Carcinoma de células renales bilateral sincrónico. Presentación de un caso / Bilateral synchronic renal cell carcinoma. Report of a case

La nefrectomía radical es considerada el tratamiento de elección para el carcinoma renal. Los buenos resultados obtenidos en los últimos años con la resección parcial, hacen considerar a la cirugía conservadora como el mejor tratamiento en los casos de tumores renales bilaterales bien seleccionados. Así mismo se evita la diálisis en estos casos minimizando el riesgo subsiguiente de déficit inmunológico y mayor posibilidad de enfermedad metastásica. Sin embargo actualmente en lo que se refiere a la cirugía electiva conservadora parece existir controversia en cuanto a las indicaciones y la técnica quirúrgica a realizar (resección parcial versus enucleación). Presentamos un caso de carcinoma renal bilateral sincrónico en el que se optó por cirugía radical en el riñón izquierdo que presentaba gran tumoración con focos múltiples corticales confirmados mediante PAAF, y cirugía conservadora en el riñón derecho con enucleación de masa bien delimitada en polo inferior renal, así mismo confirmada mediante PAAF. Durante cinco años el paciente mantuvo función renal normal con buena calidad de vida, presentando en ese momento y en uno de los controles radiológicos, recidiva tumoral en el único riñón que obligó a cirugía radical e inclusión del paciente en programa de diálisis (AU)

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[Bilateral synchronous renal cell carcinoma. Report of a case]. / Carcinoma de células renales bilateral sincrónico. Presentación de un caso.

The radical nephrectomy is considered to be the optional treatment for renal carcinoma. In the last years, the good results with partial resection shows conservadora surgery the most suitable treatment for well-localized bilateral renal tumours. In this cases dialysis is avoided, and the subsequent risk of immunological deficit and the higher possibility of metastasic illness are minimized. Nowadays, however, there seems to be some controversy over conservative surgery, concerning applications and technique of surgery to practice (partial resection vs. enucleation). We have a case of bilateral synchronic renal cell carcinoma where radical surgery on the left kidney was put into practice, as it presented a great tumour with multiples points corticals confirmed by PAAF and conservative surgery on the right kidney with enucleation of localized mass in the lower renal. The patient held normal renal function with a good quality of life for five years, finding out then, in one of the radiological tests, carcinoma relapse in the only kidney, that forced to radical surgery and to his inclusion in dialysis programme.

[Pelvic lipomatosis: cause of bladder rupture]. / Lipomatosis pélvica: causa de estallido vesical.

We have a case of pelvic lipomatosis in a patient suffering from right flank pain and urinary syndrome. Before completing the diagnostic test, abdominal traumatism forced to perform a laparotomy of emergency. We found a great deal of retropubic mass with bladder rupture and thickened walls caused by perivesical fat. The anatomopathological diagnosis was pelvis lipomatosis. This is an unusual case of bladder rupture after slight traumatism.

Lipomatosis pélvica: causa de estallido vesical / Pelvic lipomatosis: cause of bladder rupture

Presentamos un caso de lipomatosis pélvica en un paciente que consultó por dolor lumbar derecho y síndrome miccional. Antes de completar pruebas diagnósticas el paciente sufrió traumatismo abdominal que obligó a laparotomía de urgencias, encontrándonos con gran masa retropúbica con estallido vesical y pared engrosada a expensas de grasa perivesical. El diagnóstico anatomopatológico fue de lipomatosis pélvica. Presentamos este caso clínico por ser una entidad rara en la literatura y por lo inusual de su presentación como estallido vesical tras traumatismo leve (AU)

[Current treatment of ureteral lithiasis]. / Tratamiento actual de la litiasis ureteral.

The treatment of ureteral lithiasis has undergone a revolution since the arrival of new techniques offering different therapeutical choices for which time is gradually elucidating the indications for each of the new procedures; although, to a large extent, a degree of controversy still persists. This paper reviews the different methods for ureteral lithiasis; spontaneous ejection and medical treatment, surgery, early endoscopic manoeuvres, backward and forward urethroscopy and, finally, extracorporeal lithority. This therapeutical experience in 3 series of ureteral lithiasis addressed with different criteria are revised together with 182 obstructive calculi of the lumbar ureter. We believe that grading the ureteral calculi according to their anatomical and functional features improves the results, since improved adjustment can be achieved for the indications of the various methods. Also it is noted that support endourology for extracorporeal lithotrity does not improve the results of treatment in lumbar calculi under 2 cm, and therefore our current approach is towards "in situ" treatment without complementary manoeuvres. Finally we show the therapeutic algorithm we are following actually to manage ureteral litiasis.

[Migration of an intrauterine device. An unusual cause of bladder foreign body]. / Emigración de dispositivo intrauterino. Una rara causa de cuerpo extraño vesical.

The origin of vesical and lower urinary tract foreign bodies is very wide, the specialized literature descriptions ranging from urethral dilators to coffee spoons handles through wires, cables and surgical instrumentation. The most frequent entry route of foreign bodies to the lower urinary tract is through the urethra usually by self-introduction or during transurethral surgical procedures. Another access route is that occurring during open or traumatic surgical manoeuvres. Less frequent is that the foreign body migrates from another anatomical structure. These patients present an heterogeneous clinical picture which depends on the location of the foreign body in the urinary tract. Thus, it can be acute if located in the urethra or subacute or chronic if found at vesical level.

