Real-space observation of ultraconfined in-plane anisotropic acoustic terahertz plasmon polaritons.

Thin layers of in-plane anisotropic materials can support ultraconfined polaritons, whose wavelengths depend on the propagation direction. Such polaritons hold potential for the exploration of fundamental material properties and the development of novel nanophotonic devices. However, the real-space observation of ultraconfined in-plane anisotropic plasmon polaritons (PPs)-which exist in much broader spectral ranges than phonon polaritons-has been elusive. Here we apply terahertz nanoscopy to image in-plane anisotropic low-energy PPs in monoclinic Ag2Te platelets. The hybridization of the PPs with their mirror image-by placing the platelets above a Au layer-increases the direction-dependent relative polariton propagation length and the directional polariton confinement. This allows for verifying a linear dispersion and elliptical isofrequency contour in momentum space, revealing in-plane anisotropic acoustic terahertz PPs. Our work shows high-symmetry (elliptical) polaritons on low-symmetry (monoclinic) crystals and demonstrates the use of terahertz PPs for local measurements of anisotropic charge carrier masses and damping.

Langmuir and Langmuir-Blodgett films of a maleic anhydride derivative: effect of subphase divalent cations.

We report the study of the equilibrium and dynamic properties of Langmuir monolayers of poly(styrene-co-maleic anhydride) partial 2-buthoxyethyl ester cumene terminated polymer and the effect of the Mg(NO(3))(2) addition in the water subphase on the film properties. Results show that the polymer monolayer becomes more expanded when the electrolyte concentration in the subphase increases. Dense polymer films aggregate at the interface. The aggregates are transferred onto silicon wafers using the Langmuir-Blodgett methodology and the morphology is observed by AFM. The structure of aggregates depends on the subphase composition of the Langmuir film transferred onto the silicon wafer.

[Rigid gas permeable contact lenses fitted in a case of congenital glaucoma]. / Adaptación de lentes de contacto rígidas permeables al gas en un caso de glaucoma congénito.

CASE REPORT: A 27-year-old woman with congenital glaucoma with high myopia, low visual acuity and nystagmus in both eyes, was referred for contact lens fitting. We fitted her with aspherical rigid gas permeable (RGP) contact lenses with high transmissibility, which she wore on a daily basis. Her visual acuity improved with the wearing of these lenses, which remained comfortable whilst being worn for 10 hours a day. DISCUSSION: Contact lenses were fitted according to her corneal topography. Gas permeable contact lenses were chosen as first choice and with proper fitting and vigilant follow-up they may be worn safely on a daily basis.

[Multifocal renal cell carcinoma on renal allograft]. / Carcinoma de células renales multicéntrico en injerto renal.

Development of neoplasms after a renal transplantation is well known, but allograft neoplasms are uncommon. Diagnostics studies include routine ultrasonography, and CT. In some selective cases, if the graft is functionally salvageable and it is technically feasible, a nephron-sparing surgery should be performed. In any case, standard intervention is nephrectomy. We report a case of multifocal renal cell carcinoma diagnosed in a kidney grafted 17 years before.

[In vitro three-dimensional reconstruction of human bladder mucosa]. / Reconstrucción tridimensional in vitro de mucosa vesical humana.

OBJECTIVE: The purpose of this study is to apply the in vitro keratinocyte culture techniques and the tissue engineering principles to human urothelium, to reconstruct an in vitro three-dimensional human bladder mucosa, suitable for grafting. MATERIAL AND METHODS: Biopsy specimens of human bladder mucosa were obtained from patients undergoing suprapubic prostatectomy, in vitro cultured and finally, an immunohistochemical study was made. RESULTS: A three-dimensional in vitro tissue was obtained, composed of a bio-artificial submucosa (fibrin gel and fibroblast) where the uroepithelial cells were seeding. We used a biodegradable polyglycolic acid mesh to facilitate the tissue manipulation and implantation. An immature epithelium was obtained with a weak immunostaining to cytokeratins. The immunohistochemical study could not demonstrate the development of basement membrane. CONCLUSIONS: In vitro keratinocyte culture techniques could be applied to other epithelial tissues like the urothelium. We obtained a three-dimensional in vitro tissue suitable for grafting in a relatively short time, which needs the matrix interactions in order to mature.

[Testicular epidermoid cyst: uncommon lesion of difficult preoperative diagnosis]. / Quiste epidermoide testicular: una rara entidad de dificil diagnostico preoperatorio.

