Modelo predictivo de fuerza de agarre para un grupo de trabajadores administrativos de la ciudad de Bogotá / Predictive model of grip strength for a group of administrative workers in Bogota city

Contexto La fuerza de agarre es aquella que se ejerce con la mano para apretar o soltar cualquier objeto, y es considerada un indicador de salud. Autores han concluido que la fuerza de agarre varía dependiendo de la edad, el sexo, la estatura, el peso, hábitos, factores genéticos, entre otros. Objetivos Establecer un modelo matemático para la predicción de la fuerza de agarre de un grupo de trabajadores de oficina de la ciudad de Bogotá. Métodos Con el apoyo de un dinamómetro hidráulico marca Jamar se midió la fuerza de agarre de la mano dominante y no dominante a 293 trabajadores de oficina sanos de una entidad pública de la ciudad de Bogotá. Se siguió el protocolo de la Sociedad Americana de Terapistas de la Mano. La edad, el sexo, la talla, el peso y el IMC fueron registrados para cada participante. Se aplicó la regresión lineal Stepwise para establecer los modelos de predicción para la mano dominante y no dominante, con el software R-Studio. Resultados Los participantes fueron 185 hombres y 108 mujeres, todos con dominancia derecha. En general, los hombres registraron valores más altos de fuerza de agarre respecto a las mujeres. La fuerza de la mano dominante fue superior a la de la mano no dominante. Los modelos matemáticos resultantes permiten estimar la fuerza de agarre de la mano dominante y la mano no dominante con una predictibilidad del 64,52% y el 63,23% respectivamente. Conclusiones Los modelos predictivos propuestos consideraron las variables sexo, talla y peso para la estimación de la fuerza de agarre de la mano dominante, y las variables sexo, talla, peso y edad para la fuerza de agarre de la mano no dominante (AU)

Context Grip strength is the force that is exerted with the hand to squeeze or release any object and it is considered an indicator of health. Authors have concluded that grip strength varies depending on age, sex, height, weight, habits, genetic factors, among others.Objectives To establish a mathematical model for the prediction of grip strength in a group of office workers in the city of Bogotá. Methods The grip strength of the dominant and non-dominant hand was measured with a Jamar hydraulic dynamometer in 293 healthy office workers of a public entity in the city of Bogota. The protocol of the American Society of Hand Therapists was followed. Age, sex, height, weight, and BMI were recorded for each participant. Stepwise linear regression was applied to establish prediction models for the dominant and non-dominant hand, using R-studio software. Results The participants were 185 men and 108 women, all with right dominance. In general, men recorded higher values of grip strength than women. The strength of the dominant hand was higher than that of the non-dominant hand. The proposed mathematical models allow estimating the grip strength of the dominant hand and the non-dominant hand with a predictability of 64.52% and 63.23%, respectively. Conclusions The proposed predictive models included the variables sex, height, and weight for the estimation of the grip strength of the dominant hand, and the variables sex, height, weight and age for the grip strength of the non-dominant hand (AU)

Estimulación periférica del nervio trigémino mediante frotis nasofaríngeo como posible desencadenante de migraña / Peripheral stimulation of the trigeminal nerve by nasopharyngeal swabbing as a possible trigger of migraine attacks

Introducción: La implicación del sistema nervioso central y periférico en la generación de la migraña no se conoce bien. Nuestro objetivo fue determinar si estímulos periféricos sobre el nervio trigémino, como el frotis nasofaríngeo, podrían desencadenar ataques de migraña.Sujetos y métodos: Se envió una encuesta a 658 médicos, enfermeras y estudiantes de medicina, preguntando por la presencia de cefalea sugestiva de migraña tras la realización de un frotis para la determinación del SARS-CoV-2, su historia previa de migraña, y sobre características demográficas y relacionadas con la cefalea. Los que tenían resultado positivo o que asociaban sintomatología de COVID fueron excluidos.Resultados: Se reclutó a 377 personas y se incluyó a 309. Cuarenta y siete (15,2%) refirieron cefalea sugestiva de migraña tras la realización del frotis, de las cuales 42 (89,4%) tenían historia previa de migraña. El riesgo de desarrollarla fue mayor en el subgrupo de pacientes con cefalea sugestiva de migraña previa –razón de probabilidad: 22,6 (intervalo de confianza al 95%: 8,597-59,397); p < 0,001–. No hubo diferencias entre las características principales de los ataques sugestivos de migraña previos y los desencadenados tras la prueba, excepto un porcentaje menor de aura asociada tras el frotis (42,8% frente a 26,1%; p = 0,016). Los individuos con ataques sugestivos de migraña previos con frecuencia superior a dos episodios mensuales presentaron mayor riesgo de desarrollar una cefalea sugestiva de migraña tras el test –razón de probabilidad = 2,353 (intervalo de confianza al 95%: 1,077-5,145); p = 0,03–.Conclusiones: El frotis nasofaríngeo podría desencadenar ataques de migraña, más probablemente en individuos con mayor frecuencia de migrañas previas. Esto confirmaría que estímulos periféricos sobre el nervio trigémino pueden desencadenar ataques de migraña en individuos con migraña, de acuerdo con su grado de sensibilización trigeminovascular.(AU)

