El debate del Bosniak 3 o 4 y la vigente nosología quística / The current nosology on renal cysts: Bosniak III or IV?

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Polycystosis of the renal sinus or polycystic kidney disease Controversies, challenges and history of a shared discovery. / Poliquistosis del seno renal o hilioquistosis. Controversias, retos e historia de un descubrimiento compartido.

OBJECTIVE: To recall the history of the discovery of non-nephron cystic disease, detected simultaneously in 2 hospitals in Madrid, and the vicissitudes that the authors endured during the process of recognising this disease, while being ignored by the international scientific literature. MATERIAL AND METHOD: We analysed the authors' first publications and presentations, their correspondence relaying the difficulties in reporting the confusion with adult polycystic kidney disease (APKD) and the subsequent nosological identification of the process. We consulted with individuals who worked with the 2 authors to increase the accuracy and objectivity of the history report. RESULTS: We confirmed the authors' remarkable efforts in getting the process definitively recognised despite the notable difficulties. CONCLUSIONS: Rigorous clinical observation recognises processes ignored by the medical literature, and the correct application of the scientific method helps identify and reveal new nosological entities, confirming with this story's example that, in medicine, there are no exhausted issues.

Poliquistosis del seno renal o hilioquistosis. Controversias, retos e historia de un descubrimiento compartido / Polycystosis of the renal sinus or polycystic kidney disease Controversies, challenges and history of a shared discovery

Objetivo: Recordar la historia del descubrimiento de la enfermedad quística no nefronal, detectada simultáneamente en 2 hospitales madrileños y las vicisitudes que sufrieron los autores para que el proceso, ignorado en la literatura mundial, fuese reconocido. Material y método: Se han analizado las primeras publicaciones y presentaciones de los autores, la correspondencia entre ellos con el relato de las dificultades habidas para denunciar la confusión con la enfermedad renal poliquística del adulto y la posterior identificación nosológica del proceso. Se han consultado colaboradores de ambos autores para mayor precisión y objetividad del relato histórico. Resultados: Se confirma el notable esfuerzo de los autores hasta conseguir el definitivo reconocimiento del proceso a pesar de señaladas dificultades. Conclusiones: La observación clínica rigurosa reconoce procesos ignorados por la literatura médica y la correcta aplicación del método científico permite identificar o desvelar nuevas entidades nosológicas, confirmando con la ejemplaridad de este relato que en Medicina no hay temas agotados

Objective: To recall the history of the discovery of non-nephron cystic disease, detected simultaneously in 2 hospitals in Madrid, and the vicissitudes that the authors endured during the process of recognising this disease, while being ignored by the international scientific literature. Material and method: We analysed the authors’ first publications and presentations, their correspondence relaying the difficulties in reporting the confusion with adult polycystic kidney disease (APKD) and the subsequent nosological identification of the process. We consulted with individuals who worked with the 2 authors to increase the accuracy and objectivity of the history report. Results. We confirmed the authors' remarkable efforts in getting the process definitively recognised despite the notable difficulties. Conclusions: Rigorous clinical observation recognises processes ignored by the medical literature, and the correct application of the scientific method helps identify and reveal new nosological entities, confirming with this story's example that, in medicine, there are no exhausted issues

Corynebacterium urealyticum: trascendencia histórica de su descubrimiento / Corynebacterium urealyticum: the historical importance of its discovery

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Hemodinámica en vena cava y hemorragia durante trombectomía en la cirugía del tumor renal / Vena cava haemodynamics and haemorrhage during thrombectomy in renal tumour surgery

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Urología en la universidad europea: Adaptaciones a Bolonia. El modelo de la Universidad Autónoma de Madrid / Urology at the European university: Adaptations to the Bologna Plan. The model of the Autonomous University of Madrid

El Plan de Convergencia de Bolonia tiene como objetivo fundamental normalizar, armonizar y estandarizar la enseñanza de Medicina en las facultades médicas europeas, imponiendo un curriculum similar. Esto ha supuesto la presencia de la Urología como disciplina universitaria en todas las escuelas médicas europeas. Simultáneamente ha modificado las técnicas pedagógicas y las distribuciones temáticas, insistiendo en la enseñanza práctica y en la activa participación del estudiante en la adquisición de conocimientos y habilidades. Todo ello realza la presencia curricular de la Urología y obliga a una mayor dedicación del profesorado que ahora, en un tiempo limitado presencial y de aulas, tiene que informar y formar al estudiante de Medicina sobre el amplísimo compromiso asistencial de la Urología como especialidad médico-quirúrgica. La adaptación a Bolonia de las numerosas escuelas médicas europeas plantea ciertas dificultades que pueden ser fácilmente superadas, como puede verse en el plan diseñado en la Facultad de Medicina en la Universidad Autónoma de Madrid

