ABSTRACT
Objetivo: Evaluar el efecto de la visión en 3 dimensiones (3D) en comparación con 2 dimensiones (2D) sobre la carga mental de trabajo soportada y el rendimiento laparoscópico en ejercicios de simulación. Material y métodos: Se llevó a cabo un estudio prospectivo aleatorizado cruzado en sujetos sin experiencia en laparoscopia. Se incluyeron 46 participantes, los cuales completaron 5 ejercicios en pelvitrainer basados en un programa validado usando ambos sistemas de visión. El rendimiento se evaluó mediante el tiempo transcurrido y el número de errores cometidos, y la carga mental de trabajo a través del cuestionario validado NASA-TLX. Resultados: Los participantes realizaron las actividades mejor con la visión 3D de forma global en términos de tiempo (3D = 1.006,08 ± 315,94 vs. 2D = 1.309,17 ± 300,28; p < 0,001) y número total de errores (3D = 0,84 ± 1,26 vs. 2D = 1,86 ± 1,60; p < 0,001). Cuando se analizó el tiempo de forma independiente por ejercicios, el uso de 3D mostró diferencias estadísticamente significativas en: «transferencia de objetos» (p = 0,001), «sutura» (p < 0,001), «clipar y cortar» (p < 0,05) y «manejo de la aguja» (p < 0,001). Además, el uso de la visión 3D produjo menos carga mental de trabajo de acuerdo con los resultados del NASA-TLX (p < 0,001), aunque se asoció con un mayor malestar visual (p < 0,01) y dolor de cabeza (p < 0,05). Conclusión: La incorporación de sistemas 3D en cirugía laparoscópica facilitaría la adquisición más temprana de habilidades laparoscópicas, ya que se asocia a un mejor rendimiento y menor carga mental de trabajo en sujetos sin experiencia, si bien existen inicialmente algunos efectos indeseables como malestar visual o dolor de cabeza (AU)
Objective: To assess the effect of vision in three dimensions (3D) versus two dimensions (2D) on mental workload and laparoscopic performance during simulation-based training. Materials and methods: A prospective, randomized crossover study on inexperienced students in operative laparoscopy was conducted. Forty-six candidates executed five standardized exercises on a pelvitrainer with both vision systems (3D and 2D). Laparoscopy performance was assessed using the total time (in seconds) and the number of failed attempts. For workload assessment, the validated NASA-TLX questionnaire was administered. Results: 3D vision improves the performance reducing the time (3D = 1006.08 ± 315.94 vs. 2D = 1309.17 ± 300.28; P < .001) and the total number of failed attempts (3D = .84 ± 1.26 vs. 2D = 1.86 ± 1.60; P < .001). For each exercise, 3 D vision also shows better performance times: «transfer objects» (P = .001), «single knot» (P < .001), «clip and cut» (P < .05), and «needle guidance» (P < .001). Besides, according to the NASA-TLX results, less mental workload is experienced with the use of 3 D (P < .001). However, 3 D vision was associated with greater visual impairment (P < .01) and headaches (P < .05). Conclusion: The incorporation of 3 D systems in laparoscopic training programs would facilitate the acquisition of laparoscopic skills, because they reduce mental workload and improve the performance on inexperienced surgeons. However, some undesirable effects such as visual discomfort or headache are identified initially (AU)
Subject(s)
Humans , Male , Female , Young Adult , Laparoscopy/education , Imaging, Three-Dimensional , Simulation Training , Urologic Surgical Procedures , Students, Medical/statistics & numerical data , Imaging, Three-Dimensional/adverse effects , Workload , Vision Disorders/epidemiology , Prospective StudiesABSTRACT
OBJECTIVE: To assess the effect of vision in three dimensions (3D) versus two dimensions (2D) on mental workload and laparoscopic performance during simulation-based training. MATERIALS AND METHODS: A prospective, randomized crossover study on inexperienced students in operative laparoscopy was conducted. Forty-six candidates executed five standardized exercises on a pelvitrainer with both vision systems (3D and 2D). Laparoscopy performance was assessed using the total time (in seconds) and the number of failed attempts. For workload assessment, the validated NASA-TLX questionnaire was administered. RESULTS: 3D vision improves the performance reducing the time (3D = 1006.08 ± 315.94 vs. 2D = 1309.17 ± 300.28; P < .001) and the total number of failed attempts (3D = .84 ± 1.26 vs. 2D = 1.86 ± 1.60; P < .001). For each exercise, 3D vision also shows better performance times: "transfer objects" (P = .001), "single knot" (P < .001), "clip and cut" (P < .05), and "needle guidance" (P < .001). Besides, according to the NASA-TLX results, less mental workload is experienced with the use of 3D (P < .001). However, 3D vision was associated with greater visual impairment (P < .01) and headaches (P < .05). CONCLUSION: The incorporation of 3D systems in laparoscopic training programs would facilitate the acquisition of laparoscopic skills, because they reduce mental workload and improve the performance on inexperienced surgeons. However, some undesirable effects such as visual discomfort or headache are identified initially.
