Genetic Ancestry, Race, and Severity of Acutely Decompensated Cirrhosis in Latin America.

BACKGROUND & AIMS: Genetic ancestry or racial differences in health outcomes exist in diseases associated with systemic inflammation (eg, COVID-19). This study aimed to investigate the association of genetic ancestry and race with acute-on-chronic liver failure (ACLF), which is characterized by acute systemic inflammation, multi-organ failure, and high risk of short-term death. METHODS: This prospective cohort study analyzed a comprehensive set of data, including genetic ancestry and race among several others, in 1274 patients with acutely decompensated cirrhosis who were nonelectively admitted to 44 hospitals from 7 Latin American countries. RESULTS: Three hundred ninety-five patients (31.0%) had ACLF of any grade at enrollment. Patients with ACLF had a higher median percentage of Native American genetic ancestry and lower median percentage of European ancestry than patients without ACLF (22.6% vs 12.9% and 53.4% vs 59.6%, respectively). The median percentage of African genetic ancestry was low among patients with ACLF and among those without ACLF. In terms of race, a higher percentage of patients with ACLF than patients without ACLF were Native American and a lower percentage of patients with ACLF than patients without ACLF were European American or African American. In multivariable analyses that adjusted for differences in sociodemographic and clinical characteristics, the odds ratio for ACLF at enrollment was 1.08 (95% CI, 1.03-1.13) with Native American genetic ancestry and 2.57 (95% CI, 1.84-3.58) for Native American race vs European American race CONCLUSIONS: In a large cohort of Latin American patients with acutely decompensated cirrhosis, increasing percentages of Native American ancestry and Native American race were factors independently associated with ACLF at enrollment.

Utilidad de las tiras reactivas para el diagnóstico temprano de peritonitis bacteriana espontánea en pacientes cirróticos con ascitis / Usefulness of test strips for early diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites

Introducción: La peritonitis bacteriana espontánea requiere un diagnóstico temprano para el inicio de antibioticoterapia. El estudio diagnóstico ideal es el citoquímico del líquido ascítico, el cual puede ser costoso, demorado y de disponibilidad limitada en centros primarios de atención en salud. Objetivo: Evaluar la utilidad y precisión diagnóstica de las tiras reactivas Multistix 10SG para el diagnóstico de peritonitis bacteriana espontánea en pacientes cirróticos con ascitis. Materiales y métodos: Estudio observacional descriptivo de prueba diagnóstica en pacientes cirróticos con ascitis. Se determinó el conteo de leucocitos del líquido ascítico por la escala colorimétrica de la tira reactiva Multistix 10SG y se comparó con el gold standard para el diagnóstico (polimorfonucleares ≥ 250 células/mm³). Resultados: De 174 pacientes con ascitis (51,7% mujeres, promedio de edad 59 años) 30 fueron diagnosticados con peritonitis bacteriana espontánea. Con un punto de corte grado ++, la tira reactiva tuvo sensibilidad 73,3%, especificidad 96,5%, valor predictivo positivo 81,4%, valor predictivo negativo 94,5%, razón de probabilidad positiva 21,2 y razón de probabilidad negativa 0,27. Conclusiones: Las tiras reactivas tienen adecuada especificidad y valor predictivo negativo, siendo una herramienta de bajo costo, uso sencillo, rápida interpretación y fácil acceso, para apoyar la decisión de no iniciar antibiótico en pacientes con ascitis y sospecha de peritonitis bacteriana espontánea. Por su baja sensibilidad no reemplazan al estudio citoquímico como prueba de elección para el diagnóstico definitivo, pero si es útil para optimizar el abordaje inicial de estos pacientes.

