Absceso renal estafilocócico trasforunculosis cutánea / Staphylococcus renal abscess after cutaneous furunculosis

Los abscesos renales son patologías infrecuentes, pero de alta morbi-mortalidad si no son diagnosticados temprano y tratados precozmente. Su vaga e inespecífica sintomatología: dolor abdominal o lumbar, fiebre o mal estado general hacen que su diagnostico sea a veces tardío. La ecografía y/o la TAC dan el diagnóstico en el 100 por ciento de los casos lo que hace posible su tratamiento temprano. El objetivo de este artículo es poner de relieve que el absceso renal es una causa de urgencia urológica a tener presente en pacientes fundamentalmente del sexo femenino, con síntomas de dolor abdominal o fiebre sin clara focalidad urológica.MATERIAL Y MÉTODOS: Se presenta el caso de una adolescente de 16 años con antecedente reciente de forunculosis cutánea supurada en rodilla derecha, que acudió a urgencias por dolor en flanco derecho y fosa iliaca derecha de 10 días de evolución sin fiebre ni síntomas miccionales. Se nos consultó para su valoración, siendo la ecografía el método diagnóstico que se utilizó para la localización de un absceso renal derecho subcapsular de 44 mm en polo superior, y posteriormente para su drenaje percutáneo al no responder porcompleto al tratamiento antibiótico i.v. El cultivo del material purulento del drenaje percutáneo aisló un Staphyloccocus aureus no meticilin resistente. El tratamiento antibiótico i.v asociado a drenaje percutáneo seguido de cloxacilina oral a su alta, curó a la paciente. A raíz de este caso se revisan las series y revisiones sobre abscesos renales de los últimos 10 años, con un total de 179 pacientes, y las publicaciones sobre abscesos renales por Staphyloccocus aureus con tan sólo 13 casos. CONCLUSIONES: Los abscesos renales han de tenerse en cuenta entre las urgencias urológicas. Su diagnóstico y tratamiento percutáneo es mayormente radiológico, reservándose la cirugía abierta o la nefrectomía para abscesos > de 5 cm o pacientes sépticos...

Renal abscesses are infrequent pathologies, but with a high morbidity-mortality if they are not diagnosed and treated early. Its vague and unspecific symptomatology: abdominal or lumbar pain, fever or poor general state, make its diagnosis late sometimes. The ultrasound and/or TAC provide a 100 percent diagnosis of the cases where its early treatment is possible. The objective of this article is to give importance to the fact that renal abscess is a cause of an urological emergency to keep in mind in patients, particularly females with symptoms of abdominal pain or fever without a clear urological focus. MATERIAL AND METHODS: The case of a 16-year-old adolescent is presented with a recent history of festered cutaneous furunculosis on the right knee. She went to the emergency room due to pain on the right side and right illiac fosa with 10 days evolution without fever or urinary symptoms. She came to us for its evaluation, an ultrasound was used for diagnosis to locate a right subcapsular renal abscess of 44 mm on the superior pole, and later for its percutaneous drainage when it did not completely responded to I.V. antibiotic treatment. The culture of the purulent material of the percutaneous drainage isolated a resistant non-methicillin Staphyloccocus aureus. The I.V. antibiotic treatment associated to percutaneous drainage followed by oral cloxacillin upon release cured the patient. CONCLUSIONS: Renal abscesses have to be taken into account among the urological emergencies. Their diagnosis and percutaneous treatment is mainly radiological, leaving open surgery or nephrectomy for abscesses > 5cm or with septic patients...

