[Arteriovenous fistula of the renal stump after nephrectomy]. / Fistula arteriovenosa renal secundaria a la ligadura en bloque del pedículo renal.

An arteriovenous fistula of the renal pedicle is a rare complication after nephrectomy. Most of cases we identify it time along after surgery. We present a case of an arteriovenous fistula of the right renal pedicle after nephrectomy done for pyonephrosis 40 years before. We comment the clinical features, treatment and evolution of the patient. We also review the actual literature.

[Cystic lymphangioma. Our experience]. / Linfangioma quístico. Nuestra experiencia.

OBJECTIVE: To comment on the most relevant aspects and to review the literature on this unusual pathology. MATERIAL AND METHODS: We present two cases of cystic lymphangioma, their clinical, diagnosis, therapy and development, and we review the actual literature. The first case is a young man with the diagnosis of cystic lymphangioma of the scrotum and pelvis. The second case is one patient with a cystic lymphangioma of the retroperitoneum. DISCUSSION: Cystic lymphangioma is a congenital lymphatic hamartoma of the lymphatic system that usually appears at childhood like a big mass at soft tissues that has a tendency to grow unless a completed excision is performed. CONCLUSIONS: There are few cases of scrotal cystic lymphangioma in the literature; they are often misdiagnosed as other common cystic scrotal conditions leading to an improper surgical approach and an incomplete surgery that predisposes later recurrence. Cystic lymphangioma of the retroperitoneum is a rare entity diagnosis in most cases as an incidentaloma.

[Isolated intraepithelial prostatic neoplasia and positive prostate adenocarcinoma results at repeated biopsy. Review of our series]. / Neoplasia intraepitelial prostática aislada y positividad para adenocarcinoma en la rebiopsia. Revision de nuestra serie.

OBJECTIVE: To review the incidence of isolated prostatic intraepithelial neoplasia (PIN) as well as the positive prostate cancer results in repeat biopsy in our series of transrectal biopsy of the prostate. We compare these results with the actual literature. MATERIALS AND METHODS: We review the 2.475 transrectal ultrasound guided biopsies of the prostate made in our department from January 1992 to June 2004 looking for intraepithelial neoplasia and looking in particular for isolated High-grade PIN (HGPIN). We review repeat biopsies made at this patients and the likelihood of detecting prostate cancer in them. RESULTS: The diagnosis of PIN was found in 31 biopsies, 13 of them were isolated HGPIN what means a 0.52% incidence of the total biopsies performed in our department. We performed 7 repeat biopsies of the 13 cases in a period from 3 months to 2 years after the first biopsy, and we found 3 cases of prostate cancer what means that 43% of isolated HGPIN with repeated biopsy showed prostate cancer. The mean age of the patients studied was 67 years (range 53-88). The median PSA value of the studied cases was 9.8 ng/ml. The Gleason score of the positive biopsies was always between 3 and 7. In our series, age and PSA levels did not have correlation with the positive results for prostate cancer in repeated biopsies. CONCLUSIONS: In spite of a lower number of HGPIN cases in our series, the positive for prostate cancer in repeated biopsy (43%) is similar to the incidence reported in literature so it is advisable rigorous controls and repeated biopsies for these patients.

Adenovirus-mediated wt-p16 reintroduction induces cell cycle arrest or apoptosis in pancreatic cancer.

Pancreatic cancer has long carried poor prognosis. The development of new therapeutic approaches is particularly urgent. Inactivation of the tumor-suppressor gene p16(INK4a/CDKN2), a specific inhibitor of the cyclin-dependent kinases CDK4 and CDK6, is the most common genetic alteration in human pancreatic cancer, making it an ideal target for gene replacement. Here we transfected tumor cells using a recombinant adenovirus containing the wt-p16 cDNA (Ad5RSV-p16). The overexpression of p16 decreased cell proliferation in all four human pancreatic tumor cell lines (NP-9, NP-18, NP-29, and NP-31). However, G1 arrest and senescence were observed in only three. In contrast, the fourth (NP-18) showed a significant increase in apoptosis. This differential behavior may be related to the differences found in the expression level of E2F-1. Experiments on subcutaneous pancreatic xenografts demonstrated the effectiveness of p16 in the inhibition of pancreatic tumor growth in vivo. Taken together, our results indicate that approaches involving p16 replacement are promising in pancreatic cancer treatment.

Host-parasite relationships of Zootoca vivipara (Sauria: Lacertidae) in the Pyrenees (North Spain).

