Search

Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined.Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020.A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms.High-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

Cancer renal incidental en pacientes menores de 40 anos: hallazgos clinicos e histopatologicos Objetivo: Evaluar las caracteristicas clinicas y patologicas del cancer renal (CR) en nuestra serie de tumores, analizando su impacto en el grupo de edad de menores de 40 anos. Material y metodo: Se estudiaron 294 pacientes con CR. En 252 se realizo un estudio del ADN tumoral mediante citometria de flujo e histopatologico de las piezas quirurgicas. Los pacientes fueron divididos en dos grupos en funcion de la edad, mayores y menores de 40 anos. Las caracteristicas clinicas e histopatologicas fueron comparadas entre ambos grupos. Resultados: De los 294 pacientes, 26 (8,94%) se incluyeron en el grupo de edad menor o igual a 40 anos. No hallamos diferencias significativas entre los grupos al comparar estadio, tamano tumoral o tratamiento realizado, aunque encontramos un mayor numero de tumores indiferenciados en los pacientes de menor edad (p=0,018). El analisis del ADN no evidencio diferencias en el porcentaje de aneuplodias al comparar ambos grupos. Tampoco encontramos diferencias al comparar la probabilidad de supervivencia actuarial cancer especifica en funcion de la edad. Conclusiones: El comportamiento biologico del CR en pacientes menores de 40 anos (jovenes) no parece diferente al del grupo de mayor edad. Por ello pensamos que los esquemas de tratamiento y seguimiento no deben diferir en funcion de la variable edad.

Introducción: Los traumatismos genitourinarios constituyen el 8-10% de los traumatismos abdominales y en el 50% de los casos es el riñón el órgano más afectado, sobretodo el izquierdo. La decisión de adoptar un tratamiento conservador o quirúrgico en estos casos dependerá del tipo de lesión que encontremos en la unidad renal afecta y de las condiciones clínicas del paciente. Objetivo: Los objetivos del estudio son determinar la posibilidad de llevar acabo un tratamiento conservador en los traumatismos renales de alto grado y estudiar la evaluación y aparición de complicaciones en los mismos. Material y métodos: Hemos analizado retrospectivamente los 309 casos de traumatismos renales acontecidos en nuestro Servicio en el período de tiempo comprendido entre Enero 1984 y Enero 2006, estudiando variables como la etiología del traumatismo, lesiones asociadas en otros órganos, actitud terapéutica adoptada y presencia de complicaciones, tanto a largo como a corto plazo. Resultados: De los 309 traumatismos renales analizados, el 94,1% (291 casos) fueron traumatismos renales cerrados o contusos. La distribución por grados del total de traumatismos fue: Grado I: 213 casos (69%), grado II: 39 casos (12.6%), grados III y IV: 32 casos (10,3%) y grado V: 25 casos (8%). Realizamos tratamiento conservador en el 84,6% de los casos etiquetados como grados III y grado IV (24 casos en total). Se practicaron 4 nefrectomías de urgencia en los grado III por inestabilidad hemodinámica y 4 nefrectomías en grados IV por el mismo motivo, una de ellas parcial, diferidas a las 48-72 horas del traumatismo. En 67% de los traumatismos grado V se realizó nefrectomía de urgencia. Conclusiones: De acuerdo a nuestra experiencia y a los resultados obtenidos, consideramos adecuado el manejo conservador en los traumatismos renales de alto grado siempre y cuando las condiciones hemodinámicas del paciente lo permitan.

Objetivo: Averiguar si en la ascension a una montana de mas de 3.000 m se produce alguna alteracion ventilatoria, si esta se modifica por la aclimatacion y si se relaciona con los cambios en la saturacion arterial de oxigeno (SaO2) o con la aparicion de sintomas de mal de montana agudo (MAM). Sujetos y metodos: En 8 montaneros no aclimatados que ascendieron a la cumbre del Aneto (3.404 m) y permanecieron 3 dias en ella medimos: la capacidad vital forzada (FVC), el volumen espiratorio forzado en el primer segundo (FEV1), la respuesta a la inhalacion de terbutalina, la SaO2 y los sintomas de MAM. Resultados: Al llegar a la cumbre disminuyeron el FEV1 (12,3 ± 5,7%) y la FVC (7,6 ± 6,7%) con la relacion FEV1/FVC% normal. Al dia siguiente aumentaron ambos parametros. No hubo respuesta al tratamiento broncodilatador. La restriccion se corrigio totalmente al descender. La SaO2 en la cumbre aumento progresivamente con la aclimatacion. Durante la ascension el FEV1 se correlaciono con la SaO2 (r = 0,79). Un participante con MAM presento FEV1/FVC menor del 70% y la peor SaO2 durante la estancia en la cima. Esta obstruccion precedio a los sintomas, no cedio con tratamiento broncodilatador y se corrigio con el descenso. Conclusiones: Los montaneros que ascienden a montanas de mas de 3.000 m presentan una restriccion que se correlaciona con la hipoxemia, no mejora con el tratamiento broncodilatador, se alivia con la aclimatacion y desaparece con el descenso. Un sujeto con MAM sufrio una obstruccion que no respondio a la terbutalina y desaparecio con el descenso.