Sobre los nudos en medicina, cirugía y urología: implicaciones clínicas ycomplicaciones / About knots in medicine, surgery and urology: clinical implications and complications

Estudiar el papel de los nudos en otros campos de la ciencia distintos a las Matemáticas o la Topología, tales como las Ciencias Biológicas, la Medicina, la Cirugía y la Urología. Evaluar su utilidad médica tanto clínica como en el acto quirúrgico, sus complicaciones, los procesos patológicos emparentados con los nudos y reseñar posibles aplicaciones futuras de la topología en Medicina. MATERIAL Y MÉTODOS: Revisión bibliográfica en PubMed/Medline, Dialnet y Google.es sobre las relaciones, implicaciones e importancia de la Topología y los nudos en la práctica médica y quirúrgica habitual, en la patogenia de diversas enfermedades y complicaciones quirúrgicas; así como reseñar otras potenciales aplicaciones médicas de las ciencias topológicas. Para la búsqueda bibliográfica se han utilizado las palabras clave en inglés: “knot, Biology knots, Medicine knots, Surgery knots, catheter knotting” y en castellano: “nudos, quipus, enlaces, trenzas, concatenaciones, y bucles” en combinación con: “Matemáticas, Topología, Biología, Medicina, Cirugía y Urología”. Se obtuvieron un total de 6972 artículos sobre nudos en Medicina desde 1845 a junio de 2014. La revisión de los originales o de los abstracts de PubMed dió lugar a una selección de 65 considerados de mayor interés para la presente revisión. Se consiguieron copias de los artículos originales disponibles o información de los abstracts de PubMed. RESULTADOS: El estudio bibliográfico comprendió desde 1845, fecha en la que se identificó el primer artículo, hasta el 30 de junio de 2014, fecha en la que se cerró el estudio, separados ambos por más de siglo y medio de historia de la medicina.La revisión bibliográfica localizó 6972 artículos desde 1845 al 30 de junio de 2014, de los que se seleccionaron 65, considerados a nuestro juicio los más interesantes para estudiar las relaciones de los nudos con la Biología, Medicina, Cirugía y Urología. Los 65 seleccionados se subdividieron en los siguientes temas: 10...

Study the role of knots in other fields of science other than Mathematics or Topology, such as Biological Sciences, Medicine, Surgery and Urology. Evaluate their medical use, both clinically and in surgery, their complications, the pathological processes related with the knots and to identify possible future applications of the topology in Medicine. MATERIAL AND METHODS: Bibliographical revision in PubMed/Medline, Dialnet and Google.es about the relationships, implications and importance of the Topology and the knots in medical practice and normal surgery, in the pathogeny of several illness and surgical complications; as well as to identify other potential medical applications of the topological sciences. For the bibliographical search, key words in English have been used: “knot, Biology knots, Medicine knots, Surgeryknots, catheter knotting” and in Spanish: “nudos, quipus, enlaces, trenzas, concatenaciones and bucles” together with “Mathematics, Topology, Biology, Medicine, Surgery and Urology”. A total of 6972 articles were found on knots in Medicine from 1845 to June 2014. The revision of the originals or of the abstracts from PubMed led to a selection of 65, considered to be of greater interest for this revision. Copies were obtained of the original articles available or information of the abstracts from PubMed. RESULTS: The bibliographical study covered from 1845, date on which the first article was identified, to June 30th 2014, date on which the study was closed, these dates covering more than a century and a half of medical history. The bibliographical review found 6972 articles from 1845 to June 30th 2014, from which 65 were chosen, these being the most interesting ones in our opinion to study the relations of knots with Biology, Medicine, Surgery and Urology. The 65 that were chosen were subdivided into the following topics: 10 of general interest about knots, 16 on knots and DNA, 20 on knots in Medicine and Surgery, 9 about series of...

Cálculo gigante enclavado en meato uretral femenino: resolución en área de urgencias / Giant calculus located in the female urethral meatus: resolution in an emergency setting