Subject(s)
Imaging, Three-Dimensional , Laparoscopy/psychology , Simulation Training , Surgeons/psychology , Urologic Surgical Procedures , Clinical Competence , Cross-Over Studies , Female , Headache/etiology , Humans , Imaging, Three-Dimensional/adverse effects , Laparoscopy/methods , Male , Mental Fatigue/etiology , Prospective Studies , Psychomotor Performance , Surveys and Questionnaires , Vision Disorders/etiology , Young AdultABSTRACT
OBJECTIVE: We retrospectively review the patients treated at our institution for renal cell carcinoma (RCC). We compare the patients classified in TNM state T1N0M0 in the 1997 revision with the 1992 one in order to determine survival differences. We divide patients in three size related groups and compare its survival rates. MATERIAL AND METHODS: We review 168 surgically treated patients. 72 of them were classified into T1N0M0 stage. We compare cancer-free survival in patients included in 1997 and 1992 T1 stage. We divide patients in three groups: 1-3 cm, 3-5 cm, 5-7 cm and compare respective cancer-free survival. RESULTS: There is a survival difference between T1(1997)-T2(1992) (p = 0.478). There is an inferior survival in size group 5-7 cm compared with 1-3 cm and 3-5 cm ones (p = 0.02/0.0465). CONCLUSIONS: In our patients, 1997 revision of T1 size supposes a descent of cancer-free survival compared with 1992 one. We consider a better stage limit under 5 cm, instead of actual 7 cm.
Subject(s)
Carcinoma, Renal Cell/pathology , Kidney Neoplasms/pathology , Neoplasm Staging/standards , Aged , Carcinoma, Renal Cell/diagnosis , Carcinoma, Renal Cell/mortality , Carcinoma, Renal Cell/surgery , Disease-Free Survival , Female , Hematuria/etiology , Humans , Incidental Findings , Kidney Neoplasms/diagnosis , Kidney Neoplasms/mortality , Kidney Neoplasms/surgery , Length of Stay , Life Tables , Male , Middle Aged , Neoplasm Staging/methods , Nephrectomy , Pain/etiology , Postoperative Complications/epidemiology , Retrospective Studies , Spain/epidemiology , Survival Rate , Treatment OutcomeABSTRACT
After the nuclear accident of Chernobyl, in the population of zones contaminated the malignant renal tumors was increased from 4.7 to 7.5 per 100,000 of total population. Cesium 137 (137Cs) constitutes 80-90% of the internal exposure of these people as well as eliminated through kidneys becomes an important risk factor. We present a case of a patient, residing in radiocontamined area, who consulted for abdominal pain and left flank mass. We review relevant literature and the management of these patients.
