Cultura de la depresión: la transformación psicocultural del imaginario adolescente / Cultura de la depressió: la transformació psicocultural de l'imaginari adolescent / Culture of depression: the psychocultural transformation of the imaginary adolescent

Este artículo se plantea comoun diálogo entre la psicología de la adolescencia y la crítica cultural. La comprensión clínica del adolescentecontemporáneo implica necesariamente una contextualización. Para acercarnos a la adolescencia, no debemoshacerlo como si fuera un sujeto universal, ya que se trata de una conceptualización ligada a procesos socio-históricos y determinada culturalmente. Desde esta perspectiva constatamos cómo el continuo normalidad-psicopatología en los adolescentes ha evolucionado en las últimas décadas, cambios de los que hoy tenemosevidencia clínica pero que se pueden ir observando también a través de la representación cultural del imaginarioadolescente.

his article is posed as adialogue between adolescent psychology and cultural criticism. The clinical understanding of the contemporaryadolescent necessarily implies a contextualization. In order to approach adolescence, we must not do so as if itwere a universal subject, since it is a conceptualization linked to sociohistorical processes and culturally determi-ned. From this perspective we note how the normality-psychopathology continuum in adolescents has evolvedin recent decades, changes of which we now have clinical evidence but which can also be observed through thecultural representation of the imaginary adolescent.(AU)

Aquest article es planteja coma un diàleg entre la psicologia de l'adolescència i la crítica cultural. La comprensió clínica de l'adolescent contem-porani implica necessàriament una contextualització. Per apropar-nos a l'adolescència, no ho hem de fer comsi fos un subjecte universal, ja que es tracta d'una conceptualització lligada a processos sociohistòrics i deter-minada culturalment. Des d'aquesta perspectiva, constatem com la continuïtat normalitat-psicopatologia en elsadolescents ha evolucionat en les darreres dècades, canvis dels quals avui tenim evidència clínica però que espoden anar observant també a través de la representació cultural de l'imaginari adolescent.(AU)

Comparison of surgical approaches to radical prostatectomy in our series beyond oncological and functional outcomes.

OBJECTIVES: To evaluate the outcomes of robot-assisted radical prostatectomy (RARP) compared to those of open (ORP) and laparoscopic (LRP) surgery. The interest lies fundamentally in the quality-of-life (QoL) evaluation, postoperative recovery, and personal satisfaction of patients with the intervention (PS) beyond oncological and functional outcomes. METHODS: Six hundred eighty-five RPs were performed in our center between 2011-2018 (17,8% ORP, 22,2% LRP and 60% RARP). Patients were prospectively assessed through follow-up until April 2020 and a multiple questionnaire at 12-months post-RP that included ICIQ-SF, SHIM, IPSS, IQL and questions about pain, postoperative recovery and PS. Also baseline and postoperative patient- and treatment-related data were collected, and binomial logistic regressions were performed for the 1 vs.1 comparisons (ORP vs. RARP and LRP vs. RARP). RESULTS: RARP patients have overall fewer comorbidities, less tumor aggressiveness, more operative time requirements and more positive surgical margins than ORP and LRP patients. Nevertheless, RARP outperforms ORP in: hospital stay (days) (OR 0,86; 95% CI: 0,80-0,94), hemoglobin loss (OR 0,38; 95% CI: 0,30-0,47), transfusion rate (OR 0,18; 95% CI: 0,09-0,34), early complications (p = 0,001), IQL (OR 0,82; 95% CI: 0,69-0,98), erectile function (OR 0,41; 95% CI: 0,21-0,79), pain control (OR 0,82; 95% CI: 0,75-0,89), postoperative recovery (p < 0,001) and choice of a different approach (OR 5,55; 95% CI: 3,14-9,80). RARP is superior to LRP in: urinary continence (OR 0,55; 95% CI: 0,37-0,82), IPSS (OR 0,96; 95% CI: 0,93-0,98), IQL (OR 0,76; 95% CI: 0,66-0,88), erectile function (OR 0,52; 95% CI: 0,29-0,93), postoperative recovery (p = 0,02 and 0,004), PS (p = 0,005; 0,002; and 0,03) and choice of a different approach (OR 7,79; 95% CI: 4,63-13,13). CONCLUSIONS: The findings of our study globally endorse a positive effectiveness of RARP over ORP and/or LRP, both on functional issues, postoperative recovery, QoL and PS. Oncologic results should still be improved.

What is the impact of post-radical prostatectomy urinary incontinence on everyday quality of life? Linking Pad usage and International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) for a COMBined definition (PICOMB definition).

AIMS: To identify the definition for urinary continence (UC) after radical prostatectomy (RP) which reflects best patients' perception of quality of life (QoL). METHODS: Continence was prospectively assessed in 634 patients, 12 months after RP using the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) and the number of pads employed in a 24-hour period (pad usage). We used the one-way ANOVA technique with posthoc pairwise comparisons according to Scheffé's method (homogeneous subsets) for assessing the degree of QoL deficit related to urinary incontinence (UI). RESULTS: The continence prevalence is 64.4%, 74.1%, 88.3%, and 35.8% using "0 pads," "1 safety pad," "1 pad," and "ICIQ score 0" definitions, respectively. Pad usage is moderately strongly associated with ICIQ 1, 2, and 3 (ρ = 0.744, 0.677, and 0.711, respectively; p < 0.001). Concordance between classical UC definitions is acceptable between "0 pads-ICIQ score 0" (K = 0.466), but poor for "1 safety pad" and "1 pad" (K = 0.326 and 0.137, respectively). Patients with "0 pad usage" have better QoL related to urine leakage than patients with "1 safety pad" or "1 pad" (1.41 vs. 2.44 and 3.11, respectively; p < 0.05). There were no significant differences found regarding QoL between patients with ICIQ score 0 and ICIQ score 2 (1.01 vs. 1.63; p = 0.63). CONCLUSIONS: Pad usage and the ICIQ-SF's answers provide useful information. We propose a combined definition (0 pads and ICIQ score ≤2) as it is the definition with the least impact on daily QoL.

