P=0.002) and CV mortality (HR 2.14; 1.18-3.86, P=0.012). CONCLUSIONS: Hypogonadism discovered during hospitalization is associated with in-hospital and long-term mortality in elderly male patients and predicts both all-cause mortality and CV mortality in this population.

Natural course of hypogonadism diagnosed during hospitalization in aged male patients.

Our aim was to assess short-term natural course of hypogonadism diagnosed during hospitalization for acute disease in aged male patients after discharge. A group of 43 hypogonadal males, aged 86.7±5.7 year, was studied. Serum concentrations of testosterone (T) and gonadotropins (follicle-stimulating hormone, FSH, and luteinizing hormone, LH) were measured in every patient both at admission and one month after discharge. Mean serum T at entry was 115.4±48.0 ng/dl. Hypogonadism was hyper-, hypo-, and normogonadotropic in 20 (46.5%), 20 (46.5%), and 3 (7.0%) patients, respectively. One month after discharge serum T concentrations increased significantly (230.9±135.6 ng/dl, p<0.001). At this point, more than half of the patients (n=27, 62.8%) showed normal serum T concentrations. Both gonadotropins, FSH (p<0.001), and LH (p=0.04) also increased one month after discharge. Approximately, half of the patients (13, 48.1%) who normalized serum T concentrations also showed normal serum gonadotropin concentrations. Patients who normalized their serum T concentrations one month after discharge showed significantly higher baseline values of T (134.7±33.9 ng/dl) than those who persisted with hypogonadism (n=16, 32.7%; 82.8±51.6 ng/dl, p<0.001). Lastly, serum T was the only independent predictor for achieving eugonadal status (OR 1.030; CI 95%, 1.010-1.050; p<0.001). In conclusion, about 63% of aged patients hospitalized for acute illness with hypogonadism discovered during hospitalization spontaneously normalize their serum T concentrations one month after discharge. Serum gonadotropin concentrations also increased after discharge. Serum T levels at admission was an independent predictor for the normalization of serum T concentrations.

Hypogonadism in aged hospitalized male patients: prevalence and clinical outcome.

OBJECTIVE: Male hypogonadism is common in the elderly and has been associated with increased risk of mortality. Our objective has been to assess the prevalence of primary and central hypogonadism in elderly male patients admitted to the hospital because of acute illness. We also evaluated the relationships between gonadal dysfunction and in-hospital mortality. PATIENTS AND METHODS: 150 patients, aged ≥65 years, admitted during 2010 and 2011 in our geriatric unit, were studied. Serum concentrations total, bioavailable and free testosterone, as well as of follicle-stimulating hormone and luteinizing hormone were quantified in every patient. Hypogonadism was defined by the presence of serum testosterone levels lower than 200 ng/dl. RESULTS: Hypogonadism was found in 80 patients (53.3 %). Serum gonadotropin concentrations were elevated in 43.7 % of these patients, whereas 41.3 % of hypogonadic patients showed normal and 15 % low gonadotropin concentrations. Respiratory tract infection and congestive heart failure were the main causes of hospitalization in hypogonadal men, whereas acute cerebrovascular disease was the main reason for admission in eugonadal patients. Of the 13 patients who died during hospitalization, 12 were hypogonadic. Patients who died showed significantly lower serum levels of total, free and bioavailable testosterone than those found in patients who survived. CONCLUSION: Our results show that about half of patients admitted for acute illness have hypogonadism, mainly of non-hypergonadotropic type. Gonadal hypofunction is significantly related with in-hospital mortality. A low value of serum testosterone may be a predictor for mortality in elderly male patients.

[Incidence of axillary recurrence after a negative sentinel lymph node result in early stages of breast cancer: a 5-year follow-up]. / Incidencia de recurrencia axilar tras un ganglio centinela negativo en cáncer de mama en estadios iniciales: seguimiento de 5 años.

