Ischaemic priapism as a presentation of chronic myeloid leukaemia.

OBJECTIVE: To describe ischemic priapism as an atypical presentation of chronic myeloid leukaemia. METHODS / RESULTS: We discuss two patients diagnosed with chronic myeloid leukaemia presenting an episode of priapism, adequately resolved after applying the treatment protocol established in our center. CONCLUSION: Priapism is defined as a persistent erection that persists despite not having sexual stimulus, without involvement of the spongy tissue of the penis. Its debut appearance as a hematologic dyscrasia is a rare event. It is a urological emergency, requiring early multidisciplinary (Urology and Hematology) management, since the speed in treatment will result in good functional results and the preservation of a good quality of life.

Priapismo isquémico como presentación de leucemia mieloide crónica / Ischaemic priapism as a presentation of chronic myeloid leukaemia

OBJETIVO: Describir el priapismo isquémico como forma de presentación atípica de la leucemia mieloide crónica. MÉTODO/RESULTADO: Comentamos 2 pacientes diagnosticados de leucemia mieloide crónica a partir de un episodio de priapismo, resueltos adecuadamente tras la aplicación del protocolo de tratamiento establecido en nuestro centro. CONCLUSIÓN: El priapismo se define como una erección persistente, que se mantiene a pesar de no haber estimulo sexual, sin participación del tejido esponjoso del pene. Su aparición como debut de una discrasia hematológica es un suceso poco frecuente, constituyendo una urgencia urológica que requiere un manejo precoz y multidisciplinar por parte de los servicios de Urología y Hematología, ya que la rapidez en el tratamiento derivará en una función eréctil conservada, y con ello preservar la calidad de vida

OBJECTIVE: To describe ischemic priapism as an atypical presentation of chronic myeloid leukaemia. METHODS / RESULTS: We discuss two patients diagnosed with chronic myeloid leukaemia presenting an episode of priapism, adequately resolved after applying the treatment protocol established in our center. CONCLUSION: Priapism is defined as a persistent erection that persists despite not having sexual stimulus, without involvement of the spongy tissue of the penis. Its debut appearance as a hematologic dyscrasia is a rare event. It is a urological emergency, requiring early multidisciplinary (Urology and Hematology) management, since the speed in treatment will result in good functional results and the preservation of a good quality of life

PSA levels in patients on hemodialysis treatment.

OBJECTIVES: Standardized prostate-specific antigen (PSA) levels are based upon the general population levels and, although a higher incidence of prostate cancer in patients on hemodialysis (HD)has not been demonstrated, some studies point at the possibility of observing higher PSA levels in this type of patients than in males with preserved renal function. The objective of the present study is to compare PSA levels in males on hemodialysis with those of the population with normal renal function. METHODS: Comparative, transversal study of the variables age, total PSA, free PSA and PSA index in 190 patients with chronic renal disease on hemodialysis treatment (group 1) and 237 subjects without renal disease ( group 2). We carried out a descriptive analysis and a comparative study of the above mentioned variables using the SPSS software. RESULTS: Median age of patients on HD was 55 in cases (47-61)and 59 in controls (54-63.5). Mean total PSA was 1.49 ng/mL [1.24-1.73] in cases and 1.62 ng/mL [1.29-1.95] in controls; mean free PSA was 1.40 ng/mL [0.89-1.91] in group 1 and 2.31 ng/mL [-0.83-5.45] in group 2; mean PSA index was 27.67% [19.91-35.63] in cases and 14.82%[12.79-16.85]] in controls. The comparative study showed differences between the two groups in free PSA (p ≤ 0.007), PSA index (p ≤ 0.000) and total PSA (p ≤ 0.000) in patients under 50 after an age-specific analysis. CONCLUSIONS: Total PSA is higher in patients on HD within the subgroup of patients under 50 with statistically significant but not clinically relevant difference. PSA index is remarkably higher in the group of patients on HD. These data could have clinical implications as far as indications for biopsy is concerned.

