Ovarian Leydig cells (OLC): A histomorphological and immunohistochemical study.

Testicular Leydig cells (LC) regulate the proper development of male individuals, both during fetal life (fetal LC) and puberty (adult LC). In the ovaries of adult women, there are cells that are very similar to Leydig cells, the ovarian hilus cells (OHC), which also produce testosterone. The origin of these cells, in both sexes, remains unknown and is still a matter of debate. We have studied the location, characteristics and relationships of the OHC in 90 patients. The indications for oophorectomy were: metrorrhagia (n=9), prolapse (n=8), endometrial hyperplasia (n=14), cancer (endometrial, myometrial, or cervical) (n=35), uterine leiomyomata (n=14), and various ovarian tumors (cysts and benign tumors, borderline and malignant) (n=10). In addition to the hilus, occasionally the nodules, nests and clusters of OHC were located in the mesovarium, the mesosalpinx, and in the medullar and cortical regions of the ovaries. The morphological (including crystalloids of Reinke) and immunohistochemical (positivity for calretinin and alpha-inhibin) findings were similar to those described for testicular LC. Therefore, OHC can be considered ovarian Leydig cells (OLC). LC are usually found in small numbers in the ovaries, but if one looks for them intentionally, one always finds them. Close relationships were observed between the OLC with nerves and vessels. Moreover, an intraneural location of the OLC was demonstrated in all cases, and these intraneural cells showed similar characteristics to extraneural OLC, suggesting that they derive from endoneural cells which are present in the vegetative nerves of the ovaries.

¿Puede el sugammadex salvar a un paciente en situación "no intubable no ventilable"? A propósito de un caso / No disponible

Mujer de 43 años, programada para tiroidectomía total por bocio multinodular, a quien fue imposible intubar tras la inducción de la anestesia general mediante fentanilo, propofol y rocuronio. Tras tres intentos de intubación, el edema y el sangrado de la vía aérea por manipulación impidieron una adecuada ventilación. El sugammadex no solo permitió revertir la función neuromuscular sino también el restablecimiento de la ventilación espontánea antes de alcanzar una desaturación de hemoglobina crítica. Se analiza el impacto clínico que en la actualidad puede representar el sugammadex en una situación real de "no intubable no ventilable" y como puede influir en el algoritmo de vía aérea difícil de la American Society of Anesthesiologists (ASA) (AU)

Woman, 43 years, scheduled for total thyroidectomy for multinodular goiter, who was unable to intubate after induction of general anesthesia with fentanyl, propofol and rocuronium. After three attempts at intubation, swelling and bleeding of the airway manipulation prevented adequate ventilation. Sugammadex notonly allowed but reverse neuromuscular function also restoring spontaneous ventilation before reaching a critical hemoglobin desaturation. We analyze the clinical impact that today may represent the sugammadex in a real situation of "no intubable not breathable" and how it can influence the difficult airway algorithm of the American Society of Anesthesiologists (ASA) (AU)

Novedades en el uso clínico del Sugammadex / New on the clinical use Sugammadex give

El uso del sugammadex en la práctica clínica ha producido una revolución en el campo de la reversión del bloqueo neuromuscular no despolarizante (BNMND) del grupo de los aminoesteroideos, especialmente rocuronio y vecuronio. Se exponen las últimas novedades en el uso clínico del sugammadex en las poblaciones y patologías especiales, junto con las últimas publicaciones de ensayos clínicos y nuestra experiencia como centro de referencia en la monitorización del bloqueo neuromuscular, así como las nuevas posibilidades terapéuticas del fármaco y las situaciones clínicas con las que el anestesiólogo puede encontrarse en su práctica clínica. Se precisan todavía estudios para poder conocer todas las posibilidades de los usos clínicos del sugammadex en la práctica anestésica. Igualmente, hay un amplio margen para la investigación y el desarrollo de nuevas publicaciones de un fármaco que podría reducir a cero los problemas de la curarización residual, siendo su principal inconveniente su elevado precio(AU)

