[Retroperitoneal malignant fibrous histiocytoma]. / Histiocitoma maligno fibroso retroperitoneal.

We report a new case of retroperitoneal tumor: a malignant fibrous histiocytoma, in its less aggressive histologic type, the mixoid variety. This is a recently isolated histologic presentation from other sarcomas, with a low incidence, non-specific clinic findings and poor prognosis due to its tendency to reappear and to produce metastasis.

[Retroperitoneal neurilemmona]. / Neurilemoma retroperitoneal.

Schwannoma is an uncommon tumor arising from neural sheath of peripheral nerves. Histological findings showing Antoni A and B zones are the main diagnostic features. We report a new case of a retroperitoneal located one, which is not its most usual place to appear, in a 60 year old male, presenting left flank pain. He received surgical treatment, having a satisfactory evolution.

[Analysis of renal neoplasms in adult patients under 40]. / Análisis de las neoplasias renales en adultos menores de 40 años.

OBJECTIVES: To analyze within our sample population the number of patients under 40 receiving surgery as a result of renal neoplasm; to describe the characteristics of these patients and compare them with those of adult patients over 40. PATIENTS AND METHODS: We have revised the clinical history of the 379 patients with renal neoplasm who have undergone surgery in our Service from January 1986 through June 2003. Patients were divided into two groups. Group I, formed by 36 subjects (9.5%) < or = 40. Group II includes 343 patients (90.5%) over 40. Data were included in a database created using the software programme Access and were subsequently analysed using the statistical package SPSS. A descriptive analysis was performed and life expectancy was calculated for both groups using the Kaplan-Meier survival curve. RESULTS: 7.3% of the total number of renal cell carcinomas included in our series occurs in patients of or under 40. No significant differences have been observed as regards the distribution per sexes, laterality, size, incidental occurrence, clinical symptoms, anatomopathology, staging or surgical technique employed. However, we have observed differences as regards cancer-specific survival rate after 5 years, being 94.74% in the case of group I and 68.64% in group II (log-rank 0.0338). CONCLUSIONS: The number of patients < or = 40 undergoing surgery as a result of renal cell carcinoma in the sample under study matches other series already published. No statistically significant difference has been observed as regards staging among patients under and over 40. Differences do exist as regards cancer-specific survival rate. In the case of our patients, irrespective of the age group to which they were ascribed, it is more common to diagnose a renal neoplasm incidentally than through the clinical manifestations.

[Adrenal metastases of Ewing's sarcoma. Report of one case]. / Metastasis suprarrenal de sarcoma de Ewing. A propósito de un caso.

Adrenal metastases are more frequent than primary adrenal carcinoma. The most frequent are, in this order: breast and lung cancer, stomach and kidney carcinomas, adrenal gland contralateral tumors and melanoma. Less frequent are tumours of the bladder, colon, esophagus, gall bladder, liver, pancreas, prostate, stomach and uterus. The rest of the tumours rarely spread toward adrenal glands. The metastases to the adrenal glands caused by sarcomas are rare and normally they happen in the contest of a massive metastases affecting several organs at the same time. We present a case of a patient affected by adrenal metastases of Ewing's sarcoma who has been referred to us for surgical treatment because it is a unique metastases (there is no sing of more illnesses in other organs at the time of the exploration).

[Predictive model for prostate cancer in patients with biopsy indication]. / Modelo predictivo de cáncer de próstata en pacientes con indicación de biopsia.

