[Kidney angiomyolipoma as aetiology of haemorragic shock]. / Angimiolipoma renal como causa de shock hemorrágico agudo.

This is a case of retroperitoneal hematoma and hypovolemic shock as a presentation of renal angiomyolipoma, a rarely benign and asymptomatic tumor. The massive and spontaneous bleeding of the tumor was diagnosed by an abdominal ecography and confirmed by an abdominal computer tomography in the emergency room. Although that kind of tumor needs non-aggressive treatment, as a general rule, because of the size and severity of the following symptoms, the patient has been submitted to a selective embolization of the renal mass when he was hemodinamically stabilized. The evolution was favorable; it was not necessary to do more aggressive surgical handling neither to urgently remove the angiomyolipoma.

[Modification of nephritic colic and 24-hour calcium excretion in urine in primary hyperthyroidism after parathyroidectomy]. / Modificación de los cólicos nefríticos y de la excreción de calcio en orina de 24 horas en el hiperparatiroidismo primario tras la paratiroidectomía.

We documented the frequency of nephritic colic in patients with primary hyperparathyroidism, and determined its modification after the parathyroidectomy; we also studied laboratory parameters such as calcium, phosphorus and parathyroid hormone in serum, and the excretion of Cao 24h, previous and later to the intervention. At sight of the results it is possible to be concluded that the parathyroidectomy is useful in the treatment of the kidney stone disease produced by the primary hyperparathyroidism.

[Leiomyoma of the bladder as a cause of unilateral ureteral obstruction associated with uterine leiomyoma and polycystic ovary]. / Leiomioma de vejiga causante de una obstrucción unilateral del uréter asociado a leiomiomas uterinos y ovarios poliquísticos.

A case of a female patient with bladder leiomyoma associated to uterus containing several leiomyomatous nodules and polycystic ovaries is presented. The diagnostic convenience that ecography can provide, showing neoformations and their definition with regard to neighbouring organic structures, is highlighted. The existing relationship between uterine leiomyomas and estrogens is outlined, as well as the action of GnRH agonists on such leiomyomas after long-term therapy.

[Charles II: From spell to genitourinary pathology]. / Carlos II: del hechizo a su patología génito-urinaria.

OBJECTIVES: We attempt to unravel the complex condition of the last king of the Hapsburg dynasty in Spain, Charles II, called The Bewitched, in whom a genitourinary disorder was preponderant, preventing him from fulfilling one of the objectives of the monarchial institution, engendering a heir, and causing a series of complications that led to his death. METHODS: We review the works describing the life of the King, with special emphasis on his bloodline, the doubts about his sex at birth, his pathological processes, the repercussion among European Courts, but above all on his marriages and the inability to engender an heir. We also emphasize the thought of 17th century Spanish society which led to the belief that he was bewitched. The nickname he passed into history with. RESULTS: It was deduced that he could have presented posterior hypospadias which, together with monorchism and atrophic testicle, led to the belief that he presented an intersexual state with ambiguous genitals. The physical phenotype leans more towards true hermaphro-ditism and above all a XX male, rather than the more often attributed Klinefelter's syndrome. This is probably also associated with a fragile X syndrome. Very possibly congenital monorenal, death was due to chronic kidney failure caused by glomerulopathy or interstitial nephro-pathy as a consequence of renal lithiasis plus recurrent infections of the urinary tract. CONCLUSIONS: As a result of a reiterated endogamic matrimonial policy, the Hapsburg dynasty died out in Spain in 1700, represented by Charles II, a pluripatho-logical king who can only be freed from speculation by chromosomal and genetic studies of his remains buried in El Escorial monastery.

Carlos II: Del hechizo a su patología génito-urinaria / Charles II: From spell to genitourinary pathology

OBJETIVO: Tratar de desentrañar la compleja patología del último rey de la dinastía de los Austrias, Carlos II, apodado El Hechizado, dentro de la cual la urogenital fue preponderante, impidiéndole cumplir con una de las finalidades de la institución monárquica cual es la transmisión a un descendiente y produciéndole una serie de complicaciones que le llevaron al fallecimiento.MÉTODOS: Revisamos las obras en las cuales se describe la vida del Rey, haciendo hincapié en sus antecedentes consanguíneos, en las dudas sobre su sexo en el momento del nacimiento, sus procesos patológicos, la repercusión en las Cortes Europeas, pero sobre todo en sus matrimonios y en la incapacidad para generar un heredero. Resaltamos como, siguiendo el pensamiento de la sociedad española del siglo XVII, hizo pensar que se encontraba hechizado. Sobrenombre con el que pasó a la historia.RESULTADO: Deducimos que pudo presentar un hipospadias posterior que junto con la monorquia y testículo atrófico, hace pensar que presentó un estado intersexual con genitales ambiguos. Su fenotipo físico inclina más hacia un hermafroditismo verdadero y sobre todo un varón XX, que hacia un síndrome de Klinefelter que ha sido el más atribuido. Es probable su asociación con un síndrome X frágil. Monorreno congénito muy posiblemente, su muerte se debió a una insuficiencia renal crónica producida por una glomerulopatía o una nefropatía intersticial a consecuencia de una litiasis renal más infecciones del tracto urinario recidivantes.CONCLUSIONES: Fruto de una reiterada política matrimonial endogámica, feneció en 1700 la dinastía de los Habsburgo en España encarnada en Carlos II, un monarca pluripatológico que sólo se libraría de especulaciones si se efectuaran estudios cromosómicos y genéticos de sus restos presentes en el monasterio de El Escorial(AU)

