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OBJECTIVE: The aim of this study is toanalyze urine concentrations (mg/dl) of different lithogenicfactors in a sample of 24 h as a predictor of thesechanges rather than absolute values depend on the volumeof diuresis.METHODS: A total of 131 patients from the North AlmeriaHealth Management Area (Spain) with urinary calstonedisease in whom a metabolic study was indicatedwere included from June 2014 to May 2015. Theconcentrations of calcium, oxalate, uric acid, citrateand magnesium were measured in the urine, and thecalcium/citrate ratio was calculated. The classificationsused were: hypercalciuria (>260mg/24h), hyperuricosuria(>750mg/24h), hyperoxaluria (>40mg/24h),hypocitraturia (< 320mg/24h) and hypomagnesuria(< 35mg/24h). The statistical analysis was performedusing SPSS 17.0.RESULTS: A cut-off point of 12.55mg/dl, with a sensitivityof 90% and a specificity of 85% and a relative risk(RR) of 51.2 (13.9-188.4), was estimated for urinarycalcium. For oxalate the cut-off point was 1.86mg/dl,with a sensitivity of 91% and a specificity of 84% with anestimated RR of 67.2 (8.3-540.6). As regards the uric acidconcentration in urine, a cut-off point of 31.2mg/dl wasestimated, with a sensitivity of 85% and a specificity of70% and a RR of 12 (3.8-37.6). For citrate the cut-offpoint was 18.8mg/dl, with a sensitivity and specificityof 82% and 74%, respectively, with a RR of 13.7 (4.4-42.6). The cut-off point for magnesium was 2.26mg/dlwith a sensitivity of 95% and specificity of 78%, with aRR of 67.6 (11.4-398.3).CONCLUSION: The determination of urine concentrations,instead of absolute values, depends to a largeextent on urine output, appears to be useful when estimatingclassic metabolic alterations and should be takeninto account in the evaluation of patients with urinarystone disease.
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INTRODUCTION: The cystographic study of patients who have undergone radiotherapy (RT) and pelvic surgeries is uncommon in the literature, not described in patients without complications, and mostly related to urinary fistulae.OBJECTIVE: The study of the lower urinary tract (LUT) by cystography in these patients, with a description of some other types of radiation lesions.METHODS: 127 cystographies have been performed (88 and 39 ) in consecutive patients undergoing radiotherapy (RT) (48 monotherapy and 79 cases combined with surgery), with a mean age of 69.6 years, and a mean time from radiation of 215 months (17 years). A General Electric X ray equipment has been used. We studied: behavior of the bladder neck at rest and during micturition, assessment of vesicoureteral reflux (VUR), bladder morphology (BM), urethral strictures (UE) and fistulas (F).RESULTS: We observed: Filling phase bladder neck incompetence (BNI) (37.8%), bladder smooth morphology (60.6%), coughing urinary incontinence (UI) (26.4%), basal cystocele (64.7%) and Valsalva cystocele (96.6%), a normal opening bladder neck (96,1%), reduction of the urethral diameter during voiding (41.3%), and vesicoureteral reflux (VUR) (13.2%). Five cases of filling BNI, were all related to prostate cancer (PC) (one of them with colon cancer as well). There were six cases of fistulae (4.14%), five of them women. Forty two patients (28.96%) had reduced urethral lumen, thirty five of them affecting the posterior urethra (83%), five (11.9%) the anterior and, finally, two cases of mixed lesion (5%). 95% were patients with PC without concurrent interventions (67%). Significant differences were found regarding the gender and the background of pelvic surgery. The filling BNI (p=0.007), the irregular bladder morphology (p=0.004) and the reduction of the urethral lumen (p<0.001) have been found to be more common in male patients, while the coughing UI was more common in women (p=0.007). The study shows that BNI (p=0.046), VUR (p=0.02) and the IU due to cough (p=0.03) were more frequent in operated patients, while reduced urethral lumen was less common (p<0.01). Patients with VUR present more time from radiotherapy, but not in other cystography variables. There was a relationship between RT and the BNI, stress urinary incontinence, anterior urethral stricture and VUR. The risk factor was increased by surgery.CONCLUSIONS: Bladder neck incompetence, stress UI, anterior urethral stricture and VUR have been related to radiotherapy. Surgery increased the risk factor in operated patients
