¿Podemos basar la indicación de cistectomía precoz en algo más que características clínico patológicas? / Can we base the indication of early cystectomy on more than clinical-pathological characteristics?

No disponible

Dermatological side effects of intravesical Mitomycin C: Delayed hypersensitivity. / Efectos secundarios de la administración de Mitomicina C intravesical: dermatitis por hipersensibilidad retardada.

OBJECTIVE: To know the dermatologic side effects of intravesical treatment with Mitomycin C in non muscle invasive bladder cancer. METHODS: We describe two cases of palm and plantar dermatitis after such treatment. RESULT: We describe two types of dermatitis pathogenesis during treatment with intravesical Mitomycin C: contact dermatitis and delayed hypersensitivity dermatitis. CONCLUSIONS: Contact dermatitis of non-allergic origin is a common side effect described in many instances in the literature, on the other hand exists dermatitis secondary to delayed hypersensitivity type IV much less common, requiring treatment with corticosteroids.

Negative global phosphorus budgets challenge sustainable intensification of grasslands.

Grasslands provide grass and fodder to sustain the growing need for ruminant meat and milk. Soil nutrients in grasslands are removed through withdrawal in these livestock products and through animal manure that originates from grasslands and is spread in croplands. This leads to loss of soil fertility, because globally most grasslands receive no mineral fertilizer. Here we show that phosphorus (P) inputs (mineral and organic) in global grasslands will have to increase more than fourfold in 2050 relative to 2005 to achieve an anticipated 80% increase in grass production (for milk and meat), while maintaining the soil P status. Combined with requirements for cropland, we estimate that mineral P fertilizer use must double by 2050 to sustain future crop and grassland production. Our findings point to the need to better understand the role of grasslands and their soil P status and their importance for global food security.

¿Es el poliomavirus BK la causa de cistopatía hemorrágica en los pacientes sometidos a trasplante de progenitores hematopoyéticos alogénicos? / Is polyomavirus BK the cause of hemorrhagic cystopathy in patients who undergo allogeneic hematopoietic progenitor cell transplantation?

No disponible

Tratamiento anestésico en la exéresis de un quiste hidatídico cardíaco / Anaesthetic treatment in the removal of a cardiac hydatid cyst

La equinococosis es una infección endémica en los países cálidos. La afectación cardíaca es rara, pero grave. El riesgo de shock anafiláctico durante la cirugía, precisa de un rápido diagnóstico intraoperatorio y de un tratamiento inmediato. Presentamos el caso de un varón de 35 años, al que se le detectó un quiste hidatídico cardíaco, tributario de cirugía. Previo tratamiento con albendazol oral durante un mes y pauta de anti-H1, anti-H2 y corticoides las 24h previas, se procedió a extirpar el quiste con circulación extracorpórea. Intraoperatoriamente se administraron además, bolus de hidrocortisona y dexclorfeniramina y se protegió el campo quirúrgico con gasas empapadas en suero salino hipertónico. El paciente precisó perfusión de noradrenalina para mantener la estabilidad hemodinámica. Evolucionó sin más complicaciones y fue dado de alta a los 14 días(AU)

Echinococcosis is an endemic infection in hot countries. Cardiac involvement is rare, but serious. The risk of anaphylactic shock during surgery requires a rapid intra-operative diagnosis and immediate treatment. We present the case of a 35 year-old male in whom a cardiac hydatid cyst was detected that required surgery. He was given preliminary treatment with oral albendazole for one month and prescribed anti-H1, anti-H2 and corticosteroids prior to the removal of the cyst using bypass surgery. During the operation he was also given a bolus of hydrocortisone and dexchlorpheniramine and the surgical area was protected by gauzes soaked in hypertonic saline. The patient required an infusion of noradrenaline to maintain haemodynamic stability. He progressed with no more complications, and was discharged at 14 days(AU)

[Anaesthetic treatment in the removal of a cardiac hydatid cyst]. / Tratamiento anestésico en la exéresis de un quiste hidatídico cardíaco.

