Reservorio urinario continente cateterizable de Indiana / Indiana continent catheterizable urinary reservoir

Introducción: La cirugía radical pélvica requiere de una derivación urinaria, incontinente o continente. Existen numerosas técnicas, siendo la más utilizada la neovejiga ortotópica. En ocasiones, cuando esta derivación no es posible o no está indicada, un reservorio urinario continente es una buena alternativa. El objetivo de este trabajo es presentar nuestra experiencia con el reservorio urinario continente de Indiana. Material y métodos: La serie está constituida por 85 pacientes, 66 mujeres y 19 hombres, con una edad media de 56 años (31 a 77 años). Las variables analizadas fueron el tiempo operatorio, la pérdida sanguínea, la tasa de transfusión, la estancia hospitalaria y las complicaciones perioperatorias. Resultados: La indicación principal fue la resolución de complicaciones derivadas del tratamiento del cáncer cérvico-uterino en 49 casos. La duración media de la derivación urinaria fue de 110,5 min (rango 80-130 min). El sangrado promedio fue de 450 cc (rango 100-1.000 cc). Hubo complicaciones postoperatorias inmediatas en 16 pacientes (18,85%), todos tratados médicamente. Un paciente tuvo una fístula anastomótica. La estancia hospitalaria fue 19 días (rango 5-60 días). No hubo mortalidad en la serie. Complicaciones alejadas ocurrieron en 26 pacientes (32%): estenosis de la anastomosis ureteral en 11 casos, estenosis del estoma cutáneo en 9 casos y litiasis del reservorio en 6 casos. Conclusión: El reservorio urinario continente y cateterizable de Indiana es una opción válida para el tratamiento de neoplasias urológicas o ginecológicas, y también para el manejo de enfermedades pélvicas relacionadas con complicaciones del tratamiento de cánceres pélvicos

Introduction: Radical pelvic surgery requires continent or incontinent urinary diversion. There are many techniques, but the orthotopic neobladder is the most used. A continent catheterizable urinary reservoir is sometimes a good alternative when this derivation is not possible or not indicated. This paper has aimed to present our experience with the Indiana pouch continent urinary reservoir. Materials and methods: The series is made up of 85 patients, 66 women and 19 men, with a mean age of 56 years (31-77 years). Variables analyzed were operating time, estimated blood loss, transfusion rate, hospital stay and peri-operatory complications. Results: The main indication in 49 cases was resolution of complications related to the treatment of cervical cancer. Average operation time was 110.5 minutes (range 80-130 minutes). Mean blood loss was 450 cm3 (100-1000 cm3). Immediate postoperative complications, all of which were treated medically, occurred in 16 patients (18.85%). One patient suffered anastomotic leakage. Hospital stay was 19 days (range 5-60 days) and there was no mortality in the series. Late complications occurred in 26 patients (32%), these being ureteral anastomotic stenosis in 11 cases, cutaneous stoma stenosis in 9 cases and reservoir stones in 6 cases. Conclusion: The Indiana continent catheterizable urinary reservoir is a valid option for the treatment of both urological and gynecological malignancies as well as for the management of pelvic morbidity related to the treatment of pelvic cancers

Indiana continent catheterizable urinary reservoir.

INTRODUCTION: Radical pelvic surgery requires continent or incontinent urinary diversion. There are many techniques, but the orthotopic neobladder is the most used. A continent catheterizable urinary reservoir is sometimes a good alternative when this derivation is not possible or not indicated. This paper has aimed to present our experience with the Indiana pouch continent urinary reservoir. MATERIAL AND METHODS: The series is made up of 85 patients, 66 women and 19 men, with a mean age of 56 years (31-77 years). Variables analyzed were operating time, estimated blood loss, transfusion rate, hospital stay and peri-operatory complications. RESULTS: The main indication in 49 cases was resolution of complications related to the treatment of cervical cancer. Average operation time was 110.5 minutes (range 80-130 minutes). Mean blood loss was 450 cc (100-1000 cc). Immediate postoperative complications, all of which were treated medically, occurred in 16 patients (18.85%). One patient suffered anastomotic leakage. Hospital stay was 19 days (range 5-60 days) and there was no mortality in the series. Late complications occurred in 26 patients (32%), these being ureteral anastomotic stenosis in 11 cases, cutaneous stoma stenosis in 9 cases and reservoir stones in 6 cases. CONCLUSION: The Indiana continent catheterizable urinary reservoir is a valid option for the treatment of both urological and gynecological malignancies as well as for the management of pelvic morbidity related to the treatment of pelvic cancers.

Note: Methodology for the analysis of Bluetooth gateways in an implemented scatternet.

