Una actualización en el protocolo en cáncer de próstata metastásico hormonosensible / Hormone sensitive protocol for metastatic prostate cancer, an update

Revisar y actualizar los últimos protocolos en cáncer de próstata metastásico hormonosensible para mejorar su manejo clínico en la práctica clínica. Realizar un análisis de los datos y los protocolos más recientes en el cáncer de próstata metastásico hormonosensible según paneles de expertos en este ámbito. Actualmente se necesita un grupo de consenso nominal para unificar y mejorar las recomendaciones para el manejo de pacientes sensibles con cáncer de próstata metastásico. Este documento unifica y mejora el manejo de los pacientes con cáncer de próstata metastásico hormonosensible, con una metodología que combina datos cuantitativos y cualitativos, y basada en la participación de un amplio comité científico designado por la Asociación Española de Urología (AU)

To review and update last protocols in hormone sensitive metastatic prostate cancer for improving clinical management in routine. Evidence analysis available about recent updates protocols in hormone sensitive metastatic prostate cancer according to expert panel of clinicians about this field. A nominal consensus group for unify and improve the recommendations to the management of sensitive metastatic prostate cancer patients is currently needed. This document unifies and improve the management of patients with hormone sensitive metastatic prostate cancer, with a methodology that combines data quantitative and qualitative and based on the participation of a broad scientific committee appointed by the Spanish Association of Urology (AU)

Hormone sensitive protocol for metastatic prostate cancer, an update.

To review and update last protocols in hormone sensitive metastatic prostate cancer for improving clinical management in routine. Evidence analysis available about recent updates protocols in hormone sensitive metastatic prostate cancer according to expert panel of clinicians about this field. A nominal consensus group for unify and improve the recommendations to the management of sensitive metastatic prostate cancer patients is currently needed. This document unifies and improve the management of patients with hormone sensitive metastatic prostate cancer, with a methodology that combines data quantitative and qualitative and based on the participation of a broad scientific committee appointed by the Spanish Association of Urology.

Inflammatory myofibroblastic tumor of the esophagus treated by endoscopy.

Inflammatory myofibroblastic tumors are rare lesions that have been described in virtually every organ including the gastrointestinal tract. The esophagus is an extremely unusual site for these tumors, with only a few cases described in the literature. Surgery has been the most common therapeutic approach used for the resection of these lesions. In the present case, a patient diagnosed with an inflammatory myofibroblastic tumor of the upper esophagus was reported, and it was successfully removed by endoscopy with no complications.

Divertículo vesical / No disponible

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[Acute abdominal pain and mesenteric cyst: Presentation of a case.]. / Abdomen agudo y quiste de mesenterio: Presentación de un caso.

The cysts of mesentery (QM) are organizations whose embryological origin is multiple and the clinical presentation is not clear, in most of the times it is diagnosed of incidental form or by exclusion of other organizations.At least the third part is diagnosed before the 15 years of age, and tends to be of benign nature, but the recurrence she is high when no parched the surgical treatment the totality of the injury.Little series exist reported in Literature in the last years that try to classify and to know the behavior clinical the organization as well as the surgical findings and the histological types without being able to group series greater to 4 patients.The present work tries to inform on the findings ofa pediatric patient of 4 years of age that enter our hospital by a picture of acute abdomen whose diagnosis of certainty was of a QM and to make are vision of Literature in special in our country.

[Dysphagia: Forestier and Rotes Querol disease]. / Disfagia: enfermedad de Forestier y Rotes Querol.

Inside of the study of Dysphagia, until 38% of the greater patients of 50 years, they present/display cervical Osteophytes like cause of Dysphagia; frequently I diagnose passes for the methods of radiology and endoscopy unnoticed. The disease of Forestier and Rotes better well known Querol or like skeletal hiperostosis diffuse idiophatic it is characterized by the formation of spinal and cervical Osteophytes, ossification of ligaments and muscles for vetebrates of the cervical column. Frequently it produces affectation to medullar that it can pronounce like Dysphagia and crosstalk. We presented/displayed the case of a patient of 78 years with chronic pneumopathy, that presents/displays Dysphagia and progressive crosstalk with pondered loss, in where radiology of the cervical column they show cervical osteofitos with espondilolistesis, rectification of the cervical lordosis and diminution of the intersomatic spaces that they compress the trachea and column of air and an extrinsic compression below the cricopharyngeal is documented by endoscopy.

