Giant adrenal carcinoma associated with renal vein and inferior vena cava thrombus. Case report and literature review.

OBJECTIVE: To present a case of giant adrenal carcinoma associated with renal vein and inferior vena cava (IVC) thrombus. Up to now, there is no similar case reported in the national literature. METHODS: 75 year old woman with signs of virilization. CT-scan showed an 18 cm adrenal mass with venous thrombus and possible pulmonary metastases. The working diagnosis was primary suprarenal carcinoma. RESULT: Due to elderly age and advanced stage, including metastasis, we decided to not perform surgery, and initiate chemotherapy. CONCLUSIONS: Adrenal Cancer is an infrequent and very aggressive tumor. Surgery is the only curative treatment. In advanced stages chemotherapy is recommended, but with poor results.

[Mature cystic teratoma of the testis (dermoid cyst). Case report and literature review]. / Teratoma quístico maduro testicular (quiste dermoide). Aportación de un caso y revisión de la literatura.

SUMMARY OBJECTIVES: Case report of a mature cystic teratoma (dermoid cyst), pseudopilomatrixoma like variant. METHOD: 53-year old patient with a left testicular mass, diagnosed as mature cystic teratoma of the testis(dermoid cyst), the pilomatrixoma-like variant, after radical orchiectomy. Tumoral markers were negative and no extension was observed. The patient is disease-free after 6 months follow-up. RESULTS: Testicular teratoma is a tumour composed of cells derived from the three embryonic layers (ectoderm, endoderm and mesoderm). They can appear at any age, but they are much more prevalent in childhood. They appear at any age, but are much more common in childhood, where they comprise up to 30% of all tumours. They are much less prevalent in adults,representing only 7% of all testicular germ cell tumours CONCLUSIONS: Prepubertal cases are invariably benign in nature, regardless of their histology. However, cases which appear after puberty are potentially malignant, even if histologically pure. Mature cystic teratoma (dermoid cyst) is the only exception to this rule, as no malignant degeneration of these types of tumours has been published.

Minimally invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia. Our initial experience with Urolift® under local anaesthesia and sedation. / Tratamiento mínimamente invasivo de los síntomas del tracto urinario inferior por hiperplasia benigna de próstata. Nuestra experiencia inicial con Urolift® bajo anestesia local y sedación.

INTRODUCTION: The treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia with the Urolift® system has been carried out since 2005 with good results in the medium term. In this work, we present our experience performing this technique under local anaesthesia and sedation in 2 Spanish centres. MATERIAL AND METHODS: A prospective study was conducted with 20 patients treated with Urolift® under local anaesthesia and sedation between April 2017 and April 2018. The anaesthesia protocol consisted in the placement of 2 lubricants with cold lidocaine (the first one, 10min before the intervention, and the second one, just before introducing the cystoscopy). A prostate block (similar to the one employed in prostate biopsies) was administered to one third of the patients and 1mg of intravenous midazolam was added if required during the procedure. Our primary objective is to evaluate the tolerability of this procedure under local anaesthesia using the validated Visual Analogue Scale measurement instrument. RESULTS: The procedure has been performed under the same anaesthetic protocol to 20 patients from 2 different centres. The average pain scores on the Visual Analogue Scale were 1.37 for the cystoscopy procedure and 1.19 for the placement of the implants. When asked whether the pain sensations had been higher, lower or the same during the procedure or at the preoperative cystoscopy, only 18% of the patients responded it was higher. In all cases there was a good tolerance to the procedure, and changes to the anaesthesia protocols were never required. CONCLUSIONS: We consider that the Urolift® system under local anaesthesia and sedation is a well-tolerated, safe and effective method for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.

High-intensity focused ultrasound therapy for the treatment of prostate cancer: Medium-term experience. / Terapia ultrasonido focalizado de alta intensidad (HIFU) para el tratamiento del cáncer de próstata: Experiencia a medio plazo.

