Acetato de abiraterona prequimioterapia. Propuesta de un algoritmo de tratamiento en el carcinoma de próstata resistente a castración / Pre-chemotherapy abiraterone acetate. A proposal of a treatment algorithm in castration resistant prostate cancer

Contexto: El tratamiento del cáncer de próstata sigue siendo un reto para el urólogo. El control médico en el cáncer de próstata metastásico o localmente avanzado se realiza habitualmente con análogos LHRH y antiandrógenos. Cuando se produce la progresión bioquímica y clínica de la enfermedad diferentes tratamientos han sido propuestos y otros nuevos han cambiado la perspectiva y esperanza de vida de los pacientes. Objetivo: El objetivo de esta revisión es establecer el papel actual del acetato de abiraterona en el tratamiento del cáncer de próstata resistente a la castración y facilitar la toma de decisión del urólogo mediante un algoritmo de tratamiento. Adquisición de la evidencia: Se realiza una búsqueda de la evidencia actual del tratamiento con abiraterona en pacientes con cáncer de próstata metastásico resistente a castración en PubMed, analizando principalmente aquellos estudios diseñados como ensayos clínicos. Además se realiza una revisión y actualización del papel del tratamiento hormonal y de los receptores androgénicos en el cáncer de próstata. Síntesis de la evidencia: Existen en la actualidad fundamentalmente 2 ensayos clínicos que demuestran la eficacia de abiraterona en el cáncer de próstata metastásico con respecto a placebo. En el estudio COU AA-302 se observa un beneficio evidente con abiraterona previo a quimioterapia en pacientes con cáncer de próstata resistente a castración, lo que permite establecer un algoritmo de tratamiento inicial que facilita la toma de decisión por parte del urólogo. Conclusión: Abiraterona es una opción de tratamiento prequimioterapia en pacientes seleccionados con cáncer de próstata metastásico resistente a la castración, aunque debe mejorarse la oferta económica y diseñar más ensayos clínicos multicéntricos para optimizar la relación coste/beneficio

Context: Prostate cancer treatment remains a challenge for the urologist. Medical control in locally advanced or metastatic prostate cancer is usually performed with LHRH analogs and/or antiandrogens. Different treatments have been proposed when there is biochemical and clinical progression of the disease and other new ones have changed the patients’ perspective and life expectancy. Objective: This review has aimed to establish the current role of abiraterone acetate in the treatment of castration-resistant prostate cancer and facilitate decision-making by the Urologist by means of a Treatment Algorithm. Acquisition of the evidence: A search of current evidence on Abiraterone treatment in patients with castration-resistant metastatic prostate cancer was performed in PubMed, mainly analyzing those studies designed as clinical trials. In addition, we reviewed and updated the role of hormone therapy and androgen receptors in prostate cancer. Evidence synthesis: There are currently basically two clinical trials that demonstrate the effectiveness of Abiraterone in metastatic prostate cancer compared to placebo. The study COU-AA 302 shows a clear benefit with Abiraterone prior to chemotherapy in patients with castration-resistant prostate cancer, this making it possible to establish an algorithm for initial treatment that facilitates decision-making by the urologist. Conclusion: Abiraterone is a pre-chemotherapy treatment option in selected patients with castration-resistant metastatic prostate cancer, although it is necessary to improve the cost and to design more multicenter clinical trials to optimize the cost/benefit ratio

Disfunción eréctil, síndrome metabólico y arteriopatía. Relación clínico-patológica mediante ecografía carotídea / Erectile dysfunction, metabolic syndrome and arterial disease. Clinical-pathological relation by carotid ultrasonography

