Melatonin exerts direct inhibitory actions on ACTH responses in the human adrenal gland.

In nonhuman primates and rodents, melatonin acting directly on the adrenal gland, inhibits glucocorticoid response to ACTH. In these species, an intrinsic adrenal circadian clock is involved in ACTH-stimulated glucocorticoid production. We investigated whether these findings apply to the human adrenal gland by determining i) expression of clock genes in vivo and ii) direct effects of melatonin in ACTH-stimulated adrenal explants over a) expression of the clock genes PER1 (Period 1) mRNA and BMAL1 [Brain-Muscle (ARNT)-like] protein, ACTH-induced steroidogenic acute regulatory protein (StAR), and 3ß-hydroxysteroid dehydrogenase (3ß-HSD) and b) over cortisol and progesterone production. Adrenal tissue was obtained from 6 renal cancer patients undergoing unilateral nephrectomy-adrenalectomy. Expression of the clock genes PER1, PER2, CRY2 (Cryptochrome 2), CLOCK (Circadian Locomotor Output Cycles Kaput) and BMAL1, was investigated by RT-PCR in a normal adrenal and in an adenoma. In independent experiments, explants from 4 normal adrenals were preincubated in culture medium (6 h) followed by 12 h in: medium alone; ACTH (100 nM); ACTH plus melatonin (100 nM); and melatonin alone. The explants' content of PER1 mRNA (real-time PCR) and StAR, 3ß-HSD, BMAL1 (immuno slot-blot), and their cortisol and progesterone production (RIA) were measured. The human adrenal gland expresses the clock genes PER1, PER2, CRY2, CLOCK, and BMAL1. ACTH increased PER1 mRNA, BMAL1, StAR, and 3ß-HSD protein levels, and cortisol and progesterone production. Melatonin inhibited these ACTH effects. Our study demonstrates, for the first time, direct inhibitory effects of melatonin upon several ACTH responses in the human adrenal gland.

Mutations in the amino-terminal domain of the human poly(ADP-ribose) polymerase that affect its catalytic activity but not its DNA binding capacity.

Poly-ADP ribosylation of nuclear proteins is activated when poly(ADP-ribose) polymerase (PARP), a nuclear zinc-finger enzyme, binds to single-strand DNA breaks. To understand how the signal emerging from its DNA-binding domain (DBD) bound to such breaks is transduced to its catalytic domain, the structure-function relationship of the DBD was investigated. We have used mutagenesis by the polymerase chain reaction (PCR) to generate a random library of PARP mutants. In this work, we describe the identification of catalytically inactive mutants bearing single point mutations, located outside the two zinc fingers in the DBD, that have conserved their full capacity to bind DNA. The results obtained demonstrate that the DNA-dependent activation of PARP requires not only a capacity to bind DNA but also a number of crucial residues to maintain a conformation of the domain necessary to transfer an 'activation signal' to the catalytic domain.

Poly(ADP-ribose) polymerase: structure-function relationship.

Dissection of the human poly(ADP-ribose) polymerase (PARP) molecule in terms of its structure-function relationship has proved to be an essential step towards understanding the biological role of poly(ADP-ribosylation) as a cellular response to DNA damage in eukaryotes. Current approaches aimed at elucidating the implication of this multifunctional enzyme in the maintenance of the genomic integrity will be presented.

Involvement of poly(ADP-ribose) polymerase in base excision repair.

Poly(ADP-ribose) polymerase (PARP) is a zinc-finger DNA binding protein that detects and signals DNA strand breaks generated directly or indirectly by genotoxic agents. In response to these lesions, the immediate poly(ADP-ribosylation) of nuclear proteins converts DNA interruptions into intracellular signals that activate DNA repair or cell death programs. To elucidate the biological function of PARP in vivo, the mouse PARP gene was inactivated by homologous recombination to generate mice lacking a functional PARP gene. PARP knockout mice and the derived mouse embryonic fibroblasts (MEFs) were acutely sensitive to monofunctional alkylating agents and gamma-irradiation demonstrating that PARP is involved in recovery from DNA damage that triggers the base excision repair (BER) process. To address the issue of the role of PARP in BER, the ability of PARP-deficient mammalian cell extracts to repair a single abasic site present on a circular duplex plasmid molecule was tested in a standard in vitro repair assay. The results clearly demonstrate, for the first time, the involvement of PARP in the DNA synthesis step of the base excision repair process.

