Pandemia COVID-19: impacto y reacción rápida de la Urología / COVID-19 Pandemic: Impact and rapid reaction of Urology

La pandemia COVID-19 causada por el virus SARS-CoV-2 ha ocasionado decenas de miles de muertos en España y logrado colapsar los hospitales de la red sanitaria en la Comunidad de Madrid, debido en gran parte a su particular tendencia a causar neumonías graves con necesidad de soporte ventilatorio. Este hecho ha ocasionado el colapso de nuestro centro, llegando a tener una ocupación del 130% de sus camas por enfermos COVID-19, y causando por tanto el cese absoluto de actividad del servicio de urología, la práctica desaparición de la docencia de los residentes y la incorporación de buena parte de la plantilla de urología al grupo de personal médico que atiende a estos pacientes. Para la recuperación de esta elevada cantidad de actividad suspendida será necesaria una priorización de la patología en base a criterios puramente clínicos, para la cual se proponen tablas que recogen la relevancia de cada patología dentro de cada área de la urología. Herramientas brindadas por la tecnología como la formación online o los simuladores quirúrgicos podrán ser útiles para la necesaria restitución de la formación de residentes

The COVID-19 pandemic caused by the SARS-CoV-2 virus has caused tens of thousands of deaths in Spain and has managed to breakdown the healthcare system hospitals in the Community of Madrid, largely due to its tendency to cause severe pneumonia, requiring ventilatory support. This fact has caused our center to collapse, with 130% of its beds occupied by COVID-19 patients, thus causing the absolute cessation of activity of the urology service, the practical disappearance of resident training programs, and the incorporation of a good part of the urology staff into the group of medical personnel attending these patients. In order to recover from this extraordinary level of suspended activity, we will be obliged to prioritize pathologies based on purely clinical criteria, for which tables including the relevance of each pathology within each area of urology are being proposed. Technology tools such as online training courses or surgical simulators may be convenient for the necessary reestablishment of resident education

[COVID-19 Pandemic: Impact and rapid reaction of Urology]. / Pandemia COVID-19: impacto y reacción rápida de la Urología.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has caused tens of thousands of deaths in Spain and has managed to breakdown the healthcare system hospitals in the Community of Madrid, largely due to its tendency to cause severe pneumonia, requiring ventilatory support. This fact has caused our center to collapse, with 130% of its beds occupied by COVID-19 patients, thus causing the absolute cessation of activity of the urology service, the practical disappearance of resident training programs, and the incorporation of a good part of the urology staff into the group of medical personnel attending these patients. In order to recover from this extraordinary level of suspended activity, we will be obliged to prioritize pathologies based on purely clinical criteria, for which tables including the relevance of each pathology within each area of urology are being proposed. Technology tools such as online training courses or surgical simulators may be convenient for the necessary reestablishment of resident education.

Análisis de cuestionario de salud y desarrollo de cuestionario de satisfacción en pacientes tratados con litotricia extracorpórea por ondas de choque (SATISLIT) / Health questionnaire analysis and development of satisfaction questionnaire for patients treated with extracorporeal shock wave lithotripsy (SATISLIT)

INTRODUCCIÓN: Debido a la ausencia de instrumentos específicos para estudiar la esfera psicosocial de los pacientes que reciben litotricia extracorpórea por ondas de choque (LEOC), el objetivo es desarrollar un cuestionario de satisfacción respecto al tratamiento recibido con LEOC a partir de un cuestionario de salud ya diseñado y validado previamente. MATERIAL Y MÉTODOS: El diseño del cuestionario de satisfacción se realizó en 5 fases a partir de una escala de salud en pacientes tratados con LEOC (ESPTL) ya validada previamente, utilizando una muestra total de 135 pacientes tratados en nuestro centro a los que se entrevistó por vía telefónica. En la fase 1 se realizó análisis descriptivo de la serie y de las puntuaciones de los 8 ítems de ESPTL. En la fase 2 se compararon las puntuaciones de ESPTL según sexo con U-Mann Whitney, estudiando la correlación con la edad mediante Rho de Spearman en la fase 3. En la fase 3 se compararon las puntuaciones de los factores de ESPTL según el sexo y se analizó la correlación con la edad al igual que en las fases 2 y 3 con la puntuación global. En la fase 5 se obtuvo la subescala de satisfacción-SATISLIT- y se realizó análisis descriptivo, comparación según sexo, correlación con la edad y modelo de regresión lineal con respecto a ESPTL. RESULTADOS: Ciento treinta y cinco pacientes, 85 (63%) hombres, 50 (37%) mujeres. Mediana (mínimo-máximo) de edad 56 (27-79) y puntuación ESPTL 31 (8-39). Diferencias en puntuación global ESPTL entre hombres y mujeres (p < 0,001), así como en los ítems 1 (p = 0,029), 3 (p = 0,002), 6 (p = 0,006), 7 (p = 0,005) y 8 (p = 0,025). Correlación no significativa de ESPTL con la edad. Significativa en ítems 2, 4, 5 y 8 pero correlación muy débil (< 0,2). Cuatrofactores con 2 ítems cada uno, con diferencias estadísticamente significativas según sexo en F2 (p = 0,001), F3 (p = 0,007) y F4 (p = 0,001). Correlación significativa con la edad únicamente en F1 y F3 pero muy débil (< 0,2). Mediana (mínimo-máximo) SATISLIT 18 (4-20). Diferencias estadísticamente significativas según sexo (p = 0,001). Correlación no significativa con la edad (p = 0,836). Regresión lineal de SATISLIT con respecto a ESPTL significativa (p < 0,001). CONCLUSIONES: El trabajo realizado a partir de un cuestionario validado de salud ha proporcionado un nuevo instrumento de evaluación de la satisfacción tras tratamiento con LEOC llamado SATISLIT. Serán necesarios futuros estudios de validación externa y validación temporal para contrastar su verdadera utilidad clínica