Echinococcosis is an endemic infection in hot countries. Cardiac involvement is rare, but serious. The risk of anaphylactic shock during surgery requires a rapid intra-operative diagnosis and immediate treatment. We present the case of a 35 year-old male in whom a cardiac hydatid cyst was detected that required surgery. He was given preliminary treatment with oral albendazole for one month and prescribed anti-H1, anti-H2 and corticosteroids prior to the removal of the cyst using bypass surgery. During the operation he was also given a bolus of hydrocortisone and dexchlorpheniramine and the surgical area was protected by gauzes soaked in hypertonic saline. The patient required an infusion of noradrenaline to maintain haemodynamic stability. He progressed with no more complications, and was discharged at 14 days.

Nutrient-mediated modulation of incretin gene expression: a systematic review.

Incretins are a cluster of hormones which are secreted and released into the bloodstream after food intake by gut enteroendocrine cells, reaching to pancreas where produce a potentiating effect on insulin release. The aim of this study was to perform a systematic review of incretins gene expression mediated by nutrients using specific search equations in the PubMed database. The two most relevant incretins are GLP-1 and GIP, which come from proglucagon and proGIP precursor respectively. GLP-1 is mainly synthesized and released by ileum and colon L cells, in contrast to GIP which does it by K cells in duodenum and proximal jejunum. It has been shown that canonical Wnt signalling pathway is closely related to the production of these hormones, since transcription factor TCF7L2 affects proglucagon and proGIP gene expression in L and K enteroendocrine cells. On the other hand, it has been shown that the hexosamine biosynthetic pathway can produce N-linked glycosylation of -catenin, an essential component of canonical Wnt signalling. This process hinders ß-catenin phosphorylation and, thereby prevents proteasome degradation. Increasing glucose concentration enhances the hexosamine pathway and thus ß-catenin glycosylation. This causes a ß-catenin cytoplasmic accumulation allowing entry into nucleus, where it exerts its action by binding to a clump of molecules and transcription factors, allowing to express the target genes, including the incretin hormones. There is also evidence that glucose, through the hexosamine pathway, can induces autocrine activation of Wnt signalling pathway by stimulating secretion of Wnt proteins.

Vetrabutine clorhydrate use in dystocic farrowings minimizes hemodynamic sequels in piglets.

The objective was to measure the effects of VC (a uterotonic drug with vasodilator effects) in eutocic and dystocic sows, on the acid-base balance and some vitality traits of piglets at birth. Farrowing was induced with prostaglandin F2α. Four groups of sows (20 sows/group) were monitored; Groups 1 and 2 were eutocic sows, whereas Groups 3 and 4 were dam-fetal dystocic sows. Groups 1 and 3 (control) were given saline, whereas Groups 2 and 4 were given VC im (1.66 mg/kg of body weight) after the first piglet was born. Piglets' physio-metabolic performance was monitored peripartum. Treatment with VC reduced (P<0.0001) the percentage of intrapartum stillbirths in sows either with eutocic (5.2 vs. 10.0%) and dystocic (7.6 vs. 16.7%) farrowings and increased (P<0.0001) the number of pigs born alive without any evidence of AFS (89.9 vs. 79.9%, eutocic and 81.6 vs. 65.2%, dystocic). In addition, for the group of pigs with no acute fetal suffering (AFS), VC treatment enhanced survival responses with a half point grater vitality score in Group 4; it also reduced the latency to first teat contact by 6 min (P<0.05) in both treated groups compared to controls; and it improved the condition of the pigs' umbilical cord, with more adhered (98 vs. 86% in eutocic and 88 vs. 80% in dystocic; P<0.05) and less ruptured cords. Moreover, VC reduced the severity of adverse physio-metabolic indicators and the acid-base balance of piglets with AFS at birth by lowering blood lactate (89.8 vs. 93.5 mmol/L in eutocic groups and 94.6 vs. 100.2 mmol/L in dystocic groups; P<0.05), PaCO2 and Ca2+, and by increasing blood pH, HCO3 and PaO2 levels (P<0.05).