The use of sugammadex in clinical practice has been a revolution in the field of neuromuscular blockade reversal of no depolarizing (BNMND) group of the aminosteroid, especially rocuronium and vecuronium. We describe the latest developments in clinical use of sugammadex in special populations and conditions, the latest publications of clinical trials and our experience as a reference center for monitoring of neuromuscular blockade, and moreover new therapeutic possibilities of the drug for different clinical situations that the anaesthesiologist can be found in their clinical practice. Studies are required to know all possibilities of clinical use of sugammadex in anaesthetic practice. Furthermore, there are great possibilities for research and development of new publications of a drug that could reduce to zero problems of residual curarization. However, the high price it is the main disadvantage(AU)

Nuevos horizontes en la anestesia actual con el Sugammadex / New horizons in current anesthesia with Sugammadex

Desde la introducción del curare en la anestesia clínica en 1942, la utilidad de los bloqueantes neuromusculares se ha descrito ampliamente en la literatura. Pero a pesar de sus beneficios, siguen teniendo una serie de limitaciones importantes. La dosis del bloqueante neuromuscular durante la intubación orotraqueal continúa siendo un problema debido a la duración clínica de su efecto en cirugías de corta o mediana duración. También estamos muy limitados ante la necesidad urgente de una reversión inmediata en una situación "no intubable no ventilable". Además en cirugía mayor ambulatoria, se continúa pagando el precio de una duración larga del bloqueante neuromuscular al no tener una reversión rápida y predecible del mismo. Por otra parte, también estamos muy limitados para conseguir unas condiciones quirúrgicas óptimas con un bloqueo profundo hasta el final de cirugías exigentes que lo precisan, debido al problema de la curarización residual. Por todo esto, se analiza el impacto clínico del sugammadex desde su introducción hace cuatro años y cómo nos está ayudando a salvar todas estas limitaciones, abriéndonos puertas a nuevos escenarios en nuestra práctica clínica(AU)

Since the introduction of curare in clinical anesthesia in 1942, the utility of neuromuscular blocking agents has been widely described in literature. But despite its benefits, are still a number of important limitations. The dose of neuromuscular blocker during tracheal intubation remains a problem due to the clinical duration of effect in surgery for short or medium term. We are also limited to the urgent need for an immediate reversal in a "cannot intubate cannot ventilate” situation. Also in ambulatory surgery, continue paying the price for a long duration of neuromuscular blocking by not having a predictable and rapid reversal of it. Moreover we are bound to get optimal surgical conditions with a profound block to the end of demanding surgeries that require it due to the problem of residual curarization. For all this, we analyze the clinical impact of sugammadex since its introduction four years ago and how is helping to save all these limitations, opening doors to new scenarios in our clinical practice(AU)

Sugammadex, ¿la última bala frente al shock anafiláctico por rocuronio? / Sugammadex: the last shot for anaphylactic shock due to rocuronium?

No disponible

Hemangioendotelioma epitelioide de pene / Epithelioid hemangioendothelioma of penis

Describimos un HE de pene en un varón de 64 años. Se trata de un tumor vascular de potencial maligno intermedio entre un hemangioma y un angiosarcoma de muy escasa aparición en esta localización. Su tratamiento comprende la extirpación amplia y la vigilancia una vez descartada la presencia de metástasis o multifocalidad. La histopatología es esencial en el diagnóstico

A case of EH of the penis in a sixtyfour-year-old patient is described. This is a rare –in this location- vascular tumor of borderline malignant potential between hemangioma and angiosarcoma. Local excision of the tumor with a cut-off of normal tissue and careful follow-up of the patient is the accepted procedure. Immunohistochemistry is essential for the diagnosis

[Epithelioid hemangioendothelioma of penis]. / Hemangioendotelioma epitelioide de pene.

