Valor pronóstico de la invasión microvascular en la predicción de la supervivencia en el carcinoma de células renales / Prognostic value of microvascular invasion in predicting survival in renal cell carcinoma

Objetivos: Evaluar el significado de la invasión microvascular y de otras variables clínicas e histológicas como factores predictivos de supervivencia libre de progresión y supervivencia cáncer-específica de pacientes con carcinoma renal tras cirugía. Material y métodos: Se realizó un estudio analítico retrospectivo sobre 238 pacientes consecutivos con carcinoma renal sometidos a cirugía radical o parcial entre 1990 y 2006, incluyendo tanto casos de enfermedad localizada como aquellos con afectación locorregional o con enfermedad metastásica a distancia en el momento del diagnóstico (pT1-4; N0-1; M0-1). Se evaluó la supervivencia libre de progresión y la supervivencia cáncer-específica tras un seguimiento medio de 75 meses (rango: 1-189). Las variables analizadas incluyeron: edad, sexo, tamaño tumoral, clasificación TNM 2010, gradación nuclear, subtipo histológico e invasión microvascular. Resultados: Se evidenció existencia de invasión microvascular en 79 casos (33,2%). La presencia de invasión microvascular tumoral en el estudio histológico se asoció estadísticamente con la edad (p = 0,010), el tamaño tumoral (p = 0,000), el grado de Fuhrman (p = 0,000), el estadio pT 2010 (p = 0,000), el estadio N 2010 (p = 0,000) y el estadio M 2010 (p = 0,000). En el análisis múltiple las variables que finalmente se mostraron como factores predictores de supervivencia libre de progresión fueron el sexo, el grado de Fuhrman, el estadio pT y el tipo histológico, mientras que lo fueron para supervivencia cáncer específica el sexo, el grado de Fuhrman, el estadio pT 2010, el estadio M 2010, el tipo histológico y la invasión microvascular. Conclusiones: Los resultados de nuestro estudio muestran que la invasión microvascular es un factor predictor de supervivencia cáncer-específica en pacientes con carcinoma renal (AU)

Objective: To assess microvascular tumor invasion and other clinical and histological parameters as potential prognostic factors in surgically treated renal cell carcinoma. Materials and methods: Surgical specimens from 238 consecutive patients who underwent radical or partial surgery between 1990 and 2006 were retrospectively evaluated. The series included clinically localized or metastatic renal cell carcinoma (pT1-4; N0-1; M0-1). Disease-free and cancer-specific survival assessments were the end points with median follow-up of 75 months (range 1-189 months). Variables studied included: age, sex, tumor size, TNM 2010 classification, Fuhrman grade, histological subtype and microvascular tumor invasion. Results: Microvascular tumor invasion was observed in 79 patients (33,2%) and was significantly associated with age (P =0 .010), tumor size (P =0 .000), Fuhrman grade (P = 0.000), pT stage 2010 (P = 0.000), N stage 2010 (P =0 .000) and M stage 2010 (P = 0.000). Multivariate analyses determined that sex, Fuhrman grade, pT stage 2010 and histological subtipe were independent prognostic factors of disease-free survival, while sex, Fuhrman grade, pT stage 2010, M stage 2010, histological subtype and microvascular invasion were prognostic factors for cancer-specific survival. Conclusions: Our study shows that microvascular tumor invasion is an independent prognostic factor for cancer-specific survival in surgically treated patients with renal cell carcinoma (AU)

Prognostic value of microvascular invasion in predicting survival in renal cell carcinoma.

OBJECTIVE: To assess microvascular tumor invasion and other clinical and histological parameters as potential prognostic factors in surgically treated renal cell carcinoma. MATERIALS AND METHODS: Surgical specimens from 238 consecutive patients who underwent radical or partial surgery between 1990 and 2006 were retrospectively evaluated. The series included clinically localized or metastatic renal cell carcinoma (pT1-4; N0-1; M0-1). Disease-free and cancer-specific survival assessments were the end points with median follow-up of 75 months (range 1-189 months). Variables studied included: age, sex, tumor size, TNM 2010 classification, Fuhrman grade, histological subtype and microvascular tumor invasion. RESULTS: Microvascular tumor invasion was observed in 79 patients (33,2%) and was significantly associated with age (P=.010), tumor size (P=.000), Fuhrman grade (P=.000), pT stage 2010 (P=.000),N stage 2010 (P=.000) and M stage 2010 (P=.000). Multivariate analyses determined that sex, Fuhrman grade, pT stage 2010 and histological subtipe were independent prognostic factors of disease-free survival, while sex, Fuhrman grade, pT stage 2010, M stage 2010, histological subtype and microvascular invasion were prognostic factors for cancer-specific survival. CONCLUSIONS: Our study shows that microvascular tumor invasion is an independent prognostic factor for cancer-specific survival in surgically treated patients with renal cell carcinoma.

