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BACKGROUND AND OBJECTIVE: Hypersensitivity reactions to oxaliplatin may affect prognosis by jeopardizing the timely completion of scheduled treatment sessions or by forcing reactive patients into unexpected changes in therapy. Rapid drug desensitization (RDD) enables these patients to receive their first-choice treatments safely. However, the possible effects of RDD on the efficacy of oxaliplatin have never been studied. Objective: The objective of this study was to evaluate the effect of RDD on survival rates in oxaliplatin-hypersensitive patients. METHODS: We performed a 7-year retrospective study to compare survival between oxaliplatin-hypersensitive cases (patients receiving oxaliplatin by RDD) and nonallergic controls (patients receiving standard oxaliplatin infusions). The primary endpoint of this study was overall survival (OS) in cases and controls (Kaplan-Meier method with log-rank test comparisons). RESULTS: OS was 23.7 months (95%CI, 15.3-30.9) for the 67 cases who underwent 337 RDDs, while for controls (n=143), OS was 34.5 months (95%CI, 21.7-55.5). There were no significant differences between the groups (HR, 1.42; 95%CI, 0.93-2.17; P =.104). CONCLUSIONS: Survival outcomes of oxaliplatin-hypersensitive patients who received oxaliplatin via RDD did not differ significantly from those of control patients who received oxaliplatin via standard administration. Receiving oxaliplatin by means of RDD might be an effective therapeutic alternative for oxaliplatin-hypersensitive patients.

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BACKGROUND: Hypersensitivity reactions to oxaliplatin may affect prognosis by jeopardizing the timely completion of scheduled treatment sessions or by forcing reactive patients into unexpected changes in therapy. Rapid drug desensitization (RDD) enables these patients to receive their first-choice treatments safely. However, the possible effects of RDD on the efficacy of oxaliplatin have never been studied. OBJECTIVE: The objective of this study was to evaluate the effect of RDD on survival rates in oxaliplatin-hypersensitive patients. METHODS: We performed a 7-year retrospective study to compare survival between oxaliplatin-hypersensitive cases (patients receiving oxaliplatin by RDD) and nonallergic controls (patients receiving standard oxaliplatin infusions). The primary endpoint of this study was overall survival (OS) in cases and controls (Kaplan-Meier method with log-rank test comparisons). RESULTS: OS was 23.7 months (95%CI, 15.3-30.9) for the 67 cases who underwent 337 RDDs, while for controls (n=143), OS was 34.5 months (95%CI, 21.7-55.5). There were no significant differences between the groups (HR, 1.42; 95%CI, 0.93-2.17; P =.104). CONCLUSIONS: Survival outcomes of oxaliplatin-hypersensitive patients who received oxaliplatin via RDD did not differ significantly from those of control patients who received oxaliplatin via standard administration. Receiving oxaliplatin by means of RDD might be an effective therapeutic alternative for oxaliplatin-hypersensitive patients

ANTECEDENTES: Las reacciones de hipersensibilidad al oxaliplatino podrían afectar al pronóstico vital cuando fuerzan a los pacientes a cambiar de tratamiento o cuando impiden que lo finalicen. La desensibilización rápida medicamentosa permite que estos pacientes reciban sus tratamientos de primera elección. Sin embargo, no existen datos sobre si la desensibilización rápida medicamentosa podría tener algún efecto sobre la eficacia del oxaliplatino. OBJETIVO: El objetivo de este estudio es evaluar los efectos que la desensibilización rápida medicamentosa al oxalipatlino pudiera tener sobre la eficacia del tratamiento en los pacientes alérgicos al oxaliplatino sometidos a desensibilización. MÉTODOS: Estudio retrospectivo comparando datos de supervivencia, durante un periodo de 7 años, de pacientes alérgicos al oxaliplatino (recibiendo oxaliplatino mediante desensibilización rápida medicamentosa) y controles no alérgicos (recibiendo administraciones estándar de oxaliplatino). La supervivencia global se seleccionó como el criterio de valoración de la eficacia principal y se analizó con el estimador Kaplan-Meier utilizando comparaciones mediante la prueba de log-ran. RESULTADOS: La supervivencia global de los 67 casos fue de 23,7 meses (IC95%, 15,3-30,9), que se sometieron a 337 desensibilizaciones rápidas medicamentosas. Para los 143 controles la supervivencia global fue 34,5 meses (IC95%, 21,7-55,5). No se encontraron diferencias significativamente estadísticas entre ambos grupos (HR, 1,42; IC95%, 0,93-2,17;P=0,104). CONCLUSIONES: Los resultados de supervivencia de los pacientes sometidos a desensibilización no fueron significativamente distintos a los de los controles que recibieron oxaliplatino de forma estándar. La desensibilización se presenta como una alternativa para recibir oxaliplatino de forma eficaz en pacientes alérgicos

