[Study of cathepsin D levels in invasive bladder cancer and its stroma. Correlation with tumor stage, cytological grade, lymph node metastasis and survival]. / Estudio de los niveles de catepsina D en el tumor vesical infiltrante y en su estroma, y de su correlación con el estadio tumoral, grado citológico, afectación ganglionar y supervivencia.

OBJECTIVE: The aim of this study was to evaluate cathepsin D as a prognostic marker in invasive bladder cancer and to determine its relationship with stage, grade, lymph-node metastasis and survival too. MATERIAL AND METHODS: An immunohistochemical staining of 32 radical cystectomy specimens suffering from transitional cell carcinoma was performed, using a monoclonal antibody anti-cathepsin D (Novocastra). We made a semicuantitative measurement of the cathepsin D expression in the tumor and in the peritumoral stroma in a 400 x microscopic high power field. Patient population was composed of 31 men and 1 woman with a mean age of 63.25 years. The mean follow up was 23.6 months. Stage was classified with the WHO 1997 classification. Grade was classified with the ISUP/WHO 1998 classification. For the statistical analysis the Chi-square test, Pearson's test R, the Kaplan Meier method and the log-rank test were used. RESULTS: The pathological stages of the surgical specimens were as follows: pTo:3.1% (1), pT1:12.5% (4), pT2:15.6% (5), pT3:34.4% (11). (p < 0.001) A high cytologic grade was found in 81.25% of the tumors. There was a 43.8% progression rate and 40.6% mortality. There was no statistically significant relationship among Cathepsin's D levels in the stroma and lymph node metastases, stage, or grade (p = 0.473, p = 0.604, p = 0.2423). There was no statistically significant relationship among Cathepsin's D levels in the tumor and lymph node metastases, stage or grade (p = 0.496, p = 0.722 and p = 0.461). The cathepsin D levels, neither in the stroma nor in the tumor, showed no influence neither on the disease free intervals nor in the survival rates (p = 0.785; p = 0.355 and p = 0.614; p = 0.601 respectively). CONCLUSIONS: Immunohistochemical Cathepsin D levels do not seem to play a role in the prognostic of transitional tumors of the urinary bladder.

Estudio de los niveles de catepsina D en el tumor vesical infiltrante y en su estroma, y de su correlación con el estadio tumoral, grado citológico, afectación ganglionar y supervivencia / Cathepsin D levels study in invasive bladder cancer and its stroma. Correlation with tumor stage grade, lymph-node metastasis and survival

OBJETIVO: Evaluar la catepsina D como marcador pronóstico en el carcinoma transicional vesical infiltrante y determinar su relación con variables pronósticas reconocidas como son el estadio, el grado y la afectación ganglionar.MATERIAL Y MÉTODOS: Se realizó una tinción inmunohistoquímica de 32 piezas de cistectomía radical afectadas por carcinoma transicional infiltrante, practicadas entre noviembre de 1996 y mayo de 1999, con anticuerpo monoclonal anti catepsina D (Novocastra), realizando una medición semicuantitativa de la expresión de catepsina en las células tumorales y en el estroma peritumoral por campo de 400x.La serie estudiada se compuso de 31 varones y una mujer con un rango de edad entre 41 y 75 años y una edad media de 63,25 años (Desviación estandard de 8,77) y un seguimiento medio de 23,6 meses (1 a 44 meses). Los estadios se clasificaron según la clasificación de la WHO de 1997. El grado citológico se clasificó según la clasificación de la ISUP /WHO de 1998.Para el análisis de las variables se utilizó el test Chi-Cuadrado y test R de Pearson. El test de supervivencia se realizó según el método de Kaplan Meier y los niveles de significado mediante el test del logaritmo del rango (log-rank test).RESULTADOS: Los estadios diagnosticados en el momento de realizar la cistectomía fueron: pTo:3,1 per cent (1), pT1:12,5 per cent (4), pT2:15,6 per cent (5), pT3:34,4 per cent (11), pT4: 34,4 per cent (11). (p<0,001).El 81,25 per cent de los tumores fueron de alto grado citológico y el 18,75 per cent de los tumores fue de bajo grado.Se apreció afectación ganglionar en el 40,7 per cent de los casos.Existió una progresión del 43,8 per cent y una mortalidad del 40,6 per cent.No se encontraron valores significativos de asociación entre el nivel de catepsina en el estroma y el grado de afectación ganglionar, estadio tumoral o grado citológico (p=0,473, p=0,604, p=0,2423 respectivamente), ni con los niveles de catepsina tumoral y los parámetros referidos anteriormente (p=0,496, p=0,722 y p=0,461 respectivamente).Los niveles de catepsina en el estroma y tumor no mostraron influencia en los intervalos libres de enfermedad (p=0,785 y p=0,355 respectivamente) ni sobre la supervivencia (p=0,614 y p=0,601).CONCLUSIÓN: En nuestra serie la determinación semicuantitativa de los niveles de catepsina D con métodos inmunohistoquímicos no aporta información pronóstica en el tumor vesical infiltrante (AU)

[Acute renal infarction. Report of 2 cases]. / Infarto renal agudo. Presentación de dos casos.

Diagnosis of acute renal infarction is often delayed or missed due to both the rarity of the disease and its unespecific clinical presentation. Definitive radiologic diagnosis often requires invasive procedures such as angiography. Computed tomography (CT) may be useful in diagnosing acute renal infarction and is considered the standard of reference for diagnosis of acute renal infarction, with the advantage of being non-invasive and potentially available 24 hours a day. We report two cases, in the first case we show a segmentary renal infarction; at the second one we report a case of complete renal infarction. Presentation, diagnosis and therapeutic aspects are discussed.

