Low-dose-rate brachytherapy for prostate cancer in renal transplant recipients.

PURPOSE: Prostate cancer (PCa) is the most common malignancy among men and one of the most common neoplasms affecting renal transplant recipients (RTRs). The available treatments for localized PCa among the general population (GP), surgery and external beam radiotherapy, carry a risk of damage to the transplanted kidney, the ureters, and the bladder and therefore tend to be avoided by most groups. The objective of this study was to assess the efficacy and feasibility of low-dose-rate brachytherapy (LDR-BT) for PCa in RTRs. METHODS AND MATERIALS: We carried out a retrospective review on all RTRs diagnosed of PCa who had undergone LDR-BT at our institution between 2000 and 2015. Nine patients met these criteria, but 1 did not fulfill the followup. Hence, we analyzed 8 patients. We reviewed all clinical data for PCa and graft function in these patients and compared the results with the GP. RESULTS: Mean baseline prostate-specific antigen was 6.8 ± 1.9 ng/mL. All PCa had a Gleason score of 6 and were classified as low risk according the Europe Association of Urology guidelines. Mean followup after seed implantation was 48 ± 12.8 months. All 8 patients remain free of prostate-specific antigen failure. Five-year progression-free survival, cancer-specific survival, and overall survival rates were 100%, 100%, and 62.5%. There was no specific toxicity associated with LDR-BT, and there were no acute adverse events affecting the graft. CONCLUSIONS: LDR-BT is a feasible and acceptable treatment for localized PCa in RTRs. Oncological outcomes are similar to the GP, and there is minimal toxicity to the renal graft.

Predicción mediante radiología simple y tomografía axial computarizada de la energía necesaria para fragmentar litiasis de distinta composición empleando litotricia extracorpórea por ondas de choque / Prediction of the energy required for extracorporeal shock wave lithotripsy of certain stones composition using simple radiology and computerized axial tomography

Objetivo: Demostrar que las litiasis urinarias necesitan, según su composición, una determinada energía para ser fracturadas mediante litotricia extracorpórea por ondas de choque (LEOC), pudiendo ser estimada antes del tratamiento mediante radiografía simple y TAC. Material y método: Estudio experimental, prospectivo y ciego, con 308 cálculos urinarios de 4 hospitales. No cumplieron criterios de inclusión 115: litiasis intactas, mayores de 0,5 cm y de composición pura (> 75%) de oxalato cálcico monohidrato (OCM), úrico o carboapatita, o mixta oxalocálcica mono y dihidratada (OCMix). Las 193 restantes fueron sometidas a radiografía simple y a tomografía (TAC), valorando digitalmente el gris máximo (Gmax) y el gris mediano (Gmda) presentado mediante Adobe Photoshop(R) CS5, y la atenuación en unidades Hounsfield (UH). Posteriormente se les administró LEOC a una frecuencia fija de 1 Hz hasta alcanzar una conminución preestablecida, registrándose así la dosis de energía (Edose) y la Edose ajustada a superficie litiásica (EdAJ). Resultados: La composición OCM resultó la más dura, precisando una Edose de 119.624 mJ/cm3 y una EdAJ de 36.983 mJ/cm3, seguida de OCMix (75.501/36.983), carboapatita (22.734/21.186) y úrico (22.580/6.837) (p < 0,05). Gmax y Gmda se correlacionaron con Edose (r = 0,434 y r = 0,420) y EdAJ (r = 0,599 y r = 0,545) (p < 0,01). Las UH se correlacionaron, tanto en ventana de tejido blando como óseo, con Edose/cm3 (r = 0,478 y r = 0,539) y EdAJ/cm3 (r = 0,745 y r = 0,758) (p < 0,01). Conclusiones: Las litiasis precisan, por las características propias de su composición, una determinada cantidad de energía para su rotura con LEOC en fragmentos de diámetro menor de 2 mm, que es predecible empleando la atenuación en UH en TAC, o escala de grises en la radiografía simple

