Actitud expectante en el síndrome del cascanueces

Nutcracker syndrome is caused by compression of the left renal vein between the aorta and the superior mesenteric artery where it passes in the fork formed at the bifurcation of these arteries. The phenomenon results in left renal venous hypertension. The syndrome is manifested by left flank and abdominal pain, with or without unilateral haematuria. The nutcracker syndrome has been treated in various ways. We report one case of the syndrome and discuss the place of surveillance in its management.     

Smoking behavior characteristics of non-selected smokers with childhood attention-deficit/hyperactivity disorder (AD/HD) history: a systematic review and meta-analysis

It is unclear whether adult smokers with childhood attention-deficit/hyperactivity disorder history (CH) have more severe smoking behavior than non-CH smokers, while it is clearly suggested that CH adolescents have more severe smoking behavior than CH adolescents. The aim of the present comprehensive meta-analysis is to determine whether CH smokers have more severe smoking behavior characteristics than those without and the effect of age on the association between CH and smoking behavior. We included all case–control studies and first round data collection of observational studies addressing the difference in smoking behavior characteristics of CH smokers versus non-CH smokers, with validated scales or structured interviews, without any language or date restriction. Nine studies (including 365 smokers with CH and 1,708 smokers without) were included. Compared to non-CH smokers, CH smokers smoked significantly more cigarettes [standardized mean differences (SMD) = 0.15, 95 % CI 0.01–0.28, p = 0.04] and began to regularly smoke earlier (SMD = ?0.28, 95 % CI ?0.49; ?0.07, p = 0.01) but were not significantly more nicotine dependent (SMD = 0.23, 95 % CI ?0.04 to 0.48, p = 0.08). After removing the single adolescent study, the significant association between CH and number of daily smoked cigarettes disappeared, and subgroups analyses confirmed that the significant association between CH and number of daily smoked cigarettes disappeared as age increased. Our meta-analysis illustrates a clinically important link between CH and tobacco smoking in adolescence but not later in life. Further high-quality studies are needed to confirm this finding, as only two studies included participants with a mean age below 20 years.     

Resultados a los tres años de la reparación de un cistocele transvaginal con malla de propileno usando una técnica sin tensión

ObjectivesTo evaluate the long term efficacy and safety of transvaginal implantation of a non-resorbable synthetic prosthesis (Gynemesh®) for the treatment of cystocele using transvaginal free tension technique.Materials and methodsProspective study of patients that have been submitted to correction of cystocele between April 2004 and July 2007. A prolene mesh was cut to an appropriate size to cover the whole cystocele leaving two tabs on each side. The two tabs of the mesh were then placed in paravaginal spaces, tension free, without stitches. Mesh was used in 31 patients. All patients had a symptomatic cystocele ≥ 2 according to Baden-Walker halfway classification. Patients were reviewed initially at 1and 3 month and then every 6 months.ResultsThe mean age of the patients was 58 years (range: 47-70 years). Mean parity was 5.8 (range 1-11), and mean weight was 75 kg (range 60-82Kg). All women were postmenopausal. The operation was combined with vaginal hysterectomy in 2 patients, Posterior colporraphy in 2 patients, Perineorrhaphy in 1 patient, Sacrospinous fixation in 2 patients, transobturator tape for stress urinary incontinence in 7 women. Average time of surgery was 23 minutes for cystocele. There were no major complications, such as trauma to the bladder, urethra, bowels, or large vessels in the patient group treated. There was no immediate postoperative complications (up to 7 days) recorded. No hematoma or infection was observed in the operative area. Mesh erosion was detected in one patient. It was treated by excision of the eroded part of the mesh.Mean follow-up was 36.4 months (18 to 52 months). Using our definition of success based on both anatomic and functional outcomes, the overall cure rate was 74.19% (asymptomatic with no or grade 1 cystocele). The improvement rate (asymptomatic with a grade 2 cystocele) was 19.35% and the overall failure rate (symptomatic or with a grade 3 or 4 cystocele) was only 6.4% (2 women).Discussion and conclusionsThe interposition of a sub-vesical transversal tension-free polypropylene mesh by the vaginal route seems to be an excellent procedure in the definitive surgical treatment of anterior vaginalwall prolapse. This procedure is simple, mini-invasive, reproducible and efficient with low morbidity and good tolerance. The results seem to be stable after three years of follow up.     

Hydronephrosis arterial hypertension. Report of 4 cases

Four cases of ureteropelvic junction syndrome associated with arterial hypertension were reported. The authors discuss the ethiopathogenic of hypertension, on the basis of these observations and a review of the literature. They conclude that union bilateral hydronephrosis can lead to hypertension and renal failure by both inappropriate production of renin and water chronic retention. The correction of ureteropelvic junction should return blood pressure to normal levels.     

Intrascrotal inflammatory pseudotumor (a case report)

We report one case of intrascrotal inflammatory tumour in a 12 year-old boy. The clinical symptomatology was a tumoral rise in the right scrotal volume. The rate of biological markers was normal. A testicular neoplasm was highly suspected in scrotal ultrasound and CT scan. A radical orchidectomy was accomplished and histological examination revealed a peritesticular inflammatory tumor without neoplasm. The clinical and imaging findings of the tumor are discussed.     

Hemospermia: diagnosis and therapeutic aspects. Seven case reports

Hemospermia or hematospermia is a common benign condition, but its prevalence remains unknown and can result from several causes. The aetiology is idiopathic in about 30-70% of the cases. The hemospermia is first of inflammatory origin, in the young patients, where it is due to uretroprostatitis or orchi-epididymitis, but in the older, it is due to a benign of malignant prostatic tumors. Transrectal ultrasonography and magnetic resonance imaging can afforded the opportunity to best investigate the patients with hemospermia. Hemospermia is not an uncommon problem and in most instances has little clinical significance other than evoking much anxiety for the patient. In view of the literature, the authors discus the diagnostic and therapeutic approach of hemospermia through a series of seven cases.     

Paratesticular rhabdomyosarcoma. Three case reports]

Paratesticular rhabdomyosarcoma is a rare and highly aggressive tumor. The authors discuss the diagnosis and therapeutic problems raised by this lesion and report three cases with a review of the literature.     

Renal oncocytoma. Three case reports

Renal oncocytoma represents a rare benign tumor accounted for 3-5% of renal neoplasms. It has been mistaken for and mistabled as granular or dark cell carcinoma. Between 1993 and 1998, 3 women with renal oncocytoma were recognized at formation and underwent radical nephrectomy. Sonography and the CT scan was performed but the Accurate diagnosis was not possible before performing surgery and histologic investigations. The mean Follow-up of 3 patients was 48 month and showed a benign clinical behaviour in all cases.     

L’adénome métanéphrique bilatéral du rein

Renal metanephric adenoma is an uncommon benign epithelial neoplasm. The diagnosis is exclusively histological. Differential diagnosis essentially includes Wilms’ tumor and papillary renal cell carcinoma. Cytogenetic analysis seems to be important for distinguishing these three histological entities. Bilateral metanephric adenoma of the kidney is an exceptional entity (to our knowledge only one case has been reported in the literature) which renders the differential diagnosis with bilateral cancer of the kidney difficult. We report a new case seen in a 64-year-old patient.