Objective TO ascertain whether climbing a mountain over 3000 meters high produces any alterations in ventilation, whether such alterations are modified by acclimatization, and whether they correlate with changes in arterial oxygen saturation (SaO2) or the development of acute mountain sickness (AMS). Subjects and methods The following parameters were measured in 8 unacclimatized mountaineers who climbed Aneto (3404 m) and spent 3 days at the summit: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), airway response to inhaled terbutaline, SaO2, and the symptoms of AMS. Results At the summit, mean (SD) FEV1 declined by 12.3% (5.7%) and mean FVC by 7.6% (6.7%) while the ratio of FEV1 to FVC remained normal. The means for both parameters were higher on the following day. No airway response to bronchodilator treatment was observed. The restriction disappeared entirely on descent. At the peak, SaO2 increased progressively as the climbers became acclimatized. During the ascent, FEV1 correlated with SaO2 (r = 0.79). One participant who suffered from AMS had a ratio of FEV1 to FVC less than 70% and the worst SaO2 during the 3 days on the summit. Obstruction preceded the AMS symptoms, did not respond to bronchodilator treatment, and disappeared when the climber descended. Conclusions The mountaineers who climbed over 3000 meters presented restriction that correlated with hypoxemia. This restriction did not respond to bronchodilator treatment, improved with acclimatization, and disappeared on descent. One person with AMS presented obstruction that did not respond to terbutaline and disappeared on descent.

Two different sets of noncoding markers (microsatellites and Alu elements) from the human chromosome six were analysed in 106 individuals from Valencia (Spain), with the aim of exploring the effect of evolutionary forces on the genetic variability of the major histocompatibility complex (MHC) and assessing the potential usefulness of these genetic loci in phylogenetic studies. Linkage disequilibrium (LD) analyses revealed statistically significant associations among markers located in the MHC class I region, and also between the microsatellite D6S2792 and several genetic loci from MHC class I, II and III regions. Results of the Ewens-Watterson test indicated that only D6S2792 showed significant departure from selective neutrality. Despite the paucity of haplotype data in the literature, results of the phylogenetic analyses at world scale (Alu elements) showed that the genetic relationships of Valencia were mainly determined by the ethnic ancestry of the populations considered, whereas at European scale (microsatellites) population affinities were strongly influenced by geography. Our findings suggest that noncoding markers from the MHC such as Alu and microsatellite loci might have a potential value as lineage (ancestry) markers in investigations into evolutionary, medical and forensic perspectives.

Five short tandem repeats (STRs) located at human chromosome 6 were analysed in 97 autochthonous Basques from Guipuzcoa (northern Spain), with the aim of assessing the genetic relationships of Basques at a European scale, based on the variability of the major histocompatibility complex (MHC) region, and comparing the phylogenetic information obtained from STRs, and from HLA class I genes (HLA-A and HLA-B) for the same set of European populations. The integrative approach was focused on D6S265 and D6S2792, according to availability of population databases. F(ST) genetic distances obtained from STRs and from HLA loci were very similar, thereby describing a comparable pattern of genetic structuring among the European populations. These findings were supported by results of the Mantel test of matrix correspondence (r = 0.796, P = 0.0022) and by significant correlations between the first two F(ST) eigenvectors of STRs and HLA genes. Coinciding with previous phylogenetic studies, Basques showed substantial genetic differentiation within the European context, probably as a result of the impact of random genetic drift and high inbreeding levels for extended periods of isolation even from adjacent populations. Analysis of the geographical distribution of the allele frequencies revealed a great number of latitudinal frequency clines in both the MHC STRs and the HLA class I genes, which supports the notion of the post-glacial resettlement of Europe being a crucial factor in the genetic make-up of Europeans. Our results indicate that analysing the genetic variability of MHC microsatellites could be a suitable strategy in evaluating the role of evolutionary forces such as natural selection (because of genetic hitchhiking effect), genetic drift and gene flow in the maintenance of polymorphism at the MHC region, because STRs can efficiently complement the genetic information obtained from HLA genes.

Health-related quality of life (HRQoL) is considered by patients with urinary symptoms as the main outcome variable. Descriptive data about HRQoL in patients with urinary incontinence (UI) and/or overactive bladder (OAB) are reported. These data may serve as a reference for comparison purposes.Data were taken from EPICC, a national, multicenter, observational, epidemiological study. Data from representative samples of four population groups were analyzed: working patients of both sexes aged 50-64 years, and institutionalized elderly patients of both sexes with no cognitive impairment. In addition to demographic and clinical data, HRQoL data from the Overactive Bladder Questionnaire (OAB-q SF) and the SF-12 Health Survey were also analyzed.Of the total patients in the EPICC study, 26.53% completed the HRQoL questionnaires. Patients with both UI and OAB symptoms had poorer scores than those with OAB or UI respectively in the PCS (41.34 vs. 47.17 and 45) and MCS (46.01 vs. 49.04 and 47.78) of the SF-12, and in the symptom (32.21 vs. 19.19 and 16.65) and quality of life (82.32 vs. 86.72 and 89.45) dimensions of the OAB-q SF. Impact of OAB and UI on HRQoL was higher in men over 65 years of age as compared to women of the same age (76.76 vs. 82.79).Concurrent symptoms of both UI and VH have a greater impact on HRQoL than those of either UI or VH alone. Impact on HRQoL is similar in middle-aged men and women, but higher in elderly men.

