Prostate health index (PHI) as an accurate prostate cancer predictor.

PURPOSE: This study aims to compare the ability of the PHI versus tPSA test to predict the presence of PCa in our population. METHODS: A prospective observational study was performed. We included patients with tPSA ≥ 2.5 ng/ml, biopsy naïve or previous negative biopsy, undergoing a blood test, which includes tPSA, fPSA, and p2PSA, and a prostate biopsy between March 2019 and March 2022. Patients with PCa found in the biopsy-Group A-were compared with patients with a negative biopsy result-Group B. Diagnostic accuracy of tPSA and PHI was assessed by receiver operating characteristic [ROC] curves and logistic regression. RESULTS: 140 men were included. Fifty-seven (40.7%) had a positive prostate biopsy result (Group A), and 83 (59.3%) had a negative biopsy result (Group B). The mean age was similar in both groups (mean ± standard deviation), 66.86 ± 6.61 years. No difference was found in the tPSA value between the groups (Group A PSA: 6.11 ng/ml (3.56-17.01); Group B: 6.42 ng/ml (2.46-19.45), p = 0.41). The mean value of PHI was statistically different between groups (Group A 65.50 (29-146) vs. Group B 48 (16-233), p = 0.0001). The area under the curve 0.44 for tPSA and 0.77 for PHI. The multivariate logistic regression model applied to PHI showed a significant increase in its predictive accuracy: 72.14% in the model without PHI, 76.09% with PHI. CONCLUSION: The PHI test improves PCa detection compared to tPSA in our population.

Use of urinary concentrations in mg/dl in relation to absolute values in 24-hour samples for the evaluation of lithogenic factors in stone forming patients. / Uso de las concentraciones urinarias en mg/dl en relación a los valores absolutos en 24 h para la evaluación de factores litogénicos en pacientes litiásicos.

OBJECTIVE: The aim of this study is to analyze urine concentrations (mg/dl) of different lithogenic factors in a sample of 24 h as a predictor of these changes rather than absolute values depend on the volume of diuresis. METHODS: A total of 131 patients from the North Almeria Health Management Area (Spain) with urinary calstone disease in whom a metabolic study was indicated were included from June 2014 to May 2015. The concentrations of calcium, oxalate, uric acid, citrate and magnesium were measured in the urine, and the calcium/citrate ratio was calculated. The classifications used were: hypercalciuria (>260mg/24h), hyperuricosuria (>750mg/24h), hyperoxaluria (>40mg/24h), hypocitraturia (<320mg/24h) and hypomagnesuria (<35mg/24h). The statistical analysis was performed using SPSS 17.0. RESULTS: A cut-off point of 12.55mg/dl, with a sensitivity of 90% and a specificity of 85% and a relative risk (RR) of 51.2 (13.9-188.4), was estimated for urinary calcium. For oxalate the cut-off point was 1.86mg/dl, with a sensitivity of 91% and a specificity of 84% with an estimated RR of 67.2 (8.3-540.6). As regards the uric acid concentration in urine, a cut-off point of 31.2mg/dl was estimated, with a sensitivity of 85% and a specificity of 70% and a RR of 12 (3.8-37.6). For citrate the cut-off point was 18.8mg/dl, with a sensitivity and specificity of 82% and 74%, respectively, with a RR of 13.7 (4.4- 42.6). The cut-off point for magnesium was 2.26mg/dl with a sensitivity of 95% and specificity of 78%, with a RR of 67.6 (11.4-398.3). CONCLUSION: The determination of urine concentrations, instead of absolute values, depends to a large extent on urine output, appears to be useful when estimating classic metabolic alterations and should be taken into account in the evaluation of patients with urinary stone disease.

Treatment with hydrochlorothiazide and alendronate in patients with stones and bone mineral density loss. Evolution of bone metabolism and calciuria with medical treatment. / Tratamiento con hidroclorotiazida y alendronato en pacientes con litiasis y pérdida de densidad mineral ósea. Evolución de la calciuria y metabolismo óseo en el tratamiento médico.

