Ovarian Leydig cells (OLC): A histomorphological and immunohistochemical study

Testicular Leydig cells (LC) regulate the proper development of male individuals, both during fetal life (fetal LC) and puberty (adult LC). In the ovaries of adult women, there are cells that are very similar to Leydig cells, the ovarian hilus cells (OHC), which also produce testosterone. The origin of these cells, in both sexes, remains unknown and is still a matter of debate. We have studied the location, characteristics and relationships of the OHC in 90 patients. The indications for oophorectomy were: metrorrhagia (n=9), prolapse (n=8), endometrial hyperplasia (n=14), cancer (endometrial, myometrial, or cervical) (n=35), uterine leiomyomata (n=14), and various ovarian tumors (cysts and benign tumors, borderline and malignant) (n=10). In addition to the hilus, occasionally the nodules, nests and clusters of OHC were located in the mesovarium, the mesosalpinx, and in the medullar and cortical regions of the ovaries. The morphological (including crystalloids of Reinke) and immunohistochemical (positivity for calretinin and alpha-inhibin) findings were similar to those described for testicular LC. Therefore, OHC can be considered ovarian Leydig cells (OLC). LC are usually found in small numbers in the ovaries, but if one looks for them intentionally, one always finds them. Close relationships were observed between the OLC with nerves and vessels. Moreover, an intraneural location of the OLC was demonstrated in all cases, and these intraneural cells showed similar characteristics to extraneural OLC, suggesting that they derive from endoneural cells which are present in the vegetative nerves of the ovaries.

Angiogenic imbalance and plasma lipid alterations in women with preeclampsia from a developing country

BACKGROUND

An imbalance between anti-angiogenic factors (e.g. soluble vascular endothelial growth factor receptor-1 (s-FLT1) and soluble endoglin (s-Eng)) and pro-angiogenic factors (e.g. placental growth factor (PlGF)) as well as increased oxidized low-density lipoprotein (ox-LDL) concentrations have been associated with preeclampsia (PE). Risk factors associated with the development of PE, however, are known to be different between developed and developing countries. The aim of the study was to determine the levels of s-FLT1, s-Eng, PIGF, and ox-LDL in women with PE from a developing country.

METHODS

A multi-center case-control study was conducted. One hundred and forty three women with PE were matched by age and parity with 143 healthy pregnant women without cardiovascular or endocrine diseases. Before delivery, blood samples were taken and serum was stored until analysis.

RESULTS

Women with PE had lower concentrations of PIGF (p<0.0001) and higher concentrations of s-Eng (p=0.001) than healthy pregnant women. There were no differences between the groups regarding ox-LDL or s-FLT1. Women with early onset PE had higher s-FLT1 concentrations (p=0.0004) and lower PIGF concentrations (p<0.0001) than their healthy pregnant controls. Women with late onset PE had higher concentrations of s-Eng (p=0.005). Women with severe PE had higher concentrations of s-Eng (p=0.0008) and ox-LDL (p=0.01), and lower concentrations of PIGF (p<0.0001).

CONCLUSIONS

Women with PE from a developing country demonstrated an angiogenic imbalance and an increased rate of LDL oxidation. Findings from this study support the theory that PE is a multifactorial disease, and understanding differences in these subpopulations may provide a better target to approach future therapies.

[Epithelioid hemangioendothelioma of penis]

A case of EH of the penis in a sixtyfour-year-old patient is described. This is a rare--in this location--vascular tumor of borderline malignant potential between hemangioma and angiosarcoma. Local excision of the tumor with a cut-off of normal tissue and careful follow-up of the patient is the accepted procedure. Immunohistochemistry is essential for the diagnosis.

[Fibroepithelial polyp of the urethra in an adult]

We present the case of a fibroepithelial polyp of the prostatic urethra in a forty-five year old patient. This type of polyp is rare in the adult. The principal symptoms which the patient presented were haematuria and an intermittent reduction in micturitional flow. Endoscopic images of the tumour are shown and certain details of its histology; this is a polypoid lesion of loose connective tissue covered by typical urothelium, with occasional fascicles of smooth muscle, no prostatic-type glandular structures and no appreciable inflammatory component.

Parallel-stranded hairpins containing 8-aminopurines. Novel efficient probes for triple-helix formation

We describe novel oligomers with a greater propensity to form triplexes than oligomers containing only natural bases. They consist of a polypyrimidine sequence linked head-to-head with a polypurine sequence carrying one or several 8-aminoadenine or 8-aminoguanines. The presence of 8-aminopurines also stabilised the parallel-stranded duplex structure.

