Initial experience with thulium fiber laser for prostate enucleation: Analysis of the intraoperative and short-term outcomes in a prospective, multicenter cohort.

INTRODUCTION: Holmium laser enucleation of the prostate has rapidly become the gold standard for the surgical treatment of benign prostate hyperplasia, although thulium fiber laser (TFL) has also been postulated as an effective and safe alternative for prostate enucleation. The aim of this study is to describe our initial experience with the TFL for endoscopic enucleation of the prostate. MATERIAL AND METHODS: All patients proposed to TFL prostate enucleation were included in the analysis, regardless their prostate volume, catheter status and severity of symptoms, in 3 centers. Preoperative characteristics, intraoperative times and functional 3-months follow-up variables were collected, along with complications. RESULTS: Fifty-six patients were available, with a mean age of 68.7 years. Enucleation and morcellation efficiencies were 2.04 and 7.47 g/min, respectively. Median hospital stay was one day. Comparable functional data, pre and 3-month post-surgery was: mean prostate volume 88.9 vs 21.3 g, maximum urinary flow 13.2 vs 27.3 ml/s, post-void residual volume 149 vs 7.8 ml, prostatic specific antigen level 11.2 vs 1 ng/ml, and International Prostate Symptom Score 20.75 vs 3.96. Fourteen out of 56 (25%) patients presented with complications grade ≤2, according to the Clavien-Dindo classification. DISCUSSION: With wider evidence for other urological indications, very recent evidence about the suitability of TFL for prostate enucleation has arisen, since the first case described in 2021. Our results seem to back up these previous successful experiences as long as we obtained good intraoperative and short term follow-up functional results. However, there is still a need of longer follow-up data. CONCLUSIONS: TFL represents a novel technology for prostate enucleation, with a good intraoperative and short follow-up functional results, and a safety profile similar to the observed for those techniques that have been wider used for this indication. Further studies with longer follow-up periods and comparative with these other techniques are necessary.

Formulación magistral en patología de la mucosa oral / Drug Compounding for Diseases of the Oral Mucosa

Los medicamentos industriales comercializados para uso tópico oral son muy escasos y con vehículos poco adecuados. En consecuencia, frecuentemente hay que recurrir a preparados magistrales que permitan aplicar principios activos en vehículos diseñados especialmente para su aplicación en la mucosa oral. La formulación magistral también permite incluir varios principios activos en un mismo vehículo y prescribir fármacos actualmente en desabastecimiento, entre otras ventajas. Describimos las principales fórmulas magistrales para el tratamiento de la patología de la mucosa oral más frecuente

Commercial topical medications for oral conditions are scarce and the vehicles used are not very suitable. Therefore, formulations containing active ingredients in vehicles specially designed for oral application must often be prepared. Drug compounding offers other advantages, including the possibility of combining several active ingredients in a single vehicle and prescribing drugs that are in short supply. In this article, we describe the main pharmaceutical formulations used to treat the most common diseases of the oral mucosa

Drug Compounding for Diseases of the Oral Mucosa. / Formulación magistral en patología de la mucosa oral.

Commercial topical medications for oral conditions are scarce and the vehicles used are not very suitable. Therefore, formulations containing active ingredients in vehicles specially designed for oral application must often be prepared. Drug compounding offers other advantages, including the possibility of combining several active ingredients in a single vehicle and prescribing drugs that are in short supply. In this article, we describe the main pharmaceutical formulations used to treat the most common diseases of the oral mucosa.