Objetivo: Comunicar un caso inusual de cálculo uretral femenino gigante enclavado en meato, que debutó por sangrado genital, sin retención urinaria ni síntomas miccionales. El cálculo era visible en el introito. Se efectuó tratamiento resolutivo en el área de urgencias, cursándose el alta a las pocas horas. Métodos: Se presenta el caso de una paciente de 82 años, con antecedentes remotos de cirugía vesical, que acudió a urgencias por sangrado genital. Valorada por Ginecología se apreció un gran cálculo uretral que a¬ oraba por el meato, derivándose a Urología. Tras la exploración física se solicitó radiografía simple de pelvis donde se apreció un gran calculo uretral de 6 x 4 cm. Bajo anestesia local se practicó meatotomía inferior con luxación y extracción del cálculo; siendo dada de alta a continuación con sonda vesical hasta la cicatrización de la herida. Resultados: La evolución tras el “parto del cálculo” fue favorable. Se cursó el alta con sonda vesical a las pocas horas de la extracción litiásica. Acudió nuevamente a urgencias 12 horas más tarde por arrancamiento involuntario de la sonda, siendo nuevamente sondada y dada de alta. La evolución posterior fue favorable, retirándose la sonda y conservando la micción espontanea. Conclusiones: El síntoma de sangrado genital femenino, no siempre se corresponde con problemas ginecológicos. La patología de la uretra femenina también puede ser su responsable: carúnculas, prolapsos, divertículos, quistes parauretrales de Skene, estenosis o cálculos como el caso presentado. Casos como éste pueden ser resueltos en la propia área de urgencias con relativa facilidad y sin necesidad de ingreso hospitalario.

Objective: To communicate the unusual case of a giant female urethral calculus located in the meatus, which presented with genital bleeding, without urinary retention or voiding symptoms. The calculus was visible at the introitus. Resolving treatment was performed in the emergency setting, progressing to discharge in a few hours. Methods: The case involved an 82–year-old patient with a remote history of bladder surgery who came to the emergency room with genital bleeding. On evaluation by the Gynecology staff, a large urethral calculus was found in the meatus, and a referral was made to the Urology department. After a physical examination, simple radiographs of the pelvis were ordered, in which a large urethral calculus (6 × 4 cm) was identified. Under local anesthesia, an inferior meatotomy was performed with luxation and extraction of the calculus; the patient was discharged with a catheter that was left in place until the wound healed. Results: The evolution after the “birth” of the calculus was favorable. The patient was discharged with a catheter a few hours after extraction of the lith. She returned to the emergency setting 12 hours later after inadvertently pulling out the catheter and was recatheterized and discharged. The patient’s later evolution was favorable; after removing the catheter, she maintained spontaneous voiding. Conclusions: The symptom of female genital bleeding does not always correspond to gynecological problems. Female urethral pathology can also be responsible; caruncles, prolapses, diverticuli, paraurethral cysts of the Skene’s gland, stenosis, or calculi, as in the case presented, can all result in bleeding. Cases like this one can be resolved in the emergency department relatively simply and without necessitating an inpatient admission.

Young male patient with bilateral synchronous testicular germ cell tumour. Considerations for partial orchiectomy

Bilateral synchronous testicular cancer is a rare disease and is usually associated with similar histological findings in each testicle. The standard therapy of bilateral testis cancer is generally considered to be inguinal orchiectomy. We present a case of synchronous bilateral testicular germ cell tumour, with different histology, initially treated with testis-sparing surgery. After pathology review, the margin of the partial orchiectomy was considered affected, and an inguinal orchiectomy was planned. Options for testis-sparing surgery are discussed (AU)

No disponible

[Vasectomy: study of 300 interventions. Review of the national literature and of its complications]. / La vasectomía: estudio de 300 intervenciones. Revisión de la literatura nacional y de sus complicaciones.