Introduction: The role of the central and peripheral nervous system in the generation of migraine is not well understood. Our aim was to determine whether peripheral trigeminal nerve stimuli, such as nasopharyngeal swabs, could trigger migraine attacks.Subjets and methods: survey was sent to 658 doctors, nurses and medical students, asking about the presence of headache suggestive of migraine after carrying out a SARS-CoV-2 swab test, their previous history of migraine, and demographic and headache-related characteristics. Those who tested positive or had associated clinical signs and symptoms of COVID were excluded.Results: total of 377 people were recruited, 309 of whom were included in the sample. Forty-seven (15.2%) reported headache suggestive of migraine after the swab test and 42 (89.4%) of them had a previous history of migraine. The risk of developing migraine was higher in the subgroup of patients with a history of headache suggestive of migraine – odds ratio: 22.6 (95% confidence interval: 8.597-59.397); p < 0.001. No differences were found between the main characteristics of attacks suggestive of migraine before and after the swab test, except for a lower percentage of associated aura afterwards (42.8% vs. 26.1%; p = 0.016). Individuals with previous attacks suggestive of migraine with a frequency of more than two episodes per month had a higher risk of developing a headache suggestive of migraine after the test – odds ratio = 2.353 (95% confidence interval: 1.077-5.145); p = 0.03.Conclusions: Nasopharyngeal swabbing may trigger migraine attacks, with a greater likelihood in individuals with a higher frequency of previous migraines. This would confirm the idea that peripheral stimuli on the trigeminal nerve can trigger migraine attacks in individuals with migraine, according to their degree of trigeminovascular sensitisation.(AU)

[Peripheral stimulation of the trigeminal nerve by nasopharyngeal swabbing as a possible trigger of migraine attacks]. / Estimulación periférica del nervio trigémino mediante frotis nasofaríngeo como posible desencadenante de migraña.

INTRODUCTION: The role of the central and peripheral nervous system in the generation of migraine is not well understood. Our aim was to determine whether peripheral trigeminal nerve stimuli, such as nasopharyngeal swabs, could trigger migraine attacks. SUBJECTS AND METHODS: A survey was sent to 658 doctors, nurses and medical students, asking about the presence of headache suggestive of migraine after carrying out a SARS-CoV-2 swab test, their previous history of migraine, and demographic and headache-related characteristics. Those who tested positive or had associated clinical signs and symptoms of COVID were excluded. RESULTS: A total of 377 people were recruited, 309 of whom were included in the sample. Forty-seven (15.2%) reported headache suggestive of migraine after the swab test and 42 (89.4%) of them had a previous history of migraine. The risk of developing migraine was higher in the subgroup of patients with a history of headache suggestive of migraine - odds ratio: 22.6 (95% confidence interval: 8.597-59.397); p < 0.001. No differences were found between the main characteristics of attacks suggestive of migraine before and after the swab test, except for a lower percentage of associated aura afterwards (42.8% vs. 26.1%; p = 0.016). Individuals with previous attacks suggestive of migraine with a frequency of more than two episodes per month had a higher risk of developing a headache suggestive of migraine after the test - odds ratio = 2.353 (95% confidence interval: 1.077-5.145); p = 0.03. CONCLUSIONS: Nasopharyngeal swabbing may trigger migraine attacks, with a greater likelihood in individuals with a higher frequency of previous migraines. This would confirm the idea that peripheral stimuli on the trigeminal nerve can trigger migraine attacks in individuals with migraine, according to their degree of trigeminovascular sensitisation.

