ABSTRACT
When a system deviates from equilibrium, it is possible to manipulate and control it to drive it towards equilibrium within finite time t_{f}, even by reducing its natural relaxation timescale τ_{relax}. Although numerous theoretical and experimental studies have explored these shortcut protocols, few have yielded analytical results for the probability distribution of the work, heat, and produced entropy. In this study, we propose a two-step protocol that captures the essential characteristics of more general protocols and provides an analytical solution for the relevant thermodynamic probability distributions. Additionally, we present evidence that for a very short protocol duration t_{f}âªτ_{relax}, all protocols exhibit universal behavior for the ratio of probability distribution functions of positive and negative work, heat, and the produced entropy.
ABSTRACT
PURPOSE: To evaluate the preoperative and intraoperative risk factors for revision after artificial urinary sphincter (AUS) implantation in male patients with stress urinary incontinence (SUI). METHODS: A retrospective analysis from a prospectively maintained database was performed. Male patients, with moderate-tosevere SUI, undergoing AUS implantation were included. All patients underwent placement of AMS 800. Cause of revision, type of revision, and time to revision were recorded. Multivariable analyzes were performed using a logistic regression to investigate the risk factors. Competing risk analysis according to Fine-Gray model was used to study time to event data. RESULTS: A total of 70 patients were included. Revision surgery was performed in 22 of 70 patients (31.4%), after a median (interquartile range) time of 26.5 months (6.5-39.3 months). Overall, 19 of 22 repairs (86.4%) and 3 of 22 explants (13.6%) were recorded. Mechanical dysfunction, urethral erosion, urethral atrophy, and device infection were the causes of revision in 11 of 22 (50.0%), 6 of 22 (27.3%), 3 of 22 (13.6%), and 2 of 22 patients (9.1%). Vesicourethral anastomosis stenosis (P=0.02), urethral cuff size of 3.5 cm (P=0.029), and dual implantation (P=0.048) were independent predictors for revision. Vesicourethral anastomosis stenosis (P=0.01) and urethral cuff size of 3.5 cm (P=0.029) predicted a lower survival of the AUS. CONCLUSION: The vesicourethral anastomosis stenosis, urethral cuff size of 3.5 cm, and dual implantation are independent predictors for revision after AUS implantation. However, only the vesicourethral anastomosis stenosis and urethral cuff size of 3.5 cm predict a lower survival of AUS.
ABSTRACT
OBJECTIVE: To investigate the role of contemporary minilaparoscopy (ML; 3 mm instruments and laparoscope) and to identify predictive factors for complications in a prospective multicenter series for renal and adrenal surgeries. MATERIALS AND METHODS: From July 2013 to December 2014, 110 patients from 6 laparoscopic Spanish centers were enrolled. A common database was used and data were collected in a prospective manner. Standard approach was defined as 3 to 4 3-mm trocars with a 3-mm laparoscope and 3-mm instruments (Karl Storz, Tuttlingen, Germany). Descriptive variables were analyzed and statistical analysis was performed for predictive factors for complications. RESULTS: Patient mean age was 57.8 ± 14.6 years, with an average body mass index of 25.3 ± 3.6 kg/m(2). Median American Society of Anesthesiologists score was II and 32% (n = 35) of the patients had a previous surgery. A total of 59 nephrectomies, 20 partial nephrectomies, 9 nephroureterectomies, 13 pyeloplasties, 3 pyelolithotomies, and 6 adrenalectomies were performed. Overall operative time was 180 ± 64 minutes. There were 12 clampless partials and 8 with a mean warm ischemia time of 14 ± 7 min. There were 5% of intraoperative and 8% of postoperative complications (Clavien II-IV). Mean hospital stay was 5 ± 2.3 days, with optimal pain and cosmetic control. CONCLUSION: To our knowledge, this is one of the largest prospective series of ML for renal and adrenal surgeries. Despite a mean operative time possibly longer than in standard laparoscopy, clinical and safety outcomes are not compromised. Furthermore, ML results in excellent pain control and cosmetic outcomes.
Subject(s)
Adrenalectomy/methods , Laparoscopy/methods , Nephrectomy/methods , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Prospective Studies , Young AdultABSTRACT
En los últimos años la tomografía computarizada helicoidal sin contraste ha modificado el manejo mediante técnicas de imagen de los pacientes que acuden a urgencias con un cuadro clínico sugestivo de cólico nefrítico. En el presente trabajo, basándonos en la bibliografía y en nuestra propia experiencia con 140 pacientes con dolor cólico de probable origen litiásico, revisamos la semiología radiológica de este cuadro, y describimos la utilidad de esta técnica para confirmar el diagnóstico, predecir el curso clínico y detectar otras patologías que debutan con idéntica sintomatología (AU)
