Shipwrecked on the Rock, or Not Quite: Gypsophytes and Edaphic Islands.

Species-area relationships (SAR) constitute a key aspect of ecological theory and are integral to other scientific disciplines, such as biogeography, which have played a crucial role in advancing biology. The theory of insular biogeography provides a clear example. This theory initially expanded from true islands to other types of systems characterized by their insularity. One such approach was linked to geoedaphic islands, as seen in gypsum outcrops. While these continental areas have been considered insular systems, only limited and mostly indirect evidence thereof has been provided. This study utilized SAR to advance the understanding of gypsum outcrops as insular continental territories. It is hereby hypothesized that gypsum outcrops are edaphic islands, although their insular nature depends on the different functional or ecological plant types, and this nature will be reflected in the potential Arrhenius model z values. The results obtained support both hypotheses and provide insight into the ecological factors that help interpret the insularity of these areas. This interpretation goes beyond their mere extent and the distance among outcrops, emphasizing the importance of environmental filters. Said filters vary in permeability depending on the degree of gypsophily, or preference for gypsum, exhibited by different species.

Spontaneous Primary Succession and Vascular Plant Recovery in the Iberian Gypsum Quarries: Insights for Ecological Restoration in an EU Priority Habitat.

Gypsum covers a vast area of the Iberian Peninsula, making Spain a leader in its production. Gypsum is a fundamental raw material for modern societies. However, gypsum quarries have an obvious impact on the landscape and biodiversity. Gypsum outcrops host a high percentage of endemic plants and unique vegetation, considered a priority by the EU. Restoring gypsum areas after mining is a key strategy to prevent biodiversity loss. For the implementation of restoration approaches, understanding vegetation's successional processes can be of invaluable help. To fully document the spontaneous succession in gypsum quarries and to evaluate its interest for restoration, 10 permanent plots of 20 × 50 m were proposed, with nested subplots, in which vegetation change was recorded for 13 years in Almeria (Spain). Through Species-Area Relationships (SARs), these plots' floristic changes were monitored and compared to others in which an active restoration was carried out, as well as others with natural vegetation. Furthermore, the successional pattern found was compared to those recorded in 28 quarries distributed throughout the Spanish territory. The results show that an ecological pattern of spontaneous primary auto-succession is widely recurring in Iberian gypsum quarries, which is capable of regenerating the pre-existing natural vegetation.

Plants on Rich-Magnesium Dolomite Barrens: A Global Phenomenon.

For botanists and ecologists, the close link between some plants and substrates, such as serpentine or gypsum, is well known. However, the relationship between dolomite and its flora has been much less studied, due to various causes. Its diffuse separation from limestone and the use of a vague approach and terminology that, until now, no one has tried to harmonize are among these reasons. After carrying out an extensive review, completed with data on the distribution of plants linked to dolomite, the territories in which this type of flora appears at a global level were mapped using a geographic information system software. In addition, data on soils were collected, as well as on their influence on the ionomic profile of the flora. These data were completed with the authors' own information from previous research, which also served to assess these communities' degree of conservation and the genetic diversity of some of their characteristic species. The results showed that the so-called "dolomite phenomenon" is widely represented and is clearly manifested in the appearance of a peculiar flora, very rich in endemisms, on dry soils, poor in nutrients, and with a high Mg level. Although dolomite habitats cause adaptations in plants which are even more recognizable than those of other rock types, they have not been widely studied from an ecological, evolutionary, and conservation point of view because, so far, neither their characteristics nor their universal demarcation have been precisely defined.

Plant evolution in alkaline magnesium-rich soils: A phylogenetic study of the Mediterranean genus Hormathophylla (Cruciferae: Alysseae) based on nuclear and plastid sequences.