Intratesticular epidermoid cysts are rare tumours that constitute one percent of all testicular masses. They are bening lesions that make differential diagnosis from malignant testicular tumours difficult. The absence of serum markers elevation and ultrasound imaging could support these lesions being bening epidermoid cysts, and in that case, conservative surgery is adequate. We present the case of a 22 years old patient who complains of a left testicular mass. In this case ultrasound diagnosis was non-specific and a left radical inguinal orchiectomy was performed.

[Comparative study between cystoscopy, urinary cytology, NMP-22 and a new method, bladder chek, in the follow-up of superficial bladder cell carcinoma]. / Estudio comparativo entre cistoscopia, citología urinaria, NMP-22 y un nuevo método, bladder chek, en el seguimiento del cáncer vesical superficial.

OBJECTIVE: The goal of this work tries to evaluate the utility of the qualitative determination of NMP-22 in the evaluation of the superficial bladder carcinoma in asymptomatic patients, comparing it with its quantitative determination, the cytology and the cystoscopy. MATERIALS AND METHODS: A simple of urine just voided was taken in 88 asymptomatic patient follow-up for superficial bladder cell carcinoma. This dose was distributed in 3 parts, for performed cytology, for determination of NMP-22, and 4 drops of the third part are added to device bladder chek. Later, we performed cystoscopy and transurethral resection in patients with a suspicion of bladder cancer. RESULTS: 26 patients had tumor relapse and 62 patients were free of disease. The sensitivity for the bladder chek was of 28%, 34.62% for NMP-22, 34.62% for cytology and 100% for cystoscopy. The specificity was of 93.55%, 80.33%, 87.10% and 87.10% respectively. The sensitivity by degree was 25 in G1, 28.57 in G2 and 50 in G3 for Bladder chek; 29.41, 42.86 and 50 for NMP-22; 23.53, 71.43 and 0 for cytology. The sensitivity by stages was 27.7 in Ta-1 and 50 in T2 for Bladder chek; 34.78 and 50 for NMP-22; 39.13 and 0 for the cytology. CONCLUSIONS: The low sensitivity of bladder chek invalidates it like alternative method to the cystoscopy in the follow-up of the superficial asymptomatic bladder cell carcinoma.

[Surgical aspects in the third and fourth kidney retransplant]. / Aspectos quirúrgicos en los terceros y cuartos retrasplantes renales.

INTRODUCTION AND OBJECTIVES: A quarter of patients waiting for kidney transplantation are patients with previous graft failure. Outcome of first and second renal transplant make these the gold standard for end renal stage disease, but this is not so clear in the case of third and further renal transplant, especially at the time of organ shortage. We revise our experience in patients with three or more kidney transplants focusing on surgical aspects and graft outcome. MATERIAL AND METHOD: 1364 renal transplants have been carried out in our centre since 1975 until December 2003. We have retrospectively revised the 34 patients with three renal transplants and the 5 with four. We analyse the surgical technique, surgical complications and graft outcome. RESULTS: Mean age was 42 years (21-65). Average mismatches between donor and recipient was 3.2. All kidneys, but one case of living donor, were harvested from cadaver donors, mostly in multiple organ-procurement. Average time from the last renal transplant was 5 years (3 days-17 years) and from the last transplant carried out in the iliac fossa reused until the new transplant was 9 years (3 days- 17.5 years). All implants were performed through an iterative lumboliliac incision (25 on the right side, 11 on the left one and in 3 cases where side was not registered). Mean average duration of the procedure was 166 minutes (100-300). Nephrectomy of previous graft at the moment of the implant was carried out in 13 patients (33%). Vascular anastomosis was made on the common iliac vessels (50%) or on the external ones (50%) in end to side way, Ureteroneocystostomy was performed in an extravesical way except in 1 patient with cutaneous diversion. Vascular complications were 4 haemorrages (1 patient died), 3 venous and 2 arterial thrombosis. We had an abscess secondary to intestinal fistulae. Other surgical complications were 4 lymphoceles, three of them needed surgical treatment, and one perirenal haematoma treated in a conservative way. No urological complications were seen. In total 6 grafts (15%) were lost due to surgical complications. Graft actuarial survival rate at 1 year was 65%, 40% at 5 and 28% at 10 years. CONCLUSIONS: Three and four renal transplant survival rates are shorter than first and second ones. Iterative access through lumboiliac incision is associated with a higher vascular complication rate, probably in these patients a transperitoneal access would be better. Multicentric studies with higher numbers of patients are needed to define more clearly which patients would benefit from multiple kidney retransplants.

[Renal cell carcinoma in crossed fused renal ectopia]. / Tumor renal en ectopia renal cruzada con fusión.

