Je Rosas-Nava

Treatment of reno-ureteral colic by twelfth intercostal nerve block with lidocaine versus intramuscular diclofenac

Introduction and objectiveRenal colic is one of the most intense pains known to humans. Standard treatment usually consists of nonsteroidal anti-inflammatory drugs and opiates, but they do not always provide optimum efficacy and speed in relieving the pain. For more than 25xa0years, our hospital has been employing twelfth subcostal nerve block. The objective of the present study was to compare the efficacy of subcostal nerve block with lidocaine versus intramuscular diclofenac in renal colic management.MethodsSixty patients of both sexes, above the age of 18xa0years, and presenting with renal colic were randomly selected for the study. The visual analog scale was applied prior to the treatment and at minutes 1, 3, 5, 30, and 45 after the application of the twelfth nerve block or the intramuscular administration of diclofenac.ResultsA total of 60 patients, 35 women and 25 men, were included in the study. There were statistically significant differences in the mean scores for pain from minute 1 to minute 45. There were no adverse effects.ConclusionsTwelfth Subcostal nerve block with lidocaine is an efficacious, safe, inexpensive, and very fast-acting medication for pain control related to renal colic. These characteristics make it superior to diclofenac.

Enucleation of schwannoma of the penis with neurovascular bundle sparing using the VTI 20 MHz Microvascular Doppler System

A 48-year-old man had an unremarkable past medical history. His current illness began 8 years prior to medical consultation with a non-painful, progressive increase in volume at the base of the penis in the dorsal region. The patient had adequate erections but was unable to perform coitus due to the presence of a mass. He complained of no other symptomatology. Physical examination revealed an uncircumcised cylindrical penis and a central meatus. A non-painful, mobile, stony hard tumor measuring approximately 6 cm × 5 cm was located at the dorsal region of the base of the penis. It was not fixed to the deep planes and there were no color changes. MRI of the penis identified a round, solid, well-circumscribed tumor with a heterogeneous content and extremely vascularized aspect. It was not dependent on the corpora cavernosa but caused compression and displacement to the left. The penile tumor was completely extirpated using the VTI 20 MHz Microvascular Doppler System, sparing the neurovascular bundles. The histopathologic report and immunohistochemistry study confirmed the diagnosis of Schwannoma of the penis. At follow-up at more than two years, the patient has no signs of tumor activity and erections are adequate.

Tumor testicular metacrónico 19 años después

Resumen Los tumores testiculares germinales son los tumores solidos mas comunes en los adolescentes y adultos jovenes entre los 15 y 35 anos. Los tumores testiculares bilaterales son raros, la incidencia de un segundo tumor testicular contralateral en pacientes con antecedente de tumor germinal es del 1% al 5% publicada en las grandes series. Se han identificado diversos factores de riesgo como la historia familiar, criptorquidia, disgenesia gonadal, infertilidad, atrofia testicular, trauma escrotal. Se sabe que el antecedente de tumor testicular germinal es el principal factor para el desarrollo de tumores testiculares contralaterales. Aproximadamente el 50% de las lesiones metacronicas aparecen en un periodo de 5 anos, se ha reportado que hasta el 23% de los pacientes presenta tumor metacronico mas de 10 anos despues. Presentamos un caso clinico de un paciente con tumor testicular metacronico, despues de 19 anos de la orquiectomia radical.

Pancreatitis posterior a resección transuretral de próstata

Resumen La pancreatitis aguda post-reseccion transuretral de prostata (RTUP) es una complicacion reportada con poca frecuencia, dicha situacion puede condicionar retraso en el diagnostico si no se considera como posibilidad, lo que requiere identificar el cuadro clinico (dolor abdominal localizado en epigastrio de moderada a gran intensidad), la determinacion de enzimas pancreaticas y la toma de estudios de imagen a tiempo. Se reportan 2 casos de paciente que desarrollan pancreatitis aguda post-RTUP, los cuales presentan evolucion torpida con falla multiorganica, que condiciona la muerte de ambos pacientes.