UNLABELLED: The sentinel lymph node (SLN) biopsy is currently the procedure of choice for axillary node staging in initial stages of breast cancer. The purpose of this study is to establish our false negative rate within a 5-year follow-up period in 258 patients with breast cancer staged with this procedure. METHODS: A retrospective study on 258 consecutive T1-T2<3 cm pN0 staged breast carcinomas treated from January 1, 2001 to December 31, 2005 was performed. The combined technique of isotope plus blue dye was used for detection. The subjects underwent a minimum follow-up of 5 years, mean 81 months, with an end of follow-up at December 31, 2010. Evidence of axillary recurrence, tumor recurrence in the breast and signs of disease progression or death were the events collected and analyzed. RESULTS: Of the 258 patients, 3 false negatives (1.1%) with axillary recurrence were detected at 10, 11 and 29 months of the surgery. This did not have a significant repercussion in the survival analysis on the contrary to the existence of breast recurrence or the appearance of distant metastasis in 4.7% and 6.2% patients, respectively. Global survival related with the cancer was 93.0 (240/258) and disease free survival was 89.1% (230/258). CONCLUSION: The risk of developing axillary recurrence after a negative SLN without axillary node dissection is low enough to consider the SLN procedure to be the best approach for axilla staging in early breast cancer. This staging technique also makes it possible to achieve local disease control without diminishing the survival of the patients.

Fasting hyperglycaemia and in-hospital mortality in elderly population.

BACKGROUND: Admission hyperglycaemia has shown to be a marker of poor clinical outcome. The prevalence of admission hyperglycaemia and its relationship with in-hospital mortality in elderly population has not been clearly defined. We assessed the prevalence and prognostic significance of admission fasting hyperglycaemia in aged patients. METHODS: A total of 808 elderly patients were studied. Patients were classified into group I (serum glucose < 126 mg/dl), II (126-180 mg/dl) and III (> 180 mg/dl). Groups II and III were considered newly recognised fasting hyperglycaemia (NRFH) in non-diabetic patients. RESULTS: NRFH was present in 18.6%. After excluding diabetic patients (n = 206, 25.5%), the distribution of patients (n = 602, 74.5%) was as follows: group I (n = 452, 55.9%), group II (n = 122, 15.1%) and group III (n = 28, 3.5%). In the whole cohort, median fasting glucose was lower in patients who survived [105 mg/dl (88-135)] than in those who died [127 mg/dl (93-159), p < 0.001]. This significant difference was maintained only when non-diabetic patients were considered [100 mg/dl (87-122) vs. 118 mg/dl (92-149), p < 0.001]. In-hospital mortality rate in groups I, II and III was 8.5%, 14.1% and 22.9%, respectively (p < 0.001). Mortality rate was 8.4%, 18.0% and 32.1% (p < 0.001) in groups I, II and III, respectively in non-diabetic population. Both low albumin and high glucose serum concentrations were the only independent risk factors for in-hospital all-cause mortality in non-diabetic patients. CONCLUSIONS: In non-diabetic elderly patients admitted for acute disease, serum glucose concentration is an important, simple and independent predictor of hospital mortality.

Serum thyrotropin concentration is an early marker of normalization of low triiodothyronine syndrome in aged hospitalized patients after discharge.

OBJECTIVES: To assess short-term spontaneous evolution of alterations in thyroid function tests in aged hospitalized patients after discharge. METHODS: A group of 146 patients (mean age±SD 85.9±6.2 yr) was studied. Serum concentrations of TSH, free T4 (FT4), and free T3 (FT3) were evaluated in every patient both after admission and 1 month after discharge. RESULTS: At entry, both serum TSH [median (interquartile range), 2.19mU/l (0.89-2.31)] and FT4 (mean±SD, 16.7±3.4 pmol/l) concentrations were into the normal range, whereas serum FT3 concentrations were low (3.3±0.7 pmol/l). After discharge TSH and FT4 concentrations remained normal and FT3 low. However, both serum TSH [2.53 mU/l (1.24-3.33); p<0.01] and FT3 (3.7±1.0 pmol/l; p<0.001) concentrations significantly increased. Most patients (no.=124, 84.9%) showed the euthyroid sick syndrome (ESS). After discharge, ESS diminished to 76 (52.1%) subjects. Patients who normalized thyroid function tests showed significantly lower TSH values at entry compared with those who persisted with altered thyroid function tests [1.27 mU/l (0.69-1.89) vs 1.69mU/l (0.96-2.91), p<0.05]. Logistic regression analysis showed that serum levels of TSH at admission was the only variable negatively related to normalization of thyroid function [odds ratio 0.730; confidence interval 95%, 0.567-0.940; p=0.01). CONCLUSIONS: About 35%of aged patients hospitalized for acute illness spontaneously normalize their thyroid function tests 1 month after discharge, mainly due to the correction of ESS. Serum TSH levels at admission seem to be the only variable negatively related to normalization of thyroid function at this time.