Objective: To demonstrate that urinary lithiasis have a specific susceptibility to fracture through extracorporeal shock wave lithotripsy (ESWL), which is common for all calculi with the same composition and which can be estimated before treatment using CT or plain X-ray. Material and method: We present an in vitro, prospective, randomized, blind and multi-center study involving 308 urinary calculi. 193 of these met the inclusion criteria: whole calculi composed purely of calcium oxalate monohydrate (COM), uric acid (UA) or carbonate apatite (CA), or a mix of oxalate (COMix) and of a size greater than 0.5 cm. The samples were broken using lithotripsy until reaching a pre-established level of comminution. The variables employed were energy dose (Edose) per cm3 of lithiasis and Edose adjusted to lithiasic surface (EdAJ) per cm3. Results: COM was the hardest, requiring an Edose of 119,624 mJ/cm3 and an EdAJ of 36,983 mJ/cm3, followed by COMix (75,501/36,983), CA (22,734/21,186) and UA (22,580/6837) (p < 0.05). Gmax and Gmda were correlated with Edose (r = 0.434/r = 0.420) and EdAJ (r = 0.599/r = 0.545) (p < 0.01). UH were correlated, in bone window and soft tissue window, with Edose/cm3 (r = 0.478/r = 0.539) y EdAJ/cm3 (r = 0.745/r = 0.758) (p < 0.01). Conclusions: In our in vitro research lithiasis require, due to the specific nature of their composition, a given amount of energy in order to be broken by ESWL, which is inherent to all those sharing the same composition, and can be predicted using CT or plain X-ray

Prediction of the energy required for extracorporeal shock wave lithotripsy of certain stones composition using simple radiology and computerized axial tomography.

OBJECTIVE: To demonstrate that urinary lithiasis have a specific susceptibility to fracture through extracorporeal shock wave lithotripsy (ESWL), which is common for all calculi with the same composition and which can be estimated before treatment using CT or plain x-ray. MATERIAL AND METHOD: We present an in vitro, prospective, randomized, blind and multi-centre study involving 308 urinary calculi. 193 of these met the inclusion criteria: whole calculi composed purely of calcium oxalate monohydrate (COM), uric acid (UA) or carbonate apatite (CA), or a mix of oxalate (COMix) and of a size greater than 0.5 cm. The samples were broken using lithotripsy until reaching a pre-established level of comminution. The variables employed were energy dose (Edose) per cm(3) of lithiasis and Edose adjusted to lithiasic surface (EdAJ) per cm(3). RESULTS: COM was the hardest, requiring an Edose of 119,624 mJ/cm(3) and an EdAJ of 36,983 mJ/cm(3), followed by COMix (75,501/36,983), CA (22,734/21,186) and UA (22,580/6,837) (P < .05). Gmax y Gmda were correlated with Edose (r = 0.434/r = 0.420) and EdAJ (r = 0.599/r = 0.545) (P < .01). UH were correlated, in bone window and soft tissue window, with Edose/cm(3) (r = 0.478/r = 0.539) y EdAJ/cm(3) (r = 0.745/r = 0.758) (P < .01). CONCLUSIONS: In our in vitro research lithiasis require, due to the specific nature of their composition, a given amount of energy in order to be broken by ESWL, which is inherent to all those sharing the same composition, and can be predicted using CT or plain x-ray.

[Renal oncocytoma. Review of our 22 patients]. / Oncocitoma renal. Revisión de nuestra serie de 22 pacientes.

UNLABELLED: Renal oncocytoma (OR) is a benign tumor. It may represent up to 3-7% of solid kidney masses, and shows specifics cellular and evolutive characteristics. Metacronicity, multifocality and bilateralism has been reported. MATERIALS AND METHODS: Between 1986 and 2005, 478 kidney tumors have been surgically treated at our institution. We report the frequency and characteristics of OR in our patients, compared with renal cell carcinomas (RCC). We try to find out the rate of multifocality, bilateralism and other tumor association, and the number of neoplasms originally diagnosed as OR before surgery. Mean and median follow up: 36.86 and 13 months (1-193). Specific survival rate 100%. RESULTS: We found 24 OR in 10 men and 12 women with a mean age of 59 years (34-84). 12 in the left kidney and 12 in the right one, one patient presenting oncocytomatosis. Tumor mean size was 4.64 cm (1-12.5 cm). Tumors were discovered incidentally in 17 cases. Presentation symptoms in the rest of patients were gross hematuria. CONCLUSIONS: The rate of OR found in our sample population of renal tumors undergoing surgery matches other series already published. Two synchronic OR, but not metacronous, bilateral or metastatic tumors were found. All cases presented a benign evolution.