INTRODUCTION: Due to the absence of specific instruments to study the psychosocial sphere of patients undergoing extracorporeal shock wave lithotripsy (SWL), the objective of this study is to develop a satisfaction questionnaire regarding the SWL treatment from a health questionnaire which was already designed and had been previously validated. MATERIAL AND METHODS: The design of the satisfaction questionnaire was carried out in 5 phases, based on a previously validated health scale in patients treated with SWL (ESPTL), including a total cohort of 135 patients treated at our center who received a phone interview. Phase 1: descriptive analysis of the series and scores of the 8 items of ESPTL. Phase 2: U-Mann Whitney comparison of ESPTL based on the patients' sex. Phase 3: study of ESPTL correlation with age using Spearman's Rho. Phase 4: grouping by factors of ESPTL, comparison by sex and correlation with age, as performed in phases 2 and 3 with the global score. Phase 5: obtaining the satisfaction subscale -SATISLIT-, descriptive analysis, comparison according to sex, correlation with age and linear regression model of SATISLIT with respect to ESPTL. RESULTS: 135 patients, 85(63%) men, 50(37%) women. Median (minimum-maximum) age 56 (27-79) and ESPTL score 31 (8-39). Differences in global ESPTL score between men and women (p < .001), as well as in items 1 (p =.029), 3 (p = .002), 6 (p = .006), 7 (p = .005) and 8 (p = .025). Non-significant correlation of ESPTL regarding age. Significant correlation in items 2, 4, 5 and 8 but, very weak (< 0.2).4 factors, each one with 2 items, with statistically significant differences regarding sex in F2 (p = .001), F3 (p =.007) and F4 (p = .001). Significant correlation with age only in F1 and F3, but very weak (< 0.2). Median (minimum-maximum) SATISLIT 18 (4-20). Statistically significant differences regarding patients' sex (p =.001). Non- significant correlation with age (p =.836). Significant linear regression of SATISLIT with respect to ESPTL (p < .001). CONCLUSIONS: Based on validated health questionnaire, the present work has provided a new instrument called SATISLIT for assessing patients' satisfaction after treatment with SWL. Future studies with external and temporal validation will be necessary to contrast its real clinical usefulness

Perforación traumática aislada de la vesícula biliar: revisión de la literatura actual con reporte de un caso / Isolated gallbladder perforation following blunt abdominal trauma: literature review and case report

Resumen Introducción La lesión de la vesícula biliar secundaria a trauma abdominal cerrado constituye un evento infrecuente de perforación traumática de ella, de presentación tardía. Objetivo Revisar la literatura científica actualmente disponible y además describimos un caso. Materiales y Método Utilizando la plataforma PubMed se buscan las siguientes palabras clave: " Blunt abdominal trauma ". Se seleccionan las series con lesiones de la vesícula biliar: " Traumatic gallbladder rupture". Se seleccionan los reportes de lesiones aisladas de la vesícula biliar: " Isolated gallbladder rupture ". Se seleccionan los reportes de presentación tardía de lesiones aisladas de la vesícula biliar: " Delayed presentation of isolated gallbladder rupture ". Resultados De todas estas publicaciones se seleccionan las que a criterio de los autores son relevantes para el presente caso. Discusión La mayoría de las perforaciones de la vesícula biliar se producen en vesículas sanas de paredes delgadas distendidas por el ayuno o el consumo de alcohol. No existe una presentación clínica clásica. Los estudios imagenológicos son inespecíficos y se llega al diagnóstico definitivo durante la exploración quirúrgica. El tratamiento de esta lesión es la colecistectomía. Conclusiones El diagnóstico no es fácil, pero la resolución es relativamente simple y el pronóstico es bueno. El presente caso ilustra este tipo de lesiones en pacientes con trauma abdominal cerrado.