[Elderly patients with chronic kidney disease: what happens after 24 months of follow-up]. / Ancianos con enfermedad renal crónica: ¿qué ocurre a los 24 meses de seguimiento?

INTRODUCTION: Systematic application of mathematical formulae to estimate the glomerular filtration rate (eGFR) of the general population, according to KDOQI classification of Chronic Kidney Disease (CKD), has permitted to calculate its high prevalence, so as to be considered as a public health problem. Many patients with CKD according to this classification (at least stage 3) are elderly with a low GFR and without any other typical manifestations of renal damage, which is generating a worry between nephrologists due to a significant increment in non justified referrals to their clinics. Our aim in this study is to follow-up during twenty-four months a group of elderly with a low eGFR. PATIENTS AND METHODS: 80 clinically stable patients, with a mediane age of 83 years (range 69-97), recruited alleatory in a consultation of Geriatric and Nephrology General, within January and April 2006, were followed up during twenty-four months. We separated them in two groups based in serum creatinine: Group 1: 38 patients with serum creatinine >_ 1,1 mg/dl (range 0,7-1,1), and Group 2: 42 patients with serum creatinine >1.1 mg/dl (range 1,2-3). Clinically we registered morbimortality and treatments received, and biochemically we measured in serum: creatinine and calculated eGFR at the time of recruitment and after twenty-four months of follow-up using two equations: Cockroft and abreviated MDRD. In urine we determinated basic urinalysis in all patients, protein/creatinine in group 1 and determinated protein in collection urine 24 hours group 2. Statistical comparisons were made using repeated measures, chisquare, and logistic regression of the SPSS 11.0 program. RESULTS: 22,5% of the patients died during the follow up. Heart and infectious problems were the kind of morbidity more frequently found. Only a small proportion (23,3%) of group 2 patients were receiving erithropoietin treatment. Estimated GFR and proteinuria remained stable at the end of twenty-four months independently of basal eGFR. We found no significant differences between both groups in the rest of analytical parameters studied except a significant decrease of hematocrit in the elderly of group 2. Only a small proportion (23,3%) of group 2 patients were receiving erithropoietin treatment. CONCLUSION: In old patients without proteinuria, the stability of its renal function along the time allows us to give a soothing message at the moment of facing the so called CKD "epidemic" in this population.

Alterations in thyroid function tests in aged hospitalized patients: prevalence, aetiology and clinical outcome.

BACKGROUND: Thyroid dysfunction is common in aged people and has recently been associated to mortality. AIMS: Our aims have been (1) to assess the prevalence of alterations in thyroid function tests in hospitalized patients over age 60 years and (2) to study the relationship between thyroid functional status and mortality during hospitalization. METHODS: We studied a group of 447 patients (62% women), aged 61-101 year, hospitalized during 2005. Thyroid dysfunction was assessed by measuring serum concentrations of thyrotrophin (TSH), free thyroxine (FT4), and free thriiodothyronine (FT3). Thyroid autoimmune status was evaluated through thyroid peroxidase (TPO) and thyroglobulin (TG) antibodies quantification. RESULTS: Twenty-one patients (4.7%, 19 women) showed previously known thyroid dysfunction. 332 patients (74.3%) showed alterations in thyroid function tests. Euthyroid sick syndrome (ESS) was the derangement more frequently found (n = 278, 62.2%). After excluding ESS patients, 60 patients (13.4%) showed thyroid dysfunction: overt hypothyroidism, 14 (3.1%); subclinical hypothyroidism, 25 (5.6%); overt hyperthyroidism, 11 (2.5%), and subclinical hyperthyroidism, 10 patients (2.2%). Thyroid autoimmunity was positive in only 4.0% and 2.3% of patients, for TPOAb and TgAb, respectively. The presence of alterations in thyroid function tests was positively associated with the age of the patients and mortality during hospital stay (P < 0.001). Serum levels of FT3 were negatively related to death during hospitalization (OR 0.56; CI 95%, 0.38-0.81; P < 0.01). CONCLUSIONS: About three quarters of patients admitted in our geriatric unit exhibited alterations in thyroid function tests. This finding was associated with elevated age and poor prognosis. The reduction of FT3 values was a powerful predictor for mortality during hospitalization in elderly patients.

