[Our experience with adrenalectomy (1994-2000). Overall review]. / Nuestra experiencia en adrenalectomías (1994-2000). Revisión de conjunto.

OBJECTIVE: Thirty cases of adrenalectomy are presented. The diagnostic and therapeutic aspects of adrenal disease are reviewed. METHODS: Over the last 6 years, 30 adrenalectomies were performed in 28 patients (20 females and 8 males) aged 16-83 years (mean age 51 years). The lesion was incidentally discovered in 18.5%, 33.3% presented abdominal or lumbar pain, 18.5% had Cushing's syndrome, 18.5% presented headache and hypertension, and 7.4% virilization. Diagnostic evaluation included laboratory studies, ultrasound and CT assessment. Scintigraphic localization with MIBG, MRI or arteriography was performed in specific cases. The flank approach was utilized in 53% of the cases. RESULTS: The postoperative period ranged from 7-23 days (mean 11). Postoperative complications (38.4%) following adrenalectomy were splenectomy, hemorrhage, hypertensive episodes, vascular complications, wound infection and pneumonia. Fifty percent of the masses were pheochromocytomas, 10% carcinomas and 5% adenomas. The rest were two neural crest derived tumors, one calcified cyst, one myelolipoma and one metastatic renal carcinoma. CONCLUSION: The diagnostic and therapeutic aspects of adrenal disease are reviewed.

[Artificial sphincter implantation in women with urinary incontinence using a combined abdomino-vaginal approach]. / Implantación del esfínter urinario artificial en la mujer con incontinencia urinaria por vía combinada abdomino vaginal.

OBJECTIVE: The artificial sphincter has been utilized for urinary incontinence due to intrinsic sphincteric insufficiency, with good fixation of the urethra and a maximum urethral closing pressure of 20-30 cms H2O, or after failed attempts at correction using other techniques. This procedure is difficult to perform since the patients have generally undergone several operations and it is necessity to prepare the cleavage between the urethra and vagina. We propose a modified combined vaginal and suprapubic approach of the technique described by Appell and Abbassian in 1988 for enhanced exposure of the urethra and bladder neck and easy access. METHODS: The modified combined abdominovaginal approach has been utilized in 18 females aged 16-62 years since 1995. RESULTS: 16 patients were continent (88%). One patient (5.5%) required removal of the artificial sphincter due to infection. Another patient (5.5%) has mild incontinence and requires 2 pads a day. Four patients (22%) with detrusor instability are receiving anticholinergics. Three patients (16%) with an underlying neurogenic incontinence require intermittent catheterization. Fourteen patients (77.7%) have type III stress urinary incontinence. We performed the Kelly procedure in 10 patients (55.5%), the Marshall-Marcetti-Kranz in 7 (38.8%), Gittes in 3 (16.6%), and 2 patients (11.1%) had a sling procedure. Two techniques were simultaneously performed in some patients. CONCLUSIONS: Although the number of patients in this series is small, the fact that only one case required removal of the artificial spincter due to infection indicates that this is a useful alternative approach that significantly facilitates implantation of the artificial sphincter in these patients.

[Retroperitoneal ganglioneuroma]. / Ganglioneuroma retroperitoneal.

Presentation of one case of retroperitoneal ganglioneuroma in a 31-year old female. This type of neoformation, with origin at the sympathetic system nodes level, is considered to be the benign homologous of neuroblastoma. Peak incidence age ranges from 3 to 20 years. The retroperineum is one of the most frequent sites, second only to the mediastinum. Diagnosis is normally casual and is considered definite when, following mass removal and completion of the pathoanatomical study, the presence of neuroblasts in the tumour can be ruled out.

[Acute scrotum: unusual presentation of Schönlein-Henoch purpura]. / Escroto agudo: un modo de presentación insólito de la púrpura de Schönlein-Henoch.

Being a systemic vasculitis, Schöenlein-Henoch purpura may affect the scrotum and its content. According to the series studied, this occurs in about 10% patients (2-38%) and sometimes requires a differential diagnosis with the spermatic cord torsion. An isotopic study with 99Tc may avoid a surgical procedure quite often unnecessary. In the case reported here, vasculitis presented as an acute scrotum, which is highly infrequent in the literature and makes a correct presumption diagnosis extraordinary difficult.

[Intraparenchymatous vascular tumors of the testicle: report of a new case of cavernous hemangioma]. / Tumores vasculares intraparenquimatosos de testículo: aportación de un nuevo caso de hemangioma cavernoso.