La tromboprofilaxis quirúrgica en el día a día de la cirugía urológica: más allá de la terapia puente / Surgical thromboprophylaxis in daily urologic surgery: Beyond bridge therapy

Introducción: Con el avance de la cirugía laparoscópica y robótica, la profilaxis tromboembólica en los procedimientos urológicos se han basado clásicamente en la experiencia de otras especialidades quirúrgicas. En este trabajo se realiza un análisis de la actualidad de las recomendaciones, basado en un estudio pormenorizado de las guías clínicas europeas y en la bibliografía, aplicando las recomendaciones de tromboprofilaxis a la práctica urológica diaria. Objetivos: Elaborar unas recomendaciones generales aplicables a los pacientes quirúrgicos en urología, evitando la aparición de eventos tromboembólicos en el periodo perioperatorio. Optimizar la medicación y el ajuste en pacientes crónicos y conocer qué pacientes son candidatos a terapias puente. Material y métodos: Se ha realizado una revisión de la literatura disponible y de las guías clínicas europeas. Se analizan los artículos de consenso más recientes realizando una revisión de la bibliografía disponible y los estudios y revisiones en los que se basan las guías europeas de tromboprofilaxis en urología. Resultados: La profilaxis tromboembólica se debe emplear en aquellas cirugías que requieran abordajes abdominales, encamamiento prolongado o enfermedades oncológicas. Las terapias puente con heparinas de bajo peso molecular deben ser reducidas. Los pacientes en tratamiento crónico se pueden beneficiar de terapias puente en casos concretos. Conclusiones: El empleo de heparinas, tan habitual en la práctica clínica, puede ser excesivo según las guías actuales. La aparición de nuevos fármacos anticoagulantes, los cuales poseen antagonistas directos, permiten la reducción de los tiempos de reintroducción de la medicación crónica y un control más eficaz del sangrado

Introduction: With the advanced laparoscopic and robotic surgery, thromboembolic prophylaxis in urologic procedures has traditionally been based on the experience of other surgical specialties. This paper aims to analyze the current recommendations, through a detailed study of the European clinical guidelines and bibliography, applying the recommendations of thromboprophylaxis to the daily urological practice. Objectives: To elaborate general recommendations to surgical patients in Urology, avoiding the risk of perioperative thromboembolic events. Optimize medication in chronic patients and accurately classify who are eligible for bridge therapy. Material and methods: A review of the available literature and the European clinical guidelines was carried out. We analyzed the most recent consensus articles by studying the available bibliography, trials and reviews on which the European guidelines for thromboprophylaxis in urology are based. Results: Thromboembolic prophylaxis should be targeted towards surgeries that require abdominal approaches, prolonged bed rest or oncological pathologies. Bridge therapies with low molecular weight heparins should be limited. Patients undergoing treatment for chronic conditions can benefit from bridge therapies in specific cases

Surgical thromboprophylaxis in daily urologic surgery: Beyond bridge therapy. / La tromboprofilaxis quirúrgica en el día a día de la cirugía urológica: más allá de la terapia puente.

INTRODUCTION: With the advanced laparoscopic and robotic surgery, thromboembolic prophylaxis in urologic procedures has traditionally been based on the experience of other surgical specialties. This paper aims to analyze the current recommendations, through a detailed study of the European clinical guidelines and bibliography, applying the recommendations of thromboprophylaxis to the daily urological practice. OBJECTIVES: To elaborate general recommendations to surgical patients in Urology, avoiding the risk of perioperative thromboembolic events. Optimize medication in chronic patients and accurately classify who are eligible for bridge therapy. MATERIAL AND METHODS: A review of the available literature and the European clinical guidelines was carried out. We analyzed the most recent consensus articles by studying the available bibliography, trials and reviews on which the European guidelines for thromboprophylaxis in urology are based. RESULTS: Thromboembolic prophylaxis should be targeted towards surgeries that require abdominal approaches, prolonged bed rest or oncological pathologies. Bridge therapies with low molecular weight heparins should be limited. Patients undergoing treatment for chronic conditions can benefit from bridge therapies in specific cases. CONCLUSIONS: According to the current guidelines, there might be an overuse of heparins in the daily clinical practice. The development of -direct oral- anticoagulants have shown to reduce the time to reintroduction of medication for chronic conditions as well as a more effective bleeding management.

[Prognostic factors and response predictors in castration resistant prostate cancer.] / Factores pronósticos y predictores de respuesta en cáncer de próstata resistente a la castración.