Loss of heterozygosity at 9q32-33 (DBC1 locus) in primary non-invasive papillary urothelial neoplasm of low malignant potential and low-grade urothelial carcinoma of the bladder and their associated normal urothelium.

Tumour recurrence has a major impact on patients with non-invasive papillary urothelial tumours of the bladder. To explore the role of DBC1 (deleted in bladder cancer 1 locus), a candidate tumour suppressor gene located at 9q32-33, as prognostic marker we have performed loss of heterozygosity (LOH) testing in 49 patients with primary papillary urothelial tumours and associated normal urothelium. Data from the 38 tumours and 11 specimens of normal urothelium that were informative in the LOH study (D9S195 marker) showed that LOH in urothelium (45.4%) but not in non-invasive tumours (60.5%) was associated with tumour recurrence (p = 0.026) but not to grade or progression. Also, tumours whose normal urothelium had LOH were larger (p = 0.020) and showed cyclin D1 over-expression (p = 0.032). Non-significant increased expression of p53, p21Waf1, apoptotic index and tumour proliferation, and decreased expression of p27Kip1 or cyclin D3 also characterized tumours whose normal urothelium had LOH. The expression of these G1-S modulators, apoptotic index and tumour proliferation was more heterogeneous in papillary urothelial tumours, irrespective of having retained heterozygosity or LOH. Also, Bax expression decreased in papillary urothelial tumours having LOH (p = 0.0473), but Bcl-2 was unrelated to LOH status. In addition, FGFR3 protein expression decreased in LOH tumours (p = 0.036) and in those having LOH in their normal urothelium (p = 0.022). FGFR3 immunohistochemical expression was validated by western blot in selected cases. The survival analysis selected LOH in normal urothelium as a marker of disease-free survival (log-rank 5.32, p = 0.021), progression-free survival (log-rank 3.97, p = 0.046) and overall survival (log-rank 4.26, p = 0.038); LOH in tumours was significant in progression-free survival (log-rank 3.83, p = 0.042). It is concluded that LOH at the DBC1 locus in normal urothelium seems to be relevant in the prognosis of non-invasive papillary tumours of the bladder via selecting cases with increased proliferation, frequent alterations of the G1-S phase modulators, and decreased FGFR3 protein expression.

Impaired response of HIV type 1-specific CD8(+) cells from antiretroviral-treated patients.

Impairment of the response of HIV-specific CD8(+) T cells, in spite of the high frequency of occurrence of these cells even in the advanced phase of HIV-1 infection, has been demonstrated. It is also known that new antiretroviral treatments are able to reduce the viral load and partially repair the immunological damage caused by HIV-1, but it is not clear whether the extent of these changes affects the functional profile of HIV-specific CD8(+) T cells. We evaluated, in HIV-1(+) patients undergoing antiretroviral therapy, the HIV-specific CD8(+) subset distribution and their functional capacity as intracellular expression of IFN-gamma, TNF-alpha, and perforin after PMA stimulation. Our results indicate that HIV-1(+)-treated individuals show distributions of HIV-specific CD8 subsets similar to nontreated patients, while the frequency of HIV-specific CD8 cells expressing IFN-gamma and perforin after stimulation is lower in HAART-treated patients. This indicates that HAART, which controls viral replication, may impair the HIV-specific CD8(+) response.