OBJECTIVES: Treatment of calcium stones is based on diet and pharmacological measures such as the use of thiazides and other drugs. The aim of this study is to assess the effect of alendronate on hydrochlorothiazide on urinary calcium and bone mineral density in patients with calcium stones. METHODS: Prospective observational study involving 77 patients with relapsing calcium stones divided into 2 groups according to treatment received. Group 1: 36 patients treated with alendronate 70 mg/week; Group 2: 41 patients treated with hydrochlorothiazide 50 mg/day. All patients receive diet recommendations and fluid intake. Studied and analyzed among other variables were bone mineral density, bone turnover markers and calciuria before and after 2 years of treatment. Statistical study with SPSS 17.0, statistical significance p<0.05. RESULTS: No statistically significant differences in the distribution by sex or age of the patients between groups. In group 1 statistically a significant decrease was observed in the Β-crosslaps and improvement in bone mineral density, along with decreased urinary calcium after 2 years of treatment. In Group 2 statistically significant decrease in urinary calcium and fasting calcium/creatinine was seen, along with improvement in bone mineral density after 2 years of treatment. In group 1, there is a more obvious and significant improvement in bone mineral density compared to 2 and Β-crosslaps decrease. However, in group 2 the decrease in urinary calcium and calcium/creatinine was more significant than in group 1. CONCLUSION: Treatment with thiazide decrease calciuria and produces an improvement in bone mineral density, although not in the same range as treatment with alendronate.

A study of Internet searches for medical information in dermatology patients: The patient-physician relationship.

BACKGROUND: The use of the Internet to search for medical information is considered by some physicians as an invasion of their medical domain and a reflection of a lack of trust in their advice and recommendations. OBJECTIVE: The main objective of this study was to estimate the amount of medical information gathered from the Internet and to establish whether these online searches reflect a lower degree of patient satisfaction. PATIENTS AND METHODS: A survey was conducted among 175 patients seen at the melanoma and psoriasis units of San Cecilio University Hospital in Granada, Spain between May 2010 and December 2011. RESULTS: Online searches for medical information were performed by 44.4% of patients who returned correctly completed questionnaires. The main reasons given for these searches were to complement appropriate information provided by the physician (67.3%) and to gather information before consultation with the physician (36.5%). Variables associated with the search for medical information on the Internet in the multivariate analysis were a higher educational level, a higher score on two items in the Need for Cognition Scale, and consultation of mass media other than the Internet. LIMITATIONS: Studies with larger numbers of patients and other diseases, however, are required to confirm these results. CONCLUSIONS: The search for medical information is a widespread reality among patients with psoriasis and melanoma and it is not associated with a poor relationship with the physician. Dermatologists can play a beneficial role by recommending trustworthy Internet sites during the patient's visit and by promoting the development of pages by scientific societies to provide high-quality information.

Calcium and phosphorus metabolism and lithogenic factors in patients with osteoporotic fracture.

OBJECTIVES: To demonstrate the attendance of mineral metabolism disorders and lithogenic factors in patients' urine with osteoporotic fracture without previously known stones MATERIAL AND METHODS: 67 patients with osteoporotic fractures surgically treated in trauma service are included. The area of the fracture site, fracture mechanism and the presence of osteoporosis were the factors taken into account to diagnose osteoporotic fracture. Mineral metabolism, calciuria, oxaluria, uricosuria and citraturia in 24hours urine were analyzed. The presence of abnormal calcium and phosphorus metabolism was proved comparing hypercalciuria patients with normocalciuria ones. RESULTS: 12 men and 55 women with mean age 68.8±14.5 years old were included. Mean Body Mass Index (BMI) was 27.4±4.1kg/m2. 42% of patients showed hypercalciuria, 34% hyperoxaluria, 34% hypocitraturia and 7% hyperuricosuria. Statistically significant differences were observed only in fasting calcium/creatinine ratio (0.17 vs. 0.08; P<.0001) when comparing patients with hypercalciuria with those with normocalciuria. CONCLUSIONS: Patients with osteoporotic fractures show different lithogenic factors in urine, mainly hypercalciuria, always in fasting conditions.

Radical cystectomy, hysterectomy with double adnexectomy and bilateral nephroureterectomy with transvaginal extraction.

