Ictus isquémico tras el recambio de una nutrición parenteral en un paciente postoperado / Ischaemic stroke in a post-surgical patient after replacement of a parenteral nutrition bag

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Treatment planning after hydrogel injection during radiotherapy of prostate cancer.

PURPOSE: Imaging for treatment planning shortly after hydrogel injection is optimal for practical purposes, reducing the number of appointments. The aim was to evaluate the actual difference between early and late imaging. PATIENTS AND METHODS: Treatment planning computed tomography (CT) was performed shortly after injection of 10 ml hydrogel (CT1) and 1-2 weeks later (CT2) for 3 patients. The hydrogel was injected via the transperineal approach after dissecting the space between the prostate and rectum with a saline/lidocaine solution of at least 20-ml. Hydrogel volume and distances between the prostate and rectal wall were compared. Intensity-modulated radiotherapy (IMRT) plans up to a dose of 78 Gy were generated (rectum V70 < 20 %, rectum V50 < 50 %; with the rectum including hydrogel volume for planning). RESULTS: A mean planning treatment volume of 104 cm(3) resulted for a prostate volume of 37 cm(3). Hydrogel volumes of 30 and 10 cm(3) were determined in CT1 and CT2, respectively. Distances between the prostate and rectal wall at the levels of the base, middle, and apex were 1.7 cm, 1.6 cm, 1.5 cm in CT1 and 1.3 cm, 1.2 cm, 0.8 cm in CT2, respectively, corresponding to a mean decrease of 24, 25, and 47 %. A small overlap between the PTV and the rectum was found only in 1 patient in CT2 (0.2 cm(3)). The resulting mean rectum (without hydrogel) V75, V70, V60, V50 increased from 0 %, 0 %, 0.6 %, 10 % in CT1 to 0.1 %, 1.2 %, 6 %, 20 % in CT2, respectively. CONCLUSION: Treatment planning based on imaging shortly after hydrogel injection overestimates the actual hydrogel volume during the treatment as a result of not-yet-absorbed saline solution and air bubbles.

Quality of life after intensity-modulated radiotherapy for prostate cancer with a hydrogel spacer. Matched-pair analysis.

BACKGROUND: Hydrogel spacer is an innovative method to protect the rectal wall during prostate cancer radiotherapy. Clinical effects are not well known. METHODS: Patients have been surveyed before, at the last day, and 2-3 months after radiotherapy using a validated questionnaire (Expanded Prostate Cancer Index Composite). Median dose to the prostate in the spacer subgroup (SP) was 78 Gy in 2 Gy fractions. The results were independently compared with two matched-pair subgroups (treated conventionally without spacer): 3D conformal 70.2 Gy in 1.8 Gy fractions (3DCRT) and intensity-modulated radiotherapy (IMRT) 76 Gy in 2 Gy fractions. There were 28 patients in each of the three groups. RESULTS: Baseline mean bowel bother scores were 96 points in all subgroups. Similar mean changes (SP 16, 3DCRT 14, IMRT 17 points) were observed at the end of radiotherapy. The smallest difference resulted in the spacer subgroup 2-3 months after radiotherapy (SP 2, 3DCRT 8, IMRT 6 points). Bowel bother scores were only significantly different in comparison to baseline levels in the spacer subgroup. The percentage of patients reporting moderate/big bother with specific symptoms did not increase for any item (urgency, frequency, diarrhoea, incontinence, bloody stools, pain). CONCLUSION: Moderate bowel quality-of-life changes can be expected during radiotherapy irrespective of spacer application or total dose. Advantages with a spacer can be expected a few weeks after treatment.

Impact of the incorporation of tyrosine kinase inhibitor agents on the treatment of patients with a diagnosis of advanced renal cell carcinoma: study based on experience at the Hospital Universitario Central de Asturias