Introduction Gallbladder injury secondary to blunt abdominal trauma is a rare event. Aim Review the current available scientific literature and describe a case. Materials and Method Using the PubMed platform, the following keywords were searched: "Blunt abdominal trauma". Series with gallbladder lesions were selected: "Traumatic gallbladder rupture". Reports of isolated lesions of the gallbladder were selected: "Isolated gallbladder rupture". Reports of late presentation of isolated lesions of the gallbladder were selected: "Delayed presentation of isolated gallbladder rupture". Of all these publications, those that were relevant to the present case were selected according to the criteria of the authors. Case report A 20 years-old male patient suffered an abdominal trauma two weeks before presentation at our Institution. He underwent an exploratory laparotomy showing bilious content and a gallbladder perforation over the peritoneal wall as an isolated injury. Discussion Most isolated gallbladder perforations occur in healthy gallbladders with thin walls and distended because fasting or alcohol consumption. There are no classical clinical features to diagnose this specific injury and radiologic studies are nonspecific. Definitive diagnosis is often reached during surgery as it was with our patient. Recommended treatment is cholecystectomy. Conclusions This case illustrates this unique kind of gallbladder injury in patients with blunt abdominal trauma. A clear diagnosis is not easy however, the treatment is simple and prognosis is good.

Health questionnaire analysis and development of satisfaction questionnaire for patients treated with extracorporeal shock wave lithotripsy (SATISLIT). / Análisis de cuestionario de salud y desarrollo de cuestionario de satisfacción en pacientes tratados con litotricia extracorpórea por ondas de choque (SATISLIT).

INTRODUCTION: Due to the absence of specific instruments to study the psychosocial sphere of patients undergoing extracorporeal shock wave lithotripsy (SWL), the objective of this study is to develop a satisfaction questionnaire regarding the SWL treatment from a health questionnaire which was already designed and had been previously validated. MATERIAL AND METHODS: The design of the satisfaction questionnaire was carried out in 5 phases, based on a previously validated health scale in patients treated with SWL (ESPTL), including a total cohort of 135 patients treated at our center who received a phone interview. Phase 1: descriptive analysis of the series and scores of the 8 items of ESPTL. Phase 2: U-Mann Whitney comparison of ESPTL based on the patients' sex. Phase 3: study of ESPTL correlation with age using Spearman's Rho. Phase 4: grouping by factors of ESPTL, comparison by sex and correlation with age, as performed in phases 2 and 3 with the global score. Phase 5: obtaining the satisfaction subscale -SATISLIT-, descriptive analysis, comparison according to sex, correlation with age and linear regression model of SATISLIT with respect to ESPTL. RESULTS: 135 patients, 85(63%) men, 50(37%) women. Median (minimum-maximum) age 56 (27-79) and ESPTL score 31 (8-39). Differences in global ESPTL score between men and women (p <.001), as well as in items 1 (p =.029), 3 (p =.002), 6 (p =.006), 7 (p =.005) and 8 (p =.025). Non-significant correlation of ESPTL regarding age. Significant correlation in items 2, 4, 5 and 8 but, very weak (<0.2). 4 factors, each one with 2 items, with statistically significant differences regarding sex in F2 (p =.001), F3 (p =.007) and F4 (p =.001). Significant correlation with age only in F1 and F3, but very weak (<0.2). Median (minimum-maximum) SATISLIT 18 (4-20). Statistically significant differences regarding patients' sex (p =.001). Non- significant correlation with age (p =.836). Significant linear regression of SATISLIT with respect to ESPTL (p <.001). CONCLUSIONS: Based on validated health questionnaire, the present work has provided a new instrument called SATISLIT for assessing patients' satisfaction after treatment with SWL. Future studies with external and temporal validation will be necessary to contrast its real clinical usefulness.

[COVID-19 Pandemic: Impact and rapid reaction of Urology]. / Pandemia COVID-19: impacto y reacción rápida de la Urología.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has caused tens of thousands of deaths in Spain and has managed to breakdown the healthcare system hospitals in the Community of Madrid, largely due to its tendency to cause severe pneumonia, requiring ventilatory support. This fact has caused our center to collapse, with 130% of its beds occupied by COVID-19 patients, thus causing the absolute cessation of activity of the urology service, the practical disappearance of resident training programs, and the incorporation of a good part of the urology staff into the group of medical personnel attending these patients. In order to recover from this extraordinary level of suspended activity, we will be obliged to prioritize pathologies based on purely clinical criteria, for which tables including the relevance of each pathology within each area of urology are being proposed. Technology tools such as online training courses or surgical simulators may be convenient for the necessary reestablishment of resident education.