OBJECTIVES: The aims of this paper are: 1. To study the demand and reasons why of the vasectomy in area 12 of Valencian Community. 2. To analyse the adverse effects of our series and the predictable risk factors. 3. To review the adverse effects in the national series. 4. To review the adverse effects referred to in international publications. PATIENTS AND METHODS: A retrospective study was made of 300 patients who had submitted themselves to a vasectomy between january 1992 and december 2000. All the clinical dossiers were reviewed according to 10 pre-established variables. age, number of offspring, reasons why, pre-vasectomy anticontraceptives; date of operation, type of anaesthesia used, pathologic anatomy, semen analysis after vasectomy, adverse effects and their possible causes (risk factors). The basic statistic study was done using a data base of Microsoft Access and the interpretations of the different variables using a table of Excel. RESULTS: The demand for contraceptive attention (vasectomy) is the 8th cause for external urological consulting and the 4th for urological local ambulatory surgery of our area. 300 operations were done during that period. The average age of the patients was 37.5 years old (ranging from 25 to 51). The number of offspring ranged from 1 to 7, with a promedia of 2.41 children/patient. The reasons why were: voluntary family planning (86%), medical illnesses of the female which contraindicated gestation (9%), genetic reasons (4.33%) and social-sanitary problems (0.66%). Contraceptive methods used by 71.63% are known: The widest-used method being IUD (49.74%) and the preservative (25.88%). 30 patients (10%) had adverse effects, 29 patients having light adverse effects. The most frequent were: 12 orchiepididymitis (4%), 5 spermatic granulomas (1.66%), 3 chronic scrotal pain (1%), 2 scrotal haematoma (0.66%) and 2 bleeding (0.66%). There was one serious complications and of all the cases mentioned above only one needed hospitalization (impetigo-sepsis) and another needed surgery due to a spermatic granuloma. There were no pregnancies or post-vasectomy court cases. 81% of the patients had been declared azoospermic within 45 to 60 days after the vasectomy in one or two consecutive semen analysis. CONCLUSIONS: The vasectomy is a safe and simple way for male sterilization. It's the most widely done urologic operation in Spain. The technique isn't extent of adverse effects (0 to 18%) and its seriousness varies from a simple ecchymosis to Fournier's gangrene, endocarditis or sepsis. A doctor would be considered negligent if he/she didn't inform the patient about the remote possibility of a spontaneous recanalisation of the vas deferens leading to renewed fertility (failure of the vasectomy). It is imperative to give post-vasectomy information where the patient must continue using his habitual anticonceptive method until the azoospermia shown in 2 semen analysis confirm the sterility of the patient so that the urologist has no legal problem.

La vasectomía: estudio de 300 intervenciones. Revisión de la literatura nacional y de sus complicaciones / The vasectomy: A study of 300 operations. A review of its adverse effects and of national literature

OBJETIVOS: Los objetivos que nos hemos marcado en este trabajo son: 1. Estudiar la demanda e indicaciones de vasectomía en el área 12 de la Comunidad Valenciana. 2. Analizar las complicaciones de nuestra serie y los factores de riesgo previsibles. 3. Revisar las complicaciones de las series nacionales.4. Revisar las complicaciones referidas en las publicaciones internacionales. PACIENTES Y MÉTODOS: Se realiza un estudio retrospectivo de 300 pacientes sometidos a vasectomía durante el periodo de tiempo comprendido entre enero de 1992 y diciembre de 2000. Se revisaron todas las historias clínicas evaluando 10 variables preestablecidas: edad, número de hijos, indicación, método contraceptivo utilizado pre-vasectomía, fecha de intervención, tipo anestesia, anatomía patológica, seminogramas de control, complicaciones, y posibles causas de las complicaciones (factores de riesgo). Se realiza el estudio estadístico básico con ayuda de una base de datos de Microsoft Access y para la interpretación estadística de las distintas variables se utilizó una tabla de Excel. RESULTADOS: La demanda de atención contraceptiva (vasectomía) constituye la 8ª causa de consulta externa urológica y la 4ª de cirugía urológica local ambulatoria en nuestra área. Durante este periodo se realizaron 300 intervenciones de vasectomía. La edad media de los pacientes fue de 37,5 años (rango entre 23-51). El número de hijos osciló entre un mínimo de 1 y un máximo de 7, con un promedio de 2,41 hijos/paciente. Las indicaciones de la vasectomía fueron: planificación familiar voluntaria (86%), enfermedades medicas de la mujer que contraindicaban la gestación (9%), consejo genético (4,33%), y problema socio-sanitario (0,66%). Los métodos contraceptivos utilizados por las parejas previamente a la vasectomía se conocían en el 71,63% de los pacientes. Los más utilizados fueron: el DIU (49,74%) y el preservativo (25,88%) (AU)

