Tratamiento endoscópico de cálculos ureterales: experiencia en una serie de 102 casos / Endoscopic treatment of ureteral stones: experience in a series of 102 cases

INTRODUCCIÓN: La ureterolitectomía endoscópica (URS) es una técnica validada para el manejo de cálculos ureterales, ya que tiene alto poder resolutivo y es poco invasiva. El desarrollo de instrumentos flexibles ha facilitado el manejo endoscópico de los cálculos en uréter medio y proximal. El objetivo de este trabajo es describir la experiencia de nuestro centro en URS. Material y metodos: Análisis retrospectivo de las URS realizadas en nuestro centro entre Diciembre 2009 y Mayo 2012. Se consignaron las características del cálculo, el método de fragmentación, la efectividad del procedimiento y las complicaciones. Se utilizaron los ureteroscopios semirrígido Wolf (6,0-9,5 Fr) y flexible Karl Storz Flex X2. Resultados: Se revisaron 102 ureteroscopías, 85 con ureteroscopio semirrígido y 17 con flexible. Los cálculos tuvieron un promedio de 5,7 mm y 642 UH. El 89,4 por ciento de los cálculos resueltos mediante URS semirrígida se localizaban en uréter distal y 52,9 por ciento de los resueltos con URS flexible en uréter proximal. Se realizó litotripsia con láser Holmium en un 25,9 por ciento y 70,6 por ciento de los casos con URS semirrígida y flexible, respectivamente. Se utilizó litotripsia pneumática en un 4,7 por ciento de los casos de URS semirrígida. En URS semirrígida y flexible, la tasa de stone-free + fragmentos < 2 mm fue de 89,4 por ciento y 88,2 por ciento, respectivamente. Sólo hubo una complicación en nuestra serie (infección urinaria febril en 1 caso con URS flexible). La mediana de hospitalización fue de 1 día (rango 1-5 días). Conclusion: Nuestros resultados reafirman a la URS como una técnica eficaz, segura y poco invasiva para el tratamiento de los cálculos ureterales.

INTRODUCTION: The endoscopic ureterolithotomy (URS) is a validated technique for the management of ureteral calculi, which is highly resolutive and minimally invasive. The development of flexible instruments has facilitated the endoscopic management of stones in the mid and proximal segments of the ureter. The aim of this paper is to describe the experience of our center in endoscopic ureterolithotomy. Material and methods: Retrospective analysis of URS performed at our center between December 2009 and May 2012. We recorded the characteristics of the stones, the fragmentation method, the effectiveness of the procedure and complications. The Wolf semi-rigid (6.0 to 9.5 Fr) and the flexible Karl Storz Flex X2 ureteroscopes were used. RESULTS: We reviewed 102 URS, 85 with semi-rigid and 17 with flexible ureteroscope. The calculi were 5.7 mm and 642 HU in average. 89.4 percent of the stones treated with a semi-rigid URS were localized in the distal ureter and 52.9 percent of the calculi treated with a flexible URS were in the proximal ureter. Holmium laser lithotripsy was performed in 25.9 percent and 70.6 percent of the cases of semi-rigid and flexible URS, respectively. Pneumatic lithotripsy was used in 4.7 percent of the semi-rigid URS. In semi-rigid and flexible URS, the rate of stone-free + fragments < 2 mm was 89.4 percent and 88.2 percent, respectively. There was only one complication in our series (febrile urinary tract infection in 1 case of flexible URS). The median length of stay was 1 day (range 1-5 days). CONCLUSION: Our results confirm that URS is an effective, safe and minimally invasive treatment for ureteral calculi.

Depressive symptoms are associated with food insufficiency and nutritional deficiencies in poor community-dwelling elderly people.