The helminths infesting the common lizard, Zootoca vivipara (Jacquin, 1787), were studied with special attention to the relations between the number of nematodes, Oswaldocruzia filiformis (Goeze, 1782), and the size, sex and age class of the host. The possible seasonality of the parasite intensity and the relationship with the feeding habits of the host were also tested. Helminth infracommunities of Z. vivipara were depauperate with lizards harbouring only two species, the trematode Plagiorchis molini (Lent et Freitas, 1940) and the nematode O. filiformis. A positive correlation between host size and the number of O. filiformis was found for female Z. vivipara. However, no correlation was detected between intensity and sex or age class. The feeding habits of Z. vivipara, the isolation of the population studied and the low level of interaction with other reptilian or amphibian species are suggested as the causes of the depauperate helminth infracommunities found in this lacertid lizard.

[Inflammatory pseudotumor: differential diagnosis of tumors of the 4th ventricle]. / Pseudotumor inflamatorio: diagnóstico diferencial de los tumores del IV ventrículo.

INTRODUCTION: An inflammatory pseudotumour is a condition of unknown origin and inflammatory nature. It is rarely found in the CNS. We report a case of inflammatory pseudotumour localized to the IV ventricle and review the clinical characteristics of previously reported cases in order to outline the clinical profile of this condition. CLINICAL CASE: A 40 year old man was admitted to hospital complaining of a subacute condition involving difficulty in speaking and in moving his right arm and leg. On examination he had ocular deviation on initial gaze, a complete right Horner's syndrome, right supranuclear facial palsy, dyssynergy-asymmetry on the right finger-nose test and a dissociated sensitivity disorder of the left arm. On MR of the brain there was a space occupying lesion, nodular in form and fixed to the roof of the fourth ventricle. The histopathological report on the specimen removed by surgery stated it to be an inflammatory pseudotumour. On a MEDLINE search for reported cases of inflammatory pseudotumour of the CNS, 27 were found since 1967. Four cases, including ours, involved masses growing into the interior of the fourth ventricle. CONCLUSIONS: Inflammatory pseudotumour of the CNS is a condition affecting young adults, with a slight male predominance and some association with clinical and analytical data suggesting autoimmune dysfunction. The intraventricular site, particularly within the fourth ventricle, is relatively common (4/28) and is usually associated with clinical features of dysfunction of the posterior fossa and/or intracranial hypertension. We consider that inflammatory pseudotumour should be included in the differential diagnosis of tumours of the fourth ventricle.

[Recuperation of ureteral peristalsis in the rat after denervation]. / Recuperación del peristaltismo ureteral en la rata tras denervación.

The paper presents the experimental work carried out on the influence of various surgical situations on ureteral peristalsis in the rat. It included 43 rats divided in three groups. Group I (n = 10) acted as control group and had only ureterolysis performed. In group II (n = 10), single section and subsequent anastomosis was performed. Group III (n = 23) included section at two levels, ureter extraction from the animal and subsequent autotransplantation of the ureter. The three groups were re-operated two months later to ratify peristalsis of the intervened ureter. Both in the first and second operations peristalsis, as well as the features and appearance of antiperistaltic waves were quantified. After 60 days, no changes were observed in group I, but groups II and III exhibited normal peristalsis to presence of antiperistaltic waves. Both groups had complications like stenosis, fistulas and hydronephrosis, but also normal functioning, histology and peristalsis.

[Clinical and diagnostic aspects of infective nephrobronchial fistulae]. / Aspectos clínicos y diagnósticos de las fístulas nefrobronquiales infecciosas.

After reviewing all of our hospital admittances, this paper presents two cases of nephrobronchial fistula (NBF) occurring in two patients, one with renal abscess-like granulomatous pathology and one with xantogranulomatous pyelonephritis (XGP). After commenting on these cases and including iconography, among which a fistulography, very rare in this type of cases, should be emphasized, the coincidence of the three microorganisms (and the presence of Morganella morganii) in lung cultures, and kidney in one case, is recorded. The paper remarks on the hidden clinical development, modes of presentations and the time of diagnosis which was pre-operative. Also clinical, diagnostic and behaviour of the NBFs and etiological diseases is reviewed.

[Accidentally diagnosed hypernephromas. Retrospective study and evaluation of their importance in clinical practice]. / Hipernefromas de diagnóstico accidental. Estudio retrospectivo y evaluación de su importancia en la práctica clinica.

Presentation of a retrospective study on 50 hypernephromas seen in our service, including an evaluation of those that were accidentally diagnosed. Nineteen of these were diagnosed by chance and 9 as a result of other investigations required for the study of a gastrointestinal disease, these studies being in most cases an ultrasound recording. Data obtained with this review allows us to compare these results with those from other authors, as well as to evaluate the relevance of such diagnoses in the daily clinical practice. The study concludes that the fact that these tumours are found in earlier stages is more than enough to raise questions on the way in which we could increase the number of this chance diagnosis.

[Dermatomyositis and small cell tumor of the kidney]. / Dermatomiositis y tumor renal de células pequeñas.

