Effects of androgen deprivation therapy on elderly men with high-risk prostate cancer: PROSARC observational study.

INTRODUCTION: Prostatic carcinoma (PC) is a frequent neoplasm in elderly patients. Although androgen deprivation is associated with survival benefits, it is also related to adverse effects such as osteoporosis, frailty, or sarcopenia, which can negatively affect the patient's quality of life. This study aims to quantify and evaluate the prevalence of osteoporosis, frailty, or sarcopenia in elderly PC patients before and after androgen deprivation. We present data from an interim analysis. MATERIALS AND METHODS: PROSARC is a national (Spain) prospective observational study (May-2022-May-2025) still in progress in 2 hospitals. It includes patients with high-risk PC, aged ≥70 years, non-candidates for local treatment and scheduled to start androgen deprivation therapy. The following variables are analyzed: comorbidity, frailty (Fried frailty phenotype criteria), osteoporosis, sarcopenia (EWGSOP2), fat mass and muscle mass, before treatment and after 6 months of follow-up. RESULTS: A 6-month follow-up was completed by 12/25 included patients (mean age, 84 years), with a high baseline prevalence of pre-frailty/frailty (67.7%), sarcopenia (66.7%) and osteoporosis (25%). Treatment did not significantly alter these variables or comorbidity. We observed changes in body mass index (p=0.666), decreased mean value of appendicular muscle mass (p=0.01) and increased percentage of fat mass (p=0.012). CONCLUSION: In patients with high-risk PC, advanced age and a considerable prevalence of osteoporosis, frailty and sarcopenia, androgen deprivation (ADT; 6 months) produces decreased muscle mass without impact on the incidence of the known adverse effects of androgen deprivation.

Utilidad de la quimioterapia neoadyuvante en el carcinoma vesical músculo invasivo no metastásico / Usefulness of neoadjuvant chemotherapy in non-metastatic muscle-invasive bladder cancer

Objetivo: Analizamos el perfil de pacientes candidatos a quimioterapia neoadyuvante (QTn) en estadio pT2-4aN0M0, la tolerabilidad y adherencia de nuestro protocolo basado en cisplatino y los resultados oncológicos.Material y métodosEstudio observacional de cohortes retrospectivo que incluye a pacientes con diagnóstico de carcinoma vesical músculo infiltrante tratados con QTn. Se analizaron las características clínicas, histopatológicas, terapéuticas y evolutivas de los pacientes. El uso de la QTn se evaluó mediante la respuesta completa en la pieza quirúrgica (pT0). Este y otros factores anatomopatológicos se relacionaron con la supervivencia global y el tiempo libre de progresión.ResultadosIncluimos a 90 pacientes con carcinoma vesical músculo invasivo (estadio clínico T2a-T4aN0M0) que recibieron algún esquema de QTn basado en cisplatino, entre enero de 2011 y diciembre de 2018, antes del tratamiento quirúrgico radical. El 40% de los pacientes presentaron alguna reacción adversa al tratamiento, con un cumplimiento del protocolo de QTn del 92,2%. No se presentaron muertes relacionadas con el tratamiento sistémico y ninguna reacción adversa al tratamiento imposibilitó la realización de la cistectomía radical. Tras la cistectomía radical, se objetivó la presencia de respuesta completa (pT0) en 20 pacientes (21%), un estadio inferior en pieza quirúrgica ( p = 0,012), en enfermos con afectación ganglionar respecto a pN0 (65,4 vs. 28,2 meses; p=0,014) y en aquellos con bordes quirúrgicos afectos respecto a los que presentaban márgenes libres de tumor (63,5 vs. 8,5 meses; p=0,021).ConclusiónLa selección adecuada de los pacientes con carcinoma vesical músculo infiltrante ha mostrado una buena tolerancia a la QTn, con una alta tasa de cumplimiento previo a la CR. La mejoría en la tasa de respuesta completa implica una mayor supervivencia en este grupo de pacientes. La afectación ganglionar y los bordes quirúrgicos positivos son factores pronósticos importantes. (AU)

