Propranolol: tratamiento del hemangioma capilar con afectación orbitaria / Propranolol: Treatment of capillary hemangioma with orbital involvement

Caso clínico: Lactante de 2 meses con un hemangioma de crecimiento rápido en la hemicara izquierda, que afecta al párpado superior y la porción superoexterna de la órbita, obstaculizando el eje visual y desplazando medialmente el recto lateral y el globo ocular. Se administra propranolol oral y se observa una rápida y sostenida disminución del hemangioma, con regresión del componente órbito-palpebral. Discusión: Según estudios previos el propranolol parece ser un fármaco seguro y efectivo en el tratamiento del hemangioma infantil. En nuestro caso, la respuesta al propranolol fue satisfactoria y no se presentaron efectos adversos. Este tratamiento debe ser considerado como una alternativa promisoria(AU)

Clinical case: A 2-months-old girl had a fast growth hemangioma in the left side of the face, that involved upper eyelid and superior and external portion of the orbit, covering her visual axis and pushing the eye and lateral rectus muscle. We gave oral propranolol as treatment and we noticed a fast and constant hemangioma reduction and resolution of orbital and palpebral component. Discussion: According to previous researches, propranolol seems to be an effective and safe drug to treat capillary hemangioma. In our case, response to propranolol was satisfactory and with no side effects. This treatment should be considered as a promising alternative(AU)

[Propranolol: Treatment of capillary hemangioma with orbital involvement]. / Propranolol: tratamiento del hemangioma capilar con afectación orbitaria.

CLINICAL CASE: A 2-months-old girl had a fast growth hemangioma in the left side of the face, that involved upper eyelid and superior and external portion of the orbit, covering her visual axis and pushing the eye and lateral rectus muscle. We gave oral propranolol as treatment and we noticed a fast and constant hemangioma reduction and resolution of orbital and palpebral component. DISCUSSION: According to previous researches, propranolol seems to be an effective and safe drug to treat capillary hemangioma. In our case, response to propranolol was satisfactory and with no side effects. This treatment should be considered as a promising alternative.

[Giant inguino-scrotal hernia of the bladder. Clinical case and review of the literature]. / Hernia vesical inguinoescrotal gigante. Caso clínico y revisión de la literatura.

Bladder hernia is an uncommon condition with a frequency between 0.5 and 3%, reaching the 10% between patients older than 50 years. It's more predominant in males aged between 50 and 70. The diagnosis usually happens in the course of surgical repair of inguinal hernias, because the bladder hernia has no specific clinical findings. Management includes the resection or reduction of the bladder hernia, with de-obstruction of the lower urinary tract, if present, and repairmen of inguinal path. We report a new case and review the literature.

[Benign presacral schwannoma producing obstructive uropathy. Clinical case and review of the literature]. / Schwannoma presacro benigno que provoca uropatía obstructiva. Caso clínico y revisión de la literatura.

We report a case of a presacral benign schwannoma which causes right hydroureteronephrosis without other clinical findings. After a fine-needle aspiration (FNA) biopsy under computed tomography (CT) guidance, a fusocellular tumour without athypia was demonstrated. With the initial diagnosis of benign schwannoma the patient was operated on, removing the tumour, and with the immunohistochemical examination (reactivity for S-100) this diagnosis was confirmed.

Hernia vesical inguinoescrotal gigante. Caso clínico y revisión de la literatura / Giant inguinoscrotal bladder hernia. Case report and review of the literature

La hernia vesical es una patología infrecuente con una incidencia que oscila entre el 0,5 por ciento y el 3 por ciento, alcanzando el 10 por ciento en pacientes mayores de 50 años. Presenta un predominio en varones con edades comprendidas entre los 50 y 70 años. La hernia vesical carece de clínica específica, esto hace que su diagnóstico sea con frecuencia intraoperatorio durante la reparación quirúrgica de las hernias inguinales. El tratamiento consiste en la resección o reducción de la hernia vesical, con desobstrucción del tracto urinario inferior, si existe, y reparación del trayecto inguinal. Aportamos un nuevo caso clínico y revisamos la literatura (AU)

Schwannoma presacro benigno que provoca uropatía obstructiva. Caso clínico y revisión de la literatura / Presacral bening schawannoma with obstructive uropathy. Case report and review of the literature

Presentamos un caso clínico de schwannoma benigno de localización presacra, que provoca ureterohidronefrosis derecha sin sintomatología. Tras un diagnóstico inicial mediante punción aspiración con aguja fina dirigida por TC, de tumor fusocelular sin atipia citológica compatible con schwannoma, se realiza exéresis quirúrgica, cuyo estudio anatomopatológico (con técnicas inmunohistoquímicas sobre la proteína S-100) confirma el diagnóstico de schwannoma benigno (AU)

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[Cystic dysplasia in the seminal vesicle. Case report and literature review]. / Displasia quística en vesícula seminal. Caso clínico y revisíon de la literatura.