TITLE: Estimulación periférica del nervio trigémino mediante frotis nasofaríngeo como posible desencadenante de migraña.Introducción. La implicación del sistema nervioso central y periférico en la generación de la migraña no se conoce bien. Nuestro objetivo fue determinar si estímulos periféricos sobre el nervio trigémino, como el frotis nasofaríngeo, podrían desencadenar ataques de migraña. Sujetos y métodos. Se envió una encuesta a 658 médicos, enfermeras y estudiantes de medicina, preguntando por la presencia de cefalea sugestiva de migraña tras la realización de un frotis para la determinación del SARS-CoV-2, su historia previa de migraña, y sobre características demográficas y relacionadas con la cefalea. Los que tenían resultado positivo o que asociaban sintomatología de COVID fueron excluidos. Resultados. Se reclutó a 377 personas y se incluyó a 309. Cuarenta y siete (15,2%) refirieron cefalea sugestiva de migraña tras la realización del frotis, de las cuales 42 (89,4%) tenían historia previa de migraña. El riesgo de desarrollarla fue mayor en el subgrupo de pacientes con cefalea sugestiva de migraña previa ­razón de probabilidad: 22,6 (intervalo de confianza al 95%: 8,597-59,397); p < 0,001­. No hubo diferencias entre las características principales de los ataques sugestivos de migraña previos y los desencadenados tras la prueba, excepto un porcentaje menor de aura asociada tras el frotis (42,8% frente a 26,1%; p = 0,016). Los individuos con ataques sugestivos de migraña previos con frecuencia superior a dos episodios mensuales presentaron mayor riesgo de desarrollar una cefalea sugestiva de migraña tras el test ­razón de probabilidad = 2,353 (intervalo de confianza al 95%: 1,077-5,145); p = 0,03­. Conclusiones. El frotis nasofaríngeo podría desencadenar ataques de migraña, más probablemente en individuos con mayor frecuencia de migrañas previas. Esto confirmaría que estímulos periféricos sobre el nervio trigémino pueden desencadenar ataques de migraña en individuos con migraña, de acuerdo con su grado de sensibilización trigeminovascular.

Late vascular complications after cranial radiotherapy: A report of two illustrative cases.

Cranial radiotherapy (CRT) is used to treat a large variety of benign and malignant disorders. We present two cases of late neurological complications after CRT and briefly discuss its diagnosis and their shared pathophysiological aspects. The first case is a patient with cognitive impairment associated to mineralizing microangiopathy ten years after CRT for nasopharyngeal carcinoma and the second one is a woman with Stroke-like Migraine Attacks after Radiation Therapy (SMART) syndrome two years after CRT for anaplastic meningioma. Nowadays, higher survival rates might cause an increase in appearance of late neurological complications after CTR. These reported cases show that late complications can mimic a wide variety of neurological conditions and the importance of magnetic resonance image (MRI) to get a diagnosis.

Uso del análisis de la capa de células ganglionares para el diagnóstico en la neuromielitis óptica anti-glucoproteína de la mielina del oligodendrocito / Use of ganglion cell layer analysis for diagnosing anti-glycoprotein neuromyelitis optica of oligodendrocyte myelin

Paciente de 26 años con episodios de neuritis óptica recurrentes en contexto de diagnóstico de sospecha de neuromielitis óptica. En el primer brote la paciente presentó gran afectación de la agudeza visual del ojo izquierdo; se objetivó en la tomografía de coherencia óptica afectación de la capa de células ganglionares en ambos ojos, que evidenciaba posible lesión extensa del nervio, que llegaba hasta el quiasma óptico. Así mismo, en la RMN con contraste se objetivó afectación del nervio óptico izquierdo de gran longitud que comprometía el quiasma y que permitía la sospecha etiológica de neuromielitis. A pesar de que los anticuerpos anti-MOG y anti-AQP4 fueron negativos en un primer momento, la afectación bilateral de las células ganglionares hizo sospechar una lesión extensa, que es más característica de las neuromielitis anti-MOG seropositivas

