A method for the inline measurement of milk gel firmness using an optical sensor.

At present, selection of cutting time during cheesemaking is made based on subjective methods, which has effects on product homogeneity and has prevented complete automation of cheesemaking. In this work, a new method for inline monitoring of curd firmness is presented. The method consisted of developing a model that correlates the backscatter ratio of near infrared light during milk coagulation with the rheological storage modulus. The model was developed through a factorial design with 2 factors: protein concentration (3.4 and 5.1%) and coagulation temperature (30 and 40°C). Each treatment was replicated 3 times; the model was calibrated with the first replicate and validated using the remaining 2 replicates. The coagulation process was simultaneously monitored using an optical sensor and small-amplitude oscillatory rheology. The model was calibrated and successfully validated at the different protein concentrations and coagulation temperatures studied, predicting the evolution of storage modulus during milk coagulation with coefficient of determination values >0.998 and standard error of prediction values <3.4 Pa. The results demonstrated that the proposed method allows inline monitoring of curd firming in cheesemaking and cutting the curd at a proper firmness to each type of cheese.

Diagnóstico y tratamiento inicial de la uveítis por médicos no oftalmólogos / Diagnosis and treatment of uveitis by non-ophthalmologist physicians

Resumen Objetivos: Describir los principales signos y síntomas, así como el tratamiento inicial de un paciente con diagnóstico de uveítis con el propósito de evitar retardo en la remisión y el inicio del manejo oportuno de esta patología. Métodos: Se realizó una revisión sistemática de la literatura en la cual se identificaron los principales signos y síntomas que deben ser tenidos en cuenta para sospechar el diagnóstico de uveítis y su tratamiento indicado. Se llevó a cabo una búsqueda en PubMed durante el periodo del 2010-2015, se eligieron 439 artículos, los cuales fueron sometidos a dos procesos de filtrado manual, eligiendo por un grupo de investigadores los resúmenes que respondieran nuestra pregunta de investigación. Posteriormente un grupo de oftalmólogos expertos y médicos con experiencia en oftalmología realizaron una segunda revisión. Resultados: Posterior al primer proceso de filtrado se obtuvieron 73 artículos que se sometieron a un segundo proceso de selección donde se obtuvieron 30 artículos. De la selección final de artículos: seis fueron estudios observacionales o ensayos clínicos; los artículos restantes fueron revisiones de la literatura. Los estudios observacionales y ensayos clínicos aleatorizados se evaluaron con la herramienta GRADE siendo la mayoría de evidencia alta. Se hizo una revisión de los treinta artículos seleccionados, por parte de nuestros investigadores, dando como resultado recomendaciones para el diagnóstico y tratamiento de la uveítis para el personal médico no oftalmólogo. Conclusiones: Existen un conjunto de signos y síntomas que pueden hacer sospechar al médico no oftalmólogo el diagnóstico de uveítis. Ante un paciente que presenta dolor ocular asociado a disminución de la agudeza visual, fotofobia, ojo rojo sin secreción conjuntival, miosis pupilar, depósitos retroquératicos y hallazgos al fondo de ojo como vitreitis o coriorretinitis se debe sospechar una uveítis. El manejo precoz de la uveítis anterior no infecciosa puede ser instaurado por el médico no oftalmólogo con corticoides tópicos, sin embargo, en caso de uveítis intermedia y posterior es importante remitir al oftalmólogo cuanto antes. Proponemos un algoritmo para ayudar al diagnóstico de la uveítis y recomendaciones para su manejo inicial.

Abstract Objective: The purpose of this study was to describe the main diagnostic features and the initial management of uveitis, in order to avoid delays in the treatment and the remission to the ophthalmologist. Methods: A systematic review of the literature, which identified the main signs and symptoms and initial treatment for patients with uveitis, was done. A search of the literature published through 2010-2015 was performed using PubMed database. Four hundred and thirty nine eligible articles underwent a selection process in which titles, abstracts and full texts were reviewed, obtaining thirty final articles. Results: Thirty articles were reviewed, six were observational studies and clinical trials; 24 articles were reviews or case reports. The observational studies and clinical trials were rated with the Grading of Recommendations Assessment (GRADE) tool. After the grading tree of the articles were of high level of evidence. Conclusions: In a patient with ocular pain related to decreased visual acuity, photophobia, red eye without secretion, miosis, keratic precipitates, and vitritis or chorioretinitis the healthcare provider should rule out the diagnosis of uveitis. A non-ophthalmologist physician can start the initial management of an anterior uveitis and then refer the patient to the ophthalmologist as soon as possible. If the diagnosis is an infectious anterior uveitis, intermediate uveitis or posterior uveitis the patient should be derived to the ophthalmologist immediately.