Modulación de la expresión de genes de incretinas mediada por nutrientes; revisión sistemática / Gene expression modulation of incretins mediated by nutrients; a systematic review

Las incretinas son una serie de hormonas que tras una ingesta de alimentos son secretadas y liberadas al torrente sanguíneo por células enteroendocrinas del intestino, llegando al páncreas, donde producen un efecto potenciador en la liberación de insulina. El objetivo de este trabajo ha sido realizar una revisión sistemática de la modulación de la expresión génica de las incretinas mediada por nutrientes utilizando ecuaciones especificas de búsqueda en la base de datos PubMed. Las dos incretinas mas relevantes son el péptido análogo al glucagón 1 (GLP-1) y el péptido insulinotrópico dependiente de glucosa (GIP), que provienen de los precursores proglucagón y proGIP, respectivamente. GLP-1 es mayoritariamente sintetizado y secretado por las células L del ileon y del colon, a diferencia de GIP que lo hace por las células K de duodeno y yeyuno proximal. Se ha demostrado que la ruta canónica de señalización Wnt esta estrechamente relacionada con la producción de estas hormonas, ya que el factor de transcripción TCF7L2 influye en la expresión génica de proglucagón y proGIP en células enteroendocrinas L y K. Por otra parte, se ha demostrado que la ruta biosintetica de las hexosaminas es capaz de glicosilar la β-catenina, componente fundamental de la señalización canonica Wnt, lo que interfiere en la fosforilacion de esta proteína, impidiendo así su degradación en el proteasoma. El aumento de la concentración de glucosa incrementa la ruta de las hexosaminas y de esta manera la glicosilación de la β-catenina. Esto produce una acumulación de esta proteína en el citoplasma celular y permite su entrada al núcleo, donde ejerce su acción al unirse a una serie de moléculas y factores de transcripción, permitiendo de este modo que se expresen los genes diana, entre los que se encuentran los de las hormonas incretinas. También hay evidencias de que la glucosa, a través de la ruta de las hexosaminas, es capaz de inducir la activación autocrina de la ruta de señalización Wnt estimulando la secreción de proteínas Wnt (AU)

Incretins are a cluster of hormones which are secreted and released into the bloodstream after food intake by gutenteroendocrine cells, reaching to pancreas where produce a potentiating effect on insulin release. The aim of this study was to perform a systematic review of incretins gene expression mediated by nutrients using specific search equations in the Pub Med database. The two most relevant incretins are GLP-1 and GIP, which come from proglucagon and pro GIP precursor respectively. GLP-1is mainly synthesized and released by ileum and colon Lcells, in contrast to GIP which does it by K cells in duodenum and proximal jejunum. It has been shown that canonical Wnt signalling pathway is closely related to the production of these hormones, since transcription factorTCF7L2 affects proglucagon and proGIP gene expression in L and K enteroendocrine cells. On the other hand, it has been shown that the hexosamine biosynthetic pathway can produce N-linked glycosylation of -catenin, an essential component of canonical Wnt signalling. This process hinders β-catenin phosphorylation and, there by prevents proteasome degradation. Increasing glucose concentration enhances the hexosamine pathway and thusβ-catenin glycosylation. This causes a β-catenin cytoplasmic accumulation allowing entry into nucleus, where itexerts its action by binding to a clump of molecules andtranscription factors, allowing to express the target genes ,including the incretin hormones. There is also evidence that glucose, through the hexosamine pathway, can induces autocrine activation of Wnt signalling pathway by stimulating secretion of Wnt protein (AU)

Guía práctica para el manejo y tratamiento ante la cistitis radical / Practical treatment approach of radiation induced cystitis

