Impacto de la prostatectomía radical en los resultados urodinámicos de pacientes con cáncer de próstata tratados con radioterapia de intensidad modulada / Impact of a radical prostatectomy on the urodynamic results of prostate cancer patients treated with intensity modulated radiation therapy

Introducción y objetivos Evaluar el efecto de la prostatectomía radical y la edad en los resultados urodinámicos antes y después de la radioterapia de intensidad modulada administrada a pacientes con cáncer de próstata. Materiales y métodos La muestra incluyó a 40 pacientes con cáncer de próstata, 22 de los cuales habían sido sometidos a prostatectomía radical. Se midieron y compararon los parámetros urodinámicos antes y después de una media de 4,2 meses de radioterapia. La radioterapia externa se administró mediante técnicas de terapia de arco volumétrico modulado y de radioterapia de intensidad modulada. Resultados No se vieron cambios significativos en los parámetros de uroflujometría. En el caso de la cistomanometría los datos no mostraron un aumento de la incontinencia urinaria de esfuerzo secundaria, pero sí un incremento del 7% en la incontinencia urinaria de urgencia. Hubo cambios estadísticamente significativos en la reducción de la capacidad vesical, con un deseo miccional fuerte, con urgencia miccional y también en la presión del detrusor con un deseo miccional normal. Además, el estudio de presión/flujo reveló una reducción estadísticamente significativa del volumen de orina residual. Conclusiones El efecto de la prostatectomía y la edad varía según la evolución del estudio urodinámico. Hubo una reducción significativa del volumen de orina residual, así como de la presión del detrusor, con un deseo miccional normal en los pacientes sin prostatectomía y en aquellos menores de 75 años. Además de un aumento en la incontinencia de urgencia, también se produjo un empeoramiento significativo del resultado urodinámico de llenado vesical y una disminución de la capacidad vesical cistomanométrica, con un deseo miccional fuerte y urgencia miccional. Ninguno de estos factores se vio afectado por la edad o la prostatectomía (AU)

Introduction and objectives To evaluate the effect of radical prostatectomy and age on urodynamics before and after intensity-modulated radiation therapy administered to prostate cancer patients. Materials and methods The sample consisted of 40 prostate cancer patients, 22 of whom had undergone a radical prostatectomy. Urodynamic parameters before and after an average of 4.2 months of radiotherapy were measured and compared. External radiotherapy was administered via Volumetric Modulated Arc Therapy (VMAT), Intensity Modulated Radiation Therapy (IMRT) techniques. Results Uroflowmetry presented no significant parameters. In the case of Cystomanometry, the data did not show an increase in secondary stress urinary incontinence, although there is 7 percent increase in urge urinary incontinence. There were statistically significant changes in reduced bladder capacity with a strong desire to void, with an urge to void and also in the detrusor pressure with a normal desire to void. Furthermore, pressure/flow analysis revealed a statistically significant reduction of residual urine volume. Conclusions The effect of prostatectomy and age varies according to the evolution of urodynamics. There was a significant reduction in terms of residual urine volume and detrusor pressure with a normal desire to void in patients without a prostatectomy and in those under 75 years old. In addition to an increase in urge incontinence, there was also a significant worsening of the bladder filling urodynamics and a decrease in the cystomanometric bladder capacity with a strong desire and an urge to void. None of these were modified by age or prostatectomy (AU)

Impact of a radical prostatectomy on the urodynamic results of prostate cancer patients treated with intensity modulated radiation therapy.

INTRODUCTION AND OBJECTIVES: To evaluate the effect of radical prostatectomy and age on urodynamics before and after intensity-modulated radiation therapy administered to prostate cancer patients. MATERIALS AND METHODS: The sample consisted of 40 prostate cancer patients, 22 of whom had undergone a radical prostatectomy. Urodynamic parameters before and after an average of 4.2 months of radiotherapy were measured and compared. External radiotherapy was administered via Volumetric Modulated Arc Therapy (VMAT), Intensity Modulated Radiation Therapy (IMRT) techniques. RESULTS: Uroflowmetry presented no significant parameters. In the case of Cystomanometry, the data did not show an increase in secondary stress urinary incontinence, although there is 7 percent increase in urge urinary incontinence. There were statistically significant changes in reduced bladder capacity with a strong desire to void, with an urge to void and also in the detrusor pressure with a normal desire to void. Furthermore, pressure/flow analysis revealed a statistically significant reduction of residual urine volume. CONCLUSIONS: The effect of prostatectomy and age varies according to the evolution of urodynamics. There was a significant reduction in terms of residual urine volume and detrusor pressure with a normal desire to void in patients without a prostatectomy and in those under 75 years old. In addition to an increase in urge incontinence, there was also a significant worsening of the bladder filling urodynamics and a decrease in the cystomanometric bladder capacity with a strong desire and an urge to void. None of these were modified by age or prostatectomy.

