[Unilateral absence of excretion in urography after external injury]. / Ausencia unilateral de excreción en la urografía post-traumatismo externo.

We communicate a case of unilateral renal non visualization in the pyelogram after an external trauma, due to traumatic occlusion of the main renal artery. The etiology and pathogenesis are reviewed and the frequent associated injuries of other abdominal organs are emphasized. The Pyelogram, used as a screening technique, is useful, though in these situations, CT-scan and rarely angiography are the methods of choice in the evaluation of parenchymal and vascular injures of the kidneys, as well as in evaluating other abdominal organs. El surgical treatment is not necessary early, nephrectomy of the ischemic kidney may be postponed depending on the evolution of the patient.

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

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

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

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

[Results of external radiotherapy in localized cancer of the prostate]. / Resultados de la radioterapia externa en el cáncer de próstata localizado.

OBJECTIVE: External radiotherapy is considered to be a modality of treatment with a curative purpose for carcinoma de prostata. We have analysed a series of patients that received radical irradiation as treatment for tumor prostatic. We have the biochemical control results for these patients. We introduce the connection of the PSA nadir value (nPSA) and other prognostic variables with the survival free of biochemical failure. MATERIAL AND METHODS: Between January 1992 to January 1998, 46 patients with prostate cancer T1-3 NX M0 received external radiotherapy with a curative purpose. A number of 26 of these patients received treatment with androgen blockers. The answer to this treatment was established as a fall in PSA to levels equal/minor than 1.5 ng/ml. The biochemical relapse was established as three rises of PSA over the value of nPSA. RESULTS: We introduce the connection between nPSA and prognostic variables (clinic stage, gleason, PSA pretreatment y hormonal therapy). Three of these variables--clinic stage, Gleason grade and hormonal therapy--were the ones that showed a significantly connection with obtaining a low level of PSA. The 3-year actuarial BDFS was of 69.5%. The BDFS was of 84.3%, 9% and 6% for a value of nPSA of < or = 1 ng/ml, 1-2 ng/ml and > 2 ng/ml respectively (p < 0.05). CONCLUSION: Radiotherapy seems to be a good therapeutical option with patients suffering from localised prostate carcinoma. The nPSA value after radiation is a good early determinant of outcome.

[C.F.C.-type ureterosigmoidostomy. Results]. / Ureterosigmoidostomía tipo C.F.C. Aportación de resultados.

This paper presents the results obtained with a C.F.C. type ureterosygmoidostomy technique described by us. A total of 25 patients aged between 52 and 74 years (mean age, 65 years), 23 (23/25) male and 2 (2/25) female were evaluated. 24 of the total 25 patients had infiltrant neoplasia of the bladder (pT2: 8; pT3a: 12; pT3b: 4) which was graded as moderately differentiated (G2: 10) or undifferentiated (G3: 14). The remaining patient, a female, had tuberculous microbladder. Male patients underwent radical cystoprostatectomy (23/25); while in two females traditional cystectomy was performed (2/25). Patients with neoplasia of the bladder (24/25) were performed bilateral lymphadenectomy prior to radical surgery. All 25 patients were performed C.F.C. type ureterosygmoidostomy (Actas Urol Esp 20: 324, 1996). Follow-up of patients was carried out over a mean period of 27 months (July 1994-October 1997). The complications reported were 4 cases of ureterointestinal stricture and one stercoral fistula. The strictures were resolved with endoscopic techniques and the fistula through discharge colostomy. Death (6/25) occurred as a result of the tumour progression, and in no case was related to the surgical technique. All patients showed daytime continence (100%), and 22/25 were also continent during the nighttime (88%): there were occasional leaks in 5/25 (20%). No metabolic disorders were seen in any of the patients. (All patients were given drug therapy to prevent metabolic acidosis).

[Cost-effectiveness comparative study of ceftriaxone verus cefotaxime in the treatment of complicated urinary infections]. / Estudio comparativo coste eficacia ceftriaxona versus cefotaxima en el tratamiento de las infecciones urinarias complicadas.

Prospective, randomized, multicenter study in 267 patients with complicated urinary infection from 9 hospitals nationwide. Drug treatment was either Ceftriaxone 1 g once daily parenterally or Cefotaxime parenteral 1 g 8 hourly for a minimum of 7 days. Patients were clinically, analytically and microbiologically evaluated before and after treatment to assess the efficacy and tolerance of both drug products. To evaluate treatment cost, we used the price of both drugs and the material required for their administration (syringe and disposable needle). 119 patients were excluded from the cost-efficacy evaluation and 148 remained in the study (75 assigned to treatment with Ceftriaxone and 73 to Cefotaxime). Clinical efficacy of treatment was 93% and 87.6% for Ceftriaxone and Cefotaxime respectively (p > 0.05). Cost per patient was 27,347 pesetas for Ceftriaxone and 34,490 for Cefotaxime (p < 0.05).

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

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

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

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

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Resultados de la radioterapia externa en el cáncer de próstata localizado / Results of external radiotherapy in the treatment of localized prostate cancer

OBJETIVO: La radioterapia externa está considerada una modalidad de tratamiento con intención curativa en el carcinoma de próstata. Hemos analizado nuestra serie de pacientes que recibieron irradiación radical como tratamiento de su tumor prostático. Presentamos los resultados de control bioquímico de estos pacientes, así como la relación del valor de nadir de PSA (nPSA) y otras variables pronósticas con la supervivencia libre de fracaso bioquímico. MATERIAL Y MÉTODOS: Entre enero de 1992 y enero de 1998, 46 pacientes con adenocarcinoma de próstata T1-3 NX M0 fueron tratados mediante radioterapia externa con intención curativa. De estos pacientes, 26 recibieron tratamiento con bloqueo androgénico. La respuesta al tratamiento quedó definida como un descenso de PSA a niveles menores o igual a 1,5 ng/ml. La recaída bioquímica quedó definida como tres elevaciones del PSA por encima del valor de nPSA. RESULTADOS: Se presenta la relación de nPSA con las variables pronósticas (estadio, gleason, PSA pre-tratamiento y hormonoterapia). De estas variables, fueron el estadio clínico, gleason y hormonoterapia las que se relacionaron de forma significativa con la consecución de un nPSA bajo. La supervivencia libre de fracaso bioquímico (SLFB) a los tres años mínimos de seguimiento, fue del 69,5 per cent. La SLFB fue del 84,3 per cent, 9 per cent y 6 per cent para valores de nPSA de 1 ng/ml, 1-2 ng/ml y >2 ng/ml respectivamente (p < 0,05).CONCLUSIONES: La radioterapia es una buena opción terapéutica en pacientes con adenocarcinoma de próstata localizado. El valor nadir de PSA tras radioterapia es un buen parámetro para vigilar la eficacia de la radioterapia y predecir los resultados del tratamiento (AU)