Clinical characteristics and long-term outcomes of patients undergoing combined heart-kidney transplantation: a single-center experience.

BACKGROUND: The purpose of the study was to describe clinical characteristics and long-term survival of patients undergoing combined heart-kidney transplant in a single center. METHODS: We conducted a retrospective analysis of 22 consecutive patients who underwent combined heart-kidney transplant at our institution between 1995 and 2013. Long-term outcomes were analyzed by means of the Kaplan-Meier method. RESULTS: Four patients underwent re-do transplant (2 cardiac re-transplants, 1 kidney re-transplant, and 1 combined heart-kidney re-transplant). Most frequent underlying cardiac conditions were coronary artery disease (54%), dilated cardiomyopathy (23%), and chronic rejection of a previous heart graft (18%). Known causes of chronic renal dysfunction were nephroangioesclerosis (23%), drug-related toxicity (14%), and Wegener granulomatosis (5%). Non-specified chronic renal dysfunction was present in 50% patients. In-hospital postoperative mortality rate was 5 of 22 (23%). Causes of early death were directly related to kidney transplant surgery in 4 of 5 (80%) patients. Among the remaining 17 patients who surmounted the postoperative period, long-term survival rates 1 year, 5 years, and 10 years after HKT were 88%, 82%, and 65%, respectively. Over a mean follow-up of 6.7 ± 6.4 years, cumulative incidences of cytomegalovirus infection, coronary allograft vasculopathy, malignancy, and acute cardiac graft rejection were 41%, 6%, 24%, and 41%, respectively. There was no episode of acute renal graft rejection. At the end of follow-up, all survivors (n = 11) were in functional New York Heart Association class I. Mean creatinine serum level was 1.68 mg/dL. CONCLUSIONS: In our experience, combined heart-kidney transplant is a feasible therapeutic option that yielded favorable long-term outcomes, with a low cumulative incidence of cardiac graft dysfunction. These results were obtained at the expense of a significant risk of early postoperative mortality, which was mainly related to complications of kidney transplant surgery.

[Leiomyosarcoma of the inferior vena cava. Incidental finding]. / Leiomiosarcoma de cava inferior. Hallazgo incidental.

OBJECTIVE: Leiomyosarcoma of the inferior vena cava is a rare tumor, clinically silent which often remains undiagnosed for much longer. Imaging methods allow us to detect these entities. We report a single case and perform a bibliographic review. METHODS: 58-year-old woman with a 6 cm adrenal mass, which during surgery was found to be a tumor from the wall of the vena cava. We performed complete removal of the mass. Radiotherapy of the surgical area was applied within three months following surgery. RESULTS: Two years later, there is no evidence of disease recurrence. CONCLUSION: This is a rare entity, with low prevalence. Complete surgical excision is the gold standard for treatment. Local recurrence is a common finding during follow up.

Atrapamiento peneano por anillos metálicos / Penile entrapment by metallic rings

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Leiomiosarcoma de cava inferior. Hallazgo incidental / Leiomyosarcoma of the inferior vena cava. Incidental finding

Objetivo: El leiomiosarcoma de cava inferior es una entidad poco frecuente, clínicamente insidiosa o silente y detectable en muchas ocasiones únicamente mediante estudios de imagen. Se presenta un caso intervenido en nuestro servicio y se revisa la literatura al respecto. Método: Mujer de 58 años con una masa suprarrenal derecha de 6 cm evidenciando su origen en la pared de vena cava durante el acto quirúrgico. Se realiza exeresis completa de la tumoración, y posteriormente , radioterapia adyuvante sobre el lecho quirúrgico. Resultados: Tras más de 2 años de evolución, la paciente se encuentra libre de enfermedad. Conclusiones: Esta entidad presenta una escasa prevalencia, y en muchas ocasiones su hallazgo es incidental. La resección quirúrgica completa es la clave del tratamiento, aunque la probabilidad de recidiva local es elevada (AU)

Objective: Leiomyosarcoma of the inferior vena cava is a rare tumor, clinically silent which often remains undiagnosed for much longer. Imaging methods allow us to detect these entities. We report a single case and perform a bibliographic review. Methods: 58-year-old woman with a 6 cm adrenal mass, which during surgery was found to be a tumor from the wall of the vena cava. We performed complete removal of the mass. Radiotherapy of the surgical area was applied within three months following surgery. Results: Two years later, there is no evidence of disease recurrence. Conclusion: This is a rare entity, with low prevalence. Complete surgical excision is the gold standard for treatment. Local recurrence is a common finding during follow up (AU)

[Metastasis of prostatic carcinoma to the urethra: report of a case]. / Metástasis de carcinoma de próstata en uretra: a propósito de un caso.

