["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.

[Inhibition of tumor cell growth by the action of high-energy sources]. / Inhibición del crecimento celular tumoral por acción de las fuentes de alta energía.

In vitro comparison of the cytotoxic action of high-energy shockwave and megavoltage radiotherapy on tumoral cells. The inhibitory action these two therapeutic approaches have on cell viability is determined both singly and jointly, through life staining exclusion and nucleoside uptake tests. High energy shockwaves have a cytotoxic action significantly greater than low- and medium-energy levels of megavoltage radiation. The cytotoxic effect from megavoltage radiation is significantly greater than that resulting from high levels of high-energy shockwave as shown by the life staining exclusion tests. However, the nucleoside uptake test shows that cytotoxicity from either type of energy is no significantly different. When measuring the cumulative cytotoxic action of high energy shockwaves plus megavoltage radiation, the level of cytotoxicity is greater than the individual inhibitory actions on cell viability, but the degree of cytotoxicity induced cannot be comparable to that produced by higher energy levels from both sources separately.

[Leiomyosarcoma of the vena cava: presentation of 2 clinical cases]. / Leiomiosarcoma de cava: presentación de dos casos clínicos.

Presentation of two cases of leiomyosarcoma of a cava vein, an infrequent retroperitoneal tumour. Both cases were treated by means of anatomical reconstruction by a PTFE prosthesis. Brief review of diagnostic and therapeutical choices.

[Shockwave cytotoxicity on neoplastic and non-neoplastic cells]. / Evaluación de la citotoxicidad de las ondas de choque sobre células tumorales y no tumorales.

Since initial application of high-energy shockwaves to treat renal lithiasis, their usefulness has been extended within both the clinical and experimental fields. Shockwaves cytotoxic action is determined by means of cell viability methods of vital staining exclusion and nucleoside uptake. Application of shockwaves on cell cultures is carried out by means of an electromagnetic lithotripter. High-energy shockwaves have had cytotoxic action both on non-tumoral and tumoral cells, during "in vitro" experiments. The cytotoxicity produced by the shockwaves, however, is different in tumoral and non-tumoral cells, the viability inhibition being higher in tumoral cells.

Extracorporeal shock wave lithotripsy of ureteral stones: clinical experience using a second generation lithotripter.

Extracorporeal shock wave lithotripsy (ESWL) has proven to be effective for the treatment of renal calculi. However, its use for ureteral stones as monotherapy is controversial. In this study, 142 patients underwent in situ ESWL for ureteral stones. Stone fragmentation was achieved in 87.4% of the patients. Stone clearance rate at 3 months was 95.8%, 94.7%, and 94.2% for stones located in upper, middle, and lower ureter, respectively. Efficiency quotient calculated for the overall stone clearance at 15 days, 1 month, and 3 months was 74.6, 71.8, and 71.7, respectively. Treatment was performed in 82.5% of patients as an outpatient procedure. Our data show that in situ monotherapy is an effective and noninvasive method for treating ureteral stones.

[Monotherapy of ureteral calculi with extracorporeal shockwave lithotripsy]. / Monoterapia de los cálculos ureterales con litotricia extracorpórea por ondas de choque.

We reviewed our experience with ESWL in the treatment of 401 patients with ureteral stones in order to evaluate if a higher disintegration and clearance rates could be achieved without prior manipulation of ureteral calculi, i.e., ESWL used as "in situ" monotherapy. The global stone free rate were 83%, 85% and 91% at 15 days, 1 month and 3 months after ESWL. We also analyzed the results according to the efficiency quotient (EQ).

[Infiltrating carcinoma of the bladder: preliminary results of multidisciplinary protocols with radiotherapy and neoadjuvant chemotherapy]. / Carcinoma vesical infiltrante: resultados prelimares de protocolos multidisciplinarios con radioterapia y quimioterapia neoadyuvante.

