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OBJECTIVE: Bladder cancer is a commonly diagnosed malignancy in Europe, being 30% muscle-invasive at diagnosis. In these patients, metastases can develop both at diagnosis and after progression. Metastatic disease can manifest in a number of different ways, even as hydroelectrolytic alterations. In this work, we go through the causes of hyponatremia in patients suffering from bladder cancer and its relationship with disseminated disease. METHOD: We present two cases of patients with muscleinvasive bladder cancer with a common electrolytic misbalance, hyponatremia. RESULTS: As a result of the study, bone and cerebral metastases were revealed. CONCLUSIONS: The electrolytic alterations in the oncologic patient can have several causes: chemotherapy, urinary diversion, pain, or even to the tumor itself or its metastases. It is necessary to conduct an exhaustive study in order to discard the most important causes of hyponatremia and be able to decide an appropriate treatment.

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OBJETIVO: El carcinoma vesical es una neoplasia de frecuente diagnóstico en Europa, siendo en un 30% de los casos musculo-infiltrante al diagnóstico. En estos pacientes la enfermedad metastásica puede presentarse al diagnóstico o con la progresión de la enfermedad. La presencia de metástasis puede manifestarse de diversas formas, incluso como alteraciones analíticas. En este trabajo realizamos un repaso de las causas de hiponatremia en los pacientes con carcinoma vesical y su relación con la enfermedad diseminada. MÉTODO: Presentamos 2 casos clínicos de pacientes con un carcinoma vesical infiltrante y con una alteración analítica en común, la hiponatremia. RESULTADO: A raíz del estudio de la hiponatremia, se evidencia la presencia de metástasis. CONCLUSIONES: Las alteraciones electrolíticas en el paciente oncológico pueden ser de causas diversas: tipo de derivación urinaria, quimioterápicos, dolor, o incluso la propia neoplasia ó sus metástasis. Se debe seguir un estudio exhaustivo para descartar las causas más importantes y poder realizar un correcto tratamiento de estos pacientes

OBJECTIVE: Bladder cancer is a commonly diagnosed malignancy in Europe, being 30% muscle-invasive at diagnosis. In these patients, metastases can develop both at diagnosis and after progression. Metastatic disease can manifest in a number of different ways, even as hydroelectrolytic alterations. In this work, we go through the causes of hyponatremia in patients suffering from bladder cancer and its relationship with disseminated disease. METHOD: We present two cases of patients with muscleinvasive bladder cancer with a common electrolytic misbalance, hyponatremia. RESULTS: As a result of the study, bone and cerebral metastases were revealed. CONCLUSIONS:The electrolytic alterations in the oncologic patient can have several causes: chemotherapy, urinary diversion, pain, or even to the tumor itself or its metastases. It is necessary to conduct an exhaustive study in order to discard the most important causes of hyponatremia and be able to decide an appropriate treatment

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OBJECTIVES: Kidney transplant may be a good choice to treat chronic renal failure even in patients with two or more previous renal grafts. However, there might be several surgical complications and other difficulties we have to deal with. The aim of this report is to analyze the third, fourth and fifth transplants performed in our center focusing on the surgical complications and graft and patient survivals. METHODS: We performed a retrospective analysis of the 73 third, fourth and fifth kidney transplants performed in our center between February 1975 and December 2015. Statistical analysis has been performed with IBM SPSS 23.0 software. RESULTS: 62 patients received a third graft, 10 received a fourth one and one patient received a fifth graft. The median age of the recipients was 48 years, while for donors it was 50. Median cold ischemia time was 21 hours. Transplantectomy was not necessary in 49.31% of the cases. In 59.7% of the cases the graft vessels were anastomosed to the external iliac vessels. There were 21 cases of relevant postoperative complications (27.4% of the total grafts). Vascular thrombosis appeared in 5.5%. After 49 months of follow-up, the 1-, 3-, and 5-year graft survival were 64.3%, 56.16% and 50.69%, respectively. CONCLUSIONS: A new renal transplant in patients with two or more previous grafts is feasible, being necessary to individualize the cases. In spite of being more complex operations than previous transplants with a higher complication rate, we can obtain both acceptable graft and patient survival outcomes with an appropriate approach.

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Objetivos: El trasplante renal puede ser una buena opción terapéutica en la insuficiencia renal terminal, incluso en los pacientes con dos o más injertos previos. Sin embargo, pueden existir una serie de dificultades y complicaciones quirúrgicas a las cuales el equipo de trasplante debe enfrentarse. El objetivo de este artículo es revisar los terceros, cuartos y quintos trasplantes realizados en el Hospital Universitario Marqués de Valdecilla (HUMV) analizando las dificultades quirúrgicas, sus complicaciones y la supervivencia de injertos y pacientes. Método: Revisión retrospectiva desde Febrero de 1975 hasta Diciembre de 2015 que incluye 73 trasplantes (3º,4º y 5º) realizados en el HUMV. El estudio estadístico ha sido realizado con el programa informático IBM SPSS versión 23.0. Resultados: 62 pacientes han recibido un tercer trasplante, 10 de ellos posteriormente han recibido un cuarto y 1 única paciente ha recibido un quinto. La mediana de edad de los receptores fue 48 años y la de los donantes 50. La mediana de isquemia fría fue de 21 horas. No fue necesaria la trasplantectomía de los injertos previos en un 49,31 % de los casos. En un 59,7% de los casos se pudieron anastomosar los vasos del injerto a los vasos iliacos externos del receptor. Se registraron un 27,4% de complicaciones postquirúrgicas relevantes, con un 5,5% de trombosis en los vasos de los injertos. Tras una mediana de seguimiento global de 49 meses la supervivencia del injerto a 1, 3 y 5 años fue del 64,3%, 56,16% y 50,69% respectivamente. Conclusión: A pesar de ser necesario individualizar los casos, un nuevo trasplante en pacientes con dos o más injertos renales previos, sigue siendo una opción terapéutica a considerar. Aunque pueden ser cirugías complejas y de alto riesgo de complicaciones, con un manejo óptimo y cirujanos expertos se pueden obtener cifras de supervivencia de injerto aceptables (AU)

Objectives: Kidney transplant may be a good choice to treat chronic renal failure even in patients with two or more previous renal grafts. However, there might be several surgical complications and other difficulties we have to deal with. The aim of this report is to analyze the third, fourth and fifth transplants performed in our center focusing on the surgical complications and graft and patient survivals. Methods: We performed a retrospective analysis of the 73 third, fourth and fifth kidney transplants performed in our center between February 1975 and December 2015. Statistical analysis has been performed with IBM SPSS 23.0 software. Results: 62 patients received a third graft, 10 received a fourth one and one patient received a fifth graft. The median age of the recipients was 48 years, while for donors it was 50. Median cold ischemia time was 21 hours. Transplantectomy was not necessary in 49.31% of the cases. In 59.7% of the cases the graft vessels were anastomosed to the external iliac vessels. There were 21 cases of relevant postoperative complications (27.4% of the total grafts). Vascular thrombosis appea-red in 5.5%. After 49 months of follow-up, the 1-, 3-, and 5-year graft survival were 64.3%, 56.16% and 50.69%, respectively. Conclusions: A new renal transplant in patients with two or more previous grafts is feasible, being necessary to individualize the cases. In spite of being more complex operations than previous transplants with a higher complication rate, we can obtain both acceptable graft and patient survival outcomes with an appropriate approach (AU)

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