Histerectomías laparoscópicas en un hospital comarcal español: nuestros resultados / The outcomes of laparoscopic hysterectomies in a Spanish district hospital

OBJETIVO: Calcular la tasa de conversión y describir las indicaciones, tipos de cirugía y complicaciones de las histerectomías laparoscópicas en un hospital comarcal. Analizar los tiempos quirúrgicos y el peso uterino. MÉTODO: Estudio retrospectivo y descriptivo de la base de datos quirúrgica de las mujeres atendidas en el Servicio de Ginecología y Obstetricia del Hospital Comarcal de Valdeorras (Orense). Programamos a 78 mujeres para histerectomía laparoscópica desde mayo del 2011 hasta febrero de 2018. Describimos las características demográficas, clínica, tipo de cirugía y tratamientos previos. Realizamos 62 histerectomías totales, 15 subtotales y una operación de Manchester. Calculamos la tasa de conversión, porcentaje de morcelación, tiempo quirúrgico, complicaciones (clasificadas según la escala de Clavien-Dindo y el Comprehensive Complication Index) y los resultados de anatomía patológica. RESULTADOS: Nuestra tasa de conversión fue del 5,13%. El porcentaje de morcelación fue 35,90%. En las histerectomías totales calculamos un peso uterino teórico (190 g o más) a partir del cual la morcelación sería más probable. No hubo transfusiones. Encontramos mayor tiempo quirúrgico entre los cirujanos junior, pero no más complicaciones. Las complicaciones según Clavien-Dindo fueron: 10 pacientes grado I, 10 grado II, uno grado IIIa y 4 grado IIIb. Según el Comprehensive Complication Index, 20 pacientes obtuvieron una puntuación baja (<30 puntos) y 4 pacientes entre 31 y 40 puntos. La cesárea previa estaba asociada a mayor riesgo de lesión vesical. La estancia media fue de 2,48 días. No hubo resultados de malignidad entre los úteros morcelados. CONCLUSIONES: La histerectomía laparoscópica es una técnica quirúrgica fácilmente reproducible en hospitales comarcales, con baja tasa de conversión y escasas complicaciones

OBJECTIVE: To calculate the conversion rate and describe indications, type of surgery, and complications of laparoscopic hysterectomies in a district hospital, as well as to analyse surgical time and uterine weight. METHODS: A descriptive and retrospective study was carried using the database of the Surgical Record of Gynaecology (Canadian Task Force classification III). It was conducted in the Gynaecology and Obstetrics Department of Valdeorras District Hospital (Orense, Spain). The study included 78 women scheduled for laparoscopic hysterectomy from May 2011 to February 2018. A description is presented of the demographic characteristics, symptoms, type of surgery, and previous medical treatments. A total of 62 total and 15 subtotal hysterectomies, were performed, as well as one Manchester surgery. A calculation was made of the rate of conversion, morcellation percentage, operating time, complications (classified according to the Clavien-Dindo scale and the Comprehensive Complication Index), and pathology results. RESULTS: The conversion rate was 5.13%, and the morcellation percentage was 35.90%. A theoretical cut-off was calculated of a uterus weight of 190 grammes or more for being morcellated among total hysterectomies. There were no transfusions. There were longer operating times with junior surgeons, but no difference in surgical complications compared to senior surgeons. Complications according to the Clavien-Dindo scale: 10 patients grade I, 10 grade II, one grade IIIa, and 4 grade IIIb. Using the CCI, 20 patients attained a low score (<30 points), and 4 patients scored 31-40 points. A history of caesarean section was associated with a higher risk of bladder injury. Mean days to discharge was 2.48 days. There were no malignant samples among the morcellated uteruses. CONCLUSIONS: Laparoscopic hysterectomy is a technique that can be performed in a district hospital and in most cases with a minimum conversion rate and few complications

Resultados a largo plazo de la cirugía de prolapsos genitales con mallas de polipropileno / Long-term results of genital prolapse surgery with polypropylene mesh