Anorgasmia masculina como síntoma inicial de mielitis transversa / Male anorgasmia as initial symptom of transverse myelitis

No disponible

Alargamiento de la vena renal derecha en 120 trasplantes consecutivos. Análisis comparativo / Elongation of the Right Renal Vein in 120 Consecutive Transplant Patients. A Comparative Analysis

Objetivos: La menor longitud de la vena renal derecha (VRD) puede representar una dificultad añadida para el trasplante. El objetivo de este trabajo es presentar nuestra experiencia con el alargamiento de la VRD en el riñón de donante cadáver y comparar los resultados con el resto de riñones trasplantados en el mismo periodo de tiempo. Material y método: En los últimos 11 años se realizaron 377 trasplantes renales y en 120 se alargó la VRD con la vena cava. Se describe la técnica quirúrgica y se comparan los resultados con el resto de trasplantes de la serie. Se valoró la función renal a uno, 3 y 12 meses, la supervivencia del injerto y las complicaciones. Los datos se obtuvieron de forma retrospectiva de la base de datos del Servicio de Urología y de la historia clínica del Hospital. Resultados: En los 377 trasplantes ocurrieron 4 (1%) trombosis venosas, de ellas 2 (1,6%) eran riñones con alargamiento de la VRD y 2 (0,7%) en el resto de riñones trasplantados. No hubo diferencia en el sangrado postoperatorio, 11 (9,1%) ocurrió en riñones con la VRD alargada y 22 (8,5%) en el resto de riñones. En ningún caso el sangrado estuvo relacionado con segmento alargado. La supervivencia del injerto y la función renal fue superponible en ambos grupos. Conclusiones: El alargamiento de la VRD con la vena cava es un procedimiento rápido, sencillo y efectivo, que no aumenta la morbilidad ni altera la función renal o la viabilidad del injerto. Facilita la realización de las anastomosis vasculares y sitúa el riñón en una posición menos forzada, acorta el tiempo de isquemia caliente y evita el riesgo de acodadura de la arteria renal, ya que iguala su longitud a la de la vena (AU)

Objectives: Shorter length of the right renal vein (RRV) may represent an additional difficulty for transplant. This paper has aimed to present our experience with RRV elongation in the kidney from a cadaveric donor and to compare the results with the rest of kidneys transplanted in the same period of time. Material and methods: We performed 377 kidneys transplants within the last 11 years. Of these, in 120, the RRV was elongated with the vena cava. The surgical technique is described and the results compared with the remaining transplants of the series. Renal function, graft survival and complications were assessed at 1, 3 and 12 months. Data were obtained retrospectively from the database of the Urology Department and Hospital medical records. Results: In the 377 transplants, there were 4 (1%) venous thrombosis, 2 (1.6%) of which concerned kidneys with elongation of the RRV and 2 (0.7%) in the rest of transplanted kidneys. There was no difference in postoperative bleeding, 11 (9.1%) occurred in kidneys with elongated RRV and 22 (8.5%) in the remaining kidney. In no case was the bleeding related to the elongated segment. Graft survival and renal function were similar for both groups. Conclusions: Elongation of the RRV with the vena cava is a feasible, fast, and effective procedure that does not increase morbidity or affect renal function or graft viability. It facilitates vascular anastomosis and places the kidney in a less forced position, shortens the warm ischemia time and avoids the risk of kinking of the renal artery because it is equal to the length of the vein artery (AU)

Influence of fat replacement by inulin on rheological properties, kinetics of rennet milk coagulation, and syneresis of milk gels.