INTRODUCTION: The treatment of localised prostate cancer seeks to minimise the impact on sexual function and urinary continence. In this respect, therapy with high-intensity focused ultrasound offers important results. We present our experience with this technique in 2 Spanish centres. MATERIAL AND METHODS: We conducted a retrospective review of 75 patients with localised prostate cancer treated with high-intensity focused ultrasound between March 2007 and July 2016. The oncological results and perioperative complications were assessed, as well as the impact on sexual function and continence. RESULTS: A total of 67 patients were analysed. The mean follow-up was 7.2 years. The PSA nadir was 0.2ng/mL (0-3), 24 patients (35.5%) presented biochemical recurrence, and 18 underwent a further biopsy, with 10 cases (55.5%) presenting disease recurrence. The overall biochemical relapse-free survival at 5 and 8 years was 93.2 and 80.5%, respectively. The cancer-specific survival at 5 and 8 years was 96% in both cases. In the postoperative period, 50 patients (74.6%) were continent, 16 (23.9%) reported mild incontinence, and one (1.5%) reported moderate incontinence. The median International Index of Erectile Function-5 before and after the surgery was 17 (5-25) and 16 (2-23) points, respectively. Nine patients reported de novo erectile dysfunction (13.5%). CONCLUSION: High-intensity focused ultrasound appears to be a safe alternative for the treatment of localised prostate cancer, especially for low-risk localised prostate cancer. In our experience, this technique offers advantages in preserving urinary continence, and the medium-term oncological results are encouraging. Given the natural progression of prostate cancer, long-term studies with a larger number of cases are needed to corroborate these results.

[Influence of climate, according to Koppën classification and Lang's index, on gross rate mortality associated with prostate cancer in the geographical area of Spain]. / Influencia de la climatología, según la clasificación de Koppën e índice de Lang, sobre la tasa bruta de mortalidad asociada al cancer de próstata en el área geográfica de España.

OBJECTIVE: To evaluate if the climatic factors of temperature and rainfall influence mortality associated with prostate cancer for a period of five years. MATERIAL AND METHODS: The mortality trends associated with prostate cancer will be evaluated in the period ranging from 1st january 1998 to 31st december 2002, in the geographical area of Spain. The demographic and mortality data were obtained from the National Institute of Statistics and the climatologically data on temperature and rainfall were obtained from the National Meteorology Institute applying the values registered in 2002. Based on the meteorological data, the different provinces are classified in accordance with Koppën climate classification and climatic index of Lang that defines them from the mean annual and monthly temperature and rainfall data. Mortality rates will be expressed by 100.000 men year, applying for their study the Kruskall-Wallis test for "n" independent samples through the SPSS v12.0 Windows software. RESULTS: Three main climatic areas are obtained, one area with type B climate, which accounts for 13% of the total population, a Csa climate, and a Csb, accounting for 67 and 20% respectively. The mortality found is higher in the Csb type for prostate cancer (p= 0.007), as compared to the other two climatic areas. CONCLUSION: Mortality associated with prostate cancer is significantly higher in the regions with a lower sun exposure. However, randomized prospective studies confirming these findings are warranted.

Safety and efficacy of intraurethral alprostadil in patients with erectile dysfunction refractory to treatment using phosphodiesterase-5 inhibitors.

INTRODUCTION: Phosphodiesterase-5 inhibitors (PDE5i) are the first choice for treating erectile dysfunction (ED) but are not always effective. The aim of this study was to present our experience in treating patients with ED, refractory to treatment with PDE5i, using intraurethral alprostadil (MUSE). MATERIAL AND METHODS: We conducted a review of 82 patients with ED and no response to PDE5i, from March 2013 to October 2014. Forty-seven patients (57%) had hypertension (AHT), 24 (29%) had diabetes (DM) and 20 (24%) had AHT and DM. Additionally, 19 (23%) had undergone radical prostatic (RP) surgery. The patients were evaluated after the treatment was applied and at 4 weeks using the following validated questionnaires: International Index of Erectile Function (IIEF-5/SHIM), Global Assessment Questionnaire (GAQ), Sexual Encounter Profile (SEP) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). RESULTS: The mean patient age was 60.5 years (40-80), and the mean follow-up was 11.3 months (1-20). Sixty-eight percent of the treated patients responded to MUSE(®) (74% in the AHT group, 65% in the AHT+DM group, 62.5% in the DM group and 58% in the RP group). The mean IIEF-5 score was 11.7±4.7, which increased to 18.6±4.9 after MUSE was administered (P=.027). The mean EDITS score at 4 weeks was 61.6 (6-81.9). The most common adverse effect was urethral burning, which occurred in 24 patients (29%). There were no cases of urinary tract infection, syncope or priapism. CONCLUSIONS: Intraurethral alprostadil is an effective treatment and has a broad safety profile for treating patients with erectile dysfunction refractory to oral treatment with PDE5i.