Objetivo: Establecer una pauta de actuación y un algoritmo terapéutico ante la aparición de hematuria en pacientes con antecedentes de radioterapia pélvica, revisando para ello las diferentes opciones de tratamiento reflejadas en la literatura médica. Material y métodos: A través de PubMed se realiza una revisión bibliográfica de artículos relacionados con la cistitis rádica, incluyendo términos de búsqueda referidos a las diferentes opciones de tratamiento: ácido hialurónico endovesical; estrógenos conjugados, pentosan polisulfato, ácido aminocaproico oral, factor VIIa recombinante, cámara hiperbárica, embolización, aluminio endovesical, balón Helmstein y formolización. Se limita la búsqueda a publicaciones en castellano e inglés y se excluyen aquellas referidas a la experimentación animal. Resultados: Se expone cada una de las opciones citadas, haciendo referencia al mecanismo de acción, pauta y dosis de administración, efectos secundarios y prevención de los mismos si es posible así como eficacia del tratamiento. Tras conseguir estabilizar hemodinamicamente al paciente y descartar la presencia de lesiones neoformativas vesicales y/o hematurias originadas en tramo urinario superior, se debe iniciar un tratamiento escalonado. Conclusiones: El conocer diferentes opciones de tratamiento y sus pautas de administración permitirá al urólogo obtener una mayor tasa de éxitos en el difícil manejo de esta patología (AU)

Objective: Establish a pattern of behavior and treatment algorithm at the onset of hematuria in patients with a previous history of pelvic radiation, checking for this different treatment options reflected in the literature. Material and methods: Through performing a PubMed literature review of articles related to IC lies, searching items includes the different treatment options: intravesical hyaluronic acid, conjugated estrogens, pentosan polysulfate, oral aminocaproic acid, recombinant factor VIIa, hyperbaric chamber, embolization, aluminum intravesical, Helmstein ball and formalin. Limits the search to english or spanish publications and excluding those related to animal experimentation. Results: Every option is exposed, referring to the physiopathology, dosage regimen and administration, side effects and treatment efficacy. Conclusions: Once patient hemodynamic stabilization is achieved, and after rule out bladder tumors injuries and /or haemathuria originating from the upper urinary tract, treatment should start rolling. To know different treatment options and patterns of administration will allow the urologist to obtain a higher rate of success in the difficult management of this condition (AU)

[Practical treatment approach of radiation induced cystitis]. / Guía práctica para el manejo y tratamiento ante la cistitis radical.

OBJECTIVE: Establish a pattern of behavior and treatment algorithm at the onset of hematuria in patients with a previous history of pelvic radiation, checking for this different treatment options reflected in the literature. MATERIAL AND METHODS: Through performing a PubMed literature review of articles related to IC lies, searching items includes the different treatment options: intravesical hyaluronic acid, conjugated estrogens, pentosan polysulfate, oral aminocaproic acid, recombinant factor VIIa, hyperbaric chamber, embolization, aluminum intravesical, Helmstein ball and formalin. Limits the search to english or spanish publications and excluding those related to animal experimentation. RESULTS: Every option is exposed, referring to the physiopathology, dosage regimen and administration, side effects and treatment efficacy. CONCLUSIONS: Once patient hemodynamic stabilization is achieved, and after rule out bladder tumors injuries and /or haemathuria originating from the upper urinary tract, treatment should start rolling. To know different treatment options and patterns of administration will allow the urologist to obtain a higher rate of success in the difficult management of this condition.

Fournier's gangrene: a monographic urology center experience with twenty patients.

