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Historical research has allowed us to reviewand document the author of the first description of the intrasinusal route for access to the renal hilum as astrategy for accessing kidney stones through the bibliography. This new route described and published by M. Serés represented a paradigm shift in open surgery for kidney stones. We want to highlight that the Spanish urological anatomical-surgical investigation with the investigations of Manuel Serés, meant a singular contribution and of enormous importance for the History of International Urology, whose value we must claim with its indisputable and reliable references.La investigación histórica nos ha permitido revisar y mostrar documentalmente por la bibliografía el autor de la primera descripción de la via intrasinusal para el acceso al hilio renal como estrategia de accesoa la litiasis renal. Esta nueva via descrita y publicada por M. Serés supuso un cambio de paradigma en la cirugía abierta de la litiasis renal. Queremos resaltar que la investigación anatomo-quirúrgica urológica española con las investigaciones de Manuel Serés, significó una aportación singular y de enorme trascendencia para la Historia de la Urología Internacional, cuyo valor debemos reivindicar con sus referencias indiscutibles y fehacientes.

Few specialties have gone through as many transitions in the last decades as Urology. Progressive physiology advances in several disease have become part of the urological knowledge. Laparoscopic surgery and ESWL (Extracorporeal Shock Wave Lithotripsy) wave have completely turn upside down the whole management of disease. The current text provides a back to the future sigh into Urology.Pocas especialidades médicas y quirúrgicas han experimentado en las últimas décadas tantos y tan significativos avances terapéuticos como la Urología. Además de progresos en los conocimientos fisiopatológicos de las distintas enfermedades que conforman el corpus del saber Urológico. La cirugía laparoscópica y las ondas de choque extracorpóreas han revolucionado la especialidad en su totalidad, provocando cambios de paradigma tanto en las indicaciones terapéuticas como en la interpretación de algunos procesos patológicos. Aportamos unas reflexiones desde una mirada retrospectiva.

Bladder cancer is the fourth most common cancer in men and the ninth most common in women in the Western world. The management of bladder carcinoma requires a multidisciplinary approach. Optimal treatment depends on several factors, including histology, stage, patient status, and possible comorbidities. Here we review recent findings on the treatment of muscle-invasive bladder carcinoma, advanced urothelial carcinoma, upper tract urothelial carcinoma, non-urothelial carcinoma, and urologic complications arising from the disease or treatment. In addition, we present the recommendations of the Spanish Oncology Genitourinary Group for the treatment of these diseases, based on a focused analysis of clinical management and the potential of current research, including recent findings on the potential benefit of immunotherapy. In recent years, whole-genome approaches have provided new predictive biomarkers and promising molecular targets that could lead to precision medicine in bladder cancer. Moreover, the involvement of other specialists in addition to urologists will ensure not only appropriate therapeutic decisions but also adequate follow-up for response evaluation and management of complications. It is crucial, however, to apply recent molecular findings and implement clinical guidelines as soon as possible in order to maximize therapeutic gains and improve patient prognosis.

La incorporación de las TICs en la educación superior responde a las capacidades y a las demandas de la generación de “nativos digitales” y puede resultar un recurso de gran valor en los proyectos de educación e innovación. Las TICs permiten desarrollar nuevos métodos de enseñanza y aprendizaje que convierten al estudiante en protagonista activo del proceso. Este Proyecto de Innovación Educativa financiado por la UPM permite explorar los beneficios de la integración de los medios digitales a la enseñanza de la Arquitectura a través del viaje. Por ello, este proyecto propone la construcción colectiva de un repositorio vivo y abierto de visitas virtuales de los edificios visitados durante el viaje de curso mediante una experiencia de realidad virtual. Las “visitas virtuales” son registradas y editadas por los propios estudiantes y que posteriormente, coordinados por los docentes, generan una base documental capaz de activar una comunidad de usuarios que dinamice los contenidos. The incorporation of ICTs in superior education responds to the social demands of the generation of "digital natives" and is indispensable in education and innovation projects. ICTs allow the development of new methods of teaching and learning that turn the student into the active protagonist of learning. This Project of Educational Innovation of the UPM allows to explore the benefits of the integration of digital media to the teaching of Architecture through travel. The trip is a fundamental formative activity for the architect. Therefore, this project proposes the collective construction of a live and open repository of virtual visits of the buildings visited during the trip through a virtual reality experience. The "virtual visits" are registered and edited by the students themselves and later, coordinated by the teachers, they generate a documentary base capable of activating a community of users that dynamizes the contents.