Relationship between gonadotrophin secretion, inhibin B and spermatogenesis in oligozoospermic men treated with highly purified urinary follicle-stimulating hormone (uFSH-HP): a preliminary report.

PURPOSE: To study the potential relationship between circulating follicle-stimulating hormone (FSH) gonadotrophin, inhibin B, spermatogenesis and the benefit of highly purified urinary FSH (uFSH-HP) treatment in men with oligozoospermia. METHODS: Twenty-nine normogonadotropic, normogonadal men with oligozoospermia were evaluated. Serum hormonal concentration and spermiogram were analyzed before and after 3-month treatment with uFSH-HP. RESULTS: Our results support the hypothesis that inhibin B is involved in the physiological regulation of FSH secretion and reflects the FSH-stimulated Sertoli cell function. After treating with uFSH-HP for 3 months a significant increase in all semen parameters was observed in most of the patients. CONCLUSIONS: Although the benefit of inhibin B as a prognosis factor in oligozoospermic patients treated with FSH is not defined, it can be considered as an important serum marker in reproductive and testicular functions. Treatment of oligozoospermic patients with uFSH-HP has shown to be an effective and safe therapy.

Mortality evolution study of burn patients in a critical care burn unit between 1971 and 1991.

This study was carried out in the critical care area of a burn unit. The mortality of burn patients was studied over three periods: 1971-83; 1984-87; 1988-91. The first period was studied retrospectively, the more recent periods were studied prospectively. The number of patients included in the study was 2859. The incidence of fatal burns during the three periods was compared standardizing for age, body burn surface and burn depth. Taking the first period as a reference, the mortality reduction in the second and third period was 14 and 37 per cent, respectively. In both the more recent periods of intensive medical care was introduced for the patients; early surgical treatments; nasal, pharyngeal, intestinal and burn surface decolonization and catheter puncture prophylaxis. We believe that the observed mortality reduction was due to these reasons. Using logistic regression a predictive mortality equation was obtained with three risk factors: age, total body surface area burned and burn depth. We are now able to obtain a mortality score soon after the patient is admitted to the unit.

Efficacy comparison of glutaraldehyde-phenate vs other glutaraldehydes in fomites disinfection, by different methods.

OBJECTIVE: To compare the efficacy of glutaraldehyde-phenate against four other glutaraldehydes. DESIGN: We use two methods: (1) Bacteriostatic method- With 97 microrganisms of 8 different species. (2) Bactericide method- With a low contamination (10(4)cfu) plus organic soil (simulating the work conditions of glutaraldehyde when we wash fomites before disinfection), we used six microorganisms (the most sensitive and the most resistant, according to the first method, of three species: P. aeruginosa, R. pneumoniae and S. aureus) in different times and concentrations. RESULTS: Glutaraldehyde-phenate is the most active against Gram-positives, but less with Gram-negatives. However when we study the total effect of the five glutaraldehydes, there are no significant differences among the mean of the minimum inhibitory concentrations (MICm). With the bactericide method the total bactericide effect (0% survival) is easily achieved with the five glutaraldehydes at 2% dilution, but when we reduced the concentration (1/16) we needed 60 minutes for glutaraldehyde-phenate and 15-30 minutes with the rest. CONCLUSIONS: The five products have got a similar efficacy in higher concentration, but at 1/16 dilution glutaraldehyde-phenate need increase the contact-time on the fomite.

