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Sex differences influence the clinical characteristics and course of illness of bipolar disorder (BD).Therefore, the aim of the present study was to examine the role of sex differences in neurocognitive performance and psychosocial functioning in a large sample of euthymic patients suffering from BD.The sample included 462 individuals, 347 patients with BD (148 males and 199 females) and 115 healthy controls (HC) (45 males and 70 females). Performance on a comprehensive neuropsychological battery assessing six cognitive domains and psychosocial functioning was compared between groups using linear mixed models, with sex and group as main effects, group by sex interactions and center as a random effect.Males performed better than females in working memory (p 0.001), whereas females outperformed males in the verbal learning (p = 0.03) and memory recognition (p = 0.03) tasks. No significant group by sex interactions were detected in cognitive performance. There were no overall sex differences or group by sex interactions in psychosocial functioning.Lack of assessment of visuo-spatial working memory.There were no overall sex differences in neurocognition and psychosocial functioning. However, small sex differences in some measures of working memory and verbal memory were found. Individual differences of each patient, including sex perspective, should be considered in order to perform a tailored intervention plan adjusted to specific needs in the context of personalized treatment.

Patients with mood disorders show heterogeneity in non-emotional cognition. However, it is unclear whether emotional cognition (EC) is characterised by similar heterogeneity. We aimed to investigate the heterogeneity in EC among remitted patients with mood disorders and explore its association with familial risk. Data from 269 partially or fully remitted patients with mood disorders, 87 of their unaffected relatives (UR) and 203 healthy controls (HC) were pooled from two cohort studies. Hierarchical cluster analysis was conducted using the EC data from patients. UR were categorised into groups consistent with their affected relatives’ cluster assignment. Clusters were compared to HC on EC, non-emotional cognition, clinical characteristics and functioning. We identified three clusters: an ‘emotionally preserved’ (57%), an ‘emotionally blunted’ (26%) and an ‘emotionally volatile’ cluster (17%). ‘Emotionally blunted’ and ‘emotionally volatile’ patients also presented more deficits in non-emotional cognition (global cognition read z=-0.3 and -0.5 respectively). Relatives of ‘emotionally preserved’ patients were more successful at dampening negative emotions (p=.01, d=0.39, 95% CI [-0.76,-0.09]), whereas UR of ‘emotionally impaired’ patients underperformed in verbal fluency (p=.03, d=0.46, 95% CI [.03, 0.68]) compared to HC. The existence of impaired EC groups in remitted mood disorder highlights a need to screen for and treat EC in mood disorders. Improved ability to dampen emotions in UR of ‘emotionally preserved’ patients may reflect a resilience marker while impaired verbal fluency in UR of ‘emotionally impaired’ patients may reflect distinct genetic risk profiles in these EC subgroups.

Background The efficacy of adjunctive group psychoeducation in bipolar disorder has been proven although treatment response differ among individuals. The aim of this study was to characterize responders and non-responders to group psychoeducation in order to identify baseline variables that could predict treatment response. Methods The sample was composed of 103 medicated euthymic patients with bipolar disorder referred to 21 sessions of group psychoeducation (6 months). Sociodemographic and clinical variables, temperament, circadian rhythms, BDNF, cognitive and psychosocial functioning were collected. At the 18-month endpoint, the patients were split in two groups on the basis of having suffered any recurrence. Significant group differences were included in a logistic regression analysis. Results Ninety patients out of 103 engaged in group psychoeducation, 47 of whom (52.2%) responded to psychoeducation and 43 (47.8%) did not. Recurrences occurred more often in the follow-up, the most common being depression. Responders and non-responders differed in gender, age at diagnosis, latency of diagnosis, temperament, attention composite score and BDNF. Lower age at diagnosis of bipolar disorder, lower cyclothimic temperament scores and being male -which was associated with bipolar type I and a trend to more previous manic episodes- were significantly related to a better response to psychoeducation in the regression analysis. Limitations No control group. Conclusions This study identifies age at diagnosis as a significant modifiable risk factor of treatment response, highlighting the need for early identification of bipolar disorder. Existing programs should be adjusted to the characteristics of specific subpopulations in the framework of a personalized approach.

Introduction Bipolar disorder is related to a high level of personal, familial, social and economic burden. There is a need for feasible adjunctive psychological interventions easy to implement in clinical practice in order to enhance aspects that medication alone cannot achieve. This study aims to evaluate the impact of a 12-session adjunctive integrative program designed for patients with bipolar disorder. Methods This is a single-blind prospective, randomized controlled trial involving a total of 132 outpatients with bipolar disorder who will be recruited from the Hospital Clinic of Barcelona. All participants will be randomly assigned to two arms. All the patients will receive treatment as usual (TAU) but in addition the experimental group will receive an integrative approach consisting of 12-sessions of 90 min each in which contents of psychoeducation for patients have been combined with a session for family members, and complemented with aspects related to health promotion, mindfulness training, and strategies for cognitive and functional enhancement. The whole sample will be assessed at baseline, after completion (3-months) and at 12 months from baseline regarding demographic and clinical variables, psychosocial and cognitive functioning, wellbeing and quality of life. The primary outcome measure will be improvement in psychosocial functioning. Conclusions If the integrative approach is effective, it would allow clinicians to cover different areas that may be affected by bipolar disorder, by means of a brief intervention that can therefore be easily generalized to clinical practice. Trial registration NCT04031560 . Date registered July 24, 2019.