OBJECTIVES: We attempt to unravel the complex condition of the last king of the Hapsburg dynasty in Spain, Charles II, called The Bewitched, in whom a genitourinary disorder was preponderant, preventing him from fulfilling one of the objectives of the monarchial institution, engendering a heir, and causing a series of complications that led to his death. METHODS: We review the works describing the life of the King, with special emphasis on his bloodline, the doubts about his sex at birth, his pathological processes, the repercussion among European Courts, but above all on his marriages and the inability to engender an heir. We also emphasize the thought of 17th century Spanish society which led to the belief that he was bewitched. The nickname he passed into history with.RESULT: It was deduced that he could have presented posterior hypospadias which, together with monorchism and atrophic testicle, led to the belief that he presen-ted an intersexual state with ambiguous genitals. The physical phenotype leans more towards true hermaphro-ditism and above all a XX male, rather than the more often attributed Klinefelter’s syndrome. This is probably also associated with a fragile X syndrome. Very possibly congenital monorenal, death was due to chronic kidney failure caused by glomerulopathy or interstitial nephro-pathy as a consequence of renal lithiasis plus recurrent infections of the urinary tract.CONCLUSIONS: As a result of a reiterated endogamic matrimonial policy, the Hapsburg dynasty died out in Spain in 1700, represented by Charles II, a pluripatho-logical king who can only be freed from speculation by chromosomal and genetic studies of his remains buried in El Escorial monaster(AU)

[Metastatic tumors of the penis]. / Tumores metastásicos de pene.

The authors present four cases of metastasic penis tumours, two of which followed a prostate carcinoma, one vesical carcinoma and the other a carcinoma of the excretory duct. They make a review of world literature on the subject and study the possible ways of dissemination as well as the clinical picture and differential diagnosis with other pathological processes of the male genital organ and they stress in particular the bad prognosis as the metastases appear at a very advanced stage of the primitive illness.

Angimiolipoma renal como causa de shock hemorrágico agudo / Kidney angiomyolipoma as aetiology of haemorragic shock

Presentamos un caso de hematoma retroperitoneal y shock hipovolémico como forma de presentación de angiomiolipoma renal, tumor benigno poco frecuente y generalmente asintomático. El sangrado masivo y espontáneo del tumor, fue diagnosticado mediante la realización de ecografía abdominal y confirmado por TAC abdominal de urgencia. Pese a que el tratamiento de este tipo de tumores, en general, es conservador, el tamaño y la severidad de la clínica acompañante obligó a trasladar a la paciente, una vez estabilizada hemodinámicamente, a hospital de tercer nivel para realizar embolización selectiva de la masa renal. La evolución fue favorable sin necesidad de realizar maniobras quirúrgicas más agresivas ni extirpación del angiomiolipoma de forma urgente (AU)

This is a case of retroperitoneal hematoma and hypovolemic shock as a presentation of renal angiomyolipoma, a rarely benign and asymptomatic tumor. The massive and spontaneous bleeding of the tumor was diagnosed by an abdominal ecography and confirmed by an abdominal computer tomography in the emergency room. Although that kind of tumor needs non-aggressive treatment, as a general rule, because of the size and severity of the following symptoms, the patient has been submitted to a selective embolization of the renal mass when he was hemodinamically stabilized. The evolution was favorable; it was not necessary to do more aggressive surgical handling neither to urgently remove the angiomyolipoma (AU)

Modificación de los cólicos nefríticos y de la excreción de calcio en orina de 24 horas en el hiperparatiroidismo primario tras la paratiroidectomía / Modification of nephritic colic and 24-hour calcium excretion in urine in primary hyperthyroidism after parathyroidectomy

Se documentó la frecuencia de cólicos nefríticos en pacientes con hiperparatiroidismo primario, y se determinó su modificación tras la paratiroidectomía; así mismo se estudiaron parámetros de laboratorio tales como calcio, fósforo y parathormona en suero, y excreción de calcio en orina de 24h previos y posteriores a la intervención. A la vista de los resultados se puede concluir que la paratiroidectomía es útil en el tratamiento de la enfermedad calculosa renal producida por el hiperparatiroidismo primario (AU)

We documented the frequency of nephritic colic in patients with primary hiperparathyroidism, and determined its modification after the parathyroidectomy; we also studied laboratory parameters such as calcium, phosphorus and parathyroid hormone in serum, and the excretion of Cao 24h, previous and later to the intervention. At sight of the results it is possible to be concluded that the parathyroidectomy is useful in the treatment of the kidney stone disease produced by the primary hyperparathyroidism (AU)