Agavins Impact on Gastrointestinal Tolerability-Related Symptoms during a Five-Week Dose-Escalation Intervention in Lean and Obese Mexican Adults: Exploratory Randomized Clinical Trial.

Agavins are prebiotics and functional fiber that modulated the gut microbiota and metabolic status in obese mice. Here, we designed a placebo-controlled, double-blind, exploratory study to assess fluctuations in gastrointestinal (GI) tolerability-related symptoms to increasing doses of agavins in 38 lean and obese Mexican adults for five weeks and their impact on subjective appetite, satiety, metabolic markers, and body composition. All GI symptoms showed higher scores than placebo at almost every dose for both lean and obese groups. Flatulence caused an intense discomfort in the lean-agavins group at 7 g/day, while obese-agavins reported a mild-to-moderate effect for all five symptoms: no significant differences among 7, 10, and 12 g/day for flatulence, bloating, and diarrhea. Ratings for any GI symptom differed between 10 and 12 g/day in neither group. The inter-group comparison demonstrated a steady trend in GI symptoms scores in obese participants not seen for lean volunteers that could improve their adherence to larger trials. Only body weight after 10 g/day reduced from baseline conditions in obese-agavins, with changes in triglycerides and very-low-density lipoproteins compared to placebo at 5 g/day, and in total cholesterol for 10 g/day. Altogether, these results would help design future trials to evaluate agavins impact on obese adults.

Testicular tumors: residual retroperitoneal mass surgery after chemotherapy;Is it possible to predict their histology?

OBJECTIVES: We present our series of residual retroperitoneal mass surgery after chemotherapy. We evaluate possible preoperative parameters that can predict the retroperitoneal mass histology. Survival and relapse rates were also evaluated. METHODS: We reviewed sixty resections of residual retroperitoneal masses of testicular tumours after chemotherapy performed at our department between 1995 and 2007. We evaluate the relationship between histology of the retroperitoneal mass and possible risk factors, such as outcomes after chemotherapy, which was evaluated as changes in the size of the retroperitoneal mass, and negativization of serum tumor markers. We also evaluate histology and size of the primary testicular cancer. RESULTS: The histology of retroperitoneal mass was necrosis or fibrosis in 25 (42%) cases, teratoma in 29 (48%) and viable tumor in 6 (10%). The size of the retroperitoneal mass decreased after the chemotherapy in 62% cases; moreover negative serum tumor markers were found in 87%. Elevated values of human chorionic gonadotropin were associated with viable cells in the retroperitoneal mass (p=0.014) and, the presence of teratoma in the primary tumor may be associated with teratoma in the retroperitoneal mass histology (p=0.002). However, no other preoperative factors that predict the residual mass histology were found. Repeated resections of retroperitoneal masses were required in four patients and 9 patients died during follow-up. CONCLUSIONS: We cannot determine preoperative parameters that accurately predict the histology of retroperitoneal masses. Therefore, resection of residual retroperitoneal masses after chemotherapy in non-seminomatous germ cell tumours must be performed.

Tumores testiculares: cirugía de masas retroperitoneales residuales tras tratamiento quimioterápico; ¿es posible predecir su histología? / Testicular tumors: residual retroperitoneal mass surgery after chemotherapy; ¿is it possible to predict their histology?

OBJETIVO: Presentamos nuestra serie de cirugías de masas retroperitoneales residuales postquimioterapia, evaluando aquellos parámetros que pudieran predecir su histología y mostramos la evolución tras la cirugía.MÉTODOS: Revisamos retrospectivamente 60 cirugías de masas retroperitoneales residuales tras quimioterapia, secundarias a tumores testiculares de células germinales realizadas en nuestro servicio entre 1995 y 2007. Estudiamos la relación entre la histología de la masa y sus posibles factores predictores, tales como: la respuesta a la quimioterapia valorada como reducción del tamaño de la masa retroperitoneal y evolución de los marcadores tumorales, la anatomía patológica y el tamaño del tumor primario.RESULTADOS: La histología de las masas residuales fue necrosis/fibrosis en 25 (42%) casos, teratoma en 29 (48%) y tumor viable en 6 (10%). La quimioterapia consiguió reducir el tamaño de la masa en el 62% de los casos, se logró negativización de los marcadores en el 87%. Aunque valores más altos de gonadotropina coriónica humana se asocian con masas que contienen células viables (p=0,014) y la presencia de teratoma en el tumor primario puede orientar hacia la histología de la masa retroperitoneal (p=0,002), no encontramos otros factores preoperatorios predictivos de la histología de la masa residual. En 4 pacientes fueron necesarias varias cirugías ante la existencia de recidiva y 9 pacientes fallecieron durante el seguimiento.CONCLUSIONES: No encontramos claros factores predictores de la histología de la masa retroperitoneal. Por tanto, en los tumores germinales no seminomatosos debe realizarse una completa resección quirúrgica de las masas retroperitoneales residuales tras el tratamiento quimioterápico(AU)