BackgroundImproving functioning in patients with bipolar disorder (BD) is one of the main objectives in clinical practice. Of the few psychosocial interventions that have been specifically developed to enhance the psychosocial outcome in BD, functional remediation (FR) is one which has demonstrated efficacy. The aim of this study was to examine which variables could predict improved functional outcome following the FR intervention in a sample of euthymic or subsyndromal patients with BD.MethodsA total of 92 euthymic outpatients were included in this longitudinal study, with 62 completers. Partial correlations controlling for the functional outcome at baseline were calculated between demographic, clinical and neurocognitive variables, and functional outcome at endpoint was assessed by means of the Functioning Assessment Short Test scale. Next, a multiple regression analysis was run in order to identify potential predictors of functional outcome at 2-year follow-up, using the variables found to be statistically significant in the correlation analysis and other variables related to functioning as identified in the previous scientific literature.ResultsThe regression model revealed that only two independent variables significantly contributed to the model (F(6,53): 4.003; p = 0.002), namely verbal memory and inhibitory control. The model accounted for 31.2% of the variance. No other demographic or clinical variable contributed to the model.ConclusionsResults suggest that patients with better cognitive performance at baseline, especially in terms of verbal memory and executive functions, may present better functional outcomes at long term follow-up after receiving functional remediation.

Background The Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego (TEMPS-A) is a self-administered questionnaire intended to assess five affective temperaments: depressive, cyclothymic, hyperthymic, irritable and anxious. Our objective was to examine the psychometric properties of the TEMPS-A using a sample comprised by patients with bipolar disorder (BD) and healthy controls (HC) and to determine cut-off scores for each temperament. Methods Five hundred and ninety-eight individuals (327 BD and 271 HC) completed the TEMPS-A. Cronbach's alpha was used to examine internal consistency reliability. Test-retest reliability and association between different temperamental scales were assessed using Spearman correlation. To confirm factor structure a confirmatory factor analysis (CFA) was carried out. Cut-off scores indicating the presence of dominant temperament were also calculated. Results Internal consistency was optimal for all temperament subscales (α: 0.682- 0.893). The questionnaire demonstrated good test-retest reliability (ρ: 0.594–0.754). The strongest positive associations were found between cyclothymic and anxious and between depressive and anxious temperaments. Hyperthymic and depressive as well as hyperthymic and anxious temperaments showed a strong negative correlation. Limitations The HC sample was not matched with the BD group. There were some sociodemographic and clinical differences between groups that may impact on the obtained results. A portion of patients with BD was recruited from tertiary centers. Conclusions The Spanish version of the Barcelona TEMPS-A questionnaire presents a good internal consistency and their results are stable in clinical population. The performance of the Barcelona TEMPS-A is as good as the original scale.

Clinical and epidemiological research suggests that behavioral addictions (BA) are associated with a wide range of psychiatric disorders. However, the relationship between BA and bipolar disorders (BD) has not been thoroughly explored. The aim of this systematic review was to critically summarize and evaluate the current available evidence regarding a possible association between BA and BD. A systematic review of major electronic databases according to PRISMA guidelines was conducted from inception to 31st December 2017. We sought quantitative studies data concerning prevalence of comorbidity, features and treatment related to BA-BD comorbidity. Data were narratively synthesized. Of the 1250 studies returned from the search, a total of 28 articles were included in this review. BA may be overrepresented in BD samples, and the other way around. Pathological gambling and kleptomania were the most prevalent conditions followed by compulsive buying, compulsive sexual behavior and internet addiction. BA was also associated with other mood disorders, anxiety disorders and substance use disorder. BD-BA comorbidity was related with more severe course of illness. Studies on treatment strategies for BD–BA comorbidity are rather limited; only one randomized controlled trial that fulfilled inclusion criteria was identified. Methodological heterogeneity in terms of design and results among studies was found. BD-BA commonly co-occurs although there is a need for rigorous studies. Routine screening and adequate assessment may be helpful in BD patients to identify individuals at risk for BA and to effectively manage the complex consequences associated with BA-BD comorbidity.

Objectives Cognitive impairment occurs in approximately 50% of remitted patients with bipolar disorder (BD). However, there exists no treatment with replicated and robust efficacy on cognition in BD. This is partially due to limited insight into the neuronal underpinnings of cognitive impairment in these patients. This is the first study to investigate neuronal underpinnings of cognitive impairment in a large functional magnetic resonance imaging (fMRI) dataset comparing neural activity patterns between distinct neurocognitive subgroups of partially or fully remitted patients with BD. Methods Patients (n = 153) and healthy controls (HC) (n = 52) underwent neuropsychological assessment and fMRI, during which they performed a verbal N-back working memory (WM) task. Based on hierarchical cluster analysis of neuropsychological test performance, patients were grouped into one of two neurocognitive subgroups (cognitively impaired, n = 91; cognitively normal compared to HC, n = 62) that were compared on WM-related neural activity. Results Cognitively impaired patients displayed WM-related hypo-activity in left dorsolateral prefrontal cortex and frontal and parietal regions within a cognitive control network (CCN) as well as hyper-activity in the default mode network (DMN) compared to cognitively normal patients. In contrast, cognitively normal patients only exhibited hypo-activity within a small cluster in the superior frontal gyrus relative to HC. Conclusions Cognitive impairment in BD seems to originate from a failure to recruit key regions in the CCN and to suppress task-irrelevant DMN activity during cognitive performance. These results highlight modulation of aberrant dorsal prefrontal and DMN activity as a putative target for pro-cognitive treatment in BD.