Impacto de la pandemia COVID-19 en el servicio de urología de un centro de referencia en la Comunidad de Madrid / Impact of the COVID-19 pandemic on the urology service of a tertiary referral center in the Community of Madrid

La pandemia COVID-19 causada por el virus SARS-CoV-2 ha causado decenas de miles de muertos en España y logrado colapsar los hospitales de la red sanitaria en la Comunidad de Madrid, debido en gran parte a su particular tendencia a causar neumonías graves con necesidad de soporte ventilatorio. Este hecho ha ocasionado el colapso de nuestro centro, llegando a tener una ocupación del 130% de sus camas por enfermos COVID-19, y causando por tanto el cese absoluto de actividad del servicio de urología, la práctica desaparición de la docencia de los residentes y la incorporación de buena parte de la plantilla de urología al grupo de personal médico que atiende a estos pacientes. Para la recuperación de esta elevada cantidad de actividad suspendida será necesaria una priorización de la patología en base a criterios puramente clínicos, para la cual se proponen tablas que recogen la relevancia de cada patología dentro de cada área de la urología. Herramientas brindadas por la tecnología como la formación online o los simuladores quirúrgicos podrán ser útiles para la necesaria restitución de la formación de residentes

The COVID-19 pandemic caused by the SARS-CoV-2 virus has caused tens of thousands of deaths in Spain and has managed to breakdown the healthcare system hospitals in the Community of Madrid, largely due to its tendency to cause severe pneumonia, requiring ventilatory support. This fact has caused our center to collapse, with 130% of its beds occupied by COVID-19 patients, thus causing the absolute cessation of activity of the urology service, the practical disappearance of resident training programs, and the incorporation of a good part of the urology staff into the group of medical personnel attending these patients. In order to recover from this extraordinary level of suspended activity, we will be obliged to prioritize pathologies based on purely clinical criteria, for which tables including the relevance of each pathology within each area of urology are being proposed. Technology tools such as online training courses or surgical simulators may be convenient for the necessary reestablishment of resident education

Evaluation of new biomarkers of stress in saliva of sheep.

Some routine handling procedures can produce stress in farm animals, and an adequate control of these stressors is important to avoid the negative effects on animal health and production. The measurement of biomarkers in saliva can be a suitable tool for the evaluation and control of stress. In this report, lipase, butyrylcholinesterase (BChE), total esterase (TEA) and adenosine deaminase (ADA) activities in the saliva of sheep were evaluated as biomarkers of stress. For this purpose, they were measured after inducing stress by facing a dog (experiment 1) and shearing (experiment 2), and comparing them to other stress salivary biomarkers such as α-amylase (sAA) and cortisol, as well as heart rate (HR). Each analyte was measured at the basal time, and during and just after the end of the stressful stimulus, and at various times for the first hour after the period of stress induction. Values were compared with those obtained from a control group. Lipase was the only analyte that showed significant changes between the stress and the control group in both experiments. Although TEA and ADA increased after stress, no significant differences were seen compared with the control group. Lipase was correlated highly with sAA and HR, in experiment 1; and correlated moderately with cortisol and HR in experiment 2. Lipase showed the greatest percentage increase after the stressful stimuli and less overlap with the control group in the two experiments. From the results of this study it can be concluded that lipase, TEA, BChE and ADA are enzymes present in the saliva of sheep and that they can be measured by using simple and fast colorimetric methods. Further studies should be undertaken with regard to the possible application of lipase as a biomarker of stress in sheep.

Utilidad de la ecotomografía doppler en el diagnóstico de la arteritis de células gigantes / Utility of the doppler ultrasound in the diagnostic approach of giant cell arteritis

Resumen: La arteritis de células gigantes es una vasculitis sistémica frecuente, especialmente en mayores de 50 años. Ante la sospecha clínica el diagnóstico debe ser confirmado con histología o estudios de imágenes. La biopsia de arteria temporal se considera el gold standard, sin embargo, tiene sus limitaciones, una de ellas es la alta tasa de falsos negativos. El estudio por ecotomografía Doppler permite la visualización de las arterias temporales y en manos experimentadas puede constituir un procedimiento diagnóstico alternativo a la biopsia en el estudio inicial de esta entidad. Esta técnica es de fácil acceso, bajo costo, sin riesgos y no expone al paciente a radiación ionizante. En este trabajo revisamos la utilidad clínica de la ecotomografía Doppler en el estudio de la arteria temporal y sus hallazgos imagenológicos en la aproximación diagnóstica a la arteritis de células gigantes, siendo las características de compromiso el engrosamiento parietal arterial hipoecogénico, habitualmente concéntrico, no compresible.

Abstract: Giant cell arteritis is a frequent systemic vasculitis, especially in patients older than 50 years old. When clinically suspected, the diagnosis should be made on the basis of histology or imaging methods. Temporal artery biopsy is considered the gold standard for the diagnosis but it has some caveats, especially the existence of false negatives. Doppler ultrasound study is a low cost, accessible tool that allows visualization of temporal arteries and, in experienced hands, can replace the biopsy in the initial evaluation of the disease, without the risks of ionizing radiation. In this article we review the clinical utility of the temporal artery Doppler ultrasound and its findings in the diagnostic approach of giant cell arteritis, being characteristic a non-compressible, hypoechoic, most commonly concentric arterial wall thickening.

