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OBJECTIVES: It is exceptional that the data of a disease are taken from a historical account in which the author, King Alfonso X the Wise himself, in one of the songs (Cantigas) to Mary, the Virgin (monument of universal literature), recites the facts from his childhood in the city of Cuenca, in the middle of August of 1226. These Facts had a great resonance. METHODS: The medical studies were in full decay that did not improve until the creation of the Universities (Paris, Naples, Padua, Bologna and Montpellier). In this Cantiga some good physicals, doctors, are mentioned. There does Peter of Montpellier come from, the Court doctor for King Fernando III that took care of his wife Beatriz of Swabia (daughter of Felipe, Roman King, and Irene Angelo). She was baptized like Isabel but adopted the name in memory of her older sister, empress of the Holy Roman Empire that died in 1212 in a battle. RESULTS: Beatriz, with a very advanced pregnancy, “had such a great fever” and dismay due to a probable urinary cause: “but Pero de Monpisler and other good physicals, they said: –she will not live”. Her husband, Fernando III, had marched twelve weeks before, in campaign, to the lands of his ally the King of Baeza. Their children Fadrique and Alfonso, the elder one, were with Queen Beatriz. Condemned by doctors, the patient implored her healing to a miraculous image of Mary, the Virgin, which devotees brought over her in the days when the Assumption festivity was coming. The healing became effective and coincided with the return of Fernando III after the capture of the fortified town of Capela. CONCLUSIONS: Alfonso, in thanksgiving for the healing of his mother, Queen Beatriz, would dedicate this Cantiga to Mary, the Virgin (1).
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OBJETIVE: Through two historic episodes we find that they are closely related with urinary lithiasis. METHODS: The cases are described and documentedin the same historical account. RESULTS: The lithiasic disease of two historical known characters. Both in a different cultural environment looked for a miraculous healing. CONCLUSIONS: Cure was not achieved in the first case but in the second. Both happened in the Middle Age within a period of 100 years and more than 5,000 kilometers away from each other.
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OBJECTIVES: To evaluate if there is acorrelation between the abdominal leak pressure point(ALPP) of the urodynamic study and several tools toevaluate severity and quality of life associated to stressurine incontinence (SUI).METHODS: Prospective correlation study of womenreferred to urodynamic study for stress urinary incontinencein Centro Urológico Profesor Bengió between September2014 and October 2015. Anamnesis, physicalexamination (where the SUI was demonstrated), ICIQSFurine incontinence questionnaire and incontinenceimpact questionnaire (IIQ-7) were performed to everypatient. Uroflowmetry and complete urodynamic studywere performed in all cases. Intrinsic sphincter deficiency(ISD) was defined as ALPP value ≤ 60 cm H2O. Therelation between abdominal leak pressure point (ALPP)and incontinence severity measurements and quality oflife (daily protectors, Sandvik score, ISIQ-SF score andshort IIQ7 score) was evaluated with the Spearmancoefficient correlation.RESULTS: 105 females were studied. Mean ALPPwas 84 H2O cm (30-170). 21 and 84 patientshad ALPP values lower and higher than 60 H2O cmrespectively. There were no differences between thegroups when general and demographic characteristicswere evaluated. No correlation between ALPP andincontinence severity measurements was demonstrated:daily protectors (ρ 0.10; p NS), Sandvik severity score(ρ 0.05; p NS), ISIQ-SF score (ρ 0.0004; p NS)and IIQ7 Score (ρ 0.06; p NS). When patients withIED (ALPP ≤ 60 cm H2O) and those without IED DEI(ALPP > 60 cm H2O) were analyzed, there was nostatistically significant difference between the groups inthe comparison according to severity and quality of lifequestionnaires.CONCLUSIONS: In this series, there is not a significantcorrelation between abdominal leak pressure point andseverity and quality of life measurements in patients withstress urinary incontinence.
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OBJECTIVES: We reviewed the feasibilityand safety of nephron sparing surgery for renal cellcarcinoma in patients with von Hippel Lindau (VHL)disease.METHODS: We selected 22 patients with (VHL) diseasewith a mean age of 43 (range 30-56), from whom 16underwent radical nephrectomy or nephron sparingsurgery at our department between 2000 and 2015.RESULTS: A total of 33 tumors were treated, by eithertumorectomy (n=20), partial nephrectomy (n=5),percutaneous renal radiofrequency ablation (n=3)edaorradical nephrectomy (n=5). All procedures weresuccessfully completed without intraoperative andpostoperative complications. The diameter of the tumorranged from 2.8 to 4.8 cm. The interval betweentreatments in patients operated more than once was40 months. Renal function stayed stable with basalcreatinine and current creatinine 0.74 ± 0.21 mg/dland 0.93 ± 0.22 mg/dl respectively. Median follow-upwas 72.3 months. Cancer-specific survival was 97%.CONCLUSIONS: nephron sparing surgery in renaltumors >3 cm is an effective and safe treatment for VHLpatients.
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OBJECTIVE: To evaluate patient compliance with treatment for urinary lithiasis and to detect differences in adherence, causes of this behavior and associated factors. METHODS: We performed a retrospective study of 93 patients with positive urinary metabolic study (UMS) for lithogenic pathology, diagnosed between 2013 and 2015, gathering data from the digital medical records and a structured telephonic questionnaire in 75 of them. Results were analyzed using the X2 test. RESULTS: 68% of the patients were males. Median age 42.92 (12.17) years. Mean follow up was 2.65 years. Most frequent metabolic alterations were: Hyperoxaluria (42.7%), Hypercalciuria (33.3%) and hipocitraturia (30.7%). Most frequently prescribed drugs: Potassium citrate (70.7%), Thiazide diuretics (26.7%) and calcium supplements (15.1). 84.2% of the patients did not know their UMS and 29.8% did not know the treatment prescribed. 41.9% followed the doses prescribed less than 50% of the times. Dietetic treatment was abandoned by 65% of the patients and pharmacological treatment by 43.5%, mainly due to laziness (62.9% vs46.2%). 72.6% of the compliant patients experienced improvement. We find a significant relationship between academic level and diagnosis knowledge (p=0.022) and treatment (p=0.036). There were no differences in compliance depending on the number of drugs taken. CONCLUSIONS: Despite urine metabolic study being well valued and treatment well tolerated therapeutic compliance is very low. Most patients would repeat or restart the treatment prescribed in case of recurrence. Diagnostic and therapeutic information provided was not understood.