Objective: We analyzed the profile of patients who were candidates for neoadjuvant chemotherapy (NACT) in stage pT2-4aN0M0, the tolerability and adherence of our cisplatin-based protocol and oncological outcomes.Material and methodsRetrospective observational cohort study including patients diagnosed with muscle-invasive bladder carcinoma treated with NACT. Clinical, histopathological, therapeutic and evolutionary characteristics of the patients were analyzed. The use of NACT was evaluated by the complete response in the surgical specimen (pT0). This and other pathological factors were related to overall survival and progression-free survival.ResultsWe included 90 patients with muscle-invasive bladder carcinoma (clinical stage T2a-T4aN0M0) who received a cisplatin-based NACT regimen between January 2011 and December 2018, prior to radical surgery. Forty percent of patients presented an adverse reaction, with a compliance with the NACT regimen of 92.2%. There were no deaths related to systemic treatment and no adverse reaction to treatment made radical cystectomy impracticable. After performing radical cystectomy, the presence of complete response (pT0) was observed in 20 patients (21%), lower stage in the surgical specimen ( P=0.012), in patients with lymph node involvement compared to pN0 (65.4 vs. 28, 2 months, P=0.014) and in those with positive surgical margins compared to those with tumor-free margins (63.5 vs. 8.5 months, P=0.021).ConclusionThe adequate selection of patients with muscle-invasive bladder carcinoma has shown a good tolerance to NACT, with a high compliance rate prior to RC. The improvement in the complete response rate implies a greater survival in this group of patients, with lymph node involvement and positive surgical margins being important prognostic factors. (AU)

Solid-state culture of Azospirillum brasilense: a reliable technology for biofertilizer production from laboratory to pilot scale.

A biofertilizer of Azospirillum brasilense was produced in solid-state culture (SSC) from laboratory to pilot scale. Similar operation conditions (continuous aeration and mild intermittent mixing) and two dimensionless numbers with similar L/D ratio and a similar working volume were applied to reach a scale-up factor of 75. An innovative bioreactor with rotating helical ribbons (15 kg wet matter) was used at pilot scale. A mathematical model was proposed and validated to evaluate the respirometry trends at laboratory and pilot scale exhibiting similar behavior. The cell viability was (1.3 ± 0.4) × 109 and (1.3 ± 0.3) × 109 colony-forming units per gram of initial dry mass at laboratory and pilot scale, at 36 and 43 h, respectively. A. brasilense maintains its viability twelve months of storage at 4 and 30 °C. This is the first report of A. brasilense being cultivated in SSC under controlled conditions. SSC processes involving unicellular microorganisms with tolerance to agitation are a promising technology to produce biofertilizers.

Usefulness of neoadjuvant chemotherapy in non-metastatic muscle-invasive bladder cancer. / Utilidad de la quimioterapia neoadyuvante en el carcinoma vesical músculo invasivo no metastásico.

OBJECTIVE: We analyzed the profile of patients who were candidates for neoadjuvant chemotherapy (NACT) in stage pT2-4aN0M0, the tolerability and adherence of our cisplatin-based protocol and oncological outcomes. MATERIAL AND METHODS: Retrospective observational cohort study including patients diagnosed with muscle-invasive bladder carcinoma treated with NACT. Clinical, histopathological, therapeutic and evolutionary characteristics of the patients were analyzed. The use of NACT was evaluated by the complete response in the surgical specimen (pT0). This and other pathological factors were related to overall survival and progression-free survival. RESULTS: We included 90 patients with muscle-invasive bladder carcinoma (clinical stage T2a-T4aN0M0) who received a cisplatin-based NACT regimen between January 2011 and December 2018, prior to radical surgery. Forty percent of patients presented an adverse reaction, with a compliance with the NACT regimen of 92.2%. There were no deaths related to systemic treatment and no adverse reaction to treatment made radical cystectomy impracticable. After performing radical cystectomy, the presence of complete response (pT0) was observed in 20 patients (21%), lower stage in the surgical specimen (

