Breast density in NF1 women: a retrospective study.

Neurofibromatosis type 1 (NF1) is an autosomal dominant condition caused by neurofibromin haploinsufficiency due to pathogenic variants in the NF1 gene. Tumor predisposition has long been associated with NF1, and an increased breast cancer (BC) incidence and reduced survival have been reported in recent years for women with NF1. As breast density is another known independent risk factor for BC, this study aims to evaluate the variability of breast density in patients with NF1 compared to the general population. Mammograms from 98 NF1 women affected by NF1, and enrolled onto our monocentric BC screening program, were compared with those from 300 healthy subjects to verify differences in breast density. Mammograms were independently reviewed and scored by a radiologist and using a Computer-Aided Detection (CAD) software. The comparison of breast density between NF1 patients and controls was performed through Chi-squared test and with multivariable ordinal logistic models adjusted for age, body mass index (BMI), number of pregnancies, and menopausal status.breast density was influenced by BMI and menopausal status in both NF1 patients and healthy subjects. No difference in breast density was observed between NF1 patients and the healthy female population, even after considering the potential confounding factors.Although NF1 and a highly fibroglandular breast are known risk factors of BC, in this study, NF1 patients were shown to have comparable breast density to healthy subjects. The presence of pathogenic variants in the NF1 gene does not influence the breast density value.

Evaluación del virus del papiloma humano en varones: primera revisión exhaustiva de la literatura / The role of human papilloma virus test in men: First exhaustive review of literature

La infección por el virus del papiloma humano (VPH) es la enfermedad de transmisión sexual más común en todo el mundo. Hay una alta tasa de detección en jóvenes sexualmente activos y además el riesgo en los varones persiste durante años. Actualmente, el Centro Americano para el Control y Prevención de Enfermedades no recomienda la evaluación del VPH en hombres, y, por diversas razones, la bibliografía existente respalda esta postura. El objetivo del artículo fue evaluar la utilidad de los métodos de detección del VPH en hombres; se realizó una revisión completa y exhaustiva de la literatura. Muchos son los métodos para la detección del VPH utilizados en el cribado del cáncer cervical, así como en el estudio y manejo de pacientes con alteraciones citológicas del tracto genital inferior. La necesidad de disponer de métodos de detección del VPH en los hombres se debe a diversos motivos: para el cribado por pareja o género; verrugas anogenitales; papilomatosis respiratoria recurrente; cánceres relacionados con el VPH en hombres y fertilidad. La FDA no ha aprobado ninguna prueba de VPH para hombres, ni ninguna para detectar el virus en otras áreas que no sean el cérvix o cuello uterino. Muchos de estos métodos de detección del VPH han mostrado su utilidad en algunas de las patologías asociadas con VPH masculino, pero a pesar de esto, ninguno de ellos ha sido aprobado para hombres

Human papilloma virus (HPV) infection is the most common sexually transmitted infection worldwide. There is a high detection rate in sexually active young people but the risk, in males, persists over years. Currently, the American Center for Disease Control and Prevention does not recommend the evaluation of men for HPV and, the extant bibliography, backs up this stance for several reasons. Objective of the paper was to evaluate the usefulness of HPV detection methods for men; A comprehensive and exhaustive review of the literature was performed. Many are methods for HPV detection used in cervical cancer screening as well as in the study and management of patients with cytological alterations of the lower genital tract. Need for HPV detection methods in men are numerous: screening for both partner/gender; anogenital warts; recurrent respiratory papillomatosis; HPV-related cancer in men; fertility. No HPV test for men has been approved by the FDA, nor has any test been approved for detection of the virus in areas other than the cervix. Many are methods for HPV detection that have shown their usefulness in some of the pathologies associated with male HPV but, despite this, none of them has been approved for man

The role of human papilloma virus test in men: First exhaustive review of literature. / Evaluación del virus del papiloma humano en varones: primera revisión exhaustiva de la literatura.

Human papilloma virus (HPV) infection is the most common sexually transmitted infection worldwide. There is a high detection rate in sexually active young people but the risk, in males, persists over years. Currently, the American Center for Disease Control and Prevention does not recommend the evaluation of men for HPV and, the extant bibliography, backs up this stance for several reasons. Objective of the paper was to evaluate the usefulness of HPV detection methods for men; A comprehensive and exhaustive review of the literature was performed. Many are methods for HPV detection used in cervical cancer screening as well as in the study and management of patients with cytological alterations of the lower genital tract. Need for HPV detection methods in men are numerous: screening for both partner/gender; anogenital warts; recurrent respiratory papillomatosis; HPV-related cancer in men; fertility. No HPV test for men has been approved by the FDA, nor has any test been approved for detection of the virus in areas other than the cervix. Many are methods for HPV detection that have shown their usefulness in some of the pathologies associated with male HPV but, despite this, none of them has been approved for man.

