RESUMO
We report a man in whom a 15 cm. renal tumor was excised at the age of 49. The pathological examination showed a clear cell carcinoma. Five years later, he presented with headache, vomiting and unilateral palpebral ptosis. Imaging studies showed a sellar tumor with pituitary apoplexy. The tumor was excised and the pathological study disclosed a clear cell tumor, positive for vimentin, cytokeratins AE1 and AE3 and immunohistochemically negative for LH, TSH, ACTH and GH. Considering the similar histopathological features, it was considered as a metastasis of the renal tumor. The patient was supplemented with thyroid, adrenal and gonadal hormones. Seven years later, he presented a new tumor in the remaining kidney, that corresponded to a cystic papillary renal cell carcinoma. Afterwards, he presented a transitional urinary bladder tumor. Mortality associated to renal cell tumors is 90 percent at 5 years, and pituitary metastases are extraordinarily uncommon
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/secundário , Apoplexia Hipofisária/etiologia , Carcinoma de Células Renais/complicações , Neoplasias Hipofisárias/complicações , Apoplexia Hipofisária/cirurgia , Apoplexia Hipofisária/diagnóstico , Seguimentos , Metástase Neoplásica , Nefrectomia , Carcinoma de Células Renais/cirurgia , Diagnóstico DiferencialAssuntos
Humanos , Feminino , Neoplasias Urogenitais/diagnóstico , Neoplasias Urogenitais/tratamento farmacológico , Neoplasias Urogenitais/cirurgia , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/cirurgia , Neoplasias Pélvicas/tratamento farmacológico , Neoplasias Pélvicas/cirurgia , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/cirurgia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/cirurgia , Neoplasias Ureterais/tratamento farmacológico , Neoplasias Ureterais/cirurgia , Procedimentos Cirúrgicos UrológicosRESUMO
Background: five percent of consultations at the emergency room of Catholic University Hospital are due to nephrolithiasis. The causes of this high frequency remain unknown. Aim: to know the main metabolic and anatomic factors involved in the genesis of nephrolithiasis. Patients and methods: 41 patients (31 male) were studied presenting with a renal colic were studied as soon as the acute episode subsided and without diet modifications. Fasting blood calcium and creatinine and 24 h urine calcium, uric acid, citrate, magnesium and pH were measured and an intravenous pyelogram was performed. 21 subjects without a history of nephrolithiasis were used as controls. Results: Patients with nephrolithiasis did not differ from controls in urinary calcium (159 ñ 67 and 172 ñ 67 mg/24 h respectively), uricosuria (417 ñ 171 and 431 ñ 121 mg/24 h respectively) or urinary magnesium (55 ñ 19 and 62 ñ 21 mg/24 h respectively, whereas urinary citrate was lower (219 ñ 172 vs 319 ñ 179 mg/24 h in controls p <0.05). All patients had a normal renal functions, urinary acidification and intravenous pyelogram. Seven percent of patients with nephrolithiasis had hypercalciuria, 2.4 percent had hyperuricosuria, 68.3 percent had a low urinary citrate and 44.4 percent had low urinary magnesium. Conclusions: in this sample, there is a strong association of nephrolithiasis with low levels of crystallization inhibitors in special with urinary citrate, a crystallization inhibitor
Assuntos
Adulto , Pessoa de Meia-Idade , Cálculos Urinários/metabolismo , Purinas/metabolismo , Urografia , Estudos de Casos e Controles , Cálcio/metabolismo , Cálculos Urinários/fisiopatologia , Cristalização , Espectrofotometria Atômica/métodos , Comportamento AlimentarRESUMO
Desde octubre 1976 hasta junio 1986, 185 pacientes portadores de seminoma puro de testículo han sido tratados con radioterapia. 101 pacientes etapificados en estado I recibieron irradiación infradiafragmática y 84 pacientes etapificados como estado II recibieron irradiación infra y supra diafragmática. Con seguimiento mínimo de 36 meses, la sobrevida para pacientes en estado I fue del 98%, subiendo a 99% luego de rescate, en estado II la sobrevida sin evidencia de enfermedad fue 93%, subiendo a 96% luego de rescate. Ni desarrollo de segundos tumores testiculares, compromiso escrotal, albugínea, epididímo, cordón, rete testis, carcinoma in situ, multifocalidad, diferenciación, título de beta gonadotrofinas fueron de importancia pronóstica. En pacientes en estado II sólo presencia de masa abdominal palpable fue de influencia adversa
Assuntos
Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Disgerminoma/terapia , Disgerminoma/diagnóstico , Disgerminoma/radioterapiaRESUMO
En 36 pacientes con Ca vesical se usó BCG en instalación local. Se evaluó en 18 de ellos aspectos de respuesta clínica y morfológica frente a dosis variable decreciente de BCG (50 mg a 2 mg). Se usó cepa Pasteur con alta viabilidad. La respuesta anátomo-clínica encontrada fue independiente de la dosis empleada. La presencia de inflamación vesical granulomatosa post tratamiento coincidió en mayor frecuencia con la desaparición persistente del tumor, no así la inflamación vesical inespecífica que tuvo más recurrencia