UNLABELLED: Depression is associated with nutritional deterioration in older persons and is highly prevalent among people of low socioeconomic status (LSES). OBJECTIVES: To determine the prevalence of depressive symptoms and food insufficiency, and to examine the relationship between dietary intake, food insufficiency and depression, in LSES community dwelling elderly. DESIGN: Cross-sectional study. SETTING: Lod, a town in the central Israel. PARTICIPANTS: Community-dwelling welfare recipients aged 60 to 92. MEASUREMENTS: Depression was assessed by 15-item Geriatric Depression Scale (GDS-short version), using a score ≥ 10 as the cut off point for clinically important depressive symptoms. Dietary intake was evaluated using a 24-hour dietary recall. Food insufficiency was defined by participants reporting that they did not have enough food to eat " sometimes " or " often " . RESULTS: This study reports on 112 persons aged 60 years and above (27.1% men). The prevalence of depression in this population was 47%; 25% of the study sample was classified as " food insufficient " . Macronutrients intake was similar for depressed and non-depressed persons, except for polyunsaturated fats which was lower among the depressed group (7.9 ± 4.9 vs.11.0 ± 7.5 g/day in the non-depressed, p=0.03). Vitamins and minerals intake was lower than recommended for both groups; vitamin E intake was associated with depression. In regression models controlling for confounding variables, an increase of 1 mg in vitamin E intake and 1 gram in polyunsaturated fatty acids (PUFA) intake was associated with lower risk for depression (OR=0.73, p=0.008 and OR=0.86, p=0.007 respectively) Participants who reported food insufficiency were 10 times more likely to be depressed compared with those who reported sufficient food. CONCLUSIONS: Given the evaluated adverse association between depressive symptoms and food insufficiency, more efforts are needed to guarantee adequate food intake, particularly foods rich in vitamin E and PUFA, in poor elderly people. Further studies are needed to clarify the temporal relationship between the emotional and nutritional domains in this vulnerable population.

Relapses in the Guillain-Barré syndrome after treatment with intravenous immune globulin or plasma exchange.

To clarify the question of whether Guillain-Barré syndrome (GBS) patients treated with intravenous immune globulin (i.v.IG) relapse at a higher frequency than those treated with plasma exchange (PE), 54 patients with GBS were studied retrospectively. A higher frequency of relapses was noted in the PE-treated patients than in those receiving i.v.IG. The presence of an associated medical condition correlated with an increased risk of relapses, while earlier onset of treatment resulted in a decrease of relapses of GBS. This study found no support for prior suggestions of increased relapses in patients with GBS treated with i.v.IG as opposed to those treated with PE.

Occipital lobe tumor presenting as migraine with typical aura.

We report the case of a 60-year-old woman in whom migraine with typical aura heralded the presence of an occipital lobe tumor. Her headache was characterized by recurrent episodes of visual aura confined to the left visual field followed by right hemicranial throbbing headaches accompanied by nausea, photophobia, and phonophobia. Interictal neurologic and ophthalmologic examinations were negative, as was an unenhanced brain CT scan. The headaches increased in frequency over 4 months despite a number of medications known to prevent attacks of migraine. A low-grade right occipital lobe tumor was eventually discovered on MR scan. This case illustrates that headache fulfilling the International Headache Society (IHS) criteria for migraine with typical aura can occur in association with an occipital lobe tumor.

[Nasogastric tubes in geriatric patients].

The nasogastric tube (NGT) not only provides nutritional support, but is also an effective diagnostic and therapeutic aid. We present the profile of the geriatric patient who needs the NGT, the reasons for its use, and mortality in these patients. 25 women (aged 83.9 +/- 5.5) and 25 men (aged 79 +/- 7.7) required the NGT, 15 of them only temporarily (TNGT) and 35 permanently (PNGT). The percentage of those with chronic neurologic disorders and/or incontinence (fecal or urinary), was highest in the PNGT group, as was the number of drugs used per patient (4.2 +/- 1.8 vs. 2.9 +/- 1.4). Laboratory studies showed no differences between the groups. PNGT was used in those whose conditions were chronic and progressive (inability to swallow or not sufficiently alert for oral nutrition). TNGT was used commonly as a diagnostic or therapeutic aid. During the study 20 patients died (40%), all in the PNGT group. Pneumonia was the main cause of death (18%), followed by decubitus ulcer (14%) and urinary tract infections (8%).

