Dopamine agonist therapy in Parkinson's disease: Spanish expert consensus on its use in different clinical situations.

BACKGROUND: Different types of therapies were proven effective for the medical management of motor and non-motor symptoms in Parkinson's disease (PD). We aimed to gain consensus on the dopamine agonist (DA) therapy use in different clinical scenarios of Parkinson's disease (PD) patients. METHODS: This consensus study was based on the nominal group technique. Initially, a consensus group comprising 12 expert neurologists in the PD field identified the topics to be addressed and elaborated different evidence-based preliminary statements. Next, a panel of 48 Spanish neurologists expressed their opinion on an internet-based systematic voting program. Finally, initial ideas were reviewed and rewritten according to panel contribution and were ranked by the consensus group using a Likert-type scale. The analysis of data was carried out by using a combination of both qualitative and quantitative methods. The consensus was achieved if the statement reached ≥ 3.5 points in the voting process. RESULTS: The consensus group produced 76 real-world recommendations. The topics addressed included 12 statements related to DA therapy in early PD, 20 statements concerning DA treatment strategy in patients with motor complications, 11 statements associated with DA drugs and their side effects, and 33 statements regarding DA therapy in specific clinical scenarios. The consensus group did not reach a consensus on 15 statements. CONCLUSION: The findings from this consensus method represent an exploratory step to help clinicians and patients in the appropriate use of DA in different stages and clinical situations of PD.

Transverse fractures through the body of the lunate with delay in consolidation. Experience with arthroscopic treatment. / Fracturas transversales del cuerpo del semilunar con retraso en la consolidación. Experiencia en el tratamiento artroscópico.

BACKGROUND AND AIM: Lunate traumatic fractures represent between 0.5% and 1% of carpal bone fractures. Transverse fracture through the body of the lunate (type V) are the least frequent and need surgical treatment if displaced, because it has a high risk of necrosis or pseudoarthrosis. The objective of this paper is to present our experience with arthroscopic treatment in patients with a delay in consolidation after a transverse fracture through the body of the lunate. METHODS: Two clinical cases of delay in consolidation in transverse fracture through the body of the lunate are presented. Both cases have delay in consolidation. RESULTS: Both fractures were misdiagnosed in initial simple radiographic exploration and were diagnosed with computerised tomography. Both patients were treated by debridement, bone grafting and osteosynthesis under arthroscopic control, obtaining a correct radiographic consolidation. CONCLUSION: Arthroscopic treatment is a valid, effective and safe technique for the treatment of delay in consolidation of transverse fractures through the body of the lunate and avoids complications and soft tissues injury of the open surgery techniques.

Superior labral anterior to posterior (SLAP) injury in the workplace. / Lesión del labrum superior anteroposterior (SLAP) en el entorno laboral.

BACKGROUND AND OBJECTIVE: Superior labral anterior to posterior (SLAP) injuries are widely recognised as a cause of pain and dysfunction in the shoulders of active patients. The aims of the present study were to analyze SLAP injuries in the workplace, and to evaluate the reliability of physical examination and imaging techniques for the diagnosis of work-related SLAP injuries. MATERIAL AND METHODS: Retrospective chart review of 58 SLAP injuries treated in our occupational health centre from 2005 to 2015 in 815 patients undergoing shoulder arthroscopy. Data were collected on mechanism of injury, clinical proceedings, complementary tests (contrasting the initial magnetic resonance imaging report with that of a radiologist specializing in musculoskeletal pathology), arthroscopy findings and treatments performed. RESULTS: The most common mechanism of injury was acute injury while handling weight, in the majority of cases, above the head. SLAP injury was suspected in 41% of cases through anamnesis and physical exam, in 29% through the initial magnetic resonance imaging report, and in 52% through the specialised radiologist's report. In 78%, associated injuries were present, the most common being rotator cuff injuries. CONCLUSIONS: SLAP injuries in the workplace are rare and are often a diagnostic finding during surgical intervention performed for a different associated injury. Arthro-magnetic resonance imaging and magnetic resonance imaging have lower reliability than physical exams in the diagnosis of work-related SLAP injuries. A radiologist specializing in musculoskeletal pathology could probably improve the reliability of imaging test interpretation in work-related SLAP injuries.

