Influence of Donor and Recipient Ages in Survival of Simultaneous Pancreas-Kidney Transplantation.

INTRODUCTION: Simultaneous pancreas-kidney transplantation (SPKT) is a well treatment for patients with insulin-dependent diabetes and end-stage renal disease. Donor age is a barrier to the acceptance of organs. Age matching has been extensively studied in kidney transplantation; however, there are no studies in graft survival after SPKT. We aimed to study the combined influence of the ages of the donors and recipients in graft survival after SPKT. MATERIAL AND METHODS: Donors and recipients are classified as younger (age <40 years) or older (age ≥40 years). There were four study groups (young-young, young-old, old-young, and old-old). They were evaluated retrospectively for demographic and clinical characteristics of donors and recipients and the long-term survival between 2001 and 2012 of kidney pancreas transplantation patients at our center. RESULTS: A total of 115 transplantations were performed. The four groups had 55 young-young, 40 young-old, 10 old-young, and 10 old-old patients. Serious complications occurred in 32%, 42%, 30%, and 40%, respectively, and deaths were 2%, 5%, 0%, and 20%, respectively, in the groups. Pancreas graft survival at 3 years for each group was 80%, 87, 5%, 90%, and 60%, respectively, and kidney graft survival was 92.7%, 90%, 90%, and 70%, respectively. Panel-reactive antibodies (PRAs) >30% were associated with poor graft survival, and serious postoperative complications associated with poor pancreas-kidney graft survival. CONCLUSIONS: In conclusion, both younger and older recipients show excellent long-term graft and patient survival after SPKTs from younger donors. We recommended that older-recipient SPKT be transplanted from younger donors because older recipients who have been transplanted from older donors had decreased survival.

Validation of the Pancreatic Donor Risk Index in Simultaneous Pancreas-Kidney Transplantation Performed in Córdoba Hospital From 2000 to 2015.

BACKGROUND: The Pancreatic Donor Risk Index (PDRI) was developed in 2010 in the United States to predict graft survival after pancreas transplantation, based on donor characteristics and logistical and technical conditions. The aim of the study was to validate the utility of PDRI as a pancreas allograft survival predictor in simultaneous pancreas-kidney transplantation (SPK) transplants performed in our hospital between 2000 and 2015. METHODS: This retrospective analysis of 126 SPK transplants was performed by the same surgical team from the years 2000 to 2015. Donor variables that are integrated in the PDRI were calculated (age, sex, race, creatinine serum levels, body mass index, height, cold ischemia time, cause of death, type of pancreas transplant). Pancreatic graft survival at 1 and 5 years was calculated by use of the Kaplan-Meier test. Comparison of survival curves between PDRI risk quartiles was calculated by use of the log-rank test. Association between graft survival and variables integrating the PDRI was calculated by use of univariate Cox regression analysis. RESULTS: Log-rank analysis found no statistically significant association between global graft survival and PDRI quartiles. Univariate Cox regression analysis showed a statistically significant association between graft survival and cold ischemia time (P < .05). CONCLUSIONS: PDRI was not a useful tool to predict pancreatic graft outcomes in a Spanish reference population.

Graft Survival in Patients With Polycystic Kidney Disease With Nephrectomy of Native Kidney Pretransplant.

INTRODUCTION: Autosomal-dominant polycystic disease (ADPKD) represents 5%-10% of cases of end-stage renal failure. However, management of these patients in terms of whether or not to perform a transplant and optimal timing remains controversial. The objective of our analysis was to evaluate graft survival in patients with ADPKD in which we conduct pretransplant nephrectomy. METHODS: This retrospective study including renal transplant patients secondary to ADPKD in our hospital between January 2000 and December 2012. Pretransplant native kidney nephrectomy was indicated in cases of need for space or repeated complications (cysts). We compared the initial function and graft survival between groups of transplanted based on whether nephrectomy had been performed or not. RESULTS: Eighty-seven patients underwent a kidney transplant owing to ADPKD; 62% (n = 54) were male, with an average age of 55.22 years. Twenty-seven patients (30%) underwent nephrectomy native kidneys before transplantation. There were no serious postoperative complications. Patients who underwent nephrectomy (group 1) showed values of creatinine of 1.57 and 1.50 mg/dL at 3 and 6 months, respectively. In the no nephrectomy group, these values were 2.03 and 1.83 mg/dL, respectively. Graft survival after the first year was of 98% for group 1 and 95% for group 2. The 5-year implant survival was 95% and 80%, respectively. CONCLUSIONS: Native kidney nephrectomy before transplantation in ADPKD is safe in an experienced center, both in terms of surgery-related morbidity and mortality and graft survival and function.