Niveles de PSA de los pacientes en hemodiálisis / PSA levels in patients on hemodialysis treatment

OBJETIVO: Los niveles de PSA por los que nos regimos actualmente están basados en la población general, y aunque no se ha demostrado una mayor incidencia de cáncer de próstata en los pacientes en hemodiálisis (HD), algunos estudios señalan la posibilidad de encontrar niveles de PSA más elevados en estos pacientes que en los varones con función renal conservada. El objetivo de este estudio es medir y comparar los niveles de PSA de los varones en diálisis con los de la población con función renal normal. MÉTODO: Estudio transversal comparativo de las variables edad, PSA total, PSA libre e índice de PSA en 190 pacientes con enfermedad renal crónica en tratamiento sustitutivo en hemodiálisis (grupo 1) frente a 237 pacientes sanos desde el punto de vista renal (grupo 2). Realizamos análisis descriptivo y estudio comparativo de las variables referidas con el paquete informático SPSS. RESULTADOS: La mediana de edad de los pacientes en HD fue 55 años en los casos (47-61) y de 59 años (54-63,5) en los controles. El PSA total medio fue de 1,49 ng/ml [1,24-1,73] en los casos y 1,62 ng/ml [1,29-1,95] en los controles; el PSA libre medio 1,40ng/ml [0,89- 1,91] en grupo 1 y 2,31ng/ml [-0,83- 5,45] en grupo 2; el índice de PSA medio 27,67 % [19,91-35,63] en los casos y 14,82 % [12,79-16,85] en los controles. En el estudio comparativo encontramos diferencias entre los 2 grupos con respecto al PSA libre (p ≤0,007) y el índice (p ≤0,000) así como en el PSA total (p ≤0,000) en menores de 50 años tras un análisis por rangos de edad. CONCLUSIONES: El PSA total es más elevado en pacientes en HD en el subgrupo de edad de menos de 50 años con diferencia estadísticamente significativa aunque no clínicamente relevante. El índice de PSA es significativamente más alto en el grupo de pacientes en HD. Estos datos podrían tener implicación clínica en cuanto a la indicación de biopsia (AU)

OBJECTIVES: Standardized prostate-specific antigen (PSA) levels are based upon the general population levels and, although a higher incidence of prostate cancer in patients on hemodialysis (HD) has not been demonstrated, some studies point at the possibility of observing higher PSA levels in this type of patients than in males with preserved renal function. The objective of the present study is to compare PSA levels in males on hemodialysis with those of the population with normal renal function. METHODS: Comparative, transversal study of the variables age, total PSA, free PSA and PSA index in 190 patients with chronic renal disease on hemodialysis treatment (group 1) and 237 subjects without renal disease (group 2). We carried out a descriptive analysis and a comparative study of the above mentioned variables using the SPSS software. RESULTS: Median age of patients on HD was 55 in cases (47-61) and 59 in controls (54-63.5). Mean total PSA was 1.49ng/mL [1.24-1.73] in cases and 1.62 ng/mL [1.29-1.95] in controls; mean free PSA was 1.40ng/mL [0.89-1.91] in group 1 and 2.31ng/mL [-0.83- 5.45] in group 2; mean PSA index was 27.67% [19.91-35.63] in cases and 14.82% [12.79-16.85] in controls. The comparative study showed differences between the two groups in free PSA (p ≤ 0.007), PSA index (p ≤ 0.000) and total PSA (p ≤ 0.000) in patients under 50 after an age-specific analysis. CONCLUSIONS: Total PSA is higher in patients on HD within the subgroup of patients under 50 with statistically significant but not clinically relevant difference. PSA index is remarkably higher in the group of patients on HD. These data could have clinical implications as far as indications for biopsy is concerned (AU)