Ectopia renal cruzada con fusión / Crossed renal ectopia with fusion

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Relationship between osteopenia, free testosterone, and vitamin D metabolite levels in HIV-infected patients with and without highly active antiretroviral therapy.

The prevalence of osteopenia in HIV-infected patients is high. However, the mechanisms implicated in bone mass loss in HIV infection are unclear. Because of this, we analyzed serum free testosterone and vitamin D3 hydroxylated metabolites in HIV-infected patients, with and without antiretroviral treatment, and the relation between them and osteopenia. Seventy-four HIV-infected patients were selected because they had frozen sera available at a date close to a DEXA evaluation. Free testosterone, 25(OH)D3, and 1,25(OH)2D3 were determined in frozen serum. There were no differences in free testosterone, 25(OH)D3, and 1,25(OH)2D3 levels between patients with and without osteopenia. 25(OH)D3 levels in naive and HAART-treated patients were 26.2 (10.3-32.8) and 33.1 (20.6-46.8) ng/ml, respectively (p = 0.04). 1,25(OH)2D3 levels in naive and HAART treated patients were 60.3 (49.2-80.8) and 85.5 (68-111.6) pmol/liter (p = 0.01). Free testosterone levels in 9 naive men and in 50 HAART-treated men were 42.6 (24.1-67.3) and 69.2 (47.5-112.1) pmol/liter, respectively (p = 0.04). In conclusion, HIV-infected patients with and without osteopenia showed similar levels of vitamin D metabolites and free testosterone. However, antiretroviral drug-naive patients showed lower serum levels of vitamin D metabolites and free testosterone than HAART-treated patients.

[Prostatic leiomyosarcoma. Report of a case a review of the literature]. / Leiomiosarcoma de próstata. Aportación de un caso y revisión de la literatura.

A 48-year-old male with a leiomyosarcoma of the prostate is presented. The clinical presenting features were those of rapidly evolving prostatism and rectal symptoms (rectal bleeding, sense of rectal fullness and perineal pain). Arising from the smooth muscle cells of the prostate gland, this is a rare neoplasm that account for less than 0.1% of prostate malignancies, with a poor prognosis. It is often difficult to determine a definite origin, being necessary the differential diagnosis with pseudosarcoma, inflammatory fibrosarcoma, prostate abscess and other rare tumors. There is no established protocol of treatment. Combined modality therapy including radical surgery, radiation therapy and chemotherapy seems to be the best, although prognosis remains poor.

Leiomiosarcoma de próstata. Aportación de un caso y revisión de la literatura / Prostate leimiosarcoma. Contribution of a new case and revision of the literature

Presentamos el caso de un paciente de 48 años con un leiomiosarcoma de próstata. Los síntomas iniciales fueron prostatismo de rápida evolución e intensos síntomas rectales (rectorragias, tenesmo rectal, estreñimiento y dolor perineal). El leiomiosarcoma de próstata es una neoplasia poco frecuente (supone menos del 0,1-0,2 por ciento de los tumores prostáticos), con mal pronóstico, que se origina en las células del músculo liso de la glándula prostática. Frecuentemente es difícil determinar su origen rectal o prostático, y debe establecerse el diagnóstico diferencial con el absceso prostático, el pseudosarcoma, el fibrosarcoma inflamatorio y otras neoplasias poco frecuentes de próstata y vesículas seminales. No existe un protocolo terapéutico establecido, aunque la mayoría de los autores proponen una terapia combinada con cirugía radical, quimioterapia y radioterapia. Aún así no se ha conseguido un aumento significativo de la supervivencia, que parece depender más del momento del diagnóstico que de la modalidad terapéutica empleada (AU)

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[Granulomatous orchitis]. / Orquitis granulomatosa.

