Finerenone protects against progression of kidney and cardiovascular damage in a model of type 1 diabetes through modulation of proinflammatory and osteogenic factors.

The non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone (FIN) improves kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD) in type 2 diabetes (T2D). We explored the effect of FIN in a novel model of type 1 diabetic Munich Wistar Frömter (MWF) rat (D) induced by injection of streptozotocin (15 mg/kg) and additional exposure to a high-fat/high-sucrose diet. Oral treatment with FIN (10 mg/kg/day in rat chow) in diabetic animals (D-FIN) was compared to a group of D rats receiving no treatment and a group of non-diabetic untreated MWF rats (C) (n = 7-10 animals per group). After 6 weeks, D and D-FIN exhibited significantly elevated blood glucose levels (271.7 ± 67.1 mg/dl and 266.3 ± 46.8 mg/dl) as compared to C (110.3 ± 4.4 mg/dl; p < 0.05). D showed a 10-fold increase of kidney damage markers Kim-1 and Ngal which was significantly suppressed in D-FIN. Blood pressure, pulse wave velocity (PWV) and arterial collagen deposition were lower in D-FIN, associated to an improvement in endothelial function due to a reduction in pro-contractile prostaglandins, as well as reactive oxygen species (ROS) and inflammatory cytokines (IL-1, IL-6, TNFα and TGFß) in perivascular and perirenal adipose tissue (PVAT and PRAT, respectively). In addition, FIN restored the imbalance observed in CKD between the procalcifying BMP-2 and the nephroprotective BMP-7 in plasma, kidney, PVAT, and PRAT. Our data show that treatment with FIN improves kidney and vascular damage in a new rat model of DKD with T1D associated with a reduction in inflammation, fibrosis and osteogenic factors independently from changes in glucose homeostasis.

[Bilateral and synchronic testicular neoplasia. A report of a new case]. / Neoplasia testicular bilateral sincrónica. Presentación de un nuevo caso.

Bilateral and synchronic testicular tumor is an unfrequent fact (0,17% of germinative tumors of testicle), being most cases seminomas. We present the case of a male, 25-year old patient underwent a bilateral radical orchiectomy for bilateral and synchronic testicular tumor. The result of anatomopathological examination revealed bilateral seminoma (pT2 in both testes). Patient received four courses of adjuvant chemotherapy (etoposide and cisplatin) for metastases (N2, M1). The patient is without evidence of disease two years after orchiectomy.

Neoplasia testicular bilateral sincrónica. Presentación de un nuevo caso / Bilateral and synchronic testicular neoplasia. A report of a new case

El tumor testicular bilateral y sincrónico es un hecho infrecuente (0,17% de los tumores germinales de testículo), siendo la mayoría de los casos seminomas. Nosotros presentamos el caso de un varón de 25 años de edad sometido a orquiectomía radical bilateral por tumor testicular bilateral sincrónico. El resultado del examen anatomopatológico reveló seminoma bilateral (pT2 en ambos testes). El paciente recibió 4 ciclos de quimioterapia (etopósido y cisplatino) adyuvante por enfermedad metastásica (N2, M1). 2 años después de la orquiectomía, el paciente está sin evidencia de enfermedad

Bilateral and synchronic testicular tumor is an unfrequent fact (0,17% of germinative tumors of testicle), being most cases seminomas. We present the case of a male, 25-year old patient underwent a bilateral radical orchiectomy for bilateral and synchronic testicular tumor. The result of anatomopathological examination revealed bilateral seminoma (pT2 in both testes). Patient received four courses of adjuvant chemotherapy (etoposide and cisplatin) for metastases (N2, M1). The patient is without evidence of disease two years after orchiectomy

[Mucinous adenocarcinoma of the urachus and peritoneal pseudomyxoma]. / Adenocarcinoma mucinoso de uraco y pseudomixoma peritoneal.

