Divertículo uretral gigante / Giant urethral diverticulum

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Extravasación urinaria tras nefrolitotomía percutánea / Subcutaneous urinary extravasation after percoutaneous nephrolithotomy

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[Transitional cell carcinoma of the bladder metastatic to bone marrow presenting as isolated anaemia and thrombocytopenia]. / Anemia y trombopenia aisladas por infiltración de médula ósea de un carcinoma urotelial de vejiga.

OBJECTIVES: Transitional cell carcinomas (TCC) of the bladder are usually aggressive and may produce bone metastases that infiltrate the bone marrow. Most of these cases present with bone symptoms and metastases and are detected with imaging tests. It is extremely rare for asymptomatic patients with a normal bone scan to have bone marrow involvement (anaemia and thrombocytopenia) due to tumour infiltration. We aim to examine that state with a case report. METHODS: We present the case of a 41-year old male with infiltrating TCC of the bladder, who presented with isolated, unexplained anaemia and thrombocytopenia after radical cystoprostatectomy. A bone marrow puncture was required, in which metastatic infiltration was revealed. We performed a literature search of similar cases. RESULTS: There are very few cases of TCC with bone marrow infiltration which become apparent only through haematological changes and have normal imaging tests. CONCLUSIONS: Patients with infiltrating carcinoma of the bladder with isolated haematological changes and a negative extension study should be assessed by bone marrow puncture for correct staging and to be able to offer the best treatment.

Anemia y trombopenia aisladas por infiltración de médula ósea de un carcinoma urotelial de vejiga / Transitional cell carcinoma of the bladder metastatic to bone marrow presenting as isolated anaemia and thrombocytopenia

OBJETIVOS: Los carcinomas uroteliales de vejiga suelen ser agresivos y pueden producir metástasis óseas que infiltren la médula ósea. La mayoría de estos casos presentan síntomas óseos y se objetivan las metástasis con pruebas de imagen. Es muy raro que pacientes asintomáticos y con un rastreo óseo normal presenten afectación medular (anemia y trombopenia) por infiltración tumoral. Lo que pretendemos es analizar esa situación a propósito de un caso.MÉTODOS: Presentamos el caso de un varón de 41 años con un carcinoma urotelial de vejiga infiltrante que tras cistoprostatectomia radical presentó anemia y trombopenia aisladas e inexplicables que obligó a realizar una punción de médula ósea objetivándose infiltración metastásica a dicho nivel. Realizamos una búsqueda bibliográfica de casos similares. RESULTADOS: Existen muy pocos casos de carcinoma urotelial con infiltración de la médula ósea que se manifiesten solamente por alteraciones hematológicas y tengan las pruebas de imagen normales.CONCLUSIONES: Se debe valorar en pacientes con carcinoma infiltrante de vejiga con alteraciones hematológicas aisladas con estudio de extensión negativo realizar una punción de médula ósea para estadiar correctamente al paciente y poder ofrecer el mejor tratamiento(AU)

OBJECTIVES: Transitional cell carcinomas (TCC) of the bladder are usually aggressive and may produce bone metastases that infiltrate the bone marrow. Most of these cases present with bone symptoms and metastases and are detected with imaging tests. It is extremely rare for asymptomatic patients with a normal bone scan to have bone marrow involvement (anaemia and thrombocytopenia) due to tumour infiltration. We aim to examine that state with a case report.METHODS: We present the case of a 41-year old male with infiltrating TCC of the bladder, who presented with isolated, unexplained anaemia and thrombocytopenia after radical cystoprostatectomy. A bone marrow puncture was required, in which metastatic infiltration was revealed. We performed a literature search of similar cases.RESULTS: There are very few cases of TCC with bone marrow infiltration which become apparent only through haematological changes and have normal imaging tests.CONCLUSIONS: Patients with infiltrating carcinoma of the bladder with isolated haematological changes and a negative extension study should be assessed by bone marrow puncture for correct staging and to be able to offer the best treatment(AU)

[Proximal migration of a Double J catheter: case report and review of the literature]. / Migración proximal de catéter doble J: presentación de un nuevo caso y revisión de la literatura.

OBJECTIVE: To report one case of proximal migration of ureteral stent. To perform a bibliographic review about other cases and management to avoid this complication. METHODS/RESULTS: 48-year-old woman who presents right obstructive uropathy after gynecologic surgery. After the introduction of the right ureteral stent we observed a proximal stent migration. We put on a right nephrostomy tube and antergrade ureteral stent. CONCLUSIONS: The right stent length and proper location of the distal tip are important factors to avoid this complication.

