[Radical cystectomy with orthotopic urinary diversion in patients older than 70 years of age]. / Cistectomía radical con derivación urinaria ortotópica en pacientes mayores de 70 años.

Some patients with infiltrant vesical cancer can be treated successfully with radical cysto-prostatectomy and urinary by-pass and increasingly more authors publish successful results in series of selected patients over 70- and 80-year old. Between February 1988 and July 1996, 18 radical cystectomies with orthotopic urinary by-pass were performed in the Urology Service, Policlinico Vigo, in patients over 70 (range 70-84 years), with an operative mortality rate of 11%. 8 patients (44%) developed immediate complications and 9 patients (50%) presented distant complications. Overall mortality in our series was 33.3% and survival 66.6% after a mean follow-up of 30.7 months. We believe orthotopic-continent by-pass is a valid alternative with operative mortality and complication rates similar to those of ileal ducts, with the advantage for the patient of avoiding permanent urinary stoma.

[Vaginal metastasis of renal adenocarcinoma: report of 2 clinical cases]. / Metástasis vaginal de un adenocarcinoma renal: presentación de 2 casos clínicos.

Presentation of 2 case reports of female patients with vaginal metastasis from renal adenocarcinoma presenting genitorrhage which was part of a polymetastatic picture. Discussion of the clinical, diagnostic and prognostic aspects of this disease.

[Adenocarcinoma in ileocystoplasty]. / Adenocarcinoma en ileocistoplastia.

Case report of an adenocarcinoma in ileocystoplasty in a 54-year old female that at the age of 24 had undergone right nephrectomy and partial cystectomy surgery followed by vesical extension with ileon due to urinary tuberculosis. Discussion on the rare incidence of this condition, its diagnostic features, the need for long-term follow-up and the relevance of a broad resection of the affected intestinal portion.

[Iatrogenic splenectomy in surgery of renal tumors]. / Esplenectomía iatrógena en cirugía del tumor renal.

A description of our experience with iatrogenic spleen lesions requiring splenectomy caused during surgery for a renal tumour. Out of a total 83 nephrectomies due to renal tumour performed in our Centre between 1988 and 1996, 46 were left and 4 of them (8.7%) involve splenectomy. Clinical, surgical, pathoanatomical and follow-up data of these 4 cases is analyzed. Anatomical relationship of the spleen with kidney and colon, as well as factors to consider during surgery to avoid splenic lesions are discussed.

[Partial nephrectomy for renal cancer in patients with a normal contralateral kidney]. / Nefrectomía parcial por cáncer renal en pacientes con riñón contralateral normal.

There has been a growing interest over the last few years in partial nephrectomy as the elective surgery for renal cancer in selected groups of patients with normal contralateral kidney. Between July 1990 and April 1996, 14 partial nephrectomies were performed in our service in patients with presumed diagnosis of renal cancer and normal contralateral kidney 10 of which had histological diagnosis of renal carcinoma and 4 showed absence of malignancy. From the analysis and discussion of these cases it can be deduced: 1) partial nephrectomy in selected groups of patients is an oncologically valid technique; 2) computerized tomography is a highly sensitive method for detection of renal cancer carrier patients, although it presents low specificity, mainly in small tumours, resulting in a number of false positive cases that must be considered when deciding the surgical technique; 3) tumour topography should not exclude conservative surgery of the kidney; 4) patients should be available for follow-up.

[Retroperitoneal paraganglioma. Differential diagnosis with hypernephroma]. / Paraganglioma retroperitoneal. Diagnóstico diferencial con hipernefroma.

Paraganglioma are tumours that show embryological origin from the neural crest, and which derive from the paraganglia. They can be found in any location throughout the aorta and/or in association to the sympathetic chain. They can be either functioning or non-functioning based on hormone production. The authors present here a non-functioning retroperitoneal paraganglioma as an incidental finding in a 72-year old female patient. Pre-operative diagnosis was cystic hypernephroma, for which radical nephrectomy was performed. The extra-renal origin of the tumour was found subsequently on examining the piece. A discussion is included on the diagnosis, treatment, prognosis as well as a review of the literature.

[Emphysematous cholecystitis: percutaneous treatment]. / Colecistitis enfisematosa: tratamiento percutáneo.

We present two patients with emphysematous cholecystitis treated successfully by means of percutaneous cholecystostomy. We emphasize the high mortality rate of the disease, and the good response achieved with the percutaneous technique, as well as the low complication rate of the procedure.