The case concerns a 26-year-old patient with bilateral recurrent optic neuritis episodes in the context of suspected neuromyelitis optica. In the first outbreak, she had greatly impaired visual acuity of the left eye, as well as seeing ganglion cell layer damage in both eyes in the optic coherence tomography, with evidence of a possible extensive lesion in the optic chiasma. Likewise, MRI with contrast showed a great involvement of the left optic nerve that compromises the chiasma increasing the suspicion of a neuromyelitis origin. Althogh the anti-myelin oligodendrocyte glycoprotein (MOG) and anti-AQP4 (aquaporin-4) antibodies were negative at first, bilateral involvement of the ganglion cells suggested an extensive lesion that is more characteristic of seropositive anti-MOG neuromyelitis

Use of ganglion cell layer analysis for diagnosing anti-glycoprotein neuromyelitis optica of oligodendrocyte myelin. / Uso del análisis de la capa de células ganglionares para el diagnóstico en la neuromielitis óptica anti-glucoproteína de la mielina del oligodendrocito.

The case concerns a 26-year-old patient with bilateral recurrent optic neuritis episodes in the context of suspected neuromyelitis optica. In the first outbreak, she had greatly impaired visual acuity of the left eye, as well as seeing ganglion cell layer damage in both eyes in the optic coherence tomography, with evidence of a possible extensive lesion in the optic chiasma. Likewise, MRI with contrast showed a great involvement of the left optic nerve that compromises the chiasma increasing the suspicion of a neuromyelitis origin. Althogh the anti-myelin oligodendrocyte glycoprotein (MOG) and anti-AQP4 (aquaporin-4) antibodies were negative at first, bilateral involvement of the ganglion cells suggested an extensive lesion that is more characteristic of seropositive anti-MOG neuromyelitis.

Nefroureterectomía y desinserción transuretral láser-endoscópica en decúbito lateral sin cambio de posición: adaptación progresiva al abordaje por retroperitoneoscopia / Laparoscopic nephroureterectomy with laser endoscopic transuretral disinsertion in lateral decubitus: progressive adaptation to retroperitoneocopic approach

Introducción: La técnica de desinserción ureteral con rodete vesical continúa su evolución. Presentamos la técnica láser-endoscópica transuretral combinada con abordaje trans y retroperitoneal laparoscópicos en decúbito lateral, sin reposicionamiento del paciente para carcinomas uroteliales del tracto urinario superior. Materiales y métodos: Presentamos 3 nefroureterectomías laparoscópicas, una trans y 2 retroperitoneales. La desinserción se realizó en decúbito lateral utilizando un cistoscopio flexible y una fibra de 365 μ de laser Holmio. La técnica endoscópica se adaptó progresivamente a los abordajes retroperitoneoscópicos de 3 puertos y puerto único. Antes de la manipulación laparoscópica del riñón el uréter fue clipado por debajo del tumor, iniciándose posteriormente la técnica endoscópica. Ambos abordajes se combinaron simultáneamente. Resultados: Se lograron nefroureterectomías con desinserción endoscópica del rodete vesical en bloque, garantizando un sistema cerrado, comparable con la técnica abierta. El segundo caso precisó reconversión por problemas técnicos y prolongación del tiempo quirúrgico. No se diagnosticaron recidivas durante el seguimiento. Conclusión: Los resultados alcanzados son comparables con los de la cirugía abierta y la técnica garantizó el cumplimiento de los principios oncológicos. Permitió la desinserción en decúbito lateral evitando el reposicionamiento del paciente, ahorrando tiempo quirúrgico. Los resultados reflejaron los beneficios de la cirugía mínimamente invasiva en todos los casos

Background: The ureteral disinsertion with bladder cuff technique continues to evolve. We present the endoscopic laser transurethral technique combined with a transperitoneal and retroperitoneal laparoscopic approach in lateral decubitus, without patient repositioning, for treating urothelial carcinomas of the upper urinary tract. Materials and methods: We present 3 laparoscopic nephroureterectomies: 1 transperitoneal and 2 retroperitoneal. Disinsertion was performed in lateral decubitus using a flexible cystoscope and a 365-μm holmium laser fiber. The endoscopic technique was progressively adapted to 3-port and single-port retroperitoneoscopic approaches. Before laparoscopic handling of the kidney, ureter was clamped below the tumour. The endoscopic technique was then started. Both approaches were simultaneously employed. Results: Nephroureterectomies were achieved performing en bloc endoscopic disinsertion of the bladder cuff and ensuring a closed system comparable to open technique. The second case required reconversion due to technical problems and extension of the surgical time. No relapses were diagnosed during follow-up. Conclusion: Results are comparable to open surgery, technique ensured compliance to oncology principles, enabled disinsertion in lateral decubitus and avoid patient repositioning saving surgical time. The results reflect the benefits of minimally invasive surgery in all cases