Subject(s)
Accidents , Air Pollutants, Radioactive/adverse effects , Carcinoma, Renal Cell/etiology , Cesium Radioisotopes/adverse effects , Kidney Neoplasms/etiology , Neoplasms, Radiation-Induced/etiology , Nuclear Reactors , Adult , Allelic Imbalance , Carcinoma, Renal Cell/diagnosis , Carcinoma, Renal Cell/genetics , Chromosomes, Human, Pair 3/genetics , DNA, Neoplasm/genetics , Female , Genes, ras , Humans , Kidney Neoplasms/diagnosis , Kidney Neoplasms/genetics , Neoplasms, Radiation-Induced/diagnosis , Neoplasms, Radiation-Induced/genetics , Proliferating Cell Nuclear Antigen/analysis , Spain , Ukraine/epidemiologyABSTRACT
OBJETIVO: Realizamos un estudio retrospectivo de los pacientes tratados en nuestra institución por carcinoma de células renales (CCR). Comparamos los pacientes clasificados en el estadio T1N0M0 según la revisión TNM de 1997 con la clasificación según la revisión de 1992 para establecer diferencias de supervivencia. Comparamos diferentes cortes por tamaño tumoral y valoramos su implicación en la supervivencia. MATERIAL Y MÉTODOS: Análisis retrospectivo de una serie de 168 pacientes intervenidos por CCR, de ellos 72 clasificados en estadio T1N0M0. Comparamos supervivencia según las dos últimas revisiones TNM y en tres grupos de tamaño: 1-3 cm, 3-5 cm y 5-7 cm. RESULTADOS: Hallamos menor supervivencia en los pacientes T11997 (p=0,0478) y en grupo de tamaño 5-7 cm, con respecto al 1-3 cm (p=0,02) y al de 3-5 cm (p=0,0465).CONCLUSIONES: En nuestra serie, la revisión de 1997 en el estadio T1 supone un descenso de supervivencia. El límite en 7 cm es excesivo, lo consideramos más apropiado por debajo de 5 cm (AU)
Subject(s)
Middle Aged , Aged , Male , Female , Humans , Spain , Life Tables , Survival Rate , Treatment Outcome , Disease-Free Survival , Pain , Postoperative Complications , Nephrectomy , Retrospective Studies , Incidental Findings , Carcinoma, Renal Cell , Length of Stay , Hematuria , Neoplasm Staging , Kidney NeoplasmsABSTRACT
Después del accidente nuclear de Chernobyl, en la población de zonas contaminadas la incidencia de carcinoma renal se incrementó de 4,7 a 7,5 por 100.000 habitantes. La elevada concentración corporal de Cesium 137 (137Cs) así como su eliminación por vía renal los convierte en pacientes de alto riesgo. Presentamos un caso de una paciente, residente en la zona contaminada que acudió a nuestro hospital por dolor abdominal y sensación de masa en flanco izquierdo. Realizamos una revisión de la literatura y analizamos el manejo en este tipo de pacientes (AU)
After the nuclear accident of Chernobyl, in the population of zones contaminated the malignant renal tumors was increased from 4,7 to 7,5 per 100.000 of total population. Cesium 137 (137Cs) constitutes 80- 90% of the internal exposure of these people as well as eliminated through kidneys becomes an important risk factor. We present a case of a patient, residing in radiocontamined area, who consulted for abdominal pain and left flank mass. We review relevant literature and the management of these patients (AU)
Subject(s)
Adult , Female , Humans , Nuclear Reactors , Accidents , Spain , Ukraine , Proliferating Cell Nuclear Antigen , Genes, ras , Allelic Imbalance , Cesium Radioisotopes , Chromosomes, Human, Pair 3 , Carcinoma, Renal Cell , Air Pollutants, Radioactive , Neoplasms, Radiation-Induced , DNA, Neoplasm , Kidney NeoplasmsABSTRACT
We report on two new cases of encrusted pielitis, a lithiasic disease of infectious ethiology--Corynebacterium of D group-. The clinic diagnostic is difficult and this disease develops in immunosuppressed patients, mainly in renal transplanted ones. One of our two cases is diagnosed in a patient with a transplanted kidney and the other one develops the disease within her native kidneys. We remark on the clinic features and therapeutic options.
