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Resumen Objetivo Evaluar la asociación entre el cociente de los dedos segundo y cuarto (2D:4D), como un biomarcador de la exposición prenatal a andrógenos, y la presencia de cáncer de próstata (CaP). Métodos Estudio de casos y controles con 260 hombres que consultaron en el Servicio de Urología del Hospital General Universitario Reina Sofía (Murcia, España). Los casos (n = 125) fueron pacientes diagnosticados de CaP por anatomía patológica a los que se les realizó una prostatectomía radical. Los controles (n = 135) fueron pacientes que consultaron en Urología por otro motivo y que no mostraron signos ni síntomas de patología prostática. La longitud del 2D y 4D de la mano derecha fue medida mediante un pie de rey digital y se calculó el cociente entre ambos (2D:4D). Para los análisis estadísticos se utilizaron modelos de regresión logística obteniendo Odds ratios (OR) crudas y ajustadas e intervalos de confianza al 95%. Resultados Los casos presentaron un cociente 2D:4D significativamente menor que los controles. El cociente 2D:4D se relacionó significativamente con la presencia de CaP. Tras el ajuste multivariante, se observó que los varones que se encontraban en el primer tercil de distribución del cociente 2D:4D, presentaban casi el doble de riesgo de padecer CaP (OR 1,9: IC 95% 1,1–4,0; P-valor = 0,040) en comparación con los varones que se encontraban en el segundo y tercer tercil. Conclusiones Una mayor exposición prenatal a andrógenos, reflejada por un cociente 2D:4D menor, podría estar asociado con riesgo aumentado de padecer CaP, pero más estudios son necesarios para corroborar esos hallazgos.

Resumen Introduccion y objetivo La distancia entre los genitales y el ano (distancia anogenital [AGD]) es un reflejo de la concentracion de androgenos durante el desarrollo prenatal en mamiferos. En la actualidad solo existe un estudio que indique la relacion entre AGD y riesgo de presentar cancer de prostata (CaP). El objetivo de este estudio fue evaluar la utilidad clinica de la AGD, como biomarcador del ambiente androgenico prenatal y el riesgo de presentar CaP en una amplia poblacion. Material y metodo Se realizo un estudio de casos y controles sobre 260 pacientes, atendidos en la consulta externa de Urologia, a los que se sometio a examen fisico y andrologico, y cumplimentaron cuestionarios. En los pacientes con CaP (n = 125) hubo confirmacion histologica de la enfermedad y se dividio a los pacientes segun la puntuacion de Gleason acorde con los grupos de riesgo de d’Amico. Los controles (n = 135) fueron hombres sin signos, ni sintomas de CaP que fueron atendidos en la consulta externa de Urologia para un examen rutinario. Se midieron 2 variantes de AGD (del ano a la base posterior del escroto [AGDAS] y del ano a la insercion cefalica del pene [AGDAP]). Se utilizaron pruebas parametricas y no parametricas y curvas ROC para determinar la relacion entre la AGD y la presencia de CaP. Resultados La mayor area bajo la curva se obtuvo para el subgrupo de Gleason = 7 con las mediciones AGDAS y AGDAP (0,69; IC del 95%: 0,60-0,78 y 0,69; IC del 95%: 0,61-0,77, respectivamente), con una sensibilidad y especificidad del 83 y el55%, y el 91 y el 41%, un valor predictivo positivo del 39 y el 35%, y predictivo negativo del 90 y el 93%, respectivamente. Conclusion Nuestros resultados sugieren que la AGD podria ser una herramienta clinica util para el diagnostico del CaP.