Survival analysis of clear cell renal carcinoma according to the Charlson comorbidity index.

PURPOSE: We assessed the convenience of elective surgery for clear cell renal carcinoma with regard to overall survival in accordance with established comorbidity criteria. MATERIAL AND METHODS: This retrospective study included all patients with a histological diagnosis of clear cell renal carcinoma diagnosed between July 1, 1983 and June 1, 2006 in a population of 200,000 inhabitants. All tumors were classified in stages according to the classification of the American Joint Committee on Cancer based on the 2002 UICC TNM classification. Comorbidity in each patient was assessed by the Charlson comorbidity index. Study variables were gender, age, smoking, Charlson index, Charlson index 2 or less and greater than 2, tumor stage, localized stage and locally advanced or metastatic stage. The chi-square or Fisher exact test, or ANOVA was used to analyze the groups, as applicable. Survival associated with each tumor stage and comorbidity group was evaluated by the Kaplan-Meier test. Similarly a binary logistical regression model was used to assess survival after 1, 5 and 10 years. No minimum followup was established for including a patient in the analysis. SPSS, version 12.0 for Windows software was used for statistical analysis with a probability of the null hypothesis of lower than 0.05 considered significant. RESULTS: A total of 232 renal masses were diagnosed during the study period, of which 192 (82.7%) were useful for the study. There were no significant differences between the genders in age (p = 0.486), stage (p = 0.659) and Charlson index (p = 0.463). Median followup was 1,416 days. Of the 192 patients 33 (17.2%), 28 (14.6%), 32 (16.7%), 29 (15.1%), 32 (16.7%) and 38 (19.8%) showed a Charlson index of 1 to 5 or greater, respectively. Stage was I to IV in 29 (15.1%), 69 (35.9%), 40 (20.8%) and 47 cases (24.5%), respectively. It proved impossible to determine tumor stage in 4 cases (2.1%). There were 72 deaths (37.5%), including 25 (34.7%) from intercurrent disease and 45 (62.5%) from clear cell renal carcinoma. The cause of death could not be determined in 2 cases (2.8%). Survival analysis revealed significant differences in overall survival according to stage (p <0.001) and Charlson index (p = 0.02), between localized stages and locally advanced or metastatic stages (p <0.001) and between patients with a Charlson index of 2 or less vs greater than 2 (p <0.001), particularly in those with local stage (p <0.001) but not in those with locally advanced or metastatic stage (p >0.05). In the logistical regression model tumor stage and the comorbidity index were prognostic factors after 1 year (B exponential 2.4 and 1.3, respectively, p <0.05), after 5 years (B exponential 1.6 and 1.3, p <0.05) and after 10 years (B exponential 1.5 and 1.4, respectively, p <0.05). The first was of greatest importance for short-term survival. CONCLUSIONS: Patients with localized clear cell renal carcinoma and a comorbidity index of greater than 2 may choose observation as treatment for the condition.

[Intrauterine testicular torsion]. / Torsión testicular intrautero.

OBJECTIVE: We present the clinical case of an intrauterine testicular torsion. METHODS/RESULTS: Three days old boy complaining of testicular pain and scrotum enlargement with the diagnosis of intrauterine testicular torsion. Left testicular extirpation and right fixation were performed. CONCLUSIONS: We analyze cases reported, clinical diagnosis and therapeutic options. Testicular torsion can be misdiagnosed with other pathologies like tumors, testicular infarctions, hydrocele, etc. We should always consider it a surgical emergency. The future fertility of the patient can be compromised.

Análisis de la donación renal efectiva por muerte encefálica en un hospital de nivel 2 de la comunidad de Madrid en un período de 10 años / Analysis of effective renal donation from brain-dead donors in a level II hospital over 10 years