Habitats with alkaline edaphic substrates are often associated with plant speciation and diversification. The tribe Alysseae, in the family Brassicaceae, epitomizes this evolutionary trend. In this lineage, some genera, like Hormathophylla, can serve as a good case for testing the evolutionary framework. This genus is centered in the western Mediterranean. It grows on different substrates, but mostly on alkaline soils. It has been suggested that diversification in many lineages of the tribe Alysseae and in the genus Hormathophylla is linked to a tolerance for high levels of Mg+2 in xeric environments. In this study, we investigated the controversial phylogenetic placement of Hormathophylla in the tribe, the generic limits and the evolutionary relationships between the species using ribosomal and plastid DNA sequences. We also examined the putative association between the evolution of different ploidy levels, trichome morphology and the type of substrates. Our analyses demonstrated the monophyly of the genus Hormathophylla including all previously described species. Nuclear sequences revealed two lineages that differ in basic chromosome numbers (x = 7 and x = 8 or derived 11, 15) and in their trichome morphology. Contrasting results with plastid genes indicates more complex relationships between these two lineages involving recent hybridization processes. We also found an association between chloroplast haplotypes and substrate, especially in populations growing on dolomites. Finally, our dated phylogeny demonstrates that the origin of the genus took place in the mid-Miocene, during the establishment of temporal land bridges between the Tethys and Paratethys seas, with a later diversification during the upper Pliocene.

[Mesenteric desmoid tumor mimicking a testicular cancer recurrence]. / Tumor desmoide mesentérico simulando una recidiva de cáncer testicular.

OBJECTIVE: Report of one case of desmoid tumor in a patient who had been treated of a testicular seminoma 26 months before, with excision of a retroperitoneal mass and chemotherapy. On followup he presented with a mesenteric abdominal mass which was clinically labeleled as a recurrence of the seminoma. RESULTS: Histologically it was reported as a mesenteric desmoid tumor. Differential diagnosis with gastrointestinal stromal tumor was performed with immunohistochemical studies. CONCLUSIONS: Desmoid tumor is rare. There are few cases reported in patients with history of previous testicular tumor. It should be included in the differential diagnosis of testicular tumor recurrences.

Tumor desmoide mesentérico simulando una recidiva de cáncer tesitular / Mesenteric desmoid tumor mimicking a testicular cancer recurrence

Objetivo: Presentar un caso de un tumor desmoide en un paciente tratado de un seminoma testicular que simulaba una recidiva del tumor testicular. Método: Presentamos el caso de un paciente de 41 años, tratado de un seminoma testicular 26 meses antes, mediante extirpación de una masa testicular retroperitoneal y quimioterapia, que presenta en el seguimiento, una masa abdominal mesentérica que se etiquetó clínicamente de recidiva de seminoma. Resultado: Histológicamente se informa de tumor desmoide mesentérico. Se hace diagnóstico diferencial con un tumor de estroma gastrointestinal mediante el estudio inmunohistoquímico. Conclusiones: El tumor desmoide es un tumor raro. Se han descrito pocos casos en pacientes afectos previamente de tumor testicular. Debe incluirse en el diagnóstico diferencial de las recidivas por tumor testicular (AU)

Objective: Report of one case of desmoid tumor in a patient who had been treated of a testicular seminoma 26 months before, with excision of a retroperitoneal mass and chemotherapy. On follow-up he presented with a mesenteric abdominal mass which was clinically labeleled as a recurrence of the seminoma. Results: Histologically it was reported as a mesenteric desmoid tumor. Differential diagnosis with gastrointestinal stromal tumor was performed with immunohistochemical studies. Conclusions: Desmoid tumor is rare. There are few cases reported in patients with history of previous testicular tumor. It should be included in the differential diagnosis of testicular tumor recurrences (AU)

[Inflammatory prostatic pseudotumor (fibromyxoid pseudosarcomatous tumor)]. / Pseudotumor inflamatorio de prostata (tumor fibromixoide pseudosarcomatoso).

OBJECTIVES: To report one case of an exceptional benign prostatic pathology and its differential diagnosis with malignant tumors. METHODS: 67-year-old male who suffers an acute urinary retention requiring bladder catheterization and subsequent negative catheter removal tests. Digital rectal examination showed a small prostate, adenomatous, without nodules. PSA was 1.01 ng/ml. The patient underwent transurethral resection of the prostate because of the persistence of urinary retention. RESULTS: Pathologic study reported a hypercellular stroma, with a perivascularly distributed inflammatory infiltrate and myxoid stromal background with slightly atypical fusiform cells. Immunohistochemical studies showed positive staining of fusiform cells for vimentin and histiocytes in the lesion for CD68, and negative staining for cytokeratin. The final diagnosis was prostatic inflammatory pseudotumor. CONCLUSIONS: In spite of being an unfrequent presentation it is important to take this benign lesion under consideration to avoid unnecessary aggressive radical complementary treatments.