[Elderly patients with Chronic Kidney Disease: what is their course at one year?]. / Ancianos con enfermedad renal crónica: ¿Cuál es su evolución al cabo de un año?

INTRODUCTION: Aging is associated to several structural and functional kidney changes. Recently, there is a great interest in the detection of Chronic Kidney Disease (CKD) in the general population. A classification of CKD, based on several stages of the estimated glomerular filtration rate (eGFR), has been established. In this study we followed up, clinically and biochemically, during one year eighty patients older than 65 years so as to ascertain the applicability and utility of such classification to those patients. PATIENTS AND METHODS: 80 clinically stable patients, with a median age of 83 years, recruited within January and April 2006, were followed up during one year. We separated them in two groups: Group 1: 38 patients with serum creatinine pound sterling 1,1 mg/dl (range 0,7-1,1) and with no proteinuria; and Group 2: 42 patients with serum creatinine > or =1.1 mg/dl (range 1,2-3) and with proteinuria <3 grs/24 hours. Clinically we registered morbimortality and treatments received, and biochemically we measured serum creatinine and eGFR at the time of recruitment and after one year of follow up using two equations: Cockroft and abbreviated MDRD. Statistical comparisons were made using the general lineal model for repeated measures of the SPSS 11.0 program. RESULTS: 10% of the patients died during the follow up. Cardiac problems were the kind of morbidity more frequently found. Only a small proportion (23%) of group 2 patients were receiving erythropoietin (EPO) treatment. Estimated GFR and proteinuria remained stable at the end of one year independently of basal GFR; we found no significant differences between groups in the rest of analytical parameters. CONCLUSION: in old patients with no significant proteinuria, the similarity of their clinical evolution and the stability of their eGFR (independently of its basal value), as well as the lack of differences in other analytical parameters, appears not to confer any advantages to the use of mathematical formulae to classified them according to their eGFR.

[Sentinel node biopsy in T2 breast cancers larger than 3 cm and clinically negative axilla compared with the T1-T2 <3 cm standard indication]. / La biopsia del ganglio centinela en cáncer de mama de más de 3 cm y axila clínicamente negativa frente a la indicación estándar T1-T2 < 3 cm.

OBJECTIVE: To present our experience in the application of sentinel node (SN) biopsy in patients with breast cancer T > 3 cm without clinical evidence of axillary metastasis. MATERIAL AND METHOD: Retrospective study of 393 cases in the period 2001--2006, divided into group (A) 47 patients with 3-5 cm T2N0 tumours and group (B) 346 patients T < 3 cm, N0. We employed the combined technique with 99mTc-colloidal rhenium sulphide and isosulfan blue dye. Preoperative lymphoscintigraphy was performed and the SN was located intraoperatively with a gamma ray detection probe and the blue dye. Axillary lymph node dissection was completed only when the SN was positive for metastasis in the histopathology analysis or not located. RESULTS: The SN detection rate for T2 > 3 cm was 94 % in the scintigraphy and 96 % with the probe, with no statistically significant differences between T < 3 cm (97 % and 98 %). In T2 > 3 cm, the final staging was 45 % pN0, 8 % pN1mi, 34 % pN1a, 11 % pN2a and 2 % pN3a. We found statistically significant differences (p < 0.05) when compared with palpable T < 3 cm and non-palpable cancer (62 % pN0 and 74 % pN0, respectively). In the follow-up of T2 > 3 cm (median 42.88 months) we did not find any axillary relapse which could be considered a false negative of the technique. CONCLUSION: The detection of sentinel lymph nodes is feasible and safe in tumours larger than 3cm with clinically negative axilla. Axillary lymph node dissection can be avoided in 45 % of these patients and therefore, we consider that they should be included as a general indication in breast cancer SN detection.

