Hipertensión arterial mal controlada secundaria a quiste vascular suprarenal / Vascular adrenal cyst causing difficult to control high blood pressure

La hipertensión arterial supone un importante problema de salud pública en los países desarrollados. Las masas suprarrenales pueden pasar desapercibidas, ya que no son lesiones frecuentes y no producen síntomas o no se les atribuyen directamente. Estas circunstancias hacen que sea fundamental la actuación médica multidisciplinar. Comunicamos el caso de una mujer de 72 años, hipertensa mal controlada de años de evolución (3 fármacos antihipertensivos, sin alcanzar la tensión arterial en rango de normalidad), remitida por hallazgo incidental de lesión retroperitoneal derecha. Se diagnostica de quiste de origen suprarrenal posiblemente responsable del cuadro hipertensivo. Realizamos revisión de la literatura analizando diferentes actitudes diagnósticas y terapéuticas. Tras adrenalectomía por abordaje laparoscópico, conseguimos estabilizar a la paciente en cifras de tensión arterial dentro de la normalidad. La integración coordinada de servicios médicos y quirúrgicos es clave para el manejo de situaciones clínicas poco frecuentes. La cirugía laparoscópica constituye el tratamiento de elección en la enfermedad retroperitoneal (AU)

Hypertension is a prevalent disease in developed countries. Adrenal masses, and especially adrenal cysts, are a rare and usually asymptomatic finding, which can go unnoticed or be detected as incidental findings in imaging tests. These circumstances make the multidisciplinary approach mandatory. The case is presented on a 72 year-old woman with uncontrolled high blood pressure referred to the Urology Department due to the incidental finding of a right retroperitoneal mass. A functional and imaging study was performed, establishing a diagnosis of adrenal cyst causing hypertensive symptoms. A literature search was performed in order to assess diagnostic and therapeutic approaches. With the diagnosis of adrenal cyst causing uncontrolled high blood pressure, a right laparoscopic adrenalectomy was performed. After surgery the patient has maintained blood pressure within the normal range. A multidisciplinary approach is necessary for the management of rare diseases. The surgical approach, if possible, should be laparoscopic (AU)

[Vascular adrenal cyst causing difficult to control high blood pressure]. / Hipertensión arterial mal controlada secundaria a quiste vascular suprarrenal.

Hypertension is a prevalent disease in developed countries. Adrenal masses, and especially adrenal cysts, are a rare and usually asymptomatic finding, which can go unnoticed or be detected as incidental findings in imaging tests. These circumstances make the multidisciplinary approach mandatory. The case is presented on a 72 year-old woman with uncontrolled high blood pressure referred to the Urology Department due to the incidental finding of a right retroperitoneal mass. A functional and imaging study was performed, establishing a diagnosis of adrenal cyst causing hypertensive symptoms. A literature search was performed in order to assess diagnostic and therapeutic approaches. With the diagnosis of adrenal cyst causing uncontrolled high blood pressure, a right laparoscopic adrenalectomy was performed. After surgery the patient has maintained blood pressure within the normal range. A multidisciplinary approach is necessary for the management of rare diseases. The surgical approach, if possible, should be laparoscopic.

Comparability and reproducibility of adult male anogenital distance measurements for two different methods.

The distance from the genitals to the anus, anogenital distance, reflects androgen concentration during prenatal development in mammals. The use of anogenital distance in human studies is still very limited and the quality and consistency of measurements is an important methodological issue. The aim of this study was to assess the feasibility and reproducibility of adult male anogenital distance measurements by two different methods. All men were attending an outpatient clinic at a university hospital and underwent an andrological examination and completed a brief questionnaire. Two variants of anogenital distance [from the anus to the posterior base of the scrotum (AGDAS ) and to the cephalad insertion of the penis (AGDAP )] by two methods (lithotomy or frog-legged position) were assessed in 70 men. Within and between coefficient of variations, intra-class correlation coefficients, two-way repeated-measures analysis of variance, and scatter and Bland-Altman plots were calculated. The two methods produced similar values for AGDAP but different estimates for AGDAS . Nonetheless, the overall agreement (ICC ≥ 0.80) was acceptable for both measures. Therefore, both methods are internally consistent and adequate for epidemiological studies, and may be used depending on the available medical resources, clinical setting, and populations.