Introducción: Diferentes estudios ponen de manifiesto la relación entre disfunción eréctil, síndrome metabólico y enfermedad cardiovascular. El objetivo de este estudio fue evaluar la presencia de arteriopatía mediante la realización de ecografía de carótidas en pacientes con y sin disfunción eréctil. Material y métodos: Hemos realizado un estudio caso-control con 44 pacientes que consultan por disfunción eréctil y 20 controles. Todos los sujetos rellenaron el test IIEF-5 y se estudiaron los criterios de síndrome metabólico, además de una ecografía carotídea, para estudiar el grosor íntima-media y la presencia de placas de ateroma. Resultados: La media del grosor íntima-media en milímetros fue de 0,71 ± 0,21 para la derecha y de 0,71 ± 0,17 para la izquierda en los pacientes con disfunción eréctil. En el grupo control las medias fueron de 0,54 ± 0,11 y de 0,59 ± 0,15 respectivamente, existiendo diferencias estadísticamente significativas (p = 0,02 y p = 0,05 respectivamente). No se encontró placa de ateroma en ningún control, pero sí en el 25% de ambas carótidas de los pacientes con disfunción eréctil (p = 0,01). En cuanto al síndrome metabólico, según la American Heart Association, se diagnosticó a un 52,8% de los pacientes con disfunción eréctil y a un 16,7% de los controles, y según la International Diabetes Federation un 52,3% de los pacientes con disfunción eréctil y un 25% de los controles cumplen criterios diagnósticos. En ambos casos existieron diferencias significativas (p < 0,01 y p = 0,02 respectivamente). Hemos encontrado correlación lineal y positiva entre el perímetro abdominal y el grosor íntima-media en ambas carótidas (p < 0,05). Conclusiones: Los pacientes con disfunción eréctil pueden presentar mayor riesgo de enfermedad cardiovascular, determinado por la presencia de arteriopatía en las carótidas, lo cual nos indica que debería realizarse un estudio más detenido y global a los pacientes con disfunción eréctil

Introduction: Different studies have shown the relationship between erectile dysfunction, metabolic syndrome and cardiovascular disease. The objective of this study was to evaluate the presence of arteriopathy performing carotid ultrasound in patients with and without erectile dysfunction. Material and methods: We conducted a case-control study with 44 patients consulting for erectile dysfunction and 20 controls. All subjects completed the IIEF-5 test and we studied the criteria for metabolic syndrome, and a carotid ultrasound to study the intima-media thickness and the presence of atherosclerotic plaques was performed. Results: Mean intima-media thickness was 0.71 mm±0.21 for the right and of 0.71±0.17 for the left carotid in patients with erectile dysfunction. In the control group, the means were 0.54±0.11and 0.59±0.15 mm respectively, statistically significant differences (P = 0.02 and P = 0.05 respectively).No plaque was found in any control, but in 25% of both carotid arteries of patients with erectile dysfunction (P = 0.01). As metabolic syndrome, according to the American Heart Association, were diagnosed 52.8% of patients with erectile dysfunction, and 16.7% of controls, and according to the International Diabetes Federation, 52.3% of patients with erectile dysfunction and 25% of controls met diagnostic criteria. In both cases there were significant differences (P < 0.01 and P = 0.02 respectively). We found a positive linear correlation between waist circumference and the intima-media thickness in both carotid (P < 0.05). Conclusions: Patients with erectile dysfunction may be at increased risk of cardiovascular disease, as determined by the presence of arterial disease in the carotid arteries, which indicates that we should made a more thorough and comprehensive study of patients with erectile dysfunction

Erectile dysfunction, metabolic syndrome and arterial disease. Clinical-pathological relation by carotid ultrasonography.