Clasificación de la OMS 2004 para los tumores vesicales: resumen y comentarios / The 2004 who classification of bladder tumors: a summary and commentary

Los puntos clave de la última clasificación de la OMS para los tumores uroteliales no invasivos son los siguientes: la descripción de las categorías ha aumentado para mejorar su reconocimiento: los tumores con particular buen pronóstico (neoplasia papilar urotelial de bajo potencial maligno) no deben ser etiquetados como 'cáncer'; esto evita el uso de una gradación ambigua tal como grado 1/2 o 2/3 (como se hacía en la clasificación de la OMS de 1973); el grupo de los tumores no invasivos de alto grado es bastante grande pues contiene todos los tumores con propiedades biológicas similares a las de los carcinomas invasivos, e igualmente un alto nivel de inestabilidad genética. Este esquema es el que se propone para sustituir a la clasificación de la OMS de 1973, pero no debe invalidarse definitivamente, y usarse conjuntamente con la nueva clasificación de 2004 hasta que esta última esté lo suficientemente validada

The Key points of the latest World Health Organization (WHO) classification of non-invasive urothelial tumors are the following: the description of the categories has been expanded to improve their recognition: a tumor with particularly good prognosis (papillary urothelial neoplasm of low malignant potential) no longer carries the label of 'cancer'; it avoids the use of ambiguous grading as grade 1/2 o 2/3 (as done in the 1973 WHO classification); the group of non-invasive high-grade carcinoma is large enough to virtually contain all those tumors having biological properties similar to those seen in invasive urothelial carcinoma, and a similarly high level of genetic instability. This scheme is meant to replace the 1973 WHO classification, but the use of both the 1973 and the latest WHO classification is recommended until the latter is sufficiently validated

Elective orthognathic treatment decision making: a survey of patient reasons and experiences.

OBJECTIVE: Few studies have explored decisions about orthognathic treatment (OGT) from the patient's perspective. This study describes the factors associated with the patient's decision to have or not have orthognathic treatment, and assesses whether the process can be considered to be informed decision making. DESIGN: A cross-sectional survey employing both interview and questionnaire methods, conducted in four OGT services in Yorkshire. SAMPLE: Participants were patients aged over 16 years, either making an OGT decision over a 6-month period or had made their treatment choice 18-42 months prior to the study start date in 2003. MEASURES: Questionnaires assessed patient demographics, dental history and psychopathology (anxiety, satisfaction with self, body satisfaction, facial appearance); interviews explored patients' reasons for, and experiences of, orthognathic treatment. RESULTS: Of 138 patients approached, 61 participated (mean age 25 years, 66% female). Psychopathology scores were within the normal range. The thematic content analysis of interview transcripts found: reasons given for having OGT were to improve the 'bite', as well as gaining a more normal facial appearance; most patients reported the service information was satisfactory, but about half made negative comments, with some reporting staff communications made them feel worse; knowledge of OGT risks and benefits was poor; patients had strong emotions about their facial appearance and the orthognathic treatment they received, which did not seem to be addressed by current practice. CONCLUSIONS: Some OGT patients do not appear to be making informed decisions about their treatment. They seem to have unmet needs in relation to support for their decision making, and managing the emotional effects of undergoing and adjusting to treatment. The implications for information provision, assessment and support during treatment are discussed.

[The 2004 WHO classification of bladder tumors: a summary and commentary]. / Clasificación de la OMS 2004 para los tumores vesicales: resumen y comentarios.

The Key points of the latest World Health Organization (WHO) classification of non-invasive urothelial tumors are the following: the description of the categories has been expanded to improve their recognition: a tumor with particularly good prognosis (papillary urothelial neoplasm of low malignant potential) no longer carries the label of "cancer"; it avoids the use of ambiguous grading as grade 1/2 o 2/3 (as done in the 1973 WHO classification); the group of non-invasive high-grade carcinoma is large enough to virtually contain all those tumors having biological properties similar to those seen in invasive urothelial carcinoma, and a similarly high level of genetic instability. This scheme is meant to replace the 1973 WHO classification, but the use of both the 1973 and the latest WHO classification is recommended until the latter is sufficiently validated.

Maxillary midline diastema: a case report involving a combined orthodontic/maxillofacial approach.

This paper presents an orthodontic case of a large (14.5 mm) maxillary midline diastema that was related to the presence, and subsequent removal of 2 median maxillary supernumerary teeth and resulting bone loss. A combined orthodontic and maxillofacial approach involving bone grafting and fixed appliances was used to close the space. This episode of care was organized as interceptive treatment during development of the permanent dentition.

