[The Internet in medicine. A help, a problem, a cause of errors...?].

The Internet has been a breakthrough for Professional Medical Training. Medline databases are increasingly being used by the scientific community at large. Patients have also started to use the Internet as a source of information on their illnesses, and look in the web for a second opinion.

Management of urethral recurrence in patients with Studer ileal neobladder.

Objective: The overall risk of urethral recurrence (UR) of transitional cell carcinoma (TCC) in patients with orthotopic neobladder ranges from 2% to 6%. We are presenting herein our experience in order to evaluate and define the management of these patients, since the cases with urethral recurrence in patients with orthotopic neobladder are very scarce.

Materials And Methods: Five hundred and sixteen radical cystectomies due to TCC were performed at our Centre between January 1990 and February 1998.

[Should hernioplasty be combined with surgery of the prostate?].

Objective: In some patients consulting for a prostatic condition, inguinal hernia might be incidentally discovered during evaluation. The results achieved by simultaneous prostatectomy and hernia repair are presented.

Methods: 52 patients with hyperplasia of the prostate and inguinal hernia underwent treatment for both conditions during the same surgical procedure.

Incidentally detected renal angiomyolipoma with tumour thrombus into the inferior vena cava.

A right-renal angiomyolipoma with tumour thrombus into the inferior vena cava was incidentally detected. This is the ninth published case of its type and the second incidental case. Presence of a thrombus does not imply invasive disease, but the tumour then is often bigger than 6 cm and radical surgery is mandatory.

Growing teratoma syndrome: experience of a single institution.

Objective: To analyze the clinical outcome of patients diagnosed with growing teratoma syndrome (GTS) at a single center during a long follow-up.

Patients And Methods: Eleven patients with GTS are reported. GTS lesions were located in the metastatic sites involved at disease presentation.

[Cell cycle and carcinogenesis].

This presentation allows us to understand the terminology used for oncogenesis by Molecular Biology investigators. Thanks to the minute description of the normal physiology of the cell cycle, its regulatory mechanisms and growth stimulating and inhibiting effects, we are able to understand the language used. We are now able to fill the gap in our knowledge and to establish the increasingly necessary relationship between routine practice and Molecular Biology.

Renal abscess due to Aspergillus fumigatus in a patient with the acquired immunodeficiency syndrome.

Disseminated aspergillosis is a systemic fungal infection that may occur in previously healthy or immunocompromised patients. The condition, although rare, is being recognized with increasing frequency in persons with the human immunodeficiency virus. Clinical genitourinary involvement is unusual.

[Post-nephrectomy duodeno-cutaneous fistula resolved with parenteral nutrition and octreotide (somatostatin analogue)].

After a right nephrectomy of ischemic kidney, a high-output duodenal fistula developed on the third postoperative day. Sixteen days of total parenteral nutrition were unsuccessful, so octreotide (a synthetic analogue of somatostatin) was added (0.1 mg subcutaneously every 8 hours).

[Renal angiomyolipoma: diagnostic difficulties and surgical indications in 20 surgically treated patients].

Between 1982 and 1993, 6 male and 14 female patients underwent partial or total nephrectomy due to renal angiomyolipoma (AML). Presentation forms were: in 6 cases (30%) acute pain with severe haematuria or signs of visceral bleeding, 3 (15%) acute pain without other symptoms, 7 (35%) chronic pain associated to haematuria or fever, or isolated haematuria, and in 4 (20%) it was a chance finding. No significant differences were found among tumor sizes considering the severity of the presentation form, but all AMLs with serious signs and symptoms had more than 5 cm diameter.

[From shock-waves even to ureterolithotomy: various practical cases].

The Puigvert Urology Centre in Barcelona reports the detailed results of five cases of ureteric stones all treated by first-line shock wave lithotripsy. Only one case obtained a positive result (after 4 sessions). In the other four cases, shock wave therapy had to be completed by ureteroscopy (1 case) or by open surgery (3 cases) to achieve cure.

[Cytogenetic characteristics and of primary culture in multiple renal tumors].

The incidence of multiple tumours in renal cancer ranges between 1 and 30%. In these cases, it becomes very difficult to differentiate between adenoma and carcinoma just by using conventional methods, particularly in borderline cases. We carried out primary cultures and subsequent cytogenetic studies in 2 patients with multiple renal cancer.

