COMENTARIO EDITORIAL de: El inédito libro sobre terapéutica urológica del Dr. D.Victoriano Molina García (1899-1986) / PUBLISHING COMMENT of: The unpublished book on therapeutics urológica of the Dr. D.Victoriano Molina García (1899-1986)

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[The intervention of Dr Francisco Díaz in the inquisitorial process against Elena/o de Cespedes, a transsexual surgeon found guilty by the Inquistion in Toledo in 1587]. / La intervención del Dr. Francisco Díaz en el proceso inquisitorial contra Elena/o de Céspedes, una cirujana transexual condenada por la Inquisición de Toledo en 1587.

OBJECTIVES: To make known, comprehensively, an almost unknown episode in the life of Dr. Francisco Diaz (1527-1590), surgeon of the king Philip II, and author of the first urology treaty in the history of medicine. To our knowledge, to date there were few references about the participation that, as an expert, Francisco Diaz had to have in the inquisitorial process against Elena de Cespedes, a presumed hermaphrodite accused by the Inquisition because being a woman married another one pretending to be a man. The trial was carried out in Toledo in 1587 and had great impact in that time, because the accused, dressing with male clothes and usurping the prerogatives of a man, had gotten by fraud titles and favours which were forbidden for women, the title of surgeon among them. Except for the reference by Folch Jou and Burshatin, both short and incomplete, no other author or biographer of the famous surgeon had cited this episode of his life, which to our judgment could mean a great damage to his reputation. METHODS: We reviewed the works by the two aforementioned authors, all the works and biographies about Dr. Francisco Diaz that we could found, and microfilmed and transcript the whole bundle 234, expedient 24, from the section Inquisition at the National Historical Archive in Madrid, corresponding to Elena de Cespedes (alias Eleno) (> 500 pages) to obtain the greatest amount of data about the accused and the performance of Dr. Francisco Diaz. RESULTS AND CONCLUSIONS: Francisco Diaz was requested, as an expert, by the Vicar of Madrid to perform the examination of the genitourinary organs to give or not marriage license to that woman saying she was a man. In his report in the year 1586, surprisingly the urologist declared that the petitioner was a man. As it would be demonstrated during the trial, the accused, who alleged being hermaphrodite in her defense, had been able to deceive the expert with her tricks altering her genital morphology. Thanks to her surgical knowledge she had mutilated herself surgically closing her vagina and placed a device to simulate she was a male. At the end, after the opinion of the counter experts of the Inquisition Francisco Diaz had to retract, confirmed that the accused was a female, and accused her of witchcraft to save his responsibility. Nevertheless, in the work we conclude that the accused was a male transsexual, which, in part, would excuse the urologist's error 400 years later.

La intervención del Dr. Francisco Díaz en el proceso inquisitorial contra Elena/ o Céspedes, una cirujana transexual condenada por la inquisición de Toledo en 1587 / The intervention of Dr. Francisco Díaz in the inquisitorial process against Elena /o de Cespedes, a transsexual surgeon found guilty by the Inquisition in Toledo in 1587

