Factores que influyen en el desarrollo del cáncer vesical en nuestro entorno. Estudio de casos y controles / No disponible

El cáncer vesical tiene una alta incidencia y prevalencia y se ha relacionado con numerosos factores de riesgo. El objetivo del presente estudio fue determinar los factores que influyen, y en qué intensidad, en la incidencia del cáncer vesical en nuestra área sanitaria. Realizamos un estudio observacional de caso-control en 100 pacientes con tumores de vejiga emparejados con 100 controles para analizar el papel de posibles factores de riesgo en la etiología del cáncer de vejiga en nuestra área asistencial. Los factores de riesgo incluidos en el estudio fueron: antecedentes familiares de neoplasia vesical, tabaco, ocupación, ingesta de agua, ingesta de alcohol, ingesta de café, consumo de grasas, consumo de analgésicos, antecedentes patología urológica. La influencia de las variables fueron analizadas mediante cálculo de OR (..) (AU)

Bladder cancer is a disease with high incidence and prevalence and is associated with multiple risk factors. The objective of the present study was to determine the risk factors and their influence in the incidence of bladder cancer in our area. We performed a case control observational study to analyse the role of the risk factors in the aetiology of bladder cancer in our patients. The risk factors were: family history of bladder cancer, tobacco, occupation, daily water ingestion, alcohol, pattern of coffee drinking, analgesic use, previous history of urologic disorder. The analysis and comparison of variables were done with Odds ratio, chi-square and logistic regression. Tobacco was the main known etiological factor detected in 85% of cases versus 36% of controls (OR of non smokers 0,099: CI 95% 0,050-0,197;p<0,00). The house building was showed to have the tendency as a risk factor that did not reach statistical significance (16% cases vs 7% controls; OR 2,5; CI 95% 0,993-6,452; p=0,157). The rest of variables were not significant in aetiology of bladder cancer. Logistic regression highlighted tobacco habit as unique variable influencing in the etiology of bladder cancer (exp (B) OR 9,335; CI 95% 4,599- 18,950; sig 0,000).Our study showed the clear influence of tobacco in the aetiology of bladder cancer in our patients. The observed tendency in the house building workers should be evaluated in future studies. Other variables were not significant (AU)

Disseminated histoplasmosis by Histoplasma capsulatum var. duboisii in a paediatric patient from the Chad Republic, Africa.

Histoplasmosis caused by Histoplasma capsulatum var. duboisii is an endemic mycosis of sub-Saharan Africa that usually affects the skin, subcutaneous tissue, lymph nodes and bones. We present a case of a 10-year-old immunocompetent girl with severe cutaneous and subcutaneous abscesses affecting the head and upper body. Microscopic examination showed polar budding yeasts and short mycelium compatible with H. capsulatum var. duboisii. Cultures were not possible but serology showed antibodies against both H. capsulatum var. duboisii and H. capsulatum var. capsulatum antigens. Presumptive diagnosis of histoplasmosis was done but treatment with itraconazole was inefficacious. After 15 days of treatment with Amphotericin B i/v, improvement was evident and, three months later, the patient was discharged with only residual lesions. Seven months later, no relapses were observed.

[Bilateral and synchronic testicular neoplasia. A report of a new case]. / Neoplasia testicular bilateral sincrónica. Presentación de un nuevo caso.

Bilateral and synchronic testicular tumor is an unfrequent fact (0,17% of germinative tumors of testicle), being most cases seminomas. We present the case of a male, 25-year old patient underwent a bilateral radical orchiectomy for bilateral and synchronic testicular tumor. The result of anatomopathological examination revealed bilateral seminoma (pT2 in both testes). Patient received four courses of adjuvant chemotherapy (etoposide and cisplatin) for metastases (N2, M1). The patient is without evidence of disease two years after orchiectomy.