[Assessment of the Gleason score in biopsies and specimens of radical prostatectomy]. / Valoración del grado de Gleason en biopsias y piezas de prostatectomía radical.

OBJECTIVES: To evaluate the similarity between Gleason grade on prostate biopsies and their final result after radical prostatectomy. METHODS: We retrospectively review the medical records of 129 patients who underwent radical prostatectomy. Mean PSA value was 10.7 ng/ml. The relationships between pathological reports of biopsies and radical prostatectomy specimens, and other variables such as PSA were established. RESULTS: Globally, 72 cases (55.8%) were in the same risk group by grade on biopsy and surgical specimen. Biopsy result was understaged in 48 cases (37.2%) and overstaged in 9 cases (7%). We found biopsy understaging in 42 cases (60%) in the low grade group, 6 cases (10.9%) in the intermediate grade group, and 50% in the high grade group, although in this latter the number of cases was very low. CONCLUSIONS: Overall biopsy understaging was 37.2%, being much more evident in low grade tumors (60%). It seems that understaging was greater when PSA > 10 ng/ml, although differences were not significant.

Valoración del grado de Gleason en biopsias y piezas de prostatectomía radical / Evaluation of the Gleason grade in prostate biopsy and radical prostatectomy specimens

OBJETIVOS: Valorar la similitud entre la gradación de Gleason de las biopsias de próstata y el resultado final del mismo tras prostatectomía radical. MÉTODOS: Revisamos retrospectivamente, la historia de 129 pacientes sometidos a prostatectomía radical. El valor medio de PSA fue de 10,7 ng/ml. Se estableció la relación entre la histología de las biopsias y la pieza de prostatectomía y la relación con otras variables como el PSA.RESULTADO: Globalmente en 72 casos (55,8 por ciento), el grupo de riesgo según el grado fue el mismo en la biopsia y en la pieza. Existió una infragradación de la biopsia en 48 casos (37,2 por ciento) y una supragradación de la biopsia en 9 casos (7 por ciento). En el grupo de bajo grado, encontramos una infragradación de la biopsia en 42 casos (60 por ciento), en el grupo de grado intermedio encontramos una infragradación de la biopsia en 6 casos (10,9 por ciento), en el grupo de alto grado del 50 por ciento, si bien en este grupo el número de casos es escaso. CONCLUSIONES: La infragradación global de la biopsia fue del 37,2 por ciento, esta infragradación fue mucho más patente en tumores de bajo grado (60 por ciento).Parece ser que la infragradación fue mayor a partir de PSA (AU)

[Pneumopyocystitis in a patient with adult polycystic kidney disease]. / Pioneumoquistes en paciente con enfermedad poliquística del adulto.

OBJECTIVES: We present a case of adult polycystic kidney disease, also known as autosomal dominant polycystic kidney, complicated by infection of the cysts and the formation of gas within them. METHODS/RESULTS: A 59 year old patient diagnosed of adult polycystic kidney disease with chronic renal failure on treatment with haemodialysis, who presented sepsis secondary to infection of the renal cysts. The CT scan demonstrated the presence of gas within the cysts and the microbiology revealed E. coli in one of them. Urgent nephrectomy was performed. A histological specimen of the excised organ is also presented. CONCLUSIONS: Infection of one or more cysts in adult polycystic kidney disease is a rare and serious complication which may require immediate nephrectomy, particularly if gas appears within the cysts.