Linfadenectomía de rescate en pacientes con cáncer de próstata tratados con prostatectomía radical o radioterapia y tomografía por emisión de positrones (PET) con colina positiva / Salvage lymph node dissection in patients with prostate cancer treated with radical prostatectomy or radiotherapy and positive choline positron emission tomography (PET/CT) scan

Introducción y objetivos: La recidiva ganglionar en el cáncer de próstata es un escenario terapéutico controvertido. Las guías clínicas recomiendan el uso de terapia hormonal, tratamiento "la carta" o incluir en ensayos clínicos. Estudiamos en el presente estudio el impacto de la linfadenectomía de rescate en pacientes seleccionados. Material y métodos: Revisamos retrospectivamente a 23 pacientes consecutivos con cáncer de próstata tratados mediante prostatectomía radical o radioterapia externa, a quienes se les practicó linfadenectomía de rescate desde diciembre del 2005 hasta noviembre del 2015. Se realizó análisis univariante y bivariante para evaluar la relación entre factores de riesgo y respuesta a la linfadenectomía. Resultados: Encontramos que en los pacientes con respuesta bioquímica; la hormonoterapia fue retrasada 14,9 meses comparándolo con los que no respondieron (2,8 meses), p = 0,00026. A pesar de que no se alcanzó la significación estadística (p = 0,072), el tiempo de duplicación de PSA podría ser un factor pronóstico de recidiva radiológica ya que los pacientes con tiempo de duplicación < 6 meses desarrollaron recidiva radiológica 7,6 meses antes. Conclusiones: La linfadenectomía de rescate es un tratamiento que puede retrasar el uso de hormonoterapia en pacientes seleccionados

Introduction and objectives: Nodal prostate cancer recurrence is a challenging scenario. Current guidelines recommend the use of androgen deprivation therapy, tailored treatment or clinical trials. We studied the impact of Salvage lymph node dissection in selected patients. Material and methods: We retrospectively reviewed records of 23 consecutive patients with prostate cancer and previous Radical prostatectomy or Radiotherapy who underwent SLND from December 2005 to November 2015. Results: We found that in patients that showed biochemical response the introduction of ADT was delayed 14.9 months compared to patients that did not responded (2.8 months) p = 0.00026. Furthermore although statistical significance was not reached (p = 0.072) PSA-DT could be a potential prognostic factor of radiological recurrence since patients with PSA-DT < 6 months developed radiological recurrence 7.6 months earlier compared to their counterparts. Conclusions: Salvage lymph node dissection is a potential treatment that could delay ADT in selected patients

Salvage lymph node dissection in patients with prostate cancer treated with radical prostatectomy or radiotherapy and positive choline positron emission tomography (PET/CT) scan. / Linfadenectomía de rescate en pacientes con cáncer de próstata tratados con prostatectomía radical o radioterapia y tomografía por emisión de positrones (PET) con colina positiva.

INTRODUCTION AND OBJECTIVES: Nodal prostate cancer recurrence is a challenging scenario. Current guidelines recommend the use of androgen deprivation therapy, tailored treatment or clinical trials. We studied the impact of Salvage lymph node dissection in selected patients. MATERIAL AND METHODS: We retrospectively reviewed records of 23 consecutive patients with prostate cancer and previous Radical prostatectomy or Radiotherapy who underwent SLND from December 2005 to November 2015. RESULTS: We found that in patients that showed biochemical response the introduction of ADT was delayed 14.9 months compared to patients that did not responded (2.8 months) P=.00026. Furthermore although statistical significance was not reached (P=.072) PSA-DT could be a potential prognostic factor of radiological recurrence since patients with PSA-DT<6 months developed radiological recurrence 7.6 months earlier compared to their counterparts. CONCLUSIONS: Salvage lymph node dissection is a potential treatment that could delay ADT in selected patients.

Revisión sistemática de los métodos predictores de la funcionalidad del trasplante renal / Systematic review of kidney transplantation functional predictors

