A Rare Intermetatarsal Coalition With Rigid Fifth Metatarsal Deformity and Symptomatic Plantar Lesion.

Coalition or synostosis of the foot is a relatively uncommon abnormality. Some cases of synostosis of the foot, primarily involving the midfoot and hindfoot, have been reported. However, intermetatarsal coalition is extremely rare, with only a small number of cases reported. We report a case of a unilateral, congenital metatarsal coalition between the fourth and fifth metatarsal bones in a 27-year-old female. She had initially been referred because of a symptomatic plantar lesion under the fifth metatarsal head. Surgery consisted of separating the affected metatarsals, combined with a proximal osteotomy, which proved successful in establishing pain-free and more natural weightbearing.

Impacto de los modelos predictivos y la toma de decisiones en cáncer de próstata: un debate integral / No disponible

OBJETIVO: Hacer una revisión de los diferentes métodos para predecir el riesgo de padecer un cáncer de próstata o que la enfermedad localizada pueda ser curada o progrese después de un tratamiento concreto. MÉTODOS: Realizamos una revisión de los diferentes modelos matemáticos conocidos para el análisis de probabilidad del evento, con un estudio crítico de debilidades y fortalezas de cada uno de estos métodos. En una actualización del Medline, revisamos los diferentes trabajos más relevantes referidos al diagnóstico y manejo del cáncer de próstata localizado en sus vertientes de diagnóstico y tratamiento, así como las posibilidades de desarrollar enfermedad metastásica o exitus. RESULTADOS: Existen múltiples métodos y modelos para predecir los diferentes eventos en pacientes candidatos a diagnóstico de cáncer de próstata, así como para analizar posibilidades de éxito de un tratamiento concreto, en muchos casos con una importante exactitud. Destaca la heterogeneidad en los métodos empleados, datos y variables utilizadas para los análisis, básicamente sobre estudios retrospectivos. Muchos de los métodos más sofisticados, Neural Network o Cart, no presentan exactitudes mayores que los métodos clásicos como la regresión logística. CONCLUSIONES: Los modelos predictivos son un elemento importante para la toma de decisiones en la práctica clínica habitual, favoreciendo que la decisión de un diagnóstico o un determinado tratamiento no se haga de forma aleatoria y por tanto siguiendo un criterio científico. En espera de desarrollo de métodos más precisos, hemos de saber que ningún modelo es perfecto y por tanto, es una herramienta importante, que no debe dejar de lado el conocimiento personal o la experiencia en un grupo de trabajo concreto(AU)

OBJECTIVES: To review the various methods to predict the risk of having prostate cancer, or that localized disease may be cured or progress after a given treatment. METHODS: We performed a review of the various mathematic models known for the probability analysis of the event, with a critical analysis of weaknesses and strengths of each method. In a Medline update were Arch view the most relevant papers referred to diagnosis and management of localized prostate cancer in its diagnosis and management sides, as well as the probability of developing metastatic disease and to die. RESULTS: There are multiple methods and models to predict the various events in a patient candidate to diagnosis of prostate cancer, as well as to analyze the possibilities of success of a specific treatment, in many cases with an important exactness. We emphasize the heterogeneity in the methods, data and variables used for the analysis, basically about retrospective studies. Many of the most sophisticated methods, Neural Network or cart, do not present greater exactness than classic methods like logistic regression. CONCLUSIONS: Predictive models are an important element for decision making in usual clinical practice, favoring the decision of a diagnosis or certain treatment is not taken in a random manner and therefore it is taken following scientific criteria. Waiting for more precise methods, we have to know no method is perfect, and therefore it is an important tool, which should not by pass personal knowledge or the experience of a specific working group(AU)

[Lymphocele after renal transplantation: case report and bibliographic review]. / Linfocele gigante tras trasplante renal. A propósito de un caso y revisión de la literatura.

OBJECTIVES: To report the case and iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and the treatment of this surgical complication. METHODS: 69 year-old woman status post renal transplantation who presents right lower extremity edema and worsening renal function. A liquid collection was demonstrated by ultrasound and computerized tomography, compatible with lymphocele after biochemical study of the liquid obtained by percutaneous puncture. RESULTS: The patient underwent laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcome. CONCLUSION: Lymphocele is a common pathology after a renal transplantation which needs to be treated depending on its clinical manifestations. There mainly are two therapeutic alternatives depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from very selected cases, laparoscopic approach is currently considered, because of its security and effectiveness, the first choice when a surgical treatment is prescribed.

