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Toxoplasmosis is an infection of worldwide distribution caused by Toxoplasma gondii, and infects a large proportion of the world population. Only under certain circumstances of severe immunosuppression can the parasite reactivate and cause disease. The most common form of presentation of this pathology in patients with positive HIV is the brain abscess. One of the extra-cerebral forms is toxoplasmic chorioretinitis, which could lead to a chronic active form of a slowly progressive retinitis. Diagnosis is made by observing the eye fundus and confirmed by the scarring obtained after specific treatment. We report a case of a patient with diabetes and positive HIV, in whom a toxoplasmic scar injury was detected in the annual retinography follow-up. A conservative therapeutic approach was decided, with regular check-ups for possible detection of disease activation.

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The horseshoe kidney is the most common congenital renal fusion anomalies. It occurs in 0.25% of the population, or 1 in every 400 people. It is more frequent in males (ratio 2:1). The most observed complication of horseshoe kidney is stone disease, although there may be others such as, abdominal pain, urinary infections, haematuria, hydronephrosis, trauma and tumours (most commonly associated with hypernephroma and Wilms tumour). We describe a case of a male patient with horseshoe kidney, stone disease and adenocarcinoma of the prostate. One carrier of this condition who suffered a transitional cell carcinoma of the prostate was found in a review of the literature.

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The combination of a pneumothorax and lung cancer is rare and diagnosis is complex. Clinical suspicion of cancer must be based on radiological findings and the existence of risk factors. We discuss the mechanisms involved in the development of pneumothorax in patients with lung cancer, as well as the clinical significance, the recommended diagnostic approach, and therapeutic guidelines.

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The cutaneous horn is defined as a tumour, usually of conical appearance which prevails over the length of its diameter, with large hyperkeratosis in its extreme and due to varied causes. It may be associated with benign, pre-malignant (actinic keratosis) and malignant (squamous cell carcinoma) skin, usually requiring complete excision of the lesion and a histopathological examination. We report a case of a 94 year old woman with a cutaneous horn and an initial pathological diagnosis of actinic keratosis, which subsequently progressed to squamous cell carcinoma, along with and a brief review of the literature. The treatment is complete excision of the lesion, deepening its base due to the likelihood of association with malignant lesions.

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OBJECTIVE: To present a clinical case of a 41 year-old woman, with a stage IV squamous cell carcinoma of the oesophagus. METHODS AND PATIENTS: We present a clinical case of 41 year-old woman with a history of type 2 diabetes mellitus, and resection of a haemosiderin plaque on the tongue. A space occupying lesion (SOL) was studied using ultrasound and Nuclear Magnetic Resonance (NMR), detecting, but unable to differentiate, a gradually increasing haemangioma or hepatocarcinoma. She was seen at the clinic due to dysphagia and loss of weight. In oesophagogastroscopy with biopsy a squamous cell carcinoma of the oesophagus was diagnosed. The Computed Tomography (CT) of the neck, thorax and abdomen showed a stenosing tumour in the oesophagus with metastasis in the lungs and left adrenal gland, and a SOL in the liver compatible with a neo-formative process. The erythrocyte sedimentation rate was 55 mm. She was referred to Surgery and Oncology, who performed a gastrostomy for enteral feeding and started treatment with palliative chemotherapy. CONCLUSIONS: Squamous cell carcinoma of the oesophagus is very frequent. The two most important risk factors are alcoholism and nicotine poisoning. The dysphagia is the most common symptom (96% of the patients). The prognosis is a poor, with high mortality. Surgery is the standard treatment when the tumour is located. Chemotherapy and radiotherapy are palliative treatments, but has not shown to be very effective.

