Rotura de pseudoaneurisma ilíaco como complicación tardía de cirugía de bypass aortobifemoral: a propósito de un caso y revisión de la bibliografía / Rupture of an iliac pseudoaneurysm as late complication of an arto-bifemoral bypass: A case report and review of the literature

Introducción. En pacientes con un bypass aortobifemoral por patología aneurismática, la aparición y/o elcrecimiento de un aneurisma ilíaco excluido constituye un hallazgo poco frecuente. Presentamos un caso que se iniciócon rotura de un pseudoaneurisma de la arteria ilíaca primitiva, de dimensiones gigantescas, como complicación tardíade cirugía de bypass aortobifemoral. Caso clínico. Varón de 70 años de edad, con antecedente de aneurisma de aortaabdominal intervenido hace 13 años, con resección de aneurisma y realización de bypass aortobifemoral. Ingresa deurgencia por shock hipovolémico, con clínica previa de dolor abdominal en hipogastrio y mareo con pérdida de conciencia.En la exploración presenta dolor en el abdomen, con palpación de una masa en el hemiabdomen izquierdo. Latomografía computarizada abdominopélvica revela gran hematoma retroperitoneal izquierdo que desplaza el riñón haciaarriba y se extiende hacia la pelvis, y que produce un desplazamiento de la rama izquierda del bypass aortobifemoral,sin identificarse fuga de contraste desde los vasos retroperitoneales. A través de una laparotomía media se encuentraun importante hematoma retroperitoneal izquierdo que engloba al riñón; se realiza nefrectomía izquierda y la extracciónde un hematoma gigante antiguo de unos 15 cm; al retirar la última capa de trombo estratificado, se identificael punto sangrante origen del pseudoaneurisma, y se une con doble ligadura y punto de transfixión. Conclusión. Dado elantecedente de bypass aortobifemoral con exclusión de aneurismas ilíacos y el hallazgo de un falso aneurisma ilíaco,se establece que la rotura crónica mantenida de un aneurisma de arteria ilíaca primitiva, alimentado retrógradamentepor circuitos hipogástricos, ha sido el origen del desarrollo de un pseudoaneurisma que se rompe de forma tardía(AU)

Introduction. In patients with an aorto-bifemoral bypass due to an aneurysmal pathology, the appearanceand/or growth of an excluded iliac aneurysm is rare. We report a case that began with the rupture of a huge pseudoaneurysmin the common iliac artery as a delayed complication of surgery performed in order to introduce an aortobifemoralbypass. Case report. A 70-year-old male, who had previously undergone surgery involving resection of theaneurysm and insertion of an aortobifemoral bypass to treat an abdominal aortic aneurysm 13 years before. The patientwas admitted as an emergency due to hypovolemic shock, with previous clinical symptoms of abdominal pain in thehypogastric region and dizziness with loss of consciousness. The examination revealed pain in the abdomen, withpalpation of a mass in the left-hand side of the abdomen. A computerised tomography scan of the abdominal-pelvicregion showed a large retroperitoneal haematoma on the left side which displaced the kidney upwards and extendedtowards the pelvis. It also produced a displacement of the left branch of the aorto-bifemoral bypass, although no leakageof contrast from the retroperitoneal vessels was observed. A medial laparotomy revealed an important retroperitonealhaematoma on the left-hand side which encompassed the kidney; a left-side nephrectomy was performed and an oldgiant haematoma of about 15 cm was extracted. Removal of the last layer of the stratified thrombus made it possible toidentify the bleeding point causing the pseudoaneurysm, and it was joined with double ligation and a point oftransfixation. Conclusions. Given the history of aorto-bifemoral bypass with exclusion of iliac aneurysms and thediscovery of a false iliac aneurysm, the chronic maintained rupture of an aneurysm in the common iliac artery, fed in aretrograde manner by hypogastric circuits, was established as the origin of the development of a delayed-rupture pseudoaneurysm(AU)

Ulcus vulvae acutum / Ulcus vulvae acutum

El ulcus vulvae acutum es una úlcera en vulva de diagnóstico infrecuente que suele aparecer en mujeres adolescentes sin relación con enfermedad venérea. Las úlceras son grandes, múltiples y dolorosas asociándose a fiebre muy alta. Curan espontáneamente, pero el clínico debe hacer un buen diagnóstico diferencial para evitar un sobrediagnóstico de enfermedades ulcerativas más frecuentes, corno el herpes genital, con peor pronóstico evolutivo para la paciente

Ulcus vulvae acutum is a rare diagnosis with fever, ulceration of extemal genital organs and lymphadenomegaly most often seen in adolescent girls without venereal infection. The sloughy ulcers are often multiple. They heal spontaneously but this rare disease is usually misdiagnosed by specialists and is a diagnosis to considerer when herpes simplex, which is the most common cause for genital ulceration, is not the cause

[Bladder endometriosis. Diagnostic and treatment]. / Endometriosis vesical. Diagnóstico y tratamiento.