OBJECTIVE: Attemp to determine the probability of developing prostate carcinoma taking into acc age, digital rectal examination and PSA once a transrectal biopsy has been indicated, so that both doctors and patients have mor information to face such pathology. MATERIAL AND METHODS: Retrospective study of 633 biopsies, taken into acc the patient's age, digital rectal examination, PSA level and histology. The data were included in a database created with Access and were put a logistic regression by mens the software program SPSS. RESULTS: Once the biopsy is indicated, digital rectal examination is the parameter offesing a higher discriminatory valuer with an odd ratio of 5.9 (CI 95%, 3.9-8.9). The mathematical model obtained shows a sensitivity level of 57% and a level of specificity of 84%. Pre-test probability is 36%, the probability post-test increasing up to 70%, and a negative predictive value of 77% and a positive predictive value of 67%. CONCLUSIONS: The mathematical model obtained individually determines the probability of suffering from prostatic carcinoma. Moreover, using this model the probabilities obtained re more precise than those derived from the fact of fulfilling the criteria for a prostatic biopsy. Once a biopsy is indicated, the rectal examination becomes the parameter with a higher predictive value of PC, irrespective of PSA and age. The PPV of the model is higher than of the PSA or the digital recta examination used separately.

[Validation of ESCAP-CD as an instrument of measure for the evaluation of the quality of life in prostatic cancer. Part 2a]. / Validación del ESCAP-CDV como instrumento de medida para la valoración de la calidad de vida en el cáncer de próstata. 2a Parte.

UNLABELLED: In order to make a measure of quality of life related to health (QLRH) useful in the investigation, it must fulfill the psychometric properties (validity, reliability and sensibility). The selection of an instrument is a job for the clinic that must choose the most effective for each proposed objective. We set out the objectives to validate the ESCAP-CDV in a multicentric study in Andalusia. We studied 88 patients who were submitted to the instrument presented to validation and two more tests recognized already: the QLQ-C30 from EORTC gold standard in Europe in the valuation of the neoplastic patients' quality of life and the KARNOFSKY the most clinic utility index in neoplastic patients, used to correlate the items. RESULTS: Questionnaire acceptance analysis: The difficulty of understanding was greater for QLQ C30 items (6.81%) than ESCAP items (1.98%). The lapse of time needed to carry out the test was shorter in the ESCAP test (9.84 min) than in the QLQ C30 (13.13), test. Structural analysis or internal validity analysis: The homogeneity index of the items is high (alfa of Cronbach = 0.93). The dimensionality proposed is not accepted, due to the existence of some modifications pund in the factorial analysis. Finally, the established dimensions: Physical and Emotional Capacity (PEC), 5 items; General Symptoms (GS), 4 items; Pain (P), 3 items; Ligh Functional Capcity (LFC), 4 items; Serious Functional Capacity (SFC), 2 items; Economic State (ES), 3 items; Social and Family State (SFE), 5 items; Capacity Sexual (CSX), 2 items; Isolated Variables (IV), 2 items; and Specific Questionnaire (P), 6 items. The ESCAP is a scale with a normal distribution. Approach or external validity analysis: The ESCAP test is well correlated with the other two scales. Reliability test retest: The interclass correlation coefficient is 0.94 in the ESCAP, not so in the KARNOFSKY that is 0.77. CONCLUSIONS: The ESCAP-CDV is a new instrument of valuation of the QLRH composed of a general questionnaire and other specific test of prostate cancer. It has turned out to be a very homogeneous scale due to its internal consistence (alfa of Cronbach of 0.93), showing that it has a normal distribution, that correlates correctly with the scales compared and it is a valid scale to measure the prostate cancer patients' quality of life. The ESCAP-CDV has shown to be a scale with a high reliability (0.94), setting up as an instrument not only useful for investigation, but to clinical use, as well.

[Development of the ESCAP-CDV as measuring tool for the assessment of quality of life in prostatic cancer]. / Desarrollo del ESCAP-CDV como instrumento de medida para la valoración de la calidad de vida en el cáncer de próstata. Primera parte.

The current following of oncological patients is based in a biopsychosocial model where in addition to evaluate the response to treatment, the interval free of illness and the global survival it includes the functional capacity and the psychosocial charge the illness causes in patients. Nowadays, different treatments have improved the survival, therefore the number of years of inability increase. It creates a new variable, the quality of life related to health (QLRH) that valves the individual respond to the physical, mental and social effects that health or illness produces on patients daily life. To establish the QLRH as an instrument of measure is needed. In Spain there isn't any validated instrument for the evaluation of it in patients with prostate cancer. We have developed the ESCAP-CDV (Quality of Life study on prostate cancer) an instrument elaborated by an interdisciplinary group made of urologist, psichologists and a doctor specialized in family medicine expert in psychometric validation of scales. We evaluate multiple dimensions of quality of life in a questionnaires autoadministed.

