[Hyperammonaemic encephalopathy, possible complication after urinary diversion in radical cystectomy. Review of the literature with regard to a clinical case]. / La encefalopatia hiperamonémica, una posible complicación por derivación urinaria tras cistectomía radical. Revisión de la literatura a proposito de un caso.

INTRODUCTION: Radical cystectomy is an intervention with an important morbidity. Urinary diversion is a possible cause of metabolic complications like hyperammonaemic encephalopathy. CASE REPORT: We present the case of a patient treated with a radical cystectomy and modified ureterosigmoidostomy after diagnosis of bladder cancer. After surgery the patient presented in 4 ocasions recurrent episodic confusion. Laboratory and image tests were normal. Levels of seric ammonium was increased. After supportive treatment and hemodyalisis symptoms disappeared. Later patient was reoperated and a reconstruction to ileal conduit was made. DISCUSSION: Continent urinary diversions are advised due to important negative impact on quality of life produced by ileal conduit. However these diversions have several complications, like encephalopathy secondary to non-hepatic hyperammonaemia. Increased absortion of ammonium by intestinal tissue of the new-ladder induces encephalopathy. Early diagnosis of this complication is essencial in order to administer an effective treatment.

Treatment guidelines in ovarian cancer.

National and international specialists have met with the aim of writing down the guidelines for the treatment of epithelial ovarian cancer (in the Spanish Castilian language). These guidelines are based on the International Consensus that was published in English in the Annals of Oncology in 2005. This condition is the leading cause of death from gynaecological cancer in western countries. Its low rate of survival, barely 30% at 5 years, is above all due to late diagnosis and inappropriate surgery, so emphasis is put on these aspects. After describing the methodology for early detection and a scheme of surgical diagnostic procedures in view of the staging of an ovarian mass, the following therapeutic strategies will be recommended: cytoreductive surgery together with platinum chemotherapy under normal conditions, and also in the case of relapse. Likewise, very recent models of treatment focused on molecular targets are presented, and a broad section on methodology of clinical assays. As for this, co-operation among groups is crucial in order to make the conclusions of these studies valid for the development of new therapies.

[Phlegmasia cerulea dolens in patients with testicular carcinoma]. / Flegmasia cerulea dolens en paciente con carcinoma testicular.

We describe a case of phlegmasia cerulea dolens secondary to venous thrombosis due to compression of inferior vena cava, in a 31-year-old man with a germ cell tumour. He was treated with systemic thrombolytic agents, intravenous heparin and urgent chemotherapy He presented a complete tumoral response and complete revascularization of the vena cava and right femoral vein.

Adjuvant chemotherapy with adriamycin, fluorouracil, cyclophosphamide, methotrexate, with or without tamoxifen in operable breast cancer.

Between January 1982 and February 1985, 70 breast cancer patients with histologically confirmed axillary node involvement and T1-3a were treated following surgery with a combination of adriamycin, fluorouracil, cyclophosphamide, methotrexate, with or without tamoxifen according to the estrogen and progesterone receptors state. At 60 months of study (median follow-up, 41 months), the estimated proportion remaining disease-free was 62%. The estimated survival rate was 81%. A comparison of the actuarial disease-free and overall survival with data reported in the literature indicates a similar positive effect of adjuvant systemic therapy as described in adjuvant studies using polychemotherapy regimens. Patient acception of chemotherapy regimen was generally good. This can be accounted for because of an adequate emesis control and real compliance of the patients with the oncologist.