The merozoite surface protein 6 gene codes for a 36 kDa protein associated with the Plasmodium falciparum merozoite surface protein-1 complex.

A complex of non-covalently bound polypeptides is located on the surface of the merozoite form of the human malaria parasite Plasmodium falciparum. Four of these polypeptides are derived by proteolytic processing of the merozoite surface protein 1 (MSP-1) precursor. Two components, a 22 and a 36 kDa polypeptide are not derived from MSP-1. The N-terminal sequence of the 36 kDa polypeptide has been determined, the corresponding gene cloned, and the protein characterised. The 36 kDa protein consists of 211 amino acids and is derived from a larger precursor of 371 amino acids. The precursor merozoite surface protein 6 (MSP-6) has been designated, and the 36 kDa protein, MSP-6(36). Mass spectrometric analysis of peptides released from the polypeptide by tryptic digestion confirmed that the gene identified codes for MSP-6(36). Antibodies were produced to a recombinant protein containing the C-terminal 45 amino acid residues of MSP-6(36). In immunofluorescence studies these antibodies bound to antigen at the parasite surface or in the parasitophorous vacuole within schizonts, with a pattern indistinguishable from that of antibodies to MSP-1. MSP-6(36) was present in the MSP-1 complex immunoprecipitated from the supernatant of in vitro parasite cultures, but was also immunoprecipitated from this supernatant in a form not bound to MSP-1. Examination of the MSP-6 gene in three parasite lines detected no sequence variation. The sequence of MSP-6(36) is related to that of the previously described merozoite surface protein 3 (MSP-3). The MSP-6(36) amino acid sequence has 50% identity and 85% similarity with the C-terminal region of MSP-3. The proteins share a specific sequence pattern (ILGWEFGGG-[AV]-P) and a glutamic acid-rich region. The remainder of MSP-6 and MSP-3 are unrelated, except at the N-terminus. Both MSP-6(36) and MSP-3 are partially associated with the parasite surface and partially released as soluble proteins on merozoite release. MSP-6(36) is a hydrophilic negatively charged polypeptide, but there are two clusters of hydrophobic amino acids at the C-terminus, located in two amphipathic helical structures identified from secondary structure predictions. It was suggested that this 35 residue C-terminal region may be involved in MSP-6(36) binding to MSP-1 or other molecules; alternatively, based on the secondary structure and coil formation predictions, the region may form an intramolecular anti-parallel coiled-coil structure.

The 22 kDa component of the protein complex on the surface of Plasmodium falciparum merozoites is derived from a larger precursor, merozoite surface protein 7.

The gene coding for merozoite surface protein 7 has been identified and sequenced in three lines of Plasmodium falciparum. The gene encodes a 351 amino acid polypeptide that is the precursor of a 22-kDa protein (MSP7(22)) on the merozoite surface and non-covalently associated with merozoite surface protein 1 (MSP1) complex shed from the surface at erythrocyte invasion. A second 19-kDa component of the complex (MSP7(19)) was shown to be derived from MSP7(22) and the complete primary structure of this polypeptide was confirmed by mass spectrometry. The protein sequence contains several predicted helical and two beta elements, but has no similarity with sequences outside the Plasmodium databases. Four sites of sequence variation were identified in MSP7, all within the MSP7(22) region. The MSP7 gene is expressed in mature schizonts, at the same time as other merozoite surface protein genes. It is proposed that MSP7(22) is the result of cleavage by a protease that may also cleave MSP1 and MSP6. A related gene was identified and cloned from the rodent malaria parasite, Plasmodium yoelii YM; at the amino acid level this sequence was 23% identical and 50% similar to that of P. falciparum MSP7.

DNA repair defect in poly(ADP-ribose) polymerase-deficient cell lines.