[Interpretation of the metabolic study in renal lithiasis and its treatment]. / Interpretación del estudio metabólico en la litiasis renal y su tratamiento.

Urolithiasis is a common disease, and is an important health problem that is associated with a great economic burden. The nature of stone disease varies according by dietary and lifestyle factors, including, among others, climate variations. The majority of patients will suffer a new lithiasic episode at some point in their life, unless preventive measures, such as changing lifestyles and dietary habits, are put in place to avoid it. The risk factors involved in lithogenesis should be evaluated in order to reduce recurrences. In the majority of these patients, metabolic changes are observed in the urine that predispose lithogenesis. The kind of evaluation depends on stone composition and on the clinical presentation. A diagnosis of systemic and renal diseases of lithogenic nature can be diagnosed with these studies, and they also enable the adoption of precise prophylactic measures that achieve control of recurrence in a great number of patients.

Comparative analysis of the expression of metalloproteases (MMP-2, MMP-9, MMP-11 and MMP-13) and the tissue inhibitor of metalloprotease 3 (TIMP-3) between previous negative biopsies and radical prostatectomies. / Análisis comparativo de la expresión de metaloproteasas (MMP-2, MMP-9, MMP-11 y MMP-13) y del inhibidor tisular de la metaloproteasa 3 (TIMP-3) entre las biopsias previas negativas y las prostatectomías radicales.

Metalloproteases (MMPs) and tissue inhibitor of metalloprotease-3 (TIMP-3) have been associated to the risk of having cancer and tumor aggressiveness. When facing the difficulties of prostate cancer diagnosis, the expression of MMPs and TIMP-3 in negative biopsies could be helpful to evaluate a diagnostic suspicion. Our objective is to carry out a comparative study of the expression of MMPs and TIMP-3 in previous negative biopsies and radical prostatectomies (RP). MATERIAL AND METHODS: Retrospective analysis of a hospital-based cohort including 21 patients with suspicion of prostate carcinoma, whose expressions of MMP-2, 9, 11 and 13 and TIMP-3 were evaluated by immunohistochemistry in the tumor area from previous negative biopsies and RP. RESULTS: Immunohistochemical staining values (Score) for MMPs (-11 and -13) and TIMP-3 showed no significant differences when comparing the areas of negative biopsies where tumors subsequently developed with those of the RP. However, we did observe a significant difference in the increased expression of MMP-2 (P=.002) and MMP-9 (P=.001) in the tumor area of the RP with respect to the corresponding area of the previous negative biopsy. CONCLUSIONS: Our data indicate a higher overall expression of MMP-2 and MMP-9 in the tumor area of the RP compared to the corresponding areas of the negative previous biopsy, which seems to be associated to the process of malignant transformation.

Problemas de la esfera sexual en el paciente renal / Sexual disorders in the renal patient

En la actualidad se considera a la calidad de vida relacionada con la salud como uno de los objetivos terapéuticos primordiales en pacientes que precisan tratamiento sustitutivo para seguir viviendo. La salud sexual es un derecho básico que afecta positivamente a la calidad de vida. Aunque una parte significativa de pacientes crónicos presenta algún tipo de disfunción sexual, esta no se plantea abiertamente en la consulta. Es importante que el médico aborde la dimensión sexual de estos pacientes. Repasamos la fisiopatología de las disfunciones sexuales del paciente renal crónico, tanto en hombres como en mujeres. Explicamos los efectos de la diálisis y el trasplante sobre la función sexual. Y exponemos las principales disfunciones sexuales y su tratamiento

Quality of Life Related to Health is currently considered one of the primary therapeutic objectives in renal failure patients who need substitution treatment as life prolonging therapy. Sexual health is a basic right that positively affects the quality of life. Although a significant percentage of chronic patients have some type of sexual dysfunction, this is not openly discussed, making it important for doctors to address these issues in the clinic. A review is presented on the pathophysiology of sexual dysfunctions in both male and female chronic renal patients. The effects of dialysis and transplantation on sexual function will be addressed, as well as presenting the main sexual dysfunctions and their treatment

[Sexual disorders in the renal patient]. / Problemas de la esfera sexual en el paciente renal.

