Melamine urinary bladder stone.

We report a unique case of a melamine bladder urinary stone. A physiopathologic mechanism of formation is proposed and discussed.

Pancreatitis fibrosante idiopática en pediatría / Idiopathic fibrosing pancreatitis in pediatrics

No disponible

[Epidermoid carcinoma of the penis. Review of 30 cases]. / Carcinoma epidermoide de pene. Revisión de 30 casos.

OBJECTIVE: To review our series of epidermoid carcinoma of the penis. METHODS: 30 cases of epidermoid carcinoma of the penis are reviewed. The clinical features, tumor stage, grade, treatment and outcome are analyzed. RESULTS: The time to diagnosis ranged from one month to 10 years, mean 10.3 months (1 to 36); therefore the mean diameter of the tumors was significantly greater (1.9 cm) at the time of diagnosis than at the beginning of the lesion. Eighteen patients had tumor superinfection. Twenty-four patients (80%) had low grade carcinoma; 6 had verrucous carcinoma, 6 (16.7%) intermediate and one (3.3%) high grade. Total penectomy with perineal meatus was performed in 5 cases, 23 had a partial penectomy with 2 cm margin and circumcision was done in two cases. Patients with positive lymph nodes at exploration after antibiotic treatment (13 cases) were submitted to lymphadenectomy, which was associated with chemotherapy in 4 patients. The surgical complications were mainly lymphorrhea and edema and infection of the surgical incision after lymphadenectomy. Complications at the site of penile resection were unusual. Only 6 patients have more than 5 years' follow-up (7-14), with only 1 local recurrence. The remaining patients have a mean follow-up of 22 +/- 16 months (6-60). Of these, only one patient had died from penile cancer (previously pT2pN0M0). This patient had lymph node and distant metastases 6 months following penectomy due to invasive local recurrence (pT3pN2pM1). Lymph node recurrence has been detected in three other patients. CONCLUSION: Inguinal lymphadenectomy is clearly of therapeutic value in cancer of the penis and performing it early in infiltrating tumors is likely to improve the outcome in these patients.

[Renal adenocarcinoma in young patients]. / Adenocarcinoma renal en pacientes jóvenes.

OBJECTIVE: To discover potential differences in known prognostic factors of renal adenocarcinoma in patients under 40 years of age. PATIENTS AND METHODS: A series of 246 patients with renal adenocarcinoma included 17 patients 40 years. Both groups were analyzed for sex, tumour size, histological characteristics and stage, examining the relative proportions within each group and looking for an association between those sets of data and age. RESULTS: No statistically significant associations were found, although it should be noted that in some cases data is incomplete. A larger proportion of low stages at least locally and a greater proportion of granule cell tumours was found in patients 40 years-old compared to those over 40. CONCLUSIONS: Existence of differences in the biological and histological characteristics of renal adenocarcinomas that develop at a younger age is not unlikely. The analysis of each factor and the survival rates in larger series should elucidate these questions, which will also be of interest to improve our understanding of the histogenesis of this type of tumours.

[Retrospective study of the treatment of 329 patients with prostatism syndrome and review of the literature]. / Análisis retrospectivo del tratamiento de 329 pacientes con síndrome de prostatismo y revisión de la bibliografía.

OBJECTIVES: New drugs for the treatment of prostatism have been developed in recent years; only surgery, however, has been demonstrated to achieve cure. Each modality of drug therapy may afford symptomatic relief in those patients in whom surgery is not indicated and a symptom-based stepwise indication could be established. METHODS: 329 patients with prostatism were treated by surgery, administration of finasteride, alphablockers or plant extracts, according to the recommendations of the WHO. Patient evaluation included abdominal US. PSA determination and uroflowmetry. Patients with urodynamic or other derangements were excluded from the study. RESULTS: Patients with a worse quality of life and important obstructive symptoms underwent surgery. Patients with important obstructive symptoms and no complications requiring surgery (infection, urinary retention, etc.) received finasteride, which proved to be effective in these patients, although 16.6% required another type of treatment and two presented impotence. Patients treated with plant extracts had moderate prostatism; 17% of these patients required another type of treatment. Patients treated with alphablockers presented symptoms that were similar to those treated with plant extracts, but they had a more important irritative component; 24% of these patients withdrew from the study due to the side effects or inefficacy of their treatment regimen. CONCLUSIONS: Further studies and a longer follow-up are warranted to determine whether these new drugs can replace or effectively delay (avoiding the appearance of complications) surgery. We believe that the indications for each treatment should be established according to the different stages of prostatism. Moreover, further insight into the pathogenesis of BPH, appropriate diagnostic methods and patient selection are essential to the development of new therapeutical modalities and to achieving enhanced results.

[Review of 408 cases of prostatism syndrome. Have the new classifications improved its practical management?]. / Revisión de 408 casos de síndrome de prostatismo. Han mejorado las nuevas clasificaciones su manejo práctico?

