Long-term efficacy of percutaneous tibial nerve stimulation for faecal incontinence and a new approach for partial responders.

BACKGROUND: The aim of the present study was to evaluate the long-term efficacy of percutaneous tibial nerve stimulation (PTNS) for patients with faecal incontinence (FI) refractory to conservative treatment. Secondary aims were to identify predictors of response and validate new treatment pathways for partial responders. METHODS: A prospective, interventional study was carried out in a specialist defecatory disorder unit from a university hospital between January 2010 and June 2017 on patients > 18 years old with FI refractory to conservative treatment. Thirty-minute PTNS sessions were performed in three phases (weekly, biweekly and monthly) up to a year, with clinical reassessment at 3, 6, 12 and 36 months. Patients were classified as optimal responders when their pretreatment Wexner score decreased > 50%; partial responders when it decreased 25-50%; and insufficient responders if it decreased < 25%. Only optimal and partial responders progressed into successive phases. RESULTS: Between 2010 and 2017, 139 patients (110 women, median age 63 years [range 22-82 years]) were recruited. After the first phase, 4 patients were optimal responders, 93 were partial responders and 36 were insufficient responders. At 6 and 12 months, 66 and 89 patients respectively were optimal responders, with an optimal response rate of 64% at the end of treatment. A total of 93.3% patients with a partial response initially finally became optimal responders. Furthermore, at 36 months, 71.9% of patients were still optimal responders without supplementary treatment, although their quality of life did not improve significantly. Baseline Wexner scores ≤ 10 and symptom duration < 1 year were identified as predictive factors for positive responses to PTNS. CONCLUSIONS: Patients undergoing PTNS for 1 year following this protocol had optimal long-term responses. PTNS sessions for up to 1 year in patients who were partial responders prevents a high percentage of them from needing more invasive treatments, and maintains long-term continence in patients who were optimal responders.

Update in Infectious Diseases 2019.

The IX Course of Antimicrobials and Infectious Diseases update included a review of the main issues in clinical microbiology, epidemiology and clinical aspects for a current approach of infectious pathology. The present introduction summarizes about the most important meetings related to infectious diseases during 2018 (ECCMID, IAS, ASM and ID Week). In addition, the course provides a practical information to focus on nosocomial infection models, with immunosuppressed patients or complex multidrug-resistant pathogens. The closing lecture of this year reviewed the infection during donation process.

Effect on anal pressure of percutaneous posterior tibial nerve stimulation for faecal incontinence.

AIM: Previous studies on percutaneous posterior tibial nerve stimulation (PTNS) for faecal incontinence do not report anal pressure changes. In the present study the effect of percutaneous PTNS on anal manometry was determined. METHOD: This was a prospective observational study of patients with faecal incontinence. They underwent one 30-min session of PTNS weekly for 12 consecutive weeks. Patients who showed improvement were given six more sessions at 2-weekly intervals. Anal manometry was performed before and after treatment. Clinical data including the Wexner score, psychological testing, quality of life using the Fecal Incontinence Quality of Life Score and the contents of a continence diary were recorded before and after the procedure. RESULTS: Twenty-four patients were included in the study of whom 17 (70.83%) demonstrated some degree of clinical or manometric improvement at 3 months. Before treatment 18 patients had urgency of <1 min. At 3 and 6 months this had risen to 5 min in 62.5% and 70.83% (P < 0.001). The anal resting pressure increased from 21.7 to 37.6 mmHg (P = 0.021), the maximum squeeze pressure from 58.2 to 72.2 mmHg (P = 0.045) and the Wexner score fell from 15 to 10 (P = 0.018) at 6 months. Predictive factors for a response included fewer than three incontinent episodes per week (P = 0.027). Negative predictive factors included episiotomy and an initial Wexner score of > 12 (P = 0.035). CONCLUSION: Percutaneous PTNS was effective in over 70% of patients in the present study with improvements in urgency, anal pressures and Wexner score.

Formation of metacinnabar by milling of liquid mercury and elemental sulfur for long term mercury storage.

In this paper we present the results of the formation of black HgS (metacinnabar) from liquid mercury and elemental sulfur using the mechanical energy provided by a ball mill in different conditions. Metacinnabar formation was observed even after short milling times (15 min) and unreacted liquid mercury was no longer detected after 60 min of milling. The reaction mechanism was monitored with a scanning electron microscope. The impact and friction forces of milling on the Hg and S mixture resulted in the formation of metacinnabar by reducing the size of mercury drops, giving rise to microspheres, and lowering the surface tension to allow sulfur grains to become adhered at the reaction interface. After 60 min of milling, the metacinnabar formation reaction was observed to be more than 99.99% complete, yielding a Toxicity Characteristic Leaching Procedure value of 3.1 microg/L Hg. The reaction product thus complies with the limits of the most stringent Universal Treatment Standard requirements, which allow a maximum TCLP concentration of 25 microg/L.

Cáncer de mama en varones / Breast cancer in men

El cáncer mamario en varones es una enfermedad infrecuente,que representa menos del 1% de la patología tumoral malignaen los pacientes de este sexo. Es difícil establecer criterios y guíasde diagnóstico y terapéutica sobre esta enfermedad, por lo quese utilizan los procedimientos empleados en el manejo del cáncerde mama en mujeres también para los hombres. Hemos realizadoun estudio retrospectivo de los 33 casos diagnosticados en losúltimos 40 años y seguidos durante un largo periodo en nuestraunidad, analizando en global los resultados y extrayendo ciertascaracterísticas particulares diferentes a las mujeres

The breast cancer in men is an infrequent disease, that representsless of 1% of the malignant tumorlike pathology inthe patients of this sex. It is difficult to establish criteria andguides of therapeutic and diagnosis on this disease, reasonwhy the procedures used in the handling of the breast cancerin women are also used for the men. We have made a retrospectivestudy of the 33 cases diagnosed in the last 40 yearsand followed for a long period in our unit, analyzing in globalthe results and extracting certain particular characteristics differentfrom the women

Removal of copper ions from aqueous solutions by a steel-making by-product.

A study is made of the use of a steel-making by-product (rolling mill scale) as a material for removing Cu(2+) ions from aqueous solutions. The influence of contact time, initial copper ion concentration and temperature on removal capability is considered. The removal of Cu(2+) ions from an aqueous solution involves two processes: on the one hand, the adsorption of Cu(2+) ions on the surface of mill scale due to the iron oxides present in the latter; and on the other hand, the cementation of Cu(2+) onto metallic iron contained in the mill scale. Rolling mill scale is seen to be an effective material for the removal of copper ions from aqueous solutions.

Hydrolysis and heat treatment of aluminum dust.

Aluminum dust is a toxic and hazardous byproduct of Al remelting. The present research was performed to characterize and evaluate its behavior in water. The materials obtained by hydrolysis were also characterized, and the gases generated during the process were qualitatively analyzed. The effects of hydrolysis reaction time and temperature on the dust were also explored. The hydrolysis of Al dust is an exothermic reaction that gave rise to a solid composed of aluminum oxide, silicon oxide, and spinel (MgAl2O4). Most of the CH4, NH3, and SH2 gases generated were emitted immediately upon the start of the reaction, though their production continued for a long time. This slow reaction, which was moderately accelerated by temperature, led to the formation of a material less reactive than the untreated dust. On the other hand, heat treatment of the dust gave rise to an inert material composed of spinel, alumina, and magnesium and aluminum silicates.