Cyclin D3 expression in primary Ta/T1 bladder cancer.

Cyclin D3 deregulation has recently been reported in bladder cancer but its prognostic significance remains uncertain. A cohort of 159 patients with stage Ta or T1 primary bladder tumours was investigated to determine the significance of cyclin D3 expression in association with other G1-S phase regulators of the cell cycle (p53, p21Waf1, p27kip1, cyclin D1), including tumour proliferation (ki67-MIB1); its association with conventional clinicopathological parameters; and the relationship between cyclin D3 and loss of heterozygosity (LOH) at the 9p21 (p16INK4a locus) chromosome region. The end point of the study was progression-free survival. Cyclin D3, other G1-S phase regulators, and tumour proliferation were investigated by immunohistochemistry and measured by the grid-counting method. To validate the immunohistochemical expression, cyclin D3 was additionally assessed by western blotting in selected cases. LOH at the 9p21 chromosome region (marker D9S171) was assessed in 125 cases using an AB Prism 310 genetic analyser and a set of microsatellite fluorescence-labelled primers. Cyclin D3 overexpression was related to larger tumour size (>5 cm; p < 0.0001) and high tumour proliferation (>10%; p = 0.025). Mean cyclin D3 expression increased with 2004 WHO grading categories in stage Ta (p = 0.035, ANOVA) and stage T1 (p = 0.047, t test) tumours. Cyclin D3 was not related to other clinicopathological parameters, G1-S phase modulators, or 9p21 LOH. Cox's multivariate analysis selected cyclin D3 as an independent predictor of progression-free survival (p = 0.0012, relative risk (RR) = 5.2366) together with tumour size (p = 0.0115, RR = 4.4442) and cyclin D1 (p = 0.0065, RR = 3.3023). Cyclin D3 expression had the highest risk ratio. Our results suggest that expression of cyclin D3 is relevant to the progression-free survival of patients with Ta/T1 bladder carcinomas.

Ki-67 MIB1 labelling index and the prognosis of primary TaT1 urothelial cell carcinoma of the bladder.

AIMS: To evaluate whether ki-67 labelling index (LI) has independent prognostic value for survival of patients with bladder urothelial tumours graded according to the 2004 World Health Organisation classification. METHODS: Ki-67 LI was evaluated in 164 cases using the grid counting method. Non-invasive (stage Ta) tumours were: papilloma (n = 5), papillary urothelial neoplasia of low malignant potential (PUNLMP; n = 26), and low (LG; n = 34) or high grade (HG; n = 15) papillary urothelial carcinoma. Early invasive (stage T1) tumours were: LG (n = 58) and HG (n = 26) carcinoma. Statistical analysis included Fisher and chi2 tests, and mean comparisons by ANOVA and t test. Univariate and multivariate survival analyses were performed according to the Kaplan-Meier method with log rank test and Cox's proportional hazard method. RESULTS: Mean ki-67 LI increased from papilloma to PUNLMP, LG, and HG in stage Ta (p<0.0001) and from LG to HG in stage T1 (p = 0.013) tumours. High tumour proliferation (>13%) was related to greater tumour size (p = 0.036), recurrence (p = 0.036), progression (p = 0.035), survival (p = 0.054), and high p53 accumulation (p = 0.015). Ki-67 LI and tumour size were independent predictors of disease free survival (DFS), but only ki-67 LI was related to progression free survival (PFS). Cancer specific overall survival (OS) was related to ki-67 LI, tumour size, and p27kip1 downregulation. Ki-67 LI was the main independent predictor of DFS (p = 0.0005), PFS (p = 0.0162), and cancer specific OS (p = 00195). CONCLUSION: Tumour proliferation measured by Ki-67 LI is related to tumour recurrence, stage progression, and is an independent predictor of DFS, PFS, and cancer specific OS in TaT1 bladder urothelial cell carcinoma.

Once-daily antiretroviral therapy: Spanish Consensus Statement.