To the variety of symptoms known as prostatism, ultrasound, flowmetry, PSA and other complementary testing has been added over the last few years in an attempt to define it better. Also, several score tables such IPSS have been used to grade more objectively each symptom. It remains to be seen, however, whether all this is really useful to define a specific treatment in the clinical practice. To this end, we intend to analyze our own series taking advantage of a table of symptoms routinely used for years, together with the patient's own perception of his quality of life, checking which factors have more influence on the latter. We believe that the use of different overall scores in the usual practice is not effective, although they could be added to the patient's evaluation since they seem a good tool to establish comparisons between different communities.

[Leydig cell tumor in the adult]. / Tumor de células de Leydig del adulto.

Presentation of 3 cases of Leydig's cells tumour in the adult seen in our hospital over the last 10 years. They account for 3% of all testicular tumours, 20 to 25% of them appearing during the pre-puberty period. Although an isolated testicular nodule is the most frequent symptom, gynaecomastia can be found in about 30% of adult patients, as it happened in 2 of our patients. Even though no malignant case has been described in children, up to 10% of cases in adults have metastasis, this being the only demonstration of malignant behaviour in these tumours, so radical orchiectomy is the choice therapy. Certain histological and hormonal parameters may be suggestive of the aggressive behaviour of this neoplasia which, however, we have not found in our series of all whom presented a good evolution after surgery. The most common diagnostic and therapeutic approaches, based on the different characteristic of the tumour, are reviewed.

[Testicular infarction as a cause of benign intrascrotal tumor]. / Infarto testicular como causa de tumoración benigna intraescrotal.

OBJECTIVES: We report on a patient with an increase in testicular size that had been initially diagnosed as neoplasm. METHODS: The ultrasound and histological findings, the atypical clinical features and possible causes are analyzed. RESULTS: Segmental infarction with diffuse testicular atrophy. CONCLUSION: Infarction of testis may atypically present as a testicular mass that may lead us to suspect a testicular neoplasm since the age of presentation of both types of lesions are similar.

[Long-term results of endoscopic urethrotomy]. / Resultados a largo plazo de la uretrotomía endoscópica.

OBJECTIVES: To analyze the long-term results of treatment of urethral strictures by internal endoscopic urethrotomy, a simple, easily reproducible procedure that carries a low morbidity and requires a short period of convalescence. MATERIAL AND METHODS: We report our experience of 78 cases submitted to urethrotomy as primary treatment. The results at 19.7 months mean follow-up (range 6 months--5 years) are presented. A maximum of three Sachse procedures were performed if stricture recurred. RESULTS: The complications were rare. Although the results were poor in only 21% of the patients 6 months postoperatively, 46% had recurrent strictures. Moreover, nearly 50% of these strictures recurred after a second or third urethrotomy. CONCLUSIONS: The nature of the stricture, determined by spongiofibrosis, is the main prognostic factor. Internal urethrotomy is indicated in urethral strictures without exorbitant spongiofibrosis, otherwise stricture will recur after internal urethrotomy and other treatment modalities will be required.

[Our experience with renal adenocarcinoma (III): results of surgical treatment, other treatments. Survival analysis]. / Nuestra experiencia en adenocarcinomas renales (III): Resultados del tratamiento quirúrgico, otros tratamientos. Análisis de la supervivencia.

OBJECTIVES: Evaluation of survival and results of treatment of renal cell carcinoma. METHODS: We reviewed the records of 229 consecutive cases of renal cell carcinoma diagnosed at our hospital. In 178 surgical treatment was done to achieve cure and in 6 patients it was palliative. RESULTS: No statistical differences in survival were found according to the surgical approach, or extensive vs hilar lymphadenectomy, or in the presence or absence of venous involvement. There were statistical differences in survival depending on the tumor stage and an inverse correlation between survival and tumor size. Sixty-nine cases received complementary treatments. Radiotherapy, alpha 2b interferon and vinblastine, resection of metastasis, or gestagen therapy failed to improve survival. No improvement in survival was achieved with palliative embolization, but it ameliorated local symptoms. The mean survival in patients with metastasis and without treatment was 5.5 months and there was no statistical difference in survival relative to the number of site of metastasis, or the number of affected viscera. The mean survival in patients that were not operated and had no metastasis was greater: 23.5 months. CONCLUSIONS: Surgery, regardless of the surgical approach or type of lymphadenectomy, is the only treatment that improves survival in renal cell carcinoma. Patients with metastasis receiving no treatment have a worse prognosis.

[Our experience with renal adenocarcinoma (II): clinical course, diagnosis, and prognostic factors before surgical treatment]. / Nuestra experiencia en adenocarcinomas renales (II): Clínica, diagnóstico y factores pronósticos antes del tratamiento quirúrgico.

