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Resumen Introduccion y objetivos La hemorragia secundaria a la fistula arteriovenosa (FAV) o al pseudoaneurisma (PA) es una complicacion poco frecuente de la nefrolitotomia percutanea (NLPC). El objetivo de este estudio es evaluar las complicaciones hemorragicas (CH) tras la NLPC y los resultados del tratamiento endovascular. Materiales y metodos Entre mayo de 2009 y diciembre de 2019 se realizaron en nuestro centro 1.335 NLPC por litiasis renal. Analizamos la incidencia de CH tempranas y tardias, el tratamiento administrado, la necesidad de embolizacion posterior y los datos clinicos y analiticos de los pacientes. Resultados Un total de 59 (4,4%) pacientes presentaron CH, y todos fueron tratados con arteriografia y embolizacion selectiva (AES) para controlar el sangrado. Se observo hematoma perirrenal en 38 pacientes (64%). En cuanto a los hallazgos angiograficos, hubo 32 (54%) PA, 8 (14%) FAV, 4 (7%) extravasaciones por laceracion vascular y 15 (25%) PA combinadas con FAV. En un caso, fueron necesarios 3 procedimientos para controlar la hemorragia. En 30 pacientes (51%) no se requirio transfusion de sangre, mientras que en 29 (49%) se transfundio una media de 1,3 unidades. La mediana de seguimiento fue de 24 ± 21 meses. El intervalo de tiempo medio entre la NLPC y la AES fue de 7,3 ± 4,9 dias. Un total de 24 (41%) pacientes reingresaron tras el alta debido a una CH tardia que requeria AES. La demora entre el reingreso y la AES fue de 4,8 ± 4,6 horas de media. Conclusion Las CH tempranas y tardias tras la NLPC pueden ser mayores. El tratamiento con AES tras la deteccion precoz es un metodo efectivo y minimamente invasivo que evita multiples transfusiones de sangre, en muchos casos insuficientes.

Poroma is a benign, exclusively cutaneous, adnexal tumor with a predilection for palmoplantar skin.To analyze the clinical characteristics of poroma in our population.Retrospective study of patients diagnosed with poroma between 2002 and 2021. We conducted a chart review to record age; sex; number, location, and diameter of lesions; time since onset; clinical characteristics; suspected clinical diagnosis; resection margin status; recurrences; and follow-up duration. Categorical variables were compared using the Fisher exact test. Continuous variables were compared using the t test or the Mann-Whitney U test depending on whether they were normally or nonnormally distributed.We studied 80 patients (31 women and 49 men) with a median (interquartile range [IQR]) age of 65.5 (29) years. Median time since onset of poroma was 12 (21) months. Median lesion diameter was 8 (7) mm, and none of the patients had multiple lesions. The lesions were located on the head and neck in 13 cases, the trunk in 13, the upper extremities in 11, and the lower extremities in 43. Twenty-three lesions (28.8%) were located at acral sites (5 on the palms and 18 on the soles). Women were more likely to have scalp lesions (P = .041). Acral lesions were more likely to be erythematous (P = 014). Five patients experienced local recurrence.Although poromas are particularly common in acral locations (especially the feet), most of the lesions in our series (71.3%) were located elsewhere. Acral lesions were more likely to show the classic clinical features of erythema and exophytic growth.

Introduction and objectives Hemorrhage due to arteriovenous fistula (AVF) or pseudoaneurysm (PA) is a rare complication after percutaneous nephrolithotomy (PCNL). The objective of this study is to evaluate hemorrhagic complications (HC) after PCNL and the results of their endovascular treatment. Materials and methods Between May 2009 and December 2019, 1335 PCNL were performed in our center for kidney stone disease. We analyzed the incidence of early and late HC, their management, the need for subsequent embolization, as well as clinical and analytical data of these patients. Results A total of 59 (4.4%) patients presented HC. Bleeding was managed with arteriography and selective embolization (ASE). Perirenal hematoma was seen in 38 patients (64%). Regarding angiographic findings, there were 32 (54%) PA, 8 (14%) AVF, 4 (7%) extravasations due to vascular laceration and 15 (25%) PA combined with AVF. In one case, 3 procedures were required to control the bleeding. In 30 patients (51%) blood transfusions were not necessary, while in 29 (49%), a mean of 1.3 units were transfused. Median follow-up was 24 ± 21 months. Mean time interval between PCNL and ASE was 7.3 ± 4.9 days. A total of 24 (41%) patients were readmitted after discharge due to late HC requiring ASE. Delay between readmission and ASE was 4.8 ± 4.6 h in average. Conclusion Early and late HC after PCNL can be severe. Rapid identification and treatment with ASE is an effective and minimally invasive and avoids multiple blood transfusions which in many cases constitute an insufficient treatment.