A natural pharma standard supplement formulation to control treatment-related toxicity and oxidative stress in genitourinary cancer: a preliminary study.

OBJECTIVE: Oncological treatments are associated with toxicities that may decrease compliance to treatment in most genitourinary cancer patients. Supplementation with pharmaceutical-standardized supplement may be a supplementary method to control the side effects after chemo- and radiotherapy and the increased oxidative stress associated to treatments. This registry study evaluated a natural combination of supplements containing curcumin, cordyceps, and astaxanthin (Oncotris™) used as supplementary management in genitourinary cancer patients who had undergone oncological therapy. PATIENTS AND METHODS: Patients with genitourinary cancers (prostate or bladder malignancies) who had undergone and completed cancer treatments (radiotherapy, chemotherapy or intravesical immunotherapy with increased oxidative stress and residual symptoms) were recruited in this registry, supplement study. Registry subjects (n = 61) freely decided to follow either a standard management (SM) (control group = 35) or SM plus oral daily supplementation (supplement group = 26). Evaluation of severity of treatment-related residual side effects, blood count test, prostate-specific antigen (PSA) test and plasma free radicals (oxidative stress) were performed at inclusion and at the end of the observational period (6 weeks). RESULTS: Two patients dropped out during the registry. Therefore, the analysis included 59 participants: 26 individuals in the supplementation group and 33 in the control group. In the supplement group, the intensity of signs and symptoms (treatment-related) and residual side effects significantly decreased at 6 weeks: minimal changes were observed in controls. Supplementation with Oncotris™ was associated with a significant improvement in blood cell count and with a decreased level of plasmatic PSA and oxidative stress. CONCLUSIONS: Naturally-derived supplements, specifically Oncotris™ (patent pending), could support the body to overcome the treatment-related toxicities - and the relative oxidative stress in cancer patients.

Colonization by multidrug-resistant organisms in long-term care facilities in Italy: a point-prevalence study.

OBJECTIVES: To determine prevalence and risk factors for colonization by multidrug-resistant organisms (MDROs) in long-term care facility (LTCF) residents in Italy. Genotypes of MDRO isolates were investigated. METHODS: A point-prevalence study was conducted at 12 LTCFs located in four Italian cities (2 February to 14 March 2015). Rectal swabs, faeces and nasal/auxiliary swabs were cultured for extended-spectrum ß-lactamase (ESBL)- and/or carbapenemase-producing Enterobacteriaceae, Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) respectively. Antimicrobial susceptibility testing, detection of ESBL and/or carbapenemase genes and molecular typing of MDROs were performed. Risk factors for colonization were determined by univariate and multivariate analysis. RESULTS: A total of 489 LTCF residents aged ≥65 years were enrolled. The prevalence of colonization by ESBL-producing Enterobacteriaceae, MRSA and C. difficile was 57.3% (279/487), 17.2% (84/487) and 5.1% (21/409) respectively. Carriage rate of carbapenemase-producing Enterobacteriaceae was 1% (5/487). Being bedridden was a common independent risk factor for colonization by all MDROs, although risk factors specific for each MDRO were identified. ESBL-producing Escherichia coli carriage was associated with the sequence type (ST) 131-H30 subclone, but other minor STs predominated in individual LTCF or in LTCFs located in the same city, suggesting a role for intrafacility or local transmission. Similarly, MRSA from LTCF residents belonged to the same spa types/ST clones (t008/ST8 and t032/ST22) commonly found in Italian acute-care hospitals, but infrequent spa types were recovered in individual LTCFs. The prevalent C. difficile PCR ribotypes were 356/607 and 018, both common in Italian acute-care hospitals. CONCLUSIONS: MDRO colonization is common among residents in Italian LTCFs.

Polymorphisms of dopamine receptor genes and risk of visual hallucinations in Parkinson's patients.

BACKGROUND: Visual hallucinations (VHs) are frequent non-motor complication of Parkinson's disease (PD), associated to a negative prognosis. Previous studies showed an association between dopamine receptor (DR) gene (DR) variants and psychosis in Alzheimer's disease, addictions, schizophrenia, and bipolar disorder. However, there are only a few studies on DR variants and VHs in PD, which did not provide conclusive results. OBJECTIVES: The present study aimed to determine whether genetic differences of DR are associated with visual hallucinations (VHs) in a cohort of Parkinson's disease (PD) patients. METHODS: A case-control study of 84 PD subjects, 42 with and 42 without VHs,that were matched for age, gender, disease duration, and dopaminergic medication was conducted. Polymerase chain reaction for SNPs in both D1-like (DRD1A-48G [rs4532] and C62T [rs686], DRD5T798C [rs6283]) and D2-like DR (DRD2G2137A [rs1800497] and C957T [rs6277], DRD3G25A [rs6280] and G712C [rs1800828], DRD4C616G [rs747302] and nR VNTR 48bp) analyzed genomic DNA. RESULTS: Patients carrying allele T at DRD1C62T had an increased risk of VHs, expressed as OR (95 % CI, p value), of 10.7 (2.9-40, p = 0.0001). Moreover, patients with DRD1-48 GG and 62TT genotype displayed shorter time to VHs, whereas a longer time to VHs was found in subjects carrying the DRD4 CG alleles. CONCLUSIONS: PD patients with VHs display higher frequency of DR SNPs associated with increased D1-like activity and decreased D2-like activity. Our data are in line with associations reported in other neurodegenerative and psychiatric conditions. Results likely provide valuable information for personalizing pharmacological therapy in PD patients.