The objective of this study was to evaluate the effect of inulin as a fat replacer on the rheological properties, coagulation kinetics, and syneresis of milk gels. A randomized factorial design, replicated 3 times, with 3 inulin concentrations (0, 3, and 6%), 2 levels of fat (<0.2 and 1.5%), and 3 coagulation temperatures (27, 32, and 37°C) was used. The coagulation process was monitored using near-infrared spectrometry, small amplitude oscillatory rheometry, and visual coagulation indexes. The syneresis was evaluated by volumetric methods. Inulin addition increased the rates of aggregation and curd firming reactions in the casein gels. The observed effect, which was more evident on the aggregation reaction, depended on the concentration of inulin and the coagulation temperature. Addition of 6% inulin reduced the clotting time by approximately 26% and the time at which the gel reached a storage modulus equal to 30 Pa by approximately 36%. The optical parameter R'max, defined as the maximum value of change in light backscatter profile/change in time (where R' = dR/dt), was used to calculate an approximation of the temperature coefficients (Q10) for milk coagulation. Increasing fat concentration induced a consistent increase in all the optical, rheological, and visual parameters studied, although the observed trend was not statistically significant. The addition of inulin at a level of 6% produced a reduction in syneresis and increased the curd yield by approximately 30%. It was concluded that the addition of inulin affects the kinetics of milk coagulation and the cutting time and, therefore, the use of inline sensors such as near-infrared spectrometry may be necessary for optimal process control.

[Elongation of the right renal vein in 120 consecutive transplant patients. A comparative analysis]. / Alargamiento de la vena renal derecha en 120 trasplantes consecutivos. Análisis comparativo.

OBJECTIVES: Shorter length of the right renal vein (RRV) may represent an additional difficulty for transplant. This paper has aimed to present our experience with RRV elongation in the kidney from a cadaveric donor and to compare the results with the rest of kidneys transplanted in the same period of time. MATERIAL AND METHODS: We performed 377 kidneys transplants within the last 11 years. Of these, in 120, the RRV was elongated with the vena cava. The surgical technique is described and the results compared with the remaining transplants of the series. Renal function, graft survival and complications were assessed at 1, 3 and 12 months. Data were obtained retrospectively from the database of the Urology Department and Hospital medical records. RESULTS: In the 377 transplants, there were 4 (1%) venous thrombosis, 2 (1.6%) of which concerned kidneys with elongation of the RRV and 2 (0.7%) in the rest of transplanted kidneys. There was no difference in postoperative bleeding, 11 (9.1%) occurred in kidneys with elongated RRV and 22 (8.5%) in the remaining kidney. In no case was the bleeding related to the elongated segment. Graft survival and renal function were similar for both groups. CONCLUSIONS: Elongation of the RRV with the vena cava is a feasible, fast, and effective procedure that does not increase morbidity or affect renal function or graft viability. It facilitates vascular anastomosis and places the kidney in a less forced position, shortens the warm ischemia time and avoids the risk of kinking of the renal artery because it is equal to the length of the vein artery.

Bladder transitional cell carcinoma and BK virus in a young kidney transplant recipient.

Kidney transplant recipients have a heightened risk of developing neoplasms. Immunosuppressive treatments decrease the incidence of transplant rejection but increase the risk of infections, including BK virus (BKV). This infection is acquired in childhood and remains latent in the renal and urinary epithelium. In cases of immunodeficiency, BKV has been implicated as a tumor virus, but the role of BKV in cancer is a controversial topic and is difficult to determine. In the tumor cells, it is possible to detect fragments of the viral genome that could alter the control mechanisms of the cell cycle and DNA repair. We report the case of a kidney transplant recipient who developed BKV nephropathy and carcinoma of the bladder, supporting a possible role for BKV in the oncogenic pathway in this clinical setting, but the role of BKV in cancer remains a controversial topic and difficult to determine.