Valor pronóstico del recuento de leucocitos y plaquetas, en tumores testiculares de células germinales / Leukocyte and platelet counts as prognostic values of testicular germ cell tumors

Introduction: The immune system plays an essential role in the organism's response to cancer. Several hematological markers can influence prognosis and survival of patients. The objective of this study is to determine their prognostic value in testicular germ cell tumors. Material and methods: Retrospective cohort study on 164 patients with germ cell tumors. Clinical, analytical, histological and evolutionary data were collected. The absolute neutrophil and absolute platelet counts, neutrophil-lymphocyte (NLR), platelet-lymphocyte and lymphocyte-monocyte ratios were estimated at diagnosis. The association that these markers can have with the classic prognostic factors, as well as their effect on prognosis and survival, have been analyzed. Results: 17.7% had NLR > 4 and 14.6% ANC > 8000/μL. These patients presented higher percentages of residual disease and stage II-III tumors. Patients with elevated absolute neutrophil showed also higher percentages of progression and exitus. 7.3% presented absolute platelet > 400,000/μL. These patients obtained higher rates of residual disease, nonseminomatous and stage III tumors. 28.4% showed platelet-lymphocyte values > 150. This data was associated to higher percentages of residual disease, progression, stage II and III tumors and seminomatous tumors. 83.3% had a lymphocyte-monocyte > 3. These patients presented: higher tumor markers in normal range, decreased residual disease rates and higher percentages of stage I and II tumors. The mean survival time was shorter in patients with NLR > 4 and absolute neutrophil > 8000/μL. The ROC curves showed significance in the prediction of progression and values of lymphocyte-monocyte >3, and prediction of survival and values NLR > 4. Conclusion: Our results indicate that the analyzed hematological markers are associated with poor prognoses at diagnosis. Therefore, their use in daily clinical practice can be a valuable tool in the diagnosis and prognosis of patients with testicular germ cell tumors

Introducción: El sistema inmune ejerce un papel clave en la respuesta del organismo frente al cáncer. Existen diversos marcadores hematológicos que pueden influir en el pronóstico y supervivencia de los pacientes. El objetivo de este estudio es determinar su valor pronóstico en tumores testiculares de células germinales. Material y métodos: Estudio de cohortes retrospectivo sobre 164 pacientes con tumores testiculares de células germinales. Se recogieron datos clínicos, analíticos, histológicos y evolutivos. Se estimaron, al diagnóstico, el recuento total de neutrófilos y plaquetas, la ratio neutrófilo-linfocito (RN/L), plaqueta-linfocito(RP/L) y linfocito-monocito (RL/M). Se analizó la relación que estos marcadores pueden tener sobre los factores pronósticos clásicos, así como sobre el pronóstico y supervivencia. Resultados: Un 17,7% tuvieron una RN/L > 4 y un 14,6% un RNT > 8000/μL. Estos enfermos, presentaron mayor porcentaje de enfermedad residual y tumores en estadios II y III. Los enfermos con recuento total de neutrófilos elevado también tuvieron mayor porcentaje de progresión y éxitus. Un 7,3%, tenían un recuento total de plaquetas > 400000/μL. Estos enfermos tuvieron un mayor porcentaje de tumores no seminomatosos, de enfermedad residual y tumores en estadio III. El 28,4% mostraron valores RP/L>150, asociándose este dato a mayor porcentaje de tumores seminomatosos, enfermedad residual, estadios II y III y progresión. El 83,3% tuvieron una RL/M > 3. Estos enfermos presentaron: mayor porcentaje de marcadores tumorales en rango normal, menor porcentaje de enfermedad residual y mayor porcentaje de pacientes en estadio I y II. El tiempo medio de supervivencia fue menor en pacientes con RN/L > 4 y con recuento total de neutrófilos > 8.000/μL. Las curvas ROC mostraron significación en la predicción de progresión y valores de RL/M > 3, y predicción de supervivencia y valores RN/L > 4. Conclusión: Nuestros resultados indican que los marcadores hematológicos analizados se asocian situaciones de mal pronóstico en el momento del diagnóstico. Por tanto, su utilización en la práctica clínica diaria puede ser considerada como una herramienta más en el diagnóstico y pronóstico de pacientes con tumores testiculares de células germinales de testículo

Leukocyte and platelet counts as prognostic values of testicular germ cell tumours. / Valor pronóstico del recuento de leucocitos y plaquetas, en tumores testiculares de células germinales.

