A. Gelabert Mas

Expresión inmunohistoquímica de p53, p21, p16 y Ciclina D1 en el cáncer de vejiga superficial: Estudio en un soporte de tissue microarray

INTRODUCTION AND OBJECTIVES: To retrospectively assess the relationship between immunohistochemical expression of p53, p21, p16, and cyclin D1, with recurrence, progression and survival in superficial bladder cancer. METHODS: 163 patients undergoing transurethral resection for superficial bladder cancer between February 1995 and March 2004. Tumor samples were included in a tissue microarray support that was serially sectioned for immunohistochemical staining. Grade and stage associations for each marker were evaluated by the Chi-square test. Assessment of the relationship with recurrence, progression, and survival Kaplan-Meier curves and log-rank test were used. RESULTS: There were no statistically significant differences in marker expression depending on tumor grade and stage, with the exception of Cyclin D1, that was significantly different depending on tumor stage (p=0.030). p21 expression was related to tumor recurrence (p=0.035), progression (p=0.008) and survival (p=0.034). p16 expression was also related to recurrence (p=0.048) and survival (p=0.047), but not to tumor progression (p=0.116). p53 and Cyclin D1 were not statistically associated with tumor recurrence, progression or survival. CONCLUSIONS: In our experience, only p16 and p21 may be useful in the management of superficial bladder tumors, as they are predictors of recurrence and survival in Ta and T1 patients.

Actitud diagnóstica y terapéutica en el tumor germinal bilateral: Presentación de un caso y revisión de la literatura

Resumen El tumor germinal bilateral representa entre el 1 y el 4% de los tumores de testiculo y suele plantear al urologo importantes dificultades en su diagnostico y tratamiento. Aportamos el caso de un paciente de 30 anos, diagnosticado de seminoma con areas de tumor del saco vitelino en teste izquierdo, que fue tratado con orquiectomia. Once meses despues, presento una segunda neoplasia en el teste contralateral, cuya histologia fue de seminoma clasico con carcinoma “in situ” peritumoral, siendo tratado tambien con orquiectomia Se revisa la literatura medica, con especial referencia a los factores de riesgo implicados y al manejo de estos tumores: la deteccion de carcinoma “in situ” aparece como factor predictivo mas potente. Se plantea la realizacion de biopsia testicular contralateral en casos seleccionados. Aunque la orquiectomia radical sigue siendo el tratamiento de eleccion, la radioterapia local y la cirugia conservadora representan una alternativa en casos de tumor bilateral

Doxazosina en formulación de liberación retardada en la retención aguda de orina por hiperplasia benigna de próstata: Acción del incremento de dosis sobre el efecto rescate

DOXAZOSIN IN THE GASTROINTESTINAL THERAPEUTIC SYSTEM (GITS) FORMULATION AND TRIAL WITHOUT CATHETER AFTER ACUTE URINARY RETENTION DUE TO BPH. DOSE INCREASE ACTION ON RECOVERY EFFECT OBJECTIVE: Prospective and randomised study to assess the effectiveness of doxazosin in sustained release formulation in Acute Urinary Retention (AUR) treatment due to benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: The trial was carried out with a cohort of 40 males who had all suffered their first attack of AUR caused by BPH. Twenty were randomly selected and treated for 7 days with 4 mg of sustained release doxazosin before removing the catheter. The patients not treated that could not spontaneously urinate were also administered 4 mg of doxazosin. Finally, all the patients that still had a catheter due to unsuccessful removal were treated with 8 mg of doxazosin and the percentage of patients responding to treatment was assessed. The predictive value of the response to treatment for age, IPSS, QoL, retained urine volume, prostate volume and the evolution time of the prostratism was determined by means of logistic regression analysis. RESULTS: 82.5% of the patients (33/40) could urinate after removal of the catheter. 84.8% (28/33) were treated with doxazosin (21 with 4 mg and 7 with 8 mg). In the first attempt at removal, 60% of the patients (12/20) treated with 4 mg of doxazosin could spontaneously urinate, while only 25% (5/20) of those not treated, p=0.02. Similarly, 60% of the patients (9/15) treated with 4 mg of doxazosin in the second attempt could spontaneously urinate. Fifty per cent (7/14) of the patients still with a catheter, after the treatment with 4 mg of doxazosin, could urinate with 8 mg. In the logistic regression analysis, none of the variables analyzed allowed us to predict the response to the treatment. CONCLUSION: The treatment for 7 days with 4 mg of sustained release doxazosin shows greater success when removing the catheter after suffering AUR due to BPH. With this treatment, 60% of the patients could spontaneously urinate again. By increasing the dose to 8 mg, the catheter can be removed in half the patients that did not initially respond. Before removing the catheter it is not possible to predict which patients would be able to spontaneously urinate.

Independent multiple primary tumors and second primary neoplasms. Relationship between smoking

Abstract Multiple primary tumors and second primary neoplasms have been increasing in incidence in recent decades and are reviewed in this paper. The reasons attributed to this significant increase are fundamentally the best diagnosis of multiple concurrent cases and increased overall survival of patients diagnosed with cancer, allowing surface new primary tumors in other organs during or after standard monitoring. At the same time the widespread use of radio and chemotherapy for the first tumor are invoted as possible causes. The genitourinary system is frequently involved in cases of multiple neoplasms; urological organs are one of the few settlement sites of primary tumors in almost a quarter of cases. This suggests a susceptibility/genitourinary system increased target for neoplastic disease. For this same reason, the urologist has a fundamental role in managing these patients and especially during follow up. We believe that the concept of clinical monitoring of this subset of patients should be revised, and should entail a screening of the most common second primary neoplasms since the risk of developing a subsequent independent cancer after presenting a urothelial tumor is considerably increased.