Penile metastases from prostate carcinoma are uncommon events, much more in urethra and corpus spongiosum, we add a case to the preexisting literature. A patient with hormone resistant prostate cancer consults for haematuria and voiding difficulties. During TURP we observe tumors at the penile urethra which are resected and result to be prostate cancer metastases. Patient is fine and without voiding disturbance after 7 months of following. We think is an interesant case because there is few reports in literature.

Metástasis de carcinoma de próstata en uretra: a propósito de un caso / Prostate carcinoma metastatic to the urethra: a case report

Las metástasis peneanas de cáncer de próstata son raras, sobre todo en uretra y cuerpo esponjoso, aportamos un caso a la literatura. Se trata de un paciente con cáncer de próstata hormonorresistente que durante la evolución del mismo cursa con dificultad miccional y hematuria ocasional. Se observa durante la RTU unas formaciones mamelonadas en uretra peneana que se resecan, resultando ser metástasis de su carcinoma de próstata. El paciente se encuentra con buen estado general y sin clínica urinaria tras 7 meses de seguimiento. Nos parece muy interesante porque existen pocos casos reportados de metástasis en dicha localización (AU)

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[Multiple urinary lithiasis and nephrocalcinosis secondary to primary Sjögren syndrome]. / Litiasis urinaria múltiple y nefrocalcinosis secundaria a síndrome de Sjögren primario.

A 39 year old women with a primary Sjögren syndrome (pSS) had bilateral and multiple nephrolithiasis and nephrocalcinosis due to distal renal tubular acidosis (dRTA), hypercalciuria and hypocitraturia. She had in serum positive antinuclear antibodies with mottled pattern 1/320, totals ENA, Anti-SSA/Ro 52, Anti-SSA/Ro 60 and Anti-SSB-La antibodies. Stones were removed with extracorporeal shock wave lithotripsy satisfactory and were composed of calcium phosphate and calcium oxalate. Metabolic abnormalities were resolved with potassium citrate and hydrochlorothiazide. At two years of follow-up, the patient hadn't stone recurrence and had normal 24-hour urinary levels of citrate and calcium.

[Metabolic risk factors in calcium urolithiasis according to gender and age of the patients]. / Factores de riesgo metabólico en urolitiasis cálcica según el sexo y edad de los pacientes.

INTRODUCTION: Little information is available on the metabolic changes found in relation to gender and aging in patients with urolithiasis. In this study a comparison has been made of the metabolic profiles in men and women, in different groups of aging, with calcium-containing urinary stones in order to identify possibly significant differences. MATERIAL AND METHODS: In the past five years, a total of 500 patients with calcium-containing urinary stones, 226 male (45.2%) and 274 female (54.8%), have undergone comprehensive metabolic evaluation. The mean age was 47.4 years, with a range of 20 to 75 years. The patients was included in 3 groups: 151 patients aged 20-39 years, 255 patients aged 40-59 years and 94 patients aged 60-75 years. A comparison has been made of the frequency of metabolic changes, the urinary biochemical parameters and the supersaturation index (AP(CaOx)) between a group of men and a group of women and the different groups of aging. All patients carried out in an identical manner to metabolic diagnosis. The patients with morphologic and functional abnormalities were excluded. RESULTS: Hyperoxaluria, hyperuricosuria and hypocitraturia were more common in men than in women, whilst in women, hypercalciuria and a low urinary volume were more frequent with respect to men, though the differences in hypercalciuria were not statistically significant. Men excrete higher levels of calcium, phosphate, oxalate, uric acid and magnesium than women. On the other hand, women excrete higher levels of citrate than men. The AP(CaOx) index is significantly higher in men than in women. Hypercalciuria were more common in patients aged < 60 years, and low urinary volume were more frequent in patients aged < 40 years. Patients aged < 60 years excrete higher levels of calcium, phosphate and uric acid. The AP(CaOx) index is significantly higher in patients aged < 60 years. CONCLUSIONS: Differences were observed between the metabolic profiles of men and women, and in different groups of aging. Men and younger patients afford a metabolic profile of upper lithogenic risk compared with women and older patients; this is consistent with the upper reported prevalence of lithiasis and the upper tendency to recurrence in men and middle-age patients.