Deber ético del radiólogo: confidencialidad y secreto médico, respeto a la intimidad y dignidad del paciente / Radiologists' duties: confidentiality and professional secrecy, respect for patients' dignity and intimacy

La práctica médica debe estar siempre enmarcada en un ejercicio profesional moralmente aceptable, que procure la promoción y respeto de los principios éticos fundamentales de la medicina, manteniendo el beneficio del paciente como objetivo principal. Al igual que otras especialidades, en el ejercicio de la radiología, se debe cuidar el marco ético profesional que obliga a velar por el respeto de la dignidad e intimidad de las personas y todo lo relacionado con la confidencialidad del acto médico. En el ejercicio de la radiología, al igual en que otros actos médicos, se tiene acceso a información sensible y privada de los pacientes, lo que obliga a hacer un correcto uso de ella, resguardando las normas de privacidad y secreto profesional. Se debe enseñar y sensibilizar a los alumnos y al personal que asiste en el cuidado de los pacientes, para asegurar un comportamiento acorde a las normas éticas que rigen la práctica radiológica.

An ethical and professional medical behavior, which promotes and respects the ethical principles of medicine, is a goal that should always be pursued in medical practice. In radiology, as in other medical specialties, this includes respect for patients' dignity, intimacy and confidentiality. The possibility of accessing patients' private information compels radiologists to make a correct usage of this information, in order to respect professional secrecy and privacy codes that rule medical practice. Radiologists must teach and raise awareness among their students and co-workers in health care institutions of the importance of ethical behavior in their daily practice.

Herramientas útiles y métodos de búsqueda bibliográfica en PubMed: guía paso a paso para médicos / Useful tools and methods for literature retrieval in pubmed: step-by-step guide for physicians

Developing skills to search the medical literature has potential benefits on patient care and allow physicians to better orient their efforts when answering daily clinical questions. The objective of this paper is to share useful tools for optimizing medical literature retrieval in MEDLINE using PubMed including MeSH terms, filters and connectors.

Modelos de riesgo en pacientes con carcinoma de células renales localizado / Risk models for patients with localised renal cell carcinoma

Introducción: Realizamos un análisis retrospectivo de nuestra serie para evaluar los factores influyentes en la supervivencia libre de enfermedad (SLE) y en la supervivencia cáncer-específica (SCE) en pacientes con carcinoma de células renales (CCR) localizado y realizamos unos grupos de riesgo propios. Material y métodos: Entre enero de 1990 y diciembre de 2012 fueron operados 596 pacientes con CCR localizado (tanto de células claras como papilares o cromófobos). Se analizan las variables clinicopatológicas influyentes en la SLE y en la SCE mediante modelos de regresión de Cox y con ellas se diseñan grupos de riesgo de SLE y de SCE. Resultados: La mediana de seguimiento de la serie es de 5,96 años. Al final del estudio 112 pacientes (18,8%) evidenciaron recidiva de la enfermedad, siendo la SLE del 82%, 77% y 72% a 5, 10 y 15 años respectivamente. Los factores de influencia independiente en la SLE en el estudio multivariado fueron: grado de Furhman III-IV, hematuria, afectación vascular linfática, la presencia de necrosis tumoral y el estadio patológico pT3-pT4. Por otro lado, al final del estudio 57 pacientes (9,6%) fallecieron a causa del cáncer renal, siendo la SCE del 92%, 86% y 83% a 5, 10 y 15 años respectivamente. Los factores de influencia independiente en la SCE en el estudio multivariado fueron: Grado de Furhman III-IV, afectación de la grasa perirrenal y la presencia de necrosis tumoral. Conclusiones: Además del estadio patológico pT3-pT4 en pacientes con CCR localizado son importantes otros factores, como la presencia de hematuria y la afectación vascular linfática para la SLE; y especialmente relevantes el grado de Furhman III-IV y la presencia de necrosis tumoral tanto para la SLE como para la SCE

Introduction: We conducted a retrospective analysis of our series to assess the factors that influenced disease-free survival (DFS) and cancer-specific survival (CSS) for patients with localised renal cell carcinoma (RCC). We also created our own risk groups. Material and methods: Between January 1990 and December 2012, 596 patients underwent surgery for localised RCC (clear cell, papillary or chromophobe). Using Cox regression models, we analysed the clinical-pathological variables that influenced DFS and CSS and designed risk groups for DFS and CSS with the variables. Results: The median follow-up for the series was 5.96 years. By the end of the study, 112 patients (18.8%) had a recurrence of the disease, with DFS rates of 82%, 77% and 72% at 5, 10 and 15 years, respectively. The independent factors that influenced DFS in the multivariate study were the following: A Furhman grade of 3-4, haematuria, lymphocytic or vascular invasion, the presence of tumour necrosis and a disease stage pT3-pT4. Furthermore, by the end of the study, 57 patients (9.6%) died due to renal cancer, with CSS rates of 92%, 86% and 83% at 5, 10 and 15 years, respectively. The independent factors that influenced CSS in the multivariate study were the following: A Furhman grade of 3-4, perinephric fat invasion and the presence of tumour necrosis. Conclusions: Factors in addition to the disease stage pT3-pT4 in patients with localised RCC are important, such as the presence of haematuria and lymphocytic or vascular invasion for DFS. A Furhman grade of 3-4 and the presence of tumour necrosis are especially relevant for DFS and CSS