INTRODUCTION: For nearly the past two decades, cytokines (CKs) have been the only systemic treatment option available for advanced renal cell carcinoma (RCC). In recent years, tyrosine kinase inhibitors (TKIs) have demonstrated clinical activity on this tumour. Our purpose is to describe one centre's experience with the use of CKs and TKIs in the treatment of patients with advanced RCC. MATERIALS AND METHODS: This study was designed as a retrospective chart review of RCC patients who were treated with CKs and/or TKIs in our department between July 1996 and June 2008. Efficacy and toxicity were assessed using World Health Organization (WHO) criteria. The Kaplan-Meier method was used to estimate progression-free (PFS) and overall (OS) survival. RESULTS: Ninety-four patients were classified into three groups depending on the modality of treatment administered: 46 were treated with CKs alone and/or chemotherapy (27 with immunotherapy, one with chemotherapy and 18 with both), 28 with TKIs alone (25 with sunitinib and 13 with sorafenib) and 20 with TKIs in second-line treatment following failure with CKs (17 with sunitinib, eight with sorafenib, four with bevacizumab and one with lapatinib). The median age was 60 years in the CK group and 65 and 62, respectively, in TKI in first and second-line treatment groups. Eighty-five percent of patients treated with CKs and 75% in the TKI group in first-line treatment and 80% in second-line treatment were men. Overall, 89% of patients had favourable risk, and 11% had intermediate risk. All patients were considered evaluable for toxicity. The main grade 3-4 (%) toxicity was asthenia for both groups, (ten in TKIs and 15 in CKs). Other grade 1-2 toxicities were mucositis (39), bleeding (8), hypertension (19), skin toxicity (33) and hypothyroidism (12.5) associated with TKIs; and anaemia (33), cough (29), asthenia (39) and emesis (14) associated with CKs. The objective response rate among 80 patients evaluable for activity was 10.6% with CKs and 46.5% and 35%, respectively, with TKIs in first- and second-line treatments. Disease stabilisation with CKs was recorded at 59% of patients and with TKIs 25% and 50% in first- and second-line treatment groups, respectively. The median progression-free survival (PFS) with CKs was 122 days [95% confidence interval (CI) 82-162] and with TKIs 201 days (65-337) in the first and 346 days (256-436) in second-line treatment groups. The median overall survival (OS) was 229 days (142-316) and 2,074 days (1,152-2,996) for patients treated with CKs and TKIs. CONCLUSIONS: Our results are in line with the activity and survival rates previously reported in the literature regarding the use of TKIs for patients with advanced RCC in first- and second-line treatment, which has demonstrated an acceptable toxicity level (AU)

Seroepidemiology of infection with Toxoplasma gondii in waste pickers and waste workers in Durango, Mexico.

Municipal waste is a potential source of infection for Toxoplasma gondii as it may contain contaminated meat with parasite tissue cysts and cat excrement with parasite oocysts. Therefore, we sought to determine the prevalence of T. gondii infection and associated characteristics in two populations exposed to municipal solid waste in Durango, Mexico. Ninety waste pickers and 83 waste workers of Durango City, Mexico were examined for T. gondii infection. They were tested for anti-T. gondii IgG and IgM antibodies using enzyme-linked immunoassays. In addition, socio-demographic and behavioural characteristics from each participant were obtained. Nineteen (21.1%) of the 90 waste pickers and seven (8.4%) of the 83 waste workers were positive for anti-T. gondii IgG antibodies. The difference in prevalence among the groups was statistically significant (P =0.03). Waste pickers aged 31-50 years showed a significantly higher prevalence (40.9%) than waste workers of the same age group (2.9%, P < 0.001). Anti-T. gondii IgM antibodies were found in two (2.2%) of the waste pickers but in none of the waste workers. The seroprevalence of T. gondii was significantly higher in workers of the waste transfer station (25.0%) than in drivers or helpers of waste vehicles (2.5%) (P =0.03). Multivariate analysis showed that T. gondii infection was associated with consuming food found in the garbage [adjusted odds ratio (OR) = 4.4; 95% confidence interval (CI) 1.6-11.8] and with lack of education (adjusted OR = 3.2; 95% CI 1.1-8.8). From this study, we conclude: (i) waste pickers may represent a risk group for T. gondii infection; (ii) lack of education might be a contributing factor for T. gondii infection; (iii) the higher the exposure to garbage, the higher the seroprevalence of T. gondii infection; (iv) Eating food products from the garbage may represent an important route for T. gondii infection.