OBJECTIVES: We present our series of residual retroperitoneal mass surgery after chemotherapy. We evaluate possible preoperative parameters that can predict the retroperitoneal mass histology. Survival and relapse rates were also evaluated. METHODS: We reviewed sixty resections of residual retroperitoneal masses of testicular tumours after chemotherapy performed at our department between 1995 and 2007. We evaluate the relationship between histology of the retroperitoneal mass and possible risk factors, such as outcomes after chemotherapy, which was evaluated as changes in the size of the re-troperitoneal mass, and negativization of serum tumor markers. We also evaluate histology and size of the primary testicular cancer.RESULTS: The histology of retroperitoneal mass was necrosis or fibrosis in 25 (42%) cases, teratoma in 29 (48%) and viable tumor in 6 (10%). The size of the retroperitoneal mass decreased after the chemotherapy in 62% cases; moreover negative serum tumor markers were found in 87%. Elevated values of human chorionic gonadotropin were associated with viable cells in the retroperitoneal mass (p=0.014) and, the presence of teratoma in the primary tumor may be associated with teratoma in the retroperitoneal mass histology (p=0.002). However, no other preoperative factors that predict the residual mass histology were found. Repeated resections of retroperitoneal masses were required in four patients and 9 patients died during follow-up.CONCLUSIONS: We cannot determine preoperative parameters that accurately predict the histology of retroperitoneal masses. Therefore, resection of residual retroperitoneal masses after chemotherapy in non-seminomatous germ cell tumours must be performed(AU)

[Treatment with tamsulosin. Should the cataract be operated before?]. / Tratamiento con tamsulosina. Debe operarse la catarata antes?

OBJECTIVE: Recently, intraoperative floppy-iris syndrome (IFIS) has been related to tamsulosin treatment. This review evaluates the epidemiological evidence of the association of tamsulosin with IFIS and the necessity of a prior ophthalmolo-gic examination in this group of patients. METHOD: Systematic review of the literature. RESULTS: Since 2005, when the syndrome was described, some studies have confirmed this association. Tamsulosin is the most clearly involved drug. No prospective studies have been published, but some authors consider that the syndrome affects, at least, half of the patients receiving this drug. No medical treatment has demonstrated its usefulness in the prevention of this syndrome. CONCLUSION: Considering the high prevalence of this syndrome, all the patients who are going to start this treatment should receive previous ophthalmologic examination, to evaluate the convenience of performing early cataract surgery in order to avoid intraoperative complications.

Tratamiento con Tamsulosina. ¿Debe operarse la catarata antes? / Treatment with tamsulosin. Should the cataract be operated before?

Objetivo: Recientemente se ha relacionado el síndrome del iris flácido (intraoperative floppy-iris syndrome o IFIS) con el consumo de tamsulosina A través de esta revisión pretendemos evaluar esta asociación epidemiológica, así como la necesidad de que este grupo de pacientes sea sometido a un examen oftalmológico previo al inicio del tratamiento. Método: Revisión crítica de la literatura relacionada. Resultado: Desde que en el año 2005 se describiera por primera vez este síndrome, varios estudios han confirmado esta asociación. El fármaco más claramente asociado es la tamsulosina, y aunque no se han publicado estudios prospectivos se considera que afecta, al menos, a la mitad de los pacientes que reciben este tratamiento. No existe ningún tratamiento médico que haya demostrado ser eficaz en su prevención. Conclusiones: Dada la alta prevalencia de este síndrome, sería recomendable que todos los pacientes que vayan a iniciar este tratamiento sean valorados previamente por el oftalmólogo con la finalidad de que en caso de considerarse necesario se lleve a cabo la cirugía de la catarata de forma precoz, para evitar de este modo posibles complicaciones quirúrgicas (AU)

