SWI Susceptibility Vessel Sign in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke.

BACKGROUND AND PURPOSE: The frequency and clinical significance of the susceptibility vessel sign in patients with acute ischemic stroke remains unclear. We aimed to assess its prevalence in patients with acute ischemic stroke undergoing mechanical thrombectomy and to analyze its association with interventional and clinical outcome parameters in that group. MATERIALS AND METHODS: Six hundred seventy-six patients with acute ischemic stroke and admission MR imaging were reviewed retrospectively. Of those, 577 met the eligibility criteria for further analysis. Imaging was performed using a 1.5T or 3T MR imaging scanner. Associations between baseline variables, interventional and clinical outcome parameters, and susceptibility vessel sign were determined with multivariable logistic regression models. Results are shown as adjusted ORs with 95% CIs. RESULTS: The susceptibility vessel sign was present in 87.5% (n = 505) of patients and associated with tandem occlusion (adjusted OR, 3.3; 95% CI, 1.1-10.0; P = .032) as well as successful reperfusion, defined as an expanded TICI score of ≥2b (adjusted OR, 2.4; 95% CI, 1.28-4.6; P = .007). The susceptibility vessel sign was independently associated with functional independence (mRS ≤ 2: adjusted OR, 2.1; 95% CI, 1.1-4.0; P = .028) and lower mortality (adjusted OR, 0.4; 95% CI, 0.2-0.7; P = .003) at 90 days, even after adjusting for successful reperfusion. The susceptibility vessel sign did not influence the number of passes performed during mechanical thrombectomy, the first-pass reperfusion, or the risk of peri- or postinterventional complications. CONCLUSIONS: The susceptibility vessel sign is an MR imaging phenomenon frequently observed in patients with acute ischemic stroke and is associated with successful reperfusion after mechanical thrombectomy. However, superior clinical functional outcome and lower mortality noted in patients showing the susceptibility vessel sign could not be entirely attributed to higher reperfusion rates.

Blood eosinophils, fraction of exhaled nitric oxide, and serum eosinophil cationic protein as surrogate markers for sputum eosinophils in asthma: influence of treatment with inhaled corticosteroids

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Liver cirrhosis reversion is improved in hamsters with a neurointermediate pituitary lobectomy.

Regulating mechanisms of fibrosis is an important goal in the treatment of fibrosis and liver cirrhosis. The role of arginine vasopressin (AVP) in promoting fibrosis in several organs has been well documented. However, the result of an AVP deficiency during liver fibrosis has not been reported. We herein study the effects of an AVP deficiency, which was induced by neurointermediate pituitary lobectomy (NIL), on liver cirrhosis and liver cirrhosis reversion. Hamsters were intact (control) or underwent CCl4-induced cirrhosis, the latter animals divided into four groups: Cirrhotic, NIL-cirrhotic, Cirrhotic-reversion (R) and NIL-cirrhotic-R. Liver function, liver histopathology (including the fibrosis area and collagen types) and liver expression of MMP-13 and TIMP-2 were assessed. Results show that the AVP deficiency decreased the levels of alkaline phosphatase in serum and the expression of type I collagen and TIMP-2, and increased type III collagen deposition, MMP-13 expression and the size of regeneration nodules in NIL-cirrhotic and NIL-cirrhotic-R animals. A significantly greater recovery was found in the NIL-cirrhotic-R than the Cirrhotic-R group. We conclude that an AVP deficiency participates importantly in hamster liver regeneration by: 1) prompting the fibroblasts to produce type III collagen deposit, 2) influencing the activity of AP from bile duct cells, and 3) inhibiting TIMP-2 expression while favoring the fibrolytic activity of MMP-13.

Práctica actual de la ureteronefroscopia flexible con láser en América Latina para el tratamiento de la litiasis renal / Current practice in Latin America of flexible ureterorenoscopy with laser for treating kidney stones

