[Wünderlich s syndrome: importance of diagnostic imaging]. / Síndrome de Wünderlich: importancia del diagnóstico por imagen.

INTRODUCTION: Wünderlich's Syndrome is a spontaneous retroperitoneal haemorrhage characterised by sudden lumbar pain, tangible mass in the lumbar region and signs of hypovolaemic shock. CASE REPORT: A 65 year-old female presented the classic triad indicating Wünderlich's syndrome. Imaging techniques with three-dimensional reconstruction enabled us to determine the diagnosis and aetiology, and aided in determining the treatment. DISCUSSION: We emphasise the importance of imaging methods in diagnosing and choosing treatment for Wünderlich s Syndrome.

Síndrome de Wünderlich: importancia del diagnóstico por imagen / Wünderlich´s syndrome: importance of diagnostic imaging

Introducción: El síndrome de Wünderlich es una hemorragia retroperitoneal espontánea, caracterizada por dolor lumbar de inicio brusco, tumoración lumbar palpable y signos de shock hipovolémico. Caso clínico: Mujer de 65 años de edad que se presenta con la tríada clínica del síndrome de Wünderlich. Las técnicas de imagen empleadas, con reconstrucciones tridimensionales, permitieron establecer el diagnóstico y la etiología y facilitaron el tratamiento (la decisión actitud terapéutica). Discusión: Destacamos la importancia de las técnicas de imagen para el diagnóstico y el enfoque terapéutico del síndrome de Wünderlich (AU)

Introduction: Wünderlich’s Syndrome is a spontaneous retroperitoneal haemorrhage characterised by sudden lumbar pain, tangible mass in the lumbar region and signs of hypovolaemic shock. Case report: A 65 year-old female presented the classic triad indicating Wünderlich’s syndrome. Imaging techniques with three-dimensional reconstruction enabled us to determine the diagnosis and aetiology, and aided in determining the treatment. Discussion: We emphasise the importance of imaging methods in diagnosing and choosing treatment for Wünderlich´s Syndrome (AU)

[Local recurrence after radical prostatectomy and salvage radiotherapy]. / Recidiva local después de la prostatectomía radical y radioterapia de rescate.

OBJECTIVE: To evaluate the efficacy of radiotherapy to the prostatic bed in patients with biochemical recurrence prostate cancer after radical prostatectomy. METHODS: We analyse the outcomes of 292 patients who underwent radical prostatectomy for localized prostate cancer T1-T2 between January 1992 and June 2003, with an average follow-up of 36 months (range 6 months to 12 years). We detected biochemical recurrence (PSA > 0.20 ng/ml) in 75 (26%) patients. 75 patients with biochemical recurrence, 9 (12%) were diagnosed of local recurrence by the following criteria: a) First PSA obtained 6 weeks after radical prostatectomy < 0.20 ng/ml. b) Time to biochemical recurrence > 6 months. c) Prostate specific antigen doubling time > 6 months. d) Prostate specific antigen velocity after radical prostatectomy < 0.75 ng/ml/year. e) Prostate specific antigen level after radical prostatectomy < 2.5 ng/ml. The 9 patients diagnosed of local recurrence received an average dose of 56.42 Gy to the prostate bed. RESULTS: Of all 9 patients with local recurrence, 8(88.8%) have complete response with a mean follow-up of 30 months (12-36 months). The time between the radiotherapy and the response, in patients with complete response, was lower than 3 months in 7 patients and 12 months in 1 patient. Significant adverse effects associated to radiotherapy were not observed. CONCLUSIONS: Salvage radiotherapy may be beneficial in selected patients with local recurrence. The characteristics of prostate specific antigen elevation are useful in distinguishing men with local recurrence from those with distant metastases.

Recidiva local después de la prostatectomía radical y radioterapia de rescate / Local recurrence after radical prostatectomy and salvage radiotherapy

