Análisis estadístico de la influencia del virus del papiloma humano en el desarrollo del carcinoma vesical / Statistical analysis of the influence of the virus of pailoma human in the development of the vesical carcinoma

Introducción: El carcinoma de vejiga es una enfermedad importante por su morbi-mortalidad y su multifactorialidad. Actualmente, entre los posibles agentes etiológicos que se han señalado, se encuentra la infección por el virus del papiloma humano (VPH). El objetivo del estudio es analizar, mediante la realización de un meta-análisis, la relación existente entre el cáncer vesical y la infección por el virus del papiloma humano. Material y métodos: Realizamos una búsqueda en la base de datos electrónica MEDLINE de los artículos publicados hasta septiembre del 2004 que relacionan la infección del VPH con los tumores vesicales. De los 414 artículos listados, seleccionamos 38 artículos. Resultados: Los artículos se clasificaron en dos grupos, según empleen o no métodos basados en la detección del ADN. En los artículos basados en la detección del ADN, resultó que la proporción global de los casos que tuvieron contacto con el virus, a través de la detección del genoma fue del 19,4% (IC 95%: 0,160-0,228). Del total de estudios basados en la detección del ADN se seleccionaron 8, por mostrar un grupo control definido, en los cuales, se investigó la OR. Si combinamos las ORs, obtenemos una OR estimada de 3,2 (IC al 95% de 1,19 a 8,60) y una p=0,02. Conclusiones: La mayor parte de estos estudios pusieron de manifiesto la relación planteada al inicio del estudio. Aunque la mayoría carecían de un grupo control definido, es posible analizar el valor de la Odds ratio global debido al comportamiento homogéneo de los estudios con casos y controles bien definidos. Esto demostró una asociación entre VPH y el cáncer de la vejiga

Introduction: The bladder cancer is an important disease by its morbi-mortality and its multifactorialidad. At the moment, between the possible aetiology agents that they have been indicated is the infection by the virus of papilloma human (VPH). The objective study is to analyse, by meta-analysis, the relationship between bladder cancer and infection by human papillomavirus Material and methods: We made a search in the electronic data base MEDLINE of the articles published until September of the 2004 that relate the infection of the VPH to the bladder tumors. Of 414 listed articles, we selected 38 articles. Results: The articles were classified in two groups, according to they use or non methods based on the detection of the DNA. In articles based on the detection of the DNA, it was that the global proportion from the cases that had contact with the virus, through the detection of the genome was of the 19.4% (95% CI 0.160 to 0.228). Of the total of studies based on the detection of the DNA 8 were selected, to show to a group defined control, in which, the OR was investigated. If we combined the ORs, we obtain an OR estimation of 3.2 (95% CI 1.19 to 8.60) and p=0.02. Conclusions: Most of these studies showed the relation rose at the beginning of the study. Although the majority lacked a group defined control, is possible to analyze the value of the Odds global ratio due to the homogenous behaviour of the studies with defined cases and controls affluent. This demonstrated to association between VPH and the bladder cancer

[Renal cell carcinoma in patient with situs inversus and Kartagener syndrome]. / Carcinoma de células renales en paciente con situs inversus y síndrome de Kartagener.

A case of a adenocarcinoma renal in a patient with situs inversus complete to which was associated bronchiectasis and chronic sinusitis (kartagener's syndrome) is reported. It is the third case described in the international literature of a renal cells carcinoma in a patient with situs inversus totalis and the first in patient the one which has the triada classic of the kartagener's syndrome plus sterility. The tumor was discovered in a way incidental upon accomplishing a TAC toracoabdominal and was solved through nefrectomia for lumbotomy approach.

Carcinoma de células renales en paciente con situs inversus y síndrome de Kartagener / Renal cell carcinoma in a patient with situs inversus and Kartagener's syndrome

Se presenta el caso de un adenocarcinoma renal en un paciente con situs inversus completo al que se asociaban bronquiectasias y sinusitis crónica (síndrome de Kartagener). Es el tercer caso descrito en la literatura internacional de un carcinoma de células renales en un paciente con situs inversus total y el primer en el que el paciente tiene la triada clásica del síndrome de Kartagener más esterilidad. El tumor se descubrió de forma incidental al realizar un TAC toraco-abdominal y se resolvió mediante nefrectomía por vía lumbotómica (AU)

[Bacterial content of the enucleated prostate gland]. / Contenido bacteriano de la glándula prostática enucleada.