INTRODUCTION: The immune system plays an essential role in the organism's response to cancer. Several haematological markers can influence prognosis and survival of patients. The objective of this study is to determine their prognostic value in testicular germ cell tumours. MATERIAL AND METHODS: Retrospective cohort study on 164 patients with germ cell tumours. Clinical, analytical, histological and evolutionary data were collected. The absolute neutrophil and absolute platelet counts, neutrophil-lymphocyte (NLR), platelet-lymphocyte and lymphocyte-monocyte ratios were estimated at diagnosis. The association that these markers can have with the classic prognostic factors, as well as their effect on prognosis and survival, have been analysed. RESULTS: 17.7% had NLR>4 and 14.6% ANC>8000/µL. These patients presented higher percentages of residual disease and stage II-III tumours. Patients with elevated absolute neutrophil showed also higher percentages of progression and exitus. 7.3% presented absolute platelet >400000/µL. These patients obtained higher rates of residual disease, nonseminomatous and stage III tumours. 28.4% showed platelet-lymphocyte values>150. This data was associated to higher percentages of residual disease, progression, stage II and III tumours and seminomatous tumours. 83.3% had an lymphocyte-monocyte >3. These patients presented: higher tumour markers in normal range, decreased residual disease rates and higher percentages of stage I and II tumours. The mean survival time was shorter in patients with NLR>4 and absolute neutrophil >8,000/µL. The ROC curves showed significance in the prediction of progression and values of lymphocyte-monocyte >3, and prediction of survival and values NLR>4. CONCLUSION: Our results indicate that the analysed haematological markers are associated with poor prognoses at diagnosis. Therefore, their use in daily clinical practice can be a valuable tool in the diagnosis and prognosis of patients with testicular germ cell tumours.

Metástasis vaginal de carcinoma urotelial de vía urinaria superior / Vaginal metastasis of upper urinary tract urothelial carcinoma

Las metástasis vaginales de carcinomas uroteliales han sido descritas en raras ocasiones. Presentamos un caso de carcinoma urotelial de vía urinaria superior, metastatizado en vagina, en una paciente que comenzó con un cuadro de dolor en fosa renal izquierda y hematuria. La paciente fue sometida a nefroureterectomía izquierda y escisión de la lesión vaginal. Este caso revela la variabilidad en el mecanismo de diseminación de los carcinomas uroteliales

Vaginal metastases from urothelial carcinomas have been reported in rare cases. We present a case of vaginal metastasis of upper urinary tract urothelial carcinoma in a patient who presented with pain in the left renal Fossa and haematuria. The patient underwent left nephroureterectomy and excision of the vaginal injury. This case reveals variability in the mechanism of spread of urothelial carcinomas

Extrofia vesical y vejiga rectal / No disponible

No disponible

Collateral urethral duplication in an adult.

OBJECTIVE: Congenital anomalies or malformations of the urethra that involve number are extremely rare and only 7 cases of trifurcation of the urethra and under 500 cases of urethral duplication have been described. METHODS: In the case we present, urethral duplication was diagnosed in adulthood, even though glans malformation with 2 urethral orifices was clearly evident and only 1 was functional. RESULTS: The condition is usually diagnosed in childhood due to the presence of 2 urethral meatus or from double stream if both are functional; at other times, the condition is diagnosed from complications that trigger infections or obstruction or if it is associated with more extensive malformations. CONCLUSIONS: Urethral duplication is an extremely rare birth defect, and diagnosis in adulthood is even more uncommon. No single embryologic argument explains all the anatomic variants of urethral duplication. The treatment of the urethral duplication should be individualized according to the type of duplication and the clinical symtoms.