Objective: Recently, intraoperative floppy-iris syndrome (IFIS) has been related to tamsulosin treatment. This review evaluates the epidemiological evidence of the association of tamsulosin with IFIS and the necessity of a prior ophthalmologic examination in this group of patients. Method: Systematic review of the literature. Results: Since 2005, when the syndrome was described, some studies have confirmed this association. Tamsulosin is the most clearly involved drug. No prospective studies have been published, but some authors consider that the syndrome affects, at least, half of the patients receiving this drug. No medical treatment has demonstrated its usefulness in the prevention of this syndrome. Conclusion: Considering the high prevalence of this syndrome, all the patients who are going to start this treatment should receive previous ophthalmologic examination, to evaluate the convenience of performing early cataract surgery in order to avoid intraoperative complications (AU)

[Penile tunica albuginea plication for the treatment of penile curvature secondary Peyronie's disease]. / Plicatura de la albugínea como tratamiento de la incurvación de pene causada por la enfermedad de Peyronie.

OBJECTIVE: To evaluate, in a retrospective analysis, our long-term results of patients undergoing the Essed plication procedure for the correction of penile curvature due to Peyronie's disease. METHODS: Between January 1998 and June 2003, 83 patients with acquired penile deviation were treated with the Essed technique in our hospital. We analyse the following data: age, main complaint, type of deviation, erection before and after the surgery, physical exploration, ecographic data, complications and results. RESULTS: Mean follow-up was 36 months. Main complaint was penile curvature in 96.3% of patients. The most frequent types of deviation were dorsal (55.4%) and left lateral (48.1%). Erection before surgery was sufficient for sexual intercourse in 74.7%. Physical exploration revealed a plaque in 79.5% of the patients. 93% of the cases reported complete penile curvature correction or residual deviation < 10 degrees. 65.1% of the patients were satisfied or very satisfied with the result of the operation and 64% were able to perform sexual intercourse. CONCLUSIONS: The Essed plication is a simple and minimally invasive method for correcting acquired penile deviation. Although functional results seem to be satisfactory, in our experience the degree of satisfaction with the outcome is not as good, among the patients, as it could be expected.

Plicatura de la albugínea como tratamiento de la incurvación de pene causada por la enfermedad de Peyronie / Penile tunica albuginea plication for the treatment of penile curvature secondary Peyronie´s disease

OBJETIVO: Evaluar nuestros resultados enel tratamiento de la incurvación peneana causada porla enfermedad de Peyronie mediante la plicatura albugíneadescrita por Essed.MÉTODOS:Revisión retrospectiva de los 83 pacientestratados quirúrgicamente de incurvación peneanaadquirida en nuestro centro mediante la técnica de plicaturaentre enero de 1998 y junio de 2003, analizandolas siguientes variables: edad, motivo de consulta,antecedentes personales, exploración física,datos ecográficos, tipo de incurvación, erección pre ypostcirugía, complicaciones y resultados de la técnicaquirúrgica.RESULTADOS:El seguimiento medio fue de 36 meses.El motivo de consulta principal fue la desviación peneanaen erección (96,3%). El tipo de incurvación másfrecuente fue dorsal (55,4%) y lateral izquierda(48,1%). La erección previa a la cirugía era suficientepara mantener una relación sexual en el 74,7% de lospacientes. La exploración física reveló la existencia deplaca en el 79,5% de los casos. En cuanto a los resultadosde la cirugía, el 93% refieren una correccióncompleta de la incurvación o una desviación residualmenor de 10º. El 65,1% manifestaron encontrarse satisfechoso muy satisfechos con la operación, mientrasque el 64% eran capaces de llevar a cabo una relaciónsexual.CONCLUSIONES: La plicatura de Essed es un procedimientosencillo y mínimamente invasivo para corregirla desviación adquirida de pene. En nuestra experiencia,aunque los resultados funcionales parecen ser buenos,el grado de satisfacción entre los pacientes tras lacirugía no es tan alto como cabría esperar

