Penile granulomas after BCG instillations. A case report and review of literature.

Penile granulomas has been rarely reported in the setting of BCG instillations. We present a 70 year-old male with multiple penile granulomas during BCG instillations due a high-grade urothelial bladder cancer. Histopathological study revealed granulomatous structures with central necrosis as seen after BCG therapy. Local treatment with cryotherapy has been shown to be effective. This case emphasizes the importance to suspect this adverse effect in patients under BCG treatment.

The impact of prenatal environment on postnatal life and performance: Future perspectives for prevention and treatment.

The present review aims to offer a non-comprehensive outline of the current state-of-the-art and future perspectives on management and therapeutic tools for intrauterine growth restriction (IUGR) and associated prenatal programming in both human and animal species. Animals are used as models for the study of phenomena related to IUGR, but also for research on prenatal therapies with the main objective of designing and developing preventive and therapeutic strategies. The research is currently paying attention on maternal-focused pharmacological treatments and nutritional strategies but also on fetal-focused treatments. Fetal-focused treatments, administered either directly at the fetus or by using infusion of umbilical cord, amniotic sac or placenta, which avoids the administration of substances at high doses to the mother for allowing their availability at the fetoplacental level. The results obtained in this area of research using large animals (rabbits, pigs and ruminants) have a dual interest, for translational biomedicine and for veterinary medicine and animal production.

α-Tocopherol modifies the expression of genes related to oxidative stress and apoptosis during in vitro maturation and enhances the developmental competence of rabbit oocytes.

The developmental competence of invitro maturation (IVM) oocytes can be enhanced by antioxidant agents. The present study investigated, for the first time in the rabbit model, the effect of adding α-tocopherol (0, 100, 200 and 400µM) during IVM on putative transcripts involved in antioxidant defence (superoxide dismutase 2, mitochondrial (SOD2), glutathione peroxidase 1 (GPX1), catalase (CAT)), cell cycle regulation and apoptosis cascade (apoptosis tumour protein 53 (TP53), caspase 3, apoptosis-related cysteine protease (CASP3)), cell cycle progression (cellular cycle V-Akt murine thymoma viral oncogene homologue 1 (AKT1)), cumulus expansion (gap junction protein, alpha 1, 43 kDa (GJA1) and prostaglandin-endoperoxide synthase 2 (prostaglandin G/H synthase and cyclo-oxygenase) (PTGS2)) and metabolism (glucose-6-phosphate dehydrogenase (G6PD)). Meiotic progression, mitochondrial reallocation, cumulus cell apoptosis and the developmental competence of oocytes after IVF were also assessed. Expression of SOD2, CAT, TP53, CASP3 and GJA1 was downregulated in cumulus-oocyte complexes (COCs) after IVM with 100µM α-tocopherol compared with the group without the antioxidant. The apoptotic rate and the percentage of a non-migrated mitochondrial pattern were lower in COCs cultured with 100µM α-tocopherol, consistent with better-quality oocytes. In fact, early embryo development was improved when 100µM α-tocopherol was included in the IVM medium, but remained low compared with invivo-matured oocytes. In conclusion, the addition of 100µM α-tocopherol to the maturation medium is a suitable approach to manage oxidative stress and apoptosis, as well as for increasing the in vitro developmental competence of rabbit oocytes.

Improvements in the conception rate, milk composition and embryo quality of rabbit does after dietary enrichment with n-3 polyunsaturated fatty acids.