OBJECTIVES: The onset of synchronous urothelial carcinoma in the upper or lower urinary tract is uncommon. Even more uncommon is the onset the bilateral form. The aim of this article is to describe the surgical technique of complete laparoscopic exeresis of the urinary apparatus and to add several variants of the technique that improve the patient's hemodynamics during surgery. MATERIAL AND METHODS: We present the technique of cystectomy with bilateral nephroureterectomy, hysterectomy with double adnexectomy and bilateral ilio-obturator lymphadenectomy by laparoscopy and transvaginal extraction of specimens from a 58-year-old patient with multiple prior vesical resections of high-grade urothelial carcinoma. The patient currently presents bladder recurrence and bilateral ureteropelvic tumor. The technique consists first of the hysterectomy and double adnexectomy along with the lymphadenectomy and cystectomy, maintaining the urethrovesical, ureterovesical and uterovaginal junctions. After changing the patient's position, both nephroureterectomies were performed. Lastly, we completed the resection of the previously mentioned segments to extract the specimens transvaginally. RESULTS: The histological result was high-grade urothelial carcinoma that affected the bladder and both ureteropelvic junctions, along with endometrial carcinoma. After reviewing the literature, we found less than 10 cases in which complete exeresis of the urinary apparatus was performed and none with the technical description presented in this article. In most cases described in the literature, surgery was performed at 2 separate times and without preserving renal function until the end of the complete exeresis. CONCLUSION: This technique helps maintain diuresis for a longer time during surgery and thereby facilitates the work of the anesthesiologist and improves the patient's circulatory dynamics. Additionally, the technique prevents any type of handling of the urinary tract, thereby avoiding the passage of tumor cells to the peritoneal cavity, given that the specimens are extracted whole through the vagina.

Erectile dysfunction, metabolic syndrome and arterial disease. Clinical-pathological relation by carotid ultrasonography.

INTRODUCTION: Different studies have shown the relationship between erectile dysfunction, metabolic syndrome and cardiovascular disease. The objective of this study was to evaluate the presence of arteriopathy performing carotid ultrasound in patients with and without erectile dysfunction. MATERIAL AND METHODS: We conducted a case-control study with 44 patients consulting for erectile dysfunction and 20 controls. All subjects completed the IIEF-5 test and we studied the criteria for metabolic syndrome, and a carotid ultrasound to study the intima-media thickness and the presence of atherosclerotic plaques was performed. RESULTS: Mean intima-media thickness was .71mm±.21 for the right and of .71±.17 for the left carotid in patients with erectile dysfunction. In the control group, the means were .54±0.11 and 0.59±0.15mm respectively, statistically significant differences (P=.02 and P=.05 respectively). No plaque was found in any control, but in 25% of both carotid arteries of patients with erectile dysfunction (P=.01). As metabolic syndrome, according to the American Heart Association, were diagnosed 52.8% of patients with erectile dysfunction, and 16.7% of controls, and according to the International Diabetes Federation, 52.3% of patients with erectile dysfunction and 25% of controls met diagnostic criteria. In both cases there were significant differences (P<.01 and P=.02 respectively). We found a positive linear correlation between waist circumference and the intima-media thickness in both carotid (P<.05). CONCLUSIONS: Patients with erectile dysfunction may be at increased risk of cardiovascular disease, as determined by the presence of arterial disease in the carotid arteries, which indicates that we should made a more thorough and comprehensive study of patients with erectile dysfunction.

Retroperitoneal schwannoma. A complex surgical treatment of a tumor with uncertain behavior.

BACKGROUND: Retroperitoneal schwannoma is a rare nerve sheath tumor; the surgical removal of this tumor is sometimes compromised by its location. The aim of this study is to analyze our experience with the diagnosis and treatment of this type of tumor. METHOD: We present our experience between 1999 and 2011 in the diagnosis and treatment of retroperitoneal schwannoma. During that time, we diagnosed and treated five female patients (four adults and one infant) with the condition. The tumors appeared sporadically and were not associated with neurofibromatosis or other syndromes. Diagnosis was performed by computed tomography (CT) imaging in four cases and by magnetic resonance imaging (MRI) in one case. RESULTS: All patients underwent surgical treatment and complete resection of the lesion. An open resection was performed in four cases, and in the most recent case, the excision was conducted laparoscopically. In all of the cases, the histological diagnosis was retroperitoneal schwannoma, and in one case, there was a melanocytic variant that was not associated with Carney syndrome. At the time of this report, there has been no evidence of recurrence. CONCLUSION: Retroperitoneal schwannoma is a tumor that is difficult to diagnose with imaging techniques, and because of its localization, the tumor is difficult to remove surgically.