Introducción y objetivo: El riesgo de intervención por prolapso urogenital en la vida de una mujer es del 11,1%. Las recidivas después de la cirugía clásica alcanzan el 38%. Para tratar de mejorar estos resultados se usan kits de mallas de polipropileno transvaginales. El propósito del estudio es describir los resultados de eficacia y seguridad a largo plazo de la cirugía de prolapsos vaginales con mallas de polipropileno, evaluar los síntomas subjetivos pre- y postoperatorios y el grado de satisfacción. Pacientes y métodos: Estudio descriptivo, retrospectivo de 58 mujeres con prolapsos genitales sintomáticos operadas con mallas de polipropileno entre septiembre de 2011 y noviembre de 2016. La edad media fue 66,53 años; el 98,27% eran menopáusicas, el 77,59% tenía sobrepeso/obesidad, el 29,31% contaba con cirugías ginecológicas previas y el 55,17% con prolapsos combinados. Se insertaron 46 Elevate anterior y 12 Elevate posterior. La media del seguimiento fue de 34,02 meses. Se aplicó el cuestionario PFDI pre- y posquirúrgico y un cuestionario de satisfacción. Resultados: El índice de curación fue del 91,38%. Las recidivas se asociaron con un mayor IMC y con el antecedente de recidiva de cirugía previa. Estancia media: 2,5 días. El 70,69% no necesitó analgesia al alta. Complicaciones Clavien-Dindo: una tipo I (retención urinaria), 5 tipo II (infección urinaria) y una tipo IIIa (erosión). La incontinencia urinaria de esfuerzo de novo se presentó en el 3,44%, mientras que la dispareunia de novo ocurrió en el 14,28%. El 89,36% de las pacientes habían mejorado de los síntomas subjetivos y el 95,92% se mostraron satisfechas. Conclusión: Esta cirugía consigue altas tasas de curación, con escasas complicaciones, mejoría subjetiva de los síntomas y alto grado de satisfacción de las pacientes

Introduction and objective: The risk of intervention due to urogenital prolapse in a woman's life is 11.1%. Recurrences after classic surgery reach up to 38%. With the aim of improving these results, transvaginal mesh kits are used. The purpose of the study is to describe the results of efficacy and long-term safety of vaginal prolapse surgery with polypropylene mesh, assess subjective symptoms before and after surgery and the level of satisfaction. Patients and methods: A descriptive, retrospective study of 58 women with symptomatic genital prolapses operated with polypropylene mesh between September / 2011-November / 2016. Mean age: 66.53 years, 98.27% menopausal women, 77.59% overweight/obesity, 29.31% with previous gynaecological surgery and 55.17% with combined prolapse. 46 Elevate anterior and 12 posterior were inserted. The mean follow-up period was 34.02 months. The PFDI questionnaire was used pre and post-surgery, as well as the satisfaction questionnaire. Results: Healing rate of 91.38%. Recurrences were associated with a higher BMI and with background of recurrence of previous surgery. Mean length of stay: 2.5 days. 70.69% did not need analgesia at discharge. Clavien-Dindo complications: 1 type I (urinary retention), 5 type II (urinary tract infection) and 1 type IIIa (erosion). De novo stress urinary incontinence occurred in 3.44%, while de novo dyspareunia 14.28%. 89.36% patients improved subjective symptoms, and 95.92% were satisfied. Conclusion: This surgery achieves high healing rates, with few complications, improvement of subjective symptoms and high level of satisfaction of the patients

Long-term results of genital prolapse surgery with polypropylene mesh. / Resultados a largo plazo de la cirugía de prolapsos genitales con mallas de polipropileno.

INTRODUCTION AND OBJECTIVE: The risk of intervention due to urogenital prolapse in a woman's life is 11.1%. Recurrences after classic surgery reach up to 38%. With the aim of improving these results, transvaginal mesh kits are used. The purpose of the study is to describe the results of efficacy and long-term safety of vaginal prolapse surgery with polypropylene mesh, assess subjective symptoms before and after surgery and the level of satisfaction. PATIENTS AND METHODS: A descriptive, retrospective study of 58 women with symptomatic genital prolapses operated with polypropylene mesh between September / 2011-November / 2016. Mean age: 66.53 years, 98.27% menopausal women, 77.59% overweight/obesity, 29.31% with previous gynaecological surgery and 55.17% with combined prolapse. 46 Elevate anterior and 12 posterior were inserted. The mean follow-up period was 34.02 months. The PFDI questionnaire was used pre and post-surgery, as well as the satisfaction questionnaire. RESULTS: Healing rate of 91.38%. Recurrences were associated with a higher BMI and with background of recurrence of previous surgery. Mean length of stay: 2.5 days. 70.69% did not need analgesia at discharge. Clavien-Dindo complications: 1 type I (urinary retention), 5 type II (urinary tract infection) and 1 type IIIa (erosion). De novo stress urinary incontinence occurred in 3.44%, while de novo dyspareunia 14.28%. 89.36% patients improved subjective symptoms, and 95.92% were satisfied. CONCLUSION: This surgery achieves high healing rates, with few complications, improvement of subjective symptoms and high level of satisfaction of the patients.

