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Introduction: The present study analyzes cases of urachal abnormalities treated with laparoscopic approach in our hospital., Case Description: A retrospective descriptive study of urachal disorders with laparoscopic surgery approach performed at our hospital in the period 1999-2015. Patients' clinical data are presented (radiological findings, surgical data, pathology findings, complications and a follow-up of each patient)., Results: 7 Adults presented complicated urachal disorders treated laparoscopically. The average age was 43.1 years old (DE ±11). The mean surgical time of laparoscopic management was 154.2 minutes (range 120-240). Mean hospital stay was 4.9 days (DE ±1.1). There were no early or late postoperative complications., Conclusion: Laparoscopic removal of urachal remnants is a safe and reproducible technique.

Background: Prostate cancer (PC) is the most prevalent among men and yet its risk factors are little known. This article aims to determine the hospital incidence, trend and municipal distribution of PC in Health Area of León (HAL)., Methods: We included new cases of prostate cancer (ICD-9: 185, ICD-10: C61) enrolled in the Hospital Tumor Registry of the Complejo Asistencial Universitario de León, between 1996 to 2010 with residence in HAL. We calculated crude triennial hospital incidences and adjusted at global and European population. As denominator we used the INE population data disaggregated by five-year age groups of residents in municipalities of the HAL. To analyze the spatial distribution, we estimated municipal relative risks (RR) smoothed by fitting the Besag, York and Mollié model and the posterior probability (PP) of RR >1 using Bayesian methods., Results: 3,366 cases were included. Standardized rates at European population amounted of 30.3 (1996-98) to 119.0 (2008-2010) new cases per 100,000 men. The number of organ-confined cases were increased from 281 (1999-2001) to 999 (2008-2010). PSA determinations amounted from 30,985 (1999-2001) to 117 396 (2008-2010)., Conclusions: A great increase was observed in the frequency of PC at the expense of organ-confined cases which correlate very well with PSA determinations performed in HAL. There were no differences of interest in the municipal distribution incidences.

Schistosomiasis is typically a tropical disease; however, given the large influx of immigrants to our country and the boom in tourism to exotic locations, schistosomiasis should be taken into account in the differential diagnosis of certain clinical entities. The flatworm Schistosoma haematobium can cause a large variety of lesions in the urinary tract. The most common sites of involvement are the bladder and the lower third of the ureters, where it can cause lesions ranging from lithiasis and ureteral stenosis to the formation of masses inside the bladder. Ultrasonography is the imaging technique of choice for evaluating these alterations in the bladder; in addition to being fast, noninvasive, and painless, it is very useful for monitoring the response to antihelmintic treatment. We believe that it is essential to know the alterations in the urinary tract caused by this trematode, as this infectious disease that can be cured with Praziquantel might be confused with tumor diseases, such as vesical masses.

Objectives: To report three cases of atherosclerotic embolic vascular disease with clinical presentation in the lower urinary tract. This disease is not frequent; it mainly affects the skin, kidneys and skeletal muscle. Other organs of the urinary tract are rarely affected and they are exceptionally the clinical site of debut without previous known involvement of other areas., Methods/results: The first patient presented with hematuria associated with an ultrasound/cystoscopical image suspicion for neoplasia. Pathologic report of the transurethral resection chips showed polypoid cystitis with some small size arteries occupied by cholesterol needles, associated with inflammation, ulcers and hematic extravasation. The second patient underwent cystoprostatectomy for a transitional cell carcinoma and, incidentally, numerous cholesterol emboli were found, mainly in the lamina propria, but also in other layers of the bladder wall, prostate, urethra, veru montanum, and one seminal vesicle; this two latter sites have not being reported in previous publications. The third patient showed the embolus within a prostate biopsy core., Conclusions: This unfrequent disease may present as a bladder or prostatic process and be diagnosed by biopsy of these organs. It may simulate a bladder neoplasia on ultrasound or cystoscopy and should be included among related or etiologic entities of polypoid cystitis, a well-known simulator of neoplasia.

Objectives: To report our experience with one case of penile silicone granuloma, that has clinical interest for its unfrequent presentation., Methods/results: We report the case of a patient with sexual dysfunction secondary to subcutaneous injection of liquid silicone in the penis resulting in a penile granuloma and migration of the particles to the penile root and midline scrotal raphe. We proceeded to the surgical excision of the granuloma and migrated particles, repairing the penile defect with scrotal skin., Conclusions: Subcutaneous injection of liquid silicone is a practice that does not have any justification because of its devastating effects and requires major perations for the elimination of the injected material.

Since the 90s there increasing interest in early detection of neonatal hearing loss due to the feasibility of universal neonatal screening as well as to the possibility of early intervention. This has led to set up neonatal screening programs based upon otoacoustic emissions and to a great increase in the number of publications in the field. Our hospital started a neonatal hearing loss screening program using otoacoustic emission in March 2000. We used a Capella Cochlear Emissions (MADSEN electronics) equipment. Until May 2003 we have performed the test in 6372 children with a median age of 71 days. In our study, the sensibility of the test was 90.9% and the specificity 99.7%. Our results are similar to those reported in the literature although the age of the children was higher and we have found an incidence of hearing loss lower than other studies.