This work attempts to confirm the effect of an enriched diet with n-3 polyunsaturated fatty acids (PUFA) trying to mitigate the reproductive performances issues such as low conception rate of primiparous rabbits. A total of 127 does were fed ad libitum throughout their two first cycles with two diets with different fat sources: mixed fat in the control and salmon oil in the enriched one, with 3.19 g/100 g (n=63 does) and 28.77 g/100 g (n=64 does) of n-3 of the total fatty acid, respectively. Feed intake was similar between groups (P>0.05). Plasma progesterone concentration was higher in the enriched females than in control ones at 7 (30.9±2.18 v. 23.9±2.30 ng/ml, respectively; P=0.029) and 14 (38.7±2.18 v. 28.2±2.30 ng/ml, respectively; P=0.001) days of first gestation. Considering both cycles, reproductive parameters of mothers (fertility, duration of gestation and prolificacy) and litter parameters (weight at parturition and weaning, mortality and average daily gain (ADG) of kits during lactation) were similar in both groups. However, individual measurements of neonates of enriched group improved 5.87%, 7.10% and 18.01% (P0.05), but embryo apoptosis rate was higher in control group than in enriched one (31.1±4.56% v. 17.1±3.87%, respectively; P<0.05). In conclusion, dietary PUFA enrichment from the rearing and throughout two productive cycles improved plasma progesterone during pregnancy, fertility, milk fatty acid profile and neonates development of primiparous supporting the beneficial effect of n-3 PUFA supplementation in rabbit does.

[Prescription pattern in the management of Type I open forearm fractures in pediatric patients]. / Patrón de prescripción en el manejo de las fracturas expuestas tipo I de antebrazo en pediatría.

BACKGROUND: Pediatric open fractures account for more tan 10% of hospital admissions in a Pediatric Trauma Clinical Department. It is important to identify the predominant surgical management prescription pattern in pediatric patients presenting with Type I open forearm fractures at a referral center in an emerging economy. MATERIAL AND METHODS: Observational, cross-sectional, analytical, secondary-source (logs) sampling study of consecutive cases. The cases included subjects under 17 years of age presenting with Type I open forearm fractures at a Pediatric Trauma Clinical Department from January 1st, 2009 to December 31st, 2013. RESULTS: Ninety-two patients with a diagnosis of Type I open forearm fracture were included. All patients received parenteral antibiotics and underwent surgical debridement. However, in 69 (75%) of them a cast was used; in 9 (10%) a splint was used; 9 (10%) underwent fixation with Kirschner nails, and 5 (5.4%) underwent open reduction and internal fixation (ORIF). Eight patients (9%) required reoperation. CONCLUSIONS: Surgical management is the predominant prescription pattern in pediatric patients with Type I open forearm fracture. The latter is the predominant eepidemiology. The type of management was associated with a second surgery (p 0.000); however, this did not have a statistically significant impact on the hospital stay (p = 0.09).

ANTECEDENTES: Las fracturas expuestas en niños comprenden más de 10% de los ingresos hospitalarios a un departamento clínico de traumatología pediátrica. Resulta importante identificar el patrón de prescripción de manejo quirúrgico predominante en pacientes pediátricos atendidos en un centro de referencia de una economía emergente con fractura expuesta tipo I de antebrazo. MATERIAL Y MÉTODOS: Estudio por muestreo de casos consecutivos, observacional, transversal, analítico y de fuentes secundarias (bitácora). Fueron considerados todos los casos de sujetos menores de 17 años con fracturas expuestas tipo I de antebrazo, hospitalizados en un departamento clínico de traumatología pediátrica del 1o de Enero de 2009 al 31 de Diciembre de 2013. RESULTADOS: Noventa y dos personas con diagnóstico de fractura expuesta tipo I de antebrazo fueron incluidas. A todas se les realizó administración de antibiótico parenteral, así como desbridamiento quirúrgico; sin embargo, a 69 también se les colocó aparato de yeso (75%), a nueve se les puso férula (10%), a nueve se les realizó fijación con clavillos Kirschner (10%) y a cinco se les realizó reducción abierta y fijación interna (RAFI), (5.4%). Ocho niños (9%) requirieron una reintervención. CONCLUSIONES: Predomina el patrón de prescripción de manejo quirúrgico en pacientes pediátricos con fractura expuesta tipo I de antebrazo, así como su epidemiología. El tipo de manejo estuvo asociado con una segunda cirugía (p 0.000); sin embargo, esto no tuvo impacto estadísticamente significativo en la estancia hospitalaria (p = 0.09).

