Tratamiento de la incontinencia urinaria de esfuerzo tras prostatectomía con el sistema masculino transobturador ajustable (ATOMS(R)) con puerto escrotal premontado / Treatment of stress urinary incontinence after prostatectomy with the adjustable transobturator male system (ATOMS(R)) with preattached scrotal port

Introducción: La incontinencia urinaria de esfuerzo (IUE) es una secuela importante del tratamiento quirúrgico del cáncer de próstata. Se presenta la técnica quirúrgica y se evalúa efectividad y seguridad del sistema masculino transobturador ajustable (ATOMS(R)) con puerto escrotal premontado. Material y método: Estudio abierto prospectivo realizado en un hospital universitario. El objetivo principal fue cambio de situación basal tras ajuste en el recuento diario de compresas (pad-count) y su peso húmedo (pad-test). Los objetivos secundarios fueron evaluación de calidad de vida (ICIQ-SF e IIQ-7 basal y al ajuste), resultados percibidos por el paciente (PGI y GRA al año) y evaluación de complicaciones según Clavien-Dindo. Los valores numéricos se expresan en mediana + RIC. Resultados: Se analizan 60 pacientes consecutivos con seguimiento de 21+22 meses. El pad-test basal fue 465 + 450 ml y pad-count 5 + 3 compresas/día. La IUE basal fue leve (11,6%), moderada (25%) y severa (63,3%). El tiempo operatorio fue 60 + 25 min, la estancia hospitalaria 1+0 días y la EVA de dolor en día-1 postoperatorio 0 + 1. El llenado total fue 16,5+7ml y el número de rellenos 1+2. Pad-test y pad-count tras ajuste fueron 0 + 20 ml y 0+1, respectivamente (ambos p<0,0001 respecto a basal). La IUE desapareció (81,7%) o se mantuvo leve (11,7%), moderada (5%) y severa (1,6%). Se objetivó reducción en ICIQ-SF (p < 0,0001) e IIQ-7 (p = 0,0003). Tanto la continencia (p=0,002) como la satisfacción (p = 0,03) resultaron peores en pacientes irradiados. Sucedieron complicaciones en 11 casos (18,6%), siendo 8(13,5%) grado I y 3(5,1%) grado III. La tasa de satisfacción con el tratamiento fue 91,7% y la percepción de mejoría global percibida por el paciente al año fue muy marcada (score PGI-I 1+1 y GRA 6+1). Conclusiones: El tratamiento de la IUE masculina con ATOMS(R) tercera generación es seguro y eficaz a corto plazo, incluso en pacientes con IUE severa. La tasa de pacientes secos tras el ajuste supera el 80% y la tasa de satisfacción el 90%. Los pacientes valoran muy positivamente este tratamiento

Introduction: Stress urinary incontinence (SUI) is a significant sequela of prostate cancer surgery. In this article, we present the surgical technique and safety and efficacy of the adjustable transobturator male system (ATOMS(R)) with preattached scrotal port. Material and method: An open prospective study was conducted at a university hospital with the main objective of changing the baseline condition after adjustment in the daily pad count and their wet weight (pad test). The secondary objectives were the quality-of-life assessment (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Incontinence Impact Questionnaire-7 [IIQ-7], baseline and after the adjustment), patient-perceived results (Patient Global Index [PGI] and Global Response Assessment [GRA] at 1 year) and assessment of complications according to Clavien-Dindo. The numerical values are expressed in median ± IQR. Results: We analysed 60 consecutive patients with a follow-up of 21 ± 22 months. The baseline pad-test was 465 ± 450 mL, and the pad-count was 5 + 3 pads/day. The baseline SUI was mild (11.6% of patients), moderate (25%) and severe (63.3%). The operative time was 60 ± 25 min, the hospital stay was 1 ± 0 days, and the visual analogue scale of pain on day 1 after surgery was 0 ± 1. The total filling was 16.5 ± 7 mL, and the number of refillings was 1 ± 2. The pad-test and pad-count after the adjustment were 0 ± 20 mL and 0±1, respectively (both p < .0001 compared with baseline). SUI disappeared (81.7%) or remained mild (11.7%), moderate (5%) or severe (1.6%). We observed a reduction in the ICIQ-SF (p < .0001) and IIQ-7 scores (p = .0003). Both continence (p=.002) and satisfaction (p = .03) were lower in the irradiated patients. Complications occurred in 11 cases (18.6%), 8 (13.5%) of which were grade I and 3 (5.1%) of which were grade 3. The treatment satisfaction rate was 91.7%, and the patient-perceived overall improvement at 1 year was highly pronounced (PGI-I score, 1 ± 1; GRA, 6 ± 1). Conclusions: SUI treatment of men using third-generation ATOMS(R) is safe and effective in the short-term, even in patients with severe SUI. The rate of dry patients after the adjustment exceeded 80%, and the satisfaction rates exceeded 90%. The patients assessed this treatment highly positively

Treatment of stress urinary incontinence after prostatectomy with the adjustable transobturator male system (ATOMS®) with preattached scrotal port. / Tratamiento de la incontinencia urinaria de esfuerzo tras prostatectomía con el sistema masculino transobturador ajustable (ATOMS®) con puerto escrotal premontado.

