Pathological implications of areas of lower enhancement on contrast-enhanced computed tomography in renal-cell carcinoma: additional information for selecting candidates for surveillance protocols.

PURPOSE: Areas of lower enhancement on computed tomography are frequently seen in renal-cell carcinoma. We investigated whether tumor enhancement on the most prominent hypodense areas correlates with the nuclear grade and other pathologic variables. METHODS: From 2004 to 2009, all consecutive patients with a preoperative tomography who underwent radical or partial nephrectomy for renal-cell carcinoma at our tertiary referral center were retrospectively analyzed. Enhancement of the entire tumor on the slice with most prominent areas of lower enhancement was determined. RESULTS: Forty-eight patients were included. Clear-cell carcinoma comprised 91.6 %. Mean areas of lower enhancement for nuclear grade tumors 1-4 were 67.4, 38.7, 27.9, and 15.1 HU, respectively. Areas of lower enhancement negatively correlated with size, nuclear grade, T stage, and pathological stage. Tumors with extension beyond Gerota's fascia (10.5 vs. 35.9 HU, p < 0.001) and positive surgical margins (21.2 vs. 34.8 HU, p = 0.04) had more prominent areas of lower enhancement than organ-confined tumors. When comparing nuclear grade 1-3 to nuclear grade 4 tumors, these areas were significantly lower in the later (36.5 vs. 15.1 HU, p < 0.001). Receiver-operating characteristics curves for detecting nuclear grade 4 showed an area under the curve of 0.808 (95 % CI 0.659-0.957). CONCLUSIONS: Lower enhancement of the entire tumor at the point where hypodense tumor areas are more predominant on tomography is associated with higher nuclear grade and more advanced stage.

Impact of metabolic syndrome on biochemical recurrence of prostate cancer after radical prostatectomy.

INTRODUCTION: Metabolic syndrome (MS) is linked to hormone-dependent cancers. Its prognostic implication in prostate cancer (PCa) is unclear. We analyzed the impact of MS in the survival of men with PCa treated surgically. PATIENTS AND METHODS: We studied patients with PCa, treated surgically between 1990 and 2007, and compared the survival of men with MS (group 1) and without MS (group 2). A subgroup analysis of those in stage pT2 was also performed. We calculated biochemical progression-free survival (bPFS) and cancer-specific survival, and the relation of clinical and pathological variables with these end-points. RESULTS: 65 men had MS. The 5- and 10-year bPFS in group 1 was 36 and 32% vs. 72 and 68% in group 2 (p < 0.0001). In multivariate analysis, prostate-specific antigen (p = 0.001) and MS (p < 0.0001) predicted biochemical progression/recurrence (BP/R). There was no difference in cancer-specific survival between groups (p = 0.40). Of 146 men in stage pT2, 38 had MS; group 1 men had worse 5- and 10-year bPFS (55 and 48%) than group 2 (80 and 73%; p = 0.001). In multivariate analysis, MS was the strongest predictor of BP/R (p = 0.0007). CONCLUSIONS: MS is related to adverse characteristics in PCa and confers poor bPFS after radical prostatectomy. MS is independently associated to the risk of BP/R.

[Prognostic factors in renal-cell carcinoma treated surgically: analysis of a cohort of 345 cases]. / Factores pronósticos en carcinoma de células renales tratado quirúrgicamente: análisis de una cohorte de 345 casos.

