[Urachal adenocarcinoma treated with robotic assisted laparoscopy partial cystectomy]. / Cistectomóa parcial laparoscópica asistida por robot Da Vinci para el tratamiento del adenocarcinoma de uraco.

OBJECTIVE: To describe a case of urachal adenocarcinoma treated with robotic assisted laparoscopic partial cystectomy and en-bloc exeresis of urachus and umbilicus and bibliographic review. METHODS: A 63 year-old man with hematuria and hypogastric pain. He was diagnosed of urachal adenocarcinoma by transurethral resection and axial tomography. We performed a robotic assisted laparoscopic partial cystectomy using a da Vinci® S HD (Intuitive Surgical System) device. We describe the surgical technique and examine total length of time for surgery and for console, pathology report, margin status, postoperative outcome and oncological status 7 months after surgery. RESULTS: 4 ports were used for robotic arms and one additional for the assistant. Cystoscopy was performed during surgery to mark tumor margins. Bladder was closed using a running suture with Poliglactin 0. Total length time for surgery was 2hs 28 minutes, console time was 1h54'. Two days later patient was discharged and no complication was reported. After two weeks Foley cathether was removed and bladder volume was 300ml. Pathology report informed undifferentiated urachal adenocarcinoma with perivesical tissue infiltration with margins free from tumor, corresponding to Sheldon IIIB and Ontario III classification. Seven months later patient was fee from recurrence. CONCLUSION: Robotic assisted laparoscopy partial cystectomy with en-bloc exeresis of urachal and umbilicus is feasible.

Cistectomía parcial laparoscópica asistida por robot da Vinci para el tratamiento del adenocarcinoma de uraco / Urachal adenocarcinoma treated with robotic assisted laparoscopy partial cystectomy

OBJETIVO: Describir un caso de adenocarcinoma de uraco tratado con cistectomía parcial con extracción en bloque del uraco y ombligo por vía laparoscópica asistida por robot y hacer una revisión de la literatura. MÉTODOS: Varón de 63 años que consultó por hematuria y dolor durante la micción en hipogastrio diagnosticado de adenocarcinoma localizado de uraco mediante resección transuretral de vejiga y tomografía axial computada (TAC). Se realizó una cistectomía parcial laparoscópica asistida por robot utilizando una unidad da Vinci® (Intuitive Surgical System) modelo S HD de cuatro brazos. Describimos la técnica quirúrgica y evaluamos el tiempo de consola, tiempo quirúrgico total, sangrado introperatorio, anatomía patológica, márgenes quirúrgicos, evolución postoperatoria y su situación clínica tras 5 meses de seguimiento. RESULTADOS: Se dispusieron 4 trocares robóticos y uno adicional para la aspiración. Se demarco el limite vesical por vía endoscópica para asegurar márgenes negativos.. El tiempo de consola fue de 1:54hs, tiempo total de cirugía de 2:48hs con un sangrado de 100ml. Evolucionó sin complicaciones con alta a las 48hs. La sonda vesical fue retirada a los 15 días permaneciendo con una capacidad vesical de 300ml al mes de la cirugía. La anatomía patológica informó un adenocarcinoma de uraco pobremente diferenciado con infiltración del tejido fibroadiposo perivesical y márgenes quirúrgicos libres de tumor. Clasificación de Sheldon IIIB y Ontario III. Sin signos de recidiva a los 7 meses de seguimiento. CONCLUSIÓN: La cistectomía parcial con extracción en bloque del uraco y ombligo realizada por vía laparoscópica asistida por robot es factible (AU)

OBJECTIVE: To describe a case of urachal adenocarcinoma treated with robotic assisted laparoscopic partial cystectomy and en-bloc exeresis of urachus and umbilicus and bibliographic review. METHODS: A 63 year-old man with hematuria and hypogastric pain. He was diagnosed of urachal adenocarcinoma by transurethral resection and axial tomography. We performed a robotic assisted laparoscopic partial cystectomy using a da Vinci® S HD (Intuitive Surgical System) device. We describe the surgical technique and examine total length of time for surgery and for console, pathology report, margin status, postoperative outcome and oncological status 7 months after surgery. RESULTS: 4 ports were used for robotic arms and one additional for the assistant. Cystoscopy was performed during surgery to mark tumor margins. Bladder was closedusing a running suture with Poliglactin 0. Total length time for surgery was 2hs 28 minutes, console time was 1h54`. Two days later patient was discharged and no complication was reported. After two weeks Foley cathether was removed and bladder volume was 300ml. Pathology report informed undifferentiated urachal adenocarcinoma with perivesical tissue infiltration with margins free from tumor, corresponding to Sheldon IIIB and Ontario III classification. Seven months later patient was fee from recurrence. CONCLUSION: Robotic assisted laparoscopy partial cystectomy with en-bloc exeresis of urachal and umbilicus is feasible (AU)

[Giant cell arteritis and polymyalgia rheumatica: diagnosis and evolution of 90 cases]. / Arteritis de células gigantes y polimialgia reumática: diagnóstico y evolución de 90 casos.

OBJECTIVE: To compare the clinical features of giant cell arteritis (GCA) and polymyalgia rheumatic (PMR), and to evaluate the criteria proposed by the American College of Rheumatology in our results. PATIENTS AND METHODS: A retrospective analysis of 90 patients with GCA (n = 57.55 of whom were diagnosed by biops) and PMR (n = 33) diagnosed over the last 10 years. RESULTS: Headache was present in 45 patients (78.94%) with GCA and in 7 (21.21%) with PMR (p < 0.001); polymyalgic syndrome was observed in 15 patients (26.31%) with GCA and in 33 (100%) with PMR (p < 0.001); jaw or tongue claudication was observed in 14 patients (24.57%) with GCA and in 2 (6.06%) with PMR (p < 0.05), and visual disturbances were only present in 9 patients (15.79%) with GCA. The erythrocyte sedimentation rate (ESR) was > or = 50 mm/h in 84 patients (93.33%), and > or = 100 mm/h in 43 of them (51.19%). The ESR became normal (20 Pounds mm/h) in less of 8 weeks after the treatment was started in 64 patients (76.19%). At the time of diagnosis, 61 patients (61.67%) had anemia, which was severe (Hb < 10 g/dl) in 17 cases (27.86%). After steroid treatment 43 patients (70.49%) improved their anemia in less of 12 weeks, and 25 of them (58.13%) in less of 8 weeks. CONCLUSIONS: The cranial symptoms were predictive for a positive temporal artery biopsy. The anemia and its quick normalization after steroid treatment can help to the diagnostic.