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INTRODUCTION: Fluoroscopy is used for access sheath insertion and postoperative control during retrograde intrarenal surgery(RIRS) operation but with this technique both patient and operation team are exposed to radiation. The use of fluoroscopy is disadvantage for both patient and surgeon. Considering results of recent studies, it is clearly seen that fluoroscopy doesn’t affect the success and complication rates of RIRS. In this study, we aimed to compare the results of both fluoroscopy and fluoroscopy-free groups, to show if there is a significant difference.METHODS: 385 patients were included in the study and they were divided into two groups. 284 patients were in Group I where fluoroscopy was used. 101 patients were in Group II and fluoroscopy was not used. The success rates of primary operation and final success rates were compared. Data from both groups were evaluated objectively using classification systems and imaging methods. RESULTS: Success rates(primary and final) were higher in Group II, and that can be attributed to experience gained over time. Complication rate was lower and success rate was higher in fluoroscopy-free group. According to multivariate analysis, It is clear that the stone dimension is the foreground of the factors that influence the success, and the effect of the stone location is also observed. CONCLUSION: When considering the comparison of success and complication rates between two groups, it is clearly understood that the use of fluoroscopy has not a positive effect on results. According to the outcomes of our study, fluoroscopy-free RIRS can be performed with safe and high success rates. This outcome also leads an important point for avoiding unnecessary radiation exposure.
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OBJECTIVE: Mitomycin-c (MMC) is the most used intravesical adjuvant agent in non-muscle invasive bladder cancer to prevent recurrence. However, a consensus on about appropriate dosage and treatment schedule of MMC is lacking. We, therefore, aimed to evaluate the most appropriate MMC dosage using an in vitro model of high-grade human bladder cancer. METHODS: UMUC-3 cells, a model for high-grade bladder cancer, were exposed to MMC in different time courses to assess its toxicological effects. XTT cell proliferation kit was used to evaluate the effect of MMC on the proliferation of UMUC-3 cell line. Gene expression analysis for the MDR1, BCL2 and ANXA5 genes was performed by Real-time PCR and flow cytometry analysis were conducted to evaluate the cell death mechanism and acquired resistance after MMC exposure. An ANXA5 kit was used to detect apoptotic cells, and 7-AAD was used to detect necrotic cells. RESULTS: Cell proliferation was prevented to a large extent (IC50, 0.175–0.081 mg/mL) and cytotoxic effects were observed after 5 µg/mL and 10 µg/mL MMC administrations for 1 and 2-h, after the 4th and 2 nd dose cycles, respectively. Moreover, cell death was observed at 5 µg/mL and 10 µg/mL MMC applications for 1-h and 2-h by the sixth and second week, respectively. Flow cytometry exhibits increased subpopulation of drug- extruding UMUC-3 cells after a single dose of MMC for 1-h. MMC did not increase the number of apoptotic or necrotic cells; yet, MDR1 (multiple drug resistance) and ANXA5 (apoptotic) expression levels were increased and BCL2 (anti-apoptotic) expression was decreased. Limitations: In-vitro nature of the study and working with only one cell culture are inherit limitations of this project. CONCLUSION: A single dose of MMC administration for 1 or 2-h results in drug-resistance. If maintenance treatment is administered for one hour, it should be continued throughout a 6-week period.
Case Report
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OBJECTIVE: Nested type transitional cell car-cinoma of the bladder is a rare histological variant among bladder tumors. Although clinical presentation is similar to the other bladder tumors, its macroscopic appearance may be equivocally benign, with submucosal growing which is difficult to detect on cystoscopy, so that diagnosis may be delayed.METHODS: We present the characteristics of nested type transitional cell carcinoma and review the differential diag-nosis for this entity with possible counterfeiters.RESULTS: In this article, we report two cases of nested type transitional cell carcinoma that presents, in one of them, all three growing patterns.CONCLUSIONS: Microscopically nested transitional cell carcinoma is characterized by a cell distribution forming nests and tubules. They generally present low cytologic atypia simulating a low grade urothelial carcinoma, or be-nign bladder lesions such as von Brunn nests or nefrogenic adenoma.
Case Report
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OBJECTIVE: Bladder cancer is a commonly diagnosed malignancy in Europe, being 30% muscle-invasive at diagnosis. In these patients, metastases can develop both at diagnosis and after progression. Metastatic disease can manifest in a number of different ways, even as hydroelectrolytic alterations. In this work, we go through the causes of hyponatremia in patients suffering from bladder cancer and its relationship with disseminated disease. METHOD: We present two cases of patients with muscleinvasive bladder cancer with a common electrolytic misbalance, hyponatremia. RESULTS: As a result of the study, bone and cerebral metastases were revealed. CONCLUSIONS: The electrolytic alterations in the oncologic patient can have several causes: chemotherapy, urinary diversion, pain, or even to the tumor itself or its metastases. It is necessary to conduct an exhaustive study in order to discard the most important causes of hyponatremia and be able to decide an appropriate treatment.