Distribution of peptidergic populations in the human dentate gyrus (somatostatin [SOM-28, SOM-12] and neuropeptide Y [NPY]) during postnatal development.

The postnatal development of the human hippocampal formation establishes the time and place at which we start autobiographical memories. However, data concerning the maturation of the neurochemical phenotypes characteristic of interneurons in the human hippocampus are scarce. We have studied the perinatal and postnatal changes of the dentate gyrus (DG) interneuron populations at three rostrocaudal levels. Immunohistochemically identified neurons and fibers for somatostatin (SOM-12 and SOM-28) and neuropeptide Y (NPY) and the co-localization of SOM-28 and NPY were analyzed. In total, 13 cases were investigated from late pregnancy (1 case), perinatal period (6 cases), first year (1 case), early infancy (3 cases), and late infancy (2 cases). Overall, the pattern of distribution of these peptides in the DG was similar to that of the adult. The distribution of cells was charted, and the cell density (number of positive cells/mm(2)) was calculated. The highest density corresponded to the polymorphic cell layer and was higher at pre- and perinatal periods. At increasing ages, neuron density modifications revealed a decrease from 5 postnatal months onward. In contrast, by late infancy, two immunoreactive bands for SOM-28 and NPY in the molecular layer were much better defined. Double-immunohistochemistry showed that NPY-positive neurons co-localized with SOM-28, whereas some fibers contained only one or other of the neuropeptides. Thus, this peptidergic population, presumably inhibitory, probably has a role in DG maturation and its subsequent functional activity in memory processing.

Duplicidad uretral colateral en un adulto / Collateral urethral duplication in an adult

OBJETIVO: Las anomalías o malformaciones congénitas uretrales de número son muy escasas; así, se han descrito solo siete casos de trifurcación uretral 1 y no llega a quinientos de duplicación. METODOS: En el caso que presentamos el diagnóstico se hizo en edad adulta, a pesar de que era muy evidente la malformación del glande con dos orificios uretrales, aunque solo uno de ellos funcional. RESULTADOS: Suele diagnosticarse en la infancia cuando existen dos meatos uretrales, o si son ambas funcionales por efectuar micciones con doble chorro; otras veces se diagnostican por las complicaciones que pueden desencadenar, especialmente infecciosas u obstructivas o por estar asociadas a malformaciones más extensas. CONCLUSIONES: La duplicación uretral es una malformación congénita de muy escasa frecuencia, y su diagnóstico en el adulto todavía más. No existe un argumento embriológico único que explique las diferentes variantes anatómicas de duplicidad uretral. El tratamiento de la duplicidad uretral deberá ser individualizado y dependerá del tipo de duplicidad y de la clínica que provoque (AU)

OBJECTIVE: Congenital anomalies or malformations of the urethra that involve number are extremely rare and only 7 cases of trifurcation of the urethra and under 500 cases of urethral duplication have been described. METHODS: In the case we present, urethral duplication was diagnosed in adulthood, even though glans malformation with 2 urethral orifices was clearly evident and only 1 was functional. RESULTS: The condition is usually diagnosed in childhood due to the presence of 2 urethral meatus or from double stream if both are functional; at other times, the condition is diagnosed from complications that trigger infections or obstruction or if it is associated with more extensive malformations. CONCLUSIONS: Urethral duplication is an extremely rare birth defect, and diagnosis in adulthood is even more uncommon. No single embryologic argument explains all the anatomic variants of urethral duplication. The treatment of the urethral duplication should be individualized according to the type of duplication and the clinical symtoms (AU)

[Distal radius fracture: clinico-radiographic correlation after fixation with volar plate]. / Fractura de radio distal, correlación clínica-radiográfica posterior a fijación con placa volar.