Resumen Objetivos Evaluar la efectividad y seguridad de la nefrolitotomia percutanea bilateral simultanea realizada en pacientes afectados de litiasis renales bilaterales. Material y metodos Estudio prospectivo, periodo de septiembre de 2012 a noviembre de 2016. Se incluyeron pacientes diagnosticados de litiasis renales bilaterales por TC abdominal. Tecnica quirurgica posicion en prono, puncion renal guiada por fluoroscopia y dilatacion del tracto hasta 24 Ch. Se revisaron las caracteristicas demograficas y de las litiasis, la tasa libre de litiasis, el exito clinico, las complicaciones y el seguimiento. Resultados Durante el periodo de estudio, se realizaron 732 nefrolitotomias percutaneas. Dieciocho pacientes (36 unidades renales; 2,5%), 13 hombres y 5 mujeres con una mediana de edad de 58 anos y un rango intercuartilico (RIC) de 40-66. Tamano de la litiasis mediana de 228 mm2 (RIC 134-389), tiempo operativo mediana de 150 min (RIC 97-180) y una estancia hospitalaria mediana de 5 dias (RIC 5-15). La tasa libre de litiasis fue del 80%. Se reportaron litiasis residuales en 8 unidades renales (22,2%) que requirieron tecnicas complementarias para su completa resolucion, 4 litotricias extracorporeas por ondas de choque, una ureterolitotomia por laparotomia, 2 ureteroscopias y un segundo procedimiento. Complicaciones mayores incluyeron 4 hemorragias manejadas mediante embolizacion por angiografia. Mediana de seguimiento 36 meses (rango 26-46). Conclusiones La nefrolitotomia percutanea bilateral simultanea es un procedimiento eficaz y seguro en pacientes afectados con calculos renales bilaterales. Es un desafio quirurgico que debe realizarse en pacientes seleccionados y en centros con experiencia.

Objectives To evaluate the effectiveness and safety of simultaneous bilateral percutaneous nephrolithotomy performed in patients affected with bilateral renal calculi. Materials and methods This is a prospective study from September 2012 to November 2016. Patients diagnosed of bilateral kidney stones with abdominal CT scan were included. Surgical technique prone position, renal puncture guided by fluoroscopy and tract dilation up to 24Ch. We reviewed demographic and stone characteristics, stone free rate, clinical success, complications and follow-up. Results During the study period, 732 percutaneous nephrolithotomies were performed. Eighteen patients were included (36 renal units, 2.5%), 13 men and 5 women, with a median age of 58 years and an interquartile range (IQR) of 40–66. Median stone burden was 228 mm2 (IQR 134–389); median operative time, 150 min (IQR 97–180); and median hospital stay, 5 days (IQR 5–15). Stone free rate was 80%. Residual calculi were encountered in 8 renal units (22.2%) and required other complementary techniques for their complete resolution 4 external shockwave lithotripsies, one open ureterolithotomy, 2 ureteroscopies and one second look. Major complications included 4 cases of severe hemorrhage managed with angiographic embolization. The median follow-up was 36 months (range 26–46). Conclusions Simultaneous bilateral percutaneous nephrolithotomy is an effective and safe procedure in patients affected with bilateral renal calculi. It is a surgical challenge that should be performed in selected patients and in centers with experience.

