Priapismo de alto flujo en población pediátrica: serie de casos y revisión de la literatura / High-flow Priapism in Pediatric Population: Case Series and Review of the Literature

Introducción: El priapismo consiste en una erección mantenida durante más de cuatro horas. Es una patología infrecuente en la población pediátrica, estimada en 0,3 a 1,5 por cada 100.000 niños al año. La secuencia diagnóstica incluye anamnesis, exploración física y ecografía doppler peneana (EcoDP). No siempre es necesaria la punción de cuerpos cavernosos para establecer el diagnóstico diferencial entre priapismo de alto y bajo flujo. El tratamiento de elección en la edad pediátrica no está bien definido.Material y métodosEstudio multicéntrico, retrospectivo, descriptivo de pacientes menores de 14 años con priapismo de alto flujo, entre los años 2010 y 2020. Revisión de la literatura.ResultadosUn total de siete pacientes fueron diagnosticados de priapismo de alto flujo. Ninguno requirió punción de cuerpos cavernosos. Se realizó un manejo conservador en todos ellos, dos pacientes necesitaron embolización arterial superselectiva por persistencia de la clínica.ConclusionesEl priapismo de alto flujo es una entidad muy infrecuente en la edad pediátrica por lo que es importante conocer el diagnóstico y manejo adecuados. Actualmente, la ecografía doppler suele ser suficiente para el diagnóstico, obviando el uso de la gasometría. El manejo inicial en niños es conservador, reservando la embolización para los casos refractarios. (AU)

Introduction: Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined.Patients and methodsMulticentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020. Literature review.ResultsA total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms.ConclusionsHigh-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases. (AU)

High-flow priapism in pediatric population: Case series and review of the literature.

INTRODUCTION: Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined. PATIENTS AND METHODS: Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020. RESULTS: A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms. CONCLUSIONS: High-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

High-flow Priapism in Pediatric Population: Case Series and Review of the Literature. / Priapismo de alto flujo en población pediátrica: serie de casos y revisión de la literatura.

INTRODUCTION: Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined. PATIENTS AND METHODS: Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020. RESULTS: A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms. CONCLUSIONS: High-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

Afecciones cutáneas en trabajadores con empleos de subsistencia y su relación con factores socioambientales y laborales. Medellín, Colombia / Skin conditions in workers with subsistence jobs and related socio-environmental and labor factors. Medellin Colombia

Introducción: La información acerca de lesiones en piel y sus factores asociados, en trabajadores informales en América Latina y el Caribe aun es escasa. Objetivo: Determinar la relación existente entre las condiciones sociodemográficas, ambientales, laborales y la prevalencia de afecciones en la piel auto-reportada por trabajadores informales “venteros” del centro de Medellín. Material y Métodos: Estudio transversal con intención analítica y fuente primaria de información. Se incluyeron 686 trabajadores. Se aplicó encuesta asistida, previa realización de prueba piloto y estandarización de los encuestadores. Variable dependiente; prevalencia de afecciones en piel. Variables independientes; condiciones laborales, sociodemográficas y ambientales. Se realizó control de errores con análisis estadísticos y sesgos de selección e información. Se realizaron análisis univariado, bivariado y multivariado. Resultados: Trabajadores fundamentalmente hombres (57.6%), edades entre 45-59 años, 60,0% procedente de zona rural. Trabajaban > 8 horas/día (80,6%), toda la semana, con > 20 años (50,7%) en su labor. El 72,2% no utilizaba mecanismos de protección personal. 61,5% consideraba que la contaminación ambiental afectaba su labor y su salud. 19,83% presentó afectaciones cutáneas, como; alergias (12,0%), prurito y sarpullido. Menor prevalencia de alergias en hombres (24,0%) y ≥ 60 años. Mayores prevalencias en quienes laboraban >8 horas/día (94,0%), toda la semana (43,0%), con exposición a sustancias químicas (RP=1,88.IC=1,11;3,20), vendedores de mercancía y cacharro (RP =2,06.IC: 1,08;3,91). Conclusión: Explican mayor prevalencia de alergias proceder de la zona urbana, vender mercancía y cacharro, trabajar >8 horas/día, toda la semana, exponerse a sustancias químicas, considerar que la calidad del aire afecta su labor, y presentar comorbilidades (AU)

