El recuerdo de un niño / A child's memory

OBJETIVOS: Es excepcional que los datos de una enfermedad se tomen de un relato histórico en que el autor, el propio rey Alfonso X el Sabio en una de las Cantigas a la Virgen María (monumento de la literatura universal), recita los hechos de cuando era un niño en la ciudad de Cuenca, a mediados de agosto de 1226. Hechos que tuvieron gran resonancia. MÉTODOS: Los estudios de Medicina estaban en plena decadencia que no remontaron hasta la creación de las Universidades (París, Nápoles, Padua, Bolonia y Montpellier). En esta Cantiga se cita a los buenos físicos, médicos. De ahí provenía Pedro de Montpellier, el médico de la Corte del rey Fernando III, que atendió a su mujer Beatriz de Suabia (hija de Felipe, rey de Romanos e Irene Angelo). Fue bautizada como Isabel pero adoptó el nombre de Beatriz en recuerdo de su hermana mayor, emperatriz del S. I. Romano que murió en 1212 en una batalla. Beatriz, con un embarazo muy avanzado, auía tan gran féuer y postración debida a una probable causa urinaria: -ca Pero de Monpisler boos físicos y eran, dizian: -Non uiuerá. Su marido, Fernando III, hace doce semanas que marchó, en campaña, a tierras de su aliado el rey de Baeza. Están con la reina Beatriz sus hijos Fadrique y el mayor, Alfonso. Desahuciada por los médicos, la paciente implora su curación a la imagen milagrosa de la Virgen María que los devotos le acercan estando próxima la fecha de la Asunción. RESULTADOS: La curación se hace efectiva y coincide con el regreso de Fernando III tras la toma de la fortificada Capela. CONCLUSIONES: Alfonso, en acción de gracias por la curación de su madre, la reina Doña Beatriz, dedicará esta Cantiga a la Virgen María

OBJECTIVES: It is exceptional that the data of a disease are taken from a historical account in which the author, King Alfonso X the Wise himself, in one of the songs (Cantigas) to Mary, the Virgin (monument of universal literature), recites the facts from his childhood in the city of Cuenca, in the middle of August of 1226. These Facts had a great resonance. METHODS: The medical studies were in full decay that did not improve until the creation of the Universities (Paris, Naples, Padua, Bologna and Montpellier). In this Cantiga some good physicals, doctors, are mentioned. There does Peter of Montpellier come from, the Court doctor for King Fernando III that took care of his wifeBeatriz of Swabia (daughter of Felipe, Roman King, and Irene Angelo). She was baptized like Isabel but adopted the name in memory of her older sister, empress of the Holy Roman Empire that died in 1212 in a battle. RESULTS: Beatriz, with a very advanced pregnancy, "had such a great fever" and dismay due to a probable urinary cause: "but Pero de Monpisler and other good physicals, they said: -she will not live". Her husband, Fernando III, had marched twelve weeks before, in campaign, to the lands of his ally the King of Baeza. Their children Fadrique and Alfonso, the elder one, were with Queen Beatriz. Condemned by doctors, the patient implored her healing to a miraculous image of Mary, the Virgin, which devotees brought over her in the days when the Assumption festivity was coming. The healing became effective and coincided with the return of Fernando III after the capture of the fortified town of Capela. CONCLUSIONS: Alfonso, in thanksgiving for the healing of his mother, Queen Beatriz, would dedicate this Cantiga to Mary, the Virgin (1)

La litiasis, una enfermedad seguida a través de sus huellas históricas / Urinary lithiasis, a disease followed through its historical footprints

OBJETIVO: A través de dos episodios, encontramos que están íntimamente relacionados con la litiasis. MÉTODOS: En el mismo relato histórico se describen documentalmente los casos. RESULTADOS: La enfermedad litiásica de dos personajes históricamente conocidos. Ambos, en su diferente ambiente cultural, buscan la curación milagrosa. CONCLUSIONES: No se logró en el primer caso y sí en el segundo. Ambos, se sucedieron en plena Edad Media, en un espacio de cien años y a más de cinco mil km. de distancia

OBJECTIVE: Through two historic episodes we find that they are closely related with urinary lithiasis. METHODS: The cases are described and documented in the same historical account. RESULTS: The lithiasic disease of two historical known characters. Both in a different cultural environment looked for a miraculous healing. CONCLUSIONS: Cure was not achieved in the first case but in the second. Both happened in the Middle Age within a period of 100 years and more than 5,000 kilometers away from each other

[Bone lithiasis in the period of the Enlightenment: D.F.J.B. Trehet]. / La litiasis ósea en el periodo de la ilustración: D.F.J.B. Trehet.

