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Prostate cancer has become one of themost frequently diagnosed tumors in men and is one ofthe leading causes of death in men over 50 years old.Due to the development of molecular biology techniquesused in recent prostate cancer studies, many new aspectsof the disease are being discovered and may help indiagnosis, treatment and even to establish prognosisfor these patients. Therefore, despite not yet common inclinical practice, several molecular biology techniquesfrequently need to be discussed with other physiciansand even with the patient. In this article, we review someof the most important tools used in molecular biology andtheir recent discoveries in the study of prostate cancer
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OBJECTIVES: To investigate our case series of patients with primary retroperitoneal tumors over the past 10 years, analyzing clinical symptoms, diagnostic tests, tumor pathology, surgical data, concomitant can-cer treatments, recurrence and survival rates.METHODS: Retrospective analysis of 37 patients with primary retroperitoneal tumors diagnosed at our hospital over the past 10 years.RESULTS: Computed tomography (CT) was the imaging technique used most often and the most accurate. Tumors were malignant in 83% of patients and benign in 17%. Complete tumor resection was performed in 73% of cases; the most common approach was midline la-parotomy. Neighboring organs were also removed in 51.8% of cases in which radical resection was perfor-med. The recurrence rate was 45% in patients who un-derwent surgery. Median time to onset of recurrence following open surgery was 23 months. Repeat resec-tion was performed in 66% of cases with recurrence. Five-year survival following total resection of malignant tumors was 44%. The mean patient survival after repeat resection was 9.8 months.CONCLUSIONS: Primary retroperitoneal tumors are rare and usually malignant. Surgery is the treatment of choice and complete tumor resection is the main factor that determines prognosis.
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OBJECTIVES: To detect and enumeratecirculating prostatic tumor cells (CTC) in the peripheralblood of patients with prostate cancer (PC) and studythe relationship between CTCs and clinical-pathologicalparameters.METHODS: Prospective three-arm study: 26 patients (p)with localised PC (LPC); 24 P with metastatic PC (MPC)and 30 healthy volunteer controls. A single 7.5 mlsample of peripheral blood was retrieved; CTCs wereisolated using an immunomagnetic method based onthe CellSearch system (Veridex). CTCs were identifiedas nucleated cells negative for CD45 (leukocytes) andpositive for cytokeratins. (8, 18 y 19) The relationshipbetween CTC numbers and PSA levels, Gleason scoreand TNM classification was studied.RESULTS: Only 10% of the healthy controls had 1CTC/7.5 mL, none of the patients with localised PChad more than 3 CTCs (88% ≤ 2 CTCs), and patientswith MPC had significantly higher CTC levels [m: 29 (1-178)] compared with the other two groups (P: 0.000).A positive correlation was demonstrated between theCTC count and PSA levels, tumor size, and presen-ce orabsence of enlarged lymph nodes. Gleason score wasthe only parameter that did not show any correlationwith CTC levels, and although the number of CTCs washigher in patients with visceral metasta-ses [m: 297 (0-416)] compared with bone metastases patients [m: 68(9.5-168)], these differences were not significant
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OBJECTIVES: The relationship between hyperparathyroidism and lithiasis is quite known, so the study of parathyroid glands is especially mandatory in the face of relapses. Our objective is to analyze both primary hyperparathyroidism (PHPT) associated with renal lithiasis and the evolution of this condition after parathyroidectomy, as well as to study factors associated with the presence of lithiasis or bone pathology, and carry out a review on bibliography.METHODS: We describe a retrospective study of a series comprising 287 cases of hyperparathyroidism: 237 of them were primary and the remaining 50, secondary. We have included: sex, age, evolution time and symptoms, diagnostic tests (biochemical, radiological and histological). Factors such as number of episodes prior to diagnosis and treatments were analyzed in patients with symptomatic lithiasis to know whether patients exhibited residual lithiasis after the management of calculi or whether patients underwent episodes after parathyroidectomy, or whether or not they were