Tromboprofilaxis en pacientes médicos y quirúrgicos: resultados de un estudio multicéntrico realizado en hospitales de la Ciudad de México / Thromboprophylaxis in medical and surgical patients: results of a multicenter study in hospitals of Mexico City

Resumen: ANTECEDENTES: la enfermedad tromboembólica venosa es una complicación que puede manifestarse durante o después de la hospitalización. Existen pocos antecedentes en nuestro país que evalúan el comportamiento médico en este tema. OBJETIVO: conocer la prescripción relacionada con el tipo, duración y posibles causas de la omisión de tromboprofilaxis en pacientes hospitalizados. MATERIAL Y MÉTODO: estudio descriptivo, transversal y no probabilístico en el que de septiembre a noviembre de 2016 se evaluaron médicos de Medicina Interna, Cirugía General, Terapia Intensiva y Urgencias. Se recolectaron datos por cuestionario y presentación de resultados a través de estadística descriptiva. También se evaluó la duración de la prescripción y la dosis administrada. RESULTADOS: se encuestaron 556 médicos adscritos, 14 jefes de servicio y 234 residentes total: 804 de siete hospitales de la Ciudad de México pertenecientes al sistema de salud. El 30% refirió que su hospital cuenta con un programa de tromboprofilaxis; 97.7% la considera segura y 1.2%, riesgosa. El 96% respondió que prescribe tromboprofilaxis en sus pacientes; 592 74% utilizan alguna escala de previsión clínica de enfermedad tromboembólica venosa. El 71% recomienda heparina de bajo peso molecular para tromboprofilaxis y 0.74% administra anticoagulantes orales de nueva generación. CONCLUSIONES: la enfermedad tromboembólica venosa es potencialmente prevenible; sin embargo, la prescripción muestra oportunidades de mejoría en aspectos de farmacología.

Abstract: BACKGROUND: Venous thromboembolic disease VTE is a complication that may occur during or after hospitalization. There are few antecedents in our country that evaluate the medical behavior in this subject. OBJECTIVE: To know the prescription related to type, duration and possible causes for omission of thromboprophylaxis in hospitalized patients. MATERIAL AND METHOD: A descriptive, transversal and non-probabilistic study was done, in which from September to November 2016 physicians of Internal Medicine, General Surgery, Intensive Care and Urgency were evaluated through a data collection by questionnaire and presentation of results through descriptive statistics. We also evaluated duration of prescription and dose administered. RESULTS: A total of 556 seconded physicians, 14 service heads, and 234 residents 804 in total were surveyed in seven hospitals in Mexico City belonging to the health system. Thirty percent reported that their hospital has a thromboprophylaxis program; 97.7% consider it safe and 1.2% risky; 96% responded that they prescribe thromboprophylaxis in their patients; 592 73.6% used some clinical prediction scale for VTE; 71% recommended low molecular weight heparin for thrombo prophylaxis and 0.74% administered new generation oral anticoagulants. CONCLUSIONS: Venous thromboembolic disease is potentially preventable; however, prescription shows opportunities for improvement in aspects of pharmacology.

Human Brucella canis Infection and Subsequent Laboratory Exposures Associated with a Puppy, New York City, 2012.