Treatment of stage I testicular tumours.

Between 1980 and 1989, 138 patients with stage I carcinoma of the testes were treated and followed up; 81 patients had seminoma and 57 had non-seminomatous tumours. Between January 1980 and December 1983, patients with seminoma were treated by orchiectomy, followed by complementary radiotherapy to aortic and ipsilateral pelvic nodes. Retroperitoneal lymph node dissection (RPLND) was performed in patients with non-seminomatous tumours.

[Gastrocystoplasty for renal insufficiency in adults].

Vesical substitution or augmentation with various segments from the gut is a frequent occurrence in urology. In the presence of normal renal function there are few or no metabolic disorders. In the presence of renal failure the most suitable gut segment is the stomach due to its characteristics of Cl- and ammonium excretion, smaller mucus formation, acid pH provided to the urine and because it allows easy ureteral regrafting.

[Physiopathological aspects of the treatment of benign prostatic hypertrophy. Role of prostatic stroma and estrogens].

The hypothesis of the etiopathogenesis of Benign Prostatic Hypertrophy (BPH) on the basis of stroma-epithelium interaction is presented. The fetal prostate has its origin in the urogenital sinus depending on the dehydrotestosterone stimulating the stromal cells having androgenic receptors. This stroma hyperplasia is considered to be the initial factor in the BPH formation.

Postsurgical management of the patient undergoing radical prostatectomy.

Radical prostatectomy is a useful procedure for the treatment of prostate cancer limited to the gland; however, failure may occur as a result of the immediate or delayed complications of surgery, or to disease recurrence related to incomplete tumour excision. Seventy-nine radical prostatectomies were performed between April 1985 and August 1991 in patients with prostate cancer (primarily stage B1) who averaged 63 years of age. Immediate post-operative complications included vesicocutaneous fistulae, cystic lymphangiomas, abdominal wall abscesses, extraperitoneal haematoma, acute cholecystitis, and enterocutaneous fistula.

[Carcinosarcoma of the prostate. Immunophenotype, morphologic course and clinico-pathologic differential diagnosis].

The observation of a patient with a malignant tumor of the prostate initially classified as adenocarcinoma with desmoplasia, reclassified as adenocarcinoma with a malignant spindle cell component of uncertain cell line following two large tumor recurrences over a period of 4 months, and subsequently as carcinosarcoma with heterologous mesenchymal areas has prompted us to review the 11 reported cases of prostatic carcinosarcoma and the diagnostic algorithm of the proliferative processes of the prostate with elongated cells in order to recognize (from the histological features and the inclusion and exclusion immunophenotypes) the pseudosarcomatous stromal reactions, fusicellular changes of the carcinoma, benign and malignant phyllodes tumors and carcinosarcoma.

Intensive chemotherapy in poor-prognosis nonseminomatous germ cell tumors of the testis.

Forty-one patients with poor-prognosis nonseminomatous germ cell tumors (NSGCT) of the testis were treated between 1980 and 1989. This group was defined by the presence of one of the following features: multiple large lung metastases, bone, liver or brain metastases, abdominal mass greater than 10 cm, abdominal mass greater than 5 cm with high serum concentration of the tumor markers [alpha-fetoprotein (alpha FP) greater than 500 kU/l or beta-subunit of human chorionic gonadotropin (beta HCG) greater than 1,000 IU/l) or very high serum tumor marker concentrations (alpha FP greater than 5,000 kU/l or beta HCG greater than 10,000 IU/l). The first 21 patients were treated with cisplatin, vinblastine, bleomycin (PVB) chemotherapy and the following 20 with an intense, alternating 6-drug chemotherapy consisting of cisplatin, bleomycin, vincristine, methotrexate, etoposide and ifosfamide (BOMP/EPI).

[Filling defects in the upper urinary tract: update on the etiologic diagnosis and review of the specific value of urinary cytology].

We present 3 cases with upper tract filling defect and exfoliative cytology positive for malignant cells in 2 of these cases (micturition and via ureteral catheter, respectively). The initial suspicion of urinary tract tumor was discarded by subsequent work up in 2 patients who were managed conservatively and followed closely. The third patient was submitted to nephroureterectomy.