[Renal cancer: descriptive analysis of a series of 267 intervened cases]. / Cáncer renal: análisis descriptivo de una serie de 267 casos intervenidos.

OBJECTIVE: To present the results of a descriptive analysis of 267 surgically treated renal tumors. METHODS: From January 1986 to October 1999, 267 patients (153 males and 114 females) with renal tumor were treated in our department. All data were introduced into the Access data base program and analyzed using the SPSS software. Descriptive analysis was performed and life expectancy was calculated with the Kaplan-Meier survival curve. Mean follow-up was 42.72 months. RESULTS: 56.4% were in the right and 43.6% were in the left kidney. 41.2% of the cases were incidentally discovered. In the symptomatic patients, the most common presenting feature was hematuria (51.8%). Radical nephrectomy was performed in 94.2%, partial in 3.1% and tumor resection in 2.7%. The lumbar approach was used in 75.5% of the cases. In regard to the histology, 88.7% were carcinomas. Clear cell was the most frequent cell type (91.5%). By grade, 55.8% were GI, 32.9% GII and 11.3% were GIII. By stage (according to the 1992 TNM classification), 64.3% were stage I, 15.4% stage II, 17% stage III and 3.3% stage IV. 80.5% showed no vascular involvement. The 5-year overall survival was 71.93% (mean 114 months; median 167 months). Currently, 76% of the patients are alive. CONCLUSIONS: Distribution by sex in our series was different to that reported in most of the studies. The tumor was incidentally discovered in a high proportion of the cases. The lumbar access was the most widely used surgical approach. The overall survival is similar to that reported by other groups.

[Hydatid cyst and horseshoe kidney: an exceptional association]. / Quiste hidatidico y riñón en herradura: una asociación excepcional.

We report on a case of kidney ecchinococosis associated with a horseshoes renal anomaly. The diagnostic procedures used to confirm this association were serological tests, pyelography and computerized tomography. Periquistectomy was done with good recovery of the left renal unit. We believe to report on a pathological association extremely infrequent.

[Primary signet ring cell adenocarcinoma of the bladder]. / Adenocarcinoma vesical primario de células en anillo de sello.

An additional case of signet ring cell adenocarcinoma of the bladder is described. This tumor type is considered to be uncommon; however, recent studies have reported a higher incidence. The etiopathogenesis and clinical features are discussed. Because it is silent and very aggressive, it is always diagnosed late and the outcome is poor. Treatment is by surgery since radio and chemotherapy have been shown to be little effective.

[Angiomyolipoma of the kidney. Comments on 3 recent cases]. / Angiomiolipoma renal. Comentarios sobre tres recientes observaciones.

We report another three cases of renal angiomyolipoma with different modes of presentation and treatment. Two cases are considered to be of particular interest; one patient presented chyluria in the course of the disease and Wunderlich's syndrome posteriorly, and in the other patient the presenting features were extrarenal. The diagnostic and therapeutic possibilities are discussed and attention is focussed on the conservative approach whenever possible.

[Echography and cytology versus cystoscopy in the follow-up of patients with superficial tumors of the bladder]. / Ecografía y citología versus cistoscopia en el seguimiento de los enfermos con tumores vesicales superficiales.

We present a prospective study on 100 consecutive patients diagnosed with superficial vesical tumour who have had a transurethral resection done on them. For the detection of relapses we use the echography-cytology association and confirm the findings observed by performing a cystoscopy. In view of the high rate of concordancy obtained we conclude by backing this association as a possible alternative to be applied in the control of specific patients with superficial vesical tumours.