Four year study of the risk factors of surgical wound infection in 5260 traumatological patients.

We carried out a four-year prospective study in the rehabilitation and traumatology center of the Hospital La Paz, where a total of 5260 patients were included. The objective of the study was to know the main risk factors that could influence the development of an infection of surgical wound, and get a predictive equation of infection of surgical wound in our patients. We utilized logistic regression for it, following the patient by means of active epidemiological surveillance; the main risk factors found were: immunodeficiency (OR = 8.3) wrong scaring (OR = 14.4), more than one intervention (OR = 3.5), type of surgical intervention (OR = 4.8) and incorrect use of prophylaxis (OR = 6.3). We considered that this knowledge could permit us to diminish the incidence of infections, specially if there is some of these factors, like the antimicrobial prophylaxis, that could be easily modified. Finally, upon applying to our patients the gotten equation, we get a ROC curve with 85% of the area under it, and if we take the point of cut of greater sensibility and specificity in this situation of very low prevalence of illness, it determines we could use it better in order to mark patients that don't suffer infection (high negative predictive value), making this possible to improve the efficacy of our work.

[Nosocomial infection over three years in a neonatal intensive care unit. Multivariate study]. / Infección nosocomial durante tres años en una unidad de vigilancia intensiva neonatal. Estudio multivariante.

BACKGROUND: The Neonate Intensive Care Units (NICU) present high frequencies of hospital infections (HI) as well as patients with high intrinsic and extrinsic infection risks. PATIENTS AND METHODS: A prospective study of 3 years in a NICU was carried out. Six-hundred and five neonates with stays longer than 48 hours were included. A descriptive study and a predictive equation, by non-conditional logistic regression, were performed, including the principal HI risk factors. RESULTS: The HI incidence was 25.8/1,000 patients-day, and it was most frequent in children with weight lower than 2,500 g. The main etiologic agents were Streptococcus epidermis and Pseudomonas aeruginosa. The risk factors for HI in NICU were assisted respiration (odds ratio [OR] = 5.1; 95% CI, 2.3-11.5), low weight at birth (OR = 3.2; 95% CI, 1-1.08), transfusion (OR = 3.8; 95% CI, 1.4-10.1) and central venous catheter. Validation by ROC curve was satisfactory. CONCLUSIONS: The incidence of HI in NICU is high, and depends on both disease features and instrumentation in NICU.

[Composite gastric lymphoma: MALT gastric lymphoma associated with Hodgkin's disease]. / Linfoma gástrico compuesto: linfoma gástrico tipo MALT asociado a enfermedad de Hodgkin.

We report a case of MALT (Mucosa Associated Lymphocytic Tissue) gastric lymphoma which occurred in a 52-year-old woman, associated with Hodgkin's disease, Lymphocyte Predominant type, in epiploic nodes. Although many cases of composite lymphomas have been reported, we were not able to find cases of gastric MALT lymphoma associated with Hodgkin's disease. This is probably the first case reported in the literature.

[Determination of the tumor marker CA 72-4 in gastric carcinoma]. / Determinación del marcador tumoral CA 72-4 en el carcinoma gástrico.

In this study, the authors determined the sensitivity and specificity of the new tumor marker CA 72-4 in detecting adenocarcinoma of the stomach. CA 72-4 serum levels were investigated in 279 patients consisting of: 100 control subjects, 88 patients with benign gastrointestinal disease and 91 patients with gastrointestinal cancer (31 with gastric cancer). We used a cut-off of 5 U/ml. The specificity of CA 72-4 was 91% and the sensitivity was 68%. Highest levels of CA 72-4 were found in patients with more advanced tumor (stages III-IV) and four of 5 patients with stage I had elevated levels of this tumor marker. These findings suggest that the use of serum CA 72-4 measurements may be more useful than other tumor markers in the diagnosis, prognosis and detection of recurrence in patients with gastric cancer. Although CA 72-4 can be elevated in other gastrointestinal adenocarcinomas, it can be useful in alerting the clinician to the possible presence of an intraabdominal neoplasm.