OBJECTIVE: To assess the prognostic role of clinical and pathological variables in patients with renal-cell carcinoma (RCC) treated surgically. MATERIAL AND METHODS: We retrospectively analyzed our database of 394 consecutive patients with renal tumors. We excluded those with hereditary conditions, benign tumors or histological diagnosis other than RCC. The variables evaluated were weight loss, performance status, thrombocytosis, tumor diameter, nuclear grade, lymph node invasion and metastases. The main endpoint was cancer-specific survival (CSS). We performed univariate and multivariate analysis to determine prognostic factors. RESULTS: We identified 345 patients with RCC treated surgically between 1980 and 2009. After a median follow-up of 32 months, 23% died from cancer; they had larger tumors (p<0.0001), higher nuclear grade (p<0.0001) and lymphovascular invasion (p<0.0001). The 5- and 10-year CSS was 97.6 and 97.6% for stage I, 75.3 and 63.8% for stage II; 62.3 and 55.5% for stage III; 16.5 and 11.0% for stage IV (p<0.0001). All variables were associated with CSS on univariate analysis. On multivariate analysis tumor size, thrombocytosis, nuclear grade, lymph node invasion and metastases were independently associated with cancer-related mortality. CONCLUSION: Our findings confirm the potential role of tumor size, nuclear grade, lymph node invasion and metastases. Thrombocytosis also has a prognostic role in patients with renal-cell carcinoma.

Time to recurrence after nephrectomy as a predictor of cancer-specific survival in localized clear-cell renal cell carcinoma.

OBJECTIVE: To evaluate the prognostic impact of early recurrence (within 12 months) after surgery on cancer-specific survival (CSS) of patients with localized clear-cell renal cell carcinoma (ccRCC). METHODS: Patients with surgically treated localized ccRCC were studied. Using the Kaplan-Meier method, we calculated CSS; by univariate and multivariate models we analyzed the association of early recurrence with cancer-related mortality. RESULTS: We identified 259 patients with pT1-4/NX/0M0 ccRCC treated between February 1981 and September 2009; of 66 (25.5%) with disease recurrence, 29 (43.9%) had early relapse. Overall, 43 patients (16.6%) died from ccRCC. The 5- and 10-year CSS for those without, late and early recurrence was 98.5 and 96.5%, 53 and 39.8%, and 23 and 23%, respectively (p < 0.0001). In the multivariate Cox model, pT stage (p = 0.01) and early recurrence (p < 0.0001) independently predicted CSS. CONCLUSIONS: Recurrent disease after localized ccRCC confers a poor prognosis, especially if detected within 12 months after surgery. Thus, this criterion should be included as an independent risk factor for cancer-related mortality.

Impact of lymph node invasion and sarcomatoid differentiation on the survival of patients with locally advanced renal cell carcinoma.

INTRODUCTION: The application of current prognosticators in locally advanced nonmetastatic renal cell carcinoma (RCC) is controversial. We analyzed the impact of clinical and pathological variables on the survival of this subset of patients. PATIENTS AND METHODS: We studied patients with RCC in stages III and IV without metastases, treated surgically between 1980 and 2009. We calculated disease-free (DFS) and cancer-specific survival (CSS), and the relation of clinical and pathological variables with these end-points. RESULTS: We identified 126 patients with locally advanced RCC; 8.7% had sarcomatoid differentiation. Tumor stage was pT3a in 48% and pT3b in 42%; 11.9% had lymph node invasion (N+). Patients with N- and N+ had a 10-year DFS of 49.0 and 23.4%, respectively (p = 0.0001). In multivariate analysis N+ (p = 0.0002) was the strongest predictor of DFS. The 10-year CSS of patients without sarcomatoid differentiation was 53.1% while those with sarcomatoid differentiation did not reach the median time to death (p < 0.0001). In multivariate analysis, sarcomatoid differentiation (p = 0.01) was the strongest predictor of CSS. CONCLUSIONS: Locally advanced RCC portends poor prognosis. Preoperatively, weight loss and Eastern Cooperative Oncology Group performance status are predictors of recurrence and mortality, respectively. However, the most powerful predictors of DFS and CSS in our cohort were lymph node status and sarcomatoid differentiation.

[Influenza A H1N1 (2009): considerations at the time of declaring the end of the contingency in Mexico]. / La influenza A H1N1 (2009): el recuento al declararse el término de la contingencia en México.