Introducción: Actualmente se ha incrementado la ureteronefroscopia flexible para el tratamiento de cálculos renales, existiendo gran variación en la técnica quirúrgica e indicaciones a través de todo el mundo. Objetivos: Conocer la práctica actual, variaciones en la técnica, uso e indicaciones de la ureteronefroscopia flexible para tratamiento de cálculos renales en Latinoamérica. Métodos: Enviamos un cuestionario anónimo de 30 preguntas sobre ureteronefroscopia flexible para el tratamiento de cálculos renales, vía correo electrónico y enlace Web a urólogos de Latinoamérica de enero de 2015 a julio de 2015. Recolectamos las respuestas a través del sistema Survey Monkey. Resultados: Participaron 283 urólogos de 15 países latinoamericanos (tasa de respuesta del 10,8%); 254 contestaron completamente el cuestionario; 52,8% son urólogos de México y 11% de Argentina, 11,8% realizan > 100 casos por año, 15,2% consideran la ureteronefroscopia como tratamiento de elección para cálculos > 2 cm y 19,6% realiza ureteronefroscopia en etapas solo para cálculos > 2,5 cm. El 78,4% utiliza fluoroscopia, el 69,1% utiliza camisa ureteral en todos sus casos, el 55,8% deja el catéter doble J al final de la cirugía, el 37,3% considera estado libre de lito con 0 fragmentos y el 41,2% utiliza radiografía simple para evaluar el estado libre de cálculos. Conclusiones: La mayoría de urólogos participantes considera la ureteronefroscopia flexible como el tratamiento de primera elección para cálculos < 2 cm, un pequeño porcentaje realiza > 100 ureteronefroscopias por año. Más de la mitad utiliza fluoroscopia y camisa de acceso ureteral rutinariamente, el método más frecuente para la evaluación del estado libre de cálculos es la radiografía simple de abdomen

Introduction: The use of flexible ureterorenoscopy for treating kidney stones has increased in recent years, with considerable worldwide variation in the surgical technique and indications. Objectives: To determine the current practice, technique variations, use and indications of flexible ureterorenoscopy for treating kidney stones in Latin American. Methods: We sent (by email and web link) an anonymous questionnaire with 30 questions on flexible ureterorenoscopy for treating kidney stones to Latin American urologists from January 2015 to July 2015. We collected the responses through the Survey Monkey system. Results: A total of 283 urologists in 15 Latin American countries participated (response rate, 10.8%); 254 answered the questionnaire completely; 52.8% were urologists from Mexico and 11% were from Argentina; 11.8% of the responders stated that they performed > 100 cases per year; 15.2% considered ureterorenoscopy as the treatment of choice for stones > 2 cm, and 19.6% performed ureterorenoscopy in single stages for calculi measuring > 2.5 cm. Some 78.4% use fluoroscopy, 69.1% use a ureteral sheath in all cases, 55.8% place double-J catheters at the end of surgery, 37.3% considered a stone-free state to be 0 fragments, and 41.2% use plain radiography to assess the stone-free condition. Conclusions: Most participating urologists consider flexible ureterorenoscopy as the first-choice treatment for stones < 2 cm; a small percentage of these urologists perform > 100 ureterorenoscopies per year. More than half of the urologists routinely used fluoroscopy and ureteral access sheath; the most common method for determining the stone-free state is plain abdominal radiography

Current practice in Latin America of flexible ureterorenoscopy with laser for treating kidney stones. / Práctica actual de la ureteronefroscopia flexible con láser en América Latina para el tratamiento de la litiasis renal.

INTRODUCTION: The use of flexible ureterorenoscopy for treating kidney stones has increased in recent years, with considerable worldwide variation in the surgical technique and indications. OBJECTIVES: To determine the current practice, technique variations, use and indications of flexible ureterorenoscopy for treating kidney stones in Latin American. METHODS: We sent (by email and web link) an anonymous questionnaire with 30 questions on flexible ureterorenoscopy for treating kidney stones to Latin American urologists from January 2015 to July 2015. We collected the responses through the Survey Monkey system. RESULTS: A total of 283 urologists in 15 Latin American countries participated (response rate, 10.8%); 254 answered the questionnaire completely; 52.8% were urologists from Mexico and 11% were from Argentina; 11.8% of the responders stated that they performed >100 cases per year; 15.2% considered ureterorenoscopy as the treatment of choice for stones >2cm, and 19.6% performed ureterorenoscopy in single stages for calculi measuring >2.5cm. Some 78.4% use fluoroscopy, 69.1% use a ureteral sheath in all cases, 55.8% place double-J catheters at the end of surgery, 37.3% considered a stone-free state to be 0 fragments, and 41.2% use plain radiography to assess the stone-free condition. CONCLUSIONS: Most participating urologists consider flexible ureterorenoscopy as the first-choice treatment for stones <2cm; a small percentage of these urologists perform >100 ureterorenoscopies per year. More than half of the urologists routinely used fluoroscopy and ureteral access sheath; the most common method for determining the stone-free state is plain abdominal radiography.

Spirometric and exhaled nitric oxide reference values in preschool children from the community of Navarra.

