[The role of thiazides in the prophylaxis of recurrent calcium lithiasis]. / Papel de las tiazidas en la profilaxis de la litiasis cálcica recidivante.

OBJECTIVE: To show the prolonged efficacy of thiazides in the prophylaxis and treatment of recurrences in patients with calcium oxalate and phosphate lithiasis. METHODS: A randomised prospective study is conducted, with a three-year follow-up, in 150 patients diagnosed with recurrent calcium lithiasis. The patients are divided into three groups: A) 50 cases subject to observation with no treatment, B) 50 cases treated with 50 mg/day of hydrochlorothiazide, and C) 50 cases treated with 50 mg of hydrochlorothiazide and 20 mlEq of potassium citrate/day. Each group is subject to a renal study with imaging techniques and a urinary metabolic study at baseline, 12, 24 and 36 months. RESULTS: The patients treated with thiazides (Groups B and C) obtain a significant reduction in lithiasis recurrence compared with the control group (Group A). The most common abnormality found in the metabolic study was hypercalciuria, 52% of cases; 16% present a mixed lithogenic pattern. The number of recurrences and need for new sessions of extracorporeal lithotripsy in patients with hypercalciuria treated with thiazides is significantly smaller than in Group A (p=0.003). CONCLUSIONS: We observe a significant relation between lithogenic pattern and lithiasis recurrence. Thiazides help us to control lithogenic factors and recurrences in patients with calcium lithiasis. This effect is prolonged and significant in patients with hypercalciuria.

Papel de las tiazidas en la profilaxis de la litiasis cálcica recidivante / The role of thiazides in the prophylaxis of recurrent calcium lithiasis

Objetivo: Demostrar la eficacia prolongada de las tiazidas en la profilaxis y tratamiento de las recidivas en pacientes con litiasis cálcica de oxalato y fosfato cálcico. Métodos: Se realiza un estudio prospectivo aleatorizado, con un seguimiento de tres años, en 150 pacientes diagnosticados de litiasis cálcica recidivante. Los pacientes se distribuyen en tres grupos: A) 50 casos sometidos a observación sin tratamiento, B) 50 casos tratados con 50 mg/día de hidroclorotiazida y C) 50 casos tratados con 50 mg de hidroclorotiazida y 20 mlEq de citrato potásico/día. En cada grupo se realiza estudio renal con técnicas de imagen, y estudio metabólico urinario basal, 12, 24 y 36 meses. Resultados: En los pacientes tratados con tiazidas (Grupo B y C) se obtiene una reducción significativa de recidiva litiásica en relación con el grupo control (Grupo A). La alteración más frecuente encontrada en el estudio metabólico fue hipercalciuria, 52% de los casos; el 16% presentan patrón litógeno mixto. El número de recidivas y necesidad de nuevas sesiones de litotricia extracorpórea en los pacientes con hipercalciuria tratados con tiazidas disminuye significativamente con respecto al Grupo A (p=0.003) Conclusiones: Se observa una relación significativa entre patrón litógeno y recidiva litiásica. Las tiazidas nos ayudan a controlar los factores litogénicos y las recidivas en pacientes con litiasis cálcica. Este efecto es prolongado y significativo en pacientes con hipercalciuria

Objective: To show the prolonged efficacy of thiazides in the prophylaxis and treatment of recurrences in patients with calcium oxalate and phosphate lithiasis. Methods: A randomised prospective study is conducted, with a three-year follow-up, in 150 patients diagnosed with recurrent calcium lithiasis. The patients are divided into three groups: A) 50 cases subject to observation with no treatment, B) 50 cases treated with 50 mg/day of hydrochlorothiazide, and C) 50 cases treated with 50 mg of hydrochlorothiazide and 20 mlEq of potassium citrate/day. Each group is subject to a renal study with imaging techniques and a urinary metabolic study at baseline, 12, 24 and 36 months. Results: The patients treated with thiazides (Groups B and C) obtain a significant reduction in lithiasis recurrence compared with the control group (Group A). The most common abnormality found in the metabolic study was hypercalciuria, 52% of cases; 16% present a mixed lithogenic pattern. The number of recurrences and need for new sessions of extracorporeal lithotripsy in patients with hypercalciuria treated with thiazides is significantly smaller than in Group A (p=0.003) Conclusions: We observe a significant relation between lithogenic pattern and lithiasis recurrence. Thiazides help us to control lithogenic factors and recurrences in patients with calcium lithiasis. This effect is prolonged and significant in patients with hypercalciuria

[Malignant fibrohistiocytoma of the spermatic cord]. / Fibrohistiocitoma maligno del cordón espermático.

A malignant fibrous histiocytoma (MFH) of the spermatic cord is presented and a review of the literature has been performed. The patient here presented survived for eight years and is probably cured of his tumour. In general, MFHs of the spermatic cord have a good prognosis, even when they attain a big size. They have a worse evolution when satellite nodules are present. Although more experience is needed. It is our feeling, that a spermatic MFH smaller than 8 cm, without any satellite nodule and less than 25% nuclei positive to MIB-1 (cell proliferation marker), may have a conservative therapy, including only tumorectomy.

Fibrohistiocitoma maligno del cordón espermático / Malignant fibrous histiocytoma of the spermatic cord

Se presenta un fibrohistiocitoma maligno (FHM) del cordón espermático y se realiza una revisión de la literatura. El paciente aquí presentado, ha sobrevivido a su tumor por más de 8 años y podemos suponer que está curado del mismo. Parece ser que los FHMs del cordón espermático tienen un buen pronóstico, incluso cuando alcanzan un tamaño considerable. Tienen una evolución peor cuando se acompañan de nódulos satélites. Aunque se necesita más experiencia al respecto, pensamos que los FHMs del cordón espermático, con un tamaño inferior a 8 cm, sin nódulos satélites y menos del 25 per cent de los núcleos positivos con MIB-1 (marcador de proliferación celular), se pueden beneficiar de una terapia conservadora que incluya sólo la tumorectomía (AU)

[Leiomyosarcoma of the bladder. Report of a new case and review of the literature]. / Leiomiosarcoma de vejiga. Aportación de un nuevo caso y revisión de la literatura.

Contribution of a new case of bladder leiomyosarcoma due to the rarity of its presentation. There are barely one hundred cases reported in the medical literature. Clinico-pathological, therapeutic and prognostic assessment of this type of bladder sarcoma and discussion on the convenience of complementary therapy after surgery.