OBJETIVO: Dar a conocer, de un modo exhaustivo, un episodio casi inédito en la vida del Doctor Francisco Díaz (1527-1590), cirujano del rey Felipe II, y autor del Primer Tratado de Urología en la historia de la Medicina. Que sepamos hasta la fecha existían pocas noticias de la actuación que, como experto, tuvo que realizar Díaz en el proceso inquisitorial contra Elena/o de Céspedes, un presunto hermafrodita acusado por el Santo Oficio que siendo mujer y haciéndose pasar por hombre, se había casado con otra. El juicio tuvo lugar en Toledo en 1587 y alcanzó gran resonancia en su época, ya que la encausada, vestida con indumentaria masculina y usurpando las prerrogativas del varón, había conseguido fraudulentamente títulos y prebendas vedadas a la mujer, entre ellos la titulación de cirujana. Salvo las referencias de Folch Jou y Burshatin, ambas escuetas e incompletas, ningún autor ni biógrafo del celebre cirujano, había hecho cita de este pasaje de su vida que a nuestro juicio debió suponer para el urólogo un gran quebranto de su reputación. MÉTODOS: Se han revisado los trabajos de los dos autores antes citados, todas las obras y biografías del Dr. Francisco Díaz a nuestro alcance y microfilmado y transcrito en su totalidad el legajo 234, expediente 24, de la Sección Inquisición del Archivo Histórico Nacional de Madrid, correspondiente a Elena de Céspedes (alias Eleno de) (> de 500 folios) para extraer el mayor número de datos acerca de la acusada y sobre la actuación en el proceso del Dr. Francisco Díaz. RESULTADO Y CONCLUSIONES: La exploración como especialista en órganos génito-urinarios había sido solicitada a Francisco Díaz por el Vicario de Madrid para conceder o no una licencia de matrimonio a dicha mujer que afirmaba ser varón. En su informe de 1586 el urólogo declaró, sorprendentemente, que el peticionario era hombre. Como se demostraría durante el juicio la encausada, que en su defensa alegaba ser hermafrodita, había logrado engañar al experto con sus «malas artes» alterando su morfología genital. Gracias a sus conocimientos en cirugía se había automutilado obturando quirúrgicamente su vagina y colocado un «artificio» para simular que era varón. Al final, tras la opinión de los contraexpertos del Santo Oficio, Francisco Díaz tendría que retractarse, confirmar que era mujer y acusar a la reo de hechicería para salvar su responsabilidad. En el trabajo, sin embargo, concluimos que la acusada era un transexual masculino lo que, en parte, disculparía el error del urólogo 400 años después (AU)

OBJECTIVES: To make known, comprehensively, an almost unknown episode in the life of Dr. Francisco Diaz (1527-1590), surgeon of the king Philip II, and author of the first urology treaty in the history of medicine. To our knowledge, to date there were few references about the participation that, as an expert, Francisco Diaz had to have in the inquisitorial process against Elena de Cespedes, a presumed hermaphrodite accused by the Inquisition because being a woman married another one pretending to be a man. The trial was carried out in Toledo in 1587 and had great impact in that time, because the accused, dressing with male clothes and usurping the prerogatives of a man, had gotten by fraud titles and favours which were forbidden for women, the title of surgeon among them. Except for the reference by Folch Jou and Burshatin, both short and incomplete, no other author or biographer of the famous surgeon had cited this episode of his life, which to our judgment could mean a great damage to his reputation. METHODS: We reviewed the works by the two a fore mentioned authors, all the works and biographies about Dr. Francisco Diaz that we could found, and microfilmed and transcript the whole bundle 234, expedient 24, from the section Inquisition at the National Historical Archive in Madrid, corresponding to Elena de Cespedes (alias Eleno) (> 500 pages) to obtain the greatest amount of data about the accused and the performance of Dr. Francisco Diaz. RESULTS AND CONCLUSIONS: Francisco Diaz was requested, as an expert, by the Vicar of Madrid to perform the examination of the genitourinary organs to give or not marriage license to that woman saying she was a man. In his report in the year 1586, surprisingly the urologist declared that the petitioner was a man. As it would be demonstrated during the trial, the accused, who alleged being hermaphrodite in her defense, had been able to deceive the expert with her tricks alteringher genital morphology. Thanks to her surgical knowledge she had mutilated herself surgically closing her vagina and placed a device to simulate she was a male. At the end, after the opinion of the counter experts of the Inquisition Francisco Diaz had to retract, confirmed that the accused was a female, and accused her of witchcraft to save his responsibility. Nevertheless, in the work we conclude that the accused was a male transsexual, which, in part, would excuse the urologist's error 400 years later (AU)

[Infertility and varicocele through history]. / La infertilidad y el varicocele a través de la historia.