To investigate the physiological function of poly(ADP-ribose) polymerase (PARP), we used a gene targeting strategy to generate mice lacking a functional PARP gene. These PARP -/- mice were exquisitely sensitive to the monofunctional-alkylating agent N -methyl- N -nitrosourea (MNU) and gamma-irradiation. In this report, we have analysed the cause of this increased lethality using primary and/or spontaneously immortalized mouse embryonic fibroblasts (MEFs) derived from PARP -/- mice. We found that the lack of PARP renders cells significantly more sensitive to methylmethanesulfonate (MMS), causing cell growth retardation, G2/M accumulation and chromosome instability. An important delay in DNA strand-break resealing was observed following treatment with MMS. This severe DNA repair defect appears to be the primary cause for the observed cytoxicity of monofunctional-alkylating agents, leading to cell death occurring after G2/M arrest. Cell viability following MMS treatment could be fully restored after transient expression of the PARP gene. Altogether, these results unequivocally demonstrate that PARP is required for efficient base excision repair in vivo and strengthens the role of PARP as a survival factor following genotoxic stress.

[Unusual presentation of urinary tract infection in 6 cases]. / Presentaciones inhabituales de infecciones del tracto urinário en 6 casos.

Urinary tract infections may have different clinical presentations that may range from asymptomatic bacteriuria to purulent collections and severe sepsis. We report 6 diabetic patients, 3 presenting with a renal carbuncle and 3 with an emphysematous pyelonephritis. All required medical and surgical treatment and had a good evolution. Two carbuncles were caused by beta- hemolytic type B streptococcus. This is the second notification of this agent as causative of renal abscesses, probably reaching the kidney through hematogenous dissemination from cutaneous foci.

A dominant-negative mutant of human poly(ADP-ribose) polymerase affects cell recovery, apoptosis, and sister chromatid exchange following DNA damage.

Poly(ADP-ribose) polymerase [PARP; NAD+ ADP-ribosyltransferase; NAD+:poly(adenosine-diphosphate-D-ribosyl)-acceptor ADP-D-ribosyltransferase, EC 2.4.2.30] is a zinc-dependent eukaryotic DNA-binding protein that specifically recognizes DNA strand breaks produced by various genotoxic agents. To study the biological function of this enzyme, we have established stable HeLa cell lines that constitutively produce the 46-kDa DNA-binding domain of human PARP (PARP-DBD), leading to the trans-dominant inhibition of resident PARP activity. As a control, a cell line was constructed, producing a point-mutated version of the DBD, which has no affinity for DNA in vitro. Expression of the PARP-DBD had only a slight effect on undamaged cells but had drastic consequences for cells treated with genotoxic agents. Exposure of cell lines expressing the wild-type (wt) or the mutated PARP-DBD, with low doses of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) resulted in an increase in their doubling time, a G2 + M accumulation, and a marked reduction in cell survival. However, UVC irradiation had no preferential effect on the cell growth or viability of cell lines expressing the PARP-DBD. These PARP-DBD-expressing cells treated with MNNG presented the characteristic nucleosomal DNA ladder, one of the hallmarks of cell death by apoptosis. Moreover, these cells exhibited chromosomal instability as demonstrated by higher frequencies of both spontaneous and MNNG-induced sister chromatid exchanges. Surprisingly, the line producing the mutated DBD had the same behavior as those producing the wt DBD, indicating that the mechanism of action of the dominant-negative mutant involves more than its DNA-binding function. Altogether, these results strongly suggest that PARP is an element of the G2 checkpoint in mammalian cells.

A dual approach in the study of poly (ADP-ribose) polymerase: in vitro random mutagenesis and generation of deficient mice.