Se presentaron complicaciones en 30 pacientes (10%); de ellas en 29 pacientes fueron leves (9,66%), siendo las más frecuentes: 12 orquiepididimitis (4%), 5granulomas espermáticos (1,66%), 3 orquialgias crónicas “síndrome del testículo doloroso”, (1%), 2 hematomas escrotales (0,66%) y 2 hemorragias de herida (0,66%). Se presentó una complicación grave por impétigo escrotal estafilocócico con posterior sepsis estafilocócica (0,33%). De todas las complicaciones sólo 1 caso requirió hospitalización (impétigo-sepsis) y 1 caso cirugía debido a granuloma espermático. No hubo embarazos no deseados ni demandas judiciales postvasectomía. La azoospermia definida al principio del estudio con 1 seminograma sin espermatozoides y en la actualidad con 2 seminogramas sin espermatozoides con una diferencia entre ellos de 15 días ó 30 días, se logró en el 81% de pacientes entre los 45 y 60 días post-vasectomía. CONCLUSIONES: La vasectomía es un método seguro y simple para conseguir la esterilidad del varón. Es la intervención urológica más practicada en España. La técnica no está exenta de complicaciones (tasa de 0-18%), y su gravedad varía, desde la simple equimosis, hasta la gangrena genital de Fournier, la endocarditiso la sepsis. En la información pre-vasectomía el facultativo incurre en negligencia si no informa al paciente de la posibilidad, remota pero existente, de recanalización espontánea de los deferentes, con recuperación de la fertilidad (fallo de la vasectomía). La información post-vasectomía, sobre prolongar la utilización del método contraceptivo habitual hasta confirmar la esterilidad y el seguimiento del paciente hasta la azoospermia demostrada con 2 espermiogramas, es fundamental para el urólogo si no quiere verse envuelto en problemas legales (AU)

OBJECTIVES: The aims of this paper are: 1. To study the demand and reasons why of the vasectomy in area 12 of Valencian Community.2. To analyse the adverse effects of our series and the predictable risk factors. 3. To review the adverse effects in the national series. 4. To review the adverse effects referred to in international publications. PATIENTS AND METHODS: A restrospective study was made of 300 patients who had submitted themselves to a vasectomy between january 1992 and December 2000. All the clinical dossiers were reviewed according to 10 pre-established variables. age, number of offspring, reasons why, pre-vasectomy anticontraceptives, date of operation, type of anaesthesia used, pathologic anatomy, semen analysis after vasectomy, adverse effects and their possible causes (risk factors).The basic statistic study was done using a data base of Microsoft Access and the interpretations of the different variables using a table of Excel. RESULTS: The demand for contraceptive attention (vasectomy) is the 8th cause for external urological consulting and the 4th for urological local ambulatory surgery of our area. 300 operations were done during that period. The average age of the patients was 37.5 years old (ranging from 25 to 51). The number of offspring ranged from 1 to 7, with a promedia of 2.41 children/patient (AU)

The reasons why were: voluntary family planning (86%), medical illnesses of the female which contraindicated gestation (9%), genetic reasons (4.33%) and social-sanitary problems (0.66%). Contraceptive methods used by 71.63% are known: The widest used method being IUD (49.74%) and the preservative (25.88%).30 patients (10%) had adverse effects, 29 patients having light adverse effects. The most frequent were: 12 orchiepididymitis (4%), 5 spermatic granulomas (1.66%), 3 chronic scrotal pain (1%), 2 scrotal haematoma (0.66%) and 2 bleeding (0.66%). There was one serious complications and of all the cases mentioned above only one needed hospitalization (impetigo-sepsis) and another needed surgery due to a spermatic granuloma. There were no pregnancies or post-vasectomy court cases. 81% of the patients had been declared azoospermic within 45 to 60 days after the vasectomy in one or two consecutive semen analysis (AU)