Litiasis renal cálcica y densidad mineral ósea. Importancia del metabolismo óseo en la litiasis urinaria / Calcium Renal Lithiasis and Bone Mineral Density. Importance of Bone Metabolism in Urinary Lithiasis

Contexto: La litiasis renal cálcica es una enfermedad multifactorial, en la que intervienen en su fisiopatología diferentes factores minerales y metabólicos que pueden encontrarse alterados, entre ellos el metabolismo óseo y fosfocálcico. Objetivo: Establecer la evidencia científica y demostrar la relación existente entre litiasis renal cálcica y pérdida de densidad mineral ósea, mediante el uso de marcadores de remodelado óseo y metabolitos urinarios y séricos. Adquisición de la evidencia: Se realiza una revisión bibliográfica en PubMed utilizando diferentes MeSHTerms como Nephrolithiasis, Bone mineral density, Urinary stones, Calcium, Bone resorption y Bone formation, usando diferentes combinaciones. Se seleccionan únicamente los trabajos con resúmenes en inglés o español y se descartan casos clínicos y trabajos con estudio estadístico inapropiado. Se seleccionan un total de 40 publicaciones. Síntesis de la evidencia: En los diferentes estudios analizados se observa que los pacientes con hipercalciuria presentan una mayor pérdida de densidad mineral ósea con respecto a los normocalciúricos. Entre los pacientes con litiasis cálcica, tanto los que tienen normocalciuria como los que tienen hipercalciuria presentan pérdida de densidad mineral ósea, siendo más evidente en estos últimos. Esta pérdida de densidad mineral está acentuada y es importante en los pacientes con litiasis recidivante. El aumento de los marcadores calcio/creatinina en ayunas y β-crosslaps son los más determinantes de litiasis y pérdida de densidad mineral en estos pacientes. Conclusión: Se recomienda solicitar marcadores de remodelado óseo y calcio/creatinina en ayunas en pacientes con litiasis cálcica recidivante por la importante presencia de pérdida de densidad mineral ósea, con un nivel de evidencia III (AU)

Context: Calcium Nephrolithiasis is a multifactorial disease; in its pathophysiology is involved various minerals and metabolic factors that may be altered, including bone and phosphor-calcium metabolism. Objective: To establish the scientific evidence and demonstrate the relationship between calcium nephrolithiasis and bone mineral density loss, through the use of bone turnover markers, serum and urinary metabolites. Evidence acquisition: We performed a PubMed literature review using different MeSH Terms like «Nephrolithiasis» «Bone mineral density»,«Urinary stones», «Calcium», «Bone resorption» and «Bone formation», with different combinations. We only selected articles with abstracts in English or Spanish and discarded clinical cases and articles with inappropriate statistical study. A total of 40 articles were selected. Evidence synthesis: In different studies reviewed have been observed that patients with hypercalciuria have a higher bone mineral density loss with respect to normocalciuric. Among patients with calcium stones (normocalciuric or hypercalciuric), there is loss of bone mineral density, being more evident in patients with stones and hypercalciuria. This mineral density loss is marked and important in patients with recurrent calcium stones. Increased markers like fasting calcium/creatinine and β-CrossLaps are determinant of nephrolithiasis and mineral density loss in these patients. Conclusion: We recommend perform markers of bone turnover and fasting calcium/creatinine in patients with recurrent calcium stones by the significant presence of bone mineral density loss, with a level of evidence III (AU)

Descriptive analysis of the economic costs of periprosthetic joint infection of the knee for the public health system of Andalusia.

This study offers a descriptive analysis of the economic costs of Periprosthetic joint infection (PJI) of the knee for the public health system of Andalusia (Spain) The data are based on consecutive patients with PJI treated in our Bone and Joint Infection Unit between January 2005 and January 2010. The total cost for all patients with knee PJI was 4,151,843 $ (3,202,841 €), i.e., a mean cost per patient of 52,555 $ (40,542 €). The mean cost per patient was 24,980 $ (19,270.80 €) for patients with early PJI and rose to 78,111 $ (60,257 €) for those with late PJI. The main cost was for the hospital stay and the specific in-hospital care received, followed by the cost of the surgical procedure.

Calcium renal lithiasis and bone mineral density. Importance of bone metabolism in urinary lithiasis.