Endometriosis is a common gynecologic disease in which endometrial tissue is deposited outside the normal confines of the uterine cavity. Rarely endometriosis involves urinary tract. The bladder is the most frequent organ affected into this tract. A delay in detection can result in months or years of morbidity.

Endometriosis ureteral / Ureteral endometriosis

La endometriosis es una enfermedad ginecológica muy frecuente y probablemente en aumento. La afectación del tracto urinario es poco común pero suele ser clínicamente significativa, pudiendo obstruir los uréteres y condicionando la pérdida de la función renal y eventualmente la nefrectomía (AU)

Endometriosis vesical. Diagnóstico y tratamiento / Bladder endometriosis. Diagnostic and treatment

La endometriosis es una enfermedad ginecológica muy frecuente en la que el tejido endometrial aparece fuera de la cavidad uterina. En raras ocasiones la endometriosis afecta al tracto urinario, siendo la vejiga el órgano más frecuentemente afectado. Un retraso en su detección puede condenar a la paciente a meses de morbilidad innecesaria (AU)

[Post-traumatic high flow priapism in a child]. / Priapismo de alto flujo postraumático infantil.

We report on the case of a post-traumatic high-flow priapism in a 14 year-old boy, which was confirmed by cavernous blood gas measurement color flow Doppler sonography, and arteriography. It was successfully treated with superselective embolization of the right internal pudendal artery, resulting a clear disappearance of cavernus rigidity.

Priapismo de alto flujo postraumático infantil / Post-traumatic high-flow priapism in childhood

Presentamos el caso de un priapismo de alto flujo tras traumatismo perineal directo en un varón de 14 años, que se confirmó mediante gasometría de cuerpos cavernosos, estudio Eco-doppler peneano, y arteriografía pudenda. Se trató satisfactoriamente mediante embolización supraselectiva de una rama de arteria pudenda interna derecha, obteniendo disminución manifiesta de la rigidez cavernosa (AU)

[Suprarenal hemorrhage as the first manifestation of a small cell pulmonary carcinoma. Presentation of a case]. / Hemorragia suprarrenal como primera manifestación de un carcinoma pulmonar de células pequeñas. Presentación de un caso.

OBJECTIVE: To report on a case of small cell lung carcinoma presenting as adrenal hemorrhage. METHODS: A case of small cell lung carcinoma presenting as adrenal hemorrhage in a 60-year-old male is presented. The most important features of this tumor type and the adrenal metastasis are described. RESULTS: Treatment with carboplatin and VP-16 was unsuccessful. A brain CT scan showed several space occupying parenchymal lesions. Palliative radiotherapy was administered. The patient's condition has progressively become worse. He is currently receiving only palliative treatment. CONCLUSIONS: The adrenal gland is a common site of metastasis. One of the tumor types that frequently metastasize to the adrenals is small cell lung carcinoma, which is characterized by early local and systemic dissemination, associated paraneoplastic syndromes and its sensitivity to cytostatic agents. Adrenal metastasis from lung carcinoma should be suspected in patients with a large, heterogeneous, bilateral lesion.

[Significance of random biopsies of healthy mucosa in superficial bladder tumor]. / Significado de las biopsias al azar de mucosa sana en el tumor de vejiga superficial.

OBJECTIVE: To analyze the characteristics of the random biopsies of normal-appearing mucosa taken during TUR of superficial bladder tumors and to correlate them with the outcome and characteristics of the superficial tumor. METHODS: Multiple random biopsy specimens from normal-appearing areas of 300 TUR procedures for primary or recurrent superficial urothelial carcinoma were analyzed. Preoperative cytologies were obtained in most of the patients and tumor number, localization, size, stage and grade according to the WHO classification were determined. In patients with multiple tumors, the stage, size and grade of the worst tumor were utilized. Patients who showed a risk of recurrence during follow-up received intravesical therapy postTUR of the bladder. The site and characteristics of recurrence were analyzed and compared with the random biopsy findings. RESULTS: In 38 superficial tumors (12.7%), significant histological changes were found in the random biopsies of normal-appearing mucosa taken during resection. A significant difference was found between patients with and without positive random biopsies only for tumor stage. Statistically significant differences were found when comparing the primary and recurrent tumors, due to the greater number of high and moderate grade tumors in the primaries. There were significant differences in regard to the positive preoperative cytologies between the patients with negative and those with positive random biopsies. No statistical correlation was found between the localization of the superficial tumor and a positive biopsy or between the latter and the site of tumor recurrence. There were 126 recurrences (42%); mean time to recurrence was 13.5 months (median 9.5 months). No significant difference was found (log-rank) for time to recurrence in patients with positive or negative random biopsies, but significant differences were found when we analyzed the number of superficial tumors and the use of intravesical therapy, but not for the type of therapy. CONCLUSIONS: Multiple random biopsies permit a better categorization of the tumor and complete staging. The outcome and the decision to administer intravesical therapy following TUR of the bladder are influenced by the foregoing. The practical results of random biopsies, however, are scanty, since the prognostic significance of the histological changes found in these biopsies is not worse than that of the superficial tumor resected. There are, however, a few cases with a higher risk of recurrence and/or progression than the superficial tumor. Preoperative cytology is useful in the selection of these patients. Furthermore, since the proportion of high grade tumors is higher in primary tumors, performing multiple biopsies is mandatory in these cases if previous urine cytology is not available.