Neoplasia testicular bilateral sincrónica. Presentación de un nuevo caso / Bilateral and synchronic testicular neoplasia. A report of a new case

El tumor testicular bilateral y sincrónico es un hecho infrecuente (0,17% de los tumores germinales de testículo), siendo la mayoría de los casos seminomas. Nosotros presentamos el caso de un varón de 25 años de edad sometido a orquiectomía radical bilateral por tumor testicular bilateral sincrónico. El resultado del examen anatomopatológico reveló seminoma bilateral (pT2 en ambos testes). El paciente recibió 4 ciclos de quimioterapia (etopósido y cisplatino) adyuvante por enfermedad metastásica (N2, M1). 2 años después de la orquiectomía, el paciente está sin evidencia de enfermedad

Bilateral and synchronic testicular tumor is an unfrequent fact (0,17% of germinative tumors of testicle), being most cases seminomas. We present the case of a male, 25-year old patient underwent a bilateral radical orchiectomy for bilateral and synchronic testicular tumor. The result of anatomopathological examination revealed bilateral seminoma (pT2 in both testes). Patient received four courses of adjuvant chemotherapy (etoposide and cisplatin) for metastases (N2, M1). The patient is without evidence of disease two years after orchiectomy

[Mucinous adenocarcinoma of the urachus and peritoneal pseudomyxoma]. / Adenocarcinoma mucinoso de uraco y pseudomixoma peritoneal.

The adenocarcinoma of the urachus is very rare tumor, with an incidence of 1/5.000.000 inhabitants, represents less than 0.001 of all types of bladder cancer. Peritoneal pseudomixoma is a rare neoplasm characterized by mucinous acites that involvement the peritoneal surface and omentum. Usually is associated with benign o malignant mucinous tumor of the appendix or ovary. In this paper, we present a case of peritoneal pseudomixoma caused by a mucinous adenocarcinoma of the urachus.

Adenocarcinoma Mucinoso de Uraco y Pseudomixoma Peritoneal / AB muncinous adenocarcinoma of the urachus and peritoneal pseudomyxoma

El adenocarcinoma de uraco es un tumor extremadamente raro, con una incidencia de 1/5.000.000 de habitantes, lo que representa menos del 0,001 de todos los tumores de vejiga. El pseudomixoma peritoneal es una neoplasia rara caracterizada por ascitis mucinosa que envuelve la superficie peritoneal y el omento. Usualmente está asociada con tumores mucinosos benignos o malignos del apéndice u ovario. En este trabajo, presentamos un caso de pseudomixoma peritoneal causado por un adenocarcinoma mucinoso de uraco

The adenocarcinoma of the urachus is very rare tumor, with an incidence of 1/5.000.000 inhabitants, represents less than 0,001 of all types of bladder cancer. Peritoneal pseudomixoma is a rare neoplasm characterized by mucinous acites that involvement the peritoneal surface and omentum. Usually is associated with benign o malignant mucinous tumor of the appendix or ovary. In this paper, we present a case of peritoneal pseudomixoma caused by a mucinous adenocarcinoma of the urachus

[A Spanish multicenter trial of TVT for female urinary incontinence]. / TVT para la incontinencia urinaria femenina: estudio multicéntrico español.

OBJECTIVE: The purpose of this study was to evaluate results and complications of TVT in a large series from different hospital centers in Spain. METHOD: We retrospectively studied the results of TVT placement from 6 centers with 272 consecutive patients (median follow-up was 636 days). All types of stress urinary incontinence with a surgical indication were included and no previous conditions were established regarding the indication. No protocol was used for either the intervention or postoperative support measures. Data collection was protocolized and carried out using a common questionnaire that was completed by an urologist at each center from 3 to 6 months after the intervention and then annually. All patients who underwent intervention were asked about their satisfaction with the outcome. Multivariate studies were made to identify the factors that influenced the recovery of continence and the occurrence of complications. RESULTS: 92.1% of patients were continent and 2.4% have not shown any improvement. 91.6% of the patients claimed to be satisfied whereas only 2.7% were dissatisfied. After four years only 2.8% of patients showed mild incontinence with time and 0.4% had moderate incontinence. Only previous surgery for incontinence was found to be significantly unfavorable factor for achieving postoperative continence. CONCLUSION: We have reproduced a scenario closer to daily clinical reality than the results of series from a single institution or analyses using stricter selection criteria. This multicenter study verifies the viability and reproducibility of TVT with minimal complications in centers where patients are not selected and where not all urologists are specialized in urinary incontinence.

