Asunto(s)
Coristoma/diagnóstico , Pólipos/diagnóstico , Próstata , Enfermedades de la Vejiga Urinaria/diagnóstico , Biomarcadores de Tumor/análisis , Coristoma/cirugía , Cistoscopía , Humanos , Masculino , Persona de Mediana Edad , Pólipos/química , Pólipos/cirugía , Antígeno Prostático Específico/análisis , Enfermedades Raras , Resultado del Tratamiento , Ureteroscopía , Enfermedades de la Vejiga Urinaria/cirugíaRESUMEN
Based on a case report and a review of the literature, the authors describe the features of emphysematous pyelonephritis. This rare disease with a poor prognosis constitutes a difficult clinical diagnosis. The positive diagnosis is based on urgent computed tomography. The reference treatment is emergency nephrectomy in an intensive care context.
Asunto(s)
Pielonefritis , Urgencias Médicas , Enfisema/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Nefrectomía , Pronóstico , Pielonefritis/diagnóstico , Pielonefritis/cirugía , Tomografía Computarizada por Rayos XRESUMEN
The authors report two cases of bladder leiomyosarcoma, an extremely rare invasive bladder tumour, with a very poor prognosis due to very early local invasion. The definitive diagnosis can only be established by histological examination. The treatment modalities for this histological type of bladder tumour have not been standardized and remain controversial. However, the treatment of choice appears to be radical prostatocystectomy preceded by neoadjuvant chemotherapy when compatible with the patient's general state.
Asunto(s)
Leiomiosarcoma/diagnóstico , Neoplasias de la Vejiga Urinaria/diagnóstico , Adulto , Anciano , Cistectomía , Humanos , Leiomiosarcoma/patología , Leiomiosarcoma/cirugía , Masculino , Prostatectomía , Tomografía Computarizada por Rayos X , Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/cirugía , UrografíaRESUMEN
Hyperprolactinemia is the cause of erectile dysfunction in less than 1% of cases. From 1989 to 1996, 13 patients consulted for erectile disorders associated with hyperprolactinemia. The mean age was 47.5 years. 10 patients complained of decreased libido. 3 patients had gynecomastia. Plasma prolactin levels ranged from 31.3 ng/ml to 1,300 ng/ml. 7 patients had a plasma testosterone less than 4 ml/ng. 7 patients had a micro- or macroadenoma of the sella turcica visualized by MRI. After drug treatment, plasma prolactin levels returned to normal in all patients in whom assays were performed. 6 patients considered that their erectile function was restored. 5 of the 6 patients with no improvement of their sexual function had a concomitant disease able to explain the impotence. Hyperprolactinemia is a rare cause of erectile dysfunction, but it must be considered in any patient presenting with idiopathic erectile dysfunction associated with decreased libido, gynecomastia, and decreased plasma testosterone. Drug treatment is effective and MRI of the sella turcica should be performed looking for a pituitary adenoma.
Asunto(s)
Disfunción Eréctil/etiología , Hiperprolactinemia/complicaciones , Adulto , Anciano , Bromocriptina/uso terapéutico , Antagonistas de Hormonas/uso terapéutico , Humanos , Hiperprolactinemia/tratamiento farmacológico , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: Evaluation of a protocol of intravesical BCG therapy using 75 mg of Pasteur strain BCG with 2 years of maintenance treatment, and a follow-up of up to 60 months. MATERIAL AND METHODS: 189 patients treated by transurethral resection (TUR) for a pTa (N = 80) or pT1 (N = 109) bladder tumour were included in the study. The local and general safety was excellent. We retrospectively compared this series to a group of patients treated by TUR alone (N = 42) another group treated with TUR and Mitomycin C (MMC) (N = 81). The 3 groups were statistically comparable. RESULTS: At 48 months, 62% of patients treated with BCG were recurrence-free, versus only 18% for patients treated with TUR alone and 38% for patients treated with TUR and MMC (p = 0.001). At 42 months, 11% of pT1 tumours treated with BCG had progressed to invasive carcinoma, and this progression occurred during the first 18 months in every case. In comparison, this progression was observed in 25% of pT1 tumours treated by TUR alone and 21% of tumours treated with TUR and MMC. CONCLUSIONS: Our study confirms the efficacy of our BCG protocol ro reduce the potential for recurrence and progression of superficial bladder tumours, despite reduction of the dose to 75 mg. It also suggests the superiority of BCG compared to MMC in terms of recurrence and progression.