A case of EH of the penis in a sixtyfour-year-old patient is described. This is a rare--in this location--vascular tumor of borderline malignant potential between hemangioma and angiosarcoma. Local excision of the tumor with a cut-off of normal tissue and careful follow-up of the patient is the accepted procedure. Immunohistochemistry is essential for the diagnosis.

[Fibroepithelial polyp of the urethra in an adult]. / Pólipo fibroepitelial de uretra en un adulto.

We present the case of a fibroepithelial polyp of the prostatic urethra in a forty-five year old patient. This type of polyp is rare in the adult. The principal symptoms which the patient presented were haematuria and an intermittent reduction in micturitional flow. Endoscopic images of the tumour are shown and certain details of its histology; this is a polypoid lesion of loose connective tissue covered by typical urothelium, with occasional fascicles of smooth muscle, no prostatic-type glandular structures and no appreciable inflammatory component.

Pólipo fibroepitelial de uretra en un adulto / Fibroepithelial urethral polyp in an adult

Presentamos el caso de un pólipo fibroepitelial de uretra prostática en un paciente de cuarenta y cinco años. Este tipo de pólipos son poco frecuentes en el adulto. Los síntomas principales que manifestaba el paciente eran hematuria y disminución ocasional del chorro miccional. Mostramos las imágenes endoscópicas del tumor, así como detalles de su histología que corresponde a una lesión polipoide con un revestimiento urotelial típico sobre tejido conectivo laxo, con algún fascículo de músculo liso sin estructuras glanduliformes de tipo prostático ni componente inflamatorio apreciable (AU)

[Adrenal ectopy in epididymis]. / Ectopia adrenal en epidídimo.

OBJECTIVE: To report a case of ectopic adrenal in the epididymis. METHODS: A 17-year-old male consulted for a left varicocele and complaints referred to the right epididymis a year and a half after an episode of acute epididymitis. A nodule was excised from the epididymis. RESULTS: The pathological analysis showed an 0.4 cm nodule comprised of adrenocortical tissue. CONCLUSIONS: Ectopic adrenal cortical tissue is a benign lesion. Although routine search for this lesion is not indicated, it should be resected for histological analysis and differential diagnosis when it is found during a surgical procedure in this area.

[Genital wound caused by low-speed fire arm]. / Herida genital por arma de fuego de baja velocidad.

OBJECTIVE: To report a case of genital gunshot injuries and review the literature. METHODS: A case of low velocity multiple gunshot penile injuries is described. Surgical exploration was performed, gunshot removed and the albuginea repaired. A broad spectrum antibiotic was administered prophylactically for infection. RESULTS: Good cosmetic and functional results, including sexual potency and voiding, were achieved. CONCLUSIONS: Surgical exploration is mandatory in genital gunshot injuries. The best approach to the albuginea is by a crown incision and denudation of the penile skin, which permits surgical repair with excellent cosmetic results.

[Fournier's gangrene after vasectomy]. / Gangrena de Fournier postvasectomía.

OBJECTIVE: An uncommon case of Fournier's gangrene following vasectomy is described. METHODS/RESULTS: A 35-year-old male with no remarkable previous history, who underwent vasectomy in another hospital, developed a clinical picture compatible with Fournier's gangrene 7-8 days later. The patient required wide, aggressive surgical debridement on several occasions with broad spectrum antibiotic coverage. After a long stay at the hospital, the patient was finally discharged and referred to another hospital for plastic surgery. CONCLUSIONS: Fournier's gangrene is a polymicrobial infection of the perineoscrotal region that manifests as a rapidly progressive necrotizing fasciitis. Most of the cases have a predisposing and/or triggering factor. Fournier's gangrene following vasectomy is uncommon. The morbidity and mortality in this severe complication depend on early diagnosis and aggressive surgical management.

[Retroperitoneal mass secondary to Bellini carcinoma]. / Masa retroperitoneal secundaria a carcinoma de Bellini.