Escleroterapia del hidrocele y quiste de cordón con polidocanol. Estudio de eficiencia / Sclerotherapy of hydrocele and epididymal cyst with polidocanol: efficiency study

OBJETIVOS: Comprobar la eficiencia (coste/beneficio) de la escleroterapia con polidocanol en nuestro medio para el tratamiento del hidrocele y quiste de cordón. PACIENTES Y MÉTODOS: Estudiamos 86 pacientes con este diagnóstico desde mayo de 1995, hasta abril de 2000. Aplicamos los costes por proceso según los indicadores de gestión precio de nuestro hospital en el año 1999.RESULTADOS: 79 pacientes completaron el protocolo. Hemos curado al 83,87 por ciento de los pacientes con escleroterapia sólo; el 42,3 por ciento en el primer tratamiento. Un 4,5 por ciento de los pacientes tuvo dolor significativo y un 7,4 por ciento alguna complicación. DISCUSIÓN: Fueron necesarios 1,5 tratamientos de media para conseguir la curación, resultando ésta 4,78 veces más barata que mediante cirugía. CONCLUSIÓN: La escleroterapia con polidocanol del hidrocele o quiste de cordón es un tratamiento eficaz, seguro, sencillo, razonablemente confortable y sobre todo, económico (AU)

[Transitional carcinoma of the ureter and ipsilateral synchronous renal cell carcinoma in hydronephrotic atrophic kidney: infrequent association]. / Carcinoma transicional de uréter y carcinoma ipsilateral sincrónico de células renales en riñón atrófico hidronefrótico: asociación infrecuente.

We report a new case of simultaneous occurrence of renal cell carcinoma and transitional cell carcinoma into ipsilateral ureter. A review of the literature to date indicates this is the 45 world-wide case and the 8 in the Spanish publications.

Carcinoma transicional de uréter y carcinoma ipsilateral sincrónico de células renales en riñón atrófico hidronefrótico: asociación infrecuente / Transitional cell carcinoma of the ureter and sinchronous ipsilateral renal cell carcinoma in hydronephrotic-atrophic kidney: an infrequent association

Presentamos un nuevo caso de aparición simultánea de adenocarcinoma de células renales y carcinoma urotelial del uréter ipsilateral. La revisión de la literatura indica que éste es el caso 45 mundial y 8 en publicaciones españolas (AU)

[Sclerotherapy of hydrocele and cord cyst with polidocanol. Efficiency study]. / Escleroterapia del hidrocele y quiste de cordón con polidocanol. Estudio de eficiencia.

OBJECTIVES: Checking the efficiency (cost/benefit) of the sclerotherapy with polidocanol in our country for the treatment of hydrocele and epididymal cyst. PATIENT AND METHODS: We studies 86 patients with this diagnosis from may of 1995, until april of 2000. We have applied the costs for process according to the indicators of administration-cost our hospital in the year 1999. OUTPUTS: 79 patient completed the protocol. The overall cure rate was 83.87% with sclerotherapy; 42.3% with first one treatment. Only a 4.5% of the patients had significant pain and a 7.4% others complications. DISCUSSION: There were necessaries 1.5 sclerotherapies of mean for curation, resulting this treatment 4.78 more cheaper than surgery. CONCLUSION: The sclerotherapy with polidocanol of the hydrocele or epididymal cyst are an effective treatment, sure, simple, reasonably comfortable and fundamentally, economical.

[Significance of simple radiography of the abdomen in nephritic colic]. / El valor de la radiología simple de abdomen en el cólico nefrítico.

BASIS: The utility of the abdominal plain film in the emergency department to evaluate urolithiasis is questionable. Between another things, there are influence of the different formation of distinct examinators. METHODS: A retrospective study in 65 patients referrals to urology in 1997 and 1998 by suspicion of renal colic was carried out. The radiography of abdomen took in the emergency room the day of the income is reviewed with a protocol, by a resident of Familiar and Community Medicine and by the urologist, separately and without information of the medical records. RESULTS: We have excluded three patients. At last, we diagnose 49 patients as renal colic with certainty, 6 patients with doubtful diagnosis and 7 patients with distinct diagnosis. The urologist achieved the most adequate reading in 11 cases; in 7 was best the resident, to equal in 31, and in 13 the differences were not important. The resident obtained of radiography a sensitivity of the 67% and a specificity of the 42% and the urologist 71% and 57% respectively. CONCLUSIONS: There are few differences of reading, at least when the resident dispose a protocol of interpretation. Despite to the almost null diagnostic utility of the radiography, supply additional ation, and permit to value the evolution with a few aggressive technique.