The capability of the electroencephalography (EEG) of recording the bioelectrical activity of the brain has made of it a fundamental tool for the evaluation of the patient's neurological condition. In recent years, moreover, it has also begun to be used in obtaining information for other kind of variables, as the ones related with the cerebral hemodynamics.To study the potential relationship between the EEG activity and the intracranial pressure (ICP) in patients suffering from traumatic brain injury and subarachnoid hemorrhage, during their stay at the intensive care unit.Twenty-one adult patients (10 women) were included in the present observational prospective cohort study. They suffered from either traumatic brain injury or subarachnoid hemorrhage, requiring continuous EEG and ICP monitoring. In every patient, Granger causality between spectral functions of the EEG and the ICP was evaluated. Temporal windows of 10 minute were used to evaluate whether a causal relationship between those variables exist or not. In all of the cases, several days of continuous recording and assessment were performed.In most patients and during most of the time, Granger causality turns out to be significant in the direction from the EEG to the ICP, meaning that the EEG dynamics actually leads the ICP dynamics.The present work provides useful information and shed light in discovering a hidden relationship between the ICP and EEG dynamics. The potential use of this relationship could lead to develop a medical device to measure ICP in a non-invasive fashion.Es posible obtener informacion de la presion intracraneal a partir de la actividad electroencefalografica?Introduccion. El electroencefalograma (EEG) permite obtener informacion directa de la actividad bioelectrica del cerebro y es una herramienta fundamental para la evaluacion de la condicion neurologica del paciente. En los ultimos años ha comenzado a emplearse tambien para obtener indirectamente informacion sobre la hemodinamica cerebral y las variables que intervienen en la autorregulacion del flujo sanguineo cerebral. Objetivo. Estudiar la posible relacion entre la actividad electroencefalografica y la presion intracraneal (PIC) en pacientes con traumatismo craneoencefalico y hemorragia subaracnoidea ingresados en cuidados intensivos. Pacientes y metodos. Se incluyo a 21 pacientes (10 mujeres) mayores de 18 años con traumatismo craneoencefalico o hemorragia subaracnoidea que requerian monitorizacion de la PIC y a los que se les registro el EEG de forma continua. Se determino la causalidad de Granger entre la PIC con respecto a las variables espectrales del EEG para ventanas temporales de 10 minutos durante la estancia en cuidados intensivos. Resultados. La causalidad de Granger mostro una alta correlacion entre la PIC con las bandas del EEG. En la mayoria de los pacientes existe una causalidad de Granger significativa en la direccion del EEG hacia la PIC en gran parte del tiempo de monitorizacion, de forma que las variables del EEG precedian a la PIC. Conclusiones. El presente trabajo expone la relacion temporal subyacente entre la dinamica de la PIC y la actividad bioelectrica cerebral registrada mediante EEG en pacientes con traumatismo craneoencefalico y hemorragia subaracnoidea. El potencial uso de esta relacion podria permitir estimar la PIC de manera no invasiva.

Introduction Clavien-Dindo classification system has been proposed to grade perioperative complications in percutaneous nephrolithotomy. The complications of this technique that have taken place in the last 2 years are reported in this article according Clavien-Dindo classification. Materials and methods Between 2011 and 2012, a total of 255 percutaneous nephrolithotomy were performed at our center for stones more than 2 cm in size. In order to determine the incidence of complications classified in the modified Clavien-Dindo system, statistical analysis of the data obtained was carried out. Results During the period analyzed, 255 percutaneous nephrolithotomy were performed in 249 patients, 41% of the right side, 57% of the left side and 2% bilateral and simultaneous. 137 and 112 patients were males and females, respectively. The most prevalent comorbidities were: hypertension (AHT) in 101 patients (40.6%), BMI > 30 in 81 patients (32%), diabetes mellitus in 46 patients (18.5%) and coagulation abnormalities in 24 patients (9.6%). A total of 70 cases (27.4%) were distributed according to Clavien-Dindo classification: grade i 8.4%, grade ii 8.4%, grade iiia 4.4%, grade iiib 6% grade iva 0.8%, grade ivb: 0% and grade v 0%. Conclusions A graded classification scheme for reporting the complications of percutaneous nephrolithotomy is useful for monitoring and reporting outcomes. We propose a standardized use of this classification in order to make the results comparable among different centers performing the technique.

Resumen Introduccion La clasificacion de Clavien ha sido propuesta como sistema para determinar el grado de complicaciones perioperatorias en la nefrolitotomia percutanea. Comunicamos las complicaciones acaecidas en los ultimos 2 anos en la realizacion de esta tecnica utilizando la clasificacion estratificada de Clavien-Dindo. Materiales y metodos Entre 2011 y 2012 se han realizado 255 nefrolitotomias percutaneas en nuestro centro por litiasis renal superior a 2 cm. A partir de los datos obtenidos se lleva a cabo un analisis estadistico para determinar la incidencia de complicaciones segun la clasificacion de Clavien-Dindo modificada. Resultados Durante el periodo analizado se realizaron 255 nefrolitotomias percutaneas en 249 pacientes, 41% del lado derecho, 57% del lado izquierdo y 2% bilateral simultaneo, de ellos 137 fueron hombres y 112 mujeres. Entre las comorbilidades mas prevalentes encontramos la HTA en 101 pacientes (40,6%), IMC > 30 en 81 pacientes (32%), diabetes mellitus 46 pacientes (18,5%) y alteraciones de la coagulacion en 24 pacientes (9,6%). Encontramos 70 casos (27,4%) de complicaciones que se distribuyen segun la clasificacion de Clavien-Dindo en: grado i 8,4%, grado ii 8,4%, grado iii a 4,4%, grado iii b 6% y grado iv a: 0,8%, grado iv b: 0% y grado v 0%. Conclusiones Un esquema de clasificacion graduada para informar las complicaciones de la nefrolitotomia percutanea es util para el seguimiento y notificacion de los resultados. Consideramos de gran utilidad estandarizar su uso para poder hacer comparables los resultados entre los distintos centros que realizan dicha tecnica.