Contexto: El trasplante renal de donantes con criterios expandidos ha aumentado el pool de riñones a costa de un riesgo superior de disfunción del injerto a corto y/o largo plazo. La cuestión principal reside en determinar qué riñones ofrecerán una función y supervivencia aceptables comparado con el riesgo que supone la cirugía y la posterior inmunosupresión. Objetivo: El objetivo de nuestro artículo es revisar la evidencia actual sobre las herramientas para predecir la funcionalidad del trasplante renal de donantes de cadáver con criterios expandidos y determinar la validez para su uso en la práctica habitual. Adquisición de evidencia: Hemos realizado una revisión sistemática de la literatura según los criterios PRISMA, a través de Medline (http://www.ncbi.nlm.nih.gov), utilizando las palabras clave, aisladas o conjuntamente: cadaveric renal transplantation; kidney graft function appraisal; graft function predictors. Se seleccionaron series prospectivas y retrospectivas, así como artículos de revisión. Un total de 375 artículos fueron analizados, de los cuales 39 fueron finalmente seleccionados para revisión. Síntesis de evidencia: Entre los predictores de la funcionalidad se encuentran: los índices de riesgo del donante; el cálculo del peso funcional renal o la valoración de la masa nefrónica; la medición de las resistencias vasculares durante la perfusión en hipotermia; la medición de biomarcadores en la orina del donante y en el líquido de perfusión; la medición de parámetros funcionales y de reperfusión en normotermia y la medición de los parámetros morfológicos, micro y macroscópicos, del órgano diana. En este artículo presentamos un resumen explicativo de cada uno de estos parámetros, así como su evidencia más reciente al respeto. Discusión: Ningún parámetro de los revisados fue capaz de predecir por sí mismo, con fiabilidad, la función renal y la supervivencia del trasplante. Existe un importante vacío en cuanto a la valoración macroscópica del trasplante renal. Conclusiones: Es necesario continuar desarrollando los predictores de la funcionalidad renal para definir con precisión la distribución de cada uno de los riñones de los donantes que disponemos en la actualidad

Context: Kidney transplantation from donors with expanded criteria has increased the pool of kidneys at the cost of a higher risk of short and long-term graft dysfunction. The main issue lies in determining which kidneys will offer acceptable function and survival compared with the risk represented by surgery and subsequent immunosuppression. Objective: The objective of our article is to review the current evidence on the tools for predicting the functionality of kidney transplantation from cadaveric donors with expanded criteria and determining the validity for their use in standard practice. Acquisition of evidence: We conducted a systematic literature review according to the PRISM criteria, through Medline (http://www.ncbi.nlm.nih.gov) and using the keywords (in isolation or in conjunction) "cadaveric renal transplantation; kidney graft function appraisal, graft function predictors". We selected prospective and retrospective series and review articles. A total of 375 articles were analysed, 39 of which were ultimately selected for review. Summary of the evidence: The predictors of functionality include the following: The donor risk indices; the calculation of the renal functional weight or the assessment of the nephronic mass; the measurement of vascular resistances during perfusion in hypothermia; the measurement of the donor's biomarkers in urine and in the perfusion liquid; the measurement of functional and reperfusion parameters in normothermia; and the measurement of morphological parameters (microscopic and macroscopic) of the target organ. In this article, we present an explanatory summary of each of these parameters, as well as their most recent evidence on this issue. Discussion: None of the reviewed parameters in isolation could reliably predict renal function and graft survival. There is a significant void in terms of the macroscopic assessment of kidney transplantation. Conclusions: We need to continue developing predictors of renal functionality to accurately define the distribution of each currently available donor kidney

Systematic review of kidney transplantation functional predictors. / Revisión sistemática de los métodos predictores de la funcionalidad del trasplante renal.

CONTEXT: Kidney transplantation from donors with expanded criteria has increased the pool of kidneys at the cost of a higher risk of short and long-term graft dysfunction. The main issue lies in determining which kidneys will offer acceptable function and survival compared with the risk represented by surgery and subsequent immunosuppression. OBJECTIVE: The objective of our article is to review the current evidence on the tools for predicting the functionality of kidney transplantation from cadaveric donors with expanded criteria and determining the validity for their use in standard practice. ACQUISITION OF EVIDENCE: We conducted a systematic literature review according to the PRISM criteria, through Medline (http://www.ncbi.nlm.nih.gov) and using the keywords (in isolation or in conjunction) "cadaveric renal transplantation; kidney graft function appraisal, graft function predictors". We selected prospective and retrospective series and review articles. A total of 375 articles were analysed, 39 of which were ultimately selected for review. SUMMARY OF THE EVIDENCE: The predictors of functionality include the following: The donor risk indices; the calculation of the renal functional weight or the assessment of the nephronic mass; the measurement of vascular resistances during perfusion in hypothermia; the measurement of the donor's biomarkers in urine and in the perfusion liquid; the measurement of functional and reperfusion parameters in normothermia; and the measurement of morphological parameters (microscopic and macroscopic) of the target organ. In this article, we present an explanatory summary of each of these parameters, as well as their most recent evidence on this issue. DISCUSSION: None of the reviewed parameters in isolation could reliably predict renal function and graft survival. There is a significant void in terms of the macroscopic assessment of kidney transplantation. CONCLUSIONS: We need to continue developing predictors of renal functionality to accurately define the distribution of each currently available donor kidney.