TVT para la incontinencia urinaria femenina: estudio multicéntrico español / A spanish multicenter trial of TVT for female urinary incontinence

Objetivo: Evaluar resultados y complicaciones del TVT en una gran serie multicéntrica española. Método: Estudio retrospectivo de 272 pacientes consecutivas con colocación de TVT en 6 centros españoles (mediana seguimiento 636 días). Se incluyó cualquier tipo de incontinencia de esfuerzo con indicación quirúrgica. No se utilizó protocolo de uniformidad para la intervención ni cuidados postoperatorios. Recogida de datos, estandarizada a 3, 6 meses y anualmente tras intervención. Se realizó estudio multivariado para identificar factores influyentes en la recuperación de la continencia y aparición de complicaciones. Se valoró la satisfacción de la paciente respecto a la intervención. Resultados: El 92,1% de las pacientes obtuvieron la continencia frente al 2,4% que no mostraron ninguna mejoría. A los cuatro años sólo el 2,8% de las pacientes mostraron incontinencia mínima y el 0,4% incontinencia moderada en el tiempo. Solo se encontró como factor influyente (desfavorable) para continencia postoperatoria el antecedente de cirugía previa anti-incontinencia. 91,6% declararon estar satisfechas mientras que sólo el 2,7% estaban insatisfechas. Conclusión: Creemos haber reproducido un escenario cercano a la realidad clínica diaria. El estudio multicéntrico verifica la viabilidad y reproducibilidad de los resultados del TVT con mínimas complicaciones en pacientes no seleccionadas y en centros donde no todos los urólogos están especializados en incontinencia urinaria (AU)

Objective: The purpose of this study was to evaluate results and complications of TVT in a large series from different hospital centers in Spain. Method: We retrospectively studied the results of TVT placement from 6 centers with 272 consecutive patients (median follow-up was 636 days). All types of stress urinary incontinence with a surgical indication were included and no previous conditions were established regarding the indication. No protocol was used for either the intervention or postoperative support measures. Data collection was protocolized and carried out using a common questionnaire that was completed by an urologist at each center from 3 to 6 months after the intervention and then annually. All patients who underwent intervention were asked about their satisfaction with the outcome. Multivariate studies were made to identify the factors that influenced the recovery of continence and the occurrence of complications. Results: 92.1% of patients were continent and 2.4% have not shown any improvement. 91.6% of the patients claimed to be satisfied whereas only 2.7% were dissatisfied. After four years only 2.8% of patients showed mild incontinence with time and 0.4% had moderate incontinence. Only previous surgery for incontinence was found to be significantly unfavorable factor for achieving postoperative continence. Conclusion: We have reproduced a scenario closer to daily clinical reality than the results of series from a single institution or analyses using stricter selection criteria. This multicenter study verifies the viability and reproducibility of TVT with minimal complications in centers where patients are not selected and where not all urologists are specialized in urinary incontinence (AU)

[Neoplastic pathology of the urothelium]. / Patologia neoplásica del urotelio.

Bladder cancer is one of the most common diseases treated by urologists. In this article, we will try to review some of the controversies and all the available data which come from the systematic review and meta-analysis.

[Second resection in patients with Ta-T1 bladder tumors]. / Segunda resección en pacientes con tumores vesicales Ta-T1.

OBJECTIVES: To study the incidence of "residual/recurrence" tumor after a second bladder resection (2nd TUR). METHODS: 40 patients with new or recurrent superficial bladder tumor underwent repeat transurethral resection within 3 months after the initial resection. 37 patients were staged as Ta-T1. We study the incidence of tumor after the 2nd TUR both macroscopically detected or included in the bladder scar. We also study the influence of possible factors as the time between both resections, stage, grade, number of tumor size, localization in the bladder, primary or recurrent tumor and tumor pattern. RESULTS: After the 2nd TUR we found tumor in 14 of 37 (37.8%) Ta-T1 bladder tumors. Among the 14 tumors, 10 (71.5%) were macroscopically visible tumors and 4 cases the tumor were found after resection of the bladder scar of the first resection. We did not find relation between the presence of tumor in the 2nd TUR and any of the variables. CONCLUSIONS: After a TUR of superficial bladder tumor the complete removal of tumor is not always achieved. The early 3 months cystoscopy may not find residual tumor. Although we have found tumor in 37.8% in the 2a TUR we can not recommend routine 2nd TUR in superficial bladder cancer.