We review important aspects of the pandemic influenza A (H1N1) at the time of declaring the end of the contingency in Mexico. The pre-established surveillance system had to be modified during the course of the epidemic. From the first epidemic weeks, viral monitoring recorded the displacement of other pathogens by the pandemic virus. Patients at high risk for complications were identified together with the need for early treatment with antiviral drugs, thus avoiding the saturation of intensive care beds. The difficulties of surging services for seriously ill patients are described. Preventive measures such as the use of masks and hand hygiene are reviewed, as well as the vaccination drive and the difficulties for its application in health personnel. The review concludes with the need to learn the teachings of the pandemic, describing the necessary elements to prepare against the next one.

Genetic association of monocyte chemoattractant protein 1 (MCP-1)-2518 polymorphism in Mexican patients with transitional cell carcinoma of the bladder.

OBJECTIVE: To investigate the role of MCP-1-2518, stromal cell-derived factor-1 (SDF-1)-G801A and chemokine receptors CCR5-Delta32, CCR5-59 029, and CCR2-64I gene polymorphisms in transitional cell carcinoma of the bladder in Mexican Mestizo patients. METHODS: Forty-seven unrelated consecutive patients with non-muscle-invasive transitional cell carcinoma (TCC) and 126 unrelated healthy individuals were studied. Genomic extraction was carried out from complete blood samples using the salting out method. The PCR-RFLP method was used to amplify the following polymorphisms: MCP-1-2518, SDF-1-G801A, CCR5-Delta32, CCR5-59 029, and CCR2-64I. RESULTS: The patients were divided according to low, intermediate, and high risk of progression and treated accordingly with surveillance or immunotherapy with BCG. SDF-1-G801A, CCR5-Delta32, CCR5-59 029, and CCR2-64I polymorphisms were not associated with the genetic susceptibility to non-muscle-invasive TCC of the bladder in Mexican patients. The distribution of AA, AG, and GG genotypes of MCP-1-2518 was significantly different in bladder cancer patients compared with controls (P = .006). There was a significant decrease both in the frequency of the G mutant allele (P = .021, OR = 1.752; C 95% CI 1.088-2.828) and in the GG genotype (P = .001, OR = 6.097 95% CI 1.885-19.570) in TCC patients, compared with controls. CONCLUSIONS: This preliminary study shows that MCP-1 polymorphism is associated with TCC.

The role of radical prostatectomy in the management of patients with high-grade prostate cancer and/or locally advanced disease.

OBJECTIVE: To analyze the outcome of patients with clinically localized prostate cancer (PCa) treated with radical prostatectomy (RP) in whom high-grade (HGPCa) and/or locally advanced disease (LAPCa) was found at RP specimen and to evaluate the prognostic value of well-known factors in this subset of patients. MATERIAL AND METHODS: Biochemical progression-free (bPFS) was determined with the Kaplan-Meier method. The effect of PSA, biopsy Gleason, clinical stage and number of adverse pathological factors was assessed with univariate and multivariate analyses. RESULTS: After RP, 87 men had HGPCa (20.7%) or LAPCa (56.3%), with 20 (23%) having both criteria. Mean PSA was 15.5 +/- 14.0 ng/mL and mean follow-up 50.5 +/- 42.6 months. The 5-year bPFS for men with PSA < 10 ng/mL and > or = 10 ng/mL was 54.7% and 35.7%, respectively (p = 0.03). Regarding biopsy Gleason, the 5-year bPFS was 49% and 26% for patients with a score < or = 7 and > 7, respectively (p = 0.002). In the multivariate model, the biopsy Gleason score remained independently associated with biochemical progression. CONCLUSIONS: HGPCa and/or LAPCa confer poor prognosis; however, RP appears to offer acceptable control, particularly when initial PSA is < 10 ng/mL and biopsy Gleason is 7 or less.

Primary synovial sarcoma of the kidney: corroboration with in situ polymerase chain reaction.