Cistitis y disfunción vesical asociada al consumo de ketamina / Cystitis and Ketamine Associated Bladder Dysfunction

Objetivos: Analizar la prevalencia de sintomatología del tracto urinario inferior (STUI) en consumidores de ketamina con fines recreativos y valorar su relación con el patrón de consumo. Material y métodos: Valoración de 13 consumidores de ketamina. Se analizó la presencia de STUI, hematuria macroscópica y dolor lumbar. Se registró el patrón de consumo de ketamina: inicio, vía de administración, dosis en el último mes y frecuencia de consumo. Resultados: Seis pacientes (46%) refirieron STUI, con un ritmo diurno medio de micciones cada 42 minutos y nocturia media de 3 episodios, con disuria (100%), urgencia (100%), incontinencia(20%), disminución del caudal (80%), dolor hipogástrico o perineal (80%), hematuria macroscópica (80%) y dolor lumbar bilateral (40%). Los pacientes sintomáticos describieron un consumo medio de ketamina inhalada de 3 g/día (DE 2), el 80% con una frecuencia diaria, y los asintomáticos de 1,03 g/día (DE 0,92) limitado a los fines de semana. El tiempo medio de consumo hasta la aparición de los síntomas fue de 31 meses (DE 16,29). La intensidad de la sintomatología se relacionó con la dosis de ketamina, y mejoró al aumentar la ingesta hídrica. Conclusiones: Parece haber una relación del cuadro con la dosis y la frecuencia de consumo, existiendo factores que refuerzan la hipótesis de que esta acción de la droga se debe a su efecto lesivo sobre el urotelio. Hay que conocer el proceso para identificarlo a tiempo, ya que la única medida efectiva conocida es abandonar el consumo en las fases iniciales (AU)

Objectives: To analyze the prevalence of lower urinary tract symptoms (LUTS) in recreational ketamine users and evaluate its relationship with the consumption pattern. Material and methods: Evaluation of 13 ketamine users. The presence of LUTS, gross hematuria and lumbar spine pain was analyzed. The ketamine usage pattern was recorded: initiation, administration route, dose in the last month and frequency of usage. Results: Six patients (46%) reported LUTS, with daily mean micturations every 42 minutes and night time of 3 episodes, with dysuria (100%), urgency (100%), incontinence (20%), decreased flow (80%), hypogastric or perineal pain (80%), gross hematuria (80%) and bilateral lumbar spine pain (40%). Symptomatic patients described a mean intake of inhaled ketamine of 3 g/day (SD 2), 80% with a daily frequency and the asymptomatic ones of 1.03 g/day (SD 0.92) limited to weekends. The mean consumption time to the appearance of the symptoms was 31 months (SD 16.29). Intensity of the symptoms was related with the ketamine dose and improved on increasing water intake. Conclusions: There seems to be a relationship between the picture with the dose and frequency of consumption, there being factors that reinforce the hypothesis that this action of the drug is due to the harmful effect on the urothelium. The process to identify it on time should be known, since the only known effective measure is to stop the consumption in the initial phases (AU)

[Cystitis and ketamine associated bladder dysfunction]. / Cistitis y disfunción vesical asociada al consumo de ketamina.

OBJECTIVES: To analyze the prevalence of lower urinary tract symptoms (LUTS) in recreational ketamine users and evaluate its relationship with the consumption pattern. MATERIAL AND METHODS: Evaluation of 13 ketamine users. The presence of LUTS, gross hematuria and lumbar spine pain was analyzed. The ketamine usage pattern was recorded: initiation, administration route, dose in the last month and frequency of usage. RESULTS: Six patients (46%) reported LUTS, with daily mean micturations every 42 minutes and nighttime of 3 episodes, with dysuria (100%), urgency (100%), incontinence (20%), decreased flow (80%), hypogastric or perineal pain (80%), gross hematuria (80%) and bilateral lumbar spine pain (40%). Symptomatic patients described a mean intake of inhaled ketamine of 3g/day (SD 2), 80% with a daily frequency and the asymptomatic ones of 1.03 g/day (SD 0.92) limited to weekends. The mean consumption time to the appearance of the symptoms was 31 months (SD 16.29). Intensity of the symptoms was related with the ketamine dose and improved on increasing water intake. CONCLUSIONS: There seems to be a relationship between the picture with the dose and frequency of consumption, there being factors that reinforce the hypothesis that this action of the drug is due to the harmful effect on the urothelium. The process to identify it on time should be known, since the only known effective measure is to stop the consumption in the initial phases.

Clinical-pathological differences and smoking habit depending on gender in a cohort of patients with transitional cell carcinoma of the bladder: retrospective study.