Estudio retrospectivo en pacientes con diagnóstico de carcinoma de pulmón no microcítico estadio avanzado tratados con la combinación gemcitabina y vinorelbina: valoración de la eficacia terapéutica y factores pronósticos / No disponible

Introducción: La Gemcitabina (G), la vinorelbina (V) y su combinación (GV) han demostradosu utilidad en pacientes con Carcinoma de Pulmón no Microcítico (CPNM). El propósito del estudioha sido confirmar la eficacia de GV e identificar factores pronósticos relacionados con los resultadosterapéuticos.Pacientes y Métodos: Se revisó de forma retrospectiva la historia de 144 pacientes conCPNM avanzado tratados entre octubre del 96 y abril del 05 con G (1.000-1.250 mg/m2) + V (25-30mg/m2) administrados el día 1 y 8 cada 21 días.Resultados: El tratamiento fue bien tolerado, desarrollando un 18% de los pacientes leucopeniagrado 3-4 incluyendo un 7% de neutropenia febril como peor toxicidad. La tasa de respuestas objetivasfue del 36,8% (IC al 95: 28,9–44,7) y las medianas de supervivencia libre de progresión y globalfueron de 21 (18–25) y 33 (26–40) semanas respectivamente. En el análisis multivariante sólo la histologíade adenocarcinoma (HR 3; p<,0001), la enfermedad limitada a una o ninguna localización metastática(HR 1,7; p =,02) y el índice Karnofsky (IK) mayor a 70% (HR 1,5; p=,02) tuvieron una asociaciónsignificativa con mayor supervivencia.Conclusiones: La combinación de GV se tolera bien y es eficaz en pacientes con CPNM avanzado.La histología de adenocarcinoma, la enfermedad limitada a una o ninguna localización metastásicay un IK superior a 70% se han identificado como variables independientes relacionadas con unamejor supervivencia

Introduction: Gemcitabine (G), vinorelbine (V) and their combination (GV) have shown to beuseful in patients with non-small cell lung cancer (NSCLC). The purpose of this study is to confirmthe activity of GV administration and to identify prognostic factors related with the clinical outcome.Methods: A retrospective analysis was carried out in relation to 144 patients with NSCL treatedbetween October 1996 and April 2005 with G (1000-1250 mg/m2) + V (25-30 mg/m2) both administeredon days 1 and 8 every three weeks.Results: Treatment was well tolerated, grade 3-4 neutropenia being registered as the worse toxiceffect in 18% cases, including 7% of neutropenic fever. The objective response rate was 36.8% (95%CI: 28.9-44.7) and the median progression free survival and overall survival rates were 21 (18-25) and33 (26-40) weeks respectively. In multivariate analysis only the histology of adenocarcinoma (HR 3;p<0.001), less than two metastatic sites (HR 1.7; p<0.02) and Karnofsky index (KI) above 70% (HR1.5; p<0.02) showed a significant association with longer survival.Conclusion: The GV combination therapy is well tolerated and active in patients with advancedNSCLC. The histology of adenocarcinoma, less than two metastatic sites and KI above 70% were identified as independent variables related with longer survival (AU)

Combining inter- and intrapopulation information with the Weitzman approach to diversity conservation.

This article introduces a new perspective on Weitzman's methodology for assessing the distribution of resources in genetic diversity conservation programs. Intrapopulation information is added to the procedure by diffusion process formulas to calculate genetic extinction probabilities, and therefore the marginal diversities and elasticities of diversity. The method was tested with a set of European cattle breeds from Spain and France and provided satisfactory results.

Prospective randomised phase II study of docetaxel versus paclitaxel administered weekly in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy.

BACKGROUND: Docetaxel and paclitaxel have activity in the second-line treatment of non-small-cell lung cancer (NSCLC), and can be administered as weekly schedules. This phase II randomised study was designed to test the efficacy and toxicity of both taxanes in patients with NSCLC previously treated with platinum-based chemotherapy. PATIENTS AND METHODS: Patients (n = 71) with documented NSCLC were randomised to receive docetaxel (n = 35 patients; 36 mg/m(2)) or paclitaxel (n = 36 patients; 80 mg/m(2)) as a 1 h weekly infusion for 6 weeks followed by a 2-week rest. The cycles were repeated until disease progression or non-acceptable toxicities occurred. RESULTS: Treatment achieved partial response of one versus five patients, median time-to-progression of 74 versus 68 days, and overall survival of 184 versus 105 days, with docetaxel and paclitaxel, respectively. The most common non-haematological toxicities were (docetaxel versus paclitaxel): grade 3/4 pulmonary toxicity in seven versus one patient; grade 2/3 diarrhoea in nine versus five; and grade 3/4 haematological toxicities occurred in two versus four patients. There were no treatment-related deaths. CONCLUSIONS: Docetaxel and paclitaxel administered weekly have discrete efficacy in patients with NSCLC previously treated with platinum-based chemotherapy. The higher non-haematological toxicity of docetaxel, particularly pulmonary toxicity and diarrhoea, is of concern and warrants further investigation.