Anatomical and morphological study of the subcoracoacromial canal.

INTRODUCTION: Many clinical anatomy studies have looked into how variations in the acromion, coracoacromial ligament (CAL) and subacromial space are associated with rotator cuff injuries. However, no study up to now had defined anatomically the fibro-osseous canal that confines the supraspinatus muscle in the subcoracoacromial space. Through an anatomical study of the scapula, we defined the bone-related parameters of this canal and its anatomical variations. MATERIALS AND METHODS: This study on dry bones involved 71 scapulas. With standardised photographs in two orthogonal views (superior and lateral), the surface area of the subcoracoacromial canal and the anatomical parameters making up this canal were defined and measured using image analysis software. The primary analysis evaluated the anatomical parameters of the canal as a function of three canal surface area groups; the secondary analysis looked into how variations in the canal surface area were related to the type of acromion according to the Bigliani classification. RESULTS: Relative to glenoid width, the group with a large canal surface area (L) had significantly less lateral overhang of the acromion than the group with a small canal surface area (S), with ratios of 0.41±0.23 and 0.58±0.3, respectively (P=0.04). The mean length of the CAL was 46±8mm in the L group and 39±9mm in the S group (P=0.003). The coracoacromial arch angle was 38°±11° in the L group and 34°±9° in the S group; the canal surface area was smaller in specimens with a smaller coracoacromial arch angle (P=0.20). CONCLUSION: Apart from acromial morphology, there could be innate anatomical features of the scapula that predispose people to extrinsic lesions to the supraspinatus tendon (lateral overhang, coracoacromial arch angle) by reducing the subcoracoacromial canal's surface area. LEVEL OF EVIDENCE: Anatomical descriptive study.

[Imaging diagnosis in Focal Therapy for prostate cancer: Multiparametric Magnetic Resonance Imaging]. / Diagnóstico por imágen en Terapia Focal para el cáncer de próstata: Resonancia Magnética multiparamétrica.

The use of prostatic multiparametric MRI (mpMRI) has increased significantly over the last years, and has emerged as a crucial test for diagnosis, staging and treatment of prostate cancer (PCa). The use of the various available sequences (T2W, T1W, diffusion, perfusion and spectroscopy), as well as the different parameters they associate, not only enables to determine the group of patients subsidiary of focal ablative therapy, but also to perform a proper determination of the áreas to treat, as well as to monitor the development of therapy and to evaluate both oncological results and possible therapeutic failures. Despite the excellent results showed in the different studies, it is necessary to reach a consensus about its use on the different features associated with focal therapy, since it is a technique that requires not only large experience in its operation but also standardization. All this make it a complex technique and not free of difficulties in its interpretation.

Bone mass and vitamin D levels in women with a diagnosis of fibromyalgia.