To evaluate the effectiveness and safety of simultaneous bilateral percutaneous nephrolithotomy performed in patients affected with bilateral renal calculi.This is a prospective study from September 2012 to November 2016. Patients diagnosed of bilateral kidney stones with abdominal CT scan were included. Surgical technique prone position, renal puncture guided by fluoroscopy and tract dilation up to 24Ch. We reviewed demographic and stone characteristics, stone free rate, clinical success, complications and follow-up.During the study period, 732 percutaneous nephrolithotomies were performed. Eighteen patients were included (36 renal units, 2.5%), 13 men and 5 women, with a median age of 58 years and an interquartile range (IQR) of 40-66. Median stone burden was 228mmSimultaneous bilateral percutaneous nephrolithotomy is an effective and safe procedure in patients affected with bilateral renal calculi. It is a surgical challenge that should be performed in selected patients and in centers with experience.

Introduccion. El electroencefalograma (EEG) permite obtener informacion directa de la actividad bioelectrica del cerebro y es una herramienta fundamental para la evaluacion de la condicion neurologica del paciente. En los ultimos anos ha comenzado a emplearse tambien para obtener indirectamente informacion sobre la hemodinamica cerebral y las variables que intervienen en la autorregulacion del flujo sanguineo cerebral. Objetivo. Estudiar la posible relacion entre la actividad electroencefalografica y la presion intracraneal (PIC) en pacientes con traumatismo craneoencefalico y hemorragia subaracnoidea ingresados en cuidados intensivos. Pacientes y metodos. Se incluyo a 21 pacientes (10 mujeres) mayores de 18 anos con traumatismo craneoencefalico o hemorragia subaracnoidea que requerian monitorizacion de la PIC y a los que se les registro el EEG de forma continua. Se determino la causalidad de Granger entre la PIC con respecto a las variables espectrales del EEG para ventanas temporales de 10 minutos durante la estancia en cuidados intensivos. Resultados. La causalidad de Granger mostro una alta correlacion entre la PIC con las bandas del EEG. En la mayoria de los pacientes existe una causalidad de Granger significativa en la direccion del EEG hacia la PIC en gran parte del tiempo de monitorizacion, de forma que las variables del EEG precedian a la PIC. Conclusiones. El presente trabajo expone la relacion temporal subyacente entre la dinamica de la PIC y la actividad bioelectrica cerebral registrada mediante EEG en pacientes con traumatismo craneoencefalico y hemorragia subaracnoidea. El potencial uso de esta relacion podria permitir estimar la PIC de manera no invasiva.

Clavien-Dindo classification system has been proposed to grade perioperative complications in percutaneous nephrolithotomy. The complications of this technique that have taken place in the last 2 years are reported in this paper according Clavien-Dindo classification.Between 2011 and 2012 a total of 255 percutaneous nephrolithotomy were performed at our center for stones more than 2 cm in size. In order to determine the incidence of complications classified in the modified Clavien-Dindo system, statistical analysis of the data obtained was carried out.During the period analyzed, 255 percutaneous nephrolithotomy were performed in 249 patients, 41% of the right side, 57% of the left side and 2% bilateral and simultaneous. 137 and 112 patients were males and females, respectively. The most prevalent comorbidities were: hypertension (AHT) in 101 patients (40.6%), BMI30 in 81 patients (32%), diabetes mellitus in 46 patients (18.5%) and coagulation abnormalities in 24 patients (9.6%). A total of 70 cases (27.4%) were distributed according to Clavien-Dindo classification: grade i, 8.4%, grade ii 8.4%, grade iiia 4.4%, grade iiib 6% grade iva .8%, grade ivb: 0% and grade v 0%.A graded classification scheme for reporting the complications of percutaneous nephrolithotomy is useful for monitoring and reporting outcomes. We propose a standardized use of this classification in order to make the results comparable among different centers performing the technique.