Quality indicators in radiation oncology: proposal of the Spanish Society of Radiation Oncology (SEOR) for a continuous improvement of the quality of care in oncology.

PURPOSE: Current cancer treatment options include surgical intervention, radiotherapy, and chemotherapy. The quality of the provision of each of them and their effective coordination determines the results in terms of benefit/risk. Regarding the radiation oncology treatments, there are not stabilised quality indicators to be used to perform control and continuous improvement processes for healthcare services. Therefore, the Spanish Society of Radiation Oncology has undertaken a comprehensive project to establish quality indicators for use with the information systems available in most Spanish healthcare services. METHODS: A two-round Delphi study examines consensus of several possible quality indicators (n = 28) in daily practice. These indicators were defined after a bibliographic search and the assessment by radiation oncology specialists (n = 8). They included aspects regarding treatment equipment, patient preparation, treatment, and follow-up processes and were divided in structure, process, and outcome indicators. RESULTS: After the evaluation of the defined quality indicators (n = 28) by an expert panel (38 radiation oncologist), 26 indicators achieved consensus in terms of agreement with the statement. Two quality indicators did not achieve consensus. CONCLUSIONS: There is a high degree of consensus in Spanish Radiation Oncology specialists on which indicators in routine clinical practice can best measure quality. These indicators can be used to classify services based on several parameters (patients, equipments, complexity of the techniques used, and scientific research). Furthermore, these indicators allow assess our current situation and set improvements' objectives.

Use of platelet-rich plasma in the treatment of rotator cuff pathology. What has been scientifically proven? / Utilización del plasma rico en plaquetas en el tratamiento de la patología del manguito de los rotadores. ¿Qué hay demostrado científicamente?

PURPOSE: To analyze the current scientific and/or clinical evidence supporting the use of platelet-rich plasma (PRP) in the treatment of rotator cuff pathology. METHODS: After a systematic review in PubMed, studies assessing PRP efficacy in the treatment of rotator cuff pathology published since 2013 to date were identified. Data were grouped based on type of study (laboratory, clinical or meta-analysis); accordingly study design, pathology treated and clinical outcomes were summarized. RESULTS: Thirty five articles have been analyzed: 10 laboratory studies, 17 clinical assays and 8 meta-analyses. While laboratory studies report positive or partially positive results for the use of PRP, 70.6% of clinical studies and 75% of meta-analysis found no statistically significant differences between the PRP group and the control group. DISCUSSION: The positive results of laboratory studies do not translate well to clinical practice. There is no concordance among the few positive results reported in the clinical studies, and even some contradictory effects have been reported. CONCLUSIONS: There is no solid scientific and/or clinical evidence supporting the use of PRP in the treatment of rotator cuff pathology in routine clinical practice.

Real-life management of primary immune thrombocytopenia (ITP) in adult patients and adherence to practice guidelines.

Very few data exist on the management of adult patients diagnosed with primary immune thrombocytopenia (ITP). The objectives of this study were to describe the diagnostic and treatment patterns for ITP and to compare the findings to recent ITP guidelines. We retrospectively analyzed the medical records of adult ITP patients diagnosed with primary ITP between January 2011 and June 2012 and examined whether management strategies were consistent or not with eight recent guideline-recommended practices. Overall, median age at the diagnosis of the disease (n = 101) was 58 years and median platelet count 12 × 10(9)/L with 75.2 % of patients having symptoms of ITP. The study perceived two major shortcomings in the diagnostic approach: (1) failure to perform peripheral blood film examination in 22.8 % of patients, a test that is mandatory by all guidelines, and (2) ordinary bone marrow assessment in more than half of the patients at diagnosis (50.5 %), a test not routinely recommended by guidelines. Low appropriateness in therapeutic management of patients included (1) unjustified use of intravenous immunoglobulin in the absence of bleeding in 54.8 % of patients and (2) splenectomy not being deferred until 6-12 months from diagnosis (median 161 days). Data also reflect a trend towards the early use of thrombopoietin receptor agonists in the treatment of patients who are refractory to any first-line therapy. We have recognized important areas of inapropriateness in the diagnostic and therapeutic management of adult ITP patients. Compliance with established guidelines should be encouraged in order to improve patient outcomes.