Synovial sarcoma is a tumor of the soft tissues with a unique chromosomal translocation t(X;18)(p 11.2;q11.2) that can be detected by polymerase chain reaction in tissue homogenates. The case of a 32-year-old woman with a primary synovial sarcoma of the kidney is described, the diagnosis was corroborated by the recently developed method of in situ polymerase chain reaction (IS-PCR). Synovial sarcoma of the kidney may be confused with other spindle cell tumors, for that reason IS-PCR may be useful to confirm the diagnosis in paraffin-embedded material.

Association between polymorphisms of the androgen and vitamin D receptor genes with prostate cancer risk in a Mexican population.

INTRODUCTION: Prostate cancer (PCa) is a worldwide health issue, because of its high incidence and mortality. Its etiology is complex and includes certain risk factors such as age, hormonal status, ethnic origin and family history of PCa. Genetic predisposition is proposed as a major risk factor and there are several controversial reports on the association of PCa and gene polymorphism such as the receptors of the androgen receptor (AR) and the vitamin D (VDR). Objective. To evaluate the CAG triplet repeats in the first exon of the AR and polymorphisms in the restriction site Taql in the VDR in Mexicans with PCa. MATERIAL AND METHODS: A total of 68 Mexicans with histopathological diagnosis of PCa and 48 healthy Mexican with normal prostate-specific antigen and rectal exam where included. 10ml of peripheral blood were extracted to isolate DNA and the polymorphisms were evaluated with specific primers for the AR and VDR. RESULTS: The allelic and genetic distributions of the AR and VDR polymorphisms were consistent with the Hardy-Weinberg equilibrium, and there were no statistical differences between the PCa patients and controls (p > 0.05). However, there was a statistical difference between the number of CAG repeats in younger patients with PCa compared to controls (p = 0.045) but when the young patient group was compared versus the elder group there was not stadistically difference (p = 0.085), but the results showed a tendency towards less repetitions of CAG in elder patients. Concerning the VDR, when we analyzed the patients with PCa and a bad pathological prognosis they had a less frequent genotype of TT (p = 0.03). CONCLUSIONS: Our results suggest an association between the VDR and AR gene polymorphisms, and the histopathological score and age at diagnosis in Mexican patients with PCa, respectively. However, it is important to confirm these results in a larger scale study.

Partial nephrectomy for renal tumors using selective parenchymal clamping.

PURPOSE: To describe our experience with partial nephrectomy using selective parenchymal clamping for the treatment of renal tumors. PATIENTS AND METHODS: Between 2003 and 2005, seven patients with solid renal tumors underwent partial nephrectomy with selective parenchymal clamping at our Institution. In five, the tumor was in the right kidney and in two the tumor was in the left. Only one patient had a tumor within a solitary kidney. The tumor was located in the upper pole in 2 patients and in the lower pole in 5. Partial nephrectomy was performed with the DeBakey aortic clamp without occlusion of renal vessels. RESULTS: Mean operative time was 236 min (range 175-298 min). Mean intraoperative blood loss was 485 ml with only one patient requiring blood transfusion. There were no major complications. Mean preoperative serum creatinine level was 0.74 mg/dl (range 0.58-1.26 mg/dl) and mean postoperative serum creatinine level was 0.81 mg/dl (range 0.69-1.21 mg/dl) with no patient requiring dialysis. Mean hospital postoperative stay was 5 days (range 4-7 days). Mean tumor size was 2.9 cm (range 1.3-4.0 cm). Pathologic analysis detected renal cell carcinoma in 5 patients, angiomyolipoma in 1 and fibrosis with chronic hemorrhage in 1, all with negative surgical margins. After a mean follow-up of 18 months (range 3-32 months), all patients are free of disease recurrence. CONCLUSION: Partial nephrectomy with selective parenchymal clamping allows resection of solid masses without damage to normal renal tissue, avoids the risk of renal failure and offers an excellent local cancer control.