[Genital wound caused by low-speed fire arm]

OBJECTIVE

To report a case of genital gunshot injuries and review the literature.

METHODS

A case of low velocity multiple gunshot penile injuries is described. Surgical exploration was performed, gunshot removed and the albuginea repaired. A broad spectrum antibiotic was administered prophylactically for infection.

RESULTS

Good cosmetic and functional results, including sexual potency and voiding, were achieved.

CONCLUSIONS

Surgical exploration is mandatory in genital gunshot injuries. The best approach to the albuginea is by a crown incision and denudation of the penile skin, which permits surgical repair with excellent cosmetic results.

[Fournier's gangrene after vasectomy]

OBJECTIVE

An uncommon case of Fournier's gangrene following vasectomy is described.

METHODS/RESULTS

A 35-year-old male with no remarkable previous history, who underwent vasectomy in another hospital, developed a clinical picture compatible with Fournier's gangrene 7-8 days later. The patient required wide, aggressive surgical debridement on several occasions with broad spectrum antibiotic coverage. After a long stay at the hospital, the patient was finally discharged and referred to another hospital for plastic surgery.

CONCLUSIONS

Fournier's gangrene is a polymicrobial infection of the perineoscrotal region that manifests as a rapidly progressive necrotizing fasciitis. Most of the cases have a predisposing and/or triggering factor. Fournier's gangrene following vasectomy is uncommon. The morbidity and mortality in this severe complication depend on early diagnosis and aggressive surgical management.

[Retroperitoneal mass secondary to Bellini carcinoma]

Bellini Collecting Duct carcinoma is a rare and aggresive histological variety of renal adenocarcinoma which originates from the epithelium of the collecting tubule, with a well established histological, cytogenetic and inmunohistochemic characterization. It allows us to differenciate this tumor type from the rest of renal adenocarcinomas. There are 7 cases already published in the national literature. We introduce a new case with a particularity that is to show an unusual presentation form. It appears clinically without a specific urological symptomatology and radiologically it present a retroperitoneal mass shape with explains the patient's clinical manifestations.

[The results of open surgery in the ureteropelvic junction syndrome]

OBJECTIVE

To evaluate the efficacy of the Anderson-Hynes pyeloplasty in 47 patients with pelviureteric junction syndrome and to compare our results with the reported results for open surgery and other techniques.

METHODS

The records of 47 patients (21 males, 26 females) with pelviureteric junction syndrome treated at the Marqués de Valdecilla University Hospital from 1979-1997 were reviewed. Twenty-eight patients had right-sided involvement and two were bilateral. Mean age at the time of surgery was 35 years. Pain was the most common presenting feature (nephric colic, 28 pts; chronic lumbar pain, 11 pts).

RESULTS

The Anderson-Hynes technique was performed in 43 of the 47 patients. IVP showed good results in 74.5%.

CONCLUSION

In our experience the success rate achieved with the Anderson-Hynes technique is comparable to those reported elsewhere, which ranges from 65%-100%. Although currently there is considerably less experience with endoscopic and laparoscopic techniques, the results achieved to data appear to be similar to those of open surgery.

[The association of pelvic injuries with urethral ruptures]

INTRODUCTION

Pelvic trauma is associated in a high rate of patients with posterior urethral injuries. Blood at the urethral meatus or the inability to void are suspicious of urethral damage, but their absence do not exclude it. The attempt to pass a urethral catheter can worse a previous injury.

METHOD

Retrospective study of 565 pelvic trauma along the last 5 years in the Hospital Valdecilla of Santander. We asses the urethral injury according Colapinto and McCallum classification and their relationship with the pelvic trauma, their outcome and diagnosis methodology.

RESULTS

There was 60 urethral injuries among 565 pelvic trauma (10.61%); 15 (25%) grade I were associated with trauma of the posterior ring of the pelvis; 17 (28.3%) grade II were associated in 12 cases with fractures of the anterior ring and in 5 cases with severe fractures of the posterior ring; 28 (46.66%) grade III were associated in 26 cases with fractures of the anterior ring and 2 fracture-luxation of the posterior one. Against the suggest of avoiding the attempt of passing a urethral catheter, nearly all patients had suffered and attempt before the urologist were asked for. The deferred combined urethrography was the best method of urethral evaluation.