Estudio de la incidencia de los efectos adversos en el Complejo Hospitalario Universitario de Albacete / No disponible

Objetivo: El Objetivo de este estudio es determinar la incidencia de Efectos Adversos (EA) y de pacientes con EA en el Complejo Hospitalario Universitario de Albacete (CHUA). Método: Diseño. Estudio retrospectivo de cohortes.Ámbito de estudio. Pacientes dados de alta del 5 al 19 de Noviembre de 2006. Definición de caso: todo accidente o incidente recogido en la Historia Clínica que ha causado daño al paciente o lo hapodido causar, ligado sobre todo a las condiciones de la asistencia sanitaria y no a la enfermedad de base del paciente. Instrumentalización: Guía de cribado de efectos adversos, adaptada del estudio de Harvard. Versión española del Formulario Modular para revisión retrospectiva de casos, MRF2. Análisis estadístico: Análisis univariante, bivariante y un modelo de regresión logística. Resultados: La incidencia de pacientes con EA relacionados con laasistencia hospitalaria fue de 6,8%. La incidencia fue diferente significativamente según la edad, la presencia de factores de riesgo intrínsecos y ext nsecos (excluyendo el catéter venoso periférico). El 8,2% de los EA se relacionó con los cuidados, el 14,3% con la medicación, el 26,5% con las infecciones nosocomiales, el 35,7% con problemas técnicos durante unprocedimiento, el 11,2% con el diagnóstico y el 4,1% restante con otros tipos de EA. El 12,2% se consideró leve, el 78,6% moderado y el 8,2% grave. El 50% de los EA aumentó la estancia, y en un 34,7% el EA condicionó el ingreso. El 63,3% de los EA se consideró evitable. Conclusiones: El Estudio de EA en el CHUA constituye un aspecto de mejora dentro del programa de calidad del Hospital. Las incidencias de pacientes con EA relacionadas con la asistencia sanitaria se encuentran entre las alcanzadas en el conjunto de estudios cuyo objetivo es la mejora de la calidad (AU)

Objective: To determine the incidence of adverse effects AE in the University Hospital complex of Albacete (CHUA). Method: Retrospective cohort study. Patients discharged from 5 to 19 November 2006. Case definition: every accident or incident in the Medical record that has caused harm to the patient or has been able to cause it, linked to the conditions of health care and noto the patient basel disease. Instrumentalization: Review of the medical records during the stay through the screening guide and the IDEA project adapted MRF2. Statistical analysis: univariate, bivariate analysis and a logistic regression model.Results: The incidence of patients with EA related to hospital healthcare was 6.8%. The incidence was significantly different depending on the age, the presence of intrinsic and extrinsic risk factors (excluding peripheral venous catheter). 8.2% was related to care, 14.3% with medication, 26.5% with nosocomial infections, 35.7% with technical problems during a procedure, 11.2% with diagnosis and 4 % with other types of EA. 12.2% was considered mild, moderate 78.6% and 8.2% serious. 50% increased stay and 34.7% conditioned the entry. 63.3% was considered avoidable. Conclusion: The study of EA in the CHUA is an aspect of improving programme quality hospital. Incidences of patients with EA related to healthcare are among the accomplished throughout the studies aiming to improve quality (AU)

New Solid-State Contact for lon-Selective Liquid Membrane Electrodes.