The fundamental objective of the Convergence Plan of Bologna is to normalize, harmonize and standardize the teaching of medicine in European medical schools by implementing a similar curriculum. This objective assumes the presence of Urology as a university discipline in all European medical schools. At the same time, the teaching techniques and subject distributions have been modified, emphasizing practical teaching and active participation of the student in the acquisition of expertise and skills. This approach enhances the curricular presence of Urology and requires increased dedication from the teaching staff. These staff members, with limited face-to-face and classroom time, must inform and educate medical students on the broad healthcare commitment of urology as a surgical/medical specialty. The adaptation of the numerous European medical schools to the Bologna Plan raises a number of problems that can be easily overcome, as can be seen in the plan designed by the Faculty of Medicine at the Universidad Autonoma de Madrid

Urology at the European university: adaptations to the Bologna Plan. The model of the Autonomous University of Madrid.

The fundamental objective of the Convergence Plan of Bologna is to normalize, harmonize and standardize the teaching of medicine in European medical schools by implementing a similar curriculum. This objective assumes the presence of Urology as a university discipline in all European medical schools. At the same time, the teaching techniques and subject distributions have been modified, emphasizing practical teaching and active participation of the student in the acquisition of expertise and skills. This approach enhances the curricular presence of Urology and requires increased dedication from the teaching staff. These staff members, with limited face-to-face and classroom time, must inform and educate medical students on the broad healthcare commitment of urology as a surgical/medical specialty. The adaptation of the numerous European medical schools to the Bologna Plan raises a number of problems that can be easily overcome, as can be seen in the plan designed by the Faculty of Medicine at the Universidad Autonoma de Madrid.

Organización Nacional de Trasplantes (ONT). Reflexiones en su 25 aniversario / National Transplant Organization (ONT). Reflections from the 25th anniversary

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Injerto renal y los inconvenientes técnicos debidos a la cortedad de la vena renal derecha / Renal Grafting and the Short Right Renal Vein Technical Inconveniences

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Relación entre volumen de la glándula prostática y algunos marcadores histológicos de malignidad / Relation Between Prostate Gland Volume and Some Histological Markers of Malignancy

Objetivos: La relación entre el volumen total de la glándula prostática, o el peso de la misma tras prostatectomía radical, y los marcadores histológicos de malignidad en casos de cáncer de próstata, es motivo de controversia. Hemos analizado 100 muestras consecutivas de prostatectomía radical para determinar la relación entre el volumen o el peso de la glándula prostática y la agresividad biológica del proceso tumoral expresado por diferentes marcadores histológicos. Material y métodos: Se han revisado las piezas de prostatectomía radical de 100 pacientes consecutivos, que no recibieron tratamiento hormonal preoperatorio. Estas muestras quirúrgicas fueron procesadas siguiendo un protocolo común. En la ulterior valoración se investigó con mayor precisión: el grado de Gleason, volumen tumoral, multifocalidad, invasión vascular o neural, estadio pT y presencia de focos de PIN. Los hallazgos fueron comparados con el peso de la glándula utilizando el paquete estadístico de WINDOWS SPSS 13.0 con valor estadístico significativo de p<0,05. Según el peso de la glándula se formaron tres grupos:<40g (33%), entre 40-90g (61%) y >90g (6%). Resultados: Se encontró una asociación estadísticamente significativa (p=0,001) entre el peso de la glándula y el volumen del tumor, ya que 15 de 33 glándulas de peso inferior a 40g mostraron más del 50% de la glándula afectada por tumor, comparado con ninguno de los 6 pacientes con peso total mayor de 90g. También se encontró relación significativa entre la multifocalidad y el peso (p=0,03), de forma que 24 de 33 glándulas menores de 40g tenían multifocalidad bilateral en comparación con solo una de 6 glándulas mayores de 90g. La invasión neural, el número de focos de PIN y un grado combinado de Gleason más alto fueron más frecuentes en las próstatas pequeñas, pero la diferencia no alcanzó significación estadística. Conclusiones: Nuestro estudio indica que las glándulas prostáticas de gran volumen albergan tumores de menor malignidad (volumen tumoral, bilateralidad). El hallazgo justifica la conveniencia de contar con el volumen total de la glándula prostática para decisiones diagnósticas (indicación de biopsia prostática y repetición de las mismas) y determinación pronóstica (AU)