Oncocitoma renal. Revisión de nuestra serie de 22 pacientes / Renal oncocytoma. Review of our 22 patients

Introducción: El oncocitoma renal es un tumor benigno cuya frecuencia de presentación oscila entre el 3- 7% de las masas renales sólidas. Muestra especiales características celulares y evolutivas, con posibilidad de metacronicidad, bilateralidad y multifocalidad, además de un difícil diagnóstico diferencial con neoplasias malignas. Material y Método: Revisamos retrospectivamente en 428 tumores renales intervenidos desde Enero de 1986 hasta Abril de 05 la proporción de oncocitomas diagnosticados, analizando sus características anatomopatológicas y comportamiento clínico, comparándolas con las presentadas por los carcinomas de células renales. Observamos su posible bilateralidad, multifocalidad y asociación con otros tumores. Determinamos en cuántos casos los métodos diagnósticos de imagen permitieron sospechar la naturaleza tumoral benigna previamente a la intervención. Seguimiento medio y mediano 13 y 36,86 meses respectivamente (1-193). Resultados: Hemos encontrado 24 oncocitomas (5,67%), en 10 hombres y 12 mujeres con una edad media de 59 años (34-84). 12 de ellos en riñón izquierdo y 12 en derecho, además de una oncocitomatosis renal. Tamaño medio de 4,64 cm (1-12,5). En 17 pacientes el diagnóstico ha sido incidental. En los 5 restantes el síntoma de debut fue hematuria. Supervivencia específica 100%. Se sospechó la naturaleza tumoral benigna o específicamente oncocitomatosa previamente a la cirugía en 22,73% (5/22) y 9,9% (2/22) respectivamente. Conclusiones: En nuestra serie de tumores renales intervenidos el porcentaje de oncocitomas coincide con lo publicado en la literatura. Hemos encontrado dos casos de tumor sincrónico, pero ninguno metacrónico, bilateral ni metastásico. Todos han presentado un comportamiento benigno

Renal oncocytoma (OR) is a benign tumor. It may represent up to 3-7% of solid kidney masses, and shows specifics cellular and evolutive characteristics. Metacronicity, multifocality and bilateralism has been reported. Materials and methods: Between 1986 and 2005, 478 kidney tumors have been surgically treated at our institution. We report the frequency and characteristics of OR in our patients, compared with renal cell carcinomas (RCC). We try to find out the rate of multifocality, bilateralism and other tumor association, and the number of neoplasms originally diagnosed as OR before surgery. Mean and median follow up: 36.86 and 13 months (1-193). Specific survival rate 100%. Results: We found 24 OR in 10 men and 12 women with a mean age of 59 years (34-84). 12 in the left kidney and 12 in the right one, one patient presenting oncocytomatosis. Tumor mean size was 4.64cm (1-12.5 cm). Tumors were discovered incidentally in 17 cases. Presentation symptoms in the rest of patients were gross hematuria. Conclusions: The rate of OR found in our sample population of renal tumors undergoing surgery matches other series already published. Two synchronic OR, but not metacronous, bilateral or metastatic tumors were found. All cases presented a benign evolution

[Complex vesicoureteral reflux. Our experience]. / Reflujo vesicoureteral complejo. Revisión de nuestra serie.

