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OBJECTIVES: To review the biographyand scientific contributions of Dr. Angel Pulido Martin,fourth chairman of the Department of Urology at theHospital Provincial of Madrid,andformerly at the UrologyClinic at the San Juan de Dios Hospital of Madrid. Inaddition, to show a panoramic view on how doctors whoobtained scholarships to study outside Spain were trainedin a speciality at the beginning of the 20th century.METHODS: We reviewed memoirs books from Dr.Pulido Martin («Medical letters», «Dr. Pulido and histime», and «Memoirs of a doctor»), his Ph.D. thesis andother works. We also reviewed biographic data obtainedfrom his contemporaries in different publications.RESULTS: We report his experiences as a student in thespecialities of Urology and Gynecology, since he firstthought about taking this last one. Main european urologicand gynecologic centers of that time are represented, aswell as some of the main characters in these specialities.We appreciate his great working spirit, which wasinculcated into him by his father Dr. Pulido Fernandez, hisenterprising desire, and the great professional he was,creating departments of urology which were school andmodel for many urologists of his time.CONCLUSIONS:Asincere clinician, Dr. Pulido Martinliked accuracy and daily self-improvement. He also wasexceptional for his kindness treating patients and disciples.His publications on urologic topics were numerous; healso was fluent and entertaining as a non medical writer.He was an outstanding urologist in the early 20th century;he was member of the committee which elaborated thestatutes of the Spanish Society of Urology, in which he wasPresident for 11 years. He was also one of the foundingmembers of the International Society of Urology anddelegate of its Spanish chapter. He was official lecturer inseveral meetings, and alsomemberof the SpanishAcademyof Medicine and Surgery.
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OBJECTIVES: We report six cases of adrenalcyst,ararepathologicentitywhichposesdiagnostic problems and therapeutic controversies.
METHODS: We report six cases of adrenal cysts in 4 female and 2 male patients ages 26 to 68 years. All cases underwent surgical treatment.
RESULTS: Pathologic studies showed that all were adrenal cysts without malignancy in any case.
CONCLUSIONS: Adrenal cysts are a rare disease of which correct diagnosis is difficult so that many times patients undergo surgery without a proper preoperative diagnosis. There are controversies about the right management of adrenal cysts.
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OBJECTIVES: To confirm the relationshipbetween hypertension and lower urinary tract symptoms(LUTS) in our environment, and to evaluate the associationbetween hypertension and LUTS secondary to benignprostatic hypertrophy (BPH).METHODS: We prospectively studied during 3 monthsall male patients older than 50 years (163 patients)analysing previous medical history, IPSS, digital rectalexamination, urine sediment, basic biochemical profile,PSA, uroflowmetry, and urinary tract ultrasound. Patientswith neurological diseases, previous pelvic trauma, diabetesmellitus, suspicious digital rectal examination,abnormal PSA, or under treatment with alpha blockers,antidepressants, finasteride or antipsychotic drugs wereexcluded.RESULTS: From a total of 163 patients 113 wereclassified as suffering clinicalBPH(LUTS,prostate greaterthan 30 gm, and uroflowmetry non hypertensive patients (22.7%), being the differencestatistically significant.CONCLUSIONS: Our study confirms what has beenpreviously reported by other authors, that there is astatistically significant relationship between hypertensionand LUTS secondary to BPH.< 15ml/sec), and 75 ashypertensive.Among75hypertensive patients31presentedIPSS greater than 7 (41.3%) in comparison to 20 out of 88
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OBJECTIVES: To evaluate which clinical variables are predictive for prostate cancer and possible relationships among them, in patients with elevated PSA and non suspicious digital rectal examination (DRE) undergoing first prostate biopsy. METHODS: 1618 patients with elevated PSA and non suspiciousDREwhounderwent sextant peripheral prostate biopsy were selected from our database. PSA, age, prostate volume, and detectable nodule by ultrasound were selected as variables related to cancer detection in first and second biopsies. RESULTS: Mean age was 67.5 +/-7.4 (37-88) years, mean PSA was 16.9 +/- 116.5 (3.6-4500) ng\ml, mean prostate volume was 65.7+/- 37.8 (8-352) cc. 23.3% patients presented a hypoechoic nodule within the peripheral zone of the gland. 18.8% presented prostate cancer on first biopsy. On multivariate analysis, age (p<0,001), prostate volume (p<0.001), and presence of a nodule on ultrasound (p = 0.003) were considered independent predictive variables for cancer detection on biopsy. Direct relationship with age, and inverse relationship with prostate volume were shown. Detection rates on second biopsy were greater in patients with prostates =40cc in comparison to those > 40 cc (p = 0.02). First two biopsies detected 95% of cancer cases, first three up to 98%. CONCLUSIONS: Age and prostate volume should be taken into consideration when individualizing the number of cores to obtain at the time of biopsy. The efficacy of peripheral sextant biopsy in prostates= for 40 cc should be re-evaluated. Third and fourth biopsies should be reserved for patients with very adverse risk factors.