Asymptotic variances of QTL estimators with selective DNA pooling.

Investigation on QTL-marker linkage usually requires a great number of observed recombinations, inferred from combined analysis of phenotypes and genotypes. To avoid costly individual genotyping, inferences on QTL position and effects can instead make use of marker allele frequencies. DNA pooling of selected samples makes allele frequency estimation feasible for studies involving large sample sizes. Linkage studies in outbred populations have traditionally exploited half-sib family designs; within the animal production context, half-sibships provide large families that are highly suitable for DNA pooling. Estimators for QTL position and effect have been proposed that make use of information from flanking markers. We present formulas derived by the delta method for the asymptotic variance of these estimators.

Power analysis of QTL detection in half-sib families using selective DNA pooling.

Individual loci of economic importance (QTL) can be detected by comparing the inheritance of a trait and the inheritance of loci with alleles readily identifiable by laboratory methods (genetic markers). Data on allele segregation at the individual level are costly and alternatives have been proposed that make use of allele frequencies among progeny, rather than individual genotypes. Among the factors that may affect the power of the set up, the most important are those intrinsic to the QTL: the additive effect of the QTL, and its dominance, and distance between markers and QTL. Other factors are relative to the choice of animals and markers, such as the frequency of the QTL and marker alleles among dams and sires. Data collection may affect the detection power through the size of half-sib families, selection rate within families, and the technical error incurred when estimating genetic frequencies. We present results for a sensitivity analysis for QTL detection using pools of DNA from selected half-sibs. Simulations showed that conclusive detection may be achieved with families of at least 500 half-sibs if sires are chosen on the criteria that most of their marker alleles are either both missing, or one is fixed, among dams.

Phase III trial of cyclophosphamide, epirubicin, fluorouracil (CEF) versus cyclophosphamide, mitoxantrone, fluorouracil (CNF) in women with metastatic breast cancer.

BACKGROUND: The mitoxantrone combination CNF and the epirubicin combination CEF have shown similar activity and less toxicity than the standard CAF combination in metastatic breast cancer (MBC). A prospective randomised study was started to compare safety and activity between CEF and CNF administered using a classical chemotherapeutic schedule in MBC. PATIENTS AND METHODS: From December 1987 to June 1993, 151 patients were randomised to receive cyclophosphamide (C) 100 mg m(-2) p.o. days 1-14, fluorouracil (F) 500 mg m(-2) i.v. days 1 and 8, and epirubicin (E) 30 mg m(-2) i.v. days 1 and 8, or mitoxantrone (N) 6 mg m(-2) i.v. days 1 and 8, every 4 weeks. Seventy-three patients were eligible for CEF and 72 for CNF. RESULTS: Objective responses were observed in 61.6% of the CEF group and 44.4% in CNF group (p = 0.004). The median duration of response was 64 weeks in CEF and 50 weeks in CNF group (p = 0.02) and median time to progression was 51 and 33 weeks, respectively (p = 0.0004). At the time of analysis, all except six patients (one in CNF and five in CEF) had died and the median survival time in the CEF group was longer than in CNF (74.4 weeks vs 51.4 weeks; log-rank chi2 test p = 0.015). CNF produced more hematologic toxicity than CEF (WHO scale; grades 2-4); leucopenia 84% vs 68% (p = 0.03) and thrombocytopenia 17% vs 4.5% (p = 0.01); CEF caused more grade 2 and 3 alopecia: 93% vs 70% (p = 0.001). CONCLUSION: The combination CEF using this schedule and dosage in metastatic breast cancer is more effective with less toxicity than CNF, except for alopecia, and was associated with longer survival.

[Meningeal carcinomatosis in bladder tumor]. / Carcinomatosis meníngea en un tumor vesical.

We report a strange case of a bladder whose first metastasic manifestation, after two years of the diagnosis, was a peripheric polyneuropathia. This patient was treated with immunotherapy with BCG for superficial carcinoma of the bladder during one year. Gradually central neurological symptoms appeared and the patient died one month later. A meningeal carcinomatosis was identify as the cause. No bone metastases existed, which is the most frequent way of tumours extension towards leptomeninges. We argue about the way to arrive at meninges.