OBJECTIVE: To briefly describe the life and works of D.F.J.B. Trehet, a physician of the city of Rouen (France), who was the first to describe the "osseous points" in a renal calculus. Trèhet has not been recognized or referenced for this original observation in the urological publications. METHODS: Trehet lived in the period of the Enlightenment and endured the upheavals of the French Revolution. Data gleaned from several sources have permitted and elaborate description of this French physician from both the social and professional perspectives. RESULTS: After completing his studies at the Hôtel Dieu in Rouen, D.F.J.B. Trehet pursued his education at the School of Health in Paris. He read his doctorate's thesis at the Paris School of Medicine in 1803 and published his observation of a renal calculus "with osseous points" in 1812. Other studies by D.F.J.B. Trehet were also published in Le Journal de Médecine, Chirurgie et Pharmacie. CONCLUSIONS: D.F.J.B. Trehet should be recognized as the first to describe an osseous renal calculus.

[Lithogenesis. Towards a new approach]. / Litogénesis. Hacia un nuevo planteamiento.

OBJECTIVE: To describe a more general, less restrictive approach to stone formation that takes into account experimental data and to develop a hypothesis of stone formation based on experimental, molecular biology and clinical findings. METHODS/RESULTS: Stone formation is reviewed in the light of the authors' findings by means of an appropriate experimental method in an attempt to understand fundamental aspects of urolithiasis. This project, which is currently under discussion, attempts to provide answers to the physiopathological issues of this old disease. CONCLUSIONS: Observation of the experimental phenomena that result in stone formation constitutes a new approach that can provide further insight into stone formation.

[Pyelocalicial diverticula]. / Divertículos pielocaliciales.

OBJECTIVE: To review the embryological and clinical aspects of the different types of pyelocaliceal diverticula, with special reference to the differential diagnosis and treatment. METHODS: Images of type I and II pyelocaliceal diverticula are shown. The conditions that cause difficulty in making the differential diagnosis are discussed. RESULTS: Urography continues to be the diagnostic method preferred and is sometimes aided by retrograde ureteropyelography. CONCLUSIONS: Pyelocaliceal diverticula are cystic eventrations of the upper urinary tract lying within the renal parenchyma that communicate through a narrow channel into the main collecting system. They occur in 0.2 to 0.5% of the population and are congenital in origin. Calyceal diverticula are frequently found incidentally on routine excretory urograms, but patients may complain of flank pain, hematuria or recurrent urinary infections. In the past, treatment required open renal surgery. Endourologic procedures are widely utilized today.

[Nanobacteria. An experimental neo-lithogenesis model]. / Nanobacteria. Un modelo de neo-litogénesis experimental.

OBJECTIVE: To study the phenomenon of biomineralization in an experimental model of lithogenesis by percutaneous renal punction without laparotomy and no antibiotics. METHODS/RESULTS: The study comprised 4 Brown-Norway rats. Nanobacteria inoculum (X, 2X and 4X) was administered to three rats and the remaining one was used as control. The analytical and radiological findings showing the development of obstructive pyelocaliceal lithiasis in the kidneys of rats no. 2 and 3 are presented. CONCLUSIONS: Translumbar percutaneous renal puncture has permitted performing laparotoy without antibiotic coverage, which was the main difficulty of the experimental model of lithogenesis. Nanobacteria were cultured successfully, but not without difficulty, and formation of calculi in the rat pyelocaliceal system was achieved. This experimental model will provide further insight into lithogenesis and will allow us to find the answers to some of the many questions concerning this condition that remain.