Management of active surveillance (AS) in low-risk prostate cancer (PCa) patients could be improved with new biomarkers, such as the 4Kscore test. We analyze its ability to predict tumor reclassification by upgrading at the confirmatory biopsy at 6 months. Observational, prospective, blinded, and non-randomized study, within the Spanish National Registry on AS (AEU/PIEM/2014/0001; NCT02865330) with 181 patients included after initial Bx and inclusion criteria: PSA ≤10 ng/mL, cT1c-T2a, Grade group 1, ≤2 cores, and ≤5 mm/50% length core involved. Central pathological review of initial and confirmatory Bx was performed on all biopsy specimens. Plasma was collected 6 months after initial Bx and just before confirmatory Bx to determine 4Kscore result. In order to predict reclassification defined as Grade group ≥2, we analyzed 4Kscore, percent free to total (%f/t) PSA ratio, prostate volume, PSA density, family history, body mass index, initial Bx, total cores, initial Bx positive cores, initial Bx % of positive cores, initial Bx maximum cancer core length and initial Bx cancer % involvement. Wilcoxon rank-sum test, non-parametric trend test or Fisher’s exact test, as appropriate established differences between groups of reclassification. A total of 137 patients met inclusion criteria. Eighteen patients (13.1%) were reclassified at confirmatory Bx. The %f/t PSA ratio and 4Kscore showed differences between the groups of reclassification (Yes/No). Using 7.5% as cutoff for the 4Kscore, we found a sensitivity of 89% and a specificity of 29%, with no reclassifications to Grade group 3 for patients with 4Kscore below 7.5% and 2 (6%) missed Grade group 2 reclassified patients. Using this threshold value there is a biopsy reduction of 27%. Additionally, 4Kscore was also associated with changes in tumor volume. Our preliminary findings suggest that the 4Kscore may be a useful tool in the decision-making process to perform a confirmatory Bx in active surveillance management.

Objetivo La ratio digital del segundo y cuarto dedo de la mano (2D:4D) es un marcador de la exposición a andrógenos prenatal que presenta un dimorfismo sexual en mamíferos, siendo menor en hombres que en mujeres. El objetivo de nuestro estudio fue analizar la asociación entre la ratio 2D:4D (como marcador indirecto del ambiente hormonal intrauterino) y la severidad preoperatoria del cáncer de próstata (CaP). Material y métodos Se trata de un estudio transversal que incluyó 118 pacientes intervenidos de CaP y con confirmación histológica por biopsia desde abril de 2007 hasta julio de 2015. A cada paciente se le realizó una exploración física y se midió desde la base de la falange proximal hasta el extremo de la falange distal tanto en el cuarto como en el segundo dedo de la mano derecha. La asociación entre la ratio 2D:4D y los indicadores de severidad prequirúrgicos de CaP se realizaron mediante test de medias, correlación de Spearman y regresión lineal simple. Resultados La ratio 2D:4D se asoció significativamente con el PSA prequirúrgico (p = 0,023) y con el porcentaje de cilindros afectados en la biopsia (p = 0,05) Conclusión Nuestros resultados sugieren que una mayor exposición androgénica prenatal, reflejado en una ratio 2D:4D disminuida, estaría asociada con una mayor severidad prequirúrgica del CaP.

Resumen Objetivo La estenosis de la anastomosis uretrovesical (EAU-V) afecta al 8,4% de pacientes intervenidos de prostatectomía radical retropúbica por cáncer. Nuestro propósito fue estudiar los factores de riesgo de estenosis de cuello vesical asociada a prostatectomía radical por carcinoma prostático en nuestro centro. Material y Métodos Estudio de casos-controles en una cohorte constituida por 120 pacientes intervenidos por adenocarcinoma prostático entre 2005 y 2012. Realizamos un análisis descriptivo de la muestra y el cálculo de la incidencia de EAU-V, un análisis univariante de los factores asociados mediante la t de Student y la chi cuadrado de Pearson, un análisis del tiempo transcurrido hasta la aparición de estenosis y una predicción del riesgo de EAU-V. Resultados La incidencia de EAU-V tras prostatectomía radical en nuestro servicio fue del 22,5%. Encontramos mayor riesgo en aquellos pacientes con débito por drenaje Jackson-Pratt (J-P) mayor de 500cc, drenaje J-P retirado después del tercer día, estancia superior a 8 días, hemoglobina postoperatoria baja, PSA preoperatorio bajo, densidad de PSA elevada o que fueron intervenidos por el cirujano 1 o 5. Todas las estenosis se produjeron en los 3 primeros años tras la cirugía. Los pacientes con un débito del drenaje por encima de 500cc y en los que el drenaje se retiró después del tercer día tienen 7,7 y 3,2 veces, respectivamente, más riesgo de padecer una EAU-V. Conclusiones Nuestra incidencia de EAU-V y sus factores asociados coinciden con los publicados. El modelo predictivo desarrollado tiene utilidad meramente teórica ya que no abarca la totalidad de los factores que pueden influir en la aparición de la estenosis.