BACKGROUND AND OBJECTIVE: Preschool children can perform quality, reproducible spirometric maneuvers, provided appropriate equipment is used and specially trained nursing staff training are available. However, use of spirometry for the diagnosis and follow-up of preschool children with respiratory diseases remains limited in clinical practice, because consensus on test quality and acceptability criteria and reference data are lacking. We initiated the present study with the aim of developing reference equations, since tables of normal values for this age group are not available in our area. PATIENTS AND METHODS: The study population comprised healthy preschool children in our community. Normal values for exhaled nitric oxide in this age range were assessed. Regression equations were constructed using univariate and multivariate models. RESULTS: A total of 114 healthy preschool children aged 3 to 6 years were enrolled. According to the criteria of the American Thoracic Society/European Respiratory Society, 60 children were able to perform acceptable and reproducible spirometric maneuvers. The best correlations were observed for the untransformed linear regression model that included height. The correlation coefficients for forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV0.5 were 0.89, 0.88, and 0.86, respectively. The regression equations for the calculation of reference values were as follows: FVC = -2.6 + 0.036 x height, cm FEV1 = -2.04 + 0.029 x height, cm FEV0.5 = -1.53 + 0.022 x height, cm. We obtained fraction of inhaled nitric oxygen (FeNO) values for 56 children. The mean (SD) value was 11 (4.9) ppb. CONCLUSIONS: Most preschool children in our area were able to perform quality spirometry maneuvers. We obtained regression equations that allowed us to calculate the reference ranges in our population and the distribution of normal FeNO values.

Spirometric and exhaled nitric oxide reference values in preschool children from the Community of Navarra

Background and Objective: Preschool children can perform quality, reproducible spirometric maneuvers, provided appropriate equipment is used and specially trained nursing staff training are available. However, use of spirometry for the diagnosis and follow-up of preschool children with respiratory diseases remains limited in clinical practice, because consensus on test quality and acceptability criteria and reference data are lacking. We initiated the present study with the aim of developing reference equations, since tables of normal values for this age group are not available in our area. Patients and Methods: The study population comprised healthy preschool children in our community. Normal values for exhaled nitric oxide in this age range were assessed. Regression equations were constructed using univariate and multivariate models. Results: A total of 114 healthy preschool children aged 3 to 6 years were enrolled. According to the criteria of the American Thoracic Society/ European Respiratory Society, 60 children were able to perform acceptable and reproducible spirometric maneuvers. The best correlations were observed for the untransformed linear regression model that included height. The correlation coefficients for forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1 ), and FEV 0.5 were 0.89, 0.88, and 0.86, respectively. The regression equations for the calculation of reference values were as follows: FVC = -2.6 + 0.036 x height, cm FEV 1 = -2.04 + 0.029 x height, cm FEV 0.5 = -1.53 + 0.022 x height, cm We obtained fraction of inhaled nitric oxygen (FeNO) values for 56 children. The mean (SD) value was 11 (4.9) ppb. Conclusions: Most preschool children in our area were able to perform quality spirometry maneuvers. We obtained regression equations that allowed us to calculate the reference ranges in our population and the distribution of normal FeNO values (AU)

Antecedentes: Los niños preescolares pueden realizar maniobras espirométricas de calidad y reproducible, siempre y cuando se utilice un equipamiento adecuado y se disponga de personal de enfermería con entrenamiento específico para ello. Sin embargo su uso clínico en este rango de edad tanto en diagnóstico como en seguimiento de pacientes con enfermedades respiratorias sigue siendo muy escaso, por diversas razones. Entre otras se encuentran la falta de un consenso en los criterios de calidad y aceptabilidad de la prueba la escasez de datos de referencia. Objetivo y métodos: Debido a que no se disponía de tablas de valores normales para este rango de edad en nuestra área, se inició este estudio con el fin de obtener ecuaciones de referencia provenientes de una población de niños preescolares sanos de nuestra comunidad, aprovechando el esfuerzo para obtener también valores de normalidad de óxido nítrico en aire exhalado en este rango de edad. Para la obtención de las ecuaciones de regresión se utilizaron modelos uni y multivariantes. Resultados: Se incluyeron un total de 114 niños preescolares sanos con edades comprendidas entre los 3 y los 6 años. De ellos 60 fueron capaces de realizar maniobras espirométricas aceptables y reproducibles, de acuerdo a los criterios ATS/ERS. El modelo de regresión lineal no transformado que incluía la altura, obtuvo las mejores correlaciones. La introducción de otras variables no mejoraba significativamente los resultados. Los coeficientes de correlación para FVC, FEV 1 and FEV 0,5 fueron 0.89, 0.88 y 0.86 respectivamente. Las ecuaciones de regresión para el cálculo de los valores de referencia fueron: FEVC= -2,6+0,036*altura (cm) FEV 1 = -2.04 + 0.029*altura (cm) FEV 0,5 = -1,53+ 0,022*altura (cm) El cociente FEV 1 /FVC disminuía con la edad y la altura, si bien los resultados de los distintos modelos eran pobres y no permitían el uso de las ecuaciones de regresión para el cálculo de valores de referencia. Obtuvimos valores de FeNO en 56 niños. El valor medio fue 11 ppb (SD 4,9) con un rango entre 5 y 18 ppb. Conclusiones: La mayoría de los preescolares de nuestra área pudieron realizar espirometrías de calidad. Se han obtenido ecuaciones de regresión que nos permiten calcular los rangos de referencia en nuestra población y también la distribución de los valores normales de FeNO (AU)