CONTEXT: Calcium Nephrolithiasis is a multifactorial disease; in its pathophysiology is involved various minerals and metabolic factors that may be altered, including bone and phosphor-calcium metabolism. OBJECTIVE: To establish the scientific evidence and demonstrate the relationship between calcium nephrolithiasis and bone mineral density loss, through the use of bone turnover markers, serum and urinary metabolites. EVIDENCE ACQUISITION: We performed a PubMed literature review using different MeSH Terms like "Nephrolithiasis", "Bone mineral density", "Urinary stones", "Calcium", Bone resorption" and "Bone formation", with different combinations. We only selected articles with abstracts in English or Spanish and discarded clinical cases and articles with inappropriate statistical study. A total of 40 articles were selected. EVIDENCE SYNTHESIS: In different studies reviewed have been observed that patients with hypercalciuria have a higher bone mineral density loss with respect to normocalciuric. Among patients with calcium stones (normocalciuric or hypercalciuric), there is loss of bone mineral density, being more evident in patients with stones and hypercalciuria. This mineral density loss is marked and important in patients with recurrent calcium stones. Increased markers like fasting calcium/creatinine and ß-CrossLaps are determinant of nephrolithiasis and mineral density loss in these patients. CONCLUSION: We recommend perform markers of bone turnover and fasting calcium/creatinine in patients with recurrent calcium stones by the significant presence of bone mineral density loss, with a level of evidence III.

Hyperthyroidism as a clinical manifestation of a embryonal carcinoma of the testis.

This case report describes a case of hyperthyroidism as manifestation of an embryonal carcinoma, and illustrates the causes that led to it. The case describes a 33-year-old male patient who complained of chest pain, palpitations, mild dyspnoea, and weight loss. Blood analysis reveals high levels of human chorionic gonadotropin (833818 mlU/ml), T3 (16.90 pg/ml), and T4 (7.77 ng/dl), as well as a fall of TSH (0.01 ulU/ml). Physical examination and imaging procedures confirm the occurrence of a left testicular tumour associated with numerous lung, hepatic and retroperitoneal metastases. Treatment with carbimazol and propanolol is established to manage hyperthyroidism, and an urgent orchiectomy is performed; the histologic diagnosis confirms an embryonal carcinoma (organoid type), but the patient died unexpectedly 24 hours later after having suffered sudden dyspnoea, tachypnoea, and tachyarrhythmia. Hyperthyroidism is a rare manifestation of a testicular tumour that should be borne in mind with regard to the patient's symptomatology and HCG levels.

Síndrome metabólico y perfil hormonal en pacientes con disfunción eréctil / Metabolic Syndrome and Hormone Profile in Patients with Erectile Dysfunction

Objetivos: Demostrar la existencia de relación entre síndrome metabólico y disfunción eréctil y analizar el perfil hormonal de estos pacientes con respecto a un grupo de población sana. Material y métodos: Se ha diseñado un estudio de casos y controles con 65 hombres divididos en dos grupos según la presencia o no de disfunción eréctil. El grupo A está formado por 37 hombres con disfunción eréctil y el grupo B por 28 hombres sanos sin disfunción eréctil. La edad estuvo comprendida entre 40 y 65 años. Se estudió la presencia de síndrome metabólico según la definición ATP III, la realización de ejercicio físico, tabaquismo, índice de masa corporal (IMC) y perfil hormonal completo incluyendo testosterona total, libre y biodisponible. Resultados: Se ha detectado mayor presencia de síndrome metabólico entre los hombres del grupo A (72,9%) con respecto a los del grupo B (17,8%) (p=0,0001). Entre los parámetros que conforman el síndrome metabólico existen diferencias entre ambos grupos en los niveles de presión arterial sistólica y diastólica, la glucemia en ayunas y el perímetro abdominal, siendo todas ellas significativas. Tras realizar análisis multivariante entre síndrome metabólico y disfunción eréctil ajustado por edad, IMC, IIEF, ejercicio físico y tabaquismo hemos observado relación significativa independiente entre síndrome metabólico y disfunción eréctil. No hemos encontrado diferencias entre ambos grupos en ningún parámetro hormonal. Conclusión: Existe relación entre síndrome metabólico y disfunción eréctil, por lo que parece recomendable llevar a cabo el estudio de perfil metabólico y riesgo cardiovascular en estos pacientes (AU)