OBJECTIVE: To determine the prevalence of prostatic colonization or infection in patients undergoing prostatic surgery for obstructive symptoms due to benign hyperplasia of the prostate (BPH), to identify and quantitate the microorganisms isolated in quantitative bacterial tissue cultures, and to determine the influence of open surgery vs endoscopy on the microbiological findings. METHODS: A prospective study was conducted on 175 patients undergoing surgery for BPH. All patients were entered into a study protocol that included quantitative bacterial cultures of prostatic tissue. Data of previously defined variables were entered into a data base for subsequent analysis comprised of redefinition of the variables and descriptive and analytical studies. RESULTS: 44 of the 175 patients (25.1%) had a positive bacterial culture of prostatic tissue. Histological lesions indicating prostatitis associated with BPH were found in 68 of the 175 patients (38.9%), regardless of the presence or absence of bacteria. Of these 68 patients with histologically demonstrated prostatic inflammation, only 19 (27.9%) had a positive prostatic tissue culture. The incidence of granulomatous prostatitis was 1.1%. CONCLUSIONS: The presence of bacteria was demonstrated in prostates of a significant number of patients (25.1%) undergoing prostatectomy for BPH. The microorganisms most frequently isolated in the quantitative bacterial cultures were, by order of frequency, coagulase negative Staphylococci, Escherichia coli and Enterococcus faecalis, which were present in concentrations of at least 10(4) CFU/Gm in prostatic tissue of 79.6% of the cases. No differences were found between the type of procedure the patient underwent and the presence or absence of prostatic infection.

[Inflammatory changes in the obstructed prostate: the correlation between the bacteriological and histological findings]. / Cambios inflamatorios en la glándula prostática obstructiva: correlación entre los hallazgos bacteriológicos e histológicos.

OBJECTIVES: To analyze the incidence and nature of the prostatic inflammatory changes, to determine the prevalence of prostatic colonization or infection in patients undergoing surgery for benign hyperplasia of the prostate (BPH) and to correlate the inflammatory lesions with the bacteriological findings. METHODS: A prospective study was conducted on 175 patients undergoing surgery for BPH. All patients were entered into a study protocol that included quantitative bacterial cultures of the prostatic tissue and histological analyses of the surgical specimens. Data of previously defined variables were entered into a data base for subsequent analysis comprised of a descriptive and an analytical study. RESULTS: 44 of the 175 patients (25.1%) had a positive bacterial culture of prostatic tissue. Histological lesions indicating prostatitis associated with BPH were found in 68 of the 175 patients (38.9%), regardless of the presence or absence of bacteria. Of these 68 patients with a histologically demonstrated inflammation of the prostate, only 19 (27.9%) had positive prostatic tissue cultures. The incidence of granulomatous prostatitis was 1.1%. CONCLUSIONS: Histological lesions indicating prostatitis associated with BPH were found in 68 of the 175 patients (38.9%). The presence of bacteria was demonstrated in the prostates of a significant number of patients (25.1%) who underwent adenomectomy for BPH. No differences were found between the patients with a positive or negative bacterial culture and histological evidence of prostatitis.

[Relationship between preoperative urine cultures and prostatic gland cultures in patients treated for benign prostatic hyperplasia]. / Relación entre los cultivos de orina preoperatorios y los cultivos de la glándula prostática en pacientes intervenidos de HBP.