INTRODUCTION: Different studies have shown the relationship between erectile dysfunction, metabolic syndrome and cardiovascular disease. The objective of this study was to evaluate the presence of arteriopathy performing carotid ultrasound in patients with and without erectile dysfunction. MATERIAL AND METHODS: We conducted a case-control study with 44 patients consulting for erectile dysfunction and 20 controls. All subjects completed the IIEF-5 test and we studied the criteria for metabolic syndrome, and a carotid ultrasound to study the intima-media thickness and the presence of atherosclerotic plaques was performed. RESULTS: Mean intima-media thickness was .71mm±.21 for the right and of .71±.17 for the left carotid in patients with erectile dysfunction. In the control group, the means were .54±0.11 and 0.59±0.15mm respectively, statistically significant differences (P=.02 and P=.05 respectively). No plaque was found in any control, but in 25% of both carotid arteries of patients with erectile dysfunction (P=.01). As metabolic syndrome, according to the American Heart Association, were diagnosed 52.8% of patients with erectile dysfunction, and 16.7% of controls, and according to the International Diabetes Federation, 52.3% of patients with erectile dysfunction and 25% of controls met diagnostic criteria. In both cases there were significant differences (P<.01 and P=.02 respectively). We found a positive linear correlation between waist circumference and the intima-media thickness in both carotid (P<.05). CONCLUSIONS: Patients with erectile dysfunction may be at increased risk of cardiovascular disease, as determined by the presence of arterial disease in the carotid arteries, which indicates that we should made a more thorough and comprehensive study of patients with erectile dysfunction.

Pre-chemotherapy abiraterone acetate. A proposal of a treatment algorithm in castration resistant prostate cancer.

CONTEXT: Prostate cancer treatment remains a challenge for the urologist. Medical control in locally advanced or metastatic prostate cancer is usually performed with LHRH analogues and/or antiandrogens. Different treatments have been proposed when there is biochemical and clinical progression of the disease and other new ones have changed the patients' perspective and life expectancy. OBJECTIVE: This review has aimed to establish the current role of Abiraterone Acetate in the treatment of castration-resistant prostate cancer and facilitate decision-making by the Urologist by means of a Treatment Algorithm. ACQUISITION OF THE EVIDENCE: A search of current evidence on Abiraterone treatment in patients with castration- resistant metastatic prostate cancer was performed in PubMed, mainly analyzing those studies designed as clinical trials. In addition, we reviewed and updated the role of hormone therapy and androgen receptors in prostate cancer. EVIDENCE SYNTHESIS: There are currently basically two clinical trials that demonstrate the effectiveness of Abiraterone in metastatic prostate cancer compared to placebo. The study COU-AA 302 shows a clear benefit with Abiraterone prior to chemotherapy in patients with castration-resistant prostate cancer, this making it possible to establish an algorithm for initial treatment that facilitates decision-making by the urologist. CONCLUSION: Abiraterone is a pre-chemotherapy treatment option in selected patients with castration resistant metastatic prostate cancer, although it is necessary to improve the cost and to design more multicenter clinical trials to optimize the cost/benefit ratio.

Retroperitoneal schwannoma. A complex surgical treatment of a tumor with uncertain behavior.

BACKGROUND: Retroperitoneal schwannoma is a rare nerve sheath tumor; the surgical removal of this tumor is sometimes compromised by its location. The aim of this study is to analyze our experience with the diagnosis and treatment of this type of tumor. METHOD: We present our experience between 1999 and 2011 in the diagnosis and treatment of retroperitoneal schwannoma. During that time, we diagnosed and treated five female patients (four adults and one infant) with the condition. The tumors appeared sporadically and were not associated with neurofibromatosis or other syndromes. Diagnosis was performed by computed tomography (CT) imaging in four cases and by magnetic resonance imaging (MRI) in one case. RESULTS: All patients underwent surgical treatment and complete resection of the lesion. An open resection was performed in four cases, and in the most recent case, the excision was conducted laparoscopically. In all of the cases, the histological diagnosis was retroperitoneal schwannoma, and in one case, there was a melanocytic variant that was not associated with Carney syndrome. At the time of this report, there has been no evidence of recurrence. CONCLUSION: Retroperitoneal schwannoma is a tumor that is difficult to diagnose with imaging techniques, and because of its localization, the tumor is difficult to remove surgically.