This Note introduces a novel methodology to analyze the time performance of Bluetooth gateways in multi-hop networks, known as scatternets. The methodology is focused on distinguishing between the processing time and the time that each communication between nodes takes along an implemented scatternet. This technique is not only valid for Bluetooth networks but also for other wireless networks that offer access to their middleware in order to include beacons in the operation of the nodes. We show in this Note the results of the tests carried out on a Bluetooth scatternet in order to highlight the reliability and effectiveness of the methodology. The results also validate this technique showing convergence in the results when subtracting the time for the beacons from the delay measurements.

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

Feocromocitoma maligno: comunicación de 2 casos tratados con cirugía de mínima invasión / Malignant pheochromocytoma treated with minimally invasive surgery

Introducción: El Feocromocitoma es un tumor de células cromafines productor de catecolaminas. Su variedad maligna es muy poco frecuente. Objetivo: Describir 2 casos de Feocromocitoma maligno tratados con cirugía mínimamente invasiva. Casos clínicos: Presentamos 2 pacientes de sexo femenino, de 31 y 51 años respectivamente. La primera con historia de hipertensión arterial de larga data y uso de múltiples fármacos. La segunda paciente debuta con dolor abdominal. En ambos casos los estudios radiológicos y metabólicos confirmaron el diagnóstico de Feocromocitoma. A la primera paciente se le realizó un procedimiento laparoscópico puro, mientras que a la segunda paciente se le realizó un procedimiento laparoscópico asistido por robot. En ambos casos fue necesario realizar adrenalectomía en bloque con el riñón, por compromiso del hilio renal. No hubo complicaciones severas intra ni post-operatorias, como tampoco conversión a cirugía abierta. La histopatología confirmó el diagnóstico de Feocromocitoma maligno con metástasis ganglionares regionales y márgenes quirúrgicos negativos. Ambas se mantienen en control, sin evidencia de recurrencia. Conclusión: El Feocromocitoma maligno puede ser manejado de forma mínimamente invasiva, con morbilidad y resultados oncológicos comparables a cirugía abierta.

Introduction: Pheochromocytoma is a tumor derived from chromaffin cells that produces cathecolamines. Malignant pheochromocytomas are extremely rare. Aim: To describe 2 cases of malignant Pheochromocytoma treated with pure laparoscopic and robot assisted surgery. Clinical cases: Two female patients, 31 and 51 years of age, presented with a history of high blood pressure and abdominal pain. Radiologic and metabolic studies confirmed the diagnosis of Pheochromocytoma in both patients. A pure laparoscopic approach was performed in the first patient while a robotic assisted laparoscopy was done in the second patient. In both cases, adrenalectomy with in bloc nephrectomy was performed due to compromise of the renal sinus. There were no complications or conversion to open surgery. Histopathology confirmed the diagnosis of malignant Pheochromocytoma with metastasis to regional nodes and negative surgical margins. At follow-up, there is no evidence of recurrence. Conclusion: Malignant Pheochromocytoma can be treated with minimally invasive surgery, with morbidity and oncological outcomes similar to open approach.

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.

Ultrasonic wave-based structural health monitoring embedded instrument.

Piezoelectric sensors and actuators are the bridge between electronic and mechanical systems in structures. This type of sensor is a key element in the integrity monitoring of aeronautic structures, bridges, pressure vessels, wind turbine blades, and gas pipelines. In this paper, an all-in-one system for Structural Health Monitoring (SHM) based on ultrasonic waves is presented, called Phased Array Monitoring for Enhanced Life Assessment. This integrated instrument is able to generate excitation signals that are sent through piezoelectric actuators, acquire the received signals in the piezoelectric sensors, and carry out signal processing to check the health of structures. To accomplish this task, the instrument uses a piezoelectric phased-array transducer that performs the actuation and sensing of the signals. The flexibility and strength of the instrument allow the user to develop and implement a substantial part of the SHM technique using Lamb waves. The entire system is controlled using configuration software and has been validated through functional, electrical loading, mechanical loading, and thermal loading resistance tests.

Spatial learning of an escape task by young corn snakes, Elaphe guttata guttata.

Spatial learning is critical to most animals for many behaviours necessary to survival. In vertebrates, most studies on spatial learning and memory have been conducted in mammalian and avian species with few studies on reptiles. We examined spatial learning in the corn snake, Elaphe guttata guttata by training 17 young snakes to find the one open shelter in an eight-hole arena, where the entrance was not visible from the arena surface. Over a 16-trial, 4-day training period, snakes showed (1) a significant decrease in the mean latency to the goal, (2) a significant decrease in the mean total distance travelled, (3) a significant increase in the percentage of the total distance travelled in the quadrant containing the goal, and (4) a significant increase in movement in the goal quadrant above chance. Although no differences were found in the number of errors made over the training period, snakes made fewer errors on all days than expected by chance. This study shows that snakes can learn rapidly a spatial-escape task that is relevant behaviourally and suggests that entering a shelter reinforces this learning. Mechanisms of orientation for the task described are discussed. Copyright 1999 The Association for the Study of Animal Behaviour.