El valor de la radiología simple de abdomen en el cólico nefrítico / The value of plain abdominal radiography in renal colic

FUNDAMENTO: La utilidad de la radiografía de abdomen en urgencias para diagnosticar cálculos urinarios es cuestionable. Entre otros motivos, influye la diferente formación de los distintos lectores. MÉTODOS: Estudiamos retrospectivamente 65 pacientes ingresados en 1997 y 1998 por sospecha de cólico nefrítico. La radiografía de abdomen hecha en urgencias el día del ingreso es revisada con un protocolo, por un residente de Medicina Familiar y Comunitaria y por un adjunto de Urología, separadamente y sin información de la historia clínica. RESULTADOS: Tres pacientes se han excluido. Finalmente diagnosticamos 49 pacientes como cólico nefrítico con certeza, 6 pacientes con diagnóstico dudoso y 7 pacientes con diagnóstico distinto. El adjunto hizo mejor lectura en 11 casos; en 7 mejor el residente, igual en 31, y en 13 las diferencias eran intrascendentes. El residente obtuvo de la radiografía una sensibilidad del 67 por ciento y una especificidad del 42 por ciento y el adjunto 71 por ciento y 57 por ciento respectivamente. CONCLUSIONES: Existen mínimas diferencias de lectura, al menos cuando al residente se le proporciona un protocolo de interpretación. Pese a la casi nula utilidad diagnóstica de la radiografía, suministra información adicional, y permite valorar la evolución de forma poco agresiva (AU)

[Acute scrotum without technology]. / El escroto agudo sin tecnología.

The highly developed diagnostic technologies of our time applied to acute scrotum is not readily available in many of our hospitals. With the purpose of evaluating our results in the diagnosis and treatment of this nosologic entity, and to compare them with those reported by other hospitals where modern technologies are being used, our group revised all patients referring this condition who were given emergency treatment by the urologist on call during the first 100 months of our unit. An analysis is made of the etiology, patient's age, disease location, time of evolution, diagnosis, treatment received and final outcome. The epidemiological data obtained is similar to other series published, except for the hydatid torsion, which was more frequent than previously reported. In cord's torsion, a similar background should be considered a poor prognostic factor. In summary, the left testicle is more exposed to the various acute scrotal diseases. Surgery is an attractive option for hydatid torsion. Finally, an earlier intervention in the event of suspicious cord torsion remains the most important factor in the prognosis. Our results, using no state-of-the-art diagnostic technologies, are similar to other series and we see no trend towards unnecessary surgical examination.

[Primary epidermoid carcinoma of the renal pelvis]. / Carcinoma epidermoide primitivo de pelvis renal.

Epidermoid carcinomas account for 9 to 17% of primitive pyelocaliceal tumours. Key predisposing factor are infections and lithiasis, pre-operative diagnosis being difficult due to insidious growth and absence of pathognomonic syndrome. The paper introduces one case of epidermoid pyelocaliceal carcinoma where diagnosis was supported by intravenous urography, ultrasound and CAT, and where the catheter-obtained cytology was definite in terms of diagnostic value. Ureteropyeloscopy can be a crucial examination in case of diagnostic doubt. Choice therapy is nephroureterectomy with vesical collar resection when the tumour's anatomical state or the subtotal nephrectomy allow it. Prognosis of these tumours is very poor, mean survival of patients being of about 4 months. Our patient died one month after surgery.

[Acute scrotal hematoma in Schoenlein-Henoch purpura. Infrequent urologic manifestation]. / Hematoma escrotal agudo en la púrpura de Schönlein-Henoch. Manifestación urológica infrecuente.