Granulomatous orchitis is an inflammatory change of the testis. This is a rare lesion of unknown etiology. Usually are unilateral. The clinical appearance varies, and it is difficult to differentiate from testicular cancer. The diagnosis usually being made on histological examination after orchiectomy. Our paper report one case of granulomatous orchitis in a 27 year old patient. A review of the literature is made on the diagnosis and pathogenesis.

Orquitis granulomatosa / Granulomatous orchitis

La orquitis granulomatosa es un proceso inflamatorio en el testículo. Es una lesión rara de etiología desconocida. Habitualmente es unilateral. La forma de presentación clínica es variable y es difícil diferenciar del cáncer de testículo. El diagnóstico habitualmente se realiza mediante estudio histológico después de orquiectomía. Presentamos un caso de orquitis granulomatosa en un varón de 27 años y revisamos la literatura en lo referente al diagnóstico y al tratamiento. (AU)

[Giant renal angiomyolipoma]. / Angiomiolipoma renal gigante.

OBJECTIVE: To present a cae of giant renal angiomyolipoma that required surgical treatment owing to its size and concomitant intratumoral hemorrhage. METHODS: The characteristics of the case are presented and discussed. RESULTS/CONCLUSIONS: Giant renal angiomyolipoma is one of the most frequent causes of Wünderlich syndrome and is diagnosed by ultrasound and CT. The decision to operate is based on the size of the lesion and/or symptomatology, as in the case described herein, which required a simple nephrectomy.

[Intestinal obstruction secondary to peritoneal carcinomatosis after iatrogenic perforation during TUR for transitional cell carcinoma of the bladder]. / Obstrucción intestinal secundaria a carcinomatosis peritoneal tras perforación yatrogénica durante RTU de carcinoma de células transicionales de vejiga.

OBJECTIVE: A case of intestinal obstruction following transurethral resection (TUR) of a locally advanced transitional cell carcinoma of the bladder is presented. METHODS/RESULTS: The unique features of the present case are described. Laparotomy was performed and peritoneal carcinomatosis was found. Renal function became impaired and the abdominal condition persisted. The patient died five days postoperatively. CONCLUSIONS: Intestinal obstruction following TUR of transitional cell carcinoma of the bladder is an uncommon complication that is mainly due to peritoneal seeding following iatrogenic perforation of the tumor or the bladder wall during resection. Still, TUR is undeniably useful in the diagnosis, staging and treatment of bladder neoplasm.

[Self-expanding metallic endoprosthesis in the treatment of recurrent ureteral stenosis]. / Endoprótesis metálicas autoexpandibles en el tratamiento de las estenosis ureterales recidivantes.

OBJECTIVE: To describe two cases of recurrent fibrotic stricture of the uretero-vesical junction treated with a metallic self-expanding endoprosthesis which has successfully achieved patency of the stenotic area in the medium-term. METHODS: Two cases of difficult ureteral stricture are described. Both cases presented obstruction of the terminal ureter by abundant fibrotic tissue in the bladder wall following radical prostatectomy in one case and TUR in the other for non-infiltrating bladder carcinoma. Several attempts to recover patency by endoscopic resection and placement of a double-J stent in these patients had previously failed. The patients were therefore submitted to resection of the fibrotic area and insertion of a self-expanding endoprosthesis (Wallstent), which was eventually enclosed by fibrous tissue at its vesical portion. Both cases underwent resection again and another endoprosthesis (Memotherm) was inserted to extend the previous prosthesis 1 cm within the bladder lumen. RESULTS/CONCLUSIONS: When the endoprosthesis is placed in the uretero-vesical junction with its tip flush with the bladder wall, it is eventually enclosed by fibrous tissue, which invariably leads to recurrent obstruction. We have found that extending the prosthesis 1 cm within the bladder lumen can overcome the foregoing complication, although the long-term results have as yet to be established.