OBJECTIVES: 1.--Investigate the bacteriuria preoperative in patients who will be operate on for Being Prostatic Hyperplasia (BPH). 2.--Define the prevalence of the prostatic colonization or infection. 3.--Try to correlate the bacteriological findings of urine and prostate, and find the degree of concordance between the microorganisms which can be commonly found in urine and prostatic tissue. METHOD AND MATERIALS: Prospective series of 175 patients undergoing prostatectomy for obstructive symptoms. The protocol revealed, among others variables: the preoperative urine culture; the presence or the absence of catheter; and the quantitative bacteriological culture of prostatic tissue. The information could be analised and its results could be obtained later on. The analysis stages consisted of both a descriptive and an analytic study. RESULTS AND CONCLUSIONS: 1.--Only 36 patients (20.6%) presented bacteriological increase of microorganisms (> or = 10(4) UFC/ml) in the preoperative urine culture. The Escherichia coli was the most common microorganism, followed by the Enterococcus faecalis, coagulase-negative Staphylococcus and the Pseudomona aeruginosa. A single microorganism grew in 31 out of the 36 positive cultures. 2.--The prevalence of the infection or colonization of the prostatic tissue was 25.1% (44 patients). The most common isolated microorganism was the coagulase-negative Staphylococcus followed by the Escherichia coli and the Enterococcus faecalis, in concentrations of at least 10(4) UFC/gr of tissue in the 79.6%. A single microorganism was isolated in 32 out of 44 patients. 3.--The proportion of positive prostatic cultures, in patients with positive urine culture (38.3%), was significantly higher than the one obtained in patients with negative urine cultures (16.5%) (p < 0.0001). Nevertheless, 52.3% of the 44 patients with positive prostatic cultures had negative urine culture, and only 21 (58.3%) out of the 36 patients with positive urine cultures presented a bacteriological growth in prostate. The degree of concordance (Kappa index) between the microorganisms which were found in preoperative urine and prostatic tissue is low or none for the majority of them.

[Extensive ureteral lesions: management with substitution with small intestine]. / Lesiones ureterales extensas: manejo mediante sustitución por intestino delgado.

Wide ureteral injuries are unusual but not exceptional and have few conservative therapeutic options, specially those that involve the upper ureter. Autotransplantation, ureteral substitution by intestine and combined Boari bladder flap-psoas bladder hitch are basically the only chances to avoid nephrectomy. In this paper we report five cases in which ileum was used to substitute the ureter and review the most outstanding literature about this subject.

[Liposarcoma of the spermatic cord: a report of a new case and a review of the literature]. / Liposarcoma de cordón espermático: aportación de un nuevo caso y revisión de la literatura.

Malignant paratesticular tumors are uncommon. Of these, liposarcoma of the spermatic cord constitutes a rare tumor. Only a hundred cases have been reported. They are typically presented in elderly people. The usually have a good prognosis because of their low level of malignancy and their relapses tend to be localized. It has a high rate of survival over 5 years. Preoperative diagnosis is infrequent, it is suggested by the appearance of a progressively enlarging mass in the scrotum and the ultrasonography which shows a solid mass of the spermatic cord that is independent of the testicle. The choice treatment is radical orchidectomy, while long-term follow-up of these patients is mandatory because of local relapses. When local relapses become evident, the choice treatment is extensive local excision followed by adjuvant radiotherapy. In the present study we report a new case of a recurring, well differentiated spermatic cord liposarcoma of the type sclerotic, in a 50-year-old man. An exhaustive review of the literature has been made.

[Spontaneous renal hemorrhage. Report of 8 cases]. / Hemorragia renal espontánea. A propósito de ocho casos.

Spontaneous renal haemorrhage or Wünderlich syndrome is a rare condition; it is however of great significance given the emergency, sometimes vital, situation that it creates. The etiology of the condition is varied, the most frequent being tumoral. The clinical manifestations and the use of imaging techniques are of great interest to establish the diagnosis. The choice treatment is controversial. This paper presents eight cases of Wünderlich syndromes seen in our urology service. The background, etiology, clinical manifestations, diagnostic methods and treatment used in each case are analyzed.

[Leiomyosarcoma and rhabdomyosarcoma: rare tumors of the kidney]. / Leiomiosarcoma y rabdomiosarcoma: tumores raros del riñón.

Renal sarcoma represents 2.8% of all renal malignant tumours. The most common kind is leiomyosarcoma while rhabdomyosarcoma is the most unusual. Clinical presentation and diagnosis of both types of tumours are unspecific. Treatment is controversial and the overall prognosis poor. The present paper presents two cases, one leiomyosarcoma and one rhabdomyosarcoma which were treated surgically and were followed by chemo- and radiotherapy. A revision of the criteria for grading these as primary tumours of the kidney is also included.

