[Polyarthritis secondary to intravesical BCG instillation, a case report]. / Poliartritis secundaria a instilaciones intravesicales de BCG, a propósito de un caso.

Immunotherapy with intravesical instillation of Bacillus Calmette is the best complementary after TUR treatment against T1 grade 2- 3 and CIS bladder cancer. However, this therapy is associated with several side- effects, incluiding joint symptoms. In this article we describe a case of polyarthritis associated with intravesical instillation, a rare complication. We review the clinical features, the pathogenic mechanisms and treatments described previously in the medical literature. Finally, we expose our brief experience and our final result.

Recidiva local y afectación metastásica única de tumor renal. Factores pronósticos y supervivencia / Local relapse and single site of metastatic involvement of renal tumour. Prognostic factors and survival

Objetivo: Valorar las características clínicas y patológicas y la supervivencia de los tumores renales que presentaron recidiva local o metástasis única y fueron tratadas quirúrgicamente. Material y método: Estudio retrospectivo de 321 nefrectomías valorando las variables clínicas y patológicas de aquellos pacientes que presentaron recidiva local o metástasis única y fueron tratados quirúrgicamente. Estudio y comparación de la supervivencia en los diferentes grupos. Resultados: El único factor influyente de forma independiente en la presentación de recidivalocal es el estadio patológico. La recidiva local y la presencia de metástasis única tienen una supervivencia similar, estadísticamente peor que el resto de pacientes no metastásicos al diagnóstico, pero mejor que los pacientes con presencia de metástasis al diagnóstico. Conclusiones: La presencia de recidiva local tiene el mismo pronóstico que la progresión en forma de una única metástasis resecable, pero mejor pronóstico que los pacientes inicialmente metastásicos a los que se realiza nefrectomía previa al tratamiento sistémico (AU)

Objective: To evaluate the clinical and pathological characteristics and survival in patients surgically treated for renal tumours that had local recurrence or metastasis to a single site. Material and Methods: A retrospective study of 321 nephrectomies, evaluating the clinical and pathological variables in patients having local recurrence or metastasis to a single site, and who were treated surgically. Study and comparison of survival in the different groups. Results: The only factor found to have an independent influence on local recurrence is pathological stage. Local recurrence and the presence of metastasis to a single site have similar survival rates, both being statistically worse than in patients without metastasis at diagnosis, but better than in those having metastasis at diagnosis. Conclusions: The presence of local recurrence has the same prognosis as a single excisable metastatic site, the prognosis being better than those initially with metastasis subjected to nephrectomy before receiving systemic treatment (AU)

Feocromocitoma con trombo en cava / Pheochromocytoma with thrombus in cava

El feocromocitoma, paraganglioma de localización suprarrenal, es un tumor cromafín secretor de catecolaminas. La extensión de éstos tumores a vena cava es rara y que el trombo alcance la aurícula derecha es excepcional. Presentamos el caso de una paciente que, sin clínica previa, presentó un cuadro de disfunción multiorgánica como primera manifestación de un tumor suprarrenal con extensión vascular hasta la aurícula derecha y afectación de la vena suprahepática derecha (AU)

Pheochromocytoma, a paraganglioma of suprarenal location, is a catecholamine-secreting chromaffin cell tumour. Spread of these tumours to the vena cava is rare and the thrombus only reaches the right atrium in exceptional cases. We present the case of a patient who, without previous symptomatology, presented with a clinical picture of multiorganic dysfunction with primary manifestation of a suprarenal tumour with vascular spread to the right atrium affecting the right suprahepatic vein (AU)

[Incidentally detected renal cancer. Prognostic factors]. / Tumores renales incidentales. Factores pronósticos.

OBJECTIVE: To study the clinical and pathological characteristics of incidental renal tumors treated in our center. MATERIAL AND METHODS: A retrospective review is conducted of 318 nephrectomies comparing the clinico-pathological variables of renal tumors diagnosed incidentally with those of symptomatic renal tumors. The factors influencing disease-free survival are analyzed in both groups. RESULTS: In our experience, although incidental renal tumors presented better survival than symptomatic ones owing to their better pathological state and tumor grade, incidental diagnosis was not an independent influencing factor in the multivariate study. Only when patients were studied who did not present metastases on diagnosis did incidental diagnosis become an influencing factor very close to statistical significance. CONCLUSIONS: Incidental diagnosis is not an independent prognostic factor.

[Follicular carcinoma of the thyroid manifested initially as asymptomatic primary renal neoplasm]. / Masa renal asintomática como primera manifestación de carcinoma folicular de tiroides.

Metastases in the kidney are rare, evenmore if primary source is thyroid. We report the tenth case of metastases in the kidney from thyroid, and it is the first to be follicular type and absolutely asymptom. Sonography and computerized tomography with suspicion of renal tumour are showed in a asymtom female 75 years old. Left partial nephrectomy was perfomed, initially it has been pathologically diagnosed as renal clear cells tumour, however the definitive pathologic report showed follicular tumour of thyroid. Local and systemic stage was discovered with complementary techniques. Sources of metastases in kidney and diagnoses techniques are discussed.

[Mutations of the androgen receptor gene in patients with clinically localized adenocarcinoma of the prostate]. / Mutaciones del gen del receptor de andrógenos en pacientes con adenocarcinoma de próstata clínicamente localizado.

UNLABELLED: The aim of this study was to detect mutations in the human androgen receptor gene in radical prostatectomy specimens. MATERIAL AND METHODS: The genomic sequence was realized in 67 radical prostatectomy specimens. The mean age was 64 years old. The PSA median was 15 ng/ml. TNM 1997: 34.3% were T1 and 65.7% T2. Genomic sequence: 1. Radical prostatectomy specimens desparaffitation. 2. Extraction of the DNA 3. DNA amplification. 4. Automatic genome sequence. 5. Comparison with Gene-Bank. RESULTS: 16.7% of the specimens were mutated. The most frequent mutation was the punctual mutation. The exon most frequent mutated was exon 1.

[Female incontinence: urodynamic evaluation]. / Incontinencia femenina: evaluación urodinámica.

OBJECTIVE: To evaluate the functional studies in women with stress urinary incontinence. METHODS: Emphasis is placed on comprehensive understanding of stress urinary incontinence in women as well as Urodynamic techniques and findings which apply to women with this condition. RESULTS: Although prospective randomized controlled trials to evaluate the clinical efficacy, cost-effectiveness and effect on quality of life of a pre-operative Urodynamic assessment are necessary, to date only Urodynamic Investigation (Non-invasive uroflowmetry, filling cystometrogram, valsalva leak point pressure, pressure-flow studies and urethral profile) provide enough information for treatment decisions and prognosis in cases of female urinary incontinence.

[Solitary lung metastasis after radical prostatectomy]. / Metástasis pulmonar solitaria tras prostatectomía radical.

Prostate carcinoma is diagnosed in earlier phases of its evolution, but this carcinoma may have an unpredictible evolution. Radical treatment (surgery and radiotherapy) is the best treatment in clinically localized tumors. The biochemical failure over 5 years from the surgery is 20-50% of the patients; the biochemical failure over 10 years from the surgery is less frequent because of prognostic factors from the biologic nature of the tumor. We report a case with biochemical and clinical failure over 10 years from the surgery.

[Prognosis factors in pT3 renal carcinoma]. / Factores pronóstico en carcinoma renal pT3.

OBJECTIVES: To identify independent predictors of progression and global survival in patients affected by pT3 renal cell carcinoma. To make risk groups by risk factors. MATERIAL AND METHODS: We evaluated 117 patients with pT3 renal cell carcinoma. 88 was M0 and 29 M1. Most frequent clinical feature: asintomatic patients. 80 males (69%) and 37 females (31%). Mean age 59 (24-82). Median follow up 34 months (mean 44 +/- 39 months). RESULTS: Pathological stage (TNM 1997) was pT3a in 52 patients (43.6%), pT3b 63 patients (53.6%) and pT3c 2 patients. HISTOLOGY: clear cell carcinoma 106 patients (90.6%), papillary 5 patients (4.3%) an dchromophobe 4 patients (3.4%). Nuclear grading according Fuhrman's classification: G1 13 patients, G2 45 patients, G3 32 and G4 12 patients. Size > 4 cm (p = 0.005/p = 0.0019), grade 3-4 (p = 0.006/p = 0.0007), N+ (p = 0.034/p = 0.009) and M+ (p = 0.035/p = 0.042) were independent prognosis factors for progression and global survival of the pT3 renal cell carcinoma. Patients M0 with 0 or 1 risk factor have better global survival tanh patients M0 with 3 or 4 risk factors and patients M1. CONCLUSIONS: Size, grade, N+ and M+ were independent prognosis factors for progression and global survival of the pT3 renal cell carcinoma. Tera are no differencies in global survival between patients M0 with 2 or 3 risk factors and patients M1.

[Treatment of renal carcinoma]. / Tratamiento del carcinoma renal.

The standard therapy for renal carcinoma is radical surgery. When dealing with single, under 4 cm tumors and in the case of renal tumors in single-kidney patients, the choice therapy is nephrectomy or partial nephrectomy. Response rates in metastatic renal carcinoma using the various immune therapy approaches available range from 15 to 35%, responses being short-lasting.