Introduction: The information on skin lesions and their associated factors in informal workers in Latin America is scarce. Objective: To determine the existing relationship between sociodemographic, environmental and labor conditions and the prevalence of skin conditions, self-reported by informal workers “venteros” from the Medellin downtown. Material and Methods: Cross-sectional study with analytical intention and primary source of information. 686 workers were included. An assisted survey was applied, after conducting a pilot test and standardization of the interviewers. The presence of skin conditions was considered as the dependent variable and the working, sociodemographic and environmental conditions as independent variables. Error control was performed with statistical analysis, selection and information biases were controlled. Univariate and bivariate analysis was performed. Results: Mainly male workers (57.6%), ages 45-59 years, 60.0% from rural areas. They worked> 8 hours / day (80.6%), all week, with> 20 years (50.7%) in their work. 72.2% did not use personal protection mechanisms. 61.5% considered that environmental pollution affected their work and their health. 19.83% presented skin affectations, such as allergies (12.0%), pruritus and rash. Lower prevalence of allergies in men (24.0%) and ≥60 years. Higher prevalences in those who worked> 8 hours / day (94.0%), all week (43.0%), with exposure to chemical substances (PR = 1.88, IC = 1.11, 3.20), sellers of merchandise and equipment (PR = 2.06.IC: 1.08; 3.91). Conclusion: They explain a higher prevalence of allergies coming from the urban area, selling merchandise and junk, working> 8 hours / day, all week, being exposed to chemical substances, considering that air quality affects their work, and presenting comorbidities (AU)

¿Es eficaz a largo plazo la malla ajustable TVA en el tratamiento de la incontinencia de esfuerzo femenina? / Is the adjustable TVA mesh effective for the long-term treatment of female stress incontinence?

Objetivos: Valorar a largo plazo la eficacia y seguridad de la malla ajustable TVA en el tratamiento de la incontinencia urinaria de esfuerzo. Material y métodos: Estudio seudoexperimental, antes y después, realizado en un servicio universitario de urología. Ochenta y dos pacientes fueron invitadas a participar desde enero de 2002 a marzo de 2005. Treinta y dos accedieron a participar y se les implantó una malla ajustable TVA. El estudio preoperatorio incluyó historia médica, examen físico con vejiga llena, flujometría, residuo, estudio urodinámico completo y los cuestionarios autoadministrados I-QoL, ICIQ-SF. En la evaluación postoperatoria se añadió el cuestionario PGI-I, no realizándose el estudio urodinámico completo. Resultados: Veintinueve pacientes (90,6%) eran continentes en la prueba de esfuerzo al año. Veintiocho (87,5%) a los diez años. Veinte pacientes (62,5%) nunca tenían escape al año. Dieciséis (50%) a los diez años. Veintiocho pacientes (87,5%) estaban satisfechos al año de la cirugía. Veinticinco (78%) a los diez años. Veintiocho (87,5%) tenían buena calidad de vida al año y veintiuno (62,5%) a los diez años. No hubo complicaciones importantes al final del periodo de estudio. Conclusiones: El tratamiento de la incontinencia urinaria de esfuerzo con malla TVA presenta un alto grado de cura objetiva y satisfacción a los diez años, sin efectos adversos graves. El estudio muestra que la satisfacción no siempre significa continencia total sino que expresa la mejoría de los síntomas y la consiguiente calidad de vida

Objectives: To assess the long-term safety and efficacy of the adjustable TVA mesh in treating stress urinary incontinence. Material and methods: Pseudoexperimental study, before and after, conducted in a university urology department. Eighty-two patients were invited to participate from January 2002 to March 2005. Thirty-two patients agreed to participate and were implanted an adjustable TVA mesh. The preoperative study included a medical history review, physical examination with full bladder, flowmetry, residue study, complete urodynamic study and the self-administered questionnaires I-QoL and ICIQ-SF. In the postoperative assessment, the PGI-I questionnaire was added, but a complete urodynamic study was not performed. Results: Twenty-nine (90.6%) and 28 (87.5%) patients were continent in the stress test at 1 and 10 years, respectively. Twenty (62.5%) and 16 (50%) patients had no urine escape at 1 and 10 years, respectively. Twenty-eight (87.5%) and 25 (78%) patients were satisfied 1 and 10 years after the surgery, respectively. Twenty-eight (87.5%) and 21 (62.5%) patients had a good quality of life at 1 year and at 10 years, respectively. There were no significant complications at the end of the study period. Conclusions: Treatment of stress urinary incontinence with the TVA mesh presented a high degree of objective healing and satisfaction at 10 years, with no severe adverse effects. The study showed that satisfaction does not always mean total continence but rather it reflects the improvement of symptoms and consequent quality of life

The Key Role of Pain Catastrophizing in the Disability of Patients with Acute Back Pain.

