[Intensity modulated radiotherapy treatment for prostate cancer, first experience in Chile]. / Tratamiento del cáncer de próstata con radioterapia por modulación de intensidad, primera experiencia en Chile.

BACKGROUND: Intensity modulated radiotherapy (IMRT) is an important step forward in cancer treatment. AIM: To report the first experience in Chile with IMRT for prostate cancer and compare the results obtained with different doses. PATIENTS AND METHODS: From January 1997 through June 2008, 156 patients with a mean age of 70 years, were treated with radiotherapy and 121 with IMRT. Patients were staged according to American Commission on Cancer Staging. Their biochemical relapse risk was classified according to the MD Anderson classification. Patients were routinely checked during and after therapy to evaluate side effects and relapse. RESULTS: Median follow up was 46 months (4-120). Overall five years survival was 85%. Biochemical relapse free five years survival for low, intermediate and high risk patients was 100, 82 and 70%, respectively. Biochemical relapse free survival for patients receiving radiotherapy doses over 76 Gy was 83%, compared to 30% for those receiving lower doses (p < 0.05). Urinary and gastrointestinal acute toxicity was low in 80% and 90% of patients respectively. Late toxicity developed in less than 3% of patients. CONCLUSIONS: IMRT for prostate cancer is readily available and safe in Chile. Biochemical disease free survival improved with higher doses with low toxicity rates.

Ascitis quilosa post cirugía abdominal: caso clínico y revisión de la literatura / Chylous ascites management: clinical case and literature review

Chylous ascites is a peritoneal collection with milky appearance, rich in triglycerides produced by the presence of thoracic or intestinal lymph in the abdominal cavity. The increasing number of surgical interventions has meant an increase of this disease in the last time. We present the case of a 39-yearsold woman with a history of a retroperitoneal cystic lesion in the abdominal ultrasound, which was a finding, and was followed up for 5 years. In the last control abdominal ultrasound showed an accelerated growth, the study was complemented with a Magnetic Resonance Imaging of the abdomen showed a retroperitoneal cystic lesion, 7 cm larger diameter in contact with aorta, left ureter and lower pole of the left kidney, suspecting malignancy, reason why its surgical resection was decided. It evolved after the surgical intervention with progressive increase of the abdominal perimeter, diffuse pain and early satiety, performing abdominal ultrasound showing a liver of normal structure with moderate ascites. The diagnostic paracentesis gave out 1,000 mL of milky-white liquid with triglycerides of 1,287 mg/dL. The diagnosis of chylous ascites was proposed, secondary to thoracic duct injury and it was managed with a diet with low intake of saturated, polyunsaturated and monounsaturated fats, with medium chain triglycerides with favorable results. The pathophysiology, etiology, nutritional and non-nutritional management of chylous ascites are discussed.

La ascitis quilosa es una colección peritoneal con apariencia lechosa, rica en triglicéridos producido por la presencia de linfa torácica o intestinal en la cavidad abdominal. El creciente número de intervenciones quirúrgicas ha significado un aumento de esta patología en el último tiempo. Se presenta el caso de una mujer de 39 años, con historia de una lesión retroperitoneal quística en la ecotomografía abdominal, que fue un hallazgo, realizándose seguimiento por 5 años. En la última ecotomografía de control presentó crecimiento acelerado por lo que se complementa estudio con una Resonancia Nuclear Magnética de abdomen que muestro lesión quística retroperitoneal de 7 cm de diámetro mayor en contacto con aorta, uréter izquierdo y polo inferior del riñón izquierdo, sospechándose malignidad, por lo que se decide su resección. Evolucionó posterior a la intervención quirúrgica con aumento progresivo del perímetro abdominal, dolor difuso y saciedad precoz, realizándose ecotomografía abdominal que muestra un hígado de estructura normal con ascitis moderada. La paracentesis diagnóstica dio salida a 1.000 mL de líquido blanquecino de aspecto lechoso con triglicéridos de 1.287 mg/dL. Se planteó el diagnóstico de ascitis quilosa, secundario a lesión del conducto torácico y se manejó con dieta con bajo aporte en grasas saturadas, poliinsaturadas y monoinsaturadas, con aporte de triglicéridos de cadena media con resultados favorables. Se discuten la fisiopatología, etiología, manejo nutricional y no nutricional de la ascitis quilosa.

[Ascites and renal failure caused by a bladder fistula: report of one case]. / Ascitis y falla renal: no olvidar el uroperitoneo.

Bladder fistula to open peritoneum is an uncommon cause of ascites. We report a 50 year-old woman with a history of pain in the lower abdomen and slight weight loss. The patient had a history of a repaired bladder perforation 12 years before, during a labor with forceps. The patient had microscopic hematuria and an abdominal CAT scan showed ascites. Serum creatinine was 2.2 mg/dl. An abdominal Doppler ultrasound showed normal portal and suprahepatic veins. Due to the suspicion that ascites accumulation could be urine, a sample was obtained and urea nitrogen and creatinine were measured. Since both levels were high in the ascitic fluid the patients was subjected to a cystoscopy that disclosed a fistula between the bladder and peritoneum. The patient was operated and the fistula excised. The postoperative period was uneventful, and the serum creatinine normalized.