[Cost-effectiveness comparative study of ceftriaxone verus cefotaxime in the treatment of complicated urinary infections]. / Estudio comparativo coste eficacia ceftriaxona versus cefotaxima en el tratamiento de las infecciones urinarias complicadas.

Prospective, randomized, multicenter study in 267 patients with complicated urinary infection from 9 hospitals nationwide. Drug treatment was either Ceftriaxone 1 g once daily parenterally or Cefotaxime parenteral 1 g 8 hourly for a minimum of 7 days. Patients were clinically, analytically and microbiologically evaluated before and after treatment to assess the efficacy and tolerance of both drug products. To evaluate treatment cost, we used the price of both drugs and the material required for their administration (syringe and disposable needle). 119 patients were excluded from the cost-efficacy evaluation and 148 remained in the study (75 assigned to treatment with Ceftriaxone and 73 to Cefotaxime). Clinical efficacy of treatment was 93% and 87.6% for Ceftriaxone and Cefotaxime respectively (p > 0.05). Cost per patient was 27,347 pesetas for Ceftriaxone and 34,490 for Cefotaxime (p < 0.05).

[Medical treatment of bladder instability. Our experience]. / Tratamiento médico de la inestabilidad vesical. Nuestra experiencia.

OBJECTIVE: To identify the factors that influence response to treatment of vesical instability. METHODS: A retrospective study was conducted to assess the efficacy of drug therapy with oxybutinin and imipramine in 89 patients with urodynamically demonstrated detrusor hyperreactivity. Control evaluations were performed at 2, 5 and 8 months. Evaluation of the results took into account the etiology, pressure and volume at which the wave of instability appeared. RESULTS: The results were evaluated according to patient subjective criteria. We observed a positive response (cure and improvement) to treatment with oxybutinin alone or oxybutinin+imipramine in 66.25% of the cases; side effects were observed in 44%. There was a 20% improvement in the positive response rate when the wave intensity was greater than 55 cm H2O and the bladder volume at which this occurred was greater than 150 ml. No patient treated with second line drug therapy (flavoxate, nifedipine and trospium chloride) cured. CONCLUSIONS: The etiology of vesical instability did not influence response to therapy. Waves with a greater intensity and those that appeared at higher volumes responded better to treatment. Nearly half of the patients with side effects required a reduction of the dosage or withdrawal of the drug. Our results and those reported elsewhere indicate that non-responders to treatment with oxybutinin alone or in combination with imipramine are unlikely to improve with currently available drug therapy.

[Systemic chemotherapy with cisplatin, methotrexate, and vinblastine, and bladder preservation in T2/T3a bladder cancer]. / Quimioterapia sistémica con cisplatino, metotrexato, y vinblastina y preservación vesical en el cáncer de vejiga T2/T3a.

We are currently witnessing a lively controversy over which should be the optimal treatment for patients with infiltrant urothelial carcinoma with muscle location (stage B Jewett's Grading or T2-T3 on the TNM Rating Scale, UICC 1992). This paper reports a randomized, prospective study in 37 patients with T2-T3a tumours. Arm A (n = 20) received systemic chemotherapy with cisplatin, methotrexate and vinblastine (CMV) after TUR, and was carefully followed aiming for vesical preservation. Arm B (n = 17) was given chemotherapy with CMV after TUR and then underwent cystectomy. Disease-free survival at 5 years for the overall series is 69%, 47% for group A and 88% for group B (log-rank, p = 0.14). No statistically significant differences in survival were detected relative to age (under or over 65 years), growth patterns (papillary or plain), histological grade (G2 or G3), and size (smaller or greater than 5 cm). Survival was different depending on the clinical suspicion of nodular involvement (log-rank, p < 0.001). In summary, although the number of patients in the series does not allow to draw conclusions in terms of statistical significance, there is enough evidence to consider that vesical preservation based on TUR and systemic chemotherapy as definitive treatment is a dangerous option without the good survival rates achieved by T2/T3a patients undergoing cystectomy.

[Suburethral sling in the treatment of urinary incontinence: our experience]. / Cabestrillo suburetral en el tratamiento de la incontinencia urinaria: nuestra experiencia.