[Vesico-uterine fistula: report of 2 new cases]. / Fístula vésico-uterina: aportación de dos nuevos casos.

Contribution of two new cases of vesicouterine fistula secondary to a cesarean incision. In one case, diagnosis was achieved through cystography and cystoscopy, while in the second case cystography, cystoscopy and stain testing (methylene blue) were used. In both cases management was through transperitoneal and transvesical fistulorrhaphy. The two cases showed favourable post-operative evolution with no relapse.

[Sertoli cell tumor of the testis: clinical pathologic varieties. Report of a case]. / Tumor testicular de células de Sertoli: variedades clínicas patológicas. A propósito de un caso.

Tumours derived from sex cords and primitive gonadal stroma account for 4% of total testicular tumours. The low frequency of Sertoli's cells tumour (SCT) and the uneven study and follow-up of patients makes analysis of this tumoral entity difficult. This paper contributes one case report of a Sertoli's giant cell tumour calcified in a 13-year old patient, and reviews the clinical aspects, clinico-pathological varieties believed to require assessment in patients with this type of disease. This type of tumour is considered benign in its biological behaviour, although some malignant forms have also been described. SCT is actually an heterogeneous tumoral pathogenic entity with regard to pathogenic and prognostic aspects. Our final conclusions show that the clinico-pathological variety, age, size and associated clinical manifestations appear to be related to the prognosis.

[Myasthenia gravis as paraneoplastic syndrome in small cell tumor of the bladder]. / Miastenia gravis como síndrome paraneoplásico en tumor vesical de células pequeñas.

Only 0.48% of vesical tumours are of the small cells epithelial type with positive neuroendocrine immunohistochemical markers, although the description of new cases is becoming increasingly common. These tumours may be associated to paraneoplastic syndromes of the endocrine and neurological types. This paper contributes one case report of a female patient diagnosed with a small cells epithelial vesical tumour associated to myasthenia gravis. The histological and histochemical features as well as the differential diagnosis with other tumours of vesical location are explained. Clinically, these entities evolve with acute haematuria and have a highly aggressive evolution. Quite frequently the tumour is associated to neuromuscular syndromes such as Lamber-Eaton's, myasthenia-like syndromes, and in rare occasions to myasthenia gravis. Different studies have reported anti-acetylcholine receptors in cells of this tumoral class that may stimulate the formation of antibodies against the neuromotor plaque. Diagnosis of this neurological syndrome and other similar ones may be attributed to early treatment and better prognosis of this tumoral entity.

Self-expanding wallstent endoprosthesis for malignant ureteral obstruction.

We present our experience with the self-expanding Wallstent endoprosthesis for ureteral recanalization in obstructive uropathy secondary to malignant pelvic disease. In total, 19 stents were inserted in 14 ureters. The follow-up included 100% of the patients. To date, except for one case, the patency of the stent has always persisted for the period of the survival of the patients, the longest ones being 4 and 4.1 years.

[Post-TUR radiotherapy in the treatment of locally advanced bladder tumor]. / Radioterapia post RTU en el tratamiento de tumores vesicales localmente avanzados.

Treatment of infiltrant vesical cancer has traditionally been the grounds for intense controversy. Transurethral resection (TUR) followed by high voltage radiotherapy (RT) in selected cases of locally advanced vesical urothelial tumours can be a valid alternative for the treatment of this condition. This paper discloses the experience of our center in the treatment of this type of tumours over the last few years (1979-1993) on 85 selected patient, with a considerable percentage of living patients and with no evidence of disease after the follow-up period; taking into account the influence on these results of the cytologic grade, tumoral size, gross appearance of the tumour, and tumoral stage. Additionally, these results are compared with those from other authors using similar therapeutic method as well as with the results from different therapeutical approaches, illustrating one more the intense controversy that exists relative to the management of these patients.

[Laparoscopic treatment of the symptomatic renal cyst: the indications and a bibliographic review]. / Tratamiento por vía laparoscópica del quiste renal sintomático: indicaciones y revisión bibliográfica.