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OBJECTIVES: To analyze the effect ofPygeum africanum extracts on the in vitro proliferation ofhuman prostate cells.METHODS: Prostate cancer cell lines and benignprostatic hyperplasia derived epithelial cells were culturedand treated with P. africanum extracts. The effect on cellproliferation was monitored by H3-timidin andbromodeoxiuridin uptake and flow cytometry assays.RESULTS: The incubation with P. africanum extracts,with or without addition of amino acids, significantly andin a dose-dependent manner inhibits the proliferation ofprostate cancer derived cells LnCaP, PZ-HPV-7, and CAHPV-10. In the PZ-HPV-7 cells P. africanum extractscounteract the mytogenic action of EGF and block thetransition from G1 to S in the cell cycle. P. africanum extracts also exert a potent antimytogenic action on theepithelial cells derived from benign prostatic hyperplasiaexplants.CONCLUSION: The ethanolic P. africanum extractshave an antimytogenic effect on prostate cancer cells andbenign prostatic hyperplasia epithelial cells. Such effectis associated with the inhibition of the mytogenic action ofEGF, and it is accompanied by a decrease of cells enteringthe S Phase of the cell cycle.
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- OBJECTIVES: To evaluate the influenceof receptorës age on the outcomes of kidney transplantswith organs from non heart beating donors.METHODS: Observational study of the historic cohortof 570 kidney transplants performed at the Hosptal ClÌnico San Carlos between 1991 and 1999. Receptor's weredivided into two age groups, group 1 younger than 50years, and group 2 older than 50 years. All organs whereharvested from non heart beating donors.RESULTS: We studied 110 kidney transplants comingfrom non heart beating donors; 52 belonged to group 1,and 57to group 2. Three-year patient survivalfor receptorësyounger than 50 years was 100%. The probability of threeyear survival for receptor's older than 50 years was79,39% (p 0.07). Graft survival was 88.46%, 86.54%, and86.54% at 12, 24, and 36 months respectivelyfor receptorësyounger than 50 years. When receptors were older than 50years the probability of functioning graft in the sameperiods of time was 89.20%, 89.20%, and 86.32%respectively. CONCLUSIONS: Receptorës age doesnít seem toinfluence graft survival when kidneys from non heartbeating donors are used.
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OBJECTIVES: To analyze the effect ofinjury of the sympathetic element of vesico-urethralinnervation on lower urinary tract.METHODS: We studied clinical, urodynamic, andradiological features in a sample of 261 patients studiedbecause of neurogenic vesico-urethral dysfunction. Three types of inferior sympathetic lesions were establishedbasedonurodynamicandradiologic behaviors.Westudiedrelationships between this kind of lesions and clinical,urodynamic, and radiological features, as well as theassociation of lower sympathetic lesions with the rest ofvesicourethral innervation elements. Resultswereanalyzedby logistic regression, and linear multivariate regression,controlling for urodynamic factors, age, sex, and differentneurological diagnosis.RESULTS: 95 patients were diagnosed of lowersympathetic lesions. This type of lesions were observed inrelation to congenital pathology, being more frequent inboys. These lesions were related with urinary incontinenceand vesicoureteral reflux. Lesions producing bladderdynamics disturbances had a higher location than thoseresponsible for bladder neck incompetence development.CONCLUSIONS: Vesicourethral sympatheticinnervation lesion of the lower motor neuron type isrelated to urinary incontinence and vesicoureteral reflux,being bladder neck complex incompetence a determinantfactor in both circumstances. This kind of lesions could bea group of different types, with location in different partsof the central and peripheral nervous system that producevery different vesicourethral behaviors.