Human Brucella canis infection incidence is unknown. Most identified cases are associated with pet dogs. Laboratory-acquired infections can occur following contact with Brucella spp. We identified a paediatric B. canis case, the source and other exposed persons. A 3-year-old New York City child with fever and dyspnoea was hospitalized for 48 h for bronchiolitis. After her admission, blood culture grew B. canis, she was prescribed anti-microbials and recovered. B. canis was also isolated from blood of the child's pet dog; these isolates were genetically similar. The dog originated from an Iowa breeding facility which was quarantined after identification of the dog's infection. Additionally, 31 laboratory workers were exposed and subsequently monitored for symptoms; 15 completed post-exposure prophylaxis. To our knowledge, this is the first report strongly suggesting B. canis zoonotic transmission to a child in the United States, and highlights the need for coordinated control policies to minimize human illness.

Methods for characterizing magnetic footprints of perpendicular magnetic recording writer heads.

In this work, the magnetic footprints, along with some of its dynamic features in recording process, of perpendicular magnetic recording writer heads have been characterized by using three different techniques. Those techniques are the spin-stand stationary footprint technique, the spin-stand dynamic footprint technique, and the coherent writing technique combined with magnetic force microscope imaging method. The characteristics of those techniques have been compared to one another. It was found experimentally that the spin-stand stationary method could not precisely catch some peculiar recording dynamics of the write heads in certain conditions. The advantages and disadvantages among all those techniques are also examined and discussed in detail.

First measurement of the form factors in the decays D0 → ρ- e+ ν(e) and D+ → ρ0 e+ ν(e).

The beauty to up quark coupling constant |V(ub)| can be extracted from B → ρ e+ ν(e) combined with the form factors for D → K* e+ ν(e) and B → V ℓ+ ℓ- and D → ρ e+ ν(e). Using the entire CLEO-c ψ(3770) → DD event sample, corresponding to an integrated luminosity of 818 pb(-1) and approximately 5.4×10(6) DD events, we measure the form factors for the decays D0 → ρ- e+ ν(e) and D+ → ρ0 e+ ν(e) for the first time and the branching fractions with improved precision. A four-dimensional unbinned maximum likelihood fit determines the form factor ratios to be V(0)/A1(0)=1.48±0.15±0.05 and A2(0)/A1(0)=0.83±0.11±0.04. Assuming Cabibbo-Kobayashi-Maskawa unitarity, the known D meson lifetimes, and our measured branching fractions we obtain the form factor normalizations A1(0), A2(0), and V(0). We also present a measurement of the branching fraction for D+ → ω e+ ν(e) with improved precision.

Observation of the h(c)(1P) Using e+ e- collisions above the DD threshold.

Using 586 pb(-1) of e+ e- collision data at E(c.m.) = 4170 MeV, produced at the Cornell Electron Storage Ring collider and collected with the CLEO-c detector, we observe the process e+ e- → π+ π- h(c)(1P). We measure its cross section to be 15.6±2.3±1.9±3.0 pb, where the third error is due to the external uncertainty on the branching fraction of ψ(2S) → π0 h(c)(1P), which we use for normalization. We also find evidence for e+ e- → ηh(c)(1P) at 4170 MeV at the 3σ level and see hints of a rise in the e+ e- → π+ π- h(c)(1P) cross section at 4260 MeV.

Análisis de la situación alimentaria en El Salvador / Analysis of the food situation in El Salvador

El documento tuvo el objetivo de analizar la disponibilidad de alimentos a nivel de hogar con base en los datos de la Encuesta Nacional de Ingresos y Gastos de Hogares, 2006 con el propósito de: medir la suficiencia de la energía alimentaria per cápita, a disponibilidad per cápita de vitaminas y minerales y la diversidad del consumo de alimentos según área de residencia, regiones, nivel de pobreza y tamaño del hogar.

Treatment interruption after pregnancy: effects on disease progression and laboratory findings.

OBJECTIVE: To assess clinical progression and inflammatory markers among women stopping or continuing antiretroviral therapy (ART) after pregnancy. METHODS: ART-naïve women with CD4+ lymphocyte counts >350 cells/uL initiating ART during pregnancy had clinical events and laboratory markers compared over one year postpartum between those stopping (n = 59) or continuing (n = 147) ART. RESULTS: Slopes in CD4 count and HIV RNA did not differ between groups overall and in subsets of ZDV or combination therapy. The hazard ratio (HR) of a new class B event was 2.09 (95% CI 0.79-5.58) among women stopping ART, 1.24 (0.31-4.95) in those stopping ZDV, and 2.93 (0.64-13.36) among those stopping combination therapy. Women stopping ART had increased immune activation. No significant differences were seen in C-reactive protein, lipids, leptin, or interleukin-6. CONCLUSIONS: While changes in CD4 and HIV RNA levels over one year were similar between women stopping or continuing ART postpartum, higher immune activation among women stopping therapy requires further study.