BACKGROUND: Administration of antiretroviral therapy (ART) once daily is creating extraordinary interest among the members of the scientific community and also among those who receive the therapy. However, in clinical practice, some doubts remain about its use. OBJECTIVES: This document examines the characteristics and possibilities of treatment administered once daily. METHODS: Consensus of 248 Spanish experts in the field. RESULTS: Once-daily dosing is considered an added value which could favour adherence and, therefore, efficacy, as well as the quality of life of certain patients, however, the objective of adequate adherence in the long term is often difficult to achieve regardless of the treatment used. In theory, any patient can receive once-daily therapy, although some patients could particularly benefit from it, e.g. those with unfavourable social or personal circumstances, including drug users, patients whose treatment must be supervised, patients receiving multiple medications, or those who need rescue therapy after multiple treatment failures. At present, it is possible to design once-daily ART using some of the combinations of drugs considered as first-choice in national and international recommendations for antiretroviral therapy, but the options are still limited. The marketing of new drugs with this characteristic could allow us to increase the number and types of patient who can benefit from once-daily regimens, including those patients who need rescue therapy. CONCLUSIONS: Once-daily ART is a good alternative to regimens administered several times each day when a potent combination of active drugs is available.

Prognostic factors in stage T1 grade 3 bladder cancer survival: the role of G1-S modulators (p53, p21Waf1, p27kip1, Cyclin D1, and Cyclin D3) and proliferation index (ki67-MIB1).

OBJECTIVE: To determine the prognostic value of a subset of regulators of the transition from G1-to-S phase of cell cycle in stage T1 grade 3 bladder cancers. METHODS: Fifty-one such cases were investigated to determine the significance on patient's survival of p53, p21Waf1, p27Kip1, Cyclin D1, Cyclin D3, and ki67-MIB1 (proliferation index). The statistical analysis included Kaplan-Meier methodology with Log-rank test and Cox' proportional hazard analysis. RESULTS: Tumor size (p=0.0034), and the labeling index of ki67-MIB1 (p=0.0034), p53 (p=0.0332), p27kip1 (p=0.0059) and Cyclin D1 (p=0.0103) were associated to disease-free survival. Progression-free survival was related to tumor size (p<0.0001), ki67 (p=0.0163), p53 (p=0.0041), p27kip1 (p=0.0161), Cyclin D1 (p<0.0001) and Cyclin D3 (p<0.0001). Patient's overall survival was associated to Cyclin D3 (p<0.0001), p53 (p=0.0017), p21Waf1 (p=0.0142), Cyclin D1 (p<0.0001), ki67-MIB1 (p=0.0450), and tumor size (p=0.0296). Down-regulation of p27kip1 and Cyclin D3 over-expression (disease-free), over-expression of p53, Cyclin D1 and Cyclin D3 (progression-free), and over-expression of Cyclin D3 (overall survival) were independent predictors by Cox's multivariate analysis. Down-regulation of p27kip1 (p<0.001, R.R. 0.997, 95%C.I. 0.995-0.999), and over-expression of Cyclin D1 (p<0.001, R.R. 1.009, 95%C.I. 1.004-1.014) and Cyclin D3 (p=0.005, R.R. 1.013, 95%C.I. 1.004-1.022) were the main independent predictors. CONCLUSION: Down-regulation of p27kip1 and over-expression of Cyclin D1 and Cyclin D3 might be relevant predictors of survival in stage T1 grade 3 bladder cancers, thus selecting a group of patients at higher risk of malignant behavior.

Orthodontic and orthognathic management of a patient with osteogenesis imperfecta and dentinogenesis imperfecta: a case report.

This case report describes a patient's severe Class III malocclusion, managed with a combination of orthodontic and orthognathic treatment. The medical history was complicated by osteogenesis imperfecta and dentinogenesis imperfecta. In addition the patient was a Jehovah's Witness. Patients with osteogenesis imperfecta carry an increased risk of perioperative haemorrhage, and this led to bimaxillary surgery being carried out as two discrete surgical episodes for the patient described. In addition, the risk of enamel fracture led to orthodontic bands being cemented on all teeth. In spite of the increased risks a successful outcome was achieved.

[Review of cut-off points between stages T1 and T2 in the 1997 TNM classification of renal carcinoma]. / Revisión del punto de corte entre los estadios T1 y T2 en la clasificación TNM del carcinoma renal de 1997.