The presence of abnormalities in emotional decision-making and reward processing among bipolar patients (BP) has been well rehearsed. These disturbances are not limited to acute phases and are common even during remission. In recent years, the existence of discrete cognitive profiles in this psychiatric population has been replicated. However, emotional decision making and reward processing domains have barely been studied. Therefore, our aim was to explore the existence of different profiles on the aforementioned cognitive dimensions in BP. The sample consisted of 126 euthymic BP. Main sociodemographic, clinical, functioning, and neurocognitive variables were gathered. A hierarchical-clustering technique was used to identify discrete neurocognitive profiles based on the performance in the Iowa Gambling Task. Afterward, the resulting clusters were compared using ANOVA or Chi-squared Test, as appropriate. Evidence for the existence of three different profiles was provided. Cluster 1 was mainly characterized by poor decision ability. Cluster 2 presented the lowest sensitivity to punishment. Finally, cluster 3 presented the best decision-making ability and the highest levels of punishment sensitivity. Comparison between the three clusters indicated that cluster 2 was the most functionally impaired group. The poorest outcomes in attention, executive function domains, and social cognition were also observed within the same group. In conclusion, similarly to that observed in "cold cognitive" domains, our results suggest the existence of three discrete cognitive profiles concerning emotional decision making and reward processing. Amongst all the indexes explored, low punishment sensitivity emerge as a potential correlate of poorer cognitive and functional outcomes in bipolar disorder.

Objective The aim was to examine the heterogeneity of psychosocial outcomes in euthymic bipolar disorder (BD) patients and analyse the potential influence of distinct variables on functioning. Method Using a hierarchical cluster exploratory analysis, 143 euthymic patients with diagnosis of BD were grouped according to their functional performance based on domains scores of the Functioning Assessment Short Test (FAST). The resulting groups were compared on sociodemographic, clinical and neurocognitive variables to find factors associated with each functional cluster. Results Patients were grouped in three functional profiles: patients with good functioning in all the FAST areas, patients with an intermediate profile showing great difficulties in the occupational domain and milder difficulties in most of the rest domains, and a third group with serious difficulties in almost all functional areas. Both functionally impaired groups were characterized by higher subthreshold symptoms (depressive and manic) and higher unemployment rates. The most functionally impaired group also showed lower scores on some measures of processing speed. Conclusion Two of three functional profiles showed some kind of impairment which was associated with subsyndromal symptoms and cognitive performance. These patterns should be taken into consideration to develop more individualized interventions to restore, or improve, psychosocial outcomes.

Background The present study aims to characterize emotional intelligence (EI) variability in a sample of euthymic bipolar disorder (BD) patients through the Mayer- Salovey-Caruso Emotional Intelligence Test (MSCEIT). Method A total of 134 euthymic BD outpatients were recruited and divided into three groups according to the total Emotional Intelligence Quotient (EIQ) score of the MSCEIT, following a statistical criterion of scores 1.5 SDs above/below the normative group mean, as follows: a low performance (LP) group (EIQ 115). Afterwards, main sociodemographic, clinical, functional and neurocognitive variables were compared between the groups. Results Three groups were identified: 1) LP group (n=16, 12% ), 2) NP group (n=93, 69% ) and 3) HP group (n=25, 19% ). There were significant differences between the groups in premorbid intelligence quotient (IQ) (p=0.010), axis II comorbidity (p=0.008), subthreshold depressive symptoms (p=0.027), general functioning (p=0.013) and in four specific functional domains: autonomy, occupation, interpersonal relations and leisure time. Significant differences in neurocognitive performance were found between groups with the LP group showing the lowest attainments. Limitations The cross-sectional design of the study. Conclusion Our results suggest that EI variability among BD patients, assessed through MSCEIT, is lower than expected. EI could be associated with premorbid IQ, subthreshold depressive symptoms, neurocognitive performance and general functioning. The identification of different profiles of SC may help guide specific interventions for distinct patient subgroups aimed at improving social cognition, neurocognitive performance and psychosocial functioning.

Over the last decade, there has been a growing appreciation of the importance of identifying and treating cognitive impairment associated with bipolar disorder, since it persists in remission periods. Evidence indicates that neurocognitive dysfunction may significantly influence patients’ psychosocial outcomes. An ever-increasing body of research seeks to achieve a better understanding of potential moderators contributing to cognitive impairment in bipolar disorder in order to develop prevention strategies and effective treatments. This review provides an overview of the available data from studies examining treatments for cognitive dysfunction in bipolar disorder as well as potential novel treatments, from both pharmacological and psychological perspectives. All these data encourage the development of further studies to find effective strategies to prevent and treat cognitive impairment associated with bipolar disorder. These efforts may ultimately lead to an improvement of psychosocial functioning in these patients.