Staging the axilla with selective sentinel node biopsy in patients with previous excision of non-palpable and palpable breast cancer.

PURPOSE: To present our experience in the therapeutic approach of the sentinel node biopsy (SNB) in patients with previous excision of the breast cancer, divided in non-palpable and palpable lesions, in comparison with time treatment and stagement of breast cancer. METHODS: In the period 2001-2006, 138 patients with prior diagnostic excisional biopsy (96 non-palpable and 42 palpable breast cancer) and 328 without previous surgery (32 non-palpable; 296 palpable cancer) were treated. The combined technique ((99m)Tc-colloidal rhenium and isosulfan blue dye) was the approach for sentinel lymph node (SLN) detection. Axillary lymph node dissection (ALND) was completed only when the SLN was positive for metastasis or not located. RESULTS: Detection rate, if there was prior surgery, was 95% for non-palpable and 98% for palpable cancer, and 99% for one-time treatment group. Metastasis rate in the SLN was 15% in non-palpable cancer (14/91), significantly smaller than in palpable breast cancer (39% if prior surgery and 37% in one-time surgery). According to tumoral size, ALND metastasis rate was similar for T1 and T2 tumors (43-44%). In the follow-up of the groups with prior diagnostic biopsy or surgery of the breast cancer we have not found any false negative in the axilla. CONCLUSION: The detection of the SLN is also feasible in patients with previous surgery of breast cancer. Because SLN metastasis rates are significantly smaller in non-palpable lesions, the effort in screening programs for early detection of breast cancer and also in improving histopathological confirmation of malignancy with ultrasound or stereotactic guided core biopsies must continue.

[Pandrial gastroesophageal reflux in healthy preterm infants]. / El reflujo gastroesofágico pandrial en pretérminos sanos.

UNLABELLED: The neutralization of gastric content during feeding and in the immediate postpandrial period, has determined that until recently time these periods were excluded in the studies of the gastroesophageal reflux disease (GERD) that were made with pH-metría. The aim of this study was to characterize the events of reflux during feeding with pH and impedance,and later to compare them with which it happens in fasting periods. MATERIAL AND METHOD: We recording pH and Impedance in 21 preterms neonates without associated pathology, except the prematurity, during 8 periods of feeding-fasting (1 hour of feeding and 2 hours of rest), replacing the nasogastric tube by a catheter of feeding + impedance, previous informed consent. RESULTS: The average of reflux during the meals per hour was of 3.36 h +/- 1.23 h, whereas in fasting periods was 1.02 h was of 2.65 h +/- (p = 0.068). The number of acid reflux per hour during the fasting was higher [1, 05 (0.34-1.23) h] than in feeding periods [0, 20 (0-1.12) h] (p = 0,044). The number of weakly acid reflux per hour was significantly higher in feeding periods [2, 71 (2.03-3.30) h] than in fasting periods [1, 35 (1.13-1.97) h] (p = 0, 05). The acid exposure during the meals was of 2, 35% whereas in fasting periods was of 7, 23%. CONCLUSION: The incorporation of the Impedance within the battery of tests for the diagnosis of the gastroesophageal reflux in the pediatric population, at the moment allows us to know the pattern behavior of esophagus during the meals: feeding periods were associated with a greater number of reflux per hour, most of which weakly acidic; the acid exposure was significantly greater during fasting periods.

[Acid and non-acid gastro-esophageal reflux in newborns. Preliminar results using intraluminal impedance]. / Reflujo gastroesofágico ácido y no ácido en el recién nacido. Datos preliminares de estudio con impedancia intraesofágica.

