Role of (F-18) Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Prediction of Response to Neoadjuvant Therapy in Esophageal Cancer: Correlation with Pathological Response and Survival.

Purpose: The purpose of this study is to assess the correlation between metabolic response with fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and pathological response in patients with locally advanced esophageal cancer treated with neoadjuvant chemoradiotherapy and to study FDG-PET parameters for the prediction of pathological response and outcome. Methods: Twenty-five patients with locally advanced esophageal cancer underwent two FDG-PET/CT scans for initial staging and after neoadjuvant chemoradiotherapy. FDG uptake in the primary tumor was calculated in both scans (SUVmax, SULpeak, and TLG). Metabolic response was assessed according to the reduction of PET parameters: complete response (mCR = 100%), partial response (mPR ≥50%), and no response (mNR ≤50%). Pathological response was also classified as complete (pCR), partial (pPR), or no response (pNR). Patients were followed up (range, 8-99 months) determining free-disease interval (FDI) and overall survival (OS). Results: Two patients were excluded due to exitus for nonesophageal-related causes. The metabolic response was observed in 18/23 remaining patients (3mCR, 15 mPR), of which 12/18 patients showed a pathological response (3 pCR, 9 pPR). A major discrepancy was observed in 2 mNR patients who achieved pPR. FDI and OS were longer in patients with metabolic response than nonresponders, but no statistical difference was found. No significant correlation was found between PET parameters and pathological response, FDI, and OS. Conclusions: FDG-PET/CT is a useful technique to assess response to neoadjuvant chemoradiotherapy in esophageal cancer. Although in this preliminary study, no correlation between metabolic and pathologic response was found and no statistical differences between responders and nonresponders were observed, a tendency of longer FDI and OS was apparently found in responders patients.

Mediastinal Recurrence of Uterine Cervix Cancer on 18F-FDG PET/CT.

ABSTRACT: We report the case of a 64-year-old woman with a mediastinal relapse of a uterine cervix cancer with positive human papillomavirus, an unusual site of recurrence. She consulted because of solid and liquid dysphagia of sudden appearance. Endoscopic study and non-contrast-enhanced CT showed intraluminal esophageal stenosis with a retrograde esophageal distension. 18F-FDG PET/CT demonstrated an infiltrating hypermetabolic lesion in posterior mediastinum, middle and lower esophagus, and stomach, with no signs of local or regional relapse of the uterine neoplasm.

Coastal Evolution in a Mediterranean Microtidal Zone: Mid to Late Holocene Natural Dynamics and Human Management of the Castelló Lagoon, NE Spain.

We present a palaeoenvironmental study of the Castelló lagoon (NE Spain), an important archive for understanding long-term interactions between dynamic littoral ecosystems and human management. Combining geochemistry, mineralogy, ostracods, diatoms, pollen, non-pollen palynomorphs, charcoal and archaeo-historical datasets we reconstruct: 1) the transition of the lagoon from a marine to a marginal environment between ~3150 cal BC to the 17th century AD; 2) fluctuations in salinity; and 3) natural and anthropogenic forces contributing to these changes. From the Late Neolithic to the Medieval period the lagoon ecosystem was driven by changing marine influence and the land was mainly exploited for grazing, with little evidence for impact on the natural woodland. Land-use exploitation adapted to natural coastal dynamics, with maximum marine flooding hampering agropastoral activities between ~1550 and ~150 cal BC. In contrast, societies actively controlled the lagoon dynamics and become a major agent of landscape transformation after the Medieval period. The removal of littoral woodlands after the 8th century was followed by the expansion of agrarian and industrial activities. Regional mining and smelting activities polluted the lagoon with heavy metals from the ~11th century onwards. The expansion of the milling industry and of agricultural lands led to the channelization of the river Muga into the lagoon after ~1250 cal AD. This caused its transformation into a freshwater lake, increased nutrient load, and the infilling and drainage of a great part of the lagoon. By tracking the shift towards an anthropogenically-controlled system around ~750 yr ago, this study points out Mediterranean lagoons as ancient and heavily-modified systems, with anthropogenic impacts and controls covering multi-centennial and even millennial timescales. Finally, we contributed to the future construction of reliable seashell-based chronologies in NE Spain by calibrating the Banyuls-sur-Mer ΔR offset with ceramic imports from the Emporiae archaeological site.