Resumen El rinon en herradura constituye la anomalia congenita mas frecuente del rinon. La dificultad en el drenaje urinario influye en que un 20% de los mismos desarrollan litiasis renal. El papel de la litotricia extracorporea por ondas de choque (LEOC) en el tratamiento de la litiasis en pacientes afectos de malformaciones congenitas renales es todavia motivo de controversia Objetivo Evaluar la eficacia de la LEOC en el tratamiento de la litiasis en el rinon en herradura Material y metodos Entre abril de 1988 y diciembre de 1999 hemos tratado a 30 pacientes con rinon en herradura portadores de 32 litiasis sintomaticas que han requerido de 65 sesiones de LEOC para su resolucion. Hasta marzo de 1999 hemos utilizado un equipo Litotriptor Dornier HM-4 de energia electrohidraulica. Posteriormente dos tratamientos se han realizado con equipo Dornier Lithotripter S de energia electromagnetica. Todos los tratamientos han sido realizados sin anestesia ni sedacion con el equipo Dornier HM-4 y utilizamos analgesia con meperidina con el Dornier Lithotripter S. En ningun caso se ha forzado diuresis con diureticos ni sueroterapia. Todos los tratamientos se han realizado de forma ambulatoria Resultados El indice tratamiento/litiasis ha sido de 2.03. El numero de pacientes libres de litiasis tras el tratamiento es de 16 lo que supone un 54%. En 9 pacientes (30%) se consiguio fragmentacion de la litiasis y en 5 pacientes (16%) no se produjeron cambios tras el tratamiento. En tres de los casos se recurrio a la cirugia convencional para la resolucion de su litiasis. Se ha producido recidiva en 2 pacientes lo que supone un 6%. Obtenemos mejor o total eliminacion de la litiasis cuando esta esta alojada a nivel pielico y es de un tamano igual o inferior a 10 mm. Evolucion clinica: asintomaticos 20 pacientes; lumbalgia 5 pacientes; colico nefritico con o sin hematuria: 5 pacientes. No hemos asistido a ninguna complicacion mayor en esta serie Conclusiones Estos resultados sugieren que la LEOC es la primera opcion terapeutica a utilizar ante una litiasis renal de pequeno tamano (=10 mm) alojada en un rinon en herradura

Resumen introduccion La litiasis urinaria es una complicacion infrecuente del trasplante renal; diversos factores de riesgo se han encontrado en pacientes trasplantados renales, pero en muchos casos no hay una relacion entre estos factores de riesgo y la formacion del calculo. El tratamiento de estos pacientes es complejo debido a su estado de inmunosupresion y su funcion renal limite Material y metodo Desde 1980 hasta febrero de 2000 se han llevado a cabo 1.198 trasplantes renales en nuestro centro. Describimos nuestra serie, que consiste en 22 calculos (15 en el injerto, 3 en el ureter y 4 en la vejiga) en 18 pacientes, incluyendo 7 litiasis diagnosticadas en el donante cadaver Resultados Se practico litotricia extracorporea por ondas de choque (LEOC) en 7 ocasiones, cirugia en banco en 4, litotricia mecanica endoscopica en 5, cirugia abierta en 1 y actitud expectante en 6. Los calculos contenian oxalato calcico (mono o dihidrato) en 9 de los 13 analizados. Aparecieron alteraciones metabolicas en 15 de los 18 pacientes, la mas comun fue la hiperuricemia. No han aparecido complicaciones del tratamiento y en dos litiasis (9%) fue necesario un tratamiento de rescate. Cuatro calculos recidivaron (22,2%). Estan libres de litiasis 12 pacientes (66,7%) y 3 con litiasis clinicamente no significativas (83,3% asintomaticos) Conclusiones La presencia de litiasis en el donante renal cadaver no es una razon para rechazar el injerto para el trasplante. En el tratamiento de los calculos renales mayores de 2 cm y ureterales, debe valorarse el tratamiento quirurgico como primera opcion. En los calculos calicilares menores de 5 mm la abstinencia terapeutica es la actitud recomendable

First described by the end of the fifties, pelvic lipomatosis is an uncommon disease that develops as a result of an excessive proliferation of benign fat tissue within the perivesical and perirectal spaces. The compressive effect on the urinary, and to a lesser degree, the digestive and vascular structures result in the well-known symptoms. Diagnosis is reached through X-ray studies, primarily computerised tomography. Contribution of four new cases in young males diagnosed through imaging studies as well as biopsies in three of them. Evolution has been varying, with medical control of symptoms in two cases and renal function impairment due to upper obstructive uropathy in the other two.