OBJECTIVES: To perform a historical review of varicocele and male infertility with the aim to find descriptions that first related them. In parallel, we review the evolution of treatment for varicocele up to date. METHODS/RESULTS: We refer to multiple authors and their treaties on Medicine, from first to 20th Century, in which descriptions of these pathologies are found, focusing on descriptions of the surgical technique for treatment of varicocele and their application in Spain. CONCLUSIONS: Varicocele was already described in treaties from the first century having bee of n its treatment predominantly surgical from the first description to our days. Not identified as a cause of infertility until late, by the end of the 19th century, it is the main indication for treatment nowadays. The surgical technique has suffered many modifications over time, both in the approach as in the "radicality" of a vascular ligature applied.

[Adrenal cysts: presentation of 6 cases]. / Quistes suprarrenales: presentación de seis casos.

OBJECTIVES: We report six cases of adrenal cyst, a rare pathologic entity which poses diagnostic problems and therapeutic controversies. METHODS: We report six cases of adrenal cysts in 4 female and 2 male patients ages 26 to 68 years. All cases underwent surgical treatment. RESULTS: Pathologic studies showed that all were adrenal cysts without malignancy in any case. CONCLUSIONS: Adrenal cysts are a rare disease of which correct diagnosis is difficult so that many times patients undergo surgery without a proper preoperative diagnosis. There are controversies about the right management of adrenal cysts.

[Henry IV de Castilla( 1454-1474). An exceptional urologic patient. Morphological and personality portrait of Henry IV " The impotent" in contemporary chronicles and manuscripts (I)]. / Enrique IV de Castilla (1454-1474). Un singular enfermo urológico. Retrato morfológico y de la personalidad de Enrique IV "El Impotente" en las crónicas y escritos contemporáneos (I).

OBJECTIVES: To make an update on Gregorio Marañon's work "Biological essay about Henry IV and his time" (Madrid 1930), reviewing the clinical diagnosis made by the famous spanish doctor-historian more than 70 years ago on the last Monarch of the Castilian Trastamara, because we consider that diseases suffered by Henry IV were urologic mainly. METHODS: We reviewed 10 chronicles, 5 contemporary manuscripts, and 25 works about the figure of Henry IV published up to year 2000. For comparisons between works we evaluated not only the chronicles and works used by Marañon, but also the more recent ones of medical character, which have resulted in a significant increase in the amount of data about the figure of the Monarch. Additionally, following our current knowledge we tried to adapt the clinical diagnosis from Marañon--eunucoid dysplasia with acromegalic reaction--to current nomenclature in order to define the kind of endocrinopathy the Monarch suffered. RESULTS: Following a review of contemporary chronicles and recent bibliography about Henry IV, the Monarch was a singular urologic patient. He suffered chronic renal lithiasis, impotence, a presumptive penile anomaly, and almost surely infertility, although all his uro-andrological diseases were part of the endocrinopathy the Monarch suffered, probably a hypophyseal tumor. Included in the work there are descriptions of his physiognomy and psychopathological characters of his personality from the chronicles, commenting on all clinical symptoms the Monarch suffered according to his biographers and present day doctors and historians.

[Henry IV of Castilla (1454-1474). An exceptional urologic patient. An endocrinopathy causing the uro-andrological problems of the Monarch. Chronic renal lithiasis (II)]. / Enrique IV de Castilla (1454-1474). Un singular enfermo urológico. Una endocrinopatía causa de los problemas uro-andrológicos del monarca. La litiasis renal crónica (II).

OBJECTIVES: To review all known data about the endocrinopathy and renal disease suffered by Henry IV of Castile according to contemporary chronicles and manuscripts, comparing the clinical diagnosis made by Gregorio Marañon 70 years ago in his work "Biological essay about Henry IV and his time" (Madrid 1930) with present concepts, because we consider, as other medical authors, that his endocrinopathy is not well determined. Regarding his chronic renal lithiasis, it could have played an important role as negative factor in the Monarch's quality of life, and have been related to his endocrinopathy, so that it should also be reviewed. METHODS: We reviewed a total of 10 chronicles and 5 contemporary manuscripts treating the look and diseases of Henry IV to obtain the most important data about both diseases and be able to characterize the kind of endocrine disease suffered by the Monarch, and all aspects regarding his lithiasis, and compare them with our current knowledge. RESULTS: From the review of those chronicles and manuscripts, it is my opinion that Henry IV suffered acromegaly secondary to a GH and prolactine producing hypophyseal tumor from childhood, which might justify the impotence he suffered from his youth and other symptoms clearly referred in the chronicles. Chronic renal lithiasis (flank pain, lumbar illness, and hematuria) finally led to acute obstructive uropathy, main cause of his death. This fact has not been emphasized by historians. The renal lithiasis benign part of a multiple endocrine neoplasia syndrome (MEN I) can not be ruled out.

