Women in urology: what is their current situation in Spain?

OBJECTIVE: To analyze the current state of women in urology in Spain. MATERIAL AND METHODS: Descriptive study based on the results of an online survey sent between February and April 2020 through the database of the Residents and Young Urologists group (RAEU) of the Spanish Association of Urology (AEU). Characteristics of the survey and its results were analyzed. RESULTS: In total, 257 responses were obtained from 210 women (81.71%) and 47 men (18.29%) belonging to 111 hospitals. Statistically significant differences were observed (p < 0.001) with a higher proportion of men in all categories except for the group of young female and male attendings (29-39 years, p = 0.789), and the group of female residents against male residents (p = 0.814). The number of men was higher in hospitals with subspecialty units except for the Pelvic Floor Unit, where no statistically significant difference was observed (p = 0.06). Regarding positions of responsibility, only 7 out of 111 hospitals had female Department Chiefs. CONCLUSIONS: Women's representation in urology is increasing, mainly due to the younger generations. However, the access of these women to relevant positions is anecdotal.

Safety and efficacy of various strains of bacille Calmette-Guérin in the treatment of bladder tumours in standard clinical practice. / Eficacia y seguridad de distintas cepas de BCG en el tratamiento del tumor vesical en práctica clínica habitual.

BACKGROUND: The natural progression of bladder tumours (nonmuscle-invasive bladder cancer [NMIBC]) is recurrence with a high rate of progression. Bacille Calmette-Guérin (BCG) has been shown effective in reducing these rates, but there are few comparative studies between strains. MATERIAL AND METHODS: An observational, prospective and multicentre registry studied 433 patients with a 12-month follow-up visit from 961 registered patients, assessing disease-free survival (DFS), progression-free survival (PFS) cancer-specific survival (CSS) and adverse effects. We studied the Tice, Russian, Tokyo, Connaught and RIVM strains. RESULTS: The sociodemographic data, NMIBC history, comorbidities, size, number, stage, grade, associated carcinoma in situ and transurethral resection were well balanced. DFS: There were 85 relapses (19.6%). The median DFS time was 20months. When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.93). LPS: There were 33 cases of progression (7.62%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.69). CSS: Seven patients died (1.68%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.93). In terms of safety, 33.3% of the patients presented some type of adverse effect, mostly lower urinary symptoms (no urinary tract infections) <48h, >48h and haematuria. According to the Common Toxicity Criteria of the European Organisation for Research and Treatment of Cancer, 92.7% of the patients were grade1. There were no statistically significant differences between the strains. CONCLUSIONS: In this intermediate analysis, the risk of recurrence, progression, specific death and safety were independent of the BCG strain employed.

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva / Monitoring intraoperative neuromuscular blockade and blood pressure with one device (TOF-Cuff): A comparative study with mechanomyography and invasive blood pressure

Objetivo. Determinar la capacidad del dispositivo TOF-Cuff (manguito de presión modificado que incluye electrodos de estimulación) para monitorizar la presión arterial no invasiva (PANI) y el nivel de bloqueo neuromuscular (BNM) inducido farmacológicamente. Material y método. Estudio observacional, prospectivo, de 32 pacientes adultos ASA I-III programados para cirugía bajo anestesia general, para la validación de la monitorización del BNM con el dispositivo TOF-Cuff vs. mecanomiografía (MMG, método control) durante la fase de recuperación del BNM, cuando se alcanzó un TOF-ratio de 0,9 con TOF-Cuff y de 0,7 con la MMG (variable principal). Para completar el estudio principal se realizó un estudio adicional consecutivo al anterior y que incluyó a 17 pacientes para validar el dispositivo TOF-Cuff en la monitorización de la PANI en comparación con la presión arterial invasiva a nivel de la arteria radial (método control). Los datos fueron analizados mediante el método de Bland-Altman. Resultados. Se produjo un adelanto de la recuperación medida con TOF-Cuff respecto a la mecanomiografía. Al comparar un TOF-ratio>0,9 cuantificado mediante TOF-Cuff con un TOF-ratio>0,7 en la MMG tuvo una especificidad del 91% y un valor predictivo positivo del 84%. En la medición de la PANI, el error medio y la desviación estándar tanto de la presión arterial sistólica (1,6±7mmHg) como diastólica (−3,4±6,3) estuvieron dentro de los requisitos europeos de precisión para aparatos sanitarios. Conclusiones. El dispositivo TOF-Cuff ha mostrado ser válido y seguro en la monitorización del BNM y en la medición de la PANI, no presentando ningún paciente acontecimientos adversos, lesiones a nivel de la piel o dolor residual. No es intercambiable con la MMG, teniendo un TOF-ratio>0,9 cuantificado mediante el dispositivo TOF-Cuff, una buena correlación con un TOF-ratio>0,7 en la MMG (AU)