Litiasis en divertículo uretral. Diagnóstico y tratamiento / Urethral diverticulum lithiasis. Diagnostic and therapeutic management

Introducción: la incidencia del divertículo uretral es menor en hombres, siendo más frecuentes los casos adquiridos. Es extraordinario encontrar una litiasis ocupando la totalidad del divertículo. Caso clínico: presentamos varón de 34 años con litiasis en divertículo uretral secundaria a intervención quirúrgica previa. Conclusión: mujeres el tratamiento de elección será la diverticulectomía con la técnica más simple posible

Introduction: the urethral diverticulum incidence is lower in men than in women. Acquired cases are more frequent. Is extremely rare to find a diverticulum lithiasis. Case report: we present a 34 years old male with urethral diverticulum lithiasis due to previous urethral surgery. Conclusion: treatment of choice is diverticulectomy with lithiasis removement

Tumor miofibroblástico de epididímo / Myofibroblastic tumor of epididymis

No disponible

Corrección de curvatura peneana utilizando la técnica de "Plicatura de 16 puntos" / Corrrection of penile curvature using the 16-Dot plication technique

En 1965 Nesbit describió por primera vez la corrección quirúrgica de la curvatura de pene siendo posteriormente modificadapor múltiples autores. Presentamos dos pacientes con incurvación peneana corregida mediante la técnica de "plicatura de 16 puntos" (AU)

In 1965 Nesbit first described the surgical correction of penile curvature that was later modified by many authors. We present two patients with penile curvature corrected using the 16-dot plication technique (AU)

Cumplimentación del consentimiento informado para la transfusión de hemoderivados en los Servicios de Urología y Cirugía / Enforcement of informed consent request for blood transfusion in urology and surgery departments

Objetivo: Aplicar un círculo de mejora a la petición de consentimiento informado (CI) para la transfusión de hemoderivados en los servicios de Cirugía General y Urología. Métodos: Durante 8 meses se incluyeron 120 pa­cientes intervenidos en el Hospital General Reina Sofía de Murcia. Tras realizar un análisis de causa-efecto de Ishikawa, se establecieron 4 criterios: C1: identifica­ción del médico; C2: identificación del paciente; C3: firma del paciente; C4: fecha del documento. En el pri­mer periodo se incluyeron 60 pacientes. Se analizaron Ias causas de incumplimiento y se aplicaron las medidas correctoras, reevaluando los criterios en otros 60 pacientes. Resultados: Todos los criterios estaban por debajo del estándar: C1: 3%; C2: 95%; C3: 16% y C4: 65%. En la segunda evaluación el cumplimiento de C1 (70%), C3 (98%) y C4 (88%) mejoró significativamente pero aún así los resultados continúan, también significativamente, por debajo de los estándares establecidos. Los resultados se expresan en porcentaje de cumplimiento con un intervalo de confianza del 95%. Conclusiones: La realización de un ciclo de mejora ha permitido detectar y corregir incumplimientos en el C1 de transfusiones sanguíneas. El nivel de cumplimiento de los criterios mejoró en la segunda evaluación aunque continuamos por debajo del estándar establecido. Hemos conseguido una mayor concienciación por parte de los profesionales a la hora de cumplimentar el consentimiento.

Objective: To analyze the degree of compliance with a variety of standards defined for the quality control of the informed consent request for human blood products transfusion in our departments of Surgery and Urology. Material and method: Retrospective study of patients treated during 8 consecutive months in a university teaching hospital (n=120). Assessment of quality was performed through measurements of compliance using 4 criteria: C1, Physician Identification; C2, patient identification; C3, patient signature; C4, document date. In the first period 60 patients were included. Corrective measures aimed at resolving the quality problem were applied to the deficient criteria during one month, paying particular attention to those criteria with the highest percentage of errors in the study. During a third period of six months (60 patients) the information of all criteria was gathered again and the improvement with regard to the standard values and to the compliance of the first period was evaluated. Results: Compliance of all criteria was significantly below standard values in the first evaluation: C1 :3%; C2: 95%; C3: 16% and C4: 65%. In the second period all the criteria below its standard improved with regard to the first period; nonetheless the results are, also significantly, below the established standards. Conclusions: This improvement cycle enabled us to detect and correct breaches on the informed consent request for human blood products transfusion. Corrective measures introduced were effective since it was improved in all the criteria below standard. We have achieved a good awareness of health professionals to complete the authorization.