Quality of Life Related to Health is currently considered one of the primary therapeutic objectives in renal failure patients who need substitution treatment as life prolonging therapy. Sexual health is a basic right that positively affects the quality of life. Although a significant percentage of chronic patients have some type of sexual dysfunction, this is not openly discussed, making it important for doctors to address these issues in the clinic. A review is presented on the pathophysiology of sexual dysfunctions in both male and female chronic renal patients. The effects of dialysis and transplantation on sexual function will be addressed, as well as presenting the main sexual dysfunctions and their treatment.

Resultados de la adrenalectomía en la metástasis del cáncer de pulmón / Results of adrenalectomy in lung cancer metastases

Introducción: El objetivo de este estudio es describir la experiencia en nuestro centro sobre pacientes con carcinoma de pulmón y metástasis adrenal tratados de manera secuencial, resección pulmonar y adrenalectomía, en los últimos 15 años. Pacientes y método: Analizamos una serie retrospectiva de 19 pacientes a los que se les realizó adrenalectomía por metástasis de carcinoma de pulmón. Todos los pacientes fueron operados en un mismo centro, entre octubre de 2000 y octubre de 2015. Se llevó a cabo un análisis descriptivo y de supervivencia global y libre de enfermedad. Resultados: Se incluyeron 13 varones y 6 mujeres. El tumor primario de pulmón más frecuente fue el adenocarcinoma, siendo el 87,5% G3. En 7 pacientes la metástasis adrenal se detectó de forma sincrónica, y en 12 metacrónica. El tamaño mediano de la metástasis fue de 63mm. El 21% de los casos presentaron recidiva local y el 79% metástasis a distancia. La mediana para la SLE fue de 21.5 meses, mientras la estimación de la SLE a 5 años fue del 58,33%. La mediana para la supervivencia global fue de 37,3 meses, mientras la estimación de la supervivencia a los 5 años fue del 42,86%. Ninguno de los factores pronósticos evaluados tuvieron significación estadística. Conclusiones: La adrenalectomía en casos de metástasis aislada de carcinoma de pulmón puede ofrecer una mayor supervivencia global. La edad y el grado de diferenciación del primario pulmonar son los factores que más influirían en una peor supervivencia

Background: The aim of this study was to report our centre's experience over the past 15 years with patients with lung carcinoma and adrenal metastases treated sequentially with lung resection and adrenalectomy. Patients and methods: We analysed a retrospective series of 19 patients who underwent adrenalectomy for lung carcinoma metastasis. All patients were operated on at the same centre, between October 2000 and October 2015. We performed a descriptive analysis and an overall survival and disease-free survival analysis. Results: The study included 13 men and 6 women. The most common primary lung tumour was adenocarcinoma, 87.5% of which were G3. In 7 patients, the adrenal metastasis was detected synchronously, and in 12 patients it was detected metachronously. The median size of the metastasis was 63mm. Twenty-one percent of the cases presented local recurrence, and 79% presented distant metastasis. The median DFS was 21.5 months, while the DFS at 5 years was calculated at 58.33%. The median overall survival was 37.3 months, while survival at 5 years was calculated at 42.86%. None of the prognostic factors evaluated were statistically significant. Conclusions: Adrenalectomy in cases of isolated lung carcinoma metastasis can offer increased overall survival. Age and the degree of differentiation of the primary lung carcinoma are the factors that most influence poorer survival

Qué debe saber el médico de primaria sobre los nuevos marcadores en el cáncer de próstata / What primary care physicians should know about new markers in prostate cancer

La utilización del antígeno prostático específico como herramienta diagnóstica en el cribado del cáncer de próstata se ve reflejada en un incremento en la incidencia, un incremento en el diagnóstico de cánceres más precoces y un aumento en los tratamientos con intención curativa, aun a costa de un sobretratamiento. Sabemos, por datos recogidos en la literatura, que no todo paciente con antígeno prostático específico elevado necesita biopsia, y que no todo paciente con diagnóstico de cáncer de próstata necesita tratamiento. Con los nuevos marcadores prostáticos emergentes vamos a tratar de mejorar la especificidad del antígeno prostático específico en la zona gris (4-10 ng/ml) evitando biopsias innecesarias, de mejorar la sensibilidad en la detección de cáncer de próstata significante con antígeno prostático específico bajo y a intentar reducir el riesgo de sobretratamiento. Por otro lado, los biomarcadores pronósticos con test genómicos nos van a ayudar a elegir la mejor opción terapéutica para el paciente