The adenocarcinoma of the urachus is very rare tumor, with an incidence of 1/5.000.000 inhabitants, represents less than 0.001 of all types of bladder cancer. Peritoneal pseudomixoma is a rare neoplasm characterized by mucinous acites that involvement the peritoneal surface and omentum. Usually is associated with benign o malignant mucinous tumor of the appendix or ovary. In this paper, we present a case of peritoneal pseudomixoma caused by a mucinous adenocarcinoma of the urachus.

Adenocarcinoma Mucinoso de Uraco y Pseudomixoma Peritoneal / AB muncinous adenocarcinoma of the urachus and peritoneal pseudomyxoma

El adenocarcinoma de uraco es un tumor extremadamente raro, con una incidencia de 1/5.000.000 de habitantes, lo que representa menos del 0,001 de todos los tumores de vejiga. El pseudomixoma peritoneal es una neoplasia rara caracterizada por ascitis mucinosa que envuelve la superficie peritoneal y el omento. Usualmente está asociada con tumores mucinosos benignos o malignos del apéndice u ovario. En este trabajo, presentamos un caso de pseudomixoma peritoneal causado por un adenocarcinoma mucinoso de uraco

The adenocarcinoma of the urachus is very rare tumor, with an incidence of 1/5.000.000 inhabitants, represents less than 0,001 of all types of bladder cancer. Peritoneal pseudomixoma is a rare neoplasm characterized by mucinous acites that involvement the peritoneal surface and omentum. Usually is associated with benign o malignant mucinous tumor of the appendix or ovary. In this paper, we present a case of peritoneal pseudomixoma caused by a mucinous adenocarcinoma of the urachus

[Second resection in patients with Ta-T1 bladder tumors]. / Segunda resección en pacientes con tumores vesicales Ta-T1.

OBJECTIVES: To study the incidence of "residual/recurrence" tumor after a second bladder resection (2nd TUR). METHODS: 40 patients with new or recurrent superficial bladder tumor underwent repeat transurethral resection within 3 months after the initial resection. 37 patients were staged as Ta-T1. We study the incidence of tumor after the 2nd TUR both macroscopically detected or included in the bladder scar. We also study the influence of possible factors as the time between both resections, stage, grade, number of tumor size, localization in the bladder, primary or recurrent tumor and tumor pattern. RESULTS: After the 2nd TUR we found tumor in 14 of 37 (37.8%) Ta-T1 bladder tumors. Among the 14 tumors, 10 (71.5%) were macroscopically visible tumors and 4 cases the tumor were found after resection of the bladder scar of the first resection. We did not find relation between the presence of tumor in the 2nd TUR and any of the variables. CONCLUSIONS: After a TUR of superficial bladder tumor the complete removal of tumor is not always achieved. The early 3 months cystoscopy may not find residual tumor. Although we have found tumor in 37.8% in the 2a TUR we can not recommend routine 2nd TUR in superficial bladder cancer.

Segunda resección en pacientes con tumores vesicales Ta-T1 / Second TUR in patients with stage Ta-T1 transicional cell carcinoma of the bladder

OBJETIVO: Estudiar la incidencia de tumor "residual/recidivante" tras segunda resección precoz (2ª RTU), y que factores influyen en su hallazgo. MATERIAL Y MÉTODO: Estudio prospectivo de 40 pacientes con neoplasia vesical superficial a los que se les realizó una 2ª RTU precoz. Como posibles factores de riesgo de hallazgo de tumor se estudiaron el intervalo de tiempo entre ambas RTU, el estadio, el grado, el número de implantes tumorales, el tamaño de los implantes, localización dentro de la vejiga, tumor primario o recidivante y el patrón tumoral. RESULTADOS: Al realizar la 2ª RTU se confirmó histológicamente tumor en 14 (37,8 por ciento) de 37 pacientes con tumores Ta-T1 (excluimos aquellos con afectación focal de la muscular): 10 (71,5 por ciento) eran tumores macroscópicamente visibles, en 4 casos (28,5 por ciento) se encontró tumor al biopsiar las áreas de cicatriz/edema de la resección anterior. No encontramos asociación entre la presencia de tumor en la 2ª RTU y ninguna de las variables en estudio. CONCLUSIONES: La erradicación de tumor vesical superficial mediante RTU no se consigue en un elevado porcentaje de pacientes. La cistoscopia a los tres meses no puede excluir tumor residual. Aunque hemos encontrado 37,8 por ciento de tumor en la 2ª RTU, actualmente no podemos recomendarla de forma rutinaria en los tumores vesicales superficiales (AU)