Pieloplastia laparoscópica: técnica y resultados en 80 procedimientos consecutivos / Laparoscopic Pyeloplasty: Technique and Results in 80 Consecutive Patients

Objetivo: Presentar nuestros resultados a largo plazo con la técnica de pieloplastia laparoscópica de Anderson-Hynes realizada por un solo cirujano. Material y métodos: Entre agosto de 1999 y diciembre de 2009 se operaron 79 pacientes (80 cirugías) por estenosis pieloureteral primaria. Se utilizó la técnica de Anderson-Hynes por vía transperitoneal. Los pacientes fueron evaluados con ultrasonido, urografía excretora y centelleograma renal dinámico (Mag-3). Se realizó un análisis prospectivo de la serie, revisando las características perioperatorias, complicaciones y resultados. Resultados: Se realizaron 80 pieloplastias laparoscópicas en 79 pacientes. El tiempo operatorio promedio fue de 93,2 min (60-180). En 38 de 82 (46,3%) unidades renales se encontró como hallazgo vasos polares en proximidad a la unión pieloureteral. Anomalías renales hubo en 4 pacientes (un doble sistema pieloureteral, un uréter retrocavo asociado, un riñón en herradura y un riñón pélvico). Ocurrieron complicaciones en 5 oportunidades (6,5%): sangrado postoperatorio inmediato que se manejó por vía laparoscópica (Clavien 3b), un vólvulo de ciego en el cual se realizó una hemicolectomía derecha con buena evolución postoperatoria (Clavien 3b), una sepsis urinaria (Clavien 4a) y una fístula urinaria de manejo médico (Clavien 3a). No hubo mortalidad en la serie ni conversión a cirugía abierta. Hubo recurrencia en 3 de 80 pieloplastias laparoscópicas (3,7%), las cuales fueron resueltas de la siguiente forma: endopielotomía percutánea en un caso, pieloplastia laparoscópica en un caso y pieloplastia robótica en otro caso. La tasa global de éxito primario fue de 96,3%. Conclusiones: Nuestros resultados con la pieloplastia laparoscópica transperitoneal se comparan favorablemente con aquellos logrados por la cirugía abierta. Creemos que la pieloplastia laparoscópica es una alternativa segura para el manejo de la obstrucción de la unión pieloureteral primaria

Objective: To present our long-term results with the Anderson-Hynes laparoscopic pyeloplasty, performed by a single surgeon. Materials and methods: Between August 1999 and December 2009, 79 patients (80 procedures) were operated for primary ureteropelvic junction obstruction. We use the Anderson-Hynes technique by a transperitoneal approach. Patients were evaluated with Ultrasound, Excretory urography and dynamic renal scintigraphy (Mag-3). The perioperative characteristics, complications and results were reviewed. Results: We performed 80 laparoscopic pyeloplasties in 79 patients. Mean operative time was 93.2 min (60-180). Crossing vessels were found in 38 of 82 (46.3%) renal units. Kidney abnormalities occurred in 4 patients (1 double ureteropelvic system, one associated retrocaval ureter, 1 horseshoe kidney and one pelvic kidney). Complications occurred in 5 procedures (6.5%): an immediately postoperative bleeding (Clavien 3b), 1 cecal volvulus (Clavien 3b), 1 urosepsis (Clavien 4th) and 1 urinary fistula (Clavien 3a). In this series there was neither mortality nor conversion to open surgery. There was recurrence in 3 out of 80 patients (3.7%). They were resolved as follows: 1 percutaneous antegrade endopyelotomy, 1 secondary laparoscopic pyeloplasty and 1 robotic pyeloplasty. There was a 96.3% of primary overall success rate. Conclusions: Our results show that laparoscopic pyeloplasty compares favorably with the result achieved by open surgery. We believe that laparoscopic pyeloplasty is a good surgical alternative for the management of primary ureteropelvic junction obstruction