Resumen Los factores que provocan dolor en el tratamiento mediante litotricia extracorporea por ondas de choque (LEOC) son tres: la presion provocada por la onda de choque, el tamano del area focal y la distribucion de la presion en su entrada en la piel. En nuestra unidad de Litotricia hemos realizado 21.000 tratamientos ambulatorios (litotriptor Dornier HM-4) sin sedacion ni anestesia. El 10% de estos tratamientos presento dolor, motivando su suspension. La ansiedad asociada al dolor aumenta la intensidad del dolor percibido, pudiendo influir en la respuesta emocional al dolor. Objetivo Determinar si la variabilidad en la respuesta al estimulo doloroso provocado por la LEOC, esta relacionado con la ansiedad estado/rasgo del paciente.METODO: Muestra de 20 pacientes; criterios de inclusion: litiasis pielica menor de 2 cm, no haber recibido previamente LEOC y ausencia de obesidad. Realizacion de una sesion de LEOC (2500 impulsos, 22 Kv). La ansiedad se evaluo previamente mediante el cuestionario de ansiedad de estado/rasgo (STAI), y el dolor a traves de la escala Analogica Numerica una vez finalizado el tratamiento. Resultados Las puntuaciones del dolor oscilaron entre 2 y 8, con puntuacion media de 4,1 (D.S. = 1,67); puntuacion media de ansiedad rasgo de 21,8 (D.S. = 8,52) y ansiedad estado de 29 (D.S. = 5,89). Existe correlacion significativa entre dolor-ansiedad rasgo (R =, 51; p =, 02), si bien esta fue mayor al comparar dolor-ansiedad estado (R =, 67; p =, 001). Conclusiones La LEOC es una terapeutica dolorosa (el 95% de la muestra presento dolor leve-moderado); la percepcion del dolor se incrementa por la ansiedad estado (45% de la varianza del dolor) mas que por la ansiedad rasgo (26,3%); en consecuencia, el empleo de sedoanalgesia en pacientes con una elevada ansiedad estado mejoraria el cociente de eficiencia del litotriptor.

Urinary calculi is an uncommon complication in kidney transplantation; several stone risk factors are found in transplanted patients, but in most cases there is not a relationship between these risk factors and stone formation. The treatment of these patients is complex due to their both immunosuppressive status and border-line renal function.From 1980 to February 2000, 1198 kidney transplant have been performed in our institution. We describe our series consisting in 22 urinary calculi (15 in the graft, 3 in the urether and 4 in the bladder) in 18 patients, including 7 stones detected in cadaveric donor patients.We performed external shock wave lithotripsy in 7 patients, bench surgery in 4, endoscopic mechanic lithotripsy in 5, open surgery in 1 and observation in 6. Calcium oxalate (mono and dihidrate) was found in 9 of 13 calculi. Metabolic changes were found in 15 of the 18 patients, the most common was hiperuricemia. There were not complications of every treatment applied and 9% of them needed a savage treatment. We found recurrence in 4 cases (22.2%). Now 12 of the patients are stone-free (66.7%) and three have non-significative stones (83.3% without symptoms).Detection of renal calculi in cadaveric renal donors is not a reason to refuse the graft for further transplantation. In both renal calculi up to 2 cm and uretheric calculi surgical treatment is assessed as first option. In caliceal stones smaller than 5 mm observations is the best treatment.

The horseshoe kidney is the most frequent renal anomaly. As a consequence of impaired urinary drainage, urolithiasis is present in 20% of the cases. Indications for extracorporeal shock wave lithotripsy (ESWL) in the treatment of patients with anomalous kidneys is still the subject of controversy.To evaluate ESWL efficacy in the treatment for lithiasis in horseshoe kidney.Between april 1988 and december 1999 a total of 32 symptomatic lithiasis in 30 patients with horseshoe kidneys were managed by 65 sessions with ESWL. Until march 1999 a Dornier HM-4 electrohydraulic lithotripter was used. Posteriorly, two treatments was performed with an electromagnetic Dornier Lithotripter S. These procedures have been performed without anaesthesia or sedation for the Dornier HM-4 equipment. Analgesia with Meperidine was used for the Dornier Lithotripter S. Diuresis was not forced during or after treatment with diuretics or serotherapy. Treatments was conducted in an outpatient clinic in all cases.Treatment/lithiasis rate was 2.03. Following treatment 16 patients (54%) were stone-free by X-ray, 9 patients (30%) had residual fragments and in 5 patients (16%) no sign of stone disintegration was observed. Open surgery was performed in three of this patients. Better results was achieved in stones located in the renal pelvis and stone size is 10 mm or less. Clinical evolution: free of symptoms in 20 patients; chronic vague flank pain in 5 patients and acute renal colic with or without hematuria in 5 patients. No major complication was observed in our compilation.These results suggest that ESWL is the method of primary choice in the treatment for small lithiasis (10 mm or less) in horseshoe kidney.

First described by the end of the fifties, pelvic lipomatosis is an uncommon disease that develops as a result of an excessive proliferation of benign fat tissue within the perivesical and perirectal spaces. The compressive effect on the urinary, and to a lesser degree, the digestive and vascular structures result in the well-known symptoms. Diagnosis is reached through X-ray studies, primarily computerised tomography. Contribution of four new cases in young males diagnosed through imaging studies as well as biopsies in three of them. Evolution has been varying, with medical control of symptoms in two cases and renal function impairment due to upper obstructive uropathy in the other two.