Prostate cancer is a health problem in many Countries worldwide. Understanding the essential function of androgens in the prostate physiology led to the development of hormonal blockade as a therapeutic option in advanced disease, with limited response with time and development of resistance. In this stage, where castration resistant prostate cancer (CRPC) is defined, it is associated with poor prognosis because survival varies between 18 and 24 months. Even with castration levels, tumors are dependent on the functional androgen receptor (AR). In this paper, we analyze pretreatment clinical parameters such as prognostic or progression-predictive biomarkers, castration resistance mechanisms, the development of new technologies for the use of the so called liquid biopsies from biological ayufluids and the identification of circulating tumor cells as CRPC response and progression biomarkers. Currently ongoing clinical trials are partially oriented to the search of new prognostic and predictive biomarkers, that will enable to open up precision medicine and so to improve oncological patient's quality of life with it.

[Immunotherapy in castration resistant prostate cancer.] / Inmunoterapia en cáncer de próstata resistente a la castración.

We review the role of immunotherapy in castration resistant prostate cancer. Two immunotherapeutic strategies have been applied, isolated or in combination, either with each other or with other agents with demonstrated efficacy in this scenario that would play a role as immunomodulators: vaccines or monoclonal antibodies aimed to block immune response checkpoint inhibitors. Although CRPC presents, a priori, characteristics suggesting that immunotherapy may play a relevant role as a therapeutic strategy, its clinical application has demonstrated a limited and heterogeneous activity, in terms of proportion of responders and response intensity. Generally, the objective response rate is very low, although, in patients who have response it is possible to detect a clear, long-lasting benefit. Only the autologous vaccine Sipuleucel T has demonstrated an overall survival increase in patients with good prognosis criteria. In these treatments, it is characteristic that no progression free survival increase is visible due to its action mechanism. PSA evolution may not be considered a surrogate variable of radiological response or clinical benefit in this environment either. It is necessary to identify what patient's or tumor's characteristics are able to maximize the response. An important limitation is the absence of response predictive biomarkers that serve for patient preselection. As a general rule, the best responses with isolated immunotherapeutic treatments have been observed in patients with low tumor load, which may suggest that their optimal application could be in earlier phases of the disease (high risk localized, biochemical failure, etc) Combination strategy, without doubt the one with best future, is based on additional treatments increasing cell lysis with the subsequent antigen exposure and/ or producing an immunomodulatory effect that can surmount tumor induced immunologic tolerance. The results obtained suggest that immunotherapy may be more effective in combined therapy with other active therapies (abiraterone, enzalutamide, Radium 223, docetaxel) in a fight to achieve disease chronification.

Inmunoterapia en cáncer de próstata resistente a la castración / Immunotherapy in castration resistant prostate cancer

Revisamos el papel de la inmunoterapia en el cáncer de próstata resistente a castración. Se han aplicado dos estrategias inmunoterápicas, de forma aislada o en combinación, bien entre ellas o bien con otros agentes de eficacia demostrada en este escenario y que ejercerían un papel inmunomodulador: vacunas o anticuerpos monoclonales destinados al bloqueo de puntos de control inhibidores de la respuesta inmune. Aunque a priori el CPRC presenta características que sugieren que la inmunoterapia podría jugar un papel relevante como estrategia terapéutica, su aplicación clínica ha demostrado una actividad limitada y heterogénea, en cuanto a la proporción de respondedores e intensidad de respuesta. En términos generales, la tasa de respuestas objetivas es muy baja, aunque, en los pacientes que responden, es posible detectar un beneficio claro y duradero. Sólo la vacuna autóloga Sipuleucel T ha demostrado un aumento de la supervivencia global en pacientes con criterios de buen pronóstico. Es característico en estos tratamientos que no se observe un incremento en la supervivencia libre de progresión debido a su propio mecanismo de acción. Tampoco la evolución del PSA puede considerarse una variante subrogada de respuesta radiológica o beneficio clínico en este entorno. Se hace necesario identificar qué características de los pacientes o del tumor son capaces de maximizar la respuesta. Una limitación importante es la ausencia de biomarcadores predictores de respuesta que sirvan para la preselección de pacientes. Como norma general, las mejores respuestas con tratamientos inmunoterápicos aislados se han observado en pacientes con baja carga tumoral, lo cual puede sugerir que su aplicación óptima podría ser en fases más precoces de la enfermedad (localizado de alto riesgo, fracaso bioquímico, etc.). La estrategia de combinación, sin lugar a dudas la de más futuro, se fundamenta en que los tratamientos adicionales incrementan la lisis celular con la consiguiente exposición antigénica y/o ejercen un efecto inmunomodulador capaz de vencer la tolerancia inmunológica inducida por el tumor. Los resultados obtenidos sugieren que la inmunoterapia puede ser más efectiva en modo tratamiento combinado con otros tratamientos activos (abiraterona, enzalutamida, Radio 223, docetaxel) en la lucha por lograr cronificar la enfermedad

