Tumour size in adrenal tumours: its importance in the indication of adrenalectomy and in surgical outcomes-a single-centre experience.

OBJECTIVE: To evaluate the relevance of tumour size in adrenal tumours in the estimation of malignancy risk and in the outcomes of adrenalectomy. METHODS: We evaluate the histological results and surgical outcomes (intraoperative and postsurgical complications) in a retrospective single-centre cohort of patients without history of active extraadrenal malignancy with adrenal tumours consecutively operated in our centre during January 2010 and December 2020. We compared these results in lesions smaller and larger than 40, 50, and 60 mm. RESULTS: Of 131 patients with adrenal tumours who underwent adrenalectomy, 76 (58.0%) had adrenal masses measuring ≥ 40 mm; 47 were > 50 mm and 28 > 60 mm. The final diagnosis was adrenocortical carcinoma (ACC) in 7 patients, pheochromocytoma in 35, and benign lesions in the remaining. All patients with ACC had adrenal masses > 50 mm, with Hounsfield units > 40 and low lipidic content in the CT. The risk of ACC and pheochromocytoma increased as tumour size did. The diagnostic accuracy of tumour size was quite good for the prediction of ACC (AUC-ROC 0.883). Nevertheless, when only adrenal tumours with HU < 40 were considered, the risk of ACC was 0% independent of tumour size. For pheochromocytomas, the risk was of 8.6% independent of tumour size for lesions with < 20HU. The risk of intraoperative and postoperative complications was independent of tumour size. CONCLUSION: Risk of malignancy and of pheochromocytoma increased as tumour size increased, but, in the presurgical estimation of malignancy risk and of pheochromocytoma, not only tumour size, also lipidic content and other radiological features, should be considered. The risk of complications was independent of tumour size, but hospital stay was longer in patients with complication or open approach.

[COVID-19 Pandemic: Impact and rapid reaction of Urology]. / Pandemia COVID-19: impacto y reacción rápida de la Urología.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has caused tens of thousands of deaths in Spain and has managed to breakdown the healthcare system hospitals in the Community of Madrid, largely due to its tendency to cause severe pneumonia, requiring ventilatory support. This fact has caused our center to collapse, with 130% of its beds occupied by COVID-19 patients, thus causing the absolute cessation of activity of the urology service, the practical disappearance of resident training programs, and the incorporation of a good part of the urology staff into the group of medical personnel attending these patients. In order to recover from this extraordinary level of suspended activity, we will be obliged to prioritize pathologies based on purely clinical criteria, for which tables including the relevance of each pathology within each area of urology are being proposed. Technology tools such as online training courses or surgical simulators may be convenient for the necessary reestablishment of resident education.

[COVID-19 Pandemic: Impact and rapid reaction of Urology]. / Pandemia COVID-19: impacto y reacción rápida de la Urología.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has caused tens of thousands of deaths in Spain and has managed to breakdown the healthcare system hospitals in the Community of Madrid, largely due to its tendency to cause severe pneumonia, requiring ventilatory support. This fact has caused our center to collapse, with 130% of its beds occupied by COVID-19 patients, thus causing the absolute cessation of activity of the urology service, the practical disappearance of resident training programs, and the incorporation of a good part of the urology staff into the group of medical personnel attending these patients. In order to recover from this extraordinary level of suspended activity, we will be obliged to prioritize pathologies based on purely clinical criteria, for which tables including the relevance of each pathology within each area of urology are being proposed. Technology tools such as online training courses or surgical simulators may be convenient for the necessary reestablishment of resident education.

Tinea nigra: Report of three pediatrics cases. / Tiña negra: reporte de tres casos pediátricos.

INTRODUCTION: Tinea nigra is a superficial mycosis caused by Hortaea werneckii. Its clinical characte ristic is the appearance of a blackish brown macula of rapid growth, caused by the pigment produced by the fungus itself. The presence of a dark, fast growing, acral pigmentary lesion causes concern among patients and their treating physician about the possibility of a malignant pigmentary lesion. OBJECTIVE: To present a series of three clinical cases in pediatric patients with this pathology and to show the tools that help to make a differential diagnosis. CLINICAL CASES: Three patients between three and five years of age, which present a macular pigmented lesion on palms or soles, whose parents reported a rapid growth over a short period of time. Two of the patients reported previous trips to the Caribbean. Clinical and dermatoscopy suspicion of tinea nigra lead to a direct mycological exa mination, which confirmed the diagnosis. In all three cases, treatment with topical antifungals led to complete healing of the lesions. CONCLUSIONS: Although tinea nigra is rare in a dry climate, increasing travel of patients to tropical countries will increase the number of cases. Dermatoscopy and direct mycological examination are the tools that allow performing a correct diagnosis and avoiding unne cessary biopsies and/or surgeries.