BACKGROUND: Fournier's gangrene (FG) is a fatal synergistic infectious disease with necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in males and the vulva in females. The aim of this study was to share our experience in the management of this infectious disease. METHODS: A retrospective chart review was performed in 20 patients with a diagnosis of FG between January 1991 and December 2007. Patient's age, source and predisposing factors, microbiological findings, duration of hospital stay, treatment modalities, and outcome were analyzed. RESULTS: The mean age of the patients was 53.9 +/- 9.56 (range 23-71) years. The source of gangrene was urinary in 5 patients, perirectal in 5, cutaneous in 1, and unknown in 9 patients. The main predisposing factors included diabetes mellitus in 9 patients (45%) and immunosuppression in 5 patients (25%). The mean duration of hospital stay was 39 +/- 10 (range 6-62) days. Although early intervention and intensive treatment were carried out, 4 patients died with an overall mortality of 20% as a result of septicemia complications. The mortality rate was higher in elderly patients and those with diabetes mellitus, but it was not statistically significant. Regarding the mortality rate, duration of symptoms, number of debridements, culture results and source of infection were not found to be significant factors. CONCLUSIONS: FG is still a severe disease. Management of this infectious entity must be aggressive. Despite the use of contemporary effective antibiotic treatment, aggressive debridements, and state-of-the-art intensive-care conditions, FG still has high mortality and morbidity rates.

[Treatment with amniotic membrane in keratolysis secondary to adult gonococcal keratoconjunctivitis]. / Tratamiento con membrana amniótica en queratolisis secundaria a queratoconjuntivitis gonocócica del adulto.

CASE REPORT: We present a 46-year-old man diagnosed initially with atypical adenoviral conjunctivitis and advanced marginal queratolysis with risk of perforation. The final diagnosis was gonococcal keratoconjunctivitis. The patient was successfully treated with amniotic membrane transplant, topic and systemic ceftriaxone (50 mg/ml and 1 grame/12 hours intravenous). DISCUSSION: Gonorrhea must be suspected in cases of torpid evolution conjunctivitis.

[Pterygium surgery: comparative study of conjunctival autograft with suture versus fibrin adhesive]. / Cirugía del pterigión: estudio comparativo entre autoinjerto conjuntival con sutura y con adhesivo tisular.

PURPOSE: To compare recurrence rate, complications, and biomicroscopical findings after conjunctival autograft pterygium surgery with the use of a fibrin glue (Tissucol Duo, Baxter AG, Vienna, Austria) or suture (7-0 silk). METHODS: Patients with nasal pterygium were included in two groups of conjunctival autograft surgery. In 9 of them the graft was sutured to the surrounding conjunctiva and in 8 of them the graft was fixed to the conjunctiva using fibrin glue. RESULTS: 17 patients (17 eyes) 41.2% women and 58.8% men were surgically treated. Mean patient age was 59.8 years. Five of the patients presented recurrence for simple excision and 12 presented primary pterygium. The extent of corneal invasion was 2 to 4 mm. In the suture group, 33.3% of the patients experienced pain after surgery compared to none in the fibrin glue group. In the suture group, 44.4% of the patients presented inflammation after surgery compared to none in the glue group. One patient from the glue group lost the graft and presented a recurrence one month later. CONCLUSIONS: The use of fibrin glue in pterygium surgery reduces patient symptoms, inflammation and discomfort. The rate of recurrence seems to be similar in both procedures.

Cirugía del pterigión: estudio comparativo entre autoinjerto conjuntival con sutura y con adhesivo tisular / Pterygium sugery: comparative study of conjuctival autograft with suture versus fibrin adhesive