Predicción de efectividad de litotricia extracorpórea por ondas de choque en cálculos del tracto urinario. Grupos de riesgo para precisar retratamiento / Predicting the effectiveness of extracorporeal shock wave lithotripsy on urinary tract stones. Risk groups for accurate retreatment

Introducción: La litotricia extracorpórea por ondas de choque (LEOC) es un tratamiento no invasivo, seguro y efectivo para las litiasis del tracto urinario cuya efectividad varía según la localización y el tamaño del cálculo, entre otros factores; en ocasiones es necesario realizar varias sesiones. El objetivo es tratar de predecir el éxito o fracaso conociendo previamente las variables influyentes. Material y métodos: Analizamos a 211 pacientes con TAC previa entre aquellos tratados mediante LEOC entre los años 2010 y 2014. Se estudian las variables influyentes en la necesidad de retratamiento utilizando modelos de regresión logística binaria (estudio uni- y multivariado): densidad máxima, diámetro máximo, área, localización, desintegración y distancia del panículo adiposo. Con las variables influyentes se ha diseñado un modelo de riesgo valorando con regresión logística todas las posibles combinaciones (IBM SPSS versión 20.0). Resultados: Las variables de influencia independiente en la necesidad de retratamiento son: densidad máxima >864UH, diámetro máximo >7,5mm y localización pielocalicial. Utilizando estas variables, el mejor modelo incluye 3grupos de riesgo con probabilidades de necesitar retratamiento significativamente diferentes: grupo 1-bajo riesgo (0 variables) con 20,2%, grupo 2-riesgo intermedio (1-2 variables) con 49,2% y grupo 3-alto riesgo (3 variables) con 62,5%. Conclusiones: La densidad, el diámetro máximo y la localización pielocalicial del cálculo son factores determinantes en la efectividad del tratamiento con LEOC. Con estas variables, que se pueden obtener antes de la decisión terapéutica, el modelo de riesgo diseñado permite una aproximación precisa de cara a elegir el tratamiento más adecuado para cada caso en particular

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive, safe and effective treatment for urinary tract lithiasis. Its effectiveness varies depending on the location and size of the stones as well as other factors; several sessions are occasionally required. The objective is to attempt to predict its success or failure, when the influential variables are known beforehand. Material and methods: We analysed 211 patients who had had previous CT scans and were treated with ESWL between 2010 and 2014. The influential variables in requiring retreatment were studied using binary logistic regression models (univariate and multivariate analysis): maximum density, maximum diameter, area, location, disintegration and distance from the adipose panniculus. With the influential variables, a risk model was designed by assessing all possible combinations with logistic regression (version 20.0 IBM SPSS). Results: The independent influential variables on the need for retreatment are: maximum density > 864 HU, maximum diameter > 7.5 mm and pyelocaliceal location. Using these variables, the best model includes 3risk groups with a probability of requiring significantly different retreatment: group 1-low risk (0 variables) with 20.2%; group 2-intermediate risk (1-2 variables) with 49.2%; and group 3-high risk (3 variables) with 62.5%. Conclusions: The density, maximum diameter and pyelocaliceal location of the stones are determinant factors in terms of the effectiveness of treatment with ESWL. Using these variables, which can be obtained in advance of deciding on a treatment, the designed risk model provides a precise approach in choosing the most appropriate treatment for each particular case

Risk models for patients with localised renal cell carcinoma. / Modelos de riesgo en pacientes con carcinoma de células renales localizado.

INTRODUCTION: We conducted a retrospective analysis of our series to assess the factors that influenced disease-free survival (DFS) and cancer-specific survival (CSS) for patients with localised renal cell carcinoma (RCC). We also created our own risk groups. MATERIAL AND METHODS: Between January 1990 and December 2012, 596 patients underwent surgery for localised RCC (clear cell, papillary or chromophobe). Using Cox regression models, we analysed the clinical-pathological variables that influenced DFS and CSS and designed risk groups for DFS and CSS with the variables. RESULTS: The median follow-up for the series was 5.96 years. By the end of the study, 112 patients (18.8%) had a recurrence of the disease, with DFS rates of 82%, 77% and 72% at 5, 10 and 15 years, respectively. The independent factors that influenced DFS in the multivariate study were the following: A Furhman grade of 3-4, haematuria, lymphocytic or vascular invasion, the presence of tumour necrosis and a disease stage pT3-pT4. Furthermore, by the end of the study, 57 patients (9.6%) died due to renal cancer, with CSS rates of 92%, 86% and 83% at 5, 10 and 15 years, respectively. The independent factors that influenced CSS in the multivariate study were the following: A Furhman grade of 3-4, perinephric fat invasion and the presence of tumour necrosis. CONCLUSIONS: Factors in addition to the disease stage pT3-pT4 in patients with localised RCC are important, such as the presence of haematuria and lymphocytic or vascular invasion for DFS. A Furhman grade of 3-4 and the presence of tumour necrosis are especially relevant for DFS and CSS.