INTRODUCTION: Stress urinary incontinence (SUI) is a significant sequela of prostate cancer surgery. In this article, we present the surgical technique and safety and efficacy of the adjustable transobturator male system (ATOMS®) with preattached scrotal port. MATERIAL AND METHOD: An open prospective study was conducted at a university hospital with the main objective of changing the baseline condition after adjustment in the daily pad count and their wet weight (pad test). The secondary objectives were the quality-of-life assessment (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Incontinence Impact Questionnaire-7 [IIQ-7], baseline and after the adjustment), patient-perceived results (Patient Global Index [PGI] and Global Response Assessment [GRA] at 1 year) and assessment of complications according to Clavien-Dindo. The numerical values are expressed in median ± IQR. RESULTS: We analysed 60 consecutive patients with a follow-up of 21±22 months. The baseline pad-test was 465±450mL, and the pad-count was 5+3 pads/day. The baseline SUI was mild (11.6% of patients), moderate (25%) and severe (63.3%). The operative time was 60±25min, the hospital stay was 1±0 days, and the visual analogue scale of pain on day 1 after surgery was 0±1. The total filling was 16.5±7mL, and the number of refillings was 1±2. The pad-test and pad-count after the adjustment were 0±20mL and 0±1, respectively (both p<.0001 compared with baseline). SUI disappeared (81.7%) or remained mild (11.7%), moderate (5%) or severe (1.6%). We observed a reduction in the ICIQ-SF (p<.0001) and IIQ-7 scores (p=.0003). Both continence (p=.002) and satisfaction (p=.03) were lower in the irradiated patients. Complications occurred in 11 cases (18.6%), 8 (13.5%) of which were grade I and 3 (5.1%) of which were grade 3. The treatment satisfaction rate was 91.7%, and the patient-perceived overall improvement at 1 year was highly pronounced (PGI-I score, 1±1; GRA, 6±1). CONCLUSIONS: SUI treatment of men using third-generation ATOMS® is safe and effective in the short-term, even in patients with severe SUI. The rate of dry patients after the adjustment exceeded 80%, and the satisfaction rates exceeded 90%. The patients assessed this treatment highly positively.

Evaluation of Encephaloduroarteriosynangiosis Efficacy Using Probabilistic Independent Component Analysis Applied to Dynamic Susceptibility Contrast Perfusion MRI.

BACKGROUND AND PURPOSE: Indirect cerebral revascularization has been successfully used for treatment in Moyamoya disease and symptomatic intracranial atherosclerosis. While angiographic neovascularization has been demonstrated after surgery, measurements of local tissue perfusion are scarce and may not reflect the reported successful clinical outcomes. We investigated probabilistic independent component analysis and conventional perfusion parameters from DSC-MR imaging to measure postsurgical changes in tissue perfusion. MATERIALS AND METHODS: In this prospective study, 13 patients underwent unilateral indirect cerebral revascularization and DSC-MR imaging before and after surgery. Conventional perfusion parameters (relative cerebral blood volume, relative cerebral blood flow, and TTP) and probabilistic independent components that reflect the relative contributions of DSC signals consistent with arterial, capillary, and venous hemodynamics were calculated and examined for significant changes after surgery. Results were compared with postsurgical DSA studies to determine whether changes in tissue perfusion were due to postsurgical neovascularization. RESULTS: Before surgery, tissue within the affected hemisphere demonstrated a high probability for hemodynamics consistent with venous flow and a low probability for hemodynamics consistent with arterial flow, whereas the contralateral control hemisphere demonstrated the reverse. Consistent with symptomatic improvement, the probability for venous hemodynamics within the affected hemisphere decreased with time after surgery (P = .002). No other perfusion parameters demonstrated this association. Postsurgical DSA revealed an association between an increased preoperative venous probability in the symptomatic hemisphere and neovascularization after surgery. CONCLUSIONS: Probabilistic independent component analysis yielded sensitive measurements of changes in local tissue perfusion that may be associated with newly formed vasculature after indirect cerebral revascularization surgery.

Subchronic effects of dipyrone on the fish species Rhamdia quelen.

The use of the non-steroidal anti-inflammatory drugs such as dipyrone is so widespread that this drug and its metabolites have been detected in effluents and surface water. This study aimed to evaluate the potential toxic effects of dipyrone on the aquatic environment, using a native fish species, Rhamdia quelen. Fish were exposed to three concentrations of dipyrone, 0.5, 5 and 50 µg/L, in the water for 15 days, and hematological, biochemical, genetic and morphological biomarkers were evaluated. The glutathione S-transferase activity decreased in the highest concentration in relation to the control group. In addition, hematocrit, red blood cells and thrombocyte counts were decreased in all three exposed groups in relation to the control group. The comet assay showed DNA damage at the lowest concentration of dipyrone and significant kidney damage. Those results suggest that a constant exposure of aquatic organisms to dipyrone presents potential toxic effects.

