[Fibroepithelial polyp of the urethra in an adult]. / Pólipo fibroepitelial de uretra en un adulto.

We present the case of a fibroepithelial polyp of the prostatic urethra in a forty-five year old patient. This type of polyp is rare in the adult. The principal symptoms which the patient presented were haematuria and an intermittent reduction in micturitional flow. Endoscopic images of the tumour are shown and certain details of its histology; this is a polypoid lesion of loose connective tissue covered by typical urothelium, with occasional fascicles of smooth muscle, no prostatic-type glandular structures and no appreciable inflammatory component.

Pólipo fibroepitelial de uretra en un adulto / Fibroepithelial urethral polyp in an adult

Presentamos el caso de un pólipo fibroepitelial de uretra prostática en un paciente de cuarenta y cinco años. Este tipo de pólipos son poco frecuentes en el adulto. Los síntomas principales que manifestaba el paciente eran hematuria y disminución ocasional del chorro miccional. Mostramos las imágenes endoscópicas del tumor, así como detalles de su histología que corresponde a una lesión polipoide con un revestimiento urotelial típico sobre tejido conectivo laxo, con algún fascículo de músculo liso sin estructuras glanduliformes de tipo prostático ni componente inflamatorio apreciable (AU)

[Adrenal ectopy in epididymis]. / Ectopia adrenal en epidídimo.

OBJECTIVE: To report a case of ectopic adrenal in the epididymis. METHODS: A 17-year-old male consulted for a left varicocele and complaints referred to the right epididymis a year and a half after an episode of acute epididymitis. A nodule was excised from the epididymis. RESULTS: The pathological analysis showed an 0.4 cm nodule comprised of adrenocortical tissue. CONCLUSIONS: Ectopic adrenal cortical tissue is a benign lesion. Although routine search for this lesion is not indicated, it should be resected for histological analysis and differential diagnosis when it is found during a surgical procedure in this area.

[Non-functional renal paraganglioma associated with carotid paraganglioma and appendicular mucocele]. / Paraganglioma renal no funcionante asociado con un paraganglioma carotídeo y un mucocele apendicular.

OBJECTIVE: A case of nonfunctional renal paraganglioma associated with appendicular mucocele and metachronic carotid paraganglioma is presented. METHODS/RESULTS: A 68-year-old patient consulted for abdominal pain. Patient evaluation with US, CT and opague enema showed an elongated mass that compromised the cecum and a solid mass in the right kidney. The patient underwent appendectomy and radical right nephrectomy. The anatomopathological findings showed an appendicular mucocele and renal paraganglioma. The postoperative hormone analyses were normal. A carotid paraganglioma was removed 8 months later. CONCLUSIONS: Renal tumors arising from neural crest cells are uncommon. To our knowledge, this is the third case of nonfunctional renal paraganglioma reported in the literature. The associated appendicular mucocele was an incidental finding.

[Perioperative transfusion in prostatic surgery]. / Transfusión perioperatoria en la cirugía de próstata.

OBJECTIVE: To analyze the likelihood of perioperative transfusion in prostate surgery. METHODS: The records of patients who underwent prostate surgery at the Hospital Central de Asturias en 1996 were reviewed. The abstracted patient discharge records, encoded according to the ICD-9-CM, were analyzed for gender, age, diagnosis, surgical and non-surgical procedures, including transfusions of blood products. RESULTS: 29 (14.2%) of 204 operated patients required transfusion. By univariate analysis, the likelihood of requiring transfusion was significantly higher in patients with cancer (28.8%), patients undergoing radical prostatectomy (40%), and those undergoing more than one surgical procedure (21.2%). By multivariate logistic regression analysis, the surgical procedure, age and simultaneous urinary bladder surgery were related with the likelihood of requiring transfusion. The adjusted odds ratio for perioperative transfusion was 10.14 times in radical prostatectomy than in transurethral prostatectomy, 2.67 times for patients more than 75 years than in those aged less, and 2.85 times in patients undergoing simultaneous urinary bladder surgery than those who do not. CONCLUSIONS: Due to the wide range of variability of the adjusted likelihood for transfusion in prostate surgery (3.5% to 83.4%), estimation of the individual likelihood for transfusion could be useful for planning surgical transfusions, pretransfusion tests and autologous transfusion in these patients.

[Innervation of the human adrenal gland]. / Inervación de la glándula suprarrenal humana.

OBJECTIVE: To study the innervation of the human adrenal gland by immunohistochemical techniques using monoclonal antibodies against the 200-kDa phosphorylated neurofilament and S-100 protein, specific markers of the axons and Schwann cells, respectively. METHODS: 24 specimens of normal adrenal gland from patients that had undergone radical nephrectomy for a renal tumor were analyzed. The tissue was embedded in paraffin and prepared for analysis by immunohistochemical techniques with the indirect peroxidase method using primary monoclonal antibodies against the 200-kDA phosphorylated neurofilament and protein S-100. RESULTS: The nerves localized in the adrenal gland form a subcapsular plexus where branches arise that extend to the medulla and come into contact with the enterochromaffin cells and medullary neurons. The adrenal neurons are restricted to the medulla; they are dispersed or form ganglia. The satellite cells of the medullary ganglia and the sustentacular cells were positive for S-100. CONCLUSIONS: Most of the nerve fibers penetrate into the human adrenal gland, extending directly to the medulla apparently without coming into contact with the cells of the adrenal cortex and form similar connections to the synaptics with the chromaffin cells and the medullary neurons. The microganglia of the human adrenal gland are dispersed and comprised of few neurons.