Crossed renal ectopia its a rare congenital malformation and in most cases it presents with fusion of both kidneys. Patients should be asynptomatic until 4a-5a decade and at that time they unfold urinary infection, urolithiasis, abdominal mass or pain that simulates a gastric disease. We report a case of renal cell carcinoma in a patient with crossed fused renal ectopia, showed in a Scan that was performed for gastric disease suspicion.

[Usefulness of abdominal leak point pressure determination in the diagnosis of female urinary incontinence in the TVT era]. / Utilidad de la determinación de la presión abdominal de fuga en el diagnóstico de la incontinencia de orina femenina en la epoca del TVT.

OBJECTIVE: To analyse our results about continence in the treatment of female urinary incontinence with the tension-free vaginal tape (TVT) procedure based on abdominal leak point pressure(ALPP). PATIENTS AND METHODS: Retrospective study of the fifty two patients who had urodynamic study and abdominal leak point pressure determination and were operated on between 1999 and 2002 for stress urinary incontinence. We reviewed the data of clinical history, physical examination and urodynamic report, surgery, complications, and objective and subjective results. Those patients having ALPP > 100 are included in group 1, between 61 and 100 in group 2 and less than 60 in group 3. RESULTS: There were 19 patients in group 1, 17 in group 2 and 16 in group 3. We found no difference between the three groups regarding age, delivery, menopause, hysterectomy, evolution, previous surgery, grade of cystocele, association of anterior colporraphy to TVT and type of anaesthesia. The Obrink clinical grade increased as the ALPP decreased (grade 3 in 26.32% of group 1, 31.58% in group 2 and 68.71% in group 3). 100% of patients in groups 1 and 2 were continent with effort and 93.75% in group 3. Complications, especially de novo instability or urgency-frequency episodes or persistence of instability in patients having mixed incontinence, caused a decrease in the satisfaction degree to 79% in group 1, 76.5% in 2 and 62.5% in 3. CONCLUSIONS: Abdominal leak point pressure determination does not change our decision of perform a TVT procedure but permits us to differentiate one group in which results could be worse.

[Experimental study about viability of autologous free graft in vitro cultivated urinary epithelium]. / Estudio experimental sobre la viabilidad del injerto libre de epitelio urinario autólogo cultivado in vitro.

OBJECTIVE: The purpose of this study is to apply the in vitro keratinocyte culture techniques and the tissue engineering principles to urothelium, to obtain a three-dimensional autologous tissue suitable for grafting. We also showed the viability of free graft cultured urothelium in an experimental model. MATERIAL AND METHODS: An animal experimental model was designed to apply the techniques of cellular culture and tissue engineering. Biopsy specimens of bladder mucosa were obtained, in vitro cultured and posteriorly implanted in each animal. We established three groups based on different follow-up periods (7, 14 and 30 days), and made a final histomorphological study to demonstrate the viability of the graft at the end of its respective follow-up period. RESULTS: A three-dimensional in vitro tissue was obtained, composed of a bio-artificial submucosa (fibrin gel and fibroblast) where the uroepithelial cells were seeding; a biodegradable polyglycolic acid mesh was used to facilitate the tissue manipulation and implantation. In the morphological study all the implants appeared viable, but the grafts with longer implantations periods were better conformed, showing a tisular structure with multiple cellular layers. CONCLUSIONS: In vitro keratinocyte culture techniques could be applied to other epithelial tissues as the urothelium. We obtained a three-dimensional in vitro tissue suitable for grafting in a relatively short time. The histological study demonstrated that free autologous urothelial graft is totally viable, opening future clinics applications.

[Current status of tissue engineering in urology. Review of the literature]. / Estado actual de la ingeniería de tejidos en urología. Revisión de la literatura.

In the eighties a new field of the medicine appears wich applies the principles of cellular cultivation to synthetic biodegradable polymers scaffolds with the purpose of creating autologous biological substitutes that could improve, maintain or restore the function of organs or damaged tissues. The Tissue Engineering constitutes a new discipline in full phase of development especially in USA, with multiple potential applications in several medical specialities. Our speciality can't remain indifferent to interest and encouraging future originated by this new science. In this work we have made a wide bibliographical revision in the Medline to know the antecedents, current state and the possible future applications of Tissue Engineering in Urology.

[Corrective surgery of penile inward curvature]. / Cirugía correctora de la incurvación peneana.