A diet supplemented with n-3 polyunsaturated fatty acids influences the metabomscic and endocrine response of rabbit does and their offspring.

The aim of the present study was to evaluate the productive, endocrine, and metabomscic responses as well as oxidative stress of rabbit does and their offspring when fed a diet supplemented with -3 PUFA during their first productive cycle. To this aim, a total of 105 rabbit does were fed ad mscibitum from d 60 to 172 of age 2 isoenergetic and isoproteic diets differing in fatty acid composition. The control diet ( = 52 does) contained 45.9 g/kg of -3 of the total fatty acids and the enriched diet ( = 53 does) contained 149.2 g/kg of -3 of the total fatty acids. Both experimental groups had similar feed intake during rearing, pregnancy, and lactation. The enrichment of diet had no effect on ultrasonographic assessment of does on d 9 and 16 of pregnancy, with an embryonic vesicle number and fetus and placenta size similar between groups ( > 0.05). Even though there were no major effects ( > 0.05) on fertimscity, duration of gestation, and number born amscive and stillborn kits at parturition, mscive kits from enriched does were longer (71.6 ± 2.42 vs. 79.5 ± 2.13 mm; < 0.05) and tended to be heavier (42.5 ± 3.94 vs. 50.8 ± 3.47 g; = 0.07) than those from control does ( < 0.05). The 2 groups had similar milk production and mortamscity values during lactation; consequently, there were no differences between diets in ADG, mscitter weight, and number of weaned kits ( > 0.05). In enriched does, higher plasma leptin and estradiol concentrations than in control does ( < 0.05) were observed. In addition, enriched females also had lower total and high-density mscipoprotein cholesterol (HDL-c) than control females during lactation ( < 0.05). Regarding offspring, the enrichment of diet with PUFA caused a hypermscipidemic status (greater values of plasma triglycerides, total cholesterol, and HDL-c; < 0.05) at 1 d postpartum (dpp), compared with the control group, that disappeared at 32 dpp. Supplemented does before parturition and their offspring at 1 dpp had greater oxidative stress than those in the control group. In conclusion, an increase of -3 PUFA concentration in the diet of rabbit does and, consequently, of their offspring during a productive cycle alters their mscipid profile and the indicators of oxidative stress, without major endocrine modifications or improvements in the productive variables.

In vivo and in vitro maturation of rabbit oocytes differently affects the gene expression profile, mitochondrial distribution, apoptosis and early embryo development.

In vivo-matured cumulus-oocyte complexes are valuable models in which to assess potential biomarkers of rabbit oocyte quality that contribute to enhanced IVM systems. In the present study we compared some gene markers of oocytes and cumulus cells (CCs) from immature, in vivo-matured and IVM oocytes. Moreover, apoptosis in CCs, nuclear maturation, mitochondrial reallocation and the developmental potential of oocytes after IVF were assessed. In relation to cumulus expansion, gene expression of gap junction protein, alpha 1, 43 kDa (Gja1) and prostaglandin-endoperoxide synthase 2 (Ptgs2) was significantly lower in CCs after in vivo maturation than IVM. In addition, there were differences in gene expression after in vivo maturation versus IVM in both oocytes and CCs for genes related to cell cycle regulation and apoptosis (V-Akt murine thymoma viral oncogene homologue 1 (Akt1), tumour protein 53 (Tp53), caspase 3, apoptosis-related cysteine protease (Casp3)), oxidative response (superoxide dismutase 2, mitochondrial (Sod2)) and metabolism (glucose-6-phosphate dehydrogenase (G6pd), glyceraldehyde-3-phosphate dehydrogenase (Gapdh)). In vivo-matured CCs had a lower apoptosis rate than IVM and immature CCs. Meiotic progression, mitochondrial migration to the periphery and developmental competence were higher for in vivo-matured than IVM oocytes. In conclusion, differences in oocyte developmental capacity after IVM or in vivo maturation are accompanied by significant changes in transcript abundance in oocytes and their surrounding CCs, meiotic rate, mitochondrial distribution and apoptotic index. Some of the genes investigated, such as Gja1, could be potential biomarkers for oocyte developmental competence in the rabbit model, helping improve in vitro culture systems in these species.