[Determination of free prostatic specific antigen cut point for the selection of patients in first prostate biopsy]. / Determinación del punto de corte del porcentaje de PSA libre para la selección de pacientes sometidos a primera biopsia de próstata.

OBJECTIVES: Determine the cut point of free PSA rate for optimize the first prostate biopsy indication. MATERIAL AND METHODS: Prospective trial between june 2002-september 2004, We included patients in first prostate biopsy with normal rectal digital examen, total PSA between 3-10 ng/ml and normal transrectal prostate ultrasound. We realize descriptive stadistic analisis of variables age, total PSA, prostate volume and % free PSA and analitic stadistic analisis with ROC curves of variables total PSA and % free PSA for determine as of her predicts the best one rate of prostate cancer. RESULTS: We reclute 727 men with a mean age 62.91 years, total PSA mean 6.12 ng/ml, prostate volume mean 42.78 cc and % free PSA mean 15.22%. We had 106 prostate cancer, the prostate cancer rate in first biopsy was 14.6%; 77 cases had 1 lobe prostate cancer and 29 in 2 lobes. The most frecuent gleason was 6 (46 cases 43.4%) and the second gleason 7 (43 cases 40.6%). In the ROC curves analysis, total PSA had area under the curve 0.476 (p=0.3) and 0.611 (p=0.023) for % free PSA. The optime cut point for % free PSA in our trial was 19% (Sensibility 91.4% and Specificity 20%). The use of this cut point had allowed the saving us 138 biopsies (19.11%) with the lost one of diagnose of 10 cases of cancer of prostate. CONCLUSIONS: The use of the % free PSA is useful and allows in our region the best indication of the patients who are going to first biopsy of prostate, avoiding the accomplishment of unnecessary biopsies.

Determinación del punto de corte del porcentaje de PSA libre para la selección de pacientes sometidos a primera biopsia de próstata / Determination of free prostatic specific antigen cut point for the selection of patients in first prostate biopsy

Objetivo: Determinar el punto de corte de %PSA libre que nos permita optimizar la indicación de primera biopsia de próstata. Material y métodos: Estudio prospectivo entre junio 2002 y septiembre 2004 en el que incluimos pacientes sometidos a primera biopsia de próstata con tacto rectal normal, niveles de PSA total entre 3-10 ng/ml y ecografía transrectal de próstata normal. Realizamos estudio estadístico descriptivo de las variables edad, PSA, volumen prostático y porcentaje de PSA libre. Realizamos análisis estadístico analítico mediante curvas ROC de las variables PSA y % PSAL determinando cual de ellas predice mejor la existencia de cáncer de próstata en la primera biopsia transrectal de próstata. Resultados: Se reclutan un total de 727 hombres con una edad media de 62,91 años, el PSA medio de 6,12 ng/ml, el volumen prostático medio 42,78 cc, el % PSA libre medio de 15,22%. Se diagnosticaron un total de 106 tumores de próstata, obteniendo una tasa de biopsia prostática del 14,6%; 77 con afectación de 1 lóbulo y 29 con afectación de los 2 lóbulos. El gleason más frecuente fue el 6 (46 casos 43,4%) seguido del gleason 7 (43 casos 40,6%). En el análisis mediante curvas ROC el área bajo la curva para el PSA total fue de 0,476 (p=0,3) y para el % PSA libre de 0,611 (p=0,023). El punto de corte óptimo para el % PSA libre en nuestra serie se situó en el 19% con una sensibilidad del 91,5% y una especificidad del 20%. El uso de este parámetro nos hubiese permitido la realización de 138 biopsias menos (19,11%) con la pérdida de diagnóstico de 10 casos de cáncer de próstata. Conclusiones: El uso del %PSA libre es útil y permite en nuestro medio la mejor indicación de los pacientes que van a ser sometidos a primera biopsia de próstata, evitando la realización de biopsias innecesarias