Surgical treatment of Peyronie's disease with small intestinal submucosa graft patch.

The objective of the study was to report our results using a porcine small intestinal submucosa graft (Surgisis ES, Cook Medical) for tunica albuginea substitution after plaque incision. We retrospectively evaluated patients surgically treated at our institution for Peyronie's disease (PD) by means of plaque incision and porcine small intestinal submucosa grafting (Surgisis) between 2009 and 2013. At the same time a literature review was conducted, searching for similar reports and results. Forty-four patients were identified who had been diagnosed with PD between 2009 and the beginning of 2013, and had been treated with corporoplasty, plaque incision and grafting with Surgisis for a severe curvature of the penis. Curvature of the penis was dorsal in 40 patients (90%) and laterally on the right in 4 patients (10%). Mean duration of surgery was 165 min (range 90-200). Mean size of the graft was 6.5 cm(2) and the mean follow-up was 19.2 months (range 11-48). In patients with severe curvature of the penis due to PD and the need for corporoplasty with plaque incision and graft placement, Surgisis represents a good option with a low risk of complications, below the rate described with previously investigated graft tissues.

Anti-inflammatory effects exerted by Killox®, an innovative formulation of food supplement with curcumin, in urology.

OBJECTIVE: In this Open Controlled Trial we administered an innovative formulation of food supplement with curcumin (Killox®) to test its efficacy, safety and compatibility with other drugs, in the therapy of post-surgery complications of transurethral resection of prostate (TURP) and transurethral resection of bladder (TURB), and in the prevention of late complications. Furthermore, Killox® effects were verified in subjects with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Killox® was administered to 40 TURP patients for 20 days, to 10 TURB patients for 10 days and to 30 BPH patients for 60 days. The study was an open controlled trial, approved by the internal Review Board, with a completely independent set of retrospective observations. RESULTS: In the subjects who underwent surgery the treatment warded off postoperative and late complications, whereas among controls, without anti-inflammatory therapy after surgery until one week later, 21 (52.5%) out of 40 TURP subjects and 4 (40%) out of 10 TURB subjects were still found with symptoms of inflammation and urinary burning, and they had to be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) for seven days. Moreover among controls 2 in TURP group presented an urethral stricture, and no one in TURB group. Killox® patients did not report any adverse effect and the therapy was well tolerated, instead among 21 control subjects, who were treated with NSAIDs, 7 reported nausea and epigastric pain. Also in BPH patients the product was effective in a satisfying manner, shortening the duration of irritation symptoms. Noteworthy, Killox® administration did not modify the efficacy of the other treatments. The effect of Killox® was found statistically significant vs controls. CONCLUSIONS: The therapeutic activity and safety of Killox® in urology allow physicians to administer a new efficient product in substitution of NSAIDs.

Use of herbal remedies by multiple sclerosis patients: a nation-wide survey in Italy.

Though recent progress in multiple sclerosis (MS) treatment is remarkable, numerous unmet needs remain to be addressed often inducing patients to look for complementary and alternative medicines (CAM), especially herbal remedies (HR). HR use, scarcely investigated in MS, may cause adverse reactions (AR) and interfere with conventional treatment. We performed a survey aimed at evaluating use and attitudes towards HR and factor associated to HR use. Other CAM use and attitudes have been investigated as well. Multiple-choice questionnaires were distributed to MS out patients attending 14 Italian referral Centers. Multivariable logistic regression was used to identify HR use determinants. Present/past HR use for either MS or other diseases was reported in 35.6 % of 2419 cases (95 % CI 36.0-40.0 %). CAM use was reported in 42.5 % of cases. Independent predictors of HR use were represented by higher education, geographic area, dissatisfaction with conventional treatment of diseases other than MS and benefit perception from CAM use. Both HR and CAM use were not always disclosed to the healthcare professional. In conclusion, HR and other CAM appear to be popular among MS patients. The involvement of the healthcare professionals appears to be scarce with potential risk of AR or interference with conventional treatments.