[Adrenal tuberculosis. Diagnosis using polymerase chain reaction]. / Tuberculosis suprarrenal. Diagnóstico mediante la reacción en cadena de la polimerasa.

OBJECTIVE: To present a case of a patient suffering from adrenocortical insufficiency (Addison's disease) and to demonstrate the utility of the polymerase chain reaction (PCR) in the diagnosis of adrenal cortex tuberculosis. METHODS/RESULTS: Herein we describe a patient with Addison's disease who had developed pulmonary tuberculosis a few years earlier. CT and PCR test were utilized in making the diagnosis. CONCLUSION: Although adrenocortical tuberculosis is uncommon today, it must be considered when evaluating adrenocortical insufficiency, especially if the patient has or has had tuberculosis. Although Mycobacterium tuberculosis might not be demonstrated by bacteriologic techniques, PCR can be useful in making the etiological diagnosis.

[Stenosis of the ileal loop in a patient with Bricker type urinary diversion]. / Estenosis de asa ileal en paciente con derivación urinaria tipo Bricker.

Stenosis of the ileal loop itself in the urinary diversion performed with the technique described by Bricker is uncommon, particularly in adults, and nowadays is basically managed through non-invasive methods. This paper contributes one case of stenosis of the ileal loop in a patient with urinary diversion performed with Bricker's technique, which was treated by partial resection of the ileal loop, since use of non-invasive techniques was not possible due to technical hindrances. The pathoanatomical study showed the different etiopathogeny of this type of stenosis relative to others related to the ileal loop (stoma and ureteroileal attachment stenosis). A review is made of the etiopathogeny, signs and symptoms, diagnosis and treatment of this type of stenosis. Occurrence of stenosis as late complication has lead us to consider the convenience for late revisions in this type of surgery.

[Pure prostatic leiomyoma]. / Leiomioma prostático puro.

We report a case of pure leiomyoma of the prostate, an uncommon benign tumor with a leiomyomatous component distinct from benign prostatic hyperplasia. The literature is reviewed and several considerations are put forward relative to the etiopathogenesis, clinical and anatomopathological features, differential diagnosis and prognosis of this tumor.

[Acquired cystic renal disease: a case of intracystic hemorrhage simulating renal tumor]. / Enfermedad quística renal adquirida: un caso de hemorragia intraquística simulando tumoración renal.

We report a case of intracystic hemorrhage in a patient with acquired cystic kidney disease, undergoing hemodialysis. A surgical procedure was performed owing to the discrepancy between the clinical and radiological findings. The histological analyses revealed no evidence of kidney tumours.

[Villous polyp of the urethra]. / Pólipo velloso de uretra.

Villous polyps of the urethra are rare. This condition can be seen more frequently in patients aged 30-40 years. Hematuria is usually the major symptom. Generally, the polyps are localized in or around the verumontanum and do not recur after TUR or electrocoagulation. A case of villous polyp of the verumontanum is described in a patient who presented with symptoms and signs of obstructive micturition. The patient continues to be asymptomatic 6 months following treatment by electrocoagulation.

[Emergency conservative surgery in rupture of angiomyolipoma of the kidney]. / Cirugía conservadora de urgencia por rotura de angiomiolipoma renal.

A case of spontaneous perirenal hematoma from a ruptured angiomyolipoma is described. Diagnosis was made at the time of presentation and treatment was by conservative surgery. The different diagnostic methods and treatment of this condition are discussed.

[Mucinous adenocarcinoma of the urachus]. / Adenocarcinoma mucinoso del uraco.

Malignant tumours of the urachus are very rare and they give certain difficulty in their differential diagnosis with vesical cupula adenocarcinoma. We present a case of mucinous adenocarcinoma of the urachus in a 75-year-old patient and we analyse the behaviour, clinical background, diagnosis and treatment of these tumours.

[Activity of total cholesterol and its HDL fraction in vasectomized patients. A 3-month follow-up]. / Estudio del comportamiento del colesterol total y su fraccíon HDL en pacientes vasectomizados. Tres meses de seguimiento.

Vasectomy is an ever-increasingly used contraceptive method owing to its effectiveness and easy execution, although various studies have questioned its innocuousness. We have studied various parameters in 70 patients three months before and after the vasectomy was performed. The analytical factors controlled were as follows: glycemia, triglycerides, total cholesterol, HDL-cholesterol, LDL cholesterol, FSH, LH, testosterone and estradiol. Other data handled were arterial tension and body weight index. We questioned them about physical activity, distributing them into three groups, and about family history of arteriosclerosis, distributing them into two groups. Three months after the operation we found an increase in body weight index of 24.11 +/- 2.49 to 24.77 +/- 2.51, with a p less than 0.01. Total cholesterol also rose from 201 Cae 39 mgr% to 208 +/- 38 mgr% with a p less than 0.05. We also observed a drop in arterial tension. Patients with no family history of arteriosclerosis had an increase of total cholesterol of 199 +/- 39 mgr% to 210 +/- 35 mgr% with a p less than 0.001. In the heavy smoker group, total cholesterol also rose from 203 %/- 48 mgr% to 214 +/- 40 mgr% with a p less than 0.05. We discuss our results and our surgical complications and our conclusion in that, based on our study, we cannot assert the vasectomy plays a role as a risk factor of arteriosclerosis.