[The REVELA13 observatory to study new cases of bladder tumor among women living in Bouches-du-Rhône county]. / Rôle de l'observatoire REVELA13 dans l'épidémiologie des tumeurs de vessie des femmes dans les Bouches-du-Rhône.

INTRODUCTION: The REVELA13 observatory is a unique epidemiological tool listing the new cases of kidney tumors, bladder tumors and acute leukaemias in the Bouches-du-Rhône county (France). Aim was to exploit for the first time data from this observatory regarding new cases of bladder tumors≥T1 in women from 2012 to 2014. MATERIALS: This epidemiological study was observational and descriptive. Fifteen non-nominative variables from the REVELA13 database were analyzed in order to describe the clinical and pathological characteristics of the incident cases as well as their spatial and temporal distribution. The incidence rates expressed in new cases per year per 100000 inhabitants were standardized on the world age, calculated with 95 % confidence intervals and compared to national estimates for the same period. RESULTS: Incident bladder tumor cases were recorded in 291 women, corresponding to a standardized incidence on the world age of 3.85 [3.32-4.37] new cases per year per 100,000 population, 54 % higher than the national estimates of 2012 and 2015. Median age of diagnostic was 75.9 years. Sex ratio was 19.41 % (W/M). Tumors were predominantly non-muscle-invasive (52 %), high grade (69 %) and without associated carcinoma in situ (Cis) (49 %). The two most affected territories were Marseille and Aubagne-La Ciotat. CONCLUSION: The REVELA13 observatory has improved our epidemiological knowledge on female bladder tumors in Bouches-du-Rhône county and highlighted a local over incidence. LEVEL OF EVIDENCE: 3.

Tiña negra: reporte de tres casos pediátricos / Tinea nigra: report of three pediatrics cases

Resumen: Introducción: La tiña negra es una micosis superficial causada por Hortaea werneckii. Su caracte rística clínica es la aparición de una mácula café negruzca de rápido crecimiento, producto del pig mento sintetizado por el mismo hongo. Sus características pigmentarias y de rápido crecimiento, de localización preferentemente acral, genera preocupación en los pacientes y en sus médicos tratantes por la sospecha de una lesion névica en evolución. Objetivos: Presentar 3 casos clínicos de pacientes pediátricos con esta patología y dar a conocer las herramientas para su diagnóstico diferencial. Casos clínicos: Tres pacientes, edades 3 y 5 años, con lesión macular pigmentada en palmas o plantas, cuyos padres referían habían crecido en forma rápida en poco tiempo. Dos de los casos tenían antecedentes de viajes previos al Caribe. Ante la sospecha clínica y dermatoscópica de una tiña negra, se realizó exámen micológico que confirmó el diagnóstico. En todos los casos, el tratamiento con antimicóticos tópicos llevó a la resolución completa de las lesiones. Conclusión: Aunque la tiña negra es rara en un clima seco, los viajes cada vez más frecuentes de los pacientes a países tropicales, probablemente aumentarán el número de casos. La dermatoscopía y el examen micológico son las herramientas que permiten realizar un correcto diagnóstico, evitando biopsias y/o cirugías innecesarias.

Abstract: Introduction: Tinea nigra is a superficial mycosis caused by Hortaea werneckii. Its clinical characte ristic is the appearance of a blackish brown macula of rapid growth, caused by the pigment produced by the fungus itself. The presence of a dark, fast growing, acral pigmentary lesion causes concern among patients and their treating physician about the possibility of a malignant pigmentary lesion. Objective: To present a series of three clinical cases in pediatric patients with this pathology and to show the tools that help to make a differential diagnosis. Clinical cases: Three patients between three and five years of age, which present a macular pigmented lesion on palms or soles, whose parents reported a rapid growth over a short period of time. Two of the patients reported previous trips to the Caribbean. Clinical and dermatoscopy suspicion of tinea nigra lead to a direct mycological exa mination, which confirmed the diagnosis. In all three cases, treatment with topical antifungals led to complete healing of the lesions. Conclusions: Although tinea nigra is rare in a dry climate, increasing travel of patients to tropical countries will increase the number of cases. Dermatoscopy and direct mycological examination are the tools that allow performing a correct diagnosis and avoiding unne cessary biopsies and/or surgeries.