ALERGIA A LA PROTEíNA DE LA LECHE DE VACA. EVALUACIóN DE SU RESOLUCIóN ESPONTáNEA POR MEDIO DE DESAFíOS DOBLE CIEGO PLACEBO CONTROLADOS / cows milk allergy. an assesment of its spontaneous resolution through double blind placebo controlled challenges.

Introducción. la alergia a la leche de vaca (aplv) es un problema sanitario global. Su diagnóstico adecuado y su seguimiento son esenciales ya que la leche de vaca es un alimento importante en la dieta de muchos lactantes. los desafíos orales doble ciego controlados por placebo (ddcpc) son la herramienta ideal para el diagnóstico y seguimiento de las alergias alimentarias. este estudio describe las características evolutivas de pacientes con aplv y las posibles variables que la pudieran modificar. material y métodos. Se estudiaron pacientes con diagnóstico de aplv previo con desafíos abiertos. Se catalogaron las reacciones de acuerdo a la normativa dracma. positivas fueron las pruebas en las que se presentaron alteraciones clínicas o variaciones hemodinámicas. negativas fueron aquellas en las que el paciente toleró la leche. Se consideraron edades de inicio y de realización del ddcpc, sexo y patología de aplv. resultados. Se estudiaron 106 pacientes (50 masculinos, 56 femeninos), promedio edad de inicio de síntomas 5,31 m (rango: 1-48 meses) y al procedimiento 23,14 m (5 meses - 5 años), y 13 pruebas positivas. un conjunto se refirió al mecanismo fisiopatológico y se dividió en ige mediadas (n=55) con 8 pruebas positivas y mixtas/celulares (n=51) con 5 pruebas positivas. otro conjunto fueron no gastrointestinales (n=61) con 7 pruebas positivas y gastrointestinales (n=45) con 6 pruebas positivas. todos los grupos fueron similares en cuanto a las variables demográficas. el sexo masculino y el diagnóstico de anafilaxia fueron factores de riesgo para no resolver su aplv (p=0,0125 y p=0,002 respectivamente). conclusiones. el momento de resolución de la aplv es independiente del mecanismo fisiopatológico subyacente o la edad de inicio de los síntomas. en general resuelven el problema de manera espontánea hacia los dos años de vida en más de un 87% de los casos. el sexo masculino (en ige mediadas) y el antecedente de anafilaxia podrían ser factores de riesgo para tener menos probabilidades de resolver la APLV. (AU)

Introduction: cow´s milk allergy (cma) is a global health issue. a proper diagnosis and follow up become essential. double blind placebo controlled challenges (dbpcc) is the gold standard for this purpose. this paper describes clinical evolution and characteristics of cma, as well as variables that may modify the affection course. methods & material: a group of patients, with a previous diagnosis of cma by open challenges, has been studied and its results cataloged according to dracma guidelines. tests with hemodynamic changes or clinical symptoms were considered as positives, while those with no clinical reaction were considered as negatives. variables involved were: age of symptoms starting, age of dbpcc performing, gender and cma clinical manifestations. results: 106 patients has been studied (50 male, 56 female), with a median age of 5,31 mo (range 5 ­ 48 mo) at the starting symptoms, and a median age of 23,14 mo (range 5 mo ­ 5 y) at the performing of dbpcc. 13 tests were negative. as regards to the different immune mechanisms, 55 were ige dependent (8 negative), and 51 were mediated by mixed/cellular (5 negative). patients were divided into two groups: with gastrointestinal symptoms (n=45) and with no gastrointestinal symptoms (n=61). they showed 6 and 7 negative results, respectively. all groups were similar. male gender, and anaphylaxis diagnosis turned out to be risk factors not to resolve cma (p=0,0125 and p=0,002 respectively). conclusions: cma resolution is independent of the immune mechanisms involved or the age of its symptoms starting. cma is solved spontaneously towards the age of two in 87% of the cases. male gender, and anaphylaxis may become risk factors not to resolve cma.(AU)

Placement of port-a-cath through the right internal jugular vein under ultrasound guidance.

PURPOSE: This study was undertaken to demonstrate the effectiveness of ultrasound (US)-guided placement of porta-cath (PC) through the right internal jugular vein (RIJV) by evaluating the onset of early and late complications. MATERIALS AND METHODS: From 30 June 2008 to 30 June 2011, we placed 695 port-a-caths in 694 patients with a mean age of 58 years. Exclusion criteria were active infection, bleeding disorders and life expectancy <6 months. The procedures were performed in the angiography suite under local anaesthesia. After US-guided puncture of the RIJV, the subcutaneous pocket was prepared, followed by tunnelling of the vein and closure of the surgical wound. In order to evaluate pneumothorax (PNX), all patients underwent chest X-ray a few hours after the end of the procedure unless there were clinical indications. We evaluated the technical success of the procedure and the rate of complications. RESULTS: Technical success was achieved in all cases. The device was kept in place for an average of 168 days. There was one case of PNX (0.14%) as shown on chest X-ray and five cases of late complications (0.70%): one case of intracatheter thrombosis (0.14%), two cases of disconnection between the reservoir and catheter (0.28%) and two cases of PC infection (0.28%). CONCLUSIONS: This procedure incurs very small number of complications compared with other positioning techniques using accesses such as the subclavian vein. Complications recorded in our study are comparable, in type and incidence, to those found by other authors, with the most frequent being device infection.