OBJECTIVE: To evaluate the corporoplasty techniques performed on 59 patients to correct congenital penile curvature and Peyronie's disease. PATIENTS AND METHOD: From april 1991 to december 2001, 39 Nesbit technique, 12 Ruiz-Castañé method and 8 Essed-Schröeder procedure were performed on forty-four congenital curvatures and fifteen Peyronie's diseases. The mean age was 24 years old. Trying to hide the knots, in all patients except five a nonabsorbable inverting sutures were placed. RESULTS: The mean follow-up was 12 months. Postoperatively, 53 patients (86%) had satisfactory cosmetic and functional results. Four patients of five with absorbable sutures had residual curvature which needed another successful surgical correction. One patient complained of penile shortening, one of glans hypoaesthesia, one of foreskin oedema and five of palpable plication sutures. No differences were found depending on the applied surgical technique. CONCLUSIONS: The results reported are in accordance with the literature showing a higher recurrence rate with the absorbable sutures. The outcome is very similar with the three described techniques.

[Complications in a consecutive series of 133 cases of radical prostatectomy]. / Complicaciones de una serie consecutiva de 133 casos de prostatectomía radical.

OBJECTIVE: To evaluate the surgical complications of radical prostatectomy in our hospital. PATIENTS AND METHOD: From august 1991 to december 1999, 138 patients with clinically localized prostate cancer underwent Walsh technique radical prostatectomy. The follow-up is known from 133 patients with a mean age of 64.8% and a mean PSA of 17.6 ng/ml. RESULTS: The mean follow-up is 43 months. Urinary fistula (9%), lymphatic leakage (5.22%) and rectal injury (2.2%) are the most common early complications. Urinary incontinence (27%), erectile dysfunction (98%) and urethrovesical junction stenosis (12%) are the delay complications. Only three patients have died due to prostate cancer. Our results are compared with another series. CONCLUSIONS: The morbidity of radical prostatectomy is very similar to the compared series. Urinary incontinence and erectile dysfunction are the most worrying complications which the patient must know to have the opportunity to choose another therapeutic option.

[Leydig cell tumor. Report of 2 cases and review of the literature]. / Tumor de células de Leydig. Aportación de dos casos y revisión de la literatura.

The Leydig cell tumor is the most frequent of non-germ cell tumors of the testis. Clinical findings depend on the age of presentation. We present two cases of Leydig Cell tumors of the testis, diagnosed in a 8 years old child with isosexual precocity, and a 42 years old adult with Gynaecomastia. After reviewing the existing literature on this uncommon pathology we consider that the iconography presented is very interesting for furthering the knowledge on this subject.

[Correlation between imaging findings and anatomopathologic results in radical prostatectomy. Data from our series]. / Correlación de los hallazgos por imagen y resultados anatomopatológicos en la prostatectomía radical. Datos de nuestra serie.

OBJECTIVE: To analyze the diagnostic methods utilized in prostate cancer and the preoperative information on the extent of the tumor, and compare these results with those obtained from anatomopathological analyses of the radical prostatectomy specimen. METHODS: Data on the radical prostatectomies performed during the study period were obtained from the Admissions and Clinical Records services and were analyzed using the SPSS statistical analysis software for Windows. RESULTS: From 1991 to 1998, 109 radical prostatectomies were performed. Evaluation by transrectal US was carried out in 89 patients (81.6%) and detected a tumor (unilateral or bilateral) in 77, for a sensitivity of 86% (CI 78.8-93.2). A CT study was performed in 94 patients and was positive in 25, for a sensitivity of 26.5% (CI 17.6-35.4). The sensitivity for transrectal US and CT were 4.17% and 3.33% for capsular involvement, 5.88% and 5.26% for seminal vesicle involvement, and 0% and 0% for node involvement, respectively. CONCLUSIONS: Transrectal ultrasound is a reliable diagnostic imaging method, although it has a low sensitivity when used to determine the extent of the tumor. In our series, the radiological methods showed a low sensitivity when they were utilized to determine the extent of the prostate cancer. Routine preoperative assessment by CT can be obviated in prostate cancer.

[Incidence of priapism at the Marqués de Valdecilla University Hospital in Santander]. / Incidencia de priapismo en el Hospital Universitario Marqués de Valdecilla de Santander.

OBJECTIVE: Our experience in the management of priapism, its etiology, blood gas changes, treatment and outcome are presented. METHODS: The records of patients that had been treated at the Urology services of our hospital over the last 8 years were reviewed. During this period, patients with erectile dysfunction were treated according to a protocol. RESULTS: There were 9 episodes of priapism in 8 patients; all cases were low flow and the patients were aged 37-71 years. The duration of the prolonged erection ranged from 4 to 72 hours. Of these 9 cases, the etiology was intracavernosal PGE in 7, after trazodone administration in one case, and unknown in one case. Intracavernosal metoxamine was administered in all cases with excellent results, except one case that required a saphenous-cavernosal shunt and another case that was initially treated with adrenalin also with good results. CONCLUSIONS: Since intracavernosal agents have been utilized in the treatment of erectile dysfunction, priapism has become a more frequent urological emergency. Although a lower incidence has been reported for PGE, the dose should be well adjusted to avoid a higher incidence.