[Assessment and prevalence of urinary incontinence after radical prostatectomy: Analysis of a historical series]. / EVALUACIÓN Y PREVALENCIA DE INCONTINENCIA URINARIA TRAS PROSTATECTOMÍA RADICAL: ANÁLISIS DE UNA SERIE HISTÓRICA.

OBJECTIVES: Prostate cancer can be treated by radical prostatectomy and provoke urinary incontinence as secondary effect. Our aim is to calculate the prevalence of urinary incontinence, characteristics of leakage and influential factors, through a historical series. METHODS: We perform a descriptive, observational and retrospective study of 1310 patients who received treatment for PCa between 1989 and 2011. Prevalence was obtained after 12 months of recovery and using ICS definition. To complete ICIQ-SF and number of pads/day used we perform a cross-sectional study. The series is studied globally and divided in two groups according to oncologic characteristics. We perform a descriptive, comparative and predictive analysis. RESULTS: Prevalence of the series was 23.5%, 296 patients. 279 incontinent patients completed ICIQ-SF with a mean score of 11.1±4.03. 16.4% of the patients use 1 pad/day or none, 69% (11.4% of the total) use compress and 22% diapers. 8% of the total use more than 1 pad/day. Clinico-pathological factors divide series in two groups: 1989-1999 with a prevalence of 24.6% and 2000-2011 with 22.8%. Multivariate analysis shows influential factors: age (65 years) (OR:1.65, p=0.013) and prostate volume (50cc) (OR:1.49, p=0.029). CONCLUSIONS: Urinary incontinence is a disease with some prevalence that varies depending on definition. The most common situation was to leak several times a day (42.2%), a small amount (59.1%), using compress (69%) most of incontinents with a mild (0-7: 88.2%) impact on quality of life. Predictive factors were age (65 years) and prostate volume (50cc). The historical changes does not influence over prevalence.

Evaluación y prevalencia de incontinencia urinaria tras prostatectomía radical: análisis de una serie histórica / Assessment and prevalence of urinary incontinence after radical prostatectomy: analysis of a historical series

OBJETIVO: El tratamiento del cáncer de próstata mediante prostatectomía radical puede ocasionar incontinencia urinaria. Nuestro objetivo es calcular la prevalencia de incontinencia urinaria a través del análisis de una serie histórica, analizar las características de las pérdidas y los factores influyentes en la aparición de incontinencia. MÉTODOS: Estudio descriptivo, observacional y retrospectivo de las variables clinicopatológicas de 1310 pacientes intervenidos entre 1989-2011. La prevalencia se calcula a los 12 meses de la cirugía usando la definición de ICS. Estudio transversal para completar el cuestionario ICIQ-SF y las protecciones usadas. Se estudia la serie completa y en dos grupos según características oncológicas. Se realiza estudio descriptivo, comparativo y predictivo. RESULTADOS: La prevalencia de la serie es de 23.5% con 296 pacientes. 279 incontinentes completaron el cuestionario ICIQ-SF con una media de 11.1±4.03. 16.4% de los pacientes intervenidos usan al menos 1 protección al día, de ellos el 69% usan compresas (11.4% del total), y el 22% pañales clásicos. El 8% usa más de una protección al día. Las características clinicopatológicas dividen la serie en dos grupos distintos: 1989-1999 con una prevalencia de 24.6% y grupo 2000-2011 con 22.8%. El análisis multivariado encontramos la edad (65 años) (OR:1.65, p = 0.013) y volumen prostático (50cc) (OR:1.49, p = 0.029) influyentes de forma independiente. CONCLUSIONES: La incontinencia urinaria es una enfermedad de cierta prevalencia, que varía según la definición que utilicemos. La situación más frecuente en los pacientes incontinentes es tener pérdidas varias veces al día (42.2%), poca cantidad (59.1%), usando protecciones tipo compresa (69%) y afectando la calidad de vida de forma leve-moderada (0-7: 88.2%). Las variables predictivas fueron la edad (65 años) y el volumen prostático (50cc). La evolución histórica de los pacientes no influye en la prevalencia de incontinencia urinaria