Objective. The overall objective of the study is to determine the ability of TOF-Cuff device (blood-pressure modified cuff, including stimulation electrodes) to monitor with the same device the non-invasive blood pressure (NIBP) and the depth of a neuromuscular blockade (NMB) induced pharmacologically, by stimulation of the brachial plexus at the humeral level and recording evoked changes in arterial pressure. Material and method. Clinical, single-centre, open-controlled study with 32 adult patients ASA I-III for scheduled elective surgery under general anaesthesia in supine position, for the validation of neuromuscular monitoring, comparing the values obtained from neuromuscular relaxation TOF-Cuff with those obtained by mechanomyography (MMG) (control method) during the recovery phase of NMB, when a TOF ratio>0.7 and>0.9 (primary endpoint) were reached respectively. And an additional consecutive study of 17 patients for validation of NIBP monitoring with TOF-Cuff device vs invasive blood pressure measured by an intra-arterial catheter. All data were analyzed using the Bland-Altman method. Results. Recovery from NMB measured with the TOF-Cuff was earlier compared to MMG. Comparing TOF-ratio>0.9 measured with TOF-Cuff vs TOF-ratio>0.7 with MMG, a specificity of 91% and a positive predictive value of 84% were obtained. In NIBP measurement, the mean error and standard deviation of both systolic blood pressure (1.6±7mmHg) and diastolic blood pressure (−3.4±6.3) were within the European accuracy requirements for medical devices. Conclusions. The TOF-Cuff device has been shown to be valid and safe in the monitoring of NMB and in the measurement of NIBP, with no patient presenting any adverse events, skin-level lesions or residual pain. It is not interchangeable with MMG, having a TOF-ratio>0.9 quantified by the TOF-Cuff device, a good correlation with a TOF-ratio>0.7 on MMG (AU)

Monitoring intraoperative neuromuscular blockade and blood pressure with one device (TOF-Cuff): A comparative study with mechanomyography and invasive blood pressure. / Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva.

OBJECTIVE: The overall objective of the study is to determine the ability of TOF-Cuff device (blood-pressure modified cuff, including stimulation electrodes) to monitor with the same device the non-invasive blood pressure (NIBP) and the depth of a neuromuscular blockade (NMB) induced pharmacologically, by stimulation of the brachial plexus at the humeral level and recording evoked changes in arterial pressure. MATERIAL AND METHOD: Clinical, single-centre, open-controlled study with 32 adult patients ASA I-III for scheduled elective surgery under general anaesthesia in supine position, for the validation of neuromuscular monitoring, comparing the values obtained from neuromuscular relaxation TOF-Cuff with those obtained by mechanomyography (MMG) (control method) during the recovery phase of NMB, when a TOF ratio>0.7 and>0.9 (primary endpoint) were reached respectively. And an additional consecutive study of 17 patients for validation of NIBP monitoring with TOF-Cuff device vs invasive blood pressure measured by an intra-arterial catheter. All data were analyzed using the Bland-Altman method. RESULTS: Recovery from NMB measured with the TOF-Cuff was earlier compared to MMG. Comparing TOF-ratio>0.9 measured with TOF-Cuff vs TOF-ratio>0.7 with MMG, a specificity of 91% and a positive predictive value of 84% were obtained. In NIBP measurement, the mean error and standard deviation of both systolic blood pressure (1.6±7mmHg) and diastolic blood pressure (-3.4±6.3) were within the European accuracy requirements for medical devices. CONCLUSIONS: The TOF-Cuff device has been shown to be valid and safe in the monitoring of NMB and in the measurement of NIBP, with no patient presenting any adverse events, skin-level lesions or residual pain. It is not interchangeable with MMG, having a TOF-ratio>0.9 quantified by the TOF-Cuff device, a good correlation with a TOF-ratio>0.7 on MMG.