OBJETIVOS: Las características epidemiológicas del donante en muerte encefálica se han modificado a lo largo del tiempo sin un incremento significativo en la tasa de explantes efectuados. Evaluar si las características epidemiológicas (sexo, edad y causa de exitus) del donante en muerte encefálica se han modificado a lo largo del tiempo. Evaluar si la tasa de explantes efectivos se ajustan a un estándar de calidad. MÉTODOS: En este estudio retrospectivo se incluyeron todos los pacientes con donación renal (una o dos unidades renales) en el período comprendido entre el 1 de enero de 1995 y el 31 de diciembre de 2005, en un hospital de Nivel 2 con Unidad de Cuidados Intensivos, pero sin Neurocirugía y sin ser centro de referencia de politraumatismos severos, en un área sanitaria de la Comunidad de Madrid (Móstoles, 200.000 habitantes). Se evaluó la causa de éxitus, la edad, serología para VHB o VHC, así como la donación conjunta de otros órganos (hígado, páncreas, intestino, corazón, pulmón y tejidos). Además se evaluarán las diferencias entre dos periodos de tiempo consecutivos: 1995-1999 y 2000-2005. Para el análisis estadístico se aplicará el Test T para muestras independientes, considerándose como significativo un error alfa inferior a 0.05, median- te el Software SPSS v13.0 (Chicago, Illinois, USA) para Windows. Para el ajuste de la tasa de explantes se utilizará como indicador de calidad un mínimo de un 0,2 % del total de exitus intrahospitalario. RESULTADOS: Durante todo el periodo a estudio hubo 4314 exitus en todo el ámbito hospitalario. Se realizaron 46 extracciones renales con una edad media de 58.1 años (error estándar de la media -eem- de 14.25). En el primer periodo (1995-1999) se produjeron 20 donaciones con una edad media de 52.8 años (eem 12.13) y en el segundo periodo (2000-2005) se produjeron 26 donaciones con una edad media de 62.23 (eem 14.49) años. No obstante no existieron diferencias estadísticamente significativas entre ambos grupos (p=0.273). En total 8 pacientes fueron VHB positivos (17.4 %) y 4 (8.7 %) VHC positivo. En el 80.4 % de los pacientes la causa de muerte encefálica fue una hemorragia cerebral (37 pacientes), el 15.2 % por en- cefalopatía hipóxica (7 pacientes), un paciente falleció por embolia grasa tras accidente de tráfico y otra por púrpura trombótica. No existieron diferencias en cuanto a la causa de exitus entre ambos periodos (p>0.05). Se realizó extracción hepática en el 74 % de los pacientes, cardiaca y pulmonar en el 6,5 %, pancreática en el 4,3 % y de tejido en el 50 %. La tasa de donación fue de un 1,05 %. CONCLUSIONES: 1. Existe una tendencia al alza en la edad del donante en muerte encefálica, aunque sin significación estadística, probablemente debido al tamaño muestral. 2. Las tasas de detección de donantes en muerte encefálica se encuentra por encima de los estándares de calidad. No obstante, se deberían establecer programas formativos a nivel hospitalario para la detección de estos pacientes y mejorar los resultados obtenidos (AU)

OBJECTIVES: The epidemiological characteristics of brain-dead donors have changed with time without a significant increase in the rate of explants performed. The objective of this article is to evaluate if the epidemiological characteristics (sex, age, and death cause) have changed with time, and To evaluate if the rate of effective explants is adjusted to a quality standard. METHODS: All patients who became renal donors (one or two renal units) between January 1st 1995 and December 31st 2005 in a level II hospital with intensive care unit but without neurosurgery, which is not a re- ference center for severe polytrauma patients, within a health-care area of the Autonomic Community of Madrid (Mostoles, 200.000 inhabitants), were included in this retrospective study. Cause of death, age, HBV and HCV serologies, as well as multiorgan donation (liver, pancreas, bowel, heart, lungs, and tissues). Additionally, the differences between two consecutive periods of time will be analyzed: 1995-1999 and 2000-2005. SPSS v 13.0 software (Chicano, Illinois, USA) was used for the statistical analysis; the T test for independent samples was applied, considering an alpha error inferior to 0.05 for significance. A minimum of 0.2% of the total number of hospital deaths was considered as quality indicator for the adjustment of donation rate. RESULTS: Over the whole study period there were 4314 deaths in the hospital. Forty-six renal harvestings were performed with a mean donor age of 58.1 yr. (mean standard error (SE)14.25) . In the first study period (1995-1999) there were 20 donations with a donor mean age of 52.8 yr. (SE 12.13), and there were 26 donations in the second period (2000-2005) with a mean age of 62.23 yr. (SE 14.49) . Nevertheless, the- re were no statistically significant differences between both groups (p = 2.273). A total of eight patients were HBV positive (17.4%) and four (8.7%) HCV positive. In 80.4% of the patients the cause of brain death was brain hemorrhage (37 patients),15.2% hypoxic encephalopathy (7 patients), one patient died due to fat embolism after motor vehicle accident, and another one from thrombotic purpura. There were no differences in death cause between both periods (p> 2.05). Hepatic extraction was performed in 74% of the patients, heart and lung in 6.5%, pancreas in 4.3%, and tissues in 50%. Donation rate was 1.05%. CONCLUSIONS: 1. There is a trend to higher brain- dead-donor age, although it is not statistically significant, probably due to sample size. 2. The rate of brain-dead donor detection is over quality standards. Nevertheless, training programs to detect these patients and improve results should be established at the hospital level (AU)