UNLABELLED: The purpose of the study was to assess and correlate the clinical and radiographic results of patients with distal radius fracture treated with a volar approach and plate osteosynthesis thus identifying the factors that determine or contribute to functional results in these patients. METHODS: All patients who underwent surgical treatment for distal radius fracture with a volar approach and plate osteosynthesis from May 2010 to May 2011 were identified. They were radiographically assessed with measurements of the volar and radial angle and clinically with the Mayo Wrist Score; the correlation coefficient was used to obtain the results. RESULTS: A total of 35 patients met the selection criteria; 23 females and 12 males; mean age was 40 years (18-62); the right extremity was predominant (25:10) and was the dominant limb in 57% of cases. The assessment using the MWS was done at postoperative year one; mean score was 81 (50-100): 37% were excellent, 31% good, 26% satisfactory, and 6% poor. The correlation showed that the MWS-radial angle and the MWS-volar angle had statistically significant values with p values of 0.0001 and 0.0008 respectively, both with a 95% confidence interval. CONCLUSION: The clinical and radiographic correlation showed that the radial and volar angles are determining factors for a satisfactory course. Age, sex, the dominant limb, the number of days elapsed and the AO classification did not show statistically significant values for patient course.

Suprarrenalectomía laparoscópica transperitoneal / Transperitoneal Laparoscopic Adrenalectomy

Objetivos: Presentar nuestros resultados en suprarrenalectomía laparoscópica transperitoneal tras haber realizado 70 procedimientos. Material y métodos: Entre julio de 2002 y diciembre de 2010, 70 pacientes fueron sometidos a suprarrenalectomía laparoscópica transperitoneal con los siguientes diagnósticos: 22 de síndrome de Conn, 18 adenomas no funcionantes, 10 casos de síndrome de Cushing, 7 feocromocitomas, 4 mielolipomas, 6 casos de metástasis tras tratamiento de neoplasia primaria no adrenal, un ganglioneuroma, un hematoma de glándula suprarrenal y un carcinoma suprarrenal. Describimos el tamaño, el tiempo quirúrgico y de hospitalización, la pérdida sanguínea y la necesidad de transfusión, las complicaciones quirúrgicas y la tasa de conversión a cirugía abierta. Resultados: De los 70 pacientes 35 fueron hombres y otras 35 mujeres (1:1) con una edad media de 58,2 años (82,2 - 29,1). La localización predominante fue la izquierda (58%) frente a la derecha (42%). Con un tamaño medio de la pieza quirúrgica de 5,11cm, el tiempo quirúrgico promedio fue de 119,2 minutos (50 - 240) y el sangrado operatorio medio de 140,6 cc (30 - 800), precisando tan sólo en tres pacientes transfusión sanguínea. El período promedio para alimentación oral fue de 17 horas y la estancia media hospitalaria fue de 4,3 días (15 - 2). Como complicaciones observamos dos casos de infecciones quirúrgicas, un íleo paralítico prolongado, un caso de laceración esplénica y otro de perforación intestinal; ambos precisaron reconversión a cirugía abierta (4,28%). Conclusiones: La suprarrenalectomía por vía laparoscópica es una técnica quirúrgica segura, con un bajo porcentaje de complicaciones y que precisa breve estancia hospitalaria. La elección de esta vía de acceso dependerá de la experiencia individual del cirujano, teniendo en cuenta tanto la etiología como el tamaño de la lesión en cada caso (AU)