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OBJECTIVE: To analyze the results of transurethral incision of the prostate in 205 patients with prostatic obstruction. METHODS: 205 patients comprised the study. The clinical records and surgical reports were reviewed for patient age, pre and postoperative symptoms, physical examination (principally digital rectal examination), ultrasound findings (prostate weight), endoscopy, type of surgery (type of incision), operating time, hospital stay and complications. RESULTS: 37.07% were aged 60-69 years, 59.51% were grade I according to the DRE and ultrasound findings, and prostatic weight. Bilateral incision was performed in 65.36%. The operating time was 15 minutes in 79.02% of the cases and the length of stay was 3 days in 89.75% of the cases. Postoperative hematuria was the most common complication. CONCLUSIONS: Endoscopic transurethral incision of the prostate is an alternative minimal invasive surgery in the treatment of early onset benign hyperplasia of the prostate with small prostates and short urethras.

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OBJECTIVE: To demonstrate the utility of fine needle aspiration biopsy in the diagnosis of prostatic tumors, basically carcinoma of the prostate. METHODS/RESULTS: The clinical records of 497 patients who underwent fine needle aspiration biopsy were reviewed. Age, skin color, clinical diagnosis by DRE, transrectal core biopsy, correlation between clinical and histological diagnosis, distribution according to type of adenocarcinoma, correlation between cytological and histological diagnosis, and complications were analyzed. Of the 497 patients, 162 had histological confirmation. Of these 162 patients, the Galen and Gambino statistical method was utilized in 132 which represented the true negatives and positives. Sensitivity was 86%, specificity 96%, positive predictive value 91%, negative predictive value 93%, and efficiency was 92%. The complication rate was low. CONCLUSIONS: Fine needle aspiration biopsy is a safe and efficient diagnostic method in prostatic tumors and causes minimal discomfort to the patient.

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OBJECTIVE: To present a rare case of well-differentiated mucus-producing adenocarcinoma of the renal pelvis. METHODS: Patient history, the results of the complementary tests after surgery, treatment and anatomopathological findings are presented. RESULTS/CONCLUSIONS: Well-differentiated mucus-producing adenocarcinoma of the renal pelvis is rare and is often associated with lithiasis, a long history of obstruction and inflammation. Nests of tumor cells surrounded by abundant mucus is a characteristic histological finding in this tumor type.

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OBJECTIVE: To present a case of tubular renal adenocarcinoma associated with transitional cell carcinoma of the bladder. METHODS/RESULTS: A case of tubular renal adenocarcinoma associated with transitional cell carcinoma of the bladder in a 42-year-old patient is described. Patient evaluation included intravenous urography, nephrotomograms, renal and bladder ultrasound evaluation and cystoscopic examination with biopsy. The patient underwent nephroureterectomy and partial cystectomy with subsequent radiotherapy and intravesical chemotherapy. At two-years follow-up, there is no evidence of disease progression. CONCLUSIONS: The appearance of various early-stage urological tumors in the same patient, is uncommon. Although a review of the literature showed that these cases were considered a medical curiosity, it should be taken into account that there is an increasing number of new cases.

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OBJECTIVE: To report a case of renal parenchymal neurilemoma and review the literature. METHODS/RESULTS: A 44-year-old male patient presented with total hematuria. Patient evaluation by IVP, renal US and CT revealed a right renal mass. Radical nephrectomy was decided. The anatomopathòlogical analysis showed a renal parenchymal neurilemoma. CONCLUSIONS: Renal parenchymal neurilemoma is a rare benign tumor. The diagnosis is based on the clinical symptoms and the IVP, renal US and CT findings and confirmed by the anatomopathological findings. Surgical resection achieves cure and there is usually no recurrence.

