Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Bernard, Jean Pierre y otros. Tableau des Partís Politiques en Amerique du Sud. Paris. Fondation Nationale des Sciences Politiques, 1969, p. 430.

Case report: A 53-year-old female with a deceased-donor kidney transplant who was receiving quadruple sequential immunosuppressive therapy, with a delayed graft function in her immediate postoperative period, and no need for dialysis. Two months later, the patient was hospitalized due to sudden eye pain, low grade fever and myalgia. A nuclear magnetic resonance showed space occupying injuries in the CNS, suggesting an infectious process and diffuse graft pyelonephritis, requiring a transplantectomy. The patient died 24 hours after the surgery despite the antifungal therapy. The kidney tissue culture revealed Scedosporium apiospermun growth.    Relevance: The case highlights the importance of knowing and being able to manage infections in a timely manner, given the growing number of transplanted patients with immunosuppressive therapy.  Clinical implications: The Scedosporium apiospermun is an emerging, ubiquitous, and opportunistic fungus that causes systemic infections in immunocompromised patients that may produce up to 90% of mortality, and local infections that requires surgical debridement and long-term antifungal treatment with voriconazole for at least 3 months. Conclusions: Despite this type of infection not being frequently seen, it demands a quick differential diagnosis and an appropriate treatment, given the potential mortality and morbidity outcomes.

Abstract Description: A 50-year-old male who was admitted to intensive care with a Coronavirus-19 diagnosis for strict handling requiring oxygen therapy. He presented distention and abdominal pain, for which an abdomen-pelvic tomography was requested, reporting lack of filling in the right renal artery and renal infarcts requiring angioplasty and double antiplatelet therapy. The evolution was favorable, and the patient was discharged. Currently, a renal Doppler reports adequate vascularization. The patient presents proper renal function. Clinical Significance: The coronavirus disease is a contagious and life-threatening infection caused by the severe acute respiratory syndrome coronavirus 2. It can lead patients to arterial and venous thrombosis. However, acute renal artery occlusion is considered a rare disease. Clinical Implications: Prompt diagnosis and treatment are important to prevent permanent kidney damage or permanent loss of kidney function. Conclusion: The underlying etiology of renal infarcts remains largely unknown at present, but it may include direct viral cytopathic effects on endothelial cells. Most patients are managed conservatively. Some cases undergo angioplasty successfully. The patient in this case received earlier treatment with doses of anticoagulant enoxaparin, and his glomerular filtration remained stable, although complementary treatment was required.

Description of the clinical case: A 62-year-old female comes to our unit with oppressive pain in the bilateral lumbar area. Bilateral ureteral lithiasis was diagnosed those conditions severe bilateral hydronephrosis and it was decided to divert the urinary tract to later perform a definitive treatment. Due to the findings in the laboratory and cabinet studies, primary hyperparathyroidism was diagnosed as the cause of the bilateral ureteral lithiasis.   Relevance: The presence of stones indicates the need for parathyroidectomy in patients diagnosed with primary hyperparathyroidism with hypercalcemia or normocalcemia unless there are contraindications. Patients with nephrolithiasis should explore strategies to prevent stone formation even after parathyroidectomy.   Clinical implications: The most common consequences of excessive parathyroid hormone secretion are hypercalciuria and kidney stones. They occur in 8-20% of patients with primary hyperparathyroidism and are the most common complication of the disease. They can be silent in 7-11% and bilateral in 16.4% of patients. It is very important to be able to identify patients with this disease to avoid multiple complications.   Conclusions: Patients with primary hyperparathyroidism have a high risk of developing kidney complications. We must analyze all the factors that made us suspect in a primary hyperparathyroidism in patients who debut with renal or ureteral stones and thus avoid the recurrence of the same