OBJECTIVES: The increased incidence of transitional cell carcinoma (TCC) of the bladder in men is known, generally attributed to greater exposure to the effect carcinogenic products. Although it has been reported that cancer-specific outcome can be particularly adverse in women due to socioeconomic or biological factors, clinical-pathological differences of TCC at the time of diagnosis have not been sufficiently studied. The aim of this study is to analyze whether there are gender-related differences in grade and tumor stage in primary bladder TCC. METHODS: All consecutive primary bladder TCC diagnoses made in our institution between 1990 and 2009 have been included. We retrospectively analyzed age, smoking, symptoms at presentation, tumor grade (WHO 1973), tumor size and number, and TNM stage, comparing men and women. Statistical analysis was conducted using the Mann-Whitney U test as non-parametric test and Chi-squared test to compare frequencies. RESULTS: We analyzed 1196 patients (992 males and 204 females) with a 5:1 ratio. We found significant differences in age (69 years vs. 73 years), smoking (46.5% vs. 11.2%)and muscle-invasive stage (12.1% vs. 18.1%). Correcting by tobacco consumption, never-smoker women have larger and more aggressive tumors with a frequency of muscle-invasive disease three times higher than male never-smokers and equaling to male current-smokers. CONCLUSION: TCC of the bladder is more frequent in males than females. In this series, women are older at the time of diagnosis and most often affected by muscle-invasive disease particularly in never-smokers. We need studies to analyze the potential impact of passive smoking to justify these results.

Diferencias clínico-patológicas y tabaquismo en función del sexo en una cohorte de pacientes con carcinoma de células transicionales de vejiga: un estudio retrospectivo / Clinical-pathological differences and smoking habit depending on gender in a cohort of patients with transitional cell carcinoma of the bladder: retrospective study

OBJETIVO: Es conocida la mayor incidencia de carcinoma de células transicionales (CCT) de vejiga en los varones, generalmente atribuida a una mayor exposición al efecto de los carcinógenos. A pesar de que se ha comunicado que la evolución puede ser especialmente adversa en las mujeres debido a factores socioeconómicos o biológicos, no han sido suficientemente estudiadas las diferencias clínico-patológicas del CCT en el momento del diagnóstico entre el hombre y la mujer. El objetivo de este estudio es analizar las diferencias en la exposición al tabaco, el grado y el estadio tumoral del CCT primario de vejiga en función del sexo.MÉTODOS: Se han incluido todos los diagnósticos consecutivos de CCT primario de vejiga realizados en nuestra institución entre 1990 y 2009. Se analizan, de forma retrospectiva, edad, hábito tabáquico, sintomatología, grado tumoral (OMS 1973), tamaño tumoral, multiplicidad y estadio TNM, comparándolas entre hombres y mujeres. Para el análisis estadístico se empleó la U de Mann-Withney como test no paramétrico y el test de Chi-cuadrado para la comparación de frecuencias.RESULTADOS: Se han analizado 1196 pacientes (992 hombres y 204 mujeres) con una razón observada de 5:1. Se han encontrado diferencias significativas en la edad (69 años vs 73 años), hábito tabáquico (46.5% vs 11.2%) y estadio músculo-infiltrante (12.1% vs 18.1%). Corrigiendo por el hábito tabáquico, las mujeres no fumadoras presentan tumores de mayor tamaño y grado con una frecuencia de enfermedad músculo-infiltrante 3 veces superior a los varones no fumadores e igualando a los fumadores.CONCLUSIÓN: El CCT de vejiga tiene mayor incidencia en los varones. En esta serie, las mujeres tenían una edad más avanzada en el momento del diagnóstico y presentan con más frecuencia enfermedad músculo-infiltrante afectando especialmente a las no fumadoras. Hacen falta estudios dirigidos a analizar el potencial impacto del tabaquismo pasivo que justifiquen estos resultados(AU)