Torsión testicular intrautero / Intrauterine testicular torsion

Objetivo: Presentación de un caso clínico de torsión testicular intauterina. Métodos/Resultados: Varón de tres días de vida que consulta por dolor y aumento de hemiescroto izquierdo, diagnosticado de torsión testicular intrauterina. Se procede a realización de extirpación del teste afecto y fijación contralateral. Conclusiones: Analizamos los casos hasta ahora publicados y hacemos referencia a las dificultades diagnósticas y las opciones terapéuticas. La torsión testicular puede confundirse con otras patologías como tumores, infartos testiculares, hidroceles, etc. Siempre ha de (AU)

Objective: We present the clinical case of an intrauterine testicular torsion. Methods/Results: Three days old boy complaining of testicular pain and scrotum enlargement with the diagnosis of intrauterine testicular torsion. Left testicular extirpation and right fixation were performed. Conclusions: We analyze cases reported, clinical diagnosis and therapeutic options. Testicular torsion can be misdiagnosed with other pathologies like tumors, testicular infarctions, hydrocele, etc. We should always consider it a surgical emergency. The future fertility of the patient can be compromised (AU)

[Will the climate change affect the mortality from prostate cancer?]. / Afectara el cambio climatico a la mortalidad por cancer de prostata?

UNLABELLED: The global heating of the atmosphere, as well as the increase of the exposition to sunlight, will be associated with a decrease of the mortality from prostate cancer, due to an increase of the plasmatic levels of vitamin D. OBJECTIVES: To evaluate if climatological factors (temperature, rainfall, and number of sunlight hours per year) may influence the mortality associated with prostate cancer over a five-year period. METHODS: In this ecology type study we will evaluate the trends of prostate tumors associated mortality in the period between January 1st 1998 and December 31st 2002, in the geographic area of Spain (17 Autonomic communities-CA-and 2 Autonomic cities- Ceuta and Melilla-, 43 million inhabitants). Demographic and mortality data were obtained from the National Institute of Statistics (INE) and climatological data about temperature and rainfall were obtained from the National Institute of Meteorology (INM). The provinces were classified using the climatic index of Martonne (defined as the quotient between annual rainfall and mean annual temperature plus 10). Areas with a quotient below 5 ml/m2/o C are considered extremely arid zones; between 5 and 15 ml/m2/o C are considered arid zones, between 15 and 20 ml/m2/o C semiarid zones; between 20 and 30 ml/m2/o C subhumid zones; between 30 and 60 ml/m2/o C humid zones; and over 60 ml/m2/o C superhumid zones. We compared mortality rates between different climatic areas using the Jonckheere-Terpstra test for six independent samples following the index of Martonne. All calculations were performed using the SPSS v 13.0 for Windows software. A logistic regression model was performed to identify climate factors associated with prostate cancer mortality. A likeliness of the null hypotheses inferior to 0.05 was considered significant. RESULTS: Prostate cancer mortality presented statistically significant differences, being higher in provinces with higher Martonne index (p < 0.001) and lower in areas with a greater number of sunlight hours per year (p = 0.041). The adjusted mortality rate associated with extreme aridity regions and was 21.51 cases/100,000 males year, whereas in humid zones it was 35.87 cases/100,000 males years. CONCLUSIONS: Mortality associated with prostate cancer is significantly superior in regions with less exposition to the sunlight. The climate change may lead to a modification of the main epidemiologic patterns, and it may be associated with a modification of cancer mortality rates. Nevertheless, these results should be taken with caution and should be confirmed by prospective studies.

¿Afectará el cambio climático a la mortalidad por cáncer de próstata? / Will the climate change affect the mortality from prostate cancer?