A dual approach to the study of poly (ADP-ribose)polymerase (PARP) in terms of its structure and function has been developed in our laboratory. Random mutagenesis of the DNA binding domain and catalytic domain of the human PARP, has allowed us to identify residues that are crucial for its enzymatic activity. In parallel PARP knock-out mice were generated by inactivation of both alleles by gene targeting. We showed that: (i) they are exquisitely sensitive to gamma-irradiation, (ii) they died rapidly from acute radiation toxicity to the small intestine, (iii) they displayed a high genomic instability to gamma-irradiation and MNU injection and, (iv) bone marrow cells rapidly underwent apoptosis following MNU treatment, demonstrating that PARP is a survival factor playing an essential and positive role during DNA damage recovery and survival.

Requirement of poly(ADP-ribose) polymerase in recovery from DNA damage in mice and in cells.

Poly(ADP-ribose) polymerase [PARP; NAD+ ADP-ribosyltransferase; NAD+: poly(adenosine-diphosphate-D-ribosyl)-acceptor ADP-D-ribosyltransferase, EC 2.4.2.30] is a zinc-finger DNA-binding protein that detects specifically DNA strand breaks generated by genotoxic agents. To determine its biological function, we have inactivated both alleles by gene targeting in mice. Treatment of PARP-/- mice either by the alkylating agent N-methyl-N-nitrosourea (MNU) or by gamma-irradiation revealed an extreme sensitivity and a high genomic instability to both agents. Following whole body gamma-irradiation (8 Gy) mutant mice died rapidly from acute radiation toxicity to the small intestine. Mice-derived PARP-/- cells displayed a high sensitivity to MNU exposure: a G2/M arrest in mouse embryonic fibroblasts and a rapid apoptotic response and a p53 accumulation were observed in splenocytes. Altogether these results demonstrate that PARP is a survival factor playing an essential and positive role during DNA damage recovery.

Técnica de desclampeo precoz en nefrectomía parcial laparoscópica, reduciendo el tiempo de isquemia / Early De-Clamping in laparoscopic partial nephrectomy. Reducing ischemia times

Con el fin de disminuir el tiempo de isquemia durante la nefrectomía parcial, se han diseñado distintas opciones como clampeo arterial selectivo, técnica sin clampeo con hipotermia corporal y técnica de des clampeo precoz (DP). El objetivo del presente trabajo es analizar el resultado y complicaciones de un grupo de pacientes sometidos a nefrectomía parcial laparoscópica (NPL), aplicando la técnica de DP. Materiales y métodos: A través de una base de datos que se mantiene prospectivamente, se analizó los datos clínicos de los pacientes sometidos a nefrectomía parcial laparoscópica con técnica de desclampeo precoz entre los años 2010 y 2011.Resultados: Once pacientes fueron sometidos a NPL con técnica de DP entre agosto de 2010 y diciembre de 2011. Seis hombres y 5 mujeres, mediana de edad 59 (43-76) años. El tiempo operatorio fue de 180 min (180-220), con tiempo de clampeo 19,5 min (11-23). El sangrado total fue 300 ml (180-2.500). No hubo necesidad de conversión a cirugía abierta, pero un paciente requirió nefrectomía radical por sangrado importante. Márgenes positivos se encontró en un solo caso. Conclusión: El desclampeo precoz permite disminuir el tiempo de isquemia en la nefrectomía parcial laparoscópica, sin aumentar el riesgo de sangrado. Además, podría disminuir las complicaciones vasculares. Sin embargo, técnicamente es una cirugía compleja que requiere entrenamiento adecuado...

To decrease the time of ischemia during partial nephrectomy, various options were designed as selective arterial clamping, unclamping technique with body hypothermia and early unclumping technique (EU). The aim of this paper is to analyze the results and complications of a group of patients undergoing laparoscopic partial nephrectomy (LPN), using the EU technique. Materials and Methods: Using a prospective database, the clinical data of patients undergoing laparoscopic partial nephrectomy with early uncclamping technique between 2010 and 2011 is analyzed. Results: 11 patients underwent LPN with EU technique between August 2010 and December 2011. 6men and 5 women, median age 59 (43-76) years. The operative time was 180 min (180-220), with clamping time 19.5 min (11-23). The total estimated bleeding was 300 ml (180-2500). There was no need for conversion to open surgery, but one patient required radical nephrectomy due major bleeding. Positive margins were found in one case Conclusion: Early unclamping technique decreases the ischemia time in laparoscopic partial nephrectomy without increasing the risk of bleeding. Furthermore, it may reduce vascular complications. However, this is a technically demanding surgery that requires proper training...