Onicomadesis secundaria a enfermedad pie-mano-boca: una manifestación frecuente y motivo de preocupación de los padres / Onychomadesis secondary to hand-foot-mouth disease: a frequent manifestation and cause of concern for parents

INTRODUCCIÓN: Las alteraciones ungueales en niños provocan gran ansiedad en los padres y múltiples consultas en su mayoría innecesarias. La onicomadesis corresponde al despegamiento completo e indoloro de la lámina ungueal desde el pliegue proximal. Este hallazgo ungueal autoresolutivo se ha descrito como una complicación tardía de la enfermedad pie-mano-boca, exantema viral frecuente en la edad pediátrica. OBJETIVO: Reportar un caso pediátrico clásico de enfermedad pie-mano-boca que evolucionó con onicomadesis y revisión de la literatura. CASO CLÍNICO: Paciente masculino de 3 años de edad, con cuadro agudo de microampollas eritematosas, peribucales en un comienzo, luego brazos y manos, glúteos, muslo y pies, asintomático y sin compromiso del estado general. Se reali za diagnóstico clínico de enfermedad pie-mano-boca. Evoluciona con resolución total de lesiones cutáneas , pero al mes, desprendimiento completo de uñas, las que se recuperan con posterioridad. CONCLUSIÓN: El reconocimiento de la asociación entre enfermedad pie-mano-boca con onicomadesis nos permite orientar a los padres sobre un fenómeno benigno y transitorio que puede ocurrir como parte de la evolución de esta virosis, evitando así la ansiedad, derivación y tratamientos innecesarios.

INTRODUCTION: Nail alterations in children are an important cause of parent anxiety and derive in multiple and unnecessary consultations. The onychomadesis corresponds to the complete and pain less detachment of the nail plate from the proximal fold. This self-resolving nail finding has been described as a late complication of hand-foot-mouth disease, a frequent viral exanthema in the pedia tric age. OBJECTIVE: To describe a classic pediatric case of hand-foot-mouth disease with subsequent onychomadesis. CLINICAL CASE: A 3-years-old male patient with an acute presentation of acute erythe matous perioral papulovesicles, which extend to upper extremities and hands, buttocks, thighs and feet, asymptomatic, and without compromising general condition. Skin lesions resolve completely, but after one month, he develops detachment of the nails, with subsequent complete recovery. CONCLUSIONS: The recognition of this association will allow primary care physicians to guide the parents about a benign and self-resolving process that may occur as part of the evolution of hand-foot-mouth disease, thus avoiding unnecessary anxiety, referral and treatments.

Vitamina D y fotoprotección / Vitamin D and photoprotection

La radiación ultravioleta produce fotodaño, por lo que tratamos de evitar su acumulación en nuestra piel. Al mismo tiempo, es esta misma, en su espectro UV-B, la responsable de iniciar la única vía metabólica para la síntesis de vitamina D en el organismo humano. La vitamina D tiene un impacto benéfico en nuestro sistema óseo, inmune, y cardiovascular, entre otros. Es por esto que se genera controversia sobre el uso de fotoprotección, en cuanto a sus beneficios versus su interferencia en la síntesis de esta vitamina liposoluble. No hemos encontrado suficiente evidencia que demuestre que el uso de fotoprotección disminuya significativamente los niveles de vitamina D, como si existe para la protección contra fotodaño que los fotoprotectores proveen. Planteamos mantener la recomendación de uso de fotoprotectores, añadiendo vitamina D como suplemento oral a la dieta encaso de deficiencia.

Ultraviolet radiation generates photodamage. Therefore, we try to avoid its accumulation in our skin. At the same time, this radiation, in its UV-B wavelength, is the only catalyst of the endogenous metabolic pathway of vitamin D synthesis. This vitamin has beneficial impact in our bones, immune and cardiovascular system, among others. This is why controversy arises regarding photoprotection, its benefits versus its interference in this lipid vitamin. We have not found concrete evidence that proves that the use of photoprotection significantly lowers vitamin D levels, though we have found vast evidence of its beneficial effects concerning photodamage prevention. We suggest following the current sunscreen recommendations, and adding vitamin D oral supplements to our diet in case of deficiency.