[Bladder pseudotumor in childhood]. / Pseudotumor vesical en edad infantil.

Case report of a 10 year-old male with vesical mass suggestive of a rabdomiosarcoma based on the radiologic studies performed. The existence of an inflammatory process with no signs of malignancy was confirmed by transurethral resection. The serological studies were negative and the absence of malignant disease in further substantiated by immunohistochemistry. We want to emphasize that certain vesical masses. which appear to be malignant on the radiological study (Pseudotumours), may be just inflammatory processes.

[A benign retroperitoneal schwannoma: a review of the literature and a report of a new case]. / Schwanoma retroperitoneal benigno: revisión de la literatura y aportación de un nuevo caso.

In a 42-years-old woman, an abdominal sonography was done, and a 10 x 9-cm solid cystic tumor on the left kidney appeared. Abdominal CT and arteriography showed a retroperitoneal heterogeneous mass surrounding and obstructing the ureteropelvic left junction. Tumor was removed under open surgery and the pathological study showed a benign schwannoma. We present this case because of its rarity 1%-10% of all primary retroperitoneal tumors.

[Renal tuberculosis associated with renal adenocarcinoma: unusual association]. / Tuberculosis renal asociada a adenocarcinoma renal: una asociación poco frecuente.

We present a patient 50 years old, complaining of right lumbar pain and miccional syndrome for three weeks. After analytic and x-ray studies, renal tuberculosis and renal cell carcinoma was the diagnosis. We started with specific antibiotic therapy and a radical nephrectomy was developed. According with the literature revised, just three cases has been published before. Because is an unusual clinic presentation we present these clinical note, we discuss the pathogenic and therapeutic procedures.

[Rapidly-growing renal angiomyolipoma associated with pregnancy]. / Angiomiolipoma renal de rápido crecimiento asociado a embarazo.

Renal angiomyolipoma is a relatively uncommon entity which can occur either as a solitary angiomyolipoma or associated to a systemic condition such as Bourneville's disease or tuberous sclerosis. Presentation of one case of a large, fast growing renal angiomyolipoma associated to pregnancy, which required surgery during the third month of pregnancy.

[Prospective and randomized study comparing mitomycin C and interferon alpha 2b in the prevention of superficial tumors of the bladder]. / Estudio prospectivo y aleatorio comparando mitomicin C e interferon alfa 2b en la profilaxis de los tumores superficiales de vejiga.

Contribution of our experience in 66 patients included in a prospective randomized study to compare the efficacy of Mitomycin C (MMC) and Alpha 2B Interferon (IFN) in the prevention of relapse of vesical surface tumours. Thirty-five patients were included in the MMC arm, 29 of which completed the treatment. Thirty-one patients were included in the IFN arm, 26 of which are evaluable. MMC was given endovesically at a rate of 30 mg weekly for one month, and then monthly to complete one year. Through the same route, 50 million units of IFN were given weekly for 3 months, and then monthly to complete one year. Within the MMC arm, three patients (10.3%) showed progress, twelve patients (451.3%) relapsed, and seventeen (58.7%) are disease free. With regard to IFN treated patients, one patient (3.8%) showed progress, ten (38.4%) relapsed, and sixteen (61.6%) are disease free. We conclude that there are no significant differences between these two drugs.

[Nosocomial infection in BPH: economic costs and increase in hospital stay]. / Infección hospitalaria en HBP: costes economicos y aumento del tiempo de hospitalización.

We present a cohort study where 40 matched pairs of patient (infected and no infected) were included. All of the patients had prostatic benign hyperplasia and open surgery or thransuretral resection was developed. Infected patients stay 3 days more in the hospital and they cost 120.000 pts more than uninfected patients.

[Bladder urothelial carcinoma in patients under 10 years of age: report of 2 new cases]. / Carcinoma urotelial vesical en pacientes menores de 10 años: aportación de dos nuevos casos.

Contribution of two cases of vesical tumours in patients under 10 years. Up to date, some 25 cases have been described in the international literature; and some in the national literature. Due to their exceptional nature, we believe the contribution of these two new cases to be of interest.