Association between polymorphisms of the androgen and vitamin D receptor genes with prostate cancer risk in a Mexican population / Asociación entre polimorfismo de andrógenos y receptores de vitamina D con riesgo de cáncer prostático en una población mexicana

Introduction. Prostate cancer (PCa) is a worldwide health issue, because of its high incidence and mortality. Its etiology is complex and includes certain risk factors such as age, hormonal status, ethnic origin and family history of PCa. Genetic predisposition is proposed as a major risk factor and there are several controversial reports on the association of PCa and gene polymorphism such as the receptors of the androgen receptor (AR) and the vitamin D (VDR). Objective. To evaluate the CAG triplets repetitions in the first exon of the AR and polymorphisms in the restriction site Taql in the VDR in Mexicans with PCa. Material and methods. A total of 68 Mexicans with histopathological diagnosis of PCa and 48 healthy Mexican with normal prostate specific antigen and rectal exam where included. 10ml of peripheral blood were extracted to isolate DNA and the polymorphisms were evaluated with specific primers for the AR and VDR. Results. The allelic and genetic distributions of the AR and VDR polymorphisms were consistent with the Hardy-Weinberg equilibrium, and there were no statistical differences between the PCa patients and controls (p > 0.05). However, there was a statistical difference between the number of CAG repeats in younger patients with PCa compared to controls (p = 0.045) but when the young patient group was compared versus the elder group there was not stadistically difference (p = 0.085), but the results showed a tendency towards less repetitions of CAG in elder patients. Concerning the VDR, when we analyzed the patients with PCa and a bad pathological prognosis they had a less frequent genotype of TT (p = 0.03). Conclusions. Our results suggest an association between the VDR and AR gene polymorphisms, and the hystopathological score and age at diagnosis in Mexican patients with PCa, respectively. However, it is important to confirm these results in a larger scale study.

Introducción. El cáncer de próstata (PCa) es un problema de salud mundial, tanto por su elevada incidencia como mortalidad. Su etiología es compleja e incluye factores de riesgo reconocidos como la edad, estado hormonal, origen étnico y antecedentes familiares de PCa. El fondo genético es un factor de riesgo y existen reportes controversiales de la asociación de PCa y polimorfismos en los genes como son los receptores de vitamina D (VDR) y el de andrógenos (AR). Objetivo. Evaluar las repeticiones de tripletes de CAG en el primer exon del AR y polimorfismos en el sitio de restricción Taql en el VDR en mexicanos con PCa. Material y métodos. Se incluyeron 68 mexicanos con diagnóstico histopatológico de PCa y 48 mexicanos con niveles normales de antígeno prostático y tacto rectal normal. Se les extrajo 10 mL de sangre periférica para aislar DNA y mediante olígos específicos se evaluaron los polimorfismos mencionados. Resultados. La distribución alélica y genotípica de los polimorfismos en el AR y VDR fueron consistentes con el equilibrio de Hardy-Weinberg, y no mostraron diferencias significativas entre los casos y controles (p > 0.05). Sin embargo, el número de repeticiones de CAG en el AR fueron estadísticamente diferentes en pacientes jóvenes con PCa comparados con los controles (p = 0.045), cuando se comparó el grupo de pacientes de jóvenes contra aquellos mayores de 60 años no se encontró diferencia estadísticamente significativa (p - 0.085); sin embargo, se observó una tendencia de un número menor de repetidos CAG en pacientes mayores con PCa. Por otra parte, al comparar VDR en los pacientes con PCa de mal pronóstico por el patrón histológico tenían menor frecuencia de genotipos TT (p - 0.03). Conclusiones. Nuestros resultados sugieren una asociación entre los polimorfismos de los genes del VDR y AR, y el patrón histológico y la edad al diagnóstico en pacientes mexicanos con PCa, respectivamente. Sin embargo, es necesario confirmar estos resultados en un estudio con mayor número de pacientes.

Carcinoid tumor arising in a horseshoe kidney.

