Punción accidental de la arteria ilíaca durante retirada de Catéter Doble J por ureteroscopia, una complicación nodescrita / Accidental puncture of the iliac artery when pulling back a double J by ureteroscopy, an undescribed complication

La punción de la arteria iliaca durante ureteroscopia es una complicación rara pocas veces descrita en la literatura pero potencialmente grave. La ureteroscopia es un procedimiento seguro para el diagnóstico y tratamiento de la patología del tracto urinario superior. Presentamos por tanto, un caso clínico no muy frecuente como llamada de atención para todos a no subestimar ningún tipo de acto quirúrgico, y que demuestra la importancia de la comunicación entre todos los profesionales que cuidamos del paciente durante una cirugía. Por último queremos llamar la atención sobre la mascarilla laríngea que permitió una ventilación eficaz de la paciente durante todo el procedimiento (AU)

SUMMARY: the puncture of the iliac artery during an ureteroscopy is a rare complication seldom described in the literature but potentiallyserious. Ureteroscopy is a safe procedure for diagnosis and treatment of the pathology of the higher urinary tract. We present a clinical case as a warning not to underestimate any surgical procedure. This case emphasizes the importance of communication among all medical personnelwho participate in a surgical procedure. Finally we wish to draw attention to the laryngeal mask that allowed the efficient ventilation of the patient during the whole procedure (AU)

[Value of positive resection margins in patients with pT2 prostate cancer. Implications for adjuvant treatment]. / Valor de los márgenes quirúrgicos de resección positivos en lospacientes con cáncer de próstata pT2. Implicaciones en eltratamiento adyuvante.

OBJECTIVE: To analyse the impact on the recurrence-free biochemical survival of tumour involvement of surgical resection margins in patients with localized prostate cancer (pT2) in the prostatectomy specimen and its implications for adjuvant treatment. MATERIALS AND METHOD: Retrospective study of 536 patients with stage pT2 prostate cancer, treated with radical prostatectomy between 1996 and 2007. Subsequent to the prostatectomy, the following variables were collected: Gleason score, pathological stage, capsular invasion, surgical margins and perineural invasion. We performed a univariate analysis and subsequently adjusted it by means of a Cox proportional hazard model (enter method). RESULTS: 21.7% presented positive surgical margins and 20.9% developed biochemical recurrence after a mean follow-up of 57 months. 37.9% of the patients with pathological involvement of the resection surgical margins presented biochemical recurrence against 16% that did not have it (p<0.001). In the multivariate analysis, only the surgical margin (p<0.001) and the Gleason score greater or equal to 8 (p<0.001) behaved as independent biochemical recurrence factors. On stratifying the series according to these two variables, we found that the patients with positive surgical margins and a Gleason score of ≤ 7 have a recurrence probability at 5 and 10 years of 35% and 50% against 74% and 87% in the group with positive surgical margins and a Gleason score of ≥ 8 (p=0.002). CONCLUSION: Patients with pT2 prostate cancer, positive surgical margins and a Gleason score of ≥ 8 will benefit from adjuvant radiotherapy. 50% of the patients with positive margins and a Gleason score of ≤ 7 will not recur, which means that the indication of adjuvant radiotherapy continues to be controversial.

Second cadaveric kidney transplantations in the pediatric population.

OBJECTIVE: To evaluate the functional outcomes and complications among a series of second in comparison to first kidney transplantations in pediatric patients. MATERIALS AND METHODS: We reviewed 163 consecutive kidney transplants in pediatric recipients performed from 1978 to present: 120 cases (69.3%) were first transplants (group A) and 43 (24.8%), second transplant (group B). We analyzed the incidences of delayed graft function (DGF), medical and surgical complications, as well as medium- and long-term graft survivals. RESULTS: We observed DGF among 51 group A patients (43%) versus 32.5% of group B. Ten patients suffered vascular complications in group A (8.3%) versus one in group B (2.3%) (P < .05). The 15-year graft survivals were 54.2% for group A and 45% for group B. The 15-year patient survivals were 84.9% in group A versus 93.6% in group B. CONCLUSIONS: Second kidney transplantations for children are a satisfactory option that achieves good functional results as well as acceptable graft and patient survivals.