Resumen Introduccion La calidad de vida relacionada con la salud (CVRS) es considerada por los pacientes con sintomas urinarios como el principal indicador de resultados. Se presentan datos descriptivos de la CVRS de sujetos con incontinencia urinaria (IU) y/o vejiga hiperactiva (VH), que serviran de marco de referencia poblacional para comparaciones. Material y metodos Datos extraidos del estudio EPICC, estudio epidemiologico, observacional, multicentrico y de ambito nacional. Se analizaron los datos de muestras representativas de cuatro grupos de la poblacion: mujeres y varones de entre 50 – 64 anos, laboralmente activos, y mujeres y varones mayores de 65 anos, institucionalizados, con nivel cognitivo conservado. Ademas de datos sociodemograficos y clinicos, se analizaron los datos de los cuestionarios de CVRS: cuestionario sobre vejiga hiperactiva OAB-q SF y cuestionario de salud SF-12. Resultados Del total de incluidos en el estudio EPICC, el 26,53% respondio los cuestionarios de CVRS. Los pacientes que presentaban sintomas de VH y de IU, respecto de los que tenian sintomas de VH o de IU, tuvieron peores puntuaciones en la dimension fisica del cuestionario de salud SF-12 (41,34 vs. 47,17 y 45) y en la dimension mental del cuestionario de salud SF-12 (46,01 vs. 49,04 y 47,78) y en sintomas (32,21 vs. 19,19 y 16,65) y calidad de vida (82,32 vs. 86,72 y 89,45) del OAB-q SF. El impacto de la VH y la IU sobre la CVRS fue superior en varones de mas de 65 anos respecto a las mujeres de la misma edad (76,76 vs. 82,79). Conclusiones La presentacion conjunta de sintomas de VH y de IU ocasiona mayor impacto en la CVRS que la presentacion aislada de VH o IU. El impacto sobre la CVRS es similar en varones y mujeres en la mediana edad pero superior en varones de mas de 65 anos.

Introducción: La calidad de vida relacionada con la salud (CVRS) es considerada por los pacientes con síntomas urinarios como el principal indicador de resultados. Se presentan datos descriptivos de la CVRS de sujetos con incontinencia urinaria (IU) y/o vejiga hiperactiva (VH), que servirán de marco de referencia poblacional para comparaciones. Material y métodos: Datos extraídos del estudio EPICC, estudio epidemiológico, observacional, multicéntrico y de ámbito nacional. Se analizaron los datos de muestras representativas de cuatro grupos de la población: mujeres y varones de entre 50-64 años, laboralmente activos, y mujeres y varones mayores de 65 años, institucionalizados, con nivel cognitivo conservado. Además de datos sociodemográficos y clínicos, se analizaron los datos de los cuestionarios de CVRS: cuestionario sobre vejiga hiperactiva OAB-q SF y cuestionario de salud SF-12. Resultados: Del total de incluidos en el estudio EPICC, el 26,53% respondió los cuestionarios de CVRS. Los pacientes que presentaban síntomas de VH y de IU, respecto de los que tenían síntomas de VH o de IU, tuvieron peores puntuaciones en la dimensión física del cuestionario de salud SF-12 (41,34 vs. 47,17 y 45) y en la dimensión mental del cuestionario de salud SF-12 (46,01 vs. 49,04 y 47,78) y en síntomas (32,21 vs. 19,19 y 16,65) y calidad de vida (82,32 vs. 86,72 y 89,45) del OAB-q SF. El impacto de la VH y la IU sobre la CVRS fue superior en varones de más de 65 años respecto a las mujeres de la misma edad (76,76 vs. 82,79). Conclusiones: La presentación conjunta de síntomas de VH y de IU ocasiona mayor impacto en la CVRS que la presentación aislada de VH o IU. El impacto sobre la CVRS es similar en varones y mujeres en la mediana edad pero superior en varones de más de 65 años. Introduction: Health-related quality of life (HRQoL) is considered by patients with urinary symptoms as the main outcome variable. Descriptive data about HRQoL in patients with urinary incontinence (UI) and/or overactive bladder (OAB) are reported. These data may serve as a reference for comparison purposes. Materials and methods: Data were taken from EPICC, a national, multicenter, observational, epidemiological study. Data from representative samples of four population groups were analyzed: working patients of both sexes aged 50-64 years, and institutionalized elderly patients of both sexes with no cognitive impairment. In addition to demographic and clinical data, HRQoL data from the Overactive Bladder Questionnaire (OAB-q SF) and the SF-12 Health Survey were also analyzed. Results: Of the total patients in the EPICC study, 26.53% completed the HRQoL questionnaires. Patients with both UI and OAB symptoms had poorer scores than those with OAB or UI respectively in the PCS (41.34 vs. 47.17 and 45) and MCS (46.01 vs. 49.04 and 47.78) of the SF-12, and in the symptom (32.21 vs. 19.19 and 16.65) and quality of life (82.32 vs. 86.72 and 89.45) dimensions of the OAB-q SF. Impact of OAB and UI on HRQoL was higher in men over 65 years of age as compared to women of the same age (76.76 vs. 82.79). Conclusions: Concurrent symptoms of both UI and VH have a greater impact on HRQoL than those of either UI or VH alone. Impact on HRQoL is similar in middle-aged men and women, but higher in elderly men.