El calentamiento global de la atmósfera, así como el incremento de la exposición a la luz solar, se asociará a un descenso de la mortalidad unida al cáncer de próstata, debido a un incremento de los niveles plasmáticos de Vitamina D. OBJETIVOS: Evaluar si los factores climatológicos (temperaturas, precipitación y número de horas de luz solar al año) influyen sobre la mortalidad asociada al cáncer de próstata a lo largo de un período de cinco años. METODOS: En este estudio de tipo ecológico se evaluaron las tendencias de mortalidad asociada a los tumores de próstata en el período comprendido entre el 1 de Enero de 1998 y el 31 de Diciembre de 2002, en el área geográfica de España (17 Comunidades Autónomas -CCAA- y dos Ciudades Autónomas -Ceuta y Melilla-, 43.000.000 habitantes). Los datos demográficos y de mortalidad se obtuvieron del Instituto Nacional de Estadística (INE) y los datos climatológico de temperaturas y precipitaciones se obtuvieron del Instituto Nacional de Meteorología (INM). Se clasificaron las diferentes provincias mediante el índice climático de Martonne (definido como el cociente entre las precipitaciones anuales y la temperatura media anual mas 10). Se consideraron zonas de aridez extrema aquellas cuyo cociente sea inferior a 5 ml/m2/ºC, zonas áridas aquellas cuyo cociente se encuentre entre 5 y 15 ml/m2/ºC, zonas semiáridas aquellas que se encuentren entre 15 y 20 ml/m2/ºC, subhúmedas entre 20 y 30 ml/m2/ºC, húmedas entre 30 y 60 y pérhúmedas cuando sean superiores a 60 ml/m2/ºC. Se valoraron las diferentes tasas de mortalidad entre las distintas áreas climáticas mediante el test de Jonckheere-Terpstra para 6 muestras independientes según el Índice de Martonne. Todos los cálculos se realizarán mediante el software SPSS v13.0 para Windows. Se realizó un modelo de regresión logística para identificar factores climáticos asociados a la mortalidad por cáncer de próstata. Se consideró significativo una verosimilitud de la hipótesis nula inferior a 0,05. RESULTADOSLa mortalidad por cáncer de próstata presentó diferencias estadísticamente significativas siendo superior en las provincias con índice de Martonne más elevado (p< 0,001) y menor en las áreas con mayor numero de horas de sol al año (p=0,041). La tasa de mortalidad ajustada asociada a las áreas de aridez extrema fue de 21,51 casos/100.000 varones y año, mientras que en las zonas húmedas fue de 35,87 casos/100,000 varones y año. CONCLUSIONES: La mortalidad asociada al cáncer de próstata es significativamente superior en las regiones con menor exposición solar. El cambio climático puede conducir a una modificación en los patrones epidemiológicos, pudiendo asociarse a una modificación de las tasas de mortalidad por cáncer. No obstante, estos resultados hay que tomarlos con precaución y deben ser confirmados por estudios prospectivos (AU)

The global heating of the atmosphere, as well as the increase of the exposition to sunlight, will be associated with a decrease of the mortality from prostate cancer, due to an increase of the plasmatic levels of vitamin D. OBJECTIVES: To evaluate if climatological factors (temperature, rainfall, and number of sunlight hours per year) may influence the mortality associated with prostate cancer over a five-year period. METHODS: In this ecology type study we will evaluate the trends of prostate tumors associated mortality in the period between January 1st 1998 and December 31st 2002, in the geographic area of Spain (17 Autonomic communities-CA-and 2 Autonomic cities- Ceuta and Melilla-, 43 million inhabitants). Demographic and mortality data were obtained from the National Institute of Statistics (INE) and climatological data about temperature and rainfall were obtained from the National Institute of Meteorology (INM). The provinces were classified using the climatic index of Martonne (defined as the quotient between annual rainfall and mean annual temperature plus 10). Areas with a quotient below 5 ml/m2/o C are considered extremely arid zones; between 5 and 15 ml/m2/o C are considered arid zones, between 15 and 20 ml/m2/o C semiarid zones; between 20 and 30 ml/m2/o C subhumid zones; between 30 and 60 ml/m2/o C humid zones; and over 60 ml/m2/o C superhumid zones. We compared mortality rates between different climatic areas using the Jonckheere-Terpstra test for six independent samples following the index of Martonne. All calculations were performed using the SPSS v 13.0 for Windows software. A logistic regression model was performed to identify climate factors associated with prostate cancer mortality. A likeliness of the null hypotheses inferior to 0.05 was considered significant. RESULTS: Prostate cancer mortality presented statistically significant differences, being higher in provinces with higher Martonne index (p < 0.001) and lower in areas with a greater number of sunlight hours per year (p = 0.041). The adjusted mortality rate associated with extreme aridity regions and was 21.51 cases/100,000 males year, whereas in humid zones it was 35.87 cases/100,000 males years. CONCLUSIONS: Mortality associated with prostate cancer is significantly superior in regions with less exposition to the sunlight. The climate change may lead to a modification of the main epidemiologic patterns, and it may be associated with a modification of cancer mortality rates. Nevertheless, these results should be taken with caution and should be confirmed by prospective studies

[Analysis of effective renal donation from brain-dead donors in a level II hospital over 10 years]. / Análisis de la donación renal efectiva por muerte encefálica en un Hospital de Nivel 2 de la Comunidad de Madrid en un periodo de 10 años.