PURPOSE: This study investigated the role of anxiety sensitivity, resilience, pain catastrophizing, depression, pain fear-avoidance beliefs, and pain intensity in patients with acute back pain-related disability. METHOD: Two hundred and thirty-two patients with acute back pain completed questionnaires on anxiety sensitivity, resilience, pain catastrophizing, fear-avoidance beliefs, depression, pain intensity, and disability. RESULTS: A structural equation modelling analysis revealed that anxiety sensitivity was associated with pain catastrophizing, and resilience was associated with lower levels of depression. Pain catastrophizing was positively associated with fear-avoidance beliefs and pain intensity. Depression was associated with fear-avoidance beliefs, but was not associated with pain intensity. Finally, catastrophizing, fear-avoidance beliefs, and pain intensity were positively and significantly associated with acute back pain-related disability. CONCLUSION: Although fear-avoidance beliefs and pain intensity were associated with disability, the results showed that pain catastrophizing was a central variable in the pain experience and had significant direct associations with disability when pain was acute. Anxiety sensitivity appeared to be an important antecedent of catastrophizing, whereas the influence of resilience on the acute back pain experience was limited to its relationship with depression.

Is the adjustable TVA mesh effective for the long-term treatment of female stress incontinence? / ¿Es eficaz a largo plazo la malla ajustable TVA en el tratamiento de la incontinencia de esfuerzo femenina?

OBJECTIVES: To assess the long-term safety and efficacy of the adjustable TVA mesh in treating stress urinary incontinence. MATERIAL AND METHODS: Pseudoexperimental study, before and after, conducted in a university urology department. Eighty-two patients were invited to participate from January 2002 to March 2005. Thirty-two patients agreed to participate and were implanted an adjustable TVA mesh. The preoperative study included a medical history review, physical examination with full bladder, flowmetry, residue study, complete urodynamic study and the self-administered questionnaires I-QoL and ICIQ-SF. In the postoperative assessment, the PGI-I questionnaire was added, but a complete urodynamic study was not performed. RESULTS: Twenty-nine (90.6%) and 28 (87.5%) patients were continent in the stress test at 1 and 10 years, respectively. Twenty (62.5%) and 16 (50%) patients had no urine escape at 1 and 10 years, respectively. Twenty-eight (87.5%) and 25 (78%) patients were satisfied 1 and 10 years after the surgery, respectively. Twenty-eight (87.5%) and 21 (62.5%) patients had a good quality of life at 1 year and at 10 years, respectively. There were no significant complications at the end of the study period. CONCLUSIONS: Treatment of stress urinary incontinence with the TVA mesh presented a high degree of objective healing and satisfaction at 10 years, with no severe adverse effects. The study showed that satisfaction does not always mean total continence but rather it reflects the improvement of symptoms and consequent quality of life.

Mechanisms of Bacterial Extracellular Electron Exchange.

The biochemical mechanisms by which microbes interact with extracellular soluble metal ions and insoluble redox-active minerals have been the focus of intense research over the last three decades. The process presents two challenges to the microorganism. Firstly, electrons have to be transported at the cell surface, which in Gram-negative bacteria presents an additional problem of electron transfer across the ~6nm of the outer membrane. Secondly, the electrons must be transferred to or from the terminal electron acceptors or donors. This review covers the known mechanisms that bacteria use to transport electrons across the cell envelope to external electron donors/acceptors. In Gram-negative bacteria, electron transfer across the outer membrane involves the use of an outer membrane ß-barrel and cytochrome. These can be in the form of a porin-cytochrome protein, such as Cyc2 of Acidithiobacillus ferrooxidans, or a multiprotein porin-cytochrome complex like MtrCAB of Shewanella oneidensis MR-1. For mineral-respiring organisms, there is the additional challenge of transferring the electrons from the cell to mineral surface. For the strict anaerobe Geobacter sulfurreducens this requires electron transfer through conductive pili to associated cytochrome OmcS that directly reduces Fe(III)oxides, while the facultative anaerobe S. oneidensis MR-1 accomplishes mineral reduction through direct membrane contact, contact through filamentous extensions and soluble flavin shuttles, all of which require the outer membrane cytochromes MtrC and OmcA in addition to secreted flavin.