Theoretical calculations, synthesis and base pairing properties of oligonucleotides containing 8-amino-2'-deoxyadenosine

Theoretical calculations on double and triple helices containing 8-amino-2'-deoxyadenosine were made to analyze the possible differences in base pairing properties between 8-aminoadenine and adenine. These calculations indicate a strong preferential stabilization of the triplex over the duplex when adenine is replaced by 8-aminoadenine. In addition, a protected phosphoramidite derivative of 8-amino-2'-deoxyadenosine was prepared for the introduction of 8-aminoadenine into synthetic oligonucleotides using the phosphite-triester approach. DNA triple helical structures are normally observed at acidic pH. However, when oligonucleotides carrying 8-aminoadenine are used, very stable triple helical structures can be observed even at neutral pH. Biological applications of triple helices could benefit from the use of 8-aminoadenine derivatives.

[Iatrogenic ureteral lesions in open surgery: review of 10 years]

OBJECTIVE

To carry out a revision of iatrogenic ureteral damage during open surgery occurred in our hospital over a 10-year period, to review the literature and to contrast the results.

MATERIAL AND METHOD

Between January 1987 and December 1996, 19 cases of iatrogenic ureteral damage were reported in 18 patients. Ureteral damage was the result of gynaecological surgery in 8 cases (42%), general surgery in 5 cases (26.5%), vascular surgery in 4 cases (21.1%) and urological surgery in 2 cases (10.5%). Four patients had been given radiotherapy. In 15 of the ureteral units involved, reconstructive open surgery was performed while the remaining 4 units received conservative therapy.

RESULTS

In 11 cases of open surgery the results were good, 2 cases are nephrostomy carriers and 2 underwent nephrectomy. Conservative treatment was resolutive in all instances.

CONCLUSIONS

Gynaecological and general surgery are the major causes of ureteral iatrogeny in our media. In more than half the cases, diagnosis is late. Radiotherapy was associated to late diagnosis in all cases. When diagnosed early, both surgical and conservative therapy achieve good results.

[Urethral diverticula in the male. Our experience over 10 years]

OBJECTIVE

To review our series of urethral diverticulum in the male, an uncommon condition whose etiology continues to be a subject of discussion. The clinical features, diagnostic methods and treatment are analyzed.

METHODS

A 10-year retrospective study was conducted at our hospital. The etiopathogenic factors, risk factors, presenting features, methods of diagnosis, treatment, postoperative and non-surgical complications (lithiasis, intradiverticular tumors...) were analyzed.

RESULTS

Only six cases of diverticulum of the male urethra were found and were mainly of acquired origin. Recurrent infection was the most common clinical presentation. Patients were evaluated by voiding and retrograde cystourethrography. All patients underwent surgery. Postoperative control evaluation was performed by cystourethrography. The surgical complication rate was low.

CONCLUSIONS

Diverticulum of the male urethra is an uncommon urological disease whose etiopathogenesis has as yet to be established, although it is accepted to be predominantly of acquired origin. Its clinical features are unspecific, for which reason it should be considered when making a diagnosis. Although transrectal ultrasound appears to be useful, diverticulum of the male urethra is usually diagnosed by conventional cystourethrography. Treatment is by endoscopic or open surgery, which achieves good results.

[Female urethral diverticula. Our experience over 10 years]

OBJECTIVE

To review our series of urethral diverticulum in the female, an uncommon condition whose etiology continues to be a subject of discussion. The etiopathogenic hypotheses are briefly reviewed. The clinical features, current diagnostic methods and treatment are analyzed.

METHODS

A 10-year retrospective study was conducted at our hospital. The risk factors, presenting features and postoperative complications were analyzed.

RESULTS

Only six cases of diverticulum of the female urethra were found. Recurrent infection and the presence of a palpable mass were the most common clinical features. Diagnosis was made by voiding and retrograde cystourethrography and urethroscopy. All patients underwent surgery. Postoperative control evaluation was performed by cystourethrography.

CONCLUSIONS

Diverticulum of the female urethra is an uncommon urological disease which should be taken into account when making a diagnosis. Its etiopathogenesis has as yet to be established, although it is accepted to be predominantly of acquired origin and related with paraurethral gland pathology. Its clinical features are unspecific or it may cause florid urinary symptoms. Our patients were diagnosed by cystourethrography, although other diagnostic imaging techniques are currently available. Treatment is by surgery, which achieves good results and the complication rate is low.

