Litiasis reno-uretero-vesical sobre catéter doble J. Forma de presentación de abdomen agudo en paciente inmigrante / Reno-uretero-vesical lithiasis on a double-J catheter. Mode of presentation of acute abdomen in an immigrant patient

Presentamos un caso de formación de cálculo de grandes dimensiones sobre catéter ureteral doble J en una paciente inmigrante tras la permanencia de ocho años, precisando extirpación quirúrgica. La formación de incrustaciones cálcicas sobre catéteres ureterales es un hecho relativamente frecuente que depende de factores como el éstasis urinario, la infección y sobre todo del tiempo de permanencia como ocurrió en este caso. Para resolverlos disponemos de diversas técnicas eficaces como la ESWL (extracorporeal shock wave lithotripsy), la extracción endoscópica y la cirugía como último recurso que finalmente fue la empleada (AU)

Formation of huge dimension calculus on "Pig Tail" catheter is so rare. We describe the case of an immigrant female patient who was seen in "Emergency Room" and needed urgent surgery. She was complaining of the presence of ureteric catheter for the last eight years. The formation of urinary calculi on a neglected (abandoned) urinary catheter is not, relatively, unfrequent and depends on several factors such as: urinary stasis, infection and specially on the time it should be forgotten like this case. We have different techniques to resolve them like ESWL, endoscopic or open surgery removal. This last was the choice of our’s (AU)

Surgical management of retroperitoneal tumors with vena caval thrombus in the inferior cava using cardiopulmonary bypass, arrested circulation and profound hypothermia.

OBJECTIVE: It was our aim to review our surgical experience with retroperitoneal tumors extending to the vena cava by using cardiopulmonary bypass, deep hypothermia and circulatory arrest. METHOD: We performed this procedure in 15 patients. The ages ranged between 16 and 70 years. The primary malignancies were renal cell carcinoma (n = 13), Wilms' tumor (n = 1) and paratesticular rhabdomyosarcoma (n = 1). RESULTS: There were no operative deaths. One patient died on the fourth postoperative day because of pulmonary embolization. The most common postoperative complications were: 1 patient required surgical reexploration because of hemorrhage, there was transitory renal failure in 3 patients, 1 patient developed a postoperative reactive psychosis and 1 patient developed a subclinical pericarditis. CONCLUSION: We believe that the resection of retroperitoneal malignancies with venous tumor thrombus extension offers, in selected patients, the only chance of reasonable long-term survival. The application of a cardiopulmonary bypass and hypothermia in high level vena cava thrombi is an important advance that has improved the safety and technical efficacy of a difficult surgical undertaking.

Long survival of a patient with paratesticular rhabdomyosarcoma with inferior vena cava involvement.

A 13-year-old boy with a paratesticular embryonal rhabdomyosarcoma and a large thrombus into the inferior vena cava reaching the suprahepatic vein is presented. We used cardiopulmonary bypass with deep hypothermic circulatory arrest to realize a complete exeresis of the tumor and thrombus, followed by systemic chemotherapy and radiotherapy. Ten years later the patient is alive and doing well without any sequelae.

Incidentally detected renal cell carcinoma.

OBJECTIVES: To determine the incidence of renal cell carcinoma (RCC) detected incidentally and to compare the survival of these patients with that of patients presenting with suspected RCC. PATIENTS AND METHODS: In a retrospective study, 157 patients surgically treated for RCC from 1979 to 1993 were grouped according to whether the tumour was found incidentally (n = 55) or whether the renal tumour was suspected (n = 102). The groups were compared for tumour grade, stage and size, patient age, sex and survival using univariate and multivariate analyses. RESULTS: There were significant differences between the groups in the number of patients with T2 (P < 0.001), T3a (P < 0.05), T3b (P < 0.01), T4 (P < 0.05) and M1 (P < 0.05) stages of disease. There was also a significantly greater proportion of patients with grade 1-2 tumours (P < 0.05) in those diagnosed incidentally. The accumulated overall survival rate was 64% at 5 years, 50% in the group with suspected RCC and 86% in those with tumours discovered incidentally over the same period. There were significant differences (P < 0.001) in the distribution of survival in the two groups. CONCLUSION: The patients with incidentally discovered RCC had a prognostically more favourable tumour stage, grade and size. Pathological stage and lymph node metastases influenced the difference in survival between the groups. As there was no difference in survival with tumour stage (T1-2), we consider that grade, size and particularly pathological stage determine the better prognosis.

[Bilateral synchronous adrenal metastasis of renal adenocarcinoma]. / Metástasis suprarrenales bilaterales sincrónicas de adenocarcinoma renal.

Contribution of one case of renal adenocarcinoma with synchronous metastasis in both adrenal glands. Treatment was radical surgery with palliative resolution and steroid replacement therapy. Brief comments on this uncommon clinical situation and review of other author's experience.

[Urothelial inverted papilloma]. / Papiloma invertido urotelial.

Review of 60 cases of inverted urothelial papilloma published in our country in different urological journals. Analysis of clinical, diagnostic and therapeutical issues. Also an analysis is made of the possible association with other neoplasias or their malignant development.