Microsatellites and Alu elements from the human MHC in Valencia (Spain): analysis of genetic relationships and linkage disequilibrium.

Two different sets of noncoding markers (microsatellites and Alu elements) from the human chromosome six were analysed in 106 individuals from Valencia (Spain), with the aim of exploring the effect of evolutionary forces on the genetic variability of the major histocompatibility complex (MHC) and assessing the potential usefulness of these genetic loci in phylogenetic studies. Linkage disequilibrium (LD) analyses revealed statistically significant associations among markers located in the MHC class I region, and also between the microsatellite D6S2792 and several genetic loci from MHC class I, II and III regions. Results of the Ewens-Watterson test indicated that only D6S2792 showed significant departure from selective neutrality. Despite the paucity of haplotype data in the literature, results of the phylogenetic analyses at world scale (Alu elements) showed that the genetic relationships of Valencia were mainly determined by the ethnic ancestry of the populations considered, whereas at European scale (microsatellites) population affinities were strongly influenced by geography. Our findings suggest that noncoding markers from the MHC such as Alu and microsatellite loci might have a potential value as lineage (ancestry) markers in investigations into evolutionary, medical and forensic perspectives.

Genetic variability in autochthonous Basques from Guipuzcoa: a view from MHC microsatellites.

Five short tandem repeats (STRs) located at human chromosome 6 were analysed in 97 autochthonous Basques from Guipuzcoa (northern Spain), with the aim of assessing the genetic relationships of Basques at a European scale, based on the variability of the major histocompatibility complex (MHC) region, and comparing the phylogenetic information obtained from STRs, and from HLA class I genes (HLA-A and HLA-B) for the same set of European populations. The integrative approach was focused on D6S265 and D6S2792, according to availability of population databases. F(ST) genetic distances obtained from STRs and from HLA loci were very similar, thereby describing a comparable pattern of genetic structuring among the European populations. These findings were supported by results of the Mantel test of matrix correspondence (r = 0.796, P = 0.0022) and by significant correlations between the first two F(ST) eigenvectors of STRs and HLA genes. Coinciding with previous phylogenetic studies, Basques showed substantial genetic differentiation within the European context, probably as a result of the impact of random genetic drift and high inbreeding levels for extended periods of isolation even from adjacent populations. Analysis of the geographical distribution of the allele frequencies revealed a great number of latitudinal frequency clines in both the MHC STRs and the HLA class I genes, which supports the notion of the post-glacial resettlement of Europe being a crucial factor in the genetic make-up of Europeans. Our results indicate that analysing the genetic variability of MHC microsatellites could be a suitable strategy in evaluating the role of evolutionary forces such as natural selection (because of genetic hitchhiking effect), genetic drift and gene flow in the maintenance of polymorphism at the MHC region, because STRs can efficiently complement the genetic information obtained from HLA genes.

[Impact of urinary incontinence and overactive bladder syndrome on health-related quality of life of working middle-aged patients and institutionalized elderly patients]. / Impacto de la incontinencia urinaria y del síndrome de vejiga hiperactiva en la calidad de vida relacionada con la salud de pacientes de mediana edad laboralmente activos y mayores de 65 años institucionalizados.