The use of prostate-specific antigen as a diagnostic tool in the screening of prostate cancer is reflected in an increase in the incidence, an increase in diagnosis at initial stages, and an increase in radical therapies, even at the expense of over-treatment in some cases. It is known from the data collected in the literature that not every patient with high prostate-specific antigen needs a biopsy, and that not every patient diagnosed with prostate cancer needs treatment. With the new emerging prostate markers, we will try to improve the specificity of prostate-specific antigen in the grey area (4-10 ng/ml) should be improved. This should avoid unnecessary biopsies. The sensitivity in the detection of significant prostate cancer with low prostate-specific antigen should also be improved in an attempt to reduce the risk of over-treatment. On the other hand, prognostic biomarkers with genomic tests will help to choose the best therapeutic option for the patient

[What primary care physicians should know about new markers in prostate cancer]. / Qué debe saber el médico de primaria sobre los nuevos marcadores en el cáncer de próstata.

The use of prostate-specific antigen as a diagnostic tool in the screening of prostate cancer is reflected in an increase in the incidence, an increase in diagnosis at initial stages, and an increase in radical therapies, even at the expense of over-treatment in some cases. It is known from the data collected in the literature that not every patient with high prostate-specific antigen needs a biopsy, and that not every patient diagnosed with prostate cancer needs treatment. With the new emerging prostate markers, we will try to improve the specificity of prostate-specific antigen in the grey area (4-10 ng/ml) should be improved. This should avoid unnecessary biopsies. The sensitivity in the detection of significant prostate cancer with low prostate-specific antigen should also be improved in an attempt to reduce the risk of over-treatment. On the other hand, prognostic biomarkers with genomic tests will help to choose the best therapeutic option for the patient.

Results of adrenalectomy in lung cancer metastases. / Resultados de la adrenalectomía en la metástasis del cáncer de pulmón.

BACKGROUND: The aim of this study was to report our centre's experience over the past 15 years with patients with lung carcinoma and adrenal metastases treated sequentially with lung resection and adrenalectomy. PATIENTS AND METHODS: We analysed a retrospective series of 19 patients who underwent adrenalectomy for lung carcinoma metastasis. All patients were operated on at the same centre, between October 2000 and October 2015. We performed a descriptive analysis and an overall survival and disease-free survival analysis. RESULTS: The study included 13 men and 6 women. The most common primary lung tumour was adenocarcinoma, 87.5% of which were G3. In 7 patients, the adrenal metastasis was detected synchronously, and in 12 patients it was detected metachronously. The median size of the metastasis was 63mm. Twenty-one percent of the cases presented local recurrence, and 79% presented distant metastasis. The median DFS was 21.5 months, while the DFS at 5 years was calculated at 58.33%. The median overall survival was 37.3 months, while survival at 5 years was calculated at 42.86%. None of the prognostic factors evaluated were statistically significant. CONCLUSIONS: Adrenalectomy in cases of isolated lung carcinoma metastasis can offer increased overall survival. Age and the degree of differentiation of the primary lung carcinoma are the factors that most influence poorer survival.

Aspectos actuales sobre el cribado en el cáncer de próstata / Current aspects of prostate cancer screening

Los programas de cribado de cáncer de próstata basados en la determinación sérica del antígeno específico de próstata han llevado a un sobrediagnóstico y, como consecuencia, a un sobretratamiento. Un porcentaje de varones diagnosticados de cáncer de próstata tienen un tumor que no progresará o lo hará lentamente (sobrediagnóstico o pseudoenfermedad). Esta tasa de sobrediagnóstico oscila entre el 17-50%. El cribado poblacional se define como la exploración sistemática de hombres asintomáticos. La detección precoz o cribado oportunista conlleva la búsqueda de casos individuales, siendo iniciada por el médico o el propio paciente. Ante un paciente que acuda a consulta solicitando un antígeno específico de próstata se le deben explicar una serie de cuestiones relativas al sobrediagnóstico, el sobretratamiento y los posibles daños derivados de la biopsia. Con los datos de los estudios aleatorizados sobre el antígeno específico de próstata y el cribado de cáncer de próstata, ninguna sociedad urológica recomienda realizar cribado poblacional (AU)