Schönlein-Henoch purple is a systemic vasculitis due to hypersensitivity. It is typical of childhood and more unusual in adults. The etiology is unknown. It is identified by the presence of skin purpura, joint involvement, abdominal colic pain and quite often renal involvement (nephropathy). Urological manifestations are uncommon and include: haematuria, scrotal swelling, cord haematoma, signs and symptoms mimicking cord or hydatid torsion, testicular pain due to intratesticular segmented infarction, painful ecchymotic induration of the scrotum, or testicular necrosis. Contribution of one case of Schönlein-Henoch purpura developed in adulthood with scrotal-perineal haematoma associated to skin purpura and abdominal colic pain in a 75-year old patient.

[Epididymal adenomatoid tumor. Review of the national literature and report of a case]. / Tumor adenomatoide de epidídimo. Revisión de la literatura nacional y aportación de un caso.

Benign epididymal epithelial tumours are very uncommon. Their frequency rating is as follows: adenomatoid tumour, leiomyoma and papilliferous cystoadenoma. This paper contributes a new case of epididymal adenomatoid tumour in a 29-year old male who presented with testicular pain. Diagnosis was achieved through physical examination and echography. A simple tumourectomy was performed. As a result of this case, a review was made of the Spanish literature.

[Inguinoscrotal bladder hernia. Report of a case]. / Hernia vesical inguinoescrotal. A propósito de un caso.

Presentation of one case of scrotal vesical hernia in a 66-year old patient who presented with scrotal mass, micturition difficulty and two-phase micturition that improved when pressure was exerted on the scrotum. Diagnosis was established by physical examination and CUMS. The patient underwent surgery during which a direct inguinal hernia due to paraperitoneal vesical sliding was found. Right herniorrhaphy was performed with Shouldice's technique. Postoperative radiological monitoring showed normal vesical morphology. The pathogeny, classification and treatment, as well as the differential diagnosis uncommonly reported by the authors consulted, are commented.

[Adrenal myelolipoma. Report of a case and review of the literature]. / Mielolipoma suprarrenal. Aportación de un caso y revisión de la literatura.

OBJECTIVES: Herein we describe an additional case of myelolipoma of the adrenal gland, an uncommon tumor of the adrenal cortex, that had been incidentally discovered during abdominal US evaluation of the biliary tree. The clinical features, diagnosis and treatment of the condition are discussed. METHODS: Surgical treatment of the biliary tree and myelolipoma was performed through a Chevron transversal incision during the same surgical session. RESULTS: Surgery achieved good results and the postoperative course was unremarkable. CONCLUSIONS: Myelolipoma is a benign nonfunctioning tumor of the adrenal cortex comprised of adipose and hematopoietic tissue. It is usually asymptomatic and incidentally discovered during diagnostic evaluation for other pathologies. The diagnosis is made by US, CT and MRI. There is no agreement on whether surgical treatment is warranted.

[Lumbago-sciatica syndrome as the first manifestation of metastatic renal adenocarcinoma]. / Síndrome de lumbociática como primera manifestación de un adenocarcinoma renal metastásico.

Presentation of one case of metastatic renal adenocarcinoma with iliac bone and soft parts involvement which presented as a lumbosciatic picture. A comment is made on the different diseases which can result in painful lumbar syndrome, reaching an agreement on the need to conduct more extensive studies given the lack of response to standard medical treatment.

[Adipose retroperitoneal tumors. Apropos a giant myxoid liposarcoma]. / Tumores adiposos retroperitoneales. A propósito de un liposarcoma mixoide gigante.

Liposarcomas are the most frequent retroperitoneal tumours, second only to lymphomas. We present a new case of giant retroperitoneal liposarcoma treated in our hospital. A discussion is presented on the most peculiar aspects of this tumour, such us: multicentricity, tendency to local relapse, and need to post-operative (adjuvant) radiotherapy. A review of all nationwide cases over the last few years is included.