Reversión de vasectomía: técnica simplificada / Reversal vasectomy: a simpliefed technique

Introducción. Aproximadamente un 3 por ciento de los hombres que se han sometido a una vasectomía se realizan posteriormente una reversión de ésta con intención de fertilidad. La vasovasostomía (VV) microquirúrgica como técnica de reversión de vasectomía, permite la recanalización de los conductos deferentes, ofreciendo muy buenos resultados. Objetivo. Describir los resultados quirúrgicos y la efectividad de la VV en una serie de pacientes operados mediante una técnica simplificada. Materiales y Métodos. Estudio retrospectivo. Se analizaron antecedentes demográficos y quirúrgicos. Se utilizó una técnica de VV simplificada que consiste en realizar una miniincisión de abordaje (1 cm), sin evaluar el líquido seminal mediante la graduación de Silber y realizar la anastomosis en un plano único con material de sutura no reabsorbible 9-0. Se controló con espermiograma al primer y tercer mes post-cirugía, evaluando concentración espermática, motilidad progresiva, morfología y volumen seminal entre otros. Se calculó la tasa de permeabilidad deferencial (definida como presencia de espermatozoides en el eyaculado) y la tasa de embarazo post VV. Resultados. Un total de 75 pacientes fueron incluidos en el estudio, operados entre agosto de 2009 y julio de 2016 por 2 cirujanos (CP, MM). La edad media (± desviación estándar) de los pacientes y de sus parejas fue de 43,9 ± 6,4 años y 34,4 ± 4,2 años, respectivamente. La mediana del tiempo transcurrido entre la vasectomía y la VV fue de 8 años (2 ­ 21 años). La mediana del tiempo quirúrgico fue de 110 minutos (85 ­ 183 minutos), con menos de un 3 por ciento de complicaciones post-operatorias (todas grado-I según escala Clavien-Dindo). Al primer mes el 93% de los pacientes tenía espermatozoides en el eyaculado, con una mediana de concentración de 12 x 10

Introduction. Approximately 3 pertcent of men subjected to a vasectomy undergo a subsequent reversal with fertility purposes. The microsurgical vasovasostomy (VV) as a vasectomy reversal technique allows recanalization of the deferential ducts, offering very good results. Objetive. To describe the surgical results and effectiveness of VV in a series of patients in whom a simplified technique was performed. Materials y Methods. Restrospective study. Demographic and surgical records were analyzed. The VV was performed using a simplified technique, meaning a mini-incision approach (1 cm), avoidance of the proximal seminal fluid analysis using the Silber score and performing the anastomosis in a single-layered fashion with a 9-0 non-absorbable suture. A sperm analysis was performed at first and third postoperative month., assesing sperm concentration, progressive motility, morphology and sperm volume among other factors. The deferential permeability rate (defined as presence of spermatozoids in semen) and pregnancy rates after VV were calculated. Results. A total of 75 patients were included in the study. All surgeries were performed by 2 surgeons (CP, MM) between August 2009 and July 2016. The average age (± standard deviation) of patients and their sexual partners were 43.9 ± 6.4 years and 34.4 ± 4.2 years, respectively. The median time span between the vasectomy and reversal was 8 years (range 2 ­ 21 years). The median surgical time was 110 minutes (range 85 ­ 183 minutes), with less than a 3 pertcent rate of postoperative complications (all grade-I according to Clavien-Dindo classification). At the first postoperative month 93 pertcent of the patients had spermatozoids in the eyaculate, with a median concentration of 12 x 10

Increased time exposure to tenofovir is associated with a greater decrease in estimated glomerular filtration rate in HIV patients with kidney function of less than 60 ml/min/1.73 m2.

Tenofovir (TDF), atazanovir (ATAZ) and indinavir (IND) have been reported as possible risk factors for incident chronic kidney disease (CKD) in HIV-infected patients. We investigated the relationship between the duration of antiretroviral exposure and estimated glomerular filtration rate (eGFR) evolution in CKD patients. In a cohort of 1,750 HIV-infected patients, we identified 121 CKD patients with a mean follow-up of 44 ± 35 months. The relationship between mean eGFR at baseline, eGFR slope and time exposure to antiretroviral treatment as well as confounding factors were investigated using a joint modeling procedure. Seventy (58%), 30 (25%) and 33 patients (27%), with a mean age of 50.3 ± 11.7 years, mean eGFR at baseline of 53.0 ± 0.8 (ml/min/1.73 m(2)) and eGFR slope of 0.46 ± 0.07 ml/min/1.73 m(2)/year, were exposed to TDF, ATAZ and IND, respectively. In univariate analysis, hepatitis C virus infection, decreased nadir of log CD4 count, high blood pressure at baseline, angiotensin-converting enzyme inhibitor treatment and greater time exposure to TDF during follow-up were associated with a higher slope, whereas greater time exposure to IND was associated with a lower slope. In multivariate analysis, higher TDF time exposure was still significantly associated with eGFR decline, with a dose-effect relationship (slope ± standard error of the mean: 1.1 ± 0.1, 0.5 ± 0.1, -0.07 ± 0.08 and -0.87 ± 0.06 ml/min/1.73 m(2)/year for no time exposure, <34, 34-67 and ≥67%, respectively; trend test: p < 0.001), whereas the IND time exposure association was abolished. In HIV patients with CKD, a greater TDF time exposure was independently associated, in a graded manner, with a greater eGFR decline.