The use of mannitol in partial and live donor nephrectomy: an international survey.

PURPOSE: Animal studies have shown the potential benefits of mannitol as renoprotective during warm ischemia; it may have antioxidant and anti-inflammatory properties and is sometimes used during partial nephrectomy (PN) and live donor nephrectomy (LDN). Despite this, a prospective study on mannitol has never been performed. The aim of this study is to document patterns of mannitol use during PN and LDN. MATERIALS AND METHODS: A survey on the use of mannitol during PN and LDN was sent to 92 high surgical volume urological centers. Questions included use of mannitol, indications for use, physician responsible for administration, dosage, timing and other renoprotective measures. RESULTS: Mannitol was used in 78 and 64 % of centers performing PN and LDN, respectively. The indication for use was as antioxidant (21 %), as diuretic (5 %) and as a combination of the two (74 %). For PN, the most common dosages were 12.5 g (30 %) and 25 g (49 %). For LDN, the most common doses were 12.5 g (36.3 %) and 25 g (63.7 %). Overall, 83 % of centers utilized mannitol, and two (percent or centers??) utilized furosemide for renoprotection. CONCLUSIONS: A large majority of high-volume centers performing PN and LDN use mannitol for renoprotection. Since there are no data proving its value nor standardized indication and usage, this survey may provide information for a randomized prospective study.

La re-resección transuretral puede no ser necesaria en todos los tumores vesicales no músculo-invasivos de alto grado / A Second Transurethral Resection Could Be not Necessary in All High Grade Non-muscle-invasive Bladder Tumors

Objetivo: Evaluar la tasa de persitencia, infraestadificación y complicaciones perioperatorias en pacientes con tumor no músculo-invasivo de alto grado que han sido sometidos a re-resección transuretral (re-RTU). Material y métodos: Revisión retrospectiva de 47 pacientes con estadio clínico de tumor vesical de alto grado no músculo-invasivo sometidos a re-RTU entre enero de 2007 y diciembre de 2009 en nuestro centro. Evaluamos la tasa de tumor residual (persistencia) y de infraestadificación, así como las complicaciones quirúrgicas y el coste de la re-RTU. Resultados: En 22 casos se indicó la re-RTU por ausencia de muscular propia en el espécimen (cTx). Observamos tumor residual en 8/47 pacientes (17%) e infraestadificación en 2 casos (4,2%), en los 2 únicos pacientes infraestadificados no se había observado muscular propia en el espécimen de la RTU inicial. Los 20 cTx restantes (90%), fueron cT0 en la re-RTU. No observamos ningún caso de cT1 en los que en la re-RTU apareciera infraestadiaje (igual o mayor cT2). Seis pacientes (12,6%) presentaron complicaciones secundarias a la re-RTU (una estenosis uretral, 2 reintervenciones por sangrado, una infección urinaria febril y 2 perforaciones vesicales). Conclusiones: En nuestro estudio la ausencia de muscular en el espécimen de la RTU es el único factor de riesgo de infraestadificación. Es por ello que en estos casos consideramos que la re-RTU es obligatoria. Por el contrario, en los casos donde la RTU ha sido completa y la muscular se encuentra libre de tumor (cTa-T1) creemos que la re-RTU sistemática es innecesaria, solo indicada en casos concretos y más no estando exenta de complicaciones (AU)

Objectives: Evaluate the rate of residual tumor, understaging and perioperative complications in patients with high grade non-muscle-invasive bladder cancer who underwent second transurethral resection (re-TUR). Material and methods: A retrospective review of 47 patients with high grade non-muscle-invasive bladder cancer who underwent second TUR from January 2007 to December 2009 at our institution. We evaluated the rate of residual tumor and understaging detected by re-TUR, complications, and the cost of the surgery. Results: Twenty-two patients underwent second TUR because of the absence of muscle in the initial resection specimen (cTx). We observed residual disease in 8/47 patients (17%) and understaging in 2 cases (4.2%), the only 2 patients understaged muscularis propria was not present in the sample of initial TUR. The other 20 cTx (90%) were cT0 in the re-TUR. We did not identify any case of cT1 understaged in the re-TUR (major cT2). Six patients (12.6%) reported complications related with the second TUR (one urethral stricture, two patients required reintervention because of bleeding, one febrile urinary infection and two bladder perforations). Conclusions: Our findings show that the absence of muscle in the initial resection specimen is the only risk factor for understaging. Therefore, we consider re-TUR is mandatory in these cases. On the other hand, when complete TUR has been performed and the muscularis propria is present and tumor free (cTa-T1), we consider systematic re-TUR is not necessary and only indicated in selected patients, even more if we consider that re-TUR is not exempt from complications (AU)