UNLABELLED: No differences in either bone mineral density or serum 25OHD levels have been found between 205 women with fibromyalgia (both pre- and postmenopausal) and their controls. However, a lack of the expected 25OHD summer rise was observed in patients. INTRODUCTION: Contradictory data have been published regarding a possible association between fibromyalgia and osteoporosis or hypovitaminosis D. Most studies, however, have been performed in small size samples and have excluded postmenopausal women. We decided to study this association in a larger sample of fibromyalgia patients including both pre- and postmenopausal women. METHODS: Two hundred five patients were recruited from a clinic specializing in fibromyalgia and 205 healthy controls were enrolled from the census of a Primary Care Center. Controls were matched with patients by age and the time of the year they were included in the study. Bone mineral density (BMD) was measured by DXA. Serum 25OHD, iPTH, P1NP, and CTX were also determined. RESULTS: BMD was similar in both groups (lumbar spine, 0.971 ± 0.146 g/cm(2) in patients and 0.970 ± 0.132 g/cm(2) in controls; femoral neck, 0.780 ± 0.122 g/cm(2) and 0.785 ± 0.117 g/cm(2), respectively). 25OHD levels were also similar: 23.0 ± 9.5 ng/ml and 24.1 ± 9.6 ng/ml. However, while controls showed the usual summer rise in 25OHD, fibromyalgia patients did not. PTH did not show seasonal changes, but on average was higher in patients (51 pg/ml vs. 48 pg/ml; p = 0.034). P1NP or CTX were similar in both groups. CONCLUSIONS: No differences in BMD were found between patients and controls. As for 25OHD, a lack of its expected summer rise was observed. It is doubtful whether this has any homeostatic consequence. We consider that the association reported in other studies is merely circumstantial, and not due to the intrinsic characteristics of these disorders.

La formulación magistral en la terapéutica dermatológica actual / Compounding as a Current Therapeutic Option in Dermatology

A pesar de la gran cantidad de productos disponibles producidos por la industria farmacéutica, hoy en día la formulación magistral sigue teniendo un papel muy importante en el tratamiento de las afecciones dermatológicas. Desde los inicios de la Dermatología se ha usado, siendo muy útil en el tratamiento de enfermedades para las que no se disponía de preparados farmacéuticos específicos; sin embargo, a medida que fueron apareciendo nuevos productos comercializados se puso en duda la utilidad de la formulación, cuestionando su seguridad, estabilidad y efectividad. Esto contrasta con la tendencia actual de recuperar la formulación, haciendo que vuelva a ocupar su lugar en la práctica dermatológica habitual. En el presente artículo revisamos las patologías en las que se usa con más frecuencia la formulación, sus utilidades e inconvenientes, la legislación actual al respecto en nuestro ámbito, aportando las últimas novedades descritas en cuanto a vehículos y principios activos disponibles (AU)

Compounding continues to play a key role in the treatment of skin conditions, despite the abundance of products made by the pharmaceutical industry. Right from the earliest days of dermatology, compounding proved very useful in the treatment of diseases for which no specific drugs were available. However, as new products came onto the market, this usefulness was called into question, and doubts over safety, stability, and effectiveness were raised. Today, compounding is regaining the place it once held in routine dermatological practice. We review the advantages and disadvantages of compounding, the most common indications, current legislation in our setting, and the latest developments in active ingredients and vehicles (AU)

Compounding as a current therapeutic option in dermatology.

Compounding continues to play a key role in the treatment of skin conditions, despite the abundance of products made by the pharmaceutical industry. Right from the earliest days of dermatology, compounding proved very useful in the treatment of diseases for which no specific drugs were available. However, as new products came onto the market, this usefulness was called into question, and doubts over safety, stability, and effectiveness were raised. Today, compounding is regaining the place it once held in routine dermatological practice. We review the advantages and disadvantages of compounding, the most common indications, current legislation in our setting, and the latest developments in active ingredients and vehicles.

[Antiparasitic drugs. Review of the useful drugs in the treatment of classic and emergent parasitic diseases]. / Antiparasitarios. Revisión de los fármacos útiles en el tratamiento de parasitosis clásicas y emergentes.

INTRODUCTION: In the 10 last years, the increase of international travels and immigration from low income countries to Spain was related with an increased of prevalence of parasitic diseases. SOURCE: Critical review of the literature. STRUCTURE: Firstly, several general considerations were made on the antiparasitic drugs revised in this paper. Chemical structures and mechanisms of action of the main drugs with antiparasitic effect were considered in the second part of the review. Further, antiparasitic spectrum of selected drugs, main pharmacokinetical characteristics, usual posology, possible side effects and contraindications were detailed. Finally, some practical aspects, such as interactions and the methods for practical obtention of these drugs are indicated. This information is relevant because in Spain many anti-parasitic drugs may be obtained using non conventional methods. CONCLUSION: In Spain, the increase of parasitic diseases necessitates an update on antiparasitics drugs for their treatment.