[Tethered cord syndrome in the adult]

OBJECTIVES

To describe a case of tethered cord syndrome, with special reference to the diagnostic and therapeutic difficulties.

METHODS

A case of an adult patient with tethered cord syndrome after the complications post-TURP is described. The most relevant radiological and urodynamic features are presented.

CONCLUSIONS

The tethered cord syndrome in the adult has a wide variety of symptoms. The age of onset depends on the level of cord involvement and the precipitationg factors. The urological symptoms are as varied as the urodynamic features, therefore each case must be treated independently. Treatment is a controversy; untethering offers little benefit to the patients. The incidence of the tethered cord syndrome in the adult may be higher than the reported incidence, particularly in patients with progressive and unexplained neurological, orthopedic or urological symptoms.

[Role of nitric oxide in warm ischemia of the transplanted kidney]

OBJECTIVE

Nitric oxide (NO) is a gas considered to have two roles: cytoprotective, derived from its vasodilating and anti-platelet aggregation effects, and cytotoxic, due to its free oxygen radical. It is produced by NO synthase; nitrites and nitrates are its end products. We investigated the role of NO in ischemia-perfusion injury.

METHODS

For the study, we utilized dogs weighing 15 to 25 kg. Autotransplantation of the left kidney and right nephrectomy were performed. Group I comprised 9 dogs submitted to renal autotransplantation; group II comprised 6 dogs submitted to renal autotransplantation after 24 h cold ischemia; group III comprised 6 dogs submitted to renal autotransplantation after 24 h cold ischemia and subsequent warm ischemia of 30 min; group IV comprised 9 dogs submitted to renal autotransplantation after 24 h cold ischemia and 60 min warm ischemia.

RESULTS

A significant fall in nitrite levels was observed in dogs that had some type of surgical injury. Nitrate levels increased significantly in dogs that had warm ischemia. At 30 min reperfusion, a significant increase in the production of constitutive enzyme was observed in all groups. A significant increase in inducible enzyme at 30 min reperfusion was observed in the first three groups and no inducible enzyme was produced in the group that had more injury from ischemia (group IV).

CONCLUSION

Nitrites are markers of the injury produced by surgery. Nitrates clearly express the injury to the organs caused by warm ischemia-reperfusion. The cNOS enzyme increases after surgery in response to surgical insult or stress. The iNOS enzyme increases in the kidneys that have suffered ischemia and are viable. Non-viable kidneys express no enzymatic activity (cNOS, iNOS).

[Incidental versus clinical renal adenocarcinoma: comparative study (1970-1994)]

A revision has been made of 286 renal adenocarcinoma treated in the Urology service at the Hospital marqués de Valdecilla, Santander, during the period from January 1970 through December 1994, dividing the study in two groups based on diagnosis being incidental or clinically suspected, and comparing the following parameters: 5-year intervals incidence, age, gender, intrarenal location, tumoral diameter, histology, nuclear grade, tumour stage and survival. The objective was to analyze the possible differences between renal cell neoplasias diagnosed based on clinical behaviour and those diagnosed incidentally over a 25 year period. Of the 286 renal adenocarcinomas, 217 (77.5%) were symptomatic at diagnosis, 63 (22.5% were found accidentally, while presentation in 6 cases is unknown. The percentage of incidental diagnosis increases gradually from 0% during the 1970-75 period to 44.2% from 1990 to 1994. No significant differences were found between incidental and clinical cases with regard to gender, age at presentation, affected side or intrarenal location of the tumours. The tumoral diameter of incidental cases was 6.74 +/- 3.31 cm, and 8.53 +/- 3.66 in the clinical ones, the difference being significant (p < 0.001). Nuclear grade is lower in incidental cases than in clinical ones, with a significant difference (p < 0.01). Asymptomatic tumours occur with higher proportion at low Robson stages, 60.3% stage I vs. 30.5% of symptomatic cases (p < 0.001). A comparison of survival shows the existence of significant differences (p < 0.001) between incidentalomas and clinical adenocarcinomas, the significance in this differences fading when both groups are compared based on the stage. Relative to suspected cases, incidental tumours present less size, lower nuclear grade, lower stage and better survival, all these differences being highly significant. No significant differences are seen in survival between incidentalomas and symptomatic ones when compared by stage at tumour presentation.