[Bilobular benign retroperitoneal schwannoma]. / Schwannoma retroperitoneal benigno bilobulado.

OBJECTIVE: To describe an additional case of retroperitoneal schwannoma. METHODS: A case of retroperitoneal neoplasm in a 29-year-old woman is presented. The clinical and therapeutic aspects are discussed. RESULTS: The anatomopathological study showed a benign schwannoma. CONCLUSIONS: Retroperitoneal schwannoma is an uncommon lesion that is difficult to diagnose preoperatively. Treatment is by surgical resection.

Loss of heterozygosity in renal and hepatic epithelial cystic cells from ADPKD1 patients.

Autosomal dominant polycystic kidney disease (ADPKD) is one of the commonest genetic diseases in man, affecting 1:1000 individuals in the Caucasian population. It is caused by mutations in the PKD1 or PKD2 genes. Recently, controversial data regarding the mutational mechanism underlying cyst initiation have been reported: genetic analyses have shown that second somatic mutations may lead to cyst formation (detected as microsatellite loss of heterozygosity, LOH, and point mutations), but immunohistochemical studies show strong immunoreactivity for polycystin in some cysts. In order to further characterise this matter we have analysed 211 cysts from seven different patients for LOH, we have detected a 13.3% LOH for PKD1. This loss was specific to PKD1 as no LOH was detected when other chromosomal regions were studied. Whenever linkage analysis has been possible, it has been proved that the lost allele corresponded to the wild-type. Our data supports previous results in the two-hit theory for ADPKD due to the large number of cysts studied. ADPKD would occur through a recessive cellular mechanism. The probability of cyst development would depend on the probability of mutation in the second allele. The different phenotypical expression of the same mutation reported in ADPKD could be due to the different tendency of inactivation in the second allele in each individual.

Usefulness of urinary nuclear matrix protein 22 (NMP22) as a marker for transitional cell carcinoma of the bladder.

OBJECTIVES: The purpose of this study was to evaluate an immunoassay for urinary nuclear matrix protein, NMP22, as a novel marker for urothelial cancer. PATIENTS AND METHODS: NMP22 values were determined for 71 patients and 21 healthy volunteers. Each subject provided a single (3 voids) urine sample for analysis at the time of entry into the study. Each sample was assayed for levels of NMP22. RESULTS: When the cut-off value was set at 10 U/ml, the positive rate for urinary NMP22 in bladder cancer was 37.8% (17 out of 45), whereas that in post-treatment cases and benign diseases was 30.8% (8 out of 26) compared to 14.3% (3 out of 21) for healthy volunteers. This cut-off value provided a sensitivity of 37.8% and a specificity of 80.9%. In the bladder cancer group, NMP22 levels were related to tumor size, shape, grade and stage. CONCLUSIONS: Despite the many reports that suggest NMP22 as a promising urinary marker for monitoring transitional cell carcinoma, this study does not support its usefulness as a substitute tool for urinary cytology in the control of bladder tumors.

[Renopancreatic transplant. Urologic complications]. / Transplante renopancreático. Complicaciones urológicas.

OBJECTIVE: Retrospective study of urological complications in our series of reno-pancreatic transplants. MATERIAL AND METHODS: Between February 1983 and May 1994 our group has conducted 93 RPT, 80 of which, mean age 36 +/- 6 years (24-54 years), are studied in this paper: 57 male and 23 female with an average time in dialysis of 20 +/- 15 months (0-84 months) and diabetes evolution of 21 +/- 5 years (11-37 years). RESULTS: Actuarial annual survival of patient, renal graft and pancreatic graft has been 85%, 79% and 74% respectively. Haematuria: 25% incidence, with graft pancreatitis etiology in 16 cases, rejection in 8 and urinary fistula in 6. Urinary infection: 85% incidence, symptomatic in 23 patients (29%) and asymptomatic in the remaining cases. Dysuria, urethritis and urethral stenosis: 14 patients, all male, most with both conditions associated. Reconversion of pancreatic exocrine secretion by intestinal route was performed in 7 patients. Urinary fistula: secondary to surgery in 9 cases and rejection in 4. Etiology of one case remained unknown. In 4 cases it was resolved with conservative treatment, and with surgical correction in 8. One patient required pancreatic transplantectomy and one patient died of AMI. CONCLUSIONS: Urological complication in RPT account for a significant morbidity, urinary fistula being the one with greater repercussion on the patient and pancreatic graft survival.

[Is there an age limit for cadaveric kidney donors currently?]. / Existe actualmente un límite de edad en el donante renal de cadáver?