Screening programs for prostate cancer based on the determination of serum prostate specific antigen has led to overdiagnosis, and consequently overtreatment. A percentage of men diagnosed with prostate cancer have a tumour that will not progress, or do so slowly (overdiagnosis or pseudo-disease). This overdiagnosis rate ranges from 17-50%. Mass screening is defined as the systematic examination of asymptomatic men. Early detection or opportunistic screening involves the pursuit of individual cases being initiated by the doctor or the patient. In the case of a patient who requests a prostate specific antigen from their general practitioner, a number of issues on overdiagnosis, over-treatment and possible damage from the biopsy, should be explained to him. With data from randomised studies on prostate specific antigen and prostate cancer screening, population screening is not recommended by any urological society (AU)

[Current aspects of prostate cancer screening]. / Aspectos actuales sobre el cribado en el cáncer de próstata.

Screening programs for prostate cancer based on the determination of serum prostate specific antigen has led to overdiagnosis, and consequently overtreatment. A percentage of men diagnosed with prostate cancer have a tumour that will not progress, or do so slowly (overdiagnosis or pseudo-disease). This overdiagnosis rate ranges from 17-50%. Mass screening is defined as the systematic examination of asymptomatic men. Early detection or opportunistic screening involves the pursuit of individual cases being initiated by the doctor or the patient. In the case of a patient who requests a prostate specific antigen from their general practitioner, a number of issues on overdiagnosis, over-treatment and possible damage from the biopsy, should be explained to him. With data from randomised studies on prostate specific antigen and prostate cancer screening, population screening is not recommended by any urological society.

[Therapeutic effect of mitomycin C in the immediate postoperative period in patients with intermediate-risk non-muscle-invasive bladder tumors]. / Efecto terapéutico de mitomicina C en el postoperatorio inmediato de pacientes con tumores vesicales no músculo invasores de riesgo intermedio.

INTRODUCTION: Approximately 70-85% of transitional bladder cell carcinomas are non-muscle-invasive. After an initial surgery, around 60-90% will have a recurrence, being the highest risk period the first two years. Urothelium instability could be the main reason for recurrence in mid grade tumours, reason why a single dose of a chemotherapy after transurethral resection of the bladder (TURB) might be insufficient. That is why a deferred therapy in occasions associated with maintenance is recommended. PATIENTS AND METHODS: A prospective, controlled and randomized study was performed. We included non-muscle-invasive mid risk bladder tumours. All patients had initially a TURB performed and were randomized to receive a single dose of mitomycin C (MMC), in the immediate postoperative period. RESULTS: A total of 105 patients were included. Mean follow-up was 22, 70 +/- 8, 15 months. MMC was administered to 53 patients. Of these 66, 0% had no recurrence and 34.0% had a non-muscle-invasive recurrence. Of the 52 patients in the non MMC group, 53.8% had no recurrence and 44.2% had a non-muscle-invasive recurrence and only 1 patient had a muscle-invasive progression. We did not find significantly differences in time to recurrence in mid risk tumours when using immediate postoperative single dose of MMC or deferred therapy. There was only one case of myelosuppression. DISCUSSION: In mid risk non-muscle-invasive tumors, some studies suggest that early intravesical instillation of chemotherapy reduces the risk of recurrence after TURB. We could not show significantly differences when comparing postoperatorive MMC versus traditional deferred instillations.

Efecto terapéutico de Mitomicina C en el postoperatorio inmediato de pacientes con tumores vesicales no músculo invasores de riesgo intermedio / Therapeutic effect of mitomycin C in the immediate postoperative period in patients with intermediate-risk non-muscle-invasive bladder tumors

Introducción: Aproximadamente del 70-85% de los carcinomas de células transicionales de vejiga no invaden la muscular propia. La recidiva después de la cirugía se cifra en un 60-90% de pacientes, siendo el periodo de alto riesgo los dos primeros años. La causa fundamental de recidiva en tumores de riesgo intermedio podría ser la inestabilidad del urotelio, por lo que la instilación única de un quimioterápico después de la RTU podría considerarse insuficiente, recomendándose un tratamiento diferido asociado con mantenimiento en algunos casos. Pacientes y Métodos: Estudio prospectivo, controlado y randomizado. Sólo se incluyeron pacientes con tumores vesicales no músculo-invasores de grado intermedio. Todos los pacientes fueron sometidos inicialmente a RTU y posteriormente randomizados para recibir Mitomicina C (MMC) postoperatoria en dosis única. Resultados: Se incluyeron 105 pacientes. La media de seguimiento fue de 22,70±8,15 meses. Se administró MMC en 53pacientes, de los cuales el 66% no recidivó y el 34% lo hicieron como tumor vesical no invasor. De los 52 pacientes que no recibieron MMC, el 53,8% no recidivaron, el 44,2% recidivaron como tumor no invasor y sólo un caso recurrió como tumor invasor.En cuanto al tiempo libre de enfermedad, no se encontraron diferencias significativas en los que se empleó MMC postoperatoriao tratamiento diferido. Sólo existió un caso de mielosupresión. Discusión: En tumores no músculo invasores de medio riesgo, diversos estudios sugieren que una instilación intravesical inmediata de un quimioterápico disminuye el riesgo de recidiva después de la RTU. No hemos logrado demostrar diferencias significativas al comparar la MMC postoperatoria frente a las instilaciones diferidas tradicionales (AU)