OBJETIVE: To evaluate, in a retrospective analysis, our long term results of patients undergoing the Essed plication procedure for the correction of penile curvature due to Peyronie´s disease. METHODS: Between January 1998 and June 2003, 83 patients with acquired penile deviation were treated with the Essed technique in our hospital. We analyse the following data: age, main complaint, type of deviation, erection before and after the surgery, physical exploration, ecographic data, complications and results. RESULTS: Mean follow-up was 36 months. Main complaint was penile curvature in 96.3% of patients. The most frequent types of deviation were dorsal (55.4%) and left lateral (48.1%). Erection before surgery was sufficient for sexual intercourse in 74.7%. Physical exploration revealed a plaque in 79.5% of the patients. 93% of the cases reported complete penile curvature correction or residual deviation < 10º. 65.1% of the patients were satisfied or very satisfied with the result of the operation and 64% were able to perform sexual intercourse. CONCLUSIONS: The Essed plication is a simple and minimally invasive method for correcting acquired penile deviation. Although functional results seem to be satisfactory, in our experience the degree of satisfaction with the outcome is not as good, among the patients, as it could be expected

[Testicular epidermoid cyst: report of a new case and bibliographic review]. / Quiste epidermoide testicular: a propósito de un nuevo caso y revisión de la literatura.

OBJECTIVES: The epidermoid cyst of the testis is a rare benign tumor. It accounts for approximately 1% of all testicular tumors. Generally, the testis has a palpable, painless mass with tumor markers (AFP, BHCG, and LDH) within normal ranges. Pathology reveals a cavity consisting of squamous epithelial cells containing keratin and non-nucleated keratic flakes in the absence of atypia or elements of teratoma. METHODS/RESULTS: We report the case of a young man who was diagnosed of epidermoid cyst after orchiectomy. CONCLUSIONS: Tumor enucleation would be a proper treatment when ultrasound studies suggest this diagnosis. However, we often perform orchiectomy due to a low rate of suspicion, non conclusive ultrasound studies, or due to the high percentage of malignant testicular tumors in this age range.

[Renal colic in a patient with crossed renal ectopia]. / Crisis reno-ureteral en paciente con ectopia renal cruzada.

OBJECTIVES: To report a new case of renal colic in a patient with crossed renal ectopia and L-shaped kidney, and to perform a bibliographic review. METHODS AND RESULTS: A 33-year-old male patient consulted for abdominal right pain. Ultrasound and CT showed a L-Shaped Kidney with left renal and ureteral stones. These stones produced obstructive left collecting system. This patient was managed with left pyelolithotomy and ureterolithotomy. The transabdominal approach was recommended to resolve this stones. CONCLUSIONS: The crossed renal ectopia with fusion is a rare condition. The abnormal kidney position and the anomalous kidney supply may impede drainage from the collecting system, creating a predisposition to urinary tract infection and calculus formation. The colic in this patient sometimes is misdiagnosed how abdominal disease. The usual method of detection was excretory urography but now ultrasonography and CT have showed more cases. The indications for open surgery in treatment the stones, are generally failure of extracorporeal shock wave lithotripsy, this is common in these cases for the anatomic abnormality, and the transabdominal approach is recommended to resolve its complications in this kidneys.

Retroperitoneal abscesses--analysis of a series of 66 cases.

OBJECTIVE: To analyze our experience with the management of retroperitoneal abscesses. PATIENTS AND METHODS: A retrospective study was made of 66 patients with retroperitoneal abscesses treated at our hospital from January 1975 to July 2001 for the purpose of analyzing the diagnosis and treatment of these rare infections. In each case, we analyzed patient characteristics, abscess location and origin, predisposing factors, clinical presentation, microbiology, radiographic findings, treatment, and outcome. RESULTS: In our series, the most frequent type of abscess was perinephric (45.4%), and the most frequent origin was the kidney (72.7%), generally renal lithiasis or previous urological surgery. Gram-negative bacilli were the microorganisms most often involved as causal agents of abscesses. CT had the best diagnostic performance (95%). Percutaneous drainage resolved the abscess in 86.3% of the patients in which it was used, compared with 87.5% for traditional surgical drainage. In 4 cases, the only treatment was administration of antibiotics. In all these cases the abscesses were smaller than 3 cm and patients were in good general condition. The mortality rate was excellent (1.5%), probably due to the low rate of comorbidity in our patients. CONCLUSIONS: Gram-negative bacilli were the most frequent microorganisms in our retroperitoneal abscesses. CT was the imaging technique that produced the most reliable and rapid diagnosis. Radiographically-guided percutaneous drainage was a safe and effective therapeutic alternative when used as definitive treatment or preoperatively.