OBJECTIVES: The indications and usefulness of laparoscopic renal cystectomy are analyzed. METHODS: Five patients with symptomatic or recurrent simple renal cyst were submitted to laparoscopic cystectomy; section of the posterior peritoneum, dissection of the cyst, puncture-aspiration and resection of the cyst wall. RESULTS: Complete removal of the cyst wall was achieved with minimum morbidity, the cyst and symptoms disappeared and the hospital stay was short. There was one case of hematoma in the lumbar fossa that resolved with conservative management. CONCLUSIONS: Laparoscopic resection of the cyst wall appears to be a useful therapeutic approach for symptomatic or recurrent simple renal cysts.

[Clinico-flowmetric analysis of patients being surgically treated for BPH]. / Análisis clínico-flujométrico en pacientes sometidos a tratamiento quirúrgico por H.B.P.

Benign prostatic hypertrophy (BPH) is a common urological disease with a standard surgical approach, transurethral resection (TUR) or open adenectomy (OA), but the flowmetric clinical results are controversial. Fifty-five patients were evaluated; in 23 of them TUR was performed and 32 underwent OA. The Boyarsky clinical questionnaire was filled in, and a flow evaluation conducted prior and subsequent to the procedure to measure maximum and average flow (Qmax and Qave) which was correlated to mictional volume according to Siroky's nomogram. The purpose is to compare the flowmetric clinical results of TUR and OA, and to evaluate flowmetry as a prognostic factor. Correlation of obstructive symptoms and Qmax is low (r = 0.49) and minor for irritative symptoms. Both groups of patients achieve significant clinical improvement (p < 0.001). OA obtains a 248% increase in Qmax, while this figure is 76% with TUR. Patients with post-treatment obstruction after OA are 9.3%, and 26.9% for TUR. Results are better when Qmax prior to surgery is < 5 ml/s than when it is > 10 ml/s.

[Renal trauma in children: our experience and review of the literature]. / Traumatismos renales en la infancia: nuestra experiencia y revisión de la literatura.

Twenty-seven cases of kidney injury in children under 15 years old are reviewed. All of them were diagnosed, treated and subsequently followed in our Service between 1979 and 1992. Clinical evaluation, blood and urine analyses, and imaging techniques are the three basic tools in the management of kidney injuries. Regarding imaging techniques, dynamic CT is currently the best diagnostic method, mainly due to its high anatomic resolution and because it permits evaluation of renal function and of possible associated lesions in other organs. Kidney injuries were classified into three categories: I (18 cases), II (4 cases), and III (4 cases). The last injury affected a pathological kidney. Emergency surgical procedures were performed in 7 cases (25.9%): 2 were category II, 4 category III, and the pathologic kidney that suffered trauma. Surgery was deferred in one case (category II) and the remaining 19 cases (74.1%) were treated conservatively: 18 were category I and 1 category II. Nephrectomy was required only for the pathologic kidney. All the other kidneys were preserved.

[Examination of Doppler color ultrasound in patients with ESWL]. / Examen mediante US Doppler color en enfermos tratados con ESWL.

Although treatment by shock waves has been proven useful in destroying calculi, it is not free from complications and may cause lesions to the kidney whose importance has not been completely elucidated. The present study utilized color Doppler US to determine the changes produced by ESWL on the kidney and its vessels in particular. The results achieved by Doppler evaluation of 25 patients immediately before ESWL, 2, 7 and 30 days post-ESWL show an increased resistance index 2 days after treatment which tended to return to normal at 30 days. We discuss the different results obtained depending on stone location and the complications.

[Carcinoma of the penis: our experience in 24 cases and review of the literature]. / Carcinoma de pene: nuestra experiencia en 24 casos y revisión de la literatura.

Squamous cell carcinoma of the penis has a very scant incidence in our setting and evolves slowly. From 1978 to 1991, 24 cases of penile carcinoma had been treated and followed at our service. The results achieved with partial amputation of the penis have been highly satisfactory for stages T1 and T2, which was combined with postoperative radiotherapy for the latter tumor stage. Since carcinoma of the penis generally presents with infection, if lymphadenectomy is performed, it has to be performed after the amputation. The peculiar features of this disease, patient characteristics and the diversity of the therapeutical approaches make penile carcinoma a lesion whose treatment is controversial and, in many cases, difficult to follow.