[Experience in superselective embolization of bladder arteries in the treatment of intractable hematuria]. / Experiencia en embolización supraselectiva de arterias vesicales para manejo de hematuria incoercible.

INTRODUCTION: The hematuria, one of the main motives of urologic consultations, is produced by an extensive number of urinary pathologies from infections to cancer. The management of hematuria can require the action of Interventional Radiology in those cases in which the pathology is outside of surgery therapy. This is an approximation less invasive for the management of this pathology. MATERIAL AND METHODS: Retrospective review of 6 cases of supraselective embolization of bladder arteries with micropaticles in intractable macroscopic hematuria with associated anemia. Short and extensive monitoring. RESULTS: Four patients had a favorable evolution, with disappearance of macroscopic hematuria at 48 hours of the procedure. In two cases it was necessary a second endovascular procedure (coils) one week later. The patients did not present complications related to the intervention during the period of current monitoring. CONCLUSION: In ineligible patients for surgical resolution of hematuria or in those with failure of habitual processing, the selective embolization seems to be a viable alternative and without immediate complications for the management. Studies with greater number of cases and more prolonged monitoring are required to test this hypothesis.

Experiencia en embolización supraselectiva de arterias vesicales para manejo de hematuria incoercible / Experience in superselective embolization of bladder arteries in the treatment of intractable hematuria

Introducción: La hematuria, uno de los principales motivos de consulta urológica, es producida por un amplio número de patologías desde infecciones urinarias hasta neoplasias malignas. El manejo de la hematuria incoercible puede requerir la acción de Radiología Intervencional en aquellos casos en que la patología queda fuera del alcance terapéutico habitual. Esta es una aproximación menos invasiva para el tratamiento de esta patología. Material y métodos: Revisión retrospectiva de 6 casos de embolización supra selectiva de arterias vesicales con micropartículas, en hematurias macroscópica incoercible. Seguimiento a corto y mediano plazo. Resultado: Cuatro pacientes tuvieron una evolución favorable, con desaparición de la hematuria macroscópica a las 48 horas del procedimiento. En dos casos se requirió de un segundo procedimiento endovascular (coils) a una semana. Los pacientes no presentaron complicaciones relacionadas a la intervención, durante el período de seguimiento. Discusión: En pacientes no aptos para resolución quirúrgica de hematuria o en aquellos con falla de tratamiento habitual, la embolización supraselectiva parece ser una alternativa viable y sin complicaciones inmediatas. Se requieren estudios con seguimiento más prolongado y mayor número de casos para probar esta hipótesis (AU)

Introduction: The hematuria, one of the main motives of urologic consultations, is produced by an extensive number of urinary pathologies from infections to cancer. The management of hematuria can require the action of Interventional Radiology in those cases in which the pathology is outside of surgery therapy. This is an approximation less invasive for the management of this pathology. Material and Methods: Retrospective review of 6 cases of supra selective embolization of bladder arteries with micropaticles in intractable macroscopic hematuria with associated anemia. Short and extensive monitoring. Results: Four patients had a favorable evolution, with disappearance of macroscopic hematuria at 48 hours of the procedure. In two cases it was necessary a second endovascular procedure (coils) one week later. The patients did not present complications related to the intervention during the period of current monitoring. Conclusion: In ineligible patients for surgical resolution of hematuria or in those with failure of habitual processing, the selective embolization seems to be a viable alternative and without immediate complications for the management. Studies with greater number of cases and more prolonged monitoring are required to test this hypothesis (AU)

HIV and Leishmania coinfection: a review of 91 cases with focus on atypical locations of Leishmania.

A retrospective study was conducted in France in 1998 to determine the clinical features of visceral leishmaniasis (VL) in 91 patients infected cocomitantly with human immunodeficiency virus. Our data suggest that the clinical manifestations of VL may be influenced by the immunological status, with atypical locations of Leishmania amastigotes more frequently found in severely immunocompromised patients. In such patients, the involvement of atypical locations may lead to the discovery of VL.

The cerebro-costo-mandibular syndrome: 9-year follow-up of a case.

Cerebro-costo-mandibular syndrome (CCMS) is a rare multiple congenital anomaly with a low survival rate. There are few reports of long-term survival in this condition. We describe the findings and management of a 9-year-old survivor of CCMS, outline the importance of early intervention and multidisciplinary team approach. The child presented in the neonatal period in respiratory distress with classical features of the syndrome. Aggressive initial respiratory management was later followed up with an integrated multidisciplinary team approach. He has been carefully followed up for nine years now, illustrating well, the course of the syndrome.