Impacto de la obesidad central en el diagnóstico de cáncer prostático y su agresividad en tumores cT1c / Impact of central obesity in the diagnosis and prognosis of cT1c prostate cancer

La obesidad y el sobrepeso afectan al 62,8 por ciento de la población chilena. Esta condición aumenta los niveles de insulina, IGF-1 y otros mediadores inflamatorios asociados al cáncer prostático (CaP). La relación entre CaP y obesidad, utilizando al índice de masa corporal (IMC) como indicador, ha evidenciado resultados inconsistentes. Sin embargo, la obesidad central (OC), determinada por una circunferencia de cintura (CC) mayor de 95 cm, es en la actualidad un mejor predictor de los efectos metabólicos y cardiovasculares de la adiposidad. El objetivo de este estudio fue evaluar la asociación entre OC y CaP. Como objetivo secundario se evaluó los efectos de la OC sobre: volumen prostático (VP), APE, score de Gleason y porcentaje de cáncer en biopsia transrectal (BTR).Materiales y Método: Se diseñó un estudio de casos y controles prospectivo. Se incluyeron todos los pacientes sometidos a BTR, con clasificación cT1c, en dos hospitales de Santiago, entre junio de 2008 y julio de 2009. Se realizó medición de IMC y CC previo a la BTR, según protocolos validados. Se realizaron tests estadísticos bivariados y multivariados, para medir asociaciones brutas y ajustadas entre las variables estudiadas y el resultado histológico de la BTR. Resultados: Se incluyeron 150 pacientes. El promedio de edad fue 63,1 años. El 53,3 por ciento tuvo una CC mayor de 95 cm. Ambos grupos de exposición fueron comparables. Hubo 40,0 por ciento con CaP y, entre ellos, el 40,0 por ciento fue considerado de alto riesgo. No se encontró asociación significativa entre CC y las variables: VP, APE y presencia de cáncer en la biopsia. Sin embargo, en el análisis multivariado la CC se asoció positivamente con el score de Gleason (p= 0,0352) y con el porcentaje total de CaP en la BTR (p= 0,0341). A mayor VP fue menos probable hallar CaP, y la densidad del APE predijo significativamente el 70 por ciento Conclusiones: En este estudio, la CC no fue un factor de riesgo significativo para la...

Obesity and overweight affect 62 percent of the Chilean population. This condition increases insulin levels, IGF-1 levels and other inflammatory mediators associated to prostate cancer (PCa). The relationship between PCa and obesity using the body mass index (BMI) as an indicator, has been inconsistent. However, central obesity (CO), determined by a waist circumference (WC) over 95 cm, is currently a better predictor for the metabolic and cardiovascular effects of adiposity. The objective of this study was to evaluate the association between CO and PCa. As a secondary objective, we evaluated the effects of CO on: prostate volume (PV), serum PSA, Gleason score and percentage of cancer in the transrectal biopsy (TRB).Materials and method: We designed a prospective case control study. All patients submitted to TRB, with cT1c tumors, at 2 hospitals in Santiago between June 2008 and July 2009, were included. Before TRB, BMI and WC were measured, according to standard protocols. Bivariated and multivariated statistical tests were used to measure both raw and adjusted associations between the studied variables and the histologic result of the TRB. Results: The study included 150 patients. Average age was 53.1 years. A WC over 95 cm was found in 53 percent of them. Both groups were comparable. PCa was present in 40 per cent of the subjects; among them, 40 percent had high risk tumors. No significant association was found between WC and the following variables: PV, PSA level and the presence of cancer in the TRB. However, in the multivariate analysis, WC was associated with Gleason score (p =0.0352). Also, the total percentage of PCa in the TRB was associated with WC (p =0.0341). At higher PV, PCa was less frequent and PSA level predicted 70 percent of PCa. Conclusions: In this study, WC was a significant risk factor for the presence of PCa. Nevertheless, a pathologic WC was associated with higher Gleason scores and higher percentage of PCa in the TRB...