Agreement between preoperative transvaginal ultrasound and intraoperative macroscopic examination for assessing myometrial infiltration in low-risk endometrioid carcinoma.

OBJECTIVE: To compare diagnostic performance of preoperative transvaginal ultrasound (TVS) and intraoperative macroscopic examination for determining myometrial infiltration in women with low-risk endometrial cancer, and to estimate the agreement between the two methods. METHODS: This was a single-center observational study comprising women with preoperative diagnosis of well- or moderately differentiated endometrioid carcinoma of the endometrium. All women underwent preoperative TVS by a single examiner. According to the examiner's subjective impression, myometrial infiltration was stated as ≥ 50% or < 50%. Surgical staging was performed in all cases. Intraoperative macroscopic examination of the removed uterus was performed by pathologists who were unaware of the ultrasound findings, and myometrial infiltration was stated as ≥ 50% or < 50%. Definitive histological diagnosis of myometrial infiltration was made by frozen section analysis and was used as the gold standard. Sensitivity and specificity with 95% CIs were calculated for TVS and intraoperative macroscopic inspection and compared using McNemar's test. Agreement between TVS and intraoperative macroscopic inspection was estimated using Cohen's kappa index (κ) and percentage of agreement. RESULTS: Of 209 eligible women, 152 were ultimately included. Mean (± SD) age was 60.9 ± 10.2 years, with a range of 32-91 years. Definitive histological diagnosis revealed that myometrial infiltration was < 50% in 114 women and ≥ 50% in 38 women. Sensitivity and specificity of TVS for detecting deep myometrial infiltration were 81.6% and 89.5%, respectively, whereas the respective values for intraoperative macroscopic examination were 78.9% and 90.4% (McNemar's test, P > 0.05 when comparing TVS and intraoperative macroscopic examination). Agreement between methods was moderate with κ = 0.54 (95% CI, 0.39-0.69) and percentage of agreement of 82%. CONCLUSIONS: Although the agreement between preoperative TVS and intraoperative macroscopic examination for detecting deep myometrial infiltration was only moderate, both methods had similar accuracy when compared with frozen section histology. Preoperative TVS might reasonably be proposed as a method for assessing myometrial infiltration as an alternative to intraoperative macroscopic examination, especially when performed by an experienced examiner and image quality is not poor. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Transvaginal/transrectal ultrasound for preoperative identification of high-risk cases in well- or moderately differentiated endometrioid carcinoma.

OBJECTIVE: To evaluate the role of transvaginal/transrectal ultrasound for preoperative identification of high-risk cases among women with well-differentiated (G1) or moderately differentiated (G2) endometrioid carcinoma of the endometrium. METHODS: This was a single-center prospective observational cohort study comprising a consecutive series of women with a preoperative diagnosis of G1/G2 endometrioid carcinoma of the endometrium. All women underwent transvaginal or transrectal ultrasound examination by a single examiner. According to the examiner's subjective impression, patients were considered high risk if myometrial infiltration was ≥ 50% and/or involvement of the cervix and/or adnexa was suspected. FIGO surgical staging was performed in all cases. According to definitive histological data regarding myometrial infiltration, cervical involvement and adnexal involvement, women were classified as low risk (no myometrial infiltration, no cervical involvement and no adnexal involvement) or high risk (myometrial infiltration ≥ 50% and/or cervical involvement and/or adnexal involvement). Sensitivity, specificity and positive (LR+) and negative (LR-) likelihood ratios, with 95% CIs, of transvaginal/transrectal ultrasound for detecting stage ≥ IB were calculated. Agreement between risk determined by transvaginal/transrectal ultrasound and postoperative definitive histology was calculated. RESULTS: Of 209 eligible women, 169 were included in the study. Mean (± SD) age of the study cohort was 60.7 ± 10.3 years, with a range of 32-91 years. Sensitivity, specificity, LR+ and LR- of transvaginal/transrectal ultrasound identifying high-risk cases according to myometrial infiltration, cervical involvement and adnexal involvement were 78.0% (95% CI, 63.7-88.0%), 89.1% (95% CI, 81.7-93.8%), 7.14 (95% CI, 4.19-12.18) and 0.25 (95% CI, 0.15-0.42), respectively. CONCLUSIONS: Preoperative transvaginal/transrectal ultrasound may play a significant role in identifying high-risk cases among those with G1/G2 endometrioid carcinoma of the endometrium according to preoperative biopsy, and could be a useful test in this clinical setting. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Comparative analysis of the incidence of bladder cancer in the communities of Andalusia, Catalonia and Madrid in 2011.