New approaches for prostate cancer are needed due to limitations of current therapies for the treatment in advanced stages of the disease. In fact, there is no effective treatment for these patients. Development in molecular biology research on prostate cancer has improved the knowledge of common alterations encoded in DNA sequence, which may be useful as targets for prostate cancer approach. In this review we give an overview of current gene therapy concepts, the most common gene alterations in prostate cancer and the gene therapy treatment strategies.

Retroperitoneal tumours are extremely rare neoplasms, most of them malignant. We described the case of a 48-year-old man with a large retroperitoneal mass detected during the study of a constitutional syndrome. The mass was treated surgerically and pathological diagnosis was malignant fibrous histiocytoma. Literature is reviewed and clinical features, histological findings, radiological techniques and therapeutic management are analyzed.

Resumen Introduccion Debido a las limitaciones existentes en el tratamiento del cancer de prostata en estadios avanzados, se precisan nuevas estrategias de tratamiento para estos pacientes. El desarrollo de la biologia molecular en el campo del cancer de prostata, ha proporcionado un mayor conocimiento de las alteraciones mas comunes a nivel del ADN de las celulas cancerigenas, que podrian ser utilizadas como dianas terapeuticas. En este articulo se han revisado los conceptos actuales en el campo de la terapia genica, las alteraciones genicas mas frecuentes en el cancer de prostata y posibles estrategias de tratamiento.

to evaluate the clinical and pathological renal cancer (CR) characteristics in our series of tumours, analyzing its impact in the group of age less than 40 years.We studied 294 patients with CR. The pathologic characteristics were analyzed and DNA ploidy pattern of the surgical pieces were done in 252 patients. The patients were divided in two groups based on age, greater or less to 40 years, well then clinical and pathologic characteristics were compared between.Of all patients, 26 of 294 patients (8,94%) were included in the young age group (less to 40 years). We did not found differences between both groups comparing stage, tumoral volume, treatment realized or DNA ploidy pattern, but in nuclear grade with more aggressive tumours in young people (p=0,0018), without differences in recurrence-free survival or actuarial disease specific survival rate.The findings in our study indicate that the natural history and outcome of the RC is similar in both older and younger patients. Therefore, in our opinion, the management of CR in young people should be established with independence of the age.

Genitourinary trauma amount to an 8-10% of abdominal trauma with the kidney being the most affected organ in 50% of cases, especially the left one. The choice of treatment will depend on the kind of lesion found in the affected renal unit and on the patient's clinical conditions.The aims of this study are twofold: to determine the applicability of conservative treatment in major renal trauma and to assess the evaluation and emergence of possible complications.We have analysed 309 cases of renal trauma dealt with in our department between January 1984 and January 2006, analyzing such variables as the etiology of the trauma, associated lesions in other organs, the therapeutic approach adopted as well as the presence of complications, both in the long and short run.Out of a total of 309 renal trauma analyzed, a 94.1% (291 cases) were blunt renal trauma. The distribution by grade was: Grade I, 213 cases (69%); Grade II, 39 cases (12.6%); Grade III/IV, 32 cases (10.3%); Grade V, 25 cases (8%). We have given a conservative approach in the 84.6% of the grade III/IV cases (24 cases). 4 grade III nephrectomies were carried out in the Emergency Room because of haemodynamic instability, other 4 grade IV nephrectomies were done for the same reason, one of which was a partial nephrectomy, 48-72 hours after the trauma. The treatment for grade V was nephrectomy in 67%.According to our experience and in the light of the results obtained, we consider the conservative approach adequate for major renal trauma as long as the patient is haemodynamically stable.

Los tumores retroperitoneales primarios son neoformaciones extremadamente raras, de naturaleza maligna en la mayoría de los casos. Presentamos el caso de un varón de 48 años con una gran masa retroperitoneal detectada durante el estudio de un síndrome constitucional. La masa fue tratada quirúrgicamente y el diagnóstico anatomopatológico fue de histiocitoma fibroso maligno. Realizamos una revisión de la literatura y analizamos su presentación clínica, hallazgos histológicos, pruebas diagnósticas de imagen y manejo terapéutico.