Nefrectomía parcial laparoscópica: experiencia en 227 casos consecutivos / Laparoscopic partial nephrectomy: An experience in 227 cases

Objetivo: Analizar nuestra experiencia a largo plazo con la técnica de nefrectomía parcial laparoscópica (NPL) y revisar la literatura. Material y métodos: Entre junio de 1995 y junio de 2010 se efectuaron 227 nefrectomías parciales laparoscópicas. Los datos fueron registrados en forma prospectiva y se realizó una revisión retrospectiva de los datos demográficos y quirúrgicos, complicaciones perioperatorias, estancia hospitalaria, tasa de márgenes positivos y de recurrencia, y hallazgos histopatológicos. Resultados: La edad promedio fue de 56,4 años (18-87). El sangrado intraoperatorio promedio fue de 250 ml (10-1.800). El tiempo operatorio medio fue de 108,42 min (30-240) y la mediana de tiempo de isquemia caliente fue de 25 min (10-60). La tasa de complicaciones intraoperatorias fue de 2,64% (6/227), de las cuales 5 (2,2%) fueron por sangrado. La tasa de complicación postoperatoria fue de 5,72% (13/227), siendo también el sangrado la más frecuente en un 3% (7/227) de los casos. Según la clasificación de Clavien, el 1,32% (3/227), el 0,88% (2/227) y el 3,52% (8/227) fueron grado i , ii y iii b, respectivamente. La estancia hospitalaria media fue de 3,66 días (1-12). El carcinoma de células renales fue el hallazgo histopatológico más frecuente en el 74,6% (150 pacientes), presentando estadios clínicos T1a, T1b y T2 en el 90,74% (206/227), el 7,48% (17/227) y el 1,76% (4/227), respectivamente. No hubo conversión ni mortalidad relacionada con la cirugía. Hubo margen quirúrgico positivo en 4 pacientes (2,7%), sin recurrencia a largo plazo. En un seguimiento promedio de 27 meses hubo solo un caso de metástasis en los puertos y carcinomatosis peritoneal. Conclusión: La NPL es una alternativa segura y viable a la nefrectomía parcial abierta, entregando resultados oncológicos equivalentes y una morbilidad comparable a la cirugía tradicional en centros con experiencia

Objective: To evaluate our long-term experience with laparoscopic partial nephrectomy (LPN) and to review the literature. Material and methods: We performed a retrospective chart review, evaluating 227 consecutives laparoscopic partial nephrectomies performed between June 1995 and June 2010. Perioperative data were recorded along with clinical a oncological outcomes. Results: Mean age was 56.4 years (18-87) and clinical stages were T1a, T1b and T2 in 90.74% (206/227), 7.48% (17/227) and 1.76% (4/227), respectively. Median blood loss was 250 ml (10-1800). The mean operative time was 108.42 min (30-240) and median warm ischemia time was 25 min (10-60). The intraoperative complication rate was 2.64% (6/227), 5 (2.2%) secondary to bleeding. The postoperative complication rate was 5.72% (13/227) and bleeding is also the most frequent in 3% (7/227) of the cases. According to the Clavien classification, 1.32% (3/227), 0.88% (2/227) and 3.52% (8/227) were grade I, II and III b, respectively. The mean hospital stay was 3.66 days (1-12). Clear cell carcinoma was the most common histological finding in 74.6% (150 patients). TNM classification was T1a, T1b and T2 in 90.74% (206/227), 7.48% (17/227) and 1.76% (4/227), respectively. No conversion or mortality was reported. Positive surgical margins were found in 4 patients (2.7%), with no local recurrence after long-term follow-up. At a mean follow up of 27 months, one patient had port site and peritoneal recurrence. Conclusion: Laparoscopic partial nephrectomy is a safe and viable alternative to open partial nephrectomy, providing equivalent oncologic outcomes and comparable morbidity to the traditional approach in experienced centers

Laparoscopic partial nephrectomy: An experience in 227 cases.