OBJECTIVES: To determine the incidence of bladder cancer (BC) in the autonomous communities that include the largest number of cases in the national hospital BC registry (Andalusia, Catalonia and Madrid) and report the clinical, pathological and diagnostic differences and similarities of BC in these regions. MATERIAL AND METHODS: An observational epidemiological study was performed in 2011 in 12 public hospitals with reference population areas according to the National Health System (Spain). Demographic and clinical variables were collected from new cases and relapses, with histopathologic confirmation of BC. The raw incidence rate was calculated using the number of diagnosed cases in all the participating centers compared with the aggregate total population assigned to each center. The raw rates by age and sex were obtained from the National Institute of Statistics (2011) by weighting the assigned population with the distribution by age and sex. RESULTS: The 3 autonomous communities recorded 51% of the 4285 cases included in the national registration, with relapses corresponding to 42.8% of these cases. The raw annual incidence rate for new episodes was 22.6 (95% CI: 20.7; 24.6) in Andalusia, 23.5 (95% CI: 20.9; 26.0) in Catalonia and 22.0 (95% CI: 19.9; 24.1) in Madrid. CONCLUSIONS: Except for the larger proportion of smokers and lower tumor grade of lesions in Andalusia, the 3 autonomous communities studied are similar in terms of clinical characteristics, comorbidities, patient symptoms and diagnostic processes for BC.

Autodilatación uretral tras cirugía radicalde próstata / No disponible

Esta comunicación está basada en la experiencia adquirida en la consulta de enfermería urológica con pacientes que presentan estenosisde uretra, tras ser intervenidos de prostatectomía radical. A través del adiestramiento en la autodilatación conseguimos que el pacienteparticipe de una forma activa en su autocuidado, logrando así que sea más autónomo, con más confianza en sí mismo y mejorando sucalidad de vida. Se trata de un estudio descriptivo y retrospectivo basado principalmente en nuestra experiencia, ya que existe muy pocabibliografía en autodilatación uretral tras prostatectomía radical. Los resultados obtenidos con la autodilatación son muy favorables tantopara el paciente como para la institución, por lo que potenciamos mucho esta técnica, obteniendo una buena relación coste-beneficio (AU)

This communication is based on acquired experience in urological nursing practice of urological with patients who present urethra stenosis,after being operated on radical prostatectomy. Through the training about selfdilation, we get the patient to share an active form in theirselfcare, thus managing more autonomy, with more confidence in themselfs and improving their life quality. It is a descriptive and retrospectivestudy based mainly on our experience, since there is very few bibliography about urethral selfdilation after radical prostatectomy.The results obtained with selfdilation are very favorable for the patient as well as for the institution, therefore we promote this techniquea lot, obtaining good cost-profit relation (AU)