Newborn genetic identification: a protocol using microsatellite DNA as an alternative to footprinting.

Newborn identification by foot- or finger-printing presents serious drawbacks. This study proposes an alternative method based on DNA analysis of blood-spots taken from the newborn child. CSF1PO, TPOX and TH01 microsatellite loci were chosen to develop a fast and reliable protocol to be applied in cases where it is suspected that newborn children have been exchanged. The advantage of these loci is that one can simultaneously amplify them by PCR multiplex reaction and determine their alleles, thereby reducing the time needed for identification tests. Moreover, the amplification products of these loci are very small (< 350 bp) and so can be analyzed in samples with degraded DNA. We have been able to prove that it is possible to obtain results in blood-spots taken from newborns up to 13 years before and kept at room temperature. Thus the protocol proposed here can be applied in long-term post-natal identification cases.

Conversion of atrial fibrillation with ajmaline in a pregnant woman with Wolff-Parkinson-White syndrome.

Pregnancy is related to an increased frequency of arrhythmias in asymptomatic patients with Wolff-Parkinson-White syndrome, which might lead to sudden death. A 40-year-old woman, with Wolff-Parkinson-White syndrome which was not diagnosed until pregnancy, presented in the 34th week with an atrial fibrillation, with high risk criteria for ventricular fibrillation. Intravenous ajmaline was given to convert the tachyarrhythmia to sinus rhythm. We obtained an excellent maternal control with no maternal or fetal adverse effects.

Early neonatal sudden death or near death syndrome. An epidemiological study of 29 cases.

Early neonatal sudden death syndrome (SIDS) is a rare but well known disease entity. Between January 1975 and December 1991, 29 full-term newborn infants delivered in our maternity unit and, considered healthy at birth, suffered early SIDS (n = 15) or early apparent life threatening events (ALTE) (n = 14). Data from the whole population of live full-term infants born in our hospital during the past five years have been used as a reference (n = 27,841). The general rate of early SIDS was 0.14 per 1000 (15/107,263). Combining early ALTE cases, the overall rate was 0.27 per 1000 (29/107,263). A postmortem examination was performed for all infants who died (20/29): no cause of death could be determined, and we did not observe a single case with evident sequelae. There were 9 deaths (31%) within the first hour after delivery and 12 deaths occurred in the early morning hours (04:00-08:00; RR = 3.76; p = 0.0008). The lowest incidence was in the spring (RR = 0.21; p = 0.03). There was a tendency for an increased incidence during the weekend and the summer. No influence of sex, maternal age, gestational age, infant weight presentation, delivery, anesthesia or presence of meconium-stained fluid was found. In our opinion, SIDS can take place even during the first hour of life and it is not possible to predict when a baby might be affected. Pediatrically trained caregivers, close observation by the mother during the first few days and resuscitation facilities in maternity wards may be the most important preventive measures to reduce the risk of early SIDS and the consequences of ALTE in the early newborn period.

Delayed childbearing and pregnancy outcome.

This study is to analyze the effect of delayed childbearing on pregnancy outcome among nulliparous women. A hospital-based study was conducted with prospectively collected data from the computerized perinatal data base that includes information about all patients delivered in our Hospital. We studied 17,230 nulliparous women who were > or = 20 years of age with a singleton gestation delivered between 1987 and 1992. We assessed the rates of low birth weight (< 2500 g), preterm delivery (< 37 weeks), small for gestational age, perinatal death (> 500 g and 28 days of life), and selected complications of pregnancy and delivery (ante partum complications, meconium, labor abnormal fetal heart rate, cesarean section, breech presentation, Apgar score, umbilical cord-pH, and rates of neonatal admission). Compared with women aged 20-29 years, women aged > or = 35 years had no significantly higher odds ratio (OR) of low birth weight < 2500 g (OR = 1.3); preterm delivery < 37 weeks (OR = 1.2); small for gestational age (OR = 1.0); and perinatal death (OR = 1.7). In contrast, we found a significantly higher rates of specific antepartal complications (OR = 1.9); cesarean section (OR = 2.5); breech presentation (OR = 1.4); and higher rates of admission to the newborn intensive care unit (OR = 1.4); but excluding infants delivered before 37 weeks of gestation, we found no significantly higher odds ratio of neonatal admission (OR = 1.4). Delayed childbearing is associated with an increased risk of complications of pregnancy and delivery although neonatal outcomes were not appreciably different from those among infants of younger women.