Objectives: To present our results with transperitoneal laparoscopic adrenalectomy after completion of 70 procedures. Material and Methods: Between July 2002 and December 2010, transperitoneal laparoscopic adrenalectomy was performed in 70 patients with the following diagnoses: Conn syndrome (22 cases), nonfunctioning adenomas (18), Cushing syndrome (10), pheochromocytomas (7), myelolipomas (4), metastasis after treatment of primary nonadrenal tumors (6), ganglioneuroma (1), adrenal gland hematoma (1) and adrenal carcinoma (1). We describe the size, surgical and hospitalization times, blood loss, need for transfusion, surgical complications and rate of conversion to open surgery. Results: Of 70 patients, 35 were men and 35 women (1:1) with a mean age of 58.2 years (range, 82.2- 29.1). The most common site was left (58%) compared to right (42%). The mean size of the surgical specimen was 5.11cm, mean surgical time was 119.2minutes (50-240) and mean operative bleeding was 140.6 (30-800) cc. Only 3 patients required blood transfusion. The mean time until oral feeding was 17hours, and the mean hospital stay was 4.3 (2-15) days. Complications included 2 cases of surgical infections, 1 of prolonged paralytic ileus, and 1 of splenic laceration and 1 of intestinal perforation which both which required reconversion to open surgery (4.28%). Conclusions: Laparoscopic adrenalectomy is a safe procedure, with a low percentage of complications and a short hospital stay. The choice of this approach will depend on the surgeon's experience with the lesion etiology and size in each case (AU)

[Transperitoneal laparoscopic adrenalectomy]. / Suprarrenalectomía laparoscópica transperitoneal.

OBJECTIVES: To present our results with transperitoneal laparoscopic adrenalectomy after completion of 70 procedures. MATERIAL AND METHODS: Between July 2002 and December 2010, transperitoneal laparoscopic adrenalectomy was performed in 70 patients with the following diagnoses: Conn syndrome (22 cases), nonfunctioning adenomas (18), Cushing syndrome (10), pheochromocytomas (7), myelolipomas (4), metastasis after treatment of primary nonadrenal tumors (6), ganglioneuroma (1), adrenal gland hematoma (1) and adrenal carcinoma (1). We describe the size, surgical and hospitalization times, blood loss, need for transfusion, surgical complications and rate of conversion to open surgery. RESULTS: Of 70 patients, 35 were men and 35 women (1:1) with a mean age of 58.2 years (range, 82.2- 29.1). The most common site was left (58%) compared to right (42%). The mean size of the surgical specimen was 5.11 cm, mean surgical time was 119.2 minutes (50-240) and mean operative bleeding was 140.6 (30-800) cc. Only 3 patients required blood transfusion. The mean time until oral feeding was 17 hours, and the mean hospital stay was 4.3 (2-15) days. Complications included 2 cases of surgical infections, 1 of prolonged paralytic ileus, and 1 of splenic laceration and 1 of intestinal perforation which both which required reconversion to open surgery (4.28%). CONCLUSIONS: Laparoscopic adrenalectomy is a safe procedure, with a low percentage of complications and a short hospital stay. The choice of this approach will depend on the surgeon's experience with the lesion etiology and size in each case.

[Ureterocalicostomy: a forgotten surgical technique?]. / La ureterocalicostomía: ¿una cirugía olvidada?

INTRODUCTION: ureterocalicostomy is a surgical technique that is rarely indicated and that urologists currently apply very occasionally. MATERIALS AND METHOD: a patient with a right pyelical retraction cicatricial process, which resulted in obstructive uropathy of the upper and mid caliceal system, excluding the lower caliceal system is presented. We performed a surgical exploration and ureterocalicostomy with successful result. In the very long term, the patient is cured and has normal kidney functionalism. RESULTS: we present the technical results of the surgery and, from a present-day perspective, we review the indications of this technique and the determining factors required to obtain good results. CONCLUSION: ureterocalicostomy is a technique that present-day urologists have almost forgotten, which still maintains some indications and premises effective. For this reason, urologists dedicated to reconstructive surgery must know this technique and include it in their surgical arsenal.

La ureterocalicostomía: ¿una cirugía olvidada? / Ureterocalicostomy: a forgotten surgical technique?