BackgroundCognitive reserve (CR) reflects the capacity of the brain to endure neuropathology, minimize clinical manifestations and successfully complete cognitive tasks. The present study aims to determine whether high CR may constitute a moderator of cognitive functioning in bipolar disorder (BD).MethodsOne hundred and two patients with BD and 32 healthy controls were enrolled. All patients met DSM-IV criteria for I or II BD and were euthymic (YMRS ≤ 6 and HDRS ≤ 8) during a 6-month period. All participants were tested with a comprehensive neuropsychological battery, and a Cerebral Reserve Score (CRS) was estimated. Subjects with a CRS below the group median were classified as having low CR, whereas participants with a CRS above the median value were considered to have high CR.ResultsParticipants with BD with high CR displayed a better performance in measures of attention (digits forward: F = 4.554, P = 0.039); phonemic and semantic verbal fluency (FAS: F = 9.328, P = 0.004; and Animal Naming: F = 8.532, P = 0.006); and verbal memory (short cued recall of California Verbal Learning Test: F = 4.236, P = 0.046), after multivariable adjustment for potential confounders, including number of admissions and prior psychotic symptoms.ConclusionsHigh cognitive reserve may therefore be a valuable construct to explore for predicting neurocognitive performance in patients with BD regarding premorbid status.Disclosure of interestDr. I. Grande has received a Juan Rodés Contract (JR15/00012), Instituto de Salud Carlos III, Spanish Ministry of Economy and Competiveness, Barcelona, Spain and has served as a consultant for Ferrer and as a speaker for AstraZeneca, Ferrer and Janssen-Cilag.Disclosure of interestDr. I. Grande has received a Juan Rodés Contract (JR15/00012), Instituto de Salud Carlos III, Spanish Ministry of Economy and Competiveness, Barcelona, Spain and has served as a consultant for Ferrer and as a speaker for AstraZeneca, Ferrer and Janssen-Cilag.

Background Lithium is recommended as a first line treatment for bipolar disorders. However, only 30% of patients show an optimal outcome and variability in lithium response and tolerability is poorly understood. It remains difficult for clinicians to reliably predict which patients will benefit without recourse to a lengthy treatment trial. Greater precision in the early identification of individuals who are likely to respond to lithium is a significant unmet clinical need. Structure The H2020-funded Response to Lithium Network (R-LiNK; http://www.r-link.eu.com/) will undertake a prospective cohort study of over 300 individuals with bipolar-I-disorder who have agreed to commence a trial of lithium treatment following a recommendation by their treating clinician. The study aims to examine the early prediction of lithium response, non-response and tolerability by combining systematic clinical syndrome subtyping with examination of multi-modal biomarkers (or biosignatures), including omics, neuroimaging, and actigraphy, etc. Individuals will be followed up for 24 months and an independent panel will assess and classify each participants’ response to lithium according to predefined criteria that consider evidence of relapse, recurrence, remission, changes in illness activity or treatment failure (e.g. stopping lithium; new prescriptions of other mood stabilizers) and exposure to lithium. Novel elements of this study include the recruitment of a large, multinational, clinically representative sample specifically for the purpose of studying candidate biomarkers and biosignatures; the application of lithium-7 magnetic resonance imaging to explore the distribution of lithium in the brain; development of a digital phenotype (using actigraphy and ecological momentary assessment) to monitor daily variability in symptoms; and economic modelling of the cost-effectiveness of introducing biomarker tests for the customisation of lithium treatment into clinical practice. Also, study participants with sub-optimal medication adherence will be offered brief interventions (which can be delivered via a clinician or smartphone app) to enhance treatment engagement and to minimize confounding of lithium non-response with non-adherence. Conclusions The paper outlines the rationale, design and methodology of the first study being undertaken by the newly established R-LiNK collaboration and describes how the project may help to refine the clinical response phenotype and could translate into the personalization of lithium treatment.

(1) Background: The cognitive reserve (CR) concept has not been precisely defined in severe mental disorders and has been estimated using heterogeneous methods. This study aims to investigate and develop the psychometric properties of the Cognitive Reserve Assessment Scale in Health (CRASH), an instrument designed to measure CR in people with severe mental illness; (2) Methods: 100 patients with severe mental illness (non-affective psychoses and affective disorders) and 66 healthy controls were included. The internal consistency and convergent validity of CRASH were assessed. Spearman’s correlations coefficients were also performed to examine the relationship between CRASH and neuropsychological tests, psychosocial functioning, and clinical course; (3) Results: The internal consistency was high (Cronbach’s alpha coefficient = 0.903). The CRASH global score had a large positive correlation with the Cognitive reserve questionnaire total score (r = 0.838, p < 0.001), demonstrating good convergent validity. The correlation coefficients between the CRASH total scores and clinical, functional, and neuropsychological performance were different between groups. In order to provide clinical interpretation, severity classification based on diagnosis (non-affective psychotic disorders, affective disorders, and healthy controls) have been created; (4) Conclusions: CRASH is the first CR measure developed specifically for patients with severe mental illness, facilitating reliable and valid measurement of this construct. The scale may aid in the stratification of patients and the implementation of personalized interventions.