We review the role of immunotherapy in castration resistant prostate cancer. Two immunotherapeutic strategies have been applied, isolated or in combination, either with each other or with other agents with demonstrated efficacy in this scenario that would play a role as immunomodulators: vaccines or monoclonal antibodies aimed to block immune response checkpoint inhibitors. Although CRPC presents, a priori, characteristics suggesting that immunotherapy may play a relevant role as a therapeutic strategy, its clinical application has demonstrated a limited and heterogeneous activity, in terms of proportion of responders and response intensity. Generally, the objective response rate is very low, although, in patients who have response it is possible to detect a clear, long-lasting benefit. Only the autologous vaccine Sipuleucel T has demonstrated an overall survival increase in patients with good prognosis criteria. In these treatments, it is characteristic that no progression free survival increase is visible due to its action mechanism. PSA evolution may not be considered a surrogate variable of radiological response or clinical benefit in this environment either. It is necessary to identify what patient`s or tumor's characteristics are able to maximize the response. An important limitation is the absence of response predictive biomarkers that serve for patient preselection. As a general rule, the best responses with isolated immunotherapeutic treatments have been observed in patients with low tumor load, which may suggest that their optimal application could be in earlier phases of the disease (high risk localized, biochemical failure, etc) Combination strategy, without doubt the one with best future, is based on additional treatments increasing cell lysis with the subsequent antigen exposure and/ or producing an immunomodulatory effect that can surmount tumor induced immunologic tolerance. The results obtained suggest that immunotherapy may be more effective in combined therapy with other active therapies (abiraterone, enzalutamide, Radium 223, docetaxel) in a fight to achieve disease chronification

Factores pronósticos y predictores de respuesta en cáncer de próstata resistente a la castración / Prognostic factors and response predictors in castration resistant prostate cancer

El cáncer de próstata es un problema de salud en muchos países a nivel mundial. La comprensión de la función esencial que los andrógenos tienen en la fisiología de la próstata condujo al desarrollo del bloqueo hormonal como opción de tratamiento en la enfermedad avanzada, con respuesta limitada en el tiempo y desarrollo de resistencia. Es en esta etapa donde se define el cáncer de próstata resistente a la castración (CPRC) y se asocia con mal pronóstico ya que la supervivencia oscila entre 18 y 24 meses a partir de ese momento. Aún con niveles de castración, los tumores son dependientes del receptor androgénico (RA) funcional. En el presente trabajo analizamos los parámetros clínicos pre-tratamiento como biomarcadores pronósticos o predictivos de progresión, los mecanismos de resistencia a la castración, el desarrollo de nuevas tecnologías para el uso de las denominadas biopsias líquidas a partir de fluidos biológicos y la identificación de células tumorales circulantes como biomarcadores de respuesta y progresión en CPRC. Los ensayos clínicos actualmente en marcha están en parte orientados hacia la búsqueda de nuevos biomarcadores pronósticos y predictivos, lo que permitirá abrir las puertas a la medicina de precisión y con ello mejorar la calidad de vida del paciente oncológico

Prostate cancer is a health problem in many Countries worldwide. Understanding the essential function of androgens in the prostate physiology led to the development of hormonal blockade as a therapeutic option in advanced disease, with limited response with time and development of resistance. In this stage, where castration resistant prostate cancer (CRPC) is defined, it is associated with poor prognosis because survival varies between 18 and 24 months. Even with castration levels, tumors are dependent on the functional androgen receptor (AR). In this paper, we analyze pretreatment clinical parameters such as prognostic or progression-predictive biomarkers, castration resistance mechanisms, the development of new technologies for the use of the so called liquid biopsies from biological ayufluids and the identification of circulating tumor cells as CRPC response and progression biomarkers. Currently ongoing clinical trials are partially oriented to the search of new prognostic and predictive biomarkers, that will enable to open up precision medicine and so to improve oncological patient's quality of life with it

Staghorn stones in renal graft. Presentation on two cases report and review the bibliography.

OBJECTIVE: To describe two clinical cases of staghorn stones in renal allografts and to perform a review of this condition. METHODS/RESULTS: Case 1. 71-year-old woman with a renal transplant and recurrent UTI presented lithiasis in the graft on renal ultrasound. We started medical treatment and later one ESWL session was performed. The subsequent evolution of the patient was bad, requiring transplant nephrectomy. Case 2. 68-year old woman with renal transplant presented acute deterioration of renal function due to staghorn stones. Emergency ureteral catheter insertion was carried out, medical treatment was started and after one ESWL session she had a good subsequent evolution and normal function of the graft. CONCLUSIONS: Staghorn stones occupy most of the collecting system. They are usually made of struvite. They form in the context of urinary tract infections caused by urea splitting germs. Long-term persistence of staghorn calculi in the kidney causes functional and anatomical deterioration that can lead to kidney loss.

Litiasis coraliforme en injerto renal. presentación de dos casos clínicos y revisión de la bibliografía / Staghorn stones in renal graft. presentation on two cases report and review the bibliography

OBJETIVO: Describir los casos clínicos de dos pacientes trasplantadas renales con litiasis coraliforme del injerto. MÉTODOS/RESULTADOS: Caso 1. Mujer de 71 años trasplantada renal con episodios de ITU de repetición, presenta en ecografía doppler renal litiasis en el injerto. Se instaura inicialmente tratamiento médico y después se realiza LEOC. El desarrollo posterior es tórpido llevando la realización de trasplantectomía. Caso 2. Mujer de 68 años trasplantada renal que presenta deterioro agudo de la función renal por litiasis coraliforme. Se realiza cateterismo de urgencia, se inicia tratamiento médico y LEOC con buena evolución posterior y normofunción del injerto. CONCLUSIONES: Los cálculos coraliformes ocupan gran parte del sistema colector. Suelen estar constituidos por estruvita. Se forman en el contexto de infecciones urinarias producidas por gérmenes urolíticos. A largo plazo la persistencia de litiasis coraliforme en el riñón ocasiona un deterioro funcional y anatómico que puede llevar a la pérdida del riñón