Predicting the effectiveness of extracorporeal shock wave lithotripsy on urinary tract stones. Risk groups for accurate retreatment. / Predicción de efectividad de litotricia extracorpórea por ondas de choque en cálculos del tracto urinario. Grupos de riesgo para precisar retratamiento.

INTRODUCTION: Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive, safe and effective treatment for urinary tract lithiasis. Its effectiveness varies depending on the location and size of the stones as well as other factors; several sessions are occasionally required. The objective is to attempt to predict its success or failure, when the influential variables are known beforehand. MATERIAL AND METHODS: We analysed 211 patients who had had previous CT scans and were treated with ESWL between 2010 and 2014. The influential variables in requiring retreatment were studied using binary logistic regression models (univariate and multivariate analysis): maximum density, maximum diameter, area, location, disintegration and distance from the adipose panniculus. With the influential variables, a risk model was designed by assessing all possible combinations with logistic regression (version 20.0 IBM SPSS). RESULTS: The independent influential variables on the need for retreatment are: maximum density >864HU, maximum diameter >7.5mm and pyelocaliceal location. Using these variables, the best model includes 3risk groups with a probability of requiring significantly different retreatment: group 1-low risk (0 variables) with 20.2%; group 2-intermediate risk (1-2 variables) with 49.2%; and group 3-high risk (3 variables) with 62.5%. CONCLUSIONS: The density, maximum diameter and pyelocaliceal location of the stones are determinant factors in terms of the effectiveness of treatment with ESWL. Using these variables, which can be obtained in advance of deciding on a treatment, the designed risk model provides a precise approach in choosing the most appropriate treatment for each particular case.

Combined transanal total mesorectal excision (taTME) with laparoscopic instruments and abdominal robotic surgery in rectal cancer.

Laparoscopic surgery for rectal cancer can be technically challenging. We describe a hybrid technique combining abdominal robotic dissection and transanal total mesorectal excision. This procedure was performed in a 50-year-old man with rectal adenocarcinoma at 5 cm from the dentate lane. Preoperative staging was T2N0M0. Surgery went well without complications, and estimated blood loss was less than 50 mL. Robotic surgical time was 90 min, and total operative time was 160 min. The patient was discharged on postoperative day 3. Pathology analysis revealed an intact mesorectum (TME grade 3) and a T2N0 tumor with negative margins. Hybrid surgery with pelvic robotic dissection and transanal total mesorectal excision was feasible, quick and safe in this patient and may be a method that can be developed further.

[Useful tools and methods for literature retrieval in pubmed: step-by-step guide for physicians]. / Herramientas útiles y métodos de búsqueda bibliográfica en PubMed: guía paso a paso para médicos.

Developing skills to search the medical literature has potential benefits on patient care and allow physicians to better orient their efforts when answering daily clinical questions. The objective of this paper is to share useful tools for optimizing medical literature retrieval in MEDLINE using PubMed including MeSH terms, filters and connectors.

Core mathematical abilities in infants: Number and much more.

Adults' ability to process numerical information can be traced back to the first days of life. The cognitive mechanisms underlying numerical representations are functional in preverbal infants, who are able to both track a small number of individuals and to estimate the numerosity of large sets across different modalities. This ability is closely linked to their ability to compute other quantitative dimensions such as spatial extent and temporal duration. In fact, the human mind establishes, early in life, spontaneous links between number, space, and time, which are privileged relative to links with other continuous dimensions (like loudness and brightness). Finally, preverbal infants do not only associate numbers to corresponding spatial extents but also to different spatial positions along a spatial axis. It is argued that these number-space mappings are at the origins of the "mental number line" representation, which is already functional in the first year of life.

Transanal Hartmann reversal: a new technique.

BACKGROUND: Hartmann procedure consists in a sigmoidectomy followed by a terminal colostomy. However, the stoma is associated with complications and suboptimal quality of life, so the restoration of colonic continuity should be, at least, considered in any case. Open restoration has been associated with significant morbidity and mortality; therefore, many authors have described the advantages of laparoscopic Hartmann reversal. We want to go a step further showing our experience using a combined laparoscopic and transanal approach in an attempt to improve the surgical technique. METHODS: Patients with an end colostomy due to an emergency Hartmann procedure are selected for this intervention. This approach is performed simultaneously laparoscopically and transanally, with single-port devices, through the colostomy wound in the first case and trough anal canal in the second one. The previous stapler line is resected transanally and the proximal rectum and mesorectum are dissected until the peritoneal reflexion, where both teams work together to complete the adhesiolysis. Finally an end-to-end anastomosis is performed under laparoscopic control. RESULTS: As in patients with rectal cancer, dissection of the stump in Hartmann reversal procedure may be better and associated with shorter operative time. CONCLUSIONS: As with any new surgical procedure, it is probably too early to draw conclusions, but nowadays transanal combined with laparoscopic approach seems to be a safe and feasible technique to perform a Hartmann reversal.