Introduction: Spontaneous bacterial peritonitis requires an early diagnosis to start antibiotic therapy. The ideal diagnostic study is the cytochemical of ascites fluid, which can be expensive, delayed and of limited availability in primary health care centers. Objective: Evaluate the usefulness and diagnostic accuracy of Multistix 10SG test strips for the diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Materials and methods: Observational descriptive study of diagnostic test in cirrhotic patients with ascites. The leukocyte count of ascites fluid was determined by the colorimetric scale of the Multistix 10SG test strip and compared with the gold standard for diagnosis (polymorphonuclear ≥ 250 cells / mm³). Results: Of 174 patients with ascites (51.7% women, average age 59 years) 30 were diagnosed with spontaneous bacterial peritonitis. With a grade ++ cut-off point, the test strip had sensitivity 73.3%, specificity 96.5%, positive predictive value 81.4%, negative predictive value 94.5%, positive likelihood ratio 21.2 and negative likelihood ratio of 0.27. Conclusions: The test strips have adequate specificity and negative predictive value, being a low cost tool, simple use, quick interpretation and easy access, to support the decision not to start an antibiotic in patients with ascites and suspected spontaneous bacterial peritonitis. Due to their low sensitivity they do not replace the cytochemical study as the test of choice for the definitive diagnosis, but it is useful for optimizing the initial approach of these patients.

[Usefulness of test strips for early diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites]. / Utilidad de las tiras reactivas para el diagnóstico temprano de peritonitis bacteriana espontánea en pacientes cirróticos con ascitis.

INTRODUCTION: Spontaneous bacterial peritonitis requires an early diagnosis to start antibiotic therapy. The ideal diagnostic study is the cytochemical of ascites fluid, which can be expensive, delayed and of limited availability in primary health care centers. OBJECTIVE: Evaluate the usefulness and diagnostic accuracy of Multistix 10SG test strips for the diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites. MATERIALS AND METHODS: Observational descriptive study of diagnostic test in cirrhotic patients with ascites. The leukocyte count of ascites fluid was determined by the colorimetric scale of the Multistix 10SG test strip and compared with the gold standard for diagnosis (polymorphonuclear ≥ 250 cells / mm³). RESULTS: Of 174 patients with ascites (51.7% women, average age 59 years) 30 were diagnosed with spontaneous bacterial peritonitis. With a grade ++ cut-off point, the test strip had sensitivity 73.3%, specificity 96.5%, positive predictive value 81.4%, negative predictive value 94.5%, positive likelihood ratio 21.2 and negative likelihood ratio of 0.27. CONCLUSIONS: The test strips have adequate specificity and negative predictive value, being a low cost tool, simple use, quick interpretation and easy access, to support the decision not to start an antibiotic in patients with ascites and suspected spontaneous bacterial peritonitis. Due to their low sensitivity they do not replace the cytochemical study as the test of choice for the definitive diagnosis, but it is useful for optimizing the initial approach of these patients.

Fístula biliopleurobronquial: reporte de un caso / Bronchobiliary fistula: Report of a case

La fístula biliopleurobronquial (FBB) es una comunicación anormal entre la vía biliar y el árbol bronquial. Es una condición infrecuente, generalmente secundaria a un proceso infeccioso local o a un evento traumático. La bilioptisis es patognomónica. Presentamos el caso de una mujer de 37 años con historia de cirrosis biliar secundaria, en lista para trasplante hepático, con múltiples episodios de colangitis previos y usuaria de derivación biliar externa, quien curso con bilioptisis y mediante gammagrafía HIDA con SPECT se confirmó fistula biliopleurobronquial. Éste caso se resolvió con derivación percutánea de la vía biliar

Bronchobiliary fistula (BBF) is an abnormal communication between the biliary tract and the bronchial tree. Is an infrequent condition, usually secondary to a local infectious process or a traumatic event. Bilioptisis is pathognomonic. We present the case of a 37 year old woman with secondary biliary cirrhosis, in list for liver transplantation, with several episodes of cholangitis and carrier of external biliary diverivation, who presented bilioptisis and HIDA scintigraphy with SPECT confirmed BBF. This case was resolved with percutaneous derivation of the biliary tract

Modification of titanium alloys surface properties by plasma electrolytic oxidation (PEO) and influence on biological response.