[Multivariate analysis of graft survival prognostic factors in renal transplantation]. / Análisis multivariado de los factores pronósticos en la supervivencia del injerto en el trasplante renal.

OBJECTIVE: The aim of this paper is to identify the variables that could be of interest in the outcome of a series of cadaveric kidney transplantation performed at the University Hospital, Navarra School of Medicine, by means of multifactorial and multivariate statistical analyses. METHOD: We analyzed 307 cadaveric kidney transplantation performed since 1976 at the University Hospital, School of Medicine, University of Navarra. Two series are included: the historical and the actual. The former did not include cyclosporine A in the immunosuppressor protocol. RESULTS: The first step was to compare survival in both series. The cyclosporine A series had a better survival, which was statistically significant (p < 0.0001). The prognostic factors in both series were also analyzed. The influence of the different variables were studied in the survival distribution. The worse prognostic variables of the historical group on allograft survival were donor's age (particularly between 20 and 50 years old), delayed graft function, serum creatinine level greater than 2.5 mg/dl at the first month following transplantation, general surgical complications, and vascular and other complications. In the actual group, the allografts with the worst survival were in those that received 4-10 pre-transplant blood transfusions, those with more that 2 HLA-DR mismatches, the hyperimmunized receptors with a level of pre-formed cytotoxic antibodies greater than 50%, those who rejected the allograft in the initial post-transplant period, those with a serum creatinine level greater than 2.5 mg/dl and those who presented surgical complications in general and urinary and vascular complications in particular. CONCLUSIONS: The multivariate analysis reveals that the prognostic factors of the historical group were delayed graft function, surgical complications, HLA A+B mismatches and the donor's age. In the actual group, the factors were receptor's age, surgical complications, large ischemia time, peak reactive antibody and number of rejections.

[Idiopathic retroperitoneal fibrosis. Report of 12 cases]. / Fibrosis retroperitoneal idiopática. Presentación de 12 casos.

Review of 12 patients with diagnosis of idiopathic retroperitoneal fibrosis (IRF). To establish diagnosis, computerized axial tomography (CT) was used in all cases. Nine patients underwent surgical treatment. After a mean follow-up of three and a half years, the clinical and laboratory (serum creatinine) evolution appears to be favourable.

[TPS in prostate cancer]. / TPS en cáncer de próstata.

A study of the tumour proliferation marker TPS in prostate cancer has been carried out. The levels of this marker were determined in the following groups: controls (n = 51), prostate hyperplasia (n = 17), prostate cancer in clinical remission (n = 15), and progressive prostate cancer (n = 13). An upper normal limit of 129 U/l (percentile 95) was established. When the progressive disease group was compared with the other groups, a significant difference (p < 0.001) was found. Sensitivity, specificity and positive predictive value obtained in order to dismiss progression were 71%, 94% and 62% respectively.

[Multivariate analysis of the impact of surgical complications in renal transplant]. / Análisis multivariado del impacto de las complicaciones quirúrgicas en el trasplante renal.

We analyzed 307 cadaver kidney transplantations performed since 1976 at the University Hospital of the University of Navarra. Two series, the historical and the current one, are presented. In the former, cyclosporine A was not included in the immunosuppressor protocol. The surgical complications were evaluated in both series and their influence on the survival of the allograft. The current series showed a significant decrease in surgical complications. Allograft survival in the historical series was influenced by surgical complications in general, and vascular and other complications in particular. The current series was influenced by surgical complications in general, and urinary and vascular complications in particular. The multivariate analysis showed that surgical complications were one of the most important prognostic factor in both series.

[Prognostic implications of urological complications in the renal transplantation]. / Implicaciones pronósticas de las complicaciones urológicas en el trasplante renal.

We describe the urological complications occurred in 302 patients undergoing first cadaveric renal transplantation in 16 years in the University Hospital. two series can be distinguished: "Historical" (1976-86) and "Actual" (1986-92). Thirty patients (10%) presented 33 (11%) urological complications: 73% urinary fistula and 27% ureteral stenosis. The vast majority (80%) were early complications (before 90 days). No statistical difference was observed in the survival rates of both the patients and grafts presenting or not urinary complications, except in the last series. A multivariate analysis was performed to examine the influence of prognostic factors. These analysis revealed that cold ischemia time and organ retrieval were the technical variables significantly related with urologic complications among historical and global series. Only recipient age was associated with urologic complications in actual series.

[Errors in the clinical staging of prostatic cancer]. / Errores en el estadiaje clínico del cáncer de próstata.

The relationship between the clinical and pathological stages of clinically localized prostate cancer (PCa) was analyzed in 68 patients. All of then underwent ilio-obstructive lymphadenectomy and node affectation was found in 16 patients (23%). Out of 64 patients undergoing radical prostatectomy, 23 (36%) presented invasion of prostate capsule and/or seminal vesicle infiltration. Of the total 68 patients, 28 (41%) showed local dissemination and/or nodular affectation. A direct correlation was seen between clinical stage and both incidence of local dissemination and nodular affectation. Pre-operative PSA and tumoral grade were correlated to the pathological stage.