Cytokines - their pathogenic and therapeutic role in chronic viral hepatitis.

Cytokines make up a network of molecules involved in the regulation of immune response and organ functional homeostasis. Cytokines coordinate both physiological and pathological processes occurring in the liver during viral infection, including infection control, inflammation, regeneration, and fibrosis. Hepatitis B and hepatitis C viruses interfere with the complex cytokine network brought about by the immune system and liver cells in order to prevent an effective immune response, capable of viral control. This situation leads to intrahepatic sequestration of nonspecific inflammatory infiltrates that release proinflammatory cytokines, which in turn favor chronic inflammation and fibrosis. The therapeutical administration of cytokines such as interferon alpha may result in viral clearance during persistent infection, and revert this process.

Antiparasitarios. Revisión de los fármacos útiles en el tratamiento de parasitosis clásicas y emergentes / Antiparasitic drugs. Review of the useful drugs in the treatment of classic and emergent parasitic diseases

Introducción. En los últimos 10 años, el aumento de los viajes internacionales y la inmigración procedente de países en vías de desarrollo ha ocasionado un aumento de enfermedades parasitarias en nuestro país. Fuentes. Revisión crítica de la bibliografía. Desarrollo. En un primer apartado se delimitan los fármacos que serán revisados posteriormente. El segundo epígrafe incluye un breve resumen de las características químicas y un esquema general del mecanismo de acción de estas moléculas. Posteriormente se revisan varios aspectos de interés: el espectro de acción de cada uno de los antiparasitarios estudiados, las características farmacocinéticas de los mismos, la posología general, los principales efectos secundarios y las contraindicaciones de empleo. Finalmente se indican otros aspectos prácticos, como las interacciones y la forma práctica de obtener esta medicación, ya que muchos deben ser adquiridos a través de medicación extranjera. Conclusiones. El incremento de las parasitosis en España hace preciso una actualización de las características de los antiparasitarios útiles en su tratamiento (AU)

Introduction. In the 10 last years, the increase of international travels and immigration from low income countries to Spain was related with an increased of prevalence of parasitic diseases Source. Critical review of the litterature. Structure. Firstly, several general considerations were made on the antiparasitic drugs revised in this paper. Chemical structures and mechanisms of action of the main drugs with antiparasitic effect were considered in the second part of the review. Further, antiparasitic spectrum of selected drugs, main pharmacokinetical characteristics, usual posology, possible side effects and contraindications were detailed. Finally, some practical aspects, such as interactions and the methods for practical obtention of these drugs are indicated. This information is relevant because in Spain many antiparasitic drugs may be obtained using non conventional methods. Conclusion. InSpain, the increase of parasitic diseases it does necessary an update on antiparasitics drugs for their treatment (AU)

Cytokines – their pathogenic and therapeutic role in chronic viral hepatitis

Cytokines make up a network of molecules involved in the regulationof immune response and organ functional homeostasis. Cytokinescoordinate both physiological and pathological processesoccurring in the liver during viral infection, including infection control,inflammation, regeneration, and fibrosis. Hepatitis B and hepatitisC viruses interfere with the complex cytokine networkbrought about by the immune system and liver cells in order to preventan effective immune response, capable of viral control. This situationleads to intrahepatic sequestration of nonspecific inflammatoryinfiltrates that release proinflammatory cytokines, which in turnfavor chronic inflammation and fibrosis. The therapeutical administrationof cytokines such as interferon alpha may result in viral clearanceduring persistent infection, and revert this process(AU)

Acalculous cholecystitis in a patient with Plasmodium falciparum infection after a trip to the Dominican Republic.

Acalculous cholecystitis has been associated with several infectious agents, but its relation with Plasmodium falciparum infection has not been clearly defined. This is the first case of acalculous cholecystitis produced by Plasmodium falciparum infection that is directly documented and should be included among the differential diagnoses of acalculous cholecystitis.