El Diccionario Filosófico de Cambridge, en su segunda edición editada por Robert Audi en 1999, define lo con¬tingente como aquello que no es ni imposible ni necesario. El término contingencia se refiere, por tanto, a aquello que, pese a reunir todas las condiciones necesarias para suceder, puede acabar por no ocurrir. En la misma entra¬da del diccionario, más adelante se afirma que el concepto es sin duda aplicable a proposiciones, estados o eventos, pero se pone en cuestión que podamos referirnos a objetos contingentes. La investigación que se desarrolla a continuación bajo el título Sobre el Concepto de Contingencia en Arquitectura. Procedimientos para la definición del objeto contingente en Arquitectura pretende demostrar que el concepto de contingencia es aplicable también a objetos. Más concretamente, el trabajo trata de exponer cómo la construcción de esos objetos contingentes ha sido tarea fundamental de la práctica arquitectónica internacional más relevante de los últimos 30 años, durante las que oficinas alrededor de todo el mundo han proyectado desde la consciencia de la aleatoriedad de los entornos en lo que su producción se emplazaba. Desde principios de la década de los años 40 del siglo XX el tiempo pasó a ser una cuestión inevitable para la Arquitectura. La publicación de Espacio, Tiempo y Arquitectura por Sigfried Giedion, que podemos considerar hito en la construcción de un reconocimiento explícito al peso de lo temporal, en realidad no hacía más que res-paldar la actitud temerosa con la que la arquitectura se estaba aproximando a la cuestión, tratando de domesticar el tiempo en la interacción con su producción. El caso de Le Corbusier y su promenade architecturale resulta paradigmático en este sentido, y retrata la relación con el tiempo de un arquitecto que predicó en uno de sus mani¬fiestos más significativos la ‘expulsión de las presencias contingentes’ en la construcción del espacio más elevado. Sin embargo el tránsito entre la década de los 80 y los 90 del mismo siglo trajo consigo una nueva actitud frente a la incertidumbre que ya introdujo lo temporal con todas sus consecuencias en el diseño del objeto arquitectónico. La arquitectura ha desarrollado desde entonces una aproximación que reconoce lo eventual como una de las ca¬racterísticas que define de forma más significativa el entorno en el que trabaja. Desde esa posición, las últimas décadas han visto desarrollarse prácticas que han hecho frente a ello no sólo sin renunciar a la condición objetual de su producción sino reforzándola, en un movimiento paradójico si atendemos a las reticencias expuestas al inicio. La investigación se aproxima a esta producción, ampliamente divulgada, con una metodología que se deriva de una lectura intencionada de la obra de Richard Rorty Contingencia, ironía y solidaridad. En el primer apartado del primer capítulo de su obra, titulado ‘La contingencia del lenguaje’, se expone cómo a través de la acción de redescribir repetidamente algo aparentemente conocido, el lenguaje es capaz de señalar un nuevo interés y una nueva forma de proceder vinculada. La propiedad dúctil del lenguaje permite utilizarlo en la construcción de ese nuevo campo a partir de la observación tangencial de prácticas sobradamente conocidas. De esta forma, se desarrolla un estudio de casos agrupado en un ‘Manual de arquitectura contingente’ que recoge una muestra significativa de arquitecturas cuyo trato con la incertidumbre resulta especialmente relevante para el marco de interés definido en la tesis. El manual está ordenado según los procedimientos que el estudio ha revelado útiles para la definición de cada uno de esos objetos contingentes, que son transferidos a la arquitectura desde el cuerpo de conocimiento empresarial dedicado a la elaboración de los ‘planes de contingencia’. El manual recoge prácticas extensamente difundidas como las de OMA, Lacaton & Vassal, SANAA (también tanto Kazuyo Sejima como Ryue Nishizawa en su práctica por separado), Diller Scofidio, OFFICE, Sou Fu¬jimoto, Atelier Bow-Wow o incluso de artistas trabajando en propuestas radicalmente espaciales (y por tanto arquitectónicas) como Olafur Eliasson o Ann Veronica Janssens. Sus trabajos son vueltos a describir desde la construcción que proponen de objetos contingentes, y ordenados a través de las cuatro estrategias de continuidad que los ‘planes de contingencia’ proponen: centro frío, centro caliente, centro espejo y centro móvil. Todo ello para construir una evidencia práctica de la posibilidad del objeto contingente en Arquitectura. ---------- ABSTRACT---------- The Philosophical Dictionary of Cambridge, in its second edition edited by Robert Audi in 1999, defines contingent as that which is neither impossible nor necessary. The term contingency refers, therefore, to what despite meeting all the necessary conditions to happen, may end up not occurring. In the same entry of the dictionary, it is affirmed later that the concept is certainly applicable to propositions, states or events, but it is put in question that it can refer to contingent objects. The research expounded on below under the title On the Concept of Contingency in Architecture. Procedures for the definition of the contingent object in Architecture aims to demonstrate that the concept of contingency is also applicable to objects. More specifically, the thesis tries to explain how the construction of these contingent objects has been a fundamental task for the most relevant international architectural practices during the last 30 years, in which offices around the world they have projected aware of the randomness of the environments in which its production was located. From the beginning of the 1940s, time became an inevitable issue for Architecture. The publication of Space, Time and Architecture by Sigfried Giedion, which we can consider as a milestone in the construction of an explicit recog-nition of the weight of temporality, actually only supported the fearful attitude with which architecture was approa¬ching the question, trying to tame the time in the interaction with its production. The case of Le Corbusier and his promenade architecturale is paradigmatic in this sense, and portrays the relationship with time of an architect who preached in one of his most significant manifests the ‘expulsion of contingent presence’ in the construction of the highest space. However, the transition between the 1980s and 1990s brought with it a new attitude towards uncertainty, which already introduces temporality with all its consequences in the design of the architectural object. Since then, architecture has developed an approach that recognizes eventuality as one of the characteristics that define in a more significant way the environment in which it works. From this position, the last decades have seen practices that have been faced with this, not only without renouncing the objective condition of their production but reinforcing it, in a paradoxical movement if we attend to the reluctance exposed at the beginning. The research approaches this production, widely disseminated, with a methodology derived from an intentional reading of Richard Rorty’s work Contingency, irony and solidarity. In the first section of the first chapter of his work, entitled ‘The contingency of language’, it is exposed how through the action of repeatedly describing something apparently known, language is able to stand out a new interest and a new way of proceeding linked. The ductile property of language allows it to be used in the construction of this new field based on the tangential observation of well-known practices. In this way a case study is developed, grouped in a ‘Manual of contingent architecture’ that includes a significant sample of architectures whose treatment with uncertainty is especially relevant to the framework of interest de¬fined in the thesis. The manual is ordered according to the procedures that the study has shown as useful for the definition of each of these contingent objects, which the research conceptually moves from the body of business knowledge dedicated to the elabor ation of ‘contingency plans’. The manual includes widely used practices such as OMA, Lacaton & Vassal, SANAA (also both Kazuyo Sejima and Ryue Nishizawa in their separate practice), Diller Scofidio, OFFICE, Sou Fujimoto, Atelier Bow-Wow or even artists working on proposals radically spatial (and therefore architectural) such as Olafur Eliasson or Ann Veronica Janssens. Their works are re-described from the construction they propose of contingent objects, and ordered through the four continuity strategies that the ‘contingency plans’ describes: Cold center, Hot center, Mirror center and Mobile center. All this to build a practical evidence of the existence of the contingent object in Architecture.