OBJECTIVE: To describe two clinical cases of staghorn stones in renal allografts and to perform a review of this condition. METHODS/RESULTS: Case 1. 71-year-old woman with a renal transplant and recurrent UTI presented lithiasis in the graft on renal ultrasound. We started medical treatment and later one ESWL session was performed. The subsequent evolution of the patient was bad, requiring transplant nephrectomy. Case 2. 68-year-old woman with renal transplant presented acute deterioration of renal function due to staghorn stones. Emergency ureteral catheter insertion was carried out, medical treatment was started and after one ESWL session she had a good subsequent evolution and normal function of the graft. CONCLUSIONS: Staghorn stones occupy most of the collecting system. They are usually made of struvite. They form in the context of urinary tract infections caused by urea splitting germs. Long-term persistence of staghorn calculi in the kidney causes functional and anatomical deterioration that can lead to kidney loss

[Renal cell carcinoma molecular biology. Prognostic and therapeutic usefulness]. / Biología molecular en adenocarcinoma renal (RCC). Su utilidad pronóstica y terapéutica.

Renal cell adenocarcinoma requires different therapeutic pathways because it is one of the most therapy-resistant tumors, on the other hand it is biologically one of the most attractive tumors. Its pathological classification has a genetic base. There is an anomaly of the Von Hippel Lindau gene in 80% of adenocarcinomas, being this fact determinant to know the biological characteristics of tumor initiation and development, as well as the identification of factors susceptible to be used as therapeutic targets. Since 2005 a group of molecules have been used in the treatment of metastatic adenocarcinomas and, even though therapeutic results are significant but not clinically relevant yet, we are sure they are a key way for more efficient future developments. The present study tries to make a tour on the research of the biological anomalies in renal adenocarcinoma with special emphasis in the Von HippelLindau gene.

Biologia molecular en adenocarcinoma renal (RCC). Su utilidad pronóstica y terapéutica / Renal cell carcinoma molecular biology. Prognostic and therapeutic usefulness

El adenocarcinoma renal requiere caminos terapéuticos diferentes porque es uno de los tumores más resistentes a tratamiento, por contra es uno de los tumores biológicamente más atractivos. Su clasificación anatomopatológica tiene un fundamento genético. En el 80% de los adenocarcinomas existe una alteración del gen Von Hippel Lindau y este hecho ha sido determinante para conocer las características biológicas de la aparición y desarrollo tumoral así como la identificación de factores que pueden ser susceptibles de ser utilizados como dianas terapéuticas. Desde 2005 un grupo de moléculas se ha utilizado en el tratamiento de los adenocarcinomas metastásicos y aunque los resultados terapéuticos son significativos pero no todavía clínicamente relevantes, estamos seguros que son un camino clave para desarrollos posteriores más eficientes. El presente estudio pretende hacer un recorrido por la investigación de las alteraciones biológicas en adenocarcinoma renal haciendo especial énfasis en las alteraciones del gen Von Hippel Lindau(AU)

Renal cell adenocarcinoma requires different therapeutic pathways because it is one of the most therapy-resistant tumors, on the other hand it is biologically one of the most attractive tumors. Its pathological classification has a genetic base. There is an anomaly of the Von Hippel Lindau gene in 80% of adenocarcinomas, being this fact determinant to know the biological characteristics of tumor initiation and development, as well as the identification of factors susceptible to be used as therapeutic targets. Since 2005 a group of molecules have been used in the treatment of metastatic adenocarcinomas and, even though therapeutic results are significant but not clinically relevant yet, we are sure they are a key way for more efficient future developments. The present study tries to make a tour on the research of the biological anomaliesin renal adenocarcinoma with special emphasis in the Von HippelLindau gene(AU)

Impact of renal retransplantation on graft and recipient survival.

OBJECTIVES: The aim of this study was to evaluate the influence of retransplantation in graft and recipient survival. METHODS: We carried out a retrospective study in 419 renal transplants and studied the influence of retransplantation in graft and patient survival. A homogeneity study was performed between the two groups with a Student`s T and a chi-square tests. Graft survival analysis was performed with Kaplan-Meyer and log rank tests. RESULTS: Of 419 transplants, 370 (88.3%) were first transplantations, 45 (10.7%) second transplantations and 4(1%) third ones. Mean follow-up of the whole group was 72.5 months (±54.1 SD). There were no differences in follow-up between groups (Mean Follow-up 73.1 months ±54.4 SD in first transplantations vs. 61.6 months ±51.2 SD in repeat transplantation. p >0.05). The actuarial graft survival showed no differences between patients with first transplantation and those with a repeat one. [3 and 5 year SV of 89% (95% CI: 87-91%) and 84%(95% CI: 82-86%) Vs 88% (95% CI; 83-93%) and 85% (95% CI:i; 80-90%) respectively]. After adjusting for all the heterogeneity variables we still did not find differences on graft survival. The actuarial recipient survival showed no differences between patients with first transplantation and those with a repeat one. [3 and 5 year SV of 98% and 96% Vs.97%]. CONCLUSIONS: There are no differences of graft and recipient survival between patients with a first transplantation and those with a repeat one.