Presentación perirrenal de la enfermedad de Rosai-Dorfman extranodal / Perirrenal presentation of extranodal Rosai-Dorfman disease

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Characterization of early changes in fetoplacental hemodynamics in a diet-induced rabbit model of IUGR.

Intrauterine growth restriction (IUGR) is associated with adverse perinatal outcomes and late-onset diseases in offspring. Eating disorders, voluntary caloric restriction and maternal undernutrition can all induce IUGR but a relevant model is required to measure all its possible consequences. In this work, pregnant rabbits were used as an IUGR model. Control females (n=4) received ad libitum diet throughout pregnancy, whereas underfed females (n=5) were restricted to 50% of their daily requirements. Offspring size was measured by ultrasonography and in vivo at birth. Hemodynamic features of the umbilical cords and middle cerebral arteries (systolic peak velocity, end diastolic velocity, pulsatility index and resistance index) were characterized by Doppler ultrasonography. At day 21, maternal underfeeding resulted in a significant reduction of fetal size (occipito-nasal length). At birth, the size of kits from the underfed group was significantly lower (lower crown-rump length, biparietal and transversal thoracic diameters) and a reduced weight with respect to the control group. Feed restriction altered blood flow perfusion compared with does fed ad libitum (significant higher systolic peak, time-averaged mean velocities and lower end diastolic velocity). Fetuses affected by IUGR presented with compensative brain-sparing effects when compared with the control group. In conclusion, the present study supports using rabbits and the underfeeding approach as a valuable model for IUGR studies. These results may help to characterize IUGR alterations due to nutrient restriction of mothers in future research.

Lesión de los cuerpos cavernosos por arma de fuego. Presentación de un caso y revisión de la literatura / Corpora cavernosa lesion by gunshot. Case study and literature review

La rotura de los cuerpos cavernosos es una lesión de muy baja incidencia. La causa más frecuente es un traumatismo durante el coito. Aún más excepcional es la producida por arma de fuego, en la que lo más habitual es la lesión concomitante de otras estructuras. Mostramos el caso de un paciente que presentó lesión de los cuerpos cavernosos por arma de fuego y se le realizó una exploración quirúrgica de urgencia. Se revisa la literatura existente y se comprueba que, siempre que haya una herida genital por arma de fuego, lo primero que se debe hacer es estabilizar al paciente y lo segundo, una exploración quirúrgica de la región afectada (AU)

Rupture of the corpora cavernosa is a very rare lesion. It occurs most commonly during intercourse. A far more exceptional cause is a gunshot wound; in this case, there are frequently concomitant lesions to other structures. We present the case of a man who suffered a lesion to the corpora cavernosa due to a gunshot and underwent emergency surgery. We reviewed existing literature and verified that the first step in managing a genital gunshot wound is to stabilise the patient, following which we should surgically explore the affected area (AU)

Corpora cavernosa lesion by gunshot. Case study and literature review.

Rupture of the corpora cavernosa is a very rare lesion. It occurs most commonly during intercourse. A far more exceptional cause is a gunshot wound; in this case, there are frequently concomitant lesions to other structures. We present the case of a man who suffered a lesion to the corpora cavernosa due to a gunshot and underwent emergency surgery. We reviewed existing literature and verified that the first step in managing a genital gunshot wound is to stabilise the patient, following which we should surgically explore the affected area.

Probability of prostate cancer as a function of the percentage of free prostate-specific antigen in patients with a non-suspicious rectal examination and total prostate-specific antigen of 4-10 ng/ml.