Actualización en el manejo de la litiasis pediátrica / Update in the management of pediatric lithiasis

Entre el 5% y el 10% de la población mundial sufre litiasis pero solo del 0,5 al 5% son niños. Es poco frecuente en países desarrollados, y endémico en países en vías de desarrollo. Puede afectar a cualquier edad y localización, pero la mayoría se presenta en el tramo urinario superior, exepto en los países en vías de desarrollo que se ubica más frecuentemente en la vejiga. En un proceso multifactorial, pero los cambios en la alimentación, la obesidad infantil y la disminución en la ingesta hídrica pueden aumentar su prevalencia en edad pediátrica. La clínica es variable según la edad. La microhematuria es más constante , sobre todo en niños pequeños. La ecografía y la TAC son los métodos auxiliares más utilizados para su diagnóstico y localización. El manejo ha cambiado con los avances tecnológicos, la elección del tratamiento depende de la edad, el número, tamaño , localización, composición de la litiasis y posibilidades de cada centro. La mayoría de las litiasis pueden ser tratadas con procedimientos mínimamente invasivos, como LEOC o ureteroscopia. La NLP es de elección para las litiasis renales de gran tamaño o refractarias a LEOC. La cirugía abierta se deja para casos muy seleccionados (AU)

It is uncommon in developed countries and endemic in developing countries. It can occur at any age and localization, but mostly occurs in the upper urinary trat with the exeption of in developing countries where the most frequent location is in the bladder. It is a multifactorial process, however changes in nutrition, childhood obesity and decrease in water intake may increase its prevalence in the pediatric age. Symptoms vary according to aged. Microhematuria is the most constant, above all in small children. Ultrasonography and CT scan are the most used auxiliary methods for its diagnoses and localization. Its management has changed with technological advances, the choice of treatment depends on age, number, size, localization, composition of the lithiasis and possibilities of each center. Most lithiases can be treated with minimally invasive procedures such as the extracorporeal shockwave lithotripsy (ESWL) or ureteroscopy. The percutaneous nephrolithotomy (PCNL) or ureteroscopy. The percutaneous nephrolithotomy (PCNL) is of choice for large sized renal lithiasis or those refractory to ESWL. Open surgery is reserved for very select cases (AU)

[A second transurethral resection could be not necessary in all high grade non-muscle-invasive bladder tumors]. / La re-resección transuretral puede no ser necesaria en todos los tumores vesicales no músculo-invasivos de alto grado.

OBJECTIVES: Evaluate the rate of residual tumor, understaging and perioperative complications in patients with high grade non-muscle-invasive bladder cancer who underwent second transurethral resection (re-TUR). MATERIAL AND METHODS: A retrospective review of 47 patients with high grade non-muscle-invasive bladder cancer who underwent second TUR from January 2007 to December 2009 at our institution. We evaluated the rate of residual tumor and understaging detected by re-TUR, complications, and the cost of the surgery. RESULTS: Twenty-two patients underwent second TUR because of the absence of muscle in the initial resection specimen (cTx). We observed residual disease in 8/47 patients (17%) and understaging in 2 cases (4.2%), the only 2 patients understaged muscularis propria was not present in the sample of initial TUR. The other 20 cTx (90%) were cT0 in the re-TUR. We did not identify any case of cT1 understaged in the re-TUR (≥cT2). Six patients (12.6%) reported complications related with the second TUR (one urethral stricture, two patients required reintervention because of bleeding, one febrile urinary infection and two bladder perforations). CONCLUSIONS: Our findings show that the absence of muscle in the initial resection specimen is the only risk factor for understaging. Therefore, we consider re-TUR is mandatory in these cases. On the other hand, when complete TUR has been performed and the muscularis propria is present and tumor free (cTa-T1), we consider systematic re-TUR is not necessary and only indicated in selected patients, even more if we consider that re-TUR is not exempt from complications.