Background Anogenital distance (AGD), the distance from the centre of the anus to the genitals, is a sexually dimorphic phenotype in mammals. Experimental studies have shown that AGD is a biomarker of prenatal androgen exposure during the masculinisation period of development. The aim of this study is to assess the relationship between anogenital distance (AGD), as an indirect marker of prenatal hormonal environment, and prostate cancer (PCa) severity. Materials We conducted a cross-sectional study with a total of 120 PCa patients with confirmed biopsy of the tumour from April 2007 to July 2015. Two variants of the anogenital distance were assessed, from the anus to the posterior base of the scrotum (AGDAS ) and to the cephalad insertion of the penis (AGDAP ). We compared differences in groups to evaluate the association between AGD measurements and severity of the preoperative biopsy and clinical scores. Results Longer AGDAS was significantly associated with the highest Gleason score (P = 0.015) and D'Amico nomogram (P = 0.048). In contrast, no statistical differences were found in the AGDAP and severity of the preoperative biopsy. Conclusions These findings are consistent with the hypothesis that a higher prenatal androgen exposure is associated with higher severity of PCa. Prostate 77: 406-411, 2017. © 2016 Wiley Periodicals, Inc.

To evaluate the associationbetween anogenital distance (AGD), as a biomarker ofprenatal androgen milieu, and risk of prostate cancer(PCa).A case-control study was conducted on260 men attending a university hospital where theyunderwent physical and andrological examination andcompleted a brief questionnaire. PCa patients were confirmedby biopsy of the tumor. Controls were men withoutPCa attending the urology outpatient clinic for routineexaminations. Two variants of AGD [from the anus to theposterior base of the scrotum (AGDAS) and to the cephaladinsertion of the penis (AGDAP)] were measured.Unconditional multiple logistic regression was used toestimate the association between AGD measurementsand presence of PCa, and Odds Ratios and 95% confidenceintervals (CI) were calculated.Cases showed significantly shorter AGDAPand AGDAS than controls. Subjects with AGDAP andAGDAS in the lowest compared to the upper tertile were2.6 times (95% CI 1.2-5.6) and 3.2 times (95% CI 1.5-6.9) more likely to have PCa, respectively.We found that shorter measurementsof both distances (AGDAS and AGDAP) were associatedwith higher risk of PCa. A previous study reportedsimilar results, showing that longer AGDAP was associatedwith lower risk of PCa, but this relationship was notfound for AGDAS, as it was in our study with a largersample size.Evaluar la asociación entre la distancia anogenital (AGD) como biomarcador de la ventana androgénica prenatal y el riesgo de padecer cáncer de próstata (PCa).MATERIAL Y MÉTODO: Estudio de casos y controles realizado en 260 pacientes. Todos los pacientes fueron sometidos a examen físico y andrológico y completaron un breve cuestionario. Los pacientes con PCa tenían diagnóstico histológico por biopsia prostática. Los controles fueron varones sin sospecha de PCa que acudieron a la consulta externa de Urología para exámenes rutinarios. Se midieron dos variantes de AGD [del ano a la base posterior del escroto (AGDAS) y del ano a la inserción dorsal del pene (AGDAP)]. Se utilizóanálisis de regresión logística múltiple para estimar la asociación entre las medidas de AGD y la presencia de PCa. Se calcularon Odds Ratios (ORs) e intervalos de confianza (IC) 95%.Los casos mostraron unas AGDAP y AGDAS significativamente más cortas que los controles.Los pacientes con AGDAP y AGDAS en el tercil inferior comparado con los pacientes del tercil superior mostraron 2,6 (IC 95% 1,2-5,6) y 3,2 veces (IC 95% 1,5-6,9) más riesgo, respectivamente, de padecer PCa.Encontramos que las medidas acortadas de ambas AGDs se asociaron con un mayor riesgo de padecer PCa. Un estudio previo obtuvo resultados similares, mostrando que una AGDAP alargada se asoció con un menor riesgo de padecer PCa, pero noobservó ninguna relación con respecto a la AGDAS, como sí objetivamos en este estudio con un mayor tamaño muestral.