Surface characteristics can mediate biological interaction improving or affecting the tissue integration after implantation of a biomaterial. Features such as topography, wettability, surface energy and chemistry can be key determinants for interactions between cells and materials. Plasma electrolytic oxidation (PEO) is a technique used to control this kind of parameters by the addition of chemical species and the production of different morphologies on the surfaces of titanium and its alloys. With the purpose to improve the biological response, surfaces of c.p titanium and Ti6Al4V were modified by using PEO. Different electrolytes, voltages, current densities and anodizing times were tested in order to obtain surfaces with different characteristics. The obtained materials were characterized by different techniques such as X-ray diffraction (XRD), scanning electron microscopy (SEM) and glow discharge optical emission spectroscopy (GDOES). Wettability of the obtained surfaces were measured and the corresponding surface energies were calculated. Superhydrophilic surfaces with contact angles of about 0 degrees were obtained without any other treatment but PEO and this condition in some cases remains stable after several weeks of anodizing; crystal phase composition (anatase-rutile) of the anodic surface appears to be critical for obtaining this property. Finally, in order to verify the biological effect of these surfaces, osteoblast were seeded on the samples. It was found that cell behavior improves as SFE (surface free energy) and coating porosity increases whereas it is affected negatively by roughness. Techniques for surface modification allow changes in the coatings such as surface energy, roughness and porosity. As a consequence of this, biological response can be altered. In this paper, surfaces of c.p Ti and Ti6Al4V were modified by using plasma electrolytic oxidation (PEO) in order to accelerate the cell adhesion process.

[Bronchobiliary fistula. Report of a case]. / Fístula biliopleurobronquial: reporte de un caso.

Bronchobiliary fistula (BBF) is an abnormal communication between the biliary tract and the bronchial tree. Is an infrequent condition, usually secondary to a local infectious process or a traumatic event. Bilioptisis is pathognomonic. We present the case of a 37 year old woman with secondary biliary cirrhosis, in list for liver transplantation, with several episodes of cholangitis and carrier of external biliary diverivation, who presented bilioptisis and HIDA scintigraphy with SPECT confirmed BBF. This case was resolved with percutaneous derivation of the biliary tract.

Guía de práctica clínica para la enfermedad hepática grasa no alcohólica / Clinical practice guideline for nonalcoholic fatty liver disease

Objetivo: brindar una guía de práctica clínica basada en la evidencia más reciente para el diagnóstico y tratamiento de la enfermedad hepática grasa no alcohólica teniendo en cuenta la efectividad y seguridad de las intervenciones dirigidas a pacientes, personal asistencial, administrativo y entes gubernamentales de cualquier servicio de atención en Colombia. Materiales y métodos: esta guía fue desarrollada por un equipo multidisciplinario con apoyo de la Asociación Colombiana de Gastroenterología, el Grupo Cochrane ITS y el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas clínicas relevantes y se realizó la búsqueda de guías nacionales e internacionales en bases de datos especializadas. Las guías existentes fueron evaluadas en términos de calidad y aplicabilidad; una guía cumplió los criterios de adaptación, por lo que se decidió adaptar 3 preguntas clínicas. El Grupo Cochrane realizó la búsqueda sistemática de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas con base en la metodología GRADE. Las recomendaciones de la guía fueron socializadas en una reunión de expertos con entes gubernamentales y pacientes. Resultados: se desarrolló una guía de práctica clínica basada en la evidencia para el diagnóstico y tratamiento de la enfermedad hepática grasa no alcohólica en Colombia. Conclusiones: el diagnóstico y manejo oportuno de la enfermedad hepática grasa no alcohólica contribuirá a disminuir la carga de la enfermedad en Colombia, así como de las enfermedades asociadas.

Objective: To provide a clinical practice guideline with the latest evidence for diagnosis and treatment of nonalcoholic fatty liver disease for patients, caregivers, administrative and government bodies at all levels of care in Colombia. Materials and Methods: This guide was developed by a multidisciplinary team with the support of the Colombian Association of Gastroenterology, Cochrane STI Group and Clinical Research Institute of the Universidad Nacional de Colombia. Relevant clinical questions were developed and the search for national and international guidelines in databases was performed. Existing guidelines were evaluated about quality and applicability. One guideline met the criteria for adaptation, so the group decided to adapt 3 clinical questions. Systematic literature searches were conducted by the Cochrane Group. The tables of evidence and recommendations were made based on the GRADE methodology. The recommendations of the guide were socialized in a meeting of experts with government agencies and patients. Results: An evidence-based Clinical Practice Guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease was developed for the Colombian context. Conclusions: The opportune detection and appropriate management of nonalcoholic fatty liver disease would contribute to the burden of the disease in Colombia.

Osseointegration improvement by plasma electrolytic oxidation of modified titanium alloys surfaces.