OBJETIVO: Evaluar la eficacia de laradioterapia en el lecho prostático en pacientes concáncer de próstata y fracaso bioquímico después de laprostatectomía radical.MÉTODOS: Analizamos los resultados de 292 pacientesa los que se le practicó prostatectomía radical porcancer de próstata localizado T1-T2, entre Enero de1992 y Junio de 2003, con un seguimiento medio de36 meses(rango 6 meses a 12 años). Se detecta fracasobioquímico(PSA > 0.20 ng/ml) en 75(26%)pacientes. De los 75 pacientes con fracaso bioquímico,9(12%) se diagnosticó de recidiva local siguiendolos siguientes criterios: a/ Primer PSA obtenido a las 6semanas de la intervención 6 meses. c/ Tiempo deduplicación del PSA > 6 meses. d/ Velocidad de PSAdespués de la prostatectomía radical <0.75/ng/ml/año. e/ Nivel de PSA después de laprostatectomía radical < 2.5 ng/ml. Los 9 pacientesdiagnosticados de recidiva local reciben una dosismedia de 56.42 Gy en el lecho prostático.RESULTADOS: De los 9 pacientes diagnosticados derecidiva local, en 8(88.8%) se obtuvo una respuestacompleta durante una mediana de seguimiento de 30meses(12-36 meses). El tiempo entre la radioterapia yla respuesta, en los pacientes con respuesta completa,fue inferior a los 3 meses en 7 pacientes y a 12 mesesen 4 pacientes. No se observaron efectos adversosimportantes secundarios a la radioterapia.CONCLUSIONES: La radioterapia de rescate puedeser beneficiosa en un seleccionado grupo de pacientescon recidiva local. La cinética del PSA después de laprostatectomía radical es útil para distinguir las recidivaslocales de las metástasis a distancia

OBJETIVE: To evaluate the efficacy ofradiotherapy to the prostatic bed in patients withbiochemical recurrence prostate cancer after radicalprostatectomy.METHODS: We analyse the outcomes of 292 patientswho underwent radical prostatectomy for localizedprostate cancer T1-T2 between January 1992 and June2003, with an average folow-up of 36 months (range6 months to 12 years). We detected biochemical recurrence(PSA > 0.20 ng/ml) in 75(26%) patients. 75 patientswith biochemical recurrence, 9 (12 %) were diagnosedof local recurrence by the following criteria: a) First PSAobtained 6 weeks after radicalprostatectomy 6 months. c) Prostate specific antigen doublingtime > 6 months. d) Prostate specific antigen velocityafter radical prostatectomy < 0.75 ng/ml/year. e)Prostate specific antigen level after radical prostatectomy< 2.5 ng/ml. The 9 patients diagnosed of local recurrencereceived an average dose of 56.42 Gy to the prostatebed.RESULTS: Of all 9 patients with local recurrence,8(88.8%) have complete response with a mean followupof 30 months (12-36 months). The time between theradiotherapy and the response, in patients with completeresponse, was lower than 3 months in 7 patients and12 months in 1 patient. Significant adverse effectsassociated to radiotherapy were not observed.CONCLUSIONS: Salvage radiotherapy may be beneficialin selected patients with local recurrence. The characteristicsof prostate specific antigen elevation are useful indistinguishing men with local recurrence from those withdistant metastases

[Prognostic factors of prostate cancer: usefulness of Ki-67 expression in preoperative biopsies]. / Factores pronósticos del cáncer de próstata: utilidad de la expresión del Ki67 en las biopsias preoperatorias.

OBJECTIVES: To evaluate the usefulness of Ki-67 expression in preoperative diagnostic biopsies to predict prostate cancer biochemical relapse after radical prostatectomy. METHODS: We analyze the expression of Ki-67 in ultrasound guided biopsies of 103 patients who underwent radical prostatectomy. Mean follow-up was 3.4 years (1.3-8.8 yr.). We correlated biochemical progression with traditional prognostic factors such as PSA (> 10/< or = 10), Gleason (> or = 7/< 7), pT classification (pT3/pT 0-2), and the immunohistochemical prognostic factor Ki-67 (> 3%/< or = 3%). RESULTS: 71/103 (69%) patients did not have progression and 32 (31%) had biochemical progression. Mean preoperative PSA was 10.7 ng/ml in patients without progression and 20.90 ng/ml in patients with biochemical progression (p = 0.0001). Mean Gleason score was 6.03 in patients without progression and 6.75 in patients with biochemical progression (p = 0.0001). Ki-67 expression was 3.95% in patients without progression in comparison to 5.05% of patients with biochemical progression. 12/67 (17.9%) of pT 0-2 tumors and 20/36 (55.6%) pT3 tumors progressed (p = 0.0001). Multivariate analysis indicates that there is not relationship between Ki-67 (> 3% < or = 3%) in preoperative biopsy specimens and prostate cancer biochemical progression after radical prostatectomy (p = 0.204). CONCLUSIONS: The immunohistochemical prognostic factor Ki-67 (> 3%/< or = 3%) in preoperative biopsies is less effective than classic factors, PSA (> 10/< or = 10), Gleason score (> or = 7/< 7) and pT classification (pT3/pT 0-2), to predict prostate cancer biochemical progression after radical prostatectomy.