Radioterapia en cáncer no melanoma / Radiotherapy for non-melanoma skin cancer

La radioterapia es la disciplina que emplea radiaciones ionizantes en terapia médica. Es una herramienta ampliamente utilizada en Oncología y también dentro de la patología oncológica cutánea. Se trata de un procedimiento agresivo y no exento de riesgos; sin embargo, sus beneficios se encuentran claramente demostrados desde hace décadas. En los últimos años han aparecido nuevas alternativas terapéuticas menos agresivas y, por lo tanto, muy atractivas. El objetivo de este trabajo es explicar los principios básicos de la radioterapia aplicada a la Dermatología, mostrar los tratamientos más representativos y sus resultados en cáncer de piel.

Radiotherapy is the discipline that uses ionizing radiation in medical therapy. It is widely used in both oncology and cutaneous oncological pathologies. While it is an aggressive procedure and not risk-free, its benefits have been clearly demonstrated for years.In recent years, new, less aggressive - and therefore more popular - therapies have appeared. We review the basic principals of radiotherapy applied to dermatology, present the most representative treatments, as well as its results on skin cancer.

[Primary percutaneous approach in staghorn kidney calculus]. / Abord per-cutané premier dans la lithiase rénale coralliforme.

36 staghorn calculi were treated percutaneously under ultrasound guidance between 1983 and 1992. Each stone had a renal pelvic element and at least two caliceal branches. The area of each stone was measured on the plain abdominal x-ray (mean: 1,020 mm2) and the total length of the various caliceal branches was measured from the pelvic element (mean: 50.2 mm). These 36 procedures represented 8.2% of the 438 percutaneous nephrolithotomies performed over the same period. The stone was able to be entirely removed by nephrolithotomy in 12 patients. Of the 24 residual stones after percutaneous nephrolithotomy, 16 were treated by extracorporeal shock-wave lithotripsy, which eliminated all stones in 12 of these patients. Eight of the remaining 12 patients were lost to follow-up and treatment was not completed, and 4 present a residual stone (11% of failures). These results are compared with those of other series and are comparable to those of surgery which gives a similar residual stone rate of 16% in the AFU 1982 report [6]. The primary percutaneous approach to staghorn calculi therefore represents an effective therapeutic modality, whose use and results must be weighed up with those of surgery.

[Treatment of acute leukemia: usefulness of an immunodepressed unit]. / Tratamiento de la leucemia aguda: utilidad de una unidad de inmunodeprimidos.

A special unit for immune-depressed patients was used in the treatment of acute leukemia in 33 patients. Results of therapy were compared to those in 30 historical controls treated in a general ward. Both groups were comparable regarding age, sex, type of leukemia and severity of bone marrow depression. The incidence of fever and the percentage of complete remission were higher in patients treated in the unit, including patients with acute lymphoblastic leukemia. The remission rate in the subgroup of patients with acute myeloid leukemia was not improved. Mortality rates were also not different. We recommend the use of this unit for treatment of patients with acute leukemia, given the lower infection rate and the higher probability of remission.

[Infection in severe neutropenia: analysis of 140 episodes]. / Infecciones en neutropenias severas: analisis de 140 episodios.

We analyzed infections complicating 140 episodes of severe neutropenia in 86 patients. The underlying diagnosis was acute leukemia in 64, lymphoma in 12 and isolated cases of bone marrow aplasia, agranulocytosis, dysmyelopoiesis and solid tumors. No fever developed in 35 (25%) episodes. No cause for the fever was identified in 40% of the remaining episodes. Clinical evidence of an infection was present in 20%, with positive bacteriologic findings in 27%. Respiratory infection (16%), pneumonia (11%) and sepsis (10%) were the most common infectious processes. Infectious agents isolated were gram negative bacilli (72%), gram positive cocci (19%) and fungi (9%). The association of amikacin and carbenicillin or cephalosporins proved to be superior to gentamycin-penicillin (p less than 0.01). 16 patients died for an overall mortality of 11%. Pneumonia and infection by K pneumoniae or C albicans were associated to a poorer prognosis.