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is an option for the treatment of urinary lithiasis. Objective: To describe the outcomes of ESWL for the treatment of urinary lithiasis in children. Methods: A descriptive and retrospective study of 51 patients with urinary lithiasis that underwent ESWL from 2014 to 2019. Results: Males and 15–18-year-old patients prevailed; 27.4% had prior surgery; 10-20 mm lithiasis of renal location and density between 400-799 HU were the most common; a double J stent was the most utilized urinary derivation prior to lithotripsy treatment; 7.8% required retreatment; 13.7% additional interventions; the stone-free rate was 74.5% at one month and 92.2% at three months. The size of the lithiasis was associated with the success of the treatment (p<0.023). The most frequent complication was steinstrasse; endourologic procedures were the most utilized, grade III b (Clavien-Dindo) prevailed and were associated to older patients (p=0.04), renal lithiasis localization (p=0.017), larger size (p=0.08), and density(p=0.036). Conclusions: ESWL is effective and safe for treating urinary lithiasis in children. Its success was significantly associated to smaller stone size and its complications to patients of older age, larger stone size, density and renal localization of the lithiasis.

Introduction: Tumor Enucleation (TE) of renal masses as an alternative of nephron-sparing surgery has increased in the past years. Objectives: To describe the perioperative, oncological and functional outcomes of laparoscopic TE in a series of patients with renal masses. Material and method: A descriptive and retrospective study of 71 patients who underwent laparoscopic TE surgery for renal mass in La Habana, Cuba at the Centro Nacional de Cirugía de Mínimo Acceso, between 2010 and 2019. Clinical-epidemiological and perioperative variables, complications, Clavien-Dindo grade and oncological variables were considered. The SPSS program, version 23.0 was utilized. Frequencies, mean percentages, standard deviation and Student´s t- test (p<0.05) were estimated. Survival was appraised by using the Kaplan Meier curve. Results: Mean age was 58 years. Male patients prevailed (60.6%), with comorbidities (87.3%), incidental diagnosis (73.2%), low complexity tumors (64.8%). Mean tumor size and RENAL score was 33.6 mm and 6.1, respectively. Hand-assisted transperitoneal approach was performed (92.9%), mean bleeding was 335.9 ml and length of hospital stay 5.2 days. Postoperative renal function was preserved (p=0.082). Postoperative complications prevailed (14.1%), bleeding (8.4%) and grade II and IV (4.2%, respectively). Most masses were malignant (71.8%), ccRC prevailed (52.1%), pT1a (78.4%), overall survival and cancer specific survival was 100% and 96.0%, respectively. Mean follow-up time was 7.4 years. Conclusions: Laparoscopic TE is a feasible alternative for treating select renal masses, with satisfactory perioperative, oncological and functional outcomes.

We report the case of a 37-year-old male patient who presented renal failure secondary to a pelvic tumor. The diagnostic approach revealed a pubic-dependent tumor corresponding to a mesenchymal chondrosarcoma that conditioned obstructive uropathy as well as bladder and sigmoid compression. Mesenchymal chondrosarcomas are soft tissue dependent sarcomas with an extremely rare incidence, the clinical importance of our report is due to the fact that chondrosarcomas, must be considered in the differential diagnoses of obstructive uropathy due to their compressive effect on the urinary tract. We carry out a brief review of diagnostic approach, therapeutic options and prognosis of this pathology.

Description of the clinical case: A 16-year-old patient presented trauma with 48-hour evolution, after a fall from a moving bicycle, impacting on his left side against the pavement. The abdominal tomography revealed the presence of an expanding perirenal hematoma. An exploratory laparotomy was performed, observing hemoperitoneum and left renal hematoma, renal ileus injury with active bleeding, and expanding hematoma. It was decided to perform left nephrectomy. Relevance: Kidney trauma is the most common genitourinary injury. About 90% are blunt trauma. Clinical implications: Although most kidney traumas are limited and a rare cause of death, when they are not properly diagnosed and treated, they cause high morbidity due to late complications: arterial hypertension, hydronephrosis, traumatic pseudonephrosis, renal atrophy and renal lithiasis. Conclusion: Young patients are in greater risk of abdominal injuries.