[Henry IV of Castilla (1454-1474). An exceptional urologic patient. An endocrinopathy causing the uro-andrological problems of the monarch. Impotence and penile malformation (III)]. / Enrique IV de Castilla (1454-1474). Un singular enfermo urológico. Una endocrinopatía causa de los problemas uro-andrológicos del monarca. Impotencia y malformación de pene (III).

OBJECTIVES: To review, in accordance to contemporary and current chronicles and manuscripts, all data known about impotence and presumptive penile malformation suffered by Henry IV of Castile. Although currently the monarch's homosexuality is almost totally rejected, because according to many authors slandering, mainly of the sexual kind, was used as a political arm to discredit him by his enemies, it is yet to be demonstrated if his erectile dysfunction and presumptive genital anomaly were also slanderly disseminated by his detractors to avoid recognizing his daughter Juana "La Beltraneja" as successor to the throne. METHODS: We reviewed a total of 10 chronicles, 5 contemporary texts and manuscripts, and 25 books about the figure of Henry IV published before year 2000, analyzing medical works in detail, particularly those from Marañon, Eisenberg, and Irvine and Mackay, who studied both pathologies trying to differentiate if both diseases could be justified by the kind of endocrinopathy the monarch suffered. RESULTS: Although it is understandable that the study could be mistaken by document manipulation undertaken during Henry IV's life and posteriorly during the reign of the "Catholic Kings", and due to the lack of impartiality of some of his chroniclers, it is my opinion that the most probable cause of Enrique IV's erectile dysfunction was a GH and prolactine producing hypophyseal tumor, that he suffered from his youth producing complete impotence and acromegaly. It is not well documented if the Monarch also suffered a congenital penile anomaly.

[Henry IV of Castilla (1454-1474). An exceptional urologic patient. An endocrinopathy causing the uro-andrological problems of the Monarch. Artificial insemination attempts (IV)]. / Enrique IV de Castilla (1454-1474). Un singular enfermo urológico. Una endocrinopatía causa de los problemas uro-andrológicos del monarca. Infertilidad o esterilidad. Intentos de inseminación artificial (IV).

OBJECTIVES: To analyze, in accordance to contemporary and current chronicles and manuscripts, all known data about possible infertility or sterility suffered by Henry IV and attempts of artificial insemination undertook by his wife Juana of Portugal with the Monarch's semen due to his complete impotence. His possible infertility was unfairly used by his enemies to deny the right of succession to his daughter Juana, called "La Beltraneja", in a similar way than what has happened with his erectile dysfunction. In our work, we tried to demonstrate if Henry IV was or not able to conceive and paternity of his daughter Juana, based on our current knowledge and presumed endocrinopathies suffered by the Monarch in accordance to some medical writers. METHODS: We reviewed a total of 10 chronicles, 5 contemporary texts and manuscripts, and 25 books about the figure of Henry IV published before year 2000, analyzing medical works in detail, particularly those from Marañon, Eisenberg, and Suarez, who studied the facts referred to the presumed Monarch's infertility and his paternity trying to establish a relationship with current endocrinologic syndromes that cause infertility or sterility and with the chronological dates of conception and birth of Juana "La Beltraneja". RESULTS: As it has been said before, although the study may be falsified by document manipulation done by those chroniclers partisans of the Catholic Kings, retrospective analysis seems to show that if the Monarch suffered eunuchism (hypogonadism) or hypophyseal tumor he should have been sterile. In a similar way than Suarez, we don't dare to judge if the attempts of artificial insemination performed to his wife Juana were successful or not, so the historical controversy about "La Beltraneja" continues.