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OBJECTIVES: To evaluate the currentstateoflaparoscopicnephrectomyinchildren.Wecompa-re the published techniques and results of the trans- andretro-peritoneal approaches.METHODS: Literature search under "laparoscopicnephrectomy, children" in Medline, PubMed, AmericanAcademy of Pediatrics, Digital Urology Journal and,Doctor's Guide.RESULTS: Laparoscopic surgery is well established inPediatricUrologyasevidencedbymorethan330reported procedures on the subject of simple nephrectomy, partialnephrectomy, bilateral nephrectomy, nephrectomy forhorseshoe kidney and, nephro-ureterectomy. Retro-peritoneoscopicnephrectomywasdescribedlaterthanthetrans-peritonealprocedurebutseemstohavegainedmorepopularity since more cases have been reported. Meanoperativetimefortransperitonealapproachis126minutes(range 40-355 minutes), and for retro-peritoneoscopicapproach is 85 minutes (range 35- 210 minutes). Medianblood loss for both approaches for simple nephrectomy is30 ml (range 5-150 ml). Median hospitalization time foreither approach is 2 days (range >1- 4 days).CONCLUSIONS: Pediatric lapararoscopicnephrectomy is supported by low morbidity and rapidrecuperation, creating an increasing demand for theprocedure. The main disadvantage seems to be a longeroperativetime,butinrecentseriesthetimesareimproving.The retro-peritoneoscopic approach seems to be gainingmomentum as more and more case are reported
Case Report
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OBJECTIVES: To report a case of synchronicneoplasia -chromophobe renal cell carcinoma and low grade nonHodgkin lymphoma- in a 38-year-old male patient, because, althoughassociation of these two neoplasias is known, the fact of renalneoplasia being a chromophobe carcinoma is rarely referred to inmedical bibliography (3 cases described after Med-Line search).METHODS/RESULTS: The diagnostic study included ultrasoundand CT scan in a patient presenting with in non specific abdominalsymptoms and neck adenopathy; patient underwent left radicalnephrectomy and excision of neck adenopathy. Histologic andimmuno-histochemical studies revealed the coexistence ofchromophobe type renal cell carcinoma and diffuse centrocyticlymphoma.CONCLUSIONS: Column in the association betweenchromophobehistologicaltyperenalcellcarcinomaandnonHodgkinlymphoma is very rare. Presence of these two tumors in the samepatientmayposeproblemsforclinicalstaging,prognosticpredictions,and treatment. Then, due to the fact that it is not usual and that a localstage renal carcinoma presents with neck adenopathies, when theyappear possible coexistence of these tumors should be suspected.
Case Report
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OBJECTIVES: To report a new case of prostaticrhabdomyosarcoma in a child.METHODS: Blood analysis, urinalysis, radiologic tests ( abdominalultrasound, intravenous urography, cystography, barium enema,lower extremities X-rays), and prostatic biopsy were performed..RESULTS/CONCLUSIONS: Neoadjuvant treatment withchemotherapy and radiotherapy were started prior to intendedradical prostatectomy, but the patient died before due to diseaseprogression with dissemination.
Case Report
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OBJECTIVES: To report one case of retroperitoneal fibrosarcoma in a 45 year-old caucasian patient cared for at the Public Health System hospitals in Republic of Cuba. METHODS: Blood analysis showed increased erythrocyte sedimentation rate and moderate anemia. Intravenous urography showed that left kidney was displaced towards midline but presented a good contrast uptake and excretion. Renal ultrasound discovered a large hyperechogenic mass with internal calcifications. CT scan confirmed a left flank tumor with internal necrosis which displaced the kidney. Complete tumour resection was performed confirmatory of the histological diagnosis of retroperitoneal fibrosarcoma. Postoperative chemotherapy was administered. RESULTS/CONCLUSIONS: Four months after surgery patient presentedwith severelumbar-abdominal pain; abdominal ultrasound showed retroperitoneal and intraperitoneal recurrences; patient have a sudden death after a dyspnea episode one month later. Necropsy revealed right pulmonary thromboembolism, abdominal ganglionar metastases and retroperitoneal tumour extension. Our experience confirms the aggressiveness of this tumours and their tendency to local recurrence.