Factores influyentes en la respuesta al rescate con radioterapia tras prostatectomía radical / Influential Factors in the Response to Salvage Radiotherapy After Radical Prostatectomy

Objetivo: Analizar en los pacientes prostatectomizados con posterior progresión bioquímica (PB) y tratados con radioterapia de rescate (RTP) los factores influyentes en la respuesta. Material y métodos: Analizamos 313 pacientes con cáncer de próstata pT2/pT3 que reciben tratamiento de rescate por PB (de una serie de 1.310 pacientes operados entre 1989-2012). De los 313 pacientes 159 (50,8%) reciben solo deprivación androgénica (DA), 63 (20,1%) radioterapia (RTP) más DA concomitante y 91 (29,1%) solo RTP, de los cuales 57 (62,6%) mantienen respuesta completa y 34 (37,4%) fracaso del tratamiento. Resultados: Estudio del grupo tratado solo con RTP de rescate: 91 pacientes son tratados con RTP de rescate. Mediana de seguimiento 6,4 años. Mediana hasta progresión 11 meses. La supervivencia libre de progresión bioquímica post-RTP (SLPBPR) es de 68 ± 7% y 30 ± 10% en 5 y 10 años y la mediana de SLPBPR 7,3 años (6,3-8,3). En el análisis multivariado presentan influencia independiente en la respuesta: el PSA inicial (HR: 1,08; IC 95%: 1,01-1,1; p = 0,02) con mejor punto de corte PSA > 20 ng/ml (HR: 13,6; IC 95%: 2,1-86; p = 0,005) y PSA pre-RTP (HR: 1,9; IC 95%: 1,2-3,3 p=0,009), mejor punto de corte PSA preRTP de 0,92 ng/ml (HR: 4,5; IC95% 1,3-15,6; p = 0,01). SLPBPR a 5 años 81 ± 9% frente a 58 ± 9% con PSA inicial < 20 o > 20 ng/ml (p=0,03). SLPBPR a 5 años 93 ± 5% frente a 53 ± 10% según PSA pre-RTP < 0,9 o > 0,9 ng/ml (p = 0,02). Conclusiones: En los pacientes prostatectomizados tratados con RTP de rescate el PSA preoperatorio > 20 ng/ml y el PSA preRTP > 0,92 ng/ml tienen influencia independiente en la respuesta

Objective: To analyze the influential factors in the response in prostatectomized patients with subsequent biochemical relapse (BCR) and treated with salvage radiotherapy (RTP). Material and methods: We analyzed 313 patients with pT2/pT3 prostate cancer who were receiving salvage therapy due to biochemical relapse (from a series of 1,310 radical prostatectomies between 1989-2012). Of the 313 patients; 159 (50.8%) only received androgen deprivation (AD), 63 (20.1%) Radiotherapy (RTP) plus concomitant AD and 91 (29.1%) only RTP. Of these, 57 (62.6%) have maintained complete response and 34 (37.4%) had failure response with post-RTP BCR. Results: Study of the group treated exclusively with salvage RTP. Ninety-one patients were treated with salvage RTP. Median follow-up was 6.4 years and median to recurrence 11 months. Post-RTP biochemical relapse-free survival (PRBRFS) was 68 ± 7% and 30 ± 10% in 5 to 10 years. Median PRBRFS was 7.3 years (6.3-8.3). Initial PSA (HR: 1.08; 95% CI: 1.01-1.1 P = .02) with best PSA cut-off point PSA > 20 ng/ml (HR: 13.6; 95% CI: 2.1-86 P = .005) and PSA pre-RTP (HR: 1.9; 95% CI: 1.2-3.3; P = .009), best PSA cut-off point PSA preRTP 0.92 ng/ml (HR: 4.5; 95% CI: 1.3-15.6; P = .01) showed independent influence in the response in the multivariate study. PRBRFS at 5 years, 81 ± 9% versus 58 ± 9% with initial PSA < 20 or > 20 ng/ml (P = .03). PRBRFS at 5 years, 93 ± 5% versus 53 ± 10% according to PSA pre-RTP < 0.9 or > 0.9 ng/ml (P = .02). Conclusions: In patients treated with salvage RTP after radical prostatectomy, the preoperative PSA > 20 ng/ml and PSA preRTP > 0.92 ng/ml shows an independent influence on the response