Linfocele gigante tras trasplante renal. A propósito de un caso y Revisión de la literatura / Giant lymphocele after renal transplantation. Case report and bibliographic review

OBJETIVOS: Comunicar el caso y la iconografía de un linfocele postrasplante renal y revisar la literatura sobre diagnóstico y tratamiento de esta complicación quirúrgicaMÉTODOS: Mujer de 69 años sometida a trasplante renal, que se presenta con edema en miembro inferior derecho y deterioro de función renal. Se demostró con ecografía y TAC una colección líquida, compatible con linfocele tras estudio bioquímico del líquido obtenido por punción percutánea. RESULTADOS: Se somete a la paciente a una marsupialización del linfocele por vía laparoscópica, con buenos resultados quirúrgicos.CONCLUSIONES: El linfocele es una entidad frecuente tras el trasplante renal, precisando tratamiento según las manifestaciones clínicas. Existen fundamentalmente dos alternativas terapéuticas, dependiendo del tamaño: escleroterapia y marsupialización quirúgica. Salvo casos muy seleccionados, el abordaje laparoscópico se considera actualmente, por su seguridad y eficacia, de primera elección cuando se indica tratamiento quirúrgico(AU)

OBJECTIVES: To report the case and iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and the treatment of this surgical complication.METHODS: 69 year-old woman status post renal transplantation who presents right lower extremity edema and worsening renal function. A liquid collection was demonstrated by ultrasound and computerized tomography, compatible with lymphocele after biochemical study of the liquid obtained by percutaneous puncture.RESULTS: The patient underwent laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcome.CONCLUSION: Lymphocele is a common pathology after a renal transplantation which needs to be treated depending on its clinical manifestations. There mainly are two therapeutic alternatives depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from very selected cases, laparoscopic approach is currently considered, because of its security and effectiveness, the first choice when a surgical treatment is prescribed(AU)

[Pulmonary fibrosis and endovesical mitomycin C]. / Mitomicina C endovesical y fibrosis pulmonar.

The Mitomycin C is a chemotherapeutic agent used in several types of carcinomas. In the superficial vesical carcinoma comes using since more than a quarter century in the form of endovesical instillations. It is a drug relatively safe, although there have been described adverse effects related to its systemic administration as myelosuppression, anaemia, kidney toxicity and less frequently pulmonary fibrosis. In this article we presented the case of a patient who suffers a respiratory illness compatible with interstitial lung disease that develops a respiratory severe insufficiency finishing with the death, after the administration of endovesical mitomycin C, being this adverse effect exceptional for this route of administration.

[Giant lymphocele after renal transplantation. Case report and bibliographic review]. / Linfocele gigante tras trasplante renal. A propósito de un caso y revisión de la literatura.

OBJECTIVE: To report the case and the iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and treatment of this surgical complication. METHODS: 69 year-old woman who undergone renal transplantation and presented right lower extremity edema and worsening renal function. It was demonstrated by ultrasound and computerized tomography a liquid collection, compatible with lymphocele after biochemical study of the liquid which was obtained by percutaneous puncture. RESULTS: The patient underwent a laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcomes. CONCLUSION: Lymphocele is a common pathology after a renal transplantation, which needs to be treated depending on its clinical manifestations. There are mainly two therapeutic alternatives, depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from highly selected cases, laparoscopic approach is currently considered first choice when a surgical treatment is prescribed due to its security and effectiveness.

Degeneración quística gigante de la rete testis / Giant cystic degeneration of the rete testis

OBJETIVOS: Presentar el caso de un quiste gigante de la rete testis.MÉTODO/RESULTADO: Se trata de un paciente de 85 años que durante el seguimiento por un adenocarcinoma de próstata con bloqueo androgénico completo consulta por aumento del tamaño del hemiescroto izquierdo de dos meses de evolución. Se realizó una orquiectomía bilateral, confirmando en el estudio histopatológico de dilatación quística de la rete testis de 11x11x9cm de tamaño. CONCLUSIÓN: Este caso de degeneración quística de la rete testis, con un tamaño fuera de lo común (11x11x9cm, mientras que en la literatura refieren un tamaño medio de 3x3x3cm) podría estar relacionado con el disbalance andrógeno-estrogénico por el BAC en el contexto de un cáncer de próstata(AU)