OBJECTIVES: The increased incidence of transitional cell carcinoma (TCC) of the bladder in men is known, generally attributed to greater exposure to the effect carcinogenic products. Although it has been reported that cancer-specific outcome can be particularly adverse in women due to socioeconomic or biological factors, clinical-pathological differences of TCC at the time of diagnosis have not been sufficiently studied. The aim of this study is to analyze whether there are gender-related differences in grade and tumor stage in primary bladder TCC.METHODS: All consecutive primary bladder TCC diagnoses made in our institution between 1990 and 2009 have been included. We retrospectively analyzed age, smoking, symptoms at presentation, tumor grade (WHO 1973), tumor size and number, and TNM stage, comparing men and women. Statistical analysis was conducted using the Mann-Whitney U test as non-parametric test and Chi-squared test to compare frequencies.RESULTS : We analyzed 1196 patients (992 males and 204 females) with a 5:1 ratio. We found significant differences in age (69 years vs. 73 years), smoking (46.5% vs. 11.2%) and muscle-invasive stage (12.1% vs. 18.1%). Correcting by tobacco consumption, never-smoker women have larger and more aggressive tumors with a frequency of muscle-invasive disease three times higher than male never-smokers and equaling to male current-smokers.CONCLUSION: TCC of the bladder is more frequent in males than females. In this series, women are older at the time of diagnosis and most often affected by muscle-invasive disease particularly in never-smokers. We need studies to analyze the potential impact of passive smoking to justify these results(AU)

Behaviour of human heterochromatic regions during the synapsis of homologous chromosomes.

BACKGROUND: Alterations of synapsis can disturb or arrest meiosis and result in infertility. Synaptic abnormalities are frequently observed in infertile patients but also in fertile men. METHODS: The subtelomere-specific multiplex fluorescence in-situ hybridization (stM-FISH) has been applied in combination with immunofluorescence to identify all synaptonemal complexes (SCs) and to analyse those presenting synaptic anomalies in fertile and infertile men. RESULTS: SCs with heterochromatin blocks other than centromere (noncentromeric heterochromatin) presented a higher frequency of gaps (SC discontinuities) and splits (unsynapsed SC regions) at pachytene, the incidences for 9qh, 1qh, 15p and 21p being the highest ones. Inter-individual variability in the incidence of synaptic anomalies in these regions has been observed. In addition, synaptic anomalies in other SC regions are more frequent in infertile cases than in controls. Clear association of the SC15 and SC21 to the XY pair has been seen. CONCLUSION: Noncentromeric heterochromatic regions are the last to synapse. The inter-individual variation observed in the incidence of gaps and splits in these regions may be explained by the heteromorphism of these regions in the general population. The presence of synaptic anomalies in other SC regions may indicate nuclei with a severely affected synapsis. Noncentromeric heterochromatic regions might play a role in the association of autosomal SC15 and SC21 with the XY pair.

FISH characterization of a dicentric Yq (p11.32) isochromosome in an azoospermic male.

The most common structural rearrangements of the Y chromosome result in the production of dicentrics. In this work, we analyze an abnormal Y chromosome, detected as a mosaic in an azoospermic male ascertained for infertility. FISH with seven different DNA probes specific for Y chromosome sequences (Y alpha-satellite, Y alpha-satellite III, non-alpha-satellite centromeric Y, SRY gene, subtelomeric Yp, subtelomeric Yq, and PNA-tel) and CGH analysis were performed. FISH results showed that the abnormal Y chromosome was a dicentric Yq isochromosome and that the breakpoint was distally in band Yp11.32. Lymphocyte chromosomes showed a mosaicism with 46,X,idicY(qter-->p11.32::p11.32-->qter) (51.7%), 46,XY (45.6%), and other cell lines (2.7%). In oral interphase cells, the mosaicism was 46,XidicY (62.8%), 46,XY (25.7%), 45,X (6.6%), and others (4.9%). The possible origin of this dicentric Yq isochromosome is discussed. Finally, we compare differences in mosaicism and phenotype among three reported cases with the breakpoint at Yp11.32

[Comparative study of the effect of complete prolonged neoadjuvant hormonal blockade versus standard hormonal blockade]. / Estudio comparativo del efecto del bloqueo hormonal completo neoadyuvante prolongado frente al estándar.