INTRODUCTION: Health-related quality of life (HRQoL) is considered by patients with urinary symptoms as the main outcome variable. Descriptive data about HRQoL in patients with urinary incontinence (UI) and/or overactive bladder (OAB) are reported. These data may serve as a reference for comparison purposes. MATERIALS AND METHODS: Data were taken from EPICC, a national, multicenter, observational, epidemiological study. Data from representative samples of four population groups were analyzed: working patients of both sexes aged 50-64 years, and institutionalized elderly patients of both sexes with no cognitive impairment. In addition to demographic and clinical data, HRQoL data from the Overactive Bladder Questionnaire (OAB-q SF) and the SF-12 Health Survey were also analyzed. RESULTS: Of the total patients in the EPICC study, 26.53% completed the HRQoL questionnaires. Patients with both UI and OAB symptoms had poorer scores than those with OAB or UI respectively in the PCS (41.34 vs. 47.17 and 45) and MCS (46.01 vs. 49.04 and 47.78) of the SF-12, and in the symptom (32.21 vs. 19.19 and 16.65) and quality of life (82.32 vs. 86.72 and 89.45) dimensions of the OAB-q SF. Impact of OAB and UI on HRQoL was higher in men over 65 years of age as compared to women of the same age (76.76 vs. 82.79). CONCLUSIONS: Concurrent symptoms of both UI and VH have a greater impact on HRQoL than those of either UI or VH alone. Impact on HRQoL is similar in middle-aged men and women, but higher in elderly men.

Impacto de la incontinencia urinaria y del síndrome de vejiga hiperactiva en la calidad de vida relacionada con la salud de pacientes de mediana edad laboralmente activos y mayores de 65 años institucionalizados / Impact of urinary incontinence and overactive bladder syndrome on health-related quality of life of working middle-aged patients and institutionalized elderly patients

Introducción: La calidad de vida relacionada con la salud (CVRS) es considerada por los pacientes con síntomas urinarios como el principal indicador de resultados. Se presentan datos descriptivos de la CVRS de sujetos con incontinencia urinaria (IU) y/o vejiga hiperactiva (VH), que servirán de marco de referencia poblacional para comparaciones. Material y métodos: Datos extraídos del estudio EPICC, estudio epidemiológico, observacional, multicéntrico y de ámbito nacional. Se analizaron los datos de muestras representativas de cuatro grupos de la población: mujeres y varones de entre 50–64 años, laboralmente activos, y mujeres y varones mayores de 65 años, institucionalizados, con nivel cognitivo conservado. Además de datos sociodemográficos y clínicos, se analizaron los datos de los cuestionarios de CVRS: cuestionario sobre vejiga hiperactiva OAB-q SF y cuestionario de salud SF-12. Resultados: Del total de incluidos en el estudio EPICC, el 26,53% respondió los cuestionarios de CVRS. Los pacientes que presentaban síntomas de VH y de IU, respecto de los que tenían síntomas de VH o de IU, tuvieron peores puntuaciones en la dimensión física del cuestionario de salud SF-12 (41,34 vs. 47,17 y 45) y en la dimensión mental del cuestionario de salud SF-12 (46,01 vs. 49,04 y 47,78) y en síntomas (32,21 vs. 19,19 y 16,65) y calidad de vida (82,32 vs. 86,72 y 89,45) del OAB-q SF. El impacto de la VH y la IU sobre la CVRS fue superior en varones de más de 65 años respecto a las mujeres de la misma edad (76,76 vs. 82,79). Conclusiones: La presentación conjunta de síntomas de VH y de IU ocasiona mayor impacto en la CVRS que la presentación aislada de VH o IU. El impacto sobre la CVRS es similar en varones y mujeres en la mediana edad pero superior en varones de más de 65 años (AU)

Introduction: Health-related quality of life (HRQoL) is considered by patients with urinary symptoms as the main outcome variable. Descriptive data about HRQoL in patients with urinary incontinence (UI) and/or overactive bladder (OAB) are reported. These data may serve as a reference for comparison purposes. Materials and methods: Data were taken from EPICC, a national, multicenter, observational, epidemiological study. Data from representative samples of four population groups were analyzed: working patients of both sexes aged 50-64 years, and institutionalized elderly patients of both sexes with no cognitive impairment. In addition to demographic and clinical data, HRQoL data from the Overactive Bladder Questionnaire (OAB-q SF) and the SF-12 Health Survey were also analyzed. Results: Of the total patients in the EPICC study, 26.53% completed the HRQoL questionnaires. Patients with both UI and OAB symptoms had poorer scores than those with OAB or UI respectively in the PCS (41.34 vs. 47.17 and 45) and MCS (46.01 vs. 49.04 and 47.78) of the SF-12, and in the symptom (32.21 vs. 19.19 and 16.65) and quality of life (82.32 vs. 86.72 and 89.45) dimensions of the OAB-q SF. Impact of OAB and UI on HRQoL was higher in men over 65 years of age as compared to women of the same age (76.76 vs. 82.79). Conclusions: Concurrent symptoms of both UI and VH have a greater impact on HRQoL than those of either UI or VH alone. Impact on HRQoL is similar in middle-aged men and women, but higher in elderly men (AU)