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

OBJETIVO: Determinar si la expresión de p53 en pacientes con carcinoma vesical infiltrante tiene valor pronóstico en el estadiaje clínico y supervivencia del tumor.MÉTODOS: El análisis inmunohistoquímico de p53 se realizó en 34 pacientes (33 hombres y 1 mujer) tratadoscon cistectomía por carcinoma vesical infiltrante con seguimiento medio de 16 meses.RESULTADOS: Se detectó sobreexpresión de p53 en 18 pacientes (64%). En el grupo con positividad p53 se encontraron 2 pacientes con estadio T1G3, 18 pacientesT2, 1 paciente T3 y 2 pacientes T4. En el grupo con negatividad inmunohistoquímica se encontró una mejor correspondencia entre el estadiaje de la RTU y de la cistectomíaencontrándose empeoramiento del estadio en solo 3 pacientes. Tras el seguimiento los pacientes p53 positivos presentaron peor evolución al tener peor estadio,aunque no significativa estadísticamente (p 0,24). En los pacientes que pasaron a protocolo de conservaciónvesical (n=6), los p53 negativos experimentaron una remisión completa de la enfermedad.CONCLUSIONES: Observamos una diferencia significativade infraestadiaje/evolución local más agresiva en pacientes p53 positivos y no mayor mortalidad en este grupo. La expresión de p53 no contraindica la entrada de un paciente en protocolo de conservación vesical aunque serán necesarios estudios más amplios para confirmar estos resultados

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

Irrigación en colostomías / Irrigation in colostomies

El nivel de aceptación de la irrigación de la colostomía varía ostensiblemente de unos trabajos a otros, por lo que estudiamos lo que acontece en nuestro medio, diferenciando los pacientes que han utilizado previamente otros procedimientos (Grupo A), de aquellos que han sido informados y entrenados desde el postoperatorio inmediato (Grupo B).Grupo A: 48 pacientes. No se consideran adecuados para la irrigación 22 (46 por ciento). De los 26 a los que se les propone aceptan 14 (54 por ciento). De éstos la abandonan 5 (36 por ciento) y mantienen su práctica 9, lo que representa el 64 por ciento de los que la aceptan, el 35 por ciento de los que se les propuso y el 19 por ciento del grupo total. Grupo B: 189 pacientes. No se propone a 95 (50 por ciento). De los 94 a los que se propone, aceptan 65 (69 por ciento). De ellos, abandonan 22 (34 por ciento) y continúan 43, lo que representa el 66 por ciento de los que aceptan, 46 por ciento de los que se les propuso y 23 por ciento del grupo total. Conclusiones: La práctica de la irrigación oscila en nuestro medio entre el 19 y 23 por ciento de pacientes ostomizados, sin diferencia significativa en función del momento de comienzo. Una primera aproximación de este estudio fue presentada en el III Congreso Nacional de Enfermería en Ostomías (AU)

Functional analysis of the highly conserved exon IV of XIST RNA.

X inactivation is effected by a large CIS-acting RNA molecule termed the X inactive specific transcript (XIST). Exon IV of XIST RNA is highly conserved at the primary sequence level and is predicted to form a stable stem-loop structure. These features suggest that it is important for XIST RNA function. We have used homologous recombination to delete exon IV of the mouse XIST gene. Surprisingly we found no detectable effects on X inactivation. Heterozygous female animals show normal random X inactivation and transcripts from the mutant allele were seen to localise IN CIS over the length of the inactive X chromosome. There was however a reduced steady state level of mutant relative to wild type XIST RNA. This effect was not attributable to decreased stability, suggesting that the deletion affects transcription or processing of XIST RNA.

[Irrigation in colostomies]. / Irrigación en colostomías.

The degree of acceptation of irrigation from a colostomy varies ostensibly from some cases to others, therefore, we study what occurs in our medium, separating those patients which have previously undergone other procedures (Group A) from those patients who have been informed and trained about the immediate postoperative period (Group B). GROUP A: 48 patients, 22 or 46% of these patients were considered not apt for irrigation. Of the 26 to whom this procedure was proposed, 14 or 54% accepted. Of these, 5 or 36% abandoned its use while 9 continued its use; this is 64% of those who accepted this procedure, 35% of those to whom it was proposed and 19% of the total study group. GROUP B: 189 patients. This procedure was not recommended to 95 patients, 50%. Of the 94 patients to whom this procedure was proposed, 65 or 69% accepted. Of these, 22 or 34% abandoned its use while 43 continued its use; this is 66% of those; who accepted this procedure, 46% of those to whom it was proposed and 23% of the total study group. CONCLUSIONS: In our medium, the practice of irrigation oscillates between 19 and 23% of patients who have undergone a colostomy, without any significant difference referring to the moment when a patient started this procedure. A first report on this study was submitted in the III National Congress for Nursing in Colostomies.