OBJECTIVE The main aims of this study were to examine the differences in the Emotional Intelligence (EI), the emotional domain of social cognition (SC), between euthymic patients with bipolar disorder (BD) and healthy controls (HC) and to evaluate the contribution of sociodemographic, clinical, and neuropsychological variables to EI. METHODS We recruited 202 patients with BD and 50 HC. EI was evaluated using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). The sociodemographic, clinical, and neurocognitive variables that showed a significant association with EI were entered into hierarchical multiple regression analysis. RESULTS BD patients obtained significantly lower scores compared to HC in the Emotional Intelligence Quotient (EIQ) and in the Understanding Emotions branch score. The best fitting model for the variables associated with EI in the patients group was a linear combination of gender, estimated IQ, family history of affective diagnosis, and executive function. The model, including these previous variables, explained up to 27.6% of the observed variance (R2 = 0.276, F = 16.406, P

Background During the last fifteen years, the possibility of delivering psychoeducation programs through Internet-based platforms have been explored. Studies evaluating those programs have shown good to acceptable retention rates. In this context, we developed a smartphone application (SIMPLe) collecting information about mood symptoms and offering personalized psychoeducation messages. The main aims of this study were to evaluate the feasibility, acceptability and satisfaction of the smartphone application. Methods The study was conducted from March to August 2015. Participation in the study was proposed to a consecutive sample of adult patients attending an outpatient mental health clinic. Sociodemographic data, clinical and functional assessments alongside smartphone ownership and uses were collected at baseline and at 3 months' follow-up. A 5 item Likert-scale satisfaction questionnaire was also employed. Results 51 participants were initially enrolled in the study, 36 (74%) remained actively using the application after 3 months. The whole sample interacted with the application a mean of 77 days (SD=26.2). During these days they completed 88% of the daily tests. Over 86% of the participants agreed that the experience using the application was satisfactory. Limitations The diversity of smartphones operating systems led to a moderate, although representative, sample number. Additionally, the subjective data reporting, narrow time frame of use and stability of the patients could have affected the results. Conclusions The results confirm that this particular intervention is feasible and represent a satisfactory and acceptable instrument for the self-management of bipolar disorder as an add-on to the usual treatment but future clinical trials must still probe its efficacy.

Lithium (Li) and valproate (VPA) are used in the treatment of bipolar disorder (BD), with narrow therapeutic window requiring periodic control of serum levels. This prevents intoxication, lack of efficacy due to low serum concentrations, and allows monitoring adherence. We aimed at evaluating the bioequivalence of salivary and blood levels of LI or VPA in a sample of adult BD patients. Secondarily, lithium bioequivalence was evaluated across different patients' lifespans. BD patients treated with either Li or VPA underwent contemporary standard serum and salivary measurements. Blood levels of both drugs were taken according to standard procedures. Li salivary levels were performed by an adapted potentiometric method on the AVL9180 electrolyte analyzer. VPA salivary levels were taken with an immune-assay method with turbidimetric inhibition. A total of 50 patients (38 on Li, 12 on VPA) were enrolled. Blood-saliva bioequivalence for VPA was not found due to a high variability in salivary measures. Li measures resulted in a high correlation (r=0.767, p

Objectives Although it is well established that euthymic patients with bipolar disorder can have cognitive impairment, substantial heterogeneity exists and little is known about the extent and severity of impairment within the bipolar II disorder subtype. Therefore, the main aim of this study was to analyze cognitive variability in a sample of patients with bipolar II disorder. Methods The neuropsychological performance of 116 subjects, including 64 euthymic patients with bipolar II disorder and 52 healthy control subjects, was examined and compared by means of a comprehensive neurocognitive battery. Neurocognitive data were analyzed using a cluster analysis to examine whether there were specific groups based on neurocognitive patterns. Subsequently, subjects from each cluster were compared on demographic, clinical, and functional variables. Results A three-cluster solution was identified with an intact neurocognitive group (n = 29, 48.3%), an intermediate or selectively impaired group (n = 24, 40.0%), and a globally impaired group (n = 7, 11.6%). Among the three clusters, statistically significant differences were observed in premorbid intelligence quotient (p = 0.002), global functional outcome (p = 0.021), and leisure activities (p = 0.001), with patients in the globally impaired cluster showing the lowest attainments. No differences in other clinical characteristics were found among the groups. Conclusions These results confirm that neurocognitive variability is also present among patients with bipolar II disorder. Approximately one-half of the patients with bipolar II disorder were cognitively impaired, and among them 12% were severely and globally impaired. The identification of different cognitive profiles may help to develop cognitive remediation programs specifically tailored for each cognitive profile.

Resumen El adenocarcinoma de uraco es un tumor extremadamente raro, con una incidencia de 1/5.000.000 de habitantes, lo que representa menos del 0,001 de todos los tumores de vejiga. El pseudomixoma peritoneal es una neoplasia rara caracterizada por ascitis mucinosa que envuelve la superficie peritoneal y el omento. Usualmente esta asociada con tumores mucinosos benignos o malignos del apendice u ovario. En este trabajo, presentamos un caso de pseudomixoma peritoneal causado por un adenocarcinoma mucinoso de uraco.

We report a case of primary signet-ring cell adenocarcinoma of the urinary bladder. It is a extremely rare tumor. Gross hematuria is the commonest clinical presentation as well as this case. Our patient presented with advanced tumour invasion into perivesical fat at dome. The treatment was partial cystectomy together with quimiotherapy. Medical literature are reviewed with special remark on histopathology and its bladder origen.