OBJECTIVE: To analize the proportion of complex reflux in the whole amount of patients treated endoscopically of vesicoureteral reflux in our hospital. To determine the endoscopic treatment success in complex reflux, and the influence of reflux grade in it. MATERIAL AND METHODS: We present our experience between 1992 and 2003 with three kinds of substances (polytetrafluoroethylene, polydimethylsiloxane and dextranomer-hyaluronic acid copolymer). We treated complex reflux in 74 patients with endoscopic injection. All patients were scheduled to have voiding cystourethrogram 3 and 9 moths after injection. A positive response was defined as grade 0 or I reflux. RESULTS: Reflux was solved using the endoscopic procedure in 86.25% after first injection, 93.75% after second and 96.25% after third. The corresponding results for reflux grade II, III and IV were 88.9%, 83.3% and 100%. CONCLUSIONS: We conclude that subureteral injection of different sustances (Teflon, Macroplastique or Deflux) is a useful treatment for most cases of vesicoureteral reflux. We propose it as first step of treatment.

[Xanthogranulomatous pyelonephritis in childhood. A case report]. / Pielonefritis xantogranulomatosa en la infancia. A propósito de un caso.

Xanthogranulomatous pyelonephritis is an uncommon chronic inflammatory renal disorder. Most cases have been described in middle aged women and it is extremely rare in children. We report a case of a 4 year old girl who suffered from recurrent urinary tract infection and antibiotic therapy resistance. She had low growth-rate and palpable left renal mass on examination and was confirmed by radiological findings. We performed left kidney partial resection and then histological examination showed focal xanthogranulomatous pyelonephritis. The focal form of the disease may respond to antibiotic treatment although usually an enucleation or partial resection must be performed. In conclusion xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass and recurrent urinary tract infection in childhood.

Reflujo vesicoureteral complejo. Revisión de nuestra serie / Complex vesicoureteral reflux. Our experience

Objetivos: Analizar la proporción de reflujos secundarios o complejos en el total de reflujos vesicoureteral estratados endoscópicamente en nuestro hospital. Determinar el éxito conseguido y su relación con el grado de reflujo presentado. Material y método: Presentamos nuestra experiencia entre 1992 y 2003 con tres tipos de sustancias(politetrafluoroetileno, polidimetilsiloxane y dextranomero-copolímero de ácido hialurónico). Tratamos endoscópicamente con la inyección de estas sustancias a 74 pacientes con reflujo vesicoureteral complejo. Todos ellos se siguieron sistemáticamente mediante cistografía a los 3 y 9 meses tras la inyección. Definimos éxito del tratamiento como aquellos reflujos grado 0 ó I. Resultados: El reflujo fue solucionado endoscópicamente en el 86,25% de las ocasiones en el primer intento, 93,75% tras el segundo y 96,25% tras el tercero. El éxito según el grado de reflujo fue 88,9% para los de grado II, 83,3% para los de grado III y 100% para los de IV. Conclusiones: Concluimos que la inyección subureteral de distintas sustancias (Teflon®,Macroplastique® o Deflux®) constituye una alternativa útil de tratamiento en la mayoría de reflujos vesicoureterales complejos. Opinamos que debe considerarse como el primer escalón del tratamiento (AU)

Objective: To analize the proportion of complex reflux in the whole amount of patients treated endoscopically of vesicoureteral reflux in our hospital. To determine the endoscopic treatment success in complex reflux, and the influence of reflux grade in it. Material and methods: We present our experience between 1992 and 2003 with three kinds of substances (polytetrafluoroethylene, polydimethylsiloxane and dextranomer-hyaluronic acid copolymer). We treated complex reflux in 74 patients with endoscopic injection. All patients were scheduled to have voiding cystourethrogram 3 and 9 moths after injection. A positive response was defined as grade 0 or I reflux. Results: Reflux was solved using the endoscopic procedure in 86,25% after first injection, 93,75% after second and 96,25% after third. The corresponding results for reflux grade II, III and IV were 88.9%, 83.3% and 100%. Conclusions: We conclude that subureteral injection of different sustances (Teflon®, Macroplastique® or Deflux®) is a useful treatment for most cases of vesicoureteral reflux. We propose it as first step of treatment (AU)

Pielonefritis xantogranulomatosa en la infancia. A propósito de un caso / Xanthogranulomatous pyelonephritis in childhood. A case report