Ultrasonic evaluation of the physical and mechanical properties of granites.

Masonry is the oldest building material that survived until today, being used all over the world and being present in the most impressive historical structures as an evidence of spirit of enterprise of ancient cultures. Conservation, rehabilitation and strengthening of the built heritage and protection of human lives are clear demands of modern societies. In this process, the use of nondestructive methods has become much common in the diagnosis of structural integrity of masonry elements. With respect to the evaluation of the stone condition, the ultrasonic pulse velocity is a simple and economical tool. Thus, the central issue of the present paper concerns the evaluation of the suitability of the ultrasonic pulse velocity method for describing the mechanical and physical properties of granites (range size between 0.1-4.0 mm and 0.3-16.5 mm) and for the assessment of its weathering state. The mechanical properties encompass the compressive and tensile strength and modulus of elasticity, and the physical properties include the density and porosity. For this purpose, measurements of the longitudinal ultrasonic pulse velocity with distinct natural frequency of the transducers were carried out on specimens with different size and shape. A discussion of the factors that induce variations on the ultrasonic velocity is also provided. Additionally, statistical correlations between ultrasonic pulse velocity and mechanical and physical properties of granites are presented and discussed. The major output of the work is the confirmation that ultrasonic pulse velocity can be effectively used as a simple and economical nondestructive method for a preliminary prediction of mechanical and physical properties, as well as a tool for the assessment of the weathering changes of granites that occur during the serviceable life. This is of much interest due to the usual difficulties in removing specimens for mechanical characterization.

Parenteral antibiotic prophylaxis of bacterial infections does not improve cost-efficacy of oral norfloxacin in cirrhotic patients with gastrointestinal bleeding.

OBJECTIVE: Selective intestinal decontamination with norfloxacin is useful in the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding. However, bleeding cirrhotic patients with ascites, encephalopathy, or shock are at high risk to develop bacterial infections in spite of prophylactic norfloxacin. The aim of this study was to assess whether the addition of intravenous ceftriaxone could improve the efficacy of prophylaxis with norfloxacin in these patients. METHODS: Fifty-six cirrhotic patients with gastrointestinal hemorrhage and ascites, encephalopathy, or shock were randomized into two groups: Group 1 (n = 28) received oral norfloxacin 400 mg/12 h for 7 days, and group 2 (n = 28) received norfloxacin plus intravenous ceftriaxone 2 g daily during the first 3 days of admission. RESULTS: Ten patients were excluded because of community-acquired infection, surgery, or death within the first 24 h. The incidence of bacterial infections during hospitalization was 18.1% in group 1 and 12.5% in group 2 (p = NS). The incidence of severe infections (spontaneous bacterial peritonitis, bacteremia, or pneumonia) was also similar in both groups: 9% in group 1 versus 8.3% in group 2 (p = NS). There were no statistical differences between the two groups with respect to duration of hospitalization or mortality. The cost of antibiotic therapy (including prophylaxis and treatment of infections) was significantly higher in group 2. CONCLUSION: These results suggest that the addition of intravenous ceftriaxone during the first 3 days of hospitalization does not improve the cost-efficacy of oral norfloxacin in the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding and high risk of infection.

[Digestive hemorrhage due to duodenal angiodysplasia in the periampullary area]. / Hemorragia digestiva por angiodisplasia duodenal en región periampular.

A case of digestive hemorrhage due to duodenal angiodysplasia at the level of the Vater papilla is presented. Diagnosis was achieved by analysis of the surgical resection sample.

[Ascites caused by portal hypertension in a patient with chronic myelomonocytic leukemia]. / Ascitis por hipertensión portal en paciente con leucemia mielomonocítica crónica.

The case of a 79 years old man with chronic myelomonocytic leukemia and transudative ascites is described. Portal hypertension was produced by hepatic infiltration due to the hematological disorder, confirmed by liver biopsy.

[Value of ultrasonography in the early diagnosis of hepatocellular carcinoma]. / Valor de la ecografía en el diagnóstico precoz del carcinoma hepatocelular.

The size and the treatment of 135 hepatocellular carcinomas (HCC) has been analyzed, comparing patients diagnosed by a US screening program (group 1) and these diagnosed outside this program (group 2) to determine whether US screening on patients with chronic liver disease is able to diagnose (HCC) at an early stage. alpha-fetoprotein levels above 500 U/ml were considered as diagnostic. Twenty (46.5%) out of 43 patients from group 1 showed a HCC < 5 cm. vs. 14/92 (15.2%) in group 2 (p = 0.001). Only 5.9% of the HCC < 5 cm. showed AFP > 500 U/ml. vs. 29.7% of the advanced HCC (p = 0.003). 88.3% of patients of group 1 vs. 63% of group 2 received specific treatment for HCC (p = 0.002). By means of US screening it is possible to diagnose HCC of smaller size and more susceptible to treatment. AFP is not useful in the early diagnosis of HCC.