[Prognostic factors for disease progression in patients with renal cell carcinoma]. / Análisis de los factores pronósticos de progresión tumoral en el adenocarcinoma renal.

INTRODUCTION: More than 40% of patients with renal cell carcinoma present with disease progression after surgery. The objective of the current study was to identify a clinically useful set of prognostic factors that would correlate significantly with the capacity of progression. MATERIAL AND METHODS: The authors studied 252 patients with renal cell carcinoma who underwent radical nephrectomy. Followup ranged from 12-246 months (median 36 months). Several morphologic parameters of the tumors were considered. DNA content was analyzed by flow cytometry and tumor size was determined from the surgical specimen. A Cox proportional hazards regression model was used to identify significant independent prognostic factors for disease progression. RESULTS: A total of 224 out of 252 were available for suitable histograms. Of the 224 patients, 95 (42.4%) were aneuploid tumors, 106 (47.2%) were organ-confined renal cell carcinoma and 87 (39.74%) presented disease progression. At 5 and 10 years of followup, disease free survival was found to be 66.31% and 62.23%, respectively. Univariate analysis revealed that DNA ploidy, Furhman grade and stage (TNM) had a statistically significant predictive value for disease progression. Survival univariate analysis found a worse probability of survival for aneuploid tumors, grade III-IV tumors, non organ-confined tumors and conventional and undiferentiated tumors. Using multivariate survival analyses, Furhman grade, stage (TNM) and DNA ploidy were the only independent prognostic factors. So, the probability of death for aneuploid tumor was 1.7 times higher than for diploid tumors. CONCLUSIONS: Stage, DNA content and Furhman grade were the only significant independent predictors of disease progression. Tumoral size and histological type did not provide more additional information.

[Gene therapy: is possible a vaccine for prostate cancer?]. / Terapia génica en el cáncer de próstata. Es posible una vacuna?

BACKGROUND: New approaches for prostate cancer are needed due to limitations of current therapies for the treatment in advanced stages of the disease. In fact, there is no effective treatment for these patients. Development in molecular biology research on prostate cancer has improved the knowledge of common alterations encoded in DNA sequence, which may be useful as targets for prostate cancer approach. In this review we give an overview of current gene therapy concepts, the most common gene alterations in prostate cancer and the gene therapy treatment strategies.

Análisis de los factores pronósticos de progresión tumoral en el adenocarcinoma renal / Prognostic factors for disease progression in patients with renal cell carcinoma

