Guidelines for Transrectal Ultrasonography-Guided Prostate Biopsy: Korean Society of Urogenital Radiology Consensus Statement for Patient Preparation, Standard Technique, and Biopsy-Related Pain Management

The Korean Society of Urogenital Radiology (KSUR) aimed to present a consensus statement for patient preparation, standard technique, and pain management in relation to transrectal ultrasound-guided prostate biopsy (TRUS-Bx) to reduce the variability in TRUS-Bx methodologies and suggest a nationwide guideline. The KSUR guideline development subcommittee constructed questionnaires assessing prebiopsy anticoagulation, the cleansing enema, antimicrobial prophylaxis, local anesthesia methods such as periprostatic neurovascular bundle block (PNB) or intrarectal lidocaine gel application (IRLA), opioid usage, and the number of biopsy cores and length and diameter of the biopsy needle. The survey was conducted using an Internet-based platform, and responses were solicited from the 90 members registered on the KSUR mailing list as of 2018. A comprehensive search of relevant literature from Medline database was conducted. The strength of each recommendation was graded on the basis of the level of evidence. Among the 90 registered members, 29 doctors (32.2%) responded to this online survey. Most KSUR members stopped anticoagulants (100%) and antiplatelets (76%) one week before the procedure. All respondents performed a cleansing enema before TRUS-Bx. Approximately 86% of respondents administered prophylactic antibiotics before TRUS-Bx. The most frequently used antibiotics were third-generation cephalosporins. PNB was the most widely used pain control method, followed by a combination of PNB plus IRLA. Opioids were rarely used (6.8%), and they were used only as an adjunctive pain management approach during TRUS-Bx. The KSUR members mainly chose the 12-core biopsy method (89.7%) and 18G 16-mm or 22-mm (96.5%) needles. The KSUR recommends the 12-core biopsy scheme with PNB with or without IRLA as the standard protocol for TRUS-Bx. Anticoagulants and antiplatelet agents should be discontinued at least 5 days prior to the procedure, and antibiotic prophylaxis is highly recommended to prevent infectious complications. Glycerin cleansing enemas and administration of opioid analogues before the procedure could be helpful in some situations. The choice of biopsy needle is dependent on the practitioners' situation and preferences.

A questão da psicanálise em Fabio Herrmann: crise em crise? / La cuestión del psicoanálisis en Fabio Herrmann: ¿crisis en crisis? / The question of psychoanalysis in Fabio Herrmann: crisis in Crisis?

O artigo expõe a ideia de Fabio Herrmann sobre a história da psicanálise como resistência à Psicanálise. Atribui a crise atual da Psicanálise à sua redução, depois de Freud, à clínica padrão de consultório, sustentada por uma teoria padrão.

El artículo expone la idea de Fabio Herrmann sobre la historia del psicoanálisis como resistencia al Psicoanálisis. Atribuye la actual crisis del Psicoanálisis a su reducción, después de Freud, a la clínica padrón de consultorio, la cual está soportada por una teoría padrón.

The paper deals with Fabio Herrmann’s idea on the history of psychoanalysis as resistance to Psychoanalysis. Herrmann attributes the contemporary crisis in Psychoanalysis to its reduction, after Freud, to the practice of a standard technique in the consulting room that is supported by a standard theory.

Heart Transplantation. A Retrospective Analysis of the Long-Term Results

Long-term results of orthotopic heart transplantation vary among different institutions. The purpose of the present study was to assess the factors, which might affect long-term survival and complications. Between November 1992 and July 2003, 112 heart transplantations (M/F=89: 23) were performed. The standard technique was used in the first 57 patients and the bicaval technique in the latter 55 patients. Indications for transplantation in decreasing order of frequency were dilated cardiomyopathy (75%), ischemic cardiomyopathy (7%), and others (18%). The mean follow up duration was 51.8 +/- 31.3 months with 98 patients remaining alive. Preoperatively, all patients were either in NYHA functional class III or IV. Postoperatively, all patients showed improvement to functional class II or I, except 3 patients that remained in NYHA class III. The mean number of rejection cases within the first year was 0.6 +/- 0.8, with humoral rejection noted in 3 cases. The graft vascular disease (GVD) -free survival at 3 and 5 years was 96% and 83%, respectively. The 7-year survival after heart transplantation was 84%. There were 16 deaths, of which infection (n=4) was the most common followed by rejection (n=3), and malignancy (n=2). The present long-term results, were relatively superior to those seen in western countries. The relatively low GVD-free survival rate is thought to have contributed. The complications encountered after transplantation were mostly immunosuppressive drug related, suggesting further potentials for improvement in long-term survival.

Heart Transplantation. A Retrospective Analysis of the Short and Intermediate Term Results / 대한구급학회지

BACKGROUND: Heart transplantation is still the best therapy for end-stage heart disease. However, the longterm outcome among different institutions vary. The current series is an assessment of the important factors which determine prognosis. METHODS: Between November of 1992 and September of 2000, 85 heart transplantations were performed at our institution. The standard technique was used in the first 57 patients (group I) where as in the latter 28 patients (group II), the Bicaval technique was utilized. The mean waiting time was approximately 4.7 months, and the causes in decreasing order were Dilated cardiomyopathy (n=69), Ischemic cardiomyopathy (n=10), Hypertrophic cardiomyopathy and others (n=6). The mean follow up was about 31 months. The immunosuppressive protocol comprised cyclosporin, Azathioprine (AZA), and prednisone. Later changes included induction with IL-2 receptor monoclonal antibody and changing AZA to mycophenolate mofetil. RESULTS: The mean donor ischemic time was 95.8 28.3 mins and the implantation time was 59.3 7.6 mins. There was a higher incidence of significant TR in group I along with a greater postoperative pacing requirement. There were 35 postoperative complications of which infectious events were most common (26). Of these, only 3 were early infections and the rest occurred late postoperatively. There were a total of 8 mortalities of which only one occurred early postoperatively and among the 7 late deaths, 3 were medically related and 4 were related to social factors. Only 5% of the patients had graft vascular disease. The overall 1YSR was 92% and the 5 YSR was 85%. CONCLUSIONS: The superior long term results of this current series was attributable to strong early immunosuppression, a homogenous population, and very low incidence of CMV infection.