Review of 17 female patients who underwent placing of Suburethral Sling as anti-incontinence procedure with the purpose of assessing the results obtained. The most frequent complications were urinary retention and post-surgical urgency. A larger proportion of patients with Stress Urinary Incontinence had retention and during more days than those with Mixed Urinary Incontinence. In most cases of mixed urinary incontinence, asymptomatic prior to surgery, the placing of a suburethral sling provokes signs and symptoms of urgency, and even of post-surgical urgency-incontinence. Both complications were attenuated in all cases using measures such as conservation of urinary by-pass or administration of anti-cholinergics. Results at 2 years have been successful in 68.75% cases, thus encouraging us to reduce the number of indications for this technique.

[Survival in stage T2-T3A bladder cancer treated with radical cystectomy]. / Supervivencia del cáncer de vejiga estadio T2-T3A tratado mediante cistectomía radical.

OBJECTIVE: The optimal treatment for patients with localized muscle-infiltrating urothelial carcinoma (Jewett stage B or T2-T3a of the TNM classification, UICC 1992) continues to be a controversy. The present study analyzed the survival rate in patients with stage T2-T3a bladder cancer who had been treated by radical cystectomy. METHODS: The records of 50 patients with T2-T3a NO tumor, submitted to pelvic lymphadenectomy and radical cystoprostatectomy, were reviewed to determine the prognosis in this group of patients. Seventeen patients (34%) received three courses of systemic chemotherapy (CMV) prior to cystectomy. RESULTS: The overall 5-year survival rate was 73%; 76% for those with T2 (n = 30) and 67% for those with T3a (n = 20) (log-rank, p = 0.27). No statistically significant differences were observed for age (less than or over 65 years), tumor growth pattern (papillary or flat), tumor size (less or greater than 5 cms) or treatment (with or without induction CMV). However, patients with G1-2 tumor had a better survival rate (94% at 5 years) than those with G3 tumor (51%), a difference with statistical significance (log-rank, p = 0.047). The Cox regression analysis showed no independent variable of prognostic significance. CONCLUSION: Muscle-infiltrating urothelial carcinoma is highly curable by radical surgery. Some authors believe it is unnecessary to distinguish T2-T3a lesions; therefore a critical review of the TNM classification appears to be warranted. We are unable to distinguish patients with a better prognosis that might benefit from less aggressive therapeutic options. Similarly, the therapeutic benefits of induction chemotherapy prior to cystectomy in patients with stage T2-T3a tumor could not be demonstrated.

[Renal hemangiopericytoma and secondary hypertension]. / Hemangiopericitoma renal e hipertensión secundaria.

OBJECTIVES: Tumors arising from pericytes are rare; even more so are those located in the kidney. A case of renal hemangiopericytoma is described herein. The literature is reviewed with special reference to the unclear prognosis of the foregoing condition and the therapeutic approach. METHODS: A 51-year-old male with renal hemangiopericytoma who underwent radical nephrectomy is described. RESULTS/CONCLUSIONS: The arterial hypertension that had led to the diagnosis of this neoplasm remitted after surgery and can be considered to be a paraneoplastic manifestation.

[Trigono-cervico-prostatotomy (TCP) versus transurethral resection of the prostate (TURP). Our experience]. / Trigonocervicoprostatotomía (TCP) versus resección transuretral de próstata (RTU). Nuestra experiencia.

OBJECTIVE: Trigonocervicoprostatotomy (TCP) has been considered up to now an alternative treatment to transurethral resection of the prostate (TURP) when evaluating the size of the prostate. This paper demonstrates that endoscopic visualization is more important when choosing the surgical procedure and that both techniques can achieve satisfactory results. METHODS: The prostate volume is evaluated by ultrasound and according to the endoscopic findings, TURP or TCP is performed. The prostatic lobes are routinely biopsied if the latter procedure is chosen. RESULTS: We compared the results of 34 TCP and 30 TURP procedures using the values of I-PSS and uroflowmetry before and after surgery. In 86.2% of the TCPs and 80% of the TURPs, the patients are asymptomatic with I-PSS less than 7 and significantly improved uroflowmetry data. Biopsy disclosed adenocarcinoma in one patient submitted to TCP. CONCLUSIONS: TCP represents an alternative to TURP not only for small prostates (30 gm) but also for medium-sized prostates (50-60 gms), depending on the endoscopic findings. TCP is not indicated for lateral lobes that fall on the prostate floor. Performing a biopsy routinely in TCP does not prolong the operating time significantly and permits detecting subclinical adenocarcinoma of the prostate.