[Cutaneous metastasis of a transitional-cell bladder carcinoma]. / Metástasis cutánea de un carcinoma vesical de células transicionales.

Transitional cell of bladder carcinoma metastasizing to the skin is uncommon finding, generally appearing in the final stages such that occurred in our patient that indicated a poor prognosis. A lesion located in the pubic region and internal face of the left lower limb with at erythematous, indurated, and aggregated appearance was found. The histological examination of the specimen after cold biopsy demonstrated cutaneous metastasis from transitional cell carcinoma.

[Oat cell carcinoma of the bladder]. / Carcinoma de células pequeñas oat cell de vejiga.

Small cell carcinoma (CCP) of the urinary bladder is an uncommon tumor, having usually an aggressive behavior. We report a new case of CCP seen at our centre and we communicate the applied therapeutic method. Although total cystectomy followed by chemo and radiotherapy seems to be the most effective treatment, we have carried out radical RTU of the bladder accompanied by chemo and radiotherapy as conservative therapy obtaining complete remission after 2 year of diagnosis, without local and distant evidence of the disease.

Metástasis cutánea de un carcinoma vesical de células transicionales / Cutaneous metastasis from transitional cell carcinoma of the bladder

La metástasis en piel por un carcinoma vesical epitelial es una manifestación infrecuente, generalmente aparece en estadios avanzados, tal como sucedió en nuestro paciente y se asocia con un mal pronóstico. Se trata de una lesión localizada en región suprapúbica y cara interna del muslo, con aspecto eritematoso, indurada y confluente; el examen histológico tras biopsia fría resultó una metástasis por carcinoma transicional (AU)

Carcinoma de células pequeñas oat cell de vejiga / Oat cell carcinoma of the bladder

El carcinoma de células pequeñas (CCP) de localización vesical es un tumor poco frecuente, teniendo por lo general una evolución agresiva. Presentamos un nuevo caso de CCP aparecido en nuestro servicio y comunicamos la actitud terapéutica aplicada. Si bien la exéresis total de vejiga seguida de quimio y radioterapia parece ser el tratamiento más efectivo, hemos realizado RTU radical de vejiga asociada a quimio y radioterapia como finalidad conservadora, consiguiendo remisión completa después de 2 años del diagnóstico, sin evidencia local y a distancia de la enfermedad (AU)

Increasing uterine receptivity by decreasing estradiol levels during the preimplantation period in high responders with the use of a follicle-stimulating hormone step-down regimen.

OBJECTIVE: To analyze the effect on uterine receptivity of a decrease in E2 levels during the preimplantation period with the use of a step-down regimen in high responders undergoing IVF. DESIGN: Prospective controlled clinical study. SETTING: The Instituto Valenciano de Infertilidad. PATIENT(S): High responders in whom at least one previous IVF attempt failed in which 3-4 good-quality embryos were transferred and E2 levels were >3,000 pg/mL on the day of hCG administration. INTERVENTION(S): Gonadotropins were administered according to two different protocols. Blood samples were collected and IVF was performed. MAIN OUTCOME MEASURE(S): Serum E2 levels and reproductive outcome of IVF. RESULT(S): Estradiol levels on the day of hCG administration and throughout the preimplantation period and the number of oocytes collected were significantly lower with the use of the step-down regimen than during the previous failed cycle in which the standard protocol was used. The fertilization rate was similar and the number of good-quality embryos transferred was comparable. However, the implantation and pregnancy rates were significantly improved in patients who underwent the step-down regimen compared with those who received the standard protocol. CONCLUSION(S): With the use of a step-down regimen with FSH in high responders, our clinical results demonstrate that uterine receptivity can be improved when E2 levels are decreased during the preimplantation period.

Selection of Candida glabrata strains with reduced susceptibility to azoles in four liver transplant patients with invasive candidiasis.

