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.

[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.

[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.

[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.

[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 malacoplakia. Report of a new case]. / Malacoplaquia renal. Aportación de un nuevo caso.

The malacoplakia is an infrequent granulomatous inflammatory disease which pathogenesis is not well understood and affects predominantly the genitourinary system, through every organ can be affected. We present a case of unilateral renal malacoplakia in a male that made ist debut with septic shock and perinephritic abscess. It was operated under the suspicious diagnostic of renal neoplasm. The histologic study grave us the diagnosis of renal malacoplakia extending until the skin. After nephrectomy and medical treatment the patient had an uneventful course.

[Renal carcinoma. Our experience of 20 years]. / Carcinoma renal. Nuestra experiencia de 20 años.

Review of 174 renal parenchyma adenocarcinoma surgically removed over a period of 20 years with follow-up ranging from 1 to 20 years. Age, sex, time from onset of symptoms and treatment, tumour size and cell type did not influence survival. This was improved the lower the stage was at surgery (80% at 5 years in I, 56% in II, 55.5% in III-A, 11% in III-B+C, 0% in IV). The lack of differences in survival between stages II and III-A is conditioned by the fact that III-A included cases with and without perirenal fat involvement but with a common factor of renal vein involvement. Such factor modifies survival with equal local size (80% at 5 years for T1-2 VO and 83% for T1-2 V1; 56% for T3 VO and 44% for T3 V1. Survival for G1+2 was 66% at 5 years, versus 33% for G3+4. Initial therapy was radical nephrectomy with hilar lymphadenectomy, and there was no difference in survival with regard to the access route used.

[Retroperitoneal fibrosis]. / Fibrosis retroperitoneal.

Review of 8 patients with retroperitoneal fibrosis treated in our unit, 7 between 1985 and 1990 and one secondary to chronic use of non-steroidal anti-inflammatory agents diagnosed in 1980. In five patients no underlying reason was found and the remaining three were considered to be secondary (two to drugs and one to pelvic radiotherapy). Diagnostic and therapeutic approaches as well as patient's evolution are analyzed, also reviewing the existing literature.

[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.

[Papillary adenocarcinoma of the kidney. Report of 12 cases and update]. / Adenocarcinoma papilar de riñón. Aportación de 12 casos y puesta al día.

Revision of 12 cases of papillary adenocarcinoma of the kidney operated in this Unit over a period of 20 years, representing 6.03% of all renal adenocarcinomas. Their main characteristics were evaluated finding that they appear at a similar age than non papillary cases (55 years of age) and have a similar average size (9.1 cm). They show no differences with non papillary cases with regard to clinical signs and symptoms. Among the various diagnostic procedures used, the most typical one is the hypo or avascular patterned arteriography. The tendency to appear at low stages (79.9% in stage I and II) is higher than with the non papillary cases (51.86%), having a better prognosis than the latter.

[Prognostic value of isolated invasion of the renal vein in renal adenocarcinoma]. / Valor pronóstico de la invasión aislada de la vena renal en el adenocarcinoma renal.

A total of 38 renal adenocarcinomas with isolated invasion of the renal vein and maximum local extension to perirenal fat, operated over a 20-year period and with long-term follow-up were reviewed. They were divided in two subgroups, 12 T1-2,N0,M0,V1 cases were compared to 54 T1-2,N0,M0,V0 cases treated in the same period of time, but no significant differences were found in survival (83% and 68% at 5 and 10 years for V1 versus 80% and 64% for V0); and 26 T3,N0,M0,V1 cases compared to 49 T3,N0,M0,V0, again with no significant difference found in survival (40% at 5 years and 26.5% at 7 years for V1, versus 38.5% and 34% for T3V0). When comparing the survival rate of T1-2,N0,M0,V0-1 with that of T3,N0,M0,V0-1, the difference was significant (p). It is concluded that the isolated invasion of the renal vein and an equal locoregional extension of the tumour do not modify the prognosis for renal carcinoma, and that this parameter should be included in the new TNM classification of the isolated UICC, since when included within the T3b category it places cases with good prognosis (T1-2 V1) above cases with poor prognosis due to the existence of invasion of the perirenal fat (T3a).

[Carcinoma of Bellini's duct]. / Carcinoma del conducto de Bellini.

First case in the Spanish literature of a carcinoma of Bellini's duct. Differentiation of this tumor from the classic renal adenocarcinoma, mainly the papillary type, is based on the different embryological origin, microscopic characteristics and immunohistochemical studies. Prognosis is worse than for the other renal adenocarcinomas.

[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.

[Stress urinary incontinence. Our experience with its treatment using the transvaginal colposuspension technique (Raz I and II)]. / Incontinencia urinaria de esfuerzo. Nuestra experiencia en su tratamiento mediante la técnica de colposuspensión transvaginal (Raz I Y II).

Presentation of our experience in the surgical treatment of urinary stress incontinence, with transvaginal colposuspension techniques, specifically those described by S. Raz and known as Raz I and Raz II. Over a 24-month period, 25 transvaginal colposuspensions (22 Raz I and 3 Raz II) were performed. The results achieved were 21 patients (84%) have recovered, while 4 (16%) remain incontinent, 3 of them referring improvement and 1 without improvement, after a follow-up of 12 to 36 months. With regard to complications, there has been 5 cases (20%) of postoperative retention, one vesical perforation while passing the needles, and a vesicle perforation during vaginal dissection of the retropubic space.

[Nuclear area versus nuclear grade in the prognosis of renal carcinoma. Long-term results]. / Area nuclear versus grado nuclear en el pronóstico del carcinoma renal. Resultados a largo plazo.

Fürhman's nuclear grading was used to compare the prognostic value of nuclear morphometry (represented by the nuclear area) in 95 renal adenocarcinomas treated by radical nephrectomy with a 11 to 25 years follow-up. The morphometric study was conducted by measuring 100 randomly selected nuclei, with a x1000 MOP-Videoplan morphometer and a light chamber adapted to a microscope. Based on the nuclear area, 2 prognostic groups were made up, one for area values below 35 microns2 and another one for areas over 35 microns2. The nuclear grade was reassigned in all cases according to Fürhman's rating, assembling G1-2s as low grade and G3-4s as high grade for statistical convenience. Staging was done using Tonson's classification; stage II was divided into III-A (venous involvement) and III B + C (presence of adenopathy). The survival analysis was included in the sample overall analysis and in each stage. Survival showed significant differences between groups with areas over and below 35, and between high and low grade. Only 2 cases in stage III B + C and none in stage IV had areas below 35. When comparing survival between under 35 and low grade cases, and between over 35 and high grade cases, no significant difference was obtained. It was therefore conclude that, although nuclear morphometry is a good prognostic factor in renal carcinoma, it contributes little to nuclear grading and it has the drawback of being too elaborate.