Tumor mulleriano mixto maligno de endometrio con componente rabdomiosarcoma / Malignant mixed mullerian tumour of the endometrium with a rhabdomyosarcomatous component

Presentamos dos casos de tumor mulleriano mixto maligno de endometrio con componente heterólogo rabdomiosarcomatoso. Este tipo de tumores, más conocidos como carcinosarcomas, tienen epitelio y estroma malignos. Los componentes estromales se han dividido en homólogos y heterólogos. Los estudios immunohistoquímicos basados en la coloración positiva de los anticuerpos de las muestras del tumor son muy útiles para realizar el diagnóstico (AU)

Recurrent lentigo maligna as amelanotic lentigo maligna melanoma.

Amelanotic lentigo maligna and lentigo maligna melanoma are extremely rare tumours. Even rarer is a recurrent amelanotic lentigo maligna or amelanotic lentigo maligna melanoma at the site of a previously removed pigmented lentigo maligna. We describe two cases of recurrent amelanotic lentigo maligna melanoma manifesting as erythematous plaques evolved from previously excised pigmented lentigo maligna.

Influencia de la analgesia epidural en el tipo de parto / Influence of epidural analgesia on type of delivery

Objetivo: Valorar si la analgesia epidural en el parto produce un aumento de partos instrumentales y de cesáreas. Sujetos y métodos: Todas las gestantes que dieron a luz en el hospital de León durante el año 1997, que no había analgesia epidural y el año 1999 que era a petición de la paciente, con un 62 por ciento de utilización. Se compara el tipo de parto entre el total de gestantes y en el subgrupo de primíparas. Resultados: En 1997 hubo 221 partos instrumentales, sin embargo en 1999 fueron 408 (11,2 por ciento frente al 21,9 por ciento), con una significación estadística p < 0,001. En el subgrupo de primíparas varía desde el 15,9 por ciento (año que no había analgesia epidural) al 29,6 por ciento, con una significación estadística p < 0,001. La tasa de cesáreas permanece igual en ambos grupos. Conclusiones: Hay un aumento estadísticamente significativo de partos instrumentales el año que se oferta la analgesia epidural, pero la tasa de cesáreas no varía (AU)

Rectovesical fistula treated by covered self-expanding prosthesis: report of a case.

Postoperative rectovesical fistulas require surgical intervention for their treatment. We present a case treated by placement of a silicone self-expanding prosthesis in the rectum and vesical drainage and give technical details of the procedure.

Loss of heterozygosity of TP53 is not correlated with clinicopathological variables in sporadic colorectal carcinomas.

We have analyzed the loss of heterozygosity (LOH) of TP53 in a series of 96 sporadic colorectal carcinomas by means of PCR, using two microsatellite sequences (TP53 and Mfd152), to investigate its possible relationship with several clinicopathological variables in the Spanish population. Forty six of the 96 patients (48%) showed loss of one allele of the microsatellite TP53, Mfd152 or both, when compared with normal colorectal mucosae and blood samples of the same patient. This high percentage of LOH seems to corroborate the important role of p53 in sporadic colorectal cancer. However, we have found that LOH on this region is independent of histological grade and tumour location. With regard to tumour Dukes' stage, the fact that a substantial proportion of tumours show LOH on 17p from the first stages of the disease could imply that this alteration is not related with the invasiveness acquisition staging.

Visceral leishmaniasis with cutaneous lesions in a patient infected with human immunodeficiency virus.

We report a case of visceral leishmaniasis (VL) with cutaneous lesions in a patient infected with human immunodeficiency virus (HIV). The cutaneous lesions consisted of erythematous papules on the legs. Biopsy of one lesion showed abundant Leishmania amastigotes within epithelial cells of an eccrine sweat gland in the dermis. Leishmania organisms were also found in a blood smear. Rapid and complete clearance of the cutaneous lesions was achieved after antimony therapy. Cutaneous lesions in VL are being reported increasingly frequently in patients with HIV infection and their significance remains in discussion.