Background: Bladder and lung cancer are among the ten most common cancers in both genders. The NKG2D receptor and one of its ligands, MICA, are associated with smoking and susceptibility to both chronic obstructive pulmonary disease and lung cancer. Objective: We hypothesized that NKG2D-MICA system was associated with other smoking-related epithelial cancers such as bladder cancer. Design, Setting, and Participants: 70 cases of primary non-muscle invasive bladder cancer were screened for the MICA expression and CD8+, CD4+ and NK cell infiltration. Most patients (n = 55, 78.6%) were current or former smokers. Measurements: Tissue microarray (TMA) technology was chosen to evaluate MICA and tumor infiltrating lymphocytes in samples with confirmed bladder cancer. Kaplan-Meier curves and univariate Cox analysis was used to assess relapse, all-cancer mortality and specific bladder cancer mortality. Results and Limitations: MICA was expressed in most cancer specimens examined (i.e., 70%). Relapse of bladder cancer was not associated with the status of MICA expression (log rank p = 0.1123). Nevertheless, a significant association existed between high MICA expression and bladder cancer mortality (HR = 0.25; CI95% = 0.06 - 0.97). Tumor infiltrating CD4+ and CD8+ lymphocytes were found in the majority (64%) of samples. Cells expressing the NKG2D receptor were found in only 3% of the samples. There was no linear function between NKG2D+ cells and number or ratio of CD4+ and CD8+ TIL. Conclusions: MICA is expressed in a significant proportion of bladder carcinomas. MICA expression associates with significant survival advantages in the face of both all-cancer and bladder cancer. The NKG2D-MICA system could represent a common mechanism involved in the immunopathology and natural history of bladder neoplasms.

OBJECTIVES To classify bladder tumors according to their genomic imbalances and evaluate their association with patient's outcome. METHODS Sixty-three superficially and minimally invasive bladder tumors were analyzed by conventional comparative genomic hybridization. Subtelomeric screening in 15 of these tumors was performed by multiplex ligation-dependent probe amplification. RESULTS Losses of 9q and 9p (32% and 25% of all cases, respectively) as well as gains of chromosomes Xq and Xp (28% and 25%, respectively) were the most frequent chromosome imbalances. Losses of 8p and gains in 1q and 8q were detected in >20% of cases. Tumors were classified into 3 groups according to their individualized pattern of gains and losses. The largest group was characterized by few chromosome imbalances, presenting 77% and 49% of the Ta and T1 tumors, respectively. Another group characterized by chromosomal gains, was composed of equal number of Ta and T1 tumors, with +1q and +17q gains being the most common imbalances. A minority group was characterized by chromosomal losses on 11q, 5q, and 6q. The multiplex ligation-dependent probe amplification study showed good correlation with comparative genomic hybridization results. With regard to the biological significance of this classification, a remarkable fact is that this minority group composed mainly of T1 tumors, showed a significant decrease in patient overall survival. CONCLUSIONS Our data suggest that superficial carcinomas of the bladder can be subdivided into a larger number of subclasses than had previously been expected. Our results also demonstrate a decreased survival among patients whose tumors show more genomic losses than gains. UROLOGY 75: 347-356, 2010. Crown Copyright (C) 2010 Published by Elsevier Inc.

Study Type – Prognosis (case series) Level of Evidence 4 OBJECTIVE To estimate the relative risk of developing a second primary neoplasm, in particular lung cancer, after having non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS Patients were included in the study if they had developed NMIBC between 1995 and 2003. All clinical data were extracted from the medical records of our institution’s database. The interval between neoplasms, smoking habits, histological subtypes and survival were also analysed. Patient follow-up was ≥5 years. RESULTS We found 231 patients with NMIBC, 39 of which had a second primary neoplasm: 10 lung cancer, one pancreas, one gastric, one pharynx, one liver, one parathyroid, one oesophageal, five basal cell carcinoma, three larynx, two colon, three rectal and 10 prostate. In patients with lung cancer, NMIBC was the first primary tumour. Overall, the median (range) interval between occurrence of NMIBC and lung cancer was 54.2 (8–168) months. For the relationship between the observed and expected cases of lung cancer, after normalizing our frequencies to the sex ratio and age of our group of patients, the risk of lung cancer was 10.27-fold higher in patients with NMIBC as compared with the general population of Catalonia (95% confidence interval 4.92–18.88). CONCLUSION We consider that an annual examination for the detection and prevention of lung cancer must be included in clinical guides for patients with NMIBC. This proposal is reinforced by the finding that death in our group of patients with both tumours was always derived from lung cancer and not from bladder cancer.