Introducción: la ureterocalicostomía es una técnica quirúrgica que tiene escasas indicaciones y que los urólogos utilizan muy raramente en la actualidad. Material y método: se presenta una paciente con un proceso cicatricial de retracción piélica derecha, que condicionaba uropatía obstructiva sobre los sistemas caliciales superior y medio, y que excluía el sistema calicial inferior. Se llevó a cabo exploración quirúrgica y se efectuó ureterocalicostomía con resultado exitoso. A muy largo plazo la paciente se encuentra curada y con normofuncionalismo renal. Resultados: se presentan los detalles técnicos de dicha cirugía y se revisan, desde una perspectiva actual, las indicaciones de esta técnica y los condicionantes necesarios para obtener un buen resultado. Conclusión: la ureterocalicostomía es una técnica casi olvidada por el urólogo actual, que mantiene vigentes aún algunas indicaciones y premisas. Por ello, debe conocerse y tenerse presente en el arsenal quirúrgico del urólogo dedicado a la cirugía reconstructiva (AU)

Introduction: ureterocalicostomy is a surgical technique that is rarely indicated and that urologists currently apply very occasionally. Materials and method: a patient with a right pyelical retraction cicatricial process, which resulted in obstructive uropathy of the upper and mid caliceal system, excluding the lower caliceal system is presented. We performed a surgical exploration and ureterocalicostomy with successful result. In the very long term, the patient is cured and has normal kidney functionalism. Results: we present the technical results of the surgery and, from a present-day perspective, we review the indications of this technique and the determining factors required to obtain good results. Conclusion: ureterocalicostomy is a technique that present-day urologists have almost forgotten, which still maintains some indications and premises effective. For this reason, urologists dedicated to reconstructive surgery must know this technique and include it in their surgical arsenal (AU)

Poliposis ureteral en la adolescencia / Urethral polyposis in adolescence

Los pólipos de aparato urinario son poco frecuentes, siendo su localización más habitual el uréter proximal. Estas lesiones benignas y con escasa tendencia a la recidiva tienen distintas formas de presentación que, en muchos casos, deben ser diferenciadas de formas malignas. Mientras que la sospecha diagnóstica de esta entidad suele ser clínica por síntomas derivados de la obstrucción urinaria, las pruebas radiológicas desempeñan un papel fundamental en el diagnóstico final. El tratamiento es lo menos invasivo posible, con resección endoscópicao cirugía mínimamente invasiva (AU)

Polyps in the urinary tract are a rare entity in infants and children. The most frequent location when they appear is the ureter. These benign lesions with no malignant potential have a varied form of presentation and in most cases must be distinguished from malignancy. The suspected diagnosis is due to urinary obstruction; nevertheless radiological evidence played a key role in the final diagnosis. The management is as less invasive as possible, with endoscopy resection orminimally invasive surgery (AU)

[Urethral polyposis in adolescence]. / Poliposis ureteral en la adolescencia.

Polyps in the urinary tract are a rare entity in infants and children. The most frequent location when they appear is the ureter. These benign lesions with no malignant potential have a varied form of presentation and in most cases must be distinguished from malignancy. The suspected diagnosis is due to urinary obstruction; nevertheless radiological evidence played a key role in the final diagnosis. The management is as less invasive as possible, with endoscopy resection or minimally invasive surgery.

[Pheochromocytoma: more than a decade of experience. Review of the literature]. / Feocromocitoma: más de una década de experiencia. Revisión de la literatura.

OBJECTIVES: We present 18 patients with pheochromocytoma in the past 12 years. MATERIAL AND METHODS: It is a retrospective observational study evaluating the clinical, biochemical and pathological most important. RESULTS: The mean age was 53.5 years with male predominance and monitoring of five years, being the most frequent incidental findings (29%). Four patients had a familial syndrome hereditary. The tumors were equally distributed with a bilateral case. For the clinical study was made and plasma catecholamines and metanephrines in urine for 24h and subjected to control blood pressure before surgery and beta blockers. Until the introduction of laparoscopic surgery in our department in 2003, the treatment of choice was open surgery. Transabdominal subcostal access was more frequent (47%) and average duration of 207 min. No patients showed metachronous tumors and two patients developed distant metastases to death in short time. CONCLUSIONS: Pheochromocytoma in a threatening disease by cardiovascular disease, which needs to perform an analytical and functional. Surgical treatment, by open or laparoscopic surgery, depending on the characteristics of the tumor and the patient, is satisfactory and comparable results.