Nonequivalent nuclear location of immunoglobulin alleles in B lymphocytes.

Individual B lymphocytes normally express immunoglobulin (Ig) proteins derived from single Ig heavy chain (H) and light chain (L) alleles. Allelic exclusion ensures monoallelic expression of Ig genes by each B cell to maintain single receptor specificity. Here we provide evidence that at later stages of B cell development, additional mechanisms may contribute to prioritizing expression of single IgH and IgL alleles. Fluorescent in situ hybridization analysis of primary splenic B cells isolated from normal and genetically manipulated mice showed that endogenous IgH, kappa and lambda alleles localized to different subnuclear environments after activation and had differential expression patterns. However, this differential recruitment and expression of Ig alleles was not typically seen among transformed B cell lines. These data raise the possibility that epigenetic factors help maintain the monoallelic expression of Ig.

Primary non-random X inactivation associated with disruption of Xist promoter regulation.

In this report we demonstrate primary non-random X chromosome inactivation following targeted mutagenesis of a region immediately upstream of XIST promoter P(1). In heterozygous animals there is a preferential inactivation of the targeted X chromosome in 80--90% of cells. The phenotype correlates with inappropriate activation of XIST in a proportion of the mutant XY embryonic stem cells. Strand-specific analysis revealed increased sense transcription initiating upstream of XIST promoter P(1). There was, however, no discernible effect on transcription from the antisense Tsix gene. We demonstrate that the in vitro and in vivo phenotypes are specifically attributable to the presence of a PGKneo cassette at the targeted locus. These findings are discussed in the context of understanding mechanisms of XIST gene regulation in X inactivation.

Una hiperplasia benigna de próstata

El estudio de la hiperplasia benigna de próstata debe incluir: a) una valoración sintomática, para la cual utilizamos el índice IPSS; b) una medición del flujo miccional; c) una valoración del tamaño prostático mediante ecografía y/o tacto rectal, y d) no podemos olvidar la necesidad de descartar la presencia de un carcinoma, para lo cual añadiremos al estudio la determinación de PSA sérico. Una vez completado el estudio podemos catalogar al paciente dentro de unos grados de prostatismo, lo que permite establecer unas guías terapéuticas aplicables a la gran mayoría de enfermos, sin olvidar nunca que la decisión de tratamiento última se hará de forma individualizada para cada enfermo según su estado general y edad. Ante un prostatismo leve la abstención terapéutica sería lo ideal, mientras que ante un prostatismo grave lo sería la intervención quirúrgica. En los prostatismos moderados es donde se abre mayor número de posibilidades, pero sin duda son los tratamientos farmacológicos los que resultan de elección (AU)

Rehabilitación y valoración funcional de la artroplastia de hombro / Rehabilitation and functional evaluation of shoulder arthroplasty

Introducción: El recambio protésico de la articulación glenohumeral es más novedoso que los de cadera y rodilla, pero sus resultados no son tan brillantes. Pretendemos conocer las características de los pacientes intervenidos con esta técnica, valorar los resultados funcionales tras la rehabilitación y describir factores que influyen en ellos. Material y métodos: Revisamos 44 pacientes intervenidos entre enero de 1995 y mayo de 1998. Analizamos variables como sexo, edad, etiología, tipo de prótesis, procedimientos quirúrgicos asociados, tiempo de rehabilitación, movilidad alcanzada y complicaciones asociadas. En los de etiología traumática se han valorado los resultados funcionales mediante la escala de Constant. Para conocer los factores pronósticos hemos comparado los resultados funcionales según la edad, el estado del manguito de los rotadores y el tiempo de tratamiento rehabilitador. Resultados: La edad media ha sido de 66,7 años, con incidencia superior en mujeres (72,7 por ciento). La causa más frecuente fue la traumática. El tiempo medio de tratamiento rehabilitador fue de 20,3 semanas. Los resultados funcionales obtenidos en los casos traumáticos, malos en términos absolutos, mejoran al compararlos con los obtenidos en el hombro sano de los mismos pacientes. La edad es predictor de un buen resultado funcional. Conclusiones: Los resultados en cuanto rango de movilidad y fuerza son malos, sin embargo se consigue un eficaz control del dolor. Los pacientes de menor edad forman el grupo en que se obtienen mejores resultados (AU)

Transient osteoporosis of the hip.