Contribution of one case report of cystic dysplasia of the seminal vesicle with ipsilateral renal agenesis in a 32 year-old male presenting with primary infertility. The seminograms showed moderate astenoteratospermia while in the abdominal-pelvic ultrasound there were changes in the right seminal vesicle and right renal agenesis, which was confirmed with further complementary tests: UIV, transrectal ultrasound, urethrocystoscopy, arteriography and renal scan.

[Posttraumatic high-flow priapism in prepubertal age]. / Priapismo de alto flujo postraumático en edad prepuberal.

High flow priapism is an infrequent entity, generally following traumatic injuries in the genito-perineal area. Anamnesis, cavernous bodies blood gasometry and Doppler are the basic diagnostic tools for these condition. Therapeutical management is considerably different from that used for low flow venous priapism. Selective arteriography of the internal pudendal artery allows to locate the arterial lesion and, at the same time, to perform supraselective embolization of the lacerated cavernous artery which is currently considered the choice treatment. This paper presents the case report of a ten-year old patient successfully resolved through application of angioradiologic procedures.

[Current treatment of ureteral lithiasis]. / Tratamiento actual de la litiasis ureteral.

The treatment of ureteral lithiasis has undergone a revolution since the arrival of new techniques offering different therapeutical choices for which time is gradually elucidating the indications for each of the new procedures; although, to a large extent, a degree of controversy still persists. This paper reviews the different methods for ureteral lithiasis; spontaneous ejection and medical treatment, surgery, early endoscopic manoeuvres, backward and forward urethroscopy and, finally, extracorporeal lithority. This therapeutical experience in 3 series of ureteral lithiasis addressed with different criteria are revised together with 182 obstructive calculi of the lumbar ureter. We believe that grading the ureteral calculi according to their anatomical and functional features improves the results, since improved adjustment can be achieved for the indications of the various methods. Also it is noted that support endourology for extracorporeal lithotrity does not improve the results of treatment in lumbar calculi under 2 cm, and therefore our current approach is towards "in situ" treatment without complementary manoeuvres. Finally we show the therapeutic algorithm we are following actually to manage ureteral litiasis.

[Migration of an intrauterine device. An unusual cause of bladder foreign body]. / Emigración de dispositivo intrauterino. Una rara causa de cuerpo extraño vesical.

The origin of vesical and lower urinary tract foreign bodies is very wide, the specialized literature descriptions ranging from urethral dilators to coffee spoons handles through wires, cables and surgical instrumentation. The most frequent entry route of foreign bodies to the lower urinary tract is through the urethra usually by self-introduction or during transurethral surgical procedures. Another access route is that occurring during open or traumatic surgical manoeuvres. Less frequent is that the foreign body migrates from another anatomical structure. These patients present an heterogeneous clinical picture which depends on the location of the foreign body in the urinary tract. Thus, it can be acute if located in the urethra or subacute or chronic if found at vesical level.

[A metabolic study of urolithiasis. Specificity, sensitivity, efficacy and reproducibility]. / Etude métabolique de l'urolithiase. Spécificité, sensibilité, efficacité et reproductibilité.

A preliminary diagnosis of the disease responsible for the stones is essential to allow appropriate medical treatment of renal stones. In this paper, the authors describe their diagnostic and treatment protocol based on computer-assisted urinary metabolic analysis. 413 subjects, divided into four groups, were prospectively evaluated to calculate their specificity, sensitivity, reproducibility and efficacy and to demonstrate the usefulness of this protocol.

[Conservative treatment of Wünderlich syndrome in a functional monorenal patient]. / Tratamiento conservador del síndrome de Wünderlich en enferma monorrena funcional.