Pioneumoquistes en paciente conenfermedad poliquística del adulto / Pyopneumocysts in patients with adult polycystic kidney disease

OBJETIVOS: Presentamos el caso de un riñón poliquístico del adulto o riñón poliquístico autosómico dominante, complicado con la infección de los quistes y con formación de gas dentro de ellos. RESULTADOS: Paciente de 59 años de edad diagnosticado de enfermedad renal poliquística del adulto con insuficiencia renal crónica en tratamiento con hemodiálisis, que presentó sepsis secundaria a la infección de los quistes renales. El TAC demostró la presencia de gas dentro de los quistes y el estudio microbiológico demostró la presencia de E. coli en el interior de uno de ellos. Se realizó una nefrectomía urgente. Se muestra además un detalle microscópico de la pieza de nefrectomía. CONCLUSIONES: La infección de uno o varios de los quistes de un riñón poliquístico del adulto es una complicación poco frecuente y grave que puede requerir la nefrectomía inmediata, especialmente si dentro de los quistes aparece gas. (AU)

Test NMP-22. ¿Es útil en el seguimiento de pacientes con tumor vesical superficial? / NMP-22 Test. Is it useful in the follow-up of patients with superficial bladder tumors?

OBJETIVO: 1.- Valorar la eficacia de NMP-22 como test diagnóstico en recidivas de tumores vesicales. 2.- Comparar la eficacia de NMP-22 con las citologías de orina. MÉTODO: Se incluyeron 90 pacientes con tumor vesical superficial y se realizaron controles citológicos, cistoscópicos y de marcador NMP-22. Se consideró test positivo cuando el marcador señalaba cifras superiores a 10 U/ml. El test de referencia fue la cistoscopia RESULTADOS: El rango de edad de los pacientes incluidos se situó entre 45 y 91 años con una media de 69 años. Un 88 por ciento fueron varones y un 12 por ciento mujeres. Un 61,2 por ciento fueron Ta, un 37,6 por ciento T1 y un 1,2 por ciento Cis, siendo el grado un 17,8 por ciento GI, 63,4 por ciento GII y un 18,8 por ciento GIII.El NMP-22 mostró una sensibilidad global del 32,1 por ciento, una especificidad del 95,1 por ciento, Valor predictivo positivo 75 por ciento y Valor predictivo negativo 75,3 por ciento, para una tasa de recidivas del 27,7 por ciento. La citología mostró una sensibilidad global del 28,6 por ciento; una especificidad del 95,2 por ciento; un VPP del 72,7 por ciento y un VPN del 74,7 por ciento. Cuando se utilizaron los test en paralelo, obtuvimos una sensibilidad del 46,4 por ciento; una especificidad del 90,3 por ciento; un VPP del 68,43 por ciento y un VPN del 78,9 por ciento. CONCLUSIONES: El marcador NMP-22 ha demostrado una sensibilidad baja, con lo que no evitamos el uso de la cistoscopia del control. El uso de NMP-22 y citologías en paralelo aumenta mínimamente la sensibilidad. No es posible sustituir a la cistoscopia en el seguimiento de pacientes con tumor vesical superficial (AU)

[Clinical presentation of testicular germinal cancer]. / Presentación clínica del cáncer germinal de testículo.

OBJECTIVE: To review the clinical features in our series of patients of germ-cell testicular cancer. METHODS: The charts of 73 patients with diagnosis of germ-cell testicular tumours were reviewed. Age, history of cryptorchism, time to diagnosis, main symptoms, and serum markers values (alpha- fetoprotein and beta-HCG) were analysed. All cases underwent orchiectomy and extension study with abdominal CT-scan and either chest X-ray or Thoracic CT-scan. We follow the AJCC-UICC 1997 stage classification. Histological cell line, size, and clinical stage at presentation (local, regional and distance) have been analysed also. RESULTS: Among 73 germ-cell testicular tumours 34 were seminomas (46.6%) and 39 were non-seminomatous (54.4%). Clinically, 58.9% of the patients had localised stage I tumours. On presentation 85.7% seminomas were stage I compared to 35.9% non-seminomatous tumours. The remaining tumours were diagnosed in advanced phases (stages II and III). Inguinal orchiectomy was performed in all patients except 5 in whom tumours were incidentally diagnosed (atrophic testis orchiectomy, hydrocoelectomy, trauma) and needed a second operation including ipsilateral scrotal excision. When size, cell line and primary tumour T category were reviewed we found that 32.3% seminomas and 20.5% non seminomas were smaller than 4 cm. 50% seminomas and 49.7% non seminomas were pT1; 41.2% seminomas and 28.2 non seminomas were pT2; finally 8.8% seminomas were pT3 compared to 23.1% non seminomas. Vascular infiltration, also evaluated in this chapter, was present in 38.2% seminomas compared to 38.5% non seminomas. Elements of embryonal carcinoma were found in 37 non seminomatous tumours, either isolated (14) or associated with other components. Teratoma appeared in 18 non seminomatous tumours, 16 of them associated to embryonal carcinoma alone or together with other components. Elements of choriocarcinoma and endodermal sinus were evident in 5 and 4 cases respectively, always associated with other elements. CONCLUSIONS: Seminomas clinical presentation substantially differs from that of non seminomatous testicular tumours in age, clinical features, stage and histological aggressiveness.