Resumen Introduccion Aproximadamente el 40% de los pacientes con adenocarcinoma renal (AR) fallecen por progresion tumoral a pesar del tratamiento. El 30-40% de los pacientes que progresan, presentan una enfermedad quirurgicamente resecable en el momento del diagnostico. Objetivo El objetivo de este estudio ha sido evaluar que factores muestran un valor pronostico independiente de supervivencia libre de progresion en el AR. Material y metodos Estudio retrospectivo de 252 tumores renales intervenidos quirurgicamente entre 1969-2001. La mediana de seguimiento fue de 36,47 meses (12-246). Las variables evaluadas fueron la edad, el TNM (TNM 2002), grado nuclear de Furhman, tipo histologico, tamano (diametro mayor de la pieza quirurgica) y ploidia del ADN (para un minimo de 3 muestras en fresco de cada tumor). El contenido de ADN se obtuvo mediante citometria de flujo. La progresion biologica fue definida como recurrencia local, regional y/o presencia de metastasis a distancia. Se utilizaron metodos estadisticos comparativos tanto univariantes (Chi- cuadrado, metodo de Kaplan-Meyer con el log-rank test) como multivariantes (regresion multiple de riesgos proporcionales de Cox). Resultados De los 252 pacientes, 43 se desestimaron para el analisis por un estudio de la ploidia del ADN no valido (coeficiente de variacion superior a 8). De los 224 validos, progresaron 89 (39,74%). La mediana del tiempo libre de progresion fue de 9,55 meses (0-133), de tal forma que el 70,9% de los que recidivaron lo hicieron en los dos primeros anos del seguimiento. De los pacientes que progresaron, el 89,5% lo hicieron de forma locorregional, el 9,4% lo hicieron a distancia y 2 pacientes (1,2%) en el rinon contralateral. El 83,1% de los que recidivaron fallecieron por la enfermedad. Al analizar la asociacion de las variables con la progresion tumoral, los tumores de alto grado, no organoconfinados y aneuploides presentaban una probabilidad significativamente mayor de progresion. En el analisis univariante de supervivencia el estadio III-IV, el grado nuclear III-IV, los tipos histologicos indiferenciado y convencional, asi como los tumores aneuploides mostraron peor probabilidad de supervivencia. El analisis multivariante mediante regresion de Cox, utilizando como variables explicativas los factores pronosticos evaluados en el univariante, selecciono al TNM, grado nuclear y ploidia del ADN como factores pronosticos independientes de supervivencia libre de progresion. Conclusiones Los resultados de este estudio indican que el TNM 2002, el grado nuclear y la ploidia del ADN tienen un valor pronostico independiente de supervivencia libre de progresion. Ni el tipo histologico, ni el tamano tumoral aportaron informacion adicional en la prediccion pronostica.

Introduction Some studies have shown that more than 40% of patients with first episode psychosis (FEP) are nonadherent and treatment with long – acting antipsychotics (LAIs) could increase their compliance. However, studies on efficacy of LAIs versus oral antipsychotics for preventing relapse among schizophrenia patients have produced conflicting results. Objectives With this study we want to asses if patients with FEP in treatment with LAIs have a decreased incidence of readmission compared with patients in treatment with oral antipsychotics over 6 month follow – up. Methods 188 FEP patients were consecutively admitted to Hospital del Mar since January 2008 to September 2014. The included evaluation was, among others: sociodemographic data, duration of untreated psychosis (DUP), diagnosis, substance use and clinical data at baseline. Later, antipsychotic treatment and number of admissions and of emergencies over 6 months were also recorded. We studied difference sin readmission, number of emergencies between patients on LAI and oral treatment. Results We found a significative decreased incidence of readmission (p=0,000) and a lower number of emergencies (p=0,017) in the group of FEP patients treated with LAIs versus the group treated with oral antipsychotics. Conclusions In our sample, treatment with LAIs is associated with a reduced readmission rate and a lower number of emergencies in patients with FEP. This finding are agree with the results of other studies that show a significantly reduced relapse and a lowest risk of rehospitalization in FEP patients treated with LAIs.

To value the efficacy in endoscopic treatment of the vesicoureteral reflux (VUR).We have realized a prospective study in patients with RVU treated with endoscopic polydimethylsiloxane, from January 1999 until December 2001, analyzing the results after an average pursuit of 30 months. We included 144 patients, 92 girls and 52 children, with 213 VUR (124 primary ones and 89 of secondary etiology). The initial efficacy of the treatment was defined as the finished absence of RVU in the isotopic cystography, realized three months after the puncture.The global efficacy of the endoscopic treatment in secondary etiology reflux was lower than the reached one in the treatment of the primary RVU (77.7% against 86.2%) but the differences did not reach statistical significance (p=0,226). We do not also find significant differences on having compared the injected volume and the valuation of resolution of the ebb between the different causes of secondary RVU (p=0.361). We found recurrence in patients with RVU due to lower urinary tract dysfunction (4.34%).Endoscopic treatment of the secondary VUR is a minimally invasive skill, presents scarce morbidity and it is effective in chosen patients. The risk of a long term recurrence is grater in VUR secondary to functional alterations (neurogenic bladder and functional instability), for what, pursuit has to be established according to the base pathology.

The existence of bilateral renal angiomyolipoma (AML) is fairly infrequent, especially when not associated with such syndromes as tuberous sclerosis or linfangioleimiomatosis. Here we present the case of a 40-year-old woman who was accidentally diagnosed at week 33rd of gestation by an ultrasound, of bilateral renal AML and that could be treated with kidney sparing conservative treatment. We have also done a review of the literature focusing on its management and its relationship with pregnancy.

Renal leiomyoma are uncommon mesenchymal tumours, which can arise from any organ of the genitourinary tract with smooth muscle cells. The diagnostic imaging techniques available can not differentiated easily leiomyoma from other malignant renal masses. Since preoperative diagnosis cannot be made, management usually involves radical nephrectomy as in the case described. After treatment, prognosis is excellent.