Titanium (Ti) is a material frequently used in orthopedic applications, due to its good mechanical properties and high corrosion resistance. However, formation of a non-adherent fibrous tissue between material and bone drastically could affect the osseointegration process and, therefore, the mechanical stability of the implant. Modifications of topography and configuration of the tissue/material interface is one of the mechanisms to improve that process by manipulating parameters such as morphology and roughness. There are different techniques that can be used to modify the titanium surface; plasma electrolytic oxidation (PEO) is one of those alternatives, which consists of obtaining porous anodic coatings by controlling parameters such as voltage, current, anodizing solution and time of the reaction. From all of the above factors, and based on previous studies that demonstrated that bone cells sense substrates features to grow new tissue, in this work commercially pure Ti (c.p Ti) and Ti6Al4V alloy samples were modified at their surface by PEO in different anodizing solutions composed of H2SO4 and H3PO4 mixtures. Treated surfaces were characterized and used as platforms to grow osteoblasts; subsequently, cell behavior parameters like adhesion, proliferation and differentiation were also studied. Although the results showed no significant differences in proliferation, differentiation and cell biological activity, overall results showed an important influence of topography of the modified surfaces compared with polished untreated surfaces. Finally, this study offers an alternative protocol to modify surfaces of Ti and their alloys in a controlled and reproducible way in which biocompatibility of the material is not compromised and osseointegration would be improved.

Tratamiento intervencionista / Interventional treatment

Con el advenimiento de la terapia intervencionista se dio campo a una modalidad más de tratamiento que podría brindar la oportunidad a aquellos pacientes que por diferentes motivos no podían ser llevados a tratamientos quirúrgicos. De esta forma, las terapias locorregionales (ablación percutánea y quimioembolización) se han constituido en un apoyo como terapias curativas y paliativas en pacientes sin otra opción. Sin embargo, las terapias locorregionales deben estar enmarcadas en la estratificación clínica del CHC, que nos permite estimar la expectativa de vida, el mejor tratamiento para su estadio y un balance de riesgos y beneficios del tratamiento escogido.

The advent of interventional therapy has given a wider field to a form of treatment that could provide an opportunity to those patients who, for various reasons, cannot undergo surgical treatments. Thus, local and regional therapies such as percutaneous ablation and chemoembolization have become supporting curative and palliative therapies for patients with no other choice. However, local and regional therapies should be framed within the clinical stratification of HCC which allows us to estimate the life expectancy and the best treatment for the patient’s stage and the balance of risks and benefits of the treatment chosen.

Enfermedad hepática por infiltración grasa no alcohólica: la nueva pandemia del milenio: [revisión] / Non alcoholic fatty liver disease: the new millennium pandemia: [review]

La enfermedad hepática por infiltración grasa no alcohólica (NAFLD) es la más frecuente en las sociedades desarrolladas, comprometiendo 2-8% de la población general, y en las nuestras está en camino de serlo. Es generalmente asintomática o con síntomas y signos inespecíficos como fatiga, hepatomegalia y dolor, o sensación de peso en el hígado. El diagnóstico se sospecha en presencia de pruebas hepáticas o imágenes diagnósticas anormales. La biopsia hepática es el estándar diagnóstico. Existe una clara relación con la obesidad, la diabetes tipo 2, el síndrome metabólico y la resistencia a la insulina. Aproximadamente, 20-25% de los pacientes progresan a cirrosis y sus complicaciones, incluyendo el carcinoma hepatocelular y la necesidad de un trasplante hepático. La corrección de la resistencia a la insulina con modificaciones dietéticas y el aumento de la actividad física es generalmente beneficiosa. La efectividad de los múltiples medicamentos disponibles está por demostrarse.

Non-alcoholic liver disease (NAFLD) is the most common liver disease in affluent societies, affecting 2-8% of the general population, and it will be soon in our societies. It is generally asymptomatic or with a no specific picture of fatigue, hepatic pain or discomfort and hepatomegaly. It is suspected in cases with aminotransferase or imaging abnormalities. Liver biopsy is considered the gold standard for diagnosis. There is a close pathogenic relationship with obesity, type 2 diabetes, hyperlipidemia, metabolic syndrome and insulin resistance. Approximately 20-25% of the cases progress into cirrhosis with all its complications including hepatocellular carcinoma and the need for liver transplantation. Correction of insulin resistance with dietary measures and physical activity is generally beneficial. The efficacy of the multiple medications available remains to be demonstrated.