La pielonefritis xantogranulomatosa es una rara inflamación crónica del parénquima renal. Predomina en mujeres de edad media y es extremadamente rara en niños. Presentamos el caso de una niña de 4 años de edad, con infecciones del tracto urinario de repetición y mala respuesta a tratamiento médico. La paciente tenía retraso pondo-estatural y una masa en hemiabdomen izquierdo a la exploración y en las pruebas de imagen. Se realizó heminefrectomía superior izquierda, con posterior confirmación histopatológica de pielonefritis xantogranulomatosa focal. El tratamiento más frecuente de la forma focal es la nefrectomía parcial, aunque a veces responde a tratamiento antibiótico. Como conclusión la pielonefritis xantogranulomatosa debe ser considerada dentro de un diagnóstico diferencial de un niño con un riñón aumentado de tamaño e infecciones recurrentes (AU)

Xanthogranulomatous pyelonephritis is an uncommon chronic inflammatory renal disorder. Most cases have been described in middle aged women and it is extremely rare in children. We report a case of a 4 years old girl who suffered from recurrent urinary tract infection and antibiotic therapy resistance. She had low growth-rate and palpable left renal mass on examination and was confirmed by radiological findings. We performed left kidney partial resection and then histological examination showed focal xanthogranulomatous pyelonephritis. The focal form of the disease may respond to antibiotic treatment although usually an enucleation or partial resection must be performed. In conclusion xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass and recurrent urinary tract infection in childhood (AU)

[Cystic ureteritis in a kidney transplantation candidate]. / Ureteritis quística en paciente candidata a trasplante renal.

Cystic ureteritis is a very uncommon pathology, whose pathogenesis is not well established. It is usually asociated with chronic infectious factors. It presents unspecific symptoms but characteristic radiologic findings. There is not an especific treatment for this disease. Kidney transplant is the final pathway for patients with chronic renal failure. We report a case of cystic ureteritis diagnosed during pre-transplant study.

Ureteritis quística en paciente candidata a trasplante renal / Cystic ureteritis in a kidney trasplantation candidate

La ureteritis quística es una patología muy infrecuente, sin que hasta el momento se haya establecido su patogénesis exacta. Se presenta con sintomatología inespecífica, pero sin embargo los hallazgos radiológicos son bastante orientativos. No hay un tratamiento específico para estos pacientes, siendo el trasplante renal el paso final para los que desarrollen insuficiencia renal crónica terminal (IRCT).Presentamos un caso de ureteritis crónica diagnosticado durante el estudio pretrasplante de una paciente con IRCT (AU)

Cystic ureteritis is a very uncommon pathology, whose pathogenesis is not well established. It is usually asociated with chronic infectious factors. It presents unspecific symptoms but characteristic radiologic findings. There is not an especific treatment for this disease. Kidney trasplant is the final pathway for patients with chronic renal failure. We report a case of cystic ureteritis diagnosed during pre-trasplant study (AU)

[Retroperitoneal malignant fibrous histiocytoma]. / Histiocitoma maligno fibroso retroperitoneal.

We report a new case of retroperitoneal tumor: a malignant fibrous histiocytoma, in its less aggressive histologic type, the mixoid variety. This is a recently isolated histologic presentation from other sarcomas, with a low incidence, non-specific clinic findings and poor prognosis due to its tendency to reappear and to produce metastasis.

[Retroperitoneal neurilemmona]. / Neurilemoma retroperitoneal.

Schwannoma is an uncommon tumor arising from neural sheath of peripheral nerves. Histological findings showing Antoni A and B zones are the main diagnostic features. We report a new case of a retroperitoneal located one, which is not its most usual place to appear, in a 60 year old male, presenting left flank pain. He received surgical treatment, having a satisfactory evolution.