[Synchronous bilateral renal adenocarcinoma. Our experience with conservative kidney surgery]. / Adenocarcinoma renal bilateral sincrónico. Nuestra experiencia con la cirugía conservadora renal.

OBJECTIVE: To present our experience with synchronous bilateral renal adenocarcinoma. The indications for conservative surgery, the different types and the controversies are discussed. METHODS: 5 patients with bilateral renal adenocarcinoma from our series of 320 renal adenocarcinomas were analyzed for gender, age at presentation, tumor location, size, presenting features and type of surgery performed. RESULTS: Bilateral renal adenocarcinoma accounted for 1.56% in our series. Mean age at presentation was 57.8 years (range 43-69 years). All 5 patients were male. All patients underwent conservative surgery by tumor excision or partial nephrectomy of the side with less involvement followed by delayed radical surgery of the contralateral side. Follow-up ranged from 19 months to 14 years. To date all patients are disease-free and only one is on dialysis 14 years postoperatively. CONCLUSIONS: Bilateral renal adenocarcinoma has been reported to account for 1.4%-5% of all renal masses. The incidence in our series was 1.56%. Conservative renal surgery is indicated in patients like those described herein to prevent the need for dialysis. In our view, conservative renal surgery is a good therapeutic option that carries a small risk of tumor multicentricity and future recurrence.

[Renal cell carcinoma. Clinical onset with peritoneal carcinomatosis. Report of a case]. / Carcinoma de células renales. Presentación clínica debut con carcinomatosis peritoneal. A propósito de un caso.

Renal carcinoma accounts for 2-3% of malignant tumours in the adult, with high tendency for metastasis basically in liver, lymph nodes, lungs and bones. Intraperitoneal, gut, mesentery and omentum involvement is extremely rare affecting only 1% of patients with metastasis at post-mortem. Contribution of one case of renal carcinoma with initial presentation as intraperitoneal metastasis.

[Granulomatous prostatitis. Review of 22 cases]. / Prostatitis granulomatosa. Revisión de 22 casos.

Granulomatous prostatitis is an uncommon inflammatory process of the prostate, which can be caused by a variety of infectious agents or be part of a systemic allergic condition. In most cases, origin is unspecific. Clinical presentation, treatment and evolution are similar to those of benign prostatic hypertrophy and, in many cases, can only be distinguished from prostate carcinoma in the histological study. The authors present in this paper the results and conclusions of a retrospective study of 22 cases of granulomatous prostatitis.

[Pelvic lipomatosis: cause of extrinsic ureteral obstruction. Report of a case]. / Lipomatosis pélvica, causa de obstrucción ureteral extrínseca. Presentacion de un caso.

Contribution of one case of pelvic lipomatosis, suspected through diagnostic imaging (CAT) and diagnosed by exploratory laparotomy, leading to severe unilateral ureterohydronephrosis and contralateral distal ureteral ectasia. The features of the disease, presentation form, diagnosis and treatment are discussed.

[Spontaneous perirenal hematoma secondary to hydronephrosis in pelvic kidney]. / Hematoma perirrenal espontáneo secundario a hidronefrosis en riñón pelvico.

Contribution of one case of Spontaneous Perirenal Haematoma (SPH) secondary to hydronephrosis accompanied by lithiasis in pelvic kidney. SPH can result from multiple causes, the most frequent ones being renal tumours, most particularly angiomyolipoma and hypernephroma. Hydronephrosis is an uncommon cause of SPH, and very few cases are described in the literature. The present paper addresses the diagnostic usefulness of the various radiological tests as well as the therapeutical approach to be followed.