Quistes suprarrenales: presentación de seis casos / Adrenal cyst: reprot of six cases

OBJETIVO: Presentamos seis casos de quistes suprarrenales, una patología infrecuente y que plantea problemas diagnósticos y controversias en cuanto al tratamiento. MÉTODOS: Se trata de seis pacientes portadores de quistes suprarrenales, dos varones y cuatro mujeres entre 26 y 68 años de edad. Todos ellos fueron tratados quirúrgicamente. RESULTADOS: El estudio anatomopatológico reveló que se trataba de quistes suprarrenales sin focos de malignidad en ninguno de los casos. CONCLUSIÓN: Los quistes suprarrenales son una rara patología, que presenta dificultades a la hora de llegar a un correcto diagnóstico, por lo que muchas veces estos pacientes son intervenidos sin un diagnóstico preoperatorio exacto. En cuanto al tratamiento existen controversias de cual puede ser el manejo más adecuado (AU)

Retrato morfológico y de la personalidad de Enrique IV "El Impotente" en las crónicas y escritos contemporáneos (I) / Henry IV of Castile (1454-1474). An exceptional urologic patient. Morphological and personality portrait of Henry IV "The impotent" in contemporary chronicles and manuscripts (I)

OBJETIVO: Efectuar una puesta al día, según los conceptos actuales, del trabajo de Gregorio Marañón "Ensayo biológico sobre Enrique IV de Castilla y su tiempo" (Madrid 1930), revisando el diagnóstico clínico que sobre el último monarca de los Trastámara castellanos realizó el célebre médico-historiador español hace más de 70 años, ya que consideramos que las principales patologías padecidas por Enrique IV eran de carácter urológico. MÉTODO: Se han revisado un total de 10 crónicas, 5 escritos y manuscritos contemporáneos y 25 obras sobre la figura de Enrique IV publicadas hasta el año 2000. Para el cotejo de los trabajos no solo se han valorado las crónicas y obras que utilizó Marañón, sino también las más recientes de carácter médico, lo que ha incrementado sensiblemente el corpus documental sobre la figura del monarca. Además, en base a nuestros conocimientos actuales, se ha tratado de adaptar el diagnóstico clínico de Marañón: "displasia eunucoide con reacción acromegálica" a la nomenclatura actual para precisar el tipo de endocrinopatía que padecía el monarca. RESULTADOS: Según la revisión de las crónicas coetáneas y de la bibliografía reciente sobre Enrique IV, el monarca fue un singular paciente urológico. Padeció litiasis renal crónica, impotencia, una presunta anomalía peneana y casi seguro infertilidad, si bien todas sus afecciones uro-andrológicas estaban inmersas dentro de la endocrinopatía que padeció el monarca, posiblemente un tumor hipofisario. En el trabajo se describe su fisionomía y los caracteres psico-patológicos de su personalidad según las crónicas, comentando todos los síntomas clínicos que, según los biógrafos, padeció el monarca y la opinión de médicos e historiadores actuales (AU)

[Spermatic cord liposarcoma: report of a new case]. / Liposarcoma en cordón espermático: aportación de un nuevo caso.

OBJECTIVE: To report an additional case of liposarcoma of the spermatic cord. METHODS: A 69-year-old male presented with an indolent left inguinal mass that he had noted one month earlier and had gradually increased in size. Two irregular mobile nodular left inguinal lesions were detected on physical examination. Analytical tests were normal. An ultrasound showed three nodular lesions in the left spermatic cord. CT attenuation values indicated predominantly fat tissue in the lesion. The patient underwent a radical left orchidectomy and funiculectomy. RESULTS: The histopathological analysis of the surgical specimen showed a well-differentiated liposarcoma of the spermatic cord. CONCLUSIONS: Liposarcoma of the spermatic cord is uncommon. Some imaging techniques are useful in making the diagnosis. Like other authors, we believe that orchifuniculectomy is the treatment of choice in these patients.

[Leonardo de la Peña Díaz (1875-1957) and the founding of the first chair of urology in Spain]. / Leonardo de la Peña Díaz (1875-1957) y la fundación de la primera Cátedra de Urología en España.