[Encrusted pyelitis in patients with urinary diversion]. / Pielitis incrustante en pacientes con derivación urinaria.

OBJECTIVE: This is a case of Encrusted Pyelitis (EP) caused by Corynebacterium urealyticum (CU) in a patient who had undergone a cystectomy and Bricker type urinary diversion 28 months beforehand. METHODS/RESULTS: After the immediate post-operative period no urinary catheterisation or any other urological procedure was performed on the patient. Before surgery, the patient presented non functional of the right kidney, secondary to a lithiasic obstructive uropathy. Clinical symptoms were deteriorated renal function, anuria, haematuria, pyrexia and left lumbar pain. It was suspected that the patient had this pathology and this was fundamental in diagnosis. Helicoid CT was the principal method used to show calcification plaques on the wall of the left renal pelvis, and selective culture of CU confirmed the diagnosis. Early commencement of treatment with vancomycin at an initial dosage of 500 mg/12 hours, and subsequent adjustment of dosage according to blood drug levels, achieved negative urine culture within a fortnight. Oral acidification was effected using acetohidroxamic acid 125 mg/12 hours, and it was continued until CT confirmed the disappearance or considerable reduction of the pyelic calcification plaques. CONCLUSION: The presence of EP in patients with urinary diversion is a matter worthy of consideration, even in patients who have not undergone recent urological procedures. Awareness of risk factors and early commencement of effective treatment may improve the prognosis of these patients.

Crisis reno-ureteral en paciente con ectopia renal cruzada / Renal colic in a patient with crossed renal ectopia

La colección de escritos médicos griegos que se nos ha transmitido con la denominación general de Corpus Hippocraticum, se dedica a una amplia temática que incluye consideraciones generales sobre la profesión y ética médica, y estudios de fisiología, patología, dietética, y ginecología. La medicina debe a la escuela hipocrática dos contribuciones: la figura del médico y la creación de un método. El método se apoya en la experiencia, se basa en la observación estricta y esto lo acerca a la práctica actual de la anatomía patológica. "Los Aforismos" constituyen el tratado más conocido del Corpus Hippocraticum. En opinión de los autores el primer aforismo señala con especial precisión la actividad del patólogo. "La vida es breve" se dedica a Bichat, de corta vida, creador del concepto de tejido y de la Patología Tisular. "La ciencia extensa" incluye un comentario de la amplitud de conocimientos básicos, clínicos y técnicos necesarios para la práctica de la anatomía patológica. "La ocasión fugaz" alude a las indicaciones y contraindicaciones actuales de la biopsia intraoperatoria. "La experiencia insegura" se refiere a los errores patológicos y la oportunidad de corregirlos. "El juicio difícil" incluye comentarios de la variabilidad inter e intraobservador, reproducibilidad, aplicación de criterios de expertos y clasificaciones de consenso de los cuadros patológicos. La anatomía patológica requiere un proceso constante de refinamiento de los criterios diagnósticos. Esto lleva a los autores a la conclusión de que la morfología patológica aún no se ha completado. El Corpus Hippocraticum señala el origen de la medicina racional. OBJETIVOS: Presentar un nuevo caso de crisis reno-ureteral (CRU) en paciente con ectopia renal cruzada con fusión en L y revisión de la literatura. MÉTODO Y RESULTADOS: Un paciente varón de 33 años acudió a nuestro servicio por presentar dolor en fosa ilíaca derecha. Es diagnosticado mediante ecografía y T.A.C. de ectopia renal cruzada con fusión en L más uropatía obstructiva litiásica izquierda. El paciente fue sometido a pielolitectomía más ureterolitectomía izquierda con abordaje transperitoneal. CONCLUSIÓN: La ectopia renal cruzada con fusión es una patología infrecuente. La anormal posición y aporte vascular del riñón puede impedir el drenaje del sistema colector induciendo una fuerte predisposición a las infecciones del tracto urinario y a la formación de cálculos. La CRU simula en estos pacientes un cuadro de abdomen agudo. El método habitual de detección de esta patología fue la urografía intravenosa pero actualmente el uso de la ecografía y la T.A.C han mostrado más casos. Las indicaciones para la cirugía abierta en el tratamiento de las litiasis, son generalmente las derivadas del fallo de la L.E.O.C.; esto es algo común en este tipo de casos como consecuencia de las anomalías anatómicas que presentan este tipo de pacientes, siendo el abordaje transabdominal el recomendado para resolver esta complicación en estos riñones (AU)