Cumplimentación del consentimiento informado para la transfusión de hemoderivados en los Servicios de Urología y Cirugía / Enforcement of informed consent request for blood transfusion in urology and surgery departments

Objetivo: Aplicar un círculo de mejora a la petición de consentimiento informado (CI) para la transfusión de hemoderivados en los servicios de Cirugía General y Urología. Métodos: Durante 8 meses se incluyeron 120 pa¡cientes intervenidos en el Hospital General Reina Sofía de Murcia. Tras realizar un análisis de causa-efecto de Ishikawa, se establecieron 4 criterios: C1: identifica¡ción del médico; C2: identificación del paciente; C3: firma del paciente; C4: fecha del documento. En el pri¡mer periodo se incluyeron 60 pacientes. Se analizaron Ias causas de incumplimiento y se aplicaron las medidas correctoras, reevaluando los criterios en otros 60 pacientes. Resultados: Todos los criterios estaban por debajo del estándar: C1: 3%; C2: 95%; C3: 16% y C4: 65%. En la segunda evaluación el cumplimiento de C1 (70%), C3 (98%) y C4 (88%) mejoró significativamente pero aún así los resultados continúan, también significativamente, por debajo de los estándares establecidos. Los resultados se expresan en porcentaje de cumplimiento con un intervalo de confianza del 95%. Conclusiones: La realización de un ciclo de mejora ha permitido detectar y corregir incumplimientos en el C1 de transfusiones sanguíneas. El nivel de cumplimiento de los criterios mejoró en la segunda evaluación aunque continuamos por debajo del estándar establecido. Hemos conseguido una mayor concienciación por parte de los profesionales a la hora de cumplimentar el consentimiento. (AU)

Objective: To analyze the degree of compliance with a variety of standards defined for the quality control of the informed consent request for human blood products transfusion in our departments of Surgery and Urology. Material and method: Retrospective study of patients treated during 8 consecutive months in a university teaching hospital (n=120). Assessment of quality was performed through measurements of compliance using 4 criteria: C1, Physician Identification; C2, patient identification; C3, patient signature; C4, document date. In the first period 60 patients were included. Corrective measures aimed at resolving the quality problem were applied to the deficient criteria during one month, paying particular attention to those criteria with the highest percentage of errors in the study. During a third period of six months (60 patients) the information of all criteria was gathered again and the improvement with regard to the standard values and to the compliance of the first period was evaluated. Results: Compliance of all criteria was significantly below standard values in the first evaluation: C1 :3%; C2: 95%; C3: 16% and C4: 65%. In the second period all the criteria below its standard improved with regard to the first period; nonetheless the results are, also significantly, below the established standards. Conclusions: This improvement cycle enabled us to detect and correct breaches on the informed consent request for human blood products transfusion. Corrective measures introduced were effective since it was improved in all the criteria below standard. We have achieved a good awareness of health professionals to complete the authorization. (AU)

Prostatectomía radical laparoscópica. ¿Afecta la anatomía patológica de la pieza en la forma de seguimiento posterior? / Laparoscopic radical prostatectomy. Does the histopathological examination of the specimen have an effect on the postoperavie follow-up?

OBJETIVO. Analizar la capacidad predictiva del Gleason definitivo, la afectación extracapsular y la afectación de márgenes respecto a la recurrencia bioquímica y al PSA Doubling Time, en pacientes con prostatectomía radical. MATERIAL Y MÉTODO. Estudio retrospectivo. Se realizó un análisis de supervivencia de Kaplan-Meyer y una comparación de medias del PSA DT mediante la “t” de Student. RESULTADOS. De 110 pacientes estudiados, 9 presentaron recidiva bioquímica. La media de seguimiento fue de 22.57 meses. La media de meses libres de recurrencia bioquímica fue de 65.28 meses para Gleason <7 y de 35.29 meses para ?7 (p=0.03). La media de PSA DT en el grupo con afectación extracapsular fue de 24.83 meses mientras que en los que no la tenían fue de 35.66 (p=0,028). CONCLUSIONES. Pese al limitado número de pacientes y el escaso tiempo de seguimiento demostramos que un Gleason elevado, o la afectación extracapsular pueden indicar la necesidad de un seguimiento más exhaustivo (AU)

OBJECTIVE. Our aim was to analyze the predictive ability of final Gleason score, extracapsular extension and peritumoral margins affection with regard to the biochemical relapse and the PSA Doubling Time, in patients treated with radical prostatectomy. MATERIAL AND METHODS. Retrospective study. The Kaplan Meier method was used for survival analysis. The nonpaired Student's t test was used to compare the mean PSA DT. RESULTS. Of the 110 patients studied, 9 presented biochemical relapse. Median follow-up period was 22.57 (DE 16,2) months. Mean time from surgery to biochemical relapse was 65.28 months for Gleason <7 and 35.29 months for ?7 (p=0.03). The average PSA-DT for the patients in the group with extracapsular affection was 24.83 months whereas in the group without extension it was 35.66 (p=0.028). CONCLUSIONS. Despite the limited number of patients and the scarce follow-up time, our study suggests that patients with high Gleason grade or extracapsular affection are likely to need of a more exhaustive control (AU)