Our aim was to assess the usefulness of measuring the percentage of free prostate specific antigen (PSA) in serum in relation to reducing the number of prostate biopsies in men with benign prostate examinations and serum PSA levels between 4 and 10 ng/ml. The percentage of free PSA (Immulite) in serum was analyzed prospectively in 500 men, all of whom underwent ultrasound-guided sextant prostate biopsies. Cancer was detected in 21.4% (107/500) of the patients. Using a free PSA cutoff of < or = 23% as a criterion for performing prostate biopsy would have detected 94.4% of cancers, avoided 18.8% of benign biopsies and yielded a positive predictive value of 25.3%. The percentage of free PSA increased with prostate volume. Mean total PSA and mean free percent PSA values increased as patient age increased, influencing the calculation of cutoff values, sensitivity and specificity. PSA density had a sensitivity and specificity not significantly different than the percentage of free PSA. Measurement of the percentage of free serum PSA improves the specificity of prostate cancer detection in patients with elevated total serum PSA levels and benign prostate examinations.

[Conservative parenchymal surgery in kidney neoplasms]. / Cirugía conservadora de parénquima en neoformaciones renales.

OBJECTIVES: To analyze retrospectively a series of 60 nephron sparing surgeries (NSS) in patients presenting with renal masses. MATERIAL AND METHODS: The clinical histories of 59 patients undergoing NSS between january 1978 and december 1997 were reviewed. 40 were males, the mean age 54.4 years (range 17-77 years). 10 (17%) had bilateral synchronous tumors, 15 (25%) had a solitary kidney and 3 a renal insufficiency. In 25 patients NSS was obligatory, while in 34 it was elective. 30 (50%) of the renal masses had been diagnosed incidentally. Overall, 49 kidneys underwent an enucleation and 11 a partial nephrectomy. RESULTS: The histopathological exam revealed 43 (71.6%) renal cell carcinomas (RCC), 2 (3.4%) urothelial carcinomas, 6 (10.2%) oncocytomas, 7 (11.6%) angiomyolipomas and 2 (3.4%) multilocular cystic nephromas. Among the RCC, 8 had < or = 3 cm, 22 between 3.1-5 cm, 10 between 5.1-8 cm and 3 more than 8 cm. 31 (72.1%) were well encapsulated and only 2 (4.6%) invaded the nearby parenchyma. 7 (16.2%) were pT1, 34 (79%) pT2 and 2 (4.6%) pT3. 39 (90.3%) were G1 or G2, and only 4 (9.3%) were G3. Two patients (3.3%) died perioperatively, both from the obligatory group. 3 (6.8%) of the patients with malignant tumors progressed and died, all with CCR and from the obligatory surgery group. Another 3 patients of this group developed local recurrences, but were rescued with iterative surgery (conservative in 1); 2 of these patients had sporadic CCR, another a von Hippel Lindau disease. None of the 34 patients who underwent elective NSS progressed, nor recurred locally and all are alive and disease free; only 14 (56%) of the 25 patients operated on by necessity survived, although 6 of them died of causes not related with the kidney tumor. The cancer specific survival at 58.3 months of follow-up (range 5-187 months) is 86.8% for the whole series, 100% for the elective NSS group and 68.7% for the obligatory NSS group. 19 (31.6%) patients developed complications, 14 among the obligatory group; two died (hemorrhage and sepsis). 3 patients presented acute renal failure, but none required dialysis; presently 4 (6.7%) patients have poor renal function and 1 requires dialysis. CONCLUSION: NSS affords good control of renal carcinoma; in the cases operated on electively, the 100% cause specific survival yielded by NSS supports the use of conservative surgery in patients with well delimited tumors and normal contralateral kidney.

Determination of the percentage of free prostate-specific antigen helps to avoid unnecessary biopsies in men with normal rectal examinations and total prostate-specific antigen of 4-10 ng/ml.