A new kind of solid-state contact for ion-selective electrodes based on solvent polymeric membranes is described. These electrodes show similar electrochemical behaviour to conventional ion-selective membranes in contact with an internal filling solution. They exhibit no significant interference with oxygen, nitrogen or carbon dioxide.

[Giant retroperitoneal liposarcoma]. / Liposarcoma retroperitoneal gigante.

Liposarcoma is a malignant tumor that has an embryologic origin from mesodermal tissue depending on fatty tissue. Although liposarcoma is only 0.1% of all human neoplasms, it is the most common histology subtype of retroperitoneal soft tissue sarcomas. This tumor grows slowly. Diffuse abdominal pain is its most frequent symptom and abdominal mass is the most common sign. Aggressive surgical treatment is basic to get a complete resection and a local disease control. This objective is difficult because of the large tumor size it gets in the retroperitoneal location and the multiorgan involvement that require the resection of a high percentage of contiguous organs. We report a case of a giant retroperitoneal liposarcoma presenting like continuous left hemiabdominal pain because of the visceral compression. The right kidney was involved and suffering from renal vessel enlargement without renal function. There is a high probability of microscopic residual disease and a good follow-up of the patients is necessary as well as an adjuvant radiation therapy in some cases.

[Traumatic intrathoracic herniation of the left kidney]. / Herniación intratorácica traumática del riñón izquierdo.

The detection of a intrathoracic kidney is an exceptional discovery. There is a large period of time between the injury and its clinical presentation revising the literature, so it is possible that the herniation of the kidney into the chest was caused by a rise in intra-abdominal pressure but going through a preexistent congenital way not caused by the traumatism. In order to dismiss this possibility and to prove the traumatic origin of the diaphragmatic rupture, surgeons have examined the intraoperative characteristics of the rupture's borders. The elevation of the kidney has been said to be progressive because of the positive intra-thoracic pressure and the negative intra-abdominal one. Our objective is to report an extraordinary case of abdominal traumatism whose clinic and radiological proofs let us get a rapid diagnosis and surgical demonstration of the direct herniation of the left kidney into the chest through a diaphragmatic rupture caused by the same traumatism.

Herniación intratorácica traumática del riñón izquierdo / Intrathoracic traumatic herniation of the left kidney

La aparición de un riñón intratorácico como consecuencia de un traumatismo es un hallazgo excepcional. En la revisión de otros casos publicados en la literatura hay habitualmente un dilatado periodo de latencia hasta la manifestación clínica del proceso, por lo que se planteaba la posibilidad de que el incremento de la presión abdominal fuera únicamente el causante del ascenso hacia el tórax del riñón, a través de un trayecto congénito previamente existente y no causado por el traumatismo. Para descartar esta posibilidad y demostrar el origen traumático de la brecha diafragmática se ha recurrido al examen intraoperatorio de las características de los bordes del orificio herniario. Así mismo se ha sugerido que el ascenso del riñón sea progresivo en el tiempo, como consecuencia de la presión positiva abdominal y negativa intratorácica. Nuestro objetivo es presentar un caso extraordinario de traumatismo abdominal en el que la clínica y el estudio radiológico permitieron un diagnóstico inmediato y la constatación quirúrgica del ascenso directo del riñón izquierdo al tórax a través de un orificio herniario diafragmático de nueva adquisición como consecuencia del propio traumatismo (AU)

The detection of a intrathoracic kidney is an exceptional discovery. There is a large period of time between the injury and its clinical presentation revising the literature, so it is possible that the herniation of the kidney into the chest was caused by a rise in intra-abdominal pressure but going through a preexistent congenital way not caused by the traumatism. In order to dismiss this possibility and to prove the traumatic origin of the diaphragmatic rupture, surgeons have examinated the intraoperative characteristics of the rupture's borders. The elevation of the kidney has been said to be progressive because of the possitive intra-thoracic pressure and the negative intra-abdominal one. Our objetive is to report an extraordinary case of abdominal traumatism whose clinic and radiological proofs let us get a rapid diagnosis and surgical demonstration of the direct herniation of the left kidney into the chest through a diaphragmatic rupture caused by the same traumatism (AU)

[Hypertension emergency during surgery of renal carcinoma associated with non-diagnosed pheochromocytoma]. / Emergencia hipertensiva durante la cirugía de un carcinoma renal asociado a feocromocitoma no diagnosticado.