Profilaxis antibiótica "dirigida" por cultivos rectales antes de la biopsia prostática transrectal: reducción de complicaciones infecciosas y costes de atención sanitaria / Rectal culture-directed antibiotic prophylaxis before transrectal prostate biopsy: Reduced infectious complications and healthcare costs

Introducción: La biopsia prostática transrectal ecográficamente dirigida (BPTE) se asocia a complicaciones infecciosas (CI). Las CI están relacionadas con un incremento de la prevalencia de bacterias ciprofloxacino-resistentes (BCR) en la flora rectal. Estudiamos las CI ocurridas en 2 grupos. Grupo de profilaxis antibiótica «dirigida» (GPD) vs. grupo de profilaxis empírica (GPE). Evaluamos el impacto económico que supone la profilaxis antibiótica «dirigida» (PD). Material y métodos: El GPD se estudió prospectivamente (junio 2013-julio 2014). Se recogieron cultivos rectales (CR) antes de BPTE y se sembraron en medios selectivos con ciprofloxacino para determinar la presencia de BCR. Los pacientes con bacterias sensibles recibieron ciprofloxacino. Pacientes con bacterias resistentes recibieron PD según antibiograma del CR. El GPE se estudió retrospectivamente (enero 2011-junio 2009). El CR no se realizó y todos los pacientes recibieron ciprofloxacino como profilaxis. Las CI ocurridas en ambos grupos se registraron en un periodo no superior a 30 días después de BPTE (historia clínica electrónica). Resultados: Trescientos pacientes fueron sometidos a BPTE, 145 recibieron PD y 155 PE. En el GPD, 23 pacientes (15,86%) presentaron BCR en CR. Solo un paciente (0,7%) experimentó ITU. En el GPE, 26 pacientes (16,8%) experimentaron múltiples CI (incluidas 2 sepsis) (p < 0,005). El coste total estimado, incluido el manejo de las CI, fue de 57.076 € con PE vs. 4.802,33 € con PD. El coste promedio/paciente con PE fue de 368,23 € vs. 33,11 € con PD. La PD logró un ahorro total estimado de 52.273,67 €. Es necesario que 6 pacientes se sometan a PD para prevenir una CI. Conclusiones: La PD se asoció a un notable descenso de la incidencia de CI causadas por BCR y redujo los costos de atención sanitaria

Transrectal ultrasound-guided prostate biopsy (TUPB) is associated with infectious complications (ICs), which are related to a greater prevalence of ciprofloxacin-resistant bacteria (CRB) in rectal flora. We examined the ICs that occurred in 2 groups: A guided antibiotic prophylaxis (GP) group and an empiric prophylaxis (EP) group. We assessed the financial impact of GP.: Material and methods: The GP group was studied prospectively (June 2013 to July 2014). We collected rectal cultures (RCs) before the TUPB, which were seeded on selective media with ciprofloxacin to determine the presence of CRB. The patients with sensitive bacteria were administered ciprofloxacin. Patients with resistant bacteria were administered GP according to the RC antibiogram. The EP group was studied retrospectively (January 2011 to June 2009). RCs were not performed, and all patients were treated with ciprofloxacin as prophylaxis. The ICs in both groups were recorded during a period no longer than 30 days following TUPB (electronic medical history). Results: Three hundred patients underwent TUPB, 145 underwent GP, and 155 underwent EP. In the GP group, 23 patients (15.86%) presented CRB in the RCs. Only one patient (0.7%) experienced a UTI. In the EP group, 26 patients (16.8%) experienced multiple ICs (including 2 cases of sepsis) (P < .005). The estimated total cost, including the management of the ICs, was €57,076 with EP versus €4802.33 with GP. The average cost per patient with EP was € 368.23 versus €33.11 with GP. GP achieved an estimated total savings of € 52,273.67. Six patients had to undergo GP to prevent an IC. Conclusions: GP is associated with a marked decrease in the incidence of ICs caused by CRB and reduced healthcare costs

Laparoscopic nephroureterectomy with laser endoscopic transuretral disinsertion in lateral decubitus: progressive adaptation to retroperitoneocopic approach. / Nefroureterectomía y desinserción transuretral láser-endoscópica en decúbito lateral sin cambio de posición: adaptación progresiva al abordaje por retroperitoneoscopia.

