[Giant tumor thrombus in the renal vein. Diagnostic accuracy of CAT]. / Trombo tumoral gigante en la vena renal. Exactitud diagnóstica del TAC.

A clinical case of a clear-cells renal tumour, located in the left kidney, with occupation of renal vein by a 7.7 cm thick tumoral thrombus, not affecting the cava vein lumen is presented. CAT and selective left renal venography were the exploratory means which provided the diagnosis. In the study of renal vein affectation by tumoral thrombus, the CAT accuracy can be equal to that of venography, the latter being indicated in dubious cases.

[Infiltrating transitional carcinoma of the bladder. 3. Effect of regional lymph node dissemination on the prognosis]. / Carcinoma transicional infiltrante de vejiga. (3a parte). Influencia de la diseminación a ganglios regionales sobre el pronóstico.

The evolution of 168 patients, 136 of which underwent bilateral lymphadenectomy is analyzed in this paper. In 126 cases it was possible to obtain all the data in order to define N within the T.N.M. rating. With regard to the remaining patients 10, of which we lack the anatomopathological report, and 32 which did not undergo lymphadenectomy, are included under item Nx. During follow-up, metastasis was diagnosed in 60% node-positive patients. We believe it to have been already present at the time of undergoing surgery. Survival was significantly higher in the group without node dissemination than in both negative-nodes and Nx groups. When assessing the nodular dissemination group, patients treated with 2000 rad prior to cystectomy showed higher survival rates: 36% vs 22% and 11% for groups treated with 4500 rad and no radiotherapy. respectively. Metastatic percentage, however, was lower for the group managed with surgery alone (50%) than those treated with pre-operative radiotherapy (73% and 67% with 2000 and 4500 rad, respectively), on the other side, it would seem a contradiction that a 2000 rad dosage should be more effective than a 4500 rad dosage for this group of patients, since theoretically, the latter is closer to the ideal dosage to eradicate the nodular disease. Since 3 of 5 patients have micrometastasis, which we are yet unprepared to detect, all positive-node patients should receive chemotherapy immediately after recovery from surgery.