Report on the evolution of a series of 64 patients with T2-4 N0-3 M0 infiltrant transitional carcinoma of the bladder, treated with TUR and radical cystectomy (28/62) or intra-operative radiotherapy (IOR) 15 Gy and external radiotherapy 40 Gy prior to cystectomy (34/62). The last group including 24 patients which received neo-adjuvant chemotherapy. Seventy percent (15 p0N-, 5 p0N+, 1 p1N-, 3 p1N+) patients treated with radiotherapy, with and without chemotherapy, had local response. Considering just the group which received IOR, external radiotherapy and co-adjuvant chemotherapy (24/34), the local response accounts for 79% (10 p0N-, 5 p0N+, 1 p1N-, 3 p1N+). Current survival of the group receiving concomitant multiple therapy is 92 +/- 5%, 75 +/- 9% and 57 +/- 11% at 1, 3 and 5 years; for equal intervals current survival of the group undergoing cystectomy is 57 +/- 9%, 46 +/- 9% and 40 +/- 10% (p = 0.02). The univariate analysis has confirmed that stage decrease is significantly more frequent in the group receiving radiotherapy with and without chemotherapy (p less than 0.001). Such a decrease significantly biased survival (p = 0.001). In the multivariate analysis, the variables with greater prognostic power were pre-surgical renal function (p less than 0.001), use of radiotherapy (p less than 0.001) and surgical complications (p less than 0.001). Preliminary results show a very high local response to multiple therapy which has been translated so far in increased survival.

[Prophylactic antibiotic therapy in extracorporeal shock-wave lithotripsy: prospective, randomized study]. / Antibioterapia profiláctica en la litotricia extracorpórea por ondas de choque (LEOC): estudio prospectivo y randomizado.

Two hundred patients that underwent ESWL were randomized into 4 groups in order to determine the benefits of antibiotic prophylaxis. All comparisons among groups were not statistically significant. Neither cephalosporin nor quinolone prophylaxis impacted significantly on bacteriuria rate after ESWL. Thus, in patients without infected stones, urinary tract obstruction and ancillary procedures ESWL could be performed without prophylactic antibiotic regimes.

[Urologic complications in 237 recipients of cadaveric kidney transplantation]. / Complicaciones urológicas en 237 receptores de trasplante renal cadavérico.

We describe the urological complications occurred in 237 patients undergoing cadaveric renal transplant in 13 years. Two techniques of extravesical ureterocystoneostomy were used. Thirty patients (13%) presented 35 (15%) urological complications: 23 (9.7%) urinary fistula and 12 (5.1%) ureteral stenosis. The vast majority (80%) were early complications (before 90 days): 82% fistulas and 18% stenosis. All early complications were identified as technical deficiencies; all late complications were obstructive in nature. A new ureteral reimplant was performed in 15 patients, with successful results in 14. Six patients underwent nephrectomy and pyelostomy, 2 of these required a second operation. Seven patients underwent endo-urological procedures with good results. Three patients undergoing conservative treatment for urinary fistula required surgical drainage of an infected urinoma. No statistical difference was observed in the survival rates of both the grafts and the patients presenting or not urinary complications.

[Effect of time of vascular anastomosis and of hot and cold ischemia, on survival of cadaver renal graft]. / Influencia de los tiempos de anastomosis vascular, isquemia caliente y fría, en la supervivencia del injerto renal de cadáver.

A retrospective study was performed on our series of 240 primary cadaveric renal transplant recipients to dissect the influence of vascular anastomosis time, warm ischemia time and cold ischemia time on ultimate graft survival. 177 patients received conventional immunosuppression with Azatioprine and steroids, and 63 patients received Cyclosporine A therapy. The data was analyzed for sub-groups of ischemia time and comparisons were performed using the method of Tarone-Ware. The present study fails to demonstrate a detrimental effect of ischemic insults on graft survival. The use of Cyclosporine A in the pre and post-transplant, monitoring periodically serum cyclosporine levels and the use of renal allograft biopsy, allows the use of this agent without a high incidence of nefrotoxicity.

[Prognostic value of initial function in graft and patient survival in cadaveric renal transplant; impact of cyclosporin A]. / Valor pronóstico de la función inicial en la supervivencia del injerto y del paciente en el trasplante renal de cadáver; impacto de la ciclosporina A.

This paper presents our experience with 237 primary renal cadaveric transplants and analyzes related factors to Initial Non-Function, its influence on graft and patient survival as well as the impact of cyclosporin A on graft survival. Our study shows better graft survival rates in patients treated with cyclosporin A and in patients with Immediate Initial Function.

[Urothelial tumor markers: update]. / Marcadores tumorales del urotelio: estado actual.

The story of the search for tumoral markers of urotelial neoplasias is reviewed. Its routine use is at present difficult due to its technical complexity. The use of new monoclonal antibodies is a promising aspect.