OBJECTIVES: The insufficient number of kidney transplants has gradually raised the age limit to the cadaver kidney donor. The use of grafts harvested from older donors has been debated due to the existing structural and functional changes that might influence renal function and long-term graft survival. The foregoing aspects are discussed herein. METHODS: The anatomical, histological and functional changes in the kidney associated with ageing are analyzed. The clinical experience with renal grafts from older donors before and after cyclosporine became available are reviewed. The ethical issues on whether grafts from very old donors should be used and who should receive these grafts are discussed. RESULTS: The use of grafts from donors over 60 years old had no significant short and medium term differences in comparison with younger donors in terms of graft survival, although a higher incidence of acute tubular necrosis and poor renal function have been observed. There are no conclusive studies on the long-term effects on graft survival when kidneys from donors aged over 65 are utilized. In our experience, the results achieved with grafts from donors over 70 has been unsatisfactory. The guidelines utilized in the selection of grafts derived from older donors are presented. CONCLUSIONS: Grafts from donors aged 60 to 70 may be utilized in renal transplantation following precise selection criteria. Graft survival has been satisfactory, although a higher incidence of acute tubular necrosis and higher creatinine levels have been observed. We do not advocate the use of grafts from donors over 70, except in very exceptional cases. Long-term multicenter studies on grafts from very old donors and trials using alternative immunosuppressor modalities that might permit optimal use of these grafts are warranted.

Urodynamic evaluation in simultaneous insulin-dependent diabetes mellitus and end stage renal disease.

PURPOSE: We evaluated the urodynamic changes produced by insulin-dependent diabetes mellitus with end stage renal disease. MATERIALS AND METHODS: A urodynamic evaluation was performed on 51 young patients (mean age plus or minus standard deviation 35 +/- 6 years) with long-term diabetes mellitus (average 21 +/- 6 years) and end stage renal disease (86% on dialysis). RESULTS: The urodynamic study was abnormal in 84% of the patients. The bladder was hypersensitive in 39% and hyposensitive in 30% of the cases, and maximum vesical capacity was greater than 600 ml. in 33%. An acontractile detrusor was noted in 6% of the patients, while 4% had detrusor hyperreflexia and 35% had bladder outlet obstruction. CONCLUSIONS: A high frequency of vesical alterations was observed, which were modified by association of progressive vesical dysfunction and diabetes mellitus. In diabetes mellitus dialysis protects against detrusor hypocontractility but predisposes the patients to have bladder obstruction.

[Congenital urethral diverticulum]. / Divertículo uretral congénito.

Presentation of two cases of congenital diverticula of the bulbar urethra. The objective of this paper is to discuss the etiopathogenic theories, sings and symptoms, current diagnostic methods and therapeutic indications, and to conclude that this type of diverticula do not present a florid symptomatology, endoscopy being the best diagnostic and therapeutic method. Finally, a review of the literature is made based on two clinical cases.

[Beneficial effect of oxygen-free radical blockers in experimental kidney transplantation in rats]. / Efecto beneficioso de los bloqueadores de radicales libres de oxígeno en el trasplante experimental de riñón en rata.

UNLABELLED: The clinical potential of free radical (OFR) ablative therapy is dependent upon the proportion of the total injury caused by the reperfusion mechanism compared with the proportion resulting from ischemic injury itself. Prostaglandin cascade can both activate and be activated by OFR. AIM: to investigate the influence of different periods of cold ischemis in renal tissue (cortex and medulla) -regarding superoxide dismutase (S.O.D.) activity, the amount of erythrocyte trapping and prostaglandin synthesis. Also, to evaluate the effect of exogenous S.O.D. in the prevention of reperfusion injury. MATERIAL AND METHODS: 48 Lewis male rats (200-250 g) received renal isografts (RTx) preserved in Collins solution at 4 C for different periods: control group (8) non operated; group I (8) immediate RTx; group II (8) 12 hrs; group III (8) 18 hrs; group IV (8) 12 hrs+S.O.D. (13 mg/kg e.v.); group V (8) 18 hrs+S.O.D. (13 mg/kg e.v.). Before reperfusion all recipients received 1 ml of 51-Cr labelled erythrocytes. After 15 min. reperfusion grafts were removed and samples (cortex and medulla) obtained for measuring trapping of erythrocytes. S.O.D. activity and prostaglandins (PGe2, TxB2, 6-Keto-PGF1). RESULTS: A strong correlation was found between the duration of cold ischemia and the amount of trapping both in cortex and in medulla. S.O.D. administration induced a significant drop of trapping. In non-operated rats S.O.D. activity in cortex was two fold medulla content. However, after reperfusion, a significant decrease in cortex was found in all groups. S.O.D. administration raised S.O.D. activity in cortex similar to control values.(ABSTRACT TRUNCATED AT 250 WORDS)