Introducción: Aproximadamente el 40% de los pacientes con adenocarcinoma renal (AR) fallecen por progresión tumoral a pesar del tratamiento. El 30-40% de los pacientes que progresan, presentan una enfermedad quirúrgicamente resecable en el momento del diagnóstico. Objetivo: El objetivo de este estudio ha sido evaluar que factores muestran un valor pronóstico independiente de supervivencia libre de progresión en el AR. Material y métodos: Estudio retrospectivo de 252 tumores renales intervenidos quirúrgicamente entre 1969-2001. La mediana de seguimiento fue de 36,47 meses (12-246). Las variables evaluadas fueron la edad, el TNM (TNM 2002), grado nuclear de Furhman, tipo histológico, tamaño (diámetro mayor de la pieza quirúrgica) y ploidia del ADN (para un mínimo de 3 muestras en fresco de cada tumor). El contenido de ADN se obtuvo mediante citometría de flujo. La progresión biológica fue definida como recurrencia local, regional y/o presencia de metástasis a distancia. Se utilizaron métodos estadísticos comparativos tanto univariantes (Chi- cuadrado, método de Kaplan-Meyer con el log-rank test) como multivariantes (regresión múltiple de riesgos proporcionales de Cox). Resultados: De los 252 pacientes, 43 se desestimaron para el análisis por un estudio de la ploidia del ADN no válido (coeficiente de variación superior a 8). De los 224 válidos, progresaron 89 (39,74%). La mediana del tiempo libre de progresión fue de 9,55 meses (0-133), de tal forma que el 70,9% de los que recidivaron lo hicieron en los dos primeros años del seguimiento. De los pacientes que progresaron, el 89,5% lo hicieron de forma locorregional, el 9,4% lo hicieron a distancia y 2 pacientes (1,2%) en el riñón contralateral. El 83,1% de los que recidivaron fallecieron por la enfermedad. Al analizar la asociación de las variables con la progresión tumoral, los tumores de alto grado, no organoconfinados y aneuploides presentaban una probabilidad significativamente mayor de progresión. En el análisis univariante de supervivencia el estadio III-IV, el grado nuclear III-IV, los tipos histológicos indiferenciado y convencional, así como los tumores aneuploides mostraron peor probabilidad de supervivencia. El análisis multivariante mediante regresión de Cox, utilizando como variables explicativas los factores pronósticos evaluados en el univariante, seleccionó al TNM, grado nuclear y ploidia del ADN como factores pronósticos independientes de supervivencia libre de progresión. Conclusiones: Los resultados de este estudio indican que el TNM 2002, el grado nuclear y la ploidia del ADN tienen un valor pronóstico independiente de supervivencia libre de progresión. Ni el tipo histológico, ni el tamaño tumoral aportaron información adicional en la predicción pronóstica

Introduction: More than 40% of patients with renal cell carcinoma present with disease progression after surgery. The objective of the current study was to identify a clinically useful set of prognostic factors that would correlate significantly with the capacity of progression. Material and methods: The authors studied 252 patients with renal cell carcinoma who underwent radical nephrectomy. Followup ranged from 12-246 months (median 36 months). Several morphologic parameters of the tumors were considered. DNA content was analyzed by flow cytometry and tumor size was determined from the surgical specimen. A Cox proportional hazards regression model was used to identify significant independent prognostic factors for disease progression. Results: A total of 224 out of 252 were available for suitable histograms. Of the 224 patients, 95 (42,4%) were aneuploid tumors, 106 (47,2%) were organ-confined renal cell carcinoma and 87 (39,74%) presented disease progression. At 5 and 10 years of followup, disease free survival was found to be 66,31% and 62,23%, respectively. Univariate analysis revealed that DNA ploidy, Furhman grade and stage (TNM) had a statistically significant predictive value for disease progression. Survival univariate analysis found a worse probability of survival for aneuploid tumors, grade III-IV tumors, non organ-confined tumors and conventional and undiferentiated tumors. Using multivariate survival analyses, Furhman grade, stage (TNM) and DNA ploidy were the only independent prognostic factors. So, the probability of death for aneuploid tumor was 1,7 times higher than for diploid tumors. Conclusions: Stage, DNA content and Furhman grade were the only significant independent predictors of disease progression. Tumoral size and histological type did not provide more additional information

[Retroperitoneal malignant fibrous histiocytoma with contiguous organs infiltration]. / Histiocitoma fibroso maligno retroperitoneal con infiltración de organos vecinos.

Retroperitoneal tumours are extremely rare neoplasms, most of them malignant. We described the case of a 48-year-old man with a large retroperitoneal mass detected during the study of a constitutional syndrome. The mass was treated surgerically and pathological diagnosis was malignant fibrous histiocytoma. Literature is reviewed and clinical features, histological findings, radiological techniques and therapeutic management are analyzed.

Terapia génica en el cáncer de próstata. ¿Es posible una vacuna? / Gene therapy: is possible a vaccine for prostate cancer?