Bellini Collecting Duct carcinoma is a rare and aggresive histological variety of renal adenocarcinoma which originates from the epithelium of the collecting tubule, with a well established histological, cytogenetic and inmunohistochemic characterization. It allows us to differenciate this tumor type from the rest of renal adenocarcinomas. There are 7 cases already published in the national literature. We introduce a new case with a particularity that is to show an unusual presentation form. It appears clinically without a specific urological symptomatology and radiologically it present a retroperitoneal mass shape with explains the patient's clinical manifestations.

[The association of pelvic injuries with urethral ruptures]. / Asociación de los traumatismos pélvicos con las roturas de uretra.

INTRODUCTION: Pelvic trauma is associated in a high rate of patients with posterior urethral injuries. Blood at the urethral meatus or the inability to void are suspicious of urethral damage, but their absence do not exclude it. The attempt to pass a urethral catheter can worse a previous injury. METHOD: Retrospective study of 565 pelvic trauma along the last 5 years in the Hospital Valdecilla of Santander. We asses the urethral injury according Colapinto and McCallum classification and their relationship with the pelvic trauma, their outcome and diagnosis methodology. RESULTS: There was 60 urethral injuries among 565 pelvic trauma (10.61%); 15 (25%) grade I were associated with trauma of the posterior ring of the pelvis; 17 (28.3%) grade II were associated in 12 cases with fractures of the anterior ring and in 5 cases with severe fractures of the posterior ring; 28 (46.66%) grade III were associated in 26 cases with fractures of the anterior ring and 2 fracture-luxation of the posterior one. Against the suggest of avoiding the attempt of passing a urethral catheter, nearly all patients had suffered and attempt before the urologist were asked for. The deferred combined urethrography was the best method of urethral evaluation.

[Iatrogenic ureteral lesions in open surgery: review of 10 years]. / Lesiones ureterales yatrógenas en cirugía abierta: revisión de 10 años.

OBJECTIVE: To carry out a revision of iatrogenic ureteral damage during open surgery occurred in our hospital over a 10-year period, to review the literature and to contrast the results. MATERIAL AND METHOD: Between January 1987 and December 1996, 19 cases of iatrogenic ureteral damage were reported in 18 patients. Ureteral damage was the result of gynaecological surgery in 8 cases (42%), general surgery in 5 cases (26.5%), vascular surgery in 4 cases (21.1%) and urological surgery in 2 cases (10.5%). Four patients had been given radiotherapy. In 15 of the ureteral units involved, reconstructive open surgery was performed while the remaining 4 units received conservative therapy. RESULTS: In 11 cases of open surgery the results were good, 2 cases are nephrostomy carriers and 2 underwent nephrectomy. Conservative treatment was resolutive in all instances. CONCLUSIONS: Gynaecological and general surgery are the major causes of ureteral iatrogeny in our media. In more than half the cases, diagnosis is late. Radiotherapy was associated to late diagnosis in all cases. When diagnosed early, both surgical and conservative therapy achieve good results.

[The results of open surgery in the ureteropelvic junction syndrome]. / Resultados de la cirugía abierta en el síndrome de la unión pieloureteral.

OBJECTIVE: To evaluate the efficacy of the Anderson-Hynes pyeloplasty in 47 patients with pelviureteric junction syndrome and to compare our results with the reported results for open surgery and other techniques. METHODS: The records of 47 patients (21 males, 26 females) with pelviureteric junction syndrome treated at the Marqués de Valdecilla University Hospital from 1979-1997 were reviewed. Twenty-eight patients had right-sided involvement and two were bilateral. Mean age at the time of surgery was 35 years. Pain was the most common presenting feature (nephric colic, 28 pts; chronic lumbar pain, 11 pts). RESULTS: The Anderson-Hynes technique was performed in 43 of the 47 patients. IVP showed good results in 74.5%. CONCLUSION: In our experience the success rate achieved with the Anderson-Hynes technique is comparable to those reported elsewhere, which ranges from 65%-100%. Although currently there is considerably less experience with endoscopic and laparoscopic techniques, the results achieved to data appear to be similar to those of open surgery.