OBJECTIVE: The creation of the first chair of Urology in Spain and, consequently, the official recognition of the specialty in the urinary tract as a subject in the university curriculum was not an easy task for the urologists early in the last century. The curriculum of 1886 and 1902 included some medical specialties in the licentiate (ORL, Ophthalmology, Dermatology and Venereal Disease, and Neuropathy) as complementary and subsequently compulsory subjects, but not Urology. Perhaps this was due to the lack of representative or influential urologists that could exert pressure on the ministers of Public Education at that time. Although the Spanish Society of Urology was founded in 1911 and some urologists like Rafael Mollá and Rodrigo and Leonardo de la Peña Díaz, professors of the Central University, exerted pressure on the university faculty, Royal Academy of Medicine and the Ministry of Public Education, Urology was not included in the curriculum until 1920, although, in my view, its category was again devaluated since it was only an optional subject in the licentiate or doctorate. Apart from the procedures and processes, convoking the chair required political and administrative maneuvers that are shown in a broad review of newspaper articles and documents of that period. The controversial result of the competition based on merits that some considered should have been competition for a position according to the convocation, is no discredit to Leonardo de la Peña Díaz (1875-1957), the first professor of Urology in the history of Spanish Medicine. An unbiased historical and discerning evaluation clearly shows that his merits, accomplishments, tenacity and competence in teaching made him the most appropriate for the position. His merits were finally recognized not only by the board but also by his opponents.

Liposarcoma en cordón espermático: aportación de un nuevo caso / Spermativ cord liposarcoma: A case report

OBJETIVO: La presentación de un nuevo caso de liposarcoma de cordón espermático. MÉTODO: Describimos el caso de un paciente varón de 69 años que presenta una tumoración inguinal izquierda indolora, progresivamente creciente y de un mes de evolución. La exploración física confirmó la existencia de dos nódulos móviles irregulares en dicha localización. El estudio analítico fue normal. La ecografía mostró tres imágenes nodulares dependientes del cordón espemático izquierdo. Los valores de atenuación de la TAC sugirieron un predominio del tejido graso en la lesión. La cirugía practicada consistió en orquiectomía radical más funiculectomía izquierdas. RESULTADOS: El estudio histopatológico de la pieza nos permitió establecer un diagnóstico definitivo de liposarcoma bien diferenciado de cordón espermático.No existe evidencia de recidiva local ni diseminación metastásica, tras un seguimiento de 24 meses. CONCLUSIONES: Destacamos la escasa frecuencia de este tipo de neoplasias. Señalamos la utilidad que determinadas técnicas de imagen pueden tener en su diagnóstico. Coincidimos con otros autores en la orquifuniculectomía como tratamiento de elección para estos pacientes (AU)

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Leonardo de la Peña Díaz (1875-1957) y la fundación de la primera Cátedra de Urología en España / Leonardo de la Peña Díaz (1875-1957) and the creation of the first chair of Urology in Spain (1920)

La creación de la primera cátedra de Urología en España con el consiguiente reconocimiento oficial de la docencia universitaria para la especialidad de Vías Urinarias, no fue, ni mucho menos, una tarea fácil para los urólogos de principios del pasado siglo.Los Planes de Estudio de 1886 y 1902 habían permitido, respectivamente, el acceso a la licenciatura de determinadas especialidades médicas como asignaturas complementarias y luego obligatorias (O.R.L., Oftalmología, Dermatología y Sifilografía y Neuropatías), sin embargo la Urología en ambos planes quedó postergada quizás por la falta de interlocutores válidos o personas de influencia entre los urólogos que pudieran presionar sobre los correspondientes ministros de Instrucción Pública en su momento.Hasta la creación de la Asociación Española de Urología en 1911, y las presiones que algunos urólogos como Rafael Mollá y Rodrigo y Leonardo de la Peña Díaz, catedráticos ambos de la Universidad Central, pudieron ejercer sobre el Claustro universitario, Real Academia de Medicina y Ministerio de Instrucción Pública, la Urología no fue admitida como asignatura hasta 1920, si bien, en mi opinión, su categoría quedó nuevamente devaluada, ya que solamente podía cursarse con carácter voluntario en el periodo de licenciatura o doctorado.Para la convocatoria de la cátedra además de las gestiones se necesitaron determinadas maniobras político-administrativas que en el trabajo tratamos de desvelar con una amplia revisión periodística y documental de la época. El polémico resultado del concurso de méritos, que para algunos debió haber sido realizado por oposición según figuraba en la convocatoria, no enturbia, en modo alguno, la figura de Leonardo de la Peña Díaz (18751957), primer catedrático de Urología en la historia de la Medicina española, ya que, en una imparcial valoración histórico-crítica, su currículum, tenacidad y condiciones pedagógicas eran las más idóneas para ejercer la plaza.Sus méritos le serían reconocidos al final no sólo por el Tribunal sino también por sus propios oponentes (AU)