OBJECTIVE: To evaluate our long-term experience with laparoscopic partial nephrectomy (LPN) and to review the literature. MATERIAL AND METHODS: We performed a retrospective chart review, evaluating 227 consecutives laparoscopic partial nephrectomies performed between June 1995 and June 2010. Perioperative were recorded along with clinical a oncological outcomes. RESULTS: Mean age was 56.4 years (18-87) and clinical stages were T1a, T1b and T2 in 90.74% (206/227), 7.48% (17/227) and 1.76% (4/227), respectively. Median blood loss was 250 mL (10-1800). The mean operative time was 108.42 minutes (30-240) and median warm ischemia time was 25 minutes (10-60). The intraoperative complication rate was 2.64% (6/227), 5 (2.2%) secondary to bleeding. The postoperative complication rate was 5.72% (13/227) and bleeding is also the most frequent in 3% (7/227) of the cases. According to the Clavien classification, 1.32% (3/227), 0.88% (2/227) and 3.52% (8/227) were grade I, II and IIIb, respectively. The mean hospital stay was 3.66 days (1-12). Clear cell carcinoma was the most common histological finding in 74.6% (150 patients). TNM clasification was T1a, T1b y T2 in 90.74% (206/227), 7.48% (17/227) and 1,76% (4/227), respectively. No conversion or mortality was reported. Positive surgical margins were found in 4 patients (2.7%), with no local recurrence after long-term follow-up. At a mean follow up of 27 months, one patient had port site and peritoneal recurrence. CONCLUSION: Laparoscopic partial nephrectomy is a safe and viable alternative to open partial nephrectomy, providing equivalent oncologic outcomes and comparable morbidity to the traditional approach in experienced centers.

Laparoscopic pyeloplasty: technique and results in 80 consecutive patients.

OBJECTIVE: To present our long-term results with the Anderson-Hynes laparoscopic pyeloplasty, performed by a single surgeon. MATERIAL AND METHODS: Between August 1999 and December 2009, 79 patients (80 procedures) were operated for primary ureteropelvic junction obstruction. We use the Anderson-Hynes technique by a transperitoneal approach. Patients were evaluated with Ultrasound, Excretory urography and dynamic renal scintigraphy (Mag-3). The perioperative characteristics, complications and results were reviewed. RESULTS: We performed 80 laparoscopic pyeloplasties in 79 patients. Mean operative time was 93.2 minutes (60-180). Crossing vessels were found in 38 of 82 (46.3%) renal units. Kidney abnormalities occurred in 4 patients (1 double ureteropelvic system, one associated retrocaval ureter, 1 horseshoe kidney and one pelvic kidney). Complications occurred in 5 procedures (6.5%): an immediately postoperative bleeding (Clavien 3b), 1 cecal volvulus (Clavien 3b), 1 urosepsis (Clavien 4th) and 1 urinary fistula (Clavien 3a). In this series there was neither mortality nor conversion to open surgery There was recurrence in 3 out of 80 patients (3.7%). They were resolved as follows: 1 percutaneous antegrade endopyelotomy, 1 secondary laparoscopic pyeloplasty and 1 robotic pyeloplasty. There was a 96.3%. of primary overall success rate. CONCLUSIONS: Our results show that laparoscopic pyeloplasty compares favorably with the result achieved by open surgery. We believe that laparoscopic pyeloplasty is a good surgical alternative for the management of primary ureteropelvic junction obstruction.

Nefrectomía parcial robótica con compresión selectiva del parénquima (pinza de Simon) / Robotic Partial Nephrectomy With Selective Parenchymal Compression (Simon Clamp)

Objetivo: Presentar nuestra experiencia inicial en nefrectomía parcial robótica (NPR) realizando compresión selectiva del parénquima renal, sin pinzamiento del hilio renal. Material y métodos: Se realizó NPR utilizando el sistema robótico da Vinci S HD con abordaje transperitoneal y compresión selectiva del parénquima renal a 4 pacientes con masa tumoral exofítica de localización polar. Se utilizó la pinza de Simon laparoscópica (Simon's clamp Aesculap®) sin control vascular del hilio renal. La reconstrucción renal fue la utilizada regularmente. Resultados: La edad promedio fue de 49,6 años (42-59) con una relación hombre/mujer 3:1. El tiempo operatorio promedio fue de 71,6 min (40-120). El sangrado estimado promedio fue de 250 ml (50-400). El tamaño tumoral promedio fue de 3,25 cm (1,5-5,3). No hubo complicaciones perioperatorias ni postoperatorias. La estancia media hospitalaria fue de 3,5 días (1-7). No hubo complicaciones hemorrágicas intra ni postoperatorias. El examen patológico de las lesiones reveló carcinoma renal en 3 casos y quiste hemorrágico en un caso. No hubo márgenes quirúrgicos positivos. Conclusiones: Nuestros resultados preliminares muestran que la NPR con compresión regional del parénquima renal es una alternativa quirúrgica factible en pacientes seleccionados y tumores de localización polar, proporcionando un campo quirúrgico adecuado para la resección tumoral (AU)