Información y consentimiento en la práctica urológica: revisión de la doctrina, legislación y jurisprudencia / Information and consent in practice of urology: review of doctrine, legislation and jurisprudence

Una creciente toma de conciencia ciudadana frente al derecho del paciente de ser informado, y consentir libremente, ha llevado a mayores exigencias en torno a ejercer efectivamente la autonomía de la voluntad frente a decisiones de procedimientos médicos. En los registros de Asistencia Legal del Colegio Médico, un importante número de demandas por supuesta negligencia no corresponden a una mala práctica médica en sí, sino más bien a una falta de información proporcionada al paciente respecto del curso natural de la enfermedad o a los riesgos y consecuencias del tratamiento. Material y Métodos: Revisión crítica de las leyes actuales que rigen el quehacer médico y sus bases doctrinarias. Análisis descriptivo de las estadísticas sobre querellas y demandas registradas en los archivos del Colegio Médico de Chile. Búsqueda sistemática vía internet en las bases de datos electrónicas de Lexis Nersis y Microjuris, de los fallos judiciales en los tribunales chilenos, mediante palabras claves en torno al tema. Resultados: La Reforma a la Salud ha cambiado el escenario jurídico en los últimos cuatro años con la promulgación de la Leyes Nº 19.937 Autoridad Sanitaria y Gestión, Nº 19.966 Establece Régimen de Garantías en Salud (AUGE/GES) y Nº 20.015 Modifica la Ley de Isapres. Este nuevo marco regulatorio genera garantías explícitas para los usuarios con obligatoriedad de prestaciones que pueden ser exigibles en tribunales, de no ser cumplidas. La doctrina ha entendido que la Información y Consentimiento son un proceso desarrollado al interior de la relación médico-paciente de carácter dinámico, no es su esencia que se escriture, pero es fundamental como medio de prueba en caso de enfrentar una eventual querella o demanda. En junio de 2001 se envió al parlamento el Proyecto de Ley Sobre los Derechos y Deberes de las Personas en Salud, donde se regula expresamente el Consentimiento Informado. El ®Protocolo de Consentimiento Informado¼ debe contener básicamente: Descripción del procedimiento, objetivos, riesgos, posibles complicaciones, beneficios, alternativas, efectos de la no realización, disposición del médico de ampliar la información, libertad del paciente para reconsiderar la decisión tomada. La redacción debe ser simple y no abusiva, en el entendido de hacerlo renunciar a acciones legales. Conclusiones: Las Reformas a la Salud y la Justicia han determinado una judialización de la medicina...

Prostatectomía radical en pacientes sometidos a cirugía prostática previa / Radical prostactectomy in patients with previous prostatic surgery

El objetivo del presente trabajo fue evaluar si existen diferencias significativas entre los pacientes sometidos a PR teniendo un procedimiento quirúrgico previo sobre esta glándula. Pacientes y métodos: Se realizó un estudio retrospectivo de los pacientes sometidos a PR en quienes existió una cirugía prostática previa por patología benigna. Los datos fueron obtenidos de la revisión de la base de datos de nuestro departamento, considerando el período de mayo de 1999 hasta mayo de 2004. Resultados: En el período analizado se realizaron 54 PR, en pacientes con cirugía prostática previa (7,4 por ciento del total de pacientes sometidos a PR), con un promedio de edad de 68 años. Ocho pacientes fueron sometidos a cirugía abierta (3 operación de Millin, 5 transvesicales), el resto de los pacientes se realizó resección transuretral. El tiempo promedio entre la cirugía previa y la PR fue de 5,3 años. El 18,8 por ciento tuvo score de Gleason >=8, el 77 por ciento score de 7 y el 4,1 por ciento score <=6. El APE promedio fue de 13,2 ng/dl. El volumen tumoral alcanzó los 6,48 cc en la pieza patológica. La subetapificación clínico patológica llegó al 73,9 por ciento. Las lesiones órgano confinadas fueron 69,96 por ciento de la muestra. No hubo mortalidad operatoria. El 26,6 por ciento de los pacientes requirió transfusión de glóbulos rojos. En 73,4 por ciento de nuestra serie la cirugía no superó las tres horas. De la morbilidad derivada del procedimiento destacan 3 filtraciones de la anastomosis y 3 pacientes que presentaron estenosis de la anastomosis. La continencia alcanza al 90,3 por ciento. Discusión: En comparación con resultados publicados previamente por nuestro servicio y por otros centros en relación a PR, esta serie se diferencia en cuanto a, una cifra menor de APE promedio, mayor porcentaje de casos con score de Gleason 7 y de pacientes con lesiones órgano confinadas. El tiempo operatorio promedio es similar a otros reportes. No existen diferencias en cuanto a transfusión ni complicaciones.