OBJECTIVES: We evaluated the form of presentation, clinical features and analytical values and their relationship with survival in renal cell carcinoma patients and analyzed the efficiency of different diagnostic and staging procedures. METHODS: We reviewed the form of presentation, clinical features, staging procedures and analytical values of 229 consecutive renal cell carcinomas diagnosed at our hospital between 1975 and 1991. RESULTS: Malaise and weight loss or symptoms different from those of the classical triad (hematuria, pain and a flank mass) are factors of poor prognosis and lower survival. The time of presentation of symptoms does not influence prognosis. Computerized tomography was found to be the best imaging technique, with a low sensitivity and a high specificity in our experience. We have found a correlation between hypercalcemia and lower survival, but not for the more advanced tumoral stage. There was a correlation between the levels of hemoglobin and alkaline phosphatase and survival: patients with hemoglobin levels less than 14 g/dl or alkaline phosphatase levels greater than 85 U/l had a lower survival rate and a more advanced tumoral stage. CONCLUSIONS: Computerized tomography was found to be the best imaging technique. Symptoms different from those of the classical triad, malaise and weight loss, hypercalcemia, low levels of hemoglobin or high levels of alkaline phosphatase are factors of poor prognosis.

[Our experience with renal adenocarcinoma (I): epidemiologic data]. / Nuestra experiencia en adenocarcinomas renales (I): Datos epidemiológicos.

OBJECTIVES: The present study was conducted to review the epidemiological factors of patients with renal cell carcinoma. METHODS: We reviewed the familial, social, cultural, toxic, occupational and pathological factors of 229 patients who were diagnosed as having renal cell carcinoma between 1975 and 1992 at our hospital. RESULTS: As in other series, we found a greater predisposition in male patients around the seventh decade. However, unlike other studies, we observed a greater predisposition in the lower social and cultural levels and rural population. Of the epidemiological factors related to adenocarcinoma of the kidney, smoking was the most common in this series (41.8%), followed by high blood pressure (15.7%) and toxic-occupational factors (8.2%). We found no correlation between these factors and tumor stage or survival. CONCLUSIONS: Our data show a greater predisposition for renal cell carcinoma in male patients, around the seventh decade, in the lower social and cultural levels and rural population. Smoking, high blood pressure and occupational exposure to toxic agents were the most common epidemiological factors.

[Renal autotransplantation in a case of idiopathic retroperitoneal fibrosis refractory to other treatments]. / Autotrasplante renal en un caso de fibrosis retroperitoneal idiopática refractaria a otros tratamientos.

We report a case of renal autotransplantation in a patient with right retroperitoneal fibrosis that had been previously treated by ureterolysis with intraperitonization and corticoid therapy without success. The literature is briefly reviewed and the therapeutic possibilities in refractory retroperitoneal fibrosis are discussed, with special reference to renal autotransplantation.

[Renal leiomyoma. Report of a new case]. / Leiomioma renal. Aportación de un nuevo caso.

Though renal leiomyoma is an unusual tumour, symptomatic tumours are even more uncommon. They often raise problems with differential diagnosis from malignant tumours which not even the most advanced imaging techniques manage to elucidate. On the other hand, their sarcomatous degeneration has been described. Considering these premises, doubts arise on their therapeutical approach, on which we here present our own views.

[Iatrogenic lesions of the urinary tract. I: ureter]. / Lesiones yatrógenas del apartado urinario. I: Uréter.

Ureteral iatrogenic lesions occur with variable frequency in the different types of surgery, mainly in uncomplicated abdominal hysterectomy. This paper contributes 29 patients (2 male and 27 female) with several types of lesions, secondary to gynaecological, intestinal and vascular surgery. The series produced 16 cases of clamping, 6 ureterovaginal fistulae, 6 ureteral sections (5 total and 1 partial) and 1 ureterouterine fistula. The terminal ureter was the most frequently damaged. The diagnostic and therapeutical methods used in this type of lesions are analyzed.

[Rupture of the cavernous body: report of 2 new cases]. / Rotura de cuerpos cavernosos: aportación de dos nuevos casos.

Review of two new cases of fracture of the cavernous body, one treated with early surgery and the other one conservatively. In both cases, the patients preserved good erections after one year.

[Adrenal gland surgery. Review of 34 cases]. / Cirugía de las suprarrenales. Revisión de 34 casos.

Over the last few years, a better anatomical and functional knowledge of the adrenal glands has allowed us to diagnose and treat optimally most of these gland's conditions. A variety of medical (endocrinology, anaesthesiology) and surgical specialties have been used to this aim. This paper reviews the adrenal gland's diseases treated in our unit over the last 9 years. Pre-operative management, ways of approach, morbidity and mortality as well as results are analyzed and compared with those obtained by other authors.

[Vesico-uterine fistula: report of 2 new cases]. / Fístula vesico-uterina: a propósito de dos nuevos casos.

Presentation of two new cases of vesico-uterine fistulae secondary to cesarean operation. In one case our route for surgical approach is explained as a novelty; also, the time-frame within which it was performed, one month, since it is usual to recommend a minimum of three months. In the second case an in-dwelling vesical catheter was sufficient to achieve closure. The article also reviews the existing literature on the different aspects: signs, symptoms and therapy, of this infrequent pathology.