[Crossed renal ectopy with fusion: report of a case]. / Ectopia renal cruzada con fusión: presentación de un caso.

OBJECTIVE: To present a case of crossed fused renal ectopia that was incidentally discovered in a patient consulting for abdominal pain in the emergency department. METHODS: A 46-year-old patient consulted at the emergency department for abdominal pain. Assessment by diagnostic imaging techniques demonstrated a crossed renal ectopia and associated bone anomalies. RESULTS/CONCLUSIONS: Crossed renal ectopia is an uncommon congenital anomaly and in most of the cases usually presents with fusion of both kidneys. It can also be associated with congenital anomalies of other organs. No treatment is required unless there are other complications or superimposed pathologies.

Infarto renal agudo. Presentación de dos casos / Acute renal infarction. Report of two cases

El diagnóstico del infarto renal agudo es frecuentemente tardío o inadvertido, debido a lo poco común de la enfermedad y a la inespecificidad de su presentación clínica. El diagnóstico radiológico definitivo requiere en ocasiones procedimientos invasivos como la arteriografía. La tomografía axial computerizada (TAC) es útil en el diagnóstico del infarto renal agudo, y es considerada en la actualidad como la técnica de referencia, con la ventaja de ser una técnica no invasiva y estar disponible en cualquier momento. Presentamos dos casos clínicos, uno de infarto renal agudo segmentario y otro de infarto total. Se comentan las técnicas diagnósticas así como el tratamiento y la evolución de los pacientes (AU)

[Acute lobar nephronia. Report of a pediatric case]. / Nefronía lobar aguda. Presentación de un caso en la edad pediátrica.

OBJECTIVE: A case of lobar nephronia in a child is presented. METHODS: Herein we describe a case of acute lobar nephronia in a 10-year-old boy. The clinical, diagnostic and therapeutic aspects are discussed. RESULTS/CONCLUSIONS: Acute lobar nephronia or acute focal bacterial nephritis is an uncommon form of pyelonephritis that can affect both adults and children, although few cases have been reported in children. Imaging techniques are necessary for diagnosis and to distinguish it from other conditions, such as abscess or renal masses that require a different treatment. Ultrasound is the imaging technique of choice in the diagnosis and follow-up of lobar nephronia.

[Hydatidosis in a single location]. / Enfermedad hidatídica de localización única.

Hydatidosis in our country an important health problem because of its high prevalence. We present a case of renal Hydatidosis in which we point out the renal single location of the disease and emphasize that MRI helped us to find a correct preoperative diagnosis.

[The role of urethral catheterization in penile necrosis]. / Papel del sondaje uretral en la necrosis peneana.

Isolated penile necrosis is a rare entity, its main causes are diabetes mellitus and chronic renal failure. Only two cases related with urethral catheterization have been published in the literature. We present a case of penile necrosis in a patient with a Foley catheter, the possible role of the catheter in the etiology and its management are discussed.

[Leydig cell tumor: report of 2 cases]. / Tumor de células de Leydig: presentación de dos casos.

Tumors from the gonadal stroma represent 4% among testicular tumors. Leydig cell tumors are the most common neoplasms among them and account for 1-3% of all testicular tumors. Two cases of testicular Leydig cell tumors in adult patients are presented. Presentation, diagnosis and therapeutic aspects are discussed. Both were treated with radical orchiectomy through an inguinal approach. Cas 1 was diagnosed in a cryptorchid testis and developed hepatic metastasis that were successfully treated with chemotherapy. Cas 2 was incidentally diagnosed on ultrasound. Both of them remain alive and free of disease.

[Bilateral candida bezoar of the upper urinary tract]. / Bezoar candidiásico bilateral del tracto urinario superior.

Fungal urinary tract infections are due to candida albicans as first responsible germ. This sporulated oval fungus divides itself by gemmation and produces pseudohyphas when it is spread in culture mediums, organic tissues or their exudates. The most frequent predisposing factor is diabetes mellitus. Others predisposing factors are: long antibiotic administration, corticoids, immunosuppressors, neoplasias, neurogenic bladder, and catheter or foreign bodies into the urinary tract. Bezoar formation is a rare complication that sometimes produces obstructive uropathy. Although Candida albicans is the most frequent observed germ in bezoars, Candida tropicalis, Penicillium, Aspergillus, Mucor y Turolopsis have been found as well. We present the case of a diabetic patient with a bilateral bezoar formation into the upper urinary tract due to Candida albicans. Clinical features, diagnosis and treatment are described emphasizing in the are bilateral onset.

[Evaluation of urology training of resident internal physicians of the Valencian community. Quality control]. / Evaluación de la formación urológica de los médicos internos residentes de la comunidad valenciana. Control de calidad.

Report on the results of a survey conducted among Urology residents in the Valencian Community. Evaluation of the training level of the MIR system, both overall and by areas. Presentation of the views obtained with regard to possible modifications to raise their training level and improve their professional future.

[Congenital anterior urethral diverticulum]. / Divertículo uretral anterior congénito.

Contribution of one case report of congenital urethral diverticulum, located in the anterior urethra with narrow opening, that occurred in an adult male patient as a post-traumatic urethrorrage and presented with no obstructive symptomatology. The occasional incidence, etiology and atypical presentation form of this entity are examined. The diagnostic features, where urethrocystography still prevails, as well as the surgical alternatives are also discussed.