We report four cases of transient hip osteoporosis studied between 1995 and 1997. All patients were men. The diagnosis was based on clinical symptoms, absence of abnormal laboratory tests, increased uptake in the femoral head and neck on Tc-99 bone scans and magnetic resonance imaging showing Oedema of the bone marrow. In three patients radiographs showed osteopenia of the head and neck of the involved femur, whereas no major radiographic changes were seen in the fourth patient. The clinical symptoms lasted 7 months and there was no recurrence after 8-24 months' follow-up.

The mouse Rsk3 gene maps to the Leh66 elements carrying the t-complex responder Tcr.

A variant form of mouse Chromosome (Chr) 17, the t-haplotype, contains several loci responsible for transmission ratio distortion in males. Sperm carrying the responder locus (Tcr) have a high probability of fertilizing eggs at the expense of wild-type sperm, provided that distorter loci (Tcd-1 to Tcd-5) are expressed during spermatogenesis. Tcr has been mapped to the Leh66b region within a maximum of 155 kb. In the search for genes in the genomic region Leh66EI, we have identified the mouse homolog of human ribosome S6 kinase 3 (RSK3) on cosmid DNA. The complete mouse Rsk3 gene is encoded in the region Leh66a of t-haplotypes and Leh66EI of the wild-type chromosome. It consists of at least 13 exons spanning over more than 120 kb. Rsk3 is expressed in embryos and in several adult organs including testis. Cosmids covering 100 kb of the Leh66b region or 120 kb of the Leh66a region were isolated. Rsk3 covers about 65 kb of the Leh66b region and appears to be incomplete at its 5'-end. A correlation of the physical map provided here with the genetic mapping of Tcr reported previously suggests that Tcr is most likely encoded within a fragment of 30 kb upstream or 20 kb downstream of Rsk3. These data will facilitate the isolation of Tcr, a prerequisite for understanding transmission ratio distortion in mouse.

[High incidence of chromosome 8 monosomy and chromosome 7 trisomy in prostatic primary tumor and its related lymphatic metastasis. Preliminary results]. / Alta incidencia de la monosomia del cromosoma 8 y la trisomia del cromosoma 7 en el tumor primario prostático y su metástasis ganglionar asociada. Resultados preliminares.

INTRODUCTION: The research on tumoral aggressivity parameters in prostate cancer, such DNA ploidy detected by fluorescence in situ hybridization, has significant relevance to refine prognostic on an individualized patient. OBJECTIVES: To identify chromosome numeric alterations by FISH in primary prostate cancer focus and its corresponding lymph node metastases. b) To describe a cytogenetic tumoral progression pathway. METHODS: So far, we have retrospectively studies eight patients with prostate cancer and lymph node metastases performing FISH analysis on the primary prostate cancer focus and its metastatic lymph node. DNA probes for chromosomes 7, 8, 10 and 12 have been used for FISH analysis. RESULTS: a) Seven out of eight tumours (85%) were aneuploid when studied by FISH and the most frequent chromosome alterations found were monosomy 8 (100%) and trisomy 7 (85.7%). All the lymph nodes were aneuploid being monosomy 8 (87.5%) and trisomy 7 (62.5%) the most common chromosome alterations. b) Monosomy 8 and trisomy 7 appeared to be in the same cytogenetic tumoral progression pathway. CONCLUSION: Although we report about a preliminary study, monosomy of chromosome 8 and trisomy 7 are related with poor evolution, probably because of the loss of a suppressor gene or a proto-oncogen overexpression. The presence of any of them in a prostate cancer focus is related with poor prognosis.