La impresión cistoscópica frente al diagnóstico histológico en los tumores vesicales: ¿Coinciden?

Objetive How quality control in a university hospital and immediatily after to recents publications; we planed to evaluation of the correlation of cystoscopy impression with the histologic diagnosis after of transurethral resection (TUR).

Anemia y hormonoterapia neoadyuvante en la cirugía radical del cáncer de próstata localizado

Resumen Fundamento Los androgenos estimulan la eritropoyesis por accion directa sobre las celulas de la medula osea y por aumento en la produccion de eritropoyetina. La deprivacion androgenica es una causa conocida de anemia. El objetivo de este trabajo fue estudiar el efecto sobre la hemoglobina (Hb) y el hematocrito (Hto) de la hormonoterapia neoadyuvante previa a la cirugia radical en el cancer de prostata localizado Material y metodo 47 pacientes con cancer de prostata clinicamente localizado, recibieron bloqueo androgenico completo (BAC) con analogos LH-RH mas flutamida, durante un minimo de 3 meses antes de la prostatectomia radical. Se realizo un estudio hematologico basico antes de iniciar el BAC y 3 meses despues de la hormonoterapia y se valoraron los requerimientos transfusionales perioperatorios. El analisis estadistico se realizo mediante el test de la t de Student para datos pareados para valorar cambios significativos Resultados Todos los pacientes (100%) de nuestro estudio presentaron un descenso en los niveles de Hb y de Hto despues de 3 meses de BAC. El descenso medio de Hb fue 1,9 g/dl (rango de 1,6-2,2) p:0,0001 y del Hto de 5,8 (rango de 4,8-6,8) p:0,0001. La Hb fue inferior a 12 g/dL en el 10,6 de los pacientes despues de la hormonoterapia y la anemia fue normocitica-normocromica. El 60% de los pacientes requirieron una transfusion perioperatoria, con un promedio de 2 concentrados de hematies transfundidos Conclusion El BAC neoadyuvante previo a la prostatectomia radical origina un descenso significativo en los niveles de Hb y de Hto despues de 3 meses de tratamiento. Este descenso puede contribuir a aumentar los requerimientos transfusionales perioperatorios, en un grupo de pacientes sometidos a una intervencion agresiva que de por si conlleva perdidas sanguineas importantes

Desarrollo de un microarray tisular (TMA) para el estudio inmunohistoquímico del patrón de expresión molecular en el cáncer de próstata (Parte 1)

Tissue microarray technology (TMA) is nowadays considered as a powerful tool for the high-throughput analysis of molecular expression pattern of cancer. In this manuscript we show the experience of both groups in the design and building of a TMA for the study of protein expression pattern of prostatecancer as well as a summary of the technical points to analyze the results obtained with this technology. Today, different data generated by the immunostained tissues are studied to achieve a molecular profile in different clinical scenarios.

El enfoque terapéutico del cáncer renal: una nueva oportunidad de coordinación entre la Urología Oncológica y la Oncología médica

l carcinoma de celulas renales representa alrededor del 95% de todos los tumores del rinon. Su incidencia sigue incrementandose, en especial en areas industrializadas, sin que se conozcan de manera clara los motivos reales, aunque parece seguro que intervienen tanto la mejora en tecnicas diagnosticas como razones ambientales, entre otras, el tabaco y la dieta.

Validación histopatológica de la tecnología tissue-microarray de cáncer de urotelio: Nuestra experiencia

Resumen Validacion Histopatologica De La Tecnologia Tissue-Microarray De Cancer De Urotelio. Nuestra Experiencia Introduction La tecnologia array ofrece: gran ventaja a los investigadores clinicos y basicos, facilita aplicar gran cantidad de tecnicas (inmunohistoquimica, FISH, proteomica) para comprender los mecanismos moleculares del cancer, ofrece economia de escala en los reactivos versus los procedimientos convencionales. Dado que la representacion de la muestra es muy reducida, es exigible previamente validar el array. material y metodos A partir de bloques de parafina de carcinomas de urotelio almacenados, cuya antiguedad oscilaba entre 5-7 anos, se han seleccionado 52 casos consecutivos; se ha construido un array de tejido; los discos se colocaron en filas y columnas de manera aletoria, dibujando un topograma para guia de lectura. Se valido por otro patologo ajeno a la seleccion de las muestras. Resultados Se han obtenido 87 laminillas. La numero 1 se ha tenido con HE. Ha habido discrepancia en el 27% de las muestras en el estadiaje. No ha existido discrepancia en el diagnostico histologico. En 11 puntos (17%) no hay representacion de la muestra. discusion Nuestros resultados ofrecen unos buenos resultados en la validacion de las muestras. La antigenicidad del tejido esta conservada. Las muestras seleccionadas en el array representan alrededor del 97%, similar a todo el conjunto de las secciones convencionales de la muestra problema.

Ciencias básicas y urología

Resumen Articulo de opinion en el que se ofrece una vision actualizada y una predicion evolutiva de la extraordinaria repercusion que se deriva de la interaccion paulatina y real de las Ciencias Basicas a la disciplina de la Urologia. Se destaca la trascendencia de la transicion del anatomismo/conocimiento/tecnica-quirurgica hacia el conocimiento fisiopatologico/cientifico-basico/terapia medica. Con estos criterios se establecen oportunas reflexiones en multiples areas de la urologia que incluyen la funcion vesicoprostatica, la disfuncion erectil y de forma mas exhaustiva la uro-oncologia.