Three factors in extracorporeal shock-wave lithotripsy (ESWL) result in pain: shock wave pressure, size of focal area and pressure distribution at entry in the skin. Our Lithotripsy Unit has performed 21,000 outpatient treatments (Dornier HM-4 Lithotripter) with no sedation or anaesthetics. Pain requiring treatment discontinuation resulted in 10% instances. Anxiety-associated pain increases the perceived intensity of pain and influences the emotional response to pain.To determine whether the variability in the response to the pain stimulus caused by ESWL is related to the patient's status/trait of anxiety.Sample 20 patients; inclusion criteria: pyelic lithiasis2 cm, no previous SWEL and no obesity. One SWEL session (2500 pulses, 22 Kv). Anxiety was first evaluated using the status/trait of anxiety index (STAI) questionnaire; after treatment, pain was evaluated on a Numerical Analogic Scale.Pain scores ranged from 2 to 8, mean score 4.1 (S.D. = 1.67); mean score for trait of anxiety 21.8 (S.D. = 8.52), and status of anxiety 29 (S.D. = 5.89). A significant correlation was found between pain-anxiety trait (R = .51; p = .02), which was higher when compared to pain-anxiety status (R = .67; p = .001).SWEL is a painful therapy (95% of sample had mild-to-moderate pain); pain perception is increased by status of anxiety (45% of pain variance) more than by the trait of anxiety (26.3%); therefore, usage of sedation-analgesia in patients with high anxiety status would improve the lithotripter efficacy ratio.

Caliceal diverticula may be congenital or acquired malformations of the collecting system, normally asymptomatic and discovered during an IVP. Indications for treatment included chronic vague flank pain, acute renal colic, urinary tract infection and hematuria. We present the results of 29 patients with symptomatic calculi in caliceal diverticula who were managed by ESWL monotherapy. All treatments were performed with electrohydraulic machine (Dornier HM 4) in ambulatory form.The average followup was 42 months. 12 patients (40%) had passed successfully all of the stone fragments, while 2 patients (7%) had passed more than half and 4 (13.5%) had passed less than half of the fragments. 66 per cent of patients had been rendered free of symptoms. The possibility of producing a satisfactory result (66% free of symptoms and 40% stone free by X ray) and the low morbidity of ESWL suggest that this treatment may be appropriate for majority of calculi in calicea diverticula.

Presentation of the results obtained with extracorporeal shock wave lithotripsy (ESWL) applied to 3173 ureteral lithiasis with a Dornier HM-4 equipment. Location of lithiasis was pyeloureteral junction (329), lumbar ureter (1068), sacral ureter (238), iliopelvic ureter (1474) and "lithiasic path" (64). All lithiasis were treated in situ. Treatments were carried out ambulatory with no anaesthesia. Treatment/lithiasis rate was 1.3. Percentage of stone-free patients with ESWL alone was 79.2% after the first session, and reached 86.14% with retreatment. Percentage of success for lithiasis in pyeloureteral junction was 81.8%, 79.7% for lumbar ureter lithiasis, 80.09% sacral lithiasis, 90.10% iliopelvic ureter lithiasis and 79.9% for those in the "lithiasic path". 12.6% lithiasis required post-ESWL auxiliary manoeuvres. Post-ESWL minor complications (pain, vegetations) occurred in 5.6% cases and major complications (obstruction, fever, sepsis) in 2.9%. The factors influencing lithiasis fragmentation were the number of shock waves and the lithiasis duration. Size of lithiasis and presence or absence of ureteral catheter had no influence. These results suggest that ESWL is an effective method for managing ureteral lithiasis.

Verruciform xanthoma is a rare benign lesion. The most common presentation is at the oral mucosa level, although it has also been described at other locations. Our case is the twelfth verruciform xanthoma of the penis ever published. We highlight the relevance of the differential diagnosis and its excellent prognosis, the choice treatment being the simple exeresis of the lesion.

Renal haematomas after shock wave extracorporeal lithotripsy (SWEL) represent a potentially serious complication. This paper examines those cases of post-SWEL renal haematoma seen in our Centre, analyzing the likely risk factors.Between May 1988 and June 1996, 12,800 patients were treated with 15100 lithiasis at some level of the urinary tract requiring 16,000 SWEL sessions. All treatments were done with a Dornier HM-4 lithotripter. Voltage applied ranged from 18 to 26 Kv, averaging 2500 waves/session. Complementary testing (ultrasound/computerised tomography) was requested immediately after treatment if clinical complications were suspected.A total of 10 renal haematomas (0.078%) were diagnosed. Six cases were mild, but 4 presented extensive haematoma with significant haemodynamic consequence. Although in one case nephrectomy was undertaken to control haemorrhage, death finally occurred by disseminated intravascular coagulation. Four patients who developed haematoma were hypertensive and 3 had a previously corrected haemostasis alteration.The possibility of renal haematoma should be taken into account in the face of persistent and unjustified pain after SWEL treatment. Normalization of blood pressure values, correction of urinary infection as well as adequate correction of haemostatic disorders is advisable.