Hyperparathyroidism associated with Raynaud's phenomenon--a case history.

The authors describe a patient with hyperparathyroidism and Raynaud's phenomenon. This association was hitherto undescribed.

Termoterapia en adenoma prostático / Thermotheraphy in prostatic adenoma

Se presenta un informe preliminar de una pequeña casuística de 20 pacientes iniciales en el uso de un aparato de Hipertemia Prostática (THERMEX II) para el tratamiento del Adenoma Prostático mediante una acción térmica obtenida por emisión de ondas de radiofrecuencia. Se analizan las indicaciones precisas de esta simple modalidad de tratamiento del adenoma prostático, recalcando el protocolo estricto de selección. Los resultados obtenidos se analizan mediante el Score de Madsen y flujometría no invasiva al 1er. y 3er. mes del procedimiento, obteniendo resultados beneficiosos subjetivos y objetivos de mejoría de síntomas irritativos y obstructivos como consecuencia de una indicación terapeútica precisa

Incisión transuretral de prostata: informe preliminar y protocolo inicial. / Transuretheral incision of the prostate: preliminary report and first protocol

Se informa de protocolo prospectivo y randomizado de la incisión transuretral de prostata (I.T.U.P.) como método alternativo de tratamiento de uropatía obstructiva por adenoma prostático pequeño. Los resultados a largo plazo se someterán a evaluación crítica

Enterocistoplastias en vejigas neurogénicas: nuestra evolución histórica / Enterocystoplasties on neurogenic bladders: our historical evolution

Se presentan 9 casos de enterocistoplastias efectuadas en vejiga neurogénica con el fin de creare un reservorio de baja presión susceptible de ser vaciado mediante autocateterismo. Se analiza, en orden cronológico, el cambio en la técnica quirúrgica como consecuencia del conocimiento actual del comportamiento del intestino detubularizado. Los resultados de continencia y cistomanometría post-operatoria demuestran las ventajas del uso de intestino detubularizado

Neovejiga mediante técnica de "le bag" en cancer vesical / Bladder substitution by the \"le bag\" technic in bladder cancer

Se presenta una nueva técnica quirúrgica de reemplazo en el cancer vesical analizando sus detalles y su aspecto funcional respecto a continencia. Se analiza un caso clínico y se advierte que se requiere mayor casuística y seguimiento largos para evaluar los resultados, pero que esta técnica cumple con los requisitos actuales aceptados referente a dinámica de reservorios

Cancer testicular y paratesticular en mayores de 60 años / Testicular and paratesticular cancer in senile patients(older than 60 years)

Se presenta una revisión de los tumores testiculares de los pacientes que acuden al Servicio de Urología del Hospital San Juan de Dios de Santiago en un período de 12 años, encontrando, que 3 casos (1.44%) corresponden a pacientes seniles (edad X 73 anos). Se comentan los antecedentes, hallazgos de examen y el análisis histológico de cada uno de ellos, así como las alternativas terapéuticas utilizadas

Instilaciones vesicales con nitrato de Ag o argyrol en uretrotrigonitis: efecto real o placebo? / Intravesical silver nitrate instillations in urethrotrigonitis: real effect or placebo?

Se estudian 45 pacientes diagnosticadas como "uretrotrigonitis", en quienes se evalúa en doble ciego el tratamiento de instilación vesical con nitrato de plata versus placebo. No se encuentran diferencias entre ambos tratamientos, habiendo observado un buen resultado global subjetivo en el 55%. Tampoco se encuentra relación entre la mejoría subjetiva y la endoscópica