Lymphoepithelioma-like carcinoma of the bladder is an uncommon neoplasm, of which 49 cases have been described in the English literature, none of which has been studied for p53 protein expression. We studied three muscle-infiltrating cases of this tumor using immunohistochemical, in situ hybridization and polymerase chain reaction (PCR) methods. The three cases were positive for epithelial markers and negative for lymphoid antigens in the tumoral syncytial areas. The intensive infiltrate of small cells was negative for epithelial and positive for lymphoid markers. This population was mainly made up of cytotoxic T-lymphocytes, positive for TIA-1. p53 protein was intensely positive in more than 90% of the epithelial component nuclei, being negative in the lymphoid cells. PCR study did not show mutations on p53. Both lymphocytes and epithelium were negative for Epstein-Barr virus markers, such as the latent membrane protein and EBER (Epstein-Barr-encoded RNA). The prognosis was very good after radiotherapy and chemotherapy treatment, preserving the bladder despite the muscle infiltration. The presence of an intense cytotoxic T-lymphocyte population may be related to this good prognosis. Both aspects, p53 protein status and T-lymphoid population, had never been studied before in bladder lymphoepithelioma-like carcinoma.

Our aim was to determine the effects of glutamine or alanyl glutamine parenteral supplementation on the liver oxidant/antioxidant balance and on cytochrome-P450-mediated detoxication in rats. Animals were infused for 5 d with standard total parenteral nutrition (TPN), glutamine-enriched TPN, or alanyl glutamine-enriched TPN. The hepatic concentration of glutathione was reduced, and the levels of thiobarbituric-acid-reactive substances (TBARS) were increased in animals receiving standard TPN. Both glutamine and alanyl glutamine supplementation normalized glutathione, but thiobarbituric-acid-reactive substance concentration was only decreased by ananyl glutamine. This effect was parallel to a partial recovery of the activity of antioxidant enzymes. Cytochrome-P450 liver content, cytochrome-P450-dependent monooxygenases, and antipyrine clearance were not modified by glutamine or alanyl glutamine. Our data suggest a better protection against free radicals by alanyl glutamine supplementation and an absence of effects of both glutamine and alanyl glutamine on liver oxidative metabolism.

The development in the past few years of laboratory test for hepatitis C virus allow us to associate it with a broad range of autoimmune manifestations such as cryoglobulinemia and Sjögren syndrome. As in other virus' infections, rheumatic manifestations have been described during VHC infection, but there are no large studies enough to know their true frequency and characteristic. The three reported patients in this issue presented and HCV related arthropathy once clinical picture, laboratory test and following, allowed us to exclude other diagnostics. Clinical manifestations ranged from arthralgias and intermittent arthritis to symmetric polyarthritis without any kind of join damage.

The pattern of intracellular aminoacids may be reproduced individually and is different for each illness. This study seeks to measure alterations in this pattern in rats after the administration of hypocaloric peripheral parenteral nutrition (HPPN), group B, for five days, by comparing them with rats subjected to conventional fluidtherapy, group A, for the same period. HPPN tolerance was good in all cases. Our results show a higher tendency to glyconeogenesis in group A, measured by a reduction in the glycogenic aminoacids especially alanine. An increase in branched aminoacids was observed in group A due to an increase in proteolisis. The animals in group B showed a lesser reduction in the intracellular aminoacids necessary for glyconeogenesis, especially glycine. HPPN, was found, to alter the aminoacids pattern in fasting rats. The results might be corroborated in humans studies.

Cholesterol is an essential component of all tissues, as it is a part of the structure of cell membranes, and it is an immediate precursor of a series of essential substances such as vitamins, steroid hormones, and bile acids. Under physiologic conditions, the intake and output of cholesterol in the organism is coordinated and balanced with the aim of guaranteeing the availability of adequate amounts of cholesterol to satisfy the needs of the different tissues (fig. 1). Under pathological conditions there is an imbalance between these mechanism, which leads to an increase in the circulating levels of cholesterol, leading to pathological processes such as hyperlipemias, atherosclerosis and bile stones. The liver plays a central role in the regulation of the homeostasis of cholesterol. The molecule enters the liver in the form of chylomicrons and low density lipoproteins (LDL), through lipoprotein receptors, and this is also the most important organ for the de novo biosynthesis of cholesterol from acetyl coenzyme A, by means of a cascade enzyme reaction in which the enzyme 3-hydroxy-3 methyl glutaryl CoA reductase (HMG-CoA) is the key of the entire process. Cholesterol is found in the liver in the form of cholesterol esters or as free cholesterol. The two most effective ways of eliminating body cholesterol are found in the liver, with the degradation of the compound to bile acids and the biliary secretion of cholesterol. The conversion to bile acids takes place through a series of enzymatic steps in which the formation of 7-alpha-hydroxycholesterol by the enzyme cholesterol 7-alpha-hydroxylase is the key of the process. The biliary secretion of cholesterol is 600 mg/day. Both the abundance and the universality of cholesterol in living things as its clinical implications emphasize the importance and interest of this compound.