The cases of four liver transplant recipients who developed invasive candidiasis (2 cholangitis, 1 perihepatic abscess, 1 candidemia) due to azole-resistant, Candida glabrata are reported. Three patients were receiving azolic compounds (2 itraconazole, 1 fluconazole) when the infection was diagnosed. All four patients received fluconazole as intestinal decontamination during the first three weeks post transplantation. The infections occurred two months after transplantation in all patients, and in one patient Candida infection was the direct cause of death. Infection of the biliary tree was the origin of candidiasis in three patients; the fourth patient developed neutropenic-related candidemia. Fluconazole MICs exceeded 16 micrograms/ml in all cases; itraconazole MICs were 16, 2, 1, and 2 micrograms/ml, respectively. The potential role of Candida species other than albicans in these patients after administration of azole agents is discussed.

Effects of pharmacological therapy on anthropometric and biochemical status of male and female institutionalized psychiatric patients.

OBJECTIVE: The pathophysiological condition and potential drug interactions may influence nutritional status. Therefore, the aim of this study was to determine, separately in male and female schizophrenic subjects, the influence of neuroleptic treatment on different indices of nutritional status. DESIGN: The survey was conducted at a 750-bed mental hospital in 311 custodial care patients, where anthropometric and hematological estimations were measured. RESULTS: In the present study, prevalence of obesity, (assessed by weight-for-height) increased by 10% in males and 18% in females on neuroleptic medication as compared to psychotropic-free schizophrenic subjects. Those taking neuroleptic medication also had larger fat and protein body compartments. Statistical differences between the groups (controls vs neuroleptics) were found for triceps skinfold and arm-muscle circumference as indices of body composition, being more marked in female patients. Neuroleptic administration was associated with changes in iron status, plasma protein, high-density lipoprotein cholesterol and triglycerides in males, while only plasma protein levels were affected in the female schizophrenic group under antipsychotic therapy. CONCLUSION: This study provides further evidence of adverse consequences of neuroleptic drugs on anthropometric and biochemical markers of nutritional status, and also shows differences between male and female patients in their response to psychotropic medications.

Late surgical repair of a traumatic total stenosis of a left bronchus by free cartilage graft.

This article reports the case of a 4-year-old boy who suffered trauma to the thorax, with a fracture and late stenosis of the main left bronchus. The technique to enlarge the bronchial lumen used a free cartilage graft. The clinical and radiological results were very satisfactory.

[The biochemical assessment of the nutritional status in patients admitted to a psychiatric hospital]. / Valoración bioquímica del estado nutritivo en pacientes ingresados en un hospital psiquiátrico.

The prevalence of cases of malnutrition is common in hospitals. Also, some psychiatric disorders have been associated with deficient nutrition. Within this context, analytical evaluations represent a valuable instrument in evaluating the nutritive state of the individual and groups of people, providing specific information at an early stage. Based on the above, the influence of hospitalization and the psychopathological state of 350 patients who had been admitted to a Psychiatric Hospital were studied. The biochemical and haematological determinations performed included the following measurements, parameters and indexes: glucose, proteins, plasmatics, minerals and lipids, haemoglobin, haematocrit and seric iron, as well as a leucocytic count and creatinine-height index. These data as a whole suggest that the frequency of situations of malnutrition is similar to those observed previously in other hospitalized groups and that situations of protein-caloric malnutrition are more common than deficiencies of minerals or vitamins.

Litiase do sistema biliar. Analise de 137 pacientes operados no Hospital dos Plantadores de Cana. / Lithiasis of biliary tract. Analysis of 137 patients operated in Hospital de Plantadores de Cana

Os autores analisam 137 pacientes portadores de doenca litiasica vesicular e coledociana, operados no periodo de janeiro de 1975 a dezembro de 1979. Os pacientes foram divididos em grupos: o Grupo I formado por 106 pacientes, apresentava colelitiase isoladamente; o Grupo II formado por 31 pacientes, apresentava colelitiase com coledocolitiase ou papilite associada.Os pacientes foram analisados, segundo faixa etaria, sexo, incisao operatoria, tipos de cirurgia e complicacoes imediatas e tardias.Foram revistos no pos-operatorio tardio (um ano ou mais apos a cirurgia) 75 pacientes dos dois grupos. Estes pacientes foram classificados, em funcao das queixas em A, B, C, tendo sido rotulados 61 pacientes (81,33%) no grupo A, 7 (9,33%) no grupo B e 7 (9,33%) no grupo C