Carcinoid tumors are common neoplasms developing in gastrointestinal and respiratory tract. They are rarely found in the kidney. To date, approximately 40 cases of primary renal carcinoid tumors have been reported, with less of a third of them occurring within a horseshoe kidney. These cases appear to have a better prognosis, even in the presence of distant metastases, compared to those arising in normal kidneys.

El estudio del donador vivo para trasplante renal / Evaluation of the living kidney donor

Currently, due to the deficit of cadaveric tissues available for transplantation and due to the long waiting list for a kidney transplant, there is a clear tendency towards living donor kidney transplantations. Most donors are genetically related. Living donation should be considered a gift of extraordinary value, and should be made easy whenever a suitable donor is available. Worldwide, the number of patients on the waiting lists for a kidney transplantation has increased, in the last decades. Renal transplantation with living donor kidneys, is currently considered the best treatment for patients with end stage renal failure, due to the improved short and long term survival benefits over dialysis treatment. Since considerable difference exist between countries in the evaluation and selection criteria for kidney donors, especially in selected patients such as older donors and those with associated comorbid conditions, it is necessary to discuss and establish minimal selection criteria for this cases. A common trend includes a complete clinical record, laboratory and radiologic evaluation which are described in detail in this paper. We also discuss the increasing acceptance of older kidney donors as well as the acceptance of individuals with comorbidities (such as obesity, hipertensión, hyperglucemia, lithiasis and cancer) that were previously considered as not eligible for kidney donation.

Actualmente, por la falta de órganos para trasplante renal provenientes de cadáveres, y debido al largo tiempo de espera por un riñón, existe una tendencia a realizar trasplantes renales utilizando riñones procedentes de donadores vivos. La mayoría de los donadores son familiares del receptor. La donación de órganos debe considerarse como un regalo con un valor extraordinario y debe facilitarse a los candidatos a donación. En todo el mundo se ha observado un aumento en el número de personas en la lista de espera para un trasplante renal. El trasplante renal de donador vivo se considera actualmente como el mejor método de tratamiento en pacientes con insuficiencia renal terminal, debido a que ofrece la mayor supervivencia a corto y largo plazos. En vista de que existen diferencias significativas en los criterios de selección y evaluación de donadores renales, en especial en un grupo selecto de pacientes añosos o con enfermedades asociadas, es indispensable establecer criterios mínimos de selección. Todos los donadores deberán contar con una historia clínica completa y exámenes de laboratorio y gabinete que permitan su evaluación integral. Estos estudios se describen con detalle en este artículo. También se discuten los criterios para donadores renales con ciertas comorbilidades (obesos, hipertensos, hiperglucémicos, con litiasis y neoplasias) que previamente se descartaban como candidatos para donación.

[Evaluation of the living kidney donor]. / El estudio del donador vivo para trasplante renal.

Currently, due to the deficit of cadaveric tissues available for transplantation and due to the long waiting list for a kidney transplant, there is a clear tendency towards living donor kidney transplantations. Most donors are genetically related. Living donation should be considered a gift of extraordinary value, and should be made easy whenever a suitable donor is available. Worldwide, the number of patients on the waiting lists for a kidney transplantation has increased, in the last decades. Renal transplantation with living donor kidneys, is currently considered the best treatment for patients with end stage renal failure, due to the improved short and long-term survival benefits over dialysis treatment. Since considerable difference exist between countries in the evaluation and selection criteria for kidney donors, especially in selected patients such as older donors and those with associated comorbid conditions, it is necessary to discuss and establish minimal selection criteria for this cases. A common trend includes a complete clinical record, laboratory and radiologic evaluation which are described in detail in this paper. We also discuss the increasing acceptance of older kidney donors as well as the acceptance of individuals with comorbidities (such as obesity, hypertension, hyperglucemia, lithiasis and cancer) that were previously considered as not eligible for kidney donation.