El presente artículo forma parte de la Tesis Doctoral Sobre el Concepto de Contingencia en Arquitectura. Afinidades desestabilizadoras del objeto arquitectónico, actualmente en desarrollo en el Departamento de Proyectos Arquitectónicos de la ETSAM, bajo la codirección de Federico Soriano y Pedro Urzaiz. Se trata de una investigación cuya voluntad última es la de resolver si existe en la arquitectura contemporánea una metodología de proyecto capaz de dar respuesta eficaz –formal, programática, estructural, comunicativa– a la incertidumbre de los entornos en los que emplaza sus formas, partiendo de la convicción de que el Movimiento Moderno se construyó sobre una voluntad de suspensión de la contingencia que le impidió responder de forma eficaz a los entornos inestables en los que trabajaba, unos entornos que la arquitectura contemporánea ha asumido como condición intrínseca en la definición de sus modelos de realidad. Para ello se construye esta aproximación, personal y precisa, a la definición del concepto de contingencia en arquitectura partiendo de la toma de posición relevante de tres autores acerca del papel de la incertidumbre en la definición de entornos operativos –o arquitectónicos o aplicados a la arquitectura. This article belongs to the PhD investigation “On the Concept of Contingency in Architecture. Destabilizing affinities architectural object” currently under development at the Architectural Design Department of the ETSAM. The PhD thesis is co-directed by Federico Soriano and Pedro Urzaiz. It is an investigation whose last wish is to give an answer to the question whether there is in contemporary architecture a project methodology capable of giving effective response –formal, programmatic, structural, communicative– to the uncertainty of the environment in which forms are placed. Based on the conviction that Modern architecture was built on a willingness to suspend contingency and that it prevented it giving effective responses to unstable environments, environments that contemporary architecture has assumed as an intrinsic condition in the definition of models of reality. So this approach is started, personal and accurate, to build a definition of contingency in architecture based on relevant position taking by three authors about the role of uncertainty in the definition of operational environments (both architectural or applied to architecture).

We report a case of clear cell renal cell carcinoma in which a prominent multinucleated giant cell component was intermingled with clear, granular, and spindle cells. Histological, ultrastructural, cytometric, and cytogenetic features of giant cells were similar to those of mononucleated cells in the tumor, and therefore they were not from stromal or osteoclast derivation. These giant cells had homogeneous, finely granular, abundant cytoplasm, often with scalloped cell borders, and contained from 5 to more than 50 nuclei, all of them very similar in size and shape, with prominent central nucleoli. Occasionally, surrounding inflammatory cells were also engulfed in the cytoplasm. This syncytial appearance was more similar to that of some giant cell carcinomas from the lung than to the pleomorphic giant cells often encountered in high grade renal cell tumors. Although the patient is alive and free of disease 6 years after diagnosis, a longer follow-up will be required to assess the potential prognostic influence of this peculiar histological appearance.

The authors attempted to determine the potential prognostic value of several ultrastructural morphometric parameters, including nuclear, nucleolar, and cytoplasmic features, that could be used in the objective and reproducible histological grading of clear cell renal cell carcinoma. Several nuclear and cytoplasmic parameters were assessed by ultrastructural morphometry in 26 consecutive cases of clear cell renal cell carcinoma. The nuclear and nucleolar sizes, the number of nucleoli per nuclear section and the number of marginated nucleoli, Fuhrman's nuclear grade, and Robson's stage were recorded. In addition, the proportion of cytoplasmic components was semiquantitatively estimated and compared to light microscopic appearance. Follow-up ranged from 5 to 15 years (mean = 10 years). Statistical evaluations were performed by means of the Pearson or Spearman correlation coefficient tests, and differences in survival were estimated, using the Mantel-Cox proportional risk method. Differences in survival among patients with a mean nuclear area over and under 160 microm2, and among those with a mean nucleolar area over and under 10 microm2, were statistically significant. (Cutoff points were selected at the median value for both parameters; Mantel-Cox test: chi2 = 7.102, p < .01; and chi2 = 11.096, p < .001, respectively). Fuhrman's nuclear grade (p < .01) and tumor stage at diagnosis (p < .001) were also related to survival. These data suggest that, out of all the ultrastructural morphometric features, nucleolar area is the most useful in the reproducible and accurate grading of clear cell renal cell carcinoma.

This 2-day national symposium on recent advances in the treatment of advanced prostate cancer, organized under the auspices of the Spanish Society of Medical Oncology, the Spanish Association of Ur...

We performed a study of loss of heterozygosity (LOH) at 3p by restriction fragment length polymorphism analysis in a series of 22 renal tumors. In 11 cases, molecular results could be compared with those of cytogenetic studies. The highest frequency of allelic losses at 3p was seen in clear cell non-papillary renal tumors, whereas none of the papillary renal cell carcinomas showed LOH at 3p. Allelic losses on 3p were found to be independent of tumor grade or stage or both. One case analyzed showed a discrepancy between cytogenetic and LOH studies. This tumor displayed rearrangements of chromosome 3 and no LOH at the c-RAF-1 (close to the Von Hippel Lindau gene) locus.

Purpose: We describe our technique of scrotal epilation and the advantages of using the resultant glabrous scrotal skin in reconstructive urethral surgery.Materials and Methods: An insulated needle model adapted to scrotal hair characteristics and a thermocoagulation current generator were used.Results: An average of 3 epilatory sessions with a 4-week interval between treatments was the optimal schedule. No cutaneous infection was noted.Conclusions: The good results permitted the conversion of predetermined scrotal zones into wide areas of alopecia to be used as excellent skin flaps in complex urethral stenosis surgery in postpubertal male patients.

We determined MYC gene numerical aberrations and protein expression at different stages of penile squamous cell carcinoma carcinogenesis. We correlated these findings with clinicopathological parameters and HPV infection.We evaluated 79 cases of penile squamous cell carcinoma, including 11 in situ and 68 invasive carcinomas. The MYC cytogenetic profile was evaluated by fluorescence in situ hybridization. HPV was detected by polymerase chain reaction amplification.MYC gains were identified in 4 of 11 in situ carcinomas (36%) and 50 of 68 invasive penile squamous cell carcinomas (73%). A significant association between MYC gains, and tumor progression and poor outcome was demonstrated (p0.05). HPV DNA was detected in 32 of 79 penile squamous cell carcinomas (39%). High risk type 16 was the most prevalent type. MYC numerical aberrations did not correlate with HPV status. A significant association between HPV and MYC protein over expression was noted. In HPV negative cases MYC gains correlated with MYC over expression.MYC gains progressively increased during penile squamous cell carcinoma progression from in situ samples to metastases. MYC gains were an independent factor for poor prognosis. These findings were independent of HPV infection. MYC expression was increased in samples with HPV infection, probably reflecting direct activation of MYC.