We assessed the prognostic value of a stage pT3a diagnosis based on perirrenal fat infiltration.A series of 300 patients diagnosed of renal cell carcinoma (CCR) between 1992 and 2001 were retrospectively analyzed. Focusing on pT3a tumors as defined by perirrenal fat infiltration, a group of 92 patients (91,08%) regardless lymph node involvement (Nall) were included. Patients with distant metastases were excluded. In patients with pT3a Nall M0 tumors, tumour size was a significant parameter predicting survival. The most significant cut-off value for tumor size based on ROC curve was 5,5 cm. Therefore two groups were defined (up to 5,5 cm or greater than 5,5 cm) and actuarial survival were compared between both groups.No significant differences were found comparing actuarial survival of selected pT3a and tumour size less than 5,5 cm with pT1 and pT2 tumors. After classifying selected pT3a less than 5,5 cm as pT1, multivariate analysis showed no differences regarding to prognostic variables before and after classification. Subsequently multivariate analysis showed that modified T stage was an independent significant predictor of cancer specific actuarial survival.Perirrenal fat infiltration in renal cell carcinoma should not be used to assign T category. In our series grading tumors pT3a lesser than 5,5 cm as pT1/pT2 TNM stage does not affect their prognostic value.

We present a report of a patient that had a iatrogenic double J catheter loop after endourology procedure (neumatic balloon dilatation of ureteral estenosis) as well as its therapeutic management.

to evaluate the clinical and pathological characteristics of the CCR in our series of tumors, analyzing its impact in the group of age greater than 65 years.300 patients with renal adenocarcinoma (CCR) were studied. In 252, ploidy pattern of DNA and pathologic characteristics of the surgical pieces were done. According to the criteria of the Spanish Society of Geriatrics, the patients were divided in two groups based on the age, greater and smaller of 65 years. The clinical and pathologic characteristics were compared between both groups.103 of the 300 patients (33.3%) were included in the geriatric group. We did not found differences between both groups comparing stage, tumoral volume or treatment realized, but found differences in DNA ploidy pattern, recurrences and survey.The RCC in the elderly has a few clinical and pathological characteristics similar to the rest of patients in our series. Nevertheless differences exist in the average and actuarial survival, which is minor in the patient of more than 65 years, cause the percentage of detected aneuploidies and number of recurrences in not confined tumors in this group of age.

Resumen Presentamos el caso clinico de un paciente sometido a un procedimiento endourologico (dilatacion neumatica con balon de estenosis ureteral) que presenta en el transcurso del mismo un bucle iatrogenico del cateter doble J y su posterior manejo terapeutico.

Objetivo: evaluar las características clínicas y patológicas del CCR en nuestra serie de tumores, analizando su impacto en el grupo de edad de mayores de 65 años. Material y método: Se estudiaron 300 pacientes con adenocarcinoma renal (CCR). En 252 se realizó un estudio del ADN tumoral mediante citometría de flujo e histopatológico de las piezas quirúrgicas. Según los criterios de la Sociedad Española de Geriatría, los pacientes fueron divididos en dos grupos en función de la edad, mayores y menores de 65 años. Las características clínicas e histopatológicas fueron comparadas entre ambos grupos. También encontramos diferencias significativas al comparar la supervivencia actuarial cáncer específica de modo global, con mayor supervivencia de los pacientes menores de 65 años Resultados: De los 300 pacientes, 103 (33,3%) se incluyeron en el grupo de edad geriátrica. No hallamos diferencias significativas entre los grupos al comparar estadio, tamaño tumoral o tratamiento realizado, aunque encontramos un mayor índice de recidivas en los pacientes de edad geriátrica. El análisis del DNA evidenció un mayor porcentaje de aneuplodías en el grupo en edad geriátrica. La supervivencia actuarial cáncer específica fue superior en el grupo de menos de 65 años. Conclusiones: El CCR en la edad geriátrica, tiene unas características clínicas y patológicas similares al resto de pacientes en nuestra serie. Sin embargo existen diferencias en la supervivencia media y actuarial, que es menor en el paciente de más de 65 años por el mayor porcentaje de aneuploidías detectado y la mayor tasa de recidivas en tumores organoconfinados en este grupo de edad.

Resumen Objetivo Considerando los tumores renales en estadio pT3a por infiltracion grasa, hemos evaluado dicho estadio en funcion del tamano tumoral en nuestra serie. Material Y Metodo Hemos realizado un estudio retrospectivo de 300 pacientes con diagnostico de adenocarcinoma renal (ccr) entre los anos 1992 a 2001, con un seguimiento medio de 60 meses. incluimos en nuestro estudio a 92 pacientes (91,08%) de todos los tumores pt3a por infiltracion grasa, independientemente de la afectacion ganglionar (ncualquiera) y con ausencia de metastasis. se obtuvieron curvas roc en funcion del tamano tumoral y el estado (vivo/muerto), seleccionando el mejor valor de corte (mejor sensibilidad y especificidad). dicho punto de corte correspondio al valor 5,5 cm, permitiendo dicotomizar y definir dos grupos con diferencias significativas respecto a la supervivencia actuarial. tras diferenciar estos dos grupos, comparamos los tumores menores de 5,5 cm y estadio pt3anxm0, con el resto de subgrupos de la clasificacion tnm. Resultados No encontramos diferencias significativas al comparar la supervivencia actuarial de los tumores pT3a seleccionados y tamano inferior a 5,5 cm con el resto de tumores en estadios pT1 y pT2. Tras reclasificar los tumores pT3a menores de 5,5 cm como pT1, se realizo un analisis multivariante mediante regresion logistica para evaluar los factores pronosticos respecto a la progresion tumoral, previo y posterior a la reclasificacion de los tumores, conservando el TNM su valor pronostico independiente tras la reclasificacion. Conclusiones Los tumores de celulas renales pT3a por infiltracion grasa sin metastasis de tamano inferior a 5,5cm, se comportan como tumores organoconfinados respecto a la supervivencia y su reclasificacion no modifica el valor pronostico independiente del TNM como predictor de progresion tumoral.