[Bladder leiomyoma: report of a new case]. / Leiomioma vesical: aportación de un nuevo caso.

We present one case of vesical intramural leiomyoma in one adult woman in which an echographic fortuitous diagnostic was made. We have reviewed the bibliography and the diagnostic and therapy considerations.

["De novo" malignant tumors in kidney transplant receptors]. / Tumores malignos "de novo" en receptores de trasplante renal.

Presentation of the "de novo" tumours developed in two series of renal transplant receptors over the last 16 years. The first series, Historic, comprises the group of 178 patients who were given Azathioprin or Cyclophosphamide plus Prednisone for immunosuppression. The second series, Current, includes 129 patients who received immunosuppressive therapy with Cyclosporin A. Overall incidence of these "de novo" malignant tumours was 4% (13/307), 9 of which corresponded to the Historic Series (incidence, 5%) and 4 to the Current Series (incidence, 3%). Mean time interval from transplantation to diagnosis was 87.3 months (range, 9-177) in the Historic Series and 34.5 (range, 8-67) in the Current Series, the difference being statistically significant (p = 0.02). By locations, skin and lip tumours represent 38.5%, followed in frequency by lymphoma (23%) and lung carcinoma (15%). No urological tumours were recorded.

[Adjusted survival of the graft in renal transplantation. Multivariate analysis of prognostic factors]. / Supervivencia ajustada del injerto en el trasplante renal. Analisis multivariado de los factores pronóstico.

Three hundred and seven first corpse transplantations performed in the Clínica Universitaria of Navarra since 1976 are analyzed. The cases are divided in two series, Current and Historic, depending on whether the immunosuppressive protocol included cyclosporin A. First, actual survival curves from both series were compared, obtaining a significantly improved survival in the cyclosporin A series (p). Then, the most influential prognostic features in each series are analyzed for the various post-transplantation periods. With regard to adjusted graft survival in the Historic Series, both initial function and the number of rejections have influence during the first post-transplantation year. HLA A + B identities and the donor's age influence during the immediate one-to-three months period. In the Current Series, time of cold ischaemia and number of rejections act during the earliest (first month) and the latest (between one to three years) periods. The donor's cause of death and the recipient's age influence during the first month of evolution. The initial function and the presence of surgical complications influence between the first month and the first year.

[Multivariate analysis of the factors influencing the occurrence of surgical complications in renal transplantation]. / Análisis multivariado de los factores influyentes en la aparición de las complicaciones quirúrgicas en el trasplante renal.

Study of 307 renal corpse transplants performed in our centre, gathered in two series according to the immunosuppressive approach used, with and without cyclosporin A (Current and Historic Series, respectively). The surgical complications encountered are assessed and divided into urinary, vascular and other. Using a multivariate analysis, the factors influencing the occurrence of each of them are examined. In the Historic Series, the prognostic factors for the occurrence of urinary complications are the type of extraction and the duration of cold ischaemia. Regarding vascular complications, these factors are the type of anastomosis and the receptor's age. With respect to all other complications, the single influential factor is the initial delayed function. In the Current Series, the prognostic factors relative to urinary complications are the receptor's age, the duration of cold ischaemia, and the donor's age. No multivariate analysis is made of vascular complications due to their small number. The remaining complications are related, as in the other series, to the initial delayed function.

[Potentiation of cytotoxicity of electromagnetic shock waves by suramin, "in vitro" study]. / Potenciación de la citotoxicidad de las ondas de choque electromagnéticas por la Suramina, estudio "in vitro".

The objective of this experimental study is to assess the inhibition of tumoral cells growth induced by electromagnetic shockwaves at different energy levels in PC-3, the human prostate adenocarcinoma cell line. Also, an assessment is made of the inhibition of cell growth caused by adding Suramin to the growth medium and the enhancement of cytotoxicity when associated to that produced by electromagnetic shockwaves. Cells viability is determined by life staining exclusion methods and nucleoside incorporation. Cytotoxic action of electromagnetical shockwaves in the PC-3 cell line is dose dependent (p < 0001). Suramin significantly inhibits cell viability (p < 0001). The association of both therapeutical approaches enhances significantly their individual cytotoxicities (p < 0001).

[Urachal cyst: an unusual cause of intestinal obstruction]. / Quiste de uraco: causa inusual de obstrucción intestinal.

Contribution of one case of urachal cyst in a patient initially diagnosed with intestinal obstruction due to a probable colon-sigma neoplasia. The patient underwent discharge colostomy after finding an extension of the likely tumour to abdominal wall, bladder and right ureter. Later, the patient was reassessed and the CT showed a mass in the bladder's anterior edge with disclosure of purulent material and inflammatory cytology through the PAAF. The treatment performed was partial cystectomy, closure of colostomy and rectum-sigma re-anastomosis. Histological diagnosis was urachal cyst, abscess and pyogenic membranes, with no evidence of tumoral tissue. The idiosyncrasy of this urachal cyst is the simulation of an intestinal obstructive process of tumoral origin. Differential diagnosis in these intestinal processes rarely includes urachal cyst.