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The description and delimitation of species in an evolutionary framework is essential for understanding patterns of biodiversity and distribution, and in the assessment of conservation strategies for natural resources. This study seeks to clarify the evolutionary history and genetic variation within and between closely related octocoral species that are fundamental to benthic marine ecosystems for harbouring a high diversity of associated fauna. For our study system, we focused on members of the Gorgoniidae family in the Eastern Pacific, particularly of the Ecuadorian littoral, a less studied marine ecosystem. According to our results, the diagnosis of the genus Pacifigorgia is here amended to include species previously considered in the genus Leptogorgia. The genera Leptogorgia and Eugorgia are included within a single clade, and neither are recovered as monophyletic. In this case, according to the priority rule of the International Code of Zoological Nomenclature (ICZN), our proposal is to include the species considered in these two genera in Leptogorgia. In addition, we found evidence of interesting speciation patterns: morphological differentiation with no apparent genetic differentiation (in Pacifigorgia), and inconsistencies between mitochondrial and nuclear data that suggest a hybridisation phenomenon (in Leptogorgia). In the first case, recent radiation, ancient hybridisation, sympatric speciation, and in the second, reticulate evolution may have contributed to the evolutionary history of the studied taxa. Therefore, incongruences observed between morphological and molecular evidences in these octocorals, and in corals in general, may reveal the types of events/patterns that have influenced their evolution.

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BACKGROUND: Evidence regarding drug provocation test (DPT) with antineoplastic and biological agents is scarce. Our aim was to assess the usefulness of including DPT as a paramount gold standard diagnostic tool (prior to desensitization). METHODS: Prospective, observational, longitudinal study with patients who, during a 3-year period, were referred to the Desensitization Program at Ramon y Cajal University Hospital. Patients underwent a structured diagnostic protocol by means of anamnesis, skin tests (ST), risk assessment, and DPT. Oxaliplatin-specific IgE was determined in oxaliplatin-reactive patients (who underwent DPT regardless of oxaliplatin-specific IgE results). Univariate analysis and multivariate analysis were used to identify predictors of the final diagnosis among several variables. RESULTS: A total of 186 patients were assessed. A total of 104 (56%) patients underwent DPT. Sixty-four percent of all DPTs were negative (i.e., hypersensitivity was excluded). Sensitivity for oxaliplatin-specific IgE (0.35 UI/l cutoff point) was 34%, specificity 90.3%, negative predictive value 45.9%, positive predictive value 85%, negative likelihood ratio 0.7, and positive likelihood ratio 3.5. CONCLUSIONS: These are the first reported data based on more than 100 DPTs with antineoplastic and biological agents (paclitaxel, oxaliplatin, rituximab, infliximab, irinotecan, and other drugs). Implementation of DPT in diagnostic protocols helps exclude hypersensitivity (in 36% of all referred patients), and avoids unnecessary desensitizations in nonhypersensitive patients (30-56% of patients, depending on culprit-drug). Drug provocation test is vital to validate diagnostic tools; consequently, quality data are shown on oxaliplatin-specific IgE and oxaliplatin-ST in the largest series of oxaliplatin-reactive patients reported to date (74 oxaliplatin-reactive patients). Identifying phenotypes and predictors of a diagnosis of hypersensitivity may be helpful for tailored plans.