Dermatomyositis is an inflammation of the striated muscle with an important leukocyte infiltrate which is accompanied by a characteristic cutaneous exanthema. In the international classification we find DM associated with neoplasm in 10% of cases. It is accepted that neoplasms are related to DM if it does not exceed it in two years (prior o after the onset of the disease. The most commonly associated are lung, ovary and breast cancers. In the pas ten years only two cases of DM associated to renal cancer (both in renal cell cancers) have been published. In this article we present a case history of a woman with a DM associated to a renal oat-cell carcinoma. Also, we will review the literature on this theme and will evaluate the predictive parameters of the presence of malignancies in this pathology.

[Ambulatory diagnosis of prostatic growth. Analysis of the basic methods to determine its benign or malignant nature]. / Diagnóstico ambulatorio de los crecimientos prostáticos. Análisis de los métodos básicos para determinar la benignidad y la malignidad.

Correlation between different diagnostic procedures rectal touch (RT), intravenous urography (IU), ultrasonography (USG), acid phosphatases and prostatic fraction (AFPF) and the histology of benign and malign growths is analyzed, as well as the relationship between different combinations of these procedures and histology, addressing sensitivity, specificity and negative and positive predictive values; according to our experience RT and USG obtain the best results.

[Secondary tumors of the bladder of metastatic origin; a new case and review of the literature]. / Tumores vesicales secundarios de origen metastásico; un nuevo caso y revisión de la literatura.

We present a fresh case of gastric carcinoma with metastasis at vesical level in the year subsequent to the performance of a Billroth II type gastrectomy for this reason. The vesicle tumour manifested itself in the form of hematuria, irritative miction syndrome and obstruction of the upper left urinary tract. We have reviewed the literature of the last 10 years and confirmed, on the one hand, the infrequency of these tumours and, on the other, that the commonest localization of primary neoplasia is the stomach.

[Malignant mesothelioma of the tunica vaginalis]. / Mesotelioma maligno de túnica vaginal.

Case report of a new case of malignant mesothelioma of the tunica vaginalis testis. A mediterranean male age 62, presented with enlargement and swelling of the scrotum, treated as orchiepydidymitis within the previous 3 months. Physical and ultrasonography examination showed a left scrotal mass with extension to the skin of the scrotum. After surgery (orchiectomy and partial hemiscrotectomy) and histopathology diagnosis of locally advanced malignant mesothelioma, CT showed metastasis in retroperitoneum, Lung and Liver. The patient undergoes chemotherapy and radiotheraphy with a poor prognose. We review the diagnosis, histopathology and therapeutical approach for this uncommon kind of paratesticular tumor (less than 80 cases reported in the last 30 years).

[Surgical renal biopsies: technique, effectiveness and complications]. / Biopsias renales quirúrgicas: técnica, efectividad y complicaciones.

Retrospective study made on 140 renal surgical biopsies (RSB) performed throughout the past 4 years in our Unit. The technique's effectiveness and morbidity are emphasized and the surgical technique and type of anaesthesia described. The sample obtained was enough to perform an essay in 100% cases, and a diagnosis was reached in 98.5%. Thirty-nine patients (27.8%) presented complications, 13 (9.2%) of which were directly related to the surgical technique. No case required blood transfusion and no deaths were reported. The type of anaesthesia used was: local plus sedation in 104 (74.2%) cases, rachianaesthesia in 10 (7.1%) and general in 26 (18.5%). The same approach was used in all patients: minimal subcostal lumbotomy, using Wilde's forceps to obtain the samples. It is believed that RSB is a highly effective, low mortality procedure, easy and quick to perform, and suitable for selected patients.

[Practical treatment approach of radiation induced cystitis]. / Guía práctica para el manejo y tratamiento ante la cistitis radical.

OBJECTIVE: Establish a pattern of behavior and treatment algorithm at the onset of hematuria in patients with a previous history of pelvic radiation, checking for this different treatment options reflected in the literature. MATERIAL AND METHODS: Through performing a PubMed literature review of articles related to IC lies, searching items includes the different treatment options: intravesical hyaluronic acid, conjugated estrogens, pentosan polysulfate, oral aminocaproic acid, recombinant factor VIIa, hyperbaric chamber, embolization, aluminum intravesical, Helmstein ball and formalin. Limits the search to english or spanish publications and excluding those related to animal experimentation. RESULTS: Every option is exposed, referring to the physiopathology, dosage regimen and administration, side effects and treatment efficacy. CONCLUSIONS: Once patient hemodynamic stabilization is achieved, and after rule out bladder tumors injuries and /or haemathuria originating from the upper urinary tract, treatment should start rolling. To know different treatment options and patterns of administration will allow the urologist to obtain a higher rate of success in the difficult management of this condition.