BACKGROUND: The ureteral disinsertion with bladder cuff technique continues to evolve. We present the endoscopic laser transurethral technique combined with a transperitoneal and retroperitoneal laparoscopic approach in lateral decubitus, without patient repositioning, for treating urothelial carcinomas of the upper urinary tract. MATERIALS AND METHODS: We present 3 laparoscopic nephroureterectomies: 1 transperitoneal and 2 retroperitoneal. Disinsertion was performed in lateral decubitus using a flexible cystoscope and a 365-µm holmium laser fiber. The endoscopic technique was progressively adapted to 3-port and single-port retroperitoneoscopic approaches. Before laparoscopic handling of the kidney, ureter was clamped below the tumour. The endoscopic technique was then started. Both approaches were simultaneously employed. RESULTS: Nephroureterectomies were achieved performing en bloc endoscopic disinsertion of the bladder cuff and ensuring a closed system comparable to open technique. The second case required reconversion due to technical problems and extension of the surgical time. No relapses were diagnosed during follow-up. CONCLUSION: Results are comparable to open surgery, technique ensured compliance to oncology principles, enabled disinsertion in lateral decubitus and avoid patient repositioning saving surgical time. The results reflect the benefits of minimally invasive surgery in all cases.

Rectal culture-directed antibiotic prophylaxis before transrectal prostate biopsy: Reduced infectious complications and healthcare costs. / Profilaxis antibiótica «dirigida¼ por cultivos rectales antes de la biopsia prostática transrectal: reducción de complicaciones infecciosas y costes de atención sanitaria.

BACKGROUND: Transrectal ultrasound-guided prostate biopsy (TUPB) is associated with infectious complications (ICs), which are related to a greater prevalence of ciprofloxacin-resistant bacteria (CRB) in rectal flora. We examined the ICs that occurred in 2 groups: A guided antibiotic prophylaxis (GP) group and an empiric prophylaxis (EP) group. We assessed the financial impact of GP. MATERIAL AND METHODS: The GP group was studied prospectively (June 2013 to July 2014). We collected rectal cultures (RCs) before the TUPB, which were seeded on selective media with ciprofloxacin to determine the presence of CRB. The patients with sensitive bacteria were administered ciprofloxacin. Patients with resistant bacteria were administered GP according to the RC antibiogram. The EP group was studied retrospectively (January 2011 to June 2009). RCs were not performed, and all patients were treated with ciprofloxacin as prophylaxis. The ICs in both groups were recorded during a period no longer than 30 days following TUPB (electronic medical history). RESULTS: Three hundred patients underwent TUPB, 145 underwent GP, and 155 underwent EP. In the GP group, 23 patients (15.86%) presented CRB in the RCs. Only one patient (0.7%) experienced a UTI. In the EP group, 26 patients (16.8%) experienced multiple ICs (including 2 cases of sepsis) (P<.005). The estimated total cost, including the management of the ICs, was €57,076 with EP versus €4802.33 with GP. The average cost per patient with EP was €368.23 versus €33.11 with GP. GP achieved an estimated total savings of €52,273.67. Six patients had to undergo GP to prevent an IC. CONCLUSIONS: GP is associated with a marked decrease in the incidence of ICs caused by CRB and reduced healthcare costs.

Implantación laparoscópica de esfínter urinario artificial: una opción en el tratamiento de la incontinencia urinaria femenina recidivada / Laparoscopic implantation of artificial urinary sphincter: An option for treating recurrent female urinary incontinence