La existencia de angiomiolipomas (AML) renales bilaterales es relativamente infrecuente, sobre todo cuando no se presentan asociados a síndromes como la esclerosis tuberosa o la linfangioleiomiomatosis. Presentamos el caso de una mujer de 40 años que durante la 33ª semana de gestación fue diagnosticada, de forma incidental en una ecografía abdominal de control, de AML renales bilaterales y que pudo ser tratada mediante cirugía conservadora del parénquima renal. Además realizamos una revisión de la literatura, centrándonos en el manejo de esta entidad y su relación con el embarazo.

To analyze the influence in total serum PSA (PSA(t)) and free PSA (PSA(1)) of chronic inflammatory patterns from prostate biopsy specimens of non-symptomatic patients.518 non-symptomatic patients underwent ultrasonography and prostatic biopsy for PSA(t)4 ng/mL and/or DRE suspicious of malignancy. Those with a negative biopsy were divided into two subgroups: patients with benign prostatic lesions (LBP) and patients with chronic inflammatory signs (SIC).456 patients (88.03%) were biopsied for elevated PSA(t) or/and DRE suspicious of malignancy in 62 patients (11.97%). Mean volume in patients with LBP was 54cc, while 51cc was the mean volume in patients with histological pattern of chronic inflammatory infiltrate. Mean PSA(t) in patients with LBP was 9.43 (IC 95% +/- 7.8) and 8.8 (IC 95% +/- 5.73) in SIC's group patients.The presence of SIC has no significant influence in the eventual value of PSA(1) y PSA(t) in a selected population. As a result of that finding data from serum PSA can be reliably evaluated even in the presence of SIC in biopsy specimens.

Resumen Objetivo Analizar la influencia en los niveles sericos de PSA total (PSAt) y PSA libre (PSAl) de los signos de inflamacion cronica detectados mediante biopsia prostatica en pacientes no sintomaticos. Pacientes y metodo Seleccionamos 518 pacientes asintomaticos sometidos a ecografia transrectal y biopsia sextante de prostata por PSAt > 4 ng/mL y/o tacto rectal sugestivo de malignidad. Seleccionamos aquellos pacientes en los que la biopsia descartaba malignidad. Se definieron dos grupos, pacientes con lesion benigna de prostata (LBP) y pacientes con infiltrado inflamatorio cronico (SIC). Resultados En 456 pacientes (88,03%) la biopsia se realizo por elevacion de PSAt o/y por tacto rectal sospechoso en 62 pacientes (11,97%). El volumen medio prostatico en pacientes con LBP fue 54 cc, siendo 51 cc el volumen medio en pacientes con criterios histologicos de SIC. El PSAt medio en pacientes con LBP fue 9,43 (IC 95% ± 7,8) y 8,8 (IC 95% ± 5,73) en el grupo de SIC. Conclusiones La presencia de SIC, no tiene influencia significativa en los valores PSAl y PSAt en la poblacion estudiada. Estos hallazgos, a efectos de practica clinica, permite en nuestro medio valorar las cifras de PSA con independencia de la presencia de SIC en las muestras de biopsia.

Introduction: The involuntary placement and involuntary treatment of mentally ill patients are central issues in mental health care. Their massive impact upon the liberty and freedom of the persons concerned have made them a topic of controversial legal and ethical debates for more than 100 years. Coercive treatment in psychiatry, including the admission to a psychiatric hospital, remains an understudied issue [1]. The only replicated finding in this highly sensitive area is the significant cross-national variation concerning aspects such as provisions in mental health legislations and rates of involuntary admissions to psychiatric hospitals [2]. Objectives: The purpose of this study is to examine the impact of clinical and contextual characteristics on the decision to perform compulsory admission in psychiatric units in patients with diagnostic of schizophrenia who were attended and treated by a mobile home-care unit in the area of Barcelona (Multidisciplinary Team Support Specialist, EMSE in its Spanish acronym). Methods: We performed a cross-sectional retrospective study of the medical records of 362 patients with diagnosis of schizophrenia according to DSM-IV criteria who were attended at home by a mobile home-care unit in Barcelona. We collected the following data; age, number of visits done by EMSE at home, presence of violent behavior (evaluated with AVAT scale), awareness of disease (evaluated with SUMD scale), functionality of the patient (evaluated with WHO scale), global severity of disease (evaluated with GEP scale), clinical impression (evaluated with CGI scale), score in GAF scale, score in Positive PANSS scale, score in Negative PANSS scale and score in General PANSS scale. The sample was divided in two groups according to if patients were compulsory hospitalized or not. Results: We found more aggressiveness in the group of patients in which we decide to do compulsory hospitalization (mean AVAT score 4.87 Vs 2.99, p = 0.033). We also observed in patients compulsorily admitted to hospital worse awareness of disease (mean SUMD score 12.9 Vs 10.6, p = 0.008), major global severity of disease (mean GEP score 16.55 Vs 12.51, p = 0.047), worse clinical impression (mean CGI score 5.34 Vs 4.41, p< 0.001) and lower score in GAF scale (30.63 Vs 43.36, p< 0.001). Regarding to psychopathology we found higher score in positive PANSS scale in patients compulsorily admitted (29.44 Vs 22.54, p = 0.002), but we haven’t found statistically significant differences in negative PANSS score nor general PANSS score. Conclusions: As previously seen in the literature [3], in our study we observed that the decision to perform an involuntary admission is related with a worse awareness of disease, lower score at GAF scale and more aggressiveness in schizophrenic patients. In our sample we also observed that the decision to perform an involuntary admission is related with major severity of disease, a worse clinical impression and with higher positive psychotic symptoms.