Presentación clínica del cáncer germinal de testículo / Germ-cell testicular cancer: clinical presentation

OBJETIVOS: Revisar las manifestaciones clínicas de los pacientes diagnosticados de cáncer germinal de testículo en nuestra serie. MÉTODOS: Se han revisado 73 pacientes diagnosticados de cáncer germinal de testículo, en los que hemos analizado la edad, antecedente de criptorquidia, tiempo de demora del diagnóstico, síntomas predominantes y nivel de marcadores séricos (alfa-fetoproteína y betaHCG). En todos los casos se realizó una orquiectomía y estudio de extensión a distancia mediante TAC abdominal, radiografía de tórax o TAC torácico. Empleamos la clasificación por estadios de la AJCC-UICC de 1997.También se han analizado las estirpes histológicas, tamaño y los estadios clínicos de presentación (local, regional y a distancia). RESULTADOS: De los 73 tumores germinales de testículo, 34 eran seminomas (46,6 por ciento) y 39 no seminomas (54,4 por ciento). Un 58,9 por ciento de pacientes tenían tumores localizados, en estadio I, clínicamente. El 85,7 por ciento de seminomas se presentaron en estadio I, frente al 35,9 por ciento (14) de tumores no seminomatosos. El resto de tumores se encontraron en fases avanzadas (estadios II y III). Realizamos orquiectomía inguinal en todos los casos, salvo en 5 pacientes en los que se encontraron de forma incidental (orquiectomía de teste atrófico, hidrocelectomía, traumatismo), en cuyo caso se resecó el escroto ipsilateral en un 2º tiempo. Revisamos el tamaño, las estirpes presentes y la categoría T del tumor primario. Un 32,3 por ciento de seminomas y un 20,5 por ciento de tumores no seminomatosos eran menores de 4 cms. El 50 por ciento de seminomas y el 48,7 por ciento de tumores no seminomatosos fueron pT1. Encontramos un 41,2 por ciento de seminomas pT2 frente al 28,2 por ciento de tumores no seminomatosos. Por fin, el 8,8 por ciento de seminomas fue pT3, frente al 23,1 por ciento de no seminomas. Dentro de este parámetro, distinguimos la infiltración vascular, que estuvo presente en el 38,2 por ciento de seminomas frente al 38,5 por ciento de no seminomas. En 37 tumores no seminomatosos se encontraron elementos de carcinoma embrionario, bien aisladamente (14) ó asociado a otros componentes. Apareció teratoma en 18 tumores no seminomatosos, estando en 16 casos asociado a carcinoma embrionario sólo ó junto a otros elementos. Se evidenciaron componentes de coriocarcinoma en 5 casos y del seno endodérmico en 4 casos, estando siempre asociados a otros elementos. CONCLUSIÓN: La presentación clínica de los seminomas difiere sustancialmente de la de los no seminomas, tanto en la edad, manifestaciones, estadio y factores de agresividad histológica (AU)

[Fulminant hepatic insufficiency caused by diffuse intrasinusoidal liver metastases in a patient with transitional-cell carcinoma of the bladder]. / Insuficiencia hepática fulminante por metástasis hepática intrasinusoidal difusa en un paciente con carcinoma transicional de vejiga.