Histiocitoma maligno fibroso retroperitoneal / Retroperitoneal malignant fibrous histiocytoma

Presentamos un nuevo caso de neoplasia retroperitoneal: un histiocitoma fibroso maligno, en su variedad mixoide, la menos agresiva de ellas. Este es un tumor individualizado de forma relativamente reciente del conjunto de sarcomas retroperitoneales, de escasa frecuencia, clínica inespecífica y mal pronóstico por su alta tendencia a la recidiva y a la producción de metástasis

We report a new case of retroperitoneal tumor: a malignant fibrous histiocytoma, in its less agressive histologyc type, the mixoyd variety. This is a recently isolated histologyc presentation from other sarcomas, with a low incidence, non-specific clinic findings and poor prognosis due to its tendency to reappear and to produce metastasis

Neurilemoma retroperitoneal / Retroperitoneal neurilemmona

El schwanoma es un tumor poco frecuente, que tiene su origen en las envueltas neurales de los nervios periféricos. Para su diagnóstico es fundamental el hallazgo histológico de zonas Antoni A y B. Presentamos un nuevo caso de localización retroperitoneal, que no es su situación más frecuente, en un varón de 60 años, que presentó dolor en flanco izquierdo. Recibió tratamiento quirúrgico, siguiendo una evolución favorable

Schwannoma is an uncommon tumor arising from neural sheath of peripheral nerves. Histological findings showing Antoni A and B zones are the main diagnostic features. ;;We report a new case of a retroperitoneal located one, which is not its most usual place to appear, in a 60 years old male, presenting left flank pain. He recieved surgical treatment, having a satisfactory evolution

[Analysis of renal neoplasms in adult patients under 40]. / Análisis de las neoplasias renales en adultos menores de 40 años.

OBJECTIVES: To analyze within our sample population the number of patients under 40 receiving surgery as a result of renal neoplasm; to describe the characteristics of these patients and compare them with those of adult patients over 40. PATIENTS AND METHODS: We have revised the clinical history of the 379 patients with renal neoplasm who have undergone surgery in our Service from January 1986 through June 2003. Patients were divided into two groups. Group I, formed by 36 subjects (9.5%) < or = 40. Group II includes 343 patients (90.5%) over 40. Data were included in a database created using the software programme Access and were subsequently analysed using the statistical package SPSS. A descriptive analysis was performed and life expectancy was calculated for both groups using the Kaplan-Meier survival curve. RESULTS: 7.3% of the total number of renal cell carcinomas included in our series occurs in patients of or under 40. No significant differences have been observed as regards the distribution per sexes, laterality, size, incidental occurrence, clinical symptoms, anatomopathology, staging or surgical technique employed. However, we have observed differences as regards cancer-specific survival rate after 5 years, being 94.74% in the case of group I and 68.64% in group II (log-rank 0.0338). CONCLUSIONS: The number of patients < or = 40 undergoing surgery as a result of renal cell carcinoma in the sample under study matches other series already published. No statistically significant difference has been observed as regards staging among patients under and over 40. Differences do exist as regards cancer-specific survival rate. In the case of our patients, irrespective of the age group to which they were ascribed, it is more common to diagnose a renal neoplasm incidentally than through the clinical manifestations.

[Carcinosarcoma of the bladder: report of our cases and review of the literature]. / Carcinosarcoma vesical: análisis de nuestra serie y revisión de la literatura.

Carcinosarcomas of the bladder are rare. As a result, the natural history of them and the best methods of treatment remain uncertain. These tumors tend to be rapidly growing, invasive and recur locally. We reviewed our experience with four patients presenting between 1995 and 2002. Epidemiology findings, clinical aspects, histological features, diagnostic methods, treatment and survival are discussed in relation to literature.