Presentation of one case of Wünderlich's syndrome secondary to spontaneous mesorenal fracture due to renal angiomyolipoma. In our case, the therapeutical approach is based in the need to preserve the functional renal unit. Wünderlich's syndrome or spontaneous perirenal haematoma can occur for a variety of causes, the most frequent ones being renal adenocarcinoma and renal angiomyolipoma. The latter is a hamartoma made up of three different tissue lines: smooth muscle cells, blood vessels and adipose tissue. Based on our case, we discuss the clinical, prognostic and therapeutical aspects related to renal angiomyolipomes.

[Our experience in the treatment of cystine lithiasis]. / Nuestra experiencia en el tratamiento de la litiasis cistínica.

Contribution of six cases of patients with cystinic lithiasis, diagnosed and treated at our centre. Analysis of pathophysiological mechanisms, key data for their diagnosis and current aspects of treatment, as well as a review on past and recent literature on this disease.

[Ureteral lithiasis. Analysis of 3 series]. / Tratamiento de la litiasis ureteral. Análisis de tres series.

Presentation of our experience on 1000 cases of ureteral lithiasis treated over the last five years with ESWL, ureteroscopy and ureterolitotomy, distributed in three series of 396, 265 and 339 cases respectively. In the first series (396 cases), lumbar ureter calculi were treated with ESWL (dornier HM3) and iliopelvian calculi with ureteroscopy. In the second series (265 cases), all calculi were treated with ESWL (Siemens Lithostar). The third series was in turn subdivided in three groups: in the first group, comprising simple ureteral calculi, 'in situ' ESWL was performed; in the second group, of lumbar ureter complex calculi, ESWL was performed assisted by simple endourological techniques; ureteroscopy was performed in the third group, iliopelvian ureter complex calculi. Calculi characteristics (site, size, consistency and number), excretory tract and renal function, designated as CEP/LTS-X were assessed. These parameters allow us to grade ureteral lithiasis in Types I, II and III. A comparative study of the results in the three series was made reaching an overall conclusion that simple or Type I ureteral lithiasis can be treated with 'in situ' ESWL as first choice; in Type II or lumbar ureter complex lithiasis, 'in situ' ESWL is insufficient and other endoeurological support techniques are required, while in Type III, iliopelvian ureter complex lithiasis, ureteroscopy should be recommended.

[Distal tubular renal acidosis with nephrocalcinosis]. / Acidosis tubular renal distal con nefrocalcinosis.

Nephrocalcinosis and distal tubular acidosis are two infrequent processes caused by several etiologies which can present in association. This paper describes a clinical case of tubular acidosis and explains the differential diagnosis of both entities.

[Double-J ureteral catheter: its application in patients with complex renal lithiasis as a support measure during extracorporeal lithotripsy. Analysis of 441 consecutive cases]. / Catéter ureteral doble J: su aplicación en pacientes con litiasis renal compleja como maniobra de apoyo para litofragmentación extracorpórea. Análisis de 441 casos consecutivos.

Between August, 1986 and February, 1988, double J ureteral catheters were placed in 441 renal units of 419 patients (22 were bilateral) with complex renal stones prior to ESWL. Catheter placement was achieved in all but 3.8% of the cases using several techniques, mainly via the retrograde route. Placement of the double J catheter was indicated in almost 75% of cases with a large stone mass (staghorn or pseudo staghorn). Only 11% of post-ESWL "Steinstrasse" were obstructive; of these, 80% resolved spontaneously. The complication rate was 21%. Most of these cases were mild complications. All cases were resolved satisfactorily. We believe that the double J catheter is useful in patients with complex renal stones. Placement of a double J catheter involves a simple maneuver with a low morbidity. It aids ESWL, reduces complications, and avoids more important endourologic maneuvers.

[Chronic obstructive renal lithiasis. Extracorporeal lithotripsy or percutaneous renal surgery? Analysis of 2 series]. / Litiasis renal obstructiva crónica. Litotricia extracorpórea o cirugía renal percutánea? Análisis de dos series.

Experience has demonstrated that obstructive renal calculi with inferior infundibulocaliceal dilatation is not an indication for extracorporeal shock wave lithotripsy due to a high incidence of residual fragments in the lower calyx. These fragments are generally not spontaneously passed and become compact and form a new stone. We analyzed two groups of patients: 56 had been submitted to ESWL, and 53 to PCN. The results show that for obstructive renal lithiasis with dilatation of the lower calyx treatment is by percutaneous renal surgery first. This approach permits doing an ESWL procedure if stone fragments are observed in the early post-PCN radiologic work up. Similarly, if ESWL as monotherapy fails, we can resort to PCN.