Erectile dysfunction in obstructive sleep apnea patients: A randomized trial on the effects of Continuous Positive Airway Pressure (CPAP).

OBJECTIVES: Obstructive sleep apnea (OSA) is among the least studied risk factors for erectile dysfunction (ED). We aimed to determine ED prevalence in newly-diagnosed OSA patients, describe their main characteristics and assess continuous positive airway pressure (CPAP) effects on ED. METHODS: Cross-sectional study assessing ED prevalence in OSA patients and open-label, parallel, prospective randomized controlled trial evaluating 3-month CPAP treatment effects on sexual function, satisfaction, and psychological, hormonal and biochemical profiles. Male patients newly diagnosed with moderate/severe OSA (apnea-hypopnea index >20 events·h-1), aged 18-70 years, attending the sleep unit of a Spanish hospital during 2013-2016 were considered. A total of 150 patients were recruited (75 randomized ED patients). ED was defined as scores <25 on International Index Erectile Function 15 test. Wilcoxon's matched-pairs signed-ranks and rank-sum tests were used. RESULTS: ED prevalence was 51%. Patients with ED were older (p<0.001), had greater waist-to-hip ratios (p<0.001), were more frequently undergoing pharmacological treatment (p<0.001) and had higher glucose levels (p = 0.024) than non-ED patients. Although significant increases in erectile function (mean(SD) change: +4.6(7.9); p = 0.002), overall satisfaction (+1(2.2); p = 0.035), and sexual satisfaction (+2.1(4.3); p = 0.003) were found after CPAP treatment, only differences in sexual satisfaction (p = 0.027) and erectile function (p = 0.060) were found between study arms. CPAP treatment did not impact psychological, hormonal or biochemical profiles. CONCLUSIONS: This study confirmed the relationship between OSA and ED, suggesting the potential usefulness of ED screening in OSA patients, but could not determine conclusively whether CPAP is an effective stand-alone ED treatment, regardless of positive results on sexual satisfaction. TRIAL REGISTRATION: ClinicalTrials.gov NCT03086122.

Hidatidosis abdominal diseminada / Disseminated abdominal hydatid disease

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Prepubertal testicular tumours and efficacy of testicular preserving surgery.

STUDY TYPE: Therapy (case series). LEVEL OF EVIDENCE: 4. What's known on the subject? and What does the study add? Testicular tumours in childhood are very rare. Historically, most of these tumours have been considered malignant, but more recent studies indicate that benign lesions, particularly teratoma, are much more frequent than previously thought. Testicular tumours in this age group have traditionally been treated with inguinal radical orchiectomy, but more conservative management has been proposed in view of the higher frequency of benign tumours. In children, most testicular tumours are benign, especially before puberty. A testis-sparing procedure should be performed in children with a palpable testicular mass and negative tumour markers. OBJECTIVE: To report our experience of testicular tumours in children aged≤13 years, including our experience with testis-sparing surgery. PATIENTS AND METHODS: A retrospective study was performed of 15 patients with testicular tumours aged≤13 years who presented at our centre between 1984 and 2008. The use of testis-preserving surgery according to indication was investigated and outcomes were recorded. RESULTS: The clinical presentation was increased testicular size with a palpable mass in 80% of the cases. All 15 patients underwent surgery. The tumour was benign in 12 (80%) patients and malignant in three (20%) patients. Organ-preserving surgery was planned and achieved in 11 patients (73%). Pathology of the tumourectomy specimens disclosed benign tumours in all cases: four epidermoid cysts, two teratomas, one juvenile granulosa cell tumour, one haemangioma, one lipoma, one fibrous hamartoma and one splenogonadal fusion. In four patients who underwent radical orchiectomy, pathology identified one yolk sac tumour (stage I), two mixed germ cell tumours and one gonadoblastoma. CONCLUSIONS: In children, most testicular tumours are benign, especially before puberty. A testis-sparing procedure should be performed in children with a palpable testicular mass and negative tumour markers. The lesion, however, should be thoroughly excised to avoid recurrences.

[Early ultrasound detection of renal tumors in patients with end stage renal disease in dialysis]. / Detección ecográfica precoz de tumores renales en pacientes con insuficiencia renal crónica en diálisis.

OBJECTIVES: Patients with end stage renal disease in dialysis are a population susceptible to suffer various types of cancers, mainly in the kidney and urinary tract. These tissues suffer systemic carcinogenic effects, including all that result from chemical and immunological changes secondary to renal failure, from the treatment they receive and dialysis itself. In the present article we determine the clinical, epidemiological, and pathological characteristics of patients with chronic renal failure in dialysis who presented renal tumors during the evolution of their disease over the last ten years. METHODS: We reviewed the medical charts of patients with chronic renal failure receiving dialysis in our institution who were diagnosed of renal tumors and received surgical treatment over the last 10 years. Patients with incomplete medical charts, HIV infection, and renal adult policystic disease were excluded from the study. RESULTS: 10 tumors were detected in a total of nine patients with a mean age of 45.22 years (range 41-65 years), six males and three females; regarding the mean time from the start of dialysis to de diagnosis of the tumor: 5 appeared the first year, 2 between 2 and 5 years, and 2 more than five years from the start of dialysis. The most frequent cause of chronic renal failure was high blood pressure, in 55.5% of the patients. 90% of the tumors were diagnosed incidentally during a control study, with ultrasound being the main diagnostic test (100%), a finding that was confirmed with MRI and CT scan in 60% and 30% of the patients respectively. The operative findings were: 8 solid masses, 1 mixed mass, and 1 cystic mass. Six patients underwent open surgery and 4 laparoscopic surgery. The most frequent pathologic diagnosis was clear cell carcinoma in 60% of the tumors. CONCLUSIONS: In our study population, we found that performance of periodic ultrasound controls enabled us to achieve early diagnosis and treatment of tumors of the kidney in patients in dialysis. Over the last years laparoscopy has become the treatment of choice for renal tumors, even in patients with chronic renal failure in dialysis.