[Mucinous adenocarcinoma of the prostate. Report of a new case]. / Adenocarcinoma mucinoso de próstata. Aportación de un nuevo caso.

OBJECTIVE: To describe a case of mucinous adenocarcinoma of the prostate, an uncommon variant of prostatic carcinoma of which few cases have been reported in the literature. This tumor type is briefly reviewed with special reference to the controversial issues that remain unresolved due to the small number of cases. METHODS/RESULTS: A case of mucinous adenocarcinoma of the prostate is presented. An extraprostatic origin had been discarded. The diagnosis was made by DRE, transrectal US and histological confirmation by transrectal biopsy. PSA values were normal. Studies to determine the extent of the lesion showed advanced locoregional dissemination. Surgery was therefore not indicated and hormonal therapy was administered. Patient outcome was poor with no apparent clinical response to hormone blockade. Radiotherapy was attempted. The patient rapidly became worse and died. CONCLUSIONS: Mucinous adenocarcinoma of the prostate is characterized by the presence of significant amounts of extra and intracellular mucin. Its clinical features are not unlike those of classical adenocarcinoma and in general terms, it is considered to carry a worse prognosis and refractory to hormone therapy.

NMP 22, BTA stat test and cytology in the diagnosis of bladder cancer: a comparative study.

OBJECTIVE: To evaluate the usefulness of the NMP 22 and BTA stat test in the diagnosis and follow-up of bladder cancer and to compare these tests to cytology and cystoscopy, routine diagnostic methods. METHODS: 150 patients followed up for bladder cancer or symptoms suggestive of bladder cancer underwent cystoscopy after cytology, NMP 22 and BTA stat test using a recently voided urine sample. In suspect cases, TUR and histopathological analysis were performed. RESULTS: Bladder cancer was proven in 76 patients and excluded in 74. For NMP 22 we have used the cutoff value recommended by the manufacturer (10 U/ml) and that obtained by our receiver-operating characteristic curve (6 U/ml). Sensitivity was 84.21% for NMP 22 at the cutoff value of 6 U/ml and 76.32% with 10 U/ml; 72.37% for BTA stat test; 69.74% for cytology, and 100% for cystoscopy. Specificity was 86.49% for NMP 22 at a cutoff value of 6 U/ml and 90.54% at 10 U/ml; 89.19% for the BTA stat test; 93.24% for cytology and 89.19% for cystoscopy. NMP 22 sensitivity for grades 1, 2, and 3 was 68.75, 75.86 and 100%, respectively, at a cutoff value of 6 U/ml, and 50, 68.97 and 96.77%, respectively, at a cutoff level of 10 U/ml; for BTA stat the sensitivity was 56.25% in G1, 62.07% in G2 and 90.32% in G3, and for cytology the sensitivity was 43.75, 62.07 and 90.32%, respectively. The sensitivity of NMP 22 was 68.75% in stage Ta, 84.78% in T1 and 100% in T2-T4 at a cutoff level of 6 U/ml and 50, 80.43 and 92.86%, respectively, at a cutoff level of 10 U/ml; BTA stat sensitivity was 50% in Ta, 73.91% in T1 and 92.86% in T2-T4; and in cytology the results were 37.50, 73.91 and 85.71%, respectively. Using the McNemar test, there was only a significant difference between the sensitivity of NMP 22 at a cutoff level of 6 U/ml and cytology in the overall sample. CONCLUSIONS: The high sensitivity of the NMP 22 and BTA stat test in combination with the data obtained from the parameters used for the evaluation of the test demonstrate their usefulness in the diagnosis and follow-up of bladder cancer. NMP 22 at a cutoff value of 6 U/ml is significantly more sensitive than cytology and consequently a thoroughly valid diagnostic tool in the diagnosis of bladder cancer which may substitute voided urine cytology.

[Genital wound caused by low-speed fire arm]. / Herida genital por arma de fuego de baja velocidad.

OBJECTIVE: To report a case of genital gunshot injuries and review the literature. METHODS: A case of low velocity multiple gunshot penile injuries is described. Surgical exploration was performed, gunshot removed and the albuginea repaired. A broad spectrum antibiotic was administered prophylactically for infection. RESULTS: Good cosmetic and functional results, including sexual potency and voiding, were achieved. CONCLUSIONS: Surgical exploration is mandatory in genital gunshot injuries. The best approach to the albuginea is by a crown incision and denudation of the penile skin, which permits surgical repair with excellent cosmetic results.