[Kidney oncocytoma: diagnostic and therapeutic approach in the INCMNSZ]. / Oncocitoma renal: abordaje diagnóstico y terapéutico en el INCMNSZ.

INTRODUCTION: Renal oncocytoma is a benign tumor that in some series represents up to 18% of all solid neoplasms measuring 4 cm or less. Since radiologic distinction between a renal cell carcinoma and oncocitoma is practically impossible, the histologic examination represents the cornerstone of diagnosis. Follow up will be greatly modified by the diagnosis of oncocytoma since it displays a benign course. Eight cases are presented here that were treated at our institution with special mention to diagnosis and therapy. MATERIAL AND METHOD: A retrospective review was performed using records of 288 patients with kidney tumors from 1971 to 2002. Cases had to have several tissue staining including E&O, Schiff's peryodic acid, coloidal Iron, Alcian blue and mucicarmin. RESULTS: A total of 8 cases (4 men and 4 women) of oncocitoma were detected (2.7%). Patients had a mean age of 50 years (36-69), none had familial history of renal tumors and hipertension was detected in 6. Patients were diagnosed after surgery since radiologic studies suspected renal carcinoma in all patients. The neoplasms measuring more than 8 cm and association with renal cancer in a patient. Follow up was course benign in all patients without recurrence. DISCUSSION: Renal oncocytoma represent a small proportion of renal tumors seen in our institution. It must be suspected in solid renal neoplasms measuring less than 4 cm more so if a centrally located scar is seen on CT scan creating a wagon wheel appearance. Definitive diagnosis is made by histologic examination after a chromophobe tumor is ruled out. Since it has a benign course, minimal radiologic follow up is warrented.

[Results of nephrectomy in patients with autosomal dominant polycystic kidney disease]. / Resultados de la nefrectomía abierta en pacientes con enfermedad renal poliquística autosómica dominante.

BACKGROUND: Nephrectomy in patients with polycystic kidney disease (PKD) is indicated in cases of hematuria, pain, hypertension, infections or before a renal transplant. The purpose of this study is to report our results of this procedure during a contemporary period of time in patients with PKD. MATERIALS AND METHODS: The study consists on a retrospective of files from patients with PKD, including all cases with unilateral or bilateral nephrectomy. We analyzed general data and compared the results from the surgical procedure between bilateral nephrectomy, unilateral nephrectomy and 2 staged bilateral nephrectomy. RESULTS: A total of 14 PKD patients treated with nephrectomy where gathered. Mean patient age was 46 years; 78.5% has chronic renal insufficiency treated with dialysis. The decision of surgery was based predominantly on the presence of two or more symptoms. A total of 24 procedures where done; 7 patients with simultaneous bilateral nephrectomy, 3 with bilateral nephrectomy done in 2 different stages and 4 patients with unilateral nephrectomy. Good operative results where observed with minimal complications. Bilateral simultaneous nephrectomy was completed in a longer time interval than unilateral procedure (255 vs. 195 min, p = 0.008) and with a slight more bleeding (775 vs. 400cc, p = 0.008). CONCLUSIONS: Open nephrectomy remains as the standard procedure for patients with polycystic kidney disease (PKD). Although minimal operative differences where seen between unilateral or bilateral 2 stage nephrectomy and bilateral simultaneous nephrectomy, the overall morbidity was similar between procedures.

Immune response induced in vitro by CD16- and CD16+ monocyte-derived dendritic cells in patients with metastatic renal cell carcinoma treated with dendritic cell vaccines.