La comunicació, privilegi de la condició humana, està present i influeix de manera decisiva sobre totes les àrees de la vida. La medicina actual ha perdut molta sensibilitat a causa del fet que no es reforça la comunicació, que passa a segon lloc. En canvi, agafa preeminència el coneixement. La sanitat actual -abans la medicina- tracta usuaris -abans malalts-, i valorant-los així actua com un problema tècnic que s’ha de solucionar. Els patiments com el dolor o l'angoixa vital s’enfoquen com a problemes tècnics que s’han de reparar. Però des del moment en què s’han codificat els drets del malalt, la salut és un dret fonamental, recollit en la nova legislació. Els malalts passen a tenir un paper central en la presa de decisions sobre la seva salut. És un canvi radical sobre el concepte anterior de la praxis mèdica. Ara les habilitats de comunicació estan especialment indicades i destinades a millorar la relació metge-malalt, en general, i de manera especial en les malalties greus. D’aquí la importància que el metge tingui formació en habilitats de comunicació per poder comprendre el seu significat. Les directrius de Bolonya i els nous programes formatius de medicina van en aquesta direcció., Communication is a privilege of the human condition, one that is present and decisively influential in all areas of life. The practice of medicine has often placed emphasis on knowledge and technical advances, relegating communication to second place to the detriment of sensitivity. Users who access the healthcare system and their symptoms are treated as technical problems to be solved. Nevertheless, healthcare is a fundamental right, and patients should play a central role in making decisions about their health. A strong doctor-patient relationship and a focus on communication skills represents a radical change in previous medical practice, and one that is increasingly being adopted, particularly in the treatment of serious diseases. Therefore, doctors should receive training in communication skills, a priority that is reflected in the Bologna guidelines and other recent medical training programs., La comunicación, privilegio de la condición humana, está presente e influye de manera decisiva en todas las áreas de la vida. La medicina actual ha perdido mucha sensibilidad, debido a que no se refuerza la comunicación y pasa a un segundo lugar. En cambio toma preeminencia, el conocimiento. La sanidad actual, antes la medicina, trata usuarios, antes enfermos, y valorándolos así actúa como un problema técnico que tiene que solucionar. Los sufrimientos con dolor o angustia vital, se enfocan como problemas técnicos que deben ser reparados. Pero desde el momento en el que se han codificado los derechos de los enfermos, la salud es un derecho fundamental, recogido en la nueva legislación. Los enfermos, pasan a tener un papel central en la toma de decisiones sobre su salud. Es un cambio radical sobre el concepto anterior de la praxis médica. Ahora les habilidades de comunicación están especialmente indicadas y destinadas a mejorar la relación entre médico y enfermo, en general, y de manera especial en las enfermedades graves. De aquí la importancia que el médico tinga formación en habilidades de comunicación para poder comprender su significado. Las directrices de Boloña y los nuevos programas formativos de Medicina van en esta dirección.

Background Aneuploidy, centrosome abnormalities and gene amplification are hallmarks of chromosome instability (CIN) in cancer. Yet there are no studies of the in vivo behavior of these phenomena within the same bladder tumor. Methods Twenty-one paraffin-embedded bladder tumors were analyzed by conventional comparative genome hybridization and fluorescence in situ hybridization (FISH) with a cyclin D1 gene (CCND1)/centromere 11 dual-color probe. Immunofluorescent staining of α, β and γ tubulin was also performed. Results Based on the CIN index, defined as the percentage of cells not displaying the modal number for chromosome 11, tumors were classified as CIN-negative and CIN-positive. Fourteen out of 21 tumors were considered CIN-positive. All T1G3 tumors were included in the CIN-positive group whereas the majority of Ta samples were classified as CIN-negative tumors. Centrosome clustering was observed in six out of 12 CIN-positive tumors analyzed. CCND1 amplification in homogeneously staining regions was present in six out of 14 CIN-positive tumors; three of them also showed amplification of this gene in double minutes. Conclusions Complex in vivo behavior of CCND1 amplicon in bladder tumor cells has been demonstrated by accurate FISH analysis on paraffin-embedded tumors. Positive correlation between high heterogeneity, centrosome abnormalities and CCND1 amplification was found in T1G3 bladder carcinomas. This is the first study to provide insights into the coexistence of CCND1 amplification in homogeneously staining regions and double minutes in primary bladder tumors. It is noteworthy that those patients whose tumors showed double minutes had a significantly shorter overall survival rate (p < 0.001).

Prognosis (case series) Level of Evidence 4.To estimate the relative risk of developing a second primary neoplasm, in particular lung cancer, after having non-muscle-invasive bladder cancer (NMIBC).Patients were included in the study if they had developed NMIBC between 1995 and 2003. All clinical data were extracted from the medical records of our institution's database. The interval between neoplasms, smoking habits, histological subtypes and survival were also analysed. Patient follow-up wasor=5 years.We found 231 patients with NMIBC, 39 of which had a second primary neoplasm: 10 lung cancer, one pancreas, one gastric, one pharynx, one liver, one parathyroid, one oesophageal, five basal cell carcinoma, three larynx, two colon, three rectal and 10 prostate. In patients with lung cancer, NMIBC was the first primary tumour. Overall, the median (range) interval between occurrence of NMIBC and lung cancer was 54.2 (8-168) months. For the relationship between the observed and expected cases of lung cancer, after normalizing our frequencies to the sex ratio and age of our group of patients, the risk of lung cancer was 10.27-fold higher in patients with NMIBC as compared with the general population of Catalonia (95% confidence interval 4.92-18.88).We consider that an annual examination for the detection and prevention of lung cancer must be included in clinical guides for patients with NMIBC. This proposal is reinforced by the finding that death in our group of patients with both tumours was always derived from lung cancer and not from bladder cancer.