OBJECTIVE: To present an uncommon association of renal carcinoma with an undiagnosed ipsilateral pheochromocytoma that caused severe cardiovascular disorders during surgical treatment of the renal carcinoma, and emphasize the need for careful assessment of these adrenal nodules before resection although they may appear to be clinically irrelevant. METHODS: A 61-year-old male with mild arterial hypertension controlled with drug therapy for 40 years was diagnosed as having a right renal hypernephroma and a probable adrenal adenoma by IVP, abdominal ultrasound, CT, bone scintiscan and renal arteriography. Preoperative values were within the normal limits. The patient developed severe hypertension intraoperatively, which was controlled by administration of lidocaine, nitroglycerine, sodium nitroprusside and labetalol. Surgery was interrupted and completed when the patient was stable. RESULTS: The pathological analysis showed clear cell renal adenocarcinoma and pheochromocytoma. Postoperative evaluation showed dopamine, adrenaline, noradrenaline and vanilmandelic acid were normal. A 131 MIBG scan was normal. CONCLUSION: Although an adrenal mass may appear to be clinically irrelevant, a careful study should be performed to discard a functioning tumor and to avoid the serious complications that might arise during surgery.

Colocutaneous fistula due to polypropylene mesh.

Fistulae due to polypropylene mesh are known to occur if the prosthetic mesh is placed close to a hollow viscus. Some cases of enterocutaneous fistula have been reported but there are few cases of fistula affecting the large bowel. It is important to recognize these cases because they are severe complications of the prosthesis and difficult to manage. We present a case of colocutaneous fistula caused by fragmentation of polypropylene mesh and erosion into the sigmoid colon after recurrent incisional hernia repair.

Tissucol application in dermolipectomy and incisional hernia repair.

Biological adhesives have a lot of applications in surgical procedures. Here we present a prospective study with the aim of analyzing results of the application of Tissucol between the muscle layers and subcutaneous tissue after incisional hernia repair with polypropylene mesh and associated dermolipectomy. We assess clinical and technical parameters, local morbidity, and hospital stay. Fifty-six patients were divided into two groups. Patients with whom we used fibrin glue were older, with more obesity (P < 0.005) with associated diseases, and their incisional hernias were larger and more complicated to repair. Patients in the Tissucol group developed less local morbidity (hematomas or abscesses; P < 0.01), had a shorter mean hospital stay (P < 0.01), and required less wound care. The use of Tissucol improves the results of surgical repair of large abdominal incisional hernias repaired by mesh placement and dermolipectomy, and it decreases global morbidity and hospital stay are reduced.

Postoperative textilomas: review of 14 cases.

BACKGROUND: Textile materials of surgical origin are found in the abdominal cavity in between 1/1300 and 1/1500 laparotomies, in spite of preventive measures. It is very difficult to ascertain the exact incidence due to the lack of descriptions in the literature. METHODS: Fourteen cases of postoperative foreign bodies or textilomas are reported. The cases were collected from two hospital centers between 1985 and 1997. RESULTS: There were 12 intra-abdominal cases, 1 thoracic and 1 paravertebral. In 8 (57.1%) diagnosis was made preoperatively by radiological techniques. The mortality rate was 14.2% with 2 deaths due to multiorganic failure in one case and sepsis in the other. Both patients were over 70, with malignant pathology. The morbidity rate was 21.4%, wall abscesses which evolved favorably being the most frequent cause of complications. CONCLUSIONS: Prevention of this complication is the best treatment. It is advisable to use textile material with radiopaque contrast, to count the pieces of material to be used and perform an X-ray before the laparotomy is closed specially in emergency (bleeding and trauma patients) because in these complex cases the possibility of material being left behind is more advisable.