Introduction: Approximately 70-85% of transitional bladder cell carcinomas are non-muscle-invasive. After an initial surgery, around 60-90% will have a recurrence, being the highest risk period the first two years. Urothelium instability could be the main reason for recurrence in mid grade tumours, reason why a single dose of a chemotherapy after transurethral resection of the bladder (TURB) might be insufficient. That is why a deferred therapy in occasions associated with maintenance is recommended. Patients and methods: A prospective, controlled and randomized study was performed. We included non-muscle-invasive midrisk bladder tumours. All patients had initially a TURB performed and were randomized to receive a single dose of mitomycin C (MMC), in the immediate postoperative period. Results: A total of 105 patients were included. Mean follow-up was 22, 70±8, 15 months. MMC was administered to 53patients. Of these 66, 0% had no recurrence and 34,0% had a non-muscle-invasive recurrence. Of the 52 patients in the non MMC group, 53,8% had no recurrence and 44,2% had a non-muscle-invasive recurrence and only 1 patient had a muscle invasive progression. We did not find significantly differences in time to recurrence in mid risk tumours when using immediate postoperative single dose of MMC or deferred therapy. There was only one case of myelosuppression. Discussion: In mid risk non-muscle-invasive tumors, some studies suggest that early intravesical instillation of chemotherapy reduces the risk of recurrence after TURB. We could not show significantly differences when comparing postoperatorive MMC versus traditional deferred instillations (AU)

[The physiopathology and management of sexual dysfunction in epileptic patients]. / Fisiopatología y abordaje de la disfunción sexual en pacientes epilépticos.

AIM: To review sexual dysfunction in epileptic patients, which is an aspect of the disease that is often deemed as being of little importance, but which exerts a decisive influence on the quality of life of these patients. DEVELOPMENT: The alterations in sexual functioning in epilepsy have a complex physiopathology, can be of different types and occur during seizures, the aura or in the intercritical periods. Their clinical expression depends on the sex and age of the patient. The severity and incidence of sexual dysfunction are influenced by the treatment being used, the psychosocial adjustment of the individual, and certain aspects of epilepsy such as the age at onset, time to progression, location of the focus, the type of seizures and the degree of control the patient has over them. The therapeutic strategy is based on adjusting or modifying the antiepileptic therapy and then treating the sexual dysfunction and/or possible hormonal upsets. CONCLUSIONS: Sexuality is a fundamental human right and as a health provider, the physician must take this aspect of the disease into account when dealing with epileptic patients by attempting to detect and characterise the disorder. The patient must be informed of the possible effects of epilepsy and its treatment on sexual functioning, and also the therapeutic options the physician considers to be best suited to the patient's particular case. He or she should also be encouraged to play an active role in making decisions on the matter and it is necessary to carry out developmental monitoring that takes into account the impact that improved sexual functioning is going to have on the patient's psychosocial and family adjustment.

Fisiopatología y abordaje de la disfunción sexual en pacientes epilépticos / The physiopathology and management of sexual dysfunction in epileptic patients