OBJECTIVES: Prostate cancer can be treated by radical prostatectomy and provoke urinary incontinence as secondary effect. Our aim is to calculate the prevalence of urinary incontinence, characteristics of leakage and influential factors, through a historical series. METHODS: We perform a descriptive, observational and retrospective study of 1310 patients who received treatment for PCa between 1989 and 2011. Prevalence was obtained after 12 months of recovery and using ICS definition. To complete ICIQ-SF and number of pads/day used we perform a cross-sectional study. The series is studied globally and divided in two groups according to oncologic characteristics. We perform a descriptive, comparative and predictive analysis. RESULTS: Prevalence of the series was 23.5%, 296 patients. 279 incontinent patients completed ICIQ-SF with a mean score of 11.1±4.03. 16.4% of the patients use 1 pad/day or none, 69% (11.4% of the total) use compress and 22% diapers. 8% of the total use more than 1 pad/day. Clinico-pathological factors divide series in two groups: 1989-1999 with a prevalence of 24.6% and 2000-2011 with 22.8%. Multivariate analysis shows influential factors: age (65 years) (OR:1.65, p = 0.013) and prostate volume (50cc) (OR:1.49, p = 0.029). Concluisions: Urinary incontinence is a disease with some prevalence that varies depending on definition. The most common situation was to leak several times a day (42.2%), a small amount (59.1%), using compress (69%) most of incontinents with a mild (0-7: 88.2%) impact on quality of life. Predictive factors were age (65 years) and prostate volume (50cc). The historical changes does not influence over prevalence

Radical prostatectomy. Prognostic value of positive surgical margins in pT2 patients.

OBJECTIVES: We intend to assess the prognostic influence of surgical margins on the biochemical progression free survival (BPFS) in patients classified as pT2 after radical prostatectomy. METHODS: We analyze a series of 1,132 T1-T2 patients with prostate cancer treated with radical prostatectomy between 1989-2009. PT3b, pT4 and patients with lymph node involvement were excluded from the series. The clinicopathologic variables and the BPFS of pT2(+), pT2(-) and pT3 patients are compared. The influential clinicopathologic variables in the BPFS are identified in the pT2(+) group and risk groups are designed. RESULTS: Of 1,051 patients evaluated finally: 598 (59,6) were pT2(-) 163 (15,5%) pT2(+)80 (7,6%) pT3a(-) and 210 (20%) pT3(+). Clinical characteristics of pT2(+). It is homogeneous with the pT2(-) group and significantly better than pT3(+) group in all the clinicopathologic variables evaluated. 5 and 10 year BPFS of the pT2(68 ± 3% and 57 ± 5%) is significantly worse than pT2( -)(87 ± 1% and 79 ± 2%), similar to pT3a(-) (75 ± 5% and 64 ± 7%and better than pT3(+) (44 ± 3% and (36 ± 3%) BPFS pT2(+) influential factors: Univariate study : Pathological Gleason score 7-10 (HR:2.1 95% IC: 1.1-4.1), (p=0.02)MRI that indicates T3 (HR:3.2 95%IC: 1.4-7.3), (p=0.04) PSA > 15 ng-ml (HR:4 95% IC: 2-8.2), (p < 0.0001) and high risk D'Amico group (HR:3.3 95%IC: 1.3-8.5), (p=0.01) are influential variables. A risk model with the involved variables can be designed. Each variable present is a point. Two groups are designed : Group 1 (0-1 variable) Group 2 (2-3 variables). 5 and 10 year BPFS for Group 1 are 71±5% and 69 ± 5%, and are 37 ± 12% and 22 ± 11% for Group 2. (p < 0.0001). CONCLUSIONS: Surgical margins in pT2 patients have independent influence in the BPFS. The group is heterogeneous and it can be divided into two risk groups accordingly to the BPFS influential variables: a larger group (86% pT2(+) with worse prognosis than pT2(-), and a smaller group (remaining 14%) with similar prognosis to pT3 (+).It is likely that pT2(+) patients are a mixture of understaged patients with others with iatrogenic margins or false margins due to poor assessment of the surgical specimen.