Litiasis urinaria múltiple y nefrocalcionosis secundaria a síndrome de Sjögren primario / Multiple urinary lithiasis and nephrocalcinosis secondary to primary Sjögren syndrome

Una paciente de 39 años de edad diagnosticada de síndrome de Sjógren primario (SSp) desarrolla litiasis reno-ureteral múltiple y nefrocalcinosis bilateral secundaria a acidosis tubular renal distal (ATRd), hipercalciuria e hipocitraturia. Resultan positivos los anticuerpos ANA moteado 1/320, ENA totales, Anti-SSA/Ro 52, Anti-SSA/Ro 60 y Anti-SSB-La. Los cálculos son tratados con litotricia extracorpórea por ondas de choque con resultado satisfactorio, correspondiendo su composición a fosfato cálcico y oxalato cálcico. Los trastornos metabólicos son corregidos con la administración de citrato potásico e hidroclorotiazida. Después de dos años de seguimiento, la paciente no ha recurrido de la litiasis y mantiene niveles normales de citrato y calcio en orina de 24 horas. (AU)

Factores de riesgo metabólico en urolitiasis cálcica según el sexo y edad de los pacientes / Metabolic risk factors on calcium urinary calculi according to age and gender of patients

INTRODUCCIÓN: Se tiene limitada información de las alteraciones metabólicas observadas en pacientes litiásicos de acuerdo al sexo y edad de los pacientes. Comparamos el perfil metabólico de hombres y mujeres con litiasis cálcica, en varios grupos de edad, para identificar posibles diferencias significativas.MATERIAL Y MÉTODOS: En los últimos cinco años han sido sometidos a estudio metabólico-mineral un total de 500 pacientes con litiasis urinaria cálcica, 226 varones (45,2 por ciento) y 274 mujeres (54,8 por ciento) con una edad media de 47,4 años (rango 75-20 años). Según la edad de realización del estudio, los pacientes se dividen en 3 grupos: de 20-39 años (151 pacientes), de 40-59 años (255 pacientes) y de 60-75 años (94 pacientes). Se compara la frecuencia de alteraciones metabólicas, los valores de parámetros bioquímicos en orina y el índice de sobresaturación (AP(CaOx)) entre varones y mujeres y los diferentes grupos etarios. En todos los pacientes se siguió la misma metodología de estudio, excluyéndose aquellos con alteraciones morfológicas y funcionales de la vía urinaria.RESULTADOS: En los varones fue más frecuente la hiperoxaluria. hiperuricosuria e hipocitraturia respecto a las mujeres, mientras que en éstas fue más frecuente la hipercalciuria y el bajo volumen de orina. Los varones eliminan mayores niveles de calcio, fosfato, oxalato, ácido úrico y magnesio que las mujeres, y éstas eliminan mayores niveles de citrato que los hombres. El índice AP(CaOx) es significativamente más alto en hombres que en mujeres. En los pacientes de edad inferior a 60 años fue más frecuente la hipercalciuria. Y en los pacientes de edad inferior a 40 años fue más frecuente un bajo volumen de orina. Los pacientes de edad inferior a 60 años eliminan mayores niveles de calcio, fosfato y ácido úrico. El índice AP(CaOx) es significativamente mayor por debajo de los 60 años.CONCLUSION: Observamos diferencias en el perfil metabólico tanto entre hombres y mujeres como a distintos grupos de edad. Los varones y los pacientes más jóvenes presentan un perfil de mayor riesgo litogenético respecto a las mujeres y enfermos más añosos respectivamente, que parece corresponderse con la mayor prevalencia poblacional de litiasis v la mayor tendencia a la recurrencia que se ha venido refiriendo a los varones jóvenes y en edades media de la vida (AU)

[Vascular prosthesis in kidney transplantation]. / Prótesis vasculares en el transplante renal.

OBJECTIVE: Three cases of kidney transplantation that required a vascular prosthesis are described and the literature reviewed. METHODS: Of 920 cases of kidney transplantation, 3 required a vascular prosthesis to repair the aortoiliac vessels. One patient with severe atherosclerotic disease had an aorto-bifemoral prosthesis (Gore-Tex) six months before renal transplantation and the other two patients required a vascular prosthesis to repair iliac artery lesions discovered during transplantation. RESULTS: The initial surgical results were satisfactory. No complications arising from the vascular prosthesis were observed. Two patients have a functioning renal graft, but the third patient developed acute tubular necrosis and tubulo-interstitial rejection and died from acute pulmonary edema. CONCLUSION: The importance of the preoperative cardiovascular evaluation in patients undergoing kidney transplantation is underscored. Some patients may require a vascular prosthesis. We should therefore be familiar with the prosthetic materials and the surgical techniques, which are not particularly difficult, and optimum results can be achieved. In patients with both end-stage renal disease and severe aortoiliac atherosclerotic disease, the controversy remains whether aortoiliac repair and kidney transplantation should be done simultaneously or in two stages.