Advances in the diagnosis and management of prostate cancer have been associated with changes in clinico-epidemiological characteristics and cancer-specific mortality. Secular trends of prostate cancer patients and its correlation with PSA implementation and the introduction of combined radiation and hormonal therapy (RT + HT) were assessed in a cohort of 910 cancer patients with histologically confirmed prostate cancer diagnosed between 1992 and 2005, and included in a hospital-based database. Relative survival before and after 1999 (when RT + HT for locally advanced disease was introduced) was compared. The mean age at diagnosis decreased from 72.9 years in 1992–1996 to 68.7 in 2003–2005 and the median PSA from 34 to 8 ng/ml. In patients with stages II and III, there was an increase in the indication of RT with or without HT and a decrease in the indication of surgery (from 87.5% to 44.2%). The overall relative 5-year survival increased from 67.3% (95% CI 60.2–75.2) to 92.9% (95% CI 87.3–98.9). The same trend in stage II and stage III cancer patients was found. There was an increase in survival coincidentally with a shift towards lower stages and PSA levels at presentation. Besides other factors, changes in death rates since 1999 could be explained by secular variations in the treatment of the disease, particularly the implementation of RT + HT in intermediate and high-risk locally advanced prostate cancer.

Los avances en la comprension de la biologia molecular del RCC ha dado lugar al desarrollo de tratamientos biologicos dirigidos (terapias diana) que representan, por vez primera en mas de quince anos de tan solo disponer de las citocinas como arma terapeutica, un avance significativo en el tratamiento de esta enfermedad, con una mejora importante en la supervivencia libre de enfermedad y con algunos farmacos, de la supervivencia global. Asimismo, el perfil de toxicidad con respecto a los tratamientos considerados estandar como las citoquinas han mejorado de forma ostensible.

Kruppel-like factor 6 (KLF6) has been reported to act as a tumor suppressor gene involved in the regulation of the cell cycle by activating p21 in a p53-independent manner. Many studies suggest that KLF6 is inactivated by allelic loss and somatic mutation. However, there is a high variability in the reported frequency of mutations (from 1 to 55%). TP53 also regulates the cell cycle through the activation of p21. In prostate cancer, the reported frequency of TP53 mutations ranges from 3 to 42%. In all these reports, there is a considerable degree of methodological heterogeneity. Our aim was to determine the frequency of KLF6 and TP53 mutations in a well-defined group of prostate tumors with different stages and Gleason grades. The four exons of KLF6 and exons 4-9 of TP53 were studied in 103 cases, including 90 formalin-fixed, paraffin-embedded (FFPE) and 13 frozen samples. All tumors were analyzed through PCR and direct sequencing. All changes found were confirmed by a second independent PCR and sequencing reaction. For KLF6, mutation (E227G) was only detected in one tumor (1%) and for TP53, three different mutations (L130H, H214R, and Y234C) were detected in five tumors (5%). This low mutation index is in keeping with recent papers on the subject. Our study strongly supports the notion that KLF6 and TP53 mutations are not frequent events in prostate cancer. When using FFPE tissues, it is mandatory to perform at least two independent rounds of PCR and sequencing to confirm mutations and exclude Taq polymerase-induced artifacts.

We propose a modification to open nephroureterectomy.By a single incision (lumbar incision) a percutaneous ligation-section of the finely dissected terminal ureter is performed.This technique offers a better quality of life in the immediate postoperative period, shortens the surgical time, and it has the advantage of being oncologically safe, avoiding a double surgery.

Objetivo: Proponemos una modificación de la nefroureterectomía abierta. Método: Mediante una sola incisión (lumbotomía) se efectua una ligadura-sección percutánea del uréter terminal finamente disecado. Resultados/Conclusiones: Ofrece una mejor calidad de vida en el postoperatorio inmediato, acorta el tiempo quirúrgico, y esta lumbotomía tiene la ventaja de ser oncológicamente segura, evitando una doble cirugía.

Comparative genomic hybridization and fluorescence in situ hybridization were used to define genetic changes associated with multifocal bladder cancer and to investigate whether the genetic relationship between synchronous urothelial tumors is similar to that observed within different parts of the same tumor. We investigated 8 synchronous urothelial tumors from 3 patients and macroscopically different parts of the same tumor from 2 other patients. The most frequent imbalances were gains of 1q, 2p, and 17q, and losses in 4q. The high number of chromosome imbalances detected in the present report confirms that a high level of chromosome instability could be character- istic of multicentric bladder tumors. Comparative genomic hybridization profiles obtained from independent tumors belonging to the same patient allowed us to elaborate cytogenetic pedigrees portraying the accumulation of chromo- some alterations as a form of clonal evolution from a single precursor cell. The analysis of different macroscopic parts of the same tumor allowed us to detect chromosomal heterogeneity and to delineate intratumor clonal evolution. Some chromo- some regions that appeared as a gain in one subpopulation were amplified in others indicating a genetic evolution process. Identical processes were observed in different tumors of the same patient. Expansion of chromosome gains and losses between different parts of the same tumor as well as in different tumors of the same patient was also observed. Our results not only provide further evidence of a clonal relationship between different synchronous bladder tumors but also show that the intratumor heterogeneity present in different subpopulations of the same tumor reproduces the behavior of independent synchronous tumors in a same patient.