Litiasis renal cálcica y densidad mineral ósea. Importancia del metabolismo óseo en la litiasis urinaria / Calcium Renal Lithiasis and Bone Mineral Density. Importance of Bone Metabolism in Urinary Lithiasis

Contexto: La litiasis renal cálcica es una enfermedad multifactorial, en la que intervienen en su fisiopatología diferentes factores minerales y metabólicos que pueden encontrarse alterados, entre ellos el metabolismo óseo y fosfocálcico. Objetivo: Establecer la evidencia científica y demostrar la relación existente entre litiasis renal cálcica y pérdida de densidad mineral ósea, mediante el uso de marcadores de remodelado óseo y metabolitos urinarios y séricos. Adquisición de la evidencia: Se realiza una revisión bibliográfica en PubMed utilizando diferentes MeSHTerms como Nephrolithiasis, Bone mineral density, Urinary stones, Calcium, Bone resorption y Bone formation, usando diferentes combinaciones. Se seleccionan únicamente los trabajos con resúmenes en inglés o español y se descartan casos clínicos y trabajos con estudio estadístico inapropiado. Se seleccionan un total de 40 publicaciones. Síntesis de la evidencia: En los diferentes estudios analizados se observa que los pacientes con hipercalciuria presentan una mayor pérdida de densidad mineral ósea con respecto a los normocalciúricos. Entre los pacientes con litiasis cálcica, tanto los que tienen normocalciuria como los que tienen hipercalciuria presentan pérdida de densidad mineral ósea, siendo más evidente en estos últimos. Esta pérdida de densidad mineral está acentuada y es importante en los pacientes con litiasis recidivante. El aumento de los marcadores calcio/creatinina en ayunas y β-crosslaps son los más determinantes de litiasis y pérdida de densidad mineral en estos pacientes. Conclusión: Se recomienda solicitar marcadores de remodelado óseo y calcio/creatinina en ayunas en pacientes con litiasis cálcica recidivante por la importante presencia de pérdida de densidad mineral ósea, con un nivel de evidencia III (AU)

Context: Calcium Nephrolithiasis is a multifactorial disease; in its pathophysiology is involved various minerals and metabolic factors that may be altered, including bone and phosphor-calcium metabolism. Objective: To establish the scientific evidence and demonstrate the relationship between calcium nephrolithiasis and bone mineral density loss, through the use of bone turnover markers, serum and urinary metabolites. Evidence acquisition: We performed a PubMed literature review using different MeSH Terms like «Nephrolithiasis» «Bone mineral density»,«Urinary stones», «Calcium», «Bone resorption» and «Bone formation», with different combinations. We only selected articles with abstracts in English or Spanish and discarded clinical cases and articles with inappropriate statistical study. A total of 40 articles were selected. Evidence synthesis: In different studies reviewed have been observed that patients with hypercalciuria have a higher bone mineral density loss with respect to normocalciuric. Among patients with calcium stones (normocalciuric or hypercalciuric), there is loss of bone mineral density, being more evident in patients with stones and hypercalciuria. This mineral density loss is marked and important in patients with recurrent calcium stones. Increased markers like fasting calcium/creatinine and β-CrossLaps are determinant of nephrolithiasis and mineral density loss in these patients. Conclusion: We recommend perform markers of bone turnover and fasting calcium/creatinine in patients with recurrent calcium stones by the significant presence of bone mineral density loss, with a level of evidence III (AU)

Calcium renal lithiasis and bone mineral density. Importance of bone metabolism in urinary lithiasis.