Introduction There is good evidence from epidemiological studies that the diagnosis of schizophrenia is associated with an increased risk of violence.Some studies have linked the presence of positive symptoms, first psychotic episode, duration of untreated psychosis and lack of insight with violent behavior. Objective The primary objective was to identify factors related to violent behavior in patients diagnosed with psychotic disorder attended by our group, a multidisciplinary mobile outreach team (EMSE). Methodology We evaluated a total of 249 patients diagnosed with psychotic disorder between 2007 and 2012. We administered the following scales: PANSS, GAF (Global Assessment of Functioning), CGI (Clinical Global Impression), GEP (Severity of psychiatric illness scale, AVAT (Instrument to assess violent behavior in mental illness) and SUMD (Scale unawareness of mental disorders). To study the correlation between the scales and the score of the AVAT instrument we used the Pearson correlation. Clinical variables were also compared between aggressive and non-aggressive patients using Chisquare and Student's. Results There is a positive correlation between AVAT and PANSS-P (r = 0.544), ICG (r = 0.472), GEP (r = 0.515) and a negative correlation between AVAT and GAF (r = -0357). The correlation between AVAT and SUMD is positive (r = 0.119) but not statistically significant. Conclusion The presence of positive symptoms and clinical severity has been linked to increased aggressiveness and to predict the occurrence of violent behavior in the course of psychotic disorder. Unlike other studies, no correlation was observed with the lack of insight.

Introduction The utility of Mobile Crisis Unit (MCU) and its target population has been a controversial issue and many scientific articles have been writen about it (1,2). Objective The aim of this study is to identify the demographic and clinical features of patients diagnosed with psychotic disorder who have been hospitalized and have not required hospitalization in psychiatric unit through a Mobile Crisis Unit (MCU). Methods We collected retrospectively demographic and clinical variables. These include psychiatric rating scales of severity: Clinical Global Impression Scale (CGI) and Psychiatric Disease Severity (GEP); of functionality as Global Assessment of Functioning Scale (GAF); the aggressive behaviour and violence scale (AVAT) and psychopathology with the Positive and Negative Syndrome Scale (PANSS) of a total of 136 patients between June 2007 and July 2010. Results There have been found stadisticaly significative differences between patients who have been hospitalized versus patients who have not in the items of treatment adherence and security staff intervention (Table 1). There is a positive correlation between patients who required hospitalization and the clinical scales CGI, GEP, GAF, AVAT, SUMD, PANSS-P and PANSS-G (Table 2). Conclusions We can conclude that patients cared for by the Mobile Crisis Unit (MCU) that require of psychiatric hospitalization have poor adherence to previous treatment. A high frequency of cases require intervention of security staff for having a higher risk of aggressiveness at the moment of hospitalization. The presence of greater psychopathology and functionality severity in patients hospitalized through the Mobile Crisis Unit (MCU) is also considered. Variables No hospitalization Hospitalization p N % N % Sex Men 33 54.1 41 54.7 0.95 Cohabitation Alone 15 24.6 25 33.3 0.27 Toxics Yes 14 23 17 22.7 0.97 Psychiatric history Yes 45 78.9 54 77.1 0.81 Previous hospitalizations Yes 42 68.9 42 56 0.12 Treatment adherence Yes 14 31.1 2 3.5 Security staff Yes 1 1.7 39 57.4 Chi-square Variables No hospitalization Hospitalization p Age 45,3(17,02) 45,44(16,16) 0,96 CGI 4,24(0,82) 5,11(0,67) GEP 12,09(4,18) 15,96(3,82) GAF 47,16(14,21) 37,07 (23,72) AVAT 2,41 (1,98) 4,15 (2,45) SUMD 10,65 (3,29) 12,97 (3,08) PANSS P 22,28(7,02) 28,79(6,43) PANSS N 21,89 (8,44) 20 (8,09) 0,19 PANSS PG 38,8 (9,51) 45,28 (9,65) Mean(SD)–T-test

Varon de 48 anos sin antecedentes de interes, que presenta un cuadro de Gangrena de Fournier con afectacion uretral de unos 4 cm (Fig. 1), tras un episodio de uretritis. Se realizo un tratamiento quirurgico inicial consistente en escision amplia de los tejidos necroticos, junto con antibioterapia de amplio espectro, analgesia intravenosa y derivacion de la orina, seguido de curas diarias con apositos hidrocoloides. En la uretrografia retrograda realizada a las tres semanas, se observa la restitucion anatomica de la uretra (Fig. 2) y funcional, con un Qmax de 25 ml/s en la flujometria de control, por lo que no fue precisa una uretroplastia posterior como hubiera sido de esperar.