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INTRODUCTION: Urinary complications in kidney transplantation cause patient morbidity and can decrease graft survival. Most of the complications stem from the vesicoureteric anastomosis. Different techniques for ureteroneocystostomy (UNC) have been designed to avoid these complications. The routine use of a double J catheter after the anastomosis has the same purpose. Our aim was to show our experience and compare the use or non-use of a double J catheter and different techniques for ureteric reimplantation with the rate of urologic complications. MATERIAL AND METHODS: We conducted a retrospective, nonrandomized study of 1011 renal transplantations performed between July 1985 and April 2012. We recorded the surgical techniques for UNC, the use or non-use of a double J catheter, and urinary complications (ureteric fistulae and strictures). The first 700 kidney transplantations (group A) were performed using several UNC techniques (Taguchi, Leadbetter-Politano, and Lich-Gregoir) with a selective use of double J catheter according to the criteria of the surgeon. In the last 311 patients (group B), a surgical technique was established (Lich-Gregoir), as well as the universal use of double J catheters. RESULTS: Urinary fistula occurred in 7% of group A patients and 2% of group B patients (P = .0001). Ureteric stricture occurred in 5.3% of patients in group A and 3% of group B patients (P = .09). In our study, routine prophylactic stenting combined with the Lich-Gregoir UNC technique has decreased the incidence of postoperative fistulae. CONCLUSIONS: Individually, the use of double J catheters seems to lessen the incidence of fistulae, although statistically, the difference is not significant. Accurate knowledge of the complications rates, recommendations of guidelines, and the early diagnosis are essential to attaining reasonable results in kidney transplantation.

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OBJECTIVES: To evaluate the incidence of minor complications that rarely need treatment (haematuria, hematospermia and rectal bleeding) and major complications (fever and shock) in patients undergoing transrectal biopsy of the prostate and to identify risk factors. PATIENTS AND METHODS: We present an analytic and prospective study where we evaluated 146 patients subjected to transrectal biopsy of the prostate from December 2007 to September 2008. Complications rates and variables were analyzed. RESULTS: Eight patients (5,5%) suffered fever and seven (4,8%) of them were admitted. One of the patients (0,7%) suffered shock. The median of time between biopsy and fever was 3.5 days (1-10 days). Haematuria and hematospermia were more frequent in patients younger than 65 years (p<0.05) and fever and sepsis were more frequent in patients with prostate volume smaller than 55mL (p<0.05). CONCLUSIONS: The complications of the transrectal biopsy of the prostate are frequent, autolimited and they rarely suppose a health hazard for the patients. The most frequent are haematuria and hemospermia, specially in younger patients, whereas infectious complications are rarer and in our study are more frequent in patients with smaller prostates. We must take into account that the information to the patient is very important after a prostate biopsy, so we can avoid useless consultations (for example with haematuria) and it will enable to identify important signs like fever earlier.

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OBJECTIVE: To assess the outcome of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. METHODS: A retrospective assessment was made of 100 laparoscopic nephrectomies performed at a single hospital from 2001 to 2005. Patients with a history of prior abdominal surgery, prior procedures on the involved kidney, evidence of perirenal inflammation, renal lesions 10 cm or more in diameter, or level I renal vein thrombosis were enrolled. RESULTS: Twelve patients were enrolled. Of these, 5 had a lesion at least 10 cm in diameter, 2 had renal vein thrombosis, and 5 reported major abdominal surgery. Most patients had more than one of these findings. Three patients showed inflammatory conditions (staghorn calculi) and a T4 renal tumor was successfully treated without conversion to open surgery. Mean operating time and blood loss were 210 minutes and 310 ml respectively, while mean length of hospital stay was 3 days. No patient required conversion to open surgery. CONCLUSIONS: Hand-assisted laparoscopic nephrectomy is an attractive minimally invasive option for technically challenging tumors and has reasonable operating times, blood losses, and complication rates.