INTRODUCTION: Radical prostatectomy is considered as a curative treatment option in clinically localised prostate cancer patients. Therapy failure is related to positive surgical margins and/or extracapsular extension. The use of neoadjuvant combined androgen blockade (CAB) withdrawal therapy, mainly in cT2 disease, has been shown to decrease positive margin rates. However, CAB therapy remains controversial since there is no proof that this approach confers any benefit in relation to biochemical and clinical disease-free survival. Increasing negatives surgical margins and lower tumour volume (TV) with prolonged CAB therapy has been recently reported. AIM: To analyse the effect of 6 months neoadjuvant CAB therapy in front of 3 months in clinically localised prostate cancer patients submitted to radical prostatectomy. PATIENTS AND METHODS: The pathological stage and TV in forty-two patients treated by 6 months in front of thirty-four patients treated by 3 months were studied. The relationship of clinical stage and initial PSA concentration were analysed. RESULTS: TV was significantly lower in 6 months treated patients (0.97 cc vs. 0.48 cc, p = 0.05). The lowest TV was observed in cT1 patients, but significant differences only were observed in cT2 (1.5 cc vs. 0.86 cc, p = 0.04). No relationship between TV and PSA was obtained. No differences in the incidence of organ-confined disease were seen depending of the CAB length (47% vs. 43%, p = NS). However, increasing incidence of specimen-confined disease was observed in 6 months treated patients (56% vs. 74%, p = 0.05). CONCLUSION: The duration of neoadjuvant CAB can affect both TV and surgical margin status. Lower TV and increasing incidence of specimen-confined disease with 6 months CAB treatment were observed. Patients with palpable disease may be more benefited by this treatment option.

Estudio comparativo del efecto del bloqueo hormonal completo neoadyuvante prolongado frente al estándar / The effect of long-term neoadjuvant combined androgen blockade withdrawal therapy. Comparative study with standard therapy

INTRODUCCIÓN: La prostatectomía radical es considerado un tratamiento curativo del cáncer de próstata clínicamente localizado. El fallo quirúrgico potencial viene dado por la positividad de los márgenes y/o por la extensión extracapsular. Ha sido comunicada una reducción en la incidencia de márgenes quirúrgicos positivos, especialmente en estadios clínicos T2, con el empleo del bloqueo hormonal completo neoadyuvante1. Sin embargo, el bloqueo previo a la cirugía sigue siendo un tratamiento controvertido dado que no ha sido demostrado ningún beneficio en relación con el intervalo libre de progresión ni supervivencia. Recientemente, ha sido comunicada una mayor incidencia de márgenes libres y reducción del volumen tumoral en las piezas de prostatectomía sometidas a bloqueo más prolongado que el estándar de 3 meses. OBJETIVO: Analizar el efecto del bloqueo hormonal neoadyuvante durante 6 meses frente al estándar de 3 meses en pacientes con cáncer de próstata clínicamente localizado y sometidos a prostatectomía radical. PACIENTES Y MÉTODOS: Se estudia el volumen tumoral y el estadio patológico en 42 pacientes sometidos a 6 meses de bloqueo frente a 34 pacientes sometidos a bloqueo estándar de 3 meses. Se analiza la relación existente con el estadio clínico y con la concentración de PSA. RESULTADOS: El volumen tumoral fue significativamente menor en el grupo de pacientes tratado durante 6 meses (0,976 cc vs 0,48 cc, p = 0,05). En función del estadio clínico el menor volumen se observó en los pacientes T1 pero la diferencia fue sólo significativa en los T2 (1,5 cc vs 0,86 cc, p = 0,04). No se observó relación entre el volumen tumoral y la concentración de PSA. Al analizar el estadio patológico, no existieron diferencias en función del tiempo de bloqueo en la incidencia de tumor no confinado (47 por ciento vs 43 por ciento, p N.S.). Sin embargo, se observó un incremento en la incidencia de tumor confinado al espécimen en el grupo sometido a 6 meses de bloqueo (56 por ciento vs 73,7 por ciento, p = 0,05). CONCLUSIÓN: La duración del bloqueo neoadyuvante puede afectar tanto al volumen tumoral como al estado de los márgenes quirúrgicos. Se observa menor volumen tumoral e incremento en la incidencia de tumor confinado al espécimen con un tratamiento más prolongado que el considerado estándar. Los pacientes con tumores palpables parecen beneficiarse en mayor medida de esta modalidad de bloqueo (AU)

A longer duration of neo-adjuvant combined androgen blockade prior to radical prostatectomy may lead to lower tumour volume of localised prostate cancer.