[A metabolic study of urolithiasis. Specificity, sensitivity, efficacy and reproducibility]. / Etude métabolique de l'urolithiase. Spécificité, sensibilité, efficacité et reproductibilité.

A preliminary diagnosis of the disease responsible for the stones is essential to allow appropriate medical treatment of renal stones. In this paper, the authors describe their diagnostic and treatment protocol based on computer-assisted urinary metabolic analysis. 413 subjects, divided into four groups, were prospectively evaluated to calculate their specificity, sensitivity, reproducibility and efficacy and to demonstrate the usefulness of this protocol.

[Enterovesical fistula in Crohn disease. An infrequent presentation]. / Fístula enterovesical en enfermedad de Crohn. Una presentación poco frecuente.

Herein we describe a case of enterovesical fistula in a patient with Crohn's disease that presented exclusively as urinary symptoms. The patient had no known history of GI disorders. The clinical features, natural history and treatment of enterovesical fistula in Crohn's disease are discussed.

[Eosinophilic cystitis. Study of the clinical course in 6 new cases and review of the recent literature]. / Cistitis eosinofílica. Estudio clínico-evolutivo de 6 nuevos casos y revisión de la literatura reciente.

Presentation of a series of 6 cases of eosinophilic cystitis diagnosed in our hospital and recorded in 1988-1993, with an average follow-up of 2 years from time of diagnosis. The actual trend with regard to this particular form of chronic cystitis is to abandon the idea of considering it a "benign" disease, basically due to its increasingly less uncommon association to bladder and/or prostate tumoral pathology (in the recent literature and most particular in the present series). Also, a relative increase in the frequency of occurrence of this disease is noted, because of chemoprophylaxis of surface bladder tumour with Mitomycin-C, an association which is increasingly frequent. Based on these 6 cases, a review of the most recent literature on this topic is made.

[Granulated potassium citrate in the prevention of calcium oxalate lithiasis]. / Citrato potásico granulado en la profilaxis de la litiasis oxalocálcica.

Since the approval of potassium citrate for the treatment of urolithiasis, there are many patients in other countries who have benefited from this drug. This paper describes the biochemical changes and tolerance seen in fifteen patients treated for one month with granulated potassium citrate. Some significant changes are observed in serum potassium and creatinine, and in urinary pH, citrate and potassium. Tolerance was good. Our results confirm that potassium citrate is an effective, easy to use, and well tolerated drug for the prophylaxis of oxalocalcium lithiasis.

[Conservative treatment of Wünderlich syndrome in a functional monorenal patient]. / Tratamiento conservador del síndrome de Wünderlich en enferma monorrena funcional.

Presentation of one case of Wünderlich's syndrome secondary to spontaneous mesorenal fracture due to renal angiomyolipoma. In our case, the therapeutical approach is based in the need to preserve the functional renal unit. Wünderlich's syndrome or spontaneous perirenal haematoma can occur for a variety of causes, the most frequent ones being renal adenocarcinoma and renal angiomyolipoma. The latter is a hamartoma made up of three different tissue lines: smooth muscle cells, blood vessels and adipose tissue. Based on our case, we discuss the clinical, prognostic and therapeutical aspects related to renal angiomyolipomes.

[Percutaneous transluminal angioplasty in aortic coarctation. Report of a case]. / Angioplastía transluminal percutánea en coartación aórtica. Informe de un caso.

We describe the first case in our hospital of percutaneous transluminal angioplasty in a 16 years old boy with congenital coarctation of the aorta. The technique, hemodynamic findings, angiography before and after dilation and the advantages in comparison with the conventional cardiac surgery were analyzed. In our case the gradient decreased from 60 mmHg to 28 mmHg. We conclude that this procedure is an alternative treatment for patients with congenital coarctation of the aorta.

[Transcatheter pulmonary valvuloplasty]. / Valvuloplastía pulmonar transcateterismo.

We describe the first case of balloon pulmonary valvuloplasty performed in this country. This 12 year old girl had a transvalvular gradient of 94 mmHg and after the procedure it improved to 20 mmHg. Four months later, cardiac catheterization did not show any significative change in pulmonary valvular gradient (26 mmHg). We describe the technique, hemodynamic findings, complications, and advantages of this procedure. We also review the literature. We consider that balloon valvuloplasty should be the first choice procedure in the treatment of patients with congenital pulmonary valve stenosis.

[Crossed atrioventricular connection with straddling of the right atrioventricular valve]. / Conexion atrioventricular cruzada con cabalgamiento de la valvula atrioventricular derecha.

We describe one patient with crossed atrioventricular connection in situs inversus, concordant atrioventricular connection, double outlet right ventricle, and straddling of the right atrioventricular valve. Angiographic features are analyzed, pointing out the importance of selective angiography in order to define the atrioventricular and ventriculoarterial connections. The utility of bidimensional echocardiographic study before cardiac catheterization is emphasized in order to know the associated malformations.