Objectives: To demonstrate the existence of relation between metabolic syndrome and erectile dysfunction and to analyze the hormone profile of these patients regarding a healthy population group. Material and methods: A case-control study was designed with 65 men divided into 2 groups according to presence or non-presence of erectile dysfunction. Group A was made up of 37 men with erectile dysfunction and group B by 28 healthy men without erectile dysfunction. Ages ranged from 40 to 65 years. The presence of metabolic syndrome according to the ATPIII definition, performance of physical exercise, smoking habit, body mass index and complete hormone profile including testosterone -total, free and bioavailability, were studied. Results: Greater presence of metabolic syndrome was detected among men of Group A (72.9%) versus those of group B (17.8%) (p=0.0001). Among the parameters that make up the metabolic syndrome, there are differences between both groups in systolic and diastolic blood pressure, fast blood sugar and abdominal circumference, all these differences being significant. After performing multivariate analysis between the metabolic syndrome and erectile dysfunction adjusted for age, BMI, International Index for Erectile Function (IIEF), physical exercise and smoking habit, we have observed an independent significant relation between the metabolic syndrome and erectile dysfunction. We have not found differences between both groups in any hormone parameter. Conclusion: A relationship is found between metabolic syndrome and erectile dysfunction. Thus, it seems recommendable to perform the metabolic profile and cardiovascular risk study in these patients (AU)

Fournier gangrene: description of 37 cases and analysis of associated health care costs.

BACKGROUND AND OBJECTIVES: Fournier gangrene is a urological emergency associated with a high mortality. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department. MATERIAL AND METHODS: We carried out a retrospective study of 37 patients diagnosed with Fournier gangrene between January 2001 and October 2010. RESULTS: All the patients were men, 43.2% had diabetes, and the mean age of the patients was 57.68 years. Statistically significant differences were observed between the age of surviving patients and that of patients who died (55.8 and 69.6 years, respectively). The mean hospital stay was 27.54 days and 32.4% of patients required admission to the intensive care unit. Etiology was unknown in 39.8% of cases. Polymicrobial infection was observed in 59.5% of cases. The mean health care cost associated with a patient diagnosed with Fournier gangrene admitted to intensive care and requiring at least 1 procedure in the operating room was €25,108.67. Mortality was 13.5%. Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay. CONCLUSIONS: Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented.

Priapismo de bajo flujo transformado en priapismo de alto flujo por fístula arterio-lacunar secundaria a la técnica de Winter / Low-flow priapism turned into high-flow priapism due to arterial-lacunar fistula secondary to Winter's procedure

El priapismo es una afección patológica que consiste en una erección peneana persistente más allá de la estimulación sexual. Presentamos el caso de un paciente de 80 años, diagnosticado inicialmente, por la historia clínica, valores gasométricos de los cuerpos cavernosos y ultrasonografía Doppler color peneana, de priapismo de bajo flujo. Durante la realización de la técnica de Winter se produce iatrogénicamente la laceración bilateral de las arterias dorsales, originando una fístula arterio-lacunar y, en consecuencia, un priapismo de alto flujo. Se realizó una arteriografía selectiva de la pudenda al no ser concluyente la eco-Doppler color, que puso de manifiesto dicha fístula y permitió la embolización supraselectiva bilateral con microcoils (AU)

Priapism is a pathological condition which is a persistent penile erection beyond sexual stimulation. We report a patient of 80 years, initially diagnosed by medical history, blood gas values of the corpora cavernosa and penile color Doppler ultrasound of low-flow priapism. During the performance of the technique of Winter occurs iatrogenically bilateral laceration of the dorsal arteries, causing arterial-lacunar fistula and therefore a high-flow priapism. We performed selective arteriography of the pudendal, not being eco-color Doppler conclusively that showed that fistula and allowed superselective bilateral embolization microcoils (AU)

Gangrena de Fournier. Análisis descriptivo y coste económico-sanitario de nuestra serie de 37 casos / Fournier Gangrene: Description of 37 Cases and Analysis of Associated Health Care Costs

