Sonda uretral flexível como método alternativo para aferição invasiva da pressão intracraniana em trauma cranioencefálico induzido em coelhos / Flexible urethral catheter as alternative method to invasive measurement of intracranial pressure in induced head trauma in rabbits

O objetivo deste estudo foi utilizar a sonda uretral flexível como método alternativo para aferição da pressão intracraniana em coelhos com trauma cranioencefálico induzido pelo cateter de Fogarty 4 Fr (balão epidural) e comparar os dados obtidos com o método convencional de cateter de ventriculostomia. Foram utilizados 12 coelhos, machos, adultos, distribuídos aleatoriamente em dois grupos, denominados de G1: mensuração da PIC com cateter de ventriculostomia (n=6) e G2: mensuração com sonda uretral (n=6). Foram realizadas duas craniotomias na região parietal direita e esquerda para a implantação do cateter de ventriculostomia ou sonda uretral flexível e o balão epidural, respectivamente. A PAM, a PPC, a FC, a FR e a TR foram mensurados antes e após a craniotomia. A PIC foi avaliada após a craniotomia e a cada 10 minutos depois do preenchimento do balonete com 0,3mL de NaCl 0,9%, durante 40 minutos, e com 0,6mL, pelo mesmo período de tempo, totalizando 80 minutos. A PIC aumentou em ambos os grupos, sendo menores os valores registrados com a sonda uretral flexível. Foi possível reproduzir o aumento da PIC com o modelo experimental de TCE utilizando o cateter de Fogarty 4 Fr na região epidural e, embora haja a necessidade de outros estudos, a sonda uretral flexível demonstra ser um método alternativo de mensuração da PIC em coelhos com trauma cranioencefálico.(AU)

The aim of this study was to evaluate the use of flexible urethral catheter as an alternative method for measuring intracranial pressure in rabbits with head trauma induced by 4 F Fogarty catheter (epidural balloon) and compare the data obtained with the conventional method of ventriculostomy catheter. In this study, New Zealand rabbits were randomly distributed into two groups, G1: measuring the ICP with ventriculostomy catheter (n=6) and G2: measuring the ICP with urethral catheter (n=6). Two craniotomies were performed in the right and left parietal region for the implantation of a ventriculostomy catheter and/or flexible urethral catheter and epidural 4 Fr Fogarty arterial embolectomy catheter, respectively. MAP, CPP, HR, RF and RT values were measured before and after of the craniotomy. The ICP value was measured after craniotomy, every five minutes during 40 minutes after the balloon was inflated with 0.3 ml with NaCl and further 40 minutes after the balloon was inflated with 0.6 ml. The ICP value increased in both groups; however, the ICP values were lower in the flexible urethral catheter. The flexible urethral catheter can be used as an alternative method to measure ICP values in rabbits with head injury.(AU)

[Results of one stage transanal resection of large bowel in hirschsprung's disease]

Hirschspnmg's disease is a developmental disorder of the enteric nervous system, characterized by functional obstruction. Absence of ganglion cells in the distal colon resulting in a functional obstruction. The aim of this study was to evaluate the results and complications of one-stage transanal endorectal pull-through [OTEPT] in the management of patients with Hirschsprung's disease. A total of 40 children [31 boys and 9 girls] aged 3 days to 60 months underwent OTEPT procedure over a period of two-years at Dr. Sheikh pediatric Hospital. This study was approved by the local committee of Medical Ethics. Median follow up period was 9.10 months [range, 3 to 33 months]. Mean operation time recorded 101.60 mins [range, 25 to 270 minutes]. Hirschsprung's disease developed conventional in 55% [short segment in 30%], Ultra-short in 32.5% and long segment in 12.5%. Mean length of resected bowel measured 17.31 cm, 2 patients underwent laparatomy because of extension of aganglionic segment beyond the sigmoid colon. Mean NPO time and need to rectal tube after the operation were 4.35 and 4.41 days, respectively. 8 patients required urinary catheters after the operation with the mean remaining time of 3.30 days, 20% needed ICU care after surgery and mean hospital stay was 5.76 days. Post-operative complications included entrocolitis [n=2] and abdominal distension [n=1]. One patient expired due to non surgical reason [heart failure]. OTEPT procedure is a safe method with low incidence of postoperative complications. In Hirschsprung's disease confined to the rectosigmoid region, the hazard and morbidities associated with laparatomy and colostomy are avoided with this technique

Interstitial laser coagulation for the treatment of benign prostatic hyperplasia: a 3 year-follow-up of 30 cases.

OBJECTIVE: To report the results and 3 year-follow-up of treatment of benign prostatic hyperplasia (BPH) using interstitial laser coagulation. MATERIAL AND METHOD: Thirty men with BPH underwent treatment with interstitial laser coagulation between December 1996 and April 1997. Their average age was 68 years old. All of them were assessed prior to the treatment and post treatment for symptoms score, uroflowmetry and postvoid residual urine. Any complication and consequence were evaluated at each follow-up visit. RESULTS: Up to 36 months follow-up, all parameters showed marked improvement. The symptom score decreased from 20 to 5. Peak flow rate increased from 4 ml/sec to 17 ml/sec. Residual urine decreased from 115 ml to 8 ml. No major complication was detected. Urethral catheter or intermittent catheterization were used for the mean of 9.1 days. All of the patients who were potent prior to the treatment remained potent and 75 per cent still had prograde ejaculation. No re-treatment was needed in the 3 year-follow-up. CONCLUSION: On the basis of these results, we propose that interstitial laser coagulation appears to be a minimally invasive treatment for BPH, with substantial improvement of both objective and subjective parameters.