Objective: To present our initial experience using selective renal parenchymal ischemia, without hilar clamping, in robotic-assisted partial nephrectomy. Material and methods: In four patients with T1a renal tumor we performed robotic-assisted partial nephrectomy, using the Simon's clamp (Aesculap®). It provides selective parenchymal compression without the need of vascular clamping. All patients had exofitic renal tumors in polar location. Renal parenchymal reconstruction was done as the standard technique. Results: The median age was 49.6 years (42-59), 3 male and 1 female patient. Median operative time was 71,6 minutes (40-120). Mean stimated bleeding was 250 ml (50-400). Average tumor size was 3,25 cm (1,5-5,3). There were no complications and the average hospital stay was 3,5 days (1-7). The pathology was informed as renal cell carcinoma in three patients and one hemorrhagic cyst. The surgical margins were negative. Conclusion: Our preliminary results shows that selective renal parenchymal compression, with the Simon's clamp, provides an alternative to vascular control in selected patients with polar renal tumors (AU)

Robotic partial nephrectomy with selective parenchymal compression (Simon clamp).

OBJECTIVE: To present our initial experience using selective renal parenchymal ischemia, without hilar clamping, in robotic-assisted partial nephrectomy. MATERIAL AND METHODS: In four patients with T1a renal tumor we performed robotic-assisted partial nephrectomy, using the Simon's clamp (Aesculap). It provides selective parenchymal compression without the need of vascular clamping. All patients had exofitic renal tumors in polar location. Renal parenchymal reconstruction was done as the standard technique. RESULTS: The median age was 49.6 years (42-59), 3 male and 1 female patient. Median operative time was 71,6 minutes (40-120). Mean stimated bleeding was 250 ml (50-400). Average tumor size was 3,25 cm (1,5-5,3). There were no complications and the average hospital stay was 3,5 days (1-7). The pathology was informed as renal cell carcinoma in three patients and one hemorrhagic cyst. The surgical margins were negative. CONCLUSION: Our preliminary results shows that selective renal parenchymal compression, with the Simon's clamp, provides an alternative to vascular control in selected patients with polar renal tumors.

Síndromes mas frecuentes asociadosa a retinosis pigmentaria en Cuba / Most frequent syndromes asocciated to retinitis pigmentosa in Cuba

Propósito: Determinar los Síndromes más frecuentes Asociados a Retinosis Pigmentaria en Cuba y señalar algunas de sus características oftalmológicas. Método: Se caracterizaron clínicamente y clasificaron 245 enfermos de RP que compartiendo su cuadro oftalmológico conformaban síndromes complejos asociados. Se estimó su prevalencia y forma de progresión basados en análisis del campo visual y de la agudeza visual, así como también se correlacionaron estos últimos con los hallazgos del examen físico oftalmológico. Resultados: La prevalencia de RP asociada en Cuba fue de un 9,2 por ciento entre la población de enfermos de RP. Predominó la herencia autosómica recesiva en un 72,5 por ciento entre la población de enfermos de RP. Predominó la herencia autosómica recesiva en un 72,6 por ciento de los casos. Los Síndromes de Usher y Bardet-Biedl fueron los más frecuentes con un 64,1 por ciento y 13,9 por ciento, respectivamente. Otros Síndromes encontrados fueron el Kearns Sayre (2,4 por ciento), Strumpell Loraine (2 por ciento), el Rud, Refsum, Marphan y otras degeneraciones del sistema nervioso central que se encontraron en un 17,6 por ciento. Analizados en conjunto, el cuadro de RP sin pigmento se encontró en un 8,9 por ciento. Distintos grados de compromiso macular se determinaron en un 54 por ciento, predominando el edema cistoide y la atrofia epitelial. En un 69,4 por ciento el debut de la enfermedad fue precoz, entre 5 a 10 años de edad y un 75 por ciento de los enfermos estudiados se encontraban en un estadio final de la enfermedad. Conclusiones: La frecuencia de presentación de la RP Asociada en Cuba es ligeramente superior a la reportada en la literatura, así como precoz fue el debut de los síntomas, lo que se debe a la labor de pesquisaje

Comparison of Inoue single-balloon versus double-balloon technique for percutaneous mitral valvotomy.

