Immunomagnetic quantification of circulating tumoral cells in patients with prostate cancer: clinical and pathological correlation.

OBJECTIVES: To detect and enumerate circulating prostatic tumor cells (CTC) in the peripheral blood of patients with prostate cancer (PC) and study the relationship between CTCs and clinical-pathological parameters. METHODS: Prospective three-arm study: 26 patients (p) with localised PC (LPC); 24 P with metastatic PC (MPC) and 30 healthy volunteer controls. A single 7.5 ml sample of peripheral blood was retrieved; CTCs were isolated using an immunomagnetic method based on the CellSearch system (Veridex). CTCs were identified as nucleated cells negative for CD45 (leukocytes) and positive for cytokeratins. (8, 18 y 19) The relationship between CTC numbers and PSA levels, Gleason score and TNM classification was studied. RESULTS: Only 10% of the healthy controls had 1 CTC/7.5 mL, none of the patients with localised PC had more than 3 CTCs (88% < or = 2 CTCs), and patients with MPC had significantly higher CTC levels [m: 29 (1-178)] compared with the other two groups (P: 0.000). A positive correlation was demonstrated between the CTC count and PSA levels, tumor size, and presence or absence of enlarged lymph nodes. Gleason score was the only parameter that did not show any correlation with CTC levels, and although the number of CTCs was higher in patients with visceral metastases [m: 297 (0-416)] compared with bone metastases patients [m: 68 (9.5-168)] , these differences were not significant. CONCLUSIONS: Immunomagnetic analysis permits CTCs to be enumerated in peripheral blood and could be a possible way to correctly stage and make a reasonable prognosis of metastatic disease.

Urology at the European university: adaptations to the Bologna Plan. The model of the Autonomous University of Madrid.

The fundamental objective of the Convergence Plan of Bologna is to normalize, harmonize and standardize the teaching of medicine in European medical schools by implementing a similar curriculum. This objective assumes the presence of Urology as a university discipline in all European medical schools. At the same time, the teaching techniques and subject distributions have been modified, emphasizing practical teaching and active participation of the student in the acquisition of expertise and skills. This approach enhances the curricular presence of Urology and requires increased dedication from the teaching staff. These staff members, with limited face-to-face and classroom time, must inform and educate medical students on the broad healthcare commitment of urology as a surgical/medical specialty. The adaptation of the numerous European medical schools to the Bologna Plan raises a number of problems that can be easily overcome, as can be seen in the plan designed by the Faculty of Medicine at the Universidad Autonoma de Madrid.

[Obstructive uropathy in Gardner's syndrome. Intra-abdominal desmoid tumor]. / Uropatía obstructiva en el síndrome de Gardner. Tumor desmoide intraabdominal.

Desmoid tumours are benign neoplasias manifesting themselves clinically as aggressive fibromatoses. They may be sited both in mesenteric and retroperitoneal fat. Owing to the great size they reach and to their local infiltrative character they occasionally lead to the development of intestinal occlusive syndromes and, in exceptional cases, to obstructive uropathy of the upper urinary tract. Their incidence of presentation in the general population is low, however they develop more frequently in patients suffering from colonic polyposis in the family and they form part of the extracolonic manifestations of Gardner's syndrome. In 1987 we treated a young patient, a genetic carrier of familiar colonic polyposis who had presented relapse of a previous desmoid. The location of the tumour in narrow pelvis made its clinical debut as a intestinal pseudo-occlusion and determined a bilateral ureteral obstruction and the formation of a major urinoma. The joint utilization of instrumental maneuvers and surgical approaches enabled us to solve the intestinal and urological commitment satisfactorily. We carry out an overall review and analyse the data published on the incidence, prognosis and treatment of obstructive uropathy in Gardner's syndrome. We also carry out an updating on the biology of the desmoid tumour.

[Intrascrotal lymphangioma: report of 2 cases and review of the literature]. / Linfangioma intraescrotal: aportación de dos casos y revisión de la literatura.

Congenital lymphatic disease with scrotal location is particularly uncommon in adults and, in general, requires an exhausting differential diagnosis of testicular and paratesticular masses; among them, the lymphangioma is exceptional. Diagnosis is based on signs and symptoms, evolution and radiological studies such as ultrasound and computerised tomography as well as characteristic findings in the anatomopathologic study such as cystic dilation with endothelial walls and lymph content with no signs of malignancy. Treatment is usually surgical. Two cases of intrascrotal lymphangioma, one at Buck's fascia level in the corpus cavernosum and the other one at the subdermal tissue in the scrotal wall are contributed. An analysis is made of the usefulness of the different imaging diagnostic methods, and complete surgical resection of the lesion is proposed as the choice therapy.

[Bladder endometriosis. Diagnostic and therapeutic approximation]. / Endometriosis vesical. Aproximación diagnóstica y terapéutica.

Endometriosis is defined by the presence of functionally active endometria in ectopic position; so when its clinical behaviour adopts the characteristics of tumoration, endometrioma is accepted as an alternative name. Location of this pathology in the urinary apparatus is uncommon in terms of incidence, since the bladder is a selected site. This condition implies a high morbidity rate because it requires a high level of suspicion in order to be diagnosed. It is acknowledged that no image study (CAT, Echography, MNR, etc.) is pathognomonic for endometriosis and it is necessary to perform endoscopy and biopsy to achieve a correct diagnosis. The paper includes the strategy to follow, both with regard to diagnosis and the current therapeutic approaches.

[Urinary excretion of cytokines in bladder carcinoma]. / Excreción de citocinas urinarias en los carcinomas vesicales.

OBJECTIVE: Analysis of the urinary excretion of cytokines in vesical carcinoma. MATERIAL AND METHOD: The study includes the results obtained in the quantification of several interleukins (IL-1, IL-2, IL-4, IL-6, INF-gamma and TNF-alpha) in urine samples corresponding to 60 patients with transitional cell carcinoma (TCC) with vesical location (40 surface and 20 infiltrant). Concurrently, 40 healthy donors and 20 patients with urinary tract infections were studied. Determination of the various cytokines was done with ELISA enzyme-linked immunoassays. RESULTS: The results obtained in the study show that: a) urinary concentrations of IL-1, IL-2, IL-6, TNF- and INF- in surface TCC, are similar to those found in healthy subjects; b) levels of the mentioned cytokines are significantly higher in patients with urinary infections; c) in patients with infiltrant TCC, IL-6 urinary concentration is significantly higher than in those with S-TCC; d) urinary IL-4 levels show no difference between the various groups under study. CONCLUSION: From all the above it is concluded that there is a large diversity in the excretion of urinary cytokines from the vesical urothelium based on antigenic stimulation (bacterial or tumoral) to which it has been exposed and the tumoral stage, and that baseline determination of IL-6 urine level in patients with vesical TCC could have some prognostic influence.

[Retrovesical hemangiopericytoma]. / Hemangiopericitoma retrovesical.

The hemangiopericytoma is an uncommon variety of the mesenchymal tumour derived from pericapillary structures, most frequently located in limbs and exceptionally at the retroperitoneum level. Although macroscopically the aspect is benign, this tumour has a recognised ability for local invasion and distant dissemination.