Prostatectomía radical. Valor pronóstico de los márgenes afectados en pacientes pT2 / Radical prostatectomy. Prognostic value of positive surgical margins in pT2 patients

OBJETIVO: Valorar en pacientes prostatectomizados y calificados como pT2, la influencia pronóstica sobre la Supervivencia Libre de Progresión Bioquímica (SLPB) de los márgenes afectados. MÉTODOS: Analizamos retrospectivamente una serie de 1.132 pacientes con cáncer de próstata T1-T2 tratados con prostatectomía radical entre 1.989-2.009. Se excluyen los pacientes con afectación de vesícula seminal, afectación ganglionar y pT4. Comparamos las variables clínico-patológicas y la SLPB de los pT2 (+) con pT2 (-) y pT3. Identificamos las variables clínico-patológicas influyentes en la SLPB de los pT2 (+) y con ellas diseñamos grupos de riesgo. RESULTADOS: De los 1.051 incluídos finalmente, 598 (59,6%) son pT2 (-); 163 (15,5%) pT2 (+); 80 (7,6%) pT3a (-) y 210 (20%) pT3 (+). Características clínicas de pT2 (+). Es homogéneo con el grupo pT2 (-) y significativamente mejor que los pT3(+) en todas las variables clínico-patológicas evaluadas. La (SLPB) de los pT2 (+) (68±3% y 57±5%) es significativamente peor que la de los pT2 (-) (87±1% y 79±2%), similar a los pT3a(-) (75±5% y 64±7%) y mejor que la de los pT3(+) (44±3% y 36±3%) en 5 y 10 años. Factores influyentes en SLPB en pT2 (+): Estudio univariado. Son influyentes: Gleason patológico 7-10 (HR:2,1; IC 95% 1,1-4,1), (p=0,02); RNM que indica T3 (HR:3,2; IC 95% 1,4-7,3), (p=0,04); PSA>15 ng/ml (HR:4; IC 95% 2-8,2), (p<0,0001) y D’Amico alto riesgo (HR:3,3; IC 95% 1,3-8,5), (p=0,01). Se diseña un modelo de riesgo con las variables implicadas. Cada variable presente es un punto. Se diseñan dos grupos: Grupo 1 (86%)(0-1 variable); Grupo 2 (14%)(2-3 variables). La SLPB del grupo 1 es a 5 y 10 años de 71±5% y 69±5% y la del grupo 2 es de 37±12% y 22±11%.(p<0,0001). CONCLUSIONES: La afectación de márgenes en pacientes pT2 tiene una influencia independiente en la SLPB. El grupo es heterogéneo y puede ser dividido según las variables influyentes en la SLPB en un grupo mayor (86% de pT2 (+)) con peor pronóstico que los pT2 (-), y un grupo menor (14 % restante) con pronóstico similar a pT3 (+). Es probable que los pacientes pT2 (+) sean una mezcla de pacientes infraestadiados con otros con márgenes y atrogénicos o falsos por mala valoración de la pieza operatoria (AU)

OBJECTIVES: We intend to assess the prognostic influence of surgical margins on the biochemical progression free survival (BPFS) in patients classified as pT2 after radical prostatectomy. METHODS: We analyze a series of 1,132 T1-T2 patients with prostate cancer treated with radical prostatectomy between 1989-2009. PT3b, pT4 and patients with lymph node involvement were excluded from the series. The clinicopathologic variables and the BPFS of pT2 (+), pT2 (-) and pT3 patients are compared. The influential clinicopathologic variables in the BPFS are identified in the pT2 (+) group and risk groups are designed.RESULTS: Of 1,051 patients evaluated finally: 598 (59,6%) were pT2 (-); 163 (15,5%) pT2 (+);80 (7,6%) pT3a (-) and 210 (20%) pT 3(+).Clinical characteristics of pT2 (+). It is homogeneous with the pT2(-) group and significantly better than pT3 (+) group in all the clinicopathologic variables evaluated. 5 and 10 year BPFS of the pT2 (+) (68±3% and 57±5%) is significantly worse than pT2 (-) (87±1% and 79±2%), similar to pT3a (-) (75±5% and 64±7%) and better than pT3 (+) (44±3% and 36±3%).BPFS pT2 (+) influential factors: Univariate study: Pathological Gleason score 7-10 (HR:2.1; 95% IC: 1.1-4.1), (p=0.02); MRI that indicates T3 (HR:3.2; 95%IC: 1.4-7.3), (p=0.04); PSA>15 ng/ml (HR:4; 95%IC: 2-8.2), (p<0.0001) and high risk D’Amico group (HR:3.3; 95%IC: 1.3-8.5), (p=0.01) are influential variables. A risk model with the involved variables can be designed. Each variable present is a point. Two groups are designed: Group 1 (0-1 variable); Group 2 (2-3 variables). 5 and 10 year BPFS for Group 1 are 71±5% and 69±5%, and are 37±12% and 22±11% for Group 2 (p <0.0001). CONCLUSIONS: Surgical margins in pT2 patients have independent influence in the BPFS. The group is heterogeneous and it can be divided into two risk groups accordingly to the BPFS influential variables: a larger group (86% pT2(+)) with worse prognosis than pT2(-), and a smaller group (remaining 14%) with similar prognosis to pT3 (+).It is likely that pT2(+) patients are a mixture of understaged patients with others with iatrogenic margins or false margins due to poor assessment of the surgical specimen (AU)