CONTEXT: Calcium Nephrolithiasis is a multifactorial disease; in its pathophysiology is involved various minerals and metabolic factors that may be altered, including bone and phosphor-calcium metabolism. OBJECTIVE: To establish the scientific evidence and demonstrate the relationship between calcium nephrolithiasis and bone mineral density loss, through the use of bone turnover markers, serum and urinary metabolites. EVIDENCE ACQUISITION: We performed a PubMed literature review using different MeSH Terms like "Nephrolithiasis", "Bone mineral density", "Urinary stones", "Calcium", Bone resorption" and "Bone formation", with different combinations. We only selected articles with abstracts in English or Spanish and discarded clinical cases and articles with inappropriate statistical study. A total of 40 articles were selected. EVIDENCE SYNTHESIS: In different studies reviewed have been observed that patients with hypercalciuria have a higher bone mineral density loss with respect to normocalciuric. Among patients with calcium stones (normocalciuric or hypercalciuric), there is loss of bone mineral density, being more evident in patients with stones and hypercalciuria. This mineral density loss is marked and important in patients with recurrent calcium stones. Increased markers like fasting calcium/creatinine and ß-CrossLaps are determinant of nephrolithiasis and mineral density loss in these patients. CONCLUSION: We recommend perform markers of bone turnover and fasting calcium/creatinine in patients with recurrent calcium stones by the significant presence of bone mineral density loss, with a level of evidence III.

Hyperthyroidism as a clinical manifestation of a embryonal carcinoma of the testis.

This case report describes a case of hyperthyroidism as manifestation of an embryonal carcinoma, and illustrates the causes that led to it. The case describes a 33-year-old male patient who complained of chest pain, palpitations, mild dyspnoea, and weight loss. Blood analysis reveals high levels of human chorionic gonadotropin (833818 mlU/ml), T3 (16.90 pg/ml), and T4 (7.77 ng/dl), as well as a fall of TSH (0.01 ulU/ml). Physical examination and imaging procedures confirm the occurrence of a left testicular tumour associated with numerous lung, hepatic and retroperitoneal metastases. Treatment with carbimazol and propanolol is established to manage hyperthyroidism, and an urgent orchiectomy is performed; the histologic diagnosis confirms an embryonal carcinoma (organoid type), but the patient died unexpectedly 24 hours later after having suffered sudden dyspnoea, tachypnoea, and tachyarrhythmia. Hyperthyroidism is a rare manifestation of a testicular tumour that should be borne in mind with regard to the patient's symptomatology and HCG levels.

Síndrome metabólico y perfil hormonal en pacientes con disfunción eréctil / Metabolic Syndrome and Hormone Profile in Patients with Erectile Dysfunction

Objetivos: Demostrar la existencia de relación entre síndrome metabólico y disfunción eréctil y analizar el perfil hormonal de estos pacientes con respecto a un grupo de población sana. Material y métodos: Se ha diseñado un estudio de casos y controles con 65 hombres divididos en dos grupos según la presencia o no de disfunción eréctil. El grupo A está formado por 37 hombres con disfunción eréctil y el grupo B por 28 hombres sanos sin disfunción eréctil. La edad estuvo comprendida entre 40 y 65 años. Se estudió la presencia de síndrome metabólico según la definición ATP III, la realización de ejercicio físico, tabaquismo, índice de masa corporal (IMC) y perfil hormonal completo incluyendo testosterona total, libre y biodisponible. Resultados: Se ha detectado mayor presencia de síndrome metabólico entre los hombres del grupo A (72,9%) con respecto a los del grupo B (17,8%) (p=0,0001). Entre los parámetros que conforman el síndrome metabólico existen diferencias entre ambos grupos en los niveles de presión arterial sistólica y diastólica, la glucemia en ayunas y el perímetro abdominal, siendo todas ellas significativas. Tras realizar análisis multivariante entre síndrome metabólico y disfunción eréctil ajustado por edad, IMC, IIEF, ejercicio físico y tabaquismo hemos observado relación significativa independiente entre síndrome metabólico y disfunción eréctil. No hemos encontrado diferencias entre ambos grupos en ningún parámetro hormonal. Conclusión: Existe relación entre síndrome metabólico y disfunción eréctil, por lo que parece recomendable llevar a cabo el estudio de perfil metabólico y riesgo cardiovascular en estos pacientes (AU)