European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): part II.

OBJECTIVES: The first consensus report that had been presented by the European Germ Cell Cancer Consensus Group (EGCCCG) in 2004 has found widespread approval by many colleagues throughout the world. In November 2006, the group met a second time under the auspices of the Department of Urology of the Amsterdam Medical Center, The Netherlands. METHODS: Medical oncologists, urologic surgeons, radiation oncologists as well as pathologists from several European countries reviewed and discussed the data that had emerged since the 2002 conference and incorporated the new data into updated and revised guidelines. As for the first meeting the methodology of evidence-based medicine (EBM) was applied. The results of the discussion were compiled by the writing committee. All participants have agreed to this final update. RESULTS: The second part of the consensus paper includes the treatment of metastasised disease, residual tumour resection, salvage therapy, follow-up, and late toxicities. CONCLUSIONS: Whereas the vast majority of the recommendations made in 2004 remain valid 3 yr later, refinements in the treatment of early-stage as well as of advanced-stage testicular cancer have emerged from clinical trials. Despite technical improvements, expert clinical skills will continue to be one of the major determinants for the prognosis of patients with germ cell cancer. In addition, the particular needs of testicular cancer survivors have been acknowledged.

European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part I.

OBJECTIVES: The first consensus report presented by the European Germ Cell Cancer Consensus Group (EGCCCG) in the year 2004 has found widespread approval by many colleagues throughout the world. In November 2006, the group met a second time under the auspices of the Department of Urology of the Amsterdam Medical Center, Amsterdam, The Netherlands. METHODS: Medical oncologists, urological surgeons, radiation oncologists as well as pathologists from several European countries reviewed and discussed the data that had emerged since the 2002 conference, and incorporated the new data into updated and revised guidelines. As for the first meeting, the methodology of evidence-based medicine (EBM) was applied. The results of the discussion were compiled by the writing committee. All participants have agreed to this final update. RESULTS: The first part of the consensus paper describes the clinical presentation of the primary tumor, its treatment, the importance and treatment of testicular intraepithelial neoplasia (TIN), histological classification, staging and prognostic factors, and treatment of stage I seminoma and non-seminoma. CONCLUSIONS: Whereas the vast majority of the recommendations made in 2004 remain valid 3 yr later, refinements in the treatment of early- and advanced-stage testicular cancer have emerged from clinical trials. Despite technical improvements, expert clinical skills will continue to be one of the major determinants for the prognosis of patients with germ cell cancer. In addition, the particular needs of testicular cancer survivors have been acknowledged.

[Local anesthesia significantly improves the tolerance of prostate biopsy]. / La anestesia local mejora significativamente la tolerancia de la biopsia prostática.

UNLABELLED: Transrectal biopsy is one of the most frequent procedures in urological practice. Generally, transrectal biopsies have been practiced without anesthesia, because of a supposed good tolerance. Nevertheless, it is not infrequent to find patients with a high level of pain and adverse effects attributable to such procedure. OBJECTIVES: In the present article the effect of transrectal local anesthesia in order to significantly diminish the perception of pain by the patient is evaluated. METHODS: A total of 131 consecutive patients undergoing transrectal prostate biopsy are included in the study. After randomization, 76 patients were biopsiated with anesthesia and 55 represent the control group. Cases and control groups do not differ in age or prostate volume. Anesthesia consisted on a periprostatic nerve blockage with injection of 5 cc of 1% mepivacaine solution in the angle between prostate and seminal vesicles bilaterally. A visual analogical scale for pain was used; it was given to the patient at the end of the procedure. RESULTS: Mean pain value was 2.41 with a median of 2.0 in the group with anesthesia, and 4.02 with a median of 4 in the control group. A Student's t test comparing the means showed a statistically significant difference of 1.61 (p < 0.0001). Pain in the scale was 66% greater in the control group. CONCLUSION: The use of anesthesia in the performance of transrectal biopsies significantly diminishes the perception of pain by patients. This effect, along with the tendency to increase the number of biopsies, will result in short time in a more generalized use of local anesthesia.