¿Es posible una vejiga artificial? Progresos en las últimas décadas / Is it possible an artificial bladder? Progress in the last decades

El carcinoma de células transicionales de vejiga (CCTV) es el tumor maligno más frecuente del tracto urinario, y su incidencia va en aumento. Dependiendo del estadio del tumor, los tratamientos pueden variar de más conservador a otros como la cirugía radical. En el CCTV invasor de la vejiga el tratamiento estándar es la cistectomía radical con linfadenectomía extendida y la configuración de una bolsa continente o no continente (conducto/neo-vejiga). La reconstrucción de la neovejiga se logra usando segmentos de intestino destubulizados. Por desgracia, la cirugía intestinal presenta la posibilidad de complicaciones postoperatorias como fístulas, infecciones, trastornos metabólicos. Desde la década de 1960 los urólogos y los científicos, así como la industria biotecnológica han tratado de evitar el uso de intestino, recurriendo al uso de materiales sintéticos o biológicos alternativos para reconstruir la vejiga. Pero pese a los avances tecnológicos y de conocimiento biomédico, los resultados han sido bastante desalentadores hasta la actualidad. En esta publicación realizamos una revisión exhaustiva de los modelos aloplásticos en la construcción de neo-vejigas, y se realiza un análisis crítico sobre los pros y los contras de las diversas iniciativas que han existido sobre esta opción; y se exponen algunas reflexiones sobre como habrá de ser la prótesis sintética ideal de vejiga (AU)

Transitional cell carcinoma (TCC) of the bladder is the most frequent malignancy of the urinary tract, and its incidence is rising. Depending on the stage of the tumor, the treatments for TCC of the bladder may vary from a conservative to a radical surgery. In case of invasive TCC of the bladder the gold standard treatment is represented by radical cystectomy with extended lymphadenectomy and configuration of a continent or non-continent pouch (conduit/ pouch/neo-bladder). The reconstructive step of radical cystectomy is achieved with the use of bowel segments to restore bladder function. Unfortunately, the need for bowel has been universally considered to be the prime source of postoperative complications (i.e. fistulas, infections, metabolic disorders). Since the 1960s urologists, scientists and the industry have been trying to obviate the use of bowel with alternative synthetic and biologic materials to reconstruct the bladder. Despite the progress in technology and knowledge, the results have been quite discouraging. In this study we provide a comprehensive review for alloplastic models for neo-bladders with a critical analysis on the related pros and cons of restoring urinary bladder function with an ideal synthetic prosthesis (AU)

Ultrasound guided fine-needle aspiration biopsy of thyroid nodules: Guidelines and recommendations vs clinical practice; a 12-month study of 89 patients.

INTRODUCTION: Given the high prevalence of thyroid nodules in the general population it is essential to develop a method for identifying those nodules which require fine-needle aspiration biopsy (FNAB) due to suspicion for malignancy in order to avoid over- or under treatment of this disease. The ultrasound (US) criteria identified by Kim et al. and the American Association of Clinical Endocrinologists appear to be the most sensitive and most specific. The purpose of this study was to analyze a sample of patients who underwent FNAB of the thyroid and to compare the obtained data with the international guidelines and the recommendations for management of thyroid nodules. MATERIALS AND METHODS: This study analyzed the clinical, anamnestic and US reasons for which 97 nodules located in 89 patients underwent FNAB, and the data were compared with the criteria set by the guidelines and with the cytological results. RESULTS: Echogenicity was indication for FNAB in 99% of cases, appearance of the margins in 75.3%, presence of calcifications in 93.8% and presence of vascularity in 73.2%. In a total of 4.1% of cases, cytological outcome was positive for malignancy, 21.6% necessitated monitoring, 4.1% were referred to surgery and histological examination of the surgical specimen and 63.9% resulted negative for malignancy. DISCUSSION: The finding of hypoechoic nodules often leads to continued investigation; the presence of intranodular vascularization detected at Doppler US is perceived as suspicious and the presence of microcalcifications always leads to further investigation. On the request of the endocrinologist the dominant nodule in a goiter is in most cases subjected to FNAB even if the volume has not increased. Adequate US criteria can help identify potentially malignant nodules and guide implementation of FNAB. However, identification of malignant nodules using instrumental investigation cannot disregard medical records and clinical laboratory tests. According to the authors' experience, a close collaboration between endocrinologists, radiologists and pathologists is essential for a correct evaluation of patients with thyroid nodules in order to avoid over or under estimation of the risk of malignancy of a nodule and therefore of the necessity to perform further examinations.

Selling androgenic anabolic steroids by the pound: identification and analysis of popular websites on the Internet.

Internet websites offering androgenic anabolic steroids (AAS) were identified and available products were examined. Keywords for the website search were: "anabolic steroids," "anabolic steroids buy," "anabolic steroid purchase." The first 10 websites offering AAS in the first 10 pages of results were considered. At least two AAS-containing products per website were selected. Thirty AAS-selling websites were identified, mainly located in the United States (46.7%) and Europe (30%). Most websites sold other anabolic/ergogenic products (clenbuterol, 76.7%; GH/IGF, 60.0%; thyroid hormones, 46.7%; erythropoietin, 30.0%; insulin, 20.0%) or products for AAS-related adverse effects (mainly: estrogen antagonists, 63.3%; products for erectile dysfunction, 56.7%; 5α-reductase inhibitors, 33.3%; anti-acne products, 33.3%). AAS were sold as medicines (69.6%) or as dietary supplements (30.4%). AAS in medicines were mainly: nandronole (20.4%), methandrostenolone (18.4%), and testosterone (12.2%). Dietary supplements contained mainly DHEA and included several fake compounds. Manufacturers were declared for 97.9% of medicines and 66.7% of dietary supplements; however, several manufacturers were not found on the Internet. Described benefits were usually few adverse effects and no estrogenicity. Toxicity was seldom reported and presented as mild. Recommended doses were two-fourfold higher than current medical recommendations. In conclusion, misleading information and deceiving practices were common findings on AAS-selling websites, indicating their deleterious potential for public health.