Introduction: Radical prostatectomy is the treatment of choice for patients with organ-confined prostate cancer due to its oncological benefits and survival. With the advancement of technology, surgical techniques have been modified, and robot-assisted radical prostatectomy (RARP) is currently the procedure with the most advanced technology. Due to its multiple advantages, such as short-term functional and surgical results, shorter hospital stay and minimal invasiveness, it constitutes a valid therapeutic option to consider for this group of cancer patients. Objective: To compare the results obtained in urinary continence and erectile dysfunction after RARP with a standard da Vinci® system with 4 arms, between a group of 43 patients who underwent said procedure, without preservation of the endopelvic fascia in 2018, and 68 patients who underwent the same procedure with endopelvic fascia preservation, between January 2019 and February 2021, all at the Hospital Carlos Andrade Marín, in Quito. Methodology: A retrospective longitudinal descriptive observational study was made, with the comparison of 68 prostate cancer patients who underwent radical surgery with endopelvic fascia preservation at the Hospital Carlos Andrade Marín, between January 2019 and February 2021, and 43 patients who had the same surgery but without endopelvic preservation, in the year 2019. Results: One hundred eleven surgeries for prostate cancer with the robot-assisted radical prostatectomy technique were performed. Forty-three (37.8%) surgeries were made without endopelvic fascia preservation, and 68 (61.3%) were made with endopelvic fascia preservation. At the first month of follow-up, 25 (58%) patients of the RARP without endopelvic fascia preservation group, presented with severe erectile dysfunction, 11 (26%) with moderate erectile dysfunction, 6 (14%) with moderate to mild erectile dysfunction, and 1 (2%) with mild erectile dysfunction. At 6 months follow-up, of the 25 patients with severe dysfunction, 2 presented with moderate dysfunction and 23 remained with severe dysfunction. Of the patients who underwent RARP with endopelvic fascia preservation, 54 (80%) presented with mild incontinence, and 3 (4%) were completely continent making use of this technique. Furthermore, at 9 months follow-up, 90% of the patients had complete continence and 10% mild incontinence. Fifty six percent of the RARP patients with endopelvic fascia preservation presented severe sexual dysfunction at the first postoperative month. However, after pharmacological treatments, only 19% remained with erectile dysfunction. Conclusion: RARP is a safe and minimally invasive technique, it improves surgical and functional results, in the short and long terms, with respect to continence and sexual function. Endopelvic fascia preservation could improve results in the long term for continence and erectile dysfunction.

Objective:  To describe our experience using polymer clips (Hem-o-lok®) for renal vessel control in laparoscopic living donor nephrectomy (LLDN). Materials and methods: We conducted a retrospective and descriptive analysis from our database of all minimally invasive living donor nephrectomies (hand-assisted and pure laparoscopic) performed from 2008 to 2020 in our institution. We included patients who underwent LLDN using polymer clips (Hem-o-lok®) for vascular control of renal arteries and veins, and whose clinical records were complete. Results: 330 LLDN were performed, 183 (55.5%) were hand-assisted nephrectomies and 147 (44.5%) were pure laparoscopic nephrectomies. Mean warm ischemia time (WIT) was 3.98 minutes and median of estimated blood loss (EBL) was 100±140 ml. Four patients (1.2%) required conversion to an open procedure due to vascular injury. 31 complications (9.3%) were registered, of which 23 (6.9%) were non-life-threatening complications. No deaths nor loss of renal grafts were reported. Limitations: the main drawbacks of this study are its retrospective nature, and that it is limited to only one center. Originality and value: It is a study that questions the contraindication issued by the FDA for the use of polymer clips for vascular control in LLDN, demonstrating its use is a safe and effective option. Conclusion The use of polymer clips, specifically Hem-o-lok®, is a safe method for vascular control of the renal hilum vessels in laparoscopic living donor nephrectomies.