OBJECTIVE: We retrospectively review the patients treated at our institution for renal cell carcinoma (RCC). We compare the patients classified in TNM state T1N0M0 in the 1997 revision with the 1992 one in order to determine survival differences. We divide patients in three size related groups and compare its survival rates. MATERIAL AND METHODS: We review 168 surgically treated patients. 72 of them were classified into T1N0M0 stage. We compare cancer-free survival in patients included in 1997 and 1992 T1 stage. We divide patients in three groups: 1-3 cm, 3-5 cm, 5-7 cm and compare respective cancer-free survival. RESULTS: There is a survival difference between T1(1997)-T2(1992) (p = 0.478). There is an inferior survival in size group 5-7 cm compared with 1-3 cm and 3-5 cm ones (p = 0.02/0.0465). CONCLUSIONS: In our patients, 1997 revision of T1 size supposes a descent of cancer-free survival compared with 1992 one. We consider a better stage limit under 5 cm, instead of actual 7 cm.

The validity of computerized orthognathic predictions.

OBJECTIVE: utilizing OPAL cephalometric prediction software. DESIGN: A retrospective investigation involving the random selection of Class II orthognathic patients from surgical records. SUBJECTS: These 25 cases had undergone treatment aimed at producing Class I incisors. This involved fixed orthodontic appliances and a mandibular advancement osteotomy with rigid internal fixation. METHODS: Lateral cephalographs from three key stages were digitized and processed using the OPAL software. Pre-treatment predictions were generated and compared with the actual clinical changes. RESULTS: Prediction of some of the principal OPAL variables (SNA, ANB, LAFH%, OJ, OB) was reasonably accurate in terms of mean values. However, there were large individual variations for most measurements, and prediction of Wits, MxP/MnP, LAFH, and LPFH was prone to systematic error. In particular, there was a tendency towards over-prediction of the surgically-induced backward mandibular rotation. CONCLUSION: In lieu of further validation caution should be exercised with the interpretation of individual OPAL predictions, especially vertical skeletal changes, and an explanation given to patients that orthognathic predictions are based on generalizations.

Revisión del punto de corte entre los estadios T1 y T2 en la clasificación TNM del carcinoma renal de 1997 / Cut-off point revision between 1997 TNM classification stages T1 and T2 o renal carcinoma

OBJETIVO: Realizamos un estudio retrospectivo de los pacientes tratados en nuestra institución por carcinoma de células renales (CCR). Comparamos los pacientes clasificados en el estadio T1N0M0 según la revisión TNM de 1997 con la clasificación según la revisión de 1992 para establecer diferencias de supervivencia. Comparamos diferentes cortes por tamaño tumoral y valoramos su implicación en la supervivencia. MATERIAL Y MÉTODOS: Análisis retrospectivo de una serie de 168 pacientes intervenidos por CCR, de ellos 72 clasificados en estadio T1N0M0. Comparamos supervivencia según las dos últimas revisiones TNM y en tres grupos de tamaño: 1-3 cm, 3-5 cm y 5-7 cm. RESULTADOS: Hallamos menor supervivencia en los pacientes T11997 (p=0,0478) y en grupo de tamaño 5-7 cm, con respecto al 1-3 cm (p=0,02) y al de 3-5 cm (p=0,0465).CONCLUSIONES: En nuestra serie, la revisión de 1997 en el estadio T1 supone un descenso de supervivencia. El límite en 7 cm es excesivo, lo consideramos más apropiado por debajo de 5 cm (AU)

Combined treatment with vitamin E and colchicine in the early stages of Peyronie's disease.

OBJECTIVE: To assess the effectiveness of the combination of colchicine and vitamin E (which has anti-fibrotic, anti-mitotic and anti-inflammatory effects) in modifying the early stages of Peyronie's disease, by evaluating pain relief, correction of deformities and plaque size. PATIENTS AND METHODS: In all, 45 patients were divided into two groups and treated from January 1998 to November 2001. Their mean (range) age was 53.4 (40-62) years, the time from onset of the disease < 6 months and they had penile deformity of < 30 degrees; no patient had erectile dysfunction. Twenty-two patients were given ibuprofen 400 mg/day for 6 months, whilst 23 received a combination of vitamin E 600 mg/day plus colchicine 1 mg every 12 h. Pain, plaque size and penile deformity were assessed at 6 months. RESULTS: There were no statistically significant differences between the groups at baseline in age, time from onset of the disease until the initial evaluation or plaque size. Although the proportion of patients reporting pain relief was higher amongst those receiving colchicine plus vitamin E (91% vs 68%) this was not significantly different, but differences in plaque size and penile curvature were significant. CONCLUSIONS: The use of colchicine plus vitamin E during the early stages of Peyronie's disease (time from onset < 6 months) in patients with penile curvature of < 30 degrees and no erectile dysfunction is an effective and well-tolerated way to stabilize the disease. A more extensive study is needed, comparing these results with other oral therapies.