Resumen Introduccion Al igual que la citologia exfoliativa es un metodo de rutina en el diagnostico del cancer vesical, la citologia prostatica obtenida tras masaje puede llegar a ser un procedimiento de utilidad diagnostica en el cancer prostatico. Objetivos Obtener material citologico prostatico adecuado. Establecer el papel de la citologia exfoliativa prostatica en el diagnostico del cancer. Material Y Metodos Llevamos a cabo un estudio descriptivo, longitudinal y prospectivo, del que presentamos los resultados preliminares, sobre 60 pacientes de un total de 150, con sospecha de cancer prostatico, en un periodo de dos anos. Comparamos hallazgos citologicos (orina tras masaje) con parametros histologicos (biopsias). Resultados Cuando la citologia cumple una serie de requisitos (elevado numero de celulas prostaticas, anisocariosis y anticuerpo Ki-67 +) y estos se comparan con los datos histologicos, obtenemos para el cancer prostatico una especificidad del 100% y una sensibilidad de 67%. Con este tamano de muestra la citologia alcanza un valor predictivo del 100% y negativo del 92%. Conclusiones Es posible la obtencion de material citologico prostatico de forma simple y sencilla. La citologia prostatica puede llegar a ser un metodo util y valido en el diagnostico del carcinoma de la prostata. Este material ademas se puede utilizar para multiples procedimientos diagnosticos, de seguimiento y de investigacion.

Resumen Objetivo Estudiar la incidencia de tumor “residual/recidivante” tras segunda reseccion precoz (2a RTU), y que factores influyen en su hallazgo Material y metodo Estudio prospectivo de 40 pacientes con neoplasia vesical superficial a los que se les realizo una 2a RTU precoz. Como posibles factores de riesgo de hallazgo de tumor se estudiaron el intervalo de tiempo entre ambas RTU, el estadio, el grado, el numero de implantes tumorales, el tamano de los implantes, localizacion dentro de la vejiga, tumor primario o recidivante y el patron tumoral Resultados Al realizar la 2a RTU se confirmo histologicamente tumor en 14 (37,8%) de 37 pacientes con tumores Ta-T1 (excluimos aquellos con afectacion focal de la muscular): 10 (71,5%) eran tumores macroscopicamente visibles, en 4 casos (28,5%) se encontro tumor al biopsiar las areas de cicatriz/edema de la reseccion anterior. No encontramos asociacion entre la presencia de tumor en la 2a RTU y ninguna de las variables en estudio Conclusiones La erradicacion de tumor vesical superficial mediante RTU no se consigue en un elevado porcentaje de pacientes. La cistoscopia a los tres meses no puede excluir tumor residual. Aunque hemos encontrado 37,8% de tumor en la 2a RTU, actualmente no podemos recomendarla de forma rutinaria en los tumores vesicales superficiales

In this paper, we present a case of huge renal hydatic cyst. We review the literature with regard the clinical presentation, diagnosis methods and surgical technique of treatment.

The existence of a vesical diverticulum in the context of a congenital connective tissue disorder such as Ehlers-Danlos syndrome led us to consider the possibility of a relationship. Four types of diverticula can be found in the literature: congenital, acquired, iatrogenic and syndrome-associated. Within the later, Ehlers-Danlos syndromes type IV and IX, even type V, are associated to the existence of vesical diverticula. The potential spontaneous rupture of the diverticulum is a typical feature, as well as post-surgery relapse. The attitude towards such diverticula should be one of watchful waiting, and simple, plasty-free diverticulectomy on the bladder's neck is indicated when performing a surgical procedure.

Endoscopic approach to the ureter both as a diagnostic procedure in various diseases and treatment of low ureteral lithiasis is a widely used technique. Review of case reports where this technique was used over the last four years. A total of 73 ureteroscopies were conducted, 64 as therapeutic approach (89.04%) and 9 for diagnosis (10.96%) achieving an overall 94.4% success rate. Multiple variables such as type and location of the stones, patient's age and sex, diagnostic methods, length of stay etc. All the above data were used for a descriptive analysis of the situation in our centre. In our experience, ureteroscopy is a good therapeutic option for low ureteral lithiasis, mainly when no extracorporeal lithotrity is available, and an excellent diagnostic tool in other ureteral processes when more traditional methods fail.

Resumen La cistitis quistico-glandular se engloba dentro de las anormalidades proliferativas preneoplasicas uroteliales. En este grupo se engloban la hiperplasia atipica, los nidos de Von Brunn y la cistitis quistica. Se caracterizan por ser consecuencia de los cambios experimentados a nivel del urotelio en respuesta a la inflamacion, la irritacion o los carcinogenos. Su diagnostico se basa fundamentalmente en el estudio anatomopatologico de la biopsia obtenida tras la reseccion endoscopica. Su clinica es muy variada, estando en clara relacion con la distribucion y extension de los quistes. Su tratamiento se basa en la eliminacion de los factores irritativos, pudiendo llegar a requerir la realizacion de una cistectomia con derivacion urinaria si su evolucion clinica asi lo requiriese.