OBJECTIVES: The epidemiological characteristics of brain-dead donors have changed with time without a significant increase in the rate of explants performed. The objective of this article is to evaluate if the epidemiological characteristics (sex, age, and death cause) have changed with time, and To evaluate if the rate of effective explants is adjusted to a quality standard. METHODS: All patients who became renal donors (one or two renal units) between January 1st 1995 and December 31st 2005 in a level II hospital with intensive care unit but without neurosurgery, which is not a reference center for severe polytrauma patients, within a health-care area of the Autonomic Community of Madrid (Mostoles, 200.000 inhabitants), were included in this retrospective study. Cause of death, age, HBV and HCV serologies, as well as multiorgan donation (liver, pancreas, bowel, heart, lungs, and tissues). Additionally, the differences between two consecutive periods of time will be analyzed: 1995-1999 and 2000-2005. SPSS v 13.0 software (Chicano, Illinois, USA) was used for the statistical analysis; the T test for independent samples was applied, considering an alpha error inferior to 0.05 for significance. A minimum of 0.2% of the total number of hospital deaths was considered as quality indicator for the adjustment of donation rate. RESULTS: Over the whole study period there were 4314 deaths in the hospital. Forty-six renal harvestings were performed with a mean donor age of 58.1 yr. (mean standard error (SE)14.25). In the first study period (1995-1999) there were 20 donations with a donor mean age of 52.8 yr. (SE 12.13), and there were 26 donations in the second period (2000-2005) with a mean age of 62.23 yr. (SE 14.49). Nevertheless, there were no statistically significant differences between both groups (p = 2.273). A total of eight patients were HBV positive (17.4%) and four (8.7%) HCV positive. In 80.4% of the patients the cause of brain death was brain hemorrhage (37 patients), 15.2% hypoxic encephalopathy (7 patients), one patient died due to fat embolism after motor vehicle accident, and another one from thrombotic purpura. There were no differences in death cause between both periods (p> 2.05). Hepatic extraction was performed in 74% of the patients, heart and lung in 6.5%, pancreas in 4.3%, and tissues in 50%. Donation rate was 7.05%. CONCLUSIONS: 1. There is a trend to higher brain-dead-donor age, although it is not statistically significant, probably due to sample size. 2. The rate of brain-dead donor detection is over quality standards. Nevertheless, training programs to detect these patients and improve results should be established at the hospital level.

[Tobacco consumption and bladder cancer mortality in Spain]. / Consumo de tabaco y mortalidad por cáncer vesical en España.

OBJECTIVES: To establish the trend of the bladder cancer adjusted mortality and its correlation with tobacco consumption in different Spanish Autonomic Communities over a 15 year period. METHODS: We evaluate the trends of mortality rates associated with bladder cancer between January 1st 1989 and December 31st 2002 in the geographic area of Spain, as well as the tendency of tobacco consumption. Demographic and mortality data were obtained from the National Institute of Statistics, and consumption data were obtained from the Commissioner for the Tobacco Market in the Spanish Economics and Finances Ministry. We calculate the average number of cigarettes (1 package = 20 cigarettes) consumed per person; we also calculate bladder cancer adjusted mortality rates, presented as number of deaths for that cause per 100.000 persons year, and the ratio between number of packages of cigarettes consumed and adjusted mortality rate. We determine the yearly percentage increase over the whole period of study for both the mortality rate and tobacco consumption, and evaluate their correlation by the Spearman's coefficient. RESULTS: Mean adjusted bladder cancer mortality rate over the period of study was 9.4 deaths per 100.000 habitants year, and mean tobacco consumption was 109.7 packages per person year. There has been a 2.05% yearly increase of bladder cancer associated mortality, mean cigarette consumption has diminished 1.3% per year. The Spearman's test did not show any correlation between both factors (p = 0.722). CONCLUSIONS: Despite preventive measures for tobacco addiction in our country, there is an important continuous consumption. The increase in the incidence of bladder cancer does not seem to be related with higher tobacco consumption currently, therefore it may be related with other genetic or environmental factors.

[Renal cell renal carcinoma. Analysis of incidence and survival in a 90.000 citizens healthcare area]. / Carcinoma renal de células claras. Análisis de incidencia y supervivencia en un area sanitaria de 90,000 habitantes.