Cateter uretral a permanencia: sus complicaciones / Indwelling uretheral catheter: complication

Se evaluan en el presente estudio un total de 65 pacientes a los que se le habían colocado catéteres uretrales doble "J" o pig-tail por patologías litiásicas o no. Se estudiaron sus indicaciones, control, seguimiento, sintomatología adversa, complicaciones y tratamiento. Consideramos que los catéteres doble "J" son eficaces en el posoperatorio de cirugías endourológicas, pueden ser usados como monoterapia en las litiasis obstructivas y son útiles en las uronefrosis por compresión de la vía excretora, pero que su permanencia prolongada favorece las complicaciones

Experiencia con la litotricia extracorporal por ondas de choque (LEOCH) en nuestros primeros 500 pacientes / Experience with extracorporeal shock wave lithotripsy (ECWL) in our first 500 patients

La litotricia extracorporal por ondas de choque (LEOCH) se ha convertido en el tratamiento preferido para la litiasis renal. Entre septiembre de 1990 y diciembre de 1991 se sometieron 500 pacientes con el litotríptor Piezolith 2300 de la casa Richard-Wolf, de los uales 251 eran mujeres y 249 varones. Se efetúan con mayor frecuencia entre el cuarto y el sexto decenios de la vida, con una proporción de 23 por ciento y 22 por ciento, respectivamente. De los 702 cálculos tratados, 337 (48 por ciento) fueron del riñón derecho y 365 (52 por ciento) del izquierdo. La pelvicilla es el sitio en que se alojan los cálculos com mayor frecuencia: 156 en la izquierda (22 por ciento) y 141 en la derecha (20 por ciento). Les siguen en frecuencia los cálices inferiores. Midieron menos de 2 cm 538 (76 por ciento) de los cálculos; se instalaron 118 (16.8 por ciento) catéteres ureterales en doble J como medida auxiliar antes y después de la, y solamente se quedaron 232 insitu. Se aplicaron en pomedio 7 662 disparos por paciente. La tasa de desintegración completa con buenos resultados fue de 36 por cieno (250 de 702 cálculos); 37.8 por ciento necesitaron una sola sesión y a 13.4 por ciento se les aplicaron cuatro o más sesiones; 65 por ciento cursaron con hematuria macroscópica post; 6.3 por ciento necesitaron analgésico parenteral. 4.6 por iento de los catéteres JJ mostraron estar calcificados en citas posteriors. Los pacientes operados después: refractarios al tratamiento, portadores de litos coraliformes y/o con catéteres JJ calcificados, presentaron proceso inflamatorio perirrenal, piélico y ureteral importante. Ninguno tuvo urosepsis ni hematoma subcapsular.

Experiencia con el cateter uretral (Pig Tail) / Experience in the urethral catheter (Pig Tail)

Se presenta la experiencia en el empleo del cáteter uretral "pig tail" en 14 pacientes portadores de uropatía obstructiva de diferente etiología (estenosis post sección quirúrgica del ureter, litiasis ureteral, estenosis por tuberculosis, metástasis retriperitoneal, etc.) que ha requerido la colocación del cáteter para lograr una derivación urinaria interna

Does indication sheet reduce unnecessary urethral catheterization?

The study on the effect of indication sheet on the decision of doctors in ordering urethral catheterization was done in thirteen hospitals randomly selected from all regions of Thailand. 16,959 patients in medical and surgical wards were included between April and May 1989. The rates of urethral catheterization did not change by the influence of indication sheet. However, urethral catheterization without proper indications was reduced from 27.0 per cent in the control group to 14.3 per cent in the experiment group. The indication sheet was accepted in 96.5 per cent of the occasions when doctors prescribed urethral catheterization. The indication sheet changed the doctors' decision and hence reversed the order in 3 events (0.8%). It is concluded that indication sheet was well accepted by doctors and could reduce urethral catheterization without proper indications.

Trasplante renal y vejiga neurogénica / Renal transplant and neurogenic bladder

Tres pacientes insuficientes renales terminales portadores de espina bífida y mielomeningocele consultaron en nuestro servicio por trasplante renal. En el primer caso la vejiga era utilizable pero el paciente presentaba una esclerosis importante del esfínter externo, motivando la realización de una esfinterotomía endoscópica. El trasplante renal fue efectuado en un paciente totalmente incontinente. Se utilizó en este paciente una prótesis enfinteriana AS 800. El examen urográfico efectuado 19 meses post-trasplante muestra a la urografía intravenosa una buena evacuación urinaria y la ausencia de repercusión sobre el tracto urinario superior. Dos pacientes presentaban una vejiga inutilizable en trasplante renal, el primer paciente presentaba al inicio del estudio una nefrectomía derecha y una derivación urinaria tipo conducto ileal, el segundo caso fue tratado mediante múltiples derivaciones externas; cistostomía nefrostomía bilateral y finalmente se efectuó una ileocistoplastía. La preparación al trasplante consistió en estos pacientes, en dejarlos anéficos, la remoción posterior del conducto ileal (pte. Nro. 2), la remoción de la ileocistopatía (pte. Nro. 3) y la realización del reservorio ileal continente según la técnica de Kock con algunas variantes. La evaluación efectuada a los 15 y 12 meses post-trasplante mostró una creatinina estable, una buena capacidad del reservorio, la ausencia de residuo post-evacuación, reflujo (-) y una urografía normal