Segunda resección en pacientes con tumores vesicales Ta-T1 / Second TUR in patients with stage Ta-T1 transicional cell carcinoma of the bladder

OBJETIVO: Estudiar la incidencia de tumor "residual/recidivante" tras segunda resección precoz (2ª RTU), y que factores influyen en su hallazgo. MATERIAL Y MÉTODO: Estudio prospectivo de 40 pacientes con neoplasia vesical superficial a los que se les realizó una 2ª RTU precoz. Como posibles factores de riesgo de hallazgo de tumor se estudiaron el intervalo de tiempo entre ambas RTU, el estadio, el grado, el número de implantes tumorales, el tamaño de los implantes, localización dentro de la vejiga, tumor primario o recidivante y el patrón tumoral. RESULTADOS: Al realizar la 2ª RTU se confirmó histológicamente tumor en 14 (37,8 por ciento) de 37 pacientes con tumores Ta-T1 (excluimos aquellos con afectación focal de la muscular): 10 (71,5 por ciento) eran tumores macroscópicamente visibles, en 4 casos (28,5 por ciento) se encontró tumor al biopsiar las áreas de cicatriz/edema de la resección anterior. No encontramos asociación entre la presencia de tumor en la 2ª RTU y ninguna de las variables en estudio. CONCLUSIONES: La erradicación de tumor vesical superficial mediante RTU no se consigue en un elevado porcentaje de pacientes. La cistoscopia a los tres meses no puede excluir tumor residual. Aunque hemos encontrado 37,8 por ciento de tumor en la 2ª RTU, actualmente no podemos recomendarla de forma rutinaria en los tumores vesicales superficiales (AU)

[Epididymal carcinoma. Bibliographic review in reference to a case]. / Carcinoma de epidídimo. Revisión bibliográfica con motivo de un caso.

OBJECTIVE: To describe a case of epithelial cell paratesticular carcinoma of the epididymis and briefly review the literature on this tumor type. METHODS/RESULTS: A 69-year-old male consulted for a testicular mass and intrascrotal pain, together with irritative bladder symptoms. The patient underwent orchidectomy, but consulted again shortly thereafter for persistent irritative bladder symptoms. A TUR biopsy of the bladder wall demonstrated undifferentiated carcinoma arising from the epididymis. The patient did not respond to chemotherapy. He developed systemic metastasis and died 4 months after the diagnosis. CONCLUSIONS: Carcinoma of the epididymis is a rare malignant paratesticular tumor arising from the epithelial cells with a very poor prognosis. Its clinical features are unspecific and this tumor type should be taken into account when making differential diagnosis from intrascrotal masses arsing from other causes. Due to the rarity of this disease, it has not been possible to identify treatments that might achieve better results.

[Chromophobe carcinoma of the kidney]. / Carcinoma cromófobo de riñón.

INTRODUCTION: Chromophobe renal cell carcinoma, described in 1985 is a type of renal carcinoma which is relatively uncommon (5%). Although the majority of studies published suggest a more favourable prognosis, conclusive evidence does not exist. In this study we present the clinical and ultrastructural characteristics and particularly the prognoses of 15 patients taken from a group of 230, all of whom had been diagnosed as suffering from renal carcinoma and for which they had received surgical treatment. MATERIAL AND METHODS: 230 kidneys were analysed between June 1990 and December 1997. The tissue was fixed and dyed with H-E, Hale's acid iron colloid and PAS. Two models were defined, typical and eosinophil. In 8 cases the tissue was processed in order to quantify the DNA using flow cytometry. RESULTS: Of the 230 kidneys analyzed, 15 were identified as being compatible with a diagnosis of chromophobe carcinoma, representing 6.5% of the group studied whilst 73% corresponded to the typical model. The average follow-up period for the 15 patients studied was of three and a half years. Upon completion of the study, 14 out of the 15 patients were still alive and the remaining one had died from causes unrelated to his illness. The average period of survival was 43 months. The tumors had an average diameter of 7.9 cm. The nuclear grade was GII on 10 occasions (seven T2, one T3a and two T3b) and GIII on 5 (four T2, one T3a and two T3b). The study of flow cytometry showed four cases of multiploids two of aneuploids one tetraploid and one diploid. CONCLUSIONS: Chromophobe renal cell carcinoma is a relatively uncommon (6.5%) type of renal carcinoma. The typical ultrastructural type is the most common (73%). The highly favourable pathologic stage (p2 73%) and the significantly low nuclear grade (66% GII) suggest that this is a tumour with a rather better prognosis, as is shown by an increased period of survival.