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INTRODUCTION: Controversy exists as to whether cystocele has a causative role in bladder outlet obstruction (BOO). OBJECTIVE: To assess the relationship between cystocele and bladder outlet obstruction. MATERIALS AND METHODS: Two hundred women undergoing a urodynamic study from December 2007 to December 2008 were retrospectively assessed. Patients were divided into two groups: Group A: Patients with no cystocele (Grade 0) and Grade I cystocele Group B: Patients with Grade II-IV cystocele. EXCLUSION CRITERIA: 1. Absence of flowmetry or voided volume < 150 ml. 2. Neurological disorders. 3. History of urogenital surgery. Bladder outlet obstruction was defined as follows: Postvoid residue (PVR) > 20%; peak flow (Qmax) < 15 ml/sec; detrusor pressure at maximum flow (PdetQmax) > 25 cm H2O. RESULTS: Group A included 64% of patients, and Group B the remaining 36%. A pathological PVR > 20% was found in 26.6% and 40.3% of patients in Group A and Group B respectively (p=0.04). A Qmax < 15 mL/sec was seen in 15.6% and 27.8% of Group A and Group B patients respectively (p=0.03). A PdetQmax > 25 cm H2O was found in 26.3% and 47.8% of Group A and Group B patients respectively (p=0.01). CONCLUSIONS: A statistically significant association exists between cystocele and bladder outlet obstruction.

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Objetivo: evaluar los resultados de nefrectomía laparoscópica asistida por la mano en pacientes con masas renales técnicamente complejas. Métodos: se ha realizado una evaluación retrospectiva de 100 nefrectomías laparoscópicas realizadas en un solo hospital entre 2001 y 2005. Se ha seleccionado a los pacientes con antecedentes de cirugía abdominal previa, procedimientos previos en el riñón afectado, evidencia de inflamación perirrenal, lesiones renales de más de 10 cm de diámetro o trombosis venosa renal tipo I. Resultados: se ha incluido un total de 12 pacientes; 5 de ellos presentaban una lesión de al menos 10 cm de diámetro, dos trombosis venosa renal y 5 referían cirugía abdominal mayor. La mayoría de los pacientes tenía más de uno de estos hallazgos. Tres pacientes presentaban procesos inflamatorios (cálculos coraliformes) y un tumor renal T4 fue tratado con éxito, sin necesidad de reconversión. El tiempo operatorio y la pérdida sanguínea medias fueron de 210 minutos y 310 ml, respectivamente, con una estancia media de tres días. Ningún paciente requirió reconversión a cirugía abierta. Conclusiones: la nefrectomía laparoscópica asistida por la mano es una opción mínimamente invasiva, atractiva en el contexto de masas técnicamente complejas, con un tiempo operatorio, una pérdida sanguínea y una tasa de complicaciones razonables (AU)

Objective: To assess the outcome of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. Methods: A retrospective assessment was made of 100 laparoscopic nephrectomies performed at a single hospital from 2001 to 2005. Patients with a history of prior abdominal surgery, prior procedures on the involved kidney, evidence of perirenal inflammation, renal lesions 10 cm or more in diameter, or level I renal vein thrombosis were enrolled. Results: Twelve patients were enrolled. Of these, 5 had a lesion at least 10 cm in diameter, 2 had renal vein thrombosis, and 5 reported major abdominal surgery. Most patients had more than one of these findings. Three patients showed inflammatory conditions (staghorn calculi) and a T4 renal tumor was successfully treated without conversion to open surgery. Mean operating time and blood loss were 210 minutes and 310 ml respectively, while mean length of hospital stay was 3 days. No patient required conversion to open surgery. Conclusions: Hand-assisted laparoscopic nephrectomy is an attractive minimally invasive option for technically challenging tumors and has reasonable operating times, blood losses, and complication rates (AU)