Trabajo basado en 11 libretas de campo, con sus anotaciones y descripciones de las preparaciones anatómicas macro y microscópicas. Existe además un cuaderno con varios dibujos hechos a mano y a lápiz de mina negra, que reproducen la anatomía microscópica del cuello; además cinco láminas de formato 60x40 cm. de dibujos histológicos, varias preparaciones histológicas, así como algunos papeles de carta con el membrete de Don Salvador en sus distintas facetas institucionales. Our work is based on 11 field notebooks with his notes and descriptions of macroscopic and microscopic anatomic preparations. There is also one notebook with several handmade drawings on black lead pencil, reproducing the microscopic anatomy of the bladder neck; there are also five 60 x 40 cm prints with histologic drawings, several histologic preparations, as well as several letter papers with Dr. Salvador’s letterhead in his various institutional aspects.

Prostate cancer preferentially metastasizes to regional lymph nodes and bone. The incidence of dissemination has been reduced over the last years mainly due to the compost use of PSA. For this reason, the indication of complementary diagnostic tests has evolved with the aim of improving the diagnostic yield. Some of these techniques are currently under evaluation and may contribute in the close future to change the study of dissemination in the clinical practice. CT scan or MRI are the standard imaging studies for lymph node dissemination, whereas bone scan continues to be the routine test for bone dissemination.

El cáncer de próstata (CP) metastatiza a distancia preferentemente en los ganglios linfáticos regionales y en el hueso. La incidencia de la diseminación se ha visto reducida en los últimos años debido principalmente al amplio uso del antígeno prostático específico (PSA). Por este motivo, la indicación de la realización de las exploraciones complementarias ha ido evolucionando en un intento de mejorar su rentabilidad. Algunas de estas técnicas se encuentran actualmente en evaluación y pueden contribuir en un próximo futuro a cambiar la práctica clínica del estudio de extensión. En la evaluación de la diseminación ganglionar, el TC o la RM son las técnicas por imagen estándar mientras que en la evaluación ósea la GO continúa siendo el rastreo de rutina.

Adrenal masses have different presentations, from an incidentally diagnosed mass to a blooming Cushing's syndrome, this stimulated our interest to evaluate and describe our case series over the last 10 years, besides to perform a bibliographic update.Retrospective and descriptive study of 22 patients suffering from adrenal masses, evaluating their clinical and radiological characteristics, functional disturbances, and histological diagnosis, emphasizing the first suspicion or finding suggesting adrenal disease.Men were more often affected than women in this series, 12 men vs. 10 women. Mean age was 51.2 years (33-71). Regarding side, 10 cases were right, 8 left and 2 presented bilateral disease, one of them bilateral adenoma and the other asynchronous renal carcinoma metastasis. The inverted "Y" morphology usually observed on CT scan was lost in 14 patients. Size varied between the following ranges: 2-4 cm--9 cases, 4-6 cm--12 cases, and one case of a gigantic cyst within the left hemi-abdomen.Results in our series are similar to those in the literature, adrenal masses are uncommon and despite their low incidence they have different clinical and a histological forms of presentation. 27% of them were incidental, which represents a significant percentage in comparison with other series. Adequate clinical and functional studies as well as their radiological characteristics will set the indication for adrenalectomy or follow-up. Most cases4 cm (7/9) were renal carcinoma metastasis or pheochromocytoma. Incidentally diagnosed cases have increased with the development of new imaging technologies as well as with more frequent use of them. The functional study of adrenal masses has suffered little change. Surgical treatment of these pathologies is suffering important changes with the advent of laparoscopic urologic surgery.

To present two cases of extrinsic ureteral obstruction secondary to gynaecological inflammatory diseases, and to perform a bibliographic review.We present two cases of obstructive uropathy with uretero-hydronephrosis secondary to tubo-ovarian abscesses diagnosed at our department. Clinical features at presentation, diagnostic tests, and preoperative management are reported.We report the clinical resolution of each case and perform a review about this pathology.Extrinsic ureteral obstruction is a frequent problem in urology. Inflammatory gynaecologic disease should be included among possible causes at the time of differential diagnosis. A methodical diagnosis process allows defining the exact location of the obstruction, diagnostic possibilities, and most adequate treatment plan for each case. Although association of gynaecological pathology and urinary tract obstruction is well known, there are not many bibliographic references in the national and international literature.

To achieve an effective, safe and fast hemostasis. To translate it into a great diminution of operating time, avoiding multiple ligatures that are time consuming and being merely a mechanical, repetitive act do not add any element of quality to surgery in general and to urologic pelvic procedures in particular.A new hemostatic system has been experimented in pelvic urologic open surgery, specifically in radical cystectomy (RC) (with orthotopic substitution or urinary diversion) and radical prostatectomy (RP). It achieves vascular sealing by means of tissue collagen precipitation when applied in previously dissected vascular pedicles during radical cystectomy and neuro-vascular bundles during radical prostatectomy.It has been noted a complete efficacy in the coagulation of all vascular pedicles as well as a significant decrease in operating time (around 25%) because the use of ligatures is completely avoided. It has also been noted a great decrease in blood loss, with reductions in transfusion needs down to 50% of the cases.The new hemostatic system by tissue collagen coagulation allows a fast, effective and safe hemostasis in complex urological pelvic surgery, which translates into operative time savings and minimal blood loss.