The results of percutaneous mitral valvotomy by means of the Inoue single-balloon (N = 85, group 1) and the double-balloon (N = 322, group 2) techniques were compared in a nonrandomized study. The groups were not significantly different with regard to age, sex, calcification, or hemodynamic values before percutaneous mitral valvotomy. After percutaneous mitral valvotomy, patients in both groups had significant hemodynamic and clinical improvement. The increases in mitral valve area and cardiac output and the decreases in mitral valve gradient, mean pulmonary artery pressure, and mean left atrial pressure were greater in group 2. Mitral valve area determined by the Gorlin method increased 191% in group 2 and 106% in group 1; Doppler-determined mitral valve area increased 133% in group 2 and 98% in group 1. Optimal results were achieved in 93% of the patients in group 2 and 76% in group 1 (p less than or equal to 0.0001). In group 1, 6% of patients had a left-to-right shunt as shown by angiography versus 14% in group 2 (p less than or equal to 0.05). In group 2, 46% of patients had at least a 1+ increase in mitral regurgitation versus 52% in group 1. Among the patients who had an increase in mitral regurgitation, 36% of those in group 1 versus 9% in group 2 had a 2+ or more increase (p less than or equal to 0.001). The mean balloon diameter to anulus ratio was larger in group 2, and the larger the balloon diameter to anulus ratio, the greater the increase in mitral valve area.(ABSTRACT TRUNCATED AT 250 WORDS)

Behavioral vs beta-blocker therapy in patients with primary hypertension: effects on blood pressure, left ventricular function and mass, and the pressor surge of social stress anger.

We compared the relative effects of relaxation therapy, conventional hygienic techniques, and a beta-receptor blocker, atenolol, on control of arterial pressure, left ventricular mass, and diastolic function in patients with mild primary hypertension. Furthermore, we related these effects to baseline neural tone and its changes and assessed the efficacy of relaxation or the pressor surge of "social stress" anger. In group I left ventricular mass index was related to both systolic and diastolic blood pressure (r = 0.46; p less than 0.05). Plasma norepinephrine was related to age (r = 0.33; p less than 0.01). Slope was inversely related to both plasma norepinephrine (r = -0.29; p less than 0.05) and age (r = -0.31; p less than 0.05). Relaxation therapy reduced both supine systolic and diastolic blood pressures, 4.5% and 7.6%, respectively, but did not affect plasma norepinephrine. Hygienic informational therapy reduced plasma norepinephrine by 18%, (p less than 0.05) and did not change blood pressure. Blood pressure responders to nondrug therapy (i.e., diastolic blood pressure reduction of 7% or more) had a 7% reduction of left ventricular mass index (p less than 0.02). On the other hand, atenolol reduced systolic and diastolic blood pressure by 10% and 15%, respectively, (p less than 0.01) and improved left ventricular function by 17% (p less than 0.05) without a significant change in left ventricular mass index. Finally, relaxation therapy but not hygienic therapy reduced systolic blood pressures 4% and 6%, respectively (p less than 0.01), both before and during social stress anger.(ABSTRACT TRUNCATED AT 250 WORDS)

La implantación del cálculo económico en las empresas cooperativas de Villa Clara / Implementation of economic computation in cooperative enterprises from Villa Clara

Se visitaron 12 Cooperativas de Producción Agropecuaria (CPA) de la provincia de Villa Clara donde se analizaron los logros mas significativos en la implantación del Cálculo Económico en las Empresas Cooperativas, las deficiencias fundamentales relacionadas con la aplicación de la distribución según el trabajo, el perfecionamiento de los Contratos y los controles Económicos así como del Sistema de Precios. El análisis posibilito fundamentar una serie de recomendaciones cuya aplicación permitirá superar las deficiencias existentes en la gestión económica de las CPA

Comparison of simple sugar/salt versus glucose/electrolyte oral rehydration solutions in infant diarrhoea.

In a randomized double-blind trial, infants with mild or moderate diarrhoeal dehydration were rehydrated orally either with a simple solution containing table sugar and salt (without potassium or bicarbonate) or with a complete glucose/electrolyte formula. All 32 given glucose/electrolyte solution and 27 (93%) of 29 infants given sugar/salt were successfully rehydrated with similar improvement in metabolic acidosis and rapidity of rehydration. The drawbacks to oral therapy with simple sugar/salt solution were the frequent development of hypokalaemia and greater volume of vomiting during treatment. Carefully prepared sugar/salt solution, if accompanied by adequate potassium supplementation, may be used as an alternative to the preferred glucose/electrolyte formula when the latter is unavailable.