Effect of Positive Surgical Margins in Patients Who Undergo a Partial Nephrectomy Regarding Recurrence, Overall Survival, Recurrence/Progression-Free Survival, and Metastasis-Free Survival. A Systematic Review and Meta-Analysis.

BACKGROUND: To determine the effect of positive surgical margins in patients who undergo a partial nephrectomy regarding recurrence, overall survival, disease-free survival, recurrence and progression-free survival, and metastasis-free survival. METHODS: We performed a systematic review accomplishing with Cochrane recommendations. We searched in Medline, Embase, and central. We also looked for unpublished literature. There was no language or setting restrictions. We performed a random-effects meta-analysis for all outcomes. RESULTS: We included 44 studies for qualitative and quantitative analysis. We found that positive margins increase the risk of local recurrence (RR 4.14 95%CI 2.75-6.24), recurrence (RR 4.8 95%CI 3.38-6.62), mortality (RR 1.83 95%CI 1.08-3.1), metastasis (RR 8.1 95%CI 3.88-16.92), and improved the recurrence/progression-free survival (HR 2.9 95%CI 1.88-4.49) and metastasis-free survival (HR 2.91 95%CI 1.25-6.79) with moderate, moderate, very low, very low, and high certainty of the evidence, respectively. We found no change in overall survival (HR 1.48 95%CI 0.98-2.22) with very low certainty of evidence. CONCLUSIONS: A positive margin is an independent predictor of local recurrence, recurrence, mortality, metastasis, with no effect on overall survival. Therefore, a tailored intense and prolonged follow-up is mandatory.

The role of contrast enhanced ultrasound in the differential diagnosis of segmental testicular infarction.

A 43-year-old male presented to the emergency department with acute left testicular pain. Physical exam showed a tender left testicle and epididymis with mild swelling. Doppler and contrast enhanced ultrasound revealed a heterogeneous, avascular lesion with hyper vascularized surrounding. Follow-up contrast enhanced ultrasound performed a few days later showed persistence of the sparsely vascularized lesion with more hypoechoic echo structure. Despite the tumor markers being negative, a necrotic tumor could not be ruled out and a left orchiectomy was performed. Pathology report described an extensive segmental testicular infarction with no evidence of malignant tissue. We present the ultrasound and pathology findings, differential diagnostic pearls and clinical perspective of segmental testicular infarction.

Social media and medical journals: a promising relationship? / Medios sociales y periódicos médicos: ¿una relación prometedora?

Have you ever heard the question: "what is your impact factor?" Impact factor (IF) has become an important metric to obtain grants, to promote your own career, to justify the presence of the best speakers at meetings, as well as a measure of "professional value." It is the impact that publishing research has in our own academic life. However, we should not forget that the IF was not created to rank an individual work or paper, and for sure it was not created to measure the quality of the authors.

¿Alguna vez has oído la pregunta: "¿Cuál es tu factor de impacto?" El factor de impacto (FI) se ha convertido en una medida importante para la obtención de becas, para promover su propia carrera, para justificar la presencia de los mejores oradores en las reuniones, así como una medida de "valor profesional". Es el impacto que la investigación editorial tiene en nuestra propia vida académica. Sin embargo, no debemos olvidar que el MI no fue creado para clasificar un trabajo o documento individual, y por supuesto no fue creado para medir la calidad de los autores.

Metastasis of gastric carcinoma simulating a urothelial tumor. Case report and review of the literature.

OBJECTIVE: To review two cases with the diagnostic suspicion of urinary tract tumor by clinical picture and imaging tests in which pathology of the surgical specimen revealed metastasis of gastric adenocarcinoma. METHODS: 82 and 68 year-old patients with past history of gastric adenocarcinoma that had undergone surgical treatment 6 months and 6 years before urology consultation,respectively. They were diagnosed upper urinary tract tumors by CT scan. RESULTS: Definitive pathologic diagnosis of urinary tract metastasis of gastric adenocarcinoma was obtained after radical surgery in both cases. CONCLUSIONS: Clinical and radiologic presentation of urothelial metastases of gastric adenocarcinoma may simulate de novo urothelial tumors. Evolution in these patients is usually bad although we currently don't have enough information to issue a therapeutic guide to follow.

Metástasis de carcinoma gástrico simulando tumor urotelial. Presentación de dos casos clínicos y revisión de la literatura / Metastasis of gastric carcinoma simulating a urothelial tumor. Case report and review of the literature

OBJETIVO: Revisión de dos casos de pacientes con sospecha diagnóstica de tumor de vías por clínica y pruebas de imagen que la anatomía patológica de la pieza quirúrgica reveló una metástasis de adenocarcinoma gástrico. MÉTODO: Pacientes de 82 y 68 años respectivamente con antecedentes de adenocarcinoma gástrico tratados quirúrgicamente 6 meses y 6 años antes de acudir a nuestra consulta, en la que fueron diagnosticados por TAC de tumor de vías urinarias altas. RESULTADO: Tras cirugía radical en ambos casos, se hace el diagnótico patológico definitivo de metástasis de adenocarcinoma gástrico en la vía urinária. CONCLUSIONES: La presentación clínica y radiológica de una metástasis urotelial de adenocarcinoma gástrico puede simular un tumor urotelial de novo. La evolución de estos pacientes suele ser mala aunque no disponemos en la actualidad de suficiente información para emitir una conducta terapéutica a seguir (AU)

OBJECTIVE: To review two cases with the diagnostic suspicion of urinary tract tumor by clinical picture and imaging tests in which pathology of the surgical specimen revealed metastasis of gastric adenocarcinoma. METHODS: 82 and 68 year-old patients with past history of gastric adenocarcinoma that had undergone surgical treatment 6 months and 6 years before urology consultation, respectively. They were diagnosed upper urinary tract tumors by CT scan. RESULTS: Definitive pathologic diagnosis of urinary tract metastasis of gastric adenocarcinoma was obtained after radical surgery in both cases. CONCLUSIONS: Clinical and radiologic presentation of urothelial metastases of gastric adenocarcinoma may simulate de novo urothelial tumors. Evolution in these patients is usually bad although we currently don`t have enough information to issue a therapeutic guide to follow (AU)

Síndrome de Cushing y recidiva de un cáncer de próstata con antígeno prostático específico indetectable / Cushing syndrome and prostate cancer recurrence with undetectable prostate-specific antigen

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[Determination of P53 in infiltrative primary bladder tumors as a prognostic factor for understaging]. / La determinación de p53 en tumor vesical primario infiltrante como factor pronóstico de subestadiaje.

OBJECTIVES: To determine if p53 expression in patients with infiltrative bladder cancer is a prognostic factor on clinical staging and cancer specific survival. METHODS: Immunohistochemical analysis of p53 in 34 patients (33 males and 1 female) undergoing radical cystectomy for infiltrative bladder cancer, with a mean follow-up of 16 months. RESULTS: p53 overexpression was detected in 18 patients (64%). In the p53 positive group two patients were stage T1G3, 18 patients T2, 1 patient T3, and 2 patients T4. In the negative group a better correspondence between TUR and cystectomy stage was found, with stage worsening only in 3 patients. On follow-up, p53 positive patients showed worse outcomes due to their worse stages, although no statistical differences were found (p = 0.24). In the group of patients following a bladder sparing protocol (n = 6), p53 negative patients had complete remission of the disease. CONCLUSIONS: We see significant differences on understaging/more aggressive local outcome in p53 positive patients, with no greater mortality in this group. P53 expression does not contraindicate the inclusion of a patient in a bladder sparing protocol, although larger studies would be necessary to confirm these results.