The occurrence of a vascular tumour at the intraparenchymatous testicular level is a fact little reported in the literature. Searching for such events, 19 cases were found all of which showed benign clinical behaviour. The most commonly seen histological pattern is cavernous haemangioma (11 patients). Mean age at presentation is 19 years old and the most usual pre-operative diagnosis, germinal cell neoplasia. Since there are no specific ultrasound patterns that may allow to differentiate benign from malignant masses, inguinal orchiectomy is the choice treatment in this type of lesions. Furthermore, the case of a 44-year old patient with hypoechogenic solid mass in left testis who consulted for sporadic episodes of long-standing scrotal pain is presented. After radical exeresis of the gonad, the histological analysis showed existence of testicular cavernous haemangioma.

[Our experience with renal adenocarcinoma (III): results of surgical treatment, other treatments. Survival analysis]. / Nuestra experiencia en adenocarcinomas renales (III): Resultados del tratamiento quirúrgico, otros tratamientos. Análisis de la supervivencia.

OBJECTIVES: Evaluation of survival and results of treatment of renal cell carcinoma. METHODS: We reviewed the records of 229 consecutive cases of renal cell carcinoma diagnosed at our hospital. In 178 surgical treatment was done to achieve cure and in 6 patients it was palliative. RESULTS: No statistical differences in survival were found according to the surgical approach, or extensive vs hilar lymphadenectomy, or in the presence or absence of venous involvement. There were statistical differences in survival depending on the tumor stage and an inverse correlation between survival and tumor size. Sixty-nine cases received complementary treatments. Radiotherapy, alpha 2b interferon and vinblastine, resection of metastasis, or gestagen therapy failed to improve survival. No improvement in survival was achieved with palliative embolization, but it ameliorated local symptoms. The mean survival in patients with metastasis and without treatment was 5.5 months and there was no statistical difference in survival relative to the number of site of metastasis, or the number of affected viscera. The mean survival in patients that were not operated and had no metastasis was greater: 23.5 months. CONCLUSIONS: Surgery, regardless of the surgical approach or type of lymphadenectomy, is the only treatment that improves survival in renal cell carcinoma. Patients with metastasis receiving no treatment have a worse prognosis.

[Renal autotransplantation in a case of idiopathic retroperitoneal fibrosis refractory to other treatments]. / Autotrasplante renal en un caso de fibrosis retroperitoneal idiopática refractaria a otros tratamientos.

We report a case of renal autotransplantation in a patient with right retroperitoneal fibrosis that had been previously treated by ureterolysis with intraperitonization and corticoid therapy without success. The literature is briefly reviewed and the therapeutic possibilities in refractory retroperitoneal fibrosis are discussed, with special reference to renal autotransplantation.

[Adrenal gland surgery. Review of 34 cases]. / Cirugía de las suprarrenales. Revisión de 34 casos.

Over the last few years, a better anatomical and functional knowledge of the adrenal glands has allowed us to diagnose and treat optimally most of these gland's conditions. A variety of medical (endocrinology, anaesthesiology) and surgical specialties have been used to this aim. This paper reviews the adrenal gland's diseases treated in our unit over the last 9 years. Pre-operative management, ways of approach, morbidity and mortality as well as results are analyzed and compared with those obtained by other authors.

[Vesico-uterine fistula: report of 2 new cases]. / Fístula vesico-uterina: a propósito de dos nuevos casos.

Presentation of two new cases of vesico-uterine fistulae secondary to cesarean operation. In one case our route for surgical approach is explained as a novelty; also, the time-frame within which it was performed, one month, since it is usual to recommend a minimum of three months. In the second case an in-dwelling vesical catheter was sufficient to achieve closure. The article also reviews the existing literature on the different aspects: signs, symptoms and therapy, of this infrequent pathology.

[Renal adenocarcinomas associated with other malignant neoplasms]. / Asociación de adenocarcinomas renales y otras neoplasias malignas.

The renal adenocarcinoma is not a frequent tumour within the scope of multiple neoplasias, at least in the clinical series. Conversely, it appears at a higher relative rate in the post-mortem series. This paper submits a review of renal adenocarcinoma associated in life to other malignant neoplasias, enumerating their major clinical and epidemiological data. Also, it reviews the literature with regard to frequency and etiology, applying the data to our series. The paper concludes that hypernephroma is not a tumour frequently associated with others in life, given its tendency to be secondary to other primary ones, therefore its development depending on survival to the initial tumour. It also emphasizes the need for adequate anamnesis aimed to detect multi-cancer syndromes and the etiology of multiple neoplasias. Further studies are needed to understand the scope of multiple neoplasias and their relative risk.