[Prostate adenocarcinoma. Predictive clinical model of seminal vesicle involvement]. / Adenocarcinoma de próstata. Modelo clínico predictivo de afectación de vesícula seminal.

OBJECTIVES: Our aim is to design a predictive model of seminal vesicle involvement. using clinical data. METHODS: We studied 1128 patients with clinically localized adenocarcinoma treated by radical prostatectomy (127 were pT3b). We identified (logistic regression) clinical variables related with pT3b. With the multivariate study influential variables a seminal vesicle involvement risk model is designed. RESULTS: Seminal vesicle involvement related factors: In univariate study: the influential variables are: Gleason 7 (OR:2);Gleason 8-10 (OR:4.5) T2 (OR:2.6); bilateral involvement in biopsy (OR:3.1); PSA 10-20 ng/ml ( OR:3.3); PSA >20 ng/ ml (OR:9.5). In the multivariate study are influential: Gleason 7 (OR:1.56) Gleason 8-10 ( OR: 3.4); T2 (OR:1.9); PSA 10-20 ng/ml (OR:3.1) and PSA >20 ng/,ml (OR:8.8). Predictive model: using multivariate logistic regression the weight of each variable is valued and a value between 1 and 4 is given. Gleason 2-6, T1; PSA<10 ng/ml value 1; Gleason 7; T2 y PSA 10-20 ng/ml value 2; Gleason 8-10 and PSA >20 ng/ml value 4. Each patient has a marker that fluctuates between 3 and 10. 5 Groups are designed with significantly different risks (p<0.05 in all cases ): Group 1 (3 points) (OR:1) (risk: 2.4% 95%IC 0.7%-4.3%) Group 2 (4 points) (OR:2.7) (risk: 6.5% 95%IC 5%-7.9%); Group 3(5-6 points) (OR:7.1)( risk:15% 95%IC 11%-19%) Group 4 ( 7--8 points) (OR:33.4) (risk: 45.5%; 95%IC 30%-59%) Group 5 (9-10 points) (OR:57.3) (risk: 58.8% 95%IC 35%- 82%). CONCLUSION: The clinical model allows an accurate approximation to the seminal vesicles involvement risk.

Adenocarcinoma de próstata. Modelo clínico predictivo de afectación de vesícula seminal / Prostate adenocarcinoma. Predictive clinical model of seminal vesicle involvement

OBJETIVOS: Se pretende diseñar utilizando los datos clínicos un modelo predictivo de afectación de vesícula seminal. MÉTODOS: Se estudian 1.128 pacientes con adenocarcinoma clínicamente localizado tratados mediante prostatectomía radical (127 son pT3b). Se identifican (regresión logística) las variables clínicas relacionadas con pT3b. Con las variables del estudio multivariado se diseña un modelo de riesgo de afectación de vesícula seminal. RESULTADOS: Factores relacionados con afectación de vesícula seminal: En estudio univariado: las variables influyentes son: Gleason 7 (OR:2); Gleason 8-10 (OR:4,5); T2 (OR:2,6); afectación bilateral en biopsia (OR:3,1); PSA 10-20 ng/ml (OR:3,3); PSA >20 ng/ml (OR:9,5). En el estudio multivariado son influyentes: Gleason 7 (OR:1,56); Gleason 8-10 (OR: 3,4); T2 (OR:1,9); PSA 10-20 ng/ml (OR:3,1) y PSA >20 ng/ml (OR:8,8). MODELO PREDICTIVO: mediante regresión logística multivariante se valora el peso de cada variable y se da un valor entre 1 y 4. Gleason 2-6, T1; PSA<10 ng/ml valor 1; Gleason 7; T2 y PSA 10-20 ng/ml valor 2; Gleason 8-10 y PSA >20 ng/ml valor 4. Cada paciente tiene un marcador que oscila entre 3 y 10. Se diseñan 5 grupos con riesgos significativamente diferentes (p<0,05 en todos los casos): Grupo 1 (3 puntos)(OR:1)(riesgo: 2,4%; IC95% 0,7%-4,3%). Grupo 2 (4 puntos) (OR:2,7)(riesgo: 6,5%; IC95% 5%-7,9%). Grupo 3 (5-6 puntos)(OR:7,1) (riesgo:15%; IC95% 11%-19%). Grupo 4 (7-8 puntos)(OR:33,4)(riesgo: 45,5%; IC95% 30%-59%). Grupo 5 (9-10 puntos)(OR:57,3)(riesgo: 58,8%; IC95% 35%-82%). CONCLUSIÓN: El modelo clínico permite una aproximación precisa al riesgo de afectación de vesículas seminales (AU)