Detección ecográfica precoz de tumores renales en pacientes con insuficiencia renal crónica en diálisis / Early ultrasound detection of renal tumors in patients with end stage renal disease in dialysis

Objetivo: Los pacientes con insuficiencia renal crónica terminal en diálisis, son una población susceptible a padecer diferentes tipos de cánceres, especialmente del riñón y tracto urinario. Estos tejidos padecen los efectos carcinogénicos sistémicos, incluyendo todos los que resultan de los cambios químicos e inmunológicos propios de la insuficiencia renal, del tratamiento al que son sometidos y a la terapia dialítica per se. En el presente estudio se determinan las características clínicas y epidemiológicas y anatomopatológicas de los pacientes con insuficiencia renal crónica en diálisis, que presentaron tumores renales durante la evolución de su enfermedad en los últimos 10 años. Métodos: Se revisaron las historias clínicas de los pacientes con insuficiencia renal crónica que recibían tratamiento dialítico en nuestra institución en los últimos 10 años, que presentaron durante la evolución de su enfermedad tumores renales y fueron sometidos a tratamiento quirúrgico. Se excluyeron del estudio a los pacientes que tenían una historia clínica con datos incompletos, pacientes con HIV, pacientes con poliquistosis renal del adulto. Resultados: Se detectaron 10 tumores renales en un total de 9 pacientes con una edad media de 45.22 años (Rango de 41-65 años), 6 varones y 3 mujeres, en relación tiempo promedio de seguir en el programa de diálisis al detectarse el tumor, 5 en el primer año, 2 entre 2 a 5 años y 2 más de 5 años. La causa de insuficiencia renal crónica mas frecuente fue la hipertensión arterial en 55.5% de pacientes. El 90% de tumores fueron diagnosticados de manera casual durante un estudio de control, siendo la ecografía el principal método diagnostico (100%), hallazgo que fue confirmado por RMN y TC en un 60% y 30% respectivamente. Dentro de los hallazgos radiológicos 8 fueron informados como masas sólidas, 1 como masa mixta y 1 como masa quística. Seis se operaron mediante cirugía abierta y 4 por cirugía laparoscópica. El resultado anatomopatológico mas frecuente fue de tumor de células claras en el 60% de tumores. Conclusiones: En nuestra población de estudio se encontró que los tumores malignos de riñón en pacientes sometidos a terapia dialítica al ser identificados por control ecográfico periódico, ha permitido el diagnóstico y tratamiento de esta patología en un estadio precoz. La laparoscopia se ha convertido en el tratamiento de elección en los últimos años de la patología renal tumoral, aún a pesar de tratarse de pacientes con IRC y en diálisis (AU)

Objectives: Patients with end stage renal disease in dialysis are a population susceptible to suffer various types of cancers, mainly in the kidney and urinary tract. These tissues suffer systemic carcinogenic effects, including all that result from chemical and immunological changes secondary to renal failure, from the treatment they receive and dialysis itself. In the present article we determine the clinical, epidemiological, and pathological characteristics of patients with chronic renal failure in dialysis who presented renal tumors during the evolution of their disease over the last ten years. Methods: We reviewed the medical charts of patients with chronic renal failure receiving dialysis in our institution who were diagnosed of renal tumors and received surgical treatment over the last 10 years. Patients with incomplete medical charts, HIV infection, and renal adult policystic disease were excluded from the study. Results: 10 tumors were detected in a total of nine patients with a mean age of 45.22 years (range 41-65 years), six males and three females; regarding the mean time from the start of dialysis to de diagnosis of the tumor: 5 appeared the first year, 2 between 2 and 5 years, and 2 more than five years from the start of dialysis. The most frequent cause of chronic renal failure was high blood pressure, in 55.5% of the patients. 90% of the tumors were diagnosed incidentally during a control study, with ultrasound being the main diagnostic test (100%), a finding that was confirmed with MRI and CT scan in 60% and 30% of the patients respectively. The operative findings were: 8 solid masses, 1 mixed mass, and 1 cystic mass. Six patients underwent open surgery and 4 laparoscopic surgery. The most frequent pathologic diagnosis was clear cell carcinoma in 60% of the tumors. Conclusions: In our study population, we found that performance of periodic ultrasound controls enabled us to achieve early diagnosis and treatment of tumors of the kidney in patients in dialysis. Over the last years laparoscopy has become the treatment of choice for renal tumors, even in patients with chronic renal failure in dialysis (AU)