Objectives: To demonstrate the existence of relation between metabolic syndrome and erectile dysfunction and to analyze the hormone profile of these patients regarding a healthy population group. Material and methods: A case-control study was designed with 65 men divided into 2 groups according to presence or non-presence of erectile dysfunction. Group A was made up of 37 men with erectile dysfunction and group B by 28 healthy men without erectile dysfunction. Ages ranged from 40 to 65 years. The presence of metabolic syndrome according to the ATPIII definition, performance of physical exercise, smoking habit, body mass index and complete hormone profile including testosterone -total, free and bioavailability, were studied. Results: Greater presence of metabolic syndrome was detected among men of Group A (72.9%) versus those of group B (17.8%) (p=0.0001). Among the parameters that make up the metabolic syndrome, there are differences between both groups in systolic and diastolic blood pressure, fast blood sugar and abdominal circumference, all these differences being significant. After performing multivariate analysis between the metabolic syndrome and erectile dysfunction adjusted for age, BMI, International Index for Erectile Function (IIEF), physical exercise and smoking habit, we have observed an independent significant relation between the metabolic syndrome and erectile dysfunction. We have not found differences between both groups in any hormone parameter. Conclusion: A relationship is found between metabolic syndrome and erectile dysfunction. Thus, it seems recommendable to perform the metabolic profile and cardiovascular risk study in these patients (AU)

Fournier gangrene: description of 37 cases and analysis of associated health care costs.

BACKGROUND AND OBJECTIVES: Fournier gangrene is a urological emergency associated with a high mortality. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department. MATERIAL AND METHODS: We carried out a retrospective study of 37 patients diagnosed with Fournier gangrene between January 2001 and October 2010. RESULTS: All the patients were men, 43.2% had diabetes, and the mean age of the patients was 57.68 years. Statistically significant differences were observed between the age of surviving patients and that of patients who died (55.8 and 69.6 years, respectively). The mean hospital stay was 27.54 days and 32.4% of patients required admission to the intensive care unit. Etiology was unknown in 39.8% of cases. Polymicrobial infection was observed in 59.5% of cases. The mean health care cost associated with a patient diagnosed with Fournier gangrene admitted to intensive care and requiring at least 1 procedure in the operating room was €25,108.67. Mortality was 13.5%. Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay. CONCLUSIONS: Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented.

Gangrena de Fournier. Análisis descriptivo y coste económico-sanitario de nuestra serie de 37 casos / Fournier Gangrene: Description of 37 Cases and Analysis of Associated Health Care Costs

Introducción: La gangrena de Fournier es una urgencia urológica definida como una fascitis necrotizante, con una alta mortalidad, resultado de una infección polimicrobiana que se origina en la región anorrectal y/o genitourinaria. El objetivo de este estudio es analizar las características epidemiológicas y clínicas, así como las variables que han influido en la evolución y mortalidad de los pacientes tratados en nuestro Servicio. Material y métodos: El estudio analiza retrospectivamente 37 pacientes diagnosticados de gangrena de Fournier en el periodo de tiempo comprendido entre enero del 2001 a octubre de 2010. Resultados: Todos los pacientes son hombres, con una edad media de 57, 68 años, existiendo diferencias estadísticas en la edad de los fallecidos respecto a los que sobreviven, 69,6 años frente a 55,8 años. El 43,2% eran diabéticos. La estancia media hospitalaria fue de 27,54 días. El 32,4% precisó de ingreso en la UCI. En el 39,8% se desconoce su etiología. La infección fue polimicrobiana en el 59,5% de los casos. El coste sanitario medio de un paciente diagnosticado de gangrena de Fournier que ingresa en la Unidad de Cuidados Intensivos (UCI) y requiere de al menos una cura en quirófano es de 25.108,67 euros. La mortalidad fue del 13,5%. Al estratificar las patologías estudiadas de forma independiente se observa que sólo la cardiopatía isquémica se relacionó de forma significativa con la mortalidad y una mayor estancia hospitalaria. Conclusión: La gangrena de Fournier es una patología con una alta mortalidad, a pesar de un tratamiento adecuado precoz. Es una patología con una baja incidencia, pero supone un coste elevado para el sistema sanitario, por lo que serían necesarias medidas de prevención primaria y secundaria (AU)