Resumen Dentro de la patologia tumoral excepcional del testiculo y paratesticulo figuran los tumores de estirpe epitelial comun, que aunque de histogenesis discutida se acepta que derivan de restos mullerianos o de diferenciacion mesotelial de la vaginal. Guardan estrechas similitudes con sus equivalentes ovaricos y en general, se les atribuye buen pronostico debido a su caracter bordeline o de bajo potencial maligno, pero se precisa de mas experiencia con estos raros tumores para evaluar su potencial biologico.

Resumen Objetivo Determinar las caracteristicas ecograficas del complejo anastomotico vesico-uretral en pacientes sometidos a prostatectomia radical, con el fin de diferenciar las fosas prostaticas normales de las patologicas por recurrencia local o tumor residual. Material y metodos En un periodo de tiempo comprendido entre enero de 1998 y junio de 1999 se realizaron 15 biopsias transrectales ecodirigidas de las anastomosis vesico-uretrales o fosas prostaticas, en pacientes que habian sido sometidos a prostatectomia radical por adenocarcinoma de prostata. Los criterios de seleccion para llevar a cabo la puncion en estos pacientes fueron que tuvieran, despues de la prostatectomia radical, un estudio de extension (TAC abdomino-pelvico y gammagrafia osea) negativo, un PSA por encima de 0,4 ng/ml y/o un tacto rectal sospechoso. Se completo el trabajo con la realizacion de 10 ecografias transrectales en pacientes despues de prostatectomia radical con PSA y tacto rectal normales. Se compararon los parametros obtenidos de las ecografias transrectales de los pacientes en los que las biopsias dieron resultados positivos para tumor, con aquellos otros parametros de los pacientes con biopsias negativas y con aquellos que se obtuvieron de las ecografias transrectales en pacientes con PSA, y tactos rectales normales. Resultados Los parametros ecograficos que mejor definieron las anomalias a nivel de la fosa prostatica, fueron la presencia de alguna masa o nodulo hipoecoico y la integridad o no del plano graso retro-anastomotico. Cuando se encontro masa o nodulo hipoecoico a nivel de la anastomosis, el 80% de las biopsias fueron positivas para recurrencia local tumoral. Este porcentaje aumento cuando, ademas, se evidencio alguna alteracion a nivel del tejido graso retro-anastomotico. Conclusiones A pesar de la buena correlacion que pueda existir entre anomalias ecograficas y biopsias positivas, los hallazgos sonograficos de la anastomosis vesico-uretral en pacientes sometidos a prostatectomia radical no estan bien definidos. Pueden existir nodulos o irregularidades ecograficas en fosas prostaticas normales, y por el contrario anastomosis ecograficamente normales con recidiva tumoral. Consideramos la ecografia transrectal de la anastomosis vesico-uretral como el mejor metodo del que disponemos a la hora de valorar la recurrencia local o la persistencia tumoral despues de prostatectomia radical.

Most commercially available test kits for water and foodstuffs use beta-galactosidase activity for coliforms and beta-glucuronidase activity for Escherichia coli. We tested the effects on the beta-glucuronidase activity of E. coli W3110 of substances usually present in foods and several synthetic pharmaceutical compounds. Thirteen substances were tested: three carbohydrates, four flavonoids, five monosaccharide derivatives, and dimethyl sulphoxide. In a minimum medium without any other carbon source, glucose (0.1 mM), quercetin (0.1 mM), silymarin (10 mg/L), D-gluconic acid (0.01 mM), D-gluconic acid lactone (0.01 mM), isopropyl-beta-D-thiogalacto pyranoside (1 mM), p-nitrophenyl beta-D-glucuronide (1 mM), and DMSO (1 M) completely inhibited E. coli glucuronidase activity at the above concentrations. However, the following compounds stimulated E. coli glucuronidase activity within the ranges of concentrations shown: glucose (0.0001-0.01 mM), lactose and sucrose (>0.1 mM), D-saccharic acid 1,4 lactone (0.0001-0.1 mM), p-nitrophenyl beta-D-glucuronide (0.001-0.01 mM) and DMSO (2-500 mM). In a rich culture medium that contained other carbon sources (lauryl tryptose broth) E. coli glucuronidase activity in the presence of the extra nutrients was unaffected by the test substances and therefore, under normal conditions in water or foods, they should not interfere with E. coli assays based on measurements of beta-glucuronidase activity.

The adenocarcinoma of the urachus is very rare tumor, with an incidence of 1/5.000.000 inhabitants, represents less than 0.001 of all types of bladder cancer. Peritoneal pseudomixoma is a rare neoplasm characterized by mucinous acites that involvement the peritoneal surface and omentum. Usually is associated with benign o malignant mucinous tumor of the appendix or ovary. In this paper, we present a case of peritoneal pseudomixoma caused by a mucinous adenocarcinoma of the urachus.

The same as the exfoliative cytology is a routine method to diagnose bladder tumour, the prostatic cytology obtained after massage may become a useful procedure to diagnose prostate cancer.To obtain suitable prostatic cytologic material. To establish the role of the exfoliative cytology to diagnose cancer.We made a prospective longitudinal descriptive study with 60 patients out of 150 (all of them with possible prostate cancer) for two years. We compared cytologic discoveries (urine after massage) with histological parameters (biopsies).When the cytology fulfills a series of requirements (a high number of prostatic cells, anisokariosis and antibodies Ki-67+) and these are compared with the histological data, we obtained a specificity of 100% and a sensibility of 67% for prostatic cancer. With this information the cytology reaches a predictive value of 100% and negative of 92%.It is possible to obtain prostatic cytologic material in a simple and easy way. The prostatic cytology may become a valid and useful method to diagnose the carcinoma of the prostate. Also this material can be used for multiple diagnostic, follow-up and research procedures.