OBJECTIVE: To assess the usefulness of measuring the percentage of free prostate-specific antigen (PSA) in serum to reduce the number of prostate biopsies in men with serum PSA levels between 4 and 10 ng/ml and benign prostate examinations. MATERIALS AND METHODS: The percentage of free PSA (Immulite((R))) in serum was analyzed prospectively in 180 men with benign digital rectal examinations and total PSA serum levels of between 4 and 10 ng/ml. All patients underwent ultrasound-guided sextant prostatic biopsies. Sensitivity, specificity and positive and negative predictive values were calculated as well as the percent of patients in which biopsies could have been avoided for various cutoff values of the percentage of free PSA as an indicator for biopsy. Influence of age in the determination of cut points was evaluated. RESULTS: Cancer was detected in 22.2% (40/180) of the patients. Mean percentage of free PSA was 13.4% in patients with cancer and 18.9% in patients with benign prostatic hyperplasia (p = 0.001). Using a percentage of free PSA cutoff of 22% or less as a criterion for performing prostatic biopsy would have detected 95% of cancers, avoided 25% of benign biopsies and yielded a positive predictive value of 29% in patients who underwent biopsy. Mean percent of free PSA values increased as mean subject age increased, influencing the calculation of cut points, sensitivity and specificity. Leaving the cut point constant across all age groups will oblige older patients to undergo an increased number of unnecessary biopsies, although allowing for higher sensitivity in younger men. CONCLUSIONS: Measurement of the percentage of free serum PSA improves specificity of prostate cancer detection in patients with elevated total serum PSA levels and benign prostate examinations. Subject age seemed to influence the determination of optimal cut points.

Cirugía conservadora de parénquima en neoformaciones renales / Kidney sparing surgery for renal tumors

OBJETIVOS: Analizar retrospectivamente una serie de 60 intervenciones ahorradoras de parénquima en pacientes con masas renales. MATERIAL Y MÉTODOS: Se han revisado los protocolos clínicos de 59 pacientes operados conservadoramente entre Enero de 1978 y Diciembre de 1997; 40 eran varones, la edad media era de 54 años (rango 17-77); 10 (17 por ciento) tenían tumores bilaterales sin-crónicos, 15 (25 por ciento) eran monorrenos y 2 tenían insuficiencia renal; en 25 pacientes (26 operaciones) la indicación de cirugía ahorradora fue obligada, mientras que en 34 fue electiva, por tener un riñón contralateral sano. Treinta (50 por ciento) de las masas renales habían sido descubiertas incidentalmente. En total se realizaron enucleaciones en 49 riñones y nefrectomías parciales en 11.RESULTADOS: El estudio histopatológico de los tumores extirpados reveló 43 (71,6 por ciento) carcinomas de células renales (CCR), 2 (3,4 por ciento) carcinomas uroteliales, 6 (10,2 por ciento) oncocitomas, 7 (11,6 por ciento) angiomiolipomas y 2 (3,4 por ciento) nefromas quísticos multiloculares. Entre los CCR, 8 medían ?3 cm, 22 medían entre 3,1-5 cm, 10 entre 5,1-8 cm y 3 más de 8 cm; estaban bien encapsulados 31 (72,1 por ciento) y sólo en 2 (4,6 por ciento) casos había infiltración del parénquima vecino. Siete (16,2 por ciento) eran pT1, 34 (79 por ciento) eran pT2 y 2 (4,6 por ciento) eran pT3, 39 (90,7 por ciento) eran G1 ó G2 y sólo 4 (9,3 por ciento) eran G3.Hubo 2 (3,3 por ciento) muertes perioperatorias, ambas en el grupo de cirugía obligada; 3 (6,8 por ciento) de los pacientes con tumores malignos pro-gresaron y murieron, todos del grupo de cirugía obligada con CCR. Otros 3 de este grupo desarrollaron recidivas locales, pero fueron rescatados con nueva cirugía (conservadora en 1); 2 de ellos tenían CCR esporádicos, pero el tercero padecía un von Hippel-Lindau. Ninguno de los 34 pacientes operados electivamente progresó, ni tuvo recidiva local y todos viven libres de enfermedad; sólo sobreviven 14 (56 por ciento) de los 25 operados por necesidad, si bien 6 murieron por causas ajenas al tumor. La supervivencia cáncer específica a los 58,3 meses de seguimiento (rango 5-187 meses) es del 86,8 por ciento para toda la serie, del 100 por ciento para los casos operados electivamente y del 68,7 por ciento para los operados de necesidad. Han presentado complicaciones 19 (31,6 por ciento) de las operaciones, de las cuales 14 eran obligadas; dos de ellas fueron mortales (hemorragia y sepsis). Tres pacientes hicieron fracasos renales agudos, pero no precisaron diálisis y actualmente hay 4 (6,7 por ciento) pacientes con pobre función renal, de los cuales 1 precisa diálisis. CONCLUSIÓN: La cirugía ahorradora de parénquima proporciona un control excelente de los carcinomas renales; en los casos operados electivamente, la supervivencia cáncer específica del 100 por ciento justifica continuar indicando la cirugía conservadora en pacientes con masas renales bien delimitadas, aunque tengan el riñón contralateral sano (AU)

