[Renal angiomyolipoma: study of 39 patients and general review]. / Angiomiolipoma renal: estudio de 39 pacientes y revisión de conjunto.

Between 1969 and 1991, 39 patients totalling 48 renal units with renal angiomyolipoma (RAMP) were diagnosed and treated in the Urology Service of the Hospital La Paz. In 5 patients, RAMP was part of a tuberous sclerosis, and was isolated in the remaining ones. RAMP was symptomatic in 32 cases (32/48 = 66.6%), 10 with Wundrelich's syndrome, and in 24 cases (24/48 = 50%) was larger than 4 cm. In the first cases of our series, clinical diagnosis through renal arteriography was achieved in 33% (5/14) cases; later, with the arrival of ultrasound and CAT, pre-operative diagnosis was possible in 88% (30/40) of cases. There was also 2 periods with regard to treatment, the initial one with predominance of radical surgery and the present one of observation and/or conservative surgery depending on size as well as signs and symptoms. Overall, 23 nephrectomies, 2 partial nephrectomies and 6 tumorectomies were performed, while there has been 17 cases (with no histological confirmation) treated with conservative approach and followed-up with ultrasound and CAT. With an average follow up of 8.4 years (range: 0.5-20 years), there has been no local or metastatic relapse of RAMP. There was one case of lymphatic affection which was explained as evidence of RAMP's multifocal condition and not as an indication of malignancy. In 3 patients, histological examination revealed coexistence of RAMP and renal carcinoma; 2 of these patients who underwent nephrectomy are free of disease; the third patient, treated with conservative surgery (tumorectomy), showed renal carcinoma relapsed after 2 years and had it removed. RAMP's incidence, histogenesis, diagnostic methods and treatment criteria are discussed.

[Are benzodiazepines correctly used in the elderly?]. / 'Se hace un buen uso de las benzodiazepinas en el anciano?

Benzodiazepines are substances susceptible of producing drug dependence in addition to tolerability to sedative effects and frequent interactions when associated with other drugs. Thus, use of long half life benzodiazepines and inadequate intermediate and short half life dosage is related with falls and fractures in elderly patients. A retrospective study was conducted on the official prescriptions made during 2000-2003 and the daily dose defined per thousand patients/day (DDD/I) was used as a measurement of drug consumption. Prescription of benzodiazepines that are eliminated by oxidative metabolism should be revaluated and modified by other of conjunctive metabolism when treating elderly patients to decrease adverse reactions such as excess sedation, risk of falls and associated fractures.

[Monotopic coralliform calculus and simultaneous contralateral lithiasis]. / Calculo coraliforme monotópico y litiásis contralateral simultánea.

A study is made of 15 patients with monotopic coralliform stones, suffering from simultaneous, contralateral, renoureteral lithiasis. There are certain special features in these patients which we consider to be sufficient to distinguish them as a separate group amond cases of lithiasis in general and coralliform stones in particular. The high percentage of septic complications observed in these patients demand special treatment within the field of urinary lithiasis.

Atrioventricular electrotonic interaction in complete atrioventricular block: an experimental model using radiofrequency energy in the rabbit heart.

UNLABELLED: Provided the conditions for electrotonic transmission exist, an automatic focus surrounded by a block zone may be externally modulated. The atrioventricular (AV) electrotonic interaction was studied in 16 perfused rabbit hearts with supra-Hisian complete AV block induced using low radiofrequency energy doses (2.5 watts; 10 seconds). In nine experiments the sinus node was preserved (group I), whereas in seven it was removed maintaining an AV nodal rhythm (group II). The V-V (ventricular cycle length) and V-A (coupling of the intervening atrial beat) in both groups, and also the A-A (atrial cycle length) and A-V (coupling of the intervening ventricular beat) intervals in group II, were measured beat by beat after current delivery. The phase response curves V-V versus V-A, and A-A versus A-V showed AV interaction in five experiments from group I, and in four from group II, as follows: (1) accelerating phase response curve, characterized by a pacemaker acceleration (V-V or A-A abbreviation) at a critical V-A or A-V coupling interval; maximum acceleration could be progressively (phase response curve without rapid cross-over) or briskly (phase response curve with rapid crossover) reached; from this point onwards acceleration decreased with a further increase in V-A or A-V coupling interval (acceleration slope). (2) Biphasic phase response curve, characterized by initial delaying and late accelerating phases. Maximum acceleration and the acceleration slope were both smaller in accelerating phase response curves without rapid cross-over. On reverting complete block in two experiments, a progressive increase in maximum acceleration and acceleration slope was observed. CONCLUSIONS: (1) AV interaction in complete AV block can be manifested as accelerating or biphasic phase response curves; (2) transition from electrotonic interaction to conduction seems to be a continuum.

Value of testicular ultrasound in the evaluation of blunt scrotal trauma without haematocele.