[Skin metastasis from transitional cell carcinoma of the bladder]. / Metástasis cutánea de carcinoma de células transicionales de la vejiga.

OBJECTIVES: An additional case of cutaneous metastasis arising from transitional cell carcinoma of the bladder is described. Its form of presentation, dissemination pattern, pathological features, clinical course and treatment are briefly discussed. METHODS: This article reports on a 62-year-old male with bladder carcinoma stage PT3B, PN0, PMx, who underwent radical cystoprostatectomy and detubularized ileal neobladder four months earlier. RESULTS: A solid tumor with an ulcerated surface was found on the dorsal side of the left shoulder. Microscopic analysis disclosed neoplastic cells resembling transitional cells in dermis, the first manifestation of distant tumoral spread. Patient survival was only two months. CONCLUSIONS: Transitional cell carcinoma of bladder metastasizing to the skin is an uncommon finding despite the high incidence of this tumor, although more cases are being reported. Skin metastasis generally presents in the late stages of this disease and indicates a poor outcome.

[Bladder metastases of pulmonary carcinoma. A report of 2 cases]. / Metástasis vesicales de carcinoma pulmonar. Presentación de dos casos.

Metastatic vesical tumours caused by blood- or lymph-borne neoplasias from any part of the body are extremely uncommon (less than 1% of vesical tumours), and even within this group lung tumours are the origin in a very small number of cases. Diagnosis usually happens in advanced stages due to the limited symptomatology exhibited. This paper refers two cases of vesical metastatic neoplasias from lung tumours, one an oat-cell anaplastic carcinoma and one epidermoid. Also, in the first one there was the peculiarity of haematuria being the early manifestation which lead to the diagnosis of lung neoplasia.

[Kidney transplants from asystolic donors]. / Trasplante de riñón procedente de donantes en asistolia.

Review of our experience on renal transplantation with graft from removal in asystole. We have performed 31 transplantations of kidneys removed while in asystole, 25 of which were treated only with cardiocompression and assisted ventilation as support measures, the average asystole time being 45 minutes. Two donors were treated by in situ cold perfusion of the abdominal organs (time of asystole, 70 and 218 minutes). One patient was maintained with body cooling by cardiopulmonary by-pass for 90 minutes. Graft survival at three months was 77%, with a delay in the initial function of 70%, secondary to acute tubular necrosis, this being the only parameter in which a significant difference is observed when comparing them to those from a control group of 50 transplant performed over the same interval. No significant differences were seen at one year with regard to either graft survival or the recipients in both groups.

[Kidney transplant with pediatric grafts from donors under a year old. The implantation technics]. / Trasplante renal con injertos pediátricos menores de un año. Técnicas de implantación.

Although the number of renal transplants performed in our country is high, it is far surpassed by the number of patients with end-stage chronic renal failure awaiting transplantation. The foregoing has led to the use of grafts from donors aged less than one year. Our series of 6 renal transplants in adults using grafts from these donors are presented. Both kidneys were transplanted in all cases, but two different techniques were utilized. The kidneys were transplanted "en bloc" in 4 cases and sequentially into the right iliac fossa in 2 cases. In 2 of the cases submitted to "en bloc" transplantation, the grafts never functioned and were lost due to venous thrombosis. The remaining cases (2 "en bloc" and 2 sequential) are functioning well at 6 to 20 months follow-up, with no vascular or urinary complication. In our view, the kidneys from pediatric donors less than one year old are an acceptable alternative for transplantation into adult patients using the classical "en bloc" or the sequential technique, although in certain aspects the latter may offer more advantages over the former.

[Paravesical tumor of adrenal gland residues]. / Tumor paravesical de restos adrenales.

Presentation of one case of ectopic suprarenal tissue residues' tumour found at paravesical level. The singularity of this diagnosis, unless hormonally active, or when very large in size, as well as its various locations is recalled. Ultrasound, CAT and hormone characterization are the mainstays to achieve clinical diagnosis. Surgery is always the course adopted. Only when such an option is unsuitable, drugs are used to block the steroidogenesis.