La anestesia local mejora significativamente la tolerancia de la biopsia prostática / Local anesthesia significantly improves the tolerance of prostate biopsy

La biopsia transrectal es uno de los procedimientos mas frecuentes en la práctica urológica. Usualmente las biopsias transrectales se han practicado sin administrarse anestesia, ante la consideración de una buena tolerancia. Sin embargo no es infrecuente encontrarnos ante pacientes con un nivel del dolor alto e incluso efectos adversos atribuibles al mismo. OBJETIVO: Se evalúa en el presente trabajo si la anestesia local transrectal puede disminuir significativamente la percepción del dolor por el paciente. MÉTODOS: Se incluyen en el siguiente estudio 131 pacientes consecutivos y sometidos a biopsia transrectal. Efectuándose la randomización 76 pacientes fueron biopsiados con anestesia y 55 representan el grupo control. Casos y controles no difieren en edad ni volumen prostático. La anestesia se efectuó administrándose 10 cc del anestésico mepivacaína al 1%, 5 cc en cada lado en el ángulo entre la próstata y las vesículas seminales. Se empleó una escala analógica y visual del dolor que se suministró al paciente una vez acabado el procedimiento. RESULTADOS: En el grupo de pacientes anestesiados la media de valoración del dolor fue de 2,41 con una mediana de 2 y en el grupo control se obtuvo una media de 4,02 con una mediana de 4. Se realizó test de comparación de medias (t de Student), obteniéndose entre los grupos una diferencia estadísticamente significativa de 1,61 (< 0,0001). Porcentualmente encontramos una diferencia en la escala del dolor de un 66 % más en el grupo control. CONCLUSIÓN: La utilización de anestesia en la realización de las biopsias transrectales disminuye significativamente la percepción del dolor por los pacientes. Este efecto junto a la tendencia en incrementar el número de biopsias, generalizará en poco tiempo el empleo de la anestesia local

Transrectal biopsy is one of the most frequent procedures in urological practice. Generally, transrectal biopsies have been practiced without anesthesia, because of a supposed good tolerance. Nevertheless, it is not infrequent to find patients with a high level of pain and adverse effects attributable to such procedure. OBJECTIVES: In the present article the effect of transrectal local anesthesia in order to significantly diminish the perception of pain by the patient is evaluated. METHODS: A total of 131 consecutive patients undergoing transrectal prostate biopsy are included in the study. After randomization, 76 patients were biopsiated with anesthesia and 55 represent the control group. Cases and control groups do not differ in age or prostate volume. Anesthesia consisted on a periprostatic nerve blockage with injection of 5 cc of 1% mepivacaine solution in the angle between prostate and seminal vesicles bilaterally. A visual analogical scale for pain was used; it was given to the patient at the end of the procedure. RESULTS: Mean pain value was 2.41 with a median of 2.0 in the group with anesthesia, and 4.02 with a median of 4 in the control group. A Student´s t test comparing the means showed a statistically significant difference of 1.61 (p<0.0001). Pain in the scale was 66% greater in the control group. CONCLUSION: The use of anesthesia in the performance of transrectal biopsies significantly diminishes the perception of pain by patients. This effect, along with the tendency to increase the number of biopsies, will result in short time in a more generalized use of local anesthesia

Factor de impacto / Impact factor

El Factor de Impacto es un índice bibliométrico utilizado para medir la calidad de las revistas y de los artículos, pero tiene limitaciones, y no puede ser el único. No se debe sobrevalorar la cantidad de veces que, por distintas circunstancias, ha sido citado un artículo, sin medir la real calidad de la investigación o del trabajo

[Penile tunica albuginea plication for the treatment of penile curvature secondary Peyronie's disease]. / Plicatura de la albugínea como tratamiento de la incurvación de pene causada por la enfermedad de Peyronie.

OBJECTIVE: To evaluate, in a retrospective analysis, our long-term results of patients undergoing the Essed plication procedure for the correction of penile curvature due to Peyronie's disease. METHODS: Between January 1998 and June 2003, 83 patients with acquired penile deviation were treated with the Essed technique in our hospital. We analyse the following data: age, main complaint, type of deviation, erection before and after the surgery, physical exploration, ecographic data, complications and results. RESULTS: Mean follow-up was 36 months. Main complaint was penile curvature in 96.3% of patients. The most frequent types of deviation were dorsal (55.4%) and left lateral (48.1%). Erection before surgery was sufficient for sexual intercourse in 74.7%. Physical exploration revealed a plaque in 79.5% of the patients. 93% of the cases reported complete penile curvature correction or residual deviation < 10 degrees. 65.1% of the patients were satisfied or very satisfied with the result of the operation and 64% were able to perform sexual intercourse. CONCLUSIONS: The Essed plication is a simple and minimally invasive method for correcting acquired penile deviation. Although functional results seem to be satisfactory, in our experience the degree of satisfaction with the outcome is not as good, among the patients, as it could be expected.