Análisis de las neoplasias renales en adultos menores de 40 años / Analysis of renal neoplasms in adult patients under 40

OBJETIVOS: Analizar en nuestra serie la proporción de pacientes menores de 40 años intervenidos de neoplasia renal, describir sus características y compararlas con las presentadas por adultos mayores de 40. PACIENTES Y MÉTODO: Hemos revisado las historias clínicas de los 379 pacientes intervenidos en nuestro Servicio por neoplasia renal desde enero de 1986 a junio de 2003. Estos pacientes han sido divididos en dos grupos. El grupo I, formado por 36 individuos (9,5%), reúne los pacientes de edad ≤ 40 años. El grupo II, compuesto por 343 enfermos (90,5%), agrupa a los pacientes mayores de 40 años. Los datos se incluyeron en una base de datos creada en el programa Access, y posteriormente analizados mediante el paquete informático SPSS, realizándose un análisis descriptivo y calculando la expectativa de vida mediante la curva de supervivencia de Kaplan-Meier para ambos grupos. RESULTADOS: El 7,3% del total de carcinomas de células renales de nuestra serie se presenta en pacientes de edad igual o inferior a 40 años. No hemos encontrado diferencias significativas en cuanto a distribución por sexos, lateralidad, tamaño, incidentalidad, clínica, anatomía patológica, estadiaje ni técnica quirúrgica empleada. Sin embargo, sí las ha habido en la supervivencia cáncer-específica acumulada a cinco años, que ha sido del 94,74% en el grupo I y del 68,64% en el grupo II (log-rank 0,0338). CONCLUSIONES: La proporción de pacientes de 40 años o menores intervenidos por carcinoma de células renales en la serie revisada concuerda con otras series publicadas. No hemos encontrado diferencias estadísticamente significativas en el estadiaje entre pacientes menores y mayores de 40 años. Sí las hay respecto a la supervivencia cáncer-específica. En nuestros pacientes, con independencia del grupo de edad en que los encuadremos, es más frecuente diagnosticar una neoplasia renal de forma incidental que por la presentación clínica secundaria al mismo (AU)

OBJECTIVES: To analyze within our sample population the number of patients under 40 receiving surgery as a result of renal neoplasm; to describe the characteristics of these patients and compare them with those of adult patients over 40. PATIENTS AND METHODS: We have revised the clinical history of the 379 patients with renal neoplasm who have undergone surgery in our Service from january 1986 through june 2003. Patients were divided into two groups. Group I, formed by 36 subjects (9.5%) ≤ 40. Group II includes 343 patients (90.5%) over 40. Data were included in a database created using the software programme Access and were subsequently analysed using the statistical package SPSS. A descriptive analysis was performed and life expectancy was calculated for both groups using the Kaplan-Meier survival curve. RESULTS: 7.3% of the total number of renal cell carcinomas included in our series occurs in patients of or under 40. No significant differences have been observed as regards the distribution per sexes, laterality, size, incidental occurrence, clinical symptoms, anatomopathology, staging or surgical technique employed. However, we have observed differences as regards cancer-specific survival rate after 5 years, being 94.74% in the case of group I and 68.64% in group II (log-rank 0.0338). CONCLUSIONS: The number of patients ≤ 40 undergoing surgery as a result of renal cell carcinoma in the sample under study matches other series already published. No statistically significant difference has been observed as regards staging among patients under and over 40. Differences do exist as regards cancer-specific survival rate. In the case of our patients, irrespective of the age group to which they were ascribed, it is more common to diagnose a renal neoplasm incidentally than through the clinical manifestations (AU)

Carcinosarcoma vesical: análisis de nuestra serie y revisión de la literatura / Carcinosarcoma of the Bladder: Report of our cases and review of the literature

El carcinosarcoma vesical es una neoplasia de muy baja frecuencia de aparición. Por ello su historia natural y las formas de tratamiento no están claramente determinadas. Suelen ser tumores rápido crecimiento, invasivos y con tendencia a la recurrencia. Presentamos la revisión de los cuatro casos que hemos tenido ocasión de diagnosticar y tratar entre 1995 y 2002. Analizamos los aspectos epidemiológicos, sintomatología presentada, hallazgos histológicos, métodos diagnósticos, tratamiento y supervivencia, revisando además la literatura al respecto (AU)

Carcinosarcomas of the bladder are rare. As a result, the natural history of them and the best methods of treatment remain uncertain. These tumors tend to be rapidly growing, invasive and recur locally. We reviewed our experience with four patients presenting between 1995 and 2002.Epidemiology findings, clinical aspects, histological features, diagnostic methods, treatment and survival are discussed in relation to literature (AU)