Marcadores tumorales urinarios para el cáncer vesical / Urinary tumor markers for bladder cancer

En los últimos años se han aprobado las pruebas de marcadores tumorales no invasivos para el diagnóstico del carcinoma vesical ImmunoCyt/uCyt+, BTA TRAK, BTA STAT, NMP22, NMP22 BladderChek y UroVysion, sin embargo, ninguno de estos nuevos marcadores ha demostrado una sensibilidad y especificidad de manera simultánea lo suficientemente elevadas que permita sustituir la cistoscopia. Globalmente han demostrado mayor sensibilidad que la citología de orina, con una sensibilidad y especificidad medias del 64,80% y del 71-95% respectivamente, y valores predictivos positivo y negativo medios del 49-84% y del 79-95%. Las pruebas BTA TRAK, BTA stat, NMP22 y NMP22 BladderChek están limitadas por el elevado número de falsos positivos en casos de litiasis, infección urinaria o hematuria y debido a su baja especificidad, no se recomienda el uso de BTA TRAK, BTA stat, NMP22 Y NMP22 BladderChek sin descartar primero la presencia de una enfermedad genitouriana benigna o maligna aparte del cáncer de vejiga. Solamente UroViysion alcanza un 80% de sensibilidad y un 94% de especificidad (AU)

Over the last years, the non-invasive diagnostic tests, ImmunoCyt /uCyt+, BTA TRAK, BTA stat, NMP22, NMP22 BladderChek and UroVysion, for the diagnosis of bladder carcinomas have been approved. Nonetheless, these new markers have failed to achieve high enough sensitivity and specificity to replace cystoscopy. Globally they have shown higher sensitivity than urine cytology with a median sensitivity and specificity of 64-80% and 71-95% respectively, and median positive and negative predictive values of 49-84% and 79to 95%. The BTA TRAK, BTA stat, NMP22 and NMP22 BladderChek test have the limitation of a high false positive rate in the context of litbiasis, urinary infection or haematuria and do to its low specificity, the use of BTA TRAK, BTA stat, NMP22 and NMP22 BladderChek without first ruling out the presence of a benign or malignant genitourinary disease beside bladder cancer is not recommended. Only the UroVysion test reaches 80% sensitibity and 94% specificity (AU)

Actualización en el tratamiento médico del carcinoma renal avanzado / Update on the medical treatment of advanced kidney cancer

El tratamiento quirúrgico del cáncer de células renales (CCR) avanzado se ve reforzado por la aplicación de fármacos con capacidad citorreductora. La inmunodependencia del CCR lo hace sensible a terapias como la Interleukina e el Interferón, aunque los resultados son discretos. Nuevas terapias médicas han conseguido mejores resultados. Dentro del grupo de los inhibidores de las multiquinasas, el Sunitinib bloquea los receptores del VEGF, PDGFR, C-Kit, FLT-3 tirosina quinasa que juegan un papel en la carcinogénesis del CCR; y el Sarafenib bloquea VEGFR-2 y PDGFR por inhibición de RAF-1. Por su parte de anticuerpos anti-VEGF, como el Bavicizumab neutralizan la actividad de VEGF-A. Los inhibidores de mTOR, como el Tensirolimus, y el Everolimus, inhiben a la rapamicina-quinasa, responsable de la proliferación y la hipoxia celular. Se presenta un caso de CCR avanzado con buena respuesta al tratamiento médico (AU)

Surgical treatment of renal cell cancer (RCC) is reinforced by the application of drugs with cytoreductive capacity. The CRC inmunomodulation makes it amenable to therapies such as interleukin and interferon, although the results are discrete. New medical therapies have better results. Within the group of the multi-kinase inhibitors, Sunitinib blocks the receptors of VEGF, PDGFR, C-kit and FLT-3 tyrosine kinase that plays a role in carcinogenesis soft RCC, while Sorafenib blocks VEGFR-2 and PDGFR through inhibition RAF—1. Anti-VEGF antibodies such as Bevacizumab neutralize the activity of VEGF-A. MTOR inhibitors, such as Tensirolimus and Everolimus, inhibits rapamycin-kinase responsible for proliferation and cellular hypoxy. A case of advanced RCC with good response to treatment is presented (AU)