Pielitis incrustante en pacientes con derivación urinaria / Encrusted pyelitis in patients with urinary diversion

OBJETIVO: Presentamos un caso de pielitis incrustante (PI) ocasionada por Corynebacterium urealyticum (CU) sobre paciente cistectomizado hace 28 meses y al que se le realizó una derivación urinaria tipo Bricker. MÉTODO/RESULTADOS: Desde el postoperatorio inmediato, no había sido sometido a cateterismo urinario ni a ninguna otra manipulación urológica. El sujeto presentaba con anterioridad a la cirugía, anulación funcional del riñón derecho secundario a uropatía obstructiva litiásica. El deterioro de la función renal, anuria, hematuria, fiebre y dolor lumbar izquierdo fue la clínica de presentación. La sospecha de esta entidad fue primordial para su diagnóstico. La TC helicoidal fue el método principal para mostrar las placas de calcificación en la pared de la pelvis renal izquierda, siendo el cultivo selectivo para CU el método diagnóstico de confirmación. La instauración precoz de tratamiento con vancomicina a una dosis inicial de 500 mg/ 12 horas y ajustando posteriormente su dosificación según los niveles de fármaco en sangre, logró una negativización del urocultivo en 15 días. Se llevó a cabo acidificación oral con ácido acetohidroxámico a dosis de 125 mg/ 12 horas, y se mantuvo su administración hasta la constatación mediante TC de la desaparición o reducción considerable de las placas de calcificación piélicas. CONCLUSIÓN: La existencia de PI en pacientes portadores de derivaciones urinarias es un hecho a tener en cuenta, incluso en aquellos pacientes que no han sufrido manipulaciones urológicas recientes. El conocimiento de los factores de riesgo y la instauración precoz de un tratamiento eficaz puede mejorar el pronóstico de estos sujetos (AU)

Tumor testicular fundido / "Burned out" testicular tumor

OBJETIVO: En este artículo revisamos los distintos aspectos relacionados con el tumor testicular fundido o fenómeno de "autoquemadura".MÉTODO: Se han revisado los artículos publicados hasta la actualidad referentes a esta entidad clínica. Para ello hemos recurrido a una búsqueda informatizada (MEDLINE 1980-1999), y se han revisado citas bibliográficas utilizadas en los artículos seleccionados. RESULTADOS: El fenómeno de "autoquemadura" supone la regresión de un foco de tumor testicular tras la producción de metástasis a distancia, sin conocerse su causa. A pesar de esto, podemos identificar lesiones histológicas características, como son la presencia de una lesión compuesta de tejido colágeno, con células neoplásicas dispersas en su interior. El diagnóstico se realiza mediante el estudio anatomopatológico de la pieza de orquiectomía, debiendo llevarse a cabo ésta en pacientes con tumor germinal extragonadal que presentan alteraciones en la exploración física o en la ecografía. CONCLUSIONES: La presencia de un tumor testicular fundido debe tenerse en cuenta en pacientes con tumores germinales extragonadales, debiendo realizarse una cuidadosa exploración física y ecografía testicular. La orquiectomía puede mejorar el pronóstico de estos tumores, ya que la quimioterapia puede no ser efectiva (AU)