The effects of the pharmacological manipulation of postoperative intestinal motility on colonic anastomoses. An experimental study in a rat model.

INTRODUCTION: The aim of the study was to determine the effects of pharmacological manipulation of postoperative intestinal motility on the resistance of colonic anastomoses. MATERIALS AND METHODS: Seventy-one Sprague-Dawley rats were divided into three groups: Group 1 (n = 20; colonic anastomosis+1 cc of saline solution subcutaneously, daily); Group 2 (n = 29; colonic anastomosis+1.2 mg/100 g body weight metoclopramide in 1 cc subcutaneously, daily); and Group 3 (n = 22; colonic anastomosis+2 mg/100 g body weight hyoscine N-butyl-bromide in 1 cc subcutaneously, daily). Surviving rats (20 in each group) were sacrificed 4 days after surgery and adhesions were evaluated. Each segment containing an anastomosis was removed and the bursting pressure was determined. RESULTS: The cause of death during the early postoperative period was dehiscence in 8 cases (7 in Group 2 and 1 in Group 3). General adhesion scores in Group 2 were higher than in Group 3 (P = 0.003). The score for adhesions to the anastomosis in Group 1 was higher than in Group 2, but no statistically significant difference was found. Bursting-pressure was significantly lower in Group 2 than in other groups (P = 0.001). In all cases leakage of dye was observed at the anastomosis. CONCLUSION: The use of metoclopramide (a gastrointestinal prokinetic agent) during the early postoperative period was associated with an increase in dehiscence in colonic anastomosis and, when animals survived, there was a significant decrease in anastomotic resistance. Hyoscine (an inhibitor of gastrointestinal motility) did not improve the healing of anastomoses.

Relationship between peritoneal adhesion phenomena and the experimental resistance of colonic anastomoses: influence of omentoplasty.

The repair processes that follow surgical injury constitute the physiopathological basis of peritoneal adhesion phenomena. The aim of the present study was to investigate the influence of the peritoneal adhesion process on the resistance of colonic anastomoses during the early postoperative period. Sixty Sprague-Dawley rats were divided into three groups (n = 20 each) according to procedure: transverse colon section and anastomosis (group 1); omentoplasty performed on the anastomosis (group 2), and thin latex sheeting covering the anastomosis (group 3). The rats were sacrificed 4 days after surgery and the adhesion evaluated. The segment containing the anastomosis was removed and the bursting pressure determined; the diameter and Laplace's law were used to calculate the bursting wall tension (BWT). The mean BWT in group 1 was 30.73 dyn. 10(3)/cm. In the multivariate analysis, adhesions to the anastomotic line were found to exert the greatest influence on the BWT (p = 0.005). The mean BWT of the anastomoses with adhesions affecting 100% of the circumference was greater than when at least part of the latter remained free (p = 0.006). In group 2 the BWT was 55.92 dyn. 10(3)/cm, i.e., greater than in group 1 overall (p = 0.005) and similar to those anastomoses in that group completely covered by adhesions (p = 0.017). Mean BWT in group 3 was 14.62 dyn. 10(3)/cm, i.e., lower than in either group 1 or 2 (p = 0.009 and 0.000, respectively). No differences were seen when comparing with group 1 segments in which the anastomotic line was not entirely covered. Adhesions to the anastomotic line exert a beneficial effect on colonic anastomotic resistance 4 days after surgery. Adhesion formation should therefore not be interfered with. An omentoplasty secures 100% coverage of the anastomotic line, and should thus be considered when performing high-risk colonic anastomoses.

Effects of an intra-abdominal latex (drain-like) tube on anastomotic resistance and adhesion formation in a rat model.