Subject(s)
Corynebacterium Infections/complications , Kidney Calculi/microbiology , Pyelitis/microbiology , Aged , Female , Humans , Middle AgedABSTRACT
Presentamos dos nuevos casos de pielitis incrustada, una enfermedad litiásica de etiología infecciosa relacionada con el Corynebacterium del grupo D. El diagnóstico clínico es difícil y se desarrolla en enfermos inmunodeprimidos, sobre todo en aquellos sometidos a trasplante renal. Nuestros pacientes desarrollan la enfermedad en un caso en un enfermo trasplantado y en el otro en riñones no trasplantados. Detallamos las características clínicas y las opciones terapéuticas (AU)
Subject(s)
Middle Aged , Aged , Female , Humans , Pyelitis , Corynebacterium Infections , Kidney CalculiABSTRACT
OBJETIVO: Determinar si la subdivisión morfológica de los tumores vesicales de grado I entre neoplasia papilar de bajo potencial maligno (BPM) y cáncer vesical de bajo grado, tiene correlación con la evolución clínica y supervivencia del paciente. MATERIAL Y MÉTODOS: Se revisan 257 tumores vesicales superficiales consecutivos sometidos a resección transuretral entre 1990 y 1995 en el HU Reina Sofía de Córdoba, y se reevalúan según los criterios de la nueva clasificación de consenso de la OMS/ISUP de 1998. Se obtienen 12 pacientes con papiloma urotelial, 51 pacientes con neoplasia papilar BPM, 43 pacientes con cáncer vesical de bajo grado Ta, 65 pacientes con cáncer vesical de bajo grado T1 y 37 pacientes con cáncer vesical de alto grado. Once pacientes son reevaluados como T2 y 38 (14,8 por ciento) son perdidos de control. Se revisan los historiales clínicos de cada paciente con un seguimiento mínimo de 5 años, determinando las recidivas y progresiones dentro de cada grupo. Se comparan los resultados entre grupos con el test Chi-Cuadrado y se evalúan los factores de riesgo para la recidiva y progresión mediante análisis multivariado (Odds ratio). La función supervivencia se representa con las tablas de Kaplan y Meier, comparándolas con el test log rank. RESULTADOS: No encontramos diferencias entre ambos grupos con respecto a la edad ni distribución por el sexo. Las diferencias en el número de tumores no son significativas, mientras que el tamaño tumoral medio es significativamente mayor en el grupo "cáncer de bajo grado". En cuanto a los factores de riesgo para la recidiva y progresión de la enfermedad, sólo hallamos significativo el tamaño tumoral. Sorprendentemente, el uso de quimioterapia endovesical parece tener influencia en la aparición de recidiva. No encontramos diferencias en las tasas de recidiva y progresión entre ambos grupos, aunque los porcentajes son siempre mayores para el grupo "cáncer vesical de bajo grado". CONCLUSIÓN: La división de los tumores vesicales de bajo grado (G-I) entre "neoplasia de bajo potencial maligno" y "cáncer de bajo grado" sí presenta suficientes diferencias clínicas como para considerarlas entidades patológicas distintas. Sólo el tamaño tumoral aumentado es factor pronóstico dentro de cada grupo. Creemos que el uso de quimioterapia endovesical no está justificado en este tipo de tumores (AU)
Subject(s)
Middle Aged , Male , Female , Humans , Carcinoma , Urinary Bladder NeoplasmsABSTRACT
OBJECTIVE: To determine if the morphologic subgrouping of grade I bladder tumors between papillary neoplasm of low malignant potential and low grade papillary carcinoma is of clinical and survival value. MATERIAL AND METHODS: All 257 consecutive patients diagnosed of superficial bladder cancer between 1990 and 1995 in HU Reina Sofia of Cordoba were reviewed and further reclassified according to WHO/ISUP consensus classification of urothelial neoplasms of the bladder. Of the tumors 12 were urothelial papilloma, 51 were papillary neoplasm of low malignant potential, 43 were low grade papillary carcinoma Ta, 65 were low grade papillary carcinoma T1 and 37 were high grade papillary carcinoma. Eleven patients were reevaluated as T2 tumors and 38 (14.8%) were lost of control. All patients were reviewed with a follow-up at least of 5 years. We compare the results between groups with Fisher test and the risk factors for recurrence and progression are analyzed by multivariate analysis (Odds ratio). The survival function was calculated using Kaplan-Meier estimates and compared with the log-rank test. RESULTS: There are no differences between groups respect the age or sex distribution. The differences in the multiplicity are not significant and only the mean size is higher in papillary low grade carcinoma. About the risk factors for recurrence and progression of the disease, only is significative the tumor size. Rarely, the use of chemotherapy seems to play a role in the recurrence. There are no differences in recurrence and progression between the groups, although the percentages are always higher in the papillary low grade carcinoma group. CONCLUSIONS: There are enough clinical differences between the two groups and we consider them as distinct pathologic entities. Only the higher tumoral size is prognostic factor in each group. We think that the use of chemotherapy must be avoided in this low grade bladder tumors.