Revisar la disfunción sexual en epilépticos, un aspecto de la enfermedad a menudo infravalorado, peroque puede influir decisivamente sobre la calidad de vida de estos pacientes. Desarrollo. Las alteraciones de la función sexual en la epilepsia tienen una fisiopatología compleja, pueden ser de diferentes tipos y acontecer durante las crisis, el aura o los períodos intercríticos. Su expresión clínica depende del sexo y la edad de los pacientes. El tratamiento utilizado, el ajuste psicosocial del individuo y determinados aspectos de la epilepsia, como la edad de comienzo, el tiempo de evolución, la localización del foco, el tipo de crisis y el grado de control de las mismas, influyen sobre la gravedad y la incidencia de la disfunción sexual. La estrategia terapéutica se basa en ajustar o modificar la terapia antiepiléptica y abordar después la disfunción sexual y/o las posibles alteraciones hormonales. Conclusiones. La sexualidad es un derecho fundamental del ser humano, y ante un paciente epiléptico es obligación del médico, como proveedor de salud, atender este aspecto de la enfermedadtratando de detectar y caracterizar la alteración, informando al paciente de los posibles efectos de la epilepsia y su tratamiento sobre la función sexual, exponiéndole las opciones terapéuticas que considera más adecuadas, animándole a participar activamente en la toma de decisiones al respecto, y realizando un control evolutivo que tenga en cuenta el impacto que la mejoría de la función sexual va a producir sobre el ajuste psicosocial y familiar del paciente

To review sexual dysfunction in epileptic patients, which is an aspect of the disease that is often deemed asbeing of little importance, but which exerts a decisive influence on the quality of life of these patients. Development. The alterations in sexual functioning in epilepsy have a complex physiopathology, can be of different types and occur during seizures, the aura or in the intercritical periods. Their clinical expression depends on the sex and age of the patient. Theseverity and incidence of sexual dysfunction are influenced by the treatment being used, the psychosocial adjustment of the individual, and certain aspects of epilepsy such as the age at onset, time to progression, location of the focus, the type of seizures and the degree of control the patient has over them. The therapeutic strategy is based on adjusting or modifying the antiepileptic therapy and then treating the sexual dysfunction and/or possible hormonal upsets. Conclusions. Sexuality is a fundamental human right and as a health provider, the physician must take this aspect of the disease into account whendealing with epileptic patients by attempting to detect and characterise the disorder. The patient must be informed of the possible effects of epilepsy and its treatment on sexual functioning, and also the therapeutic options the physician considers tobe best suited to the patient's particular case. He or she should also be encouraged to play an active role in making decisions on the matter and it is necessary to carry out developmental monitoring that takes into account the impact that improved sexual functioning is going to have on the patient’s psychosocial and family adjustment

Significance of collagenase 3 (matrix metalloproteinase 13) in invasive bladder cancer: correlation with pathological parameters.

PURPOSE: To determine if collagenase 3 expression is associated with stage progression and prognosis of bladder cancer. PATIENTS AND METHODS: Immunohistochemical staining for collagenase 3 was carried out on serial sections from specimens of 42 patients (32 males and 10 females) who underwent radical cystectomy for bladder cancer (median follow-up, 67.2 +/- 5.99 months). RESULTS: Immunohistochemical expression of collagenase 3 was detected in 13 (31%) patients. Pathological stage was pT2 in 12 (28.57%) patients, pT3a in 7 (16.6%), pT3b in 21 (50%) and pT4 in 2 (4.76%). Four tumours (9.52%) were grade II and 38 (90.47%) were grade III. Stage and tumours >3 cm in size were associated with bladder cancer progression-free survival and overall survival. We did not find any statistical differences with collagenase 3 expression related with stage and size. CONCLUSIONS: Immunohistochemical expression of matrix metalloproteinase 13 in invasive bladder cancer is not useful as marker for transformation and invasion. These findings should be evaluated in large multicentre prospective trials.

[Primary psoas abscess due to Streptococcus pneumoniae]. / Absceso primario de psoas por Streptococo pneumoniae.

INTRODUCTION AND OBJECTIVES: To report to the literature a new case of primary psoas abscess. METHODS: The patient is a 65 years old woman who suffered back and left hip pain for approximately 1 month. A CTA showed a retroperitoneal mass that involved the left Psoas. It was drained 1800 cc of purulent fluid infected by Streptococo pneumoniae. RESULTS: In a CTA made 21 days after drainage, showed a very small residual collection. CONCLUSIONS: Primary Psoas Abscess are a very rare entity, with a low rate of mortatility if well treated.