PURPOSE: Aim of the present study was to determine effect of a latex drain on colonic resistance and its relation to adhesion phenomena. METHODS: Forty Sprague-Dawley rats were divided into two groups (n = 20): Group 1, simple colonic anastomosis; and Group 2, colonic anastomosis with drain "ad latum." Rats were sacrificed four days after surgery, and adhesions were evaluated. Segment containing anastomosis was removed, and bursting pressure was determined. RESULTS: General adhesion scores in Group 2 were higher than in Group 1 (P = 0.002). Score for adhesions to anastomotic line in Group 1 was higher than in Group 2 (P = 0.016). Bursting pressure was significantly lower in Group 2 (Group 1, 67.90 +/- 31.39 mmHg; Group 2, 46.95 +/-1 29.69 mmHg; P = 0.034). In all cases, leakage of dye was observed at the anastomotic line. A multiple regression test was applied to both groups (40 cases), taking bursting pressure as the dependent variable and other parameters as independent variables. A strong relationship appeared to exist between anastomotic resistance and fraction of anastomotic line that was covered by the neighboring organ (P < 0.001). CONCLUSIONS: Placing a latex drain near a colonic anastomosis is associated with local inhibition of spontaneous adhesions to anastomotic line and, therefore, to significantly decreased resistance.

[Endoscopic pyelotomy with the "ACUCISE" probe]. / Pielotomía endoscópica por sonda "ACUCISE".

OBJECTIVES: The aims of the present study were to assess the results achieved by the newly designed ACUCISE cutting probe in the treatment of the PUJ syndrome, to describe its advantages and disadvantages and to determine the possibility of its replacing other previously utilized techniques. METHODS: The ACUCISE cutting probe was utilized in 10 patients with pyeloureteral stricture. After the stent had been left indwelling for two months, it was removed and the patients had regular control evaluations two months thereafter. RESULTS: The results have been optimal to date, with complete resolution of the pyeloureteral stricture in 100% of the cases. No significant complications have been observed. Some of the control images are presented. CONCLUSIONS: In our view, the availability of the ACUCISE cutting probe represents a major contribution to minimally invasive surgery in the treatment of the PUJ syndrome. Its advantages far surpass its disadvantages, some of which can be overcome by the skill acquired from more experience. Its only major drawback is that it cannot be used in children under thirteen because of its caliber. When positioned correctly, the ACUCISE cutting probe achieves a clean, precise and an even cut of the same diameter and extent. It is a useful alternative to the other techniques utilized in the treatment of PUJ stricture.

[The relation of the adhesion phenomenon and the experimental resistance of colonic anastomoses. The effect of epiploplasty]. / Relación entre el fenómeno adherencial y la resistencia experimental de las anastomosis cólicas. Influencia de la epiploplastia.

INTRODUCTION: We made an experimental study of the influence of the peritoneal adherence process on the strength of colic anastomosis. METHOD: 60 rats, in three groups of 20. Group I, colic anastomosis; Group II, colic anastomosis with epipoplasty; Group III, colic anastomosis covered with plastic material. They were slaughtered on the fourth post-operative day and we assessed the adherence parameters, removing the segment with anastomosis and measuring its breakage strength. Laplace's Law was applied to calculate Wall Breakage Stress (WBS). RESULTS: Group I: The statistically most significant influence on WBS was that of adherences to the anastomotic line (p = 0.005). WBS measured in anastomosis with adherence on 100% of the circumference was greater than in those where some part remained to be covered (p = 0.006). Group II: mean WBS was higher than in Group I as a whole (p = 0.005) and similar to that of the anastomosis in this group 100% covered by adherences (p = 0.017). Group III: mean WBS was lower than that of Group I (p = 0.009) and Group II (p = 0.000). CONCLUSIONS: The beneficial effect was demonstrated of adherences to the anastomotic line on the strength of colic anastomosis so that this process should not, wherever possible, be obstructed. During an epiploplasty, 100% coverage must be ensured: this technique must therefore be considered to belong to the group of high-risk colic anastomoses.