OBJECTIVES: Our aim is to design a predictive model of seminal vesicle involvement. using clinical data. METHODS: We studied 1128 patients with clinically localized adenocarcinoma treated by radical prostatectomy (127 were pT3b). We identified (logistic regression) clinical variables related with pT3b. With the multivariate study influential variables a seminal vesicle involvement risk model is designed. RESULTS: Seminal vesicle involvement related factors: In univariate study: the influential variables are: Gleason 7 (OR:2);Gleason 8-10 (OR:4.5); T2 (OR:2.6); bilateral involvement in biopsy (OR:3.1); PSA 10-20 ng/ml (OR:3.3); PSA >20 ng/ml (OR:9.5). In the multivariate study are influential: Gleason 7 (OR: 1.56); Gleason 8-10 (OR: 3.4); T2 (OR:1.9); PSA 10-20 ng/ml (OR:3.1) and PSA >20 ng/ml (OR:8.8). Predictive model: using multivariate logistic regression the weight of each variable is valued and a value between 1 and 4 is given. Gleason 2-6, T1; PSA<10 ng/ml value 1; Gleason 7; T2 y PSA 10-20 ng/ml value 2; Gleason 8-10 and PSA >20 ng/ml value 4. Each patient has a marker that fluctuates between 3 and 10. 5 Groups are designed with significantly different risks (p<0.05 in all cases): Group 1 (3 points) (OR:1)(risk: 2.4%; 95%IC 0.7%-4.3%) Group 2 (4 points) (OR:2.7)(risk: 6.5%; 95%IC 5%-7.9%) Group 3 (5-6 points) (OR:7.1)(risk:15%; 95%IC 11%-19%) Group 4 (7-8 points) (OR:33.4)(risk: 45.5%; 95%IC 30%-59%) Group 5 (9-10 points) (OR:57.3)(risk: 58.8%; 95%IC 35%-82%). CONCLUSION: The clinical model allows an accurate approximation to the seminal vesicles involvement risk (AU)

Ureteroiliac fistula secondary to radiotherapy in a patient with single renal metastasis of colon adenocarcinoma.

We report the case of a 61-year-old man diagnosed in 2001 with rectal cancer (stage T3N1M0). The patient was treated with surgery, adjuvant chemotherapy and radiotherapy. In 2009, he was admitted to the urology department with a complaint of right hemiabdominal pain. The anatomopathological investigation reported renal metastasis of colon adenocarcinoma. After surgery, he received adjuvant chemotherapy. No tumour recurrence or metastasis was reported at the 22-month follow-up.

Complications of kidney transplantation with grafts from expanded criteria donors.