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Introducción: existen controversias con respecto a si la presencia de cistocele, y el grado de este, es un factor de obstrucción del tracto urinario inferior (TUI).Objetivos: valorar la relación entre el cistocele y la obstrucción infravesical. Material y métodos: evaluamos retrospectivamente a 200 mujeres sometidas a estudio urodinámico, entre diciembre de 2007 y diciembre de 2008.Se clasificó a las pacientes en 2 grupos: Grupo A: ausencia de cistocele (grado 0) y grado I. Grupo B: cistocele grado II-IV. Criterios de exclusión: 1. Ausencia de flujometría libre o volumen vaciado < 150 ml. 2. Existencia de patología neurológica. 3. Antecedentes de cirugía urogenital. Definimos obstrucción del TUI según los siguientes parámetros: volumen residual postmiccional (VRP) > 20%; flujo máximo (Qmáx) < 15 ml/s; y presión del detrusor en el flujo máximo (PDetQmáx) > 25 cmH2O. Resultados: el grupo A incluyó al 64,0% de las pacientes y el grupo B al 36% restante. Seapreció volumen residual postmiccional (VRP) patológico en el 26’6% en el grupo A y en el 40,3% en el grupo B (p= 0,04); Qmáx < 15ml/s en 15,6% en el grupo A y en el 27,8% en el grupo B (p= 0,03); PDetQmáx > 25 cmH2O en el 26,3% en el grupo A y en el 47,8% en el grupo B (p= 0,01). Conclusiones: existe una asociación estadísticamente significativa entre el cistocele y parámetros de obstrucción infravesical (AU)

Introduction: Controversy exists as to whether cystocele has a causative role in bladder outlet obstruction (BOO).Objective: To assess the relationship between cystocele and bladder outlet obstruction. Materials and methods: Two hundred women undergoing a urodynamic study from December 2007 to December 2008 were retrospectively assessed. Patients were divided into two groups: Group A: Patients with no cystocele (Grade 0) and Grade I cystocele Group B: Patients with Grade II-IV cystocele. Exclusion criteria: 1. Absence of flowmetry or voided volume < 150 ml.2. Neurological disorders. 3. History of urogenital surgery. Bladder outlet obstruction was defined as follows: Postvoid residue (PVR) > 20%; peak flow(Qmax) < 15 ml/sec; detrusor pressure at maximum flow (PdetQmax) > 25 cm H2O. Results: Group A included 64% of patients, and Group B the remaining 36%. A pathological PVR > 20% was found in 26.6% and 40.3% of patients in Group A and Group B respectively (p=0.04). A Qmax < 15 mL/sec was seen in 15.6% and 27.8% of Group A and Group B patients respectively (p=0.03). A PdetQmax > 25 cm H2O was found in 26.3% and 47.8% of Group Aand Group B patients respectively (p=0.01). Conclusions: A statistically significant association exists between cystocele and bladder outlet obstruction (AU)

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INTRODUCTION: The prostate biopsy is the only valid tool to diagnose the existence of cancer of prostate. The indications of the biopsy, according with EAU, are the existence of high PSA, increased velocity PSA and a rectal suspicious tact. OBJECTIVES: validation of the utility of the prostate biopsy, to know the value of the PSA as a marker of prostate cancer in our way and to value the indication and efficiency of repeated biopsies. MATERIAL AND METHODS: we practice a manual review of the biopsies in our hospital, between the years 1990 and 2002. We study the level of PSA before the biopsy, number of prostatic cores and histologic information of the biopsy. A statistical descriptive and inferencial study has been performed by SPSS 12.0 package. RESULTS: The total number of biopsies registered was a 1202, with 36.96% of biopsy positive. The PSA before the biopsy (available in the biopsies realized between the year 1999 and 2002: 578 biopsies, 48.08% of the whole) was > 10 ng/ml in 55,88% of these patients, 4-10 ng/ml in 39.27% and 0-4 ng/ml in 4.84%. The average and PSA's median is of 19.09 (standard error: 1.87) and 10.6, respectively. The positividad of the biopsy increases with PSA's level: 48,61% with PSA > 10; 25.11% with PSA 4-10 and 21,4% in patients with PSA < 4. There was realized prostate rebiopsy (2 or more biopsies) in 132 patients (21.97% positive) 88,36% of the cancers was diagnosed in the first biopsy, and 6.62% in the second one (94,98% of the diagnoses of cancer of prostate carried out with the first 2 biopsies). CONCLUSIONS: The information obtained in the study by means of the descriptive analysis of our series meets in conformity the published in other studies and publications. There exists a need to increase the diagnostic profitability of the biopsy of prostate, for which we have introduced a protocol of biopsy under local anesthesia in order to be able to increase the number of obtained cylinders.