Objetives: Determine the cut point of free PSA rate for optimize the first prostate biopsy indication. Material and methods: Prospective trial between june 2002-september 2004, We included patients in first prostate biopsy with normal rectal digital examen, total PSA between 3-10 ng/ml and normal transrectal prostate ultrasound. We realize descriptive stadistic analisis of variables age, total PSA, prostate volume and % free PSA and analitic stadistic analisis with ROC curves of variables total PSA and % free PSA for determine as of her predicts the best one rate of prostate cancer. Results: We reclute 727 men with a mean age 62.91 years, total PSA mean 6.12 ng/ml, prostate volume mean 42.78 cc and % free PSA mean 15.22%. We had 106 prostate cancer, the prostate cancer rate in first biopsy was 14.6%; 77 cases had 1 lobe prostate cancer and 29 in 2 lobes. The most frecuent gleason was 6 (46 cases 43.4%) and the second gleason 7 (43 cases 40.6%). In the ROC curves analysis, total PSA had area under the curve 0.476 (p=0.3) and 0.611 (p=0.023) for % free PSA. The optime cut point for % free PSA in our trial was 19% (Sensibility 91.4% and Specificity 20%).The use of this cut point had allowed the saving us 138 biopsies (19.11%) with the lost one of diagnose of 10 cases of cancer of prostate. Conclusions: The use of the % free PSA is useful and allows in our region the best indication of the patients who are going to first biopsy of prostate, avoiding the accomplishment of unnecessary biopsies

[Review of cut-off points between stages T1 and T2 in the 1997 TNM classification of renal carcinoma]. / Revisión del punto de corte entre los estadios T1 y T2 en la clasificación TNM del carcinoma renal de 1997.

OBJECTIVE: We retrospectively review the patients treated at our institution for renal cell carcinoma (RCC). We compare the patients classified in TNM state T1N0M0 in the 1997 revision with the 1992 one in order to determine survival differences. We divide patients in three size related groups and compare its survival rates. MATERIAL AND METHODS: We review 168 surgically treated patients. 72 of them were classified into T1N0M0 stage. We compare cancer-free survival in patients included in 1997 and 1992 T1 stage. We divide patients in three groups: 1-3 cm, 3-5 cm, 5-7 cm and compare respective cancer-free survival. RESULTS: There is a survival difference between T1(1997)-T2(1992) (p = 0.478). There is an inferior survival in size group 5-7 cm compared with 1-3 cm and 3-5 cm ones (p = 0.02/0.0465). CONCLUSIONS: In our patients, 1997 revision of T1 size supposes a descent of cancer-free survival compared with 1992 one. We consider a better stage limit under 5 cm, instead of actual 7 cm.

Revisión del punto de corte entre los estadios T1 y T2 en la clasificación TNM del carcinoma renal de 1997 / Cut-off point revision between 1997 TNM classification stages T1 and T2 o renal carcinoma

OBJETIVO: Realizamos un estudio retrospectivo de los pacientes tratados en nuestra institución por carcinoma de células renales (CCR). Comparamos los pacientes clasificados en el estadio T1N0M0 según la revisión TNM de 1997 con la clasificación según la revisión de 1992 para establecer diferencias de supervivencia. Comparamos diferentes cortes por tamaño tumoral y valoramos su implicación en la supervivencia. MATERIAL Y MÉTODOS: Análisis retrospectivo de una serie de 168 pacientes intervenidos por CCR, de ellos 72 clasificados en estadio T1N0M0. Comparamos supervivencia según las dos últimas revisiones TNM y en tres grupos de tamaño: 1-3 cm, 3-5 cm y 5-7 cm. RESULTADOS: Hallamos menor supervivencia en los pacientes T11997 (p=0,0478) y en grupo de tamaño 5-7 cm, con respecto al 1-3 cm (p=0,02) y al de 3-5 cm (p=0,0465).CONCLUSIONES: En nuestra serie, la revisión de 1997 en el estadio T1 supone un descenso de supervivencia. El límite en 7 cm es excesivo, lo consideramos más apropiado por debajo de 5 cm (AU)

Combined treatment with vitamin E and colchicine in the early stages of Peyronie's disease.