[Influence of neoadjuvant treatment on bladder infiltrating tumors treated with radical cystectomy]. / Influencia del tratamiento neoadjuvante en los tumores infiltrantes de vejiga tratados con cistectomía radical.

Retrospective study of 107 patients diagnosed with infiltrant tumour of the bladder in stage T3-T4 N0-N1, treated with radical surgery. Eighty-four (84) received neoadjuvant therapy with radio- and/or chemotherapy. The neoadjuvant treatment was seen to provide significantly better survival, but the specific type of neoadjuvant treatment appears to have no influence. The multivariate study evidenced that the two most influential variables for survival are the complementary treatment and the clinical stage.

[Gene sequence analysis of suppressor oncogene p53 in bladder carcinoma]. / Análisis por secuenciación genómica del oncogen supresor p53 en el carcinoma vesical.

A prospective study which analyzes the presence of mutations in the suppressor oncogene p53 through automated genome sequentiation in 75 specimens of transitional cell carcinoma. The presence of mutations correlated to the pathological stage and cellular grade. Also, both the different types of mutations detected and the diversity of their location indicate the heterogeneity of bladder transitional cells carcinoma. The automated genome sequentiation method allows to detect both the type of mutation and the exact location. The detection of suppressor oncogene p53 mutations allows to identify those patients who may be at higher risk of disease progression and therefore those who should undergo a more intense follow-up.

[Pheochromocytoma]. / Feocromocitoma.

Presentation of 7 case reports of pheochromocytome, diagnosed and treated in our Centre between 1981 and 1995. Clinically all patients had hypertension. Three presented the triple condition of hypertension, pulsatile headache and palpitations. The most useful analytical studies were urine vainillylmandelic acid (VMA) and catecholamines. The main radiologic method was the scanner (CT). Pre-surgical preparation was with alpha-blockers in 5 patients, adding beta-blockers in 3. Treatment was surgical in all cases, and the approach was selected based on the tumour's size and location. One patient with severe rheumatic heart disease died on day 3 post-surgery. Mean follow-up is 19 months, and only one patient requires anti-hypertensive medication following surgery.

[The complications of retropubic radical prostatectomy]. / Complicaciones de la prostatectomía radical retropúbica.

Between January 1989 and October 1995, 104 prostatectomies were performed in patients with prostate carcinoma in our centre. Mean follow-up 22 months, range 3-84 months. Overall frequency of complications was 33%. No fatal complications were reported. Complications in the early post-operative occurred in 17 patients (16%); late complications in 18 patients (17%), the most frequent one was stenosis of urethrovesical by-pass. No case of total incontinence has been recorded. The rate of stress incontinence at 3 months was 36% and 15% at 9 months.

[Bladder metastasis of lung adenocarcinoma]. / Metástasis vesical de adenocarcinoma de pulmón.

Secondary or metastatic vesical tumours are a very uncommon condition (less than 1% of vesical tumours). Dissemination routes are usually through blood and lymph, and diagnosis occurs typically in advanced stages. This paper presents one case of metastatic vesical neoplasia that developed 5 years after diagnosis of the primary lung tumour.

[Retroperitoneal sarcomas]. / Sarcomas retroperitoneales.

Presentation of 11 cases of retroperitoneal sarcoma. Mean time from the beginning of symptoms to diagnosis is 6 months. The primary complementary study is CT. Surgery was performed in all cases, using complete resection in 6 cases, and partial resection in 5. Ten patients relapsed. 9 of which were treated with surgical rescue, in one or more occasions; chemotherapy was added in 6 cases and radiotherapy in 7. Survival at five years is 68%, with a mean follow-up of 66 months.