OBJECTIVES: To evaluate the most relevant epidemiological and survival data of the renal cell carcinoma (RCC) in a 90.000 citizens geographic area, as well as its association with risk factors such as tobacco or diuretic drugs use. METHODS: All patients with the pathologic diagnosis of renal cell carcinoma between January 1st 1987 and January 31st 2004 were included in the study. Adjusted incidence rates (standardized) per 100.000 inhabitants year, annual percentage increase, and epidemic index in the health-care area VIII in Ciudad Real (90.000 inhabitants) were calculated. For the population adjustment we used the data Published by the National Institute of Statistics. We evaluated the differences in mortality between males/females, as well as in relation to tobacco consumption, using the chi-square test or the Fisher exact test, and the overall survival by a Cox regression model. RESULTS: Thirty-eight RCC were diagnosed, with a maximum incidence of 7.21 cases per 100.000 inhabitants year. There was an annual percentage increase of 2.06% over the whole period. There were no statistically significant differences in gender-associated mortality (p = 0.1), tumor stage (p = 0.063), tobacco consumption (p = 0.13), diuretic drugs consumption (p = 0.69), or both (p = 0.5). Mortality was significantly higher during the first 5 years after surgery. CONCLUSIONS: The incidence of RCC is progressively increasing, and it is predictable that this trend will be maintained in the next years. Overall mortality (any cause) associated with RCC is higher in the first five years after diagnosis.

Carcinoma de células claras. Análisis de incidencia y supervivencia en un área sanitaria de 90.000 habitantes / Renal cell renal carcinoma. Analysis of incidence and survival in a 90.000 citizens healthcare area

OBJETIVOS: Evaluar los datos epidemiológicos y de supervivencia más relevantes del carcinoma renal de células claras (CCR) en un área geográfica de 90,000 habitantes, así como su asociación a factores de riesgo como el tabaco o el uso de diuréticos. MÉTODOS: Se incluyeron todos los pacientes con diagnóstico histológico de carcinoma renal de células claras, entre el 1 de Enero de 1987 y el 31 de Enero de 2004. Se calcularon las tasas de incidencia ajustada (estandarizada) por 100.000 habitantes y año en el área sanitaria VIII de Ciudad Real (90.000 habitantes), el incremento porcentual anual y el índice epidémico. Para el ajuste poblacional se utilizaron los datos publicados por el Instituto Nacional de Estadística. Se evaluarán las diferencias de mortalidad entre ambos sexos, así como en función del consumo de tabaco, diuréticos o ambos, mediante el test de chi-cuadrado, o test exacto de Fischer,y la supervivencia global mediante un modelo de regresión de Cox. RESULTADOS: Se diagnosticaron 38 CCR, con una incidencia máxima de 7,21 casos por 100,000 habitantes y año. Se produjo un incremento porcentual anual durante todo el periodo de un 2,06%. No existieron diferencias estadísticamente significativas en la mortalidad asociada al sexo (p= 0,1), estadio tumoral (p=0,063), consumo de tabaco (p=0,13), diuréticos (p=0,69) o ambos (p=0,5). La mortalidad fue significativamente superior durante los primeros 5 años tras la intervención quirúrgica. CONCLUSIONES: La incidencia del CCR está aumentando de forma progresiva, y es de preveer que esta tendencia se mantenga al alza en los próximos años. La mortalidad global (por cualquier causa) asociada al CCR es superior los primeros 5 años tras el diagnóstico

OBJECTIVES: To evaluate the most relevant epidemiological and survival data of the renal cell carcinoma (RCC) in a 90.000 citizens geographic area, as well as its association with risk factors such as tobacco or diuretic drugs use. METHODS: All patients with the pathologic diagnosis of renal cell carcinoma between January 1st 1987 and January 31st 2004 were included in the study. Adjusted incidence rates (standardized) per 100.000 inhabitants year, annual percentage increase, and epidemic index in the health-care area VIII in Ciudad Real (90.000 inhabitants) were calculated. For the population adjustment we used the data Published by the National Institute of Statistics. We evaluated the differences in mortality between males/females, as well as in relation to tobacco consumption, using the chi-square test or the Fisher exact test, and the overall survival by a Cox regression model. RESULTS: Thirty-eight RCC were diagnosed, with a maximum incidence of 7.21 cases per 100.000 inhabitants year. There was an annual percentage increase of 2.06% over the whole period. There were no statistically significant differences in gender-associated mortality (p = 0.1), tumor stage (p = 0.063), tobacco consumption (p = 0.13), diuretic drugs consumption (p = 0.69), or both (p = 0.5). Mortality was significantly higher during the first 5 years after surgery. CONCLUSIONS: The incidence of RCC is progressively increasing, and it is predictable that this trend will be maintained in the next years. Overall mortality (any cause) associated with RCC is higher in the first five years after diagnosis