OBJECTIVE: To present a case of transitional cell carcinoma of the bladder with diffuse intrasinusoidal metastases to the liver that presented as fulminant hepatic failure. METHODS/RESULTS: A 65-year-old patient who presented at the emergency department of this hospital with fever and pain in the right hypochondrium and flank is described. Three months previously the patient had undergone operation in our department for a recurrence of a tumor affecting the bladder and urethra (Tis of the bladder and T1 GII of the prostatic urethra). The blood tests on admission were practically normal but showed alterations from the twelfth day onwards, suggesting acute liver failure in the differential diagnosis; the patient died 21 days later. The ultrasound and CT scans showed hepatomegaly with multiple heterogeneous areas which were not visible three months earlier and with no space-occupying lesions. At autopsy, the liver was found to be enlarged, with no macroscopic metastatic nodules. Microscopic examination revealed massive tumoral infiltration of the hepatic sinusoids with diffuse replacement of the hepatocytes. CONCLUSIONS: Secondary, metastatic liver cancer usually presents as multiple nodular lesions and only vary on very rare occasions as a diffuse infiltration leading to acute hepatic failure. This case provides the first description of the autopsy findings in a bladder transitional cell carcinoma with diffuse intrasinusoidal metastases to the liver.

Insuficiencia hepática fulminante por metástasis hepática intrasinusoidal difusa en un paciente con carcinoma transicional de vejiga / Fulminant hepatic failure from diffuse intrasinosoudal metastasis to the liver in a patient with transitional cell carcinoma of the bladder

Objetivos: Presentamos el caso de un carcinoma de células transicionales (CCT) de vejiga con metástasis hepáticas intrasinusoidales difusas (MHID) que se manifestaron como un fallo hepático fulminante.Métodos/resultados: Paciente de 65 años de edad que acude al Servicio de Urgencias de nuestro hospital presentando fiebre y dolor en hipocondrio y vacío derechos. Tres meses antes había sido intervenido en nuestro Servicio por una recidiva de tumor vesical y uretra prostática (CIS vesical y T1,GII en próstata). Al ingreso la analítica era prácticamente normal, pero empeoró a partir del duodécimo día, planteando el diagnóstico diferencial de una insuficiencia hepática aguda que le llevó al exitus en 21 días. La Ecografía y el TAC mostraba una hepatomegalia con múltiples zonas heterogéneas, sin masas ocupantes de espacio, que no se observaban tres meses antes. En la necropsia se vio un hígado agrandado sin nódulos macroscópicos metastásicos y a nivel microscópico infiltración tumoral masiva de los sinusoides hepáticos con reemplazamiento difuso de los hepatocitos.Conclusiones: El cáncer metastásico de hígado habitualmente se manifiesta como lesiones nodulares múltiples y muy rara vez se presenta como una infiltración difusa que provoca una insuficiencia hepática aguda. Este caso describe por primera vez los hallagos de una necropsia en un CCT vesical con MHID (AU)

[NMP-22 test. Is it useful in the follow-up of patients with superficial bladder tumor?]. / Test NMP-22. Es útil en el seguimiento de pacientes con tumor vesical superficial?

OBJECTIVES: 1.--To evaluate the efficacy of the NMP-22 as a diagnostic test for bladder tumor recidives; 2.--To compare the efficacy of NMP-22 vs. urine cytology. METHODS: 90 Patients with superficial bladder tumors were included in the study, undergoing cytologic, cystoscopic and NMP-22 marker controls. NMP 22 test was considered positive when the marker signal was higher than 10 U/ml. Cistoscopy was the reference test. RESULTS: Patients in the study had an average age of 69 years, ranging from 45 to 91. 88% were males and 12% females. 61.2% of the tumors were Ta, 37.6% T1 and 1.2% Cis, being 17.8% grade I, 63.4% grade II and 18.8% grade III. NMP-22 showed a global sensitivity of 32.1%, and a specificity of 5.1%. Positive predictive value (PPV) was 75% and negative predictive value (NPV) 75.3% for a relapse rate of 27.7%. Urine cytology showed an overall sensitivity of 28.6%, 95.2% specificity, PPV 72.7% and NPV 74.7%. When both tests were used altogether sensitivity was 46.4%, specificity 90.3%, PPV 68.43% and NPV 78.9%. CONCLUSIONS: The NMP-22 marker has shown low sensitivity so that control by cystoscopy may not be avoided. The combination of NMP-22 and urine cytology increases sensitivity minimally. It is not possible to replace cystoscopy in the follow-up of patients with superficial bladder tumors.