Hepatitis B: Diagnóstico y manejo / Hepatitis B: Diagnose and managing

La infección por hepatitis B, junto a la Hepatitis C y la enfermedad hepática por alcohol, son las principales causas de cirrosis y hepatocarcinoma en el mundo con alta morbi-mortalidad. Recientemente, se han publicado las guías, para el diagnóstico y tratamiento de los pacientes con Hepatitis crónica por Virus B, de varias asociaciones científicas: La Asociación Americana para el estudio de las enfermedades hepáticas (AASLD), la Asociación Europea para el estudio del Hígado (EASL), la Asociación del Asia Pacífico para el estudio del hígado (APASL) y la Asociación Gastroenterológica Americana (AGA). Nosotros revisamos, basados en estas guías, el diagnóstico y la terapia actual para la hepatitis B crónica

Plicatura de la albugínea como tratamiento de la incurvación de pene causada por la enfermedad de Peyronie / Penile tunica albuginea plication for the treatment of penile curvature secondary Peyronie´s disease

OBJETIVO: Evaluar nuestros resultados enel tratamiento de la incurvación peneana causada porla enfermedad de Peyronie mediante la plicatura albugíneadescrita por Essed.MÉTODOS:Revisión retrospectiva de los 83 pacientestratados quirúrgicamente de incurvación peneanaadquirida en nuestro centro mediante la técnica de plicaturaentre enero de 1998 y junio de 2003, analizandolas siguientes variables: edad, motivo de consulta,antecedentes personales, exploración física,datos ecográficos, tipo de incurvación, erección pre ypostcirugía, complicaciones y resultados de la técnicaquirúrgica.RESULTADOS:El seguimiento medio fue de 36 meses.El motivo de consulta principal fue la desviación peneanaen erección (96,3%). El tipo de incurvación másfrecuente fue dorsal (55,4%) y lateral izquierda(48,1%). La erección previa a la cirugía era suficientepara mantener una relación sexual en el 74,7% de lospacientes. La exploración física reveló la existencia deplaca en el 79,5% de los casos. En cuanto a los resultadosde la cirugía, el 93% refieren una correccióncompleta de la incurvación o una desviación residualmenor de 10º. El 65,1% manifestaron encontrarse satisfechoso muy satisfechos con la operación, mientrasque el 64% eran capaces de llevar a cabo una relaciónsexual.CONCLUSIONES: La plicatura de Essed es un procedimientosencillo y mínimamente invasivo para corregirla desviación adquirida de pene. En nuestra experiencia,aunque los resultados funcionales parecen ser buenos,el grado de satisfacción entre los pacientes tras lacirugía no es tan alto como cabría esperar

OBJETIVE: To evaluate, in a retrospective analysis, our long term results of patients undergoing the Essed plication procedure for the correction of penile curvature due to Peyronie´s disease. METHODS: Between January 1998 and June 2003, 83 patients with acquired penile deviation were treated with the Essed technique in our hospital. We analyse the following data: age, main complaint, type of deviation, erection before and after the surgery, physical exploration, ecographic data, complications and results. RESULTS: Mean follow-up was 36 months. Main complaint was penile curvature in 96.3% of patients. The most frequent types of deviation were dorsal (55.4%) and left lateral (48.1%). Erection before surgery was sufficient for sexual intercourse in 74.7%. Physical exploration revealed a plaque in 79.5% of the patients. 93% of the cases reported complete penile curvature correction or residual deviation < 10º. 65.1% of the patients were satisfied or very satisfied with the result of the operation and 64% were able to perform sexual intercourse. CONCLUSIONS: The Essed plication is a simple and minimally invasive method for correcting acquired penile deviation. Although functional results seem to be satisfactory, in our experience the degree of satisfaction with the outcome is not as good, among the patients, as it could be expected