Monocyte-derived dendritic cells (mDC) are increasingly used as cancer vaccines. However, human monocytes are a heterogeneous cell population. We showed previously that DC derived from a monocyte subset expressing CD16 (16+mDC) stimulated allogeneic naïve T lymphocytes to secrete higher levels of IL-4 than DC derived from regular CD14(high)CD16(-) monocytes (16-mDC). Th1-type responses have been associated with effective antitumor responses, thus the use of mDC containing 16+mDC as cancer vaccines might be disadvantageous. Here, we evaluate the primary and memory immune response elicited in vitro by 16+mDC and 16-mDC in five patients with metastatic renal cell carcinoma vaccinated with autologous mDC pulsed with tumor lysates (TuLy) and keyhole limpet hemocyanin (KLH). After therapy, three of the five patients had stable disease. Surprisingly, patients with longer survival showed the highest amount of peripheral blood CD16+ monocytes. Analysis of KLH-specific antibodies revealed high titers of IgG2 in patients with longer survival. CD4+ T lymphocyte proliferation against KLH and TuLy increased after treatment, and some patients showed an augmented rate of CD4+ T lymphocyte proliferation against KLH (3/5) and TuLy (2/3) when 16+mDC were used as antigen presenting cells (APC). Before treatment, the IFN-gamma/IL-4 ratio against TuLy and KLH was higher when using 16-mDC as APC, but after vaccination four of five patients had an increased ratio for TuLy with 16+mDC. These results suggest that the immune response elicited by 16-mDC and 16+mDC is modified when memory or naïve T cells are stimulated, and 16+mDC could favor a stronger and more beneficial antitumoral Th1 memory response in vivo.

Experiencia en la reconstrucción de conductos deferentes: análisis retrospectivo de una institución / Experience with the reconstruction of the vas deferens after vasectomy: retrospective analysis of a single-center experience

Introducción: La práctica de la reconstrucción de conductos deferentes (RCD) ha ido en aumento considerable en la actualidad ya que hasta un 6 por ciento de los pacientes vasectomizados la solicitan, teniendo un éxito que va del 28 al 76 por ciento. Material y métodos: se realizó una revisión de los expedientes de los pacientes operados de RCD por vasectomía de 1981 a 1998 analizando la edad, tiempo transcurrido entre vasectomía y RCD, éxito obtenido en base a la espermatobioscopía y logro de embarazo y complicaciones. Resultados: se incluyeron 44 pacientes en el estudio en quienes se utilizó técnica microquirúrgica para la RCD. La edad promedio fue de 35.8 años con un rango que varió de 28 a 52 años. La mayoría pertenecía a la cuarta década de la vida. El tiempo transcurrido entre la vasectomía y la RCD fue de 6.6 años con un rango de 2 a 18 años. Se logró un éxito parcial (espermatobioscopía cualitativa y cuantitativa satisfactoria) de 84 por ciento y total (reflejada por embarazos efectivos) de 52.2 por ciento. Sin embargo si se analiza el éxito con el tiempo transcurrido de obstrucción, los que fueron operados antes de los 5 años tuvieron un éxito parcial de 94.0 por ciento y total de 78.9 por ciento a diferencia de los que se operaron después de los 5 años con éxito parcial de 76.0 por ciento y total de 32 por ciento. Conclusiones: la vaso-vasoanastomosis continúa siendo una de las técnicas microquirúrgicas más efectivas acorde a los recursos con que contamos en nuestro medio. El éxito de esta cirugía tiene una relación inversa con el tiempo transcurrido entre la vasectomía y la RCD

Neoplasias malignas en pacientes con trasplante renal / Malignants neoplasms in patients with renal transplant

Además del riesgo de la pérdida de la función del injerto por rechazo inmunológico, el paciente con transplante renal también está expuesto al riesgo de desarrollar tumores malignos. Se comunica la experiencia en el diagnóstico y tratamiento del cáncer en pacientes con trasplante renal. De agosto de 1967 a diciembre de 1991 se realizaron 338 trasplantes renales en 318 pacientes. De este total, 16 sujetos (5.4 porciento) desarrollaron 25 enfermedades malignas, mismas que fueron diagnosticadas con bases clínicas e histopatológicas. Se analizaron: tipo de tumor, edad, sexo, fuente de injerto, esquema de inmunosupresión, tiempo para diagnóstico del tumor, curso clínico, tratamiento y seguimiento.