Consumo de tabaco y mortalidad por cáncer vesical en España / Tobacco consumption and bladder cancer mortality

OBJETIVO: Determinar la tendencia de la mortalidad ajustada por cáncer vesical y establecer una correlación con el consumo de tabaco en las diferentes Comunidades españolas a lo largo de un periodo de quince años.MÉTODOS: Se evaluarán las tendencias de mortalidad asociada al cáncer vesical en el periodo comprendido entre el 1 de Enero de 1989 y el 31 de Diciembre de 2002, en el área geográfica de España, así como las tendencias en el consumo de tabaco durante el mismo periodo. Los datos demográficos y de mortalidad se obtuvierondel Instituto Nacional de Estadística y los datos de consumo de tabaco se obtuvieron del Comisionado para el Mercado de Tabacos del Ministerio de Economiay Hacienda.Se calcularán el número medio de cajetillasde cigarrillos (1 cajetilla equivale a 20 cigarrillos) consumidas por persona; así como las tasas de mortalidadajustadas por cáncer de vejiga expresada como fallecimientos por dicha causa por 100.000 personas y año, y el ratio entre las cajetillas de cigarrillos consumidosy la tasa de mortalidad ajustada.Se determinará el incremento porcentual anual durante todo el periodo, tanto para la tasa de mortalidad como para el consumo de tabaco, y se evaluará la correlación entre ambas tendencias mediante el coeficiente de Spearman.RESULTADOS: Durante todo el periodo a estudio, la tasa media de mortalidad ajustada por cáncer vesical fue de 9,4 fallecidos por cada 100,000 habitantes y año, y el consumo medio de tabaco fue de 109,7 cajetillas por persona y año. Se ha producido un incremento de la mortalidad asociada a cáncer vesical de un 2,05 % anual, mientras que el consumo de cigarrillos ha disminuidoun 1,3 % al año. El test de Spearman no muestra correlación entre ambos factores (p=0,722).CONCLUSIONES: A pesar de las medidas de prevencióndel tabaquismo en nuetro medio, continúa produciéndoseun importante consumo del mismo. El incrementoen la incidencia de cáncer vesical no parece estar en relación con un mayor consumo de tabaco en la actualidad, por lo que puede estar en relación con otros factores genéticos o ambientales

OBJECTIVES: To establish the trend of the bladder cancer adjusted mortality and its correlation with tobacco consumption in different Spanish Autonomic Communities over a 15 year period. METHODS: We evaluate the trends of mortality rates associated with bladder cancer between January 1st 1989 and December 31st 2002 in the geographic area of Spain, as well as the tendency of tobacco consumption. Demographic and mortality data were obtained from the National Institute of Statistics, and consumption data were obtained from the Commissioner for the Tobacco Market in the Spanish Economics and Finances Ministry. We calculate the average number of cigarettes (1 package = 20 cigarettes) consumed per person; we also calculate bladder cancer adjusted mortality rates, presented as number of deaths for that cause per 100.000 persons year, and the ratio between number of packages of cigarettes consumed and adjusted mortality rate. We determine the yearly percentage increase over the whole period of study for both the mortality rate and tobacco consumption, and evaluate their correlation by the Spearman’s coefficient. RESULTS: Mean adjusted bladder cancer mortality rate over the period of study was 9.4 deaths per 100.000 habitants year, and mean tobacco consumption was 109.7 packages per person year. There has been a 2.05% yearly increase of bladder cancer associated mortality, mean cigarette consumption has diminished 1.3% per year. The Spearman’s test did not show any correlation between both factors (p = 0.722). CONCLUSIONS: Despite preventive measures for tobacco addiction in our country, there is an important continuous consumption. The increase in the incidence of bladder cancer does not seem to be related with higher tobacco consumption currently, therefore it may be related with other genetic or environmental factors

[Circumcision in religious art]. / La circuncisión en el arte religioso.

OBJECTIVES: The objective of this study is to perform a historical journey through the topic of circumcision from the Italian Renaissance to the Spanish Baroque. METHODS: We evaluated the paintings about circumcision between both periods, including their most representative works. RESULTS AND CONCLUSIONS: Circumcision is a frequent topic in the religious painting in both periods.