Anogenital distance (AGD), the distance from the centre of the anus to the genitals, is a sexually dimorphic phenotype in mammals. Several experimental studies have demonstrated that AGD is a biomarker of prenatal androgen exposure during the masculinisation period of development. The objective of this study was to assess the relationship between AGD (as an indirect marker of prenatal hormonal environment) and severity of the surgical specimen and prostate cancer (PCa) prognosis.We conducted a cross-sectional study with a total of 119 PCa patients with confirmed biopsy of the tumour. Every participant underwent a physical examination where two variants of the AGD were assessed, a) from the anus to the cephalad insertion of the penis (AGDAP) and b) to the posterior base of the scrotum (AGDAS). To assess the association between both AGD and severity and PCa prognosis multiple logistic regression analysis was used.Longer AGDAS was significantly associated with biochemical recurrence and affected margins of the surgical specimen (OR: 2.5; IC 95%:1.2-5.5, and 2.8; IC 95%: 1.1-7.5, respectively).Our findings suggest that a higher prenatal androgen exposure, resulting in a longer AGD, is associated with worse prognosis of PCa.

The distance from the genitals to the anus (anogenital distance [AGD]) reflects androgen concentration during prenatal development in mammals. At the present time, there is only one study suggesting the relationship between AGD and risk of prostate cancer (CaP). The goal of this study was to assess the performance and clinical utility of AGD, as a biomarker of prenatal androgenic milieu, and risk of CaP in a larger population, in CaP diagnosis.A case-control study was conducted on 260 men seen in a hospital outpatient clinic where underwent a physical and andrological examination and completed a brief questionnaire. CaP patients were confirmed by biopsy of the tumor. Controls were men without CaP seen in the urology outpatient clinic for routine examinations. Two variants of AGD (from the anus to the posterior base of the scrotum [AGDThe highest area under the curve (0.69; 95% CI 0.60 to 0.78 and 0.69; 95% CI 0.61 to 0.77) was obtained for the Gleason=7 subgroup with the AGDAGD may be a useful clinical tool for the CaP diagnosis.

Sanchez-Rodriguez C, Grande I, Sampedro J, Rivilla-Garcia J. Is the date of birth an advantage/ally to excel in handball? J. Hum. Sport Exerc. Vol.8, No. Proc3, pp. S754-S760, 2013. The Relative Age Effect (RAE) has been analyzed in a population of Spanish international handball players (n=161) divided into four different levels: Senior, Junior, Juvenile and Promising Talents. The variables registered were quarter, half year and year of birth using the initial information of their date of birth. The data were collected from the Royal Spanish Handball Federation on-line data base. The statistical method used was the χ 2 and the minimum level of significance was set at p

Anogenital distance (AGD), the distance from the centre of the anus to the genitals, is a sexually dimorphic phenotype in mammals. Experimental studies have shown that AGD is a biomarker of prenatal androgen exposure during the masculinisation period of development. The aim of this study is to assess the relationship between anogenital distance (AGD), as an indirect marker of prenatal hormonal environment, and prostate cancer (PCa) severity.We conducted a cross-sectional study with a total of 120 PCa patients with confirmed biopsy of the tumour from April 2007 to July 2015. Two variants of the anogenital distance were assessed, from the anus to the posterior base of the scrotum (AGDLonger AGDThese findings are consistent with the hypothesis that a higher prenatal androgen exposure is associated with higher severity of PCa. Prostate 77: 406-411, 2017. © 2016 Wiley Periodicals, Inc.

Hepatic angiosarcoma is a malignant mesenchymal neoplasm of endothelial cells of high grade. Hepatic angiosarcoma represents two percent of all primary neoplasm liver. The highest incidence is between the sixth and seventh decade of life, youth and children is rare, predominantly in men (3:1). Most are idiopathic (75 %). Diagnosis is difficult because clinical manifestations and imaging studies are inconclusive. When clinical manifestations begin progression is often fast, and possibilities for curative treatment are limited. We report the case of a man aged 17, presented two clinical episodes of hemoperitoneum with ultrasound and CT diagnosis of hepatic hemangioma, hepatectomy was performed in the right lobe, the histological study reported multicenter liver angiosarcoma.