Ectopia adrenal en epidídimo / Ectopic adrenal in epididymis

OBJETIVO: Presentar un nuevo caso de ectopia adrenal, situada en este caso en el epidídimo. MATERIAL Y MÉTODOS: Un varón de 17 años consultó por varicocele izquierdo y molestias en epidídimo derecho, año y medio después de una epididimitis aguda. Se extirpó un nódulo del epidídimo. masa de consistencia elástica por arriba del mismo. Analítica: leucocitosis de 16.100, con 87 por ciento polimorfonucleares; glucemia, BUN y creatinina, normales. Sedimento urinario: hematuria (20 eri/c) y leucocituria (20-25 leu/c). Ecografía: riñones y vejiga normales; distensión de vesícula seminal derecha (Fig. 1). TAC: masa retrovesical con zona central hipodensa, sugestiva de absceso de vesícula seminal (Fig. 2). Se tomó una muestra de orina para cultivo, iniciando a continuación tratamiento con cefuroxima (1,5 g IV/8h). La evolución fue buena, con defervescencia a partir del tercer día. El cultivo de orina resultó positivo para E. Coli sensible a muchos antibióticos, pasando a tratamiento oral con ofloxacino (200 mg/12 h). El paciente continuó asintomático, siendo alta hospitalaria el séptimo día para continuar tr tamiento y control ambulatorio. Dos semanas después el paciente seguía asintomático y el tacto rectal era normal. Recomendamos continuar el mismo tratamiento durante siete días más (para completar cuatro semanas) y repetimos cultivo de orina y ecografía, siendo ambos normales. RESULTADOS: En el estudio anatomopatológico se encontró un nódulo de 0,4 cm constituido por tejido cortical adrenal. CONCLUSIONES: La ectopia adrenocortical es una lesión benigna cuya existencia no se descarta de forma rutinaria. Sin embargo, cuando se detecta esta lesión durante una intervención quirúrgica en esta zona deberá resecarse para el análisis histológico y el diagnóstico diferencial (AU)

Determinación de NMP-22 como marcador de recidivas en el cáncer vesical. Estudio preliminar / Determination of NMP-22 as a marker for recurrence in bladder cancer. preliminary study

OBJETIVO: 1.- Valorar la eficacia de NMP-22 como test diagnóstico en recidivas de tumores vesicales.2.- Comparar la eficacia de NMP-22 con las citologías de orina. MÉTODO: Se incluyeron 30 pacientes con tumor vesical y se realizaron controles citológicos, cistoscópicos y de marcador NMP-22 a los 3 y 6 meses de la RTU vesical. Se consideró test positivo cuando el marcador señalaba cifras superiores a 10 U/ml. RESULTADOS: El rango de edad se situó entre 41 y 87 años con una media de 73,4 años. Un 83,4 por ciento fueron varones y un 16,6 por ciento mujeres. Un 80,7 por ciento fueron T1, un 15,3 por ciento T2-T3, siendo el grado un 76,8 por ciento GI y II y un 23,2 por ciento GIII. El NMP-22 mostró una sensibilidad del 69 por ciento, especificidad del 64 por ciento, valor predictivo positivo 52 por ciento y valor predictivo negativo 78 por ciento, cuando se consideró como unidad de análisis la presencia de recidivas tanto a los 3 como a los 6 meses, para una tasa de recidivas del 36 por ciento. La citología mostró una sensibilidad del 44 por ciento; una especificidad del 92 por ciento; un VPP del 77 por ciento y un VPN del 74 por ciento. Cuando se utilizaron los test en paralelo, obtuvimos una sensibilidad del 87,5 por ciento; una especificidad del 64,2 por ciento; un VPP del 58,3 por ciento y un VPN del 90 por ciento. En los tumores de grado I los niveles de NMP-22 mostraron una sensibilidad del 100 por ciento y una especificidad del 77,7 por ciento un VPP del 60 por ciento y un VPN del 69 por ciento. CONCLUSIONES: El marcador NMP-22 ha demostrado una sensibilidad aceptable pero con un VPP bajo con lo que no evitamos el uso de la cistoscopia del control. El uso de NMP-22 y citologías en paralelo aumenta la sensibilidad y el VPN. Encontramos muy útil el NMP-22 en recidivas de bajo grado (AU)