Background and objectives: Fournier gangrene is a urological emergency associated with a high mortality. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department. Material and methods: We carried out a retrospective study of 37 patients diagnosed with Fournier gangrene between January 2001 and October 2010. Results: All of the patients were men, 43.2% had diabetes, and the mean age of the patients was 57.68 years. Statistically significant differences were observed between the age of surviving patients and that of patients who died (55.8 and 69.6 years, respectively). The mean hospital stay was 27.54 days and 32.4% of patients required admission to the intensive care unit. Etiology was unknown in 39.8% of cases. Polymicrobial infection was observed in 59.5% of cases. The mean health care cost associated with a patient diagnosed with Fournier gangrene admitted to intensive care and requiring at least 1 procedure in the operating room was €25 108.67. Mortality was 13.5%. Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay. Conclusions: Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented (AU)

[Metabolic syndrome and hormone profile in patients with erectile dysfunction]. / Síndrome metabólico y perfil hormonal en pacientes con disfunción eréctil.

OBJECTIVES: To demonstrate the existence of relation between metabolic syndrome and erectile dysfunction and to analyze the hormone profile of these patients regarding a healthy population group. MATERIAL AND METHODS: A case-control study was designed with 65 men divided into 2 groups according to presence or non-presence of erectile dysfunction. Group A was made up of 37 men with erectile dysfunction and group B by 28 healthy men without erectile dysfunction. Ages ranged from 40 to 65 years. The presence of metabolic syndrome according to the ATPIII definition, performance of physical exercise, smoking habit, body mass index and complete hormone profile including testosterone -total, free and bioavailability, were studied. RESULTS: Greater presence of metabolic syndrome was detected among men of Group A (72.9%) versus those of group B (17.8%) (p=0.0001). Among the parameters that make up the metabolic syndrome, there are differences between both groups in systolic and diastolic blood pressure, fast blood sugar and abdominal circumference, all these differences being significant. After performing multivariate analysis between the metabolic syndrome and erectile dysfunction adjusted for age, BMI, International Index for Erectile Function (IIEF), physical exercise and smoking habit, we have observed an independent significant relation between the metabolic syndrome and erectile dysfunction. We have not found differences between both groups in any hormone parameter. CONCLUSION: A relationship is found between metabolic syndrome and erectile dysfunction. Thus, it seems recommendable to perform the metabolic profile and cardiovascular risk study in these patients.

[Fournier gangrene: description of 37 cases and analysis of associated health care costs]. / Gangrena de Fournier. Análisis descriptivo y coste económico-sanitario de nuestra serie de 37 casos.

BACKGROUND AND OBJECTIVES: Fournier gangrene is a urological emergency associated with a high mortality. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department. MATERIAL AND METHODS: We carried out a retrospective study of 37 patients diagnosed with Fournier gangrene between January 2001 and October 2010. RESULTS: All of the patients were men, 43.2% had diabetes, and the mean age of the patients was 57.68 years. Statistically significant differences were observed between the age of surviving patients and that of patients who died (55.8 and 69.6 years, respectively). The mean hospital stay was 27.54 days and 32.4% of patients required admission to the intensive care unit. Etiology was unknown in 39.8% of cases. Polymicrobial infection was observed in 59.5% of cases. The mean health care cost associated with a patient diagnosed with Fournier gangrene admitted to intensive care and requiring at least 1 procedure in the operating room was €25,108.67. Mortality was 13.5%. Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay. CONCLUSIONS: Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented.