[Crossed renal ectopia: radiological possibilities of helicoidal CAT]. / Ectopia renal cruzada: posibilidades radiológicas de la TAC helicoidal.

OBJECTIVES: To evaluate the diagnostical possibilities of helicoidal CAT in crossed renal ectopy (CRE) and review 36 cases published in Spain, including our 3 new patients. CLINICAL CASES: We present two women and a man aged between 54 and 82 who were diagnosed of left CRE. One of them showed an ureterocele and other one presented a splenic angiosarcoma. DISCUSSION: Main embriological theories, clinical presentation, associated anomalies and different radiological systems used in the diagnosis of this infrequent congenital malformation are evaluated.

Ectopia renal cruzada: posibilidades radiológicas de la TAC helicoidal / Crossed renal ectopia: Radiological possibilities with helicoida CAT

OBJETIVOS: Evaluar las posibilidades diagnósticas de la TAC helicoidal en la ectopia renal cruzada (ERC) a la vez que se realiza una revisión de 36 casos publicados en España, incluyendo nuestros 3 nuevos pacientes. CASOS CLÍNICOS: Presentamos 2 mujeres y 1 varón con edades comprendidas entre 54 y 82 años, que fueron diagnosticados de ERC izquierda. Uno de ellos mostraba asociadamente un ureterocele ipsilateral y otro presentaba un angiosarcoma esplénico. DISCUSIÓN: Las principales teorías embriogénicas, presentación clínica, anomalías asociadas y distintos medios radiológicos en el diagnóstico de esta infrecuente malformación congénita son evaluados (AU)

[Sugar: treatment of choice in irreducible paraphimosis]. / Azúcar: tratamiento de elección en la parafimosis irreductible.

PURPOSE: To evaluate the effectivity of granulated sugar in the treatment of irreductable paraphimosis. CLINICAL CASES: During last year three patients have been treated by application of granulated sugar on prepuce and glands penis during 1-2 hours until edema reduction was observed. Paraphimosis could be reducted in all three cases. CONCLUSIONS: Sugar application reduce local edema permitting reduce paraphimosis in an incruent, cheap and without side effects way.

[Urologic disease emergency. Clinico-epidemiologic analysis at a district hospital]. / Patología urológica urgente. Análisis clínico-epidemiológico en un hospital comarcal.

OBJECTIVE: To present the results of a one-year retrospective study that analyzed the clinical and epidemiological aspects of urological emergencies, which is not a negligible percentage of all hospital emergencies. METHODS: Data on all the urological emergencies of the emergency department of our hospital were collected during a one-year period by filling out a form that included sex, age, whether referred or not, disease, etc. RESULTS: There were 1504 urological emergencies; the urologist was required in 458 of these cases (30.45%). There were more men (837) than women (667). Patient ages ranged from 1-101 years (mean 53 years); a higher incidence was found for those aged 65 years. By age groups, there were more patients aged 61-80 years (575 patients). Most of the patients came to the hospital on their own initiative (1114) and 390 had been referred by their primary care physician. Renal colic (670 cases) was the most common diagnosis in both males and females, followed by cystitis, which was prevalent in the females (67.35%). Other conditions seen were urinary retention, hematuria, etc. CONCLUSIONS: There was a higher prevalence of males that consulted for urological conditions at the emergency department and there was a higher incidence in patients in the 6th and 7th decades of life, which is similar to the findings reported in other studies. Renal colic was the main reason for consultation for both genders and for all age groups, except those younger than 20 who presented more scrotal and penile involvement. Infective conditions involving the lower urinary tract (cystitis) and pyelonephritis were prevalent in the females. The large number of patients that were discharged from the emergency department and who consulted on their own initiative shows their confidence in the emergency services and that they could have been attended to at other health centers and did not have to come and unnecessarily strain the hospital emergency services.

[Nephrogenic adenoma of the bladder: metaplasia or embryologic alteration?]. / Adenoma nefrogénico vesical: metaplasia o alteración embriológica?

OBJECTIVES: To present a new case of nephrogenic adenoma of the bladder and to review the current concepts on the etiopathogenesis of this lesion. CLINICAL CASE: Seventy years old female with repetitive haematuria who was diagnosed as having a nephrogenic adenoma of the bladder which was extirpated by cold biopsy forceps. No tumoral relapse was detected after 16 months of follow up. DISCUSSION: In the light of the present knowledges, the origin of nephrogenic adenoma is a phenomenon of urothelial metaplasia due to a chronic irritative stimulus wich would lead a cellular proliferation with potentialities to originate mesonephric tissues and which starting point could be on not completely involutioned mesonephric cellular rests and/or on de-differentiated mature urothelial cells.

[Pulmonary thromboembolism after chronic bladder distention]. / Thrombo-embolie pulmonaire à la suite d'une rétention vésicale chronique.

OBJECTIVE: To report a case of pulmonary embolism secondary to chronic over-distended bladder, responsible for iliac vein obstruction. CLINICAL CASE: A 73-year-old patient presented with sudden onset of pulmonary embolism, confirmed by isotope lung scan, after drainage of 2,300 cc of urine from an over-distended bladder, responsible for bilateral iliac vein obstruction and a bilateral obstructive uropathy. The patient had a favourable course after anticoagulation with heparin and temporary bladder catheterization, leading to resolution of the peripheral oedema and obstructive uropathy. CONCLUSION: About thirty cases of obstruction of large pelvic vessels due to over-distended bladder have been reported to date. However, and after an extensive review of the literature, this case appears to be the first report of pulmonary embolism secondary to chronic over-distended bladder.

[Inflammatory pseudomotor of the bladder. A diagnostic and therapeutic dilemma]. / Pseudotumore infiammatorio vescicale. Un dilemma diagnostico e terapeutico.

Inflammatory pseudotumor is a reactive benign lesion which can be very difficult to distinguish from some malignant bladder tumors like sarcomas or sarcomatoid carcinoma. The aim of this study was to present a new case of inflammatory pseudotumor and to review the present diagnostic and therapeutic criteria for this lesion. A 72-year-old female was admitted to the emergency room due to important hematuria. Transurethral resection of a bladder tumor located in the left lateral wall was performed. Pathologic studies were suggestive of inflammatory pseudotumor, but a mixoid leiomyosarcoma couldn t be completely discarded and a partial cystectomy with ipsilateral lymphadenectomy were carried out. Immunohistochemical studies were positive for vimentin, desmin, smooth muscle actin and cytoqueratins while epithelial membrane antigen and S-100 protein were negative. The patient is disease free after a year follow-up. When diagnosis is certain, complete transurethral resection is the treatment of choice. However, if there is no total pathologic confirmation, if it is a very wide lesion or if it is recurring after endoscopic resection, a partial cystectomy is suggested.

Azúcar: tratamiento de elección en la parafimosis irreductible / Sugar: elective treatment of irreducible para phimosis

PROPÓSITO: Evaluar la efectividad del uso del azúcar granulado en el tratamiento de la parafimosis irreductible. CASOS CLÍNICOS: Durante el último año han sido tratados 3 pacientes mediante la aplicación de azúcar sobre glande y prepucio durante 1-2 horas, hasta observar la reducción del edema. Se ha conseguido la reducción de la parafimosis en todos los casos. CONCLUSIONES: La aplicación de azúcar local reduce el edema de la parafimosis permitiendo reducir ésta de forma incruenta, barata y carente de efectos secundarios (AU)

Adenoma nefrogénico vesical: ¿metaplasia o alteración embriológica? / Nephrogenic adenoma of the bladder: metaplasia or embriological disturbance?

OBJETIVOS: Presentación de un nuevo caso de adenoma nefrogénico vesical, y revisar los conocimientos actuales sobre la etiopatogenia de esta lesión. CASO CLÍNICO: Mujer de 70 años con hematuria de repetición que es diagnosticada de un adenoma nefrogénico vesical, que fue extirpada mediante biopsia fría. No se ha detectado recidiva de la neoformación tras 16 meses de seguimiento. DISCUSIÓN: A la luz de los conocimientos actuales, el origen del adenoma nefrogénico podría estar en un fenómeno de metaplasia urotelial secundario a un estímulo irritativo crónico, que induciría una proliferación celular con potencialidad para generar tejido mesonéfrico, y cuyo origen podría encontrarse en restos celulares mesonéfri-cos incompletamente involucionados y/o en la desdiferenciación de células uroteliales maduras (AU)

[Which language will MEDLINE speak in the next millennium?]. / Qué idioma hablará MEDLINE el próximo milenio?

OBJECTIVES: To analyze the trends in the prevalence of the languages used in Medline, since its creation up to the present time, for the overall indexed articles in this database and those specifically related to the field of Urology. The results are extrapolated to determine the trend over the next 15 years. METHODS: The Pubmed page on Internet (http:www.nlm.nih.gov/pubs/factsheets/nlm. html) and the Medline database (OldMedline 1960-1965 and current Medline 1966-1999) were accessed to determine the total number of indexed articles and the distribution by year, language and country. The same method was applied for articles specifically pertaining to the field of Urology. RESULTS: Overall, English accounts for 75% of the nearly 10 million articles indexed in Medline since its creation. The prevalence of the English language has grown steadily since 1966 when it already accounted for 53% of these indexed articles up to 89% in 1999, for a yearly increase of 1%. Similar results were found for the articles specifically pertaining to the field of Urology. The number of the indexed articles in the English language has grown to almost 400% since 1966, whereas those written in other languages have dropped by 40%. In some countries like Holland, Germany or Japan, most of the articles are published in English. CONCLUSIONS: If the current trend continues, all the articles indexed in the Medline database will comprise only those written in the English language by 2014.

[A solitary cerebellar metastasis: a diagnostic exercise]. / Metástasis cerebelosa solitaria: un ejercicio diagnóstico.

Presentation of a solitary cerebellar mass lead us to think about the presence of a primary tumour or the possibility of a pulmonary, mammary or digestive metastasis. However, once discarded these origins, is necessary to search the primary neoplasms in less frequent organs. Approximately, 5% of all intracranial metastasis have it's origin in a renal cancer. These lesions generally appear at the supratentorial area and within a generalized disease. In the other hand, the presentation of a solitary cerebellar metastasis from a renal carcinoma without affectation of other organs is a very unusual fact. We present a case of these characteristics discussing about diagnostic, therapeutic and prognostic aspects of this unpredictable tumor.

[Kaposi's sarcoma: a sexually transmitted cancer?]. / Sarcoma de Kaposi: un cáncer de transmisión sexual?

Kaposi's sarcoma is a lymphoproliferative opportunistic tumor associated with acquired immunodeficiency syndrome whose frequency is going down due to the use of combined therapies including proteases and others antivirals. During the last years, it has been postulated that it's origin is in the oncogenic potential of HVH-8; however, for the development of the disease, it's necessary the presence of some coadjuvant factors including immunodeficiency and probably a propicious hormonal status. We practiced a bibliographic review of some recent works related with it's etiology and coadyuvant factors implicated in the development of this neoplasia, phrasing some questions that should be answered in the light of future investigative works.