Guía práctica para el manejo y tratamiento ante la cistitis radical / Practical treatment approach of radiation induced cystitis

Objetivo: Establecer una pauta de actuación y un algoritmo terapéutico ante la aparición de hematuria en pacientes con antecedentes de radioterapia pélvica, revisando para ello las diferentes opciones de tratamiento reflejadas en la literatura médica. Material y métodos: A través de PubMed se realiza una revisión bibliográfica de artículos relacionados con la cistitis rádica, incluyendo términos de búsqueda referidos a las diferentes opciones de tratamiento: ácido hialurónico endovesical; estrógenos conjugados, pentosan polisulfato, ácido aminocaproico oral, factor VIIa recombinante, cámara hiperbárica, embolización, aluminio endovesical, balón Helmstein y formolización. Se limita la búsqueda a publicaciones en castellano e inglés y se excluyen aquellas referidas a la experimentación animal. Resultados: Se expone cada una de las opciones citadas, haciendo referencia al mecanismo de acción, pauta y dosis de administración, efectos secundarios y prevención de los mismos si es posible así como eficacia del tratamiento. Tras conseguir estabilizar hemodinamicamente al paciente y descartar la presencia de lesiones neoformativas vesicales y/o hematurias originadas en tramo urinario superior, se debe iniciar un tratamiento escalonado. Conclusiones: El conocer diferentes opciones de tratamiento y sus pautas de administración permitirá al urólogo obtener una mayor tasa de éxitos en el difícil manejo de esta patología (AU)

Objective: Establish a pattern of behavior and treatment algorithm at the onset of hematuria in patients with a previous history of pelvic radiation, checking for this different treatment options reflected in the literature. Material and methods: Through performing a PubMed literature review of articles related to IC lies, searching items includes the different treatment options: intravesical hyaluronic acid, conjugated estrogens, pentosan polysulfate, oral aminocaproic acid, recombinant factor VIIa, hyperbaric chamber, embolization, aluminum intravesical, Helmstein ball and formalin. Limits the search to english or spanish publications and excluding those related to animal experimentation. Results: Every option is exposed, referring to the physiopathology, dosage regimen and administration, side effects and treatment efficacy. Conclusions: Once patient hemodynamic stabilization is achieved, and after rule out bladder tumors injuries and /or haemathuria originating from the upper urinary tract, treatment should start rolling. To know different treatment options and patterns of administration will allow the urologist to obtain a higher rate of success in the difficult management of this condition (AU)

Experimental study of ureteral free grafts. I. Surgical findings in transplanted and abandoned ureter.

OBJECTIVE: To develop two experimental models in rats to study the ureter under conditions of total devascularization and denervation. METHODS: The ureter was autotransplanted as an integrated autologous free graft (IAFG) or abandoned in the retroperitoneum as a non integrated autologous free graft (NIAFG). Both models were compared with a normal group and a surgical control group. Sixty-two rats were randomly distributed: Normal ureter (NU) group (n = 20); surgical control, only ureterolysis (SC) group (n = 15); abandoned ureter as NIAFG (AU) group (n = 13); reimplanted ureter as IAFG (RU) group (n = 14). RESULTS: SC group: in all cases a ureter with no alterations was observed although with slight periureteral fibrosis. AU group: some ureter specimens had a smaller caliber. Periureteral fibrosis was observed in all the cases. Vessel distribution was similar to that of the NU group. All the ureters conserved their lumen. 53.8% of the ureters showed spontaneous contractions and 100% contractions after mechanical stimulation. Cyst formation, necrosis, fistulas or stenosis of the lumen were not observed. RU group: microscopic findings of the ureter segment used as IAFG were compatible with those of a normal ureter. In all the cases a moderate degree of periureteral fibrosis was observed. In the majority of the cases a vascular framework of the fat immediately adjacent to the ureter was observed. In 13 of the 14 operated cases spontaneous contractions were observed. The ureteral segment used as IAFG showed no alterations in 10 cases and with alterations of various types in 4 cases. In 8 cases there was a greater or lesser degree of stenosis of the proximal suture. CONCLUSIONS: The surgical findings and the macroscopic aspects of the four groups show the viability of the ureter free graft, IAFG as well as the NIAFG, in spite of the macroscopic changes.

Rapid identification of Serratia marcescens by coagglutination.

All 20 O serotypes of Serratia marcescens produce a common, soluble antigen. Crude antigen was obtained by ammonium sulfate precipitation of spent growth medium, antiserum was produced in rabbits, and a coagglutination test for rapid identification of S. marcescens was developed. A total of 701 clinical isolates of gram-negative bacilli were examined, and a 100% correlation between biochemical identification of S. marcescens and identification by coagglutination was found.