Introducción: El fallo de la cirugía anti-incontinencia oscila entre el 5-80%. En la actualidad no existe consenso sobre el uso del esfínter urinario artificial (EUA) como tratamiento de la incontinencia urinaria recidivada en la mujer. Varios autores han demostrado que el EUA es útil si se comprueba la deficiencia intrínseca del esfínter. Presentamos, a nuestro entender, el primer caso descrito en España sobre la implantación laparoscópica de un EUA como tratamiento de la incontinencia urinaria recidivada femenina. Material y métodos: Bajo anestesia general se colocó a la paciente en decúbito supino con ligero Trendelenburg y se comprobó el acceso a la vagina. Mediante un abordaje laparoscópico pélvico transperitoneal se desarrolló el espacio de Retzius y seguidamente los espacios laterovaginales hasta la fascia endopélvica. Para facilitar la disección del cuello vesical se introdujo una torunda en la vagina, realizando maniobras simultáneas de tracción y contratracción. Como puerta de entrada para el EUA se amplió la incisión del trocar inferior. Se ajustó el manguito periuretral y seguidamente se colocan: el reservorio y la bomba en el espacio latero-vesical y el labio mayor de la vulva respectivamente. Finalmente, se conectaron los 3 elementos del EUA y se cerró el peritoneo para aislarlo del intestino. Resultados: Tiempo operatorio: 92 min. Pérdida hemática estimada < 100 cc3. Estancia hospitalaria: 48 h. No ocurrieron complicaciones intra ni postoperatorias. El EUA se activó a las 6 semanas. A los 24 meses la paciente lo manipula adecuadamente y alcanzó continencia total. Conclusiones: La implantación laparoscópica del EUA es una técnica factible. Las maniobras transvaginales de tracción y contratracción pueden evitar lesiones intraoperatorias

Introduction: The failure rate for anti-incontinence surgery ranges from 5% to 80%. There is not actual consensus on the use of artificial urinary sphincter (AUS) as treatment for recurrent urinary incontinence in women. Several authors have shown that AUS can be useful, if the intrinsic sphincteric deficiency is checked. We present the first case in Spain, to our knowledge, of laparoscopic implantation of AUS as treatment for female recurrent urinary incontinence. Material and methods: Under general anaesthesia, patient was placed in supine decubitus with slight Trendelenburg, access to the vagina was verified. Through a transperitoneal pelvic laparoscopic approach, Retzius space was opened and then the laterovaginal spaces up to the endopelvic fascia. To facilitate the dissection of the bladder neck, we inserted a swab into the vagina, performing simultaneous traction and countertraction manoeuvres. As an access port for the AUS, we widened the incision of the lower trocar. We adjusted the periurethral cuff and then placed the reservoir and the pump in the laterovesical space and the labia majora of the vulva, respectively. Lastly, we connected the 3 AUS elements and peritoneum was closed to isolate AUS from the intestine. Results: The surgical time was 92 min, the estimated blood loss was < 100 cc3 and the hospital stay was 48 h. There were no intraoperative or postoperative complications. The AUS was activated at 6 weeks. At 24 months, patient managed the AUS adequately and total continence was achieved. Conclusions: Laparoscopic implantation of AUS is a feasible technique. Transvaginal traction and countertraction manoeuvres can prevent intraoperative lesions

Laparoscopic implantation of artificial urinary sphincter: An option for treating recurrent female urinary incontinence. / Implantación laparoscópica de esfínter urinario artificial: una opción en el tratamiento de la incontinencia urinaria femenina recidivada.

INTRODUCTION: The failure rate for anti-incontinence surgery ranges from 5% to 80%. There is not actual consensus on the use of artificial urinary sphincter (AUS) as treatment for recurrent urinary incontinence in women. Several authors have shown that AUS can be useful, if the intrinsic sphincteric deficiency is checked. We present the first case in Spain, to our knowledge, of laparoscopic implantation of AUS as treatment for female recurrent urinary incontinence. MATERIAL AND METHODS: Under general anaesthesia, patient was placed in supine decubitus with slight Trendelenburg, access to the vagina was verified. Through a transperitoneal pelvic laparoscopic approach, Retzius space was opened and then the laterovaginal spaces up to the endopelvic fascia. To facilitate the dissection of the bladder neck, we inserted a swab into the vagina, performing simultaneous traction and countertraction manoeuvres. As an access port for the AUS, we widened the incision of the lower trocar. We adjusted the periurethral cuff and then placed the reservoir and the pump in the laterovesical space and the labia majora of the vulva, respectively. Lastly, we connected the 3 AUS elements and peritoneum was closed to isolate AUS from the intestine. RESULTS: The surgical time was 92min, the estimated blood loss was <100cc(3) and the hospital stay was 48h. There were no intraoperative or postoperative complications. The AUS was activated at 6 weeks. At 24 months, patient managed the AUS adequately and total continence was achieved. CONCLUSIONS: Laparoscopic implantation of AUS is a feasible technique. Transvaginal traction and countertraction manoeuvres can prevent intraoperative lesions.