OBJECTIVE: To assess the effectiveness of the combination of colchicine and vitamin E (which has anti-fibrotic, anti-mitotic and anti-inflammatory effects) in modifying the early stages of Peyronie's disease, by evaluating pain relief, correction of deformities and plaque size. PATIENTS AND METHODS: In all, 45 patients were divided into two groups and treated from January 1998 to November 2001. Their mean (range) age was 53.4 (40-62) years, the time from onset of the disease < 6 months and they had penile deformity of < 30 degrees; no patient had erectile dysfunction. Twenty-two patients were given ibuprofen 400 mg/day for 6 months, whilst 23 received a combination of vitamin E 600 mg/day plus colchicine 1 mg every 12 h. Pain, plaque size and penile deformity were assessed at 6 months. RESULTS: There were no statistically significant differences between the groups at baseline in age, time from onset of the disease until the initial evaluation or plaque size. Although the proportion of patients reporting pain relief was higher amongst those receiving colchicine plus vitamin E (91% vs 68%) this was not significantly different, but differences in plaque size and penile curvature were significant. CONCLUSIONS: The use of colchicine plus vitamin E during the early stages of Peyronie's disease (time from onset < 6 months) in patients with penile curvature of < 30 degrees and no erectile dysfunction is an effective and well-tolerated way to stabilize the disease. A more extensive study is needed, comparing these results with other oral therapies.

[Encrusted pyelitis. Lithiasic disease with infectious etiology]. / Pielitis incrustada. Una enfermedad litiásica de etiología infecciosa.

We report on two new cases of encrusted pielitis, a lithiasic disease of infectious ethiology--Corynebacterium of D group-. The clinic diagnostic is difficult and this disease develops in immunosuppressed patients, mainly in renal transplanted ones. One of our two cases is diagnosed in a patient with a transplanted kidney and the other one develops the disease within her native kidneys. We remark on the clinic features and therapeutic options.

Pielitis incrustada. Una enfermedad litiasica de etiologia infecciosa / Encrusted pyelitis. A renal lithiasic disease of infectious ethiology

Presentamos dos nuevos casos de pielitis incrustada, una enfermedad litiásica de etiología infecciosa relacionada con el Corynebacterium del grupo D. El diagnóstico clínico es difícil y se desarrolla en enfermos inmunodeprimidos, sobre todo en aquellos sometidos a trasplante renal. Nuestros pacientes desarrollan la enfermedad en un caso en un enfermo trasplantado y en el otro en riñones no trasplantados. Detallamos las características clínicas y las opciones terapéuticas (AU)

Diferencias clínico-patológicas entre neoplasia vesical de bajo potencial maligno y carcinoma de bajo grado / Clinicopathological differences between papillary neoplasm of low malignant potential and low grade papillary carcinoma

OBJETIVO: Determinar si la subdivisión morfológica de los tumores vesicales de grado I entre neoplasia papilar de bajo potencial maligno (BPM) y cáncer vesical de bajo grado, tiene correlación con la evolución clínica y supervivencia del paciente. MATERIAL Y MÉTODOS: Se revisan 257 tumores vesicales superficiales consecutivos sometidos a resección transuretral entre 1990 y 1995 en el HU Reina Sofía de Córdoba, y se reevalúan según los criterios de la nueva clasificación de consenso de la OMS/ISUP de 1998. Se obtienen 12 pacientes con papiloma urotelial, 51 pacientes con neoplasia papilar BPM, 43 pacientes con cáncer vesical de bajo grado Ta, 65 pacientes con cáncer vesical de bajo grado T1 y 37 pacientes con cáncer vesical de alto grado. Once pacientes son reevaluados como T2 y 38 (14,8 por ciento) son perdidos de control. Se revisan los historiales clínicos de cada paciente con un seguimiento mínimo de 5 años, determinando las recidivas y progresiones dentro de cada grupo. Se comparan los resultados entre grupos con el test Chi-Cuadrado y se evalúan los factores de riesgo para la recidiva y progresión mediante análisis multivariado (Odds ratio). La función supervivencia se representa con las tablas de Kaplan y Meier, comparándolas con el test log rank. RESULTADOS: No encontramos diferencias entre ambos grupos con respecto a la edad ni distribución por el sexo. Las diferencias en el número de tumores no son significativas, mientras que el tamaño tumoral medio es significativamente mayor en el grupo "cáncer de bajo grado". En cuanto a los factores de riesgo para la recidiva y progresión de la enfermedad, sólo hallamos significativo el tamaño tumoral. Sorprendentemente, el uso de quimioterapia endovesical parece tener influencia en la aparición de recidiva. No encontramos diferencias en las tasas de recidiva y progresión entre ambos grupos, aunque los porcentajes son siempre mayores para el grupo "cáncer vesical de bajo grado". CONCLUSIÓN: La división de los tumores vesicales de bajo grado (G-I) entre "neoplasia de bajo potencial maligno" y "cáncer de bajo grado" sí presenta suficientes diferencias clínicas como para considerarlas entidades patológicas distintas. Sólo el tamaño tumoral aumentado es factor pronóstico dentro de cada grupo. Creemos que el uso de quimioterapia endovesical no está justificado en este tipo de tumores (AU)

Treatment with sildenafil citrate in renal transplant patients with erectile dysfunction.

OBJECTIVE: To assess the safety and efficacy of sildenafil citrate in renal transplant patients with erectile dysfunction, as up to half of men with renal failure may be affected and only 60-75% recover potency after transplantation. PATIENTS AND METHODS: Fifty patients with erectile dysfunction and a functioning renal transplant were treated using sildenafil (mean age 54 years, mean time on dialysis 35 months, mean time from transplantation 20 months). The hypogastric artery was not used during transplantation in any patient. Sildenafil citrate was prescribed at doses of 25 or 50 mg depending on baseline creatinine values and on the response, and plasma levels of cyclosporin/FK506 were monitored. RESULTS: Thirty patients (60%) had a satisfactory response, with a mean time on dialysis of 23 months. Six patients (12%) did not take the sildenafil and in 14 (28%) the drug was ineffective. The mean time on dialysis in this group was 43 months. Six patients (12%) had side-effects that in no case led to withdrawal of treatment. Plasma levels of cyclosporin/FK506 remained within the safety and efficacy limits in all patients. CONCLUSIONS: Treatment with sildenafil citrate in renal transplant patients with erectile dysfunction is an effective and safe option, with few side-effects. Plasma levels of immunosuppressants are unchanged. The response was more effective in patients with a shorter time on dialysis, as penile vascular disease is less advanced.

[Renal abscess in patients with HIV infection in the era of highly active antiretroviral therapy]. / Absceso renal en el paciente con infección por VIH en la era de la terapia antiretroviral de alta eficacia.

Renal abscess is a very rare complication of HIV infection, usually occurs in patients with severe immune deficiency. The immune status is the main factor that predict disease advancement. Highly activate antiretroviral therapy (HAART) improve the CD4 cell count. We present a case of renal abscess for Aspergillus niger in a HIV+ patient who complained of right flank mass and fever. We review relevant literature and the management of these patients.

Absceso renal en el paciente con infección por VIH en la era de la terapia antiretroviral de alta eficacia / Renal abscess in the patient with HIV infection in the era of highly antiretroviral therapy

El absceso renal es una rara complicación en la infección por VIH y normalmente ocurre en pacientes con severa inmunodeficiencia. El estado inmunitario del paciente es el factor determinante de la progresión de la enfermedad. La terapia antiretroviral de alta eficacia (HAART) mejora el recuento de subpoblaciones linfocitarias CD4. Presentamos un caso de absceso renal por Aspergillus niger en un paciente VIH+, que debutó con una masa en flanco derecho y fiebre. Realizamos una revisión de la literatura y analizamos el manejo en este tipo de pacientes (AU)

[Pneumocysts, unusual infective complication in diabetics]. / Pneumocistos, una rara complicación infecciosa en diabéticos.

We report on a case of fully gas-filled bladder with no evidence of intramural gas, fistula between bladder and gastrointestinal tract or instrumentation. The patient is diagnosed of a diabetic neurogenic bladder. We comment the causes of this rare finding and its relation with emphysematous cystitis.