[Encrusted pyelitis. Lithiasic disease with infectious etiology]. / Pielitis incrustada. Una enfermedad litiásica de etiología infecciosa.

We report on two new cases of encrusted pielitis, a lithiasic disease of infectious ethiology--Corynebacterium of D group-. The clinic diagnostic is difficult and this disease develops in immunosuppressed patients, mainly in renal transplanted ones. One of our two cases is diagnosed in a patient with a transplanted kidney and the other one develops the disease within her native kidneys. We remark on the clinic features and therapeutic options.

Pielitis incrustada. Una enfermedad litiasica de etiologia infecciosa / Encrusted pyelitis. A renal lithiasic disease of infectious ethiology

Presentamos dos nuevos casos de pielitis incrustada, una enfermedad litiásica de etiología infecciosa relacionada con el Corynebacterium del grupo D. El diagnóstico clínico es difícil y se desarrolla en enfermos inmunodeprimidos, sobre todo en aquellos sometidos a trasplante renal. Nuestros pacientes desarrollan la enfermedad en un caso en un enfermo trasplantado y en el otro en riñones no trasplantados. Detallamos las características clínicas y las opciones terapéuticas (AU)

Diferencias clínico-patológicas entre neoplasia vesical de bajo potencial maligno y carcinoma de bajo grado / Clinicopathological differences between papillary neoplasm of low malignant potential and low grade papillary carcinoma

OBJETIVO: Determinar si la subdivisión morfológica de los tumores vesicales de grado I entre neoplasia papilar de bajo potencial maligno (BPM) y cáncer vesical de bajo grado, tiene correlación con la evolución clínica y supervivencia del paciente. MATERIAL Y MÉTODOS: Se revisan 257 tumores vesicales superficiales consecutivos sometidos a resección transuretral entre 1990 y 1995 en el HU Reina Sofía de Córdoba, y se reevalúan según los criterios de la nueva clasificación de consenso de la OMS/ISUP de 1998. Se obtienen 12 pacientes con papiloma urotelial, 51 pacientes con neoplasia papilar BPM, 43 pacientes con cáncer vesical de bajo grado Ta, 65 pacientes con cáncer vesical de bajo grado T1 y 37 pacientes con cáncer vesical de alto grado. Once pacientes son reevaluados como T2 y 38 (14,8 por ciento) son perdidos de control. Se revisan los historiales clínicos de cada paciente con un seguimiento mínimo de 5 años, determinando las recidivas y progresiones dentro de cada grupo. Se comparan los resultados entre grupos con el test Chi-Cuadrado y se evalúan los factores de riesgo para la recidiva y progresión mediante análisis multivariado (Odds ratio). La función supervivencia se representa con las tablas de Kaplan y Meier, comparándolas con el test log rank. RESULTADOS: No encontramos diferencias entre ambos grupos con respecto a la edad ni distribución por el sexo. Las diferencias en el número de tumores no son significativas, mientras que el tamaño tumoral medio es significativamente mayor en el grupo "cáncer de bajo grado". En cuanto a los factores de riesgo para la recidiva y progresión de la enfermedad, sólo hallamos significativo el tamaño tumoral. Sorprendentemente, el uso de quimioterapia endovesical parece tener influencia en la aparición de recidiva. No encontramos diferencias en las tasas de recidiva y progresión entre ambos grupos, aunque los porcentajes son siempre mayores para el grupo "cáncer vesical de bajo grado". CONCLUSIÓN: La división de los tumores vesicales de bajo grado (G-I) entre "neoplasia de bajo potencial maligno" y "cáncer de bajo grado" sí presenta suficientes diferencias clínicas como para considerarlas entidades patológicas distintas. Sólo el tamaño tumoral aumentado es factor pronóstico dentro de cada grupo. Creemos que el uso de quimioterapia endovesical no está justificado en este tipo de tumores (AU)