Introducción: La gangrena de Fournier es una urgencia urológica definida como una fascitis necrotizante, con una alta mortalidad, resultado de una infección polimicrobiana que se origina en la región anorrectal y/o genitourinaria. El objetivo de este estudio es analizar las características epidemiológicas y clínicas, así como las variables que han influido en la evolución y mortalidad de los pacientes tratados en nuestro Servicio. Material y métodos: El estudio analiza retrospectivamente 37 pacientes diagnosticados de gangrena de Fournier en el periodo de tiempo comprendido entre enero del 2001 a octubre de 2010. Resultados: Todos los pacientes son hombres, con una edad media de 57, 68 años, existiendo diferencias estadísticas en la edad de los fallecidos respecto a los que sobreviven, 69,6 años frente a 55,8 años. El 43,2% eran diabéticos. La estancia media hospitalaria fue de 27,54 días. El 32,4% precisó de ingreso en la UCI. En el 39,8% se desconoce su etiología. La infección fue polimicrobiana en el 59,5% de los casos. El coste sanitario medio de un paciente diagnosticado de gangrena de Fournier que ingresa en la Unidad de Cuidados Intensivos (UCI) y requiere de al menos una cura en quirófano es de 25.108,67 euros. La mortalidad fue del 13,5%. Al estratificar las patologías estudiadas de forma independiente se observa que sólo la cardiopatía isquémica se relacionó de forma significativa con la mortalidad y una mayor estancia hospitalaria. Conclusión: La gangrena de Fournier es una patología con una alta mortalidad, a pesar de un tratamiento adecuado precoz. Es una patología con una baja incidencia, pero supone un coste elevado para el sistema sanitario, por lo que serían necesarias medidas de prevención primaria y secundaria (AU)

Background and objectives: Fournier gangrene is a urological emergency associated with a high mortality. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department. Material and methods: We carried out a retrospective study of 37 patients diagnosed with Fournier gangrene between January 2001 and October 2010. Results: All of the patients were men, 43.2% had diabetes, and the mean age of the patients was 57.68 years. Statistically significant differences were observed between the age of surviving patients and that of patients who died (55.8 and 69.6 years, respectively). The mean hospital stay was 27.54 days and 32.4% of patients required admission to the intensive care unit. Etiology was unknown in 39.8% of cases. Polymicrobial infection was observed in 59.5% of cases. The mean health care cost associated with a patient diagnosed with Fournier gangrene admitted to intensive care and requiring at least 1 procedure in the operating room was €25 108.67. Mortality was 13.5%. Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay. Conclusions: Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented (AU)

[Fournier gangrene: description of 37 cases and analysis of associated health care costs]. / Gangrena de Fournier. Análisis descriptivo y coste económico-sanitario de nuestra serie de 37 casos.

BACKGROUND AND OBJECTIVES: Fournier gangrene is a urological emergency associated with a high mortality. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department. MATERIAL AND METHODS: We carried out a retrospective study of 37 patients diagnosed with Fournier gangrene between January 2001 and October 2010. RESULTS: All of the patients were men, 43.2% had diabetes, and the mean age of the patients was 57.68 years. Statistically significant differences were observed between the age of surviving patients and that of patients who died (55.8 and 69.6 years, respectively). The mean hospital stay was 27.54 days and 32.4% of patients required admission to the intensive care unit. Etiology was unknown in 39.8% of cases. Polymicrobial infection was observed in 59.5% of cases. The mean health care cost associated with a patient diagnosed with Fournier gangrene admitted to intensive care and requiring at least 1 procedure in the operating room was €25,108.67. Mortality was 13.5%. Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay. CONCLUSIONS: Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented.

[Metabolic syndrome and hormone profile in patients with erectile dysfunction]. / Síndrome metabólico y perfil hormonal en pacientes con disfunción eréctil.

OBJECTIVES: To demonstrate the existence of relation between metabolic syndrome and erectile dysfunction and to analyze the hormone profile of these patients regarding a healthy population group. MATERIAL AND METHODS: A case-control study was designed with 65 men divided into 2 groups according to presence or non-presence of erectile dysfunction. Group A was made up of 37 men with erectile dysfunction and group B by 28 healthy men without erectile dysfunction. Ages ranged from 40 to 65 years. The presence of metabolic syndrome according to the ATPIII definition, performance of physical exercise, smoking habit, body mass index and complete hormone profile including testosterone -total, free and bioavailability, were studied. RESULTS: Greater presence of metabolic syndrome was detected among men of Group A (72.9%) versus those of group B (17.8%) (p=0.0001). Among the parameters that make up the metabolic syndrome, there are differences between both groups in systolic and diastolic blood pressure, fast blood sugar and abdominal circumference, all these differences being significant. After performing multivariate analysis between the metabolic syndrome and erectile dysfunction adjusted for age, BMI, International Index for Erectile Function (IIEF), physical exercise and smoking habit, we have observed an independent significant relation between the metabolic syndrome and erectile dysfunction. We have not found differences between both groups in any hormone parameter. CONCLUSION: A relationship is found between metabolic syndrome and erectile dysfunction. Thus, it seems recommendable to perform the metabolic profile and cardiovascular risk study in these patients.