Objectives: The relationship between the total volume of the prostate gland or its weight after radical prostatectomy and the histological markers of malignancy in cases of prostate cancer is a controversial subject. We have analyzed 100 consecutive radical prostatectomy specimens in order to determine the relationship between volume or weight of the prostate gland and the biological aggressiveness of the tumor process by different histological markers. Material and methods: One hundred consecutive radical prostatectomy specimens in patients who had not received pre-operative hormone treatment were retrospectively reviewed. These surgical samples were processed according to a standardized protocol. In a subsequent evaluation, the following were studied with greater detail: Gleason grade, tumor volume, multimodality, neural or vascular invasion, put stage, and presence of PIN foci. The histological findings were compared with the prostate gland weight using Windows SPAS, 13.0 statistical package with a significance value of p<0.05. According to the prostate gland weight, three groups were established: <40g (33%), 40 - 90g (61%), and >90g (6%). Results: A statistically significant association (p=0.001) was found between the prostate gland weight and tumor volume since 15 of the 33 glands with weight under 40g accounted for more than 50% of the glands affected by tumor compared to none of the 6 patients with total weight over 90g. A significant relationship was also found between the multimodality and weight. (P=0.03), so that 24 of the 33 glands under 40g had bilateral multimodality compared to only 1 out of the 6 glands over 90g. The neural invasion, number of PIN foci and the highest combined Gleason grade were frequent in low volume prostates, but the difference did not reach statistical significance. Conclusions: Our study indicates that large volume prostate glands have tumors with lower malignancy (tumor volume, bilateralism). This finding justifies the adequacy of using total volume of the prostate gland for diagnostic decision (indication of prostatic biopsy and their repetition) and the prognostic determination (AU)

Comentario a: «Relación entre volumen de la glándula prostática y algunos marcadores histológicos de malignidad» / Comment to: «Relation Between Prostate Gland Volume and Some Histological Markers of Malignancy»

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[Relation between prostate gland volume and some histological markers of malignancy]. / Relación entre volumen de la glándula prostática y algunos marcadores histológicos de malignidad.

OBJECTIVES: The relationship between the total volume of the prostate gland or its weight after radical prostatectomy and the histological markers of malignancy in cases of prostate cancer is a controversial subject. We have analyzed 100 consecutive radical prostatectomy specimens in order to determine the relationship between volume or weight of the prostate gland and the biological aggressiveness of the tumor process by different histological markers. MATERIAL AND METHODS: One hundred consecutive radical prostatectomy specimens in patients who had not received pre-operative hormone treatment were retrospectively reviewed. These surgical samples were processed according to a standardized protocol. In a subsequent evaluation, the following were studied with greater detail: Gleason grade, tumor volume, multimodality, neural or vascular invasion, put stage, and presence of PIN foci. The histological findings were compared with the prostate gland weight using Windows SPAS, 13.0 statistical package with a significance value of p<0.05. According to the prostate gland weight, three groups were established: <40 g (33%), 40 - 90 g (61%), and >90 g (6%). RESULTS: A statistically significant association (p=0.001) was found between the prostate gland weight and tumor volume since 15 of the 33 glands with weight under 40 g accounted for more than 50% of the glands affected by tumor compared to none of the 6 patients with total weight over 90 g. A significant relationship was also found between the multimodality and weight. (P=0.03), so that 24 of the 33 glands under 40 g had bilateral multimodality compared to only 1 out of the 6 glands over 90 g. The neural invasion, number of PIN foci and the highest combined Gleason grade were frequent in low volume prostates, but the difference did not reach statistical significance. CONCLUSIONS: Our study indicates that large volume prostate glands have tumors with lower malignancy (tumor volume, bilateralism). This finding justifies the adequacy of using total volume of the prostate gland for diagnostic decision (indication of prostatic biopsy and their repetition) and the prognostic determination.