Objetivo: Comparar la tasa de recurrencias, complicacionesy hallazgos biomicroscópicos despuésde cirugía de pterigión con autoinjerto conjuntivalusando adhesivo tisular (Tissucol Duo®, BaxterAG, Viena, Austria) o sutura (seda 7-0).Material y métodos: Se han incluido en el estudiopacientes con pterigión nasal en dos grupos de cirugíade autoinjerto conjuntival: en 9 de ellos el injertose sutura a conjuntiva y en 8 de ellos se fija conadhesivo tisular.Resultados: Se intervinieron 17 ojos de 17 pacientes,41,2% mujeres y 58,8% hombres con edadmedia de 59,8 años. 5 ojos presentaban recurrenciade resección simple y 12 de ellos presentaban pterigiónprimario. El tamaño de la invasión cornealosciló entre 2 y 4 mm. 33,3% de los pacientes delgrupo de sutura presentaron molestias después de lacirugía frente a ninguno en el grupo de adhesivo.44,4% de los pacientes presentaron inflamación trasla cirugía frente a ninguno en el grupo de sutura. Enuno de los pacientes del grupo del adhesivo se produjo una pérdida del injerto causando una posteriorrecidiva del pterigión.Conclusiones: El uso de adhesivo tisular reduce lossíntomas postquirúrgicos así como la inflamación yel disconfort. La tasa de recurrencias parece sersimilar con los dos procedimientos(AU)

Purpose: To compare recurrence rate, complications,and biomicroscopical findings after conjunctivalautograft pterygium surgery with the use of afibrin glue (Tissucol Duo®, Baxter AG, Vienna,Austria) or suture (7-0 silk).Methods: Patients with nasal pterygium wereincluded in two groups of conjunctival autograftsurgery. In 9 of them the graft was sutured to thesurrounding conjunctiva and in 8 of them the graftwas fixed to the conjunctiva using fibrin glue.Results: 17 patients (17 eyes) 41.2% women and58.8% men were surgically treated. Mean patient agewas 59.8 years. Five of the patients presented recurrencefor simple excision and 12 presented primary pterygium.The extent of corneal invasion was 2 to 4 mm. Inthe suture group, 33.3% of the patients experiencedpain after surgery compared to none in the fibrin gluegroup. In the suture group, 44.4% of the patients presentedinflammation after surgery compared to none inthe glue group. One patient from the glue group lost thegraft and presented a recurrence one month later. Conclusions: The use of fibrin glue in pterygiumsurgery reduces patient symptoms, inflammationand discomfort. The rate of recurrence seems to besimilar in both procedures(AU)

Tratamiento con membrana amniótica en queratolisis secundaria a queratoconjuntivitis gonocócica del adulto / Treatament with amniotic membrane in keratolysis secondary to adult gonococcal keratoconjunctivitis

Caso clínico: Varón de 46 años diagnosticado inicialmentede conjuntivitis adenovírica atípica conqueratolisis marginal avanzada y riesgo de perforaciónocular. El diagnóstico final fue queratoconjuntivitisgonocócica. El paciente fue tratado eficazmentecon recubrimiento de membrana amniótica,ceftriaxona tópica y sistémica (50 mg/ml y1 gr/12 h intravenosa).Discusión: La gonorrea debe ser sospechada encasos de conjuntivitis de evolución tórpida(AU)

Case report: We present a 46-year-old man diagnosedinitially with atypical adenoviral conjunctivitisand advanced marginal queratolysis with risk ofperforation. The final diagnosis was gonococcalkeratoconjunctivitis. The patient was successfullytreated with amniotic membrane transplant, topicand systemic ceftriaxone (50 mg/ml and 1 grame/12hours intravenous).Discussion: Gonorrhea must be suspected in casesof torpid evolution conjunctivitis(AU)

[Questionnaire for urological emergency room quality evaluation]. / Cuestionario de evaluación de la calidad asistencial en un servicio de urgencias urológicas.

INTRODUCTION: Quality is defined as an essential and distinguishing attribute of something, which allows to evaluate its worth. The quality evaluation has become something necessary during the last years. The assistencial quality should be something inherent to the offered service, including scientific and technical quality, management and quality noticed. A periodical assesment, as auto-evaluation or through an outsourcing, is a recommendable way to detect potential improvement items. MATERIAL AND METHODS: Using the EFQM,ISO 9001:2000 and Malcolm Baldrige model, and through the items from National Health System, a self-questionnaire of urological emergency room quality evaluation is proposed. CONCLUSION: A new self-questionnaire of urological emergency room quality evaluation is proposed.