Tratamiento del cáncer de próstata con radioterapia por modulación de intensidad, primera experiencia en Chile / Intensity modulated radiotherapy treatment for prostate cancer, first experience in Chile

Background: Intensity modulated radiotherapy (IMRT) is an important step forward in cancer treatment. Aim: To report the first experience in Chile with IMRT for prostate cancer and compare the results obtained with different doses. Patients and Methods: From January 1997 through June 2008, 156 patients with a mean age of 70 years, were treated with radiotherapy and 121 with IMRT. Patients were staged according to American Commission on Cancer Staging. Their biochemical relapse risk was classified according to the MD Anderson classification. Patients were routinely checked during and after therapy to evaluate side effects and relapse. Results: Median follow up was 46 months (4-120). Overall five years survival was 85%. Biochemical relapse free five years survival for low, intermediate and high risk patients was 100, 82 and 70%, respectively. Biochemical relapse free survival for patients receiving radiotherapy doses over 76 Gy was 83%, compared to 30% for those receiving lower doses (p < 0.05). Urinary and gastrointestinal acute toxicity was low in 80% and 90% of patients respectively. Late toxicity developed in less than 3% of patients. Conclusions: IMRTforprostate cancer is readily available and safe in Chile. Biochemical disease free survival improved with higher doses with low toxicity rates.

Ascitis y falla renal: no olvidar el uroperitoneo / Ascites and renal failure caused by a bladder fistula: Report of one case

Bladder fistula to open peritoneum is an uncommon cause of ascites. We report a 50 year-old woman with a history of pain in the lower abdomen and slight weight loss. The patient had a history of a repaired bladder perforation 12 years before, during a labor with forceps. The patient had microscopic hematuria and an abdominal CAT scan showed ascites. Serum creatinine was 2.2 mg/dl. An abdominal Doppler ultrasound showed normal portal and suprahepatic veins. Due to the suspicion that ascites accumulation could be urine, a sample was obtained and urea nitrogen and creatinine were measured. Since both levels were high in the ascitic fluid the patients was subjected to a cystoscopy that disclosed a fistula between the bladder and peritoneum. The patient was operated and the fistula excised. The postoperative period was uneventful, and the serum creatinine normalized.

Cáncer de próstata en menores de 50 años / Prostate cancer in people younger than 50 years old

Se reconocen las características clínicas de los pacientes con CaP menores de 50 años. Material y método: Se revisaron en forma retrospectiva los antecedentes clínicos entre julio 1994 y julio 2004. Se estudiaron las características de la pieza operatoria, la evolución quirúrgica, la sobrevida y recurrencia, incluyendo la necesidad de tratamientos complementarios. Resultados: Entre julio 1994 y julio 2004 se intervinieron 33 pacientes por CaP de 50 años o menos, se contaba con los datos necesarios para el estudio en 30. La edad promedio al momento del diagnóstico fue 46 años. El 30 por ciento de los pacientes tenía un hermano o padre con diagnóstico de CaP. El nivel de APE promedio en el momento del diagnóstico fue de 10,36 ng/ml. El estadio clínico fue T1c en el 66 por ciento, T2 en el 19 por ciento y T3 en el 9,5 por ciento. Veintinueve pacientes fueron sometidos a prostatectomía radical, confirmándose adenocarcinoma de próstata. En todos los pacientes que se realizó linfadenectomía, ésta fue negativa. El estadio patológico fue pT3 en el 39 por ciento y pT2 en el 61 por ciento. En 15 pacientes se preservó los haces neurovasculares, y el 72 por ciento de ellos preservó función eréctil. En todos los pacientes la continencia es completa. Un 69 por ciento de los pacientes operados mantienen APE indetectable hasta la fecha, sin necesidad de tratamiento complementario. Dos pacientes fueron sometidos a radioterapia complementaria por falla bioquímica. Un paciente se presentó por una adenopatía supraclavicular cuya biopsia fue compatible con un adenocarcinoma de próstata que falleció luego de hormono, radio y quimioterapia. Conclusión: Pensamos que la detección precoz de cáncer prostático es particularmente relevante en este grupo etáreo en quienes debemos emplear parámetros de APE estrictos. Esto permite identificar portadores de CaP de pronóstico favorable al ser sometidos a prostatectomía radical, logrando una baja morbilidad y una excelente calidad de vida.

Nódulo suprarrenal no funcionante / Non functioning suprarenal nodule

Entre los años 1969 y 1991 se han operado en nuestro servicio 62 pacientes por patología de la glándula suprarrenal, 16 (25,3 por ciento) corresponden a lesiones adrenales no funcionantes o silentes desde el punto de vista endocrino. Siete pacientes (43,75 por ciento) se diagnosticaron por un hallazgo de los medios por imagen. Las causas más frecuentes de nódulo SR NF fueron Feocromocitoma no funcionante 25 por ciento, Metástasis 25 por ciento y Cáncer SR 18,7 por ciento. Se analiza la metodología diagnóstica la vía de acceso y la morbilidad quirúrgica

Fístulas entero-urinarias / Enterourinary fistula

Presentamos 10 casos de fístulas enterourinarias de diversa ubicación. La radioterapia, los traumatismos y los cánceres constituyen la causa de la mayoría de los casos. El manejo de ellas se hizo considerando la patología de base para obtener en algunos casos la curación. En la mayoría de los casos debido a la patología de base, sólo son accequibles soluciones mediocres médicamente, pero tolerables socialmente