treated. Statistical analysis was carried out through SPSS 15.0 for Windows. RESULTS: Forty five percent of the patients had suffered lithiasis episodes; 50%, osteopenia/osteoporosis; 23%, musculoskeletal pain; 23%, asthenia and/or depressive syndrome. In 13.5% of cases, diagnosis was supported by the presence of hypercalcemia; no other symptoms were detected.We have analyzed factors that favor or inhibit renal lithiasis formation and compared biochemical parameters from the group of primary hyperthyroidism that exhibited lithiasis (41 patients) with those patients who did not (49). We noted that lithiasis patients showed higher values of calcium, alkaline phosphatase, intact PTH, mean PTH, osteocalcin, and chlorine/phosphate, calciuria and phosphaturia indexes. Student’s t test on two independent samples revealed significant statistical differences in calcium levels (p<0.05), intact PTH (<0.05) and osteocalcin.CONCLUSIONS: Primary hyperparathyroidism patients with lithiasis presented higher values of parathormone, alkaline phosphatase, osteocalcin, and Cl/P and calciuria indexes than lithiasis-free PHPT patients.These patients exhibit objective improvement of symptoms after parathyroidectomy, and rarely a recurrence of lithiasis, a factor that generally coincides with persistence of residual lithiasis.
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Antimuscarinics are the drugs of choice for the treatment of overactive bladder syndrome, and their benefit/risk ratio depends largely on selectivity for the different subtypes of muscarinic receptors. Solifenacin is the antimuscarinic that presents greatest selectivity for M3 bladder receptors, which may translate into a lower incidence of undesirable effects related to other receptor subtypes. Metabolic pathways of the antimuscarinics may impact efficacy and appearance of interactions. Solifenacin is metabolized only by the CYP3A4, giving three inactive metabolites and one with a similar activity to the original compound. However, other drugs in the group are also a substrate for the CYP 2D6 which presents polymorphisms, whereby their pharmacokinetics may be modified in slow metabolizers. The risk of interactions of solifenacin is low, and it is lower than that of the antimuscarinics which are also metabolized by the CYP 2D6. The unaltered fraction of solifenacin which is eliminated in urine, together with the active metabolite, can contribute to the therapeutic effect by acting on the urothelium receptors. It is not necessary to adjust doses of solifenacin in elderly patients or those with moderate liver or kidney impairment.
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OBJECTIVES: Crossed fused renal ectopia is a rare congenital anomaly. We report the case of a 3 year old boy with diagnosis of right crossed fused renal ectopia, history of recurrent urinary tract infection and previous failure of surgical treatment.METHODS: Three year old boy with diagnosis of right crossed fused renal ectopia of the inferior moiety underwent a laparoscopic heminephrectomy of the inferior renal unit, due to severe hidronefrosis and recurrent urinary tract infections. RESULTS: A laparoscopic right heminephrectomy of the inferior renal moiety was performed uneventfully. Operation room time was 200 minutes and there were no perioperative complications. Patient was discharged 18 hours after the procedure. After 5 years of follow up patient remains asymptomatic with good renal function.CONCLUSIONS: The laparoscopic approach is an acceptable option to treat this anomaly, with all the advantages of minimally invasive surgery
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OBJECTIVES: The majority of renal cell carcinomas are now incidentally detected as small renal masses in asymptomatic patients due to the widespread use of ultrasound and new improved noninvasive abdominal imaging modalities. Nephron-sparing surgery is the treatment of choice for patients with small renal masses in presence of normal contralateral kidney or in presence of an anatomic or functional solitary kidney. We reviewed retrospectively our experience in open and laparoscopic partial nephrectomy. METHODS: The records for all patients who underwent nephron-sparing surgery for a renal mass since 1995 at British Hospital of Buenos Aires and Hospital Aleman and since 2000 at Hospital Universitario Austral were reviewed. The most relevant data of 246 patients were collected, with special focus on demographic data, operative details, pathology results, complications and outcome in cancer control.RESULTS: We have performed 254 nephron-sparing surgeries. Open partial nephrectomy was performed in 220 procedures and the laparoscopic partial nephrectomy since 2001 in 34 patients. The indication was elective or relative in 236 patients with 8 patients with bilateral tumors and 18 tumors in a solitary kidney. The pedicle was clamped in 168 procedures with hypothermia in 43 patients. Mean ischemia time was 24.7 minutes. Average tumor size was 3.49 cm. The pathologic findings demonstrate a carcinoma in 193 cases and benign lesions in 61 patients (24%). One patient presented a positive surgical margin in the pathologic examination, but subsequent nephrectomy was negative for residual tumor. One patient presented a pseudo-tumoral mass on follow-up on CT scan and MRI, but nephrectomy was negative for residual tumor. There were postoperative complications in 20 patients (7.9 %). Oncologic follow up was available in 84% of the patients for an average of 46.6 months showing progression with metastasis in 8 patients. Local recurrence was observed in 4 patients (2%). One patient developed a tumor in the contralateral kidney 20 months after partial nephrectomy and another one 10 years later. The cancer specific survival and overall survival rates were 98 % and 95% respectively. In the last year the laparoscopic approach duplicated the indications of all previous years. CONCLUSIONS: Open partial nephrectomy is considered nowadays the gold standard treatment of small renal masses, and in our experience it is a safe and effective technique of treatment of these tumors. The evolution of the technology and the acquirement of laparoscopic skills allow us in selected cases to duplicate the open approach in a laparoscopic way, obtaining similar results
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OBJECTIVES: Case report of a 5 cm. male urethral leiomyoma (UL).METHOD: UL is extremely rare entity, with only seven cases in the literature. Its etiology is still unknown. Leiomyoma may be present in several locations inside the urinary tract. When located in the urethra it usually produces obstructive symptoms, but also may have asymptomatic behavior. Definitive diagnosis requires histological confirmation. Intraurethral neoplasms must be included in the differential diagnosis.RESULTS: Patient is free of lower urinary tract symptoms after complete excision of his urethral leiomyoma.CONCLUSIONS: Indication and surgical approach depend on tumor and size location. Prognostic is excellent after surgical removal.
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OBJECTIVES: To describe a clinical caseof renocolic fistula as a complication of radiofrequencyablation of renal cell carcinoma. We reviewed theliterature and presented different diagnostic and therapeuticapproaches.METHOD: Beyond postoperative suspicion, retrogradepyelogram was performed, the images of which aredisplayed, and demonstrated the fistula.RESULTS: Treatment has been definitive nephrectomy afterfailed attempt to seal the fistula with suture and TachoSil.CONCLUSIONS: Although radiofrequency ablation can bea valid technique for treating small renal tumors in patientswith high morbidity, it is not without significant complicationsas described in this case, despite the precautions taken
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OBJECTIVE: To present two clinical cases of testicular T cell lymphomas and perform a review of this condition.METHODS/RESULTS: Case 1. Forty-two year old male presenting with painful mass in the right testicle which appeared 2 months earlier. Testicular ultrasound showed diffuse increase in size of the testicle, with alteration in its echogenicity. The patient underwent orchidectomy, and based on histopathological and immunohistochemical tests, a peripheral nonspecific T cell lymphoma was diagnosed. Case 2. Forty-four year old male who presents with a 3 month history of left testicular enlargement without pain associated with reddish-brown macular lesions in the thigh and back and subsequent involvement of the right side of the scrotum. The ultrasonography showed testicles with increased size, with echogenicity altered diffusely. Left orchidectomy was performed and sent for histopathological and Immunophenotypic study which revealed a non-Hodgkin peripheral T cell lymphoma.CONCLUSION: T cell lymphomas involve the testis infrequently, which deserve special attention because of the poor prognosis and the need to make an appropriate diagnosis which could lead to a better therapeutic strategy.
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