Surface wetlands for the treatment of pathogens in stormwater: three case studies at Lake Macquarie, NSW, Australia.

The treatment of stormwater using surface constructed wetlands has become common in the last decades. However, the use of constructed wetlands for stormwater management has not been thoroughly evaluated in their capacity to treat microbial loads. The case studies presented in this paper are situated at Lake Macquarie, a large estuarine lagoon located approximately 150 km north of Sydney, Australia. To protect the lake ecosystem from the impact of increasing urban development, the local Council constructed numerous stormwater quality improvement devices (SQIDs) at selected locations. The SQIDs typically consisted of trash racks, gross pollutant traps and surface constructed wetlands. To evaluate the effectiveness of three of these devices in reducing faecal contamination, water samples were collected for faecal coliforms (FC) during and following rainfall at inlets and outlets of the structures. Results indicated one of the SQIDs as the most efficient for bacterial reduction, while the other two provided low or non reduction of FC. Results also illustrated dependence of bacteria reduction on flow conditions. Comparison of devices suggested that hydraulic residence times and other design parameters strongly influenced the capacity of each device to reduce FC counts during different weather conditions.

J/psi and psi(2S) Radiative Transitions to eta_{c}.

Using 2.45x10;{7} psi(2S) decays collected with the CLEO-c detector at the Cornell Electron Storage Ring we present the most precise measurements of magnetic dipole transitions in the charmonium system. We measure B(psi(2S)-->gammaeta_{c})=(4.32+/-0.16+/-0.60)x10;{-3}, B(J/psi-->gammaeta_{c})/B(psi(2S)-->gammaeta_{c})=4.59+/-0.23+/-0.64, and B(J/psi-->gammaeta_{c})=(1.98+/-0.09+/-0.30)%. We observe a distortion in the eta_{c} line shape due to the photon-energy dependence of the magnetic dipole transition rate. We find that measurements of the eta_{c} mass are sensitive to the line shape, suggesting an explanation for the discrepancy between measurements of the eta_{c} mass in radiative transitions and other production mechanisms.

Observation of D+ --> etae + nue.

Using a 281 pb-1 data sample collected at the psi(3770) resonance with the CLEO-c detector at the Cornell Electron Storage Ring, we report the first observation of D+ --> etae + nue. We also set upper limits for D+ --> eta'e + nue and D + --> varphie + nue that are about 2 orders of magnitude more restrictive than those obtained by previous experiments.

Search for lepton flavor violation in upsilon decays.

In this Letter, we describe a search for lepton flavor violation (LFV) in the bottomonium system. We search for leptonic decays Upsilon(nS)-->mutau (n=1, 2, and 3) using the data collected with the CLEO III detector. We identify the tau lepton using its leptonic decay nu_{tau}nu[over ]_{e}e and utilize multidimensional likelihood fitting with probability density function shapes measured from independent data samples. We report our estimates of 95% C.L. upper limits on LFV branching fractions of Upsilon mesons. We interpret our results in terms of the exclusion plot for the energy scale of a hypothetical new interaction versus its effective LFV coupling in the framework of effective field theory.

Observation of chicJ radiative decays to light vector mesons.

Using a total of 2.74 x 10(7) decays of the psi(2S) collected with the CLEO-c detector, we present a study of chi(cJ)-->gammaV, where V=rho(0), omega, phi. The transitions chi(c1)-->gammarho(0 and chi(c1)-->gammaomega are observed with B(chi(c1)-->gammarho(0))=(2.43+/-0.19+/-0.22) x 10(-4) and B(chi(c1)-->gammaomega)=(8.3+/-1.5+/-1.2) x 10(-5). In the chi(c1)-->gammarho(0) transition, the final state meson is dominantly longitudinally polarized. Upper limits on the branching fractions of other chi(cJ) states to light vector mesons are presented.