[Epidemiology of urinary lithiasis in our Unit. Clinical course in time and predictive factors]. / Epidemiología de la litiasis urinaria en nuestra Unidad. Evolución en el tiempo y factores predictivos.

OBJECTIVES: To analyze the incidence of lithiasis and stone composition in our setting. The trend is compared with the results of the majority of studies on urinary calculi reported in the literature based on the number and composition of stones. METHODS: The study comprised patients referred to the Urolithiasis Unit of our hospital over the last 21 years. Stone composition was analyzed by infra-red spectroscopy. The study period was divided into 4 time intervals: 1977-1979, 1977-1980, 1977-1987 and 1977-1998 in order to determine the trends of the incidence of lithiasis in our setting. RESULTS: A total of 5516 patients were reviewed; of these, 766 had recurrence. The distribution was 385, 995, 3378 and 5516, respectively. Calcium oxalate calculi showed an incidence of 61.3%, calcium phosphate 18.5%, uric acid 11.2%, infectious calculi (ammonium urate and ammonium magnesium phosphate) 6.6%, and finally the incidence of cysteine calculi was 0.77%. Concerning the distribution according to sex, 62% of the males had calcium oxalate stones, 68% uric acid, 42.5% phosphate and 45% infectious lithiasis. The trends for uric acid, infectious, oxalate and phosphate calculi changed over time. CONCLUSIONS: There is a clear trend of calculi prevalence in the male, particularly oxalate and uric acid calculi. There is a trend for cysteine calculi to remain the same, calcium phosphate and oxalate calculi to increase, and uric and infectious calculi to decrease. The changes observed may be due to dietary changes and improvement in the quality of life.

[Silica urolithiasis: report of a new case]. / Litiasis urinaria de sílice: aportación de un nuevo caso.

We report a new case of silica urolithiasis in a 71-year-old patient with background of medicament ingesta (antacid) which could justify the formation of these calculi with so uncommon composition. Medicament calculi amounts about 1% from total urinary calculi. Among them, silica ones (silicon dioxide or Si O2) have been relate din their etiology to chronical ingest of antacid drugs, specially those with magnesium trisilicate. Silica formation in urine is facilitated and conditioned by an acid pH of it. Diagnosis and therapeutical approach does not change in relation to other lithiasis with similar dimension or location. After its composition report, and ruling out the possibility for patient's malingering, urine alkalinization was applied, with an excellent follow-up afterwards. The antacid was substituted by other drug. We analyze the most important aspects about this case. We also make reference to the main related bibliography.

Litiasis urinaria de sílice: aportación de un nuevo caso / Silica urolithiasis: report of a new case

Presentamos un nuevo caso de litiasis urinaria de sílice en un paciente varón de 71 años con antecedentes de ingesta medicamentosa (antiácido) que pudiera justificar la formación de estos cálculos de composición poco común. Los cálculos medicamentosos constituyen aproximadamente un 1 por ciento del total de cálculos urinarios. Dentro de estos, los de sílice (dióxido de silicio o Si O2) han sido relacionados en cuanto a su etiología con la ingesta crónica de fármacos antiácidos, especialmente aquellos que contienen trisilicato de magnesio. La formación de sílice en orina estaría facilitada y condicionada a la presencia de valores ácidos en su pH. El diagnóstico de la litiasis y su enfoque terapéutico no varía con respecto a otros cálculos de similares dimensiones y localización. Tras el informe de su composición, y descartando simulación por parte del paciente, fue instaurada alcalinización urinaria, con una evolución posterior excelente. El antiácido fue sustituido por otro medicamento. Analizamos los aspectos más importantes acerca del caso. Hacemos referencia asimismo a la bibliografía más destacada (AU)

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[Partial nephrectomy in lithiasis]. / Nefrectomía parcial en la patología litiásica.