Impacto del retrasplante renal en la supervivencia del injerto y receptor / Impact of renal retransplantation on graft and recipient survival

OBJETIVO: Nuestro objetivo es valorar si un segundo o tercer trasplante tienen influencia en la supervivencia del injerto renal y en la del receptor.MÉTODOS: Analizamos retrospectivamente 419 trasplantes renales consecutivos realizados entre 1994 y 2010, analizando la influencia del retrasplante en la supervivencia del injerto renal. Se ha realizado un estudio de homogeneidad de los dos grupos mediante Tablas de contingencia para las variables cualitativas y t de student para las cuantitativas. La supervivencia y comparación de supervivencia con Kaplan-Meyer y log-rank..RESULTADOS: De los 419 trasplantes, 370 (88,3%) fueron primeros trasplantes 45(10,7%) segundos trasplantes y 4(1%) terceros. Media de seguimiento de todo el grupo de 72,5 meses (+/- 54,1 DE) y mediana de 68,8 meses( Rango de 0 a 188 meses ).No existen diferencias en el tiempo de seguimiento (Media del grupo de pacientes con un solo trasplante de 73,1 meses +/-54,4DE Vs. 61,6 meses +/-51,2DE del grupo de pacientes retrasplantados. p >0,05).El análisis de la supervivencia actuarial del injerto revela que no existen diferencias estadísticamente significativas entre los pacientes con un primer trasplante y los retrasplantados [SPV 89% (95% IC; 87- 91%) y 84% (95% IC; 82-86%) a los 3 y 5 años frente a 88% (95% IC; 83-93%) a los 3 años y 85% (95% IC; 80-90%) a los 5 años]. Al ajustar por las variables para las que los grupos no fueron homogeneos las diferencias se siguen manteniendo.El análisis de supervivencia de los receptores revela que tampoco existen diferencias entre los dos grupos [SPV del 98% y 96% a los 3 y 5 años en los primeros trasplantes frente a 97% a los 3 años y 5 años en los retrasplantados].CONCLUSIONES: No existen diferencias en la supervivencia del injerto ni en la de los receptores entre pacientes trasplantados por primera vez y aquellos que reciben un retrasplante(AU)

OBJECTIVES: The aim of this study was to evaluate the influence of retransplantation in graft and recipient survival.METHODS: We carried out a retrospective study in 419 renal transplants and studied the influence of retransplantation in graft and patient survival.A homogeneity study was performed between the two groups with a Student`s T and a chi-square tests. Graft survival analysis was performed with Kaplan-Meyer and log rank tests.RESULTS: Of 419 transplants, 370 (88.3%) were first transplantations, 45(10.7%) second transplantations and 4(1%) third ones. Mean follow-up of the whole group was 72.5 months (+/-54.1 SD).There were no differences in follow-up between groups (Mean Follow-up 73.1 months +/-54.4 SD in first transplantations vs. 61.6 months +/-51.2 SD in repeat transplantation. p >0.05). The actuarial graft survival showed no differences between patients with first transplantation and those with a repeat one. [3 and 5-year SV of 89% (95% CI: 87-91%) and 84% (95% CI: 82-86%) Vs 88% (95% CI; 83-93%) and 85% (95% CI; 80-90%) respectively].After adjusting for all the heterogeneity variables we still did not find differences on graft survival.The actuarial recipient survival showed no differences between patients with first transplantation and those with a repeat one. [3 and 5 year SV of 98% and 96% Vs. 97%].CONCLUSIONS: There are no differences of graft and recipient survival between patients with a first transplantation and those with a repeat one(AU)

Association of steroid and xenobiotic receptor (SXR) and multidrug resistance 1 (MDR1) gene expression with survival among patients with invasive bladder carcinoma.

UNLABELLED: What's known on the subject? and What does the study add? SXR and MDR1 are known as responsible for chemo and radiotherapy resistance in some cancers, like kidney cancer (MDR1). Invasive bladder cancer is an aggressive disease, with different behaviour upon its tumoral stage, and also within the same tumoral stage, therefore molecular markers are sought. This study shows a new molecular marker, which has shown as a predictor for bad prognosis cancers, therefore, allowing us for a better patient selection for aggressive therapies. OBJECTIVE: To investigate the prognostic value of steroid and xenobiotic receptor (SXR) and multidrug resistance 1 (MDR1) gene expression in relation to survival among patients with invasive bladder cancer. PATIENTS AND METHODS: The prospective study included 67 patients diagnosed with invasive bladder cancer and treated with radical cystectomy at one of two institutions. SXR and MDR1 gene expression was assessed by real-time quantitative polymerase chain reaction (RT-PCR) in tumoral and normal tissue from frozen surgical specimens. RESULTS: Patients were followed for a mean of 29 months; 31 patients (46%) had progression. In univariate analysis, significant predictors of overall survival (OS) were pathological stage, lymph node (LN) status, histological grade, vascular-lymphatic invasion, and SXR expression. In multivariate analysis, independent predictors of OS were LN status (odds ratio [OR], 2.96; P=0.034), vascular-lymphatic invasion (OR, 2.50; P=0.029), and SXR expression (OR, 1.05, P=0.03). Among the 51 patients with negative LNs (pN0), univariate predictors of OS were SXR expression, MDR1 expression, and pathological stage. In multivariate analysis, SXR expression (OR, 1.06; P=0.01) and MDR1 expression (OR, 3.27; P=0.03) were independently associated with survival. Within the pN0 group, patients with SXR expression had shorter progression-free survival than did those without expression (P=0.004). This association persisted in the N0 subgroup with stage pT3-pT4 disease (P=0.028). However, in the pN1 group SXR expression did not have any influence. CONCLUSIONS: For patients with invasive bladder cancer, SXR expression has value as a predictor of survival independent of the standard pathological predictors. Its maximum importance appears to be in patients with stage pT3-pT4 pN0 disease.