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OBJECTIVE: We report our experience in the diagnosis, medical management and surgical treatment of priapism. METHODS/RESULTS: The clinical records of 67 patients that had been treated for priapism at our hospital from 1978-1994 were analyzed for age, race, occupation, marital status, symptoms, treatment, complications and time to remission of symptoms following treatment. Sixty-four patients were treated surgically and 3 patients were successfully treated medically. We performed 52 cavernospongiosal shunts, 14 sapheno-cavernous shunts and in 10 patients corpora cavernosa puncture was performed. The complications were sepsis, thrombosis, hematoma, phlebitis and urethral fistula. The complication rate was low for the cavernospongiosal shunt and corpora cavernosa puncture with phenylephrine. CONCLUSIONS: The highest incidence was observed in patients aged 15-40 years, with a prevalence in the black race. The principal presenting feature was a painful erection without sexual contact. Idiopathic priapism was the most prevalent, although the sickle cell anemia was an important etiological factor. The surgical technique most commonly used was the cavernospongiosal shunt. Intracavernosal injection of phenylephrine was the treatment of choice for pharmacological priapism. Seven patients had erectile dysfunction.

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OBJECTIVE: To report a case of hydronephrotic ectopic kidney with lithiasis and pelvic localization, its diagnostic aspects and surgical treatment. METHODS/RESULTS: A 39-year-old male consulted at the emergency services for low abdominal pain. Physical examination disclosed a hypogastric mass. Patient evaluation by ultrasound, intravenous urography and pyelography revealed a right hydronephrotic ectopic kidney with lithiasis and pelvic localization. Nephrectomy via a right infraumbilical incision was performed. CONCLUSION: Pelvic renal ectopy is uncommon, but not rare in our area. This anomaly is associated with a higher than normal incidence of hydronephrosis and lithiasis. The diagnostic techniques most frequently used to evaluate these patients are ultrasound, intravenous urography, cystography and pyelography. When a surgical procedure is performed, the anatomical features of this anomalous condition should be considered, such as abnormal vascularization, pyelourethral anomalies, kidney rotation and absence of perirenal fat tissue.

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OBJECTIVES: To determine the incidence of asymptomatic bacteriuria in women consulting at our hospital and its relationship with other chronic diseases. METHODS: A cross-sectional study was conducted on 735 women who had consulted at our hospital from February to September, 1996. Urinary sediment, serial urine culture, serum urea and creatinine values were analyzed. Patient records were reviewed to obtain pertinent data for the study. RESULTS: The incidence of asymptomatic bacteriuria was 8%; 47.4% of the cases were women over 60 years of age. E. coli was identified as the causative organism in 77.9% of the urine cultures. Diabetes mellitus was the most frequent associated chronic disease (27.1%). The incidence of renal damage was not statistically significant and was not directly related with bacteriuria. CONCLUSIONS: We emphasize the importance of performing a urine culture when leukocyturia is detected. The incidence of asymptomatic bacteriuria increases with age. E. coli was the most frequent causative organism. Diabetes mellitus was the most frequent associated chronic disease. The incidence of renal damage was not statistically significant.

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OBJECTIVE: To describe an uncommon case of bladder calculus arising from an intrauterine device (IUD). METHODS/RESULTS: A female patient with an IUD for the past 10 years consulted for frequent episodes of cystitis. Patient evaluation demonstrated a bladder calculus that warranted surgery. Treatment was by cystolithotomy, which disclosed a 6 cm calculus attached to the IUD. CONCLUSION: Bladder calculus arising from an IUD is rare. The case described herein was successfully managed by cystolithotomy.

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OBJECTIVE: To report on our experience in the diagnosis and surgical treatment of distal urethral stenosis arising from fibrous periurethritis in women. METHODS: 9 patients who had undergone surgery for distal urethral stenosis caused by fibrous periurethritis are described. Patient history, clinical symptoms, the surgical technique employed, complications and post-operative course are presented. RESULTS: All 9 patients had a history of recurrent urinary infection and alteration of the urinary stream. The results obtained by surgery were satisfactory in all cases. CONCLUSIONS: Distal urethral stenosis arising from fibrous periurethritis is uncommon, but not rare. Diagnosis is principally based on the clinical symptoms, characterized by low urinary obstructive symptoms, and the finding at physical examination of a narrow meatus and periurethral enlargement caused by fibrous tissue surrounding the distal urethra. The Richardson urethrolysis technique achieved satisfactory results in these patients.

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