Perinatal outcome of very low birthweight infants by mode of delivery.

In order to evaluate the influence of mode of delivery on perinatal morbidity and mortality in vertex infants weighing less than 1500 g (VLBW), we made a retrospective study of 152 singleton newborns, in vertex presentation, with a birthweight of less than 1500 g, delivered in the Cruces Hospital (Vizcaya, Spain), a major perinatal referral center, between 1 January 1987 and 31 December 1989. Twins and infants with lethal congenital anomalies or gross intrauterine growth deviations were excluded from the study (n = 71). Of the infants studied (n = 81), 37 were delivered by cesarean section (mean weight 1120 +/- 206 g, range: 680-1495 g) and 44 were delivered vaginally (mean weight 1029 +/- 283 g, range: 530-1475 g). The patients were divided into four groups: Group A: 500-749 g (n = 10); Group B: 750-999 g (n = 21); Group C: 1000-1249 g (n = 27); and Group D: 1250-1499 g (n = 23). The percentages of cesarean sections in each group were 10%, 42%, 66% and 39%, respectively. A comparison within each group of immediate perinatal outcome (Apgar score and umbilical vein cord pH), as well as mortality and sequelae up to 1 year of age did not yield any significant differences between cesarean and vaginal birth. We conclude that cesarean delivery does not appear to offer improved outcome over vaginal delivery in live births without congenital anomalies. For this reason, we believe that fetal weight should not be the only obstetrical variable considered when deciding whether or not to perform a cesarean section in these circumstances.

Repeat pregnancy associated with cardiac pacemaker.

Two pregnancies in a patient with a fixed-rate pacemaker are reported. The first pregnancy was uneventful. The second had no maternal complications either. A moderate tachysystolia was detected during the second period. The newborn was delivered with forceps applied under spinal anesthesia. Newborn infant evolution presented no hazards, but umbilical cord analysis revealed a severe acidosis, in spite of a normal scalp analysis 45 min earlier. Epidural anesthesia is recommended for such patients.

[Comparative study of peridural anesthesia with bupivacaine alone and combined with fentanyl during vaginal delivery]. / Estudio comparativo entre la anestesia peridural con bupivacaína sola o asociada a fentanilo durante el parto vaginal.

Two groups of primiparous women with single fetus in cephalic presentation were prospectively randomized at the end of pregnancy to receive epidural analgesia with 0.25% bupivacaine, either single (n = 102) or associated with 0.05 mg of phentanyl (n = 102). Phentanyl significantly reduces the period of development of analgesia and increases the interdose period. The quality of analgesia is significantly better when fentanyl is associated with bupivacaine. The evolution of delivery (dilatation and expulsion) and the perinatal results (cord pH and vitality of the newborn as assessed by the Apgar test) were similar in both groups. We conclude that the association of phentanyl with bupivacaine has advantages for epidural analgesia during delivery, as the quality of analgesia is improved, its duration is prolonged and there are no adverse effects on the evolution of delivery or on the newborn.

Pruritic urticarial papules and plaques of pregnancy.

The authors present a rare case of pruritic urticarial papules and plaques of pregnancy in a 25-year-old caucasian primigravida admitted to our department because of pruritus in the third trimester of gestation. Recommendations for management are discussed.

Selective embryo reduction in a sextuplet pregnancy.

The treatment course of a 29-year-old infertile woman using hMG and TDI was the cause of a sextuplet pregnancy in which a successful embryo reduction was carried out during the first trimester. The reduction was performed twice: the first around the 9th week of pregnancy transvaginally, and the second during the 12th week by transabdominal puncture. The perinatal outcome was favorable, and the patient spontaneously delivered a healthy infant on the 39th week of pregnancy.

Verapamil to inhibit the cardiovascular side effects of ritodrine.

Side effects of beta-sympathomimetic drugs are of primary interest in the treatment of preterm labor. Incidence of side effects are dose-dependent, as is the efficacy of the beta-agonist in uterine relaxation. the effect of verapamil (Ca2+) inhibitor with antiarrhythmic action) on ritodrine does not modify the value of ritodrine in prolonging pregnancy, but clearly diminishes the incidence of maternal tachycardia and hypotension. The authors suggest that in the treatment of preterm labor with ritodrine infusion above 200 micrograms/min, the addition of verapamil (dosage, 80-120 micrograms/min) is useful because it substantially reduces the cardiovascular side effects associated with ritodrine hydrochloride.