OBJECTIVES: We present a case of giant cyst of the rete-testisMETHODS/RESULTS: 85 year-old patient on follow-up for prostate cancer with maximum androgen blockade (MAB) treatment consults for a left hemiscrotum increase in size over a 2-month period. We performed bilateral orchiectomy confirming the histopathological diagnosis of cystic dilatation of the rete-testis sized 11x11x9cm.CONCLUSIONS: This case of cystic degeneration of the rete-testis, with a size out of common (11x11x9cm versus medium size in the literature: 3x3x3cm), could be related with an androgen-estrogen misbalance caused by a MAB in a prostate cancer context(AU)

Mitomicina C endovesical y fibrosis pulmonar / Pulmonary fibrosis and endovesical Mitomycin C

La Mitomicina C es un agente quimioterápico usado en varios tipos de carcinomas. En el carcinoma vesical superficial se viene usando desde hace más de un cuarto de siglo en forma de instilaciones endovesicales. Se trata de un fármaco relativamente seguro, aunque se han descritos efectos adversos relacionados con su administración sistémica como la mielosupresión, anemia, toxicidad renal y con menor frecuencia fibrosis pulmonar. En este artículo presentamos el caso de un paciente que sufre un cuadro respiratorio compatible con enfermedad pulmonar intersticial que evolucionó hasta una insuficiencia respiratoria severa y éxitus tras la administración endovesical demitomicina C, siendo este efecto adverso excepcional para esta vía de administración (AU)

The Mitomycin C is a chemotherapeutic agent used in several types of carcinomas. In the superficial vesical carcinoma comes using since more than a quarter century in the form of endovesical instillations. It is a drug relatively safe, although there have been described adverse effects related to its systemic administration asmyelosuppression, anaemia, kidney toxicity and less frequently pulmonary fibrosis. In this article we presented the case of a patient who suffers a respiratory illness compatible with interstitial lung disease that develops a respiratory severe insufficiency finishing with the death, after the administration of endovesical mitomycin C, being this adverse effect exceptional for this route of administration (AU)

Linfocele gigante tras trasplante renal. A propósito de un caso y revisión de la literatura / Giant lymphocele after renal transplantation. Case report and bibliographic review

OBJETIVO: Comunicar el caso y la iconografía de un linfocele postrasplante renal y revisar la literatura sobre diagnóstico y tratamiento de esta complicación quirúrgicaMÉTODOS: Mujer de 69 años sometida a trasplante renal, que se presenta con edema en miembro inferior derecho y deterioro de función renal. Se demostró con ecografía y TAC una colección líquida, compatible con linfocele tras estudio bioquímico del líquido obtenido por punción percutánea.RESULTADOS: Se somete a la paciente a una marsupialización del linfocele por vía laparoscópica, con buenos resultados quirúrgicos.CONCLUSIONES: El linfocele es una entidad frecuente tras el trasplante renal, precisando tratamiento según las manifestaciones clínicas. Existen fundamentalmente dos alternativas terapéuticas, dependiendo del tamaño: escleroterapia y marsupialización quirúgica. Salvo casos muy seleccionados, el abordaje laparoscópico se considera actualmente, por su seguridad y eficacia, de primera elección cuando se indica tratamiento quirúrgico(AU)

OBJECTIVE: To report the case and the iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and treatment of this surgical complication.METHODS: 69 year-old woman who undergone renal trans-plantation and presented right lower extremity edema and worsening renal function. It was demonstrated by ultrasound and computerized tomography a liquid collection, compatible with lymphocele after biochemical study of the liquid which was obtained by percutaneous puncture.RESULTS: The patient underwent a laparoscopic intraperito-neal drainage of the lymphocele, with good surgical outco-mes.CONCLUSION: Lymphocele is a common pathology after a renal transplantation, which needs to be treated depending on its clinical manifestations. There are mainly two therapeu-tic alternatives, depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from highly selected cases, laparoscopic approach is currently considered first choice when a surgical treatment is prescribed due to its security and effectiveness(AU)

[Left renal atrophy and ureteral abouchement in seminal vesicle. Laparoscopic surgical treatment]. / Atrofia renal izquierda y abocamiento ureteral a vesícula seminal. Tratamiento quirúrgico laparoscópico.

Renal atrophy with an ectopic drainage of the ureter is an uncommon malformation. Zinder described in 1914 a cystic dilation of the seminal vesicle in association with an ipsilateral renal agenesis. Usually, these patients present lower urinary tract symptoms with perineal discomfort and fever. The most accurate diagnosis is given by the MRI, while CT and ultrasonography are less precise. We present a case of a patient who goes into hospital because of left lumbar pain and urinary sepsis data, whose CT detects an ectopic drainage of the left uereter in the seminal vesicle. He underwent a successful laparoscopic surgical treatment.