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Introducción: La biopsia prostática es la única herramienta válida para diagnosticar la existencia de cáncer de próstata. Las indicaciones para su realización según la Asociación Europea de Urología son la existencia de PSA elevado, velocidad aumentada y la evidencia de un tacto rectal sospechoso. Objetivos: Valoración tanto de la utilidad clínica de la biopsia prostática, como del PSA como marcador de cáncer de próstata en nuestro medio y la indicación y eficacia de sucesivas biopsias. Material y Métodos: Efectuamos una revisión manual de las biopsias realizadas en nuestro servicio entre los años 1990 y 2002, valorando nivel de PSA previo a la biopsia, número de cilindros obtenidos y datos de la biopsia. Se llevó a cabo un estudio estadístico descriptivo mediante el programa estadístico SPSS 12.0. Resultados: Se han realizado 1202 biopsias en este periodo, con un porcentaje de positividad global del 36.96%. El PSA previo a la biopsia (disponible en las biopsias realizadas entre los años 1999 y 2002: 578 biopsias, 48.08% del total) era >10 ng/ml en el 55,88% de estos pacientes, 4-10 ng/ml en el 39.27% y 0-4ng/ml en el 4,84%. La media y mediana de PSA es de 19,09 (error típico: 1,87) y 10,6, respectivamente. La positividad de la biopsia aumenta con el nivel de PSA: 21,4% en pacientes con PSA<4; 25,11% con PSA 4-10 y 48,61% con PSA >10. Fue realizada rebiopsia prostática en 132 pacientes (21,97% positivas) El 88,36%de los cánceres fueron diagnosticados en la primera biopsia, y un 6,62% en la segunda (94,98% de los diagnósticos de cáncer de próstata se realizaron con las 2 primeras biopsias). Conclusiones: Los datos obtenidos en el estudio mediante el análisis descriptivo de nuestra serie se encuentran en concordancia con lo publicado en otros estudios y publicaciones. Existe una necesidad de aumentar la rentabilidad diagnóstica de la biopsia de próstata, para lo cual hemos introducido un protocolo de biopsia bajo anestesia local con el fin de poder aumentar el número de cilindros obtenidos (AU)

Introduction: The prostate biopsy is the only valid tool to diagnose the existence of cancer of prostate. The indications of the biopsy, according with EAU, are the existence of high PSA, increased velocity PSA and a rectal suspicious tact. Objectives: validation of the utility of the prostate biopsy, to know the value of the PSA as a marker of prostate cancer in our way and to value the indication and efficiency of repeated biopsies. Material and methods: we practice a manual review of the biopsies in our hospital, between the years 1990 and 2002. We study the level of PSA before the biopsy, number of prostatic cores and histologic information of the biopsy. A statistical descriptive and inferencial study has been performed by SPSS 12.0 package. Results: The total number of biopsies registered was a 1202, with 36.96 % of biopsy positive. The PSA before the biopsy (available in the biopsies realized between the year 1999 and 2002: 578 biopsies, 48.08 % of the whole) was> 10 ng/ml in 55,88 % of these patients, 4-10 ng/ml in 39.27 % and 0-4ng/ml in 4.84 %. The average and PSA’s median is of 19.09 (standard error: 1.87) and 10.6, respectively. The positividad of the biopsy increases with PSA’s level: 48,61 % with PSA> 10; 25.11 % with PSA 4-10and 21,4 % in patients with PSA <4. There was realized prostate rebiopsy (2 ó more biopsies) in 132 patients (21,97 % positive) 88,36 % of the cancers was diagnosed in the first biopsy, and 6.62 % in the second one (94,98% of the diagnoses of cancer of prostate carried out with the first 2 biopsies).Conclusions: The information obtained in the study by means of the descriptive analysis of our series meets in conformity the published in other studies and publications. There exists a need to increase the diagnostic profitability of the biopsy of prostate, for which we have introduced a protocol of biopsy under local anesthesia in order to be able to increase the number of obtained cylinders (AU)

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