Comparative genomic hybridization (CGH) and conventional cytogenetic karyotyping were used to screen for losses and gains of DNA sequences along chromosomes in ten renal tumors (RCC) of different histologic types (clear-cell RCC, papillary RCC, and one oncocytoma). Loss of 3p was the most common change in clear-cell RCC. All papillary tumors, either adenomas or carcinomas revealed gains of chromosomes 7 and 17q without limitation to size and grade. Homozygotic loss of the pseudoautosomal Xp or Yp region was detected in three RCC tumors. A dicentric (Y;14) was present as the sole chromosome abnormality in the oncocytoma. Both techniques showed concordant results in tumors with homogeneous karyotype. However, in tumors with several composite clones some discrepancies were observed, especially in cases of clear-cell RCC where chromosomal abnormalities present in a low number of metaphases could not be detected by CGH.

To report a case of focalized stage II xanthogranulomatous pyelonephritis and the diagnostic difficulties encountered.A 63-year-old female consulted at the emergency services for fever during the last two months and right lumbar pain. Urinary cultures were negative. A CT scan showed a poorly-defined heterogeneous mass in the lower pole of the right kidney. Fine needle punction-aspiration biopsy was compatible with renal cell carcinoma. The patient underwent radical nephrectomy.The histopathological study showed focalized stage II xanthogranulomatous pyelonephritis but no evidence of neoplasia.Xanthogranulomatous pyelonephritis can mimic the clinical, cytological and imaging features of renal neoplasia.

We used comparative genomic hybridization to analyze 10 primary tumor samples from patients with transitional cell carcinoma of the renal pelvis. The most frequent loss was located at 9q, that is, in 50% of the tumors. Gains of DNA sequences were most frequently observed in chromosome regions 1q21 approximately q23, 2p23 approximately p25, 8q21.1 approximately q22 and in the whole chromosome 20. High level amplifications at 1q21 approximately q25, 6p22 approximately p23, 8q21 approximately q22, 8q22 approximately q24.1, 11q13, and 12q14 approximately q21 were detected. Most of these regions have previously been reported to be involved in transitional cell carcinoma of the bladder, thus confirming the importance of an increasing number of chromosome imbalances in the development and progression of this type of tumors.

Forty-eight transitional cell carcinomas of the bladder and three transitional cell carcinomas of the renal pelvis were examined for loss of heterozygosity (LOH) on chromosomes 3p, 6q, and 17p. The most frequent allelic loss was seen on 17p (18/36, 50%) followed by 6q (6/22, 27%), and 3p (5/22, 23%). In cases with LOH at more than one locus, the same DNA sample often varied in degree of signal reduction for missing alleles. This observation indicates that LOH studies can serve to detect intratumor heterogeneity. No correlation was found between allelic losses at these chromosome arms and tumor grade and stage. Allelic losses on 6q were associated with tumors having a solid growth pattern; in this kind of tumors, allelic losses on 3p were associated with invasion.

The aim of this study was to analyse the clinical utility of serum bone alkaline phosphatase (BAP) in addition to prostate-specific antigen (PSA) in the staging of newly diagnosed untreated prostate cancer patients. A prospective study was conducted, analysing serum BAP and PSA concentrations in 295 consecutive newly diagnosed untreated prostate cancer patients (T1–4, N0–1, M0–1b), 93 of whom had bone metastases on bone scan. The relationship of each marker with extent of bone disease, the influence of several clinical variables on both serum marker levels, the efficiency in predicting bone metastasis through receiver operating characteristic curves and, finally, the clinical utility in avoiding unnecessary bone scans were determined. Significant differences were found in the serum levels of both BAP and PSA between patients with and patients without bone metastases. Multiple regression analysis showed the extent of bone disease to be the only variable that influenced both serum levels. However, while serum BAP levels showed a statistical relationship with extent of bone disease, serum PSA levels did not. The best prediction of bone scan findings was obtained with the combination of both markers using a cut-off of 20 ng/ml, with positive and negative predictive values of 46.5% and 100%, respectively. This greater efficiency could permit 32.2% of initial bone scans to be avoided. False-positive and false-negative rates of BAP were 7.5% and 14%, respectively. This study suggests that serum BAP levels could play a complementary role in the diagnosis of bone metastasis in prostate cancer patients. This marker could provide useful clinical information on the degree of skeletal metastasis and constitute an easy way of enhancing the clinical utility of PSA. The addition of this marker to PSA in the initial evaluation could permit staging bone scan to be avoided at a PSA range of 10–20 ng/ml, with significant implications for cost saving.

The authors report a renal cell carcinoma composed largely of spindle cells of Fuhrman's nuclear grade II in which the bland appearance of the cells and low mitotic index were reminiscent of a benign or low-grade smooth muscle tumor. Keratin immunostaining was positive, but evidence of epithelial differentiation was obtained by electron microscopy. The tumor was an incidental finding and it did not invade the perirenal fat or the renal vein. Follow-up is only 24 months but the histological features suggest that the prognosis may be better than that of a classic sarcomatoid renal cell carcinoma.

The main current indication for open testicular biopsy is the extraction of sperm cells for intracytoplasmic sperm injection in patients with azoospermia. Usually the surgical assistant or operator holds the testicle with the nondominant hand throughout the operation. We propose using a scrotal device in the shape of a Rumel tourniquet to maintain the testicle fixed and tight against the scrotal wall all the time with no need to be held by the hand.The Rumel tourniquet is made of a Penrose-type rubber drain and a piece of plastic tube. It is placed at the base of the scrotum to include the 2 testicles, while tension is adjusted until the skin becomes tense and the scrotal wall is held tightly against the testicles. Placing the eyelid retractor is unnecessary since the various scrotal wall layers become spontaneously separated.We have used this device in 20 consecutive testicular biopsies in patients with obstructive azoospermia and for histopathological diagnosis. It was useful in all cases. No device related complications were observed.This straightforward scrotal device simplifies the procedure since no surgical assistant is required, the surgeon can use 2 hands during the operation and testicular biopsy is achievable through a small incision.