Pneumocistos, una rara complicación infecciosa en diabéticos / Pneumositos, a rare infectious complication in diabetics

Publicamos un caso en el cual la luz vesical aparece completamente ocupada por gas en ausencia de gas intramural, fístula con tracto gastrointestinal o instrumentación previa, en una paciente afectada por vejiga neurógena diabética. Comentamos las causas de esta rara complicación infecciosa y su relación con la cistitis enfisematosa, más frecuente (AU)

[Clinico-pathologic differences between bladder neoplasm with low malignant potential and low-grade carcinoma]. / Diferencias clínico-patológicas entre neoplasia vesical de bajo potencial maligno y carcinoma de bajo grado.

OBJECTIVE: To determine if the morphologic subgrouping of grade I bladder tumors between papillary neoplasm of low malignant potential and low grade papillary carcinoma is of clinical and survival value. MATERIAL AND METHODS: All 257 consecutive patients diagnosed of superficial bladder cancer between 1990 and 1995 in HU Reina Sofia of Cordoba were reviewed and further reclassified according to WHO/ISUP consensus classification of urothelial neoplasms of the bladder. Of the tumors 12 were urothelial papilloma, 51 were papillary neoplasm of low malignant potential, 43 were low grade papillary carcinoma Ta, 65 were low grade papillary carcinoma T1 and 37 were high grade papillary carcinoma. Eleven patients were reevaluated as T2 tumors and 38 (14.8%) were lost of control. All patients were reviewed with a follow-up at least of 5 years. We compare the results between groups with Fisher test and the risk factors for recurrence and progression are analyzed by multivariate analysis (Odds ratio). The survival function was calculated using Kaplan-Meier estimates and compared with the log-rank test. RESULTS: There are no differences between groups respect the age or sex distribution. The differences in the multiplicity are not significant and only the mean size is higher in papillary low grade carcinoma. About the risk factors for recurrence and progression of the disease, only is significative the tumor size. Rarely, the use of chemotherapy seems to play a role in the recurrence. There are no differences in recurrence and progression between the groups, although the percentages are always higher in the papillary low grade carcinoma group. CONCLUSIONS: There are enough clinical differences between the two groups and we consider them as distinct pathologic entities. Only the higher tumoral size is prognostic factor in each group. We think that the use of chemotherapy must be avoided in this low grade bladder tumors.

[Incidence of high grade prostatic intraepithelial neoplasia in urologic practice]. / Incidencia de la neoplasia intraepitelial prostática de alto grado en la práctica urológica.

High grade (PIN AG) intraepithelial neoplasia of the prostate is a likely precursor of prostate adenocarcinoma (PA) because of their association. Since the risk to suffer PA increases in patients with no previous PIN AG, its finding requires an arduous search for PA. This paper reviews the incidence of PIN AG in 499 histological studies in prostate transrectal biopsies, prostate TUR and adenomectomy specimens and radical prostatectomy (RP) sections. Evaluation of data obtained, type of presentation and association to prostate carcinoma, indicating the approach taken in the various cases.

[Wolfram syndrome. Urologic implications]. / Síndrome de Wolfram. Implicaciones urológicas.

OBJECTIVES: We report on four new cases of Wolfram's Syndrome. We emphasize in urological aspects of this disease. PATIENTS AND METHODS: Three male siblings. The other patient is also a male, without familiar relation with the other ones. All four patients presents different levels of urological alterations, mainly urinary collecting system dilation and decrease in detrusor muscle contractility. CONCLUSIONS: Urological findings are cardinal aspects in Wolfram syndrome. Due to its high frequency and prognostic value in natural history of disease. Urological disease seems to be within a systemic neurological tissues affectation of etiology that remains unknown.

[Malignant fibrohistiocytoma of the bladder]. / Fibrohistiocitoma maligno de vejiga.

We report on new case of a rare vesical tumour. We result the importance of immunohistochemistry and ultrastructural study to support the diagnosis of malignant fibrous histiocytoma of the urinary bladder. There has been described another 16 cases of this tumour in the literature, however, only four of them -five with ours- reports an extensive immunohistochemical and ultrastructural study. The rarity of vesical localization of this tumour may delay its diagnosis. It must be supported by a immunohistochemistry and/or ultrastructural study, in order to differentiate from other tumours with fibrohistiocytoma-like pattern: leiomyosarcoma and sarcomatoid carcinoma of the bladder. After radical removal of tumour, adjuvant therapy is recommended both systemic chemotherapy and local radiotherapy, although survival rates are over 5.3 months after first therapeutical actuation.