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OBJECTIVES: Retrograde intrarenalsurgery (RIRS) has become an important alternative forthe treatment of kidney stones due to its increased safetyand efficiency. The purpose of this study is to compareefficacy and safety features of RIRS against percutaneousnephrolithotomy (PCNL) for the treatment of 2 - 3.5 cmkidney stones.METHODS: 142 cases (106 RIRS and 36 PCNL)encompassing 2 - 3.5 cm kidney stones that have beentreated in our center between December 2009 andDecember 2011 have been considered. Demographicvariables, stone characteristics, surgical stay and surgicaltime have been evaluated. Additionally, the complicationprerateand success rate after one and two procedures(retreatment) have also been assessed. Student`s T,Mann-Whitney U y Chi2 - V Cramer (p=0.05) tests wereused for statistical analysis.RESULTS: There are not statistically significant differencesin demographic or stone variables. The calculatedmean surgical time was lower for PCNL (85 min) thanfor RIRS (112 min). Mean hospital stay was statisticallysignificantly shorter in RIRS (16 h vs. 98 h in RIRS,p=0.001). PCNL exhibited a higher global complicationrate of 19.4% vs. 6.6% for RIRS (p=0.001). PCNL alsoshowed a higher successful rate (80.6% vs. 73.6%for RIRS), although this difference was not statisticallysignificant (p=0.40). When comparing the success rateafter a second procedure, PCNL results in 94.3% vs.93.5% for RIRS (p=0.88).CONCLUSION: RIRS was found to be a safe andefficient procedure with a short hospital stay. Overall,RIRS can be considered as an alternative to PCNL for thetreatment of renal stones smaller than 3.5 cm.
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Neural tube defects (NTD) are the most common congenital malformations of the nervous system, they have a multifactorial etiology, are caused by exposure to chemical, physical or biological toxic agents, factors deficiency, diabetes, obesity, hyperthermia, genetic alterations and unknown causes.Some of these factors are associated with malnutrition by interfering with the folic acid metabolic pathway, the vitamin responsible for neural tube closure. Its deficit produce anomalies that can cause abortions, stillbirths or newborn serious injuries that cause disability, impaired quality of life and require expensive treatments to try to alleviate in some way the alterations produced in the embryo. Folic acid deficiency is considered the ultimate cause of the production of neural tube defects, it is clear the reduction in the incidence of Espina Bifida after administration of folic acid before conception, this leads us to want to further study the action of folic acid and its application in the primary prevention of neural tube defects.More than 40 countries have made the fortification of flour with folate, achieving encouraging data of decrease in the prevalence of neural tube defects. This paper attempts to make a literature review, which clarify the current situation and future of the prevention of neural tube defects.
Case Report
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OBJECTIVE: Basal cell carcinoma andleiomyoma of the scrotum are rare. We describe threecases of scrotal tumors and provide information regardingthis disease.METHODS: Between 2000 and 2014, 3 patients withscrotal tumors were diagnosed and treated at our institution.A review was performed using the clinical records of thesepatients.RESULTS: We describe two cases of basal cell carcinomaof the scrotum in men 72 and 71 year old, who presentedwith a left scrotal lesion that was excised and thepathological diagnosis was basal cell carcinoma. In onepatient, surgical margin was affected and a recurrent basalcell carcinoma appeared. It was excised with enlargementof surgical margin. We also describe a case of scrotalleiomyoma in a 48 year old man with an elastic, firm andnontender lesion in the right scrotum. During follow-up thepatients remain clinically asymptomatic.CONCLUSIONS: Scrotal lesions in the elderly should beexcised and submitted for pathological examination. Thebasal cell carcinoma of the scrotum appears as a plaque,nodule or ulcer. Long-term surveillance is recommended forthese patients. Leiomyoma of the scrotum is presented as anon-ulcerative nodule and his treatment is complete surgicalexcision.
Case Report
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OBJECTIVE: To know the dermatologic side effects of intravesical treatment with Mitomycin C in non muscle invasive bladder cancer.METHODS: We describe two cases of palm and plantar dermatitis after such treatment. RESULT: We describe two types of dermatitis pathogenesis during treatment with intravesical Mitomycin C: contact dermatitis and delayed hypersensitivity dermatitis. CONCLUSIONS: Contact dermatitis of non-allergic origin is a common side effect described in many instances in the literature, on the other hand exists dermatitis secondary to delayed hypersensitivity type IV much less common, requiring treatment with corticosteroids.