[Congenital bladder diverticulum and Ehlers-Danlos syndrome: an unusual association]. / Divertículo vesical congénito y síndrome de Ehlers-Danlos: una rara asociación.

The existence of a vesical diverticulum in the context of a congenital connective tissue disorder such as Ehlers-Danlos syndrome led us to consider the possibility of a relationship. Four types of diverticula can be found in the literature: congenital, acquired, iatrogenic and syndrome-associated. Within the later, Ehlers-Danlos syndromes type IV and IX, even type V, are associated to the existence of vesical diverticula. The potential spontaneous rupture of the diverticulum is a typical feature, as well as post-surgery relapse. The attitude towards such diverticula should be one of watchful waiting, and simple, plasty-free diverticulectomy on the bladder's neck is indicated when performing a surgical procedure.

[Glandular cystic cystitis]. / Consideraciones sobre la cistitis quística glandular.

Cystic-glandular cystitis is considered as part of the urothelial pre-neoplastic proliferative abnormalities. This group includes atypical hyperplasia. Von Brunn's nidus, and cystitis cystica. They are a consequence of the changes experienced at the urothelium level in response to inflammation, irritation or carcinogens. Diagnosis is mainly based in the pathoanatomical study of the biopsy obtained following endoscopic resection. The signs and symptoms it presents are varied and show a clear relationship to distribution and extension of cysts. Treatment is based in the removal of irritative factors. Cystectomy with urinary by-pass may be necessary if required by clinical evolution.

Divertículo vesical congénito y síndrome de Ehlers-Danlos: una rara asociación / Congenital vesical diverticulum and Ehlers-Danlos syndrome: a rare association

La existencia de un divertículo vesical en el contexto de una alteración congénita del tejido conectivo como es el Síndrome de Ehlers-Danlos, nos hizo plantearnos su posible relación. En la literatura se describen en la actualidad cuatro tipos de divertículos: congénitos, adquiridos, yatrogénicos y asociados a síndromes. Dentro de este último, el síndrome de Ehlers-Danlos en sus tipos IV y IX y ocasionalmente en el tipo V se relaciona con la existencia de divertículos vesicales. Es característica la posible ruptura espontánea del divertículo, así como su recidiva tras cirugía. La actitud ante estos divertículos debe a poder ser expectante y sólo, la diverticulectomía simple sin plastia sobre el cuello vesical está indicada, si fuera necesaria realizar alguna técnica quirúrgica. (AU)

Consideraciones sobre la cistitis quística glandular / Reflections on glandular cystitis cystica

La cistitis quístico-glandular se engloba dentro de las anormalidades proliferativas preneoplásicas uroteliales. En este grupo se engloban la hiperplasia atípica, los nidos de Von Brunn y la cistitis quística.Se caracterizan por ser consecuencia de los cambios experimentados a nivel del urotelio en respuesta a la inflamación, la irritación o los carcinógenos. Su diagnóstico se basa fundamentalmente en el estudio anatomopatológico de la biopsia obtenida tras la resección endoscópica. Su clínica es muy variada, estando en clara relación con la distribución y extensión de los quistes. Su tratamiento se basa en la eliminación de los factores irritativos, pudiendo llegar a requerir la realización de una cistectomía con derivación urinaria si su evolución clínica asi lo requiriese (AU)

[Mullerian-type papillary serous tumor: exceptional pathology of the testis. Report of a case and discussion]. / Tumor seroso papilar tipo mülleriano: una patología excepcional del testículo. Presentación de un caso y discusión.