OBJECTIVE: To analyze our series of patients with renal lithiasis who underwent partial nephrectomy from 1980-1999. METHODS: 28 patients who underwent partial nephrectomy were analyzed (22 females; mean age 48.09 years, and 6 males; mean age 60 years). Surgery for lithiasis had been previously performed in 5 renal units. Nine patients had previously undergone ESWL (more than 3 sessions), all of whom subsequently developed multiple residual calculi. Twelve patients had a microbiologically confirmed positive urine culture. The renal lithiasis amenable to treatment by partial nephrectomy was frequently localized in the lower calyces (17 cases). RESULTS: Histopathological analysis of the nephrectomy specimen showed a prevalence of signs of chronic parenchymal atrophy (25 cases). Three cases showed segmental renal dysplasia (those in whom a superior heminephrectomy was performed for duplex excretory system). Fifty percent of the stone fragments analyzed showed calcium phosphocarbonate. Eight patients had postoperative complications; the most important were two cases of renal cutaneous fistula and one subphrenic abscess. At 9 1/2 years' mean follow-up, renal function is normal in 25 patients. Lithiasis developed in the contralateral unit in 6 cases and in the same renal unit in one case. CONCLUSIONS: Partial nephrectomy continues to be a therapeutic option for lithiasis. Its indication depends on the morphological and functional characteristics of the compromised renal unit, especially in those cases in whom renal preservation can be obviated due to its scanty significance.

[The historical setting of cystine lithiasis]. / Entorno histórico de la litiasis cistínica.

W. H. Wollaston, who first described cystine stones, as well as the most outstanding contemporary figures and their contribution to the understanding of this uncommon type of lithiasis are described.

[Adult renal polycystosis as the causal entity of an intercostal hernia containing an intestinal loop: an unusual clinical case]. / Poliquistosis renal del adulto como entidad causante de hernia intercostal que contiene asa intestinal: caso clínico excepcional.

OBJECTIVE: To describe a case of adult renal polycystosis causing intercostal hernia with intestinal segment. To our knowledge, no such case has been previously reported in the literature. METHODS/RESULTS: Diagnosis was by abdominal CT. Treatment was by bilateral nephrectomy and surgical repair of the diaphragmatic and intercostal hernia. CONCLUSIONS: Surgery is indicated in adult renal polycystosis if kidney size causes gastrointestinal involvement and above all, if the lungs are compromised by the intercostal diaphragmatic hernia.

[Saint Liborius, patron of European urology. Iconography found in Croatia and Spain]. / San Liborio, patrón de la Urología Europea. La iconografía hallada en Croacia y España.

The discovery made by the group of Dr. Stella Fatovic-Ferencic in Varazdin (Croatia) of a painting of St. Liborius, patron saint invoked for calculi, and the painting of the Sevillian school (circa 1700) discovered by another group in Spain have led to the retrieval of part of the history of European Urology forgotten 250 years ago. Saint Liborius, bishop of Le Mans (France), died in 397, at the time the barbarian hordes were ravaging the Roman Empire, which had been divided into a Western and an Eastern Empire on the death of Theodosius I. Learning more about St. Liborius is of interest. Here is an example of the Graeco-Roman culture of antiguity that is passed on to the present time. The significance of both paintings and their differences are described. The article concludes that on the basis of his biography, St. Liborius should be considered the patron saint of Urology.

[Adenomatoid tumor of testicular tunica albuginea: a case report. Histogenetic and therapeutic considerations]. / Tumor adenomatoide de la albuginea testicular: aportación de un nuevo caso. Consideraciones histogenéticas y terapéuticas.

OBJECTIVE: To describe a rare case of adenomatoid tumor of the testicular tunica albuginea and to discuss the clinical, histogenetic and therapeutic aspects. METHODS/RESULTS: A rare case of adenomatoid tumor of the testicular tunica albuginea is presented. The clinical, histogenetic and therapeutic aspects are discussed. CONCLUSIONS: Adenomatoid tumors of the testicular tunica albuginea are rare and are therefore rarely considered. Although 99% of testicular tumors are malignant, it must be emphasized that there are benign testicular tumors, such as adenomatoid tumor, that initially do not require aggressive surgical treatment but intraoperative biopsy and tumor resection.

[Conservative surgery in metanephric renal adenoma]. / Cirugía conservadora en el adenoma metanéfrico renal.