Abscesos renales y perinefríticos / Renal and perinephritic abscess

Se efectúa un análisis retrospectivo de las características de 28 pacientes operados por Absceso Renal y/o Perinefrítico en el Servicio de Urología Dr. Sótero del Río, entre Enero de 1988 y Septiembre de 1994, en relación a la frecuencia del cuadro, los métodos diagnósticos, la bacteriología y el tratamiento efectuado a éstos pacientes. Destaca la contribución al diagnóstico de la Ecotomografía de urgencia y la presencia de bacterias anaeróbicos en el 15 por ciento de los casos. Se reporta una frecuencia de ingreso de 0.3 pacientes por mes por año y de 0.011 por ciento del total de ingresos hospitalarios. Cifra similar a la publicada en la literatura, con una mortalidad de 3.5 por ciento y 17.8 por ciento de nefrectomías

Cáncer de próstata D* tratados con castración y flutamida / Prostatic cancer D* treated by castration and flutamide

Se revisa la sobrevida de 23 pacientes portadores de Cáncer de Próstata D* que inician tratamiento con Flutamida y Castración Subalbugínea entre abril 1986 y agosto 1987. Seis pacientes fallecen durante el período de observación (abril 1986- septiembre 1989), cuatro de ellos por progresión de la enfermedad. En 19 pacientes el dolor permanece estable o disminuye. Se evidencia regresión radiológica y/o cintigráfica en 7/17 casos, permaneciendo estables en otros 10. La sobrevida actuarial es 87% y 66% a 2 y 3 años respectivamente

Factores pronósticos en el cáncer testicular de celulas germinales no seminomatoso / Prognosis factors in the non-seminomatous germ cell testicular cancer

En el servicio de Urología del Hospital Dr. Sótero del Río, se revisaron los antecedentes de 100 pacientes portadores de cáncer testicular que fueron atendidos entre 1987 y 1999. El promedio de edad fue de 31,8 porciento de años. La histopatología demostró 47 porciento seminomas y 53 porciento tumores no seminomatosos, puros o mixtos. Treinta y dos pacientes con cáncer testicular de células germinales no seminomatosos (CTCGNS) en etapa I fueron seguidos e promedio 23,5 meses. En este grupo se revisó la presencia de carcinoma embrionario, compromiso del cordón espermático e invasión vascular y/o linfática del expecimen obtenido por orquidectomía radical.

Tratamiento quirúrgico del cáncer de pene: análisis de 15 casos / Penis cancer surgical treatment: 15 cases analysis

Se estudian 15 pacientes con diagnóstico de carcinoma epidermoide de pene, atendidos en el Hospital Dr. Sótero del Río, desde enero de 1981 a septiembre de 1995. La edad promedio es de 64 años. Se realiza penectomía total a 7 pacientes, más linfadenectomía en 4 casos. Aquellos pacientes con tumores < de 5 cm tuvieron mejor evolución, que los con tumores > de 5 cm. No hubo diferencias significativas en la sobrevida entre los pacientes sometidos y no sometidos a linfadenectomía. La sobrevida global de la serie fue de 70,4 por ciento a 13 años, con un seguimiento del 100 por ciento. La tasa de complicaciones fue alta. No hubo mortalidad quirúrgica