OBJECTIVES: To analyse tumour volume (TV) in clinically localised prostate cancer patients treated with neo-adjuvant combined androgen blockade (CAB) therapy prior to radical prostatectomy. PATIENTS AND METHODS: Two hundred consecutive patients treated between 1996 and 2000 were retrospectively analysed. Fifty patients underwent radical prostatectomy alone and 45 were treated with CAB for 1-3 months, 83 for 4-6 months and 22 for more than 6 months before surgery. Logistic regression analysis was performed to identify the strongest independent prognosticator of organ-confined disease. RESULTS: No evidence of residual cancer was found in 11 specimens (5.6%). Regarding TV, 20 specimens showed less than 0.1cc, 33 between 0.1 and 0.49cc and 86 more than 0.5cc. Smaller TV was found in CAB-treated patients. Significant correlation was observed between treatment duration and TV. In logistic regression analysis, only CAB duration and TV were significantly correlated with organ-confined disease. CONCLUSIONS: Prominent regressive features and lower TV were found after neo-adjuvant CAB. It seems that more prolonged treatment may lead to greater tumoural regression. Only tumour burden and length of CAB therapy were independent variables significantly correlated with pathologically localised prostate cancer.

Effect of antibiotic treatment on serum PSA and percent free PSA levels in patients with biochemical criteria for prostate biopsy and previous lower urinary tract infections.

BACKGROUND: Controversy exists as to the influence of inflammatory foci on total and free prostate-specific antigen (PSA) concentrations. The objective was to analyze the biological variations of PSA and percent free PSA (%f-PSA) in patients with biochemical criteria for prostate biopsy (PSA higher than 4 ng/mL and normal rectal examination) and compare them with the variation induced by antibiotic treatment in a cohort of patients with a history of lower urinary tract infections and no clinical evidence of prostatitis. METHODS: Ninety patients with a history of lower urinary tract infections, non-suspicious digital rectal examination and PSA between 4 and 20 ng/mL were analyzed. PSA concentration and %f-PSA were determined. Forty-five patients were treated with three weeks of ofloxacin, following which marker determination was repeated. All patients underwent ultrasound-controlled transrectal six-core prostate biopsy. RESULTS: Sixty-seven patients presented benign prostatic hyperplasia (BPH) (30 with prostatitic foci) and 23 cancer. Significant variations in PSA (6.97 ng/mL vs. 5.82 ng/mL, p=0.001) and %f-PSA (14.84% vs. 17.53%, p=0.01) were found only in the treated patients. These differences were significant for patients with BPH-associated prostatitic foci and not for patients with BPH or cancer. The tendency was for PSA to decrease (15 treated patients with PSA <4 ng/mL vs. six non-treated patients) and for %f-PSA to increase. The median variation of %f-PSA was greater than that of PSA. When the cutoff for %f-PSA was set at 25%, 18.9% of unnecessary biopsies after the first determination and 20% after the second could be avoided. By associating the reduction in PSA, up to 46% could be avoided in treated patients. CONCLUSION: Biochemical criteria for prostate biopsy may be modified in patients with a history of lower urinary tract infections due to variations greater than those explained by intraindividual biological variations, and may be influenced by the antibiotic treatment. These results suggest that subclinical inflammatory foci may influence PSA and %f-PSA.

Total anterior urethral reconstruction with the 'BAES flap' in a spinal cord-injured patient.

STUDY DESIGN: A case report of urethral destruction in a spinal cord injured (SCI) patient. OBJECTIVES: To report the reconstruction of the whole anterior urethra in one-stage using an epilated scrotal flap. SETTING: Institut Guttmann, Hospital de Neurorehabilitació, Barcelona, Spain. METHODS: A one-stage tubular substitution urethroplasty based on a bi-axial epilated scrotal flap design ('BAES flap') was performed successfully. RESULTS: Long-term follow-up of 6 years has confirmed the excellent adaptation of the flap to its urethral function. CONCLUSION: The bipedicle epilated scrotal flap can effectively resolve this challenging urethral pathology.