Association of crossed renal ectopia and aortic aneurism. Case report.

OBJECTIVE: Renal malformations are rare entities and rarely have clinical consequences. Crossed renal ectopia has an incidence of 1/2.000 autopsies. The association with aortic aneurysm is even more exceptional. METHODS: We present our case and perform a bibliographic review. RESULTS: To date and in our knowledge, seven cases of crossed renal ectopia associated with aortic aneurysm were described on the literature. This malformation makes the treatment of the aneurysm more complex. The possibility of renal function decrease caused by injuries to the renal arteries during the surgical procedure is always present. Because of this risk of injury of the kidney during surgery preoperative evaluation of the vascularization must include image technologies as the MRI, CT-angiography or conventional arteriography. During the aortic intervention vascular conservation must be performed and it is necessary to minimize the time of renal ischemia. CONCLUSIONS: The association of crossed renal ectopia and aortic aneurysm is a rare event. The surgical intervention of the aorta does not have to necessarily originate a loss of renal function. Anyway the worsening of the renal clearance must be foreseen.

Asociación entre ectopia renal cruzada con fusión y aneurisma aórtico. A propósito de un caso / Association of crossed renal ectopia and aortic aneurism. Case report

OBJETIVO: La malformación renal es una entidad poco frecuente y rara vez tiene traducción clínica. La ectopia renal cruzada tiene una incidencia de 1 de cada 2.000 autopsias. Su asociación con un aneurisma aórtico es todavía más excepcional.MÉTODOS: Presentamos nuestro caso y revisamos la literatura.RESULTADOS: Hasta la fecha y en nuestro conocimiento hay descritos 7 casos de ectopia renal cruzada con fusión asociados a aneurisma aórtico. Este fenómeno hace que el tratamiento del aneurisma sea más complejo pudiendo ocasionar una disminución de la función renal por lesiones en su vascularización. Para evitarlo, la vascularización renal debe ser estudiada preoperatoriamente mediante pruebas como la RM, el Angio-Tac o la Arteriografía. Durante la intervención sobre la aorta se deben realizar técnicas de conservación vascular y se debe de minimizar el tiempo de isquemia renal.CONCLUSIONES: La asociación de riñón ectópico cruzado y aneurisma de aorta es un evento raro. La cirugía o procedimientos sobre la aorta no tienen por qué acarrear una perdida de función renal importante y ésta debe ser prevista antes de la intervención (AU)

OBJECTIVE: Renal malformations are rare entities and rarely have clinical consequences. Crossed renal ectopia has an incidence of 1/2.000 autopsies. The association with aortic aneurysm is even more exceptional.METHODS: We present our case and perform a bibliographic review.RESULTS: To date and in our knowledge , seven cases of crossed renal ectopia associated with aortic aneurysm were described on the literature. This malformation makes the treatment of the aneurysm more complex. The possibility of renal function decrease caused by injuries to the renal arteries during the surgical procedure is always present. Because of this risk of injury of the kidney during surgery preoperative evaluation of the vascularization must include image technologies as the MRI, CT-angiography or conventional arteriography. During the aortic intervention vascular conservation must be performed and it is necessary to minimize the time of renal ischemia.CONCLUSIONS: The association of crossed renal ectopia and aortic aneurysm is a rare event. The surgical intervention of the aorta does not have to necessarily originate a loss of renal function. Anyway the worsening of the renal clearance must be foreseen (AU)

Respuesta y supervivencia libre de progresión en tumores vesicales en estadios T2-T4 tratados con tratamiento trimodal de conservación vesical / Response and Progression-Free Survival in T2 to T4 bladder tumors treated with trimodality therapy with bladder preservation

Objetivo: Evaluar la respuesta y la supervivencia libre de progresión (SLP) en pacientes diagnosticados de carcinoma vesical infiltrante tratados con RTU-quimioterapia-radioterapia y compararlos con una serie no aleatorizada de pacientes tratados con cistectomía radical. Material y métodos: Análisis retrospectivo de 43 pacientes con carcinoma vesical infiltrante tratados entre 1994–2007 con dos pautas de conservación vesical y estudio comparativo con pacientes sometidos a cistectomía radical (145 casos) en el mismo periodo. Las variables pronósticas para estudio fueron estadio y grado clínico, presencia o no de hidronefrosis, tratamiento quimioterapéutico recibido, dosis de radioterapia y alteraciones en p53 y Ki67. Resultados: La media y la mediana de los pacientes sometidos a conservación vesical fueron de 51 y de 39 meses, respectivamente. El 72% de los pacientes con conservación vesical obtuvo respuesta completa (RC) al finalizar el tratamiento. Solo la hidronefrosis tuvo influencia pronóstica (OR: 7,3; p=0,02). Al final del estudio, el 74% de los que obtuvieron RC mantenía la respuesta. Ninguna de las variables analizadas fueron predictoras del mantenimiento de la respuesta. La SLP en el grupo fue del 69±7 y del 61±7% a 3 y a 5 años. La dosis de radioterapia >60Gy (OR: 6,1; p=0,001) y la ausencia de hidronefrosis (OR 7,5; p=0,02) fueron las únicas variables influyentes. La SLP del grupo con RC fue del 80±7 y del 58±10% a 3 y a 5 años. Al concluir el estudio, 23/43 (53,5%) conservaban la vejiga y estaban libres de enfermedad. Se realizaron 145 cistectomías radicales a pacientes diagnosticados de carcinoma vesical infiltrante. La media y la mediana de seguimiento de este grupo fueron de 29 y 18 meses, respectivamente. El análisis estadístico reflejó que los pacientes que se habían sometido a conservación vesical presentaban únicamente peor estadio clínico que los pacientes sometidos a cistectomía radical (p=0,17).La SLP a 3 y a 5 años de los pacientes sometidos a cistectomía radical fue del 72±5 y del 63±7%, no evidenciando diferencias estadísticamente significativas (p=0,83) con respecto a los pacientes sometidos a pauta de conservación vesical. Conclusiones: Los pacientes sometidos a conservación vesical obtienen una supervivencia similar a la de los pacientes a los que se les ha realizado cistectomía radical. La dosis de radioterapia >60Gy y la ausencia de hidronefrosis son factores de influencia independiente en la SLP (AU)