Metástasis adrenal metacrónica solitaria contralateral de un carcinoma renal primario: aportación de un nuevo caso / Solitary metachronous contralateral metastasis of primary renal cell carcinoma

OBJETIVO: Presentar el caso de una metástasis adrenal solitaria metacrónica contralateral, secundaria a un carcinoma renal previamente extirpado. MÉTODO: Describimos el caso de un paciente varón de 63 años al que se había practicado nefrectomía radical derecha por un carcinoma de células renales. En la revisión correspondiente a los 24 meses post-intervención, refiere discreto aumento de la mama izquierda. El estudio analítico y hormonal no reveló hallazgos significativos (salvo creatinina sérica de 1,75 mg/dl). En la TAC se objetivó no obstante un nódulo suprarrenal izquierdo de tres centímetros, siendo tras seis meses de actitud expectante su nuevo diámetro de 4,3 cm. La PAAF guiada mediante tomografía axial evidenció malignidad de la lesión. Se indicó la adrenalectomía izquierda. RESULTADOS: El análisis histopatológico de la pieza mostró una metástasis adrenal de un carcinoma renal de células claras. No existe evidencia de recidiva metastásica en la actualidad, tras 21 meses de seguimiento del paciente post-suprarrenalectomía. El potencial premaligno del leiomioma de epidídimo ha sido considerada ya que en especímenes de leiomiosarcoma, se han localizado áreas de leiomioma benigno, que han suscitado la hipótesis de una transformación maligna del leiomioma, lo que fundamentaría el seguimiento tras el tratamiento (fundamentalmente pacientes jóvenes) que consiste en la extirpación quirúrgica de la masa o epididimectomía total o parcial cuando la tumoración está bien delimitada y no ofrece dudas en cuanto a su malignidad; si se sospecha ésta, sería necesario realizar orquioepididimectomía (5). Finalmente, el estudio anatomopatológico coincide generalmente con la descripción de células de músculo liso, fusiformes, alargadas que crecen formando remolinos y que son positivas para la actina. CONCLUSIONES: Señalamos la baja frecuencia de este tipo de casos. Destacamos la importancia del estudio analítico y hormonal en el diagnóstico de la patología adrenal; así como el de la TAC más PAAF. Coincidimos con otros Autores en la validez de la suprarrenalectomía en casos como el aquí presentado (AU)

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Francisco Díaz (1527-1590), "Padre de la Urología" / Francisco Díaz (1527-1590), \"Father of aurology\"

La aparición del tratado de todas las enfermedades de los riñones, vexiga y carnosidades de la verga y urina, de Francisco Díaz (Madrid, 1588) marca un hito en la historia de la medicina. La originalidad y precocidad de su doctrina planteó una verdadera revolución en la concepción de la literatura medicoquirúrgica, pues el texto constituyó una genial anticipación de la época de las especializaciones. La prioridad en la descripción de varios instrumentos, por él inventados, para el tratamiento de determinadas afecciones urológicas, el ser pionero en la utlización de los mismos, y el reconocerle por su innovadora obra como el primer tratadista de la especialidad, otorgan a Francisco Díaz el merecido título de "Padre de la urología".