Case Report
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OBJECTIVE: To describe a squamous cell carcinomaof the penis with rhabdoid phenotype. We believe that only threesquamous cell carcinomas with rhabdoid cells have been previouslypublished and none of them was located in the penis.METHODS AND RESULTS: A 76 year old man presented atumoral lesión in his penis, which had all the light microscopic andimmunohistochemical features of a squamous cell carcinoma withrhabdoid phenotype. Rhabdoid cells were mainly located in areaswith an alveolar pattern, most of them being isolated and intermixedwith necrotic cells and necrotic debris.CONCLUSIONS: First case of rhabdoid squamous cell carcinomalocated in the penis. We suggest that rhabdoid phenotype couldrepresent a type of degeneration, or a preliminary stage beforeapoptosis or cell necrosis occurs, instead of a specific differentiation.The most important prognostic factors in extrarenal tumors withrhabdoid features are stage and histologic type of tumors.
Case Report
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OBJECTIVES: To report the case of a patient withthe diagnosis of solid renal mass after ultrasound and confirmatoryCT scan, whose final diagnosis was inflammatory pseudotumour, arare benign tumour.METHODS: We describe the case, diagnostic difficulties andtreatment because of the exceptional character of the case.RESULTS: A bibliographic review was necessary to achieveconsensus acceptance of an etiologic relationship between tumourand previous renal trauma 15 years before.CONCLUSIONS: The hypothesis of renal pseudotumour shouldnot be rejected in similar cases.
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OBJECTIVES: Clinical and pathological study ofeight cases of localized amyloidosis of the seminal vesicles. Reviewof the literature.METHODS: Immunohistochemical and histochemical study insurgical specimens.RESULTS: Two of the eight cases studied for amyloidosis inseminal vesicles, were obtained from radical prostatectomyspecimens; patients had prior androgen deprivation therapy for twomonths. Four cases were obtained from radical cistoprostatectomyspecimens because of urothelial carcinoma and the last two caseswere diagnosed bytransrectal prostatic needle biopsywhichincludinga portion of seminal vesicle. Amyloidosis of seminal the vesicle ispermanganate-sensitive; A-Amyloid, laminin , amyloid P proteinand collagen IV negative.CONCLUSION: Localized amyloidosis ot the seminal vesicle isnot an unusual finding. The incidence increases with age. Thehistochemical and immunohistochemical features are different fromother amyloid deposits.
Case Report
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OBJECTIVES: To present a short review of thediagnosis,clinicalfeatures,andtreatmentofmalegenitalianecrosisunder the format of a case report.METHODS: We review the case of a diabetic patient withoutgood blood sugar control who suffered from various diabeticcomplications diagnosed and treated at our hospital of a penilenecrosis. We perform a bibliographic review about male genitalianecrosis regarding its etiology, diagnosis and treatment.RESULTS: Male genitalia necrosis is a rare disease but it isassociated with high morbidity and mortality. The present case wasdiagnosed at the emergency room at our Hospital. Conservativetreatment with antibiotic therapy and corticosteroid ointments wasundertaken successfully.CONCLUSIONS: To perform an etiologic evaluation of thenecrosis(dryorinfectious)isimportanttoselecttherighttreatment.The high mortality of these diseases requires a precise and earlydiagnosis, since this influences the good or bad evolution of thedisease
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OBJECTIVES: To assess the feasibilityand a validity of the Spanish version of the FACT-P and itsrelation to urinary symptoms.METHODS: The Spanish version of the FACT-P wasself-administered to 60 Prostate Cancer patients (pts)waiting to undergo radical treatment and 20 age-matchedcontrols (con) with a negative biopsy. Clinical stage forpatients was T1c in 34 and T2 in 26. FACT-P was analysedfor internal consistency (Chronbach’s a) and relation tosymptom scales (IPSS, IPSS bother score and incontinencequestionnaire (ICI-SF)).RESULTS: Feasibility (evaluable questionnaires) was80.9 for con and95%for pts. Internal consistency was highfor all sub-scales (a >0.7). Emotional well-being subscaleand IPSS were significantly higher in pts. (worse emotionalwellbeing and more lower urinary tract symptoms). Therewere no statistically significant differences between ptsand con. in any of the other FACT-P sub-scores nor in symptom scores. Correlations were found between someFACT-P sub-scores and bother score.CONCLUSIONS: The Spanish version of the FACTP isfeasible and psychometrically valid. Pts undergoingtreatment for localized disease have similar QoL that acontrol group, but higher scores for emotional distressand IPSS.