We report a case of primary signet-ring cell adenocarcinoma of the urinary bladder. It is a extremely rare tumor. Gross hematuria is the commonest clinical presentation as well as this case. Our patient presented with advanced tumour invasion into perivesical fat at dome. The treatment was partial cystectomy together with quimiotherapy. Medical literature are reviewed with special remark on histopathology and its bladder origin.

To study the incidence of "residual/recurrence" tumor after a second bladder resection (2nd TUR).40 patients with new or recurrent superficial bladder tumor underwent repeat transurethral resection within 3 months after the initial resection. 37 patients were staged as Ta-T1. We study the incidence of tumor after the 2nd TUR both macroscopically detected or included in the bladder scar. We also study the influence of possible factors as the time between both resections, stage, grade, number of tumor size, localization in the bladder, primary or recurrent tumor and tumor pattern.After the 2nd TUR we found tumor in 14 of 37 (37.8%) Ta-T1 bladder tumors. Among the 14 tumors, 10 (71.5%) were macroscopically visible tumors and 4 cases the tumor were found after resection of the bladder scar of the first resection. We did not find relation between the presence of tumor in the 2nd TUR and any of the variables.After a TUR of superficial bladder tumor the complete removal of tumor is not always achieved. The early 3 months cystoscopy may not find residual tumor. Although we have found tumor in 37.8% in the 2a TUR we can not recommend routine 2nd TUR in superficial bladder cancer.

In this paper, we present a case of huge renal hydatic cyst. We review the literature with regard the clinical presentation, diagnosis methods and surgical technique of treatment.

The existence of a vesical diverticulum in the context of a congenital connective tissue disorder such as Ehlers-Danlos syndrome led us to consider the possibility of a relationship. Four types of diverticula can be found in the literature: congenital, acquired, iatrogenic and syndrome-associated. Within the later, Ehlers-Danlos syndromes type IV and IX, even type V, are associated to the existence of vesical diverticula. The potential spontaneous rupture of the diverticulum is a typical feature, as well as post-surgery relapse. The attitude towards such diverticula should be one of watchful waiting, and simple, plasty-free diverticulectomy on the bladder's neck is indicated when performing a surgical procedure.

Cystic-glandular cystitis is considered as part of the urothelial pre-neoplastic proliferative abnormalities. This group includes atypical hyperplasia. Von Brunn's nidus, and cystitis cystica. They are a consequence of the changes experienced at the urothelium level in response to inflammation, irritation or carcinogens. Diagnosis is mainly based in the pathoanatomical study of the biopsy obtained following endoscopic resection. The signs and symptoms it presents are varied and show a clear relationship to distribution and extension of cysts. Treatment is based in the removal of irritative factors. Cystectomy with urinary by-pass may be necessary if required by clinical evolution.

Endoscopic approach to the ureter both as a diagnostic procedure in various diseases and treatment of low ureteral lithiasis is a widely used technique. Review of case reports where this technique was used over the last four years. A total of 73 ureteroscopies were conducted, 64 as therapeutic approach (89.04%) and 9 for diagnosis (10.96%) achieving an overall 94.4% success rate. Multiple variables such as type and location of the stones, patient's age and sex, diagnostic methods, length of stay etc. All the above data were used for a descriptive analysis of the situation in our centre. In our experience, ureteroscopy is a good therapeutic option for low ureteral lithiasis, mainly when no extracorporeal lithotrity is available, and an excellent diagnostic tool in other ureteral processes when more traditional methods fail.

To determine the ultrasound characteristics of the vesico-urethral anastomotic complex in patients with radical prostatectomy to separate normal prostate fossae from those affected by local recurrence or residual tumour.Between January 1998 and June 1999 15 ultrasound guided transrectal biopsies of vesico-urethral anastomosis or prostate fossae were performed in patients with radical prostatectomy. The selection criteria to perform puncture in these patients were a negative extension study (abdominal-pelvic CT and bone scan), PSA higher than 0.4 ng/mL and/or suspicious DRE. The study was completed with 10 transrectal ultrasound (TRU) after radical prostatectomy in patients with normal PSA and DRE. TRU parameters in patients with tumour-positive biopsies were compare to those from patients with negative biopsies and those obtained from TRU in patients with both normal PSA and normal DRE.The ultrasound parameters that best described prostate fossa abnormalities were the presence of hypoechoic masses or nodes and the integrity or not of the retro-anastomotic fat layer. When a hypoechoic mass or node was found at the anastomosis level, 80% biopsies were positive for tumour local recurrence. The percentage increases when changes are seen at the retro-anastomotic fat layer.In spite of a good correlation between ultrasound abnormalities and positive biopsies, ultrasound findings from the vesico-urethral anastomosis in patients with radical prostatectomy are not well defined. Nodes or ultrasound irregularities can exist in normal prostate fossae as well as normal anastomosis ultrasound in the presence of tumoral relapses. We believe TRU of vesico-urethral anastomosis to be the best method available to evaluate local recurrence or tumoral persistence after radical prostatectomy.