Objective: A ureteral pathology arising from inflammatory aneurysm of the abdominal aorta is described., Methods/results: A case of inflammatory abdominal aortic aneurysm causing entrapment of both ureters, destruction of a renal unit and ureterohydronephrosis of the contralateral kidney is described., Conclusions: Treatment of inflammatory aneurysm of the abdominal aorta is by surgical repair with a prosthesis. Endourological urinary drainage is warranted prior to surgical repair, but ureterolysis to preserve renal function is unnecessary.

We report on a patient who developed postoperative spindle cell nodule one month following TURP for prostatic adenocarcinoma. The foregoing was compared with other benign fibrous lesions from our records: one case of nodular fasciitis and one case of proliferative myositis. Although they were all well-defined and clinically distinct disease entities, a very close relationship concerning their origin was demonstrated histologically and immunohistochemically.

Total parenteral nutrition is associated with different hepatic alterations such as cholestasis, steatosis or cholelithiasis. To study such alterations anaesthetised rats, in which the enterohepatic circulation of bile acids is interrupted, have been widely used. A model of free moving rat with venous and biliary catheterization has been developed in this work. This overcomes the interferences induced by anaesthesia as well the alterations in hydrostatic pressure or restraint-induced stress present in other models. The use of our animal model has confirmed previous data from anesthetised rats indicating that parenteral solutions of amino acids induce a cholestasis effect, with decreases in bile flow but not significant change in bile acid secretion.

Total parenteral nutrition is associated with hepatic metabolic and morphologic changes. Histological alterations induced by administration of glucose plus amino acids (group A) or glucose plus amino acids and lipids (group B) have been investigated in the rat. Parenteral nutrition provided 187 kcal/kg/day in both groups of animals. Rats in group B received 30% of nonprotein calories as lipids (Intralipid). In group A the most frequent histopathological findings were inflammation, portal edema and microesteatosis. Those alterations did not disappear by lipid addition, being frequent the existence of congestive phenomenons and esteatosis together with occasional pigment deposits in Kupffer cells. Those data suggest that supplementation of solutions with LCT-base lipid emulsions does not compensate for the histopathological alterations induced by parenteral nutrition.

Five patients were diagnosed as having angiomyolipoma. Evidence or signs of tuberous sclerosis were observed in no patient. In 2 patients the presenting symptoms was massive retroperitoneal hemorrhage which required emergency surgery. The kidney could be preserved in 4 cases. One underwent nephrectomy for synchronous clear cell renal tumor. CT and US afford a diagnostic accuracy of nearly 100 percent. According to the data reported in the literature, tumors larger than 4 cm are amenable to treatment by conservative surgery. Smaller tumors can be followed carefully. However, surgical exploration is warranted not only in patients with pain and hemorrhage, but also in those cases with complex lesions less than 4 cm.

Three cases of encrusted cystitis caused by Corynebacterium group D2 are described. The vesical damage previous to the establishment of this bacteria is noteworthy and the very rapid increase in urease activity explains the pathogenesis of the situation. Thus allowing for its identification and is relevant to treatment. Cloudy urine with a strong smell of ammonium, alkaline pH and crystals of ammonium magnesium phosphate in the sediment will bring this microorganism and its characteristic growth pattern to mind thus avoiding a falsely negative report. Treatment combining an antimicrobial agent and cystoscopic resection of the encrusted stones, where Corynebacterium group D2 has lodged, has proved efficacious. Vancomycin and teicoplanin have always been active and are eliminated through the kidneys.

Corynebacterium D2, a saprophytic microorganism of skin, causes alkaline encrusted cystitis in patients with a previous bladder injury. In 5 patients that had presented this nosological entity, these gram-positive rods were isolated in urine cultures and calculi. Four patients had undergone urological instrumentation maneuvers and one patient (female) had a history of recurrent cystitis from gram-negative bacteria. Corynebacterium D2 grows slowly and under certain conditions, as those described above, must be considered pathological despite counts of less than 100,000/ufc-cc. It is ureolytic and highly resistant to antibiotics. The synergistic effects of antimicrobials, acetohydroxamic acid and transurethral resection of the lithiasic plaques achieve satisfactory treatment of alkaline encrusted cystitis from Corynebacterium D2.

Six patients diagnosed as having urothelial carcinoma with varying degrees of squamous features are described. Four had pure squamous carcinoma. Two had transitional cell carcinoma (1 with squamous areas and the other had carcinoma in situ). The histological analyses of specimens were performed using immunohistochemical techniques to detect epithelial markers with low molecular weight monoclonal antibodies to cytokeratin. The tests were positive for pure squamous carcinoma and transitional cell carcinoma with squamous areas, and were negative for all areas of transitional cell carcinoma. We underscore the importance of the squamous component in the prognosis of urothelial carcinomas as well as the usefulness of this type of markers, particularly low molecular weight antibodies to cytokeratin, in differentiating squamous areas.