Cambio en el patrón de presentación del cáncer de próstata en Oviedo en los últimos 10 años: patrón de presentación, manifestaciones clínicas y anatomo-patológicas (Parte I) / Changes in the clinical and anatomopathological presentation of prostate cancer in Oviedo in the last 10 years (Part I)

Objetivos: Describir el patrón de presentación tanto clínico como anatomo-patológico de los pacientes diagnosticados de cáncer de próstata en nuestro servicio, comparando los datos obtenidos en el año 1995 y en el 2004. Material y métodos: Se revisaron las 216 historias clínicas de los pacientes diagnosticados en 1995 y 2004, recogiéndose unos datos según un protocolo establecido. Resultados: La edad media al diagnóstico fue significativamente más baja en el año 2004. En ese año, prevaleció el incremento de la concentración de PSA como causa de diagnóstico, seguido por los síntomas urinarios del tracto urinario inferior (STUI), mientras que en el año 1995 destacaron los STUI y el tacto rectal sospechoso. Se observó una mayor proporción de tumores de alto grado en el año 1995, donde los tumores predominantes fueron los de alto riesgo mientras que en el año 2004 fueron los de bajo riesgo y encontramos una mayor proporción de tumores de bajo grado. Conclusiones: La migración de la estadificación clínico patológica hacia estadios más precoces descrita tras el uso generalizado del PSA en pacientes asintomáticos, se confirmó en nuestro estudio, como demuestra la mayor proporción de tumores de alto grado con Gleason entre 8-10 ng/ml diagnosticados en la serie del año 1995 y un mayor número de tumores de bajo grado en el año 2004

Objectives: To describe the clinical and pathological factors of prostate adenocarcinomas diagnosed in our department in the years 1995 and 2004. Material and method: We review the 216 patients diagnosed in both years, recording several features. Results: The mean age was significatively lower in the year 2004. In that year, the increments of the PSA levels was the main reason for the diagnosis of the prostate cancer, followed by low urinary tract symptons (LUTS), while the LUTS was the main reason in 1995. There was a greater proportion of high grade tumors in 1995 and also in this year, high risk tumors were the most frequently found, while in 2004 low risk and low grade tumors were predominant. Conclusions: Due to the general determinations of PSA levels in asymptomatic patients in 2004, we found a greater proportion of high grade tumors in 1995 and lower grade tumors in 2004

Cambio en el patrón de presentación del cáncer de próstata en Oviedo en los últimos 10 años: diagnóstico y tratamiento (Parte II) / Changes in the presentation pattern of the prostate cancer in Oviedo in the last 10 years: diagnostic and treatment (Part II)

Objetivos: Describir el patrón de diagnóstico y tratamiento en los pacientes diagnosticados de cáncer de próstata en nuestro servicio, comparando los datos obtenidos en el año 1995 y en el 2004. Material y métodos: Se revisaron las 216 historias clínicas de los pacientes diagnosticados en 1995 y 2004, recogiéndose unos datos según un protocolo establecido. Resultados: Se observaron diferencias significativas en las medias del número de cilindros obtenidos en las biopsias en el año 19952,3 frente a las del 20041,6. Respecto al tratamiento, en el año 1995 predominó la deprivación androgénica seguida de la prostatectomía radical mientras que en el año 2004 la terapia más utilizada fue la radioterapia (externa y/o braquiterapia), seguida por la deprivación androgénica y la prostatectomía radical. Resultaron factores independientes para plantear el tipo de tratamiento la edad (OR=5,6) y el grupo de riesgo (OR=2,8) en el año 2004 y únicamente la edad (>70 años vs <=70 años) en el año 1995. Conclusiones: La evolución experimentada en las distintas técnicas terapéuticas ha convertido al cáncer de próstata en una enfermedad multidisciplinar obteniendo una gran mejoría en los resultados del tratamiento. Pese a todo esto, el desconocimiento existente en la actualidad acerca de la historia natural del cáncer de próstata y de su evolución en la mayoría de los casos, hace que sea necesario la realización de grandes estudios prospectivos, los cuales se están llevando a cabo, para determinar si el cribado del cáncer de próstata mediante el uso del PSA puede ser útil o no

Objectives: To describe and compare the diagnostic and treatment factors of prostate adenocarcinomas diagnosed in our department in the years 1995 and 2004. Material and method: We review the 216 patients diagnosed in both years, recording several features. Results: Significant differences were found in the mean of cylinders taken in the biopsies, being higher in 20041,6 than in 19952,3. Hormonal deprivation was the predominant treatment in 1995 followed by radical prostatectomy, while in 2004 radiotherapy (external beam or braquitherapy) was the most frequent therapy used followed by hormonal deprivation and radical prostatectomy. Independent factors to apply the treatment was the age (OR=5,6) and the risk groups (OR=2,8) in the year 2004 and only the age (>70 years vs <=70) in the year 1995. Conclusions: The evolution held in treatment therapies for prostate adenocarcinomas, made this disease in terms of treatment a multidisciplinary disease obtaining better results