Utilidad del cociente psa-l/psa-t y la dpsa para la discriminación entre hipertrofia benigna de próstata y cáncer de próstata / Usefulness of free/total prostate-specific antigen (PSA) ratio and PSA density to enhance differentiation of benign prostatic hyperplasia from prostate cancer

OBJETIVO: Investigar la rentabilidad diagnóstica del cociente PSA-L/PSA-T y densidad de PSA, en el diagnóstico del cáncer de próstata en pacientes con cifras de PSA-T en la zona gris de decisión diagnóstica entre 4-10 ng/ml. Establecer el punto de corte para hacer el diagnóstico diferencial entre enfermedad benigna de la próstata y cáncer, con el fin de evitar biopsias innecesarias. MÉTODO: Estudio prospectivo realizado a 136 varones de edades comprendidas entre 54 y 87 años (media 70,6). Los pacientes acuden a la consulta de urología por síntomas urinarios. Se les solicita una prueba de PSA-T, PSA-L, cociente de PSA-L/PSA-T, se realiza tacto rectal y ecografía transrectal con biopsia en octantes, se mide el volumen de la próstata y se calcula la densidad de PSA. A 113 pacientes se solicita estudio anatomopatológico, encontrándose 82 casos de HBP y 31 de carcinoma de próstata en diferentes estadios. RESULTADOS: No se encontraron diferencias significativas entre el grupo de pacientes con HBP y CAP para el PSA-T, PSA-L, cociente PSA-L/PSA-T ni tacto rectal. La DPSA y el volumen de la próstata son significativamente diferentes p < 0,05 en los pacientes con HPB y CAP. Para una sensibilidad del 94% (78,5-99), el punto de corte para el cociente de PSA sería de 0,28 y la especificidad del 11% (5,2-19,8). Con una sensibilidad del 96,2% (80,3-99,4) el punto de corte obtenido para DPSA es de 0,109 y la especificidad de 25% (15,5-36,6).CONCLUSIONES: En pacientes con cifras de PSA-T entre 4 y 10 ng/ml el cociente PSA-L/PSA-T no tiene ventajas sobre el PSA-T en el diagnóstico precoz del cáncer de próstata. La DPSA puede mejorar la especificidad, sin comprometer el diagnóstico de CAP (AU)

[Usefulness of free/total PSA ratio and PSA density in distinguishing benign prostatic hypertrophy from prostatic cancer]. / Utilidad del cociente PSA-L/PSA-T y la DPSA para la discriminacion entre hipertrofia benigna de próstata y cáncer de próstata.

OBJECTIVE: To investigate the clinical significance of the free-to-total prostate-specific antigen ratio (f/tPSA) and PSA density (PSAD) for prostate cancer detection in patients with intermediate tPSA levels (4-10 ng/ml). To establish a cutoff to discriminate between benign prostatic disease (BPH) and prostate cancer (CaP), avoiding unnecessary biopsies. METHODS: This prospective study included 136 men, aged between 54 and 85 (mean 70.6) years old. Urinary tract symptoms were present in these patients. Serum samples were obtained to measure tPSA, fPSA, and f/tPSA; digital rectal examination and transrectal ultrasound eight-sector biopsies were performed. Prostate volume was measured and PSAD calculated. The pathologic study, carried out in 113 patients, showed 82 with BPH and 31 with prostate cancer in various stages. RESULTS: There were no significant differences between patients with BPH and CaP when comparing tPSA, fPSA, f/tPSA or digital rectal examination. PSAD and prostate volume were significantly different in patients with BPH and CaP. With a sensitivity of 94% (78.5-99), the f/tPSA cutoff was 0.28 with a 11% (5.2-19.8) specificity. With a sensitivity of 96.2% (80.3-99.4) cutoff for PSAD was 0.109 and specificity 25% (15.5-36.6). CONCLUSIONS: In patients whose tPSA level is between 4 and 10 ng/ml, f/tPSA has no advantages over tPSA measurement for early detection of prostate cancer. DPSA can improve specificities, without compromising the detection of CaP.