Primary melanoma of the female urethra is very rare. Early diagnosis is very difficult and thus involves a long-term non-resolutive therapeutic approach. This paper presents the case of a 61-year old female patient with this type of tumour and nodular dissemination at the time of diagnosis. The patient developed lung and cranial metastasis with 5-year survival.

Presentation of one case of intrasinusale located renal angiomyolipoma. Given the location, the ECO as well as the IVU, arteriography and CAT presented diagnostic doubts. We believe this unusual presentation should be added to those circumstances where uncertainty of tumor diagnosis due to size, behaviour or clinical signs and symptoms, elicits a more aggressive attitude.

Exposition of results and complications in 7,162 consecutive sessions with Shockwave Extracorporeal Lithotripsy (SWEL) applied to 3,950 lithiasis located at all levels of the urinary tract. These procedures have been performed without sedation or anaesthesia. Diuresis was not forced during or after treatment with serotherapy, mannitol, or diuretics. Treatment was conducted in an outpatients clinic in all cases. The treatment/lithiasis ratio in this initial series was 1.7. Following therapy, 7.09% of patients treated attended the emergency unit due to colic pain/fever. 3.60% of patients treated required hospitalization due to major complications: subcapsular-retroperitoneal haematoma, 9 cases; ureteral obstruction, 120 cases; septicemia, 22 cases; renal function annulment, 11 cases and death, 2 cases.

Leukoplakia is a morphological term that attempts to define keratinizing desquamative squamous metaplasia of the transitional epithelium. It is uncommon in the upper urinary tract (less than 100 cases have been reported) and has been attributed to infection or mechanical injury to the epithelium and/or genetic factors. We present a case of leukoplakia in a male patient with renal tuberculosis that had been in remission for the past 15 years. Eight years earlier he had intermittently passed keratin laminas (pathognomonic of leukoplakia) during the course of various episodes of nephritic colic. After discarding a reactivation of tuberculosis and malignancy of the metaplastic lesion, we continued conservative treatment with radiologic and cytologic control evaluations.

Review of 18 cases of ureterocele in the adult. The first clinical symptoms are unspecific, with a long-term evolution, and were found while carrying out routine urological examinations. The association to secondary lithiasis in over 60% cases and the presence of complete duplicity in 44% cases is highlighted. The choice treatment is by endoscopy in the simple cases without hydronephrosis or associated reflux. The technique of transversal incision in 'smiling mouth' at the base of the ureterocele produces good results.

Renal metastasis of localized tumours in the economy are rare. In our series of 162 renal tumours only 3 were metastatic. Even more unusual is that the metastasis should be the presenting form. Such is the case we are reporting: a 59 year-old male complaining from back pain and toxic syndrome. Supplementary examinations were performed sequentially until arriving at an open biopsy which confirmed the oat cell histology. The paper explains the results from the various examinations. The ominous prognosis of this histology is illustrated.

1) Sixty percent of low and moderate risk cardiac surgery patients could be succesfully extubated within 11 h of operation. 2) As a result length-of-stay in ICU was reduced and the percentage of patients discharged within 24 h was increased. 3) There was no increase in postoperative morbidity.

Patients with bone marrow transplant may present with acute, life-threatening complications which frequently (40% of our cases) require intensive care unit treatment and result in an increased mortality (76% in this series). In an attempt to reach a more objective prognostic assessment, we have analyzed those factors related to the worst outcome in the 25 patients with bone marrow transplant admitted into our intensive care unit. Respiratory failure was the most frequent complication (72%), with an 83% mortality. Graft-versus-host disease and neutropenia led to a greater number of infectious complications with a poor outcome. Failure of more than three organ systems, septic shock and mechanical ventilation were statistically associated with mortality (p less than 0.05), and all patients who required mechanical ventilation for more than seven days or needed intensive therapy for more than 10 days died. The presence of septic shock, multisystem failure and severe neutropenia on admission should be considered as initial indicators of a poor prognosis. More than 7 days of mechanical ventilation and an intensive care unit stay of more than 10 days could be critical points in the reassessment of the intensity and prolongation of treatment.

Summary— Testosterone concentrations in saliva were measured in 13 patients with prostatic carcinoma after surgical or medical (diethylstilboestrol or Estracyt) orchiectomy. The salivary testosterone values in these patients were significantly lower than in normal males but not significantly different from those in normal females. The salivary testosterone concentrations were measured for 6 consecutive months and did not vary significantly from month to month. The results suggest that the measurement of salivary testosterone concentrations could be useful in evaluating the androgenic function of patients with prostatic carcinoma after medical or surgical orchiectomy.