Preterm infants present often Gastroesophageal refluxes (GER). Esophageal pH monitoring to reflux detection is of limited use in this infants because their gastric pH is normally higher than 4 for 90% of the time. Other methods such as the Intraluminal Impedance Technique (MII) technique and the use of micromanometric catheters try to palliate the difficulties for measuring GER by pH monitoring. The aim of this study, in a first step, was to obtain the normal Intraluminal Impedance values on control children and, in a second step, to study the relationship between GER and cardiorespiratory episodes using simultaneous recording of the end-tidal fraction of expired CO2, 02 saturation by pulse-oximetry, respiratory frequency, esophageal impedance and manometry, gastro-esophageal pHmetry, and electrocardiography in selected patients. Data from simultaneous pH and Intraluminal Impedance during 24 hours in 7 control preterms showed 89 acid refluxes, 192 non-acid refluxes, 79.36% of all refluxes reached the proximal esophagus. Therefore the impedance is an innocuous method which opens new horizons in the study of such a common illness as the GER in the preterm infants.

Study of the distribution of glycosidic residues in eccrine sweat glands, with special reference to the content of sialic acid.

We used a group of lectins (Con-A, WGA, SBA, DBA, RCA-1, UEA-1), enzymes (neuraminidase digestion) and conventional histochemical techniques (periodic acid-Schiff reaction and reduction-saponification-Schiff reaction) in order to detect the presence of glycoproteins rich in sialic and neuraminic acids in the human eccrine sweat glands. Using both identification systems, our results showed an abundant secretion, rich in C8Oxi-acylated sialic acid.

Intermediate scale for assessment of Parkinson's disease. Characteristics and structure.

The present study is devoted to the verification of the basic metrical characteristics of the ISAPD. One hundred and sixty-seven Parkinson's disease (PD) patients were included. Group A (n = 40) was simultaneously assessed by five raters who applied the ISAPD and other PD rating scales (PDRS). A set of timed tests, the MiniMental State Examination (MMSE) and the Hamilton Scale for Depression (HSD) were administered by an independent examiner. Group B (n = 127) was individually assessed through the UPDRS and the other PDRSs by separate neurologists in four different hospitals. The ISAPD was administered in 7.0 +/- 3.7 min. The internal consistency of this scale was high (Cronbach's alpha = 0.97). The inter-rater reliability of their items was very satisfactory (for all items, kappa > 0.70). There was a high correlation with the Hoehn and Yahr classification (r(s) = 0.71; p < 0.001) and some timed tests. The convergent validity with the other PDRS (UPDRS and Schwab and England Scale) was also very high (r(s) = 0.83-0.92; p < 0.001). The ISAPD also correlated with the MMSE and the HSD. Factor analysis identified three factors (activities of daily living; gait and mobility; speech and eating) that explained 76% of the variance. The ISAPD is an easy to apply, reliable, and valid scale that fulfills the aim for which it was designed.

[Deep cystic enteritis in Peutz-Jeghers syndrome (pseudoinfiltrating lesions in a patient with enteric polyps)]. / Enteritis quística profunda en síndrome de Peutz-Jeghers (lesiones pseudoinfiltrantes en paciente con pólipos entéricos).

We report a case of enteritis cystica profunda observed in a patient who, owing to both his personal and familial history, had been diagnosed and suffering from Peutz-Jeghers syndrome. The patient was operated because of a clinical picture of intestinal invagination. Together with hamartomatous polyps, anatomopathological study of the segment of the small intestine removed revealed the presence of lesions typical of Enteritis cystica profunda consisting in the presence of benign encysted glands and pools of mucous in the deep layers of the intestinal wall. The main characteristics of this interesting and rare entity are briefly commented.

[Bladder schistosomiasis. Report of a case]. / Esquistosomiasis vesical. Presentación de un caso.

OBJECTIVES: We report an additional case of schistosomiasis of the urinary bladder, an unusual parasitic infection in our setting, with special reference to the histomorphological findings that permitted its diagnosis. METHODS: Biopsy was performed via cystoscopy and bladder tissue was obtained from an area in the trigone with an abnormal appearance. RESULTS: Microscopic examination of the biopsy specimen revealed eggs of the parasite Schistosoma haematobium. CONCLUSIONS: The present case shows the importance of close collaboration between clinicians and pathologists and the usefulness of cystoscopy for diagnosis in urological patients.