Search for very light CP-odd Higgs Boson in radiative decays of Upsilon(1S).

We search for a non-SM-like CP-odd Higgs boson (a(1)(0)) decaying to tau(+)tau(-) or mu(+)mu(-) in radiative decays of the Upsilon(1S). No significant signal is found, and upper limits on the product branching ratios are set. Our tau(+)tau(-) results are almost 2 orders of magnitude more stringent than previous upper limits. Our data provide no evidence for a Higgs state with a mass of 214 MeV decaying to mu(+)mu(-), previously proposed as an explanation for 3 Sigma(+)-->pmu(+)mu(-) events observed by the HyperCP experiment. Our results constrain NMSSM models.

Measurement of the eta'-meson mass using J/psi-->gammaeta'.

We measure the mass of the eta;{'} meson using psi(2S)-->pi;{+}pi;{-}J/psi, J/psi-->gammaeta;{'} events acquired with the CLEO-c detector operating at the CESR e;{+}e;{-} collider. Using three decay modes, eta;{'}-->rho;{0}gamma, eta;{'}-->pi;{+}pi;{-}eta with eta-->gammagamma, and eta;{'}-->pi;{+}pi;{-}eta with eta-->pi;{+}pi;{-}pi;{0}, we find M_{eta;{'}}=957.793+/-0.054+/-0.036 MeV, in which the uncertainties are statistical and systematic, respectively. This result is consistent with but substantially more precise than the current world average.

Precision measurement of the mass of the hc(1P1) state of charmonium.

A precision measurement of the mass of the h_{c}(1P1) state of charmonium has been made using a sample of 24.5x10;{6} psi(2S) events produced in e;{+}e;{-} annihilation at the Cornell Electron Storage Ring (CESR). The reaction used was psi(2S)-->pi;{0}h_{c}, pi;{0}-->gammagamma, h_{c}-->gammaeta_{c}, and the reaction products were detected in the CLEO-c detector. Data have been analyzed both for the inclusive reaction and for the exclusive reactions in which eta_{c} decays are reconstructed in 15 hadronic decay channels. Consistent results are obtained in the two analyses. The averaged results of the present measurements are M(h_{c})=3525.28+/-0.19(stat.)+/-0.12(syst.) MeV, and B(psi(2S)-->pi;{0}h_{c})xB(h_{c}-->gammaeta_{c})=(4.19+/-0.32+/-0.45)x10;{-4}. Using the ;{3}P_{J} centroid mass, DeltaM_{hf}(1P) identical withM(chi_{cJ})-M(h_{c})=+0.02+/-0.19+/-0.13 MeV.

Study of the decays D0-->pi{-}e{+}nu{e}, D{0}-->K{-}e{+}nu{e}, D{+}-->pi{0}e{+}nu{e}, and D{+}-->K0e{+}nu{e}.

By using 1.8x10{6} DDpairs, we have measured B(D{0}-->pi{-}e{+}nu{e})=0.299(11)(9)%, B(D{+}-->pi{0}e{+}nu{e})=0.373(22)(13)%, B(D{0}-->K{-}e{+}nu{e})=3.56(3)(9)%, and B(D{+}-->K{0}e{+}nu{e})=8.53(13)(23)% and have studied the q;{2} dependence of the form factors. By combining our results with recent lattice calculations, we obtain |V{cd}|=0.217(9)(4)(23) and |V{cs}|=1.015(10)(11)(106).

Measurement of the absolute branching fraction of Ds+ --> tau+ nutau decay.

Using a sample of tagged D(s)(+) decays collected near the D(s)(*+/-)D(s)(-/+) peak production energy in e(+)e(-) collisions with the CLEO-c detector, we study the leptonic decay D(s)(+)-->tau(+)nu(tau) via the decay channel tau(+)-->e(+)nu(e)nu(tau). We measure B(D(s)(+)-->tau(+)nu(tau))=(6.17+/-0.71+/-0.34)%, where the first error is statistical and the second systematic. Combining this result with our measurements of D(s)(+)-->mu(+)nu(mu) and D(s)(+)-->tau(+)nu(tau) (via tau(+)-->pi(+)nu(tau)), we determine f(D(s))=(274+/-10+/-5) MeV.