OBJECTIVE: To confirm that metanephric adenoma is a benign tumor with no potential to malignancy, observing its course 6 years after conservative surgical management. METHODS: A light microscopic, immunohistochemical and electron microscopic study of the surgical specimen were performed and the DNA euploidy and proliferation index were determined. RESULTS: Metanephric adenoma is comprised of tubular epithelial structures of small diameter or with virtual lumen, with or without calcifications, psammoma bodies and bony trabeculae. No cell atypia or mitosis was observed. The immunohistochemical study is useful to discard the unlikely metastatic nature of the tumor. It has a euploid DNA distribution and there is practically no proliferation. Electron microscopy showed a scanty amount of microvilli and abundant material between the tubules that appeared to be similar to that of the basement membrane. CONCLUSIONS: Knowledge about this benign disease entity is emphasized in order to avoid unnecessary radical nephrectomies.

[Amino acid sequence of the protein in a pure proteinic calculus]. / Secuencia de aminoácidos de la proteína de un cálculo proteico puro.

OBJECTIVE: The fact that for an equivalent oversaturation of solutes, urine of lithiasic patients has a greater tendency to form crystals, indicate that urine of stone-formers may contain substances that promote crystallization. METHODS: A renal calculus was analyzed by infra-red spectrophotometry, x-ray dispersion energy spectrophotometry, ultraviolet absorption spectrophotometry, acid hydrolysis cationic exchange chromatography, SDA-Page gel electropheresis with Coomassie Blue and amino acid sequence. RESULTS: It was a pure protein calculus formed by a beta 2-microglobulin anomaly. It was a residue that had lost its first 19 amino acids and phenylalanine replaced serine in position 19 CONCLUSIONS: Changes in the amino acid sequence of urinary proteins can cause these to behave like urinary calculus-promoting substances.

[Endometriosis: the cause of hematuria in the dysfunctional ureter]. / Endometriosis: causa de hematuria en uréter desfuncionalizado.

OBJECTIVES: To review the diagnosis and treatment of ureteral stenosis arising from endometriosis and describe a case of mixed (intrinsic and extrinsic) ureteral endometriosis. METHODS: The diagnostic and therapeutic aspects of ureteral stenosis due to endometriosis are reviewed. The case of a patient with a nonfunctioning right kidney and hematuria is described. The patient had previously undergone hysterectomy and double adnexectomy for uterine leiomyofibromas and a right ureteral lesion that warranted cuff ureterocystoneostomy leaving the extreme distal third of the pelvic ureter. CT evaluation disclosed a right retrovesical mass. The therapeutic strategy consisted in performing percutaneous nephrostomy, ureteroscopy of nonfunctioning ureter and determining the nature of the retrovesical mass by fine needle punction aspiration biopsy. RESULTS: Percutaneous nephrostomy achieved functional recovery of the renal unit. Endoscopic incision of the stricture with intravesical invagination of the compromised segment was performed with the combined antegrade and retrograde approach. The anatomopathological findings of ureteroscopic biopsy of an intraureteral lesion in the nonfunctioning ureter disclosed ureteral endometriosis. This finding obviated fine needle punction aspiration biopsy and the patient was treated with danazol for 6 months. CONCLUSIONS: Diagnosis by ureteroscopy should be considered in intrinsic and mixed forms of ureteral endometriosis. Endoscopic incision of the ureteral stricture combined with hormone therapy is a valid therapeutic option.

[Urology of the XIX century in the life of a famous painter. Federico de Madrazo and his medical, historic, and artistic environment]. / La urología del siglo XIX en la vida de un pintor de fama. Federico de Madrazo y su entorno médico, histórico y artístico.

The life Federico de Madrazo y Kuntz, a prominent figure in the history of Spanish Art, is briefly described, highlighting some biographical information about the painter, his contemporaries (Francisco de Goya, whose 250 th anniversary is being celebrated this year; Juan de Villanueva, the architect who designed the Prado Museum), the famous physicians of his paintings, doctors and urologists who treated him for different ailments, one of which was lithiasis.