The value of ultrasound in testicular trauma with haematocele has been questioned inasmuch as the injured testis should always be explored surgically. Ultrasonography, however, plays an important role in the diagnosis and follow-up of patients with blunt scrotal trauma without haematocele. We have evaluated 17 such patients with real-time ultrasound. In 9 cases the testis and epididymis were normal to palpation, although in 6 of them parenchymal lesions, mainly subcapsular haematomas and parenchymal contusions not amenable to surgical intervention, were detected with ultrasonography. Seven patients presented with changes in the testicular or epididymal morphology at palpation and in 1 case the testes were not palpable. Ultrasonography was of great value, indicating surgery in 6 of these patients where physical examination alone was not sufficient to establish the need for surgical exploration.

[Inverted bladder papillomas. Report of 3 cases and review of the literature]. / Papilomas invertidos de vejiga. Presentación de tres casos y revisión de la literatura.

The authors present three cases of what are currently called inverted, bladder papillomas and make a review of the literature, during the course of which they have found 98 cases published under this name so far. With regard to this name, provided by POTTS and Hirst in 1963 and which has proved so popular in the world literature, this does not mean that the picture was described by them for the first time as many European authors had already done so, from ALBARRAN (1891) to PASCHKIS (1927). Emphasis is placed on the value of following an oncological system in order to prevent diagnostic and therapeutic mistakes and they stress that the suitable treatment for these neoplasias is UTR.

Effects of atrial impulse timing on AV concealed conduction in the rabbit heart.

The influence of the timing of a nontransmitted or transmitted atrial impulse on the atrioventricular (AV) conduction time of the subsequent impulse was studied in nine isolated rabbit hearts. AV conduction curves were determined by applying the atrial extrastimulus test. The extrastimulus was delivered preceded or not by an interposed atrial impulse whose coupling interval with respect to the last atrial beat of a basic train was kept constant at 100, 120, 140, 160, 175, 200, 225, 250, and 300 msec. In all experiments, there was a "concealment interval," i.e., the AV effective refractory period was longer than the atrial functional refractory period, and in seven experiments was comprised between 100 and 160 msec. For any given extrastimulus coupling interval in the presence of an interposed nontransmitted atrial impulse, AV conduction time was significantly greater than in its absence; the increase was greater than the longer the nontransmitted atrial impulse coupling interval, i.e., the shorter the subsequent transmitted impulse coupling interval with respect to the previous interposed nontransmitted impulse. The AV conduction curves relating the extrastimulus AV conduction time to its coupling interval with respect to the last atrial impulse of the basic train fitted to a hyperbolic model both in the absence of the interposed atrial impulse and in its presence (mean square residual 31 +/- 23 msec2), and the interposed atrial impulse modified the constants of the functions; the slope of the linear transformations was progressively more negative as the interposed atrial impulse was delayed. Furthermore, the effects of the interposed atrial impulse--transmitted or not--on AV conduction time of the subsequent impulse were qualitatively similar, their magnitude depending on the time elapsed were qualitatively similar, their magnitude depending on the time elapsed between the two.

[Clinical aspects of renal adenocarcinoma]. / Aspectos clínicos del adenocarcinoma renal.

We present for study a series of 80 patients suffering from renal adenocarcinoma, pointing out that the most frequent reason for consultation was hematuria, observed in 44 patients (57.5%) which constituted at the same time the predominating initial symptom. The period of time which elapsed between its presentation and the diagnosis ranged, in most cases, between 1 and 6 months. There were numerous paraneoplastic findings, of which hyper-alpha2-globulinemia 21/25 patients (60%) and high sedimentation speed 41/80 (51.2%) were important due to their frequency. Metastases were detected in 16 patients with the most frequent location being the bone system, 11 cases (55%). We point out the need for a good knowledge of the varied evolutionary behaviour of this kind of neoplasia and the numerous systemic repercussions, with a view to obtaining an earlier diagnosis in the absence of local symptoms, in order to improve the prognosis.

[Kaposi's sarcoma in kidney transplant treated with cyclosporin and azathioprine]. / Sarcoma de Kaposi en un trasplante renal tratado con ciclosporina y azatioprina.

We report on a renal transplant patient who had developed Kaposi's sarcoma with cutaneous involvement 20 days after transplantation. The patient had a functioning renal graft and was on immunosuppressive therapy consisting of prednisone, azathioprine and cyclosporine. Azathioprine and cyclosporine were discontinued and chemotherapy was instituted with vinblastine first and methotrexate later; however, Kaposi's tumor did not respond to the foregoing therapeutic regimen. Thirty-two months following transplantation, the kidney graft presented acute interstitial rejection that warranted graft removal. The patient is currently receiving treatment for Kaposi's sarcoma but tumor regression has not been achieved. We discuss the atypical course of this case in comparison with those reported elsewhere.

[Evaluation of extravesical ureteroneocystostomy in kidney transplantation]. / Evaluación de la ureterocistoneostomía extravesical en el trasplante renal.

The present study evaluates extravesical ureteroneocystostomy, the technique used for reconstruction of the urinary tract in 120 kidney transplants. The urological complications ascribable to this technique were observed in 10% (12/120) and consisted of urinary extravasation (10), and ureteric obstruction (2). The treatment of the foregoing complications, which was successful in 8 cases, is described. The indications and advantages afforded by this technique in renal transplantation are discussed.