[Emphysematous cystitis]. / Cistitis enfisematosa.

The presence of gas in the bladder wall and/or lumen (emphysematous cystitis) is an uncommon disease entity that may be caused by infectious organisms. Diabetes and chronic urinary infection are predisposing factors. Its clinical features are unspecific and the prognosis depends on the degree of aggressiveness at presentation. Early diagnosis and treatment (bladder drainage + antibiotics) are very important in order to resolve the condition before severe sequelae are caused. We report on 75-year-old diabetic female with mild emphysematous cystitis caused by Clostridium perfringens which resolved with bladder drainage and antibiotics. The incidence, forms of presentation, pathogenesis, diagnosis and treatment of this condition are discussed.

[Abdominal desmoid]. / Desmoide abdominal.

Abdominal desmoid tumor or fibromatosis is a benign non-urological connective tumor which can be mistaken for a urological tumor due to its localization (generally in muscles and aponeurosis of the abdominal wall). It is locally invasive and potentially recurrent. We report on a 53-year-old male with abdominal desmoid tumor whose only symptom was pain. The clinical diagnosis was corroborated by the US and CT findings and confirmed by anatomopathological findings. Wide local surgical excision is the treatment of choice since hormone therapy, radiotherapy and chemotherapy achieved scant results.

[Supernumerary spleen]. / Bazo supernumerario.

The diagnosis of the accessory spleen, if unsuspected, is basically anatomopathological due to its frequency and, above all, its nonspecific clinical features. We report a case of a retroperitoneal mass that was shown to be composed of accessory splenic tissue.

[Renal transplantation: results]. / Trasplante renal: resultados.

Between June 1986 and December 1991, 125 kidneys were transplanted in our hospital. Survival results of patients per annum was 94%, 90% of which represent grafts. Regarding the complications occurred in our series the most frequent ones were medical followed by surgical [urological (4%), vascular (2.4%) and others derived from the surgical procedure (20%)]. It was necessary to perform 5 transplantectomies.

[Secondary ureterectomy in an ectopic ureteral opening into the seminal vesicle]. / Ureterectomía secundaria en la desembocadura ureteral ectópica en vesícula seminal.

The ectopic ureter opening to the seminal vesicle is uncommon in the male and even less in a duplex kidney. It commonly presents as recurrent urinary infection with pelviperineal pain. Treatment is by heminephrectomy with total ureterectomy and removal of the seminal vesicle if it is cystic. Herein we describe a 70-year-old patient who had previously undergone a heminephrectomy and partial ureterectomy due to an ectopic ureter opening to the seminal vesicle of the ureter of the upper pelvis of the left kidney. The patient was submitted to a second ureterectomy procedure due to pyoureter in the ureteral stump. The main features of this pathological condition are described and the surgical approach is discussed.

[Multilocular renal cyst]. / Quiste multilocular renal.

A case of multilocular renal cyst in a 37-year-old patient is presented, which met all of the diagnostic criteria described by Powell (1951) and Boggs and Kimmelstiel (1956). The frequency of renal hydatid cyst observed in our setting warrants differential diagnosis from this disease entity. Conservative surgery is advocated as treatment.

[Complications during and after extracorporeal lithotripsy in elderly patients]. / Complicaciones per y post-litotricia extracorpórea en los pacientes de edad avanzada.

Report of our experience of complications arisen from treatment of urinary lithiasis with extracorporeal shock-wave lithotripsy, using a Dornier HM3 lithotripter in 218 elderly patients (over 65 years). No complications arose during lithotripsy in 160 patients (73.39%). Most frequent complications (when they happened) were skin disorders, which occurred in 33 patients (15.13%). One hundred and thirty-six (62.38%) patients had no post-lithotripsy non-obstructive urological complications, but when these occurred, renal colic, evident in 52 patients (23.85%), was the most frequent one. During the post-lithotripsy period, 88.53% patients (193) had no obstructive urological complications. When they emerged, they usually developed asymptomatically (13 patients, 5.95%). With regard to the approach used to treat the obstructive cases, the most common one was medical, representing 56%. Surgery was used only in 2 occasions. A total of 175 patients (80.27%) presented no post-lithotripsy complication, fever of up to + 38 degrees C being the most prevalent condition (9.65%).

[Bladder adenocarcinoma of urachal origin. A rare tumor]. / Adenocarcinoma vesical de orígen uracal. Un raro tumor.

With the description of this new case of urachal adenocarcinoma in the vesical cupula we provide a review on the clinical, pathological and immunohistochemical aspects of this rare tumour, as well as a diagnostic and therapeutical approach. Its subepithelial infiltrant nature delays discovery and denotes both an insidious evolution and poor prognosis. Mucinoid production, nodes pattern and certain immunohistochemical substances as well as abnormalities in the cell's DNA content are attributes of this entity. Only surgery, either partial or exeresis, is effective since this is a radioresistant and dubiously chemosensitive tumour.

[Non-functioning retroperitoneal paraganglioma]. / Paraganglioma no funcionante retroperitoneal.

Extra-adrenal pheochromocytoma or paraganglioma are rare, usually benign tumours, which clinical behaviour varies in function of whether they are able to secrete vasopressor hormones. The case of a 66 year-old male with non-functional retroperitoneal paraganglioma (chemodectoma) accidentally found with an echography is presented here. The paper analyzes the most relevant features from a pathological, clinical, evolutive, diagnostic and therapeutic point of view.

[Growing teratoma syndrome]. / Síndrome del teratoma en crecimiento.

Appearance of residual masses following chemotherapy of retroperitoneal metastasis from testicle's non-seminomatous germinal cell tumour does not always imply we are facing an active tumoral disease. When exeresis of these masses discovers the presence of a mature teratoma during the histological study, what we have is the so called Growing Teratoma Syndrome. Such teratoma is unresponsive to chemotherapy but the patient can be cured by means of a full exeresis of the residual mass, thus the relevance of having into account the likelihood of this pathology. The paper presents the case of a patient with retroperitoneal non-seminomatous testicle tumour and metastasis which, following chemotherapy, presented a residual mass with normal serological markers. After the exeresis it was found out that it was made up by mature teratoma. Four months after rescue surgery, the patient remains asymptomatic, has normal markers and no signs of neoplastic recurrence.

[Parotid metastasis of renal adenocarcinoma: report of a case]. / Metástasis parotidea de adenocarcinoma renal: a propósito de un caso.

Renal adenocarcinomas are tumours which sometimes tend to remain clinically silent, and initially become evident through distant metastasis. This paper presents the case of a 54 year-old patient whose initial clinical evidence was parotid metastasis from kidney clear cells adenocarcinoma. The patient had a metastasis and renal tumour exeresis with application of supplementary chemotherapy and immunotherapy, presenting early pulmonary metastasis which remains currently unchangeable. Some comments apropos of distant metastasis, its prognosis and regression in renal tumours are made.