Prospective comparative study with intracavernous sodium nitroprusside and prostaglandin E1 in patients with erectile dysfunction.

PURPOSE: To compare the effectiveness of intracavernous administration of sodium nitroprusside and prostaglandin E1 to induce penile erection in men with erectile dysfunction. MATERIAL AND METHODS: 100 patients with erectile dysfunction entered the study prospectively. As part of the diagnostic workup, each patient received an intracavernous injection of 20 microg prostaglandin E1 and a second injection of 600 microg sodium nitroprusside 1-7 days later. A tourniquet was placed at the base of the penis before each injection. The data recorded included time required to initiate tumescence, local and systemic side effects, objective and subjective quality of erections, duration of tumescence and patient satisfaction by means of a personal questionnaire. RESULTS: Prostaglandin E1 induced better overall responses than sodium nitroprusside, the difference being almost significant (p = 0.055). The overall duration of erections was also significantly longer with prostaglandin E1 (mean 81.3 min) than with sodium nitroprusside (mean 65.4 min; p < 0.04). 67% of the patients considered the erections induced with prostaglandin E1 to be of better quality than those with sodium nitroprusside, and only 11% stated that sodium nitroprusside was superior. Side effects were minimal with both drugs, the most frequent side effect being systemic hypotension, which was induced by sodium nitroprusside in 7% of the patients. CONCLUSIONS: The moderate risk of systemic hypotension and the lower potency of sodium nitroprusside to induce erections compared to prostaglandin E1 rules out sodium nitroprusside as a routine alternative intracavernous drug in men with erectile dysfunction at the doses employed. Sodium nitroprusside, however, could be used in patients who have intolerance or penile pain with intracavernous prostaglandin E1.

[Hemangiopericytoma of the renal sinus. Report of a case and review of the literature]. / Hemangiopericitoma del seno renal. A propósito de un caso y revisión de la literatura.

OBJECTIVES: Since the initial report of renal hemangiopericytoma by Black and Heinemann in 1955, only 24 cases of this rare vascular neoplasm, involving the renal capsule, parenchyma or sinus have been described in the world literature. Herein we describe an additional case and review the literature. METHODS: We report on a 65-old woman in whom a 5 x 4 cm solid mass was incidentally found in the left sinus. The tumor compressed the renal pelvis and caused hydronephrosis and parenchymal atrophy. A radical left nephrectomy was performed. Histological and immunological studies revealed a hemangiopericytoma of renal sinus soft tissues. RESULTS: The patient did well postoperatively and remains disease-free at the present time. CONCLUSIONS: Although there are other histological and clinical criteria indicative of worse prognosis, the malignancy of hemangiopericytoma is determined by the presence of hematogenous metastases.