PURPOSE: The limited availability of kidneys for transplantation has been addressed by expanding the criteria for allowing a donor kidney to be transplanted, but this tendency may cause suboptimal kidneys to be implanted and could be associated with greater risk of complications. METHODS: A retrospective study of 407 kidney transplantations was done to compare complications of transplantation with non-expanded (n = 244) and expanded criteria donors (n = 163). Expanded criteria donors were donors older than 60 years, or donors aged 50-60 years who had ≥ 2 of the following risk factors: hypertension, diabetes mellitus (type 2), creatinine >1.5 mg/dL, or death caused by stroke. RESULTS: Compared with transplant recipients from non-expanded criteria donors, transplant recipients from expanded criteria donors had significantly greater frequency of graft loss, delayed graft function, pneumonia, overall surgical complications, early reoperation, wound eventration, hydronephrosis, postoperative hemorrhage, and wound infection. When analyzing surgical complications types, a significant greater frequency of urologic, wound, vascular, early and late surgical complications was found. In terms of severity, expanded donor criteria transplantation was related to Clavien I, III, and IV complications. CONCLUSIONS: Transplantation of kidneys from expanded criteria donors is associated with a significant higher risk of medical and surgical complications than kidneys from non-expanded criteria donors.

Recipient and donor risk factors for surgical complications following kidney transplantation.

OBJECTIVE: The aim of this study was to evaluate recipient and donor risk factors that are related to surgical complications after renal transplantation. MATERIAL AND METHODS: In total, 419 kidney transplantations were analysed with regard to the influence of recipient and donor risk factors on the main postoperative surgical complications. RESULTS: The mean follow-up for the entire group was 72.8 months (± 54.2 SD). Vascular complications were independently associated with donor age; and urological complications with recipient age >65 years and cyclosporine rather than tacrolimus therapy. Wound complications were independently associated with recipient age, preoperative dialysis time, recipient body mass index (BMI) and cyclosporine rather than tacrolimus therapy. Collections were independently associated with retransplantation, type 2 diabetes mellitus and wound complications. Overall surgical complications were associated with donor age and delayed graft function. In terms of severity, grade I complications were independently associated with recipient age and surgical revision, grade II with recipient age >50 years, grade III with recipient BMI, and grade IV with donor age. CONCLUSIONS: Recipient characteristics are the primary determinants of wound, urological and minor (Clavien grades I, II and III) complications; however, graft or donor characteristics are the primary risk factors for vascular, overall and major (Clavien grade IV) surgical complications.

Prostatic leiomyoma. Case report.

OBJECTIVE: We try to show the relevance of this rare pathology and to set its importance in the differential diagnosis of prostate masses. METHODS: We report a case and perform a search in the MEDLINE database of the series described up to the date. RESULTS: Prostatic leiomyoma is a extremely rare anatomopathological finding, though the appearance of a glandular hyperplasia with small areas of leiomyomatous growth is more common. Up to date there are just a hundred cases described. They are benign mesenchymal tumors without evidence of disease recurrence after surgery. When they present symptomatology, they emulate benign hyperplasia with urinary tract infections. Although it has benign nature, surgical intervention is indicated when severe clinical symptoms appear. CONCLUSIONS: The recognition of this benign entity and the distinction from other neoplasias has important therapeutic and prognostic implications. Imaging techniques and pathological analysis are crucial for this reason. When an unusual prostatic mass is detected, the leiomyoma must be included in the differential diagnosis.

Leiomioma de próstata. A propósito de un caso / Prostatic leiomyoma. Case report

OBJETIVO: Pretendemos poner en relevancia esta rara patología y recalcar su importancia en el diagnóstico diferencial de las masas prostáticas.MÉTODOS: Presentamos nuestro caso y revisamos la patología descrita hasta la fecha en la base de datos de MEDLINE.RESULTADOS: El leiomioma prostático es un hallazgo anatomopatológico de extremada rareza, si bien la aparición de una hiperplasia glandular con pequeños focos de crecimiento leiomiomatoso es más común.Hasta la fecha y en nuestro conocimiento tan sólo hay un centenar de casos descritos. Son tumores mesenquimales benignos de buen pronóstico y sin evidencia de casos de recurrencia de la enfermedad tras su exéresis quirúrgica. La mayor parte de las veces cuando presentan sintomatología lo hacen emulando a la de la hiperplasia benigna de próstata o con infecciones del tracto urinario. Aunque se trata de una enfermedad benigna, la intervención quirúrgica está indicada cuando existen síntomas clínicos severos.CONCLUSIONES: El reconocimiento de esta entidad y su distinción de otras lesiones neoplásicas de la próstata, tiene importantes implicaciones terapéuticas y pronósticas. Las pruebas de imagen y el análisis anatomopatlógico son fundamentales para ello.Cuando una masa prostática inusual se detecta, el leiomioma debe incluirse en el diagnóstico diferencial y la RM puede ser útil para identificarla(AU)