Introducción: Debido a las limitaciones existentes en el tratamiento del cáncer de próstata en estadios avanzados, se precisan nuevas estrategias de tratamiento para estos pacientes. El desarrollo de la biología molecular en el campo del cáncer de próstata, ha proporcionado un mayor conocimiento de las alteraciones más comunes a nivel del ADN de las células cancerígenas, que podrían ser utilizadas como dianas terapéuticas. En este artículo se han revisado los conceptos actuales en el campo de la terapia génica, las alteraciones génicas más frecuentes en el cáncer de próstata y posibles estrategias de tratamiento

Background: New approaches for prostate cancer are needed due to limitations of current therapies for the treatment in advanced stages of the disease. In fact, there is no effective treatment for these patients. Development in molecular biology research on prostate cancer has improved the knowledge of common alterations encoded in DNA sequence, which may be useful as targets for prostate cancer approach. In this review we give an overview of current gene therapy concepts, the most common gene alterations in prostate cancer and the gene therapy treatment strategies

[Conservative approach in major renal trauma]. / Manejo conservador de los traumatismos renales de alto grado.

INTRODUCTION: Genitourinary trauma amount to an 8-10% of abdominal trauma with the kidney being the most affected organ in 50% of cases, especially the left one. The choice of treatment will depend on the kind of lesion found in the affected renal unit and on the patient's clinical conditions. OBJECTIVE: The aims of this study are twofold: to determine the applicability of conservative treatment in major renal trauma and to assess the evaluation and emergence of possible complications. MATERIAL AND METHODS: We have analysed 309 cases of renal trauma dealt with in our department between January 1984 and January 2006, analyzing such variables as the etiology of the trauma, associated lesions in other organs, the therapeutic approach adopted as well as the presence of complications, both in the long and short run. RESULTS: Out of a total of 309 renal trauma analyzed, a 94.1% (291 cases) were blunt renal trauma. The distribution by grade was: Grade I, 213 cases (69%); Grade II, 39 cases (12.6%); Grade III/IV, 32 cases (10.3%); Grade V, 25 cases (8%). We have given a conservative approach in the 84.6% of the grade III/IV cases (24 cases). 4 grade III nephrectomies were carried out in the Emergency Room because of haemodynamic instability, other 4 grade IV nephrectomies were done for the same reason, one of which was a partial nephrectomy, 48-72 hours after the trauma. The treatment for grade V was nephrectomy in 67%. CONCLUSIONS: According to our experience and in the light of the results obtained, we consider the conservative approach adequate for major renal trauma as long as the patient is haemodynamically stable.

[Incidental renal cancer in young adults: clinical and histopathological findings]. / Cancer renal incidental en pacientes menores de 40 años: hallazgos clinicos e histopatológicos.

OBJECTIVE: to evaluate the clinical and pathological renal cancer (CR) characteristics in our series of tumours, analyzing its impact in the group of age less than 40 years. MATERIAL AND METHODS: We studied 294 patients with CR. The pathologic characteristics were analyzed and DNA ploidy pattern of the surgical pieces were done in 252 patients. The patients were divided in two groups based on age, greater or less to 40 years, well then clinical and pathologic characteristics were compared between. RESULTS: Of all patients, 26 of 294 patients (8,94%) were included in the young age group (less to 40 years). We did not found differences between both groups comparing stage, tumoral volume, treatment realized or DNA ploidy pattern, but in nuclear grade with more aggressive tumours in young people (p=0,0018), without differences in recurrence-free survival or actuarial disease specific survival rate. CONCLUSIONS: The findings in our study indicate that the natural history and outcome of the RC is similar in both older and younger patients. Therefore, in our opinion, the management of CR in young people should be established with independence of the age.

Histiocitoma fibroso maligno retroperitoneal con infiltración de órganos vecinos / Retroperitoneal malignant fibrous histiocytoma with contiguous organs infiltration

Los tumores retroperitoneales primarios son neoformaciones extremadamente raras, de naturaleza maligna en la mayoría de los casos. Presentamos el caso de un varón de 48 años con una gran masa retroperitoneal detectada durante el estudio de un síndrome constitucional. La masa fue tratada quirúrgicamente y el diagnóstico anatomopatológico fue de histiocitoma fibroso maligno. Realizamos una revisión de la literatura y analizamos su presentación clínica, hallazgos histológicos, pruebas diagnósticas de imagen y manejo terapéutico

Retroperitoneal tumours are extremely rare neoplasms, most of them malignant. We described the case of a 48-year-old man with a large retroperitoneal mass detected during the study of a constitutional syndrome. The mass was treated surgerically and pathological diagnosis was malignant fibrous histiocytoma. Literature is reviewed and clinical features, histological findings, radiological techniques and therapeutic management are analyzed