OBJETIVO: El objetivo de éste estudio ha sido revisar el resultado de las estenosis ureterointestinales tratadas de forma endourológica y comparar nuestros resultados a largo plazo, con lo publicado en otras series de similares características en tiempo de seguimiento y número de pacientes. MÉTODOS: Desde Marzo de 1994 a Junio de 2003, hemos revisado de forma retrospectiva, el tratamiento de 27 estenosis ureterointestinales, con un seguimiento medio de 30.2 meses (1 día - 53 meses). En 6 casos, no se culminó tratamiento endourológico. Se realizaron 13 dilataciones + catéter doble J permanente (3 de forma anterógrada). Tratamos 8 casos con endoureterotomías + catéter doble J (5 con Acucise*). RESULTADOS: Conseguimos mejorar y/o estabilizar la función renal en 12/21 unidades renales (57.14%). A destacar la ausencia de complicaciones en el intra y postoperatorio inmediato excepto 1 paciente con dilatación + c. doble J y muy mal pronóstico oncológico, que falleció al día siguiente por sepsis. CONCLUSIONES: El tratamiento endourológico ha demostrado proporcionar buenos resultados funcionales a corto y medio plazo, en pacientes que por su patología de base, edad, comorbilidad... la cirugía abierta, sería una opción terapéutica más agresiva, pese a ser el tratamiento de elección en situaciones ideales.

Primary mucinous epithelial tumors of the testis are extremely rare. Although isolated case reports and small series have been published, these interesting neoplasms are less well-known. We report a case of a primary intratesticular mucinous cystadenoma in an asymptomatic 44-year-old man. Right radical orchiectomy was performed because a malignant testicular tumor was suspected. We discuss the management of this uncommon testicular tumor based on the limited reports.

Carlos del Pozo Vegas1,∗, Sara del Amo Ramos1, Raul Lopez Izquierdo1, Fernando Garcia Martin1, Pablo Royuela Ruiz1, Virginia Carbajosa Rodriguez1, Jesus Alvarez Manzanares1, Isabel Gonzalez Manzano1, Nuria Diez Monge1, Maria Antonia Udaondo Cascante2, Mario Hernandez Gajate1, Juan Carlos Sanchez Rodriguez1, Henar Bergaz Diez1, Beatriz Herrero Bregon1, Marta Moya de la Calle1, Belen Salvador Montero3, Maria Luisa Lopez Grima3, Begona Arcos Rodriguez3, Eva Salvo Marco4, Jose Ramon Oliva Perez1 1 Hospital Universitario Rio Hortega, Valladolid, Spain 2 Hospital Clinico Universitario, Valladolid, Spain 3 Hospital Universitario Dr. Peset, Valencia, Spain 4 Hospital Universitario La Fe, Valencia, Spain

Pilar Palma1, Angel Ruiz2, Francesc Carmona1,∗, Ramon Soliba2, Elisabet Barrau3, David Paredes2 1 Sistema d’Emergencies Mediques, Catalonia, Spain 2 Donation Unit, Hospital Clinic, Barcelona, Spain 3 ABS Montclar, ICS, Sant Boi de Llobregat, Spain Purpose: To analyze how LUCAS® device has affected kidney transplant rate in a “donor after circulatory death” program (DACDP) and to describe donors’ characteristics after 10 years of the program start. Methods: A prospective analytic study was performed from January 2002 to December 2011. From all the potential donors in a DACDP, all those who finally accomplished the program criteria were entered in NECMO and were not rejected by other causes different than those related to perfusion. Studied variables were: donors’ sex, age, body mass index (BMI) and presence of cardio-circulatory risk factors (CCRF), total out-of-hospital CPR time (OHCPR), kidney transplantation and use of LUCAS® device. Qualitative data are presented as percents and compared with Chi square test. Quantitative data are presented as mean and standard deviation and compared with Student’s T test. A logistical regression model was performed to adjust the LUCAS® effect over transplantation by possible confounding factors. Results: From the 160 potential donors, 97 accomplished the study criteria. 91.8% (89) weremales. Themean age was 47.8 years (SD=12.3), mean BMI was 27.1 kg/m2 (SD=4), and mean OHCPR was 60.3min (SD=17.8). 48.5% (47) had CCRF and LUCAS was used in 52.6% of patients (51). 144 out of 194 kidneyswere transplanted. LUCAS® was associated with an increase of the transplant rate in a 13% (CI 95%=0.7–25) (p=0.039). Lower mean age and BMI were also associated with an increase of the transplant rate (p=0.004 and0.001). Noother significant statistical associationwas observed but a trend in lower OHCPRmean (p=0.145). After adjusting LUCAS effect by donors age and BMI, OHCPR and their first order interactions in a logistic regression model, the use of LUCAS® multiplies by 1.9 the transplantation odds (CI 95%=0.94–3.8). Conclusions: The use of LUCAS® increases the number of transplanted kidneys when used in a DACDP.