Within the exceptional tumoral pathology of the testis and paratesticular region are the common epithelial type tumors. Although, its histogenesis is under discussion, it has been interpreted as arising from the remnants of the müllerian duct, or from the mesothelium of the tunica vaginalis differentiating in a müllerian direction. Similarities with homologous ovarian tumors are well recognized and in generally we accept a good prognostic due to its low malignant potential or borderline type, more experience with these uncommon lesions is necessary to evaluate their biologic potential.

Tumor seroso papilar tipo mülleriano:una patología excepcional del testículo. Presentación de un caso y discusión / Serous papillar tumour müllerian type: a axceptional textis pathology. A case presentation and discussion

Dentro de la patología tumoral excepcional del testículo y paratestículo figuran los tumores de estirpe epitelial común, que aunque de histogénesis discutida se acepta que derivan de restos müllerianos o de diferenciación mesotelial de la vaginal. Guardan estrechas similitudes con sus equivalentes ováricos y en general, se les atribuye buen pronóstico debido a su carácter bordeline o de bajo potencial maligno, pero se precisa de más experiencia con estos raros tumores para evaluar su potencial biológico (AU)

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[Transitional carcinoma of the prostate]. / Carcinoma transicional de próstata.

Case report of prostate transitional carcinoma diagnosed by transurethral resection, an infrequent tumour with incidence ranging from 1% to 4% of all prostate neoplasias which appears in 2.8% of all radical cystoprostatectomies specimens carried out at the Mayo Clinic. Most commonly, when it appears in the prostate this tumour is simultaneous or subsequent to other transitional carcinoma arisen in other organs mostly the bladder. Very rarely it occurs as an early form within the ducts and even less often within the prostate acinus. Review of the neoplasia histology, signs and symptoms, diagnostic procedures and management, emphasising the aggressiveness of its behaviour (such as in our case report) when the prostate gland stroma is infiltrated by the tumour.

[Testicular tumors: our experience]. / Consideraciones sobre los tumores de testículo: nuestra experiencia.

OBJECTIVE: To report our series of testicular tumors diagnosed from June 1990 to June 1998. The diagnostic protocol, treatment and follow-up are described and data on patient survival over the 8-year period are presented. METHODS: Our series comprised 21 testicular tumors; 19 germ cell and two non-germ cell tumors. There were 5 seminoma, three pure embryonary carcinoma, two mature cystic teratoma, 9 mixed germ cell tumor and two lymphoma. Treatment was by orchidectomy plus radiotherapy, chemotherapy and some cases were closely followed. RESULTS: All 5 patients with seminoma are currently tumor-free, for a mean survival of 38.6 months. Of the 14 non-seminomatous tumors, there were two deaths; the remaining patients are in complete remission, for a mean survival of 37.5 months. The overall survival rate was more than 95% at a mean follow-up of 48 months. CONCLUSIONS: Testicular tumor is one of the most common tumors in young male patients; germ cell tumors are the most frequent type. The different therapeutic regimens currently available have achieved a 5-year survival rate of more than 95%.

[Primary lymphoma of the testicle]. / Linfoma primario de testículo.

Case report of a testicular lymphoma. A diagnosis of primary neoplasia of the testis was made since no involvement to the lymphoreticular system in any other organ was demonstrated. We review the clinical, diagnostic and therapeutical aspects and make a note on the rarity of our case, a type T tumour, due to the exceptional nature of this variety within primary lymphomas of the testis.

[Bladder hemangioma: a clinical case]. / Hemangioma vesical: caso clínico.

Contribution of a new case of vesical haemangioma in a 65-year old male. This is a benign and very rare tumour with not even 90 cases described in the urology literature to date. Haematuria was reported in all cases. This paper presents a review of the literature and a discussion of clinical and pathological features as well as diagnostic methods and recent changes in management approach.