Objective: To evaluate the response and the free-survival progression in pacients diagnosed of invasive bladder cancer who have been treated with transurethral resection, chemotherapy and radiotherapy. This multimodal treatment is compared with a not random serie of patients treated by radical cistectomy. Material and methods: Retrospective analysis of 43 cases of invasive bladder cancer treated with two schemes of bladder preservation between 1994–2007. They are compared with 145 cases treated with radical cistectomy in the same period of time. Pronostic variables included in the study are clinical stage, grade of differentiation, presence of ureteral obstruction, chemotherapy modality, radiotherapy doses and p53 and ki-67 expression. Results: Mean and median time are 51 and 39 months in patients with multimodal treatment. Complete response is achieved in 72% of cases treated with bladder preservation. Ureteral obstruction is a prognostic factor (OR: 7,3;p:0,02). 72% patients with complete response mantain it at the end of the study. None of analyzed variables are predictors of maintenance of the response. Survival rates with a intact bladder were 69±7% and 61±7% at three and five years. Radiotherapy doses greater than 60Gy (OR: 6,1; p<0,001) and the absence of ureteral obstruction (OR: 7,5; p<0,002) were pronostic variables. Free-survival in patients with complete response was 80±7% and 58±10% at three and five years. At the end of the study, 53,5% of patients had a intact bladder and free-disease. In the same period of time, 145 radical cistectomies were performed due to muscle invasive bladder cancer. Mean and median time in this group were 29 and 18 months respectively. Stadistical analysis reveals a worse clinical stage in the group of patients treated with multimodal treatment (p:0.01). Free-survival was 72±5% and 63±7% at 3 and 5 years in the group of radical cistectomies. There was not stadistical significant differences between cistectomies and bladder preservation. Conclusions: Patients treated with bladder preservation have a free-survival similar to those treted with radical cistectomy. Radiotherapy doses greater than 60Gy and absence of ureteral obstruction were free-survival prognostic variables (AU)

[Response and progression-free survival in T2 to T4 bladder tumors treated with trimodality therapy with bladder preservation]. / Respuesta y supervivencia libre de progresión en tumores vesicales en estadios T2-T4 tratados con tratamiento trimodal de conservación vesical.

OBJECTIVE: To evaluate the response and the free-survival progression in patients diagnosed of invasive bladder cancer who have been treated with transurethral resection, chemotherapy and radiotherapy. This multimodal treatment is compared with a not random serie of patients treated by radical cistectomy. MATERIAL AND METHODS: Retrospective analysis of 43 cases of invasive bladder cancer treated with two schemes of bladder preservation between 1994-2007. They are compared with 145 cases treated with radical cistectomy in the same period of time. Pronostic variables included in the study are clinical stage, grade of differentiation, presence of ureteral obstruction, chemotherapy modality, radiotherapy doses and p53 and ki-67 expression. RESULTS: Mean and median time are 51 and 39 months in patients with multimodal treatment. Complete response is achieved in 72% of cases treated with bladder preservation. Ureteral obstruction is a prognostic factor (OR: 7,3;p:0,02). 72% patients with complete response mantain it at the end of the study. None of analyzed variables are predictors of maintenance of the response. Survival rates with a intact bladder were 69±7% and 61±7% at three and five years. Radiotherapy doses greater than 60Gy (OR: 6,1; p<0,001) and the absence of ureteral obstruction (OR: 7,5; p<0,002) were pronostic variables. Free-survival in patients with complete response was 80±7% and 58±10% at three and five years. At the end of the study, 53,5% of patients had a intact bladder and free-disease.In the same period of time, 145 radical cistectomies were performed due to muscle invasive bladder cancer. Mean and median time in this group were 29 and 18 months respectively. Stadistical analysis reveals a worse clinical stage in the group of patients treated with multimodal treatment (p:0.01). Free-survival was 72±5% and 63±7% at 3 and 5 years in the group of radical cistectomies. There was not statistical significant differences between cistectomies and bladder preservation. CONCLUSIONS: Patients treated with bladder preservation have a free-survival similar to those treated with radical cistectomy. Radiotherapy doses greater than 60Gy and absence of ureteral obstruction were free-survival prognostic variables.