[Bladder infection by schistosoma: an uncommon cause of haematuria]. / Infección vesical por esquistosoma: una causa inhabitual de hematuria.

Immigration is a real phenomenon in our country with direct consequences into the public health system. In the attendance to these patients we do not have to forget the existence unusual diseases in our setting. We presented the clinical case of a patient with hematuria caused by bladder schistosomiasis.

[Prognostic factors for disease progression in patients with renal cell carcinoma]. / Análisis de los factores pronósticos de progresión tumoral en el adenocarcinoma renal.

INTRODUCTION: More than 40% of patients with renal cell carcinoma present with disease progression after surgery. The objective of the current study was to identify a clinically useful set of prognostic factors that would correlate significantly with the capacity of progression. MATERIAL AND METHODS: The authors studied 252 patients with renal cell carcinoma who underwent radical nephrectomy. Followup ranged from 12-246 months (median 36 months). Several morphologic parameters of the tumors were considered. DNA content was analyzed by flow cytometry and tumor size was determined from the surgical specimen. A Cox proportional hazards regression model was used to identify significant independent prognostic factors for disease progression. RESULTS: A total of 224 out of 252 were available for suitable histograms. Of the 224 patients, 95 (42.4%) were aneuploid tumors, 106 (47.2%) were organ-confined renal cell carcinoma and 87 (39.74%) presented disease progression. At 5 and 10 years of followup, disease free survival was found to be 66.31% and 62.23%, respectively. Univariate analysis revealed that DNA ploidy, Furhman grade and stage (TNM) had a statistically significant predictive value for disease progression. Survival univariate analysis found a worse probability of survival for aneuploid tumors, grade III-IV tumors, non organ-confined tumors and conventional and undiferentiated tumors. Using multivariate survival analyses, Furhman grade, stage (TNM) and DNA ploidy were the only independent prognostic factors. So, the probability of death for aneuploid tumor was 1.7 times higher than for diploid tumors. CONCLUSIONS: Stage, DNA content and Furhman grade were the only significant independent predictors of disease progression. Tumoral size and histological type did not provide more additional information.

Mycobacterial infection in a series of 1261 renal transplant recipients.

OBJECTIVE: To describe the incidence and clinical characteristics of mycobacterial infection in renal transplant recipients. METHODS: We retrospectively analyzed the cases of mycobacterial infection in a series of 1261 renal transplants carried out in our Unit of Renal Transplantation from 1980 to 2000. Demographic parameters and clinical antecedents such as age, cause of end-stage renal disease, time of follow-up of the graft, previous renal function and type of immunosuppression were considered. Moreover, the clinical onset, diagnostic tools, treatment policy and evolution were studied. The pathogenesis of the different types of mycobacteria isolated was also analyzed. Diagnosis was made with the Ziehl-Neelsen staining method. Culture was performed by the conventional Löwenstein-Jensen method and the Bactec-460 radiometric method. RESULTS: We found mycobacterial infection in 27 patients (2.1%), due to Mycobacterium tuberculosis in 20 cases, M. kansasii in five patients, and M. fortuitum in two patients. The mean elapsed time from the renal transplant was 20.5 months; the infection appeared in 18 patients during the first eight months after transplantation. The clinical onset was pulmonary infection in 17 cases (12 M. tuberculosis and five M. kansasii); five had urinary symptoms (three M. tuberculosis and two M. fortuitum); three cases of M. tuberculosis infection had abdominal symptoms; another one began with a perineal tuberculous abscess; the rest of the patients were asymptomatic. The types of specimen on which microbiological identification was carried out were, in decreasing order: sputum and/or bronchial washing/pleural aspiration, urine, feces, gastric and peritoneal fluids, bone marrow and blood. The first-line drug isoniazid had the highest resistance index in the susceptibility test. Clinical dissemination was observed in eight patients, four of whom died. Another three patients had a significant impairment in renal function, and in one of these patients an allograft nephrectomy was necessary due to a severe septic syndrome. CONCLUSIONS: Mycobacterial infection, mainly by M. tuberculosis, has an important impact on kidney transplant recipients, particularly during the first year after surgery. Diagnosis often presents some difficulties, and a delay in treatment represents a determinant factor for the evolution, with a risk of death or permanent damage in renal function. Therefore, early diagnosis is mandatory. When the Mantoux reaction is positive, antituberculous prophylaxis seems advisable.