OBJECTIVE: We try to show the relevance of this rare pathology and to set its importance in the differential diagnosis of prostate masses.METHODS: We report a case and perform a search in the MEDLINE database of the series described up to the date.RESULTS: Prostatic leiomyoma is a extremely rare anatomopathological finding, though the appearance of a glandular hyperplasia with small areas of leiomyomatous growth is more common. Up to date there are just a hundred cases described. They are benign mesenchymal tumors without evidence of disease recurrence after surgery.When they present symptomatology, they emulate benign hyperplasia with urinary tract infections. Although it has benign nature, surgical intervention is indicated when severe clinical symptoms appear.CONCLUSIONS: The recognition of this benign entity and the distinction from other neoplasias has important therapeutic and prognostic implications. Imaging techniques and pathological analysis are crucial for this reason. When an unusual prostatic mass is detected, the leiomyoma must be included in the differential diagnosis(AU)

Immediate renal Doppler ultrasonography findings (<24 h) and its association with graft survival.

PURPOSE: Renal Doppler ultrasonography (DUS) is the gold-standard image test for follow-up after renal transplantation, it is potentially useful to detect renal disease and it could be related with long-term survival. We evaluate whether renal graft survival can be predicted by immediate renal Doppler ultrasonography (IRDUS), defined as ultrasonography carried out in the first 24 h post-surgery. MATERIALS AND METHODS: Immediate renal DUS findings (resistance index, hydronephrosis, fluid collection, bruises, and vascularization abnormalities) and their association with graft survival were analyzed in a retrospective observational study of 343 renal allografts. Renal transplantation was done using a standard technique, and DUS was performed 24 h post-transplantation. The association of variables with graft survival was evaluated by Cox univariate and multivariate proportional hazards analysis. Kaplan-Meier survival analysis and the log-rank test were used to examine graft survival. RESULTS: The follow-up median was 85 months. On IRDUS, 137 patients (39.9%) had abnormal findings. The best RI cutpoint for the prediction of graft survival was 0.7; therefore, we defined two different groups: RI ≤ 0.7 (n = 247) versus RI > 0.7 (n = 96). Univariate analysis revealed that graft survival was significantly lower in patients with RI > 0.7 (P ≤ 0.001), vascularization abnormalities (P ≤ 0.001) or bruises (P = 0.026). In multivariate analysis, the only factors independently associated with graft survival were RI (odds ratio 2.4; 95% CI 1.4-4.1) and vascularization abnormalities (odds ratio 2.7; 95% CI 1.1-6.5). CONCLUSIONS: IRDUS can be useful, besides being highly useful in the diagnosis of graft primary dysfunction in the transplanted patient also yields information that can help to predict long-term graft survival.

Effects of mining wastes on a seagrass ecosystem: metal accumulation and bioavailability, seagrass dynamics and associated community structure.

Two different Cymodocea nodosa (Ucria) Ascherson beds growing in mining-contaminated sediments were compared with two reference beds in the Mar Menor coastal lagoon. The accumulation of Zn, Pb and Cd in different fractions of the plant, the sediment parameters that regulate the availability of metals, the seabed structure and dynamics of each seagrass bed and its associated macroinvertebrate community were studied. C. nodosa accumulates metals from the sediments and reflects their bioavailability for this seagrass. At each station, the metal content of the rhizomes was lower than that of leaves and roots. The concentration of acid-volatile sulfides does not seem to influence the availability of metals to the seagrass, possibly due to oxygen transport to underground tissues. The highest metal concentration in all the contaminated stations was found in the leaf-biofilm, due to the formation of complexes between metals and the extracellular polymeric substances that form the biofilm. All the seagrass beds were seen to be undergoing expansion, those growing in contaminated sediments accumulating great quantities of metals and showing highest photosynthetic leaf surface area and highest leaf biomass. However, these structural parameters were not seen to be responsible for the differences in the faunal composition observed between contaminated and reference beds. Moreover, the multivariate analysis identified the metal content of leaves, biofilm and sediments as important variables that may be responsible for these differences in faunal composition. In this study we have demonstrated that both the seagrass C. nodosa and the biofilm on the plant leaves may be used as environmental tools in the Mar Menor lagoon. The former is an useful indicator of sediment contamination, whereas the latter seems to be a good sentinel of water quality.